Rituximab is currently used as a first-line therapy for phospholipase A 2 receptor-associated membranous nephropathy due to its good efficacy and safety. Although the remission rate after rituximab treatment is more than 60%, nearly 40% patients still do not respond to treatment. We used obinutuzumab to treat 3 cases of rituximab resistant PLA 2R-associated membranous nephropathy. After the first dose of 1 000 mg with or without additional dose, the amount of anti-PLA 2R antibody and urinary protein decreased significantly and the adverse reactions were mild. The results show that obinutuzumab has a certain therapeutic effect on rituximab resistant PLA 2R-associated membranous nephropathy, but the time of follow-up observation is short and can only be used as individual cases, which needs to be confirmed by a large sample and high-quality prospective cohort study.

Objective:To evaluate the clinical efficacy of Wenyang Huoxue Jiedu Decoction combined with trimetazidine tablets in the treatment of patients with acute myocardial infarction (AMI) after interventional therapy.Methods:A total of 90 patients with AMI of syndrome of cold coagulation of heart vein after interventional surgery in the angshan Hongci Hospital , who met the inclusion criteria were enrolled between February 2020 and April 2021, and they were divided into two groups by the random number table method, with 45 in each group. The control group was given conventional western medicine treatments such as anti-coagulation, lipid regulation and oral administration of trimetazidine tablets, while the observation group adopted Wenyang Huoxue Jiedu Decoction on the basis of the control groups. Both groups were treated for 2 weeks. Before and after treatment, TCM symptoms were scored, and serum creatine kinase isoenzyme (CK-MB), cardiac troponin T (cTnT) and myoglobin (MYO) were detected by ELISA. Left ventricular ejection fraction (LVEF), stroke volume (SV) and left ventricular end-systolic diameter (LVESD) were detected by color ultrasonic instrument, and the clinical efficacy was evaluated. Results:The effective rate was 95.6% (43/45) in the observation group and that in the control group was 88.9% (40/45) ( χ2=1.39, P=0.238). The scores of excruciating pain in the chest, wheezing and incapability of supination, chest tightness and shortness of breath and palpitation in the observation group were significantly lower than those in the control group ( t=5.07, 3.43, 4.98, 5.15, P<0.01). After treatment, the levels of CK-MB [(47.62±8.31) U/L vs. (53.49±8.27) U/L, t=3.36], cTnT [(0.48±0.16) μg/L vs. (0.63±0.25) μg/L, t=3.39] and MYO [(125.47±25.63) μg/L vs. (163.28±30.17) μg/L, t=6.41] were significantly lower in the observation group compared to the control group ( P<0.01). The LVESD [(42.15±7.04) mm vs. (46.03±7.26) mm, t=2.57] in the observation group after treatment was significantly lower than that of the control group ( P<0.05), while the LVEF [(56.73±8.34)% vs. (52.49±8.26)%, t=2.42] and SV [(71.58±4.31) ml vs. (65.47±4.23) ml, t=6.79] were significantly higher than those in the control group ( P<0.05 or P<0.01). Conclusion:Wenyang Huoxue Jiedu Decoction combined with trimetazidine tablets can improve the cardiac function, alleviate the myocardial injury, relieve symptoms of patients with AMI of syndrome of cold coagulation of heart vein after interventional surgery.

Objective:To evaluate the clinical effect of embolization of congenital parotid arteriovenous fistula(AVF) using coils and absolute ethanol.Methods:From January 2015 to December 2019, 8 patients with congenital AVF in parotid region were admitted to the Department of Interventional Radiology Shanghai Ninth People’s Hospital. AVF was confirmed by angiography of common carotid artery and vertebral artery through femoral artery puncture with Seldinger technique. Using coaxial microcatheter to reach the fistula via artery or using direct percutaneous puncture to reach the dilated vein and introduced microcatheter to the fistula via puncture needle. Combined detachable coils with fiber coils, and used absolute ethanol to occlude the fistula. Then the outcome was evaluated.Results:There were 7 males and 1 female involved in this study. The average age was 28.5 years (3-58 years). All of the 8 patients were confirmed AVF in parotid region by angiography, five on the right and three on the left. The feeder artery was external carotid artery, and the outflow vein was external jugular vein. Among them, 6 patients used coaxial microcatheter to reach the fistula via artery, 2 patients used direct percutaneous puncture after failure via transarteral approach. All the 8 patients were treated with absolute ethanol, the total amount of which was 17.4 ml on average. After embolization, the external carotid angiography demonstrated that the fistula was completely occluded, the branches of the external carotid artery at the distal end of the fistula were normal, and there was no obvious reflux vein. After the operation, all the patients had no pulsation and tremor. The external jugular vein dilation disappeared in 4 patients. One patient had temporary facial paralysis on the same side of the operation area. The symptoms disappeared three days after treatment. This patient had undergone coils exposed three months after operation. After local debridement, the exposed coils were removed and the wound healed. The 8 patients were followed up for 6-12 months without recurrence.Conclusions:Embolization with coils combined with absolute ethanol is safe and affective treatment for congenital parotid AVF.

Objective:To evaluate the clinical effect of embolization of congenital parotid arteriovenous fistula(AVF) using coils and absolute ethanol.Methods:From January 2015 to December 2019, 8 patients with congenital AVF in parotid region were admitted to the Department of Interventional Radiology Shanghai Ninth People’s Hospital. AVF was confirmed by angiography of common carotid artery and vertebral artery through femoral artery puncture with Seldinger technique. Using coaxial microcatheter to reach the fistula via artery or using direct percutaneous puncture to reach the dilated vein and introduced microcatheter to the fistula via puncture needle. Combined detachable coils with fiber coils, and used absolute ethanol to occlude the fistula. Then the outcome was evaluated.Results:There were 7 males and 1 female involved in this study. The average age was 28.5 years (3-58 years). All of the 8 patients were confirmed AVF in parotid region by angiography, five on the right and three on the left. The feeder artery was external carotid artery, and the outflow vein was external jugular vein. Among them, 6 patients used coaxial microcatheter to reach the fistula via artery, 2 patients used direct percutaneous puncture after failure via transarteral approach. All the 8 patients were treated with absolute ethanol, the total amount of which was 17.4 ml on average. After embolization, the external carotid angiography demonstrated that the fistula was completely occluded, the branches of the external carotid artery at the distal end of the fistula were normal, and there was no obvious reflux vein. After the operation, all the patients had no pulsation and tremor. The external jugular vein dilation disappeared in 4 patients. One patient had temporary facial paralysis on the same side of the operation area. The symptoms disappeared three days after treatment. This patient had undergone coils exposed three months after operation. After local debridement, the exposed coils were removed and the wound healed. The 8 patients were followed up for 6-12 months without recurrence.Conclusions:Embolization with coils combined with absolute ethanol is safe and affective treatment for congenital parotid AVF.

Objective To investigate the treatment and prognosis of spinal giant cell tumors recurrence after total spondylectomy.Methods Between February 2001 and February 2016,five female patients suffered from spinal giant cell tumors recurrence after total spondylectomy were retrospectively analyzed.They underwent total spondylectomy with an age ranging from 17 to 63 years old (average 32.6 years).Four cases were primary cases and 1 was recurrent case at the first time of visit.Tumors were located in the thoracic vertebrae in 3 cases,including 1 case in T10 and 2 cases in T11.Tumors were involved in lumbar vertebrae in 2 cases,which were L2 and L5,respectively.According to Tomita spinal tumor classification,all cases were type 5.The Frankel classification for spinal cord injury was grade A in 1 case,grade C in 1 case,grade D in 1 case and grade E in 2 cases.Reoperation was introduced to treat the recurrent tumors after total spondylectomy with adjuvant radiotherapy and drug.The effect of tumor therapy,postoperative complications,nerve function and so on were observed in follow-up.Results One patient was treated with total en bloc spondylectomy (TES) and 4 patients was treated with piecemeal total spondylectomy.The operative approach was onestage posterior approach in 4 patients and combined antero-posterior approach in 1 patient.One patient received radiotherapy and 1 patient was treated with bisphosphonate post operation.The spinal cord function recovered to grade D in 1 patient and grade E in 4 patients.The average interval of recurrence after total spondylectomy was 12-57 months (average 29.6 months).At the second visit,the Frankel classification was grade C in 1 patient.Grade D and grade E were in 2 patients,respectively.Three patients were treated with reoperation to resect the tumors.One patient received radiotherapy and another one was untreated.All 5 patients were followed up with 47-196 months (average 108 months).Four patients survived without tumor and 1 patient without treatment for recurrence survived with tumor.Two patients occurred internal fixation fractures were treated with revision surgery.One of the patients had postoperative spinal canal infection and was cured after internal fixation removal,irrigating and drainage,and antibiotic treatment.The loosening screw in 1 patient was fixed again.Two patients suffered from obvious titanium mesh subsidence (＞ 5 mm).In the last follow-up,there were 1 patients with Frankel grade A,1 with grade D and 3 with grade E.Conclusion Active reoperation combined with radiotherapy and drugs therapy can significantly improve the prognosis of patients with recurrent spinal giant cell tumors after total spondylecmy.

Objective To observe effectiveness of Chinese herbal fumigation therapy combined with six-step knee-release massage on patients with knee osteoarthritis. Methods 80 cases with knee osteoarthritis were randomly divided into a treatment group and a control group, 40 in each. The treatment group was given Chinese herbal fumigation therapy combined with six-step knee-release massage, while the control group was treated only by six-step knee-release massage. 20 days of treatment was considered as 1 course, after which major symptoms and signs were observed and X-ray examination was applied to determine the curative effect. Results① As for clinical effectiveness, the total effective rate was 92.5%in the treatment group and 70%in the control group. There was statistical difference between two groups(χ2=11.087, P<0.01). ② HSS scores showed that , except quadriceps strength(t=2.082, P>0.05),there was statistical difference in terms of pain, functionality, motion, fixed deformity, stability, subtractions and total score between two groups(t values were 8.081, 10.977, 3.846, 9.450, 9.611, 9.450, 15.984 respectively, P<0.01). Conclusion Chinese herbal fumigation therapy combined with six-step knee-release massage could effectively relieve clinical symptoms like joint pain, morning stiffness and inflexibility. It is worth popularizing in clinical treatment of knee osteoarthritis.

Objective To explore the characteristics of blood oxygen level dependent (BOLD) magnetic resonance imaging (MRI) in healthy native kidneys. To investigate the relationship between BOLD-MRI and common physiological in-dexes. Methods GE 3.0T MRI scanner and Torsopa phased-array coil were employed to acquire renal coronal T1WI and BOLD image. Ninety patients who were ruled out chronic kidney diseases underwent BOLD-MRI with T2*-spoiled gradient recalled echo (T2*SPGR) sequence. BOLD images were analyzed on R2*map software. Cortical and medullary R2*values were analyzed in bilateral kidneys and in different gender. Different regional R2*values in cortex and medulla were also ana-lyzed. Physiological indices including age, body height and weight, body mass index (BMI), body surface area (BSA), estimat-ed glomerular filtration rate (eGFR) were recorded. Correlation between R2*value and physiological indices were analyzed. Results Bilateral renal cortical R2*values [left (16.56±1.40) Hz and right (16.66±1.28)Hz, respectively] were less than val-ues in medulla [left (28.82±3.71)Hz and right (28.36±3.72)Hz, respectively]. Female and male cortical R2*values [female (16.55±1.30Hz) and male (16.66±1.38)Hz, respectively] were also less than corresponding values in medulla [female (28.46± 3.64) Hz and male (28.70±3.78) Hz, respectively]. In bilateral renal medullary region, R2*values in low pole (27.29±3.05) Hz was less than values in middle (29.32±3.47) Hz and upper pole (29.16±4.21)Hz (F=15.184, P<0.001). Age was positive-ly correlated with R2* values in medulla (r =0.284, P =0.002). However, eGFR was negatively correlated with medullary R2*value (r=-0.232, P=0.007). Conclusion R2*values reflected the levels of renal partial pressure of oxygen and as-sessed the degree of renal ischemia. BOLD MRI could offer a simple, convenient and noninvasive method for to evaluate renal oxygen metabolism in cortex and medulla.

Objective To summarize the diagnosis and treatment strategy of the retroperitoneal fibrosis(RPF)associated with hydronephrosis.Methods The clinical data of 26 RPF cases treated from Jan.2005 to Mar.2012 were analyzed retrospectively.Early symptoms mainly included lumbar,flank,abdominal pain,nausea and vomit.Retroperitoneal mass was found in 12(46.2％)cases by ultrasonography,while in 23(88.5％)cases by CT.Results Ureterolysis with intra-peritoneal transposition was underwent in 10 cases who were followed up for 6-25 months,and no relapse was found.Ureterocystostomy was underwent in 1 cases for difficulty in ureterolysis who was followed up for 45 months,and no relapse was found.D-J stent inter-ureter drainage was performed in 15 cases,all of whom had replaced the D-J stent discontinuously except that 2 cases had ceased replacement successfully,and all of the obstruction were relieved during the follow-up period for 16-84 months post-operatively.Conclusions Retroperitoneal mass can be found by CT of abdomen effectively.The therapeutics should depend on the pathological condition of the retroperitoneal mass.Obstruction can be relieved effectively by both ureterolysis with intraperitoneal transposition and D-J stent inter-ureter drainage and replacement.The complication occurred in the replacement of D-J can be relieved or eliminated by all kinds of measures.The unimpaired kidney drainage should be paid attention in the follow-up.

Objective To establish the quality standard for Fufang Xiongdan Yinchen Granule. Methods TLC was employed to identify Pulvis ellis urs, Capillary Wormwood Herbin, Atractylodis Macrocephalae Rhizoma and Glycyrrhizae Radix, and HPLC was used to determine the content of sodium tauroursodeoxycholic acid in Fufang Xiongdan Yinchen Granule. Kromail 100-5 C18 column (4.6 mm× 250 mm, 5 μm) in an oven at 25 ℃ was need, with a mobile phase consisting of methanol-0.03 mol/L sodium dihydrogen phosphate solution (60∶40, pH=4.4) and UV detector at 210 nm, the flow rate was 1.0 mL/min. Results Pulvis ellis urs, Capillary Wormwood Herbin, Atractylodis Macrocephalae Rhizoma and Glycyrrhizae Radix can be detected by TLC. The linearity of sodium tauroursodeoxycholic acid was obtained in the range of 0.182 1-1.821 mg (r=0.999 98). The average recovery was 100.39%, and RSD was 1.70% (n=6). Conclusion The method is simple, accurate, specific, and can control the quality of Fufang Xiongdan Yinchen Granule effectively.

The quality control of traditional Chinese medicine (TCM) preparations is a key issue related to their curative effect, safety and stability. The application of modern analytical means and the development of new disciplines improve the quality control of TCM preparations to some extent. For a long time, however, the quality control level of TCM preparations remains low and the quality standards exist in name only unable to effectively control drug quality and ensure therapeutic effect and safety. The essay makes a systematic analysis on possible factors impacting TCM preparations and current situation of quality control and discusses possible approaches and new methods for improving quality control of TCM preparations, in order to give an impetus to the quality control standards and the mode evolvement of TCM preparations and ensure safety, efficiency and quality controllability of TCM preparations.
Drugs, Chinese Herbal ; Medicine, Chinese Traditional ; methods ; Quality Control