Objective To study the inducement and prognosis of pregnancy-induced hypertension syndrom(PIH) with heart failure. Methods The clinical data of 13 patients suffered from PIH-related heart failure were retrospectively analysed. Results PIH-related heart failure was associated with no regular antenatal care, anemia, hypoproteinemia, infection of respiratory tract and fluid infusion overloading. There is no maternal mortality in 13 patients.The main prenatal diseases included asphyxianeonatorum (53 84%) low-birth weight(53 84%) and IUGR(31%). Conclusion Regular antenatal care and cardiac function monitoring should be strengthen in patients with PIH. Preventing anemia, and hypoproteinemia, treating the infection and reducing heart load could promote maternal and fetal quality in patients with PIH.

BACKGROUND:The region around the hip is a bone tumor predilection site. It is difficult to conduct tumor resection due to the involvement of weight loading area. Tumor resection requires high surgical technique. The pelvis and hip are often needed to be rebuilt.
OBJECTIVE:To compare the effects of three reconstruction methods after tumor resection around the hip.
METHODS:From January 2007 to December 2012, 20 patients with bone tumors around the hip were treated by surgery in the Zhongshan Hospital, Wuhan University, including 7 benign tumors, 13 borderline and malignant tumors. Eight patients received al ograft. Eight patients received arthroplasty. Four patients received saddle prosthesis.
RESULTS AND CONCLUSION:A total of 20 patients were fol owed up for 5 to 60 months (averagely 40 months). According to Enneking evaluation criterion, the operative outcome was evaluated as excellent in 8 cases, good in 5 cases, average in 4 cases, and poor in 3 cases. Excellent and good rate was 65%. Results suggested that after excision of bone tumors, al ograft, arthroplasty or saddle prosthesis can significantly elevate patient’s survival rate, improve patient’s living quality and is an effective therapy for treating tumors around the hip.

Objective To investigate the relationship of peroxisome proliferator activated receptor gamma ( PPAR?)C161T gene polymorphism with related diseases of metabolic syndrome. To disscuss the mechanism of the elderly diseases from gene level and the relation between the gene polymorphism and lipid metabolism. Methods Three hundred seventy one non-sibship subjects of Han nationality were investigated in this study, including 69 old healthy subjects, 302 elderly cases diagnosed as metabolic syndrome. PPAR? C161T gene polymorphism was determined by polymerase chain reaction and restriction fragment length polymorphism, and radioimmunoassay was used to detect serum insulin. The insulin resistance was obtained from homeostasis model assessment (HOMA), and blood glucose, blood lipoprotein, height, weight and so on were tested. The frequencies of PPAR? C161T genotypes and the allele were compared with the clinical data. Results (1) In the groups of old normal health and metabolic syndrome, "T" allele frequency was 0.217,0.201, and "C" allele frequency was 0.783, 0.798 . There was no significant difference between the groups. (2)The triglyceride in CC genotypes of the metabolic syndrome was significantly higher than that in "T" allele carriers. Conclusions (1) The distributing trend of PPAR ? C161T gene polymorphism of the Han nationality in Wuhan in the elderly normal healthy group was in accord with that in the group of the elderly metabolic syndrome. (2) PPAR ? C161T substitution can influence metabolic syndrome, especially in liporprotain metabolism. "T" allele is associated with lower level of triglyceride.

Objective To evaluate the feasibility,safety and efficacy of tubeless percutaneous nephrolithotomy ( PCNL).Methods Patients who underwent PCNL were randomized into 2 groups by extracting a random number generated from random number table,tubeless PCNL group and traditional PCNL group when the stones were cleared.Each patient in tubeless PCNL group was treated with insertion of a F5 ureteral double pigtail stent without placement of nephrostomy tube,while both double pigtail stent and F16 nephrostomy tube were placed in patients in traditional PCNL group.Exclusion criteria were severe bleeding requiring blood transfusion,stone residual requring a second PCNL,severe hydronephrosis with the thickness of renal parenchyma less than 5 mm,pyonephrosis,stricture of ureter or ureteropelvic junction,and severe perforation of the collecting system.A total of 50 patients were enrolled in this study.Tubeless PCNL and traditional PNCL were performed in 25 patients,including 27 kidney units,respectively.The two groups had comparable demographic data.All the operations were performed by the same surgeon.Evaluation factors included postoperative pain,decreased hemoglobin,blood transfusion rate,incidence of fever and perirenal hematoma,and duration of hospitalization.Results The average visual analogue scale (VAS) score on postoperative day 1 in tubeless PCNL group was 2.24 compared with 5.04 in traditional PCNL group (P ＜ 0.01 ).The average hospital stay in tubeless PC NL group (3.04 d) was significantly shorter than that in traditioal PCNL group (6.88 d) (P ＜0.01 ).The differences in average hemoglobin drop and stone clearance in the 2 groups were not significant.The differences between the 2 groups in blood transfusion ( 1/25 in tubeless PCNL group vs 3/25 in traditional PCNL group,P ＞0.05),renal hematomas rate (6/27 in tubeless PCNL group vs 7/27 in traditional PCNL group,P ＞ 0.05) and fever rate (3/25 in tubeless PCNL group vs 4/25 in traditional PCNL group,P ＞0.05 ) were not significant.There was no incidence of urinary leakage from the nephrostomy site in the 2 groups.Conclusions Tubeless PCNL can significantly decrease postoperative pain and discomfort and shorten the duration of hospitalization without increase of complications.Tubeless PCNL is safe,effective and performable,but the contraindications such as massive haemorrhage,pyonephrosis,ureteral obstruction,severe perforation of the collecting system,residual stone requring a second PCNL,should be kept in mind.

Objective To investigate the efficacy and safety of electronic flexible ureteroscope Holmium laser lithotripsy in the treatment of kidney stones larger than 2. 0 cm. Methods From October 2012 to December 2013,43 cases of kidney stones larger than 2. 0 cm in diam-eter were treated with holmium laser lithotripsy under electronic flexible ureteroscope. A double-J stent was indwelled in ureter for 1~2 weeks before operation in each patient. Ureteral catheter guide wire was firstly put into the ureter with F8. 0/9. 8 semi-rigid ureteroscope,and the ac-cess sheath was put along the wire. Then,the electronic flexible ureteroscope(Olympus V5) was introduced into the pelvis. Stones were frag-mented with holmium laser,and greater than 3 mm crushed stones were removed with a set of stone basket. Results The diameter of the stones of the 43 patients ranged from 2~3. 2 cm,with an average of 2. 4 cm. The operation time ranged from 35~120 min,with an average of 68 min. Three patients complicated with chills,fever and other symptoms of infection,who were improved by active anti-infective treatment. No serious complications occurred. Postoperative hospital stay was 2~4 d,with an average of 3. 2 d. After 12 weeks of follow-up,stone clearance rate was 86% (37/43). Conclusion It is safe and efficacy to treat kidney stones larger than 2. 0 cm with electronic flexible ureteroscope, especially for the elderly,solitary kidney,and patients with a previous incision or percutaneous nephrolithotomy.

Objective To compare the safety and efficacy of flexible ureteroscopic lithotripsy (F-URS) and mini-percutaneous nephrolithotomy(MPCNL) for treating upper ureteral calculi by the randomized controlled clinical trial .Methods 120 cases of up-per ureteral calculi treated in this hospital from May to September 2013 were randomized into the F-URS group and the MPCNL group with 60 cases in each group .The postoperative clinical curative effects were compared between the two groups .Results The initial stone clearance rates of the F-URS group and the MPCNL group were 68 .33% and 95 .00% respectively ,and the difference was statistically significant (P< 0 .05) .The clearance rate of the two groups after postoperative 3 months were 96 .67% and 98 .33% respectively ,and the difference between the two groups had no statistical significance (P>0 .05) .The operating time of the F-URS group and the MPCNL group was (35 .33 ± 11 .57)min and (53 .75 ± 17 .31)min respectively ,the average hospital stay after operation was(3 .05 ± 0 .62)d and (5 .43 ± 1 .84)d respectively ,and the average visual analogue scale(VAS) score on first postoper-ative day was 1 .70 ± 1 .37 and 3 .68 ± 1 .57 respectively .These indicators had statistically significant differences between the two groups(P<0 .05) .The average dropped amount of hemoglobin and the occurrence rate of complications after operation had no sta-tistically significant differences between the F-URS group and the MPCNL group(P>0 .05) .Conclusion For upper ureteral calculi with surgical indication ,the effect of F-URS is equivalence to MPCNL in the aspect of the stone clearance rate ,but F-URS has high-er security and shorter postoperative hospital stay .In the department with the condition to conduct F-URS ,F-URS should be ranked as the preferred treatment method for upper ureteral calculi .

OBJECTIVE:To establish an optimal therapeutic window concentration of CsA trough levels in renal transplant recipients on triple immunosuppressants regimen METHODS:A total 1 874 samples from 268 renal transplant recipients were measured by fluorescence polarization immunoassay(FPIA) According to the duration after operation and clinical diagnoses ,the whole blood CsA trough levels were compared among subgroups RESULTS:The optimal therapeutic window concentration of CsA was 300～400?g/L(within 1 month after operation),250～350?g/L(2nd～3rd month),150～250?g/L(4th～6th month),100～200?g/L(7th～12th month)and 100～150?g/L(more than 12 months) CONCLUSION:The above mentioned therapeutic window concentratin of CsA trough levels was ideal for renal transplant recipients with no marked acute toxic effects and rejection reaction

BACKGROUND: Peroxisome proliferation-activated receptor-gamma (PPARγ) is the member of nuclear receptor superfamily, and closely related with the formation of atherosclerosis.OBJECTIVE: To investigate the relationship between PPARγ C161→T gene polymorphism and coronary atherosclerotic heart disease (CAHD).DESIGN: Randomized controlled experiment SETTING: Department of Cardiology, Tonai Hospital of Huazhong University of Science and Technology; Department of Cardiology, Zhongnan Hospital of Wuhan University; Center for Human Genome Research,Huazhong University of Science and Technology; Department of Internal Medicine, Affiliated Hospital of Hubei University of Traditional Chinese Medicine; Institute of Geriatrics, Dongzhimen Hospital, Beijing University of Chinese Medicine PARTICIPANTS: Totally 203 CAHD patients aged (65±11) years, including 129 males and 74 females, were the inpatients and outpatients of Zhongnan Hospital of Wuhan University and Tonai Hospital of Huazhong University of Science and Technology from June 2002 to December 2005.And 156 cases of them were diagnosed by coronary arteriongraphy, among which 43 patients without coronary artery affection or with coronary stricture ＜ 50%, and 113 patients with coronary stricture ＞ 50 %. While 89 healthy physical examinees of Han race and mean (59±9) years old were enrolled as control group, including 56 males and 33 females. There was no blood relationship between controls and patients.METHODS: The experiment was conducted at Tongji Hospital of Huazhong University of Science and Technology from June 2002 to December 2005. PPARγ C161→T gene polymorphism was determined by polymerase chain reaction and restriction endonuclease fragment length polymorphisms. The radio-immunity technique, coronary angiography and clinical routine biochemical index were applied to analyze the genotypic frequency and allele frequency distributions as well as the relation between clinical data, biochemical index and different genotypes. The risk factors of CAHD were estimated in the patients of different genotypes.MAIN OUTCOME MEASURES: The genotypic frequency and allele frequency distributions, the relation between clinical data, biochemical index and different genotypes, along with the blood lipid, blood glucose, fasting insulin and body mass index (BMI).RESULTS: Totally 103 CAHD patients and 89 controls were involved in the result analysis of gene polymorphism and yielded different gene distribution frequencies.① In control group, "T" allele frequency was 0.213 and "C" allele frequency was 0.787, and in CAHD group, "T" allele frequency was 0.192 and "C" allele frequency was 0.808. There was no significant difference in the genotypic frequency and C, T allele frequencies between two groups (P ＞ 0.05).② The CC genotype was dominant in CAHD patients with coronary artery lesions, and showed significant differences from "T"allele carriers (CT+TT) (P ＜ 0.05). The CAHD risk in the "T" allele carries (OR: 0.56, 95% CI: 0.24-0.63) was much lower than that in the CC homozygote (OR: 1.92, 95% CI: 1.09-2.54).③ Apolipoprotein B in patients with CC genotype was obviously higher than that in patients with "T" allele (CT+TT) (P ＜ 0.05), and there was insignificant difference in the insulin resistance index (P ＞ 0.05).CONCLUSION: There is an important correlation between the substitution of PPARγ C161→T and CAHD, and "T" allele carriers demonstrate a lower risk of CAHD.

Objective To investigate the clinical efficacy and safety of flexible ureteroscopic lithotripsy ( FURL) using holmium laser for medullary sponge kidney stones. Methods A flexible ureteroscope was placed into renal calyx via a ureteral access sheath ( UAS) . The stones underlying the mucosa were found,and then broken by holmium laser following incision of renal papillary mucosa. The stone fragments were washed or clamped out. The remission of clinical symptoms and incidence of perioperative complications were observed,and a KUB plain film was rechecked postoperatively. Results Stones underlying mucosa were found and broken successfully in all 14 patients and there was no serious bleeding. Back pain symptoms of patients were relieved in 3 to 7 days postoperatively or after the removal of double J stent. The stone fragments were mainly discharged spontaneously. The rechecking KUB showed the amount of stones of most patients was significantly re-duced three months after operation. Conclusion FURL using holmium laser is effective for the treatment of medullary sponge kidney stones as it can significantly reduce the loads of stones without serious complications. It’ s a minimally invasive,effective,safe and suitable way which is suitable for further spread of clinical application.

Objective To investigate the efficacy of leflunomide combined with prednisone in the induction therapy of proliferative lupus nephritis (LN).Methods A prospective,multicenter,randomized controlled clinical trial was conducted in patients with biopsy-proved proliferative lupus nephritis recruited from 15 renal centers from 2013 to 2015.Patients were randomized to two groups.Oral leflunomide or intravenous cyclophosphamide was given to patients in each group.Both groups received a tapering course of oral prednisone therapy.All patients were followed up for 24 weeks.The blood biochemistry,urine index,clinical curative effect and adverse reaction were recorded and analyzed statistically.Results A total of 100 patients were enrolled in this clinical trial,including 48 patients in leflunomide group and 52 patients in cyclophosphamide group.After 24 weeks,the overall response rate was 79％ (95％ CI 67％-90％) in the leflunomide group and 69％ (95％ CI 56％-82％) in the cyclophosphamide group.23％ (95％CI 11％-35％) of patients in leflunomide group showed complete remission compared with 27％ (95％CI 24％-30％) in cyclophosphamide group (P=0.35).The levels of 24-hr urine protein excretion,SLEDAI and anti-dsDNA antibody titers were decreased in patients treated with leflunomide group after 24-weeks treatment.And the levels of serum albumin and complement 3 after treatment were significantly higher compared with these before treatment.There was also no significant difference in changes of 24-hr urine protein excretion,SLEDAI score,anti-dsDNA antibody titers,serum albumin and complement C3 levels after treatment between two groups.Incidence of adverse events did not differ between the leflunomide and cyclophosphamide group.Conclusions Leflunomide combined with prednisone showed same efficacy compared with cyclophosphamide as induction therapy for lupus nephritis.Leflunomide might be an useful medicine in the induction therapy of lupus nephritis.