Post-transplant lymphoproliferative disorders (PTLD) is one of the most potentially lifethreatening complications after allogeneic hematopoietic stem cell transplantation (a]lo-HSCT),and is mostly associated with Epstein-Barr virus infection.PTLD may have a wide range of clinical manifestations and pathological classifications.The rapid progression and high fatality of early PTLD should prompt clinicians to a timely diagnosis.This paper presents a review of the latest update on epidemiology,pathogenesis,clinical manifestations,diagnosis,management and prognosis of post allo-HSCT PTLD.

Objective:To compare the estimation of glomerular filtration rate(GFR)by renal dynamicimaging with that estimated by two-sample method and evaluate the reliability of measurement of GFR byrenal dynamic imaging.Methods:The study was performed in 54 patients(33 males and 21 females;aged 15 to 82 years)with primary or secondary chronic nephrosis.The patients were intravenously bolusinjected with 185 MBq/1 mL of (99)~Tc~m-DTPA 20 min after drinking 300 mL of water.Renal dynamic ima-ging was performed and the image was processed according to standard procedure(Gates' method)to ob-tain GFR.3mL of blood was withdrawn 2h and 4h postinjection,respectively,and radioactivity of 1mLplasma was measured.GFR was calculated by the formula of two-sample method.The correlation ofGFRs measured by renal dynamic imaging and by two-sample method was analyzed using regression anal-ysis.The correlations of GFRs determined by the two methods with urea and creatinine were also meas-ured.Results:The GFR measured by renal dynamic imaging was slightly lower than that measured bytwo-sample method.Excellent correlation was obtained by two methods with r=0.881 5 and P

Objective To analyze the postoperative complications in aged patients receiving pancreaticoduodenectomy. Methods Pancreaticoduodenectomy was employed for the treatment of 52 aged patients. Of the 52 patients with a mean age of 70.5(65-76), 32 were male and 20 female. Postoperative pathological examination confirmed that 24 patients suffered from Vater,s ampullary and duodenal cancers, 16 from pancreatic carcinoma and 12 from cholangiocarcinoma. Results The mortality was 7.7%. Severe complications included bleeding (upper gastrointestinal tract or abdominal cavity),MOF, ARDS, postsurgical gastroparasis syndrome(PGS), mental disorder, pancreaticogastrostomy leak and biliary-enteric anastomotic leak et al. Conclusion MOF is the main lethal complication. Incidence of PGS and mental disorder is high.

Positron emission tomography-computed tomography (PET-CT) is widely used in the diagnosis and grading of FDG-uptake lymphoma,particularly in the extranodal lesions.Baseline PET-CT improves the accuracy of subsequent response assessment.Focal FDG uptake within the bone or bone marrow is highly sensitive for involvement in Hodgkin' s lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL) and is better than bone marrow biopsy.Many international trials suggest that interim scan is prognostic,but not proven as a method to guide therapy.A negative PET-CT scan at the end of therapy is the best predictor of a good outcome.However,surveillance PET-CT scan should not be done routinely.

10.3969/j.issn.2095-4344.2013.26.020

The INK4a-ARF locus is located on CDKN2A point in human chromosome 9p21 and is known to encode two functionally distinct tumor-suppressor genes p16INK4a (MTS1/CDKN2/INK4a/p16) and p14ARF, have been shown to play significant roles in cell-cycle regulation in cancer. p16 is encoded by the exon 1a-exon 2-exon 3 transcript and functions as a negative regulator of the cell cycle through its inhibition of cyclin-dependent kinases (CDKs) 4 and 6 and subsequent blockage of the cyclindependent phosphorylation of pRB . Thus, loss of p16 function leads to deregulation of pRB's suppressive block of the G1-to-S transition and cell proliferation. In contrast, p14ARF is encoded by the exon 1?-exon 2 transcript and acts upstream of p53. Biochemical evidence has demonstrated that p14ARF physically interacts with human double minute 2 (HDM2) gene product and consequently stabilizes p53, leading to G1 cell-cycle arrest. Overall, somatic mutation of the INK4a/ARF tumor suppressor locus, resulting in functionally deficient p16 and possibly p14ARF proteins, seems to be a prevalent event in the development of oesophagus carcinoma.

Objective To explore the effect of nitroglycerin on ET/NO, TXA2/PGI2 and pancreas pathomorphology changes in severe acute pancreatitis (SAP) rats. Methods Sixty SD rats were random divided into five groups, including control group (A group, n = 12) and experimental group(B,C,D and E group, n = 12). The SAP was induced by injection of 5% sodium taurocholate through retrograde common biliopancreatic ducts via duodenal papilla with epidural catheter. Group C, D and E were intravenously injected with nitroglycerin 0.5μg/kg/min,1μg/kg/min and 2μg/min in 30 min respectively, and group A and B was injected with Sodium Chloride 0.5ml. The indexes of changed pathomorphology and ET/NO, TXB2/6-keto-PGF1a, were determined at the 6th and 12th hour after operations, respectively. Results The specimen data of the 6th and 12th hour displayed that the indexes of changed pathomorphology, ET, ET/NO, TXB2, and TXB2/6-keto-PGF1a of the group C,D and E degraded respectively, compared to group B(P < 0.05). Conclusion The nitroglycerin could degrade ET, ET/NO,TXA2 and TXA2/PGI2, improve the microcirculation of pancreas, and delay the pathological inflammation change in SAP rats.

Objective:To study the efficacy and safety of saxagliptin or pioglitazone combined with metformin in the newly diag-nosed patients with type 2 diabetes mellitus(T2DM) with inadequate glycemic control by metformin alone. Methods:Totally 82 newly diagnosed T2DM patients with inadequately control by metfomin monotherapy for 12 weeks were randomly divided into two groups, sax-agliptin group ( saxagliptin combined with metforminc) and pioglitazone group ( pioglitazone combined with metformin) . The blood glu-cose control, homeostatic model assessment of insulin resistance index ( HOMA-IR) , body weight change and adverse reactions were assessed before and after the treatment for 12 weeks. Results:After the 12-week treatment,the level of fasting plasma glucose ( FPG) , two-hour postprandial plasma glucose (2hPG) and glyeosylated hemoglobin(HbA1c) in both groups were significantly decreased. Compared with the pioglitazone group,the level of 2hPG and HbAlc was lower while the level of FPG was higher in the saxagliptin group (P<0. 05). Compared with the saxagliptin group,the level of fasting plasma insulin(FINS) was significantly decreased and HOMA-IR was significantly improved in the pioglitazone group. The body mass index ( BMI) of the patients was increased in the pioglitazone group(P<0. 05) and showed no change in the saxagliptin group(P>0. 05). There was no statistical difference in the adverse reac-tions between the two groups(P>0. 05). Conclusion:The combination of saxagliptin or pioglitazone with metformin in the treatment of newly diagnosed patients with type 2 diabetes can improve glycemic control with low incidence of hypoglycemia and adverse reactions. Saxagliptin is more suitable for the patients with heart diseases or old patients.

Objective To analyze the clinical and laboratory features of acute pulmonary embolism for diagnosis as possible as early.Methods For 15 patients of pulmonary embolism,who have not history of heart-lung disease and have been diagnosed by high speed multislice CT, the clinical and other laboratory data of these patients were retrospectively analyzed.Results The clinical manifestations were dyspnea ,chest distress, palpitation;the signs including tachypnea, systole murmur, tachycardia etc. The examinations were mainly color Dopple echocardiography and blood gas analysis. In some cases of embolism were found in their pulmonary artery; in all cases tricuspid regurgitation were found by color Dopple echocardiography and their pulmonary systole pressure were all over normal value(42～76mmHg).The blood gas analysis showed that PaO 2 was obviously lower than normal value(30～65mmHg).Conclusions The patient who has symptoms of dyspnea and palpitation must be examined by high speed multislice CT , color Dopple echocardiography and other measurements to get an immediate diagnosis . The first choice is color Dopple echocardiography when there is no high speed multislice CT. The patients can get exact diagnosis and prompt treatment by manifestation of pulse spectral of pulmonary artery, increase of pulmonary artery pressure, right ventricular enlargement.

Purpose:To analyse the dosimetric parameters measured by the silicon diode, and to describe the features of the dose distributions for small fields.Materials and Methods:P-type silicon diode with small volune and high sensitivity was chosen to measure the PDD,OAR and Sc,p at isocenter for circular fields of 5mm ～50mm in diameter used for stereotactic irradiation .The dosimetric data measured are evaluated by comparising with ones by other methods, such as ionization chamber and films,and ones in literature.Results:The values PDD of 10 and 30 fields at depth from 5cm～20cm are almost the same as those in reference 7 within ?0.6; The effective linear attenuation coefficient extrapolated to zero fiels size is 0.0510cm -1 for 6MV-X rays. The Sc,p value measured by diode and chamber(NE2571) are agread each other within variations of ?0.4% for large field size, but a great difference appears when the field size is 2 times smaller than the diameter of chamber. The Sc,p values by diode for field size of 12.5mm～27.5mm are agreed well with the results by Monte Carlo calculations. The OARs measured by diode are ageed well within 1mm with ones by films developed by ourself. The penumbras(90%～10%) measured by diode are coincidence with the results published.Conclusion:Due to the high dose gradients at the beam edge and the absence of lateral electron equilibrium for the smaller fields, the detector size and positioning are the most impostant factors influenced the measured results. Our practice shows that the silicon diode with diameter of 2mm or smaller is the best choice for the dosimetric date collection for beams used in X-ray stereotactic irradiation.