Objective To investigate the efficacy of decompressive craniectomy (DC) combined with ipsilateral external ventricular drainage (iEVD) for severe traumatic brain injury (sTBI). Methods A retrospective case control study was performed on the clinical data of 54 sTBI patients admitted to the First People's Hospital of Taizhou from January 2015 to March 2018. There were 38 males and 18 females, aged 18-72 years [ (51. 8 ± 15. 4)years]. The Glasgow Coma Scale (GCS) of patients ranged from 3 to 8 points. Among 54 patients, 27 received DC treatment, including 18 males and nine females aged (50. 1 ± 2. 9)years (DC group);27 patients received DC combined with iEVD, including 18 males and nine females aged (53. 4 ± 3. 1) years (DC-iEVD group). Intracranial pressure after surgery and complications ( hydrocephalus and subdural hygroma) 2 weeks after surgery, andModified Rankin Scale (mRS) 3 months after surgery were compared between the two groups. Results All patients were followed up for 2.5-4 months [(3.0 ±0.8)months]. No significant difference was found in intracranial pressure at postoperative 12 hours and 24 hours between the two groups (P>0. 05). However, the intracranial pressure of DC-iEVD group were significantly lower than those of DC group at 36, 48, 60 and 72 hours after operation (P<0. 05). The hydrocephalus incidence 2 weeks after surgery of DC-iEVD group was 15％ (4/27), while that of DC group was 7％ (2/27)(P >0. 05). The subdural effusion incidence 2 weeks after surgery of DC-iEVD group was 19％ (5/27), while that of DC group was 44％ (12/27) (P<0. 05). According to mRS, patients with good outcome in DC-iEVD group accounted for 63％(17/27) while the ratio was 44％ (12/27) in DC group. The prognosis of DC-iEVD group was slightly better than that of DC group, but the difference was not statistically significant(P>0. 05). Conclusion For sTBI, combined use of DC and iEVD can better control intracranial pressure and reduce the occurrence of subdural effusion.

Objective To investigate the effect of pyrin domain 3 (NLRP3) inflammasome in the process of contrast induced human kidney cell apoptosis.Methods Human kidney 2 (HK-2) cells were cultured in DMEM-F12 medium with 5％ FBS.Cells were divided into control group,Contrast group (O group),NLRP3-siRNA+Iohexol group (si-NLRP3+O group),ASC-siRNA+Iohexol group (si-ASC+O group),and mannitol group (M group).Different concentrations of hypotonic contrast agent were added to HK-2 cell culture plates for 24,48 and 72 h.Flow cytometry was used to detect apoptosis.NLRP3 and ASC mRNA expressions were detected by RT-PCR.The expressions of NLRP3,ASC,caspase-8/cleaved caspase-8,Bcl-2/Bax,caspase-1/cleaved caspase-1,and caspase-3/cleaved caspase-3 protein were detected by Western blot.The levels of interleukin (IL) 1β and IL-18 in supernatant were detected by ELISA.Results Compared with the control group,the rate of apoptotic cells,as well as the expressions of NLRP3,ASC and cleaved caspase-1 proteins were increased in HK-2 cells of contrast group.The expressions of NLRP3 and ASC mRNA in the contrast group also increased,so did IL-1β and IL-18 levels (all P＜0.05),suggesting that NLRP3 inflammasome in HK-2 cells was activated by contrast.Compared with the control group,the expressions of cleaved caspase-8,Bax and cleaved caspase-3 protein were increased,and the expression of anti-apoptotic protein Bcl-2 was decreased (all P ＜ 0.05).Compared with the contrast group,the rate of apoptotic cells in the si-NLRP3 + contrast group and si-ASC + contrast group was significantly decreased;the expression of cleaved caspase-1 was decreased;the expressions of Bax and cleaved caspase-3 were decreased,and Bcl-2 level was increased.The expressions of IL-1β and IL-18 in the supernatant of cells were decreased (all P ＜ 0.05).Conclusion Contrast agent can activate the NLRP3 pathway in HK-2 cells and induce apoptosis,which could be reduced by blocking the NLRP3 pathway.

Objective To investigate the factors affecting the efficacy of leflunomide combined with medium/low dose corticosteroids in the treatment of progressive IgA nephropathy (IgAN).Methods Clinical and pathological parameters were collected retrospectively in patients of primary IgAN with proteinuria＞ 1.0 g/24 h and chronic kidney disease (CKD) stage 1-3 treated with leflunomide combined with medium/low dose corticosteroids in Ren Ji Hospital,School of Medicine,Shanghai Jiao Tong University from Jan 2005 to Dec 2010.According to the treatment effects,patients were divided into complete remission group and non-complete remission group.The biochemical and pathological indexes of the two groups were compared.Results A total of 42 patients were included.The remission rates at 3,6,9 and 12 months were 62％,64％,67％ and 74％,respectively.Seventeen (40.5％) and fourteen (33.3％) patients achieved complete and partial remission after one-year treatment,and the remission rate remained stable within one year after withdrawal of drugs.The 24hour proteinuria was 1.50 (0.67,2.66) g,which was significantly reduced compared with the baseline 2.44 (1.36,3.74) g (P ＜ 0.01).The decrease rate was 31.3％.There was a slight decrease in proteinuriawithin one year after withdrawal of drugs.Estimated glomerular filtration rate (eGFR) remained stable during the treatment and a year of follow-up.No serious adverse event was observed during the followup period.Among 31 responder patients,6(19.4％) patients relapsed.Logistic multivariate regression analysis suggested that the degree of renal interstitial inflammatory infiltration was an independent predictor of complete remission with one-year treatment of leflunomide combined with medium / low dose corticosteroids (HR=0.067,95％ CI 0.008-0.535,P=0.011).Conclusions IgAN treated with leflunomide and medium/low dose corticosteroids can achieve remission in early stage,and the remission rate remains stable after withdrawal of drugs.It is a safe option for the treatment of IgAN.Renal interstitial inflammatory infiltration is an independent predictor of complete remission.

Objective To evaluate the ability of contrast-enhanced ultrasound (CEUS) as a prognostic indicator of renal function in chronic kidney disease (CKD) patients.Methods A total of 122 patients with CKD were collected,and patients with allergies to sulfur hexafluoride,pregnancy,cardiopulmonary insufficiency,urinary calculus and tumour were excluded.These patients were divided into estimated glomerular filtration rate [eGFR,ml·min1· (1.73 m2)-1] ≥60 group,eGFR 30-59 group and eGFR ＜ 30 group.CEUS was performed after an intravenous bolus injection of 1.5 ml SonoVue (BR1;Bracco Milan,Italy).Time-intensity curves (TICs) and quantitative indexes were created using QLAB quantification software.Followed up for 2 years,and patients with eGFR dropped 50％,double serum creatinine and end-stage renal disease (ESRD) were regarded as having kidney failure events.Risk factors related to kidney survival were investigated using a multivariate Cox regression model.Results One hundred patients were enrolled in the study,with 78％ patients in CKD 1-2 stages,16％ in CKD 3 stage and 6％ in CKD 4-5 stages.Patients were followed for a mean period of 14.1 months,ten (10％) patients exhibited composite kidney failure events.Among 3 groups,significant differences in the left kidney length derived peak intensity (DPI) were noted (P=0.014,P=0.010).Multivariate Cox regression analysis revealed that the DPI was an independent factor of progression of kidney disease.Multiple linear regression showed that age,basic eGFR,peak intensity were associated with eGFR decline rate.Patients with DPI ＜ 12.27 db were less to recover from kidney disease progression as compared with patients with DPI≥ 12.27 db (P=0.008).The area under the curve (AUC) for DPI was 0.778(95％ CI 0.612-0.944,P＜ 0.05),with a sensitivity of 64％ and a specificity of 88％.Conclusions The DPI might be the most valuable CEUS parameter for the evaluation of renal function.The DPI could serve as an independent predictor of the long-term prognosis of CKD patients.

Objective To compare the efficacy and safety of leflunomide (LEF) combined with medium/low dose corticosteroids and full dose of corticosteroids in the treatment of IgA nephropathy. Method Primary IgAN patients diagnosed by renal biopsy with 18?65 years old and eGFR≥30 ml·min?1·(1.73 m2)?1 and proteinuria>0.5 g/24 h were enrolled in a prospective controlled clinical study. They were randomly divided into leflunomide combined with medium/low dose corticosteroids (LEF group) and corticosteroids alone (steroid group). The primary outcomes were (1) end stage renal disease or dialysis (2) 50% increase in serum creatinine above the baseline. Secondary outcome was the remission of proteinuria. Results Ninety patients completed the follow?up. The 24?hour proteinuria at baseline were 2.00(1.10, 2.88) g and 1.87(1.13 ,3.08) g in LEF group and steroid group respectively. Compared with baseline, it was significantly decreased in both groups at 6 months [0.30(0.11, 0.93) g, 0.30(0.14, 1.33) g] and 12 months [0.30(0.09, 0.82) g, 0.32(0.14, 0.66) g], (P<0.05). Estimated glomerular filtration rate (eGFR) at baseline, 6 months and 12 months were (80.39 ± 28.56), (87.12±28.70) and (88.20±30.26) ml·min-1·(1.73 m2)-1. It was decreased in steroid group (P<0.05), while no significant difference was detected in LEF group[baseline (87.63 ± 27.35), 6 months (86.91 ± 32.45), 12 months (90.06 ± 30.00) ml·min-1·(1.73 m2)-1, P>0.05]. At 6 and 12 months, there was no significant difference in terms of 24?hour proteinuria, serum creatinine and eGFR (CKD?EPI) between groups (P>0.05). There was no statistically significant difference in adverse events between groups during the treatment (9/40 cases in LEF group and 11/50 cases in steroid group, P>0.05). The average follow?up was 79 months, and there was no difference in the renal prognosis between the two groups. Multivariate Cox regression analysis revealed that serum creatinine at baseline and renal interstitial inflammatory cell infiltration predicted the risk of the progress of IgA nephropathy. Conclusion Leflunomide plus medium/low dose corticosteroids has a similar effect as full dose of corticosteroids in IgA nephropathy and does not increase the risk for adverse events during the treatment.

Objective To compare the complications and outcomes of urgent?start peritoneal dialysis (PD) and hemodialysis (HD) in end?stage renal disease (ESRD) patients, and explore the safety and effectiveness of PD which was as an urgent?start dialysis modality in ESRD patients. Methods All patients for urgent?start dialysis, who initiated dialysis without a long?term dialysis access or had the long?term dialysis access under 30 days in Renji Hospital from January 1st 2013 to December 31st 2014, were enrolled. According to the dialysis modalities, patients were divided into PD group and HD group. Participants were followed up until death, transferred to other centers, lost of follow up or January 1st 2016. Dialysis?related complications within 30 days of implantation, complications of reimplantation and the occurrence of bacteremia between two groups were compared, and their survival rates were tested by Kaplan?Meier curves. Results Among 178 patients in this study, there were 96 (53.9%) patients in PD group and 82 (46.1%) patients in HD group. Compared with those of HD group, patients of PD group presented more cardiovascular disease [21(21.9%) vs 8(9.8%), P=0.029], higher serum potassium [(4.5±0.8) mmol/L vs (4.3±0.8) mmol/L, P=0.038], but less heart failure (NYHA Ⅲ?Ⅳ) [26(30.2%) vs 40 (48.8%), P=0.014], lower brain natriuretic peptide (BNP) [328.5 (129.5, 776.8) ng/L vs 503.5(206.0, 1430.0) ng/L, P=0.008], higher hemoglobin [(81.5 ± 17.7) g/L vs (75.3 ± 22.5) g/L, P=0.039], higher serum albumin (33.5±5.7) g/L vs (31.3±6.7) g/L, P=0.022] and higher serum pre?albumin (304.5±78.0) mg/L vs (257.0 ± 86.1) mg/L, P<0.001]. PD group presented less dialysis?related complications [5 (5.2%) vs 20(24.4%), P<0.001], less dialysis?related complications requiring reimplantation [1(1.0%) vs 20(24.4%), P<0.001] and less bacteraemia [3(3.1%) vs 11(13.4%), P=0.011]. The 3?, 6?and 12?month patient survival rates of PD and HD group were 97.9% vs 98.4%, 97.9% vs 98.4%, and 92.1%vs 93.0% respectively, and no significant difference was found (Log ? rank=0.004, P=0.947). Conclusions Patients with urgent?start PD have less complications within 30 days of implantation and occurrence of bacteremia than patients with urgent?start HD, and the same survival rates. PD may be a feasible and safe urgent?start dialysis modality for ESRD patients.

Objective To investigate the incidence of colorectal disease in patients with chronic kidney disease (CKD) and analyze the risk factor of colorectal disease in patients with CKD.Methods The clinical data of 719 patients with CKD underwent colonoscopy examination and 404 patients without CKD underwent colonoscopy examination were collected.The incidence of colorectal disease was compared between patients of the two groups.According to the results of colonoscopy examination,the patients with CKD were divided into colonoscopy positive group and negative group,and clinical biochemical indexes of the two groups were analyzed.The rank-sum test or t-test was used to compare the measurement data.Rates were compared by Chi-square test.The risk factors of colorectal disease in patients with CKD were evaluated by logistic regression.Results The positive rate of colonoscopy examination in 719 patients with CKD was 21.28％ (153/719),which was higher than that of patients without CKD (12.62 ％,51/404; x2 =13.036,P＜0.01).The positive rate of colonoscopy in patients with CKD at stage 1 was 17.50％ (56/320),at stage 2 or 3 was 22.68％(66/291),at stage 4 or 5 was 28.70％ (31/108).There were significant differences among the three groups (x2-6.623,P＜0.05).The incidence of colorectal cancer in patients with CKD was 3.89 ％ (28/719),which was higher than that of patients without CKD (1.73％,7/404; x2 =4.003,P＜0.05).The incidence of colorectal polyps in CKD group was 8.34％(60/719),which was higher than that of non-CKD group (5.20％,21/404; x2 =3.827,P＜0.05).The incidence of inflammatory bowel disease in CKD group was 9.04％(65/719),which was higher than that of non-CKD group (5.69 ％,23/404; x2 =4.013,P＜0.05).The incidence of colorectal cancer and colorectal polyps in patients with CKD at stage Ⅰ was 2.50％(8/320) and 6.25％(20/320),at stage 2 or 3 was 3.78％(11/291) and 8.59％(25/291),at stage 4 or 5 was 8.33％(9/108) and 13.89％ (15/108).There were significant differences among the three groups (x2-7.359 and 6.199,both P＜ 0.05).The age of colonoscopy positive group was older than that of colonoscopy negative group (t=-3.821,P＜0.01); there were lower hemoglobin (t=3.541,P＜0.01),increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (Z=-4.996 and-7.493,both P＜0.01),higher cholesterol and low density lipoprotein (t=-2.659 and-3.248,both P＜0.01),increased serum creatinine (Z=-3.683,P＜0.01) and declined glomerular filtration rate (Z=-6.227,P＜0.01) in colonoscopy positive group than in colonoscopy negative group; the differences were statistically significant.Logistic regression analysis indicated that age (β=0.981,95％ CI 0.965 to 0.998,P =0.032),serum creatinine (β=1.006,95％CI 1.002 to 1.009,P=0.001) and ESR (β=1.029,95％CI 1.018 to 1.040,P＜0.01) were risk factors of colorectal disease in patients with CKD.Conclusions The incidence of colorectal disease in patients with CKD is high,and it increases along with the declined glomerular filtration rate.The colorectal disease in patients with CKD patients may be associated with age,anemia,lipid metabolism,inflammation and impaired renal function.

Objective To access the long-term efficacy and safety of immunosuppression on the progression of IgA nephropathy (IgAN) by Meta analysis.Methods Databases EMBASE,Pubmed,Elsevier Science Direct,Scopus,Web of Science,Google Scholar,Cochrane Library,China National Knowledge Infrastructure,WanFang and VIP Data were retrieved to collect the randomized controlled trials (RCTs) at least 3 years follow-up on immunosuppression for IgAN published before May 2014.The literatures were screened independently by two reviewers according to the inclusion and exclusion criteria,and the methodological quality was assessed.Statistic software Stata 12.0 was used to conduct analysis.Results Nine articles were included in this study with a total of 568 patients.Immurnosuppression could lowered the risk for the progression to ESRD (RR=0.32,95％CI:0.20-0.49,P ＜ 0.01).As far as the efficacy of immunosuppression,subgroup analysis indicated that three studies with more than 7 year follow-up (RR=0.28,95％CI:0.13-0.59,P ＜ 0.01) were similar with 7 studies followed by for less than 7 years (RR=0.34,95％ CI:0.19-0.59,P＜0.01); six adopted immunosuppressor monotherapy (RR=0.29,95％ CI:0.15-0.58,P＜ 0.01) were similar to two used corticosteroids plus other immunosuppression (RR=0.33,95％CI:0.18-0.59,P ＜ 0.01); There were no significant differences between four studies from Europe (RR=0.27,95％CI:0.14-0.53,P ＜ 0.01) and five from Asia (RR=0.35,95％ CI:0.19-0.65,P＜0.01).Immunosuppression was associated with an increased risk for adverse events (RR=2.33,95％ CI:1.33-4.09,P＜0.01).Conclusion Immunosuppression for IgAN may reduce long-term risk of progression to ESRD,but increase the risk of adverse events to some extent.

Objective To investigate the effect and mechanism of human amniotic epithelial cells (hAECs) transplantation in treatment of cerebral hemorrhage in rabbits.Methods Thirty New Zealand white rabbits were used to induce cerebral hemorrhage.Animals were divided into hAECs group and isotonic saline group according to random number table,with 15 rabbits per group.Before transplanted to rabbits,hAECs were transfected with the retrovirus carrying green fluorescent protein (GFP).Morphologic and behavioral changes in both groups were noted periodically.Survival of transplanted hAECs and expressions of glial fibrillary acidic protein (GFAP) and microtubule-associated protein 2 (MAP-2)in focal cerebral tissues were observed.Results In hAECs group,the rabbits obtained progressive recovery in walking,supporting and coordinated motion.Restoration period mostly ranged from 2-3 weeks.Most of the rabbits in hAECs group had limb motor function recovered to grade Ⅱ-Ⅲ,while the recovery is slow in isotonic saline group with most ranging from grade Ⅰ-Ⅱ.According to Tarlov score,limb motor function presented significant difference between hAECs group and isotonic saline group (P ＜ 0.05).Immunohistochemical staining showed positive expressions of GFAP and MAP-2 in hAECs group,but no expressions in isotonic saline group (P ＜ 0.05).Conclusion hAECs transplantation effectively improves neural behavior and reduces nerve function impairment in treatment of cerebral hemorrhage in rabbits.

Objective To evaluate the values of urinary liver-fatty acid binding protein (uL-FABP) and urinary neutrophil gelatinase-associated lipocalin (uNGAL) in diagnosis of acute kidney injury (AKI) caused by obstructive nephropathy and in the prediction of renal prognosis.Methods Clinical data of 30 patients with obstructive nephropathy were collected prospectively.uL-FABP and uNGAL were measured by ELISA at various time points.Risk factors of the renal outcome were evaluated.The patients were followed up for at least one year.Results Patients with AK1 had higher levels of uL-FABP and uNGAL compared to those without AKI [700.00(154.62-1216.14) μg/g· Cr vs 26.90 (16.77-41.38) μg/g·Cr; 1266.69 (671.57-3396.07) μg/g·Cr vs 179.12 (90.98-215.16) μg/g·Cr,all P ＜ 0.01].Positive correlations of uL-FABP and uNGAL with serum creatinine were found (r =0.552,0.553,all P ＜ 0.01).The AUCs of uL-FABP and uNGAL to detect AKI were 0.925 and 0.900.Patients with non complete renal recovery had higher levels of uL-FABP before operation and 72-hour after operation compared to those with complete renal recovery (all P ＜ 0.01).Before operation,the AUC of uL-FABP to detect renal prognosis was 0.948,sensitivity was 85.7％ and specificity was 90.9％.72-hour after operation,the AUC of uL-FABP to detect renal prognosis was 0.935,sensitivity was 85.7％ and specificity was 90.9％.Kaplan-Meier analysis revealed that uL-FABP before operation over 366.57 μg/g · Cr or uL-FABP 72-hour after operation over 223.60 μg/g · Cr were closely related to the poor progression of renal function.Conclusions uL-FABP and uL-NGAL have good accuracy in detecting AKI.The level of uL-FABP before operation and 72-hour after operation is helpful to predict the renal outcome of obstructive nephropathy.