Doctors ought to belong to a social stratum with fairly high incomes. The high input and long cycle that is essential to becoming a high-caliber doctor constitute the high costs of the medical profession; high technology, high responsibility and high sacrifices constitute the high risks of the medical profession; the contrast between the input of high intelligence, high academic degree, and high expertise and the output of low economic income tends to warp the minds of doctors. The inversion of the burden of proof in medical lawsuits has practically put doctors on the weak side. Their rights and interests as well as their practice circumstances have been disregarded. For the sake of the development of the health cause, it is imperative to respect the labor of doctors and to provide them with sound survival circumstances.

Objective To investigate the effects of N-acetylcysteine (NAC) on the expression of transforming growth factor-β1 (TGF-β1) in renal cortex of diabetic nephropathy rats.Methods A rat model of DN was established.The rats were randomly divided into control group,DN group and NAC group.After 8 weeks treatment,urinary albumin excretion rate (UAER) was determined.The expression of TGF-β1 in renal cortex was detected by immunohistochemistry and RT-PCR analysis.Pathomorphological changes of renal cortex were observed.Results (1)The levels of UA ER were significantly higher in DN group and NAC group [(1268.3±297.5) μg/24 h and (315.9-±86.8) μg/24 h] than in control group [(31.2±8.9) μg/24 h,q-29.85,16.76,both P＜0.01].The groups of DN and NAC versus group of control showed the increased levels of activity of TGF-β1 in renal cortex [immune-histochemistry index of glomerular mesangial area:7.35±1.17 and 3.87 ± 0.71 vs.1.95±0.34,q= 10.75,5.82,both P＜0.01];immune-histochemistry index of renal tubulointerstitium [21.21± 3.78 and 10.67±1.86 vs.3.62±0.79,q=15.20,11.36,both P＜0.01];the expression of mRNA in renal cortex[0.72±0.06 and 0.45±0.05 vs.0.23±0.04,q=9.13,7.45,both P＜0.01].The pathomorphological changes were significant in DN group and NAC group.(2)The NAC group versus DN group showed a decreased levels of UAER (q=8.17,P＜0.01),activity of TGF-β1 in renal cortex [immune-histochemistry index of glomerular mesangial area:q= 4.97,P＜0.01]immune-histochemistry index of renal tubulointerstitium (q = 6.86,P ＜ 0.01 );the expression of mRNA in renal cortex (q= 3.69,P＜0.05) and showed improvement of pathomorphology in renal cortex.(3) There was a significantly positive correlation between expression quantity of TGF-β1 mRNA in renal cortex and UAER level in NAC group(r= 0.749,P＜0.05).Conclusions The protective effects of NAC on the kidney of DN rats may be partly related with inhibition on the expression of TGF-β1.

Objective To observe the efficacy of early application of continuous venovenous hemofiltration (CVVHF) in elderly patients with contrast-induced acute kidney injury (AKI) .Methods A total of 36 elderly inpatients with contrast-induced AKI were randomly divided into two groups:CVVHF group (n= 18) and routine treatment group (n = 18).The renal function, the incidences of contrast-induced nephropathy (CIN), in-hospital events (pulmonary edema, myocardial infarction and shock), temporary renal-replacement therapy and in-hospital mortality were observed.Results The incidence of CIN was higher in routine treatment group than in CVVHF group [88.9% (16/18) vs.16.7% (3/18), P<0.05].Temporary renal-replacement therapy was required in 13(72.2%) patients of routine treatment group and in 2(11.1%) patients of CVVHF group (P<0.05).The rate of in-hospital events was higher in routine treatment group than in CVVHF group [83.3%(15/18) vs.22.2% (4/18), P<0.01].In-hospital mortality rate was higher in routine treatment group than in CVVHF group [16.7%(3/18) vs.5.6%(1/18), P>0.05].Conclusions Early application of CVVHF in patients with contrast-induced AKI after percutaneous coronary intervention appears to be effective in preventing the deterioration of renal function, and it could improve in-hospital outcomes.

ObjectiveTo evaluate the effect of N-acetylcysteine (NAC) on alleviating hepatorenal damage caused by combined chemotherapy using cisplatin-based regiments in elderly patients. MethodsAll 40 elderly patients with malignant tumors were randomly divided into AB and BA group in cross-over pattern. In AB group, combination of chemotherapy and NAC was administrated for 10 days first, and then combination of chemotherapy, carnine and vitamin C was given for 10 days. In BA group, combination of chemotherapy, earnine and vitamin C was administrated for 10 days first, and then combination of chemotherapy and NAC was given for 10 days, a cycle was 21 days. The hepatorenal damage degree was observed and the curative effect of NAC on hepatorenal damage was evaluated. ResultsThere were no differences in the levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST) and serum creatinine(Cr) between pre chemotherapy and post chemotherapy in A cycle[(25.32±5.23) U/L vs. (29.18±5.43) U/L,(29.21±6.51)U/L vs. (32.37±7. 13)U/L, (89.87±19.56)Mmol/L vs. (95.22±20. 60)μmol/L,all P>0. 05] . In B cycle, the levels of ALT,AST and Cr were (56.76±5.53) U/L, (48.83±6.64)U/L and (137.33±21.16)μmol/L post chemotherapy, respectively, which were evidently higher than pre chemotherapy[(26.19 ± 5.51) U/L, (29.95±6.56) U/L and (88.66±18.27)μmol/L,respectively] (all P<0.01) . ConclusionsNAC has better preventive and therapeutic effects on hepatorenal damage caused by the chemotherapeutic drugs in elderly patients with malignant cancer.

Objective To evaluate the therapeutic effect of extendable intramedullary nail on children with femoral deformity due to osteogenesis imperfecta.Methods From June 2009 to June 2012,21 patients with femoral deformity due to osteogenesis imperfecta were treated with extendable intramedullary nail.There were 13 males and 8 females,aged from 9 years and 6 months to 15 years and 7 months (average,12 years and 3 months).All children had been performed osteotomy on the shaft of femur and implanted with non-extendable nail before 2-4 years (average,3 years).All children had suffered refracture and deformity,including 9 children with femoral bending deformity and 12 with refracture.The deformity angle ranged from 10°to 30°,with an average of 15°.According to revised Sillence classifications,there were 6 cases with type Ⅲ and 14 with type Ⅳ and 1 case with type Ⅴ.Twenty-one patients were operated with extendable nail for fixing fracture and correcting deformity and incisions were 2-3 cm long and located on the great trochanter and distal osteotomy point.Results All of 21 children were followed up for 6-30 months (average,18 months).The bone healing time was 7-12 weeks (average,8.5 weeks).Patients started to walk after X-ray showing bone union.Parents of 21 children were satisfied with surgical operation effect and deformity correction.The Barthel index score improved from 72.85 (range,50-90 points) preoperatively to 91.42 (range,80-100 points) postoperatively at the latest follow-up of patients.WeeFIM index score increased from preoperative average of 55.42 points (range,40-70points) to postoperative average 79.00 points (range,70-86 points).Ten of all children with stick aid preoperative could walk independently after small incision repairing,and 6 of all children in sickbed preoperative,4 of 6 children could walk independently,2 of 6 children could walk with stick aid.Conclusion Small incision repair with extended intramedullary nail operation therapy is advantaged.It gets less bloody,less damages,less pain,less healing time and walking after removing plaster.

Objective To investigate the effects of the low-osmolar nonionic contrast media on renal function in elderly patients suffering from ischemic cerebral vascular disease and undergoing angiography.To study the incidence and risk factors for contrast-induced nephropathy (CIN).Methods 276 elderly patients who were going to receive selective cranial angiography and bilateral renal angiography were included.The 0.9 ％ sodium chloride (1 ml · kg-1 · h-1) was administered in all patients 6 hours before and 12 hours after contrast media administration.No patients suffered from obviously congestive heart failure.The levels of serum creatinine (Scr) and serum urea nitrogen (SUN) were measured 3 days before and at day 1,2,6 after the administration of contrast media respectively.Then creatinine clearance rate (Ccr) was calculated.Multivariate predictors of contrastinduced nephropathy were determined by logistic regression.Results Among the 276 patients,CIN occurred in 19 patients (6.9％),among whom 4 patients suffered from severe renal artery stenosis and received percutaneous transluminal renal angioplasty (PTRA) at 1 week after undergoing angiography.The renal function in the other 15 cases with CIN were recovered to baseline 1evel 3 months after the use of contrast media.No patients underwent a maintenance hemodialysis.In the 19 patients with CIN,the levels of SUN and Scr were higher and Ccr was lower at day 1 and 2 after angiography than before the procedure (all P ＜ 0.05),but the parameters were decreased to preoperative level at day 6 after angiography (all P＞0.05).Logistic regression analysis showed that renal dysfunction,diabetes mellitus and severe renal artery stenosis were the major risk factors for contrast-induced nephropathy.Conclusions Low-osmoiar nonionic contrast used in angiography is safe for elderly patients if adequately hydrated with 0.9 ％ sodium chloride.The clinical risk factors for CIN are renal dysfunction,diabetes mellitus and severe renal artery stenosis.

OBJECTIVETo determine such molecular characteristic parameters as absolute molecular weight, molecular weight distribution, root-mean-square turning radius (Rg) and polydispersity index (Mw/Mn) of four components contained in Hedysari Radix polysaccharide 3 (HPS-3) and map weight-average molecular weight (Mw) with root-mean-square turning radius (Rg), in order to calculate conformations of the four components at solution state.

METHODThe gel permeation chromatography-multi angle laser light scatting (GPC-MALLS) was adopted, with 0.1 mol x L(-1) NaNO3 contained 0.02% NaN3 as the mobilephase, Ultrahydrogel 1000 connected in series with Ultrahydrogel500.

RESULTAmong the four components of HPS-3, HPS-3-C showed the highest weight average molecular weight of 1.986 x 10(5) g x mol(-1), followed by HPS-3-B 1.113 x 10(5) g x mol(-1) and HPS-3-D 8.457 x 10(4) g x mol(-1) HPS-3-A showed the lowest weight average molecular weight of 1. 223 x 10(4) g x mol(-1) but the highest square radius of gyration, that is 55.5 nm. HPS-3-D had the widest range of molecular weight distribution in four components, with the polydispersity index (Mw/Mn) of 2.543. In the mobile phase, HPS-3-A was globular structure, HPS-3-C was random coil, HPS-3-B and HPS-3-D were both highly branched structure.

CONCLUSIONThe results provided necessary basis for further studies on molecular characteristics of the four components contained in HPS-3 and their relationship with bioactivity.

Chromatography, Gel ; Drugs, Chinese Herbal ; chemistry ; Lasers ; Light ; Polysaccharides ; chemistry ; Scattering, Radiation