DEK protein is an abundant chromatin protein in metazoans with highly conserved nuclear factor. This protein is a unique member of its family and is preferentially expressed in actively proliferating and malignant cells. Recently, much attention has been paid to the role of DEK protein in the development of various cancers, which was originally discovered in a subset of acute my-elogenous leukemia. Oncogene DEK is overexpressed in several malignancies including hepatocellular carcinoma, glioblastoma, retino-blastoma, bladder cancer, malignant melanoma, and cervical cancer. Oncogene DEK is a chromatin remodeling protein that supports cancer cell proliferation and invasion. In this review, we summarized research advancements in the correlation between DEK protein and oncogenesis.

Objective To evaluate the therapeutic effect and toxicities of low dose Gemcitabine combined with Oxaliplatin in the treatment of advanced or metastatic uroedthelial carcinoma.Methods A total of 42 patients pathologically confirmed advanced or metastatic urothelial carcinoma (23 bladder cancer cases,11 ureteral carcinoma cases,and 8 renal pelvic carcinoma cases) were reviewed.Karnofsky score for each patient before treatment was more than 60.Combined treatment with Gemcitabine and Oxaliplatin regimen was as follows:Gemcitabine 700 mg/m2,iv infusion at day 1,8 and day 15,Oxaliplatin 100 mg/m2,iv infusion at day 2.The regimen was administered for more than 2 cycles (every 4 weeks) and the response rate was evaluated.The regimen was used in palliative chemotherapy and adjuvant chemotherapy,respectively.Results According to WHO evaluation criteria on therapeutic effectiveness,7 patients (16.7％) had complete response,13 patients (30.9％) had partial response,14 cases (33.3％) remained stable status,and 8 cases (19.1％) had progression.The overall response rate was 47.6％.The main side effects included thrombocytopenia,leucopenia,nausea,vomiting and alopecia,which were mild to moderate and disappeared when the chemotherapy was ceased.No chemotherapy related death occurred.Conclusions Combined treatment with low dose Gemcitabine and Oxaliplatin is effective for advanced or metastatic urothelial carcinoma,with mild and tolerable toxicities.

BACKGROUND:In senile osteoporosis patients, capacity of pedicle screw fixation is relatively poor due to fragile bone substance. Currently, augmentation of pedicle screw fixation with bone cement can improve the ability of screw fixation, but bone cement leakage and difficulties in screw removal become the problem to be solved. OBJECTIVE:To develop a novel pourable pedicle bone cement and to investigate its biomechanical properties, safety and practicality, thus providing the basis for clinical treatment of osteoporosis and spinal diseases.
METHODS:Six cases of complete wetting spines were colected at the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from December 2013 to January 2015, including 42 vertebrae. Pedicle screw fixation with X-ray assisted bone cement injection (2 mL) was performed unilateraly as experimental group, and conventional pedicle screw fixation was done contralateraly as control group. Bone cement dispersion was observed in the two groups. RESULTS AND CONCLUSION:It was 3-4 minutes for bone cement to agglomerate. Injection of bone cement paste into the infusion cylinder using a syringe was more convenient. The cylinder was connected tightly with the tail-end of the screw with no leakage. The push bar could provide sufficient perfusion force. Bone cement dispersion was found in the holow part and side holes of the screw. Side holes arranged regularly, and the hole pitch was equal. Compared with the control group, the yield load and yield displacement were significantly higher in the experimental group (P < 0.05), but the ultimate strength and ultimate displacement were significantly lower in the experimental group (P < 0.05). Bone cement around the pourable cement screw dispersed regularly, which was diffused into the surround cancelous bone and integrated with adjacent bone cement mass. The axial withdrawal force was increased by 114% in the experimental group compared with the control group (P < 0.05). The maximum rotary torque was significantly higher in the experimental group than the control group (P< 0.05). These finding suggest that the new pourable cement screw combined with bone cement putter and infusion cylinder is applied more convenient, can effectively control the leakage of bone cement, and can improve the stability of the pedicle in osteoporosis patients, which has been widely used.

AIM: To investigate the role of mild heat stress towards the immunological function of splenic macrophages and significance of BiP protein expression. METHODS: Primary cultured splenic macrophages were prepared and placed in 41 ℃ thermostat for thermal stress and restored to 37 ℃ after an hour. Heat stressed macrophages were separated into groups at time points of 0 min, 30 min, 60 min, 120 min and 180 min, and their BiP mRNA and BiP protein expressions were detected. At the same time, the phagocytic function, cytotoxicity and chemotaxis of the macrophages were detected. RESULTS: After heat stress, the expressions of BiP mRNA and BiP protein in splenic macrophages remarkably increased, and reached to peak after 30-60 min, still remained higher than control group after 120 min and restored to normal level after 180 min. At the same time, mild heat stress enhanced the phagocytotic, cytotoxicity and chemotactic activities of splenic macrophages, and reached to peak after 60 min then gradually decreased. CONCLUSION: The expression of BiP protein is enhanced after mild heat stress, synchronous changes happen both in BiP protein expression and cellular function. There is close relation between BiP protein expression and increased functions of splenic macrophages induced by mild heat stress.

Objective To give an empirical study on the interests claims of patients in public hospitals. Methods By questionnaire investigation, to sum up data using factor analysis and pairedsamples T test, and to compare difference between different kinds of patients using ANOVA. Results The interests claims of patients can be summed up to six factors and there is no significant difference between different kinds of patients. Conclusion At current stage, public hospitals need improve medical technique and cut down medical expenses.

Objective To identify anatomical characteristics of neurovascular compression associated with trigeminal newralgia(TN).Methods Fifty patients with TN (23 of 50 patients underwent microvascular decompression) and 50 patients without facial pain underwent 3.0 T MRI scanning for analysis of 50 trigeminal nerves ipsilaterai to TN symptoms,50 contralateral to TN symptoms,and 100 in asymptomatic patients.MRI sequences included balanced fast-field echo and 3D MR angiography.Images were fused and reconstructed into virtual cisternoscopy images to determine the degree (severity of compression was defined as follows:1=no compression; 2 =compressed by a vein; 3 =contacted by an artery; 4 =indented by an artery; and 5 =nerve displaced or distorted by an artery) and site of neurovascular compression ( the point of each offending vascular structure:proximal was defined as located in 1/3 length of the cisternal segment of the trigeminal nerve near root entry zone; the place of superior was defined as above the cisternal segment of the trigeminal nerve).Reconstructed MPR images were used to measure nerve length and cross sectional area.The chi-square test was used for all 2 × 2 contingency tables.The t-test was used for dependent samples.The Logistic regression was used for prediction of occurrence of the event of TN.Results Twenty-three of 50 patients with TN underwent microvascular decompression,which confirmed predicted neurovascular relationships in all cases,and 21of 23 patients were pain free after the operation.The incidence of neurovascular compression on asymptomatic nerves ( no.of level 1=79,level 2 =5,level 3 =8,level 4 =8),on nerves contralateral to TN symptoms( no.of level 1=27,level 2 =6,level 3 =9,level 4 =8),and on nerves ipsilateral to TN symptoms(no.of level 1=4,level 2 =12,level 3 =12,level 4 =7,level 5 =15) was 21.0％ (21/100),46.0％ (23/50),and 92.0％ (46/50),respectively.The difference between symptomatic and asymptomatic nerves was significant regarding nerve distortion ( level 4 and 5,x2 =27.0,P ＜ 0.01),the point of compression ( no.of proximal of symptomatic nerves =32,not proximal of symptomatic nerves =14,proximal of asymptomatic nerves =4,not proximal of asymptomatic nerves =17,x2 =14.8,P ＜ 0.01),the place of vascular compression ( no.of superior of symptomatic nerves =36,not superior of symptomatic nerves =10,superior of asymptomatic nerves =5,not superior of asymptomatic nerves =16,x2 =18.0,P ＜0.01) and the mean cross-sectional area of the CPA cistern [ ipsilateral:( 183.9 + 52.5 ) mm2,contralateral:( 217.8 + 58.8 )mm2,t =- 3.04,P ＜ 0.01].Decreased nerve size was observed in patients with TN [ the section area of ipsilateral nerve ( 6.3 ±1.3) mm2,contralateral (7.7+1.6) mm2,t =-4.80,P ＜0.01; length of ipsilateral nerve:(8.0 ±1.9) mm,contralateral:(9.0 + 2.0) mm,t =- 2.64,P ＜ 0.05 ].Conclusions Trigeminal neurovascular compression can occur in asymptomatic patients,but is more severe,more proximal,more superior and with smaller size of cross-sectional area of the CPA cistern in patients with TN.This information may help identify patients who are likely to benefit from microvascular decompression.

Objective To investigate the immune injury in genital tract of BALB/c mice induced by plasmid protein pORF5 of Chlamydia trachomatis and its possible mechanism.Methods GST(glutathione-S-transferases)-pORF5 fusion protein was expressed and digested with PreScission Protease to obtain the target protein without GST tag.After further purification and endotoxin removal,pORF5 protein was injected into the posterior fornix of BALB/c mice on day 1,3 and 6,while the control groups were injected with PBS or GST protein respectively,and then all the mice were sacrificed on day 7 to evaluate genital tract gross pathology and histopathological characterization.The levels of TNF-α,IL-1β and IL-6 in serum,splenocytes culture supernatant and vaginal douche were detected by ELISA.Results Mice in pORF5 group developed different degrees of swelling in isthmic portion and ampulla of uterine tube,connective tissue adhesion and hydrosalpinx in the genital tract tissues,while the PBS group and the GST group did not show any obvious change.The inflammatory score showed that the genital tract pathology in pORF5 group was much more severe than PBS and GST control groups (P＜0.O1).The levels of TNF-α,IL-1β and IL-6 in vaginal douche and splenocytes culture supernatants in pORF5 group were obviously higher than those of PBS and GST groups (P＜0.05).The levels of TNF-α and IL-1β in serum were also higher than those of GST and PBS groups (P＜0.01).Conclusion pORF5 plasmid protein could induce pathological immune response in the genital tract of BALB/c mice,which may be associated with the increase of the production of the inflammatory cytokines TNF-α,IL-1β and IL-6 in BALB/c mice.

Objective To evaluate the clinical value of spectral CT monochromatic imaging in improvement of imaging quality of bronchial arteries.Methods We retrospevtively analyzed the chest CT images in 38 patients who underwent the contrast-enhanced spectral CT.These images included a set of 140 kVp polychromatic images and default 70 keV monochromatic images.Using a standard Gemstone Spectral Imaging (GSI)viewer at an advanced workstation (AW4.6),an optimal energy level (in keV)for obtai-ning the best CNR of the bronchial artery could be automatically obtained.The SNR,CNR and objective imaging quality score for these 3 imaging sets (140 kVp,70 keV and optimal energy level)were obtained and compared with one-way ANOVA .Results The optimal energy levels for obtaining the best CNR were (62.58±2.74)keV.The SNR of the 140 kVp polychromatic images,70 keV monochromatic images,and the optimal keV monochromatic images were 1 6.44±5.85,20.96 ±8.32 and 24.91 ±9.91,the CNR were 13.30±5.45,1 7.25±6.97 and 20.67±8.62,and the subjective imaging quality scores were 1.97 ±0.82,3.24±0.75 and 4.47±0.60,respectively,exhibiting significant differences among groups (F =10.1 7,10.1 7 and 1 1 1.12,P <0.00).The optimal monochromatic group was superior to the 70 keV group and the 140 kVp mixed-energy group.Conclusion Monochromatic images at approximately 62 keV in dual-energy spectral CTA yields the best CNR and highest diagnostic confidence for imaging bronchial ar-teries,which may improve imaging quality for imaging bronchial arteries.

Objective:To summarize the experience of Bacillus Calmette-Guerin(BCG) in the treatment of bladder cancer secondary to renal transplantation.Methods:The clinical data of 5 patients who underwent BCG bladder irrigation after secondary bladder cancer after kidney transplantation in Tianjin First Central Hospital from January 2015 to December 2019 were analyzed. There were 1 male and 4 female cases. During the period of immunosuppression after transplantation, 1 case developed secondary high-level non-muscular invasive bladder cancer (NMIBC), 3 cases developed secondary low-grade NMIBC, and 1 case developed secondary glandular cystitis (4 cases). The mean age of the 5 patients with secondary bladder cancer was 59.7±4.0 years. Case one with high level NMIBC was treated with transurethral resection of bladder tumor (TURBT) and postoperative irrigation of epirubicin. Case 3 and 5 with low-level NMIBC accepted regular postoperative irrigation of gemcitabine. No irrigative therapy was performed in case 2. Bladder cancer recurred in case 1, 2, 3 and 5 after 20.1±9.7 months. TURBT was observed in all the 4 patients, among which 3 were of high grade NMIBC and 1 was of low grade NMIBC. Four patients were irrigated with BCG 2 weeks after operation. Postoperative pathology indicated low-level NMIBC in case 4, and BCG was irrigated 2 weeks after the operation. During perfusion therapy, immunosuppressive agents were continued.Results:During BCG perfusion, 4 of the 5 cases showed BCG related local inflammation, among which 2 cases presented symptoms of bladder irritation, 1 case presented hematuria, and 1 case presented hematuria with low fever. Patients with frequent urination, pain in urine, hematuria and other symptoms improved after drinking plenty of water, taking bed rest and taking levofloxacin (0.5g/ day ×7 days). Patients with low fever were treated with antipyretic treatment. No antituberculous agents were used prophylactically during BCG perfusion. There were no symptoms of tuberculosis infection or sepsis. The function of transplantated kidney was normal and no tendency of rejection. The 5 patients were followed up for 7-24 months, 1 patient was lost to follow-up after 7 months of BCG bladder perfusion, and no tumor recurrence or metastasis was found in 5 patients during the follow-up.Conclusions:The use of immunosuppressive agents does not reduce the biological activity of BCG, and BCG does not increase the risk of systemic toxicity or affect the function of transplanted kidneys in immunocompromised patients. BCG is a treatment option for bladder cancer secondary to renal transplantation.

Objective To investigate the feasibility of the adaptive cardio sequence prospective ECG-gated dual-source CT coronary angiography (CTCA).Methods Thirty one patients underwent prospective ECG-gated dual-source CTCA. The patients were divided into two groups: group A, heart rate ≤ 75 times / minutes, 70% of R-R interval was chose; group B, heart rate> 75 times / minutes, 40% of R-R interval was chose. Two experienced radiologists assessed the image quality of 15 segments of coronary arteries in a double blinded fashion in a four score scale. Student t test was used to compare the image quality between two groups. CT dose index(CTDIvol) and effective dose(ED) were also calculated for both groups. Results 437 segments of coronary arteries in 31 patients were included this analysis, 408 segments (93.4%) had assessable image quality, while 29 segments (6.6%) had non assessable image quality. Of 226 segments in group A, 12 segments (5.3%) had non assessable image quality; however, 17 segments (8.1%) of 211 segments in group B had non assessable image quality. The average score of image quality was 3.57±0.64 in 31 patients. There was no statistical difference for mean image quality of group A (3.65±0.39) and group B (3.41±0.43)( t=1.62,P=0.12 ) . There was a statistical difference for mean image quality for segment 10 on a per segment basis ( t = 3.8 ,P＜0.05). CTDIvol and ED were (18.88±5.04) mGy and (4.31±1.05) mSv, respectively.Conclusion Adaptive cardio sequence prospective ECG-gated dual source CT can acquire assessable image quality of coronary artery with lower radiation dose to the patients, which has the potential to be a routine CTCA technique.