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The Expert Consensus on the Diagnosis and Therapy of myelodysplastic syndrome (MDS) (2014) will be interpreted in this paper focusing on whether it is scientific and reasonable.Some advises and views will be put forward,hoping that it will be useful to improve the diagnostic and therapeutic ability on MDS for clinicians in our country.

Objective To explore the reason of colon cancer with appendicitis and reduce the rate of misdiagnosis. Methods We car-ried out analysis retrospectively to analyze 1 094 hospitalized patients with colon cancer in the First Affiliated Hospital of Harbin Medical Uni-versity from January 2006 to March 2013. Results Among 1 094 colon cancer patients,31 patients who firstly diagnosed with acute appendi-citis received appendectomy,1 patient with appendiceal abscess received non-surgical treatment. Among 31 patients with acute appendicitis,6 patients were found to be with ileocecal tumors during surgeries;24 patients were diagnosed with colon cancer within one year;incision of 1 patient did not heal, with continuous drainage of brown liquid;the appendicitis of 1 patient who received non-surgical treatment was recur-rent. Conclusion As lack of typical symptoms,colon cancer is prone to misdiagnose and diagnose incorrectly when the cancer co-exists with appendicitis and symptoms of appendicitis were showed firstly. Therefore,clinicians should be vigilant for patients with appendicitis. In order to induce the rate of misdiagnosis,it is essential that requesting disease history carefully,timely and relevant inspection and appropriate ex-ploratory surgery for the patients with appendicitis.

Objective To analyze the genetic model of attention deficit hyperactivity disorder(ADHD).Methods The segregation analysis and polygenic multiple threshold model were used to prove the polygenic model and to estimate the heritability and recurrence risk of ADHD in each degree relatives.Results 1. The average heritability of ADHD was (102.47?9.78)%;2.The first-degree relatives of probands were in high risk for ADHD(23.0%)compared with colony prevalence rate(2.6%). The ADHD prevalence of each degree relatives rapidly decreased with the increased magnitude of consanguineous relationship of each degree relatives and ADHD probands. Conclusions The genetic model of ADHD is the most likely polygenic inheritance with major genes, which suggested that the genetic factor might play an important role in the liability variance of ADHD.Apart from the involvement of multiple genes,each gene contributes a small additive effect,and the major genes may be involved as well.

Objective To investigate the spiral CT features of gastric carcinoma in the invasion and metastasis and its correlation with the expression of phosphatase and tensin horology deleted on chormosome ten(PTEN)and basic fibroblast grouth factor(bFGF).Methods Spiral CT plain scan and triphasic enhanced scans were performed in 83 patients.The postoperative specimens were embedded with paraffin to obtain 5?m thickness tissues and stained with HE and immunohistochemistry.Spiral CT findings were compared with the expression of phosphatase and tensin horology deleted on chormosome ten(PTEN)and basic fibroblast growth factor(bFGF).Results(1)The accuracy of spiral CT in T and N staging of gastric carcinoma was 94.0%(78/83)and 89.2%(74/83),respectively.(2)The expression of PTEN was 47.0%(39/83)in gastric carcinoma.The expression of PTEN in T_(3.4)(40.8%,29/71)and N_(1+2) (38.3%,23/60)gastric carcinoma was significantly lower than that of T_2(10/12)and N_0(16/23)gastric carcinoma,respectively(X~2=7.439,P=0.006;X~2=6.511,P=0.011).(3)The expression of bFGF was 63.9%(53/83)in gastric carcinoma.The expression of bFGF in T(3.4)(70.4%,50/71)and N_(1+2) (71.7%,43/60)gastric carcinoma was significantly higher than that of T_2(3/12)and N_0(10/23)gastric carcinoma,respectively(X~2=7.314,P=0.007;X~2=5.724,P=0.017).(4)Both PTEN-positive expression and bFGF-positive expression were detected in 16 specimens.The expression of PTEN(41.0%, 16/39)was negatively correlated with that of bFGF(30.2%,16/53)(r=-0.447,P=0.000). Conclusion Spiral CT triphasic enhanced scans combined with biologic characteristics can improve diagnostic accuracy of gastric carcinoma in the invasion,metastasis and prognosis.

Objective To study the long-term effect of argon plasma coagulation (APC) combined with proton pump inhibitor (PPI) on Barrett esophagus (BE). Methods A total of 36 patients, histologically proven as having BE from 2004 to 2007, were enrolled to underwent a therapy of APC plus PPI. The patients were re-examined on endoscopy at 1, 6 and 12 months after first APC and once a year thereafter.Results A total of 48 APC sessions were given to 36 patients with a mean number at 1. 33 per patient. The effective rate of reversal of BE was 100%. The follow-up was accomplished for all patients in 14-51 months with a median of 36months. The total recurrence rate (RR) of BE reached 16. 7% (6/36). The 1-year and 2-year RRs were 2. 8% (1/36) and 11.1% (4/36), respectively. The logistic regression analysis suggested that 2-year and total RRs were related to APC sessions ( P ＜ 0. 01 ). Conclusion The therapy of APC combined with PPI for BE is safe and of long-term effects.

Objective To study dose-response relationship and screen the optimized fractionated irradiation schedules in subclinical tumors of malignant glioma.Methods Balb/c-nude mice bearing human malignant glioma xenograft were assigned randomly into control group,fractionated irradiation schedules group and nimotuzumab-conventional fraction group.The fractionated schedules were 200 cGy x 5f/w,300 cGy ×5f/w,160 cGy ×2f/d x5 d and 400 cGy ×3f/w with total dose of 40 Gy and 60 Gy,respectively.Measurement indexes were tumor-forming rate,average recurrence time and maximum diameter of the tumor bottom.The observation lasted 24 weeks.Results With the total dose of 40 Gy,none of the significant long-term tumor regression were detected in any fractionated irradiation schedules; 400 cGy x 3f/w with complete tumor response at the end of treatment showed a better short-term curative effect.With the total dose of 60 Gy,long-term control rate of each fractionated irradiation schedule group was improved with prolonged average recurrence time of varable degrees,except 200 cGy x 5f/w fractionated schedule (tumor formation rate was 100％ at the end of treatment and average recurrence time was the poorest of 108 d).160 cGy × 2f/d × 5 d fractionated schedule showed the best curative effect with no tumor formation in 2 of 8 mice and longest recurrence time of 143 d.300 cGy x 5f/w fractionated schedule ranked second with no tumor formation in 1 of 8 mice and average recurrence time was 137 d.400 cGy x 3f/w fractionated schedule produced the poorest outcome with no case cured.There were no significant changes in the tumor-forming rate or average recurrence time when nimotuzumab was concurrently used for subclinical tumors of malignant glioma with total dose of 60 Gy.Conclusions Conventional fractionated irradiation is not the best option to control the sustained growth.160 cGy ×2f/d ×5 d and 300 cGy × 5f/w might be the optimized fractionated irradiation schedules for subclinical tumors of malignant glioma.

Objective To compare the efficacy of different sedation depths of monitored anesthesia care (MAC) in vitrectomy.Methods Ninety-six patients of both sexes,aged 40-64 yr,with body mass index ≤ 35 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective vitrectomy,were randomly divided into 2 groups (n =48 each) using a random number table:mild sedation group (group Ⅰ) and profound sedation group (group Ⅱ).Anesthesia was induced with iv midazolam 0.02 mg/kg and sufentanil 0.15 μg/kg.Anesthesia was maintained with iv infusion of propofol 0.5-2.0 mg · kg-1 · h-1 maintaining bispectral index (BIS) value＞80 in group Ⅰ,or with iv infusion of propofol 2-6 mg · kg-1 · h-1 maintaining BIS value at 65-80 in group Ⅱ.The occurrence of unexpected head movement,SPO2＜90％,snoring,and oculocardiac reflex during the procedure,postoperative nausea and vomiting,and the time when the patients in supine position were turned to prone position were recorded after surgery.Results Compared with group Ⅰ,the incidence of unexpected head movement,SpO2 ＜90％,and snoring was significantly increased,and the time when the patients in supine position were turned to prone position was prolonged (P＜0.05),and no significant difference was found in the incidence of postoperative nausea and vomiting and oculocardiac reflex during the procedure in group Ⅱ (P＞0.05).Conclusion Mild sedation of MAC (BIS value ≥ 80) provides better efficacy than profound sedation (BIS value 65-80) when used for vitrectomy.

BACKGROUND:To inhibit the expressions of prothrombin activator inhibitor 1 and tissue plasminogen activator is one potential target for the treatment of cerebral infarction. OBJECTIVE:To investigate the expressions of serum inflammatory cytokines in rats with cerebral infarction undergoing bone marrow mesenchymal stem cel transplantation combined with edaravone. METHODS:Sixty Sprague-Dawley rats were enrol ed to prepare models of focal cerebral infarction by middle cerebral artery occlusion, and were randomly divided into four groups. Rats were given intravenous injection of PBS via tail veins for 5 consecutive days as model group, rats were subjected to intravenous injection of 2.0×109/L bone marrow mesenchymal stem cel suspension (1 mL) via tail veins, twice daily for 5 days as stem cel transplantation group, and those were given intravenous injection of 30 mg edaravone combined with intravenous injection of 2.0×109/L bone marrow mesenchymal stem cel suspension (1 mL) via tail veins for 5 days, twice daily, as combined group. RESULTS AND CONCLUSION:Compared with the model group, modified neurologic severity scores were lower, expressions of serum prothrombin activator inhibitor 1 and tumor necrosis factor-αmRNA in the brain decreased, and the infarct area reduced in the stem cel transplantation and combined groups. And the changed levels of above indicators in the combined group were significantly larger than those of the stem cel transplantation group. In conclusion, combination of bone marrow mesenchymal stem cel transplantation with edaravone can promote neural function recovery after cerebral infarction.

BACKGROUND:Previous animal experiments have demonstrated that mandibular advancement can cause the remodeling of temporomandibular joint tissue of young SD rats. This is mainly characterized by accelerated growth rate of the condyle tissue and secondary growth of mandible. But the ultrastructural remodeling of condylar chondrocytes remains poorly understood. OBJECTIVE:To observe the histological and ultrastructural variations of reconstructed condylar cartilage of young rats under the effect of continuous mandibular advancement. METHODS:SD rats aged 4 weeks were randomly divided into control and experimental groups. Rats in the experimental group were subjected to mandibular advancement for 24 hours and sacrificed at 3, 7, 14, 21 and 30 days of intervention. Condylar cartilage samples were harvested and their histological and ultrastructural changes were observed under optical microscope and transmission electron microscope. RESULTS AND CONCLUSION:After 14 days of intervention, the thickness of condylar cartilage in the experimental group increased first and then became thin in the period of observation. The cartilage thickness variations in the postmedian condylar were significant (P < 0.01). After 7 days of intervention, the ultrastructure of condylar chondrocytes was reconstructed, including intracelular karyopyknosis, rough endoplasmic reticulum compartment sweling, smaler even absent lipid droplets, less and irregular microfilaments around the nucleus, broadened and increased extracelular matrix and the emergence of large gaps. These results demonstrate that under continuous mandibular advancement, the rat condylar cartilage wil become thick or thin with the endurance time, and chondrocyte matrix synthesis ability wil be significantly enhanced.