New details indicated by different stainings during conjugation of ciliated protozoa Paramecium

During conjugation of Paramecium caudatum, nuclear events occur in a scheduled program. Morphological studies on nuclear behavior during conjugation of P. caudatum have been performed since the end of the 19th century. Here we report on new details concerning the conjugation of P. caudatum through the staining of conjugating ceils with protargol, carbol fuchsin solution, Hoechst 33342 and immunofluorescence labeling with monoclonal antibody of anti-a tubulin. 1） The crescent nucleus is a characteristic of the meiotic prophase of P. caudatum, has an unstained area. We stained this area with protargol, which was separated from the chromatin area and was not detected by the other stainings. 2） In regards to the four meiotic products, it has long been considered that only one product enters the paroral cone region （PC） and survives after meiosis. However, our protargol and immunofluorescence labeling results indicated that PC entrance of the meiotic product happened before the completion of meiosis instead of after. 3） In our previous study, protargol staining indicated the presence of a swollen structure around the central part of the ＂U＂ and ＂V＂ shaped spindles connecting the two types of prospective pronuclei. However, immunofluorescence labeling with anti-a tubulin antibodies gave a different image from protargol. All these observations form the basis for further studies of their molecular mechanisms.

Quantitative analysis on the dynamic characteristics of megadunes around the Crescent Moon Spring, China

The Crescent Moon Spring is a precious natural heritage. However, the dynamic characteristics of megadunes around the Crescent Moon Spring are not well known. This paper quantitatively studied the character- istics and changes of megadunes around the Crescent Moon Spring by interpreting aerial photographs taken in 1985 and 2004 and analysing the dune crestlines and the wind data collected from 2011 to 2012. Results revealed that pyramid dunes were formed by a complex wind regime. The Crescent Moon Spring was not buried by shifting sands because of the stable wind regime and relative stability of pyramid dunes. The crestlines of the dunes around the spring moved northward between 1985 and 2004. The south-facing slip faces were also exposed to wind ero- sion, whereas the other faces were under deposition, thus indicating that the southerly wind was relatively en- hanced. Limiting the scale of tall windbreaks and architectures in the Dunhuang oasis at the north of the spring was necessary to maintain the dynamic equilibrium of the wind regime and sand transport.

Computational fluid dynamics evaluation of the effect of different city designs on the wind environment of a downwind natural heritage site

Disturbance in wind regime and sand erosion deposition balance may lead to burial and eventual vanishing of a site.This study conducted 3D computational fluid dynamics(CFD)simulations to evaluate the effect of a proposed city design on the wind environment of the Crescent Spring,a downwind natural heritage site located in Dunhuang,Northwestern China.Satellite terrain data from the Advanced Spaceborne Thermal Emission and Reflection Radiometer(ASTER)Digital Elevation Model(DEM)were used to construct the solid surface model.Steady-state Reynolds Averaged Navier-Stokes equations(RANS)with shear stress transport(SST)k-ωturbulence model were then applied to solve the flow field problems.Land-use changes were modeled implicitly by dividing the underlying surface into different areas and by applying corresponding aerodynamic roughness lengths.Simulations were performed by using cases with different city areas and building heights.Results show that the selected model could capture the surface roughness changes and could adjust wind profile over a large area.Wind profiles varied over the greenfield to the north and over the Gobi land to the east of the spring.Therefore,different wind speed reduction effects were observed from various city construction scenarios.The current city design would lead to about 2 m/s of wind speed reduction at the downwind city edge and about 1 m/s of wind speed reduction at the north of the spring at 35-m height.Reducing the city height in the north greenfield area could efficiently eliminate the negative effects of wind spee.By contrast,restricting the city area worked better in the eastern Gobi area compared with other parts of the study area.Wind speed reduction in areas near the spring could be limited to 0.1 m/s by combining these two abatement strategies.The CFD method could be applied to simulate the wind environment affected by other land-use changes over a large terrain.

Primary glomerular diseases in the elderly

Primary glomerular diseases in the elderly population are a frustrating topic due to difficulties in both the diagnosis and decision making about treatment. The most frequent type of primary glomerular disease in elderly is membranous nephropathy; while its counterpart in younger population is Ig A nephropathy. The most frequent cause of nephrotic syndrome in the elderly is also membranous nephropathy. Pauci-immune crescentic glomerulonephritis(GN) rate increases both in elderly and very elderly population. Pauci-immune crescentic GNs should be regarded as urgencies in elderly patients as in their younger counterparts due to potential for causing end-stage renal disease in case of delayed diagnosis and treatment, and also causing mortality due to alveolar hemorrhage in patients with pulmonary involvement. Renal biopsy is the inevitable diagnostic method in the elderly as in all other age groups. Renal biopsy prevents unnecessary treatments and provides prognostic data. So advanced age should not be the sole contraindication for renal biopsy. The course of primary glomerular diseases may differ in the elderly population. Acute kidney injury is more frequent in the course and renal functions may be worse at presentation. These patients are more prone to be hypertensive. The decision about adding immune suppressive therapies to conservative methods should be made considering many factors like co-morbidities, drug side effects and potential drug interactions, risk of infection, patient preference, life expectancy and renal functions at the time of diagnosis.

Morphological variation of star dune and implications for dune management: a case study at the Crescent Moon Spring scenic spot of Dunhuang, China

Aerial photographs and 3-D laser scans of a 90-m high star dune at the Crescent Moon Spring scenic spot in Dunhuang,China,are used to investigate the changes in dune morphology on timescales from months to decades.The result revealed that relative-equilibrium airflow strength in three wind directions of northeast,west and south was an important condition for the stability of star dunes with limited migration.Transverse and longitudinal airflows exerted a crucial impact on variation processes of star dune morphology.Controlled by transverse airflows,the easterly winds,the east side was dominated by wind erosion;and strong deposition occurred on the south-south-east arm with a maximum deposition rate of 0.44 m/a in the 46-a monitoring period,causing the east side becoming steep and high.Controlled by longitudinal airflows,the westerly winds,the west-north-west side was mainly eroded and the north arm migrated from west to east with a rate of 0.30 m/a,causing the dune slope becoming gentle and elongate.The local air circulation(southerly winds)exerted a significant impact on the development process of the star dune.Due to the influence of human activities,the south side present surface processes from a concave profile to a convex profile in 46 a,which is a potential threat to the Crescent Moon Spring.The results indicate that rehabilitating the airflow field at most is a crucial strategy to the protection of Crescent Moon Spring from burial.Opening up the passage of easterly,westerly and southerly winds through intermediately cutting the protection forest,demolishing the enclosed wall and changing the pavilion into a porous pattern have been suggested to protect the Crescent Moon Spring from burial.

Experimental study on modulational instability and evolution of crescent waves

A series of experiments on the instability of steeP water wave trains in water with finite water depths and infinite water depths in a wide wave basin were performed. It was found that under the coupled development of modulational instability and class-Ⅱ instability, the initial two-dimensional steep wave trains evolved into three＇dimensional crescent waves, followed by the occurrence of disordered water surfaces, and that the wave energy transferred to sidebands in the amplitude spectrum of the water surface elevation. The results also show that water depth has a significant effect on the growth of modulational instability and the evolutiin of crescent waves. The larger the water depth, the more quickly the modulational instability suppresses class-II instability.

Grain size distribution at four developmental stages of crescent dunes in the hinterland of the Taklimakan Desert,China

Although scientists have performed many studies on crescent （barchan） dunes in the Taklimakan Desert,few studies reported the changes in grain size at different development stages of crescent dunes.In order to evaluate the changing trends of surface sediment grain size with dune development,we investigated the grain size characteristics at four developmental stages （oval sand pile,shield dune,incipient crescent dune and mature crescent dune） of crescent dunes by measuring the morphology of sand dune and observing the near-surface wind regime.The dunes have developed in a wide inter-dune corridor between high compound longitudinal ridges in China＇s Taklimakan Desert.The surface sediments at four developmental stages of the crescent dunes were primarily composed of fine sands,followed by very fine and medium sands.Mean grain sizes ranged from 2.8 to 3.1 φ,with a unimodal distribution.The sands were moderately well-sorted,their distribution varied from platykurtic to very platykurtic,and symmetrical or skewed towards the fine particles.From oval sand piles through shield and incipient crescent dunes to mature crescent dunes,incipient grain size gradually increased,particles became finer,sorting became better,kurtosis and skewness increased.Grain sizes on the surface layer became coarser upwards from the toe of the windward slope and then became finer towards the bottom of the leeward slope.We found that the coarsest particles at different positions at the four developmental stages were different.The coarsest particles were distributed at the top of the oval sand piles and shield dunes,versus at the middle of the windward slope of the incipient and mature crescent dunes.Correlations between the mean grain size and other grain size parameters showed that as mean grain size became finer,sorting became better and kurtosis became wider,but skewness changed only slightly.In addition,grain size variation in the surface sediments correlated with the movement speed of the dunes in the study area.In the open ground among tall-complex longitudinal ridges in the hinterland of the Taklimakan Desert where aeolian environment is characterized by comparatively strong wind and unsaturated sand flow,faster dune movement corresponded to coarser grain size.

Bacterial diversity in the sediment of Crescent Moon Spring,Kumtag Desert,Northwest China

Desert lake, a unique oasis in desert ecosystems, harbours different bacterial communities. Thus, it is considered as a hub of bacterial diversity. In this study, bacterial diversity in the sediment of Crescent Moon Spring, Kumtag Desert, Northwest China was analyzed using high-throughput amplicon pyrosequencing analysis. The sequences of the most abundant OUTs （Operational Taxonomic Units） in the sediment of Crescent Moon Spring were compared with the sequences of those most abundant OUTs of various origins from NCBI GenBank database to detect the origins of bacteria in the sediment of Crescent Moon Spring. Also, bacterial compositions between sediment of Crescent Moon Spring and other desert and lake ecosystems （including desert lakes） worldwide were compared using cluster analysis to determine the possible factors affecting bacterial compositions. In total, 11,855 sequences were obtained and 30 phyla were identified. At the phylum level, the dominant phylum was Proteobacteria with α-Proteobacteria being the first dominant class and the second dominant phylum was Planctomycetes. Our finding that α-Proteobacteria being the first dominant class of Proteobacteria and Planctomycetes being the second dominant phyla are somewhat contradictory with reports from other desert lake sediments. This difference could be resulted from water hydration and conductivity, as well as oligotrophic conditions of Crescent Moon Spring. At the genus level, Rhodobacter, Caldilinea, Planctomyces, and Porphyrobacterwere the dominant genera in the sediment of Crescent Moon Spring. Comparisons on sequences of the most abundant OUTs （including OTU3615, OTU6535, and OTU6646） between sediment of Crescent Moon Spring and various origins from NCBI GenBank database indicate that the origins of bacteria in the sediment of Crescent Moon Spring are likely from the underground water. Furthermore, cluster analysis on comparisons of bacteria compositions between sediment of Crescent Moon Spring and other desert and lake ecosystems （including desert lakes） worldwide shows that at regional scales, bacterial compositions may be mainly affected by geographical patterns, precipitation amounts, and pH values. Collectively, our results provide new knowledge on the bacterial diversity in desert lake ecosystems.

Antineutrophil cytoplasmic antibodies crescentic allograft glomerulonephritis after sofosbuvir therapy

Antineutrophil cytoplasmic antibodies(ANCA) are well known to be associated with several types of vasculitis, including pauci-immune crescentic glomerulonephritis, a form of rapid progressive glomerular nephritis(RPGN). ANCA vasculitis has also been reported after administration of propylthiouracil, hydralazine, cocaine(adulterated with levimasole), allopurinol, penicillamine and few other drugs. All previously reported cases of drug-associated ANCA glomerulonephritis were in native kidneys. Sofosbuvir is a new and effective drug for hepatitis C virus infection. Here, we report a case of ANCA vasculitis and RPGN following sofosbuvir administration in a kidney transplant recipient. It also represents the first case of drug-associated ANCA vasculitis in a transplanted kidney. Further drug monitoring is necessary to elucidate the degree of association and possible causal effect of sofosbuvir and perinuclear ANCA vasculitis.

Progress on research and mitigation of wind-blown sand risk in Dunhuang Singing Sand Mountain and Crescent Spring Scenic area,China

The Singing Sand Mountain and Crescent Spring Scenic Spot in Dunhuang,Northwest China is a world-renowned desert attraction that is also an integral component of the Dunhuang UNESCO Global Geopark.This scenic area underwent a 30-year transformation,i.e.,from a severe sand risk with spring water threatened by sand burial due to dune deformation,to restoration of the original sand flow field and mitigation of the sand burial problem.The current paper summarizes the research on the intensive monitoring of the dynamic change of star dunes near the spring,observation of wind and sand flow movement,and then restoring the harmonic vibration of the sand particles(singing sand)that were previously silenced.The existing and prospective impacts of anthropogenic and natural forces on the deformation of the sand dunes are investigated by integrated methods,guiding the implementation of mitigating measures with significant ameliorative effects.Contrast to common sand control practices that aim to reduce wind speed and stop blown sands,our research highlights the importance of maintaining the natural wind flow field in stabilizing surrounding dunes.These mitigation measures consist of removing excessive vegetation and newly constructed buildings to recover the original wind flow field and sand transport activity.Such research and mitigation efforts ensure the scientific protection and restoration of the special desert landform,and contribute to the mutual enhancement of the conservation and exploitation of this desert scenic spot and similar sites.

Reproductive characteristics of transgenic (TG) chickens caping an exogenous gene

An exogenous gene (lacZ/MiwZ) introduced into the germinal crescent region (GCR) of avian embryos was con-firmed to be successfully transferred to the gonads via the primordial germ cells (PGCs). Following hatching, the chickswere raised until the stage of sexual maturation. The incorporation of MiwZ DNA was detected in male and female trans-genic chickens, respectively. The normal male and female transgenic birds were subjected to artificial insemination ac-cording to routine methods. Fertilized eggs obtained from female transgenic chickens were incubated for 72 h and the em-bryos removed from the yolk were examined by X-gal staining to detect the introduction of MiwZ in the offspring. As aresult, the expression of MiwZ was detected in the offspring. Furthermore, the presence of MiwZ in the extracts fromembryos was also detected by polymerase chain reaction (PCR) analysis. In male transgenic chickens, the presence of in-jected MiwZ in the extracts from sperm was also confirmed. The exogenous gene introduced into the GCR migrated suc-cessfully to the gonad resulting in its incorporation into the offspring and spermatozoa of transgenic chickens. (Asian JAndrol 1999 Sep ; 1: 139 - 144)

Impact of post-ruminally infused macronutrients on bovine mammary gland expression of genes involved in fatty acid synthesis, energy metabolism, and protein synthesis measured in RNA isolated from milk fat

Background: Characterising the regulation of milk component synthesis in response to macronutrient supply is critical for understanding the implications of nutritional interventions on milk production. Gene expression in mammary gland secretory cells was measured using RNA isolated from milk fat globules from 6 Holstein-Friesian cows receiving 5-d abomasal infusions of saline, essential amino acids(AA), or glucose(GG) or palm olein(LG)without(LAA) or with(HAA) essential AA, according to a 6 × 6 Latin square design. RNA was isolated from milk fat samples collected on d 5 of infusion and subjected to real-time quantitative PCR. We hypothesised that m RNA expression of genes involved in de novo milk fatty acid(FA) synthesis would be differently affected by GG and LG,and that expression of genes regulating transfer of tricarboxylic acid cycle intermediates would increase at the HAA level. We also hypothesised that the HAA level would affect genes regulating endoplasmic reticulum(ER)homeostasis but would not affect genes related to the mechanistic target of rapamycin complex 1(m TORC1) or the integrated stress response(ISR) network.Results: Infusion of GG did not affect de novo milk FA yield but decreased expression of FA synthase(FASN).Infusion of LG decreased de novo FA yield and tended to decrease expression of acetyl-Co A carboxylase 1(ACC1).The HAA level increased both de novo FA yield and expression of ACC1, and tended to decrease expression of mitochondrial phosphoenolpyruvate carboxykinase(PCK2). m RNA expression of m TORC1 signaling participants was not affected by GG, LG, or AA level. Expression of the ε subunit of the ISR constituent eukaryotic translation initiation factor 2 B(EIF2 B5) tended to increase at the HAA level, but only in the presence of LG. X-box binding protein 1(XBP1) m RNA was activated in response to LG and the HAA level.Conclusions: Results show that expression of genes involved in de novo FA synthesis responded to glucogenic,lipogenic, and aminogenic substrates, whereas genes regulating intermediate flux through the tricarboxylic acid cycle were not majorly affected. Results also suggest that after 5 d of AA supplementation, milk protein synthesis is supported by enhanced ER biogenesis instead of signaling through the mTORC1 or ISR networks.

Accuracy of crescent sign on ocular ultrasound in diagnosing papilledema

AIM To study the usefulness of orbital ultrasonography in the diagnosis of papilledema.METHODS Fifty patients who were referred to the neurophthalmology clinic and clinically suspected to have papilledema were selected. Thorough, clinical examination with slitlamp biomicroscopy and visual acuity assessment was done. These patients underwent ultrasonography to demonstrate the crescent sign. The patients were further evaluated with the neurologist and magnetic resonance imaging(MRI) thus confirming the diagnosis of papilledema. The results of our ultrasonographic evaluation were correlated with final diagnosis after thorough clinical evaluation, imaging and the neurologist's opinion.RESULTS Out of 50 patients diagnosed having papilledema on MRI, 46(92%) showed crescent sign on B scan ultrasonography. Headache was most common presenting complaint in 47(94%) and idiopathic intracranial hypertension was most common underlying cause of papilledema in 30(60%) cases.CONCLUSION"Crescent sign" seen on ultrasonography is a sensitive tool for diagnosis of papilledema. It is cost effective, less cumbersome and effective tool to differentiatebetween papilledema and pseudo papilledema before subjecting the patients to costly investigations like MRI. A positive crescent sign should always be followed by MRI to find out the cause of papilledema.

Flock Dynamics and Approaches for Reducing Mortality Rate among Mubende Goats at BuZARDI Semi-Intensive Farm, Hoima, Uganda

Goats are globally very important domestic small ruminants being kept for meat, milk, skin, byproducts and several socio-cultural purposes. Goat farmers in the Lake Albert Crescent Zone (LACZ) of Uganda identified dry-season feed scarcity, poor breeds, diseases, informal marketing and theft as major constraints which underscore the scarcity of information on improved management technologies and the need for targeted decisions. At BuZARDI goat farm, a semi-intensive farm that is also experiencing similar challenges, we documented management practices and collected production related data for 2 years. We computed flock dynamics and mortality rates purposely to influence decisions aimed at increasing the farm’s productivity. Data were collected using pens and books, validated and analyzed using MS office 2013 and SPSS version 22. The flock size increased from 37 goats in July 2020 to 175 goats in June 2022. One hundred twenty-five goats were introduced into the farm as breeding stock, 89 kids were born on the farm and 61 goats died due to various causes. The average number of goats in the farm per month was 109.2 (SEM = 13.7), female 79.8 (SEM = 10.8) and male 29.4, (SEM = 9.9). Average population of goats at risk of death was 95 and the Mortality rate was 27 goats per 1000 goat months. The disaggregated mortality rate of 5 goats per 1000 goat months and 39 goats per 1000 goat months were obtained for the period FY 2020-2021 and FY2021-2022 respectively. The main contributors to the mortality of goats were worm infestation (33%), fracture and injuries arising from stampedes (18%), Ticks and tick borne diseases (18%), respiratory tract infections (11%) and malnutrition (10%). We recommend strict adherence to the flock health program;improved parasite management, separation & improved care for kids, vaccinations, safer feeding, and evidence based disease management, adoption of digital data collection tools and development of an appropriate app for more accurate determination of mortality rates.

A Restrained Iran:Consolidating the Shiite Crescent

The Arab Spring is supposed to be the Arab world’s great changes and turmoil,but Iran has repeatedly become the focus in the following changes.Whether it is in the Syrian civil war,or strikes against ISIS,or the Qatar crisis,Iran repeatedly appeared.There are different attitudes towards Iran’s behavior.The Trump administration holds the opinion that Iran is

The Impact of Water Scarcity on Food Security in Iraq

Iraq is part of the Fertile Crescent with the two large rivers:Tigris and Euphrates and their tributaries that secure the required quantity and quality of water to the Iraqi population for their different uses;including agriculture,industry,and other domestic requirements.During the last decades,however,the quantity and quality of water in these rivers decreased causing water scarcity in the country.This scarcity is having severe impacts on food security in Iraq since large cultivated areas in different parts of the country that grow different agricultural products have been abandoned due to lack of water.The worsening situation is attributed mainly to global climate changes including decreasing rainfall amounts,increase in air temperature,and insufficient water inflows in the two main rivers and their tributaries.This last issue is exasperated by the unfair water sharing policies of the riparian countries namely Turkey and Iran.In writing this article relevant data from different sources were used.Numerous published reports and papers dealing with this important issue were consulted,while at the same time,the long experience of the authors in these very important issues was also drawn upon to elucidate the difficulties that are current today and those expected in the future in this field.

C3 glomerulonephritis

A case of rapidly progressive glomerulonephritis with pathological changes to the crescent glomerulonephritis“C3 glomerulonephritis”in the Third Affiliated Hospital of Inner Mongolia Medical University was collected and its diagnosis,clinical manifestation,and pathological characteristics were explored.The experts analyzed the disease from the perspective of its causes,diagnosis,complications and treatment.Timely renal biopsy is required to clarify pathological diagnosis as the primary glomerular disease was newly recognized with a lower incidence.So misdiagnosis and delayed healing is more frequent.The paper aims to enhance the clinician’s understanding of“C3 glomerulonephritis”.

Post-streptococcal acute glomerulonephritis in children:Association between proteinuria levels and renal outcomes

BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with significant long-term morbidity,and histological abnormalities such as crescentic glomerulonephritis are infrequently reported.PSAGN has also been linked to late-onset chronic kidney disease in some populations due to high levels of proteinuria.METHODS This prospective observational study was conducted at Lady Ridgeway Hospital(Colombo,Sri Lanka)over 15 months.Children with PSAGN were enrolled based on clinical and laboratory criteria.Persistent proteinuria≥2+for 2 weeks and serum creatinine>100μmol/L warranted renal biopsy,assessed via light microscopy and immunofluorescence.Normalization of complement 3(C3)within 6 to 8 weeks was required for inclusion.Data on clinical features,urine protein levels,and renal function were collected from patient records,and potential associations were analysed using Statistical Package for the Social Sciences and R language for statistical computing.Ethical approval was obtained from the Ethical Review Committee,Lady Ridgeway Hospital for Children(Ref No:LRH/ERC/2021/60).RESULTS Forty-four patients were recruited.There were 27(61.4%)male patients and 17(38.6%)female patients.Thirty-seven(84%)of them were above 5 years of age.Twenty(45%)patients had a history of skin sepsis,and eighteen(41%)had a history of throat infection.Among patients with proteinuria≥2+,53%had serum creatinine>100µmol/L,while among those with proteinuria<2+,7%had serum creatinine>100µmol/L.The association of high-degree proteinuria with elevated serum creatinine was significant(χ²=7.8,P=0.005)in PSAGN.The odds ratio of the logistic regression model was 1.049(95%confidence interval:1.003-1.098),indicating a positive direction with statistically significant association(P=0.037).There was no significant association between proteinuria and the degree of hypertension or estimated creatinine clearance.Ten children underwent renal biopsy.Crescents(less than 50%)were demonstrated in five children,while three children had typical diffuse proliferative glomer-ulonephritis.One child had severe acute tubular necrosis,and another had crescentic glomerulonephritis(crescents>50%).The immunofluorescence studies revealed deposition of immunoglobulin G and C3 in all biopsy specimens.CONCLUSION High-degree proteinuria was significantly associated with elevated serum creatinine(>100μmol/L)in children with PSAGN.The majority of children with persistent proteinuria≥2+for more than 2 weeks and the highest recorded serum creatinine>100μmol/L had atypical renal histological findings.

Retrospective study of mycophenolate mofetil treatment in IgA nephropathy with proliferative pathological phenotype

Background Mycophenolate mofetil （MMF） and cyclophosphamide （CTX） are widely used in treating various kidney diseases.However,whether they are effective and which one is better for treating IgA nephropathy patients with proliferative pathological phenotype in renal diseases,such as endocapillary proliferation,cellular crescents,and/or capillary loops fibrinoid necrosis is still unknown.We,therefore,initiated a study to compare the effects of MMF and CTX in treating IgA nephropathy with the above pathological lesions.Methods One hundred and nineteen patients with IgA nephropathy who had at least one of the three aforementioned lesions were enrolled.All patients were treated with prednisone; 48 patients received prednisone only （Pred group）,40 received MMF and prednisone （MMF ＋ Pred group）,and 31 were treated with CTX and prednisone （CTX ＋ Pred group）.The median time of follow-up was 30 months （maximum：96 months）.The primary endpoint was defined as renal survival.The incidence of remission of proteinuria was the secondary endpoint.Results Serum creatinine in all groups declined significantly at different follow-up times （P=0.002）,and the differences among the three groups were significant （P＜0.001）.At 24 months of follow-up,the decline rates were 12.35％,32.95％,and 24.14％ in the Pred,MMF ＋ Pred,and CTX ＋ Pred groups respectively.For urine protein excretion,the decline rates were 49.12％ （Pred）,73.67％ （MMF ＋ Pred）,and 63.53％ （CTX ＋ Pred） respectively at 24 months of follow-up.The differences among the three groups were not significant （P=0.714）.Renal survival （the primary endpoint） was significantly different （P=0.027）; however,the sencondary endpoint was similar for all the three groups （P=0.100）.Conclusions For IgA nephropathy patients with endocapillary proliferation,cellular crescents,and/or fibrinoid necrosis of capillary loops,prednisone combined with MMF was more effective in lowering the serum creatinine than with CTX.Combined MMF and orednisone treatment led to a better renal survival compared to that of prednisone with CTX.

The clinical and pathological characteristics of Chinese patients with pauci-immune crescent glomerulonephritis

目的 对寡免疫复合物型新月体肾炎进行临床病理分析。方法 采用病理检查包括 :光镜检查、免疫病理分析、血清学检查、肾功能检查以及统计学分析。结果 6 4 0 0例非移植肾活检中发现 2 4例寡免疫复合物型新月体肾炎 (PICGN)患者 ,占肾活检总数的 0 37% ,占新月体肾炎总数的 2 3 9% ,其中女性 16例 ,男性 8例 ,平均年龄 33岁。血管炎中微型多动脉炎 (33 3% )和结节性多动脉炎 (8 3% )为常见继发病因。抗中性粒细胞胞浆抗体 (ANCA)阳性率为 52 2 %。临床上多表现为急进性肾功能减退 (75 0 % ) ,发作性肉眼血尿发生率高 (58 3% ) ,高血压发生率为 4 5 8% ,肾病综合症发生率为 4 1 7% ,2 5%患者出现少尿无尿症状。除贫血外 ,肾外表现较少。病理上血管襻坏死 (6 2 5% )、单核及中性粒细胞浸润(6 6 7% )及小血管炎等为常见的急性病变 ;然而 ,小球硬化 (4 5 8% )、小管萎缩 (83 3% )、间质纤维化 (75 0 % )等慢性化病变也较严重。 2 2例患者行免疫抑制治疗 ,16例随访 8— 92个月 ,有 4例肾功能在正常范围 (<12 4 μmol/L) ,8例行非透析保守治疗 ,仅 4例进入终末期肾功能衰竭需进行维持性血透析治疗。结论 免疫抑制冲击治疗是治疗PICGN的有效方法。