Background The pathogenesis of pterygium has been in the study.Relative molecular biology study showed that pterygium is a tumor-like lesion,and based on overseas literatures,human papillomavirus (HPV) is positively expressed in 100％ patients with pterygium in some region.However,if this result is suitable for Chinese patients is unclear.Objective This study was to identify the role of human HPV in the pathogenesis of pterygia in Wuxi area.Methods Forty-eight pterygium specimens including 7 recurrent pterygia and 41 primary pterygia were collected during the operation,and these patients were from Wuxi area.Two cervical carcinoma specimens and 2 conjunctiva specimens from normal donors were obtained as positive control and negative control respectively.The fluorescent quantitative polymerase chain reaction (FQ-PCR) was used to detect HPV DNA of specimens.Results The amplified curves of HPV 6,11 of pterygium specimens,cervical carcinoma specimens and normal specimens were all below the positive quality control curve,but the amplified curves of HPV16,18 were above the quality control curve in cervical carcinoma specimens; while those of pterygium specimens and normal conjunctival specimens were all below the quality control curve.HPV16/18 was identified in 2 cervical carcinoma specimens,but no HPV6/11 was detected in 2 cervical carcinoma specimens.However,HPV DNA expression in primary and recurrent pterygias were absent.Conclusions According to these results,HPV is not the primary cause for the pathogenesis of pterygium in Wuxi region.

Referring to the relevant ancient books and documents, the processing methods for Gardenia jasminoides Ellis in suc-cessive dynasties were summed up to understand the processing development. And referred to the modern research on the processing of Gardenia jasminoides Ellis,the preparation process, product quality control and pharmacological effects of the processed products of Gardenia jasminoides Ellis were summarized to provide theoretical basis for the clinical application and quality control of the processing and processed products.

Objective To investigate the effects of ultrasound irradiating hydroxycamptothecin (HCPT)-loaded microbubbles on apoptosis in human hepatoma SMMC-7721 cells, and to clarify its probable mechanism. Methods The SMMC-7721 cells were randomly divided into six groups as follows: control group, blank liposome microbubbles plus ultrasound, HCPT-loaded microbubbles, HCPT, HCPT plus ultrasound,and HCPT-loaded microbubbles plus ultrasound. Apoptosis was ascertained by Annexin V-Fire/ PI and TUNEL methods. The expression of Bcl-2 and Bax protein was detected by immunocytochemistry staining technique. Results In the group of HCPT-loaded microbubbles plus ultrasound,the apoptosis rate at early term was found to reach (12.18 ± 1.38)% by Annexin V-Fitc/PI assay, brown-colored positive apoptotic cells were observed and the apoptosis rate at advanced term was found to reach (34.25 ± 1.83)% with TUNEL method. The expression of Bcl-2 was found to decrease,the expression of Bax increase,and the ratio of Bcl-2/bax significantly decrease by immunocytochemistry staining technique in the same group. Differences with other groups were significant. Conclusions The method of ultrasound irradiating HCPT-loaded microbubbles can notability induce human hepatoma SMMC-7721 cells apoptosis. The decrease in the ratio of Bcl-2 to Bax might be responsible for cells apoptosis.

Objective To explore the short axial strain of left ventricle in patients with atrial septal defect(ASD)before and after the transcatheter closure by using two-dimensional speckle tracking imaging (2D-STI).Methods A total of 30 patients with ASD underwent echocardiography before and after the transcatheter closure.The procedure was performed to obtain the peak of circumferential strain(Sc)and radial stain(Sr)of left ventricle by 2D-STI.Thirty healthy volunteers were enrolled as controls.Results ①Compared with the control group,regional myocardial Sc of ASD group decreased(P <0.05).Sc of anterior septum (AS),anterior wall (AW),laterior wall (LW)and posterior wall (PW)increased (P <0.05)at 2-days after the transcatheter closure and those parameters were higher than control group.At the six-months after the transcatheter closure,those parameters reduced to the normal level (P <0.05).Sc of inferior wall (IW)and mid-posterior septum (MP-Sept)increased to the normal level at 2-days after the closure surgery (P <0.05).②Compared with control group,regional myocardial Sr of ASD group decreased(P <0.05 ) except PW,two-days after the transcatheter closure these parameters increased to the normal level.Sr of PW in ASD group increased compared with control group(P <0.05),and there were no statistical changes at 2-days after the transcatheter closure.Sr of PW in ASD decreased (P <0.05 )to normal level until 6-months after the transcatheter closure.③ Global circumferential strain (GCS)of left ventricular in ASD group were lower than control group (P <0.05 ).At two-days after undergoing transcatheter closure the GCS increased (P <0.05)and those parameters were higher than control group (P <0.05).Six-months after the transcatheter closure those parameters reduced to the normal level (P < 0.05 ).There were no statistical differences of left ventricular global radial strain (GRS)between control group and ASD group. However,the GRS of ASD group increased (P < 0.05 )and those parameters were higher than control group (P <0.05)after 2-days undergoing the transcatheter closure.At six-months after the transcatheter closure those parameters were reduced to normal level (P <0.05 ).Conclusions 2D-STI can quantitative evaluate left ventricular circumferential strain and radial strain in patients with ASD before and after the transcatheter closure.

Objective To discuss combined detection of pleural biopsy under medical thoracoscopy and pulmonary serum tumor markers in diagnosis of pleural effusion with unknown reason.Methods 76 patients with pleural effusion caused by unknown reason from January 2014 to March 2016 were retrospectively analyzed. Pleural biopsy was conducted under medical thoracoscopy and sent for pathological examination, and 10 ml venous blood was collected from these patients upon admission for testing serum tumor markers (CEA, SCC-AG, ProGRP and CYFRA21-1).Results Among the 76 patients, there were 32 cases with benign lesions (14 with pulmonary tuberculosis, 9 with inlfammatory lesions, 6 with granulomatous inlfammation, 2 with empyema and 1 with hamartoma) and 44 cases with malignant lesions (18 with adenocarcinoma, 13 with squamous carcinoma, 6 with small cell lung cancer, 3 with adeno-squamous carcinoma, 2 with mesothelioma, 1 with large cell carcinoma and 1 with thymoma). The detection of serum tumor markers showed statistically significant differences in the levels of CEA, SCC-AG, ProGRP and CYFRA21-1 in serum between the malignant pleural effusion group and benign pleural effusion group (P = 0.021,P = 0.006,P = 0.003 andP = 0.010). The levels of various serum tumor markers in the malignant pleural effusion group were obviously higher than those in the benign pleural effusion group. According to the pathological results, patients with pleural effusions not caused by lung cancer (2 with mesothelioma and 1 with thymoma) were eliminated from 44 patients with malignant pleural effusions. The rest 41 patients with pleural effusions caused by lung cancer were divided into non-small cell lung cancer and small cell lung cancer according to the pathological types. The results showed that there were statistically signiifcant differences in the levels of CEA, ProGRP and CYFRA21-1 between non-small cell lung cancer and small cell lung cancer (P = 0.036,P = 0.005 andP = 0.008), while there was no statistically signiifcant difference in the level of SCC-AG (P = 0.811).Conclusions Due to high detection rate and high accuracy in detecting pleural effusions caused by unknown reason, medical thoracoscopy is of great signiifcance, especially for the diagnosis of malignant pleural effusions of pleural metastases. However, serum indicators may provide important reference values for us before the pathological results are available. Thus, it is an important means of diagnosing malignant pleural effusions caused by lung cancer and should be promoted in clinic.

50; 3 female patients had minor ISRS. Among all factors, female patients had higher incidence of ISRS than male (P=0.038); balloon-expanding after stenting and accompanying with other artherosclerosis of periphery vessel had correlation about ISRS (P=0.037, P=0.016). Conclusion The severe restenosis rate is acceptable. Female patients were more likely to have ISRS. Balloon-expanding maybe have effect on reducing incidence of ISRS and controlling artherosclerosis was helpful.

Objective To explore the occurrence of enteral feeding intolerance and its influencing factors in patients with severe acute pancreatitis. Methods A retrospective analysis of severe acute pancreatitis patients undergoing enteral nutrition therapy admitted to a tertiary hospital from October 2012 to October 2015 was performed. The occurrence of enteral feeding intolerance was analyzed,and its influencing factors were evaluated by single factor analysis and multivariate logistic regression analysis. Results There were 54 patients suffered from enteral feeding intolerance among 92 patients. The results of single factor analysis and multivariate regression analysis showed that higher APACHE II score,intra-abdominal pressure and central venous pressure were independent risk factors of feeding intolerance,while adding dietary fiber was a protective factor. Conclusion Severe acute pancreatitis patients with higher APACHE II score,intra-abdominal pressure and central venous pressure can aggravate the risk of feeding intolerance,while adding dietary fiber is beneficial for reducing the incidence.

BackgroundPterygium is an ocular surface disease of abnormal cell proliferative kind and angiogenesis plays an important role in its development and recurrence.Several anti-angiogenic therapies have been used to treat pterygium,but there very few studtes for the in vivo observation of the microvessles in pterygium.ObjectiveThis study was to observe angiogenesis in pterygium with a high-resolution confocal microscope in vivo and to perform immunohistochemical study in vitro.MethodsA prospective case-controlled study was designed.Twenty eyes of 20 consecutive patients with primary pterygia and 20 age- and sex-matched patients with inner eye diseases and strabismus with normal conjunctiva were enrolled in this study.An in vivo confocal microscopy imaging system (Heidelberg Retina Tomograph Ⅱ Rostock Cornea Module) was used to collect microvascular pictures from the anterior part of pterygia and normal nasal conjunctiva of controls,and then immunochemistry was performed to examine the expression of CD31 in microvessel in vitro.The vascular density values were compared between these two groups.The correlation of vascular density values between in vivo Heidelberg Retina Tomograph and in vitro immunohistochemistry was calculated.Written informed consent was obtained from pationts before any examination and surgery.ResultsUnder the in vivo confocal microscope,the microvessel density was (8929±2993) μm/mm2 and (4202 ±692)μm/mm2,respectively,in pterygium and the normal conjunctiva group with a statistically significant difference between them (t =6.881,P＜0.01 ).Immunochemistry revealed that the expression of CD31 to measure vascular density was ( 21.00 ± 4.06/400 × field ) and ( 6.07 ± 1.75/400 × field ) in pterygium and the normal conjunctiva group,showing significant difference (t =12.312,P＜0.01 ).Positive correlations were found in the vascular density values between in vivo corneal laser confocal microscopy examination and in vitro immunochemistry examination in both the pterygium group and normal conjunctiva group (pterygium group:r=0.649,P＜0.01 ;normal conjunctiva group: r=0.572,P＜0.01 ) ConclusionsIn vivo confocal microscopy imaging is superior to in vitro immunochemistry in evaluating the microvessel of pterygium.The results of this study offer a new way index for further investigation of the biological behavior of pterygium and its mechanism.

Background Mechanism of dry eye disease has not been established clearly.Some increasing evidences showed that inflammation plays an important role in pathogenesis and development of dry eye disease.However,the association of interleukin-6 (IL-6) with dry eye has not been clarified.Objective This study was to assess the correlation of IL-6 levels in tear and serum of patient with dry eye disease and clinical symptom.Methods Twenty patients with Sj（o）gren syndrome (SS) and 20 cases with non-Sj（o）gren syndrome (NSS) were enrolled from Second Affiliated Hospital of Nanjing Medical University,and 20 healthy volunteers were recruited as the normal controls.Symptom questionnaires were self-answered and multiple dry eye-related clinical tests were performed,including tear film breakup time (BUT),Schirmer Ⅰ test (S Ⅰ t) and corneal fluorescence staining.IL-6 concentrations in serum and tear were detected by enzyme-linked immunosorbent assay (ELASA).The correlation between IL-6 level and tear film and ocular surface parameters was analyzed by Spearman rank correlation.Written informed consent was obtained from each subject initial of this trial.Results The scores of symptom questionnaires were 18.50 (11.75,23.00),23.00 (19.00,32.00) and 2.00 (0.25,4.00) in the SS group,NSS group and the normal control group,and significantly increasing values were seen in the SS group and NSS group compared with the normal control group (P=0.00,0.00).BUT values in the SS group and NSS group were 2.50 (2.00,3.88) seconds and 3.50 (2.13,4.00) seconds and were lower than 15.00 (13.13,17.00) seconds in the normal control group (P=0.00,0.00).S Ⅰ t values in the SS group,NSS group and the normal control group were 2.00 (1.50,2.88),4.00 (3.00,5.75) and 19.00 (18.00,25.00)mm,showing significant differences between the SS group and the normal control group (P =0.00),the SS group and the NSS group (P =0.00) or the NSS group and the normal control group (P=0.00).The marked elevation of keratoepithelioplasty score was seen between the SS group and the normal control group (5.75 (4.00,7.75) vs.0.00 (0.00,0.75) (P =0.00) or the NSS group and the normal control group (4.50(3.63,6.00) vs.0.00(0.00,0.75)) (P=0.00).Concentrations of IL-6 in serum and tear in the SS group,NSS group were (131.47±21.04) μg/L and (77.81 ± 15.68) μg/L and were significantly higher than (31.62±8.57) μg/L of the normal control group,and those in the tear were (33.44±8.01) μg/L,(18.78 ±5.73) μg/L and (8.77 ± 3.43)μg/L,respectively in the three groups,with a significant reduce in the normal control group (all P=0.00).tL-6 levels in serum and tear were positively correlated with the score of symptom questionnaires or keratoepithelioplasty and negatively correlated with BUT and S Ⅰ t (all P =0.00).Conclusions IL-6 levels in the tear and serum of the dry eye patient are associated with the severity of the disease.IL-6 levels in serum and tear may be objective,sensitive and reliable indicators of dry eye.

A 57-year-old man was admitted to the hospital for a 7-year progressively spreading plaques involving the entire body surface, and multiple irregularly sized red nodules and infiltrated patches on the face, trunk and limbs. Histopathological examination showed pleomorphic tumor cells diffusely dis-persed throughout the dennis, giving an appearance of low proliferation. Some cells with cytoplasmic pro-cesses appeared multiangular in shape, lmmunohistochemically, tumor cells were negative for CDla or S-100, but positive for CD45, FXIIIa, CDl4, MHC- Ⅱ, CD68 and lysozyme with extracellular interstitial expression. Ultrastructurally, the cells exhibited cytoplasmic processes and irregularly sized nuclei; no Birbeck granules were observed. Vesicules of low electron-density were seen diffusely in cytoplasm and extracellular matrix. The case is herein diagnosed as cutaneous non-Langerhans cell histiocytosis, which presents with a chronically invasive clinical course. These cells may develop from immature dermal dendritic cells.