Type 1 diabetes mellitus ( T1DM),arising through a complex interaction of immune,genetic and environmental factors,results from autoimmune destruction of insulin-producing β cells.In up to one third of patients the autoimmune attack is not limited to β cells,but expands into autoimmune polyendocrine syndromes(APS).APS are characterized by functional insufficiency of multiple endocrine organs due to an immunologically mediated destructive process.APS can commonly be divided into three types,including APS type Ⅰ,APS type Ⅱ and immune dysregulation,polyendocrinopathy,enteropathy,X-Linked syndrome (IPEX).Here,we discuss the susceptible factors,clinical manifestation,screening and treatment of APS,with the perspective of the clues they can offer to the pathogenesis and treatment of type 1 diabetes mellitus.

Objectives To explore the process and regularity of graft after vascularized bone allograft. Methods An adult rabbit model of massive femoral defect was established and reconstmcted with vascularized bone allograft based by laterial rotating femoral vessel.The experiments were carried out in two groups,the experimental group(vascularized bone allograft)and the control group(nonvascularized bone allograft).Then observation on periosteum,cortex and marrow was performed after operation containing in ink-infused specimen. Results The revascularization in the experimental grouD was observed synchronicly on periosteum,cortex and marrow after operation,while the phenomenon of vascularization took place from periosteum to marrow in the control group.The density of micro-vessel in experimental group were 10.0±1.8,15.8±1.5 and 13.8±1.5,13.8±1.5 respectivly after 2,4,8 and 16 weeks.and those were 2.8±0.8,6.0±0.9,5.5±1.0,6.0±1.1 in control group.The ink-infused experiment demonstrated a better revascularization in the experimental group. Conclusion The vaseularization can promote revascularization of graft during bone allograft.

Objective To investigate the status of microchimerism in recipients and the relation between microchimerism and immunologic tolerance after vascularized allograft bone transplantation. Methods X-ray and histological examinations were performed on recipients after massive vascularized shaft of femur from female Japanese white rabbit donors was transplanted to male recipients. Microchimerism in different organs and tissues were checked postoperatively using a semi-quantitative polymerase chain reaction (PCR) with a Y-chromosome specific primer at different time. Results X-ray and histological examinations showed typical bone union in the experiment group but irregular new bone calluses surrounded the transplanted bones, with high density sequestrum in the control group.Semiquantitative PCR with a Y-chyomosome specific primer indicated that the incidence of microchimerism in organs and tissues in the experiment group was higher than that in the control group postoperatively and increased with time. Conclusions After vascularized allograft bone transplantation, organs and tissues show microchimerism that has a positive correlation with the histocompatibility of the transplanted bones.

Objective To investigate the efficacy and adverse reactions of SOX and GP combined with two chemotherapy methods.Methods From January 2014 to September 2016 came to our hospital for treatment of three advanced breast cancer patients with negative 84 cases as the research object of observation,were randomly divided into SOX group and GP group were given chemotherapy measures and clinical observation on the treatment of.Results Two groups of patients with CR,PR,SD,PD,the number of cases and the total effective rate comparison,P values were 0.693,0.637,0649,0.801,0.823; two groups of patients with diarrhea,liver damage,thrombocytopenia,nausea and vomiting,neurotoxicity,anemia,leukopenia,rash,renal toxicity,appetite the incidence rate of decline,P values were 0.374,0.629,0.643,0.374,0.645,0.434,0.450,0.693,0.645,0.815.Conclusion Standard chemotherapy regimens for advanced three negative breast cancer was not uniform,but the SOX and GP regimens are safe and effective,can be used for clinical treatment.

The assisted reproductive techniques in China have witnessed rapid development in the past two decades.However,it also brings up issues of ethics and laws,especially the urgent regulation and reinforcement of the procedure of informed consent.This article begins with an explanation of the procedure of informed consent.Then it discusses the decision of the content,major and difficult points of informed consent in assisted reproductive technology services based on the practice in this field.Finally,it discusses the challenges to informed consent.To well enforce an informed consent process,we should first ensure the contents are reasonable and just;second,clinicians should have a scientific understanding of the importance of informed consent and establish normative procedure of informed consent;third,we must work according to relative ethic demands.Last but not least,respecting patients is the key to the principle of ethics.

Objective To explore the clinical value of transvaginal four-dimensional hysterosalpingo-contrast sonography (TVS 4D-HyCoSy)in evaluation of the patency of fallopian tubes. Methods Totally 53 patients underwent SonoVue TVS4D-HyCoSy to observe the tubal patency. Results Among the 106 tubes in 53 patients, TVS 4D-HyCoSy showed 47 unobstructed tubes, 23 obstructed tubes, and 36 partially passable tubes. In unobstructed cases, the fallopian tubes were smooth and regular in morphology, and contrast agents flowed into and dispersed over pelvic cavity rapidly and evenly. In the cases of partially passable tube, fallopian tubes were discontinuous and irregular in morphology, and contrast agents lfowed into and dispersed over pelvic cavity slowly and unevenly. In obstructed cases, there were no or little contrast agents into the fallopian tubes. Compared with the results of laparoscopy, the diagnostic accuracy of TVS 4D-HyCoSy was 94.4%(17/18). Conclusions TVS 4D-HyCoSy is a useful tool in demonstrating the morphological features of fallopian tube, diagnosing intrauterinc adhesion and lesion and assessing the tubal patency.

Objective To investigate the value and clinical significance of congenital heart diseases (CHD)detection in twins.Methods A total of 1103 twins were included in this study(127 twins were at high risk for CHD).The fetal hearts were scanned by ultrasound using Yagel's heart examination method. Autopsies were done when the pregnancy was terminated.And blood samples from fetal hearts or umbilical veins were used to evaluate fetal chromosomes.A close follow-up was conducted for normal heart cases and another heart examination was done within three months after birth.Results(1)12 twins(1.09%,12/ 1103)had CHD.Among them,4 cases were from the high risk for CHD group(33.3%,4/12),and 8 cases(66.7%,8/12)were from the low risk pregnancy group.(2)Two twins suffered from the same CHD (one pair were both TOF,and the other pair were both rhabdomyoma).One pair of twins had different abnormalities(one baby was TOF,and the other was duodenal atresia with a normal heart).All three pairs of twins chose termination and autopsies were conducted.Unanimous conclusions between prenatal ultrasound and autopsy were obtained.Nine twins were CHD in one baby and a normal heart in the other baby.Seven of them had the same conclusion after delivery.(3)Two twins with CHD were found with fetal abnormal chromosome.(4)1091 cases were not found having any abnormality,however,one fetus from one twin pair was diagnosed with ventricular septal defect(VSD)with abnormal chromosome after birth,and one fetus from another twin pair had patency of ductus arteriosus after birth.(5)The sensitivity of Yagel's heart examination was 82.4% and specificity was 100% in twins.Conclusion Yagel's heart examination is an effective and time-saving method to scan fetal hearts in twins.

Objective To investigate the risk factors of acute kidney injury (AKI) in patients after acute myocardial infarction (AMI).Methods A total of 1 371 adult patients diagnosed AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were analyzed retrospectively.AKI was defined according to the 2012 KDIGO AKI criteria.Based on the occurrence of AKI,the patients were divided into AKI group and non-AKI group.According to the AKI timing,the patients were divided into subgroups including conservative treatment groups,coronary angiography (CAG) groups and coronary artery bypass grafting (CABG) groups,respectively.Related risk factors of AKI were analyzed by univariate and multivariate logistic regression.Results Of the 1 371 patients,410(29.9％) developed AKI.Compared to the non-AKI group,in-hospital mortality increased significantly in the AKI group (17.1％ vs 3.9％,x2=68.0,P ＜ 0.001).Multifactor retrospective analysis showed that decreased baseline eGFR (OR=2.049,95％ CI:1.246-3.370),increased fasting plasma glucose(FPG) (OR=1.070,95％CI:1.018-1.124),diuretics (OR=1.867,95％CI:1.220-2.856) and Killip class 4 status (OR=1.362,95％ CI:1.059-3.170) were all independent risk factors of AKI,while increased DBP on admission was a protective factor (OR=0.986,95％ CI:0.974-0.998) for the conservative management group.Decreased baseline eGFR (OR=2.371,95％CI:1.500-3.747),increased FPG(OR=1.009,95％CI:1.005-1.012),diuretics (OR=1.674,95％CI:1.042-2.690),intraoperative hypotension (OR=2.276,95％ CI:1.324-3.575) and acute infection (OR=1.678,95％CI:1.023-2.754) were independent risk factors of AKI for the CAG group.Decreased baseline eGFR (OR=2.246,95％CI:1.340-3.981),increased FPG (OR=1.059,95％CI:1.018-1.124),diuretics (OR=1.723,95％CI:1.122-2.650),and low cardiac output syndrome after operation (OR=2.331,95％ CI:1.277-3.286) were independent risk factors of AKI for CABG group.Conclusions AKI is a common complication and associated with increased mortality after AMI.Decreased baseline renal function,increased FPG and diuretics were common independent risk factors of AKI after AMI.

Objective To investigate the effect of the ubiquitin-proteasome pathway inhibitor MG132 on the natural resistance to cisplatin in the human cervical cancer line (HCE1) muhicellular spheroid (HCE1/MCS) model and to probe it if MG132 could reverse the HCE1/MCS resistance to cisplatin, as well as the possible mechanism of drug resistance.Methods (1) HCE1/MCS was obtained using liquid overlay and rotating technique.(2)Four groups were established (MG132 group, cisplatin group, MG132 + cisplatin group, the control group).Cell viability were measured by trypan blue exclusion assay.Cell cycle and apoptosis were detected by flow cytometry.(3) The expression of nuclear factor (NF) kB of both HCE1 monolayer cells (HCEI/MC) and HCE1/MCS was detected by western blot, and the expression of B cell lymphoma/leukemia-2 (bcl-2) was detected by immunohistochemistry.Results (1) HCE1/MCS was established successfully.(2) Cell inhibited rate of HCE1/MC and HCE1/MCS was: in MG132 group, (11.67 ± 2.34) % vs (10.78 ± 1.17) % (P > 0.05) ; in MG132 + cisplatin group, (92.67 ± 2.52)% vs (91.33 ±2.18)% (P>0.05); in cisplatin group, (45.01±7.44)% vs (9.45±5.98)% (P<0.05).(3)The rate of apoptosis of HCE1/MC and HCE1/MCS were: in MG132 group, 8.14% and 5.97% ; in MG132 + cisplatin group, 99.01% and 95.22% ; in cisplatin group, 33.61% and 0.88%.(4)The expression level of NF-kB and the high expression rate of bcl-2 were: in HCE1/MCS of control group, 0.67 and 60% ; in HCE1/MCS of cisplatin group, 0.85 and 83% ; in HCE1/MCS of MG132 group, 0.39 and 20% ; in HCE1/MCS of MG132 + cisplatin group, 0.47 and 33%.Conclusions (1) HCE1/ MCS present natural resistance to cisplatin and may become a good model for the study of cervical cancer drug resistance in vitro.(2) MG132 could induce the inhibition and apoptosis of HCE1/MCS cells and partially reverse the natural resistance of HCE1/MCS to cisplatin, of which partially reverse the natural resistance may be in relation to the down-regulation of NF-kB and bcl-2 expression.

The 1.7 kb full-length hemagglutinin (HA) gene fragment of H5N1 subtype avian influenza virus was amplified by RT-PCR and then cloned into the pFastBacHT donor plasmids. The recombinant plasmid pFastBac-H5 was identified by restriction enzyme digestion and sequencing. Following the transposition pFastBac-H5 into the bacmid in DH10Bac E.coli competent cells, the colonies were identified by blue and white selection. The recombinant bacmid (rBacmid-H5) was verified by PCR analysis. Transfection of rBacmid-H5 DNA into sf9 cells using Cellfectin reagent results in the production of recombinant viral stock. Cells were harvested 72h post infection and analyzed by SDS-PAGE, Western-blot, hemagglutination and hemagglutination inhibition test;the expressed HA protein (rH5)shows hemaggluting activity and can be inhibited by H5N1 virus immunized chicken sera. On the other hand, immunization of chickens with rH5 protein results in high titers of H5N1 virus specific hemagglutation inhibition antibodies, which proved its biological activity.