Objective To find out early lesion of rentanl function in elderly patients with dipper essential hyperten-sion and morning blood pressure surge( MBPS) , and to find out the value of homocysteine( Hcy) with high-sensitiv-ity C reactive protein ( hs-CRP) in detecting early lesion of rentanl function in hypertensive patients. Methods Totally 168 elderly paritents with dipper essential hypertension were divided into MBPS group( observation group, n=73) and non-MBPS group (control group, n=95) according to the accompanying MBPS or not. The cystatin C ( Cys C) , urinary microcalbumin ( U-mAlb) ,urinary transferring( U-TRF) ,Hcy, hs-CRP,serum creatinine( SCr) , blood urea nitrogen(BUN), blood glucose(Glu),cholesterol(TCH),triglyceride(TG), high density lipoprotein cholesterol( HDL-C) and low density lipoprotein cholesterol( LDL-C) were tested. The differences in Cys C, Hcy, hs-CRP, the U-mAlb positive incidence and the U-TRF positive incidence between the two groups were analyzed. Results There were no statistical concernments in SCr, BUN, GLu, TCH, TG,HDL-C,and LDL-C between the two groups. The amplitude of variation in morning systolic pressure peak was higher in MBPS group than in non-MBPS group(P=0. 000). The obvious varieties in the Cys C, Hcy,and hs-CRP were higher in MBPS group than in non-MBPS group ( P=0. 000 ) . The U-mAlb positive incidence was higher in MBPS group than in non-MBPS group(χ2 =18. 014,P =0. 000). The U-TRF positive incidence was higher in MBPS group than in non-MBPS group(χ2 =19. 694,P=0. 000). Conclusion MBPS has a great effect on Cys C,U-mAlb,U-TRF,Hcy and hs-CRP. MBPS is apt to cause early lesion of rental function in elderly patients with dipper essential hypertension. And Hcy and hs-CRP can be used to diagnose the early renal insufficiency.

Objective To explore the potential association between HLA-DRB1 Alleles and systemic scleroderma (SSc) of the Zhuang Nationality in Guangxi region. Methods Polymerase chain reaction-special sequence primers (PCR-SSP) was used to study the HLA-DRB1 alleles in 58 patients with SSc and 50 healthy controls of the Zhuang Nationalty in Guangxi Province. Comparisons between groups were performed with χ2 test or exact probabilities. Results Sixteen HLA-DRB1 alleles were discovered from the specimens,including 14 in the SSc specimens, and 16 in the control specimens. Among them,the allele frequencies of HLA-DRB1 * 1301 (7.760%, OR=9.000, χ2=4.341, P=0.037), HLA-DRB1 * 1305 (11.207%, OR=3.322,χ2=4.206, P=0.040) and DRB1 * 15 (26.724%, OR=2.679, χ2=6.038, P=0.014) were significantly higher in SSc patients than those of the controls (respectively for 1.000%, 4.000%, 15.000%). Conclusion Our data suggest that the HLA-DRB1 * 1301, HLA-DRB1 * 1305 and HLA-DRB1 * 15 may be the susceptible genes of SSc in Zhuang nationality population.

Objective:To explore the correlation between hepatitis B virus (HBV) infection and deep infection after spinal internal fixation surgery and analysis of pathogenic bacteria.Methods:One hundred and eighty-four patients who underwent spinal internal fixation with HBV infection in Xiaogan First People′s Hospital of Hubei Province from January 2013 to January 2019 were selected as the HBV infection group, and 184 patients who underwent spinal internal fixation with non-HBV infection were selected as the non-HBV infection group. The incidence of deep infection and the distribution of pathogenic bacteria were compared between 2 groups. The influencing factors of postoperative deep infection and HBV reactivation in patients with HBV infection were analyzed by single factor analysis and multi-factor Logistics regression analysis.Results:The incidence of deep infection after spinal internal fixation surgery in HBV infection group was significantly higher than that in non-HBV infection group: 19.57% (36/184) vs. 9.24% (17/184), and there was statistical difference ( P<0.01). The pathogenic bacteria of deep infection in both groups were mainly acinetobacter bausinensis, klebsiella pneumoniae, staphylococcus aureus, staphylococcus epidermidis. There was no statistically significant difference in the distribution of pathogenic bacteria between 2 groups ( P>0.05). The deep infection incidences in age ≥ 65 years, operation time ≥ 3 h, intraoperative blood loss ≥ 1000 ml, CD 4+/CD 8+<1.4, total lymphocyte count<0.7 × 10 9/L, liver function abnormalities (AST>40 U/L or ALT>50 U/L), HBV-DNA (+) patients with HBV infection were significantly higher: 27.16%(22/81) vs. 13.59%(14/103), 28.77%(21/73) vs. 13.51%(15/111), 31.15%(19/61) vs. 13.82%(17/123), 29.69%(19/64) vs. 14.17%(17/120), 27.78% (20/72) vs. 14.29%(16/112), 7/18 vs. 17.47%(29/166), 30.43%(21/69) vs. 13.04%(15/115), and there were statistical differences ( P<0.05 or <0.01). Multivariate Logistic regression analysis showed that intraoperative blood loss (≥ 1 000 ml), CD 4+/CD 8+(<1.4), total lymphocyte count (<0.7 × 10 9/L), and HBV-DNA (+) were independent risk factors for deep infection after spinal internal fixation in patients with HBV infection ( P<0.01 or <0.05). The HBV reactivation incidence in age ≥ 65 years, operation time ≥ 3 h, intraoperative blood loss ≥ 1 000 ml, liver function abnormalities, HBV-DNA (+), postoperative deep infection patients with HBV infection were significantly increased: 33.33% (27/81) vs. 18.45% (19/103), 34.25% (25/73) vs. 18.92% (21/111), 34.43% (21/61) vs. 20.33% (25/123), 8/18 vs. 22.89% (38/166), 34.78% (24/69) vs. 19.13% (22/115), 41.67% (15/36) vs. 20.95% (31/148), and there were statistical differences ( P<0.05). Multivariate Logistic regression analysis showed that intraoperative blood loss (≥ 1 000 ml), HBV-DNA (+) and postoperative deep infection were independent risk factors for HBV reactivation after spinal internal fixation in patients with HBV infection ( P<0.05 or <0.01). Conclusions:HBV infection significantly increases the incidence of deep infection after spinal internal fixation surgery, and the independent risk factors are intraoperative blood loss (≥1 000 ml), CD 4+/CD 8+ (<1.4), total lymphocyte count (<0.7 × 10 9/L), and HBV-DNA (+). Spinal internal fixation surgery can cause HBV reactivation, and its independent risk factors are intraoperative blood loss (≥ 1 000 ml), HBV-DNA (+) and postoperative deep infection.

Objective To study the diagnosis and surgical treatment of primary sarcoma of liver in order to obtain a better understanding of this disease and to improve its clinical treatment.Methods The clinical data on the clinicopathological features,surgical treatments and prognosis of 17 patients with primary liver sarcoma who were treated from January 2001 to May 2016 were retrospectively analyzed.Results Of 17 patients with primary sarcoma of liver,elevation of preoperative serum AFP was detected in one patient (5.9％),HBsAg positivity in 3 patients (17.6％),elevation of CEA in 2 patients (11.8％) and abnormal liver function in 3 patients (17.6％).The main clinical symptoms included epigastric pain in 9 patients,epigastric distention in 7 patients,loss of appetite in 5 patients (including in one patient after resection of gastric carcinoma).Twelve of these 17 patients underwent resection (resection rate 64.7％).Five patients underwent laparotomy and biopsy.Among patients who were treated with surgical resection,10 patients had R0 resection and 2 patients had R1 resection.Postoperatively,5 of these patients underwent adjuvant selective hepatic arterial infusion chemotherapy (mitomycin + fluorouracil + epirubicin),and 4 patients were treated with adjuvant systemic chemotherapy (vincristin,cisplatin,cyclophosphamide and Doxorubicin).The postoperative 1,3 and 5-year overall survival rates for all the patients were 58.8％ (10/17),29.4％ (5/17) and 11.7％ (2/17),respectively.In patients with liver resection,the survival rates were 83.3％ (10/12),41.6％ (5/12) and 16.7％ (2/12),and for R0 resection,100.0％ (10/10),50.0％ (5/10) and 20.0％ (2/10),respectively.Condusions The diagnosis of primary sarcoma of liver was difficult before operation.High survival rate could be achieved by radical resection and adjuvant chemotherapy.

Background Laser peripheral iridoplasty (LPI) is widely used in the treatment of glaucoma by flattening the iris and widening angle of anterior chamber (AA).However,no evidence suggests the optimal site of LPI in iris.Objective This study was to compare the therapeutic effects of LPI at different sites of iris for glaucoma.Methods Glaucoma models were established in the right eyes of 40 healthy adult male pigment rabbits by intrachamber injection of 0.1 ml compound carbomer solution with 0.3％ carbomer and 0.025％ dexamethasone.The models were randomly divided into model control group,corneoscleral limbus group,one spot from corneoscleral limbus group and two spots from corneoscleral limbus group.LPI was performed at corresponding site of iris by 532 nm argon laser with the spot diameter 500 μm,energy 300 mW,exposure time 0.3 seconds and laser number 24 spots,and the rabbits in the model control group did not receive LPI.Intraocular pressure (IOP),coefficient of outflow facility (C value) were measured and calculated with Schi(o)tz tonometer before LPI and 2,4,7,14 and 30 days after LPI,and anterior chamber depth (ACD),AA,anterior chamber angle opening distance within 500 μm radius from scleral spur (AOD500) were measured with ultrasound biomicroscope (UBM).The eyeballs were extracted 30 days after LPI,and the chamber angle were observed under the optical microscope after hematoxylin and eosin staining.The use and care of the animals complied with the Guide for the Care and Use of Laboratory Animals of the National Institutes of Health.Results UBM showed that compared with the model control group,the anterior chamber angle was evidently widened in all the LPI groups,with the best effectiveness in the one spot from corneoscleral limbus group and the worst one in the two spots from corneoscleral limbus group.Compared with the model control group,the IOP was evidently reduced,and C values,AA and AOD500 were significantly increased in the corneoscleral limbus group,one spot from corneoscleral limbus group and two spots from corneoscleral limbus group after LPI,showing significant differences among the four groups (IOP:Fgroup =16.848,P ＜ 0.01;C value:Fgroup =9.629,P ＜ 0.01;AA:Fgroup =62.336,P＜0.01;AOD500:Fgroup =77.779,P ＜ 0.01).IOP was reduced and C value,AA and AOD500 were increased in 2,4,7,14 and 30 days after LPI as compared with before LPI,with significant differences over time (IOP:Ftime =3.041,P =0.011;C value:Ftime =4.311,P＜0.01;AA:Ftime =14.627,P＜0.01;AOD500:Ftime =20.378,P＜0.01).Compared with the model control group,the ACD was significantly increased in the corneoscleral limbus group and one spot from corneoscleral limbus group,and that in the two spots from corneoscleral limbus group was significantly reduced,and the ACD was insignificantly increased over time after LPI (Fgroup =18.017,P＜0.01;Ftime =0.022,P =1.000).Hematoxylin and eosin staining showed that the trabecular meshwork and adhesion of tissure were reopened and the anterior chamber angle was widened after LPI.Conclusions LPI can widen anterior chamber angle and lower the IOP.The best therapeutic outcome for glaucoma is displayed when LPI is performed at the iris site corresponding to one spot from the corneoscleral limbus.

Objective To investigate the clinical characteristics,surgical treatment and outcome for patients with duodenal stromal tumor.Methods Data of 40 patients with stromal tumor of duodenum were reviewed retrospectively.Results All patients received resection including local resection in 14 cases,segmental resection of the duodenum in 17 cases,and pancreaticoduodenectomy in 9 cases.38 cases were followed-up,and two were lost.The median follow-up was 59 months (range 3-240 mos).The 1,3,and 5-year overall survival rates were 92％,76％ and 68％,respectively.No recurrence was found in very-low-risk tumor (n =1) and low-risk turmors (n =4).The 1,3,and 5-year overall survival rates for intermediate-risk tumors were 95％,80％ and 70％,respectively;and those were 69 ％,31％,and 0 for high-risk tumors,respectively.14 of 33 cases (42％) suffered from recurrence after radical resection for intermediate or high-risk tumors.33 postoperative cases received treatment with Imatinib (Glivec) for more than one year,and one case developed recurrence at 2.5 years after operation.4 patients with synchronous liver metastasis received palliative resection and Imatinib,and two survived more than 1 year.Conclusion Surgery is the first choice for duodenal stromal tumor,and Imatinib should be administered for high-risk disease after surgery.

OBJECTIVETo analyze the relationship between the pathological features and 64-multislice spiral computed tomography (64-MSCT) findings of pulmonary nodules in autopsies from patients with coal workers' pneumoconiosis (CWP), to investigate the optimal imaging method for the distribution of pulmonary nodules, and to provide data for the establishment of CT diagnostic criteria for CWP.

METHODSCadaveric lung specimens were collected from 7 CWP patients. All of them were men, aged 42∼77 years (mean, 60.00±13.00 years), and their dust exposure time was 5∼30 years (mean, 15.4±8.01 years). The cadaveric lung specimens were treated by aeration, sectioning, and immobilization and were then examined by coronary 64-MSCT. The primitive images were reconstructed into the maximumintensity projection (MIP) images (slice thickness: 3 mm, 5 mm, and 8 mm). The sensitivities of imaging methods with different slice thickness were evaluated based on the pathology and anatomy of local pulmonary nodules, and the correlation between pathological results and radiological findings was analyzed.

RESULTSThere were significant differences between the stages determined by pathological examination and high-kV chest radiography (before death) (χ(2) = 4.667, P < 0.05; kappa value = 0.167, P < 0.05). A total of 271 nodules were found in all pathological sections, including peribronchovascular nodules (27, 9.9%), centrilobular nodules (67, 24.6%), interlobular nodules (65, 24.3%), nodules within 5 mm from the pleura (45, 16.5%), pleural plaque-like nodules on the lateral chest wall (45, 16.5%), and nodules on the interlobar pleura (22, 8.1%). The likelihood ratio was the highest (0.981) between 5-mm MIP images and pathological results according to the chi-square test.

CONCLUSIONThe stage of pulmonary nodules determined by pathological examination is significantly different from that determined by high-kV chest radiography. The 5-mm MIP images of 64-MSCT provide a good reflection of the local pathology and anatomy of pulmonary nodules in CWP patients.

Aged ; Anthracosis ; pathology ; Coal ; Coal Mining ; Dust ; Humans ; Lung ; pathology ; Male ; Middle Aged ; Pleural Diseases ; pathology ; Tomography, Spiral Computed

Paraneoplastic pemphigus is a rare autoimmune bullous dermatosis, which is caused by potential neoplasm, especially the Castleman's disease. Castleman's disease associated with paraneoplastic pemphigus is misdiagnosed frequently and easily in clinical practices. Furthermore, it is reported that the mortality rate for this disease is very high. Bronchiolitis obliterans is the most common complication and the most important cause of death. There was a female patient presenting recalcitrant mucocutaneous erosions, ulcers and scattered erythemas in the body. The patient was diagnosed and treated for pemphigus vulgaris with little success in Xiangya Hospital, Central South University in January 2015. Further investigations confirmed the diagnosis of paraneoplastic pemphigus with retroperitoneal tumor. Subsequently, the patient was treated with tumor resection in combination with intravenous immunoglobulin and corticosteroids. The pathology revealed that it was the Castleman's disease. Her mucocutaneous performance recovered obviously and the bronchiolitis obliteran did not appear in the follow-up. Castleman's disease associated with paraneoplastic pemphigus should be considered when mucosal and skin lesions showing no improvement under corticosteroids. Early and complete removal of the tumor together with immunotherapy could be beneficial to the patient's prognosis.
Adrenal Cortex Hormones ; therapeutic use ; Castleman Disease ; complications ; therapy ; Female ; Humans ; Immunoglobulins, Intravenous ; therapeutic use ; Paraneoplastic Syndromes ; complications ; therapy ; Pemphigus ; complications ; therapy ; Retroperitoneal Space ; pathology