Transcription is a multi-stage process that coordinates several steps during the transcription cycle including pre-initiation,initiation and elongation.Recent advances by genome-wide study suggest that control of transcription elongation is a critical step for precise regulation of gene expression across species from Drosophila to mammals.Here we review the molecular mechanisms of how transcription elongation of RNA polymeraseⅡ(PolⅡ) is modulated by the major pausing factors-NELF,DSIF and the positive elongation factor P-TEFb,which is the key player in pause release.We also discuss the potential implications of regulation of transcription elongation in pathogenesis of cancer,inflammation and virus infection.

ObjectiveTo investigate the high risk factors,etiology,diagnosis,treatment and precaution of venous thromboembolism (VTE) in pregnancy and puerperium. MethodsData of 16 cases of VTE admitted in Department of Obstetrics and Gynecology,Peking Union Medical College Hospital from January 1992 to April 2011 were analyzed retrospectively.The differences of blood routine test and coagulation function between VTE patients (study group) and normal pregnant women (control group) were compared by paired t test in this case-control study.Results All patients were diagnosed by color Doppler ultrasound or CT pulmonary artery angiography.Five cases (31.2 ％) occurred before delivery and 11 (68.8 ％) occurred during postpartum.Two cases (12.5 ％)complicated by pulmonary thromboembolism,and one of them died.Six cases (37.5％) were older than or equal to 35 years old,and 12 cases (75.0％) had gestational complications.The hematocrit in study group were lower than that in control group (0.29±0.06 vs 0.39±0.02,t=4.56,P=0.01).There was no statistical difference between the coagulation function of the two groups.After anticoagulant therapy or surgery,15 cases recovered.One pulmonary thromboembolism patients complicated with rheumatic cardiac disease remained shock after anti-coagulants was administered,then died of hemorrhage of respiratory tract after inferior vena cava filter placement. Conclusions VTE is likcly to happen in puerperium than in pregnancy.There are no good screening indicators for thromboembolism during pregnancy and puerperium.Anticoagulation is recommended to be the first line therapy.For women with high risk of thromboembolism,it is suggested to prevent actively and treat early to decrease the complications and long-term sequelea.

Purpose:Occult carcinoma of thyroid ( OCT) is difficult to differentiate from benign thyroid nodules because it is small ( < 1 cm),often asymptomatic,shares similar ultrasonographic characteristics.The aim of this study was to retrospectively review the ultrasound diagnosis and pitfalls of ultrasound in OCT.Materials and Methods: The ultrasonography in 37 cases suspected of OCT were reviewed,analyzed and compared with histopathology.Results: 30/37 (81.1% ) cases (38 nodules) confirmed of OCT were found solid,hypoechogenic nodules in 97.4%,with irregular margins ( 33/38,86.8% ),longitudinal-to-transverse ratio = 1 ( 17/38,44.4% ),minute calcification (19/38,50.0%),decreased flow (36/38,94.7%),and resistance index < 0.7( 30/37,81.1%).7/37 (19.0%) cases of misdiag-nosis included 3 chronic lymphocytic thyroiditis with nodules,2 nodular goiter and 2 collagen nodules.They all had overlapping ultrasonographic features.Conclusion: Those ultrasonographic features were of certain value in OCT.

Objective To explore the relationship between TSLC-1 protein expression and the progression and carcinogenesis of human papillary thyroid carcinogenesis. Methods Expressions of TSLC-1 protein in 20 pieces of benign thyroid lesions and 40 pieces of papillary thyroid carcinoma tissues were examined by immunohistochemistry. Results The expression of TSLC-1 in papillary thyroid carcinoma (9/40) was lower than that in benign thyroid lesions (22.50% versus 90.00%, P < 0.05). Expression of TSLC-1 was significantly associated with lymph node metastasis and TNM in papillary thyroid carcinoma (P < 0.05). Conclusions Expression of TSLC-1 is closely related with carcinogenesis , lymph node metastasis , and clinical stage in papillary thyroid carcinoma.

Objective:To explore yhe therapeutic effect of Shenfu injection on patients of hepatic cirrhosis with seroperitoneum(yang de ciency of spleen and kidey synndrome).Methods:The 84 patients were divided into treatment group and control group,the patients in treatment group were treated with western medicine and Shenfu injection,only western medicine were used in control group,they were all treated for twenty-eight days.Results:The curative e ect,extinction time of seroperitoneum,amelioration of hepatic function and blood routine of the treatment group were better than those of control group.And there were statistical signi canc between two groups(P

Objective To compare the clinical value of Heidelberg retinal tomography (HRT-Ⅱ) and Heidelberg optical coherence tomography (HRA OCT) in discriminating healthy eyes and pre-perimetric glaucoma eyes.Methods A total of 33 patients with pre-perimetric glaucoma and 37 healthy subjects were included in this study.All individuals underwent imaging tests with HRT-Ⅱ and HRA OCT within 1-month period.ANOVA and Kruskal-Wallis test were used to compare all of the parameters from HRT-Ⅱ and HRA-OCT between pre-perimetric glaucoma eyes and normal eyes.Receiver operating characteristic curves (ROC) were calculated for all of the parameters to seek the best discriminant point of each instrument between pre-perinmetric glaucoma and healthy eyes.Results Statistically significant differences were found in most of the HRT-Ⅱ parameters except for disc area and height variation contour between pre-perimetric glaucomatous eyes and normal eyes (all P＜0.05),which showed that most of the HRT-Ⅱ parameters were capable of diagnosing preperimetic glaucoma except for the disc area and height variation contour (all P＜0.05).66.7％ of the areas under the receiver operating characteristic curves (AUC) from HRT-Ⅱ parameters were larger than 0.800 and 58.3％ of the AUC were larger than 0.900.Statistically significant differences were found in most of the HRA-OCT parameters except for the nasal retinal nerve fiber layer (RNFL)thickness between pre-perimetric glaucoma eyes and normal eyes (all P＜0.05),which showed that most of the HRA-OCT parameters were capable of diagnosing pre-perimetic glaucoma except for the nasal RNFL thickness (all P＜0.05).66.7％ of the AUC from HRA-OCT parameters were larger than 0.800 and 33.3 ％ of the AUC were larger than 0.900.No statistically significant difference was found between the AUC for the best parameter diagnosing pre-perimetic glaucoma from HRT Ⅱ (cup/disk area ratio,AUC =0.984) and HRA OCT (average RNFL thickness,AUC =0.940).No Statistically significant differences were found in specificity and sensitivity of diagnosing pre-perimetic glaucoma between the two best parameters cup/disk area ratio and average RNFL thickness (both P＞0.05).Conclusions Both HRT-Ⅱ and HRA-OCT can well reflect the damage of optic disc and retinal nerve fiber layer in eyes with pre-perimetric glaucoma.HRT-Ⅱ and HRA-OCT have higher accuracy and similar sensitivity and specificity for the diagnosis of pre-perimetric glaucoma.

Objective To analyze the clinical risk factors of type 2 diabetes complicated with cerebral infarction .Methods 508 patients with type 2 diabetes were selected and divided into two groups :group A (complicated with cerebral infarction ,n=240) and group B (without cerebral infarction ,n=268) .The basic clinical information of two groups were recorded .The coagulation indica‐tors and biochemical indicators (including blood glucose ,blood lipid ,HbA1c ,blood β2 microglobulin ,urineβ2 microglobulin ,urine microalbuminuria ,fasting insulin ,fasting C peptide etc) were detected respectively .Results There were significant differences in age ,age at onset of diabetes ,duration of hypertension and systolic blood pressure between group A and group B (P<0 .05) .The in‐cidence of hypertension and coronary heart disease in group A were higher than group B (P<0 .05) .Comparing with group B ,the levels of HbA1c ,ApoB ,fasting insulin ,fasting C‐peptide ,lipoprotein (a) ,Hcy ,blood β2 microglobulin ,urineβ2 microglobulin ,and urine microalbuminuria of group A were significantly different (P<0 .05) .The ATⅢ level of group A was significantly lower than that of group B (P<0 .05) .Conclusion The risk factors of type 2 diabetes complicated with cerebral infarction include age ,hyper‐tension ,HbA1c ,ApoB ,fasting insulin ,fasting C‐peptide ,lipoprotein (a) ,Hcy ,etc make diabetics be more prone to cerebral infarc‐tion ect .

Objective To observe the initial therapy outcomes of Valproic acid for childhood absence epilepsy (CAE),and to assess its therapeutic reaction and short-term prognosis,and to investigate the risk factors for initial therapy failure.Methods From January 2010 to December 2015,absence seizures as key words were used to search CAE in the video-electroencephalogram(VEEG) database of Children's Hospital Affiliated to Nanjing Medical University.Sixty-seven children fulfilled the CAE diagnosis criteria of International League Against Epilepsy in 1989.These patients were separated into 2 groups based on the therapy outcome after 6 months,including seizure control failure group and seizure control group.The patients' clinical characteristics and VEEG characteristics were reviewed.The gender,age of seizure onset,a family history of epilepsy or febrile seizures (FS),consistent with 2005 Panayiotopoulos diagnostic criteria,and VEEG findings were analyzed to evaluate the predictive ability of independent variables and the relationship between these features and treatment outcomes by using a stepwise multivariate Logistic regression model.Results The age at seizure onset was (5.89 ± 2.91) years old,and follow up duration was 6 months.Approximately 23 cases (34.3％) of CAE patients had poor response.No statistical correlation was made for gender,age at onset,the occurrence of generalized tonic clonic seizures,and family history of FS or epilepsy between 2 groups (all P ＞0.05).Compared with seizure control group,patients of the seizure control failure group had significantly higher rates of focal epileptic discharge (87.0％ vs.6.8％),higher rates of intermittent photic stimulation (IPS) induced seizures (52.2％ vs.6.8 ％),fewer rates of occipital intermittent delta activity (8.7 ％ vs.77.3 ％),and fewer rates of patients met the new diagnostic criteria proposed by Panayiotopoulos in 2005 (8.7％ vs.88.6％) (all P ＜ 0.001).The presence of occipital intermittent rhythmic delta activity during wake stage and the interictal focal epileptiform discharges on VEEG during sleep stage were significantly associated with the therapy outcomes in a multivariable Logistic regression analysis (OR =133.714,P ＜ 0.05;OR =0.068,P ＜ 0.05).Conclusions The presence of focal epileptiform discharges,and a typical absence induced by IPS are important factors for first-drug treatment failures with CAE,and conversely the occipital intermittent rhythmic delta activities have a good efficacy.There is no statistical correlation between clinical characteristics and treatment outcomes.

Objective To compare the efficacy of pantoprazoh based short-term quadruple regimens in the treatment of Helicobacter pylori (H. Pylori) infection for 4 days,5 days or 7days. Methods 166 patients with H. Pylori associated severe gastritis were randomly divided into pantoprozole quadruple regimens of 4-day group (n =61) ,5-day group (n = 54) or 7-day group (n = 51). The regimen was pantoprazole 40 mg,bismuth potassium citrate 220 mg,elarithromycin 250 mg and amoxicillin 1 g twice daily. The patients received pantoprazole for 1 week, bismuth potassium citrate for 2 weeks,clarithromycin and amoxicillin for 4 days,5 days or 7 days respectively. The H. Pylori eradication and symptomatic relief was determinded by 13C-UBT at least 4 weeks after the therapy. Results The H. Pylori eradication rates of 4-day,5-day or 7-day panteprazole quadruple regimens were 73.8% (45/61) ,75.9% (41/54) and 80.4% (41/51) respectively. The pain relief rates were 82.4% (42/51) ,85.1% (40/47) and 88.9% (40/45) in 4-day,5-day and 7 day group. Conclusion The 4-day and 5- day pantoprazoh based quadrual therapy is a short- term, effective, safe and lower therapeutic- cost regimen for H. Pylori eradication.

ObjectiveTo investigate the clinical features and pregnant outcomes of the pregnant women with congenital adrenal hyperplasia (CAH) 21-hydroxylase deficiency (21-OHD).MethodsThe clinical features,therapies,pregnant outcomes of the pregnant women with 21-OHD were retrospectively reviewed in Peking Union Medical College Hospital,from January 2005 to April 2011.ResultsThere were 8 pregnant womenwith 21-OHD including 5siinplevirilizing patientsand 3nonclassical 21-OHD women.Eightpatientswereacceptedprogestationalandprenatalcontinuallowerglucocorticoid treatment.During the gestational period,the dosage of glucocorticoid was adjusted in one pregnancy.The serum level of 17-alpha hydroxyprogesterone (17-OHP) were elevated after pregnancy [ (70 ± 38 ) versus (24 ±23) nmol/L,P ＜ 0.05].The fertility and offspring rate of 8 patients was 8/12,the fertility and offspring rate of patients who started treatment at preadolescence was significantly increased (4/5 versus 4/7).Four patients were accepted genital reconstructive surgery ( clitorectomy,clitoroplasty,vulvoplasty) before pregnancy.The incidence of GDM was 1/8.All patients selected caesarean at from 37 +6 gestation weeks to 39+6 gestation weeks.The average newborn birth weight was (3210 ± 447 ) g,and height was (48 ±2) cm of 8 neonates,none of them was CAH.Conclusions Medical and surgical therapy provides satisfactory fertility and pregnancy outcomes for women with 21-OHD.It is safe to pregnant women with 21-OHD and their fetus in continual lower glucocorticoid treatment.The dosage of glucocorticoid should be carefully adjusted during the pregnancy individually according to serum level of 17-OHP.