Renal replacement therapy is an effective treatment for end-stage diabetic nephropathy.This review summarized recent literatures on hemodialysis,peritoneal dialysis and renal transplantation for end-stage diabetic nephropathy.The purpose is to guide doctors for treating end-stage diabetic nephropathy more reasonably.

Objective To study the change tendency of air pollutants in Shenzhen, China in 2002-2005, further, to explore the relationship between disease spectrum and air pollution. Methods The daily mean concentration of SO2, NO2 and PM10 in 2002-2005 in eight environmental monitoring sites were determined according to Ambient Air Quality Standard. Results Air concentrations of SO2, NO2 and PM10 increased yearly in 2002-2004, from 0.018 3 mg/m3 to 0.023 4 mg/m3, 0.050 1 mg/m3 to 0.072 5 mg/m3, 0.061 0 mg/m3 to 0.075 7 mg/m3, respectively, however, the concentrations of the three indexes decreased in 2005. In the past four yeas, average levels of SO2 were under the limit of grade 2 of GB3095-1996, as for PM10, under the limit of grade 2, and most of the concentrations of NO2 were under the limit of grade 3, but in the other two monitoring sites, the concentrations of NO2 in 2004 exceeded the limit of grade 3. The year average concentrations of SO2, NO2 and PM10 in 2002-2005 in the outer region were higher compared with those in the inner region of the special economic zone, except the level of NO2 in 2002. As for the quarter average concentrations of SO2, NO2 and PM10, 1st and 4th were higher compared with 2nd and 3rd. Conclusion The air quality in Shenzhen is better in China, however, more attention should be paid to the pollution of nitrogen oxides and inhalable particle matters.

Aim To evaluate the clinical application of propofol in critical patients with mechanical ventilation. Methods22 patients with mechanical ventilation after major operation were randomly divided into control group and propofol group patient in the propofol group were continually transfused with propofol by micro pump. Clinical manifestations, blood pressure, heart rate and the concentration of epinephrine (E)and norepinephrine (NE) in patients of both groups were observed. Results The patients in propofol group were all in sleeping state, while those in the control group had evidently higher blood pressure,heart rate and the concentration of epinephrine and norepinephrine after wearing of ventilator. There was a significant difference between the two groups ( P＜0.05) . Conclusion Propofol can make the critical patients quiet and inasleepingstate,inhilitthereleaseof epinephrine and norepinephrine, which rescdt in hemodynamic stability.

[Objective] To search a reasonable approach to the treatment of nasopharyngeal carcinoma (NC) with traditional Chinese medicine integrated with western medicine. [ Methods ] Seventy - six cases of NC were randomized into Group A and Group B. Group A ( n = 39) was treated with herbs for activating blood and removing blood - stasis, nourishing yin and clearing heat during radiotherapy and herbs for replenishing qi and nourishing yin, generating body fluid, moistening dryness and clearing heat after radiotherapy. Group B ( n = 37) was treated with radiotherapy alone. Short - term therapeutic effect, long - term survival rate, the relief of main symptoms, the reduction of cervical lymph node metastasis and side effect of radiotherapy in the two groups were observed. [ Results ] After treatment, the complete relief (CR) rate was 84.6% and 15.4% and partial relief (PR) rate was 73.0% and 27.0% in Group A and B respectively, the differences being significant ( P

OBJECTIVE:To study pharmacokinetics of cyclosporine in healthy volunteers, and to investigate the relationship of drug exposure with blood sampling time after treatment. METHODS: The data of trial at the first 12 blood sampling time points after medication were collected from bioequivalence test in 24 healthy volunteers (trial preparation vs. reference preparation). Multiple linear regression analysis was used to study the blood concentrations of cyclosporine at different sampling time points and the area under the blood concentration-time curve (AUC). RESULTS: The concentrations at two points were adopted to estimate AUC. The correlation coefficient of different cyclosporines could reach 0.9 with estimation deviations less than 15%. The AUC of cyclosporine of trial preparation could be estimated by C8 and C12, and that of reference preparation by C2.5 and C12. CONCLUSION: The AUC estimated by concentrations at two points can meet clinical demand. There is great difference in estimate point among different preparations.

Objective To discuss influence factors on prognosis of the patients with capillary leak syndrome (CLS) in ICU.Methods The clinical data of 191 patients with CLS in ICU were reviewed,and the patients were divided into three groups according to prognosis:death group ( n =37),cured group ( n =132) and non-healed group (n =22).The clinical data of death group were compared with those of cured group at admission,during the course of CLS and before discharging from hospital.Results Compared with the cured group,the central venous pressure and serum albumin decreased ( P ＜ 0.01 ) ; anion gap,triglycerides,pressure adjusted heart rate (PAHR) and oxygenation index were lower ( P ＜ 0.01 or P ＜ 0.05) ; serum glucose and SIRS score increased ( P ＜ 0.01 ) in death group.There was higher rate of poor renal function at admission in death group than that in other groups ( P ＜ 0.01 ).There were more many patients treated with intravenous administration of hydroxyethyl starch,ulinastatin and continuous blood filtration therapy in cured group than those in other groups ( P ＜ 0.05).Conclusions The factors influencing the outcomes of the patients with CLS were hypovolemia,severe hypoproteinemia,interior milieu disorder,malnutrition,hypoxemia,renal injury and severe systemic inflammatory response.The outcomes of patients with CLS in ICU could be improved by using hydroxyethyl starch,ulinastatin and continuous blood filtration therapy.

Objective To study the effects of pulse high volume hemofiltration (PHVHF) on the changes of Th17 cells (T helper 17 cells) and CD4 + CD25 + reguratory T cells (Treg cells) in peripheral blood of patients with sepsis and to evaluate the clinical value of this intervention. Methods The patients were included in this prospective study as per the criteria of sepsis set by America Chest Physicians College/America Society for Critic Care Medicine in 1992. The patients were excluded: ① immune system disorder, ② acute stroke, ③ myocardial infarction, ④ virus hepatitis,⑤ human immunodeficiency virus infection, ⑥ under immunosuppressive therapy. Forty patients (24 males, 16 females, aged from 25 to 75years) with sepsis in ICU were enrolled from January. 2008 to November. 2010. According to the severity of disease, the patients were divided into three groups; moderate sepsis group (n = 14, 8 males, 6 females) , severe sepsis group (n = 15, 9 males, 6 females) , and septic shock group (n = 11, 7 males, 4 females). The initially clinical data of three groups were comparable. Twenty healthy individuals served as controls. According to the mode of treatment, forty patients were also divided into two groups: conventional treatment group (group A, n= 15) in which patients were treated without PHVHF within 5 days after admission and trial group (group B, n=25) in which patients were treated with pulsed high volume hemofiltration (PHVHF) within 5 days after admission. In group B, high volume hemofiltration (70 mL · kg-1 · h-1) was given to patients for 6 ～ 8 hours, and then conventional continuous vein - vein hemofiltration (35 mL · kg-1 · h-1) for 16 ~ 18 hours. The total length of period for continuum blood scavenging was 24 hours as one cycle. The interval between two cycles of blood scavenging was 24 hours. The changes of Th17 cells and CD4+ CD25 + Treg cells of 40 patients were detected with flow cytometry on the 1st day and the 5th day after admission. The data were analyzed by using SPSS version 13. 0 software. Measurement data were analyzed with Paired-samples t-test, independent-samples t-test or one way ANOVA . Ratio of small samples was compared with fisher's exact test, and the correlation was analyzed by using Pearson correlation analysis. Results The rates of Th17 cells were( 0.91 ±0.38)%, (2.09 ±0. 53)% , (3.90 ±0. 80)% , and ( 1. 85 ±0.35)% in control, moderate sepsis, severe sepsis, and septic shock groups, respectively, while the rates of CD4+ CD25+ Treg cells were (0.39 ±0.23)%, (1. 72 ±0. 59)% , (2.72 ±0. 22)% , and (3. 55 ±0. 51)% , respectively. The rate of Thl7 cells on the 1st day was higher in severe sepsis group than that in other two groups ( P < 0. 05 ) without significant difference between septic shock and moderate sepsis groups ( P > 0. 05). Moreover , the rate of CD4+ CD25 + Treg cells was up - regulated on the 1st day in the following order from high to low: septic shock group > severe sepsis group > sepsis group (P < 0.05). The rates of Th17 cells and CD4 + CD25 + Treg cells in patients of group B decreased in greater degree than that did in patients of group A (P < 0.05 ). Conclusions The changes of Th17 cells and CD4 + CD25 + Treg cells may play an important role in pathogenesis of sepsis, and the pulsed high volume hemofiltration may be one of the effective treatments for the patients with sepsis by regulating the rates of Thl7 cells and CD4 + CD25 + Treg cells.

Objective To compare the effect,relapse rate and outcomes between mycophenolate mofetil(MMF)and pulse intravenous cyclophosphamide(CTX)in the induction therapy of pauci-immune crescentic glomerulonephritis(PICGN)in Chinese.Methods A total of 44 patients who had PICGN[16 male,28 female,age(46.8?13.7)y],of whom 25 patients were ANCA positive,were enrolled in this study.All patients had renal involvement with ≥50% crescent formation prior to the study and received either MMF treatment(MMF group,n=22)or intermittent CTX pulse therapy(CTX group,n=22).The patients in both groups also received methylprednisolone(MP)pulse therapy followed by oral prednisone.General conditions,clinicopathological findings,remission rate,relapse rate,and outcomes were compared.All the patients were followed up until June 2005,with an average follow-up of 8～60(Med 27)months in the MMF group,and 6～72(Med 29)months in the CTX group.Results No significant difference was found between MMF group and CTX group in general conditions,base parameters of clinical and pathological findings.The remission rate at the 12th month in MMF and CTX group was 90.9% and 72.7% respectively.The complete remission rate in MMF group(59.1%)was significantly higher than that of the CTX group(27.3%)(P

Objective To investigate the results and complications in the treatment of the mechanically unstable fractures of the distal femur when Less Invasive Stabilization System (LISS) is used.Methods From September 2011 to July 2014,81 patients with mechanically unstable fractures of the distal femur were treated with the LISS,according to the inclusion criteria and exclusion criteria,59 patients meet the condition including 31 male and 28 female.The mean age of the patients was 49.8 years (range 18-80 years).The fractures occurred on the left side in 40 cases and on the right side in 19 cases.According to AO classification,27 type 33A2,14 type 33A3,13 type 33C2,5 type 33C3.2 cases combined with ipsilateral fractures of the femoral shaft,according to AO classification,1 type 32A1,1 type 32C1.The mechanism of injury was a fall from the height in 8 cases,a traffic accident in 18 cases,a crush injury in 7 cases,a fall injury in 26 cases.55 fractures were closed,and 4 were open.According to the Gustilo-Anderson classification,there were 3 type Ⅰ,1 type Ⅱ.Results The 7-hole plate were used in 21 patients,9-hole plate in 26 patients and 13-hole plate in 12 cases.The 3.5 mm or 6.5 mm lag screw were placed around the LISS plate to stabilized the articular fracture fragment in 11 cases.The mean operation time was 105.2 min (85-145 min),the mean bleeding volume was 203 ml (130-315 ml).All patients were followed up 11-27 months (average 13.2 months).1 delayed union(13 months),the average time to union was 16 weeks (range 12-21 weeks).The average flexion of the knee was 116 degree,0 degree in extension.The functional outcome:32 had an excellent result,19 had a good result and 8 had a fair result,with 86.4％ excellent and good results.No deep infections occurred.No loss of reduction.3 cases had malalignment,2 failed fixation,4 patients with symptomatic hardware irritation.27 cases underwent implants removal after union,cold-welding occurred in 4 cases (9 screws) which resulted in difficult removal.Conclusion LISS is one of the reliable and effective methods in fixation of mechanically unstable fractures of the distal femur.However,its operation indications and operating instructions should be strictly followed.

Objective To explore the clinical therapeutic effects of St. John's Wort exact (SWE)on depressive disorder and blood glucose in elderly type 2 diabetic patients Methods 118 patients with type 2 diabetes and depressive disorder were randomly assigned to SWE group (26 cases),lorazepam group (22 cases ), psychotherapy group (24 cases), physicotherapy group (24 cases) and control group (routine therapy,22 cases) for 12 weeks' treatment. The clinical effects were evaluated with the percentage reduction in HAMD score after the treatment, HbAlc levels were obtained to monitor glycemic control. Results (1) The percentage reduction in HAMD score in SWE group was the highest (80. 8%), and it was lower in lorazepam group ( 63. 6%), psychotherapy group (62. 5%) and physicotherapy group(58. 3%). The percent decrease in H AMD score was higher in four groups than in control group ( 18. 2%) and the difference was significant (P < 0. 01). The therapeutic effect of SWE was better than the others(P0. 05). (2) The level of HbAlc in SWE group (6.5±0. 6)% was significantly lower than the others [( 7. 5 ± 0. 8) %, (7.4 ± 0. 8) %, (7. 4 ±1.0) % (P < 0. 01 )]. Conclusions St. John' s Wort exact (SWE) can efficiently improve the depressive disorder in elderly type 2 diabetic patients, and it is good for controlling blood glucose of the patients.