It is important in clinical practice to identify the types of serum free light chain (FLC),especially to measure the concentration of serum FLC.The serum FLC assay in combination with other serum protein analysis are very valuable in the diagnosis,monitor,and response evaluation of patients with plasma cell disorders(PCD).The methods progress of the measurement of serum FLC and clinical application in diagnosis and evaluation of treatment are reviewed.

Objective To investigate the pathogenesis of hepatorenal syndrome(HRS),especially the role of the vasoconstrictor that and vasodilator that played in the process.Methods The patients were divided into two groups for observation:The patients of chronic hepatitis with HRS were observational group,the patients of chronic hepatitis without hepatorenal syndrome were control group.Immunoenzyme technique was used for detecting the quantity of renin、atrial natruretic polypeptide、nitric oxide and endothelin in blood and ascites of all patients in two groups respectively.Then we compared the data of the two groups.Results Compared with those of the control group,rennin and endothelin in blood and ascites of the observational group increased significantly(P

Objective To analyze the significance of the liquid-based thinprep cytologic test (TCT ) in early cervical cancer screening by comparing cervical atypical squamous cells (ASC) and the histologic diagnostic results in order to guide the clinician to correctly understand the meaning of ASC and further explore the effective method of early cervical cancer screening .Methods 163 cases of cervical ASC diagnosed by histology and TCT were retrospectively analyzed and the comparative analysis was performed . Results Among 163 cases of cervical biopsy ,50 cases were ASC of undetermined significance (ASC-US) diagnosed by TCT ,the positive cases verified by the histology accounted for 49 .3% ;13 cases were ASC of highly squamous intraepithelial lesions diag-nosed by TCT ,the positive cases verified by the histology accounted for 76 .9% .The cases of ASC-US diagnosed by cytology and cervical intraepithelial neoplasia grade Ⅱ(CIN Ⅱ) and above diagnosed by histology accounted for 12% .Conclusion ASC-H high-ly suggests the clinical possibility of high-grade intraepithelial neoplasia .ASC-US is a suggestive diagnosis rather than a clarity di-agnosis .Correctly understanding the clinical significance of ASC can discover early cervical lesions as early as possible .

Objective:To observe the flow density (FD) of macular and optic disc and area of foveal avascular zone (FAZ) in severe nonproliferative diabetic retinopathy (S-NPDR).Methods:A prospective cross-sectional study. From October 2019 to April 2020, 31 eyes of 25 S-NPDR patients (S-NPDR group) who were diagnosed in the ophthalmological examination of Jiangsu Province Hospital and 30 eyes of 30 age- and sex-matched healthy volunteers (control group) were included in this study. Optical coherence tomography angiography (OCTA) was used to scan the macular area of 6 mm×6 mm and optic disc of 4.5 mm×4.5 mm. The software automatically divides it into three concentric circles centered on the macular fovea, which were foveal area with a diameter of 1 mm, parafoveal area of 1 to 3 mm, and foveal peripheral area of 3 to 6 mm. The area around the optic disc was divided into 8 areas: nasal upper, nasal lower, inferior nasal, inferior temporal, temporal lower, temporal upper, superior temporal and superior nasal. The FD of the optic disc, the superficial capillary layer (SCP) and deep capillary layer (DCP) of the retina and FAZ area were measured. The FD and FAZ area were compared between the two groups by independent sample t test. The correlation between FAZ area and FD was analyzed by Pearson correlation. Results:In parafoveal and perifoveal area, compared with the control group, the FD of SCP ( t=6.470, 5.220; P<0.001) and DCP ( t=7.270, 7.370; P<0.001) decreased in S-NPDR group. In foveal area, there was statistically significant difference in the FD of DCP between the two groups ( t=2.250, P=0.030), while the difference in FD of SCP between the two groups was not statistically significant ( t=0.000, P=0.900). The FAZ area in S-NPDR group was larger than that in control group, and the difference was statistically significant ( t=2.390, P=0.030). The FD in the S-NPDR group was lower than that in the control group except the superior nasal, the difference was statistically significant ( t=7.520, 5.000, 4.870, 3.120, 2.360, 2.120, 5.410, 5.560, 2.640; P<0.05). Pearson correlation analysis showed that the FAZ area of S-NPDR was negatively correlated with FD of SCP ( r=-0.513, P=0.004), and had no correlation with FD of DCP ( r=0.034, P=0.859). Conclusion:The overall FD in macular area and optic disc of patients with S-NPDR decreased and the FAZ area enlarged.

Objective To investigate the effect of gastrodin on rat vascular smooth muscle cell (VSMC) migration induced by platelet-derived growth factor-BB (PDGF-BB) and its possible mechanisms.Methods Enzyme digestion method wasused to obtain rataorticVSMCs and be purified bypassage.Immunofluorescence staining was used to identify VSMC marker proteins.A PDGF-BB induced cell migration model was established.Transwell chamber assay was used to evaluate the effect of gastrodin on PDGF-BB induced VSMC migration.Western blots were performed to detect the phosphohorylation levels of c-jun N-terminal kinase (JNK).Results The purity of primary cultured VSMC was more than 99％.The VSMC migrated number in the PDGF-BB group was 85.2 ± 3.486 per field.It was significantly more than 42.5 ± 1.927 per field in the control group (t =9.981,P＜0.001),and gastrodin was enable to make PDGF-BB induced the number of VSMC migration significantly reduce to 71.3 ± 1.783 per filed (t=3.550,P =0.002).Western blots analysis showed that gastrodin inhibited PDGF-BB induced JNK phosphorylation (0.190 ± 0.015 vs.0.190 ± 0.015; t =14.548,P =0.000).Conclusions Gastrodin inhibits PDGF-BB induced VSMC migration,its mechanisms may be associated with the inhibition of the JNK signaling pathway activation.

Objective To summarize and study the clinicopathologic features,diagnosis and differential diagnosis of tricho-blastoma (TB).Methods The clinicopathological characteristics,histomorphology features and immunophenotype features of TB and differential diagnosis with multiple diseases in 3 cases of TB were retrospectively analyzed;moreover,5 cases of basal cell carci-noma were selected and performed the immunophenotype detection,which focused on the differential diagnosis with TB.Results The masses in 3 cases were located under the skin without connecting with the epidermis and were composed of basal-like cells with palisade arrangement of peripheral cells.The case 1 showed unequal-sized multiple cyst cavities and pigment deposition and was di-agnosed as pigmented TB.The papillary mesenchymal bodies were found in case 2,which was diagnosed as TB.The basal cells of tumor in case 3 distributed as palisade arrangement and formed the wave structure,which was diagnosed as rippled-pattern TB.AR in 3 cases and Bcl-2 in 2 cases were negative expression,CK20 in 1 case was sporadically positive,CD10 stroma and papillary struc-ture in 3 cases were positive,paliform-like arrange tumor cells CD10 around basal cell carcinomas in 5 cases were positive,AR in 4 cases was positive,Bcl-2 in 3 cases was positive and CK20 in 5 cases was negative.Conclusion TB is a benign tumor derived from the hair follicle germinal epithelium with a good prognosis after complete resection and the differential diagnosis focuses on basal cell carcinomas.

Objective:To analyze the distribution characteristics of traditional Chinese medicine (TCM) syndromes in patients with coronavirus disease 2019 (COVID-19) in plateau areas, and to provide theoretical basis for further clinical treatment of patients with COVID-19.Methods:From August 9 to August 24, 2022, patients with COVID-19 admitted to the Third People's Hospital of Tibet Autonomous Region (designated hospital for COVID-19) were included, and their baseline characteristics (age, gender, source), clinical classification and distribution of TCM syndrome types were collected and analyzed. Data analysis was performed using SPSS 26.0 statistical software.Results:A total of 161 COVID-19 patients were enrolled with ethnic distribution: 124 (77.02%) Tibetans, 35 (21.74%) Han, and 2 (1.24%) Hui, 68 males and 93 females. The male-to-female ratio was 0.73∶1. Aged 1 to 94 years, the average age was (39.06±23.64) years old, of which 4 patients were under 1 year old (excluded because the information was missing). A total of 157 patients were enrolled, and 124 patients (78.9%) were under 60 years old, including 120 cases of common type, 4 cases of severe type, 0 cases of critical type, 7 cases over 80 years old, 1 case over 90 years old, and 32 cases under 18 years old. The clinical manifestations of the patient are mainly cough, expectoration, fever, aversion to cold, dry throat, headache, fatigue, running nose, dry mouth, bitter mouth, etc. Most of the tongue is pale, red, and white greasy moss or thin white coating. In TCM, the most common syndrome was cold-dampness blocking lung syndrome (99 cases, 63.06%), followed by cold-dampness stagnant lung syndrome (22 cases, 14.01%), damp-heat accumulating lung syndrome (22 cases, 14.01%), and humidity stagnant lung syndrome (11 cases, 7.01%). Syndromes of epidemic (2 cases, 1.27%), epidemic toxins blocking the lung pattern (1 cases, 0.64%), toxins with dryness intense heat in both qi and ying phases pattern (0 cases) accounted for less than 2%, and the distribution of various syndrome types in COVID-19 patients was uneven ( χ2 = 0.48, P < 0.05). Conclusion:The most common TCM syndromes of COVID-19 patients in Lhasa are cold-dampness blocking lung syndrome, followed by cold-dampness stagnant lung syndrome, damp-heat accumulating lung syndrome, and humidity stagnant lung syndrome.

Objective To investigate the effect of the number of lymph nodes examined (NLNE) on the prognosis of esophageal squamous cell carcinoma (ESCC).Methods The retrospective case-control study was conducted.The clinicopathological date of 628 ESCC patients who underwent radical resection in the Tianjin Medical University Cancer Institute and Hospital from January 2005 to March 2013 was collected.Patients underwent radical resection of ESCC through right thorax.Observation indicators:(1) surgical and postoperative pathological examinations;(2) follow-up and survival situations;(3) effect of NLNE on the prognosis of ESCC;(4) factors analysis affecting prognosis of ESCC patients;(5) subgroup analysis.Follow-up using outpatient examination,telephone interview and mail was performed to detect postoperative survival up to February 2018.Measurement data with skewed distribution were described as M (range).Receiver operating characteristic (ROC) curve analysis was used to determine the appropriate cut-off of the NLNE.The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method,and the survival analysis was done by the log-rank test.Multivariate analysis was done by the Cox proportional hazard model.Results (1) Surgical and postoperative pathological examinations:472 and 156 patients underwent respectively Ivor-Lewis and Mckeown operations.There were 284 patients with tumor diameter ≤ 3.5 cm and 344 patients with tumor diameter ＞ 3.5 cm.The total NLNE was 11 139 for all of the 628 patients,with an average NLNE of 18 per case(range,2-78 per case) and a median NLNE of 16 per case.Of 628 patients,high-,moderate-and low-differentiated tumors were respectively detected in 48,469 and 111 patients;staging T0-1,T2,T3 and T4a of depth of tumor invasion in 30,119,260 and 219 patients;N0,N1,N2 and N3 of degree of lymph node metastasis in 349,173,69 and 37 patients;rN0,rN1,rN2 and rN3 of rate of lymph node metastasis in 349,184,54 and 41 patients.(2) Follow-up and survival situations:all the 628 patients were followed up for 3-144 months,with a median time of 36 months.The 1-,3-and 5-year survival rates were 82.4％,53.7％ and 41.3％,respectively.(3)Effect of NLNE on the prognosis of ESCC:ROC curve showed that the appropriate cut-off value of the NLNE was 16.Using NLNE =16 as a cut-off value,5-year survival rate was respectively 36.7％ in patients with NLNE ＜ 16 and 45.1％ in patients with NLNE ≥ 16,with a statistically significant difference in survival (x2 =9.527,P＜0.05).According to a median NLNE of 23,the patients with NLNE ≥ 16 were further divided into patients with 16 ≤ NLNE ≤ 23 and NLNE ＞ 23.Results showed that 5-year survival rate in patients with NLNE ＜ 16,16 ≤ NLNE ≤ 23 and NLNE ＞ 23 was respectively 36.7％,41.2％ and 50.3％,with a statistically significant difference in survival among them (x2 =10.588,P＜0.05),between patients with NLNE ＜ 16 and 16 ≤ NLNE ≤ 23 (x2 =4.419,P＜0.05).There was no statistically significant difference between patients with 16 ≤ NLNE ≤ 23 and NLNE ＞ 23 (x2 =1.413,P＞0.05).Five-year survival rate in patients with NLNE ≤ 23 and NLNE ＞23 was respectively 38.6％ and 50.3％,with a statisctically significant difference (x2 =5.885,P＜0.05).(4)Factors analysis affecting prognosis of ESCC patients:results of univariate analysis showed that age,smoking history,BMI,tumor diameter,NLNE,depth of tumor invasion,degree and rate of lymph node metastasis were related factors affecting the prognosis of ESCC patients (x2 =5.454,4.875,7.669,10.691,10.588,30.612,59.780,76.565,P＜0.05).Results of muhivariate analysis showed that age,tumor diameter,NLNE,depth of tumor invasion and rate of lymph node metastasis were independent factors affecting the prognosis of ESCC patients [HR=1.268,1.300,0.762,1.354,1.357,95％ confidence interval (CI):1.034-1.556,1.038-1.629,0.662-0.878,1.183-1.549,1.089-1.692,P＜0.05].(5) Subgroup analysis:among 279 patients with lymph node metastasis,5-year survival rate in patients with NLNE ＜ 16,16 ≤ NLNE ≤ 23 and NLNE ＞ 23 was respectively 23.7％,19.4％ and 39.5％,with a statistically significant difference among them (x2 =8.397,P＜0.05),between patients with 16≤ NLNE ≤ 23 and NLNE ＞ 23 (x2=5.425,P＜0.05).There was no statistically significant difference between patients with NLNE ＜ 16 and 16 ≤ NLNE ≤ 23 (x2 =0.389,P＞ 0.05).Five-year survival rate in patients with NLNE ≤ 23 and NLNE ＞ 23 was respectively 21.9％ and 39.5％,with a statisctically significant difference (x2=7.942,P＜ 0.05).Among 349 patients without lymph node metastasis,5-year survival rate in patients with NLNE ＜ 16,16 ≤ NLNE ≤ 23 and NLNE ＞ 23 was respectively 45.6％,60.3％ and 59.2％,with a statistically significant difference among them (x2 =9.755,P＜0.05) and between patients with NLNE ＜ 16 and 16 ≤ NLNE ≤ 23 (x2 =8.208,P＜0.05).There was no statistically significant difference between patients with 16 ≤ NLNE ≤ 23 and NLNE ＞ 23 (x2 =0.284,P＞0.05).Five-year survival rate in patients with NLNE ≤ 23 and NLNE ＞ 23 was respectively 51.1％ and 59.2％,with no statisctically significant difference (x2 =1.147,P＞ 0.05).Conclusions The NLNE is an independent factor affecting the prognosis of ESCC patients,and at least 16 to 23 lymph nodes should be dissected.For patients with lymph node metastasis,and more than 23 lymph nodes should be dissected.For patients without lymph node metastasis,more than 23 lymph nodes dissection cannot obviously improve the prognosis of patients.

OBJECTIVETo observe the trends on prevalence of early syphilis and HIV infection among men who had sex with men in the last six years from a HIV/AIDS counseling and testing clinic in Nanjing, and to develop relative strategies.

METHODSMen who have sex with men involved in AIDS/HIV and syphilis voluntary counseling and testing services were recruited and investigated from 2008 to 2013 in this clinic. Clients whose syphilis serologic test showed positive were determined the diagnosis by physician within the referral network from sexually transmitted diseases clinics. Demographic information on early syphilis, HIV infection or co-infection with HIV and early syphilis was described while related epidemic trend analysis was performed.

RESULTSThe annual numbers of men having sex with men under survey were 1 004 in 2008, 1 218 in 2009, 1 236 in 2010, 748 in 2011, 1 019 in 2012 and 1 420 in 2013. The prevalence rates of early syphilis appeared to be: 2.19% in 2008, 2.71% in 2009, 2.43% in 2010, 1.74% in 2011, 3.04% in 2012 and 2.32% in 2013, with the trend as: P > 0.05. The prevalence rates of HIV infection were 1.29% in 2008, 2.63% in 2009, 5.42% in 2010, 8.82% in 2011, 11.97% in 2012 and 10.42% in 2013, with trend as: P < 0.01. The prevalence rates of early syphilis with HIV infection increased from 0.20% in 2008 to 1.06% in 2013 (trend: P < 0.01). The proportion of HIV co-infection among men having sex with men with early syphilis infection, increased from 9.09% in 2008 to 45.45% in 2013, with trend: P < 0.01.

CONCLUSIONEarly syphilis infection among men who having sex with men showed a stable trend but the number of HIV and co-infections with early syphilis and HIV increased rapidly in the last six years in Nanjing. Continued intervention strategies should target on men who have sex with men to slow down the epidemic of syphilis and HIV infection.

China ; epidemiology ; Coinfection ; Counseling ; HIV Infections ; epidemiology ; Homosexuality, Male ; statistics & numerical data ; Humans ; Male ; Prevalence ; Surveys and Questionnaires ; Syphilis ; epidemiology ; Syphilis Serodiagnosis

ObjectiveTo investigate the efficacy and safety of Shengxiantang in the treatment of early Parkinson's disease with autonomic dysfunction of Qi deficiency pattern. MethodA total of 82 eligible patients were randomized into control group （41 cases） and traditional Chinese medicine （TCM） group （41 cases）. On the basis of standardized treatment of western medicine， TCM group was prescribed Shengxiantang while control group were treated with placebo for 12 consecutive weeks additionally. Scale for Outcomes in Parkinson's Disease-Autonomic （SCOPA-AUT） questionnaire， Unified Parkinson's Disease Rating Scale （UPDRS）， Traditional Chinese Medicine Qi Deficiency Symptom Score of Parkinson's Disease （TCMQDSSPD）， serum levels of glutathione peroxidase （GPx） and superoxide dismutase （SOD）， daily dosage of pramipexole and levodopa and benserazide hydrochloride， and safety index were evaluated both before and after treatment. ResultAfter treatment， the total score of SCOPA-AUT， gastrointestinal score， urinary score， and thermoregulatory score in the control group were higher than those before treatment （P<0.01）， while the above sores in the TCM group were lower than those before treatment （P<0.05， P<0.01）. In addition， the cardiovascular score， pupillomotor score， and sexual score in two groups showed no significant difference from those before treatment. After treatment， the total score of SCOPA-AUT， gastrointestinal score， urinary score， and thermoregulatory score in the TCM group were lower than those in the control group （P<0.05， P<0.01）， and cardiovascular score， pupillomotor score， and sexual score showed no significant difference between two groups. After treatment， the total score of TCMQDSSPD， main symptom scores， and minor symptom scores in the control group had no significant difference from those before treatment. The total score of TCMQDSSPD and minor symptom scores of TCM group were lower than those before treatment （P<0.01）， while the main symptom scores of the TCM group showed no significant difference from those before treatment. After treatment， the UPDRS score， serum GPx and SOD levels， and daily dosage of pramipexole and levodopa and benserazide hydrochloride demonstrated no significant difference from those before treatment in the two groups and between the two groups. No abnormality was found in the safety indexes. ConclusionBased on the standardized treatment of western medicine， Shengxiantang can effectively and safely improve the autonomic symptoms of gastrointestinal system， urinary system， and thermoregulation， as well as the symptoms of Qi deficiency syndrome in early Parkinson's disease with autonomic dysfunction.