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To analyze the interest distribution relationship and symbiotic mode in the construction of urban medi-cal groups,based on the symbiotic theory,a framework for analyzing the interest distribution relationship of urban medical groups is constructed.Based on actual cases,urban medical groups are summarized and divided into four types:one-way supply type,partial benefit symbiosis type,asymmetric reciprocity symbiosis type,and symmetric reciprocity symbiosis type.The focus of a one-way supply oriented urban medical group is on reshaping the profit distribution mechanism,a partial benefit symbiotic urban medical group is on establishing a profit compensation mechanism for benefit medical institutions,and an asymmetric and mutually beneficial symbiotic urban medical group is on building a long-term benefit balance mechanism.
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Objective:To analyze the clinical efficacy of prednisone, hydroxychloroquine (HCQ) combined with plasmapheresis (PE) or not for the treatment of systemic lupus erythematosus (SLE) during pregnancy.Methods:Fourteen patients with SLE during pregnancy were analyzed. Totally 7 patients in the non-PE group were given prednisone and HCQ only while 7 patients in PE group were given prednisone and HCQ combined with PE. The fetus outcomes and clinical data, such as erythrocyte sedimentation tate (ESR), urine protein level, blood cell count and systemic lupus erythematosus disease activity index (SLEDAI) score before and after treatment at 3, 6, 12 months were used to evaluate the efficacy between the two groups. The comparison between groups was performed by repeated measures analysis of varianc (ANOVA).Results:Totally 11 patients delivered successfully in both groups while three of the 7 patients in the non-PE group had stillbirth. The 11 fetuses developed well and were born with an Apgar score of 8 or more at birth in both groups. There was a significant difference in ESR and platelet counts between the two groups ( F=7.838, P<0.05 ; F=32.269 , P<0.05). The ESR of the PE group was lower than that in the non-PE group at 3, 6 and 12 months after delivery, while the platelet count was higher than that in the non-PE group. Although there was no significant difference in the SLEDAI scores between the two groups ( F=2.816, P=0.119), the average of SLEDAI scores in the PE group was lower than that in the non-PE group at 3, 6 and 12 months after delivery. In addition, the urine protein of 7 patients in the PE group turned negative at 6, 12 months after delivery. In the non-PE group, urinary protein-positive patients were present in 3, 6, 12 months after delivery. Conclusion:PE in combination with oral prednisone and HCQ is a more effective than oral prednisone and HCQ alone for patients with active SLE during pregnancy, which reduces pregnancy loss and promote the patient's outcome.
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Objective To test the hypothesis of autophagy that silencing PHD2 gene could increase hypoxia inducible factor (HIF)-1α levels in the renal medulla and attenuate hypoxia injury in cultured human renal proximal tubular epithelial cell (HK-2) under cobalt dichloride (CoCl2) exposure.Methods HK-2 cells were harvested at hour 0,6,12,24,36 and 48 after exposure to CoC12 (200 μmol/L).The role of HIF/PHD pathway in CoCl2-induced cell apoptosis/autophagy was studied by employing small-interfering RNA (siRNA).Dynamic profiles of apoptosis markers (Bax,Bcl-xl) and autophagy marker (LC3) of HK-2 cells within 48 h after exposing to CoCl2 were recorded.Alamar Blue assay was used for quantitative analysis of cellular growth and viability.Electron microscopy analysis was employed to evaluate the changes in autophagic structures.Results The protein expressions of PHD2 were gradually increased after exposing to CoCl2 (200 μmol/L),with statistics significance at 24 h and reached the peak at 48 h (both P ＜ 0.01).PHD2 siRNA reduced PHD2 levels by ＞ 60％ and significantly increased HIF-1α protein levels (P ＜ 0.01),but had little effect on HIF-2α.The protein expression of Bcl-xl was significantly up-regulated,while the level of Bax and LC3-Ⅱ/LC3-Ⅰ were down-regulated in PHD2 siRNA group (all P ＜ 0.01),compared with the negative control group.Meanwhile,either 3-Methyladenine (an autophagy inhibitor) treatment or PHD2 knockdown rescued cell death and increased cell viability through autophagy inactivation.The ratio of LC3-Ⅱ/LC3-Ⅰ and the quantity of autophagosomes were decreased,and the cell ultrastructure was also relatively intacter than the negative control group.Of interest,co-administration of HIF-1α siRNA with PHD2 siRNA abrogated renoprotective effect conveyed by PHD2 siRNA alone,suggesting that activation of endogenous HIF-1α-dependent pathways mediated the autophagy inactivation effects of PHD2 silencing.Conclusions Direct inhibition of PHD2 promotes renal epithelia cell survival against CoCl2-induced cell apoptosis/autophagy.Activation of the HIF-1α signaling pathway is required to reduce apoptosis and autophagy via up-regulating the expression of Bcl-xl protein.
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Objective To investigate the molecular mechanism of protection of ischemia preconditioning on renal ischemia reperfusion injury. Methods Male C57/BL6N mice were randomly divided into two groups: in IR group, 35 min ischemia was induced by occlusion of both renal pedicles followed by 24 h perfusion (I/R). 15 min ischemia was induced 4 days before I/R in IPC group. Blood sample and kidney were collected in IR and IPC group after 24 h perfusion. Serum creatinine (Scr) and histological changes were used to evaluate the renal injury. PHD2 and HIF-1αwere evaluated by Western blotting, miR-21 expression was confirmed by real-time PCR. In vitro, hypoxic model was established by 1% O2 in HK-2 cells. Knockdown of miR-21 in hypoxic model was perfermed by locked nucleic acid modified-anti-miR-21 transfection. The levels of miR-21, HIF-1α and PHD2 mRNA were confirmed by real-time PCR. The levels of HIF-1α and PHD2 proteins were tested by Western blotting. Results In vivo, Compared with IR group, the renal function and histological changes were improved in IPC group (P<0.01). Compared with IR group, the expression of miR-21(P<0.01) and HIF-1α(P<0.05) were increased in IPC group, while PHD2 was reduced (P<0.01). In vitro, hypoxia reduced miR-21. The inhibition of miR-21 could increased the expression of PHD2 (P<0.05). Conclusions Ischemia preconditioning may exert protection against renal ischemia reperfusion injury by inhibiting PHD2.