Clinical characteristics and prognosis of peritoneal dialysis treatment in children with acute kidney injury / 中华肾脏病杂志

Objective:To investigate the efficiency and safety of peritoneal dialysis (PD) in pediatric patients with acute kidney injury (AKI).Method:A retrospective study of children who underwent PD for AKI in the First Affiliated Hospital of Xi’an Jiaotong University from 2003 to 2013 was performed, and the laboratory examinations, the causes, the complication, the prognosis and the risk factors were evaluated.Results:The study included 48 children, with the age of (67.6±51.7) months (ranging from 3 months to 15 years old), including 31 males (64.6%) and 34 co-infections (70.8%). Primary glomerulonephritis (27.1%) was the most common cause of AKI, followed by the hemolytic uremic syndrome (18.7%) and drug induced AKI (18.7%). Peritoneal dialysis was performed manually using percutaneous or adapted catheters. The duration of PD during hospitalization was 11(7,14) days. PD treatment was highly effective in attenuation of toxics retention and correction of electrolyte disturbances (all P<0.05). There were 3 cases of PD-related complications, including 1 case of peritonitis, 1 case of catheter outflow obstruction, 1 case of catheter exit site hematoma, and no child patient died of PD complications. Among the AKI children, 37 cases (77.1%) recovered with the PD treatment and had the catheter successfully removed till discharge, 7 cases (14.6%) needed further peritoneal dialysis and 4 cases (8.3%) died. The serum albumin level was significantly higher in patients who got recovered with PD treatment than other unrecovered cases [(32.6±6.7) g/L vs (23.2±4.3) g/L, t=-3.994, P<0.001]. Conclusions:PD can be safely and efficiently performed for the treatment of pediatric AKI. Low albumin level may be related to poor prognosis of AKI.

Morphological differences of proximal femoral medullary cavity in elderly patients and its effect on proximal femoral nail fixation / 中华创伤杂志

Objective To investigate the morphological differences of proximal femoral medullary cavity in elderly patients with intertrochanteric fracture and its effect on the treatment efficacy of proximal femoral nail antirotation (PFNA). Methods A retrospective case series study was conducted on the clinical data of 112 elderly patients with intertrochanteric fracture of the femur from December 2012 to January 2017, including the preoperative and postoperative hip joints orthotopic X ray (including the proximal femur), lateral X ray, and pelvic orthotopic X ray films. The proximal femoral canal flare index (CFI) and the metaphyseal canal flare index (MCFI) were measured. The proportion of patients with different types of medullary cavity and the gender difference were analyzed according to Dorr typing. The fractures were classified according to the modified Evans classification. Operation time, fracture reduction quality, tip apex distance (TAD), incidence of intraoperative split fracture around the rotors, postoperative fracture reduction loss rate, weight bearing time, and fracture healing time were recorded. Results The proximal femoral canal flare index (CFI) was significantly correlated with the intramedullary diameter above the lesser trochanter, the inner diameter of the affected side medullary cavity isthmus, and metaphyseal canal flare index (MCFI) (P ＜0.01). There was clear difference in gender in terms of the medullary cavity diameter 20 mm above the middle point of lesser trochanter, medullary isthmus internal diameter, the medullary cavity diameter 20 mm below the middle point of lesser trochanter, CFI, and MCFI. Thereinto, there was significant difference in the medullary cavity diameter 20 mm above the middle point of lesser trochanter [male (52.6 ± 6.4) mm, female: (49.9 ± 5.4) mm], the medullary cavity diameter 20 mm below the middle point of lesser trochanter [male: (26.5 ± 3.7) mm, female: (23.1 ±2.8)mm], and MCFI (male:2.0 ±0.3, female:2.2 ±0.2). No significant difference between the medullary isthmus internal diameter and CFI was found (P＞0.05). In this group, the medullary cavity of proximal femur was classified by Dorr: the proportion of funnel type, normal type, and chimney type was 5.4％ (6/112), 73.2％ (82/112), and 21.4％ (24/112), respectively. There was no significant difference in the modified Evans fracture stability among different morphological types of the proximal femoral medullary cavity. The difference of weight bearing time between normal group and chimney group was statistically significant [normal type: (21.4±16.9)d, chimney type: (45.5 ± 11.2)d] (P ＜ 0.05), but there were no significant differences in operation time, reduction quality, TAD, intraoperative incidence of cleavage fracture incidence, reduction loss rate, and healing time between the two groups (P＞0.05). Conclusions The occurrence and development of osteoporosis can cause significant changes in the morphology of proximal femoral medullary cavity, mainly manifesting as the gradual increase of the proportion of chimney type. The efficacy of PFNA in treatment of the intertrochanteric fracture is satisfactory. However, the risk of intraoperative cleavage fracture and postoperative reduction loss should be taken seriously.

Clinical and pathological features of primary IgA nephropathy in patients of different gender / 西安交通大学学报(医学版)

Objective To explore the clinical and pathological features of primary IgA nephrology in patients of different gender.Methods The clinical manifestations,laboratory examination and renal pathology results were compared in 192 IgA nephrology patients.Results Not only the onset age of the male patients was older than that of the female ones (P0.05 ).Patients of different gender significantly differed in the renal-interstitial lesions grading (Z=-3.0432,P<0.05);to be more specific,the scores of glomerulosclerosis and renal tubule interstitia were higher in the male patients (P<0.05).Conclusion Patients of different gender differ in the clinical and pathological features of primary IgA nephrology.And clinical pathology of male patients is worse than that of female ones.

Immunological mechanism of class IV lupus nephritis through lymphocyte subsets and cytokine profile / 中南大学学报(医学版)

OBJECTIVE@#To obtain a global view of lymphocyte subset changes in the peripheral blood and cytokine profile in patients with class IV lupus nephritis (LN).@*METHODS@#A total of 30 patients with biopsy proven active class IV LN, 30 patients with biopsy proven active class V LN, and 30 healthy controls were enrolled. Serum concentration of Th1 cytokines (IFN-γ, IL-1, IL-2, and TNF-α) and Th2 cytokines (IL-4, IL-5, IL-6, IL-10, IL-13) were simultaneously analyzed by Fast Quant Human Th1/Th2 protein array. The expression of lymphocyte subsets was measured by flow cytometer. Clinical parameters such as urine protein of 24 h, autoantibodies and complement were detected. Pearson analysis was used to examine the relation between lymphocyte subsets and clinical parameters, cytokine and clinical parameters.@*RESULTS@#The patients with class IV LN had evident anemia (P<0.001), hypocomplementemia, and hypoalbuminemia (P<0.05). There were no significant difference both in the ratio and number of CD4+ lymphocytes between the controls and the patients. In the patients with class IV LN, the ratio and number of CD4+ lymphocytes were both lower than those of the controls (P<0.01). The ratio and number of CD20+ lymphocytes were both higher than those of the controls (P<0.05), and a significant decrease in CD4+CD25+Foxp3+ regulatory T cells (Tregs) was observed in the patients compared with healthy age-matched controls (P<0.001). The abnormality of lymphocytes in class IV patients was obviously notable, especially in CD4+CD25+Foxp3+ regulatory T cells. In class IV patients, most of the detected cytokines levels were markedly elevated as compared with the controls, including Th2 cytokines INF-γ (P<0.05), IL-2 (P<0.05) and TNF-α (P<0.01), and Th2 cytokines IL-4 (P<0.05), IL-6 (P<0.05), IL-10 (P<0.01) and IL-13 (P<0.01). Only 4 out of 9 cytokines significantly increased in class V patients. In addition to IL-2, all of them belonged to Th2 (IL-4, IL-10 and IL-13) cytokines. There was negative correlation between CD4+CD25+Foxp3+ regulatory cells and urine protein, anti-dsDNA titer or SLEDAI (r=-0.781, -0.746 and -0.646, respectively; P<0.05). There was positive correlation between IL-5 and anti-dsDNA titer (r=0.708, P<0.05), between IL-5 and creatinine (r=0.681, P<0.05), and between IL-10 and SLEDAI (r=0.877, P<0.01). There was also negative correlation between IL-10 and urine protein of 24 h (r=-0.659, P<0.05), between IL-10 and hemoglobin concentration (r=-0.856, P<0.01), and between IL-13 and urine protein of 24 h (r=-0.769, P<0.05). There was little correlation between cytokines and clinical parameters in patients with class V LN.@*CONCLUSION@#There is extensive abnormality in lymphocyte subsets and cytokine profile in patients with class IV LN, which may be the mechanism of immunosuppressive agents to treat patients with class IV LN.

Inhibition of Notch signaling pathway promotes the differentiation of bone marrow mesenchymal stem cells into islet / 中华肾脏病杂志

Objective To investigate the effect of Notch signaling during bone marrow mesenchymal stem cells (BMSC) differentiating into islet in vitro.Methods The specific inhibitor of γ-secretase DAPT was used to inhibit the Notch signaling pathway.Mter induction,DTZ staining,indirect immunofluorescence staining,RT-PCR and Westenn blotting were used to detect the expression of insulin,glucagon,Pdx-1 and Ngn3.Results (1) Identification of BMSCs:Indirect immunofluorescence staining showed that BMSCs could express CD59 and CD90,which both were makrers of mesenchymal stem cells.Besides,BMSCs could express nerve culluar markers such as NSE,GFAP,suggesting multi-directional differentiation.(2) The result of MTT showed DAPT could inhibit the cell proliferation in a time-dependent manner and a dose-dependent mannar.Besides,DAPT could inhibit the expression of target gene of Notch signal pathway in a time-dependent manner and a dosedependent mannar.After treated by 1,5,20 μmol DAPT,the expression of Hes1 had reached to 92.06％,71.40％ and 46.89％ of controls respectively,suggesting efficiency of inhibition on Notch reached 7.94％,28.6％ and 53.11％ respectively (all P＜ 0.05).(3) Indirect immunofluorescence staining showed the expression of pancreas-specific markers such as insulin and glucagon were much higher in DAPT treated BMSCs than that in controls,which was confirmed by RT-PCR and Western blotting analyses.The proportion of insulin-producing cells differentiated from DAPT treated BMSCs was (74.03 ± 3.96)％,which was higher than that from controls[(36.49 ± 3.24)％,P＜ 0.05].(4)Furthermore,RT-PCR and Western blotting analysis showed that the expressions of Pdx-1 and Ngn3 were earlier than that of insulin and glucagon,and the expressions of Pdx-1 and Ngn3 were higher in DAPT treated BMSCs than that in controls.Conclusions Notch signaling pathway plays a role in the differentiation of BMSCs into islet in vitro.Pharmacological interference with Notch signaling pathway may provide a novel method to obtain islet for therapeutic use.

Clinical and pathological analysis on renal biopsy of elderly patients / 中华老年医学杂志

Objective To study the epidemiology,pathologies and clinical manifestations of renal diseases in elderly patients of different genders in China northwest region.Methods Retrospective analysis was used to evaluate the clinical and pathological informations of patients above 60 years old who underwent renal biopsy and had the integrated data in the past 20 years.Results (1)Among the 559 patients,there were 347 men accounting for 62.1％,and there were 212 women accounting for 37.9％ ； the average age was (66.7±5.3)years,the median course of disease was 5.0months when receiving renal biopsy,and 50％ cases was (1.3 ～ 12.0)months.(2) Primary glomerulopathy accounted for 69.59％(389/559),secondary glomerulopathy,tubulointerstitial disease and the others accounted for 25.4％ (142/559),3.8％ (21/559) and 1.3％ (7/559),respectively.(3)According to clinical manifestation,nephrotic syndrome was the most common disease(accounting for 60.7％),and then chronic glomerulonephritis accounted for 31.6％.In pathology,membranous nephropathy was the most frequently category accounting for 34.5％,then mesangial proliferative glomerulonephritis accounted for 32.4％.(4) Among secondary glomerulopathy,the frequent diseases were primary polyangitis,diabetic nephropathy,amyloidosis of kidney and lupus nephritis,accounting for 24.7％,19.7 ％,13.4 ％ and 10.6 ％,respectively,and the number of women was more than men in lupus nephritis(P＜0.05).(5) The common diseases of primary glomerulopathy that would result in renal insufficiency were nephrotic syndrome and chronic glomerulonephritis,accounting for 76.5 ％ (26/34)and 76.2 ％ (48/63),respectively,and the common pathological type was both mesangial proliferative glomerulonephritis.The common diseases of secondary glomerulopathy that would result in renal insufficiency were primary small vessel vasculitis and diabetic nephropathy,accounting for 46.3％(19/41)and 34.4％(11/32),respectively.Conclusions (1)the number of men was more than women in this group,and was opposite in lupus nephritis.(2) The most common disease was primary glomerulopathy,as for clinical manifestation,nephrotic syndrome and chronic glomerulonephritis were most common； the most common pathological type were membranous nephropathy and mesangial proliferative glomerulonephritis.(3) The common disease resulting in secondary kidney damage were primary small-vessel vasculitis and diabetic nephropathy.(4)The pathological type of disease resulting in renal insufficiency was mesangial proliferative glomerulonephritis,the common diseases resulting in acute renal insufficiency were nephrotic syndrome,primary small vessel vasculitis,and those resulting in chronic renal insufficiency were chronic glomerulonephritis and diabetic nephropathy.

Clinical and pathological analysis of patients with primary mesangial proliferative glomerulonephritis in different genders / 中国综合临床

Objective To understand the differences between sexes in the clinical and pathological features of patients with mesangial proliferative glomerulonephritis(MPGS).MethodsOne hundred and five patients with MPGS admitted to our hospital were retrospectively studied in clinical and pathological aspects.Results( 1 ) The proportion of male patients were 75 of 105 ( 71.43 ％ ) and that of females were 30 of 105 ( 28.57％ ) ; ( 2 ) The average age of the male patients was ( 40.25 ± 15.50 ) and that of the females was (36.23 ± 15.26) in year.There was no significant difference between the two groups( t =1.206,P =0.231 ) ;(3) There was no significant difference in duration of disease,hematuria,edema,hypertension prevalence and mean blood pressure( P ＞ 0.05 ).The proportion of patients with hematuria was 56.19％ (59/105).The males accounted for 69.33％ ( 52/75 ) and the females were 63.33％ ( 19/30 ) in the main clinical manifestations of nephrotic syndrome.There was no significant difference( x2 =0.352,P ＞ 0.05 ) between the proportion of males and females; (4)Males and females groups had no significant difference( P ＞ 0.05 )on levels of urinary protein,serum albumin,immunoglobulin,complement,urea nitrogen and serum creatinine.Complement decreased in 53 cases,accounting for 53％ of all the participants.The proportion of male patients with renal insufficiency was 24.00％ (18/75),and the proportion of females with renal insufficiency was 13.33％ (4/30).There was no significant difference ( x2 =1.472,P ＞ 0.05 )on the percentage of males and females with renal insufficiency.The mean value of urea nitrogen was higher than the normal levels ; (5) The proportion of male cases with different deposition of immune complexes was 93.06％ (67/72),and the proportion in females were 92.86％ (26/28) in the exception of 5 cases ( male 3 and female 2 ) with no glomeruli in immunofluorescence examination.No significant difference was found between the two groups( x2 =0.001,P ＞ 0.05 ) ; ( 6 ) There was no significant gender differences( x2 =1.696,P ＞ 0.05 ) found in risk assessment.ConclusionThe prevalence of MPGS is higher in male patients than in females,the main clinical manifestations of which were nephrotic syndrome.Patients were found to have a higher rate of hematuria,decreased complement C3,and renal dysfunction than the normal levels.There was no significant difference in gender on the clinical and pathological aspects of MPGS.

Role of study on cytokine profiling in class V lupus nephritis from the perspective of systemic biology / 西安交通大学学报(医学版)

Objective To study the effects of cytokines Th1 and Th2 in Class V lupus nephritis (V-LN). Methods Serum concentration of Th1 cytokines (IFN-γ, IL-1, IL-2 and TNF-α) and Th2 cytokines (IL-4, IL-5, IL-6, IL-10 and IL-13) were simultaneously analyzed using fast quant human Th1/Th2 protein array, and Pearson analysis was used to evaluate the association between cytokines and clinical parameters. Results ① Cytokine profiling: Among the 9 cytokines detected simultaneously by fast quant human Th1/Th2 protein array, the expression of four cytokines was up-regulated obviously, namely, Th1 cytokines (IL-2) and Th2 cytokines (IL-4, IL-10 and IL-13); that of IL-10 was 10 times above the normal control. ② Pearson correlation analysis: There was a positive correlation between IL-10 and SLEDAI (r=0.877, P<0.01), but a negative correlation between IL-10 and hemoglobin concentration (r=-0.856, P<0.01). There was also a negative correlation between IL-4 and 24h urine protein (r=-0.754, P<0.05), between IL-13 and 24h urine protein (r=-0.769, P<0.05). Besides, IL-1 and creatinine were positively correlated (r=0.784, P<0.05). Conclusion There were extensively abnormal Th2 cytokines in V-LN patients, suggesting that anti-Th2 therapy may produce a marked effect on V-LN.

Diffuse proliferative lupus nephritis and membranous lupus nephritis: does different serum cytokine profiling suggest different immunological pathogenesis? / 中华风湿病学杂志

Objective To obtain a global view of cytokine profile in lupus nephritis (LN), and to co-mpare the pattern of cytokine profile in patients with different renal lesions, primarily diffuse proliferative lupus nephritis (Ⅳ-LN) and membranous lupus nephritis (Ⅴ-LN). Methods Thirtypatients with biopsy proven active LN (class Ⅳ, n=15; class Ⅴ, n=15) and 15 healthy controls were enrolled in this study. Serum conc-entration of Th1 cytokines (IFN-γ, IL-1, IL-2, and TNF-α) and Th2 cytokines (IL-4, IL-5, IL-6, IL-10, IL-13) were simultaneously analyzed using Fast Quant Human Th1/Th2 protein array. Results ① Cytokine profiling: in patients with class Ⅳ-LN, the levels of most of the detected cytokines elevated marked compared to normal controls, including both Th1 (IL-2, INF-γ and TNF-α) and Th2 (IL-4, IL-6, IL-10 and IL-13) cytokines. Among them, both Th1 (INF-γ and TNF-α) and Th2 (IL-6, IL-10 and IL-13) cytokines were 10 times higher than normal controls. However, patients with class Ⅴ LN demonstrated a different cytokine pro-filing compared to class Ⅳ LN. Only 4 out of 9 cytokines were significantly increased. In addition to IL-2, all of those cytokines produced by Th2 (IL-4, IL-10 and IL-13) as well as IL-10 was 10 times higher than normal controls. The main difference of cytokines between patients with class Ⅳ LN and patients with class Ⅴ LN was among Th1 cytokines (IFN-γ, IL-2 and TNF-α). There was a significant correlation between clinical manifestations and cytokines in class Ⅳ LN, especially among Th2 cytokine. There was positive correlation between IL-5 and anti-dsDNA titer(r=0.708, P<0.05), IL-5 and creatinin(r=0.681, P<0.05) and IL-10 and SLEDAI scores (r=0.877, P<0.0 ). On the other hand, there was also negative correlation between some Th2 cytokines and clinical manifestations. There was negative correlation between IL-5 and complement C3 level (r=-0.643, P<0.05), IL-10 and proteinuria(r=-0.659, P<0.O5), IL-10 and hemoglobin level (r=-0.856, P<0.001), as well as IL-13 and proteinuria (r=-0.769, P<0.05). In addition, IL-1 was positive correlated with SLEDAI, while it was negatively correlated with bemoglobulin level. As for class Ⅴ LN, there was positive correlation between IL-1 and creatinin level (r=0.784, P<0.05), but negative correlation between IL-4 and proteinuria (r=-0.754, P<0.05). Conclusion Patients with class Ⅳ renal lesion have shown a broad changes of cytokine activity, while up-regulation of Th2 cytokines is more predominant in patients with class Ⅴ LN. These suggest that the expression of different cytokines may be associated with different patterns of lupus renal lesions. These findings may shed light on the further exploring of the underlying mechanisms that mediate different patterns of renal lesions, as well as designing a rational therapeutic strategy for the treatment of LN.

Improvement for New Blinking Emergency Location Transmitter / 医疗卫生装备

Objective To develop a more reliable blinking emergency location transmitter with longer time for aircrew in distress. Methods The new LED and new type of explosion-proof casing material (Polycarbonate) with new technologies are adopted. Results Environmental tests and performance tests were done on the new emergency location transmitter according to the environmental requirements of aeronautic products. Conclusion The new emergency location transmitter can meet the operation requirements for aircrew in distress.

Pancreatic duodenal homeobox-1 advances transdiffenentiation of bone marrow mesenchymal stem cells into insulin-producing cells in vitro / 医学研究生学报

Objective: To investigate the possible effects of Pancreatic duodenal homeobox-1((Pdx-1))expression in transdifferentiation of bone marrow mesenchymal stem cells(MSC) in vitro. Methods: The eukaryotic expression vector containing Pdx-1 was constructed.After such vector was transfected into MSC using Superfect,G418 was used to select the positive cells.Then both(Pdx-1~(+)MSC)and((Pdx-1~-MSC)) were induced to transdifferentiate in vitro.The expressions of insulin were analyzed by immunohistochemistry staining. Results: Restricted enzyme analysis and sequencing showed that interest gene segment was consistent with that in Gen Bank,Recombination vector was effectively transformed into MSC demonstrated by fluorescence microscope;insulin-producing cells from Pdx-1~(+)MSC were higher than that from Pdx-1~(-)MSC[(28.23?2.56)% and(7.08?2.69)%,respectively]. Conclusion:Pdx-1 can promote adult rat MSC to transdifferentiate into insulin-producing cells in vitro,and this approach might lead to a widespread cell replacement therapy for type I diabetes.

High expression of PDX-1 in bone marrow mesenchymal stem cells mediated by superfect / 中国病理生理杂志

AIM:To construct a eukaryotic expression vector containing pancreatic duodenal homebox-1(PDX-1)and to elevate the expression efficiency of exogenous gene in rat bone marrow mesenchymal stem cells(MSCs).METHODS:Recombinant vector containing PDX-1 was constructed.Flow cytometry was used to identify the cell cycle of bone marrow mesenchymal stem cells(MSCs)cultured in vitro.Recombinant vector containing PDX-1 was transfected into bone marrow MSCs using superfect in medium.After being selected by G418,RT-PCR and Western blotting were used to investigate the expression of PDX-1 in MSCs.RESULTS:Restricted enzyme analysis and sequencing showed that PDX-1 gene segment was consistent with that in GenBank.Flow cytometry showed that there were about 85.9% cells at the cell cycle of G_0/G_1.The whole cells transfected emitted green fluorescence under flow cytometry.The efficiency of transfection was above 40%.RT-PCR and Western blotting demonstrated that there was expression of PDX-1 in transfected bone marrow MSCs.CONCLUSION:Recombinant vector containing PDX-1 was constructed successfully.Superfect mediated expression of exogenous gene in bone marrow MSCs in a high efficiency,and bone marrow MSCs containing exogenous gene are an ideal cells for gene therapy.