Objective:To evaluate the risk factors of hypoalbuminemia (serum albumin <35 g/L) in the maintenance hemodialysis (MHD) patients.Methods:From January 2011 to December 2018, 915 patients (≥18 years) who underwent MHD programs from 12 hospitals in south China were enrolled in a retrospective analysis. Univariate and multivariate Logistic regression analysis was applied to evaluate the risk factors of hypoalbuminemia in the MHD patients.Results:The MHD patients had poor albumin level in general, with hypoalbuminemia accounting for about 20.55% (188/915). Compared with the patients with normal albumin level, the patients with hypoalbuminemia had older age (61.46 years vs. 55.85 years, P<0.01), the greater incidence of diabetes [29.79%(56/188) vs. 19.39%(141/727), P = 0.002] and the lower application in high flux dialysis [42.55%(80/188) vs. 57.36%(417/727), P<0.01], while the gender, duration of dialysis, dialysis frequencies and the incidence of hepatitis showed no significant difference between 2 groups. In linear correlation analysis, albumin and hemoglobin level were positively correlated ( r = 0.213, P<0.01). In Spearmen correlation analysis, albumin was negatively correlated with age, hypersensitive C reactive protein (hsCRP), alkaline phosphatase, and diabetes ( r = -0.232, -0.176, -0.153 and -0.132; P<0.01); and it was positively correlated with the Kt/V and the application in high flux dialysis ( r = 0.151 and 0.124, P<0.01). The multivariate Logistic regression analysis showed that age, diabetes, alkaline phosphatase and hsCRP were the independent risk factors of hypoalbuminemia, while the application of high flux dialysis and hemoglobin were the independent protection factors. Conclusions:The patients undergoing a MHD program have poor albumin level. Diabetes is the independent risk factor of hypoalbuminemia of MHD patients, and the practice of high flux dialysis may reduce the hypoalbuminemia.

Long non-coding RNAs (lncRNAs) are a kind of transcripts which are longer than 200nt and have not protein-coding ability due to the lack of an open reading frame. However, lncRNAs can be involved in tumorigenesis and progression in various ways at the transcriptional and post-transcriptional levels. Bladder cancer associated transcript 1 (BLACAT1) as a lncRNA located on human chromosome 1q32.1, is ectopic expression in various tumors (bladder cancer, gastric malignant tumor, lung carcinoma, et al) and can regulate tumor cell proliferation, anti-apoptosis, invasion and metastasis by different mechanisms leading to occurrence and development of tumors. In this review, we summarized current studies of the functions and mechanisms of BLACAT1 in malignant tumors.

Objective To explore the value of controlled decompression under intracranial pressure monitoring in craniotomy of patients with severe cerebral hemorrhage.Methods One hundred and six patients with severe cerebral hemorrhage,admitted to our hospital from January 2015 to July 2018,were prospectively enrolled.These patients were divided into control group (n=5 l) and treatment group (n=55) according to their families' wishes.The patients in the control group were treated with traditional craniotomy and hematoma removal;the patients in the treatment group were treated with controlled decompression combined with craniotomy and hematoma clearance under intracranial pressure monitoring,and intracranial pressure monitoring and management were carried out after operation.The rate of bone flap acceptance during operation,incidences of complications such as re-bleeding,scalp exudation,intracranial infection and cerebral infarction after operation,rate of re-operation and Glasgow outcome scale scores 6 months after injury were compared and analyzed between the two groups.Results Five patients had midway withdrawal (2 from the control group and 3 from the treatment group),and 101 patients (49 from the control group and 52 from the treatment group) were included in the statistical analysis.The rate of bone flap acceptance in the treatment group (69.2％) was significantly higher than that in the control group (24.5％,P＜0.05).The incidences of complications such as bleeding,scalp exudation,intracranial infection and cerebral infarction (11.5％,7.7％,3.8％,and 13.5％) were significantly lower than those in the control group (30.6％,22.4％,16.3％,and 34.7％,P＜0.05).The re-operation rate (3.8％) was significantly lower than that in the control group (16.3％,P＜0.05).Good recovery rate in the treatment group (76.9％) was significantly higher than that in the control group (55.1％,P＜0.05).The mortality rate (7.7％) was significantly lower than that of the control group (22.4％,P＜0.05).Conclusion For patients with severe cerebral hemorrhage,controlled decompression under intracranial pressure monitoring combined with craniotomy and hematoma removal can significantly improve the rate of bone flap acceptance,reduce the rate of second-stage cranioplasty,reduce the incidence of complications and re-operation rate,and more effectively improve the quality of life and prognosis of patients.

Objective To explore the value of pulse index continuous cardiac output (PICCO) combined with intracranial pressure monitoring in patients with severe craniocerebral injury.Methods One hundred and thirty-eight patients with severe craniocerebral injury accepted controlling decompression surgical treatment in our hospital from February 2015 to February 2019 were prospectively chosen.According to patients' families will,postoperative application of PICCO combined with intracranial pressure monitoring for fluid management was performed in 72 patients (treatment group) and application of central venous pressure combined with intracranial pressure monitoring for fluid management was performed in 66 patients (control group).All patients were adjusted according to the monitoring results.The intracranial pressure and cerebral perfusion pressure one week after surgery,incidences of new traumatic cerebral infarction,neurogenic pulmonary edema,pulmonary infection,scalp exudation,and intracranial infection,average hospitalization days,total hospitalization costs,intensity of antimicrobial use,and Glasgow coma scale scores two weeks after operation were compared and analyzed between the two groups.Glasgow outcome scale was used to evaluate the prognoses of the patients 6 months after injury.Results There were 7 patients (3 from the control group and 4 from the treatment group) dropped out of the study due to various reasons and 131 patients (63 from the control group and 68 from the treatment group) included in the final statistical analysis;there was no significant difference in drop-out rate of the two groups (P＞0.05).The intracranial pressure in the treatment group ([14.28±2.98] mmHg) was significantly lower than that in the control group ([18.99±2.78] mmHg) and cerebral perfision pressure ([66.72±2.25] mmHg) was significantly higher than that in the control group ([52.96±3.12] mmHg) one week after operation (P＜0.05).During hospitalization,the incidences of new traumatic cerebral infarction,neurogenic pulmonary edema,pulmonary infection,scalp exudation and intracranial infection in the treatment group (8.8％,13.2％,11.8％,7.4％,and 2.9％) were significantly lower than those in the control group (22.2％,27.0％,25.4％,19.0％,and 12.7％,P＜0.05).The average hospitalization days,total hospitalization expenses and intensity of antimicrobial use in the treatment group were significantly shorter/lower than those in the control group (P＜0.05).Glasgow coma scale scores (11.88±1.78) and good recovery rate (76.5％) in the treatment group were significantly higher than those in the control group (8.06±1.12,54.0％) two weeks after operation (P＜0.05).Good recovery rate (76.5％) in the treatment group was significantly higher than that in the control group (54.0％,P＜0.05).The mortality rate (5.9％) was significantly lower than that in the control group (17.5％,P＜0.05).Conclusion PICCO combined with intracranial pressure monitoring can effectively improve intracranial pressure,optimize cerebral perfusion,reduce complications such as traumatic cerebral infarction,neurogenic pulmonary edema,pulmonary infection and intracranial infection in patients with severe craniocerebral injury,thereby improving prognosis and reducing mortality;besides that,it can reduce patients' exposure to anti-brain infection,and the breadth and intensity of bacterial drugs can reduce the length of hospitalization and total cost of hospitalization,thereby reducing the burden of family and society.

Objective To evaluate the clinical efficacy of prophylactic cranial irradiation (PCI) in the treatment of surgically resected small cell lung cancer (SCLC).Methods Clinical data of SCLC patients undergoing radical resection surgery in Zhejiang Cancer Hospital from 2003 to 2015 were retrospectively analyzed.According to the treatment modality,all patients were allocated into the PCI and non-PCI groups.A total of 52 patients were finally included,including 19 patients in the PCI group (5 cases of stage Ⅰ,5 stage Ⅱ and 9 stage Ⅲ) and 33 in the non-PCI group (12 cases of stage Ⅰ,5 stage Ⅱ and 16 stage Ⅲ).Kaplan-Meier method was utilized for survival analysis.Cox proportional hazards model was adopted to analyze clinical prognosis.Results The median survival time was 32.9 months in the PCI group,and 20.4 months in the non-PCI group.The 2-year overall survival rate was 72％ in the PCI group,significantly higher than 38％ in the non-PCI group (P=0.023).The median brain metastasis-free survival (BMFS) was 32.5 months in the PCI group,and 17.1 months in the non-PCI group.In the PCI group,the 2-year BMFS rate was 89％,significantly better than 53％ in the non-PCI group (P=0.026).Subgroup analysis demonstrated that PCI could confer survival benefit to patients with p-stage Ⅲ (p=0.031) rather than p-stage Ⅰ (P=0.924) and Ⅱ (P=0.094) counterparts.Multivariate analysis revealed that PCI (HR=0.330,P=0.041) was an independent prognostic factor of the overall survival.Conclusions PCI can reduce thr risk of brain metastasis rate and improve the overall survival of patients with surgically resected SCLC.

BACKGROUND:Spermatogonial stem cel s with abilities of differentiation, self renewal and proliferation are a kind of adult stem cel s that can transfer genetic information into offspring, which have great application prospects in medicine, genetics and zoology. OBJECTIVE:To review the source, biological characteristics, and application of spermatogonial stem cel s as wel as self-renewal and molecular regulation underlining these differentiations. METHODS:PubMed and CNKI databases were searched by the first author using key words of“spermatogonial stem cel , biological characteristics, self-renewal, differentiation”in English and in Chinese, respectively, to retrieve relevant articles published from 1990 to 2015. Literatures addressing spermatogonial stem cel s were included, and 46 articles were chosen for further analysis eventual y. RESULTS AND CONCLUSION:Spermatogonial stem cel s can be cultured in vitro, cryopreserved, and genetical y modified as wel as used for al ogeneic or xenogeneic transplantation, al of which contribute to understanding the mechanisms of spermatogenesis, thereby providing new means for treatment of male sterile disease and genetic diseases and providing new hopes for chemotherapy-induced germ cel damage in young cancer patients. Microenvironment and Plzf, GDNF, SCF/c-Kit signaling pathways can play an important role in the regulation of spermatogonial stem cel self-renewal and differentiation. As a cel model, spermatogonial stem cel s become an important tool for the researches on spermatogenesis mechanism, regeneration of spermatogenesis in sterile individuals and reproduction of transgenic animals.

Objective To provide evidence for clinical diagnosis and treatment of staphylococcus peritonitis through retrospective analysis of peritoneal dialysis related clinical characters. Methods Patients who experienced staphylococcus peritonitis were observed as peritonitis group.Patients did not experience peritonitis were observed as one-to-one control group in order to investigate predictors of staphylococcus peritonitis,bacteria spectrum,antimicrobial resistance and clinical outcomes. Results There were 74 patients enrolled in either group.For patients in peritonitis group,Kt/V(1.74±0.03 vs 2.61±0.48,P＜0.01),CrCL[(55.82±2.22) ml/min vs (76.13±17.42) ml/min,P＜0.01],GFR [(1.32±0.55) ml/min vs (3.08±0.75) ml/min,P＜0.01],nutrition index,hemoglobin[(91.70±25.43) g/L vs (111.50±19.59) g/L,P＜0.01],potassium[(3.43±0.70) mmol/L vs (3.78±0.73) mmol/L,P=0.002],sodium [(137.09±5.06) mmol/L vs (140.57±3.55)mmol/L,P＜0.01],chloride [(98.31±6.14) mmol/L vs (101.52±4.58) mmol/L,P=0.001] and calcium [(2.23±0.24) mmol/L vs (2.31±0.22) mmol/L,P=0.04] in serum were significantly lower than those in control group.The morbidity of staphylococcus peritonitis was 0.030 episode per year in recent five yearn.The major strains were Staphylococcus epidermidis,followed by Staphylococcus aureus.Staphylococci were all sensitive to vancomycin,teicoplanin and linezolid.The cure rate was 89.19％,and mortality was 4.05％.Relapse rate of Staphylococcus epidermidis peritonitis was higher (40％) than other strains. Conclusions Poor nutrition,insufficient dialysis,longer followup interval,anemia,electrolytic imbalance are the risk factors of Staphylococcus peritonitis.The morbidity and mortality are lower than before.Staphylococcus epidermidis peritonitis has higher relapse rate and requires more attention to prevention and treatment.

Objective To explore the relationship between serum cccDNA and liver damage in the patients with chronic HBV infection.Methods Serum cccDNA,ALT of 156 patients with chronic HBV infection were measured,and pathology of liver tissue in 85 patients was detected.Results The positive rate of Serum cccDNA and ALT had no significant difference(P＞0.05).Between pathology light,medium and severe group,S0_(～1) and S_(2～4) group,G_(0～1) and G_(2～4) group the serum cccDNA mean was significantly different(P＜0.01).The positive rate of serum cccDNA was significantly different between the group of NAASC and ASC,CH,LC,HCC,and the group of ALT ≤40u/Land 40～80,80～400,≥400u/L(P＜0.01).Conclusion Serum cccDNA and liver inflammation,fibrosis and ALT had no relevance,serum cccDNA with at a low level may be non-active,but should be excluded from serious liver diseases.

The National key disciplines are determined in accordanee with the national development strategies and major requirements.It is not only an important base to culture creative talents and cant out scientific research works but also a great measure to promote the health service.This paper described the content,method and ten issues of construction of the national key disciplines using the research institute of general surgery,medical school of Nanjing university (Nanjing General Hospital of Nanjing PLA Command) as an example.It put forward the valuable refefences for the administrators of the health and discipline construction.

OBJECTIVETo investigate the relationship between the presence of the TNF2 allele and plasma concentrations of tumor necrosis factor-alpha (TNF alpha) and soluble TNF receptor (sTNF-R) with the development of acute severe pancreatitis (ASP) and severe sepsis.

METHODSGenomic DNA was prepared from peripheral blood leukocytes. The TNF1 and TNF2 biallelic polymorphisms were identified by analyzing NcoI-digested DNA fragments obtained from PCR products. Plasma levels of TNF alpha and sTNF-R were measured by EASIA.

RESULTSThe overall TNF2 allele frequency in ASP patients was comparable to that found in healthy volunteers (29.2% vs. 29.3%, P > 0.05). Severe sepsis occurred in 26 of 72 patients. Patients with severe sepsis showed a significantly higher prevalence of TNF2 than those without (46.2% vs. 19.6%, P < 0.05). Plasma TNF alpha, sTNF-R I, and sTNF-R II levels were (36 +/- 31) pg/ml, (5.4 +/- 3.5) ng/ml, and (11.2 +/- 7.8) ng/ml, respectively, in patients with severe sepsis, and (31 +/- 25) pg/ml, (4.6 +/- 3.8) ng/ml, and (8.8 +/- 6.6) ng/ml in non-severe sepsis subjects. Differences in TNF levels were not statistically significant between patients with ASP and control group (P > 0.05). Moreover, there was no correlation between TNF2 allele frequency and TNFalpha levels [(37 +/- 31) pg/ml vs. (31 +/- 25) pg/ml in TNF2 group and TNF1 group, respectively, P > 0.05].

CONCLUSIONSOur results suggest that there is no relationship between ASP and the TNF2 allele, but that the TNF2 allele is associated with a susceptibility to severe sepsis as a result of ASP.

Acute Disease ; Adult ; Female ; Humans ; Male ; Middle Aged ; Pancreatitis ; genetics ; Polymorphism, Genetic ; Receptors, Tumor Necrosis Factor ; blood ; Sepsis ; genetics ; Tumor Necrosis Factor-alpha ; analysis ; genetics