Objective:To research the correlation of serum levels of IL-21,TGF-β1,TNF-α and IgA1 in children with allergic purpura and the purpura nephritis.Methods:57 cases with allergic purpura who were treated in our hospital from November 2015 to May 2016 were selected and 29 cases were diagnosed with general allergic purpura,and another 28 cases were diagnosed with purpuric nephritis.30 healthy children were selected as the control group.Then the serum levels of IL-21,TGF-β1,TNF-α,IgAl,immunoglobulin A (IgA),C3 and C4 between the three groups were observed and compared.Results:The serum levels of IL-21,TGF-β1,TNF-α,IgA1 and IgA in the purpuric nephritis group were higher than those of the control group and the general allergic purpura group,and the differences were statistically significant (P＜0.05);The serum levels of IL-21,TGF-β1,TNF-α,IgA1 and IgA in the general allergic purpura group were higher than those of the control group,and the differences were statistically significant (P＜0.05);There was no statistically significant difference about the C3 and C4 in the three groups (P＞0.05).Conclusion:The serum levels of IL-21,TGF-β1,TNF-α and IgA1 may be involved in the development ofhenoch-schonlein purpura and purpura nephritis.

Objective:To investigate the baseline levels of 25-hydroxy-vitamin D [25-(OH) D] in 3340 hospitalized children, analyze the 25-( OH) D levels in children with different diseases, age and gender in different seasons, and study the correlation between the 25-( OH) D levels and the clinical indicators. Methods:Totally 3340 hospitalized children were randomly selected, the 25-( OH) D levels were detected by an ELISA method, and Pearson correlation analysis of 25-( OH) D levels and clinical indicators such as liver function, myocardial enzymes, immunoglobulins, lymphocyte subtypes and thyroid function was performed. Results: The serum 25-(OH) D level in 3340 cases (1850 male, 1490 female) was (33. 00 ± 13. 42) ng·m1 -1, and that in those with neonatal diseases was the lowest followed by those with primary nephrotic syndrome, Henoch-schordeinpurpura and juvenile idiopathic arthritis. The ser-um 25-( OH) D levels in the premature was higher than that in full term infant. Except the newborn, the level of serum 25-( OH) D gradually reduced along with the age increase, while the percentage of insufficiency gradually increased. The serum 25-( OH) D level between the male and the female had no significant difference. The 25-( OH) D levels of hospitalized children were the highest in sum-mer. The serum level of 25-( OH) D was positively correlated with body mass index ( BMI) , alanine transaminase ( ALT) , aspartate transaminase (AST), creatine kinase (CK), creatine-phosphokinase (CK-MB), lactate dehydrogenase(LDH), free T4 (FT4) and free T3 (FT3), and negative correlation with alkaline phosphatase(ALP), immunoglobulin E (IgE) and immunoglobulin M (IgM). Conclusion:The incidence of vitamin D insufficiency is high in hospitalized children. The level of vitamin D is different among various diseases. The level of serum 25-( OH) D may have certain relevance with BMI, allergies, myocardial damage and thyroid function.

OBJECTIVETo study subtype classification of gastric neuroendocrine neoplasm (NEN) and their clinicopathological characteristics in order to provide reference for clinical practice.

METHODSClinicopathological data of 241 gastric NEN patients (174 cases from China-Japan Friendship Hospital and 67 cases from The First Affiliated Hospital of Sun Yat-Sen University) between January 2011 and June 2016 were retrospectively summarized. According to serum gastrin, 24-hour intragastric pH monitoring and pathological grade, patients with gastric NEN were divided into 4 types: type I( (hypergastrinemia and achlorhydria, related to autoimmune chronic atrophic gastritis), type II( [hypergastrinemia and Zollinger-Ellison syndrome, related to gastrinoma or multiple endocrine neoplasia type I( (MEN-I()], type III( (sporadic disease with normal serum gastrin level), and type IIII( [poorly differentiated gastric neuroendocrine carcinoma (NEC) and mixed adenoneuroendocrine carcinoma (MANEC)]. Clinicopathological features, treatment and prognosis of 4 types were analyzed.

RESULTSOf 241 gastric NEN cases, there were 86 cases (35.7%) in type I(, 7 cases (2.9%) in type II(, 61 cases (25.3%) in type III( and 87 cases(36.1%) in type IIII(. Among 86 cases of type I( gastric NEN, 73 cases (84.9%) were multiple lesions,tumor size of 66 cases (76.7%) was less than 1 cm, all the 86 cases were polypoid or granular lesions. 2 cases(2.3%)presented distant metastasis, 69 cases (80.2%) had pathological grading as NET G1; most of them received endoscopic surgery treatment and follow-up; somatostatin analogs(SSA) was used in patients with multiple lesions and repeated recurrence after endoscopic treatment. Among 7 cases of type II(, 4 cases were gastrinoma, 3 cases MEN-I(; 5 cases presented distant metastasis; treatment included surgery, SSA and proton pump inhibitor (PPI) therapy. Among 61 cases of type III( gastric NEN, 49 cases(80.3%) were single lesion,tumor size of 25 cases(41.0%) was more than 2 cm, 29 cases(47.5%) had lymph node metastasis or distant metastasis; treatment included endoscopic resection, surgery or SSA therapy according to the tumor staging. Among 87 patients of type IIII( gastric NEN, 74 cases(85.0%) had single lesion,tumor size of 51 cases (58.6%) was more than 2 cm; lesions were found in gastric cardia in 35 cases (40.2%); 65 cases (74.7%) had lymph node metastasis or distant metastasis; treatment included chemotherapy, or surgery plus chemotherapy. At the end of follow-up(June 30, 2016), 58 patients were dead, including 1 case of type I(, 12 cases of type III( and 45 cases of type IIII(. The overall survival rate of all the patients was 74.2%, and was 98.8%, 100%, 79.3%, 39.2% of types I(, II(, III(, IIII( respectively. The overall survival rate between type III( and type IIII( gastric NEN was significantly different(P = 0.000).

CONCLUSIONSSubtype classification of gastric NEN is very significant for making therapeutic decisions and prognostic evaluation. Patients of type I( or type II( gastric NEN have good prognosis,while those of type III( and type IIII( have poor prognosis, and those of type IIII( have the worst prognosis.

Adult ; China ; Female ; Humans ; Lymphatic Metastasis ; Male ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Neuroendocrine Tumors ; pathology ; therapy ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; pathology ; therapy ; Survival Rate

Objective To test the effects of Vitamin D (VitD) on endothelial nitric oxide(NO) production and to study the signal pathway leading to NO release.Methods In vitro cultured human umbilical vein endothelial cells (HUVEC) were treated with various concentrations of VitD(0 mmol/L,0.01 mmol/L,0.10 mmol/L,1.00 mmol/L,10.00 mmol/L) for 60 min,and VitD at concentration of 1.00 mmol/L at different time points (30 min,60 min,90 min,120 min).The effect of VitD on NO production in presence of VitD receptor(VDR) agonist(ZK191784) or antagonist(ZK159222) for 60 min were examined in cell culture supernatant with kit for the detection of nitric oxide fluorescent probe(DAF-FM DA).HUVEC was cultured with VitD in presence of VDR agonist or antagonist for 60 min,and the effect of VitD on NO production with DAF-FM DA and the protein expression and phosphorylation of Caveolin-1 and endothelial nitric oxide synthase(eNOS) were detected by Western blot,respectively.Results VitD caused a concentration-dependent increase in NO production.The maximum effect was observed at a concentration of 1.0 mmol/L and the optimal time of stimulation was 60 min.Effects induced by VitD were enhanced by VDR agonist,and abolished by antagonist.VitD and VDR agonist maintained the expression of Caveolin-1 at the same low phosphorylation level the same as normal,increased the phosphorylated level of eNOS.However,VDR antagonist increased the phosphorylation of caveolin-l,but reduced the level of eNOS phosphorylation,respectively.Conclusions VitD can induce a significant increase in endothelial NO production through VDR.VitD interaction with VDR causes the low phosphorylation of caveolin-1 leading to eNOS activation and NO production.

Objectives To study the protective effects of vitamin D (VitD) on podocyte insulin resistance and its mecha-nisms. Methods Immortalized mouse podocytes in vitro were randomly divided into 4 groups:podocytes+5 mmol/L glucose group (group A);podocytes+5 mmol/L glucose+1 nmol/L propylene glycol group (group B);podocytes+30 mmol/L glucose+1 nmol/L propylene glycol group (group C); podocytes+30 mmol/L glucose+1 nmol/L propylene glycol+1 nmol/L VitD group (group D). The percentage of podocyte apoptosis was determined after 48 h of incubation. Podocyte viability was assessed by MTT assay. The mRNA expressions of vitamin D receptor (VDR) and insulin receptor substrate protein 1 (IRS1) in podocyte were detected by RT-PCR. Western blot analysis was performed to measure the protein levels of p-IRS1/IRS, p-Akt/Akt and p-ERK1/2/ERK1/2. Results There were significant differences in apoptosis percentage, viability and the expression of VDR, IRS1, p-ERK1/2 of podoctyes(P<0.05)among 4 groups. There was no difference in p-Akt/Akt expression among 4 groups(P>0.05). Compared with group A, B , and D, the percentage of podocyte apoptosis in group C was significantly increased, the cell viabi-lity was decreased, the expressions of VDR and IRS1 mRNA and p-IRS1 and p-Akt proteins were down-regulated, whereas p-ERK1/2 was up-regulated in group C. The levels of p-IRS1/IRS1, p-Akt/Akt, p-ERK1/2/ERK1/2 had no statistical differences in group A, B, and D (P>0.05). Conclusions VitD-VDR system alleviates podocyte apoptosis induced by high glucose, and acti-vates insulin signaling pathway and counteracts insulin resistance signal to improve podocyte insulin resistance.

Objective To investigate the protective effect of Vitamin D (VitD) on diabetic rats,and whether the protective mechanism is associated with the expression of nuclear factor kappa B (NF-κB) and insulin resistance (IR).Methods Diabetic Wistar rats were established by intraperitoneal injection of streptozotocin,and randomly divided into diabetic group,VitD treatment group (treatment group).Normal rats were served as normal control group.Treatment group was treated with VitD for 8 weeks.The levels of 24 h urinary protein (24 h UP),fasting plasma glucose (FPG),plasma insulin (p-Ins),plasma adiponectin (p-Adi),plasma glucagon (p-Gln) were measured.Tumor necrosis factor alpha (TNF-α),monocyte chemotactic protein 1 (MCP-1),interleukin-6 (IL-6) were determinated in renal cortical homogenate.The activity of NF-κB was evaluated by electrophoretic mobility shift assay.The mRNA expressions of glucose transporter protein 1 (GLUT1) and GLUT4 in renal cortex were detected by reverse transcriptase (RT)-PCR.Western blot analysis was performed to measure the phosphorylation of NF-κB and its inhibitor I kappa Balpha (IκBα),insulin receptor substrate protein 1 (IRS1),phosphatidylinositol 3 kinase (PI3K),p38 mitogen activated protein kinase (p38MAPK).Results Compared with the normal control group,24 h UP,FPG,p-Ins,p-Gln were significantly increased,and inflammatory markers and the expression of GLUT1 elevated in renal cortex in DM group,there were significant differences(all P ＜0.01).The activity of NF-κB (P ＜0.01) and the phosphorylation of NF-κB p65 and p38MAPK were elevated (all P ＜ 0.01),and phosphorylation of IκBα,IRS1,PI3K were decreased (all P ＜ 0.05,0.01) in diabetic group compared with those of normal control group.VitD treatment could ameliorate urine protein,increase p-Adi,reduce inflammatory markers and NF-κB activity (P ＜ 0.01),maintain GLUT1 expression,but had no effect on GLUT4 expression in renal cortical,attenuate NF-κB p65,p38MAPK phosphorylation (all P ＜ 0.05),partly restore IκBα,IRS1,PI3 K phosphorylation in diabetic rats (all P ＜ 0.05,0.01).Conclusions Protective role of VitD is associated with inhibiting the expression of NF-κB and reducing the insulin resistance in diabetes.

Objective To explore the possible role of vitamin D in the pathogenesis of IgA nephropathy (IgAN). Me-thods After the IgAN model was successfully induced at 12 weeks, the BALB/C mice were randomly divided into IgAN group (n=15) and IgAN+VitD group (n=15). The nephrosis mice were administrated with 100 μl/d propylene glycol or propyl-ene glycol+1,25(OH)2D, 3 ng/(100g?d), for 6 weeks. The control group was setted (n=15). The level of 24 hour urine protein was determined at week 0, 12 and 18. At week 18, the levels of serum 25(OH)D, ifbroblast growth factor 23 (FGF23) and galactose-deifcient IgA1 (Gd-IgA1) were detected. The mRNA and protein expressions of interleukin-21 (IL-21) in Peyer’s patches (PPs) were detected by lfuorescent quantitative reverse transcription-polymerase chain reaction and western blot respectively. The protein expression of Bcl-6 was detected by western blot. The percentages of Tfh cells/T lymphocytes, B220+IgM+/B lympho-cytes, B220+IgA+/B lymphocytes, B220-IgA+/B lymphocytes in PPs were determined by lfow cytometry. Results Compared with control group, the levels of 24 hour urine protein, FGF23 and Gd-IgA1 were increased, serum 25(OH)D was decreased, the mRNA and protein expressions of IL-21 and the protein level of Bcl-6 were increased, the percentages of Tfh cells/T lym-phocytes, B220+IgM+/B lymphocytes, B220+IgA+/B lymphocytes, B220-IgA+/B lymphocytes were elevated in IgAN group (P<0.05). These indicators were improved in IgAN+VitD group. Compared with the IgAN group, the differences were statisti-cally signiifcant (P<0.05), however compared with control group, some indicators showed no signiifcant differences (P>0.05). Conclusions 1,25(OH)2D may protect the microenvironment of PPs in IgAN through inhibiting the differentiation of Tfh cells and B cells and the generation of Gd-IgA1.

A novel disposable three electrodes blood alcohol biosensor strip was fabricated by a screen printing technique. Multi-wall carbon nanotube(MWCNT), Meldola′s(MB), alcohol dehydrogenase(ADH)and nicotinamide adenine dinucleotide cofactor (NAD+) were modified on the surface of the carbon working electrode. Then hydrophilic membrane was stuck in the outermost of the three electrodes to make a reaction camera of 5 μL. Experimental results indicated that the biosensor possessed good accuracy and stability, the linear response range was 0.5-20 mmol/L with correlation coefficient of 0.9949, detection limit was 0.22 mmol/L, and the response time was less than 15 s. Some influencing factors to the biosensor were investigated, such as the pH, temperature and interferences. Correlation analysis showed that there was a significant correlation between the methods of biosensor and the headspace vapor phase chromatography in 10 whole blood samples(r=0.97583). Small volume whole blood sucked using siphonage to detect blood alcohol directly and quantitatively was the obvious character of the biosensor.

Objective To estimate the current quality of the reporting of randomized controlled trials (RCTs) related to digestive diseases in China. Methods All the papers related to RCTs published in Chinese Journal of Digestion from 1999 to 2008 were hand-searched by professional staff then evaluated and analyzed them according to the international reference standard. ResultsIn the 3298 issues of the recent ten years, there were 92 research papers of RCTs which was accounting for 2.8%. The sample size ranged from 18 to 5241. Sixty-one (66.0%) trials included the exact standard of internalize and exclusion. Sixteen (17.4%) trails told the specific method of random allocation and 22(23.9%) were double-blinded. Fifty-eight (63.0%) trials compared the baseline condition of each groups. Seventy-three(79.3%) trails showed the specific approach of statistic. In the end, only 7(5.7%) trails were identified as the strictly-designed RCTs. Conclusions The quantity and quality of the clinical RCTs can not satisfy the demand of clinical practice. Strictly-scientific designed, multicentered, large sample prospective clinical RCT should be advocated.

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD)in treatment of patients with early gastric cancer(EGC).Methods A total of 4 3 consecutive patients with EGC were treated with ESD at Changhai Hospital from July 2007 to July 2008.The data referred to one-piece resection,histologically complete resection,operation time,complications,the post-ESD ulcer-healing and local recurrance were retrospectively analyzed.ResultsEn bloc resection was achieved in 97.7 0A(4 2/43)lesions in one-piece resection.The histologically complete resection rate was 95.3%(41/43).Only one patient had acute minor bleeding during the ESD procedure(2.3%,1/43)and one patient had delayed bleeding(2.3%,1/43).Post-ESD epigastric pain was found in 2 2 patients(51.2%).There was no complications such as acute major bleeding,perforation,requiring surgical treatment and death.The median operation time was 60.4 miutes.The post-ESD ulcer-healing was achieved in 100%(42/42)8 weeks after esomeprazole treatment.During follow-uP of 10.3 months(ranged from 8 to 1 8 months),no residual or local recurrence of EGC was seen.Conclusion ESD has the advantages of increasing one-piece resection and histologically curative resection rates.It is a safe and effective procedure in treatment of EGC.