Refractory nephrotic syndrome(RNS) is a subtype of primary NS with high treatment difficulty, mainly including steroid-resistant NS and steroid-dependent/frequently relapsing NS. Traditional immunosuppressants have limited efficacy and insufficient safety, which can hardly meet current clinical demands. Anti-CD20 monoclonal antibody(anti-CD20McAb) has shown outstanding performance in the treatment of RNS due to its targeting specificity. This review focuses on anti-CD20McAb drugs, including rituximab, ofatumumab, and obinutuzumab, analyzes their related mechanisms of action, as well as the clinical efficacy and differences among common pathological types of RNS, to provide a reference for clinical practice.

Nephrotic syndrome(NS) is a group of clinical syndromes characterized by massive proteinuria and complicated pathogenesis, and its treatment strategies urgently require a breakthrough. In recent years, abnormal activation of the complement system has been confirmed as a key link leading to damage to the glomerular filtration barrier, and targeted therapy against specific complement components has become a cutting-edge research direction in nephrology. This review focuses on the core role of complement component 5a and its receptor axis, mannan-binding lectin serine protease 2 of the lectin pathway, and the alternative pathway in driving NS progression, summarizes the clinical advances of related pathway inhibitors, and discusses their therapeutic potential, the available evidence, and future research directions.

Objective To investigate the effect and mechanism of lysine demethylase 5B(KDM 5B) on the biological function of acute myeloid leukemia(AML) cells. Methods Peripheral blood and bone marrow samples were collected from 23 AML patients and 20 healthy donors, and the expression levels of KDM5B were compared. The AML cells HL- 60 were transfected with KDM5B short hairpin RNA (shRNA)(sh-KDM5B), overexpression vector(KDM5B), cathepsin F shRNA(sh-CTSF) and overexpression vector(CTSF), as well as B-cell lymphoma-2 shRNA(sh-BCL-2). Chromatin Immunoprecipitation(ChIP) was employed to analyze the binding of KDM5B to the promoter region of CTSF, while Coimmunoprecipitation (CoIP) was used to investigate the interaction between CTSF and BCL-2 proteins. The CCK-8 assay and Transwell experiment were used to detect the proliferation and invasion abilities of the cells, while flow cytometry was employed to analyze the number of apoptotic cells. Results The expression of KDM5B in the peripheral blood and bone marrow samples of AML patients was significantly higher than that in healthy donors(P＜0.01). The expression of KDM5B in AML cells(HL-60, ML-1) was significantly higher than that in human bone marrow cells HS-27A(P＜0.01). Silencing KDM5B significantly inhibited the proliferation and invasion of AML cells and induced cell apoptosis(P＜ 0.01). KDM5B bound to the promoter of CTSF and upregulated the expression of CTSF. The upregulated CTSF then interacted with BCL-2 protein to inhibit its protein expression. Silencing CTSF inhibited cell proliferation and invasion, and induced cell apoptosis(P＜0.01). Silencing BCL-2 can counteract the effects of CTSF silencing on AML cells(P＜ 0.05). Conclusion KDM5B is significantly upregulated in AML. Its overexpression promotes the proliferation and invasion of AML cells and inhibits cell apoptosis by upregulating the expression of CTSF and inhibiting the expression of BCL-2.

Objective To investigate the effect of Xiangsha Liujunzi decoction combined with tegoprazan on gastrointestinal dynamics in patients with reflux esophagitis(RE). Methods A total of 100 RE patients admitted in Linquan county people's hospital from February 2023 to March 2025 were selected and divided into the control group and the observation group by simple random sorting method, with 50 cases in each group. The control group was treated with mosapride citrate capsules combined with tegoprazan, while the observation group was treated with Xiangsha Liujunzi decoction combined with tegoprazan. Both groups were treated for 8 weeks. The efficacy, gastrointestinal motility indexes, inflammatory indexes, and scores of the Reflux Disease Questionnaire(RDQ) and Gastroesophageal Reflux Disease Qu estionnaire(GerdQ) were compared between the two groups. Results After treatment, the total effective rate of the observation group was higher than that of the control group(90.00% vs. 82.00%). After treatment, the gastrointestinal motility indexes and inflammatory indexes of both groups were improved compared with those before treatment(P＜ 0.05), and the levels of gastrin, motilin, cholecystokinin, tumor necrosis factor-α, interleukin-6, interleukin-17 and gastric emptying time in the observation group were better than those in the control group(P＜0.05). The reflux symptoms of both groups were improved compared with those before treatment, and the scores of RDQ and GerdQ in the observation group were lower than those in the control group(P＜0.05). There was no significant difference in the incidence of c omplications between the two groups(P＞0.05). Conclusion Xiangsha Liujunzi decoction combined with tegoprazan can effectively promote the recovery of gastrointestinal motility, relieve clinical symptoms and reduce inflammatory response in RE patients, with significant curative effect.

Objective To investigate the preventive effect of low-dose esketamine on catheter-related bladder discomfort(CRBD) in patients during anesthesia recovery period. Methods A total of 300 patients with benign prostatic hyperplasia admitted to our hospital from June 2021 to December 2024 were prospectively selected as the research subjects. The patients were divided into the control group and the observation group using simple sorting random method, with 150 patients in each group. The control group was intravenously injected with an equal volume of 0.9% sodium chloride solution after anesthesia induction, while the observation group was intravenously injected with a low dose of esketamine(0.25mg/kg). All included patients underwent transurethral prostatectomy treatment.The indicators related to CRBD and postoperative pain control were recorded. The secondary observation indicators included multiple dimensions such as perioperative rehabilitation and monitoring, drug safety, biological parameters, and long-term follow-up of urinary function. Results The indicators related to CRBD, postoperative pain control and early rehabilitation, as well as the levels of neurotransmitters(such as substance P and acetylcholine) at 1 hour and 24 hours after extubation, and inflammatory factors(such as interleukin-6 and tumor necrosis factor-α)and the urinary function indicators(such as international prostate symptom score, residual urine volume, and maximum urine flow rate) at 1 month and 3 months after surgery in the observation group were all better than those in the control group(P＜0.05), while there were no statistically significant differences in the operation time, bladder capacity at 24 hours after surgery, and the incidence of adverse drug reactions between the two groups(P＞0.05). Conclusion Low-dose esketamine can effectively reduce the incidence and severity of CRBD in patients undergoing transurethral prostatectomy during the anesthesia recovery period, optimize postoperative pain control and early rehabilitation indicators, regulate neurotransmitter and inflammatory factor levels, and does not increase adverse drug reactions, and facilitate the recovery of bladder function after surgery.

Objective To investigate the efficacy of repetitive transcranial magnetic stimulation(rTMS) at different sites combined with escitalopram oxalate in patients with post-stroke depression(PSD). Methods The PSD patients admitted to the Affiliated Hospital of Shandong Second Medical University from June 2023 to March 2025 were selected as the research subjects. All subjects received treatment with escitalopram oxalate. They were divided into four groups by simple random sorting method: the drug group(group A), the left magnetic stimulation group[group B, highfrequency rTMS targeting the dorsolateral prefrontal cortex(DLPFC) on the left side], the right magnetic stimulation group(group C, low-frequency rTMS targeting the DLPFC on the right side), and the bilateral magnetic stimulation group (group D, bilateral rTMS), 31 patients in each group. All patients were treated continuously for 4 weeks. The scores of the Patient Health Questionnaire(PHQ)-9, the National Institutes of Health Stroke Scale(NIHSS), and Hamilton Depression Rating Scale 17-item(HAMD-17) were statistically analyzed before and after treatment. The levels of serum neuroendocrine-related markers[S100 calcium binding protein B subunit(S100β), 5-hydroxytryptamine(5-HT), neuronspecific enolase(NSE)], inflammatory factors[tumor necrosis factor(TNF)-α, interleukin(IL)-1β, IL-6], and sleep electroencephalogram parameters[sleep latency(SL), total sleep time(TST), sleep efficiency] were compared before and after treatment. Results During the study period, some patients were excluded due to various reasons. Ultimately, 30 cases remained in group A, 29 cases in group B, 30 cases in group C, and 30 cases in group D. After treatment, the NIHSS, PHQ-9 and HAMD-17 scores, levels of S100β, NSE, IL-1β, TNF-α, and IL-6 in group D were lower than those of the other three groups, and group B and group C were lower than group A. The levels of 5-HT, TST, and sleep efficiency in the serum of group D were higher than those in the other three groups, and the levels in groups B and C were higher than those in group A. The serum IL-1β level in group B was lower than that in group C, and the serum TNF-α level in group C was lower than that in group B. The SL in group D was shorter than that of the other three groups, and the SL in groups B and C was shorter than that in group A. All of the above differences were statistically significant(P＜0.05). Conclusion The combined treatment regimen of bilateral rTMS and escitalopram oxalate applied to patients with PSD can regulate neural functions and inflammatory factors, reduce depression levels, and improve neurological function and sleep quality.

Objective To investigate the effects of amlodipine besylate tablets combined with anti-tuberculosis drugs on clinical symptoms and blood pressure level in patients with pulmonary tuberculosis complicated with hypertension. Methods A total of 152 patients with pulmonary tuberculosis combined with hypertension admitted to our hospital from March 2021 to March 2024 were enrolled. The patients were divided into the control group and the observation group by simple sorting random method, with 76 cases in each group. On the basis of conventional quadruple anti-tuberculosis treatment, the control group was treated with nifedipine extended-release tablets, and the observation group was treated with amlodipine besylate tablets, both groups continued treatment for 2 months. Blood pressure, vascular endothelial cell factors, and renal function indexes were compared between the two groups before and after treatment. Improvement of patients' clinical symptoms, degree of lesion absorption were evaluated. The blood pressure compliance and blood pressure reduction were analyzed in patients with different grades of hypertension and degrees of pulmonary tuberculosis. Results The effective rates of clinical symptom improvement in the observation group was higher than that in the control group(80.26% vs. 92.11%, P＜0.05). After treatment, the systolic and diastolic blood pressure in both groups decreased day and night compared to before treatment, and the observation group was lower than the control group(P＜0.05). Blood vessel endothelial cytokines such as nitric oxide, thrombomodulin, and endothelin, as well as renal function indicators including creatinine and urea nitrogen, all improved compared to before treatment, and the observation group was better than the control group(P＜0.05). The proportion of lesions with absorption grades 1 and 2 in the observation group were higher than those in the control group, while the proportions of grades 3 and 4 were lower(P＜0.05). There was no significant difference in the incidence of adverse reactions between the two groups(13.16% vs. 89%, P > 0.05). In the grade 2 hypertension subgroup and the severe pulmonary tuberculosis subgroup, the blood pressure control rate in the observation group was higher than that in the control group, and the reductions in both systolic and diastolic blood pressure were greater than those in the control group(P＜0.05). Conclusion Short-term treatment with amlodipine besylate tablets combined with anti-tuberculosis drugs can effectively control blood pressure levels in patients with pulmonary tuberculosis complicated with hypertension, improve the clinical symptoms, regulate the levels of vascular endothelial cytokines, with mild impairment to renal function, and has good safety. Particularly in the grade 2 hypertension subgroup and the severe pulmonary tuberculosis subgroup, the blood pressure control rate is higher and the blood pressure reduction is more significant, making it worthy of clinical application.

Objective To observe the clinical efficacy of subchondral bone combined with intra-articular injection of platelet-rich plasma(PRP) in patients with knee osteoarthritis(KOA), and its effects on the levels of proinflammatory cytokines. Methods A total of 84 patients with KOA treated in the department of orthopedics and traumatology of Shijiazhuang hospital of traditional Chinese medicine from May 2022 to May 2024 were selected as research subjects. They were divided into group A(intra-articular injection of sodium hyaluronate), group B(intra-articular injection of PRP) and group C(subchondral bone combined with intra-articular injection of PRP) by stratified block randomization method, with 28 cases in each group. Perioperative adverse reactions, Knee Injury and Osteoarthritis Outcome Score(KOOS) [including pain score and activity of daily living(ADL) score, etc.], levels of interleukin(IL)-1β, tumor necrosis factor(TNF)-α and matrix metalloproteinase(MMP)-9 were observed in the three groups. Results By the end of followup, 1 case withdrew in both group A and group B. At 6 months after surgery, the KOOS scores of all three groups were significantly better than those before surgery, with significant differences(P＜0.001). At 12 months after surgery, the KOOS score, pain score and ADL score of group C were significantly higher than those at 6 months after surgery, and also higher than those of group A and group B, with significant differences(P＜0.01). At 4 weeks after surgery, the levels of IL-1β, TNF-α and MMP-9 in the three groups were significantly decreased compared with those before surgery(P＜ 0.001). At 12 months after surgery, the levels of IL-1β, TNF-α and MMP-9 in group C were significantly lower than those in group A and group B, and the differences were significant(P＜0.01). Conclusion During the 12-month follow-up period of this study, subchondral bone combined with intra-articular injection of PRP achieves ideal efficacy in improving KOOS functional score and proinflammatory cytokine levels in patients with KOA.

Objective To explore the optimal application time and method of compound lidocaine cream before facial botulinum toxin injection, so as to optimize the analgesic effect, reduce the incidence of adverse drug reactions, and improve patient treatment satisfaction. Methods A total of 140 patients who underwent facial botulinum toxin injection in the cosmetic dermatology clinic of our hospital from November 2023 to February 2024 were randomly divided into C group(60 min application of compound lidocaine cream with plastic wrap), E1 group(60 min application of compound lidocaine cream without plastic wrap), E2 group(90 min application of compound lidocaine cream without plastic wrap) and E3 group(90 min application of compound lidocaine cream with plastic wrap) according simple sequential randomization method, each group 35 cases. The Short-Form McGill Pain Questionnaire was used to evaluate pain intensity[includes pain rating index(PRI), visual analogue scale(VAS) and present pain intensity(PPI)]. Skin allergic reactions were recorded at 20 minutes after injection and before discharge. The Scoring Atopic Dermatitis was used to evaluate skin condition. Results The VAS score of E1 group was significantly lower than that of C group[(1.94±1.16)points vs. (2.77±1.33) points, P＜0.05 ] , and the PRI and PPI scores of E1 group were also better than those of other groups. E3 group had the highest incidence of skin allergic reactions(11.4%), manifested as patchy redness, pruritus and tingling. No severe allergic reactions occurred in E1 group. Conclusion The optimal application scheme of compound lidocaine cream before facial botulinum toxin injection is60-min application without plastic wrap. This scheme can ensure the analgesic effect while reducing skin adversere actions, and improve the treatment safety and patient experience.

Objective To explore the effect of live Lactobacillus as an adjuvant treatment on vaginal microecology and local immune factors in postoperative patients with cervical intraepithelial neoplasia(CIN) complicated with high-risk human papilloma virus(HR-HPV) infection. Methods A total of 126 patients with CIN complicated by HR-HPV infection who underwent surgical treatment in the department of obstetrics and gynecology of Longyou county people's hospital from March 2022 to February 2025 were retrospectively selected. According to different postoperative treatment methods, the patients were divided into the control group[treated with Baofukang suppositories combined with interferon(IFN)- α2b] and the observation group(treated with live Lactobacillus in addition to the regimen used in the control group). After propensity score matching, 54 patients were included in the control group and 54 patients in the observation group.The total effective rate of HR-HPV improvement, vaginal microecology, cervical local immune factor levels and adverse reactions were compared between the two groups at 3 months after operation, and the recurrence was observed during 6 months of postoperative follow-up. Results At 3 months after operation, the total effective rate of HR-HPV improvement in the observation group was higher than that in the control group(87.04% vs. 70.37%, P＜0.05). The vaginal pH value, bacterial density and diversity in the observation group were better than those in the control group(P＜0.05). Compared with the control group, the level of interleukin(IL)-10 in the observation group was lower, while the levels of IL-2 and IFN-γ were higher, with statistically significant differences(P＜0.05). There was no statistically significant difference in adverse reactions or postoperative recurrence rate between the two groups(P＞0.05). After 6 months of follow-up, the recurrence rate of the observation group was lower than that of the control group, but the difference was not statistically significant(3.70% vs. 11.11%, P＞0.05). Conclusion For patients with CIN complicated with HR-HPV infection, adjuvant use of live Lactobacillus after operation can improve the total effective rate of HR-HPV clearance, regulate vaginal microecological balance, enhance cervical local immune function, reduce the risk of postoperative recurrence, and has high safety.

Objective To compare and analyze the risk factors for benign and malignant endometrial lesions in patients with abnormal uterine bleeding(AUB). Methods The clinical data of 350 AUB patients treated in our hospital from January 2022 and November 2025 were retrospectively analyzed. Patients with malignant endometrial lesions were assigned to the malignant group(n＝30), those with benign endometrial lesions were assigned to the benign group(n＝ 217), and those with normal endometrium were assigned to the control group(n＝103). Clinical data of the three groups were compared, and the relevant risk factors associated with benign and malignant endometrial lesions were analyzed. Results Age, endometrial thickness, and the proportion of postmenopausal patients in the malignant group were all higher than those in the other two groups, and the above indicators in the benign group were higher than those in the control group, with all differences being statistically significant(P＜0.05). The number of patients with positive tumor markers in the malignant group was higher than that in the other two groups, and the number of diabetic patients in the malignant group and benign group was higher than that in the control group, with all differences being statistically significant(P＜ 0.05). Multivariate logistic regression analysis showed that risk factors for benign endometrial lesions included age,menopausal status, endometrial thickness, and diabetes mellitus(P＜0.05), while age, menopausal status, endometrial thickness, and positive tumor markers were risk factors for malignant endometrial lesions(P＜0.05). Conclusion There are certain differences in the risk factors for benign and malignant endometrial lesions in AUB patients. Age, menopausal status, endometrial thickness and positive tumor markers were risk factors for malignant endometrial lesions. In clinical diagnosis and treatment, early differential identification and comprehensive assessment of lesion risk should be carried out to guide the formulation of subsequent diagnosis and treatment plans.

Objective To analyze the clinical characteristics and risk factors of piperacillin-tazobactam-associated thrombocytosis. Methods The data of patients hospitalized in Inner Mongolia Autonomous Region People's Hospital who treated with piperacillin tazobactam from January 1, 2024 to December 31, 2024 were collected and divided into the thrombocytosis group and the platelet-normal group. The differences in demographic data, liver and kidney functions, coagulation functions, platelet counts, indicators of infections, and medication use of piperacillin tazobactam were compared between the two groups. Multivariate logistic regression analysis was used to identify risk factors for piperacillin-tazobactam-associated thrombocytosis. Results A total of 247 patients were included, 41 in the thrombocytosis group and 206 in the platelet normal group. Multivariate logistic regression analysis revealed that C-reactive protein(P＝ 0.024), treatment duration(P＝0.012), and baseline platelet count(P＜0.001) were independent risk factors for thrombocytosis. Conclusion C-reactive protein, duration of medication and baseline platelet count are independent risk factors for piperacillin-tazobactam-associated thrombocytosis.

Objective To explore the influencing factors of diabetic peripheral neuropathy(DPN) occurrence in patients with type 2 diabetes mellitus(T2DM) of different Chinese medical constitutions. Methods A total of 723 patients with T2DM from Longhua Hospital Affiliated to Shanghai University of Tradition Chinese Medicine from January 2022 to December 2024 were selected and divided into the DPN group and the non-DPN group according to whether they had DPN. The patients' traditional Chinese medicine constitutions were determined, and the demographic data, disease duration, body mass index(BMI), and laboratory indicators were collected. Data were analyzed using logistic regression and mediation effect analysis. Results Compared with the non-DPN group, the DPN group was older, had a longer disease duration, a lower BMI, and had a higher proportion of males(P＜0.005). The proportion of Yin deficiency constitution was higher(P＝0.045), and the proportion of phlegm-dampness constitution was lower(P＝0.022). Multivariate logistic regression analysis showed that phlegm-dampness constitution was an independent protective factor for DPN(P＝0.045, odds ratio＝0.56, 95% confidence interval: 0.31 - 0.99). Mediation analysis showed that BMI had a potential mediating effect in the negative association between phlegm-dampness constitution and DPN, with a mediating effect accounting for 25.4%(95% confidence interval: -0.5 - 126.1), while age, disease duration, and glycated hemoglobin did not show significant mediating effects. Conclusion In patients with T2DM, phlegm-damp constitution is negatively correlated with DPN. This constitution serves as a protective factor against DPN, and its protective effect may be mediated by higher BMI.

Pneumonia caused by non-tuberculous mycobacteria(NTM) has a subtle onset and is difficult to diagnose. It is more common in children with immune dysfunction or chronic lung diseases. Next-generation sequencing of alveolar lavage fluid has gradually received clinical attention in the diagnosis of NTM pneumonia, which is helpful for timely and effective diagnosis. This article analyzed the treatment process of a child with normal immune function who was infected by Mycobacterium abscessus. The clinical pharmacist, after consulting relevant literature and discussing with the clinical doctor, prescribed treatment regimen including azithromycin, imipenem/cilastatin, cefoxitin, and tigecycline. After two months of treatment, the child's clinical symptoms improved and the lung lesions also showed improvement. After discharge, the patient was continued to receive treatment with azithromycin dry suspension, linezolid tablets and moxifloxacin tablets. The combined treatment lasted for over 7 months. Since then, there had been no recurrence during the follow-up period. Reports of lung diseases caused by Mycobacterium abscessus in children with normal immune function and under 3 months of age were rare. Clinical pharmacists were involved in the entire diagnosis and treatment process of the children. By optimizing the treatment plan and conducting safety monitoring, the therapeutic effect of the children was significantly improved. This provided an important reference for the clinical use of drugs in infants with Mycobacterium abscessus infection.

As the largest organ of the human body, the skin serves as the first physical and immune barrier against pathogen invasion, playing a crucial role in safeguarding human health. Currently, in skin research, traditional models such as animal models and two-dimensional cell models have limitations in simulating the complex structure and physiological functions of human skin, thus exhibiting significant deficiencies in the mechanism research of skin diseases and drug development. Skin organoids, as an emerging three-dimensional in vitro model, can highly recapitulate multiple cell types, layered structures, and key functions of human skin, providing a novel tool for skin research. This review summarized the construction technologies of skin organoids and their applications in disease model establishment, regenerative medicine, and wound repair, aiming to offer references for the future applications of skin organoids.

Diabetic osteoporosis(DOP) is a prevalent chronic complication of diabetes mellitus that considerably compromises patients' quality of life. In the management of DOP, Western medicine predominantly relies on hypoglycemic agents, anti-osteoporotic drugs, and lifestyle modifications. Traditional Chinese Medicine(TCM), in contrast, follows the therapeutic principles of nourishing the liver and kidney, strengthening the spleen and Qi, promoting blood circulation, and resolving blood stasis, with a primary emphasis on reinforcing vital energy(strengthening healthy Qi), supplemented by syndrome differentiation and individualized treatment based on specific clinical manifestations. The integrated application of Western and TCM therapies can harness their complementary strengths, thereby enhancing overall therapeutic efficacy. This paper systematically reviews recent advances in the treatment of DOP using Western medicine, TCM, and their combination, aiming to provide a valuable reference for clinical practice.

Sicca syndrome is a systemic autoimmune disease characterized by the involvement of exocrine glands. Its main symptoms include dry eyes and dry mouth. Iramud is a small molecule antirheumatic drug with multi-target anti-inflammatory and immunomodulatory effects. This article briefly introduces the disease characteristics and current treatment overview of sicca syndrome, and focuses on reviewing the mechanism of action, clinical efficacy and safety research progress of ilarimod in this disease, as well as its future application prospects.