ObjectiveTo evaluate retrospectively the incidence and treatment of nosocomial infection of senile leukemia.MethodsTo study the incidence, pathogenic microorganism and treatments of nosocomial infection in 78 patients from October 1998 to December 2000 in our hospital.ResultsIncidence of nosocomial infection was 41.0% in all 78 cases. 7 patients (21.9%) died of mixture infection.Conclusions Immune dysfunction of patients is the major cause of infectious death. Supporting treatment must be reinforced to patients of senile leukemia.

Objective To study clinical characteristics and prognosis of patients with liver injury of acute pancreatitis.Methods 290 cases of acute pancreatitis admitted between January 2001 to October 2003 were reviewed and analyzed retrospectively.Results Through comparing different types of AP with liver injury and C-reactive protein (CRP) changes,it was found that the more severe AP was,the more significant liver injury was;and liver injury of severe AP had some connection with CRP(.P.

Objective To lay a foundation for the cultivation of disease-free plantlet of Citrus medica L.var.sarcodactylis Swingle(CMS) by discussion of the factors affecting survival rate for micro-grafted shoot-tip of CMS.Methods With citrus limon seedlings cultured in the dark as the rootstock,shoot-tip of CMS was grafted to the inverse T-shaped cut in the cotyledon of rootstocks.Then an investigation was carried out on the factors which affected the survival rate for micrografted shoot-tip of CMS.The factors included age of rootstocks,scion size,culture medium with different concentrations of phytohormones,and rootstocks with or without cotyledon.Results The survival rate for micro-grafted shoot-tip of CMS was closely related to the factors mentioned above.A higher survival rate was obtained when CMS shoot-tip with 4 pieces of leaf primordia was grafted to the inverse "T" shaped cut in the cotyledon of parental stock(citrus limon seedlings) which was cultured in the dark for 14 days,and when the citrus limon seedlings were cultivated in MT-based medium with ?-naphthylacetic acid 0.1 mg?L-1 added.Conclusion The optimized micro-grafting conditions for CMS shoot-tips improve the propagation of micro-grafted plantlet and the survival rate of micro-grafted shoot-tip of CMS.

Objective To provide a new approach of preservation for germplasm resources of Citrus medica var.sarcodactylis(CMS).Methods A micrografting test was made on CMS shoot-tips after vitrified cryopreservation,resulting in living shoot-tip.Results First the CMS shoot-tip is inoculated in medium consisting of MS,5%DMSO,and 5%sucrose for 48 h preincubation.Then the shoot-tips were cut off 3—4 mm long and fore-treated by 60%PVS_2 at room temperature(25℃) for 30 min.After that,they were treated by PVS_2 at 0℃for another 80 min and conserved in liquid nitrogen for 24 h.Next the shoot-tips were defrosted by aqueous bath at 40℃and cleaned twice at room temperature(25℃) by MT minimal medium with additive 1.2 mol/L sucrose,10 min once.Finally data collected recorded a higher survival rate of 81.25%by TTC inspectation and a better regeneration rate of 52.94%if the CMS shoot-tips had been grafted on darkly-cultured parental stock,growing,and differentiating normally afterwards.The plantlets detected by polymerase chain reaction(PCR) showed that the pathogens of Huanglong disease had been removed.Conclusion Therefore a conclusion is made that the approach of vitrified cryopreservation may be applied to the preservation of CMS germplasm resources.

Objective To assess the safety and the efficacy of endoscopic ultrasound (EUS)-guided transmural drainage of pancreatic pseudocysts (PPC).Methods A total of 17 patients with PPC who underwent EUS to detect the optimal site and depth of puncture.The needle was punctured into the PPC cavity through endoscopic biopsy hole,cyst fluid was drained with a syringe.The guide wire was inserted along the pinhole under X-ray,and then the needle-knife was sent along the guide wire to cut the gastric wall and pseudocysts wall,followed by balloon dilation.The way of drainage was selected according to the cyst fluid properties.The technical success rate,treatment success rate,complication occurring rate and the skills were evaluated.Results Four patients were with nasalcystic catheter drainage,9 patients with double pigtail stents internal drainage,and 4 patients with nasal-cystic catheter and double pigtail stents combination drainage.The treatment success rates were 3/4,7/9,and 4/4 respectively.Only 1 patient subsequently developed bleeding from puncture site after stent successively placed,and was turned to surgery because of ineffective endoscopic treatment.Infection occurred in 4 patients during drainage,two of those were switched to surgical resection due to poor medical treatment response,and the other 2 were cured with intravenous infusion of antibiotics sensitive to cyst fluid bacteria and metronidazole rinse PPC.The median follow-up duration was 28.5months,and there was none of recurrence.Conclusions EUS-guided transmural drainage of PPC is safe.Stent placement and nasal-cystic catheter play an important role in PPC treatment.

Objective To investigate the serum levels of procalcitomn (PCT) and high mobility group box chromosomal protein-1 ( HMGB1 ) in patients with acute pancreatitis (AP) ; and study the relationship between the serum levels of PCT,HMGB1 and the severity and prognosis of AP.Methods The blood samples were collected from 80 AP patients,including 38 severe acute pancreatitis (SAP) patients and 42 mild acute pancreatitis (MAP) patients.The serum levels of HMGB1 were measured by ELISA kit,and the levels of PCT were measured by immunoassay chemiluminescent technique,then their relationship with other biochemical parameters,the severity and prognosis of AP was analyzed.30 healthy adults were treated as the control group.Results The serum PCT and HMGB1 levels were ( 8.18 ± 3.24) μg/L and ( 11.79 ± 3.98 ) μg/L in SAP group,and the corresponding values were (5.67 ± 2.43) μg/L and ( 5.38 ± 2.06) μg/L in MAP group,and both were significantly higher than those in control group [ ( 1.85 ± 0.86) μg/L and ( 1.87 ± 1.47) μg/L,P ＜0.01 ].The serum level of PCT was positively correlated with serum 1evel of HMGB1 ( r =0.276,P =0.014),and both were positively correlated with Ranson score,APACHE Ⅱ score,Balthazar CT score (P＜0.05 or ＜0.01 ).The HMGB1 levels were significantly higher in patients with organ dysfunction than those in patients without organ dysfunction (P ＜0.05).Conclusions In AP patients,serum PCT and HMGB1 levels were significantly increased,and they were positively correlated with disease severity.These results suggest that PCT and HMGB1 may act as potential serum markers for AP severity evaluation.

Objective To investigate the expression of Delta-like 4 (DLL4) in pancreatic cancer and its clinical significance.Methods The expression of DLL4 in pancreatic cancer was examined by immunohistochemistry method.The microvessel density (MVD) was calculated after CD34 staining specifically for microvessel endothelium; and their correlations and relationship between them and clinicopathological parameters as well as prognosis of pancreatic carcinoma was investigated.Results The expression of DLL4 in pancreatic cancer was significantly higher than that in normal pancreatic tissue (68.3％ vs 20％,P ＜ 0.01).The over-expression of DLL4 in pancreatic cancer was related to degree of differentiation,TNM staging,lymph node metastasis and invasion depth,while not related to the size,location and histological types.The MVD in pancreatic cancer tissues was notably higher than that in normal tissues (34.9 ± 13.2 vs 18.9 ± 2.2,P ＜0.01).MVD was correlated to degree of differentiation,lymph node metastasis,but not related to the size,location and histological types.DLL4 expression was closely associated with prognosis.COX model analysis showed that TNM staging and DLL4 expression were independent prognostic factors for pancreatic cancer.Conclusions The over-expressions of DLL4 may play an important role in metastasis and invasion of pancreatic cancer.Expression of DLL4 and TNM staging is useful for predicting the prognosis of patients with pancreatic cancer.

Multidrug resistance (MDR) is the main obstacle for cancer to cure,failure of chemotherapy and relapse.Cancer stem cells (CSCs) are driven force for tumorigenesis,the evolution of metastasis and recurrence,and the most fundamental reason for cancer drug-resistance.The primary drug resistance mechanism includes:ABC transporters strengthening CSCs drug resistance,high level expression of the anti-apoptotic genes,DNA repair capacity enhancement and hypoxic niches,and so on.To study CSCs biological characteristics and clarify the resistance molecular mechanisms,and to develop a targeted therapy for CSCs,and then to overcome and reverse the multidrug resistance of CSC,will enhance cancer cure rate and reduce the relapse rate.

Objective To analyze the clinical features of patients with IgG4-associated biliary and pancreatic diseases,and to improve the understanding of these diseases.Methods Nine cases of patients with IgG4-associated pancreatitis and cholangitis were analyzed retrospectively,which included clinical manifestations,serological examination,imaging test,pathology,treatment and prognosis.Results Of the 9 patients,8 were male,1 was female,the average age was 61 years old.Four cases were presented with jaundice,2 cases with jaundice and abdominal pain,2 cases with abdominal pain,and 1 case with diabetes.Serum IgG4 levels were 3.46-21.3 g/L (mean 9.743 g/L) in 6 cases,and which were higher than normal value,3 patients did not undergo blood test of IgG4.Nineteen auto-antibodies (including ANCA) were all negative in 9 cases.CA19-9 was increased in 4 cases.CT manifestations showed 5 cases with low density pancreas mass (2 cases with biliary tract dilatation);1 case had pancreas swelling with dilatation of bile duct,and 2 cases with bile duct dilatation only,and CT findings in 1 case were negative.Four patients underwent EUS-FNA,and EUS features included hypoechoic lesions without peripancreatic lymph nodes.FNA results indicated 2 cases with IgG4 related chronic inflammation,2 cases with chronic inflammation with negative IgG4.Seven cases were confirmed to have IgG4 related pancreatitis,and 2 cases with IgG4 related cholangitis.Six patients received glucocorticoid treatment,and the dose ranged from 8-40 mg;3 patients underwent surgery and the surgical pathology indicated IgG4 positive plasma cell.Follow-up showed the serum IgG4 returned to normal,clinical symptoms improved remarkably,and pancreatic mass decreased.Conclusions IgG4 positive plasma cell infiltration is the main feature of IgG4-associated cholangitis and pancreatitis.The diagnosis should combine image,serology with pathology.Glucocorticoid is an effective treatment.

Objective To compare the efficacy of stents 7 F and 10 F in drainage of pancreatic pseudocyst via EUS-FNA.Methods A retrospective analysis of patients with pancreatic pseudocyst who received endoscopic ultrasonography guided puncture drainage by using 7 F and 10 F double pigtail plastic stent respectively in Drum Tower Hospital of Nanjing University Medical School from 2010 to 2014 was conducted.Patients' hospitalization period, the time for 50％ cyst reduction, removal time, infection rate, and recurrence rate were compared.Results Twenty three patients with pancreatic pseudocyst were included, among whom 14 were male and 9 were female.The age ranged from 13 to 70 with an average of 45.1 years.Eleven patients were treated with 7 F pigtail plastic stents whereas 12 patients with 10 F pigtail plastic stents.All patients were treated with additional 8.5 F joint nose cyst drainage.Four cases in 7 F group got fever, 3 of whom were successful in anti-infection and 1 failed, having to change the stent.One case (9.1％) relapsed without symptoms after 52 months during the follow-up and received no intervention.Five cases in 10 F group got fever, 4 of whom were successful in anti-infection and 1 failed, having to change the stent.One case (8.3％) was identified as mild hemorrhage, and replantation needed to be performed in 1 case (8.3％) because stent was found to slip after 12 days.Two cases (16.7％) relapsed without symptoms after 11 and 24 months respectively and no intervention was received.There was no significant difference in patients' age, cyst size, removal time, infection rate and recurrence rate between the two groups.However, patients in group 10 F had a markedly shorter hospitalization period and time for cyst reduction by at least 50％ than those in group 7 F (P ＜ 0.05).Conclusion 10 F double pigtail plastic stents can drain the cyst faster, shorten the hospital stay, but there is no significant difference in infection or recurrence rate of cyst compared with 7 F stents.