Objective To explore the clinical application value of blood uric acid(SUA),beta 2 microglobulin(β2-MG),lipopro-tein(a)[LP(a)]and C-reactive protein(CRP)in the early renal damage caused by elderly hypertension.Methods According to the clinical diagnosis,210 elderly patients with primary hypertension were selected as the research subjects and 50 healthy elderly per-sons as the healthy control.The SUA,β2-MG,LP(a)and CRP levels were detected.The differences were compared between the groups with the different severity degrees of hypertension and the healthy control group;Furthermore,these 210 cases of hyperten-sion were divided into the simple hypertension group and the hypertensive renal group according to the creatinine clearance rate (Ccr)for observing the changes of the four indicators.Results The blood SUA,β2-MG,LP(a)and CRP levels in the hypertension group were significantly increased,which were higher than those in the normal control group,the differences had statistical signifi-cance(P <0.01);In the study by grouping according to the increase degree of blood pressure:the blood SUA,β2-MG,LP(a)and CRP levels in the three groups of the grade 1,2,3 hypertension were significantly increased,the statistical analysis showed the sig-nificant difference between groups(P <0.05);Compared with the simple hypertension group,the SUA,β2-MG,LP(a)and CRP lev-els were significantly increased compared with the hypertensive renal group,the difference showed the statistical significance(P <0.05).Conclusion Monitoring blood SUA,beta 2-MG,LP(a)and CRP levels in elderly patients with hypertension can effectively monitor the early renal function damage in the patients with senile hypertension,can find the renal lesions more rapidly and effec-tively and is conducive to early diagnosis and treatment in clinic.

Objective To investigate the influence of gonadotropin releasing hormone agonist (GnRH-a) on the expression mRNA of nerve growth factor (NGF) and its receptors (TrkA and P75NTR) in normal and eutopic endometrial stromal cells (ESC).Methods From January to April 2009,3 patients with endometriosis undergoing surgery in Peking Union Medical College Hospital were obtained eutopic endometrium as study group matched with eutopic endometrium from 3 parents with teratoma as control group.ESC were incubated with different concentration of GnRH-a (0,5 × 10-11,5 × 10-10,5 × 10-9,5 ×10-8,5 × 10-7 g/ml).The expression of mRNA of NGF,TrkA and P75NTR were measured by real-time-PCR.Results At concentration of 0 g/ml,the levels of NGF,TrkA and P75NTR mRNA in ESC were 6.32,8.55,8.08 in study group,which were significantly higher than 0.94,0.67,1.08 in control group (P ＜0.05).Treated by the following concentration of GnRH-a (5 × 10-11,5 × 10-10,5 × 10-9,5 × 10-8,5 ×10-7 g/ml),the median expression of NGF,TrkA and P75NTR mRNA was 1.00,0.96,1.05; 1.09,0.82,1.27 ; 1.04,0.52,0.81 ; 1.00,0.55,0.64; 0.78,0.49,1.02 in study group.Compared with the expressions of those untreated by GnRH-a in study group, they showed significantly lower trends (P ＜0.05).In control group,the median expression of NGF,TrkA and P75NTR mRNA was 0.98,0.37,0.92; 0.70,0.45,1.15; 1.55,0.80,1.35; 1.09,0.41,1.35; 0.90,0.82,1.18.Compared with the expressions of those untreated by GnRH-a in control group,there were no statistically differences ( P ＞0.05).And treated by the same concentration of GnRH-a,the expressions of NGF,TrkA and P75NTR mRNA did not show statistically difference between the two groups ( P ＞ 0.05 ).Conclusion The expression of NGF.TrkA and P75NTR mRNA were suppressed by GnRH-a.

Objective To evaluate the status of P-selectin and platelet activating factor(PAF) in vivo in patients with deep venous thrombosis(DVT) and to observe their changes under interneving of medicines.Methods P-selectin and PAF of fourty patients and twenty normal subjects were fluorescence labled with corresponding monoclonal antibodies by flow cytometry( FCM ) and immunologic method respectively. Results P-selectin and PAF in patients with DVT were higher than that in normal subjects in early period of the disease, and they significantly decreased in different time after patients were treated. P-selectin was significantly different between patients who received sodium ozagrel treatment and those who not (P ＜0.05 ), but PAF was similar( P ＞ 0. 05 )after fourteen days. One month later, P-selectin and D-dimer in DVT patients were lower than before. However, the positive rate of P-selectin of DVT was still higher than normal subjects. Conclusions The platelet is activated in vivo in patients with DVT, so does fibrinolysis. Sodium ozagrel can decrease activity of platelet. P-selectin and PAF may be used diagnostic markers. Post-discharge patients are still at high-risk and must be regularly followed-up.

Objective To investigate the relationship between the distribution of nerve fibers in multiple endometriosis lesions and pelvic pain.MethodsFrom Sept.2007 to Sept.2008, 120 endometriosis patients treated in Peking Union Hospital were enrolled in this study, which including 19 cases with stage Ⅰ , 29 cases with stage Ⅱ , 44 cases with stage Ⅲ and 28 cases with stage Ⅳ.The pain symptom was evaluated by visual analogue scales(VAS) score and nerve fibers in multiple endometriosis lesions were detected by immunohistochemical staining.Results The number of nerve fibers in multiple endometriosis lesions were (29.74 ± 17.33)/mm~2 in uterosacral ligament, (24.53 ± 13.34)/mm~2 in vaginal septum, (17.09 ± 10.09)/mm~2 in uterus rectum crux, (6.77 ± 4.21)/mm~2 in peritoneal endometriosis lesions, (0.07 ± 0.25)/mm~2 in endometriosis ovarian cyst wall.The number of nerve fibers in uterosacral ligament was mostly correlated with the degree of pain (r = 0.56).The nerve fibers of uterus rectum crux and vaginalseptum were correlated with defecation pain (r = 0.58 and 0.41) and dyspareunia (r = 0.82 and 0.67),which were significantly higher than those in endometriosis leision in peritoneum and ovary.There was no significant different number of nerve fibers among different stage disease (P > 0.05).Conclusion There was significantly different distribution of nerve fibers in multiple endometriosis lesions, which was correlated with dysmenorrhea, anus pain, dyspareunia and chronic pelvic pain, not with clinical staging.

Objective To investigate clinicopathological characteristics of recurrent endometriosis and outcomes of secondary surgery.Methods From Jan.2003 to Dec.2008,69 cases with recurrent endometriosis operated by the same senior gynecologist in Peking Union Medical College Hospital were studied retrospectively in order to summarize clinicopathological characteristics and clinical outcomes.In prior surgery,both ovaries were involved in 29 cases (42％,29/69),and unilateral ovarian endometriomas were found in 40 cases ( 58％,40/69),including 19 cases (48％,19/40) with left lesions and 21 cases (52％,21/40) with right lesions.After first surgery,57 cases presented recurrent pelvic cystic masses and 12 cases presented moderate to severe pain without pelvic mass.Results The median recurrence interval was 38 ( 1 - 144) months.Among 57 cases with recurrent pelvic masses,bilateral ovarian endometiomas recurred in 24 cases at median recurrence interval of 31 months.Unilateral ovarian endometrioma recurred in 33 cases at recurrence interval of 39 months.There was no significant different recurrence period between blilateral and unilateral recurrent ovarian mass ( P =0.452).The recurrent rate of left and right side ovarian lesion was 77％ (37/48) and 68％ (34/50 cases),respectively,which did not reach statistical difference (P=0.396).Among 12 recurrent cases with pure pelvic pain,10 cases were founded combined with adenomyosis ( AM),of which 4 cases had deep infiltrated endometriosis (DIE).Compared with the 40 cases of simple ovarian endometriomas,29 cases complicated by DIE and (or) AM had longer operation time (75.1 min vs.49.9 min,P=0.017) and more blood loss (114.9 ml vs.38.4 ml,P＜0.05).In those 69 recurrent endometriosis patients,the median period of following-up was 32 months (3 months to 8 years).Six cases showed recurrent disease again at median recurrence interval of 3 years ( 6 months 6 years).Thirty-eight cases had expecting childbearing,however,only 4 women underwent childbirth.Conclusions The rate of clinical diagnosis of recurrent endometriosis is quite high.Pain is mostly associated with AM.The major difficulty and challenge of secondary surgery was ovarian endometrioma combined with DIE or AM.Prognosis of recurrent endometriosis is not optimistic after secondary surgery.

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.

Objective To investigate the characteristics of the anatomical distribution of posterior deeply infiltrating endometriosis (PDIE) lesions, pain symptoms and effects of laparoscopic surgery.Methods Clinical data of 176 PDIE patients with laparescopically diagnosed and histologically confirmed were analyzed and compared with data of 179 cases with non-PDIE. According to the invasion of rectum or vaginal fomix, 176 PDIE cases were divided into three groups: simple (144 cases), fornix (18 cases) or rectum group (14 cases). Results Compared with the non-PDIE patients, the risk of pain symptoms in PDIE patients were significantly increased, OR for dysmenorrhea, chronic pelvic pain, deep dyspareunia,dyschezia were 6.73 (95% CI, 3.66-12.40), 1.90 (95% CI, 1.17-3.05), 3.09 (95% CI, 1.94-4. 92) and 4.90 (95% CI, 2.07-8.11), respectively (all P < 0.05). The highest incidence of dyschezia was observed in rectum group (50. 0%, P <0.05), while deep dyspareunia in fornix group (72.2%, P < 0.05). The longest operative duration (82±31) minutes and the postoperative hospitalization (7.7±2.1) days were observed in rectum group (P <0.01). The median pain relief time was 56 months in the patients with complete excision of PDIE lesions, which was significantly longer than that in patients with incomplete excision (25 months, P <0.01). Multivariate analysis demonstrated that only incomplete excision of PDIE lesions was the risk factor for shorter pain relief time (P<0.05). Conclusion Conservative laparoscopic surgery may effectively relieve pelvic pain symptoms in patients with PDIE, while incomplete excision of PDIE lesions was the only significant predictor of shorter pain relief time.

Objective To study the relationship between the clinic-pathological features and pain symptoms in patients with endometriotic cyst(EM).Methods The medical data of symptoms,laparoscopy and pathology examination in 416 patients with endometriosis were studied retrospectively.All cases were divided into two groups on the existence of ovarian endometrioma,including 338 patients in cyst group and 78 cases in non-cyst group.The relationship between clinical symptoms and location and type of endometrioma was studied.Results(1)Serum CA125 level:the level of CA125 were(61 ± 39)kU/L in cyst group(28 ± 24)kU/L in non-cyst group,which reached statistical difference(P ＜ 0.01).(2)Pathological features:among 338 cases,34.0％ of cyst were on left side(115/338),26.3％ were right side(89/338),and 39.6％ were on both side(134/338).And 95.8％(324/338)of cases were combined with the other type of endometriosis,which were 48.5％(164/338)with peritoneal endometriosis,47.3％(160/338)with deep infiltrating endometriosis(DIE).In cystic patients,the incidences of endometriosis lesion were 13.9％(47/338)on the uterine surface,38.5％(130/338)on obstruction of cul-de sac,40.5％ (137/338)on utero-sacral ligament of DIE,which were significantly higher than 5.1％,(4/78),9.0％ (7/78)and 28.2％(22/78)in noncyst group.(3)Pain symptom:the incidence and degree of dysmenorrhea and dyschezia had no statistical difference between two groups(P ＞ 0.05),and the incidence of chronic pelvic pain(CPP)of 24.6％(83/338)and dyspareunia of 29.9％(101/338)in the cyst group were significantly lower than 35.9％(28/78)and 44.9％(35/78)in non-cyst group(P ＜ 0.05).The incidence of dysmenorrheal was 85.1％(114/134)in cases with bilateral cyst,which was higher than 74.0％(151/204)in cases with single cyst.The incidence of dysmenorrheal and dyschezia in moderatesevere adhesion was 89.0％(138/155)and 18.7％(29/155),which was significantly higher than 68.8％ (126/183)and 8.2％(15/183)in mild adhesion.In the patients cyst existed with DIE,the risk of dysmenorrheal,CPP,dyspareunia,and dyschezia were obviously raised(OR respectively was 5.17,3.01,3.05,2.75).Conclusions The endometriotic cyst often co-exists with other type of endometriotic lesions.Ovarian endometrioma was associated with lesion localized on uterine surface,cul-de-sac,sacrum ligament.The risk of all the pain symptoms would be raised when the endometriotic cyst co-exit with the DIE lesions.So the treatment for DIE lesions was as same important as the endometriotic lesions in order to relieve pain symptoms and delay the relapse.

Objective To detect the expressions of two protein factors hypoxia-inducible factor (HIF)-1α and Helicobacter pylori (Hp) in gastric cancer in Mongolian and Han two nationalities respectively,and to explore the relationship of HIF-1α and Hp in the development of gastric cancer.Methods A modified Warthin-Starry (W-S) silver staining method was used to detect Hp infection in 27 Mongolian patients with gastric cancer and 30 Han patients with gastric cancer.Immunohistochemical (S-P) method and reverse transcription polymerase chain reaction (RT-PCR) method were used to detect protein and mRNA expressions of HIF-1α in cancer tissue,paracancerous tissue and normal tissue samples.The relationship of HIF-1α protein and Hp expression was analyzed between gastric carcinoma tissue samples of Mongolian patient group and Han patient group.Results Hp infection rates were 81.5％ (22/27) and 66.7％ (20/30) in Mongolian and Han patients with gastric cancer.The difference in infection rate was not statistically significant between two groups of patients (~=1.608,P ＞ 0.05).The positive expression levels of HIF-1α protein were 62.96％ (17/27) and 70.00％ (21/30) in gastric cancer tissue samples of Mongolian and Han groups.The relative expression levels of HIF-1α mRNA were 0.891 4±0.075 0 and 0.907 4±0.065 5.There was no significant difference in the HIF-1 α mRNA expression between the two nationalities.No positive expressions of HIF-1α protein and mRNA were found in paracancerous tissue and normal tissue samples.There was a positive correlation in the positive expression of HIF-1α protein and Hp infection in gastric cancer tissue samples of Mongolian and Han patient groups (r,=0.424 and 0.617,P ＜ 0.05).Conclusion HIF-1α and Hp are pathogenic factors of gastric cancer.Hp and HIF-1α may promote the occurrence of gastric cancer together.The pathogenic mechanism of HIF-1α and Hp in gastric cancer may be the same for Mongolian and Han patients.

Objective To investigate the changes of mestruation patterns and adverse effects during the treatment of levonorgestrel-releasing intrauterine system (LNG-IUS) for symptomatic adenomyosis in a prospective cohort study. Methods From December, 2006 to December, 2014, patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in Peking Union Medical College Hospital were given LNG-IUS. Before and after placement of IUS, all patients′ parameters were recorded, including carrying status of IUS, symptoms and scores of dysmenorrhea, menstruation scores, biochemical indicators, physical parameters, menstruation patterns and adverse effects. Risk factors for changes of menstruation patterns and adverse effects, and their impact on treatment effects were analyzed. Results Totally 1 100 cases met inclusion criteria, with median age 36 years (range 20-44 years), median follow-up 35 months (range 1-108 months). During follow-up changes of menstruation patterns increased significantly with amenorrhea and shortened-menstruation being the most common manifestations. On 3, 6, 12, 24, 36, 48 and 60 months after the placement of LNG-IUS, 0, 5.8%(43/744), 6.9%(47/682), 10.1%(60/595), 17.3%(87/502), 27.2%(104/383) and 29.6%(82/277) patients achieved amenorrhea respectively (P<0.01). Total and subclassification of adverse effects decreased significantly (P<0.01). Within 12 months and >12 months after placement, abdominal pain and body weight increasing ≥5 kg/year were the most common adverse effects. Changes of menstruation patterns, total and subclassifications of adverse effects were neither dependent on patient parameters, treatment modes and treatment effects, nor could predict future LNG-IUS carrying status (all P>0.05). After taking out of LNG-IUS, most changes of menstruation and adverse effects disappeared. Conclusions During the treatment of LNG-IUS for symptomatic adenomyosis, changes of menstruation patterns increase gradually with amenorrhea and shortened-menstruation being the most common manifestations, while adverse effects decrease significantly. Changes of menstruation patterns or adverse effects neither have any risk factor nor have impact on treatment effects.