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The paper reported a patient under maintained hemodialysis for 11 years, with a large mass appeared in the right thigh after local injury. The mass was clinically considered as tumoral calcinosis combined with clinical, imaging and pathological findings. Several treatments such as enhancing dialysis adequacy, low calcium dialysate, calcimimetic agent, non-calcium- phosphorus binding agents, parathyroidectomy and intravenous infusion of sodium thiosulfate could not vanish the mass. Finally, the lump was surgically removed. The treatment of tumoral calcinosis in the hemodialysis patient can provide a instruction for similar situations in clinical practice.
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Objective:To analyze the correlation between human immunodeficiency virus (HIV)-1 reservoir and poor immune reconstitution of HIV/acquired immunodeficiency syndrome (AIDS) patients, and to investigate the influence of HIV-1 reservoir on the immune reconstitution.Methods:Cross-sectional survey was conducted to measure HIV-1 RNA and T lymphocyte subsets from 219 patients with HIV/AIDS who had been treated with anti-retroviral therapy (ART) for more than two years with HIV RNA lower than the limit of detection. Among them, there are 195 patients from the Sixth People′s Hospital of Zhengzhou, 12 patients from Shangqiu Municipal Hospital and 12 patients from Zhoukou Infectious Diseases Hospital. Peripheral blood mononuclear cells (PBMC) were collected and HIV-1 DNA was detected. The measurement data of normal distribution were analyzed by two independent sample t-test. The measurement data of skewness distribution were analyzed by rank sum test. Spearman′s rank correlation was used for correlation analysis. Receiver operating characteristic curve (ROC) was used to predict the predictive value of occurrence of poor immune reconstitution AIDS patients. Results:There were 121 patients with poor immune reconstitution and 98 patients with healthy immune reconstitution. HIV-1 DNA was (2.50±0.52) copies/1×10 6 PBMC in the group with poor immune reconstitution, which was significantly higher than the healthy immune reconstitution group ((2.11±0.66) copies/1×10 6 PBMC, t=4.78, P<0.001). The CD4 + T lymphocyte counts in the group with poor immune reconstitution was 192(139, 227)/μL, which was lower than that in the healthy immune reconstitution group (573(457, 730)/μL). The difference was statistically significant ( Z=12.68, P<0.001). HIV-1 DNA was reversely correlated with CD4 + T lymphocyte counts and CD4 + /CD8 + T lymphocyte ratio (after adjusting the influence of age and ART time, r=-0.277 and -0.316, respectively, both P<0.001). The area of ROC curve for HIV-1 DNA to predict poor immune reconstitution was 0.679(95% confidence interval ( CI) 0.604 to 0.750). The HIV-1 DNA threshold value was 100 copies/1×10 6 PBMC with the sensitivity of 90.13% and specificity of 42.91%. The area of ROC curve of CD4 + /CD8 + T lymphocyte ratio to predict poor immune reconstitution was 0.905 (95% CI 0.863 to 0.942). The threshold value of CD4 + /CD8 + T lymphocyte ratio was 0.536 with the sensitivity of 77.68% and specificity of 89.84%. Conclusions:There is correlation between HIV-1 DNA and poor immune reconstitution in HIV/AIDS patients. The value of HIV-1 DNA higher than 100 copies/1×10 6 PBMC and CD4 + /CD8 + T lymphocyte ratio lower than 0.536 could be used as predictor of poor immune reconstitution.
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Objective@#To compare the irradiated dose to unprotected lymph node stations (LNS) between volume-modulated arc therapy (VMAT) and 5-field intensity-modulated radiotherapy (5F-IMRT) in the treatment of patients with upper thoracic esophageal cancer.@*Methods@#A total of 20 patients were selected for re-planning. LNS were not included in the GTV and CTV, instead, LNS were contoured as normal tissues. However, LNS were not constrained in the VMAT and 5F-IMRT inverse optimization for protection. Dosimetric parameters of conformal index (CI), homogeneity index (HI) of targets, V95, V110 of planning target volume (PTV), Dmean, V5, V20, V30 of lung, Dmean, V25 of heart, Dmax of spinal cord, MU, as well as the equivalent uniform dose (EUD) and V40 of LNS were compared between the two plans.@*Results@#5F-IMRT was superior in PTV_V95% (t=-9.4, P<0.05), but worse in terms of CI (t=-5.3, P<0.05) compared with VMAT. 5F-IMRT reduced the V5 of lung by 10.9% (t=-7.8, P<0.05) and the Dmax of spinal cord by 9% (t=-10.2, P<0.05), but increased the MU (t=-6.2, P<0.05) compared with VMAT. The average EUD and V40 of LNS in upper thoracic were significantly increased by 4.7% and 2.4% in 5F-IMRT compared with VMAT, respectively. The irradiated doses to LNS were significantly associated with the volume of PTV (R=0.716-0.933, P<0.05) expect for 106tbL.@*Conclusions@#The irradiated doses to unprotected LNS were less for IMRT plans and were highly associated with PTV volume in patients with upper thoracic esophageal cancer.
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Objective To compare the irradiated dose to unprotected lymph node stations (LNS) between volume-modulated arc therapy (VMAT) and 5-field intensity-modulated radiotherapy (5F-IMRT) in the treatment of patients with upper thoracic esophageal cancer.Methods A total of 20 patients were selected for re-planning.LNS were not included in the GTV and CTV,instead,LNS were contoured as normal tissues.However,LNS were not constrained in the VMAT and 5F-IMRT inverse optimization for protection.Dosimetric parameters of conformal index (CI),homogeneity index (HI) of targets,V95,V110 of planning target volume (PTV),D V5,V20,V30 of lung,D V25 of heart,Dmax of spinal cord,MU,as well as the equivalent uniform dose (EUD) and V40 of LNS were compared between the two plans.Results 5F-IMRT was superior in PTV_ V95% (t=-9.4,P<0.05),but worse in terms of CI (t=-5.3,P<0.05) compared with VMAT.5F-IMRT reduced the V5 of lung by 10.9% (t=-7.8,P<0.05) and the Dmax of spinal cord by 9% (t=-10.2,P<0.05),but increased the MU (t=-6.2,P<0.05) compared with VMAT.The average EUD and V40 of LNS in upper thoracic were significantly increased by 4.7% and 2.4% in 5F-IMRT compared with VMAT,respectively.The irradiated doses to LNS were significantly associated with the volume of PTV (R =0.716-0.933,P<0.05) expect for 106tbL.Conclusions The irradiated doses to unprotected LNS were less for IMRT plans and were highly associated with PTV volume in patients with upper thoracic esophageal cancer.
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Objective To explore the sleep structure characteristics and risk factors in patients with Parkinson disease psychosis (PDP).Methods Fifty-one patients with Parkinson disease were enrolled.Sixteen cases met the diagnostic criteria of Parkinson disease psychosis were included in the PDP group,while the remaining 35 cases were included in the PD group as the control group.Sleep status was monitored by polysomnography.Neuropsychological assessment of patients with Parkinson disease was performed by Parkinson quality of life questionnaire,Montreal cognitive assessment(MoCA)and Hoehn-Yahr state (H-Y) of Parkinson disease.Results There were statistically significant differences in age of onset in PD group and PDP group (64.11±8.87,57.44±10.07,t=1.242),course of disease (2 (1,4),6 (4,7),Z=-3.888),HY stage (2 (1.5,2.5),3 (2,3),Z=-2.487)(all P<0.05).The total sleep time in the PDP group was lower than that in the PD group ((344.06±26.39)min,(361.74± 17.16)min,P<0.05).Compared with the PD group,the proportion of slow wave sleep phase Ⅰ in the PDP group was bigger ((42.88 ± 7.99) %,(37.14±5.21) %,t=-3.065),and the proportion of slow wave sleep phase Ⅱ in the PDP group was smaller ((31.19±5.92) %,(37.51±5.70) %,t=3.634) (P<0.05).Single factor binary logistic regression analysis showed that the course of disease,age of onset,RBD,HY stage,PDQ-39 questionnaire score,total sleep time,slow wave sleep stage Ⅰ (%) and slow wave sleep stage Ⅱ (%) were the risk factors of PDP (P<0.05).Multivariate binary logistic regression analysis showed that the course of disease and RBD were independent risk factors for patients with PDP (P< 0.05).Conclusion Sleep structure changes in patients with PDP,and RBD is the independent risk factor for patients with Parkinson's psychotic disorders.
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Objective To evaluate the difference of set-up errors between thermoplastic mask and breast bracket in patients receiving intensity-modulated radiotherapy after breast conserving surgery,and the impact of clinical factors associated with set-up errors.Methods A total of 34 patients treated with intensity-modulated radiotherapy after breast conserving surgery from January 2016 to June 2018 were reviewed.Eighteen patients were fixed with thermoplastic mask,and sixteen were with breast bracket.Weekly CBCT scan records were used to analyze set-up errors,and group systematic and random errors were computed.The influence of clinical factors on set-up errors was also analyzed.Results The immobilization technique with thermoplastic mask showed great superior in comparison with breast bracket;however,only in the Ty(translation) and Ry(rotation),the differences had significance.Based on group systematic and random errors,PTV margins in Tx,Ty and Tzwere 2.65,4.36 and 2.87 mm in thermoplastic mask group,as well as 5.71,6.07 and 4.20 mm in breast bracket group,respectively.Multi-factor regression analysis showed that BMI was independent factors affecting set-up errors.Conclusions Compared with breast bracket,the immobilization technique with thermoplastic mask has the potential of reducing set-up errors and PTV margins in patients receiving intensity-modulated radiotherapy after breast conserving surgery,especially in patients with high BMI.
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Objective To evaluate the clinical efficacy and safety of different stitching methods,over-the-scope-clip (OTSC) and metal clips combined with nylon rope (King closure),for full-layer gastric wall defect.Methods Data of 75 cases,who underwent endoscopic full-thickness resection (EFTR) of gastric SMTs from May 2015 to May 2018 in our endoscopy center were retrospectively analyzed.According to the closure method,the patients were divided into the OTSC group (20 cases) and the King closure group (55 cases).Comparison was made in gender,age,the largest diameter of tumor,the location of tumor,defect surface diameter,total operating time,defect closure time,closure success rate,the length of hospital stays,cost and postoperative complications between the two groups,Results The baseline data were comparable,and there were no significant differences in age,gender,tumor location,tumor diameter,and defect surface diameter between the two groups(all P>0.05).The success rate of closure was 100% in both groups.In terms of length of hospital stay,there was no significant difference between the two groups (t =1.13,P=0.268).The total operating time was 63.24±43.22 min in the King closure group versus 47.60± 18.13 min in the OTSC group (t =2.20,P =0.030).The closure time of the defect surface was 20.85 ± 16.35 min in the King closure group versus 10.95±5.20 min in the OTSC group (t =2.65,P=O.010).Hospitalization costs were 24 200±800 yuan in the King closure group versus 36 200±2 350 yuan in the OTSC group (t=6.21,P<0.001).Postoperative abdominal elevation radiographs in both groups indicated a small amount of subphrenic free gas,and no intervention was given due to the small amount of gas and no obvious symptoms.No late bleeding,recurrent perforation,infection or other complications occurred after operation,and all patients were discharged successfully.Six months after surgery,15 patients (27%) in the King closure group developed metal clips or nylon rope residue,which were successfully removed by endoscopy.The anastomosis clamp of nighteen patients (95%) in the OTSC group were in the original position.None of the patient received open surgery.Conclusion OTSC and King closure are both safe and effective in the treatment of full-thickness defect of gastric wall.OTSC has the advantages of short total operation time and short closure time,but with high cost.
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Objective To evaluate the efficacy of testa triticum tricum purif combined with polyethylene glycol electrolyte powder for bowel preparation before colonoscopy in patients with constipation. Methods A total of 190 patients with constipation who underwent colonoscopy were randomized into 2 groups. The study group(n=93)were given testa triticum tricum purif and polyethylene glycol electrolyte powder,whereas the control group(n=97)were given polyethylene glycol electrolyte powder only.The bowel cleanness,adenoma detection rate,and incidence of adverse events during bowel preparation were compared. Results The bowel preparation score(7.31±1.14 VS 6.06±1.22,P=0.000)and effective rate(95.70%VS 69.07%, P=0.000)in the study group was significantly higher than that in the control group. The incidence of adverse events in the study group was lower than that in the control group(5.38% VS 17.53%, P=0.009). There was no significant difference in the adenoma detection rate between the two groups (36.56% VS 26.80%, P=0.148). Conclusion Testa triticum tricum purif combined with polyethylene glycol electrolyte powder is superior to conventional method of polyethylene glycol electrolyte powder alone for colonoscopy bowel preparation in patients with constipation.
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With the development of imaging, molecular biology, and pathology, the pathogenesis of cerebral small vessel disease (CSVD) has been deeply understood, but the exact pathogenesis is still unclear. This article reviews the pathogenesis of CSVD, including oxidative stress, inflammatory reaction, amyloid beta amyloid deposition, vascular endothelial dysfunction, and blood-brain barrier damage.
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Intracranial arterial dolichoectasia, also known as dilated cerebral artery disease, is characterized by an increase in the length and diameter of at least one intracranial artery, and the involved intracranial arteries enlarge and dilate. Cerebral small vessel disease mainly refers to diseases caused by small vessel lesions in the brain. It is usually used to describe a series of imaging changes of white matter and subcortical gray matter, including recent subcortical small infarction, lacuna, white matter hyperintensity, enlarged perivascular space, cerebral microhemorrhage, and cerebral atrophy. Recently, more and more studies have shown that there is a certain correlation between intracranial arterial dolichoectasia and cerebral small vessel diseases.
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Objective To explore the value of OTSC( over-the-scope-clip) for upper digestive tract perforation. Methods Thirteen patients with old and fresh upper digestive tract perforation, treated with an OTSC clip at the Department of Digestive Endoscopy from May 2015 to June 2016, were enrolled. All OTSCs were 11/6t, and all procedures were performed by experienced endoscopists. Results Seven cases of fresh perforation were iatrogenic after treatment for gastric submucosal tumor. Six cases of old perforation included 2 cases of spontaneous esophageal rupture, 2 fistula after operations for esophageal foreign body, 1 fistula after the operation for gastric stromal tumor, and 1 anastomotic fistula after esophagectomy. Eight cases of perforation occurred in stomach and 5 in esophageal. Fresh lesion sizes were from 4 to 30 mm ( average 15. 3 mm), old lesion sizes from 5 to 10 mm(average 7. 8 mm). OTSC′s release time in fresh lesions was 6-27 min(average 15. 1 min), that in old 15-80 min(average 42. 3 min) with significant difference. Technical success rate was 100%(13/13),clinical success rate in fresh lesions was 100%(7/7),and 50% (3/6) in old lesions. No patient had special treatment or complication. Conclusion OTSC is useful and safe for the treatment of upper digestive tract perforation, which is superior for fresh perforation than for the old. The perfect time to release OTSC for old perforation is when there is no obvious fibrosis caused by inflammation. The success rate is higher when the lesion size is smaller than 30 mm. Self-releasing of OTSC is rare. The necessity and the timing to take them out still needs further study.
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AIM:To investigate radiosensitization effect of apatinib, a vascular endothelial growth factor (VEGF) receptor2 tyrosine kinase inhibitor, on human gastric carcinoma cell line SGC-7901 and its mechanism.METHODS:SGC-7901 cells were divided into control group, apatinib group, radiotherapy group and combination group.The cell viability was measured by CCK-8 assay.The changes of cell apoptosis and cell cycle were analyzed by flow cytometry.The protein levels of cell apoptosis biomarkers, such as PARP, cleaved caspase-9, cleaved caspase-3 and Bcl-2, and cell proliferation biomarkers, p-PLCγ1 and p-ERK1/2, were detected by Western blot.γ-H2AX expression was detected by immunofluorescence.RESULTS:Compared with apatinib group and radiation group, the cell viability was inhibited after treatment with both apatinib and X-ray (P<0.01).The protein levels of cell proliferation markers p-PLCγ1 and p-ERK1/2 were down-regulated.The cell apoptosis was enhanced (P<0.01).The protein levels of cell apoptosis makers such as PARP, cleaved caspase-9 and cleaved caspase-3 were up-regulated, while Bcl-2 was down-regulated.The disappearance of γ-H2AX foci in the nucleus was delayed, indicating that apatinib impaired the repair of radiation-induced DNA double-strand breaks.The proportion of G2 phase was significantly increased (P<0.01).The combination treatment had more significant effect on SGC-7901 cells than treating with apatinib or radiotherapy alone.CONCLUSION:Apatinib increases the radiosensitivity of gastric cancer cells via blocking VEGF pathway.
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Objective To evaluate the effect of second-line antiretroviral treatment (ART) on human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and provide reference for subsequent HIV/AIDS treatment.Methods Two hundred and twenty-eight HIV/AIDS patients received second-line ART during January 2011 and December 2015 in Zhengzhou were included.Two hundred and forty-eight who received first-line ART during this period were randomly enrolled as control group.CD4+ T cell count and HIV RNA load before and after treatment were compared with x2 test and t test when appropriate.Results There were 228 patients (137 male and 91 female) in the second-line ART group and 248 patients (176 male and 72 female) in the control group.In second-line ART group, CD4+ T cells increased from (274±200)/μL to (476±261)/μL after an average treatment of (39.5±18.8) months.The difference was statistically significant (t=12.91, P0.05).During the treatment, the rates of immunological failure were 9.6% (22/228) in second-line ART group and 12.9% (32/248) in the control group.There was no statistical difference between two groups (x2=1.251, P>0.05).Complete viral inhibition rates were 83.3% (190/228) in second-line ART group and 88.7% (220/248) in control group with no statistical difference (x2=2.881, P>0.05).Conclusions Second-line ART regimen has equivalent treatment efficacy with first-line ART.To achieve a better outcome, second-line ART regimen should be selected as an alternative option when first-line regimen fails.Compliance is the key to guarantee the success of antiviral therapy.
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<p><b>OBJECTIVE</b>Microstructural changes in dentin carious lesions were investigated using a 3D laser scanning microscope, which has a morphological theoretical foundation in the further study of clinical caries disease prevention and treatments.</p><p><b>METHODS</b>Six fresh extracted caries molars were prepared into cross-section specimens. The sections were examined by 3D and laser measuring morphology.</p><p><b>RESULTS</b>Zones were identified in the lesions on the basis of their optical appearance. Two zones were identified in the lesions on the basis of their laser appearance. The microstructure showed that the tubular was partly closed in transparent dentin; peritubular and intertubular dentin were reduced in the zone of demineralization; peritubular and intertubular dentin were damaged and fused; a beaded sample and oval lesions formed in the zone of bacterial invasion; and abnormal dentin structure was present in the zone of destruction on the basis of their laser appearance. Four zones were iden-tified in the lesions according to their colors, as determined from their 3D appearance.</p><p><b>CONCLUSIONS</b>3D laser scanning micros-cope may be a powerful, accessible, and non-destructive technique, as it identified the lesion and tubular zones, as well as peritubular and intertubular dentin in the four zones' lesions. The microstructure of dentin caries lesions may have significant merit in the evaluation of clinical prevention and treatment.</p>
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Humans , Dental Caries , Dentin , Microscopy, ConfocalABSTRACT
Objective Pulmonary hypertension (PH) was an independent predictor of mortality and new onset cardiovascular events in maintenance hemodialysis (MHD) patients. Recent studies revealed PH complicated by pericardial effusion (PE) increased mortality in non-CKD (chronic kidney disease) population. No such evidence existed in MHD patients. Methods We enrolled 108 MHD patients with diagnosed PH by echocardiography (61 with PE) between 2009 and 2011. All patients had been followed-up for 2 years. The endpoints were all-cause mor-tality, cardiovascular (CV) mortality and new onset CV events. Results The mean age was (60.2 ± 14.1) years, 55.6% were males and SPAP was (53.0 ± 15.4) mmHg. 12.0% were severe PH and 1.9% were moderate-to-severe PE. The overall mortality, cardiovascular mortality and new on-set cardiovascular events in PE and non-PE group were 34.4% vs. 21.3%、 23.0% vs. 12.8% and 54.1% vs. 42.6%, respectively (P > 0.05). Kaplan-Meier curve showed there was no difference on all-cause mortality , CV mortality nor new-onset CV events between PE and non-PE group (Log Rank P > 0.05). Conclusions Compared with patients without PE, the presence of PE in patients with PH did not increase the mortality and worsen the cardiovascular outcome in MHD patients.
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Objective] To explore the theoretical origin, clinical application method, effect and practical significance of the treatment of ectopic pregnancy with blood stasis. [Method] From blood stasis on the treatment by promoting blood circulation to remove blood stasis, Yiqi Yangxue Huayu Shapei, expelling blood circulation, method to eliminate the disease, stage of treatment, a reasonable choice of promoting blood circulation and removing blood stasis drugs in the treatment of ectopic pregnancy. [Results] From blood stasis on the treatment of ectopic pregnancy, it can accelerate the beta HCG negative, and speed up the ectopic pregnancy mass absorption, clinical curative effect significantly, the greatest degree of protection of fallopian tube integrity, improve blood circulation, and tubal function recovery, increase after treatment the chances of conception. [Conclusion] Qi stagnation, blood stasis and Qi deficiency and blood stasis are ectopic pregnancy basic pathogenesis, less empirical abdominal blood stasis is the essence of its pathogenesis. The existence of blood stasis in ectopic pregnancy of each type and disease development of the whole process, in the occurrence of the disease, and occupies an important position in the development, promoting blood circulation and removing blood stasis is the basic treatment, should be in clinical dialectical treatment of the whole process of fusion.
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Objective To introduce improved program for traction wire production in endoscopic submucosal dis-section assisted by oral traction. Methods A retrospective analysis was performed on 40 patients who received en-doscopy intervention. Through the use of improved traction and normal traction, they were divided into experimental group and control group. Then analyze and compare their clinical data like gender, age, traction line installed perfect time, fixed lesions after hemostatic clip off times, one-time complete resection, enbloc resection rate, bleeding and perforation and other complications and other clinical conditions. Results The improvement time was (53.30 ±12.85) s in experimental group, it was significantly shorter than that in control group (105.00 ± 11.68) s ( = 3.42, <0.05). The experimental group fixed lesions after hemostatic clamp off times were significantly less than that in con-trol group (χ2=2.37, <0.05). Conclusions Using innovative methods, adequate preoperative preparation, the op-erator's tacit understanding of nursing cooperation, close attention to the disease after surgery is the key to achieve the desired results of endoscopic surgery.
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Objective To analysis clinical effect of Diyu Shengbai tablets combined with granulocyte colony stimulating factor on cancer related fatigue syndrome.Methods II-VI primary cancer 60 patients from January 2011 to December 2013 were admitted to department of internal medicine, Fourth Hospital of Hebei Medical University,and randomly divided into two groups.Control goup(n=30)were treated with granulocyte colony stimulating factor(G-CSF).Experimental group(n=30)were treated with Diyu Shengbai tablets and G-CSF.Results After chemotherapy, ratio of patients in the experimental group appeared fatigue syndrome and changes in leukocyte was significantly lower than that of control group, the difference was statistically significant ( P <0.05 ) . Conclusion Diyu Shengbai tablets combined with G-CSF have better clinical efficacy for leukopenia caused by tumor chemotherapy, the symptom of fatigue also can improve significantly.
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Objective To explore cardiovascular disease in postmenopausal women with polycystic ovary syndrome(PCOS) phenotype.Methods This study was a prospective follow-up study which included subjects with PCOS phenotype admitted from Jan.1st, 2005 to Dec.31st, 2007 in Gynecology Department of Dongyang People's Hospital.These subjects were divided into two groups according to the presence or absence of PCOS phe -notype and were followed .Kaplan-Meier method was used to estimate survival rate .The survival difference be-tween the two groups was compared using the log-rank test.Multivariate Cox proportional hazards regression was used to determine the independent risk factors of major adverse cardiac events ( MACE) .Results 11 patients in non-PCOS phenotype group had MACE , and 6 patients in PCOS phenotype group had MACE .PCOS phenotype group had a significantly decreased MACE-free survival(χ2 =4.957,P=0.026).Multivariate Cox proportional hazards regression analysis showed that low level of HDL-C, presence of PCOS phenotype and high level of hs-CRP were independent predictors for MACE .Conclusion PCOS phenotype is an independent risk factor for car-diovascular disease in postmenopausal women , help to make further risk stratification and shows cardiovascular disease is closely related to PCOS .
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<p><b>OBJECTIVE</b>To investigate RANK-RANKL expression in the kidneys of a rat model of puromycin aminonucleoside nephropathy (PAN).</p><p><b>METHODS</b>Thirty-six SD rats were randomly divided into PAN model group and normal control group. PAN was induced by a single intravenous injection of 100 mg/kg puromycin aminonucleoside. Serum creatinine and 24-hour urinary protein were measured on days 3, 7, and 14 after the injection, and renal pathologies were assessed with optical and immune transmission electron microscopy. The expression of RANK and RANKL in the kidneys was examined using reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting.</p><p><b>RESULTS</b>The PAN model rats showed massive proteinuria and elevated serum creatinine on day 3, which peaked on day 7. RANK-RANKL protein and mRNA expressions in PAN model group was higher than those in the control group. In the PAN rats, RANK was expressed mainly on the top cell membrane and in the cytoplasm of renal podocytes with a significantly increased expression level compared with that in the control group.</p><p><b>CONCLUSION</b>The PAN rat model shows aberrant RANK and RANKL expressions in the podocytes, indicating their contribution to podocyte injury in PAN.</p>