Treatment of complicated urinary tract infection and acute pyelonephritis by short-course intravenous levofloxacin (750 mg/day) or conventional intravenous/oral levofloxacin (500 mg/day): prospective, open-label, randomized, controlled, multicenter, non-inferiority clinical trial.

OBJECTIVE: To compare the efficacy and safety of short-course intravenous levofloxacin (LVFX) 750 mg with a conventional intravenous/oral regimen of LVFX 500 mg in patients from China with complicated urinary tract infections (cUTIs) and acute pyelonephritis (APN). METHODS: This was a prospective, open-label, randomized, controlled, multicenter, non-inferiority clinical trial. Patients with cUTI and APN were randomly assigned to a short-course therapy group (intravenous LVFX at750 mg/day for 5 days) or a conventional therapy group (intravenous/oral regimen of LVFX at 500 mg/day for 7-14 days). The clinical, laboratory, and microbiological results were evaluated for efficacy and safety. RESULTS: The median dose of LVFX was 3555.4 mg in the short-course therapy group and 4874.2 mg in the conventional therapy group. Intention-to-treat analysis indicated the clinical effectiveness in the short-course therapy group (89.87%, 142/158) was non-inferior to that in the conventional therapy group (89.31%, 142/159). The microbiological effectiveness rates were also similar (short-course therapy: 89.55%, 60/67; conventional therapy: 86.30%, 63/73; p > 0.05). There were no significant differences in other parameters, including clinical and microbiological recurrence rates. The incidence of adverse effects and drug-related adverse effects were also similar for the short-course therapy group (21.95%, 36/164; 18.90%, 31/164) and the conventional therapy group (23.03%, 38/165; 15.76%, 26/165). CONCLUSION: Patients with cUTIs and APN who were given short-course LVFX therapy and conventional LVFX therapy had similar outcomes in clinical and microbiological efficacy, tolerance, and safety. The short-course therapy described here is a more convenient alternative to the conventional regimen with potential implication in anti-resistance and cost saving.

[Non-compaction cardiomyopathy in a 5-generation Chinese family].

OBJECTIVE: Familial left ventricular noncompaction(LVNC) is quite rare. We screened for the presence of LVNC and related clinical characteristics in a 5-generation Chinese family. METHODS: Comprehensive medical history was obtained from 40 members in a 5-generation Chinese family. Systemic clinical investigations including echocardiography (UCG), routine and ambulatory electrocardiogram (ECG), X-rays were performed in 33 family members. Cardiovascular magnetic resonance image (MRI) was carried out in 2 family members. RESULTS: Sudden cardiac death (including 1 occurred while following-up) was reported in 7 family members (17.5%, 7/40). LVNC was diagnosed in 10 out of the 33 family members (30.3%) and heart enlargement was evidenced in 3, heart failure in 2, complete left branch conductive block in 3, serious sick sinus syndrome (SSS) treated with permanent pacemaker implantation in 1 and paroxysmal supraventricular tachycardia treated with radiofrequency ablation procedure in 1 out of these 10 LVNC patients. Primary pedigree analysis revealed that offspring from female patients were at the highest risk to be affected by LVNC (15/18, 83.3%) while LVNC was absent in offspring of male LVNC patients (0/8). Moreover, clinical heart failure symptoms and arrhythmias were more severe in female LVNC patients than in male LVNC patients. CONCLUSION: Primary familial investigation reveals the matrilineal inheritance of familial LVNC in this 5-generation Chinese family, further investigations are warranted to explore the potential mutations in the mitochondrial genome responsible for LVNC in this family.

Antithrombotic drug therapy for IgA nephropathy: a meta analysis of randomized controlled trials.

BACKGROUND: Antithrombotic agents, including antiplatelet agents, anticoagulants and thrombolysis agents, have been widely used in the management of immunoglobulin A (IgA) nephropathy in Chinese and Japanese populations. To systematically evaluate the effects of antithrombotic agents for IgA nephropathy. METHODS: Data sources consisted of MEDLINE, EMBASE, the Cochrane Library, Chinese Biomedical Literature Database (CBM), Chinese Science and Technology Periodicals Databases (CNKI) and Japana Centra Revuo Medicina (http://www.jamas.gr.jp) up to April 5, 2011. The quality of the studies was evaluated from the intention to treat analysis and allocation concealment, as well as by the Jadad method. Meta-analyses were performed on the outcomes of proteinuria and renal function. RESULTS: Six articles met the predetermined inclusion criteria. Antithrombotic agents showed statistically significant effects on proteinuria (p<0.0001) but not on the protection of renal function (p=0.07). The pooled risk ratio for proteinuria was 0.53, [95% confidence intervals (CI): 0.41-0.68; I(2)=0%] and for renal function it was 0.42 (95% CI 0.17-1.06; I(2)=72%). Subgroup analysis showed that dipyridamole was beneficial for proteinuria (p=0.0003) but had no significant effects on protecting renal function. Urokinase had statistically significant effects both on the reduction of proteinuria (p=0.0005) and protecting renal function (p<0.00001) when compared with the control group. CONCLUSION: Antithrombotic agents had statistically significant effects on the reduction of proteinuria but not on the protection of renal function in patients with IgAN. Urokinase had statistically significant effects both on the reduction of proteinuria and on protecting renal function. Urokinase was shown to be a promising medication and should be investigated further.

[Classification and functional study of peripheral blood dendritic cells in patients with coronary artery disease with different atherosclerotic plaques].

OBJECTIVE: To study the quantitative and functional changes of peripheral blood dendritic cells (DCs) and their subsets in the leukocyte population in patients with coronary artery disease (CHD) with different coronary artery plaques and explore the relation between DCs and coronary plaque development. METHODS: Thirty CHD patients were divided into SAP (10 cases), UAP (10 cases) and ACS (10 cases) groups, with another 10 patients having negative result in coronary angiography as the control group. Intravascular ultrasound (IVUS) was performed to identify the nature of the plaques. The percentage and absolute number of peripheral blood DCs and DC subsets were measured by flow cytometry. The functional status of the DCs was analyzed by enzyme-linked immunosorbent assay (ELISA) and flow cytometry. RESULTS: In the SAP group, IVUS found stable plaques in 8 cases and unstable plaques in 2 cases; in UAP group, 7 patients had unstable plaques, 2 had stable plaques, and 1 had plaque rupture. Plaque rupture, unstable plaques and stable plaques were found in 6, 3 and 1 patients in ACS group, respectively. In comparison with patients with stable plaques, those with unstable plaques had significantly increased percentages and number of DCs, mDCs and mDC1 (P<0.05), while the mDC2s and pDCs showed no obvious difference between them (P>0.05). The percentages and number of DCs, mDCs, mDC1s and pDCs were significantly decreased in patients with ruptured plaques (P<0.05). In peripheral blood monouclear cells cultured for 7 days, the CD83 expression was significantly higher in unstable and rupture plaque groups than in stable plaque group, and no significant difference was found between stable plaque group and the control group (P>0.05). In unstable and rupture plaque groups, co-culture with 2x10(5)/ml DCs evoked strong proliferation of the T cells in comparison with the stable plaque group, but no difference was found between the stable plaque and the control groups (P>0.05). Significantly higher levels of interleukin-2 and interferon-alpha were detected in the supernatant of the mixed lymphocyte reaction in unstable and ruptured plaque groups than in stable plaque and control groups, without obvious difference between the latter two groups. CONCLUSION: The percentage and absolute number of peripheral blood DCs and their functional status suggest the alterations of the coronary artery plaques in CHD patients.

Effectiveness of a school-based AIDS education program among rural students in HIV high epidemic area of China.

PURPOSE: To evaluate the feasibility and effectiveness of a life-planning skills training program using participatory methods among rural senior high school students in Shangcai County, Henan Province, China. METHODS: The study was a quasi-experimental study conducted in three Shangcai County senior high schools with comparable socioculture-economic and demographic characteristics (two interventions and one control). The intervention, a life-planning skills program that uses participatory training methods, combining information education with effective skills building, was provided to all first-grade students (14-18 years old; 87% of them are between 15 and 17 years old) in the intervention group from October 2003 to December 2003. In total, 717 students from the intervention group, and 457 from the control enrolled at baseline, and over 91% of these were followed up at posttest. RESULTS: Group x time interaction effects in ordinal logistic regression analysis were found on HIV/AIDS-related knowledge (p < .0001), attitudes toward daily contact with HIV-positive persons (p < .0001), and subjects' protection self-efficacy (p < .0001), suggesting the intervention increased subjects' knowledge significantly, changed their attitudes positively, and improved their protection self-efficacy. The intervention also significantly improved subjects' communication with teachers and peers on HIV/AIDS issues (p < .0001). However, no significant change was observed on respondents' attitudes toward premarital sex or their communication with parents between the two surveys (p > .05). CONCLUSIONS: Three months of short-term HIV/AIDS education through life-planning skills training was welcomed by students and positively influenced HIV/AIDS-related knowledge, attitudes, protection self-efficacy, and communication among senior high school students in a rural area with high HIV prevalence.

[The effect of telomerase reverse transcriptase on 5-HT induced pulmonary artery smooth muscle cells proliferation].

OBJECTIVE: To investigate the effect of telomerase reverse transcriptase (TERT) to the proliferation of 5-HT induced pulmonary artery smooth muscle cells (PASMCs). METHODS: The PASMCs proliferation experiment was performed to detect the effort on PASMCs of 5-HT or ASODN TERT (antisense oligoribonucleotides TERT designed according to the rat TERT mRNA sequence of gene bank). The immunohistochemistry staining experiment and the in situ hybridization experiment were to detect the TERT protein and mRNA expression with 5-HT or ASODN TERT. FITC marked ASODN TERT experiment was done to research the distribution of ASODN TERT in PASMCs. RESULTS: 5-HT promoted PASMCs proliferation in a dose-dependent manner (10(-9) - 10(-5) mol/L). 5-HT also significantly increased TERT expression at protein and mRNA levels as shown by immunohistochemistry staining and the in situ hybridization studies. This effect could be blocked by ASODN TERT in a time and dose-dependent manner. CONCLUSIONS: Our experiments show TERT is one of the key factors in the procession of 5-HT induced PASMCs proliferation. ASODN TERT might be a potential therapy agent for pulmonary hypertension.

[Oxidative stress status in patients with various degrees of chronic renal insufficiency].

OBJECTIVE: To observe the changes of lipid peroxidation and antioxidative enzyme activities of chronic renal insufficiency (CRI) and to explore their effects on the pathogenesis of CRI. METHODS: Serum levels of malondialdehyde (MDA), serum glutathione peroxidase (GSH-Px) and serum superoxide dismutase (SOD) in 36 non-dialyzed patients with various degrees and 12 hemodialyzed (HD) were determined with the method of chemistry colorimetry. RESULTS: Thirty-six CRI and 12 HD patients included in the study had higher SOD activities when compared with the controls [(110.30+/-18.60) kNU/L]. They also had lower serum GSH-Px activity than the controls [(120.63+/-27.57) x 10(4)U/L]. Serum MDA levels in the patients were higher than that in the controls [(4.06+/-0.67) micromol/L]. Serum SOD, GSH-Px and MDA concentrations in 36 non-dialyzed patients with various degrees were also correlated with creatinine clearance (r(G)=0.68, P<0.01; r(M)=-0.52, P<0.01; r(S)=-0.44, P<0.05). CONCLUSION: Free radicals, lipid peroxidation and the abnormality in antioxidative system may play an important role in the pathogenesis of CRI and correlated with impaired renal function, and that they can be regarded as important clinical indexes to infect the severity of chronic renal insufficiency.

[Expression of urotensinII in human coronary artery and coronary atherosclerosis].

OBJECTIVE: To assess the expression intensity of urotensinII (UII) in normal and atheromatous human coronary artery and explore its significance in coronary atherosclerosis. METHODS: Specimens of coronary arteries were obtained from 5 normal subjects and the expression of human UII in the specimens was detected by immunohistochemical method. RESULTS: UII expression was found in the endothelial cells (ECs), foam cells (FCs), inflammatory cells (ICs) and intima smooth muscle cells (ISMs) of human coronary artery. Even in the normal coronary artery, UII expression could be detected immunohistochemically in the ECs, which, however, was characterized by higher UII expression levels in fatty streak lesions but by almost normal levels in fibrous and atheromatous plaque in the coronary artery. Enhanced UII expression was observed in FCs and ICs when fibrous plaque and atheromatous plaque developed in comparison with that in fatty streak lesions. The ISMs in all the lesions had mild UII immunoreactivity, but as the atherosclerosis exacerbated, the immunoreactivity tended to intensify. CONCLUSION: Human UII may regulate the functions of ECs, FCs, ICs and ISMs in the development and progression of coronary atherosclerosis.

[Effects of basic fibroblast growth factor on rat models of Alzheimer disease].

OBJECTIVE: To study the effects of basic fibroblast growth factor (bFGF) on the praxiology and cerebral acetylcholinesterase (AchE) fiber density of kainic acid-lesioned rat models of Alzheimer disease (AD). METHODS: AD models were induced in 30 normal adult rats by damaging the rat nucleus basalis of Meynert (NBM) with kainic acid, and the models were then assigned into 3 groups to receive cerebroventricular infusion with bFGF, saline or nothing for treatment, serving respectively as the treatment group at 30 min, 1, 3 and 7 d after the injury, sham treatment group or injury group. Another 10 rats were used as control group, which received saline injections into the NBM without further treatment. The learning and memory abilities of the rats were measured through Y-maze test 30 d after the operations, and AchE cytochemical study was conducted to calculate the density of the AchE fibers in the hippocampus and forebrain of the rats. RESULTS: In comparison with the injury group, improvement was noted in the memory ability of rats with bFGF treatment and the density of AchE fiber was also significantly increased (P<0.01), but the improvement in both respects failed to reach the normal level (P<0.01). CONCLUSIONS: AD model can be successfully established by damaging the NBM with kainic acid, and bFGF is beneficial in improving the impaired learning and memory abilities and increasing the density of AchE fibers in the basal forebrain cortex and hippocampus in the models.