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Objective:To investigate the effect of nurse-led integrated care on sense of coherence and relocation stress in family members of severe neurological disease patients after ICU transfer.Methods:A total of 78 severe neurological disease patients and family members were divided into study group and control group with 39 cases each by random digits table method. Participants in the control group received routine nursing, while the study group carried out nurse-led integrated care program. The scores of relocation stress and sense of coherence were assessed by Family Relocation Stress Scale (RFSS) and Sense of Coherence-29 (SOC-29), respectively.Results:After transfertion, the scores of preparation for relocation, family burden, satisfaction with the relocation process and total RFSS scores were (17.49 ± 3.57), (11.38 ± 1.93), (4.59 ± 0.59), (47.05 ± 4.72) points in the study group, and (13.79 ± 2.92), (9.51 ± 2.26), (3.51 ± 0.64), (39.44 ± 4.10) points in the control group, the difference was statistically significant ( t values were 3.937-7.675, P<0.05). After transfertion, the scores of comprehensibility, manageability, meaningfulness and total SOC-29 scores were (23.97 ± 2.61), (29.49 ± 4.55), (21.13 ± 3.73), (74.49 ± 6.77) points in the study group, and (21.49 ± 2.88), (27.23 ± 4.02), (17.05 ± 3.85), (65.79 ± 6.09) points, the difference was statistically significant ( t values were 2.321-5.960, P<0.05 or 0.01). Conclusions:Nurse-led integrated care can promote sense of coherence and alleviate relocation stress of family members of severe neurological disease patients after ICU transfer.
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Objective To compare the changes of serum hepcidin,hemoglobin and other indexes of pure hemodialysis and hemodialysis combined with hemodiafiltration in treatment of maintenance hemodialysis patients,and to investigate the effect of hemodialysis combined with hemodiafiltration therapy on serum hepcidin clearance,the improvement of anemia and the relationship between them of maintenance hemodialysis patients.Methods Twenty-two patients with maintenance hemodialysis patients were collected from Shengjing Hosphal Affiliated to China Medical University from January 2015 to February 2017.This study was self-controlled study,before enrollment all patients were given only regular hemodialysis,after enrollment all patients were given hemodialysis combined with hemodiafiltration therapy for 3 months,compared the changes of serum hepcidin,hemoglobin,reticulocyte percentage,ferritin,serum iron,transferrin saturation and EPO of pure hemodialysis(before treatment) and hemodialysis combined with hemodiafiltration treatment for 3 months of patients,and analyzed the correlationship between serum hepcidin and other indexes.Results After hemodialysis combined with hemodiafiltration therapy for 3 months,compared with pure hemodialysis serum hepcidin levels were significantly lower((77.61±3.31) μg/L vs.(89.49±7.87) μg/L,t=9.660,P<0.01),hemoglobin levels were increased((112.73±11.02) g/L vs.(88.32±11.83) g/L,t=-11.957,P<0.01).The correlations between serum hepcidin and other indexes show that serum hepcidin and hemoglobin and ferritin were related,serum hepcidin was negatively correlated with hemoglobin(r=-0.851,P<0.01)and positively correlated with ferritin(r=0.385,P<0.05),and found no correlations between hepcidin and reticulocyte percentage(r=-0.151,P=0.328),serum iron(r=0.123,P=0.427),transferrin saturation(r=0.211,P=0.170) and EPO(r=-0.173,P=0.261).Conclusion To compare with pure hemodialysis,hemodialysis combined with hemodiafiltration therapy can more effectively remove hepcidin and improve anemia,and they are related.
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Objective:To analyze clinical application of intra?aortic balloon pump in the treatment of septic shock.Methods:A total of 62 patients with septic shock in our hospital were assigned into the control group and the observation group according to digital table method, with 31 cases in each group. Patients in the control group were treated with conventional antishock method and patients in the observation group were given intra?aortic balloon pump therapy based on the treatment.Blood pressure, heart rate, urine volume and adverse event in the two groups were compared after treatment.Results:After treatment,blood pressure, heart rate and urine volume of the observation group were improved significantly compared with that in the control group (P<0.05).The overall incidence of adverse events in the observation group (16.13%) was significantly lower than that in the control group (45.16%) after treatment (P<0.05). Conclusion:Intra-aortic balloon pump therapy exerts obvious effect in the treatment of septic shock, significantly improves the patient??s blood pressure and heart rate, increases urine volume, causes less adverse events,and is safe and effective.
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Objective:To evaluate the curative efficacy of tacrolimus (FK506)combined with corticosteroids in the treatment of idiopathic membranous nephropathy (IMN ), and to analyze the response of anti-M-type phospholipase A2 receptor (PLA2R)antibody to the treatment.Methods:Sixty-one adult IMN patients were divided into FK506 group (FK506 combined with corticosteroids,n = 24)and CTX group (cyclophosphomide combined with corticosteroids,n=37)according to their willing to the acceptance of different immunosuppressives. The remission rates of the patients at 4,8,12 and 24 weeks after treatment in two groups were analyzed.The ELISA method was used for the detection of serum anti-PLA2R antibodies of the patients before and after treatment.The antibody level changes were observed and the difference of remission rates was compared between the antibody positive patients and the negative patients in FK506 group.Results:The total remission rates of the patients in FK506 and CTX groups 24 weeks after treatment were 91.7% and 64.9% respectively and the total remission rate of the patients in FK506 group was significantly higher than that in CTX group (P 0.05).The total remission rates of the antibody positive patients and negative patients at baseline in FK506 group 24 weeks after treatment were 88.9% and 100.0%,respectively;there was no significant difference (P > 0.05).Except the characteristic side effects of corticosteroids,the patients in FK506 group presented no hyperglycemia,tubulointerstitial damage,hepatic lesion or neurotoxicity. But the patients in CTX group showed mild hepatic lesion or gastrointestinal symptoms.Conclusion:The remission rate of FK506 combined with corticosteroids is higher than that of CTX combined with corticosteroids in the treatment of IMN patients.FK506 treatment has relatively rapid effect and less side effects as well.The negative conversion of serum anti-PLA2R antibody follows the remission after treatment;however,the negative conversion rate has no significant difference between FK506 group and CTX group.The remission rate of IMN patients treated with FK56 combined with hormone has no relationship with the baseline anti-PLA2R antibody.
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Objective To detect serum level of anti-M-type phospholipase A2 receptor (PLA2R) antibody in elderly patients with idiopathic membranous nephropathy (IMN) and to explore its clinical significance in IMN disease.Methods A total of 134 patients with renal biopsy-proved glomerular diseases were enrolled in this study,including 42 elderly cases with IMN,45 non-elderly cases with IMN,19 elderly cases with minimal change nephropathy (MCN),12 elderly cases with IgA nephropathy (IgAN),8 elderly cases with hepatitis B-associated membranous nephropathy (HBV-MN) and 8 elderly cases with focal segmental glomerulosclerosis (FSGS).Western blotting was used to detect serum anti-PLA2R antibody and the correlation of anti-PLA2R antibody with laboratory parameters in elderly IMN patients was analyzed.Results The elderly and non-elderly patients with IMN showed that the positive rate of anti-PLA2R antibody was 71.4％ and 73.3％,respectively (P＞ 0.05).The positive rate of anti-PLA2R antibody in elderly IgA nephropathy,HBV-MN and MCN patients was 16.7 ％,12.5％ and 5.3％ respectively.Anti-PLA2R antibody was not detected in serum from elderly FSGS patients.The positive rates of serum anti-PLA2R antibody were significantly higher in both elderly and non-elderly IMN patients than in elderly patients with secondary MN and other types of glomerlonephritis (P ＜ 0.01).Furthermore,anti-PLA2R autoantibody level was positively correlated with 24-hour urine protein level and negatively correlated with the concentration of serum albumin in elderly patients with IMN (P＜0.01).Conclusions Anti-PLA2R antibody is a sensitive serological marker of IMN.Detection for anti-PLA2R antibody might be helpful for the diagnosis of both elderly and non-elderly IMN and for the monitor of IMN disease severity.
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Objective Idiopathic membranous nephropathy(IMN)is a common cause of nephrotic syndrome in adults,and the prognosis of IMN varies among individuals. The aim of this study was to investigate the prognosis and risk factors,especially the prognostic indicators in kidney patholo?gies for IMN. Methods Patients diagnosed as IMN by renal biopsy from January 2006 to December 2011 were collected and those who finished at least 12 months of follow?up were enrolled in this study. The clinical and renal pathological indicators were collected and the correlation between the pathological indicators and the prognosis was analyzed. Results Totally 137 patients were enrolled in this study,18 patients(13.14%)reached the follow up ending point(defined as eGFR<30 mL/min). The prognosis of kidney function was poor in IMN patients with interstitial fibrosis,tubular atrophy and severe vascular sclerosis and those who were older at disease onset and demonstrated to have higher MAP,poorer renal function,intersti?tial fibrosis,tubular atrophy and worse vascular sclerosis. Conclusion Renal pathological characteristics during renal biopsy were correlated with the renal prognosis of IMN. Severe interstitial fibrosis,tubular atrophy and vascular sclerosis were identified as risk factors for the poor prognosis of re?nal function in IMN patients.
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Objective To investigate the correlation of M-type phospholipase A2 receptor (PLA2R) genetic polymorphism in two single nucleotide polymorphisms (SNPs) with idiopathic membranous nephropathy (IMN) of Chinese Han population in Northeast China.Methods A total of 327 individuals were enrolled in the study including 95 adult patients with biopsy-proved IMN (IMN group) followed up for (25.4±11.6) months and 232 healthy people identified by healthy examination in China-Japan Union Hospital of Jilin University (HC group).Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to detect the genotype and allele frequency of rs35771982 and rs3828323 site in PLA2R gene.The x2 test was performed to compare the distribution difference of allelic frequency and genotype frequency of the two sites in PLA2R gene between two groups.Unconditional Logistic regression analysis was used to determine the risk factor of IMN.Results IMN and HC group were matched in male predominance and body mass index (BMI).Patients with IMN were older than the healthy controls and had higher Scr,serum total cholesterol (TC),24-hour urine protein level and lower serum albumin (Alb) level,lower estimated glomerular filtration rate (eGFR) than the healthy controls (all P ＜ 0.01).The CC genotype frequency and the C allele frequency at SNP rs35771982 site of PLA2R gene in IMN group were significantly higher than those in HC group (x2=13.658,P=0.001;x2=15.315,P=9.10× 10-5),whereas there was no distribution difference of genotype and allele frequency at rs3828323 site between two groups (x2=2.844,P =0.241; x2 =2.959,P=0.085).The CC genotype at rs35771982 site in patients with IMN was not related to,age,gender,BMI,blood pressure and several laboratory indexes such as Alb,TC,Scr,eGFR and 24-hour urine protein level (all P ＞ 0.05).Unconditional Logistic regression analysis revealed that the genotype at rs35771982,age,TC,Scr and eGFR were correlated with IMN occurrence.The CC genotype at rs35771982 was the risk factor of IMN (OR =4.408,95％CI 1.488-13.058).Conclusions The CC genotype and C allele at rs35771982 site in PLA2R may be associated with the susceptibility to IMN,whereas the correlation between gene polymorphism at rs3828323 site and IMN is not demonstrated.The CC genotype at rs35771982 is the independent risk factor of IMN in Chinese Han population in Northeast China.
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Objective To investigate the magnetic resonance imaging (MRI) characteristics of cerebral lesions,laboratory data and prognosis of patients with neuropsychiatric systemic lupus erythematosus (NPSLE) and evaluate the correlation of MRI findings,autoantibodies and prognosis of NPSLE.Methods Thirty-one patients with NPSLE admitted during Jan 1998 to Oct 2011 were enrolled into this study,including 2 males and 29 females.MRI characteristics of cerebral lesions,laboratory data and clinical outcomes were retrospectively analyzed.x2-test and Spearman's correlation were used for statistical analysis.Results Cranial MRI scans on admission were abnormal in 27 (87％) of the 31 patients,among which 17 cases showed diffuse manifestations,9 cases showed focal lesions in brain and 1 case showed brain atrophy.The percentage of cases with focal lesions in the dead group (86％) was significantly higher than that of the survival group (13％) (P＜0.01),while the percentage of diffuse lesion cases was significantly lower in dead group (P＜0.01).Although the mean lesion numbers in the dead group were fewer compared with the survival group,lesion numbers in brainstem (18％) (P＜0.01) or basal ganglia (29％) (P＜0.05) were much more in the dead group.The positive rate of anti-ribosomal P protein antibodies shown in the dead group (43％) was markedly higher than that in the survival group (29％) (P＜0.05).The positive rates of ACL in cases with diffuse lesions and cases with focal lesion were higher compared with cases showing normal MR images (P＜0.01).Furthermore,the positive rate of anticardiolipin antibodies (ACL) in cases with focal lesions (56％) were higher than cases with diffuse lesion (35％) (P＜0.05).There was no correlation between the seven types of autoantibodies and lesion locations such as basal ganglia,subcortical white matter,anterior and posterior horn of lateral ventricle,semiovale center,cerebral cortex,brainstem and cerebellum.Conclusion MRI findings and autoantibodies are correlated in patients with NPSLE and both of them may be used as prognostic markers for NPSLE.Focal lesions,location of brainstem and basal ganglia on cranial MR images,positive anti-ribosomal P protein antibody may predict an unfavorable clinical outcome of NPSLE; however,the correlation between ACL and prognosis could not be determined.
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Objective To investigate the correlation of serum anti-M-type phospholipase A2 receptor (PLA2R) antibody with laboratory parameters of idiopathic membranous nephropathy (IMN) in adult patients with membranous nephropathy (MN),and to explore the role of anti-PLA2R antibody in the pathogenesis of IMN. Methods Forty-six adult patients with biopsy-proved glomerular diseases were involved in this study,including 20 cases with IMN,7 cases with IgA nephropathy (IgAN),6 cases with hepatitis B-associated membranous nephropathy (HBV-MN),6 cases with minimal change nephropathy (MCN),4 cases with focal segmental glomerulosclerosis (FSGS) and 3 cases with class Ⅴ lupus nephritis.Total RNA was extracted from human glomeruli and was reversely transcribed to the first-strand cDNA.The full-length human M-type PLA2R was amplified by PCR and the 605 bp product was subcloned into eukaryotic expression vector containing CMV promoter.The recombinant human M-type PLA2R plasmid vector was transiently transfected into human embryonic kidney (HEK) 239T cell line using the FuGene6 transfection reagent.Western blotting was used to detect serum anti-PLA2R antibodies.Correlations of antiPLA2R antibody level with laboratory parameters,including serum albumin,total cholesterol,Scr and 24-hour urine protein,of IMN patients were evaluated. Results Among 20 cases with IMN,15 cases showed positive anti-PLA2R antibodies (positive rate 75％).Of 7 cases with IgAN and 6 cases with HBV-MN,only 1 case showed positive anti-PLA2R antibody respectively (positive rate 14.29％ and 16.67％ respectively).Anti-PLA2R antibody was negative in other patients.The positive rate of anti-PLA2R antibody in IMN patients was significantly higher than that in patients with secondary MN and other types of glomerlonephritis (all P＜0.01).Furthermore,anti-PLA2R antibody level was positively correlated with 24-hour urine protein(r=0.803,P＜0.01) and negatively correlated with serum albumin in IMN patients (r=-0.816,P＜0.01). Conclusions The high positive ratio of anti-PLA2R antibody may indicate that it is the specific autoantibody in IMN.AntiPLA2R antibody is correlated with IMN disease severity,which indicates that it may be the pathogenic autoantibody in IMN.
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Objective To investigate the effect of aliskiren on type 2 diabetic nephropathy in db/db mice.Methods Eight-week old db/db and db/m mice were subjected to right nephrectomy to hasten the development of diabetic nephropathy.At age of 16 weeks,they were divided into four groups:db/m group (normal control),db/db group ( diabetic control),db/db+ A3 group (db/db mice treated with aliskiren 3 mg·kg-1d-1) and db/db+A25 group (db/db mice treated with aliskiren 25 mg kg-1 d-1).Body weight,blood glucose,glycosylated hemoglobin,proteinuria and systolic blood pressure were measured before and after treatment.After treatment,renal histological examination by PAS staining,TGF-β1 and PAI-1 protein by ELISA,expression of ColⅣ and FN protein by immunofluorescence,mRNA expression of TGF-β1,PAI-1,ColⅣ,FN and renin by real time PCR,renin activity and angiotensin Ⅱ level by radioimmunoassay were performed.Results Treatment for 4 weeks of aliskiren at a dose of 25 mg kg-1 d-1 markedly decreased urinary albumin excretion,glomerulosclerosis and suppressed synthesis of TGF-β1,PAI-1,Col Ⅳ,FN without inducing significantl change in systolic blood pressure,compared to those of db/db group (all P＜0.05).Aliskiren also suppressed renin activity and angiotensin Ⅱ level in renal cortex (all P＜0.05).Conclusion Aliskiren protects against type 2 diabetic nephropathy.
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Objective To investigate the changes and the role of plasma thrombomodulin(TM),von willebrand factor (vWF) ,and coagulation status indicators in children with Henoch-Schonlein purpura(HSP).Methods The plasma concentrations of TM,vWF were measured by ELISA method and the levels of D-dimer,PT,APTT,palatelet count were measured in 56 acute SHP patients,50 recovery patients and 40 healthy controls. Results The plasma levels of TM、vWF、D-dimer、palatelet count in acute group were significantly higher than those in healthy controls group and those of recovery group ( P = 0. 000). The plasma levels of PT、APTT showed no significant difference among three groups( P ＞ 0. 05 ). The plasma levels of TM、vWF in recovery group were significantly higher than those in healthy controls group ( P ＜ 0. 05, P ＜ 0. 01 ), while the levels of D-dimer、palatelet count reduced to nomal levels(P ＞0. 05). As compared to non-renal damage group, The plasma levels of TM、vWF、 D-dimer were higher in renal damage group ( P ＜ 0. 05, P ＜ 0. 01 ), the levels of PT 、APTT、palatelet count showed no significant difference ( P ＞ 0. 05 ). Conclusion The damage of vascular endothelium and hypercoagulability play an important role in the pathogenesis of HSP. Changes of plasma TM、 vWF、palatelet count can be used as an indicator of the early lesion of renal function.
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Objective To analyze the pathogenesis, clinical features, treatment and prognosis of pulmonary hypertension (PHT) in systemic lupus erythematosus (SLE) patients. Methods Thirty-eight patients admitted during Jan 2001 to Aug 2008 were diagnosed as SLE associated with PHT and were analyzed retrospectively. Results All cases were female with the mean age of 35.7 yds. The mean period from PHT to the diagnosis of SLE was 2.3 years. Three cases were severe PHT with remarkable heart failure. Twenty-seven eases demonstrated Raynaund's phenomenon. Antinuclear antibody (ANA) was positive in all 38 cases and the titer was 1:320. Anti-DNA antibody, anti-Sin antibody, anti-U1RNP antibody and anti-SSA, anti-SSB were positive in 21 cases, 16 cases, 15 cases, 8 cases respectively. Antiphospholipid antibody and rheumatoid factor (RF) were elevated in 4 cases and 13 cases respectively. Seven cases were involved in lung fibrosis and pulmonary function test showed mild to moderate restrictive abnormality in these 7 cases. After treated with the combination of steroid and immunosuppressive agents, one case died on the 10th day and 2 cases died in 2 to 3 years after the diagnosis was established. The other 35 cases stayed stable. Conclusion PHT is one of the severe complications of SLE and often accompanied by poor outcome. Therefore early diagnosis and early combined therapy is very important.
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Objective To investigate the efficacy and the adverse effect of mycophenolate mofetil(MMF)in HBV associated glomerulonephritis.Methods Twenty patients with HBV-GN diagnosed by renal biopsy were treated with MMF.The initial dosage of MMF was 1.5 g/d.The dosage was reduced to 1.0 g/d when 24 h excretion of urinary protein decreased to 0.5 g/d.Blood routine test,hepatic and renal function,plasma albumin,serum triglyceride and cholesterol,24 h urinary protein excretion,HBV DNA were performed before and after 2,3,6,9 months' treatment.Results Twenty-four-hour urinary protein excretion was significantly reduced by the treatment with mycophenolate mofetil(P
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Objective CD4+ T lymphocytes have been shown to play an important role in the pathogenesis of systemic lupus erythematosus (SLE). To identify the commonly accumulated T cell clones and to investigate its role in murine lupus models, it was analyzed that the T cell clonality infiltrating in different tissues derived from (NZB?NZW)F1 as well as MRL/lpr mice. Methods The expressions of T cell receptor (TCR) V? gene were analyzed by reverse transcriptase polymerase chain reaction (RT-PCR) combined with single-strand conformation polymorphism (SSCP) study. The phenotype of T cells expanded in different organs was determined by magnetic cell sorting (MACS). Results RT-PCR and SSCP study of TCR V? chain demonstrated that there were some identical T cell clonotypes expanded and accumulated in different organs in aged diseased mice. Most of these identical clonotypes were CD4+ T cells in both of the two strains. In contrast, young mice exhibited little accumulation of common clone in different organs. The TCR V? usage of these identical clonotypes was limited in V?2, V?6, V?8.1, V?10, V?16, V?18 in MRL/lpr mice and V?6, V?7 in (NZB?NZW)F1 mice respectively. Conclusion The results suggest that activated and clonally expanded CD4+ T cells commonly accumulated in different tissues in aged murine lupus models. These CD4+ T cell clonotypes may be involved in specific immune responses of SLE, thus playing a pathogenic role in these lupus mice.
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Objective There were some identical T cell clonotypes expanded and accumulated in different organs in aged diseased (NZB?NZW)F1 and MRL/lpr mice. The amino acid motifs in the third complementarity determining region (CDR3) from the T cell receptor (TCR) V? chain was analyzed to demonstrate the antigenic specificity of these identical clones. Methods The TCR V?6 gene in kidneys and brains from different individuals of aged diseased lupus mice were amplified by reverse transcriptase polymerase chain reaction (RT-PCR) respectively. The amino acid motifs in CDR3 loops of TCR V?6 chain were demonstrated by DNA cloning and DNA sequence analysis. The amino acid motifs from the identical T cell clones accumulated in different organs were identified by single-strand conformation polymorphism (SSCP). Results Some conserved amino acid motifs such as isoleucine (I) and aspartic acid (D) were observed in CDR3 loops of TCR V?6 from these identical T cell clones in different individuals of aged diseased (NZB?NZW)F1 mice. Likewise, I, glycine (G) and D or glutamic acid (E) were also found in MRL/lpr mice. Conclusion These identical T cell clones may recognize restricted T cell epitopes on autoantigens and are involved in specific immune responses in SLE.
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Abstract Objective: To study the effect of Trichosanthin on cytokines production and ion channel of human PBMC, to demonstrate its immune regulatory mechanism.Methods: The levels of IL-2 and IL-6 produced by PBMC under stimulation of PHA-M were measured by radio-immunoassay after cultured with Trichosanthin. The current intensity of voltage-dependent potassium channel [K(V) channel] were recorded by patch-clamp technique after added Trichosanthin.Results: Both IL-2 and IL-6 production were enhanced by Trichosanthin, and the current in-tensity of K(v) channel were markedly increased from (210.2 ?53.6)PA to (2 223.0 ?310.7)PA.Conclusion: Trichosanthin can enhance the production of both IL-2 and IL-6 of human PBMC and increase the current intensity of K( v) channel on T lymphocyte membrane, which im-prove cell-mediated immunity and humoral immunity.
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The age-related changes of serum lipid peroxide (LPO), RBC supero-xide dismutase activity (SOD) and glutathione peroxidase activity (GSH-Px), Cu, Zn and Se of blood were observed in 217 normal male persons aged 6~82. It was found that LPO increased significantly with age and SOD, GSH-Px decreased significantly in the elderly (60-70yrs). Blood Zn, Cu and Zn/Cu were highest in the childhood and lowest in the elderly. No significant change of Se with age was observed.The stepwise regression analysis showed that the factors influencing aging mainly were LPO and GSH-Px. It seems that LPO can be used as an indicator of aging.LPO was positively but GSH-Px, SOD, Zn and Cu negatively correlated with aging.
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Twenty six healthy males, 60-70 years old, having the same vitamin C nutritional status detected by saturation test were selected for this study. They were divided into 4 groups and supplemented orally with various amounts of vitamin C for 15 days. The intake of each group was 59, 94, 149 and 223 ing/day per capita respectively. After comparing the vitamin C contents of 4-hour saturation test urine and early morning 1 hour fasting urine at the end of the experiment, it seems that the optimal daily requirement for the elderly is about 95 mg, and the saturated daily requirement is a little higher than 223 mg.