Objective To study the diagnosis,treatment and prognostic factors of pancreatic neuroendocrine neoplasms (pNENs).Methods The clinical,pathological and follow-up data of 44 patients with pNENs treated at the Peking University First Hospital from Jan.2007 to Dec.2016 were retrospectively studied.Survival analysis was performed with the Kaplan-Meier method.Results There were 21 male and 23 female patients.The mean age was (54.8 ± 14.0) years.25 patients had non-functional,while 19 had functional pNENs.Curative resection was performed in 40 patients.Neural invasion and intravascular cancer emboli were found in 7 and 5 patients,respectively.The pathologic data showed that the number of patients with G1,G2,G3 were 23 (52.3 ％),15 (34.1％),6 (13.6％),respectively.The number of patients with stage Ⅰ,Ⅱ,Ⅲ,and Ⅳ were 23 (52.3 ％),16 (36.4％),2 (4.5 ％) and 3 (6.8 ％),respectively.The predictive factors on prognosis included curative resection or not,WHO grade,TNM staging,lymph node metastasis and distant metastasis (P ＜ 0.05).Conclusions Curative surgical resection is the first choice of treatment for pNENs.WHO grade,TNM staging,lymph node metastasis and distant metastasis were significantly related to the prognosis of pNENs.

As social views on disability changed,how to support intellectual disabled adult so they can be involved in ordinary social life is not only the hot topic of special education and rehabilitation service system,but also the concern of psychologists.For the improvement of social inclusion,psychologists should provide assessment,intervention and support for intellectual disabled adults at personal and social supportive levels,and relative policy advices for the government should be included.

Objective To investigate the diagnostic value of dual energy CT for small central cervical metastatic lymph nodes in patients with papillary thyroid cancer.Methods The data of 43 patients with thyroid papillary carcinoma confirmed by pathology were retrospectively analyzed.All of the patients underwent dual energy CT scan before operation.The short diameter,iodine concentration and normalized iodine concentration (NIC) of enhanced arterial and venous phases and the slope of the energy spectrum curve were analyzed between metastatic central cervical lymph nodes and non-metastatic lymph nodes.ROC curve was used to analyze the diagnosis efficacy of iodine concentration and NIC for metastatic lymph nodes of thyroid carcinoma.Results Totally there were 119 lymph nodes in 43 patients included 55 thyroid papillary carcinoma metastasis lymph nodes (metastasis group) and 64 non-metastatic lymph nodes (non-metastasis group).There was significant differences of the mean short diameter of the lymph nodes between the two groupos (t=-2.20,P=0.03).In arterial phase,the average iodine concentration of metastasis group and non-metastasis group were (2.93±1.62)mg/ml and (2.17±1.09)mg/ml;the NIC were 0.33±0.21 and 0.19 ± 0.12;and the slope of the energy spectrum curve were 0.79±0.43 and 0.63±0.37 respectively.In venous phase,the average iodine concentration of metastasis group and non-metastasis group were (2.68± 1.54) mg/ml and (2.17 ± 1.01) mg/ml;the NIC were 0.51 ± 0.18 and 0.43 ± 0.15;the slope of the energy spectrum curve were 0.54 ± 0.42 and 0.62 ± 0.39 respectively.The iodine concentration and NIC in both phases and the slope of spectrum curve in arterial phase had statistical differences between the metastasis and non-metastasis groups (all P＜0.05).ROC curve showed that the area under the curve (AUC) of iodine concentration and NIC in the diagnosis of metastatic lymph nodes were 0.62 and 0.73 in arterial phase,respectively.And the AUC of iodine concentration and NIC were 0.61 and 0.63 in venous phase,respectively.Conclusion There are differences of iodine concentration,NIC in arterial and venous phases and curve slope in arterial phase of dual-energy between malignant and benign central cervical lymph nodes in thyroid papillary carcinoma.Dual energy CT technology is helpful in identifying of metastatic from non-metastatic small central cervical lymph nodes.

Objective To investigate the effect of microbubble-enhanced non-focused ultrasound on liver uhrastructure during the treatment of hepatic trauma.Methods The model of hepatic trauma was established in 18 healthy New Zealand rabbits.The subjects were divided into trauma group,ultrasound group and ultrasound-microbubble group according to the random number table,with 6 rabbits each.Thicker region of the left hepatic lobe was treated by custom-made non-focused ultrasound for 5 min.Peak intensity (PI) was used to evaluate the blood reperfusion of the target region after treatment.Liver specimens were performed transmission electron microscope examination immediately and 24 h after treatment to analyze ultrastructure changes.Results PI ratio in ultrasound-microbubble group (15.1 ± 2.6) was significantly lower than that in trauma group (23.1 ± 1.1) and ultrasound group (23.4 ± 1.3) (P ＜ 0.05).But the difference between trauma and ultrasound groups was insignificant (P ＞ 0.05).Compared with trauma and ultrasound groups immediately after treatment,hepatic cells in ultrasoundmicrobubble group had obvious edema,sinusoids thinned,organelles arranged in disorder,mitochondrial edema was present,endothelia cells of interlobular hepatic artery,interlobular vein and bile canaliculi in the portal area damaged,and microvilli of bile canaliculi disappeared.Hepatic cells showed morphology of apoptosis 24 h after treatment.Conclusion Microbubble-enhanced non-focused ultrasound can be used to make rapid hemostasis by decreasing the blood perfusion,but it causes certain damage to the ultrastructure of hepatic cells and may induce apoptosis in the radiation zone and neighboring cells.

Objective To study the effect of mild hypothermia combined with edaravone on the expressions of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in cerebrospinal fluid(CSF)of patients with severe traumatic brain injury(sTBI)and on their prognoses. Methods A prospective randomizd controled trial was conducted. Seventy-seven patients in the Center for Neurology and Neurosurgery of Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces were randomly assigned into control group(38 cases)and treatment group(39 cases)according to random number table. All the patients were treated with routine treatments such as dehydration of intracranial pressure(ICP),neural nutrition,anti-infection,mechanical ventilation and maintenance of water and electrolyte balance in control group,while in treatment group,the patients received mild hypothermia combined with edaravone on the basis of routine treatment within 24 hours after injury. The contents of TNF-αand IL-6 in CSF were measured by radio-immunoassay(RIA)at different time points in both groups. In the meantime,the ICP was also measured. The prognosis was evaluated after 6 months of injury according to Glasgow outcome scale(GOS). Results Compared to control group,in the treatment group,the expression levels of TNF-αand IL-6 in CSF had no significant difference(both P>0.05)on the 1st day after injury,but they were significantly increased on the 3rd day after injury,began to decline on the 7th day,and reached to the valley value on the 14th day after injury,the degree of descent in treatment group being more significant than that in control group〔TNF-α(μg/L):2.43±0.39 vs. 3.12±0.47,IL-6(ng/L):83.53±11.48 vs. 101.69±13.64,both P<0.01〕. Before the treatment,the level of ICP in treatment group had no significant difference from that of control group(P>0.05),but it was gradually increased on the 1st day after injury in both groups,it reached the peak value on the 3rd day after injury,and began to decline on the 7th day after injury,the degree of descent being more significant in treatment group〔mmHg(1 mmHg=0.133 kPa):14.88±3.73 vs. 21.76±4.78,P<0.01〕. The favorable prognosis rate was significantly higher〔35.9%(14/39)vs. 21.1%(8/38),P<0.05〕,and the mortality was obviously lower in treatment group than those of control group〔28.2%(11)vs. 42.1%(16),P<0.05〕. Conclusion In patients with sTBI,mild hypothermia combined with edaravone can protect brain tissue through alleviating high ICP and decreasing the expression levels of TNF-αand IL-6 in CSF, resulting in promoting the recovery of nerve functions and improving prognosis.

Objective To observe the effect of Huazhuo-Jiedu-Huoxue Tongluo recipe on local inflammation of cerebral ischemia reperfusion injury in mice. Method Fifty Kunming Mice were randomly divided into five groups: model group, high-dose group of TCM, low-dose group of TCM, nimodiping group and sham operation group. Each group had 10 mice. Mice models of the right middle cerebral artery CIRI in the first four groups were established through thread embolism method. Physiological saline was given to the mice in the model group and sham operation group. Nimodipine solution was given to the mice in the Nimodipine group. High and low dose of Huazhuo-Jiedu-Huoxue-Tongluo Chinese medicine decoction were given to the mice in the high dose of TCM group and low dose of TCM group respectively after the models were successfully established. To assess the expression level of IL-6 and TNF-α by radioimmunoassay after the treatment. Results Compared with model group [(219.29±39.28) pg/ml, (1.325 ± 0.236) ng/ml] , the level of IL-6 and TNF-α of high dose of TCM group[(120.69±49.23)pg/ml, (1.086±0.178)ng/ml], low dose of TCM group[(173.97±49.03)pg/ml, (0.937 ± 0.105)ng/ml]and nimodipine group[(170.88± 47.06)pg/ml, (1.092±0.184) ng/ml]decrease (P<0.05). There is no significant difference between the high dose of TCM group and the sham operation group (P>0.05). Conclusion Huazhuo-Jiedu-Huoxue-Tongluo recipe can restrain the expression of inflammatory cytokines and reduce the infiltrating of leukocytes in mice with cerebral ischemia reperfusion injury.

A 1-year-old boy developed multiple skin-colored nodules on the forehead and extremities when he was 4 months old.Physical examination revealed that his general condition was well with no hepatomegaly,splenomegaly,lymphadenectasis,testicle abnormality or gingival hypertrophy.Pathologically,the epidermis was normal,while the dermis and subcutaneous tissue were diffusely infiltrated with medium-to large-sized deformed cells,which had a small amount of cytoplasm,oval nucleus,irregular shape and fine chromatin.Some infiltrating cells had nuclear groove and nucleoli.Immunohistochemical studies showed that the tumor cells were positive for S-100 protein,CD56,CD123,CD163,CD68,Ki-67 (40％),weakly positive for CD4 (some),but negative for myeloperoxidase,CD1,CD21.Bone marrow smears showed a 24.5％ infltration by monoblasts and promonocytes.A diagnosis of monoblastic sarcoma cutis preceding acute monoblastic leukemia was made.

Streptozotocin-induced diabetic rats were treated with GSH for 12 weeks.The results showed that GSH significantly improved the expressions of NF-KB and inducible nitrie oxide synthase and ameliorated the myocardial tissue injury.

The continuing education system at the Peking University Health Science Center for vis-iting scholars (Research program for young and middle-aged doctors) is a relatively advanced and compre-hensive medical continuing education system in China, among which, the tutorial system is a good method to guide the visiting scholars of continuing education. On this basis we conducted scholars learning effect questionnaire survey and combined with the feedback results, discussed the advantages and disadvantages of the current educational system of visiting scholars in China, and put forward some concrete suggestions on the development of the continuing education in China.

Objective To observe the effect of trichostatina to induce mesenchymal stem cells(MSCs) differentiating into cardiomyocyte cells and to explore the potential interference approaches.Methods MSCs were incubated with different concentrations of TSA and different time,then to detecte the histone deacetylase(HDAC) activity;the differentiation of MSCs was observed by phase-contrast mictmcopy;fluorescence immunohistochemistry assessed cardiac troponin T and RT-PCR detected the expression of Nkx-2.5,GATA-4 genes.Results HDAC activity was the lowest when incubated with 300 nmol/L TSA for 24 hours,expression of cTnT of the cells was enhanced after incubation with TSA.The expression of Nkx-2.5,GATA-4 genes was enhanced before interference.ConclusionTSA can promote MSCs to differentiate into cardiomyocyte cells in vitro in an optimized condition.