Objective To assess the value of serum creatinine(Scr),serum ?_2-microglobulin(?_2-MG),glomerular filtration rate(GFR),proteinuria index,and Cystatin C(Cys C)to detect impairing of expressing of diease in patients with chronic kidney disease.Methods Peripheral blood was collected from 54 chronic kidney diease:Scr was analyzed using RXL fully automated biochemistry assay instrument,then GFR was calculated;Cys C was measured using particle-enhanced nephelometric immunoassay(PENIA);?_2-MG was measured using chemiluminescent method,proteinuria index was measured by the product of duration and amount of proteinuria,nephropathological progress was measured using the degree of glomerular mesangial proliferation and the dgree of tubulointerstitial fibrosis.Results The level of serum Cys C,Scr,serum ?_2-MG,proteinuria index,and GFR of the CKD patients was correlated with nephropathological progressing.Conclusion In patients with chronic kidney disease serum creatinine,serum ?_2-micro-globulin,glomerular filtration rate,proteinuria index,and Cystatin C are markers of progessing of kidney disease.The sensitivity and correlation of GFR and serum Cys C are higher than others.

Purpose:To evaluate the relationship between the expressions of MDR and GST-? and the response to neoadjuvant chemotherapy and prognosis in cervical carcinoma. Methods:The expressions of MDR and GST-? were examined by Envision immunohistochemistry using pretreatment biopsy specimens. The stage distribution of 57 patients in the study was 7 stage Ib, 35 stage IIa, 15 stage IIb. Treatment consisted of 2 courses of neoadjuvant chemotherapy followed by radical hysterectomy and lymphonectomy. If the patient was found to have parametrial involvement, pelvic lymph node metastasis, microscopic tumor emboli or disease in vagina stemp, she was given adjuvant radiotherapy after operation. All patients were followed up and the median follow-up time was 35 months (21-66 months). Statistical method used was SPSS 8.0 package. Results:There were 14 patients with cervical carcinoma who had expression of MDR. The rate of expression of MDR was 24.6% (14/57). Also there were 29 patients who had expression of GST-?. The rate of expression was 50.8% (29/57). The total response rate of neoadjuvant chemotherapy was 81%. The complete clinical response rate was 19% (11/57) and partial response rate was 61% (35/57). All patients were treated by operation following chemotherapy and 13 patients were given adjuvant radiotherapy after operation. The 5-year survival rate in stage Ib was 100%, stage IIa 90% and stage IIb 78.5%. The results showed the expression of MDR was related to response of neoadjuvant chemotherapy and 5-year survival. It is 93%(40/43) in group of MDR(-) and 43%(6/14) in group of MDR(+)( P =0.001). But it was not related to FIGO, histopathologic, parametrial involvement, and pelvic lymph nodes metastasis. The expression with GST-? only related to response of chemotherapy. The response rate in the group with expression of GST-? is 69% and it is 93% in the group with GST-?(-)( P =0.02).Conclusions:The response rate of neoadjuvant chemotherapy in group of MDR(-) and GST-?(-) was better than in the group with expression of MDR and GST-?. The measure of MDR and GST-? is helpful to predict the response of neoadjuvant chemotherapy in cervical cancer and MDR may related to prognosis of cervical cancer.

Objective To identify the chemoresistant factors predicting the response to preoperative chemotherapy and clinicopathological prognosis in bulky cervical cancer. Methods 68 patients with bulky cervical carcinoma treated with two courses of intraarterial infusion of cisplatin 80mg, 5 fluorouracil(5Fu) 1500mg and AT 1258 or EADR 60mg, followed by radical hysterectomy and pelvic lymphnodenectomy at our hospital between 1996-1999 were retrospectively reviewed. Expressions of the chemoresistance related proteins, such as P glycoprotein glutathione S transferase ?(GST ?), and proliferating cell nuclear antigen(PCNA) in the tumor cells were examined by immunohistochemistry in previous biopsy specimens. These results were compared with the chemotherapeutic response obtained by gynecological examination and vagina ultrasonic. 68 patients were followed up. SPSS 8.0 was used. Results P glycoprotein expression rate was 31% and GST ? expressioin rate was 51%. There were 38 patients whose PCNA labellings were more than 50% and 30 less than 50%. The total chemotherapeutic response rate was 84%. Chemotherapeutic response rate was significantly correlated with P glycoprotein expression( P =0.013) and PCNA labelling ( P =0.001), but not GST ? expression in the tumor cells. Parautrial involvement and lymph node metastasis were independent factors for prognosis in this group. The survival rate in MDR(+) group was lower than MDR(-) group. No significant correlation between eigher the expression of GST ? or PCNA. Conclusions The expression of P glycoprotein and PCNA is potentially useful for predicting the response to preoperative chemotherapy for cervical cancer. The parautrial involvement and lymph node metastasis were independent prognostic factors for the survival rate including. the expression of P glycoprotein.

Objective To evaluate the impact of multiple lacunar infarction (MLI) on the outcomes of mild cognitive impairment (MCI). Methods MCI patients were selected in outpatients and hospitalized patients using a common international standard MCI screen. Magnetic resonance imaging (MRI) and computer tomography (CT) were used to determine the presence of MLI. MCI patients were followed up for 6～24 months and their cognitive status and the impact of MLI on MCI were evaluated using Kaplan-Meier survival analysis. Results One hundred twenty patients were diagnosed as having MCI based on clinical evaluation and neuropsychological assessment. Among them, 43 (35.8%) patients had MLI and the rest 77 (64.1%) patients did not have. Twenty-seven MCI patients with MLI (62.8%) developed dementia, while 15 MCI patients without MLI (19.4%) developed dementia during 6～24 months follow-up. Kaplan-Meier analysis indicated that the incidence of dementia was significantly higher in patients with MLI than in patients without MLI did (P＜0.05). Conclusions MCI patients with MLI are more prone to dementia. These results suggest that early interventions aimed at controlling the modifiable risks are warranted for dementia prevention in MCI patients with MLI.

Objective To evaluate the clinical significance of positive peritoneal cytology in patients with endometrial cancer.Methods The records of 315 patients with endometrial cancer who were operated at Cancer Hospital, Fudan University between January 1996 and December 2008 were reviewed.Peritoneal cytology were performed and diagnosed in all patients.Factors related with peritoneal cytology were analyzed by correlation analysis.Log-rank test and Cox regression test was used for the analysis of prognosis,respectively.Results (1) Peritoneal cytology were positive in 30 (9.5%) patients.Positive peritoneal cytology was associated with pathological subtype ( P = 0.013 ), stage ( P = 0.000 ), myometrial invasion ( P =0.012), lymph-vascular space invasion ( P = 0.012 ), serosal involvement ( P = 0.004 ), cervical involvement ( P = 0.016), adnexal involvement ( P = 0.000), and omental involvement ( P = 0.000), with no association with grade ( P = 0.152 ) and lymph node metastasis ( P = 0.066 ).( 2 ) Three-year overall survival (OS) and progression-free survival(PFS) were 93.0% and 85.5% ,respectively.Positive peritoneal cytology, surgical stage, pathological subtype, myometrial invasion, grade, and lymph-vascular space invasion were significantly associated with worse prognosis by univariate analysis ( P ＜ 0.05 ), while only surgical-pathology stage and myometrial invasion were independent prognostic factors by multivariate analysis ( P ＜ 0.05 ).For 30 cases with positive peritoneal cytology, the patients with no high risk factors shown significantly prognoses better than those with any risk factors.The results shown that for patients with late stage (stage Ⅲ - Ⅳ ) endometrial cancer with positive peritoneal cytology was significantly associated with the worse OS and PFS by multivariate analysis ( P = 0.006).Conclusions Positive peritoneal cytology was associated with serosal involvement, cervical involvement, adnexal involvement, omental involvement, and late stage.Therefore, peritoneal cytology should be performed and reported separately as a part of full surgical staging procedure.

Objective To investigate instant messenger management on moderate asthma control in young and middle-aged patients.Methods Sixty young and middle-aged asthma patients enrolled were divided into 2 groups by random number table,traditional management group (group A) and messenger management group (group B),and received the asthma treatment with traditional management or messenger management for 1 year.The compliance,control condition,pulmonary function and Saint George respiratory questionnaire(SGRQ) were compared between two groups.Results After one year management,there were 20 patients in proceeding of the standard treatment,15 total control,10 partial control and 5 uncontrolled in group A,while there were 26 patients in proceeding of the standard treatment,21 total control,7 partial control and 2 uncontrolled in group B.Compared with group A,the treatment adherence(x2 =6.331,P ＜ 0.05),satisfaction degree (t =6.051,P ＜ 0.01),asthma control rate (x2 =6.490,P ＜ 0.05),efficacy satisfaction (t =6.051,P ＜ 0.01) were all increased in group B.Forced expiratory volume in 1 second was elevated more significantly in group B than that in group A [(0.132 ± 0.175) L vs.(0.326 ± 0.125) L] (t =5.099,P＜ 0.01).SGRQ scores were decreased more obviously in group B than that in group A (t =4.316,P ＜ 0.01).Conclusions The asthma control,respiratory and pulmonary function can be improved by messenger management in young and middle-aged patients.So promoting the messenger management model actively is advantageous to improve the level of prevention and treatment of asthma in China.

Objective To investigate changes of coagulation function in patients with high altitude polycythemia (HAPC) .Meth‐ods Activated partial thromboplastin time (APTT) ,prothrombin time (PT) ,thrombin time (TT) and fibrinogen (Fbg) were de‐tected and compared between 69 patients with HAPC and 60 healthy subjects (controls) .Results Fbg ,APTT and TT levels in pa‐tients with HAPC were higher than controls (P<0 .05) ,while the difference of PT was not significant (P>0 .05) .Dynamic obser‐vation indicated that comprehensive therapy could these recover coagulation function .Conclusion Hemorrhage and coagulation process in patients with HAPC could be very complicated ,including physiological adaptation and the process of physiology evolving into pathology .

Objective To assess the efficacy of fish oil in the treatment of IgA nephropathy using the method of Meta-analysis. Methods Randomized controlled trials of fish oil in the treatment of IgA nephropathy were searched in the database of Cochrane library,PubMed, EMBASE and CNKI. Data extracted from the literatures were analyzed with Revman software (version 5.0). Results In comparison with the controlled group, proteinuria in the fish oil group was significantly decreased [SMD=-0.27, 95%CI (-0.52 to -0.03), P=0.03], while the renal function deteriorated [SMD=0.30,95%CI(0.05 to 0.55), P=0.02]. Conclusion Fish oil can decrease the proteinuria of IgA nephropathy, but can not prevent renal function from deterioration.

Objective To study the effect of different dialysis modalities on pruritus in elderly maintenance hemodialysis patients.Methods Totally 51 patients were randomly divided into hemoperfusion combined with hemodialysis group (HD+ HP),hemodiafiltration group (HDF) and hemodialysis group (HD).Plasma β2-microglobulin(β2-MG) and intact parathyroid hormone (iPTH) were measured by means of radio immunoassay at pre and post dialysis,4 weeks and 8 weeks after dialysis,cutaneous pruritus was scored.The remission rate of itching was calculated at 8 weeks after dialysis.The parameters were compared among different groups.Results The level of plasma β2-MG was lower in HD+HP group after dialysis than pre dialysis [(13.48±3.05)mg/L vs.(16.27±4.73) mg/L,t＝2.044,P＜0.05],at 4 weeks and 8 weeks after dialysis,its levels were decreased to (10.97±3.25)mg/L(t＝3.808,P＝0.002)and (6.47±2.35)mg/L(t＝7.650,P＝0.000),respectively.The levels of iPTH were also found decrease from(887.5 ± 242.7)ng/L to (688.3 ±223.4)ng/L(t＝3.384,P＝0.004)at 4 weeks and (467.2±102.5) ng/L(t＝6.578,P＝0.000) at 8weeks after dialysis in HD+HP group (all P＜0.01).There were differences of the levels of plasma β2-MG and iPTH at 4 weeks and 8 weeks after dialysis in HDF group (all P＜ 0.05),but no differences of the levels of plasma β2-MG and iPTH during every period were found in HD group(all P＞0.05).The scores of cutaneous pruritus were decreased from (21.17± 5.01) scores to (13.37±2.85) scores(t＝ 5.580,P＝0.000)at 4 weeks and (8.52±4.38) scores(t＝7.838,P＝0.000)at 8 weeks after dialysis in HD+ HP group,and also the scores at 4 and 8 weeks after dialysis in HDF group (all P＜0.01),but there were no significant differences of the scores during every period in HD group (all P＞0.05).The remission rate of itching was better in HD+ HP group than in HDF group [88.24％ (15/17 cases) vs.58.82％ (10/17 cases),x2＝14.44,P＝0.000],better in HDF group than in HD group 23.53％ (4/17 cases) (x2 ＝4.37,P＝0.037).Conclusions HD+HP is superior to HDF in efficiently clear β2-MG and iPTH,and relief cutaneous pruritus,but HD can poorly clear β2-MG and iPTH or relief itching.

Objective To understand the current situation and level of clinical laboratory about the analysis of cellular morphology in Tibet region .Methods Authors investigated the information about the staff of clinical laboratory testing the patient′s blood smear under microscope ,executing the rules and regulations by using standard questionnaires .Results Some of the clinical laboratory didn′t founded the rule and standardization of rechecking about abnormal blood routine (5/15 ,33 .3% ) .Some of the divi-sion leadership didn′t pay enough attention to the staff′s basic operation (2/15 ,13 .3% ) .Most of the staff didn′t being trained about cellular morphology in special purpose workshop (6/43 ,88 .8% ) .Some of the hospital didn′t carried out the chemistry stai-ning about blood cells(10/15 ,66 .7% ) .Conclusion It′s important to promote the quality and level about the analysis of cellular morphology in Tibet region .