Volume 87  ·   Issue 42  ·  2007

Gastrointestinal mucosa not only has the function of digestion and absorption, but also an important natural barrier of human body. Gastrointestinal mucosa barrier dysfunction is not only seen in gastrointestinal diseases, liver cirrhosis, severe pancreatitis and other gastrointestinal diseases, but also often secondary to craniocerebral diseases, extensive burns, shock, severe infection, malignant tumors, radiotherapy and chemotherapy, etc. It needs to attract the attention of clinicians in internal medicine, surgery, neurology and pediatrics, and is the link of multi-disciplinary research.

Children's gastrointestinal dysfunction refers to the clinical syndrome caused by the damage of any link of digestion of food, absorption of nutrients and excretion of waste products. It often manifests as vomiting, abdominal distension, abdominal pain, diarrhea and constipation, etc. In severe cases, hematemesis, hematochezia and toxic intestinal paralysis may also occur. Although the basic diseases causing gastrointestinal dysfunction in children are different from those in adults, gastrointestinal mucosal injury is an important pathological basis.

Objective to evaluate the efficacy of oral tolerance and nasal tolerance therapy on experimental colitis in rats, and the effects of adding adjuvant on the efficacy respectively. Methods A rat model of experimental colitis with trinitrobenzenesulfonic acid (TNBS) was established. Ovalbumin (OVA) was used as the inducing antigen and lipopolysaccharide was used as the adjuvant. The established rat models of TNBS colitis were divided into colitis group, oral tolerance group, nasal tolerance group, oral plus adjuvant group, nasal plus adjuvant group, adjuvant control group and blank control group according to different intervention methods. The rats in each group were sacrificed on the 21st day of enema after the above different treatments. The therapeutic effect was evaluated by intestinal gross and histopathological scores, and the induction effect of mucosal tolerance was evaluated by spleen lymphocyte proliferation experiment. Results The intestinal gross scores (mean rank 9.5 vs 3.5, P<0.01) and histopathological scores (mean rank 9.5 vs 3.5, P<0.01) The results of spleen lymphocyte proliferation experiment showed that the oral tolerance group could not induce the immune tolerance to OVA in the colitis state of rats, while the oral plus adjuvant group (0.11±0.05 vs 0.30±0.13, P<0.05), the nasal plus adjuvant group (0.12±0.07, P<0.05) and the nasal plus adjuvant group (0.06±0.04 vs 0.30±0.13, P<0.05) could induce the immune tolerance, and the difference of immune tolerance induced by different pathways was not statistically significant. Compared with the colitis group, the oral plus adjuvant group (gross score 3.0±1.3 vs 6.3±0.8, histopathological score 3.0±1.1 vs 7.5±1.0, all P<0.05), the nasal plus adjuvant group (gross score 2.0±0.6, histopathological score 2.7±1.0, all P<0.05) and the adjuvant control group (gross score 4.3±1.0, histopathological score 4.6±1.6, all P The intestinal scores of rats were all significantly lower, among which the intestinal scores of rats in the nasal plus adjuvant group decreased most significantly. Conclusion TNBS experimental colitis interfered with the induction of oral tolerance, but not nasal tolerance. Both oral tolerance with adjuvant and nasal tolerance with adjuvant had certain therapeutic effects on experimental colitis, and adjuvant alone also had certain curative effects, among which nasal tolerance with adjuvant was the best.

Objective to investigate the protective effect and mechanism of catechin monomer epigallocatechin gallate (EGCG) on the intestinal mucosa of rats with inflammatory bowel disease (IBD). Methods 72 healthy SD rats were randomly divided into normal control group, model group, drug positive control group, large and low dose (100, 50 mg/kg) EGCG group and EGCG pretreatment group, 12 rats in each group, and the rat IBD model was made by enema with trinitrobenzenesulfonic acid (TNBS). Immunohistochemistry and semi-quantitative reverse transcription (RT) -PCR were used to detect the expression levels of cyclooxygenase (COX) -2 in intestinal mucosal cells of each group from the levels of protein and mRNA, respectively. Results Different doses of EGCG enema could improve the pathological and histological signs of intestinal mucosal cells of IBD model rats to varying degrees. The histological scores of the model group and EGCG high and low dose groups were 6.8 ± 1.0, 3.6 ± 0.8 and 4.1 ± 1.0, and the differences between the latter two groups and the model group were statistically significant (both P<0.05). Both of them could inhibit the protein and RNA expression levels of COX-2 in intestinal mucosal cells, and there was a certain dose-effect relationship with the dosage. Among them, EGCG pretreatment group had the best effect (P<0.01). Conclusion EGCG has a protective effect on intestinal mucosal cells of IBD model rats, which may be achieved by inhibiting the activity of COX-2.

Objective to study the protective effect of Pim-3 gene on burn and endotoxin-induced intestinal mucosal injury. Methods In vivo experiments were conducted in adult Wistar rats, which were divided into group A (burn group), group B (lipopolysaccharide group) and group C (normal control group). The small intestine of each group was taken at 3, 6, 12, 24 and 48 h after treatment, and total RNA and protein were extracted. The expressions of endogenous Pim-3, intercellular adhesion molecule (ICAM-1) and tight junction protein occludin in intestinal tract were detected by reverse transcription (RT) -PCR and Western blot, respectively. The effects of burn and endotoxin on the expression of endogenous Pim-3 gene in intestinal tract and the correlation between Pim-3 gene and intestinal mucosal injury were observed. In vitro experiments, primary intestinal epithelial cells were isolated and cultured, then transfected with recombinant plasmid pEGFP-N2/Pim-3 and treated with endotoxin. The primary intestinal epithelial cells were divided into 6 groups: ① normal control + endotoxin treatment group (5 μ g/ml); ② Empty plasmid pEGFP-N2 transfection + endotoxin treatment group (5 μ g/ml); ③ Recombinant plasmid pEGFP-N2/Pim-3 transfection + endotoxin treatment group (5 μ g/ml); ④ Normal control group; ⑤ No-load plasmid pEGFP-N2 transfected group; ⑥ Recombinant plasmid pEGFP-N2/Pim-3 transfected group; After endotoxin treatment for 6 h, the total RNA of each group was extracted, and the indexes of each group were detected by reverse transcription (RT) -PCR, and the apoptosis of each group was observed by flow cytometry.Results (1) In vivo, the expression of endogenous Pim-3 gene in groups A and B increased at 3 h, which was (12.25±1.01) and (15.08±1.07) times that of group C, respectively, and reached its peak at 6 h, which was (21.13±1.78) and (25.24±1.80) times that of group C, respectively, and then gradually decreased. The expression of ICAM-1 in groups A and B remained high after 6 h, and reached its peak at 12 h, which was (88±7) and (58±5) times that of group C, respectively, and the difference was statistically significant (P<0.05). The expression of atresin in groups A and B increased at 3 h, and reached its peak at 6 h, which was (6.65±0.24) and (6.25±0.26) times that of group C, respectively, and the difference was statistically significant (P<0.05). (2) In vitro, the expression of Pim-3 and atresin in group ⑥ was different from that of group ④ and ⑤ The expression of ICAM-1 in group ①②③ was significantly different from that in group ④⑤⑥ (P<0.05). Conclusion Proto-oncogene Pim-3 can not only inhibit the apoptosis of intestinal epithelial cells, but also enhance the expression of atresin and inhibit the local inflammatory reaction caused by lipopolysaccharide, thus achieving the role of protecting the intestinal mechanical barrier.

Objective to evaluate the incidence and prognosis of cardiac arrhythmia after treatment of membranous ventricular septal defect (VSD). Methods to compare and analyze the changes of ECG arrhythmia in 358 patients with membranous VSD (intervention group) from August 2002 to February 2006. The patients were followed up for 1, 3, 6 and 12 months continuously. Results Except for bundle branch block, all other arrhythmias in the two groups disappeared before discharge. Complete right bundle branch block and incomplete right bundle branch block in surgical group were 13 cases (26%) and 14 cases (28%), respectively, which were significantly higher than those in intervention group; At 1-year follow-up, complete right bundle branch block (3.3%), incomplete right bundle branch block (3.3%), complete right bundle branch block with left anterior hemiblock (1.7%) and III-degree atrioventricular block (0.56%) were significantly improved in the interventional group, but no improvement in the surgical group. 180 cases were followed up in the interventional group and 50 cases were followed up in the surgical group. There were no statistical differences in gender, age, weight, membranous VSD size and proportion of membranous bulging tumors between the two groups (all P>0.05). Conclusion The clinical effects of the two groups are consistent, but interventional therapy is safer than surgery; Incomplete right bundle branch block and left anterior hemiblock caused by interventional therapy mostly disappeared after 6~12 months, while complete right bundle branch block or complete right bundle branch block and left anterior hemiblock need long-term follow-up.

Objective to determine the indexes of glycosylated serum albumin (GA) in diabetic patients and analyze the influencing factors on GA to provide a theoretical basis for accurate clinical evaluation of GA. Methods Fasting blood glucose (FPG), 2 h postprandial and 2 hPG, GA, glycosylated hemoglobin (HbA1c) were measured in 445 patients with type 2 DM admitted from May 2006 to November 2006, and monitored by dynamic blood glucose monitoring system (CGMS). GA was measured by liquid enzyme method (GA-L). Results (1) The average GA value of type 2 DM patients at admission was (24.9 ± 7.0) %, and HbA1c was (8.9 ± 2.2) %. (2) There was a good correlation between GA and HbA1c, r =0.818 (P<0.001). There was a good correlation between GA and FPG, 2 hPG, and CGMS mean blood glucose (MBG), r values were 0.573, 0.409, 0.531, respectively (P<0.01). (3) The GA value of diabetic patients was negatively correlated with body mass index (BMI). (4) Gradually more

Objective to investigate the isolation of Candida in patients with high risk of deep fungal infection and the risk factors of deep candida infection in nosocomial.Methods A prospective cohort study was conducted to monitor the possible risk factors and deep candida infection in all patients admitted to hematology department, geriatrics department and ICU ward from May 2004 to April 2005.The patients with deep candida infection and those without deep candida infection were compared, and the risk factors of deep candida infection were analyzed by unconditional Logistic regression model.Results A total of 440 patients were enrolled, of which 426 Candida strains were isolated in 152 cases, Candida albicans accounted for 67.4%, and other candida strains accounted for 32.6%. A total of 61 patients had colonization, mainly Candida albicans. Multivariate analysis of risk factors in 193 patients with complete data showed that 2 OR more broad spectrum antibiotics were used (OR =16.204; 95% CI: 2.005-130.980), Candida colony colonization (OR =10.636; 95% CI: 3.743-30.222) and Conclusion Candida albicans still ranks first among the candida isolated from patients with high risk of deep fungal infection. The risk factors of deep candida infection are the application of two or more broad spectrum antibiotics, colonization of candida colonies and application of urinary catheters.

Objective to analyze the clinical characteristics of angina pectoris in patients with coronary artery disease complicated with renal artery stenosis, and to judge its diagnostic value for coronary artery disease. Methods 2820 inpatients underwent renal artery and coronary artery angiography simultaneously from January 1998 to May 2005. The symptoms of angina pectoris in the three groups included angina pectoris, exertion emotion induction and nitroglycerin relief at rest. Any stenosis of renal artery and coronary artery over 50% can be diagnosed as renal artery stenosis and coronary artery disease, respectively. Results 243 cases (85.6%) in the group with renal artery stenosis and 2577 cases in the group without renal artery stenosis were diagnosed with chest pain and nitroglycerin relief at rest, exertion emotion induction, and angina pectoris at rest. The sensitivity, specificity and positive predictive values were 94.2%, 69.7% and 75.5%, 14.3%, 40.0% and 25.7%, respectively, and 86.7%, 87.3% and 85.8%. The negative predictive values were 29.4%, 18.2% and 15.0%, respectively. The sensitivity, specificity, 40.0%, 62.9% and 45.7%, positive predictive values were 87.2%, 90.1% and 88.8%, and negative predictive values were 17.7%, 19.6% and 21.9%, respectively. The sensitivity, missed diagnosis rate, most specificity and misdiagnosis rate of angina pectoris in group 1, group 2 and group 3 for the diagnosis of coronary heart disease were not significantly different in patients with or without renal artery stenosis. In patients with renal artery stenosis, the positive predictive value was larger and the negative predictive value was smaller.

Objective to investigate the characteristics of energy metabolism in patients with chronic severe viral hepatitis, so as to guide the early clinical and active nutritional support treatment of chronic severe hepatitis and improve the survival rate of patients. Methods The resting energy expenditure (REE) level of 55 patients with chronic severe hepatitis in early and middle stage was measured by indirect calorimetry, and compared with the predicted value calculated by Harris-Benedict formula (HB formula); The dietary structure of patients was analyzed by dietary nutrition expert software system, and the correlation between energy expenditure and the main functional indexes of liver (ALT, AST, TBiL, PTA) was analyzed. Results the measured value of REE (20.7±6.0) kcal·kg-1·d-1 in patients with chronic hepatitis was lower than the predicted value calculated by HB formula (22.1±2.2) kcal·kg-1·d-1 (P<0.01); the measured value of REE (19.2±6.1) kcal·kg-1·d-1 in patients with chronic hepatitis was lower than the predicted value calculated by HB formula (23.1±2.3) kcal·kg-1·d-1 (P<0.01); the carbohydrate intake (21.6±7.4) kcal·kg-1·d-1 was significantly greater than the consumption (7.9±7.3 kcal·kg-1·d-1 (P<0.01); the protein and fat intake [(3.4±1.6) kcal·kg-1·d-1, (4.1±2.5) kcal·kg-1·d-1] were lower than the consumption [(5.3±3.7) kcal·kg-1·d-1, (6.5±10.0) kcal·kg-1·d-1 There was a positive correlation between blood glucose and fat oxidation (r =0.310, P<0.05); serum total protein level was negatively correlated with protein oxidation (r = -0.284, P<0.05), and positively correlated with carbohydrate oxidation and respiratory quotient (r =0.362, P<0.01; r =0.348, P<0.01); serum cholesterol was negatively correlated with fat oxidation (r = -0.328, P<0.05), and positively correlated with carbohydrate oxidation and respiratory quotient (r =0.338, P<0.05; r =0.354, P<0.01); serum triglycerides were negatively correlated with protein oxidation (r = -0.387, P<0.05). The consumption of the three major nutrients was mainly carbohydrate, but the consumption of proportionally distributed protein increased obviously, and the body showed negative nitrogen balance; ALT, TBil and PTA had no significant correlation with resting energy consumption, but had correlation with blood glucose, total protein, cholesterol and triglyceride.

Objective to investigate the occurrence of GJB2 gene mutation in non-syndromic deafness (NSHL) populations of Uygur and Han nationalities in Xinjiang, in order to preliminarily grasp the mutation spectrum and mutation frequency of GJB2 gene in the main different ethnic groups in Xinjiang.Methods A total of 127 deaf patients from 61 Uygur and 66 Han nationalities in Xinjiang participated in the study, and 98 normal hearing patients from Uygur nationalities were used as controls.Detailed medical history and venous blood were collected, and the genomic DNA from blood samples were extracted and all samples were sequenced directly.Results The frequency of GJB2 gene mutation carried was basically the same in Uygur and Han nationalities deafness populations.The GJB2 35delG mutation was found only in Uygur deafness populations,while the GJB2 235delC mutation was found in both Uygur and Han nationalities deafness populations.The allele frequency of GJB2 35delG mutation was 7.4% (9/122), 0 (0/128) and 0 (0/196), respectively.GJB2 V27I and E114G were the most common polypeptides in each group.Conclusion the incidence of GJB2 gene mutation in Xinjiang is higher, the carrier rate of 35delG in Xinjiang Uygur is significantly higher than that in Han nationality.235DelC is more common in both Uygur and Han nationality.These findings provide theoretical basis for clinical genetic diagnosis of deaf patients in specific areas.

Objective to observe the antiviral effects, immune reconstitution effects and side effects of highly active antiretroviral therapy (HAART) in 24 months of human immunodeficiency virus type 1 (HIV-1) infected patients. Methods 27 cases of HIV-1 infected patients were treated with didanosine, stavudine and nevirapine for 24 months. Plasma HIV RNA viral load, CD3+ CD4+, CD3+ CD8+ lymphocytes, CD4+ CD45RA + CD62L + pure cells, CD4+ CD45RO + memory cells, CD8+ CD38+ activated lymphocytes and CD8+ CD38+ /CD3+ CD8+ percentage were detected before treatment and at 3, 6, 12, 18 and 24 months after treatment, respectively. Results the virological and immunological indexes of 27 HIV-1 infected patients were significantly improved during 24 months of treatment, the changes were more significant at 3 or 6 months, and the above-mentioned indexes did not reach the values of the normal control group at 24 months. Among them, 19 infected patients had digestive tract reactions, peripheral neuritis, skin rash, abdominal pain, headache, fever and alopecia, and 21 infected patients had blood phase abnormalities, liver function or renal function changes, blood lipids abnormalities, and γ-glutamyl transpeptidase and amylase increases, and 3 infected patients changed the drug because of grade Ⅲ peripheral neuritis and suspected lactic acid poisoning. Conclusion HIV-1 infected patients treated with didanosine, stavudine and nevirapine for 24 months showed good antiviral effects and immune reconstitution effects, but the side effects of the drug were more.

Objective to investigate the relationship between gastrointestinal motility disorder and cholinergic and nitrogenic neurons in the gastrointestinal myenteral plexus in streptozotocin (STZ) -diabetic rats. Methods Forty-five SD rats were randomly divided into control group, diabetic group and insulin group. The gastrointestinal motility of rats was measured 16 weeks after modeling, and the morphological changes of cholinergic and nitrogenic neurons in the gastrointestinal myenteral plexus were observed. Results Compared with the control group, the gastrointestinal motility of rats in the diabetic group was weakened (P<0.01), and the counts of cholinergic neurons in the gastric antrum and small intestinal myenteral plexus (6.6±2.9 vs 15.7±3.815.6±10.3 vs 22.6±7.4, P<0.01) and nitrogenic neurons in the gastric antrum (5.3±1.2 vs 11.8±2.2, P<0.01) were significantly decreased. The counts of gastrointestinal motility, nitrogenic neurons in the gastric antrum and small intestinal cholinergic neurons in the insulin group were significantly higher than those in the diabetic group (P<0.05), but all were lower than those in the control group (P<0.05). Conclusion The gastrointestinal motility disorder in STZ-diabetic rats may be related to cholinergic and nitrogenic neurons in the gastrointestinal myenteral plexus Insulin therapy can improve gastrointestinal motility disorders in diabetic patients to some extent.

Objective to obtain the evidence that normal cloned stem cells (CD34+ CD59+) from patients with paroxysmal nocturnal hemoglobinuria (PNH) support long-term hematopoiesis.Methods the bone marrow CD34+ CD59+ cells from PNH patients were purified and expanded and transplanted into combined immunodeficiency (SCID) mice, and the bone marrow cells from the first transplanted mice were transplanted for a second time 90 days later. The expression of CD45 in the tissues of the two groups of mice was not statistically significant. There was no statistically significant difference in peripheral blood cell levels in the mice transplanted with bone marrow cells reconstructed from PNH patients and normal control bone marrow CD34+ CD59+ cells on 30 days after transplantation. The expression of CD45 in the tissues of both groups of mice was not statistically significant; Conclusion CD34+ CD59+ cells from bone marrow of PNH patients after transplantation have the same long-term hematopoietic ability as normal CD34+ CD59+ cells.

Objective to investigate the expression and significance of α-actin in smooth muscle cells of corpus cavernosum of rats with diabetic erectile dysfunction. Methods Streptozotocin (STZ) was used to make diabetic and diabetic erectile dysfunction models. Forty male rats with SPF grade were randomly divided into two groups (20 rats in each group) according to time, respectively, 7 weeks after STZ injection and 4 weeks after STZ injection. Then, according to the treatment factors, i.e., whether the rats were given intraperitoneal injection of STZ (60 mg/kg) to form a model, they were divided into control group (5 rats without STZ injection), adult diabetic erectile dysfunction model group, adult diabetic non-erectile dysfunction group and non-model group. The samples of different treatment groups were studied for α-actin by immunohistochemical SP staining, and the samples of different treatment groups were studied for intermuscular line protein by immunohistochemical SABC staining, and the changes of osteopontin (OPN) mRNA content in different groups were detected by in situ hybridization. The cumulative optical density (IOD) was measured at random per high-power scope, and the value of IOD was used to reflect the expression degree of the corresponding positive substances in tissue sections. Results the IOD of the diabetic erectile dysfunction group was lower than that of the control group, the diabetic non-erectile dysfunction group and the non-model group (all P<0.05), and the IOD of the diabetic non-erectile dysfunction group was lower than that of the control group and the non-model group (P<0.05). There was no significant difference in IOD between different time points (F =3.801, P =0.62), and the interaction effect was not significant (F =1.549, P =0.225). There was no significant difference in IOD between different time points of immunohistochemical staining (F =0.052, P =0.821), and there was no significant difference in IOD between each treatment group (F =0.045, P =0.987), and the interaction effect was not significant (F =0.572, P =0.639). There was no significant difference in IOD between different time points of OPN mRNA in situ hybridization staining (F =1.288, P =0.266), and the interaction effect was not significant (F =1.819, P =0.168 The IOD of the diabetic erectile dysfunction group was higher than that of the other three groups (all P<0.001). The IOD of the diabetic non-erectile dysfunction group was higher than that of the control group and the non-model group (all P<0.001). There was no significant difference between the IOD of the control group and the non-model group (P =0.873). Conclusion Diabetes can cause phenotypic transformation of the smooth muscle of the corpus cavernosum of the penis; phenotypic transformation of the smooth muscle of the corpus cavernosum of the penis can lead to erectile dysfunction.

Objective to investigate the characteristics of 15-deoxyprostaglandin J2 (15-d-PGJ2) induced anorexia and apoptosis in human hepatocellular carcinoma cell line BEL-7402 in vitro and to explore its mechanism.Methods The growth status and morphological changes of cells treated with different factors were observed by light microscope in fibronectin (Fn) or poly-2-hydroxyethyl methacrylate (poly-HEMA) coated culture plates. DNA fragment analysis and flow cytometry were used to observe the apoptosis of cells; The expression of focal adhesion kinase (FAK) and phosphorylated FAK (p-FAK) protein was observed by Western blot technique. Results BEL-7402 cells grown adherently in FN-coated culture plates were treated with 15-d-PGJ2 for 24 or 48 h, and the cells became rounded and changed from extracellular matrix in suspension state, and the changes were time-and dose-dependent; The concentration of 15-d-PGJ2 at 20 μ mol/L was the most significant, and the adhesion ratio of cells at 24 h and 48 h was (66.0±3.6) % and (35.0±5.0) %, respectively, and the difference was statistically significant compared with that of hepatocellular carcinoma cells (P<0.05). After flow cytometry and DNA fragment analysis, it was found that hepatocellular carcinoma cells had anodisation and apoptosis. Western blot showed that p-FAK protein decreased, but the expression level of FAK protein did not change. Conclusion 15-d-PGJ2 can induce anodisation and apoptosis in BEL-7402 cells in vitro, which is related to the decrease of FAK phosphorylation level.

A 32-year-old male was diagnosed with acute lymphocytic leukemia (L2, T-cell type) and massive pericardial effusion in December 2004 because of leukemia. After chemotherapy, the patient was given consolidation chemotherapy, and his condition was in complete remission. In June 2005, he received haplotype bone marrow transplantation. The donor was her sister (3 sites of human leukocyte antigen were compatible). The pretreatment regimen was cytarabine + cyclophosphamide + whole body irradiation. After transplantation, he was given combined immunosuppressants (cyclosporine A, methotrexate, mycophenol and methylprednisolone). The transplantation process went smoothly, and the blood cytomegalovirus antigen (CMV-PP65) was tested regularly after transplantation, and all of them were negative. On September 14, 2005, he developed fever with a body temperature of 39 ℃, no obvious respiratory symptoms, and the chest radiograph showed right upper pneumonia. On September 28, 2005, the lung CT examination showed small dense shadows in the anterior segment of the upper lobe of the right lung, with clear boundaries, and "air bronchus" Several small lymph nodes were observed in the mediastinum (Figure 1). After active anti-inflammatory treatment, the body temperature was normal, but there was no obvious change on chest X-ray examination on October 31, 2005. Subsequently, during the reduction of immunosuppressant methylprednisolone, the patient developed fever, body temperature 39.7 ℃, and no respiratory symptoms.

natural orifice translumenal endoscopic surgery (NOTES) is a surgical science that uses the natural opening and lumen of the human body to penetrate the endoscope through the wall of the tube and enter the body cavity for endoscopic surgery [1]. It is a new discipline between laparoscopy and flexible endoscopy. Flexible endoscopy has long been limited to the examination and treatment of the digestive tract lumen, but recently innovative attempts have broken the traditional concept-endoscopy penetrates the stomach wall and enters the abdominal cavity for surgery [2]. The difference between NOTES and traditional surgery is that endoscopic intraabdominal surgery is completed through the natural orifice without incision in the abdomen. So far, many NOTES techniques have been introduced one after another, such as NOTES through the stomach, colon, vagina and urethra. Intra-abdominal surgery performed by NOTES has also been reported, such as abdominal exploration, liver biopsy, tubal ligation, gastrojejunostomy, partial hysterectomy, oophorectomy, cholecystectomy, appendectomy, liver wedge resection and splenectomy, etc. In 2005, 14 digestive endoscopy and laparoscopy experts from the American Society of Digestive Endoscopy (ASGE) and the Society of Digestive Endoscopic Surgery (SAGES) set up a special working group-NOSCAR in New York, and published a white paper of the working group in 2006, which formally put forward the concept of NOTES [1]. The advent of NOTES marks the intersection and fusion of traditional internal medicine and surgery, which will affect the division of labor between traditional internal medicine and surgery, such as respiratory system, circulatory system and genitourinary system, besides digestive system. This paper summarizes the progress and future development trend of this latest field, aiming at making more internal medicine and surgeons in China understand this new development direction.

Three-dimensional CT colonography (CTC), or virtual colonoscopy, is used to generate a series of two-dimensional X-ray images by computed tomography, and then constitute a three-dimensional image of the colon; Recently, by comparing CTC with optical colonoscopy (OC), Dr. Kim of the University of Wisconsin School of Medicine found that CTC can be used as a preliminary screening method for advanced colorectal tumors and before colonoscopy. The results of this study were published in the October 4th issue of the New England Journal of Medicine (N Engl J

Because the risk factors of colorectal tumors and coronary artery disease (CAD) are similar, the two diseases are more likely to occur simultaneously. In order to observe the incidence of colorectal tumors in CAD patients and identify the common risk factors of these two diseases, Annie On On Chan and colleagues from the University of Hong Kong, China, conducted a cross-sectional study, the results of which were published in the recent issue of JAMA (JAMA, 2007, 298, 1412-1419).

Small cell lung cancer has high malignancy and poor prognosis. The median survival time of advanced patients without treatment is only 2~4 months. The statistical results of 1973 and 2000 in the United States show that the 2-year survival rate is 1.5% and 4.6%, respectively. Brain metastasis is very common, and about 18% of patients have brain metastasis at the time of diagnosis, and the proportion can reach 80% at 2 years. Although the short-term effect of chemotherapy is good, the long-term effect is poor, and the incidence of brain metastasis can not be reduced, and the treatment effect on brain metastasis is poor. The results of a randomized controlled trial on prophylactic cranial radiotherapy for advanced small cell lung cancer initiated by the European Organization for Cancer Therapy were published recently in the New England Journal of Medicine (N Engl J Med, 2007, 357: 664-672).

In order to determine whether intake of omega-3 and omega-6 fatty acids in children can trigger islet autoimmunity (IA), Dr. Jill M. Norris from the Department of Preventive Medicine and Biometrics at the University of Colorado and her colleagues conducted a longitudinal observational study named "Diabetes autoimmunity Study in Young Adults (DAISY)" in the Denver area of Colorado from January 1994 to December 2006, and its results were published in the recent issue of JAMA (JAMA, 2007, 298, 1420-1428).

The Second National Symposium on Basic and Clinical Studies of Gastrointestinal Mucosal Barrier, sponsored by Chinese Medical Journal, was held in Beijing from August 25 to 26, 2007. The conference was chaired by Professor Hu Fulian of Peking University First Hospital and Professor Leng Xisheng of Peking University People's Hospital.

A 26-year-old male was admitted to hospital due to "abnormal urine test for 4 days". The patient was found to have "hematuria and proteinuria" on physical examination 4 days ago, and was admitted for further diagnosis and treatment. The patient had a history of hypertension for 1 year, and was diagnosed as "alopecia universalis" 10 years ago due to "total hair loss"; No family history of "universal alopecia". Physical examination: blood pressure 150/100 mm Hg (1 mm Hg =0.133 kPa), hair, eyelashes, body hair, axillary hair and pubic hair have fallen off, nails and toenails are dotted with white onychos and concave spots, and the concave spots of the nails are arranged horizontally or vertically in a fence shape (Figure 1). Urine examination showed: urine occult blood + +; 17 erythrocytes/HPF; Protein (+), 24-h urine protein quantification was 224 mg; Sex hormones, trace elements, immune indexes and renal function were in the normal range.