Adjunctive Electroconvulsive Therapy for Schizophrenia: A Meta-analysis of Randomized Rater-Masked Controlled Trials [RETRACTED].

OBJECTIVE: The aim of the study was to examine published randomized controlled trials (RCTs) for the efficacy and safety of adjunctive electroconvulsive therapy (ECT) when combined with antipsychotics (APs) versus AP therapy for schizophrenia and related disorders during the acute phase. METHODS: Two evaluators independently selected studies, extracted data, and conducted quality assessment and data synthesis. Standardized and weighted mean differences (SMD/WMD), risk ratio (RR) ±95% confidence intervals (CIs), number needed to treat (NNT), and number needed to harm (NNH) were calculated. RESULTS: Twenty-two RCTs (n = 1365, age = 36.9 years, male = 53%), including double-blind (8 RCTs) and rater-masked (14 RCTs) designs, were identified and analyzed. Adjunctive ECT was superior to AP therapy regarding (1) symptomatic improvement at last-observation endpoint (standardized mean difference, -0.67; P < 0.00001; I = 79%); (2) study-defined response (RR = 1.81, I = 0%, P < 0.00001, NNT = 4) and remission (RR = 2.05, I = 0%, P = 0.0004, NNT = 13); and (3) positive, negative, and general psychopathology subscores (weighted mean difference, -4.01 to -1.79; P = 0.005-0.0001). Results were similar in all preplanned subgroup analyses including Chinese (11 RCTs) versus non-Chinese (7 RCTs) origin, those with a Jadad score 3 or higher (12 RCTs) versus lower than 3 (6 RCTs), and those with clozapine (5 RCTs) versus those with non-clozapine treatments (13 RCTs). Compared with AP therapy, adjunctive ECT AP was significantly associated with more headache (RR = 2.72, P = 0.04, NNH = 5) and memory impairment (RR = 14.24, P = 0.01, NNH = 7). CONCLUSIONS: Adjunctive ECT seems to be an effective and safe option for schizophrenia and related disorders during acute phases but was associated with transient memory impairment and headaches.

Electroconvulsive Therapy Alone for Schizophrenia: A Meta-analysis of Randomized, Single-blind, Controlled Trials [RETRACTED].

PURPOSE: Electroconvulsive therapy (ECT) is a common treatment in practice for schizophrenia in most developing countries. This is a meta-analysis of the efficacy and safety of ECT alone versus antipsychotic (AP) monotherapy for schizophrenia using randomized, single-blind, controlled trial (RCT) data. METHODS: Two assessors independently extracted data. Standardized and weighted mean difference (SMD/WMD), odds ratios (ORs) ± 95% confidence intervals (CIs), and number needed to harm (NNH) were calculated by Review Manager Version 5.3 and the Comprehensive Meta-Analysis Version 2 software. RESULTS: Five RCTs (n = 365; age, 34.1 ± 4.7 years; percentage of male, 52.8 ± 9.5; range on the Jaded scale, 2-3) were identified and analyzed. Electroconvulsive therapy alone was superior to AP monotherapy with chlorpromazine, haloperidol, paliperidone, clozapine, and risperidone, respectively, regarding symptomatic improvement at last-observation end point (SMD, -0.84; P = 0.02; I = 89%). Improvement with ECT separated from AP as early as weeks 1 to 2 (SMD, -1.26; P = 0.01; I = 89%). Meta-analysis of the end point memory quotient of the Wechsler Memory Scale-Revised, Chinese version, revealed that the ECT alone group had poorer memory performance than the AP group (WMD, -9.34; P < 0.00001; I = 0%), but the difference lost its significance within 2 weeks after ECT (WMD, 0.09 to -6.54; P = 0.11-0.97; I = 0%). Compared with AP monotherapy, ECT was associated with more memory impairment (OR, 14.11; P = 0.004; NNH, 6) but with less akathisia (OR, 0.06; P = 0.0009; NNH, 6), tremor (OR, 0.08; P = 0.02; NNH, 7), and tachycardia (OR, 0.06; P = 0.006; NNH, 5). There were no significant differences in other adverse events and all-cause discontinuation. CONCLUSIONS: Electroconvulsive therapy alone could be an effective and safe treatment option for schizophrenia, with transient memory impairment and headache being the major side effects.

The effect of chronic lymphocytic thyroiditis on patients with thyroid cancer.

BACKGROUND: The purpose of this study was to investigate the association between chronic lymphocytic thyroiditis (CLT) and malignant tumors of the thyroid. METHODS: A retrospective review of 647 patients who underwent thyroid surgery at the Department of Breast and Thyroid Surgery in Anhui Provincial Hospital, China in 2012 was performed. The clinicopathological characteristics of patients with thyroid malignancies and CLT were collected. CLT was diagnosed by histopathological method. RESULTS: Among 647 patients, 144 patients had thyroid malignancies and 108 patients had been diagnosed with CLT. Moreover, in total, 44 patients had thyroid malignancies coexistent with CLT: forty-one (93.2%) patients had been diagnosed with the papillary thyroid cancer (PTC); two (4.5%) patients suffered from medullary carcinoma; and one (2.3%) patient suffered from lymphoma. The morbidity of thyroid malignancies in patients with CLT was significantly higher than that in patients without CLT (40.7% versus 18.6%; P <0.001). A female preponderance was observed in the patients with CLT compared with those without CLT (P <0.001). There was no statistically significant difference in the tumor size (P = 0.073), multifocality (P = 0.0871), neck lymph node metastasis (P = 0.350), age (P = 0.316), microcarcinoma (P = 0.983) and tumor-node-metastasis (TNM) stage (P = 0.949) between the patients of thyroid malignancies with CLT and without CLT. CONCLUSIONS: Female predominance was observed in patients with CLT. CLT may have no effect on the progression of thyroid malignant tumor. Nevertheless, the influences of CLT on the prognosis of the thyroid carcinoma still need to be investigated with a larger sample size.

Efficacy and safety of percutaneous transhepatic biliary radiofrequency ablation in patients with malignant obstructive jaundice.

BACKGROUND: Percutaneous transhepatic cholangiodrainage (PTCD) and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice, yet the safety and effect of endobiliary radiofrequency ablation (EB-RFA) combined PTCD is rarely reported, in this article, we report our experience of EB-RFA combined PTCD in such patients. AIM: To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice. METHODS: Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected, the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases. The general conditions of all patients, preoperative tumour markers, total bilirubin (TBIL), direct bilirubin (DBIL), albumin (ALB), alkaline phosphatase (ALP), and glutamyl transferase (GGT) before and on the 7th day after the procedure, as well as perioperative complications, stent patency time and patient survival were recorded. RESULTS: All patients successfully completed the operation, TBIL and DBIL decreased significantly in all patients at the 7th postoperative day (P = 0.009 and 0.006, respectively); the values of ALB, ALP and GGT also decreased compared with the preoperative period, but the difference was not statistically significant. Perioperative biliary bleeding occurred in 2 patients, which was improved after transfusion of blood and other conservative treatments, pancreatitis appeared in 1 patient after the operation, no serious complication and death happened after operation. Except for 3 patients with loss of visits, the stent patency rate of the remaining 14 patients was 100% 71% and 29% at the 1st, 3rd, and 6th postoperative months respectively, with a median survival of 4 months. CONCLUSION: EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety, which is worthy of further clinical practice.

[Effect of moxibustion on skin lesions and immune inflammatory response in psoriasis mice].

OBJECTIVE: To observe the effect of moxibustion on skin lesions and immune inflammatory response in psoriasis mice, and to explore the possible mechanism of moxibustion for psoriasis. METHODS: A total of 32 male BALB/c mice were randomly divided into a normal group, a model group, a moxibustion group and a medication group, 8 mice in each group. Psoriasis model was induced by applying 5% imiquimod cream on the back for 7 days in the model group, the moxibustion group and the medication group. At the same time of model establishment, the moxibustion group was treated with suspension moxibustion on skin lesions on the back, 20 min each time, once a day; the medication group was treated with 1 mg/kg methotrexate tablet solution by gavage, once a day. Both groups were intervened for 7 days. The daily changes of skin lesions were observed, and the psoriasis area and severity index (PASI) score was evaluated; the histopathological changes of skin lesions were observed by HE staining; the positive expression of proliferating cell nuclear antigen (PCNA) and T lymphocyte surface marker CD3 were detected by immunohistochemistry; the expression level of serum interleukin (IL) -17A was detected by ELISA, and the relative expressions of tumor necrosis factor-α (TNF-α), IL-1ß and IL-6 mRNA in skin lesions were detected by real-time PCR. RESULTS: The increased and hypertrophy scale, dry skin, red and swollen epidermis and obvious infiltration were observed in the model group, and each score and total score of PASI were higher than those in the normal group (P<0.01). The scale score, infiltration score, and total score of PASI in the moxibustion group were lower than those in the model group (P<0.01); the infiltration score and total score of PASI in the medication group were lower than those in the model group (P<0.01, P<0.05). The inflammatory cell infiltration in the model group was obvious, and the thickness of epidermal layer was increased compared with that in the normal group (P<0.01); the inflammatory cell infiltration and Munro micro abscess were decreased in the moxibustion group and the medication group, and the thickness of epidermal layer was decreased compared with that in the model group (P<0.01). Compared with the normal group, the positive cell number of PCNA and T was increased (P<0.01), and the body mass was decreased, and the spleen index was increased (P<0.01), and the expression of serum IL-17A and the relative expression of TNF-α, IL-1ß and IL-6 mRNA in the skin lesions was increased in the model group (P<0.01). Compared with the model group, the positive cell number of PCNA and T was reduced (P<0.01), and the spleen index and the relative expression of TNF-α, IL-1ß and IL-6 mRNA were reduced (P<0.01) in the moxibustion group and the medication group; the body mass of mice in the moxibustion group was higher than that in the model group (P<0.01); the content of serum IL-17A in the medication group was lower than that in the model group (P<0.01); the relative expression of TNF-α, IL-1ß mRNA in the moxibustion group was higher than that in the medication group (P<0.01). CONCLUSION: Moxibustion could effectively improve the scale and infiltration of skin lesions in psoriasis mice. Its mechanism may be related to inhibiting inflammatory response and regulating immunity.

Risk factors for post-hepatectomy liver failure in 80 patients.

BACKGROUND: Post-hepatectomy liver failure (PHLF) is a serious complication and a leading cause of death after hepatectomy, an accurate prediction of PHLF is important for improvement of prognosis after hepatectomy. AIM: To retrospectively analyze the risk factors for postoperative liver failure in patients undergoing hepatectomy for liver tumors. METHODS: The clinical data of 80 patients undergoing hepatectomy in our hospital from June 2018 to January 2020 were collected. With laboratory examination as well as pre- and post-operative abdominal three-dimensional reconstructive computed tomography, the demographic data, surgical data, biochemical indicators, coagulation index, routine blood tests, spleen and liver volumes, relative remnant liver volume, and other related indicators were obtained and compared between patients with PHLF and those without PHLF. RESULTS: PHLF occurred in 19 (23.75%) patients. Univariate logistic regression analysis showed that gender, history of hepatitis/cirrhosis, and preoperative bilirubin, albumin, coagulation function, albumin-bilirubin ratio, aspartate amino-transferase-to-platelet ratio index (APRI), Model for End-Stage Liver Disease score, spleen volume (SV), spleen volume/liver volume ratio (SV/LV), and relative remnant liver volume were statistically associated with the occurrence of PHLF (all P < 0.05). Multivariate regression analysis showed that preoperative total bilirubin, platelets (PLT), APRI, and SV/LV were independent risk factors for PHLF (all P < 0.05). The area under the curve and cut-off values were 0.787 and 18.6 mmol/L for total bilirubin, 0.893 and 146 × 1012/L for PLT, 0.907 and 0.416 for APRI, and 0.752 and 20.84% for SV/LV, respectively. CONCLUSION: For patients undergoing liver resection, preoperative total bilirubin, PLT, APRI, and SV/LV are independent risk factors for PHLF. These findings may provide guidance to safely perform liver surgery in such patients.

Efficacy and safety of benazepril for advanced chronic renal insufficiency.

BACKGROUND: Angiotensin-converting-enzyme inhibitors provide renal protection in patients with mild-to-moderate renal insufficiency (serum creatinine level, 3.0 mg per deciliter or less). We assessed the efficacy and safety of benazepril in patients without diabetes who had advanced renal insufficiency. METHODS: We enrolled 422 patients in a randomized, double-blind study. After an eight-week run-in period, 104 patients with serum creatinine levels of 1.5 to 3.0 mg per deciliter (group 1) received 20 mg of benazepril per day, whereas 224 patients with serum creatinine levels of 3.1 to 5.0 mg per deciliter (group 2) were randomly assigned to receive 20 mg of benazepril per day (112 patients) or placebo (112 patients) and then followed for a mean of 3.4 years. All patients received conventional antihypertensive therapy. The primary outcome was the composite of a doubling of the serum creatinine level, end-stage renal disease, or death. Secondary end points included changes in the level of proteinuria and the rate of progression of renal disease. RESULTS: Of 102 patients in group 1, 22 (22 percent) reached the primary end point, as compared with 44 of 108 patients given benazepril in group 2 (41 percent) and 65 of 107 patients given placebo in group 2 (60 percent). As compared with placebo, benazepril was associated with a 43 percent reduction in the risk of the primary end point in group 2 (P=0.005). This benefit did not appear to be attributable to blood-pressure control. Benazepril therapy was associated with a 52 percent reduction in the level of proteinuria and a reduction of 23 percent in the rate of decline in renal function. The overall incidence of major adverse events in the benazepril and placebo subgroups of group 2 was similar. CONCLUSIONS: Benazepril conferred substantial renal benefits in patients without diabetes who had advanced renal insufficiency. (ClinicalTrials.gov number, NCT00270426.)

[Analysis of Factors Influencing Prognosis of 87 Adults with Ph Chromosome Negative ALL].

OBJECTIVE: To explore the factors influencing total complete remission (CR), recurrence, disease-free survival (DFS) rate and overall survival (OS) rate in adults with Philadelphia (Ph) chromosome negative acute lymphoblastic leukemia (ALL) and the effect of subsequent allogeneic hematopoietic stem cell transplantation (allo-HSCT) on prognosis. METHODS: The clinical data of 87 adult patients with Ph negative ALL were retrospectively analyzed, the CHOP regimen plus L-asparaginase (L-Asp) was used for the induction therapy, and the CHOP+ modified Hyper-CVAD or methotrexate was set up as the consolidation chemotherapy regimen. After consolidation chemotherapy for 3-6 courses, 45 patients (51.72%) received allo-HSCT , and 42 patients (48.28%) continually received the maintained consolidation chemotherapy. The average follow up time of the surviving patients was 40.13 (3-60 months). RESULTS: Out of 87 patients with Ph-ALL one patient died (1.15%). In 86 patients who could be evaluated, 68 cases (79.67%) reached CR at the end of 1 course, 80 cases obtained CR (93.02%). Multivariate regression analysis showed that the enlargement of lever, spleen and lymphomode, WBC count≥ 100×109/L were affecting factors for total CR (P<0.05). Among 80 cases with CR, 27 cases (33.75%) relapsed, 5 years' overall survival (OS) rate and disease-free survival (DFS) rate were 47.50% and 45.00% respectively. Multivariate regression analysis yet showed that the induction chemotherapy without L-Asp, presence of CNS leukemia at diagnosis, absence of allo-HSCT and no CR after indution chemotherapy for 4 weeks were affecting factors for relapse and poor prognosis of patients (P<0.05). According to 4 prognostic factors such as presence of CNS leukemia or no, WBC count≥100×109/L or no, induction chemotherapy with L-Asp or no and CR after induction chemotherapy for 4 weeks or no, 86 patients were divided into low-risk group (without poor prognostic factor), middle-risk group (with 1 poor prognostic factor), high-risk group (with 2-4 poor prognostic factors). Statistical results showed that allo-HSCT treatment in low-risk group had no significant effect on OS and DFS (P>0.05). The rate of OS and DFS in middle and high-risk group were significantly higher than those of patients without allo-HSCT treatment (P<0.05). CONCLUSION: Patients with central nervous system leukemia, high white blood cell count (≥100×109/L), induction chemotherapy without L-Asp, no CR after 4 weeks of chemotherapy and absence of allo-HSCT treatment are the factors influencing the prognosis of adult patients with Ph negative ALL, so the patients with those poor prognostic factors should take active treatment of allo-HSCT.

Memory Impairment Following Electroconvulsive Therapy in Chinese Patients with Schizophrenia: Meta-Analysis of Randomized Controlled Trials.

PURPOSE: To evaluate memory impairment associated with electroconvulsive therapy (ECT)-antipsychotic (AP) combination in comparison to AP monotherapy in schizophrenia. DESIGN AND METHODS: A systematic literature search of randomized controlled trial (RCTs) was performed. FINDINGS: Eleven RCTs that compared ECT-AP combination (n = 508) with AP monotherapy (n = 510) were analyzed. ECT-AP combination was associated with greater impairment than AP monotherapy in (1) endpoint memory quotient (MQ) of the Wechsler Memory Scale (WMS)-Revised at the end of the ECT course; and (2) picture recall, counting, recognition, and associative learning of the WMS. However, no group difference was found in MQ at 1 and 2 weeks post-ECT. PRACTICE IMPLICATIONS: The ECT-AP combination was associated with greater transient memory impairment compared to AP monotherapy.

[Renal artery embolization with exploratory laparotomy for management of massive colonic hemorrhage after renal biopsy: a case report].

We report a case of massive colonic hemorrhage after renal biopsy managed by renal artery embolization combined with exploratory laparotomy. Clinicians must be alert for such rare anatomical abnormalities as ectopic colon behind the kidney and the risk of colonic hemorrhage following renal biopsy. In this case, artery embolization combined with exploratory laparotomy successfully and quickly stopped the bleeding and avoided possible organ resection.

Electroconvulsive Therapy Added to Non-Clozapine Antipsychotic Medication for Treatment Resistant Schizophrenia: Meta-Analysis of Randomized Controlled Trials.

This meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of the combination of electroconvulsive therapy (ECT) and antipsychotic medication (except for clozapine) versus the same antipsychotic monotherapy for treatment-resistant schizophrenia (TRS). Two independent investigators extracted data for a random effects meta-analysis and pre-specified subgroup and meta-regression analyses. Weighted and standard mean difference (WMD/SMD), risk ratio (RR) ±95% confidence intervals (CIs), number needed to treat (NNT), and number needed to harm (NNH) were calculated. Eleven studies (n = 818, duration = 10.2±5.5 weeks) were identified for meta-analysis. Adjunctive ECT was superior to antipsychotic monotherapy regarding (1) symptomatic improvement at last-observation endpoint with an SMD of -0.67 (p<0.00001; I2 = 62%), separating the two groups as early as weeks 1­2 with an SMD of -0.58 (p<0.00001; I2 = 0%); (2) study-defined response (RR = 1.48, p<0.0001) with an NNT of 6 (CI = 4­9) and remission rate (RR = 2.18, p = 0.0002) with an NNT of 8 (CI = 6­16); (3) PANSS positive and general symptom sub-scores at endpoint with a WMD between -3.48 to -1.32 (P = 0.01 to 0.009). Subgroup analyses were conducted comparing double blind/rater-masked vs. open RCTs, those with and without randomization details, and high quality (Jadad≥adadup analyses were Jadad<3) studies. The ECT-antipsychotic combination caused more headache (p = 0.02) with an NNH of 6 (CI = 4­11) and memory impairment (p = 0.001) with an NNH of 3 (CI = 2­5). The use of ECT to augment antipsychotic treatment (clozapine excepted) can be an effective treatment option for TRS, with increased frequency of self-reported memory impairment and headache. Trial Registration: CRD42014006689 (PROSPERO).

[Increased levels of advanced oxidation protein products are associated with atherosclerosis in chronic kidney disease].

OBJECTIVE: Accumulation of advanced oxidation protein products (AOPP) has been found in patients with chronic kidney disease (CKD). The study was performed to investigate the association between serum levels of AOPP and atherosclerosis in CKD. METHODS: 109 CKD patients were involved in this cross-sectional cohort study. Carotid artery intima-medial thickness (IMT), cross-sectional calculated intima-media area (cIM area) and plaques were determined with non-invasive high-resolution B-mode ultrasonography. Serum levels of AOPP, malonyldialdehyde (MDA), glutathione peroxidase (GSHPx) and C-reactive protein (CRP) were also determined. RESULTS: Higher serum AOPP levels were found in patients with CKD [(64.72 +/- 19.69) micromol/L] as compared with those in healthy controls [(30.16 +/- 6.46) micromol/L, P < 0.01]. AOPP levels in dialysis patients [(70.02 +/- 16.51) micromol/L] were significantly higher than those in pre-dialysis patients [(51.71 +/- 15.53) micromol/L, P < 0.01]. AOPP levels increased with the progression of renal dysfunction and inversely correlated with creatinine clearance (Ccr) (r = -0.292, P < 0.05). Patients with carotid artery plaques showed significantly higher levels of AOPP [(73.87 +/- 19.40) micromol/L] as compared with patients without carotid artery plaques [(58.41 +/- 16.09) micromol/L, P < 0.01]. Serum levels of AOPP were strongly associated with carotid artery IMT (r = 0.332, P < 0.01) and cIM area (r = 0.288, P < 0.05). By stepwise multiple regression analysis and adjusting for age, gender, blood pressure, smoking, diabetes, body mass index (BMI), hemoglobin, lipid and albumin, strong association was still present between AOPP levels and carotid artery IMT (beta = 0.313, P < 0.001) and cIMarea (beta = 0.301, P < 0.01). Serum levels of AOPP were correlated positively with serum MDA (r = 0.300, P = 0.01) and CRP levels (r = 0.255, P < 0.05), while negatively with serum GSHPx (r = -0.647, P < 0.01). CONCLUSIONS: Serum levels of AOPP increased with the progression of renal failure and closely associated with occurrence of atherosclerosis. Strong association between serum AOPP and CRP suggests that AOPP might be involved in the pathogenesis of micro-inflammation which has been considered as a contributing factor for atherosclerosis in CKD.

[Effects of peritoneal dialysis solution on apoptosis and intracellular free calcium, cell surface ICAM-1 expression of rat peritoneal mesothelial cells].

OBJECTIVE: To investigate the effects of peritoneal dialysis solution (PDS) on apoptosis and intracellular free calcium([Ca(2+)]i), cell surface ICAM-1 expression of rat peritoneal mesothelial cells (RPMCs). METHODS: The RPMCs apoptosis rate were determined by flow cytometry. [Ca(2+)]i in the cells were monitered the fluorescence at 528 nm by confocus laser microscopy. Cell surface ICAM-1 expression were detected by flow cytometry. RESULT: After PDS treatment for 1 h, the RPMCs apoptosis rate were increased. Such increase was more manifest with higher glucose concentration in PDS and longer treatment time of the cells. At the same times, after 3 hours, ICAM-1 expressions of the PDS containing glucose and mannitol are all increased. With the increase of glucose concentrations, the descend of [Ca(2+)]i levels were aggravated. CONCLUSION: PDS containing high- concentration glucose can induce significant apoptosis of RPMCs in vitro. This may be related with the enhanced level of ICAM-1 expressions and the decreased level of [Ca(2+)]i. Which may due to the occurrence of peritoneal fibrosis and ultrafiltrate failure in patients suffering long term peritoneal dialysis.

[Comparison of two rat models of IgA nephropathy].

OBJECTIVE: To study the methods for rapid establishment of rat models of IgA nephropathy. METHODS: Forty female SD rats weighing 160-200 g were randomized into 3 groups. In group A, the rats received intravenous injection of staphylococcal enterotoxin B (SEB) and oral bovine serum albumin (BSA), and in group B, CCl4 was injected subcutaneously in addition to the above treatments; the rats in group C received no treatments to serve as the normal control group. The rats were sacrificed 10 and 14 weeks after the treatment for biochemical testing of the arterial blood and histopathological and IgA immunofluorescence examination of the renal tissues. The twenty-four-hour urine was collected at 10, 12, and 14 weeks after the treatments for detecting the urine proteins. RESULTS: Compared with the control group, the rats in groups A and B showed significantly increased serum creatinine, urine nitrogen and protein levels. Pathological examination of the renal tissue showed mild to moderate mesangial expansion and mesangial cell proliferation in groups A and B, without obvious difference between the two groups; but hematuria and proteinuria occurred earlier in group B with stronger IgA immunofluorescence than in group A. CONCLUSION: Both of the methods used in group A and group B can successfully induce IgA nephropathy in rats, but in group B, hematuria and urineprotein occurs earlier and IgA immunofluorescence is more stronger. Therefore intravenous SEB injection combined with oral BSA and subcutaneous CCl4 administration is a better method for time-efficient establishment of rat models of IgA nephropathy.

[Foxp3-transfected CD4+ CD25- T cells suppress function of dendritic cells].

To explore the relationship between expression of Foxp3 gene and immune activity of CD4(+) T cells, the Foxp3 gene was transfected with retroviral vector and applied to forcedly express Foxp3 protein in naive CD4(+)CD25(-) T cells, and then the effect of transfected CD4(+)CD25(-) T cells on immune co-stimulatory molecules and immune function of dendritic cells (DCs) was investigated, and the dependence of direct contact between Foxp3-transfected CD4(+)CD25(-) T cells and DCs was clarified by Transwell test. The results showed that through transfection of retroviral vector, CD4(+)CD25(-) T cells model expressing Foxp3 was established. At 1 week after transfection, proportion of T cells expressing Foxp3 was 38%. CD4(+)CD25(-) T cells forcedly expressing Foxp3 could play immune suppression role in vitro and induce down-regulation of CD80 and CD86 expression on the membrane of DCs. The lymphocyte proliferation test in vitro indicated that Foxp3 transfected CD4(+)CD25(-) T cells could inhibit effect of DCs on activation of allo-lymphocytes. It is concluded that the effect of Foxp3-transfected CD4(+)CD25(-) T cells on DC depends on intercellular direct contact.

[Effects of leflunomide combined with hormone therapy for refractory IgA nephropathy].

OBJECTIVE: To investigate the effects and safety of leflunomide combined with hormone therapy for refractory IgA nephropathy. METHODS: Thirteen patients with refractory IgA nephropathy were treated with leflunomide and hormone therapy, and the clinical data were collected and evaluated before and in weeks 2, 4, 8, 12, 16, 20 and 24 during the treatment. RESULTS: Leflunomide therapy significantly improved proteinuria (Plt;0.001) and increased serum albumin in these patients (Plt;0.001) but caused no significant changes in serum creatinine (Pgt;0.05). Only mild tolerable adverse effects were observed. CONCLUSION: Leflunomide combined with hormone therapy can be one of the safety and effective choices for treatment of refractory IgA nephropathy.

[Induction of tolerogenic dendritic cells by membrane-bound HLA-G in vitro].

In order to study how to induce tolerogenic dendritic cells in vitro and its mechanism, the K562 cells transduced with HLA-G construct were used to co-culture with DC. Then their related immunological changes, such as membrane molecules CD80, CD86, ILT3 and ILT4 expression levels were detected by flow cytometry. Allogeneic proliferation of peripheral blood mononuclear cells (PBMNC) was detected by mixed lymphocyte reaction. The results showed that CD80 and CD86 expressions on DC were downregulated, while ILT3 and ILT4 expressions were upregulated after co-culturing with K562-HLA-G cells. The DCs were less able to stimulate the allogenic PBMNC. It is concluded that the membrane-bound HLA-G can upregulate expression of inhibitory receptors ILT3 and ILT4, inducing tolerogenic DC in vitro, which may provide a novel strategy for transplant tolerance induction.

[Study of paired immunoglobin-like receptor B expression on dendritic cells and its relationship with immune tolerance in mouse].

OBJECTIVE: To investigate the expression of paired immunoglobin-like receptor B (PIR-B) on dendritic cells (DCs) and its relationship with tolerogenic DCs (T-DCs) in mouse. METHODS: DC2.4 cells, an immature dendritic cell line derived from C57BL/6 mouse, were stimulated by lipopolysaccharide (LPS) for 48 h to induce the mature dendritic cells (mDC) and cultured respectively with the recombined mouse interleukin-10 (rmIL-10) or recombined human transforming growth factor beta1 (rhTGF-beta1) to develop the tolerogenic dendritic cells (T-DC). Special small interference RNA (siRNA) molecular of PIR-B was chemically synthesized and transfected into DC2.4 cells (si-DC) by lip2000. The expression of PIR-B on DC2.4 cells was measured by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) and Western blot. The allogeneic lymphocyte proliferative capacity of DCs was measured by mixed lymphocyte reaction (MLR) using 3H-thymidine incorporation test. The concentration of IFN-gamma in supernatants of MLR was analyzed by ELISA. RESULTS: Semi-quantitative RT-PCR and Western blot showed that PIR-B mRNA and protein were expressed on DC2.4 cells. RmIL-10 and rhTGF-beta1 induced the higher PIR-B mRNA and protein level on T-DCs (Relative values were 0.51 +/- 0.08 and 0.58 +/- 0.23; 0.85 +/- 0.07 and 0.87 +/- 0.14; 0.79 +/- 0.10 and 0.85 +/- 0.34, respectively) (P < 0.05). LPS down-regulated the PIR-B expression on mDC (0.35 +/- 0.10 and 0.32 +/- 0.04) (P < 0.05). The PIR-B mRNA and protein expression were inhibited by siRNA transfection (decreased by 78.9% and 74.2% respectively after 48 h interference) (P < 0.05). DC2.4 cells stimulated the proliferation of BALB/c mouse allo-genetic spleen cell. The mDC enhanced alloreactivity in MLR and the IFN-gamma secretion in supernatants. The T-DCs alleviated the allo-genetic spleen cell proliferation (P < 0.05) and IFN-gamma secretion in MLR (P < 0.05). Silence of the PIR-B expression (si-DC) also promoted of alloreactivity and enhanced the IFN-gamma secretion in MLR (P < 0.05). CONCLUSION: High expression of immune inhibition receptor PIR-B is one of the general features and molecular mechanism of dendritic cells to acquire immune tolerance in mouse.

[Expression of SDF-1alpha and its receptor CXCR4 in acute leukemias and their relationship with extramedullary infiltration].

The study was aimed to explore the expression of stromal cell derived factor-1alpha (SDF-1alpha) and its receptor CXCR4, and their relationship with the extramedullary infiltration in acute lymphoblastic, grannulocytic and monocytic leukemia. 66 cases of acute leukemia included 31 cases of acute lymphoblatic leukemia (ALL), 20 cases of acute grannulocytic leukemia (M(2)) and 15 cases of acute monocytic leukemia (M(4)+M(5)). There were 41 cases with extramedullary infiltration and 25 cases without-extramedullary infiltration. Enzyme-linked immunoabsorbent assay (ELISA) and flow cytometry were used to determine expression of SDF-1alpha and CXCR4 respectively on leukemia cells in peripheral blood and bone marrow of different groups. The results showed that average plasma level of SDF-1alpha in the ALL, M(4)+M(5), M(2) patients and the normal control were 1317.87 +/- 220.76, 1339.79 +/- 187.06, 1063.70 +/- 190.74, 1908.34 +/- 135.55 (pg/ml) respectively. The average levels in the ALL, M(4)+M(5) and M(2) patients groups were lower than those in normal control group. Both levels in ALL and M(4)+M(5) patient groups were higher than that in M(2) patient group. The average levels of SDF-1alpha in patient group with extramedullary infiltration and patient groups without-extramedullary infiltration were 1252.49 +/- 263.12, 1234.91 +/- 185.50 (pg/ml) respectively. The former seemed as if higher than the latter, but without statistical significance. The MFI of CXCR4 expression in ALL, M(4)+M(5), M(2) patient group were 78.47 +/- 33.96, 67.21 +/- 24.29, 41.66 +/- 17.18, respectively. CXCR4 expression in ALL and M(4)+M(5) patient groups were higher than that in M(2) patient group (P > 0.05). There was no significant difference between the ALL and M(4)+M(5) patient group (P > 0.05). The MFI of CXCR4 expression in patients with extramedullary infiltration and patients without extramedullary infiltration were 81.72 +/- 27.63, 36.94 +/- 11.86 respectively. The former was higher than the latter (P < 0.05). It is concluded that the higher expression of CXCR4 on acute lymphoblatic and monocytic leukemia cells may be one of the molecular mechanisms of extramedullary infiltration in both kinds of leukemia. The average plasma levels of SDF-1alpha decreased in leukemia patients and this decrease not related to the extramedullar infiltration, which may be due to the SDF-1alpha local expression in the organ infiltrated.

[Clinical significance of antineutrophil cytoplasmic antibodies in patients with lupus nephritis].

OBJECTIVE: To analyze the clinical features of patients with lupus nephritis positive for antineutrophil cytoplasmic antibodies (ANCA) and explore the clinical implications of ANCA detection. METHODS: Totally 261 patients with lupus nephritis were enrolled in this study, including 53 ANCA-positive and 208 ANCA-negative ones. The clinical data of the patients pertaining to the disease history, physical examination, laboratory examinations and pathological inspection were retrospectively analyzed. RESULTS: Compared with patients negative for ANCA, the ANCA-positive patients had significantly higher incidence of serositis (75.5%), acute renal failure (64.2%), myocarditis (30.2%), neuropsychiatric involvement (26.4%) and lung hemorrhage (7.5%)(P<0.05). Significant differences were also found between the two groups in SLE disease active index (SLE-DAI), number of the diagnostic criteria, erythrocyte sedimentation rate (ESR), anemia, anti-Sm antibodies, and serum complement C(3). Most patients positive for ANCA (67.9%) had type IV lupus nephritis with more crescent formation, renal tubular atrophy, hyaline thrombi, and higher mortality rate as well than the negative patients. CONCLUSION: ANCA detection may benefit the estimation of the disease severity and prognostic evaluation of lupus nephritis.