Refractory nephrotic syndrome(RNS) is one of the main causes of end-stage renal disease (ESRD) in children,which is also a difficult issue in clinic.Several therapies,including immunosuppressive agents,have been shown to be effective and safe for RNS.It is proved,however,that a substantial number of children are still refractory to treatment despite these therapies.Recently,rituximab as a new immunosuppressant has achieved good results for RNS,and a number of case reports and clinical trials have suggested that rituximab may be effective for children with RNS.This review will analyse the scientific basis for the efficacy and safety of using rituximab in children with RNS.

Acute kidney injury (AKI)was a common problem in children in clinic.pRIFLE Criteria, AKIN Criteria, KDIGO Criteria are the main classification criteria of AKI.Though serum creatinine is still used as the most common biomarkers for diagnosis of AKI, the sensitivity and specificity is unsatisfactory.In recent years, many potential biomarkers of AKI have been studied in a variety of experimental and clinical settings.This review describes the novel biomarkers of AKI, including cystatin C, neutrophil gelatinase associated lipocalin, interleukin-18 ,kidney injury molecule-1 and liver-type fatty acid binding protein,, which have now made a progress in clinic.

AIM: To investigate the effect of intravitreal injection of anti-vascular endothelial growth factor (VEGF) drug Bevacizumab on connective tissue growth factor(CTGF) and pigment epithelium derived factor (PEDF) in proliferative membranes in patients with proliferative diabetic retinopathy (PDR).METHODS: From January 2015 to December 2016, 117 patients (126 eyes) with PDR were analyzed using the case-control study.The selected cases were randomly divided into two groups, respectively, Group A of 60 cases (63 eyes) and Group B of 57 cases (63 eyes).The Group A was treated with vitrectomy alone, while the Group B received intravitreal injection of 0.05mL/1.25mg bevacizumab before vitrectomy.The peeled epiretinal membranes in patients were stained and then the histopathological changes were observed for primitive cells and angiogenesis, the expression of CTGF and PEDF were tested.RESULTS: The expression of CTGF and PEDF in the proliferative membrane of the two groups were expressed in the cytoplasm.The Group A showed positive expression in 38 cases, the positive rate was 60.3%.Compared with Group A, the positive expression rate of CTGF in Group B (92.1%) was significantly higher (P<0.05).The positive expression rates of PEDF in the two groups were 90.5% and 95.2% respectively, and there was no significant difference between the two groups (P>0.05).CONCLUSION: In patients with PDR after intravitreal injection of bevacizumab, the retinal neovascularization is significantly reduced, which is conducive to vitrectomy.The positive expression rate of CTGF significantly increased in patients with PDR after intravitreal injection of bevacizumab, but there was no significant change in the expression of PEDF in the anterior membrane.

AIM: To study the effect of intravitreal injection of anti-vascular endothelial growth factor (VEGF) on best corrected visual acuity (BCVA) and multifocal-electroretinogram (mfERG) before and after treatment for choroidal neovascular disease.METHODS: A total of 264 patients (332 eyes) with macular neovascularization (MCNV) and idiopathic choroidal neovascular disease (ICNV) who underwent pathologic myopia from January 2015 to January 2017 were enrolled in this study.Intraocular pressure and BCVA, fundus using 90D front mirror and slit lamp detection, and the fundus photograph, OCT, ICGA and FFA angiography, mfERG detection were taken.One month after the drug, 1mo after the final treatment, we recorded BCVA, intraocular pressure and mfERG and so on.RESULTS: Ranibizumab was injected into the 254 eyes, and 78 eyes were injected with conbercept.There were 37 eyes injected once, 147 eyes were injected twice, 72 eyes were injected 3 times, 57 eyes were injected 4 times, 19 eyes 5 times.There were no significant differences on intraocular pressure between the two groups (P>0.05).The BCVA before treatment was significantly different compared with those 1mo after treatment and 1mo after the final treatment (P>0.05).The amplitude of Ring1, Ring2 and Ring4 increased after treatment, the difference was statistically significant.(P<0.05).The amplitude of Ring3 and Ring5 increased at 1mo after final treatment(P<0.05).CONCLUSION:Intravitreal injection of anti-VEGF drugs has a significant effect on BCVA and mf ERG in patients with choroidal neovascular disease and is safe.

Influenza A(H1N1)virus is a re-mixed strains of human influenza virus genes,avian influenza virus gene and swine influenza virus gene.Influenza A(H1N1)pandemic influenza has spread around the world,which has drawn worldwide attention.In order to early discovery,early diagnosis,early treatment and effective prevention of Influenza A(H1N1),we describe the characteristics of linfluenza A(H1N1)virus,epidemiology,pathogenesis,clinical manifestations,laboratory examination and effective treatment and preventive measures.

AIM: To optimize the process of extracting effective constituents from Radix Polygalae by central composite design/response surface methodology. METHODS: Independent variables were ethanol concentration,reflux time and solvent fold,dependent variable was extraction rate of senegenin in Radix Polygalae.Linear or nolinear mathematic models were used to estimate the relationship between independent and dependent variables.Response surface methodology was used to optimize the process of extraction.Prediction was carried out through comparing the observed and predicted values. RESULTS: Regression coefficients of binomial fitting complex model was as high as 0.979 0, the optimum conditions of extraction process were 60% ethanol,2.5 hours for reflux,10-fold solvent and 2 times for extraction.Bias between observed and predicted values was-5.93%. CONCLUSION: It shows that the optimum model is highly predictive.

Diagnosis and management of hip injuries has advanced significantly in the past few years with the improvement of arthroscopic techniques of the hip. Many of pathologic conditions previously unrecognized and untreated have been diagnosed and treated correctly under hip arthroscopy . Current application for hip arthroscopy include management of labral tears,osteoplasty for femoroacetabular impingement, thermal capsulorrhaphy and capsular plication for subtle rotational instability and capsular laxity, lateral impact injury and chondral lesions, osteochondritis dissecans, ligamentum teres injuries, internal and external snapping hip, removal of loose bodies, synovial biopsy, subtotal synovectomy, synovial chondromatosis, infection, and certain cases of mild to moderate osteoarthritis with associated mechanical symptoms. In addition,patients with long-standing, unresolved hip joint pain may benefit from arthroscopy. Patients with reproducible symptoms and physical findings that reveal limited functioning, and who have failed an adequate trial of conservative treatment will have the greatest likelihood of success after arthroscopic intervention. Prescise attention to thorough physical examination, detailed imaging,and adherence to safe and reproducible surgical techniques are essential for the success of this procedure.

Two types of elbow arthroplasties are used in current clinial practice:interpositional and implant arthroplasty.Interposition elbow arthroplasty neither completely eliminates pain nor restores full function.It may be indicated for young active patients with severe inflammatory or posttraumatic arthritis,especially those with limited elbow motion.Current implant arthroplasty has come a long way in the past three decades.Elbow implant survival data nearly approach those of knee arthroplasty.The majority of patients have significant improvement in function and marked pain relief after total elbow replacement.However,the complication rate is higher than that for total hip and knee arthroplasty,is likely inherent in the anatomic uniqueness of the elbow itself.Greater caution must be paid to prevention of the complications of total elbow replacement.This article reviews the types,indications,contraindications and results of elbow arthroplasty.

[Objective]To evaluate the therapeutic effect of arthroscopic treatment for osteoarthritis of the knee,and explore the factors related to clinical outcome. [Methods]Three hundred and sixty-two patients with knee osteoarthritis were treated by arthroscopic surgery in the 88th hospital from May 2000 to November 2007. Of them,124 patients were followed-up completely. Quantified clinical data were input into computer and analyzed statistically by SPSS 16.0 software. Lysholm score was used to evaluate the therapeutic effect. Lysholm scores before surgery and at follow up were compared with paired t test. Patients were divided into different subgroups according to sex,locking,X -ray grade,arthroscopic grade and surgical methods. Lysholm scores at the final follow up of different subgroups were compared with variance analysis. The factors related to operation outcome were explored by using multiple stepwise linear regression analysis.[Results]One hundred and twenty-four patients were followed up from 7 to 96 months with an average of 39.6 months. Preoperative Lysholm score was (46.10?2.80),the score at follow up was (70.69+2.90),there was significant difference between preoperative score and at follow up (t=9.362,P0.05). The difference was significant between groups whether locking or not (F=10.654,P

[Objective]To explore the effects of joint synovial fluid on tendon-bone healing of reconstructed ligament. [Methods]Forty female New Zealand rabbits,aged 6 months,weight 2.5~3.5 kg,were divided into 4 groups randomly.Transfer of semitendinosus tendon to the bone tunnels was performed to make bone-tendon healing model,on the right knee the bone tunnel was not communicated to the joint cavity,in contrast,the bone tunnel on the left knee was connected with synovial fluid.Animals in one group were killed at 8 weeks after operation,bone-tendon healing samples were harvested for biomechanical test.Animals in other three groups were killed at 2,4 and 8 weeks after operation respectively to harvest the samples for histological observation.HE and Masson staining were conducted to examinant histological change.[Results]At 2 weeks after operation,there was no significant difference between non joint synovial fluid group and joint synovial fluid group in bone-tendon interface healing,which were filled with granulation tissue.At 4 weeks postoperatively,interface healing in non joint synovial fluid group was obvious better than that in joint synovial fluid group.Fibroblast cells and cartilage cells increased obviously,and collagen fibers synthesized.At 8 weeks after operation,tendon-bone interface in joint synovial fluid group was filled with connective tissue,the collagen fibers arranged disorderly.In contrast,more compact collagen fibers were seen in non joint synovial fluid group.Interface cell accounts in non joint synovial fluid group were superior to that in joint synovial fluid group at 2,4,8 weeks after operation (P