It mainly discusses the therapy of kidney edema on“Shanghan Lun”,which is caused by nephritis,nephrotic syndrome and renal failure.In addition to the manifestation and therapeutic principle of edema,the implication of some herbs combination is also described in detail.Meanwhile,some viewpionts are strengthened with concepts of modern medicine.In conclusion,Zhang Zhongjing puts importance on the etiology,pathogenesis of disease when treating edema.Therefore,ascending and discending Qi is highlightened as the general principle during the treatment of kidney edema.

[Objective] To evaluate the clinical efficiency of refratory edema based on daytime prelonged Online-HDF.[Methods] Six patients include four females and two males whose age ranging from 28 to 74 years old and average 55 years old.Online-HDF treatment for 3-9 times,vascular access was percutaneous femoral or internal jugular catheterization.One patient's temporary access was changed to permanent access because who needed continous hemodialysis.The machine version was Ganbro AK-100S.To filter by u2000 and replace fluid online for 6-10 hous,blood flow was 200-250ml/min,uf 1200-8600,the total fluid used for replacement was 20-42 liter,during the process,regular heparin or low molecular was used for anticoagulation.[Results]Three patients' clinical symptoms resulted from edema resolved,one patient accepted continous hemodialysis treatment for inpaired kidney function,one patient left hospital for expensive medical cost,one patient accepted ventilation treatment for respiratory failure in ICU.[Conclusion]Daytime prelonged Online-HDF is effective on the trentment of refratory edema,especially effective on dyspnea,tachypnea,chest distress that resulted from edema.

Cytotoxic T lymphocytes (CTLs) are critical effectors which play important roles both in anti-tumor and anti-virus immune responses.Through T cell receptors(TCRs),CTLs can specifically recognize MHC- Ⅰ -peptides complexes presented on the surface of target cells,and then release biological substances such as perforin and granzymes into the target cells and dissolve them.Since the significant potential value of CTLs,more and more people are focusing on its basic and appliedstudies.Most researches are about the transformation of the TCR gene.With the development of molecular biology,cloning and transduction of TCR gene have been more mature.Researchers are finding ways to ensure that TCR gene expresses efficiently and assemble correctly.

One hundred and fifty cases of gouty arthritis were divided into two groups.Treatment group(85 cases) were treated with Tong Feng lotion and control group(65 cases)with external application of Voltaren. Results indicated that Tong Feng lotion could improve clinical symptoms and function of joints, and decrease blood sedimentation,reaction protien C,blood uric acid and blood viscosity; the total effective rate was 89.42% in the treatment group and 75.38% in the control group, with significant difference between the two groups(P<0.05); there was no obvious relation between therapeutic effects and TCM syndrome types.

Nursing experiences on 4 children with organic acidemia were summarized. The nursing care focused on correct collection of samples for early diagnosis,prompt opening of an effective intravenous route to manage water,electrolyte,acid-base and metabolic imbalances,special medication nursing,strict diet control to prevent relapse,health education to keep normal growth and development. Three children were followed up for 1 month,7 months and 1 year respectively with disease controlled and a child was withdrawn treatment from.

Objective To investigate the relatio nship between the DNA methylation status of gluco-corticoid receptor (GR) gene promoter and mRNA expression level of GRα gene of peripheral blood mononuclear cells (PBMCs) in patients with systemic lupus erythematosus (SLE). Methods Fifteen new onset SLE patients and fifteen healthy controls were enrolled in this study. The DNA methylation status of GR gene promoter 1 of PBMCs was detected through bisulfite sequencing polymerase chain reaction (PCR). The mRNA expression of GRα, DNA methyltransferases, growth arrest and DNA damage-induced 45α (GADD45α) of PBMCs was detected using the quantitative real-time polymerase chain reaction method. T-test and χ2-test were used to detect the differences between the two groups, Pearson's correlation coefficient was used to analyze the linear correlation between two variables. Results Compared with healthy controls, the mRNA expression of GRα was signi-ficantly declined in SLE patients (10±5, 17±7, t=2.69, P<0.05), and the mRNA expression of DNMT1 and GADD45α was significantly elevated in SLE patients (t=3.11, P<0.05 and t=2.98, P<0.05). The overall mean methylation status of the 142 CpG islands of the four promoters was significantly elevated in SLE patients [(16±8)%vs (11±6)%, t=2.75, P<0.05]. The global methylation status of PBMCs in SLE patients was obviously lower than healthy controls (t=4.39, P<0.05). Conclusion Hypermethylation of GRα promoter may result in GRαgene low expression in PBMCs of patients with SLE.

One hundred and fifty cases of gouty arthritis were divided into two groups.Treatment group(85 cases) were treated with Tong Feng lotion and control group(65 cases) with external application of Voltaren. Results indicated that Tong Feng lotion could improve clinical symptoms and function of joints, and decrease blood sedimentation,reaction protien C,blood uric acid and blood viscosity; the total effective rate was 89.42% in the treatment group and 75.38% in the control group, with significant difference between the two groups(P<0.05); there was no obvious relation between therapeutic effects and TCM syndrome types.

Objectives:To investigate the efficacy and toxicity of the full coverage radiation to primary and all metastatic lesions in patients with oligometastatic castration-resistant prostate cancer (CRPC).Methods:Forty-four patients with oligometastatic CRPC was retrospective analyzed from Oct. 2011 to Jun. 2017 at Peking University 1 st Hospital. Before radiotherapy, average age was 72(57-86), the median value of initial PSA was 38.545 (6.640-1 066.000)ng/ml, the median value of PSA nadir after initial androgen deprivation therapy(ADT) was 0.259(0.011-18.762)ng/ml, the time interval between initial ADT to diagnosis of metastatic castration resistant prostate cancer(mCRPC) was 12(4-96) months, and the median PSA value pre-radiotherapy was 3.765(2.040-187.000) ng/ml. There were 23(52.3%)patients with Gleason score 9-10 and 15(34.0%) patients with Gleason score 8. At the time of initial diagnosis, there was 41(93.2%) cases with stage T 3-T 4, 23(52.3%)cases with lymph node metastasis, and 29 (63.9%) case with distant metastasis. The number of metastatic foci before radiotherapy was 1 in 22(50.0%)cases, 2 in 12(27.3%)cases, 3 in 6(13.6%)cases and 4 in 4(9.1%)cases. There were 3 cases of pelvic lymph node metastasis (6.8%), 9 cases of retroperitoneal lymph node metastasis(20.5%), 21 cases of bone metastasis(47.7%), 11 cases of bone metastasis+ lymph node metastasis(25.0%), and no visceral metastasis. Image-guided volumetric modulated arc therapy(IGRT-VMAT) was used to fully cover primary and metastatic foci. The prostate and seminal vesicle were routinely underwent 76Gy/38 fractions, and the bioequivalent dose(BED 3) was 126.67 Gy. For those with pelvic lymph node metastasis, the drainage area of pelvic lymph node was 46Gy/23 fractions. According to the tolerance of different normal tissues around the lesions, the median BED 3 of local radiotherapy dose in the metastatic foci was 112.26(91.14-140.77)Gy. The efficacy and side effects of all these patients were recorded. Kaplan-meier method was used to analyze the overall survival and the new metastasis-free survival. Results:Only 1 patient had grade 3 urinary tract obstruction and underwent indwelling catheter. All the other patients had grade 1-2 toxic and side effects. After a median follow-up of 34.5(9-96) months, the PSA-nadir after radiotherapy was 0.088(0.003-132.000)ng/ml. Forty(90.9%) patients showed a decrease in PSA after radiotherapy, and 34(77.3%) cases. showed a decrease of >80%. The 1, 3, and 5-year overall survival rates were 90.9%, 54.5%, 36.8%, the 1, 3, and 5-year new metastasis free survival rates were 47.7%, 25.0%, 12.9%, respectively.Conclusion:The full coverage radiotherapy to primary and metastatic lesions showed high PSA response rate, the satisfactory survival and tolerable toxicity in oligometastatic CRPC patients.

Objective To analyze the survival and prognostic factors in the treatment of angiosarcoma. Methods A retrospective study was performed on clinical data of 30 patients pathologically diagnosed with angiosarcoma who were admitted to our hospital from 1988 to 2015 and had complete follow?up data. In those patients, 18 patients received comprehensive treatment, containing 9 patients treated with surgery plus radiotherapy, 4 patients with surgery plus chemoradiotherapy, and 5 with surgery plus chemotherapy;12 patients received non?comprehensive treatment, containing 11 patients treated with surgery alone and 1 patient radiotherapy alone. The survival rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. The Cox regression model was used for multivariate prognostic analyses. Results The 1?, 2?, and 5?year sample sizes were 29,26, and 18, respectively. The 1?, 2?, and 5?year overall survival ( OS) rates were 70?1%, 49?1%, and 40?9%, respectively;the 1?, 2?, and 5?year local relapse?free survival rates were 52?8%, 44?0%, and 35?2%, respectively;the 1?, 2?, and 5?year distant metastasis?free survival rates were 81?6%, 68?0%, and 56?7%, respectively. The multivariate analysis showed that tumor site, tumor size, staging, and visible tumor residue after initial treatment were prognostic factors for OS ( P= 0?027, 0?027, 0?011, 0?000 );In the patients with stage Ⅰ or Ⅱ disease, the comprehensive treatment achieved a significantly lower local?relapse rate than the individual treatment ( P=0?006);gender, age, staging, and tumor site were prognostic factors for distant metastasis ( P=0?028, 0?011, 0?015, 0?022 ) . Conclusions Early diagnosis and early treatment are recommended for angiosarcoma, which has high local recurrence and distant metastasis rates. Comprehensive treatment ( surgery plus radiotherapy and/or chemotherapy) is recommended for patients with stage Ⅰ or Ⅱ disease. Tumor site, tumor size, staging, and visible tumor residue after initial treatment are prognostic factors.

Objective: To develop the mental health knowledge questionnaire in order to know about the awareness of mental health knowledge in non-psychiatric clinicians. Methods: A sample of the 641 non-psychiatric clinicians from 2 tertiary general hospitals, 2 second-class general hospitals, and 1 community hospital were used for item analysis and internal consistency test; 38 cases were selected for the re-test interval of 2 weeks to test the test-retest reliability. And totally 99 psychiatrists finished the survey as controls. The awareness rates between the non-psychiatric and psychliatric clinicians were compared. Results: The questionnaire included 46 items and consis-ted of 6 subscales, involving anxiety, schizophrenia, depression, dyssomnia and psychological counseling, or-ganic brain disorder, and recognition for mental health service situation in general hospital The results of confirma-tory factor analysis showed that the ratio of chi-square and degree of freedom was below 3. The fitting indexes except GFI and AGFI were more than 0.90. The Cronbach's alpha coefficients ranged from 0.73 to 0.89, and test-retest Pearson correlation coefficient of reliabifity ranged from 0.59 to 0.78. Awareness rate was 47.6% in general hospital and 90.9% in psychiatric hospitals. Conclusion: The mental health knowledge questionnaire has good psychometric properties and may be applied in clinical studies.