To explore the risk factors of acute kidney injury(AKI)in adult primary nephrotic syndrome(PNS). Totally 185 patients with PNS were divided into AKI group(=51)and non-AKI group(=134).The demographic data and clinical and histological features at admission were compared between the two groups.The independent risk factors for AKI were evaluated by Logistics regression analysis. In 51 PNS patients with AKI,the common pathological types of AKI included minor glomerular abnormalities(29.4%),IgA nephropathy(25.5%),and membranous nephropathy(17.6%).The incidences of renal tubular casts and epithelial vacuoles in the AKI group were significantly higher than those in the non-AKI group(=0.004,=0.030).Males were more likely to suffer from AKI than females(=0.000).Patients in AKI group had significantly lower albumin level(=0.015)and higher levels of random urine protein,serum creatinine,uric acid,urea nitrogen,and triglyceride than non-AKI group(=0.030,=0.000,=0.000,=0.000,and =0.006),and polyserous and oliguria occurred more often in the AKI group(=0.000,=0.002).The AKI group had significantly higher incidences of high blood pressure and infections(=0.035,=0.000).Multivariate logistics regression analysis showed albumin(<25 g/L),serum creatinine(>96 μmol/L),urea nitrogen(≥6.8 mmol/L),uric acid(≥400 μmol/L),diabetes,infection,and renal tubular casts were the independent risk factors for AKI. AKI complicating PNS is associated with a variety of factors.Its independent risk factors include the levles of albumin,serum creatinine,urea nitrogen,and uric acid,diabetes,infections,and renal tubular casts.
Acute Kidney Injury ; etiology ; Adult ; Creatinine ; Female ; Humans ; Kidney ; Male ; Nephrotic Syndrome ; complications ; Risk Factors

Objective To determine the median effective dosage of 0.5% ropivacaine for ultrasoundguided lateral popliteal sciatic nerve block. Methods Twenty-three ASA Ⅰ or Ⅱ patients of both sexes, aged 19-20 yr weighing 52-90 kg received lateral popliteal nerve block guided with ultrasound for foot and ankle surgery.The volume of 0.5% ropivacaine injected was determined by the response of the previous patient using an up-anddown technique. The initial volume was 18 ml. Each time the volume increased/decreased by 2 ml.Successful nerve block was defined as complete loss of pinprick sensation in both tibial and common peroneal nerve distribution with concomitant inability to perform plantar or dorsal flexion of the foot 30 min after injection. Results The median effective dosage of 0.5% ropivacaine resulting in complete block of the sciatic nerve in 50% patients was 13 ml (95% confidence interval 11.3-14.9 ml).Conclusion The median effective dosage of 0.5% ropivacaine for ultrasound-guided lateral popliteal sciatic nerve is 13.0 ml.

Objective To investigate correlation between the expression of TIG1 and the prognostic significance in acute leukemia (AL).Methods The TIG1 expression level of 75 AL and 20 normal control (NC) were measured by Real-Time Quantitative PCR(RT-QT-PCR).Results TIG1 gene expressed at a higher level in NC(0.0609±0.0281 ) than that in de novo AL(0.0057±0.0035)(U=-6.321,P=0.000).The expression of TIG1 in complete remission patients(AL-CR)(0.0409±0.0244)were lower than that in NC too(U=-2.582,P=0.01).The expression of TIG1 in AL-CR patients (83.3 ％) were higher than that in de novo AL (53.1％)(U=-6.366,P=0.000).In AL patients,the CR rate of high TIG1 level cases were higher than that in low level cases (x2=4.563,P=0.033).Conclusions Reduced expression of TIG1 may play an important role in the pathogenesis of AL.TIG1 can serve as a marker of poor prognosis in AL.

Objective:To study the curative effect of hydrotalcite combined with omeprazole in the treatment of gastric ulcer with gastric bleeding. Methods:Seventy-six patients with gastric ulcer and bleeding in the stomach were selected and randomly divided into two groups. Thirty-two patients in the control group were treated with omeprazole alone while 44 patients in the observation group were treated with hydrotalcite combined with omeprazole. The therapeutic effects were compared between the two groups. Results:The total effective rate in the observation group was 100% while that was 87. 5% in the control group,and the difference between the two groups was statistically significant(P<0. 05). The comprehensive score of symptoms of the patients in the observation group was(4. 2 ± 1. 2)while that was(6. 2 ± 1. 4)in the control group,and the difference was significant(P<0. 01). The abdominal pain,abdominal distention and belching remission time in the observation group were slightly shorter than those in the control group(P<0. 05)and the time of hematemesis and hemafecia remission was significantly shorter than that in the control group(P<0. 05). After the 3-month treatment,the re-bleeding rate in the observation group was 6. 82%,which was slightly better than that in the control group,and the difference had no statistical significance(P<0. 05). The incidence of adverse reactions in the observation group was 9. 09% while that was 6. 25% in the control group,and there was no significant difference between the two groups(P>0. 05). Conclusion:Hydro-talcite combined with omeprazole in the treatment of gastric ulcer with gastric bleeding is effective and safe.

Objective To investigate the abnormity of blood lipids and uric acid ,and to analyze their relationship in health exami-nation population over 18 years in Yangzhou .Methods Totally 28 202 individuals receiving the health examination from October 2011 to August 2012 in the physical examination center of this hospital were enrolled in our study .Total cholesterol(TC) ,triglycer-ide(TG) ,low density lipoprotein cholesterol(LDL-C) ,high density lipoprotein cholesterol(HDL-C) and blood uric acid(UA) were detected ,and the relationship between age and sex with the abnormity of blood lipids and uric acid and the relationship between UA levels and blood lipids were analyzed .Results Among the detection population ,the detection rates of abnormal TG ,abnormal TC , abnormal HDL-C ,abnormal LDL-C and hyperuricemia were 31 .5% ,32 .1% ,15 .9% ,18 .4% and 17 .3% respectively .Compared with females ,males had the higher rates of abnormal blood lipids and UA (P<0 .05) .The rate of abnormal blood lipids was in-creased with age increase before 50 years old ,the > 50 -70 years old group had the highest abnormity rate of blood lipids ,then which was gradually decreased after 70 years old .The morbidity rate of hyperuricemia was increased with age .Compared with nor-mal UA group ,the hyperuricemia group had the higher rate of abnormal blood lipids (P<0 .01) .Conclusion The health examina-tion population over 18 years have the higher abnormity rate of blood lipids and uric acid ,which is significantly correlated with age and sex ;the increase of uric acid has certain correlation with abnormal blood lipids metabolism .Both blood lipids and uric acid are the risk factors of cardiocerebralvascular diseases ,rational dietary structure and periodic physical examination have the important significance to prevent the occurrence of these diseases .

Objective To investigate the relationship between interaction of peroxisome proliferators-activated receptor alpha (PPARα), cytochrome P450 oxysterol 7α-hydroxylase (CYP7B1) and estrogen receptor (ER) and intrahepatic cholestasis in pregnant rats. Methods Eighty clean SD pregnant rats were selected and divided into four groups randomly with 20 in each. Since the 13th day of pregnancy,rats in the control group was injected subcutaneously with refined vegetable oil 2.0 ml · kg-1 · d -1 , those in the low-dose, moderate-dose and high-dose groups received 17-α-ethynylestradiol (EE) 1.0 mg · kg-1 · d-1,1.25 mg · kg-1 · d-1 and 1.5 mg · kg-1 · d-1, respectively. All rats were sacrificed at the 21at day of pregnancy and maternal hepatic tissues were collected. The serum levels of alanine aminotransferase(ALT), aspartate transaminase (AST), total bile acid (TBA) and bilirubin (BIL) were determined by enzyme linked immunosorbent assay (ELISA). The mRNA expressions of PPARα, CYP7B1, Erα and Erβ in maternal rat livers were examined by real-time PCR. Results (1) Biochemical indicators: the serum levels of ALT,AST, TBA and BIL were significantly lower in the control group than in the rest 3 groups,respectively [ control group: (41.1 ± 2.8 ) U/L, (44.4 ± 3.6) U/L, (26.4 ± 5.6 ) μmol/L and( 2.8 ± 0.2)U/L;low-dose group: (48.2 ±3.4) U/L,(47.9 ±3.7) U/L,(36.4 ±4.2) μmol/L and (4.2 ±0.2) U/L;moderate-dose group: (70.4 ± 5.3 ) U/L, (68.4 ± 5.6) U/L, (64.3 ± 3.8 ) μmol/L and ( 6.2 ± 1.2)U/L; high-dose group: (72.4 ±7.6) U/L, (70.2 ±3.8) U/L, (72.4 ±7.8) μmol/L and (8.2 ±2.2)U/L, P<0.05], and those in the moderate or high-dose groups were higher than in the low-dose group (P<0.05). (2) mRNA expression of Erα and Erβ: the mRNA expression of Erα in pregnant rat livers increased in a dose-dependent manner, which were all significantly higher than that in the control group,respectively ( low-dose group: 0.76 ± 0.02 ); moderate -dose group: ( 0.99 ± 0.04; high-dose group:1.21 ±0.01 ;control group:0.65 ±0.01, P <0.05), but no difference was found among the 4 groups in the mRNA expression of Erβ ( P > 0.05 ). (3) mRNA expression of CYP7B1 and PPARα: the mRNA expression of CYP7B1 in pregnant rat livers increased from the low-dose group to the high-dose group, and were all higher than that of the control group ( low-dose group: 0.93 ± 0.01; moderate-dose group: 0.99 ±0.06; high-dose group: 1.22 ± 0.04; control group: 0.75 ± 0.02, P < 0.05 ). However, the mRNA expression of PPARα decreased from the low-dose group to the high-dose group, and were all lower than that of the control group (low-dose group: 0.83 ± 0.05; moderate-dose group: 0.71 ± 0.02; high-dose group:0.64 ± 0.03; control group: 1.35 ± 0. 05; P < 0.05 ) . Conclusions The down regulated mRNA expression of PPARα, caused by higher dose of estrogen, may increase the expression of CYP7B1 due to the ineffectiveness of the inhibition of PPARα on CYP7B1, which may further stimulate the Erα activity and then induce intrahepatic cholestasis. Abnormal expression of PPARα, CYP7B1 and ER may play a role in the pathogenesis of estrogen-induced intrahepatic cholestasis.

Antibody-drug conjugate (ADC) has become an effective method for treating various diseases, especially cancer, due to its clear target and good selectivity in clinical practice. However, the monoclonal antibodies in traditional ADC have poor tissue permeability, high modification costs, pose risks such as immunogenicity and immunotoxicity. The nanobody (Nb) which is extracted from the blood of camel animals, is the smallest antibody fragment known to have complete antigen binding ability. It has advantages such as strong tissue permeability, strong specificity, low immunogenicity, and high stability, and can replace traditional monoclonal antibodies to participate in the construction of nanobody-drug conjugate (NDC). This article reviews and discusses the advantages of Nb structure, the construction and application of NDC in the hope of providing ideas for the research and development of NDC.

B cell maturation antigen (BCMA) is a receptor of B lymphocyte stimulator (BLyS). Human IgG1Fc fusion proteins with the extracellular domain of BCMA(eBCMA), also called decoy receptors, have beenused as a potential BLyS antagonists to block BLyS activities. In order to design novel BLyS antagonistpeptides, computer-aided homologue modeling was used to construct an eBCMA-Fc fusion protein based on thecrystal structures of BCMA and Fc fragmant. To ensure the activity of eBCMA not to be interfered by Fcfusion, the root mean square distance (RMSD) for eBCMA and Fc were calculated to be 0.036 nm and 0.064nm, respectively, based on molecular docking modeling. An eBCMA-Fc fusion gene was constructed andintroduced into E. coli for expression. As expected, the purified 36 kD eBCMA-Fc fusion protein was able tobind BLyS in vitro at a dosage-dependent manner and demonstrated an anti-proliferative activity induced byBLyS in Daudi cells. The results have provided useful information on the evaluation of computer modeling andthe in vitro biological activity for the design of potential BLyS antagonist peptides.

Objective To investigate the social support of the elderly hospitalized individuals and its relationship with outcomes and to study its influential factors.Methods The elderly in-patients aged＞65 years old who were treated from April to June 2012 in Geriatric Department were recruited.The comprehensive geriatric assessment (CGA) that included social support scale (SSRS) was used.According to SSRS,the patients were assigned to the lower or higher score group.The participants were followed up for 1 year,and 12-month mortality and re-hospitalization were recorded.Student's t test,Chi-square test and multiple logistic regression were used for data analysis.Results The total score of social support was 26.58±8.99,which was significantly lower than the national norm (34.56±3.73,t =-7.52,P＜0.05).Those with advanced age,less household,depression,insufficient ability of daily life and instrument daily life showed relatively lower SSRS (t values were-2.54,8.22,-6.61,6.72 and 6.95,respectively; all P＜0.05).The patients with no spouse also got less social support (x2 =8.58,P＜0.05).At 1 year,no significant difference of re-hospitalization and mortality was found between the two groups (x2 values were 1.94 and 3.28,respectively; both P＞0.05).In multiple logistic regression analysis,fanily member,characteristics and living ability were the major influential factors of social support.Conclusions Medical staff should pay more attention to the elderly hospitalized patients and offer them sufficient social support to improve their quality of life.

Experiment examination plays an important role in evaluation of clinical microbiology experiment teaching.Standardized experiment examination system of clinical microbiology is a fair,objective and scientific assessment of students' learning effect and an important mean to evaluate teaching quality.The standardized experimental evaluation system includes organization,standardized examination contents,standardized procedures and operations,standardized invigilation and record,standardized scoring criteria,correction and prevention measures.