The determination of tumor markers is of great value for esophageal squamous cell carcinoma. This article reviews the application status of routine tumor markers and the progression on the role of tumor markers in early diagnosis, predicting chemotherapy or radiotherapy response, monitoring disease recurrence and evaluation of prognosis in esophageal squamous cell carcinoma.

Objective To assess the predictive and prognostic role of the alteration of serum carcinoembryonic antigen (CEA),squamous cell carcinoma antigen (SCC-Ag) and cytokeratin 19 fragment (CYFRA21-1) during chemotherapy in patients with advanced esophageal squamous cell carcinoma (ESCC).Methods The serum levels of CEA,CYFRA21-1 and SCC-Ag were measured in 50 patients with advanced ESCC at baseline and after first line chemotherapy.The data was correlated with objective efficacy and overall survival.To evaluate the role of tumor marker change in predicting response to therapy,receiver operating characteristic (ROC) curves were constructed.Results CEA,SCC-Ag and CYFRA21-1 increased higher than the cutoffs in 22.0 %,34.0 %,and 44.0 % of tested patients,respectively.Statistically significant correlations were observed between CYFRA21-1 and SCC responses and objective efficacy evaluated by RECIST criteria (Z =3.181,2.389; P = 0.001,0.017).Based on the ROG curve analysis,a post treatment 32 % and 38 % increase in serum concentration was used as cut-off level for defining CYFRA21-1 and SCC-Ag change,respectively.When the cut-off levels were used to predict chemotherapy efficacy,the accuracy for CYFRA21-1 and SCC-Ag were 76 % and 70 %.In the univariate survival analysis,a statistically significant prognostic impact on survival from the change of CYFRA21-1 and SCC-Ag was observed.Conclusion CYFRA21-1 and SCC-Ag are useful for diagnosis,predicting chemotherapy objective efficacy and prognosis in advanced ESCC.

Objective:To assess mechanical hyperalgesia of the bilateral masseter muscles following the induction of experimental unilateral malocclusion in rats. Methods:① An elastic rubber(3M Unitek,1/8#) was inserted between the first and sencond upper molars on the left side of 4 Sprague- Dawley rats to induce malocclusion.② The left maxillary first molar of 4 rats were filled with metal arsenic for 7 days to inactivate tooth pulp, and then a dentin pin(d 0.75 mm, long 1.5-2.0 mm,0.5-1.0 mm above the occlusion surface)was bonded in the pulp chamber to induce acute traumatic occlusion, and 4 control animals were treated as the same procedure but not raised occlusion surface.③ According to Ren's method, von Frey filaments were used to assess the muscle mechanical threshold.Head withdrawal, leg raising and crying were observed as painful actions. Results:① In gradually induced malocclusion group,hyperalgesia was induced in bilateral masseter muscles from 3 to 9 d, and the peak time was the 7th day. ②In the acute traumatic occlusion group, the ipsilateral masseter muscle was demonstrated hyperalgesia for 5-7 days, and the peak time was the 2nd day. Conclusions:Traumatic occlusion may lead to masseter muscles hyperalgesia, and there existe some differences for pain behavior between the acute and the chronic occlusion trauma.

Objective To compare the effect of crystalloid and crystalloid plus albumin in the treatment of pediatric septic shock.Methods Data of 63 pediatric patients with septic shock admitted to Department of Critical Care Medicine of Hebei Provincial Children's Hospital were collected and retrospectively analyzed.The patients were divided into two groups according to whether they received albumin for volume resuscitation within 1 day after admission or not.The patients in observation group (crystalloid + albumin group,n =33) received normal saline (20 mL/kg) followed by 1 g/kg albumin 30 minutes after admission,and those in control group (crystalloid group,n =30) received only normal saline (20 mL/kg) 30 minutes after admission,and normal saline resuscitation was continued according to the effect of fluid therapy.Anti-infection and vasoactive drugs strategies were the same in both groups.The first-hour infusion volume,time showing stable hemodynamics,the incidence of pulmonary edema,and blood lactate levels at 0,6,12 hours after achieving the goals were compared,and blood lactate clearance rates were calculated.Results The first-hour infusion volume time in the observation group was lower than that in control group (mL:41.56 ± 10.50 vs.57.24 ± 7.54,t=4.596,P=0.000),and time showing stable hemodynamics was shorter than that in control group but without statistically significant difference (minutes:219.87 ±70.23 vs.287.10 ± 67.00,t=2.047,P=0.360).The incidence of pulmonary edema in observation group was slightly lower than that in control group [6.1％ (2/33) vs.10.0％ (3/30),x2±2.272,P=0.259].The lactic acid levels were decreased gradually along with rehabilitation time,while lactate clearance rate was increased in both groups.At 0 hour and 6 hours after resuscitation,the lactate level (mmol/L) in the observation group was significantly lower than that in control group [0 hour:3.65 ± 2.84 vs.5.72 ± 2.11,t＝ 1.940,P=0.046; 6 hours:2.12 ± 1.21 vs.4.09 ± 1.45,t=2.892,P=0.005],while the lactate clearance rate was significantly increased compared with control group [0 hour:(0.38 ± 0.15)％ vs.(0.18 ± 0.09)％,t=1.447,P=0.018; 6 hours:(0.62 ± 0.14)％ vs.(0.51 ± 0.11)％,t=1.920,P=0.047].However,at 12 hours after resuscitation,there were no statistically significant differences in the lactic acid level (mmol/L:1.46 ± 0.39 vs.1.54 ± 1.90,t=0.450,P=0.072) and the lactate clearance rate [(0.78 ± 0.19) ％ vs.(0.77 ± 0.18) ％,t =0.091,P=0.928] between observation group and control group.Conclusion Albumin resuscitation in children with septic shock can stabilize hemodynamics earlier,reduce the incidence of pulmonary edema,and improve the successful rescue rate of refractory septic shock.

Objective To investigate the guidance of a new classification on the treatment methods selection for cystic dilation of bile duct (CDBD).Methods The clinical data of 213 patients with CDBD who received treatment according to the Todani 2003 classification at the Peking Union medical College Hospital from September 1968 to July 2013 were retrospectively analyzed.The CDBD was reclassified with a new classification proposed by Dong Jiahong et al,and the guidance of the new classification on the treatment methods selection for CDBD was analyzed.Patients were followed up via out-patient examination and telephone interview till August 2013.Results Of the 213 patients,139 were with Todani type Ⅰ CDBD (type C CDBD of the new classification) ; 3 were with Todani type Ⅱ CDBD (type C1 CDBD of the new classification) ; 1 was with Todani type Ⅲ CDBD (type E CDBD of the new classification); 52 were with Todani type Ⅳa CDBD (35 with type D1 and 17 with type D2 CDBD of the new classification) ; 1 was with Todani type Ⅳb CDBD (type C CDBD of the new classification) ; 8 were with Todani typeⅤ-Ⅰ CDBD (type B CDBD of the new classification) ; 9 were with Todani type Ⅴ-Ⅱ CDBD (type A CDBD of the new classification).Eighteen patients did not receive the surgical treatment.Of the 195 patients who received surgical treatment,patients with type C and D CDBD of the new classification took a large proportion.Patients with type C CDBD of the new classification received cystectomy,biliary cyst resection,Rouxen-Y cholangiojejunostomy or internal drainage.Patients with type D CDBD of the new classification received extrahepatic biliary cyst resection,Roux-en-Y cholangiojejunostomy.Patients with severe intrahepatic disease and with type D1 CDBD of the new classification received concomitant left hemihepatectomy or pancreaticoduodenectomy.Patients with type A1 CDBD of the new classification received right hemihepatectomy.Patients with type A2 CDBD of the new classification were cured by conservative treatment after split liver transplantation.Patients with type B1 CDBD of the new classification received left hemihepatectomy and Roux-en-Y cholangiojejunostomy.Patients with type B2 CDBD of the new classification received bile duct stone extraction.There was 1 patient with type E CDBD,and partial resection of the CDBD ± bile duct reconstruction was carried out.Pancreatic fistula,biliary fistula,reflux cholangitis,cholangitis and anastomotic stricture were detected on 74 patients,and they were cured by conservative treatment or lithotomy.A total of 187 patients were followed up with the median time of 85 months (range,1-432 months).One hundred of seventy-five patients recovered well,and 12 patients with canceration of the bile duct died of tumor metastasis at postoperative 1-282 months.Conclusion This new classification simplifies the typing of extrahepatic bile duct dilation,refines the typing of intrahepatic bile duct dilation,and has better guidance for surgical treatment.

Objective To investigate the expression and tissue distribution of CD31 in the process of the calf cortical with partial cancellous bone xenograft, to explore the healing mechanism and relationship between bone remodeling and revascularization, and to provide a basis for the further study of tissue engi-neered bone.Methods Thirty-six New Zealand rabbits were selected as our experimental animals.All ani-mals were implanted with the calf cortical with partial cancellous bone.Specimens were procured at 4, 8, 12 and 24 weeks after surgery, respectively.The expression and tissue distribution of CD31 were observed in the process healing with general condition, X-ray, histology and immunohistochemistry.The image analy-sis computer system was used for quantitative analysis.The extent of revascularization and remodeling was separately represented by revascularization indexes and new bone areas.The relationship was studied be-tween bone remodeling and revascularization.Results ⑴ The X-ray showed significant healing.⑵ The positive expression of CD31 was seen in the whole process of bone xenograft and was different at various stage and sites.By the 4 weeks and 8 weeks postoperative,the strong positive expression was seen in the pe-ripheral soft tissue of graft bone, the callus of joint and the periphery of cartilage nests.Much positive ex-pression was seen in the cancellous bone.There was seen some single, cord, and cluster vascular endotheli-al cells.The positive expression was seen in the enlarged haversian canals and periphery.By the 24 weeks postoperative,the positive expression was seen in the enlarged haversian canals and periphery with increasing newborn capillaries.⑶ The correlation analysis between new bone areas and revascularization showed a closely positive correlation ( r =0.984).Conclusions The positive expression of CD31 was seen in the whole process of bone xenograft and was different at various stage and sites.The positive expression of CD31 reflected the extent of revascularization and bone remodeling of bone grafts.The extent of revascularization of bone grafts and bone remodeling showed a closely positive correlation.

Objective To investigate the diagnosis and treatment strategy of primary sclerosing cholangitis (PSC). Methods From January 1991 to August 2009, 31 patients with PSC were treated at the Peking Union Medical College Hospital. A retrospective study was performed based on the clinical data of these patients to evaluate the methods of diagnosis, curative treatment and prognosis. Results Obstructive jaundice, fever and abdominal pain were the main symptoms of PSC, which accounted for 90% (28/31) , 65% (20/31) and 52% (16/31) , respectively. Thirty patients presented with an elevation of alkaline phosphatase. The positive rate of autoantibody was 45% (14/31). The positive expression of serum tumor markers of 15 patients was elevated, and 13 of the 15 patients had an elevated expression of CA19-9 (84-5000 U/mL). The diagnostic accuracies of B-mode ultrasound, computed tomography, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography (ERCP) were 3/28, 2/24, 2/18, 18/25, respectively. Nineteen patients received drug therapy and only one patient had no obvious discomfort after the treatment. Twelve patients received surgical treat-ment and the prognosis of two patients who underwent liver transplantation was good. Eleven patients received endoscopic treatment, only one patient had no obvious discomfort and the condition of the remaining 10 patients was alleviated after treatment. Conclusions PSC is usually characterized by an elevated expression of CA19-9. ERCP has a high diagnostic accuracy. Conventional treatments can only relieve the symptoms, whereas liver transplantation has a favorable long-term efficacy.

Objective To recommend the safety guidelines for workplace violence on health care sector according to the incidents of violence status on medical workplace.Methods A pilot study was conducted using a two-round Delphi method to study out the safety guidelines for hospital violence.Results In two subsequent rounds,the group discussed and screened out 50 entries from 51 items in the six modules as safety guidelines for hospital violence.Conclusions Establishment of safety guidelines for hospital violence on health care sector using Delphi method requires further clinical validation.

AIM:To explore the feasibility and biological characterization of long-term regulated expansion of JAK2 transduced human CD34+ cord blood cells in vitro.METHODS: A retrovirus (RV) vector which contains JAK2 catalytic domain and two binding sites for a chemical inducer, dimerization (AP20187), was cloned (designated MGI-F2JAK2). CD34+cells were enriched from cord blood with a MiniMACS system. The purified CD34+cells were transfected with supernatant from the retrovirus packaging cell line that expressed JAK2. Following transduction, cells were expanded into four groups: AP20187 alone, FL alone, TPO, alone, AP20187+FL+TPO, respectively. The expanded cells were monitored by GFP expression, immunophenotyping, progenitor colony assay, karyotype analysis as well as tumorigenesis in nude mice. RESULTS: The purity of selected CD34+ cells was over 91% and gene transfer rate was 49.32%?6.21%. Only the group of AP20187 +FL+ TPO was obtained a significant sustained outgrowth of the transduced CD34+ cord blood cells. The percentage of GFP+ cells consistently produced a rise to the 90% peak level by the end of 8th week of culture. Flow cytometry analysis showed that the phenotype of the expanded cells was CD33+, CD61+ and Gly-A+ partial positive; CD38+ and HLA-DR+ strong positive, while CD2, CD7 and CD19 were almost negative. Colony assays performed in methycelluos, which can give rise to BFU-E, CFU-GM and CFU-Mix, the CFU-GM was predominantly in all colonies. The tumor was not observed in nude mice and the karyotype analysis was normal from expanded cells.CONCLUSION: The results demonstrate that AP20187-mediated activation of JAK2 signaling is capable of stimulating expansion JAK2 transduced CB CD34+ cells in combination with FL and TPO. This system may have applications for studies in signaling transduction, hematopoiesis, and for gene and cell therapy.

Objective To summarize the experience in prevention and management of delayed-diagnosed injury in choledocho-pancreatico-duodenal junction. Methods The clinical data of 5 patients with injury in chole-docho-pancreatico-duodenal junction who had received surgery from 2000 to 2007 in Peking Union Hospital was summarized and analyzed retrospectively. All the 5 patients were diagnosed 24 hours after the injury. The injury was caused after endoscopic retrograde cholangiopancreatography (or endoscopic sphincterotomy) +endovascular stent placement in 4 patients and by vehicle accident in 1 patient. Results All the patients were treated conserva-tively for 24-72 hours, and peritonitis was not alleviated, and were subsequently transferred to surgery. Three patients received gastrostomy +choledochostomy +jejunostomy. The abdominal pain was alleviated in 1 patient, and 2 died of multiple organ dysfunction syndrome 5-6 weeks later. Two patients received duodenal diverticulariza-tion + gastrostomy + jejunostomy + Roux-en-Y choledachojejunostomy + Roux-en-Y gastrojejunostomy, and had good prognosis. Conclusion Duodenal diverticularization is a proper choice for patients with perforation combined with severe intraabdominal infection.