BACKGROUND: The p27, one of the cyclin-dependent kinase inhibitors in renal disease, regulates cell growth through affecting cellular events. Abundant evidence has suggested that p27 has great role in regulating re nal cell proliferation, hypertrophy, differentiation and apoptosis, etc. OBJECTIVE: To investigate the relationship of protein 27 expressions in renal tissue with cell proliferation and apoptosis. DESIGN: Completely randomized grouping design, control animal experi ment. SETTING: Nephrology Laboratory, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology. MATERIALS: This experiment was carried out at Nephrology Laboratory of Internal Medicine, Tongji Hospital and Micro-Pathology Center in Tongji Medical College from September 2004 to January 2005. A total of 48 adult male SD rats were enrolled, all belonged to cleaning grade. METHODS: ①Establishing diabetic models: diabetic rat models were es tablished with streptozotocin, 60 mg/Kg, given through intraperitoneal in. Jection in the experimental group. Blood glucose and urine glucose from caudal vein were measured after 48 hours. Animals in experimental group whose random serum glucose at least 16.7 mmol/L and urine glucose ()- ()-() were regarded as successful models. ②Six rats in experimental group and the control group, respectively were sacrificed in the experimental pe riod of the 3rd, 7th, 14th and 28th days. Before sacrificed, creatinine clearance (Ccr) was measured. Concentration of Retinal binding protein (Rbp) in urine was measured. Proteinuric elements were analyzed by sodium dodecyl sulfate-polyacrlamide gelelectrophoresis (SDS-PAGE). ③Renal tissues were observed pathologic changes through light microscopy and electronic mi croscopy. ④Expression of p27 and proliferation cellnuclear antigen (PC NA) were detected by immunohistochemical staining method, and apoptosis was determined by Terminal deoxynucleotidy 1 transferase-mediated dUTP nick end labeling (TUNEL). We use positive glomerular cells / total glomerular cells to present positive rate and apoptosis rate. ⑤The data were analyzed for statistically significant group difference using unpaired t test and Spearman correlative-analysis. MAIN OUTCOME MEASURES: Renal function, urine protein, p27 ex pression in glomerular cells, positive rate and apoptosis rate of proliferating cell nuclear antigen (PCNA) expression and compared with the control group. RESULTS: Totally 48 rats were involved in the result analysis. ①Changes of pathology: At the 7th day after establishing models, glomerular hypertro phy was found through light microscopy and focal fusion of epithelial foot processes through electron microscopy. At the 14th day, mesangial region, which kept expanding through electronic microscopy, was seen under electron microscope. At the 28th day, slight segmental hypercellularity be gan to show in light microscopy. ②Ccr and Rbp levels of diabetic rats were higher significantly than those in the control group at the 7th, 14th and 28th days (t=2.143-3.004,P ＜ 0.05 ). The results of SDS-PAGE showed that middle and low molecular protein could be observed in every group from the 3rd day. ③The level of p27 expression in glomerular cells were lower obviously at the 3rd day(t=2.536,P ＜ 0.05), but higher at the 7th, 14th and 28th days in diabetic rats, which was higher remarkably than that in the control group (t=2.704-2.823,P ＜ 0.05). The number of PCNA positive cell in diabetic glomerulus became the largest at the 3rd day, then decreased continuously, it was still higher than that in the control group at the 7th dan 14th days (t=2.681,2.525,P ＜ 0.05), but became normal at day 28. The number of TUNEL positive cells in glomerulus also increased significantly at the 3rd day (t=2.764,P ＜ 0.05), but it was smaller than that in the control group at the 7th, 14th and 28th days(t=2.096-2.627,P ＜ 0.05). ④The level of p27 expression and the number of PCNA positive cells in glomerulus were negative correlated (r=-0.446, P ＜ 0.05). The level of p27 expression and the number of TUNEL positive cells in glomerulus were also negative correlated (r=-0.517, P ＜ 0.05).CONCLUSION: Functional impairment of reabsorption induced by proximal convoluted renal tubule and high filtering of glomerulus in early diabetics occurs synchronously. Protein p27 may be participated in the occurring and developing of diabetic nephropathy by checking of proliferation and apoptosis of renal cell in the early stage of diabetes.

Objective To explore the application value of uterine incision suture in multiple segment shrinkage in cesarean section.Methods 85 pregnants with uterine scar who taken cesarean section were selected.In the single month,the pregnants were included in the observation group(43 cases):after pruning scars,uterine lower segment weak muscle tissue by wrinkling suture to reinforce the thickness of the lower segment again from both sides of the suture,intermediate knotted suture the uterine incision.In the bimonth,the pregnants were included in the control group(42 cases):after pruning scars by conventional suture incision of lower uterine segment.The duration of vaginal bleeding time after operation ,postoperative 42 days ,3 months ultrasonography of uterine incision healing were observed.Results The postoperative vaginal bleeding volume of the observation group was less than that of the control group[(480.55 ±53.75)mL vs.(550.14 ±50.45)mL],the bleeding time was less than that of the control group[(21.31 ±6.78)d vs.(30.45 ±5.16)d],the differences were statistically significant(t =3.65,2.28,all P <0.05).March B -ultrasonography uterine incision after surgery,the good healing rate of the observation group was 95.35%,which of the control group was 78.57%,the difference was statistically significant(χ2 =4.35,P <0.05). Conclusion Incision under section shrinkage joint is conducive to the incision structure and muscle layer mechanical recovery and can reduce the amount of vaginal bleeding and time and defect healing of incision morphology.

AIM:To reveal the characteristics and patterns of mental activity in the cerebral cortex of patients with attention deficit hyperactivity disorder (ADHD) and explore the pathogenetic characteristics of ADHD.METHODS: The ADHD patients were asked to record their mental activity, general health condition and obsessions before the onset of pathological symptoms by means of psychological introspective reports.RESULTS: The direct cause of attention distraction and failure of attention focus is the patients' inability to perform cognitive tasks (including perception, memory and recollection, imagination, association and thought)in a continuously ongoing manner in relaxation. The frequent stagnancy and pause during the course of recognition precipitated the patients in a stressful state, which contributed to the onset of various hyperactivities and also resulted in the acquisition of "silent verbal thinking". This is an important psychopathological phenomenon long been neglected. All theses abnormalities caused the patients much discomfort, which was naturally relieved by means of impulsive and irritable behaviors.CONCLUSION: A series of clinical symptoms of ADHD arises from the same pathogenic factor of difficulty in mental activity and inability to carry out the activities in the cerebral cortex in a relaxed manner. The difficulty in mental activity is the key problem of ADHD and the source of various synptoms, which should be ;reated for the first place. The cause of this key problem is possibly lowered metabolism of the cerebral cortex, and the effect of "instinct" can not be neglected in the attempt to explain the pathogenesis of ADHD.

Objective To establish animal models in order to provide an experimental study basis for both the pathogenesis study and taking effective prevention scheme for doxorubicin extravasation injury. Methods A total of 20 Kunming mice for experiments on doxorubicin extravasation injury were divided in-to four groups, I.e., high dose group(2 g/L), medium dose group(1 g/L), low dose group(0.5 g/L) and the control group (injection with water). Dosages were administered with subcutaneous injection on both sides of mice abdomen. The adverse reaction of body, damage areas of extravasation injury, recovery period were observed and histopathologic slides of animal models on both 4 days and 11 days after experiment were performed and compared. Results No significant adverse body reaction was observed after injection for all groups. The damage areas due to extravasation injury were dosage and concentration dependent. In addi-tion, significant differences in recovery period were observed for mice in different groups, that is, the higher injection concentration and dose led to the longer recovery period. Results from the histopathologic study in-dicated that the putrescence of damage area was developed in high dose group mice, and the ulcer occurred after 4 d of dosage in medium dose group mice, respectively. In contrast, no ulcer was observed in low dose group mice. Conclusions It would be feasible to establish a prevention model for mice on doxorubicin extravasation injury by subcutaneous injection at a dosage of 0.05ml(1 g/L).

Objective To systematically evaluate the efficacy of high-flow nasal cannulae oxygen (HFNC) in patients with respiratory failure.Methods Computerized PubMed, Embase, Web of Science, the Cochrane Library, CNKI, CBM, VIP, Wanfang Database up to March 31st, 2017, all published available randomized controlled trials (RCTs) or cohort studies about HFNC therapy for patients with respiratory failure were searched. The control group was treated with face mask oxygen therapy (FM) or non-invasive positive pressure ventilation (NIPPV), while the experimental group was treated with HFNC. The main outcomemeasurements included endotracheal intubation rate, patient comfort, and the secondary outcome was in-hospital mortality. The quality of the literature was completed by two professionally trained evidence-based medical students, and meta-analysis was performed on quality-compliant literature. Funnel plot was used to analyze the publication bias.Results A total of 17 articles were enrolled including 15 RCTs and 2 cohort studies. There were 3909 patients enrolled, 1907 patients in HFNC group, and 2002 in control group (1068 patients with FM, and 934 with NIPPV). Meta-analysis showed that HFNC had a significant advantage over FM in reducing the tracheal intubation rate of patients with respiratory failure [odds ratio (OR) = 0.51, 95% confidence interval (95%CI) = 0.29-0.89,P = 0.02], but there was no significant difference as compared with that of NIPPV (OR = 0.80, 95%CI = 0.54-1.17,P = 0.25). It was shown by pooled analysis of two subgroups that compared with FM/NIPPV, HFNC had a significant advantage in reducing tracheal intubation rate in patients with respiratory failure (pooledOR = 0.66, 95%CI = 0.47-0.94, P = 0.02). Compared with FM, patients with respiratory failure were more likely to receive HFNC for comfort [standardized mean difference (SMD) = -0.41, 95%CI = -0.56 to -0.26,P < 0.00001]. There was no significant difference in hospital mortality between HFNC and FM (OR = 0.82, 95%CI = 0.55-1.24,P = 0.35) or NIPPV (OR = 0.66, 95%CI = 0.37-1.17, P = 0.16). The results of pooled analysis of two subgroups were still unchanged (pooledOR = 0.75, 95%CI = 0.54-1.05, P = 0.09). It was shown by the funnel analysis that there was a bias in the study of tracheal intubation rate in the literature, while the bias of patient comfort and hospital mortality was low.Conclusions Compared with FM, HFNC could reduce the rate of tracheal intubation in patients with respiratory failure, but no difference was found as compared with NIPPV. Compared with FM, HFNC made patients more comfortable, and it was easier to be accepted and tolerated. However, there was no difference in hospital mortality among FM, NIPPV, and HFNC.

Objective:To investigate the effects of mindfulness based stress reduction on irritable bowel syndrome.Methods:PubMed,EMBASE,Cochrane Library,Web of Science,CNKI,Wanfang Data was searched and randomized clinical trials of MBSR treatment in irritable bowel disease were involved.At last two reviewers extracted the data independently.According to Cochrane Handbook5.1.0 handbook,a quality assessment was made.All the data would be analyzed with meta-analysis by the software of Stata.Results:Totally 5 randomized controlled trials were eligible,including 461 participants.Meta-analysis showed that MBSR would be better therapy method to improve the symptom severity of irritable bowel syndrome in 3 months,[SMD =-0.60,95％ CI:-0.86 ～-0.34,P ＜0.01],and the pain index at the 3 months and 6 months was relieved compared to the baseline [SMD =-1.11,95％ CI:-1.45 ～-0.76,P ＜ 0.01,SMD =-0.14,95％ CI:-0.43 ～ 0.14,P ＜ 0.05].Conclusion:Mindfulness based stress reduction therapy could be a adjunctive therapy method in treatment of irritable bowel syndrome.

Disability-adjusted life years (DALYs) has been increasingly used to estimate burden of disease worldwide. By giving a particular attention to DALYs, the objectives of the study were to review various data sources and to conduct an extended estimation on the burden of cancer in China. Based on the publications released by the GLOBOCAN 2008 program and the Global Burden of Disease 2010 (GBD 2010) program, we reviewed the methodological information and gathered DALY data associated with burden of cancer in China, and then we extracted and summarized the data and conducted an extended analysis. From a methodological perspective, both of the programs applied the utility weights mainly from populations other than China. The data from GLOBOCAN 2008 suggests that liver cancer has replaced lung cancer and became the leading cancer in males in China when using DALY rather than mortality rate as the indicator (6.3 million and 5.4 million DALYs, respectively); although the ranking is different, data from the GBD 2010 project shows DALYs caused by liver cancer is comparable to that associated with lung cancer (7.9 million and 8.0 million, respectively). The years lived with disability (YLDs) comprised 26% and 12% of the total DALYs associated with breast cancer and colorectal cancer in China. Both projects suggest that liver cancer might have become or is becoming the leading contributor to males' DALYs in China. There are indications that, along with economic development, YLD will play a more important role in estimation of burden of cancer in China; it suggests that China should consider introducing DALY into the estimation system as early as possible. It also suggests that research on quality of life and utility associated with the major cancers in China need to be systematically conducted to facilitate more accurate DALY estimation.
China ; Cost of Illness ; Disabled Persons ; Humans ; Liver Neoplasms ; Male ; Neoplasms ; Quality of Life ; Quality-Adjusted Life Years ; Regression Analysis ; Research

Objective To develop a diagnosis model for active pulmonary tuberculosis. Methods The proteomic fingerprinting of 264 sera from active tuberculosis patients and controls were analyzed using the surface-enhanced laser desorption ionization time of flight mass spectrometry (SELDI-TOF-MS) and protein-chip technology. The peaks were detected and filtrated by Ciphergen PrnteinChip(R) Software (version 3.1.1). Using the Biomarker Pattern 5.0 software, a diagnostic model was developed for diagnosis of active tuberculosis. Re-sults Fifty protein peaks were significantly different between the patients with active pulmonary tuberculosis and the controls with overlapping clinical features (P<0.01). Five protein peaks at 4360, 3311, 8160, 5723, 15173 m/z were chosen for the system classifier and the development of diagnosis model 1. The model differenti-ated the patients with active pulmonary tuberculosis from the controls with a sensitivity of 83.0%, and a speci-ficity of 89.6%. The diagnostic accuracy was up to 86.4%. Three protein peaks at 5643, 4486, 4360 m/z were chosen for the system classifier and the development of diagnosis model 2. The model differentiated the pa-tients with active pulmonary tuberculosis from the controls with a sensitivity of 96.9%, and a specificity of 97.8%. The diagnostic accuracy was up to 97.3%. Conclusion It might be a new diagnostic test for the de-tection of sera from the patients with active pulmonary tuberculosis using SELDI-TOF-MS and protein chip.

Objective To identify the significance of serum phospholipase A2 receptor antibody (PLA2R-Ab) in idiopathic membranous nephropathy (IMN) patients.Methods A total of 108 patients diagnosed as IMN by medical history,physical examination,laboratory examination and renal biopsy in Tongji Hospital affiliated to Tongji Medical College,Huazhong University of Science and Technology between Dec 1,2014 and Aug 31,2017 were enrolled,and all related data were recorded.According to the results of serum PLA2R-Ab test,patients were divided to positive group and negative group,and the data were compared with the independent sample t test and the chi-square test.Kaplan-Meier survival analysis was performed to compare remission rates between groups,and the Logrank method was used to evaluate the significance of differences.Univariate and multivariate Cox regression analysis were used to verify predicting factors for achieving remission.Results Overall,67.6％(73/108) patients had detectable serum PLA2R-Ab.Compared with patients in negative group,patients in positive group exhibited higher proportion of male patients (P=0.002),lower level of serum albumin (P ＜ 0.001),higher level of cholesterol (P ＜ 0.001),lower level of immunoglobulin G (P ＜0.001),higher level of proteinuria (P=0.003),a lower of chance of remission (P=0.049),longer time needed to achieve partial remission (P=0.001) and complete remission (P=0.002).The 1-and 2-year cumulative renal partial remission rates were 72.4％,86.1％,and the cumulative renal complete remission rates were 43.8％,54.0％,respectively.Patients in negative group had higher partial remission (x2=9.84,P=0.002) and complete remission (x2=15.50,P＜0.001) than those in positive group.Multivariate Cox regression model indicated that serum positive PLA2R-Ab was a significant independent risk factor.Conclusions IMN patients with serum PLA2R-Ab show more severe condition and lower remission rates than those without serum PLA2R-Ab.Serum positive PLA2R-Ab is an independent remission-related predictor for IMN patients.

Objective To investigate the clinical characteristics and risk factors of secondary infection in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV).Methods One hundred and eighteen patients newly diagnosed with AAV at the institute of nephrology,Tongji hospital affiliated to Huazhong university of science and technology,from 2012 to 2017,were analyzed retrospectively.Induction therapy included single corticosteroids,combination of corticosteroids with cyclophosphamide and combination of corticosteroids with other immunosuppressive agents.End point was defined as moderate to severe infection which was diagnosed by the clinical and radiological manifestation as well as microbiological evidences.The infection-related survival curve was drawn to reflect the time when the infection occurred.The clinical baseline variables in patients with and without infection were compared.Multivariate Logistic regression model was used to determine the independent predictors of infection.Receiver-operating characteristic curve (ROC) was plotted for evaluating the predictive value of lymphocyte on moderate to severe infection.Results During followup of median 3 months (1-30 months),88 infection episodes were found in 63 (53.4％) patients,of which 54 times (61.4％) occurred within 6 months after treatment,46 times (52.3％) happened within 3 months after treatment.The most common organ of infection was lung (62.5％),and the most common pathogen was bacteria (51.1％).Multivariate Logistic regression model showed that lung involvement (OR=4.44,95％ CI 1.59-12.41),moderate reduction of lymphocyte in follow-up (OR=5.69,95％ CI 2.05-15.85) and severe lymphocyte reduction (OR=36.28,95％CI 3.45-381.17) were independent risk factors of secondary infection in AAV patients (all P ＜ 0.05).ROC curve showed that the area under the curve of lymphocyte as a predictor of severe infection was 0.767 (95％ CI 0.64-0.89,P ＜ 0.05).Based on lymphocyte less than 0.49× 109/L which was the cut-off value for predicting severe infection,the sensitivity and the specificity were 83.9％ and 71.9％,respectively.Conclusions Lung involvement and moderate-severe lymphopenia during follow-up are independent risk factors of secondary infection in AAV patients.Hence,physician should pay more attention to those patients,and adjust treatment in time to avoid the occurrence of infection.