Objective To observe the effect of leflunomide and cyclophosphamide combined with prednisone in the treatment of idiopathic membranous nephropathy .Methods 30 patients with idiopathic membranous nephropa-thy were randomly divided into two groups ,15 cases in each group .A group was treated by leflunomide combined with prednisone , B group was treated by cyclophosphamide combined with prednisone , 6 months a course .The clinical effect,24h urine protein quantity,serum albumin levels,blood fat,renal functions and adverse reactions were com-pared.Results 3,6 months after treatment ,the remission rates in A group were 60.00%,73.33%,those in B group were 53.33%,66.67%(χ2 =0.965,0.896,all P>0.05).After treatment,24h urine protein quantity,serum albu-min levels in the two groups [A group:(1.33 ±1.25)g/24h,(38.24 ±4.84)g/L;B group:(1.42 ±1.37)g/24h, (37.12 ±5.43)g/L] were significantly lower than those before treatment [A group:(7.34 ±2.75)g/24h,(20.31 ± 7.33)g/L;B group:(7.22 ±2.84)g/24h,(20.46 ±7.73)g/L] (A group:t=6.232,5.734,all P<0.05;B group:t=5.934,5.267,all P<0.05).After treatment,total cholesterol,triglyceride in the two groups [A group:(6.74 ± 1.45)mmol/L,(2.43 ±0.75)mmol/L;B group:(6.63 ±1.45)mmol/L,(2.14 ±0.63)mmol/L] were significantly lower than those before treatment [A group:(11.94 ±2.98) mmol/L,(3.56 ±1.35) mmol/L;B group:(11.53 ± 2.84)mmol/L,(3.24 ±1.46)mmol/L] (A group:t=6.246,5.234,all P<0.05;B group:t=5.256,5.672,all P<0.05).There were no significant differences in urea nitrogen ,serum creatinine between before and after treatment in the two groups(all P>0.05).There were no significant differences in above indicators between A group and B group after treatment (all P>0.05).The incidence rate of adverse reactions in A group (13.33%) was significantly lower than that in B group(40.00%)(χ2 =4.246,P<0.05).Conclusion The clinical efficacy of leflunomide is similar to cyclophosphamide in treating idiopathic membranous nephropathy with fewer adverse reactions .

Objective To investigate the risk factors of postoperative infectious complications (PIC) after liver resection for hepatocellular carcinoma (HCC) using evidence based medicine to provide a basis for prediction and prevention of PIC.Methods The fixed-effects or random-effects model was performed on studies on risk factors of PIC in HCC patients published from January 1990 to May 2015 by searching the PubMed,Embase,CNKI,VIP and Wanfang Data.Results Fourteen studies involving HCC 5 841 patients were included in this meta-analysis.The level of serum albumin was significantly lower in the PIC group than the NPIC group (WMD =-1.80,95％ CI:-2..79 ～-0.80 ; P ＜ 0.05) ; Patients with diabetes mellitus had a higher incidence of PIC than those without diabetes mellitus (OR =1.94,95％ CI:1.27 ～ 2.95 ; P ＜ 0.05) ; Patients with operation time less than 5 h had an decreased incidence of PIC than the other group (OR =0.31,95 ％ CI:0.22 ～ 0.45 ; P ＜ 0.05).Patients with blood loss less than 2 000 ml had a lower incidence of PIC than the other group (OR =0.30,95％ CI:0.19 ～ 0.48 ; P ＜ 0.05).Patients with blood transfusion had a higher incidence of PIC than those without transfusion (OR =2.83,95％ CI:2.04 ～ 3.93 ; P ＜ 0.05).Patients with postoperative bile leakage had a higher incidence of PIC than those without bile leakage (OR =3.79,95％ CI:2.06 ～ 6.96; P ＜ 0.05).Patients after primary hepatectomy had a higher incidence of PIC than those after repeat hepatectomy,but there was no significant difference between the two groups (OR =1.52,95％ CI:0.99 ～ 2.33 ; P =0.05).Patients with tumor diameter less than 5 cm had a higher incidence of PIC than the other group,but there was no significant difference between the two groups (OR=1.09,95％CI:0.76 ～1.56; P＞0.05).Conclusion A low level of serum albumin,diabetes mellitus,operation time more than 5 h,blood loss more than 2 000 ml,blood transfusion,bile leakage were risk factors for the development of PIC.

Objective To investigate the effect of Dicer knockdown on the proliferation,migration and invasion of cholangiocarcinoma cell line TFK-1.Methods The study used liposome-mediated method to transfect Dicer-siRNA into TFK-1 cells.The mRNA and protein expressions of Dicer after transfection were detected by real-time PCR and western blot.CCK8 assay,scratch test and transwell assays were performed to analyze the influence on the proliferation,migration and invasion of cells,respectively.Results Compared with the control,Dicer mRNA level at 48 h and Dicer protein level at 96 h were both significantly reduced after transfection with Dicer-siRNA (P ＜ 0.01).CCK8 assay revealed that the absorbance value significantly increased at 72 h,96 h and 120 h after transfection (P ＜0.01).Scratch test and transwell assay showed that the migration ability and the number of invasive cells significantly increased (P ＜ 0.05).Conclusion Dicer knockdown enhanced the proliferation,migration and invasion of cholangiocarcinoma cell line TFK-1.

Objective To investigate the effect of orphan nuclear receptor NR4A1 expression on oxygenglucose deprivation (OGD)-induced apoptosis in cultured rat cerebellar granule neurons and its possible mechanisms.Methods Primary rat cerebellar granule neurons were cultured for 7 to 8 days,and then treated with OGD.The activity of cultured rat cerebellar granule neurons was assessed by methyl thiazolyl tetrazolium (MTT) assay,apoptosis was detected with flow cytometry,the expressions of NR4A1,caspase-3 and cytochrome c were determined by Western blot analysis,NR4A1 mRNA expression was detected with real-time polymerase chain reaction.The rat cerebellar granule neurons were transfected with lentiviral vector-encoding rat NR4A1.The apoptotic rates and expressions of caspase-3 and cytochrome c in rat cerebellar granule neurons transfected with NR4A1 were detected after OGD.Results The activity of rat cerebellar granule neurons decreased significantly,the apoptotic rate increased significantly,the expressions of NR4A1 mRNA and protein as well as caspase-3 and cytochrome c incrased significantly along with the OGD time.NR4A1 was overexpressed,apoptosis rate was significantly reduced in rat cerebellar granule neurons transfected with NR4A1.The expressions of caspase-3 and cytochrome c were significantly reduced in the rat cerebellar granule neurons transfected with NR4A1 after OGD.Conclusions NR4A1 overexpression may reduce OGD-induced apoptosis in rat cerebellar granule neurons by downregulating the expressions of caspase-3 and cytochrome c.

Objective To explore the method for repair of total avulsion of 2~4 fingers and to find the best procedure. Methods The wrap-round flap with part toenail combind with the dorsal pedical flap to repair soft tissue defect of the dorsal of finger and part of the palmar of finger, the second simepulp flap to repair soft tissue defect of the palmar of finger,transfer of two tissues with one pedicle to repair total avulsion of 2~4 fingers. Results All of 9 composite transplants in 6 cases were survived,the received areas were primary healing in 8 finger,1 case repaired by the bilateral wrap-round flaps and second simepulp flaps for index and middle finger,the distal phalanx of middle finger necrosis because of dislocation of DIP,3 months later,injury healed after the necrosis of phalanx excised,but the nail and the nail bed were dead.Except 1 case which the grafted skin necrotized in the donor area of the big toe,the rest had primary healing.All cases were followed up 6~14 months,the activity of joints were: MP 0-70,PIP 0-40.The repaired pulps had excellent appearance,the nail was fine,1 finger's mail was atrophy and 1 finger's nail was defect.The donor area had good fountion without pain and edema,the grafted skin had normal color and the activity of joints were nomal. Conclusion The wrap-round flap with part toenail combined with the second simepulp flap is a good approach in treatment of the skin avulsion injury in the finger.

Purpose To explore the clinical value of131I-whole body scan (131I-WBS) and 18F-FDG PET/CT on the metastatic management of patients with differentiated thyroid cancer (DTC) after operation.Materials and Methods Serum thyroglobulin (Tg) of 27 patients after DTC surgery was measured one day before131I therapy, and the patients underwent131I-WBS on 3-5 days after131I therapy. According to the results of Tg and 131I-WBS, all the patients were divided into 4 types as follows: type I: Tg (+),131I-WBS (-); type II: Tg (+),131I-WBS (+); type III: Tg (-),131I-WBS (+); and type IV: Tg (-), 131I-WBS (-). Then the patients received18F-FDG PET/CT scan within a week after 131I-WBS. The results of131I-WBS and18F-FDG PET/CT scan were analyzed according to histopathologic findings or clinical and imaging follow-up of at least 6 months as diagnosis standard.Results The examinations uncovered that metastasis occurred in 52 lesions of 22 cases out of the 27 cases.131I-WBS revealed 24 metastatic lesions (46.2%) in 8 cases (36.4%), and18F-FDG PET/CT showed 35 metastatic lesions (67.3%) in 15 cases (68.2%), the difference with statistic significance (χ2=4.46 and 4.74,P<0.05). Metastasis were confirmed in 13 type I cases (100.0%); 5 type II cases (100.0%); 3 type III cases (100.0%) and 1 type IV case (16.7%), respectively. The rate of detecting metastasis by 18F-FDG PET/CT was 100.0% in type I, 20.0% in type II, 0% in type III respectively, the difference with statistic significance (χ2=9.14 and 10.11,P<0.05); and 100.0% in type IV, the difference without statistic significance (χ2=1.25,P>0.05). Based on that, therapeutic plans were modified for 13 patients with type I metastasis and 1 patient with type IV metastasis.Conclusion131I-WBS and18F-FDG PET/CT are complementary for detecting metastatic lesion and help to decide the following treatment of DTC patients after surgery. Moreover,18F-FDG PET/CT shows advantages in detecting metastatic lesion in Tg-positive and negative131I-WBS type of DTC patients after surgery, thus can provide an important clinical guidance for this type of patients.

Objective To investigate the effects of Zuogui Jiangtang Yishen decoction (ZGJTYS) on the expression of nephrin and podocin in podocyte of MKR mice with diabetic nephropathy (DN), and explore its mechanism. Methods Forty MKR mice (8 weeks old) were randomly divided into four groups as follows:negative control group (group A), DN model group (group B), ZGJTYS group (group C) and positive control group (group D, Gliquidone and benazepri). All mice from group B, C and D were received high-fat diet feed and unilateral nephrectomy. Four weeks after operation, all mice were received drug intervention, and four weeks later, all mice were put to death. The levels of UmAlb were observed by ELISA, the serum BUN and Cr by biochemical, and the FBG by electrochemical detection method. The nephrin and podocin mRNA expression were measured by RT-PCR and the protein expression by western blotting. The morphological structure changes of the podocytes were observed by transmission electron microscopes. Results As compared with group A, FBG, BUN, SCr and urine UmAlb in the mice of group B increased significantly (P<0.01), the expression level of nephrin and podocin mRNA and protein were markedly decreased (P<0.01). After intervention of drugs, all biochemical indicators above in the mice of group C and D significantly decreased (P<0.01), the expression level of nephrin and podocin mRNA and protein were markedly increased (P<0.01, P<0.05), compared with group B. The renal pathological lesions of group C and D were significantly improved compared with group B. Conclusion ZGJTYS decoction exerts reno-protective effect via reinstating nephrin and podocin expression to repair the damaged podocyte.

Objective To observe the effect of catechol-O-methyltransferase inhibitor (COMTI) tolcapone on levodopa-treated patients with Parkinson's disease (PD) and on the motor function fluctuation, and safety taking this drug.Methods50 PD patients treated with levodopa were divided into the trial group and control group with 25 cases in each group. The patients in the trial group were given tolcapone 100 mg three times per day. The cases in the control group were given placebo with the same dose. The hepatic function of the patients was examined every month after administration. The time variety of patients' motor function fluctuation was recorded by the diary. The time of clinical observation was 6 months.ResultsThe UPDRS scores of the trial group in the first and second months after taking tolcapone were not significantly different from that of the control group ( P>0.05), but scores of the third to sixth months were significantly different from that of the control group ( P<0.05～0.01). There was a significant difference between UPDRS scores of the trial group before and after treatment ( P<0.01～0.001). The Honhe-Yahr scores of the trial group in the first and second months after treatment were not significantly different from that before treatment ( P>0.05), but scores of the third to sixth months were significantly different from that before treatment ( P<0.05). The motor function fluctuation of the patients in the trial group improved significantly after treatment ( P<0.05). The numbers of the cases had dry mouth, nausea and astriction were 3 respectively; those had acratia, insomnia and diarrhea were 2 respectively; those had muscular soreness, abdominal distention, hidrosis and fidget were 1 respectively. All adverse effects had a little influence to administration. The hepatic function of all patients had no significant change.ConclusionTolcapone can increase the curative effect of PD patients treated with levodopa and improve the motor function fluctuation, and is safety after taken.

Objective To investigate the impact and the associated parameters of malnutrition and inflammation status on hospitalization and mortality of maintenance hemodialysis (MHD) patients. Method A total of 118 MHD patients were included in the study with 1 year's follow-up.The malnutrition and inflammation parameters were compared between the hospitalized patients and out-patients.Cox's proportional hazard regression model was used to explore the malnutrition and inflammation parameters which could forecast the risk of hospitalization and mortality. Result The hospitalization rate of MHD patients with mild,moderate and severe malnuttition was 32.93％,56.67％ and 83.33％ respectively,and the mortality was 3.66％,6.67％ and 80.00％ respectively.The hospitalization rate of MHD patients with or without microinflammation status was 56.45％ and 46.43％,and the mortality was 14.29％ and 1.61％.Inpatients had a higher malnutrition-inflammation score(MIS,8.36 vs 5.86,P＜0.05) and subjective global assessment of nutrition (MQSGA,14.49 vs 12.88,P＜0.05),a lower creatinine level (886.83 μmol/L vs 991.76 μmol/L,P＜0.05 ) and a lower albumin level (38.57 g/L vs 40.27 g/L,P＜0.05) than out-patients.Inpatients also had a higher level of TNF-α (65.41 μg/L vs 59.76 μg/L,P＜0.05) than out-patients.Cox proportional hazard model analysis showed that MIS and TNF-α were associated with patient's first hospitalization risk. Conclusions For the MHD patients,the more severe the malnutrition and micro-inflammation status is,the worse the clinical outcome is.The higher levels of MIS and TNF-α result in greater risk of hospitalization.

Objective To study the effects of eliminating free radical and increasing antioxidative capacity of glutathione peroxidase 1(GPX1) on PC12 cells. MethodsGPX1 recombinant plasmid and Plncxplasmid were transfected into PC12 cells and PC12 cells highly-expressing GPX1 stably were sieved by G418 solution. PC12 ceils were treated with different concentrations of amyloid β-protein (Aβ25-35) for 48 h, to decide the optimal concentration of Aβ25-35 and construct ideal cell model. GPX1/pLNCX/PC12 group, pLNCX/ PC12 group and PC12 group were treated with optimal concentration of Aβ25-35 ,respectively for 48 h, and their absorbance (A) value by MTT conversion was compared among three groups.ResultsCell clone highly expressing GPX1 stably were obtained by G418 selection. The increment of cell inhibition ratio was 24.7 ％ after 20 μmol/L Aβ25-35 treatment for 48 h, compared with control group (P＜0.01). Thus the optimization concentration of Aβ25-35 was 20 μmol/L. After treatment with 20 μmol/L for 48 h, the A value was significantly higher in GPX1/pLNCX/PC12 group than in pLNCX/ PC12 group and in PC12 cells group(0.53±0. 02 vs. 0.44±0.02;0.53±0.02 vs. 0.39±0.07, P＜0.01). Conclusions Transfection of GPX1 recombinant plasmid may protect cell against injury from free radical and reverse the decrease of PC12 cell survival rate impaired by Aβ25-35.