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简介：AbstractBackground:Minimal change nephropathy (MCD) is a common pathological type of nephrotic syndrome and is often associated with acute kidney injury (AKI). This study aimed to investigate the clinical characteristics and related factors of AKI in patients with MCD and nephrotic syndrome.Methods:Patients from Chinese People’s Liberation Army General Hospital who were diagnosed with pathological renal MCD with clinical manifestations of nephrotic syndrome were included from January 1, 2013 to December 31, 2017. Patients diagnosed with membranous nephropathy (MN) by renal biopsy from January 1, 2013 to December 31, 2017 are included as a control population. We retrospectively analyzed the clinical and pathological characteristics of patients as well as the percentages and clinical characteristics of AKI in different age groups. We assessed the correlation of pathological characteristics with serum creatinine using multivariate linear regression analysis.Results:A total of 367 patients with MCD were included in the analysis, with a sex ratio of 1.46: 1 (male: female) and an age range of 6 to 77 years. Among all the patients, 109 developed AKI (29.7%), and of these patients, 85 were male (78.0%). In the 586 patients with MN, 27 (4.6%) patients developed AKI. The percentage of AKI in MCD patients was significantly higher than that in MN patients (χ2 = 41.063, P < 0.001). The percentage of AKI increased with age in the MCD patients. The percentage of AKI in patients aged 50 years or older was 52.9% (46/87), which was significantly higher than that [22.5% (63/280)] in patients under 50 years (χ2 = 6.347, P = 0.013). We observed statistically significant differences in age (43 [27, 59] years vs. 28 [20, 44] years, Z = 5.487, P < 0.001), male (78.0% vs. 51.4%, χ2 = 22.470, P < 0.001), serum albumin (19.9 ± 6.1 g/L vs. 21.5 ± 5.7 g/L, t = 2.376, P = 0.018), serum creatinine (129.5 [105.7, 171.1] μmol/L vs. 69.7 [57.7, 81.9] μmol/L, Z = 14.190, P < 0.001), serum urea (10.1 [6.2, 15.8] mmol/L vs. 4.7 [3.6, 6.4] mmol/L, Z = 10.545, P < 0.001), IgE (266.0 [86.7, 963.0] IU/ml vs. 142.0 [35.3, 516.5] IU/ml, Z = 2.742, P = 0.007), history of diabetes (6.4% vs. 1.2%, P = 0.009), and history of hypertension (23.9% vs. 5.1%, χ2 = 28.238, P < 0.001) between the AKI group and the non-AKI group. According to multivariate linear regression analysis, among the renal pathological features analyzed, renal tubular epithelial cell damage (β = 178.010, 95% CI: 147.888-208.132, P < 0.001) and renal interstitial edema (β = 28.833, 95% CI: 11.966-45.700, P = 0.001) correlated with serum creatinine values.Conclusions:The percentage of AKI in MCD patients is significantly higher than that in MN patients. Patients over 50 years old are more likely to develop AKI. Renal tubular epithelial cell injury and renal interstitial edema may be the main pathological lesions that are associated with elevated serum creatinine in patients with MCD.

简介：AbstractBackground:Postural tachycardia syndrome (POTS) is a common childhood disease that seriously affects the patient’s physical and mental health. This study aimed to investigate whether pre-treatment baseline left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) values were associated with symptom improvement after metoprolol therapy for children and adolescents with POTS.Methods:This retrospective study evaluated 51 children and adolescents with POTS who received metoprolol therapy at the Peking University First Hospital between November 2010 and July 2019. All patients had completed a standing test or basic head-up tilt test and cardiac echocardiography before treatment. Treatment response was evaluated 3 months after starting metoprolol therapy. The pre-treatment baseline LVEF and LVFS values were evaluated for correlations with decreases in the symptom score after treatment (ΔSS). Multivariable analysis was performed using factors with a P value of <0.100 in the univariate analyses and the demographic characteristics.Results:A comparison of responders and non-responders revealed no significant differences in demographic, hemodynamic characteristics, and urine specific gravity (all P > 0.050). However, responders had significantly higher baseline LVEF (71.09% ± 4.44% vs. 67.17% ± 4.88%, t = -2.789, P = 0.008) and LVFS values (40.00 [38.00, 42.00]% vs. 36.79% ± 4.11%, Z = -2.542, P = 0.010) than the non-responders. The baseline LVEF and LVFS were positively correlated with ΔSS (r = 0.378, P = 0.006; r = 0.363, P = 0.009), respectively. Logistic regression analysis revealed that LVEF was independently associated with the response to metoprolol therapy in children and adolescents with POTS (odds ratio: 1.201, 95% confidence interval: 1.039-1.387, P = 0.013).Conclusions:Pre-treatment baseline LVEF was associated with symptom improvement after metoprolol treatment for children and adolescents with POTS.

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简介：目的：观察电针对慢性疲劳大鼠模型下丘脑、垂体、肾上腺指数及下丘脑促肾上腺皮质激素释放激素（CRH）mRNA表达的影响，从神经内分泌角度探讨电针治疗慢性疲劳综合征（CFS）的作用机制。方法：模型组与电针组采用强制性冷水游泳的方法制作CFS大鼠模型，电针组在造模的同时在百会、足三里穴给予电针治疗。通过行为学检测对模型进行判定；采用称量法计算下丘脑、垂体、肾上腺指数；荧光定量聚合酶链反应法检测cRHmRNA含量。结果：模型组大鼠行为出现改变，产生了心理和躯体的疲劳状态。CFS大鼠下丘脑、垂体、肾上腺指数升高，下丘脑CRHmRNA的表达上升，经电针治疗后，其心理和躯体疲劳状态明显改善，肾上腺指数降低，下丘脑CRHmRNA的表达下降。结论：CFS与下丘脑、垂体、肾上腺指数及下丘脑CRHmRNA表达上调关系密切。电针可能通过下调体内下丘脑cRHmRNA的表达及降低肾上腺指数，以纠正异常的HPA轴功能来治疗CFS。

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简介：Inordertoelucidatethemolecularandimmunologicalmechanismsaswellasthepathogenesisofhemorrhagicfeverwithrenalsyndrome(HFRS),theCD8^+cytotoxicTlymphecytes(CTL)clonewasestablisheddirectlyfromperipheralbloodmononuclearcells(PBMC)ofpatientswithHFRS.TheactivitiesofCTLweredetectedasusualwithEBV-transformedlymphoblastoidcellline(BLCL)astargetcells.TheresultsshowedthattheCTLclonecouldrecognizedandkilledthetargetcellswithspecificityofnucleocapsidproteinofHantaanvirus(HTNVNP)withthecytotoxicitypercentagesof50.2%,25.4%and39.0%respectively.TheseresultsdemonstratedthattheantigenicepitopesofHTNVNPmainlylocatedontheC-temainaloftheviralnucleocapsidprotein.

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简介：AbstractBackground:C-arm-based flat-panel detector cone-beam computed tomography (CBCT) venography has never been used in the management of iliac vein compression syndrome (IVCS). This study aimed to determine the technical feasibility and safety of CBCT venography in the diagnosis of IVCS compared with conventional venography (CV).Methods:Twenty patients with clinical manifestations of lower extremity venous insufficiency were prospectively enrolled between May 2018 and December 2018. Each patient underwent both CV and CBCT venography. The feasibility and safety of CBCT venography were assessed by technical success rate and complication rate. The relationships between the clinical indexes and the results of CBCT venography and CV were analyzed with correlation analysis. The consistency of the diagnosis of IVCS using each modality was analyzed by the kappa test.Results:The technical success rate was 100% for CBCT venography and for CV, without any complications. Compared with CV, CBCT venography was able to show more details of adjacent tissues which might be helpful for making etiological diagnosis. The stenosis rate under CBCT venography had excellent consistency with that under CV (kappa= 0.78, Chi-square test). The stenosis rate under CBCT venography was positively correlated with the presence of collateral veins (odds ratio 1.12, 95% confidence interval: [1.00, 1.26], P= 0.049), while the stenosis rate under CV was not. Unexpectedly, only one patient had a venous pressure gradient of more than 2 mmHg (1 mmHg = 0.133 kPa).Conclusions:For the diagnosis of IVCS, C-arm-based CBCT venography was technically feasible, with good safety. The presence of collateral veins on CBCT was clinically significant. A C-arm fluoroscopy-based technique that combines CV and CBCT might be a promising protocol for the management of IVCS during a single session.

简介：BackgroundInpatientswithacutecoronarysyndrome(ACS),loweradmissionsystolicbloodpressure(SBP)levelsinferaworseprognosis.However,thepredictivepotentialofadmissionSBPon1-yearmortalityhasnotfullyelucidatedinpatientswithnon-ST-segmentelevationACS(NSTEACS).MethodsWeenrolled1325patientstoinvestigatetheassociationbetweenadmissionSBPinpatientshospitalizedforNSTEACS.WeanalyzedtheassociationbetweenadmissionSBPand1-yearmortality.AdmissionSBPwascategorizedaslow(<110mmHg),normal(110-140mmHg),high(141-160mmHg),andveryhigh(>160mmHg).ResultsComparedwithpatientswithnormaladmissionSBP,thosewithlowSBPhadasignificantlyincreasedhazardratios(HRs)for1-yearmortalityof3.03(P<0.05),whilepatientswithhighandveryhighadmissionSBPhadnosignificantlyincreasedHRsfor1-yearmortality.ConclusionLowadmissionSBP,butnotelevatedadmissionSBP,isastrongindependentpredictorof1-yearmortalityinpatientswithNSTEACS.

简介：Purpose:Arandomized,controlledtrialwasconductedtodeterminewhethera6-weeklowcaloriedietandaerobicexerciseinterventioncouldaltermetabolicsyndrome(MetS)riskfactorsinpre-pubescentobeseChinesechildren.Methods:Thesubjectswererandomizedintodietandexercise(DE)andcontrol(C)groups.TheDEgroupingested1600-2000kcal/dayadjustedtoeachparticipant’sbasalmetabolicrate,andengagedinhigh-volumeaerobicexercise(6days/week,twicedaily,for3hpersession)for6weeks.Atotalof215obesechildrenbetweentheagesof11and13yearswererecruitedintothestudy,with167subjects(DE,n=95;C,n=72)completingallphases.Pre-andpost-studymeasuresincludedbodyweight,bodymassindex,waistcircumference,bodyfatpercentage,bloodpressureandotherMetS-relatedmarkersfromfastingbloodsamples(serumcholesterol,triglycerides,insulin,andglucose).Results:Comparedtocontrols,theDEsubjectsexperiencedsignificantlyreducedlevelsforalloutcomemarkers(p<0.05),exceptforfastingbloodglucoseinboys(p=0.09).Conclusion:Anintensive,6-weekdietandexerciseinterventionhadfavorableeffectsinalteringMetSriskfactorsinobeseChinesechildrenaged11to13.

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简介：AbstractBackground:With the ongoing worldwide coronavirus disease 2019 (COVID-19) pandemic, an increasing number of viral variants are being identified, which poses a challenge for nucleic acid-based diagnostic tests. Rapid tests, such as real-time reverse transcription-polymerase chain reaction (rRT-PCR), play an important role in monitoring COVID-19 infection and controlling its spread. However, the changes in the genotypes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants may result in decreased sensitivity of the rRT-PCR assay and it is necessary to monitor the mutations in primers and probes of SARS-CoV-2 detection over time.Methods:We developed two rRT-PCR assays to detect the RNA-dependent RNA polymerase (RdRp) and nucleocapsid (N) genes of SARS-CoV-2. We evaluated these assays together with our previously published assays targeting the ORF1ab and N genes for the detection and confirmation of SARS-CoV-2 and its variants of concern (VOCs). In addition, we also developed two rRT-PCR assays (S484K and S501Y) targeting the spike gene, which when combined with the open reading frames (ORF)1ab assay, respectively, to form duplex rRT-PCR assays, were able to detect SARS-CoV-2 VOCs (lineages B.1.351 and B.1.1.7).Results:Using a SARS-CoV-2 stock with predetermined genomic copies as a standard, the detection limit of both assays targeting RdRp and N was five copies/reaction. Furthermore, no cross-reactions with six others human CoVs (229E, OC43, NL63, HKU1, severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus) were observed using these assays. In addition, the S484K and S501Y assays were combined with the ORF1ab assay, respectively.Conclusions:Four rRT-PCR assays (RdRp, N, S484K, and S501Y) were used to detect SARS-CoV-2 variants, and these assays were shown to be effective in screening for multiple virus strains.

简介：AbstractA significant number of SARS-CoV-2 (COVID-19) pandemic patients have developed chronic symptoms lasting weeks or months which are very similar to those described for myalgic encephalomyelitis/chronic fatigue syndrome. This study reviews the current literature and understanding of the role that mitochondria, oxidative stress and antioxidants may play in the understanding of the pathophysiology and treatment of chronic fatigue. It describes what is known about the dysfunctional pathways which can develop in mitochondria and their relationship to chronic fatigue. It also reviews what is known about oxidative stress and how this can be related to the pathophysiology of fatigue, as well as examining the potential for specific therapy directed at mitochondria for the treatment of chronic fatigue in the form of antioxidants. This study identifies areas which require urgent, further research in order to fully elucidate the clinical and therapeutic potential of these approaches.

简介：AbstractObjective:To review the literature on long-term neurodevelopmental outcome after fetoscopic laser surgery for twin-twin transfusion syndrome (TTTS).Methods:A literature search in PubMed, Embase, Emcare, Web of Science, Cochrane library, and Academic Search Premier was performed. Inclusion criteria were studies between 2009 and 2019 in TTTS-survivors treated with fetoscopic laser surgery and followed-up after the neonatal period with cognitive developmental tests and neurologic exams. Exclusion criteria were non-English articles and reviews, case reports, letters, and guidelines.Results:Nineteen articles were included. Long-term severe neurodevelopmental impairment (NDI) was reported by seven and ranged from 4.0% to 18.0% with a mean of 9.7% (95% confidence interval (CI): 7.8-11.5). The prevalence of cerebral palsy ranged from 1.6% to 18.2%, with a mean of 5.1% (95% CI: 4.1-6.2). The mean prevalence of minor impairment was 13.7% (95% CI: 11.4-16.0). However, only 78.9% (15/19) studies used a validated neurodevelopmental test. As studies lack uniform definitions of primary outcome, timing of follow-up, inclusion criteria, and methods, adequate comparison is hampered.Conclusion:The prevalence of severe NDI and cerebral palsy after fetoscopic laser surgery for TTTS in the last decade remains stable around 9.7% and 5.1%, respectively. International agreements on primary outcomes, methods, and follow-up are necessary to improve the knowledge of NDI in TTTS-survivors.

简介：BackgroundNon-ST-segmentelevationacutecoronarysyndrome(NSTE-ACS)isanacuteheartdiseasecausedbyincompleteocclusionofrelatedcoronaryarterieswithunstableatheroscleroticplaques.LeadaVRSTsegmentelevationandcTnIpositivearecloselycorrelatedtotheprognosisofNSTE-ACSpatients.However,therearefewstudiesapplyingthetwopredictorstoearlyriskstratificationinNSTE-ACSpatients.MethodTwohundredandfivecasesofNSTE-ACSpatientsfollowedupfor6monthsafterdischargewerereviewed.Allpatientsweredividedintofourgroups:GroupA-cTnInegativecombinedwithaVR-non-ST-segmentelevationgroup(100cases);GroupB-cTnInegativecombinedwithaVR-ST-segmentelevationgroup(31cases);GroupC-cTnIpositivecombinedwithaVR-non-ST-segmentelevationgroup(43cases);GroupD-cTnIpositivecombinedwithaVR-ST-segmentelevationgroup(31cases).Therewasnosignificantdifferenceingender,age,oldmyocardialinfarction,previousPCIhistory,hypertension,anddiabetesbetweenaVR-STelevationgroupandnoaVR-STelevationgroup.Themorbidityofleftmainorthree-vesselcoronaryarterydiseaseaswellasadversecardiovasculareventsinthefourgroupswereobservedandanalyzed.Results(i)Themorbidityofleftmainorthree-vesselcoronaryarterydiseasewashighestinGroupD(87.1%),andwasmarkedlyhigherinGroupB(41.9%)thanthatinGroupA(7%)orGroupC(9.3%);(ii)TheincidenceofadversecardiovasculareventswashighestinGroupD(77.4%),andwasmuchhigherinB(35.5%)ascomparedwiththattinGroupA(1%)orgroupC(7%).ConclusionElectrocardiographicleadaVRST-segmentelevationcombinedwithcTnIpositivehasanimportantclinicalvalueinpredictingtheprognosisofthepatientswithNSTE-ACS.