Refractory nephrotic syndrome(RNS) is one of the main causes of end-stage renal disease (ESRD) in children,which is also a difficult issue in clinic.Several therapies,including immunosuppressive agents,have been shown to be effective and safe for RNS.It is proved,however,that a substantial number of children are still refractory to treatment despite these therapies.Recently,rituximab as a new immunosuppressant has achieved good results for RNS,and a number of case reports and clinical trials have suggested that rituximab may be effective for children with RNS.This review will analyse the scientific basis for the efficacy and safety of using rituximab in children with RNS.

Acute kidney injury (AKI)was a common problem in children in clinic.pRIFLE Criteria, AKIN Criteria, KDIGO Criteria are the main classification criteria of AKI.Though serum creatinine is still used as the most common biomarkers for diagnosis of AKI, the sensitivity and specificity is unsatisfactory.In recent years, many potential biomarkers of AKI have been studied in a variety of experimental and clinical settings.This review describes the novel biomarkers of AKI, including cystatin C, neutrophil gelatinase associated lipocalin, interleukin-18 ,kidney injury molecule-1 and liver-type fatty acid binding protein,, which have now made a progress in clinic.

AIM: To investigate the effect of intravitreal injection of anti-vascular endothelial growth factor (VEGF) drug Bevacizumab on connective tissue growth factor(CTGF) and pigment epithelium derived factor (PEDF) in proliferative membranes in patients with proliferative diabetic retinopathy (PDR).METHODS: From January 2015 to December 2016, 117 patients (126 eyes) with PDR were analyzed using the case-control study.The selected cases were randomly divided into two groups, respectively, Group A of 60 cases (63 eyes) and Group B of 57 cases (63 eyes).The Group A was treated with vitrectomy alone, while the Group B received intravitreal injection of 0.05mL/1.25mg bevacizumab before vitrectomy.The peeled epiretinal membranes in patients were stained and then the histopathological changes were observed for primitive cells and angiogenesis, the expression of CTGF and PEDF were tested.RESULTS: The expression of CTGF and PEDF in the proliferative membrane of the two groups were expressed in the cytoplasm.The Group A showed positive expression in 38 cases, the positive rate was 60.3%.Compared with Group A, the positive expression rate of CTGF in Group B (92.1%) was significantly higher (P<0.05).The positive expression rates of PEDF in the two groups were 90.5% and 95.2% respectively, and there was no significant difference between the two groups (P>0.05).CONCLUSION: In patients with PDR after intravitreal injection of bevacizumab, the retinal neovascularization is significantly reduced, which is conducive to vitrectomy.The positive expression rate of CTGF significantly increased in patients with PDR after intravitreal injection of bevacizumab, but there was no significant change in the expression of PEDF in the anterior membrane.

AIM: To study the effect of intravitreal injection of anti-vascular endothelial growth factor (VEGF) on best corrected visual acuity (BCVA) and multifocal-electroretinogram (mfERG) before and after treatment for choroidal neovascular disease.METHODS: A total of 264 patients (332 eyes) with macular neovascularization (MCNV) and idiopathic choroidal neovascular disease (ICNV) who underwent pathologic myopia from January 2015 to January 2017 were enrolled in this study.Intraocular pressure and BCVA, fundus using 90D front mirror and slit lamp detection, and the fundus photograph, OCT, ICGA and FFA angiography, mfERG detection were taken.One month after the drug, 1mo after the final treatment, we recorded BCVA, intraocular pressure and mfERG and so on.RESULTS: Ranibizumab was injected into the 254 eyes, and 78 eyes were injected with conbercept.There were 37 eyes injected once, 147 eyes were injected twice, 72 eyes were injected 3 times, 57 eyes were injected 4 times, 19 eyes 5 times.There were no significant differences on intraocular pressure between the two groups (P>0.05).The BCVA before treatment was significantly different compared with those 1mo after treatment and 1mo after the final treatment (P>0.05).The amplitude of Ring1, Ring2 and Ring4 increased after treatment, the difference was statistically significant.(P<0.05).The amplitude of Ring3 and Ring5 increased at 1mo after final treatment(P<0.05).CONCLUSION:Intravitreal injection of anti-VEGF drugs has a significant effect on BCVA and mf ERG in patients with choroidal neovascular disease and is safe.

Henoch Schonlein purpura nephritis is a systemic inflammatory response of systemic vasculitis in anaphylactoid purpura,it is often occurred in childhood with systemic vasculitis reaction.Some patients will develop nephritic syndrome or nephrotic syndrome,even kidney failure,either of which is harmful to the health of children.However,a unified standard for the diagnosis and treatment of purpura nephritis is still lack.Combined with the latest research results,this research intends to review the pathogenesis,clinical diagnosis and treatment of purpura nephritis.

Objective: To assess the mental health status of poor medical students.Methods: 40 poor medical students and 40 ordinary medical students were studied controlly with symptom checdlist-90. Results: poor medical students than ordinary medical students had more scores in factors and all average. Conclusion: the mental health status of poor medical students is not good.The work of mental health education and consultation should be accessed according to their mental status for them.

Subclinical hypothyroidism is common in children,but its clinical significance is widely debated.The pathogenesis is not very clear and etiology appears to be multifactorial,such as autoimmune thyroiditis,obesity,antiepileptic drugs and so on.Currently there is no broad consensus on the management of children with subclinical hypothyroidism.In this review,the available evidences regarding to investigation,risk factors,trreatments and outcomes for this disease are summarized.

Hereditary renal diseases (inherited kidney diseases) include glomerular diseases,tubular diseases and cystic diseases.The incidence of inherited kidney diseases is relatively low, but the variety of clinical insufficient understanding of the disease, the means test about inherited kidney diseases is also not standardized, easily lead to missed diagnosis and misdiagnosis.As the common clinical manifestation of hereditary renal disease and congenital/hereditary renal disease are mainly low blood potassium, kidney stones, polyuria, growth retardation, and may develop renal failure without treatment.Therefore, clinicians should pay special attention to the diagnosis of congenital/hereditary renal disease, and early interventions are recommended.

Objective To study the treatment influences on immunity and tumor recurrence of oral canc -er patients with the combination therapy of hyperbaric oxygen treatment and postoperative adjuvant chemotherapy . Methods In the period from March 2011 to March 2014 ,84 patients were clearly diagnosed with oral cancer and randomly divided into hyperbaric oxygen treatment combined postoperative adjuvant chemotherapy group ( group A,n=42)and postoperative adjuvant chemotherapy group (group B,n=42).From day 1 prior to the last day of chemotherapy ,patients in group A were treated with hyperbaric oxygen ,and patients in group B were just accepted chemotherapy.After chemotherapy,we tested the levels of CD3 +,CD4 +,CD8 +and NK cells by flow cytometry, and the expression of IL -2,IL-4,IL-10 and INF-γby ELISA essay.All patients had been followed for two years.Results The levels of CD4 +and NK cells in group A were higher than group B (P<0.05),but the levels of CD3 +and CD8 +between the two groups were obviously different (P>0.05).Compared with group B,the ratio of CD4 +and CD8 +was increased in group A(P<0.05).The levels of cytokines involved IL -2,IL-4,IL-10 and INF-γin group A were higher than the levels of group B ( P<0 .05 ) .Follow-up results showed that pa-tients treated with hyperbaric oxygen combined postoperative adjuvant chemotherapy had less recurrence in 2 years(P<0.05).Conclusion Hyperbaric oxygen combined postoperative adjuvant chemotherapy can improve the patients′immune function ,and to be effective in preventing two years′recurrence .

Diagnosis and management of hip injuries has advanced significantly in the past few years with the improvement of arthroscopic techniques of the hip. Many of pathologic conditions previously unrecognized and untreated have been diagnosed and treated correctly under hip arthroscopy . Current application for hip arthroscopy include management of labral tears,osteoplasty for femoroacetabular impingement, thermal capsulorrhaphy and capsular plication for subtle rotational instability and capsular laxity, lateral impact injury and chondral lesions, osteochondritis dissecans, ligamentum teres injuries, internal and external snapping hip, removal of loose bodies, synovial biopsy, subtotal synovectomy, synovial chondromatosis, infection, and certain cases of mild to moderate osteoarthritis with associated mechanical symptoms. In addition,patients with long-standing, unresolved hip joint pain may benefit from arthroscopy. Patients with reproducible symptoms and physical findings that reveal limited functioning, and who have failed an adequate trial of conservative treatment will have the greatest likelihood of success after arthroscopic intervention. Prescise attention to thorough physical examination, detailed imaging,and adherence to safe and reproducible surgical techniques are essential for the success of this procedure.