Duodenal varices are an uncommon disease which occurs along the entire gastrointestinal tract outside the esophagus or stomach.Among ectopic varices,duodenal varices are the most common one.Cirrhosis,hepatic portal hypertension,extrahepatic portal vein occlusion and vasculitis contribute to the pathogenesis of ectopic variceal formation.The unusual pathophysiology,location,diversity and uncertain curative effect of DV are associated with its low detection rate and high mortality of patients.Therefore,the diagnosis and treatment of DV is one of the tough problems in clinical practice.This article reviews the current research advances in pathophysiology,diagnosis and treatment of duodenal varices to provide reference for clinical practice.

A total of 206 patients of type 2 diabetes mellitus (T2DM) were assigned into the trial group (n =156) and the control group (n =50) according to whether real object-based diabetic diet was provided.Traditional nutritional education for both groups during hospitalization.The patients in the trial group received a real object-based diabetic diet guided by a nutritionist who adjusted feeding regimens and skills before and after operation.The control group had a free access to a normal diet.The patient understanding of knowledge,attitude and practice (KAP) was examined by nutrition surveys.And their postoperative nutrition states and complications were assessed by questionnaires during a 6-month follow-up.The total average score of cognitive divided was 93.4 ± 7.5,the average score of diet therapy knowledge 13.8 ± 1.6 and the average scores of attitude and practice 9.6 ± 1.9 and 32.2 ±3.9.Significant differences existed between two groups (P ＜ 0.05).The incidence rates of hypoglycemia,hyperglycemia and gastrointestinal obstruction were lower than the control group (P ＜ 0.05,P ＜ 0.01).It suggested that real object-based diabetic diet guidance plus traditional nutrition education could improve the KAP level and may lower the incidence of postoperative complications in T2DM patients with gastric bypass.

Objective To observe the effect of small interfering RNA(siRNA) targeting Survivin gene on survivin expression,proliferation and apoptosis of hepatocellular carcinoma cell line MHCC-97H.Methods Survivin sequence specific siRNA was designed and synthesized.siRNA/liposome complex was transfected into hepatocellular carcinoma cell line MHCC-97H.The MHCC-97H cells were divided into Survivin siRNA group(Si-survivin),negative control siRNA group(NC group)and blank group (normal control group).Survivin mRNA and protein expressions were detected by reverse transcription-PCR and Western blot,respectively.The proliferation of MHCC-97H was measured by methythiazolydiphenyl-tetrazolium bromide assay.The Annexin V/PI double labeled flow cytometry was employed to measure the apoptosis at 24 h after transfection in different concentrations of Survivin siRNA(12.5,25.0 and 50.0 nmoL/L,respectively).Results After 48 h of transfection,the Survivin mRNA levels were 0.55 ± 0.16 (Si-survivin group),0.85 ± 0.28 (NC group) and 0.93 ± 0.40 (normal control group),respectively,which were significantly different among 3 groups (F =414,P ＜ 0.01).The level of Survivin mRNA was the lowest in Si-survivin group,which was statistically different with NC group and normal control group (t =-20.56,-28.37,all P ＜ 0.001).The levels of Survivin protein expression in 3 groups were 0.602 ± 0.005 (Si-survivin group),0.835 ± 0.007 (NC group) and 0.993 ± 0.003 (normal control group) at 48 h after transfection,which were statistically different among 3 groups (F =238,P ＜0.01).The lowest level of protein expression was in Si-survivin group,which was statistically different with NC group and normal control group (t =-40.17,-66.03,all P ＜ 0.001).After 72 h and 96 h of transfection,the inhibitory rate of cell growth was significantly higher in Si-survivin group [(19.5 ± 3.6)％,(12.0 ± 0.9)％] compared with that in NC group [(3.6 ± 0.9) ％,(-1.3 ± 6.1) ％] (t--36.18,42.53,all P ＜ 0.05).The apoptosis rates in 12.5,25.0,50.0 nmol/L Survivin siRNA were (22.64 ± 2.54) ％,(35.37 ± 3.28) ％ and (53.28 ± 4.35) ％,respectively.However,in NC group and normal control group,the apoptosis rates were (8.77 ± 1.25) ％ and (9.72 ± 1.37) ％.The rates were statistically different among those 5 groups(F =35.93,P ＜0.01).And in the apoptosis rates of siRNA groups in different concentratiom were statistically different when compared between each two groups (t =-29.73,-38.57,all P ＜ 0.001).Conclusion Survivin specific siRNA can inhibit the proliferation and induce the apoptosis by blocking Survivin gene expression in hepatocellular carcinoma cell line MHCC-97H.

Minichromosome maintenance protein 7 (MCM7) is an important regulator of DNA replication,and plays an important role in replication initiation and elongation steps.Recent studies show that MCM7 is closely related with the formation and growth of digestive tumors.The detection of MCM7 protein can provide new ideas for the early diagnosis,treatment and prognosis of the digestive tumors.

Objective To analyze the cases of anaphylactic death cases and explore the standards of judi-cial expertise of anaphylactic death for providing evidence for judicial expertise. Methods Fifty-nine cas-es death due to allergic reaction in Shanghai were collected. And details of medical history, clinical manifestation of anaphylactic reaction and postm ortem exam ination findings were review ed for all cases. Results In the 59 cases, there were 58 cases died from drug allergy, including 77.6% of them were an-tibiotics. The rates of treating in standard hospital and illegal clinic were 37.3% and 61.0%, respectively. The allergic sym ptom s were dyspnea and facial cyanosis. The time from contacting allergens to death ranged from 1 m in to 3 d. The concentration of total serum IgE ranged from 50 to 576.92 IU/m L . The results of clinical manifestation and pathological anatomy had obviously changes. Conclusion B ased on the exclusion of all other cause of death and synthetically analysis of details of cases, medical history, clinical manifestation and anatomy, the conclusion of anaphylactic death can reached. The details of cas-es including clinical history, exposure to allergens, and clinical manifestation play an im portant role in diagnosis of anaphylactic death.

Objective To study the chemical constituents of Lignum Aquilariae Resinatum.MethodsThe compounds were isolated and purified by silica chromatography and their structures were identified on the basis of physicochemical constant and spectral analysis.Results The compounds were determined as 6-hydroxy-2-[2-(3'-methoxy-4'-hydroxy phenylethyl)] chromone(Ⅰ)and a triterpene,hederagenin(Ⅱ).Conclusion Compound I is a new compound and compound Ⅱ is found in this plant for the first time.

【Objective】To explore the long-term storage method for the seeds of Aquilaria sinensis(Lour.)Gilg..【Methods】The seeds of Aquilaria sinensis(Lour.)Gilg.with different water contents were preserved with liquid nitrogen for 55 days.And then the seeds were taken out to detect their germination capacity.The effect of cryopreservation methods on the germination capacity was also observed.【Results】The seeds with water content being 16.30% lost their germination capacity completely,the seeds with water content being 13.02% and 9.34% had a lower germination capacity,and the seeds with water content being 7.35% had a higher germination capacity.Quickly-frozen seeds had a higher germination capacity than the slowly-frozen seeds.【Conclusion】Cryopreservation with liquid nitrogen is suitable for the long-term preservation of the seeds of Aquilaria sinensis (Lour.)Gilg.with water content being 7.35%.

【Objective】To devise the optimal method and the optimal water content for the storage of seeds of Aquilaria sinensis(Lour.) Gilg..【Methods】The seeds of Aquilaria sinensis(Lour.) Gilg.were stored in plastic bag,drying apparatus,wet sand and dry sand separately.And then the germination capacity of the seeds with different water content was detected at 4℃ and room temperature(30℃) in different time.【Results】The germination capacity of Aquilaria sinensis(Lour.) Gilg.decreased with the prolongation of storage time and with the decrease of water content.The seeds with water content being 9.34% and 7.35% had a higher germination capacity when stored at 4℃ for 35 days than that stored at room temperature.The fresh seeds stored in wet sand sprouted and the seeds stored in drying apparatus and dry sand had lower germination capacity and went mouldy.【Conclusion】Low temperature and moderate water content are benificial to the storage of the seeds of Aquilaria sinensis(Lour.) Gilg..

Objective:To analyze the clinical features and CYP17A1 gene mutation of 17α-hydroxylase/17, 20-lyase deficiency (17OHD). Methods:The clinical data, laboratory examination and genetic results of 6 children with 17OHD in the Department of Endocrinology, Children′s Hospital Affiliated to Capital Institute of Pediatrics from March 2014 to December 2019 were enrolled and analyzed retrospectively.Meanwhile, the clinical types of all congenital adrenocortical hyperplasia (CAH) patients were calculated and then the incidence of 17OHD was calculated.Results:The 6 cases were from 5 families, and the age at diagnosis was ranged from 1 year and 6 months to 15 years old, in which 2 cases were 46, XX and 4 cases were 46, XY.Their gender were all female.Three cases presented with hypertension (50.0%), 4 cases with hypokalemia (66.7%), and 1 case with labia mass (16.7%). The gonad developed into a testis in patients with 46, XY, and patients with 46, XX had ovarian hypoplasia.The laboratory tests revealed an decrease in the cortisol at 8 AM in all cases, ranging from 0.62 to 5.93 mg/L.Five cases displayed an increase in adrenocorticotropic hormone (ACTH) in the range of 84-271 ng/L, and 1 patient with normal ACTH (58 ng/L) had a peak cortisol of 1.75 mg/L after the ACTH challenge test.Elevated progesterone was detected in 6 patients with a normal 17 hydroxyprogesterone level.Further results proved low levels of testosterone and estradiol, and high levels of luteinizing hormone (LH), and follicle stimulating hormone (FSH). CT scan showed mild adrenal hyperplasia in all cases.Among 114 CAH patients during the same period, the incidence of 17OHD came second at 5.3%.The CYP17A1 gene mutation results indicated that 2 unrelated patients were homozygous mutation for p. Y329fs (c.985_987delTACinsAA), 2 siblings were compound heterozygous mutations for p. Y329fs and exon 1-7 deletion, 1 patient was compound heterozygous mutations of p. Y329fs and p. R416C (c.1246C>T), and 1 patient was homozygous mutations for p. L465P (c.1394T> C), which was first reported in China. Conclusions:17OHD is not rare in CAH.Female children with hypokalemia, hypertension, and hypogonadism can lead to diagnostic suspicion of 17OHD.The p. Y329fs mutation in Chinese 17OHD children is a hotspot.The p. L465P (c.1394T>C) mutation is a new mutation in China and it could enrich the mutant spectrum of CYP17A1 gene in China.

Objective To analyze the genetic changes and detailed clinical presentations of 5 maturity-onset diabetes of the young (MODY) cases in order to enhance the knowledge about MODY in children.Methods Seventy-eight patients initially diagnosed as diabetes mellitus between January 1 and December 31,2015 in Capital Institute of Pediatrics were retrospectively studied.Nine of them were suspected of MODY,and 5 patients were diagnosed as MODY through gene test.Clinical informations were collected including age,gender,main complaint,family history,body mass index (BMI),fasting blood glucose,fasting blood insulin,2-hour blood glucose and insulin after oral glucose tolerance test and glycosylated hemoglobin.The blood glucose was monitored dynamically in 2 patients.Targeted capture panel was designed to capture the 16 genes related to MODY,including 12 genes from MODY1 to MODY13 type and 4 genes with weak evidence of MODY according to Human Gene Mutation Database Exome capture,and Next-Generation sequencing on a HiSeq2000 (Illumina) was performed.After bioinformatics analysis,all prioritized variants detected in patients were validated by Sanger sequencing,including the probands and their parents.Results Five patients were confirmed as MODY by molecular diagnosis,accounting for 6.4％ of all the 78 patients in 2015.The ratio of male to female was 2 ∶ 3.The ages at diagnosis ranged from 2 to 11 years old,and the median age was 3 years old.Two cases were found to have abnormal blood glucose in physical examination.The rest 3 cases were discovered with abnormal blood glucose during hospitalization because of pneumonia (1 case)or diarrhea (2 cases).In 4 cases,their mothers had gestational diabetes history,in 1 case the father suffering from diabetes.BMI ranged 15.68-23.40 kg/m2.Fasting blood glucose was 6.3-7.2 mmol/L.Fasting blood insulin was 0.5-8.0 IU/L.Glucose tolerance test results showed that blood glucose of the patients was 8.6-10.8 mmol/L after 2 hours.The level of glycosylated hemoglobin was 5.5％-6.7％.Blood glucose was 3.9-13.0 mmol/L.All the 5 confirmed patients were caused by GCK gene mutation (MODY2 type).The mutations detected were located at Exon7 (2 cases),Exon4 (1 case),Exon5 (1 case),and Exon10 (1 case).Conclusions All the confirmed MODY patients were identified either through medical exam or infectious disease,and all had positive family history.Their BMI ranged widely.Fasting blood glucose was slightly elevated and glycosylated hemoglobin was normal or slightly elevated,but fasting blood insulin was normal in all the patients.Abnormal glucose tolerance test results were found in all 5 patients.Glycosylated hemoglobin was normal or slightly elevated.MODY2 was the only subtype detected in this group,which indicated that the common type in children was different from that in adults.