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Objective To analyze the immunological effect and its influencing factors of HAART on HIV/AIDS with a baseline CD4 of less than 350 cells/mm3 in Hubei Province during 2011-2020. Methods The treatment information of people living with HIV/AIDS (PLWH) was collected through China Disease Control and Prevention Information System, and the change of CD4 mean value was analyzed by Wilcoxon sign rank sum test. Chi square test and multivariate logistic regression were used to analyze the factors influencing the immunological effect. Results The mean value of CD4 cell count at baseline was (172.78±107.65) cells/mm3 before treatment and (398.85±206.71) cells/mm3 in the fifth year after treatment. Patients with baseline CD4<50 /mm3 had the largest increase in CD4 mean value after treatment (P<0.05). Multivariate logistic regression analysis showed that Age ≥35 years, heterosexual transmission, time interval from diagnosis to treatment≥1 month, baseline CD4<50 /mm3, treatment time 7-<18 months, and drug failure were the risk factors for the success of antiviral therapy(P<0.05). Conclusion The immunological effect of HIV/AIDS antiviral therapy in Hubei Province is affected by many factors. It is necessary to strengthen the implementation of early detection and early treatment strategy and promote treatment compliance education for patients aged ≥35 years.
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Objective:To explore the mediating role of self-control in the relationship between alexithymia and internet addiction.Methods:From August to September 2019, a total of 433 college students were selected from three universities in Jiangxi province by cluster random sampling method. The Chinese internet addiction scale-revised, the twenty-item Toronto alexithymia scale and brief self-control scale were used for questionnaire testing. SPSS 23.0 software was used for descriptive statistics, Pearson correlation analysis and PROCESS V3.5 macro program was used to test the mediating effect.Results:The total scores of alexithymia, internet addiction and self-control were (53.61±9.44), (45.31±9.84) and (41.91±6.09), respectively. Pearson correlation analysis showed that alexithymia was significantly positively correlated with internet addiction ( r=0.47, P<0.01), and significantly negatively correlated with self-control ( r=-0.37, P<0.01). The negative correlation between self-control and internet addiction was significant ( r=-0.46, P<0.01). Multivariate hierarchical regression analysis showed that alexithymia directly predicted internet addiction after controlling the influence of gender. Self-control played a partially mediating role in the relationship between alexithymia and internet addiction (effect size=0.13, 95% CI: 0.082-0.185), the mediating effect accounted for 25% of the total effect. Conclusion:Alexithymia not only directly affects college students′ internet addiction, but also indirectly affects college students′ internet addiction through self-control.
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To analyze the differential expression of RAW264.7 macrophage-derived exosomes miRNA stimulated by free silicon dioxide (SiO2). Methods: RAW264.7 was stimulated with SiO2 (200 mg/L) for 48 h (exo_48 h group), and the supernatant was collected. The exosomes in the supernatant were extracted by ultracentrifugation. Transmission microscopy, nanoparticle tracking analysis (NTA) and Western blotting were used to identify exosomes. High-throughput sequencing was performed to compare the differential expression of exosome miRNAs between the exo_control group (RAW264.7 cultured for 48 h without SiO2) and the exo_48 h group; miRanda, TargetScan and starBase were used to predict target genes of differential miRNAs. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were performed on target genes to further analyze the biological functions of genes. Results: The transmission microscopy showed that the exosomes were lipid membrane coated vesicles, which were heterogeneously distributed, with a diameter ranging from 30 to 100 nm, and the shape was round or elliptical. The volume kurtosis was concentrated between 40 and 100 nm and the exosome marker protein TSG101 was positive. High-throughput sequencing screened 148 differentially expressed exosomal miRNAs. MiR-219c-3p, let-7d-3p, let-7a-1-3p, miR-328-3p, miR-365-3p, and miR-7219-3p were significantly up-regulated, and miR-378d and miR-5106 were significantly down-regulated compared with the control group. Target genes were mainly enriched in mTOR signaling pathway, Wnt signaling pathway, TGF-β signaling pathway, and so on. Conclusion: The exosomes secreted by SiO2-induced macrophages contain abundant miRNAs, and their expressions are significantly different. These differential miRNAs may be involved in the activation of lung fibroblasts and epithelial-mesenchymal transition.
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Animais , Camundongos , Linhagem Celular , Exossomos , Sequenciamento de Nucleotídeos em Larga Escala , Macrófagos , MicroRNAs , Dióxido de SilícioRESUMO
Objective@#To study clinical and pathologic characteristics of leiomyomas of the gastrointestinal tract, and to investigate the distribution characteristics of interstitial cells of Cajal ( ICCs ) in gastrointestinal leiomyomas.@*Methods@#One hundred and forty-seven cases of leiomyomas of gastrointestinal tract were collected at the Second Affiliated Hospital of Zhengzhou University from June 2012 to June 2017. Clinical and pathologic findings were analyzed, combined with immunohistochemistry, Alcian blue-osafranin staining and molecular study.@*Results@#The age of patients ranged from 13-82 years with mean age of 52 years. Male to female ratio was about 1∶2. Histologically, all tumors were composed of ovoid to spindle cells arranged in short intersecting fascicles. All tumors were diffusely and strongly positive for smooth muscle antibodies, desmin and h-caldesmon by immunohistochemical staining. A prominent interspersed subpopulation of elongated/dendritic-like cells with CD117 and DOG1 positivity (accounting for 1% to 30% of all tumor cells) and negative for Alcian blue-osafranin staining was identified in all esophageal leiomyomas, 16 of 20 (80%) gastric leiomyomas and 3 of 12 small bowel leiomyomas, but none in colonic/rectal leiomyomas. Mutational analysis in 16 cases showed absence of mutation in exons 9, 11, 13 or 17 of C-KIT and exons 12 or 18 of PDGFRA.@*Conclusions@#ICCs are identified in esophageal and gastric leiomyomas, as well as in small percentage of intestinal leiomyomas. Such findings may bring significant diagnostic pitfalls for misdiagnosis as gastrointestinal stromal tumor. Careful attention to the distribution of CD117 and DOG1 positive cells and molecular mutation analysis of C-KIT and PDGFRA may be necessary to establish the correct diagnosis.
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Objective@#To analyse the clinicopathologic features of gastric plexiform fibromyxoma (PF) including diagnosis, differential diagnosis, immunohistochemistry and molecular pathology.@*Methods@#Eight cases of PF were collected from June 2006 to June 2017 at the Second Affiliated Hospital of Zhengzhou University and the First Affiliated Hospital of Zhengzhou University. The clinicopathologic findings of eight cases of PF were retrospectively analyzed, and immunohistochemistry (EnVision method) and molecular detection of glioma-associated oncogene homologue 1 (GLI1) gene translocation were performed. All cases were histologically reviewed with immunohistochemical staining for smooth muscle actin (SMA), CD10, CD117, DOG1, CD34, ER, PR, ALK and S-100. Fluorescence in situ hybridization (FISH) was used to detect the GLI1 gene translocation, and mutation of CKIT exons 9, 11, 13 and 17; and PDGFRA exons 12, 14 and 18 were identified by Sanger sequencing in four cases. Relevant literature was reviewed.@*Results@#The study included four men and four women, age ranged from 26 to 72 years (mean 51 years). Histologically, the tumors were rich in small thin-walled blood vessels and myxoid matrix, and exhibited multiple nodular growth pattern in the gastric wall. The tumor cells were bland, spindled or oval. Immunohistochemically, all cases strongly expressed vimentin and SMA, and some expressed CD10 (4/8), desmin (3/8), H-caldesmon (5/8) and PR (5/8), but were negative for CD34, S-100, ER, ALK, CD117 and DOG1. The GLI1 gene translocation detection was performed in eight cases by FISH with three positive cases and five negative cases. Mutation analyses for exons 9, 11, 13, and 17 of CKIT genes and exons 12, 14, and 18 of the PDGFRA genes were performed and the tumors all of four tested cases were wild-type. Seven patients were followed up (ranged from 24 to 95 months, mean 50 months) after diagnosis and none of the patients had recurrence or metastasis.@*Conclusions@#PF is a rare novel mesenchymal tumor of the stomach. Its distinct clinicopathologic features and immunohistochemical positivity for SMA, CD10 and PR can help differentiating this entity from other gastrointestinal mesenchymal tumors. FISH detection of GLI1 gene translocation offers an additional molecular diagnostic marker for the diagnosis.
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Objective To observe the effectiveness of routine nursing plus foot exercise on the peripheral neuropathy and plantar pressure in patients with diabetic foot.Methods Toally 100 patients with diabetic foot were randomly divided into 2 groups.On the basis of routine nursing care,50 patients in the observation group were given foot exercises for 12 weeks,50 patients in the control group were given routine nursing only.Before and after intervention,the Toronto clinical scoring system (TCSS),left and right foot peak pressure variation were observed.Results Before intervention,there was no statistical difference between the two groups' TCSS sore and the peak pressure of left and right foot (P ＞0.05).After intervention,the observation group's average total score of TCSS was lower,there was significantly different between two groups (P＜ 0.001).The peak pressure of left and right foot is lower in the observation group,the difference was statistically significant (P ＜ 0.05).Conclusion Foot exercises is worthy of clinical promotion,because it can improve the peripheral neuropathy of patients with diabetic foot,so as to reduce the plantar pressure,reduce the pain of patients and improve their life quality.
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Objective:To investigate the cognition of terminal stage patients'dignity therapy,attitude towards its concept and scheme,willingness of its promotion in college students and to gain some recommendations for improvement.Methods:Combined quantitative and qualitative methods,an anonymous questionnaire survey was conducted in a convenience sample of 220 college students,of which 20 students were selected for in-depth interviews.Results:Only 17.73％ of students had a correct understanding of dignity therapy,94.98％ of them accepted its concept,92.96％ of them held a positive attitude,74.38％ of them were willing to promote dignity therapy,in which female students were dominated (P =0.041).Interview results showed that the contents of dignity therapy were to some extent stiff and not fit for Chinese patients,which might impede its promotion.Conclusion:College students lack the cognition of dignity therapy.But they hold a positive attitude and are willing to promote dignity therapy when they get to know its concept and contents.As seen,dignity therapy has a good future but there are still some obstructions in the promotion,and need to be localized.
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<p><b>OBJECTIVE</b>To understand the HIV infection status among MSM in Hubei province and provide scientific evidence for the development of intervention strategy.</p><p><b>METHODS</b>A total of 11 438 samples were collected from MSM in sentinel surveillance during 2010-2013 to detect HIV-1 antibody. BED-CEIA was used to identify the recent HIV infection, and the recent HIV infection rate among the MSM was estimated. The age, group and area specific recent infection rate and condom use rate were analyzed.</p><p><b>RESULTS</b>The annual HIV positive rates among MSM were 3.34% , 3.74% , 2.96% and 3.15% respectively and the annual recent infection rates were 2.31% , 1.91% , 1.53% and 1.71% respectively during 2010-2013. The HIV positive rate in age group ≤ 30 years was lower than that in age group >30 years, but the recent HIV incidence rate was higher in age group ≤ 30 years than in age group >30 years. The detection rate of recent HIV infection varied with sample source, the highest detection rate was among the samples form work group/CDC and public bathroom (3.54% and 3.49%, respectively). The recent HIV i nfection rate in Wuhan was highest (5.73%). The proportion of MSM using condoms in each homosexual behavior during past six months was 38.91% . Multiple logistic regression analysis indicated that the factors related to recent HIV infection included sample source (OR = 0.344-0.713), area (OR = 3.581-9.577) and condom usage (OR = 6.686).</p><p><b>CONCLUSION</b>The HIV-1 infection rate in MSM was at a high level in Hubei, especially in some areas. The condom use rate was low, it is necessary to strengthen the prevention and control of HIV infection in MSM.</p>
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Adulto , Humanos , Masculino , China , Epidemiologia , Preservativos , Infecções por HIV , Epidemiologia , HIV-1 , Homossexualidade Masculina , Sexo SeguroRESUMO
Death with dignity is now not legislation in our country .This paper mainly discussed about some barriers to the legalization of death with dignity in China , from the viewpoint of Chinese traditional ideas , the lack of death education , risk of abusing , the subject change of the informed consent right , doctor-patient communica-tion and trust lsot and so on .It is proposed that our country should perfect the medical security system , strengthen the education of death at the same time and help the citizen set up the view of science .Outside, still need to fur-ther deepen the reform of medical system in our country , the maintaining patient ’ s autonomy and right of choosing , protect the informed consent right of patients .Create the doctor-patient relationship of mutual trust .
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Objective:To evaluate the efficacy and safety of amisulpride and risperidone in the treatment of schizophrenia. Meth-ods:The RCTs literatures on amisulpride and risperidone in the treatment of schizophrenia were retrieved and screened, and the quali-fied ones were analyzed by meta-analysis. Results:A total of 10 literatures were included involving 802 patients. Meta-analysis results showed that the difference between the two groups after the treatment was not statistically significant by comparing the clinical efficien-cy, PANSS score and TESS score. About the incidence of adverse reactions, amisulpride was better than risperidone in the endocrine function, extrapyramidal symptoms, weight gain and cardiovascular system. The incidence of nausea and vomiting of amisulpride was more than that of risperidone. There was no statistical significance in insomnia, headache, dizziness and the others. Conclusion:Ex-isting literature analysis shows that amisulpride is safe and effective in the treatment of schizophrenia.
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Objective To report 1 case with renal immunoglobulin light and heavy chain deposited disease (IgG-κ light chain and γ1 heavy chain).Methods The clinical manifestations,serum immunofixation electrophoresis,light and heavy chain abnormalities of blood and urine,bone marrow biopsy and renal biopsy data laboratory data were recorded and analyzed.Results A 63-year-old woman presented with massive proteinuria,microscopic hematuria,hypertension,anemia and serum IgG-κ light chain.Bone marrow aspirate revealed 4％ plasma cells.Renal biopsy revealed nodular glomerulopathy with congo red staining-negative.Immunofluorescence showed that κ light chain and IgG1 (γ1 heavy chain) were deposited along the glomerular basement membranes (GBM) and tubular basement membranes (TBM).Electron-microscopy revealed electrondense deposits that delineate the outer aspect of TBM and endothelial aspect of GBM.Conclusion The diagnosis of renal immunoglobulin light and heavy chain deposited disease (IgG-κ light chain and γ1 heavy chain) should be addressed combine with clinical and is pathology,especially with immune pathological examination.
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Objective To investigate the renal pathologic changes in both donors and transplant recipients with delayed graft function (DGF).Methods The clinical and laboratory data were retrospectively analyzed in 144 renal recipients with DGF.All the patients received renal biopsy,and donors' biopsy was performed on 131 recipients.The pathological changes were examined under the light microscopy (LM),immunofluorescence (IF) and electron microscopy (EM).Results (1) The incidence of DGF was 10.16%-7.48% during 1994 to 2005,and decreased to 5.35 % during 2006 to 2009.(2) Anuria occurred in 24 cases (16.67 %),oliguria in 24 (16.67%) and hypertension in 68 cases (47.22 %).The enlargement of transplanting kidney and the increased vascular resistance was detected in 79.67 % (98/123 cases) and 45.53 % (56/123 cases) respectively by ultrasound examination.(3) The level of serum creatinine was ranged from 451 to 707 μmol/L.The high level of urinary NAG enzyme was found in 102 cases (70.83 %),proteinuria in 79 recipients (54.86 %) and hematuria in 77 cases (53.47 %).(4) The acute rejection was observed in 66 cases (45.83 %),toxicity of CNI in 22 (15.28 %),IgA nephropathy in 18 (12.50 %),acute tubular necrosis in 8 (5.56 %),and recurrent FSGS in 2 cases (1.39 %).(5) In most recipients (66/109 cases,60.55 %)immunosuppressive regimen altered and renal replacement therapy was given.Conclusion The causes of DGF are complicated.The quality of donors' kidney and early histological changes of recipients are contributed to the development of DGF.It is necessary to perform renal biopsy not only in donors but also in recipients with DGF.And kidney biopsy in transplanted patients was also beneficial to the treatment.
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BACKGROUND: Further studies are needed to understand the cytobiological character, functional regulation, gene changes and expression difference of CD34~+ and CD133~+ stem cells induced by basic fibroblast growth factor (bFGF) using gene chip. OBJECTIVE: To compare the differences of gene expression and the response to bFGF of human umbilical cord CD34~+ and CD133~+ cells, and to explore gene expression changes of bFGF-induced umbilical cord CD34~+ and CD133~+ hematopotic stem cells/hemapoietic progenitor cells in vitro. METHODS: Human umbilical cord blood CD34~+ and CD133~+ cells were isolated and purified by MiniMACS immunomagnetic beads selection. The CD34~+ and CD133~+cells were cultured for 10 to 15 days in DMEM/F12 medium, supplemented with bFGF and B27. Total RNA from these cells was extracted and the genetic level of these cells was performed using Oligo GEArray(r) chip and GEArray software. Selected rate of CD34~+ and CD133~+ hematopoietic stem cells was detected using flow cytometry. CD34~+ and CD133~+ cell morphological changes were measured before and after bFGF induction. The concentration and purity of RNA were determined by agarose gel electrophoresis degeneration. Gene-chip test results were analyzed.
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Objective To study the sequence variation in the env V3-V4 human immunodeficiency virus (HIV)-1 predominant subtype B strains in Hubei Province and to understand the epidemic characteristics and mutations of HIV-1. Methods Epidemiologic survey was done in the HIV-1 carriers in Hubei area. HIV-1 env V3-V4 regions were amplified by nested-polymerase chain reaction (nPCR). The sequences were determined and then phylogenetic analysis was performed. The difference of gene distance were checked by chi square test and the variation of gene distance were descriptively analyzed. Results Four HIV-1 strains or circulating recombinant forms (CRF) were identified in Hubei Province subtype B', B'/C, CRF01_AE and C were 82.69%, 7.69%, 7.69% and 1.92% ,respectively. B' strains were closely related with B. CN. RL 42 from Yunnan Province and B. CN. 02. 02HN from Province Henan, the gene distances were 7.08 ± 2.19 and 7.88 ± 2.28, respectively. Genetic divergence of env of B' strains showed that subtype B' has existed in Hubei area for about 10 years. Amino acid sequence analysis of section env showed V4 was more variable than C3, V3. The top four peptides of V3 loop were GPGR (46.5%), GPGK (30.2%), GPGQ (13.6%) and GQGR (9.3%). Predictions for the potential use of co-receptors on the basis of the critical amino acids within V3 loop disclosed that 16.28% were CCR5-using (R5/NSI), 13.95% were CXCR4-using (X4/SI) while the co-receptor usage of the vast majority (69.77%) could not be predicted. The analysis of glycosylation sites showed that there were 9 sites in env V3-V4 regions of HIV-1 strains in Hubei area and there were deletions in 8 of them, Conclusions Subtype B' is still the main epidemic subtype in Hubei Province and high homologous to the strains from Yunan and Henan Province.
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<p><b>OBJECTIVE</b>To analysis the pathological demography in Chinese patients undergoing renal biopsy from our nephrology center.</p><p><b>METHODS</b>Between January 1979 and October 2000 in Jinling Hospital, Nanjing, China, 10,002 attempts of percutaneous renal were performed in patients with renal disease from 33 provinces of China. The pathological classifications were made according to the WHO criteria of 1982 for renal pathology or the modified WHO criteria of 1995 by a panel of pathologists and nephrologists during routine clinical-pathological rounds. The pathological demography between those specimens collected from 1979 - 1989 and those from 1990 - 1999 was compared.</p><p><b>RESULTS</b>The mean age of the 10,002 subjects undergoing renal biopsy was 31.4 +/- 13.0 years (ranging from 1 to 78 years), with a male to female ratio of 1.3:1; for the 592 renal transplant recipients, the mean age was 37.5 +/- 9.1 years (ranging from 16 to 66 years), with a male to female ratio of 2.36:1. Primary glomerular diseases (PGD) accounted for 71% of the total patients undergoing renal biopsies, secondary glomerular nephritis (SGN) 23%, tubular-interstitial diseases 3.2%, unclassified renal diseases 1.3%, hereditary and congenital renal diseases 1.0%, end stage renal diseases 0.96%, and recently realized or rare renal diseases 0.15%. IgA nephropathy (IgAN) was the most frequent pathological pattern (40%) of PGD, followed by mesangial proliferative lesion (MsPL) (30%), membranous nephropathy (MN) (10%), and focal segmental glomerulosclerosis (FSGS) (6%). Lupus nephritis (LN) was the most pathology common seen (74%) in SGN. During the 22 years of the study period, there was a steady increase in patients with SGN discovered during pathological evaluation of renal disorders. A rise in prevalence was found in IgA nephropathy, MN (both P < 0.001), crescentic glomerulonephritis (P < 0.0001), anti-GBM disease, and hemolytic-uremic syndrome/thrombotic thrombocytopenic purpura related renal damages (both P < 0.001). There was a decrease in endocapillary proliferative glomerulonephritis (P < 0.001) and IgM nephropathy (IgMN) (P < 0.01) from 1990 - 1999 as compared to 1979 - 1989. Infrequent renal pathological entities were also diagnosed in this group, including Niemann Pick disease, Fabry's disease, POEMS syndrome, and lipoprotein glomerulonephropathy.</p><p><b>CONCLUSIONS</b>This is the largest series of renal biopsy data in China, and therefore may reflect the demographic picture of renal diseases in this country. Changes in prevalence of renal pathological entities were reflected in this group of patients over the last 22 years. In primary glomerular diseases, IgA nephropathy is still the most frequently observed pathological pattern. In SGN, LN appeared the most often. Increased prevalence was found in anti-GBM nephritis and HUS/TTP.</p>
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Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Japão , Epidemiologia , Nefropatias , Epidemiologia , Patologia , PrevalênciaRESUMO
<p><b>OBJECTIVE</b>To investigate retrospectively the incidence, distribution of primary disease and clinicopathologic characteristics of diffuse crescentic glomerulonephritis (DCGN) in Chinese patients.</p><p><b>METHODS</b>One hundred and seventy-two consecutive patients diagnosed as having DCGN out of 9828 cases of non-transplanting renal biopsies over sixteen years, were studied. DCGN is categorized into three types according to immunopathologic characteristics. The incidence of this disease, its primary diseases, clinical characteristics and serum antineutrophil cytoplasmic antibodies (ANCAs) were analyzed.</p><p><b>RESULTS</b>The distribution of patients among the three classifications was 8.7% type I, 68.6% type II and 22.7% type III. Clinically, the majority of patients (69.8%) presented rapidly progressive glomerulonephritis (RPGN), but 30.2% manifested a chronic nephritic syndrome or chronic renal failure. In terms of related conditions, 93% were anemic, 61.6% had hypertension, 50.6% oliguria, 45.3% nephrotic syndrome, 43% uremic syndrome and 39.5% displayed gross hematuria. Those patients who were positive in serum for ANCAs had predominantly type III DCGN. Two cases with anti-GBM-antibody crescentic glomerulonephritis and three with lupus nephritis were also positive for ANCAs in serum.</p><p><b>CONCLUSION</b>DCGN is not rare in Chinese patients. A majority of patients in our study presented with RPGN, but 30.2% manifested a chronic renal failure. Lupus patients with DCGN that were positive for ANCAs had more severe vasculitic lesions.</p>
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Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , China , Epidemiologia , Glomerulonefrite , Classificação , EpidemiologiaRESUMO
<p><b>OBJECTIVE</b>To investigate retrospectively the efficacy of cyclosporine A (CsA) in the treatment of membranous lupus nephropathy (MLN).</p><p><b>METHODS</b>Twenty-four patients with systemic lupus erythematosus (SLE) and biopsy-proven MLN were treated with CsA in combination with prednisone. CsA was given at a starting dosage of 5 mg x kg(-1) x d(-1) for 3 months, with a 1 mg x kg(-1) x d(-1) reduction every month and then maintained at a dosage of 2 mg x kg(-1) x d(-1). The dosage of oral prednisone differed from person to person according to levels of extra-renal activity. Clinical efficacy and adverse reactions were retrospectively analyzed. Complete remission was defined as having a urinary proteinuria level (Upr) of < 0.4 g/d, and normal serum albumin and serum creatinine (SCr) levels, without SLE activity. Partial remission was defined as having a UPr decrement > 50% of baseline value and a serum albumin value of 30 - 35 g/L, without SLE activity. No response was defined as having a Upr decrement < 50% of baseline value and > 2.0 g/d, or as a deterioration of renal function, or as having active SLE.</p><p><b>RESULTS</b>One patient could no longer undergo follow-up, and the other 23 patients were treated with CsA and followed up for 6 - 36 months (mean 16.8 +/- 8.4 months). The mean starting dosage of CsA was 4.7 +/- 0.5) mg x kg(-1) x d(-1) and the trough level of the whole blood CsA was 248 +/- 110) micro g/L. Twelve patients (52.2%) achieved complete remission, 10 patients (43.3%) achieved partial remission after CsA treatment, and one patient showed no response. At different CsA treatment timepoint, the complete remission rates were 17.4% (3rd month), 21.7% (6th month), 40% (12th month), 88.9% (18th month) and 100% (24th month) respectively. SCr elevation, when within a normal limit was not observed in most patients during early CsA administration, and at the end of the follow-up all the patients had a normal SCr. Relapse occurred in 33.3% of the patients after withdrawing CsA for 4 - 24 months. No chronic CsA renal toxicity was observed in 4 patients who had a repeat renal biopsy after CsA treatment for 6 - 24 months.</p><p><b>CONCLUSIONS</b>CsA could be regarded as an effective therapy for patients with membranous lupus nephropathy, but its adverse effects, especially its nephrotoxicity, should be carefully monitored during CsA treatment.</p>
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Adolescente , Adulto , Feminino , Humanos , Masculino , Ciclosporina , Usos Terapêuticos , Glomerulonefrite Membranosa , Tratamento Farmacológico , Nefrite Lúpica , Tratamento Farmacológico , Prednisona , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Objective:To analyze and compare the clinicopathological characteristics in low weight proteinuria(LWP) and nephrotic proteinuria(NP) multiple myeloma(MM) patients with renal involvement.Methods:From October 1991 to October 2005,46 patients with MM were diagnosed in the Research Institute of Nephrology of Jinling Hospital(Nanjing,China).Renal biopsies were done in 41 of them.The patients were devided into two groups,LWP and NP groups.Their clinical and pathological features were investigated and compared. Results:The epidemiological features and type of MM in LWP and NP groups were similar.The patients in LWP group had higher incidence of D-S Ⅲ stage and heavier anaemia compared to NP group.Compared to patients in NP group,patients in LWP group had higher incidence of renal insufficiency and lower urine osmotic pressure.Part of patients checked urine N-acetyl-?-glucosaminidase,RBP and there were no difference between two groups.Cast nephropathy was the most frequent pathologic type in LWP group,while light chain deposition disease and glomerular amyloidosis were the most common pathologic type in NP group.Conclusion:According to this study,we get the conclusion that proteinuria analysis may be a significant test to evaluate the clinicopathological characteristics of MM patients with renal involvement.
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<p><b>OBJECTIVE</b>To make an open label prospective trial for comparing the therapeutic effects of mycophenolate mofetil (MMF) vs cyclophosphamide (CYC) pulse therapy on patients with diffuse proliferative lupus nephritis (DPLN).</p><p><b>METHODS</b>Forty-six patients with biopsy proven active DPLN were enrolled in this study. Twenty-three patients were given MMF orally at a dosage of 1.0 - 1.5 g/d (MMF Group). Another 23 cases received conventional intermittent CYC pulse therapy (CYC Group). Supplemental steroid treatment was offered in the same manner to both groups. The age, sex distribution and severity of renal damage were matched in two groups. Therapeutic effects were evaluated at the end of six-month treatment. Fifteen patients in the MMF Group and 12 patients in the CYC Group had repeated renal biopsy at that time.</p><p><b>RESULTS</b>MMF therapy was more effective in reducing proteinuria and hematuria. A 50% reduction of urinary protein and urinary red blood cell excretion from baseline value in 69.6% and 91.3% patients in the MMF Group, while only 47.8% and 65.2% in the CYC Group. MMF was more effective in inhibiting autoantibody production (especially anti-dsDNA antibody) and in decreasing serum cryoglobulin levels. Pathologically, the MMF group showed more markedly reduction in glomerular immune deposits with less glomerular necrosis, and less microthrombi, less crescent formation and vascular changes in the repeated renal biopsy as compared with the CYC group. Adverse reactions related to the treatment included gastrointestinal symptoms 26.1% and 43.5% in the MMF and CYC Groups respectively, infection 17.4% in the MMF group and 30.4% in the CYC group.</p><p><b>CONCLUSION</b>MMF was more effective in controlling the clinical activity of DPLN and renal vascular lesions as compared with CYC pulse therapy in a 6 month follow-up study.</p>
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Adulto , Feminino , Humanos , Masculino , Ciclofosfamida , Usos Terapêuticos , Gastroenteropatias , Imunossupressores , Usos Terapêuticos , Infecções , Rim , Patologia , Nefrite Lúpica , Tratamento Farmacológico , Ácido Micofenólico , Usos Terapêuticos , Pneumonia , Estudos Prospectivos , Resultado do TratamentoRESUMO
<p><b>OBJECTIVE</b>To study glomerular expression of C-C chemokines, monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1alpha and beta (MIP-1alpha, MIP-1beta) and the effect of steroid and cyclophosphamide (CTX) intermittent intravenous pulse therapy on expression in patients with crescentic glomerulonephritis (CGN) to further investigate the underlying mechanism of the treatment.</p><p><b>METHODS</b>Twelve patients with initial biopsy-proven CGN(2), 6 with lupus nephritis (lupus-CGN, LN-CGN) and 6 with vasculitis, (vasculitis-CGN, V-CGN) were enrolled in this study. They underwent an initial biopsy before steroid and CTX intermittent intravenous pulse therapy and were biopsied again one to three months later. Expression of MCP-1, MIP-1alpha, MIP-1beta, and CD68 in glomeruli with cellular and fibrocellular crescents were examined by immunohistochemical analysis in serial sections of renal biopsies. The effect of the pulse therapy on histopathological changes was also observed.</p><p><b>RESULTS</b>Although steroid and CTX intermittent intravenous pulse therapy markedly reduced the degree of glomerular crescent formation both in LN-CGN and V-CGN, the effect of the therapy on glomerular chemokine expression was significantly different between LN-CGN and V-CGN. It was found that steroid and CTX intermittent intravenous pulse therapy reduced the expression of CD68, MCP-1, and MIP-1alpha, but had no effect on MIP-1beta in glomeruli with cellular crescents of patients with LN-CGN. In patients with V-CGN, the therapy also reduced the expression of CD68, but had no effect on MCP-1, MIP-1alpha, and MIP-1beta in glomeruli with cellular crescents. It was noted that the degree of glomerulosclerosis and tubular interstitial fibrosis increased more significantly at the second biopsy in V-CGN as compared to LN-CGN.</p><p><b>CONCLUSIONS</b>The efficacy of steroid and CTX intermittent intravenous pulse therapy in CGN might be affected by reduction of glomerular chemokine expression. The different changes in glomerular expression of MCP-1 and MIP-1alpha in patients with LN-CGN and V-CGN after pulse therapy may correlate to different responses to treatment and prognosis.</p>