RA AND ANCA positive IgAN
antiaging英文作文
antiaging英文作文1. Aging is a natural process that everyone goes through. It's a part of life, and there's nothing wrong with getting older. Embracing the changes that come with age can be empowering and liberating. Instead of fighting against the inevitable, we should focus on living a healthy and fulfilling life at any age.2. Society often puts pressure on individuals to look young and stay youthful. The beauty industry bombards us with anti-aging products and treatments, promising to reverse the signs of aging. However, it's important to remember that true beauty comes from within. Taking care of our physical and mental well-being should be the priority, rather than obsessing over wrinkles and gray hair.3. It's never too late to start taking care of ourselves. Engaging in regular exercise, eating a balanced diet, and getting enough sleep are essential for maintaining a healthy body and mind. These habits can alsoslow down the aging process and improve overall well-being. It's never too late to adopt a healthy lifestyle and reap the benefits.4. Aging gracefully means embracing our experiences and wisdom. With age comes a wealth of knowledge and life lessons that can be shared with others. It's important to value the wisdom that comes with age and use it to make a positive impact on the world around us. Aging should be seen as an opportunity for growth and self-improvement.5. It's important to stay socially active as we age. Surrounding ourselves with loved ones and engaging in meaningful relationships can have a positive impact on our mental and emotional well-being. Loneliness and isolation can accelerate the aging process and lead to various health issues. Building a strong support system is crucial for a fulfilling and happy life.6. Embracing the changes that come with aging can be empowering. Accepting our physical appearance and learning to love ourselves as we are is a powerful act of self-acceptance. Instead of constantly striving for an unattainable ideal, we should focus on embracing our unique beauty and living life to the fullest.7. It's important to remember that age is just a number. Society may have certain expectations and stereotypes associated with different age groups, but it's up to us to challenge and redefine those norms. We should never let our age define us or limit our potential. It's never too lateto pursue our passions, try new things, and continuegrowing as individuals.8. In conclusion, anti-aging should not be aboutfighting against the natural process of getting older. Instead, it should be about embracing the changes, taking care of ourselves, and living a fulfilling life at any age. Aging is a privilege denied to many, and we should appreciate and celebrate the journey of growing older.。
安徽省合肥市庐阳区第六中学2025届高三下学期第五次调研考试英语试题含解析
安徽省合肥市庐阳区第六中学2025届高三下学期第五次调研考试英语试题注意事项1．考生要认真填写考场号和座位序号。
2．试题所有答案必须填涂或书写在答题卡上，在试卷上作答无效。
第一部分必须用2B 铅笔作答；第二部分必须用黑色字迹的签字笔作答。
3．考试结束后，考生须将试卷和答题卡放在桌面上，待监考员收回。
第一部分（共20小题，每小题1.5分，满分30分）1．In front of the whole audience, Premiere Li made his promise ______ the government would try its best to solve the problem of poverty in China.A．what B．whichC．whether D．that2．—I know it is really a lot to ask, but can I use your apartment during the summer?— ________. I happen to be out of town. It is all for your taking.A．Behave yourself B．Be my guestC．Have fun D．Take care3．Tom looked at Jenny, with tears _______ his eyes, and shouted out the words _______ in his heart for years. A．filling; having been hidden B．filled; hiddenC．filling; hidden D．filled; hiding4．With the development of science, more new technology ______ to the fields of IT.A．has introduced B．is being introducedC．is introduced D．was introduced5．---The prices of vegetables are going up madly. It’s really too much for us.---But for the situation where many vegetable producing areas _____ constant low temperature, things would not be like this.A．meet with B．have met withC．met with D．had met with6．The teacher came into the classroom _______ by his students.A．following B．to be following C．followed D．having followed.7．—What’s up? You look down. —I have piles of papers ________, but I type so slowly.A．to be typed B．typed C．to type D．being typed8．－The online shopkeeper has made an apology for his rude behavior.－OK. If you’re still not satisfied, you can _______ compensation.A．claim B．affordC．sacrifice D．dismiss9．Anna was in Inner Mongolia for two years, ____ as a volunteer teacher.A．having worked B．working C．worked D．to work10．What a pity! ________joined in the party, I would have met my old friend．A．lf I have B．Had I C．I had D．Have I11．The village evolved into a major e-commerce center, and _____ the past, the villagers owed their success to the reform and opening-up policy.A．reviewed B．reviewingC．to review D．being reviewed12．______ for the fire at Notre Dame de Paris, a church famous for its large collection of art treasures, I would be there for a visit this summer vacation.A．Had it not been B．Should it not beC．Were it not be D．If had it not been13．My wife sometimes _____ something she has long been looking for. That’s why she enjoys window shopping. A．looks up B．looks for C．picks up D．picks out14．Y ou can only be sure of _____ you have at present; you cannot be sure of something _____ you might get in the future.A．that; what B．what; / C．which; that D．/; that15．—Mum, I am worrying about my pet dog while we are away.—Boy, you ________. Our neighbor has offered to help us.A．can’t B．wouldn’t C．needn’t D．mustn’t16．In some countries, people eat with chopsticks, while in ________, knives and forks.A．another B．otherC．others D．the other17．Men must consider eating, drinking, clothing and finding shelter _____ they can pursue entertainment and recreation.A．until B．unlessC．before D．because18．I feel I am as well-behaved and as careful as my deskmate, but _______ I always fall behind?A．how about B．how comeC．what if D．what for19．We offered to pay our half of the cost that was needed to restore the shared doorway but Charles would have of it.A．nothing B．anythingC．none D．any20．We can communicate________people in every part of the world ________the Internet.A．with；with B．with；throughC．through；through D．through；with第二部分阅读理解（满分40分）阅读下列短文，从每题所给的A、B、C、D四个选项中，选出最佳选项。
前列腺不典型小腺泡增生
ASAP与前列腺微小癌 (m inimal volume p rostatic adeno2 carcinoma,癌占活检组织总量的 5%以下 )之间的鉴别标准 中 ,腺泡数目和病灶大小是最主要的一条 , ASAP腺泡的数目 是癌腺泡数目的 2 /3 (11、17) , ASAP病灶比癌性病灶小一半 (014 mm、018 mm ) 。核增大 、明显的核仁 、核分裂象 、腔内蓝 色黏液及并存 P IN等形态特征在前列腺微小癌中更明显 ,但 核深染及中 ～重度萎缩在 ASAP 比癌中更为常见 (分别为 44%、9%和 59%、35% ) 。 100%前列腺微小癌呈浸润性生 长 ,但浸润性的生长方式也存在于 75%的 ASAP病例中 。嗜 酸性颗粒性分泌物与类晶体在两者无明显差异 [12 ] 。
前列腺癌占男性恶性肿瘤的第 2位 ,在发达国家 ,前列 腺癌占全部恶性肿瘤的 19% ,在发展中国家为 513% [1 ] 。前 列腺穿刺活检是发现和确诊前列腺癌的重要手段 ,但穿刺标 本中经常会遇到少量不典型腺泡 ,疑似癌却又不能确定为 癌 ,这便是前列腺不典型小腺泡增生 ( atyp ical small acinar p roliferation, ASAP) 。现将 ASAP形态特征 、诊断标准 、发病 率 、临床意义以及对发现前列腺癌的预测价值等作一综述 。
1 A SA P的病理特征及应用现状
ASAP也称不典型腺体 ( atyp ia / atyp ical glands) [2 ] ,是由 Bostw ick等 [3 ]于 1993年首次提出的一个描述不典型腺样前 列腺增生的诊断术语 。4 年后这一诊断的临床意义得到首 次阐述 [4 ] 。
ASAP为不典型腺泡病变 ,表现为排列紧密的灶性增生 的小腺泡集落 。这些小腺泡被覆一层几近透明的分泌细胞 上皮 ,而基底细胞呈断片状或消失 (可经 34βE12 免疫组化 证实 ) 。组织特点为 : ①有限数量的腺体 ; ② 极少腺体出现 细胞不典型性 ,包括核增大 、核仁增大 ; ③ 组织异型 :缺乏核 异型的小腺泡杂乱无章地排列 ; ④ 腔内可见蓝色黏液 、结晶 体或粉红色蛋白样分泌物 [5 ] 。这些腺泡的结构形态和 /或细 胞形态类似于分化较好的前列腺癌 ,但数量太少 ,只是怀疑 为癌但不能明确诊断 。不足以诊断为癌而做出 ASAP这一 诊断主要见于两种情况 [6 ] : ①质的方面 ,缺乏足够的前列腺 癌细胞和组织结构特点 。例如一个病灶可能包括 12 个腺 泡 ,腺泡缺乏基底细胞层 ,呈浸润性生长 ,但细胞形态和组织 结构上尚未达到癌的诊断标准 (如缺少明显的核仁和明显 的核增大 ) ; ②量的方面 ,包含的腺泡数量太少 ,腺泡的细胞 和组织结构方面已经达到癌的诊断标准 ,但病灶的大小是其 主要限制 (如 1～3个腺泡 ) 。
IgAN
IgAN的病因迄今未明，尽管它是由免疫复合物介导 的肾小球疾病，即以免疫球蛋白A在肾小球系膜地弥 慢性沉积为主，然而迄今为止还未找到能与IgA抗体 起反应的抗原物质。
流行病学
IgA肾病是全球范围内最常见的一种 肾小球疾病，占原发性肾小球肾炎 的50% 亚洲和太平洋地区最常见，我国为 40%，欧洲为20%
到肾功能衰竭。据统计成人IgAN患者的肾脏10年存活 率为80~87%
预后不良的临床因素：
显著蛋白尿（〉2g/24h），
发病时即有高血压、肾功能损害，
男性发病年龄大，无反复发作性肉眼血尿史。
影响预后的危险因素
临床因素 病理因素
IgA肾病进展的临床因素
IgA肾病患者的临 床病程与预后极不平 衡， IgA肾病在初 诊 或肾活检时出现以下 情况，是导致肾脏生 存不利的预后影响因 素。
病因和发病机理
IgAN的病理表现
（一）免疫病理
IgA肾病的定义即免疫病理显示单纯IgA或以 IgA为主的免疫球蛋白在肾小球系膜区弥漫沉积， 其特征一般呈块状或分散的粗大颗粒分布，部分
合并IgM、IgG、C3备解素和纤维蛋白的沉积。.
免疫球蛋白和补体成分除了单独在系膜内沉积外， 部分肾活检尚可见到毛细血管壁沉积。
无变化
局灶间质水肿，偶 见细胞浸润。 小管萎缩，间质炎 症。 与Ⅳ级相似但更严 重。
IgAN的临床表现
IgAN可发生于任何年龄，但以青壮年及儿童最为 常见，发病年龄在20-40岁，青壮年占74.6%，幼 儿、小儿组占20.6%，老年组占4.8%，10岁以下及 50岁以上者不常见，男性多于女性，男女比例约2： 1。
无症状性蛋白尿及镜下血尿型
IgA 肾病
辨证分型
以病辨证 分期辨证 按临床表现辨证
以病辨证
(李亚妤)分为肝肾阴虚、脾肾气虚和气阴两虚 (张雪梅)分为脾肾气虚、气阴两虚和湿热内蕴并 认为肾病综合征患者中脾肾气虚型比例较高,占88 5%。 (朱彩凤)分为气虚、阴虚、气阴两虚三大主证及 风热、湿热、瘀阻三大兼夹证。
沉积在肾小球的IgA的来源及特征如何？ IgA在肾脏的沉积是否一定会发生肾小球肾炎？
免疫因素
粘膜免疫缺陷
常有上呼吸道感染 沉积在肾脏的IgA1来源于骨髓
抗原－骨髓－刺激IgA的合成－ IgA1增高
免疫调节异常
约35%～50% IgAN患者的血清IgA含量升高,
各种感染（细菌、病毒、食物）－－Tγ 和Ｔ δ 细胞扩增－－T细胞免疫调节功能的紊乱－ －B细胞产生了过量的IgA
1.3半乳糖苷转移酶 IgA糖基化
肝脏清除IgA1
系膜增生
细胞因子、生长因子 系膜C转分化、成纤维C增生、分泌胶原
小球硬化
诊断和鉴别诊断
临床表现及其分型 免疫病理 病理
临床表现及其分型
常见于青壮年 临床表现轻重不一,预后也各不相同。
反复肉眼血尿 大量蛋白尿 无症状尿检异常 血管炎 高血压 终未期IgAN
B 型:
持续性镜下血尿伴轻中度蛋白尿( < 2. 0 g/ 24h) ,不伴高 血压及肾功能减退。
病理
变异较大。从肾小球系膜增生性病变至肾小球硬化不等, 间质病变轻重不一,往往与临床表现难以联系。
世界卫生组织儿童标准处方集
WHO Model Formulary for ChildrenBased on the Second Model List of Essential Medicines for Children 2009世界卫生组织儿童标准处方集基于2009年儿童基本用药的第二个标准目录WHO Library Cataloguing-in-Publication Data:WHO model formulary for children 2010.Based on the second model list of essential medicines for children 2009.1.Essential drugs.2.Formularies.3.Pharmaceutical preparations.4.Child.5.Drug utilization. I.World Health Organization.ISBN 978 92 4 159932 0 (NLM classification: QV 55)世界卫生组织实验室出版数据目录：世界卫生组织儿童标准处方集基于2009年儿童基本用药的第二个标准处方集1．基本药物 2.处方一览表 3.药品制备 4儿童 5.药物ISBN 978 92 4 159932 0 (美国国立医学图书馆分类：QV55)World Health Organization 2010All rights reserved. Publications of the World Health Organization can be obtained fromWHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: ******************). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the aboveaddress(fax:+41227914806;e-mail:*******************).世界卫生组织2010版权所有。
Distributed_Adaptive_Asymptotic_Tracking_of_2-D_Ve
LetterDistributed Adaptive Asymptotic Tracking of 2-D Vehicular Platoon Systems With ActuatorFaults and Spacing ConstraintsJiayi Lei, Yuan-Xin Li, and Shaocheng TongDear Editor,This letter investigates the adaptive asymptotic tracking sliding-mode control for nonlinear 2-D vehicular platoon systems subject to actuator faults. Firstly, by using the Nussbaum function, the disad-vantageous factors brought by the unknown direction actuator faults can be attenuated. Then, a new neural network (NN) asymptotic tracking control method is presented based on the sliding-mode con-trol and bounded estimation approach. By constructing a barrier Lya-punov function, it can be guaranteed that all signals of the corre-sponding closed-loop systems are bounded, and constraints are not violated. Finally, a numerical simulation is given to verify the obtained results.In the past few decades, the research on the vehicular platoon sys-tems has received growing interests due to its great anti-interference characteristics and string stability. A plenty of representative control algorithms in this area have been developed in [1]–[4]. Although the aforementioned studies can achieve the string stability, the issue of spacing constraints was not considered. To circumvent this problem, an interesting control scheme was proposed in [5], which can guaran-tee not only the safe distance but also communication connectivity. Besides, it is desirable for vehicles to guarantee the collision avoid-ance in some chaotic environments. The distributed tracking control method was proposed for vehicle systems to deal with the problem of obstacle avoidance in [6] by means of the NN. On the basis of exist-ing researches, a vehicle model on a two-dimensional (2-D) plane was first considered in [7], which can simulate the more realistic driving scene. Besides, there were many related results on asymp-totic tracking control problem, which provided asymptotic stable tracking error systems with zero errors in [8]–[10].It is worth noting that, the aforementioned results do not consider the issue of actuator faults, which will lead to deteriorative and insta-ble performance of the system. To ensure the controlled systems’security and dependability, various advanced methods on fault-toler-ant control have been reported in [11]–[13]. Recently, the authors have turned the research direction to the fault-tolerant control of the vehicular platoon systems since various types of actuator faults trig-ger risks to vehicle mechanism. In [14]–[16], the sliding-mode con-trol method and adaptive control technique were used to eliminate the impact of faults for platoon systems. Although lots of significant progress on adaptive fault-tolerant control for vehicular platoon sys-tems have been proposed, the following defects are inevitable in the existing control strategies. 1) The disadvantageous factors brought by the unknown direction actuator faults should be considered, which widely exist in practice and can not be ignored in controller designed.2) There is no work focusing on the asymptotic tracking control for vehicular platoon systems with unknown direction actuator faults to provide tracking performance with zero-error tracking.d i(t)Motivated by the above considerations, this letter addresses the adaptive asymptotic tracking sliding-mode control problem for non-linear 2-D vehicular platoon systems subject to actuator faults with unknown directions. The main contributions lie in the following: 1) Different from the traditional control methods [1]–[6], where the pro-posed control method do not obey principle owing to the existence of unknown direction actuator faults. To solve this problem, we design a Nussbaum function to eliminate disadvantageous factors brought by the unknown direction actuator faults. 2) An asymptotic tracking control for nonlinear 2-D vehicular platoon systems with unknown direction actuator faults is first proposed in this work. Based on the sliding-mode control, we design a novel asymptotic tracking con-troller to ensure that the practical distance tracks the desired dis-tance d asymptotically.Problem formulation:Consider a nonlinear i th follower system expressed as the following form:i iψi(t)v i(t)a i(t)u Fi(t)g i(x i,y i,v i,t)r i(t)ωi(t)ϵi(t)position respectively; is the angle between the speed direction and the X-axis direction; and , respectively, the vehicle’s velocity and acceleration; denotes the actuator faults;is uncertainty under nonlinear unmodeled dynamic; represents external disturbance; is the angular rate and is the acceleration of the velocity direction deflection angle.The actuator faults in our research are modeled as follows:iγ,i i n,itγ,i t n,iwhere denote the fault factors and are the bias faults. and are unknown fault time instants.r i(t)|r i(t)|≤¯r i,i=1,2,...,nAssumption 1: The external disturbances are unknown and bounded satisfying.γi(t,tγ,i)n i(t,t n,i)0<γi≤|γi(t,tγ,i)|≤γi<∞|n i(t,t n,i)|≤¯n i,i=1,2,...,nAssumption 2: The unknown parameters and referring to (3) satisfy the following conditions:and .min max i i are respectively the distance and the velocity direction deflection0<∆min<d i(t)<∆max∆min∆maxthe spacing restrictions are given as: , where is the minimum distance to ensure safety, while is the maximum distance to maintain effective communication.In addition,to guarantee the distance restrictions, the followinga minb maxChoose the following sliding surfaces:s i(t)=˙e i(t)+ρ1e i(t)+ρ2|e i(t)|a b sgn(e i(t))(8)12ρ3where a and b are positive constants satisfying , and and are positive constants.u i(t)Then, the controller is established asCorresponding author: Yuan-Xin Li.Citation: J. Y. Lei, Y.-X. Li, and S. C. Tong, “Distributed adaptiveasymptotic tracking of 2-D vehicular platoon systems with actuator faults andspacing constraints,” IEEE/CAA J. Autom. Sinica, vol. 10, no. 5, pp.1352–1354, May 2023.The authors are with the College of Science, Liaoning University of Techno-logy, Jinzhou 121001, China (e-mail: yxinly@126.Color versions of one or more of the figures in this paper are availableonline at .Digital Object Identifier 10.1109/JAS.2023.1231501352 IEEE/CAA JOURNAL OF AUTOMATICA SINICA, VOL. 10, NO. 5, MAY 2023D i (t )=ρ1˙ei (t )+ρ2ab |e i (t )|ab −1˙e i (t )+i i d i (t ),G i (t )=s i (t )×(ˆθi ζT 1,i (X i )ζ1,i (X i )√s 2i ζT 1,i (X i )ζ1,i (X i )+σ2i +ˆφi ζT 2,i (X i )ζ2,i (X i )√s 2i ζT 2,i (X i )ζ2,i (X i )+σ2i +ηi √s 2i +σ2i)H i (t )=1−sgn(e i (t ))νi ×e i (t )k a 2−e 2i (t )+1+sgn(e i (t ))νi e i (t )k b 2−e 2i (t )where , and the adaptive update laws are pro-i i σi (t )σi (t )>0,lim t →∞ tt 0σi (ϵ)d ϵ≤σi <+∞,σi Here, , and l are positive parameters. The Nussbaum function can be chosen as [7] to attenuate the disadvantageous factors brought by unknown direction actuator faults. In addition, is any uni-form boundedness continuous function expressed as: with being an unknown positive constant.Theorem 1: Consider the 2-D vehicular platoon systems (1) satisfy-ing Assumptions 1 and 2. The controller (10) and the adaptive laws (11) can ensure that the tracking errors converge to zero asymptoti-cally, and all the signals of closed-loop system are bounded.Then, by considering (1), (4) and (8), we can obtainV (t )From (12) and Lemma in [7], the derivative of givesi i i i ˜θi (t )=θ∗i−ˆθi (t )˜φi (t )=φ∗i −ˆφi (t )where and represent the estimation of and . Defineand .W ∗Tj ,i ζj ,i (X i ),j =1,2,Referring to [12], the NN are employed to 1,i 2,i 1,i ε1,i |ε2,i (t )|≤ε2,i W ∗1,i W ∗2,i and , and are the given optimal weight vectors.µ=14θi +14φi +θi +φi +ηi where .0µσi with .V (0)∑N i =1 t0[(ςN +1)˙ξi ]d τ[0,+∞)V (t )e i ,˜θi ,˜φi ˆθi ˆφ[0,+∞)This together with Lemma in [17], it can be shown that and are bounded on . In view of the defini-tion of , the boundedness of can be achieved. Besides,we can obtain that and are bounded. Therefore, we can conclude that all the signals of the controlled system are bounded on .Next, we prove the asymptotic tracking performance of the sliding t →∞i lim t →∞e i (t )=0From that, we know . Together with (8), we canget . Therefore, the asymptotic convergence is achieved. In addition, to prove the stability of sliding surfaces, the ψi ˙Vψ(t )<0, which implies that the object of this letter is ensured that sliding surfaces are asymptotically stable.d =15m ∆min =7m ∆max =22m a 0(t )=0.6t m /s 2,2.3m /s 2,−5m /s 20s ≤t <5s ,5s ≤t <9s ,14s ≤t <15s Numerical example: A platoon of vehicles with 1 leader vehicle and 4 follower vehicles are taken into account. The desired vehicle distances are set as , and , . The ex-pected acceleration of leader is while , respectively.To verify the above results, the system parameters used for simula-LEI et al .: DISTRIBUTED ADAPTIVE ASYMPTOTIC TRACKING OF 2-D VEHICULAR PLATOON SYSTEMS 1353αi =10βi =0.0009σi =10e −5t ˆθi (t )=1ˆφi (t )=1ρ1=1.5ρ2=0.3ρ3=6a =6b =4l =170g i (x i ,y i ,v i ,t )=−a 0,i −a 1,i v i (t )−a 2,i v 2i (t )a 0,i =0.01176a 1,i =0.00077616a 2,i =0.000016n i (t ,t n ,i )=sin(it +i π)γi (t ,t γ,i )n i (t ,t n ,i )γ1(t ,t γ,1)=1.2−0.2cos(t )γ2(t ,t γ,2)=0.5−0.2cos(t )γ3(t ,t γ,3)=−0.9−0.2cos(t )γ4(t ,t γ,4)=−0.4+0.2sin(0.01t )n i (t ,t n ,i )=0.3+0.2cos(t )m =3n =0.001tions are given as: , , , ,, , , , , , . In the simu-lation, is used with , , . In addition, the distur-bance enters into the system at the beginning.Consider the fault efficiency factors and bias fault as: , , , , . For the Nussbaum function, we select , .d i (t )ψi −1(t )ψi u i Simulation results under the proposed scheme are depicted in Figs. 1(a)−1(d), Figs. 1(a) and 1(b) show the performance of output variable and and the desired reference d and , respec-tively. It can be observed from these two figures that the tracking errors converge to zero asymptotically despite of unknown direction faults occurring on the actuators, which means that the proposed con-trol scheme can completely compensate for the influence by the fault to the system. Fig. 1(c) shows the practical positions of four vehicles,which can be seen that all followers move to the line, and 2-D driv-ing scene is achieved. Fig. 1(d) shows the curve of control input .Generally, according to the simulation results, it is obvious that the tracking errors converge to zero asymptotically while the whole sig-nals of closed-loop systems are bounded.To better exhibit the effectiveness of the presented scheme, we make a comparison on convergence results between the presented scheme in this letter and existing control scheme in [7]. From the comparison in Fig. 2, it is very clear that the tracking errors in this letter are much more satisfactory than those in [7].Conclusion: In this letter, 2-D vehicular platoon asymptotic track-ing sliding-mode control under unknown directions actuator faults has been investigated. By using the Nussbaum function, the disad-vantageous factors brought by the unknown direction actuator faults can be attenuated effectively. Based on the sliding-mode control and bounded estimation approach, a new asymptotic tracking controlmethod is presented to realize the asymptotic convergence of track-ing errors. Simulations verify the performance of the proposed approach.Acknowledgment: This work was supported in part by the Funds of National Science of China (61973146, 62173172), the Distin-guished Young Scientific Research Talents Plan in Liaoning Province (XLYC1907077, JQL201915402), and the Applied Basic Research Program in Liaoning Province (2022JH2/101300276)ReferencesY. Li, C. Tang, S. Peeta, and Y. Wang, “Nonlinear consensus-basedconnected vehicle platoon control incorporating car-following interactions and heterogeneous time delays,” IEEE Trans. Intelligent Transportation Syst., vol. 20, no. 6, pp. 2209–2219, Jun. 2019.[1]G. Guo and D. Li, “Adaptive sliding mode control of vehicular platoonswith prescribed tracking performance,” IEEE Trans. Vehicular Techno -logy , vol. 68, no. 8, pp. 7511–7520, Aug. 2019.[2]X. Ge, S. Xiao, Q.-L. Han, X. M. Zhang, and D. Ding, “Dynamic event-triggered scheduling and platooning control co-design for automated vehicles over vehicular ad-hoc networks,” IEEE/CAA J. Autom. Sinica ,vol. 9, no. 1, pp. 31–46, Jan. 2022.[3]Z. Zuo, C. Liu, Q.-L. Han, and J. Song, “Unmanned aerial vehicles:Control methods and future challenges,” IEEE/CAA J. Autom. Sinica ,vol. 9, no. 4, pp. 601–614, Apr. 2022.[4]J. Wang, X. Luo, W. Wong, and X. Guan, “Specified-time vehicularplatoon control with flexible safe distance constraint,” IEEE Trans.Vehicular Technology , vol. 68, no. 11, pp. 10489–10503, Nov. 2019.[5]X. Ge, Q.-L. Han, J. Wang, and X. M. Zhang, “A scalable adaptiveapproach to multi-vehicle formation control with obstacle avoidance,”IEEE/CAA J. Autom. Sinica , vol. 9, no. 6, pp. 990–1004, Jun. 2022.[6]X. G. Guo, W. D. Xu, J. L. Wang, and J. H. Park, “Distributedneuroadaptive fault-tolerant sliding-mode control for 2-D plane vehicular platoon systems with spacing constraints and unknown direction faults,” Automatica , vol. 129, p. 109675, 2021.[7]Z. Zhang, S. Xu, and B. Zhang, “Asymptotic tracking control ofuncertain nonlinear systems with unknown actuator nonlinearity,” IEEE Trans. Autom. Control , vol. 59, no. 5, pp. 1336–1341, May 2014.[8]Z. Zhang, S. Xu, and B. Zhang, “Exact tracking control of nonlinearsystems with time delays and dead-zone input,” Automatica , vol. 52,pp. 272–276, 2015.[9]W. Wang, J. Huang, C. Wen, and H. Fan, “Distributed adaptive controlfor consensus tracking with application to formation control of nonholonomic mobile robots,” Automatica , vol. 4, no. 50, pp. 1254–1263, 2014.[10]S. Y. Xiao and J. X. Dong, “Distributed fault-tolerant containmentcontrol for nonlinear multi-agent systems under directed network topology via hierarchical approach,” IEEE/CAA J. Autom. Sinica , vol. 8,no. 4, pp. 806–816, Apr. 2021.[11]X. Jin, X. Zhao, J. Yu, X. Wu, and J. Chi, “Adaptive fault-tolerantconsensus for a class of leader-following systems using neural network learning strategy,” Neural Networks , vol. 121, pp. 474–483, 2020.[12]H. Wang, W. Bai, and P. X. Liu, “Finite-time adaptive fault-tolerantcontrol for nonlinear systems with multiple faults,” IEEE/CAA J.Autom. Sinica , vol. 6, no. 6, pp. 1417–1427, Nov. 2019.[13]G. Guo, P. Li, and L. Y. Hao, “Adaptive fault-tolerant control ofplatoons with guaranteed traffic flow stability,” IEEE Trans. Vehicular Technology , vol. 69, no. 7, pp. 6916–6927, Jul. 2020.[14]C. Pan, Y. Chen, and I. Ali, “Adaptive fault-tolerant control forautonomous vehicle platoon against fault,” in Proc. CAA Symp. Fault Detection, Supervision, Safety Technical Processes , 2021, pp. 1–5.[15]L. Y. Hao, H. Zhang, H. Li, and T. S. Li, “Sliding mode fault-tolerantcontrol for unmanned marine vehicles with signal quantization and time-delay,” Ocean Engineering , vol. 215, p. 107882, 2020.[16]Z. T. Ding, “Adaptive consensus output regulation of a class ofnonlinear systems with unknown high-frequency gain,” Automatica ,vol. 51, no. 7, pp. 348–355, 2015.[17]J. J. Slotine and W. Li. “Applied nonlinear control,” in EnglewoodCliffs , New Jersey, USA: Prentice Hall, 1991, vol. 199, no. 1, pp.1–461.[18]1050−5−10e (t ),i = 1, 2, 3, 45L 0F F F F t (s)(a) Spacing errors e i (t )1015Δ−Δ−e (t )e (t )e (t )e (t )0.20−0.2−0.4e (t ),i = 1, 2, 3, 4t (s)(b) Deflection angle errors e ψi (t )33323130292827y (t ),i = 1, 2, 3, 450100150200250300350400x (t ), i = 1, 2, 3, 4(c) 2-D driving scene 450500400020000−2000−4000u (t ),i = 1, 2, 3, 45t (s)(d) Control input u i (t )1015u (t )u (t )u (t )u (t )Fig. 1. Simulation results of this letter.1050−5−10e (t ),i = 1, 2, 3, 41050−5−10e (t ),i = 1, 2, 3, 41050−5−10e (t ),i = 1, 2, 3, 4t1050−5−10e (t ),i = 1, 2, 3, 45t (s)(a) e 1(t )10155t (s)(b) e 2(t )1015(c) e 3(t )5t (s)(d) e 4(t )10155t (s)1015e (t ) in this letter e (t ) in [7]e (t ) in this letter e (t ) in [7]e (t ) in this letter e (t ) in [7]e (t ) in this letter e (t ) in [7]e i (t )Fig. 2. Comparison results of .1354IEEE/CAA JOURNAL OF AUTOMATICA SINICA, VOL. 10, NO. 5, MAY 2023。
ANCA相关性血管炎诊疗进展
近年来，随着生物制剂的发展，如抗肿瘤坏死因子、抗CD20单克隆抗体等，为治疗提供了更多的选择 ，使治疗效果得到了显著提升。
预后和复发预测的进展
预后因素
近年来研究发现，疾病活动度、肾脏受累 、高龄、肺受累等是影响anca相关性血 管炎预后的主要因素。
VS
复发预测
通过监测ANCA滴度和抗体水平，可以预 测疾病复发的风险，从而提前调整治疗方 案，减少复发。
01
完善诊断标准
探索病因
02
03
发展新的治疗方法
未来需要进一步研究和探讨 ANCA相关性血管炎的诊断标准 ，以提高诊断的准确性。
了解ANCA相关性血管炎的病因 是制定有效治疗策略的关键，未 来需要加强对此方面的研究。
针对现有治疗方法的不足，需要 积极研发新的治疗方法，以提高 治疗效果。
临床实践建议和展望
04
挑战与展望
诊疗面临的挑战
疾病诊断标准不统一
01
目前缺乏统一的ANCA相关性血管炎的诊断标准，导致临床诊
断存在一定的困难。
病因不明
02
ANCA相关性血管炎的病因尚不明确，这给治疗带来了很大的
挑战。
治疗效果不佳
03
目前的治疗方法尚不理想，部分患者对治疗反应不佳，需要进
一步探索更好的治疗方法。
未来诊疗发展方向
感谢பைடு நூலகம்的观看
THANKS
anca相关性血管炎诊疗进 展
2023-11-05
目录
• 疾病概述 • 诊疗现状 • 诊疗进展 • 挑战与展望 • 参考文献
01
疾病概述
定义和分类
定义
ANCA相关性血管炎（ANCA-associated vasculitis，AAV ）是一组自身免疫性疾病，以血管壁的炎症性破坏和全身多 器官受累为主要特征。
体质量指数对IgA肾病患者临床病理及预后的影响
㊃论著㊃基金项目:国家自然科学基金资助项目N E T s 及其组分诱导A N C A 产生及A N C A 相关性小血管炎的机制研究(81770699);青岛市科技局成果转化计划科技惠民专项A N C A 相关性小血管炎的发病机制研究及早期发现的重大意义(15-9-2-90-n s h);青岛市卫生健康委员会优秀学科带头人培养计划通信作者:邢广群,E m a i l :g qx 99m o n a s h @163.c o m 体质量指数对I gA 肾病患者临床病理及预后的影响高鹏丽,陈丽丽,田 芬,张嘉倩,陈怿鹏,亓晓菁,邢广群(青岛大学附属医院肾内科,山东青岛266555) 摘 要:目的 探讨人体质量指数(b o d y m a s s i n d e x ,B M I )对I g A 肾病(I g An e p h r o p a t h y ,I gA N )患者的临床病理及其预后的影响㊂方法 回顾性分析2013年2月至2021年5月在青岛大学附属医院就诊并经肾穿刺活检确诊为原发性I g A N 的初治患者的临床病理资料及预后,终点事件为血肌酐翻倍和(或)进入终末期肾病(e n d -s t a g er e n a l d i s e a s e ,E S R D )和(或)肾替代治疗和(或)死亡㊂根据患者接受肾活检时的B M I 及WHO 肥胖分类分组如下:低体重组(B M I <18.5k g /m 2)㊁正常体重组(18.5ɤB M I <25.0k g /m 2)和超重肥胖组(B M I ȡ25.0k g /m 2)㊂比较各组临床病理资料㊁预后的差异㊂采用K a p l a n -M e i e r 生存曲线评估患者肾脏累计生存率,多因素C o x 回归分析影响I g A N 合并超重肥胖患者肾脏预后的危险因素㊂结果 共入选533例I g A N 患者,其中低体重组19例(3.6%),正常体重组267例(50.1%),超重肥胖组247例(46.3%)㊂与低体重组㊁正常体重组比较,超重肥胖组的年龄㊁收缩压㊁舒张压㊁血管紧张素转换酶抑制剂(a n g i o t e n s i n -c o n v e r t i n g -e n z y m e i n h i b i t o r s ,A C E I )/血管紧张素Ⅱ1型受体拮抗剂(a n g i o t e n s i n Ⅱr e c e p t o r t y pe 1,A R B )使用占比㊁血红蛋白㊁24小时尿蛋白排泄量㊁甘油三酯㊁空腹血糖㊁血清补体C 3㊁血清补体C 4㊁尿酸较高,而高密度脂蛋白胆固醇(h i g h -d e n s i t y l i p o p r o t e i nc h o l e s t e r o l ,H D L -C )㊁估算的肾小球滤过率(e s t i m a t e d gl o m e r u l a r f i l t r a t i o n r a t e ,e G F R )水平较低(均P <0.05)㊂正常体重组年龄㊁收缩压㊁舒张压㊁A C E I /A R B 使用比例㊁尿酸高于低体重组,而e G F R 低于低体重组(均P <0.05)㊂超重肥胖组和正常体重组的低密度脂蛋白胆固醇(l o w -d e n s i t y l i p o pr o t e i n c h o l e s t e r o l ,L D L -C )高于低体重组(均P <0.05)㊂与正常体重组比较,超重肥胖组的免疫球蛋白M 水平较低,男性占比㊁C 反应蛋白(C -r e a c t i v e p r o t e i n ,C R P )水平较高(均P <0.05)㊂低体重组的中性粒细胞计数高于正常体重组(P <0.05)㊂光镜检查结果显示,超重肥胖组㊁正常体重组的血管损伤程度㊁炎细胞浸润程度高于低体重组(均P <0.05)㊂与正常体重组比较,超重肥胖组的系膜C 3沉积减弱(P <0.05)㊂K a p l a n -M e i e r 生存曲线分析表明,正常体重组的肾脏累积生存率高于超重肥胖组(L o g -r a n k 检验,χ2=8.702,P =0.003),而超重肥胖组肾脏累积生存率高于低体重组(L o g -r a n k 检验,χ2=4.624,P =0.032)㊂3组的肾脏5年生存率分别为69.8%㊁75.6%㊁85.9%,正常体重组的5年肾脏生存率高于超重肥胖组(L o g -r a n k 检验,χ2=4.996,P =0.025),而超重肥胖组的5年生存率高于低体重组(L o g -r a n k 检验,χ2=5.764,P =0.016)㊂在I g A N 合并超重肥胖患者中,多因素C o x 回归分析结果提示,24小时尿蛋白排泄量㊁甘油三酯㊁血红蛋白是发生肾脏终点事件的独立危险因素㊂结论 I g A N 合并超重肥胖患者临床表现较重,有着更重的血管损伤及炎细胞浸润,肾脏预后较差㊂应重视I g A N 合并超重肥胖患者的治疗及随访过程中生活方式及体重的管理㊂关键词:肾小球肾炎,I G A ;人体质量指数;病理学;预后中图分类号:R 692.31 文献标志码:A 文章编号:1004-583X (2022)03-0234-09d o i :10.3969/j.i s s n .1004-583X.2022.03.007I m p a c t o f b o d y m a s s i n d e x i n t h e c l i n i c o p a t h o l o g y a n d p r o g n o s i s o f p a t i e n t sw i t h I g An e p h r o p a t h yG a oP e n g l i ,C h e nL i l i ,T i a nF e n ,Z h a n g J i a q i a n ,C h e nY i p e n g ,Q iX i a o j i n g ,X i n g G u a n g qu n D e p a r t m e n t o f N e p h r o l o g y ,t h eA f f i l i a t e d H o s p i t a l o f Q i n g d a oU n i v e r s i t y ,Q i n gd a o 266555,C h i n a C o r re s p o n d i n g a u t h o r :X i n g G u a n g q u n ,E m a i l :g qx 99m o n a s h @163.c o m A B S T R A C T :O b j e c t i v e T oi n v e s t i g a t et h ei m p a c to fb o d y m a s si n d e x (B M I )o nt h ec l i n i c o p a t h o l o g y a n d p r o g n o s i s o f p a t i e n t s w i t hI g A n e p h r o p a t h y (I g A N ).M e t h o d s T h ec l i n i c o p a t h o l o g i c a ld a t aa n d p r o g n o s i so f533p r i m a r y I g A N p a t i e n t s w h o w e r ed i a g n o s e db y r e n a lb i o p s y i nt h e A f f i l i a t e d H o s p i t a lo fQ i n g d a o U n i v e r s i t y fr o m F e b r u a r y 2013t o M a y 2021w e r er e t r o s p e c t i v e l y a n a l y z e d .S e r u mc r e a t i n i n e l e v e l sd o u b l i n g a n d /o re n t e r e de n d -s t a g e r e n a i l d i s e a s e (E R S D )a n d /o r r e n a l r e p l a c e m e n t t h e r a p y a n d /o r d e a t hw e r e e n d p o i n t s .A c c o r d i n g to t h eB M I a n d W o r l d H e a l t hO r g a n i z a t i o n (WHO )o b e s i t y c l a s s i f i c a t i o n ,t h e p a t i e n t sw e r e g r o u p e d a s f o l l o w s :l o wb o d y w e i g h t g r o u p (B M I <18.5k g /m 2),n o r m a lw e i g h t g r o u p (18.5ɤB M I <25.0k g /m 2)a n do v e r w e i g h t o b e s e g r o u p (B M I ȡ25.0k g/m 2).㊃432㊃‘临床荟萃“ 2022年3月20日第37卷第3期 C l i n i c a l F o c u s ,M a r c h20,2022,V o l 37,N o .3Copyright ©博看网. All Rights Reserved.T h e d i f f e r e n c e s i nc l i n i c o p a t h o l o g i c a la n d p r o g n o s i so fo f p a t i e n t s i ne a c h g r o u p w e r ec o m p a r e d.T h e K a p l a n-M e i e r s u r v i v a l c u r v ew a su s e d t o a s s e s s t h e c u m u l a t i v e r e n a l s u r v i v a l r a t eo f p a t i e n t s,a n dt h em u l t i f a c t o r i a lC o xr e g r e s s i o n a n a l y s i sw a su s e dt oa n a l y z et h er i s kf a c t o r sa f f e c t i n g t h er e n a l p r o g n o s i so fI g A N p a t i e n t s w i t ho v e r w e i g h ta n d o b e s i t y.R e s u l t s I n533I g A N p a t i e n t s,19p a t i e n t s(3.6%)w e r eu n d e r w e i g h t,267p a t i e n t s(50.1%)w e r en o r m a l w e i g h t,a n d247p a t i e n t s(46.3%)w e r eo b e s e w e i g h t.C o m p a r e d w i t hl o w b o d y w e i g h t g r o u p a n dn o r m a lw e i g h t g r o u p,t h eo v e r w e i g h to b e s e g r o u p s h o w e di n c r e a s e da g e,s y s t o l i cb l o o d p r e s s u r e(S B P),d i a s t o l i cb l o o d p r e s s u r e (D B P),a n g i o t e n s i n-c o n v e r t i n g-e n z y m e i n h i b i t o r s(A C E I)/a n g i o t e n s i n I I r e c e p t o r t y p e1(A R B)u s e r a t i o,h e m o g l o b i n, 24-h o u r u r i n a r yp r o t e i ne x c r e t i o n,t r i g l y c e r i d e s,f a s t i n gp l a s m a g l u c o s e,b l o o d c o m p l e m e n t C3a n dC4l e v e l s,a n du r i c a c i d,a n dd e c r e a s e dH D L-Ca n de G F Rl e v e l s(a l l P<0.05).I nc o m p a r i s o no fn o r m a l g r o u p a n d l o w g r o u p,n o r m a l g r o u p d i s p l a y e d i n c r e a s e d a g e,S B P,D B P,A C E I/A R Bu s e r a t i o,u r i c a c i d,a n d d e c r e a s e d e G F R(a l l P<0.05).L D L-C l e v e l sw e r eh i g h e r i nb o t h t h e o v e r w e i g h t o b e s e g r o u p a n d t h en o r m a l g r o u p t h a n i n t h e l o w g r o u p(a l l P<0.05).I g Ml e v e l sw e r e l o w e r a n dm a l e p r e v a l e n c e a n dC R Pl e v e l sw e r eh i g h e r i n t h eo v e r w e i g h t o b e s e g r o u p c o m p a r e dw i t h t h en o r m a l g r o u p(a l l P<0.05).N e u t r o p h i l c o u n t sw e r eh i g h e r i nt h e l o w g r o u p t h a n i nt h en o r m a l g r o u p(P<0.05).I n l i g h tm i c r o s c o p i c e x a m i n a t i o n,l o w g r o u p s h o w e d d e c r e a s e d t h e d e g r e e o f v a s c u l a r d a m a g e a n d i n f l a mm a t o r yc e l l i n f i l t r a t i o na m o n g t h r e e g r o u p s(a l l P<0.05).M e s a n g i a lde p o s i t i o no fC3w a sw e a k e n e d i n t h e o v e r w e i g h t o b e s e g r o u p c o m p a r e dw i t h t h en o r m a l g r o u p(P<0.05).K a p l a n-M e i e r s u r v i v a l c u r v e a n a l y s i s s h o w e d t h a t t h e c u m u l a t i v e r e n a l s u r v i v a l r a t ew a s h i g h e r i n t h e n o r m a l g r o u p t h a n i n t h e o v e r w e i g h t o b e s e g r o u p(L o g-r a n k t e s t,χ2=8.702,P= 0.003),w h e r e a s,w h i c hw a sh i g h e r i n t h e o v e r w e i g h t o b e s e g r o u p t h a n i n t h e l o w g r o u p(L o g-r a n k t e s t,χ2=4.624, P=0.032).5-y e a r r e n a l s u r v i v a l r a t e sw e r e69.8%,75.6%,a n d85.9%,f o r l o wg r o u p,o v e r w e i gh t o b e s e g r o u p a n d n o r m a l g r o u p r e s p e c ti v e l y,w i t hh i g h e r5-y e a r r e n a l s u r v i v a l r a t e s i nt h en o r m a l g r o u p t h a n i nt h eo v e r w e i g h to b e s e g r o u p(L o g-r a n k t e s t,χ2=4.996,P=0.025),a n dh i g h e r5-y e a r s u r v i v a l r a t e s i n t h e o v e r w e i g h t o b e s e g r o u p t h a n i n t h e l o w g r o u p(L o g-r a n k t e s t,χ2=5.764,P=0.016).T h e m u l t i f a c t o r i a lC o xr e g r e s s i o na n a l y s i ss h o w e dt h a t24-h o u r u r i n a r yp r o t e i ne x c r e t i o n,t r i g l y c e r i d e s,a n dh e m o g l o b i nw e r er i s kf a c t o r s f o re n d p o i n t e v e n t s i nI g A N p a t i e n t s w i t ho v e r w e i g h t o b e s e.C o n c l u s i o n A m o n g t h e I g A N p a t i e n t s,t h ec l i n i c a lm a n i f e s t a t i o n so fo v e r w e i g h t a n do b e s i t y p a t i e n t s a r ew o r s t c h a r a c t e r i z e db y s e v e r e r v a s c u l a r d a m a g e a n d i n f l a mm a t o r y c e l l i n f i l t r a t i o n,p o o r e r r e n a l p r o g n o s i s. T h u s t h e t h e r a p e u t i c e f f e c t o f t h o s e p a t i e n t s a n d f o l l o w-u p l i f e s t y l e a n dw e i g h tm a n a g e m e n t s h o u l db e e m p h a s i z e d.K E Y W O R D S:g l o m e r u l o n e p h r i t i s,I G A;b o d y m a s s i n d e x;p a t h o l o g y;p r o g n o s i sI g A肾病(I g An e p h r o p a t h y,I g A N)是我国乃至世界范围内常见的原发性肾小球疾病,是慢性肾脏病(c h r o n i c k i d n e y d i s e a s e,C K D)和肾功能衰竭的主要病因,多达30%的患者在确诊后约20年内发展成为终末期肾病(e n d-s t a g er e n a ld i s e a s e,E S R D)㊂I g A N作为一组临床病理综合征,其临床表现多样,预后与转归有很大不同[1-4]㊂一些大型队列研究显示,I g A N死亡风险增加,并伴随着更高的死亡率和更短的预期寿命㊂一项流行病学研究显示,与I g A N 相关的代谢综合征是C K D进展的重要危险因素[5]㊂然而,大多数临床对照研究都集中在确定高血压㊁高尿酸与肾脏疾病之间的关系,很少有研究探讨体质量指数(b o d y m a s s i n d e x,B M I)与I g A N的临床病理及预后的关系[6-7]㊂在一项大型亚洲人群的研究中发现,低B M I和高B M I都与各种原因导致的死亡风险增加相关,总体上呈 U 形关联[8]㊂在I g A N患者中,B M I过高,特别是B M I>25k g/m2,是肾脏疾病进展的危险因素[9-10]㊂另外,有些研究认为,体重不足是I g A N等肾脏疾病进展的独立危险因素[11]㊂此外,在过去10年里,若干临床流行病学研究发表,尽管存在很大的局限性,但它们揭示了B M I与C K D 甚至E S R D的发生有关[12-13]㊂因此,本研究收集2013年2月至2021年5月在青岛大学附属医院就诊,并行肾穿刺活检经组织病理学确诊为原发性I g A N的初治患者,依据B M I将其分为3组,在既往研究较多的指标基础上,纳入了血管损伤程度㊁炎细胞浸润程度等指标㊂以更深入地了解B M I对I g A N 临床病理特征及预后的影响,并探讨影响I g A N合并超重肥胖患者预后的危险因素㊂1资料与方法1.1病例选择收集2013年2月至2021年5月在青岛大学附属医院就诊,并行肾穿刺活检经组织病理学确诊为原发性I g A N的初治患者肾活检时的临床病理资料及预后㊂排除标准:①年龄<18岁;②继发性I g A N:系统性红斑狼疮㊁肝硬化㊁过敏性紫癜等;③肾活检时估算的肾小球滤过率(e s t i m a t e dg l o m e r u l a r f i l t r a t i o nr a t e,e G F R)<15m l/(m i n㊃1.73m2);④临床记录不足㊁缺失和肾组织活检肾小球数目<8个㊂本研究经青岛大学附属医院伦理委员会批准(Q Y F YW Z L L26468)㊂1.2方法本研究为单中心㊁回顾性研究㊂根据WHO肥胖分类(B M I于患者接受肾组织活检时测㊃532㊃‘临床荟萃“2022年3月20日第37卷第3期 C l i n i c a l F o c u s,M a r c h20,2022,V o l37,N o.3Copyright©博看网. All Rights Reserved.得),将所有患者分为以下3组:低体重组19例(B M I<18.5k g/m2)㊁正常体重组267例(18.5k g/m2ɤB M I<25.0k g/m2)㊁超重肥胖组247例(B M Iȡ25 k g/m2)㊂记录患者肾活检时的临床病理资料,并随访至2021年5月记录患者预后㊂1.2.1临床资料临床资料包括一般资料及实验室资料㊂一般资料包括:年龄㊁性别㊁收缩压(S B P)㊁舒张压(D B P)㊁激素或免疫抑制剂使用史㊁血管紧张素转换酶抑制剂(a n g i o t e n s i n-c o n v e r t i n g-e n z y m e i n h i b i t o r s,A C E I)/血管紧张素Ⅱ1型受体拮抗剂(a n g i o t e n s i nⅡr e c e p t o rt y p e1,A R B)使用史等㊂实验室资料包括:e G F R㊁血红蛋白㊁24小时尿蛋白排泄量㊁C反应蛋白(C-r e a c t i v e p r o t e i n,C R P)㊁中性粒细胞计数㊁总胆固醇(t o t a l c h o l e s t e r o l,T C)㊁低密度脂蛋白胆固醇(l o w-d e n s i t y l i p o p r o t e i n c h o l e s t e r o l,L D L-C)㊁血尿素氮(b l o o d u r e a n i t r o g e n,B U N)㊁血尿酸(u r i ca c i d,U A)㊁甘油三酯(t r i g l y c e r i d e,T G)㊁胱抑素C(c y s t a t i nC,C y s C)㊁高密度脂蛋白胆固醇(h i g h-d e n s i t y l i p o p r o t e i n c h o l e s t e r o l,H D L-C)㊁空腹血糖(f a s t i n g p l a s m a g l u c o s e,F P G)㊁尿红细胞计数㊁尿白细胞计数㊁血清补体C1q(c o m p l e m e n t1q,C1q)㊁血清补体C3 (c o m p l e m e n t3,C3)㊁补体C4(c o m p l e m e n t4,C4)㊁血清免疫球蛋白G(I g G)㊁免疫球蛋白A(I g A)㊁免疫球蛋白M(I g M)㊁免疫球蛋白E(I g E)等㊂24小时蛋白尿排泄量通过24小时尿液收集来评估㊂e G F R根据慢性肾脏病流行病学合作研究公式(C K D-E P I)计算㊂1.2.2病理资料所有肾组织标本均通过经皮穿刺活检获得,肾活检标本常规进行光镜㊁免疫荧光及电镜检查㊂病理切片由肾脏病理专家进行审查㊂①使用牛津病理分型标准进行病理评分,包括系膜细胞增生(M0/1),内皮细胞增生(E0/1),节段性硬化/黏连(S0/1),肾小管萎缩/间质纤维化(T0/1/2),新月体病变(C0/1/2)㊂②炎细胞浸润程度:无明显浸润赋值=0,<25%赋值=1,25%~<50%赋值=2, 50%~75%赋值=3,>75%赋值=4㊂③血管损伤程度:未见明显病变赋值=0,单纯血管壁增厚赋值=1,血管壁增厚合并其他赋值=2,如玻璃样病变等㊂④免疫荧光下观察肾组织中I g A㊁I g G㊁I g M㊁C3㊁C4㊁C1q的沉积强度( 阴性 赋值=0, +/- 赋值=1, + 赋值=2, ++ 赋值=3, +++ 赋值=4)㊂1.2.3预后复合终点:血肌酐水平翻倍和(或)进入E S R D和(或)肾替代治疗和(或)死亡[14]㊂1.3统计学方法采用S P S S25.0软件进行统计学分析㊂正态分布的计量资料用均数ʃ标准差(x-ʃs)描述,组间比较采用单因素方差分析;非正态分布的计量资料用M(Q25,Q75)描述,组间比较采用K r u s k a lW a l l i s秩和检验㊂计数资料用[例(%)]表示,组间比较采用χ2检验㊂使用G r a p h P a dP r i s m 8.0.1绘制累积直方图㊂采用K a p l a n-M e i e r生存曲线㊁L o g-r a n k检验比较3组肾脏生存率的差异㊂采用多因素C o x回归分析I g A N合并超重肥胖患者预后的影响因素㊂P<0.05为差异有统计学意义㊂2结果2.1入组情况2013年2月至2021年5月在青岛大学附属医院肾内科就诊,并经肾活检确诊为原发性I g A N的初治患者共568例㊂按照排除标准,排除继发性I g A N患者10例,临床记录不足㊁缺失和肾活检不充分14例,e G F R<15m l/(m i n㊃1.73m2)11例,最终533例纳入本研究㊂2.23组临床资料比较2.2.1一般资料比较总体发病年龄18~79岁,平均(39.74ʃ13.46)岁,总体B M I(16.7~38.4) k g/m2,平均(24.98ʃ3.72)k g/m2㊂533例患者中,低体重组19例(3.6%),体重正常组267例(50.1%),超重肥胖组247例(46.3%)㊂超重肥胖组的年龄㊁男性占比㊁收缩压㊁舒张压㊁A C E I/A R B使用占比大于低体重组和正常体重组(均P<0.05),正常体重组年龄㊁收缩压㊁舒张压㊁A C E I/A R B使用比例大于低体重组(均P<0.05),正常体重组的男性占比与低体重组比较,差异无统计学意义(P> 0.05)㊂3组激素或免疫抑制剂治疗占比比较,差异无统计学意义(均P>0.05)㊂见表1㊂2.2.2实验室资料比较2.2.2.13组实验室资料比较超重肥胖组血红蛋白㊁24小时尿蛋白排泄量㊁T G㊁F P G㊁血补体C3和C4水平高于低体重组和正常体重组(均P<0.05),而H D L-C水平低于低体重组和正常体重组(均P< 0.05),且正常体重组与低体重组上述指标比较,差异无统计学意义(均P>0.05)㊂低体重组e G F R高于正常体重组和超重肥胖组,且正常体重组e G F R 高于超重肥胖组(均P<0.05)㊂超重肥胖组血U A 高于正常体重组和低体重组,且正常体重组血U A 高于低体重组(均P<0.05)㊂超重肥胖组和正常体重组的L D L-C水平均高于低体重组(均P<0.05),但超重肥胖组和正常体重组L D L-C水平比较,差异无统计学意义(P>0.05)㊂与正常体重组比较,超重肥胖组的I g M水平较低㊁C R P水平较高(均P<㊃632㊃‘临床荟萃“2022年3月20日第37卷第3期 C l i n i c a l F o c u s,M a r c h20,2022,V o l37,N o.3Copyright©博看网. All Rights Reserved.0.05)㊂低体重组的中性粒细胞计数高于正常体重组(均P<0.05)㊂3组其他各项指标比较,差异无统计学意义(均P<0.05)㊂见表2㊂表13组一般资料比较项目低体重组(n=19)正常体重组(n=267)超重肥胖组(n=247)F值/H值/χ2值P值年龄(岁)27.95ʃ8.2838.13ʃ12.71*42.4ʃ13.84*#14.738<0.01性别[例(%)]男女8(42.2)11(57.8)124(46.4)143(53.6)149(60.3)#98(39.7)#10.810<0.01收缩压(mmH g)119(110,130)130(120,142)*138(130,150)*#45.073<0.01舒张压(mmH g)71(68,78)80(73,90)*83(77,92)*#22.211<0.01激素或免疫抑制剂治疗[例(%)]7(36.8)76(28.5)73(29.6)0.9650.617 A C E I/A R B治疗[例(%)]2(10.5)110(41.2)*138(55.8)*#20.098<0.01注:与低体重组比较,*P<0.05;与正常体重组比较,#P<0.05;1mmH g=0.133k P a表23组实验室资料比较项目低体重组(n=19)正常体重组(n=267)超重肥胖组(n=247)H值/F值P值e G F R[m l/(m i n㊃1.73m2)]100.3ʃ24.2485.69ʃ30.76*80.62ʃ27.72*#5.063<0.01血红蛋白(g/L)126.4ʃ20.39128.8ʃ19.74136.7ʃ18.79*#11.725<0.01 24小时尿蛋白排泄量(g/d)1.38(0.25,1.98)1.13(0.58,2.26)2.01(0.98,3.55)*#35.348<0.01 C R P(m g/L)1.99(1.15,3.7)1.33(0.79,2.20)1.88(1.05,3.27)#15.372<0.01中性粒细胞计数(ˑ109/L)4.66(3.94,6.29)3.61(2.90,4.71)*3.96(3.14,4.93)12.833<0.01 T C(mm o l/L)4.45(3.36,5.04)4.81(4.17,5.79)4.96(4.21,6.21)5.4680.065 L D L-C(mm o l/L)2.08(1.45,2.91)2.95(2.41,3.79)*3.14(2.44,3.98)*12.098<0.01 B U N(mm o l/L)4.92(3.93,6.0)5.88(4.60,7.79)5.94(4.60,7.52)4.4170.110血U A(μm o l/L)314.7ʃ102.6354.1ʃ98.88*385.40ʃ94.62*#9.528<0.01 T G(mm o l/L)0.88(0.60,1.37)1.19(0.88,1.76)1.63(1.16,2.43)*#46.493<0.01 C y s C(m g/L)0.94(0.81,1.57)1.01(0.84,1.34)1.09(0.88,147)3.3100.191 H D L-C(mm o l/L)1.45(1.22,1.67)1.36(1.16,1.64)1.18(1.02,1.41)*#32.023<0.01 F P G(mm o l/L)4.3(3.99,4.62)4.55(4.25,4.85)4.77(4.34,5.23)*#25.039<0.01尿红细胞计数(个/μL)51(19.1,109.3)65.34(22.8,132.5)56.60(21.12,117.1)1.8420.398尿白细胞计数(个/μL)5.94(3.5,16.7)7.04(3.96,13.8)6.70(3.30,14.30)0.6030.740 C1q(m g/L)167(133.2,202.3)179(155.8,205.3)183(158.9,205.4)3.2570.196 C3(g/L)0.88(0.73,1.03)1.01(0.87,1.14)1.12(1.01,1.28)*#54.860<0.01 C4(g/L)0.22(0.16,0.26)0.23(0.19,0.28)0.27(0.22,0.32)*#29.190<0.01 I g G(g/L)10.90ʃ3.3310.13ʃ3.499.99ʃ3.530.5610.571 I g E(I U/m l)59.49(17.16,155.80)66.39(22.67,149.70)50.34(21.93,141.80)0.6390.726 I g A(g/L)3.14(2.37,3.66)2.92(2.36,3.68)3.04(2.32,4.01)1.0700.586 I g M(g/L)1.04(0.86,1.58)1.00(0.72,1.41)0.89(0.62,1.25)#8.6430.013注:与低体重组比较,*P<0.05;与正常体重组比较,#P<0.052.2.2.2按性别分层后3组血U A㊁血红蛋白㊁e G F R比较由于血U A㊁血红蛋白㊁e G F R存在性别差异,3组性别差异有统计学意义可能会导致假阳性结果㊂通过性别分组后发现,在女性中,超重肥胖组血U A高于正常体重组和低体重组(均P<0.05),但低体重组与正常体重组比较,差异无统计学意义(P>0.05);低体重组e G F R高于超重肥胖组(P< 0.05);超重肥胖组血红蛋白水平高于体重正常组(P<0.05);其余指标3组比较,差异无统计学意义(均P>0.05)㊂在男性中,超重肥胖组的血红蛋白高于低体重组(P<0.05)㊂其余指标3组比较,差异无统计学意义(均P>0.05)㊂见表3㊂2.33组病理资料比较超重肥胖组㊁正常体重组的血管损伤程度㊁炎细胞浸润程度高于低体重组(均P<0.05),但超重肥胖组㊁正常体重组血管损伤程度㊁炎细胞浸润程度比较,差异无统计学意义(均P> 0.05)㊂与正常体重组比较,超重肥胖组的系膜C3沉积减弱(P=0.035)㊂3组牛津病理分型㊁系膜免疫球蛋白沉积比较,差异无统计学意义(均P> 0.05),见表4,图1㊂㊃732㊃‘临床荟萃“2022年3月20日第37卷第3期 C l i n i c a l F o c u s,M a r c h20,2022,V o l37,N o.3Copyright©博看网. All Rights Reserved.表3按性别分层后3组U A㊁血红蛋白㊁e G F R比较项目低体重组(n=19)正常体重组(n=267)超重肥胖组(n=247)F值/χ2值P值男性例数8124149血红蛋白(g/L)126.1ʃ19.25138.9ʃ19.05142.6ʃ16.64*4.2690.015 e G F R[m l/(m i n㊃1.73m2)]99.56ʃ34.7783.23ʃ32.3979.36ʃ26.611.9470.145血U A(μm o l/L)382.9ʃ120.7397.6ʃ96.8409.6ʃ95.20.5540.575女性例数1114398血红蛋白(g/L)126.5ʃ22.11120.0ʃ15.77127.0ʃ15.55#2.711<0.01 e G F R[m l/(m i n㊃1.73m2)]100.8ʃ14.5187.83ʃ29.2381.96ʃ29.21*5.767<0.01血U A(μm o l/L)265.2ʃ48.33316.4ʃ84.41350.6ʃ85.42*#8.026<0.01注:与低体重组比较,*P<0.05;与正常体重组比较,#P<0.05表43组肾脏病理改变的比较项目低体重组(n=19)正常体重组(n=267)超重肥胖组(n=247)F值/χ2值P值免疫球蛋白沉积强度I g G0.26ʃ0.700.26ʃ0.670.33ʃ0.730.9640.358 I g A3.33ʃ0.613.08ʃ0.793.05ʃ0.770.7140.408 I g M0.53ʃ0.830.82ʃ1.020.79ʃ1.040.5470.569补体沉积强度C32.13ʃ0.992.04ʃ1.111.78ʃ1.18#3.8480.035 C1q0.14ʃ0.540.09ʃ0.370.08ʃ0.360.4220.615炎细胞浸润程度1.88ʃ1.202.48ʃ1.03*2.58ʃ0.91*4.0680.018血管损伤程度0.26ʃ0.650.79ʃ0.89*0.92ʃ0.95*4.9470.007牛津病理分型[例(%)]M114(73.7)228(85.4)210(85.0)1.6380.441 E13(15.8)48(18.0)56(22.7)3.6460.110 S17(36.8)137(51.3)128(51.8)1.6160.447 T016(84.2)239(89.5)203(82.2)5.7890.055 T1+T23(15.8)28(10.5)44(17.8)C014(73.7)225(84.3)215(87.0)2.5600.278 C1+C25(26.3)42(15.7)32(13.0)注:与低体重组比较,*P<0.05;与正常体重组比较,#P<0.05图13组C3沉积㊁血管损伤程度㊁炎细胞浸润程度比较a.C3沉积;b.炎细胞浸润程度;c.血管损伤程度2.43组肾脏累积生存率比较排除随访时间<6个月的患者后,共计380例,出现终点事件33例(8.6%),其中肾脏替代治疗4例,E S R D16例,血肌酐翻倍13例㊂低体重组中位随访时间为20.4个月,出现终点事件共2例(12.5%),均达到E S R D㊂正常体重组中位随访时间为22.9个月,出现终点事件10例(6.5%),其中肾脏替代治疗2例,E S R D5例,血肌酐翻倍3例㊂超重肥胖组中位随访时间为27.7个月,出现终点事件19例(9.0%),其中肾脏替代治疗2例,E S R D7例,血肌酐翻倍10例㊂K a p l a n-M e i e r 生存曲线表明,正常体重组的肾脏累积生存率高于超重肥胖组(L o g-r a n k检验,χ2=8.702,P= 0.003),而超重肥胖组肾脏累积生存率高于低体重组(L o g-r a n k检验,χ2=4.624,P=0.032)㊂3组的㊃832㊃‘临床荟萃“2022年3月20日第37卷第3期 C l i n i c a l F o c u s,M a r c h20,2022,V o l37,N o.3Copyright©博看网. All Rights Reserved.肾脏5年生存率分别为69.8%㊁75.6%㊁85.9%,正常体重组的5年肾脏生存率高于超重肥胖组(L o g-r a n k检验,χ2=4.996,P=0.025),而超重肥胖组的5年生存率高于低体重组(L o g-r a n k检验,χ2= 5.764,P=0.016)㊂见图2㊂2.5影响I g A N合并超重肥胖患者肾脏预后的危险因素分析对超重肥胖组进行单因素C o x回归分析,结果显示,起病时e G F R降低㊁24小时尿蛋白排泄量增加㊁血红蛋白降低㊁T G升高㊁肾小管萎缩/间质纤维化比例ȡ25%与预后相关(均P<0.05),见表5㊂将上述指标纳入多因素C o x回归分析,结果显示,24小时尿蛋白排泄量增加㊁T G升高㊁血红蛋白降低是影响I g A N合并超重肥胖患者肾脏不良预后的独立影响因素(均P<0.05),见表6㊂图23组K a p l a n-M e i e r生存曲线表5影响I g A N合并超重肥胖肾脏预后的C o x单因素分析因素回归系数标准误W a l dχ2值P值H R值95%C I下限上限年龄-0.0180.0190.8740.3500.980.941.02性别0.5610.4991.2620.2611.750.664.66 B M I0.1360.0773.1150.0491.171.001.36 e G F R-0.0400.01310.2760.0010.960.930.98 24小时尿蛋白排泄量0.2050.0826.2190.0131.231.041.44血红蛋白-0.0420.01115.7900.0000.960.940.98血U A0.0050.0033.7290.0521.011.001.10 T G0.2750.1354.1250.0421.321.011.72 C30.5100.9460.2910.5731.790.2313.86肾小管萎缩/间质纤维化比例ȡ25%0.7770.3275.6410.0183.441.239.59炎细胞浸润程度0.3750.3111.4540.2281.450.792.67激素和(或)免疫抑制剂治疗-0.1640.4850.1150.6100.790.321.97 A C E I/A R B治疗0.3080.4680.4340.5101.360.543.41表6影响I g A N合并超重肥胖肾脏预后的C o x多因素分析因素回归系数标准误W a l dχ2值P值H R值95%C I下限上限24小时尿蛋白排泄量0.2030.0974.4040.0351.231.011.48血红蛋白-0.0770.01525.6410.00010.930.890.95 T G0.4320.1805.7650.0151.551.092.213讨论I g A N是中国最常见的原发性肾小球疾病, 20%~40%的患者会缓慢发展为肾功能衰竭,这使得I g A N成为E S R D的主要病因之一㊂国外一项研究显示,I g A N患者的死亡率比正常人群增加53%,比正常人群提前6年死亡[15]㊂因此,临床医师应当足够重视I g A N㊂然而,预测I g A N患者预后十分困难㊂目前,其发病机制尚未明确,除已知的免疫因素外,可能与高血压㊁高尿酸㊁肥胖等多种因素有关㊂近年来,随着生活水平的提高,肥胖发病率逐年上升,已成为我国的一大公共卫生问题㊂在最近的全国调查中,超过50%的中国成年人超重或肥胖[16]㊂在2019年,超重和肥胖导致非传染性疾病相关的死亡率从1990年的5.7%上升到了11.1%[17]㊂流行病学资料显示,超重和肥胖是C K D和E S R D的共同危险因素[18-20]㊂本研究共入选I g A N患者533例,其中46.3%合并超重肥胖,男性较多,发病年龄较大,与既往文献报道基本一致[16]㊂在对3组临床资料的比较中发现,超重肥胖组的血压(舒张压及收缩压)较高,肾功能损害较为严重,脂质代谢异常者较多,血清C3㊁C4㊁C R P水平较高,I g M较低㊂目前认为肥胖患者发生代谢紊乱的可能机制是高尿酸血症㊁高血压和高三酰甘油血症等引起的胰岛素抵抗,导致动脉硬化进程加快,从而加重I g A N患者的病情㊃932㊃‘临床荟萃“2022年3月20日第37卷第3期 C l i n i c a l F o c u s,M a r c h20,2022,V o l37,N o.3Copyright©博看网. All Rights Reserved.恶化,同时高尿酸可通过多种机制促进肾间质纤维化,进一步加重肾损伤[21-22]㊂Y o n e k u r a等[23]在4060例原发性肾小球肾炎患者中发现,B M I>25 k g/m2的I g A N患者尿蛋白排泄量明显升高㊂F o x 等[24]发现B M I与I g A N患者的G F R显著相关,是G F R降低的危险因素㊂国际上关于I g A N病因的研究显示,肥胖可能通过肾小球高滤过或者改变肾小球基底膜的超微结构从而引起24小时尿蛋白排泄量升高[25-26]㊂在关于C3㊁C4的研究中,有文献报道, C3和C4由脂肪组织表达和分泌[27],且血清C3与代谢综合征密切相关[28-29]㊂国外学者发现血清C3和C4水平与I g A N患者B M I㊁蛋白尿呈正相关,提示肥胖可能通过诱导亚临床炎症而激活补体系统,并且与I g A N患者的肾脏表现密切相关[30-31]㊂此外,在一项来自瑞典的大型临床研究发现,在调整初始体重㊁身高㊁随访时间和生活方式等因素后,血清C3水平仍随体重的增加而升高[32]㊂一项关于I g M与B M I 关系的研究显示,I g M在减轻肥胖相关炎症㊁葡萄糖耐受不良和胰岛素抵抗中发挥着重要作用,这可能是造成超重肥胖组血清I g M水平较低的原因[33]㊂虽然3组牛津分型和免疫球蛋白沉积水平差异无统计学意义,但不能否认超重和肥胖对I g A N肾脏病理结构的影响㊂在本研究中,超重肥胖组的血管损伤程度㊁炎细胞浸润程度均高于其他组㊂我们观察到超重肥胖组主要表现为肾内血管损伤㊁小动脉血管壁增厚和小动脉玻璃样变性等,与国内外的研究结果一致,他们发现I g A N血管病变的加重程度与B M I有关,推测可能是肥胖引起全身血流量增加或血压升高,使得肾脏灌注增加,从而加重肾脏血管损伤[34]㊂本研究还发现,系膜C3沉积随着B M I的增加而降低,与H o n g等[35]结果一致,他们认为肥胖对I g A N局部补体系统激活的影响是适度的,血清C3与系膜C3的变化显示出了相互矛盾的结果,推测局部补体激活在I g A N的发病过程中起着重要作用㊂目前有学者已经研究了系膜C3沉积是否对I g A N 的疾病进展有影响,但在这个问题上有很多争议㊂N a m等[36]认为肾小球系膜C3和C4d沉积是I g A N 进展的独立危险因素㊂P a r k等[37]发现,在根据系膜C3沉积程度分组后,组间肾活检时的e G F R与24小时尿蛋白排泄量无差异㊂因此,系膜补体沉积可能对肾脏的表现和预后有不同的影响,需要进一步的分析来阐明系膜区补体沉积在I g A N中的病理作用㊂在对3组肾脏累积生存率的比较中,我们发现超重肥胖组和低体重组的肾脏累积存活率明显低于体重正常组,低体重组㊁超重肥胖组和正常体重组的5年肾脏生存率分别是69.8%㊁75.6%㊁85.9%,差异有统计学意义㊂这与一项对亚洲人群的大型研究结果一致,即低B M I和高B M I均与各种原因导致的死亡风险增加有关,而且总体上呈 U 形关联[8]㊂目前,中国成人肥胖率可高达50%[16],但有关I g A N合并肥胖患者预后危险因素的文献很少,因此,我们进一步分析了I g A N合并肥胖超重患者肾脏生存时间的影响因素㊂本研究提示,24小时尿蛋白排泄量㊁T G㊁血红蛋白是影响患者进入终点事件的独立危险因素㊂既往研究证实,24小时尿蛋白排泄量对肾脏结局的预测不受其他因素影响[38-39],因此可以认为它对I g A N合并超重肥胖患者的预后具有独立预测作用㊂国外学者也发现与低体重患者比较,高B M I更容易导致蛋白尿和肾功能不全,而蛋白尿的增多又会加剧肾功能的恶化,从而形成一个恶性循环[40]㊂肥胖与血红蛋白关系的潜在机制尚未完全明确㊂有学者认为,高B M I人群食用更多的食物,因此摄入更多的铁导致血红蛋白升高[41]㊂也有学者认为,肥胖在社会经济地位较低的个体中更为普遍,他们的饮食特点是一般以碳水化合物摄取较多,而含铁食物(如肉类)较少,血红蛋白水平较低[42]㊂体外研究显示,瘦素和促红细胞生成素具有协同作用,促进红系发育,推测高B M I人群的瘦素-肥胖基因可能是导致肥胖者血红蛋白水平升高的原因[41]㊂研究表明,肥胖和低血红蛋白是导致运动耗氧量峰值下降和氧化代谢能力下降的重要因素,而且血红蛋白水平低也是I g A N进展的一个危险因素,其不良结局的风险也较高[43-45]㊂无论是超重肥胖者合并其他代谢综合征,还是高血压或血U A代谢紊乱加重超重肥胖,可能都会加速I g A N的进展,及时干预血压㊁血脂㊁血U A等可以延缓I g A N进展对改善长期预后十分重要㊂本研究存在一定的局限性:①本研究为回顾性研究,结论可能受研究方法影响,因此需要前瞻性㊁大规模㊁长期随访的研究以明确B M I对I g A N的影响㊂②仅将就诊于青岛大学附属医院的患者包括在内,未纳入我国其他地区患者,不具有普遍性㊂因此,肥胖与I g A N的临床病理资料及预后的关系有待进一步研究㊂③本研究未纳入与代谢综合征相关的参数,如腰围等㊂综上,I g A N合并超重肥胖患者的临床病理表现更为严重,且预后较差㊂尿蛋白排泄量㊁T G㊁血红蛋白为影响患者进入终点事件的独立影响因素㊂还需要进一步研究I g A N患者最适合的B M I㊂在治疗及随访过程中,对于异常B M I的I g A N患者应加强㊃042㊃‘临床荟萃“2022年3月20日第37卷第3期 C l i n i c a l F o c u s,M a r c h20,2022,V o l37,N o.3Copyright©博看网. 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[6] L uP,L i X,Z h uN,e t a l.S e r u m u r i c a c i d l e v e l i s c o r r e l a t e dw i t h t h e c l i n i c a l,p a t h o l o g i c a l p r o g r e s s i o n a n d p r o g n o s i s o f I g An e p h r o p a t h y:A no b s e r v a t i o n a l r e t r o s p e c t i v e p i l o t-s t u d y[J].P e e r J,2020,8:e10130.[7] Z h e n g Y,W a n g Y,L i uS W,e ta l.P o t e n t i a lb l o o d p r e s s u r eg o a l s i n I g A n e p h r o p a t h y:P r e v a l e n c e,a w a r e n e s s,a n dt r e a t m e n t r a t e s i nc h r o n i ck i d n e y d i s e a s ea m o n gp a t i e n t sw i t hh y p e r t e n s i o n i nC h i n a(P A T R I O T I C)s t u d y[J].K i d n e y B l o o dP r e s sR e s,2018,43(6):1786-1795.[8] Z h e n g W,M c l e r r a n D F,R o l l a n d B,e t a l.A s s o c i a t i o nb e t w e e nb o d y-m a s si n d e xa n dr i s ko fd e a t hi n m o r et h a n1m i l l i o nA s i a n s[J].N e wE n g l JM e d,2011,364(8):719-729.[9] K a t a o k a H,O h a r a M,S h i b u i K,e ta l.O v e r w e i g h ta n do b e s i t y a c c e l e r a t e t h e p r o g r e s s i o n o f I g A n e p h r o p a t h y: P r o g n o s t i c u t i l i t y o f a c o m b i n a t i o n o f B M I a n dh i s t o p a t h o l o g i c a l p a r a m e t e r s[J].C l i nE x p N e p h r o l,2012,16(5):706-712.[10] W uC,W a n g A Y,L iG,e t a l.A s s o c i a t i o no f h i g hb o d y m a s si n d e xw i t hd e v e l o p m e n t o f i n t e r s t i t i a l f i b r o s i s i n p a t i e n t sw i t hI g An e p h r o p a t h y[J].B M CN e p h r o l,2018,19(1):381.[11] O u y a n g Y,X i e J,Y a n g M,e t a l.U n d e r w e i g h ti s a ni n d e p e n d e n tr i s k f a c t o rf o r r e n a lf u n c t i o n d e t e r i o r a t i o n i np a t i e n t sw i t h I g An e p h r o p a t h y[J].P L o SO n e,2016,11(9): e0162044.[12] K i k u c h iH,K a n d aE,M a n d a iS,e ta l.C o m b i n a t i o no f l o wb o d y m a s s i n d e xa n ds e r u m a l b u m i nl e v e l i sa s s oc i a t ed w i t hc h r o n i c k id ne y d i s e a s e p r o g r e s s i o n:T h e c h r o n i c k i d n e yd i se a s e-r e s e a r c ho fo u t c o m e si nt r e a t m e n ta n de p i d e m i o l o g y(C K D-R O U T E)s t u d y[J].C l i nE x p N e p h r o l,2017,21(1):55-62.[13] Y u n H R,K i m H,P a r k J T,e t a l.O b e s i t y,m e t a b o l i ca b n o r m a l i t y,a n d p r o g r e s s i o no fC K D[J].A mJK i d n e y D i s,2018,72(3):400-410.[14]裴改琴,秦嫒雅,王思清,等.血清I g A/C3和病理C3沉积对I g A肾病患者临床预后的影响[J].中华医学杂志,2020,100(30):2372-2377.[15]J a r r i c kS,L u n d b e r g S,W e l a n d e rA,e t a l.M o r t a l i t y i nI g An e p h r o p a t h y:An a t i o n w i d e p o p u l a t i o n-b a s e d c o h o r t s t u d y[J].JA mS o cN e p h r o l,2019,30(5):866-876.[16] W a n g Y,Z h a o L,G a o L,e ta l.H e a l t h p o l i c y a n d p u b l i ch e a l t h i m p l i c a t i o n so fo b e s i t y i n C h i n a[J].L a n c e tD i a b e t e sE n d o c r i n o l,2021,9(7):446-461.[17] P a nX F,W a n g L M,P a n A.E p i d e m i o l o g y a n dd e t e r m i n a n t so f o b e s i t y i nC h i n a[J].L a n c e tD i a b e t e sE n d o c r i n o l,2021,9(6):373-392.[18] L a iY J,H uH Y,L e eY L,e t a l.A s s o c i a t i o nb e t w e e no b e s i t ya n d r i s ko f c h r o n i ck i d n e y d i s e a s e:An a t i o n w i d e c o h o r t s t u d yi nT a i w a n[J].N u t r M e t a b C a r d i o v a s cD i s,2017,27(11):1008-1014.[19] W a n g Y,C h e nX,S o n g Y,e t a l.A s s o c i a t i o nb e t w e e n o b e s i t ya n dk i d n e y d i s e a s e:A s y s t e m a t i cr e v i e w a n d m e t a-a n a l y s i s[J].K i d n e y I n t,2008,73(1):19-33.[20] Z o c c a l i C.T h eo b e s i t y e p i d e m i c s i nE S R D:F r o m w a s t i n g t ow a i s t[J].N e p h r o l D i a lT r a n s p l a n t,2009,24(2):376-380.[21] B e r t h o u xF,M o h e y H,L a u r e n tB,e t a l.P r e d i c t i n g t h er i s kf o rd i a l y s i s o r d e a t hi n Ig A n e ph r o p a t h y[J].J A m S o cN e p h r o l,2011,22(4):752-761.[22] C h o iW J,H o n g Y A,M i n J W,e t a l.T h e s e r u mu r i c a c i d l e v e li s r e l a t e dt ot h e m o r es e v e r er e n a lh i s t o p a t h o l o g y o ff e m a l eI g An e p h r o p a t h yp a t i e n t s[J].JC l i n M e d,2021,10(9):1885.[23] Y o n e k u r aY,G o t oS,S u g i y a m a H,e ta l.T h e i n f l u e n c e so fl a r g e r p h y s i c a l c o n s t i t u t i o n s i n c l u d i n g o b e s i t y o n t h e a m o u n t o f u r i n e p r o t e i n e x c r e t i o n i n p r i m a r y g l o m e r u l o n e p h r i t i s: R e s e a r c ho ft h eJ a p a n r e n a lb i o p s y r e g i s t r y[J].C l i n E x pN e p h r o l,2015,19(3):359-370.[24] F o xC S,L a r s o n M G,L e i p E P,e t a l.P r e d i c t o r s o f n e w-o n s e tk i d n e y d i s e a s e i nac o mm u n i t y-b a s e d p o p u l a t i o n[J].J AMA, 2004,291(7):844-850.[25] K a l a i t z i d i sR G,S i a m o p o u l o sK C.T h e r o l e o f o b e s i t y i nk i d n e yd i se a s e:R e c e n tf i n d i ng sa n d p o t e n t i a l m e ch a ni s m s[J].I n tU r o lN e p h r o l,2011,43(3):771-784.[26] T a n a k aM,Y a m a d a S,I w a s a k i Y,e t a l.I m p a c t o f o b e s i t y o nI g A n e p h r o p a t h y:C o m p a r a t i v eu l t r a s t r u c t u r a l s t u d y b e t w e e no b e s e a n dn o n-o b e s e p a t i e n t s[J].N e p h r o nC l i nP r a c t,2009, 112(2):c71-c78.[27] G a b r i e l s s o n B G,J o h a n s s o n J M,L o n n M,e t a l.H i g he x p r e s s i o n of c o m p l e m e n t c o m p o n e n t si n o m e n t a l a d i p o s et i s s u e i no b e s em e n[J].O b e sR e s,2003,11(6):699-708.[28] K a r k h a n e h M,Q o r b a n i M,M o h a j e r i-T e h r a n i M R,e ta l.A s s o c i a t i o no f s e r u mc o m p l e m e n t C3w i t hm e t a b o l i c s y n d r o m ec o m p o n e n t s i nn o r m a lw e i g h to b e s e w o m e n[J].J D i a b e t e sM e t a bD i s o r d,2017,16:49.[29] O h s a w a I,I n o s h i t a H,I s h i i M,e ta l.M e t a b o l i c i m p a c to ns e r u ml e v e l s o f c o m p l e m e n t c o m p o n e n t3i nJ a p a n e s e p a t i e n t s[J].JC l i nL a bA n a l,2010,24(2):113-118.[30] W l a z l oN,v a n G r e e v e n b r o e k MM,F e r r e i r aI,e ta l.L o w-g r a d e i n f l a mm a t i o n a n d i n s u l i n r e s i s t a n c e i n d e p e n d e n t l ye x p l a i ns u b s t a n t i a l p a r t sof t h ea s s o c i a t i o nb e t w e e nb o d y f a t㊃142㊃‘临床荟萃“2022年3月20日第37卷第3期 C l i n i c a l F o c u s,M a r c h20,2022,V o l37,N o.3Copyright©博看网. All Rights Reserved.。
英语作文结尾感受
英语作文结尾感受When concluding an English essay its important to leave a lasting impression on the reader. Here are some tips and examples to help you craft a powerful ending that encapsulates your overall message and leaves the reader with a sense of satisfaction or thought.1. Restate Your Thesis Begin by reiterating your main argument or thesis statement in a new way. This reinforces the central idea of your essay.Example In conclusion the importance of a balanced diet cannot be overstated. As demonstrated throughout this essay it plays a crucial role in maintaining physical health and mental wellbeing.2. Summarize Main Points Briefly summarize the key points youve made in the body of your essay. This helps to remind the reader of the evidence and arguments youve presented.Example To recap the benefits of regular exercise include improved cardiovascular health enhanced mood and increased longevity. It is clear that incorporating physical activity into our daily routines is essential for a healthy lifestyle.3. Provide a Final Thought or Reflection Offer a final insight or reflection that ties back to your thesis. This could be a personal reflection a call to action or a thoughtprovoking question.Example As we consider the future of education it is my hope that we continue to embrace technology as a tool for learning while never losing sight of the value of human interaction and mentorship.4. End with a Memorable Quote or Statement If it fits the context of your essay ending with a quote from a relevant authority or a powerful statement can leave a lasting impression.Example In the words of Mahatma Gandhi Be the change you wish to see in the world. As we move forward let us each take this message to heart and strive to make a positive impact on our communities.5. Use a Conclusion Transition Transition smoothly from the body of your essay to your conclusion. Phrases like In conclusion To sum up or In wrapping up can be effective.Example In conclusion the evidence is clear sustainable energy sources are not only beneficial for the environment but also for our economy and society as a whole.6. Avoid New Information Your conclusion should not introduce any new arguments or information. It should wrap up the discussion youve already presented.7. Be Concise and Clear Keep your conclusion brief and to the point. A longwinded conclusion can dilute the impact of your essay.8. Use Strong Positive Language The language you use in your conclusion should be strong and positive to leave the reader with a sense of affirmation or inspiration.9. Proofread As with the rest of your essay make sure your conclusion is free of grammatical errors and typos. A polished conclusion can enhance the overall quality of your writing.10. Leave a Lasting Impression Aim to end your essay in a way that makes the reader think feel or act. Whether its a call to action a question or a powerful statement the conclusion should resonate with the reader long after theyve finished reading. Remember the conclusion is your last chance to make an impact on the reader. Use it to reinforce your argument summarize your points and leave them with a final thought that encapsulates the essence of your essay.。
α型地中海贫血的英语表达
α型地中海贫血的英语表达Anemia, a Persistent Challenge: Understanding α-ThalassemiaAnemia, a complex medical condition, has long been a subject of intense research and clinical concern. Among the various forms of anemia, α-thalassemia stands out as a persistent challenge, affecting individuals across the globe. This genetic disorder, characterized by a reduction or absence of alpha-globin chain production, can have far-reaching implications on an individual's health and well-being.The prevalence of α-thalassemia varies significantly among different geographic regions and ethnic populations. It is particularly common in areas where malaria has been endemic, as the genetic mutation responsible for the condition can provide a degree of protection against the deadly disease. However, the impact of α-thalassemia goes beyond its geographic distribution, as it can have profound consequences on the lives of those affected.One of the primary challenges associated with α-thalassemia is the diverse range of clinical presentations. The severity of the condition can vary widely, ranging from asymptomatic carriers to individuals with life-threatening complications. The mildest form, known as α-thalassemia trait, often goes unnoticed, as individuals may exhibit no outward sign s of the disorder. In contrast, the most severe form, α-thalassemia major, can result in severe anemia, growth and developmental delays, and a host of other medical complications.The genetic basis of α-thalassemia adds to the complexity of the condition. The human genome contains four alpha-globin genes, and the deletion or mutation of these genes can lead to different subtypes of α-thalassemia. The inheritance pattern of the condition further complicates the clinical picture, as individuals can inherit a varying number of affected genes from their parents.Diagnosing α-thalassemia can be a daunting task, as the symptoms can often mimic those of other forms of anemia. Clinicians must rely on a combination of laboratory tests, including hemoglobin electrophoresis, genetic analysis, and clinical evaluation, to accurately identify the specific subtype of the disorder. This diagnostic process can be time-consuming and requires a high level of expertise, often leading to delays in appropriate treatment and management.The management of α-thalassemia is equally complex, as it requires a multidisciplinary approach involving hematologists, pediatricians, and other healthcare professionals. Depending on the severity of the condition, treatment options may include blood transfusions, iron chelation therapy, and in some cases, stem cell transplantation.These interventions can be costly, time-consuming, and may not be readily accessible in all healthcare settings, particularly in resource-limited regions.Beyond the medical challenges, the social and psychological impact of α-thalassemia cannot be overlooked. The stigma and misconceptions surrounding the condition can lead to discrimination, isolation, and emotional distress for those affected. Families and caregivers often face the burden of navigating the complex healthcare system, advocating for their loved ones, and providing ongoing support.In recent years, there have been significant advancements in our understanding of α-thalassemia, including the identification of genetic markers and the development of new diagnostic tools and treatment approaches. However, much work remains to be done to improve the quality of life for individuals living with this condition.Addressing the challenges of α-thalassemia requires a multifaceted approach, involving collaborative efforts among researchers, healthcare providers, policymakers, and patient advocacy groups. Increasing awareness, improving access to high-quality healthcare, and fostering international collaborations are crucial steps in the fight against this persistent and often overlooked form of anemia.By working together, we can strive to alleviate the burden of α-thalassemia, empowering affected individuals and their families to lead fulfilling lives, and ultimately, contributing to a more equitable and inclusive healthcare landscape.。
《2024年《通过接纳与承诺疗法抗癌》(节选)英汉翻译实践报告》范文
《《通过接纳与承诺疗法抗癌》（节选）英汉翻译实践报告》篇一《通过接纳与承诺疗法抗癌》英汉翻译实践报告（节选）一、引言本篇翻译实践报告旨在探讨接纳与承诺疗法在抗癌过程中的重要性，通过具体的实践案例分析，将这一治疗方法的核心内容与实际运用相结合，进行详细的英汉翻译实践。
报告的目的是提高读者对接纳与承诺疗法的认识，为相关领域的翻译工作提供参考。
二、原作介绍本篇翻译实践的原作主要介绍了接纳与承诺疗法（ACT）在抗癌过程中的运用。
ACT是一种心理治疗方法，强调接受无法改变的事实并承诺为改善自己的生活而努力。
在癌症治疗过程中，这种治疗方法能帮助患者调整心态，提高应对能力，积极面对治疗带来的压力。
三、翻译过程分析在翻译过程中，首先要充分理解原文内容，明确接纳与承诺疗法的核心思想及其在抗癌过程中的作用。
接着，根据英语句子的结构特点，灵活运用各种翻译技巧，如转换语序、增译、减译等，使译文更加符合中文表达习惯。
同时，注重保持原文的语义连贯性和逻辑性，确保译文的准确性和流畅性。
四、重点难点解析在翻译过程中，遇到了以下重点难点：1. 心理专业术语的翻译：如“接受”（acceptance）和“承诺”（commitment）等词汇在心理学领域具有特定的含义。
在翻译过程中，需要准确理解这些术语的内涵，并选择恰当的词汇进行表达。
2. 跨文化差异的处理：由于中西方文化差异较大，在翻译过程中需要充分考虑目标读者的文化背景和思维方式，使译文更加贴近目标读者的阅读习惯。
3. 原文逻辑关系的梳理：由于原文句子结构较为复杂，需要仔细分析原文的逻辑关系，确保译文的连贯性和逻辑性。
针对上述问题，我们在翻译时采取了以下措施：首先，针对心理专业术语的翻译，我们通过查阅相关心理学资料和文献，准确理解这些术语的内涵，并选择最恰当的中文词汇进行表达。
其次，针对跨文化差异的处理，我们进行了充分的调研，了解目标读者的文化背景和思维方式。
在翻译过程中，我们尽可能保留原文的文化特色，同时用更加贴近目标读者阅读习惯的中文进行表达。
关于瑜伽的英语作文
Yoga is an ancient practice that originated in India over5,000years ago.It is a holistic discipline that encompasses physical postures,breathing exercises,and meditation,all aimed at promoting a healthy body and a calm mind.The Physical Aspect of YogaThe physical practice of yoga,known as asana,involves a series of postures that are designed to improve flexibility,strength,and balance.These poses can be modified to suit all levels of practitioners,from beginners to advanced.The asanas work on various muscle groups and joints,helping to alleviate stress and tension in the body. Breathing TechniquesPranayama,or breath control,is an integral part of yoga.It involves learning to breathe deeply and rhythmically,which can help to reduce stress and anxiety.Breathing exercises are often practiced in conjunction with asanas to enhance the overall benefits of the practice.Meditation and MindfulnessYoga also includes meditation and mindfulness practices that help individuals to focus their attention and cultivate a sense of inner peace.This aspect of yoga is particularly beneficial for mental health,as it can help to reduce symptoms of depression and improve overall wellbeing.The Philosophy Behind YogaBeyond the physical and mental benefits,yoga is deeply rooted in philosophy.It is based on the belief that the mind and body are interconnected and that by practicing yoga,one can achieve a state of harmony and balance.The ultimate goal of yoga is to unite the individual with the divine,or the ultimate reality.Yoga StylesThere are various styles of yoga,each with its own emphasis.For example,Hatha yoga focuses on the balance of opposites,such as strength and flexibility,while Vinyasa yoga links breath with movement in a flowing sequence of poses.Bikram yoga,on the other hand,is practiced in a heated room and follows a set sequence of26postures.Health BenefitsRegular practice of yoga has been shown to have numerous health benefits.It can improve cardiovascular health,increase lung capacity,and strengthen the immune system. Yoga is also beneficial for those suffering from chronic conditions such as back pain, arthritis,and high blood pressure.ConclusionIn conclusion,yoga is a comprehensive practice that offers physical,mental,and spiritual benefits.It is a practice that can be adapted to suit anyone,regardless of age or fitness level,and can be a valuable addition to a healthy lifestyle.Whether you are seeking to improve your physical health,reduce stress,or explore the deeper philosophical aspects of life,yoga offers a path to personal growth and transformation.。
关于抗原检测的英文作文
关于抗原检测的英文作文Antigen testing is a crucial tool in the fight against infectious diseases. It allows for the rapid detection of specific proteins on the surface of a virus or bacteria, helping to identify infections in a timely manner.The process of antigen testing involves collecting a sample from the patient, such as a nasal or throat swab, and then analyzing the sample for the presence of thetarget antigen. This can be done using various methods, including rapid diagnostic tests that provide results in a matter of minutes.One of the key advantages of antigen testing is its speed. Unlike some other forms of testing, antigen tests can deliver results quickly, allowing for prompt action to be taken to prevent the spread of infection.However, it's important to note that antigen testing is not without its limitations. While it is highly specific,meaning it is good at detecting the target antigen, it may not be as sensitive as other forms of testing, leading to potential false negative results.Despite these limitations, antigen testing remains an important tool in the fight against infectious diseases. When used in conjunction with other testing methods and public health measures, it can help to quickly identify and isolate cases, preventing further transmission of the disease.。
做冬季运动意义的英语作文
Winter sports are a significant part of many peoples lives,especially in regions where snow and cold weather are common.Engaging in winter sports not only offers a fun and exciting way to spend time but also comes with numerous physical and mental health benefits.Heres a detailed look at the importance of winter sports:1.Physical Fitness:Winter sports such as skiing,snowboarding,and ice skating provide a fullbody workout.They help to improve cardiovascular health,increase muscle strength, and enhance balance and coordination.2.Weight Management:Due to the high energy expenditure involved in winter sports, they can be an effective way to burn calories and maintain a healthy weight.3.Mental Health:The fresh air and natural environment associated with winter sports can have a positive impact on mental health.They can reduce stress and anxiety,and providea sense of relaxation and enjoyment.4.Social Interaction:Winter sports often involve group activities,which can foster social connections and camaraderie.They provide an opportunity to meet new people and create lasting friendships.5.Skill Development:Learning and mastering winter sports requires focus,discipline, and perseverance.These skills can be transferred to other areas of life,promoting personal growth and development.6.Cultural Experience:Winter sports are deeply rooted in the culture of many regions. Participating in these activities can provide insights into local customs and traditions, enriching ones cultural understanding.7.Adaptability:Winter sports teach individuals to adapt to changing conditions and to be flexible in their approach to challenges,a valuable skill in various life situations.8.Appreciation for Nature:Engaging in winter sports can deepen ones appreciation for the natural world,promoting environmental awareness and conservation efforts.9.Economic Benefits:Winter sports can stimulate local economies by attracting tourists and creating jobs in the hospitality and sports industries.10.Lifelong Activity:Many winter sports can be enjoyed throughout ones life,providinga source of lifelong enjoyment and physical activity.In conclusion,winter sports offer a myriad of benefits that extend beyond mere physical activity.They contribute to overall wellbeing,social engagement,and personal development,making them a worthwhile pursuit for individuals of all ages and abilities.。
如何看待冠状病毒英文作文
如何看待冠状病毒英文作文The coronavirus outbreak has had a significant impact on our lives. It has caused widespread panic and fear, and has disrupted daily routines and activities. People are concerned about their health and the health of their loved ones. The virus has also had a major impact on the global economy, with businesses shutting down and people losing their jobs. It is a challenging and uncertain time for everyone.In terms of personal health, the coronavirus has made us more aware of the importance of hygiene and cleanliness. We are constantly reminded to wash our hands frequently and to avoid touching our faces. We have also become more conscious of maintaining social distancing and wearing face masks in public places. These measures are necessary to prevent the spread of the virus and protect ourselves and others.The pandemic has also highlighted the importance oftechnology and its role in our lives. With the need for social distancing, many people have turned to virtual platforms to stay connected with friends, family, and colleagues. Video calls and online meetings have become the new norm. Online shopping and food delivery services have also seen a surge in demand. Technology has allowed us to adapt to the new circumstances and continue with our daily activities in a different way.The coronavirus has exposed the vulnerabilities in our healthcare systems. It has put immense pressure onhospitals and healthcare workers. The lack of medical supplies and equipment has been a major concern. However,it has also shown the resilience and dedication of healthcare professionals who are working tirelessly totreat patients and find a cure. The crisis has highlighted the need for better preparedness and investment in healthcare infrastructure.The pandemic has had a profound impact on mental health. The isolation and uncertainty have taken a toll on people's well-being. Many are experiencing anxiety, depression, andloneliness. It is important to prioritize mental health during these challenging times. Engaging in activities that bring joy and practicing self-care can help alleviate someof the stress. It is also crucial to reach out to friends and family for support and seek professional help if needed.In conclusion, the coronavirus outbreak has had far-reaching effects on various aspects of our lives. It has changed the way we live, work, and interact with others. It has taught us the importance of personal hygiene and therole of technology in staying connected. It has exposed the weaknesses in healthcare systems and highlighted the needfor better preparedness. It has also had a significant impact on mental health. As we navigate through this crisis, it is important to stay informed, take necessary precautions, and support each other.。
合唱比赛的默契作文英语
In the realm of choral competitions,the concept of chemistry or mutual understanding among the participants plays a crucial role in the success of a performance. This chemistry is not only about the harmonious blending of voices but also the collective understanding of the music,the emotions it conveys,and the way the group works together as a cohesive unit.Understanding the Music:The first step in developing a strong sense of chemistry within a choir is a deep understanding of the music itself.Each member must not only know their part but also understand how it fits into the larger context of the piece.This includes recognizing the dynamics,tempo changes,and the emotional journey of the music.Rehearsal and Preparation:Rehearsals are where the choir members can develop their understanding of each others strengths and weaknesses.Through consistent practice,they learn to anticipate each others moves,support each others voices,and synchronize their breathing and phrasing.Communication:Effective communication is key in a choir.This includes verbal cues from the conductor, nonverbal cues like eye contact and body language,and the ability to listen and respond to each others voices.A conductor who can communicate clearly and inspire the choir can significantly enhance the groups chemistry.Trust and Support:Trusting ones fellow choir members is essential.Singers must trust that their colleagues will hit the right notes,maintain the correct tempo,and support them in their vocal parts. This trust is built over time through shared experiences and the knowledge that everyone is working towards a common goal.Individual Contribution:While the focus is on the collective sound,each choir member must also contribute their individual talents.This includes not only their vocal abilities but also their commitment to the group,their discipline in practice,and their ability to adapt to the needs of the ensemble.Embracing Diversity:A choir is made up of individuals with different voices,backgrounds,and experiences. Embracing this diversity can enrich the groups sound and dynamics.Each voice brings a unique quality that,when combined with others,creates a rich tapestry of sound.Handling Pressure:Choral competitions can be highpressure situations.The groups chemistry can be tested under these circumstances.Its important for the choir to remain focused,support each other,and maintain a positive attitude,even in the face of adversity.Performance Etiquette:On stage,the choir must present a united front.This includes maintaining good posture, making eye contact with the audience and the conductor,and ensuring that all movements are coordinated and purposeful.PostPerformance Reflection:After a performance,its beneficial for the choir to reflect on their performance together. This can help identify areas of strength and areas that need improvement,further enhancing the groups chemistry and readiness for future performances.In conclusion,the chemistry within a choir is a multifaceted concept that encompasses understanding,communication,trust,individual contribution,diversity,handling pressure, performance etiquette,and reflection.A choir with strong chemistry will not only sound better but will also be more resilient and adaptable,making them a formidable force in any choral competition.。
The impact of social support on mental health
The impact of social support on mental health is a topic that has garnered significant attention in recent years. The growing body of research in this area suggests that social support plays a crucial role in promoting mental health and well-being.Social support refers to the assistance, encouragement, and validation individuals receive from their social network, including family, friends, and community. This support can take various forms, such as emotional support, instrumental support, informational support, and appraisal support. It provides individuals with a sense of belonging, security, and connection with others, which are essential for their mental well-being.Numerous studies have demonstrated the positive effects of social support on mental health. Research has shown that individuals with strong social support systems are less likely to experience psychological distress, depression, and anxiety. They are also more resilient and better able to cope with stress and adversity. In contrast, individuals who lack social support are at a higher risk of developing mental health problems.Social support has been found to be particularly beneficial in times of crisis or trauma. Whether it's the loss of a loved one, a serious illness, or a natural disaster, having a strong support network can help individuals navigate through difficult life events and recover more quickly. The presence of caring and empathetic individuals can provide comfort, reassurance, and a sense of hope during challenging times.Furthermore, social support can also enhance individuals' self-esteem and confidence, which are important factors in maintaining good mental health. When individuals feel valued and accepted by their social network, they are more likely to have a positive self-image and a greater sense of self-worth. This, in turn, can protect them from developing mental health problems and improve their overall well-being.It's important to note that the quality of social support is key. It's not simply the number of people in one's social network that matters, but the nature of the relationships and the level of support they provide. A supportive relationship characterized by trust, empathy, and understanding is more beneficial than superficial or conflict-ridden relationships. Additionally, it's essential for individuals to feel that they can rely on their support network when needed, and that their needs and feelings are taken seriously.For some individuals, social support can come in the form of formal support groups, therapy, or community services. These resources can provide a sense of understanding and validation, as well as practical guidance and advice. For others, informal support from family and friends can provide a sense of connection and belonging, which contributes to their mental well-being.In conclusion, social support plays a crucial role in promoting and maintaining mental health. It provides individuals with a sense of belonging, security, and connection, which are essential for their well-being. Research has shown that social support can reduce the risk of developing mental healthproblems, improve coping with stress and adversity, and enhance self-esteem and confidence. As such, fostering strong social support networks at both the individual and community levels is important for promoting mental health and overall well-being.。
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Case reportA 25-year-old woman presented intermittent, painless, gross hematuria since 3 months ago. Her past medical history was significant for rheumatoid arthritis for 5 years, presented as recurrent joints pain involving bilateral waists, metacarpophalangeal joints, proximal articulationes interphalangeae manus, knees, and ankles, and morning stiffness in her hand joints with duration over 1 hour per day. Rheumatoid factor was positive. Prednisolone, methotrexate, and leflunomide had been used to control her joints pain but were ceased 1 year ago. Her joints pain was aggravate since 3 months ago. She denied history of any significant infectious disease, chronic illness, including rash, oral ulcer and photosensitization. Clinical examination revealed no significant abnormality. Blood pressure was 120/80 mmHg.Laboratory evaluation showed the following values: white blood cell count, 5.72*109/L, red blood cell count, 4.73*1012/L, hemoglobulin, 12.8g/L, platelet count, 305*109/L. Serological evaluation showed the following values: antinuclear antibody titer, 1:320 (granular pattern); negative anti–double-stranded DNA and extractable nuclear antibody; rheumatoid factor, 50 RU/ml; anti-cyclic citrullinated peptide 64RU/ml; indirect immunofluorescence (IIF) in two times test at interval of 3 month showed perinuclear antineutrophil cytoplasmic antibody (p-ANCA) positivity, further testing using enzyme linked immunosorbent assay (ELISA) confirmed the specificity of the p-ANCA for myeloperoxidase (MPO), with an concentration of 65 RU/ml and 94 RU/ml respectively; erythrocyte sedimentation rate, 15 mm/h; C-reactive protein, 2.76mg/dl; hepatitis B surface antigen, and hepatitis C antibody test results were negative. Hand x-ray revealed multiple-site damage in small hand joints. Pulmonary computed tomography scan revealed dispersedly distributed patchy-like ground-glass shadow in bilateral lung. Eye examination revealed bilateral conjunctivitis.Renal ultrasound showed a right kidney measuring 12.1 cm and a left kidney measuring 12.5 cm. Urinalysis showed a gravity of 1.015, 2+ protein, full-field red blood cell count, 1 white blood cells/high-power field, and the absence of cellular casts. A 24-hour urine collection contained 2.9 g of protein. Glomerular hematuria was confirmed by detection for deforming rate of urine red blood cell by using phase-contrast microscopy. Serum creatinine was 73umol/l. A renal biopsy was performed.Kidney Biopsy FindingsLight microscopic examination disclosed 31 glomeruli. Glomeruli appeared normal in size and showed a mild global increase in mesangial cells and matrix, and moderate focal and segmental aggravation. Basement membrane was vacuolated and segmentally incrassated. **-binding protein was deposited in subepithelium and subendothelium. In addition, 3 glomeruli showed small cellular crescent formation, and 3 glomeruli showed small fibrotic crescent formation. Tubules displayed vacuolation, granulation, and focal atrophy. There was focal interstitial infiltration of lymphocytes and monocytes accompanied with interstitial fibrosis. V essels showed mild arteriosclerosis.Immunofluorescence staining of 2 glomeruli showed granular capillary wall positivity of 2+ intensity for immunoglobulin G (IgG), and mass-like mesangial positive of 3+ intensity for IgA, global mesangial and segmental capillary wall.Sampling for electron microscopy consisted of 4 glomeruli. Glomeruli showed a mild to moderate increase in mesangial cells and matrix, mass-like electron-dense deposition in mesangial and submesangial area, and foot-process effacement. There were no significant pathologicalchanges in basement membrane. Tubules displayed vacuolation and partial atrophy. There was interstitial infiltration of lymphocytes and monocytes accompanied with collagen fibre proliferation.Clinical pathological diagnosisThe symmetrical multiple-site joints pain with the duration of 5 years accompanied with the morning stiffness and a positive rheumatoid factor established the diagnostic of rheumatoid arthritis for the female patient. In recently 3 month, the recurrent joints pain and elevated level of rheumatoid factor imply the activation of RA. In the process of exploring the pathogenesis of gross hematuria, a positive MPO-ANCA was detected, which plus the dispersedly distributed patchy-like ground-glass shadow in bilateral lung and the bilateral conjunctivitis suggested the existence of systemic vasculitis, an uncommon complication in rheumatoid arthritis. However, renal biopsy findings were diagnostic of IgA nephropathy.Clinical Follow-UpGiven the IgA nephropathy was most possibly secondary to RA and the existence of systemic vasculitis, the patient was treated with oral prednisolone (50 mg per day) and leflunomide (20 mg per day). At the 4th month follow-up, urine protein decreased to 0.3 gram per 24-hour, hematuria alleviated to 10 red blood cells/high-power field, serum creatinine maintained at 61umol/l. QuestionWhether systemic vasculitis existed in this patient? Whether the positive MPO-ANCA was associated with the presentation of systemic vasculitis in this patient?If yes, what was the association between IgA nephropathy and the positive MPO-ANCA? What was the association between IgA nephropathy and systemic vasculitis?If no, what was the association between RA and the positive MPO-ANCA? What was the association between RA and IgA nephropathy?。