BACKGROUND: Geshu (BL 17) is one of eight influential points of blood, acting on tonifying blood, nourishing blood, activating blood circulation and resolving stasis.OBJECTIVE: To explore the effect of Geshu (BL 17) on activating blood circulation and resolving stasis in blood stagnation syndrome with acupuncture.DESIGN: Randomized controlled and normal controlled observations were designed.SETTING: Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology.PARTICIPANTS: Totally 65 cases of blood stagnation syndrome were selected from inpatients in Department of Acupuncture and Moxibustion in Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology.METHODS: Totally 65 cases were randomized into experiment group (33cases) and the control (32 cases). In the control, the patent Chinese drug,longxuejie was administrated orally for activating blood circulation and resolving stasis, 4 tablets/time, 3 times/day, 15 days made 1 course of treatment. In experiment group, Geshu (BL 17) was localized bilaterally; after routine sterilization on the points, a filiform needle, 25 mm in length was inserted and manipulated with even technique after arrival of qi for 5 minutes. In 15 minutes of needle retaining, the needle was manipulated for another 5 minutes and retained for 10 minutes, and then, the needle was withdrawn. The treatment was given once a day. Radioimmunoassay (RIA)was applied to determine the levels of 6-K-P and thromboxane B2 (TXB2)in plasma. Criteria on clinical therapeutic effects: Being cured is determined by slight red tongue, retarded and forceful pulse, disappearance of limb pain, skin and mucosal ecchymosis and dysmenorrhea, basic recovery of motor function in hemiplegia and disappearance of numbness. Being effective is by dark red tongue, slightly hesitant pulse, alleviation of limb pain, reducing of skin and mucosal ecchymosis, alleviation of dysmenorrhea, partial recovery of motor function in hemiplegia and alleviation of numbness. No effect is by none of any change of clinical symptoms in comparison before and after treatment.MAIN OUTCOME MEASURES: ① Observation of therapeutic effects between two groups. ② Observation of plasma 6-K-P and TXB2 levels and 6-K-P/TXB2RESULTS: Totally 65 cases were all in the result analysis. ① Observation of therapeutic effects between two groups: The therapeutic effect in experiment group was higher remarkably than that in the control [be cured:(15,10); be effective: (13,11)]. ② Comparison of plasma 6-K-P levels: In experiment group, it was higher remarkably after treatment compared with that before treatment [(159.28±16.48), (117.25±16.47) μg/L, P ＜ 0.05]. In the control, it was higher remarkably after treatment compared with that before treatment [(133.51±13.97), (114.64±16.39) μg/L, P ＜ 0.05]. ③Comparison of plasma TXB2 level: In experiment group, it was lower remarkably after treatment compared with that before treatment [(98.21±11.38), (110.45±1067) μg/L, P ＜ 0.05]. In the control, it was lower remarkably after treatment compared with that before treatment [(101.15 ±12.14), (109.21±11.58) μg/L, P ＜ 0.05]. ④ Plasma 6-K-P/TXB2: In experiment group, it was higher remarkably after treatment compared with that before treatment (1.621±0.203, 1.101±0.316, P ＜ 0.05). In the control,it was higher remarkably after treatment compared with that before treatment (1.322±0.216, 1.234±0.305, P ＜ 0.05).CONCLUSION: Acupuncture on Geshu (BL 17) increases 6-K-P level and 6-K-P/TXB2 and reduces TXB2 level. It is explained that acupuncture on Geshu (BL 17) regulates imbalance of PGI2-TXA2 system in blood stagnation syndrome so that the blood circulation is activated and stasis is resolved.

There is an independent-regulated renin-angiotensin system(RAS)in kidney.Most of patients with hypertension or kidney diseases present increased renal RAS activity,which maintains body water and sodium balance,but contributes to the occurrence of hypertension and renal damage progression.The article reviewes some recent basic and clinical researches,focusing on the renal RAS activation mechanisms,consequences and clinical significance of the intervention of RAS blockers,which may help us recognize local RAS function of kidney,explore the treatment strategies to control hypertension and slow chronic kidney disease progression.

ObjectiveTo investigate the intervention effects of fluoxetine on hypothalamic-pituitary-thyroid (HPT) axis function changes in post-stroke depression (PSD) patients.MethodsMild to moderate stroke patients were enrolled and blood T3,T4,FT3,FT4 and TSH were measured at day 0,1,7,14,21 and 3 months.At day 7,thyroid hormone releasing hormone (TRH) stimulation test were performed.After evaluated with the anxiety scale screening using the HAMD scale assessment at day 21,the subjects were divided into simple stroke subgroup ( ＜8 points,25 cases) and PSD sub-group ( ≥ 8 points,18 cases),with 16 healthy age and sex matched individuals as control group.In the 2nd stage,TRH stimulation test were performed in PSD patients before and after 7 days of fluoxetine administration.ResultsCompared with control group,stroke patients presented lower FT3 (P ＜0.05 ) and higher serum TSH (P ＜ 0.05) at day 0,1,7,14.Furthermore,PSD patients presented lower FT3,TSH levels and higher FT4 levels than simple stroke patients did(P＜0.05).At day 21 and month 3,T3,T4,FT3,FT4 and TSH levels in stroke patients were not different from those in control group(P ＞ 0.05).TRH test showed that the responses in PSD patients were lower than those in simple stroke patients( (2.65 ±0.42)μIU/ml vs (5.31 ±0.68 ) μIU/ml,P ＜ 0.05 ).Correlation analysis showed HAMD scores correlated with TSH level changes and TSH0 ～30 in PSD subgroup closely( r=0.35,0.25,P＜0.01 ).In the 2nd stage,TRH test showed that PSD patients who took fluoxetine presented a lower TSH level change than PSD patients who did not( (4.61 ± 2.02) μIU/ml vs (7.05 ± 2.12) μIU/ml,P ＜ 0.05 ).ConclusionPSD patients present a long and severe HPT axis function inhibition,which may due to TRH deficiency,and fluoxetine may improve this abnormality.

Objective:To investigate the efficacy and safety of Rituximab (RTX) in treating children with refractory steroid-resistant nephrotic syndrome (SRNS).Methods:The clinical data of 10 children with refractory SRNS receiving RTX in the Department of Pediatrics, Jinling Hospital from September 2013 to March 2018 were analyzed retrospectively.Results:The age of onset of 10 children (including 5 males and 5 females) was (4.47±2.75) years old.The renal biopsy showed focal segmental glomerular sclerosis in 5 cases (50%), minimal change nephropathy in 3 cases (30%), IgM nephropathy in 1 case (10%), and mesangial proliferative glomerulonephritis in 1 case (10%). Ten children received RTX treatment (1 or 4 doses; 375 mg/m 2 once; maximum: 500 mg) at the age of (6.74±2.62) years old.There were 8 patients (80%) receiving a single dose of RTX, 1 patient (10%) receiving 3 doses, and 1 patient (10%) receiving 8 doses.The follow-up time was 11.93 (5.17, 25.66) months.The remission rates at the 3-month follow-up, 6-month follow-up and last follow-up were 30% (3 patients), 40% (4 patients), and 40% (4 patients), respectively.The 24-hour urinary proteinuria and serum albumin levels were improved in 10 children after RTX treatment, but there were no significant statistical difference(all P>0.05). No significant difference was found in humoral immunity and renal function before and after RTX treatment (all P>0.05). During the treatment and follow-up, 3 patients (30%) developed infusion reaction, 2 patients (20%) showed severe pulmonary infection, and 1 patient (10%) died of severe pulmonary infection. Conclusions:RTX is effective in treating some children with refractory SRNS, and a long-term follow-up should be conducted to prevent infection.

Objective:To analyze the clinical and pathological characteristics in children diagnosed with primary focal segmental glomerulosclerosis (FSGS) after repeated renal biopsy.Methods:The clinicopathological data of children who ever experienced renal biopsy in Jinling Hospital from January 1, 2000 to December 31, 2020 were retrospectively reviewed. Clinical manifestations, pathological characteristics and treatment responses were analyzed.Results:Of the 34 enrolled patients, there were 22 males and 12 females. The median age of the first renal biopsy was 14 years old (1-18 years old), and the median interval between repeat renal biopsy and first renal biopsy was 6 months (1-151 months). Thirty-one showed nephrotic syndrome, of which 22 had microscopic hematuria, and 4 had elevated serum creatinine. Among the other 3 patients, 2 had hematuria and proteinuria, and 1 had proteinuria. In the first renal biopsy, 16 cases were diagnosed as minimal change disease, 14 cases were diagnosed as mesangial proliferative glomerulonephritis, 2 cases were diagnosed as IgA nephropathy, and 2 cases were diagnosed as IgM nephropathy. All 34 children showed poor responses to hormone and immunosuppressive therapies. The pathological features of the first renal biopsy in some patients were adhesion (2/34), decreased loop podocyte attachment (2/34), peripheral loop extension to the urinary pole (2/34), renal tubular reflux (4/34), capillary thrombosis (2/34) and IgM deposition (12/34).Conclusions:The initial diagnosis of FSGS is difficult, and the lesions are atypical and easily misdiagnosed. The patients have poor responses to hormone and immunosuppressive therapies. For patients with the pathological changes of adhesion, decreased loop podocyte attachment, peripheral loop extension to the urinary pole, renal tubular reflux, capillary thrombosis and IgM deposition, follow-up is required, and if necessary, repeat renal biopsy needs be performed to determine whether it is FSGS.

Objective To compare the clinical efficacy and safety of carbon dioxide (CO2) versus high-frequency electroacupuncture based on the assistance of drilling and blunt dissection in the treatment of steatocystoma multiplex.Methods A randomized,self-controlled study was performed in 15 patients.The median line of the body served as the dividing line,and the lesions on the two sides of the median line of the body were randomly divided into 2 groups to be treated with CO2 laser or high-frequency electroacupuncture,which left micropathways into the cyst cavity.After the above treatment,contents in the cysts were squeezed out or drawn out with a mosquito clamp,and the cysts were bluntly dissected.The decrustation time,erythema subsiding time,adverse reactions and recurrence were compared among lesions at different sites or with different sizes.Results For the lesions at the same sites or with similar sizes after treatment,the decrustation time and erythema subsiding time were both significantly shorter in the CO2 laser group than in the high-frequency electroacupuncture group (both P ＜ 0.05).There were significant differences in the decrustation time and erythema subsiding time among lesions at different sites or with different sizes (all P ＜ 0.05).Mild pain occurred in the 2 groups,and no hematoma or secondary infection occurred.There were significant differences in the incidence of scar formation or pigmentation between the 2 groups (both P ＜ 0.05).During the follow-up of 6-18 months,relapse occurred in 1 patient in each group.Conclusion Compared with the high-frequency electroacupuncture,CO2 laser assisted by drilling and blunt dissection shows better efficacy in the treatment of steatocystoma multiplex,and it can remove lesions at various sites at one time.

With the population aging,the number of elderly with Alzheimer's disease or other types of dementia is increasing,which seriously threatens the health and quality of life in elderly.The early screening and detection of dementia among high-risk population and appropriate interventional measures would delay the disease course,and maintain patients' self-care abilities and dignity.Computerized neuropsychological assessment devices are economic and efficient,and suitable for screening in large population.This article reviews the theory,characteristics and application of internet-based neuropsychological assessment for age-related cognitive impairment,as well as the prospect in the future studies.

Objective:To investigate the effect of multidisciplinary team-based precise nursing on fatigue-pain-sleeping disorder symptom cluster of lung cancer patients received chemotherapy.Methods:A total of 110 lung cancer patients who received chemotherapy were randomly divided into study group (55 cases) and control group (55 cases) . The control group received routine nursing, while the study group carried out multidisciplinary team-based precise nursing. The degree of fatigue, pain and sleeping disorder was assessed by Multidimensional Fatigue Inventory-20 (MFI-20), Brief Pain Inventory-Chinese version (BPI-C) and Pittsburgh Sleep Quality Index (PSQI), respectively.Results:Before intervention, the scores of fatigue, pain and sleep quality showed no significant difference ( P>0.05). After intervention, the scores of physical fatigue, psychological fatigue, mental fatigue and total fatigue in MFI-20 were 17.78±3.96, 8.02±1.58, 10.19±2.01, 35.98±4.96 in the study group; the scores of pain right now, pain at least in the 24 hours, pain at worst in the 24 hours and pain on the average in BPI-C were 3.76±0.53, 2.15±0.39, 4.11±0.77, (2.72±0.43) in the study group; the scores of the habitual sleep efficiency, sleep latency, subjective sleep quality, sleep duration, sleep disturbances, daytime dysfunction, use of sleeping medication scores and total scores in PSQI were 0.96±0.20, 1.66±0.27, 1.74±0.36, 1.58±0.22, 1.12±0.21, 1.70±0.30, 1.45±0.28, 10.20±0.61 in the study group. However, those scores were 18.84±2.99, 9.15±1.95, 11.06±3.71, 39.05±5.28 and 5.42±1.18, 3.58±0.59, 6.18±1.44, 3.85±0.78 and 1.12±0.19, 1.74±0.27, 1.91±0.25, 1.66±0.46, 1.33±0.32, 1.75±0.29, 1.33±0.42, 10.85±0.70 in the control group. The scores of psychological fatigue, total fatigue, pain right now, pain at least in the 24 hours, pain at worst in the 24 hours, pain on the average and habitual sleep efficiency, subjective sleep quality, sleep disturbances and total PSQI scores were all significantly decreased in the study group compared to the control group ( t values were 2.815-14.873, P<0.01). Conclusion:Multidisciplinary team-based precise nursing can alleviate fatigue-pain-sleeping disorder symptom cluster of lung cancer patients during received chemotherapy.

Objective:To analyze the clinical and prognosis of primary membranous nephropathy (PMN) in children with positive glomerular M-type phospholipase A2 receptor (PLA2R).Methods:A total of 69 children diagnosed with PMN by renal biopsy admitted to the Department of Pediatrics of Eastern Theater Command General Hospital from January 2006 to December 2018 were retrospectively analyzed, including 40 males and 29 females, with an average age of 14.86 years.According to the immunofluorescence of renal pathology, they were divided into PLA2R positive group and PLA2R negative group.Pathological features between 2 groups were compared by the t test, Mann- Whitney U test and Chi- square test.Kaplan-Meier method was used to compare the long-term renal survival rate and cumulative remission rate between 2 groups. Results:A total of 69 pediatric PMN patients were included.The po-sitive rates of serum anti-PLA2R antibody and positive expression of PLA2R in renal tissues were 53.6% (37 cases) and 82.6% (57 cases), respectively.The proportion of children with clinical manifestations of large proteinuria [55 cases(96.5% ) vs.9 cases(75.0%), P=0.034] was significantly higher in the PLA2R positive group than that of the PLA2R negative group.Blood urea nitrogen level was significantly higher in the PLA2R positive group than that of PLA2R negative group[1.14(0.93, 1.54) mg/L vs.0.80 (0.44, 1.18) mg/L, P=0.049], while estimate glomerular filtration rate(eGFR) [162.26 (139.81, 185.53) mL/(min·1.73 m 2) vs.199.52 (157.58, 212.01) mL/(min·1.73 m 2), P=0.034] and serum IgG [3.58 (2.50, 5.43) g/L vs.5.14 (4.35, 6.03) g/L, P=0.016] were significantly lower.The cumulative remission rate was significantly higher in the PLA2R negative group than that of PLA2R positive group ( P<0.001). The 24 h urinary protein ≥50 mg/kg ( HR=0.119, 95% CI: 0.021-0.595, P=0.010)was an independent risk factor for renal prognosis, and PLA2R( HR=0.263, 95% CI: 0.125-0.551, P<0.001) and 24 h urinary protein ≥50 mg/kg ( HR=0.568, 95% CI: 0.125-0.551, P=0.041)were independent predictors of urinary protein remission.PLA2R ( HR=1.020, 95% CI: 0.698-1.682, P=0.656)was not associated with renal prognosis. Conclusions:The severity of PMN in children with positive PLA2R was higher than that in those with negative PLA2R.The long-term cumulative remission rate of PLA2R negative children with PMN was higher than that of PLA2R positive children.

OBJECTIVETo investigate the differentiation capability of kidney stem cells (KSCs) into renal tubular epithelial cells (RTECs).

METHODSKSCs isolated from the renal papilla of 4-week-old SD rats were co-cultured with hypoxia-exposed RTEC in induced medium (containing activin A, BMP-7, and retinoic acid) and renal epithelial cell growth medium (REGM) alternately. The KSCs cultured in MSC medium served as the control. The KSC differentiation rates in both groups were determined using flow cytometry, immunofluorescence assay and qRT-PCR.

RESULTSFlow cytometry showed a CK-18 positive rate of 6.5Percnt; in the control KSC group and of 44.2% in the induced group. Immunofluorescence assay detected the positivity for mature epithelial cell markers CK-18, E-cadherin, and ZO-1 in the induced cells. The results of qRT-PCR showed significantly increased expression of E-cadherin and AQP-1 mRNAs in the induced cells compared with the control cells (P<0.01).

CONCLUSIONRat KSCs can be induced to differentiate into RTECs in vitro.

Activins ; chemistry ; Animals ; Aquaporin 1 ; metabolism ; Bone Morphogenetic Protein 7 ; chemistry ; Cadherins ; metabolism ; Cell Differentiation ; Coculture Techniques ; Culture Media ; chemistry ; Epithelial Cells ; cytology ; Keratin-18 ; metabolism ; Kidney Tubules ; cytology ; Rats ; Rats, Sprague-Dawley ; Stem Cells ; cytology ; Tretinoin ; chemistry ; Zonula Occludens-1 Protein ; metabolism