The bone turnover markers are composed of the metabolic products of bone matrix and bone cells.The changes of these markers in serum and/or urine represent the status of bone metabolism.To measure the level of these markers will offer important information for evaluating the diagnosis and the responses of therapy in metabolic bone diseases,and to predicat the risk of bone fracture.The biochemistry,measurement and clinical aplication will be introduced in this paper.

Objective To investigate the expression of adiponectin in placenta and its correlation with preeclampsia.Methods Placental tissues were collected from normal term pregnancies(normal pregnancy group,n=20),mild preeclampsia(mild preeclampsia group,n=12)and severe preeclampsia (severe preeclampsia group,n=22).The expression of adiponectin protein and the intensity of its mRNA in placenta were detected using immunohistochemistry and RT-PCR,respectively.Integral optical density (IOD)which represents the expression level of adiponectin protein,and the ratio of adiponectin cDNA PCR products to β-actin cDNA PCR products which represents the intensity of transcription of adiponectin mRNA in placenta were analyzed.Results (1)The expression of adiponectin protein was observed in cytoplasm of placental cytotrophoblasts and syncytiotrophoblasts among three groups.There was no significant difference in adiponectin protein expression between maternal side and fetal side of placenta in three groups(all P＞0.05);(2)The expression of adiponectin protein in placenta in severe preeclampsia group(30 984 ±14 604)was significantly lower than that of mild preeclampsia group(58 360±8910,P＜0.01)and of normal pregnancy group(53 246±17 554,P＜0.01).There was also no significant difference in the expression of adiponeclln protein in placenta between term delivery and preterm delivery in severe preeclampsia group(38 890±20 386 vs 29 319±8997,P＞0.05),however,the expression of adiponectin protein in placenta in term delivery of severe preeclampsia group was significantly lower than that ofterm delivery of normlal pregnancy group(38 890±20 386 vs 53 246±17 554,P＜0.05);(3)The expression of adiponectin mRNA was detected in placental tissues among three groups also.The intensity of transcription of adiponectin in placenta in severe preeclampsia group(1.0±0.2)was markedly lower than that of mild preeclampsia group(2.9±0.8,P＜0.05)and normal pregnancy group(3.3±1.1,P=0.000).Conclusion The expression of adiponectin decreases in placenta tissues of severe preeclampsia,indicating that the abnormal expression of adiponectin may be involved in the pathogenesis of preeclampsia.

Objective To assess the histological characteristics of cervical cancer using intravoxel incoherent motion magnetic resonance imaging ( IVIMMRI) and to investigate the performance of IVIMMRI in evaluation of the efficacy of concurrent chemoradiotherapy in the treatment of intermediate/advanced cervical cancer. Methods Pelvic MRI scans, containing T2WI, IVIM (14 b values, b=0?1 000 s/mm2), and contrast?enhanced T1 scans were performed in 23 patients pathologically diagnosed with intermediate/advanced cervical cancer ( stage ≥Ⅱb ) before chemoradiotherapy, after two and four weeks of treatment, and at the end of treatment. The IVIMMRI data were processed with the bi?exponential model to generate three parameters, containing pure diffusion coefficient ( D ) , pseudodiffusion coefficient ( D?) , and perfusion fraction ( f ) . Apparent diffusion coefficient ( ADC ) was obtained using the mono?exponential model. The IVIMMRI parameters were measured at each time point and their dynamics and correlation were analyzed. Results The ADC, D, and f values were significantly higher after complete treatment ( 0?96 × 10-3 vs. 1?77 × 10-3 mm2/s, P=0?000;0?76 × 10-3 vs. 1.34± 0?12 × 10-3 mm2/s, P=0?000;0?14% vs. 0?24%, P=0?012). The above three values significantly increased after two weeks of treatment (all P=0?000) and kept increasing until the end of the treatment. In contrast, the D? value was reduced from the second week to the end of the treatment. Conclusions IVIMMRI can monitor the dynamic functional changes and early tumor responses during chemoradiotherapy for cervical cancer, which holds promise for clinical application.

Objective To analyze the pathogen distribution and drug‐resistance characteristics in the patients with lung cancer complicating non‐fermentative bacteria lung infection to provide the basis for clinicians to prevent infection and rationally use anti‐bacterial drugs .Methods The clinically submitted respiratory tract specimens in the patients with lung cancer in our hospital from January 2009 to July 2015 were retrospectively analyzed .The isolated pathogenic bacteria were identified by adopting the France Bio‐plum‐Egyptian company Vitek2‐Compact identification instrument ,the drug sensitivity test was conducted by using the K‐B disk diffusion method .The statistical analysis of data was performed by adopting the WHONET 5 .6 software .Results 176 strains of non‐fermentative bacteria mainly came from sputum ,accounting for 80 .1% ,the detection rate of Pseudomonas aeruginosa was highest ,accounting for 48 .2% ,followed by Acinetobacter baumannii and Stenotrophomonas maltophilia ,accounting for 32 .4% and 16 .5% respectively ;the drug susceptibility test results showed that non‐fermentative bacteria had different degrees of resistance to antibacterial drugs or even multiple drug resistance ,in which the resistance of Pseudomonas aeruginosa to amikacin ,tobramycin and cefoperazone/sulbactam ,the resistance of Acinetobacter baumannii to amikacin ,cefoperazone/sulbactam and the resistance of Stenotrophomonas maltophilia to minocycline ,cotrimoxazole and cefoperazone/sulbactam were less than 30 .0% ,which to other an‐tibacterial drugs were more than 30 .0% .Conclusion Non‐fermentative bacteria are common pathogenic bacteria in hospital infec‐tion ,non‐fermentative bacteria isolated from the patients with lung cancer complicating pulmonary infection have serious resistance to commonly used antibacterial drugs ,therefore clinic should strengthen the monitoring of pathogenic bacteria and drug resistance . Cefoperazone/sulbactam is the first choice for treating these bacterial infections .

Objective To elucidate the clinical and pathological characteristics of patients with mercury poisoning-associated glomerulonephropathy. Methods Seven patients with mercury poisoning-associated glomerulonephropathy were enrolled in this study. The pattern of mercury exposure, feature of mercury toxicity, and clinicopathological presentation of the kidneys were investigated. Results They were all female, averaged (28.9 ±8.1) years old. Skin-whitening cream was the only cause of mercury poisoning. Proteinuria occurred 5 to 8 months after exposure. Serum mercury were 27.0 to 98.0 μg/L, and spot urinary mercury were 34.4 to 204.0 μg/L. The presentation of all the patients was mild to moderate edema with proteinuria and decreased serum albumin level. Five patients (5/7) were diagnosed as nephrotic syndrome. Six patients underwent renal biopsy: 3 cases with minimal change disease, 2 cases with membranous nephropathy and 1 case with focal segmental glomerular sclerosis. All the patients were administrated chelation therapy with sodium dimercaptopropanal sulfonate or sodium dimercaptosuccinic acid for 3 to 7 courses. They got complete remission by 3 to 5 weeks treatment. Conclusions Patients in this study with glomerulonephropathy induced by mercury poisoning are all from skin-whitening cream exposure. Mild to moderate edema and proteinuria are the common clinical pattern. Minimal change disease, membranous nephropathy and focal segmental glomerular sclerosis are found pathologically. Chelation therapy is effective.

Objective To evaluate the role of nuclear factor erythroid 2-related factor 2 (Nrf2)/ antioxidant response element (ARE) signaling pathway in reduction of myocardial ischemia-reperfusion (I/R) injury by ischemic preconditioning in the rats.Methods Healthy male Sprague-Dawley rats,weighing 250-300 g,aged 4-6 months,were used in the study.Their hearts were excised,and retrogradely perfused with K-H solution at 37 ℃ in a Langendorff apparatus.Forty isolated hearts were randomly divided into 4 groups (n=10 each) using a random number table:control group (group C),I/R group,ischemic preconditioning group (group IPC),and ischemic preconditioning +Nrf2/ARE signaling pathway blocker luteolin group (group IPC+L).After 20 min of equilibration,the hearts were continuously perfused for 100 min in group C.After 20 min of equilibration,the hearts were subjected to 40 min ischemia at 32 ℃ followed by 60 min of reperfusion in group I/R.In group IPC,ischemic preconditioning was induced by 6 cycles of 10 s ischemia followed by 10 s reperfusion starting from the time point immediately after 20 min of equilibration,and then the hearts were subjected to 40 min ischemia at 32 ℃ followed by 58 min of reperfusion.In group IPC+L,after 20 min of equilibration,the hearts were perfused with K-H solution containing lueolin 50 μmol/L for 3 min before ischemia,and the other treatments were similar to those previously described in group IPC.Left ventricular developed pressure (LVDP),left ventricular end-diastolic pressure (LVDEP),heart rate (HR),and the maximum rate of increase of left ventricular pressure (+dp/dtmax) were recorded at the end of equilibration and reperfusion.At the end of reperfusion,left ventricular myocardial tissues were obtained for examination of the ultrastructure of myocardial cells and for determination of the expression of Nrf2,heme oxygenase-1 (HO-1),quinone oxidoreductase 1 (NQO1),and superoxide dismutase 1 (SOD1) mRNA and protein (by real-time polymerase chain reaction and Western blot,respectively).Results Compared with group C,the HR,+ dp/dtmax and LVDP were significantly decreased,and LVEDP was significantly increased at the end of reperfusion in I/R and IPC+L groups,and the expression of Nrf2,HO-1,NQO1 and SOD1 mRNA and protein was significantly up-regulated in I/R,IPC and IPC+L groups (P＜0.05).Compared with group I/R,the HR,+dp/dtmax and LVDP were significantly increased,and LVEDP was significantly decreased at the end of reperfusion,the expression of Nrf2,HO-1,NQO1 and SOD1 mRNA and protein was significantly up-regulated (P＜0.05),and the pathological changes were significantly attenuated in group IPC,and no significant change was found in the parameters mentioned above in group IPC+L (P＞0.05).Compared with group IPC,the HR,+dp/dt and LVDP were significantly decreased,and LVEDP was significantly increased at the end of reperfusion,and the expression of HO-1,NQO1,SOD1 mRNA and protein was significantly down-regulated (P＜ 0.05),no significant change was found in Nrf2 mRNA and protein expression (P＞0.05),and the pathological changes were significantly aggravated in group IPC + L.Conclusion Ischemic preconditioning reduces myocardial I/R injury through activating Nrf2/ARE signaling pathway in the rats.

Objective:To explore the clinical characteristics, diagnosis and treatment of acute leukemia patients during pregnancy.Methods:The clinical data of 16 cases with acute leukemia during pregnancy from January 2009 to December 2018 in the First Affiliated Hospital of USTC were retrospectively analyzed. The diagnosis and treatment regimens, pregnancy outcome, the early fetus and survival status of patients were also analyzed.Results:All 16 leukemia cases were confirmedly diagnosed and classified by bone marrow puncture, including 13 cases of acute myeloid leukemia (5 cases of non-acute promyelocytic leukemia and 8 cases of acute promyelocytic leukemia) and 3 cases of acute lymphoblastic leukemia. At the time of confirmed diagnosis, 6 patients were in first trimester, 6 cases in second trimester and 4 cases in late trimester. As for pregnancy outcome, 1 patient had natural birthing, 5 patients underwent cesarean operation, 9 patients underwent artificial abortion and 1 patient had spontaneous abortion. Chemotherapy was performed in 15 patients during pregnancy, 11 patients received chemotherapy for treatment of primary disease after pregnancy, 3 patients died during the treatment. During the follow-up of 13 cases, 8 patients survived and 5 patients lost follow-up.Conclusions:Early diagnosis of acute leukemia during pregnancy is very important. Bone marrow puncture should be performed timely to make clear diagnosis when blood routine result is abnormal during antenatal care. Multidisciplinary consultation should be initiated in time, and the best treatment plan should be worked out to guard against serious complications during pregnancy.

AIM:Early calcification of atherosclerotic plaques are colocalized with macrophage and high mobility group box 1 (HMGB1), a cytokine associated with biomineralizing process under physiological and pathological conditions .Our study aims to evaluate whether HMGB1 induces ectopic mineralization via promoting the secretion of matrix vesicles ( MVs) from macrophages .METHODS:HMGB1 was added to the medium of macrophages , the secretion of MVs in the supernatant was tested by flow cytometry analysis .The mineral deposition in calcifying medium was detected by Alizarin Red staining and von Kossa staining .Transmission electron microscopy showed the formation of hydroxyapatite crystals in MVs .Then we subcutaneous injection into mice with MVs to induce regional minera-lization.RESULTS:HMGB1 significantly promoted secretion of MVs from macrophages as raveled by flow cytometry analysis .TNAP activity, considered as a marker of MVs maturation , was higher in HMGB1-induced MVs compared to the control-MVs.HMGB1-MVs also led to mineral deposition in an in vitro MVs-collagen mineralization model .Subcutaneous injection into mice with MVs derived from HMGB1-treated cells showed a greater potential to initiate regional mineralization .Mechanistic experiments revealed that HMGB 1 activated neutral sphingomyelinase 2 ( nSMase2 ) that involved the receptor for advanced glycation end products ( RAGE ) and p38 MAPK (upstream of nSMase2).Inhibition of nSMase2 with GW4869 or p38 MAPK with SB-239063 prevented MVs secretion and min-eral deposition .CONCLUSIONS: HMGB1 induces MVs secretion from macrophages at least in part , via the RAGE/p38 MAPK/nSMase2 signaling pathway .Our findings thus reveal a novel mechanism by which HMGB 1 may participated in the early calcification of atherosclerotic plaques .

Objective To evaluate the relation between lung dosimetric parameters and the risk of symptomatic radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC) who had re-ceived postoperative radiotherapy. Methods From November 2002 to March 2006, 90 patients with NSCLC who had received postoperative 3-dimentinal conformal radiotherapy (3DCRT) were retrospectively analyzed, including 53 with stage ⅢA disease, 25 with stafe ⅢB disease and 12 with stage Ⅰ-Ⅱ disease but positive margins. Seventy (78%) patients underwent lobectomy, 20 ( 22% ) underwent pneumonectomy, and 38 ( 46% ) received adjuvant chemotherapy. The median radiation dose was 60 Gy given in 30 fractions of 2 Gy using 6 MV X-ray. The percentage of the whole lung volume ( Vx ) and the ipsilateral absolute lung volume ( Vipsi-dosewhich received more than a certain dose were calculated. The endpoint was grade 2 and above RP based on CTC AE 3.0. The relation between the dosimetric factors and RP was also analyzed with receiver operating characteristic (ROC) curves. Results Nine patients ( 10% ) developed symptomatic RP ( grade 2 in 7 and grade 3 in 2), and all of them were in the lobectomy group. No RP was observed in patients who received pneumonectomy. Both V30 and V35 were higher in patients with RP than those without ( 19% vs 14% ,U= -2.16,P=0.030, and 15% vs 11%,U= -2.65,P =0.007, respectively). The area under curve in receiver operating characteristic curves based on the relation between incidence of RP and the value of Vipsi-dose was 0. 757. Using Vipsi-30 of 340 cm3 as a cut-off to predict RP, the sensitivity and specificity were 88% and 70%, respectively. The incidence of RP was 3% in patients with Vipsi-30< 340 cm3 compared with 29% in those with Vipsi-30>340cm3 ( X2 = 9.75 , P = 0.003 ) . Conclusions More than340 cm3 of the ipsilateral lung receiving 30 Gy is significantly related to the risk of RP in patients undergoing lobectomy. It is safe for patients who undergo pneumonectomy to receive postoperative 3DCRT if lung V20 is less than 10%.

Objective To analyze the rule of lymph node metastasis in thoracic esophageal carcinoma,and to study the proper radiation target. Methods From September 1986 to December 1997,549 patients with esophageal carcinoma who had undergone radical reseetion were divided into surgery alone group (S,275 patients) or surgery plus radiotherapy group( S + R,274 patients). Radiotherapy was begun 3 to 4 weeks after operation. The radiation target included beth supra-clavicular areas and the entire mediastinum. The total dose was 50 Gy in 25 fractions over 5 weeks for the supra-clavicular areas and 60 Gy in 30 fractions over 6 weeks for the entire mediastinum. Results The 5-year overall survival of patients with lymph node metastasis in one anatomic site and two anatomic sites was 31.5% and 13.9% (P=0.013), respectively. For patients with > 2 positive nodes metastasis receiving surgery alone, the corresponding 5-year survival was 24.8% and 4.9% (P=0.046) ,respectively. The median number of dissected lymph nodes of the upper-,middle-and lower-segment esophageal carcinoma was 13,17 and 20, respectively. The rate of metastatic lymph node in the para-esophagus region was the highest(61.5%-64.9%) ,which was not different among the different primary sites(P=0.922). The anastomotic stoma recurrence rate of the upper-segment esophageal carcinoma was higher than that of the middle- or lower-segment carcinomas(16.7% ,3.1% ,and 7.7%, χ2=9.02,P<0.05). Conclusions For the thoracic esophageal carcinoma,the number of anatomic sites of lymph node metastasis is an important factor affecting the survival. The lower rate of lymph node metastasis of the upper segment esophageal carcinoma may be corrected with the less lymph node dissected. The rate of lymph node metastasis in para-esophageal region is not related with the lesion segment. The anastemotie stoma is an important radiotherapy target for upper segment esophageal carcinoma.