ObjectiveTo investigate the expression of Ezrin and inducible nitric oxide synthase (iNOS) and their correlation to malignant proliferation of colonic adenoma. MethodExpressions of Ezrin,iNOS and nuclear Ki-67 antigen were detected by immunohistochemistry in tubular adenoma (60 cases),villous adenoma(40 cases) and malignant (30 cases ) pleomorphic adenoma. ResultsExpressions of Ezrin,iNOS in tubular adenoma [58.3％ (35/60), 50.0％ (30/60)], villous adenoma [72.5％ (29/40), 70.00(28/40)]and malignant pleomorphic adenoma [96.7％(29/30),93.3％(28/30)]were gradually increased ( X2 = 11.600,P = 0.005; X2 = 8.451, P = 0.015 ). There was a significant positive correlation between the expression of Ezrin and iNOS (r = 0.765, P ＜ 0.01 ). Nuclear Ki-67 antigen proliferation index was increased with the increasing of Ezrin and iNOS expressions. ConclusionOverexpression of Ezrin and iNOS may promote proliferation and malignant transformation of colonic adenoma.

Objective To study the clinical pathological features, treatment and prognosis of umbilical metastases of colorectal carcinoma. Methods From January 2000 to September 2010, 10 umbilical metastases of colorectal carcinoma cases were admitted. The clinical features were reviewed. Results Four radical resection of colon cancer and resection of the umbilical plexus metastases cases with chemotherapeutic intraperitoneal perfusion lived 9,11,14 and 18 months respectively, 1 ileum-transverse colon anastomosis case with chemotherapeutic intraperitoneal perfusion lived six months, 2 patients with systemic widely transfer and umbilical transfer with pure venous chemotherapy lived 3, 3.5 months respectively, 3 colon intra-operative cases with venous chemotherapy lived 5 ,5. 5 and 7 months respectively. Conclusion Surgical resection of the primary focal and periumbilical metastases can prolong survival time with adjunctive therapy.

Objective To assess the biomechanical stability and vertebra strain distribution of asymmetrical posterior internal fixation for minimally invasive transforaminal lumbar interbody fusion ( MI-TLIF) . Methods Range of motion ( ROM) and strain distribution testing were performed in 8 fresh-frozen calf lumbar spine motion segments in flexion/extension, lateral bending, and axial rotation using 5. 0 Nm torques at the L4-5 motion segment. The sequential test configurations included intact motion segment, TLIF with unilateral pedicle screw ( UPS) , TLIF with UPS plus transfacet pedicle screws ( UPS+TFPS) , and TLIF with bilateral pedicle screw ( BPS) . The ROM was deter-mined to assess the construct stability. Strain distribution was recorded along with flexion and lateral bending configurations. Results In flexion/extension, lateral bending, and axial rotation, there was no significant difference in the ROM between BPS and UPS+TFPS fixation after TLIF. After TLIF, the UPS construct provided less segment stability than BPS and UPS+TFPS fixation in flexion, lateral bending. Strain distribution under UPS+TFPS fixation was respectively 21. 8% and 24. 2% higher than that under BPS fixation along with flexion and lateral bending. Conclusion UPS+TFPS fixation provides stability comparable to that of MI-TLIF with bilateral PS, with better load share with the vertebrae body.

Objective To study the scan parameter of spiral CT angiography in aortic dissection.Methods 34 cases with aortic dissection successively underwent SCTA were studied retrospectively.The CT scan parameters,methods of posteriorimage treating were reviewed and analysed one by one.Results In 34 cases,32 cases were diagnosed as aortic dissection and classified correctly,in accordance with the result of operation and DSA,the quality of image was satisfied and the rate of success at least above 88.9%.The use of main scan parameters:(1)the ascend aortic dissection:slice thickness 4 mm,reconstruction interval 2 mm,pitch 1.25;tube current 175 mA;(2)involed in ascend,arch,descend and throacic aorta dissection:slice thickness 5 mm,reconstruction interval 2～3 mm,pitch 1.5;tube current 150 mA;(3)involved in abdominal aortic dissection:slice thickness 6～8 mm,reconstruction interval 2～3 mm,pitch 1.5 or 1.75;tube current 125 mA.The tube voltage all were 120 kV,the dosage of contrast media was 90～100 ml;the delayed scan time was choiced 20 second in throacic aortic and 25 second in abdominal aortic.The posterior image methods main used MPR,SSD,MIP and VR. Conclusion To set a sensible scaning plan,choose and match scan parameters properly according to the scaning length,can avoid the shortage of restrain SCTA scaning length and get satisfied image.

Objective To analyze the diagnostic and prognostic value of serum pepsinogen combine with Ca724 in the patients with gastric cancer .Methods One hundred and twenty patients with suspected gastric cancer were severed as research object .All patients were accepted on serum pepsinogen Ⅰ( PGⅠ) ,serum pep-sinogen Ⅱ( PGⅡ) , Ca724 and gastroscopy .As confirmed by gastroscope biopsy under pathological findings standards ,we analyzed the diagnostic and prognostic value of PGⅠ/PGⅡ( PGR) ,Ca724 and PGR combined with Ca724 in the patients with gastric cancer .Results All the observers ,92 patients were diagnosed with stomach cancer.The diagnostic sensitivity and accuracy of PGR combined with Ca 724 were higher than PGR and Ca724, and specificity was lower than PGR and Ca724.At the same time,there was diagnostic value of PGR,Ca724 and PGR combined with Ca724 in gastric cancer diagnostic (P<0.05),and the diagnostic value of PGR combined with Ca724 was higher than PGR check and Ca 724.In addition,during the different pathological ,there were sta-tistically significant differences of PGR and Ca724,the PGR in Ⅳ group was lowest,the Ca724 in the Ⅳ group was highest(P<0.05).Conclusion Combined serum pepsinogen and Ca 724 in the diagnosis and differential diagnosis of gastric cancer have a definite application value in the assessment of prognosis .

Objective To explore the efficacy and safety of bedside continuous blood purification (CBP) in the treatment of critically ill neonates.Methods Totally ten critically ill neonates were hospitalized in Department of Neonatal Intensive Care Unit (NICU) in Shanghai Children's Hospital from June 2011 to May 2015, and managed with CBP treatment.The indications of CBP therapy were multiple organ dysfunction syndrome (MODS) failed to conventional treatment or combined with acute renal failure (ARF).The model for CBP was continuous veno-venous hemofiltration dialysis (CVVH).The clinical outcomes included blood electrolytes, serum bio markers, urine output, hemodynamic indicators, dose of intravenous epinephrine before treatment, 6, 12, 24, 48 h after treatment and at the end of CBP.Complications of CBP were also observed.Statistical analysis was performed with ANOVA and Dunnett-t test.Results The underlying problems of the ten newborns were septicemia (n=5), severe neonatal asphyxia (n=2), congenital hereditary metabolic disease (n=2) and traumatic asphyxia (n=l).The venous catheter was successfully inserted for all babies and CBP treatment continued for (86.7 ± 25.9) h averagely with obvious effect.Four of the ten cases were cured and discharged, and the rest six refused to treatment and died after due to irreversible injury of the nervous system although they had survived from the oliguric stage of ARF.The complications of CBP included thrombocytopenia (n=3), catheter blockage (n=2), hypotension (n=l).No hypothermia, thrombosis, bleeding or infection occurred.The mean blood pressure and partial pressure of oxygen in arterial blood/fraction of inspiration oxygen (PaO2/ FiO2) of the ten cases 6 h after the beginning of treatment were higher than those before [(46.4 ± 7.5) vs (36.5 ±8.3) mmHg, 1 mmHg=0.133 kPa;(210.0±62.0) vs (93.0±43.0) mmHg;t=2.647 and 6.378, both P ＜ 0.05].At the 12th hour since treatment start, the blood pH value was 7.4 ± 0.2, which was higher than that before treatment (6.9 ± 0.2, t=2.731, P ＜ 0.05), and kept in normal range.At the 24th hour, the serum levels of potassium, urea nitrogen and creatinine dropped to normal range compared to those before treatment [(4.8±2.9) vs (9.6± 3.6) mmol/L;(7.2±2.3) vs (13.6±6.3) mmol/L;(51.0± 12.0) vs (172.0±23.0) μ mol/L;t=4.571, 5.427 and 21.672, all P ＜ 0.05].Urine output increased from zero before the treatment to (0.7±0.3) ml/(kg · h) after 24 h (t=3.284, P ＜ 0.05).The maintaining dose of intravenous epinephrine decreased since 12 h after the beginning of treatment and was ceased at the 48th hour.Conclusion CBP is an effective and feasible treatment for critically ill neonates.

ObjectiveTo investigate mechanisms for IL-27 induced proliferation and differentiation of peripheral blood CD4+ T cells in primary biliary cirrhosis (PBC).MethodsPeriperal blood CD4+ T cells were isolated from patients with PBC,chonic hepatitis B (CHB) and health controls (HCs).After IL-27 stimulation,proliferation ability of CD4+ T cells was evaluated by CCK-8 kit,and cytokines were analyzed by ELISA.Real-time PCR was employed to assay mRNA expression of T-bet and GATA3 in CD4+ T cells.p-STAT-1 and pSTAT-3 expression in CD4+ T cells were detected by Western blot.ResultsEnhanced proliferation of CD4+ T cells was found in all subjects after IL-27 stimulation.However,the proliferation ability in patients with PBC was greater than that in CHB and HCs ( P＜0.001 ).Levels of IL-2 and IFN-γ in supernatant from IL-27-incubated PBC blood CD4+ T cells were higher than that from CHB and HCs (P＜0.001 ).In normal situation,T-bet mRNA of CD4+ T cells in PBC group was higher than that in CHB group (P=0.007).Furthermore,after IL-27 stimulation,elevated T-bet mRNA expression and GATA3 inhibition were found in patients with PBC.High expression of p-STAT-1 and p-STAT-3 in blood CD4+ T cells were found in PBC,CHB and HCs after stimulation by IL-27.But their expression in patients with PBC were higher than those in patients with CHB and HCs.ConclusionProliferation of blood CD4+ T cells could be induced by IL-27 in patients with PBC.The signaling pathways of p-STAT-1,p-STAT-3 were involved to induce Th1 immune response and related cytokines expression.This study implicated that IL-27 may play important roles in early inflammation damage in PBC.

Objective We investigated if the proliferative capacity of endothelial progenitor cells was affected by hypoxia and exercise. Methods Twenty four male Sprague-Dawley rats were randomly and averagely divided into 4 groups: (1) living at low altitude (LL), (2) living and training at low altitude (LLTL), (3) living at high altitude (LH), and (4) living at high altitude and training at low altitude (LHTL). Eight-week incremental treadmill exercise and hypoxic simulation were used to establish LHTL animal model. Mononuclear cells from peripheral blood were obtained by density gradient centrifugation 12 hours by the end of 8-week experiment. The cells were suspended in conditioned medium 199 for culturing in vitro. Their phenotypes were confirmed by uptake of acetylated LDL and binding of fluoresce in isothiocyanate (FITC)-labeled Ulex europaeus agglutinin 1 (UEA-1) lectin. Inverted microscopic observation was used to identify the morphological changes in endothelial progenitor cells and measure the cell count. Results Adherent cells and early CFUs in groups LLTL, LH and LHTL increased more obviously than in group LL(P<0.01), whereas the number of attached cells between group LH and LHTL was not different (P>0.05). Conclusion Proliferative capacity of endothelial progenitor cells can be promoted by both hypoxic stimulation and exercise, and the promotion is more significant if combination of hypoxia and exercise was employed simultaneously.

Objective To establish the MCF-7 cell models of Beclin 1 over-and low-expressions,and to detect the autophagic and apoptotic changes after 4 Gy irradiation,and to explore their molecular regulation mechanisms. Methods MCF-7,MCF-7 + 4Gy,MCF-7-Beclin 1 + 4Gy and MCF-7-Belcin 1 RNAi+ 4Gy groups were set up. Molecular biology method was used to construct Beclin 1 over-expression vector pcDNA3.1-Beclin 1,and to estabilish the Beclin 1 over- and low-expression cell models.After the cells were irradiated with 4 Gy, the autopahgic cell percentages were measured by fluorescence microscope with MDC staining, the apoptotic cell percentages were measured by FCM with AnnexinⅤ-FITC and PI staining,and the expressions of Beclin1,P53, Bcl-2 and Bax proteins were measured by Western blotting method.Results Compared with MCF-7 group,the autophagic and apoptotic cell percentages in MCF-7+4 Gy,MCF-7 Beclin 1 +4 Gy and MCF-7-Beclin 1 RNAi+4 Gy groups were significantly increased (P <0.05 or P <0.001 ),especially in MCF-7 Beclin 1+4 Gy group which was significantly higher than those in MCF-7 + 4 Gy (P < 0.05);while there was significant difference in the necrotic cell percentages between various groups. After 4 Gy irradiation, compared with MCF-7 group, the expression levels of Beclin 1,P53 and Bax proteins in MCF-7 + 4 Gy and MCF-7-Beclin 1 + 4 Gy groups were increased,but the expression levels of Bcl-2 protein were decreased,especially in MCF-7-Beclin 1 + 4 Gy group. Conclusion The MCF-7 cell models of Beclin 1 over-and low-expressions are successfully established,and ionizing radiation could induce the autophagy and apoptosis of MCF-7 cells,which is more obvious in Beclin 1 over-expression MCF-7 cells.Beclin 1 can activate P53,inhibit Bcl-2 and activate Bax,which forms the regulation of autophagy and apoptosis by P53 .

Objective To explore the clinical features, diagnosis, and treatment of non-immunologic hydrops fetalis (NIHF). Methods The clinical data of 10 cases of NIHF in neonatal intensive case unit during January 2011 to December 2016 were analyzed retrospectively. The related literatures were reviewed. Results In 10 cases of NIHF (6 males and 4 females). the gestational age were 32-42 weeks, and the birth weight was 2.25-3.95 kg. Among them, there were 3 cases of infectious diseases (cytomegalovirus, Streptococcus agalactiae, and parvovirus infection, one case each), 2 cases of fetal cardiovascular abnormalities, 2 cases of chromosomal abnormalities, 1 case of abnormal thoracic structures, 1 case of twin transfusion syndrome, and 1 case of etiology unknown of fetal hydrops. The clinical manifestations showed that there were 8 cases with 2 or more areas of edema (or hydrops), and only 2 cases with skin edema. Finally, 6 cases were cured and discharged, 2 cases were discharged by themself, and 2 cases died. Conclusions Prenatal ultrasound is a reliable method for the diagnosis of NIHF. Fetal edema in early pregnancy, especially with congenital malformations, is recommended for termination of pregnancy. After birth, NIHF should be diagnosed promptly so as to avoid or reduce severe complications.