Objective To determine the function and binding properties of SR-A in HMC.Methods A human mesangial cell line(HMCL) with high expression of type A SCR(HMCL-SCR) was established after stable transfection of expressive vector with cDNA encoding SR-A.Uptake of fluorescence Dil-labeled acetylated low density lipoprotein(Dil-Ac-LDL) and oxidized LDL(Ox-LDL) by HMC were evaluated by fluorescence microscopy,con-focal microscopy and Oil Red "O" staining respectively.SCR mRNA expression was examined with reverse transcription-polymerase chain reaction(RT-PCR).Results More uptake of Ox-LDL and Ac-LDL was observed in HMCL-SCR than that in the untransfected HMCL.Unlabeled Ox-LDL and Ac-LDL at a 40-fold excess concentration competed significantly with the uptake of Dil-Ac-LDL by HMC.Otherwise this phenomenon was not observed when co-cultured with LDL.Conclusion This results suggest that SR-A mediates the uptake of modified-LDL with high affinity and high specificity in human mesangial cells.

Objective: To investigate the clinical efficacy of combination therapy of selenium yeast and levothyroxine sodium in the treatment of type 2 diabetes mellitus complicated with chronic lymphocytic thyroiditis(CLT). Methods: A total of 96 patients with type 2 diabetes mellitus complicated with CLT who admitted to Wenling Hospital of Traditional Chinese Medicine from June 2017 to December 2018 were randomly divided into control group and treatment group according to the digital table, with 48 patients in each group.On the basis of stable blood sugar control, the control group received routine treatment with levothyroxine sodium tablets.The treatment group was given selenium yeast on the basis of the control group.The blood glucose, thyroid, clinical efficacy within 3 months of treatment were recorded. Results: The total effective rate of the study group was 95.83%(46/48), which was significantly higher than 68.75%(33/48) of the control group(χ²=12.080, P<0.05). The levels of blood sugar and glycosylated hemoglobin in the study group were significantly lower than those in the control group after treatment(all P<0.05), and the levels of C-peptide in the fasting and postprandial 2h were significantly higher than those in the control group(t=4.927-8.725, all P<0.05). After treatment, the serum selenium level in the study group was significantly higher than that in the control group(P<0.05), and the serum TPOAb and TGAb levels were significantly lower than those in the control group(t=17.264-27.032, all P<0.05). There were no statistically significant differences in serum TSH, FT₃ and FT₄ levels between the two groups(t=0.704-1.926, all P>0.05). Conclusion The clinical efficacy of selenium yeast and levothyroxine in the treatment of type 2 diabetes with CLT is significantly better than traditional treatment.

Objective To investigate haemodynamic change during hemodialysis and analyze effects of cardiac index (CI) on hemodynamic parameters and associated influencing factors in maintenance hemodialysis (MHD) patients.Methods Seventy-five patients bearing an arteriovenous fistula (AVF) entered the study.Cardiac output (CO),cardiac index (CI),central blood volume (CBV) and peripheral vascular resistance (PR) were determined by ultrasound dilution technique at the end of 1 hour,2 hours and 3 hours of dialysis.AVF blood flow (Qa) was also measured with the same device before haemodynamic parameters investigation.Results Mean age of patients was (55.84 ±12.39) years old (range 21-81 years) and 43 patients (57.3％) were female.Systolic arterial pressure,SV,CO,CI and CBV were significantly declined and no significant change for diastolic arterial pressure and heart rates at the end of 2 hour and 3 hour hemodialysis,whereas PR was increased gradually during hemodialysis.Patients were divided into there groups with CI less than 2.5 L·min 1·(m2)-1,2.5-4.2 L·min-1·(m2)-1 and more than 4.2 L·min-1 ·(m2)-1 at the end of 1 hour dialysis.Statistically significant decreasing SV,CO and increasing PR were detected in patients with CI＜2.5 L·min-1· (m2)-1 and 2.5-4.2 L· min-1· (m2)-1,compared with CI＞4.2 L·min-1· (m2)-1 group (P＜0.01).The hemodynamic change was the most obvious in the group of CI less than 2.5 L· min-1· (m2) 1,and no significant changes happened in CI＞4.2 L·min-1 ·(m2)-1 group.Some factors were found to be associated to CI values.Qa and systolic arterial pressure had positive relationship with CI,while age and diabetes had negative relationship with CI.Conclusions Systolic arterial pressure,CO,CI and CBV decrease and PR increases during hemodialysis.Obvious change occurs when CI is less than 2.5 L·min-1· (m2)-1.CI is associated with Qa,systolic arterial pressure,age and diabetes.

Objective To analysis the clinical and pathological features, results of laboratory tests and prognosis of nephrotic syndrome (NS) in patients with non-heamatological maligancy. Methods The data were collected from 25 patients who presented with NS around the diagnosis of non-heamatological malignancy. Results Twenty-five cases were investigated (age: (56.6±17.7) years; male/female ratio: 20/5). Malignancy and NS occurred within one year in 92% patients. There was a wide distribution of malignancy with involvement of 36% in digestive system and 20% in respiratory system. Ten patients (40%) presented with NS as their initial manifestation. Heamaturia appeared in 67% patients and acute renal insufficiency was complicated in 12% cases before treatments. Some other non-specific laboratory tests were found including elevated serum gamma-globulin in 50% and anemia not related with renal failure in 28% cases. Membranous nephropathy was the most common pathological changes in 67% cases. Although NS still continued for several weeks in 8 of 9 cases after surgery and/or chemical therapy, glucocorticoids was helpful to achieve the remission in these patients. However, no remission was achieved in patients without the treatment for malignancy. Conclusion Malignancy may present with NS as its initial manifestation. It should be inspected routinely and regularly in elder patients with NS, especially in those with membranous nephropathy, as well as gamma-globulinemia and anemia.

Objective To investigate the feasibility and prospects of nested real-time PCR(NR-PCR)technique for Treponema palladium(Tp)detection in various samples of different stages of syphilis from patients preliminarily diagnosed as syphilis. Methods Targeting the Tp polA gene, NR-PCR was performed to detect Tp DNA in various samples from the patients with various stages of syphilis at the first clinic visit, including skin tissue fluid swabs, serum, whole blood, cerebrospinal fluid(CSF)and earlobe blood. Data were analyzed with SPSS software version 13. Results A total of 368 clinical samples were collected from 200 patients with syphilis. With a detection limit of 2 Tp/ml, NR-PCR showed that the total positive rate for Tp DNA was 71.7%(264/368). The Tp DNA positive rate was highest in earlobe blood samples (92.0%, 23/25), followed by CSF samples(90.2%, 46/51), skin tissue fluid swabs(74.3%, 26/35), serum samples(66.9%, 99/148)and whole blood samples(64.2%, 70/109). There was good agreement between NR-PCR results and serologic test results, with a consistency rate of 76.0%(152/200). Furthermore, the Tp DNA positive rate did not differ between patients with primary(12/19)and secondary syphilis(14/16)in skin tissue fluid swabs(χ2 = 2.62, P > 0.05), and was slightly but insignificantly higher in patients with secondary syphilis than those with primary syphilis in the serum samples(χ2=3.6, P=0.06). The Tp DNA positive rate of whole blood samples was also higher in patients with secondary syphilis than those with any other types of syphilis. Among patients with neurosyphilis, no significant difference was observed in the Tp DNA positive rate between earlobe blood samples and CSF samples(P=0.06). Among patients with latent syphilis, the Tp DNA positive rate was significantly higher in serum samples with an RPR titer of ≥ 1:8 than those with an RPR titer of≤1:4. Conclusion NR-PCR is feasible for detecting Tp DNA in various kinds of samples, and the Tp DNA positive rate is influenced by stages of syphilis and types of samples, as well as RPR titers.

OBJECTIVETo discusses the necessity and methods of replantation for complete amputation of finger composite lateral tissue.

METHODSFrom March 2012 to April 2015, 62 cases of complete amputated finger lateral tissue for various causes were retrospectively analyzed, including 34 males and 28 females with an average age of 29.1 years old ranging from 17 to 52 years old, involved 27 cases of thumb, index finger in 15 cases, 13 cases of middle finger, ring finger in 8 cases, 2 cases of the little finger, 2 fingers were injured in 3 cases, 14 cases involving the distal interphalangeal joint. The time from injury to treatment was 30 min to 2 hour with an average of 1 hour. The appearance of the fingers, finger tip sensation and the recovery of the functional of the patients were followed up and observed.

RESULTSOf 62 cases, 58 cases survived, the survival time was 3 to 15 months with an average of 6.5 months. According to the Chinese medical association upper part of replantation function evaluation standard to assess efficacy trial, 52 cases were excellent, 3 cases were good, 3 cases were good, the excellent and good rate was 94.8%.

CONCLUSIONSThe appearance and function is good after block from the broken replantation finger lateral organizations survive, as long as the patient general condition allows, away from the broken body is complete, there are available for blood vessels and nerves anastomosis, it should strive to reattach it.

ObjectiveTo investigate the protein wasting and energy reserve in chronic renal failure (CRF) patients undergoing maintaining hemodialysis (HD) at different ages.MethodsA total of 129 CRF patients (62 men and 67 women) aged (56.33 ± 14.14) years on HD were enrolled in this study.They were divided into four age groups:below 40,40-69,60-69,and over 70 years.Nutritional status was assessed by body mass index (BMI),normalized protein catabolic rate (nPCR),and biochemical parameters including pre-albumin,cholesterol,and creatinine.Body composition was tested with multi-frequency bioelectric impedance analysis.Meanwhile,83 healthy subjects,matched for age and sex,were enrolled as controls.ResultsBMI showed no significant difference between healthy controls and HD patients.Among HD patients,38％ had an BMI higher than the normal high limit and 6.2％ had a BMI less than 18.5kg/m2 ; patients with a low body weight accounted for 0,6.2％,4.8％,and 11.1％ in the ＜40 years group,40-59 years group,60-69 years group,and above 70 years groups,respectively.nPCR in the above 70 years group was ( 1.46 ±0.28) g/( kg·d),which was significantly lower than that in the 40-59 years group [ (1.54 ±0.28) g/( kg·d) ; P =0.004) ; the serum creatinine in the the above 70 years group was (834.08 ± 184.96) μmol/L,which was significantly lower than that in 40-59 years group [ (976.24 ± 186.86) μmol/l ] ( P=0.037) ; the prealbumin in the the above 70 years group was (272.65 ±79.78) mg/L,which was significantly lower than that in 40-59 year group [ (332.07 ± 73.03 ) mg/L] ( P =0.026).Body cell mass in HD patients was (22.81 ±8.12) kg,which was significantly lower than that in the control group [ (29.95 ±6.73) kg] (P＜0.001) ; furthermore,the lean tissue mass (LTM) [ (40.16±11.90) kg vs.(47.22 ±9.84) kg] and fat [ (17.45± 8.83)vs.(13.66±7.28) kg] were also significantly lower (both P=0.001 ).The lean tissue indicators in the below 40 years group were also significantly lower than those in the healthy controls ( P =0.012).For the fat tissue ingredients,the below 40 years group ( P =0.013 ) and over 70 years group (P =0.039) showed significant differences with the controls,while the 60-69 years group (P =0.191 ) showed no such difference.ConclusionsNutritional status is different among HD patients at different ages.HD patients below 40 years and abover 70 years are more susceptible to malnutrition.Although BMI shows no difference with the normal subjects,protein wasting and increased fat tissue storage do exist in HD patients.The nutrition changes are slightest in 40-59 years old and much severer in over 70 years old patients.

Objective To prospectively investigate the characteristics and correlative influential factors of pulmonary hypertension (PHT) in patients on long-term maintenance hemodialysis (MHD). Methods Pulmonary artery systolic pressure (PASP) was assessed by echocardiography according to the guideline from the American Society of Echocardiography in 2010 and PASP more than 35 mm Hg was diagnosed as PHT.Echocardiography and pulse wall velocity (baPWV) was performed in the next day after hemodialysis.Arteriovenous fistula (AVF) flow was evaluated by the ultrasound dilution method.Hemodialysis-related informations and laboratorial parameters were detected in the same period. Results One hundred and eleven MHD patients [male 45,female 66,mean age (57.32±12.49) years old] in our hemodialysis center were included in the study.All of the patients received MHD treatment for more than 6 months with AVF as the vascular access.The patients with any possible diseases causing PHT were excluded.The mean MHD period was (70.51±44.98) months.Twenty-eight patients (25.32％) were diagnosed as PHT with mean PASP (45.68±10.83) mm Hg.Left ventricular diastolic dysfunction was severer in patients with PHT than that in patients without PHT.The prevalence of moderate to severe diastolic dysfunction was statistically higher in PHT group compared to non-PHT group (53.60％ vs 6.02％,P＜0.01).Ejection fraction (EF),fractional shortening of left ventricular diameter in PHT group were also significantly lower than those in non-PHT patients (62.06％±14.90％ vs 69.72％±8.60％,36.46％±10.04％ vs 40.20％±7.86％,P＜0.01).The patients with EF less than 50％ were 21.43％and 3.61％ in PHT and non-PHT group respectively.However,there were no significant differences in age,sex,MHD periods,body mass index (BMI),interval dialysis weight growth,blood pressure before dialysis,hemoglobin,albumin,pre-albumin,serum calcium and phosphorus,iPTH,nPCR,Kt/V,baPWV and AVF flow between the two groups. Conclusions PHT is a common complication of patients on long-term MHD.There is close relationship between PHT and left ventricular insufficiency.PHT is not significantly relevant to mineral metabolic disturbance,AVF flow,hemoglobin,dialysis adequacy and nutrition status.