OBLECTIVE:To promote a sustained and quick development of the high-tech medicine industry in our country.METHODS:The related literature was consulted and the current developmental status of the high-tech medicine in-dustry in our country was analyzed.RESULTS&CONCLUSIONS:The high-tech industry in our country can be pushed on only through rearrange industry mix at the right time,constructing a serial comprehensive development terrace,supporting es-pecially those medicine enterprises that with core technology and independent intellectual property rights,building a virtual strategic league together with the academy of higher learning and scientific research institutes.

im To study the structure-function relationship of hTNFα . Methods We compared the cytotoxicity, receptor binding ability and toxicity in animal body of wild type(wt)hTNFα with its mutants including R2K-, N30S-, R32W-, L157F-hTNFα , and two multi-site mutants(R32W-L157F-hTNFα and R2K-N30S-R32W-L157F-hTNFα ). Results We found that the two multi-site mutants remained similar cytotoxicity to several human tumor cell lines as wild type hTNFα . However, their cytotoxicity to L929 cells were decreased sharply as compared with those of wt hTNFα . The two multi-site hTNFα mutants had lower binding activity with hTR75 than hTR55. We also found that compared with the wild type, the LD50 of the mutant R32W-L157F-hTNFα was decreased about 300 fold and the dose of mutant R2K-N30S-R32W-L157F-hTNFα resulted in 30％ death was 700 folds lower than LD50 of wt hTNFα . To certify the systematic toxicity of the mutant R2K-N30S-R32W-L157F-hTNFα , we assayed its toxicity to monkeys and found that its systematic toxicity was lower than that of wt hTNFα. Conclusion A 4-site mutants(R2k-N30S-R32W-L157F-hTNFα )of hTNFα is obtained, which the mutant may possess potential application value in clinical therapy.

Objective To improve the success rate of selective cannulation of major papilla during endoscopic retrograde cholangiopancreatography (ERCP).Methods When cannulation failed with conventional methods,ultra-fine guide wire combined with taped cannulation,precut papillotomy,guide wire pancreatic occupation technique,and percutaneous transhepatic cholangial drainage (PTCD) assisted rendezvous technique was applied to improve the success rate of cannulation of major papilla.Results A total of 5743 patients received ERCP in our hospital during last 5 years,with a success rate of cannulation of major papilla at 98.6% (5664/5743).For 396 patients with difficult cannulation under conventional methods,ultra fine guide-wire technique was applied in 20,pancreatic occupation technique in 67,precut technique in 294 and PTCD assisted rendezvous technique in 15,which achieved a success rate of 80.0% (317/396).Conclusion Application of combined techniques according to the features of papilla can increase success rate of difficult cannulation.

DNA barcoding is a technique in which species identification and discovery are performed by using short and standard fragments of DNA sequences. In this study, eleven species of Paris, including seven varieties, were sampled. Five chloroplast sequences, psbA-trnH, rpoB, rpoC1, rbcL, matK, and one nuclear marker, the second internal transcribed spacer (ITS2) of ribosomal DNA, were amplified and sequenced. The PCR amplification and sequencing efficiency, intra- and inter-specific divergence and barcoding gap were used to evaluate different loci, and the identification efficiency was assessed using BLAST1 and Nearest Distance methods. The ITS2 sequences in the studied samples of Paris were amplified and sequenced successfully using primers designed by our group, while matK showed low level in the amplification and psbA-trnH was difficult for sequencing because of over 800 bp and poly (A) structure. Analysis of the intra- and inter-specific divergence and barcoding gap showed ITS2 was superior to other loci. The ITS2 showed a much higher percentage of success (100%) in identification than other five loci, none of which indicated more than 50% except matK (52.9%). The 2-locus combination of rbcL+matK didn't improve ability of authentication. In addition, the rate of successful identification with ITS2 kept 100% when the samples were expanded to 67 samples of 29 species. In conclusion, ITS2 can be used to correctly identify medicinal plants of Paris, and it will be a potential DNA barcode for identifying medicinal plants of other taxa.

Objective To evaluate the safety and efficacy of a newly designed anti-reflux metallic stent (ARMS) for malignant extra-hepatic biliary obstruction. Methods A total of 23 patients with unresectable biliary malignancy in the middle or lower part of common bile duct underwent endoscopic retrograde cholangiopancreatography (ERCP) and ARMs placement. The success rate, early complications, stent patency and patients' survival were recorded. Results The ARMSs were successfully placed in all patients and no procedure-related complication was recorded. The average operation time was similar to that of self-expanding metallic stents (SEMs). In 22 patients completing the follow-up, the total serum bilirubin dropped to normal within one month in 20. ARMs dysfunction occurred in 6, including tumor in-growth in 1, overgrowth in 2, and stent dislodgement in 3. Other patients were free of biliary symptoms until death or at the end of follow-up. The average stent patency of ARMs was 14 months. Patency rates at 3, 6, and 12 months were 95%, 74% and 56%, respectively. The mean patient survival was 7. 9 months ( 1-14 months).Postoperative survival rates at 3,6 and 12 months were 91.0%, 81.3% and 17. 2%, respectively. Conclusion Endoscopic placement of novel ARMs in patients with extra-hepatic biliary tumors is feasible,safe and effective.

Objective To evaluate the effectiveness of mouth care combined with intestinal and endoscopic working channel washing for ERCP related cholangitis.Methods A total of 573 patients diagnosed as having obstructive jaundice were randomized into three groups,190 cases in the control group,192 in the saline group and 191 in the amikacin group.Clinical and laboratory data were collected before ERCP and ERCP related cholangitis were recorded.Results There were no significant differences among the three groups in sex,age,the level of obstruction,the category of obstruction,total bilirubin or WBC counting.The incidences of ERCP related cholangitis were 21.1％ (40/190),13.5％ (26/192) and 4.7％ (9/191)in control group,saline group and amikacin group respectively,which was significantly different (x2 =22.409,P =0.000 ).The incidences of ERCP related cholangitis were 19.5％ ( 65/333 ) and 4.2％(10/240) in patients diagnosed as having hilar duct obstruction and low positioned biliary obstruction respectively (x2 =27.175,P =0.000).There was no significant difference in ERCP related cholangitis between benign and malignant biliary obstruction.Subgroup of hilar duct obstruction showed the incidences of ERCP related cholangitis were 29.7％ (33/111 ),20.5％ (24/117)and 7.6％ (8/105)in the control group,the saline group and the amikacin group,respectively (x2 =16.905,P =0.000).Conclusion The incidence of ERCP related cholangitis is relatively higher in patients with hilar duct obstruction.Mouth care combined with intestinal and endoscopic working channel washing can effectively reduce the incidence of ERCP related cholangitis,especially in the amikacin group.

ObjectiveTo evaluate the feasibility and safety of endoscopic intraductal radiofrequency ablation (RFA) for unresectable malignant biliary strictures.MethodsA total of 12 patients with malignant biliary obstructions,who were unsuitable for surgical resection,were prospectively selected for this study.During ERCP,when successful biliary cannulation achieved,a bipolar radiofrequency probe was introduced into bile duct over a guidewire.RFA was given to the tumor lesion under fluoroscopy,followed by stent placement.The patients were closely observed and followed up after the procedure.ResultsSuccessful RFA was achieved in all patients before stents insertion ( plastic and metal stents in 6 respectively,additional pancreatic stents were given to 3).Mild complications of cholangitis and pancreatitis occurred in 1 patient respectively,which were cured with short-term management.Jaundice was promptly controlled in 7 patients (58.3％ ).During the mean follow-up duration of 3.4 (range 0.5-5.5) months,one patient died of cardiocerebral accident and others survived without obvious disconffort.The 1- month and 3- month stent patency was 100％ (12/12) and 80％ (8/10),respectively.ConclusionIt is technically feasible and safe to perform endoscopic intraductal RFA for the palliation of biliary malignancies.The short-term outcome is satisfying,however,long-term result and the better therapeutic schedule need further evaluation.

Objective To evaluate endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and management of biliary cast syndrome after orthotropic liver transplantation. Methods A total of 71 consecutive patients with abnormal liver function and MRCP findings after liver transplantation underwent ERCP for diagnosis and management. Their data were retrospectively reviewed. Results A total of 188 sessions of ERCP were carried out on the 71 patients, most of whom were found to have stenosis of anastomotic stoma and/or bile duct. Bile sludge was found and removed in all patients diagnosed within 3 months after liver transplantation, while pigmentoid stones were found and removed in patients diagnosed within 3-6 months and biliary casts in patients diagnosed at more than 6 months. Each patient underwent 2.6 sessions averagely. Biliary casts were formed at an average time of 22. 7 ± 15.6 months after transplantation. PostERCP complications included 2 cases of pancreatitis and 3 cholangitis, with an occurrence rate of 2. 6%(5/188), which were all controlled with conservative treatment. The follow-up data was available in 56 patients showing improvement in liver function after ERCP, among who 42 met the endoscopic criteria of cure,1 0 received second liver transplantation because of progressive sclerosing cholangitis and 4 died from diseases other than liver transplantation. Conclusion Therapeutic ERCP for the biliary cast syndrome after liver transplantation is feasible, safe and effective, and can be performed repeatedly with good short-term effect.

Objective To analyze the correlation between functional single nucleotide polymorphisms (SNPs)in TYMS gene and the prognosis of hepatocellular carcinoma (HCC)patients treated with transcatheter arterial chemoembolization (TACE).Methods Five functional SNPs in TYMS gene were genotyped in a cohort of 41 9 unresectable Chinese HCC patients treated with TACE and prognosis analysis was performed.Results No SNP significantly associated with OS of HCC,but in patients with only TACE treat-ment,SNPs rs523230 exhibited significant associations with death risk in HCC patients under the additive model.Patients over 60 years old,SNP rs9967368 exhibited significant associations with death risk in HCC patients under the recessive model.Conclusion Genetic variations in TYMS gene may be a potential biomarker for predicting clinical outcome of HCC patients treated with TACE.

Objective To evaluate the effectiveness of mouth care combined with intestinal and endoscopic working channel flushing for ERCP related cholangitis and to investigate the mechanisms.Methods A total of 284 patients who underwent ERCP were divided into the amikacin group (n =96),the saline group (n =95) and the control group (n =93).Specimens were collected before cannulation (Sample 1),the first access to the bile duct (Sample 2) and at the end of ERCP (Sample 3).All the samples underwent bacterial culture and colony counting.Incidence of ERCP related cholangitis and bacterial results were recorded.Results The incidences of ERCP related cholangitis were 7.3％ (7/96),8.4％ (8/95)and 18.3％ (17/93)in amikacin group,saline group and control group respectively,with significant differences among three groups (x2 =6.861,P =0.032).The positive rate of bacterial culture of Sample 1 in the amikacin group,saline group and control group were 6.3％ (6/96),25.3％ (24/95) and 28.0％ (26/93) (x2 =16.833,P =0.000),respectively.The positive rate of bacterial culture of Sample 2 in amikacin group,saline group and control group were 6.3％ (6/96),16.8％ (16/95) and 24.7％ (23/93)(x2 =12.206,P =0.002),respectively.The positive rate of bacterial culture of Sample 3 in amikacin group,saline group and control group were 7.3％ (7/96),17.9％ (17/95) and 33.3％ (31/93) (x2 =20.713,P =0.000),respectively.Conclusion The procedure of ERCP can bring the intestinal bacteria into the bile duct,which could be reduced by mouth care combined with intestinal and endoscopic working channel flushing.And the incidence of ERCP related cholangitis can be effectively reduced.