Objective To evaluate the clinical manifestations and responses to treatment of adult onset Still's disease (AOSD).Methods One hundred and four AOSD patients were retrospectively analyzed with clinical features and treatment responses.Results The major clinical features were:spiking fever (100%),evanescent maculopapular rash (95%),polyarthralgia (90%),sore throat (78%),lymphadenectasis (66%),hepatosplenomegaly (57%),hydmhymenitis (30%),neutrephilia (98%),liver dysfunction (62%),increased erythrocyte sedimentation rate (96%) and hyperferritinaemia (99%).Reactive lymphnodes hyperplasia was shown in all patients underwent lymphnode biopsy.94% and 66% patients were treated with glucocorticoid and immune suppressants.Those treated with ≥40 mg/d prednisone or its equivalent dosage achieved quicker remission and less relapses.Conclusion Patients who present with spiking fever,polyarthralgia,maculopapular rash,sore throat and predominant neutrophilia should be considered the possibility of AOSD after tumor or infection are excluded.Glucoeorticoid and immune suppressive drugs are effective medications for AOSD.

Objective To evaluate the expressions of TBX2 and MDM2 protein in urothelial carcinoma of bladder.Methods The expressions of TBX2 and MDM2 protein were examined by immunohistochemistry EnvisionTM Plus method in 90 cases of urothelial carcinoma of bladder and 20 cases of normal bladder mucosa tissue.Results The positive rate of TBX2 and MDM2 protein was 0 in normal bladder mucosa tissues.The positive rate of TBX2 in urothelial carcinoma of bladder was 65.6％ (59/90).With the increased of TBX2 expression degree,the carcinoma tissue was worse cell differentiation,later clinical stage,more prone to recurrence (P ＜ 0.01).The positive rate of MDM2 in urothelial carcinoma of bladder was 31.1％(28/90).With the decreased of carcinoma tissue differentiation degree,the positive rate of MDM2 was increased (P ＜ 0.01).The positive rate of MDM2 in recurrence patients was 57.5％ (23/40),in non-recurrence patients was 10.0％ (5/50),there was statistical difference (P ＜ 0.01).The positive rate of MDM2 in pTNM stage Ta-T1 was 0,in pTNM stage T2-T3 was 73.7％ (28/38),there was statistical difference (P ＜0.01).There was positive correlation between the expression of TBX2 and MDM2 in carcinoma tissue (r =0.487,P ＜ 0.05).Conclusions The over expression of TBX2 and MDM2 protein may closely associated with aggressive biological behavior and recurrence in urothelial carcinoma of bladder.Combined analysis of TBX2 and MDM2 may provide a theoretical basis for prognostic information and treatment of patients with urothelial carcinoma of bladder.

Objective To investigate significance of interferon-γ/interleukin-4(IFN-γ/IL-4) and macrophages in uterus in early embryo loss (or resorption), and to elucidate the anti-abortive effect and the immunological modulation at maternal-fetal interface with quercetin and bornvl acetate. Methods Lipopolysaccharide (LPS)(0.10μg/mouse)was injected via tail vein in order to induce abortion in 7-day-gestation mice which received quercetin and bornvl acetate at days 4-7 of gestation. Levels of IFN-γ and IL-4 in uterus lysate supernatant were measured using enzyme-linked immuno-absorbent assay (ELISA), and uterine macrophages of each group ( n =10) were detected by immunohistochemistry. Results The amount of macrophages was much higher in the uteri of LPS-induced abortion mice than that in control mice. The abortion rate of mouse declined to certain level. The therapy of quercetin combined with bornyl acetate reversed LPS-induced abortion. Conclusion The increase of IFN-γ/IL-4 and the amount of macrophages in the LPS-treated mouse uterus is associated with the embryo loss, and quercetin and bornyl acetate have the anti-abortive effect through modulation of maternal-fetal interface immunity balance.

Objective To assess the impact of donor age on the outcome of living donor kidney transplantation.Methods A total of 217 patients undergoing living donor kidney transplantation during 2004 to 2011 were enrolled in our retrospective study.The recipients were divided into different groups according to their donors' age or the age gaps between donors and recipients.A follow-up survey was conducted to evaluate the serum creatinine level and the incidence of complications after transplantation.Results As the donors age grew,the recipients' serum creatinine increased.The serum creatinine levels of patients with older donors(age gap＞5 years) at 1 month[(143.5±42.1) μmol/L vs (114.4±30.4) μmol/L],3 months (139.9±36.6)μmol/L vs (110.6±33.3) μ mol/L],1 year [(132.1±22.1) μmol/L vs (105.5±35.9) μmol/L] and 2years (132.0±45.4) μmol/L vs (97.2±17.5) μ mol/L] after operation were significantly higher than those with younger donors(age gap＜-5)(P＜0.05).The incidence of acute rejection (19.4％ vs 9.7％,P＜0.05) and chronic rejection (9.7％ vs 1.4％,P＜0.05) was significantly higher in the group with donors older than 50 years old than those with donors younger than 50 years old.But no significant difference was observed in the survival of the grafts or the recipients.Age gap between the donor and recipient was an independent risk factor for abnormal serum creatinine level at 2 years after transplantation (OR=5.010,P＜0.05).Conclusions Donor age is an important impact factor on the outcome of living kidney transplantation.Recipients of older living donation have poorer Prognosis.

Objective To prepare Mi 2 antigen,detect anti Mi 2 antibody and investigate its significance in autoimmune connective tissue diseases (CTD).Methods Mi 2 antigen was prepared from rabbit thymus acetone powder and purified by DE52 chromatography.Anti Mi 2 antibodies were tested in 40 normal controls and 315 patients with CTD by double immunodiffusion.The distribution of anti Mi 2 antibodies in CTD was analysed.The clinical characteristics of dermatomyositis between anti Mi 2 positive group and negative group were compared.Results The precipitation line developed between the antigen and the standard anti Mi 2 serum.In DE52 chromatography,Mi 2 antigen was found in elute with 0 1 mmol/L and 0 2 mmol/L NaCl.The positive rate of anti Mi 2 antibodies was 26 1%(12/46) in dermatomyositis and 4 5%(2/44) in polymyositis respectively.There were no positive cases in 50 patients with rheumatoid arthritis,30 patients with primary Sjgren syndrome (SS),60 patients with systemic lupus erythematosus,50 patients with systemic sclerosis,35 patients with other CTD and 40 normal controls.The specificity of anti Mi 2 antibody in dermatomyositis was 99 4%.In dermatomyositis,the patients with positive anti Mi 2 antibody usually presented skin lesions at beginning,and most patients had V sign and/or shawl sign during the course of disease.On the other hand,the antibody negative ones manifested muscle involvements initially and easily got fever during the course of disease.There were statistic differences between the two groups in above features ( P

Our previous study showed that transmembrane TNF-alpha (TM-TNF-alpha) had broader tumoricidal spectrum than secretory TNF-alpha (s-TNF-alpha). This study examined the difference between the two kinds of TNF-alpha in inducing cells and the relationship between the apoptosis induced by TM-TNF-alpha and the cell cycle. Bioassay was employed to compare the cytotoxic effect of two kinds of TNF-alpha on cell lines L-929 and HepG2. TUNEL was used to detect apoptosis and the TdT and PI co-staining were used for determining the phase of apoptotic cells. Our results showed that TM-TNF-alpha could kill not only s-TNF-sensitive L929 cells but also s-TNF-tolerant HepG2 cells. TM-TNF-alpha predominantly induced apoptosis while s-TNF could induce both apoptosis and necrosis. The apoptosis of L-929 cells induced by TM-TNF-alpha mainly occurred in S phase and the apoptosis of HepG2 predominantly took place in G(1) phase. It is concluded that the cytotoxic effects of the two TNF differ substantially. Since TM-TNF-alpha works locally, mainly induces apoptosis and has broader anti-tumor spectrum, it may be more effective for the treatment of tumor than s-TNF.

Objective To explore the clinicopathologic characteristics,to screen risk factors of metastasis and to analyze the diagnosis,treatment and prognosis of gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN).Methods From January 2010 to November 2015,the clinical data of 405 patients with GEP-NEN were retrospectively analyzed.GEP-NEN tumors were classified as neuroendocrine tumor (NET,G1 and G2 grade),neuroendocrine carcinoma (NEC,G3 grade) and mixed adenoendocrine carcinoma (MANEC,G3 grade).The clinicopathologic characteristics were summarized.The staining characteristics of synaptophysin (Syn),chromogranin A (CgA) and CD56 of tumor tissues were analyzed by immunohistochemistry.x2 and t test were performed to analyze differences in pathologic characteristics between groups.Logistics regression method was used to analyze the risk factors of metastasis.KaplanMeier method and Log-rank test were used for survival analysis.Results The mean age of patients with GEP-NEN was (54.7± 13.3) years.Gastric NEN was the most common GEP-NEN (98 cases,24.2％),followed by 95 cases (23.5％) with NEN in rectum,86 cases (21.2％) in pancreas and 50 cases (12.3％)in esophagus.Among them,47 cases (11.6％) were functional GEP NEN and 358 cases (88.4％) were non-functional GEP-NEN.According to pathologic diagnosis,227 cases (56.0％) were NET,125 cases (30.9％) were NEC and 16 cases (4.0％) were MANEC.According to tumor classification,120 cases (29.6％) were grade G1,108 cases (26.7％) were grade G2 and 177 cases (43.7％) were grade G3.Immunohistochemistry staining positive ratesof Syn,CgA and CD56 were 97.4 ％ (381/391),44.0 ％ (121/275) and 83.9％(291/347),respectively.The median (lower quartile,upper quartile) diameter of grade G1,G2 and G3 tumors were 1.0 cm (0.6 cm,1.5 cm),1.5 cm (1.0 cm,2.5 cm),4.0 cm(2.5 cm,6.0 cm),respectively,and the difference was statistically significant (Z =99.171,P ＜ 0.01).The positive rate of CgA of grade G3 tumor was lower than that of grade G1 and G2(x2 =7.078 and 11.391,both P＜ 0.01).The results of Logistic regression analysis revealed that tumor size and pathologic classification were the important predictors of metastasis.The median survival time of metastasis group and non-metastasis group of grade G3 was 12.0 months and 41.5 months,and there was a significant difference between the two groups by Log-rank test (x2 =37.075,P＜0.01).Conclusions GEP-NEN may occur at any part of the digestive system.There are differences in tumor size positive rate of,immunohistochemistry staining and the primary site of tumors with different pathological grading.The tumor diameter and pathologic classification are the important predictors of metastasis.The prognosis of metastasis group is worse than that of non-metastasis group.

ObjectiveTo investigate the possible association of interleukin-23 receptor(IL-23R) polymorphisms with the susceptibility and phenotype of inflammatory bowel diseases (IBD) in Jiangsu Han population.MethodsWe genotyped 178 IBD patients including 135 patients with ulcerative colitis ( UC),43 patients with Crohn's disease (CD),and 134 headthy controls for rs11805303,rs1343151,rs11465804,rs11209032,rs17375018,rs11465788.ResultsComparing with the controls (50.4％ ),there was a significant increase in the carriage of the T allele of rs11805303 in UC (60.4％) ( P =0.020).In genotypephenotype correlation of rs17375018 in UC,clinical severity(UCDAI) was associated with the prevalence of the G allele showed a trend to mild activity.Genotype polymorphisms of rs17375018A was observed more in younger than 25 in the genotype-phenotype correlation in CD(41.7％ vs 22.0％,P =0.050,OR =2.532,95％ CI 0.988-6.494),while rs11805303 was associated with age at diagnose and disease lesion (P =O.039 and 0.044).The risk of extra intestinal manifestation in rs17375018A allele carriers was lower (23.1％ vs46.7％,P=0.040,OR =2.917,95％CI 1.027-8.283).ConclusionsWe confirmed the susceptibility of rs11805303polymorphisms with UC and first demonstrated the genotype-phenot correlation of rs11805303,rs17375018 with UC,CD in Jiangsu Han population.

Objective To evaluate the efficacy and safety of covered metallic stents in the management of proximal esophageal strictures.Methods Retrievable covered self-expanding metallic stents were inserted individually in 43 patients with malignant strictures of the proximal esophagus.Main outcome measures included improvement of dysphagia,sealing of fistula and complications were evaluated.Results A total of 45 stents were placed in 43 patients,with a success rate of 95.6％ (43/45) at the first stent placement attempt.The dysphagia score improved significantly from 3.3 ± 0.6 to 1.8 ± 0.9 (P ＜ 0.001),with 18 having an excellent response and 25 having a good response.Improvement rate of dysphagia was 95.6％ (43/45).Fistula sealing was achieved in 7 of 9 patients (77.8％).Early complications included severe pain (n =5),mediastinal emphysema (n =1),moderate fever (n =9) and collapse of the proximal end of the stent (n =1),while late complications included migration (n =3) and tissue overgrowth (n =6).Conclusion Retrievable covered metallic stent placement is effective and safe for the palliation of obstructive dysphagia and sealing of fistulas in malignant proximal esophageal strictures.

Objective To investigate the clinical,neuroimaging and pathological features of patients with corticobasal syndrome (CBS).Methods Three CBS patients underwent neuropsychological assessment,MRI scan,18F-FDG PET scan,and 11C-PiB PET scan,and the test results were analyzed.Results All three patients showed poor response to levodopa treatment and asymmetric dyskinesia including rigidity,tremor,dystonia and abnormalities in posture and gait.One patient showed apraxia and three patients presented with cognitive impairment.The crania MRI demonstrated mild cerebral atrophy which was slightly more severe in the contralateral side of the initially affected limb.The (18)F-FDG PET/CT scan revealed asymmetric decreased metabolism in the frontal,parietal,temporal,and insular lobe,as well as in basal ganglia.The results of (11)C-PiB PET showed that amyloid beta-peptide (A Beta) deposition in the cortex was positive in one patient,and negative in the other two patients.Conclusions Corticobasal syndrome is characterized by asymmetric dyskinesia and cognitive impairment,and often associated with apraxia,cortical sensory deficits,and alien limb phenomena.The MRI and FDG PET are helpful for CBS diagnosis,and the PiB PET facilitates the pathological diagnosis.