Cyclophosphamide (CPA) is the most common alkylating antineoplastic agent, as well as a strong immunosuppressant that is frequently applied to autoimmune diseases and organ transplantation. It is metabolized by cytochrome P450 oxidases (CYPs) to its active metabolite which played a critical role in therapy. CPA has serious and even fatal side effects, and its efficacy and adverse reactions are significantly varied among individuals. In this review, the association of the genetic polymorphisms in the metabolic enzymes and transporters involved in the disposition of CPA with the efficacy and adverse effects of CPA were summarized, thereby providing fundamental reference for further pharmacogenomic study of CPA.

Objective To investigate the effects of Liuwei Hezhong Powder on gastrointestinal motility and hormones,and to explore its possible mechanism.Methods The small intestinal propulsion ratio,endogastric residual rate and total gastrointestinal propulsion time in mice were observed after intragastric administration of Liuwei Hezhong Powder .Radioimmunoassay was applied to detect the changes of gastrin,motilin and vasoactive intestinal polypeptide in spleen asthenia rats.Results Compared with the blank control group,Liuwei Hezhong Powder can significantly improve the small intestinal propulsion,reduce endogastric residue and shorten total gastrointestinal propulsion time(P 0.05),but the high dosage group of Liuwei Hezhong Powder were especially remarkable(P

Objective To explore the feasibility of using the consensus of European Working Group on Sarcopenia in Older People(EWGSOP) to diagnose sarcopenia among community-dwelling women aged from seventy to seventy-nine in Shanghai.Methods Twenty-two healthy community-dwelling women were recruited as the subject group(group S),and another ten young girls were randomly selected as the control group(group C).The anthropometry,bioelectrical impedance analysis(BIA)and dual energy X-ray absorptionmetry(DEXA)were used to evaluate the circumferences of upper and lower limbs,and the dimension of muscle mass,according to relative appendicular skeletal mass(RASM)and skeletal muscle index(SMI).The grip dynamometer and isokinetic dynamometer were used to measure the muscle strength of upper and lower limbs.The ten meters gait speed,functional reach test,timed up and go test,Berg balance scale and short physical performance battery were all applied to assess the physical performance.The criteria of EWGSOP consensus were applied to diagnose the situation of sarcopenia.Results Firstly,the average biceps circumference and fat mass of upper limbs in group S were significantly higher than group C (P＜0.01),while no significant differences were observed in the muscle mass(P＞0.05).Secondly,RASM values gained from BIA and DEXA in S group were significantly higher than C group(P＜0.05),while the SMI values of the former were significantly lower than the latter(P＜ 0.01).Thirdly,absolute grip strength,relative grip strength and other bio-mechanical indexes of lower limbs in the s group were significantly lower than the C group(P＜0.01);the relative grip strength showed significant correlation with most bio-mechanical indexes of lower limbs.Fourthly,the physical performance in group S declined significantly compared with that of the c group(P＜O.05),and no significant correlation was found between muscle strength and physical performance of upper limbs except the absolute grip strength and gait speed.The prevalence was 0％ according to the RASM index,while the prevalence was 63.6％ and 45.4％ according to the BIA and DEXA respectively.Conclusion The assessing pattern from EWGSOP consensus could not be simply copied to applying on Chinese old people due to serious difference between RASM and SMI.The combination of SMI+relative grip strength+ TUG/SPPB/Berg may be better than the classical mode of RASM+absolute grip strength+gait speed in diagnosing sarcopenia.

Objective To observe the expression level change of vascular endothelial growth factor (VEGF) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), and to explore the relationships of VEGF expression with OSAHS, OSAHS related cardiovascular and cerebrovascular diseases. Methods Polysomnography (PSG) was used to conduct sleep apnea monitoring in 24 OSAHS patients from 6OSAHS popular families and 48 healthy controls with normal physical examination results. The expression of VEGF mRNA was examined by reverse transcriptionpolymerase chain reaction (RT-PCR) analysis, meanwhile, the level of VEGF in plasma was measured VEGF mRNA in PBMC were significantly higher in simple OSAHS group [plasma levels: (205.75±2.79) pg/ml; mRNA: 0. 61±0. 02] than in control group [(168.72±4.64) pg/ml; 0. 47±0. 02,cardiovascular and cerebrovascular diseases group [(288.74 ± 2.73) pg/ml, 1.16 ± 0. 03] than in simple OSAHS group [ ( 205.75 ± 2.79 ) pg/ml, 0. 61 ± 0.02, P ＜ 0. 01]. ( 2 ) There was a positive correlation of the levels of VEGF in plasma and mRNA with AHI as well as systolic and diastolic blood pressure in early morning. There was a negative correlation of the level of VEGF in plasma and VEGF mRNA with the lowest saturation of blood oxygen. There was a positive correlation of the level of VEGF mRNA with AHI as well as systolic and diastolic blood pressure in early morning.Conclusions The level of VEGF in OSAHS significantly increases, which may play a role in the pathophysiology of OSAHS and OSAHS related cardiovascular and cerebrovascular diseases.

Objective To perform facial nerve monitoring in patients under the low level of neuromuscular blockade during resection of acoustic neurinomas.Methods Twenty-eight patients with large,or medium acoustic neuroma underwent the surgery of acoustic neurinomas resection. During the operation,TOF and EEG monitoring were performed in order to detect the degree of muscle relaxation and the depth of anesthesia. Neuromuscular relaxation was maintained at T_4/T_1=25%～50% by adjusting doses of muscle relaxant and aneasthetic. Free-run EMG and Triggered EMG of orbicularis oris, orbicularis oculi, masseter and trapezius were recordered to monitor the function of the facial, trigeminal and accessory nerves, respectively. The function of the facial nerve was evaluated at first week and half year postoperatively according to House-brackmann classification.Results The facial never was successfully identified and mapped by neurominitoring in all 28 patients. successfully, tThe electrical stimulation was 0.1 mA-0.3 mA and no any involuntary body movement was observed in all patients ne of patients have moved during operation. The preservation of the facial nerve function following surgery was good. Five patients had a HB grade I, 13 a HB grade II, 8 a grade III and 2 a HB grade IV The facial nerve function was HB Grade Ⅰin 5 of 28 patients, HB GradeⅡ in 13, HB Grade Ⅲ in 8 and HB Grade Ⅳ in 2 immediately after operation. Six months after surgery, 10 casespatents showed demonstrated a HB GradeⅠof facial never function, 12 cases exhibited a slight palsy (HB Grade II) , and 5 cases exhibited a HB Grade III palsy and . Another 1 cases a exhibited severe palsy (HB Grade IV).Conclusions Facial nerve monitoring in patients under the low level of neuromuscular blockade can ensure the surgical safety and preserve the facial never function.

To improve the effect of teaching practice of blood cell morphology,typical cases of peripheral blood erythrocyte,granulocyte and platelet were chosen,case show and problem-based teaching way were applied to encourage students to find information of autonomous learning.Then teacher organized the class discussion,and the information was analyzed and summarized.In the implementation of the case teaching,we should pay attention to improving students' learning initiative.At the same time,teachers need to have knowledge,comprehensive ability and ability in organization and leadership,to promote students' active participation in discussion in the teaching,pay attention to the information feedback,and improve the teaching details

Objective To investigate the risk factors of pancreatic cancer in Wenzhou area.Methods A case control study was conducted on 220 cases with pancreatic cancer and 220 matched controls using conditional logistic regression analysis.Results Univariate analysis showed BMI ＞ 30 kg/m2,smoking,reproductive history,diabetes,cholecystitis,chronic pancreatitis,history of appendectomy,history of partial gastrectomy,history of cancer and familial history of cancer were associated with pancreatic cancer,while multivariate conditional logistic regression analysis showed that the risk factors of pancreatic cancer included smoking (OR =3.624,95％ CI i.474 ～ 8.907),BMI ＞ 30 kg/m2 (OR =1.789,95％ CI 1.030 ～ 3.108),diabetes (OR =3.191,95％ CI 1.094 ～ 9.309),chronic pancreatitis (OR =4.972,95％ CI 1.593 ～ 14.898),and cholecystitis (OR =2.289,95 ％ CI 1.024 ～5.116).Conclusions BMI ＞ 30 kg/m2,smoking and diabetes are risk factors for pancreatic cancer in Wenzhou area.

Objective To evaluate the clinical application of multimodality treatment of brain arteriovenous malformation (BAVM) with Onyx embolization and microsurgery.Methods There were 48 patients with BAVM treated by combination of Onyx embolization and microsurgery.The clinical features,therapeutic process,complications and discharge status (by MRI,DSA and Glasgow outcome scale,GOS) were recorded in detail.The prognosis was estimated by modified Rankin scale (mRS) with 6-42 months' follow-up.Results The total resection rate was 97.9％.The therapy-related complications happened in 8 patients (16.7％).Among them,4 cases had dysfunction of central nervous system (8.3％),2 cases with intra-cerebral hemorrhage (4.2％),and 2 suffered from severe cerebral edema (4.2％).Good recovery was seen in 38 cases (79.2％) evaluated by GOS when discharged from hospital.The follow-up result mRS ＜ 3 was 97.9％.Conclusion Multimodality treatment of BAVM with Onyx embolization and microsurgery should be a good therapeutic strategy.

Objective To observe the variation of cerebral brain flow (CBF)and pathological characteristics in peripheral brain tissue of nidus after operation of brain arterivenous malformations (BAVM) and explore the mechanism and theaputic strategy of normal perfusion pressure breakdown (NPPB)after microsurgery. Methods 12 cases of BAVM that have received surgical resection were analyzed prospectively, and 8 cases of them were embolized with Onyx. The pathological characteristics of the nidus and peripheral brain tissue was observed with microscope and electron microscope. The variation of CBF in peripheral brain tissue of the nidus following microsurgical resection was observed by using Laser Doppuler Perfusion Imaging (LDPI) system. The monitering result of CBF in little meniugioma(n=6) during surgery was used as the control. Results There was small vessel expantion, neuron necrosis, gliocyte hyperplasia and blood brain barriar (BBB) destruction in peripheral brain tissue of BAVM nidus, the visibal brain tissue edema and inflammatory cell infiltration in peripheral brain tissue of the nidus and the revascularization in the emolized nidus vessels were observed after embolization with Onyx. There was significant change of CBF between pre-and post-operation (P<0.05),and after controlling depressurization during surgery was the increasing CBF step down (P<0.05). Conclusion The BBB breakdown and increasing CBF of peripheral brain tissue of the nidus may be the pathological foundation of brain hemorrhage and edema after BAVM microsurgical resection. So embolization before the operation, controlling depressuriation during and after surgery is the important methods for preventing and curing the NPPB of BAVM after microsurgery.

Objective To investigate the effects of CD4+CD25high regulatory T cells(Treg)and the imbalance of helper T lymphocyte subsets(Th1/Th2)on the immunological mechanism of IgA nephropathy(IgAN)patients. Methods The percentage of Treg and helper T cells subpopulation (Th1/Th2)in the peripheral blood of IgAN patients and healthy controls was examined by flow cytometry.The FOXP3 expression was detected through intracellular staining.The correlation of Treg or Th1/Th2 with clinical parameters of IgAN was analyzed by Spearman or Pearson rank correlation test. Results The percentages of Treg and Th2 cells were significantly higher in peripheral blood of IgAN patients compared to that of healthy controls[Treg (2.14±0.82)%vs[1.59±0.53)%,Th2(2.57±0.72)%vs(1.81±1.10)%,all P＜0.05].Th1/Th2 ratio was significantly reduced in IgAN patients(5.75±1.89 vs 12.73±9.79,P＜0.05).The percentage of circulating Treg cells was positively correlated with serunl IgA concentration(r=0.397,P＜0.05),and was negatively correlated with eGFR(r=-0.376,P＜0.05).The percentage of circulating Th2 cells was positively correlated with serum IgA(r=0.468,P＜0.05). Conclusions There is a disorder of T lymphocyte population in the peripheral blood of IgAN patients.The increased Treg and Th2 cells may play an important role in the pathogenesis of IgAN.