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ABSTRACT Background This study aims to investigate the spectrum and prognosis of membranous nephropathy (MN) in patients with Sjögren's syndrome (SS). Methods SS patients with biopsy-proven kidney involvement who were diagnosed at our center between April 2007 and February 2024 were retrospectively reviewed and analyzed. Results A total of 290 SS patients with kidney involvement were enrolled. The frequency of MN increased from 16.28% during the 2007–2010 period to 44.05% during the 2021–2024 period. After 2016, MN became the most common renal pathologic type, surpassing tubulointerstitial nephritis. PLA2R antibody or antigen was detected in 74 SS-MN patients, in whom 37 (50%) showed a negative result. Within the PLA2R-negative group, five out of 15 showed positivity for EXT1/EXT2 antigen and one out of eight for THSD7A antigen. Sixty-one SS patients with MN were followed up for >6 months, and 44 (72.13%) of them achieved renal complete remission (CR). Compared with PLA2R-negative patients, PLA2R-positive patients spent a longer time to achieve CR (1.46 ± 1.16 vs. 0.74 ± 0.47 years, P = .015) and had a higher rate of progression to the renal endpoint (8/32 vs. 1/29, P = .028). After adjusting for age, proteinuria, and eGFR, Cox regression analysis showed that PLA2R positivity remained a risk factor for CR [HR = 0.511, 95% CI (0.262 to 0.998), P = .049]. Conclusions MN has become the predominant renal pathologic type in SS. PLA2R-positivity testing followed by EXT1/EXT2 and THSD7A testing is recommended for SS-MN patients. Although most patients can achieve renal CR, the prognosis is usually poor in PLA2R-positive SS-MN patients. Graphical Abstract Graphical Abstract

The rapid development of the tertiary industry has made the energy consumption of public buildings grow too fast during the operation stage, which has become a key area of energy conservation and emission reduction in China’s construction industry. This study uses the Minimum Distance to Strong effective Frontier function (MinDS) and Malmquist-Luenberger (ML) index analysis methods to measure the public building carbon emission efficiency (PBCEE) of 30 provincial-level units in China’s eight economic regions from 2010 to 2019, and analyze regional differences and evolution. Then, the influencing factors of PBCEE in different regions were analyzed using the fixed-effect panel data model. The results show that: 1) China’s PBCEE is generally low, with an average efficiency value of only 0.74, and there are great differences among regions, showing the spatial characteristics of “high in the east and low in the west.” 2) Relying on the positive impact of technological progress, the PBCEE in the eight regions increased year by year, with an annual growth rate of 1.82%. 3) The influence results and degrees of various factors on PBCEE are different in different economic zones, but increasing the proportion of electricity consumption has a certain positive effect on improving PBCEE. The same influencing factor has obvious threshold characteristics for PBCEE in different regions, so the government needs to consider the actual situation of the region when formulating carbon emission reduction policies for public buildings.

This study characterizes the composition and blood components of ultramicro‐pulverized Polygonum chinense L. and Atractylodes rhizome powder (PAUP) and investigates its protective mechanisms against Escherichia coli (E. coli)‐induced liver injury in broilers. PAUP constituents and serum metabolites were profiled by ultra‐high‐performance liquid chromatography‐mass spectrometry (UPLC‐MS). Fourteen‐day‐old broilers were randomly divided into 6 groups: control, E. coli model, gentamicin, and PAUP high/medium/low‐dose groups. Broilers were infected with 1010 CFU/mL E. coli O157:H7 via intraperitoneal injection. PAUP was administered 4 h post‐E. coli infection for 7 days by gavage. Then, serum and liver samples from half of the chicks in each group were collected for further analysis. Recovery groups were analyzed after 7 additional days. UPLC‐MS identified 718 PAUP components, predominantly lipid, flavonoids, acids, and oxides. Serum metabolomics revealed 130 significantly elevated metabolites in PAUP groups, including atractylenolide I, linoleic acid, araliadiol, baicalin, gallocatechin, atractylodin, etc. PAUP normalized weight gain, reduced feed conversion ratio (FCR), and liver index in E. coli‐infected broilers. It significantly decreased bacterial load, suppressed serum AST and TBA levels, and relieved liver histopathological damage. Furthermore, PAUP restored redox balance (increased GSH activity, decreased MDA and ROS levels) via Nrf2‐HO‐1 pathway actvation (increased protein levels of Nrf2, Keap1, NQO1 and HO‐1). PAUP obviously attenuated inflammation (decreased IL‐6 and TNF‐α) through TLR4/NF‐κB inhibition. PAUP mitigates E. coli‐induced liver injury through Nrf2/HO‐1‐mediated antioxidant activation and TLR4/NF‐κB inflammatory suppression. Reduced Antibiotic residues and resistance concerns: Offers a potential natural alternative to antibiotics for combating E. coli infections in poultry. Provided safer poultry food products: By enhancing liver function, restoring weight gain, and improving feed efficiency, PAUP supports the production of healthier chickens, ultimately contributing to safer poultry food products and greater economic value for farmers.

A stable ventilation system is an essential guarantee for the efficient production and safety of underground workers. In order to solve the big changes in underground air quantity, gas accumulation, and other problems caused by mine main fans switchover. This paper proposes a non-stop switchover system of the mine main fans based on intelligent control and establishes a dynamic optimization model for the switchover process of the mine main fans. The equilibrium optimizer algorithm is improved by chaos mapping and opposition learning machine based on refraction principle to solve the model, and the simulation experiment is carried out with MATLAB. The results show that the proposed method can effectively mitigate the change of underground air quantity during the switchover process of mine main fans. In the 120 s of system operation, the change rate of underground air quantity is consistently within 0.4%, and the two mine main fans always work in the stable interval, which proves the system's high efficiency, stability and safety.

Background The KDIGO Clinical Practice Guidelines for Glomerulonephritis recommended tacrolimus as an alternative regimen for the initial therapy for Idiopathic membranous nephropathy (IMN), however, large observational studies evaluating tacrolimus treatment in IMN remains rare. Methods A total of 408 consecutive IMN patients with nephrotic syndrome who were treated with tacrolimus in Jinling Hospital were included. The effectiveness and safety of tacrolimus treatment in IMN were analyzed in this study. Results The cumulative partial or complete remission after tacrolimus therapy were 50%, 63% and 67% at 6, 12 and 24 months, respectively, and the cumulative complete remission rates were 4%, 13% and 23%, respectively. Multivariate logistic analysis showed that higher tacrolimus exposure during induction treatment, female gender, higher eGFR and no history of previous immunosuppressive therapy were independently associated with higher probability of remission. A relapse occurred in 101 of the 271 (37.3%) patients with partial or complete remission, and 18 of the 95 (18.9%) patients with complete remission. Tapering duration of tacrolimus and complete remission versus partial remission status were independent factors associated with risk of relapse. A decline in eGFR was the most frequent adverse event during tacrolimus treatment. During tacrolimus treatment, a ≥40% decrease in eGFR was observed in 43 (10.5%) patients. Conclusions Low dose tacrolimus is effective for IMN, with a total remission rate of 66% whereas with a rather high rate of relapse. However, the safety of tacrolimus treatment needs to be further validated in large randomized clinical trials.

Background Reversal of active glomerular lesions after immunosuppressive treatment in patients with IgA nephropathy (IgAN) and their association with prognosis have not been well established. Methods Sixty patients with IgAN who received repeat biopsies after immunosuppressive treatment were recruited. Reversal of renal pathological lesions was evaluated between the first and second biopsy. The end-point was defined as a 30 % reduction in estimated glomerular filtration rate (eGFR) or end-stage renal disease after the second biopsy. Results Active glomerular lesions, i.e. endocapillary hypercellularity (E), crescents (C) and necrosis (N) were markedly decreased at the second biopsy after immunosuppressive therapy (36.7 vs. 8.3 %, p < 0.001; 85.0 vs. 25.0 %, p < 0.001; and 51.7 vs. 3.3 %, p < 0.001). Patients with E, C or N at the first biopsy but reversed at the second biopsy showed significantly decreased median levels of proteinuria and hematuria. Such clinical changes were not observed in those with active lesions at both biopsies. After a median follow-up of 32 months, 25.0 % of patients reached the end-point. Repeat biopsy confirmed that only tubular atrophy/interstitial fibrosis was associated with the renal outcome. Conclusions Active glomerular lesions can be reversed by immunosuppressive treatment in patients with IgAN. The reversal is accompanied by improvement in proteinuria and hematuria. The reversal of these lesions during the disease process may explain the lack of significant correlation of these lesions with clinical outcomes in the present study as well as in previous evaluation studies of the Oxford classification of IgAN.

Background The clinicopathological characteristics, treatment response and long-term outcome of immunoglobulin (Ig)A nephropathy with minimal change disease (MCD-IgAN) are not well defined. Methods Patients with biopsy-proven MCD-IgAN from the Jinling Hospital IgA nephropathy Registry were systematically reviewed and compared with those with IgA nephropathy without minimal change disease (Non-MCD-IgAN). Results We compared data of 247 MCD-IgAN patients and 1,121 Non-MCD-IgAN patients. Compared to Non-MCD-IgAN, MCD-IgAN patients were younger,with male predominance, had higher levels of proteinuria, total cholesterol and estimated glomerular filtration rate (eGFR), lower incidence of hypertension and microhematuria, lower level of serum creatinine, and had less severe glomerular, tubulointerstitial and vascular lesions in renal pathology. In the Non-MCD-IgAN group, 157 patients (14.0 %) reached the renal endpoint and 103 patients (9.2 %) entered end-stage renal disease (ESRD). The 5-,10-, 15- and 20-year cumulative renal survival rates from ESRD, calculated by Kaplan–Meier method, were 95.0, 83.0, 72.9 and 65.4 %, respectively. In the MCD-IgAN group, no patients entered ESRD and only 4 (1.6 %) reached the renal endpoint. Patients with MCD-IgAN had a significantly better renal outcome than Non-MCD-IgAN ( p  < 0.01). At multivariate Cox analysis, proteinuria >1.0 g/day, hypertension, eGFR <60 ml/min/1.73 m 2 , hypoproteinemia and hyperuricemia were independent risk factors of renal survival for Non-MCD-IgAN patients [hazard ratio (HR) 3.43, p  < 0.001; HR 1.65, p  < 0.05; HR 2.61, p  < 0.001; HR 2.40, p  < 0.001; HR 2.27, p  < 0.001, respectively), but not for patients with MCD-IgAN. Conclusions The long-term outcome of patients with MCD-IgAN is significantly better than that of patients with Non-MCD-IgAN.

To explore the clinicopathological characteristics and outcomes of light chain deposition disease (LCDD) in a Chinese population, we retrospectively studied the clinicopathological data, treatment, and outcomes of 48 patients with biopsy-proven LCDD from a single center. Among the patients, there were 29 males and 19 females, with an average age of 51 years. The patients presented with hypertension (79.2 %), edema (60.4 %), renal insufficiency (95.8 %), anemia (93.8 %), nephrotic proteinuria (≥3.0 g/24 h) (44.4 %), and hematuria (75.0 %). Moreover, 33.3 % had hypocomplementemia of C3, and 25 % were diagnosed with multiple myeloma. Serum immunofixation electrophoresis and a serum free light chain assay showed that 26.7 and 85.4 % of patients presented with monoclonal immunoglobulin, respectively. Nodular mesangial sclerosis was identified in 83.3 % of our cases and vascular involvement was observed in 77.1 % by light microscopy. Over an average of 22 months of follow-up, the mean renal survival was 32.5 months. Of the patients, 34.1 % had stable or improved renal dysfunction, 2.3 % had worsening renal function, and 63.6 % progressed to end-stage renal disease. Of the 33 patients receiving chemotherapy, 15 patients had stable or improved renal function and the renal survival was higher in patients with hematological and renal responses than in those without. The independent predictors of ESRD by multivariate analysis were serum creatinine ( p  = 0.008) and urinary retinol binding protein (RBP) ( p  = 0.045). In conclusion, LCDD was characterized in Chinese patients by renal dysfunction, hypertension, anemia, proteinuria, abnormal free light chain ratios, and less overt hematologic malignancies. Serum creatinine and RBP were independent prognostic factors of LCDD. As better hematologic and renal responses to chemotherapy were associated with improved renal survival, there is an urgent need for multicenter and prospective studies to establish the standardized therapy for LCDD.

Background/Aims: The long-term renal outcomes of patients with IgA nephropathy (IgAN) who present with recurrent macroscopic hematuria (RMH) have not been described in previous studies. Methods: Patients with biopsy-proven primary IgAN in Jinling Hospital were divided into three groups according to different patterns of macroscopic hematuria (MH): RMH, isolated MH (IMH), and those without a history of MH (NMH). Results: A total of 1,155 patients were enrolled in the study (158 in the RMH group, 256 in the IMH group, and 741 in the NMH group). At biopsy, patients with RMH were younger, had lower median proteinuria, a lower incidence of hypertension, and a higher estimated glomerular filtration rate than those in the NMH group. Pathologically, patients with RMH had a lower level of mesangial hypercellularity and segmental glomerulosclerosis as well as less tubular atrophy than those with NMH. The demographic and clinical features of patients with IMH fell between patients with RMH and those with NMH. During a median follow-up of 7.9 years, the 5-, 10- and 20-year cumulative renal survival after biopsy, as calculated by K-M methods, were 98, 91, and 91% in the RMH group, 95, 89, and 64% in the IMH group, and 95, 79, and 57% in the NMH group. The renal survival in patients with RMH was significantly better than patients with NMH or IMH. Conclusions: The long-term prognosis of patients who present with RMH is significantly better than patients with NMH or IMH.

Background Systemic small blood vessel vasculitis (SSV) is uncommon among pediatric patients, and the predictive value of the new histopathological classification for SSV in terms of renal outcomes in these patients is unknown. Methods The study cohort comprised 38 pediatric patients and 285 adult patients with SSV who were treated in a medical center between 1993 and 2012. Results Children accounted for 11.8 % of all patients with SSV diagnosed during the study period. In contrast to the adult patients, the pediatric patients were predominantly female (73.7 vs. 51.9 %; P  < 0.05). The prevalence of skin purpura was higher and pulmonary symptoms were less common among pediatric patients than among adult ones (36.8 vs. 13.7 %, P  < 0.01 and 26.3 vs. 46.0 %, P  < 0.05, respectively). Subtype was correlated with the baseline levels of serum creatinine and treatment response among patients with SSV and was found to have a tendency to predict end-stage renal disease (ESRD) among pediatric patients (hazard ratio 2.273, P  < 0.01). The probability of progressing to ESRD was highest in pediatric patients with the sclerotic glomerulonephritis subtype, followed by the mixed, crescentic and focal glomerulonephritis subtypes (in descending order of probability) ( P  < 0.01). Conclusions Estimated histopathological classification has a prognostic value for renal outcome and response to therapy in children with SSV.