OBJECTIVE: At present the function of Fas and Bcl-2 gene in the pathogenesis of myasthenia gravis has gained more attention and more studies have been extensively made inside and outside, to investigate the modulation of Fas and Bcl-2 gene expression is of extremely significance for exploring the pathogenesis and treatment of myasthenia gravis.DATA SOURCE: The related articles published in English from January 1990 to December 2004 were computer searched in Medline database using the terms of "Fas", "Bcl-2", "Myasthenia Gravis" and "gene".STUDY SELECTION: The data were identified preliminarily and literatures on the relationship between Fas and Bcl-2 gene and myasthenia gravis, as well as on Fas and Bcl-2 gene and genotherapy were remained for searching the full content.DATA EXTRACTION: A great deal of literatures about Fas and Bcl-2 gene were searched, 21 of which were studies on Fas and Bcl-2 gene and myasthenia gravis, and 32 on myasthenia gravis related genotherapy. A total of 20 representative articles were selected for analysis in this study.DATA SYNTHESIS: Eight out of 20 literatures were about the relationship between Fas gene and myasthenia gravis, 5 about the Bcl-2 gene and myasthenia gravis, 7 about the genotherapy in the treatment of myasthenia gravis and immune diseases.CONCLUSION: Abnormal Fas and Bcl-2 gene modulation and uncontrollable expression were closely associated with apoptosis defect of T lymphocyte and thymocytes, and even closely related to the pathogenesis of myasthenia gravis. To explore pathogenesis of myasthenia gravis at gene level by inducing cell apoptosis and depressing self-antibody production, would provide new means for the treatment of myasthenia gravis.

Objective To explore the changes of serum sFas levels and its clinical significance in patients with myasthenia gravis(MG).Methods T cell subsets and sFas levels in serum of 45 MG patients and 40 controls were measured by using flow cytometry and enzyme-linked immunosorbent assay each.Besides,the sFas levels variety of 24 MG patients using glucocorticoid(GC) were observed.Results(1) The percentage of CD~+_8T cells was much decreased in MG group[(21.50?2.21)%] compared with control group[(27.75?3.00)%]((P

Objective To study the diagnosis and treatment of portal vein complications after orthotopic liver transplantation. Methods The clinical data of 173 patients receiving orthotopic liver transplantation in our hospital from 2002 to 2005 were retrospectively analyzed. Results The incidence of portal vein complications was 3.5% (6 cases). The incidence of portal vein stenosis was 1.2% and that of portal vein thrombosis was 2. 3%. Three cases had previously been treated for portal hypertension and three cases had had a history of portal vein thrombosis before liver transplantation. All the complicated patients recovered and were discharged after successful treatment. There was no complication related mortality. Conclusions A history of previous treatment for portal hypertension, portal vein thrombosis is a risk factor predisposing the patients to portal vein complications after orthotopic liver transplantation. Color Doppler sonography is a sensitive and specific method for monitoring the portal vein complications following orthotopic liver transplantation. The angiography of portal vein is essential for diagnosis of the complications. Thrombolysis treatment is unsatisfactory for advanced stage portal vein thrombosis. Balloon dilation and stenting are both a safe and effective management modality for simple portal vein stenosis.

Objective To evaluate the clinical diagnosis and management of solid-pseudopapillary tumors of the pancreas.Methods A retrospective clinical analysis was made on 21 cases of solid-pseudopapillary tumors of the pancreas admitted from June 1994 to June 2003.Results Abdominal pain was the major complains in 13 cases , 7 cases had palpable abdominal mass.Imaging examination can show the abdominal mass clearly, but diagnosis can not be defined.There were 12 cases whose tumors were located in pancreatic head (4 underwent Whipple procedures and 8 tumor enucleations) and 9 cases with tumors in pancreatic tail (all underwent body and tail resection plus splenectomy).The average diameter of tumor was 9.5 cm (3-20).One case had liver metastasis.Diagnosis was proved by frozen pathology during operation in 14 cases, and other 3 cases initially diagnosed as insulinomas and other malignant tunors, had definite diagnosis by postoperative paraffin section and enzyme labeling.Enzyme labeling examinations showed that there were 14 cases of NSE positive in 15 cases, 8 cases of Vimentin positive in 10 cases and 7 cases of PAS positive in 8 cases.CK, EMA and CHG A were negative.Eighteen cases were followed up (85.7%) with a median period of 24 months(1～60) without tumor recurrence.Conclusion Huge pancreatic masses of pancreas in young females should suggest the diagnosis of solid-pseudopapillary tumors.Aggressive surgical therapy can result in good prognosis in these patients.

Objective To analyse the causes of postoperative complications of pancreatoduodenectomy(PD) and study measures for prevention and treatment of the complications.Methods A retrospective study was carried out on the data of 139 cases of pancreatoduodenectomy performed during recent 3 years in our(hospital).They included 91 cases of radical resection operation and 43 cases of pancreatoduodenectomy(combined) with vascular resection.Results There were 38 cases(27.4%) occurred complications after PD,including 10 cases(7.2%) of upper gastrointestinal hemorrhage,4 cases(2.9%) of hemorrhage in the abdominal cavity,and 6(4.3%) cases of pancreatic leakage,4cases(2.9%) of bile duct leakage,3((2.2%)) cases of intra-abdominal infection,5 cases(3.6%) of pulmonary infection,and 6 cases((4.3%)) of functional delayed gastric emptying.Four cases died during the peri-operative period.The overall mortality rate were 2.9%.Conclusions The main complications after PD were hemorrhage,pancreatic leakage,bile duct leakage and intra-abdominal cavity infection.Meticulons operative technique,the selection of appropriate anastomoses technique,careful observation and timely aggressive management in the postoperative period are the key points to reduce postoperative morbidity and motality rate after PD.

Pancreatic cancer is a highly malignant neoplasm with dismal prognosis. The risk of recurrence and metastasis remains high even for patients who have undergone radical dissection. Therefore, adjuvant therapy after "curative" resection is crucial. However, consensus on the optimal management of pancreatic cancer after surgery has not been reached. Both chemotherapy and concurrent chemoradiation therapy have been advocated. Yet, based upon the results of published phase Ⅲ trials, the consensus and standard strategy of adjuvant treatment after pancreatic cancer surgery is still undo" debate. According to the results of GITSG and RTOG trials, the mainstream in North American is adjuvant chemoradiation. However, based on the results of ESPAC-1 and CONKO-001 studies, the oncologists in Europe usually recommend chemotherapy alone. Furthermore, the superiority of gemcitabine over 5-FU in the adjuvant setting is largely unclear. This article reviewed the main results of the clinical trials in the field of adjuvant treatment of pancreatic cancer.From the authors' view, both the standard dosage of gemcitabine (CONCO-001) and chemoradiation (RTOG-9704) after resection of pancreatic cancer could be considered as candidates for adjuvant strategy. However, the optimal therapy will have to be determined by trials with larger number of patients.

Objective To investigate the effect of noninvasive ventilator therapy on serum C-reactive protein (CRP), endothelin-1 (ET-1) and tumor necrosis factor-α (TNF-α) levels in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and its clinical significance. Methods One hundred cases of moder-ate and severe OSAHS patients were selected by the method of parallel opening. All of the patients were given health education requirement , quitting smoking and wine , low fat diet and exercise to lose weight and other con-ventional treatment. The patients were randomly divided into the treatment group of 42 cases with noninvasive ventilator treatment , 44 cases treated with conventional treatment , to observe the changes of serum CRP , ET-1 and TNF-α levels and PSG parameters after 12 weeks in two groups. Results Apnea hypopnea index (AHI), oxygen desaturation index (ODI), the lowest oxygen saturation (LSpO2), and the average oxygen saturation MSpO2 in OSAHS patients were significantly improved after treatment (P < 0.01), but the degree of improvement in the two groups after treatment was significantly higher than the control group (P < 0.01). Plasma CRP, ET-1 and TNF-α levels in the two groups after treatment were lower than before treatment (P < 0.05 or P < 0.01), but the treatment group was significantly higher than that of the control group ( P < 0 . 05 or P < 0 . 01 ) . Conclusion Noninvasive ventilator therapy in improving the OSAHS monitoring data of patients with PSG can effectively reduce the serum CRP, TNF-α, ET-1 level, reduce the body′s inflammatory reaction.

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) guided fine needle aspiration (FNA) in patients with suspected chronic pancreatitis. Methods Forty seven patients including 28 males and 19 females (mean age 52.3 years, range 47～69 years) were enrolled into study. The diagnosis of chronic pancreatitis or pancreatic malignancy was based on results of BT PABA test, Sudan Ⅲ staining of stool and abdominal CT scanning, the mean course of disease was 6.3 year (range 3 21 year). Pancreatic tissue specimens were harvested by EUS guided FNA and investigated by histopathological study. Results Totally 31 cases (31/47, 69%) were diagnosed as chronic pancreatitis based on histopathological examination of the specimens taken by EUS FNA. Conclusion EUS FNA had the potential clinical value in diagnosis of chronic pancreatitis.

Objective To study the relationship between the expression of NKG2D ligands and oxidative stress,and to analyze the effect of oxidative stress on the function of NK cells. Methods Tumor cells were cultured and exposed to hydrogen peroxide to develope an oxidative stress model. Then to detect the expression of NKG2D ligands in cells by Real-time PCR and Flow Cytometry. The cytotoxicity of NK cells to tumor cells was detected and compared by CCK-8 kit before and after oxidative stress. Results The expression of NKG2D ligands was induced by oxidative stress,however the NKG2D ligands induced was variable. The up-regulation of NKG2D ligands increased the cytotoxicity of NK cells efficiently,and this effect was blocked by anti-NKG2D antibody. Conclusion The expression of NKG2D ligands can be selectively induced by oxidative stress on tumor cells,and the improvement of the cytotoxicity of NK cells may enhance the immune responses accordingly.

Objective To investigate the value of the Changsha version of the Montreal Cognitive Assessment Scale (MoCA) in the assessment of vascular cognitive impairment after cerebral infarction .Methods 112 cases of clinically diagnosed cerebral infarc-tion were selected and divided into the normal cognition (NC) group and vascular cognitive impairment(VCI) group .The Changsha version of MoCA and the mini-mental state examination(MMSE) were adopted to detect the cognitive function ,the correlation of two scales was analyzed and the cutoff values of the Changsha version of MoCA were preliminarily studied .Results The total scores of the Changsha version of MoCA and MMSE in the VCI group were 15 .12 ± 4 .60 and 20 .44 ± 3 .22 respectively ,which were lower than 22 .75 ± 1 .79 and 25 .21 ± 1 .74 in the NC group ,the difference had statistical significance (P< 0 .05);the total scores of the Changsha version of MoCA was positively correlated with the total scores of MMSE (r=0 .84 ,P<0 .01);the best cut-off value of the Changsha version of MoCA was 20/21 ,the sensitivity and specificity were 92% and 95% respectively .Conclusion The Changsha version of MoCA can screen VCI well and has a high screening value ,and its optimal cutoff value is 20/21 .