ObjectiveTo evaluate and compare the efficacy and adverse effects of recombinant human tumor necrosis factor receptor Ⅱ : IgG Fc protein for injection (etanercept) and methotrexate ( MTX )regimens for rheumatoid arthritis (RA). MethodsForty-six patients were randomly divided into two groups by stratified sampling method:etanercept group,22 patients were treated with 12.5 mg of etanercept,twice times per week by subcutaneous injection;and MTX group,24 patients were treated with 5-10 mg of MTX,once per week by oral administration. The course of treatment lasted 24 weeks in both groups, so as to observe their ACR20, ACR50, ACR70 and adverse effects of the drugs. ResultsAfter treated for 24 weeks,ACR50,ACR70 respectively achieved 54.5％ (12/22),31.8％ (7/22) in etanercept group,which were significantly higher than those in MTX group[16.7％(4/24),4.2％( 1/24)]. The total efficacy was 86.4％ (19/22) in etanercept group, 20.8％ (5/24) in MTX group, the difference between the two groups was significant (P ＜ 0.05 ). The incidence of adverse effects was not significant between the two groups [22.7％(5/22) vs. 50.0％ (12/24)](P ＞ 0.05). ConclusionEtanercept has a good efficacy and safety for the treatment of active RA.

OBJECTIVE:To investigate the significance of tacrolimus blood concentration monitoring to the therapy of mem-branous nephropathy. METHODS:41 patients with membranous nephropathy received tacrolimus,and the blood concentration of ta-crolimus reached to steady state. The trough concentration of tacrolimus was determined by EMIT. The patients were followed up, and clinical therapeutic efficacies were recorded. The relationship of blood concentration of tacrolimus with clinical efficacy was evaluated by SPSS 16.0 software. RESULTS:The blood concentration of tacrolimus was(7.47±2.74)ng/ml in complete remission (CR)group,(5.72±1.19)ng/ml in partial response(PR)group,and(3.30±1.08)ng/ml in no response(NR)group,with total remission rate of 75.61%. The blood concentration of CR group was the highest,followed by PR group and NR group,there was statistical significance among 3 groups(P<0.05). CONCLUSIONS:The clinical efficacy of tacrolimus in the treatment of nephrot-ic syndrome is correlate to the blood concentration intimately. Trough concentration monitoring of tacrolimus has important signifi-cance to the treatment of membranous nephropathy.

Objective To investigate the association of PGC-1 α gene single nucleotide polymorphisms (SNPs) with type 2 diabetes mellitus in Southern China Han population. Methods 350 patients with type 2 diabetes mellitus and their parents and 366 normal Han volunteers were recruited in the study. Their blood specimens were collected to extract the genornic DNA. Thr394Thr(G/A), Gly482Ser(G/A), Thr528Thr(A/G) and Thr612Met (C/T) genotypes were identified by PCR-RFLP and DNA direct sequencing. The possible association was analyzed between diabetic patients with the specific cSNPs and their haplotypes by case-control and haplotype relative risk (HRR) and transmission disequilibrium test (TDT) methods. Results (1) The case- control study indicated that G and A allele frequencies of PGC-1 α gene Gly482Ser variant were 0.589, 0.411 in type 2 diabetic group and 0.687, 0.313 in normal group respectively (X<'2> = 15.076, P < 0.01). The allele frequencies of Thr394Thr, Thr528Thr, Thr612Met polymorphisms did not show significant difference between twogroups respectively (all P > 0.05). The distributions of Thr394Thr-Gly482Ser-Thr528Thr haplotypes in the diabetic group were significanly different from the controls (X<'2> = 40.2, P < 0.05) and had a linkage disequilibrium with type 2 diabetes mellitus (t = 2.503, P < 0.05). (2) The family-basod studies showed that 482A allele was transmitted more significantly both via TDT and extended TDT from heterozygous parents to patients than expected respectively (all P < 0.05). HRR also supported that the 482A allele was more often transmitted to patients than predicted by chance (X<'2> = 7.217, P = 0.007, HRR = 1. 450). TDT analyses of haplotypes suggested that the frequencies of 394A-482A-528A-612C,394A-482A-528A-612T, 394A-482A-528G-612C and 394A-482A-528G- 612T haplotypes significantly deviated from 0.5 (P < 0.05 or P < 0.01). Conclusion In Southern China Hanpopulation, type 2 diabetes mellitus is associated with the Gly482Ser variant of PGC-1α gene, and Thr394Thr (G/ A) variant of PGC-1α gene appears to play an auxiliary role in this association.

ObjectiveTo investigate and compare the prevalence,awareness and risk factors of chronic kidney disease (CKD) between urban and rural population in Guangxi province in order to provide information for prevention and treatment of CKD.MethodsBy a stratified multistage random sampling method,18 to 74 years old residents in Guangxi province were surveyed. They wereevaluatedbyquestionnaire,urinaryalbumin/creatinineratio, hematuria (microscopic examination of centrifuged urine sediment),kidney B-mode ultrasound,and abnormal results were reviewed 3 months later.Estimated glomerular filtration rate(eGFR) was calculated with the simplified MDRD equation modified by a Chinese coefficient.The risk factors associated with CKD were also investigated.Results There were no significant differences between urban and rural residents in the prevalence of albuminuria (5.22％ vs 5.47％) and hematuria (1.07％ vs 1.11％)(all P＞0.05).The prevalence of renal lithiasis in rural residents was significantly higher than that in the town(10.54％ vs 6.95％)(P＜0.05).The decreased renal function between urban and rural residents(3.87％ vs 4.04％,P＞0.05) had no significant difference.The prevalence of CKD was 9.58％ in urban and 9.42％ in rural(P＞0.05).The prevalence of albuminuria according to the age distribution was different between urban and rural,which increased along with the age in urban but showed two peaks(30-40 years old and 60-74 years old) in rural.Based on logistic regression analysis,the risk factors for albuminuria were diabetes,hyperuricemia,the history of cardiovascular disease,chronic tonsillitis and HBsAg positive.The risk factors for kidney function decline were age,hyperuricemia,hypertension,diabetes,renal lithiasis and history of cardiovascular disease.The awareness rate of CKD in urban was significantly higher than that in rural (14.45％ vs 6.27％,P＜0.05).Conclusions The prevalenceof CKD has no significant difference between urban and rural in Guangxi province.The awareness rate of CKD in urban is significantly higher than that in rural.It is needed to enhance the prevention and treatment of CKD in rural.

Objective To explore dynamic changes of renal cortex blood perfusion in Goto-Kakizaki rats(GK rats) by contrast-enhanced ultrasonography.The clues for early diagnosis and intervention of diabetic renal impairment may be obtained from the study.Methods Male GK rats were taken as experimental groups,and Wistar male rats were used as controls.Contrast-enhanced agent SonoVue was administered via the femoral vein cannulation in a bolus fashion.Image changes of renal cortex were observed in real time, and dynamic image changes within 0 - 5 minute after injection were observed and stored.The renal cortex blood perfusion changes were analyzed using the time-intensity curve (TIC).Results (1) The kidney was quickly enhanced after the injection of contrast agent.The renal artery, cortex, renal vein were displayed in sequence.(2)The shape of renal perfusion TIC in all the objects was a single peak,steep ascending, flat descending curve.The overall shape of TIC in GK rats was wider than controls and they were wider and wider with age increasing of the GK rats.(3) Compare to controls,the time to peak (TTP)and the half time of peak descending (HDT) in GK rats was longer (P ＜0.01), the slope rates of the ascending curve (S1) and the slope rates of the descending curve (S2) decreased and the area under the curve increased in 12-week-old and 20-week-old GK rats (P ＜ 0.05 or P ＜ 0.01).Conclusions The abnormal blood perfusion of renal cortex microcirculation was present in the early stage of diabetic in GK rats.Real-time contrast-enhanced ultrasonography and TIC could display this change effectively.

Objective To evaluate the short-term therapeutic effects of DNA immunoadsorbent (IA) combined with glucocorticoid and immune depressant on patients with severe systemic lupus erythematosus(SLE). Methods 32 patients with severe SLE were selected to undergo DNA IA treatment combined with glucocorticoid plus cyclophosphamide therapy, and each patient received IA therapy 3 times, once 2.5 hours, with an interval of 24-48 hours to take another two times of IA. The changes in SLE disease activity index(SLEDAI)score, health status evaluation indexes〔 physiologic functional( PF) and emotional health( MH) scores〕,renal function indexes〔 blood urea nitrogen(BUN)and serum creatinine(SCr)〕 were observed; and anti-double stranded DNA antibody( ds-DNA), immunoglobulin (IgA, IgG, IgM), complements(C3 and C4)and high-sensitivity C-reactive protein (hs-CRP) were examined before and after IA treatment for 2 weeks. Results Two weeks after the combination therapy, the SLEDAI score, BUN, SCr, dsDNA, IgA, IgG, IgM, hs-CRP were significantly lower than those before treatment 〔SLEDAI score : 14.38±3.85 vs. 15.69±1.40, BUN (mmol/L): 11.22±4.78 vs. 16.31±7.90, SCr (μmol/L): 127.02±38.17 vs. 167.25±45.63, dsDNA( U/L): 1.36±0.12 vs. 1.43±0.18, IgA( g/L): 2.41±0.73 vs. 2.59±0.86, IgG( g/L): 16.82±4.83 vs. 21.01±4.84, IgM( g/L): 1.64±0.45 vs. 1.75±0.58, hs-CRP( mg/L): 14.41±2.20 vs. 14.94±2.60, P<0.05 or P<0.01〕; PF score, MH score, complement C3 were increased〔 PF score : 71.19±17.53 vs. 56.66±22.41, MH score : 74.01±15.72 vs. 61.50±17.98, C3( g/L): 0.56±0.09 vs. 0.52±0.10, all P<0.05〕; clinical symptoms were improved significantly, and no significant adverse reactions were found. Conclusion IA combined with medical treatment has shown that it has significant therapeutic effect for treatment of patients with severe SLE, and it may decrease the levels of dsDNA, IgA, IgG, IgM,hs-CRP, and increase the level of complement C3.

Objective To investigate the predictive factors affecting the efficacy of cyclophosphamide (CTX) combined with glucocorticoids in the treatment of idiopathic membranous nephropathy (IMN),and to evaluate the efficacy of calcineurin inhibitor (CNI) adjustment due to poor treatment.Methods A retrospective cohort study was conducted.Two hundreds and twenty-eight patients with IMN diagnosed by renal biopsy in the People's Hospital of Guangxi Zhuang Autonomous Region from January 1,2007 to December 1,2016 were enrolled.All subjects were treated with CTX in combination with glucocorticoids.The patients were divided into two groups:remission group and no remission group.Multivariable logistic regression analysis was used to determine the baseline clinical-pathological influencing factors for the remission of IMN in the enrolled patients.Results The number of total remission (including complete and partial remission) of the first CTX combined with glucocorticoid treatment in 228 patients with IMN was 188(82.5％).Among them,141 patients (61.8％) had complete remission (CR),the median time for CR was 8(6,12) months,and the median time for partial remission (PR) was 3(1,4) months.The median follow-up time for this study was 25(13,43) months.Compared with the remission group,the serum albumin level was lower in the non-remission group,the 24-hour urine protein content,the blood complement C3 and C4 levels were higher,and the pathological stage was milder (all P ＜ 0.05).Multivariate logistic regression analysis suggested that the levels of baseline serum albumin,complement C4,and pathological stage were independent predictors of clinical remission in IMN patients.Twenty-four non-remission patients were treated with CNI.The overall response rate was 66.7％(16/24) at 6 months and 77.3％(17/22) at 12 months.Conclusions The levels of baseline albumin,blood complement C4,and pathological stage were independent predictors of clinical remission in IMN patients treated with CTX plus glucocorticoids.The non-remission patients with CTX combined with glucocorticoid therapy can still achieve a higher response rate after adjusting for CNI.

Objective To analyze the echocardiography features of unilateral absence of pulmonary artery ( U APA ) features and improve the prenatal diagnosis accuracy of U APA by analyzing fetal echocardiography features . Methods Fetal echocardiographic features were analyzed retrospectively in 6 cases with prenatal diagnosis of U APA between June 2012 and October 2018 . A t the same time ,ultrasonic manifestations of 3 patients whose antenatal examinations were performed in other hospitals and diagnosed as UAPA in our hospital were retrospectively analyzed . T he fetal echocardiography characteristics of UAPA were summarized . Results Among the 6 fetuses with UAPA ,4 cases were diagnosed as isolated unilateral absence of proximal right pulmonary artery ,1 was unilateral absence of proximal left pulmonary artery with tetralogy of Fallot ( T O F ) and 1 was isolated unilateral absence of proximal left pulmonary artery . Characteristic sonographical findings included : ① When other intracardiac abnormalities were absent ,the inner diameter and proportion of the heart cavity was normal . ② M ulti‐view showed that the normal confluence structure disappeared at the branch of the main pulmonary artery ,and the diameter of normal pulmonary artery branch was widened . ③On the basis of three vessels and trachea view ( 3V T ) ,moved the probe up and dow n to make a transverse scan ,two‐dimensional and color Doppler flow imaging ( CDFI ) showed a large vessel ( the brachiocephalic trunk artery ) originating from the aortic arch w hich had dual vascular features ,it means that it was difficult to distinguish the pulmonary artery branch from the aortic branch . ④ On coronal view of the large vessel ,two‐dimensional and CDFI clearly showed that the large vessel originating from the aortic arch was the brachiocephalic trunk artery ,and the pulmonary artery branch connected with the brachiocephalic trunk artery by the ipsilateral vertical arterial duct ( DA ) which originated from the root of brachiocephalic trunk artery ,but the left pulmonary artery branch connected with the ventral side of the aortic arch by the left DA in UAPA fetus with T O F . ⑤Spectrum Doppler of the anomalous vessels of the lungs confirmed that it was the pulmonary artery ,and the blood flow of the anomalous PA branch was isolated and no exact connection with the main pulmonary artery . Conclusions U APA can be accurately diagnosed prenatally by echocardiography . T he brachiocephalic trunk artery coronary view is very important for the diagnosis of this disease .Early diagnosis plays an important role in prenatal counseling and prognosis assessment .