Child ; Evidence-Based Medicine ; Humans ; Lupus Nephritis ; diagnosis ; therapy ; Practice Guidelines as Topic

Objective To investigate the changes in pulmonary gas exchange and intrapulmonary shunting during orthotopic liver transplantation (OLT) without veno-venous bypass. Methods Sixteen ASA III-IV patients with end-stage liver diseases were studied. Anesthesia was induced with midazolam 0.1 mg ? kg-1 , fentanyl 10 ?g kg -1 , scopolamine 0.6 mg, and vecuronium 0.1 mg ? kg-1 and maintained with isoflurane and propofol infusion (2-3 mg? kg-1h-1 ) supplemented with intermittent iv boluses of midazolam, fentanyl and vecuronium. The patients were intubated and mechanically ventilated with 100% O2 Swan-Ganz catheter was inserted via right internal jugular vein. Radial artery was cannulated. MAP, HR, ECG, CVP, SpO2 and PET CO2 were continuously monitored. Body temperature was maintained at≥35.5℃ during operation. Blood samples were taken from radial and pulmonary artery for blood gas analysis. P(A-a) O2 and Qs/Qt were calculated immediately before operation (T1 ), cross-clamping (T2) and unclamping of inferior vena cava and portal vein (T3 ) , 5 min (T4) and 90 min (T5 ) after graft reperfusion and at the end of operation (T6). Results P(A-a) O2 and Qs/Qt were both higher than normal value at T1 . PaCO2, P(A-a) O2 and Qs/Qt increased significantly at T3 and T4 as compared with those at T2 P(A-a)O2 and Qs/Qt were significantly decreased at T5 and T6 as compared with those at T3 and T4 Qs/Qt was positively correlated with P(a-A) O2 and PAP. Conclusion There is a certain degree of intrapulmonary shunt before and during orthotopic liver transplantation without veno-venous bypass. The amount of fluid infused should be strictly controlled during anhepatic phase.

BACKGROUND:α-zearalanol, a natural phytoestrogen has the effect of anti- atherosclerosis like the estrogen but with less side effect. Therefore, it has a potential for more application in the future. OBJECTIVE: To investigate the effect of 17β-estradiol (E2) and α-zearalanol (ZAL) on coagulation and fibrinolysis in ovariectomized rats and to compare and analyze their effects. DESIGN: An observational and controlled experiment. SETTING:Department of Pathophysiology of the Capital University of Medical Sciences and the Department of Pathophsiology of the Institute of Basic Medical Sciences of Chinese Academy of Medical Sciences and Peking Union Medical College. MATERIALS: The experiment was completed at the Science Department of Experiment Animals from July to September 2003. Thirty-six healthy female Wistar rats aged 12-week old , weighing (250±10)g, clean grade were involved. The animals were divided into 4 groups, namely sham-operation control group, ovariectomy (OVX) group, OVX +E2 group, OVX+ZAL group with 9 rats in each group. METHODS: For the rats in the sham-operation control group, operation was performed without removing the ovary. For the rats in the OVX group,ovariectomy was performed and the rat models were made at the sterile condition. 1 mg/kg 17β-estradiol and 1mg/kg α-zearalanol were respectively injected intramuscularly into the rats in the OVX +E2 group and OVX+ZAL group 14 days after the operation, once every three days for 35days altogether. After the administration of 17β-estradiol or α-zearalanol for 5 weeks, rats were killed, and blood was collected through the common carotid artery and plasma was collected from it. The prothrombin time (PT)and the activated partial thromboplastin time (APTT) were determined with coagulation method. The level of fibrinogen (FG) was measured with an automatic biochemistry analyzer. Tissue factor(TF)level was determined with ELISA method, the activity of tissue plasminogen activator(t-PA)and plasminogen activator inhibitor type 1 (PAI-1)were determined with chromogenic substrate assay. At the same time, the uteri were cut off and weighed by an electronic scale to work out the uteri weight/body weight (g/kg). MAIN OUTCOME MEASURES: ① PT, APTT, FG,TF, t-PA, PAI-1; ②uteri mass/body mass RESULTS: All the 36 rats entered the stage of the result analysis. ①change of PT: it was shorter in the OVX group than that in the sham-operation control group (P ＜ 0.01 ), but it was longer than that in the OVX group after supplementation of E2 and ZAL (P ＜ 0.05-0.01 ). ② Change of FG and TF: they were significantly higher than those in the sham-operation control group (P ＜ 0.05-0.01 ). But, they were lower than those in the OVX group after supplementation of E2 and ZAL (P＜ 0.05-0.01 ). ③Change of tPA: It was significantly lower in the OVX group than that in the sham-operation control group [(0.33±0.33) μkat/L,(4.00±1.50) μkat/L,(q=9.43, P ＜ 0.01 )]. However, it was significantly higher than that in the OVX group after supplementation of E2 and ZAL [(1.83 ±0.67)μkat/L,(1.17±0.83) μkat/L, (q=13.50, P ＜ 0.01; q=5.00, P ＜ 0.05). ④ Change of PAI-1: It was significantly higher than that in the sham-operation control group [(2.33±0.67) μkat/L,(1.17±0.33) μkat/L,(q=10.5, P ＜ 0.01 )]. ⑤Uteri mass/body mass: It was significantly lower in the OYX +ZAL group than that in the OVX+ E2 group [0.66,1.96, (q=14.67, P ＜ 0.01)]. CONCLUSION: Both 17β-estradiol and α-zearalanol can resume the balance of coagulation-fibrinolysis of ovariectomized rats, suggesting that αzearalanol has a similar protective effect similar to that of 17β-estradiol on cardiovascular system. As α-zearalanol has less adverse effect on uteri enlarging than 17β-estradiol, it has a better prospect for substitution of estrogens as a natural phytoestrogen.

Objective To assessthe association of polymorphism in angiotensin converting enzyme insertion/deletion (ACE I/D) gene with curative effect of hypotensive drugs.Methods The studies concerning association of ACE I/D with curative effect of hypotensive drugs were retrieved by searching data base,and then screened according to inclusive and exclusive criteria.Meta-analysis was performed by review manager 5.3 software.WMD and OR were used to assess difference of levels or effective rate of blood pressure degression among DD,DI and Ⅱ gcnotype.Results Totally 12 articles with 2 528 patients were included in this study.For all patients,WMD (95％ CI) with DD:Ⅱ genotype reflecting degression level of systolic pressure (SP) and diastolic pressure (DP) were respectively 5.92(4.09～7.75) and 1.70(1.03～ 2.38),and OR (95％CI) reflecting effective rate of blood pressure degression was 2.49 (1.44～ 4.31),with statistical significance (P＜ 0.05).For subgroup analysis according to hypotensive drugs,using angiotensin Ⅱ receptor blocker (ARB),WMD (95 ％CI) of SP and DP were respectively 9.16(6.51～11.82) and 1.84(0.10～3.57) in DD:Ⅱ,or 6.75(4.21～9.28) and 3.38(0.16～6.61) in DI ∶ Ⅱ genotype,all with P＜0.05.There were no statistical significance for diuretic in DD ∶ Ⅱ,DD ∶ DI and DI ∶ Ⅱ.Using angiotensin converting enzyme inhibitor (ACEI),OR (95％CI) were respectively 3.79(1.80～8.01) and 2.97(1.34～6.55) in DD:Ⅱ and DD:DI,with P＜0.05.Conclusion Compared with I allele in patient,ACEI and ARB were more effective for D allele,while there were no difference for curative effect of diuretic between I allele and D allele.

Objective To compare the efficacy of different doses of esomeprazole based quadruple therapy on Helicobacter pylori(H.pylori) eradication in Uygur population, and to study the relationship between H.pylori eradication and dyspepsia symptoms in H.pylori caused gastritis.Methods From August 2015 to May 2016, Uygur patients diagnosed with H.pylori positive superficial gastritis in Xinjiang Uygur Autonomous Region Kashgar Prefecture were recruited.According to random number table, patients were divided into single-dose group, standard-dose group and high-dose group.In single-dose group patients received esomeprazole 40 mg, once per day;in standard-dose group patients received esomeprazole 20 mg, twice per day;and in high-dose group patients received esomeprazole 40 mg, twice per day;besides esomeprazole the treatment of three groups were all combination of amoxicillin, clarithromycin and bismuth, magnesium compound granules.The treatment course of all three groups was 14 days.The H.pylori eradication rate, clinical efficacy, symptom score and adverse drug reaction were compared.The H.pylori eradication rate was evaluated with intention to treat analysis (ITT) and per-protocol sets (PP).Chi square test, t test and one-way analysis of vaiance were used for statistical comparison.Results A total of 248 patients were enrolled,82 cases in single-dose group, 83 cases in standard-dose group and 83 cases in high-dose group.There were five, five and six cases lose to follow-up or dropped out respectively in single-dose, standard-dose and high-dose group.The results of ITT analysis showed that the eradication rates of H.pylori in single-dose group, standard-dose group and high-dose group were 62.2%(51/82),77.1%(64/83) and 89.2%(74/83),respectively;the differences between each two groups were statistically significant (x2=4.34,16.33 and 4.30, all P<0.05).The results of PP analysis showed that H.pylori eradication rates of single-dose group, standard-dose group and high dose group were 66.2%(51/77),82.1%(64/78) and 96.1%(74/77),respectively;the differences between each two groups were statistically significant (x2=5.06, 22.47 and 7.84, all P<0.05).After four weeks of eradication therapy, the total dyspepsia symptom scores of single-dose group, standard-dose group and high dose group were all significantly lower than those before treatment (52.3±27.1 vs 99.4±44.1, 38.2±25.4 vs 101.0±48.9 and 28.8±16.1 vs 99.9±46.6), and the differences were statistically significant(t=5.88, 8.79 and 9.11, all P<0.01).After treatment, the total dyspepsia symptom scores of standard-dose group and high-dose group were both lower than that of single-dose group, and the differences were statistically significant (t=2.78 and 2.91, both P<0.01).The score of upper abdominal pain, epigastric burning, abdominal distention and symptom total score of high-dose group were all lower than those of standard dose group (4.8±3.9 vs 8.1±3.5, 3.1±2.5 vs 5.8±4.1, 7.9±6.8 vs 10.5±9.6 and 28.8±16.1 vs 38.2±25.4), and the differences were statistically significant (t=1.52,1.08,1.23 and 1.96, all P<0.01).After four weeks of treatment, the total efficacy rates of single-dose, standard-dose and high-dose group were 45.5%(35/77), 74.4%(58/78) and 87.0%(67/77),respectively.There were statistically significant differences between each two groups of three groups (x2=13.49, 29.73 and 3.98, all P<0.05).The incidences of adverse drug reaction of single-dose, standard-dose and high-dose group were 6.5%(5/77), 7.7%(6/78) and 7.8%(6/77),respectively;there was no statistically significant difference among the three groups (all P>0.05).Conclusions High dose of esomeprazole based quadruple therapy can increase the eradication rate of H.pylori in Uygur population, and H.pylori eradication therapy can significantly improve the dyspepsia symptoms of H.pylori caused gastritis in Uygur.High dose of esomeprazole may improve the clinical efficacy of H.pylori caused gastritis with dyspeptic symptoms in Uygur with safety.

Background:Serum levels of pepsinogen( PG),gastrin-17( G-17)and Helicobacter pylori( Hp)infection are closely associated with gastric cancer. Studies on relationship of serum levels of PG and G-17 with Hp infection in Uygur and Han population with gastric cancer in Xinjiang area are rare. Aims:To investigate serum levels of PG and G-17 and their relationships with Hp infection in Uygur and Han population with gastric cancer in Xinjiang area. Methods:A total of 198 Uygur and 50 Han gastric cancer patients were enrolled,and healthy people with the same race were served as normal controls. Serum levels of PGⅠ,PGⅡ,G-17 were determined by ELISA,PGⅠ/ PGⅡ ratio(PGR)was calculated. Urea breath test and stool Hp antigen test were used to detect Hp infection. Results:Serum PGⅠ level and PGR in Uygur and Han patients with gastric cancer were significantly decreased than those in corresponding control groups(P < 0. 05),and serum levels of PGⅡ and G-17 were significantly increased(P < 0. 05). Serum PGⅠ level and PGR in Uygur gastric cancer patients were significantly decreased than those in Han gastric cancer patients(P < 0. 05),and serum G-17 level was significantly increased(P < 0. 05). Hp infection rate in Uygur and Han patients with gastric cancer were significantly increased than those in corresponding control groups( P < 0. 05). Serum level of PG Ⅰ and PGR were significantly decreased in Han gastric cancer patients with Hp-positive than in Hp-negative patients,and serum levels of PGⅡ and G-17 were significantly increased(P < 0. 05). Serum levels of PGⅠ,PGⅡ and G-17 were significantly increased in Uygur gastric cancer patients with Hp-positive than in Hp-negative patients,PGR was significantly decreased(P < 0. 05). Serum levels of PGⅠ,PGⅡ and PGR were significantly increased in Uygur gastric antral cancer patients than in gastric corpus cancer and proximal gastric cancer patients(P < 0. 05). Conclusions:Decreased serum PGⅠ level,PGR and increased serum level of G-17 can be used as biomarkers to screen gastric cancer in Uygur and Han population in Xinjiang area. Hp infection in Uygur and Han patients with gastric cancer is related to the changes of serum level of PGⅠ,PGR and G-17.

A Review The elastin has been investigated since the 1950 s, and it has been found that elastin relates to the vascular diseases in recent years. In this review, the elastin gene structure, distribution and its role in the pathogenesis of vascular diseases and aging are summarized.

Objective To detect the expression of telomerase catalytic subunit (TERT),telomerase in human ovarian luteinized granulosa cells and to investigate the relationship between telomerase expression and the ovarian fecundity Methods Ovarian luteinized granulosa cells were recovered from 22 women with regular menses who underwent in vitro fertilization/ intracytoplasmic sperm injection programme.We carried out in situ hybridization histochemistry on luteinized granulosa cells to detect TERT mRNA expression,and telomeric repeat amplification protocol to detect telomerase activity Results TERT mRNA were present in luteinized granulosa cells.The expression of TERT mRNA and telomerase activity in ovarian luteinized granulosa cells decreased with increase of age,basal serum follicle stimulating hormone levels Conclusions These results suggest that telomerase may play an active role in ovarian function.A reduced telomerase activity of granulosa cells may be one of the important mechanisms involved in decreased ovarian function in women.