Objective:To investigate the clinicopathological features and the prognosis of IgA nephropathy (IgAN) in children with massive proteinuria.Methods:It was a retrospective cohort study. Clinical data of IgAN children with massive proteinuria admitted to the Department of Nephrology, Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2008 to December 2021 were retrospectively analyzed. Patients were divided into effective group and ineffective group according to whether urine protein turned negative after 6 months of initial treatment. The follow-up endpoint event was defined as a reduction in proteinuria of less than 50% or end-stage renal disease (ESRD) achievement. MedCalc software was used to perform Kaplan-Meier survival analysis, and Log-rank test was used to compare the difference of renal survival between the two groups.Results:A total of 127 patients were diagnosed as primary IgAN by renal biopsy, of whom 57 patients with IgAN showed massive proteinuria. These 57 IgAN patients with macroproteinuria accounted for 44.9% of the total IgAN patients and were enrolled in the study. Among the 57 cases, 33 cases (57.9%) were Lee's grade Ⅲ, 11 cases (19.3%) were below Lee's grade Ⅲ, and 13 cases (22.8%) were above Lee's grade Ⅲ. The follow-up time was 4.0 (3.0,5.8) years. In the initial treatment, among 57 patients, 46 (80.7%) were effective (effective group) and 11 (19.3%) were ineffective (ineffective group). Compared with the effective group, the ineffective group had a higher proportion of concurrent AKI at the onset of disease and longer recovery time of renal function, with significant difference (7/11 vs. 13/46, χ2=4.878, P=0.027). Compared with the effective group, the proportion of Lee grade Ⅲ or above was higher in the ineffective group, and the difference was statistically significant (5/11 vs. 8/46, χ2=3.971, P=0.046). There were significant differences in endocapillary hypercellularity (E1), segmental glomerulosclerosis or adhesion (S1) and cellular/fibrocellular crescents (C2) of Oxford classification between IgAN children with Lee grade Ⅲ or below and those over Lee grade Ⅲ (11/13 vs. 20/44, χ2=6.204, P=0.013; 12/13 vs. 17/44, χ2=11.566, P=0.001; 9/13 vs. 7/44, χ2=14.131, P=0.001). Among 57 patients, endpoint events occurred in 2 patients who both were urinary protein unmitigated, and none of the children progressed to ESRD. There was no significant difference in cumulative renal survival between the two groups by Kaplan-Meier survival analysis and Log-rank test ( χ2=0.537, P=0.460) after addition of calcineurin inhibitors (CNIs) to the initial treatment ineffective group. Conclusions:Macroproteinuria is the prominent manifestation of IgAN in children. The pathological type is mainly Lee grade Ⅲ. Children with macroproteinuria have a good prognosis in the short and medium term after active treatment. For IgAN with macroproteinuria that does not respond well to initial treatment, AKI is more common at onset, and renal function recovery time is longer. The application of CNIs may have a certain effect on improving the renal outcome of IgAN with massive proteinuria.

The article reported one case of renal damage caused by lenvatinib in the treatment of advanced primary liver cancer. The patient was a 63-year-old male who was admitted to the hospital due to "liver cancer for 4 years, blood pressure elevation for nearly 2 years, and edema for 7 months". During the treatment of liver tumors with atezolizumab combined with lenvatinib, blood pressure increased and renal insufficiency aggravated progressively. Pathological light microscopy of renal biopsy showed endothelial cell lesion and tubulointerstitial damage, and electron microscopy showed moderate proliferation of mesangial cells and deposition of mesangial matrix. There were many agglomerated low-electron density deposits in the mesangial area, and a small amount of electron dense deposits in the subendothelium. The pathological diagnosis was endothelial cell disease (thrombotic microangiopathy) and secondary focal segmental glomerulosclerosis. Renal injury was considered as secondary to lenvatinib. After discontinuing lenvatinib and giving angiotensin receptor antagonist treatment, blood pressure was normal, urine protein turned negative, and renal function improved significantly after 8 months of outpatient follow-up.

Objective : To explore the regulatory effects of ResolvinD1 (RVD1) on autophagy and apoptosis of cardiomyocytes in aging rats , and the effects of RVD1 on mitochondria⁃associated endoplasmic reticulum membranes (MAMs) of myocardial tissue . Methods : Thirty 18⁃month⁃old SD rats were randomly divided into model group , low⁃dose RVD1 group and high⁃dose RVD1 group , with 10 rats in each group , and another 10 6 ⁃month⁃old SD rats were selected as control group . The low⁃dose RVD1 group and high⁃dose RVD1 group were injected with 50 ng/ml and 100 ng/ml RVD1 through the tail vein , respectively , control group and model group were injected with the same amount of phosphate buffered saline (PBS) for 21 days . The β ⁃galactosidase activity of rat myocardial tissue was determined by p ⁃nitrophenol method , the histopathological changes of rat myocardial tissue were detected by hematoxylin⁃eosin (HE) staining , and the collagen deposition in rat myocardial tissue was observed by Masson staining , apoptosis of rat myocardial cells was detected by dUTP in situ end labeling mediated by terminal deoxynucleotide transferase(TUNEL) , the expression of autophagy marker microtubule⁃associated protein 3 (LC3) was detecotide transferase(TUNEL) , the expression of autophagy marker microtubule⁃associated protein 3 (LC3) was detected by immunohistochemical S ⁃P method , the ratio of LC3 ⁃ Ⅱ/LC3 ⁃ Ⅰ and the expression of Beclin⁃1 , p62 in rat myocardial tissue were determined by Western blot , the structure of MAMs in rat myocardial tissue was observed by transmission electron microscopy , the expression levels of glucose⁃regulatory protein 75 (GRP75) , volt⁃dependent anion channel 1 (VDAC1) and mitochondrial fusion protein 2 (Mfn2) in rat myocardial tissue were determined by Western blot . Results : Compared with model group , β ⁃galactosidase activity of myocardial tissue decreased in low⁃dose RVD1 group and high⁃dose RVD1 group (P < 0. 05) , myocardial fiber breakage and myocardial cell damag were significantly alleviated , collagen fiber deposition was significantly reduced , and the proportion of TUNEL positive cells in myocardial tissue decreased (P < 0. 05) , the positive rate of LC3 protein increased (P < 0. 05) , the ratio of LC3 ⁃ Ⅱ/LC3 ⁃ Ⅰ increased , the relative expression level of Beclin⁃1 protein was up⁃regulated and the relative expression level of p62 protein was down⁃regulated ( P < 0. 05) , the structure of MAMs was tighter , and the percentage of MAMs in mitochondrial circumference also increased (P < 0. 05) , the relative protein expressions of GRP75 , VDAC1 and Mfn2 were up⁃regulated (P < 0. 05) . Compared with low⁃dose RVD1 group , β ⁃galactosidase activity in high⁃dose RVD1 group further decreased ( P < 0. 05) , no obvious damage was observed in myocardial tissue , collagen fiber deposition was further decreased , the proportion of TUNEL positive cells in myocardial tissue decreased (P < 0. 05 ) , and the positive rate of LC3 protein increased ( P < 0. 05 ) , LC3 ⁃ Ⅱ/LC3 ⁃ Ⅰ ratio increased , Beclin⁃1 relative expression level was up⁃regulated and p62 relative expression level was down⁃regulated (P < 0. 05) , the structure of MAMs was more compact , and their percentage in mitochondrial circumference further increased (P < 0. 05 ) , the relative expressions of GRP75 , VDAC1 and Mfn2 were further up⁃regulated ( P <0. 05) . Conclusion RVD1 can activate autophagy , alleviate myocardial apoptosis and collagen fiber deposition, and promote mitochondria⁃associated endoplasmic reticulum membranes in aging rats .

Objective:To study the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with iodine-125 ( 125Ⅰ) seed strands implantation in patients with hepatocellular carcinoma combined with portal vein tumor thrombosis. Methods:25 cases with diffuse intrahepatic tumor combined with tumor thrombus type Ⅲ/Ⅳ requiring TIPS were simultaneously implanted with 125Ⅰseed strand. Tumor thrombus was controlled with 125I seed implantation brachytherapy to keep the TIPS pathway unobstructed, reduce the portal vein pressure, and observe the changes in the cause of death of the patients. During the same period, 30 cases without TIPS and seed strand implantation were used as controls. Data between groups were compared using t-test, Chi-Squared test or Fisher's exact test. Results:TIPS combined with 125Ⅰ seed strand implantation was safe in patients with diffuse hepatocellular carcinoma combined with type III/IV portal vein tumor thrombus, and 92.0% (23/25) of the patients maintained unobstructed TIPS pathway. Compared with the control group, patients in the treatment group died of fewer lead-related complications, and most died from chronic liver failure (84.0% vs. 56.7%, χ2 = 4.771, P=0.029). The incidence of upper gastrointestinal bleeding was significantly decreased (12.0% vs. 46.7%, χ2 =7.674, P=0.006) and ascites severity was significantly improved (mild 40.0% vs. 16.7%, moderate 52.0% vs. 20.0%, severe 8.0% vs. 46.7%, χ2 =13.246 , P=0.001). Conclusions:TIPS combined with 125Ⅰ seed strand implantation is safe and feasible in patients with diffuse intrahepatic tumor combined with tumor thrombus type Ⅲ/Ⅳ. Moreover, it can effectively keep the shunt patency and reduce portal vein pressure, thereby reducing the incidence of upper gastrointestinal bleeding and improving the degree of ascites. TIPS combined with 125Ⅰ seed strand implantation may be used as a standard treatment modality for patients requiring TIPS therapy combined with tumor thrombus type Ⅲ/Ⅳ.

Objective To describe a case of lower limbs infection of Helcococcus Kunzii in North China University of Science and Technology Affiliated Hospital in October 2017 and to analyze the etiology and drug susceptibility??Methods The bacteria were identified by French Meriere mass spectrometer and BD Phoenix?100 automatic bacterial identification／drug sensitivity system??The drug resistance of the bacteria was detected by disk diffusion method,and collected the clinical information and related literature information of the Helcococcus Kunzi to analyze??Results The Gram?positive cocci was isolated from the foot secretion of a patient with venous thrombosis of lower limbs complicated with infection??The result of smear was Gram?positive cocci in double,agglomerate and varied in size??On the blood plate,there was a small colony of α hemolysis??Thixozyme negative,β galactosidase negative??The results of mass spectrometry identification and two kinds of fully automatic bacterial identification ／ drug sensitivity system were identified as Helcococcus Kunzii,the isolates was resistant to erythromycin and clindamycin among the 10 antibiotics tested??By searching,sorting out and analyzing the literature information, it is revealed that the infection of this bacterium is not related to sex??Middle?aged and elderly people are mostly infected??And the cocci easily infected patients with lower immunity??The infection of lower limbs is 47??37%,the infection of blood flow is 15??79% and the other ways of infection are 42??11%( lung, mammary gland, etc??)??Conclusion Helcococcus Kunzii is a conditional pathogen, and patients with lower immunity are more common??Erythromycin resistance could identify it from the green balloon bacteria??Moreover, the bacteria could cause a wide spectrum of diseases,and easily cause sepsis and lower limbs infections,which reminds us that we should be vigilant in clinical practice??

Objective? To evaluate the effect of physical restraintreduction strategy on improving the physical restraint practice of critical patients. Methods? Using convenient sampling method, the inpatients in the Intensive Care Uni(t ICU)of the Emergency Department of a ClassⅢ Grade A hospital in Beijing in 2017 and 2018 were selected as the research objects. According to the length of stay, the inpatients in 2017 were divided into two groups: the control group (n=282), the intervention group (n=263), the control group was given regular physical restraint strategy, and the intervention group used the developed physical restraint reduction strategy to implement the physical restraint. The rate of physical restraint, time of physical restraint, delirium, unplanned extubation and skin abnormality were compared between the two groups. Results? In the intervention group, the rate of physical restraint was 23.57%, and the rate of unplanned extubation was 1.14%, which was lower than that in the control group, the differences were statistically significant (χ2=26.830, 4.142; P＜ 0.05). The restraint time of the intervention group was (49.63±146.94) h, and that of the control group was (93.62± 186.35) h, the difference was statistically significant (t=10.04, P＜0.05). There was no significant difference in the incidence of delirium and skin abnormality between the two groups (P＞0.05). Conclusions? The strategy of body constraint reduction is helpful to reduce the rate of body constraint, the time of constraint and the rate of unplanned extubation.

Objective To evaluate the effect of dexmedetomidine on the expression of nerve growth factor (NGF) in isolated hippocampal neurons of fetal rats incubated with propofol.Methods Hippocampal neurons derived from the fetal rats of pregnant Sprague-Dawley rats at 5-13 days of gestation were primarily cultured for 7 days,and were inoculated in the culture plate at a density of 5×105 cells/ml.The neurons were randomly divided into 3 groups (n =15 each) using a random number table:control group (group C),propofol group (group P),and dexmedetomidine + propofol group (group DP).In group P,propofol with the final concentration of 100 μmol/L was added to the culture medium,and the cells were incubated for 3 h.In group DP,dexmedetomidine with the final concentration of 1 μmol/L was added to the culture medium,the cells were incubated for 30 min,and then propofol with the final concentration of 100 μmol/L was added to the culture medium,and the cells were incubated for 3 h.The viability of hippocampal neurons was assessed by CCK-8 assay.NGF mRNA expression was detected by real-time reverse transcriptase polymerase chain reaction.NGF protein expression was detected by Western blot.Results Compared with group C,the viability of hippocampal neurons was significantly decreased,and the expression of NGF protein and mRNA was down-regulated in group P (P＜0.05).Compared with group P,the viability of hippocampal neurons was significantly increased,and the expression of NGF protein and mRNA was up-regulated in group DP (P＜0.05).Conclusion Dexmedetomidine improve propofol-induced decrease in the viability of isolated hippocampal neurons of fetal rats through up-regulating the expression of NGF.

Objective To analyze the relationship between renal pathological characteristics and clinical prognosis in type 2 diabetic kidney disease patients,and discuss predictive value of pathological type and indexes for renal function declining rate and related outcome events.Methods Ninety-two type 2 diabetes patients from PUMC Hospital (with macroalbuminuria and followed up no less than 6 months,excluding patients with non-diabetic renal disease) were divided into typical diabetic glomerulopathy group (DG,n=51) and atypical diabetes-related renal disease group(ADRD,n=41) according to renal pathological findings.A retrospective cohort study was performed to investigate renal pathological features and prognosis.Results Total of 29 renal outcome events and 12 death events occurred in DG group and none in ADRD group; the survival rate and kidney survival rate are different between two groups (P ＜ 0.05); DG group,thick GBM,severe vascular and tubular lesion are predicative indicators for renal outcome event; mesangial volume fraction is predicative indicator for renal outcome events independent of age and serum creatinine.Conclusions DG and ADRD patients have different prognosis and might undergo different pathophysiological mechanisms; renal pathological type and mesangial volume fraction could help predicting outcomes of type 2 diabetic nephropathy patients.

Objective To explore the content of the goals set by medical freshmen. Meth-ods 189 freshmen who major in clinic medicine were asked to answer the goals they set in the period of five years colleges’life,another 100 freshmen were selected to categorize the goals with high frequencies and then factor analysis were employed.Results 46 goals with high fre-quency can be classified into 11 factors. Conclusion Although the content of the goals set by the medical freshmen included some unreasonable points,it is basically in line with that of our present goals of cultivating medical students.

Objective To study the protective effect of ROP2 nuclei acid vaccine in mice.Methods Forty-two BALB/c mice were divided into three groups.Each mouse in experiment group was injected with 50 ?g recombinant plasmid pc-DNA3-ROP2 through musculus quadriceps fexoris.In control groups,each mouse was injected with 50 ?g blank plasmid pc-DNA3 and with 50 ?l PBS respectively.All mice were immunized for three times with an interval of three weeks.The volume was doubled for the final injection in the two plasmid groups.Blood,spleens and lymph nodes of 4 mice in each group were taken for the detection of CD4+,CD8+ T cells and cytokines 2 weeks after the final immunization.The rest mice in 3 groups were challenged with 500 tachyzoites of Toxoplasm gondii RH strain for further observation.Results The vaccine induced strong cellular and humoral immune response.The titer of antibody in serum was high after inoculation and recognized ROP2 protein antigen expressed in vitro.The lymphocyte phenotype was analyzed.CD4+ T cells proliferated sharply(69.5?3.4)%,and the ratio of CD4+/CD8+ increased considerably by(4.69?1.32)%(P