Volume 85  ·   Issue 48  ·  2005

Objective to investigate the effect of adenovirus-mediated CTLA4Ig and OX40Ig gene transfer on prolonging the survival time of allogeneic rat heart grafts and its related mechanisms. Methods Lewis rats were randomly divided into five groups: control group, no-load virus AdEGFP group, AdCTLA4Ig group, AdOX40Ig group and AdCTLA4Ig-IRES-OX40Ig group. At the same time of heart transplantation, the control group was not treated with other treatments, and the other groups were induced by tail vein injection (1~5) ×109 pfu/ml AdEGFP, AdCTLA4Ig, AdOX40Ig and AdCTLA4Ig-IRES-OX40Ig. The survival of heart grafts was observed daily. The heart with complete arrest was determined as rejection after histological confirmation. The expression level of the target gene was determined by ELISA. The mechanism of induction of tolerance was investigated by mixed lymphocyte reaction, adoptive transfer test, IL-2 reversal test and RT-PCR. Results The mean survival time of heart grafts was 151.5 d ± 42.8 d in AdCTLA4Ig-IRES-OX40Ig group, AdCTLA4Ig-IRES-OX40Ig group<0.01), and the AdCTLA4Ig-IRES-OX40Ig treatment group was significantly better than the AdCTLA4Ig and AdOX40Ig treatment groups in prolonging the graft survival time (both P<The adoptive transfer results indicated that the low response state could be transferred to normal Lewis rats. Th1/Th2 cytokine deviation occurred in the tolerance rats. Conclusion Adctla4Ig-IRES-OX40Ig-mediated gene transfer can be highly expressed in rats for a long time and induce the long-term survival of allogeneic heart grafts, which may be related to T cell impotence, Th1/Th2 cytokine deviation and its regulatory T cells.

Objective to investigate the regulatory effect of activated Notch1 signaling system on proliferation and differentiation of epiphyseal stem cells cultured in vitro.Methods Notch1 activator rhNF-κ B and inhibitor γ-secretase inhibitor Ⅱ (MW167) were added to epiphyseal stem cells cultured in vitro.The blank control was added with PBS buffer. The expression of Notch1 and Jagged1 in epiphyseal stem cells was detected by RT-PCR,immunohistochemistry,MTT,flow cytometry,alkaline phosphatase staining and Western blot. Compared with the control group, the expression of PCNA and collagen Ⅱ protein was significantly increased in the rhNF-κ B induced group, and the effect of promoting cell proliferation was obvious (P =0.027), and the number of cells entering the division phase (S phase) was increased (26.54%), while the expression of alkaline phosphatase and collagen X protein was significantly increased in the MW167 induced group, and the expression of collagen Ⅱ protein and differentiation marker protein stathmin was significantly decreased. When the Notch signaling system is inhibited, epiphyseal stem cells differentiate.

Objective to investigate the molecular basis of different biological effects of the deletion mutant (HBx3 '-40) at the carboxy terminal of hepatitis B virus X protein (HBx). Methods Total RNA of human hepatoma Huh7 cells transfected with HBx3'-40 (experimental group) and wild-type HBx (wtHBx, control group) was extracted by Trizol method, labeled and hybridized with cDNA microarray containing 21 074 target gene points, and differentially expressed genes were obtained by scanning the hybridization signal intensity; The total proteins of the experimental group and the control group were separated by solid phase gradient two-dimensional gel electrophoresis, and the expression differences of the two groups were analyzed by silver staining. The differential protein spots in the two groups were identified by mass spectrometry. Results The results of cDNA microarray detection showed that 165 genes (0.82%) were significantly changed, 144 and 21 genes were up-regulated and down-regulated, respectively, compared with the wtHBx group and the HBx3 '-40 group. The results of two-dimensional gel electrophoresis showed that there were (135±13) protein differences in the HBx3'-40 group compared with the wtHBx group. The results of gene expression profile and mass spectrometry showed that the differentially expressed genes and proteins in the HBx3'-40 group were mainly involved in the processes of gene transcription, oncogene and tumor suppressor genes, cell junction, signal transduction and metabolism, immune response and other processes of host cells. Conclusion HBx deletion mutants have a wide influence on cellular genes and proteins, and regulate the changes of metabolic genes involved in liver tissue specificity Further research is needed to confirm.

Objective to investigate the possible mechanism of antagonistic relationship between type 1 diabetes mellitus and bronchial asthma and the role of insulin and its receptor in airway allergic inflammation. Methods Sixty-four male SD rats were randomly divided into 8 groups, 8 in each group: Group A: asthma group; Group D: diabetic group; Group I: insulin group; AD group: asthma + diabetes group; AI group: asthma + insulin group; DI group: diabetes + insulin group; ADI group: asthma + diabetes + insulin group; Group C: control group. The rat type 1 diabetes model was replicated by intraperitoneal injection of streptozotocin solution; The rat model of airway allergic inflammation was replicated after subcutaneous injection of ovalbumin and 14 days after ultrasonic inhalation of ovalbumin. The bronchoalveolar lavage fluid was collected for cell counting and classification; The pathological changes of lung were observed by HE staining; The distribution of insulin receptors in lung was observed by immunohistochemistry; The expression of insulin receptor mRNA in lung tissues was determined by semi-quantitative RT-PCR. Results the blood glucose in the diabetic group was significantly higher than that in the non-diabetic group, and the airway inflammation in the A, AI and ADI groups was mainly increased in eosinophils and neutrophils after stimulation. The airway inflammation in the AD group was between the asthmatic group and the non-asthmatic group. The insulin levels in ADI, AI and A groups (27 mIU/L ± 8 mIU/L, 83 mIU/L ± 12 mIU/L, 71 mIU/L ± 12 mIU/L, respectively) were higher than those in the corresponding controls (15 mIU/L ± 4 mIU/L, 64 mIU/L ± 9 mIU/L, 49 mIU/L ± 14 mIU/L, respectively). Immunohistochemistry showed that insulin receptor was widely distributed in lung tissues, and the number of infiltrating staining positive cells in alveolar cavity, blood vessels and peribronchial cells increased significantly in A, AI and ADI groups. The mRNA expression of insulin receptor in diabetic group was significantly higher than that in non-diabetic group (0.2588±0.0809 vs 0.0896±0.0308,P =0.00). Conclusion Low-dose insulin can significantly enhance the airway allergic inflammatory response in rats.

Objective to investigate the relationship between the expression of early growth response gene (Egr) -1, platelet-derived growth factor (PDGF) -B and transforming growth factor (TGF) -β 1 in transplanted veins and their role in intimal hyperplasia (IH). Methods 90 Wistar rats were established in autologous vein transplantation model. The right common jugular vein of the rats was anastomosed end-to-end to the inferior renal abdominal aorta. The mRNA expression of Egr-1, PDGF-B and TGF-β 1 was detected by in situ hybridization and RT-PCR, and the expression of Egr-1, PDGF-B and TGF-β 1 protein was detected by Western blotting and immunohistochemistry. At the same time, histomorphological studies were performed. Results The expression of Egr-1, PDGF-B and TGF-β 1 mRNA and protein was not detected in normal veins, but the expression of Egr-1 mRNA and protein in transplanted veins showed biphasic changes. PDGF-B mRNA reached its peak at 2 weeks of transplantation (48%±6%); The percentage of TGF-β 1 mRNA was detected by immunohistochemistry: Egr-1 protein reached its peak (40% ± 9%) at 4 weeks after transplantation; PDGF-B protein reached its peak at 4 weeks of transplantation (45% ± 4%); The expression of Egr-1, PDGF-B and TGF-β 1 was mainly expressed in vascular smooth muscle cells of media in the early stage of transplantation, while in the late stage of transplantation, Egr-1, PDGF-B and TGF-β 1 were mainly expressed in vascular smooth muscle cells of neointima. The activation and expression of PDGF-B and TGF-β 1 may be regulated by Egr-1, and may also promote the high expression of Egr-1 through feedback mechanism.

Objective to study the effect of bicyclic alcohol on chronic alcoholic liver injury in mice. Methods the mice were given 5% alcohol Lieber-Decarli whole nutrition liquid diet for 4 weeks to establish a model of chronic alcoholic liver injury. The animals were orally administered bicyclic alcohol once a day for 2~4 weeks before and after modeling. The levels of serum alanine aminotransferase (ALT), cholesterol, low/high density lipoprotein (HDL/LDL), liver triglyceride (TG), liver dimethylnitrosamine demethylase (NDMA-DM), glutathione (GSH), glutathione-mercaptotransferase (GST), glutathione reductase (GR), acetaldehyde dehydrogenase (ALDH) and pathological changes were measured 24 h after the last dose. Results Bicyclol (200/300 mg*kg-1*d-1 for 2~4 weeks) could significantly inhibit the rise of serum ALT and NDMA-DH and the decrease of GSH, GST, GR and ALDH in the liver induced by alcohol, and restored them to normal levels. In addition, Bicyclol could decrease the elevated TG in the liver by 28% ~34%, increase the serum HDL level (68% ~98%), and decrease the LDL (33% ~42%). The liver fatty degeneration was also significantly reduced. The liver pathological score of the mice in the prophylactic group (300 mg*kg-1*d-1) was 1.4 ± 1.2, and the liver pathological score of the mice in the treatment group (300 mg*kg-1*d-1) was 0.7 ± 0.5. Compared with the model group, the differences were statistically significant (P<0.05, P<0.01, respectively). Conclusion Bicyclol has obvious protective effect on chronic alcoholic liver injury in mice, and its mechanism is related to reducing liver fat accumulation, accelerating the clearance of ethanol and acetaldehyde, and improving liver antioxidant capacity.

Objective to observe the effect of lidocaine on the degree of brain damage after transient global cerebral ischemia in mice with different apolipoprotein E (apoE) genotypes. Methods Healthy male C57BL/6J wild-type mice (C57 mice) and apoE knockout mice (apoE mice) were randomly divided into: C57 control group (15 mice, sham operation), C57 ischemia group (21 mice, bilateral common carotid arteries were clipped for 17 min, and normal saline was given peritoneally), C57 lidocaine group (22 mice, bilateral common carotid arteries were clipped for 17 min, and lidocaine was given peritoneally), apoE control group (15 mice, treatment same as C57 control group), apoE ischemia group (19 mice, treatment same as C57 ischemia group), apoE lidocaine group (16 mice, treatment same as C57 lidocaine group). On the 7th day after operation, 28 mice were randomly selected from each group for neuropathological examination, and the other mice were subjected to Morris water maze test from the 8th day after operation for 5 consecutive days. Results (1) The percentages of ischemic neurons in hippocampal CA1 area were 0.3%±0.1% in C57 control group, 19.3%±4.5% in C57 ischemic group, 36.9%±2.5% in C57 lidocaine group, 0.6%±0.3% in apoE control group, 65.5%±2.2% in apoE ischemic group and 39.4%±6.5% in apoE lidocaine group, respectively.<0.01), C57 lidocaine group and apoE ischemia group were significantly more than C57 ischemia group (both P<0.01), but the apoE lidocaine group was significantly less than that of apoE ischemia group (P<0.01). (2) incubation period: Except for apoE ischemia group, all groups shortened significantly with the increase of test days (P<0.05, 0.01). The ischemia group and lidocaine group were significantly longer than the corresponding control group (P<0.05, 0.01), C57 lidocaine group and apoE ischemia group were significantly longer than C57 ischemia group (P<0.05, 0.01), but apoE lidocaine group was significantly shorter than C57 lidocaine group and apoE ischemia group (P<(3) Percentage of effective search strategies: Except for C57 lidocaine group and apoE ischemia group, all groups increased significantly with the increase of test days (P<0.05, 0.01). The ischemia group and lidocaine group were significantly lower than the corresponding control group (P<0.05, 0.01), C57 lidocaine group and apoE ischemia group were significantly lower than C57 ischemia group (P<0.05, 0.01), but the apoE lidocaine group was significantly higher than that of C57 lidocaine group and apoE ischemia group (P<Conclusion Transient global cerebral ischemia caused significant brain damage in mice, and the degree of brain damage in apoE mice was more severe than that in C57 mice; Lidocaine aggravated brain damage in C57 mice, but reduced the degree of brain damage in apoE mice.

Objective to investigate the role of (tttta) n microsatellite polymorphism in the promoter of cholesterol side chain lyase gene (CYP11a) in the pathogenesis of polycystic ovary syndrome in Chinese females. Methods Blood samples from PCOS (201) and non-PCOS (147) were collected. The age of menarche was recorded, body mass index was calculated, genotyping was performed, and serum reproductive hormones were detected. Results The difference of CYP11 genotype distribution between PCOS and non-PCOS was statistically significant [Fisher's exact test (two-tailed), P =0.031]. The main reason was that the frequency of individuals with genotype (tttta) 6/ / (tttta) 6 in PCOS was higher than that of non-PCOS [57.7% (116/201) vs 44.9% (66/147), χ 2=5.588, P =0.018]. The body mass index (BMI) of individuals with genotype (tttta) 4/ / (tttta) 4 was significantly lower than that of other genotypes (4/ /6, 6/ /6 and 6/ /8) Conclusion CYP11a genotype (tttta) 6/ / (tttta) 6 has a significant difference between PCOS and non-PCOS, and it is correlated with the large BMI in PCOS patients, suggesting that (tttta) 6 plays a certain role in the pathogenesis of PCOS.

Objective to study the incidence, clinical manifestations and prognosis of pulmonary involvement in patients with systemic lupus erythematosus (SLE). Methods the clinical data of pulmonary lesions in 320 inpatients with SLE were analyzed retrospectively. Results among the 320 patients with SLE, 142 had pulmonary involvement (the incidence rate was 44.4%), 10 had pulmonary involvement (7.0%) and 2 had no pulmonary involvement (1.1%). The difference between the two groups was statistically significant (P<0.05). There were 4 cases of acute lupus pneumonia with an incidence rate of 1.3%. The main manifestations were hypoxemia, dyspnea, fever and cough. The imaging manifestations were unilateral or bilateral diffuse patch-like consolidation shadows mainly on the lung base, and the survival rate was 100%. Diffuse alveolar hemorrhage was found in 6 cases with an incidence rate of 1.9%. Hemoptysis, dyspnea, hypoxemia, cough, anemia and bloody alveolar lavage fluid were the main manifestations. The imaging manifestations were newly appeared bilateral diffuse patch or consolidation shadows. Other pulmonary manifestations included pleural lesions in 80 cases (25%), chronic interstitial pulmonary disease in 22 cases (6.9%), pulmonary hypertension in 49 cases (15.3%), pulmonary embolism in 6 cases (1.9%) and pulmonary infection in 61 cases (19.1%). Conclusions (1) SLE can involve any part of the respiratory system and appear at any stage of the disease. (2) Critical disease is not uncommon in pulmonary involvement of SLE, and pulmonary involvement suggests poor prognosis. (3) The clinical and imaging manifestations of pulmonary involvement of SLE can overlap with each other.

Objective to analyze the risk factors of upper gastrointestinal bleeding after neurosurgery, so as to guide the clinical prevention and treatment of postoperative upper gastrointestinal bleeding in neurosurgery. Methods Retrospective analysis was adopted to establish<The investigation scale of high risk factors of gastrointestinal bleeding after neurosurgery>. The hospitalization history of 1500 neurosurgical patients was collected by time period sampling method, and multivariate analysis was carried out according to the contents of the scale. Results There were 1430 effective cases in this study, and 75 cases had postoperative gastrointestinal bleeding, with an incidence of 5.24%. The analysis results showed that the incidence of upper gastrointestinal bleeding after neurosurgery was 6.64% (54/813) in males and 3.40% (21/617) in females; The incidence of patients over 50 years old was 9.88% (41/415). Glasgow Coma Score before and after surgery<The incidence of gastrointestinal bleeding was 17.5% (14/80, preoperative GCS 7~10) and 20.9% (14/67, preoperative GCS 3~6), and 20.25% (16/79, postoperative GCS 7~10) and 23.75% (19/80, postoperative GCS 3~6), respectively. The incidence of gastrointestinal bleeding after fourth ventricle tumor in elective surgery was 15.79% (3/19), and the incidence of gastrointestinal bleeding after hypertensive cerebral hemorrhage in emergency surgery was 46.43% (13/28). Conclusion the high risk factors of clinical symptoms of gastrointestinal bleeding after neurosurgery include: age>50 years; Male; Glasgow coma score before and after surgery<10 points; The lesions were located in the brain stem and the fourth ventricle; Hypertensive cerebral hemorrhage; Craniocerebral trauma caused by intracerebral and intraventricular hemorrhage; Various complications such as pneumonia, cerebral edema, intracranial hypertension and intracranial infection appeared after operation.

The medical media is full of all kinds of "research results" and "latest discoveries", and some conclusions are even completely opposite or contradictory, which makes people confused. This is because errors are an inevitable objective existence in the field of medical research. In fact, the results obtained by a single study cannot be accepted without doubt, and the relevant data and conclusions are difficult to be completely contained in a single article. In addition, various studies vary widely in scale, level and quality, but most medical media give all kinds of studies the same status when reporting. In fact, there are great differences in errors in many studies. If we don't face the errors of studies squarely, we may confuse the correctness of research results.

Targeted oncolytic adenoviruses, also known as conditionally replicating adenoviruses (CRADs), are a group of genetically engineered adenoviruses that can selectively complete the infection-replication cycle in tumor cells, thus specifically lysing and killing tumor cells without harming normal tissues [1]. Various CRADs have been successfully constructed, which can be roughly divided into three categories according to their mechanisms of action: First, the genes necessary for virus replication in normal cells, such as E1A-CR2 gene and E1B-55kD gene, are deleted, so that they cannot replicate in normal cells; The second is to use tumor-specific promoter to regulate virus replication gene to make it transcribed and expressed only in tumor cells, and the third is to modify the envelope protein of virus to make it efficiently infect tumor cells. At present, most of CRAd are in preclinical trials and have shown their unique advantages in anti-tumor, but their anti-tumor effect is still limited when applied alone, so the combination of CRAd and other therapies such as gene therapy, radiotherapy and chemotherapy will be the best choice.

A 27-year-old woman was found to have a mass in her right thoracic cavity during routine physical examination 1 day ago. There was no fever, chills, chest pain, chest tightness, shortness of breath, dyspnea, palpitation, palpitation, shoulder and back radiation pain. The chest radiograph in an external hospital showed a mass in her right thoracic cavity. The patient was clear and energetic since the disease, with no abnormalities in diet, sleep and stool, and no obvious changes in body weight. The history of trauma and surgery, blood transfusion, hypertension, diabetes, hepatitis and tuberculosis were denied. Physical examination: pulse 82 beats/min, blood pressure 110/70 mm Hg (1 mm Hg =0.133 kPa), body temperature 36.3℃. Vital signs were stable, chest symmetric, breathing sounds in both lungs were clear, heart rate 82 beats/min, rhythm was uniform, no murmur, abdomen was flat and soft, liver and spleen were not reached, and there was no edema in both lower limbs. Blood routine, liver and kidney function, urine and fecal routine, and erythrocyte sedimentation rate were all in the normal range. Posterior and anterior chest radiograph showed an increased triangular density shadow in the right heart angle area, the lateral edge of lung field was smooth, the right heart margin and right diaphragm surface disappeared, the remaining lung field was clear, and both sides of the diaphragm The mediastinal shadow was not widened, and there were no obvious abnormalities in the ribs and thoracic vertebrae (Figure 1).

Clinical data: A 50-year-old male was admitted to the Department of Urology of Beijing Chaoyang Hospital on December 26, 2004 due to "fever for 2 days". He underwent "allogeneic kidney transplantation" in our hospital 2 months before admission. He was regularly taken with cyclosporine A, mycophenolate mofetil (MMF) and prednisone after operation, and his kidney function was normal. He developed nasal congestion, runny nose and sore limbs 7 days before admission, and fever 2 days before admission, with body temperature fluctuating at 38℃, accompanied by chest tightness, shortness of breath and dry cough.

The traditional treatment for vulvar cancer is radical vulvar cancer surgery with bilateral inguinal lymph node resection. This surgery has positive efficacy, but the incidence of complications such as large skin defects, high suture tension, easy incision necrosis, infection, decrease or loss of sexual ability, vaginal laxity, urinary and fecal incontinence after surgery is high, which seriously affects the quality of life of patients after surgery. How to close the wound after extensive vulvar resection for vulvar cancer is a difficult problem in gynecological surgery, especially for recurrent cases. Improper repair not only affects the wound healing, but also may seriously affect the quality of life of patients after surgery. We designed the anterolateral femoral flap to immediately repair the huge perineal defect wound, and achieved good clinical efficacy. The report is as follows.

Primary schwannoma is not uncommon in clinic, but it is rare for patients admitted to gynecology in the form of pelvic mass. Schwannoma originating from retroperitoneum has its non-specific clinical characteristics. Because gynecological clinicians often have insufficient understanding of this disease and lack of specific diagnostic methods, the preoperative diagnosis rate is low, which often leads to insufficient preoperative preparation and passive state during operation. The clinical data of 7 patients with primary retroperitoneal schwannoma are analyzed as follows.

Intimate partner violence is the most common form of violence in women's lives, revealed by the World Health Organization's first study on domestic violence,released on 24 November 2005.The study reported the enormous toll of physical and sexual violence by husbands and partners on the health and well-being of women worldwide and the extent to which partner violence remains largely covert.

UNAIDS and the World Health Organization released the 2005 Global AIDS Epidemic Report on November 21, 2005. The report shows that despite the decrease in HIV infection rates in several countries in 2005, the global AIDS epidemic is still intensifying. This year, 5 million people worldwide were newly infected with HIV, and 3 million people died from AIDS-related diseases. At present, there are 40.3 million people living with HIV worldwide, which is the highest level in history. The report was published ahead of World AIDS Day, which is commemorated worldwide on December 1.

In order to cooperate with the national AIDS anti-viral treatment work and provide comprehensive and standardized medical treatment services to HIV infected and AIDS patients, the Ministry of Health entrusted the Chinese Center for Disease Control and Prevention to organize the relevant members of the Ministry of Health AIDS Clinical Expert Working Group to jointly formulate and complete<Technical Guidelines for the Prevention of Main Opportunistic Infections Related to AIDS with Cotrimoxazole, published on October 9, 2005.

Sleep apnea syndrome (SAS) is a group of syndromes characterized by repeated breathing pauses during sleep. It is potentially dangerous and common, and has been paid more and more attention. Obstructive sleep apnea syndrome (OSAS) is a type of SAS, and its most prominent clinical manifestation is sleep snoring. Previous studies have shown that OSAS can induce hypertension and lead to cardiovascular and cerebrovascular diseases. Recently, scholars led by Dr. Yaggi HK of Sleep Medicine Center of Yale University School of Medicine in the United States, after nearly 7 years of research and analysis, have suggested that OSAS can significantly increase the risk of stroke and death without being affected by other risk factors.<New England Journal of Medicine (NEJM, 2005, 353:2034-2041).

A 67-year-old woman was admitted to the hospital in July 2004 due to chest tightness, shortness of breath accompanied by significant fatigue and somnolence for more than 2 months. There was no obvious cough or sputum, shortness of breath aggravated after activity, and physical strength decreased significantly compared with previous. Three years ago, she had suffered from double lung tuberculosis. She was diagnosed in a tuberculosis specialist hospital and received regular anti-tuberculosis treatment for 1 year. After treatment, the chest CT lesions were obviously absorbed, but there were more fibrous cord-like lesions in both lungs. No history of chronic heart disease and lung disease, no history of dust exposure and smoking. Physical examination at admission: emaciated constitution, breathing rate 25 times/min, superficial breathing, clear consciousness, cooperative physical examination. Mild cyanosis of lips, "flat chest" shape of thorax, low breathing sounds in both lungs, no dry and wet rales, no abnormalities in heart and abdomen examination, no pestle-like fingers, and no edema in both lower limbs. Laboratory examination: blood routine, urine routine, liver and kidney function examination were all normal. Arterial blood gas analysis showed (when breathing room air): pH 7.406, partial pressure of carbon dioxide in arterial blood (PaCO2) 88 mm Hg (1 mm Hg

Case 1: A 45-year-old male was diagnosed with acute myeloid leukemia (AML-M1) in March 2004. After chemotherapy in another hospital, he was completely relieved. In August of the same year, he was admitted to our hospital for allogeneic peripheral blood stem cell transplantation between siblings. Hematopoiesis completely recovered 17 days after transplantation. Pneumocystis pneumonia (PCP) was not prevented after transplantation. Two months after transplantation, he developed low fever, dry cough, dyspnea, oxygen saturation was 86%, and blood oxygen partial pressure was 49 mm Hg (1 mm Hg =0.133 kPa). High resolution CT showed that the texture of both lungs increased, and large shadows of increased density were visible, and the left lower lung showed ground glass-like changes. Bronchopulmonary lavage (BAL) was administered immediately, and a large number of Pneumocystis spores were visible in the lavage fluid smear. Compound trimoxazole 2 g, 4 times/d, and methylprednisolone 40 mg, 2 times/d were administered. After 3 days of treatment, the symptoms were significantly improved, and the oxygen saturation and blood oxygen partial pressure returned to normal. After 1 week of treatment, CT showed that the condition was significantly improved, and after 2 weeks, CT showed that the shadow disappeared.

The patient was a 34-year-old man who was admitted to the hospital for 3 years because of the discovery of high blood pressure. During physical examination 3 years ago, the patient found that his blood pressure was increased, with his blood pressure 180/140 mm Hg (1 mm Hg =0.133 kPa), occasional headache, no nausea, no blurred vision, no discomfort such as pale complexion and palpitation. After various antihypertensive drugs were given to other hospitals, his blood pressure continued to fluctuate in 170~180/140~150 mm Hg, and his renal function was normal for many times during this period. He came to our hospital for examination before January and showed that the blood pressure of both upper limbs was 180/135 mm Hg. B-ultrasound of both kidneys showed that the size of both kidneys was normal. Doppler ultrasound of both renal arteries showed that the stenosis of the initial segment of the left renal artery was greater than 60%. All parents in the family suffered from hypertension. Physical examination: blood pressure of left upper limb 210/140 mm Hg, blood pressure of left lower limb 230/150 mm Hg, blood pressure of right upper limb 220/150 mm Hg, blood pressure of right lower limb 235/160 mm Hg, heart, lung and abdomen were normal, no vascular murmur was heard in the neck and abdomen, and the pulsation of dorsal arteries of both feet was normal.