Objective To explore Diagnostic value of combined detection of alpha fetoprotein(AFP) ,carcino‐embryonic antigen (CEA) ,carbohydrate antigen 125(CA125) ,neurone specific enolase(NSE) and carbohydrate antigen 724(CA724) in malignant hy‐drothorax and hydroperitoneum .Methods According to the pathological diagnosis as gold standard ,receiver operating characteristic (ROC) curve was used to analyzed the cut‐off value for the diagnosis of malignant hydrothorax and hydroperitoneum in 291 pa‐tients ,and 135 patients with benign malignant hydrothorax and hydroperitoneum were enrolled as controls .Diagnostic value of sin‐gle and combined detection of tumor markers was analyzed .Results Area under the ROC curve of CEA and CA724 were higher than 0 .7 ,indicating that CEA and CA724 were with high diagnostic value .Among CEA ,CA724 ,NSE and CA125 ,used for single detection ,CEA was with high sensitivity(81 .7% ) ,Jorden index(0 .64) ,negative predictive value(67 .7% ) ,positive predictive value (90 .8% ) ,and NSE(82 .9% ) was with high specificity .Combined detection of tumor markers could increase diagnostic sensitivity , Jorden index and negative predictive value .Conclusion CEA could be with high diagnostic value of malignant hydrothorax and hydro‐peritoneum .Combined detection of tumor markers could increase diagnostic sensitivity ,Jorden index and negative predictive value .

Mannose binding lectin(MBL) is closely related to tumor formation and progression. We and others have confirmed that the MBL gene show differential expression in thyroid cancer. MBL can recognize or bind tumor cells or apoptotic cells, promote clearance of apoptotic cells, and inhibit tumor cells migration and angiogenesis. Thus, MBL can prevent tumor cells invasion and immigration.

In a survey on chronic disease management in Xujiahui Community,we found that the general practice team was facing the following problems：①Heavy burden of follow-up work by a relatively smaller number of physicians;②Misunderstanding of health and insufficient recognition of the importance of chronic disease management among community residents;and③Delayed database construction and inefficient performance.In this study,we described the strategies to improve chronic disease management in communities.

BACKGROUND:Glutathione S-transferase can get rid of active oxygen and enhance organism's antioxidative capability.OBJECTIVE:To analyze the association between glutathione S-transferase P1-105 (GSTP1-105)genetic polymorphisms and human exercise capacity in the high altitude environment.DESIGN,TIME AND SETTING:A controlled analysis was performed in the PLA Institute of Physical Education in 2007.PARTICIPANTS:A total of 86 professional mountain climbers who had strong physical performance in the high altitude environment served as experimental subjects.An additional 90 healthy students randomly selected from the PLA Institute of Physical Education served as controls.METHODS:Blood sample was taken from 86 experimental subjects and 90 healthy controls for extraction of genome DNA.GSTP1-105 genetic polymorphisms were detected by polymerase chain reaction-restriction fragment length polymorphism analysis.Distribution of GSTP1-105 alleles and genotypes were compared between experimental and control subjects.MAIN OUTCOME MEASURES:Distribution of GSTP1-105 genotype.RESULTS:Totally 3 GSTP1-105 genotypes were detected:homozygous genotype of the A allele (NA,also called wide type genotype),heterozygous genotype (NG),and homozygous genotype of the G allele (G/G).The frequency of the G allele and variant genotype (A/G+G/G)were significantly lower in the experimental than in the control subjects (P＜0.01).Variant genotype (A/G+G/G)was taken as an exposure factor,then OR=2.19 and 95% CI=1.16-4.13,indicating that in the high altitude environment,the exercise capacity in individuals with GSTP1-105 variant genotype was decreased by 1.19 times than that in individuals with GSTP1-105 wide type genotype.CONCLUSION:GSTP1-105 genetic polymorphisms correlate to human exercise capacity in the high altitude environment.Subjects with wide type genotype have exercise predominance.

Objective To evaluate the early clinical outcome of one‐stage posterior approach operation for rigid scoliosis caused by lumbosacral hemivertebra in adolescencts .Methods Eighteen adolescencts with rigid scoliosis caused by lumbosacral hemivertebra were surgically treated by the posterior hemivertebral resection and long segment fixation .Hemivertebrae were sited in L5 (14 cases) ,S1 (4 cases) .There were 12 cases of full‐segmented hemivertebrae and 5 cases of semi‐segmented hemivertebrae and 1 case of wedge vertebral body ,10 patients had coronal trunk imbalance .Results The patients were successfully completed sur‐gery .The operation time was 4 .5-8 .5 h ,averaged 6 .3 h ;and the perioperative bleeding was 600-2 800 mL ,averaged 1 180 mL . 2 patient suffered from nerve root injury who received neuro nutrition drugs and Prednisolone after operation and recovered com ‐pletely after one weeks .All cases were follow ed up for 12-38 months ,averaged 21 .6 months .The coronal Cobb angles of lumbo‐sacral curve and proximal lumbar after one week of operations and at the time of the last follow‐up were much better than those be‐fore the operations ,the differences were statistically significant (P<0 .05) .Postoperative radiography demonstrated that no implant failure was observed .Coronal trunk shift was improved in 17 patients after surgery ,1 patient had coronal trunk decompensation . Conclusion The posterior surgery with hemivertebrae resection and long segment fixation is an effective procedure in the treatment of rigid scoliosis caused by lumbosacral hemivertebra in adolescencts .The reconstruction of the coronal plane is the key to the oper‐ation .

Objective To investigate the clinical characteristics and risk factors of neonatal hyperbilirubinemia.Methods The clinical data of 826 cases with neonatal hyperbilirubinemia were retrospectively analyzed.The jaundice appeared time,clinical characteristics were monitored,and the causes of jaundice appeared were analyzed.Results The jaundice cases at ≤ 1 day,＞ 1 ～ 7 days,more than ＞ 7 days were 71 cases,471 cases,284 cases,accounted for 8.60％,57.02％,34.38％ ;The top three risk factors of jaundice constitute were breast milk jaundice,perinatal factors,infectious factors,the cases were 215 cases,206 cases,200 cases,the proportions were 26.03 ％,24.94％,24.21％ ;The proportion jaundice of newborn caused by ABO hemolytic was 9.44％ ;There were 220 cases of 812 cases had neonatal jaundice,including 170 cases of full-term of breast milk jaundice,the proportion was 27.15％,50 cases of preterm infants of breast milk jaundice,accounted for 26.88％,there was no significant difference(P ＞ 0.05) ;78 cases was full-term breast milk jaundice,the proportion was 22.94％,120 cases of cesarean section appeared breast milk jaundice,accounting for 36.81％,the difference was statistically significant(P ＜ 0.05).Conclusion The degree of neonatal jaundice is affected by many factors,which related with individual differences,geographical,economic and cultural level,race,gender,feeding methods,genetic and so on,the strict observation and identification of neonatal jaundice and the establishment of supervision system and the protection for active and effective measures,taking active and effective treatment have very good effect to reduce hyperbilirubinemia complication as well as a good effect on the prevention and treatment of neonatal hyperbilirubinemia.

Objective To investigate the cause of stoma chassis leakage (SCL) and summarize the nursing experience. Method The clinical data of 20 patients with SCL were retrospectively analyzed on the colostomy outpatients. Result The causes of SCL in those stoma patients included insufficient skills of stoma care, peridermal depression, poorly fitting stoma chassis, weight gain, poor positioning and retraction of the stoma. Conclusion Such nursing measures as enhanced awareness of SCL causes, careful reselection of a suitable stoma chassis, addition of ointment patches or heightening of the convex chassis can be effective in prevention of SCL leakage, enhancement of patient′s confidence and improvement of their quality of life.

Epigenetics, which is called second genetic code precisely and controls the total metabolic processes of eukaryotic cells,has an inseparable correlation with human health and diseases. Among all the gene silencing mechanisms of epigenetic modifications,CpG islands of DNA promoter hypermethylation/histone mod-ifications are two major causes. Promoter methylation of specific genes,such as Ras protein activator analogue 1 may lead to aberrant activation of downstream signaling pathways,following by fibroblasts proliferation and kid-ney fibrosis. In recent years,epigenetic modifications have been proved to play a major role in preventing fibro-blasts to return to their quiescent stage,ultimately contributing to fibrosis in the kidney. This paper provides a glimpse of recent studies on epigenetic mechanisms of chronic kidney diseases,especially renal fibrosis,with an aim to provide new insights into pathogenesis research and clinical diagnosis and treatment.

Toll-like receptor( TLR) ,which belongs to pattern recognition receptor,is type I transmem-brane glycoprotein. TLR activates natural immune and induces several cytokines. Foreign studies have showed that bacterial infection is closely related with TLR. In this paper,the relationship between TLR and bacterial in-fection is reviewd.

BACKGROUND: The ulcer wound is hard to heal in diabetic patients,and it is believed to be caused by the microcirculatory disorder of wound and decreased contents of endogenous growth factors in patients with diabetes mellitus.OBJECTIVE: To observe the biological effects of adeno-associated virus (AAV) mediated transforming growth factor beta1 (AAV-TGFβ1) and vascular endothelial growth factor (AAV-VEGF) in promoting the dermal ulcer healing of diabetic rabbits.DESIGN: A randomized controlled animal experiment.SETTINGS: Medical College, Qingdao University; Affiliated Hospital of Medical College, Qingdao University.MATERIALS: The experiments were carried out in the gynecological laboratory, Affiliated Hospital of Medical College, Qingdao University from July 2004 to January 2006. Twenty-four healthy adult New Zealand rabbits were randomly divided into co-transfection group (n=12) and control group (n=12).METHODS: ① The dermal ulcer models of diabetic rabbits was established by injecting alloxan (130 mg/kg) via ear vein, and the ulcer wound was made by operation. ② In the co-transfection group, the wound was locally infiltrated, and injected with AAV-TGFβ1 virus and AAV-VEGF virus (the concentration was 9×106 virus granules/mL respectively). The rabbits in the control group were treated with injection of saline.MAIN OUTCOME MEASURES: ① The levels of TGFβ1 and VEGF gene transcription in the healing tissue were detected with polymerase chain reaction (PCR) at 1 month postoperatively. ② The capillary density in the wound margin was counted with microcirculation microscope at 3 weeks postoperatively. ③ The collagen Ⅰ and Ⅲ were isolated and detected with Western blotting by protein gel electrophoresis and semi-dry electrophoretic transfer. ④ The content of collagen in the ulcer healing issue was detected at 1 day, 1, 2 and 3 weeks, 1, 2, 3, 4, 5 and 6 months postoperatively. ⑤ The thickness, color and quality of the wound healing were observed postoperatively.RESULTS: All the 24 rabbits were involved in the analysis of results. ① The expressions of TGFβ1 and VEGF gene transcription in the co-transfection group were increased as compared with those in the control group. ② The capillary density at the wound margin in the co-translection group was higher than that in the control group [(19.18±3.56), (6.43±1.52)/mm2,t=3.21, P ＜ 0.05]. ③ The content of collagen Ⅰ in the ulcer healing tissue in the co-transfection group was obviously increased, and the proportion of collagen Ⅰ in the constituent ratio of collagen Ⅱ and Ⅲ was increased.④ The contents of collagen in the ulcer healing tissue at 1 day after transfection were close without significant difference between the two groups (t=1.55, P ＞ 0.05). After that, the contents of collagen in the cotransfection group were all significantly higher than those in the control group (P ＜ 0.05). ⑤ The ulcer healing in the control group was obviously lagged with bad quality.CONCLUSION: The combination of AAV-TGFβ1 and AAV-VEGF can efficiently transfect the dermal ulcer wound in diabetic rabbits, obviously increase the capillary density in ulcer tissue, markedly improve the proportion of collagen I in the constituent ratio of collagen Ⅰ and Ⅲ in healing tissue, and obviously ameliorate the condition of ulcer healing.