Purpose To evaluate apoptosis in renal tissue of diffuse proliferative lupus nephritis and therelationship between the existence of apoptosis cells in renal tissue and histopathological or clinical changes.Methods Apoptosis was detected by in situ nick-end labeling techniques (TUNEL) in renal biopsies from 25patients with type Ⅳ LN, 12 patients with IgAN, 4 patients with MsPGN, and 3 patients with APSGN. Normalrenal tissue obtained at nephrectorny for hypemephroma in 4 adults was used as control. In addition, proliferatingcells were identified by proliferating cell nuclear antigen(PCNA) in these patients. Results Compared to otherproliferative glomerulonephritis and control,the patients with lupus nephritis had less apoptosis cells, higher ratio ofPCNA+ cells/TdT+ cells/(P/T) in renal tissues;Ratio of P/T in glomeruli and tubulointerstitium correlated withthe chronicity index, r=0. 498 3(P = 0. 013 2), r = 0. 839 9(P＜ 0.001 ), r = 0. 661 4(P = 0. 003 3),respectively. Ratio of P/T in glomerulus and tubule had positive correlation with 24 hour urinary protein, r =0.855 4(P＜0.001),r=0.713 4(P=0. 001); negative correlation with Ccr, r = - 0. 488 0(P =0. 013 3)and r = - 0. 722 9(P = 0. 001), which in tubules positively correlated with Scr, r = 0. 410 7 (P = 0.041 4 ).Conclusions Apoptosis is insufficient in proliferative lupus nephritis. Intense proliferation without followingincrease in apoptosis may be related to chronic progressive renal histopatholcgical changes.

Objective To investigate the application value of extracorporeal extended field radiotherapy in locally advanced cervical cancer. Methods A total of one hundred and twenty patients with stage IIB?IVA cervical cancer in the First Affiliated Hospital of Hebei North University from June 2012 to June 2014 were randomly divided into two groups:the control group and the observation group,each with 60 cases. The routine concurrent chemoradiotherapy was adopted in the control group. The observation group was treated with extracorporeal extended field radiotherapy combined with concurrent chemotherapy. The patients have been followed up for three years. The total efficacy rate,toxicity reaction,local progression free survival time ( PFS) and survival rate of the two groups were compared. Results The total efficacy rate in the observation group was significantly higher than that of the control group ( 88. 3%( 53/60 ) vs. 73. 3%( 44/60 ) , χ2 = 4. 357, P=0. 037),while the incidences of toxicity reaction in the two groups were 18. 3%(11/60) and 16. 7%(10/60), the difference was not statistically significant (χ2=0. 058,P=0. 810) ,the percentages of I and II degree in the two groups were 3. 4%( 2/60 ) and 3. 4%( 2/60 ) , the difference between the two groups was not statistically significant (Z=0. 000,P=1. 000). The PFS value in the observation group was significantly longer than that of the control group ( 25. 6 months vs. 13. 8 months,χ2 = 25. 624, P= 0. 000 ) , and the survival rate in the observation group improved significantly ( 53. 3%( 32/60 ) vs. 33. 3%( 20/60 ) , the difference was statistically significant (χ2 = 4. 887, P= 0. 027 ) . Conclusion Extracorporeal extended field radiotherapy is safe and effective in the treatment of locally advanced cervical cancer.

BACKGROUND: With conversion of medical patterns and revolution of healthy concept, temperament, psychological health and behavior become key topics for child care and are paid more and more attention nowadays.OBJECTIVE: To survey the status quo of psychological and behavior problems and distribution of temperamental types through questionnaire for children in Guiyang.DESIGN: Randomized cluster sampling and cross-sectional study.SETTING: Guiyang Institute for Mother and Child Health.PARTICIPANTS: Twelve settings were randomly selected from 33 duty units for child care in Guiyang. Children aged 1-6 years suffered from health check at survey stage, and those with severe body diseases and abnormal intelligence were excluded.METHODS: Problems of psychological health and behavior and distribution of temperamental types for children were surveyed with self-made psychological health scale, Chinese temperament scale for 1-3-year children,Chinese temperament scale for 3-7-year children, behavior scale for 2-3-year children and Achenbach's children behavior scale standardized by Shanghai Mental Health Center. All questionnaires were answered by parents and taken back on the spot. After 2-4 weeks, several children were randomly selected to refill in the questionnaires mentioned above to measure reliability again.MAIN OUTCOME MEASURES: Status quo of psychological and behavior problems, distribution of temperamental types and effect of social environment on temperament and behavior.RESULTS: ① Distribution of temperamental types was divided into easy nurture, difficult nurture, nearly easy nurture, nearly difficult nurture and slow development, and the percentage was 35.58%, 4.21%, 39.70%, 7.37%and 13.14%. ② Total ratio of psychological problems was 94.50%, and ratios of children in various temperamental types were 98.91%, 97.26%,96.19%, 94.05% and 93.13% (P ＜ 0.01). ③ Total ratio of behavior problems was 19.57%, and ratios of children in various temperamental types were 31.76%, 26.69%, 22.58%, 21.33% and 12.72% (P ＜ 0.01). Temperamental types and behavior problems were related to living condition, educational level of parents, marriage, supervised attitude, paternity, pregnant nutrien, illness and infirmarian, especially temperament was closely related with psychological and behavior problems.CONCLUSION: Psychological and behavior problems wildly exist among children in Guiyang and should be paid much attention. Fine personality of children can be molded through reforming relevant factors so as to decrease the incidence of psychological and behavior problems.

Objective To evaluate permissive hypocaloric intake in postoperative patients by a prospective, randomized, controlled trial. MethodsForty-two postoperative patients were randomly assigned to receive 117kJ?kg~ -1?d~ -1in control group, and 75kJ?kg~ -1?d~ -1in experimental group intravenously. Blood routine, liver and renal functions were measured one day before and day 1, 3, 5 post operation. Blood glucose level, insulin intervention, infectious complications, hospital stay, and relevant cost were also evaluated. ResultsHypocaloric intake in the experimental group post-operatively did not influence the hemoglobin level, liver function, and other indicators in the serum. The fasting blood glucose and glucose levels after infusion, as well as the volume of insulin intervention were significantly higher in the control group during 4 days of parenteral nutrition. Experimental group had lower relevant hospital cost, while two groups had similar duration of hospital stay. ConclusionPermissive hypocaloric intake shortly after surgery does not influence the patient nutritional status, besides it avoids to some extent the hyperglycemia, reduces the need for insulin intervention .

ObjectiveTo discuss the application value of high frequency ultrasound (HFUS) characteristics, acoustic radiation force impulse (ARFI) imaging technology and contrast-enhanced ultrasound (CEUS) in the diagnosis of soft tissue hemangioma.MethodsTo retrospectively analyze the clinical data of 44 cases of soft tissue hemangioma that were treated in Capital Medical University Affiliate Beijing Chaoyang Hospital from August, 2013 to May, 2014, and to analyze the difference between the characteristics of HFUS, ARFI and CEUS in soft tissue hemangioma and normal surrounding tissue.ResultsHFUS shows the features of morphological diversity of sinus shape expansion tube structure, unclear boundary, irregular configuration, compressibility and partial strong echo in the phlebolith. Color Doppler ultrasound (CDFI), detects abundant interphase red-blue bloodstream signal slowly and consistently. The blood signal is strengthened after partial compression. CDFI shows more vein spectrum in the lesion. The discrepancy of comparison between VTQ and SWV value of soft tissue hemangioma and surrounding muscular tissue possesses statistical significance [(1.082±0.183) m/svs (1.414±0.331) m/s,P<0.01]. Ultrasound contrast can show the relationship between diseased region and surrounding tissue clearly, which is beneficial to the selection of operation method and prognosis.ConclusionThrough conventional two-dimensional ultrasound and high frequency CDFI, and further combining the acoustic pulse radiation ARFI technology and CEUS technology, the soft tissue hemangioma can’t only be more accurately diagnosed, but also provides more reliable diagnostic basis for clinic.

Objective To investigate the relationship between prothrombin fragment 1+2 (F1+2) and peripherally inserted central catheter (PICC) associated thrombosis in cervical cancer patients, and provide certain clinical basis of early prevention in peripherally inserted central catheter associated thrombosis in cervical cancer patients. Methods One hundred and forty cervical patients with PICC were enrolled in this study, and they were divided into thrombosis group (35 patients) and non-thrombosis group (105 patients). The level of F1+2 was examined using enzyme-linked immunoassay, and was analyzed according to the clinic features. Results The level of F1+2 was correlated with clinical stage (r = 0.640, P = 0.004);but was not correlated with age, type of tumor and concurrent radiochemotherapy (P>0.05). The level of F1+2 in thrombosis group was (520.343 ± 121.759) pmol/L, in non- thrombosis group was (388.361 ± 104.873) pmol/L, and there was significant difference (P =0.001). The multi-factors Logistic analysis showed that the level of F1+2 (OR=1.011, P=0.001) and age (OR = 21.025, P = 0.031) were independent risk factors for the PICC associated with thrombosis in cervical cancer. Conclusions The level of F1+2 is closely related with clinical stage and PICC associated thrombosis, and it is an independent risk factor for the PICC associated with thrombosis in cervical cancer.

Objective To study the success experience of native arteriovenous fistula (AVF) operation,and provide a new reference range of blood vessel diameter for evaluating the success rate of AVF operation before surgery.Methods To proceed AVF operation to patients with 5 phase of chronic kidney disease,before surgery,patients should receive the vascular ultrasound and cardiac ultrasound to record the diameter of radio artery and cephalic vein along with the radio artery blood flow.Patients were divided into two groups:observation group(cephalic vein diameter< 2 mm)and control group(cephalic vein diameter > 2.0 mm). All those indexes examined before were re-examined 1 month after surgery. Except vessel diameter, the AVF blood flow velocity was also recorded. The range of the mature period was measured, along with the blood flow of each AVF 1 month after its initial use. The blood vessel diameter before surgery,the mature period of AVF and the blood flow on the machine of dialysis 1 month after the initial use were measured to evaluate the operation results of each group. Results In the observation group, 23 of the 25 patients showed the optimistic results. Unfortunately, 1 of the 2 pessimistic results showed the absence of vascular murmur,and the other one died of natural death before its initial use.The mature period of AVF for hemodialysis was(47.29 ± 2.45)d,significantly longer than that of control group (36.00 ± 1.29) d, and there was statistical difference (P<0.01). The blood flow of observation group showed no significant difference compared to that of control group (P > 0.05). Conclusions The patients with cephalic vein diameter<2.0 mm before operation needs a long mature period,but the blood flow after dialysis is not affected,and a good success rate is obtained.

OBJECTIVETo analyze the karyotypes and SRD5A2 gene mutations in 25 patients with sporadic or familial hypospadias.

METHODSThe patients included 10 adults and 15 children, whose chromosomes were analyzed by G-banded karyotyping, and the SRD5A2 genes were sequenced.

RESULTSTwo patients were found to have an abnormal karyotype, while eight have carried compound heterozygous mutations of the SRD5A2 gene, which included 5 genotypes formed by 6 types of mutations, i.e., p.G203S/p.R227Q, p.R227Q/p.R246Q, p.Q6X/p.Q71X, p.L20P/p.G203S, and p.Q71X/p.R227Q. Mutations of the SRD5A2 gene were present in 32% (8/25) of all patients, 35% (8/23) in those with a normal karyotype, and 44.4% (8/18) in those with proximal type hypospadia. Bioinformatic analysis, literature review and pedigree analysis confirmed that all such mutations are pathogenic.

CONCLUSIONChromosomal anomalies and mutations of the SRD5A2 gene are the main cause of hypospadias. Sequencing of the SRD5A2 gene may explain the etiology of nearly half of the patients with proximal type of hypospadas but a normal karyotype, which can facilitate genetic consulting.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase ; genetics ; metabolism ; Adolescent ; Adult ; Asian Continental Ancestry Group ; genetics ; Base Sequence ; Child ; Child, Preschool ; Female ; Humans ; Hypospadias ; enzymology ; genetics ; Infant ; Infant, Newborn ; Karyotyping ; Male ; Membrane Proteins ; genetics ; metabolism ; Mutation ; Young Adult

Objective To observe multimodal imaging characteristics in eyes with focal choroidal excavation (FCE) and preliminarily analyze the risk factors in FCE with complications correlated with RPE.Methods A retrospective case series.Thirty-one patients (31 eyes) with monocular FCE,first identified by spectral-domain (SD)-OCT in the Eye Center of The Second People's Hospital of Foshan from December 2014 to December 2018,were involved in this study.There were 14 males and 17 females,with the mean age of 45.84± 13.57 years.All patients underwent BCVA,optometry,and SD-OCT examinations.FFA and ICGA were simultaneously performed in 3 FCE patients with RPE complications.The subfoveal choroidal thickness (SFCT) and excavation width were measured with enhanced depth imaging OCT (EDI-OCT).The eyes with FCE were divided into two groups (FCE alone group 17 eyes vs.FCE complication group 14 eyes),based on whether complicated by RPE dysfunction.Among 14 eyes of FCE complication group,7 (22.6％) with choroidal neovascularization,4 (12.9％) with central serous chorioretinopathy,1 (3.2％) with polypoidal choroidal vasculopathy,and 2 (6.5％) with RPE detachment.No significant difference was found in the mean age (t=0.87),gender composition (x2=0.06),ocular laterality (x2=2.58),and spherical equivalent (t=-0.81) between two groups,respectively (P＞0.05),except that the BCVA was significantly different (t=-2.11,P＜0.05).The SFCT and excavation width of eyes in both groups and the ICGA imaging characteristics of eyes in FCE complication group were analyzed.Risk factors of FCE with RPE complications were analyzed by logistic regression analysis.Results Thirty-three excavations were identified in 31 eyes with FCE.The mean SFCT was 167.00± 85.18 μm in FCE alone group vs.228.36± 67.95 μm in FCE complication group,while the excavation width was 645.00 ± 231.93 μm vs.901.00± 420.55 μm and they were both significantly different (P＜0.05).Logistic regression analysis showed the SFCT (OR=1.016,P=0.026) and excavation width (OR=1.004,P=0.034) were risk factors for RPE complications of FCE.EDI-OCT showed the RPE at the excavation was impaired or vulnerable in all eyes of the FCE alone group,especially at the boundary area of excavation.The RPE damages were located at the boundary area of excavation in 10 eyes (71.4％) of FCE complication group.Constant choroidal hypofluorescence and filling defect were observed under the excavation in 3 eyes with ICGA imaging.Conclusions SFCT and excavation width may be risk factors for RPE complications of FCE.Impairment of RPE at boundary area of excavation and focal choroidal ischemia or aberrant circulation under the excavation may correlate with the development of FCE complications.

Objective To observe the clinical manifestation and gene mutation of a pedigree with Sorsby fundus dystrophy (SFD).Methods Ten members in 3 generations of a pedigree with SFD were included in this study.Four patients were observed in the pedigree,including 2 females and 2 males.All 10 members underwent comprehensive ophthalmic examinations,including best-corrected visual acuity,intraocular pressure,slit-lamp biomicroscopy,indirect ophthalmoscopy,fundus color photography and spectral domain optical coherence tomography.Genomic DNA was extracted from peripheral venous blood which was collected from all the members.Relevant exons of ocular diseases were detected by the next generation sequencing method from the proband.The other members underwent Sanger verification.Results Among the four patients,fading eyesight was appeared at their 44,46,47 and 40 year-old respectively.The two male patients had bilateral morbidity,and the two female patients had monocular symptoms.DNA sequencing results showed that the proband,other 3 patients and 2 members from the Ⅲ generation had heterozygous mutation of TIMP3 gene in exon 5.The amino acid encoded by TIMP3 gene No.204 codon changed from serine to cysteine (TIMP3:NM_000362:Exon5:c.A610T/p.S204C).Coclusions The invasion time of all the patients in this pedigree is after their 40 year-old.Heterozygous mutation at c.610A＞T (p.S204C) in TIMP3 gene is the causative gene of SFD in this pedigree.