Objective:To investigate the association between serum IgG concentration and renal prognosis in patients with IgA nephropathy (IgAN).Methods:It was a multi-center retrospective cohort study, patients with biopsy proven primary IgAN who were recorded in the Chinese IgA Nephropathy Information Registration System between April 1996 and September 2018 were included. Exclusion criteria were: (1) age <18 years; (2) <8 glomeruli in biopsy specimens; (3) estimated glomerular filtration rate (eGFR) <15 ml·min -1·(1.73 m 2) -1 at biopsy; (4) missing baseline serum IgG values; (5) incomplete follow-up data; (6) follow-up duration <12 months. Enrolled patients were divided into 3 groups according to the baseline tertiles of serum IgG: ≤9.50 g/L (G1 group), 9.51-11.99 g/L (G2 group), and ≥12.00 g/L (G3 group). Clinical, and pathological parameters were compared across groups. The endpoint events were defined as doubled serum creatinine level from baseline, or end-stage renal disease (ESRD). Results:A total of 1 976 IgAN patients were included in this study, 631 were in G1 group, 664 in G2 group, and 681 in G3 group. The comparison of baseline clinical data showed that there were statistically significant differences among the three groups in terms of gender, age, microscopic hematuria, edema, body mass index, systolic blood pressure, diastolic blood pressure, hemoglobin, serum creatinine, eGFR, 24-hour urine protein quantity, blood uric acid, blood albumin, serum IgA, serum IgM, the proportion of using immunosuppressants, and the proportion of using glucocorticoids (all P<0.05). In terms of pathology, the higher the serum IgG concentration, the relatively less severe the overall renal pathological damage. The results of univariate Cox regression analysis showed that gender, systolic blood pressure, diastolic blood pressure, hemoglobin, serum creatinine, eGFR, 24-hour urine protein quantity, total protein, serum albumin, globulin, serum IgG, Oxford renal pathological classification, glomerular sclerosis ratio, and glomerular IgM deposition were all associated with the occurrence of renal endpoint events (all P<0.05). Based on clinical practice and previous studies, after adjusting for gender, age, systolic blood pressure, diastolic blood pressure, eGFR, 24-hour urine protein quantity, body mass index, Oxford renal pathological classification, glomerular sclerosis ratio, and the use of renin-angiotensin-aldosterone system inhibitors, glucocorticoids, and immunosuppressants, multivariate Cox regression analysis showed that as a continuous variable, the baseline serum IgG level ( HR=0.91, 95% CI 0.87-0.96) was independently associated with the risk of renal endpoint events in IgAN patients; as a categorical variable, with serum IgG ≤ 9.50 g/L as the reference, serum IgG 9.51-11.99 g/L and serum IgG ≥ 12.00 g/L were independent factors for the occurrence of renal endpoint events in IgAN patients ( HR=0.69, 95% CI 0.49-0.96, P=0.027; HR=0.50, 95% CI 0.34-0.74, P<0.001). During a median follow-up of 33(21, 53) months started from the date of renal biopsy and continued until December 31, 2019, the median follow-up duration was 33 (21, 53) months, and a total of 232 patients (11.74%) reached the composite endpoint. Kaplan-Meier survival analysis showed that the higher the serum IgG concentration in patients with IgAN, the higher their cumulative renal survival rate (Log-rank test, χ2=47.176, P<0.001). Conclusion:The higher level of serum IgG at diagnosis is associated with better clinicopathologic features and renal outcomes, and may portend better renal survival in IgAN patients.

Objective:To investigate the association between serum IgG concentration and renal prognosis in patients with IgA nephropathy (IgAN).Methods:It was a multi-center retrospective cohort study, patients with biopsy proven primary IgAN who were recorded in the Chinese IgA Nephropathy Information Registration System between April 1996 and September 2018 were included. Exclusion criteria were: (1) age <18 years; (2) <8 glomeruli in biopsy specimens; (3) estimated glomerular filtration rate (eGFR) <15 ml·min -1·(1.73 m 2) -1 at biopsy; (4) missing baseline serum IgG values; (5) incomplete follow-up data; (6) follow-up duration <12 months. Enrolled patients were divided into 3 groups according to the baseline tertiles of serum IgG: ≤9.50 g/L (G1 group), 9.51-11.99 g/L (G2 group), and ≥12.00 g/L (G3 group). Clinical, and pathological parameters were compared across groups. The endpoint events were defined as doubled serum creatinine level from baseline, or end-stage renal disease (ESRD). Results:A total of 1 976 IgAN patients were included in this study, 631 were in G1 group, 664 in G2 group, and 681 in G3 group. The comparison of baseline clinical data showed that there were statistically significant differences among the three groups in terms of gender, age, microscopic hematuria, edema, body mass index, systolic blood pressure, diastolic blood pressure, hemoglobin, serum creatinine, eGFR, 24-hour urine protein quantity, blood uric acid, blood albumin, serum IgA, serum IgM, the proportion of using immunosuppressants, and the proportion of using glucocorticoids (all P<0.05). In terms of pathology, the higher the serum IgG concentration, the relatively less severe the overall renal pathological damage. The results of univariate Cox regression analysis showed that gender, systolic blood pressure, diastolic blood pressure, hemoglobin, serum creatinine, eGFR, 24-hour urine protein quantity, total protein, serum albumin, globulin, serum IgG, Oxford renal pathological classification, glomerular sclerosis ratio, and glomerular IgM deposition were all associated with the occurrence of renal endpoint events (all P<0.05). Based on clinical practice and previous studies, after adjusting for gender, age, systolic blood pressure, diastolic blood pressure, eGFR, 24-hour urine protein quantity, body mass index, Oxford renal pathological classification, glomerular sclerosis ratio, and the use of renin-angiotensin-aldosterone system inhibitors, glucocorticoids, and immunosuppressants, multivariate Cox regression analysis showed that as a continuous variable, the baseline serum IgG level ( HR=0.91, 95% CI 0.87-0.96) was independently associated with the risk of renal endpoint events in IgAN patients; as a categorical variable, with serum IgG ≤ 9.50 g/L as the reference, serum IgG 9.51-11.99 g/L and serum IgG ≥ 12.00 g/L were independent factors for the occurrence of renal endpoint events in IgAN patients ( HR=0.69, 95% CI 0.49-0.96, P=0.027; HR=0.50, 95% CI 0.34-0.74, P<0.001). During a median follow-up of 33(21, 53) months started from the date of renal biopsy and continued until December 31, 2019, the median follow-up duration was 33 (21, 53) months, and a total of 232 patients (11.74%) reached the composite endpoint. Kaplan-Meier survival analysis showed that the higher the serum IgG concentration in patients with IgAN, the higher their cumulative renal survival rate (Log-rank test, χ2=47.176, P<0.001). Conclusion:The higher level of serum IgG at diagnosis is associated with better clinicopathologic features and renal outcomes, and may portend better renal survival in IgAN patients.

Four unreported monoterpene indole alkaloids, tabernaecorymines B-E (1-4), together with twenty-one known indole alkaloids (5-25) were obtained from the stem bark of Tabernaemontana corymbosa. Their structures and absolute configurations were elucidated by extensive spectroscopy, quantum chemical calculations, DP4+ probability analyses and Mo₂(OAc)₄-induced electronic circular dichroism experiment. The antibacterial and antifungal activities of these compounds were evaluated and some of them showed significant activity against Staphylococcus aureus,Bacillus subtilis, Streptococcus dysgalactiae and Candida albicans.
Tabernaemontana ; Anti-Infective Agents ; Antifungal Agents ; Anti-Bacterial Agents ; Indole Alkaloids

Objective:To evaluate the effect of sodium bicarbonate Ringer′s solution on acute kidney injury(AKI) following laparoscopic hepatectomy in elderly patients.Methods:A total of 362 American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ elderly patients, aged 65-79 yr, with body mass index of 18-28 kg/m 2, scheduled for elective laparoscopic hepatectomy, were divided into 2 groups( n=181 each) using a random number table method: bicarbonate Ringer′s solution group(BR group) and lactated Ringer′s solution group(LR group). Bicarbonate Ringer′s solution and lactated Ringer′s solution were intravenously infused in BR group and LR group, respectively. All operations were performed under general anesthesia combined with abdominal fascia block, and the methods of controlled low central venous pressure and intermittent hepatic inflow occlusion were applied to reduce intraoperative bleeding. Radial artery blood samples were collected for blood gas analysis at 5 min before anesthesia induction(T 0), 20 min after occluding liver hilus(T 1), 10 min after hepatectomy and hemostasis(T 2), at the end of surgery(T 3) and at postanesthesia care unit discharge(T 4), and lactate value(Lac) was recorded. Blood samples from cubital vein were collected on admission to hospital(T A) and at 24(T 24) and 48 h after operation(T 48) for determination of serum creatinine(Cr) concentrations. Doppler-based renal resistive index(RRI) was measured at T A, T 4, T 24 and T 48. The incidence of AKI was calculated within 48 h after operation according to the Kidney Disease: Improving Global Outcomes criteria in 2012 for Cr concentration. Adverse reactions(such as nausea and vomiting) and complications(such as incision infection) within 48 h after operation were recorded. Results:Compared with the baseline at T 0, Lac concentrations were significantly increased at T 1-4 in both groups( P<0.01). Cr concentrations were significantly increased at T 24 and T 48, and RRI was increased at T 4, T 24 and T 48 than at T A in both groups( P<0.01). Compared with group LR, the incidence of AKI within 48 h after operation, Lac concentrations at T 3, 4, Cr concentrations at T 24 and T 48, and RRI at T 4, T 24 and T 48 were significantly decreased in group BR( P<0.05 or 0.01). There was no significant difference in the incidence of nausea, vomiting, incision infection, delirium, bile leakage and pulmonary infection within 48 h after operation among the two groups( P>0.05). Conclusions:Sodium bicarbonate Ringer′s solution can decrease the development of AKI following laparoscopic hepatectomy in elderly patients.

Objective:To analyze the correlations between the prognosis of patients with pancreatic cancer and macrophage infiltration, and to find the differential gene correlated with macrophage infiltration in patients with pancreatic cancer through bioinformatics.Methods:A total of 32 patients with pancreatic cancer admitted to the First Hospital of Lanzhou University from June 2015 to December 2018 were selected as the research objects, including 19 males and 13 females, with the age of (61.8±2.8) years. Cancer tissues, adjacent tissues, and related clinical data were collected. F4/80 (macrophage marker) immunohistochemical staining was performed on the samples. The survival time was followed up and its correlation with the above indexes was analyzed. The pancreatic cancer data from The Cancer Genome Atlas (TCGA) database was used for bioinformatics analysis.Results:The survival time of pancreatic cancer patients was negatively correlated with degree of macrophage infiltration in cancer tissues ( r=-0.522, P=0.002), but not with adjacent tissues ( r=0.168, P=0.358). The degree of macrophage infiltration in cancer tissue combined with preoperative serum carbohydrate antigen 19-9 (CA19-9), tumor TNM stage and vascular invasion can predict survival up to 47.4% of the survival time ( R2=0.474). TCGA database bioinformatic analysis showed that in pancreatic cancer there were 95 differentially expressed genes significantly correlated with M2 macrophage infiltration, among which JPH3 (positive correlation) and IL17REL (negative correlation) were the main genes. Conclusion:The degree of macrophage infiltration in cancer tissue can be used as a prognostic factor for patients with pancreatic cancer, and the combination with preoperative serum CA19-9, tumor TNM stage and vascular invasion is more accurate in predicting the prognosis. The related mechanism of M2 macrophage infiltration can be studied around the differential genes such as JPH3 and IL17REL.

Objective: To study the antidepressant effects of extracts fromZanthoxylum bungeanumandZanthoxylum schinifoliumin mice exposed in chronic restraint stress. Methods: 45 mice of SPF male ICR were randomly divided into five groups: normal group, model group, sertraline hydrochloride group,Zanthoxylum bungeanumextract group andZanthoxylum schinifoliumextract group, with 9 mice in each group. Except for the normal group, mice in all groups were chronically restrained to establish the depressive model. The normal group and model group were given olive oil by intragastric administration, and other groups were given sertraline hydrochloride(10 mg/kg),Zanthoxylum bungeanumextract(200 mg/kg) andZanthoxylum schinifoliumextract(200 mg/kg), respectively. The behaviors of mice in each group were evaluated by open-field test and forced swimming test. The levels of brain-derived neurotrophic factor(BDNF), 5-hydroxytryptophan(5-HT), glutathione(GSH) and nitric oxide(NO) in serum and brain were determined by ELISA. Results: Compared with model group,Zanthoxylum bungeanumextract could reduce the percentage of immobility time in forced swimming test, increase the level of cortical BDNF, and improve the levels of 5-HT and GSH in cortex and serum, with statistical significance(P<0.05).Zanthoxylum schinifoliumextract could improve the behavior of mice in open field test and forced swimming test, increase the levels of cortex 5-HT and serum GSH, and decrease the contents of NO in serum and cortex. Conclusion The extracts ofZanthoxylum bungeanumandZanthoxylum schinifoliumcan improve the depression-like behaviors of mice exposed to chronic restraint stress.

OBJECTIVE： To study the effects of ivermectin on the migration and invasion of human gastric cancer cell lines BGC-823 and MGC-803 and its mechanism. METHODS： After treated with 0， 2.5， 5， 10， 20， 40 μmol/L ivermectin for 24 h， inhibitory rate of human gastric cancer cell lines BGC-823 and MGC-803 were detected by MTT assay. Effects of 5 μmol/L ivermectin and phosphate buffercontaining 0.67‰ dimethyl sulfoxide （control group） for 24 h on the migration and invasion of` gastric cancer cells BGC-823 and MGC-803 were observed by Transwell chamber invasion assay.Western blot assay was used to detect the protein expression of TGF-β1， TGF-βR， Smad2 and Smad3 in epithelial-mesenchymal transition （EMT） markers E-cadherin， N-cadherin， Vimentin， Snail and EMT transduction pathway TGF-β/smad of BGC-823 and MGC-803 cells after treated with 5， 10 μmol/L ivermectin and phosphate buffercontaining 0.67‰ dimethyl sulfoxide （control group） for 24 h. RESULTS： Ivermectin could inhibit the growth of BGC-823 and MGC-803， inhibitory rate of it was positively correlated with its concentration. Compared with control group， the number of migration and invasion BGC-823 and MGC-803 cells were decreased significantly after treated with 5 μmol/L ivermectin （P＜0.01 or P＜0.001）； the expression of E-cadherin protein was enhanced significantly in BGC-823 and MGC-803 cells after treated with 5 and 10 μmol/L ivermectin （P＜0.05 or P＜0.01 or P＜0.001）； the protein expression of N-cadherin， Vimentin， Snail， TGF-βR， Smad2 and Smad3 were decreased significantly （P＜0.05， P＜0.01 or P＜0.001）； protein expression of TGF-β1 was decreased significantly after treated with 10 μmol/L ivermectin （P＜0.05）. CONCLUSIONS： Ivermectin can significantly inhibit the migration and invasion of gastric cancer cells BGC-823 and MGC-803， and inhibiting the biological activity of EMT by reducing the expression of TGF-β/smad pathway is one of the mechanisms that inhibit the migration and invasion of gastric cancer cells.

Objective To investigate the protective effects of stilbene glycoside(2,3,5,4'-tetrahydroxy-stilbene-2-O-β-D-glucoside,TSG) on 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced mice model of Parkinson's disease(PD).Methods Mice were randomly divided into the blank control group,the negative control group,the TSG high-dose group,the TSG low-dose group and the positive drug group(n=20 each).Mice were weighted daily to observe the changes of body weight,and mice motor and behavior function were tested by open field test.Level changes of α/β synuclein in brain cortex,cerebellum,midbrain,and hippocampal were detected by Western blot.Results Compared with the blank control group,the negative control group showed that the body weight was decreased (P ＜ 0.05).Compared with the negative control group,the body weight was increased in the TSG high-and low-dose groups and the positive drug group (P ＜ 0.05).The spontaneous behavior was impaired in the negative control group.Compared with the blank control group,the negative control group showed that the open field test showed traveled distance over a 10-min period was significantly shortened at 1 st,7th,28th days after testing(all P＜0.05).The trajectory of motor axons indicated that mice in the negative control group showed dyskinesia,but the groups of positive drug and high-and low-dose of TSG could reverse this dyskinesia.Compared with the blank control group,brain α/β synuclein protein levels were increased in the negative control group,and decreased in positive drug and TSG high-and low-dose groups (P ＜0.05).Conclusions Stilbene glycosides exert neuroprotective effects in MPTP-induced mice model of PD.

Objective To investigate the clinical value of preset balloon in abdominal aorta in assisting cesarean section for patients with placenta previa complicated by placenta accreta.Methods Preset balloon in abdominal aorta was performed in 72 patients with placenta previa complicated by placenta accreta before cesarean section was carried out.Of the 72 patients,pernicious placenta previa (type A) was seen in 33,scar uterus,placenta previa with placenta accreta (type B) in 36 patients,and placenta previa complicated by placenta accreta with no cesarean section history (type C) in 3.The amount of blood loss during cesarean section,the course of uterine resection,the X-ray radiation dose in performing placement of balloon,and the procedure-related complications were recorded.Results The average amount of intraoperative blood loss in type A,B and C group was 1461 ml,947 ml and 533 ml,respectively.Subtotal hysterectomy was adopted in 9 patients and uterine repair in 32 patients.The average radiation doses in 17 patients who received preset balloon procedure in 2015 and in 55 patients who received preset balloon procedure in 2016 were (28.5±14.1) mGy and (3.7±2.5) mGy,respectively.During hospitalization period,one patient developed right superficial femoral artery thrombosis,one patient developed venous thrombosis of right lower extremity,and subcutaneous hematoma occurred in two patients.Conclusion Temporary occlusion of the abdominal aorta with preset balloon to assist the cesarean section for patients with placenta previa complicated by placenta accreta can effectively reduce the amount of intraoperative blood loss and markedly reduce hysterectomy rate.The procedure of preset balloon is simple,and the X-ray exposure time is short.Skilled and experienced manipulation can further reduce the incidence of complications.

Objective To explore the efficacy and safety of minimal invasive adrenal sparing surgery for the treatment of Cushing syndrome caused by adrenocortical adenoma.Methods Patients who underwent minimal invasive adrenal surgery for adrenocortical adenoma in our institution from January 2010 to December 2015 were retrospectively analyzed.Preoperative, intraoperative, and postoperative variables were reviewed from the database.The mean patient age at diagnosis was 39 years and male:female ratio was 10:111.Of the 121 adenomas, 50 were located in the right adrenal and 71 in the left.The mean tumor size was 2.6 cm.84 cases had hypertension (69.4％), 36 cases had diabetes mellitus (29.8％), and 45 cases had obesity (37.2％).Postoperative follow-up was performed by evaluating adrenal gland function and imaging.Results Mininal invasive partial adrenalectomy was performed in 121 cases and the success rate of operation was 99.2％ (120/121).Sixty-two cases received operation through retroperitoneal approach,and 59 cases were through transperitoneal approach.The median operative time was 50 min with a median blood loss of 50 ml.The mean postoperative hospital stay were (5.0 ± 3.2) days.The vascular injury occurred in 2 cases (1 case in each surgical approach), while the abdominal organ injury occurred in 2 cases with 1 case of spleen injury and 1 case of liver injury (both in transperitoneal approach).Postoperative complications were observed in 6 cases:1 case of deep venous thrombosis, 1 case of wound hematoma, 4 cases of wound infection.Cortisol substitution was given in 2 to 12 months (mean 6.2 months)postoperatively.One year after operation, the remission rate of hypertension, diabetes and obesity was 58.3％ (49/84), 30.6％ (11/36) and 60.0％ (30/45), respectively.Conclusions Minimal invasive adrenal surgery using retroperitoneal and transperitoneal laparoscopic technique can be performed with low morbidity and achieve an excellent outcome.The perioperative hormone therapy may also play an important role.