70 patients with gastric carcinoma were studied by EUS prior to surgery. The results were correlated with the histology of resected specimens according to the new TNM classification. EUS was accurate in assessing the depth of tumor infiltration, the overall accuracy of EUS was 74.3%. The cancerous ulcer and obstruction are the main causes of over- and understaging, respectively. EUS was relatively accurate in the assessment of lymph node metastasis, the overall accuracy was 57.1%. However, negative-predictive rate is lower, about 42.9%. It is difficult to distinguish between inflammatory and metastatic lymph nodes. EUS was not reliable in diagnosing distant metastasis, due to its limited depth of penetration. In our experience, in staging the gastric carcinoma, greater accuracy would be achieved if we use EUS for T and N factors, and CT for M factor.

Secondary hyperparathyroidism (SHPT) is a common complication in patients with chronic renal failure (CRF).Medical treatment may be the first choice for most SHPT patients,but parathyroidectomy (PTX) is neededwhen medical treatment doesn't work in patients with refractory SHPT.However,there is no strong evidence to support which surgical procedure is the most effective one for patients with SHPT.An interdisciplinary discussion between nephrologists and surgeons is needed when choosing a preferred surgical method for refractory SHPT patients.The factors must be discussed including:the patient's age,the underlying kidney disease,clinical symptoms,the level of intact parathyroid hormones (iPTH) and blood calcium,the patient's ability to obtain and comply with medication treatment and the estimated duration of dialysis before kidney transplantation.Refractory SHPT patients will benefit from the surgical operation treatment and reoperation of recurrent SHPT is still an ideal treatment method.

Objective By contrasting and analyzing the clinic manifestations, radiological features and pathological results of patients with bone invasion from skin of the lower limbs that were associated with malignancy, authors advanced X-ray diagnostic evidence to promote its diagnostic accuracy. Methods The radiological appearances of squamous cell carcinoma arising in chronic ulcers, sinus and scars of the lower limbs in 16 patients from February 1968 to April 2002 confirmed by pathology, were analyzed retrospectively. All cases were taken posterior-anterior and lateral radiograph before operation. There were 15 males and 1 females aging from 15 to 67 years (mean, 50.4 years). The lesion was located at the front of tibia in 15, and the middle inferior part of femur. The medical history of primary diseases varied from 1 to over 50 years with an average of 20 years and 3 months. Of 16 cases, the duration of 8 cases from a sudden change of state of an illness to the final diagnosis was 4 to 6 months, 4 cases above 1 year, and 4 cases were found with no any change of state of an illness. Results There were 14 cases observed as typical chronic osteomyelitis, which demonstrated peripheral osteolytic defect, 13 cases with osteolytic destruction spreading outwards from front of tibia, and 1 case with widespread osteolytic destruction in the middle and inferior part of femur. Floating-ice-like rudimental bone in the defect was found in 11 cases, and 4 case were observed with old fracture. 2 cases without obvious history of typical chronic osteomyelitis, 1 case with soft tissue trauma and 1 case of burn, showed small Saucer-like erosion of the cortex and huge lobar soft tissue masses. Moreover, patchy shadow and Codman's triangle were found in 1 case of burn. Furthermore, lobar soft tissue masses and huge ulcer accord with osteolytic destruction was observed in all cases, and soft tissue masses were larger than the area of bony destruction in 6 cases. Conclusion Roentgenogram could display shape, location and extension of bone invasion from skin of the lower limbs that were associated with malignancy, which contribute to diagnose the lesion and provide useful evidence for surgical plan.

Objective To establish tetracycline-controlled inducible system(Tet-on) in HepG2 cell for further research of the function of related gens.Methods The HepG2 cells were transfected with pWHE146 vector by using liposome transfection reagent.The transfected cells were selected in medium containing G418,and G418-resistant clones were isolated.All individual G418-resistant clones were screened by transient transfection with plasmid pTRE-hyg-luc for clones with low background and high induction of luciferase in response to Dox.Results One HepG2 cell line,which exhibited high levels of induction(154,106 times)and high gene expression levels,was obtained.Conclusions The HepG2 cell line can be used to highly express eukaryotic gene and this Tet-on system is available for use in eukaryotic gene function studies.

Objective To investigate the value of endoscopic ultrasonography ( EUS) in diagnosing pancreatic pseudocyst. Methods EUS was performed in 35 cases with pancreatic pseudocyst. Results Of the series, 41 cysts found in the head, body, tail and both body and tail of the pancreas were 13 , 3 , 19 and 6 respectively. The cystic wall was smooth in 29 cysts and rough in 6; good signal in cystic fluid 19, floccu-lar echo 16, cystic septum 1 and calcification of cyst wall 1, associated ductus pancreaticus expansion in 7, pancreas parenchyma uneven echo in 21, pancreas parenchyma calcification in 4, pancreas atrophy in 2, pancreas carcinoma in 2 , and normal pancreas in 6, protuberances impression on gastrointestinal tract 5 ( duodenal descending part obstruction, n = 1 ) stomach varicose vein in fundus 4 and digestive tract hemorrhage 2. Conclusion EUS may clearly show cyst's size, position, configuration and relation with the pancreas, also EUS guided FNA can be performed, so it has significance in diagnosing and distinguishing pancreatic pseudocyst.

Objective To study the effects of HIF-1α expression on the growth of subcutaneously implanted human hepatocellular carcinoma (HCC) cell lines in nude mice. Methods A nude mouse model of subcutaneously implanted HCC cell line HepG2Tet-on-HIF-1α was established. This cell lines characterizes the inducible expression of HIF-1α by doxycycline (Dos). The impact of HIF-1α expression induced by Dox on the growth of subcutaneously implanted HCC cell lines in the nude mouse model was observed. Results The mRNA and protein expression of HIF-1α were significantly up-regulated in the nude mouse model by oral administration of Dox. Compared with that model in which Dox was not administrated ie Dos( - ) group, the tumor volume(513.545 ± 276. 229) mm3 vs. ( 166. 506 ± 110. 142) mm3 ( P < 0. 05 ), tumor weight ( 1.251 ± 0. 438 ) g vs. (0. 640 ± 0. 296) g ( P < 0. 05 ), and tumor growth velocity were significantly enhanced in Dox ( + ) group, while tumor necrosis was inhibited ( 31. 360% ±2. 728% vs. 36. 640% ± 3. 804% ) (P<0. 05). The weight loss of nude mice was larger in Dox( + )group( P < 0. 01 ). There was no liver or lung metastasis in either group. Conclusion The expression of HIF-1αin subcutaneously implanted HCC in a nude mouse model is up-regulated by oral Dox. High grade expression of HIF-1α promotes the growth of implanted HCC.

Objective To compare the complication and long-term efficacy of standard and extended pancreaticoduodenectomy for carcinoma of the head of pancreas by meta-analysis.Methods A literature search was performed of PubMed,Web of Science,Springer,WanFang,CNKI and CBMDisc databases from January 1990 to August 2014.Qualitative analysis of these literatures was conducted using Jadad evaluation.Patients with pancreatic head carcinoma undergoing extended radical resection and standard radical resection were divided into treatment group (extended pancreaticoduodenectomy group,EPD) and control group (standard pancreaticoduodenectomy group,SPD),respectively.Based on the heterogeneity test,meta-analysis of a fixed-or random-effect model were used.Results A total of 5 studies suitable for the selection criteria were chosen,involving 597 patients (299 in EPDs and 298 in SPDs).The results of meta-analysis showed that the EPDs have significantly longer operative time (MD =64.36,95％ CI =23.88-104.85,P =0.002) and more dissected lymph nodes (MD =16.45,95％ CI =9.61-23.29,P ＜ 0.000 01) than SPDs.There was no statistical difference (OR =1.76,95 ％ CI =0.66-4.65,P =0.26) in postoperative complications (46.3％ vs 36.0％) mortality (OR =1.31,95％ CI =0.47-3.69,P =0.61),1-year survival rate (OR =0.70,95 ％ CI =0.49-0.99,P =0.05),3-year survival rate (OR =0.79,95％ CI =0.55-1.15,P =0.22),and 5-year survival rate (OR =-0.02,95％ CI =-0.17-0.12,P =0.77).Conclusions Compared with standard radical resection,extended radical resection for pancreatic head carcinoma does not prolong the postoperative 1-,3-,and 5-year survival rates with comparable postoperative mortality and morbidity and prolonged operative time.

Objective:To study the short-term effects,toxic side effects and immune function of Aidi injection adjuvant GP methods chemotherapy for advanced non-small cell lung cancer(NSCLC).Methods:130 patients with advanced NSCLC were divided into study group and the control group according to treatment methods.The study group were given Aidi injection +GP,and the control group only treated with GP.The short-term effects,toxic side effects gradeⅢ-Ⅳand immune function changes were compared between the two groups.Results:The overall response rate was 40.28%in study group,higher than 37.93% in control group(P>0.05).The two groups showed differences in the rates of leucocyte decrease,gastrointestinal reaction and platelets decrease(P<0.05).The levels of CD4,CD8 and CD4/CD8 didn′t changed obviously in study group(P>0.05),while in the control group the levels of CD4,CD8 and CD4/CD8 changed more significantly than before(P<0.05).The two groups also produced differences in CD4,CD8 and CD4/CD8 after treatment( P<0.05 ) .Conclusion: The short-term effects of Aidi injection adjuvant GP chemotherapy regimen for advanced NSCLC is similar to only GP chemotherapy,but it can obviously reduce the incidence of toxic side effects and prevent the immune func-tion.

Objective To investigate the value of the multiple short tandem repeat (STR)amplification by fluorescence labeling polymerase chain reaction (PCR) combined with fusion gene bcr-abl mRNA expression for quantitative determination of chimerism and qualitative detection of bcr-abl transcripts,and to evaluate the status of engraftment and predict the outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods 5 relapse patients with CML after alIo-HSCT were dynamically investigated. Quantitative analysis of donor chimerism was performed by multiplex PCR amplification of STR markers and capillary electrophoresis with fluorescence detection, qualitative detection of bcr-abl transcripts was performed by RT-PCR. Results The donors alleles appeared in all of 5 patients on day 28 post transplant, and bcr-abl expression was negative. But 5 patients had unstable mixed ehimerism. (DC: 0～80.4 %) at the different time points after aIIo-HSCT and bcr-abl was positive. One of them kept eontinuely the mixed chimerism in the relapse of disease, and died after one year, and the other changed from MC to CC by intervention of clinical treatment. Reduction of donor chimerism were detected prior to the occurrence of graft rejection and disease relapse, while bcr-abl gene expression was positive. Conclusion The results of STR-PCR in the range of its sensitivity fully correspond with bcr-abl tests in patients with CML. The combination of STR-PCR with RT-PCR provides a highly sensitive and valuable tool for engraftment evaluation, graft rejection, relapse and predicting GVHD. Furthermore it can provide a basis for early intervention of clinical treatment, and can identify these patients at high risk with molecular or cytogenetic relapse after allo-HSCT.

Resident standard training for traditional Chinese medicine(TCM) is an important part of medical training, after-department examination plays the role of its quality control. Through the construction of question database for after-department examination, combining TCM residency standard training requirements and actual situation of the department, it contribute to the formation of standardized examination,improve the system of resident standardization training for TCM, help to training appropriate and qualified TCM residency.