Objective To explore the application value of the detection of vitamin B12 (VitB12 ) ,folic acid (FA) and four iron met-abolic indexes including serum ferritin (SF) ,transferring (TF) and total iron binding capacity (TIBC) and serum iron (SI) in the diagnosis and differential diagnosis of anemia .Methods 126 patients with anemia and 30 healthy controls were enrolled from Janu-ary to May 2013 and determined serum VitB12 ,FA ,SF ,TF ,TIBC and SI levels for conducting the comparison with each other . Meanwhile ,the patients with anemia were extracted bone marrow to carry out ferric stain and morphological test ,their detection re-sults and the results of above-mentioned serological markers determination were performed the comparison of the diagnostic accord-ance rate .Results The serum levels of various iron metabolism-related indexes had significant differences between the anemia group and the healthy control group (P<0 .05) ,and various different kinds of anemia had their comparatively specific serological characteristics .In 126 cases of anemia ,the diagnostic accordance rate of the bone marrow examination was 82 .5% ,which was sig-nificant higher than that of the serological examination(69 .8% )(χ2 =5 .600 ,P=0 .018);nevertheless ,in 23 cases anemia unable to determine the diagnosis by bone marrow examination ,the diagnostic accordance rate of the serological examination was 82 .6% (19/23);the inconsistent rate of the two examinations was 25 .4% (32/126) .Conclusion The bone marrow examination and the sero-logical examination have different emphasis points for the anemia diagnosis and have their own advantages ,which cannot replace each other .Their combination use has certain clinical value in the differential diagnosis between iron deficiency anemia (IDA) with anemia of chronic disease complicated with iron deficiency (ACD/ID) ,myelodysplastic syndromes (MDS) ,megaloblastic anemia (M A ) and mixed cellular anemia .

Objective To investigate the effects of alpha-melanocyte-stimulating hormone (alpha-MSH) on the production of tumor necrosis factor-alpha (TNF-alpha) and intedeukin-10 (IL-10) by peri-pheral blood monohuclear cells (PBMCs) from patients with psoriasis vulgaris. Methods Heparinized peri-pheral blood was obtained from 20 patients with psoriasis vulgaris and 10 healthy human controls. PBMCs were isolated, cultured in complete medium, and stimulated with phytohemagglutinin (PHA) alone, the com-bination of PHA and various concentrations of alpha-MSH, or nothing. After another 48-hour culture, ELISA and real-time PCR were performed to measure the secretion levels of TNF-alpha and IL-10 in the super-natants of cultured PBMCs as well as the mRNA expression levels of TNF-alpha and IL-10 in PBMCs. Results The secretion level of TNF-alpha in the supematants of patient-derived PBMCs stimulated by nothing or PHA alone was significantly higher than that from normal control-derived PBMCs (329.87 ± 99.33 ng/L vs 116.95 ± 37.15 ng/L, 1756.01 ± 183.60 ng/L vs 1287.30 ± 152.36 ng/L, both P<0.01). alpha-MSH of all tested concentrations (10-13, 10-11, 10-7,mol/L) could inhibit the secretion of TNF-alpha by PBMCs com-pared with PHA alone (all P < 0.01), and the maximum effective concentration was 10-13 mol/L. On the con-Wary, a significant decrease was observed in the secretion level of IL-10 in the supematants of patient-derived PBMCs stimulated by nothing or PHA alone compared with normal control-derived PBMCs (P <0.05 or 0.01). Moreover, the secretion of IL-10 by PBMCs was promoted by alpha-MSH of all tested con-centrations (P < 0.01 or 0.05), with the maximum effective concentration being 10-13 mol/L (P < 0.01). The alpha-MSH of 10-13 mol/L down-regulated the mRNA expression of TNF-alpha (P < 0.001), but up-regnlated that of IL-10 (P < 0.001) in PHA-stimulated PBMCs from patients. Conclusion alpha-MSH can regulate the production of TNF-alpha and IL-10 by PHA-stimulated PBMCs from patients with psoriasis vulgaris.

The clinical data and routine biochemical parameters of 64 maintenance hemodialysis (MHD)patients and 20 controls were analyzed in the study.Serum cystatin C levels were detected by latex particle enhalice inununo-turbidimetry:and the cardial structure and function were assessed by echocardiography.As MHD time extended,the levels of semm cystatin C increased gradually,accompanied with high incidence of left ventricular hypertrophy(LVH).The LVH-positive patients had higher systolic blood pressure and left veHtricular mass index,and had higher serum cystatin C than tllose in LVH-negative patients.The serum cystatin C levels were positively correlated with left yentricular mass index(r=0.633,P<0.01)and systolic blood pressure(r:0.397,P<0.01).The results suggest that serum cystatin levels may be an influencing factor for long-term cardiacvascular complication in MHD patients.

Objective To observe the changes of intedeukin (IL)-17 in patients with maintenance hemodialysis (MHD) and its relationship with anemia. Methods Twenty sera from normal people(normal group) and sixty-eight sera from patients with MHD were sampled. Patients with MHD were divided into 4 groups by haemoglobin (Hb) levels: severity anemia group (12 cases), midrange anemia group(18 cases),light anemia group(18 cases) and non-anemia group(20 cases). IL-6 and IL-17 levels were measured in all the sera with ELISA. Meantime, C-reactive protein (CRP),Hb, ferritin and iron saturation ratio was observed. Results CRP,IL-17 and IL-6 levels in MHD patients were much higher than those in normal group. IL-17 levels in severity and midrange anemia group were higher than those in light anemia group,and IL-17 was positively correlated to Hb. Conclusions IL-17,IL-6 and CRP in patients is higher than that in normal people,and the microinflammation status exists in MHD. IL-17 may play a role in pathogenesis of microinflammation in MHD patients with anemia.

Objective To observe the effects of mesenchymal stem cells (MSCs) surface CXC chemokine receptor 4 over-expression on the repair of kidney after ischemia reperfusion (I/R) injury.Methods The MSCs were co-cultured with I/R injured renal cell homogenate supernatant.The MSCs surface CXCR4 and stromal cells derived factor-1 (SDF-1α) protein levels were detected by Western blot, chemotactic ability of MSCs to SDF-1 was investigated by transwell test.The I/R injured renal model was made and pathological changes were observed in control group, I/R group, MSCs injection group and CXCR4 neutralize antibody group.Renal CXCR4 protein expression was measured by immunofluorescence histochemistry, SDF-1α、 CXCR4、 hepatocyte growth factor (HGF) and epidermal growth factor (EGF) mRNA were detected by Real-time quantitative polymerase chain reaction (RT-PCR).Comparisons among multiple groups were performed using One-way analysis of variance, and comparisons between groups were carried out using independent-sample t-test.Results In vitro, the SDF-1α protein expression markedly increased in I/R injured renal tissue homogenate, but the difference was not significant between I/R group and CXCR4 antibody group (t =0.862, P =0.403).MSCs surface CXCR4 protein expression increased significantly after co-cultured with I/R injured renal tissue homogenate (F =95.957, t =10.166, P ＜ 0.01), and the chemotactic ability of MSCs to SDF-1 increased at the same time (F =82.459, t =6.826, P ＜ 0.01), the CXCR4 protein expression (t =13.657, P ＜ 0.01) and the chemotactic ability (t =12.662, P ＜0.01) could be decreased by CXCR4 neutralize antibody.In vivo, renal tubular structure was destroyed in I/R group.After MSCs injection, the renal pathological injury improved rapidly, but the improvement could be inhibited by CXCR4 antibody.The expression of SDF-1α mRNA and level of SDF-1a protein increased in I/R group, but there was no significant difference among different groups (F =1.909,P =0.173).MSCs injection markedly up-regulated the CXCR4 protein and mRNA expression (F =6.663, P =0.006).Following the increase in CXCR4 expression, the expressions of HGF mRNA (F =11.898,P ＜ 0.01) and EGF mRNA (F =5.309, P ＜ 0.05) increased gradually which could be restrained by CXCR4 antibody (t =5.312, t =4.310, P ＜ 0.01).Conclusions I/R injured renal microenvironment markedly increased the mesenchymal stem cells surface CXCR4 expression, and increased CXCR4 expression can induce MSCs chemotaxis and stimulate the secretion of renal protective growth factors paracrine promoting the repair of the kidney.

Objective To explore the therapeutic effect and nursing points of different linked modes in hemodialysis combined with hemoperfusion on renal osteopathy disease in maintenance hemodialysis (MHD) patients.Methods Sixty-four MHD patients with renal osteopathy disease were enrolled in the study.They were divided into two groups by random digits table method:the front connection group and the back connection group with 32 cases each.Their clinical data,serum parameters and complications were recorded.The therapeutic effect of two groups were compared.Results The serum level of intact parathyroid hormone(iPTH) was (191.36 ± 53.96) ng/L in the front connection group,while (133.02 ± 38.63) ng/L in the back connection group,and there was significant difference,t=3.517,P＜0.05.The incidence of lower blood pressure and blood coagulation were 8.85％(51/576),6.94％(40/576) in the back connection group,while 14.93％(86/576),15.97％(92/576) in the front connection group,and there were significant differences,x2=10.149,23.136,P＜0.01.Conclusion The back linked mode in hemodialysis combined with hemoperfusion can obviously decrease iP:TH of MHD patients combined with renal osteopathy disease and has less complications,worth clinical promotion.

Endothelialprogenitorcels(EPCs)arethepluripotentstemcelsofvascularendothelial cels. They have self-differentiation and proliferation ability. A large number of animal experiments and preliminary clinical studies have show n that EPCs have broad prospects of clinical application. This article review s the research status of EPCs and their application in the clinical treatment of ischemic stroke.

An investigation of the current nurse-patient relationship is conducted in Guangzhou city,by analyzing the data it can be concluded that the attitude of nursing service and skills of communication,the degree of nurses' knowledge on their patients' cases have a significant influence on the nurse-patient relationship.Nurses should play a leading role in nurse-patient relationship.There is a lack of mutual consideration and understanding between nurses and patients,which lead to nurse-patient misunderstanding and conflicts.There is a strong desire to discuss the case together intensively between nurses and patients.Furthermore,the lack of effective communication and teamwork between medical staff will also hinder the relief of tension in current physician-patient relationship.

Objective: To establish a method for the determination of cinnamic acid in Lingguizhugan Decoction (Poria, Ramuls Cinnamomi, Rhizoma Atractylodis macrocephalae, Radix Glycrrhizae, etc.). Methods: Using RP HPLC with Hypersil C 18 column, methanol acetonitrile water acetic acid (10∶22∶70∶1.4,v/v) as mobile phase, detection wavelength at 254nm and p dimethylaminobenzaldehyde as the internal standard.Results: The mean recovery and RSD were 98.2% and 1.9% ( n =6), respectively, the linear range of cinnamic acid was 8.4～168?g?mL -1 ( r =0.9999). Conclusion: The method is simple, rapid, accurate and reproducible, and may be used for the determination of cinnamic acid in Lingguizhugan Decoction.

Objective To investigate the effects of citicoline combined with rehabilitative training on motor function after focal cerebral ischemia. Methods One hundred and twenty male adult Sprague-Dawley rats ( 3 months old) were subjected to left middle cerebral artery occlusion (MCAO) by suturing. Ninety-six of them were randomly divided into four groups of 24: a control group, a drug group, a rehabilitative training group, and a drug combined with rehabilitative training group. The rats in the control group did not receive any treatment. Three days after reperfusion, those in the drug group received 500 mg/kg of citicoline daily; those in the rehabilitative training group received motor training including balancing, grasping, rotating and walking exercises; those in the combined group received both citicoline and the motor training program. Behavioral tests were administered at the 7th, 14th and 21st days after MCAO. At the same time points, immunohistochemistry was used to detect calcium-binding protein S100 and β-tubulin expression in the peri-ischemia region of the cortex. Results ①As compared with the control group, the drug group at the 7th, 14th and 21st day after MCAO and the other two groups at the 7th day after MCAO showed no significant difference in average behavior scores. But at the 14th and 21st day the rehabilitative training group as well as the drug combined with rehabilitative training group had average behavior scores significantly superior to those of the control group, especially in the drug combined with rehabilitative training group. ②As compared with the control group, the expression of S100 and β-tubulin in the drug and rehabilitative training groups at the 7th day after MCAO showed no significant difference. In the drug combined with rehabilitative training group the average score was significantly higher than in the other groups at the 7th day after MCAO. All the other groups had average scores significantly higher than that of the controls at the 14th and 21st day after MCAO, especially the drug combined with rehabilitative training group. Conclusions Citicoline combined with rehabilitative training can significantly improve motor function recovery in rats. The effect of the combined modalities was more obvious, and the functional enhancement might be partially attributable to the up-regulation of S100 and β-tubulin in the cortex.