Nephrotic syndrome in syngeneic hematopoietic stem cell transplantation recipients: A case report

BACKGROUND Hematopoietic stem cell transplantation(HSCT)is widely used in the treatment of hematological diseases.However,complications after transplantation,such as acute and chronic graft-vs-host disease(GVHD),still seriously affect the quality of life and even threaten the lives of patients.There is evidence that glomerular diseases can manifest as GVHD.However,GVHD should not occur as a result of syngeneic HSCT.CASE SUMMARY A 20-year-old male diagnosed with T lymphoblastic lymphoma(stage IIIA,aaIPI 1)in September 2013 was treated with six cycles of hyper-CVAD and achieved complete remission.He underwent syngeneic HSCT in June 2014,and had no kidney disease history before the transplant.However,nephrotic syndrome occurred 24 mo later in the patient after syngeneic HSCT.Renal biopsy was performed,which led to a diagnosis of atypical membranous nephropathy.After treatment with glucocorticoids combined with cyclophosphamide and cyclosporine,the nephrotic syndrome was completely relieved.CONCLUSION We report a case of delayed nephrotic syndrome after syngeneic HSCT.Antibodymediated autoimmune glomerular disease may be the underlying mechanism.After treatment with immunosuppressive agents,the nephrotic syndrome was completely relieved but further long-term follow-up is still needed.

经络系统与针刺效应机制的科学评价

Objective:To search all available sources to find incontrovertible scientific explanation of the meridian system and mechanism of acupuncture action.Methods:Extensive search of electronic databases was carried out to identify all published scientific articles,research papers and experimental findings regarding meridian system,acupuncture points and mechanisms of acupuncture action,from both English and Chinese language journals,from inception till date.Results:There are many hypotheses and studies about meridian system such as,primovascular system as meridian,nuclear tracers study to locate the track of meridian,infrared imaging studies to prove existence of meridians,investigations about anatomical structure of acupoints,etc.There are many researches and theories about mechanism of acupuncture action such as gate control theory of acupuncture analgesia,neurotransmitters,neuro-endocrine-immune network,fMRI evidences of brain’s processing of pain signal etc.Conclusion:Researchers over half a century discovered many factual information about meridian system,acupoints,neuro-transmitters and acupuncture analgesia,neuro-hormonal mechanism etc.All these important discoveries contributed to clarify the mysteries of meridian system and acupuncture action,but they still fell short of providing an incontrovertible scientific explanation.Further coordinated studies are warranted to explore more plausible and scientifically valid explanation of meridian system and acupuncture action.

Traditional Indian medicine and history of acupuncture in India

Acupuncture, a component of Traditional Chinese Medicine, is well known to have been originated in ancient China and propagated to neighboring countries including India and now throughout the world.India having an ancient civilization had a rich traditional medicine called Ayurveda which consisted of herbal medicine, surgery, yoga and 'Suchi veda' treatment. Ayurveda gained popularity throughout the ancient India and was also disseminated into the neighbors. Suchi veda was like a pricking therapy but there is no record of its consistent practice afterwards throughout the Christian era and Middle Ages.There is record of dissemination of Chinese acupuncture in India in the 6 th century but its use was not persistent afterwards, till it was re-introduced in the mid-twentieth century, by a Chinese trained Indian physician in 1959. Currently practice of acupuncture is fast developing throughout India. some state governments already officially recognized it and recently the central government of India declared state recognition to acupuncture as an independent system of therapeutics in the health care system of the country.

Efficacy and Safety of Niaoduqing Particles for Delaying Moderate-to-severe Renal Dysfunction： A Randomized, Double-blind, Placebo-controlled, Multicenter Clinical Study

Background： Chronic kidney disease （CKD） with moderate-to-severe renal dysfunction usually exhibits an irreversible course, and available treatments for delaying the progression to end-stage renal disease are limited. This study aimed to assess the efficacy and safety of the traditional Chinese medicine, Niaoduqing particles, for delaying renal dysfunction in patients with stage 3b-4 CKD.Methods： The present study was a prospective, randomized, double-blind, placebo-controlled, naulticentcr clinical trial. Frorn May 2013 to December 2013,300 CKD patients with an estimated glomerular filtration rate （eGFR） between 20 and 45 ml ＂rain ~＂ 1.73 m 2, aged 18-70 years were recruited from 22 hospitals in 11 Chinese provinces. Patients were randomized in a 1：1 ratio to either a test group, which was administered Niaoduqing particles 5 g thrice daily and 10 g before bedtime for 24 weeks, or a control group, which was administered a placebo using the same methods. The primary endpoints were changes in baseline serum creatinine （Scr） and eGFR after completion of treatment. The primary endpoints were analyzed using Student＇s t-test or Wilcoxon＇s rank-sum test. The present study reported results based on an intention-to-treat （ITT） analysis. Results： A total of 292 participants underwent the ITT analysis. At 24 weeks, the median （interquartile range） change in Scr was 1.1 （-13.0-24.1） and 11.7 （-2.6-42.9） p, mol/L for the test and control groups, respectively （Z = 2.642, P = 0.008）, and the median change in eGFR was -0.2 （-4.3-2.7） and -2.2 （-5.7-0.8） ml.min-1·1.73 m-2, respectively （Z = -2.408, P = 0.016）. There were no significant differences in adverse events between the groups. Conclusions： Niaoduqing particles safely and effectively delayed CKD progression in patients with stage 3b-4 CKD. This traditional Chinese medicine may be a promising alternative medication for patients with moderate-to-severe renal dysfunction.