Nephroblastoma is one of the most common solid tumours in children,and the gene expression is closely related to the tumorigenesis,development and prognosis.The treatment regimens have been constantly updated,which includes the preoperative chemotherapy,nephron-sparing surgery and targeted therapy of cancer stem cells,aiming to maintain the excellent survival for children being treated for Wilms tumor,while minimizing therapy-related toxicity.This paper reviews the gene expression and treatment on wilms' tumor.

Objective To learn the correlation between thyroid function and arteriosclerosis in elderly popu-lation,and to provide research data for early clinical intervention.Methods 7 1 elderly patients with hypothyroidism were selected as A group,76 elderly patients with subclinical hypothyroidism were selected as B group,70 healthy elderly cases were selected as C group.Triiodothyronine (FT3 ),tetraiodothyronine (FT4 ),thyrotrophin (TSH ), triglyceride (TG),total cholesterol (TC ),low density lipoprotein cholesterol (LDL -C ),high density lipoprotein cholesterol (HDL-C),C reactive protein (CRP)levels of the three groups were detected.Carotid artery intima media thickness (CIMT)was examined by color Doppler ultrasonography.Results FT4 levels of A group,B group were (5.25 ±4.17)pmol/L,(10.74 ±5.02)pmol/L respectively,which were lower than (18.53 ±6.38)pmol/L of C group.TSH levels of A group,B group were (16.45 ±6.96)mU/L,(6.25 ±3.84)mU/L respectively,which were higher than (3.37 ±1.13)mU/L of C group (t=14.650,8.232,15.522,6.037,all P<0.05).FT4 level of A group was lower than that of B group,TSH level of A group was higher than B group (t=7.185,11.097,P<0.05).TC, LDL-C levels of A group,B group were (5.96 ±1.01)mmol/L,(4.15 ±1.69)mmol/L,(5.64 ±0.94)mmol/L, (3.64 ±1.17)mmol/L respectively,which were higher than those of C group [(5.17 ±1.12)mmol/L,(3.20 ± 1.06)mmol/L](t=4.400,2.754,3.992,2.374,all P<0.05).TC,LDL-C levels of A group were higher than B group (t=1.990,2.139,all P<0.05).CIMT,CRP levels of A group,B group were (0.90 ±0.23)mm,(6.20 ± 1.31)mg/L,(0.79 ±0.17)mm,(4.55 ±1.05)mg/L respectively,which were higher than those of C group [(0.68 ±0.11)mm,(3.12 ±0.88)mg/L](t=7.229,4.599,16.364,8.878,all P<0.05).CIMT,CRP levels of A group were higher than B group (t=3.312,8.453,all P<0.05 ).CIMT and TSH,LDL -C,CRP levels were positively correlated (r=0.789,0.647,0.583,all P<0.05),CIMT and FT4 levels were negatively correlated (r=-0.636,P<0.05 ).Conclusion Hypothyroidism,subclinical hypothyroidism are associated with atherosclerosis in elderly population,and elderly patients with hypothyroidism,subclinical hypothyroidism are at high risk of atherosclerosis.

Objective Aims To investigate the dynamic changes of multi-organ functional indices in esophageal carcinoma patients during peri-operation period at flatland and moderate high altitude. Methods 44 cases of esophageal carcinoma scheduled to receive gastroesophagostomy were categorized semi-randomly into three groups: Flatland control group (FCG, n=8), moderate altitude lung protection group (MPG, n=16), moderate altitude control group (MCG, n=20). The cases in FCG and MCG underwent routine pulmonary function examination and respiratory tract preparation peri-operatively. Besides the above routine treatment, the cases in MTG received administration of Rahdiola compound capsules preoperatively, with 2 pills a day. Blood-gas and biochemical indices of multi-organs were recorded in the three groups preoperatively and at 1, 3, and 5 days postoperatively respectively. The patients' systematic reaction, the changing trend of the indices reflecting organs function and the postoperative complication were observed. Results The blood-gas parameters were different significantly both preoperatively and postoperatively between the three groups. While other indices reflecting the organs function were not different significantly between the three groups before the operation, but at 1, 3, 5 days postoperatively, the indices in MCG and MPG were significantly different with that in FCG (P

Objecive To evaluate the causes of 60 cases for clinical failure in post crown.Methods Sixty cases with failure in post crown cure were entered the study.The causes of failure were analyzed.Results Among the 60 cases with failure in post crown cure,38 cases were due to the crown'loosing or broken away,12 cases with the broken dental crown,10 cases with periapical periodontitis,6 cases with broken root.Conclusions It was the loosing or broken away of post crown,periapical periodontitis,dental crown and root broken consist of the main causes for clinical failure in post crown.

Objective To evaluate the use of spiral enteroscopy in diagnosis and treatment of smallbowel diseases.Methods The data of 8 patients who underwent spiral enteroscopy from July to September 2009 were retrospectively studied.The variables including maximal insertion depth,total procedure time,complications,and outcome were evaluated.Results The average maximal depth of intubation was 2.2 m beyond the Ligament of Triez (0-3.6 m beyond Ligament of Triez),with a mean procedure time at 41 min (25 to 77 min).Small bowel Crohn's disease was diagnosed in 2 cases with biopsy suggesting active inflammation and granular formation.Small intestinal tumor was detected in 1 patient with pathological finding of high grade dysplasia.Jejunal ulcer was detected in 1 patient.Multiple polyps were found in 1 patient after jejunal anastomosis,which were then treated with endoscopic argon plasma coagulation (APC).No abnormalities were found in 3 other patients.No complications occurred during and after the procedure.The maneuver of spiral enteroscopy and APC were same as that of balloon enteroscopy.Conclusion Spiral enteroscopy is simple and convenient to operate,which is of great potential in clinical use.

Objective To evaluate the predictive value of morphology of superficial depression in estimation of histology and invasive depth in colorectal neoplasia by using magnifying chromo-endoscopy.Methods Flat or depressed and sessile eolorectal lesions which were indicated for endoscopic mucosal resection (EMR) were consecutively collected. Depressed lesions were classified into type 1 (star-like) and type 2 (round) according to the morphology of depressive areas in the colorectal neoplasia with magnifying ehromoendoscopy. The relationship between morphologic classification with histology and invasive depth was studied with reference to pathological diagnosis after EMR. Results Ninety lesions including 25 sessile and 65 flat were resected with EMR. Lesions with central depression (54. 4%,49/90) were more likely to have high-grade dysplasia (HGD) or cancer than those without ( 51.0% vs. 17. 1%,P＜0. 001 ). Depressive lesions of type 2 were more susceptible to have HGD or cancer than those of type 1 (89. 5% vs. 26. 7%,P＜0. 001 ). The overall accuracy of depression morphology for distinction between lesions of superficial submueosal (m-sm1) and deep submucosal (sm2-sm3) invasion was 83. 7% (41/49). Conclusion The morphology of superficial depression on colorectal neoplasia is highly correlated with the histology and invasive depth,which facilitates the EMR treatment.

lem and direct necessary intervention to improve the completion rate of whole small intestine examination.

Objective To discuss the clinical value of immunofecal occult blood test in screening of colorectal cancer and its precancerous lesions in a large series of health checkup population. Methods Colorectal cancer and its precancerous lesions in 5919 subjects undergoing health checkup in our hospital were screened out by using immunofecal occult blood test from July 2006 to June 2007; positive cases with the test were subjected to colorectal endoscopy or X-ray barium enema examination. Relevant results were analyzed in combination with clinical and pathological data. Results Positive result was obtained in 314 out of the 5919 subjects undergoing health checkup with immunofecal occult blood test; the positive rate was 5.30%. 241 cases(76.75% )of them accepted colorectal endoscopic examination and 23 cases(7.32%) accepted X-ray barium enema examination. The total follow up rate was 84.08% with 50 cases out of contact. After excluding the cases out of cantact, 16 cases of colorectal cancer were found morbidity 2.37‰ including 8(50.00% )cases of Dukes A,7 cases (43.75%)of Dukes B and 1 case of Dukes C (6 .25%).The detection rate of colorectal cancer with postive imunofecal occult blood test was 6.06% (16/264). 94 cases (16.01‰) of adenomatous polyps were found including 55 cases (58.51%) of tubular adenoma, 23 cases (24.47% )of villiform- tubular adenoma and 16 cases(17.02%) of villfform adenoma. Among these cases 55 (58.51%)were solitary and 39(41.49%) multiple. In addition, 6 cases of ulcerative colitis in active phase were found. Altogether 116 (43.94%)of the 264 cases with positive immunofecal blood test and not out of contact were found to have colorectal cancer or its precancerous lesions. Conclusion Immunofecal occult blood test is suitable for screening of colorectal cancer and its precancerous lesions in large series of population. Colorectal cancer and its precancerous lesions may be found in relatively early phase and be eradicated in curable stage, thus to reduce the morbidity and mortality.

Objective To evaluate the clinical effect of capsule endoscopy(CE)followed by a directed double-balloon enteroscopy(DBE)in diagnosis of patients with suspected small bowel disease.Methods Two hundred and ninety-nine consecutive patients with obscure gastrointestinal bleeding or other various indications for CE examination were analyzed.DBE was recommended after negative or indeterminate evaluation on CE.The diagnostic and follow-up data were collected and analyzed.Resails A total of 296 patients completed CE examination.Of whorn,138(46.6%)cases had positive findings,68(23.0%)cases were suspected for small bowel disease and 90(30.4%)cases had negative finding,Those who were suspected(45 cases)and negative(7 cases)for CE examination were performed DBE examination and small bowel lesions were found in 31 cases and 1 case,respectively.The false-negative diagnosis was probably made by DBE in 8 patients,whereas no false-positive case was found by DBE.The false-negative diagnosis was probably made by CE in 2 patients,whereas 8 false-positive cases were found by CE.With the results of CE examination,lesions were found by only one-side procedure of DBE in 90.3%(28/31)of patients.The results that followed up for median 17 months indicated that 93.5% of patients with positive findings by DBE were received optimal therapy.Both CE and DBE procedures were well tolerated and no severe complications occurred.Conclusions The detection rate of sinall bowel lesions with CE was high,whereas the indetermination of CE findings was also significant.Majority of suspected findings by CE may be further confirmed by DBE.The strategy that start with CE and followed by DBE may increase diagnostic yield in patients with suspected small bowel disease and improve the prognosis.

Objective To evaluate the guiding role of capsule endoscopy (CE) in choosing the access route of double-balloon enteroscopy (DBE) for small bowel diseases. Methods Patients with complete CE and with small bowel diseases confirmed by DBE were enrolled. The lesion location found on CE was represented by the time index, which was the ratio of access time from pylorus to lesion over access time from pylorus to ileocecal valve. Based on our previous retrospective evaluation, oral approach was selected when the index was ≤0. 6, otherwise the anal access would be chosen. Accuracy of time index predicting DBE access rout was evaluated. Results Data of 60 patients undergoing both CE and DBE were evaluated. All lesions detected by CE were confirmed by DBE, with 41 via oral route and 19 via anus. Based on the time index with threshold of 0.6, the accuracy of selecting the insertion route of DBE was 100%. Conclusion DBE is an effective approach to confirm CE results. In patients with complete small bowel investigation by CE, the insertion route for DBE can be reliably indicated with time index based on the CE results.