To investigate the best intennittence and reasonable dosage of CDC pulse therapy on different activity degree of lupus nephritis (LN). Methods 96 severe LN cases were divided into three groups. Croup A; CTX pusle treatment (IV-CTX), once 2 weeks, 8- 12 mg'kg'Vd for two days; Group B: IV-CTX once a month, 0.5 - 1.0/m2; Group C: IV-CTX once 3 months, 0.5 - 1.0/m2. Prednisone was given to three groups simultaneously. Results The time taking effect was shorter significantly in Group A than that in Group B and C. Remission rate was higher significantly in Group A than that in Group B and C ( P 0. 05). Intermittence of 15 cases (23.8%) from Group Ek C was changed to once 2 weeks and then the disease activity had been controlled since these patients became worse during the treatment. Intennittence of 3 patients (9% ) from Group A was delayed a week because of the decreasing of WBC counting. There was no significantly difference between three groups in side effect and its incidence. Conclusion A reasonable IV-CTX should be choosen according to the disease activity. IV-CTX 8 - 12 mg'kg'Vd for two days, once 2 weeks should be used for acute and severe LN. When disease becomes mild, IV-CTX can be changed to 0.5 - 1.0/m2, once a month. After LN activity is controlled basically, 0.5- 1.0/m2, once a month is recommended.

ve To investigate the effects of acute normovolemic hemodilution on cardiac troponin I (CTnl) and myocardial enzyme. Methods Twenty-nine ASA I-II patients undergoing hepatectomy or bilateral hip replacement were randomly divided into two groups: hemodilution group (H , n=15) and control group (C, n=14) . The patients were premedicated with diazepam and scopolamine. Left radial artery was cannulated for intra-arterial pressure monitoring and the letting of blood. Right internal jugular vein was cannulated for fluid administration and CVP monitoring. Anesthesia was induced with midazolam 0.15-0.30mg?kg-1 , fentanyl 4?g?kg-1 and vecuronium 0.08-0.1mg?kg-1 and maintained with infusion of midazolam (0.03-0.10 mg?kg-1?h-1), fentanyl (0.15-2.0?g?kg-1?h-1) and vecuronium (0.5-1.0?g?kg-1?min-1). After tracheal intubation the patients were mechanically ventilated with 100% O2 and PETCO2 was maintained at 35-45 mmHg. 15 min after induction of anesthesia hemodilution was started. Blood was withdrawn from radial artery and collected until Hct was reduced to 25%-28% . Ringer's lactate solution and hydroxyethyl starch (HES 6%) were simultaneously infused to maintain blood volume. Blood samples were taken before anesthesia, before blood transfusion, 4h after surgery and on the 1st postoperative day for determination of blood CTnI, CK and CK-MB activities. Results The demographic data including age and body weight were not significantly different between the two groups. Prior to blood transfusion Hct was reduced to 20.33% ?1.91 % in group H and 29.64%?1.78% in group C. CK increased significantly at 4h after operation and on the 1st postoperative day; CK-MB increased significantly on the 1st postoperative day. The difference between the two groups was not significant. CTnI showed little change during and after operation in both groups.Conclusions Our study suggests that hemodilution to 20% Hct does not result in myocardial injury in patients without preexisting cardiopulmonary disease as long as normal blood volume is maintained and patient suffers nohypoxia.

Objective To study the clinical characteristics and the influencing factors of hypertension in IgA nephropathy(IgAN)patients with normal renal function.Methods From 2002 to 2006,a total of 507 idiopathic IgAN patients with normal renal function(eGFR≥90 mL/min)confirmed by renal biopsy were treated in the First Affiliated Hospital of Sun Yat-sen University.The patients were divided into a hypertension group(n=93)and a normal group(n=414)according to the BP levels.Univariate and multivariate logistic regression analysis were used to analyze the relationship between the hypertension and the clinical characteristics.Results We found that 18.3%(93/507)of the IgAN patients had hypertension,with hypertension as the main symptom in some cases.Univariate analysis showed that male sex,older age,higher BMI,elevated level of triglyceride and cholesterol were the clinical risk factors for hypertension in IgAN patients(P

Objective To study the effect of mixed purified autogenic and allogeneic hematopoietic stem cell transplantation for the treatment of systemic lupus erythematosus. Methods Thirty-six MRL/lpr mice were randomly divided into the control group, the study group,the mixed group ( the ratio of autogenic to hematopoietic stem cells, mixed in different proportions were infused intravenously after 60Co irradiation. The study group were treated with daily intraperitoneal infusion of dexamethasone 1 mg·kg-1·d-1, while the control group were treated with intraperitoneal infusion of equivalent volume of saline daily. The changes of serum creatinine level, the urine protein excretion of the mice and blood WBC count were compared. Repeat measures ANOVA was used for data analysis. ELISA was used for anti-nuclear antibody detection Light microscopy, electronic micros-copy, immunofluorescence were applied to detect the pathological changes in renal tissue. Results Serum creatinine and urine protein excretion levels increased with time in the ontrol group, while those of the transplant group and the study group decreased. The reduction in mixed transplantation group and the study group was more evident compared with that of the allogeneic group. The difference was statistically significant (P＜0.05), but there was no significant difference between the mixed transplantation groups and the study group (P＞0.05). The histopathologic damage was most serious in the control group as pathological injury score of most mice were in grade 3 or 4. The majority of the histopathologic damage of the allogeneic group was in grade 2. Most f pathological damage of the study drug group and the mixed transplantation group were grade 1 or 2. Conclusion Mixed hematoopoietic stem cell transplantation for the treatment of murine systemic lupus erythematosus can effectively correct heavy proteinuria in murine systemic lupus erythematosus so improve the renal damage. It is a safe and effectively way to treat murine systemic lupus erythematosus.

Objective To evaluate the effect of CPB with or without cardioplegia on hemodynamics and myocardial function. Methods Thirty NYHA class III patients undergoing mitral valve replacement were randomly divided into three groups of ten each: group Ⅰ received no blood cardioplegia; group Ⅱ received tepid blood cardioplegia solution and group Ⅲ received cold blood cardioplegia solution. The patients were premedicated with pethidine 50mg and scopolamine 0.3mg. Swan-Ganz catheter was inserted via right interval jugular vein into pulmonary artery and radial artery was cannulated under local anesthesia before anesthesia. Anesthesia was induced with midazolam 0.05-0.01 mg.kg-1, fentanyl 15-20?g. kg-1 and pancuronium 0.12mg.kg-1 and maintained with fentanyl, midazolam and pancuromium. Patients in group Ⅰ received no cardioplegic solution. Ascending aorta was not cross-clamped. Body temperature was reduced to 32℃-33 ℃ (naso-pharyngeal T) . The empty heart was beating at 40-60 bmp. In group D and Ⅲ cardioplegic solution (modified St. Thomas solution) was added to blood from oxygenator (in the proportion of 1:4).In group Ⅱ body temperature was reduced to 32℃-33℃.Tepid (32℃ ) hyperkalemia blood cardioplegic solution was infused at 200-250ml.min-1 after ascending aorta was cross-clamped. After cardioplegic arrest hypokalemic blood cardioplegia solution was infused. In group Ⅲ body temperature was reduced to 28℃-29℃. Cold (8℃) hyperkalemic blood cardioplegic solution was infused at 200-250ml. min-1, after ascending aorta was cross-clamped. After cardioplegia arrest cold hypokalemic blood cardioplegia solution was infused every 20 min. Hemodynamic parameters (MAP, MPAP, CO, CI, SVRI, PVRI, LVSWI and RVSWI) were recorded before anesthesia (T0), before CPB (T1), 10, 30, 60 min after termination of CPB (T2-T4 ) and at the end of surgery (T5 ) . Results Demographic data including age, gender, body weight and body surface area were comparable between the three groups. CI in group 1 and Ⅱ was significantly higher at T2 -T5 than that in group Ⅲ . SVRI after CPB in group Ⅰ was significantly lower than that in group Ⅲ . Conclusion The myocardial function after CPB without cardioplegia is better than that after CPB with cold cardioplegia, but is not significantly different from that after CPB with tepid blood cardioplegia.

Objective To investigate the fungal infection situation and the risk factors in lupus nephritis(LN)patients.Methods Infection states were investigated in 93 LN patients and 45episodes(about 48.4%) occurred the different kind and different degree of Hospital-acquired infections.The fungal infection rate was 22.6% and two patients directly died of it.Except fungi,the main pathogens were bacteria and virus.The main infection sites were urinary,gastrointestinal and respiratory tract.Results The infection causes were related to the use of corticosteroids,immunodepressive,antibiotic and the aggressive operation,renal failure ,the duration in hospital and so on.Conclusion Effective prevention and treatment for infection in LN patients is an important way to improve the prognosis of LN.

Objective To explore the relationship of phospholipase A2 receptor (PLA2R) expression in renal tissue with clinical characteristics,prognosis of idiopathic membranous nephropathy (IMN) patients.Methods 134 patients diagnosed as nephropathy proven by biopsy was selected as subjects of this research,including 98 patients with IMN patients,10 patients with secondary membranous nephropathy and 26 patients with other renal glomerular diseases.The expression of PLA2R antigen in renal tissue was detected by immuno-fluorescence chemistry staining.Results The positive rate of renal PLA2R expression in IMN patients was higher than that in SMN patients (91.84％ vs 40.00％,P＜ 0.01),whereas there is no expression in other glomerular diseases.The PLA2R negative group were mainly stage Ⅰ membranous nephropathy,and positive group was mainly in stage Ⅱ.The distribution of pathological stage between the two groups was statistically significant (P ＜0.01).Compared with the positive group,the negative group was manifested with higher eGFR[(115.91± 23.32) ml· min-1 · (1.73 m2)-1 vs (94.06±27.38) ml· min-1 · (1.73 m2)-1,P=0.031],associated with the higher 12-month complete remission rate (87.50％ vs 44.07％,P=0.021).Conclusions The expression of PLA2R antigen in renal tissue plays an important role in the diagnosis,disease evaluation and prognosis of IMN.The negative PLA2R in kidney tissue of IMN may indicate a good clinical prognosis.

Objective To explore the early predictive value of red cell distribution width (RDW) for contrast-induced nephropathy (CIN) in patients after enhanced computed tomography (CT). Methods A total of 218 patients who underwent enhanced CT between June 2015 and June 2017 at Huizhou Central Municipal Hospital were enrolled in this study. Patients were divided into CIN group and no-CIN group. The diagnostic criteria for CIN is an increase in serum creatinine (Scr) of more than 44.2 μmol/L or 25％ of the baseline value within 3 days of contrast agent use. The general information and clinical characteristics in two groups were compared. The risk factors of CIN were analyzed by logistic regression analysis. The receiver operator characteristic curve (ROC) was used to assess the value of RDW for predicting the occurrence of CIN. Results Among 218 patients, 10(4.59％ ) patients had CIN. In the CIN group age, baseline Scr and baseline RDW were significantly higher, while hemoglobin, baseline estimated glomerular filtration rate (eGFR), red blood cell, white blood cell, albumin, and high - density lipoprotein cholesterol were significantly lower than those in the no - CIN group (all P＜0.05). Binary logistic regression analysis revealed that baseline RDW (OR=2.250, 95％CI 1.031-4.911, P=0.042) and eGFR (OR=0.963, 95％ CI 0.928-0.999, P=0.044) were correlated with the occurrence of CIN. ROC analysis confirmed the area under the curve of RDW as a predictor of CIN was 0.798 (P＜0.001). The cut - off value of RDW was 14.5％ , and the diagnostic sensitivity and specificity in CIN were 70.00％ and 85.58％, respectively. Conclusions Increased baseline RDW and decreased eGFR are the risk factors of the occurrence of CIN after enhanced CT. RDW has a good predictive value, and it may be a good biomarker for the early diagnosis of CIN.

OBJECTIVE: To assess the safety and efficacy of Neuroform EZ stent used in treatment of symptomatic complex severe intracranial atherosclerotic stenosis (ICAS). METHODS: Clinical data of 18 patients with symptomatic complex severe ICAS undergoing Neuroform EZ stent angioplasty from January 2016 to December 2017 were retrospectively analyzed. All the lesions of the patients in this group were considered as complex ICAS, i.e. with severe tortuous access, long (>10 mm) or occlusive or bifurcation lesions, with concurrent aneurysms near the stenotic lesion. The primary outcome was defined as any stroke (including ischemic or hemorrhagic) or deaths from any cause after stenting procedure within 30 days. The secondary outcome was defined as successful revascularization and occurrence of >50% in-stent restenosis during the follow-up period. RESULTS: All the 18 patients achieved technical success (100%) and mean stenosis rate was reduced from 85%±7% to 18%±6%. Of the 18 patients included, the 30-day stroke or death was 5.6% (1/18), which presented as basal ganglia region infarction in a patient with tandem lesions on the left vertebral artery. There was no hemorrhagic and death complications that occurred in the patients of this group. One concurrent aneurysm was embolized with micro coil (stent assisted) by stages after 1 month. In this group 12 patients were followed up with digital subtraction angiography (DSA) after hospital discharge. The follow-up period ranged from 8 months to 26 months [mean: (16±8) months]．During the follow-up period 2 patients in the 12 patients (2/12, 16.7%) developed in-stent restenosis (ISR) confirmed by DSA, and one of them was symptomatic restenosis and restored unobstructed blood flow after balloon angioplasty. CONCLUSION Neuroform EZ stent for the treatment of highly screened symptomatic complex severe ICAS is safe and effective. It has its advantages over traditional stent.
Cerebral Angiography ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Retrospective Studies ; Stents ; Treatment Outcome