A 64-year old man was admitted on July 2011 with masses both in liver and right kidney.After PET-CT and blood test examination,dual primary advanced cancers were speculated to be co-existed in this patient,which having poor prognosis.By evaluation with comprehensive geriatric assessment,the patient also had hypertension,diabetes and atherosclerosis,liver and renal insufficiency.After multidisciplinary consultation and detailed discussion with the patient,the decision of no surgery and just keep the follow-up was made.The patient has been followed up for 18 months and the functional evaluation is the same as before.It is very important to evaluate the risk/benefit equation and improve the standard of care,and make the decision as patient centered rather than disease-centered in the elderly patients.

Objective:To examine the relationships between acute stress disorder (ASD) symptoms,posttraumatic stress disorder (PTSD) symptoms and depressive symptoms in children survivors following the Lushan earthquake in China.Methods:One hundred ninety-seven children aged 1 to 14years (93 male and 104 female) were followed up at two and six weeks after Lushan earthquake.The ASDS,UCLA PTSD Reaction Index and DASS were used to measure the ASD,PTSD and depressive symptoms.Results:The average scores of ASDS and the depression subscale of DASS at two weeks after earthquake were(36.5 ± 10.9) and (3.3 ± 2.8),respectively.The average scores of UCLA PTSD Reaction Index and the depression subscale of DASS-21 at six weeks after earthquake were (18.5 ± 12.6) and (3.3 ± 3.5),respectively.The rates of ASD and PTSD were 28.6％ and 8.2％,respectively.The cross-lagged structural equation analysis with latent variables indicated that the ASD symptoms at two weeks after earthquake positively predicted PTSD symptoms (β =0.59,p ＜ 0.001) and depressive symptoms (β =0.29,p ＜0.001) at six weeks after earthquake.But there was no significant association between depressive symptoms at two weeks and PTSD symptoms at six weeks after earthquake.Conclusion:ASD symptoms in the early time postearthquake could predict subsequent PTSD and depressive symptoms,while depressive symptoms tend to remain stable within six weeks after earthquake.

Objective To observe the expression of basic fibroblast growth factor(bFGF) at different stages of tooth germ development,and explore its mechanism and significance.Methods Immunohistochemical technique was used to examine the expressions of bFGF in the tooth germs at different stages of human fetus in 8-34 weeks,the suckling mice with 1-22 d,and the dog postnatal in 6 weeks-5 months.Results bFGF expressed in tooth germ at all stages.In human fetus,the positive reaction was observed in epithelium of tooth bud,dental plate,enamel organ,external and outer enamel.The ameloblasts,odontoblasts,epithelial root sheath and dental follicle showed strongly positive reaction in the unerupted human deciduous tooth,the tooth under the eruption of neonate external enamel,stratum intermedium cells,ameloblasts and odontoblasts showed strongly positive epithelium,dental papilla and dental follicle at bud stage and cap stage,while at bell stage cells in mice and 6 week postnatal canal tooth.The positive expressions of bFGF were observed in root of tooth,peridental ligament and the osteoblasts adjoin to peridental ligament in the dog succession of decideous teeth.Conclusion bFGF is one of critical regulator in the tooth development,which can regulate the differentiation and morphogenesis of tooth germ cells and control the eruption and succession of deciduous teeth at different stages.

Objective To probe the value of clinical application of three dimensional contrast enhanced magnetic resonance angiography (3D CE MRA) for diagnosis of peripheral artery occlusive diseases (PAOD) and to assess its accuracy. Methods One hundred and three cases of PAOD received 3D CE MRA before operation. And 579 vascular segments were displayed. The diagnosis of 3D CE MRA before operation were compared with the results of vascular reconstruction surgeries of lower extremities. The image quality and how 3D CE MRA revealed the abnormal blood vessels were evaluated. Results Satisfactory images of the main arteries of the lower extremities were achieved by 3D CE MRA. In 579 vascular segments of 103 patients with PAOD,the sensitivity and specificity for detection of severe stenosis and occlusions were 97.6% and 95.4%,respectively. In 206 vascular segments of tibiofibula artery,the sensitivity was 100%. In 196 vascular segments of femoral artery,the specificity was 97%. Conclusion 3D CE MRA is accurate and reliable for determination of the degree of peripheral artery stenosis. The results of 3D CE MRA are concordant with that of operation.

Objective To explore the relationship between WT1 and prognosis of patients with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL), and to evaluate the possibility of WT1 as a potential marker for monitoring the minimal residual disease (MRD). Methods Bone marrow mononuclear cells from 58 patients with primary AML, 32 patients with primary ALL, 40 patients with AML-complete remission (CR), 28 patients with ALL-CR and 31 patients with trilineage hyperplasia (control group) were collected. Real-time fluorescent quantitative PCR method was used to detect the expression of WT1 in all patients. The expression threshold of WT1 in each group was established. WT1 copy number/ABL copy number ratio×100%denotes the relative expression level of WT1 gene. Results Median relative expression level of WT1 in the control patients was much lower than that in primary AML patients [0.026%(0-0.240%) vs. 20.880 % (3.550 %-48.500 %), Z=-7.74, P<0.000 1]. Relative expression level of WT1 between AML-CR patients [0.102%(0-5.380%)] and primary AML patients had significant difference (Z=-8.34, P<0.000 1). Moreover, the relative expression level rate of the first course in AML patients with higher WT1 expression level (>20.880 %) was 60.7 % (17/28), while the CR rate was 76.7 % (23/30) in those with lower WT1 expression. WT1 expression was increased dramatically in recurrent AML patients. Relative expression level of WT1 was significantly higher in primary ALL patients [0.350 % (0.021 %-10.780 %)] compared with that in the control group Z=-2.58, P<0.05. There was no significant difference in relative expression level of WT1 between ALL and ALL-CR patients [0.038 % (0-2.800 %), P=0.065]. Conclusion WT1 expression level in AML patients is relatively high, which could be used as an effective index of prognosis evaluation and MRD monitoring for AML patients, but not for ALL patients.

Objective To investigate the relationship of fetal total bile acid (TBA) concentration with the change of fetal pancreas endocrine secretion and its impact on fetal growth and development in intrahepatic cholestasis of pregnancy(ICP). Methods The concentrations of TBA, insulin, glucagon and glucose in the cord blood were measured in 30 fetuses with maternal ICP (case group) and 30 fetuses of normogravidas(control group) after elective cesarean section during the same period in the Department of Obstetrics of Xiangya Second Hospital of Central South University from March 2007 to February 2008. The cord blood TBA concentration was investigated by enzyme method and the concentrations of insulin and glucagon were investigated by radioimmunoassay. The glucose was measured by oxidase-superoxide method. The neonatal weight, length and the ponderal index (PI) were measured after parturition. Results (1) The cord blood insulin concentration (9.0±3.3) mU/L and the ratio of insulin over glucagon 0. 048±0. 028 in the case group was significantly lower than that of controls(10.1±3.7) mU/L,0.050±0. 020 (P<0.05). The concentrations of TBA(10.3±3. 8)μmol/L and glucagon(235±57) ng/L in case group were obviously higher than that in controls (4.1±1.3)μol/L, (205±34) ng/L(P<0.05). But no difference was shown in the glucose concentration in cord blood between the ease and control groups [(3.4±1.1) mmol/L vs (3.6± 1.2 )mmol/L, P > 0.05]. (2)The neonatal weight and length in case group were significantly lower than that of control [(3163±478) g vs (3498±393)g, (46.5±2.3) cm vs (49.3±1.9)cm, P<0.01]; while the Ponderal index in ease group was significantly higher than that of control group (3.13±0. 23 vs 2. 92±0. 29,P <0.01). (3) The cord blood TBA concentration respectively showed a linear relationship with the cord blood insulin concentration, the cord blood glucagon concentration and the ratio of insulin over glucagon in the case group. With the increase in cord blood TBA concentration, the cord insulin concentration and the ratio of insulin over glucagon decreased; meanwhile the cord blood glucagon concentration rose(P<0.01). The cord blood insulin concentration and the ratio of insulin over glucagon in case group were respectively positively correlated with the neonatal weight and length, and were negatively correlated with the PI (P<0.01); while the cord glucagon concentration was respectively negatively correlated with the neonatal weight and length, and positively correlated with the P1 (P < 0.01 ).Conclusions In 1CP fetus pancreas, there are hypoinsulinism, glucagon oversecretion, and decrease of the ratio of insulin over glucagon, which is closely correlated with fetal TBA concentration. The endocrine function of fetal pancreas affects the fetal growth and development.

Objective To explore the methods of diagnosis and appropriate treatment of pancreatic duct stone.Methods Clinical data of 16 patients with pancreatic duct stone from March,2005 to August,2009 were analyzed retrospectively.Results 15 patients presented with varying degrees of upper abdominal pain,another one with irregular diarrhea.Serum and urine amylase level was higher than the upper limit of normal level in 3 patients;serum glucose was elevated in 4 patients.The diagnostic accuracy by Bultrasonography,CT,MRI,ERCP and KUB was 93.8%(15/16),68.8% (11/16),57.1% (4/7);100%(2/2) and 50% (3/6),respectively.2 cases underwent endoscopic pancreatic sphincterotomy + pancreatic stent drainage,14 cases were treated with surgery,including transpancreatic duct lithotomy + pancreatic jejunal anastomosis in 12 cases,pancreatoduodenectomy in 1 ease,and pancreatic body and tail resection +pancreatic jejunal Roux-en-Y anastomosis in one case.All operations were successful without mortality,and abdominal pain was significantly improved.Follow up of 14 cases showed no stone recurrence.Two patients were lost in follow up,so the follow up rate was 87.5% with the duration ranging from 1 to 53 months.Conclusions B-ultrasonography was the best imaging examination for pancreatic duet stone,but the combined application of imaging tests could significantly improve the diagnostic yield,and imaging examination provided an important basis for the choice of treatment method.With the improvement of endoscopic techniques,ERCP will be as important as surgery for the treatment of pancreatic duct stone.

A new pyranocoumarin as an analogue of calophyllolide, compound 6, is firstly prepared and reported to have potent anti-inflammatory activity on carrageenin-induced edema in rats.

Objective To investigate the diagnosis and surgical treatment of pancreatic cystic tumor.Methods The clinical data of 19 cases of pancreatic cystic tumor from January 2000 to August 2009 was retrospectively analyzed. Results Patients with pancreatic cystic tumor has no specific clinical feature.Ultrasound and CT were main image examinations, but they could not distinguish the pathologic types, and the diagnostic accuracy when compared with postoperative pathologic results was 57.9% (11/19) and 68.4%(13/19) respectively. The tumors were located in the pancreatic head and neck in 5 cases, body and tail in 14 cases, the maxim diameter was between 3 ～ 15 cm. All patients underwent surgical treatment; the rate of curative resection was 84. 2% ( 16/19 ). The rate of intraoperative misdiagnosis was 21.0% ( 4/19 ).Pathologic examination results showed 6 cases of serous cystadenoma, 6 cases of mucinous cystadenoma, 5 cases of mucinous cystadenocarcinoma, and 2 cases of intraductal papillary mucinous adenoma. 15 ( 78.9% )patients were followed up. Among the 3 patients with mucinous cystadenocarcinoma, one patient who received curative resection survived for 4 years with no evidence of recurrence; the other 2 patients died 4 months and 7 months later. 12 cases of cystadenoma were alive without recurrence. Four patients, including 2 patients of cystadenoma and 2 patients of cystadenocarcinoma were lost in follow-up. Conclusions To be aware of pancreatic cystic tumors is the key to reduce misdiagnosis and mistreatment. Surgical treatment is the treatment of choice with excellent prognosis.

Objective To study the treatment of the chronic calcaneus osteomyelitis combined with skin ulcers or defects of the posterior heel following internal fixation for calcaneal fractures.Methods From February 1999 to June 2005,17 cases of calcaneus osteomyelitis combined with skin ulcers or defects following internal fix- ation for their calcaneal fractures were treated with elimination of infection focuses and dead spaces,tissue trans- plants and continuous irrigation.Skin flaps or myocutaneous flaps were used to repair heel ulcers or defects and to fill the dead spaces.Drainage and irrigation tubes were placed into the flap covered areas to carry out the continuous irrigation.Results All the cases were followed up for 3 to 36 months(mean,25 months).All the grafts survived without recurrence of calcaneus osteomyelitis.Their posterior heels regained fair appearance.Thirteen cases obtained fine sensory recovery and friction tolerance and could walk with weight-bearing.Conclusion Calcaneus os- teomyelitis can be cured by simply and effectively tissue transplants and continuous irrigation,which can provide adequate anti-infection and improve blood circulation.