OBJECTIVE To provide a basis for the rational use of nonsteroidal anti-inflammatory drugs （NSAIDs） in the perioperative period， and provide practical methods and technical references for the evaluation and selection of NSAIDs in medical institutions. METHODS Initiated by the Affiliated Hospital of Qingdao University， Clinical Pharmacy Professional Committee of the Shandong Pharmacists Association， Clinical Individualised Drug Testing and Guidance Branch of the Shandong Medical Association， Comprehensive Clinical Medication Evaluation Working Committee of the Shandong Pharmacists Association， Pain Branch of the Shandong Medical Association in conjunction with several medical institutions in Shandong Province organized 22 pharmaceutical experts and medical experts from 17 hospitals in Shandong Province to form a consensus on the rational use and comprehensive clinical evaluation of NSAIDs in the perioperative period through the literature research method， expert interview method and questionnaire survey method based on evidence-based medicine. A comprehensive clinical evaluation was also conducted on a total of 13 specifications of 9 commonly used clinical drug varieties in Shandong Province， including celecoxib， etoricoxib， imrecoxib， ibuprofen （containing reference/original drugs and national/Shandong Province’s centralized volume-based procurement varieties）. RESULTS & CONCLUSIONS A consensus opinion was formed on preoperative prophylactic use and postoperative use of NSAIDs， as well as contraindications， digestive tract risk， cardiovascular system risk， bleeding risk and kidney injury risk in the perioperative period. The evaluation and selection criteria of perioperative use of NSAIDs were established， involving 6 dimensions of safety， efficacy， economy， innovation， appropriateness， and accessibility. The results of comprehensive clinical evaluation showed that the top 6 drugs （scores over 70） were Celecoxib capsules （Celebrex） and Celecoxib capsules （Naiqi）， Diclofenac sodium sustained-release tablets，Etocoxib tablets （Arcoxia） and Etocoxib tablets （Qimingshu）， and Parecoxib sodium for injection. With the progress of clinical research， this consensus will be further updated and adjusted， and medical institutions can combine with the practice to develop a comprehensive clinical evaluation system of NSAIDs suitable for their institutions.

With the development of the Scientific, Transparent and Applicable Rankings tool for clinical practice guidelines(STAR), the publication of evaluation and ranking for scientificity, transparency and applicability of Chinese guidelines and consensus published in the medical journals in 2021and 2022, as well as the publication of the STAR evaluation and ranking for some specialities, the STAR evaluation and ranking has received widespread attention in the medical community. In order to further enhance its scientificity and transparency, Methodology and Technology Specialization Committee of the STAR Working Group presents this article to introduce sample identification and speciality assignment in the evaluation and ranking process.

Objective: To analyze the distribution of glomerular immunofluorescence IgG4 subtypes in primary membranous nephropathy, and to explore the relationship between IgG4 deposit intensity and renal pathology, clinical manifestations and prognosis. Methods: All the patients of biopsy-proven primary membranous nephropathy with IgG staining and at least one IgG subtype staining 1+ or higher on capillary loops from September 2015 to April 2017 were retrospectively enrolled. The distribution of IgG4 deposits were analyzed, and the relationship between IgG4 positive intensity and clinical manifestations, pathological indexes and clinical remission was investigated. Results: A total of 250 cases were enrolled, including 157 males (62.8%) and 93 females (37.2%), and age was (54.4 ± 14.6) years. There were 40 patients in IgG4-negative group, and 210 patients in IgG4-positive group. The IgG4-positive group was divided into subgroups as 114 cases of the mild positive subgroup (1+) and 62 cases of the moderate positive subgroup (2+), and 34 cases of the strong positive subgroup (3+, 4+). The IgG4-positive group had higher 24-hour urine protein and higher positive rate of phospholipase A2 receptor staining than those in the negative group (both P<0.05), while the strong positive subgroup had lower serum albumin and higher IgG1 staining than those in the mild positive subgroup (both P<0.05). There was no difference in the ratio of glomerular sclerosis, tubular atrophy, IgG2, IgG3 or other immunofluorescence between the groups. After a median follow-up of 180(122, 209) days, 32 individuals were lost to follow-up. Among the rest 218 patients, 45 patients (20.6%) got complete remission, 104 patients (47.7%) got partial remission, and 69 patients (31.7%) showed no response. For no response as the outcome event, multivariate Cox regression analysis showed that higher IgG4 staining intensity (HR=1.371, 95%CI 1.068-1.759, P=0.013), male (HR=1.818, 95%CI 1.028-3.214, P=0.040), higher 24-hour urine protein level (HR=1.108, 95%CI 1.003-1.225, P=0.043) were independent risk factors for disease remission. Conclusions The glomerular IgG4 positivity and intensity are related to the severity of primary membranous nephropathy. The glomerular IgG4 deposit degree may be an effective prognostic marker for the treatment response of primary membranous nephropathy.

Renal cell carcinoma is rarely diagnosed during pregnancy, but it is commonly reported urinary system tumors during pregnancy. The management is a real challenge due to the sparse literature and lack of standard guidelines. Following the continuous development of medical technology, the health and fertility needs of these patients have been well protected in recent years. The aim of this article is to review the epidemiology, risk factors, diagnosis, treatment, and prognosis of renal cell carcinoma during pregnancy.

Objective: To investigate the effect of a modified puncture cannula on prevention of bone cement leakage in percutaneous vertebroplasty (PVP). Methods: From January 2014 to February 2018, 243 patients with single-segmental osteoporotic vertebral fracture were treated with PVP at Department of Orthopedics, Shanghai Ninth People's Hospital. Their clinical data were retrospectively analyzed. Of them, a common puncture cannula was used in 169 cases (control group) and a modified puncture cannula in 74 (modified group). In the control group, there were 41 men and 128 women with an age of 71.6±9.5 years, and the fracture was distributed from T5 to T10 in 7 cases, from T11 to L2 in 132 and from L3 to L5 in 30. In the modified group, there were 20 men and 54 women with an age of 73.6±9.3 years, and the fracture was distributed from T5 to T10 in 3 cases, from T11 to L2 in 63 and from L3 to L5 in 8. The 2 groups were compared in terms of postoperative recovery of vertebral height, reduction in visual analogue scale(VAS) and bone cement leakage. Results: There were no significant differences between the 2 groups in age, gender, distribution of fractured vertebral bodies, compression degree, condition of vertebral posterior wall, or bone cement volume injected (P>0.05). There were no significant differences either between the control and modified groups in the postoperative recovery of vertebral height (7.43%±7.82% versus 6.20%±7.84%) or reduction in VAS score (5.83±0.99 versus 5.81±0.89) (P>0.05). Bone cement leakage occurred in 93 cases (55.0%) in the control group but in 26 cases (35.1%) in the modified group, showing a significant difference (P<0.05). The incidences of bone cement leakage in the paravertebral vessels [13.5% (10/74)], paravertebral soft tissue [9.5%(7/74)] and spinal canal [4.1%(3/74)] in the modified group were all significantly lower than those in the control group [25.4%(43/169), 20.1%(34/169) and 15.4%(26/169)](P<0.05). Conclusion Application of the modified end-to-side puncture cannula is an optional scheme to prevent bone cement leakage in PVP, because it can reduce the incidence of bone cement leakage without compromising postoperative short-term outcomes, especially in the spinal canal, paraspinal vessels and paraspinal soft tissue.

Objective: To evaluate the efficacy and safety of steroids-free immunosuppressive therapy including tacrolimus, cyclosporin A, tripterygium glycosides or intravenous cyclophosphamide in membranous nephropathy (MN) patients combined with type 2 diabetes mellitus (T2DM). Methods: This study was a retrospective analysis of patients with T2DM complicated with biopsy proved MN in the First Affiliated Hospital, College of Medicine, Zhejiang University from January 2009 to January 2017. The patients were divided into steroids-free group and control group. The patients in steroids-free group were treated with one or two immunosuppressive agents except glucocorticoids. The patients in control group were treated with glucocorticoid combining with immunosuppressive agents. Results: A total of 64 patients were enrolled in this study. There were 26 cases in steroids-free group and 38 cases in control group. The total remission rate was 69.24% in steroids-free group and 73.68% in control group at 12 months. In a median follow up of 33(12-106) months, two patients in control group entered hemodialysis and one of them died after 1 year of dialysis. One patient in steroids-free group died of accidental death and no patient entered dialysis. All patients in control group had elevated blood glucose level, whereas only 5 patients in steroids-free group had elevated blood glucose and all these 5 patients used tacrolimus. Conclusion Immunosuppressive regimen without glucocorticoid treatment can reduce side effects on blood glucose level in MN patients with type 2 diabetes, with a certain rate of treatment response.

Objective: To explore the factors affecting the prognosis of children with status epilepticus(SE). Methods: A retrospective review was performed on children and the outcomes were measured by Glasgow Outcome Score (GOS). GOS=5 was defined as a good outcome, and GOS<5 as a bad outcome. Results: (1)Two hundred and ninety-eight children (163 girls and 135 boys) with SE were enrolled.The ages of the patients ranged from 2 months and 7 days to 14 years and 5 months, and 106 cases were at 1-3 years old.There were 154 cases (51.68%) with previous history of convulsion, including 98 cases of epilepsy (63.63%) and 241 new onset SE (80.87%). The most common cause of SE in children was febrile seizure (92 cases, accounting for 30.87%), followed by long-term symptom (81 cases, accounting for 27.18%). A total of 109 cases (41.90%) were treated with Diazepam in time after the convulsion, and 151 cases (58.10%) were treated with antiepileptic drugs such as Phenobarbital sodium or Chloral hydrate after the convulsion.Based on GOS scale, the near-term prognosis was as follows: 254 cases(85.23%) of children with GOS=5, and the remaining 44 cases of GOS<5 points.(2) Recent overall prognostic factors: single factor analysis showed that a total of 12 factors were associated with poor prognosis (P<0.05), including age, Pediatric Intensive Care Unit (PICU), tracheal intubation, previous history of convulsions, developmental delay, new onset of SE, fever, comprehensive onset, refractory SE, electroencephalogram (EEG) abnormality, neuroimaging abnormality and etiology.Multiple factor Logistic regression analysis showed that PICU monitoring was required (OR=4.306, 95%CI: 1.554-11.933, P=0.005), developmental delay (OR=3.054, 95%CI: 1.157-8.066, P=0.024), and abnormal cranial image (OR=2.110, 95%CI: 1.121-3.970, P=0.021) was an independent risk factors for short-term poor prognosis.Comprehensive onset (OR=0.330, 95%CI: 0.139-0.782; P=0.012), and the cause of febrile convulsion (OR=0.688, 95%CI: 0.480-0.987, P=0.042) were prognostic non-risk factor.(3)Recent prognostic factors in PICU monitoring group: the hospitalization time of PICU, developmental delay, the atypical attack type, electroencephalogram abnormality, neuroimaging abnormality, and the etiology of these 6 factors were correlated with the prognosis of PICU group, among which prolonged PICU (OR=36.912, 95%CI: 5.165-263.787, P=0.000) and developmental delay (OR=14.403, 95%CI: 1.725-120.273, P=0.014) were independent risk factors for poor outcome of PICU monitoring group. Conclusions PICU monitoring, developmental backwardness and abnormal head image are the independent risk factors for poor prognosis.PICU residence time and developmental delay are the independent risk factors for poor short-term prognosis in PICU enrolled children.

Objective: To investigage the three-dimensional changes in condylar position after bilateral sagittal split ramus osteotomy (BSSRO) in skeletal class Ⅲpatients with mandibular deviation using cone-beam CT (CBCT). Methods: Twenty-five skeletal class Ⅲ patients with mandibular deviation were included. The patients (12 males and 13 females, aged 19-25 years, average age 22.4 years) were treated in the Department of Orthodontics, Affiliated Stomatological Hospital, Nanchang University from October 2013 to March 2017. The patients were divided into T1, T2 and T3 groups (T1 group: CBCT taken within 1 week before operation; T2 group: CBCT taken within 1 week after operation; T3 group: CBCT taken 6-8 months after surgery). Three sets of image data of condyles on both sides (deviation side and contralateral side) were obtained. After the DICOM data collection, the software of Mimics 17.0 was used to perform three-dimensional reconstruction and condylar position measurements: the distance from the condylar top (CoT) to the standard horizontal plane (SHP), the middle sagittal plane (MSP) and the sella coronal plane (SCP) (CoT-SHP, CoT-MSP, CoT-SCP); the distance from the condylar center (CoC) to SHP, MSP and SCP (CoC-SHP, CoC-MSP, CoC-SCP); the angle from the condyle cella plane (CCP) to SHP, MSP and SCP (CCP-SHP, CCP-MSP, CCP-SCP); the angle from the condyle sagittal plane (CSP) to SHP, MSP and SCP (CSP-SHP, CSP-MSP, CSP-SCP) and the distance of the anterior, superior, posterior, medial, central and lateral joint space. One-way ANOVA and LSD-t test were used to compare the changes in condylar position at different periods (T1, T2, and T3). Results: Within 1 week before operation on the deviation side, CoT-SHP [(2.5±1.3) mm], CSP-MSP (41.2°±8.4°) and the posterior joint space [(2.0±0.6) mm] were obviously increased (P<0.05), and CoT-SCP [(9.1±3.3) mm], CCP-MSP (78.2°±5.2°) were decreased significantly (P<0.05); on the contralateral side, CoT-MSP [(50.4±3.1) mm], CCP-MSP (80.6°±6.0°), the anterior joint space [(2.2±0.6) mm] and the medial joint space [(2.6±0.6) mm] were obviously increased (P<0.05), and CCP-SCP (11.4°±8.8°) were decreased significantly (P<0.05). Six to eight months after surgery, CoT-SHP [(2.2±1.0) mm] and the posterior joint space [(1.9±0.5) mm] on deviation side and CoT-SCP [(8.4±2.8) mm] on the contralateral side were increased significantly (P<0.05). No significant difference was found in other measurements (P>0.05). Conclusions The condylar position in skeletal class Ⅲ patients with mandibular deviation was asymmetrical. Within 1 week after the operation of BSSRO, the condyle on the deviation side was moved forward, downward and inward. Meanwhile, the condyle on the contralateral side was moved backward and outward. Six to eight months after surgery, the condylar position on both sides was gradually restored to the pre-operative condylar position.

Objective: To introduce a method for calibrating the conversion from CT Hounsfield units (HU) to relative stopping power (RSP) for proton therapy, and improve the precision of the conversion in the region for adipose tissues. Methods: The HU and RSP values of human tissues were calculated by a stoichiometric calibration method. Animal tissue was used to simulate subcutaneous adipose tissue of patients, and the HU and RSP of the animal tissue were measured. The effect of subcutaneous adipose tissue on conversion between HU and RSP were analyzed by piecewise fitting. Results: The precision of conversion curve was improved significantly with the measured HU and RSP of adipose tissue in the fitting. The effect caused by different choice in different ionization energy was less than 0.6%, and the effect of proton energy differential was less than 0.8%. Conclusions The precision of conversion curve for the transformation of HU into RSP in adipose tissues could be improved by taking subcutaneous adipose tissue into account, which would reduce the range error of proton beams when such tissues are present in the target volumes or in the beam path.

Objective: To investigate the association between the home blood pressure (BP) and morality in peritoneal dialysis (PD). Methods: PD patients from the First Affiliated Hospital of Zhejiang University from January 1, 2008 to June 30, 2016 were studied. Over the first 6 months PD therapy, systolic SB (SBP) and diastolic BP (DBP) averaged as 5 (<120 to≥150 mmHg in 10 mmHg increments) and 4 (<70 to≥90 mmHg in 10 mmHg increments) categories, respectively, as well as continuous measures. All-cause and cardiovascular mortality were assessed by using Cox regression models adjusted for demographics, laboratory measurements, comorbid conditions and antihypertensive medications. The relationships between home BP and all-cause and cardiovascular mortality were assessed by restricted cubic spline regression model. Results: A total of 1663 PD patients were included with a median follow-up of 29.9 months, in which 737 patients (44.3%) were female. The SBP and DBP were (135.2±15.8) mmHg and (83.1±10.5) mmHg, respectively. Two hundred and twenty-one PD patients died during the study period, of which 102 patients (46.2%) died of cardiac-cerebral vascular events. With 130≤SBP<140 mmHg as a refernece, SBP≥150 mmHg (HR=1.83, 95%CI 1.19-2.82, P=0.005) and SBP<120 mmHg (HR=2.05, 95%CI 1.29-3.27, P<0.001) were associated with significantly higher risks of all-cause morality, but not cardiovascular morality. With 80≤DBP<90 mmHg as a refernece, patients with DBP≥90 mmHg exhibited significantly higher risks of all-cause mortality (HR=1.80, 95%CI 1.21-2.68, P=0.009). SBP presented a U-shaped association with all-cause mortality. DBP presented a J-shaped association with all-cause mortality. Conclusions Higher SBP, lower SBP and higher DBP are associated with higher risks of all-cause mortality in PD patients. However, neither SBP nor DBP is observed statistically significant relationship with the risk of cardiovascular mortality. Further prospective and randomized clinical trials are needed to determine the optimal BP targets and improve the management of hypertension in PD patients.