Volume 86  ·   Issue 46  ·  2006

In our country, the incidence of gastric cancer is high like other common tumors, and the existing diagnosis and treatment methods are not suitable for early detection, so it is difficult to obtain satisfactory curative effect.Previous clinical data show that the 5-year survival rate of early gastric cancer after surgery is obviously higher than that of middle and late stage gastric cancer, especially the diagnosis rate of early gastric cancer in Japan is far higher than that in China.However, in view of the existing economic strength and the popularization of medical knowledge and technology in our country, it is impossible for us to adopt the same way to achieve such goal in a short time.Therefore, we should seriously consider the basic and clinical research strategies and models of gastric cancer in our country in combination with the scientific problems, social needs and our practical ability of gastric cancer prevention and treatment in our country, so as to provide theoretical guidance for reducing the incidence, improving the level of early diagnosis and improving clinical efficacy, and avoiding improper treatment and excessive treatment.

At present, gastric cancer is still a malignant tumor with high morbidity and mortality. In 2000, about 974 000 newly diagnosed gastric cancer patients and about 734 000 died of gastric cancer in the world, and the treatment effect is still not satisfactory. The situation in China is very similar, and gastric cancer has been at the forefront of the death causes of malignant tumors for decades.

Objective to compare the data of different types of primary aldosteronism, and to investigate the clinical characteristics, preoperative diagnostic methods and surgical efficacy of primary aldosterone patients with unilateral adrenal nodular hyperplasia. Methods 145 patients with primary aldosteronism were divided into aldosteronoma group, unilateral adrenal nodular hyperplasia group and bilateral hyperplasia group. The preoperative clinical data, biochemical and hormone levels, hypertensive target organ damage of each group were analyzed, and the postoperative blood pressure, serum potassium and serum aldosterone levels were compared in each group. All patients underwent adrenal CT examination before operation, and 62 patients underwent adrenal intubation blood sampling. Results Among 145 patients, unilateral nodular hyperplasia was found in 14 cases, aldosteronoma was found in 76 cases, and bilateral hyperplasia was found in 55 cases. The incidence of unilateral nodular hyperplasia was 9.7% (14/145); Sex composition, age of onset, time of hypertension, blood pressure and the degree of damage to target organs of hypertension were similar to those of the other two groups; The blood potassium, blood and urine aldosterone values were between aldosteronoma and bilateral hyperplasia; The CT examination of unilateral adrenal nodular hyperplasia was 50% (7/14) consistent with the diagnosis, and the accuracy of adrenal vein catheterization was 85.7% (12/14); The blood potassium and aldosterone of patients with unilateral adrenal nodular hyperplasia returned to normal, 50% (7/14) of blood pressure returned to normal, and 50% (7/14) of blood pressure improved significantly. Conclusion Unilateral adrenal nodular hyperplasia can be cured by surgery, and the clinical and adrenal CT examination have some suggestive effects.

Objective to compare the effects of adenosine diphosphate (ADP) on platelet aggregation rate and the expression of activation markers on platelet membrane surface during the activation of two types of thrombin receptors, and to investigate the role of ADP in the mechanism of thrombin signaling. Methods Thrombin receptor (PAR) activating peptides PAR1-AP and PAR4-AP were used to induce platelet activation, respectively, and the changes of platelet aggregation and glycoprotein (GP) Ib and P-selectin on platelet membrane surface during the action of adenosine triphosphate bisphosphatase (ADP inhibitor) VⅡ were observed. Results Both types of thrombin receptors could induce platelet activation and produce complete aggregation wave, while platelet membrane GPIb showed a reversible change with progressive decrease and then gradual recovery, and the level of P-selectin continued to increase. After apyraseV Ⅱ, the platelet aggregation induced by PAR1-AP was partially inhibited, but the platelet aggregation induced by PAR4-AP was not significantly changed. The expression of P-selectin in both activation pathways was not affected by APYRASEV Ⅱ. Conclusion ADP plays an important role in thrombin signaling, and the PAR1 pathway is closely related to the involvement of ADP.

Objective to study the pathological significance of enhancement range of hepatocellular carcinoma (HCC) from arterial stage to portal stage by contrast-enhanced ultrasound (CEUS), and to explore the application value of CEUS in defining the boundary invasion range of hepatocellular carcinoma (HCC). Methods 41 cases of hepatocellular carcinoma (HCC) were resected by surgery and 11 cases of hepatocellular carcinoma (HCC) were confirmed by ultrasound-guided puncture. The boundary enhancement range of CEUS tumor was increased or more irregularly enhanced in group A, and the boundary morphology was not changed in group B. Pathological specimens of tumor margin junction area (peritumoral tissue) were taken, and HE staining and CD34 immunohistochemical staining were performed to detect their pathological characteristics and micro-blood supply status, and comparative studies were performed. Results 32 (61.54%) of 52 hepatocellular carcinoma tumors in group A, of which 75% (24) showed unclear tumor boundary; Among the 20 lesions in group B, 40% (8 lesions) showed unclear US boundary (P<0.05). The mean maximum diameter values of tumors in group A and B were (6.1±2.9) cm and (4.4±2.1) cm, respectively (P<0.05). Analysis of 41 surgically resected hepatocellular carcinoma specimens showed that 88% (66) of 75 pathological sections in 25 lesions in group A showed invasive growth of peritumoral cancer cells, which was significantly higher than 56.3% (27/48 lesions, P<0.001) in 16 lesions in group B. CD34 immunohistochemical staining showed that the peritumoral microvessel density (MVD) in group A was significantly higher than that in group B (52.25 vs 36.82, P<0.01). Conclusion The enhancement range of hepatocellular carcinoma in CEUS is closely related to the definition of tumor boundary, and the increase of cancer cell infiltration and microvessel angiogenesis in the enhanced region of tumor boundary, which reflects the pathological characteristics of invasive growth of cancer tissue. CEUS is helpful to define the boundary size and infiltration range of hepatocellular carcinoma, and can provide reference for local treatment.

Methods From January 2001 to March 2006, 32 cases of hepatolenticular degeneration were treated by living donor partial liver transplantation, including 29 children, 3>14 years old, 3 acute liver failure, 29 chronic liver insufficiency, 13 with different degrees of nervous system dysfunction, 7 fathers and 25 mothers, with normal ceruloplasmin and 24 hours urine copper<100 μ g. Results After 3-63 months of follow-up, 28 cases survived, 2 cases died during perioperative period, 2 cases died of bile leakage and uncontrolled rejection complicated with infection, 2 cases developed hepatic artery embolism and needed retransplantation, 1 case developed common bile duct anastomotic stenosis 8 months after operation and underwent biliary enterostomy, 2 cases developed rejection at 22 and 28 months after operation, and it was reversed after switching to Procort. Among the patients with neurological dysfunction, 11 cases obtained long-term survival, and postoperative extrapyramidal symptoms, language and motor disorders were significantly improved. Conclusion Relative living donor partial liver transplantation is an effective method for the treatment of hepatolenticular degeneration. Most patients with neurological dysfunction have different degrees of improvement after operation.

Objective to compare and study the occurrence and development characteristics of peritoneal adhesion induced by trauma, ischemia, infection and foreign body in rats.Methods 236 SD rats were randomly divided into 5 groups.Group A: sham operation control group; Group B: talc-induced adhesion group; Group C: Trauma-induced adhesion group; Group D: Infection-induced adhesion group; Group E: Adhesion group caused by vascular ligation. Each group was treated with corresponding methods to make intestinal adhesion models. The adhesion degree of the blind end of the vermis process was evaluated by Bhatia grading method at 1, 2, 4 and 8 weeks after modeling, and the hydroxyproline (OHP) level and pathological examination were performed on the blind end tissues. Results (1) Degree of peritoneal adhesion: At 1, 2, 4 and 8 weeks, the degree of adhesion in groups B, C, D and E was significantly more significant than that in group A (P<0.05), and in groups B and D was significantly more significant than that in group C and E (P<0.05); There was no significant difference in the degree of adhesion between groups B and D at each time point (P>0.05), and there was no significant difference between groups C and E at 1, 2 and 4 weeks (P>0.05). The degree of adhesion was significantly reduced at 8 weeks compared with the former (P<0.05); (2) OHP level: There was no statistically significant difference between the time points in group A (P>0.05); There was no significant difference in OHP levels between groups B, D and E at 1, 2 and 4 weeks after operation (P>0.05), and it decreased significantly at 8 weeks compared with the previous 3 time points (P<0.05); In group C, the level of OHP (0.275 ± 0.031) μ g/mg at 2 weeks was significantly higher than that at 1 week [(0.221 ± 0.036) μ g/mg, P<0.05)], and the level of OHP (0.254 ± 0.030) μ g/mg at 8 weeks was significantly lower than that at 1, 2 and 4 weeks (P<0.05); At 1, 2 and 4 weeks, the levels of OHP in groups B, C, D and E were significantly higher than those in group A (P<0.05), and the levels of OHP in groups B and D were significantly higher than those in groups C and E (P<0.05); At 8 weeks, the level of OHP in group B (0.227±0.029) μ g/mg was still significantly higher than that in group A [(0.151±0.026) μ g/mg, P<0.05)], while the level of OHP in groups C, D and E had decreased to that in group A (P>0.05); (3) The correlation between the degree of adhesion and the level of OHP: There was a significant positive correlation between the degree of adhesion and the level of OHP in groups C and E (P<0.05), but the correlation between the degree of adhesion and the level of OHP in groups B and D was not significant (P>0.05); All samples in the five groups were analyzed at each time point, and there was a significant positive correlation between adhesion degree and OHP level at 1, 2 and 4 weeks, respectively (P<0.05), but there was no significant correlation at 8 weeks (P>0.05); (4) Pathological examination: Foreign body granulomatous reaction and fibrous tissue proliferation were the main in group B, while non-specific inflammatory reaction and fibrous tissue proliferation were the main in other experimental groups. Conclusion the peritoneal adhesion caused by different causes has its own characteristics in the process of occurrence and progression. Compared with the adhesion caused by trauma and ischemia, the adhesion caused by infection and foreign body is more severe and less reversible; When measuring the degree of peritoneal adhesion by OHP level, the early stage of adhesion is more reliable.

Objective to observe the effects of transplantation of hepatocytes derived from embryonic stem cells (ESC) on acute liver failure (FHF) mice. Methods D3-ES cells were selected and the differentiation of hepatocytes was induced by transforming growth factor, fibroblast growth factor and hepatocyte growth factor. The expression of hepatocyte markers such as alpha-fetoprotein (AFP), albumin (ALB) and glucose 6 phosphatase (G6P) were detected by reverse transcription polymerase chain reaction and immunocytochemistry. The spatial distribution of positive cells was observed, and the cells in positive regions were sorted by cell shovel and transplanted into the liver of the same line (129 line) mice. FHF was induced by carbon tetrachloride, and then the survival time, liver function indexes and the growth status of the transplanted cells were observed. Results (1) The expression of AFP, albumin and G6P started at the earliest day and gradually increased. (2) The mean survival time of the transplanted group (60 h) was statistically significant (P<0.05); The liver function indexes of the transplanted group were significantly improved compared with the control group (P<0.05). (3) The transplanted cells expressed ALB, and no tumor formation was found at the transplanted site. Conclusion the ESC-derived hepatocytes can express the function of mature hepatocytes, and it can play a good role in the treatment of FHF in mice after transplantation.

Objective to study the electrophysiological characteristics of the heart of "desert people" in Taklimakan. Methods 224 "desert people" were examined by resting electrocardiogram (133 males and 91 females, 151 controls, 76 males and 75 females). The 12-lead static electrocardiogram of the subjects was examined by Minnesota coding, and the relevant data were analyzed by χ 2 test.Results (1) The abnormal coding rate was 103 cases (46%) in "desert people" group, 73 males and 30 females. (2) The left ventricular hypertension (3-1, 3-3) was 73 cases (32.6%) in "desert people" group, (55 males and 18 females) in the control group, 19 cases (12.6%), (11 males and 8 females) in the control group. (3) The detection rate of hypertension was 17 cases (7.6%) in "desert people" and 59 cases (39.6%) in the control group. (4) 21 cases (9.6%) were overweight and obese in "desert people" and 23 cases (23%) in the control group. (5) Cardiac arrhythmia: 20 cases (8.9%) in "desert people" and 10 cases (6.6%) in the control group High pumping function of the heart leads to physiological hypertrophy of the myocardium and thin chest wall.

Objective to investigate the patients with nasopharyngeal carcinoma who underwent radical radiotherapy alone in our hospital, and according to the recurrence and metastasis after radiotherapy, to propose the clinical radiotherapy classification of nasopharyngeal carcinoma and summarize its distribution patterns. Methods 842 inpatients with nasopharyngeal carcinoma who underwent radical radiotherapy alone in the Cancer Prevention and Treatment Center of Sun Yat-sen University in 1990s were randomly selected. According to the 5-year follow-up results, the patients with no recurrence of primary site or regional lymph nodes and no distant metastasis were classified as radiation-sensitive and difficult to metastasize (type Ⅰ), those with recurrence of primary site or regional lymph nodes and no distant metastasis were classified as radiation-resistant and difficult to metastasize (type Ⅱ), those without recurrence of primary site or regional lymph nodes and no distant metastasis were classified as radiation-sensitive and easy to metastasize (type Ⅲ), those with recurrence of primary site or regional lymph nodes and no distant metastasis were classified as radiation-resistant and easy to metastasize (type Ⅳ), Results (1) The proportions of the four types of radiotherapy were 50.6% (426 cases), 23.2% (195 cases), 20.7% (174 cases), and 5.6% (47 cases). (2) Among the 842 patients, 264 cases could be classified according to Xie classification standard, including 24.6% (65 cases) ascending type, 23.1% (61 cases) descending type and 52.3% (138 cases) mixed type; Among the ascending types: type Ⅰ 58.5%, type Ⅱ 29.2%, type Ⅲ 10.8% and type Ⅳ 1.5%; Among the descending types: 47.5% of type Ⅰ, 9.8% of type Ⅱ, 36.1% of type Ⅲ and 6.6% of type Ⅳ; Among the mixed types, there were 34.8% of type Ⅰ, 26.8% of type Ⅱ, 33.3% of type Ⅲ, and 5.1% of type Ⅳ. (3) There were 307 cases in early stage (Ⅰ and Ⅱ) of 92, 62.2% (191 cases) of type Ⅰ, 21.2% (65 cases) of type Ⅱ, 12.4% (38 cases) of type Ⅲ, and 4.2% (13 cases) of type Ⅳ; There were 535 cases of advanced stage (Ⅲ and Ⅳ), 43.9% (235 cases) of type Ⅰ, 24.3% (130 cases) of type Ⅱ, 25.4% (136 cases) of type Ⅲ and 6.4% (34 cases) of type Ⅳ. Conclusion There are four types of radiotherapy classification in nasopharyngeal carcinoma, and their composition ratio is: radiosensitive and difficult to metastasize (Ⅰ)>radioresistant and difficult to metastasize (Ⅱ)>radiosensitive and easy to metastasize (Ⅲ)>radioresistant and easy to metastasize (Ⅳ). The proportion of radiosensitive and easy to metastasize (Ⅲ) is greater than that of radioresistant and difficult to metastasize (Ⅱ) in Xie's descending and mixed types and 92 Fuzhou clinical stages (Ⅲ and Ⅳ). Radiotherapy classification is a supplement to the clinical classification and staging of nasopharyngeal carcinoma.

Phosphatidylinositol-3 kinase (PI3K) is an important component of growth factor signaling pathway, which regulates cell proliferation, differentiation, survival and migration [1]. The constitutive activation of PI3K signaling pathway can not only lead to malignant cell transformation, but also correlates with tumor cell migration, adhesion and tumor angiogenesis [2-4]. P55 γ is one of the regulatory subunits of PI3K, which can bind to the catalytic subunit p110, and can bind to insulin receptor substrate 1 (IRS-1) when stimulated by insulin to express PI3K activity [5], but its role in growth factor signaling and PI3K function is unclear.

Objective to investigate the effect of calcyclin-binding protein (CacyBP) on the proliferation of gastric cancer cells and its possible mechanism.Methods A small interfering RNA (siRNA) expression vector of CacyBP was constructed and transfected into human gastric cancer cell line SGC7901 by liposome method.The cell growth was observed by tetramethylazolium salt (MTT) colorimetry.The tumorigenicity of transfected cells in vitro and in vivo was detected by plate cloning assay and nude mice tumorigenesis assay.The expression of some related molecules in transfected cells was detected by Western blot and semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). Results The siRNA expression vector of CacyBP was successfully constructed, and the expression of endogenous CacyBP was significantly inhibited after transfection into SGC7901 cells.The growth of transfected gastric cancer cells with down-regulated CacyBP expression was accelerated; The clone formation rate of SGC/CacyBP-siRNA1 cells (0.35±0.03) and SGC/CacyBP-siRNA2 cells (0.43±0.05) was significantly higher than that of control cells (0.18±0.03) (P<0.01), and the tumor formation ability in vitro was enhanced; The tumor of SGC/cacyBP-siRNA-bearing nude mice was significantly larger than that of control mice (P<0.001), and the survival time of the tumor-bearing nude mice was significantly shortened (P<0.01). The mRNA and protein of COX-2 and cyclin D1 were significantly increased in the transfected cells, and the protein levels of β-catenin, Rac-1 and heat shock protein 70 were increased, but the mRNA was not significantly changed.

Objective to evaluate the effect of intraperitoneal application of polypeptide PⅢ on peritoneal metastasis of gastric carcinoma during operation and early postoperative.Methods 48 nude mice were implanted in situ with intact tissue block in the stomach wall of nude mice to establish a model of peritoneal metastasis of gastric carcinoma similar to clinic.16 rats in each group were randomly divided into ① control group; ② Intraoperative polypeptide lavage in the abdominal cavity + postoperative polypeptide treatment group (immediately before closing the abdomen, the abdominal cavity was washed twice with 60 ml and 200 μ g of polypeptide PⅢ dissolved in 43℃ normal saline); ③ Postoperative polypeptide treatment group. Treatment was started 1 week after operation, and each nude mouse in the control group was intraperitoneally injected with 0.2 ml of normal saline on the 8th, 10th, 12th, 14th, 16th, 18th, 20th and 22nd days. Group 2 and Group 3 were given intraperitoneal injection of polypeptide PⅢ 2 mg/kg at the same time as the control group, respectively. Six nude mice were sacrificed on the 23rd day after transplantation, and the in situ tumor weight was measured to observe the peritoneal metastasis. The other nude mice were used for survival test. Results The in situ tumor weights of nude mice in the control group, intraoperative polypeptide lavage + postoperative polypeptide treatment group and postoperative polypeptide treatment group were (1.93±0.22) g, (1.81±0.36) g and (1.95±0.45) g, respectively. The number of peritoneal metastatic nodules in nude mice in control group, postoperative polypeptide treatment group and intraoperative peritoneal polypeptide lavage + postoperative polypeptide treatment group were (126.3±9.6), (64.2±8.3) and (9.2±1.3), respectively; The average number of peritoneal metastatic nodules larger than 2 mm in nude mice were (51.2±3.6), (21.7±4.9) and (1.6±0.2) respectively, and the differences were statistically significant compared with the control group (all P<0.01). The survival test in nude mice showed that the survival time of nude mice in the intraoperative polypeptide lavage + postoperative polypeptide treatment group was significantly longer than that in the control group and postoperative polypeptide treatment group.Conclusion Intraperitoneal administration of polypeptide PⅢ can significantly reduce the occurrence of peritoneal metastasis of gastric cancer in nude mice and prolong the survival time significantly, and it is expected to be a clinical drug for the treatment of peritoneal metastasis of gastric cancer.

Objective to investigate whether celecoxib combined with octreotide can inhibit the metastasis of human gastric cancer cells. Methods Seventy-five patients with gastric cancer were randomly divided into three groups, 25 cases in each group. (1) Control group: without any anti-tumor drugs before operation. (2) Celecoxib group: oral celecoxib 200 mg/d before operation, 7 days. (3) Combination group: Celecoxib 200 mg/d (7 d) + octreotide 100 μ g/d (subcutaneous injection 7 d) before operation. Immunohistochemistry showed the expression of epithelial cadherin (E-Cad) and matrix metalloproteinase (MMP) in gastric cancer, and the expression of MMP-2 and MMP-9 proteins in gastric cancer tissues was quantitatively detected by immunoblotting. Primary gastric cancer cells were obtained by digestion and immunomagnetic beads. The motility of gastric cancer cells in the three groups was compared with the modified Bodyen Chamber membrane invasion system. Results The abnormal expression rate of E-Cad in gastric cancer tissues was significantly lower in the combination group (28.0%) and celecoxib group (44.0%) than in the control group (56.0%, P<0.05). The integral values of MMP-2 and MMP-9 protein bands were 99±20, 260±15, 314±11, 89±13, 180±13, 241±12, respectively. The combination group and celecoxib group were also significantly lower than the control group (P<0.05). The migration of gastric cancer cells in the combination group was lower than the control group

Objective to determine the relationship between the expression changes of transforming growth factor β 1 (TGF-β 1) and its receptor genes and downstream Smad gene family members in intestinal gastric cancer and its clinicopathological characteristics and prognosis. Methods Based on the establishment of differential gene expression profiles of gastric cancer, the expression levels of TGF-β 1 in gastric cancer and adjacent tissues with normal morphology were determined. Further, the expression levels of TGF-β 1 in gastric cancer and adjacent tissues with normal morphology were detected by tissue microarray and immunohistochemical staining, respectively. Results TGF-β 1 protein was mainly cytoplasmic staining, and the expression of TGF-β 1 protein was positive in 32 cases (36%) and negative in 58 cases (64%) of 90 gastric cancer tissues. Further, the expression of TGF-β 1 protein in gastric cancer tissues with different differentiation degrees was analyzed. The results showed that 23 cases (59%) of 39 cases of high and medium differentiation tissues were positive, while 9 cases (18%) of 51 cases of poorly differentiated gastric cancer were positive, the difference was statistically significant (P<0.01). The expression of TGF-β 1 and TGF-β R-Ⅰ protein in intestinal gastric cancer with follow-up data were analyzed. The survival time of the positive and negative expression groups was analyzed by Kaplan-Meier method, and the survival and prognosis of the positive and negative expression groups were significantly better than those of the negative expression group (P =0.0058). However, the expression of TGF-β R-Ⅰ protein had no significant relationship with survival and prognosis (P =0.8453). Conclusion The expression level of TGF-β 1 is related to the differentiation degree of gastric cancer, and the prognosis of the positive and negative expression group is significantly better than that of the negative expression group, suggesting that the expression of TGF-β 1 has important clinical significance for the reclassification and classification of middle and advanced gastric cancer.

Idiopathic ventricular tachycardia (VT) and premature ventricular contractions (PVC) mainly originate from the right ventricular outflow tract (RVOT), and their ECG has obvious characteristics [1, 2], that is, they show typical left bundle branch block (LBBB type) with right deviation of the electric axis, and the migration of R wave in the chest lead mostly occurs in V4 or later, and good therapeutic effect can be obtained by radiofrequency ablation.Although radiofrequency ablation of VT and PVC in RVOT has a high success rate, some atypical LBBB type of VT and PVC can not be ablated successfully by traditional RVOT route.Literature reports that these arrhythmias may originate from the epicardium of the outflow tract, and ablation from the Valsalva sinus [3] or through the epicardial venous system can be successfully obtained [4, 5]. We have also encountered this situation in clinic.Therefore, we explored the electrocardiogram and electrophysiological characteristics of idiopathic VT and PVC successfully ablated by Valsalva left coronary sinus (LCC), and their clinical significance is discussed as follows.

Combined cardiopulmonary transplantation is an effective method for the treatment of end-stage cardiopulmonary diseases, but the operation is difficult, there are many postoperative complications, and the perioperative management is complicated.Especially in China, the number of cases is very small, and the survival rate is low. Our department completed clinical combined cardiopulmonary transplantation in 3 cases on December 24, 2004, July 21, 2005 and December 23, 2005, respectively. Some experience and lessons have been drawn from it, which are reported as follows.

Gastrointestinal stromal tumor (GIST) is rare, and primary gastrointestinal stromal tumor of the liver is rarely reported. 　　

The child, a female, 4 years old and 7 months old, had repeated bleeding with anemia for more than 4 years, aggravated for half a year. The child developed epistaxis without inducement about 5 months after birth, and it improved after symptomatic treatment. Persistent gingival bleeding occurred at 10 months, and then repeated mild skin petechiae, ecchymosis, epistaxis, gingival bleeding, and the bleeding was difficult to stop after bumping or needle pricking. Occasionally, there was a history of fever and hematuria before bleeding. No definite diagnosis has been made, and only symptomatic treatment has been made. The emergency department was admitted to the hospital with "the cause of bleeding with anemia to be investigated: hemophilia suspected". The child was delivered naturally at full term, and his parents, siblings and families of both parents had no similar medical history and genetic and metabolic history. The mother had no history of upper respiratory tract infection, medication and X-ray contact during pregnancy. Physical examination at admission: normal development, moderate nutrition, severe anemia. Old bleeding spots scattered around the skin can be seen, but the skin surface does not protrude. Several swollen lymph nodes the size of soybeans to peanuts can be palpable in the bilateral submandibular and neck, without adhesion or tenderness. The lips are pale, The oral mucosa is smooth and free of ulcers.