OBJECTIVE:Inhaled glucocorticoids(GC) are the first-line medicine for bronchial asthma during relieve phase, thereby this study was designed to explore if patient tends to suffer osteoporosis due to long term inhalation of glucocorticoids. DATA SOURCES:Literatures about GC and osteoporosis were computer-searched in Medline and Embase from January 1980 to December 2003, with the key word of " asthma, bone density, bone metabolism and inhaled glucocorticoids" and language limited to English.Meanwhile it was also computer-searched in CBM, CBM disc and manually searched in Chinese Journal of Clinical Rehabilitation between January 1990 and April 2004 with language limited to Chinese. DATA SELECTION: Literatures about the comparison of bone density and bone metabolic change between inhaled GC group and control group were consorted deleting randomized controlled trial(RCT) so as to look up the whole content of healthy controls;While patients in the treatment group received GC inhalation.Exclusive standards:obvious non-RCT. Quality assessment is mainly focused on the reality of data,the strictness of design and implementation,and the rationality of statistical management. DATA EXTRACTION:Totally 30 randomized and nonrandomized studies about the influence of inhaled GC on the bone density and bone metabolism of patients with asthma were referred to amongst which 18 studies were admitted with the other 12 excluded for similarity in content in 8 and Meta-analysis in 4. DATA SYNTHESIS:A total of 1 153 asthmatic patients in 18 studies were divided into GC inhalation group and non-inhalation control group for comparing the difference of bone density and/or bone metabolism between them. CONCLUSION:Although the results of studies on the influence of long-term inhaled GC on bone quantity were different, but there was still not enough evidence to demonstrate that osteoporosis was due to long-term GC inhalation.

Protein S deficiency is an autosomal dominant disorder that results from mutations in the protein S gene (PROS1). Inherited deficiency of protein S constitutes a risk factor for venous thromboembolism. Protein S functions as a nonenzymatic cofactor for activated protein C in the proteolytic degradation of coagulation factors V a and Villa. The frequency of protein S deficiency seems to differ between populations. More than 200 rare mutations in PROS1 have been identified in patients with protein S deficiency. Among the prevalent mutations within PROS1, the S460P substitution (known as Heerlen polymorphism) detected in Caucasians and the K196E substitution (known as protein S Tokushima) found in Japanese have been intensively studied for their structures and potential functions in the disorder of protein S deficiency. Until now, causative mutations in PROS1 have been found in only approximately 50% of cases with protein S deficiency. Co-segregation analysis of microsatellite haplotypes with protein S deficiency in families with protein S deficiency suggests that the causative defects in the PROS1 mutation-negative patients are located in or close to the PROS 1 gene. Large PROS 1 gene deletions have been identified in 3 out of 9 PROS 1 mutation-negative Swedish VTE families with protein S deficiency and 1 out of 6 PROS1 mutation-negative Japanese patients with protein S deficiency. Intensive sequencing of the entire PROS 1 gene, including introns, may be needed to identify the cryptic mutations in those patients, and these efforts might uncover the pathogenesis of protein S deficiency.

Objective To evaluate the efficacy and safety of dexmedetomidine aiding spinal -epidural anes-thesia for sedation.Methods Ninety ASAI -II female patients scheduled for elective spinal -epidural anesthesia were randomly divided into 3 groups(30 cases for each group)according to the digital table method.An epidural catheter was inseted at L2 -3 after satisfactory anesthesia,sedative drugs was intravenous.Group A received midazolam 0.05μg/kg initial loading dose for 10min and maintaining with 0.5μg·kg -1 ·h -1 .Group B received midazolam 0.06μg/kg for 5min and maintaining with 0.5mg·kg -1 ·h -1 .Group C received first intravenous injection of propo-fol 0.5 mg/kg,injection time 60s,maintaining with 0.3 -1.2mg·kg -1 ·h -1 .The infusion rate was adjusted to increase or decrease in order to maintain the desired level of sedation(Ramsay score of 3)during operation.The seda-tion efficacy and adverse reactions of three groups were compared.Results The onset time[(11.2 ±2.8)min]in group A was longer than that of group B[(6.4 ±2.4)min],group C[(5.0 ±2.1)min](t =7.12,9.70,all P <0.05).The offset time of group A,B[(12.3 ±2.4)min,(13.8 ±2.5 )min]were longer then those of group C [(7.4 ±2.3)min](t =8.36,7.95,all P <0.05).But 5 and 6 patients in the group B and C occurred hypoxia,and there were 8 and 9 patients developed partial airway obstruction due to relaxation of jaw muscle.At the time 30min, 60min and the end of surgery,the HR of the group A decreased deeply than the other two groups(t =5.02,4.92, 4.90,3.95,5.71,4.09,all P <0.05),10,5,6 patients were given atropine for increasing the HR in the group A,B and C respectively.Conclusion Dexmedetomidine is more safe and effective for the sedation of spinal -epidural an-esthesia,compared with midazolam and propofol,but with lower HR and longer onset time.

AIM: To investigate the effects of estrogen interference on ab dominal adipose accumulation in C7BL/6J mice. METHODS: Estrogen was administrated to the ovariectomized mice (estrogen-deprived model) and the changes of abdominal adipose weight of the mice in the normal estrous cycle and pro-menopausal were observed. Mice of 3 months old were randomly divided into c ontrol, ovariectomized (OVX), OVX+estrogen 15-days (E d 15 ) and OVX+ estrog en 60-days (E d 60 ) groups. Each group had 10 mice. Mice were raised and sa crificed until 7 months old after ovariectomized. 5 months and 10 months old mic e were divided into control, estrous cycle normal + estrogen 60 days, pro-menop ausal and pro-menopausal+60 days groups. 17?-estradiol time-release pellets ( 0.18 mg/pellet) were given ic in 15 days and 60 days before mice w ere sacrificed. RESULTS: The abdominal adipose weight in OVX gro up increased significantly (P 0.05 ). There was no difference in the abdominal adipo se weight between control and estrous cycle normal + estrogen 60-days groups, a nd between pro-menopausal and pro-menopausal+ estrogen 60-days groups. CONCLUSION: Ovariectomy significantly influences the metabolism of abd ominal adipose that causes adipose accumulation. Estrogen interference, especial ly long-term administration, can attenuate the abdominal adipose accumulation. Exogenous estrogen interference has no effect on abdominal adipose accumulation on cycle normal and pro-menopausal mice.

ABSTRACT • Abnormal liver function test with raised alanine aminotransferase (ALT) and raised aspartate aminotransferase (AST) are commonly seen in primary care setting. • Chronic alcohol consumption, drugs, non-alcoholic steatohepatitis (NASH) and chronic viral hepatitis are common causes associated with raised ALT and AST. • In chronic viral hepatitis, the elevation of liver enzyme may not correlate well with the degree of liver damage. • Non-hepatic causes of raised ALT and AST include polymyositis, acute muscles injury, acute myocardial infarction and hypothyroidism. • In the primary care setting, the doctor should obtain a complete history regarding the risk factors for viral hepatitis, substance abuse and request investigations accordingly. • Suspected chronic viral hepatitis and liver cirrhosis are best referred to hepatologist for further management.

Objective To investigate the impact of gantry angles on the position accuracy of buildin multi-leaf collimator (MLC) during static (step & shoot) intensity modulated radiotherapy (IMRT).Methods The position accuracy of MillenniumTM 60 pairs multi-leaf collimator (MLC) in Varian 23EX medical linear accelerator during 10 fractions of treatments with static intensity modulated radiotherapy (IMRT) was retrospectively analyzed by resolving dynamic therapy log files and MLC planning files.The single leaf position deviation and gap deviation of each MLC pairs were compared between expected values and actual outcomes.The impact of gantry angle on MLC position accuracy was also investigated with paired t-test between vertical and horizontal beams.Results All the MLC position deviations ranged within ± 1.0 mm,while the gap deviations were at the range of ± 1.5 mm.The statistical standard deviation of MLC position deviations among fractions was less than 0.06 mm.After all the 60 pairs of MLC leaves were taken into account,the M LC position deviation in the field of 103° was smaller than in the field of 0° (t =58.74,P ＜ 0.01),but there was no significant difference between 257° and 0°,while only the moving leaves were put into consideration,the MLC position deviation in the field of 103° was still smaller than in the field of 0°,but the MLC position deviation in the field of 257° was slightly higher than in thefield of 0° (t =41.95、-4.47,P ＜ 0.01).Conclusions The MillenniumTM 60 pairs MLC in Varian 23EX medical linear accelerator meets the mechanical quality assurance requirement during static IMRT treatments.The MLC positioning showed stable repeatability among treatment fractions.Although the MLC position accuracy is slightly affected by gravity from different gantry angles,but still meets the mechanical QA requirements for medical linear accelerator.This dynamic analysis method is expected to be a novel strategy which may improve the existing QA protocols.

Objective To study the changes of ventilatory function of young soldiers coming from different regions during cold - tol-erance training. Methods The recruited young soldiers were divided into 2 groups:Group Ⅰ (50 coming from the northern region)and group Ⅱ (50 coming from the southern region) . According to the new training outline of cold -tolerance in winter,their ventilatory func-tions were tested before training and 60 days after training. Ventilatory functions were compared between smoking and non - smoking sub-jects. Results 25% forced expiratory flow (FEF25%) , 50% forced expiratory flow (FEF50%) and 75% forced expiratory flow (FEF75 %) were significant different between two groups before the course of training (P < 0.05). After 60 days, ventilatory functions of two groups were improved significantly as compared with that before training (P <0.01 ,P <0.05). There was no significant difference in ventilatory between two groups after 60 days of training (P > 0.05). There was significant difference in partial small airway function be-tween smoking and non - smoking subjects. Conclusion Cold air could decline the small airway function of soldiers coming from south-ern region before training. Cold -tolerance training has significant influence on soldiers' ventilatory function. Long- term and heavy smok-ing could decline the small airway function.

Objective To investigate the value of 18F-FDG SUVmax in gastric cancer diagnosis with coincidence imaging.Methods The coincidence imaging was performed in 92 patients with gastric diseases (60 males,32 females,age 65 (32-85) years; 78 malignant cases,14 benign cases).The malignant cases included 3 remnant gastric cancers and 75 primary gastric cancers (staging: 4 of Tis,13 of T1,9 of T2,33 of T3,11 of T4 and 5 without surgery).The well-,moderately-and poorly-differentiated adenocarcinomas were 22,15 and 28,respectively.Images were analyzed retrospectively with visual method and 18F-FDG SUVmax,and the diagnostic results were compared with the histopathological findings.The ROC curve was used to analyze the SUVmax.The Pearson's correlation analysis was performed to evaluate the relationship between SUVmax and tumor size.The Wilcoxon rank sum test was applied to determine the difference of SUVmax between early and advanced gastric cancers.The Kruskal-Wallis test was used to analyze the difference of SUVmax in various types of differentiated adenocarcinoma.Results No matter visual method or SUVmax was used,the sensitivity,specificity and accuracy of coincidence imaging in diagnosis of gastric cancer were 64.1％(50/78),64.3％(9/14) and 64.1％(59/92),respectively.The AUC of SUVmax was 0.695 and the cut-off value was 0.700.SUVmax Was positively correlated with tumor size significantly(r=0.489,P＜0.001).There was statistically significant difference between SUVmax of Tis-1 and that of T2-4(0.676± 1.288 vs 3.851 ±3.764;Z=-3.754,P＜0.001).However,there was no statistically significant difference among SUVmax of various grades of differentiated adenocarcinoma(2.805±4.008,3.447±2.365,3.413± 3.737 ; x2 =2.459,P＞ 0.05).Conclusions SUVmax provides more information than visual method in assessing gastric cancer with 18F-FDG coincidence imaging.Appropriate cut-off value of SUV is necessary for improvement of the diagnostic efficiency.Relationships between SUV and pathological T stage,histopathological types and differentiation degree need further investigation.

Objective To study the efficacy and indications of percutaneous radiofrequency ablation (PRFA) for small primary liver cancer(SPLC). Methods The clinical data of 16 patients with SPLC treated by PRFA were analysed retrospectively. Results The diameter of tumor in all 16 patients were ≤3cm. After PEFA, AFP from postive returned to negative in 93.3% of patients; and BUS and CT showed the tumors shrinking with capsule formation. The 0.5,1,2-year survival rate were 93.8%,100%,100% respectively. Conclusions PRFA for SPLC has advantages such as minitrauma, safe and effective, especiolly suitable to the patients with contrainsications of operation, or the tumor locating to the deep position of liver, or around inferior vena cava, hepatic veins or hepatic porta etc.

BACKGROUND: Inhaled glucocorticoids(IGC) are powerful anti_inflammatory agents used in the treatment of asthma. But it is still uncertain whether long-term use of the IGC affects bone metabolism in asthmatic patients, especially women.OBJECTIVE: To investigate if the prolonged treatment with IGC to Chinese asthmatic woman has a detrimental effect on bone mass and metabolism.DESIGN: A matched controlled study based on the patients SETTING:Clinical Laboratory and the Department of Respiratory Medicine, First Affiliated Hospital, Nanjing Medical University.PARTICIPANTS: From February 1998 to February 2002, forty female Chinese patients with bronchial asthma, regularly followed up at our outpatient clinic, all in the Nanjing area, none of them having a history of chronic systemic GC use, agreed to take part in the study, were selected and divided into two groups: therapeutic group (IGC group): 20 asthmatic women, aged 18-63 years, 5 menopausals, received IGC therapy regularly for at least 5 months; Control group: 20 asthmatic women, aged 18-60 years, 5 menopausals, never received IGC received conventional bronchodilators . They were matched individually for sex, age and menopausal status.METHODS: Bone mineral density (BMD) at the lumbar spine (2-4),femoral neck, trochanter, ward's triangle and total body of femur were measured by dual energy X-ray absorptiometry, BMD were expressed as a absolute value and a T score considered as a SD from peak bone mass respectively. Meanwhile, BMD was also expressed as a percentage (%), which was defined by comparing the BMD absolute value of subjects and BMD normal value of isosexual age cohorts. Osteocalcin and some other markers of bone metabolism were measured by radio immunoassay in two groups.daily dose and accumulative total dose of IGC and BMD in the IGC group.RESULTS: There were no significant difference between two groups in BMD and T score (including the lumbar spine (2-4), femoral neck,trochanter, ward' s triangle and total body of femur) (P ＞ 0.05). There were also no significant correlation between daily dose of IGC and BMD of above 5 parts in the IGC group (r=-0.325 to -0.1102, P ＞ 0.05). But,there were significantly negative correlation between the accumulative total dose of IGC and BMD at lumbar spine2-4,femoral neck and ward's triangle(r=-0.495 ,-0.517,-0.531 ,P ＜ 0.05).There were no significant correlation between the accumulative total dose of IGC and T score of above 5 parts in the IGC group (r=0.443to 0.295 ,P ＞ 0.05). There was negative correlation between the age and the BMD at ward's triangle in the IGC group(r=-0.506,P ＜ 0.05). However ,BMD at 5 locus were not correlated with the age in control group (r=-0.079 to 0.326, P ＞ 0.05).Osteocalcin and some other markers of bone metabolism were no significant difference between two groups (P ＞ 0.05).CONCLUSION: The data suggests that there is no significant influence of IGC on bone mineral density and bone metabolism in asthmatic women,but if continuing exposures to high doses over many years,there may be a detrimental effect on bone mass and metabolism in women, especially elder or postmenopausal asthmatic women treated with IGC who may be more susceptible to any bone mineral loss caused by IGC.