Objective To investigate the clinical diagnosis and treatment strategies for retroperitoneal paragangliomas and to enhance the diag?nostic and therapeutic levels of retroperitoneal paragangliomas. Methods The clinical data of 49 patients having retroperitoneal paragangliomas were retrospectively analyzed. We studied 21 males and 28 females between an age range 17 and 72 years(mean 45.6 years). Hypertension was observed in 19 patients,9 patients suffered from lumbago or abdominal pain,and an abdominal mass was noted in 2 cases. Physical examination re?vealed paragangliomas in 17 patients. The positive rate of localization was 77.5%(31/40),96.0%(47/49),and 100%(10/10)using B?ultra?sound,computed tomography,and MRI respectively. Serum catecholamines were measured in 19 patients,of which 16 cases(84.2%)showed ele?vated levels. Results In our study,49 patients underwent open surgery,5 patients showed multiple tumors,and 56 tumors were found during sur?gery. The most common tumor location was periaortic and pericaval(71.4%,40/56). There were 51 cases of surgery in 49 patients. 54 tumors of 49 cases were totally resected. The tumors measured 1.5?20.0 cm in diameter with a mean diameter 6.7 cm. 75%tumors had integral pelos,14.2%(8/56)invaded the surrounding organs and vessels,and 10.7%(6/56)required resection of adjacent organs. We followed up 43 patients between 6 and 138 months after surgery. Postsurgical recurrence was noted in 4 patients,and 2 patients developed metastases. One patient died from metas?tasis during the follow?up period. Conclusion Surgical resection might be the most effective method for treatment of retroperitoneal paraganglio?mas. Sufficient preoperative and perioperative management might be the key point of successful surgery. Lifelong follow?up is important as recur?rent tumors need resection.

CYP2D6 is one of the cytochrome P450 isozymes which are involved in the metabolism of various drugs with wide use. Polymorphism at the CYP2D6 locus is one of the most widely known causes for pharmacogenetic variability in humans beings. This review focuses on the importance of CYP2D6 polymorphism in the metabolism of tamoxifen, relationships between the genetic polymorphism and prognosis of patients who have underwent endocrine therapy, and evidences indicating that CYP2D6 may be used as a predictive marker for choosing optimal endocrine therapy for patients with breast cancer.

Objective To investigate the distribution and drug resistance of major pathogens for urinary tract infections in the First Affiliated Hospital of Nanjing Medical University.Methods Strains from midstream urine culture of patients with urinary tract infections were collected during January 1 and December 31,2011.All strains were identified by API system,and disk diffusion method was used for drug sensitivity test.Results Totally 1129 strains were isolated,in which 667 (59.1％ ) were Gram-negative strains,266 (23.5％) were Gram-positive strains,and 196 (17.4) were Candida.Among Gram-negative strains,Escherichia coli,Klebsiella pneumoniae and Proteus mirabilis were highly sensitive to carbapenem antibiotics; while Acinetobacter baumannii and Pseudomonas aeruginosa were highly resistant to most antibiotics including cephalosporins and penicillinase inhibitor,and the resistance rates were over 50％.Among Gram-positive strains,the major strains Enterococcus avium and Enterococcusfaecalis were completely sensitive to vancomycin and teicoplanin,and highly sensitive to linezolid (resistance rate below 10％ ).Candida albicans and Candida glabrata were highly resistant to voriconazole and fluconazole (with the resistance rates of 47.2％ - 60.0％ ), but were completely sensitive to amphotericin and nystatin.Conclusion Gram-negative strains account for most urinary tract infections in the First Affiliated Hospital of Nanjing Medical University with high drug resistance rates.

Objective To develop the method for simultaneous identification and quantification of morphine,6-monoactylmorphine,codeine,heroin,ketamine,3,4-Methylenedioxyamphetamine (MDA),3,4-methylenedioxymethamphetamine (MDMA),amphetamine and methylamphetamine in human plasma.Methods UPLC-MS/MS was adopted to analyze plasma with protein precipitated using 10％ trichloroacetic acid.Plasma samples were separated on ACQUITY UPLC HSS C18 column with aqueous solution (0.01％ formic acid)-methanol (0.01％ formic acid) as the mobile phase,and at a flow rate of 0.3 mL·min-1.The multiple reaction monitoring (MRM) mode was performed combined with the positive ion mode for quantification in four sections.Results The retention time,the characteristic fragment ions,and the relative abundance ratio of the molecular ion peak could be used to identify these nine compounds sensitively.The liner calibration curve of morphine,codeine,heroin,ketamine,6-monoacetylmorphine,MDA,MDMA,amphetamine and methamphetamine were obtained in the concentration range of 5.00×10-3～5.00 (r=0.9934),1.00× 10-2～ 10.00 (r=0.9905),1.00× 10-2～ 10.00 (r=0.9929),2.50× 10-3 ～2.50 (r=0.9960),5.00× 10-3 ～ 5.00 (r=0.9925),5.00× 10-4 ～ 5.00 (r=0.9910),5.00× 10-4 ～ 5.00 (r=0.9924),5.00× 10-4 ～ 5.00 (r=0.9920) and 5.00×10-4～5.00 μg·mL-1 (r=0.9900) respectively.The lowest detection limit was 1.00,1.00,1.00,0.50,0.50,0.10,0.10,0.10 and 0.10 ng· mL-1 respectively.The relative standard deviation (RSD) of the inter-day and intra-day were less than 18％.The relative recovery was more than 60％,and the RSD were less than 15％.Conclusion The method is accurate,sensitive and suitable for identification and quantification of 9 drugs of opiates,ketamine and amphetamines in human plasma.

Objective To compare the effect of water-infusion colonoscopy and conventional air-infusion colonoscopy on the bowel cleanliness during withdrawing.Methods A single blind randomized controlled trial was conducted. 222 patients were randomly divided into water-infusion group (group A, 112 cases) and air-infusion group (group B, 110 cases). The cleanliness scores, scores improvement, pain scores, time of reaching cecum, depth of colonoscopy, rate of whole colon examination, adenoma detection rate (ADR), operator’s dififculty and complications were compared between the two groups.Results The cleanliness score during withdrawing was higher in group A [M(8)/IQR(1) vs M(8)/IQR(2),P = 0.000], the improvement was higher in group A [(0.53 ± 0.74) vs (0.23 ± 0.55), P = 0.000], the abdominal pain score was signiifcantly lower in group A [M(2)/IQR(1) vs M(4)/IQR(2),P = 0.000] and the ADR was higher in group A (36.61 % vs 23.64 %,P = 0.041). The operator’s dififculty evaluation score was signiifcantly lower in group A [M(1)/IQR(1) vs M(2)/IQR(1),P = 0.005]. There were no signiifcant differences at the time of reaching cecum, the depth of colonoscopy and the whole colon examination rate between the two groups.Conclusion Water-infusion colonoscopy could signiifcantly improve the bowel cleanliness during withdrawing scope, improve the ADR and reduce abdominal pain of patients, without increasing the time to reach cecum.

Objective To investigate therapeutic effects of phlorizin on the early stage of diabetic retinopathy(DR)in diabetic db/db mice.Methods The 24 db/db male mice were divided into 3 groups of phlorizin-treated diabetic group(20mg/kg of phlorizin by intragastric gavage)(DMT,n =8),diabetic group(normal saline solution by intragastric gavage)(DM,n=8),with C57BLKS/J db/ m mice as the control group(CC,n=8)for ten weeks.After ten weeks,all mice were sacrificed and the retina was isolated.The specimen was embedded in paraffin wax and sliced.The sections were dyed with Sudan red and observed for retinal morphological change.Meanwhile,the expressions of GSK-3β and phospho-GSK-3β in retinas were determined by western blot.Results During the study,the CC group showed good condition.The DM group featured with polydipsia,polyphagia and a rapid increase of body weight.Phlorizin-treated diabetic mice displayed much better than the DM group.Compared with CC group,DM group showed cells proliferation in capillary endothelia and obvious thickening in basement membrane.After administration of phlorizin,the vascular lesion of central regions was remarkably improved.The expression level of phospho-GSK-3β protein was lower in DM group than in control group(76.2±15.8 vs.255.4 ± 10.7,t =16.30,P＜0.01)and was higher in Phlorizin-treated DM group(188.5±18.4)than in DM group(76.2± 15.8,t=8.05,P＜0.01).Conclusions Phlorizin decreases phospho-GSK-3β3expression in retina in db/db diabetic mice and suppresses the GSK-3βactivity,which leads to the protection of DR.

Objective To quantifying the urine human cytomegalovirus(HCMV)DNA from the HCMV infection infants and its corresponding liver function indications,and investigate the relationship between their concentrations.Methods The u-rine samples were collected from HCMV infection infants.HCMV DNA was measured by fluorescence quantitative polymer-ase chain reaction (FQ-PCR).Serum ALT,AST,ALP,GGT,T-Bil and D-Bil liver function indications were detected and the positive rate was analyzed,simultaneously.The correlation between the logarithm urine HCMV DNA (log HCMV DNA) concentration and ALT,AST,ALP,GGT,T-Bil and D-Bil were analyzed by Spearman correlation analysis.Results The dis-tribution range ofurine log HCMV DNA in 444 HCMV infection infants was <2.70~7.90;the positive rate of serum ALT, AST,ALP,GGT,T-Bil and D-Bil were 24.8%,59.0%,95.7%,31.1%,16.7% and 16.3%,respectively.The urine log HC-MV DNA was associated with GGT and the correlation coefficient was 0.099 (P < 0.05),but no associated with ALT, AST,ALP,T-Bil and D-Bil.Conclusion The positive rate of liver function indications will rise in HCMV infection infants, the urine log HCMV DNA was associated with GGT,but not associated with other liver function indications.

Objective To observe the correlation between 1-hour postload plasma glucose and carotid intima-media thickness (IMT) in elderly male patients with hypertension.Methods One hundred and twenty six elderly male patients with hypertension were enrolled and divided into four groups: normal glucose tolerance with normal 1 h plasma glucose (1 hPG) group (low-NGT, n=42); normal glucose tolerance with high lh plasma glucose group (high-NGT, n=23);impaired glucose tolerance group (IGT, n=27) and diabetic group (n=84). The differences of blood pressure, blood glucose, blood lipid and intimia-media thickness among groups were analyzed.Results OGTT 1 hPG in high-NGT group was similar with IGT group[(12.0±1.1)mmol/L vs. (11.1±1.8)mrnol/L, P>0. 053 ,but significantly higher than that in Iow-NGT group ((12.0±1.1)mmol/L vs. (9. 1±1.4) mmol/L, P<0.01]. The value of IMT was gradually increased in four groups (P<0.05) and it was (1.02±0. 12) mm in high-NGT group. OGTT 1 hPG was the independent risk factor for IMT(P< 0.01).Conclusions OC-TT 1h plasma glucose is associated with atherosclerosis in elderly male hypertensive people.

Objective To establish a proper internal quality control(QC) system for the automated hematology analyzer accord‐ing to the corresponding stipulation by ISO15189 :2012 .Methods The high ,normal and low levels of controls offered by the instru‐ment were used to detect 22 items in whole blood cells routine analysis ,draw the Levey‐Jennings chart ,analyze and evaluate the quality control data for each month or each batch .Results A proper QC system was established ,including quality goals setting , new QC target value and standard deviation calculating and the QC rules choosing .In setting the target value for new batch of con‐trol ,MCV ,HCT and MCHC should adopt the mean values of at least 20 values ,while other items could adopt the mean values of 10 values ;the difference of CV values for some items existed in different QC levels ,different brands or different instruments in the same brand .Therefore ,the quality goals and standard deviation for new batch should be set according to different levels and differ‐ent instruments .Due to the QC characteristics and existence of QC chart drift phenomenon ,therefore MCV ,HCT and MCHC should adopt the 13 s and 22 s rules .For the other items ,the 13 s ,22 s and 10x rules were adoted .Conclusion Under the corresponding stipulations of ISO15189 and by combining with the laboratory practical situation ,a set of applicable internal quality control system is established .

Objective To explore the influence of the clinical pathway to control on hospital stay and medical expenses of pediatric rotavirus enteritis.Methods 245 infants with IRE were randomly assigned into two groups,109 in research group,136 in control group.All were treated with conventional therapy,for research group with clinical pathway.136 patients with previous medical routine therapy patients in the control group were compared.Compared two sets of average day in hospital,cure rate and cost,expenses for medicine and checking expenses proportion.Results The results shwed that the observation group of children's average hospital stay was lower than the control group,the cure rate higher than that in the control group,each time of total cost,expenses for medicine,each day medicine reducing( P ＜ 0.05 ).Checking expenses proportion was increased ( P ＜ 0.05),as to therapeutic effect,there was significant difference between two groups( P ＜ 0.05 ).Both expenses of drug ratio and ratio of the average daily expenses of drug are reduced.Conclusion Clinical pathway is applied in pediatric rotavirus enteritis can improve recovery rate,reduce hospitalization time and lower hospitalization fees and expenses,charges,medicine and inspection charge proportion.And can improve health education effect and patient satisfaction.