Chronic kidney disease(CKD)is increasingly recognized as a global public health problem.Uncontrolled complications of CKD,especially cardiovascular diseases,contribute greatly to the premature death and unfavorable prognosis.Recent evidence shows that CKD complications may occur earlier than previously thought.CKD complications deserve early detection and active treatment.Periodical follow-up and regular check should be done to adjust the therapeutic condition.Clinical practice guideline or recommendation based on evidence-based medicine is essential for management of CKD complications.Personalized treatment should be considered to improve survival and quality of life,and to make patient return to society.

To determine whether increased expressions of gelatinase A(MMP-2) and gelatinase B(MMP-9) occur in vivo in autoimmune MRL/lpr mice model and to investigate the modulation effects of "shenle." Shenle (4g?kg -1 ?d -1 ,orally) or methylprednisolone(MPS,25mg?kg -1 ?d -1 ,ip)was administered daily to MRL/lpr mice at the age of 8 weeks. The activities of MMP-2/9 by gelatin zymography were compared in kidney protein extracts and urine. After treatment for 20 weeks, a progressive reduction in positive proteinuria number/total mice (40% vs.33 3% vs.80%, proteinuria over 300 mg/dl as positive) and an elevated survival rate (70% vs.80% vs. 50%) were found in "shenle" and MPS groups compared with the control group. Histological analysis of kidney tissues indicated that both "shenle" and MPS could inhibit the mesangial proliferation and renal sclerosis. Using SDS-PAGE gelatin zymography, we have identified increased expressions of both latent and activated form enzymes of MMP-2/9 in urine and kidney extraction. Immunohistochemical staining showed both MMP-2 and MMP-9 were obviously up-regulated within glomerulus in control group. "Shenle" as well as MPS suppressed the expression of both latent and activated form of MMP-2/9. These in vivo results suggested that MMP-2/9 expressions might play an important role in murine lupus nephritis. "Shenle" delayed the development of glomerulonephritis and improved survival in MRL/lpr mice probably by suppressing the expressions and activities of MMP-2/9.

To determine thrombin activation and fibrin deposition in the development of lupus nephritis in MRL lpr/lpr mice and the inhibitory effects of "shenle". "Shenle" (4g/(kg?d) orally) was administered daily to MRL lpr/lpr mice at the age of 8 weeks. After treatment for 20 weeks, we compared thrombin receptor (Protease Activated Receptor-1, PAR-1) expression with immunohistochemistry and fibrin deposition with MSB(Martius-Scarlet-Blue)staining in renal sections. PAR-1 mRNA expression was analyzed with RT-PCR method in the two groups. With the development of murine lupus nephritis, we observed an increase in thrombin receptor mRNA and severe fibrin deposition in renal tissue in the control group, while thrombin receptor protein expression was strikingly downregulated, suggesting its continuous activation and degradation. "Shenle" inhibited PAR-1 activation significantly and it was correlated with reduced fibrin deposition. These results suggested that thrombin activation may play an important role in the development of glomerulonephritis in MRL-lpr mice. "Shenle" ameliorated the murine renal lesions probably by inhibiting thrombin receptor activation and fibrin deposition.

Objective To investigate the effects of the expression of integerin-linked kinase (ILK) on connexin 43 (Cx 43) in rat mesangial cells (RMCs). Methods RMCs were divided into three different groups (6 for each group): RMC group, ILK-con siRNA group and ILK-siRNA group. ILK siRNA was synthesized, and then transfected into RMCs by LipofectAMIN 2000. RMCs were transiently transfected with ILK-con siRNA, ILK-siRNA and lysed 24h later, and mRNA was then extracted and detected by reverse transcription-polymerase chain reaction (RT-PCR) analysis using ILK and Cx43-specific primers, and an aliquot of protein from each sample was subjected to western blot analysis using ILK and Cx43 antibodies. Cells were seeded into 96-well plates (2?103 cells/well) and then transfected with ILK-con siRNA and ILK-siRNA. After incubation for 24, 48 and 72 hours, respectively, 20?l of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) (5mg/ml) was added into each well and incubated for 4 hours. Subsequently, 150?l of dimethyl sulfoxide (DMSO) was added to each well to dissolve the formazan crystals, and the absorption at 492nm was measured. Results ILK mRNA and protein levels decreased by 30%-50% after being transiently transfected with ILK-siRNA, while Cx 43 mRNA and protein levels increased by 30%-40% and 60%-70%, respectively. The viabilities in ILK-siRNA infected RMCs at 24, 48 and 72 hours were significantly higher than that in ILK-con siRNA infected RMCs. Conclusion Inhibition of ILK pathway will up-regulate the expression of Cx 43 and the viability of RMCs, implying that the regulation of connexin 43 might possibly be achieved via ILK pathway.

Objective To determine the changes in expressions of thrombin receptor and fibrin deposit in glomeruli during the process of senility. Method Rats were divided into 3 groups (8 rats in each group): 3-month-old group (3m), 12-month-old group (12m) and 24-month-old group (24m). Fibrin deposition was detected by Martius-Scarlet-Blue staining and direct immunofluorecence method. Immunohistochemical studies were performed to detect the expression of thrombin receptor (PAR-1) and transforming growth factor-? (TGF-?). Semi-quantitative PCR was performed to detect the changes in PAR-1 mRNA expression. A quantitative analysis of the expressions was performed by image analysis system. Result Significant pathological changes were found in glomeruli during the process of senility. Fibrin deposition was not observed in glomeruli in different groups. Significant expression of PAR-1 was found in glomerular endothelial cells, mesangial cells and epithelial cells in 3m rats. On the contrary, in 24m rats, PAR-1 expression in glomeruli was significantly decreased. Expression of TGF-? was increased with senility in glomeruli. PAR-1 gene expression, barely detectable in control tissue, was strikingly increased in 24m rats. Conclusion Thrombin receptor activation could be found in glomeruli of senile rat, and it is independent of fibrin deposition. Activation of PAR-1 may play an important role in the process of renal senility.

Objective: Full expression of class I HLA molecules on tumor cells is pivotal in priming the tumor antigen-specific CTLs for effective iramunotherapies. Tumor cells display abnonnal expression of HLA class I molecules in human ovarian carcinoma. Methods: In this study, the expression of class I molecules in human ovarian cancer cells was determined by using Western bloting, immunohistochemistry testing and flow cytometry. The mRNA of TAP (transporter associated with antigen processing) and LMP(low molecular weight polypeptide) were exannined at the same time by RT-PCR. Results: It has been shown that class I molecules were unable to be, or only weakly, expressed in five of eight ovarian cancer cell lines. On these cell lines abnormal in class I expression, no or only little mRNA were detected for TAP1, TAP2, LMP2 and(or) LMP7 genes. Class I expression, however, could be partially recovered by incubating the tumor cells at 25℃ when compared with those at 37℃ . Conclusion: The results suggested that the dysfunction of TAP and IMP genes, following by a defective expression of class I molecules, might be one of the mechanisms enable ovarian cancer cells to escape from immune surveillance.

Objective To describe the clinical application of microvascular anastomotic device in head and neck reconstruction.Methods From July,2013 to November,2013,microvascular free flaps were transferred to reconstruct the defects simultaneously after tumor resection of head and neck region in 12 cases in Department of Oral and Maxillofacial Surgery,Peking University School of Stomatology.Microvascular anastomotic coupling devices (MACD) were used in vascular anastomosis.The clinical data were collected and analyzed,including the selection of free flap,diameter of donor and recipient vessels,type of MACD,time of anastomosis,instant patency of anastomosis.The flap was monitored closely after operation and the final survival rate was calculated.Results Twelve microvascular free flaps were done in this series,including 6 fibula flaps,4 forearm flaps and 2 anterolateral thigh flaps.Totally 17 MACD were used by end-to-end anastomosis in this series,including 5 arterial anastomosis and 12 venous anastomosis.The anastomose time using MACD was from 4 to 10 minutes,with a median time 6.8 minutes.The instant patency rate of anastomosis was 100％.There were some blood leakages near the anastomotic stoma in 1 arterial anastomosis using MACD.It was resolved successfully by changing a new MACD.Conclusion Our primary clinical experience showed that the MACD was well suited to the microvascular reconstruction of head and neck defect.The feasibility and reliability was confirmed by our clinical cases.It should be recommended as a safe,fast and reliable adjuvant anastomotic instrument for free tissue transfer.

Objective To observe the effects of hyperoxia on Notch 1 receptor of alveolar epithelial type Ⅱ cells (AEC Ⅱ), in a hetcrocellular culture of alveolar epithelial type Ⅱ cells and lung flbroblasts(LF), in order to explore Notch signaling in hyperoxic induced lung injury and thus make theoretical basis for prevention and treatment of a acute/chronie neonatal lung injury. Method Twelve Spragne Dawkey female rats with 200～220 g and 3 Spragne Dawkey male rats with 220～250 g were offered from experimental animal centre of Tongji Medical Colleege, Huazhong University of Science and Technology. The AEC Ⅱ/ LF co-culture system was established successfully. AEC H s from premature rats were randomly assigned to 2 groups: air control group and hyperoxia group. Air control group was kept in room air 50% ml/L CO2 enviromnent at 37°C, while hyperoxia group was exposed to 950 ml/L O2 + 250 ml/L CO2. Immuno-histochemistry was taken to detect Notch 1. Fluorescent quantitafive PCR was used to quantify the Notch 1 mRNA. MTT method was taken to assess cen proliferation viability.Flow eytometry double label method was used to detect cell percentages. Results In hyperoxia group:Notch 1 activation was inhibited, and Notch 1 mRNA decreased to 0.43,0.29,0.11,0.03 fold of control (95% confidence limit). AEC Ⅱ percentage descended predominantly[ 24 h hyperoxia group vs. control group: (68.92±6.88)%vs. (90.35±4.01)%, P =0.006;48 h hyperoxia group vs. control group: (38.03±3.27) vs. (61.47±4.81)%, P =0.000;72 h hyperoxia group vs. control group:(20.13±4.45)% vs. (52.05±3.35)%, P =0.000;96 h hyperoxia group vs. control group:(8.17±1.99)% vs. (52.59±2.93)%, P =0.0001 while that d AECI rised[24 h hyperoxia group vs. contrd group:(0.11±0.03)% vs. (0.01±0.01)%, P=0.006;48h hyperoxia group vs. control gnmp:(49.73±3.45)% vs. (16.13±2.13)%, P =0.000;72 h hyperoxia group vs. control group: (52.43±3.14) % vs. (5.98±0.95) %, P = 0.000;96h hyperorxia group vs. control group:(19.85±3.26)% vs. (29.03±3.16)%, P =0.007]. Comclusions Hyperoxia may inhibit Notch signaling pathway, which can weaken proliferation and disdifferentiation of AEC Ⅱ s. Investigations on how to control Notch signaling will provide fresh thoughts for alveolar epithelium repairing.

Objective To study the influence of 125I seed interstitial brachytherapy in parotid region on the recovery of facial nerve function. Methods A total of the data of 21 patients with primary parotid carcinoma were treated with resection and 125I interstitial brachytherapy. All the patients had no facial palsy before operation and the prescribed dose was 60 Gy. During 4 years of follow-up, the HouseBrackmann grading scales and ENoG were used to evaluate the function of facial nerve. According to the modified regional House-Brackmann grading scales, the facial nerve branches of patients in affected side were divided into normal and abnormal groups, and were compared with those in contra-lateral side.Results Post-operation facial palsy occurred in all the patients, but the facial palsy recovered within 6 months. The latency time differences between affected side and contralateral side were statistically significant in abnormal group from 1 week to 6 months after treatment ( t = 2.362, P = 0.028 ), and were also different in normal group 1 week after treatment ( t = 2.522, P = 0.027 ). Conclusions 125I interstitial brachytherapy has no influence on recovery of facial nerve function after tumor resection and no delayed facial nerve damage.

Higher education for the disabled is essential to education equality and social harmony,it represents the depth of society improvement and the level of social civilization.Inclusive education has develop from adopt physical disability into no discrimination at psychological level.This article explored 3 combination education mode (the disabled combined with the healthy,medicine combined with teaching,general stu.dies combined with the specialty) through education environment,education methods and education pathways using resources in medical colleges.This mode through no discrimination education environment for the disabled using medicine and teaching combination education methods to recover physical and psychological of the disabled,and using general studies combined with the specialty education pathways to train the disabled into a fully skilled person.