Lupus nephritis (LN) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus.Although the use of aggressive immunosuppression has improved both patient and renal survival over the past several decades,the optimal treatment of LN remains challenging.The therapeutic strategy and progress for patients with lupus nephritis are based on the accumulative evidences of the medicine,and must be personalized according to the patient condition.This paper discusses established and newer treatment options for LN.We also emphasize the challenges in the day-to-day management of lupus nephritis in the clinical practice.

Objective To further investigate the molecular mechanism underlying the preventive effect of Astragalus polysaccharide (APS) on type 1 diabetes mellitus (DM) in NOD mice. Methods In order to explore the gene expression profiles of NOD mice′s islet cells treated with APS, cDNA microarray technique was applied. Results In APS group 5.47% gene expressions were obviously changed, 28 genes up-regulated, 35 genes down-regulated, and of which, 17 genes were functionally related to immunity. Conclusion The preventive effect of APS on type 1 diabetes in NOD mice is probably related to the action of APS in correcting the imbalance of Th 1/Th 2 cytokines.

Objective To evaluate the safety and feasibility of retroperitoneal laparoscopic excision of pheochromocytoma. Methods Retroperitoneal laparoscopic excision of pheochromocytoma was performed on 20 patients with pheochromocytoma (group A).At the same period, 20 patients with pheochromocytoma undergoing open surgery served as controls (group B).Intraoperative blood pressure, heart rate, plasma noradrenalin (NE) concentration,operative time, volume of blood loss, cases receiving blood transfusion, postoperative activity out of bed days, postoperative hospital stay,were compared between the 2 groups.The NE concentration was determined using RP-HPLC-ECD. Results The operations were successful in all the patients. Intraoperatively,3 cases (15.0%) in group A and 12 cases (60.0%) in group B experienced acute fluctuation in blood pressure,heart rate and pulse [maximum blood pressure,220/110 mm Hg(1 mm Hg=0.133 kPa) vs 210/115 mmHg; minimum blood pressure,88/57 mm Hg vs 85/60!mm Hg;maximum heart rate,122/min vs 120/min, respectively].The NE concentratioo correspondingly fluctuated from the maximum 16.82 ng/ml to the minimum 6.28 ng/ml (normal reference,0.32 ng/ml) (P

Objective To explore the effect of prevention of hemorrhagic cystitis (HC) after hematopoietic stem cell transplantation (HSCT) with hyperhydration, forced diuresis and alkalinizing plus infusion mesna. Methods 32 cases of patients receiving HSCT were included in this study. 2 cases of severe aplastic anemia (SAA) received total body irradiation (TBI)+cyclophosphamide(CTX)(TBI-CTX) regimen,and the remaining 30 patients were using the classic busulfan+CTX (BU+CTX) regimen. All patients were treated with mesna combined with hydration, forced diuresis and alkalization to prevent HC. Ganciclovir and acyclovir were used to prevent cytomegalovirus (CMV) and other viral infections and monitor CMV-IgM levels of the blood. Encourage patients to urinate every hour, testing urine pH value and the calculation of urine output, every 6 h review and testing of urine routine,central venous pressure (CVP), each of 8 h of serum electrolytes. Results Only 1 patient at 6 months after transplantation appeared delayed grade Ⅱ HC after hydration, alkalization, diuretic, hemostatic, anti-graft-versus-host disease (GVHD), and ganciclovir antiviral therapy. The HC patients cured at 35 d. The remaining patients did not suffer HC. Adverse effects such as acid-base balance disturbance did not appear clear. Conclusion Mesna joint hydration, forced diuresis and alkalization was effective and safe to prevent HC.

Humans ; Occupational Exposure ; prevention & control ; Respiratory Protective Devices ; classification ; standards ; utilization ; United States

Objective To investigate health equity status of urban dwellers with different social stratification and provide evidence for health promotion.Methods 1,007 urban dwellers were surveyed in Zhejiang province in a stratified sampling based on their income,occupation and education,with their health equity analyzed.Results The proportion of urban dwellers to participate in social health insurance reached 97.5％,a proportion of statistical significance (P＜0.05).The two-week prevalence rate and two-week attendance rate of urban dwellers of different social stratification has no significant difference,but the rate of sickness without attending was significantly negatively correlated to social stratification.The proportion of no visiting because of poverty was 23.1％ in the lower social class,3.2％ in middle and lower class,and 0％ in the middle and upper class,a difference being statistically significant (P＜0.001).The outpatient clinic of first choice and ranking of the hospital was positively correlated to social stratification.Conclusion There is health inequity for urban dwellers with different social stratification,for which the government should pay more attention to lower social class.

Objective To analyze the tissue development rule of the Bufo raddei Strauch lung,to observe the expression of transforming growth factor-?(?_1,?_2,?_3)in developing lung,and to discuss their functions and relationships. Methods The tissue development of the(218) Bufo raddei Strauch lungs was studied by biological microscope technology,and the expression of TGF-? was measured in lung development by immunohistochemistry and images were analyzed by IPP,providing a basis for study of the zoology and developmental biology. Results(1) Lung bud occured in larval 22nd stage from pharynx caudal part.In 26th stage the minutenss locule began to appear.The lung bud gave rise to obvious lung cavity in 31st stage.In 33rd stage originality alveolus began to appear.In 36th stage obvious septum and alveolus appeared.There were many capillary vessel in the wall of lung.In 39th stage the lung of tadpole was like as one of young toad.The respiratory epithelium differentiated from columnar into squamous.The entire developmental process was divided into four phases,lung bud Ⅰphase,lung bud II phase,originality alveolus phase and alveolus phase.(2)In the early developmental phase,TGF-? expressed in the lung wall.In the late developmental phase,TGF-? expressed in mesenchymal at high levels.Conclusion The expression of TGF-? displayed intermittent changes during the period of development.The functions of TGF-? might be respectively different in different development stages.They not only stimulate the process of epithelium of the reticular septa,but also modulate epithelium of alveolar sac and differention.

Objective To investigate the action mechanism of blood-stage treatment that affects psoriasis vulgaris using observation of the Th17/Treg expression.Methods A total of 32 patients ( blood heat group,n =17 ; blood stasis group,n =15) and 15 healthy people ( control group,n =15 ) were observed.The frequencies of Th17 and Treg in peripheral blood were detected by flow cytometric analysis in patients before and after treated by heat-clearing and blood-cooling decoction,qi-enriching and blood-activating decoction.Results The ratio of Th17/Treg in peripheral blood [ blood heat group (4.21 ± 0.52 )％ ;blood stasis group( 3.32 ± 0.43 )％ ] was significantly increased in patients compared with controls [ ( 1.79 ±0.18)％ ] ( P ＜0.01 ).After herbal treatment,the ratio of Th17/Treg expression in the blood heat group [ ( 2.41 ± 0.22 ) ％ ] and in blood stasis group [ ( 2.02 ± 0.12 ) ％ ] was significantly decreased ( P ＜ 0.05 ),respectively.Conclusions Blood-stage treatment works well on Th17/Treg expression in patients with psoriasis vulgaris.

Objective To explore the expression of discoidin domain receptor 1 (DDR1) in rats with pulmonary fibrosis induced by paraquat (PQ) poisoning, and its relationship with the expression of transforming growth factor-β1 (TGF-β1). Methods 120 Sprague-Dawley (SD) rats were divided into control group and 20, 40, and 80 mg/kg PQ poisoning groups (each n = 30). Pulmonary fibrosis induced by PQ poisoning model was reproduced by one time administration of 20, 40, 80 mg/kg of 20% PQ, and the rats in control group were given 4 mL normal saline. Fifteen rats in control and different doses of PQ groups were sacrificed at 7 days and 21 days after intragastric administration, and lung tissues were collected. Pulmonary fibrosis was observed after hematoxylin-eosin (HE) staining. The immune-histochemical method was used to determine the expressions of DDR1 and TGF-β1. The relationship between the expression of TGF-β1 and DDR1 was analyzed by Pearson correlation analysis. Results The rats in control group were active, and no pathological changes in lung tissue were found. The rats in PQ groups became shortness of breath, bristles, and slow reaction etc. 0.5 hours after intragastric administration. After 7 days, the lung tissue was dark red, hard texture, appearance of yellow soil fiber nodules and obsolete hemorrhage, destruction of alveolar structure. The extent of lung injury increased gradually with the time of poisoning and the increase of PQ dose. It was shown by immune-histochemical staining that the control group had only a small amount of DDR1 and TGF-β1 positive expressions; in PQ groups, there were a large number of DDR1 and TGF-β1 positive expression particles in the alveolar wall, pulmonary interstitial and alveolar cavity. It was displayed by quantitative analysis that compared with the control group, DDR1 and TGF-β1 expressions were significantly increased in 20, 40, 80 mg/kg PQ groups with time- and dose-dependent [DDR1 (integral A value): 0.221±0.014, 0.249±0.021, 0.364±0.016 vs. 0.121±0.036 at 7 days; 0.247±0.025, 0.321±0.015, 0.432±0.027 vs. 0.139±0.021 at 21 days; TGF-β1 (integral A value): 0.230±0.016, 0.265±0.015, 0.339±0.016 vs. 0.129±0.032 at 7 days; 0.248±0.011, 0.295±0.016, 0.399±0.026 vs. 0.119±0.026 at 21 days; all P < 0.05]. It was shown by Pearson correlation analysis that DDR1 expression was positively correlated with TGF-β1 expression with the increase of PQ dose and poisoning time (DDR1 with TGF-β1: r = 0.996, P < 0.000; DDR1 with PQ dose: r = 0.985, P < 0.000; DDR1 with poisoning time: r = 0.989, P < 0.000; TGF-β1 with PQ dose: r = 0.992, P < 0.000; TGF-β1 with poisoning time: r = 0.972, P < 0.000). Conclusions The expression of DDR1 in the lung tissue in PQ poisoning rats showed a time- and dose-dependent change, and it was positively correlated with TGF-β1 expression. DDR1 may be involved in the process of pulmonary fibrosis induced by PQ poisoning.

Objective To present the experience of diagnosis and treatment of 21 cases of retrocaval ureter. Methods 21 cases of retrocaval ureter were retrospectively analysed. Results The main clinical symptom was right waist pain in 20 cases,4 of them with typical renal colic.8 cases had gross hematuria and calculus in the renal pelvis.1 case was void of symptom.The diagnosis of the disease depended mainly on intravenous urography (IVU) and retrograde ureteropyelography (RGU).IVU and RGU showed a "S" shaped upper ureteral segment with dilatation. Ureteral replacement and ureteroplasty were carried out in 20 cases which have been followed up from 2 months to 28 years with an average of 13 years.The symptom disappeared in 19 cases,with hydronephrosis and hydroureter significantly reduced on IVU and ultrasonography.1 case underwent ureteral reanastomosis because of stenosis at anastomosis site. Conclusions In patients with hydronephrosis and hydroureterosis of upper segment on the right side,the possibility of retrocaval ureter should be considered.Intravenous urography and retrograde ureteropyelography are the main means of diagnosis.Ureteral replacement and ureteroplasty are the treatment of choice.