Volume 86  ·   Issue 06  ·  2006

bone remodeling refers to the process of removing old bone and replacing it with new bone. It is an important replacement mechanism of mature bone tissue, which can prevent the accumulation of bone tissue fatigue injury and maintain the stability of biomechanical properties. Proper bone remodeling level is of great significance to maintain bone strength. Monitoring bone remodeling level in clinic is helpful to judge the fracture risk of osteoporosis patients and their response to anti-osteoporosis treatment.

Primary osteoporosis is a multi-factor complex disease involved by genetic and environmental factors, which has become a frequently occurring and common disease, which seriously affects the health and quality of life of the elderly.In recent years, scholars at home and abroad have carried out a lot of research on the genetic mechanism of primary osteoporosis, but its related genes and pathogenic genes are not clear yet, which is also a common problem in complex diseases.

Objective to investigate the feasibility and safety of right liver transplantation between adults. Methods From January 2002 to December 2005, 24 cases of right liver transplantation between adults were performed. A series of improved surgical techniques were used, including reconstruction of right hepatic vein, reconstruction of right inferior hepatic vein, bypass of middle hepatic vein, hepatic artery tower bridge and biliary anastomosis. The results were good. Results There were no serious complications and deaths in the whole group. Among the two recipients in the previous stage, 1 case developed hepatic vein anastomosis stenosis and the other case developed small liver syndrome, which eventually led to death. In the later stage, 22 cases developed complications in 7 cases, including acute rejection in 2 cases, hepatic artery embolism, enterointestinal anastomosis hemorrhage, bile leakage, left subdiaphragmatic abscess and pulmonary infection in 1 case, and 1 case died due to postoperative pulmonary infection and multiple organ failure. The other 10 cases were reconstructed by autogenous saphenous vein bypass and IVC, which ensured the patency of the right liver outflow tract. The weight ratio of graft to recipient was 0.72% ~1.17%, 19 cases<1.0%, including 4 cases<Conclusion Small liver syndrome can be effectively avoided by using improved surgical technique, especially the adequate reconstruction of hepatic vein outflow tract, which makes right hemihepatic transplantation a safe operation.

Objective to evaluate the changes of cardiac function after radical resection of tetralogy of Fallot (TOF) and to explore its influencing factors.Methods 43 patients with TOF (TOF group) were followed up for 1~3.5 years after radical resection of TOF; Left ventricular ejection fraction (LVEF) was determined by ultrasound, and the velocity of tricuspid annulus in late diastolic (Aa) and early diastolic (Ea) phase of right ventricle was measured by tissue Doppler technique (TDI). Right ventricular isovolumetric systolic time (ICT), isovolumetric diastolic time (IRT), isovolumetric systolic velocity (IVV), isovolumetric systolic acceleration (IVA) and right ventricular ejection isovolumetric time index were measured. Activity treadmill exercise test was performed in 21 patients over 17 years old. Results the cardiac function of patients in TOF group were Ea, Aa tricuspid annulus velocity (11.5 cm/s ± 2.6 cm/s, 9.6 cm/s ± 1.7 cm/s), E/A (1.16 ± 0.36), IVV (7.7 cm/s ± 1.8 cm/s) and IVA (131.7 cm/s2 ± 37.6 cm/s2) They were significantly smaller than those in the control group (Ea: 17.1 cm/s ± 2.4 cm/s, Aa: 12.9 cm/s ± 2.9 cm/s, E/A: 1.36 ± 0.26, IVV: 9.9 cm/s ± 1.4 cm/s, IVA: 222.5 cm/s2 ± 39.2 cm/s2)) ICT, IRT and right ventricular ejection isovolume time index increased; Conclusion the cardiac function of patients with radical TOF surgery can not recover to normal level in short term; Such patients should be closely monitored to improve their quality of life.

Objective to investigate the construction of bone marrow mesenchymal stem cell-polylactic acid polyglycolic acid copolymer complex (PLGA) and its repairing effect on damaged tissues. Methods (1) New Zealand rabbit bone marrow mesenchymal stem cells (MSCs) were isolated and cultured, labeled with 4,6-amidine-2-phenylindole (DAPI) and inoculated on PLGA scaffold. The growth of MSCs on the scaffold was observed by scanning electron microscopy and immunofluorescence microscopy at different time periods. (2) MSC-PLGA complex and PLGA scaffold were transplanted on the back skin wound of New Zealand white rabbits respectively. The wound healing was observed after surgery. After 5 weeks, the grafts were collected by HE staining, VG staining and cytokeratin AE1/AE3 immunofluorescence histochemistry. Results MSCs grew well on the scaffold, and the number of cells increased gradually with the increase of time, and the cells reached 90% fusion on the 10th day. The wound repaired by MSC-PLGA complex gradually formed new skin with the degradation of polymeric materials. The structure of new skin was similar to that of normal skin by HE staining and VG staining, The cytoplasm expressed keratin at the same time, and only a few hair follicles and thickened fibrous scars were observed on the wound repaired by PLGA scaffold. Conclusion Bone marrow mesenchymal stem cells combined with PLGA polymer is a good transplantation substitute.

Objective to observe the effects of lysophosphatidic acid (LPA) on Rho protein and invasion and metastasis of malignant tumor cells. Methods SMMC7721 cell line was cultured and prepared into single cell suspension. 2, 5 and 25 μ mol/L LPA were added to the culture medium, respectively, in three experimental groups. No LPA was added as the control group. Rho protein activity was detected by lysophosphatidic acid-induced Rho protein activity kit in SMMC7721 cells, and the expression of Rho protein was measured by Western blot. The changes of invasion, adhesion and motility of cells after drug treatment were studied by adhesion matrix analysis and reconstruction of basement membrane invasion model. Results After lysophosphatidic acid treatment, the expression of Rho protein in SMMC7721 cells increased, especially the histone content of 25 μ mol/L, which was 1.5 times that of blank control group at 5 hours and 2.4 times after 20 hours. The activity of Rho protein also increased significantly after 24 hours, from 102% ± 34% to 408% ± 95% (P<At the same time, the invasive capacity of the cells was significantly enhanced, the number of invasive cells in the control group was 531.2±65.6, and that in the 25 μ mol/L lysophosphatidic acid group was 789.7±117.5 (P<0.01). At 60 min, the cell adhesion rates of 5 and 25 μ mol/L groups were 77.9%±16.7% and 83.6%±19.3%, respectively (P<0.05), reached 93.8%±25.6% and 91.2%±29.7% at 80 min, which was statistically significant compared with the control group (P<Conclusion LPA enhances the invasion and metastasis of hepatocellular carcinoma cells in vitro mainly through Rho signal transduction.

Objective to investigate whether intrapodocyte heat shock protein 27 (HSP27) forms a complex with transcription activator 5 (ATF5) and its significance in podocyte apoptosis. Methods the apoptosis model of mouse glomerular podocyte line was established by high glucose stimulation in vitro, and apoptosis was determined by Hochest staining and flow cytometry. The activation of mitogen-activated protein kinase (MAPK) signaling pathway was detected by Western blot analysis, and the changes of HSP27 and ATF5 complexes were detected by co-immunoprecipitation technique. The effect of MAPK signaling pathway on the formation of complexes between HSP27 and ATF5 and apoptosis of podocyte was observed by blocking experiment. Results The apoptosis model of podocyte stimulated by high glucose was successfully established. The apoptosis rate of 30 mmol/L high glucose stimulated for 48 h (27.2%±8.9%) was significantly higher than that of 5.5 mmol/L normal glucose (control) for 48 h (10.6%±2.7%, P<The complexes of HSP27 and ATF5 in the normal glucose group (control) were obviously increased by 195%±36% (P<Extracellular signal-regulated kinase (ERK1/2) and p38 were activated by high glucose stimulation for 30 min. Further blocking experiments showed that ERK1/2 activation inhibitors could attenuate the complex formation of HSP27 and ATF5 induced by high glucose stimulation (109% ± 19% in PD98059+ high glucose group and 211%± 46% in high glucose group, P<0.05), and aggravate apoptosis induced by high glucose (51% ± 4% in PD98059+ high glucose group and 27%± 9% in high glucose group) (P<0.05). p38 activation inhibitors did not affect the complex formation of HSP27 and ATF5 induced by high glucose stimulation (290% ± 43% in SB20358+ high glucose group and 231% ± 20% in high glucose group, P>0.05), but could reduce apoptosis induced by high glucose (16% ± 6% in SB20358+ high glucose group and 27% ± 9% in high glucose group) (P<0.05). Conclusion High glucose depends on ERK1/2 signaling pathway instead of p38 signaling pathway to stimulate HSP5 in podocyte

Objective to observe the detection results of serum autoantibodies in patients with chronic hepatitis C and to explore the significance of autoimmunity in hepatitis C virus (HCV) infection. Methods the positive autoantibodies in patients with chronic hepatitis C in Peking University First Hospital were retrospectively analyzed, and the relationship between HCV RNA content, HCV genotype, incidence of liver cirrhosis, response rate to interferon therapy, age, sex and liver function and autoantibodies was investigated. Results (1) Autoantibodies were positive in 20 of 69 patients with chronic hepatitis C, and the detection rate was 28.9% (20/69). The autoantibodies were mainly low titers, mainly antinuclear antibodies, which was significantly higher than that in chronic hepatitis B group (4.3% (3/69, P<0.05); The detection rate of autoantibodies was significantly lower than that of autoimmune hepatitis group by 100% (P<(2) There was no significant difference in HCV RNA content and HCV genotype between autoantibody negative and autoantibody positive groups in chronic hepatitis C patients. (3) After α-interferon antiviral therapy, the interferon response rate of autoantibody positive group was higher (77.8%) than that of autoantibody negative group (51.2%, P<(4) The detection rate of autoantibodies was higher in the elderly, and the difference was statistically significant (P<(5) The incidence of cirrhosis in the autoantibody positive group (80%) was higher than that in the negative group (46.9%, P<0.05). (6) The serum alanine aminotransferase (ALT), glutamate aminotransferase (AST), total bilirubin (TBIL) and γ-globulin in patients with autoantibody positive chronic hepatitis C were higher than those in patients with autoantibody negative (respectively 191 U/L ± 89 U/L vs 113 U/L ± 69 U/L, 169 U/L ± 80 U/L vs 98 U/L ± 62 U/L, 78 μ mol/L ± 50 μ mol/L vs 51 μ mol/L ± 30 μ mol/L, 200 g/L ± 80 g/L vs 160 g/L ± 70 g/L, all P<Conclusion HCV infection can induce autoimmune response and make various autoantibodies appear in the serum of patients. The detection rate of autoantibodies is significantly related to cirrhosis and age, and the detection of autoantibodies and their titers has guiding significance for clinical diagnosis and treatment of hepatitis C patients.

Objective to evaluate and analyze the consistency of the diagnostic criteria of metabolic syndrome (MS) between the International Diabetes Federation (IDF) and the Chinese Diabetology Association. Methods In the epidemiological investigation of middle-aged and elderly people in Shijingshan, Beijing, the oral glucose tolerance test (OGTT) of 75 g was performed in patients without diabetes, and the data of 1870 cases were analyzed by questionnaire survey and physical examination. The prevalence of MS was calculated according to the two criteria respectively. Results (1) The coincidence rate of the two diagnostic criteria for MS was good (79.95%). After the fasting blood glucose (FPG) in the Chinese standard was adjusted to ≥5.6 mmol/L, the coincidence rate of the two increased (81.39%). (2) The coincidence rate of body mass index ≥25 kg/m2 was good with waist circumference ≥90 cm in men or ≥80 cm in women, and the coincidence rate was as high as 94.55% in women. (3) The prevalence of myocardial infarction and/or stroke and microalbuminuria in patients with MS diagnosed by IDF and Chinese standard were similar, 19.87% and 19.62% and 8.59% and 8.55%, respectively, which were significantly higher than those without MS (14.86% and 15.55% These patients may not belong to the typical metabolic syndrome.Conclusion the diagnostic criteria of MS recommended in China are in good agreement with IDF criteria, and both criteria can be used in Chinese population.

Objective to investigate the relationship between smoking and death risk of esophageal cancer, and to verify the feasibility and scientificity of case-control study in the cause of death investigation.Methods 24 large and medium-sized cities and 79 rural counties in China were selected by non-random and random methods to investigate the cause of death, and a population-based case-control methodology was carried out at the same time.The cases were male patients aged ≥35 years who died of esophageal cancer in the investigated area from 1986 to 1988, and two control groups were set up at the same time.Control group I was male patients aged ≥35 years who died of other digestive tract diseases at the same time; Control group Ⅱ was the surviving spouse of female patients (all causes of death) who died in the same period, and their age at the time of their wives' death was ≥35 years old. The main measurement indexes were the absolute mortality rate of esophageal cancer and the relationship between smoking and esophageal cancer death risk among smokers and non-smokers by region. Results (1) Among cases and control group Ⅰ: the absolute mortality rate of esophageal cancer among non-smokers/smokers (1/1000 people) was 0.39/0.63 in urban areas, 1.06/1.24 in inland rural areas and 1.18/1.55 in coastal rural areas. There was a significant dose-response relationship between the number of cigarettes smoked daily and the risk of death from esophageal cancer<The relative risk values of 10, 10~ and 20~ cigarettes were 1.42, 1.82, 2.22 in control group I and 1.57, 1.95, 3.18 in control group II. There was also a significant dose-response relationship between smoking years and the death risk of esophageal cancer. (2) The results obtained by different controls were in good agreement. Conclusion Smoking is an important pathogenic factor of esophageal cancer, and case-control study in the investigation of cause of death is an innovative, scientific and easy research method.

Objective to investigate the relationship between parathyroid hormone (PTH) gene polymorphism and bone mass and serum bone-related biochemical indexes in normal female population. Methods the serum concentrations of PTH, bone specific alkaline phosphatase (BAP), carboxy-terminal peptide of collagen type I, amino-terminal peptide of collagen type I, osteoprotectin and leptin were determined by ELISA in 314 patients aged 20~80 years (average age 43 ± 16 years). DNA samples from the genome of female volunteers were tested for polymerase chain reaction restriction fragment length polymorphism of the restriction endonuclease Bst BI to determine its genotype (the presence of Bst BI restriction site is indicated by "B", and the absence is indicated by "B"); The bone mineral density (BMD) of lumbar spine and femoral neck were measured by DXA. Results (1) The distribution frequencies of PTH gene BB type (120 cases before menopause and 118 cases after menopause), BB type (37 cases before menopause and 36 cases after menopause) and BB type in healthy women were 75.8%, 23.3% and 0.9% respectively; The allele frequency was 87.5%,12.5%.There was no difference in the frequency of PTH gene polymorphism in premenopausal women compared with postmenopausal women. (2) Covariance analysis showed that there was no significant difference in BMD and serum bone biochemical indexes (PTH, BAP, CTX, NTX, OPC and leptin) of female BB and BB genotypes in anterolateral lumbar spine and femoral neck; (3) Multiple stepwise regression showed that PTH gene polymorphism had no effect on the variation of BMD. Conclusion PTH gene polymorphism had no correlation with female bone mass and serum bone biochemical indexes.

Objective to investigate the changes of urinary excretion rate of carboxy-terminal peptide and amino-terminal peptide of type Ⅰ collagen (uCTX/Cr and uNTX/Cr) in healthy women with aging and their relationship with menopause, menopausal age and postmenopausal bone loss.Methods uCTX/Cr and uNTX/Cr in 659 healthy women aged 20~80 years were measured by ELISA, and bone mineral density (BMD) in different skeletal parts (lumbar anterior and lateral positions, hip and forearm) was measured by dual energy X-ray absorptiometry (DXA). According to the diagnostic criteria of WHO osteoporosis, postmenopausal women (339 cases) were divided into three groups: osteoporosis, low bone mass and normal bone mass.Results (1) uCTX/Cr and uNTX/Cr were best fitted with age by cubic regression curve, and the coefficient of determination (R2) was 0.139 and 0.149, respectively. uCTX/Cr and uNTX/Cr increased gradually after 35 years of age. (2) uCTX/Cr and uNTX/Cr were 149 mg/mol ± 80 mg/mol and 33 nmol/mmol ± 17 nmol/mmol before menopause, respectively; After menopause, uCTX/Cr and uNTX/Cr increased by 69.5% and 93.4%, respectively, and BMD decreased by 10.8% ~27.6%. (3) After controlling age and body weight, uCTX/Cr and uNTX/Cr still showed a significant negative correlation with BMD in each bone (r = -0.078~ -0.283, P<0.05 or 0.01); There was significant positive correlation between uCTX/Cr and uNTX/Cr (r =0.608, P =0.000). (4) Both uCTX/Cr and uNTX/Cr were significantly higher in osteoporosis group and low bone mass group than in normal bone mass group (P<For example, in the orthopedic lumbar spine, uCTX/Cr was 189 mg/mol±87 mg/mol, 272 mg/mol±108 mg/mol and 366 mg/mol±135 mg/mol in the normal bone mass group, low bone mass group and osteoporosis group, respectively, while uNTX/Cr was 52 nmol/mmol±22 nmol/mmol, 68 nmol/mmol±34 nmol/mmol and 108 nmol/mmol±41 nmol/mmol, respectively. Conclusion uCTX/Cr and uNTX/Cr can sensitively reflect the bone turnover status of women with age and menopause. uCTX/Cr and uNTX/Cr are negatively correlated with BMD, and they are significantly higher in low bone mass and osteoporosis, which can be used to predict age and menopause-related bone loss in women.

Objective to investigate whether the peak bone mass of the daughters of the mothers with osteoporosis was lower than that of the daughters of the normal mothers, and to investigate the factors leading to this difference. Methods 401 Han nuclear families (including both parents and a healthy daughter aged 20-40 years) were recruited from various communities in Shanghai. The BMD of the lumbar spine (L1-4) and proximal femur was measured by dual energy X-ray absorptiometry. 126 mothers with osteoporosis and their daughters and 136 age-matched mothers with normal BMD and their daughters were obtained by excluding the families whose fathers suffered from osteoporosis or osteopenia. Results BMD values of L1-4, femoral neck and trochanter greater (0.94 g/cm2 ± 0.10 g/cm2, 0.75 g/cm2 ± 0.10 g/cm2, 0.61 g/cm2 ± 0.08 g/cm2) were significantly lower than those of the daughters of the normal mothers (1.00 g/cm2 ± 0.11 g/cm2, 0.80 g/cm2 ± 0.11 g/cm2, 0.66 g/cm2 ± 0.09 g/cm2, all P<0.001), and the body weight was also significantly lower than that of the normal mother's daughter (P<Multivariate stepwise regression analysis showed that body weight was the most important factor affecting BMD in all parts of daughters, explaining 9.4%, 16.5% and 16.6% of the variation of BMD in L1-4, femoral neck and trochanter greater, respectively. After excluding the weight factor, the mother suffering from osteoporosis became the most important factor affecting BMD in daughters, explaining 5.1%, 5.3% and 4.2% of the variation of BMD in L1-4, femoral neck and trochanter greater, respectively. Conclusion The mother suffering from osteoporosis had low peak bone mass, and body weight was the most important factor, followed by low BMD in mothers.

Renal carcinoma with inferior vena cava tumor thrombus accounts for 4% ~10% of renal carcinoma cases [1]. In recent years, it is believed that if no local or distant metastasis of renal carcinoma is found, the prognosis of renal carcinoma is good if the renal vein tumor thrombus is removed and the inferior vena cava (IVC) tumor thrombus is removed at the same time with radical resection. The choice of surgical method depends on the level of tumor thrombus extending into inferior vena cava and whether IVC wall is invaded. The position of type Ⅲ IVC tumor thrombus is high, and the surgical risk is high, and there has been controversy about whether surgery under cardiopulmonary bypass is needed. From 2001 to 2004, a total of 8 patients with renal carcinoma with inferior vena cava tumor thrombus were treated in our hospital, among which 4 patients with type Ⅲ inferior vena cava tumor thrombus were treated by off-cardiopulmonary bypass surgery, with good results.

Prof. Liu Boqi and others conducted a case-control study on smoking and esophageal cancer risk in 103 regions involving 150 million people in China. Through the study of the relationship between smoking status and esophageal cancer in nearly 20,000 esophageal cancer cases and about 30,000 and 100,000 different control groups, it was shown that smoking is an important risk factor for esophageal cancer, and the attributable risk percentage ranged from 13.4% to 21.1% in rural areas and 27.6% to 31.3% in urban areas, which provided an important scientific basis for revealing the pathogenesis factors and prevention of esophageal cancer.

In recent years, the incidence and severity of Clostridium difficile-associated diarrhea (CDAD) have increased significantly in the United States, Canada and Europe. From 2000 to 2003, CDAD outbreaks occurred in the United States and Canada, respectively.

Presented at the 45th Annual International Interdisciplinary Conference on Antimicrobial Agents and Chemotherapy on 16 December 2005 in Washington, D.C., USA, the clinical results of a new combination therapy with the potential to greatly shorten the course of tuberculosis therapy, the results of a phase II trial of a gatifloxacin-containing regimen showed considerable potential. This regimen was significantly more potent than the currently recommended 6-month regimen of isoniazid, rifampicin, pyrazinamide and ethambutol and suggested that the standard 6-month regimen could be shortened to 4 months if gatifloxacin was used instead of ethambutol.

A single nucleotide polymorphism (SNP) in the gene encoding monocyte chemotactic protein-1 (MCP-1) can affect the activity of pulmonary tuberculosis, indicating that active pulmonary tuberculosis is genetically susceptible, according to a recent study by scientists from the United States, South Korea and Mexico.<J Exp Med, 2005, 202:1649-1658).

In August 2001, the capsule endoscope was approved by the US Food and Drug Administration and began to be used clinically. Since the introduction of capsule endoscope in China in 2001, it has been used in dozens of hospitals in more than 10 provinces and cities. At present, the capsule endoscopes for clinical application at home and abroad are all products of Given Company of Israel, which are of positive quality but expensive. The domestic capsule endoscope OMOM is a product independently developed by Chongqing Jinshan Technology Company, and was officially developed successfully in 2004. Its animal experiments have confirmed that the effect of OMOM capsule endoscope is positive, but there are few studies on the diagnosis and treatment of clinical gastrointestinal diseases. Since November 2004, our department has used OMOM capsule endoscope to conduct a preliminary study on 17 patients suspected of small intestinal diseases, which is summarized as follows.

Studies have shown that there are not only differences in pathogenicity among different subtypes of Helicobacter pylori (Hp) pathogenic genes (cagA, vacA, iceA), but also their distribution is obviously regional [1]. At present, there are few reports on the infection situation of Hp pathogenic gene subtypes in Northeast China. Zhuanghe City, Liaoning Province is a high incidence area of gastric cancer in northern China, and the mortality rate of gastric cancer is 49.55/100,000 in males and 22.23/100,000 in females [2]. Studies have found that the detection rate of Hp in gastric mucosa of Zhuanghe residents is significantly higher than that of residents in low incidence areas [3], which suggests that not only the incidence of gastric cancer but also the prevalence of Hp infection in Zhuanghe area is high. It is still unclear whether the distribution of Hp gene subtypes in northern China is different from the results reported in other regions of the world. The purpose of this study is to reveal the regional characteristics of Hp gene distribution in northeastern China by studying the differences between Hp gene distribution in northeastern China and foreign studies, and to provide clues for further exploring the epidemiological regularity of Hp infection and its disease correlation.

In recent years, researchers have applied cells similar to bone marrow stromal stem cells as seed cells of tissue engineering tendons [1-3], but no significant progress has been made. Skin fibroblasts and tendon cells are both derived from mesoderm, and their cell morphology is similar. If fibroblasts can replace tendon cells, they can be used as seed cells for tendon tissue engineering, which is expected to solve the problem of lack of seed cells. The authors have used fibroblasts as seed cells to repair tendon defects and achieved preliminary success [4], but the long-term observation results are lacking.

A 55-year-old male was admitted to the hospital on December 5, 2004 with "persistent pain in the left chest for more than 10 days" as the main complaint. The patient developed unexplained chills, fever and cough before seeing the doctor. After anti-infective treatment (specific medication and dose were ominous), the symptoms were relieved after 7 days. CT showed: mass in the lower lobe of the right lung and mass in the left ventricle. Color echocardiography showed: solid left ventricular occupation. In the past 10 days, the patient had persistent tingling pain in the precordial area of the left chest, which was progressively aggravated, without hemoptysis, chest tightness and palpitations. Physical examination showed that the general condition was poor, and the vital signs were normal. The breathing sound of the right lower lung was low, and a small amount of blister sound could be heard. The cardiac rhythm was uniform, and no pathological murmur was heard in each membrane area. Fiberoptic bronchoscopy showed that the mucosa of the posterior wall of the bronchus in the lower lobe of the right lung was rough and infiltrated, and the bronchial opening in the dorsal segment of the lower lobe of the right lung was infiltrated and occluded. The pathological examination showed: squamous cell carcinoma. The weight decreased by 4~5 Kg after the onset. Preoperative diagnosis: (1) squamous cell carcinoma of the lower lobe of the right lung, c-T3N2M0. (2) left ventricular mass, myxoma or metastasis? (3) Chronic bronchopneumonia, mild emphysema.

A 76-year-old male was admitted to hospital on January 7, 2004. The patient suffered from intermittent cough and asthma for 3 years, and was diagnosed as chronic bronchitis. He suffered from shortness of breath after normal activity, intermittent edema of both lower limbs, cough and asthma worsened 1 week before admission, cough of yellow phlegm, inability to lie down, edema of both lower limbs, decreased urine output, and no fever. He had a history of coronary heart and hypertension. Physical examination: 30 breaths/min, blood pressure 120/80 mm Hg (1 mm Hg =0.133 kPa), semi-recumbent position, shortness of breath, peripheral cyanosis, yellow staining of skin and sclera, jugular vein distension, signs of emphysema, a large number of dry and wet rales in both lungs, heart boundary enlarged to both sides, heart sound intensity varied, absolute irregular heart rhythm, heart rate 124 beats/min, slightly swollen abdomen, untouched liver and spleen under the costs, no tenderness in the whole abdomen, positive mobile voiced sound, normal intestinal sound.