Objective To summarize the clinical features of patients suffering from pulmonary embolism (PE) with D-dimer ＜ 0. 5 μg/mL in order to raise the diagnostic accuracy and reduce the mortality rate of PE. MethodsD-dimer-negative patients with suspected PE were admitted from January 2006 through December 2009. A comparison of clinical features including clinical manifestations, vital signs, laboratory and ancillary findings between 16 patients finally diagnosed PE and 41 patients without PE. ResultsCompared with patients without PE, the D-dimer-negative patients with PE usually had past history of venous thromembolism (VTE) or recent surgery. The symptoms of chest tightness, acute dyspnea, tachypnea, lower extremity edema and typical S I QⅢTⅢ changes of ECG were more often occurred in patients with PE than those in patients without PE of control group. ConclusionsD-dimer test is a good screening test for acute PE because its negative predictive value is high, but when the patients have acute dyspnea, lower extremity edema, previous history of VTE or/and recent surgery and ECG SI QⅢ TⅢ changes, even if D -dimer ＜ 0. 5 μg/mL, clinicians also should pay attention to and if necessary, further tests should be considered to confirm the diagnosis of PE.

0.05).In the 35 patient who had unitary incontinence before the operation,the symptom disappeared in 6(17.1%) patients,and deteriorated in 2(5.7%).While in the 38 patients without urinary incontinence before the operation,9(23.7%) showed the symptom postoperation.Totally,urinary incontinence was developed in 11 patients after the operation.Conclusions The patients with moderate-to-severe pelvic organ prolapse treated by traditional surgical procedures have a low rate of objective cure and a high rate of recurrent cystocele.It is important to repair the anterior pelvic floor during the operation.And the surgeons should be alert to the possibility of urinary incontinence.

Objective To evaluate the endotoxin-neutralizing activity of modeling peptides from the limulus antilipopolysaccharide factor (MPLALFs, Ms) in vitro. Methods The endotoxin-binding activity of Ms was examined by biosensor technique and shown in values of Kon and Kd. The endotoxin-neutralizing effect was analyzed by limulus amebocyte lysate test. Results The biosensor technique results showed that the Kon values of M_0, M_1, M_2, M_3, M_4, M_6, M_8 and M_ 10 binding to LPS 055∶B5 were (840?5.716), (549?6.532), (842?6.530), (627?2.450), (996?5.716), (814?8.982), (556?1.633) and (635?2.449) arc second, of which M_4 and M_1 had the highest and lowest endotoxin-binding activity, respectively. The M_4 reacted to LPS with a Kd of 72.377 ?mol/L. The results obtained by the limulus amebocyte lysate test were the same with those from the biosensor technique. Conclusion M_4 has a potential good endotoxin-neutralizing effect in vitro.

Objective To characterize the molecular genotypes and quantitative serological biomarker, and to explore their clinical significance in patients with chronic hepatitis B ( CHB) . Methods A total of 210 CHB patients were enrolled and HBV DNA loading, HBV molecular genotypes, quantitative serological biomarker, and ALT were measured. Patients were grouped according to the natural phases of HBV infection:HBeAg (+) immune tolerance, immune clearance, HBeAg (-) low replicative and reactivation phase. The correlation was analyzed between molecular genotypes and serological biomarkers, HBsAg and other biomarkers. Results Subgenotypes B2 with high level of HBV DNA and C2 with middle level of HBV DNA were found to be most prevalent. The positive rates were 59. 0%(B2) and 25. 2%(C2). Patients genotype with B showing more potent viral activity. Subgenotype B2 was sinificantly corelated with HB-sAg, HbeAg, and ALT levels(P < 0. 01), but there was no statistical difference for subgenotype C2. There was statistical difference be-tween positive rates of subgenotypes(P>0. 05), but HBsAg level was found to be significantly correlated with HBV DNA, HBeAg, ALT levels during some phases of CHB. Conclusion Molecular genotyping and quantitative serological biomarkers detection might be helpful for earlier prediction of the long-term disease outcomes in patients with CHB.

Objective To study the possible role of cytokines interleukin-1beta(IL-1?),interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor alpha(TNF-?)and granulocyte macrophage colony stimulating factor(GM-CSF)in the pathogenesis of vitiligo.Methods The serum levels of IL-?,IL-6,IL-8,TNF-?,and GM-CSF were measured in50patients with vitiligo and20healthy volunteers with radioimmunoassay.Results The serum level of IL-6and GM-CSF in focal type and generalized type of vitiligo,and the serum level of IL-1?in generalized type were significantly higher than those in normal controls.In segmental type of vitiligo,the serum levels of all the cytokines tested were not significantly different from those in normal controls.The GM-CSF levels in focal type and generalized type,and the IL-6level in generalized type of the progressive stage were significantly higher than those in the stable stage.Conclusion IL-6and GM-CSF may be involved in the autoimmune mechanism of non-segmental type of vitiligo.

Objective Prostate cancer is one of the most common cancer in males .The article was to investigate the expres-sion and clinicopathological significance of VEGF-C mRNA in prostate cancer , finding the molecular marker for early diagnosis and prognosis assessment of prostate cancer . Methods TaqMan real-time polymerase chain reaction ( PCR) analysis was used to detect the expression of VEGF-C mRNA in 3 prostate cancer cell lines(PC-3, DU145 and LNCap), 32 cases of prostate cancer (Pca) sam-ples and 15 cases of benign prostatic hyperplasia (BPH).Analysis was also made on the correlations of VEGF-C mRNA expression, clinicopathological features and prognosis . Results High levels of VEGF-C mRNA were detected in PC-3 ( 153 .31 ±26 .24 ) and DU145(194.62 ±41.36)compared to LNcap(1.00 ±0.00).The expression of VEGF-C mRNA in prostate cancer tissues was 3.43 folds higher than that in the benign prostatic hyperplasia tissues ([13.67 ±1.95] vs [11.89 ±1.63], P=0.004).The high expres-sion of VEGF-C mRNA in prostate cancer was associated with high Gleason score ( P =0.004 ) and lymph node metastasis ( P =0.015).In patients with high expression and low expression of VEGF-C mRNA, the 3-year survival rate was 12.5%and 40.0%re-spectively(P=0.033). Conclusion The VEGF-C mRNA expression may be related to the biological behavior of prostate cancer .It is suggested that VEGF-C mRNA can be used as a prognostic marker for prostate cancer .

Churg-Strauss Syndrome

Objective To explore the value of human epididymis protein 4(HE4),cancer antigen 125(CA125) and the risk of ovarian malignancy algorithm(ROMA) in the diagnosis of ovarian cancer.Methods Electrochemical luminescence and Enzymelinked immunosorbent assay (ELISA) were used to determine the levels of serum HE4,CA125 in 56 patients with ovarian carcinoma,73 cases of ovarian benign tumor and 50 health women,and the ROMA was calculated by HE4 and CA125 levels depending on the menopause state,drawing the receiver operating characteristics(ROC) curve and calculating the area under the curve(AUC).Results The average levels of the HE4,CA125 and the value of the ROMA were (345.33±605.03)pmol/L,(701.46±1 500.30) U/mL,(58.72±31.00) ％ in the ovarian carcinoma group,(53.84± 14.68)pmol/L,(44.25±45.81)U/mL,(10.80± 6.75) ％ in the ovarian benign tumor group,and (46.03±10.26)pmol/L,(17.39±10.64)U/mL,(6.92±3.85)％ in the health control group respectively,compared with the benign tumor group and the health control group,the ovarian carcinoma group were higher in HE4,CA125 and the ROMA value,and the difference were significantly (P＜0.05),whereas compared in the ovarian benign group and the health group,except the CA125 was higher in the benign group and the difference had statistical significance(P＜0.05),the HE4 level and the value of the ROMA had no statistical significance(P＞0.05).The sensitivities of the HE4,CA125 and ROMA were 71.43％,76.79 ％,89.28％,the specificities were 93.15 ％,53.42％,94.52 ％ and the ROC-AUCs were 0.930,0.809,0.937 respectively.When the specificity for the diagnosis of the ovarian carcinoma was 95.00％,the sensitivities of the HE4,CA125 and ROMA were 80.40％,53.60％,83.90％ respectively.Conclusion HE4 and CA125 combined detection to calculate the ROMA can elevate the sensitivity and specificity for the ovarian carcinoma diagnosis.

Objective Mitochondrial transfer RNA for leucine 1(MTTL1)is one of the most important causative genes of oxidative phosphorylation disorders.To understand the clinical,pathological and molecular genetics features of the disordel's caused by MTTL1 mutation.18 patients with a causative mutation in MTTL1 were analyzed.Methods The clinical features,the findings of tlleir biochemistry tests.the neuroimagings,the pathology of biopsied muscles and hereditary characteristics were retrospectively summarized.Results The mutations mt3243A>G and mt3271A>T within MTTL1 gene led to variant syndrome,encephalomyopathies with lactic acidosis and stroke like episodes,diabetes mellitus,progressive external ophthalmoplegia,leish syndrome and complex mitochondrial syndrome were reported.Usually,most patients were sporadic but maternal transmission was the common inherited model.Conclusion The disorders caused by the MTTL1 mutation are hishly phenotypic vailable.There is no association between phenotype and heteroplasmy in muscle.

Objective To investigate the clinical efficacy of arthroscopic Brostr(o)m-Gould procedure for chronic lateral ankle instability (CLAI).Methods A retrospective case series study was conducted to analyze the clinical data of 36 CLAI patients admitted to Zhejiang Provincial People's Hospital,Second Affiliated Hospital of Shenzhen University,Institute of Orthopedics of Soochow University,and Guangzhou Orthopedic Hospital from August 2016 to July 2017.There were 21 males (21 ankles) and 15 females (15 ankles),aged 18-42 years [(26.5 ± 8.6)years].The duration from injury to operation ranged from 6 to 30 months [(10.8-± 1.6) months].All patients received arthroscopic Brostr(o)m-Gould procedure (anterior talofibular ligament repair,capsular constriction,subextensor ligament reinforcement).The operation time and arthroscopic intra-articular lesions and treatment were recorded,and the wound healing and complications were recorded.The visual analogue score (VAS),front drawer test and varus stress test results,American Orthopedic Foot and Ankle Surgery Society (AOFAS) ankle-hind foot score and Karlsson-Peterson ankle function score were compared before operation,6 weeks after operation and at the last follow-up.Results All 36 patients were followed up for 18-29 months [(20.5 ±6.3) months].The operation time ranged from 45 to 115 minutes [(67.2 ± 18.6) minutes].During the operation,synovitis hyperplasia of ankle joint was found in 35 patients,scar tissue around ligament in 32,talus cartilage injury in 10,osteophyte in 19 and free body in 5,all of which were treated accordingly.All incisions were healed in the first stage after operation,without joint infection,superficial sural nerve injury or thread stimulation.The ankle varus was slightly limited in two patients after operation and improved after functional rehabilitation.No revision operation was needed at the last follow-up.Front drawer test and inverted stress test results were negative (-).The VAS score was (5.9 ± 1.6) points before operation,(1.9 ± 1.0) points at 6 weeks after operation,and (1.6 ± 0.3) points at the last follow-up,with significant difference compared with that before operation (P ＜ 0.01).The AOFAS ankle-hind foot score was (67.4 ± 7.4) points before operation,(89.2 ±4 6.8) points at 6 weeks after operation,and (91.7 ±5.3)points at the last follow-up,with significant difference compared with that before operation (P ＜ 0.01).Karlsson-Peterson ankle function score was (65.3 ± 9.6)points before operation,(88.6 ± 5.3) points at 6 weeks after operation,and (90.6 ± 3.8) points at the last follow-up,with significant difference compared with that before operation (P ＜ 0.0 1).Conclusion For CLAI,the arthroscopic Brostr(o)m-Gould procedure can treat the intra-articular lesions and reliably restore the stability of the lateral ankle.At the same time,quick motion recovery can be achieved,with satisfactory shortterm curative effect.