Child ; Evidence-Based Medicine ; Guidelines as Topic ; Humans ; Nephrotic Syndrome ; diagnosis ; therapy ; Steroids ; therapeutic use

Aiming at the weakness of the medical graduate students' ideological and political education,we developed the new mode via investigation and surveying,allowing for the medical characteristics. We suggested that we should bring into full play the tutors and their groups function and excavate the connotation of groups’ morality education on the basis of the scientific research groups to develop the medical students' ideological and political education.

Objective To investigate the trend of developmental expression of GluR2,subtype of alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid(AMPA) receptor and synaptophysin(SYP) in the rat cochlear nucleus(CN) in different developmental stages,and explore the association of GluR2 expression with the development of synapse. Methods SD rats of 2,3,4,6,8 and 10 weeks old were selected,the expression of GluR2 and SYP in CN was detected with immunofluorescence histochemical method,and the association of them was explored. Results GluR2 expression was observed in all the neurons of CN in each postnatal groups.The expression was relatively weaker in the second and third week,became denser in the fourth week,reached the peak in the sixth week and then sharply decreased to the weakest in the tenth week.The expression of GluR2 was denser at granular cell layer,while weaker at molecular layer and multipolar cell layer in the dorsal CN.SYP expression was detected in all the neurons of CN in each postnatal groups.The expression was weakest in the second week,significantly denser in the fourth week,reached the peak in the sixth week,was then sharply decreased and stably maintained. Conclusion The expressions of GluR2 and SYP in the postnatal rat CN exhit an equally age-dependent tendency.The expression of GluR2 in the CN may be associated with the the maturation and function development of the CN.The different expression and distribution of GluR2 and SYP in the rat CN of different developmental stages may be involved in the development and plasticity of auditory center.

Objective To evaluate the effect of penehyclidine hydrochloride (PHC) on the level of angiopoietin-1 (Ang-1) and tyrosine kinase receptor-2 (Tie-2) during endotoxin-induced acute lung injury (ALI) in rats.Methods Forty adult male Sprague-Dawley rats,weighing 180-220 g,were randomly divided into 4 groups using a random number table (n =10 each):control group (group C),ALI group,low-dose PHC group (group L-PHC) and high-dose PHC group (group H-PHC).ALI was induced with iv injection of lipopolysaccharide 5.0 mg/kg via the tail vein.In L-PHC and H-PHC groups,PHC 0.6 and 2 mg/kg were injected,respectively,via the tail vein at 1 and 24 h after lipopolysaccharide injection.The rats were sacrificed at 48 h after the initial injection of PHC to measure the lung water content,protein concentration in bronchoalveolar lavage fluid (BALF),and the expression of Ang-1,Tie-2 and phosphorylated Tie-2 in lung tissues.The morphological changes of lung tissues were observed under light microscope and the ultrastructural changes of alveolar epithelial barrier under transmission electron microscope.Results Compared with group C,the lung water content and protein concentrations in BALF were significantly increased,and the expression of Ang-1 and phosphorylated Tie-2 was down-regulated in the other three groups (P ＜ 0.05).Compared with group ALI,the lung water content and protein concentrations in BALF were significantly decreased,and the expression of Ang-1 and phosphorylated Tie-2 was up-regulated in H-PHC group (P ＜ 0.05),and no significant changes were found in the parameters mentioned above in group L-PHC (P ＞0.05).The damage to lung tissues was significantly reduced in group H-PHC as compared with group ALI.Conclusion PHC can improve the permeability of pulmonary microvascular and reduce injury to alveolar epithelial barrier,thus ameliorating endotoxin-induced ALI in rats,and the effect is dose-related and up-regulation of Ang-1 expression and inhancement of Tie-2 activity are involved in the mechanism.

Objectives To determine the effects of Matrine (Ma) on signal transducers and activators of transcription (STAT) 1, 3, connective tissue growth factor (CTGF) and platelet -derived growth factor (PDGF) in glomerular mesangial cells (MC) induced by lipopolysaccharide (LPS), and to explore the protective mechanisms of Ma. Methods Ma were added to cultured glomerular mesangial cells which were exposed to LPS for 12, 24 and 48 hours. Real time polymerase chain reaction were used to determine STAT1, 3, CTGF, PDGF mRNA, The protein expression of STATI, 3 and p-STAT1, 3 were observed by Western blot. Results Compared with the control group, MC proliferation of the LPS group (10μg/ml) significantly increased, which were suppressed in the Ma (320 μg/ml) group (P < 0.01) at 12, 24, 48 hours. The expression of STAT1, 3, CTGF, PDGF mRNA and the levels of p-STAT1 , p-STAT3 protein was significantly increased in MC under LPS medium at 12, 24, 48 hours, which were obviously lower in Ma group than those of the LPS group, especially at 24, 48 hours. Conclusions The protective mechanisms of Matrine is considered to down-regulate the expression of STAT1, 3, CTGF and PDGF.

Objective To compare the effects of remifentanil infused at different rates on median effective target plasma concentration (EC50) of propofol inhibiting responses to laryngeal mask airway (LMA) insertion and determine the optimum infusion rate of remifentanil when used for fiberoptic bronchoscopy in pediatric patients.Methods Eighty-four ASA Ⅰ or Ⅱ pediatric patients,aged 7 months-3 years,scheduled for elective fiberoptic bronchoscopy,were randomly assigned into 3 groups (n =28 each):normal saline group (group C),remifentanil infused at 3 ng· kg-1 ·min-1 group (group R1) and remifentanil infused at 5 ng· kg-1 · min-1 group (group R2).Responses to LMA insertion were defined as body movement and/or bucking during insertion.The initial target plasma concentrations of propofol were 5.2,4.8 and 4.4 μg/ml in groups C,R1 and R2,respectively.The target plasma concentration of propofol was determined by up-and-down sequential allocation.Each time the target plasma concentration increased/decreased by 0.2μg/ml.EC50 and 95 ％ confidence interval of propofol blunting responses to LMA insertion were determined by probit method.Results EC50 (95 ％ confidence interval) of propofol was 5.03 (4.92-5.12) μg/ml,4.71 (4.58-4.84) μg/rnl and 4.46 (4.20-4.94) μg/ml in groups C,R1 and R2,respectively.There was no significant difference in EC50 of propofol between groups R1 and C (P ＞ 0.05).EC50 of propofol was significantly lower in group R2 than in groups C and R1 (P ＜ 0.05).Conclusion The infusion rate of remifentanil should not be lower than 5 ng· kg-1· min-1 when combined with propofol in pediatric patients undergoing fiberoptic bronchoscopy.

Abscess ; complications ; Adult ; Brain Abscess ; complications ; Female ; Humans ; Meningocele ; complications ; Nasal Cavity ; pathology ; Nose Diseases ; complications

The characterization and management of oral and maxillofacial spaces infections in diabetic patients were studied in order to determine the pattern of this clinical condition and formulate a management plan.There were 31 cases with average age of 61 years(s=9);the mean hospitalization time was 14 days(s=6);the average fasting blood glucose level on admission was 10.4 mmol/L.Of the 31 patients 20 were multiple-space infections and 11 were single-space infections.13 patients had major complications during admission.Odontogenic infection was the most common cause of the space infections.Streptococcus viridians and staphylococcus aureus were common organisms(5/19,4/19)identified through pus and/or blood cultures.Early surgical incision and drainage,perfect blood glucose control,intravenous antimicrobial therapy,preventing asphyxia and managing major complications are necessary and effective approaches for the management plan.

Objective To compare the effect of compression hollow screw fixation,artificial femoral head replacement and total hip replacement in the elderly.Methods From August 2007 to April 2009,152 cases of femoral neck fracture in the elderly were divided into three groups: compression hollow screw fixation group(54 patients,24 males,with an average age of 59.8±5.3 years);artificial femoral head replacement group(48 patients,16 males,with an average age of 65.3±6.7 years);and total hip replacement group(50 patients,18 males,with an average age of 77.3±6.5 years).The evaluation indicators,including the average sugical time,the average amount of bleeding,the average length of stay and the average postopererative bed time,were compared respectively among the three groups.The postoperative evaluation was made according to Harris Score.Results Harris score in the three groups were 21 excellent and 23 good in the compression hollow screw fixation group,with an average score of 80.52±2.70;26 excellent and 14 good in the artificial femoral head replacement group,with an average score of 86.57±1.90;and 42 excellent and 3 good in the total hip replacement group,with an average score of 96.04±2.10.The total hip replacement group was significantly better than the other two groups(H=0.589,F=12.151,Ps＜0.05).The rate of postoperative complications were 25.93%(14/54) in the compression hollow screw fixation group,18.75%(9/48) in the artificial femoral head replacement group and 4.00%(2/50) in the total hip replacement group(H=1.291,P＜0.05).Conclusion Compared among the three surgery,total hip replacement could resume function and improve the quality of life better,with lower rate of complications.However,the surgical injury and the amount of bleeding were largest.Therefore,we suggest selecting appropriate surgery with considering the patient′s age,physical condition,displacement degree of the fracture,et al.in old femoral neck fractures patients.

Objective To investigate the correlation of serum anti-M-type phospholipase A2 receptor (PLA2R) antibody with laboratory parameters of idiopathic membranous nephropathy (IMN) in adult patients with membranous nephropathy (MN),and to explore the role of anti-PLA2R antibody in the pathogenesis of IMN. Methods Forty-six adult patients with biopsy-proved glomerular diseases were involved in this study,including 20 cases with IMN,7 cases with IgA nephropathy (IgAN),6 cases with hepatitis B-associated membranous nephropathy (HBV-MN),6 cases with minimal change nephropathy (MCN),4 cases with focal segmental glomerulosclerosis (FSGS) and 3 cases with class Ⅴ lupus nephritis.Total RNA was extracted from human glomeruli and was reversely transcribed to the first-strand cDNA.The full-length human M-type PLA2R was amplified by PCR and the 605 bp product was subcloned into eukaryotic expression vector containing CMV promoter.The recombinant human M-type PLA2R plasmid vector was transiently transfected into human embryonic kidney (HEK) 239T cell line using the FuGene6 transfection reagent.Western blotting was used to detect serum anti-PLA2R antibodies.Correlations of antiPLA2R antibody level with laboratory parameters,including serum albumin,total cholesterol,Scr and 24-hour urine protein,of IMN patients were evaluated. Results Among 20 cases with IMN,15 cases showed positive anti-PLA2R antibodies (positive rate 75％).Of 7 cases with IgAN and 6 cases with HBV-MN,only 1 case showed positive anti-PLA2R antibody respectively (positive rate 14.29％ and 16.67％ respectively).Anti-PLA2R antibody was negative in other patients.The positive rate of anti-PLA2R antibody in IMN patients was significantly higher than that in patients with secondary MN and other types of glomerlonephritis (all P＜0.01).Furthermore,anti-PLA2R antibody level was positively correlated with 24-hour urine protein(r=0.803,P＜0.01) and negatively correlated with serum albumin in IMN patients (r=-0.816,P＜0.01). Conclusions The high positive ratio of anti-PLA2R antibody may indicate that it is the specific autoantibody in IMN.AntiPLA2R antibody is correlated with IMN disease severity,which indicates that it may be the pathogenic autoantibody in IMN.