Objective To analyze the consistency of the detection results of glycosylated hemoglobin (HbA1c) by SMART POCT and Hitachi 7180 biochemical analyzers .Methods Firstly the accuracy of HbA1c detected by the SMART POCT and Hita‐chi 7180 biochemical analyzers were evaluated .And then 20 randomly selected samples were tested by both equipments .A relevance analysis between detected data from two equipments was conducted .Results There was a good correlation between the results of the HbA1c detected by two detecting systems ,with the correlation coefficient of r2 =0 .981 1 .Conclusion There is a good consis‐tency in detection results of glycosylated hemoglobin (HbA1c) detected by SM ART POCT and Hitachi 7180 biochemical analyzer .

ObjectiveTo discuss the selection of surgical approach,operative methods,and stability of reconstitution of affection of cervicothoracic junction.MethodsFrom January 2001 to February 2009,86cases with affection of cervicothoracic junction were treated surgically.The mean age of patients at the time of surgery was 43.1 years (range,17-70).Fifty-seven patients were treated with anterior approach (fixation with autologous bone grafts was done in 38 patients,Cage fixation in 5,titanium mesh in 14),21 with posterior approach(the fixation of lateral mass screw combined with pedicle screw was used in 12 patients,fixation with pedicle screw in 9),and 8 with anterior combined posterior approach.The neurological function of 53 cases of injury of cervicothoracic junction was assessed by American Spinal Injury Association (ASIA) criteria,and the rest was assessed by Japanese Orthopaedic Association(JOA) criteria; bone arthrodesis and restoring lordosis of cervical spine were assessed by Bohlman radiographic criteria.ResultsSixty-nine cases were followed up for an average of 12.4 months(range,3-45).ASIA score increased from 1.8 preoperatively to 2.3 postoperatively,and JOA score increased from 10.3 preoperatively to 12.8 postoperatively.Bone fusion reached in all patients,and lordosis of the cervical spine of 62 cases was restored.One case with respiratory dysfunction,1 case with cerebrospinal fluid leakage,2 cases with hoarseness,and 1 case with loose lateral mass screw were found after the surgery.ConclusionThe advantages of surgical reconstitution of the cervicothoracic junction included promoting recovery of neurological function,restoring the alignment and lordosis of the cervical spine,decreasing the rate of complication,which were dependent on the suitable surgical indications,surgical approach,and way of surgical reconstitution.The selection of reconstituted methods depends on disease,lesion site,type and degree of injury,experience of doctor,decompression and spinal stabilization synthetically.

Objective To study the alteration of Th17 cells and related molecules in patients with Hashimoto's thyroiditis (HT).Methods Th17 cells were determined by flow cytometry.Real-time PCR method was applied to detect the expression of the orphan nuclear receptor RORγt and interleukin(IL) -17.Serum IL-6 and IL-23 were detected by ELISA method.Results ( 1 ) Compared with healthy controls,the frequency of Th17 cells [ (0.75± 0.79) ％ vs ( 0.28 ± 0.23 )％ ] and expression of RORγt ( 0.30 ± 0.38 vs 0.04 ± 0.02,both P ＜ 0.05 ) were significantly increased in HT patients.( 2 ) The levels of IL-6 and IL23 in HT patients were higher than those in healthy controls ( 3.66 ± 4.70 vs 0.47 ± 1.11,154.7 ± 75.81 vs 80.65 ± 61.41,both P＜0.05 ).( 3 ) A positive correlation between Th17 cells and serum TgAb was revealed in HT patients ( r =0.848 4,P =0.007 7 ).(4) The results of PCR showed that IL-17 and RORγt expressed in thyroid tissues of patients HT.Conclusion An increased frequency of Thl7 cells was found in HT patients,implying that this cell subset may play an important role in the pathogenesis of autoimmune thyroid disease.

Objective To study the therapeutic effects of combined use of laparoscopic cholecystetomy and endoscopic sphincterotomy for cholecystolithiasis with secondary choledocholithiasis.Methods Thirty-five patients were diagnosed as cholecystolithiasis with secondary choledocholithiasis by B-ultrasonography and magnetic resonance cholangiopancreatography.Of them,in 28 cases,laparoscopic cholecystetomy was performed first,and ERCP and endoscopic sphincterotomy were done one week later;in 7 cases,endoscopic sphincterotomy were performed before laparoscopic cholecystectomy.Results The outcome of all the thirty-five cases was satisfactory without severe complications or conversion into open procedure.Conclusions The method of combined laparoscopic cholecystomy and endoscopic sphincterotomy,for cholecystolithiasis with secondy choledocholithiasis,especially for cases in whom the diameter of the common bile duct stone is ≤1cm,can give good therapeutic results and has advantages of minimal invasiveness,few complications and quick recovery.

Objective To assess the safety and efficacy of mycophenolate mofetil (MMF) combined with low dose corticosteroid in the treatment of adults with minimal change nephrotic syndrome and concomitant HBsAg positive (MCNS-HBsAg). Methods Thirty adults with MCNS-HBsAg were enrolled in this prospective study and were assigned to two groups. The MMF group (n=14) received low dose of prednisone combined with MMF (MMF 1.0 to 2.0 g/d patients of Pred group versus 35.7% patients of MMF group. 43.8% patients of Pred group versus 21.4% patients of MMF group received lamivudine therapy. Elevation of alanine aminotransferase(ALT) ocurred in 50% patients of Pred group and 28.6% patients of MMF group. The complete remission (CR) rate after 24 weeks treatment was 11/14 in Pred group versus 10/12 in MMF group. 6/11 patients of the Pred group and 4/10 patients of the MMF group who achieved CR experienced relapses during follow-up. Conclusions Use of MMF combined with low dose prednisone is as effective as conventional prednisone regimen in treating adults with MCNS-HBsAg. The MMF protocol seems to be superior in HBV reactivation to conventional prednisone protocol.

BACKGROUND: Peroxisome proliferation-activated receptor-gamma (PPARγ) is the member of nuclear receptor superfamily, and closely related with the formation of atherosclerosis.OBJECTIVE: To investigate the relationship between PPARγ C161→T gene polymorphism and coronary atherosclerotic heart disease (CAHD).DESIGN: Randomized controlled experiment SETTING: Department of Cardiology, Tonai Hospital of Huazhong University of Science and Technology; Department of Cardiology, Zhongnan Hospital of Wuhan University; Center for Human Genome Research,Huazhong University of Science and Technology; Department of Internal Medicine, Affiliated Hospital of Hubei University of Traditional Chinese Medicine; Institute of Geriatrics, Dongzhimen Hospital, Beijing University of Chinese Medicine PARTICIPANTS: Totally 203 CAHD patients aged (65±11) years, including 129 males and 74 females, were the inpatients and outpatients of Zhongnan Hospital of Wuhan University and Tonai Hospital of Huazhong University of Science and Technology from June 2002 to December 2005.And 156 cases of them were diagnosed by coronary arteriongraphy, among which 43 patients without coronary artery affection or with coronary stricture ＜ 50%, and 113 patients with coronary stricture ＞ 50 %. While 89 healthy physical examinees of Han race and mean (59±9) years old were enrolled as control group, including 56 males and 33 females. There was no blood relationship between controls and patients.METHODS: The experiment was conducted at Tongji Hospital of Huazhong University of Science and Technology from June 2002 to December 2005. PPARγ C161→T gene polymorphism was determined by polymerase chain reaction and restriction endonuclease fragment length polymorphisms. The radio-immunity technique, coronary angiography and clinical routine biochemical index were applied to analyze the genotypic frequency and allele frequency distributions as well as the relation between clinical data, biochemical index and different genotypes. The risk factors of CAHD were estimated in the patients of different genotypes.MAIN OUTCOME MEASURES: The genotypic frequency and allele frequency distributions, the relation between clinical data, biochemical index and different genotypes, along with the blood lipid, blood glucose, fasting insulin and body mass index (BMI).RESULTS: Totally 103 CAHD patients and 89 controls were involved in the result analysis of gene polymorphism and yielded different gene distribution frequencies.① In control group, "T" allele frequency was 0.213 and "C" allele frequency was 0.787, and in CAHD group, "T" allele frequency was 0.192 and "C" allele frequency was 0.808. There was no significant difference in the genotypic frequency and C, T allele frequencies between two groups (P ＞ 0.05).② The CC genotype was dominant in CAHD patients with coronary artery lesions, and showed significant differences from "T"allele carriers (CT+TT) (P ＜ 0.05). The CAHD risk in the "T" allele carries (OR: 0.56, 95% CI: 0.24-0.63) was much lower than that in the CC homozygote (OR: 1.92, 95% CI: 1.09-2.54).③ Apolipoprotein B in patients with CC genotype was obviously higher than that in patients with "T" allele (CT+TT) (P ＜ 0.05), and there was insignificant difference in the insulin resistance index (P ＞ 0.05).CONCLUSION: There is an important correlation between the substitution of PPARγ C161→T and CAHD, and "T" allele carriers demonstrate a lower risk of CAHD.

Objective: To compare the medium-term clinical and radiologic outcomes between anterior decompression with fusion (ADF) and posterior open-door laminoplasty (LAMP) in the treatment of multi-level cervical spondylotic myelopathy (MCSM). Methods: Data of 121 patients meeting to inclusion criteria from October 2011 to February 2016 were retrospectively analyzed. All the patients were treated with ADF (ADF group, n=57) or LAMP (LAMP group, n=64) for MCSM. There were 39 males and 18 females in ADF group, aged from 35 to 77 years, with an average age of 58.8±10.1 years. And there were 64 cases in LAMP group, including 48 males and 16 females, aged from 28 to 82 years, with an average of 60.6±12.2 years. The operation time and blood loss were recorded. The clinical efficacy was evaluated by Japanese Orthopaedic Association Scores (JOA), improvement rate and visual analogue scale (VAS) before operation, 1, 3, 6, 12 and 24 months after operation and at the latest follow-up. At the same time, sagittal alignment of the C₂-C₇ lordotic angle and range of motion (ROM) in flexion and extension on plain X-rays was measured. Residual anterior compression to the spinal cord (ACS) in LAMP group on MRI was investigated. The incidence of complications such as axial symptoms and C₅ nerve root paralysis were recorded. Results: The average follow-up period was 25.6±3.8 months in ADF group and 27.3±4.1 months in LAMP group. Demographics were similar between the two groups. The mean JOA scores in ADF group increased from preoperative 8.25±2.33 to 14.62±3.15 at the latest follow-up, with an average recovery rate of 72.81%±11.32%. The mean JOA scores in LAMP group increased from preoperative 8.84±3.65 to 12.97±4.32 at the latest follow-up, with an average recovery rate of 66.54%±14.75%. The difference between two groups was statistically significant. Both of the VAS scores in the two groups decreased significantly at 1 month after the surgery, but the difference between the ADF group (1.92±0.75) and the LAMP group (2.78±0.68) was statistically significant (t=2.364, P=0.021). There was no significant difference in VAS score between the two groups at 3 months after operation. Cervical lordosis of ADF group increased from 15.3°±7.6° to 19.2°±5.7°, while that of LAMP group decreased from 16.8°±8.3° to 13.6°±4.3°. There was significant difference in cervical curvature between the two groups at the latest follow-up. Both two groups exhibited decreased cervical ROM, 15.2°±3.6° and 18.1°±4.1°, respectively, and the difference between two groups was statistically significant (t=3.392, P=0.000) . At the latest follow-up, the incidence of complication was 35.1% in ADF group and 20.3% in LAMP group, and the difference between two groups has no statistically significant. The LAMP group was divided into two subgroups: (1) ACS(+)(n=11) comprising patients who had ACS after surgery, and (2) ACS(-) (n=53) comprising patients without ACS. At the latest follow-up, the average JOA score of patients with anterior residual compression of spinal cord was 10.85±5.46, while the average JOA score of patients without anterior residual compression of spinal cord was 14.18±4.52. The recovery rate differed significantly between the ACS(+) and ACS(-) groups, 40.52%±9.76% and 70.38%±10.52%, respectively. Also at the latest follow-up, the cervical curvature, ROM and ROM loss angle were 10.2°±7.3°, 15.6°±6.7° and 11.8°±8.3° in the group with anterior residual compression of spinal cord, respectively. The groups without anterior residual compression of spinal cord were 15.8°±6.5°, 20.4°±10.2° and 8.8°±6.8°, respectively. Conclusion Both ADF and LAMP groups provided good outcomes at 2-year time-point whereas ADF could achieve more satisfactory outcomes and better sagittal alignment at the middle-term. ADF can remove the compression directly, maintain the curvature of cervical vertebra effectively and restore the nerve function well. The clinical outcomes after LAMP could be influenced by ACS, due to the reduction of cervical curvature and the decrease of cervical range of motion.

Objective To compare the efficacy and safety of twice-daily tacrolimus (Tacrolimus BID; Prograf) vs once-daily prolonged release tacrolimus (Tacrolimus QD; Advagraf), combined with steroids and mycophenolate mofetil in preventing acute rejection in De Novo renal transplantation patients. Methods 241 patients from 11 centers were randomized into two groups with 3 months observation period post-transplantation. Advagraf was administered as a single oral dose in the morning (initially 0. 1-0. 15 mg/kg every day) and Prograf was administered in two equal oral doses 12h apart (initially 0. 1-0. 15 mg/kg). Study visits were scheduled for days 1, 3, 7, 14, 28, 56, 84post-transplantion. The efficacy, safety, compliance and adverse effects were compared between two groups. Results Totally 223 patients completed the study. The two groups were comparable in age,gender and primary disease. There were 12 episodes of acute rejection in each group. There was no graft loss or patient death in both groups. The incidence of drug related adverse events was 32. 1 %and 33. 3% respectively in the control and experimental groups. Dosage was decreased in both groups and there was significant difference in each group. The trough level was similar at the initiate period.Twenty-eight days post-transplantation the trough level in the Advagraf group was lower than in the Prograf group. Conclusion Advagraf has the same efficacy, safety and drug related adverse effects as Prograf. It is practical and feasible for Advagraf substitute for Prograf in clinical practice.

ObjectiveTo evaluate the efficacy and safety of HC-A Ⅱsolution in kidney preservation.Methods A multicenter,randomized,double-blind and controlled clinical trial was conducted.Between Jan.2008 and Dec.2010,kidney recipients from 9 transplant centers were randomly divided into two groups.Grafts in each group were perfused and stored in HC-A Ⅱ or HTK solutions respectively.Results277 patients were included in the Full Analysis Set (FAS),137 of whom were inHC-A Ⅱgroup and 140inHTK group. Demographic andbaseline medical characteristics were similar between the two groups.262 patients were included in the Per Protocol Set (PPS),133 of whom were in HC-A Ⅱ group and129 in HTK group.The percentages of patients with a serum creatinine level that returned to normal within 28 days postoperation were 86.9％ in HC-A Ⅱ group and 85.0％ in HTK group respectively (P＞0.05 ).The results from PPS analysis were consistent with those from FAS analysis The incidence of test-related adverse events was 2.9％ in HC-AⅡ group and 0.7％ in HTK group respectively (P＞0.05).No test-related serious adverse events occurred throughout the study.ConclusionHC-A Ⅱ solution,the same as HTK solution,is safe and effective in kidney preservation.

Objective To document the impact of conversion to mycophenolate mofetil (MMF)at different time points after transplantation on the renal function of renal function.Methods A longterm,multicenter,non-interventional and observational study was done.Two cohorts were included:One was Switch cohort (340 cases) including renal allograft recipients who switched to MMF at least 6 months after renal transplantation and followed up for 4 years after switch; The other was Stay cohort (123 cases),including renal allograft recipients who received MMF treatment after transplantation and followed up for 4 years after enrollment.Results GFR values of patients in Switch cohort was significantly increased after switch,and the change in GFR slope was 3.1 mL· min-1 · year-1 (P＜0.01).GFR values of patients in Stay cohort kept steady before and after enrollment,and the change in GFR slope was 0.44 mL·min-1 ·year-1 (P＞0.05).Statistically significant difference in the onset time of GFR decline (defined as 20％ decline from the baseline) was observed among subgroups within Switch cohort (P＜0.01),but there was no significant difference among subgroups within Stay cohort (P＞0.05).Stay cohort was 12％ higher than in Switch cohort every year.Conclusion Conversion to MMF ＞6 months or even many years after transplantation can obviously improve the renal function of recipients.The earlier conversion can benefit improvement of the renal function.