Local resection of duodenal papillary neoplasm has the advantages of small trauma,few complications and retaining the normal function of digestive tract.While this surgical procedure is not widely applied because of high demand of surgical techniques,difficulty in the management of complications and its efficacy still needs the verification of evidence based medicine.From January 2000 to June 2012,4 patients received local resection of duodenal papillary neoplasm at the Renji Hospital of Shanghai Jiaotong University.All patients were confirmed as with duodenal papillary neoplasm by endoscopic retrograde cholangiopancreatography,and the diameters of the tumors were under 1 cm.The results of duodenal papillary biopsy showed that 3 cases were with hyperplasia and 1 case with adenocarcinoma.Lymph node metastasis or distal metastasis was excluded by computed tomography and magnetic resonance imaging preoperatively.The results of postoperative pathological examination confirmed that 1 case of duodenal papillary adenoma and 3 cases of duodenal papillary adenocarcinoma were with negative margin and no metastasis in the hepatoduodenal ligament was detected.There was no complications except 1 case of pancreatic leakage.There was no recurrence during a follow-up period of 3-24 months.Strictly abiding the indications and technical manual of local resection of duodenal papillary neoplasm is a key point to acquire good clinical effect.

Objective To investigate changes in indicators related to inflammatory cytokines, coagulation and fibrinolysis system in patients with disseminated intravascular coagulation (DIC) and multiple organ dysfunction syndrome (MODS) resulted from sepsis. Methods In total, 97 patients diagnosed as sepsis were divided into different groups and their plasma concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), tissue factor (TF) and tissue factor pathway inhibitor (TFPI), tissue plasminogen activator (t-PA), and plasminogen activator inhibitor 1 (PAI-1) were measured by ELISA and plasma activity of protein C (PC:A) was measured by chromogenic substrate assay. Results Plasma concentrations of TNF-α and I L-6 were (38 ± 12) ng/L and (77 ± 9) ng/L, respectively, in patients of sepsis complicated with DIC, much higher than those without DIC [ ( 17±6) ng/L and (45 ± 6), respectively], P <0.05;and (63±25) ng/L and (103±28) ng/L, respectively, in those complicated with MODS, significantly higher than in those without MODS [ (29 ± 7 ) ng/L and (48±9)ng/L, respectively], P < 0/05 and those without DIC [( 17 ± 6) ng/L and (45 ± 6) ng/L, respectively], P <0. 05;as well as significantly higher in the dead than in survivors (P <0. 05). Plasma activity of protein C was (32 ± 10) percent in those with DIC and (24 ± 12) percent in those with MODS, both significantly lower than in those without DIC [ (57±28) percent] and without MODS [ (55 ± 17) percent], respectively, P <0. 05, as well as significantly lower in the dead than in survivors, P <0. 05. Plasma concentrations of t-PA and PAI-1 were significantly higher in sepsis patients with DIC [(48±17)μg/L] than that in those without DIC [(103 ± 38)μg/L], P < 0.05. Conclusions Inflammatory cytokines play important roles in development of DIC as well as MODS in patients with sepsis. Decreased activity of protein C and increased plasma level of PAI-1 can result in deposition of fibrin on the vessel wall and thrombosis, which can be used as indicators of poor prognosis for patients with DIC.

Objective To investigate the expression and effect of zinc-finger protein kuppel-like factor4(KLF4) in leukemic cell line K562. Methods The lever of mRNA and protein of KLF4 is determined with real-time PCR and Western blot in human peripheral monoeyte/macrophage and K562 cells. Results Compared with control group (0.43±0.03), the expression of KLF4 mRNA in K562 cells (0.02±0.01) wassignificant different(P＜0,05). The expression of KLF4 protein in human peripheral monocyte macrophage is higher than that in K562 cells. Conclusion The low expression of KLF4 was present in leukemic cell line K562,which may suggest that KLF4 gene maybe a tumor inhibitor factor, and partially involved in leukemogenesis.

Hemophagocytic syndrome is a group of fatal immune function disorder,which can be divided into primary and secondary HPS.The disease is complex,lacking of specificity,difficult in diagnosis with quick progress,high mortality and poor prognosis.The diagnosis is mainly based on the HPS-2004 diagnostic criteria,etoposide,dexamethasone and cyclosporine would be first chosen for treatment.This article reviews the clinical advances on etiology,diagnosis,treatment and prognosis of hemophagocytic syndrome.

Objective To develop a cutting and coagulation device with searching for surgical operation method. Methods By using the relative theory of electric technology, choice some ceramics matter and form any vibration frequency and carry out cutting biology organization and stopping blood. Results The sample instrument was made successfully, and was used in the animal experiments and clinical experiments. Conclusion This instrument has much better applying prospect and greater market demand.

Thrombotic thrombocytopenic purpura (TTP) is a kind of thrombotic microangiopathies which has low incidence but highly mortality.The outcome of TTP has been improved significantly since last decade due to the application of plasma exchange,however,early relapse occurs in some patients,and for relapsed/refractory patients the prognosis is still poor.This article reviews the recent progress in treatment and relevant influencing factors of TTP.

Objective To explore the effect of costimulatory moleculars expressed peripheral CD4+ T lymphocyts on graft-versus-host disease(GVHD) after allogeneic hematopoietic stem cell transplantation (alloHSCT). Methods 21 patients who suffered of hematology diseases or malignant solid tumors were underwent allo-HSCT and 10 normal individuals were enrolled in the study. The levels of CD28, CD80 and CD152expressions on peripheral CD4+ T lymphocytes were detected by FCM in different time(before allo-HSCT, 7 day,14 day, 21 day, 30 day after allo-HSCT, thetime of GVHD and the time after GVHD treated). STR-PCR was used to detect micro-satellites chimeras forming. Results All 21 patients achieved engraftment. By STR-PCR assay, 12 cases formed complete chimeras (CC) and 9 cases formed mixed chimeras (MC). A multivariate COX survival function modle analysis showed: CD4 CD152 was independent prognostic factors for GVHD (x2=13.128,P ＜0.0001). Patients with GVHD demonstrated higher CD4+ CD28+, CD4+ CD80+ and CD4+ CD152+ T cell levels than those without GVHD (P ＜0.01); patients with aGVHD demonstrated higher than those with cGVHD (P ＜0.05)and without GVHD (P ＜0.05); Patients with GVHD demonstrated lower CD4+ CD152+ T cell level than those without GVHD (P ＜0.01); the same result occured between aGVHD and cGVHD and without GVHD.Conclusion The incidence of GVHD between NST and traditional HSCT have no difference. B7-CD28/CD152 costimulatory pathway plays a critical role in the development of GVHD.

Objective To investigate the effect of anti-apoptotic protein HSP-90 in human multiple myeloma cell line U266 cells after bertezomib interaction. Methods The HSP-90 mRNA expression in the U266 cells was tested by reverse transcription polymerase chain reaction (RT-PCR) after 4 hours of treatment of bertezomib by different concentration. Results With the of increased concentration of bortezomib, the expression level of HSP-90 αmRNA was also increased in U266 cells. Respectively, quantitative results of HSP-90α are 0.343±0.017, 0.505±0.039, 0.640±0.029, 0.760±0.059, 0.963±0.054 from the low to high concentration of bertezomib groups. And there are statistical difference between each group(P <0.05). However, the HSP-90β quantitative results in 0 nmol/L concentration of bertezomib (0.61±0.022) have statistical difference between 50, 150, 200 nmol/L groups(P <0.05). HSP-90β quantitative results in 50(0.765±0.050)and 100 nmol/L(0.645±0.052) nmol/L groups are different(P <0.05). Compared with 100 nmol/L concentration of bortezomib group, statistical difference also exists in 150 (0.770±0.059) and 200 nmol/L (0.790±0.027)groups (P <0.05). Although there is no obvious increase in the mRNA expression of HSP-90β from the chart, statistical difference existed in the whole data (P <0.05). Conclusion Bortezomib can increase the level expression of HSP-90 mRNA, and especially increase the level expression of HSP-90α mRNA.

Objective To construct an eukaryotic vector with expression of human survivin gene with green fluorescent protein which is named pIRES2-EGFP/survivin and transfected into K562 cell line.Methods Using pDNR/Survivin plasmid as a template, the full length of survivin cDNA was amplified by PCR and subsequently cloned into T-A vector and then subcloned into pIRES2-EGFP vector. After identified by digestion of restrictive endonucleases, pIRES2-EGFP/survivin was further confirmed by sequencing. Then it was transfected into K562 cells with superfect reagents. The mRNA was isolated and survivin gene was detected by Western blotting. Results The exact sequences of pIRES2-EGFP/survivin vector were confirmed by digestion of restrictive endonucleases and sequencing. After transfection, the expressions of green fluorescent protein were present. The mRNA expression of survivin has been detected in transfected cells by RT-PCR. Conclusion The vector pIRES2-EGFP/survivin has been constructed and could express survivin gone in K562 cells successfully.

Objective To investigate the correlation between exhaled nitric oxide and lung function (FEV1)in asthmatic children.Methods Fifty three stable asthmatic children aged 5 to 14 years old were recruited from ShengJing Hospital of China Medical University.According to whether the patients were treated with inhaled corticosteroid(ICS)therapy regularly,they were divided into two groups:steroid group and non-steroid group,then fraction of exhaled nitric oxide(FeNO)and lung function were measured.Results In non-steroid group,the levels of FeNO(mean 40.450±25.428 part by billion)were significantly higher than those in the steroid group(mean 19.879±13.845 part by billion),and they were statistically significant.(P = 0.003).The mean FEVI in non-steroid group was(95.152±8.993)%,and the mean FEVI in non-steroid group was(91.350±11.690)%,and there were no significant differences between two groups (P =0.189).Significantly negative correlation was found between FeNO and FEV1 in steroid group(r =-0.465,P = 0.039),but there was no significant correlation between them in steroid group(r = 0.058,P =0.747).Conclusion The levels of FeNO were higher in non-steroid group than those of the steroid group in the stable asthmatic children.FeNO is a good biomarker to evaluate the airway inflammation of asthmatic children.