Ag-MWCNT Composites for Improving the Electrical and Thermal Properties of Electronic Paste

With the development of microelectronics products with high density and high power, it is urgent to improve the electrical and thermal conductivity of electronic paste to achieve the new requirements of packaging materials. In this work, a new synthesis method of Ag-MWCNTs was designed: Firstly, carboxylated MWCNTs and stannous chloride were used as raw materials to prepare high-loading-rate Sn-MWCNT composite material to ensure the high loading rate of metal on the MWCNT surface. Then, Ag-MWCNT composite material was prepared by the chemical displacement method to solve the problem of the low loading rate of silver nanoparticles on the MWCNT surface. On the basis of this innovation, we analyzed and compared the electrical, thermal, and mechanical properties of Ag-MWCNT composite electronic paste. Compared with the electronic paste without adding Ag-MWCNTs, the resistivity was reduced by 77%, the thermal conductivity was increased by 66%, and the shear strength was increased by 15%. Therefore, the addition of Ag-MWCNTs effectively improves the electrical, thermal, and mechanical properties of the paste, making it a promising and competitive choice for new packaging materials in the future.

Analysis of risk factors for complications following transurethral resection of the prostate

OBJECTIVE

This study investigates the risk factors for complications following transurethral resection of the prostate and provides a reference for reducing postoperative complications.

PATIENTS AND METHODS

A retrospective analysis was conducted on 322 patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate from April 2015 to January 2022. Among them, 214 patients had complete clinical and follow-up data. Clinical and follow-up data were collected, and both univariate and multivariate logistic regression analyses were performed to identify factors influencing the occurrence of postoperation transurethral resection of the prostate complications.

RESULTS

The incidence of complications after transurethral resection of the prostate was 19.16% (41/214). Among them, the incidence of Grade I-II complications was 14.96% (32/214), and Grade III-IV complications were 4.2% (9/214). The preoperative Quality of Life score (p<0.001) was identified as an independent risk factor for the occurrence of Grade I-II complications after transurethral resection of the prostate. The International Prostate Symptom Score (p=0.006) was identified as an independent risk factor for the occurrence of Grade III-IV complications after transurethral resection of the prostate.

CONCLUSIONS

The preoperative Quality of Life score is an independent risk factor for the occurrence of Grade I-II complications after transurethral resection of the prostate. The International Prostate Symptom Score is an independent risk factor for the occurrence of Grade III-IV complications after transurethral resection of the prostate.

Analysis of risk factors for stone remnants and recurrence after lateral decubitus percutaneous nephrolithotomy

OBJECTIVE

This study aims to explore the risk factors for stone remnants and recurrence after lateral decubitus percutaneous nephrolithotomy (PCNL), providing insights to enhance the stone-free rate and reduce the stone recurrence rate.

PATIENTS AND METHODS

A retrospective analysis was conducted on 356 patients with renal or upper ureteral stones who underwent lateral decubitus PCNL from January 2015 to August 2022. Among them, 271 patients had complete clinical and follow-up data. General clinical information, perioperative data, and follow-up data were collected. Univariate and multivariate logistic regression analyses were performed to identify risk factors for stone remnants and recurrence after lateral decubitus PCNL.

RESULTS

The stone-free rate after lateral decubitus PCNL was 88.6% (195/271), and the stone recurrence rate within three years was 28.1% (76/271). Stone size (p<0.001) and stone co-infection (p=0.047) were identified as independent risk factors for stone remnants after lateral decubitus PCNL. Multiple stones (p=0.003) were an independent risk factor for stone recurrence after lateral decubitus PCNL.

CONCLUSIONS

Stone size and stone co-infection are independent risk factors for stone remnants after lateral decubitus PCNL. Multiple stones are an independent risk factor for stone recurrence after lateral decubitus PCNL.

["Double Grooves-Double Rings" technique of transurethral Thulium laser enucleation of the prostate: learning curve of single surgeon]

Objective: To evaluate the learning curve of the "Double Grooves-Double Rings" (DGDR) technique of transurethral Thulium laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia (BPH) by a single surgeon. From June 2021 to July 2022, 84 patients mean age (69.0±8.0) years,preoperative prostate volume (90.9±40.3)ml with BPH underwent ThuLEP in the Department of Urology, Peking University First Hospital.Performed by a single surgeon who had no experience of transurethral resection of prostate (TURP) and any laser surgeries. The case scatter plots with the best fitting line were drawn to analyze the learning curve. According to the date of the surgeries, the patients were equally divided into three learning stages (28 patients for each group). The T-PSA,prostate volume,operative time,enucleation time, enucleation efficiency,catheter indwelling time, hemoglobin drop and perioperative complications (including re-TURP, blood transfusion, stress incontinence≥3 months and urethral stricture) were compared among the groups. The learning curve was divided into three stages, and the cutting point was shown on the 14^th case. Except the prostate volume [stage1 (75.7±30.7) ml, stage2 (93.40±39.6)ml, stage3 (103.5±46.2) ml, P<0.05], there was no significant difference of the baseline data between three groups (P>0.05). Compared with those of stage 1(100.6±24.7) min,(0.55±0.22) g/min, a statistically significant improvement was observed in both of the operative time and the enucleation efficiency among stage 2[(84.5±36.6) min, (0.87±0.33) g/min and stage 3 (71.2±26.3) min, (1.27±0.45) g/min, P<0.05]. The learning curve of the DGDR technique for ThuLEP can be divided into three stages. A ThuLEP beginner can preliminarily master this technique after completing 14 cases.

ASIC1a involves the acid-mediated activation of pancreatic stellate cells associated with autophagy induction

The acidic tumor microenvironment (TME) of pancreatic cancer affects the physiological function of pancreatic stellate cells (PSCs), which in turn promotes cancer progression. Acid-sensing ion channel 1a (ASIC1a) is responsible for acidosis-related physiopathological processes. In this study, we investigated the effect of acid exposure on the activation and autophagy of PSCs, and the role of ASIC1a in these events. The results showed that acidic medium upregulated the expression of ASIC1a, induced PSCs activation and autophagy, which can be suppressed by inhibiting ASIC1a using PcTx1 or ASIC1a knockdown, suggesting that ASIC1a involves these two processes. In addition, the acid-induced activation of PSCs was impaired after the application of autophagy inhibitor alone or in combination with ASIC1a siRNA, meaning a connection between autophagy and activation. Collectively, our study provides evidence for the involvement of ASIC1a in the acid-caused PSCs activation, which may be associated with autophagy induction.

Experimental Investigation of Effect of Flake Silver Powder Content on Sintering Structure and Properties of Front Silver Paste of Silicon Solar Cell

Optimizing the performance of front silver paste is of great significance in improving the efficiency of the photoelectric conversion of crystalline silicon solar cells. As a conductive functional phase of silver paste, the structure and performance of silver powder have an important influence on the sintering process of silver paste and the conductivity of silver electrodes. Because of their two-dimensional structure, flake silver powders can effectively increase the contact area with other silver powders and silicon cells before sintering. Additionally, flake silver particles have higher surface energy and sintering activity than spherical silver particles of the same particle size. However, recent research has mainly focused on the influence of the particle size of silver powder. This paper fills the research gap regarding the morphology of silver powders and clarifies the influence of flake silver powders on the performance of silver paste. The influence of the ratio of spherical silver powder to flake silver powder in silver paste on the sheet resistance, adhesion, and specific contact resistivity of silver film after sintering at 800 °C was studied, and the optimal ratio was determined according to a cross-sectional contact picture of the silver film. The results showed that with the increase in the mass fraction of the flake silver powder, the sheet resistance of the sintered silver film gradually increased, the adhesion first increased and then decreased, and the specific contact resistance first decreased and then increased. When the flake silver powder content was 0%, the minimum sheet resistance of the silver film was 2.41 m Ω/☐. When the flake silver powder content was 30%, the maximum adhesion of the silver film was 6.07 N. When the flake silver powder content was 50%, the minimum specific contact resistivity of the silver film was 0.25 Ω·cm². In conclusion, when the flake silver powder content was 30%, the comprehensive performance of the silver film was the best.

The Effect of the Swimmer's Trunk Oscillation on Dolphin Kick Performance Using a Computational Method with Multi-Body Motion: A Case Study

The effect of a specific Chinese swimmer’s trunk oscillation on dolphin kick was investigated in order to optimize competitive swimming movement. Using a numerical simulation method based on multi-body motion, different swimmer’s trunk oscillation during a dolphin kick was analyzed. The simulation was conducted using 3D incompressible Navier−Stokes equations and renormalization group k-ε turbulence model, combined with the Volume of Fluid method to capture the water surface. The simulation’s results were evaluated by comparing them with experimental data and with previous studies. The net streamwise forces, mean swimming velocity, and joint moments were also investigated. There was a positive correlation between the mean swimming velocity and the amplitudes of the swimmer’s trunk oscillation, where the Pearson correlation coefficient was 0.986 and the selected model was statistically significant (p < 0.05). In addition, as the mean swimming velocity increased from 1.42 m/s in Variant 1 to 2 m/s in Variant 5, the maximum positive moments of joints increased by about 24.7% for the ankles, 27.4% for the knees, −3.9% for the hips, and 5.8% for the upper waist, whereas the maximum negative moments of joints increased by about 64.5% for the ankles, 28.1% for the knees, 23.1% for the hips, and 10.1% for the upper waist. The relationship between the trunk oscillation and the vortices was also investigated. Therefore, it is recommended that swimmers should try to increase the amplitudes of trunk oscillation to increase their swimming velocity. In order to achieve this goal, swimmers should increase strength training for the ankles, knees, and upper waist during the upkick. Moreover, extra strength training is warranted for the ankles, knees, hips, and upper waist during the downkick.

Hydrodynamic Characteristics of Different Undulatory Underwater Swimming Positions Based on Multi-Body Motion Numerical Simulation Method

The study of hydrodynamic characteristics of swimming is the main way to optimize the swimming movement. The relationship between position, water depth, and swimming performance of undulatory underwater swimming are one of the main concerns of scholars. Therefore, the aim of this study is to analyze the swimming performance of three different undulatory underwater swimming positions under various swimming depths using a numerical simulation method based on multi-body motion. The simulation was conducted using 3D incompressible Navier–Stokes equations using the RNG k-ε turbulence closure equations, and in combination with the VOF method thus that we could include the water surface in our calculations. Different swimming depths based on the distance from the shoulder joint center to the initial water surface were considered. The velocity of the shoulder joint center was captured with a swimming motion monitoring system (KiSwim) and compared with the calculated results. The study found that there was a significant difference in the hydrodynamic characteristics of the three undulatory underwater swimming positions (i.e., the dorsal, lateral, and frontal positions) when swimming near the water surface, and the difference decreased as the swimming depth increased. There was a negative correlation (R(dorsal) = −0.928, R(frontal) = −0.937, R(lateral) = −0.930) between the swimming velocities of the three undulatory underwater swimming positions and the water depth (water depth = 0.2–0.7 m) and that the lateral position had the greatest average velocity. Therefore, it is recommended that swimmers travel at least 0.5 m below the water surface in any undulatory underwater swimming position in order to avoid excessive drag forces. As the swimmer approaches the water surface, the lateral position is worth considering, which has better velocity and hydrodynamic advantage than the other two undulatory underwater swimming positions.

Pancreatic sarcomatoid carcinoma: CT, MRI, and 18F-FDG PET/CT features

AIM

To investigate computed tomography (CT), magnetic resonance imaging (MRI), and combined 2-[¹⁸F]-fluoro-2-deoxy-d-glucose (¹⁸F-FDG) positron-emission tomography (PET)/CT features of pancreatic sarcomatoid carcinoma (PSC).

MATERIALS AND METHODS

The hospital database was searched retrospectively for the patients with PSC confirmed at histopathology after surgery. Ten patients who underwent unenhanced and enhanced CT (n=4), unenhanced and enhanced MRI (n=2), ¹⁸F-FDG PET/CT (n=2), and both enhanced CT and ¹⁸F-FDG PET/CT (n=2) were enrolled. Two patients underwent additional delayed PET/CT. The maximum standardised uptake value (SUVmax) was measured on PET/CT images.

RESULTS

Eleven lesions were detected in 10 patients. Solid and cystic components (n=6), intratumoural haemorrhage (n=1), nodular calcification (n=2), main pancreatic duct dilatation resulted from lesion obstruction (n=5) or compression (n=3), cholangiectasis (n=5), vascular and peripheral organ invasion (n=5 and 6, respectively), hepatic and lymphatic metastases (n=4 and 2, respectively) were detected. All five lesions in four patients who underwent PET/CT showed intense FDG uptake on PET/CT with SUVmax (16, range 10.9-21.1). Increase of FDG uptake (SUVmax = 18.9, 20.1, and 27.3, respectively) was revealed on the delayed scan of three lesions in two patients.

CONCLUSIONS

PSCs were more commonly ill-defined solid cystic masses, which caused pancreatic duct obstruction/compression without pancreatic parenchymal atrophy, and these masses on PET/CT showed high FDG uptake on both initial and delayed PET/CT.

Chronic sun exposure is associated with distinct histone acetylation changes in human skin

BACKGROUND

Photoageing is attributed to continuous sunlight or artificial ultraviolet exposure and manifests as clinical and histological changes in skin. Epigenetic changes have been found to be involved in the pathogenesis of photoageing. However, the underlying mechanisms are unclear.

OBJECTIVES

To analyse histone modification patterns in sun-exposed and nonexposed skin, and to identify the abnormally histone-modified genes related to photoageing.

METHODS

Skin biopsies were collected from both the outer forearm (sun-exposed area) and the buttock (sun-protected area) in 20 healthy middle-aged female volunteers. Global histone H3/H4 acetylation and H3K4/H3K9 methylation statuses were assessed by enzyme-linked immunosorbent assay. Expression levels of histone acetyltransferases and histone deacetylases were measured by reverse-transcriptase quantitative polymerase chain reaction (qPCR) and Western blot. Chromatin immunoprecipitation combined with DNA microarray (ChIP-chip) assay with anti-acetyl-histone H3 antibody in a sun-exposed pool (combining six sun-exposed skin samples) and a nonexposed pool (combining six nonexposed skin samples) was conducted to explore the abnormally acetylated histone H3 genes related to photoageing; ChIP-qPCR was then used to verify the results of ChIP-chip.

RESULTS

We observed higher global histone H3 acetylation levels increased EP300 and decreased HDAC1 and SIRT1 expression in sun-exposed skin compared with matched nonexposed skin. Furthermore, the ChIP-chip assay showed that 227 genes displayed significant hyperacetylation of histone H3, and 81 genes displayed significant hypoacetylation of histone H3 between the two groups. Histone H3 acetylation levels on the promoters of PDCD5, ITIH5, MMP1 and AHR were positively correlated with the mRNA expression of the corresponding gene.

CONCLUSIONS

Chronic sun exposure-induced histone H3 hyperacetylation may play a critical role in the pathogenesis of skin photoageing.

Atorvastatin attenuates experimental contrast-induced acute kidney injury: a role for TLR4/MyD88 signaling pathway

Objectives: To investigate the protective effect of different atorvastatin doses on contrast-induced acute kidney injury and the related mechanism.

Methods: Healthy male Sprague–Dawley (SD) rats were randomly divided into the blank control group, experimental control group and different-dose atorvastatin groups. A rat model of contrast-induced acute kidney injury was established. We detected changes in serum creatinine (Scr) and blood urea nitrogen (BUN) before and after model establishment, observed and scored renal tubular injury, analyzed rat renal cell apoptosis, and measure the expression of signal pathway proteins and downstream inflammatory factors.

Results: After contrast agent injection, the Scr and BUN levels of the experimental control group were significantly increased, the different doses applied in the atorvastatin group significantly reduced the Scr and BUN levels (p < .05) and ameliorated the contrast-induced acute kidney injury (p < .05) and significantly reduced Toll-like receptor 4 (TLR4), Myeloid differentiation factor 88 (Myd88), and Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) protein expression and relative mRNA expression levels (p < .05) and significantly decreased expression levels of downstream inflammatory factors (p < .05).

Conclusion: Different atorvastatin doses have protective effects on contrast-induced acute renal tubular injury in rats, possibly by targeting TLR4, suppressing TLR4 expression, regulating the TLR4/Myd88 signaling pathway, and inhibiting the expression of downstream inflammatory factors.

[Correlation analysis of serum secreted frizzled-related protein 5 levels with airway inflammation and insulin resistance in chronic obstructive pulmonary disease patients]

Objective: To investigate the relationship between serum secreted frizzled-related protein 5(sfrp5) levels, insulin resistance, and airway inflammation in patients with chronic obstructive pulmonary disease(COPD). Method: A total of 178 COPD patients visiting our respiratory outpatient clinic from February 2015 to January 2017 were enrolled, and 99 healthy control subjects from the same time period were selected. Serum sfrp5 levels were compared between the 2 groups. Serum sfrp5 and inflammatory cytokines in induced sputum were observed in the 4 subgroups: insulin resistant COPD group [homeostasis model assessment of insulin resistance (HOMA-IR)≥2.29], non-insulin resistant COPD group, non-COPD insulin resistant group, and healthy control group. Results: Serum sfrp5 levels were found to be significantly higher in the COPD group as compared to the healthy control group (t=-14.29, P<0.001). Serum sfrp5 levels in the insulin resistant COPD group [(8±3)ng/ml] were significantly lower than that of the non-insulin resistant COPD group [(10±5)ng/ml], non-COPD insulin resistant group [(13±3)ng/ml], and normal control group [(14±4)ng/ml, F=35.85, P<0.01]. The insulin resistant COPD group had higher levels of In(Homa-IR), as well as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in induced sputum as compared to the non-insulin resistant COPD group, non-COPD insulin resistant group, and healthy control group (F values were 64.968, 41.40, 64.15, respectively, P value <0.01 for all items). The non-insulin resistant COPD group had higher levels of In(HOMA-IR) as well as TNF-α and IL-6 in induced sputum as compared to the non-COPD insulin resistant group and healthy control group. FEV(1)/FVC and FEV(1)% predicted were significantly lower in the insulin resistant COPD group as compared to those of non-insulin resistant COPD group and non-COPD insulin resistant group, and healthy control group (F values were 2.481 and 8.37, respectively, P value<0.05 for all items). FEV(1)/FVC and FEV(1)% predicted were significantly lower in the non-insulin resistant COPD group as compared to those of the healthy control group and non-COPD insulin-resistant group. Serum sfrp5 levels were positively correlated to FEV(1)/FVC and FEV(1) predicted (r values were 0.466 and 0.412, respectively; P values were <0.001 and 0.007, respectively) and inversely correlated to In(HOMA-IR) and TNF-α and IL-6 in induced sputum (r values were -0.304, -0.459, -0.517, respectively; P values were <0.001, 0.002, <0.001, respectively). BMI, ln(HOMA-IR), and IL-6 in induced sputum were independent related factors (r(2) values were 0.286, 0.176, 14.69, respectively; P values were <0.01 for all items) Conclusion: Sfrp5 may be concurrently associated with COPD and insulin resistance; insulin resistance may be associated with airway inflammation and airflow limitation. Sfrp5 may be involved in the development of COPD and may be the key link by which insulin resistance exerts its effects on airway inflammation.

Applying team-based learning of diagnostics for undergraduate students: assessing teaching effectiveness by a randomized controlled trial study

Background

We aimed to introduce team-based learning (TBL) as one of the teaching methods for diagnostics and to compare its teaching effectiveness with that of the traditional teaching methods.

Methods

We conducted a randomized controlled trial on diagnostics teaching involving 111 third-year medical undergraduates, using TBL as the experimental intervention, compared with lecture-based learning as the control, for teaching the two topics of symptomatology. Individual Readiness Assurance Test (IRAT)-baseline and Group Readiness Assurance Test (GRAT) were performed in members of each TBL subgroup. The scores in Individual Terminal Test 1 (ITT1) immediately after class and Individual Terminal Test 2 (ITT2) 1 week later were compared between the two groups. The questionnaire and interview were also implemented to survey the attitude of students and teachers toward TBL.

Results

There was no significant difference between the two groups in ITT1 (19.85±4.20 vs 19.70±4.61), while the score of the TBL group was significantly higher than that of the control group in ITT2 (19.15±3.93 vs 17.46±4.65). In the TBL group, the scores of the two terminal tests after the teaching intervention were significantly higher than the baseline test score of individuals. IRAT-baseline, ITT1, and ITT2 scores of students at different academic levels in the TBL teaching exhibited significant differences, but the ITT1-IRAT-baseline and ITT2-IRAT-baseline indicated no significant differences among the three subgroups.

Conclusion

Our TBL in symptomatology approach was highly accepted by students in the improvement of interest and self-directed learning and resulted in an increase in knowledge acquirements, which significantly improved short-term test scores compared with lecture-based learning. TBL is regarded as an effective teaching method worthy of promoting.

New ideas for teaching electrocardiogram interpretation and improving classroom teaching content

Background

Interpreting an electrocardiogram (ECG) is not only one of the most important parts of diagnostics but also one of the most difficult areas to teach. Owing to the abstract nature of the basic theoretical knowledge of the ECG, its scattered characteristics, and tedious and difficult-to-remember subject matter, teaching how to interpret ECGs is as difficult for teachers to teach as it is for students to learn. In order to enable medical students to master basic knowledge of ECG interpretation skills in a limited teaching time, we modified the content used for traditional ECG teaching and now propose a new ECG teaching method called the “graphics-sequence memory method.”

Methods

A prospective randomized controlled study was designed to measure the actual effectiveness of ECG learning by students. Two hundred students were randomly placed under a traditional teaching group and an innovative teaching group, with 100 participants in each group. The teachers in the traditional teaching group utilized the traditional teaching outline, whereas the teachers in the innovative teaching group received training in line with the proposed teaching method and syllabus. All the students took an examination in the final semester by analyzing 20 ECGs from real clinical cases and submitted their ECG reports.

Results

The average ECG reading time was 32 minutes for the traditional teaching group and 18 minutes for the innovative teaching group. The average ECG accuracy results were 43% for the traditional teaching group and 77% for the innovative teaching group.

Conclusion

Learning to accurately interpret ECGs is an important skill in the cardiac discipline, but the ECG’s mechanisms are intricate and the content is scattered. Textbooks tend to make the students feel confused owing to the restrictions of the length and the format of the syllabi, apart from many other limitations. The graphics-sequence memory method was found to be a useful method for ECG teaching.

[Controlled clinical study on compound Decumbent Corydalis Rhizome and diclofenac in treatment of knee osteoarthritis]

To evaluate the efficacy and safety of compound Decumbent Corydalis Rhizome (DCR) in treating patients with knee osteoarthritis (OA). Totally 79 patients with knee osteoarthritis were selected from out-patient and inpatient departments of West China Hospital and randomly divided into the test group and the control group. The test group (n = 41) was given Compound DCR with the dosage of 1.8 g · d(-1), while the control group (n = 38) was administered with diclofenac sodium with the dosage of 75 mg · d(-1). After 12 weeks of treatment, the total efficacy rates based on patients/physicians evaluation for experimental and control groups were 68.29%, 63.41% and 71.05%, 63.16%, respectively, without significant difference between the two groups. Both of the two groups showed significant improvements in the main efficacy indexes (pain on walking 20 m) and minor indexes (tenderness on palpation, Western Ontario and McMaster Universities OA index (WOMAC) and Short-Form Health Survey (SF-36 ), but without significant difference in efficacy between them. The incidence of related adverse events was 24.39% in the test group and 47.37% in the control group, respectively, with significant differences between the two groups (P < 0.05). In the controlled study, compound DCR is as efficient as diclofenac sodium but more tolerable, with a good clinical application prospect.

Double positive CD4+CD8+ T cells: key suppressive role in the production of autoantibodies in systemic lupus erythematosus

BACKGROUND & OBJECTIVES

The presence of CD4+CD8+ (double positive) T cells (DPT) in the target organs of several autoimmune diseases has been reported. The aim of this study was to investigate the pathogenic role of DPT in systemic lupus erythematosus (SLE).

METHODS

A total of 175 SLE cases and 125 matched healthy controls were investigated for CD3+, CD4+, CD8+ lymphocytes and DPT by flow cytometry. Serum samples from SLE patients and controls were tested for antinuclear antibody (ANA), anti-double strain deoxyribonucleic acid (anti-dsDNA), anti-U1 ribonucleoprotein (anti-U1 RNP), anti-sjogren syndrome A (anti-SSA), anti-ribosomal P protein (anti-rib-P), anti-Smith (anti-Sm), anti-Sjogren syndrome B (anti-SSB), complement 3 (C3) and complement 4 (C4).

RESULTS

The DPT median and 5-95 per cent range of SLE cases and healthy controls were 0.50 [0.10-2.60] and 0.80 [0.20-2.74] respectively (P<0.001). SLE patients were divided into a ≥1:1000 subgroup and a <1:1000 subgroup according to the ANA titre. The DPT of the former subgroup was significantly lower than that of the latter (P=0.032). The DPT medians of positive subgroups with anti-dsDNA (P<0.001), anti-U1RNP (P=0.018), anti-SSA (P=0.021) or anti-rib-P (P=0.039) were also significantly lower than the negative subgroups. Likewise, DPT was significantly lower in SLE subgroups with low concentration of C3 or C4 than those with high concentration (P<0.006).

INTERPRETATION & CONCLUSIONS

Our findings show that the DPT cells may play a key suppressive role in the production of autoantibodies in SLE. Direct evidence that DPT regulates the pathogenesis of SLE needs to be investigated in future work.

[Endogenous hydrogen sulfide and androgen deficiency-induced erectile dysfunction in rats]

OBJECTIVE

To investigate the role of endogenous hydrogen sulfide (H2S) in erectile dysfunction (ED) induced by androgen deficiency.

METHODS

We randomly divided 30 eight-week-old healthy male SD rats into six groups: 2-week control (A), 4-week control (B), 2-week castration (C), 4-week castration (D), 2-week castration + androgen replacement (E), and 4-week castration + androgen replacement (F), those in groups E and F subcutaneously injected with testosterone propionate (TP) at the physiological dose of 3 mg/kg per day after castration, while those in the other groups with isodose oil instead. At 2 and 4 weeks after operation, we determined the level of serum testosterone (T) , intracavernous pressure (ICP) , mean carotid arterial pressure (MAP) of the rats, measured the concentration of H2S in the plasma and corpus cavernosum tissue, and detected the expressions of cystathionine-P3-synthase (CBS) and cystathionine-gamma-lyase (CSE) by immunohistochemistry and Western blot.

RESULTS

The serum T level was significantly lower in group C ([0.63 +/- 0.15] nmol/L) than in A ( [ 16.55 +/- 4.17] nmol/L) and E ( [ 18.99 +/- 4.62] nmol/L) (P <0.05), as well as in group D ([0.70 +/-0.22] nmol/L) than in B ([15.44 +/-5.18] nmol/L) and F ([20.99 +/-6.41] nmol/L) (P <0. 05) , and so were ICP/MAP after 5 and 7 V electrical stimulation of the pelvic ganglia (P <0. 05) , H2 S concentration (P <0.05), and the expressions of CBS and CSE (P <0.05). The expressions of CBS and CSE proteins were also significantly decreased in group C as compared with D (P <0.05).

CONCLUSION

The reduced expressions of CBS and CSE may inhibit the H2 S signaling pathway, which might be one of the mechanisms underlying androgen deficiency-induced ED in rats.

A controlled trial to compare the teaching quality of clinical-skills training faculty: the clinician-educator career path in China

BACKGROUND

Full-time clinician educators are becoming more predominant in China, yet their effect is unknown.

PURPOSES

The purpose of this study was to compare the teaching quality of full-time (FT) faculty with that of part-time (PT) faculty in one Chinese medical school.

METHODS

In 3 consecutive years, 881 3rd year medical students were enrolled and randomly distributed into two groups, being taught by either a FT faculty member or a PT faculty member. Their teaching quality was evaluated with student performance on a written exam, the standardized patient exam, and student satisfaction.

RESULTS

The students in the FT group always scored better on the written exam (1st year = 79.82 ± 9.2 vs. 81.26 ± 8.2, p < .188; 2nd year = 73.10 ± 9.8 vs. 76.51 ± 7.9, p = .001; 3rd year = 75.15 ± 9.0 vs. 79.51 ± 8.7, p < .0001). In the standardized patient exam, the students from FT groups always showed better performance in history taking and physical examination. Students continually gave higher evaluations to FT faculty in questionnaires (1st year = 76.8 ± 6.5 vs. 84.3 ± 2.2; 2nd year = 78.6 ± 3.9 vs. 89.7 ± 4.2; 3rd year = 75.8 ± 3.9 vs. 88.5 ± 3.5, all ps < .001).

CONCLUSIONS

The teaching quality of FT faculty in clinical-skills training is better than PT faculty in this study.

[Risk factors associated with cardiac involvement in patients with dermatomyositis/polymyositis]

OBJECTIVE

To identify risk factors associated with cardiac involvement (CI) in patients with dermatomyositis/polymyositis (DM/PM).

METHODS

Medical records of 129 DM/PM patients were reviewed retrospectively. The risk factors associated with CI in those patients were screened through Xt tests or independent tests before a multivariate logistic regression analysis was performed. ROC curves were constructed to determine diagnostic values of the identified risk factors.

RESULTS

CI occurred in 59 (45. 74%) of DM/PM patients, with 41 (69. 49%) showing electrocardiographic (ECG) abnormality; 25 (42. 37%) showing ultrasonic cardiogram (UCG) abnormality; 8 (13. 56%) being diagnosed with heart failure, and 2 (3. 39%) being diagnosed with myocardial infarction. Eight (13.56%) of the patients with CI died. CI was more likely to occur in patients with an older age, having interstitial lung disease, antinuclear antibody (ANA) positive, and anti-Jo-1 antibody positive (P<0.05). The logistic regression analysis revealed that interstitial lung disease (beta=1. 554), aspartic aminotransferase/creatine kinases (AST/CK) ratio (beta=1.189), positive ANA (beta= 1. 172) and age (beta=0.042) were risk factors associated with CI (P<0. 05). Notable areas under ROC curve (0. 642) was found for AST/CK in determining CI in DM/PM patients (P<0. 05), albeit with low accuracy. A cut-off of AST/CK ratio at 0. 312 was identified as a reference point for determining CI in patients with DM/PM.

CONCLUSION

Cardiac involvement is the most common complication of DM/PM, although the majority are subclinical. ECG and UCG are common tools for diagnosing cardiac involvement. Interstitial lung disease, AST/CK ratio, positive ANA and age are predictors of CI in DM/PM patients.

[Survival analysis and risk factors for survival in idiopathic inflammatory myopathies: a retrospective cohort study]

OBJECTIVE

To study predominant risk factors for survival in idiopathic inflammatory myopathies (JIM).

METHODS

The clinical data of 163 cases of IIM were reviewed, who received the diagnosis and treatments in West China Hospital from January 1997 to December 2010. Kaplan-Meier survival curve was used for the survival analysis of these patients with IIM. Univariate and multivariate analysis of risk factors for survival in the patients with IIM were carried out by Log-rank test, univariate Cox regression analysis and Cox regression model respectively.

RESULTS

There were 21 death occured among 163 patients with IIM, and the estimated 3, 5, 10-year survival rate was 93%, 89%, 80% respectively. The mortality of the patients with dermatomyositis (DM) or amyophathic dermatomyositis(ADM) increased significantly when compared with polymyositis (PM, P=0. 033, P= 0. 06). The mortality of IIM patients complicated with tumor or cadiovascular involvement was much higher than that of those patients without any complications (P<0. 001, P=0. 015). Tumor and cadiovascular involvement were two independent risk factors for the survival of IIM individuals.

CONCLUSION

DM and ADM have much unfavorable prognosis than PM. Tumor and cadiovascular involvement are two major risk factors for the survival of IIM patients.

[Idiopathic inflammatory myopathies complicated with pneumonias: clinical characteristics and pathogen analysis]

OBJECTIVE

To investigate the clinical characteristics, pathogen constitution and their tolerance to antibiotics in idiopathic inflammatory myopathies (IIM) patients complicated with pneumonia and the associated risk factors.

METHODS

The clinical data and pathogen test results of 93 IIM patients with pneumonia and 52 IIM patients without pneumonia (control group) were retrieved and compared.

RESULTS

Age of onset and interstitial lung disease were identified as risk factors associated with IIM complicated with pneumonia. Gram negative bacteria were the most common pathogen. Klebsiella pneumoniae was the most common bacteria and Candida albicans was the most common fungus causing infections in the IIM patients, which were relatively sensitive to the third- and fourth-generation of antibiotics such as cephalosporin, fluoroquinolones and aminoglycoside.

CONCLUSION

Older patients with interstitial lung disease are prone to having pneumonia, especially those caused by gram negative bacteria and other atypical pathogens. Timely and reasonable anti-infection treatment is essential.

[Expression of Gphaq in peripheral blood T lymphocytes of patients with polymyositis and its correlation with disease activity]

OBJECTIVE

To analyze the expression of Gaq in peripheral blood T lymphocytes of the patients with polymyositis (PM) and its correlation with disease activity evaluated by the clinical markers [manual muscle test (MMT),myositis disease activity assessment (MDAA),creatine phosphokinase (CK), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)].

METHODS

Blood samples were obtained from 30 patients with first onset PM and 30 healthy volunteers. Peripheral blood mononuclear cells (PBMCs) from these patients were collected and CD3+ T cells from PBMCs were sorted out with magnetic beans. The mRNA and protein expression levels of Galphaq in T cells were measured by RT-PCR and Western blot. Student's unpaired 2-tailed t-test was applied to identify Galphaq expression difference between PM patients and healthy controls. Pearson's correlation between Galphaq mRNA expression of PM and clinical evaluation markers MMT, MDAA, CK, ESR or CRP was determined.

RESULTS

Compared to health control, PM patients had significantly lower expression levels of Galphaq protein and mRNA in peripheral blood CD3+ T cells (P<0. 001). Negative correlation was found between Galphaq mRNA level and MMT (r= -0. 704, P<0. 001), MDAA (r= -0. 793, P<0. 001) or CK (r= -0. 670, P<0. 001), and no correlation was found between Galphaq mRNA level and ESR or CRP.

CONCLUSION

Galphaq expression in T cells of PM is lower than that in normal control and has negative correlation with PM disease activity.

Electrolytic partitioning of uranium and plutonium based on a new type of electrolytic mixer-settler

The design of a new type of electroreduction mixer-settler for the partitioning of uranium and plutonium during the Purex process, which is featured with E-shaped cathodes and U-shaped anodes in settling chamber, is described and the operational results achieved using this equipment are presented. The results show that this new type of mixer-settler has excellent separation performances. The flow rate of organic feed solution is 3 mL/min and the flow ratio of feed solution (1BF) to aqueous back extraction stream (1BX) and to organic wash stream (1BS) is 4/1/1. For an organic feed of 84 g/L uranium and 1.40 ⁓ 2.64 g/L plutonium, both the separation factor of plutonium from uranium and that of uranium from plutonium are apparently higher than 104

[Comparison of four diagnostic criteria for idiopathic inflammatory myopathy]

OBJECTIVE

To compare the clinical values of four different criteria for diagnosing idiopathic inflammatory myopathy (IIM).

METHODS

The four different criteria published in 1975, 1995, 1997 and 2004 were applied to 94 IIM patients and 98 patients with other myopathies in West China Hospital.

RESULTS

The sensitivity of the four criteria for diagnosing IIM was 56. 4% (1975), 87. 2% (1995), 61.7 % (1997), and 52. 1% (2004) respectively. The specificity of the four criteria for diagnosing IIM was 78. 6% (1975), 20. 4% (1995), 78. 6% (1997), and 90. 8% (2004) respectively. The Youden index was 35.0% (1975), 7.6% (1995), 40. 3% (1997), and 42.9% (2004), with an odd product of 4. 74 (1975), 1. 75 (1995), 5. 91 (1997) and 10. 77 (2004) respectively. The Kappa value of the four criteria was 0. 351 (1975, P<0.05), 0. 075 (1995, P>0. 05), 0. 404 (1997, P<0.05 ) and 0. 433 (2004, P<0.05), and their area under the ROC curve was 0. 675 (1975, P=0. 00), 0. 538 (1995, P=0.36),0. 701 (1997, P=0.00) and 0. 715 (2004, P=0.00) respectively.

CONCLUSION

The 2004 criteria have a better value in diagnosing IIM.

General acteoside of Rehmanniae leaves in the treatment of primary chronic glomerulonephritis: a randomized controlled trial

The objective of the study was to investigate the effectiveness and efficacy of the randomized, parallel, and controlled trial of Traditional Chinese Medicine, general acteoside of Rehmanniae leaves, compared with piperazine ferulate in the treatment of primary chronic glomerulonephritis. Rehmanniae leaves and piperazine ferulate can reduce proteinuria and erythrocyturia effectively in the treatment of primary chronic glomerulonephritis. A total of 400 patients diagnosed with primary chronic glomerulonephritis were recruited from outpatient clinics and were randomly assigned to the treatment group (general acteoside of Rehmanniae leaves, two 200mg tablets, bid) or the control group (piperazine ferulate, four 50-mg tablets, bid ). The primary outcome was 24-h urinary protein. Secondary outcome measures included estimated glomerular filtration rate (eGFR), erythrocyturia, and electrolytes. After 8 weeks of treatment, the treatment group and the control group showed a mean reduction in 24-h proteinuria of 34.81% and 37.66%. The 95% CI of difference of the mean reduction in 24-h proteinuria between the two groups was [-11.50%, 5.80%]. No significant differences were found between the two groups in the erythrocyturia reduction. Neither group showed obvious changes between baseline and 8 weeks in eGFR or electrolytes. Adverse events occurred at a similarly low rate in the treatment group (1.5%) and control group (2.5%, P = 0.7238). Both general acteoside of Rehmanniae leaves and piperazine ferulate can reduce proteinuria and erythrocyturia effectively in the treatment of primary chronic glomerulonephritis.

Osteoblastogenesis regulation signals in bone remodeling

Bone remodeling is essential for adult bone homeostasis. The failure of this process often leads to the development of osteoporosis, a present major global health concern. The most important factor that affects normal bone remodeling is the tightly controlled and orchestrated regulation of osteoblasts and osteoclasts. The present review summarized the recent discoveries related to osteoblast regulation from several signals, including transforming growth factor-β, bone morphogenetic proteins, Wnt signal, Notch, Eph-Ephrin interaction, parathyroid hormone/parathyroid hormone-related peptide, and the leptin-serotonin-sympathetic nervous systemic pathway. The awareness of these mechanisms will facilitate further research that explores bone remodeling and osteoporosis. Future investigations on the endogenous regulation of osteoblastogenesis will increase the current knowledge required for the development of potential drug targets in the treatment of osteoporosis.

[Comparison of the effects of alpha-keto/ amino acid supplemented low protein diet and diabetes diet in patients with diabetic nephropathy]

OBJECTIVE

To investigate if a-keto/amino acid supplemented low protein diet can slow down the progression of diabetic nephrophathy in comparison with non-supplemented diabetes diet.

METHODS

A prospective, randomized, controlled clinical study was conducted. Twenty three cases of type 2 diabetic nephropathy in IV stage were randomly divided into alpha-keto/amino acid supplemented diet group (trial group) and conventional diabetes diet group (control group), The treatment duration was 52 weeks. 24 h urine protein was measured at 0, 12, 20, 36 and 52 weeks. Before and after the 52 weeks treatment, all the patients received the measurement of glomerular filtration rate (GFR), blood glucose, blood lipids, inflammatory markers, as well as nutritional status.

RESULTS

After the treatment for 20, 36, 52 weeks, mean 24 h urine protein decreased significantly in trial groups (P < 0.05), and 24 h urine protein in trial group were significantly decreased (P < 0.05) compared with control group in 20 weeks after treatment. Either in trial group or in control group, GFR remained relatively stable during the observation period. Nutrition status, inflammatory markers, and serum calcium, phosphorus levels between the two groups were no significantly difference. The adverse events experienced by the patients in trial group were similar and consistent with the patients underlying renal diseases.

CONCLUSION

Alpha-keto/amino acid can reduce proteinuria more effectively, while improve renal function and nutritional status in diabetic nephropathy patients with well-toleration.

[Investigate the effects of compound radix notoginseng on renal interstitial fibrosis and kidney-targeting treatment]

OBJECTIVE

Investigate the effects of compound Radix Notoginseng on renal interstitial fibrosis and kidney-targeting treatment.

METHODS

100 healthy Sprague-Dawley rats were randomly divided into 5 groups: Unilateral ureteral obstruction (UUO) group, sham-operation (SOR) group, Radix Notoginseng (RN) group, compound Radix Notoginseng (CRN) group and Losartan (ARB) group. After operation, RN, CRN and ARB groups were intragastric administrated with RN (3 mL/d), CRN (3 mL/d) and ARB [20 mg/(kg x d)] respectively. Each group randomly included 18 rats for statistical analysis. The histological changes of renal interstitial tissues were observed by HE, Masson and PAS staining. Total kidney collagen content was determined by measuring the amount of hydroxyproline. The mRNA of alpha-SMA, collagen I and fibronectin were reverse transcribed and quantified by real-time PCR. The expression of alpha-SMA protein was assessed by immunohistochemistry and Western blot analysis.

RESULTS

In UUO model, the obstructed kidney showed typical features of renal tubulointerstitial fibrosis, such as severe tubular loss, dilation, atrophy, infiltration of inflammatory cells, interstitial matrix deposition (P < 0.05). Partial correlation assay showed that the expression of alpha-SMA was related to the renal tubular injury (r = 0.55; P < 0.05). Administration of RN, CRN and ARB improved tubulointerstitial damage and collagen matrix accumulation induced by UUO in different degree. The expression of the alpha-SMA at mRNA and protein levels were significantly increased in the UUO group (P < 0.05), which was also suppressed by treatment with RN, CRN and ARB in different degree. Moreover, more effective role in preventing fibrosis was observed in CRN group than when compared with that of RN group.

CONCLUSION

RN and CRN can inhibit UUO-induced renal interstitial fibrosis in rats, and CRN treatment is more effective than RN in reducing interstitial fibrosis.

[Influence of mannose binding lectin to expression of TGF-beta1 and NF-kappaB in high concentration of glucose cultured human renal glomerular endothelial cells]

OBJECTIVE

To investigate the effect of mannose binding lectin (MBL) complement pathway on expression of transforming growth factor-beta1 (TGF-beta1) and NF-kappaB in cultured human renal glomerular endothelial cells (HRGECs) stimulated by high concentration of glucose.

METHODS

Human glomerular endothelial cells in culture were randomly divided into 5 groups according to different managements: normal concentration of glucose as controlled group, MBL + normal concentration of glucose group, high concentration of glucose, MBL + high glucose and MBL + high glucose + MBL blocker respectively. Flow cytometry was used to detect the depositions of MBL and C3 on the surfaces of HRGECs. Real-time PCR method was used to detect the mRNA levels of TGF-beta1. Human TGF-beta1 ELISA kit was used to detect the concentration of TGF-beta1 in supernatant fluid. ESMA was used to detect the activity of NF-kappaB in HRGECs.

RESULTS

Compared with the normal glucose group and high glucose group, the depositions of MBL, C3 were apparently increased in MBL + high glucose group (P < 0.05). Expression of TGF-beta1 were significantly higher (P < 0.05) in MBL + high concentration of glucose groups than the normal glucose group and the high concentration of glucose group. Compared with the high glucose group, the activity of NF-kappaB in HRGECs was apparently increased in MBL + high glucose group, which could be significantly downregulated by MBL blocking antibody.

CONCLUSION

High concentration of glucose can increase the expression of TGF-beta1 of cultured human glomerular endothelial cells. At the same time, high glucose together with MBL can up regulate the expression of TGF-beta1 and the activity of NF-kappaB in HRGECs.

[Effect of high concentration of glucose on thickness of glycocalyx and expression of syndecan-1 and glypican-1 in cultured human renal glomerular endothelial cells]

OBJECTIVE

To investigate the influence of high concentration of glucose on the thickness of Glycocalyx and expression of core protein Sydecan-1 and Glypican-1 in cultured human renal glomerular endothelial cells (HRGECs).

METHODS

HRGECs in culture were randomly divided into 3 groups, high concentration of glucose (30 mmol/L D-glucose, high glucose group), normal concentration of glucose as controlled group (5 mmol/L D-glucose+25 mmol/L mannitol, normal control group), and mannitol group (30 mmol/L mannitol) respectively. After 72 hours, confocal laser scanning microscopy (CLSM) was used to observe and characterize the fully hydrated glycoalyx of HRGECs. Real time quantitative PCR and Western blot were applied to detect the mRNA levels and protein expression of Syndecan-1 and Glypican-1, and the fluorescence microscope were used to observe the immunofluorescence change of Syndecan-1 and Glypican-1.

RESULTS

Compared with normal control group, the thickness of Glycocalyx on the surface of HRGECs in high glucose group decreased to 36.8% (P < 0.05). Immunofluorescence shows the depositions of Syndecan-1 and Glypican-1 were weakened in high glucose group. The mRNA and protein expression of Syndecan-1 and Glypican-1 were significantly decreased (P < 0.05) compared with normal control group and mannitol group.

CONCLUSION

High concentration of glucose can reduce thickness of Glycocalyx on the surface of human glomerular endothelial cell. At the same time, high glucose can decrease the expression of core protein Sydecan-1 and Glypican-1 of HRGECs.

[Effects of ginsenoside Rg1 on streptozocin-induced diabetic nephropathy in rats]

This study sought to assess the effect of Ginsenoside Rg1 on streptozocin-induced diabetic nephropathy in rats and to unveil the underlying mechanism. Diabetic nephropathy (DN) was induced by intraperitoneal injection of streptozocin (STZ). Eight weeks after drug administration, the rats from each group were sacrificed. Serum creatine (Scr) and 24 hours urine protein, cross reaction protein (CRP) and tumor necrosis factor-alpha (TNF-alpha) were measured at the end of the study. The histological changes of renal interstitial tissues were observed by periodic acid-Schiff staining (PAS). Immunohistochemical method was used to examine the expression levels of ectodermal dysplasia (ED-1). The mRNA of transforming growth factor-beta1 (TGF-beta1) was measured by real-time PCR (RT-PCR), and the protein expression of TGF-beta1 was surveyed by Enzyme-Linked Immunosorbent Assay (ELISA). The renal pathological changes in DN rats given ginsenoside Rg1 treatment were ameliorated, and the expression levels of 24 h urine protein, serum creatinine, CRP, TNF-alpha, ED-1 and TGF-beta1 were significantly lower than those in the diabetic nephropathy group (P < 0.05). So, we reach a conclusion that, in the experiment, Ginsenoside Rg1 obviously reduced TGF-beta1 expression and the already-mentioned inflammatory reaction factors in the renal tissues and improved the renal pathological changes in DN rats.

[Clinical efficacy of Corydalis composite combined with methotrexate in treating rheumatoid arthritis]

OBJECTIVE

To observe the clinical efficacy and safety of Corydalis composite (CDC) combined with methotrexate (MTX) in treating rheumatoid arthritis (RA).

METHODS

Seventy-six RA patients were randomly assigned to 2 groups, 37 in the treated group received the combined therapy, and the 39 received MTX treatment alone, all were treated for 12 weeks. Efficacy of treatment was evaluated adopting the standard of American College of Rheumatology (ACR), taking ACR20 as the chief criterion; ACR50, ACR70 as well as the clinical indexes and items in Health Account Questionnaire (HAQ) as the auxiliary criteria, including joint swelling index, joint tenderness index, holding power, morning stiffness time, resting pain, erythrocyte sedimentation rate (ESR), C-reactive protein. And the adverse reaction was recorded at the same time.

RESULTS

After being treated for 4, 8 and 12 weeks, the ACR20 response rate reached 35.14%, 59.46% and 70.27% respectively in patients of the treated group, while that in the control group was 17.95%, 35.90% and 46.15% respectively, significant difference between groups was shown in the outcome of week 8 and 12 (P < 0.05). ACR50 and ACR70 improving rate at all the time points of observation were increased in the treated group, with the ACR50 improving rate at week 12 higher than that in the control group (43.24% vs. 20.51%, P < 0.05). As compared with the control group, the improvements in all the auxiliary criteria were more significant in the treated group (P < 0.05). The incidence of adverse reaction was less in the treated group than in the control group (32.43% vs. 56.41%, P < 0.05), particularly in term of the damage on liver (0 vs. 10.26%, P < 0.05).

CONCLUSION

CDC combined with MTX is more effective than MTX alone in treating active RA with less adverse reaction.

A case report of an effective treatment for diabetic foot ulcers with integration of traditional Chinese medicine and Western medicine

Diabetes contributes 75-85% of the factors predisposing to foot amputations, usually in association with infection and gangrene. The treatment of foot ulcers is expensive, and the effectiveness of treatment varies. We report herein a case of a diabetic foot ulcer that was treated with integrated traditional Chinese and Western medicine, with desirable cost-effective results. Traditional Chinese medicine (TCM) therapeutic principles include improving the spleen, nourishing yin, regulating qi, and resolving dampness, as well as activating stagnant blood. Western medicine includes wound debridement, skin grafting, and use of insulin, antibiotics, and vasodilators. The patient was treated with a holistic multidisciplinary approach (i.e., a combination of TCM and Western medicine, surgical management, education for diabetic foot care, and psychological counseling). Without this approach, the patient might have ended up with foot amputation and/or sepsis.

Astragalus mongholicus ameliorates renal fibrosis by modulating HGF and TGF-beta in rats with unilateral ureteral obstruction

Astragalus mongholicus (AM) derived from the dry root of Astragalus membranaceus Bge. var. mongolicus (Bge.) Hsiao is a widely used traditional Chinese medicine. The present study investigated the potential role of AM on renal fibrosis on a rat model of unilateral ureteral obstruction (UUO). We divided 48 Sprague-Dawley rats randomly into 4 groups: sham-operated group (Sham), untreated UUO group, AM-treated (10 g/(kg x d)) UUO group, and losartan-treated (20 mg/(kg x d)) UUO group as positive control. Haematoxylin & eosin (HE) and Masson staining were used to study the dynamic histological changes of the kidneys 7 and 14 d after operation. The expressions of fibronectin (FN), type I collagen (colI), hepatocyte growth factor (HGF), transforming growth factor-beta1 (TGF-beta1), and alpha-smooth muscle actin (alpha-SMA) were analyzed by real-time polymerase chain reaction (PCR), immunohistochemistry staining, and Western blot. Results show that, similar to losartan, AM alleviated the renal damage and decreased the deposition of FN and colI from UUO by reducing the expressions of TGF-beta1 and alpha-SMA (P<0.05), whereas HGF increased greatly with AM treatment (P<0.05). Our findings reveal that AM could retard the progression of renal fibrosis. The renoprotective effect of AM might be related to inhibition of myofibroblast activation, inducing of HGF and reducing of TGF-beta1 expression.

[Effect of ginsenoside Rgl on the expression of TNF-alpha and MCP-1 in rats with diabetic nephropathy]

OBJECTIVE

To investigate the effects of Ginsenoside Rgl on proteinuria and the expression of monocyte chemotactic protein-1 (MCP-1) and tumor necrosis factor-alpha (TNF-alpha) in rats with diabetic nephropathy (DN).

METHODS

The DN rat model was established by injection of streptozotocin (STZ, 65 mg/kg) in abdominal cavity. Forty Sprague-Dawley male rats were randomly divided into 4 groups: normal group, DN group, Ginsenoside Rgl treatment group and Irbesartan treatment group. The blood glucose was monitored routinely. Twenty-four hours urine protein and serum creatine were measured the day before the rats were killed when the eight weeks of treatments had been completed. The renal pathological and podocyte changes were evaluated. Immunohistochemistry and enzyme-linked immunosorbent assay (ELISA) were performed to examine the protein expression levels of MCP-1 and TNF-alpha, respectively. The mRNA of TNF-alpha and MCP-1 were reverse transcribed and quantified by real-time PCR.

RESULTS

The DN rats had increased volume of renal glomerulus, thickened basement membrane, and increased mesenterium mass, as well as some inflammatory cells in renal glomerulus. The number of potocyte decreased significantly in the DN group compared with the normal group (P<0.01). Compared with the DN group, the basement membrane became thinning and the number of podocyte increased in the two treatment groups (P<0.05). The rats in the DN group and the two treatment groups had significantly higher levels of twenty-four hour urine protein, serum creatine, serum glucose, serum MCP-1 and TNF-alpha than the normal rats (P<0.05). The rats in the treatment groups had lower levels of twenty-four hours urine protein and serum creatine than the rats in the DN group (P<0.05). But the serum glucose had little changes (P>0.05). There was no difference between the two treatment groups. Immunohistochemisty, ELISA and real-time PCR results indicated that the expression levels of MCP-1 and TNF-alpha in the rats in the DN group and the two treatment groups were significantly higher than those in the normal group (P<0.05). The rats in the treatment groups had lower levels of expression of MCP-1 and TNF-alpha than those in the DN group (P<0.05). The correlation analysis indicated that the levels of MCP-1 and TNF-alpha were positively related to twenty-four hours urine protein (r=0.7802, 0.6963), glomerular sclerosis index (r=0.8296, 0.7413) and thickness of podocyte membrane (r=0.7678, 0.6701, P<0.05).

CONCLUSION

Ginsenoside Rgl reduces the expression of MCP-1 and TNF-alpha, repairs the pathological lesions of podocyte and nephron, and reduces the twenty-four hour urine protein rats with diabetic nephropathy.

Ginsenoside Rb1, a panoxadiol saponin against oxidative damage and renal interstitial fibrosis in rats with unilateral ureteral obstruction

OBJECTIVE

To investigate the possible protective effect and mechanism of ginsenoside Rb1 against oxidative damage and renal interstitial fibrosis on rats with unilateral ureteral obstruction (UUO).

METHODS

In total, 80 male rats were randomly divided into 4 groups, 20 in each group: the sham operated group (SOR), UUO group, UUO with ginsenoside Rb1 treatment group (treated with intraperitoneal injection of 50 mg/ kg daily) and UUO with Losartan treatment group (as the positive control, treated with 20 mg/kg by gastrogavage per day). The rats were randomly sacrificed on day 3, 7 and 14 after surgery, respectively. The histopathologic changes of renal interstitial tissues were observed with Masson staining. The mRNA of transforming growth factor beta 1 (TGF-beta 1), collagen I and fibronectin were reversed transcribed and quantified by Real-time PCR. Enzyme-linked immunosorbent assay was used to quantitatively detect TGF-beta 1 and 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels. P47phox protein expression was assessed by immunohistochemistry and Western blot analysis.

RESULTS

In the UUO model, the obstructed kidney showed typical features of progressive renal tubulointerstitial fibrosis, and the levels of TGF-beta1, collagen I and fibronectin increased (P<0.05). As compared with the UUO group, ginsennoside Rb1 significantly inhibited the interstitial fibrosis including tubular injury and collagen deposition, and decreased the levels of TGF-beta1 (P<0.05). Ginsenoside Rb1 also inhibited the heme oxygenase (HO-1) and 8-OHdG, two markers of oxidative stress (P<0.05). Moreover, ginsenoside Rb1 suppressed the expression of p47phox, a subunit of nicotinamide adeninedinucleotide phosphate (NADPH) oxidase (P<0.05).

CONCLUSION

Ginsenoside Rb1 can obviously inhibit renal interstitial fibrosis in rats with UUO, its mechanism possibly via against the oxidative damage and suppressing TGF-beta1 expression.

Influence of ginsenoside Rg1, a panaxatriol saponin from Panax notoginseng, on renal fibrosis in rats with unilateral ureteral obstruction

Total saponins of Panax notoginseng (PNS) have been shown to ameliorate renal interstitial fibrosis. Ginsenoside Rg1, a panaxatriol saponin, is one of the major active molecules from PNS. The present study was undertaken to investigate the effect of ginsenoside Rg1 on renal fibrosis in rats with unilateral ureteral obstruction (UUO). The rats were randomly divided into 3 groups: sham-operation (n=15), UUO (n=15) and UUO with ginsenoside Rg1 treatment (n=15, 50 mg per kg body weight, intraperitoneally (i.p.) injected). The rats were sacrificed on Days 7 and 14 after the surgery. Histological examination demonstrated that ginsenoside Rg1 significantly inhibited interstitial fibrosis including tubular injury as well as collagen deposition. alpha-smooth muscle actin (alpha-SMA) and E-cadherin are two markers of tubular epithelial-myofibroblast transition (TEMT). Interestingly, ginsenoside Rg1 notably decreased alpha-SMA expression and simultaneously enhanced E-cadherin expression. The messenger RNA (mRNA) of transforming growth factor-beta1 (TGF-beta1), a key mediator to regulate TEMT, in the obstructed kidney increased dramatically, but was found to decrease significantly after administration of ginsenoside Rg1. Further study showed that ginsenoside Rg1 considerably decreased the levels of both active TGF-beta1 and phosphorylated Smad2 (pSmad2). Moreover, ginsenoside Rg1 substantially suppressed the expression of thrombospondin-1 (TSP-1), a cytokine which can promote the transcription of TGF-beta1 mRNA and the activation of latent TGF-beta1. These results suggest that ginsenoside Rg1 inhibits renal interstitial fibrosis in rats with UUO. The mechanism might be partly related to the blocking of TEMT via suppressing the expression of TSP-1.

[Effect of Astragalus mongholicus on expression of hepatocyte growth factor in SD rats with unilateral ureteral obstruction]

OBJECTIVE

To study the effect of Astragalus mongholicus (AM) on the expression of hepatocyte growth factor (HGF) in SD rats with unilateral ureteral obstruction (UUO) and to elucidate the mechanisms underlying the renoprotective effects of AM.

METHODS

Fifty four Sprague-Dawley rats were randomly divided into 3 groups: sham-operation group (SOR), UUO group (UUO) and UUO + AM group (AM). After administration of AM[10 g/ (kg x d)] for 3, 7 and 14 days,the histological changes of renal interstitial tissues were observed dynamically, and renal damage including tubular impairment and interstitial fibrosis were quantified on HE and Masson stained tissue sections. The protein expression of HGF and alpha-smooth muscle actin (alpha-SMA) was measured by immunohistochemistry. The mRNA expression of HGF and alpha-SMA were determined by real-time PCR. The expression of HGF and its receptor (C-met) were assessed by Western blot.

RESULTS

Renal damage was exacerbated and the expression of alpha-SMA was significantly increased in UUO group compared with those of SOR group (P < 0.05) at each time point. HGF and C-met expression peaked at the 7th day after UUO and then decreased greatly. After AM intervention, tubular impairment and interstitial fibrosis were alleviated, up-regulations of alpha-SMA expressions was significantly suppressed, whileas the expression of HGF and C-met were significantly increased when compared with UUO group (P < 0. 05) at each time point.

CONCLUSION

AM can ameliorate renal interstitial fibrosis induced by UUO in rats. The mechanisms of its antifibrotic effects may be related with the up-regulation of HGF and C-met expression, and the suppression of tubulo-epithelial mesenchymal transdifferentiation in renal intersitial progress.

[Effect of Astragalus mongholicus on expression of transforming growth factor- beta1 in SD rats with unilateral ureteral occlusion]

OBJECTIVE

To study the effect of Astragalus mongholicus (AM) on the expression of transforming growth factor-beta1 (TGF-beta1) in SD rats with unilateral ureteral occlusion (UUO) and to elucidate the mechanisms underlying the renoprotective effects of AM.

METHOD

Fifty-four Sprague-Dawley rats were randomly divided into 4 groups: sham-operation group, the UUO group and AM treatment group. After administration of AM (10 g kg(-1) d(-1)) for 3, 7 and 14 days, the dynamic histological changes of renal interstitial tissues were observed and renal damage including tubular impairment and interstitial fibrosis were quantified on HE and Masson stained tissue sections. The expression of TGF-beta1 and alpha-smooth muscle actin (alpha-SMA) was measured by immunohistochemistry staining sections. The mRNA of TGF-beta1 and alpha-SMA were reverse transcribed and quantified by real-time PCR. The expression of TGF-beta1 protein were assessed by Western blot.

RESULT

Renal damage was exacerbated and the expression of alpha-SMA and TGF-beta1 were all significantly increased in UUO group compared with those of sham-operation group (P<0.05) at each time point. Tubular impairment and interstitial fibrosis were alleviated, and up-regulations of expressions of TGF-beta1 and alpha-SMA were significantly suppressed by AM treatment (P<0.05).

CONCLUSION

AM can ameliorate renal interstitial fibrosis induced by UUO in vivo. The mechanisms of its antifibrotic effects might be related with the down-regulation of TGF-beta1 expression and suppression of tubular epithelial myofibroblast transdifferentiation in the progress of renal interstitial fibrosis.

[Regulative effect of Astragalus mongholicus on hepatocyte growth factor and transforming growth factor-beta1 in rats with unilateral ureteral obstruction]

OBJECTIVE

To study the effect of Astragalus mongholicus (AM) on renal interstitial fibrosis caused by unilateral ureteral obstruction (UUO) in rats in order to elucidate the mechanisms underlying the renoprotective effects of AM.

METHODS

54 Sprague-Dawley rats were randomly divided into 3 groups: sham-operation group (Sham), the UUO group(UUO) and UUO + AM group (AM). The rats were treated at the doses of 10 g/(kg X d) AM for 3, 7 and 14 days, the dynamic histological changes of renal interstitial tissues were observed and renal damage including tubular impairment and interstitial fibrosis were quantified on HE and Masson stained tissue sections. The expressions of transforming growth factor-beta1 (TGF-beta1) and hepatocyte growth factor (HGF) were measured by immunohistochemistry staining sections. The mRNA of HGF and TGF-beta1 were reverse transcribed and quantified by real-time PCR. The expressions of HGF and TGF-beta1 protein were assessed by Western blot.

RESULTS

Renal damages were exacerbated and the expressions of TGF-beta1 were significantly increased in UUO group in comparison with those of Sham group (P < 0.05) at each time point. HGF expression increased initially and peaked at the day of 7 after UUO and then decreased greatly. The tubular impairment and interstitial fibrosis were alleviated, up-regulations of expressions of TGF-beta1 were significantly suppressed, while expressions of HGF were significantly increased in UUO + AM group in comparison with UUO group (P < 0.05).

CONCLUSION

AM could ameliorate renal interstitial fibrosis induced by UUO in rats. The mechanisms of antifibrotic effects of AM may be associated with up-regulation of HGF expression and down-regulation of TGF-beta1 expression in renal intersitial progress.

[Effect of Astragalus mongholicus on expression of connective tissue growth factor in kidney of SD rats with unilateral ureteral obstruction]

OBJECTIVE

To study the effect of Astrangalus mongholicus (AM) on the expression of Connective Tissue Growth Factor (CTGF) in SD rats with Unilateral Ureteral Obstruction (UUO) and elucidate the mechanism underlying the renorotective effects of AM.

METHODS

36 Sprague-Dawley rats were randomly divided into 3 groups: sham-operation group (Sham), UUO group (UUO) and UUO + AM group (AM). After administration of AM (10 g/kg x d) for 7 and 14 days, the dynamic histological changes of renal interstitial tissues were observed and renal damage including tubular impairment and interstitial fibrosis were quantified on HE and Masson stained tissue sections. The expressions of CTGF and alpha-smooth muscle actin (alpha-SMA) were measured by immunohistochemistry staining sections. The mRNA of CTGF and alpha-SMA were reversely transcribed and quantified to real-time PCR. The expression of CTGF protein was assessed by Western blot.

RESULTS

Renal damage was exacerbated and the expressions of alpha-SMA and CTGF significantly increased in UUO group compared with those of Sham group (P < 0.05) at each time point. Tubular impairment and interstitial fibrosis were alleviated, and up-regulations of expressions of CTGF and alpha-SMA were significantly depressed by AM treatment (P < 0.05).

CONCLUSIONS

AM can ameliorate renal interstitial fibrosis induced by UUO in rats. The mechanism of its antifibrotic effects may be related to the down-regulation of CTGF expression, following suppression of tubulo-epithelial mesenchymal transdifferentation in renal intersitial progress.

[The effect of ginsenoside Rg1 on the renal interstitial fibrosis of UUO rat]

OBJECTIVE

To study the effect of ginsenoside Rg1 on the renal interstitial fibrosis caused by unilateral ureteral obstruction (UUO) of rats.

METHODS

80 healthy Sprague-Dawley rats were randomly divided into 4 groups: the UUO group (UUO), sham-operation group (SOR), ginsenoside Rg1 group (Rg1) and losartan group (ARB). From the first day after initial UUO, ARB group was intragastrically administrated with losartan 20 mg/(kg x d). UUO, Rg1 and SOR groups were intragastrically administrated with identical volume of normal saline. Rg1 group was intraperitoneally injected with ginsenoside Rg1 50 mg/(kg x d). UUO, ARB and SOR groups were intraperitoneally injected with identical volume of normal saline. At day 3, 7, 14 after UUO, 6 rats selected randomly from each group were killed. The dynamic histological changes of renal interstitial tissues were observed by HE, Masson and PAS staining. The mRNA of transforming growth factor-beta1 (TGF-beta1) was quantified by real-time PCR. The protein levels of TGF-beta1 expression were assessed by Western blot and immunohistochemical method respectively.

RESULTS

In UUO kidneys, the interstitial fibrosis including tubular atrophy, loss and dilation, inflammatory cell infiltration and interstitial matrix deposition was prominent. However, these morphological changes were notably reduced in Rg1 and ARB groups, and there was no significant difference between the two groups (P > 0.05). TGF-beta1 mRNA and protein expression were increased dramatically for UUO group at postoperative day 7 and 14 (P < 0.05). TGF-beta1 expression in Rg1 and ARB groups were significantly lower than that in UUO group (P < 0.05).

CONCLUSION

Ginsenoside Rg1 can evidently inhibit UUO-induced renal interstitial fibrosis in rat, which may be related to the down regulation of TGF-beta1 expression.