Preeclampsia is one of the most important types among hypertensive disorders during pregnancy, characterized by a high incidence, multi-organ involvement, and severe threats to maternal and fetal health. This paper reviews the historical understanding of eclampsia, explores the development of the concept of "preeclampsia" alongside advancements in blood pressure measurement and urinalysis technologies, and examines the historical explanations of the etiology of eclampsia and preeclampsia. From abnormal fetal positioning to placental dysfunction and endothelial cell dysfunction, although the exact pathogenesis of eclampsia-preeclampsia remains unclear, reviewing this historical progression provides a deeper understanding of the evolution of this field and its essence. This, in turn, helps to grasp the cognitive foundations of current practices and the potential limitations.

Objective:To explore the clinical efficacy of adult donor dual kidney transplantation.Methods:Retrospective analysis of case data of 13 adult donor kidney dual kidney transplantation (DKT) performed in the The Second Xiangya Hospital of Central South University from September 2016 to December 2020. For 13 donors, the average age and BMI were (53.5±12.4)years and (24.3±2.8) kg/m 2, respectively. Their mean Serum creatinine (SCr) at admission and before procurement was (132.9±54.1)and (228.7±112.4)μmol/L, respectively. 3 of them had diabetes mellitus history, and 8 had hypertension history. 11 met the United Network for Organ Sharing (UNOS) DKT criteria and 6 met Remuzzi score DKT criteria. For 13 recipients, the average age and BMI were (39.3±8.9)years and (20.2±2.4)kg/m 2, respectively. All of them received ABO blood type-matched kidney transplants. 2 of them had their grafts transplanted in the bilateral iliac. In 12 cases, the grafts filled rapidly and urinated immediately when opening blood flow. In 1 case, the grafts were dark in color and vascular showed weak pulsation after opening blood flow. The time to recovery of perioperative graft function (from the day of surgery to the natural reduction of SCr to the normal range 44-133μmol/L), the occurrence of delayed graft function (DGF), acute rejection (AR), ureteral and surgical incision complications, as well as the recipients’ final follow-up SCr, eGFR, urinary protein, and grafts outcome were observed. Risk factors affecting outcomes were assessed by univariate logistic regression analysis. Results:The SCr dropped to the normal range at discharge in 10 recipients, and the average recovery time was (13.8±13.0) days. In other 3 cases SCr at discharge were 300.0, 149.0, 152.5μmol/L. 4 cases had DGF, 4 had AR, 1 experienced urinary fistula, and 1 experienced incisional dehiscence, which were treated with anti-rejection, J-tube implantation, continuous catheterization to maintain bladder void, secondary suturing, respectively. The follow-up time ranged from 4 to 54 months, with a median of 28(15.5, 31.0) months. At the final follow-up time, 10 cases had good graft function, 2 suffered impaired kidney function, and 1 experienced graft failure. The average SCr and eGFR except for graft failure patient were (144.2±101.3)μmol/L and (52.9±21.2)ml/min, respectively. 4 had positive urine protein. Univariate logistic regression analysis showed that donor age, BMI, history of diabetes mellitus and hypertension, and SCr were not significantly correlated with recipients’ DGF and graft impairment ( P>0.05), and due to the small sample size, multifactorial logistic regression analysis was not performed. Conclusion:The short to medium-term effects of adult donor DKT coule be safe and feasible.

Molecular knowledge of human gastric corpus epithelium remains incomplete. Here, by integrated analyses using single-cell RNA sequencing (scRNA-seq), spatial transcriptomics, and single-cell assay for transposase accessible chromatin sequencing (scATAC-seq) techniques, we uncovered the spatially resolved expression landscape and gene-regulatory network of human gastric corpus epithelium. Specifically, we identified a stem/progenitor cell population in the isthmus of human gastric corpus, where EGF and WNT signaling pathways were activated. Meanwhile, LGR4, but not LGR5, was responsible for the activation of WNT signaling pathway. Importantly, FABP5 and NME1 were identified and validated as crucial for both normal gastric stem/progenitor cells and gastric cancer cells. Finally, we explored the epigenetic regulation of critical genes for gastric corpus epithelium at chromatin state level, and identified several important cell-type-specific transcription factors. In summary, our work provides novel insights to systematically understand the cellular diversity and homeostasis of human gastric corpus epithelium in vivo.
Humans ; Epigenesis, Genetic ; Gastric Mucosa/metabolism* ; Chromatin/metabolism* ; Stem Cells ; Epithelium/metabolism* ; Fatty Acid-Binding Proteins/metabolism*

Objective:To explore the main causes of 50 children with aplastic anemia misdiagnosed as immune thrombocytopenia(ITP), summarize differential diagnosis experience, and provide clinical reference.Methods:According to the diagnostic criteria of aplastic anemia and ITP in children, the initial data of misdiagnosed cases in other hospital admitted to the Department of Pediatrics, Shanghai Tongji Hospital from January 2007 to December 2020, and the results of their re-examination tests in this hospital were analyzed.The causes of misdiagnosis and the main points of differential diagnosis were summarized.Results:Of the 165 children with aplastic anemia treated in the same period, 50 cases (30.3%) had been misdiagnosed as ITP.The main causes of misdiagnosis were summarized as follows.(1) The clinical manifestations in 22 cases disagreed with " typical symptoms of ITP" , and necessary bone marrow examinations were not performed in accordance with the international guidelines to confirm the diagnosis.(2) The bone marrow test results were interpreted falsely.Among 28 patients who underwent the bone marrow smear examination, 6 cases (21%) showed typical aplastic bone marrow, but they were still misdiagnosed with ITP.(3) Patients (15/28 cases, 54%) with atypical bone marrow smears did not receive further bone marrow biopsy to facilitate the diagnosis.(4) In 7 cases (7/28 cases, 25%), their bone marrow examination results met the diagnostic criteria of ITP at initial diagnosis, but no necessary review was performed to verify and correct the diagnosis after glucocorticoid trea-tment failed.Conclusions:Clinical diagnosis should be made in restrict accordance with related disease diagnostic criteria to avoid empirical errors.Diagnosis of ITP requires caution.Especially for those with atypical clinical manifestations or irresponsive to first-line drugs, bone marrow examinations (bone marrow biopsy if necessary) must be performed, and the test results should be correctly interpreted according to the diagnostic criteria to prevent clinical misdiagnosis or missed diagnosis.

Objective To analyze the distribution of microorganisms in kidney perfusion fluid and perirenal drainage of the renal allografts,and provide evidence to guide clinical practice.Methods The clinical data from the kidney donors and the recipients,the microbiologic culture results of kidney perfusion fluid and perirenal drainage were retrospectively analyzed.Results Ninety-one kidney perfusion fluid samples and 91 perirenal drainage samples were collected from 61 individual renal allografts,and 48 renal allografts were paired.Fourteen (15.4％,14/91) cultured kidney perfusion fluid samples were positive,17 strains were confirmed including 13 strains of bacteria and 4 strains of fungal,and 9 (69.2％,9/13) of bacterial strains were multidrug-resistance with 7 strains resistant to carbapenems,but there was no significant heterogeneity in the outcome of recipients with positive or negative culture results of kidney perfusion fluid samples.Eight (8.8％,8/91) perirenal drainage samples from different recipients were positive,5 of 8 bacterial strains were multidrug-resistance and 3 of them were resistant to carbapenems including meropenem or imipenern.There was no significant correlation between the length of donors' hospital stay and the culture results (P＞0.05),and there was also no significant correlation between the length of recipients' hospital stay after transplantation and the culture results (P＞0.05).Conclusion The kidney with positive perfusion fluid microbiologic culture can be transplanted safely using the prophylaxis or preemptive anti-infection therapy.

BACKGROUND: Although overuse-induced patella-patellar tendon junction injury is a common disease, its pathogenesis and healing mechanism remain unclear.OBJECTIVE: To establish an overuse-induced injury animal model by a repetitive traction at the patellar tendon insertion,and to explore its pathogenesis and healing mechanism based on histomorphology and growth factor expression levels.METHODS: Twenty-eight New Zealand rabbits were randomly divided into four groups: the rabbit left and right posterior limbs without any intervention as controls (n=4); cyclic loading training targeting the left posterior limb was done in model,healing and training groups (n=8 per group) for 4 weeks. Afterwards, the rabbits in the model group were killed immediately, rabbits in the healing group relaxed for another 4 weeks and then were killed, while rabbits in the training group were subjected to 4-week low-intensity training. The histological changes and growth factor expression levels during patella-patellar tendon junction injury and healing after load training were observed.RESULTS AND CONCLUSION: Compared with the control group, in the model group, the cells and collagenous fibers arranged in disorder, and the tidemark disappeared. The healing and training groups healed incompletely, but showed better histological changes than the model group. The thickness of fibrocartilage and basic fibroblast growth factor level in the control group were significantly lower than those in the other three groups (P < 0.05). The cell density and vascular endothelial growth factor level in the model group were significantly higher than those in the control and healing groups (P < 0.05). These results show that the animal model of overuse-induced patella-patellar tendon junction injury cannot return to normal after 4 weeks of rest, but the low-intensity training is conductive to healing quality.

BACKGROUND:Patella-patellar tendon junction (PPTJ) injuries are a common disease in athletes and vulnerable to re-injury. Post-injury training is a double-edged sword. OBJECTIVE:To examine the effect of post-injury resting days on the quality of healing in PPTJ in view of histomorphology, expression levels of growth factor and collagen, and muscle tension. METHODS:Forty New Zealand white rabbits were randomly divided into control, and five post-injury training groups representing different time to restart training after acute injury:the rabbits restarted training at 24 (PIT24), 48 (PIT48), 72 (PIT72), 96 (PIT96) and 120 (PIT120) hours, respectively. All post-injury training groups received acupuncture at the PPTJ and then underwent 4-week low-intensity training. Afterwards, all rabbits were killed to take specimens for hematoxylin-eosin, safranin O and immuohistochemical staining. The muscle tension and hardness were detected using Myoton-3. The thickness of fibrous cartilage zones, cell density, as well as the expression levels of vascular endothelial growth factor and collagen were measured on Metamorph software. RESULTS AND CONCLUSION:Compared with the control group, in the PIT groups, the collagens arranged in disorder, and decreased cell density, increased mucopolysaccharide andrising tidephenomenon appeared. The fibrocartilage in the PIT24 and PIT120 groups was significantly thicker than that in the control group (P<0.05). The ratio of collagen type Ⅰ/Ⅲ was significantly decreased in the PIT24 and PIT48 groups compared with the control group (P<0.05), and the highest in the PIT72 group. The expression level of vascular endothelial growth factor in the PIT48, PIT72 and PIT96 groups was significantly higher than that in the control group (P<0.05). The muscle tension was negatively correlated with the collagen ratio (r=-0.538;P<0.01) and chondrocyte density (r=-0.570;P<0.01), while muscle hardness was positively correlated with the expression level of vascular endothelial growth factor (r=0.613;P<0.01). Our results suggest that different resting time makes significant differences in the PPTJ healing and the 72-hour resting is the best choice. Moreover, muscular properties are related to the cel density, collagen synthesis and growth factor expression, which can be used as a non-invasive indicator to guide post-injury training and prevent recurrence.

Objective To compare the clinical efficacy of kidney transplantations from donors with acute kidney injury (AKI) and without AKI,and summarize the experience of evaluation and application.Methods The clinical data of 240 kidney transplantations from donation after citizen's death (DCD) performed in our hospital between November 2011 and March 2015 were retrospectively analyzed.The recipients were classified into AKI group (n =37) and non-AKI group (n =203) according to donors' renal function and urine output.Basic characteristics and evolution of the donors and recipients were compared between the two groups.Results The donor serum creatinine was significantly higher in the AKI group than that in the non-AKI group (P＜0.01).Most transplant recipients accepted ATG for immune induction therapy in the AKI group,while Basiliximab was given in the non-AKI group,which was significantly different (P＜0.01).Delayed graft function developed more frequently and longer in the AKI group than in the non-AKI group (P＜0.01).However,patient and graft survival rates did no differ between the AKI and non-AKI groups (P＞0.05).There was no significant difference in other indexes between the two groups (P＞0.05).Conclusion The transplants from donors with AKI showed higher incidence of delayed graft function but no effect on 1-year allograft and patient survival.This type of kidney transplantation is safe and effective.

Objective To explore the prevention and treatment strategies for the infectious renal artery rupture after renal transplantation of organ donation after citizens death (DCD).Methods The clinical data of 5 donors and their corresponding recipients with infectious renal artery rupture after renal transplantation were retrospectively analyzed with review of the literature.Results The corresponding donors of 5 recipients had the potential risk factors for donor-transmitted infection (DTI):1 case of traumatic rupture of small intestine,2 cases of digestive tract injury when resecting the donor kidney from DCD donors,1 case of severe pneumonia and 1 case of multiple renal contusion.The pathogenic microorganisms were found in the culture of kidney preservation solution,including klebsiella pneumoniae in 1 case,candida albicans in i case,enterococcus.No pathogens were detected in 1 case,and kidney preservation solution taken from the external hospital was not cultured in 1 case.The pathological examination on the resected renal grafts revealed the necrosis of the arteries and the infiltration of lymphocytes.The culture of bacteria and fungi in the removed vessel walls of renal grafts and the iliac tissues showed there were 2 cases positive for candida albicans (case 2 and case 4),1 case for cryptococcus neoformans (case 1),1 case for klebsiella pneumonia (case 5).No pathogenic bacteria were detected in 1 case,but the possibility of fungal infection was more likely.In case 1,the second kidney transplantation was performed 10 months later after artery re-transplantation,and the kidney function was normal during the follow-up period.In case 4,the second kidney transplantation was performed 2 months later after transplant nephrectomy due to the refractory rejection,the transplanted kidney experienced a rapid loss of graft function,and the blood dialysis was given continuously.The remaining 3 patients survived so far,waiting for re-transplantation.No case of bleeding occurred again in the 5 recipients.Conclusion Renal graft artery rupture is one of most severe complications after renal transplantation.It is the key for preventing infectious renal artery rupture to screen strictly infection of donors and recipients,and to use sensitive and wide coverage antimicrobial to the donors before the removal of donor kidney and during the perioperative period after renal transplantation.Early detection and operation as soon as possible is the only treatment to save the lives of the recipients.

Since the biological characteristics of esophageal gastric junction (EGJ) cancer are different from those of gastric cancer and esophageal cancer, the choice of initial treatment is particularly important. This article introduces a case of locally advanced EGJ can-cer with single metastasis factor treated with preoperative radiochemotherapy in the Beijing Cancer Hospital. Through the multidisci-plinary team, we aim to achieve a better prognosis for this patient and propose new treatment practices for EGJ cancer.