Objective To analyze the clinical manifestations,immunological characteristics,pathological changes and prognosis in primary Sj(o)gren's syndrome complicated with renal involvement.Methods Three hundred and eighty-seven patients with pSS were enrolled in this retrospective study.Among these patients,198 patients were complicated with renal involvement and 189 patients without renal involvement.The data of the two groups were analyzed for clinical manifestations,blood tests,urine tests and immunological characteristics by independent sample t test,x2 test,Fisher exact probability and Logistic regression model respectively.Seventy-two patients in the group with renal involvement had kidney biopsies.Results The average of these 387 patients (female/male 345/42 cases) were (55.3±13.2) years old.The average age of 198 patients with renal involvement (female/male 168/30 cases) was (55.3±13.2) years old.The serum RF and IgG of the group with renal volvement was significantly higher than the patients without renal involvement.In the 198 patients with renal involvement;102 patients (51.5％) developed type Ⅰ renal tubular acidosis (RTA Ⅰ).Among these RTA Ⅰ patients,54 patients presented hypokalemia;12 patients developed hypokalemic plegia,30 patients with urolithiasis,6 patients with osteoporosis;69 patients presented with overt renal glomerulus impairment,36 cases had nephrotic syndrome (NS),and 33 cases had chronic glomerulonephritis;In 81 patients with renal failure,including 27 were stage 1 CKD,18 were stage 2 CKD,9 were stage 3 CKD,15 were stage 4 CKD,12 were stage 5 CKD.Among these patients with renal biopsie,light microscopy showed chronic interstitial nephritis (IN,69/72),mesangial proliferative glomerulonephritis (36/72),hyperplastic and sclerosing glomerulonephritis (9/72),partly sclerosing glomerulonephritis (9/72) and membranous nephropathy (6/72).Immunofluorescent examination revealed:IgG deposition in 21 patients (29.1％),IgA in 21(29.1％),IgM in 33(45.8％),C3 in 12(16.6％),C4 in 18(25％) and C1q in 15(20.8％).Sixty-six cases with renal biopsies were followed for (8-30)months,except the patient died of cerebral bemorrhage,all the other patients survived,and renal functions were steady or improved.Conclusion ① The pSS patients with renal involvement mainly shows interstitial nephritis.However,the occurrence of glomerulonephritis is not rare.② Rheumatoid factor (RF) or IgG is significantly associated with renal involvement in patients with pSS.③ When renal involvement is presents,renal biopsies is a necessary for patients with pSS.

Objective To develop a novel approach of transfecting the exogenous gene safely and effectively mediated by receptor according to the cavitation effect of ultrasound-mediated microbubble destruction. Methods C-myc antisense oligonucleotide(ASODN) and galactosylation polylysine(G-PLL) which was fluoresce in-labeled specificity ligand and SonoVue microbbule were coupled by electrostatic interaction. SMMC-7721 cell with c-myc ASODN were transfected in vitro by ultrasound-mediated microbubble destruction to investigate the effect of c-myc ASODN on it. The c-myc mRNA gene expression of liver cancer SMMC-7721 cells was detected. Results Cultured with 10% SonoVue microbubble and under ultrasound at 1.5 MHz,1.0 W/cm2, 10% duty cycle,60 s respectively,the SMMC-7721 cells had not been changed significantly. Reverse transcription polymerase chain reaction(RT-PCR) assay showed that c-myc expression was decreased in transfected cells(P<0.01). Conclusions Receptor-mediated targeted microbubble destruction by ultrasound can enhance the exogenous gene transfection and expression. It is a promising method in gene therapy of liver cancer.

Clinical features of 2 cases of ectopic ACTH syndrome with manifestation of severe hypercortisonism are described with the aim of exploring effective therapies.

Adult ; Bronchoalveolar Lavage ; methods ; Humans ; Male ; Middle Aged ; Pneumoconiosis ; therapy ; Respiration, Artificial ; methods ; Ventilators, Mechanical

OBJECTIVETo explore the clinical effects of minor bone anchors and palmaris longus tendon graft in treating chronic mallet fingers deformity.

METHODSFrom January 2008 to June 2013, 26 patients with chronic mallet fingers deformity were treated with minor bone anchors and palmaris longus tendon graft. There were 18 males and 8 females, aged from 18 to 52 years old with an average of (32.0±1.3) years. Among them, 8 cases caused by machine injury, 6 cases by fall injury, 6 cases by sprain from fight, 4 cases by tendon spontaneous rupture, 2 cases by knife trauma. There was no tendon attachment of extensor tendon check in 16 cases, and with 0.3 to 0.5 cm tendon attachment in 10 cases. All patients had the flexion deformity and the disability of dorsiflexion activity. During operation, the distal interphalangeal joint was fixed in 10° to 20° dorsiflexion by a Kirshner wire, the minor bone anchor was used to reconstruct the extensor tendon insertion, the palmaris longus tendon slice was transplanted the decayed area of extensor tendon insertion. Four weeks postoperatively, the Kirshner wire was removed and the plaster external fixation was used, and the patient began function exercises. Postoperative complications were observed and fingers functions were assessed according to Dargan standard.

RESULTSThe patients were followed up from 6 to 14 months with an average of (5.0±0.3) months. Wound superficial infection occurred in 2 cases, the skin pressure ulcer in 2 cases, joint activities disability in 1 case; these symptoms got improvement after symptomatic treatment. Traumatic arthritis occurred in 2 cases, 1 case was improved after treatment, and 1 case had chronic pain for a long time. No internal fixation loosening or breakage and tendon rupture were found. According to Dargan standard to evaluate the finger function, 17 cases got excellent results, 8 good, and 1 poor.

CONCLUSIONIt is an effective way to treat the chronic mallet finger deformity using minor bone anchors and palmaris longus tendon graft, and the method has advantages of reliable fixation, easy operation, satisfactory effect and less complication.

Adolescent ; Adult ; Female ; Finger Injuries ; surgery ; Fracture Fixation, Internal ; Hand Deformities, Acquired ; surgery ; Humans ; Male ; Middle Aged ; Suture Anchors ; Tendon Transfer

Objective To explore the prognosis of children under different modes of delivery in the oli?gohydramnios patients,in order to reduce unnecessary cesarean section rate. Methods One hundred and forty?eight cases of oligohydramnios from September 2013 to October 2015 in the First Affiliated Hospital of Tsinghua University were reviewed,including 74 cases of vaginal delivery,54 cases of vaginal delivery group,20 cases for fetal heart abnormalities in the induction of labor or labor in the process or abortion failure emergency caesarean birth operation( pilot transfer of emergency cesarean section delivery group);direct line selective cesarean section in 74 cases. The delivery surround unripe ending of three kinds of delivery mode was compared,and gestational weeks,estate, cervical score, maximal amniotic fluid dark area vertical depth ( AFV), amniotic fluid index ( AFI) ,fetal size,water treatment and abortion case of the vaginal delivery and emergency caesarean birth were statistically compared. Results Both fetal heart abnormality and amniotic fluid of third degree incidence of trial production of emergency cesarean section group was 80. 00%( 16/20) ,of vaginal delivery group was respectively 11. 11%( 6/54) ,29. 63 ( 16/54) ,and of selective cesarean section delivery group was 0 and 9. 50%( 7/74) re?spectively,the difference between the 3 groups was statistically significant( P<0. 05) . The gestational age of vagi?nal trial production successfully delivery group and transfer of emergency cesarean section production group was respectively (39. 33+0. 13),(40. 20+0. 2) weeks, the parity was 0 were 45 cases,20 cases respectively,the parity was 1 were 9 cases,0 case respectively;AFV was ( 2. 14+0. 06) cm,( 1. 86+0. 08) cm respectively;the water treatment rates were 66. 67%( 36/74) and 30%( 6/20) respectively;the difference between the two groups was statistically significant(P<0. 05). Induction:in vaginal delivery group,there were 24 cases of spontaneous labor without induction,12 cases treated with misoprostol for cervical mature after vaginal delivery,12 cases of contraction oxytocin induction of labor with vaginal delivery,6 cases of misoprostol for cervical ripening after va?ginal delivery;in emergency cesarean section group,there were 2 cases of natural labor,8 cases of oxytocin,miso?prostol after oxytocin in 10 cases. There was significant difference between the two groups ( P<0. 001 ) . Conclusion Low risk pregnancy, fetal reserve ability of oligohydramnios in vaginal delivery is feasible. Water treatment,gestational age < 40 weeks, the parity more than 1 times,AFV>2 cm,the high rate of abortion sensi?tive pregnant women with high rate of vaginal delivery.

Objective To explore the effects of 1α,25-dihydroxyvitamin D3 [1,25(OH)2D3] on memory CD4+T cells of focal proliferative IgA nephropathy (IgAN)patients.Methods (1) Total of twenty incipient focal proliferative IgAN patients (Lee classification:Ⅲ level) were chosen as IgAN group and 20 healthy volunteers were chosen as healthy control group.The level of serum 1,25(OH)2D3 was measured by radioimmunoassay (RIA).Peripheral blood mononuclear cells (PBMCs) were separated by the method of Ficoll density gradient centrifugation and were stimulated with anti-CD3/anti-CD28 in the absence or presence of various concentrations of 1,25(OH)2D3,Dexamethasone(DEX) and 1,25(OH)2D3and DEX combined.PBMCs were cultured for 72 hours and the levels of IFN-γ,IL-4,IL-17A,Foxp3 were measured by flow cytometry(FCM),standing for the levels of Th1,Th2,Th17,Treg.(2) IgAN group was divided into two subgroups (proteinuria ＜ 1 g/24 h subgroup,proteinuria≥ 1 g/24 h subgroup),then the serum levels of 1,25(OH)2D3,IFN-γ,IL-4,IL-17A,Foxp3 were compared.Results Compared with healthy control group,serum 1,25(OH)2D3 level of IgAN group was significantly lower (P ＜ 0.05).Serum 1,25(OH)2D3 level in proteinuria≥ 1 g/24 h subgroup was significantly lower than proteinuria ＜ 1 g/24 h subgroup and healthy control group (P ＜ 0.05).The level in proteinuria ＜ 1 g/24 h subgroup was lower than healthy control group,but the difference was not statistically significant (P ＞ 0.05).(2) The levels of IFN-γ and IL-17A and the ratios of IFN-γ/IL-4,IL-17A/Foxp3 in IgAN group increased significantly compared with healthy control group (all P ＜ 0.05),and the level of Foxp3 decreased significantly (P ＜ 0.05).The level of IL-4 also increased,but the difference was not statistically significant (P ＞ 0.05).The levels of IFN-γand IL-17A and the ratio of IL-17A/Foxp3 in proteinuria≥ 1 g/24 h subgroup increased significantly,and the level of Foxp3 decreased significantly,compared with urinary protein ＜ 1 g/24 h subgroup and healthy control group (P ＜ 0.05).The ratio of IFN-γ/IL-4 in proteinuria≥1 g/24 h subgroup and proteinuria ＜ 1 g/24 h subgroup all increased,compared with healthy control group,and the ratio in proteinuria≥ 1 g/24 h subgroup increased significantly (P ＜ 0.05).There was no significant difference in the level of IL-4 among all groups.(3) After treatment with 1,25(OH)2D3,the levels of IFN-γ and IL-17A and the ratios of IFN-γ/IL-4 and IL-17A/Foxp3 decreased significantly,and the level of Foxp3 increased significantly (P ＜ 0.05),and these effects were more obvious as the increase of the drug concentration.The level of IL-4 did not change significantly.The combination of 1,25(OH)2D3 and DEX had a synergistic inhibition on the production of IFN-γ,IL-4,IL-17A,and the ratios of IFN-γ/IL-4 and IL-17A/Foxp3,and had a synergistic promotion on the production of Foxp3.Conclusions There is a certain extent of vitamin D deficiency in focal proliferative IgAN patients,which may be associated with the severity of proteinuria.The disorder of immunomodulatory effects of memory CD4+ T cell might exist in the patients of focal proliferative IgAN.1α,25-dihydroxyvitamin D3 might have beneficial effects on the immunoregulation of memory CD4+T cells of focal proliferative IgAN patients.

Bronchoalveolar Lavage ; methods ; Humans ; Pneumoconiosis ; therapy

Adolescent ; Adult ; Aged ; Bronchoalveolar Lavage ; Female ; Humans ; Male ; Middle Aged ; Pneumoconiosis ; therapy ; Retrospective Studies ; Treatment Outcome ; Young Adult

0.05). Conclusions Our study does not support a positive association between Chlamydia pneumoniae infection or reinfection and MS. Chlamydia pneumoniae may be a bystander pathogen.