Objective To study the clinical effect of tacrolimus combined with small dose of prednisolone in treatment of IgA nephropathy.Methods 84 cases with IgA nephropathy were randomly divided into study group and the control group in accordance with the digital table method.The control group was given simple hormone treatment, while the study group was treated with tacrolimus combined with small dose of prednisolone.The clinical efficacy and safety were compared between the two groups.Results The treatment effective rate (100.00%)and complete remis-sion rate (73.81%)of the study group were significantly higher than those in the control group (76.19%, 23.81%),and the differences were statistically significant (χ2 =21.01,11.35,P <0.05 ).After treatment,24h urinary protein level was significantly decreased compared with before treatment.24h urinary protein level[(0.54 ± 0.41)g/L]of the study group was significantly lower than the control group[(1.06 ±0.62)g/L],and the difference was statistically significant (t =4.01,4.58,3.87,all P <0.05).In addition,before and after treatment,the serum creatinine,blood sugar,white blood cells,cereal third transaminase,SBP and DBP levels between two groups had no significant differences (P >0.05).When patients lighter (Lee's Ⅱ level),the team for complete response rate was significantly higher than the control group,and the difference was statistically significant (χ2 =5.01,P <0.05 ). However,with the aggravation of pathological damage (Lee),the effective rate and complete remission rate of the study group and the control group showed a downward trend.The effective rate and complete remission rate of the study group were higher than those in the control group,but the differences were not statistically significant (χ2 =1.03,2.11,1.20,1.20,all P >0.05).The incidence rate of adverse reactions in the study group (19.05%)was not significantly different from that of the control group (16.67%)(χ2 =0.08,P >0.05 ).Conclusion Tacrolimus combined with small dose hormone for the treatment of IgA nephropathy has high clinical value,it can significantly reduce the level of IgA nephropathy 24h nephropathy,and adverse reactions.

Objective To investigate the effects of astragalus membranaceus parenteral solution combined with recombinant human erythropietin (rHuEPO) on erythrocyte immunity function in patients with hemodialysis. Methods Fifty-one patients of chronic renal failure(CRF) with hemodialysis were divided into 2 groups randomly according to whether treated with astragalus membranaceus parenteral solution or not(therapeutic group, was 26 cases and control group was 25 cases). IgG, IgA, IgM, RBC-C3b,RR,RBC-ICR, erythrocyte percentage of CD35 positive and SOD was measured before treatment and 8 weeks after treatment. Results After 8 weeks' treatment, IgG,IgA,IgM levels in therapeutic group and IgG,IgA levels in control group were higher than those before treatment(P < 0.01 ). IgM [ (2.03±0.73 ) g/L ] was higher than that in control group (P< 0.05). RBC-C3B,RR, erythrocyte percentage of CD35 positive and SOD were higher and RBC-ICR was lower than those before treatment in two groups (P < 0.05 ) ;compared with that in control group, RBC-C3b, RR was higher [(10.85±2.31 )% ] and RBC-ICR was lower [(5.34±1.91 )% ] (P < 0.05 ).Conclusion Astragalus membranaceus parenteral solution combined with rHuEPO is superior to improve CRF patients' levels of immune globulin and erythrecyte immunity function.

Objective To observe the clinical efficacy of treatment of diabetic nephropathy with Shuxuening injection combined with benazepril.Methods 60 cases from January 2014 to January 2015,were randomly divided into observation group and control group of 30 patients.the control group were given benazepril treatment,observation group were based on Shuxuening injection treatment,patients were followed up and record changes related indicators.Results The urinary β2-MG and hs-CRP were after treatment(0.38±0.08,6.29±1.40)mg/L,than the control group(0.48±0.10,7.74±1.36)mg/L,and the difference was significant sex(P<0.05); after treatment observation group 24H urine protein quantitative detection of(0.69±0.50)g/24h,than the control group(1.04±0.63)g/24h,and the difference was statistically significant(P<0.05); After the observation group patients,low-density lipoprotein,serum creatinine value were(359.2±50.3mg/L,2.40±0.63mmol/L,95.6±22.3mol/L),were better than the control group(379.8±48.3mg/L,3.44±0.76mmol/L,108.5±34.2mol/L),and the difference was statistically significant(P<0.05); observation group total effective rate was 90.0％,higher than 73.0 percent,and the difference was statistically significant(P<0.05).Conclusion Shuxuening injection combined with benazepril clinical treatment of diabetic nephropathy exact,no significant side effects,is worthy of further research and application.

Objective To investigate the clinical and pathological characteristics of kidney disease by renal biopsy,thus to provide reference and help for the application of renal biopsy in the diagnosis and treatment of kidney diseases. Methods From January 2015 to June 2017,136 cases with kidney disease in Zhoushan Hospital were slected in the research. All patients received renal biopsy,histochemical staining of renal biopsy samples,immunohistochemical staining,and observed under light microscope, and the pathological changes of the situation, combined with clinical data,the clinical and pathological characteristics of renal biopsy patients were summarized. Results The distribution of pathological type of primary glomerulonephritis,the highest proportion (79. 41％),secondary glomerulonephritis (15. 44％),followed by the rest of the renal tubular and interstitial nephropathy (5. 15％). Of the primary glomerulo-nephritis,membranous nephropathy ( 28. 68％), IgA nephropathy ( 27. 94％) accounted for a relatively high proportion. However,in secondary glomerulonephritis,diabetic nephropathy (5. 88％) was the highest proportion. Of gender,the proportion of the male patients (59. 56％) was higher than that of the female patients (40. 44％,χ2 =9. 941,P<0. 05),primary glomerulonephritis in the male patients(62. 04％) was higher thanthat in the female patients (37. 96％) (χ2 =12. 519,P<0. 05). The age of renal biopsy was focused on the age of 41-50 years,>50-60 years,>60 -70 years old, which was mainly the elderly population. Conclusion Renal biopsy of kidney disease is mainly primary glomerulonephritis,the incidence of people mainly in the elderly male population. Compre-hensive diagnosis is needed for different kidney diseases with renal biopsy and the specific circumstances.

0.05).Again,compared with NG group,the protein expression of PKC? in HUVECs was up-regulated,the cytosol/nuclei ratio of PKC? was decreased,cell cycle was blocked in G0/G1 phase,the apoptosis increased significantly,and the protein content of p-FOXO1(S256) and P27kip1 increased(P

Objective To detect the relationship between plasma B-type natriuretic peptide(BNP) and left ventricular function in elderly patients with maintenance hemodialysis (MHD). Method Plasma BNP concentration were measured in 50 MHD patients (MHD group) and 30 healthy controls (control group). Echocardiographic examinations were performed including left ventricular ejection fraction (LVEF). Results The median plasma BNP level in MHD group before and after hemodialysis was 213.5 ng/L and 110.2 ng/L, and obviously higher than that in control group (20.2 ng/L) (P<0.01). Spearman rank correlation showed that plasma BNP level was significantly negatively correlated with LVEF (r=-0.4357, P< 0.05). The median plasma BNP level in the patients with LVEF < 50% before and after hemodialysis was 386.5 ng/L and 232.0 ng/L, significantly higher than that in the patients without left ventricular dysfunction (LVEF≥50%) (59.7 ng/L and 29.1 ng/L)(P<0.01). Conclusions The level of BNP may reflect dynamic change of left ventricular function in MHD patients. It can help to diagnose and treat cardiovascular disease in MHD patients early.

Objective To study the compatibility of TCM prescriptions of TCM practitioners of all dynasties of Alzheimer disease (AD). Methods Amnesia, forgetting, dementia, and idiot were set as search words to retrieve relevant literature in Encyclopadia of Traditional Chinese Medicine. Prescription information was screened and standardized to build database. Frequency analysis and association rules were used to mine TCM prescriptions and compatibility rules. Results Totally 449 AD related prescriptions were selected, involving 682 Chinese medicinal herbs. The individual herb with the highest frequency was Ginseng Radix Rhizoma (192);the herbal pair with the highest frequency was Ginseng Radix Rhizoma-Polyhalae Radix (182);the herbal combination with 3 Chinese medicinal herbs with the highest frequency was Poria with Hostwood-Ginseng Radix Rhizoma-Polyhalae Radix (79);the herbal combination with 4 Chinese medicinal herbs with the highest frequency was Polyhalae Radix-Ginseng Radix Rhizoma-Poria with Hostwood-Glycyrrhizae Radix et Rhizoma (37). The results of association rules showed that Ginseng Radix Rhizoma-Polyhalae Radix, Ginseng Radix Rhizoma-Glycyrrhizae Radix et Rhizoma, and Ginseng Radix Rhizoma-Poria with Hostwood were commonly used compatibilities in AD related prescriptions. Conclusion Treatment of TCM practitioners in all dynasties for AD mainly chooses Chinese medicinal herbs with the efficacy of tonifying qi and soothing nerves. The compatibilities and combinations are reasonable and with certain representativeness.

Objective To investigate the roles of protein kinase C(PKC)β_2 and PPARα in the mRNA expression of vascular endothelial growth factor(VEGF)and vascular cell adhesion molecule-1(VCAM-1)in human umbilical vein endothelial cells(HUVECs)exposed to high glucose,and to explore their relationship.Methods The HUVECs were divided into eight groups:normal glucose(NG,5 mmoL/L D-glucose)group,high glucose(HG,25 mmol/L D-ucose)group,osmotic control(L,NG+20 mmol/L L-glucose)group,normal glucose transfected with empty vector(NN,NG+AdS-null)group,high glucose transfected with PKCβ_2(HB,HG+Ad5-PKCβ_2)group,high glucose plus fenofibrate(HF,HG+40 μmol/L fenofibrate)group,and HB plus fenofibrate (HBF,HB+40μmol/L fenofibrate)group.HUVECs were incubated with fenofibrate for 20 minutes as HF20 group.All cells in various groups were cultured for 6 days.The expressions of VEGF and VCAM-1 mRNA were detected by RT-PCR.PPARα protein expression was tested by Western blot.The expression and traaslocation of PKCβ_2 protein were observed by confocal laser scanning microscopo.Results (1)HG increased VEGF and VCAM-1 mRNA expressions,with 1.91 and 1.56 folds of NG group,respectively(both P<0.05).VEGF and VCAM-1 mRNA expressions in HB group further increased,with 2.59 and 2.07 folds of NG group,respectively(both P<0.05).Fenofibrate significantly decreased VEGF and VCAM-1 mRNA expressions,with 68%and 74%of HG group,respectively(both P<0.05).There were no significant difierences in the expressiong of VEGF,VCAM-1 mRNA between HF20 and HG groups.(2)The protein expression of PPARα decreased by 20%in HG group compared with NG group,and further decreased in HB group,being 78%of HG group.Compared with HG group,PPARαexpression increased by 13%in HF group(P<0.05).(3)HG induced PKCβ_2 translocation from cytosol to nucleus and quantitative analysis showed the ratio of plasma/nuclear fluorescence intensity in HG group decreased by 37% compared with NG group(P<0.05).The PKCβ_2 translocation was more obvious in HB group than in HG group.Conclusion Hiigll glucose stimulates VEGF and VCAM-1 mRNA expressions in HUVECs via PKCβ_2 activationdependent PPARα pathway.

Aim To investigate the possible mecha-nisms of the levels of NO decrease induced apoptosis in human placental trophoblast cells. Methods Human placental trophoblast cells ( HTR-8 ) were cultured in 5 ml DMEM-F12 culture medium with 37℃ 5% CO2 . Then, the old culture medium was discarded and re-placed with 10,100,500,1 000 μmol·L-1 L-NAME, and the group without L-NAME was set as the control group, cultured for 48h. The effects of L-NAME on the survival of cells were detected by methylthiazolyldiphe-nyl tetrazolium bromide ( MTT); the content of NO in cells was tested by nitrate reductive enzymatic;trans-mission electron microscopy, flow cytometry analysis and Annexin-V FITC dyeing were used to test the effects of L-NAME on apoptosis in HTR-8 cells;restore Fe3+ colorimetric assay was applied for detection of to-tal antioxidant capacity ( T-AOC ) , xanthine oxidase for detection of superoxide dismutase ( SOD) activity, and thiobarbituric acid colorimetry for determination of content of MDA. Results Compared with the control group, the survival rate of HTR-8 cells and the levels of NO in 100,500,1 000 μmol·L-1 L-NAME group were significantly reduced(P<0.05,P<0.01). Flow analysis and Annexin-V FITC staining showed that L-NAME could induce cell apoptosis in a dose-dependent manner. The number of cell apoptosis was negatively correlated with the content of NO ( r = -0.5210 ) in HTR-8 cells. Transmission electron microscopy results showed that compared with the control group, the ex-perimental group's cell nucleus shape was irregular, nuclear pyknosis in irregular shape, the chromatin ag-glutination or side the collection, mitochondrial swell-ing or enrichment, crest fracture or dissolved, even vanished, forming the vacuole, especially in 100 μmol ·L-1 L-NAME group, the apoptotic bodies obviously appeared. At the same time, T-AOC, SOD levels in HTR-8 cells decreased ( P <0.05 ) , and the MDA content increased ( P<0.05 ) . The number of cell ap-optosis was negatively correlated with the level of T-AOC ( r= -0.3212 ) , SOD ( r= -0.2779 ) in HTR-8 cells , while positively correlated with the content of MDA(r=0.2807). Conclusion Oxidative stress may play an important role in the levels of NO decrease in-duced apoptosis in human placental trophoblast cells.

Objective To investigate the situation about cognitive performance of critical care staffs in nutrition therapy for mechanical ventilated chronic obstructive pulmonary disease (COPD) patients in county hospitals.Methods A chart of questionnaire about nutrition therapy was formulated according to the current guidelines.Critical care staffs from 12 hospitals of county-level of Hang Zhou city were enrolled.The role of staffs in management of nutritional therapy for patients was observed to assess their cognitive performance and influence factors were analyzed according logistic analysis.Results A total of 137 staffs were enrolled.Almost all of the staffs thought that nutrition therapy for ventilated COPD patients was very important.About 90％ of the staffs never heard about the use of NRS2002 (nutritional risk screening 2002)to evaluation COPD patients but the rate of using it was higher among senior staffs (OR =1.08,95％ CI:1.01-1.16,P =0.04).Most of staffs assess the nutritional status of patients according to biomarkers and other methods.However,doctors might assess nutritional status more often according to their experience.The majority of staffs did choose enteral nutrition for patients especially seen in doctors and senior staffs (OR =3.10 and1.13,95％ CI:1.27-7.55 and 1.03-1.23,both P =0.01).For those without malnutrition,senior staffs did not choose parenteral nutrition (OR =0.14,95％ CI:0.04-0.57,P =0.01).Besides,senior staffs did not continue the enteral nutrition in patients with unstable haemodynamics (OR =1.10,95％ CI:1.03-1.16,P =0.002).Most of staffs considered that the head piece of bed was raised up to 30-45 degree and gastric residual volume monitoring was very important.However,compared with nurses,the cognitive performance of doctors was poorer (OR =0.39,95％ CI:0.18-0.83,P =0.01).Most of staffs thought that the nutrition therapy implementation checklist was necessary but it was used in only 20％ institutions.The understanding and demand for nutritional knowledge was more urgent among doctors than nurses (OR =3.13 and 5.33,95％ CI:1.45-6.75 and 1.13-25.02,P =0.004 and 0.03).Conclusions Nutrition therapy was important for ventilated COPD patients,but the staffs were not very familiar with nutritional knowledge.The cognitive performance of medical staffs was influenced by their profession and experience of practice.