Objective To evaluate the diagnostic value of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in combination with flow cytometry (FCM) in lymphoma.Methods From January 2011 to December 2011,the cases of suspicious lymphoma with EUS-FNA examination at Shanghai Ruijin Hospital were retrospectively analyzed.The final diagnosis was according to pathological diagnosis of specimen from the surgery and follow up results.The sensitivity,specificity and accuracy of EUS-FNA combined with FCM in lymphoma diagnosis were initially analyzed.Results A total of 14 suspicious lymphoma patients were collected,eight cases were diagnosed as lymphoma by pathological examination of specimen from the surgery or.tissue from aspiration,four cases were non-lymphoma lesions and two cases still had no final diagnosis.The sensitivity and specificity of FCM alone in lymphoma diagnosis were 4/8 and 4/4 respectively.Six cases of lymphoma were detected by EUS-FNA with FCM.The sensitivity,specificity and accuracy of EUS FNA combined with FCM were 6/8,6/6 and 10/12 respectively.Conclusion EUS-FNA combined with FCM has better diagnostic value in lymphoma,especially for gastrointestinal lymphoma and those surrounding deep lesions.

Objective To investigate the relationship between glucose excursion and cognitive function in aged type 2 diabetes. Methods A total of 248 aged type 2 diabetes were recruited in this study,all of them wore continuous glucose monitoring system (CGMS) for 3 d to evaluate the glucose excursion including mean amplitude of glycemic excursions (MAGE) which was used for assessing intra-day glycemia variability,and mean daily difference (MODD) which represented day-to-day glycemic variability.During the period of CGMS monitoring,all subjects accepted mini mental status examination (MMSE) for evaluating cognitive function.The relationships of MAGE and MODD with performance on cognitive tests were assessed. Results The over intra-day glucose excursion group had lower MMSE score than the narrow intra-day glucose excursion group[(24.25±6.75)vs.(25.97±0.47),P=0.025].The MMSE score was decreased in over day-to-day glucose excursion group compared with the narrow day-to-day glucose excursion group [(24.21 ± 6.47) vs. (26.01 ± 5.49),P =0.019]. A statistically significant association was observed between MAGE and the score of MMSE(r=- 0.308,P＜0.001),and between MODD and MMSE(r=-0.226,P =0.001).Conclusions Glucose excursion may affect cognitive function in aged type 2 diabetes.The over glucose excursion decreases the score of MMSE.

Objective To explore relationship between excursion of blood glucose levels and cognitive performance in diabetic patients over aged 60 years.Methods A total of 108 diabetic patients over aged 60 years were recruited in this study and they wore under continuous blood glucose monitoring system (CGMS) for three days to evaluate excursion of their mean blood glucose (MBG) level and its standard deviation (SD).All the participants accepted cognitive function tests during continuous blood glucose monitoring, including mini mental status examination (MMSE), Montreal cognitive assessment (MOCA) and clock drawing test (CDT).Relationship of the SD of blood glucose level and cognitive performance in the three cognitive tests was assessed.Data were analyzed with CGMS software version 3.0.Results The SD reversely correlated with scores of MMSE (r = - 0.324, P ＜ 0.01 ) and CDT ( r =-0.325, P = 0.001 ), but they did not significantly correlate with MOCA scores (r = -0.212, P =0.081 ).Statistically significant difference was observed between the SD and scores of all three cognitive tests adjusted for glycosylated hemoglobin Alc (HbAlc) level (r = -0.387, -0.046 and -0.292, P =0.029, ＜0.001 and ＜ 0.001, respectively).The SD reversely correlated with scores of MMSE, MOCA and CDT adjusted for MBG (r= -0.314, -0.466 and -0.345, P ＜0.01, respectively).Results of multivariate linear regression analysis showed that the SD reversely correlated to scores of MMSE, MOCA and CDT (β = - 0.378, - 0.224 and - 0.346, all P ＜ 0.05).Conclusions Excursion of blood glucose levels can influence their cognitive performance in diabetic patients over aged 60 years, leading to decrease in their overall cognitive function and activities as its excursion large enough.

Objective To assess the theoretical knowledge and practical skills of parasitic diseases among technicians from disease control and prevention institutions. Methods The Assessment on National Parasitic Disease Control and Prevention Techniques was organized in September,2015. Together,124 subjects from disease control and prevention institutions at prov-ince,prefecture or county levels in 31 provinces joined the assessment. A database was built consisting of subjects'basic infor-mation and assessment scores. Statistical analysis was used to analyze the scores by gender,age,professional title,institutions and places of participants. Results The average total score of all the subjects was 123.3,with a passing rate of 57.3%. The av-erage scores of male subjects(48 subjects)and female subjects(76 subjects)were 125.9 and 121.7 respectively;the average scores of the subjects aged under 30 years(57 subjects),between 30 and 40 years(61 subjects)and above 40 years(6 sub-jects)were 119.6,128.1 and 111.2 respectively;the average scores of persons with junior(94 subjects),intermediate(28 sub-jects)and senior(2 subjects)professional titles were 119.2,135.9 and 140.5 respectively. The average theoretical assessment score of all the subjects was 61.9,with a passing rate of 62.9%. The average practical skill assessment score of all the subjects was 61.4,with a passing rate of 58.1%. Conclusions The theoretical assessment results range widely. The theoretical knowl-edge results of technicians from disease control and prevention institutions are low in general. Therefore ,the specific training based on daily work needs to be enhanced.

Objective To compare the diagnostic yield of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for solid pancreatic masses performed with three different needle types through the cytological results.Methods All patients with solid pancreatic masses larger than 2cm from December 2010 to May 2011 were enrolled,and divided into two groups according to different access of EUS-FNA,trans-gastric approach with 19-,22-and 25-gauge needles (n =42) and trans-duodenal approach with 22-and 25-gauge needles (n =10).In both groups,EUS-FNA was performed with randomization of needle types.During the puncture,the suction,the number of movements,and the depth of insertion were fixed.At the end of the puncture,a liquid-based cytological (LBC) preparation was used to fix the specimen.One cytopathologists was assigned to make the diagnosis and comparison.Results Technical success was 100％ and no procedure related complications occurred.No statistically significant differences were observed in different needles in terms of all cytological parameters between two groups (P ＞ 0.05).However,the 25-gauge needle showed a trend towards a higher sensitivity,specificity,positive predictive value,negative predictive value and accuracy.Conclusion There is no significant difference in yield of cytological results between different needle types,although 25-gauge needle shows a relative superiority.

Objective To evaluate the accuracy and clinical application of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in diagnosis of occupying lesions in upper digestive tract and its pe-ripheral areas. Methods The data of 64 patients who underwent EUS-FNA for occupying lesions in upper di-gestive tract, between July 2006 and December 2007, were retrospectively analyzed. Results EUS-FNA was successfully performed on 62 patients, with a success rate of 96.88%. The overall diagnostic accuracy, sensi-tivity, specificity, positive predictive value and negative predictive value of EUS-FNA for occupying lesions in upper digestive tract and its peripheral areas were 88.71%, 86.54%, 100.00%, 100.00%, and 58.82%, respectively. There was no significant difference between the foei larger and smaller than 3cm (P > 0.05), re-garding the diagnostic accuracy and average puncture numbers. Diagnostic accuracy of those with real-time cy-tolngical evaluation was significantly higher than those without (P=0.029), and the puncture numbers were less (P=0.001). Among the total 99 punctures, the positive diagnostic accuracy of those with 5ml negative pressure suction was significantly higher than those of 10 ml (P = 0.044). Conclusion EUS-FNA is a safe and applicable approach to diagnosis of occupying lesions in upper digestive tract and its peripheral areas with higher diagnostic accuracy, sensitivity, specificity and positive predictive value. Moreover, the real-time cyto-logical evaluation and adequate negative pressure might facilitate the diagnosis accuracy.

OBJECTIVE: To investigate the alterations of bcl-2 gene family in the area of CA-3 in rats and the molecular mechanism of neuronal apoptosis following traumatic brain injury. METHODS: To investigate the alterations of bcl-2 gene family in the area of CA-3 in rats and the molecular mechanism of neuronal apoptosis following traumatic brain injury. RESULTS: The immunoreactivity of bcl-2 and bcl-x proteins decreased in the hippocampus ipsilateral impact site at 6 hours after injury, and this was the main cause of down-regulation of the value of (bcl-2+bcl-x)/ bax. During the period of 1-3 days after injury, bax protein expression increased significantly, while bcl-2 and bcl-x protein expressions decreased relatively slowly. The decreased value of (bcl-2+bcl-x)/ bax was mainly due to the bax up-regulation. CONCLUSIONS: The bcl-2 gene family is involved in neuronal apoptosis after traumatic brain injury, and the protein-expression alterations of the bcl-2 gene family members lead to apoptosis of the neuronal cells.

ObjectiveTo evaluate the accuracy of EUS,EUS-guided fine needle aspiration ( EUSFNA) and targeted biopsy in the diagnosis of wall-thickened gastric lesions with negative malignant results ofendoscopic biopsies.MethodsA retrospective study was carried out in 57 patients who were found with thickened gastric wall of negative malignant endoscopic biopsies and underwent EUS from January 2008 to December 2010 in our hospital.Compared the EUS findings with the surgical results and follow-up status.The diagnostic yield of EUS was characterized by the disappearance of the layers or the changes of thickness of gastric wall,the characteristics of echo imaging,and the results of EUS-FNA or EUS targeted biopsy were recorded to evaluate the value of EUS.ResultsOf 57 cases,gastric cancer was confirmed in 19,lymphoma in 10,dysplasia in 1,Menetrier's disease in 1 and inflammatory changes in 26.EUS could clearly demonstrate the changes of gastric wall including the thickness and the changes of layers,with the accuracy rate of 73.07％ ( 14/19 ) on gastric cancer.EUS diagnosed gastric cancer in 26 cases,in which 14 (53.8％) were confirmed by pathology.Gastric lymphoma was suspected by EUS in 20 cases,in which 10 (50.0％ ) were proved.EUS-FNA was conducted in 19 cases,with positive result in 9 (accuracy rate 50％ ).EUS-guided targeted deep biopsy or piece-meal biopsy were performed in 10 cases,with 8 malignant results.ConclusionEUS with/without EUS-FNA is not a golden standard for the diagnosis of gastric lesions in thickened gastric wall,yet it still has some significance.

Objective To investigate the effect of imatinib on the growth of A549 non-small cell lung cancer transplanted tumors and the expression of PDGFB and PDGFRβ proteins in tumor tissues and stroma in nude mice and to explore the underlying tumor suppression mechanism. Methods A transplantation tumor model of A549 non-small cell lung cancer was established in nude mice. The mice were then randomly divided into four groups: control group (0.9%NaCl), low-dose imatinib group (50 mg/(kg·d)), medium-dose imatinib group (100 mg/(kg·d)), and high-dose imatinib group (200 mg/(kg·d)). The effect of different concentrations of imatinib administered by continuous gavage on tumor growth was observed for 28 days. HE staining was performed to observe the pathological changes of tumor tissues. The expression of PDGF/PDGFR pathway-related proteins and the phosphorylation levels of AKT and ERK1/2 proteins in tumor tissues were detected by Western blot analysis. Double immunofluorescence staining was used to detect the expression of PDGFB and PDGFRβ proteins in the tumor stroma. Results Imatinib inhibited the growth of A549 non-small cell lung cancer cells in nude mice, suppressed the expression of PDGFB in tumor tissues, and decreased the phosphorylation levels of PDGFRβ, AKT, and ERK1/2. The expression of PDGFB and PDGFRβ in tumor stromal fibroblasts of the administered group was significantly lower than that of the control group. Conclusion Imatinib exhibits a pronounced inhibitory effect on A549 xenografts of nude mice with non-small cell lung cancer, and its antitumor mechanism may involve the downregulation of PDGFB and PDGFRβ expression in tumor stromal fibroblasts.

Objective: To explore the clinical effects of scapular region flaps pedicled with circumflex scapular artery in the reconstruction of axillary burn scar contractures. Methods: From December 2008 to December 2018, 21 patients with axillary burn scar contractures were admitted to our department. There were 12 male patients and 9 female patients, aged 2-48 years, with an average of 17.4 years. According to the characteristics of axillary scar contractures, the patients were divided into type Ⅰ of 5 patients, type Ⅱ of 2 patients, type Ⅲ of 5 patients, and type Ⅳ of 9 patients. The preoperative abduction ranges of shoulder joint were 20-150°, with an average of 68.33°. The wound areas after resection and release of scar contractures ranged from 12 cm×4 cm to 33 cm×11 cm, with an average of 18.13 cm×5.41 cm, and the wounds were repaired with scapular region flaps pedicled with circumflex scapular artery in the areas of 14 cm×5 cm-35 cm×14 cm, with an average of 20.19 cm×7.71 cm. The donor sites of 5 patients were expanded prior to flap repair operation, and the other 16 patients were repaired by direct transfer of flaps. The donor sites were closed directly. The type, number, and transfer way of scapular region flaps were calculated, and the improvement of abduction angle of shoulder joint and condition of the flaps were observed during follow-up after operation. Results: There were 5 ascending scapular flaps, 13 scapular flaps, and 3 parascapular flaps. The flaps were transferred through open wounds in 18 cases, subcutaneous tunnel in 1 case, and trilateral foramia in the remaining 2 cases. All the flaps survived after operation. During follow-up of 3 months to 5 years, with an average of 19.4 months, the abduction angles of shoulder joints were 90-180°, with an average of 137.62°, which showed that the abduction function of shoulder joint improved obviously. The texture of flap was soft, and the color of the flap was close to the surrounding skin. The patients and/or their family members were satisfied with the operation results. Conclusions The scapular region flap pedicled with circumflex scapular artery has a lot of advantages, including a long vascular pedicle, simple technique for flap harvest, a hidden donor site, and flexible and diverse transfer mode of flap. It is an effective option for clinical reconstruction of severe axillary burn scar contracture.