Dipeptidyl peptidase-Ⅳ (DPP-Ⅳ/CD26,EC 3.4.14.5),a transmembrane serine polypeptidase,is widely distributed and has diverse effects.As a dipeptidase,DPP-Ⅳ/CD26 could not only regulate the activity of many peptide hormones,neuropeptides,cytokines and growth factors via its peptidase function,but also mediate cell-matrix and cell-cell contact through interactions with other molecules or proteins as a surface antigen.DPP-Ⅳ/CD26 plays a regulatory role in immune activation,inflammation and tumorigenesis.This review covers the structure,distribution,physiological functions and changes in pathological state of Dpp-Ⅳ/CD26.

Objective To discuss the clinical characteristics and management principles of com-posite pheochromoeytoma of adrenal gland (pheochromocytoma-ganglioneuroma). Methods Four cases of composite tumor of adrenal gland diagnosed pathologically were reviewed. All the cases were male, aged 37 to 62 years;three of them had the history of hypertension, one of them accompanied with paroxysmal palpitation, while one case was asymptomatic. Computerized tomography and ultra-sonography showed single tumor in adrenal, the diameter was about 2.5、3.8、6.3、15cm respectively. Two cases showed positive results in 131Ⅰ-metaiodobenzylguanidine (MIBG) scintigraphy. One case showed positive result in 99Tcm-hydrazinonicotinamide-3trysinoctreotide (HTOC) scintigraphy. Twenty-four hours urinary catecholamine examination revealed the average of norepinephrine, epi-nephrine and dopamine were (196.1±92.2)nmol/24 h, (26.6±8.9)nmol/24 h, (1957.9±913.5) nmol/24 h respectively. Two cases were at a little elevated level and the others with normal. All cases were managed with α-adrenergic receptor blocker preoperatively for 2-4 weeks. Results Tumor re-section was performed in all 4 cases, and 3 cases by retroperitoneal laparoscopy, one by open surgery. All 4 cases were diagnosed as composite pheochromocytoma of adrenal (Pheochromocytoma-gangli-oneuroma) by pathology. All patients had no evidence of recurrence or metastasis during follow-up from 15 to 38 months. Two of three cases with hypertension reverted to normotensive. Conclusions Composite pheochromocytoma of adrenal is rare, difficult to be diagnosed preoperatively. Except mild in eatecholamine secretion, which clinical manifestations are similar to pheochromocytoma. Pheochro-mocytoma-ganglioneuroma is no apparent tendency for aggressive behaviors, the results of surgical management are favorable.

Objective To assess the feasibility and advantage of systematic transperineal ultrasound guided template prostate biopsy. Methods In a prospective study, a total of 1270 patients(26 -90 year old,mean age 70. 4) who met the inclusion criteria underwent 11 regions systematic transperineal ultrasound guided template prostate biopsy. The median PSA level was 12. 96 ng/ml(range 0. 25000. 0 ng/ml) and the mean prostate volume was 53. 6 ml(range 7-200 ml). Results Prostate cancer was detected in 486 of 1270(38. 3%). The prostate cancer detection rate in group with PSA 0-4.0, 4. 1-10. 0, 10. 1-20. 0, 20. 1-40.0, 40. 1-60.0, 60. 1-100.0、and> 100. 0 ng/ml groups was 21.9%(16/73 )、16.6%(67/ 403)、30.7% (122/397)、46. 7%(77/165)、68. 3%(41/60)、86.2% (46/54) 、99.2% (117/118), respectively . While cancer detection rate in group with prostate volumes less than 20, 21-40, 41-60, 61-80 and great than 80 ml was 72. 1%(49/68 )、55. 6%(234/421) 、32.5%(136/418)、23.3%(48/206)、12. 1%、(19/157). The mean positives for the cancer of regions 1- 10 and region 11 (the apical region) were 35.3% vs. 44.8% in patients whose PSA＜20ng/ml(P＜0. 05). The positives for cancer within the right lobe and left lobe were 70. 8% vs. 74.2%(P>0.05)and the positives for cancer within the anterior and posterior parts were 79. 4% vs. 86. 8%(P>0. 05). No serious complication occurred during the procedure. Conclusions Systematic transperineal ultrasound guided template prostate biopsy could be accurate and safe. Prostate carcinoma foci are more frequently localized in the apical region in patients with PSA ＜20 ng/ml. Special attention should be paid to the apical region during the process of biopsy.

Objective To evaluate the safety and efficacy of adrenal autotransplantation for the treatment of persistent Cushing's disease after transsphenoidal pituitary tumor resection. Methods Four patients were treated by adrenal autotransplantation with attached blood vessels after bilateral adrenalectomy for persistent Cushing's disease from April 1991 to March 2008 in our institute. The four patients were 3 females and 1 male. Their ages ranged from 14 to 36 years, with an average of 30 years. Right adrenalectomy was performed 1 to 3 months before the left adrenalectomy. 30 % ?50 % of the left hyperplastic adrenal was placed in the left inguinal region with the anastomosis of the inferior epigastric artery and the central adrenal vein, and between the left saphenous vein and the incised adrenal envelope with the adrenal middle artery inside. The hormone replacement dosage decreased gradually after operation. They were followed up for 1.0, 1. 5, 8. 0 and 10. 0 years. The patient's symptoms, adrenal hormone (serum cortisol, urinary free cortisol and adrenocorticotroph) levels and the steroid replacement dosages were recorded and analyzed. Results The symptom of the Cushing's disease disappeared completely after operation and there was no Nelson's syndrome except one patient with slight darken skin. Through 4 ways of imaging examination, operation, clinical presentation and endocrine examination, the 4 transplanted adrenals functioned well with less steroid replacement dosage needed after operation. The 4 transplanted adrenal glands functioned steadily 1 year after the auto-transplantation, and no hyperplasia was detected in the transplanted adrenals with the stimulus of high dosage adrenocorticotroph. Conclusions The long-term effects of adrenal autotransplantation with attached blood vessels after bilateral adrenalectomy is effective and safe. Adrenal autotransplantation can be a feasible option for the treatment of persistent Cushing's disease.

Background and purpose:Indensity modulated radiotherapy(IMRT) is an advanced method in radiotherapy field.Divect machine optimization technique is an good aritmetic for IMRT optimization.The purpose of this study was to compare the dosimetric differences between traditional technique and direct machine parameter optimization(DMPO) technique in the treatment of nasopharyngeal carcinoma(NPC) using step and shoot IMRT.Methods:Eleven patients of(NPC) were treated with step and shoot IMRT in Cancer Hospital,Fudan University from Feb.2005 to May 2006.Their plans(original plan,defined as treat) were archived for comparing with four kinds of IMRT plans(defined as DMPO100,DMPO90,DMPO80,DMPO70) with different predefined maximum number of segments(100,90,80,70,respectively),which were designed to use direct machine parameter optimization(DMPO) technique.We compared the total monitor units(MU),total segments,dose distribution and conformity index among the plans.Results:All the plans showed similar target coverage.Compared with traditional technique,IMRT plans with DMPO technique showed higher conformity index,and had similar uniformity except plan DMPO70.The dose distributions of DMPO100 and DMPO90 were similar or superior to the original plan(treat) in terms of critical organs.Without sacrificing plan quality,the total segments were about half of traditional plan if DMPO technique was used for planning.Moreover,the total monitor units(MUs) and the radiation time were decreased.Conclusions:Compared with traditional technique,plans designed with DMPO technique show sharp decrease in total segments without sacrificing plans quality in the treatment of nasopharyngeal carcinoma(NPC).The DMPO technique can also decrease the total MUs and radiation time.

Objective To evaluate the role of adrenolectomy in ectopic ACTH syndrome. Methods Clinical data of 23 cases of ectopic ACTH syndrome were analysed.Of them,14 were males and 9 were female,the average age was 38.All of the 23 cases had clinical and biochemical and imaging evidences for the diagnosis of Cushing's syndrome.16 of the 23 cases were treated with total adrenalectomy and the other 7 were treated without surgical intervention. Results Sixteen cases,having no identifiable source of ectopic hormone production, treated with bilateral or unilateral total adrenalectomy,had resolution of their presenting signs and symptoms,1-year survival was 67%,2-year survival was 44% and 5-year survival was 19%.Seven of the patients who were managed without surgical intervention,1-year survival was 0%. Conclusions To most patients with no identifiable source of ectopic hormone production, bilateral adrenolectomy with hormonal replacement is effective.

Through teaching on diving site,teachers can help students strengthen the un-derstanding and memory on theoretical knowledge,translate the knowledge into practical skills,and obtain primary medical supervisal capabilities. Scene teaching in diving unites can help students learn about the great achievements in the past and the present situations. Such understandings would be good for the students’fostering the responsibility and mission sense as a diving physician. In conclusion,it is very necessary to teach on diving site in the teaching of diving medicine,and such teaching should be kept as an essential part.

Objective To evaluate the clinical application of a muhiprobe FISH (multicolor fluorescence in situ hy-bridization,M-FISH) assay in voided urine specimens for detection of bladder cancer and compare the results with those afforded by urinary cytology.Methods Voided urine specimens from 100 cancer patients with or without surgery and 10 patients with prostate hyperplasia were obtained for urinary cytology and FISH.FISH was performed using a mixture of fluorescent labeler DNA probes for the centromeric regions of chromosomes 3,7,and 17 and 9p21 region.Cystoscopy with biopsy or tumor resection was performed in all patients and compared the pathological results with the cytological and FISH findings.Results The sensitivity of M-FISH were 75.6% for low grade tumors,100% for high grade tumors,with overall sensitivity of 85.5%.Urinary cytology affords an overall sensitivity of 62.9% (33.3% for low grade tumors,96.0% for high grade tumors).Significant difference in overall sensitivity was observed between M-FISH and urinary cytology (P＜0.05).The specificity of M-FISH and urinary cytology was 84.6% and 87.8% respectively.No significant difference in specificity was observed between M-FISH and urinary cytology.Conclusion M-FISH improves the sensitivity obtained with urinary cytology for bladder cancer detection with similar specificity,so can detect all high grade infiltrating tumors patients.

Objective: To observe the clinical effect of sodium nitroprusside and dopamine injected by micro pump for the treatment of refractory heart failure. Methods:One hundred and six cases of patients with refractory heart failure were chosen as the research object, which were cardiac functionⅢ~Ⅳlevel. All patients were treated with sodium nitroprusside and dopamine injected by micro pump. Starting dose of sodium nitroprusside was 6.25 μg/min. At same time pumping dopamine, starting dose of 2 g/kg·min, the dose was increased gradually until blood pressure dropped to 90~100 mm Hg, continuous 7~10 d, the signs and symptoms after treatment and parameters of cardiac function and adverse reactions were observed. Results: 1)In 106 cases of patients with refractory heart failure after treatment, the total effective rate 85.85%(91/106). 2)The heart rate, blood pressure, cardiothoracic ratio, left ventricular short axis reduced rate,cardiac output, each index of cardiac,indexes of left ventricular ejection fraction were improved significantly after treatment. Conclusion:The clinical effect for the treatment of refractory heart failure by using the micro pump injection of small doses of sodium nitroprusside combined dopamine would be obvious, have less adverse reactions, worthy of clinical popularization and application.

Objective　To study the induction of apoptosis and the regulation of apoptosis related genes bcl-2, bax and ICE expression by wild-type p53 gene. Methods　A p53 gene recombinant adenovirus vector, ad CMV p53, was transfected into human bladder cancer cell HTB9. The level of bax mRNA was quantified by reverse transcription-polymerase chain reaction (RT-PCR). The content of Bcl-2, Bax and ICE protein were detected by immunochemical staining. Agarose gel electrophoresis of DNA、 terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) method and flow cytometric technique were used for analysis of apoptosis. Results　Introduction of wild-type p53 could increase the mRNA and protein level of bax, and could induce apoptosis in HTB9 cells with the apoptotic percentage of 50.4%. At the same time, the introduction also increased the protein level of ICE, but that of Bcl-2 decreased.Conclusion　It's very possible that wild-type p53 gene induced apoptosis by regulating the expression of apoptosis-related genes including bax, bcl-2 and ICE.