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Objective: To evaluate the safety and efficacy of submucosal tunneling endoscopic septum division (STESD) for escophageal diverticulum., Methods: Clinical data of six consecutive patients with symptomatic esophageal diverticula who received STESD in Endoscopy Center of Zhongshan Hospital, Fudan University from April 2016 to November 2016 were analyzed retrospectively. STESD was performed as following: mucosal entry was made 3 cm from the septum of esophageal diverticulum; submucosal tunnel was created towards the septum; after the satisfactory exposure of the septum, endoscopic division was made down to the bottom of the diverticulum; mucosal closure of the tunnel entry was made. The symptoms were scored using a system modified according to Eckardt score, namely dysphagia, heartburn, regurgitation, weight loss and retrosternal pain with each ranging from 0 to 3 (maximum score 15, minimum score 0, the higher the score, the more severe the symptoms)., Results: There were four males and two females with median age of 56.5 (range 50-67) years. Four patients were epiphrenic diverticula, and the other two were Zenker's diverticula. Median duration of disease was 2.5 years (range 5 months-29 years). No previous treatment was attempted. All the patients completed STESD successfully. The median septum division length was 2.5(1-4) cm. The median number of metallic clips for mucosal closure was 5(2-6). The median operation time was 51.5 (33-135) min. No major adverse events, such as perforation or bleeding were found in perioperative period. The median time of hospital stay was 5(3-9) days. All the patients had symptom relief after operation. One patient with Zenker's diverticulum reported foreign body sensation after operation and experienced relief two weeks afterwards. During a median follow-up time of 5(4-10) months, the median symptom score of 6 cases was 4.5 (1-13) before and 0.5 (0-4) after operation. The symptom scores went down to zero in 3 patients (preoperative scores 13, 1, 1, respectively), and down to 1 in 2 patients with main symptom of backflow (preoperative scores 5, 4, respectively). One patient with 29 years history of disease did not report obvious improvement in symptoms (preoperative and postoperative scores 5, 4, respectively)., Conclusion: Submucosal tunneling endoscopic septum division is efficient and safe to relieve symptomatic esophageal diverticulum in short term.

Objective: To determine the feasibility and efficacy of endoscopic submucosal dissection(ESD) in treating early gastric cancer(EGC) and precancerous lesions in the remnant stomach of patients after gastrectomy., Methods: Clinical data of 36 patients with EGC and precancerous lesions in remnant stomach undergoing ESD in Endoscopy Center of Zhongshan Hospital from January 2008 to December 2013 were retrospectively analyzed. Operative, postoperative conditions and long-term follow-up of these patients were evaluated., Results: Both the success rate and the complete resection rate were 100%. The average maximum diameter of the tumor was 1.5(range 0.6-4.5) cm. During the ESD process, two bleeding cases were treated successfully by endoscopic hemostasis. The average operation time was 40(10-80) min. The delayed hemorrhage developed in 2 cases within 1-3 days after operation, and were also treated successfully by endoscopic hemostasis. There was no perforation or delayed perforation. No emergency surgery was required for the complication. Twelve cases were diagnosed as mild-moderate dysplasia, 7 cases as high grade intraepithelial neoplasia, 16 cases as hyperplastic polyps, and 1 case as signet ring cell carcinoma with T1 stage, who underwent operation for resecting gastric stump and lymph node dissection 7 days after ESD without subsequent follow-up. The curative resection rate was 92.7%(35/36). The median follow-up of the remaining 35 patients was 36(6-78) months without discomfort and recurrence under gastroscopy., Conclusion: ESD is safe and effective for EGC and precancerous lesions in the remnant stomach.

Objective: To investigate the significance of plasma neopterin (Npt) and adenosine deaminase (ADA) in patients with secondary hemophagocytic lymphohistiocytosis (sHLH)., Methods: Serum specimens from 39 patients with newly diagnosed sHLH, 10 sHLH patients who had achieved clinical remission after treatment, and 15 healthy controls were collected.Serum Npt level was detected by enzyme linked immunosorbent assay (ELISA) and ADA activity was tested by kinetic method., Results: Npt and ADA values in sHLH group were significantly higher than those in control group [Npt: (164.6 ± 90.0) nmol/L vs (7.9 ± 3.6) nmol/L;ADA: (117.2 ± 70.2) U/L vs (11.6 ± 4.0) U/L;all P < 0.001]. Among the 10 sHLH patients who obtained effective clinical treatment, posttreatment levels of Npt and ADA were significantly lower than pretreatment data [Npt: (17.5 ± 10.9) nmol/L vs (170.6 ± 117.9) nmol/L;ADA: (22.5 ± 15.5) U/L vs (98.8 ± 52.6) U/L;all P < 0.05]. The Npt level in sHLH patients was positively correlated with the levels of serum soluble interleukin-2 receptor (sCD25) and serum ferritin (r = 0.526 and r = 0.507) ; while ADA activity had linear relationship with the level of lactate dehydrogenase (r = 0.646) .Receiver operating characteristic (ROC) curve analysis showed that 148.1 nmol/L was the critical value of serum Npt for the diagnosis of lymphoma associated hemophagocytic syndrome (LAHS) and the sensitivity and specificity were 70.0% and 78.9%, respectively. As to ADA, 103.1 U/L was the critical value for the diagnosis of LAHS and the sensitivity and specificity were 75.0% and 84.2%, respectively. The sensitivity and specificity of combined parameters of Npt and ADA were 90.0% and 94.7%, respectively., Conclusions: It is concluded that Npt and ADA have great importance in the diagnosis and evaluation of therapeutic effect in patients with sHLH.Npt and ADA provide potential evidence to diagnose patients who are suspected with LAHS.

Objective: To construct expression vector for the SEA-EGF fusion gene., Method: Clone the SEA gene and the EGF gene segment with PCR and RT-PCR independently, and connect this two genes by the bridge PCR. Insert the fusion gene EGF-SEA into the expression vector PET-44. Induced the secretion of the fusion protein SEA-EGF by the antileptic., Result: The gene fragment encoding EGF and SEA mature peptide was successfully cloned. The fusion gene EGF-SEA was successfully constructed and was inserted into expression vector., Conclusion: The new recombinant expression vector for fusion gene EGF-SEA is specific for head and neck cancer, laid the foundation for the further study of fusion protein SEA-EGF targeting immune therapy in head and neck tumors.

Objective: To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of gastrointestinal cysts., Methods: Clinicopathological data of 40 patients with gastrointestinal cyst undergoing ESD in our center during January 2008 and February 2012 were analyzed retrospectively. Complications, en bloc resection rate, and local recurrence were assessed., Results: Eight lesions located in the esophagus, 11 in the stomach, 5 in the duodenum, and 16 in the colorectum. Thirty-seven lesions were successfully resected with ESD in an en bloc fashion (92.5%). During the operation, one perforation was encountered in the ascending colon and was clipped; one massive hemorrhage occurred in the esophagus and was treated with balloon compression. Postoperative pathological examination revealed cyst samples were intact without lesions in lateral and basal resection margins. Local recurrence was not found in 36 patients during a median postoperative follow-up of 9.7 months (range, 6-12 months)., Conclusion: ESD is a safe and effective procedure for the treatment of gastrointestinal cysts.

SARS virus is a recently found coronavirus, which cause human atypical pneumonia through the binding of its spike protein to the receptor on human cells. By using the methods of immunoinformatics, we analyzed the virus surface protein and found that the epitopes, which can be recognized by human immune system, are strikingly changed or disappeared to compare with other common human coronavirus. This result may imply that the escape of SARS virus from human immune surveillance may be the causality plays a very of SARS virus infection. The immunoinformatics is a powerful fool for us to in screen the epitope specificial for SARS virus and identifying the candidate sites for peptide vaccine of SARS virus.

Objective: To explore the possibility of MAGE-4 gene encoding protein used as a target for immunotherapy in HCC patients., Methods: The expression of MAGE-4 gene in tumor tissues and tumor adjacent non-HCC liver tissues was examined by the RT-PCR method. The relationship between positive expression rate of MAGE-4 gene and other clinical and lab data including AFP, AFU, anti-HCV, HBsAg, AFP mRNA, and the diameter of the tumors in HCC patients was also determined., Results: The positive expression rate of MAGE-4 gene was significantly higher in the tumor than in tumor surrounding tissues (38.7% vs 0%, P<0.01), while the positive expression rate of MAGE-4 gene had no relationship with the clinical and lab data (P>0.05)., Conclusions: The high frequency of MAGE-4 gene expression in HCC suggests the possibility of MAGE-4 gene encoding protein as a target for immunotherapy in HCC patients, but the expression has no relationship with the tumor metastasis and the recurrence of HCC.