Objective　To study the clinical manifestation of small bowel tumors and the prognostic factors. Methods　Retrospective analysis of the clinical data were made on 42 cases of primary small bowel tumors (except periampullary tumors) admitted to our hospital from 1974 to 1999. Results　In this series, there were 6 cases of benign small bowel tumors, 5 of them were leiomyoma and 1 adenoma. Of the 36 cases of malignant 　tumors, there were malignant lyphoma in 17 cases (47.2%), adenocarcinoma in 11 (30.6%),　 leiomyosarcoma in 6(16.7%), carcinoid tumor in 1 (2.8%) and neurofibrosarcoma in 1 (2.8%). There was no characteristic clinical sign in small bowel tumors; endoscopy and barium series were the main diagnostic methods. About 50 per cent of patients with malignancy had metastasis, and only 18 cases (50%) received radical resection. Follow-up were available on 36 cases. The overall 5-year survival rate in the patients with malignant small bowel tumors was 47.3%. Multivariate analysis showed that metastasis and diameter of tumors were the main prognostic factors of the 5-year survival. Conclusions　Early diagnosis and early treatment play the key roles in improving the prognosis of malignant small bowel tumors. Radical resection should be taken if no metastasis is found.

Background In previous study,peripheral retinal nerve fiber layer (RNFL) thickness is considered to be the earliest structural changes which can be detected.3D-OCT can measure the thickness of macular ganglion cell complex (mGCC),which makes the detection of primary glaucoma possible in the early stage.Objective This study was to measure the thickness of mGCC and disc-peripheral RNFL in early stage of primary glaucomous eyes by 3D-OCT and assess the anatomic basis of glaucoma-induced optical nerve damage.Methods 3D-OCT images from 10 patients with advanced stage primary glaucoma in one lateral eye and early stage glaucoma in fellow eye from December 2010 to December 2012 were prospectively analyzed in China-Japan Friendship Hospital.The patients were diagnosed based on the recommended standard of National glaucoma group (1987 version) and received routine eye examination.3D-OCT scanning was performed using 3D-macular mode,3D-macular Wide mode and 3D-disc mode with TOPCON 3D-OCT 2000 system,and the images at macular 6 mm×6 mm area were analyzed.The posterior pole area was divided into 5 concentric rings from fovea toward periphery and equally subdivided into 100 small checks,with the area of 0.6 mm×0.6 mm for each.The probable values in each check were calculated as the ratio of each figure and corresponding normal value.The probable values were expressed as red color (P＜ 1％),yellow color (P＜5％) and gray color (P≥ 5％).Then the disc-periphery RNFL thickness and disc cup were evaluated.Results No evident abnormality was found in the thicknesses of photoreceptors layer and bipolar cell layer in both advanced glaucomous eyes and the early stage of glaucomous eyes in the 10 patients.Serious damage of visual field was seen in the advanced glaucomous eyes and presented with red color in the parapapillary RNFL area,mGCC area and macular RNFL area,showing an evidently attenuation of the thicknesses of parapapillary RNFL,mGCC and RNFL.However,the visual field was close normal in the early stage glaucomous eyes,and mGCC and macular RNFL showed yellow color,while green or yellow color was exhibited in the parapapillary RNFL area,indicating mGCC and macular RNFL thickness was reduced,but parapapillar RNFL thickness was near normal.Conclusions The change of mGCC thickness is earlier than that of peripheral RNFL at optic disc in primary glaucomaous eyes,which may imply that the disappear of macular ganglion cell body is earlier than that of the axon.

Objective:To analyze the association of clinical characteristics and laboratory indicators at initial maintenance hemodialysis(MHD)with long-term prognosis in advance-aged patients, and to find influencing factors for the prognosis in advance-aged MHD patients.Methods:This retrospective study was conducted at the Nephrology Department of Beijing Hospital between April 2007 and January 2018.A total of 61 patients receiving first-time hemodialysis at ≥ 80 years of age and undergone regular dialysis for 3 months or longer were enrolled.All patients were followed-up until death or the end of July 1, 2018.Patients were divided into the survivor and non-survivor groups, and differences in clinical characteristics and laboratory indicator values were compared between the two groups.Influencing factors for prognosis in advance-aged MHD patients were analyzed by using multivariate Cox regression.Results:For the 61 subjects, the median follow-up time was 25.8 months.During the follow-up, 32 patients died(52.5%). The main death causes were infectious diseases(40.6%, n=13)and cardiovascular and cerebrovascular diseases(37.5%, n=12). The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 75.4%(46/61), 54.1%(33/61), 37.7%(23/61), 22.9%(14/61)and 16.4%(10/61), respectively.The median survival time was 25.8 months for all patients, 27.5 months for patients aged 80-84 years, and 14.9 months for patients aged 85 years and over.The non-survivor group had a higher male ratio(65.6% or 21/32 vs.37.9% or 11/29, χ2=4.678, P=0.031)and lower levels of hemoglobin(85.4±13.0 vs.95.0±17.6 g/L, t=2.867, P=0.019)and albumin(30.3±5.0 vs.34.6±4.8 g/L, t=3.039, P=0.001)than the survivor group.Kaplan-Meier curves indicated that the survival rate decreased with age, and subjects aged less than 85 years had a higher survival rate than subjects aged 85 years and older(the median survival time: 14.9 months vs.27.5 months, Log Rank P=0.006); patients who received continuous renal replacement therapy(CRRT)before dialysis had lower survival rates than patients who did not receive CRRT(the median survival time: 7.8 months vs.29.2 months, Log Rank P=0.002); patients with high serum levels of albumin(≥33 g/L)had higher survival rates than patients with low serum levels of albumin(<33 g/L)(the median survival time: 29.2 months vs.18.9 months, Log Rank P=0.003). Multivariate Cox regression analysis showed that age at initial dialysis( HR=1.136, 95% CI: 1.005-1.285, P=0.041), female( HR=0.409; 95% CI: 0.169-0.994, P=0.048), serum albumin level( HR=0.836, 95% CI: 0.772-0.906, P<0.001)and CRRT before dialysis( HR=6.161, 95% CI: 1.848-20.538, P=0.003)were independent predictors of all-cause mortality in advance-aged patients. Conclusions:Advance-aged patients undergoing hemodialysis have complicated clinical conditions and poor prognosis.Age, gender and serum albumin level at initial dialysis and CRRT before dialysis are independent predictors of prognosis in these patients.

Objective To investigate the changes in lung resistance-related protein (LRP) and vascular endothelial growth factor (VEGF) expressions and micro-vessel density (MVD) in non-small cell lung cancer (NSCLC), and to elucidate their possible relationship and mechanism. Methods Immunohistochemistry was used to detect changes in LRP and VEGF expressions, and MVD level in lung tissues of 56 NSCLC cases and 27 normal controls. Results ① LRP expression (66.1%) was concentrated in the cytoplasm of cancer cells, which was significantly higher than that in lung tissues of control group (P<0.01); the significance was not related to the pathological type. There was no significant difference in LRP expression among gender, TNM stage, lymph node metastasis, and two-year survival in NSCLC (P>0.05). ② In comparison to the control group, NSCLC group had significantly increased VEGF expression (P<0.01), which was not related to the pathological type. VEGF expression in NSCLC group had a significant association with TNM stage and lymph node metastasis (P<0.05). ③ The NSCLC group had a significantly higher MVD than the control group (P<0.01), which was not affected by the pathological type or degree. MVD value (18.5±5.8) of stage Ⅲ and Ⅳ in NSCLC group was significantly higher than that (13.8±5.1) of stage Ⅰ (P<0.05); MVD value for patients with lymph node metastasis was higher than that without lymph node metastasis (P<0.05); MVD value for patients with two-year survival was less than those who died within two years (P<0.01). ④ NSCLC group with high VEGF and LRP expressions had a consistently increased MVD value (P<0.05). Conclusion There is a certain relationship between tumor angiogenesis and LRP expression in NSCLC. VEGF is responsible for the high expression of LRP through up-regulating LRP gene and augmenting tumor MVD. Inhibition of angiogenesis in tumor is expected to reduce or inhibit drug resistance to NSCLC.

Objective To explore body image(BI),prosthesis satisfaction and quality of life(QOL)of amputees from Wenchuan earthquake and the relationship among them to provide evidence for the intervention.Methods A total of 21 amputees accepted a survey regarding QOL,BI,and satisfaction with prosthesis.The scale of SF-36 was used to assess QOL.Amputees Bodily Image Scale(ABIS)was;used to assess BI.A self-design questionnaire wag used to evaluate the prosthesis satisfaction of amputees.Results The scores of SF-36,ABIS,and prosthesis satisfaction wag 41.90 ±15.00,64.58 ±10.60,and 59.52±11.06,respectively.The ABIS scores in women(65.07 ±12.10)were hisher than that in men(63.20 ±5.0)(P＜0.05).There was a positive correlation between score of QOL and prosthesis satisfaction,but a negative correlation between QOL and BI.The negative correlations were also observed between BI and Vitality,BI and mental health.Prosthesis satisfaction had positive correla tions with education level.QOL and mental health.Conclusion The body image disturbance(BID)and dissatis faction with prosthesis may cause negative influences on the amputees'quality of life.Relevant intervention should be provided of amputees handling their prostheses and body images correctly and raising QOL.

Objective To investigate the association between chromosome variations,abnormalities and male reproductive hor-mones level with spermatogenesis.Methods The chromosome karyotype,serum reproductive hormone including FSH,LH,T,PRL and E2,and semen were detected in 147 patients with male infertility or recurrent sponotaneous abortion.The results were per-formed the comparative analysis.Results Serum FSH,LH level and the incidence rate of azoospermia in the chromosome abnormal-ity group were significantly higher than those in the chromosome variation group and the normal group(P <0.05,P <0.01),serum T level was significantly lower than that in the chromosome variation group and the normal group(P <0.05).Serum FSH and the incidence rate of oligospermia in the Y chromosome variation group were significantly higher than those in the autosomal variation group(P <0.05).The incidence rate of azoospermia had no statistically significant difference between the Y chromosome variation and the autosomal variation group(P >0.05).Serum FSH,LH level and the incidence rate of azoospermia in the sex chromosome abnormality group were obviously higher than those in the autosomal abnormality group(P <0.05),the serum T level was signifi-cantly lower than that in the autosomal abnormality group(P <0.05).Conclusion The chromosome variation and abnormality are closely related with the reproductive hormones disorder and spermatogenetic function disorder.The obvious increase of serum FSH, LH level and obvious decrease of T level caused by sex chromosome variation and abnormality is one of the pathogenesis of oligo-spermia and azoospermia.

Objective To understand the blood pressure variability (BPV) and the influencing factors through ambulatory blood pressure monitoring during hemodialysis (HD) in the end-stage renal disease (ESRD) patients.Method Eighty-one ESRD patients on maintenancing HD for more than three months were enrolled into the study.The patients were with properly dry body weight.The blood pressure was monitored using dynamic blood pressure monitor around the HD.BPV was estimated with the coefficient of variation (CV) and standard deviation (SD) of the systolic blood pressure (SBP-CV,SBP-SD).Patients were divided into two groups according to the mean of SBP-CV:high SBPV group and low SBPV group.The possible influencing factors such as age,dialysis duration,ultrafitration volume,ultrafiltration/body weight,therapy of antihypertensive,electrolyte,nutrition state,metabolic bone disease indexes,inflammatory state and serum lipid state were analyzed and compared between the two groups.And multivariate stepwise regression analysis was made between the SBP-CV,SBP-SD and the above observational parameters.Results The average SBP-CV of the 81 patients was (8.12± 3.16)％,SBP-SD was (11.22±4.55) mm Hg.The proportion of hypertention and hypotention in high SBPV(SBP-CV≥8.12％) group (20.0％,25.7％) was higher than that in the low SBPV(SBP-CV ＜8.12％) group (8.7％,6.5％)(P =0.009).Serum high-sensitivity c-reactive protein (hs-CRP) and alkaline phosphatase (ALP) were higher in high SBPV group than that in the low SBPV group[(7.19± 5.95) mg/L vs (3.35±2.78) mg/L,P =0.001 and (180.31±96.32) U/L vs (98.00±41.19) U/L,P =0.049].Serum creatinine and potassium were higher in the low SBPV group than that in the high SBPV group [(1015.83±276.20) μmol/L vs (893.63±216.61) μmol/L,P =0.034 and (5.27±0.78) mmol/L vs (4.80± 0.23) mmol/L,P =0.005].SBP-SD was positively correlated with hs-CRP (β =0.499,P ＜ 0.01),SBP-CV was positively correlated with hs-CRP and dialysis vintage (β =0.464 and 0.211,P ＜ 0.01 and P ＜ 0.05) by the multivariate stepwise regression analysis.Conclusions The SBP-CV during HD is 8.12％ in ESRD patients.Hypertention and hypotention are more often in the higher SBPV patients.SBPV is closely related to the serum hs-CRP.

Objective To investigate the role of activities of sympathetic nerve in the pathogenesis of shoulder-hand syndrome (SHS) by analyzing the hand sympathetic skin response (SSR) at the acute stage of SHS after stroke. Methods 50 stroke patients with SHS at the acute stage were assigned as SHS group, another 50 stroke patients without SHS as control group (N-SHS group) and 50 health volunteers as health group. Every patient was subjected to the detection of bilateral hand SSR. Results The detection rates of SSR in the SHS group and N-SHS group were significantly lower than that in the Health group (P<0.01). In comparison within the SHS group, the amplitude of SSR on the affected hand was apparently higher than on the healthy hand (P < 0.05), but there was no significant difference in the SSR latencies in both hands ( P > 0 . 05 ) . In comparison with the health group , bilateral SSR latencies of the SHS group were longer than those of the health group (P<0.05) and bilateral SSR amplitudes were all lower than those of the health group (P<0.01). Conclusions The bilateral hand sympathetic skin responses could change at the acute stage of SHS after stroke, with possible presentations of central inhibition of sympathetic activity. The abnormality of SSR may be an early warning indicator in patients with hemiplegia after stroke complicated with SHS.

Objective Large-conductance culcium-activated potassium (BKCa) channel modulates vascular smooth muscle tone. In the present study, we tested the hypothesis that salt, one of the factors which significantly influence bleed pressure (BP), can regulate BKCa activity and then elevate blood pressure. Methods Male Spragne-Dawley rats aged 6 weeks were randomized into high salt diet group (HS) and control group, fed with high salt diet (containing 5% NaCi) and standard rat chow (containing 0.4% NaCl) respectively for 16 weeks. Tail systolic blood pressure (SBP), body weight (BW) and 24-hour urinary output were tested every 4 weeks. Content of urinary Na+ was detected using flame spectrophotometrical method. At the end of 16 weeks, all the rats were killed, the mesenteric arteries were obtained, and single mesenteric smooth muscle cells were isolated at once. The resting membrane potential (Em), the total potassium currents and the currents after perfusion with TEA solution of the cells were all recorded by whole cell patch clamp. The transcriptions of BKCa channel α and β1 sobunits in mesenteric arterial vascular smooth muscle cells (VSMC) of each group were calculated by real-time RT-PCR. Results There was no difference in SBP and BW at each stage between control group and HS group; the urinary Na+ level in HS animals was elevated significantly after 4 weeks.The negative values of Em in HS group VSMCs were reduced compared with these in the control group. Transcriptions of β1 subanit of BKCa channels were decreased in HS group, but α subunit transcriptions did not differ between the two groups. Whole cell potassium currents did not differ hetween HS and control groups, but BKCa currents of HS group VSMCs were lower than these of control group ones. Conclusion Even without elevating SBP, salt-loading can still modulate the expression and activity of BKCa channel in the mesenteric arterial VSMC and elevate vascular tone.

Objective To investigate the effects of magnesium metabolism and other positive ions in pathogenesis of essential hypertension(EH) patients with insulin resistance(IR). Methods The levels of Na+, K+, Ca2+, Mg2+ in erythrocyte and 24-hour urine samples were observed in 47 EH patients and in 30 subjects with normal blood pres sure. Insulin sensitivity index was used to evaluate the insulin sensitivity. Results In EH patients, the levels of K+ and Mg2+ in erythrocyte declined, but the levels of Na+ and Ca2+ in erythrocyte increased, and the 24-hour urinary excretion of Mg2+ reduced as compared to the subjects with normal blood pressure (P ＜0. 05). The levels of K+ and Mg2+ in erythrocyte of EH patients positively correlated with insulin sensitivity index, and the Mg2+ level in erythro cyte positively correlated with 24-hour urinary excretion of Ca2+ and Mg2+ , and the K+ level in erythrocyte. Conclu sion Abnormality of magnesium metabolism in EH patients may be the linking factor for hypertension and insulin re sistance, and may relate to inadequate intake of magnesium. Calcium and potassium may be involved in the occur rence of insulin resistance through affecting magnesium metabolism.