Volume 89  ·   Issue 04  ·  2009

The development of society and the progress of science and technology have obviously promoted the development of medicine and gastrointestinal surgery, which can be roughly summarized as follows.

Objective To investigate the gastric myoelectrical activity and autonomic nervous system (ANS) function in patients with non-erosive reflux disease (NERD) and reflux esophagitis (RE). Methods 42 patients with gastroesophageal reflux disease (GERD) , 21 with NERD and 21 with RE, and 20 healthy volunteers ( controls ) underwent multi-channel electrogastrography ( MEGG ) and electrocardiography simultaneously for 30 min in the fasting state and 60 min after a standard test meal. The MEGG parameters included dominant frequency (DF), dominant power (DP), normal percentage of 2 -4 times/min gastric slow waves (N%), and percentage of slow wave coupling (% SWC ). ANS was determined according to power spectra analysis of heart rate variability (HRV) which was conducted by using electrocardiogram recording, including the parameters of sympathetic activity, vagal activity, and sympathovagal balance ratio so as to evaluate the ANS function. Results The DF levels of the NERD and RE patients and healthy volunteers after test meal were all significantly higher than those in fasting state (all P < 0. 05). The % SWC levels of the 3 groups after test meal were all significantly lower than those when fasting (all P < 0. 05), and the % SWC level of the NERD patients was significantly lower than that of the healthy volunteers in fasting state [70. 5% (40. 6% -81.9% ,76. 3% (66. 4% -91.4% ) ,P <0. 05]. Test meal significantly increased the sympathetic activity and sympathovagal balance ratio of the NERD and RE patients and healthy volunteers ( all P < 0. 05), and the vagal activity levels of the 3 groups after test meal were all significantly lower than those when fasting (all P < 0. 01 ). The sympathovagal balance ratio of the NERD group was significantly lower than that of RE group after meal [ 1.4 ( 0. 8 - 2. 5 ), 2. 2 ( 1.3 - 4. 4 ), P < 0. 05 ]. Conclusion The spatial regularity of gastric slow waves and ANS function in NERD patients are significantly different from those in RE patients.

Objective To investigate the postprandial changes of blood lipid after ordinary Chinese diet and the influencing factors thereof. Methods Peripheral venous blood samples were collected from 88 patients, 72 males and 16 females, aged (65 ± 12), 53 with hypertension, 35 with coronary heart diseases, and 27 with diabetes, while fasting and 4 h after breakfast and lunch to measure the levels of lipoproteins, including total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol ( LDL-C ), apolipoprotein A ( APOA ), ApoB, lipoprotein (Lp) ( a ), oxidized LDL (ox-LDL). Homeostasis model assessment insulin resistance index (HOMA-IR) was calculated. Weight, height, waist circumference, and hip circumference were examined, and body mass index (BMI) and waist/hip ratio (WHR) were calculated. Results The TG level after breakfast was (2. 79 ± 0. 19) mmool/L, significantly higher than the fasting level by 49. 5% [ (1.94 ± 0. 13 ) mmol/L, P < 0. 05 ]. The TG level after lunch was (3. 08 ± 0. 26) mmol/L, significantly higher than the fasting level by58.8% [(1.94±0.13) mmol/L, P<0.05]. The ox-LDL after breakfast was (430±21) μg/L, significantly higher than the fasting level by 32. 6% [ ( 324 ± 14 ) μg/L, P < 0. 05 ] and the ox-LDL level after lunch was (448 ± 17) μg/L, significantly higher than the fasting level by 38. 1% [ (324 ± 14) μg/L, P < 0. 05 ]. The fasting insulin level was (62 ± 4 ) pmol/L, and the HOMA-IR was ( 15. 27 ± 1.08 ). The fasting insulin level was positively correlated with the fasting and postprandial TG levels ( all P < 0. 01 ). The IR index was positively correlated with the fasting TG and TG after breakfast ( both P < 0.05 ). Fasting insulin and HOMA-IR were negatively correlated with the fasting and postprandial HDL-C levels ( all P < 0. 05 ), and positively correlated with the fasting and postprandial TC/HDL-C levels (all P < 0. 05 ). BMI and WHR were negatively correlated with the fasting and postprandial HDL-C ( both P < 0. 01 ). BMI was positively correlated with fasting and postprandial TG (both P < 0. 05 ). The insulin level, HOMA-IR, and BMI were negatively correlated with LPL (r = -0. 232 -0. 297, P < 0. 05 ). LPL were positively correlated with fasting and postprandial HDL-C levels (r=0.37, 0.31, 0.35,all P<0.01 ).Conclusion The TG and ox-LDL levels significantly increased postprandially. The postprandial blood lipid levels are significantly correlated with the fasting blood lipids.

Objective To investigate whether antibiotic prophylaxis can reduce the risk of postoperative bacteriuria in patients undergoing transrectal prostatic biopsy (TPB) who have sterile preoperative urine. Methods MEDLINE, EMBASE, Cochrane Collaboration Reviews, CMCC, and CNKI were searched for randomized controlled trials (RCTs) comparing antibiotic prophylaxis with placebo/blank controls for patients undergoing TPB with preoperative sterile urine. The search strategy was made according to the Collaborative Review Group search strategy. Data were extracted by two reviewers using the designed extraction form. The software RevMan4.2 was used to review management and data analysis. Results 67 relevant RCTs were found, of which 12 qualified ones were included into the analysis. Antibiotic prophylaxis significantly decreased the rate of bacteriuria within the period 1 week after TPB (corresponding pooled relative risk (RR) and 95% CI was 0. 32 ( 0. 23 - 0. 46, P < 0. 01 ). The effective antibiotics included quinolones and quinolones combined with nitroimidazole , with the pooled RR and 95% CI of 0. 31 (0. 18 - 0. 53, P<0. 01) and 0. 32 (0. 17 -0. 60, P=0. 0004) respectively. There was no significant difference in the effect between short treatment course protocol and long course protocol (P = 0. 41 ). Conclusion Prophylactic antibiotics can significantly decrease the incidence of post-TPB bacteriuria. A significant decrease in bacteriuria incidence can be achieved with a range of antibiotic agents, including quinolones and-quinolones combined with nitroimidazole. Treatment protocols of any duration are effective.

Objective To investigate the correlation of pharmacokinetic profiles of mycophenolic acid (MPA) with clinic events in kidney transplant patients treated with mycophenolate mofetil (MMF). Methods Sixty-four kidney transplant patients were treated with the triple immune suppression protocol with cyclosporine, MMF, and prednisone. Before the administration of drugs, and 0. 5, 1, 1.5, 2, 2. 5, 4, 6, 8, 10, and 12 hours after the drug administration peripheral blood samples were collected to detect the plasma MPA concentrations (MPA-C0) and draw the concentration-time curve. And 4, 7, 21, and 28 days, and 1.5, 2, 3, and 6 months later peripheral blood samples were collected in the morning before drug administration so as to dynamically measure the plasma MPA concentrations. Clinical events were observed. Results No side effect or acute rejection episode occurred with the median MPA-C0 value of 0. 74 mg/L. Side effects occurred with the median MPA-C0 value of 1.32 mg/L. Sixteen case-times demonstrated acute rejection episode with the median MPA-C0 value of 0. 39 mg/L. The incidence rates of different side effects, such as infection, bone marrow depression, and digestive tract symptoms were significantly related to MPA-C0 dose-dependently. Conclusion MPA-C0 may be an appropriate pharmacokinetic monitoring parameter for kidney transplant.

Objective To analysis the clinical character of renal transplant (RTx) recipients with bilateral native upper urinary transitional cell carcinoma. Methods The clinical data of 7 cases of transitional cell carcinoma in 2236 RTx recipients who underwent non-synchronous native bilateral nephroureterectomy(BNU)for 14 case-times were retrospectively analyzed. Results The mean time between RTx and diagnosis of TCC was 49.7 months (24 -96 months). The mean interval between 2 upper urinary tract operations was 14. 0 months(2 -36 months). All specimens obtained in the 14 operations were TCC-positive. The TCC location involved pure native pelvis ( n = 2), pure native ureter ( n = 4), and pelvis combined with ureter (n = 8). The TCC pathological grades include G1 - G2 ( n = 7 ), G3 ( n = 6), and cancer in situ ( n = 1 ). The TCC stage status included pTIS ( n = 1 ), pT1N0M0 ( n = 4), pT2 N0M0 ( n = 6), pT3N0M0 ( n = 2), and pT4 N2 M1 ( n = 1 ). Five patients were observed to have TCC in bladder. Each patient underwent more then 2 times of transurethral resection of bladder tumor ( TUR -Bt). The bladder TCC was at G2 - G3 with deep of superficial muscle involvement. Metastasis was found in skin, soft tissue, and costal bone of lumbar in one patient. The blood creatinine level of the 7 patients, representing the graft's function, was 120 μmol/L (97 - 161 μmol/L). The patients were followed up for 2 - 48 months, all patients survived. Conclusion TCC after RTx has multiple sources and is invasive. Non-synchronous prophylactic native BNU with removal of bladder cuffs should be considered for those RTx recipients having multiple urinary tract malignancy in native upper urinary tract and bladder.

Objective To investigate the clinical-pathological characteristics of triple negative breast cancer. Methods The clinical-pathological characteristics of 690 breast cancer patients, all females, 127 being estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor ( HER)-2 triple negative, were analyzed. Results The expression rate of P53, a tumor suppressor gene, of the triple negative breast cancer patients was 71.42% (75/127) , significantly higher than that of the non-triple negative breast cancer patients (42. 56% , P <0. 01 ), and the expression rate of epidermal growth factor receptor (EGFR) of the triple negative breast cancer was 59. 74% , significantly higher than that of the non-triple negative breast cancer patients ( 22. 06%, P = 0. 013 ) . The local lymph nodemetastasis rate of the triple negative breast cancer was 22. 22%, significantly higher than that of the non-triple negative breast cancer patients (2. 70%, P =0. 048). The 5-year overall survival(OS) rate and 10-year OS rate of he triple negative breast cancer patients were 79. 67% and 63. 15% respectively, both significantly lower than those of the non-triple negative breast cancer patients (88. 59% and 83.28%respectively, beth P = 0. 001 ). The 5-year and 10-year disease free survival (DFS) rates of the triple negative breast cancer patients were 77.94% and 62. 87% respectively, both significantly lower than those of the non-triple negative breast cancer patients (83. 82% and 82. 53% respectively, both P = 0. 011), especially that within 36 months. Conclusion Triple negative breast cancer is related with P53 and EGFR expression, and tends to metastasize to local lympho-nodes. The survival rate of triple negative breast cancer patients is significantly lower than that of non-triple negative breast cancer.

Objective To investigate thee status of Candida colonization and the risk factors of invasive fungal infection (IFI) in hospitalized patients with hematological malignancies. Methods 114 patients with hematological malignancies admitted to the hematology wards from May 2004 to April 2005 underwent fungal culture of their samples of urine, feces, and saliva once a week until the end of the sixth week of hospitalization or they were discharged. Culture of blood, sputum, or sterile body fluids were carried out when the patients were suspected to have IFI. Results 165 strains of Candida spp. were isolated from 46 of the 114 patients, C. albicans accounting for 78. 8% and non-albicans Candida for 21.2% respectively. Candida was found in 38 patients (35. 3% ) were found to have colonization of Candida, chiefly C. albicans (76. 3% ). The risk factors of Candida colonization included long duration of leucopenia (WBC < 0. 5 × 109/L for more than 10 days ) and broad-spectrum antibiotic administration. Univariate analysis showed that the risk factors of IFI included Candida colonization, long duration of leucopenia, and administration of carbopenem antibiotics, and multivariate analysis showed that long duration of leucopenia (WBC<0.5×109/L for more than 10 days) was the only risk factor of IFI (P=0. 015). Conclusion C. albicans is still the major organism isolated from the patients with hematological malignancies. Patients with hematological malignancies have a high incidence of Candida colonization. Long duration of leucopenia is the only risk factor for IFI.

Objective To detect the serum Chemerin levels in patients with obesity and newly diagnosed type 2 diabetes mellitus (T2DM) and explore the relationship of serum Chemerin to body fat parameters, glucose and lipid metabohsm, and insulin resistance index (IR). Methods 76 newly diagnosed T2DM patients and 76 subjects with normal glucose regulation (NGR), with the body mass index (BMI) <25 kg/m2 (NW) or ≥25 kg/m2 (OW/OB), 38 in each subgroups each, underwent body measurement including body weight, height, waist circumference, and hip circumference, and waist hip ratio (WHR) and calculation of body mass index (BMI) were calculated. Peripheral blood samples were collected from them to detect the blood lipids, glucose, hemoglobin A1C, fasting insulin (FINS), and fasting C peptide. Homeostasis model assessment insulin resistance index (HOMA-IR) was calculated. ELISA was used to detect the Chemerin level, body mass index (BMI) and waist hip ratio (WHR) were evaluated and insulin sensitivity was assessed by HOMA-IR. Results The serum Chemerin level of the females was ( 109 ± 28) μg/L, significantly higher than that of the males [ (98 ± 23 ) μ/L, P < 0. 05 ]. After adjustment of gender and age, the serum Chemerin level of the OW/OB group, including NGR-OW/ OB and T2DM-OW/OB subgroups, was (113 ± 27) μg/L, significantly higher than that of the NW group [ (94±25) μg/ L, P <0. 01 ], that of the NGR-OW/OB subgroup being the highest. Partial correlation analyses showed that the serum Chemerin was positively correlated with waist circumference, WHR, fasting serum C peptide, HOMA-IR, TG, ALT, γ-GT, and uric acid (r =0.460-0. 182, all P<0.05) and negatively correlated with high density lipoprotein-cholesterol ( r = - 0. 251, P < 0. 01 ). Stepwise regression analysis showed that fasting serum C peptide and TG were the independent variables of Chemerin (β = 0. 328, 0. 280,P < 0. 05 ). Conclusion Serum Chemerin levels are much higher in females and obese subjects are much higher than in men and subjects with normal weight. Serum Chemerin is correlated with insulin level, body fat disposition and lipid metabolism which suggesting that it may play a role in the pathophysiology of obesity and metabolic syndrome.

Objective To investigatethe relation between bone morphogenetic protein type Ⅱ receptor (BMPR2) gene promoter mutation and pulmonary arterial hypertension(PAH). Methods Peripheral blood samples were collected from a 36-year-old female patientwith familial PAH (FPAH), 19 idiopathic PAH (IPAH) patients, and 50 healthy controls. DNAsequencing was conducted for the position -2022 bp upstream of the promoter transcriptionstart point of BMPR2 gene. Two fragments carrying BMPR2 promoter mutation -142A and wild -142G allele were amplified and cloned respectively into the pGL3-basic dual-luciferasereporter gene vector, thus generating two luciferase reporter constructs: pGL3-BMPR2-wildrecombinant plasmid ( carrying -142G allele) and pGL3-BMPR2-mut recombinant plasmid(carrying -142A allele ). Human pulmonary arterial smooth muscle cells (HPASMCs) andhuman pulmonary arterial endothelial cells (HPAECs) were cultured and transfected withpGL3-BMPR2-wild and pGL3-BMPR2-mut recombinant plasmids respectively. The transcriptionalactivity levels of these 2 recombinant plasmids were measured by Veritas MicroplateLuminometer, and were calculated as the ratio of firefly luciferase activity to Renillaluciferase activity. The binding sites for transcriptional factors on the flanking sequence of the wild and mutant BMPR2 gene promoter regions were analyzed by using theMAPPER Search Engine. Results A mutation -142G > A in the promoter region of BMPR2 gene was found in this female patient with FPAH. The transcriptional activity levels of the BMPR2 promoter carrying -142A allele in the HPASMCs and HPAECs were (9.58±3.85 )and (59.07±25.54) respectively, both significantly lower than those of the BMPR2promoter carrying -142G allele [(16.80±3.55) and (115.58±38.02) respectively, both P <0. 05]. The binding site of specificity protein 3, the potential transcriptional factor, was deleted in the BMPR2 promoter carrying -142A allele comparedto the BMPR2 promoter carrying - 142G allele. Conclusion BMPR2 promoter mutation -142G> A may be associated with FPAH.

Objective To study the spectrum of mutations in methyl-CpG-binding protein 2 gene (MECP2) and cyclin-dependent kinase-like 5 gene (CDKL5) in Chinese pediatric patients with Rett syndrome (RTT), and establish a simple, quick, and efficient gene test method as well as screen a strategy of genetic diagnosis for RTT. Methods Genomic DNA was extracted using standard procedures from the peripheral blood leukocytes of 117 pediatric patients diagnosed from 1987 to 2007 . PCR was used to amplify the exons 1 - 4 of MECP2 using published primers. If no mutation was identified after screening exons 2 - 4, exon 1 was screened. If no mutation was identified in MECP2 by sequencing, multiplex ligation dependent probe amplification (MLPA) was employed to screen for large deletions by using P015C kit. If no mutation was identified in the MECP2 by sequencing and MLPA respectively, then the coding region of CDKL5 was screened by denaturing high performance liquid chromatography (DHPLC). Results The total mutation frequency in MECP2 and CDKL5 genes among all RTT patients was 82%. MECP2 mutations were found in 86% (137/159) of the patients with classical RTT and in 44% (8/18) of those with atypical RTT. Most of the mutations were missense mutations, accounting for 39%, followed in order of frequency by nonsense mutations 28%, frame shift mutations 17% and large deletions 14. 5%. The eight most frequent MECP2 mutations were p. T158M ( 13% ), p. R168X ( 12% ), c. 806delG (7%), p. R255X (6%), p. R270X (5%), p. R133C (5%), p. R.306C (4%), and p. R106W (3%), with p. T158M as the most common of the MECP2 mutations and c. 806delG as a hotspot mutation in Chinese patients with RTT. Only one synonymous mutation was identified in CDKL5. Conclusion The spectrum of MECP2 mutations within the mainland Chinese RTT patients is similar to that of those patients reported in the world, p. T158M, p. R168X, c. 806delG, p. R255X, p. R270X, p. R133C, p. R306C, and p. R106W are the hotspot mutations of MECP2 and c. 806delG is a specific hotspot mutation in Chinese patients with RTT. The most effective method to screen mutations is to screen the exon 4. MLPA is an effective supplement to the routine methods.

Objective To investigate the pathological changes of tunica albuginea in erectile dysfunction (ED), the role of tunics albuginea in penis erection, and the therapeutic effect of phosphodiesterase-5 inhibitor (PDESI) on ED. Methods Thirty 8-week-old male Sprague-Dawley rats were randomly divided into 3 equal groups:(1) control group fed with normal diet for 16 weeks, (2) high-fat group fed with the diet containing 2% cholesterol and 10% pork fat, and(3) Tadalafil group fed with high-fat diet for 16 weeks and undergoing gastric perfusion of Tadalafil 2 mg/kg daily since the 13th week for 4 weeks. Sixteen weeks later, intracavernous pressure and mean arterial pressure were measured, and the ratio of maximal intracavernous pressure to mean arterial pressure (ICP/MAP) was calculated blood samples were collected. Blood samples were collected from the abdominal aorta to undergo lipid profile test. Then penis was cut. Victoria blue/ponceau red staining and color image analysis were used to observe the content of elastic fibers in the tunics albuginea. Results The ICP/MAP of the high-fat group was 0. 49 ± 0. 05, significantly lower than that of the control group (0. 82±0. 06, P <0. 01 ). The ICP/MAP of the Tadalafil group was 0. 60 ± 0. 02, significantly higher than that of the high-fat group ( P < 0. 05 ). The content of elastic fibers in tunica albuginea of the high-fat group was 468 ± 152, significantly lower than that of the the control group (3292 ± 1123, P < 0. 01 ). The content of elastic fibers in tunica albuginea of the Tedalafil group was 2062 ± 560, significantly higher than that of the high-fat group (P < 0.05 ). Conclusion High fat diet may lead to ED and reduction of elastic fibers in tunica albuginea, and PDE-5Ⅰ reverses such pathological changes.

Objective To establish a rat model of venous thromboembolism (VTE). Methods One hundred and forty-four SD rats were randomly divided into 2 equal groups: VTE-A group, undergoing local blocking of left femoral artery with micro vessel clip to cause deep vein thrombosis (DVT), and VTE-B group undergoing local blocking of left femoral artery with micro vessel clip in addition of administration of thrombin slowly injected from the distal end of the femoral vein blocked by micro clip. The rate of swelling limbs was observed. One, 4, and 7 days later 6 rats from each group were killed with their femoral veins taken out to observe the thrombosis rate by light microscopy. Other 18 rats in each group underwent injection of the thrombi from left femoral vein solution in normal saline into the fight femoral vein 1, 4, and 7 days after DVT formation to establish model of DVT-pulmonary thromboembolism (PTE). The 6 rats of each group [VTE-A-DnPn and VTE-B-DnPn groups] were killed 1, 4, and 7 days after DVT-PTE formation respectively with their lungs taken out to observe the rate of PTE by light microscopy. Results ( 1 ) On day 1 after DVT, the successful rate of DVT was 100% in both VTE-A and VTE-B groups, and the swelling limb rate of the VTE-B group was 37.5% (27/72), significantly higher than that of the VTE-A group [ 16.7% (12/72), P =0. 005]. On day 7 after DVT, the positive thrombus rate of the VTE-B group was 83.3% (20/24), significantly higher than that of the VTE-A group [41.7% ( 10/24), P =0.003 ]. One, 4, and 7 days after DVT, there were reddish, mixed, and organized thrombi in both VTE-A and VTE-B groups. (2) Tachypnea and tachycardia occurred immediately and disappeared spontaneously within 30 -60 minutes when solution of thrombi was injected into pulmonary arteries via the right femoral veins. One rat died in the VTE-B-D1P1 group 12 h after the embolization and was anatomically confirmed to suffer from fresh massive emboli lodged in pulmonary arteries. The successful rates of DVT-PTE model were 100% ( 18/18 ), 83. 3% (15/18), and 44.4% (8/18) in the VTE-A-D1Pn, VTE-A-D4Pn, and VTE-A-D7Pn groups respectively, and were 94.4% ( 17/18), 100% ( 18/18), and 83.3% (15/18) in the VTE-B-D1Pn, VTE-B-D4Pn, and VTE-B-D7Pn groups respectively. The successful rate of DVT-PTE model in the VTE-B-D7Pn group was higher than that in the VTE-A-D7Pn group (P =0. 015 ). The thrombi in pulmonary arteries caused by the 4 or 7 days thrombi of DVT showed lower dissolubility in both VTE-A and VTE-B groups. Conclusions A new rat model of VTE (DVT-PTE) has been successfully established. The successful rate of VTE can be increased when thrombin is slowly injected from the distal end of femoral vein blocked by micro clip in addition.

Objective To investigate the effects of α-zearalanol (α-ZAL) on the generation of reactive oxygen species (ROS) and ROS-activated signal transduction in the tumor necrosis factor(TNF-α)- stimulated human umbilical vein endothelial cells (HUVECs). Methods HUVECs were cultured and divided into 4 groups: (1) normal control group, (2)TNF-α stimulated group, undergoing TNF-α stimulation for 24 h, (3) α-ZAL retreatment group, undergoing re-treatment withα-ZAL of the concentrations of 1 × 10-8, 1 × 10-7, or 1 × 10-6 mol/L for 1 h, then stimulation of TNF-α for 24 h, and (4) plasmid transfection group,transfected with p47phox siRNA for 24 h to block the NADPH oxidase protein subunit p47phox in the HUVECs, or transfected with blank plasmid as control. The intracellular ROS production was detected by using 2, 7-dichlorofluorescin diacetate as probe. Semi-quantitative RT-PCR and immunocytochemistry were used to detect the mRNA and protein expression of p47phox. The activation of latory protein (SP)-1, and activator protein (AP)-1 were assessed with Western blotting. Results The ROS level in the HUVECs of the TNF-α group was higher than that of the control group by 155.4%, and α-ZAL reduced the ROS level dose-dependently. TNF-α treatment up-regulated the p47phox mRNA expression by 212. 8%, and obviously increased the p47phox protein expression; and α-ZAL pretreatment attenuated the TNF-α-induced p47phox mRNA expression by 63.0%, and also markedly inhibited the p47phox protein expression. No obvious ROS was found in the HUVECs stimulated by TNF-α after the transfection of p47phox TNF-α were abolished or markedly inhibited by α-ZAL pretreatment. Conclusion α-ZAL has a potent inhibitory effect on the ROS production and ROS-activated signaling pathway in the TNF-α stimulated endothelial cells, mainly through the inhibition of NADPH oxidase.

One of the more effective methods to prevent colorectal cancer is to remove benign prodromal lesions with high malignant potential. Traditionally, adenoma is the precancerous lesion of colorectal cancer, while hyperplastic polyps are harmless and non-neoplastic [1].

Hepatocytes are rich in keratin (K), which is the most important and largest member of the intermediate filament family of cytoskeletal proteins. It not only has important cytoprotective function but also is closely related to human diseases. Studies have shown that keratin gene variation is the direct cause of some skin and its appendages, oral cavity and corneal diseases. In recent years, keratin gene variation has also been found to be the susceptible cause of liver diseases.

Obesity has become the leading cause of health problems worldwide. The global obesity epidemic may stem from a combination of genetics and the increasing supply of high-energy diets in today's society and the reduced demand for physical activity.

It has been recently found that sleep apnea syndrome (SAHS) is associated with the onset of cardiovascular diseases. The myocardial function index (MPI) is an echocardiographic parameter that evaluates the comprehensive function of the myocardium.

A 27-year-old female was admitted to hospital in August 2007 because of repeated nodules in both lower limbs, ulceration and pain for more than 5 years. In February 2002, the patient appeared three dark red nodules in the front of the tibia of both calves, which were painful, gradually enlarged and ulcerated, with purulent and bloody secretions with fishy odor, and scab formed for several days, but the scab was easy to break and bleeding and exudating fluid.

With the progress of treatment of advanced breast cancer, the survival period of patients is gradually prolonged, and the incidence of brain metastasis is increased. Because of the existence of blood-brain barrier, macromolecular chemical drugs are ineffective in the treatment of brain metastasis.