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.

ObjectiveByreportinga fatalcaseof severelupusnephritis(LN) complicated with invasive aspergilluspneumonia and meningitis and reviewing the associated literatures,to provide a way of early diagnosis andproper management for the patients suffering from systemic lupus erythematosus(SLE) and invasive fungus infection(IFI).MethodsThe onset,diagnosis and treatment course of the disease were described and associated literatures werereviewed to analyze and summary the diagnostic methods,common pathogenic bacteria and predisposing factors of SLE patients with IFI.ResultsApplication of IFI guideline for cancer patients and those undergoing hematopoietic stem cell transplantation could be helpful in the early diagnosis and treatment of SLE patients complicated with IFI.The most common pathogen of SLE patient suffering from IFI was cryptococcus neoformans and aspergillus,not candida albicans.The mainpredisposingfactorswerehighlupusactivityandimmunosuppressant.Conclusions Guideline of IFI for cancer patients and those undergoing hematopoietic stem cell transplantation is also helpful for the SLE patients complicated with IFI.The most common pathogens of IFI in SLE patients are cryptococcusneoformansand aspergillus.The predisposing factors are high lupus activity and immunosuppressant.

Objective To investigate the long?term effect of nerve?spring radical hysterectomy( NSRH) on anorectal function after radical hysterectomy. Methods Fifty?six cases of uterine cervical carcinoma patients who met the criteria were selected for the study and were randomly divided into RH group and NSRH group. Defecation functional and anorectal manometry were compared at 1 year after surgery. Results There were 2 patients were excluded both in the two groups, and 26 cases were included in the follow up of each group. Compared with RH group, NSRH group had a lower constipation and chronic diarrhea incidence ( 2 (7. 7%),8(30. 8%);1(3. 8%),6(23. 1%);χ2=4. 457,4. 127P<0. 05),a better self?evaluation bowel func?tion(no significant change:10(38. 5%),5(19. 2%);poor:7(26. 9%),3(11. 5%);very poor:9(34. 6%),18 (69. 2%);χ2=6. 267,P=0. 044;P<0. 05),a higher level of maximal anal squeeze pressure((132. 7±43. 6) mmHg,(119. 5±45. 3) mmHg;t=2. 116,P<0. 05),a lower level of threshold perception of distension((38. 6 ±10. 5) mmHg,(45. 8±12. 4) mmHg;t=2. 326,P<0. 05) and threshold perception of evacuative stimulus ((78. 3±33. 2) mmHg,(90. 6±40. 9) mmHg;t=2. 208,P<0. 05). Conclusion RH may cause more serious long?term anorectal dysfunction,while NSRH help to protect defecation function.

Objective To study the clinical characteristics and the influencing factors of hypertension in IgA nephropathy(IgAN)patients with normal renal function.Methods From 2002 to 2006,a total of 507 idiopathic IgAN patients with normal renal function(eGFR≥90 mL/min)confirmed by renal biopsy were treated in the First Affiliated Hospital of Sun Yat-sen University.The patients were divided into a hypertension group(n=93)and a normal group(n=414)according to the BP levels.Univariate and multivariate logistic regression analysis were used to analyze the relationship between the hypertension and the clinical characteristics.Results We found that 18.3%(93/507)of the IgAN patients had hypertension,with hypertension as the main symptom in some cases.Univariate analysis showed that male sex,older age,higher BMI,elevated level of triglyceride and cholesterol were the clinical risk factors for hypertension in IgAN patients(P

Chemotherapy as a routine method for clinical treatment of cancer has disadvantages such as significant toxicity and strong resistance. In order to improve the efficacy of the drugs and reduce the by-effects, we tried to combine static magnetic field (SMF) with cisplatin or adriamycin. The growth of Hepa1-6 cells treated with the static magnetic field (SMF) combined with cisplatin or adriamycin was significantly inhibited, as detected with MTT (3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide) test. Combined treatment group cells underwent significant morphological changes as observed by HE (Hematoxylin and eosin) staining under optical microscope. Cell cycle analysis indicated that SMF increased the ratio of cells arrested in G2/M phase caused by cisplatin, and when treated with SMF combined with adriamycin, cells were almost arrested in G1 and G2/M phase. SCGE test showed that SMF can enhance the ability of cisplatin or adriamycin to promote cell DNA damage. Atomic force microscope observation found that the combination of antitumor drugs and magnetic field treatment induced larger and deeper holes on the cell membrane, and surface structure damage is serious. The combination of antitumor drugs and magnetic field technology effectively inhibits the growth of tumor cells, and reduces drug doses. The results implicate this method as potential cancer therapy.
Antineoplastic Agents ; pharmacology ; Cell Cycle ; Cell Line, Tumor ; drug effects ; Cisplatin ; pharmacology ; DNA Damage ; Doxorubicin ; pharmacology ; Humans ; Magnetic Fields

Aim To investigate the effect of ginkgolide B on junctional proteins in ox-LDL-stimulated human umbilical vein endothelial cells ( HUVECs) . Methods After incubation with ginkgolide B ( 0 . 2 ,0 . 4 ,0 . 6 g · L-1 ) for 1 h, HUVECs were treated with ox-LDL (0. 1 g·L-1 ) for 4 h. The expressions of JAM-A and Cx43 were analyzed with Western blot and immunofluo-rescence. The effect of ginkgolide B on vascular per-meability was analyzed by Transwell experiments. Re-sults JAM-A and Cx43 expressions increased by 22%and 24% in ox-LDL-treated HUVECs, respectively. Whereas ginkgolide B significantly decreased JAM-A and Cx43 expressions. LY294002, a specific inhibitor of PI3K, suppressed JAM-A and Cx43 expressions in ox-LDL-stimulated cells. Ginkgolide B potently re-duced monocyte migration in ox-LDL-treated cells. Conclusion Ginkgolide B significantly suppresses JAM-A and Cx43 expressions, and reduces monocyte migration in ox-LDL-stimulated cells. This demon-strates that ginkgolide B can improve vascular permea-bility. The mechanism might be associated with the in-hibition of PI3K/Akt signaling pathway.

Objective To investigate the clinical and pathological characteristics of IgA nephropathy (IgAN) with macrohematuria (MH).Method 1512 consecutive patients with biopsyproven IgAN diagnosed from January 2006 to December 2011 were enrolled,and divided into MH group and control group respectively,according to whether there existed episodes of MH before renal biopsy.The clinical and pathological characteristics were compared between two groups.Patients in MH group were then divided into three groups according to the interval from the last episode of MH to renal biopsy to clarify the concomitant clinicopathological changes associated with occurrence of MH.Results The rate of MH in history was 22.1％.MH group patients had significantly lower serum creatinine,slighter proteinuria,lower prevalence of hypertension and heavier microhematuria than control group (all P ＜ 0.001).The prebiopsy durations were similar in two groups (P=0.627).In MH group,chronic pathological indicators,including global/segmental sclerosis,tubule atrophy/interstitial fibrosis were all slighter (all P＜ 0.001),whereas activity indicators,including necrosis lesions,crescents and mesangial proliferation were all more severe compared with control group (all P ＜ 0.05).Those who underwent renal biopsy within 30 days of the last episode of MH had more severe proteinuria and microhematuria,higher prevalence of necrosis lesions,more severe crescents formation,and endothelial proliferation (all P ＜ 0.05).Conclusions IgAN patients with MH in history have relatively milder clinical and chronic pathological manifestations,however more active pathological changes especially in those who suffer episode of MH recently.

Objective To investigate the survival rate in elderly patients with long-term catheters hemodialysis.Methods A total of 127 elderly patients receiving maintained hemodialysis were included in this study.Patients were divided into two groups according to catheter location:long term indwelling internal jugular vein catheter group and long term indwelling vena iliac external catheter group.The baseline anthropometric and laboratory parameters were measured.The catheter dysfunction and catheter related complications were observed.Results The incidence of catheter dysfunction was higher in iliac vein catheter group than in internal jugular vein catheter group (51.5 ％ vs.24.5％,x2 =8.459,P=0.015),and there were no significant differences in the catheter related infection rate and cardiovascular (CVD) event rate between the two groups.Kaplan-Meier survival curves showed that mean survival time was lower in vena iliac external catheter group than in internal jugular vein catheter group (1.9 years vs.2.5 years,x2 =10.847,P=0.001),and still was lower after controlling the catheter dysfunction and cardiovascular events (x2 =9.915,P=0.002;x2=4.368,P =0.037).Multivariate logistic regression analysis showed that levels of hemoglobin,creatinine,systolic blood pressure,parathormone and age were the independent risk factors for mortality in elderly patients with long term catheter hemodialysis.Conclusions There is a high incidence of CVD events in elderly patients with long-term catheter hemodialysis.The incidence of catheter dysfunction is higher and the survival rate is lower in elderly patients with long-term indwelling vena iliac external catheter hemodialysis.

Objective To observe the features of the full field electroretinogram (FF-ERG) in type 1 diabetes (T1D) children without diabetic retinopathy (DR).Methods Retrospective case study.Forty-one T1D children and 25 age-matched normal controls underwent a complete ophthalmic examination,including best-corrected visual acuity,refraction,intraocular pressure,slit lamp,fundus photography,indirect ophthalmoscopy,and spectral domain optical coherence tomography to exclude DR.All FF-ERG tests were performed by an experienced technician.The ERG series includes six protocols:dark-adapted 0.01 ERG (r-b 0.01);dark-adapted 3 ERG (mix-a 3.0,mix-b 3.0);dark-adapted 10 ERG (mix-a 10.0,mix-b 10.0);dark-adapted oscillatory potentials (OPS);light-adapted 3 ERG (c-a 3.0,c-b 3.0);light-adapted 30 Hz flicker (30 Hz FP) ERG.To compare the amplitudes and implicit times of the FF-ERG between the T1D and control group children.Results Compared with the control subjects,the FF-ERG amplitudes decreased and the implicit times increased in T1D.Except for r-b 0.01 (t =-0.228,P＞0.05),the amplitudes of other FF-ERGs were all significantly attenuated (t =-1.664,-3.645,-4.324,-6.123,-5.846,-12.9,-14.4,-5.23;P＜0.05) in T1D children.The implicit times of mix-b 3.0,mix-b 10.0,c-b 3.0 and OP2 significantly increased (t=5.242,2.879,5.378,3.506;P＜0.05).The implicit times of r-b 0.01,mix-a 3.0,mix-a 10.0,c-a 3.0 and 30Hz FP changes were not significantly (t=2.331,1.677,0.557,0.84,0.064;P ＞ 0.05).Conclusion The FF-ERG amplitudes decreased and implicit times increased in T1D children compared with the control normal subjects.

AIM: To investigate the effect of 4.25%peritoneal dialysis solution (PDS) on CD40 expression in rat peritoneal mesothelial cells so as to reveal the potential mechanisms by which CD40-CD40 ligand (CD40L) interaction may be involved in the inflammation of peritoneal membrane. METHODS: Rat peritoneal mesothelial cells (MC) were harvested from the peritoneal cavity and maintained under defined in vitro conditions. Expression of CD40 on MC under normal culture or stimulation with 4.25%PDS or 4.25%PDS+IFN-? was detected by RT-PCR and FACS analyses. After activation of CD40 on MC with CD40 mAb, the expression of intercellular adhesion molecule-1 (ICAM-1) on MC was analyzed by FCAS. RESULTS: MC cultured in vitro expressed CD40 constitutively. 4.25%PDS markedly up-regulated the expression of CD40 mRNA and its protein. The expression of CD40 mRNA and its protein following stimulation with 4.25%PDS+IFN-? was significantly higher than 4.25%PDS alone. The expression of ICAM-1 on MC was significantly increased after activation of CD40 with CD40mAb.CONCLUSIONS: MC functionally express CD40. The up-regulated CD40 expression on MC following stimulation with 4.25%PDS may play an important role in local peritoneal defense mechanisms and may be involved in the chronic inflammatory process of the peritoneum.