Objective To find out a more rational pathological classification criteria for renal injury in patients with type 2 diabetes mellitus. Methods The renal clinicopathological features of forty-nine type 2 diabetic patients with maeroalbuminuria were collected and were compared retrospectively. The patients without diabetic renal disease were excluded. According to the pathological features, the patients were divided into two groups: typical diabetic glomerulopathy (DG) and atypical diabetes-related renal disease (ADRD). Results The renal biopsy revealed DG accounted for 59.2% of the patients, while the remaining 40.8% presented atypical renal injury defined as ADRD. In DG group, volume fraction of mesangium per glomerulus, glomerular basement membrane width, atrophic tubules index, intersititium injury index and prevalence of hyalinization of renal arteriole were higher; podocyte density per glomerulus was lower; duration of type 2 diabetes was longer; the level of fast blood glucose, systolic blood pressure, mean arterial pressure, proteinuria and prevalence of diabetic retinopathy (DR) were higher; glomerular filtration rate (GFR) was lower. In ADRD group, body mass index and prevalence of obesity were higher; dyslipidemia was more severe. GFR was negatively correlated with glomerular global sclerosis rate in both DG and ADRD group. Proteinuria was positively correlated with volume fraction of mesangium per glomerulus in DG. No correlation between proteinuria and pathological features was found in ADRD. DR (94.8%) and duration of type 2 diabetes over five years (90.7%) had high negative predictive value for DG. Conclusions Renal injuries in type 2 diabetes patients are heterogeneous. ADRD is an atypical renal injury in type 2 diabetes patients whieh is different from DG. DR and duration of diabetes are more helpful in predicting DG separating from ADRD.

Objective To study the pathologic pattern and clinical feature of type 2 diabetes mellitus complicated with chronic kidney diseases (CKD). Methods Clinicopathological features of 155 type 2 diabetic patients complicated with CKD were collected and analyzed retrospectively. The patients were divided into four groups: typical diabetic glomerulopathy (DG),atypical diabetes-related renal disease (ADRD), non-diabetic renal diseases (NDRD) and DG complicated with NDRD. Results Renal biopsies revealed DG accounted for 18.7% of the patients, ADRD accounted for 12.9%, NDRD accounted for 60.0%, and DG complicated with NDRD accounted for 8.4%. In DG group, duration of type 2 diabetes was longer;the level of fast blood glucose, systolic blood pressure, mean arterial pressure and prevalence of diabetic retinopathy (DR) were higher;proteinuria was heavier and evaluated glomerular filtration rate (eGFR) was lower. In ADRD group, body mass index and prevalence of obesity were higher;dyslipidemia was more severe. Gross hematuria and acute renal insufficiency could be only found in NDRD group.Without DR, duration of diabetes under 5 years, gross hematuria, acute renal insufficiency,evidences of autoimmune diseases and proteinuria≥3.5 g/24 h but eGFR ≥60 ml/min were specific valuable predictors for NDRD. Conclusions Renal injuries in type 2 diabetic patients are structural heterogeneous, in which NDRD is more common and is different from ADRD and DG.Renal biopsy should be considered when type 2 diabetic patients complicated with CKD present at least one characteristic as follows: duration of diabetes under 5 years, without DR, history of gross hematuria, acute decrease of renal function, evidences of autoimmune diseases and proteinuria ≥ 3.5 g/24 h but eGFR ≥ 60 ml/min.

Objective To explore the level of Th2 type cytokines including IL-4, IL-10 and IL-13, and the immunoreg-ulation of cytokines in patients with neurocysticercosis. Methods Lymphocytes in patients with neurocysticercosis were separated from the blood sample with density gradient centrifugation and the total RNA was extracted by guanidine isothiocynate method. cDNA was synthesized by reversed transcription reaction. The target gene was then amplified by PCR. The PCR products were analyzed by electrophoresis. Results Results of RT-PCR showed that cytokines mRNA in lymphocytes of peripheral blcod were detected in 27 patients with neurocysticercosis but not in the other 3 cases. Among the positive cases, mRNA of IL-4, IL-10 and IL-13 was detected in 16, 17 and 14 cases respectively and mRNA of IL-4, IL-10 and/or IL-13 was detected in all the 27 cases. In the detection of lymphocytes in peripheral blcod of 10 healthy subjects, expression of IL-4 and IL-10 was found in only one case at low level. Conclusion The study revealed that Th2 associated cytokines were expressed at high level and the humoral immunocompetence was relatively strong in patients with neurocysticercosis.

Objective To observe the effect of adenosine A1 receptor (A1AR) on the megalin defect in type 1 diabetic mice with early kidney disease.Methods 7-8 week-old,baseline body weight and fasting blood glucose matched wild type (WT) C57BL/6J mice were selected,and randomly divided into two groups:control group (n=6) and WT DM group (n=6).In the same way,male A1AR knock-out C57BL/6J mice were selected as A1AR-/-DM group (n=6).DM model was established by intraperitoneal injection of streptozocin.The blood glucose (BG),body weight (BW),kidney weight (KW),24 h proteinuria (24hUP) and albumin creatine ratio (ACR) were measured at 4 weeks.The renal pathological lesion was observed and the expression of megalin in proximal tubules was examined by immunohistochemistry.The expression of caspase-1,IL-18 and A1AR were detected by Western blotting.Results At 4th week,compared with WT control mice,the BG,BW,KW and 24hUP of WT DM mice were increased significantly (n=6,P ＜ 0.01),with the pathological glomerular enlargement,mesangial cell proliferation,extracellular matrix accumulation and renal tubule hypertrophy being observed.Immunohistochemistry revealed decreased expression of megalin,an important multiligand protein receptor on the brush border of proximal tubular epithelial cells in WT DM mice,which was correlated with 24hUP (r=-0.645,P ＜ 0.01).Compared with the control mice,the expressions of caspase-1,IL-18 and A1AR were significantly increased in WT DM mice (P ＜ 0.05).For A1AR-/-DM mice,more serious pathological lesion and megalin defect,together with increasing of casapase-1 and heavier proteinuria were observed than those in WT DM mice.Conclusion A1AR may play a protective role in megalin expression of diabetic mice with early kidney disease,in which the mechanism may be associated with caspase-1 related pyroptosis pathway.The details need further exploration.

OBJECTIVE:To analyze the dyeing status of cinnabar and its pieces,and provide reference for its quality clinical safetey appicaton. METHODS:TLC was used for the qualitative identification of amaranth,carmine,erythrosine,acid red 73, 808 udan and indirubin. HPLC-MS was used to detect the 808 udan :HPLC conditions were as follows,column was Acquity UPLC BEH C18 with mobile phase of cetonitrile-0.1% formic acid(70∶30,V/V)at a flow rate of 0.3 ml/min,the detection wave-length was 520 nm;MS conditions were as follows,ion source was electrospray ionization source,scanning mode was positive ion scanning with full scanning tandem mass spectrometry,nebulizer pressure was 30 psi,drying gas was nitrogen,ion spray voltage was 4 000 V,collision energy was 30 V,and the injection volume was 5 μl. The volumetric method was used for content determi-nation of HgS. RESULTS:TLC spots of amaranth,carmine,erythrosine,acid red 73,808 udan and indirubin were clear and well-separated. 4 batches of 808 udan dyeing were included in the 18 batches of samples,6 batches had non-compliance contents (including 3 batches of 808 udan dyeing). CONCLUSIONS:Dyeing-doped and other quality problems exist in the cinnabaris in markets,which should be noticed.

Objeetive: To understand the recurrence of tuberculosis patients in Yunnan Province and its influencing factors,so as to provide scientific basis for the prevention and control of tuberculosis. Methods: Through the tuberculosis management information system, the data of successful treatment of tuberculosis cases in Yunnan Province in 2013 and the data of recurrent tuberculosis cases in Yunnan Province in 2014-2018 were collected. The recurrence rate,recurrence proportion and recurrence time of tuberculosis were analyzed, and the influencing factors of tuberculosis recurrence were analyzed by Cox multi factor proportional risk model. Results : A total of 9787 cases of tuberculosis were investigated. 385 cases recurred in 5 years, accounting for 3.94%. The recurrence rate was 0.73/100 person years. The recurrence interval [M （QR）] was 35.12 （28.57） months. The following are the risk factors for pulmonary tuberculosis recurrence：male（HR=1.297,95%CI：1.031~1.631）,secondary tuberculosis(HR=2.000,95%CI：1.088~3.676) in the 40-59 age group（HR=1.618,95%CI：1.036-2.528）, the retreatment（HR=1.566,95%CI：1.040-2.356）,positive of sputum culture（HR=4.048,95%CI：1.795-9.129）and sputum?smear positive（HR=1.569,95%CI：1.266-1.945）, cavitary pulmonary tuberculosis（ HR=1.382,95%CI：1.112-1.716）. Conclusion The recurrence rate of tuberculosis is low in Yunnnan province, and the risk of pulmonary tuberculosis recurrence is high in male, in the 40-59 age group,retreatment,positive of sputum culture only and sputum smear positive,patients with cavitary tuberculosis.

Objective To study the correlation between preoperative dye exclusion test and liver function in patients with primary hepatic carcinoma.Methods This was a cross sectional survey.A total of 192 cases of primary liver cancer patients were recruited from May 2014 to March 2015 at the Second Military Medical University Affiliated Eastern Hepatobiliary Surgery Hospital.Hereinto, 160 cases were male and 32 females, the male to female ratio was 5: 1.The age of the patients ranged from 26 to 72 years old, and the average age was 50.5 years old.ICG 15 minutes retention rate of ICG clearance test was determined by PDD method in 192 cases of primary liver cancer patients.ICGR15 value was stratified into three stages: ICGR15 ＜ 10％ , ICGR1510％-20％ , and ICGR15 ＞ 20％.The ICGR15 stage of patients with different ChildPugh grades was analyzed.The biological liver function indexes of patients were simultaneous detected including TBIL, TBA, TP, ALB, PA, ALT, AST, PT-INR, HA, LN, Ⅲ, Ⅳ, APRI, PLT etc.The correlations of ICGR15 and biological indexes of liver function were analyzed using Spearman nonparametric correlation analysis.Results (1) ICGR15 was positively correlated with Child-Pugh grade (r =0.477, P ＜ 0.01) in the 192 cases of HCC.The hierarchical analysis showed that there were significant differences between ICGR15 and different Child-Pugh grades (P ＜ O.05).(2) Child-Pugh classification and ICGR15 comparison further showed that, ICGR15 increased with Child-Pugh grade.While ICG plasma clearance rate (ICGK) and effective hepatic blood flow (EHBF) reduced (P ＜ 0.05).(3) The correlation analysis between ICGR15 and biological indexes of liver function showed that: ICGR15 was positively correlated with TBIL,TBA, ALT, AST, AFU, GGT, PT-INR, HA, LN, Ⅲ, Ⅳ and APRI index [(AST/ULN) × 100/ PLT (× 109/L)] (r =0.422, 0.389, 0.219, 0.301, 0.219, 0.244, 0.325, 0.652,0.403, 0.523, 0.519, 0.434, P ＜ 0.05);and was negatively correlated with TP, ALB, PA, SOD, WBC, PLT (r =-0.290,-0.532, 0.546, 0.531, 0.256, 0.327, P＜ 0.05).Conclusions ICGR15 as a indicator for liver reserved and dynamic function can comprehensively reflect the liver reserve function is associated with the existing Child-Pugh grades and liver function biochemical indexes.Therefore, ICGR15 could be served as a sensitive index reflecting the preoperative liver reserve function.

AIM: A new HPLC-MS method was developed to determine finasteride in human plasma. METHODS: Two formulations of finasteride tablets were given to 20 healthy male volunteers according to a randomized 2-way cross-over design. The samples were extracted by ethyl acetate under basic conditions, then were separated by C18 column and determined by mass detector. RESULTS: The calibration curve of finasteride was linear and intra-day and inter-day RSD were less than 10 %. The pharmacokinetics parameters of the two formulations (4.5 ± 0.5) h for t1/2; (3.0 ± 0.7) and (2.8 ± 0.9) h for tmax, respectively. The results indicated that there was no significant difference on cmax, A UC0-24, t1/2 or tmax values between the two formulations. CONCLUTION: The relative bioavailability of tablets I with respect to tablets Ⅱ is (99.3 ± 9.2) % by the A UC0-24 measurement, and bioe quivalence is observed between the two tablets.

Objective To investigate the effect of contrast-enhanced ultrasonography (CEUS) on the treatment of knee synovial lesions in rheumatoid arthritis (RA).Methods The results of routine ultrasonography (US) and CEUS were observed in 37 patients with RA.Among them 26 knees were underwent review after treatment.The results before and after treatment were compared.Results Routine US showed that the synovial thickness of patella,medial and lateral condylar and the depth of suprapatellar bursa effusion in 37 knee joints were (0.47 ± 0.26)cm,(0.31 ± 0.15)cm,(0.36 ± 0.21)cm and (0.72 ± 0.42)cm before treatment,and (0.36± 0.16)cm,(0.28 ± 0.17)cm,(0.30 ± 0.19)cm and (0.41 ± 0.19)cm in 26 knee joints after treatment,respectively,the differences were statistically significant(P ＜0.05).The synovial blood flow classification of patella,medial and the lateral condyle in the 26 knee joints had difference between before and after treatment (P ＜0.05).CEUS showed that the peak intensity decreased,the area under the curve reduced,the time from peak to one half decreased,the wash in slope decreased and the time to peak prolonged in synovial after treatment,the differences of the parameters between before and after treatment were statistically significant(P ＜0.05).The area of synovial had some influence on the CEUS parameters and could improve the reliability of the evaluation to CEUS for treatment.Conclusions CEUS is an objective method to evaluate the efficacy of RA,which provides a reliable basis for clinical treatment of RA.

objective To analyze the clinicopathological features and prognosis of antiglomerular basement membrane(GBM)disease,and evaluate the efficacy and safety of double filtration plasmapheresis(DFPP). Methods A total of 35 hospitalized patients diagnosed as anti-GBM disease in our department were enrolled in the study.All the patients were divided into 3 groups according to the manifestations at admission.Group Ⅰ∶24 patients with severe pulmonary hemorrhage or rapidly progressive glomerulonephritis(RPGN)received pulse methylprednisolone with or without DFPP,and then followed by prednisone and CTX.Group Ⅱ∶5 patients without severe pulmonary hemorrhage and RPGN received prednisone and CTX.Group Ⅲ∶5 ESRD patients and 1 normal renal function patient did not receive immunosuppression therapy.Anti-GBM antibody titer of pre-and post-DFPP in 4 patients was measured consecutively,and removal rate was calculated.Results The mean age of all the patients was(41.1±16.6)years.Sixteen patients(45.7%)presented Goodpasture's syndrome.Eighteen patients(51.4%)had anti-GBM glomerulonephritis alone,whereas one suffered solely from pulmonary hemorrhage.20%patients had positive P-ANCA serology.54.2%crescentic glomerulonephritis and 7 with other glomerulonephritis were revealed by kidney biopsy in 24 patients.Patients in Group Ⅰ showed more severe manifestation at admission:higher Scr level,higher titer of anit-GBM antibody,greater percentage of crescents.Within the follow-up period,7 patients died and kidneys of 50%patients survived.No patient died in Group Ⅱ and Ⅲ.The elder age,anemia,higher Scr(＞300 μmol/L),oliguria or anuria,emergency hemodialysis at admission,and more glomerular sclerosis were predictors of poor prognosis.The anti-GBM antibody was negative after 4 to 6 sessions of DFPP.and the mean removal rate was 55%.During total 94 DFPP sessions,there was no unacceptable morbidity. Conclusions Different therapy strategy is necessary for anti-GBM disease with different clinical manifestations.DFPP is an effective and safe clearance way of anti-GBM antibody.