Diabetic nephropathy is one of the microvascular complications of type 2 diabetes mellitus. Recently, the modern medical researches and treatments of diabetic nephropathy have some progress, but the treatment delaying the progress of renal function is still unknown. Many clinical practices showed that the traditional Chinese medicine on this disease was effective. Thus, this paper was to summarize the traditional Chinese medicine view of etiology and pathogenesis, clinical researches, experimental researches in order provide reference for clinical treatment.

The incidence and its growth rate of hypertension are both very high. Its pathology and pathogenesis are complex and unclear,and it does serious harm to human health. Hypertension remains incurable. Chemical medicine has good effect on hypertension,but life-long application and multi-drug combination are required,with significant adverse reactions. Also,complications can′t be effectively alleviated. Traditional Chinese medicine (TCM)guided by traditional theories,can lower blood pressure,improve metabolic abnormalities and reduce complications. Its advantages or potentials have not been fully exploited and clinical application is inadequate. Metabolic hypertension has become the main form of hypertension,and its formation mechanism is mainly related to metabolic abnormalities and insulin resistance,metabolic inflammation and other pathology and pathogenesis. A better understanding of the current status of antihypertensive pharmacology of TCM,especially devel?opment and application of metabolic hypertension models is of great significance for TCM treatment of hypertension,and for exploration of new approaches to hypertension.

Objective To explore the clinical significance of human papillomavirus L1 capsid protein detection in cervical exfoliated cells in high-risk HPV positive women. Methods From November 2012 to June 2013,386 high-risk HPV positive (detected by hybrid capture Ⅱ) cases were enrolled as eligible women from Huzhou Maternity&Child Care Hospital and Women′s Hospital,School of Medicine, Zhejiang University. All eligible women underwent liquid-based cytology (ThinPrep) followed by colposcopy. Biopsies were taken if indicated. Cervical exfoliated cells were collected for HPV L1 capsid protein detection by immunocytochemistry. Expression of HPV L1 capsid protein in groups with different histological diagnosis were compared, and the role of HPV L1 capsid protein detection in cervical exfoliated cells in cervical lesions screening was accessed. Results Total 386 enrolled eligible women were finally diagnosed histologically as follwed:162 normal cervix, 94 low-grade squamous intraepithelial lesion (LSIL), 128 high-grade squamous intraepithelial lesion (HSIL) and 2 squamous cervical cancer (SCC). The positive expression rate of HPV L1 in HSIL+(HSIL or worse) group was significantly lower than that in LSIL-(LSIL or better) group (19.2% vs 66.4%,P=0.000). While identifying HSIL+ in HPV positive cases and compared with cytology, HPV L1 detection resulted in significant higher sensitivity (80.77%vs 50.77%,P=0.000) and negative predictive value (NPV;87.18% vs 76.47%,P=0.004), significant lower specificity (66.41% vs 81.25%,P=0.000),and comparable positive predictive value (PPV;54.97% vs 57.89%, P=0.619). To identify HSIL+in HPV-positive/cytology-negative women, the sensitivity, specificity, PPV, and NPV of HPV L1 detection were 87.50%, 61.54%, 41.18%, and 94.12%respectively, while 80.00%, 86.36%, 80.00%and 86.36%respectively in HPV-positive/atypical squamous cell of undetermined significance(ASCUS)women. Conclusions HPV L1 capsid detection in cervical exfoliated cells have a role in cervical lesions screening in high-risk HPV positive women, and may be a promising triage for high-risk HPV-positive/cytology-negative or ASCUS women.

Kawasaki disease is generally diagnosed base on its clinical features. Sometimes unusual or atypical presentations make the diagnosis of Kawasaki disease difficult. We experienced an unusual case of Kawasaki disease presented with unilateral parotitis in a 23-month old girl. Despite of intravenous antibiotics treatment, fever and unilateral parotid swelling persisted. Skin rashes, conjunctival injections, and coronary abnormalities showed up on the 8th day of fever. After the intravenous immunoglobulin and salicylates treatment, all symptoms disappeared. Although unilateral parotitis is very unusual presentation of Kawasaki disease, in case of no response to antibiotics, Kawasaki disease should be included in the differential diagnosis.
Anti-Bacterial Agents ; Child* ; Diagnosis ; Diagnosis, Differential ; Exanthema ; Female ; Fever ; Humans ; Immunoglobulins ; Mucocutaneous Lymph Node Syndrome* ; Parotitis* ; Salicylates

Recently, traditional Chinese medicine (TCM) researches on diabetic peripheral neuropathy made great progress. It is found that theetiology and pathogenesis was the deficiency in origin and the ecessive in superficialty. The deficiencyincluded Yin deficiency, Qi deficiency, blood deficiency, deficiency of both Qi and Yin, Yang deficiency, while the ecessive in superficialty included blood stasis, stasis of phlegm and blood. Thus, the principles of treatment were supplementing Qi and nourishing Yin, warming Yang, promoting blood and removing blood stasis, and smooth Luo, all of which showed the characteristics of TCM treatment were combination of inside and outside, and multi-target effects. This paper reviewed the progress of clinical and experimental studies on the TCM for diabetic peripheral neuropathy.

Objective To establish the ranges of normal reference values of fetal brainstem-vermis angle (BVA)and brainstem-tentorium angle (BTA)in normal fetuses at different gestational weeks,and to evaluate their clinical values in the diagnosis of mega cisterna magna.Methods Totally 320 normal singleton fetuses between 1 8 and 40 weeks of gestation were enrolled in this study.Three-dimensional ultrasound (3DUS)with volume contrast imaging (VCI)was used to measure their BVA and BTA,the correlations of BVA and BTA with gestational age were analyzed.The BVA and BTA of 24 fetuses with mega cisterna magna were also measured and were compared with those of the normal fetuses.Results In these normal fetuses,the BVA and BTA showed no correlations with gestational age (r=-0.05,0.04,both P >0.05);the ranges of normal reference values of BVA and BTA were 2.23°-19.30°and 18.53°-48.13°, respectively.The BVA and BTA of 24 fetuses with mega cisterna magna were 4.23°-17.42°and 20.41°-40.89°,respectively,which were not significantly different from those of normal fetuses (t =-0.55,0.92, both P >0.05).Conclusions 3DUS with VCI is feasible for measuring the BVA and BTA of fetuses,and the measured values can be used as the reference standards for BVA and BTA measurement in China.

Objective To evaluate the effects of right ventricular pressure load on left ventricular ( LV) myocardial mechanics using speckle tracking technology ,and to detect the change of LV function in patients with pulmonary hypertension( PH) at a earlier stage ,in order to provide reference for early clinical intervention . Methods The study included 74 patients with PH and 40 healthy volunteers ,who had of similar age and sex distribution . According to the pulmonary artery systolic pressure ( PASP) ,patients with PH were divided into mild ,moderate and severe groups ,which were marked with A ,B ,C , respectively . All subjects underwent echocardiographic examination . Conventional echocardiographic parameters ,the systolic longitudinal ,radial and circumferential peak strain ( LS ,RS ,CS) in various segments of LV ,as well as basal and apical segment myocardial rotation angle peak and peak time were determined ,LV systolic global longitudinal ,radial and circumferential strain (GLS ,GRS ,GCS) ,free wall (LAT ,lateral wall+ posterior wall) and interventricular septum ( IVS ,anteroseptal+ posteroseptal) overall LS ,RS ,CS were calculated . Results ①LVejectionfraction(LVEF):groupA,B,Chadnosignificantreduction(P>0.05)thanthe control group . ②Overall LS ,RS ,CS of LAT of LV and IVS and GLS ,GRS ,GCS of LV :B ,C group were lower than the control group and group A and C were lower than group B ( P < 0 .05) . ③ The rotation angle in ventricular apical basal segments and segment :group B and C were lower than the control group and group A and C were lower than group B ( P <0 .05) . ④GLS ,GRS ,GCS and overall LS ,RS ,CS of LAT and IVS were similar between group A and the control group( P >0 .05) ,but LV base segment rotation of groupAwaslowerthanthatofthecontrolgroup(P<0.05).Conclusions ①Rightventricularpressure overload can lead to increased LV mechanical damage ,LV strain changes were earlier than the change of LVEF . ②LV strain with increased right ventricular pressure overload is gradually reduced . ③Compared with other strain parameters , LV basal segments rotation angle were able to detect changes of LV myocardiol mechanics in patients with PH more sensitively .

Objective To analyze the double contrast-enhanced ultrasonography (DCUS) features of periamupullary carcinoma for enhancing the ultrasound diagnostic value of the disease.Methods The DCUS and clinical data of 40 patients with periampullary carcinoma confirmed by histopathology were reviewed.Results (1) The displaying rate of the lesions and the judgment of lesion location was statistically higher on DCUS than that of ordinary ultrasound (P ＜ 0.05).(2) DCUS features of periampullary carcinoma:the size of most lesions was less than 30 mm except for 1 case in which no lesion was found; In 100％ (39/39) of the lesions,the morphology did not change with duodenum movement ; In 64.1％ (25/39) of lesions hyperenhancement or isoenhancement was displayed in the arterial phase,with low enhancement in the venous phase; In 87.2％ (34/39) of lesions homogeneous enhancement was displayed; In 95％ (38/40) the bile ducts were moderately or severely dilated.The lesion locations and whether the lesions projected into the duodenal cavity or not were statistically different between the three different types of periampullary carcinoma (P ＜ 0.05).The lesions projected into the duodenal cavity of duodenum were more commonly seen in papillary carcinoma and ampullary carcinoma than distal common bile duct carcinoma.The lesion size,whether the lesion morphology changed or not with duodenum movement,enhancement level,enhancement homogeneity,the degree of bile duct dilatation,whether there was pancreatic duct dilatation or not were not statistically different between the three different types of periampullay carcinoma (P ＞ 0.05).Conclusions DCUS is an effective way to show periampullay carcinoma,and is helpful to diagnose periampullary carcinoma and distinguish the three different types of periampullary carcinoma.

Objective To analyze the molecular cytogenetic abnormalities and pathogenesis of pediatric Burkitt lymphoma (BL) by array comparative genomic hybridization (aCGH).Methods First,immunophenotype,molecular genetics and EB virus (EBV) infection status were detected using immunohistochemistry and fluorescence in situ hybridization in 21 pediatric BL patients.Second,in addition to detecting genome-wide genetic gain/deletion status,aCGH results with EBV infection status were also correlated.Results aCGH results showed genetic alterations in 19 cases (90.5 ％).Generally,frequency of chromosomal gain was higher than chromosomal deletion.The regions of frequently-occurring small DNA genomic fragment gains (≥40 ％ cases) were 3q21.1,5p13.2,19q13.32,12q23.1,14q32.33,6q27,20p13 and 20p11.21.Large DNA fragment gains and deletions could be detected in 42.9 ％ (9/21) cases in the 14q24.2 and 14q32.33 regions.There was no significant difference in genetic alterations between EBV (+) and EBV (-) BL cases (P≥0.05).Conclusion aCGH results show that BL cases have complex genetic alterations,which have no significant difference between EBV(+) and EBV(-) cases.Most BL cases show large DNA segment deletion or acquisition of 14q,indicating that 14q gene alteration plays an important role in the pathogenesis of BL.

Objective To compare the diagnostic value of 3.0T and 1.5T magnetic resonance diffusion weighted imaging (DWI) in lymph node metastasis of gastric cancer. Methods Preoperative magnetic resonance examination was performed on 50 patients with gastric cancer by using Siemens 1.5T and 3.0T superconducting magnetic resonance imaging system, and the outcomes were compared with postoperative pathological results. The sensitivity, specificity and accuracy of the diagnosis in lymph node metastasis of gastric cancer were analyzed statistically. The apparent diffusion coefficient (ADC) values of lymph nodes were also evaluated for 1.5T and 3.0T magnetic resonance DWI. Results The sensitivity, specificity and accuracy of the diagnosis on lymph node metastasis of gastric cancer by 1.5T magnetic resonance DWI were 79.4 %, 81.4%and 80.0%, respectively, and the corresponding percentages of 3.0T magnetic resonance DWI were 84.6%, 79.7%and 83.1%. The accuracy rate of 3.0T magnetic resonance DWI was slightly higher than that of 1.5T in the diagnosis of lymph node metastasis of gastric cancer (χ2=5.451, P=0.020), but there were no significant differences in the sensitivity and specificity between the two groups (both P> 0.05). The accuracy rate of 1.5T magnetic resonance DWI in the diagnosis of lymph node metastasis of gastric cancer was less effective than that of the pathological diagnosis (χ2=7.410, P=0.007), but there was no significant difference between 3.0T magnetic resonance DWI and pathological diagnosis (χ2=2.450, P=0.120). The mean ADC values of metastatic and non-metastatic lymph nodes detected by 1.5T magnetic resonance DWI were (1.036 ±0.203) × 10-3 mm2/s and (1.476 ± 0.215) × 10-3 mm2/s (t= 6.813, P< 0.001), meanwhile, the corresponding values detected by 3.0T magnetic resonance DWI were (1.154 ± 0.183) × 10-3 mm2/s and (1.502 ± 0.264) × 10-3 mm2/s (t= 5.991, P< 0.001). The coincidence of the two methods for ADC value was favorable. Conclusions The diagnostic effect of 3.0T magnetic resonance DWI on lymph node metastasis of gastric cancer is better than that of 1.5T. ADC value provides a reliable imaging quantitative indicator for the determination of metastatic lymph nodes in gastric cancer, which plays a significant role in the clinical treatment options and prognosis of patients.