Volume 87  ·   Issue 12  ·  2007

Bladder cancer is the most common urogenital malignant tumor in China.The occurrence and development of bladder cancer is a multi-gene,multi-step,multi-stage,and the activation of proto-oncogenes and inactivation of tumor suppressor genes are closely related to bladder cancer.Detection of these tumor genes and related tumor markers is of great significance for understanding the pathogenesis, monitoring and follow-up,prognosis judgment and gene therapy of bladder cancer.

Bladder cancer occupies the first place in both morbidity and mortality among urinary system tumors in China, and the morbidity is increasing year by year. Since the end of the 20th century, the genetic research of tumor has made remarkable progress, and many tumor-related genes have been discovered. In recent years, the establishment of proteomics has provided more powerful means for the study of tumor-related genes expression and function. However, it is difficult to integrate all these related knowledge into a complete system to provide practical help for clinical treatment and diagnosis. Besides genetic heterogeneity, bladder cancer also involves complex tissue microenvironment, such as vasculature, interstitial cells and connective tissue. How to organically unify tumor cell lines, experimental animal models and human in vivo research of bladder cancer is still a problem that people are facing.

Objective to detect the expression of apoptosis inhibitory gene Livin in bladder transitional cell carcinoma tissues and to explore its role in the occurrence and development of bladder carcinoma. Methods the expression of Livin gene in 60 cases of bladder transitional cell carcinoma was detected by reverse transcription polymerase chain reaction (RT-PCR). Results the positive expression rate of Livin gene in 60 cases of bladder cancer tissues was 28.3%, and none of 10 cases of non-tumor bladder tissues had positive expression of Livin gene. The expression of Livin was not related to the pathological grade and clinical stage of bladder cancer (all P>0.05); The positive expression rate of Livin in 21 cases of recurrent bladder cancer was 38.1% (8/21), which was higher than that of primary bladder cancer (23.1%, 9/39). Conclusion Livin has a certain significance in the occurrence and development of bladder cancer, and the high expression of Livin suggests that patients may have a tendency to relapse early.

Objective to package recombinant secreted endostatin adeno-associated virus (rAAV-ES) and study its antitumor effect in vitro and in vivo. Methods rAAV-ES was packaged by plasmid co-transfection; The concentration of recombinant endostatin in the supernatant was determined by ELISA and its inhibitory effect on the chemotaxis of vascular endothelial cells after transfection (plural MOI =105) of bladder cancer cells (EJ). A nude mouse tumor model was established, and the tumor formation rate of EJ cells after transfection and the inhibition of tumor development and its toxic side effects after systemic application of rAAV-ES were detected.Results the bioactive rAAV-ES was successfully packaged, and the virus titer was 1.0×1012 v·g/ml; The concentration of recombinant endostatin in the supernatant after transfection of EJ cells was 54.09 ng/ml, and the inhibition rate of chemotaxis of vascular endothelial cells was 37.45%; After rAAV-ES transfection, the tumor formation rate of EJ cells was only 2/5 of that of the control group. In vivo experiments confirmed that the serum endostatin expression was high for a long time (30~40 ng/ml) after systemic application of rAAV-ES, the tumor growth rate was slow (32 days ± 9 days), the microvessel density in tumor was low [(8 ± 3) strips/0.739 mm2], and the difference was statistically significant compared with the control group (all P<0.05). No ischemia and other abnormal changes were found in the cardiac and brain histological examination.Conclusion rAAV-ES has no toxic and side effects, and can effectively inhibit the angiogenesis of tumor, thus inhibiting the occurrence and development of bladder cancer.

Objective to compare the difference of gene expression profiles between superficial and invasive bladder carcinoma in humans.Methods the RNA of superficial and invasive bladder carcinoma was detected and analyzed by gene chip technique.The gray scanning images of the chip were obtained.The image processing software GenePix Pro 3.0 was used to analyze the images to obtain the corresponding data of expressing differential genes.The data were analyzed according to the types of differential genes and the characteristics of bladder carcinom.Results According to the criterion of significant differential genes,significant differential expression genes were selected from 13939 genes:714 genes in superficial group, of which 480 were down-regulated and 234 were up-regulated; In the invasive bladder carcinoma group, 302 were down-regulated and 168 were up-regulated. Among the significant differential genes, the number of down-regulated genes was nearly 1 times higher than that of up-regulated genes, and the immune-related genes were the most down-regulated in invasive bladder carcinoma. Conclusion The gene expression profiles of invasive bladder carcinoma and superficial bladder carcinoma have many common features, but the differential expression genes in superficial bladder carcinoma are more than that in invasive bladder carcinoma.

Objective to investigate the expression of GLI1 mRNA in Hedgehog signaling pathway in pancreatic cancer tissues and its clinical significance. Methods the expression of GLI1 mRNA in 25 cases of pancreatic cancer tissues, their adjacent tissues and adjacent normal tissues was detected by reverse transcription polymerase chain reaction (RT-PCR), and the relationship between GLI1 mRNA expression in pancreatic cancer tissues and tumor size, differentiation degree and metastasis was analyzed. Results the positive expression rates of GLI1 mRNA in pancreatic cancer tissues, adjacent tissues and adjacent normal tissues were 68.0% (17/25), 24.0% (6/25) and 0, respectively. The positive expression rates of GLI1 mRNA in pancreatic cancer tissues were significantly higher than those in adjacent tissues and adjacent normal tissues (all P<0.01); The positive expression rate of GLI1 mRNA was correlated with tumor differentiation (P =0.014), but not with tumor size, presence or absence of lymph nodes and distant metastasis (P>0.05). Conclusion the positive expression rate of GLI1 mRNA was higher in pancreatic cancer tissues, and its expression rate was correlated with tumor differentiation. Detection of GLI1 mRNA expression was helpful in the diagnosis of pancreatic cancer, and may be used as an index to judge the malignant degree and prognosis of pancreatic cancer.

Objective to compare the value of ultrasound-guided 16G needle biopsy and 18G needle biopsy in the diagnosis of space-occupying liver lesions.Methods From September 1998 to September 2005, a total of 246 patients underwent liver histological biopsies.Among them, 141 patients (77 males and 64 females, mean age 51.2 years) underwent 16G needle biopsy, and 105 patients (54 males and 51 females, mean age 60.1 years) underwent 18G needle biopsy.Postoperative pathology, typical imaging findings and/or 6-month follow-up were used as the final diagnosis, and the differences between the two methods were compared.Results 16G needle biopsy was performed in 141 patients, a total of 171 needles were taken, with an average of 1.21 needles per case, sensitivity 95.9%, specificity 100%, abdominal pain in 51 cases, abdominal hemorrhage in 3 cases. 18G needle biopsy was performed in 105 patients, a total of 161 needles were taken, with an average of 1.53 needles per case, sensitivity 83.8%, specificity 100%, abdominal pain in 37 cases, abdominal hemorrhage in 2 cases. The difference between the number of needle insertions and sensitivity between the two groups was statistically significant (P value 0.000,0.032, respectively). Liver biopsy with a 16 G needle is safe and has a higher sensitivity in diagnosing disease.

Objective to summarize the surgical technique and clinical application value of complete laparoscopic giant splenectomy combined with pericardial vascular dissection in the treatment of cirrhotic portal hypertension. Methods from March 2005 to September 2006, 23 patients with cirrhotic portal hypertension who underwent complete laparoscopic giant splenectomy combined with pericardial vascular dissection were retrospectively summarized. 3 cases (13.0%) were converted to open laparotomy, including 2 cases of splenic lobe vein rupture and 1 case of left phrenic vein rupture and bleeding; Twenty cases completed the operation successfully, of which 18 cases were treated with two-stage splenic pedicle dissection-splenic lobe arteries and veins were separated branch by branch, and the vessels were dissected with vascular clip or silk thread ligation during the separation, and 2 cases were dissected with endoluminal linear cutting and stapling device (Endo-GIA). The operation time was 180~350 min, with an average of 235min. The intraoperative blood loss was 200~1600 ml, with an average of 520 ml. After operation, plasma transfusion, diuresis and anti-inflammatory treatment were performed. Pleural effusion occurred in 3 cases, left subdiaphragmatic abscess was cured in 1 case, B-ultrasound guided puncture was cured, and mild ascites occurred in 2 cases. There were no deaths. The postoperative hospital stay was 6~17 d, with an average of 8.5 d. The average postoperative follow-up time was 9 months, and the re-bleeding rate was 0%. Conclusion Skilled laparoscopic technique, intraoperative ultrasonic scalpel and pre-ligation of splenic artery, and two-stage splenic pedicle dissection were the key technical factors for the successful operation of complete laparoscopic giant splenectomy combined with pericardial vascular dissection.

Objective to investigate the changes of mRNA and protein expression of mineralocorticoid receptor (MR) and 11 β-hydroxysteroid dehydrogenase Ⅱ (11 β HSD2), a key enzyme that confers MR specificity, in atrial muscle tissue of patients with atrial fibrillation. Methods 25 patients with rheumatic heart disease underwent prosthetic heart valve replacement were enrolled, including 12 patients with sinus rhythm and 13 patients with chronic atrial fibrillation (duration of atrial fibrillation ≥6 months). Transthoracic echocardiography was performed before operation. All patients signed informed consent before operation, and the left and right atrial lateral wall tissues were taken at the time of operation. The mRNA levels of MR and 11 β HSD2 were detected by real-time fluorescence quantitative PCR, and the protein expression changes of MR and 11 β HSD2 were detected by Western blot. Results The left atrial diameter was significantly larger in atrial fibrillation group than in sinus rhythm group (P<0.01); The expression of MR mRNA (right atrium: 5.37±1.15 vs 2.67±1.09, left atrium: 5.19±1.14 vs 2.70±0.82 P<0.01) and 11 β HSD2 mRNA (right atrium: 0.86±0.14 vs 0.33±0.12, left atrium: 0.95±0.15 vs 0.37±0.10 P<0.01) were significantly increased in patients with atrial fibrillation. At the same time, the expression of MR and 11 β HSD2 protein in patients with atrial fibrillation was also significantly increased compared with those in patients with sinus rhythm, and MR was 1.65±0.72 vs 0.86±0.33 in the right atrium, respectively (P<0.01); Left atrium: 1.72±0.62 vs 0.97±0.37 (P<0.05). 11 β HSD2 was 1.18±0.64 vs 0.71±0.21 (P<0.01); Left atrium : 1.36±0.58 vs 0.85±0.15 (P<0.05); However, there was no significant difference in mRNA and protein expression levels between MR and 11 β HSD2 between the left and right atrium, whether in sinus rhythm or atrial fibrillation (P>0.05). Conclusion The expression of MR and 11 β HSD2 in atrial muscle tissue increases during atrial fibrillation, and aldosterone receptor antagonists may play a therapeutic role in atrial fibrillation.

Objective to investigate the effect of amifotine (WR-2721) on protecting non-Hodgkin lymphoma (NHL) derived bone marrow mesenchymal stem cells (MSCs) from chemotherapy drug etoposide (VP-16) in vitro, and to provide evidence for clinical cell transplantation therapy. Methods MSCs from bone marrow of NHL patients were obtained by limiting dilution method, cultured and expanded in low serum medium, and then divided into blank control group (A), WR-2721 group (B), WR-2721+ VP-16 group (C) and VP-16 group (D) according to treatment factors. Cells were counted to draw growth curves, and their immunophenotype and apoptosis were detected by flow cytometry. MSCs were cultured with methyl cellulose semi-solid and MSCs were used as trophoblast to detect their hematopoietic capacity, and MSCs were differentiated into fat and bone by oil red O staining and Von Kossa staining. Results the factors in each group had no effect on the immunophenotype of MSCs. The proliferation and apoptosis of MSC in group (C) were significantly different from those in group (D) (P<0.05), and their hematopoietic capacity was significantly higher than that in group (D) (P<0.05). MSC in each group could be induced to differentiate into bone and fat. Conclusion WR-2721 can significantly reduce the in vitro injury of MSC suffered by chemotherapy drug VP-16, but it has no significant effect on the proliferation, apoptosis, immunophenotype, hematopoietic support and differentiation ability of MSC derived from bone marrow of NHL in vitro.

Objective to establish a simple screening method for low bone mass in postmenopausal women. Methods 405 healthy postmenopausal women in Shanghai were screened, filled in the questionnaire about the risk factors of low bone mass, and the femoral neck bone mineral density (BMD) was measured by dual energy X-ray absorptiometer to diagnose osteoporosis (T value ≤ -2.5). The BMD of femoral neck and risk factors were analyzed by unit regression analysis, and the statistically significant variables were obtained and the femoral neck BMD were analyzed by multiple regression analysis. The screening Index was used as a working characteristic curve (ROC curve), and the area under the curve (AUC) was analyzed to determine the parameters of the final model.Results the screening Index was established only by two parameters: age and body weight.The screening Index =2× body weight (kg) /10+ [-1× age (years) /10]. The sensitivity of this Index was 93.4%, the specificity was 52.6%, and its AUC was 0.818 (95% confidence: 0.766~0.870). The prevalence of osteoporosis in the high-risk group was 58%, the prevalence of the medium-risk group and the low-risk group were 26% and 2% respectively.Conclusion This screening method can help the clinical evaluation of bone mass in postmenopausal women and screen out the high-risk and low-risk osteoporosis groups.For the low-risk group, BMD examination may not be necessary to save the testing cost.

Objective to investigate the efficacy and safety of two-step portal vein embolization in liver fibrosis model.Methods Twenty New Zealand white rabbits with liver fibrosis were randomly divided into two groups (one-step group and two-step group), 10 in each group were treated with portal vein embolization preserving the right lower lobe portal vein.The one-step group was treated with lipiodol absolute ethanol emulsion and spring steel ring; In the two-step group, liver function and CT examination were performed regularly after embolization, and the hyperplasia rate of right lower lobe was calculated. After sacrifice, liver histopathological examination was performed. The data obtained were statistically analyzed and processed. Results One rat in the one-step group died during operation, and two rats in the two-step group died (bleeding and infection). The changes of alanine aminotransferase and aspartate aminotransferase in the two groups were obvious after portal vein embolization, reaching the peak at 4 days after operation, and gradually returned to normal at 7 days after embolization. There was no significant change in liver function after the second embolization in the two-step group. The hyperplasia rate of right lower lobe in the one-step group was 7.0%±1.3%, and the hyperplasia rate of right lower lobe in the two-step group was 15.4%±3.0%, and the difference of hyperplasia rate between the two groups was statistically significant (t'-7.221, P<0.05). Conclusion Two-step portal vein embolization is a safe procedure. Compared with one-step portal vein embolization, no embolization of liver lobe can obtain a good hyperplasia rate.

Objective to investigate the chemopreventive effect of oxymatrine on digestive tract tumors induced by methylnitronitrosoguanidine (MNNG) in rats and its mechanism.Methods 99 male Wistar rats were divided into 4 groups and received different drugs: negative control group (20 rats), tumor model group (36 rats), oxymatrine intervention group (23 rats) and oxymatrine control group (20 rats). The drug was stopped after 28 weeks of administration, and the gastrointestinal mucosal lesions of each group were observed after normal diet for 44 weeks.The expression of Ki67 in tumor tissues of tumor model group and oxymatrine intervention group was detected by immunohistochemistry, and the apoptosis of tumor tissues in both groups was detected by in situ nick end labeling (TUNEL) mediated by deoxyribonucleotide terminal transferase. Results 92 (92.93%) rats completed the experiment.The tumor incidence rate of oxymatrine intervention group was 30.43% (7/23), which was significantly lower than that of tumor model group [58.62% (17/29), P<0.05]; The incidence of tumor in the negative control group was 5% (1/20); The median volume of tumor in the tumor model group was 2.56 (full distance 49.5) cm3, which was greater than that in the oxymatrine intervention group (0.03 (full distance 0.009) cm3 and the control group (0.5 cm3, P<0.05). The incidence of gastrointestinal mucosal ulcer and dysplasia in the tumor model group was also significantly higher than that in the oxymatrine intervention group (P<0.05). The positive rate of Ki67 expression in tumor tissue in the tumor model group was significantly higher (48±18) % than that in the oxymatrine intervention group (25±24) % (P<0.05). The apoptosis rate of tumor tissue in the tumor model group was significantly lower (11±7) % than that in the oxymatrine intervention group [(30±16) %, P<0.05]. Conclusion Oxymatrine can effectively inhibit MNNG-induced gastrointestinal tumor in rats by inhibiting tumor cell proliferation and inducing apoptosis.

Objective to observe the effect of astragalus polysaccharide-cordyceps polysaccharide mixture on chronic rejection of abdominal aorta transplantation in rats.Methods A rat model of abdominal aorta transplantation was established.After transplantation, the rats were randomly divided into control group, mycophenolate mofetil (MMF) group, astragalus polysaccharide (APS) group and astragalus polysaccharide-cordyceps polysaccharide mixture (APS-CPS) group, and sham operation group was established.After feeding for 35 days, the pathological changes of the grafted arteries were observed, and the expression of TGF-β 1 and collagen synthesis were observed by immunohistochemistry and collagen fiber staining respectively. Flow cytometry was used to detect CD4+ and CD8+ positive T lymphocytes in the spleen. Results the vascular intima was obviously thickened, smooth muscle cells proliferated and collagen fibers proliferated in the control group; TGF-β 1 protein was expressed positively in intimal smooth muscle cells, monocytes and arterial endothelial cells. The three-layer structure of vascular wall in APS-CPS group was clear, there was no obvious proliferation of intima, and collagen fibrils were sparse; The expression of TGF-β 1 was significantly weaker than that in the control group (P<0.01), and the percentage of CD4+, CD8+ positive T lymphocytes and the ratio of CD4+ /CD8+ were not significantly changed before and after transplantation (P>0.05). Conclusion APS-CPS can inhibit chronic rejection of arterial transplantation in rats, down-regulate the expression of TGF-β 1, inhibit the proliferation of intimal smooth muscle cells and collagen synthesis, and maintain the normal ratio of CD4+ /CD8+.

Objective to investigate the optimal site of neural stem cell (NSC) transplantation for the treatment of neonatal rats with hypoxic ischemic brain injury (HIBD). Methods 7-day-old neonatal rats were randomly divided into HIBD group (12 rats), cortical transplantation group (12 rats), hippocampal transplantation group (12 rats) and lateral ventricular transplantation group (12 rats). Four weeks after transplantation, the radial maze test was performed to test the learning, memory and spatial discrimination ability, and four sensorimotor function tests were performed to test the recovery of sensorimotor function. The normal neurons per unit area in the cortex and hippocampal CA1 area were counted. Results In the radial maze test, the scores were HT group>VT group>CT group>HIBD group [water foraging time was (s): 48±17, 51±21, 58±22, 89±26], and the differences between each group and HIBD group were statistically significant (all P<0.05). The scores in the sensorimotor function test were CT group>VT group>HT group>HIBD group, and the differences between CT group, VT group and HIBD group were statistically significant (all P<0.05) Conclusion Transplantation of NSC into the lateral ventricle can effectively improve the total brain injury of HIBD in neonatal rats.

Objective to investigate the changes of potassium channel currents in the membrane of prostatic epithelial cells of male SD rats and the response to potassium channel blockers. Methods the dorsolateral lobe prostatic tissues of 3-month-old adult and 12-month-old SD rats were cut into 1~2 mm3 sizes, digested, cultured and immunized groups to identify, and the potassium channel currents of glandular epithelial cells with normal morphology and good adherence were recorded by whole cell patch clamp pattern.Results the +80 mV potassium current densities in the membrane of prostatic epithelial cells of adult and old SD rats were (10.84 ± 1.54) pA/pF vs (18.48 ± 1.7) pA/pF (n =20, P<0.01), respectively; Tetraethylamine (TEA), a calcium-activated potassium channel inhibitor (KCa channel), blocked the peak current of aged rats from 19.1 ± 2.9 to 7.2 ± 3.2, and the KCa current was inhibited by about 63%; The voltage-dependent potassium channel inhibitor 4-AP (tetraaminopyridine) has a significant blocking effect on the membrane potassium currents of prostatic epithelial cells in rats. Conclusion the membrane potassium currents of prostatic epithelial cells in aged rats are significantly enhanced than those of adult rats, and the KCa currents of aged rats are more sensitive to TEA.

Objective to establish a method for primary culture of human preomental adipocytes, and to study the biological characteristics of visceral adipoplasia, hypertrophy and endocrine function.Methods Human omental adipose tissue was selected, and spindle cells were primarily cultured by enzyme digestion.The morphology of the cultured cells was observed, the growth curve was measured by MTT assay, adipocytes were identified by oil red O adipose staining, and the levels of adipocytokines leptin and adiponectin were measured by enzyme-linked immunoassay.Results the cultured spindle cells were uniform.The proliferation began on the third day, and the exponential growth period was 4~9 days, and the doubling time was about 60 h. After 21 days of differentiation induction, about 90% of the cells differentiated into mature adipocytes.The low level of leptin secretion could be detected in preadipocytes, and the secretion amount increased continuously after induction differentiation, reaching the peak value on the 17th day (1.6 ng·ml-1·24 h-1), and then maintained high secretion state until the end of induction; The low level of adiponectin secretion could not be detected until the 7th day of induced differentiation, and the cells containing lipid droplets in cytoplasm could be seen under light microscope at this time; The secretion increased gradually from 7 to 17 days, reached the peak (99 ng·ml-1·24 h-1) on the 17th day, and then decreased obviously. The isolated and cultured cells were confirmed to be active preadipocytes by oil red O fat staining and leptin and adiponectin secretion detection. Conclusion The human preadipocyte model was successfully established, and different secretion patterns of leptin and adiponectin were observed. Adiponectin can be used as a specific endocrine function marker to identify the differentiation and maturation of preadipocytes.

Objective to investigate the expression of ACE2 and CD209L in severe acute respiratory syndrome (SARS) coronavirus (CoV) -related receptors in microvascular endothelial cells of eight different human organs and tissues, and to analyze the correlation between the expression levels of the two receptors and SARS organopathies. Methods the expression of ACE2 and CD209L in microvascular endothelial cells of eight different human organs and tissues was analyzed by reverse transcription polymerase chain reaction (RT-PCR), Western blot and immunocytochemistry. Results the expression of ACE2 and CD209L in microvascular endothelial cells of various human organs and tissues was the highest in pulmonary microvascular endothelial cells and the lowest in lymphoid endothelial cells, while the expression of CD209L was relatively high in lymphoid endothelial cells. Conclusion Human microvascular endothelial cells are important targets of SARS-CoV, and the damage of pulmonary microvascular endothelial cells and lymphoid endothelial cells may be mediated by two different SARS-CoV receptors, respectively

Objective to investigate the effect of transcription factor E2F "decoy" strategy on the phenotypic transformation of detrusor cells (DSMC) by using a self-constructed model of bladder outlet obstruction (BOO) cells. Methods Periodic tension load was applied to cultured DSMC to establish a BOO model at the cellular level; Lipofectamine 2000 was used to transfect DSMC with E2F-decoy deoxyoligonucleotide (ODN), and the E2F-decoy ODN transfection group (Decoy group) was established, and the E2F-decoy ODN transfection group (Mis-decoy group) and the blank control group (non-transfection group) were mismatched. The proliferative activity of the cells was determined by tetramethylazole salt colorimetric assay (MTT), the expression of proliferating cell nuclear antigen (PCNA) mRNA was analyzed by reverse transcription-polymerase chain reaction (RTPCR), and the expression of PCNA and cell cycle-dependent protein kinase cdk2 was detected by Western blot. The proliferative activity of Decoy group was significantly lower than that of non-transfected group and Mis-decoy group (both P<0.01); The expression of PCNA mRNA in Decoy group was significantly lower than that in non-transfected group (P<0.01); The expression of PCNA and cdk2 protein in Decoy group was significantly lower than that in non-transfected group (126±14 vs 180±10; 155±6 vs 210±22, all P<0.01); However, there was no significant difference between the Mis-decoy group and the non-transfected group (all P>0.05). Conclusion E2F-decoy ODN can transfect DSMC and obtain expression; The transcription factor E2F "decoy" strategy effectively inhibited the phenotypic transformation of DSMC after BOO, showing the prospect of improving bladder function after obstruction from the perspective of detrusor structure.

Previous studies have shown that the incidence of stroke after transient ischemic attack (TIA) is very high, especially within 90 days after TIA, with a stroke risk ranging from 9.5% to 14.6%.

A 53-year-old male was admitted to hospital for more than 1 year due to the discovery of progressively enlarged mass in the scrotum accompanied by falling distension and discomfort. The patient underwent radical gastrectomy in another hospital 3 years ago, and the postoperative pathological diagnosis was: poorly differentiated adenocarcinoma (large curvature of stomach) infiltrated into the serous layer, the upper and lower margins were negative, the lymph nodes of large curvature were 1/12 positive, the lymph nodes of small curvature were 0/6 positive, and the lymph nodes of group 12 were 0/2 positive.

A 53-year-old male was admitted to the hospital on October 3, 2005 due to fatigue after cold, yellow urine for half a month, aggravated with fever for 4 days. He had a history of hypertension for 2 years. After cold, he developed sore throat, and the sore throat improved after intravenous infusion of penicillin 12 million units once a day.

A 57-year-old male suffered from numbness in the posterior mandibular tooth area 5 months ago, which had reached the median 3 months ago, and the teeth were loosen.Specialist examination showed that the intraoral mental foramen area was swollen, the boundary was unclear, the texture was medium, the left half of the lip was red and the skin was numb, and the opening degree was normal.