Recent studies have found that inflammatory response is positively associated with the progression of liver cirrhosis,acute-on-chronic liver failure,and primary liver cancer and can affect their prognosis,and as a marker for inflammatory response,neutrophil/lymphocyte ratio (NLR) is easy to calculate,has good repeatability,and holds promise for prognostic evaluation.This article introduces the research advances in the association of NLR with the prognosis of liver cirrhosis,acute-on-chronic liver failure,and primary liver cancer and points out that NLR plays an important role in evaluating the prognosis of liver cirrhosis,acute-on-chronic liver failure,and primary liver cancer.However,there are still controversies over the selection of optimal cut-off values for different diseases,and further studies are needed.

Early and accurate diagnosis of hepatic fibrosis and application of antiviral therapy are the key to improving the prognosis of patients with chronic hepatitis B (CHB).Liver biopsy and transient elastography cannot be widely used for the diagnosis of hepatic fibrosis in clinical practice,and therefore,the serological diagnostic model has become a hot research topic in recent years.This article introduces a new serological diagnostic model,γ-glutamyl transpeptidase-to-platelet ratio (GPR),which has a high value in the diagnosis of hepatic fibrosis in CHB patients;however,the accuracy of GPR varies between different populations and different areas.GPR is also an excellent predictor for the prognosis of hepatitis B-associated liver cancer.It is pointed out that GPR has a promising future in the diagnosis of hepatic fibrosis in CHB patients,but due to a lack of clinical research data on GPR,further studies are needed to support its application in China.

Objective To observe the changes in OLETF kideys at different stage and the beneficial influences by modulating serum lipids. Methods OLETF rats aged 8 wks were randomly divided into treated group and untreated group,and LETO rats served as normal control.Fenofibrate 20 mg/kg was given daily to the treated group.OGTT was performed at the age of 8,16 and 24 wks.Blood glucose,serum lipids and 24 h urine albumin excretion(UA) were investigated.The rats were killed at 16 and 24 wks of age,and the kidney sections were stained with PAS.Transforming growth factor-?_1(TGF?_1),vascular endothelial growth factor(VEGF) and fibronectin(FN) were investigated by immunohistochemistry assay.The electron microscope(EM) sections were made to measure GBM width and to observe the mesangial matrix.Results(1) Blood glucose had no significant difference between untreated and treated groups at 16 and 24 wks of age;(2) Fenofibrate decreased serum TG, increased HDL-C markedly but had no influence on LDL-C;(3) As aging,24hrs UA increased in untreated group,and reduced significantly in fenofibrate group at 24 wks of age;(4) TGF-?_1,VEGF and FN expressions were all higher in untreated group than in treated group at 24 wks of age.(5) EM revealed GBM obviously thickened and mesangial matrix widened in untreated group.Fenofibrate attenuated the kidney lesion greatly in EM picture.Conclusions (1) Dyslipidemia occurs prior to glucose metabolism abnormity in OLETF rats;(2) As aging,dyslipidemia progresses accompanying markedly the increased UA,enlarged glomeruli,thickened GBM and widened masangial matrix;(3) Modulating lipids early couldn′t improve glucose metabolism,but corrects dyslipidemia and reveals beneficial influence on kidneys;(4) The possible mechanism is that modulating lipids decreases TGF-?_1 and VEGF expressions.

Clinical teaching effect is directly affected by internship tutors’quality which is not very good at present. For this reason,a questionnaire on teachers and students was made and several solutions were put forward by analysis on the survey results.

Chronic obstructive pulmonary disease (COPD) is the leading death cause of pulmonary diseases, ranking the fourth of global death causes. Self-management program is able to gradually improve the Airways of COPD patients with ventilation, reduce the degree of lung failure, elevate the health status as well as promoting self-efficacy, which is the key process to effectively control COPD relapse. In recent years, more and more domestic and foreign academic employ the widely-used network technology and carry out a large number of information study on COPD self-management intervention. This article reviewed literatures about the intervention methods on self-management of patients suffered from COPD, aimed at providing a better basis for exploring more effective self-management.

SUMMARY Hyperparathyroidism is the clinical syndrome that results from elevated circulating parathyroid hormones,leading to multiple systems manifestations,and is divided into three kinds: primary, secondary and ternary.This patient’s main chief complaint was intermittent melena for 3 days,with the diagnosis of upper gastrointestinal hemorrhage according to endoscopy. Hypercalcemia, hypophosphatemia and high level of circulating parathyroid hormone and chronic renal failure were also found during hospitalization. Furthermore, MIBI showed a parathyroid adenoma located near the isthmus in the lower part of the left lobe. The patient had undergone nephrectomy because of kidney carcinoma 2 years ago. Primary hyperparathyroidism usually has the common gastrointestinal syndrome , but upper gastrointestinal hemorrhage reported as the chief complaint is rare and we had never seen similar reports before.

To summarize the clinical data of two cases with severe hyponatremia diagnosed as adrenal insuffiency combined with syndrome of inappropriate secret on of antidiuretic hormone(SIADH),and to review related literatures.Case 1 diagnosed as Addison's disease for 27 years and developed severe hyponatremia again but did not response well to sufficient glucocorticoid.Further examination showed SIADH caused by lung cancer and tolvaptan worked well.Case 2 was diagnosed as SIADH caused by lung cancer and responsed well to tolvaptan.However,hyponatremia reoccurred with the decreasing level of ACTH and cortisol during the chemotherapy.It was thought that hyponatremia was caused by drug-related adrenal insuffiency and glucocorticoid replacement therapy achieved good response.Both primary/secondary adrenal insuffiency and SIADH can lead to severe hyponatremia,but it is rare that the two situations exist in one patient and occur in different time.We should consider the possibility of the situations when we make differential diagnosis of refractory hyponatremia,monitoring the curative effects carefully,then correct the diagnosis timely,and reduce missed diagnosis and misdiagnosis.

Objective To analyze the characteristics of PHPT patients of our hospital.Methods Retrospective analyze 82 PHPT patients who hospitalized in our hospital from 1974 to 2006,male 41,female 41,age 16～83 years,course 1 month～40 years.All of the final diagnosis was PHPT clinically,while 67 were confirmed by pathology.Results (1)The number of diagnosed PHPT patients was increasing year by year,the cases diagnosed in 2002—2006 were more than the sum of past years.(2)The first visit department was widespread for PHPT patients,up to 47.6% went to urology department firstly,while only 24% went to endocrinology department.(3)Clinical presentation:42.7% patients presented simple urinary system calculus,15.9% ostalgia with urinary system calculus,17.1% simple ostalgia,while 20.7% with pathologic fracture,and 7.3% chronic renal failure,3.6% peptic ulcer,2.4% chronic pancreatitis.69.5% occurred typical hypercalcinemia and hypophosphatemia,30.5% revealed hypophosphatemia chiefly.(4)The coincidence rate between the examinations preoperation and pathology:B type ultrasound 64.5%,CT scan 37.3%,99m Tc-MIBI scan 90%.(5)Pathology presentation:73% single adenoma,17.9% hyperplasia,2.9% adenoma with hyperplasia,1.5% carcinoma,other 4.5% only seen some parathyroid tissue.Conclusion PHPT patients have various clinical presentation,so there are generally missed diagnosis and misdiagnosis.we should investigate serum calcium,phosphate and PTH level to exclude PHPT.

Objective:To explore the possible molecular mechanism of abnormal renal lipid metabolism in OLETF rats, and the effects of fenofibrate or metformin on renal local lipid metabolism. Methods: OLETF rats were randomly divided into three groups:one treated with fenofibrate, one with metformin and one without treatment. LETO rats were used as age-matched normal controls. The animals were sacrificed and the kidneys were obtained respectively at the age of 17 and 30 weeks. 24-hour urine albumin contents and TG contents in renal cortex were measured. The levels of SREBP-1 protein and mRNA in kidney were measured. FAS mRNA and ACC mRNA expressions were measured with RT-PCR. Results:OLETF rats showed characters of obesity, hyperglycemia, hyperlipidemia. At the end of thirty weeks clinical characters of renal damage appeared in OLETF rats, OLETF rats showed higher levels of 24-hour urine albumin contents than those of LETO rats. 24-hour urine albumin contents were correlated positively with TG contents in kidney. The partial correlation coefficient was 0. 870(P = 0.011) by controlling for body weight, serum lipid, blood glucose and fasting insulin concentration. OLETF rats showed higher levels of SREBP-1 protein (43. 2% , P

Objective This study was designed to estimate the value of Cystatin C, compared to routine marker (Scr、Ccr), as the screening marker for reduced GFR in type 2 diabetes patient. Methods The study was performed on 51 type 2 diabetic patients, and GFR was estimated by the plasma clearance of ~ 99m Tc-DTPA. Sensitivity and specificity for the diagnosis of renal impairment were calculated by receiver operating characteristic (ROC) curves for above three parameters.Results Correlation coefficients with ~ 99m Tc-DTPA were-0.744 for serum Cystatin C,-0.658 for serum creatinine, 0.625 for creatinine clearance (all P