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.

Objective To further investigate the molecular mechanism underlying the preventive effect of Astragalus polysaccharide (APS) on type 1 diabetes mellitus (DM) in NOD mice. Methods In order to explore the gene expression profiles of NOD mice′s islet cells treated with APS, cDNA microarray technique was applied. Results In APS group 5.47% gene expressions were obviously changed, 28 genes up-regulated, 35 genes down-regulated, and of which, 17 genes were functionally related to immunity. Conclusion The preventive effect of APS on type 1 diabetes in NOD mice is probably related to the action of APS in correcting the imbalance of Th 1/Th 2 cytokines.

Objective To evaluate the safety and feasibility of retroperitoneal laparoscopic excision of pheochromocytoma. Methods Retroperitoneal laparoscopic excision of pheochromocytoma was performed on 20 patients with pheochromocytoma (group A).At the same period, 20 patients with pheochromocytoma undergoing open surgery served as controls (group B).Intraoperative blood pressure, heart rate, plasma noradrenalin (NE) concentration,operative time, volume of blood loss, cases receiving blood transfusion, postoperative activity out of bed days, postoperative hospital stay,were compared between the 2 groups.The NE concentration was determined using RP-HPLC-ECD. Results The operations were successful in all the patients. Intraoperatively,3 cases (15.0%) in group A and 12 cases (60.0%) in group B experienced acute fluctuation in blood pressure,heart rate and pulse [maximum blood pressure,220/110 mm Hg(1 mm Hg=0.133 kPa) vs 210/115 mmHg; minimum blood pressure,88/57 mm Hg vs 85/60!mm Hg;maximum heart rate,122/min vs 120/min, respectively].The NE concentratioo correspondingly fluctuated from the maximum 16.82 ng/ml to the minimum 6.28 ng/ml (normal reference,0.32 ng/ml) (P

Objective To explore the effect of prevention of hemorrhagic cystitis (HC) after hematopoietic stem cell transplantation (HSCT) with hyperhydration, forced diuresis and alkalinizing plus infusion mesna. Methods 32 cases of patients receiving HSCT were included in this study. 2 cases of severe aplastic anemia (SAA) received total body irradiation (TBI)+cyclophosphamide(CTX)(TBI-CTX) regimen,and the remaining 30 patients were using the classic busulfan+CTX (BU+CTX) regimen. All patients were treated with mesna combined with hydration, forced diuresis and alkalization to prevent HC. Ganciclovir and acyclovir were used to prevent cytomegalovirus (CMV) and other viral infections and monitor CMV-IgM levels of the blood. Encourage patients to urinate every hour, testing urine pH value and the calculation of urine output, every 6 h review and testing of urine routine,central venous pressure (CVP), each of 8 h of serum electrolytes. Results Only 1 patient at 6 months after transplantation appeared delayed grade Ⅱ HC after hydration, alkalization, diuretic, hemostatic, anti-graft-versus-host disease (GVHD), and ganciclovir antiviral therapy. The HC patients cured at 35 d. The remaining patients did not suffer HC. Adverse effects such as acid-base balance disturbance did not appear clear. Conclusion Mesna joint hydration, forced diuresis and alkalization was effective and safe to prevent HC.

Humans ; Occupational Exposure ; prevention & control ; Respiratory Protective Devices ; classification ; standards ; utilization ; United States

Objective To investigate the action mechanism of blood-stage treatment that affects psoriasis vulgaris using observation of the Th17/Treg expression.Methods A total of 32 patients ( blood heat group,n =17 ; blood stasis group,n =15) and 15 healthy people ( control group,n =15 ) were observed.The frequencies of Th17 and Treg in peripheral blood were detected by flow cytometric analysis in patients before and after treated by heat-clearing and blood-cooling decoction,qi-enriching and blood-activating decoction.Results The ratio of Th17/Treg in peripheral blood [ blood heat group (4.21 ± 0.52 )％ ;blood stasis group( 3.32 ± 0.43 )％ ] was significantly increased in patients compared with controls [ ( 1.79 ±0.18)％ ] ( P ＜0.01 ).After herbal treatment,the ratio of Th17/Treg expression in the blood heat group [ ( 2.41 ± 0.22 ) ％ ] and in blood stasis group [ ( 2.02 ± 0.12 ) ％ ] was significantly decreased ( P ＜ 0.05 ),respectively.Conclusions Blood-stage treatment works well on Th17/Treg expression in patients with psoriasis vulgaris.

Objective To present the experience of diagnosis and treatment of 21 cases of retrocaval ureter. Methods 21 cases of retrocaval ureter were retrospectively analysed. Results The main clinical symptom was right waist pain in 20 cases,4 of them with typical renal colic.8 cases had gross hematuria and calculus in the renal pelvis.1 case was void of symptom.The diagnosis of the disease depended mainly on intravenous urography (IVU) and retrograde ureteropyelography (RGU).IVU and RGU showed a "S" shaped upper ureteral segment with dilatation. Ureteral replacement and ureteroplasty were carried out in 20 cases which have been followed up from 2 months to 28 years with an average of 13 years.The symptom disappeared in 19 cases,with hydronephrosis and hydroureter significantly reduced on IVU and ultrasonography.1 case underwent ureteral reanastomosis because of stenosis at anastomosis site. Conclusions In patients with hydronephrosis and hydroureterosis of upper segment on the right side,the possibility of retrocaval ureter should be considered.Intravenous urography and retrograde ureteropyelography are the main means of diagnosis.Ureteral replacement and ureteroplasty are the treatment of choice.

Objective To analyze the tissue development rule of the Bufo raddei Strauch lung,to observe the expression of transforming growth factor-?(?_1,?_2,?_3)in developing lung,and to discuss their functions and relationships. Methods The tissue development of the(218) Bufo raddei Strauch lungs was studied by biological microscope technology,and the expression of TGF-? was measured in lung development by immunohistochemistry and images were analyzed by IPP,providing a basis for study of the zoology and developmental biology. Results(1) Lung bud occured in larval 22nd stage from pharynx caudal part.In 26th stage the minutenss locule began to appear.The lung bud gave rise to obvious lung cavity in 31st stage.In 33rd stage originality alveolus began to appear.In 36th stage obvious septum and alveolus appeared.There were many capillary vessel in the wall of lung.In 39th stage the lung of tadpole was like as one of young toad.The respiratory epithelium differentiated from columnar into squamous.The entire developmental process was divided into four phases,lung bud Ⅰphase,lung bud II phase,originality alveolus phase and alveolus phase.(2)In the early developmental phase,TGF-? expressed in the lung wall.In the late developmental phase,TGF-? expressed in mesenchymal at high levels.Conclusion The expression of TGF-? displayed intermittent changes during the period of development.The functions of TGF-? might be respectively different in different development stages.They not only stimulate the process of epithelium of the reticular septa,but also modulate epithelium of alveolar sac and differention.

Objective To investigate the learning curve of minimally invasive direct coronary artery bypass ( MIDCAB) via left anterior small thoracotomy. Methods We retrospectively reviewed results of a consecutive series of 80 patients underwent MIDCAB via left anterior small thoracotomy performed by a single surgeon.The patients were divided into 4 groups ( group A, B, C, D, n=20 in each group) according to the sequence of the operation.The left internal mammary artery ( LIMA) harvesting time, anastomosis time, total operative time, the drainage volume of the first day postoperation, mechanical ventilation time, hospital stays postoperation, in-hospital morbidity and mortality were compared.The learning curve was assessed by means of regression analysis with logarithmic curve fitting. Results The basic clinical characters were similar in all groups before the operation.The operations were accomplished successfully in all the 80 cases.No intraoperative conversion to sternotomy, death, or perioperative myocardial infarction happened.The LIMA-harvesting time in the group B, C, and D was significantly shorter than that in the group A [(53.7 ±19.2) min, (50.2 ±17.7) min, and (43.2 ±10.3) min vs.(77.0 ±30.0) min, P =0.001, 0.000, and 0.000].There was no difference between group B and C, B and D, C and D in the LIMA-harvesting time (P>0.05).The total operative time in the group B, C, and D was significantly shorter than in the group A [ (128.7 ±21.7) min, (129.0 ±33.3) min, and (112.2 ±14.5) min vs. (165.2 ±41.8) min, all P=0.000], without difference between the group B and C, B and D, C and D (P>0.05).The learning curve models were obtained: LIMA-harvesting time ( min) =113.77 -16.869 × ln ( operation number); total operative time (min)=220.281 -25.276 ×ln (operation number). Conclusion MIDCAB via left anterior small thoracotomy is safe and effective, with a learning curve of approximately 20 cases.

Objective:To analyze the rationality of off-label drug use in nephritic syndrome prescriptions to provide scientific basis for clinical rational drug use and further regulate the off-label drug use in our hospital. Methods:Totally 1 908 outpatient prescriptions of nephritic syndrome selected from our hospital during November 2014 to April 2015 were analyzed, and all the off-label drugs were listed . The rationality of the off-label drug use was analyzed and evaluated by searching the related kidney disease guidelines and litera-tures. Results:The off-label drug use of tacrolimus capsules, mycophenolate mofetil capsules, cyclophosphamide for injection, ciclos-porin soft capsules, dipyridamole tablets, hydroxychloroquine sulfate tablets and warfarin sodium tablets were recommended by domes-tic and overseas guidelines with better evidence of evidence-based medicines. Tripterygium glycosides tablets and leflunomide tablets were supported by the literatures on clinical studies at home and abroad. The above 9 kinds of off-label drugs were rational drug use. Lumbrokinase enteric-coated capsules, salvia miltiorrhiza and ligustrazine injection and pidotimod dispersible tablets were reported only by a handful of journals. Bacteria lysate capsules and boric acid powder had no related information support, which belonged to the em-pirical prescriptions of physicians. The above 5 kinds of off-label drugs were not rational drug use. Conclusion:It is a widely existing phenomenon that the medication in nephrotic syndrome is beyond the instruction, the most of off-label drug use are reasonable, and cli-nicians should prescribe medicines carefully. Our hospital needs to further standardize the management of off-label drug use supported by higher evidence in order to improve the level of clinical rational drug use and the reasonable rate of prescriptions.