Update on hemolytic uremic syndrome:Diagnostic and therapeutic recommendations

Hemolytic uremic syndrome （HUS） is a rare disease. In this work the authors review the recent findings on HUS, considering the different etiologic and patho-genetic classifications. New findings in genetics and, in particular, mutations of genes that encode the complement-regulatory proteins have improved our understanding of atypical HUS. Similarly, the comple-ment proteins are clearly involved in all types of thrombotic microangiopathy： typical HUS, atypical HUS and thrombotic thrombocytopenic purpura （TTP）. Fur-thermore, several secondary HUS appear to be related to abnormalities in complement genes in predisposed patients. The authors highlight the therapeutic as-pects of this rare disease, examining both “traditional therapy” （including plasma therapy, kidney and kidney-liver transplantation） and “new therapies”. The latter include anti-Shiga-toxin antibodies and anti-C5 mono-clonal antibody “eculizumab”. Eculizumab has been recently launched for the treatment of the atypical HUS, but it appears to be effective in the treatment of typical HUS and in TTP. Future therapies are in phases Ⅰ and Ⅱ. They include anti-C5 antibodies, which are more purifed, less immunogenic and absorbed orally and, anti-C3 antibodies, which are more powerful, but potentially less safe. Additionally, infusions of recombinant complement-regulatory proteins are a potential future therapy.

TCM Treatment of Diabetic Hearing Loss——An Audiological and Rheological Observation

35 cases (48 ears) of diabetic hearing loss were randomly assigned to 2 groups: the treatment group of 19 cases (25 ears) treated with drugs for nourishing the kidney-yin, invigorating blood circulation and removing blood stasis based on differentiation of symptoms and signs, and the control group of 16 cases (23 ears) treated with euglucon and other routine drugs. The results showed that the total effective rate for audition elevation in the treatment group was 52.0%, and that in the control group, 26.1%. In the treatment group, the rheological indexes were improved after treatment, the difference being very significant in comparison with those before treatment (P<0.05 and P<0.01); while in the control group, except the whole blood low shearing specific viscosity, all the other 4 indexes were not statistically significant before and after treatment (P>0.05).

Effect of lysozyme chloride on betel quid chewing aggravated gastric oxidative stress and hemorrhagic ulcer in diabetic rats

AIM： To evaluate the protective effect of lysozyme chloride on betel quid chewing （BQC） aggravated gastric oxidative stress and hemorrhagic ulcer in rats with diabetes mellitus （DM）. METHODS： Male Wistar rats were challenged intravenously with streptozotocin （65 mg/kg） to induce DM. Rats were fed with regular pellet food or BQC-containing diets. Afcer 90 d, rats were deprived of food for 24 h. Rat stomachs were irrigated for 3 h with normal saline or simulated gastric juice. Rats were killed and gastric specimens were harvested. RESULTS： An enhancement of various gastric ulcerogenic parameters, including acid back-diffusion, mucosal lipid peroxide generation, as well as decreased glutathione levels and mucus content, were observed in DM rats. Afcer feeding DM rats with BQC, an exacerbation of these ulcerogenic parameters was achieved. Gastric juice caused a further aggravation of these ulcerogenic parameters. Daily intragastric lysozyme chloride dose-dependently inhibited exacerbation of various ulcerogenic parameters in those BQC-fed DM rats. CONCLUSION： （1） Gastric juice could aggravate both DM and BQC-fed DM rat hemorrhagic ulcer; （2） BQC exacerbated gastric hemorrhagic ulcer in DM rats via enhancing oxidative stress and reducing defensive factors; （3） lysozyme chloride effectively protected BQC aggravated gastric damage in DM rats.

Kidneys in chronic liver diseases

Acute kidney injury(AKI),defined as an abrupt increase in the serum creatinine level by at least 0.3 mg/dL,occurs in about 20% of patients hospitalized for decompensating liver cirrhosis.Patients with cirrhosis are susceptible to developing AKI because of the progressive vasodilatory state,reduced effective blood volume and stimulation of vasoconstrictor hormones.The most common causes of AKI in cirrhosis are pre-renal azotemia,hepatorenal syndrome and acute tubular necrosis.Differential diagnosis is based on analysis of circumstances of AKI development,natriuresis,urine osmolality,response to withdrawal of diuretics and volume repletion,and rarely on renal biopsy.Chronic glomerulonephritis and obstructive uropathy are rare causes of azotemia in cirrhotic patients.AKI is one of the last events in the natural history of chronic liver disease,therefore,such patients should have an expedited referral for liver transplantation.Hepatorenal syndrome(HRS) is initiated by progressive portal hypertension,and may be prematurely triggered by bacterial infections,nonbacterial systemic inflammatory reactions,excessive diuresis,gastrointestinal hemorrhage,diarrhea or nephrotoxic agents.Each type of renal disease has a specific treatment approach ranging from repletion of the vascular system to renal replacement therapy.The treatment of choice in type 1 hepatorenal syndrome is a combination of vasoconstrictor with albumin infusion,which is effective in about 50% of patients.The second-line treatment of HRS involves a transjugular intrahepatic portosystemic shunt,renal vasoprotection or systems of artificial liver support.

Silkworm Extract Ameliorates Type 2 Diabetes Mellitus and Protects Pancreaticβ-cell Functions in Rats

Objective The aim of the present study was to investigate the hypoglycemic effects of silkworm extract(SE)on experimental type 2 diabetes mellitus(T2DM)rats.Methods SE was prepared by dissolving freeze-dried silkworm powder in 70%(v/v)aqueous ethanol.T2DM rats were induced by feeding them a high fat diet and an intraperitoneal injection of streptozotocin(STZ).The blood glucose,free fatty acid(FFA),malondialdehyde(MDA),tumor necrosis factor alpha(TNF-α)and superoxide dismutase(SOD)levels were detected by enzyme-linked immunosorbent assay(ELISA).The quality of SE was controlled by high performance liquid chromatography(HPLC;Agilent 1260,Agilent,USA).Hematoxylin-eosin(HE)staining was performed for histological evaluation.Antibody expression was assessed via immunohistochemistry(IHC)staining.Results SE could improve insulin resistance and islet cell function by reducing FFA,MDA and TNF-αlevels and increasing SOD level.In addition,pancreatic HE staining analysis revealed that SE has a protective effect on isletβ-cells.Conclusions The present study indicates that SE has hypoglycemic as well as pancreatic protective effects in T2DM model rats.

EFFECT OF CHRONIC ACE INHIBITIONONGLUCOSE TOLERANCE AND INSULIN SENSITIVITY IN HYPERTENSIVE TYPE 2 DIABETIC PATIENTS

We studied 14 moderately overweight Typo 2 diabetic patients with essential hypertension in stable metabolic control after a run-in period , and again after 3 months of antihypertensive treatment with the angiotensin-converting enzyme (ACF) inhibitor captopril. Glucose tolerance was tested with a 75g oral glucose load (OGTT) and insulin sensitivity was measured by the insulin suppression test (IST) while dietary and drug treatment of the hyperglycemia was maintained constant. In the whole group. mean blood pressure (MBP) fell progressively over 3months from a baseline value of 123± 3 mmHg (1 mmHg= 0. 133 kpa) to a final value of 115± 2 mmHg(P<0. 005). After treatment, fasting plasma glucose, insulin, free fatty acid (FFA). potassium, and glycosylated hemoglobin concentrations were unchanged from baseline. There were no significant differences in glucose tolerance and insulin sensitivity between pre- and post-trearment values. Neither endogenous (oral glucose) nor exogenous (IST) insulin caused any change in plasma potassium concentration. This resistance to the hypokalemic action of insulin was not affected by captopril.

A Clinical Study on Treatment of Diabetic Peripheral Neuropathy with Tang Zhi Min Capsules

Self-comparison before and after treatment, P<0.01 △ Comparison between the 2 groups after treatment, P<0.

Correlations Between Serum Uric Acid Level and Disease Activity,Intrathecal Inflammation Reactivity in Patients with Multiple Sclerosis

Objective To explore the correlations between serum uric acid （HA） levels and the clinical and cerebrospinal fluid （CSF） parameters of multiple sclerosis （MS）. Methods The medical reports of 47 MS patients admitted to Peking Union Medical College Hospi- tal during 2008 and 2010 were reviewed. And 49 age- and gender-matched cerebral infarction patients were enrolled as control. The mean serum HA level of the MS patients was compared with that of the control group. The correlations between the HA levels and the clinical parameters including gender, disease duration, relapse rate, and disease disabilities as assessed by the Expanded Disability Status Scale score, were explored. Forty-one patients had CSF examinations. The correlations between the IdA levels and the CSF parameters reflecting inflammation and tissue damage, including CSF protein, white blood cell count, oligoclonal band, 24-hour IgG index, and myelin basic protein, were also investigated. Results The mean serum HA level in the MS patients was lower than that in the control group （247.75 ± 52.59 jamol/L vs. 277.94 ± 74.33 pmol/L, P=0.025） and inversely correlated with the relapse rate （P=0.049）. MS patients with lower serum UA levels tended to have higher white blood cell counts and myelin basic protein level. But there was no correlation between CSF protein levels （r=0.165, P=0.273）, white blood cell counts （r=-0.051, P=0.732）, IgG index （r =0. 045, P=0.802）, or myelin basic protein level （r =-0.248, P=0.145） and the serum UA level, respectively. Conclusion In MS patients, UA levels might partly reflect the extent of disability and inflammation.

Effects of Electroacupuncture at Weiwanxiashu and Zusanli Points on Blood Glucose and Plasma Pancreatic Glucagon Contents in Diabetic Rabbits

The Effects of electroacupuncture (EA) at Weiwanxiashu (EX-B3) and Zusanli (ST 36) points on blood glucose (BG) and plasma pancreatic glucagon (PG) contents were dynamically observed in diabetic rabbits induced by Alloxan. It is found that acupuncture at Weiwanxiashu point can significantly lower the BG content and inhibit release of PG; no significant changes in BG and PG are found when acupuncture is given at Zusanli (ST 36) point alone, however BG and PG contents decrease more obviously when acupuncture employed at both Zusanli and Weiwanxiashu, suggesting that Zusanli has a marked synergetic action with Weiwanxiashu.

Prof.Guan Jinghuan's Experience in Treating Chronic Nephritic Hematuria

Our teacher Guan Jinghuan, a famous veteran TCM physician in Hubei province, has been engaging in clinical research for more than forty years in the treatment of nephrosis by the combined Chinese and western medicine, and he has accumulated a wealth of experience, especially in treating intractable nephritic diseases. The following is an introduction of his experience in treating chronic nephritic hematuria.

Should nonalcoholic fatty liver disease be regarded as a hepatic illness only?

The highly increasing prevalence of obesity and type 2 diabetes mellitus in the general population makes nonalcoholic fatty liver disease the most common diagnosis in every-day practices. Lifestyle changes （mainly exercise withdrawal and weight gain） have probably heightened the prevalence of nonalcoholic fatty liver disease. Mortality in patients with Nonalcoholic Fatty Liver Disease is significantly higher when compared with that of the same age-gender general population. Hepatologists claim to bear a new burden, being Nonalcoholic Fatty Liver Disease strongly linked to systemic diseases.

改良留置导尿法在预防尿道损伤中的应用

目的：探讨改良留置导尿法对预防尿道损伤的效果,为临床寻找更合理的尿道损伤预防方案提供依据。方法将136例需留置导尿的患者随机分为观察组和对照组,每组各68例,观察组采用改良留置导尿法,对照组采用常规留置导尿法。于插入导尿管时、留置尿管期间、拔出导尿管后,观察两组患者血性尿发生情况。结果观察组患者尿管插入时、留置尿管期间、拔出尿管后及血尿总发生率均低于对照组,两组比较差异有统计学意义（χ^2值分别为6.81,3.89,8.38,28.57；P〈0.05）。两组患者留置尿管期间漏尿发生率差异无统计学意义（P〉0.05）。结论改良留置导尿法可以降低尿道损伤的发生率,值得临床推广。

Effect of Electroacupuncture on Platelet-derived Growth Factor and the Ultrastructure of Mitochondria in Rats with Diabetic Gastroparesis

Objective To observe the effect of electroacupuncture(EA)at the pressure points Zu San Li(ST36),San Yin Jiao(SP6)and Liang Men(ST21)on platelet-derived growth factor(PDGF)and the ultrastructure of mitochondria in rats with diabetic gastroparesis(DGP).Methods Sixty Sprague Dawley(SD)rats were randomly separated into a normal control group(NC,n=10)and a modeling group(n=50).Rats in the modeling group received an injection of 2%streptozotocin(STZ)and a high-fat and highglucose diet for eight weeks to establish a DGP rat model.At the same time,blood glucose and a general symptom score were recorded every week.After modeling,30 successfully modeled rats were randomly separated into the following groups:the DGP group(n=10),the EA group(n=10)and the metoclopramide(MP)group(n=10).After three weeks of intervention,the gastrointestinal propulsive rate was measured by measuring the optical density(OD).The concentration of Ca2+was determined by fluorescence immunoassay,and levels of serum insulin(INS)and PDGF were determined by ELISA.The ultrastructure of mitochondria was observed with transmission electron microscopy.Results(1)After intervention,levels of blood glucose and the general symptom score were greatly decreased in the EA group compared to the DGP group(P<0.01).Compared with the DGP group,the gastric emptying rate and the intestinal propulsive rate of the EA group was significantly improved(P<0.01),and there was no statistically significant difference between the EA and the NC groups.(2)Compared with the NC group,the levels of INS in the DGP group markedly decreased(P<0.05),but there was no significant difference of INS levels between the EA and the MP roups.(3)Compared with the DGP group,theconcentration of Ca2+in the EA and the MP groups significantly increased(P<0.01,P<0.05,respectively).(4)Compared with the NC group,the average OD of PDGF in the DGP group was significantly higher(P<0.01).Compared with the DGP group,levels of PDGF in the EA group increased significantly(P<0.01).(5)There were abundant mitochondria with a clear structure and complete cristae in the NC group.However,in the DGP group,mitochondria were severely swollen,partly vacuolated,and cristae were either fractured,absent,or shortened.In the EA group,mitochondria were slightly swollen,with clear cristae.Conclusions Electroacupuncture at the points Zu San Li(ST36),San Yin Jiao(SP6)and Liang Men(ST21)may improve gastric motility in DGP by up-regulating the amount of PDGF and improving the ultrastructure of mitochondria.

Species Identification and Subtyping of Ureaplasma Urealyticum from Urine Specimens of Pregnant Women

Objective: To investigate U parvum (previously Ureaplasmaurealyticum biovar 1) and U urealyticum (previouslyUreaplasma urealyticum biovar 2) and their subtypes andserovars in urine specimens of pregnant women. Methods: After collecting 151 specimens and inoculatingbroth, all broth culture positive (urease positive) specimenswere amplified, species were identified and subtyped by usinggeneral primers, species-specific, and type-specific primerstargeting the multiple banded antigen (MBA) gene sequence. Results: U parvum was identified in 58 of 151 specimens andU. urealyticum in 18 (both were present in 5, and neither werefound in 6). Serovars 3, 1, and 6 were the most commonamong U parvum isolates and subtypes l and 3 were the mostcommon among U urealyticum. Multiple serovars amongclinical isolates were found. Conclusion: This PCR-based typing system could facilitatestudies of the relationship between individual ureaplasmaspecies or subtypes and human diseases.

Study of serum Helicobacter pylori soluble antigen

Objective: to explore a new serological method for detecting Helicobacter pylori ( H. pylori ) infection. Methods: Serum soluble antigen of H. pylori was detected by using avidin-biotin ELISA technique to evaluate the status of H. pylori infection and for comparison with rapid urease test ( RUT ), histologic examination and serology. Results: The sensitivity, specificity, positive predictive value and negative predictive value were 77.46%, 91.07%, 91.67% and 76.12 %, respectively. The prevalence rate of serum H. pylori soluble antigen in 138 patients undergoing endoscopy was similar to the rate obtained by 14C-UBT methods ( P> 0.05 ). Conclusions: The detection of serum H. pylori soluble antigen(HpSAg) could be used as a new serological method which is accurate, and convenient, not affected by the memorizing reaction of serum antibody; is more sensitive, more specific and suitable for clinical diagnosis, and evaluation of eradication and for follow-up of H. pylori as well as for detection in children and pregnant women.

Percutaneous closure of paravalvular leak in the treatment of anemia of mixed etiology in a patient with diabetic complications and chronic inflammation

Hemolytic anemia after implantation of an artificial mitral valve is a rare but recognized complication of surgery. The presence of paravalvular leak after surgery and the necessity of using oral anticoagulants causes that anemia emerges as a severe and potentially fatal issue.

Voltammetric Trace Determination of Prednisolone in Human Serum and Urine-Studies the Interaction with Albumin

The Voltammetric properties of Pure Prednisolone in a direct method in the aqueous solution were studied. The substance has revealed a clear and major two reduction peaks at potential -1.22 Volt and -1.45 Volt against the reference electrode （Ag/AgCI/SatKC1）. The calibration curve of the prednisolone in the Phosphate Buffer （pH = 7） has been studies. The relationship has been linear within the scope of concentration 0.398 × 10 6-3.846 ×10-6 mol. The correlation coefficients are 0.9981, 0.9958 for the first and second peaks. Another two calibration curves were also constructed in the presence of human serum and urine. Standard addition method was successful used to determine the drug in serum, urine as well as in the analysis of drug in the tablet. The molecular binding ofprednisolone with Albumin was also studied at different temperature. The Vant hoff equation is used to calculate the thermodynamic parameters, the results indicate that the （ion-ion） of binding suggested.

The Relationships Between Milk Constituents and Various Milk Properties in Anatolian Buffaloes

The objectives of this study were to investigate the relationships among milk composition, renneting time, urea concentration, acidity, density and pH of Anatolian Buffaloes＇ milk. As a total of 115 individual milk samples from 53 Anatolian buffalo cows that calved in 2004 and 2005 on days of their lactations 30 ± 15, 60 ± 15, 90 ±15, 120 ± 15, 150 ± 15, 180± 15, 210 ±15, 240 ± 15 and 270 ± 15 in 8 units of lhkpmar village were collected in morning milkings in June, September, December and March. Samples were analysed for total dry matter （TDM）, fat, protein, ash, density, pH, acidity, renneting time and urea content. Data were classified according to the following environmental factors： lactation stages： （30 ± 15, 60 i 15, 90 ±15 days）： 2 （120±15, 150 ± 15, 180 ± 15 days）： 3 （210 ± 15, 240 ± 15, 270± 15 days）; calving year： 1 （2004）, 2 （2005）; calving season： 1 （January-May）, 2 （September and October）; month of samples collection： 1 （June）, 2 （September）, 3 （December）, 4 （March）; lactation order： 1 and 2：1, 3 and 4：2, 5 and 6：3. Means and correlation coefficients for the characteristics investigated were calculated. There were negative significant correlations between daily milk yield with TDM, fat and protein percentages, and between pH and all of the milk constituents. Density reduces as TDM, fat and protein contents increase. Relationships between density and coagulation time with milk yield and pH were not significant. Relationships between milk urea concentration with none of milk constituents, milk yield, density, pH and titratable acidity were not significant statistically. It was concluded that genetic selection has to be directed towards increasing fat, protein and total not fat dry matter yields. Under selection programs in which milk yield is taken into consideration, fat and protein yields also increase, but fat and protein concentrations decrease.