Infection is a major complication in lupus nephritis patients,and also remains a major cause of morbidity and mortality in LN.The most common infected sites are respiratory tract,skin soft tissue,urinary system,et al.Immunological abnormity,use of glucocorticoid and immunosuppressive agents,renal insufficiency and hypoproteinemia are involved in the susceptibility of LN patients' infections.A wide variety of infectious pathogens are recognized in LN and bacterial infection is the most.Virus,fungi and tubercle bacillus also can be identified.The clinical manifestations of the infections are atypical,including fever,cough,headache,twitch,abnormity of spirit and action,et al and often confused with the multiplicity clinical manifestations of SLE activity.It is necessary to carry out clinical observation and pathogeny examination for diagnosis.All patients must receive effective anti-infective therapy in time,and adjust their glucocorticoid and immunosuppressive dosage.In order to avoid infection,it is necessary to strictly control the indication and dosage of glucocorticoid and immunosuppressers.

Objective:To observe the ratio of the syndrome of deficiency in origin to the syndrome of excess in superficiality in chronic renal failure(CRF)and co-existent states,and to analyze the relationship between TCM syndrome types and related biochemical indexes.Methods:TCM syndrome differentiation was carried out and related biochemical indexes were determined in 146 cases of CRF.The data were compared and analyzed with single factor analysis of variance between groups.Results:(1)Deficiency of both qi and yin of spleen and kidney was the most frequently-appeared type in the deficiency syndrome,and damp-heat syndrome was the most frequently-appeared type in the excess syndrome;(2)Serum creatinine(SCr)and blood uria nitrogen(BUN)in the patient of damp-turbid syndrome in the excess syndrome were significantly higher than those in the patient of damp-heat and blood stasis syndrome;(3)Fibrin in the patient of blood stasis was significantly higher than that in damp-heat syndrome and damp-turbid syndrome.Conclusion:Generation and development of CRF are closely related with dampness syndrome,usually marked by syndrome of damp-turbid,damp-heat,blood stasis,damp-stagnation,and was mainly related with abnormal renal function and hemorheologic indexes in the biochemical indexes.

AIM:To investigate the effects of high concentration of glucose on the expressions of serum and glucocorticoid induced protein kinase 1 (SGK1) and fibronectin in human podocytes and detect the production of fibronectin in human podocytes transfected with active and mutant forms of SGK1.METHODS: The expressions of SGK1 and fibronectin in human podocytes exposed in high glucose for 24 h were detected by using Western blotting. Human podocytes were transfected with three kinds of plasmid: pIRES2-EGFP-SGK1SD (SGK1-active plasmid), pIRES2-EGFP-SGK1KN (SGK1-mutant plasmid) and pIRES2-EGFP (empty vector plasmide). The synthesis levels of fibronectin were detected by immunofluorescence.RESULTS: The expression of SGK1 in normal human podocytes was observed and the expression level was up-regulated in podocytes exposed to high glucose for 24 h (50?4 vs 35?3), parallelly with the high expression of fibronectin (19?4 vs 12?2). The secretion of fibronectin was increased obviously in SGK1-active plasmid (SGK1SD) transfected podocytes compared with the vector transfected podocytes. Whereas, the fibronectin level was decreased significantly but not completely abolished in SGK1-mutant plasmid (SGK1KN) transfected podocytes, compared with SGK1SD transfected podocytes. CONCLUSION: SGK1 may be involved in the synthesis of fibronectin in human podocytes induced by high glucose and play a critical role in the activation of human podocytes during early stage of diabetic nephropathy.

Objective: To analyze the factors affecting the complication of pulmonary atelectasis among children with tracheobronchial tuberculosis (TBTB), so as to provide the reference for the prevention and treatment of pulmonary atelectasis complicated by TBTB. Methods: Children with TBTB admitted to Department of Paediatrics, Linping Division of the Second Affiliated Hospital of Zhejiang University School of Medicine were selected as the study subjects from October 2018 to March 2023. Subjects's basic information, etiological examination results and laboratory testing results were collected using a self-designed questionnaire, and factors affecting the complication of pulmonary atelectasis among children with TBTB were identified using a multivariable logistic regression model. Results: A total of 120 children with TBTB were included, with the age of 6 months to 12 years. There were 33 children at ages of less than one year (27.50%), 71 girls (59.17%) and 25 children with TBTB and pulmonary atelectasis (20.83%). Multivariable logistic regression analysis identified less than one year of age (OR=1.720, 95%CI: 1.126-3.358), type Ⅵ of TBTB (OR=1.669, 95%CI: 1.101-2.236), high level of C-reactive protein (OR=1.887, 95%CI: 1.088-2.686) and high level of procalcitonin (OR=1.844, 95%CI: 1.034-2.654) as risk factors for the complication of pulmonary atelectasis in children with TBTB. Conclusion Less than one year of age, type Ⅵ of TBTB, high level of C-reactive protein and high level of procalcitonin may increase the risk of pulmonary atelectasis in children with TBTB.

OBJECTIVE:To establish the quality standard for the leaves of Nauclea officinalis. METHODS:Microscopic identi-fication and TLC methods were used for qualitative identification of N. officinalis. The moisture and ash of medicinal materials were determined. HPLC method was adopted to determine the content of strictosamide in medicinal materials. The determination was per-formed on Lichrospher C18 column with mobile phase consisted of acetonitrile-0.1% phosphoric acid solution(gradient elution)at the flow rate of 1 mL/min,injection volume was 10 μL. The detection wavelength was set at 226 nm,and the column temperature was 30 ℃. RESULTS:Microscopic identification of the leaves of N. officinalis had strong characteristics,and TLC sports were clear and well-separated without interference from negative control. The linear range of strictosamide were 0.0105-0.21 mg/mL(r=0.9995);RSDs of precision,stability and reproducibility tests were all lower than 2.0%. Average recoveries were 96.25-101.82%(RSD=1.86%,n=9). Total ash of medicinal materials was 5.27%-6.44%,acid insoluble ash was 0.23%-0.36%,water content was 9.48%-11.46%,strictosamide was 0.124%-1.003%. CONCLUSIONS:Established standard can be used for quality evaluation of N. officinalis.

Objective This study aimed to evaluate the clinical significance of detecting cytokine expression with Crohn's disease(CD) by Luminex liquid chip.Methods A total of 76 patients with CD and 50 healthy volunteers as healthy control group were recruited in this study.The expression of cytokines IL-2,IFN-γ,TNF-α,IL-4,IL-6,IL-10 and IL-17A were detected by Luminex liquid chip according to the instruction of MILLIPLEX MAP Kit.Enzyme-linked immunosorbent assay(ELISA) was used to detect the levels of anti-saccharomyces cerevisiae antibodies(ASCA).Then the relationship and differences among these groups were analyzed.Results Except IL-17A,the level of IL-2,IFN-γ,TNF-α,IL-4,IL-6,IL-10 was higher in the CD group than those in control group.The serum levels of IFN-γ,TNF-α and IL-6 in patients with active stage of CD group were significantly higher than those with remission stage and healthy control group.The level of TNF-α and IL-6 in moderate and severe stages were higher than those in slight stage.The serum level of ASCA had significant difference between CD group and control group.Compared with ASCA negative group,the ASCA positive patients have a higher level of IL-6 and TNF-α.ConclusionThe cytokines like IL-6 and TNF-α is correlated with CD severity,which is important for inflammatory activity and progression of CD.Altogether,these results demonstrated that the dynamic change of cytokines had a clear relativity in stage of CD,which is very imperative for diagnosis and clinical appraisal of CD.

Objective To investigate the cardioprotective effect of losartan o n subtotal nephrectomy renal failure rats. Methods Renal failure rats were estab lished by subtotal nephrectomy, and then divided into RF group with subtotal nep hrectomy,RF+Los group with additional losartan(10 mg?kg-1?d-1) gavage. Rats underwent sham operation(sham group) with normal saline gavage as control. Hear t changes of experimental rats were observed 12 weeks after operation. Results T he RF group developed hypertension of arterial systolic blood pressure(SBP) and myocardiac myocytes hypertrophy. The levels of collagen type Ⅰ,type Ⅲ,and fi bronectin in endocardium and surrounding intracardial coronary arteries adventit ia of the RF group were significantly increased as compared to those of the sham group. The SBP and the levels of collagen type Ⅰ,Ⅲand fibronectin were marked ly decreased in the RF+Los group as compared to those of the RF group.Expressio n of angiotensin Ⅱsubtype 1 receptor (AT1R) mRNA in the myocardium of the RF+L os group was significantly down regulated as compared to that of RF group. Concl usions Losartan can prevent the cardiac ventricular remodeling with left ventric ular hypertrophy (LVH) and myocardial interstitial fibrosis by the depression of renin-angiotensin system through the down-regulation of myocardiac AT1R mRNA.

Objective To analyze the expression and regulation of components of intrarenal renin-angiotensin system (RAS) and the correlation between intrarenal angiotensin Ⅱ (Ang Ⅱ) expression and clinicopathological injury index in primary IgA nephropathy patients. Methods Expressions of intrarenal RAS components were assessed by immunohistochemistry staining (IHCS). Correlation among intrarenal RAS components and of intrarenal Ang Ⅱ expression with blood pressure, estimated glomerular filtration rate (eGFR), 24-h urinary protein and Katafuchi score in 36 primary IgA nephropathy patients were examined. Results There were positive correlations between positive IHCS area of intrarenal renin and Ang Ⅱ (r=0.43, P＜0.01), angiotensiongen and Ang Ⅱ (r=0.34, P＜0.05). There was negative correlation between positive IHCS area of intrarenal Ang Ⅱ and eGFR (r=-0.61, P＜0.01). There was positive correlation between positive IHCS area of intrarenal Ang Ⅱ and pathological chronicity index (ρ=0.39, P＜0.05), index of interstitial cell infiltration (ρ =0.52, P ＜0.05). Conclusion Expression of intrarenal Ang Ⅱ is positively correlated with expression of intrarenal renin and angiotensinogen, and plays an important role in kidney fibrosis in primary IgA nephropathy.

Objective To analyze the correlation of urinary angiotensinogen (AGT) with clinical index of kidney injury and intrarenal renin-angiotensin system (RAS) activity in chronic kidney disease (CKD) patients. Methods Urinary or plasma renin activity, AGT, angiotensin Ⅱ (Ang Ⅱ ), aldosterone were measured by RIA or ELISA in 129 CKD patients. Expression of intrarenal renin, AGT, Ang Ⅱ and angiotensinⅡ receptor was examined by immunohistochemistry staining (IHCS) in 73 CKD patients undergoing renal biopsy. Correlation of urinary AGT with other indexes was performed. Results Average urinary AGT in 129 CKD patients was (159.08 ± 125.18) μg/g Cr, Scr was (113.20± 105.05)μmol/L, and urinary AGT was positively correlated with Scr (r=0.51, P<0.01). Average estimated glomerular filtration rate (eGFR) was (58.52±27.15) ml·min-1·(1.73 m2)-1, which was negatively correlated with urinary AGT (r=-0.55, P<0.01). Average urinary protein was (2.03±2.65) g/24 h, which was positively correlated with urinary AGT (r=0.30, P<0.01). Average urinary Ang Ⅱ was (164.71 ±139.25) ng/g Cr, which was positively correlated with urinary AGT (r=0.20, P<0.05). Average urinary type Ⅳ collagen was (447.60± 800.66) μg/g Cr, which was positively correlated with urinary AGT (r=0.47, P<0.01). Average urinary soduim was (162.17±81.61) mmol/24 h, which was negatively correlated with urinary AGT (r=-0.20, P<0.05). Multiple regression analysis indicated that low eGFR (P<0.01), high Scr (P< 0.01), high urinary protein (P<0.05), high urinary Ang Ⅱ (P<0.05) and high urinary type Ⅲ collagen (P<0.01) were significantly correlated with high urinary AGT. In renal tissues of CKD patients, there was positive correlation of urinary AGT with positive IHCS area of AGT (r=0.45, P< 0.01), Ang Ⅱ (r=0.52, P<0.01) and angiotensin Ⅱ type 1 receptor (r =0.28, P <0.05). Conclusions Urinary AGT level may indicate the kidney injury severity, especially in chronic kidney injury, and may be used as a non-invasive marker of intrarenal Ang Ⅱ activity in CKD patients.

Objective To study the impact and mechanism of continuous venovenous hemofiltration (CVVH) in different uhrafihration rates on plasma cytokines in porcine endotoxemic shock. Methods Eighteen anesthetized mechanically ventilated pigs weighing 21-34 kg were randomly divided into three groups. In control group (n=6), the pigs received a 15.7 μg/kg endotoxin (E.coli 0111:84) infusion. In CVVH group (n=6) and high volume hemofihration (HVHF) group (n=6), the pigs received CVVH after the endotoxin infusion for 24 hours with an was taken before endotoxin infusion and at 0, 1, 6, 12, 24 h during CVVH. The plasma levels of TNF-α, IL-6, IL-10 and IL-18 were tested by ELISA. Results The survival time in control group was (15.4±5.2) h,CVVH group was (21.4±7.1) h,HVHF group was (22.4±6.7) h. The survival time in CVVH and HVHF group was significantly longer than that of control group (P< 0.05 ). Heart rate (HR), mean arterial blood pressure (MAP), central venous pressure (CVP) and cardiac output (CO) showed no significant differences among three groups. Plasma BUN and Ser increased gradually after the establishment of porcine endotoxemic shock model. BUN and Scr of CVVH and HVHF group were lower compared to control group (P<0.05), but there was no significant difference between CVVH and HVHF group (P>0.05). Plasma TNF-α and IL-6 peaked at T1, IL-10 peaked at TO, then they declined gradually. While IL-18 increased at TO and did not change after TO. A significant decrease of plasma IL-10 level was observed at T6, T12 and T24 in CVVH group compared with control group (P<0.05). HVHF group accomplished a greater decrease in plasma TNF-α (T6) and IL-10 (T6, T12, T24) levels compared with control group and CVVH group (P< 0.05). The levels of IL-6 and IL-18 showed no significant differences among three groups. There was a negative correlation between IL-6 and survival time (P<0.05). Conclusions HVHF and CVVH can prolong the survival time of porcine endotoxemic shock. IL-10 can be removed effectively with CVVH and HVHF. HVHF can also remove TNF-α effectively. CVVH and HVHF treatment can both remove BUN and Scr effectively. IL-6 is a powerful independent predictive factor for survival time of porcine endotoxemic shock.