Objective To study the clinicopathologic characteristics,the optimal therapy and prognosis of patients with pancreatic carcinoma with elevated serum alpha-fetoprotein (AFP).Methods CNKI,Wanfang database,VIP Database for Chinese Technical Periodicals,PUBMED and EMBASE were searched.Studies which met the inclusion criteria were evaluated.Results 24 reports were found which included 28 patients with pancreatic carcinoma with elevated serum AFP.The carcinoma was characterized clinically by a predilection for older male.The majority of patients had metastases at the time of diagnosis,especially liver metastases.Histopathologically,not all tumors were hepatoid carcinoma,and acinar cell carcinoma was most common.Surgical resection was the optimal treatment for patients at an early stage.Combined therapies were used on patients at an advanced stage.Patients with hepatoid carcinoma of the pancreas might be sensitive to treatment similarly to hepatocellular carcinoma.In AFP-producing pancreatic carcinoma,serum AFP level was a useful marker for diagnosis and evaluation of therapeutic response and recurrence.However,there were no sufficient evidence to support whether pancreatic carcinoma with elevated serum AFP was associated with a higher frequency of liver metastasis and poor survival.Conclusions Further studies are needed to identify the prognosis and the effective therapies for the AFP expression variance of pancreatic carcinoma with elevated serum AFP.Detecting AFP and variants of AFP are important for the early diagnosis of pancreatic carcinoma with elevated serum AFP,and increase in therapeutic response and prog nosis.

Objective To observe the relationship between blood stasis syndrome and clinical pathology in patients with IgA nephropathy (IgAN). Methods Clinical and pathological materials of 42 patients with blood stasis syndrome,and 73 patients with non blood stasis syndrome were analyzed. Result Patients with blood stasis syndrome are often female and accompanied with renal dysfunction. Compared with patients of non blood stasis syndrome,Lee’s grades were obviously higher,degrees of fibrinogen-related antigen (FRA) deposited in renal were stronger,and scores or ratio of tubular atrophy significantly were higher. Conclusion Blood stasis syndrome of IgAN is correlated with certain renal pathological changes. Blood stasis is the main etiological factor.

Objective To explore the role of adjustable and close persistent peritoneal drain in large ascites and acute renal insufficiency(ARI)in patients with primary nephrotic syndrome(PNS).Methods The adjustable and close persistent peritoneal drain tube were planted in 6 cases with PNS accompanied by large ascites and ARI during December 2005 and August 2006.On the basis of drain,they were treated by prednisone,anticoagulative agent,hypolipidic agent,antibiotics,antioxidant,microcirculation-improving agent and aweto preparation.Results After the treatment,ascites disappeared or decreased.ARI was cured in 5 cases.Among these patients,partial remission(PR)and no respone(NR)to treatment were present in 3 cases respectively during hospitalization.After the follow-up of 3~12 months,the complete remisson(CR)of PNS was found in 2 cases,PR in 3 cases and NR in 1 case respectively.Conclusion The adjustable and close persistent peritoneal drain may be applicable for PNS patients with large ascites and ARI and slight glomerular lesion.It can clear away the superabundant water,mitigate the renal interstitial edema and accelerate the recovery of ARI.It also makes the patients have the opportunity of the treatment which includes predenisone,anticoagulative agent and hypolipidic agent.

Objective To investigate mother-to-child transmission of HIV-1 and the factors that affect transmission. Methods 136 children who were born to HIV positive mothers in a high HIV prevalence region were interviewed and blood samples were examined for anti-HIV anti-HGV and HIV RNA or HIV DNA. Results Among 136 children who were born to HIV positive mothers, 50 were infected with HIV. The MTCT rate was 36.8% (50/136). Thirty eight DNA fragments of HIV-1 gag gene P17 obtained from HIV-1 seropositive mothers were amplified by PCR from uncultured peripheral blood mononuclear cells (PBMCs). Sequence analyses showed that all of them were HIV-1 B subtype. The HIV vertical transmission rate among mothers with AIDS (67.4%, 31/46) was significantly greater than among those with HIV alone (21.1%, 19/90), P

Objective To evaluate the antihypertensive effect and safety of domestic produced amlodipine(Lan Di) in the treatment of chronic renal insufficiency with mild-mnderate hypertension and to compare with the effect of imported amledipine.Methods Sixty-onc patients with chronic renal insufficiency(Scr:265～442 μmol/L,seated DBP 90 ～105mmHg and seated SBP≤170mmHg) were enrolled in this study.Patients were randomly assigned to receive Lan Di 5mg or novasc 5mg once daily for 4 weeks.Doses were titrating to 10mg/d for another 4 weeks in patients hating seated DBP≥80mmHg or SBP≥130mmHg at the end of 4 weeks.Blood pressure,heart rate,laboratory examinations were performed at baseline and the end of the trial,and side effects were assessed pre and post Lan Di or novasc treatment.Results Lan Di group(31 cases) and novasc group(30 cases) finished a 8 week clinical trial.At the end of 4,8 weeks,seated SBP and DBP were significantly lowered compared with those at baseline(P＜0.01 ).There was no significant difference in the reduction of seated DBP or SBP between the two groups at the end of 4,8 weeks(P＞0.05).At the end of 8 weeks ,the response rate was 87% in Lan Di group and 90% in novasc group.If the target value of blood pressure is below 130/80mmHg,the response rate was 36% in Lan Di group and 30% in novasc group.At the end of 8 weeks,no difference was found in laboratory findings compared with those at baseline in two groups(P＞0.05).Side effects were comparable during the period of treatment.Condusion Domestic produced amlodipine 5mg or 10mg daily is as effective and safe as imported amolodipine in chronic renal insufficiency patients with mild to moderate hypertension.

AIM:To observe the clinical effects of Huangkui Capsule (Abelmoschus manihot (Linn)Medic.)on the treatment of IgA nephropathy of damp-heat syndrome.METHODS: Sixty-four patients were assigned randomly into two groups: treatment group in which 32 cases were treated with Huangkui Capsule,and control group,in which 32 cases were treated with fosinopril.The therapeutic course for both groups was 12 weeks.The indexes of efficacy ,including damp-heat syndrome scores,24 h urinary protein,serum creatinine,urea nitrogen and the indexes of safety,including liver function,electrolyte and occurrence of adverse events were observed.RESULTS :There was no significant statistical difference between the two groups in aspects of baseline clinical figures,after 12 weeks of treatment,the content of 24h urinary protein significantly decreased by (0.49±0.78 )g/24 h and (0.4±0.76 ) g/24 h respectively in the two groups,showing significant difference in comparing with baseline,but insignificant difference between the two groups ( P ＞ 0.05 ),the scores of damp-heat syndrome in the two groups decreased by (0.88±1.43 ) scores and (1.94±1.63 ) scores respectively with significant difference as compared with baseline (P ＜0.05 ),and in comparison between groups(P ＜0.05 ).The total effective rate of 24 h urinary protein was 53.1% in the treatment group and 65.6% in the control group (P ＞ 0.05 ),The total effective rate of dampheat syndrome scores was 84.4% in the treatment group and 50% in the control group ( P ＞ 0.05 ).No significant change in levels of serum creatinine,urea nitrogen in the two groups was found (P ＞0.05 ).No severe adverse event occurred during the treatment,and the occurrence in the two groups was similar.CONCLUSION: Huangkui Capsule can effectively decrease the proteinuria just like fosinopril and improve clinical syndrome of patients of IgA nephropathy with damp-heat syndrome type,and shows no serious adverse reaction.

0.05).No severe adverse event occurred during the treatment,and the occurrence in the two groups was similar.CONCLUSION:Huangkui Capsule can effectively decrease the proteinuria just like fosinopril and improve clinical syndrome of patients of IgA nephropathy with damp-heat syndrome type,and shows no serious adverse reaction.

Objective To study the status of anxiety and depression on clinical decision-making participation of laryngeal cancer patients.Methods A total of 82 laryngeal cancer patients participated in the investigation by questionnaire to study the clinical decision-making participation by control preferences scale.The degree of anxiety and depression was investigated by self-rating anxiety scale and self-rating depression scale.Results During the clinical decision-making process,40.24％ of the patients were passive,29.27％ had their families as absolute representatives,20.73％ took part collaborating with their families and only 9.76％ were active.47.56％ had anxiety and 64.63％ depression,and the anxiety and depression influenced their participation in clinical decision-making postively and passively relatively.Conclusions Patients with laryngeal cancer are passive in clinical decision-making and most of them have anxiety and depression.Doctors should enhance the communication with patients,which can help to eliminate adverse psychological emotions and make satisfying clinical decision-making.

Objective To investigate the role ofglutamic acid decarboxylase autoantibody(GAD-Ab)and protein tyrosine phosphatase autoantibody(IA-2A) in postpartum follow-up of gestational diabetes mellitus (GDM).MethodsGAD-Ab,IA-2A,insulin and glucose metabolism index were measured in 82subjects with normal glucose tolerance (control group) and 84 patients with GDM(GDM group) during 24 to 28 weeks in pregnancy,postpartum 6 to 12 weeks and 2 years.GDM group was divided into antibodies positive group (GAD-Ah or IA-2A were positive) with 18 cases and antibodies negative group (GAD-Ab and IA-2A was negative) with 66 cases.Results Homeostasis model insulin resistance index (HOMA-IR) in GDM group was higher than that in control group (3.87 ± 2.17 vs.2.31 ± 0.52,P ＜ 0.05 ).Homeostasis β -cell function index (HBCI) and 30 min net increment of insulin/30 min net increment of glucose ( △ I30/△ G30) in GDM group were lower than those in control group[206.38 ± 138.06 vs.422.43 ± 228.93 and (20.16 ±11.38) mU/mmol vs.(26.54 ±24.30) mU/mmol,P ＜0.05].The numbers who had the family history of diabetes mellitus and the used of insulin for treatment in antibodies positive group were higher than those in antibodies negative group[ 83.3％ (15/18) vs.28.8％ (19/66) and 77.8％ ( 14/18 ) vs.30.3％ (20/66) ],HOMA-IR,△ I30/ △ G30 and HBCI in antibodies positive group were lower than those in antibodies negative group [3.20±0.84 vs.4.02±0.36,(16.81 ±2.91) mU/mmol vs.(21.55± 11.11) mU/mmol and 124.95 ± 5.03 vs.217.43 ± 115.64,P＜ 0.01 ].Fasting plasma glucose (FPG),2 hours postprandial glucose (2hPG)and glycosylated hemoglobin (HbA1c) in antibodies positive group were higher than those in antibodies negative group during postpartum 6 to 12 weeks and 2 years [postpartum 6 to 12 weeks: (8.20 ±3.11)mmol/L vs.(5.39 ±0.76) mmol/L,(15.22 ±7.29) mmol/L vs.(8.15 ± 1.93) mmol/L,(7.26 ± 1.04)％ vs.(5.88 ±0.41)％ ;postpartum 2 years: (8.91 ±2.80) mmol/L vs.(4.93 ±0.66) mmol/L,(15.75 ±7.87)mmol/L vs.(7.85 ± 1.79) mtmol/L,(7.18 ± 1.22)％ vs.(5.64 ± 0.32 )％,P ＜ 0.01].△ I30/ △ G30 and HBCI were significantly decreased in antibodies positive group postpartum 2 years.No change of the above parameters in antibodies negative group was found.The occurrence rate of type 1 diabetes mellitus (T1DM) was 16.7％(3/18) and 33.3％(6/18) postpartum 6 to 12 weeks and 2 years in antibodies positive group,there was no T1DM in antibodies negative group.ConclusionsWomen with GDM are partly associated with T1DM.Requiring insulin therapy during pregnancy and GAD-Ab or IA-2A positive have considerable risk for developing T1DM.It is also an important predictor to GDM after parturition.

Objective To develop and apply an ICU orientation program based on the Miller pyramid competency model. Methods 45 new ICU nurses in 2013 and 2014 were selected as the experimental group. The experimental group was oriented by the new program,including the orientation of preceptors, workshop-centered orientation courses, checklists-precepting and comprehensive competency evaluation methods. 39 new ICU nurses in 2011 and 2012 were selected as the control group. The control group was oriented by the conventional program,including focused theory classes and traditional precepting.New nurses′ satisfaction with the orientation and the competency were analyzed before and after intervention in two groups. Results Satisfaction with the orientation, self-evaluated competency and peer-evaluated competency in the experimental group were(16.71±1.19) scores, (126.52±3.31) scores and (90.00±2.68) scores respectively,which were much better than the control group and had statistically significant difference in two groups. Conclusions The ICU new nurse orientation program based on the Miller pyramid competency model can improve the new nurses′ satisfaction with the orientation and the competency after the orientation.