Anti-CD20 monoclonal antibodies for the treatment of refractory nephrotic syndrome （RNS） in children. The first- generation rituximab is the most widely used in clinical practice； it shows definite efficacy in children with RNS， is recommended by guidelines， particularly for achieving a high remission rate in minimal change nephrosis， and can significantly reduce the cumulative use of glucocorticoids and immunosuppressants. The second-generation ofatumumab has potential as an alternative treatment for patients who are intolerant or resistant to rituximab， while the third-generation obinutuzumab has shown efficacy in complex cases such as rituximab resistance or post-transplant recurrence. However， there is still controversy regarding the optimization of rituximab treatment dosage and whether ofatumumab and obinutuzumab offer greater advantages than rituximab for the treatment of RNS in children. The most common adverse reaction induced by anti-CD20 monoclonal antibodies is infusion reactions， and long-term adverse events mainly include increased risks of sustained immunosuppression and infections. Rituximab has significant economic advantages for the treatment of RNS， but additional pharmacoeconomic research based on China’s healthcare environment is needed to evaluate the cost-effectiveness of ofatumumab and obinutuzumab in this population. Given that the current use of ofatumumab and obinutuzumab in this field is considered off-label use， clinical application should only proceed after a rigorous evaluation of the patient’s benefits and risks.

Objective:To assess the altered right atrial(RA) function using two-dimensional speckle-tracking imaging(2D-STI) in patients with persistent pulmonary hypertension of the newborn(PPHN), and investigate the diagnostic value of different right heart strain parameters in PPHN.Methods:Ultrasound images of 42 newborns with clinically confirmed diagnosis of PPHN in the neonatal intensive care unit of Shenzhen Children′s Hospital (median gestational age 37 + 1 weeks, median age 6 d) and 30 normal newborns (control group, median gestational age 37 + 3 weeks, median age 6.5 d) from January 2020 to January 2023 were retrospectively analyzed, all with gestational age ≥34 gestational weeks. 2D-STI was applied to evaluate RA function: RA strain(RA LS) and area change fraction(RA FAC), where RA LS included RA reservoir strain (εs), RA conduit strain (εe) and RA active contract strain (εa), while evaluating right ventricle(RV) function: RV global longitudinal strain(RV GLS), RV FAC, etc. And the degree of pulmonary artery pressure(PAP) was assessed by tricuspid regurgitation velocity(TRV). The above parameters were compared between the PPHN group and the control group, and the correlations between RA function parameters, RV function parameters and PAP in PPHN group were analyzed. The area under ROC curve (AUC) was used to compare the accuracy of each parameter in the evaluation of impaired cardiac function in PPHN patients. Results:Compared with the control group, RA function (εs, εe, εa and RA FAC) were impaired in PPHN patients (all P<0.05). εs was positively correlated with RV GLS, RA FAC ( r=0.494, 0.356, both P<0.05) and negatively correlated with minimum right atrial area (RAA min), pulmonary artery diameter (PAD), and tricuspid annular internal diameter ( rs=-0.285, r=-0.495, -0.396; both P<0.05); εe was negatively correlated with PAD ( rs=-0.256, P<0.05); εa was positively correlated with RV GLS ( r=0.499, P<0.05) and negatively correlated with PAD and tricuspid annular internal diameter ( r=-0.390, -0.380; both P<0.05); RA FAC was positively correlated with RV GLS ( r=0.365, P<0.05) and negatively correlated with PAD and tricuspid annular internal diameter ( r=-0.439, -0.328; both P<0.05). RA LS and RA FAC had no correlations with TRV-estimated PAP ( P>0.05). ROC analysis showed that the sensitivity and specificity of εs<40.50% for diagnosing PPHN was 0.905 and 0.800, respectively, with an AUC of 0.929; the sensitivity and specificity of RV GLS<18.55% for diagnosing PPHN were 0.905 and 0.900, respectively, with an AUC of 0.963; εs combined with RV GLS was the best indicator for early detection of right heart functional impairment in PPHN, with sensitivity and specificity of 0.905 and 1.000, respectively, and AUC was 0.985. Conclusions:RA function and RV function are both impaired in PPHN patients. εs combined with RV GLS is the best indicator for early assessment of right heart function impairment and diagnosis of PPHN.

As the final resolution for end-stage lung disease, lung transplantation can not only significantly prolong the survival, but also remarkably improve the quality of life of recipients. In recent decades, with the advancement of surgical techniques, immunosuppressants and post-transplantation management, the quantity of lung transplantation has been surged around the globe. However, the shortage of donor lung has severely restricted the development of lung transplantation. It is necessary to develop innovative approaches to expand the donor pool. The number of donors and effective preservation and functional maintenance of potential donor lungs play a key role in expanding the donor pool. The quality of donor lung is a critical precondition to ensure the long-term survival of lung transplant recipients. Preservation and functional maintenance of donor lung are of significance for guaranteeing the quality of lung allograft. In this article, research progresses on the management and maintenance of donor lung before procurement, the procurement of donor lung and the preservation and functional maintenance of lung allograft were reviewed, aiming to provide reference for the development of lung transplantation in clinical practice.

Proteolysis targeting chimeria (PROTAC) degrades target proteins by utilizing the ubiquitin-proteasome pathway, subverting the concept of traditional small molecule inhibitors. Among the common mutation targets of non-small cell lung cancer (NSCLC), PROTAC technology has successfully achieved the effective degradation of kirsten rat sarcoma viral oncogene homolog (KRAS), epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK ) and other proteins in preclinical studies. PROTAC drugs with their unique event-driven advantages, are expected to overcome acquired drug resistance caused by small molecule inhibitors and show good therapeutic potential for undruggable targets, thereby providing a new strategy for the treatment of NSCLC.
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Carcinoma, Non-Small-Cell Lung/pathology* ; Humans ; Lung Neoplasms/pathology* ; Mutation ; Protein Kinase Inhibitors/therapeutic use* ; Proteolysis ; Proto-Oncogene Proteins p21(ras)/genetics*

To investigate the clinical manifestations and imaging characteristics of patients with different types of infectious sacroiliitis. Clinical data of 40 patients diagnosed with infectious sacroiliitis were retrospectively analyzed. Among the 40 patients, 16 patients were diagnosed as non-brucellar and non-tuberculous infectious sacroiliitis (ISI), 13 with tuberculous infectious sacroiliitis (TSI), and 11 with brucellar sacroiliitis (BSI). In the ISI and TSI group, female patients accounted for 11/16, 12/13, while the proportion of unilateral involvement was 15/16 and 12/13, respectively. Compared with ISI and TSI group, BSI patients were mainly male (8/11) and presented more bilateral involvement (6/11) ( P<0.05). Bone erosion was more common in ISI and TSI groups than in BSI group (6/15, 7/11 and 2/10), as well as abscess formation (3/15, 4/11 and 1/10, respectively). Symptoms in all patients relieved 1-2 weeks after administration of antibiotics or anti-tuberculosis treatment, but the resolution of the magnetic resonance imaging findings delayed about 6 (3-9) months. ISI and TSI patients with infectious sacroiliitis should be differentiated from spondyloarthritis, with a characteristic of more female patients, unilateral sacroiliitis, bone erosion, soft tissue involvement and abscess formation. However, BSI patients are mainly male, more bilateral involvement and less bone destruction and abscess formation. Antibiotic therapy demonstrates significant therapeutic effects, but resolution of the magnetic resonance imaging findings responses late.

Objective Comparation of the effects of intravenous lidocaine and dexmedetomidine on coughing during extubation after endoscopic thyroidectomy. Methods 60 patients who underwent endoscopic thyroidectomy were randomly divided into group L, group D and group C, each group included 20 cases. Group L were given a loading lidocaine 1.5 mg/kg over 10 minutes before anesthesia induction, followed by a continuous intravenous lidocaine 1.5 mg/ (kg·h) until 30 min before the end of surgery. Group D were given a loading dexmedetomidine 0.5μg/kg over 10 minutes before anesthesia induction, followed by a continuous intravenous dexmedetomidine 0.4 μg/ (kg · h) until 30 min before the end of surgery. Group C were given intravenous infusion of equal volume normal saline. The incidence and severity of coughing were recorded within 2 minutes after extubation. Hemodynamic variables were measured at T0 (before anaesthesia induction) , T1 (immediately after extubation) , and T2 (5 min after extubation). The volume of drainage was recorded within 24 hours after surgery. Results The incidence and grade of cough were significantly lower in group L and group D than in group C (P < 0.05). Compared with group L and group D, MAP and HR were significantly increased in group C at T1 and T2 (P < 0.05). Compared with group C, the volume of drainage was significantly reduced in group L and group D within 24 hours after surgery (P < 0.05).Conclusion Intravenous lidocaine and dexmedetomidine can effectively inhibit coughing during extubation period after endoscopic thyroidectomy, and there is no significant difference between the two treatments.

Objective To explore the effects of chronic sodium arsenic (NaAsO2) exposure on energy metabolism in human keratinocytes (HaCaT).Methods Malignant transformation was induced when HaCaT cells were continuously exposed to an environmentally relevant level (0.1 μ mol/L) of inorganic arsenic for 28 weeks,HaCaT and malignantly transformed cells were kept in Group of Chronic Disease and Environmental Genomics,School of Public Health,China Medical University.Basal oxygen consumption rate and extracellular acidification rate in control group and malignantly transformed group were measured by Agilent Seahorse XF24.Changes of glucose intake in malignantly transformed HaCaT cells were detected by 2-NBDG.Cells in logarithmic growth phase were collect,mRNA levels of key components in glycolytic pathwa [glucose-6-phosphate dehydrogenase (G6PD),phosphofructokinase (PFKL),glyceraldehyde-3-phosphate dehydrogenase (GAPDH)] and mitochondrial respiratory chain complex [NADH dehydrogenase iron-sulfur protein subunit 3 (NDUFS3),succinate dehydrogenase iron-sulfoprotein subunit (SDHB),cytochrome C (CYTC),CYTC oxidase subunit Ⅳ (COX4L1),ATP synthase F1 subunit (ATP5B),and ATP synthase F0 subunit (ATP5G1)] were determined by real-time quantitative PCR (RT-qPCR).Results The basal oxygen consumption rate of malignantly transformed group [(44.784 ± 10.159) pMoles/min] was lower than that of control group [(66.842 ± 15.756) pMoles/min,t =4.914,P ＜ 0.05].The glucose intakes of malignantly transformed group (1.592 ± 0.410 for cells cultured without serum,and 1.631 ± 0.323 for cells cultured with serum) were significantly higher than those of control group (1.000 ± 0.334,1.000 ± 0.196,t =2.916,4.068,P ＜0.05).The mRNA levels of G6PD (0.555 ± 0.009),NDUFS3 (0.623 ± 0.031) and SDHB (0.702 ± 0.094)in malignantly transformed group were significantly lower than those of control group (1.000 ± 0.027,1.000 ±0.034,1.000 ± 0.114,t =23.690,11.340,2.814,P ＜ 0.05);the mRNA levels of PFKL (1.787 ± 0.176),GAPDH (1.466 ± 0.111),CYTC (2.461 ± 0.179),ATP5B (1.956 ± 0.161),and ATP5G1 (2.055 ± 0.052) were significantly higher than those of control group(1.000 ± 0.153,1.000 ± 0.069,1.000 ± 0.030,1.000 ± 0.091,1.000 ± 0.237,t =4.696,4.985,11.540,7.436,6.021,P ＜ 0.05).Conclusion When continuously exposed to an environmentally relevant level of inorganic arsenic,the glucose metabolic pattern of HaCaT cells is changed along with lower oxygen consumption and higher glycolysis levels.

Renal ischemia reperfusion injury refers to the recovery failure of renal function induced by renal perfusion after ischemia,and resulting in a series of pathophysiological reactions.At present,there are no sovereign drugs for the treatment of renal ischemia reperfusion injury.Based on the pathophysiological characteristics of renal ischemia reperfusion injury and the latest research results at home and abroad,the article reviewed the research progress in the therapeutical drugs for renal ischemia reperfusion injury,including apoptotic protease inhibitors,P-selectin antagonists and antioxidants,which could provide reference for the effective intervention with the disease.

Objective To understand the spatial distribution characteristics of wild feces in schistosomiasis endemic areas of Jiangling County,Hubei Province and further explore the source of infection efficiently,so as to provide the evidence for the development of corresponding monitoring and response technology. Methods In 2011,the fresh wild feces were investigated every two months in the selected 15 villages by the severity of historical endemic in Jiangling County. The schistosome miracidi-um hatching method was used to test the schistosome infection of the wild feces. The descriptive analysis and spatial analysis were used for the description of the spatial distribution of the wild feces. Results Totally 701 wild feces samples were collected with the average density of 0.0556/100 m2,and the positive rate of the wild feces was 11.70%(82/701). The results of the re-gression analysis showed a positive spatial correlation between the positive rate of wild feces and the rate of human infection,the area with infected Oncomelania hupensis and the number of fenced cattle,and the corrected R2 of the model was 0.58. Conclu-sion The infection rate of wild feces is positively correlated with the rate of human infection,area with infected O. hupensis and number of fenced cattle in space in Jiangling County,so the prevention and control measures could be conducted according to the spatial distribution of the positive wild feces.

Objective:To observe the application effect of continuous blood purification(CBP) machine in treatment of multiple organs dysfunction syndromes(MODS) in children.Methods: 26 cases of children with MODS implemented CBP therapy were choosed as the research objects. All the patient’s treatment time, replacement liquid dosage, the quantity of liquid ultrafiltration were recorded. All the patient’s blood pressure and heart rate were monitored before and after CBP therapy. The changes in the renal function indices such as BUN and SCr, the blood gas indexes such as pH, PaO2, PaCO2, HCO3-and BE, the electrolyte indicators such as Na+, K+, Cl- and osmotic pressure were observed and compared before and after CBP therapy.Results: (1)The average period of treatment of 26 cases in children with MODS was (77±53)h. The average amount of fluid replacement was (18.4±15.8)L/d, and the average quantity of liquid of ultrafiltration was (2630±1760)ml/d. The vital signs of all the children were stable in the process of CBP therapy, and the blood pressure and heart rate had no obvious changes before and after treatment. (2)The renal function indices such as BUN and SCr decreased obviously after treatment. The differences were statistically significant (t=50.392,t=96.115;P<0.05). The blood gas indexes such as PH, PaO2/FiO2, HCO3- and BE were improved significantly after treatment (t=4.450,t=20.105,t=11.209,t=54.840;P<0.05). The electrolyte indicators such as Na+, K+, Cl- and osmotic pressure had no obvious change after treatment (P>0.05).Conclusion: CBP therapy can effectively reduce various inflammatory mediators and toxin, improve renal function, help to stabilize the environment in the body and it is an effective, safe and reliable therapeutic method in the treatment of children with MODS.