Idiopathic Refractory Nephrotic Syndrome (IRNS) has been an intractable problem in clinical treatment .Anti CD20 monoclonal antibody is a new type of immunosuppressive agent , which can induce the lysis and apoptosis of B cells .Significant-ly, it improves the prognosis of IRNS patients .In recent years, a number of case studies and clinical trials have been conducted on the effectiveness of anti CD20 monoclonal antibody in the treatment of children with IRNS .In this paper, the mechanism, clinical applica-tion, adverse effects and problems in the study of anti CD 20 monoclonal antibody in IRNS will be reviewed .

Objective:To investigate the protective effect and potential mechanism of cordycepin on renal proximal tubular cells injury induced by lipopolysaccharide (LPS).Methods:Renal proximal tubular cells NRK-52E were incubated on a cell culture plated at a density of 1×10 5/mL for experiment, then divided into control group (Ctrl group), LPS group (cells were stimulated with 1 mg/L LPS), 10 μmol/L or 20 μmol/L cordycep in intervention groups (LPS+C 10 group and LPS+C 20 group). Cell viability was measured using cell counting kit-8 (CCK-8) reagent. The level of intracellular reactive oxygen species (ROS) was detected by 2',7'-dichlorofluorescin diacetate (DCFH-DA) staining. The protein expressions of inflammatory factors intercellular cell adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), interleukin-1β (IL-1β), and nuclear factor-κB (NF-κB) were detected by Western blotting. Results:Compared with the Ctrl group, LPS significantly inhibited NRK-52E cell viability, increased intracellular ROS, and up-regulated the expressions of ICAM-1, VCAM-1, IL-1β and NF-κB. Compared with LPS group, after treated with 10 μmol/L or 20 μmol/L cordycepin, NRK-52E cell viability was significantly increased (Ctrl group as 1: 0.717±0.017, 0.916±0.036 vs. 0.554±0.046) and intracellular ROS level was significantly decreased (Ctrl group as 1: 1.527±0.165, 1.098±0.168 vs. 2.543±0.127), meanwhile the expressions of ICAM-1, VCAM-1, IL-1β and NF-κB were significantly down-regulated [Ctrl group as 1, ICAM-1/GAPDH: 2.364±0.097, 1.561±0.074 vs. 3.101±0.121; VCAM-1/GAPDH: 2.866±0.135, 1.920±0.098 vs. 4.170±0.119; IL-1β/GAPDH: 2.358±0.107, 1.563±0.179 vs. 3.301±0.210; phosphorylation NF-κB p65 (NF-κB p-p65)/GAPDH: 2.559±0.166, 1.596±0.148 vs. 3.183±0.098], the differences were statistically significant (all P < 0.05). Compared with the LPS+C 10 group, the cell activity of LPS+C 20 group was more significant (0.916±0.036 vs. 0.717±0.017, P < 0.01), and the expressions of ICAM-1, VCAM-1, IL-1β, NF-κB were down-regulated more significantly (ICAM-1/GAPDH: 1.561±0.074 vs. 2.364±0.097, VCAM-1/GAPDH: 1.920±0.098 vs. 2.866±0.135, IL-1β/GAPDH: 1.563±0.179 vs. 2.358±0.107, NF-κB p-p65/GAPDH: 1.596±0.148 vs. 2.559±0.166, all P < 0.05).Conclusion:Cordycepin could significantly increase the survival rate of NRK-52E cells, reduce intracellular ROS level, and inhibit inflammation, and the anti-inflammation effect can be related with NF-κB pathway.

Objective To evaluate puncture technique in thoracic endovascular aortic repair with abdominal aortic aneurysm and assess the feasibility and safety of using a pre-close technique for puncture and closure of femoral access sites. Methods From May 2010 to August 2013, the pre-close technique which involved two 6 F per-close ProGlide devices deployed in the femoral artery before upsizing to a 18-25 F sheath and one or two deployed before upsizing to a 14-16 F sheath were applied to 42 patients with abdominal aortic aneurysm (group A). Forty-seven patients using surgical femoral cutdown from December 2006 to April 2010 were enrolled into group B. The rate of technical success, time from procedure to the aortic delivery, operation time, low limb braking time, local complication, time from procedure to discharge, local vascular diameter after 3 months was evaluated and compared between two groups. Results There was no significant difference in endograft external diameter between two groups ( P>0.05). The rate of technical success was 97.62%(41/42) in group A and 95.74%(45/47) in group B, and there had no significant difference (P>0.05). Time from procedure to the aortic delivery, operation time and time from procedure to discharge in group A were significantly shorter than those in group B: (21.79 ± 5.79) min vs. (41.37 ± 11.79) min, (127.66±37.83) min vs. (157.84±42.71) min, (6.59±1.89) d vs. (9.14±2.57) d, P<0.05. The incidence rate of local complications, low limb braking time, and local vascular diameter after 3 months had no significant difference between two groups:7.14%(3/42) vs. 8.51%(4/47), (8.51± 1.83) h vs. (8.38±1.79) h, (1.05 ±0.36) mm vs. (0.98 ±0.31) mm, P>0.05. Conclusion The puncture technique with per-close ProGlide is safe and effective in percutaneous endovascular aortic repair which can be adopted as an alternative technique of surgical femoral cutdown approach in patients with abdominal aortic aneurysm.

Objective To investigate the correlations between the time of thoracic endovascular aortic repair (TEVAR) and prognosis in patients with type B acute aortic dissection (AADB). Methods The clinical data of 156 AADB patients with TEVAR was retrospectively analyzed and divided into 3 groups according to the time from onset of symptom to TEVAR:less than seven days was deifned as group 1 (G1, n=87), seven days to fourteen days group 2 (G2, n=48);more than fourteen days was group 3 (G3, n=21). The status of aortic reconstruction at three months TEVAR, in-hospital mortalities, mean hospital expense and length of stay were compared among three groups. Results Before TEVAR, there was no signiifcant differences in the ratio of smallest true lumen diameter and largest false lumen diameter amony the three groups (0.47±0.33, 0.42±0.18, 0.47±0.27, respectively, P>0.05). At three months after TEVAR, the ratio of largest true lumen diameter and largest false lumen diameter among the three groups was signiifcantly greater in group 1 (1.76±0.51) than group 2(1.42±0.30) and group 3(1.34±0.34, P < 0.05), when there was no signiifcant difference between the later two groups. Complete aortic reconstruction (8 from group 1 and 4 from group 2) was achieved in 12 patients at 3 months after TAVAR. Eight patients died during hospitalization, 5 from visceral ischemic, 2 from proximal aortic dissection, one patient from sudden death. Compared with G3, the hospital expense of group 1 and group 2 was cut down about ￥20000. Length of stay was signiifcant greater in group 3 than in group 1 and group 2 (P<0.05). Conclusions Early TEVAR for AADB was safe and beneifcial for aortic reconstruct and reducing the hospital expense and length of stay.

Background The main cause of X linked juvenile retinoschisis is mutation of RS1 gene.The phenotype of X linked juvenile retinoschisis is associated with the mutation types of RS1 gene.However,the relationship of genotype and phenotype of X linked juvenile retinoschisis is unclear.Objective The present study was to survey the clinical phenotype of X-linked juvenile retinoschisis in twelve Chinese families with eleven different mutations in the XLRS1 gene. Methods Complete ophthalmic examinations with slit lamp biomicroscopy,fundus examination and Dhotography were carried out in 28 affected males.Ganzfeld electroretinography (ERG),fundus fluorescein angiography,A and B-scan standardized echography and optical coherence tomography(OCT)were also performed in some patients.The coding regions of the XLRS1 gene that encodes retinoschisin were amplified by polymerase chain reaction(PCR)and analyzed by the single strand conformation polymorphism(SSCP)assay.The RS1 gene mutations were determined by direct sequencing in an automated sequencer.Written informed consent wasobtained prior to the survey. Results The 28 affected males showed a typical foveal schisis with or without peripheral retinoschisis.The typical response to white single flash ERG was seen with a reduction of the b-wave amplitude and a relative preservation of the a-wave amplitude.causing a reduced b/a ratio in the male patients.A total of eleven different XLRS1 mutations in 12 families were identified,four of these mutations,including one frameshift mutaion(22 del T)of exon 1,Asp145His,Arg156Gly and Trp163X mutations of exon 5,were first described in this survey.One non-disease-related polymorphism(NSP),or the 576C to T(Pro192Pro)change of exon 6 was also newly reported herein.In the families with a frameshift(22 del T)mutation of exon 1,a splice donor site mutation(IVS1+2T

To adapt to the need of current public heath reform and education reform ,the aim of this study is to explore and improve practical teaching mode in preventative medicine for students in specialty of clinical medicine and set up normalized practical teaching base to enhance their concept of preventative medicine and enlarge their knowledge and increase their practical ability and social adoption.

Objective To investigate the clinical significance of thyroglobulin antibody (ATG) and thyroid peroxidase antibody (ATPO) in patients with vitiligo. Methods Venous blood samples were obtained from 87 patients with vitiligo and 90 age- and sex-matched normal human controls. Chemiluminescence was applied to measure the serum levels of ATG, ATPO, free triiodothyronine, free tetraiodothyronine and thyroid stimulating hormone (TSH). Results There was a significant increase in the positivity rates of ATG (23.0% vs 6.7%, P < 0.01) and ATPO (24.1% vs 7.8%, P < 0.01) as well as the serum level of TSH (3.4 ± 2.4 vs 2.4 ± 1.2 pmol/L, P < 0.05) in the patients with vitiligo compared with the normal human controls. It is worth mentioning that all patients positive for ATG or ATPO were diagnosed with vitiligo vulgaris. The positivity rates of ATG and ATPO in patients with vitiligo aged from 11 to 20 years and 21 to 40 years were significantly higher than those in age-matched normal controls (all P < 0.05). Also, female patients had a higher positivity rate of ATG and ATPO than female controls did (34.1% vs 8.5%, χ2 = 8.90, P < 0.01; 34.1% vs 10.6%,χ2 = 7.29, P < 0.05). The highest positivity rates of both ATG and ATPO were 53.3%, which were observed in vitiligo patients aged from 11 to 20 years, followed by patients from 21 to 40 years (ATG 34.5%, ATPO 34.5%). In patients with vitiligo positive for both ATG and ATPO, the occurrence of autoimmune thyroid disease was 70% (14/20), significantly higher than that in ATG- and ATPO- positive healthy controls (16.7%, χ2 = 5.4, P < 0.05). Conclusions ATG and ATPO were observed in young female patients with vitiligo vulgaris, and they may be associated with the development of autoimmune thyroid diseases.

Objective To obtain recombinant human Smith D1 (Sm D1) antigen and establish detecting assay.Methods Human Smith D1 antigen was synthesized by PCR using human Leukemic cDNA. The prokaryotic expression vector pGEX-ST-Sm D1 was constructed and transformed into E.coli.BL21 cell.Protein expressed under the induction of IPTG.We established DIGFA for detecting anti-Sm D1 antibodies with purified Sm D1 antigens.Results Sequence and restriction analysis revealed Sm D1 gene was cloned in frame into pGEX-5T,SDS-PAGE profile showed a clear protein band with a relative molecular weight of 39 000 and western blotting indicated that the expressed product specifically reacted to polyclonal anti-human Sm D1 genes.There was no significant difference between DIGFA and IB.The agreement between DIGFA and IB was 91.7% as calculated by Kappa statistical method.The sensitivity and specificity of DIGFA were 100% and 83.3% repectively.Conclusions Human Sm D1 gene is successfully cloned、 expressed and purification.The DIGFA,using purified Sm D1 antigens,is as good as IB,rather simpler, more rapid and reliable assay.

To clone, express and primarily use human autoantigen Sm D1 in methylotrophic yeast Pichia Pastoris. The gene Sm D1 was cloned by PCR.The PCR product was inserted into the vector pPIC9k. The recombinant plasmid pPIC9k- Sm D1 was transformed into yeast SMD1168 by electroporation. The positive clones were screened in MD plates. The high copy number transformants were rapidly selected by using G418 and were induced by methanol. Supernatants after induction were analyzed by SDS-PAGE and im-munodot. The PCR product was showed about 360 bp in size which was in accordance with predicted. The pPIC9k-Sm D1 showed the same seqencing result with GenBank’s report and restriction enzyme analysis confirmed our prediction. The pPIC9k-Sm D1 positive clone produced an about 16 kD protein which had natural immunogenicity of human autoantigen Sm D1 by SDS-PAGE and immunodot. The sensitivity and specificity of immunodot were 96% and 100%, respectively. The agreement between immunodot and im-munoblot was 98%. Successfully cloning and high-level expression of human autoantigen Sm D1 in methy-lotrophic yeast Pichia pastoris laid a foundation for further research work.

While the medicine pattern of biomedicine turn to biological-psychology-society, the medical trouble communication becomes more and more important in the medical service. Good medical trouble communication ability is the essential condition of doctor. As oral cavity clinicians, only by gasping the principle of communication can we appropriately utilize some skills of communication exchange,establish the good medical trouble relations with the patient and achieve the good treatment result finally.