Nephrotic syndrome is a common kidney disease in childhood. Its pathogenesis has not been fully elucidat?ed. In recent years, gene chip is maturing and widely used in many fields. Its application in nephrotic syndrome could pro?vide important information of its pathogenesis and treatment target at gene level. This article reveiwed the current application of the gene chip technology and its prospects in the nephrotic syndrome.

Membranoproliferative glomerulonephritis(MPGN)is immune pathological diagnosis,and it has all sorts of clinical manifestations,poor prognosis and high case fatality rate.The latest classification of MPGN is divided into immunecomplex-mediated and complement-mediated.On the basis of the potential patho-physiology,its related causes can be assessed in order to choose a more appropriate treatment method.Long alter-nate day glucocorticoid-therapy is beneficial to idiopathic MPGN in children.Biological agents used in the treat-ment of MPGN has made great progresses.

Objective To explore the effect of Azithromycin on the immune mechanisms through the IL - 23 /IL - 17 axis way by observing the changes in serum levels of IL - 23,IL - 17 in rats with Adriamycin - induced nephro-sis. Methods A total of 135 rats were randomly divided into control group,model group,Azithromycin intervention group,Prednisone intervention group and united intervention group. The model was induced through a tail intravenous injection of Adriamycin for 2 times. Nine rats were randomly selected from every group to detect blood and urinary bio-chemistry,and to observe the changes of the serum levels of IL - 23,IL - 17 by enzyme - linked immunosorbent assay in 4,6,and 8 weeks. Results Compared with the model group in the 8th week,the levels of 24 - hour urinary protein [model group(354. 83 ± 70. 87)mg/ d,Azithromycin intervention group(94. 59 ± 22. 67)mg/ d,Prenisone intervention group(65. 64 ± 8. 71)mg/ d,united intervention group(47. 44 ± 9. 56)mg/ d],cholesterol[ model group(8. 71 ± 1. 60)mmol/ L,Azithromycin intervention group(3. 54 ± 0. 30)mmol/ L,Prenisone intervention group(3. 10 ± 0. 18) mmol/ L,united intervention group(2. 56 ± 0. 40)mmol/ L]were reduced significantly,while the levels of albumin [model group(16. 77 ± 3. 15)g/ L,Azithromycin intervention group(33. 82 ± 1. 16)g/ L,Prenisone intervention group (37. 80 ± 2. 73)g/ L,united intervention group(40. 78 ± 2. 63)g/ L]were increased obviously in the intervention groups,and the differences were statistically significant(F = 152. 243,99. 838,155. 836,all P ﹤ 0. 05). The serum levels of IL - 23[model group(29. 60 ± 3. 97)ng/ L,Azithromycin intervention group(29. 61 ± 2. 62)ng/ L,Prenisone intervention group(29. 74 ± 2. 23)ng/ L,united intervention group(30. 31 ± 2. 20)ng/ L],IL - 17[ model group (22. 38 ± 2. 51)ng/ L,Azithromycin intervention group(21. 97 ± 1. 89)ng/ L,Prenisone intervention group(21. 43 ± 2. 42)ng/ L,united intervention group(21. 51 ± 2. 07)ng/ L]in the model group and 3 intervention groups were higher than the control group[(17. 35 ± 3. 01)ng/ L,(14. 03 ± 2. 42)ng/ L]in the 4th week,and there were significant differences(F = 33. 819,21. 373,all P ﹤ 0. 05);and the levels of IL - 23[in the 6th week,Azithromycin intervention group(27. 20 ± 1. 71)ng/ L,Prenisone intervention group(24. 39 ± 2. 06)ng/ L,united intervention group(21. 41 ± 1. 71)ng/ L,model group(35. 78 ± 3. 21)ng/ L;in the 8th week,Azithromycin intervention group(24. 60 ± 2. 91) ng/ L,Prenisone intervention group(21. 01 ± 1. 02)ng/ L,united intervention group(18. 93 ± 1. 35)ng/ L,model group (44. 47 ± 7. 84)ng/ L],IL - 17[in the 6th week,Azithromycin intervention group(19. 12 ± 0. 37)ng/ L,Prenidone in-tervention group(18. 54 ± 0. 36)ng/ L,united intervention group(17. 57 ± 0. 42)ng/ L,model group(26. 69 ± 3. 70) ng/ L;in the 8th week,Azithromycin intervention group(17. 44 ± 0. 46)ng/ L,Prenidone intervention group(16. 37 ± 0. 49)ng/ L,united intervention group(14. 71 ± 0. 99)ng/ L,model group(34. 03 ± 3. 45)ng/ L]in the 3 intervention groups were significantly lower than those of the model group in the 6th ,8th week(F = 82. 963,44. 659 in the 6th week, F = 75. 085,200. 383 in the 8th week,all P ﹤ 0. 05). The levels of IL - 23,IL - 17 in united intervention group were lower than those in respective intervention groups(P ﹤ 0. 05),and the levels in Prednisone intervention group were lower than those in Azithromycin intervention group(P ﹤ 0. 05). Conclusions IL - 23 / IL - 17 axis' high activity may be one of the immunologic mechanisms of Adriamycin - induced nephrosis. Azithromycin may inhibit the high activity of IL - 23 / IL - 17 axis to relieve the Adriamycin - induced nephrosis. The inhibition on IL - 23 / IL - 17 axis of Azithro-mycin was similar to Prednisone,and Azithromycin may enhance the effectiveness of Prednisone.

Objective To study the clinical significance of transforming growth factor (TGF)-β1 and interleukin (IL)-18 mRNA in the diagnosis and evaluation of disease severity of primary nephrotic syndrome (PNS) in children. Methods The ex-pression levels of TGF-β1 and IL-18 mRNA in peripheral blood mononuclear cells (PBMC) were measured by real-time lfuorescent quantitative polymerase reaction (RT-PCR) in 77 children with PNS and 30 healthy children (control group). Results In children with steroid-sensitive nephrotic syndrome (SSNS), the expression levels of TGF-β1 and IL-18 mRNA before treatment and at 1, 4 weeks after hormone therapy were signiifcantly lower in children with simple type nephrotic syndrome than those in children with nephritic type nephrotic syndrome (P<0.05). The level of TGF-β1 mRNA before treatment was signiifcantly lower in children with SSNS than that in children with steroid-resistant nephrotic syndrome (SRNS). With the extension of hormone therapy, the expression levels of TGF-β1 mRNA showed a trend of declining in children with PNA. In children with SRNS, the expression levels of TGF-β1 and IL-18 mRNA before treatment and at 1, 4 weeks after hormone therapy were signiifcantly lower in children with simple type NS than those in children with nephritic type nephrotic syndrome (P<0.05). In children with SSNS, the levels of TGF-β1 and IL-18 mRNA were signiifcantly higher in acute phase than those in the remission phase. Conclusions At the early stage of PNS, the detection of the expression levels of TGF-β1 and IL-18 mRNA is useful for evaluatation of disease activity, clinical identiifcation of nephritic type nephrotic syndrome and simple type nephrotic syndrome and early prediction of SRNS.

Objective To explore the influencing factors of frequent relapse primary nephritic syndrome (PNS) in children according to the statistical analysis of their clinical data and laboratory examinations. Method We collected in-hospital and out-patient medical records of children who were diagnosed PNS from Jan. 2007 to Feb. 2010 and whole clinical data were analyzed. Results In 245 cases of children with steroid sensitine nephrotic syndrome, non-frequent replapse (NFR) accounted for 82.4% and frequent relapse (FR) accounted for 17.6%. In univariate analysis, period of first relapse between initial treatment remission within 3 months , level of serum total protein and cholesterol and IgE at onset had statistical significance in FR children and NFR children, which were significant predictors of FR. The logistic regression analysis revealed that the first relapse after initial treatment remission within 3 months and increasing of serum IgE level (more than 358 IU/ml)were risk factors of FR. Among frequent relapses factors, infection, especially upper respiratory tract infection was the first (65. 1%). The relapse with motivation mainly in January to March, accounted for 30. 4%. Conclusion FR had a proportion of 17. 6% in children with PNS under regular glucocorticoid treatment. It showed seasonality feature that relapse. peak in winter and spring. Level of the serum total protein less than 40g/L and cholesterol more than 10mmol/L at onset can be predictive index of FR. Infections are the main motivation of relapse, but the relapse by irregular treatment and specific constitutions should be pay more attentions too.

Objective To explore the effect of leukotriene receptor antagonist (LTRAs,montelukast) on serum indicators,urine indicators,renal pathology,intercellular adhesion molecule-1 (ICAM-1),nephrin and podocalyxin on renal tissue in adriamycin(ADR)-induced nephropathy(ADN) rats.Methods ADN was induced through a tail intravenons injection of ADR.The 40 healthy male Wistar rats were randomly divided into 5 groups:group A (control group),group B(ADN group),group C(prednisone-treated group),group D(montelukast-treated group) and group E (prednisone and montelukast-treated group).Twenty-four-hour urinary protein (24 h-up) and serum index were measured serially in the 4th,8th week and the values of creatinine clearance rate(Ccr) were calculated.At the end of the 8th week,all rats were sacrificed to collect kidney tissues for microscopy observation of renal pathological changes.The expression of nephrin,podocalyxin and ICAM-1 in renal tissues were detected through immunohistochemistry method.Results Compared with group A,in the 4th week,24 h-up and albumin reached the level of ADR nephropathy model.Compared with group B,in the 8th week,24 h-up,cholesterol,serum creatinine and renal pathology changes in the 3 treated groups were significantly reduced (P ＜ 0.05),but serum total protein,albumin and Ccr significantly increased (P ＜ 0.05),while extracellular matrix/glomerulararea and renal pathology score significantly reduced (P ＜ 0.01),and ICAM-1 significantly decreased(P ＜0.01).Compared with group C and group D,expressions of nephrin and podocalyxin in group E were the highest.Besides,the curative effect of integrated treatment was better than other treatments.Conclusions Maybe through inhibition of ICAM-1,LTRAs had a protective effect on renal tissue.The integrated treatment of LTRAs with prednisone has a synergistic effect and drug effect is superior to any drug alone in ADN.

Objective To explore the comparative advantage of Team based learning (TBL) in common diseases teaching among pre-selected trainees for medical non-commissioned officer. Methods 200 trainees were randomly divided into two groups of equal size (each having 100 trainees), one TBL group and another lecture based learning (LBL) group as the control group. The teaching content was both Chapters of High Altitude Illness and Hypertension. In the LBL control group, the traditional lec-ture based teaching and learning manner was followed. In contrast, the trainees in the TBL group were assigned pre-lecture self-learning outline and questions to discuss in advance, team-based group dis-cussion was conducted, and scene simulation with typical disease case analysis were adopted in class. In both groups, the teaching effectiveness were evaluated by both exam test and questionnaire manner. Results It turned out the team based learning model resulted in significantly improved overall trainee assessment scores (88.90 ± 5.28 vs. 76.10 ± 5.12, P<0.05) and higher overall teacher satisfaction scores (8.63 ± 0.85 vs 7.18 ± 0.72, P<0.05), compared to the LBL group. Conclusion TBL model is more effective in improving trainees' capabilities of cultivating team work spirit, self-confidence, learn-ing enthusiasm, problem analysis and knowledge application. TBL model significantly brings more advantage in teaching pre-selected trainees for medical non-commissioned officer.

Objective To investigate the effects of adrenocorticotropic hormone (ACTH)combined with Huaiqihuang on hypothalamic pituitary adrenal (HPA) in rats. Methods Fifty rats were randomly divided into five groups according to the random number table method:normal control group (group A), prednisone group (group B), Huaiqihuang group (group C), ACTH group (group D) and combined treatment group (group E) with 10 rats in each group. Rats in group B, C, D and E were gavaged by acetic acid prednisone water solution 12.5 mg/(kg · d) for 4 weeks to establish HPA axis suppression model. Group A was given distilled water 10 mL/(kg·d) as control. Rats in group C and E were gavaged with Huaiqihuang 5 g/(kg·d) 30 minutes after intragastric administration of prednisone acetate. At the third week of the experiment, group D and E were subcutaneous injected with ACTH 200 μg/(kg·d). The serum cortisol levels were measured respectively at the start of the ex?periment, 2 weeks and 4 weeks of experiment. Animals were sacrificed at the end of the experiment, and then weights of the pituitary, adrenal glands and the viscera index were calculated. The pathological changes of the pituitary and adrenal glands were observed by HE stainning. Results After 2 weeks, the serum cortisol levels were significantly lower in group B, C, D and E than those of group A (P<0.05), suggesting that the model was successful. After 4 weeks, the serum cortisol levels were significantly higher in group C, D and E than those of group B (P<0.05), and between the treatment group the value was group E>group D>group C (P<0.05). At the same time, the weights of pituitary and adrenal gland and the viscera in?dex were higher in the three groups than those of B group (P<0.05). The HE staining showed that there were no significant changes in the distal part of the pituitary gland in five groups. The adrenal cortex zona was thinning and the structure was dis?ordered in group B. There were different degrees of hyperplasia in group C, group D, and group E, which was the most obvi?ous in group E. Conclusion ACTH combined with Huaiqihuang can promote adrenal cortex zona hyperplasia and cortisol secretion, which reduces the glucocorticoid induced inhibition of HPA axis in rats.

Objective:To investigate the influence of chronic kidney disease(CKD),including slight renal damages,on prognosis of coronary artery disease(CAD).Methods: A retrospective study was performed in 732 patients who visited our Cardiology Department and Cardiothoracic Surgery Department in 2000-2004.All patients suspected of CAD underwent a selective coronary angiography.Five hundred and seventy-nine patients with established diagnosis of CAD were followed up and their cardiovascular events(angina pectoris,myocardial infarction,recurrent myocardial infarction,heart failure,stroke,death,etc.) were recorded.Patients with CAD were divided into normal,slight,moderate,and severe groups according to the degree of renal function damages.The influences of different degrees of renal damages on the prognosis of CAD were compared.Results: There were obvious differences in the morbidities of angina pectoris,myocardial infarction,recurrent myocardial infarction,heart failure,stroke,etc.in CAD patients with different degrees of renal function damages.The worse the renal function,the higher the incidences of angina pectoris,myocardial infarction,recurrent myocardial infarction,heart failure and stroke,etc((P