Objective:The purpose of this study was to examine the clinical features and initial treatment outcomes of elderly individuals with idiopathic membranous nephropathy.Methods:This study retrospectively analyzed the clinical characteristics and therapeutic effect of hospitalized patients aged 60 years or older with renal-biopsy-proven idiopathic membranous nephropathy for at least one year.Results:This study enrolled a total of 91 elderly patients with IMN, consisting of 51 males(56.0%)and 40 females(44.0%). The median age of the patients was 67 years.The urinary protein creatinine ratio(uPCR)and urinary albumin creatinine ratio(uACR)of the patients were 4 454.3 mg/g and 2 258.5 mg/g, respectively.The median 24-hour urinary protein and urinary albumin levels were 5 098.2 mg/24 h and 2 800.6 mg/24 h, respectively.The average estimated glomerular filtration rate(eGFR)was(60.5±20.4)ml·min -1·1.73 m -2.Out of the total of 61 patients, 67.0% achieved remission, including complete and partial remission, within a year of renal biopsy.The levels of uPCR and uACR were significantly higher in the non-remission group compared to the remission group(5 462.5 vs.2 271.1 mg/g, P<0.001; 2 774.4 vs.1 320.0 mg/g, P=0.001). Additionally, the levels of 24h urinary protein and urinary albumin were significantly higher in the non-remission group compared to the remission group(6 526.4 vs.3 210.4 mg/g, P=0.002; 3 067.7 vs.2 102.4 mg/g, P=0.007). The remission group had a higher proportion of patients receiving immunosuppressive therapy(85.2% vs.33.3%, P<0.001). The remission rates were higher in patients treated with glucocorticoid combined with cyclophosphamide, glucocorticoid combined with calcineurin inhibitors, or glucocorticoid combined with mycophenolate mofetil compared to those receiving conservative treatment(88.2% vs.31.0%, P=0.001; 80.0% vs.31.0%, P<0.001; 100.0% vs.31.0%, P=0.007). There was no significant difference in remission rate between the three immunosuppressive therapy groups( P>0.05). However, upon further analysis, it was found that the levels of uPCR, uACR, and serum cystatin C(CysC)were higher in the immunosuppressive therapy groups compared to conservative treatment.Additionally, serum total protein and albumin were lower in the immunosuppressive therapy groups, and these differences were statistically significant( P<0.05). Conclusions:The majority of elderly patients diagnosed with IMN have multiple comorbidities.For those at high risk with elevated urinary protein levels, early initiation of immunosuppressive therapy may lead to a higher initial urinary protein remission rate.Therefore, it is advisable to develop individualized treatment plans for elderly patients with IMN based on their clinical characteristics, as well as the risks and benefits associated with immunosuppressive therapy.

Objective To investigate the effects and complications of mitral valve membrane replacement surgery with preservation of mitral valve subvalvular structure on cardiac and valve function.Methods A total of 84 patients receiving mitral valve membrane replacement surgery with preserved mitral valve subvalvular structure in the First Affiliated Hospital of Soochow University from August 2019 to July 2022 were selected as the observa-tion group,and 68 patients receiving mitral valve membrane replacement surgery without preservingmitral valve subvalvular structure were selected as the control group.The surgical indicators,comorbidities,preoperative and postoperative cardiac function,and mitral valve hemodynamic parameters were compared between the two groups.Results There was no statistically significant difference between the observation group and the control group in terms of surgical history,extracorporeal circulation time,aortic occlusion time,postoperative mechanical ventilation time,ICU retention time,and postoperative hospitalization time(P>0.05).At 1,3,and 6 months after surgery,the left ventricular end systolic diameter(LVESD)and left ventricular end diastolic diameter(LVEDD)in the observation group were significantly lower than those in the control group(P<0.05),while the left ventricular short axis shortening rate(LVFS)was significantly higher than that in the control group(P<0.05).There was no statistically significant difference in left ventricular ejection fraction(LVEF)between the observation group and the control group at 1,3,and 6 months after surgery(P>0.05).There was no statistically significant difference(P>0.05)in the peak mitral valve velocity(Vmax),maximum pressure gradient difference(PGmax),and mean pressure gradi-ent difference(PGmean)between the observation group and the control group at 1,3,and 6 months after surgery.There was no statistically significant difference in creatine kinase isoenzyme(CK-MB)and N-terminal precursor brain natriuretic peptide(NT-proBNP)between the observation group and the control group at 1,3,and 6 months after surgery(P>0.05).There was no statistically significant difference in the incidence of postoperative complica-tions between the observation group and the control group(P>0.05).Conclusion The preservation of the mitral valve subvalvular structure and mitral membrane replacement surgery improved patient cardiac function,while there was no significant difference in mitral valve orifice blood flow parameters and complications compared with surgery without preservation of the mitral valve subvalvular structure.

Objective:To analyze the number of appeals volume and causes for complaints received by the government hotline against a hospital in Yangzhou during the pandemic of novel coronavirus pneumonia(hereinafter referred to as COVID-19), so as to provide reference for handling such hotline complaints during pandemics.Methods:Retrospective comparative analysis was made on the " 12345" government hotline work orders received from July 28, 2020 to August 28, 2020(routine prevention and control period) and July 28, 2021 to August 28, 2021(pandemic closure and control period). A descriptive analysis was made on the cause types of complaints and the distribution of departments in question, along with an analysis of the correlation between the cumulative number of cases of pandemic development and the number of complaints using Spearman rank correlation method.Results:The number of work orders for a hospital in Yangzhou during the pandemic control period(659 cases) was 7.7 times higher than that in the routine control period(76 cases). Management problems accounted for 96.7%(637 cases) in the level-1 type of the causes of complaints during the closure and control period of the pandemic, and workflow problems accounted for 90.9%(599 cases) in the level-2 type, which increased by 28.3 and 27.7 percentage points respectively compared with the routine prevention and control period; The highest proportion in the level-3 type of causes for complaints during the closure and control period of the pandemic was administrative management, accounting for 87.9%(579 cases). The departments being complained the most during the pandemic incubation period, outbreak period and recovery period of the pandemic were the fever clinic, oncology department and discharge center respectively. The cumulative number of cases of pandemic development was positively correlated with the number of complaints.Conclusions:During the COVID-19, the handling of the government hotline should be analyzed along with the causes of complaints, focusing on patients′ demands, providing timely feedback, developing collaborative management measures, and achieving accurate policy implementation.

Idiopathic thrombocytopenic purpura (ITP) is a common bloody disease with a high incidence in children, but its diagnostic method is exclusive diagnosis, and the existing detection techniques are mostly invasive, which may cause secondary injury to patients and also may increase the risk of disease. In order to make up for the lack of the detection method, this study made a preliminary exploration on the diagnosis of children's ITP from the perspective of infrared thermography. In this study, a total of 11 healthy children and 22 ITP children's frontal infrared thermal images were collected, and the pattern characteristic (PFD), average temperature (Troi) and maximum temperature (MAX) characteristics of 7 target areas were extracted. The weighted PFD parameters were correlated with the platelet count commonly used in clinical diagnosis, and the sensitivity and specificity of the weighted PFD parameters for children's ITP were calculated through the receiver operating characteristic curve (ROC). The final results showed that the difference of the weighted PFD parameters between healthy children and ITP children was statistically significant, and the parameters negatively correlated with platelet count. Under the ROC curve, the area under the curve (AUC) of this parameter is as high as 92.1%. Based on the research results of this paper, infrared thermography can clearly show the difference between ITP children and healthy children. It is hoped that the methods proposed in this paper can non-invasively and objectively describe the characteristics of ITP infrared thermal imaging of children, and provide a new ideas for ITP diagnosis.
Area Under Curve ; Child ; Humans ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; Thermography

Objective: To explore the analgesic effect of electroacupuncture on neuropathic pain and the role of PI3K/AKT pathway in microglial activation in spinal cord. Methods: Chronic constriction injury model was established using Sprague-Dawley rats to mimic neuropathic pain. The pain intensity was then detected by paw withdrawal threshold and thermal withdrawal latency. Real-time quantitative PCR (qRT-PCR), Western blot were used to evaluate the activation of PI3K/AKT pathway as well as microglia in L4-5 of all rats. Proinflammatory cytokines TNF-α and IL-6 were analyzed by Enzyme-linked immunosorbent assay (ELISA). Results: It was demonstrated that chronic constriction injury-induced hyperalgesia was significantly improved by LY294002 intrathecal administration and electroacupuncture stimulation at “Zusanli” 足三里 (ST36) and “Yanglingquan” 阳陵泉 (GB34). Also, treatment with electroacupuncture significantly reduced the activation of microglia and downregulated the levels of TNF-α and IL-6, which was similar to the outcomes of LY294002 intrathecal administration. Furthermore, the expression and phosphorylation of PI3K/AKT signaling was markedly suppressed by electroacupuncture treatment. Conclusions: These findings indicated that electroacupuncture exhibited the analgesic effect on CCI rats by inhibiting the activation of microglia and production of proinflammatory cytokines in spinal cord through blocking the microglial PI3K/AKT signaling activation

Objective: To investigate the number and distribution of dendritic cells (DCs), macrophages and M2 macrophages in renal tissues of patients with IgA nephropathy (IgAN) and their correlation with clinicopathological parameters, and explore its role in the progression of IgAN. Methods: Renal tissue samples from 42 patients aged ≥18 years with IgAN were collected by kidney biopsy in Guangdong Provincial People's Hospital from January 2018 to June 2018. The patients were divided into different groups according to Oxford classification and Lee grade classification criteria. The distribution and number of DCs (CD209), macrophages (CD68) and M2 macrophages (CD68 and CD206) were detected by immunohistochemistry. Spearman correlation test was used to analyze the correlation between the number of DCs and macrophages in renal tissues and clinical pathological parameters. Results: The number of DCs in the glomeruli of the M1, T0 and C1 groups increased significantly compared with the M0, T1 and C0 groups, and the number of DCs in the renal interstitium of the T1 group increased significantly compared with the T0 group (all P<0.05). The number of glomerular macrophages in group C1 was significantly higher than that in group C0. The number of macrophages in S1, T1 and Lee IV-V tubulointerstitial groups was significantly higher than that in S0, T0 and Lee II-III groups (P<0.05). The number of M2 macrophages in the S1, T1 and Lee IV-V groups was significantly higher in the tubulointerstitial group than in the S0, T0 and Lee II-III groups (all P<0.05). The blood urea nitrogen, serum creatinine and 24 h urine protein levels in the T1 and Lee IV-V groups were significantly higher than those in the T0 and Lee II-III groups, and the serum albumin levels in the Lee IV-V group were significantly lower (all P<0.05). Spearman correlation analysis showed that the number of DCs in renal interstitium was positively correlated with the proportion of tubulointerstitial fibrosis. There were a positive correlation between the proportion of glomerular segmental sclerosis and tubulointerstitial fibrosis and renal interstitial macrophages and M2 macrophages. The number of M2 macrophages was positively correlated with serum creatinine and 24 h urine protein (both P<0.05). Conclusions The number of DCs and M2 macrophages in kidneys are positively correlated with the clinicopathological features of IgAN patients, which indicates that they may be associated with disease progression.

Four hundred and twenty two patients with ureteral calculi undergoing surgical treatment from January 2016 to December 2016 were enrolled in the study.Urine samples were taken from upper and lower ureter of stone obstruction,pathogen examination and drug susceptibility tests were performed.Twenty nine strains of pathogens were isolated from the upper segment of ureter with a detection rate of 6.9%;22 strains were gram-negative bacteria(75.9%)and 3 strains were gram-positive bacteria(10.3%)and 4 strains were fungi(13.8%).Forty eight strains of pathogenic bacteria were isolated from the lower segment with a detection rate of 11.4%;37 strains were gram-negative bacteria(77.1%),11 strains were gram-positive bacteria(22.9%),no fungi was isolated.In 20 cases the positive results were obtained only from upper ureter urine samples, and in 39 cases the positive results were obtained only from lower segment samples.The same pathogens were detected from both upper and lower ureter of stone obstruction in 7 cases, and different pathogens were identified in 2 cases.The most common pathogens were Escherichia coli, followed by Proteus mirabilis, Klebsiella pneumoniae, Enterococcus faecalis and Enterococcus faecium.The resistance to quinolones in gram-negative bacteria was higher than that to cephalosporins.The resistance rate of Escherichia coli to cephalosporin was 36.7%-63.3%,that to ciprofloxacin and levofloxacin was 86.7%-100.0%; the resistance rate of Enterococcus to erythromycin was 100.0%.It is suggested that ureteral calculi obstruction may lead to negative culture results of conventional mid-stream urine samples.It is of clinical value to investigate the distribution and antibiotic resistance of pathogens both from upper and lower segments of ureter in patients with ureteral calculi.

Objective:To study the pharmacological effects of Leshibao chewable tablets for juvenile rats with anorexia. Methods:The rats were divided into 6 groups with 10 ones in each and fed with special forage for 4 weeks to establish the anorexia model of ju-venile rats. After the model establishment, from the 8th day, the treatment groups received Leshibao chewable tablets respectively at the dose of 0. 60, 0. 30 and 0. 15 g·kg-1 ·d-1 for three weeks. The general situation was observed, and the appetite and body weight were recorded during the treatment. At the end of experiment, the gastric juice amount, free gastric acidity, total gastric acidity and pepsin activity were determined, TP, ALB, TCHO, MTL and GAS were determined by kit methods. Additionally, the mice were given Leshibao chewable tablets at different doses (0. 80, 0. 40, 0. 20 g·kg-1 ·d-1 ) for 7 days, the effects of Leshibao chewable tablets on gastric emptying and intestinal propulsive function were observed. Results: Leshibao chewable tablets could significantly increase the body weight, appetite (P<0. 05 or P<0. 01), gastric juice amount, free gastric acidity , total gastric acidity and pepsin secretion (P<0. 05 or P<0. 01), significantly reduce TP, ALB and TCHO in serum (P<0. 05 or P<0. 01), significantly increase MTL and GAS contents (P<0. 05 or P<0. 01), and significantly promote gastric emptying and intestinal propulsion in mice (P<0. 05 or P<0. 01). Conclusion:Leshibao chewable tablets can significantly increase body weight and appetite, and improve digestive function re-markably, which exhibit excellent therapeutic effect in the anorexia model of juvenile rats.

Objective:To explore the effect and mechanism of SanQi HuoXue pills in the treatment of acute soft tissue injury. Methods:Totally 140 wistar rats were randomly divided into the control group, model group, posistive drug group, and Sanqi Huoxue pills group respectively at the dose of 0. 5,1. 0,2. 0 g·kg-1 . The rat model of acute soft tissue injury was used to observe the influence of Sanqi Huoxue pills on the content of PGE2 , IL-6, NO and SOD on the 3rd and 5th day after the administration, and the effects of the pills on the whole blood viscosity and plasma viscosity were studied as well on the 5th day. Results: After the administration of the pills, the levels of PGE2 , IL-6 and NO, the blood viscosity and plasma viscosity were decreased significantly, and the level of SOD was increased significantly(P<0. 01 or P<0. 05) when compared to model group. Conclusion:Sanqi Huoxue pills have therapeutic effect on acute soft tissue injury in rats. Free radical, PGE2 , IL-6 and blood hemorheology play important roles in the formation of acute soft tissue injury.

ObjectiveTo investigate the relationship between the level of plasma D-dimer(D-D) and hepatic functional reserve status in patients with hepatitis B (HB).Methods77 cases with HB were divided into two groups, hepatic function compensated group and hepatic function decompensated group.Plasma D-D, hepatic functional indexes and PT of all patients were detected.ResultsThe level of D-D in the hepatic function decompensated group was higher than that in the hepatic function compensated group(299.0 ± 498.5) μg/L vs (27.9 ± 34.0) μg/L(t =3.1, P ＜ 0.01).D-D negatively correlated with ALB and PA(r =-0.6,-0.6, all P ＜ 0.01), and positively correlated with TBIL and PT(r = 0.4,0.6, all P ＜ 0.01).ConclusionThe level of plasma D-D related with hepatic functional reserve status,and detecting the level of D-D could be helpful to estimate hepatic functional reserve and prognosis of patients with HB.