Small intestinal neuroendocrine carcinoma is poorly differentiated,highly malignant,and originated from the diffuse neuroendocrine system.It diffusely expresses the general neuroendocrine differentiation markers.The disease can be manifested as carcinoid syndrome,but most of the patients were with occult onset and absence of specific clinical symptoms,which led to difficult diagnosis before operation.On June 18,2012,a patient with manifestation of recurrent vague abdominal pain received capsule endoscopy at the Northern Jiangsu People's Hospital.The capsule endoscope was retained in the distal small intestine,and malignant ileum lesion was revealed during the surgical exploration.Finally,poorly differentiated neuroendocrine carcinoma with abdominal wall metastases was identified by pathological examination.

Objective To investigate the feasibility of reducing the radiation dose in adult pelvic CT using automatic tube current modulation (ATCM) and adaptive statistical iterative reconstruction (ASIR).Methods Totally 45 patients who underwent routine and low-dose pelvic CT examination were enrolled in our study.Three groups of images were acquired:group A (routine scan with FBP reconstruction) ;group B1 (low-dose with ASIR0) and group B2 (low-dose with ASIR50％).The scores of image quality was abtained by two radiologists.Results The CTDIvol,DLP and E of group B were significantly reduced respectively(t =12.30,12.10,12.15,P ＜ 0.05) compared with group A.Group B1 had higher noise(t =9.14,8.95,P ＜ 0.05)and lower score,SNR and CNR(t =8.72,10.62,11.83 and 8.40,9.55,11.42,P ＜ 0.05) than the others.And there was no difference in image quality between group A and group B2.Conclusions Using automatic tube current modulation and adaptive statistical iterative reconstruction could significantly reduce the noise but keep the image quality in adult pelvic CT examination.

Objective To analyze the differentially expressed genes in esophageal squamons cell carcinoma (ESCC), para-cancerous tissue (PCT) and normal esophagus tissue (NET) using oligomicroarray and to identify the target genes related to the development and progression of esophageal carcinoma. Methods The total RNAs isolated from ESCC, PCT or NET using one step Trizol method were purified and reversely transcribed into cRNAs. The cRNAs were then fluorescence labeled and hybridized with Agilent oligomicroarray (21 074 probes). The fluorescence intensity features were detected by Agilent scanner and quantified by feature extraction software. The selected candidate genes were confirmed by real time real time fluorescent quantitative RT-PCR immunohistochemistry andWestern blotting.Results ① The oligomicroarray demonstrated that there were 38 up-regulated genes and 61 down-regulated genes. ② The real time fluorescent quantitative RT-PCR revealed that five genes (CTHRC1, INHBA, SPP1 ,LUM, HRK)were more differentially expressed in up-regulated genes. Of which, CTHRC1 displayed more disparity.③ Immunohistochemistry examination showed that the higher expression of CTHRC1 (56.5 %, 26/46) was observed in ESCC. There was significantly difference in expression of CTHRC1 between patients with or without lymph node metastasis (P<0.05). ④ CTHRC1 protein was expressed in both TE-13 and Eca-109 cell lines. Conclusion CTHRC1 is probably one of the most significant biomolecules in ESCC.

Objective To study the chemical constituents in the leaves of Nelumbo nucifera. MethodsCompounds were repeatedly purified by chromatography and structures were elucidated by physicochemical properties and spectroscopic analyses. Results Nine alkaloids were isolated and identified as 2-hydroxy-1-methoxy-6-methyl-6a,7-dehydroaporphine (1),armepavine (2),dehydroroemerine (3),dehydronuciferine (4),2-hydroxy-1-methoxyaporphine (5),liriodenine (6),pronuciferine (7),roemerine (8),and nuciferine (9). Conclusion compound 1 is a new aporphine alkaloid named nelumnucine.

AIM:Activin A,a member of transforming growth factor superfamily,is the negative regulator factor in liver regeneration. In this study,the effects of extract of Ginkgo Biloba on hepatic fibrosis and the expression of Activin A in rats with cirrhosis were investigated. METHODS:The experiment was performed at in the Central Laboratory of Wuhan First Hospital from September 2005 to December 2006. ①Thirty-six male SD rats of(160?20) g were randomized into 3 groups:control group,model group and treatment group. ② Except the rats in the control group,others were intraperitoneally injected with 500 mL/L CCl4 for 8 weeks to establish models of hepatic fibrosis. Meanwhile,the extract treatment group was infused with the extract of Ginkgo Biloba(Chinese drugs preparation laboratory of Wuhan First Hospital,detected by Hubeu Wushi Medicine Industry Co.,Ltd. No. 02-391) daily for 8 weeks. ③After administration,all anesthetized rats were sacrificed. Blood samples were collected for the determination of liver function biochemical indexes. Liver tissue samples were used for histopathological examinations. The expression of Activin A was determined by immunohistochemistry and RT-PCR. RESULTS:All 36 rats were involved in the final analysis. ①The liver function in extract treatment group was significantly improved compared with that in model group. ②The grade of fibrosis in extract treatment group were remarkably lower than that in model group under light microscope. ③The positive staining of Activin A in treatment group was significantly reduced compared with model group. ④The expression of Activin A mRNA in extract treatment group was significantly reduced compared with model group. CONCLUSION:Extract of Ginkgo Biloba can effectively decrease the expression of Activin A in rats with hepatic fibrosis caused by CCl4,and lessen the degree of hepatic fibrosis.

Objective To evaluate imaging findings and treatment experience in central venous stenosis without a history of previous catheterization in hemodialysis patients. Methods Clinical data of 5 haemodialysis cases of central vein stenosis without a previous catheterization history in our hospital from July 2006 to July 2008 were analyzed retrospectively. Results Patients were three women and two men aged 43 to 65 years with mean age(53±8)years and all had arm swelling as the main complaint.The vascular accesses were located at the wrist in all the patients.The mean duration of the vascular accesses from the time of creation was(33.6±35.4)months.Venography showed occlusion in 2 cases and stenosis in 3 cages of central vein including 1 case of stenosis in brachiocephalic vein.1 case of stenosis beth in branchiocephalic vein and subclavian vein,1 case of stenosis in two segments of subclavian vein.The stenosis of branchiocephalic vein was fixed anterior to the tracheal and CT showed the compression of the vein by the aorta.Symptoms were resolved by the treatment of PTA.subclavian vein-contralateral subclavian vein bypass and ligation of the access. Conclusions Central venous stenosis in haemodialysis patients without a history of catheterization may be due to the intimal hyperplasia of the compression site or valve which is accelerated by the high flow of vascular access.Venography is the first choice for the diagnosis and the current management of central venous stenosis is far from being effective for the long term.

Objective To investigate the effect of reinforced Decoction of Angelicae Sinensis for enriching blood (RDAEB) on the immunity of immunosuppressed mice induced by cyclophosphamide (Cy). Methods Mice were given RDAEB through stomach perfusion for 10 d(50 mg/d). Then, RBC-C3bR rate,RBC-IC rate( as the indexes of erythrocyte immunity)and E-rosette forming rate,acidic α-naphthyl acetate esterase positive rate, lymphocyte transformation rate (as the indexes of cellular immunity) of mice were tested.Results RBC-C3Br rate, RBC-IC rate,E-rosette forming rate, acidic α-naphthyl acetate esterase positive rate and lymphocyte transformation rate in the Cy-RDAEB group were markedly higher than those in the Cy group (P＜0. 01 ),and returned to the levels of normal group. Conclusion RDAEB is effective in recovering and enhancing cellular and erythrocyte immunity of immunosuppressed mice.

Objective To estimate the value of urinary neutrophil gelatinase-associated lipocalin (NGAL) level for early diagnosis of acute kidney injury (AKI) in patients with sepsis.Methods One hundred and twenty-six sepsis patients admitted to intensive care unit (ICU) in Baoshan Branch Hospital of Shuguang Hospital Affiliated to Shanghai University ofTraditional Chinese Medicine from June 2014 to December 2015 were enrolled, and they were divided into two groups according to whether complication of AKI was present. The levels of urinary NGAL in the two groups of septic patients were evaluated immediately and at 12, 24 and 48 hours after the definite diagnosis, and the levels were compared between the two groups; the receiver operating characteristic curve (ROC curve) was performed and the value of urinary NGAL level in early diagnosis of sepsis AKI was evaluated.Results There were 60 septic cases complicated with AKI (AKI group), with the prolongation of time after definite diagnosis, the urinary NGAL (g/L) levels were gradually increased at 12, 24 and 48 hours, the levels were significantly higher than those at the corresponding time points in the group without AKI [non AKI group (66 cases), 12 hours: 178.2±32.8 vs. 53.8±10.4, 24 hours: 228.4±24.6 vs. 54.1±9.0, 48 hours: 186.1±43.6 vs. 52.5±9.4, allP < 0.05]. The area under ROC curve (AUC) of urinary NGAL level at 24 hours after definite diagnosis and 95% confidence interval (CI) were 0.863 (0.766-0.929) and 0.686 (0.466-0.696), respectively, when the cutoff value of urinary NGAL was 65.9μg/L, the sensitivity was 81.9% and specificity 76.1%; when the cutoff value of urinary NGAL was 57.9μg/L, the sensitivity was 70.2% and the specificity 57.2%.Conclusion Urinary NGAL level can be used as a reference marker for the early diagnosis of sepsis concomitant AKI.

Objective To investigate the therapeutic value of endoscopic papillectomy (EP) for duodenal papilla lesion.Methods Patients with duodenal papilla lesion treated with EP from June 2007 to December 2015 were enrolled.The clinical characteristics,EP technical features,complications,the treatment,postoperative recurrence were analyzed.Results A total of 43 patients were enrolled.The mean diameter of the lesion was 22.8±1.2 mm.Thirty-two patients (69.8％) received en bloc resection,and 11 (25.6％) received endoscopic piecemeal mucosal resection (EPMR).After the operation,duodenal papilla lesions recurred in 3 patients (7.0％),5 patients (11.6％) had delayed bleeding,4 (9.3％) had postoperative pancreatitis,6 (14.0％) had long-term bile duct stricture.Intraoperative pancreatic stenting (OR =0.000,95％ CI:0.000-) was the independent protective factor for postoperative pancreatitis.Pancreatic duct dilation (OR =13.500,95％ CI:1.400-130.191) was the independent risk factor for postoperative bile duct stenosis.Conclusion EP is minimally invasive with rapid recovery and less cost,and could be recommended for duodenal papilla lesions.

Objective: To study the adscription of plasma effective constituents of rat after oral administration of alkaloid fraction of Nelumbo nucifera.Methods: Based on the established HPLC analytical method of plasma effective constituents,analysis and comparison were carried out among HPLC profi les of plasma samples obtained after oral administration of alkaloid fraction of Nelumbo nucifera,blank plasma,alkaloid fraction of Nelumbo nucifera.Results: Sixteen compounds were detected under the method,three of them were architypes of compound contained in alkaloid fraction of Nelumbo nucifera,and the others were metabolites.Through the comparison of the UV spectra,seven metabolites remain essential structure because the max wavelength was same to the architypes’,the other six metabolites’ structure changed greatly.Conclusion: Through the study of the adscription of plasma effective constituents of rat after oral administration of alkaloid fraction of Nelumbo nucifera,the structure of metabolites can be conjectured,which may be helpful to study the ADME and mechanism of action.