0.05).The median duration of survival was eight months.The major toxicity was the inhibition of bone marrow,especially of leukocyte and platelet.Leukopenia and thrombocytopenia often appeared at day 8～12.Conlusion:The combined chemotherapy of ifosfamide plus vindesine and cisplatin is effective in advanced non-small cell lung cancer including the returm cases,and the toxicity is tolerable.If G-CSF is used as a complementary therapy,this regimen could be quite clinically valuable.

Objective To interpret the clinicopathological features and the key factors for diagnosis of polyomavirus-associated nephropathy (PVAN).Methods Clinicopathological data of 13casesof polyomavirus-associatednephropathyduring2008-2011inour hospitalwere retrospectively analyzed.Three cases received repeat biopsy.The clinicopathological features were analyzed according to thelight microscopicsceneandSV40-Timmunochemicalexpression.Results Recipients had a peak incidence of PVAN in 12 to 18 months period after renal transplantation,accompanied by elevated serum creatinine.Due to the progression of the disease,3patterns of histological findings could be identified.The early lesion was confined to the collected ducts,with slightly inflammatory infiltration in medullary interstitium,viral inclusions were not necessarily seen.The only findings could be enlarged nuclear and irregular arrangement of the tubular epithelial cells.At the developing stage,prominent tubulointerstitial nephritis was detected,and the involved tubules extended to other segments of renal tubule,even the parietal epithelial cells of Bowman's capsule could be compromised.The epithelial cells shed off,leading the tubular basement membrane exposed.Typical intra-nuclear inclusions as well as variable nuclear changes were found.At the end stage,the allograft showed notable chronic tubulointersititial change,with diffuse tubular atrophy and interstitial fibrosis.Although in this period,typical viral inclusions were rare, stillIHCshowedpositiveexpression of SV40-T. After immunosuppressantreductionor exchange,2 cases developed renal failure,4 cases showed sustained increment in serum creatinine,while 7 cases had a stabilized serum creatinine level.Conclusions Polyomavirus-associated nephropathy can display uneven pathological changes,as well as the morphology of the infected epithelial cells.Segments of the involved tubule are associated with the course of disease.Reduction of immunosuppressant at the early stage has a favorable effect.A prompt renal biopsy should be done in renal transplant recipient if who shows increased serum creatinine,and a routine polyomavirus immunohistochemical staining should be applied as well.

Background and purpose:It is increasingly focused on that insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 4 (IGFBP-4) effect cell proliferation, differentiation and apoptosis of tumor cells, and pregnancy-associated plasma protein-A (PAPPA) plays an important role in IGF-1-dependent IGFBP-4 protease mechanism that regulats tumor cells' growth. This study aimed to investigate the serum levels and clinical signiifcance of IGF-1, IGFBP-4, and PAPPA in patients with non-small cell lung cancer (NSCLC). Methods:IGF-1, IGFBP-4, and PAPPA plasma levels were measured by enzyme-linked immunosorbent assay from 82 patients with NSCLC and 40 control subjects, then the correlations between variables were assessed by Spearman correlation analysis, and associations between the IGFs variables and lung cancer risk were calculated through the odds ratio (OR) and its 95%conifdence interval (CI) with the use of unconditional logistic regression analysis. Results:Serum levels of IGF-1, IGFBP-4 and PAPPA in NSCLC patients were signiifcantly higher than those in the control group(P<0.05). There was a signiifcant positive correlation between the serum IGF-1 levels and PAPPA levels (r=0.835,P=0.000), and a negative correlation with IGFBP-4 levels (r=-0.612,P=0.000). IGFBP-4 and PAPPA levels were negatively correlated(r=-0.673, P=0.000). High plasma levels of IGF-1(OR=2.28, 95%CI: 1.25-4.36,P=0.008) and PAPPA (OR=1.64, 95%CI: 0.89-3.01,P=0.046)were associated with an increased risk of lung cancer, however high plasma levels of IGFBP-4(OR=0.54, 95%CI:0.30-1.01,P=0.047)were associated with reduced risk of lung cancer. Conclusion:To detect IGF-1, IGFBP-4 and PAPPA in serum in NSCLC patients is meaningful for the clinical auxiliary diagnosis and biology behavior prediction of NSCLC. And further study of signal transduction pathways of IGFs with the occurrence and development of NSCLC is a meaningful research direction.

Objective To discuss the function of respiratory exerciser tri‐ball in pulmonary rehabilitation (PR) patients with chronic obstructive pulmonary disease(COPD) .Methods Prospectie case‐control study was used in COPD patients ,the patients were randomly divided into three groups ,60 COPD patients (group A) using respiratory exerciser TRI‐BALL ,58 COPD patients (group B) using traditional pursed lips ventral breathing training ,and 58 COPD patients(group C) using general internal medicine treatment .Results Group A :compared with before breath training ,the increases of FEV1/FEV1 predicted (% ) and MVV/MVV predicted (% ) and the decrease of quality of life score (QOL) were statistically significant after breath training (P<0 .01) ,but not for FEV1/FVC(% )(P>0 .05) .Group B :compared with before breath training ,the decrease of QOL was statistically significant (P<0 .01) ,but not for FEV1/FEV1 predicted (% ) ,MVV/MVV predicted (% ) and FEV1/FVC (% )(P>0 .05) .Compared with control group after breath training ,the increases of FEV1/FEV1 predicted (% ) and MVV/MVV predicted (% ) and the decrease of quality of life score (QOL) were statistically significant in group A (P<0 .01) .Compared with control group after breath training , the decrease of quality of life score (QOL) were statistically significant in group B (P<0 .01) ,but not for FEV1/FEV1 predicted (% ) and MVV/MVV predicted (% ) (P>0 .05) .Compared the changes of pulmonary function test(PFT) index and QOL between group A and B ,the increments of FEV1/FEV1 predicted (% ) and MVV/MVV predicted (% ) were statistically significant in group A(P<0 .01) ,but not for QOL(P>0 .05) .Conclusion It is useful to improve the pulmonary function and quality of life in patients with COPD using respiratory exerciser tri‐ball .It is more effective than traditional pursed lips ventral breathing training ,due to the equipment is very small ,cheap ,easy to quantify training and convenient for household use ,it is worth to be popularized in primary hospital .

Objective To summarize the pathological characteristics of polyomavirus-associated nephropathy combined with acute rejection after renal transplantation.Methods The pathological data of 172 patients diagnosed as having polyomavirus nephropathy in our hospital from 2007 to 2018 were reviewed.Results One hundred and seventy-two patients were diagnosed as having polyomavirus nephropathy without acute rejection for the first time.In 75 (43.6％,75/172) patients who received repeat biopsy,10 (5.8％,10/172) patients developed acute rejection with an average interval of 4.8 ± 3.3 months.Common pathological features included:renal tubular epithelial cells virus inclusions reduced or even disappeared or only hyperchromatic nuclei revealed,SV40-T antigen (70％,7/10) staining negative or decreased significantly (30％,3/10),and varying degrees of interstitial inflammation,tubulitis,interstitial fibrosis and tubular atrophy.Four patients developed acute T cell-mediated rejection (Banff ⅡA),revealing aggravating tubulitis and interstitial inflammation in the area of negative SV40-T antigen (70％,7/10) staining,as well as mild endarteritis.Three patients developed acute antibody-mediated rejection,revealing glomerulitis and peritubular capillaritis and positive panel reactive antibody.Only 1 patient revealed C4d deposition of peritubular capillaries.Two patients developed mixed rejection,revealing tubulitis,interstitial inflammation,glomerulitis,peritubular capillaritis,mild endarteritis and C4d deposition of peritubular capillaries.One patient developed suspicious T cell-mediated rejection (Banff IB),revealing aggravating tubulitis and interstitial inflammation in the non-fibrotic areas but without intimal arteritis.Besides,the positive SV40-T antigen (70％,7/10) staining area was reduced significantly.Conclusion The pathological characteristics of polyomavirus nephropathy combined with acute rejection include endarteritis,glomerulitis,peritubular capillaritis and C4d deposition of peritubular capillaries.It is difficult to distinguish polyomavirus nephropathy from Banff I T cell-mediated rejection.Clinical information and repeat biopsy results are helpful for differential diagnosis.

Objective To explore the clinicopathologic characteristics of polyomavirus nephropathy (PyVN) in renal transplantation.Methods Clinicopathological data from 101 cases of PyVN from January 2006 to October 2016 in our hospital were collected and analyzed retrospectively.There were 72 males and 29 females.The mean time from operation to the diagnosis of PyVN was 16.5 months (2.2-63.9 months),with 86 cases (85.1％) occurring within 2 years.The indications for biopsy included elevated serum creatinine in 81 cases (80.2％),elevated serum creatinine with proteinuria in 13 (12.9％) cases,active BK virus(BKV) infection in 5 cases (5.0％) and proteinuria in 2 cases (2.0％).Results BK viruia was detected in 98 (97.0％) recipients with viral loads of 1.5 × 109 (0-9.0 × 1011) copies/ml,and BK viremia in 80 (79.2％) recipients with viral loads of 1.8 × 104 (0-2.1 × 107) copies/ml.5 patients lost their graft function at biopsy and the other 96 patients reserved graft function with serum creatinine of 187.0 μmol/L.After 20.1 (3.7-109.6) months of follow-up,19 (18.8％) patients lost their graft function.The average serum creatinine of the 77 patients with graft function was 165.0 μmol/L,with no statistical difference (P ＞ 0.05) compared with that of patients at diagnosis.There were 18 cases of stage A,72 cases of stage B and 11 cases of stage C with 5-year allograft cumulative survival of 92.9％,82.8％ and 55.6％,respectively.Conclusions PyVN can occur within 5 years after renal transplantation,mostly within 2 years.The typical clinical manifestations include elevated serum creatinine,BK viruia and BK viremia.The severe the histopathological lesions were correlated the worse the clinical prognosis.