The deficiencies of the 6th International Union Against Cancer (UICC)/American Joint Committee on Cancer (AJCC) staging system of nasopharyngeal carcinoma (NPC) were included as follows: ①There is a lack of hazard discrimination between some T categories; ②The maximum dimension of lymph node was not an independentprognosis in NPC; ③The subsets defi ned by T and N classifi cations that make up a given group typically have different prognosis. The introduction of new types of therapeutic interventions or new technologies may require modifi cations of the classif ication and staging systems. Compared to computerized tomography (CT), magnetic resonance imaging (MRI) is superior to in the detection of early involvement such as paranasopharyngeal space, oropharynx, and retropharyngeal lymphatic metastasis, and demonstrate deep primary tumor infi ltration such as skull base, intracranial erosion more easily, so MRI should be optional method in T stage of NPC. Positron emission tomography/ computerized tomography (PET/CT) is superior to MRI in the detection of cervical lymph node metastasis and distant metastasis. With the development of diagnostic and therapeutic techniques revolutionized in NPC, staging systems should be modified. Research based on the data of 924 NPC patients revealed:①It appeared more prognostic value to modify 4 substages into 3 substages in T-category; ②N-category was more concise by deleting nodal greatest dimension palpation;③ It showed that nodal parameters including level, laterality and extranodal neoplastic spread (ENS) are independent prognostic factors for NPC. N-staging criteria with RTOG guidelines for lymph node levels was set up which adapted to the requirement of conformal radiation therapy. Incorporating ENS and retropharyngeal lymph nodes into the N-staging system for NPC increases the predictive power.

[Objective]To observe the effect of Shenkang Infusion on latent nephritis of syndrome of deficient spleen and kidney.[Method]Select the said patients,randomly divide them into treatment group 34 and control group 35 cases,both take Ciwujia Injection and Breviscapine(IVD),the treatment group takes Shenkang Infusion.Observe their TCM sign integral,24h urinary protein quantity,protein and red cells change in routine urine test.[Result]In treatment group,the total effective rate was 83.33%,urinary protein 86.67%;and 53.33% and 60% for control group respectively;the treatment one was better than control one.Both TCM sign integrals were decreased markedly,the treatment group was more obvious.[Conclusion]Shenkang Infusion can much alleviate clinical demonstrations and reduce 24 urinary protein quantity of latent glomerulus nephritis of the disease.

Objective To evaluate of the glucose screening retest for gestational diabetes mellitus (GDM) during pregnancy. Methods A retrospective analysis of 714 pregnant women screened for GDM, between December 1,2001, and December 31,2002, was performed.The first glucose challenge test(GCT) was performed in 16～27 week and retested in 28～38 week.Diagnosis of GDM was based on the criteria of Dong.NDDG criteria was also discussed. Results (1) 1-hour glucose value of 50 g GCT ≥7.8 mmol/L was set as abnormal.The first 50 g GCT abnormal rate was 26.6%(190/714),and the retest abnormal rate was 35.2%(225/639).The mean age of pregnant women in 50 g GCT positive group was significantly higher than that in the negative group( P

Objective To investigate the distribution and drug resistance of pathogens in cancer patients with nosocomial infections. Methods Pathogens isolated from cancer patients with nosocomial infections in Zhejiang Cancer Hospital from 2004 to 2008 were analyzed. Results Totally 3454 strains of pathogens were isolated, including 1900 strains of Gram-negative bacilli (55.0%), 838 strains of fungi (24.3%), and 716 strains of Gram-positive bacteria (20.7%). Pathogenic bacteria Escherichia coli and Candida albicans were isolated mainly from surgical wound, urinary tract, respiratory tract and oral cavity. The drug resistant rates for Gram-negative Escherichia coli and Gram-positive staphylococci were high, and Candida albicans was sensitive to all antifungal drugs. Conclusion Opportunistic pathogens account for most nosocomial infections in cancer patients, and some of them are of high-level resistance to antimicrobial agents.

Objective To investigate the results of follow-up visits of pregnancy course, delivery and infants of women who got clinically pregnant by assisted reproductive technique after gonadotropin-releasing hormone agonist (GnRH-a) added for luteal support, and to analyse the influence of adding GnRH-a in luteal support on the safety of mother and infant. Methods A retrospective analysis was carried out on the medical record from 215 patients who got clinically pregnant after luteal phase long regimen fresh-cycle transfer was operated. According to the differences in luteal support methods, the patients were assigned to Group A (124 patients, progesterone+dydrogesterone group), Group B (91 patients, GnRH-a added group). The patients′ pregnancy course, delivery time, and the growth and development of infants within 1-2 years were followed up. Results (1)There was no obvious difference between Group A and Group B in terms of the abortion ratio during the early pregnancy (8.1%, 12.1%), the rate of abortion villous deformity (50.0%, 9.1%), the rate of heterotopic pregnancy (10.5%, 5.5%) and rate of twin pregnancy (19.4%, 28.6%;all P>0.05).(2)Compared to group A, during the middle and late pregnancy of single or twin pregnancy in Group B , there was no obvious difference in the rate of fetal chromosomal abnormality, organ malformation incidence, late abortion rate and stillbirth rate (all P>0.05).(3)As to childbirth, in the case of twin pregnancy, there was a higher rate of premature delivery (60.0%, 39.1%;P=0.041), as well as rate of lower birth weight of newborn (56.0%, 34.8%; P=0.037) in group B.(4)The statistics on general growth and development as well as infantile common diseases within 2 years after birth indicated that there was no obvious difference between the two groups in single birth and twin birth subgroup (all P>0.05). Conclusion On the basis of controlling of implanted embryos and reducing the occurrence of twins, GnRH-a luteal support maybe relatively safe and effective.

Autoradiography of nicotinic acetylcholine receptors (N-AChR) with the application of histochemical staining location of cholinesterase was used to observe the effect of soman on junctional and extrajunctional N-AChR. Testing with the diaphragms and extensor digitorum longus muscles of mice and rats, we found that soman mainly increased the number of extrajunctional N-AChR. It did pot alter the number of junctional N-AChR significantly, nor did it have any pronounced effects on the glycoprotein property and isoelectric point (pI) of junctional and extrajunctional N-AChR. The change of extrajunctional N-AChR number caused by soman is similar to the phenomenon of increased extrajunctional N-AChR number and sensitivity resulting from denervation, but the mechanism of action is different from the latter. The increase of N-AChR number is one of the important characteristics of soman poisoning which make it different from other nerve agents. To maintain the metabolic balance of N-AChR may be an important new approach to the treatment of soman poisoning.

Objective To investigate the existence of HBV DNA YMDD mutation in patients with chronic hepatitis B and the related significance. Methods HBV DNA YMDD mutation was detected in 90 patients with hepatitis B. The liver function, HbeAg, HBVDNA, and HBV DNA YMDD mutation in patients with HBV DNA YMDD mutation were analyzed. Results HBV DNA YMDD mutation was found in 20 out of 90 patients with hepatitis B (positive rate 12.00%). HBV DNA YMDD mutation was found in 9 out of 36 patients receiving lamivuding therapy (positive rate 25.00%), but HBV DNA YMDD mutation was found in 11 out of 54 patients without lamivuding therapy (positive rate 20.37%). In the 20 patients with HBV DNA YMDD mutation, 5 patients were negative in HBeAg. HBV DNA, ALT, and Tb of the 20 patients with HBV DNA YMDD mutation were 3.0221?10 5-2.369?10 8 (5.41?7.75?10 7) copies/ml, 34 -1 216 (288.20?338.07) IU/L, and 8.9-326.7 (48.74?72.20) ?mol/L, respectively. Conclusion HBV DNA YMDD mutation may occur during the process of lamivuding therapy or may exist naturally. YMDD mutation may co-exist with pre-C gene mutation, suggesting that mutation often occurs in many sites in HBV genes. The reproduction level of HBV DNA ranges from the middle to the high levels. The pathogenicity of YMDD mutation species is various. The liver function may be normal and may also be abnormal in various degrees in these patients with HBV DNA YMDD mutation.

Objective To report a case presented with atypical clinical and radiological appearance in the early stage and finally pathologically confirmed as chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids ( CLIPPERS) , aiming to improve the understanding of the disorder. Methods The clinical, imaging, laboratory and pathological features as well as treatment and prognosis of a pathologically confirmed CLIPPERS patient with repeated relapsing-remitting course and stepwise progression in nine years were retrospectively analyzed. Results There were five relapsing-remitting processes in total clinical course of nine years. The clinical and radiological appearance was atypical in the early stage. At the first attack, the patient presented with fever, headache, altered consciousness and epileptic seizure. In the following courses, the patient presented with ataxia, blurred vision and limb weakness. Brain MRI (2006-2009) showed multiple abnormal signals including supratentorial white matter, pons and cerebellum with patchy gadolinium enhancement. Treatment with steroids resulted in a favorable clinical and radiological improvement. The symptoms of this attack included limb weakness, blurred vision, dysdipsia and dysarthria. Physical examination showed cognitive dysfunction, multiple cranial nerves injuries and bilateral pyramidal signs. Brain MRI showed multiple abnormal signals involved pons and cerebellum predominantly as well as supratentorial white matter with punctate gadolinium enhancement peppering the pons and cerebellum. A characteristic predominantly T lymphocytic perivascular infiltration was seen on brain biopsy. Both the imaging and histological findings were consistent with the CLIPPERS features. High-dose steroids treatment was given and obvious clinical and radiological improvements were observed. After discharge, steroids were reduced slowly combined with the use of immunosuppressant to avoid relapse of the disorder. Conclusions There is heterogeneity in clinical manifestations of CLIPPERS with repeated relapsing-remitting course and imaging presentations are sometimes atypical in the early stage, which leads to the misdiagonsis and missed diagnosis. Distinctive pathology is the “gold standard” for definite diagnosis. The nosological position of CLIPPERS is still unclear. Repeated relapse-remitting leads to secondary cerebral atrophy and degeneration, with the risk of progressing to primary central nervous system lymphoma. Early and vigorous steroids treatment with continuing maintenance immunotherapy results in the decreased relapse and best long-term prognosis. The neurologist should strengthen the understanding of CLIPPERS for early correct diagnosis and treatment aiming to reduce the functional disability.

Objective To observe the anti-fibrosis therapeutic effect and mechanism of Qingshen granule for treatment of patients with chronic renal failure (CRF) accompanied by damp-heat syndrome.Methods Sixty-eight patients with CRF accompanied by damp-heat syndrome were randomly divided into a control group and a observation group, and the study was completed only in 61 patients, 31 in the control group and 30 in the observation group. Thirty subjects having taken physical health examination were assigned in a healthy control group. All the patients in both treatment groups were treated with conventional western medical therapy and traditional Chinese medicine (TCM) retention enema, and for patients in observation group, Qingshen granule was given additionally, 1 bag (10 g) thrice a day taken orally. The therapeutic course was 8 weeks. The clinical therapeutic effect, the levels of serum creatinine (SCr), the glomerular filtration rate (eGFR), serum interleukin-17 (IL-17), collagen type Ⅲ (Col-Ⅲ) and nuclear factor-κB p65 (NF-κB p65) in peripheral blood mononuclear cells (PBMC) were measured before and after treatment in the two treatment groups, and the above results were compared with those in healthy control group.Results Clinically, the total effective rates of the disease and of the TCM syndrome in observation group were significantly higher than those in the control group (86.67% vs. 58.06%, 83.33% vs. 45.16%, bothP < 0.01). In the observation group, the level of SCr was obviously lower, and the level of eGFR was markedly higher after treatment, and compared with the control group, the changes in above data after treatment in observation group were more significant [SCr (μmol/L): 250.62±164.97 vs. 393.72±183.64, eGFR (mL·min-1·1.73 m-2): 33.42±17.24 vs. 39.72±23.85, bothP < 0.05]. After treatment, the levels of serum IL-17, Col-Ⅲ and NF-κB p65 in PBMC were obviously lowered in both treatment groups compared with those before treatment, the therapeutic effect in observation group being superior to that in the control group [IL-17 (ng/L): 17.47±8.87 vs. 25.51±16.69, Col-Ⅲ (μg/L): 17.06±8.76 vs. 23.77±10.44, NF-κB p65 (μg/L): 0.58±0.34 vs. 0.83±0.30, allP < 0.05].Conclusion The Qingshen granule can ameliorate the clinical symptoms, improve renal function, decrease the levels of serum IL-17, Col-Ⅲ and NF-κB p65 in PBMC, intervene renal fibrosis in patients with CRF and damp-heat syndrome, ultimately delaying the progress of CRF.

Objective To explore the MR features of granulomatous mastitis and to improve the diagnosis of the disease.Methods MR findings of 1 1 patients with granulomatous mastitis confirmed by pathology were retrospectively reviewed.Results Nine (81.82%)lesions showed regional or diffused hyperintensity on T2 WI with heterogeneous gridding features.2 (18.18%)lesions showed mass-like enhancement and 9 lesions showed non-mass-like enhancement.Of 9 (81.82%)lesions with non-mass-like en-hancement,the enhancement patterns included diffused in 2 (18.18%)cases,regional in 4 (36.36%)cases,multiple-regional in 2 (18.18%)cases,and focal in 1 (9.09%)case,respectively.All the lesions showed early heterogeneous enhancement,and clumped-ring enhancement was seen in 6 lesions.The signal intensity of the lesions was increased and more uniform in the later stage.The time-signal intensity curve was type I in 7(63.64%)cases,type II in 3 (27.27%)cases and type III in 1 (9.09%)case.The mean ADC value was (1.82±0.1 7)×10 -3 mm2/s,and there was no significant difference between lesions and normal regions (t=1.766, P >0.05).Concomitant signs included barymastia,thickening of skin,edema surrounding the lesions,and axillary lymph node en-largement.The BI-RADS category was 3 degree in 1 (9.09%)case,4a degree in 5 (45.45%)cases,4b degree in 2 (18.18%)ca-ses,4c degree in 2 (18.18%)cases and 5 degree in 1 (9.09%)case.The misdiagnosis ratio was 54.55%.Conclusion Granuloma-tous mastitis has certain characteristic MR features.The misdiagnosis ratio of granulomatous mastitis is high.Therefore,clinical data should be referred when making diagnosis.