as idiopathic membranous nephropathy (IMN) because they have unknown etiology. [2] There are significant differences in the treatment of the two forms of diseases; the Kidney Disease: Improving Global Outcomes guidelines recommend corticosteroids combined with calcineurin inhibitors/ alkylating agents as the initial therapy for IMN. [3] However, the treatment of secondary membranous nephropathy (SMN) is mainly focused on the etiology. Given the limitations of traditional renal biopsy diagnosis, such as perirenal hematoma, arteriovenous fistulas, infection, and damage to other organs, [4] it is extremely important to find reliable serological biomarkers to differentiate between IMN and SMN. In 2009, M-type phospholipase A2 receptor (PLA2R) was identified as the first target antigen for IMN, [5] and the circulating antibody against PLA2R (PLA2R-AB) was used for the non-invasive diagnosis of IMN, with 78% sensitivity and 99% specificity. [6] Thrombospondin type I domain-containing 7A (THSD7A), which is similar to PLA2R in structure, was identified as a second autoantigen of adult IMN. [7] Several studies have indicated that the circulating THSD7A-AB levels represent another promising alternative biomarker for the diagnosis of IMN. Serological testing for circulating THSD7A-AB provides a rapid IMN diagnostic method for clinicians. However, Thrombospondin type I domain-containing 7A (THSD7A), is a specific autoantigen of adult idiopathic membranous nephropathy (IMN), whose circulating antibody (THSD7A-AB) represents a promising biomarker for diagnosis of IMN. The objective of this meta-analysis is to investigate the diagnostic efficiency of THSD7A-AB for IMN. After rigorous data extraction, quality assessment, and data analysis, 10 articles (4545 patients) are included. For IMN, the summary sensitivity is 4% (2-7%), and the specificity is 99% (98-100%). The summary positive likelihood ratio (PLR) and negative likelihood ratio (NLR) are 5.40 (2.40-11.90) and 0.97 (0.95-0.99), respectively. The diagnostic odds ratio (DOR) is 6.00 (2.00-12.00). The area under the summary receiver operating characteristic curve (AUC) is 0.78 (0.74-0.81). For M-type phospholipase A2 receptor (PLA2R)-negative IMN, the summary sensitivity is 8% (6-10%), specificity is 100% (99-100%). The summary PLR and NLR are 15.80 (5.70-44.00) and 0.93 (0.91-0.95), respectively. The DOR is 17.00 (6.00-48.00). The AUC is 0.99 (0.98-1.00). THSD7A-AB has higher diagnostic value in PLA2R-negative patients than in IMN patients. These results suggest that THSD7A-AB could possibly be applied as an auxiliary non-invasive diagnostic method for PLA2R-negative IMN.

Background: In China, large-scale population movement and increased childcare costs have brought about a "care crisis" for rural children left-behind when their parents migrate to cities. The unprecedented scale of internal population migration poses multiple challenges to the health of left-behind children in rural areas. Rural left-behind children are currently experiencing insufficient caregiving capacity of intergenerational guardians; the impact of serious parental absences; inadequate nutritional and dietary support and healthy behaviours; limited health service utilization; and abnormally high levels of poor mental health.Purpose: Using 2016 China Family Panel Studies’ micro-data two issues were explored: What is the current status of health inequality in rural left-behind children, including the degree of health inequality and differences in health inequalities of left-behind children in different regions and different age groups; and, second, what are the socioeconomic factors (income deprivation, access to medical services, migrating parents) and inter-generational care arrangements that impacted the health inequality of left-behind children? Method: The health indicators of left-behind children were measured by the concentration index (CI), and the contribution of each socio-economic variable to health inequality was decomposed through the RIF-I-OLS model.Results: The health inequality of left-behind children in rural areas was pro-rich. Left-behind children under 5 years of age had the highest health inequality in all regions; the availability of medical services had a significant negative impact on the health inequality of left-behind children in rural areas, especially in the western provinces; income deprivation had a significant positive effect on the health inequality of left-behind children in rural areas, most notably in the eastern provinces; migrant parents had a negative, and intergenerational caregivers a positive, impact on the health inequality of left-behind children; and left-behind children in the western provinces suffered the largest negative impact on their health. Finally, left-behind children experienced relative health inequality due to their sex, education level and health endowments. Policy recommendations are advanced to address issues of health inequalities in rural left-behind children.

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