Objective:To evaluate the pancreatic subclinical dysfunction after intensity-modulated radiation therapy (IMRT) for gastric cancer by analyzing biochemical indexes and pancreatic volume changes, and to reduce the dose of pancreas by dosimetric prediction and dose limitation.Methods:30 patients with gastric cancer who received 45 Gy postoperative adjuvant radiotherapy were retrospectively selected. The pancreas was delineated and its dose and anatomical relationship with planning target volume (PTV) were evaluated. Fasting blood glucose, serum lipase and amylase, and pancreatic volume changes before and after radiotherapy were analyzed. The correlation between the changes of biochemical indexes and volume and pancreatic dose was evaluated by Pearson analysis. The threshold of the dosimetric prediction was obtained by receiver operating characteristic (ROC) curve. Finally, the feasibility of dosimetric limitation in IMRT was assessed.Results:The pancreatic volume of 30 patients was 37.6 cm 3, and 89.0% of them were involved in PTV. D mean of the pancreas was 45.92 Gy, and 46.45 Gy, 46.46 Gy and 45.80 Gy for the pancreatic head, body and tail, respectively. The fasting blood glucose level did not significantly change. The serum lipase levels were significantly decreased by 66% and 77%(both P<0.001), and the serum amylase levels were significantly declined by 24% and 38%(both P<0.001) at 6 and 12 months after radiotherapy. Pancreatic volumes of 22 patients was decreased by 47% within 18 months after radiotherapy. ROC curve analysis showed that pancreatic V 45Gy had the optimal predictive value for the decrease by 1/3 of serum lipase and amylase levels at 6 months and serum amylase level at 12 months after radiotherapy, and the cut-off value was V 45Gy<85%. Pancreatic D mean yielded the optimal predictive value for the decrease by 2/3 of serum lipase level at 12 months after radiotherapy, and the cut-off value was D mean<45.01 Gy. After" whole pancreas" and" outside PTV pancreas" dose limit, V 45Gy of the pancreas was decreased by 11% and 7%, D mean of the pancreas was declined by 2% and 2%, and D mean of the pancreatic tail was decreased by 3%, respectively. Conclusions:Serum lipase and amylase levels significantly decline at 6 and 12 months after adjuvant radiotherapy for gastric cancer, and pancreatic volume is decreased significantly within 18 months after radiotherapy. Pancreatic V 45Gy<85% and D mean<45.01 Gy are the dose prediction values for the decrease of serum lipase and amylase levels. The dose can be reduced to certain extent by dosimetric restriction.

Objective To investigate the early clinical characteristics and radiographic changes in confirmed Novel coronavirus pneumonia (NCP) and excluded NCP patients. Methods Twenty-four patients with suspected NCP admitted to Shanghai Jiao Tong University Affiliated Sixth People’s Hospital and Jinshan Branch Hospital between January and February, 2020 were chosen as our research subjects. Early clinical features and radiographic changes were analyzed in 10 patients of confirmed NCP and 14 patients of excluded NCP. Results In the early stage, all 24 suspected patients were mild, and had normal blood gas analysis. Of 10 diagnosed patients, 50% were male. All the 10 patients had fever and fatigue, with body temperature between 37.5℃ and 38.5℃. Only 1 patient had dry cough. 2 patients had no clear epidemiological exposure history, the other 8 had a clear epidemiological exposure, with a possible incubation period of 1-10 days. From CT imaging, lesions were characterized as ground glass shadow ( n =9), which could be unilateral ( n =1) or bilateral ( n =9), and were mainly close to the pleura ( n =9), with nodule shadow ( n =1) and without focal necrosis, and could combined with pleural effusion ( n =1. Among patients excluded NCP, all 14 patients had a clear history of epidemic exposure, with an onset time of 1 to 13 days. 12 patients had fever , including 4 with temperature > 38.5°C, 8 with temperature 37.3-38.5°C, and 2 without fever. All patients had fatigue , 7 patients had dry cough and 2 patients had chest pain. From CT imaging, ground glass shadow appeared in 4 patients , lesions were unilateral in 10 patients and bilateral in 4 patients , and the lesions were relatively sporadic, without necrosis or pleural effusion. Conclusion 1．Not all patients with NCP have a direct history of epidemiology exposure, some patients may be infected unknowingly. 2. According to CT imaging, NCP seems to have no special manifestations different from other viral pneumonia. 3. NCP is more common among middle-aged people.

Objective To explore the abilities and personal qualities that medical undergraduates need for their future clinical work, and develop their competency model. Methods The self-made ques-tionnaire survey on medical undergraduates' competencies was conducted among the 1326 medical under-graduates in a medical university by using the cluster sampling method, and the 1099 effective question-naires were collected with effective rates of 82.88%. The exploratory factor analysis was used to analyze the internal structure of competency item and to build the competency model. The rating method was used to calculate the weight of each competency item. Results The overall Cronbach's alpha coefficient of the competency questionnaire was 0.965, and the coefficient of each dimension was above 0.832. The KMO statistic value was 0.970, and the probability associated with Bartlett test statistic was P=0.000, showing that the questionnaire has high reliability and validity. The competency model of medical undergraduates covers six aspects, namely, craftsmanship, personal qualities, professional learning, interpersonal communication, psychological adaptation and the pursuit of excellence, which contain 49 factors. The cumulative variance contribution rate was 54.729%. The weights of these six aspects in the model were 0.204 4, 0.202 1, 0.175 3, 0.158 8, 0.137 6 and 0.121 8 respectively. Conclusion The competency model of undergraduate medi-cal students has a certain scientific and practical value, which can provide new evaluation methods and ideas for medical education objectives, quality assurance, teaching evaluation, medical personnel selection and training.

Objective To investigate the incidence of recurrence and occurrence rate of recurrence of hand-foot-and-mouth disease (HFMD)in Jiangbei District of Ningbo City between 2012 and 2014,analyze the influencing fac-tors,and provide a scientific basis for the prevention and control of HFMD.Methods Data of HFMD in Jiangbei in 2012-2014 were collected from China Disease Surveillance Information System,immunization data were from Im-munization Programme Information System of Ningbo City,the recurrent infectious cases were selected and analyzed by descriptive epidemiological methods.Results The occurrence rate of recurrent HFMD in Jiangbei in 2012-2014 was 5.40% ,the median month of patients with single occurrence and recurrence of HFMD were 33.77(20.03, 47.83)and 38.26(22.05,54.75)months respectively,median month of patients with the initial occurrence were 23.93(15.87,36.87)months,median of time interval of recurrent HFMD was 10.27(5.23,16.06)months. The oc-currence rate of recurrence was the highest in 3- years old group(χ2= 37.51,P<0.001). Most were scattered chil-dren and children in child-care center. Female was a protective factor of recurrence of HFMD (OR,0.73[95% CI, 0.57-0.92]),while children in child-care center was a risk factor (OR,1 .46[95% CI,1 .16-1 .84]). The median attack rate of recurrence in HFMD group and control group in blocks within 7 days were 10.36(9.29,11.44)/100000 and 8.95(8.16,9.74)/100000 respectively,there was significant difference(Z= -2.68,P<0.001). In-oculation frequency between recurrent HFMD group and control group was not significantly different (Z= -1.38,P= 0.17).Conclusion The epidemic of recurrence of HFMD was serious in Jiangbei District of Ningbo City between 2012 and 2014,boys and children in child-care center should be paid attention,contacts with patients should be re-duced,and targeted prevention and control measures should be carried out.

Objective To compare the efficacy and safety of three different methods of laparoscopic common bile duct exploration (LCBDE).Methods The clinical data of patients with LCBDE treated in our hospital by the same surgeon from January 2010 to December 2012 were retrospectively analyzed.These patients were divided into three groups according to the 3 surgical methods:Group A:15 patients were treated with laparoscopic transcystic common bile duct exploration (LTCBDE).Group B:85 patients were treated with laparoscopic common bile duct exploration followed by primary duct closure (LCBDEPDC).Group C:20 patients were treated with laparoscopic common bile duct exploration and T tube drainage (LCBDE-TD).The study measured the TBIL,inner diameter of common bile duct,costs,length of operation,postoperative hospital stay,peritoneal drainage time,and operation-related complications.Results The operations were successfully carried out in the 3 groups of patients.When compared with group C,group A and group B had significantly shorter operative time,shorter postoperative hospital stay,shorter peritoneal drainage time,lower hospital costs,and earlier return to work (P＜0.05).The only significant difference between group A and group B was the peritoneal drainage time.There was no significant difference in the incidences of postoperative complications between the 3 groups (P＞0.05).Conclusions The three different methods of LCBDE had their own indications.LTCBDE was better than primary suture,and LCBDEPDC was better than T-tube drainage after laparoscopic common bile duct exploration.

Objective To investigate the preventive effect of postoperative pancreatic leakage by continuous invaginated pancreaticoenterostomy in pancraticoduodenectomy. Methods Twenty-twopancraticoduodenectomy procedures were performed by continuous invaginated pancreaticoenterostomy with 4-0 absorbable suture and the results were compared with those of 12 end-to-side invagination interrupted suture procedures and 23 pancreatic duct jejunum anastomosis procedures. Results All continuous invaginated pancreaticoenterostomy cases were performed successfully with the average time of 13 minutes, and one biliary leak occurred postoperatively; and there was no pancreatic anastomotic leak and no death. The mean hospital stay of the patients was 15 days. While the mean time of end-to-side invagination interrupted suture procedures was 20 minutes, one biliary leak and one abdominal infection occurred, and one patient died of abdominal bleeding. The mean time of pancreatic duct jejunum anastomosis procedures was 18 minutes, and one pancreatic leak and one upper gastrointestinal bleeding occurred. The mean postoperative hospital stay of these patients was 19 days. Conclusions Continuous invaginated pancreaticoenterostomy is applicable to any situation in the residual pancreas, and has the advantages of easy to operate, time saving and less complications, thus it is an effective improvement of pancreaticoenterostomy.

Objective To investigate the expression of aquaporin-8(AQP8)and apoptosis associated bcl-2 protein in human cervical carcinoma and their relationship.Methods The expression of AOP8 and bcl-2 protein in 74 cases of cervical carcinoma (46 cases of squamous-cell carcinoma of the uterine cervix,28 cases of adenocarcinoma of the uterine cervix),34 cases of cervical intraepithelial neoplasia (CIN)and 15 cases of normal cervices were detected by immunohistochemical technique,and their clinical significance were analyzed.Results The expression of AQP8 and bcl-2 protein were detected in intracytoplasm of atypia cells in CIN.squamous-cell carcinoma and adenocarcinoma of the uterine cervix.The positive rates of AQP8 and bcl-2 in squamous-cell carcinoma.adenocarcinoma,CIN and normal cervical epithelium were 98%,74%;61%,71%;71%,53%;53%,20%respectively.There were significant differences between squamous-cell carcinoma of the uterine cervix and other groups in AQP8(P＜0.01),but no significant differences were found in any other groups.There were significant differences between squamous-cell carcinoma of the uterine cervix and CIN or normal cervical epithelium in bcl-2.so were between adenocarcinoma of the uterine cervix.The expression of AQP8 was positively correlated with bcl-2 in human cervical carcinoma(rs=0.463,P=0.000).Conclusions There is a close relationship between high expression of AQP8 and development of human cervical carcinoma.The expression of AQP8 protein is positively correlated with bcl-2 protein in human cervical carcinoma. AQP8 protein may have anti-apoptosis function.although the detailed mechanism in human cervical carcinoma remaias to be clarified.

Rheumatoid arthritis(RA)is a serious autoimmune disease.Type Ⅱ collagen induced murine arthritis(CIA)displays polyarthritis and causes chronic and destructive joint damages,which is similar to RA in many aspects.CIA is widely used for the research on RA pathogenesis and drug discovery.In this review,we discussed the establishment of CIA and the key factors participating in the CIA pathogenesis.

Objective To found sensitive and reliable method to identify trophoblastic tumor cells in the peripheral blood of the patients suffered from gestational trophoblastic tumor.Methods Given numbers of JAR cell from ten to million were mixed into 10ml non pregnant peripheral blood as a model. Detection of ? hCG mRNA with fluorescence quantitative reverse transcription polymerase chain reaction (FQ RT PCR) and then estimation of the numbers of tumor cell in the blood. Nine cases of peripheral blood were collected from the pretreatment patients of gestational trophoblastic tumor to assay ? hCG mRNA with FQ RT PCR, then to estimate the numbers of tumor cell in the circulation blood. Results FQ RT PCR could detect ? hCG mRNA when ≥10 2 JAR cells were mixed into 10ml non pregnant peripheral blood. Four cases of bloods had been detected ? hCG mRNA expression in 9 cases of gestational trophoblastic tumor, and the numbers of tumor cell from 10 4 to 10 7 per 10ml blood. Conclusion FQ RT PCR of which primers and probe are designed for ? hCG had been proved to be very sensitive detection means, it could be used to detect gestational trophoblastic tumor cells from patient preipheral blood; With FQ RT PCR the tumor cells had been detected in some patients of gestational trophoblastic tumor.

OBJECTIVETo study the significance of Fas and Fas-L expression in adenocarcinoma of uterine cervix.

METHODSBoth carcinoma tissue and their surrounding tissues from 36 patients with adenocarcinoma of uterine cervix, previously untreated either by radiation or chemotherapy, were studied for the expression of Fas and Fas-L by immunohistochemical stain with DNA apoptosis fragment detected by TUNEL.

RESULTSThe TUNEL labeling index was negatively correlated with differentiation of adenocarcinoma of cervix. Compared to highly differentiated and moderately differentiated tumor, the TUNEL labeling index was reduced obviously in poorly differentiated adenocarcinoma (P < 0.01). Fas expression was detected in 31 cases (86%) while there were only 3 weakly stained in the normal endocervical glands around the carcinoma. The 5 unstained carcinomas were 3 highly differentiated and 2 moderately differentiated. The positively stained Fas was associated with differentiation; the stronger the stain, the less differentiation there was. The Fas-L expression was detected in all adenocarcinomas while there was only 1 weakly stained in the normal ones. No significant difference was found in the expression of Fas-L in carcinomas with different degrees of differentiation. No correlation was observed between Fas and Fas-L expression.

CONCLUSIONSThe Fas expression is positively correlated with the different degrees of differentiation and Fas-L expression may be associated with the escape from of immunal surveillance.

Adenocarcinoma ; diagnosis ; metabolism ; Apoptosis ; physiology ; Biomarkers, Tumor ; biosynthesis ; Cell Differentiation ; physiology ; Fas Ligand Protein ; Female ; Humans ; Immunohistochemistry ; Membrane Glycoproteins ; biosynthesis ; Uterine Cervical Neoplasms ; diagnosis ; metabolism ; fas Receptor ; biosynthesis