Volume 86  ·   Issue 40  ·  2006

Pancreaticoduodenectomy is still a classic surgical method for pancreatic head cancer, ampullary cancer and duodenal malignant tumor since it was founded by Whipple in 1935. Pancreaticoduodenectomy can be performed in most hospitals above the county level in China, but there are great differences in many aspects related to this operation, such as surgical indication, operation time, intraoperative and postoperative complications, lymph node dissection range, tumor resection rate and postoperative survival rate, etc. Therefore, the reported surgical treatment results of pancreatic head cancer in China are quite different. Therefore, we believe that with the rapid development of surgical technology today, it is extremely important to explore and formulate the norms and rules of radical pancreatic head cancer resection [1-4]. Based on clinical practice, we put forward the following reference opinions for pancreatic surgeons to discuss.

Methods Ninety-one adult male SD rats were divided into normal saline group, NSAID group (Ⅰ) and teprenone group (Ⅱ). The latter two groups were further divided into the following subgroups: group Ⅰ A (indomethacin 5 mg·kg-1·d-1), group Ⅰb (indomethacin 5 mg·kg-1·d-1 and prednisone 10 mg·kg-1·d-1), group Ⅰ c (celecoxib 100 mg·kg-1·d-1), group Ⅰd (celecoxib 100 mg·kg-1·d-1 and prednisone 10 mg·kg-1·d-1), group Ⅱa (teprenone 12 mg·kg-1·d-1, indomethacin 5 mg·kg-1·d-1), group Ⅱb (teprenone 12 mg·kg-1·d-1, indomethacin 5 mg·kg-1·d-1 and prednisone 10 mg·kg-1·d-1), group Ⅱc (teprenone 12 mg·kg-1·d-1 LI (0.00 (0.00-0.25), 1.00 (0.00-1.50), 0.00 (0.00-0.00), 0.00 (0.00-1.00), P<0.05) and Whittle scores of each subgroup were significantly lower than those of the corresponding group I (0.00 (0.00-0.00), 0.00 (0.00-0.50), 0.00 (0.00-0.25), 0.00 (0.00-0.50), P<0.05); There was a significant difference in LI between groups Ⅰc and Ⅰa and between groups Ⅰd and Ⅰc (P<0.05). The expression of COX-1 in gastric mucosa in groups Ⅰ (except Ⅰc) and Ⅱ (except Ⅱc) was significantly lower than that in normal saline (0.384±0.031, 0.354±0.026, 0.753±0.049, 0.366±0.035, 0.381±0.036, 0.766±0.401, P<0.001), while the expression of COX-2 mRNA in groups Ⅰ A, Ⅰ b, Ⅱa, Ⅱb was significantly increased (0.483 ± 0.056, 0.448 ± 0.046, 0.461 ± 0.050, 0.479 ± 0.032, P<0.001). There was no significant difference in COX between groups Ⅰ and Ⅱ. Conclusion COX-2 inhibitors have the effect of gastric mucosal injury, but it is less than that of traditional NSAID; Glucocorticoid prednisone can aggravate NSAID gastropathy; Besides COX-1 inhibition, other factors may be involved in the pathogenesis of NSAID gastropathy; Teprenone can effectively prevent NSAID gastropathy, but the mechanism of action may not be related to the expression of COX.

Objective to explore the quantitative methodology to describe the intrinsic characteristics of hereditary non-polyposis colorectal cancer (HNPCC) families. Methods HNPCC families from different origins who met Amsterdam criteria (AC) Ⅰ or Ⅱ were grouped according to age and colorectal cancer composition ratio, and the clinical phenotype of HNPCC was described by self-defined quantitative parameters and the number of malignant tumors involved in the family, the number of patients and the family type. Results The median age of diagnosis of first malignant tumor (FMA-DFMT) and median age of diagnosis of first colorectal cancer (CRC) (FMA-DFCRC) were both non-normal distributions; Among the families with HNPCC in accordance with AC Ⅰ, FMA-DFMT and FMA-DFCRC in most families ranged from 35 to 50 years old, accounting for 73.6% (39/53) and 69.8% (37/53), respectively, with medians of 44.0 and 43.5 years old, respectively; The proportion of CRC (FPCRC-FMT) and the proportion of colorectal cancer patients (FP-CRCP) were less than 0.6 in the first-episode malignant tumor of the family, accounting for 13.2% (7/53) and 7.5% (4/53), respectively; There was no correlation between FMA-DFMT, FMA-DFCRC and the number of patients, number of generations involved, family type, FPCRC-FMT, FP-CRCP and other parameters (all P>0.05). Conclusion Compared with traditional methods, the clinical phenotype characteristics of HNPCC families can be described more accurately by using quantitative parameters.

Objective to investigate the relationship between the diagnosis and coronary artery sclerosis of myocardial bridge-wall coronary artery (MB-MCA) by multi-slice spiral CT (MSCT). Methods Coronary angiography (CTA) was performed in patients with suspicious coronary heart disease (CHD) by 64-slice spiral CT. The existence of MB-MCA was determined by three CT diagnosticians independently. When the results were consistent, it was determined to be MB-MCA. The length of the mural coronary artery (MCA) and the thickness of the myocardial bridge (MB) were measured by means of mean ± standard deviation, and the morphological changes of the proximal and distal segments of MB-MCA were recorded. According to these three indexes, a method for calculating the coronary artery score with MB-MCA was proposed to determine the coronary artery sclerosis with MB-MCA. The relationship between vascular sclerosis and MB-MCA was judged by rank sum statistical analysis. Results Among 900 patients with suspicious CHD, MB-MCA was found in 167 cases (18.56%, 167/900) and 180 locations by coronary CTA. MB-MCA was located in the left anterior descending artery in 92.78% (167/180). MSCT showed that MCA could be completely (36.11%, 65/180) or incompletely surrounded by myocardium MCA length 10~20 mm, MB<1 mm, angle on one side adjacent to blood vessel, 2 points for each item; The degree of MCA>20 mm, MB>1 mm, angle formation on both sides of proximal and distal segments of adjacent vessels, 3 points per item. Among 167 cases, 88 cases (52.69%) showed signs of coronary artery sclerosis, and the statistical results showed that there was no significant correlation between MB-MCA carrying coronary artery sclerosis and MB-MCA morphological score (u =1.234, P>0.05). Conclusion 64-slice spiral CT can be used to judge the structural features of MB-MCA and MB-MCA carrying coronary arteries; The detection rate of MB-MCA in patients with clinical suspicion of CHD was 18.56%; There was no significant correlation between MB-MCA-loaded coronary sclerosis and MB-MCA morphological score.

Objective to establish a rapid, accurate and high-throughput gene chip technology for detecting mitochondrial DNA mutations and to explore the relationship between these mutations and diabetes.Methods Using nylon membrane as medium, wild-type and mutant probes of 28 mutation sites to be detected were fixed by ultraviolet crosslinking. The gene chip was used to screen the mitochondrial tRNA leu (UUR) gene and ND1 gene in 200 patients with type 2 diabetes mellitus and 210 healthy controls. The mutation sites were further confirmed by DNA sequencing, and the mutant genes and protein secondary structures were predicted by Mfold and Antheprot softwares.Results The mitochondrial DNA chip was successfully developed to detect 28 mutation sites. T3 290C mutation in tRNA leu (UUR) gene was detected in 2 cases (1.0%), ND1 mutation in 23 cases: G3 316A mutation in 6 cases (3.0%), T3 394C mutation in 5 cases (2.5%), A4 164G mutation in 8 cases (4.0%), T4216C mutation in 2 cases (1.0%), T3593C mutation in 1 case (0.5%) and A3 606G mutation in 2 cases ( In the control group, G3 316A mutation was detected in 1 case (0.5%) and A4 164G mutation in 5 cases (2.4%). The sequencing results of these mutation sites were consistent with the results of gene chip detection. Only T3 394C mutation rate was statistically significant between the two groups (P =0.027). G3316A mutation resulted in alanine → threonine, T3 394C mutation resulted in tyrosine → histidine, T3 593C mutation resulted in valine → alanine, T4 216C mutation resulted in tyrosine → histidine, A3 606G and A4 164G mutations were nonsensical mutations of leucine and methionine, respectively. The secondary structures of ND1 protein in the first four mutants were different from those in the wild type. Conclusion Mitochondrial DNA microarray is a fast and reliable high-throughput method for gene mutation detection, and T3 394C mutation in ND1 gene may be involved in the pathogenesis of mitochondrial gene deficiency diabetes.

Objective to observe the efficacy of AD.Egr-Smad7 in the prevention and treatment of radiation-induced pulmonary fibrosis in C57BL mice by in vivo experiments, and to explore its mechanism.Methods AD.Egr-Smad7 cDNA was packaged into replication-defective adenovirus and prepared into AD.Egr-Smad7.288 mice were randomly divided into 6 groups, namely, blank control group, simple radiation group (irradiation twice daily, 8Gy each time, 8h interval between two irradiations), AD.Egr-Smad7 group, AD.Egr-Smad7 radiation group, viral vector group and viral vector radiation group. Each group was divided into groups 0, 1, 2, 4, 8 and 12 weeks after irradiation, with 8 mice in each group. The mice were given AD.Egr-Smad7 and viral vector intratracheally, and a single whole thoracic radiation 24h later. The contents of TGF-β 1, CTGF, type Ⅰ and Ⅲ collagen in lung tissue were detected by ELISA; Determination of Hydroxyproline by Alkali Hydrolysis; Results Egr-1 promoter was activated by γ-ray irradiation to regulate adenovirus-mediated exogenous Smad7 in C57BL mice, which decreased the contents of TGF-β, type Ⅰ, type Ⅲ collagen and hydroxyproline within 1 to 4 weeks after intrapulmonary irradiation, and the differences were statistically significant compared with those in the control group (all P<0.01); The pathological changes and pulmonary fibrosis scores under light microscope also proved that the regulation of exogenous Smad7 by radiation-activated Egr-1 promoter can reduce pulmonary fibrosis at 12 weeks after radiation. Conclusion Egr-1 promoter targeted regulation of exogenous Smad7 gene expression by radiation induced by a single dose before radiation can block TGF-β signal transduction pathway to some extent within 4 weeks, and pathological results at 12 weeks show that it can block radiation-induced pulmonary fibrosis.

Objective to investigate the transduction efficiency, gene expression level and infected cell types of different serotypes of recombinant adeno-associated virus (rAAV) on retinal cells, and to provide experimental basis for selecting appropriate vectors for gene therapy of fundus diseases.Methods RPE cell lines cultured in vitro, primary cultured SD rat retinal neurons and primary cultured adult RPE cells were infected with rAAV serotypes 1 (rAAV2/1-EGFP) and 2 (rAAV2-EGFP) carrying green fluorescent protein reporter gene. The fluorescence time, positive rate and fluorescence intensity of EGFP were observed by fluorescence microscope and flow cytometry. Two different serotypes of rAAV were injected into the subretinal space of SD rats, respectively, and the fluorescence time, range, intensity and distribution characteristics of EGFP fluorescence were observed by fluoroscope. Finally, the types of retinal cells infected by AAV were observed by eye tissue section and immunohistochemical staining, Results the positive rates of EGFP were 13.5%±1.7% and 15.6%±0.8% on the 7th and 14th day after rAAV2/1-EGFP transduction, respectively, and the mean brightness was 2.75±0.12 and 3.80±0.72. The positive rates of EGFP were 1.1%±0.5% and 2.0%±0.4% on the 7th and 14th day after rAAV2/1-EGFP transduction, respectively, and the mean brightness was 1.12±0.09 and 1.75±0.20. The fluorescent areas of EGFP in the retinas were (5389±211) μ m2, (9832±364) μ m2, (14454±446) μ m2, (20528±648) μ m2 and (20264±683) μ m2 at the 7th, 14th, 28th, 75th and 4th months after rAAV2/1-EGFP infection, respectively However, type 1 rAAV is a more efficient gene delivery vector than type 2 AAV in living retina.

Objective to investigate the effect of early intervention on language, speech and cognition in infants with hearing impairment and the clinical model of early intervention. Methods 56 infants with hearing impairment aged 10 months ~2 years old were divided into two groups, 20 children with hearing aids and systematic language rehabilitation were included in the intervention group, and 36 children without treatment were included in the non-intervention group. The language, phonetic and cognitive development levels of the intervention group, the non-intervention group and the normal children were compared. Results (1) The speech ability DQ of the intervention group (92.25±17.32) was higher than that of the non-intervention group (70.44±29.99), and the difference was statistically significant (P =0.00). The speech ability DQ of the intervention group and the normal children (100.29±8.86) was not statistically significant (P =0.07). The speech ability DQ of the non-intervention group was lower than that of the normal children, and the difference was statistically significant (P =0.00). Grade correlation analysis showed that the correlation between the language rehabilitation level and the degree of hearing loss of the intervention group was not statistically significant (P =0.27). (2) The response ability DQ of the intervention group (101.40±7.66) was higher than that of the non-intervention group (83.94±22.09), and the difference was statistically significant (P =0.00). The responsive human energy DQ of children in the non-intervention group was lower than that of normal children, and the difference was statistically significant (P =0.00); There was no significant difference between the three groups of rough movement, fine movement and physical energy DQ. (3) In the intervention group, except for 1 child with extremely severe hearing impairment, the consonant pronunciation of other children was normal. In the non-intervention group, 1 case of moderate, severe and severe children showed/d/pronunciation abnormality, 6 cases of moderate/d and m/pronunciation abnormality in extremely severe children, and the other children were normal. In the intervention group, except 2 cases of extremely severe children with abnormal tone, the other children had normal tone. In the non-intervention group, there were 2 cases, 1 case, 1 case and 12 cases of moderate, moderate, severe and extremely severe children with abnormal tone, respectively. Conclusion The language, phonetic and cognitive level of infants with hearing impairment without intervention is significantly lagging behind that of normal children, and early intervention can significantly improve the language, phonetic and cognitive ability of children with hearing impairment.

Objective to investigate the possibility, safety and timeliness of using human hyperpolarization-activated cyclic nucleotide-gated cation channel gene subtype 4 to construct biological pacing points in rat heart.Methods 6-week-old SD rats were divided into control group (10 rats) and experimental group (10 rats). 50 μ l of adenovirus and human hyperpolarization-activated cyclic nucleotide-gated cation channel gene subtype 4 recombinant adenovirus (titer 1010~1012) were injected into the left ventricular apex through epicardial injection. On the 7th day after surgery, bilateral vagus nerve trunks in the neck were separated and stimulated bilaterally or unilaterally, and body surface electrocardiogram was recorded at the same time. Then, pacing mapping was performed at the apex of the heart. Finally, the heart was removed for pathological examination and immunofluorescence. Results No ventricular arrhythmia was recorded in ECG within 3 days after surgery. When the cervical vagus nerve trunks were stimulated on the 7th day after surgery, the frequency of ventricular acute beat rhythm in the experimental group was significantly faster than that in the control group (69 bpm ± 6 bpm and 41 bpm ± 10 bpm, respectively, P<0.001). Both ECG and pacing mapping confirmed that the ventricular acute beat rhythm in the experimental group originated near the injection site. Immunofluorescence confirmed that the local human hyperpolarization-activated cyclic nucleotide-gated cation channel gene subtype 4 protein was over-expressed. After one month, the expression of this protein was not detected in the heart tissue at the injection site. Conclusion The introduction of human hyperpolarization-activated cyclic nucleotide-gated cation channel gene subtype 4 into the ventricle can cause the local over-expression of channel protein, Increasing the frequency of ventricular ectopic pacemakers. The long-term effects of using human hyperpolarization activated cyclic nucleotide-gated cation channel gene subtype 4 to construct biological pacemakers in vivo need to be further investigated.

Objective to investigate the dynamic changes of serum pepsinogen (PG) content and its significance. Methods 444 cases of gastric cancer screening in Zhuanghe area of Liaoning Province were examined by enzyme-linked immunosorbent assay (ELISA) at initial examination and follow-up, respectively, and the PG Ⅰ/Ⅱ ratio was calculated. Diagnosis of gastric diseases by gastroscopy and histopathological examination of gastric mucosa; Results (1) The age groups were ≤40 years old, 41-50 years old, 51-60 years old and ≥61 years old. Among all age groups, the change rate of PG Ⅱ (0.84) was significantly lower than that of 12 months (1.22, P =0.019) and 30 months (1.24, P =0.004), and the change rate of PG Ⅰ/Ⅱ ratio (1.09) was significantly higher than that of the latter two groups (0.75, P =0.027, 0.69, P =0.001). (2) The change rate of PG Ⅰ (0.69) was significantly lower than that of 12 months (0.97, P =0.002) in the 6-month follow-up group with superficial gastritis (SG) reduction; The change rate of PG Ⅰ/Ⅱ was significantly higher in the 6-month follow-up group (1.13) than in the 30-month follow-up group (0.75, P =0.042). (3) The change rate of PG Ⅰ in the SG → NOR (normal) group (0.94) was significantly higher than that in the SG → AG group (0.79, P =0.022); The change rate of PGⅠ and PGⅡ in AG→NOR group (0.43, 0.60) was significantly lower than that in AG→SG group (0.87, P =0.000,1.11, P =0.010). (4) The change rate of PGⅠ in Hp negative → positive group (0.94) was significantly higher than that in negative → negative group (0.81, P =0.026); The change rate of PG Ⅰ and PG Ⅱ in the positive-negative group (0.74, 0.86) was significantly lower than that in the positive-positive group (0.93, 1.15, all P =0.000), and the change rate of PG Ⅰ/Ⅱ ratio (0.90) was significantly higher than that in the latter group (0.70, P =0.022). Conclusion The change rate of serum PG is closely related to the follow-up time, the nature of gastric disease and the change of Hp infection status of the subjects.

Objective to investigate the expression of Snail and E-cadherin in pancreatic cancer tissues and its effect on the invasive biological behavior of pancreatic cancer by inhibiting E-cadherin. Methods The expression of Snail and E-cadherin in 56 cases of pancreatic cancer tissues was detected by immunohistochemistry, and compared with the clinical and pathological data. At the same time, the encoding gene of Snail was introduced into pancreatic cancer cell line Panc-1 to observe its effect on the expression and invasive ability of E-cadherin in pancreatic cancer cells. Results 20 cases (36%) of Snail were positive in 56 cases of pancreatic cancer tissues. The positive expression rate of Snail was higher in cases with lymph node metastasis (P =0.006), distant metastasis (P =0.001) and decreased E-cadherin expression (P =0.038). After introducing the encoding gene of Snail into Panc-1 cells, the expression of E-cadherin was significantly inhibited and the invasive ability of cells was promoted in vitro. Conclusion Snail is re-expressed in pancreatic cancer, and Snail may play a role in the invasive process of pancreatic cancer by inhibiting E-cadherin.

Objective to observe the correlation between S100A2 and pancreatic cancer secondary radiation-resistant cell lines. Methods the expression levels of S100A2 gene and protein in pancreatic cancer cell lines and their secondary radiation-resistant strains were detected, and the changes of radiation-resistant cell lines treated with 5-aza-2-deoxycytidine were detected, and the changes of related radiosensitivity were detected. Results Compared with the parent strain, the gene and protein levels of S100A2 in pancreatic cancer cell line SW1990 radiation-resistant cell lines were significantly lower (2~3 times). The mRNA and protein levels of S100A2 in radiation-resistant cell lines treated with 5-aza-2-deoxycytidine were significantly higher (2~5 times) than those before treatment, and the radiation-resistant activity of the treated cell lines was significantly reduced. Conclusion The low expression of S100A2 in pancreatic cancer secondary radiation-resistant cell lines may be one of the mechanisms causing its secondary radiation-resistant characteristics.

Objective to investigate the role of human fibroblast growth factor receptor 1 isoform Ⅲb (FGFR1-Ⅲb) in the proliferation of TAKA-1 pancreatic ductal cells and its regulation of mitosis-activated protein kinase (MAPK). Methods The expression, distribution and structural characteristics of FGFR1-Ⅲb in TAKA-1 pancreatic ductal cells were identified by Western blot, Northern blot, immunofluorescence and glycosylation analysis. The transfected cells were stimulated by growth factor, and the function and mechanism of FGFR1-Ⅲb receptor in pancreatic ductal cells were observed by MTT assay and MAPK analysis. Results FGFR1-Ⅲb receptor was a glycosylation receptor located between 120,000 and 130~150,000, which was moderately expressed on the surface of cell membrane and cytoplasm, highly expressed in the perinuclear region of cytoplasm, but not in the nucleus. FGF-1, -2 and-4 could significantly promote the transfection FGF-1, -2 and-4 can promote the proliferation of TAKA-1 cells transfected with FGFR1-Ⅲb gene by promoting the phosphorylation of p44/p42 MAPK.

A 27-year-old male was admitted to the First Hospital of Peking University on December 19, 2005 due to intermittent gingival bleeding for more than 1 year, aggravated with fatigue and shortness of breath for more than 2 months. The patient began to have gingival bleeding 1 year ago, about 1 or 2 times a month, the amount of bleeding was not large, there was no obvious cause, and the bleeding could be stopped by itself. Because it was not accompanied by other serious symptoms, no diagnosis and treatment was performed. Two months ago, the patient's gingival bleeding aggravated, accompanied by intermittent bleeding spots and ecchymosis on both lower limbs. The gingival bleeding occurred every day, affecting brushing, but the bleeding could be stopped by itself. At the same time, the patient felt fatigue and shortness of breath, especially after activity. 40 days ago, the patient went to another hospital, and the routine blood test showed: white blood cells 0.7×109/L, hemoglobin 52g/L, and platelets 13×109/L. Bone marrow (posterior iliac) smear examination of bone marrow cell proliferation obviously active, the diagnosis of myelodysplastic syndrome-refractory anemia. The patient was given stanozolol (stanozolone), prednisone, cyclosporine A and Zaizao Shengxue Pill for treatment, and intermittent transfusion of platelet and red blood cell suspension for supportive treatment, but the condition was not improved. The patient was admitted to our hospital for further diagnosis and treatment.

With the gradual maturity of liver transplantation technology in China and the improvement of long-term survival rate of patients, post-liver transplantation diabetes mellitus (PTDM) has gradually received attention as a complication affecting the survival rate of patients. According to multi-center reports, the incidence of PTDM is about 20%, and it has the characteristics of decreasing with the prolongation of survival time [1]. The exact mechanism is still unclear. PTDM not only causes complications of the recipient's cardiovascular system, nervous system, blood system and respiratory system, but also causes risks such as acute rejection, infection, long-term microvascular disease and chronic rejection of the donor liver.

Migraine is a common primary chronic intermittent neurovascular headache, characterized by severe episodic headache accompanied by autonomic dysfunction. Some patients may have migraine aura manifested as transient neurological dysfunction. Ischemic stroke is more common in young women with migraine. At present, some studies have found that migraine (especially migraine with aura) can increase the risk of ischemic stroke. Although there are literature reports that migraine is related to adverse cardiovascular factors, the relationship between migraine and coronary heart disease is not clear

postoperative cognitive dysfunction (POCD) is a common complication of coronary artery bypass graft (CABG). The etiology of POCD is still unknown. Since it was first proved that high-dose fentanyl anesthesia can provide relative circulatory stability in 1969, opioids have been dominant in cardiac anesthesia. When using high-dose fentanyl (50~150 μ g/kg) anesthesia, patients need routine postoperative mechanical ventilation due to the prolonged respiratory depression induced by opium. However, few authors have noticed the effect of high-dose fentanyl on POCD due to the routine use of mechanical ventilation after CABG and the recognition of high-dose fentanyl anesthesia.

A 43-year-old female was admitted to the hospital on April 10, 2006 due to "repeated palpitations and shortness of breath, accompanied by aggravation of fatigue for more than 1 year". The patient was diagnosed with rheumatic heart valve disease 5 years ago, and was replaced with aortic valve and mitral valve, implanted with artificial mechanical valve, and underwent tricuspid valve Devega plasty in the cardiac surgery department of our hospital. The operation was smooth. The patient recovered well after operation and was followed up regularly. Until 1 year ago, he developed palpitations and shortness of breath, accompanied by aggravation of fatigue. Physical examination in the local hospital found abnormal heart murmur, and ultrasound showed right ventricular fistula of aortic sinus, and was treated symptomatically. Later, the patient was transferred to our hospital due to repeated disease. During the course of the disease, the patient had no history of fever and sudden chest pain.

A 58-year-old male was admitted to the hospital on July 12, 2005 due to repeated fever, cough and expectoration for 18 months. Nine years ago, the patient underwent radiotherapy, left cervical lymph node dissection and chemotherapy in the local hospital due to nasopharyngeal carcinoma with bilateral cervical lymph node metastasis and poorly differentiated squamous cell carcinoma. After treatment, his general condition was ok and he could work normally, but multiple physical examinations showed that CD4 was low. Two years ago, he started to have unclear speech, dysphagia, weakened cough reflex, repeated lung infection without obvious trigger, and the growth of Staphylococcus aureus, Enterococcus faecalis and Escherichia coli alternately appeared in sputum culture. He had respiratory failure due to lung infection twice and was rescued by ventilator, and repeatedly treated with broad-spectrum antibiotics.