Objective To study the nutritional status in different age patients with esophageal cancer during radiotherapy. Methods Ninety nine patients with esophageal carcinoma accepted radiotherapy in Zhejiang Cancer Hospital from June 2012 to August 2013 were enrolled. Patients were divided into two groups by their age: the younger age<60 years; and the older age ≥60 years. Nutritional status was measured weekly during radiotherapy, and European Nutritional Risk Screening (NRS) 2002 were used to evaluate the risk of malnutrition. Results The malnutritional incidence during radiotherapy was 23.5%-29.4% and 33.8%-49.2% in the younger group and the older group, respectively. Compared with baseline nutritional parameters, triceps skinfold thickness (TSF) of the<60 years group started to differ at the first week after the start of radiotherapy (first week to the sixth week:9.14±8.67;7.80±2.90;7.62±2.83;7.56± 2.79;7.90±2.91;7.36±2.67, respectively, all P<0.01);compared with baseline nutritional parameters(2.09± 1.28), ≥60 years group started to differ at the second week (2.34 ± 1.24, P<0.05) after the start of radiotherapy for NRS2002 the third week, 2.49 ± 1.24, P=0.016;the fourth week, 2.51 ± 1.30;P=0.013, the fifth week, 2.55 ± 1.29, P=0.006; the sixth week, 2.57 ± 1.26, P=0.004. There was no significant difference between each time point for TSF in>60 years group (P>0.05). No significant difference was found for body mass index (BMI), arm circumference (AC), arm muscle circumference (AMC) in each group (P>0.05). Conclusion The elderly patients with esophageal cancer had significantly increased risk of malnutrition and decreased nutritional status than the younger patients during radiotherapy. Early start of nutrition interventions in the elderly patients may be benefitted.

Objective To investipate the cerebral autosomal dominat arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) through the clinical features , pathology, neuroimage, and molecular genetics as well as the family tree of a case as to exploring the diagnostic method of the disease .Methods Systematic study on the clinical manifestations, genetic site, neurologic and muscular biopsy was performed. Results The main clinical features including poor memory and history of stroke were found. Neuroimaging examination showed multiinfarct lesions and leukoencephalopathy. Biopsy indicated the arteriolar hyalinosis,GOM and osmiophilic granule. A family history was confirmed. A mutation on the fourth exon of notch 3 gene was revealed. And no risk factors of hypertension and arteriosclerosis were found. All these features are in conformity with those of CADASIL.Conclusion CADAIL is not rare and is possible to be defined in vivo by way of dermal biopsy,examination of gene and neuroimage characteristics.

Objective To provide the nurse care evidence of nutritional intervention in patients with lung cancer during radiotherapy and chemotherapy by analyzing the nutritional status of these patients.Methods 55 patients with lung cancer who received chemotherapy and radiotherapy were selected.The nutritional status of these patients were evaluated by laboratory examination data at the time of hospitalized,ongoing and the end of radiotherapy. Results The hemoglobin(Hb),albumin(ALB),body mass and body mass index(BMI)were (130.50 ±17.80)g/L, (41.02 ±5.68)g/L,(61.29 ±8.75)kg,(22.36 ±2.78)kg/m2 respectively at admission;(115.90 ±19.00)g/L, (37.94 ±5.55)g/L,(59.95 ±9.05 )kg,(21.86 ±2.86)kg/m2 respectively during the course of radiotherapy;(110.40 ±19.40)g/L,(36.91 ±5.30)g/L,(58.91 ±9.30)kg,(21.48 ±2.99)kg/m2 respectively at the end of radiotherapy.At different stages of radiotherapy,the nutritional index gradually decreased,the Hb was lower in the middle of the radiotherapy than on admission,the difference was significant(t =8.611,P <0.05).The Hb in the late stage of radiotherapy was lower than the middle,the difference was significant(t =2.492,P <0.05).Although the ALB in the latter stage of radiotherapy was lower than the middle,but the difference was not statistically significant (t =1.464,P >0.05),and the difference was significant compared with on admission(t =4.815,P <0.05).The weight of the patients in the middle period of radiotherapy was less than the time of admission,but the difference was not statistically significant(t =0.781,P >0.05).The weight of patients in the late stage of radiotherapy was lower than the medium term,but the difference was not statistically significant as well(t =0.601,P >0.05),and there was no significant difference compared with on admission(t =1.382,P >0.05).The BMI of the patients with radiotherapy was lower than that at the time of admission,the difference was not statistically significant(t =0.091,P >0.05).The BMI of patients with radiotherapy was lower than that in the medium term,whereas the difference was not statistically significant(t =0.690,P >0.05),and the difference was not statistically significant compared with on admission(t =1.599,P >0.05).The Hb (F =16.643,P =0.000)and ALB(F =7.736,P =0.001)decreased significantly in particular.Conclusion The risk of malnutrition in patients with lung cancer is exist during radiotherapy and chemo-therapy,and it is obvious in the middle -late stage,the changes of physical and biochemical indexes have been appeared,and among them,Hb and ALB are the most obvious,so should be monitored and managed cause these data varied significantly.

Objective To investigate the clinical features and the gene mutation of patients with spinocerebellar ataxia type3 and type7.Methods The trinucleotide repeat mutations were detected by polymerase chain reaction (PCR),agarose gel electrophoresis method,and DNA sequencing in 13 patients,4 related members and 4 common members from 3 spinocerebellar ataxia families.Results Among the 13 patients,four patients had SCA3/MJD(CAG) n expansion mutation(n = 65 ～ 74),nine patients had SCA7 allele expansion for 40 ～ 52 times.Patients with type 3 or 7 showed significant difference in nervous system injury.Conclusion The difference of clinical feature might be used in diagnosis of SCA3/MJD and SCA7,but genotype determination would be the only method of definite diagnosis.

Objective To investgate the electromyographic and pathological features of peripheral nerve involvement in MS,and clarify factors that affect the involvement of PNS Methods Thirty three multiple sclerosis(MS) patients were selected according to Poser's definite diagnosis of MS,without other nervous system disorders and thirty volunteers served as controls All subjects received nerve conduction study:MCV,SCV,F wave and H reflex Sural nerve biopsy and pathological change were observed in light and electronic microscope Results Electromyograph findings:decreased CMAP of the median,tibial and peroneal nerves,and high amplitude of SAP of median and ulnar nerves were observed in MS Our study also showed the prolonged F wave response and H reflex in median and tibial nerves,low F wave rates Electrophysiologic abnormalities in MS showed close relationship to the EDSS,duration and lesion position in spinal cord Sural nerve biopsy revealed myelinated nerve fibers with segmental demyelination by light microscope Inflammatory cellular infiltration and onion bulb formation were not found? Axonal degeneration and laminae dissociation in myelin sheath were demonstrated by electromicroscope Conclusion MS is a demyelinating disease attacking to CNS In some MS patients,both CNS and PNS might be involved at the same time The peripheral demyelinating lesions seem to be common in spinal nerve root But the secondary axonal degeneration in distal segment should be another pathologic feature of MS EMG is a useful test method to evaluate the peripheral nerve damage and prognosis of MS

Objective To analysis of the detection result of amniotic fluid chromosome which in NIPT high-risk pregnant women.Methods Amniotic fluid cells via amniotic cavity puncture were cultured and analyzed,the chromosome karyotypes were observed.Results The highest positive predictive value of NIPT was for trisomy 21(85.00%),then trisomy 18(75.00%),sex chromosome abnormalities(68.00%),other chromosome abnormalities(41.67%),trisomy 13 (25.00%).Conclusion The highest accuracy of NIPT was shown in detection of Down''s syndrome by NIPT.NIPT was screening test which is effective and noninvasive in prenatal diagnosis.Amniotic fluid Chromosomal karyotype analysis was the gold standard in the diagnosis of fetal chromosomal disease.

BACKGROUND:It is important to establish an ideal mouse model of severe aplastic anemia for investigating the mechanism and finding new therapies for aplastic anemia. OBJECTIVE:To establish a severe aplastic anemia mouse model by using recombinant human interferon-γand busulfan. METHODS:Sixty healthy Kunming female mice were randomly divided into two groups:model group (n=50) and control group (n=10). The model group was given recombinant human interferon-γat a dose of 1×104 U/d by intraperitoneal injection and busulfan at a dose of 18 mg/(kg·d) through stomach feeding for 7 days. The same volume of physiological saline was given to control group. Multi-parameters, including general condition, body weight, blood cellcount, morphology and biopsy of bone marrow were analyzed in two groups. RESULTS AND CONCLUSION:At day 7 after treatment, the weight, white blood cellcount, hemoglobin, blood platelet, reticulocyte count in model group were significantly lower than control group (P<0.05). Bone marrow smears and biopsy of model group showed marked reduction of bone marrow proliferation and increases of percentages of non-hematopoietic cellclusters and adipose tissue. The oil drop and fat vacuole were apparently seen in the model group. Severe aplastic anemia mouse model can be established by using recombinant human interferon-γand busulfan successful y, which is economic, stable and easy to operate.

Objective To evaluate the significance of platelet activation and the expression of inter-leukin (IL)-1β in patients with RA. Methods The activation of platelets and the expression of IL-1β in pla-telets in 50 RA patients(22 high-active, 28 mediate/low active ) and 30 normal controls were determined us-ing flow cytometry. Meanwhile, inflammatory indicators such as erythrocyte sedimentation(ESR), C-reactive protein (CRP) and DAS28 were also recorded. T test and correlation analysis were performed. Results The platelet activation in RA group(19.2±4.8) was higher than the control group(9.0±2.9)(t=10.5, P=0.001). The expression of IL-1β in platelets in RA group(41±11) was higher than control group(21±8)(t=9.01, P =0.000) .The platelet activation in high-active RA group(22 ±4) was higher than mediate/low active RA group(17 ±4)(t =3.96,P =0.001). The expression of IL-1β in platelets in high-active RA group(45 ±10) was higher than mediate/low active RA group (38 ±10)(t =2.329,P =0.024). The expression of IL-1β in platelets in RA group was positively correlated with the level of ESR、CRP and DAS28 (r value and P value were 0.576, 0.578, 0.618 and 0.000, 0.000, 0.000 respectively). Conclusion The platelets of patients with RA are activated and may suggest that IL-1β, which may associate with disease activity. Our research suggest that platelet may play a role in the inflammatory process of RA by secreting IL-1β.

Objective To investigate the long-term efficacy of nonmyeloablative autologous peripheral blood stem cell transplantation(NAST) to cure refractory autoimmune disease(AD).MethodLong-term follow up of four cases of AD patients with NAST were summarized.The pretreatment regimen was intravenous injection of cytarabin (200 mg· kg-1· d-1 ) and cyclophosphamide (40 mg· kg-1· d-1).The therapeutic effect was evaluated by the change of symptoms and signs and long term complications.Changes of immune function were detected by flow-cytometry.ResultsFive cases of patients had been successfully engrafted.The average time for peripheral leucocytes count to reach 4.0×109/L was 12 days.It needed 10 days for platelets to return to 100×109/L and 22 days for hemoglobin to 120 g/L.Apparent remission of symptoms and signs was observed after transplantation.Lymphocyte subtypes analysis pre- and post- NAST showed that count of CD4+ and the ratio of CD4 +/CD8 + was returned to normal.One patient gave birth to a healthy baby four years after transplantation.Three female patients returned tonormal life. Conclusions Compared with classical myeloablative stem cell transplantation,NAST has a rapid hematopoietic recovery and good long-term therapeutic effect in AD.The quality of life in AD patients treated with NAST is higher than those treated with myeloablative hematopoietic stem cell transplantation.

ObjectiveTo investigate the correlation between serum C-reactive protein(CRP),tumor necrosis factor-alpha(TNF-α) and atherosclerosis in patients with subclinical hypothyroidism.Methods Seventy-five patients with subclinical hypothyroidism were divided into two groups according to the level of TSH:mild group (42 cases) with TSH between 5.5 and 10.0 mU/L and severe group (33 cases) with TSH ＞10.0 mU/L.Thirty healthy physical examinees or volunteers were selected as control group.TG,LDL-C,HDL-C,TSH,FT4,FT3,CRP,TNF-α and carotid intima-media thickness(CIMT) of all cases were detected and measured.ResultsCIMT of mild,severe and control groups were(0.88 ± 0.20),( 1.12 ±0.21 ),(0.62 ±0.21 ) mm,respectively.CIMT of mild and severe groups were both significantly higher than that of control group,CIMT of severe group was significantly higher than that of mild group (P ＜ 0.01 ).There were no significant differences of CRP and TNF- α among three groups (P ＞ 0.05 ).LDL-C of mild and severe groups were significantly higher than that of control group [ (3.22 ± 0.37),(3.49 ± 0.38 ) mmol/L vs.(2.48 ±0.41 )mmol/L,P ＜0.01 ].HDL-C and TG between mild and control groups had no statistical significance (P ＞0.05).Compared with control and mild groups,HDL-C of severe group decreased [(0.92 ±0.10)mmol/L vs.( 1.21 ± 0.14),( 1.17 ± 0.11 ) mmol/L] and TG increased [ ( 1.50 ± 0.49) mmol/L vs.( 1.11 ±0.53),(1.27 ±0.47) mmol/L](P＜ 0.01 or ＜ 0.05).The levels of TG,LDL-C,TSH,CRP and TNF-α had positive correlation with CIMT (r =0.52,0.37,0.48,0.39,0.45;P ＜0.05 or ＜0.01 ).FT4 was negatively correlated with CIMT (r=-0.24,P＜0.05).HDL-C had no relation with CIMT (r =0.06,P ＞0.05).ConclusionsThere are many abnormalities such as metabolism disorder of blood lipid in patients with subclinical hypothyroidism.The risk of atherosclerosis increases in these patients and inflammatory reaction may not be an important factor of subclinical hypothyroidism complicated with atherosclerosis.