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Objective@#To observe the effectiveness of mini-clinical evaluation exercise (Mini-CEX) on the standardized training of residents in the department of nephrology.@*Methods@#Mini-CEX was used to evaluate the 80 residents who received clinical standardized training in the department of nephrology from March 2017 to March 2018 in our hospital. The assessment mainly contained seven aspects: medical history taking, physical examination, clinical diagnosis, therapeutic regimen, doctor-patient communication, humanistic care, and overall clinical ability. Meanwhile, a Mini-CEX questionnaire was conducted among 9 teachers and 80 residents, including their viewpiont and satisfaction degree on Mini-CEX. The SPSS 21.0 was used for statistical analysis and the independent sample t-test was used for comparison between the two groups.@*Results@#Through the Mini-CEX assessment, every aspect of clinical competence of residents at the end of this program was significantly higher than that at the early period, and the difference was statistically significant (P<0.05). The most obvious improvement in residents was their treatment plan, overall clinical ability and physical examination. About the assessment of therapeutic regimen, the average score at the end of the training was (7.525±1.062), which was better than before (5.175±1.035), and the difference was statistically significant (P=0.000). Besides, clinical diagnosis and humanistic care were significantly better than those at the beginning (P<0.05). About the assessment of clinical diagnosis, the average score after the training was (6.925±1.071), which was better than before (5.425±1.238), and the difference was statistically significant (P=0.000). According to results of Mini-CEX questionnaire, teachers thought that Mini-CEX was a better way of assessment (88.9%) and could promote self-learning (77.8%), while residents believed that Mini-CEX was close to clinical practice and the ward-or-practice-based assessment was relatively comprehensive, which could significantly improve clinical skills (85.0%) and comprehensive quality (87.5%), with a satisfaction degree of 92.5%.@*Conclusion@#Mini-CEX is applied in the standardized training of residents in the department of nephrology, which can effectively improve clinical comprehensive ability of residents and improve Self-learning of teachers.
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Objective To observe the effectiveness of mini-clinical evaluation exercise (Mini-CEX) on the standardized training of residents in the department of nephrology. Methods Mini-CEX was used to evaluate the 80 residents who received clinical standardized training in the department of nephrology from March 2017 to March 2018 in our hospital. The assessment mainly contained seven aspects: medical history taking, physical examination, clinical diagnosis, therapeutic regimen, doctor-patient communication, humanistic care, and overall clinical ability. Meanwhile, a Mini-CEX questionnaire was conducted among 9 teachers and 80 residents, including their viewpiont and satisfaction degree on Mini-CEX. The SPSS 21.0 was used for statistical analysis and the independent sample t-test was used for comparison between the two groups. Results Through the Mini-CEX assessment, every aspect of clinical competence of residents at the end of this program was significantly higher than that at the early period, and the difference was statistically significant (P<0.05). The most obvious improvement in residents was their treatment plan, overall clinical ability and physical examination. About the assessment of therapeutic regimen, the average score at the end of the training was (7.525 ±1.062), which was better than before (5.175 ±1.035), and the difference was statistically significant (P=0.000). Besides, clinical diagnosis and humanistic care were significantly better than those at the beginning (P<0.05). About the assessment of clinical diagnosis, the average score after the training was (6.925 ±1.071), which was better than before (5.425 ±1.238), and the difference was statistically significant (P=0.000). According to results of Mini-CEX questionnaire, teachers thought that Mini-CEX was a better way of assessment (88.9％) and could promote self-learning (77.8％), while residents believed that Mini-CEX was close to clinical practice and the ward-or-practice-based assessment was relatively comprehensive, which could significantly improve clinical skills (85.0％) and comprehensive quality (87.5％), with a satisfaction degree of 92.5％. Conclusion Mini-CEX is applied in the standardized training of residents in the department of nephrology, which can effectively improve clinical comprehensive ability of residents and improve Self-learning of teachers.
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Objective:To investigate the effects of hemodialysis f on immune function of patients with end-stage nephropathy associated HBV virus infection.Methods:50 cases of patients with end-stage nephropathy associated HBV virus infection from June 2011 to June 2013 were randomly selected as observation group.50 cases of patients with end-stage renal disease as the control group.Patients in control group and observation group were treated with continuous hemodialysis therapy .24 h urinary protein ,serum al-bumin,blood urea nitrogen and creatinine in control group and observation group before and after treatment were analyzed .The regulatory T lymphocyte ,the CD8+T lymphocytes,perforin and granzyme B in peripheral blood in control group and observation group before and after treatment were analyzed by flow cytometry.Results:After dialysis treatment ,clinical symptoms and laboratory indexes of the two groups were significantly improved ( P0.05 ).There was no significant change of immune function in the control group before and after treatment ( P>0.05 ).But the ratio of Treg cells and CD 8+T lymphocyte in observation group after treatment were sig-nificantly increased than that of before treatment ( P<0.05 ).Before treatment ,the active molecule perforin and granzyme B expression rate of T cells in the peripheral blood of observation group were higher than the control group ( P<0.05 ).After treatment ,Treg cell and CD8+T lymphocyte ratio were significantly decreased as well as perforin and granzyme B expression rate ( P<0.05 ).Conclusion:Compared with control group ,hemodialysis can significantly improve the immune function of the patients with end -stage nephropathy as-sociated HBV virus infection.
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A thermal desorption ( TD) device was developed and coupled to gas chromatography ( GC) or gas chromatography-mass spectrometry ( GC-MS ) for the qualitative and quantitative analysis of semi-volatile organic compounds on atmospheric particulate matters ( PM ) . The TD was operated by direct heating and placed on the GC injector, leading to high heating rate and easy transfer of analytes to GC without focusing of analytes by cold trap. For establishing the TD-GC method, the materials used for supporting PM samples, temperature and time of thermal desorption, and types of sample injection were investigated for detection of sixteen polycyclic aromatic hydrocarbons ( PAHs) and nine n-alkanes. The limits of detection of the proposed TD-GC method were in the range of 0. 014-0. 093 ng for PAHs, and 0. 016-0. 026 ng for n-alkanes, respectively, with the correlation coefficients of correlation above 0. 9975. The TD-GC method was applied to the determination of trace PAHs and n-alkanes on PM10 samples from three cities. The recoveries were in the range of 95%-135% ( PAHs) and 95%-115% ( n-alkanes) , respectively. Finally, the TD was coupled to GC-MS for comparison of the contents of PAHs and n-alkanes on PMx with different particulate size ( x=10 , 5, 2, 1, 0. 5, 0. 25, 0. 1).
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Objective To observe P27 expression and proliferation of mesangial cells of rats with Thy1 glomerulonephritis and to evaluate the interfering effect of valsartan, a specific angiotensin Ⅱ receptor antagonist, on Thy1 glomerulonephritis. Methods Rats were divided into normal control group, Thy1 glomerulonephritis group and valsartan treatment group. Following the onset of glomerulonephritis, renal morphological changes were observed on days 1, 3, 5 and 7, and proliferating cell nuclear antigen(PCNA) and P27 expression in glomerulus were measured by immunohistochemistry and Western blotting. Results High expression of P27 was found in quiescent mesangial cells of normal rats, but decreased expression in mesangial cells of rats with Thy1 glomerulonephritis, accompanying with the proliferation of mesangial cells. In valsartan treatment group, glomerular hypercellularity, mesangial matrix expansion and PCNA expression were significantly reduced as compared with those of the untreated rats with Thy1 glomerulonephritis from day 3 to day 7( P
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Objective To investigate the changes of the expression of HSP90? in the liver of severely scalded rats at the early stage of stress Methods The expression levels of HSP90? in the liver of rats at different time points after severe scald were detected by Western blotting and then the expression of HSP90? in the nucleuses was observed by immunohistochemistry Results The expression of HSP90? significantly increased in the liver of rats after severe scald, especially during 12～48 h Abnormal high expression of HSP90? in the nucleuses around was found at 48 h after scald Conclusion The abnormal high expression of HSP90? due to severe scald may be one of the important causes resulting in the disorder of glucocorticoid receptor at the early stage of stress after severe trauma.
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Objective To investigate the effects of non-ionic low osmolar contrast media (LOCM) on the apoptosis and mRNA expression of Bcl-2/Bax in rat glomerular endothelial cells cultured in vitro. Methods Rat glomerular endothelial cells were exposed to ioversol with different concentrations for different time. Cell viability was then assessed by MTT method and morphological changes of cells were observed by inverted microscopy. In order to analyze cell apoptosis, DNA electrophoresis was applied. Meanwhile, the expression changes of Bcl-2/Bax at mRNA level were determined by RT-PCR. Results The viability of rat glomerular endothelial cells was inhibited by ioversol in a concentration and time dependent manner. After being exposed to ioversol(90 mL/L)for 24 h, the cells began to become crimple, round, and even floating. A typical DNA ladder determined by agarose gel electrophoresis was observed. Noticeably, the mRNA level of Bcl-2 in ioversol treated cells was down-regulated, while Bax was up-regulated, so that the ratio of Bcl-2 mRNA to Bax mRNA increased significantly. Conclusion Non-ionic LOCM can induce glomerular endothelial cells apoptosis, which may be partly due to the disturbance of Bcl-2/Bax balance. This is probably related to the pathogenesis of contrast media nephropathy.
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Objective To establish uremic atherosclerosis models in apoE~(-/-) mice and evaluate its feasibility.Methods Totally 70 6-week-old male apoE~(-/-) mice were randomized into 2 groups,uremic group(n=35) and nonuremic control group(n=35).All mice were fed with a Western diet.Uremic group mice underwent partial kidney ablation with electrocoagulation of right renal cortex followed by left total nephrectomy in 2 weeks later and control animals underwent sham operation.Serum levels of urea,total cholesterol and triglycerides were assessed at 0,2,4,6 and 8 weeks after the first surgery.The cross-section surface area of the lesion and the lesion area fraction were assessed.Results At 6 weeks after nephrectomy,the level of serum urea in chronic renal failure(CRF) mice was 188.3% higher than that of control mice,and total cholesterol and triglyceride concentrations were increased by 40.8% and 29.8% than those of nonuremic controls,respectively(P
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Objective To retrospectively analyze the clinical characteristics of acute renal failure ( ARF) induced by crush syndrome after Wenchuan earthquake,and summarize the rational and effective treatment managements of this kind of ARF. Methods The case histories of 12 patients diagnosed as ARF related to the crush syndrome in Wenchuan earthquake were pigeonholed. In order to evaluate the curative effects of the clinical features,laboratorial examination,continuous renal replacement therapy ( CRRT) and cure time were ana- lyzed. Results Anaemia,fever and lung infection were frequently happened in the patients diagnosed as ARF,and the frequency was 91. 67% ,66. 67% and 58. 33% respectively. Pleural effusion and acute respiratory distress syndrome ( ARDS) were noted in 41. 67% of the patients,and the increase of transaminase was noted as 91. 67% . Hypocalcaemia,hypoproteinemia and marked increase of creatine kinase ( CK) appeared in all patients. The patients with CK value exceeded 3 000 IU/L were received CRRT,and there was marked relativity between these 2 variables ( r =0. 845) for the treatment of ARF. Although the proportion of CRRT practiced highly in patients with oliguria,fasciotomies and amputations,there was no significant difference when compared with closed injury and non-oliguria patients ( P = 0. 522 7) . Compared with patients without infections,wound infections were obviously delayed the cure time of ARF ( P = 0. 025 5) . Conclusion As compared with ARF from other causes,ARF related to the crush syndrome has unique characteristics,and easily complicates with multiple organ dysfunction syndrome. Among the treatments, heteropathy and renalreplacement therapy are frequently used. Thorough debridement and infection control are beneficial to renal function recovery.
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Objective To investigate the effect of different types and dosages of contrast media on the function and cell injury of rat renal artery endothelium. Methods Renal artery rings were isolated from SD rats and incubated in IMDM medium with 30,60,90 ?l/ml Diatrizoate or Ioversol. The contents of NO and ET-1 were detected by Griess method and radioimmunoassay. The release of LDH was assessed by colotimetric method. Results After being incubated with Diatrizoate or Ioversol for 1 h,the renal artery endothelium did not show significant changes in the release of NO,but the release of ET-1 increased in a dose-dependent manner. When the renal artery endothelium was stimulated with Diatrizoate at dosage of 90 ?l/ml for 4 h,the release of LDH was increased markedly. A slight,but insignificant,increased release of LDH induced by Ioversol was observed. Conclusion Both Diatrizoate and Ioversol can affect the function of renal artery endothelium by interfering the secretion of ET-1,and the effects of Diatrizoate are more obvious than Ioversol. High-dose Diatrizoate can also induce renal artery endothelial cells injury.
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To evaluate the effects of interleukin-1 and interleukin-4 on the expression of p27 (one of the negative cell-cycle proteins) and CDK 2 (cell-cycle depending kinase, one of the positive cell-cycle proteins) on renal mesangial cells of rat in vitro, and to analyze their significance. The results showed that the proliferation of mesangial cells was induced markedly by interleukin-1, while the expression of p27 was down-regulated and that of CDK 2 was up-regulated. All of above changes were prevented by interleukin-4. The results suggested that the responses of rat renal mesangial cells to interleukin-1 and interleukin-4 were closely related to the changes in the expression of p27 and CDK 2.
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AIM:To approach the therapeutic effects of mycophenolate mofetil(MMF)in hormonal resistance nephrotic syndromes.METHODS:Patients were diagnosed as nephrotic syndrome and treated with prednisone at the dose of 1 mg?kg-1?d-1 for over 8 weeks,and 24 patients with unsatisfactory results or were palindromic were selected,and several patients in the 24 patients had been treated with cyclophosphamide or cyclosporine A.All patients were treated with MMF combined with low dose hormone.The initial dose of MMF was 1.0-1.5 g/d for 3 months,later the dose were reduced,and the maintenance dose of MMF was 0.5-1.0 g/d,the dose of prednisone was 5-20 mg/d,the follow-up visit period more than six months.The changes on urine protein,serum albumin,liver function,renal function were compared before and after treatment.RESULTS:Before and after treatment,urine protein decreased from(3.4?1.7)g/d to(0.9?0.2)g/d,serum albumin increased from(19.6?5.4)g/L to(36.1?7.7)g/L.serum creatinine level decreased from(105.7?6.4)?mol/L to(90.1?5.8)g/L.20 patients(83.3%)pathogenetic condition were relieved,15 patients(65.2%)were with complete remission.5 patients(20.8%)were partially recovered,and 4 patients(16.6%)had no response.The adverse effects were observed,including gastrointestinal events(n=8,33.3%),bacterial pneumonia(n=4,16.6%),herpes zoster(n=1,4.1%),hepatic function mild damage(n=3,12.5%).CONCLUSION:It is safe and effective to combine MMF with low dose hormone in treatment of hormonal resistance nephrotic syndrome,which could become a therapeutic option for refractory nephrotic syndrome(RNS).
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AIM: The aim of this study was to determine the relationship between PAI-1,TIMP-1 gene expression and renal tubulointerstitial fibrosis(TIF) of ureteral obstruction ,and the interfering effects of hepatocyte growth factor (HGF) treatment. METHODS: Sixty rats were divided into normal control, sham operation,unilateral ureteral obstruction(UUO),and rhHGF treated groups (received 0 5 mg?kg -1 ?d -1 HGF for twenty-one days), and were sacrificed at postoperative day 3, 7, 14, 21. The levels of PAI-1, TIMP-1 mRNA were measured by RT-PCR. MMP2 and MMP9 activities were detected by substrate zymography, and renal fibrosis was assessed by measuring tissue hydroxyproline. RESULTS: Compared to controls, expression levels of PAI-1,TIMP-1 mRNA were significantly increased in UUO rats, and this was accompanied by decreased activities of MMP2 and MMP9 and increase in tissue hydroxyproline content. HGF treatment significantly decreased expressions of PAI-1, TIMP-1 mRNA, increased MMP2 and MMP9 activities,and decreased tissue hydroxyproline content in the obstructive kidney. CONCLUSIONS: These results indicate that the increases in PAI-1, TIMP-1 mRNA expression may be the major cause of sustained decreased matrix degradation during the development of tubulointerstitial fibrosis after unilateral ureteral obstruction. rhHGF efficiently ameliorates renal tubulointerstitial injury by the reduction of PAI-1,TIMP-1 mRNA expression, and increasing MMP2, MMP9 activities. [
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Objective To investigate the effects of different doses of dexamethasone used at different time on the serumal concentrations of TNF ?, IL 1? and IL 6 of rats after severe scald in order to provide experimental basis for reasonable usage of ectogenous glucocorticoids for severe traumas. Methods The serumal concentrations of TNF ?, IL 1? and IL 6 were detected by ELISA after intraperitoneal injection of different doses of dexamethasone into rats at different time after severe scald. Results High dose(5 mg/kg) and low dose (0.5 mg/kg) of dexathemasone used during the period from 4 h to 12 h after severe scald could both significantly reduce the serumal concentrations of TNF ?, IL 1? and IL 6, and the effect of high dose was much better than that of low dose. Both doses of dexathemasone used at 24 h after scald had a significant effect on IL 1? and IL 6, but there was no difference between the two doses. No obvious effects were found of high/low dose of dexamethasone used 48 h later after scald. Conclusion According to the anti inflammatory effect, the best therapeutic efficacy may result from high dose of ectogenous glucocorticoids during the period from 4 h to 12 h and low dose from 12 h to 24 h after severe scald.
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Objective To investigate the effects of rTMP-GH, a recombinant fusion protein of thrombopoietin mimetic peptide (TMP) and human growth hormone (GH), on the proliferation and thrombocytopoiesis of cultured megakaryocytes. Methods After being treated with 100 ng/ml of rTMP-GH for 7 d, Dami cells, a kind of megakaryocyte cell line, were analyzed by observing the numbers of colony forming unit. Meanwhile, Western blotting and RT-PCR were applied to detect the expression changes of globin transcription factor-1 (GATA-1), which is a main regulator of thrombocytopoiesis in megakaryocytes. Results The numbers of colony forming unit were markedly increased in cultured Dami cells incubated with rTMP-GH. Compared with normal control and GH treatment groups, both the mRNA and protein levels of GATA-1 were up-regulated significantly in Dami cells treated with rTMP-GH. Conclusion rTMP-GH has a strong ability to promote the proliferation and thrombocytopoiesis of megakaryocytes.