Two cases of Type Ⅲ collagen glomerulopathy and literature review / 中南大学学报(医学版)

In this paper, 2 cases of collagen Type Ⅲ glomerulopathy were analyzed. The clinical manifestations mainly included nephrotic syndrome, proteinuria, hypertension and renal dysfunction. One patient showed that the complement factor H-related protein 5 (CFHR5) gene was likely a disease-causing mutation. The pathological examination of renal tissues showed hyperplasia of mesangial matrix, sub-endothelial insertion, and double-track formation. Immunohistochemistry of Type III collagen was positive. Electron microscopy revealed that massive collagen fibers (40-70 nm in diameter) deposited in the mesangial matrix and basement membrane. As for the follow-up results, the normal renal function had kept steady and the proteinuria was moderate in 1 case treated with angiotensin Ⅱ receptor blocker. Due to other system disease, another case developed into acute kidney injury and then received hemodialysis. The clinical manifestations of collagen Type Ⅲ glomerulopathy was atypical, the light microscope pathological features were various, and the disease was mainly diagnosed by electron microscopy and immunohistochemistry.

Clinical significance of Mtype phospholipase A2 receptor and thrombospondin Type 1 domaincontaining 7A in primary membranous nephropathy / 中南大学学报(医学版)

OBJECTIVES@#To evaluate the value of thrombospond in Type I domain-containing 7A (THSD7A) and M-type phospholipase A2 receptor (PLA2R) in primary membranous nephropathy (PMN) and to explore the relationship between their antibody levels and prognosis.@*METHODS@#Renal tissues in 128 patients with membranous nephropathy in the Second Xiangya Hospital of Central South University were collected from February 2015 to August 2017, including 108 patients with primary membranous nephropathy (PMN group) and 20 patients with secondary membranous nephropathy (SMN) (SMN group). Indirect immunofluorescence method was used to detect the expression of PLA2R antigen in kidney tissues,and the glomerular expression of THSD7A antigen was examined by immunohistochemistry and indirect immunofluorescence. The serum levels of anti-PLA2R antibodies and THSD7A antibodies were also detected by ELISA. According to the results of PMN examination,the patients were also divided into a PLA2R-related membranous nephropathy group and a THSD7A-related membranous nephropathy group.@*RESULTS@#The positive rate of PLA2R in the renal tissues in the PMN group was higher than that in the SMN group (78% in the PMN group, 35% in the SMN group, <0.01),while the positive rate of anti-PLA2R antibody in the PMN group was also higher than that in the SMN group (50% in the PMN group, 25% in the SMN group, <0.05).The serum level of anti-PLA2R antibody was positively correlated with 24 h urine protein (=0.254, <0.05) and negatively correlated with serum albumin (=-0.236, <0.05). The expression of THSD7A was positive in glomeruli in 7 cases of the PMN group (6%) by immuno-histochemistry, and which was positive in 1case of the SMN group (5%).The serum levels of anti-THSD7A antibody in the PMN group were higher than those in the SMN group [(0.49±0.26) pg/mL in the PMN group,(0.34±0.27) pg/mL in the SMN group, <0.05]. There was no difference in the clinical characteristics between the PLA2R-related membranous nephropathy group and the THSD7A-related membranous nephropathy group.@*CONCLUSIONS@#PLA2R and THSD7A are the target antigen of PMN, and the associated autoantibodies are helpful for the differential diagnosis of PMN. The anti-PLA2R antibody levels can reflect the severity of the disease and evaluate the effect of treatment. The incidence of THSD7A membranous nephropathy is low, and monitoring the serum anti-THSD7A antibody levels can assess patients' condition and predict disease outcome.

Diagnostic value of renal phospholipase A2 receptor and serum anti-phospholipase A2 receptor antibody in membranous nephropathy / 中南大学学报(医学版)

Objective:To examine the expression ofphospholipase A2 receptor (PLA2R) in renal tissues and the level of anti-PLA2R antibody in serum in patients with idiopathic membranous nephropathy (IMN) and secondary membranous nephropathy (SMN),and to evaluate their diagnostic value in IMN.Methods:A total of 73 patients,who were diagnosed between May,2014 and February,2015 in the Department of Nephrology of the Second Xiangya Hospital,Central South University,were divided into three groups:an IMN group (n=48),an SMN group (n=17) and a minimal change disease group (n=8) according to the renal biopsy.PLA2R expression in renal tissues and the level of antiPLA2R antibody in serum were detected by indirect immunofluorescence technique.Results:The positive rate and fluorescence intensity for PLA2R in the renal tissues in the IMN group were higher than those in the SMN group (91.7％ in the IMN group vs 29.4％ in the SMN group,P＜0.05),while the positive rate and serum level for anti-PLA2R antibody in the IMN group were higher than those in the SMN group (85.4％ in the IMN group vs 29.4％ in the SMN group,P＜0.05);the expression of PLA2R in renal tissues and the serum level for anti-PLA2R antibody were not detected in the minimal change disease group,The serum level of anti-PLA2R antibody was positively correlated with 24 h urine protein (r=0.432,P＜0.01) and negatively correlated with serum albumin (r=-0.307,P＜0.05).Conclusion:The expression of PLA2R in renal tissues and the serum level of anti-PLA2R antibody might be potential markers for diagnosis oflMN.

Role of M-type phospholipase A2 receptor and its antibody in hepatitis B virus-associated membranous nephropathy / 中南大学学报(医学版)

To examine levels of M-type phospholipase A2 receptor (PLA2R) and its antibody in the patients with hepatitis B virus-associated membranous nephropathy (HBV-MN), and to explore the correlation of PLA2R with laboratory parameters and pathological characteristics.
 Methods: A total of 49 adult patients with biopsy-proved HBV-MN were enrolled in this study. Levels of anti-PLA2R antibody in serum and PLA2R in renal tissue were detected. Patients were assigned into two groups: a positive PLA2R group and a negative PLA2R group. Differences in laboratory parameters and pathological characteristics were compared between the two groups.
 Results: Of 49 patients with HBV-MN, 17 had positive PLA2R expression in renal tissues. In the positive PLA2R group, 10 patients were positive for serum anti-PLA2R antibody. Patients with positive PLA2R expression in renal tissues showed higher levels of 24 hour urinary protein [(4.6±3.9) g/d], serum HbsAg (70.5%) and renal HbsAg expression (71%), while lower level of serum albumin [(24.1±7.5) g/L] than those of the negative group.
 Conclusion: PLA2R is expressed in the renal tissues and serum anti-PLA2R antibody can be detected in some HBV-MN patients. Positive PLA2R expression in renal tissue might be related to HbsAg deposition in serum and renal tissues. Patients with positive PLA2R expression in renal tissue have more severe glomerular sclerosis.

Evaluation of the preventive effects of nosocomial post abortion care on repeated pregnancy in unmarried female people / 中国综合临床

Objective To investigate the preventive effect of post abortion care(PAC) on unsafe sexual behaviors and deficiency in the knowledge of unmarried females,especially the youth in order to prevent repeated.unintended pregnancies as well as to promote the unmarried female's reproductive health.Methods During the period from Jan.2012 to Jun.2013,171 unmarried young women (＜ 24 years old) were enrolled in the study who were underwent free willed induced abortion due to unwanted pregnancy in Maternal and Child Health-Care Hospital of Huangpu District of Shanghai.Their reproductive health related knowledge,attitude and behavior were investigated by questionnaires.Based on the information above,they were provided with a series of post abortion services and improvement of reproductive health cognition and prevention effect of repeat pregnancy were evaluated after the intervention.Results After the nosocomial PAC intervention,the research objects are improved in the contraceptive knowledge and contraceptive behavior largely than before.The awareness rate on the female fertile time was increased from 53.8％ (92/171) to 80.6％ (137/170).The common contraceptive awareness rate increased from 49.1％ (84/171) to 91.8％ (156/170).The difference was statistically significant (x2 =27.30,x2 =75.69,P ＜ 0.05).After 1 year follow-up,the PAC intervention make in contraceptive behavior change.The contraception rate increased from 8.2％ (14/171) to 65.3％ (111/170).The contraceptive failure rate was reduced from 35.7％ (61/171) to 4.7％ (8/170) (x2 =165.24,36.12,P ＜ 0.05).There was not complications occurrence.Conclusion PAC can improve the contraception rate and reduce the unmarried female youth repeated abortion rate effectively.

Optimum dose of oxycodone for anesthesia when combined with propofol in patients undergoing induced abortion / 中华麻醉学杂志

Objective To determine the optimum dose of oxycodone for anesthesia when combined with propofol in the patients undergoing induced abortion.Methods Three hundred patients, aged 18-40 yr, weighing 40-70 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , undergoing elective induced abortion, were randomly divided into 6 groups (n =50 each) using a random number table: fentanyl group (group F) and different doses of oxycodone groups (Q1-5 groups).In group F, fentanyl 1 μg/kg was intravenously injected.In Q1-5 groups, oxycodone hydrochloride 20, 40, 60, 100 and 150 μg/kg were intravenously injected, respectively.Propofol 2.5 mg/kg was intravenously injected 1 min later in all the patients, and the operation was started when the eyelash reflex disappeared.The occurrence of hypotension, bradycardia, body movement and respiratory depression during operation, and nausea and vomiting within 4 h after operation were recorded.The uterine contraction pain was assessed with numerical rating scale (NRS) at 30 min, 1 h and 4 h after operation.Patient's satisfaction was evaluated at 1 and 4 h after operation.Results With the prolongation of time, NRS score was gradually increased, and the degree of patient's satisfaction was gradually decreased in group F (P＜0.05).With the prolongation of time,NRS score was gradually decreased, and the degree of patient's satisfaction was gradually increased in Q1-2 groups (P＜0.05).There was no significant difference in NRS score and degree of patient's satisfaction between Q3-5 groups (P＞0.05).Compared with group F, NRS score was significantly decreased, and the degree of patient's satisfaction was increased at 4 h after operation in Q1-5 groups (P＜0.05).Compared with Q1-2 groups, NRS score was significantly decreased at 30 min and 4 h after operation, and the degree of patient's satisfaction was increased at 4 h after operation in Q3-5 groups (P＜0.05).Among the Q1-5 groups,the incidence of respiratory depression, body movement, and nausea and vomiting was the lowest in group Q4 (P＜0.05).Conclusion When combined with propofol, the optimum dose of oxycodone for anesthesia is 100 μg/kg in the patients undergoing induced abortion.

Effect of high glucose peritoneal dialysis solution on PGC-1α expression and mitochondria related oxidative injury in human peritoneal mesothelial cells / 中南大学学报(医学版)

OBJECTIVE@#To investigate the mechanism of mitochondrial oxidative injury induced by high glucose peritoneal dialysis solution (PDS) and the protective effect of peroxisome proliferator activated receptor gamma coactivator 1-alpha (PGC-1α) in the mitochondria of human peritoneal mesothelial cells (HPMC) in the high glucose ambience.@*METHODS@#HPMC was cultured in a PDS containing 1.5%, 2.5% and 4.25% glucose for 24 hours. Western blot analysis was used to detect PGC-1α expression. MitoSOX? Red staining, respiratory chain complexes and antioxidant enzyme activities were determined.@*RESULTS@#The activities of respiratory chain complex III and antioxidant enzymes decreased significantly in a concentration- and time-dependent manner, along with the increased production of mitochondrial reactive oxygen species (ROS) and cellular apoptosis. In addition, protein expression of PGC-1α was also decreased in the high glucose PDS ambience.@*CONCLUSION@#High glucose PDS might inhibit PGC-1α expression, resulting in the inhibition of mitochondrial function and increase of mitochondrial ROS and cellular apoptosis.

New pathologic classification of diabetic nephropathy (retrospective study of 37 cases) / 中南大学学报(医学版)

OBJECTIVE@#To investigate the new pathological classification of diabetic nephropathy (DN) published by Research Committee of the Renal Pathology Society in 2010.@*METHODS@#Renal biopsy specimens were obtained from 37 patients with type 2 diabetes mellitus with micro-albuminuria (MAU) or clinical albuminuria (CAU). These samples were classified according to new pathological classification for DN and new standard scores for interstitial vascular injury.@*RESULTS@#Before the classification, DN was seen in 26 palients. After re-analysis according to the new pathological classification, the patients diagnosed with DN increased to 32. In these 32 DN patients, 1 was classified as type I, 3 as type IIa, 2 as type IIb, 23 as type III and 3 as type IV; 12 patients had mild interstitial injury, 15 had midrange interstitial injury, while 5 had severe interstitial injury.@*CONCLUSION@#The new pathological classification of DN can increase the diagnosis rate and attract more attention to tubular and interstitial damage in DN, contributing to the early diagnosis and treatment of DN.

Role of mitochondrial respiratory chain in hyperpermeability of human peritoneal mesothelial cells induced by high glucose peritoneal dialysate / 中华肾脏病杂志

Objective To investigate the role of mitochondrial respiratory chain in the hyperpermeability of human peritoneal mesothelial cells (HPMCs) induced by high glucose peritoneal glucose PDS was also added. Transmesothelial electrical resistance (TER) measurement was examined for detection of permeability damage in HPMCs. Immunostaining and Western blotting analysis were used to detect claudin-1 expression. Mitochondrial superoxide (MitoSOX) Red staining and respiratory chain complexes activities were determined for detection of mitochondrial reactive oxygen species (ROS) production and mitochondrial complexes activities. Results TER was decreased in a time- and concentration-dependent manner after culture with high glucose PDS for was also down-regulated significantly by high glucose PDS (P＜0.01). Complex Ⅲ activity was inhibited (10.8% of control, P＜0.01) accompanied with increased mitochondrial ROS generation.These changes were partially prevented by glutathione. Conclusion Mitochondrial respiratory complex Ⅲ pathway has crucial importance in maintaining TER of HPMCs, which may reveal a valuable target for novel therapies to fight hyperpermeability of peritoneum during the prolonged PD treatment.

Effect of glucose peritoneal dialysates on the transmesothelial electrical resistance and cellular migration of monolayer human peritoneal mesothelial cell / 中南大学学报(医学版)

OBJECTIVE@#To investigate the effect of different concentrations of glucose peritoneal dialysates (PDS) on monolayer transmesothelial electrical resistance (TER) and migration ability of cultured human peritoneal mesothelial cells (HPMCs) to clarify the cause of peritoneal hyperpermeability state and ultrafiltration failure during prolonged peritoneal dialysis.@*METHODS@#HPMCs were cultured in a 1:1 mixture of DMEM and PDS containing 1.5%, 2.5%, and 4.25% glucose. Methyl thiazolyl tetrazolium (MTT) assay and TER were measured to determine the effect of glucose PDS on the proliferation and permeability of human peritoneal mesothelial monolayers, respectively. Wound-healing assay was used to confirm whether glucose could do harm to the migration of cells.@*RESULTS@#Proliferation of HPMCs was significantly suppressed by different glucose concentrations at 24 hours. TER decreased in a time- and concentration-dependent manner after culture with different concentrations of glucose PDS. Cells lost migration in the presence of high glucose after 24 hours, and most cells lost their normal morphology and became detached from plates after 48 hours of wounding.@*CONCLUSION@#High glucose in PDS can cause peritoneal damage by suppressing cell proliferation, inducing increase in paracellular permeability of HPMCs and inhibiting cell migration after damage, which may be responsible for peritoneal hyperpermeability and the development of ultrafiltration failure.