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.

ObjectiveTo observe the effect of speech therapy on patients with dysarthria after cleft palate repairing. Methods28 patients 4 weeks after cleft palate repairing received speech training for 3～9 months. They were assessed with articulation of speech and function of velopharyngeal closure before and after training. ResultsThe nasal leakage rate reduced from (50.64±13.10)% to (23.36±13.14)% after training. 8 patients improved their speech articulation to normal, the efficient was 100%. ConclusionSpeech training may improve the speech articulation for the patients after cleft palate repairing.

Perinatal transmission of Human immunodeficiency virus(HIV),also called mother-to-child transmission(MTCT),accounts for 90% of infections in infants worldwide and occurs in 30%-45% of children born to untreated HIV-1 infected mothers.Among HIV-1 infected mothers,some viruses are transmitted from mothers to their infants while others are not.The relationship between virologic properties and the pathogenesis caused by HIV-1 remains unclear.Previous studies have demonstrated that one obvious source of selective pressure in the perinatal transmission of HIV-1 is maternal neutralizing antibodies.Recent studies have shown that viruses which are successfully transmitted to the child have growth advantages over those not transmitted,when those two viruses are grown together.Furthermore,the higher fitness is determined by the gp120 protein of the virus envelope.This suggests that the selective transmission of viruses with higher fitness occurred exclusively,regardless of transmission routes.There are many factors contributing to the selective transmission and HIV replicative fitness is an important one that should not be neglected.This review summarizes current knowledge of the role of HIV replicative fitness in HIV MTCT transmission and the determinants of viral fitness upon MTCT.

OBJECTIVE To find out the changes of pathogens and their sensitivity to antibiotics in bile samples of patients with biliary tract infection of our hospital during last six years. METHODS The data of 359 strains of microbes found in 371 patients with positive bile culture from Jan 2001 to Dec 2006 and their sensitivity to antibiotics were statistically analyzed. RESULTS There were 84 and 188 positive samples respectively in 140 samples during the first half of this study (2001-2003)and 231 ones during the second half (2004-2006) as well as 105 and 254 strains cultured. Respectively, Gram-negative bacteria accounted for 60.0%, and 50.8% and Gram-positive cocci 34.3%, and 40.2% and fungi 5.7%, and 9.0%; Escherichia coli was the major one and accounted for 36.2%, and 31.1%, with the increasing incidence of the positive rates of its ESBLs (34.2% vs 60.8%, P

Objective The laterally spreading tumor (LST) of the large intestine have received a great deal of study in Japan, but no report of such cases was found in China. We here of report 46 cases of LST (47 lesions, because one of the patients was found to have two lesions) diagnosed in our hospital in last two years. The morphological features under endoscopy, pit pattern, pathology and treatment under endoscopy were studied. Methods The 47 lesions of LST were found in a total of 5 735 patients who underwent colonoscopic examination in the last two years (from 01-12-2000 to 30-11-2002). The site, size and morphological features of LST were recorded, and the pit pattern was classified with magnification. 42 patients (totally 42 lesions) received colonoscopic surgery, and the rest refused to accept endoscopic therapy, therefore only a biopsy was done for pathological study. In those patients who accepted colonoscopic surgery, 14 patients were treated by mucosal resection (EMR) after injection of saline solution, 24 were treated by piecemeal mucosal resection (EPMR) after injection of saline solution, in 3 patients the lesion was removed by high frequency loop resection, and Cap-EMR was performed using distal hyaline hat attachment fitted to the end of endoscope. The resected or biopsy specimens were studied pathologically. Results 47 lesions of LST were found in a total of 5863 patients who underwent colonoscopic examination. The distrihution of LST lesions were as follows. 22 lesions were situated in the rectum, 10 lesions in the sigmoid colon, 7 lesions in the descending colon, 4 lesions in the transverse colon, 2 lesions in the ascending colon, and 2 lesions were located in the cecum. Macroscopic type: 25 lesions were homogeneous granular type, 12 lesions were mixed nodular granular type, 8 lesions were flat elevated type, and 2 lesions were pseudo-depressed type. The pit pattern as revealed under magnifying endoscopy indicated that 2 lesions were of type II pit, 8 lesion of type II+III L pit, 9 lesions of type III L pit, and 28 lesions of type IV. The pathological diagnosis revealed that 28 lesions were villous adenomas in which 7 lesions showed early malignant degeneration (6 intramucosal cancer and 1 submucosal cancer). 11 lesions were tubular adenomas, in which 1 was intramucosal cancer, 2 lesions were hyperplastic polyp, and 6 lesions were mixed hyperplastic polyps (serrated adenomas). Conclusion The LST manifest some special features, and their incidence may be higher in China than in Japan. EMR or EPMR may be considered as a good method for treatment for LST.

Objective To inevestigate the changes of the responses by changing the parameters in the neural response tetemety(NRT).Methods In this project,twenty patients who were implanted in Nucleus C124M were measured the electrically evoked compound action potential(ECAP)using the NRT system.It was expected to observe the changes of the responses by changing the parameters in the NRT 2.04 software.Results It was found that the parameters that made great influences to the responses were current level,stimulate pulse width,gain,delay and masker advance.Conclusion The parameters that made great influences to the record time were stimulate rate and number of sweeps.

Objective To study the effect of TFF_2 gene theragy on the healing of experimental gastric ulcer in rats and its mechanism.Methods From Jun.10,2005 to Mar.15,2006.48 Wistar rats were randomly divided into two groups:24 in therapy group,24 in control group.pcDNA3.1-TFF_2 100?g was used in each rat in therapy group,and the same volume of pcDNA 3.1 was used in control group.Each rat was injected under serous membrane of the gastric wall after making model.The rats were executed separately after 3、7、14 days.Results Ulcer index was 9.7?2.9 mm2 in therapy group and was 17.7?3.1 mm2 in control group on the 14th day.There was significant difference between the two groups.The average amount of mucous glycoprotein was 83.35?4.54 mg/g in the therapy group and 70.36?4.22 mg/g in the control group.There was no significant change in the secretion of acid between the two groups.Conclusion TFF_2 gene therapy can promote the healing of experimental gastric ulcer in rats.Its mechanisms may include increasing mucous glycoprotein of the gastric wall without suppressing gastric acid secretion.

Objective To analyze the reasons causing false positive results of white blood cells (WBC) detected by AVE‐763B automatic urine analyzer .Methods WBC positive samples ,detected by AVE‐763B automatic urine analyzer ,were re‐inspected by microscope .Results In the 740 positive samples ,224 cases were false positive ,the false‐positive rate was 30 .2% ,among which 145 cases could be correctly classified by using image analysis ,and the false‐positive rate reduced to 10 .7% .Conclusion Many fac‐tors could cause false positive results .To improve the accuracy of AVE‐763B urine analyzer ,re‐inspect should be performed .

Objective To investigate the pro-inflammatory effect of transforming growth factor β1 (TGF-β1) in rat peritoneal mesothelial cells (RPMCs) and its machanism. Methods TGF-β1-induced RPMCs model in vitro was established, and the expression of MCP-1 in the TGF-β1-induced RPMCs was observed. The intervention of Smad7 on the expression of MCP-1 and p38 signal proteins induced by TGF-β1 in RPMCs was explored as well as the intervention of p38 inhibitor SB203580 on the expression of MCP-1 induced by TGF-β1 in RPMCs. Results TGF-β1 could stimulate MCP-1 expression in RPMCs. Compared with control group, MCP-1 mRNA levels were significantly increased after 3 h treatment with TGF-β1 (P<0.05), peak MCP-1 induction occurred at 6 h (P<0.01), and the stimulatory effect of TGF-β1 persisted through 24 h (P<0.05). MCP-1 protein levels were significantly increased after 6 h treatment with TGF-β1(P<0.05), peak MCP-1 induction occurred at 48 h(P<0.01). Over-expressed Smad7 and p38 inhibitor could reduce the expression of MCP-1 induced by TGF-β1 (P<0.05). TGF-β1 could activate p38 signaling pathway, but over-expressed Smad7 could inhibit this role of TGF-β1. Compared with control group, the expression level of p-p38 was increased in TGF-β1-stimulated group. Compared with TGF-β1-stimulated group, the expression level of p-p38 was reduced in Smad7 gene transfer group. Conclusions TGF-β1-induced MCP-1 expression in rat peritoneal mesothelial cells is p38MAPK dependent.

Objective To investigate the distribution of qnr and aac(6')- Ⅰ b-cr genes of clinical isolates resistant to ciprofloxacin in Enterobacteriaceae in Wenzhou. Methods From August 2005 to April 2008 a total of 461 clinical isolates resistant to ciprofloxacin in Enterobacteriaceae (370 isolates of Escherichia coli, 39 isolates of Enterobacter cloacae and 52 isolates of Klebsiella) were collected from the First Affiliated Hospital of Wenzhou Medical College. qnr and aac(6')- Ⅰ b genes were detected by PCR for all the clinical isolates, DNA sequencing was used for qnr and aac(6')-Ⅰ b-cr identification and conjugation experiment was proved to find ways of transmission of antimicrobial resistance. Results Fifteen qnr-positive isolates were detected among 461 Enterobacteriaceae isolates, including 5 qnrA-positive isolates (4 Enterobacter cloacae isolates and 1 Klebsiella ornithinolytica isolate), 4 qnrB-positive isolates( 2 Klebsiclla paeunoniae isolates and 2 Escherichia coli isolates), 6 qnrS-positive isolates(2 Klebsiella pneunoniae isolates and 4 Escherichia coli isolates). Fifty-two among 461 Enterobacteriaceae isolates harbored aac(6')- Ⅰ b-cr gene, including 42 Escherichia coil isolates, 4 Enterobacter cloacae isolates and 6 Klebsiella isolates. DNA sequencing for 15 qnr-positive isolates found they harbored aac(6')- Ⅰ b-cr gene simultaneously. Fifteen qnr-positive isolates were susceptible to imipenem but resistant to some other drugs. Conjugation experiments were successfully carried out in 7 of 15 isolates harbored qnr and aac(6')-Ⅰ b-cr genes, and their resistance to quinolones and aminoglycosides was partly transmitted to the recipient isolates. Conclusion The qnr genes are few in clinical isolates resistant to ciprofloxaein in Enterubacteriaceae in Wenzhou, however the aac(6')- Ⅰ b-cr gene is popular.