Steroid-resistant nephrotic syndrome (SRNS) is a relatively difficult clinical type of treatment.The major therapy measures in present include steroid and immunosuppressant.Commonly used immunosuppressant include tacrolimus,cyclosporin,cyclophosphamide,mycophenolate mofetil,ect.Tacrolimus-induced clinical remission rate is superior to other immunosuppressive agents,has been the first-line agent of SRNS.Because of the individual difference in metabolism,the drug concentration of tacrolimus should be determined periodically.In order to obtain optimal efficacy of tacrolimus and reduce renal toxicity,the treatment protocols of small doses with long courses for children with SRNS were recommended.

Objective To investigate the potential of inflammatory markers for short-term prognosis of acute cerebral infarction.Methods A total of 272 consecutive patients with acute cerebral infarction were divided into a high hs-CRP group (hs-CRP level ＞3 mg/L) and a low hs-CRP group (hs-CRP level ≤3 mg/L),and their general information and medical history were collected.The Trial of Org 10172 in Acute Stroke Treatment (TOAST) stroke subtype classification was conducted and scores of the National Institutes of Health Stroke Scale (NIHSS),the Barthel index (BI) and the modified Rankin scale (mRS) were collected after admission.White blood cell count,blood glucose,blood homocysteine (Hcy) and C-reactive protein were measured within 24 hours following admission.Multivariate Logistic regression analysis was performed to identify independent risk factors for short-term prognosis of acute cerebral infarction.Results Between the high hs-CRP group and the low hs-CRP group,there were significant differences in the incidences of atrial fibrillation history,cardiogenic embolism of TOAST,blood homocysteine,blood glucose,white blood cell count,NIHSS,BI and mRS score 1,7,14 days after admission (P＜0.05 for all).The hs-CRP level (OR=0.876,P＜0.001,95％ CI:0.817-0.917),white blood cell count (OR=1.137,P=0.029,95％ CI:1.013-1.275),lipid metabolism disorders (OR=2.863,P＜0.001,95％ CI:1.561-5.250),and BI score (OR=1.038,P=0.047,95％ CI:1.001-1.077) 1 day after stroke were independent risk factors for short-term prognosis of acute cerebral infarction.Conclusions Increased levels of the inflammatory marker hs-CRP and elevated white blood cell count may be independent risk factors for short-term prognosis of acute cerebral infarction.

Objective To establish the prediction model for ischemic stroke recurrence. Methods Consecutive patients with ischemic stroke from January 1st, 2008 to December 31st, 2009 were followed up until June 30th, 2010. The rate of recurrence were described with Kaplan-Meier curve, and the factors associated with recurrence were analyzed with monovariant and multivariate Cox's proportional hazard regression. Results There were 79 cases relapsed during the follow-up. The independent risk factors associated with recurrence were age(X),history of hypertension (X2), family stroke history (X3), total cholesterol (X4), disease progression (X5), total scores of Essen stroke risk score (X6). The personal prognosis index (PI) for predicting recurrence was as: PI=0.025X1+0.681X2+0.973X3+0.395X4+0.636X5+0.283X6. As the receiver operating characteristic (ROC) curve showed, when the cut-off point of PI was 2.289, the sensitivity of the model was 0.731 and specificity was 0.795. Conclusion The model for predicting recurrence of ischemic stroke was established.

Objective To investigate the association between the HLA-DRB1 gene polymorphisms and susceptibility of pulmonary tuberculosis (TB) in patients with type 2 diabetes mellitus in North China. Methods A 1∶1 matched case-control study was adopted. Polymerase chain reaction-sequence-specific primers techniques (PCR-SSP) and restriction fragment length polymorphism (RFLP) was used to type polymorphisms (DR15, DR16, DR1, DR11). Information on environmental-related risk factors and pathological changes of tuberculosis was collected using a pre-tested standard questionnaire. Variance analysis, Chi-square, univariate and multivariate conditional Logistic analysis were conducted with SPSS 12.0 for Window. Results A sample of 124 pairs of cases and controls was studied. Univariate analysis demonstrated that DR15 mutant increased the risk of susceptibility of pulmonary tuberculosis (OR＝2.461, 95%CI: 1.363~4.444, P=0.002),and it would further increased if DR16 mutant occurred together (OR=4.904, 95%CI: 1.554~15.476). In multivariate analysis, DR15 mutant also associated with susceptibility of pulmonary tuberculosis (OR=2.996, 95%CI: 1.51~5.945). Conclusion Polymorphism of DR15 genotype might be a susceptible genotype of TB patients with type 2 diabetes mellitus in North China.

OBJECTIVETo probe the risk of colorectal polyp, colon and rectal carcinoma and the intake of NSAIDs.

METHODSCase-control study participants were from patients who underwent colonoscopy at different hospitals, the persons with the above disease was as cases, and those without the above diseases was as controls. Use of NSAIDs was assessed by interviewing the participants with a questionnaire which include a list of NSAIDs and related dietary and life style factors and family history.

RESULTSThere are 37 cases of colorectal polyp, 105 cases of colon carcinoma and 142 cases of rectal carcinoma and 66 controls. Adjusted for potential confounders, the risk of colorectal polyposis, colon carcinoma and rectal carcinoma were markedly reduced by NSAIDs. The OR values were 0.21 (95% CI 0.07-0.65, P = 0.007), 0.13 (95% CI 0.05-0.35, P < 0.001), 0.15 (95% CI 0.11-0.58, P < 0.001) respectively. The risk of the above diseases were also reduced markedly by aspirin, the OR values were 0.265 (95% CI 0.07-0.96, P = 0.044), 0.10 (95% CI 0.03-0.35, P < 0.001), 0.15 (95% CI 0.04-0.49, P = 0.002) respectively. The risk of colon carcinoma was also reduced by profen, with the OR being 0.11 (95% CI 0.02-0.64, P = 0.014).

CONCLUSIONSAspirin and other NSAIDs could reduced the risk of colorectal polyp, colon carcinoma and rectal carcinoma markedly. Aspirin was the most prospective chemopreventive agents for colorectal polyp, colon and rectal carcinoma for its capability of reducing the risk of cardio-cerebral vascular disease as well.

Adult ; Anti-Inflammatory Agents, Non-Steroidal ; therapeutic use ; Aspirin ; therapeutic use ; Colorectal Neoplasms ; prevention & control ; Female ; Humans ; Ibuprofen ; therapeutic use ; Logistic Models ; Male ; Middle Aged ; Piroxicam ; therapeutic use ; Polyps ; prevention & control ; Rectal Neoplasms ; prevention & control ; Risk Factors ; Sulindac ; therapeutic use ; Time Factors

Objective To evaluate the predictive value of eight scoring systems (Acute Physiology and Chronic Health Evaluation Ⅱ [APACHE Ⅱ] and APACHE Ⅲ,Improved Edinburgh-Scandinavian Scale [CSS],U.S.National Institutes of Health Stroke Scale [NIHSS],Activity of Daily Living [ADL] scale,Glasgow Coma Scale [GCS],Previous History of Disease Scale and Concomitant Disease Scale) in severity and outcomes of patients with acute ischemic stroke by using discriminant analysis,and to establish their mathematical models to predict the status of early death of stroke patients.Methods Three hundred and ninety-nine patients with acute ischemic stroke,admitted to our hospital from January 2008 to December 2012,were chosen in our study; these patients were tested with APACHE Ⅱ,APACHE Ⅲ,CSS,NIHSS,ADL,GCS,Previous History of Disease Scale and Concomitant Disease Scale within 24 h of admission.All of them were divided into two groups according to groups of survival (n=278) or death (n=121) one month after disease onset.Discriminant analysis was performed on all the data and the predictive values of these eight scales in the prognosis were analyzed.Results Patients from group of death had significantly higher scores of APACHE Ⅱ,APACHE Ⅲ,CSS,NIHSS and Concomitant Disease Scale,and statistically lower scores of ADL and GCS scores than those from group of survival (P＜0.05).Cluster analysis showed that CSS and NIHSS,and APACHE Ⅱ and APACHE Ⅲ,respectively,belong to clusters,which enjoyed higher predictive values than other scales.The areas under receiver operator characteristic (ROC) curves were 0.808,0.818,0.796 and 0.794 of APACHE Ⅱ,APACHE Ⅲ,CSS and NIHSS scores,respectively,enjoying good definition; Discriminant analysis was used to analyze the eight scoring systems and mathematical models were established to predict the outcomes of stroke patients,enjoying more than 80％ of coincidence rate.Conclusion APACHE Ⅱ,APACHE Ⅲ,CSS and NIHSS are superior to the other four score systems in evaluating severity of stroke patients,whose mathematical models,having more than 80％ of accuracy rate.

Objective To investigate the renoprotective effect of aspirin-triggered lipoxins(ATL)on kidney of mice with acute kidney injury(AKI).Methods Eighty-eight male specific pathogen-free(SPF)C57BL/6J mice were randomly divided into lipopolysaccharide(LPS)groups(including 2 h group,4 h group,8 h group,12 h group, 24 h group),ATL+LPS(including 2 h group,4 h group,8 h group,12 h group,24 h group)and normal control group according to random numble table,and each group had 8 mice.The mice in LPS groups were given LPS intraperitoneal injection to establish AKI animal models,while the mice in ATL+LPS groups were given ATL intraperitoneal injection 30 minutes before LPS intraperitoneal injection.The enzyme linked immunosorbent assay was used to test the serum creatinine(Scr),serum urea nitrogen(BUN),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and urine neutrophil gelatinase-associated lipocalin(NGAL),kidney injury molecule-1(KIM-1),cysteine-rich protein-61 (Cyr61)and netrin-1 levels of mice.Results The kidney tissue injury scores of mice of ATL+LPS group[4 h:(22.32 ± 1.04)scores,8 h:(31.11 ± 1.86)scores,12 h:(18.22 ± 0.92)scores,24 h:(20.87 ± 3.18)scores] were lower than those of LPS group at the corresponding time points[4 h:(35.47 ± 2.27)scores,8 h:(52.28 ± 2.82) scores,12 h:(54.99 ± 4.56)scores,24 h:(53.41 ± 4.76)scores],and the differences were statistically significant(all P<0.01).The values of Scr,BUN,TNF-α and IL-1β in ATL+LPS group[Scr 8 h:(143.07 ± 5.02)μmol/L, BUN 12 h:(33.07 ± 3.52)mmol/L,TNF-α 4 h:(196.33 ± 14.181)ng/L and 8 h:(221.77 ± 10.11)ng/L,IL-1β 4 h:(50.25 ± 2.67 ng/L)]were lower than those in LPS group at the corresponding time points[Scr 8 h:(227.43 ± 11.17)μmol/L,BUN 12 h:(59.68 ± 3.84)mmol/L,TNF-α 4 h:(267.87 ± 26.48)ng/L and 8 h:(334.78 ± 21.08)ng/L,IL-1β 4 h:(89.45 ± 5.87)ng/L],and the differences were statistically significant(all P<0.01). The urine NGAL[4 h:(56.76 ± 4.01)μg/L,8 h:(65.44 ± 7.81)μg/L],KIM-1[8 h:(78.19 ± 9.48)μg/L] and netrin-1[8 h:(40.12 ± 2.01)ng/L,12 h:(36.87 ± 2.87)ng/L]of mice in ATL+LPS group were lower than those in LPS group at the corresponding time points[NGAL 4 h:(168.77 ± 10.77)μg/L,8 h:(155.33 ± 8.26) μg/L;KIM-1 8 h:(124.73 ± 13.47)μg/L;netrin-1 8 h:(89.17 ± 2.74)ng/L,12 h:(81.11 ± 3.88)ng/L],and the differences were statistically significant(all P<0.01).Conclusions ATL can treat LPS-induced AKI and play a renoprotective role in the kidney.

To evaluate the estimation of prevalence ratio (PR) by using bayesian log-binomial regression model and its application,we estimated the PR of medical care-seeking prevalence to caregivers' recognition of risk signs of diarrhea in their infants by using bayesian log-binomial regression model in Openbugs software.The results showed that caregivers' recognition of infant's risk signs of diarrhea was associated significantly with a 13％ increase of medical care-seeking.Meanwhile,we compared the differences in PR's point estimation and its interval estimation of medical care-seeking prevalence to caregivers' recognition of risk signs of diarrhea and convergence of three models (model 1:not adjusting for the covariates;model 2:adjusting for duration of caregivers' education,model 3:adjusting for distance between village and township and child month-age based on model 2) between bayesian log-binomial regression model and conventional log-binomial regression model.The results showed that all three bayesian log-binomial regression models were convergence and the estimated PRs were 1.130(95％CI:1.005-1.265),1.128(95％CI:1.001-1.264)and 1.132(95％CI:1.004-1.267),respectively.Conventional log-binomial regression model 1 and model 2 were convergence and their PRs were 1.130(95％ CI:1.055-1.206) and 1.126(95％ CI:1.051-1.203),respectively,but the model 3 was misconvergence,so COPY method was used to estimate PR,which was 1.125 (95％CI:1.051-1.200).In addition,the point estimation and interval estimation of PRs from three bayesian log-binomial regression models differed slightly from those of PRs from conventional log-binomial regression model,but they had a good consistency in estimating PR.Therefore,bayesian log-binomial regression model can effectively estimate PR with less misconvergence and have more advantages in application compared with conventional log-binomial regression model.