Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) is an autosomal recessive hereditary cerebral artery disease in the adolescence,and its main clinical manifestations are dementia,stroke,low back pain and alopecia.At present,most cases are from Japan.3-6 exon point mutations in the HTRA1 gene are associated with the onset of CARASIL.Brain histopathological examination showed a small arterial intimal thickening medial smooth muscle cell loss and hyalinization.Brain MRI showed a diffuse white matter abnormal signal and multiple subcortical infarcts.The diagnosis mainly depends on the characteristic clinical symptoms,imaging characteristics and genetic testing.It should be differentiated from cerebral autosomal dominant arteriopathy with sulcortical infarcts and leucoencephalopathy.

Respiratory tract infection remains a hot clinical topic.Disappointingly, routine microbiology tests do not meet the needs of target antimicrobial therapy.Widespread practice of antibiotic empiricism has lead to dramatic use of broad-spectrum antibiotics and antimicrobial resistance.The application of new clinical microbiology tests to identify the offending pathogen may allow administration of narrow spectrum antibiotic therapy.To do so,the full clinical microbiology armamentarium with newer point-of-care tests and polymerase chain reaction tests must be exploited.The return of the sputum gram stain and introduction of newer molecular tests would provide information for judicious selection of antimicrobials.

This paper analyzed the procedure and organization for developing the clinical guidance by the National Institute for Health and Clinical Excellence(NICE).Focusing on the balancer role of NICE in the UK healthcare system as a statutory criteria maker,it analyzed the implementation and assurance mechanism of the clinical guidance for policy recommendations to the making and effective implantation of such a guidance in China.

In recent years,minimally invasive surgery has become the mainstream trend of modern surgery with the rapid development of endoscopic and laparoscopic techniques.However,there are limitations when either technique is used alone.The laparoscopic and endoscopic cooperative surgery (LECS),which combines the advantages and makes up the deficiencies of these two techniques,has expanded the application field of minimally invasive surgery.Laparoscopic wedge resections are increasingly applied for gastric stromal tumor.Base on clinical experience of 43 patients who underwent laparoscopic wedge resections for surgical treatment of gastric stromal tumor,we conclude that this procedure is feasible and safe.

The malaria annual reports, epidemic situation reports, case investigation reports and blood examination data for febrile patients from 2003 to 2007 in Nantong City were analysed, so as to provide the scientific evidence for the measures of malaria control. The results suggested that mobile population was the key point of malaria control in Nantong City, and the main control measures should put emphasis on epidemic situation supervision of mobile population and surveillance on febrile patients.

Objective To investigate the killing effect of donor NK cells on recipient dentritic cells (DCs) by blocking KIR2DL1 and KIR2DL3 with monoclonal antibodies CD158a and CD158b,and the possible mechanism about donor NK cells reducing the incidence of graft versus host disease (GVHD).Methods SSP-PCR was used to examine the genotypic makeup of KIR in 15 pairs of patients and their HLA-identical sibling hematopoietic stem cell transplantation (HSCT) donors in our department.Peripheral blood mononuclear cells (PBMC) from 15 pairs of patients and their donors were extracted and preserved,and donor NK cells were isolated by DYNABEADS UNTOUCHED HUMAN NK sorting kit.Methyl thiazolyl tetrazolium (MTT) reduction assay was used to detect the killing activity of donor NK cells against recipients DCs.To observe the different NK killing activity before and after KIR receptors blockade,the anti-CD158a and CD158b monoclonal antibodies were used to block KIR inhibitory receptors.Results The killing effect of donor NK cells was significantly enhanced after inhibitory receptor KIRs blockades,the killing effect of NK cells in HVG KIR ligandmismatching pattern group was significantly higher than GVH or KIR receptor-ligand matched pattern group.The killing effect became stronger when the dose of antibody was increased.ConclusionIt is demonstrated in vitro that the killing effect of alloreactive NK cells could be enhanced by KIR functional modification,and the infusion of alloreactive NK cells could be used as a new strategy of immunotherapy for GVHD.

Gastrointestinal stromal tumors (GISTs) is a subset of mesenchymal tumors and represents the most common mesenchymal neoplasm of gastrointestinal tract.In the last decade,GISTs has become well known because of the effectiveness of imatinib mesylate.The molecular targets for tyrosine kinase receptor inhibitor are not only of importance for the treatment of patients but also useful for the development of a novel drug modalities and new strategies in basic cancer therapy.The improved understanding of the molecular mechanism of GISTs has made its diagnosis standardized.Many multicenter phase Ⅱor phase Ⅲ clinical trials have been completed to establish the role of adjuvant and neoadjuvant therapy.It is important to select the correct management strategy,which is multidisciplinary,integrated,and individualized.This paper provides an overview of the rational treatment of GISTs at present.

Objective To evaluate the effect of hyperuricemia on vascular complications of type 2 diabetes and analysis of the possible mechanism. Methods 586 cases with T2DM were divided into two groups: normal serum uric acid (n=397) and hyperuricemia (n=189).The morbidity of macrovascular and microvascular complications and the serum levels of CRP,TNF,IL-1,IL-2,IL-6,IL-8 and PAI-1 were detected. Results (1)Hyperuricemia group showed higher BMI, blood pressure, TG,TC,LDL,WHR ratio and lower serum HDL-C than the group with normal uric acid (all P<0.05).(2)Group with hyperuricemia showed higher morbidities of macrovascular and microvascular complications than the group with normal uric acid (all P<0.05).(3) Group with hyperuricemia had higher levels of CRP,TNF,IL-6,IL-8,PAI-1 (all P<0.05). Conclusions (1) Hyperuricemia is associated with obesity and dyslipidemia.(2) Hyperuricemia may cause atherosclerosis by inflammation of vascular endothelium, resulting macrovascular and microvascular complications.

Objective To analyze the epidemic status and progress of malaria elimination in Nantong City,so as to provide evidences for adjusting the control measures and guiding the work of malaria elimination. Methods The data about the epidem?ic situation of malaria and malaria elimination in Nantong City from 2008 to 2014 were collected and analyzed by the method of descriptive epidemiology. Results From 2008 to 2014,a total of 305 malaria cases were reported in Nantong City,with an an?nual average incidence of 0.57/100 000. Among all the cases,26(8.52%)were local tertian malaria cases and 279(91.48%) were imported cases;276 cases(90.49%)were male and most of them were young adults,and those aged in 20-59 accounted for 91.48%(279/305). There were cases reported in each month,with no obvious seasonality. The imported cases were mainly distributed in Hai’an County(80 cases),Haimen City(71 cases)and Tongzhou District(41 cases),and the total percentage of them was 68.82%among all the imported malaria cases in Nantong City. There were no local malaria cases reported in Nan?tong City since 2011. Qidong City,Rudong County,Chongchuan District,Development Zone and Gangzha District have reached the criteria of malaria elimination in Jiangsu Province. Conclusions From 2008 to 2014,the malaria cases in Nantong City are mainly imported cases,the number of local cases has decreased significantly,and there has been no local infected cas?es reported in the continuous 4 years of 2011-2014. Totally 5 counties(cities,districts)among the 9 have reached the criteria of malaria elimination in Jiangsu City. In the future,the control of imported malaria should still be strengthened,and the work of malaria elimination should still be promoted.

BACKGROUND:Mesenchymal stem cells from transgenic animals carry green fluorescent protein that can be stably expressed in viable cells and can be used to rapidly screen modified cells in comparison with traditional virus and plasmids. OBJECTIVE:To study the biological features of bone marrow derived stromal cells from transgenic rats with green fluorescent protein gene. METHODS:Bone marrows were isolated from the bilateral long bones of 2-week-old transgenic rats with green fluorescent protein gene, and cultivated in conditioned culture medium to obtain bone marrow mesenchymal stem cells with green fluorescent protein gene. The passage 5 bone marrow mesenchymal stem cells with green fluorescent protein gene were analyzed by flow cytometry to detect cellsurface molecules, and were induced in calcium or adipogenic induction medium. After calcium induction, the alizarin red staining was performed to test the formation of calcium concentration. After adipogenic induction, bone marrow mesenchymal stem cells were detected with oil red O staining. RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cells, stably expressing green fluorescent protein gene, were obtained successful y from the transgenic rat with green fluorescent protein gene. The cells expressed CD90, CD105 strongly, but did not express or weakly expressed CD14 andCD45. After 3 weeks of calcium induction, jacinth calcium salts could be detected in the cells by alizarin red staining. At 3 weeks of adipogenic induction, the cells showed positive oil red O staining. The green fluorescent protein gene, as report gene, exerts no effect on the cellsurface molecules and multilineage potential of bone marrow mesenchymal stem cells, which can be used as an efficient tracer.