Controlling serum phosphorus levels is critical in patients with renal failure. Currently phosphate-binding agents are widely used to reduce phosphate absorption in patients with endstage renal disease. If possible,serum phosphorus level should be reduced without disturbing calcium homeostasis or increasing accumulation of potentially toxic elements. Aluminum hydroxide and traditional calcium -based phosphate binders are commonly used to control serum phosphorus level. Aluminum hydroxide can effectively lower serum phosphorus level,but aluminum can accumulates in the body and results in toxic effect. Traditional calcium-based phosphate binders tend to promote hypercalcemia and calcium overloading,and accelerate cardiovascular calcification. Therefore aluminum -free and calcium-free phosphate-binding agents have become the focus of study; however,agents like sevelamer hydrochloride and lanthanum carbonate are not widely used due to high price,although they are effective in controlling serum phosphorus level. New generation of phosphate binders,such as colestilan,nicotinic acid and magnesium salt,are cheaper than their previous counterparts,but their long -term effect still needs to be observed. This article summarizes the progress of non-calcium phosphate binders in treatment of end-stage renal diseases,hoping to help clinical drug usage.

Objective To evaluate magnifying Fuji intelligent chromo endoscopy (FICE) in diagnosis of colorectal lesions,and to explore the correlation between pit pattern,expression of Angiopeietin-2 (Ang-2) and mierovessel density (MVD). Methods A total of 100 colorectal lesions with pit patterns ranging from type Ⅰ to type Ⅴ (20 cases in each type) determined by magnifying FICE were divided into group A (n = 40,type Ⅰ and Ⅲ ),group B (n = 40,type Ⅲ and Ⅳ ) and group C ( n = 20,type Ⅴ ). The resuits of FICE were compared with pathological findings. Expression of Ang-2 was examined by immunohistochemical streptavidin-perosidase method and MVD was calculated. The correlation between pit pattern,Ang2 expression and MVD was analyzed. Results The diagnostic sensitivity,specificity and consistent rates of magnifying FICE for non-neoplastic colorectal lesions were 88.0%,92. 5% and 90. 2%,respectively,and those for neoplastic lesions were 94. 8%,91.7% and 93. 2%,respectively,with an overall consistent rate for colorectal lesions at 92. 0%. The positive expression rate of Ang-2 and MVD were progressively increasing from group A,B to C. Conclusion Magnifying endoscopy with FICE is valuable to differentiate neoplastic colorectal lesions from non-neoplastic ones. The positive expression of Ang-2 and MVD are closely correlated with the pit patterns of colorectal lesions.

Objective To evaluate the therapeutic effects of noninvasive bi-level positive airway pressure (BiPAP) ventilation after extubation in chronic obstructive pulmonary disease (COPD) complicated with type Ⅱ respiratory failure.Methods Forty-one intubated COPD eases with severe respiratory failure due to pulmonary infection (pneumonia or purulent bronchitis) were involved in the study.At the time of pulmonary infection control (PIC) window,the extubation was conducted and followed by BiPAP ventilation in 21 cases (the experimental group),while the other 20 COPD cases with similar clinical characteristics,as the control group,who continuously received invasive mechanical ventilation after PIC window.Outcomes including the duration of invasive ventilation,the total duration of ventilation support,success rate,the incidence of ventilator associated pneumonia (VAP) and mortality rate were observed and compared between the two groups.Results The two groups had similar clinical characteristics and gas exchange at the time of PIC window (P ＞ 0.05 ).Compared with the control group,the experimental group had shorter duration of invasive mechanical ventilation (6.9±3.0) d vs.(13.1 ±4.3) d,t=5.38,P＜0.001),lower rate of VAP (1/20 vs.8/20,x2 =5.51,P=0.02) andhigher extubation rate (20/21 vs.13/20,x2 =4.19,P =0.04).Conclusion In COPD patients with intubation and mechanical ventilation for respiratory failure,BiPAP ventilation after extubation at the point of PIC window may improve patients' prognosis.

Objective To study the function of cyclooxygenase 2(COX 2) and its specific inhibitor NS 398 on the cell growth and invasion ability of urothelial carcinoma cell line EJ. Methods The cox 2 cDNA was transfected into the urothelial carcinoma cell line EJ and a cell line EJ COX 2 which highly expressed cox 2 gene permanently was gained. The cell growth rate before and after transfection was observed. Then at various concentrations of NS 398, the invasion ability was detected by Boyden Chamber and expression levels of uPA by RT PCR and Western blot. Results The EJ COX 2 cell line grew more rapidly and had a stronger invasion ability than EJ and its uPA expression increased significantly. NS 398 could dose dependently inhibit the expressions of COX 2 and uPA and the invasiveness of EJ COX 2 cell. Conclusion COX 2 can stimulate the growth of urothelial cell line EJ and promote its invasion ability by stimulating the expression of uPA.

Objective:To evaluate the clinical performance of CAD/CAM zirconia all-ceramic restorations.Methods:287 all-ce-ramic Zirconia restorations in 206 patients were included in a 3-year prospectively survey with California Dental Association Standard (CDA)as a reference.The effects and the related factors such as restoration type,tooth region,fiber reinforced composite application on survival rate were analyzed.Kaplan-Meier survival analysis and Log-Rank test were used for data analysis.Results:Chipping frac-tures in 5 restorations,intense gingivitis at 4 restorations and periapical inflammation for 3 restorations were observed during the obser-vation period.The 3-year cumulative survival rate (CSR)of CAD/CAMzirconia restorations was 95.7%,The differences among the CSR of single crowns(96.3%),linked crowns (93.6%)and fixed partial dentures(95.7%)were not statistically significant(P >0.05).The difference was not statistically significant(P >0.05)between the CSR of the anterior region group(94.5%)and posterior region group(96.3%)as well as difference(P >0.05)between the CSR of fiber reinforced composite group (95.0%)and without fiber reinforced composite group(96.1%).Conclusion:The cumulative survival rate of CAD/CAM zirconia all-ceramic restorations is high.Chipping fracture is the main reason of failure.Restoration type,tooth region and fiber reinforced composite have no significant effect on the survival of zirconia restorations.

BACKGROUND: Diabetic morbidity can predict its progress tendency. National diabetic morbidity has been increased compared with previous level at present.OBJECTIVE: To compare the diabetic morbidity between populations with impaired glucose tolerance or normal blood glucose tolerance to analyze its correlative influencing factors.DESIGN: A cluster sampling survey in two communities of Liuzhou City Guangxi Zhuang Autonomous Region based on adults.SETTING: Department of endocrinology in a university hospital.PARTICIPANTS: Diabetic morbidity was investigated in 4 relative big unit communities of Liuzhou City between July and August 1994. The resident population of the communities was 11 886, which were all adults between 20 and 75 years old and lived in Liuzhou City for more than 5 years. Populations with either impaired glucose tolerance or normal blood glucose tolerance in 2 of the 4 unit communities were followed up in October 1999. Totally 9 230 individuals should be checked and 6 020 subjects were actually checked with the response rate of 65.22% (quite a few cases lost followed up due to unemployment and retirement, etc. ) . Inclusion criteria: Finally 5 539 subjects with complete data of two surveys entered into statistics. There were 5 237 normal individuals and 266 individuals with impaired glucose tolerance. And there were 3 177 males including 110 individuals with impaired glucose tolerance with an average age of(40 ± 12) years old, and 2 362 females including 156 individuals with impaired glucose tolerance with an average age of(41 ± 10) years old. Exclusion criterion: secondary diabetes.METHODS: Totally 5 539 subjects(including individuals with normal blood glucose or impaired glucose tolerance) who confirmed without diabetes in 1994 survey for diabetic morbidity in 2 unit communities of Liuzhou City Gugangxi Zhuang Autonomous Region received recheck in 1999 including blood glucose, body mass index(BMI), blood pressure and blood fat to analyze the impacts of each factor on diabetic morbidity.bidity among correlative risk factors.RESULTS: Totally 5 539 individuals were included into statistics. A totally of 46 of 5 237 normal individuals developed diabetes with the annual percent of conversion of 0.19%, while 50 of 226 individuals with impaired glucose tolerance developed diabetes with the annual percent of conversion of 3.84%, which had 20.9 times of correlative risk significantly higher than normal individuals(x2 = 1 063.1, P < 0. 000 1).CONCLUSION: The risk of diabetes is higher in individuals with impaired glucose tolerance than normal individuals. Age, BMI, hypertension, fasting blood glucose, blood glucose, and 1 hour blood glucose in Glucose tolerance test are risk factors of diabetic morbidity.

Objective To summary the experience of microsurgery of meningioma in skull base treatment. Methods To study the clinical data of 10 cases patients of meningioma in skull base who were subjected to microsurgery by using retrospective analysis. Among the 10 patients, there were 3 cases of meningioma of the olfactory groove. There were 2 cases of sphenoid ridge meningioma, meningioma in the middle cranial fossa, meningioma in the cerebellopontine angle respectively.There was 1 case of meningioma of velarium in temporal lobe. Results In 7 cases, the meningioma was completely removed. And in another 3 cases, the meningioma got subtotal resection. During and after the operation, there were no severe complications observed or death occurrence in all the 10 cases of meningioma patients. Two months post of operation,all patients got a significant amelioration in their symptoms. A total of 9 cases were followed up. There was 1 case of IIa type meningioma recurred. Conclusion To elevate the whole shearing rate of meningioma in skull base and reduce the mortality of it,it is most important for appropriate operative route selection and well mircosugical technique application.

Objective To retrospectively analyze the one-year outcomes of modified single-armed suture technique for microsurgical vasoepididymostomy in men with epididymal obstructive azoospermia (EOA).Methods From February,2012 to November,2013,microsurgical longitudinal intussusception vasoepididymostomies using a modified single-armed suture technique in 51 men with EOA was performed.The followed-up period was designed as 1 year.The correlations between the sperm motility in epididymal fluid,unilateral or bilateral procedure,anastomotic site,and the female partner age and the patency or pregnancy rate were analyzed.Results Followups were carried out for 39 (76.5％) men.The patency was noted in 24 (61.5％) men and pregnancy was reported in 15 (38.5％) female partners,including 1 received in vitro fertilization using fresh ejaculated sperm.Motile sperms in epididymal fluid were observed intraoperatively in 14 (58.3％) patent men and 3 (20.0％) nonpatent men,respectively (P ＜ 0.05).In patent cohort,the mean ages of the pregnant and non-pregnant female partners were 26.5 and 32.7 years(P ＜ 0.05),respectively.Conclusion The modified single-armed suture technique showed favourable patency and pregnancy rates in this study.It's a practical alternative in the areas without the specialized double armed suture.

Objective To study the missed diagnosis of colorectal polyps during colonoscopy and its risk factors.Methods Data of 655 patients who underwent repeated co]onoscopy in 3 months (90 days) were analyzed in three endoscopy centers in Shenzhen.Miss rates of polyps and patients were calculated.Logistic regression analysis was used to identify the suspected risk factors associated with the miss rate including gender,age,symptoms of patient and number,shape,location of polyps.Results A total of 459 polyps(20.47％,459/2 242) in 224 patients(34.20％,204/655) were missed in overall 1 783 polyps within 655 patients.The patient miss rate increased with the polyp count increasing from 1 to 4,but with no significant differences.Polyp count of more than 5 was the independent risk factor for patient miss rate during colonoscopy(OR=4.98,P=0.00).Polyps in males were easier to be missed than those in females (OR =1.76,P =0.00).Size less than 5 mm was the independent risk factor for missed diagnosis during colonoscopy(OR=2.94,P=0.00).The flat type(Yamada Ⅰ,Ⅱ) was also the independent risk factor(OR=2.72,P=0.01;OR=3.23,P=0.00 respectively).Conclusion The miss rate of polyps is related to gender,basic polyp count,the size and shape of polyp.Male with multiple polyps and polyps with flat type and small size tend to be missed.

We reported a case of polyglandular syndrome induced by programmed death-1(PD-1) inhibitors. The patient was a 51-years-old male with non-small cell lung cancer, treated with PD-1 inhibitor nivolumab/pembrolizumab because of postoperative subcarinal lymph node metastasis indicated by PET-CT. During 14 cycles of PD-1 inhibitor treatment, the patient successively developed primary hypothyroidism, and type 1 diabetes mellitus(T1DM). More than five months after the withdrawal of pembrolizumab, the patient experienced recurrentce. Laboratory examinations showed mild hyponatremia and hypopituitarism including ACTH and growth hormone(GH)/insulin-like growth factor-1(IGF-1) insufficiency. This is the first report of a patient diagnosed as polyglandular syndrome caused by PD-1 inhibitor. In particularly, the hypothyroidism and T1DM did not improve after drug withdrawal, while hypopituitarism was further aggravated. This case reminds us that we should pay more attention to the changes of endocrine function during and after the treatment of PD-1 inhibitor, so that we can make the correct diagnosis and take proper medical measures timely, to avoide missed diagnosis, and improper treatment.