Objective To explore the clinical significance of serum concentrations of Cystatin C (CysC) in children with kidney disease in different disease courses. Methods The serum concentrations of CysC, creatinine(Cr) and endogenous creatinine clearance rate(Ccr) were determined in 182 children with kidney disease. They were divided into five study groups:normal renal function group (73 cases), compensatory renal disfunction group (44 cases), non-compensatory renal disfunction group (35 cases), renal failure group(22 cases) and end stage of renal failure group(8 cases). Meanwhile 70 healthy children were involved in control group. Relationships among CysC, Cr and Ccr were calculated and the diagnostic efficiency was assessed by comparing the areas under the ROC curves. Results The serum concentrations of CysC increased in different courses of renal function impairment in children and were significantly related to the severity of impairment. CysC was positively correlated to Cr and negatively correlated to Ccr. The areas under the ROC curves of Cr and CysC were 0.764 and 0.725. Conclusions The serum concentrations of CysC can accurately identify different impairment grades of renal function and the function of glomerular filtration. As an indicator of early reduction of renal function, its sensitivities and specificities are superior to Cr and Ccr. CysC can be a sensitive endogenous marker for glomerular filtration rate determination. With simple, convenient and applicable assays methods, CysC is essential for early diagnosis of children kidney diseases.

ObjectiveTo study the different clinical effects of using 5 kinds of hemostatic surgeries to manage the intractable postpartum hemorrhage and analyse the risk factors of failed hemostasis.Methods From Jan.2007 to Jul.2011,96 patients with intractable postpartum hemorrhage were studied retrospectively and grouped by the first step surgical treatment.The hemostatic surgeries included uterine tamponade (tamponadegroup ), pelvicbloodvessels ligation(ligationgroup), pelvical arterial embolization (embolization group), uterine compression sutures (sutures group)and uterine compression sutures combining tamponade (combined group).The intraoperative and postoperation datum were compared among groups,so dose the treatment outcomes.Multivariate analysis were used for failed hemostasis.Results( 1 ) The blood loss of 96 patients ranged from 1200 to 9100 ml,and 71 patients had a succeed hemoatasis after employing these surgeries and 25 failed.(2) The blood loss before hemostasis surgeries in tamponade group and embolization group was statisically greater than in sutures group ( P ＜ 0.05 ).Blood loss during the hemostasis surgeries in ligation group was statistically greater than in embolization and sutures groups ( P ＜0.05).The operating time of embolization group was statistically shorter than ligation group,sutures group and the combined group (P ＜ 0.05 ).(3) Fine of 96 patients had uterine atony and 43 had a successful hemostasis with the success rate about 78％.Forty-six had placenta previa and 39 success with success rate 85％.Thirty-three had placenta accrete and 13 of which succeed in hemostasis with success rate about 39％.In patients with uterine atony and placenta previa,the difference of hemostasis rate in groups had no statistically significant ( P ＞ 0.05 ).In patients with placenta accrete,the hemostasis rate in embolization group was higher than in others groups (P ＜ 0.01 ). (4) The multivariate analysis found that scar uterus,placenta accrete and coagulation defects were the risk factors of failed hemotasis.The OR value respectively was 2.9 (95 ％ CI:1.1 - 7.6 ),17.9 ( 95 ％ CI:5.6 - 56.3 ) and 16.2 ( 95 ％ CI:3.2 - 83.5 ).Embolization had some extent of protective effection ( OR =0.9,95 ％ CI:0.8 - 0.9 ).Conclusions ( 1 ) Five kinds of hemostatic surgeries were all effective.Though the success rate among groups did show statistical difference,pelvical arterial embolization has the comparative advantage of shorter operating time,less operating blood loss and higher success rate in placenta accrete.(2) Since scar uterus,placenta accrete and coagulation defects were the risk factors of failed hemostasis,sufficient preparation should be made for patients with these risk factors and the hemostatic surgeries should be choosed individually.

Objective To find out the bacterial species in the vagina of postpartum women and the possible influencing factors on colonization. Methods From Jun. 2007 to Oct. 2007, 560 postparmm women from 7 hospitals in China were enrolled. Questionnaire survey, gynecological examination and Nngent score of vaginal smear and microbial spectrum study of the vaginal flora were completed. Results (1 ) According to the Nngent score, 48 out of the 560 women were normal (8.6%), 337 at the borderline (60. 2% ) and 175 (31.2%) were complicated with bacterial vaginosis (BV). Among the 560 women, Bacterium lacticum were identified in 74 cases (13. 2% ), but not in the rest 486 cases (86. 8% ). Gardnerella and bacteroids were detected in 322 women (57. 5% ) and small flectobacillus in 214 women (38. 2% ) out of the 560 subjects. (2) Influencing factors on vaginal microflora: among the 266 women who had normal vaginal delivery, 23 (9. 4% ) showed normal vaginal microflora, 148 (55.6% ) at borderline and BV was diagnosed in 93 women (35.0%). The corresponding figures among the 294 women who underwent cesarean section were 23 (7. 8% ), 189 (64. 3% ) and 82(27.9% ), respectively. However, the incidence of BV had no statistical difference between these two groups (P = 0. 204). In the 233 women who received episiotomy, 22 (9. 4% ) showed normal vaginal microflora, 135 (57.9%) at borderline and 76 presented with BV (32. 6% ), the corresponding figures among the 327 women without episiotomy were 26 (8. 0% ), 202 (61.8%) and 99 (30. 2% ), respectively. The incidence of BV did not show any statistical difference between the above two groups (P = 0. 790 ). (3 ) Prenatal vaginitis were reported in 46 women, among which 5 (10.9%) with normal vaginal flora, 26 (56.5%) at borderline and 15 (32.6%) with BV, and again in the 514 women without prenatal vaginits, the above figures changed to 43 (8.4%) , 311 (60. 5% ) and 160 (31.1%). No significant difference was found in the incidence of BV between the two groups (P =0. 962). The rate of BV in women without sex, with sex occasionally and with sex frequently during pregnancy was 27.5% (78/284), 35.6% (96/270) and 1/6, respectively (P = O. 185), and the numbers in women who had breast-feeding, bottle feeding and mixed feeding were 31.0% (67/216), 39.3% (35/89) and 28.6% (73/255), respectively (P=0.573). Conclusions The amount of Lactobacillus in vagina of postpartum women is greatly reduced leading to dysbacteria. The incidence of BV is not affected by vaginal delivery, episiotomy, vaginitis, prenatal intercourse and the way of feeding, but is higher in postpartum women.

Objective To investigate the expressions of cellular proliferative antigen (Ki-67)and androgen receptor (AR)in triple-negative breast cancer (TNBC)and their relationships with recurrence. Methods Sixty-six cases of TNBC and two hundred and fifteen cases of non triple-negative breast cancer (NTNBC)tissues between January 2006 and December 2010 in Jiangmen Hospital Affiliated to Sun Yat-sen University were collected,the expressions of Ki-67 and AR were detected by immunohistochemical,and through follow-up the relationships between TNBC recurrence and the expressions of Ki-67 and AR were analyzed.SPSS 19.0 was used to analyze the results.Results The positive rate of Ki-67 in TNBC (75.76%,50 /66)was significantly higher than that in NTNBC (62.33%,134 /215,χ2 =4.031,P =0.045),and Ki-67 expression was correlated with histological grade (χ2 =6.031,P =0.049),tumor diameter (χ2 =6.630,P =0.036)and lymph node metastasis (χ2 =5.440,P =0.020).The positive rate of AR in TNBC (31.82%,21 /66)was significantly lower than that in NTNBC (76.28%,164 /215,χ2 =44.382,P <0.001),and AR expression was correlated with menopausal status (χ2 =5.341,P =0.021 )and body mass index (χ2 =4.369,P =0.037).TNBC recurrence was related to Ki-67 expression (χ2 =4.125,P =0.042),and was not related to AR expression (χ2 =1.257,P =0.262).Conclusion High expression level of Ki-67 and low expression level of AR are characteristics of TNBC.Ki-67 positive patients are more likely to relapse,and it can be used as an indicator to predict TNBC recurrence.

To investigate the effects of Xinji' erkang (XJEK), a compound Chinese herbal medicine, on isoproterenol-induced ventricular remodeling in mice.

OBJECTIVETo investigate the relationship between two polymorphisms immediately upstream of the cyclooxygenase 2 (COX2) gene and preeclampsia in a South West Han Chinese population.

METHODSBlood samples from 205 patients with preeclampsia and 276 normal pregnant women as controls from Han Chinese in Chengdu area were analyzed by polymerase chain reaction-restriction fragment length polymorphisms.

RESULTSG and A allele frequencies for -1195G>A site were 48.54% and 51.46% in the patient group, respectively, and 40.40% and 59.60% in the control group, respectively. G and C allele frequencies for -765G>C site were 94.15% and 5.85% in the case group, respectively, and 94.38% and 5.62% in the control group, respectively. The AA genotype and variant A allelic frequencies of the -1195G>A SNP were significantly lower in patients with preeclampsia than in the control group (P<0.05), and the odds ratio for the risk of preeclampsia was 0.665 (95% CI: 0.444-0.982) in women homozygous for the variant COX2 A allele ( x²=4.233, P=0.047). The genotype and allele frequencies of the -765G>C polymorphism in patients with preeclampsia and controls showed no significant differences (P>0.05). Additional subgroup analyses (mild vs severe preeclampsia) of the two polymorphisms failed to reveal significant correlation for either genotypic or allelic frequencies. Furthermore, there was no significant association between the polymorphisms and blood pressure levels in the patient or control groups.

CONCLUSIONCOX2 -1195A homozygosity is associated with a decreased risk for preeclampsia in a South West Han Chinese population. On the other hand, the -765G>C polymorphism has no effect.

Adult ; Alleles ; Blood Pressure ; Case-Control Studies ; China ; Cyclooxygenase 2 ; genetics ; Female ; Genetic Predisposition to Disease ; Humans ; Polymorphism, Single Nucleotide ; Pre-Eclampsia ; enzymology ; genetics ; physiopathology ; Pregnancy ; Risk Factors

OBJECTIVETo investigate the relationship between polymorphisms of the growth arrest specific 6 (GAS6) gene and severe preeclampsia in a South West Han Chinese population.

METHODSBlood samples from 167 patients with severe preeclampsia and 312 normal pregnant women as controls from Han Chinese in Chengdu area were analyzed by polymerase chain reaction-restriction fragment length polymorphisms.

RESULTSC and T allele frequencies for +1332C/T site were 85.63% and 14.37% in the patient group, respectively, and 78.04% and 21.96% in control group, respectively. The TT genotype and variant T allelic frequencies of the +1332C/T polymorphism were significantly lower in patients with severe preeclampsia than in the control group (both P<0.05), and the odds ratio for the risk of severe preeclampsia was 0.602 (95%CI: 0.401-0.904) in carriers for the variant T allele (χ=6.045, P=0.014). G and A allele frequencies for 834+7G/A site were 72.75% and 27.25% in case group, respectively, and 74.36% and 25.64% in control group, respectively. The genotype and allele frequencies of the 834+7G/A polymorphism in patients with severe preeclampsia and controls showed no significant differences (both P>0.05). In addition, there was no significant association between the polymorphisms and blood pressure levels in the patient or control groups.

CONCLUSIONThe variant GAS6+1332 T allele is associated with a decreased risk for severe preeclampsia in a South West Han Chinese population. On the other hand, the 834+7G/A polymorphism has no effect on the severe preeclampsia.

Adult ; Alleles ; Asian Continental Ancestry Group ; genetics ; China ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; ethnology ; genetics ; Genotype ; Humans ; Intercellular Signaling Peptides and Proteins ; genetics ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Pre-Eclampsia ; ethnology ; genetics ; pathology ; Pregnancy ; Risk Factors ; Severity of Illness Index ; Young Adult

Objective To evaluate the efficacy and safety of motherwort (herbs leonuri/leonurus heterophyllus sweet) injection for preventing postpartum hemorrhage after caesarian section. Methods The prospective study was designed as a randomized and single blind multi-center research matched with positive agent as controls from Apt 2007 to Aug 2007. 440 women underwent caesarian section (CS) indicated by obstetric factors were enrolled from 15 teaching hospitals in China and assigned into three groups: group of motherwort: 147 cases were administered by motherwort 40 rag uterine injection during CS and 20 mg intramuscular injection per 12 hours 3 times after CS; group of motherwort + oxytocin : 144 cases were administered by motherwort 40 mg and oxytocin 10 U uterine injection during CS and motherwort 20 mg intramuscular injection per 12 hours 3 times after CS and group of oxytocin: 149 cases were administered by oxytocin 10 U uterine injection and oxytocin 10 U + 5% glucose 500 nd intravenously injection during operation and oxytocin 10 U intramuscular injection per 12 hours 3 times after CS. The following clinical parameter were collected and analyzed: (1) The amount of blood loss during operation, at 2, 6, 12, 24, 48 hours after operation. (2) The total amount of blood loss in 24 hours after CS and the incidence of postpartum hemorrhage. (3) The change of level of hemoglobin (Hb) and counting of red blood cell ( RBC ) from prepartum to postpartum. (4) Adverse reaction. Results (1) The mean amount of blood loss during operation were (368±258) ml in group of motherwort, (255±114) mi in group of motherwort + oxytocinand (269±141 ) ml in group of oxytocin, which exhibited significant difference among three groups ( P<0.01 ). Meanwhile, no statistical different amount of blood loss among three groups were observed at 2,6,12, 24, 48 hours after CS. (2)The amount of blood loss of postpartum at 24 hours were (480±276)ml ingroup of motherwort, (361±179) ml in group of motherwort + oxytocin, (381±179) nd in group of oxytocin, which showed significant difference among 3 groups(P <0.01 ). (3) The incidence of postpartum hemorrhage were 32.0% (47/147) in group of motherwort, 11.1% (16/144) in group of motherwort + oxytocin, and 18.8% in (28/149) in group of oxytocin. When comparing the lowest rate of postpartum blood loss in group of motherwort + oxytocin and the highest rate in group of motherwort, it displayed statistical difference (P<0.01). (4) The decreased level of RBC and Hb were shown that RBC(0.3±0.5)×10<'12<‘/L and Hb(9±13)g/L in group of motherwort, RBC (0.2±0.4)×10<'12/L and Hb ( 6±10) g/Lin group of motherwort + oxytocin and RBC (0.2±0.4)×10<'12/L and Hb(7±30) g/L in group of oxytocinrespectively. However, the comparison of different value of RBC and lib in group of oxytocin and motherwort +oxytocin showed significant difference (P<0.05 ). (5) Two cases with allery reaction was observed.Conclusion It is safe and efficacious that combined use of motherwort injection and oxytocin was to preventpostpartum hemorrhage during or after caesarian section.

Objective To evaluate the safety and feasibility of endoscopic ultrasonography(EUS)-guided dehydrated ethanol lavage on treatment of pancreatic cystic neoplasms(PCN). Methods The data of 15 patients with PCN treated by EUS-guided dehydrated ethanol lavage in Nanjing Drum Tower Hospital from April 2014 to December 2016 were retrospectively analyzed. All the patients underwent EUS-guided fine needle aspiration, and then the cyst cavity was lavaged with dehydrated ethanol. The curative effects and complications were evaluated after the procedure. Results Each patient had one operation and all the operations were successful. No operation-related intraoperative or postoperative complications occurred. Patients were followed up for a median time of 15 months(range from 3-30 months).Twelve patients finished a long term follow-up,including 6 cases of complete remission and 6 cases of partly remission. None of the patients underwent surgical resection. Conclusion Dehydrated ethanol lavage is safe and feasible for treatment of PCN.

Objective To evaluate the potential malignancy, prognosis and risk factors for intraductal papillary mucinous neoplasm(IPMN), which were classified into different risk levels based on Fukuoka guideline. Methods A retrospective analysis of patients with IPMN diagnosed at Nanjing Drum Tower Hospital from 2009 to 2016 was conducted. Clinical characteristics,treatment and prognosis of IPMNs were analyzed. Results A total of 94 IPMN patients were included and divided into 3 groups according to Fukuoka guideline,46 patients in high-risk(HR)group,30 in group of worrisome features(WF), and 18 in low-risk(LR)group. For patients undergoing surgery treatment, there were 5 cases(19.2%,5/26)in HR group and 2 cases(12.5%,2/16)in WF group whose postoperative pathological findings were malignant (P=0.690). The 5-year survival rates after operations were 73.9% and 77.0% in HR and WF group, respectively(P=0.830). For patients without surgery treatment, in a 5-year follow-up, there were 6 cases (33.3%,6/18),2 cases(16.7%,2/12)and 0(0.0%,0/18)progressing into pancreatic cancers in HR, WF and LR groups,respectively(P<0.05). In addition,among the three groups,the 5-year survival rates were 49.5%,85.7% and 100.0%(P=0.025). Jaundice was significantly related to prognosis(P<0.01) and the hazard ratio was 8.883(95%CI:2.953-26.721). Conclusion Jaundice is a predictive risk factor for survival of IPMN. As for the treatment to IPMN, patients in HR group should receive surgery treatment while those in LR group can be followed up. For patients in WF group,the treatment should be customized, with evaluation of predictive risk factors,and operations can be performed when needed.