It was a retrospective cohort study. Patients diagnosed with idiopathic membranous nephropathy (IMN) and received rituximab (RTX) alone for one course of treatment during hospitalization in the Department of Nephrology of the First Hospital of Jilin University from March 2020 to March 2022 were enrolled. The patients were divided into 1 g standard treatment group (once 1 g every 2 weeks for twice) and 375 mg/m 2 experimental treatment group (375 mg/m 2 once a week for 4 weeks) according to the different methods of drug administration, and the efficacy and safety of different doses of RTX in the treatment of IMN were compared between the two groups to provide a reference for optimizing the clinical treatment protocol. The patients were followed up regularly for more than 9 months after treatment and the data were complete. A total of 69 patients were included with age of (51.7±11.8) years old, and 46 males (66.7%). There were 31 patients in the 1 g standard treatment group and 38 patients in the 375 mg/m 2 experimental treatment group. The proportion of first-treatment patients in the 1 g standard treatment group was higher than that in the 375 mg/m 2 experimental treatment group (87.1% vs. 65.8%, χ2=4.174, P=0.041). There were no statistically significant differences in the general data, clinical characteristics and baseline laboratory parameters between the two groups (all P>0.05). At the end of 3 months of treatment, 22 patients (31.9%) experienced remission, including 9 patients (29.0%) in the 1 g standard treatment group and 13 patients (34.2%) in the 375 mg/m 2 experimental treatment group ( χ2=0.211, P=0.646). At 6 months, 30 patients (43.5%) experienced remission, including 12 patients (38.7%) in the 1 g standard treatment group and 18 patients (47.4%) in the 375 mg/m 2 experimental treatment group ( χ2=0.521, P=0.470). At 9 months, 38 patients (55.1%) achieved remission, including 18 patients (58.1%) in the 1 g standard treatment group and 20 patients (52.6%) in the 375 mg/m 2 experimental treatment group ( χ2=0.204, P=0.652). At 9 months, the 24 h urine protein of 1 g standard treatment group and 375 mg/m 2 experimental treatment group decreased by 7.93 (6.24, 8.46) g and 7.45 (5.66, 8.67) g (both P<0.05), respectively, and serum albumin increased by 16.4 (15.5, 17.5) g/L and 15.5 (9.0, 15.8) g/L (both P<0.05), respectively, from the baseline value. Kaplan-Meier survival analysis result showed that there was no significant difference in the time of phospholipase A2 receptor titer decreasing to <5 RU/ml between the two groups (Log-rank χ2=3.653, P=0.056). Twenty-three non-serious adverse events occurred in the 1 g standard treatment group, involving 16 patients, and 10 non-serious adverse events occurred in the 375 mg/m 2 experimental treatment group, involving 10 patients. There was better safety in the 375 mg/m 2 experimental treatment group than that in the 1 g standard treatment group ( Fisher value=8.593, P=0.015). Both 375 mg/m 2 regimen and 1 g regimen of RTX in IMN patients are effective in relieving proteinuria and elevating serum albumin. The 375 mg/m 2 regimen of RTX has a lower incidence of adverse events compared with the 1 g regimen.

慢性肾脏病( CKD )在普通人群的发病率为10％ ～13％ 〔1,2〕. 随着年龄的增长, CKD 的危险因素如糖尿病、高血压等发生率增加,导致老年CKD发病率明显增加. 美国NHANES 2011 ～2012 年调查数据显示,65～79岁CKD发病率为31. 5％,80岁及以上CKD发生率高达65％ 〔3〕.

为了完善以"岗位胜任力"为导向的住院医师规范化培训体系,本研究采用问卷调查的方法,调查内科及全科住院医师规范化培训基地中60名住院医师的基本信息、医疗法律法规知识掌握情况（主要观察指标）,以及"岗位胜任力"自我评价（次要观察指标）等,并对这些数据进行统计学分析。问卷调查结果提示在加强住院医师临床专业知识和技能培训的同时,应当重视住院医师医疗法律法规知识及沟通合作能力的培养。

住院医师规范化培训是医学生毕业后正式进入临床工作前的重要临床教育阶段,在此阶段切实有效地培养临床实践技能至关重要.文章分析了完全以临床患者为实践对象的种种弊端,引入了角色扮演以及情景模拟教学的概念,总结了角色扮演结合情景模拟教学法在肾内科住院医师规范化培训临床带教中的诸多优势,并以高钾血症为例提出了角色扮演结合情景模拟教学法的实施方案,具体包括:编写情景模拟案例、实施过程、小组讨论以及归纳总结,指出角色扮演结合情景模拟教学法可以取得较好的住院医师规范化培训教学效果,具有实际应用价值.

特发性膜性肾病（idiopathic membranous Rephropathy,1MN）是成人肾病综合征的原因之一[1]。特发性膜性肾病在我国的发生率逐渐增高[2]。免疫球蛋白G（immunoglobulin G,IgG）在特发性膜性肾病发病机制中起了重要作用。目前认为,特发性膜性肾病是因为机体产生了自身IgG型抗体,该抗体可识别肾小球足细胞的靶抗原,并形成原位免疫复合物,导致基底膜通透性增加,引起蛋白尿及低蛋白血症等一系列临床症状[1,3]。而随着肾小球基底膜通透性增加,肾小球机械屏障破坏,血中的IgG也会大量漏出[4],尿IgG水平增高。本研究旨在研究

Objective:To investigate the clinical characteristics of patient with giant ovarian mature cystic teratoma with contralateral ovarian endometriosis cysts,and to analyze the diagnostic experience and treatment process.Methods:The chinical materials of one case of giant hepatic mature cystic teratoma with contralateral ovarian endometriosis cyst was analyzed retrospectively,and the related literatures were reviewed.Results:The patient was admitted to the hospital for peritoneal giant mass in a physical examination.A large abdominal cysts was seen by gynecologic ultrasound.In the left ovary,a 61 mm× 48 mm cystic light mass was seen,and the viscous liquid was found in it.The abdominal CT showed a huge lump of mixed density in the right abdomen.The areas of density of fat,calcification density and density of soft tissue were found in the abdomen.The liver was pressured by the mass.The right ovarian tumor size was about 40 cm×35 cm×30 cm,up to the diaphragm,down to the pelvic tumor;the posterior wall of tumor adhered the left lobe of liver and the liver was squeezed to the upper right.The size of the left ovarian endometriosis cyst was about 7 cm × 6 cm× 6 cm.The operation was to remove the right ovarian tumor and left ovarian endometriosis cyst,and to reconstruct bilateral ovaries.The pathological diagnosis was right ovarian mature cystic teratoma and left ovarian endometriosis cyst.After 2 years of follow-up,norecurrence of the tumor was found.The patient was conceived with in vitro fertilization frozen embryo transfer (IVF-ET).Conclusion:The huge mature teratoma combined with contralateral ovarian endometrial cyst,which adhereds to the liver,is rare.Surgical treatment will gain good prognosis.IVF-ET should be early done when the patient is going to be infertile after surgery.

糖尿病肾病（Diabetic nephropathy,DN）是糖尿病（diabetes mellitus,DM）最常见的慢性并发症之一,是糖尿病患者死亡的主要原因。临床上约30%-50%的1型DM患者及5%-10%的2型DM患者发展为DN,且有1/3的患者最后发展为终末期肾病（end-stage renal disease,ESRD）[1]。足细