Mast cells and monocyte-macrophage cells share similar phenotypic characteristics.In recent years, it has been found that mast cell plays a role in the many pathophysiological processes such as the chronic inflammation, angiogenesis, and tissue remodeling and progressive fibrosis.More and more evidences showed that mast cells played a catalytic role in the renal chronic inflam-mation and progressive fibrosis and were related to the development and prognosis in patients with chronic kidney disease( CKD) .This paper will review the pathogenesis of renal injury induced by mast cells, especially in promoting the renal fibrosis in order to provide some new ideas for treatment and prognosis evaluation of CKD patients.

Objective Summarize the clinical nursing keys and experiences for tranplantation of leg island flap. Methods Follow- up 111 patients with transplantation of leg island flap. Results There were 109 patients had accepted survival of island flap, their function of wounded limb were recoveried satisfactory by one- year follow up. There were 2 amputation patients because of disturbance of blood circulation of distal wounded limb. Conclusions Careful perioperative nursing and observation are the keys of survival for tranplantation of leg island flap. Proper rehabilitaiton education can guarantee the satisfactory prognosis.

Objective To analyze the influence factors of long-term efficacy of different fusion combined with pedicle fixation for lumbar spondylolysis.Methods The surgical and postoperative follow-up data of 196 cases with lumbar spondylolysis were analyzed retrospectively.Age,gender,body mass index ( BMI ),disease course,preoperative Japanese orthopaedic association (JOA) score,fusion segments,fusion method,immediate postoperative recovery rate and postoperative functional exercise,which might affectlong-term operation efficacy,were selected to undergo single-factor analysis and multivariate regression analysis.Results All the patients were followed up for 5-9 years and 5.4 years for average,163 cases got excellent or good curative effect,the rate of excellent and good effect was 83.2％( 163/196);33 cases got poor efficacy.There was no cerebrospinal membrane tear,cerebrospinal fluid leakage,infection,fracture fixation and other complications happened after operation.Single-factor analysis showed that disease course,BMI,preoperative JOA score and postoperative functional exercise had obvious relation with long-term efficacy (P ＜ 0.05 ) ;while age,fusion method,fusion segments,immediate postoperative recovery rate and gender had no significant relation with long-term efficacy (P ＞ 0.05).Multivariate regression analysis showed that disease course,preoperative JOA score,postoperative functional exercise were important factors influencing long-term efficacy (OR =1.423,2.089,1.320,P=0.023,0.012,0.034).Conclusions Disease course,preoperative JOA score,postoperative functional exercise are important factors influencing long-term efficacy of surgery for patients with lumbar spondylolysis.

Objective To evaluate the clinical efficacy and safety of integrated traditional Chinese and Western medicine in treating active rheumatoid arthritis (aRA).Methods A prospective randomized controlled study was carried out. Totally 148 aRA patients were divided into the control group and the treatment group, 74 cases in each group. Control group was treated with MTX (methotrexate) and LEF (leflunomide), while the treatment group took traditional Chinese medicine based on syndrome differentiation, on the basis of treatment with MTX and LEF. The therapeutic course for all was 3 months. Efficacy indexes, like clinical symptoms and signs, ESR, TCM syndrome integrals, DAS 28 score, and safety indexes were observed.Results This study finally completed 136 cases, including 69 cases in the treatment group and 67 cases in the control group. In the two groups, significant improvement of clinical signs and symptoms, ESR, DAS28, and TCM syndrome integrals after treatment were shown, with statistical significance (P<0.01). Better effects were obtained in the treatment group in lessening tender joint numbers and swollen joint numbers, DAS28, and TCM syndrome integrals (P<0.01). The total effective rate of the TCM syndrome efficacy was 86.96% (60/69) in the treatment group, and 76.12% (51/67) in the control group, without statistical significance (P>0.05). The significant efficiency of the treatment group was 11.59% (8/69), and the control group was 5.97% (4/67), with statistical significance (P<0.05). Adverse reactions occurred fewer in the treatment group than in the control group (P<0.01).Conclusion Compared with single traditional Chinese medicine, integrated traditional Chinese and Western medicine for treating aRA can better improve DAS28 and TCM syndrome integrals, and reduce the incidence of adverse reactions.

Objective To observe the change of peripheral blood CD34+ cell level in patients with acute cerebral infarction, and explore its relationships with cerebrovascular risk factors,neurological function and carotid artery intima-media thickness (IMT). Methods The 45 patients with acute cerebral infarction (onset within 72 h) (infarction group) and 27 patients with cerebr ovascular risk factors but without cerebral infarction (high-risk group) were chosen for the study. The cerebrovascular disease risk factors including history of alcohol abuse, smoking, coronary heart disease, hypertension, diabetes, abnormal levels of serum triglycerides, total cholesterol,low-density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C) were recorded in all subjects. The peripheral blood CD34+ cell levels were measured by flow cytometry.The correlations of peripheral blood CD34+ cell level with cerebrovascular disease risk factors were analyzed. The neurological function and carotid artery IMT were recorded in infarction group, and the correlations of peripheral blood CD34+ cell level with neurological function and carotid artery IMT were analyzed. Results (1) The peripheral blood CD34+ cell level was significantly negatively correlated with coronary heart disease, hypertension, diabetes and LDL-C level (r =- 0. 749,-0. 717, - 0. 688, - 0. 764, all P＜0. 01) ; (2) Multiple linear regression analysis showed that peripheral blood CD34+ cell level was an independent relative factor of acute cerebral infarction (P＜0.05); (3) The peripheral blood CD34+ cell level was lower in infarction group than in high-risk group, and was significantly negatively correlated with neurological deficit score (r=-0. 721, P＜0.01) and carotid artery IMT (r= -0. 695, P＜0. 01). Conclusions Peripheral blood CD34+ cell level could be an independent relative factor of acute cerebral infarction; The peripheral blood CD34+ cell level is significantly negatively correlated with neurological function and carotid artery IMT in patients with acute cerebral infarction; And it can be used as cytological marker which reflect early vascular endothelial function in patients with ischemic stroke.

Objective To compare the dosimetric differences of fixed field intensity-modulated radiation therapy(IMRT),volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) for nasopharyngeal carcinoma (NPC) patients.Methods Eighteen NPC patients previously treated with VMAT were retrospectively included and re-planned using HT and IMRT (7 fields) techniques utilizing the same dose prescription and optimization objectives.The following parameters were compared across the three types of plans:homogeneity index (HI),conformity index (CI),maximum dose (Dmax) and mean dose (Dmean) of targets ; the Dmax and Dmean of organs at risk (OARs) ; the doses and volumes of volume of interest; the treatment delivery time and monitor units (MU).Results Clinically acceptable target coverage could be achieved by IMRT,VMAT and HT plans.The HT plans were the best yet IMRT plans were the worst in HI and CI of targets.IMRT imposed highest doses to OARs while HT deposited least doses to the spinal cord,brainstem and parotid.However,the VMAT plans displayed the lowest doses on optic nerves,chiasma and lens while highest doses were found in IMRT plans.The average delivery time per fraction of IMRT (8.0±0.5) min were more than that of HT (7.4 ±0.9) min and VMAT (3.9 ±0.1) min plans.The MUs of IMRT plans (711.4 ±78.7) were larger than that of VMAT plans (596.4 ±33.7).Conclusions Three types of plans can all achieve the clinical dosimetric demands,but HT has the best performance on CI and HI.VMAT is most efficient regarding the delivery time and total MUs.

Objective Our purpose was to evaluate the teaching satisfaction of clinical epi-demiology among medical postgraduate and to come up with measures for further improvement of teaching quality. Methods A self-administered questionnalre was given to all the medical postgradu-ates and doctoral students of Grade 2013 by cluster sampling when they finished the course of clinical epidemiology. A total of 559 graduate students, including 324 graduate students (58%), 235 doctoral students (42%), recruitment graduate students 350 (62.6%), on-the-job graduate student 209 (37.4%).The contents of the questionnalre included many aspects such as the investigation object in general, teaching materials evaluation satisfaction, curriculum and teacher satisfaction evaluation. Respondents ' self-administered manner was adopted. Parallel input was done by using Epidata software; data were analyzed with SPSS 19.0 software, continuous variable was made by x±s, categorical variables was expressed by n(%). Continuous variables were compared among groups by t test and analysis of vari-ance. Classification grouping variable was compared by chi-square test, and P<0.05 for the difference was statistically significant . Results Overall evaluation of theory was below that of the internship teaching materials. The satisfaction rate of practicability, meeting the learning needs and difficulty degree for theory and practice teaching material were 83.7% (468/559), 87.5% (489/559), 67.1% (375/559) and 92.7%(518/559), 89.6%(501/559), 83.0%(464/559) respectively. 41.6%(87/209) of on-the-job students and 36.7% (119/324) of postgraduates considered theory teaching material was difficult for them. The satisfaction rate for faculty teaching attitude (99.5%, 556/559), faculty teaching method (98.6%,551/559), the theories combining with practice teaching method (97.5%, 545/559) were high, but the satisfaction rate for teaching hours was low (67.4%, 377/559), with one third students consider more hours for the course. Conclusion The Teaching effect of clinical epidemiology is falrly good in our school. The postgraduates are satisfied with the teaching materials, curriculum setting, and teach-ing faculty. But there are also some shortcomings. In the future teaching work, we should appropriately increase the hours, and set corresponding teaching contents and methods according to the different learning characteristics of the on-the-job graduate students and recruitment graduate students, to improve the teaching effect and teaching quality.

Objective To observe the effect of Qi-strengthening and blood-activating Chinese patent medicine Qigui Ershen Granules on the carotid intima-media thickness(IMT ) , atheromatous plaque scores, serum fibroblast growth factor 23 (FGF23) and Klotho protein levels, and oxidation- and inflammation-associated indicators in carotid atherosclerosis patients. Methods Fifty-two carotid atherosclerosis patients were randomized into Chinese medicine group and western medicine group, 26 cases in each group. Chinese medicine group was treated with Qigui Ershen Granules orally, and western medicine group was treated with Atorvastatin Calcium Tablets orally. The mediation for the two groups lasted for 24 continuous weeks. Carotid ultrasonography was performed before and after treatment for the examination of carotid IMT and plaque Crouse scores. Double antibody sandwich enzyme-linked immunosorbent assay(ELISA) was applied for the detection of serum Klotho, FGF23, interleukin 1(IL-1) and tumor necrosis factorα(TNF-α) levels, and radio-immuno-precitation method was used for the assay of serum reactive oxygen species (ROS), malondialdehyde (MDA) and superoxide dismutase (SOD) levels. The clinical efficacy of the two groups was evaluated by the scores of Qi deficiency syndrome and blood stasis syndrome before and after treatment. Results (1) In western medicine group, 5 cases dropped out and were excluded, and a total of 21 cases completed the trial; in Chinese medicine group, 3 cases dropped out and were excluded, and a total of 23 cases completed the trial.(2) After treatment for 24 continuous weeks, IMT and Crouse scores of the plaque in the two groups were obviously reduced(P < 0.01 compared with those before treatment) , but the differences of IMT and the scores between the two groups were insignificant after treatment(P > 0.05). (3) Serum Klotho protein level was increased while FGF23 was decreased in Chinese medicine group after treatment (P < 0.01 compared with those before treatment); no obvious changes of serum Klotho protein and FGF23 levels were found in western medicine group before and after treatment(P > 0.05). The effects of Chinese medicine on increasing Klotho protein level and decreasing FGF23 level were superior to those of western medicine (P<0.01). (4) After treatment, serum IL-1, TNF-α, ROS and MDA levels were decreased and serum SOD level was increased in the two groups (P < 0.01 compared with those before treatment). The differences of the above indexes were insignificant between the two groups after treatment(P > 0.05).(5) The scores of Qi deficiency syndrome and blood stasis syndrome in Chinese medicine were decreased after treatment (P < 0.01), but showed no significant changes in western medicine group (P > 0.05). Chinese medicine group had better effect on improving the scores of Qi deficiency syndrome and blood stasis syndrome than western medicine group(P < 0.01).(6) After treatment, the total effective rate for improving Qi deficiency syndrome and blood stasis syndrome in Chinese medicine group was 82.61%, 78.26%, and that in western medicine group was 28.57%, 14.28%respectively, the difference being significant (P<0.01). Conclusion Qi-strengthening and blood-activating Qigui Ershen Granules have certain effects on counteracting atherosclerosis, inflammatory aging and oxidation.

Objective:To investigate the clinical characteristics of renal injury caused by Guanxinsuhe pill(冠心苏合丸,including slander dutchanspipe root(青木香)).Methods:The clinical data of 27 patients with renal injury caused by Guanxinsuhe pill were studied.The clinical characteristics of the renal damage caused by Guanxinsuhe pill and the relationships between duration of illness,duration of taking Guanxinsuhe pill,anemia,renal atrophy and the progression of renal injury respectively were also analyzed.Results:Twenty-seven patients all taken Guanxinsuhe pill for suspicious coronary heart disease(CHD) and were diagnosed as chronic tubulointerstitial nephropathy accompanied with renal tubular acidosis,renal glucosuria and hyposthenuria after admission.Anemia was of more severity than renal dysfunction.Atrophic kidney occurred in 26 patients.The main complains were nonspecific symptoms including fatigue,anorexia,nausea,vomiting,etc.and accompanied with different degrees of chronic renal dysfunction.Twentyfour hours urinary protein excretions were 120-900 mg((490?250) mg).There were few red and white cells in uroscopy.Sixteen patients discontinuously took the Guanxinsuhe pill(one capsule,2-3 times a day) according to the pharmacopoeia for a long period.Ten patients took a dosage(two capsules,2-3 times a day) higher than that limited by the pharmacopoeia.Twenty-six patients took Guanxinsuhe pill discontinuously.One patient continuously took Guanxinsuhe pill until got renal dysfunction.The duration of taking Guanxinsuhe pill was 1-120 months(37.38?31.58),and the amount of 50-43 800 pills(4 576.00?8 830.54) were used,but the amount of pills of 3 cases was uncertain.The renal injury occurred within 30-216 months(95.41?56.74) after initiation of the drug taken.The renal injury obviously correlated with the anemia and the duration of taking Guanxinsuhe pill.Conclusion:Taking Guanxinsuhe pill can cause renal injury.The Guanxinsuhe pill dose indicated in pharmacopoeia also causes renal damage.The onset of renal injury is insidious.Most of the patients have the history of CHD and when the chronic nephropathy in most of such patients is detected,it is advanced to stage 5.The renal injury induced by Guanxinsuhe pill usually presents as chronic tubulointerstitial nephropathy,renal tubular dysfunction and anemia.Anemia is of more severity than renal dysfunction.The 24 hours urinary protein excretions of all the patients are lower than 1 000 mg daily.It is suggested to avoid taking Guanxinsuhe pill,adjust the prescription of Guanxinsuhe pill and do not use slander dutchanspipe root as an ingredient.

Objective: To investigate electronic cigarette (e-cigarette) use and its influencing factors among junior high school students of health promotion schools in Xihu District, Hangzhou City, so as to provide insights into school-based tobacco control. Methods: Grade 1 to 3 junior high school students of health promotion schools in Xihu District were recruited using a multi-stage stratified cluster sampling method from September to December, 2021. The participants' demographic features, e-cigarette use and exposure to tobacco advertising were collected using the Chinese version of the Global Youth Tobacco Survey, and the factors affecting the intention to use e-cigarettes were identified using a multivariable logistic regression model. Results: The 1 677 respondents included 875 boys (52.18%) and 802 girls (47.82%), and grade 1 to 3 junior high school students consisted of 33.93%, 35.00% and 31.07% of all respondents, respectively. There were 1 461 students that had heard of e-cigarettes (87.12%), 101 students with intention to use e-cigarettes (6.02%), and 24 current users (1.43%). Multivariable logistic regression analysis identified living in rural areas (OR=2.364, 95%CI: 1.442-3.875), having close friends that were smokers (OR=5.614, 95%CI: 3.404-9.258), having seen smoking via TV, video or movie in the past 30 days (OR=2.106, 95%CI: 1.259-3.523), having received free tobacco products (OR=3.887, 95%CI: 1.172-12.894), considering e-cigarettes as nicotine-free (OR=208.442, 95%CI: 55.713-779.856), and considering smoking making comfortable at party (OR=4.534, 95%CI: 1.853-11.090) as factors affecting intention to use e-cigarettes. There were 38.04% (638/1 677) of junior high school students with exposure to advertisements for e-cigarettes and related products, and stores, supermarkets, convenience stores, grocery, e-cigarette experience stores or offline retail stores were the primary places to contact e-cigarettes and related products. Conclusions The percentage of intention to use e-cigarettes was low among junior high school students of health promotion schools in Xihu District in 2021, and their intention to use e-cigarettes was mainly affected by close friends' smoking status and personal recognition.