Comparative efficacy of three regimens (cyclosporine, tacrolimus, and cyclophosphamide) combined with steroids for the treatment of idiopathic membranous nephropathy.

INTRODUCTION AND OBJECTIVES: To investigate the efficacy of combined immunosuppressive regimens of cyclosporine (CsA), tacrolimus (TAC), or cyclophosphamide (CTX) combined with steroids in the treatment of idiopathic membranous nephropathy (IMN). MATERIALS AND METHODS: A total of 150 biopsy-proven IMN patients were divided into three groups: CTX, TAC, and CsA groups (50 cases each). Patients received a selected regimen for 48 weeks. The efficacy (remission rate, 24h urinary protein, and serum albumin and creatinine) and safety (adverse events) profiles of administered regimens were evaluated at 12, 24 and 48 weeks. RESULTS: At 12 weeks, the response rates for CsA, TAC, and CTX groups were 14%, 50%, and 22%, respectively. This increased to 74%, 84%, and 82%, respectively at 48 weeks. During follow-up, 24h urinary protein significantly reduced from baseline in all regimens (P<0.05), while serum albumin increased in TAC and CTX groups after 12 weeks (P<0.05), and CsA group at 48 weeks (P<0.05). No significant changes in serum creatinine levels were noted in all three regimens (P>0.05). Safety was comparable in all groups, with lower respiratory tract infection being the most frequent adverse event. CONCLUSIONS: The combined regimens (i.e., TAC, CsA, and CTX) are effective in the treatment of patients with IMN at 48 weeks, while TAC and CTX might be more beneficial in terms of shortened time to remission and increased complete response rate.

Comparative efficacy of three regimens (cyclosporine, tacrolimus, and cyclophosphamide) combined with steroids for the treatment of idiopathic membranous nephropathy / Eficacia comparativa de 3 regímenes (ciclosporina, tacrolimús y ciclofosfamida) combinados con esteroides para el tratamiento de la nefropatía membranosa idiopática

Introduction and objectives: To investigate the efficacy of combined immunosuppressive regimens of cyclosporine (CsA), tacrolimus (TAC), or cyclophosphamide (CTX) combined with steroids in the treatment of idiopathic membranous nephropathy (IMN). Materials and methods: A total of 150 biopsy-proven IMN patients were divided into three groups: CTX, TAC, and CsA groups (50 cases each). Patients received a selected regimen for 48 weeks. The efficacy (remission rate, 24h urinary protein, and serum albumin and creatinine) and safety (adverse events) profiles of administered regimens were evaluated at 12, 24 and 48 weeks. Results: At 12 weeks, the response rates for CsA, TAC, and CTX groups were 14%, 50%, and 22%, respectively. This increased to 74%, 84%, and 82%, respectively at 48 weeks. During follow-up, 24h urinary protein significantly reduced from baseline in all regimens (P<0.05), while serum albumin increased in TAC and CTX groups after 12 weeks (P<0.05), and CsA group at 48 weeks (P<0.05). No significant changes in serum creatinine levels were noted in all three regimens (P>0.05). Safety was comparable in all groups, with lower respiratory tract infection being the most frequent adverse event. Conclusions: The combined regimens (i.e., TAC, CsA, and CTX) are effective in the treatment of patients with IMN at 48 weeks, while TAC and CTX might be more beneficial in terms of shortened time to remission and increased complete response rate. (AU)

Introducción y objetivos: Investigar la eficacia de los regímenes inmunosupresores combinados de ciclosporina (CsA), tacrolimús (TAC) o ciclofosfamida (CTX) combinados con esteroides en el tratamiento de la nefropatía membranosa idiopática (NMI). Materiales y métodos: Un total de 150 pacientes con NMI comprobada por biopsia se dividieron en 3 grupos: grupos CTX, TAC y CsA (50 casos cada uno). Los pacientes recibieron un régimen seleccionado durante 48 semanas. Se evaluaron los perfiles de eficacia (tasa de remisión, proteína en orina de 24h y albúmina y creatinina séricas) y seguridad (eventos adversos) de los regímenes administrados a las 12, 24 y 48 semanas. Resultados: A las 12 semanas, las tasas de respuesta para los grupos CsA, TAC y CTX fueron del 14, el 50 y el 22%, respectivamente. Esto aumentó al 74, el 84 y el 82%, respectivamente, a las 48 semanas. Durante el seguimiento, la proteína urinaria de 24h se redujo significativamente desde el inicio en todos los regímenes (p <0,05), mientras que la albúmina sérica aumentó en los grupos TAC y CTX después de 12 semanas (p <0,05) y el grupo CsA a las 48 semanas (p <0,05). No se observaron cambios significativos en los niveles de creatinina sérica en los 3 regímenes (p> 0.05). La seguridad fue comparable en todos los grupos, siendo la infección del tracto respiratorio inferior el evento adverso más frecuente. Conclusiones: Los regímenes combinados (es decir, TAC, CsA y CTX) son eficaces en el tratamiento de pacientes con NMI a las 48 semanas, mientras que TAC y CTX podrían ser más beneficiosos en términos de reducción del tiempo de remisión y aumento de la tasa de respuesta completa. (AU)

[Effect of water conservancy schistosomiasis control projects combined with molluscicide to control Oncomelania hupensis snails in rivers connecting with Yangtze River in Pukou District, Nanjing City].

OBJECTIVE: To evaluate the effect of the water conservancy schistosomiasis control projects combined with molluscicide to control Oncomelania hupensis snails in the rivers connecting with the Yangtze River. METHODS: The water conservancy schistosomiasis control projects of Zhujiashan River, Qili River and Gaowang River were chosen as the study objects in Pukou District, Nanjing City. The data review method and field investigation were used to evaluate the effect of the water conservancy schistosomiasis control projects combined with molluscicide to control O. hupensis snails. RESULTS: After the projects of the water level control and concrete slope protection and mollusciciding were implemented, the snails in the project river sections were completely eliminated. The snail diffusion did not happen in the inland irrigation area too. In the outside of the river beach, though the snails still existed, the snail densities plunged below 1.0 snail per 1.0 m2. CONCLUSIONS: The comprehensive measures of the combination of water level control, concrete slope protection and mollusciciding can effectively control and eliminate the snails, and prevent the snails from spreading.

Evaluation of a novel device that maintains the balance of a cardiopulmonary resuscitation performer in a moving ambulance to improve chest compression quality

<p><b>INTRODUCTION</b>According to the findings of some studies, instability due to inertia during changes in speed may negatively impact the quality of chest compressions performed during cardiopulmonary resuscitation (CPR) in a moving environment. This study thus aimed to introduce a simple device that maintains the balance of a person performing CPR in a moving environment, such as an ambulance. We also sought to evaluate the effectiveness of this device in the improvement of the quality of chest compressions.</p><p><b>METHODS</b>The experiment comprised a total of 40 simulated cardiopulmonary arrest scenes (20 in the experimental group and 20 in the control), in which CPR was conducted by eight paramedics. Each simulation involved two paramedics randomly selected from the eight. The ambulance took the same route from the simulated site to the hospital, and continuous CPR was performed on a manikin in the ambulance with or without the aid of our proposed novel device.</p><p><b>RESULTS</b>The average number of chest compressions per simulation in the experimental and control groups was 1330.75 and 1266.60, respectively (p = 0.095). The percentage of chest compressions with adequate depth achieved in the experimental and control groups was 72% ± 4% and 50% ± 3%, respectively (p < 0.0001).</p><p><b>CONCLUSION</b>By maintaining the balance of the CPR performer, our proposed novel device can offset the negative impact that instability (due to a moving environment) has on chest compressions. The device may also lead to an increase in the percentage of chest compressions that achieve adequate depth.</p>

Simultaneous determination of scopolamine hydrobromide, atropine sulfate, ephedrine hydrochloride and pseudoephedrine hydrochloride in Zhichuanling oral liquid with HPLC / 中国中药杂志

<p><b>OBJECTIVE</b>To establish an HPLC method for determining the contents of scopolamine hydrobromide, atropine sulfate, ephedrine hydrochloride and pseudoephedrine hydrochloride in Zhichuanling oral liquid.</p><p><b>METHOD</b>Agela Durashell RP-C18 (4. 6 mm x250 mm, 5 microm) was adopted, with acetonitrile-sodium phosphate buffer solution (0. 07 mol L-1 sodium phosphate solution with 17.5 mmol L-1 sodium dodecylsulfate adjusted to pH 6.0 with phosphoric acid solution) (30:70) as the mobile phase. The flow rate was 0. 9 mL min -1, the detection wavelength was 207 nm, and the column temperature was 25 degree C.</p><p><b>RESULT</b>Scopolamine hydrobromide, atropine sulfate, ephedrine hlvdrochloride and pseudoephedrine hydrochloride showed good linear relations with peak areas within the concentration range of 0. 021 21-1. 060 5 pg (r =0. 999 3) , 0. 011 14-0. 557 microg (r = 0. 999 6) , 0. 200 56-10. 028 microg (r =0. 999 7) and 0.070 33-3. 516 5 gg (r =0. 999 6), respectively, with the average recoveries of 101.9% , 99. 80%, 100. 3%, 100. 2% (n=6).</p><p><b>CONCLUSION</b>The method was so quick, simple, highly reproducible and specific that it could be used as one of quality control methods of Zhichuanling oral liquid.</p>

Evaluation of the clinical and imaging examination in high-risk children with vesicoureteral reflux / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the clinical data and result of voiding cystourethrography (VCUG) in high-risk children with vesicoureteral reflux (VUR) for better awareness of VUR, and to assess the usefulness of non-radioactive voiding ultrasonography (VUS) in the diagnosis of VUR.</p><p><b>METHOD</b>Ninety-three high-risk children with VUR who were hospitalized from July 2007 to April 2010 were studied. The study included 58 cases of urinary tract infection (UTI) and 35 cases of fetal or postnatal hydronephrosis detected on a B ultrasound scan. The results of urinalysis, urine culture, renal function, B ultrasound and VCUG were evaluated. Part of patients underwent VUS followed by VCUG immediately.</p><p><b>RESULT</b>(1) Sixty-two boys and 31 girls (aged 1 month to 11.5 years, mean age 2 years) were included. VUR was detected in 26 patients (28%) by VCUG. In terms of kidney-ureter units, VUR was detected in 36 of 186 kidney-ureter units, including 6 grade I, 3 grade II, 6 grade III, 15 grade IV and 6 grade V. (2) VUR was detected in 20 of 58 UTI patients (34.5%) by VCUG. The proportion of VUR in recurrent UTI group was 61.1%, much higher than that in first UTI group (22.5%). Thirteen of 20 VUR (65%) occurred in UTI patients under 1 year of age (M/F 10/3), with more bilateral VUR and severe grades of VUR than the older group. VUR was detected in 6 of 35 fetal or postnatal hydronephrosis patients (17.1%) by VCUG. (3) Twenty-two patients underwent both VUS and VCUG. VUR was detected in 4 patients and 6 kidney-ureter units by VCUG, while in 6 patients and 9 kidney-ureter units by VUS. Taking VCUG as the reference standard, VUS had a sensitivity of 100%, specificity of 92.1%, positive predictive value of 66.7%, and negative predictive value of 100%. There was a concordance rate of 93.2% between VUS and VCUG.</p><p><b>CONCLUSION</b>It is important to early screen VUR in UTI, fetal or postnatal hydronephrosis patients. There are more VUR, especially more bilateral VUR and severe grades of VUR, occurred in UTI patients under 1 year of age compared to older children. The incidence of VUR in recurrent UTI group was much higher than that in first UTI group. VUS is an accurate, reliable and radiation-free technique for the detection of VUR. It could be used to screen high-risk children for VUR and do the evaluation in the follow-up of VUR.</p>

Outcome analysis of surveillance on endemic fluorosis during thr period of 1991 to 2006 in Jilin Province / 中国地方病学杂志

Objective To unveil the changes of endemic fluorosis in order to provide the scientific basis for making countermeasure. Methods Seven villages was selected as monitoring points in Qianan County of Jilin Province where drinking water was improved or was going tobe improved. Dental fluorosis was surveyed with Dean method and for urine fluoride content was tested using fluoride ion-selective electrode analysis in 8 - 12 years old children. Clinical skeletal fluorosis was detected in all residents of aged 16 and over in the beginning of the monitor and every 3 years. X-ray films were taken in those over 16 years old at the beginning of the monitor and every 5 years. Results Detectable rate of dental fluorosis was decreased compared with before(Weizi: 11.3% to 2.2%, Danzi: 16.3% to 12.1%, Houqi: 53.7% to 37.5%, Houju: 38.6% to 33.3%), and severity was declining, for example, in Dongnanjing, rate of being moderate was dropping from 11.3% to 7.8%, severe rate from 2.8% to 0;in Houqi: moderate rate from 16.7% to 0, severe rate from 1.9% to 0;in Houju, moderate rate from 1.4% to 0,severe rate from 1.4% to 0. However, detectable rate of dental fluorosis rose in Dabin from 61.7% to 70.0% and in Dongbin-donju from 52.7% to 71.1% due to increased fluorides in drinking water. Urine fluorides content in 8 - 12 years old children was decreased to normal level(1.5 mg/L) in most of monitoring spots, but in Dabin it still remained at a high level, being 4.03 and 4.57 mg/L before and after respectively. Detectable rate clinical skeletal fluorosis was between 11.1% - 25.7% among those aged 16 and over in 7 monitoring point in 1991 - 2006, however it increased year after year in Dabin (15.9%, 21.6% and 25.7% in 1991, 1993 and 1995). Positive X-ray rate for skeletal fluorosis was decreased from 54.9% to 24.0% in Dabin, from 40.7% to 23.5% in Dongbin-donju and from 28.6% to 20.4% in Dangnanjing. Conclusions Endemic fluorosis has been controlled attributed to improved drinking water and decreased fluorides content in drinking water. Combined methods are needed to decrease to the intake of fluorides to control the diseases.

Diagnosis value of ultrasound of knee joint in juvenile rheumatoid arthritis / 实用儿科临床杂志

Objective To evaluate the value of ultrasound (US) in assessment knee joint inflammation in patients with juvenile rheumatoid arthritis(JRA).Methods US scans of the knees obtained in 30 children at clinically active stage; JRA was compared with those obtained in 30 healthy children and 10 JRA patients in clinical remission.Results Changes in synovial membrane thickness and presence of fluid in suprapatellar bursa showed statistically significant differences between JRA patients with active disease and the other subjects.Alterations in contour of the articular cartilage were demonstrated in 10 knees of patients with JRA.Conclusion US is a simple sensitive and reliable methods for the assessment and monitoring of knee joint involvement in JRA.