Objective To explore the mechanism of IgA nephropathy(IgAN)caused by multi-glycosides of Tripterygium wilfordii(GTW)through the regulation of Silent information regulatory factor 1(SIRT 1)/nuclear transcription factor E2-related factor 2(Nrf 2)/antioxidant enzyme heme oxygenase 1(HO-1)signaling pathway.Methods Forty-five male SD rats were selected and randomly divided into two groups:the blank group(n=9)and the model group(n=36).In addition to the blank group,the BSA+CCl4+LPS group was used.At the end of 12 weeks,two rats were randomly selected for verification,and the model was successfully established.The 34 model rats were randomly divided into 3 groups:the model group(n=10),prednisone group(n=12),and GTW group(n=12).Urine,blood and kidney tissues were harvested 4 weeks after drug administration.Urinary erythrocyte number,24-h urinary protein quantification(24 h-UTP),alanine transaminase(ALT),serum albumin(ALB),urea nitrogen(BUN),and blood creatinine(SCr)were performed for each group;the protein expression of SIRT1,Nrf2,HO-1 and PINK1 was detected by Western blotting analysis;real-time polymerase chain reaction(RT-PCR)detection of SIRT1,Nrf2,HO-1 and PINK1 mRNA expression in rat kidney tissue;and detection of IgA deposition in the renal mesangial area by immunofluorescence.Kidney histopathological changes were observed in all the rats by hematoxylin-eosin(HE)staining.Results The results compared with those in the blank group,the urinary red blood cell count and 24 h-UTP,ALT,BUN,and SCr levels were significantly greater(P<0.01);The ALB level was significantly lower(P<0.01);renal tissue SIRT1,Nrf2,HO-1,PINK1 protein and mRNA expression were significantly lower(P<0.01);IgA deposition in the mesentery was obvious;renal pathological damage was severe;and the difference was statistically significant. Compared with those in the model group,urinary red blood cell counts and 24 h-UTP,ALT,BUN,and SCr levels in the prednisone and GTW groups were significantly lower (P<0.01);ALB levels were significantly greater (P<0.01);SIRT1,Nrf2,HO-1,PINK1 protein and mRNA expression were significantly greater (P<0.01);IgA deposition in the mesangial area was reduced,and renal pathology was improved,with statistically significant difference. Conclusions GTW may alleviate oxidative stress injury,protect renal function,and improve renal injury by activating the SIRT 1/Nrf 2/HO-1 signaling pathway.

Objective To explore the mechanism of IgA nephropathy(IgAN)caused by multi-glycosides of Tripterygium wilfordii(GTW)through the regulation of Silent information regulatory factor 1(SIRT 1)/nuclear transcription factor E2-related factor 2(Nrf 2)/antioxidant enzyme heme oxygenase 1(HO-1)signaling pathway.Methods Forty-five male SD rats were selected and randomly divided into two groups:the blank group(n=9)and the model group(n=36).In addition to the blank group,the BSA+CCl4+LPS group was used.At the end of 12 weeks,two rats were randomly selected for verification,and the model was successfully established.The 34 model rats were randomly divided into 3 groups:the model group(n=10),prednisone group(n=12),and GTW group(n=12).Urine,blood and kidney tissues were harvested 4 weeks after drug administration.Urinary erythrocyte number,24-h urinary protein quantification(24 h-UTP),alanine transaminase(ALT),serum albumin(ALB),urea nitrogen(BUN),and blood creatinine(SCr)were performed for each group;the protein expression of SIRT1,Nrf2,HO-1 and PINK1 was detected by Western blotting analysis;real-time polymerase chain reaction(RT-PCR)detection of SIRT1,Nrf2,HO-1 and PINK1 mRNA expression in rat kidney tissue;and detection of IgA deposition in the renal mesangial area by immunofluorescence.Kidney histopathological changes were observed in all the rats by hematoxylin-eosin(HE)staining.Results The results compared with those in the blank group,the urinary red blood cell count and 24 h-UTP,ALT,BUN,and SCr levels were significantly greater(P<0.01);The ALB level was significantly lower(P<0.01);renal tissue SIRT1,Nrf2,HO-1,PINK1 protein and mRNA expression were significantly lower(P<0.01);IgA deposition in the mesentery was obvious;renal pathological damage was severe;and the difference was statistically significant. Compared with those in the model group,urinary red blood cell counts and 24 h-UTP,ALT,BUN,and SCr levels in the prednisone and GTW groups were significantly lower (P<0.01);ALB levels were significantly greater (P<0.01);SIRT1,Nrf2,HO-1,PINK1 protein and mRNA expression were significantly greater (P<0.01);IgA deposition in the mesangial area was reduced,and renal pathology was improved,with statistically significant difference. Conclusions GTW may alleviate oxidative stress injury,protect renal function,and improve renal injury by activating the SIRT 1/Nrf 2/HO-1 signaling pathway.

Objective To explore the clinical value of enhanced recovery after surgery (ERAS) in the perioperative period of biliary surgery.Methods The prospective study was adopted.The clinical data of 800 patients diagnosed as benign biliary tract diseases who were admitted to the Cangzhou's Central Hospital from March 2011 to January 2015 were collected.Patients were randomly divided into the case and control groups by random sequence method.The patients of case group received the ERAS management and patients of the control group received traditional perioperative management.(1) Stress state evaluation:the insulin resistance (IR) index and level of serum C-reactive protein (CRP) were calculated.(2) Levels of inflammatory cytokines:levels of IL-6 and TNF-α in the 2 groups were detected by enzyme-linked immunosorbent assay (ELISA).(3)Nutritional status:level of serum prealbumin (PA) was detected.(4) Postoperative status:time to anal exsufflation,time of defecation,duration of hospital stay and treatment expenses were recorded.(5) Postoperative complications were observed.Measurement data with normal distribution were represented as x ± s and comparison between groups was analyzed using t test.Repeated measurement data were analyzed by the repeated measures ANOVA.Count data were represented as ratio and analyzed using the chi-square test.Results The 800 patients were screened for eligibility,including 400 in each group.(1) Stress state evaluation:the levels of IR and CRP from pre-operation to 7 days after operation were from 3.8 ± 0.8 to 3.7 ± 0.7 and from (18 ± 5) μg/L to (27 ±8) μg/L in the case group,from 3.9 ±0.9 to 3.8 ±1.0 and from (18 ±5) μg/L to (38 ±9) μg/L in the control group,respectively,with statistically significant differences in the changing trends (F =12.38,17.85,P ＜0.05).(2) Comparisons of levels of inflammatory cytokines:levels of IL-6 and TNF-α from pre-operation to 7 days after operation were from (9.3 ± 3.1) ng/L to (12.5 ± 2.8) ng/L and from (10.2 ± 3.5) ng/L to (12.8 ±3.3)ng/L in the case group,from (8.9 ±3.3)ng/L to (17.3 ±6.5)ng/L and from (9.9 ±2.8) ng/L to (14.3 ±4.2)ng/L in the control group,with statistically significant differences in the changing trends (F =19.93,15.74,P ＜ 0.05).(3) Comparison of nutritional status:level of PA from pre-operation to 7 days after operation was from (335 ± 53)mg/L to (332 ±50)mg/L in the case group and from (330 ± 49)mg/L to (331 ± 45)mg/L in the control group,with a statistically significant difference in the changing trends (F =4.46,P ＜ 0.05).(4)Comparisons of postoperative status:time to anal exsufflation,time of defecation,duration of hospital stay and treatment expenses were (30 ± 10)hours,(51 ± 13) hours,(7.7 ± 2.5) days,(10.2 ±2.3) × 103 yuan in the case group and (54 ± 8) hours,(70 ± 16) hours,(15.4 ± 3.1) days,(15.6 ± 4.7) × 103 yuan in the control group,with statistically significant differences (t =37.73,18.62,38.67,20.64,P ＜0.05).(5) Comparisons of postoperative complications:incidence of complications was 15.00％ (60/400)in the case group and 22.50％(90/400) in the control group,and the numbers of patients with incision infection,nausea and vomiting,abdominal infection,intra-abdominal infection,urinary tract infection,intro-abdominal hemorrhage and bile leakage were 23,15,8,5,4,3,2 in the case group and 30,20,13,10,7,5,5 in the control group,respectively,showing statistically significant differences in the incidence of complications (x2=7.39,P ＜ 0.05).Conclusion ERAS management in the perioperative period of biliary surgery is beneficial to postoperative recovery of patients,and it can also relieve postoperative stress state and inflammatory response,reduce the duration of hospital stay,treatment expenses and incidence of postoperative complications.