Objective To explore the value of bone marrow and peripheral blood examination in non-Hodgkin lymphoma(NHL) at initial diagnosis.Methods Smears of bone marrow and peripheral blood from 103 cases of NHL were stained according to Wright. Paraffin-embedded sections of bone marrow and lymphadenopathy biopsy were stained according to H-Giemsa-E. Immunotyping of NHL was performed immunohistochemically.Results Bone marrow involvement (BMI) by NHL was found in 28 (27 2%) cases.In 8 of the 28 cases without superficial lymphadenopathy,the diagnosis of NHL was established through bone marrow and peripheral blood examination.Seven of the 28 cases in stage Ⅰ?Ⅱ?Ⅲ were confirmed to be in stage Ⅳ based on bone marrow examination. Lymphoma cells in bone marrow and peripheral blood varied in morphology,they were mainly of four patterns:blast type?polymorphic lymphocyte type?small lymphocyte type?histiocyte-like lymphocyte type.Patients with BMI were more likely to have cytopenias in peripheral blood and trilineage of bone marrow depressed than those without BMI.Patients without BMI had a stimulated phenomenon in bone marrow.Conclusion Examination of bone marrow and peripheral blood is important for diagnosis and staging of NHL,especially for the diagnosis of patients without histological evidence of lymph node.

Objective To evaluate advantages and safety of bipolar electrodes for the treatment of submucosal myoma of uterus.Methods Three hundred patients with submucous myoma of uterus were performed with bipolar electrodes under hysteroscope,including 212 cases of type 0 submucous myoma,54 cases of type ?,and 34 cases of type Ⅱ.Results Total volumes of uterine distention fluid used during operation were 500-2000 ml(mean,626 ml);operation time was 20-50 min(mean,25 min);intraoperative blood loss was 10-20 ml.Cardio-cerebral syndrome occurred in one case and was relieved by timely treatment.There was no operation discontinuation as a consequence of pain.The diameters of resected myomas were 3-5 cm,with an average of 3.8 cm.The postoperative diagnosis showed leiomyosarcoma in 1 case and was performed by radical hysterectomy resection combined with a pelvic lymphadenectomy at 10 day postoperatively.During the follow-up period of 1-24 months in 277 cases,40 cases(type I in 12 cases;type II in 28 cases) needed hysteroscope operation again.Conclusions Hysteroscopic resection for submucosal myoma of uterus with dipolar electrodes has advantages of safety,minimal invasion,quicker recovery,higher efficiency,so it is worthy of being recommended.

Objective To explore the clinical effects of hysteroscopy combined with mifepristone on the diagnosis and treatment of abortive remnants.Methods A total of 56 patients with abortive remnants,who had undergone uterine curettage after the abortion,were treated with mifepristone combined with hysteroscopy.Before hysteroscopy,mifepristone was taken orally at a dose of 100 mg daily(50 mg,Bid) for 7 days.After the surgery,those who still had remnants in the uterus were given mifepristone at the same dose for 14 days.Results No patient had complication during and after the hysteroscopy except for one,who had abortive remnants at the uterine horn,experienced blood loss of 200 ml.In 40 patients,the abortive remnants were removed completely by hysteroscopy.Two weeks after the surgery,laboratory examination of the patients showed normal blood ?-hCG,and B-ultrasonography revealed no space-occupying mass in the uterus.In the other 16 patients,remnants were detected in the uterine horns after the hysteroscopy,and mifepristone was prescribed.These patients received reexaminations 2 months after the operation,and no abnormal blood ?-hCG or remnants in the uterus was found.Among the 56 patients,33 were followed up for 1-6 months(mean,3 months).During the follow-up,their symptoms including vaginal bleeding or drainage,amenorrhea,and abdominal pain disappeared,and the menstruation became normal.Conclusions Hysteroscopy combined with mifepristone is an effective measure to diagnose and treat abortive remnants.

Objective To compare the efficacy of urinary type Ⅳ collagen( Ⅳ C), N-acetyl-β-D-glucosaminidase( NAG ), serum cystatin C ( CysC ), β2 microglobulin ( β2-MG ) in early diagnosis of diabetic nephropathy(DN) ,and to develop a multiple regression equation using above mentioned indices. Methods One hundred and eight cases of DM patients were enrolled in the study. All those DM patients were divided into two groups according to 24 hr urinary albumin excretion(UAE): non-DN group( UAE ＜30 mg/24 h)and DN group (UAE ≥30 mg/24 h). Receiver operating characteristics (ROC)curve was developed using urinary IVC, NAG,serum CysC and β2-MG,and the efficiency of the four indices for early diagnosis of diabetic nephropathy were assessed by area under the curve ROC (AUCROC). Furthermore, the regression equation of four indicators was developed. All statistical analyses were performed using SPSS 13.0. Results The levels of urine Ⅳ C, NAG,CysC,β2-MG,were(3.91±1.93)ng/ml, ( 12.20 ±3.46)U/L, ( 1.18 ±0.41 )mg/L , (2. 50 ±0. 74)mg/ml in the non-DN group, respectively; and ( 14.14 ± 11.17 ) ng/ml, ( 23.12 ± 13.57 ) U/L, ( 2.69 ± 1.69 ) mg/L and(5.21 ± 2.78)mg/ml in the DN group, respectively. There were significant differences in the comparison of the four indicators between the two groups ( Ps ＜ 0.01 ). AUCROC of Ⅳ C, NAG, CysC and β2-MG were 0. 747,0.732,0.764 and 0.823 respectively;which meant the diagnostic efficacy for DN decended from β2-MG, CysC,Ⅳ C, to NAG in order. All these indices showed significant efficiency in assisting diagnosis of early DN ( Ps ＜0.01 ). The regression equation of UAE and the four indices was: UAE = - 242.624 + 6.362IVC + 8.662NAG + 64. 622CysC + 29.488β2-MG, and the equation had statisticl significance( P ＜ 0.O1 ). Conclusion Urine Ⅳ C, NAG,serum CysC, and β2-MG showed significant value in assisting diagosis of early DN, and could be sensitive indices for DN.

Objective To study the clinical significance of urinary type Ⅳ collagen(IVC)and UmAlb/UCr ratio in the diagnosis of early diabetic nephropathy. Methods We collected 52 cases of diabetes(group A)without DN(UAE ＜30 mg/24 h),35 cases of diabetes(group B)with early DN(UAE as 30-300 mg/24 h),and 50 cases of healthy controls. The differences of urine IVC,UmAlb/UCr were compared among group A,B and the control group. ROC curve was used for evaluating the use of urine IVC and UmAlb/UCr in the diagnosis of early DN. The correlation of urine IVC and UmAlb/UCr with UAE were investigated,and linear model curve were established. IVC in urine was detected by chemiluminescence,UmAlb was detected by immunoturbidimetric assay,UCr was detected by enzymatic. Statistical analysis were performed with SPSS13.0 statistical software. Results The urine IVC testing of group A,B and the control group were(2. 64 ± 0. 91),(3.91 ± 1.93)and(10. 08 ± 6. 50)μg/L,respectively. The UmAlb/UCr(mg/mmol)testing of group A,B and the control group were(1.50 ± 0. 40),(2. 58 ±2. 10)and(17.95 ± 13. 38)mg/mmol,respectively. Urine IVC and UmAlb/UCr were significant difference between group A,B and the control group(Ps ＜ 0. 01);the ROC area under the curve(AUCROC)of urine IVC and UmAlb/UCr were 0. 724,0. 945,the two indicators for early diagnosis of DN were significant(Ps ＜ 0. 01);The pearson correlation coefficients of the urine IVC and UmAlb/UCr were 0. 529,0. 919 ,respectively. They were positive and significant correlation(Ps ＜ 0. 01),On the basis of the correlation coefficient and linear model fitting curve with the UAE,the relationship of UmAlb/UCr with the UAE was better than that of IVC. Conclusions Urine IVC and UmAlb/UCr ratio,which significantly assists diagnosis in diabetic nephropathy ,can be used as a sensitive diagnostic indicator of diabetic nephropathy. Moreover,the relationship of UmAlb/UCr with the UAE is better than that with IVC.

Objective To explore the sensitivity and specificity of colposcopy directed biopsy (CDB) and the value of loop electrosurgical excision procedure (LEEP) for the diagnosis and treatment of microinvasive cervical cancer (MCC). Methods One hundred and thirty five patients with MCC were diagnosed with LEEP in Obstetrics and Gynecology Hospital, Fudan University from April 2008 to November 2010, and were retrospectively analyzed on CDB diagnoses and following treatment after LEEP. According to patient′s desire for preservation of fertility and cone margin status, following strategies after LEEP included follow-up, second LEEP, hysterectomy, modified radical hysterectomy and radical hysterectomy. Single and multiple factors related to residual lesions after LEEP were analysed with Pearson Chi-square test and logistic regression model, respectively. Results CDB diagnosed MCC with a sensitivity of 4.4%(6/135), specificity of 100.0%(4 680/4 680), and false negative rate of 95.6%(129/135). Among the 135 patients, 29 did not receive further treatment in our hospital and lost contact. One hundred and six patients had secondary treatment or follow-up in our hospital, 4 of among which were closely followed up;one hundred and two received further treatment, which included 6 cases with second LEEP (3 received extrafascial hysterectomy after repeat LEEP), 59 cases hysterectomy, 14 cases modified radical hysterectomy and 26 cases radical hysterectomy. For factors related to residual lesions after LEEP, single factor analysis showed that the ratio of residual lesion in patients aged 27-39, 40-49 and 50-65 years were respectively 19.0%(11/58), 15.4%(10/65) and 5/12 (χ2=4.505, P=0.105). Residual lesions occurred in 24.7%(23/93) of patients with positive LEEP margins, which was more than that 7.1%(3/42) of patients with negative LEEP margins (χ2=5.756, P=0.016). The ratio of residual lesions in patients with positive endocervical, ectocervical and deep stromal margins were respectively 29.6%(8/27), 17.1%(7/41)and 30.6%(11/36;χ2=2.275, P=0.321). Residual lesions in patients with or without lymph vascular space invasion (LVSI) were 2/7 and 18.8%(24/128), respectively (χ2=0.412, P=0.521). The ratio of residual lesions in patients with invasion depth of<1 mm was 17.1%(7/41), 1-<3 mm was 19.0%(16/84), and 3-5 mm was 3/10, with no significant difference among three groups (χ2=0.870, P=0.647). Logistic regression analysis showed positive cone margin (OR=5.069, P=0.014) and age (OR=1.080, P=0.024) were the independent risk factors of residual lesions after LEEP conization. Conclusions CDB alone is not adequate for the diagnosis of MCC. For young patients who desire to preserve fertility with a negative cone margin, close follow-up is acceptable. Cone margin status and age are two independent risk factors for residual lesions after LEEP.

Objective To study the chest radiographic appearances of the non-tuberculous mycobacterial(NTM) pulmonary infection in patients with acquired immune deficiency syndrome (AIDS).Methods Ten patients with AIDS and NTM underwent chest X-ray radiography and 7 patients performed high-resolution CT (HRCT) scan. Chest radiographic features of NTM in patients with AIDS were retrospectively analyzed. Results The chest radiograph showed bilateral pulmonary involvement in 6 cases and single lung involvement in 4 cases (3 cases in the right, 1 case in the left). Patchy air space consolidation (6 cases), large consolidation (5 cases), cavitation (5 cases), small nodules (3 cases),military nodules (2 cases), linear opacity ( 1 cases) were demonstrated on radiography. On HRCT, air space consolidation (7 cases), small nodules (6 cases), large consolidation (5 cases) with cavitation and cylindric bronchiectasis after the absorption of consolidation, enlarged hilar and mediastinal lymph nodes (4 cases), ground-glass opacities (3 cases), military nodules and "tree-in-bud" sign (2 case), pleural effusion ( 1 case), pericardial effusion ( 1 case) and fibrotic band ( 1 case) were found. Conclusion The most common radiographic appearances of NTM in patients with AIDS are bilateral small nodules, large consolidation with cavitation and cylindric bronchiectasis, enlarged hilar and mediastinal lymph nodes.

Objective To manifest the imaging appearances of the pulmonary mucormycesis in patients with acquired immunodeficiency syndrome(AIDS).Methods The radiographic and hiish resolution computed lomography(HRCT)features of the pulmonary mucormycosis in 13 patients with AIDS were retrospectively analyzed.Results On radiography,the infiltrative lesions were found in 5 patients,7 cases had reticular pattem,4 cages had pleural effusion,4 cages had enlarged hilar and mediagtinal lymph nodes,3 cases had diffuse milliary lesions,3 Cages had masses,2 cases had ground-slags shadows,2 cages had cystic lesions,cavity,pleural thickening,pericardia]effusion and focal pneumothorax Wag presented in 1 cage respectively.On HRCT,7 cages had enlarged mediagtinal lymph nedes,7 cages had interlobular septal thickening,the infiltrative lesion were found in 6 patients,5 cages had diffuse milliary lesions,4 cages had pleural effusion,3 cases had inasses,2 cages had ground-glass shadows,2 cases had cystic lesions,cavity,pleural thickening,focal bronchiectagis,pericardial effusion and focal pneumothorax was presented in 1 case respectively.Conclusion The main imaging appearances of the pulmonary mucormycesis in patients with AIDS include diffuse milliary lesion,enlarged hilar and mediagtinal lymph node,interiobular septal thickening,infiltrative lesion,pleural effusion and mass.

OBJECTIVE:To investigate the effects of blood concentration monitoring of cylosporin A(CsA) in patients with nephrotic syndrome(NS)on efficacy and safety. METHODS:The medical records of 154 NS patients receiving CsA and blood concentration monitoring in nephrology department of China-Japan Friendship Hospital during Jan. 2014-Aug. 2017 were analyzed retrospectively. The results of blood concentration monitoring in 63 adult inpatients with refractory NS receiving CsA for the first time within 6 months of initial treatment were analyzed statistically. The relationship of blood concentration monitoring with efficacy and safety was analyzed. RESULTS:The blood concentration of CsA in 154 patients were monitored for 512 times with an average of 3.32 times/person,and average blood concentration was(125.98±105.13)ng/mL. The patients with blood concentration of CsA＜100 ng/mL accounted for 44.14%. There was no statistical significance in average monitoring times or average blood concentration between male and female,average blood concentration of CsA among different age groups (P＞0.05). The blood concentration was monitored for 237 times in 63 adult inpatients with refractory NS receiving CsA for the first time within 6 months of initial treatment(induction period). Average blood concentration of effective group were significantly higher than ineffective group;the proportion of effective group with blood concentration＜100 ng/mL was significantly lower than that of ineffective group,with statistical significance (P＜0.05). Among 63 patients,17 patients suffered from ADR (the incidence of ADR was 26.98%). The average blood concentrations of ADR patients were significantly higher than those without ADR;the monitoring times of ADR patients with blood concentration＞150 ng/mL was significantly higher than those without ADR,with statistical significance(P＜0.05). There was no statistical significance in the incidence of ADR between effective group and ineffective group (P＞0.05). Among effective group,there was no statistically significance in average blood concentration between ADR patients and patients without ADR(P＞0.05);the monitoring times of ADR patients with blood concentration＞150 ng/mL was significantly higher than patients without ADR,with statistical significance(P＜0.05). With the increase of monitoring times,the incidence of ADR decreased gradually. There was no statistical significance in the incidence of ADR among patients who were monitored for different times (P＞0.05). CONCLUSIONS:The pharmacokinetics of CsA varies in different patients and many factors affect its blood concentration. The changes of blood concentration affect the efficacy and safety of CsA. It is difficult to determine the dosage of CsA based on experience in the treatment of NS with CsA. Great importance should be attached to blood concentration monitoring of CsA and the implementation of individualized dosage regimen based monitoring results so as to improve therapeutic efficacy and reduce the occurrence of ADR.

BACKGROUND:Disruption of biological rhythms(circadian rhythms)is a typical problem associated with aging.Maintaining the normal function of biological rhythms may be a promising anti-aging strategy.Expression of nuclear factor erthroid 2-related factor 2(Nrf2)is biologically regulated.The glycogen synthase kinase 3(GSK3)system represents a"regulatory valve"that controls subtle oscillations in Nrf2 levels.Circadian changes in the transcript levels of antioxidant genes can influence the response of organisms to oxidative stress.However,the specific molecular mechanism of GSK3/Nrf2 in regulating organismal aging is still puzzling. OBJECTIVE:To search for the general pattern of GSK3/Nrf2-regulated biological rhythms in organismal aging by reviewing the literature in this field. METHODS:The bibliographic method was used to search,review and screen the relevant literature using the keywords of"glycogen synthase kinase 3,nuclear factor erthroid 2-related factor 2,biorhythms and aging"to lay a theoretical foundation for the analysis of the whole paper.Comparative analysis method,through reading and analyzing the obtained literature,was performed to compare the similarities and differences between the literature,thereby providing reasonable theoretical support for the argument.Further comparative analysis of the literature was conducted to clarify the relationship between the relevant indicators as well as the ideas for analysis throughout the text. RESULTS AND CONCLUSION:GSK3 can indirectly regulate Nrf2 expression through the regulation of rhythm genes.GSK3 and Nrf2 are components of anti-aging programs and are associated with biological rhythms.In addition,GSK3/Nrf2 is involved in several metabolic pathways,including those associated with age-related diseases(type 2 diabetes and cancer)and neurodegenerative diseases.