Objective To investigate the curative effect of leflunomide in the treatment of diabetic nephropathy-Ⅳ (DN-Ⅳ).Methods Sixty cases with DN-Ⅳ were assigned to the leflunomide treatment group and the control group.Both groups were given hypoglycemic,antihypertensive,regulate lipid and angiotensin converting enzyme inhibitors or angiotensin Ⅱ inhibitor class of drugs.Meanwhile patients in the treatment group were orally administered leflunomide once daily for two month with a dose of 50 mg/d in the first three days and 20 mg/d afterwards.24 hour pre-and post-treatment values of urinary protein,C-reactive protein (CRP),endogenous creatinine clearance rate (Ccr),triglyceride (TG),total cholesterol (TC),albumin (ALB),glycosylated hemoglobin (HbA1c) and blood pressure were measured.Analyzed the correlation of Ccr with other laboratory indicators after treatment for one year.Results At 24 hour before treatment,after treatment for two months and one year,the level of 24 h urinary protein of the treatment group (n =26) were (3.75 ± 0.94)g/24 h,(2.02 ± 0.45) g/24 h,and (2.46 ± 0.55) g/24 h respectively,and the level of Ccr were (69.04 ± 13.35) ml/min,(71.35 ± 11.25) ml/min,and (67.48 ± 10.58) ml/min respectively.While in the control group(n =28),the 24 h urinary protein level of were (3.68 ± 1.03) g/24 h,(3.43 ± 0.65) g/24 h,and (5.46 ±0.47) g/24 h respectively at the three time points,and the Ccr level were (68.55 ± 10.09) ml/min,(66.76 ± 9.45) ml/min,(57.50 ± 15.75) ml/min respectively.The levels of 24 h urinary protein in the treatment group after treatment for two months and one year were significantly lower than before treatment in the treatment group as well as at the corresponding period of the control group (P ＜ 0.05),while the level of Ccr in the treatment group was higher than that of the control group at the same period,and the difference was statistically significant(P ＜ 0.05).The levels of CRP,TG,TC,HbAlc and systolic pressure in the treatment group after treatment for two months and one year were significantly lower than that of control group at the same period,while ALB was significantly higher than before treatment in the treatment group as well as at the corresponding period of the control group (P ＜ 0.05).The 24 h urine protein,TC,systolic blood pressure were significantly correlated with Ccr after treatment for one year (β =-0.771,-0.682,0.656,-0.530respectively;P ＜0.01).Conclusion Leflunomide treatment of diabetic nephropathy was safe and effective,but the duration of leflunomide treatment and second selection time of leflunomide therapy needed to further study.

Objective To investigate the effect of renal anemia variability on the progression of renal function in patients with chronic kidney disease and hemoglobin variability on the incidence of cardiovascularevents,mortality and re-hospitalization rate.Methods one hundred and twenty-three patients with chronickidney disease with stage Ⅲ-Ⅴ were enrolled in this study.The information of hemoglobin variability,creatinineclearance rate (Ccr),renal function,the incidence of cardiovascular events,mortality and rehospitalization rate,the incidence of cardiovascular events,mortality and rehospitalization rate were recorded and analyzed.ResultsThe change of hemoglobin level was (20.6 ± 10.7) g/L and Ccr change level was (16.3 ± 4.1) ml/min inpatients,and the pearson correlation coefficient was 0.82.Multiple covariance analysis showed that Ccr increaselevel was higher in CKD Ⅲ-Ⅴ period patients with hemoglobin fluctuations than that of hemoglobin stabilitypatients after adjusting smoking history,blood pressure,24 h urinary protein quantitative factors (F =7.6,9.1,4.3;P＜0.05).The incidence of cardiovascular events in patients,mortality,rehospitalization rate of hemoglobinwave group were higher than those of hemoglobin stabilizing group(x2 =26.9,5.1,10.6,P＜0.05 or P＜0.01).Conclusion The fluctuation of hemoglobin is able to aggravate quickly of renal function development,increasethe incidence,mortality and rehospitalization rate of cardiovascular events.

Acute appendicitis is the most common surgical or acute abdomen in childhood.Rapid and correct diagnosis is the premise of rational therapy,but there are still some problems in diagnosis and differential diagnosis.Sufficient comprehension about clinical features and differential diagnostic diseases,typical clinical symptoms,physical examination,laboratory examinations,ultrasonography or CT would make a definite diagnosis.Laparoscopy is also used to make a diagnosis if necessary.

Objective:Spectrophotometer is a device to be verified obligatory in hospital. This article introduced some techniques to avoid ordinary mistakes in measurement. Methods:We introduced principle and verification regulation of spectrophotometer. Such methods as parameter configuration, proper maintenance can reduce our mistakes. Results: This article analyzed some common problems in measurement and also offered solutions. Conclusion: In the measurements of spectrophotometers, because the operators have less spectrophotometer operation experience, they often get inaccurate data which lead to an error. Conclusion: To avoid these mistakes, strictly regulate operations in spectrophotometer’s verification and proper routine maintenance are necessary.

[Summary] This review summarized the evolution of surgical timing and procedure skills of postnatal repair in the treatment of congenital diaphragmatic hernia ( CDH ) .Minimally invasive repair of diaphragmatic hernia was highlighted.The current status, difficulties, and future trends of surgical intervention for CDH were analyzed.

Objective To study the influencing factors on the time of acute cerebral apoplexy patients visiting the hospital.Methods 64 patients with acute ischemic stroke were researched.The clinical data of all patients were collected.The influencing factors on treatment time were analyzed by univariate and multivariate Logistic regression analysis.Results In the 64 patients, 26 cases of the visiting time≤6 h(40.63%), 38 cases of visiting time>6 h(59.37%).The results of single factor analysis showed that the relationship between the time of treatment,pre-hospital transfer mode (x2=6.650,5.081,all P<0.05),educational level,living location,MRS score,whether or not know the stroke(x2=4.561,6.557,8.788,4.146,all P<0.05);the disturbance of consciousness and symptoms ≥3 symptoms compared with the visiting time had significant difference(x2=5.133,5.926,all P<0.05);in the multiple factors Logitic regression analysis,the degree of education(OR=2.332,95%CI:1.402~3.904),severity of illness(OR=3.956,95%CI:1.934~7.446),understanding of stroke(OR=3.621,95%CI:1.563~8.125),disturbance of consciousness(OR=4.336,95%CI:2.394~11.374),pre-hospital transport mode(OR=5.658,95%CI:2.546~12.554) were the risk factors of treatment time.Conclusion There is a close relationship with extension and various factors of acute ischemic stroke patients,in the future,not only need to improve the pre-hospital emergency care system,but also need to strengthen the public understanding of the disease.

Objective To investigate the relationship between pluse pressure(PP) and serum levels of C-reactive protien(Hs-CRP) in elderly patients with HBP.Methods To measure serum levels of Hs-CRP,total cholesterol(TC),triglyceride(TG),high density lipoprotein-cholesterol( HDL-C),low density lipoprotein-cholesterol(LDL-C) and FBG in 160 patients. Patients were divided into four groups according to the levels of their PP,100mmHg whose serum levels of Hs-CRP were compared.Results Hs-CRP rose with the levels of PP,and were significantly higher in four groups(P

Objective To explore the positive distribution characteristics and analyse the correlation of common food allergen-specific immunoglobulin E (sIgE) with suspected food allergy in the First Affiliated Hospital of Guangzhou Medical University.Methods Using fluorescence enzyme-linked immunosorbent assay to detect the serum sIgE antibody of 854 patients,including 7 kinds of food allergens (milk,egg white,egg yolk,shrimp,crab,peanut and soybean) from July 2006 to January 2013.Data were processed by statistical software SPSS19.0.Results The positive rates of the 7 kinds of food allergen were 39.3％ (283/720),36.3％ (216/595),9.8％ (28/285),21.2％ (36/170),24.3％ (17/70),14.8％ (9/61) and 10.0％ (5/50).Two hundred and eighty-two patients were detected egg white and egg yolk sIgE,the positive rate of egg white sIgE 59.6％ (168/282) was much higher than the egg yolk sIgE 9.2％ (26/282).The positive rate of the milk and egg white sIgE were different between the age groups and decreased with the age(milk:x2 =792.88;egg white:x2 =658.21,P ＜ 0.01).The degree in level 4 or above of milk and egg white sIgE were 1.08％ (2/186) and 1.12％ (2/178) in positive patients.Five hundred and twenty-eight patients were detected milk and egg white sIgE,26.9％ (142/528) were both positive,sIgE levels in serum of them was moderately correlated (rs =0.758,P ＜ 0.01).Serum sIgE of shrimp and crab was detected in 64 patients,16 cases was positive of the shrimp,17 cases of the crab was positive,both positive in 16 cases,sIgE levels in serum of them were highly correlated (rs =0.973,P ＜0.01).In the simultaneous detection of 34 patients' serum sIgE of peanut and soybean,peanut was positive in 4 cases,soybean was positive in 3 cases,both positive in 2 cases,sIgE levels in serum of them were highly correlated (rs =0.879,P ＜ 0.01).Conclusions Egg white is the major allergen of egg allergy.The correlations of shrimp and crab,peanut and soybean are extremely high,probably because of their homology; egg white and milk are not homologous food,but the levels of sIgE between them display a moderately correlation,indicating the existing of synergistic reaction.

OBJECTlVE To study the effect of ganoderma poIysaccharide( GLP)on zebrafish ( Danio rerio)survivaI,deveIopment and senescence. METHODS A p53-knockout zebrafish modeI was estabIished by injecting of morphoIino phosphorodiamidate(mO)into normaI zebrafish eggs in the singIe ceII deveIopment stage. Different concentrations of GLP 1,2 and 3 g·L-1 were used to treat both wiId type and p53-knockout zebrafish embryos 8 h post fertiIization(8 hpf)under 28℃ for 3 d. The survivaI and maIformation rates were caIcuIated after 72 hpf,and the effect of GLP on ceII senescence was evaI-uated by senescence associated β-gaIactosidase(SA-β-gaI)staining both in wiId type and p53-knockout zebrafish embryos. In addition,the differentiaI gene expression of cancer inhibitor gene(p53),teIomer-ase reverse transcriptase( TERT),murine doubIe minute2( mdm2)and p21 was examined by RT-PCR both in wiId type and p53-knockout zebrafish embryos after treatment with different concentrations of GLP. RESULTS GLP 1 and 2 g·L-1 had no effect on deveIopment of wiId type zebrafish embryos,but after GLP 3 g·L-1 treatment,most of zebrafish embryos dispIayed maIformation and the survivaI rate was onIy 48.6%. GLP 1,2 and 3 g·L-1 had no effect on survivaI and deveIopment of p53-knockout zebrafish embryos. After GLP 2 g·L-1 treatment for 3 d,the SA-β-gaI staining positive rate of wiId type zebrafish embryos was reduced compared with controI group(P﹤0.01),whiIe there was no significant change in p53-knockout zebrafish embryos. The resuIts of RT-PCR showed that GLP 2 g·L-1 treatment depressed p21 and p53 gene expression(P﹤0.05,P﹤0.01),and had no effect on mdm2 and TERTgene expres-sion of wiId type zebrafish embryos. For p53-knockout zebrafish embryos,the TERT,mdm2,p21 and p53 gene expression dispIayed no significant difference after GLP 2 g·L-1 treatment. CONCLUSlON GLP 2 g·L-1 may improve senescence of wiId type zebrafish embryo ceIIs. GLP ≥3 g·L-1 may Iead to death and abnormaI deveIopment of wiId type zebrafish embryos. The improvement of GLP on senescence of wiId type zebrafish embryo ceIIs might be mediated by its down-reguIation of p21 and p53 gene expression.

Objective To compare differences of gut microbiome between patients with severe acne vulgaris and healthy individuals by using high-throughput sequencing technology.Methods Stool samples were collected from 10 outpatients with severe acne vulgaris and 10 age-and sex-matched healthy controls.Then,the bacterial DNA was extracted and subjected to 16S rRNA sequencing for the identification of microbial species,and the differences of gut microbiome were compared between the patients and controls.Results There were no significant differences in the diversity of intestinal microflora,but only the relative abundance of a few bacteria differed significantly between the two groups.Gut microbiome in the two groups mainly consisted of Bacteroidetes,Firmicutes,Proteobacteria and Actinobacteria.There were no significant differences in the relative abundance of bacteria at the phylum and genus levels between the two groups.However,the relative abundance of Blautia producta and Coprococcus eutactus at the species level differed remarkably between the two groups.Conclusion No significant differences in the bacterial diversity indices are found,but some bacterial species significantly differ between the patients with severe acne vulgaris and healthy controls.