Objective:To detect A20 mutation and to investigate its relationship with clinicopathologic features, prognosis, and re-sistance to therapy of diffuse large B cell lymphoma (DLBCL). Methods:A total of 104 cases with DLBCL and their clinical data were collected;follow-up was performed on a few of DLBCL patients. The expression of P-gP and Ki-67 protein was detected with immuno-histochemical staining. The A20 gene mutation in exons 3, 6, and 7 were examined by polymerase chain reaction and DNA sequencing. Finally, the correlation of genetic abnormality of A20 with clinicopathologic features was analyzed. Results:Missense mutation in ex-on 3 of A20 gene was identified in 18 of 104 patients (17.3%). The A20 gene mutation at site 73 of exon 3 was greater in the cases with activated B cell-like-DLBCL than with germinal center B-cell-like-DLBCL (18.5%vs. 2.5%, P=0.010). In contrast to the advanced clin-ical stage and high International Prognostic Index (IPI) cases, the rate of A20 mutation was superior to the opposite (P<0.05). The ex-pression for P-gP was higher in the cases with mutation than that of those with wild-type A20 gene (16/18 vs. 52/86, P=0.021). The dif-ference in A20 mutation between the groups of low and high positive expression for Ki-67 (1/17 vs. 26/60, P=0.030) was significant. DLBCL with A20 mutation had an increasing recurrence tendency (P=0.06) and a worse survival (P=0.016) compared with those with wild-type A20 gene. Conclusion:The A20 mutation has a certain influence on the clinicopathologic characteristics and survival condi-tions of BLBCL patients. Probably, A20 mutation is a factor associated with a poor prognosis of DLBCL.

AIM:To observe the influences of IL-6 and AG490 on the growth of Raji cell line ( Burkitt lym-phoma cell, BL).METHODS:Raji cells were cultured.IL-6, an activator of signal transducer and activator of transcrip-tion 3 (STAT3), and AG490, a specific inhibitor of STAT3 were added into the medium respectively .The expression of STAT3 and survivin at mRNA and protein levels was detected by real-time PCR and Western blot .The cell viability was measured by MTT assay .Apoptosis and cell cycle were examined by flow cytometry .RESULTS:IL-6 or AG490 affected the growth of Raji cells significantly in a dose-dependent manner (P<0.05).The mRNA expression of STAT3 and sur-vivin in Raji cells was higher in IL-6 group, and lower in the AG490 group than that in the corresponding control group . The statistical differences were found in the mRNA expression of STAT 3 and survivin among different IL-6 or AG490 groups (P<0.05).The concentration dependent relationship was also presented in IL-6 and AG490 groups by the regression a-nalysis.The results of Western blot showed that the protein levels of phosphorylated STAT 3 (p-STAT3), STAT3 and sur-vivin were increased in IL-6 group, and decreased in AG490 group.The apoptotic rate of Raji cells was gradually reduced with the increasing concentration of IL-6.The opposite results were detected in the Raji cells treated with AG 490.There was significant difference in constitute of the cell cycle between the groups treated with IL -6 or AG490 and corresponding control group.The cells at G1-phase and G1/S were significantly increased , while those at S-phase had no obvious change under treating with AG490.The cells at S-phase decreased obviously in the Raji cells treated with IL-6.CONCLUSION:IL-6 and AG490 distinctly affect the growth of Raji cells .The mechanism may be associated with the activation of STAT 3 and survivin.

Objective To investigate the relation between the expression of Caspase recruitment domain-containing membrane-associated guanylate kinase protein 1 (CARMA1),clinicopathological features of gastrointestinal mucosa-associated lymphoid tissue (MALT) lymphoma,diffuse large B cell lymphoma (DLBCL),and Helicobacter pylori (H.pylori) infection.Methods From January 1999 to March 2011,34 patients with DLBCL and 20 patients with MALT lymphoma were selected,and at same period 21 cases with reactive hyperplasia of gastrointestinal lymphoid tissue were enrolled in as control.The expression of CARMA1,Ki-67 and cytotoxin-associated gene A (CagA) at protein level were examined by immunohistochemistry.The relative expression quantity of CARMA1 mRNA was detected by real-time polymerase chain reaction (PCR).The condition of H.pylori infection in 25 gastric lymphoma and 10 controls was detected by methylene boric acid and blue staining or semi-nested PCR.Chi-square test was used for counting data analysis,t test for measurement data.Multivariate COX regression analysis was implemented for survival analysis.Survival curve was drawn by Kaplan-Meier method and analyzed by Log-rank test.Results The relative expression quantity of CARMA1 mRNA of 28 patients with DLBLC (3.073±1.846) was higher than that of 14 patients with MALT lymphoma,and the difference was statistically significant (F 0.975,P＜ 0.05).The positive rate of CARMA1 expression at protein level of gastrointestinal lymphoma group (75.9 ％,41/54) was higher than that of control group (47.6％,10/21),and the difference was statistically significant (x2 =5.568,P＜0.05),and the positive rate of CARMA1 expression of MALT lymphoma group (11/20) was lower than that of DLBCL group (88.2％,30/34),and the difference was statistically significant (x2 =5.900,P＜0.05).Among 42 patients with gastrointestinal lymphoma who received surgery,the relative expression quantity of CARMA1 mRNA in cases with high proliferation (2.885±1.837) was higher than that in cases with low proliferation.The expression of CARMA1 mRNA in the cases at advanced stage of the disease (4.416± 1.010) was higher than that in cases at early stage,and the difference was statistically significant (F=3.317 and 2.972,both P＜0.05).Among 54 patients with gastrointestinal lymphoma,the positive rate of CARMA1 expression at protein level of patients with high proliferation (88.6％,31/35) was higher that that of patients with low proliferation (10/19),and the difference was statistically significant (x22 ＝ 6.847,P＜0.05).There were no significant differences in relative expression quantity of CARMA1 mRNA and the positive rate of CARMA1 expression at protein level between 11 gastric lymphoma patients without H.pylori infection and 14 gastric lymphoma patients with H.pylori infection (both P＞0.05).The positive rate of CARMA1 expression at protein level of CagA positive and CagA negative H.pylori infected gastric lymphoma patients was 11/11 and 2/3.The expression of CARMA1 at protein level was correlated with the prognosis of gastrointestinal lymphoma (RR＝4.160,P＜0.05).In the 29 cases of patients with gastrointestinal MALT lymphoma and 18 cases of patients with DLBCL who were followed up,the survival situation of gastrointestinal lymphoma patients with CARMA1 positive expression rate over 50％ was worse than that of patients with the rate less than 50％,and the difference was statistically significant (x2=5.383 and 4.028,both P＜0.05).Conclusions CARMA1 might be involved in the pathogenesis and progression of MALT and DLBCL; and it might be a related factor of poor prognosis.There was no correlation between the expression of CARMA1 and H.pylori infection in these two lymphomas.

This paper analyzed the foreign measurement and evaluation system of physician professionalism,from the perspectives of the evaluation of occupation behavior,the multi sources of evaluation,the evaluation of empathy,and the cross-cultural background.It also discussed the basic condition of the development of domestic evaluation and evaluation system,and analyzed it from the diversity and comprehensiveness of evaluation perspectives,the specific and objectivity of evaluation items,the clarity and quantitative feature of evaluation indexes,as well as the openness and feedback of evaluation system.In addition,this paper reviewed the domestic and foreign measurement and evaluation methods of physician professionalism in recent years and pointed out that the construction of good measurement and evaluation system is the only way to deepen the research of physician professionalism.

Objective: To understand the current maternal and their families' cognitive status and behavior on the placenta and discuss the measures to regulate placental disposal methods.Methods: A questionnaire survey was conducted among 131 maternal and their families in Yancheng Maternity and Child Health Care Hospital,using self-developed questionnaire on the status of postpartum placental disposal.Results: A total of 93.1％of the ma-ternal signed a placenta disposal informed consent or maternal delivery informed consent with the hospital.72.5％of the maternal or their families expressed a better understanding and very understanding on the treatment of placen-ta,90.8％of the maternal and their families chose to dispose their placenta on their own,and 107 maternal or their families answered the specific self-treatment method,of which 92.5％of the maternal or their families chose to put the placenta buried in the soil because of custom.Conclusion: To find a scientific and rational way to deal with postpartum placenta from the perspective of ethics in clinical practice requires various efforts of governments,hospitals and maternal.

By exploring the core ideas of the "Xingnao Kaiqiao" theory, analyzing the relationship between the "Xingnao Kaiqiao" theory and the TCM encephalopathy, and exploring the necessity of acupuncture for the treatment of TCM encephalopathy, in order to clarify how to diagnose and treat brain diseases in acupuncture and moxibustion. The "Xingnao Kaiqiao" is the core of the theory of the "Tiaoshen", the acupuncture of "Xingnao Kaiqiao" was based on the principle of "Xingnao","Xingshen" and "Tiaoshen", the idea of the "Tiaoshen" was inseparable from the diagnosis and treatment of the TCM encephalopathy. Based on the special features of acupuncture therapy and complexity and particularity of TCM encephalopathy, acupuncture and moxibustion treatment of encephalopathy was supposed to have their own unique system of syndrome differentiation and treatment. During the practice of acupuncture, the diagnosis and treatment of TCM encephalopathy should be based on "brain", "Xingnao Tiaoshen" as a general rule, adding and subtracting from the main points of the "Xingnao Kaiqiao", and the different brain diseases are matched with appropriate treatments.

Objective To observe the value of multimodal imaging for diagnosis of cardiac space-occupying lesions.Methods Data of 70 patients with cardiac space-occupying lesions who underwent echocardiography and cardiac CT(CCT)were retrospectively analyzed,among them 35 also underwent cardiac MRI(CMRI).The value of multimodal imaging for diagnosis of cardiac space-occupying lesions were explored according to the results of surgical pathology or clinical diagnosis.Results Among 70 cases,benign tumors were confirmed by surgical pathology in 43 cases,while malignant tumors were confirmed by surgical pathology in 3 cases and clinically diagnosed in 1 case.Meanwhile,non-tumor-occupying lesions were clinically diagnosed in 23 cases,all obviously shrunken after treatments.Among 70 cases,echocardiography correctly diagnosed 57 cases,misdiagnosed 8 cases and unclearly diagnosed 5 cases,with diagnostic accuracy rate of 81.43%(57/70).CCT correctly diagnosed 63 cases,misdiagnosed 4 cases but missed 3 cases,with diagnostic accuracy rate of 90.00%(63/70).CMRI outcomes in all 35 cases were consistent with surgical pathologic results,with diagnostic accuracy rate of 100%(35/35).Conclusion Multimodal imaging might provide objective evidences for diagnosis and treatment of cardiac space-occupying lesions.