Volume 89  ·   Issue 36  ·  2009

Coronary heart disease has become one of the main causes of disability and death in urban and rural residents in China. About 700,000 people die from coronary heart disease every year, accounting for about one quarter of all deaths [1]. The death of coronary heart disease is mainly due to acute coronary syndrome (ACS). In recent years, the treatment of ACS, such as reperfusion therapy, antiplatelet therapy, anticoagulation, statin lipid-lowering therapy and B-blocker, has significantly reduced the mortality rate of ACS. These treatment measures proved by evidence-based medicine to improve the prognosis of ACS have been included in international authoritative academic organizations and China's guidelines.

Deafness is mainly caused by environmental factors and genetic factors. The former includes drugs, infection and trauma, and the latter involves gene and mitochondrial changes [1]. The two factors can also interact with each other and eventually lead to the occurrence of deafness. For example, the change of mitochondrial DNA can lead to the increase of cochlear hair cells' sensitivity to aminoglycoside antibiotics, and then lead to the occurrence of deafness. In recent years, with the great improvement of social medical level, the deafness caused by environmental factors is less and less, and the proportion of deafness caused by genetic factors is increasing.

[Editor's Note] Since the appearance of influenza A (H1N1) cases in the mainland of China in May 2009, the Ministry of Health has promulgated<The Diagnosis and Treatment Scheme of Influenza A (H1N1) (First Edition of 2009 Trial Edition) has played an important role in clinical diagnosis and treatment, and ensured that the medical work was carried out scientifically and orderly. Recently, the clinical expert group of influenza A (H1N1) of the Ministry of Health, based on the diagnosis and treatment experience in China, based on the summary data of more than 300 cases of influenza A (H1N1) in the mainland, and drawing on the latest research and practice of influenza A (H1N1) prevention and control by the World Health Organization and other countries,<Influenza A (H1N1) Diagnosis and Treatment Plan (2009 Trial Edition First Edition)>was revised, and the study formulated<Influenza A (H1N1) Diagnosis and Treatment Plan (2009 Trial Edition Second Edition)>was promulgated and implemented on July 10, 2009.

Medicine in the 21st century has undergone earth-shaking changes, and many new technologies and means can detect and treat diseases earlier. However, with the continuous progress of technology, medicine has not met the increasing medical needs of people. This paper, from the perspective of clinicians, illustrates the importance of art in medical thinking and activities, and improves the current medical situation and the doctor-patient relationship by increasing the artistry of medicine.

Objective To investigate the molecular etiology of non-syndromic hearing impairment in two patients in a maternal inherited deafness Chinese family. Methods Peripheral blood specimens were collected and DNA templates extracted. The complete mitochondrial genomes and GJB2 geoe were sequenced in an ABI 3100 Avant sequencer. Results The proband(Ⅲ-5) and her elder sister(Ⅲ-1) were found to carry the mtDNA 12SrRNA C1494T mutation. The GJB2 gene showed no mutations. The proband had the history of using aminoglycosides before hearing loss, and exhibited severe sensorineural hearing impairment; the proband's sister had no history of using aminoglycosides, and showed moderate sensorineural hearing impairment. Conclusion The molecular etiology of each individual patient in a family yaries with individual genetic background.

Objective To study the correlation between the number of mtDNA (mitochondrial DNA) copies containing mtDNA A1555G mutation site and phenotype and further elucidate the molecular genetic basis of phenotype diversity of nonsyndromic hearing loss. Methods Real time-amplification refractory mutation system-quantitative PCR was employed to detect the number of mtDNA copies in mild type and mutant type of mtDNA 1555. Results In the sporadic group, there was no significant correlation between mtDNA A1555G homogenicity mutation copies and phenotype (R = 0.001, P = 0.997) while significant correlation existed between mtDNA A1555G heteroplasmic mutations and phenotype (R =0.771, P = 0.003). In the familial group there was significant correlation mtDNA 1555 homogenicity mutation copies and phenotype (R = 0.341, P = 0.022) and significant correlation existed between mtDNA 1555 heterogenicity mutation copies and phenotype (R = 0.85, P = 0.015) Conclusion There is significant correlation between the mtDNA A1555G mutation copies and the severity of hearing loss.

Objective To discuss how to determine the number of samples in epidemiological study about deafness genes and reveal the characteristics of GJB2, SLC26A4 and mitochondrial DNA A1555G mutations in deaf-mute patients in schools for deaf-mutes in Shandong Province. Methods A total of 485 subjects were collected from the different schools for deaf-mutes in Shandong province. Amplified target fragments included GJB2 coding sequence, mtDNA12SrRNA and exon 8,10,17,19 of SLC26A4 gene. The amplicons of mtDNA 12S rRNA were subjected to restriction enzyme Alw26I. The amplicons of patients whose enzyme reaction highly indicating A1555G mutation,amplicons of GJB2 and those exons PCR products of SLC26A4 were directly sequenced. Results The study revealed that 36.29% patients had two mutated alleles (homozygote & compound heterozygote) of GJB2 (24.12%) and SLC26A4 (6.60%) and mtDNA12SrRNA A1555G (5.57%). The 235delC and IVST-2A > G were still the mutational hot spot in GJB2 and SLC26A4 respectively. Conclusion The method of determining the number of sample is very important in the epidemiological study. There were about 24 thousand deaf-mute patients who were caused by three sensitive deafness genes mutations in Shandong province. Screening the sensitive deafness genes in newborn is imminent.

Objective To evaluate the efficacy and necessity of transurethral electro-resection as sole modality for the treatment of cystitis glandularis. Methods The clinical data of 48 cases were reviewed. The patients were divided into two groups. One control group of 25 cases was treated by transurethral electro-resection or electric coagulation combined with bladder instillation of anti-tumor drugs. The other investigation group of 23 cases was treated by transurethral electro-resection as sole modality. The cystoscopy was performed at 3 months post-operatively to judge if the disease recurred. And the efficacy of two groups was compared. Results In the control group, 21 cases had normal cystoscopic finding and the rate of lesion removal was 84%, cure rate 72% and efficacy rate 92%. In the investigation group, 19 cases had normal cystoscopic finding and the rate of lesion removal was 83%, cure rate 74% and efficacy rate 87%. There was no statistical significance between these two groups. Conclusion Using transurethral electro-resection as a major therapy without bladder instillation of anti-tumor drugs is feasible. It can reduce the hospitalization cost and economize the social resources.

Objective To explore the optimal therapeutic effect of infliximab (IFX) upon inflammatory bowel disease. Methods Eight patients with inflammatory bowel disease (IBD), including 5 Crohn's disease (CD) and 3 ulcerative colitis (UC), were treated with IFX of 5 mg/kg body weight at 0, 2 and 6 weeks, followed by scheduled maintenance therapy every 8 weeks and followed up for a long-term period. Of these patients, 5 cases were resistant to cortieosteroid, 2 cases corticosteroid dependency and one naive patient. Results All patients responded well to the scheduled program of 5 mg/kg infusion of IFX. Two CD cases achieved a complete remission. Two CD patients responded clinically; one was difficult to judge the result; of the UC patients, one achieved a complete remission and 2 responded. There were no serious side effects during the course of therapy. Conclusion Selecting the proper drug indications and therapeutic protocol, determining the doses and course of IFX on the basis of therapeutic response, combining IFX with other immunomodulators (esp. budesonide) and assessing the therapeutic efficacy of IFX by endoscopic mucosa healing rather than symptoms prevent disease recurrence and decrease side effects.

Objective To determine whether there was any lingering effect after discontinuing Zenapax in renal transplantation and investigate there was any alternative immunity-regulating pathway of Zenapax other than IL-2/IL-2R. Methods Thirty patients of renal transplantation were divided into 2 groups. One group of 15 received 2 dosages of induction therapy of Zenapax and another 15 regular immunosuppressive therapy. IL-2, IL-10, STAT5 and CD40L were tested followed up at 2 hours pre-transplantation, 1, 3 and 6 months post-transplantation. Results The levels of IL-2 and STAT had no difference between the induction group and the control group. The level of IL-10 of induction group(59.4±7.7)ng/L was obviously higher than control group (36.8±8.4) ng/L at 3 months post-transplantation. CD40L level of induction group(10.6±3.6) was lower than control group(35.6±8.4) at 1 month post-transplantation. Conclusion Zenapax can reduce B-cell-mediated humoral immunity at 1 month post-transplantation through CD40L pathway.

Objective To analyze the effect of LASIK on visual quality of anisometropia, and evaluate its clinical value in the view of visual quality. Methods Prospective observational case series. Assayed the naked vision, glasses-corrected vision and binocular vision of 45 cases with anisometropia ≥2.25D before and after the operation of LASIK. Results 91.57% of the eyes after the operation reached the vision ≥0.8,which says a significant improvement for binocular vision after the operation (P < 0.05). There was a significant difference on diopter between the pre-operation and post-operation (P < 0.05). As for anisometropia, there was no significant difference between simultaneous binocular visions (P = 0.431), but there was of great significance among combined, short and long distance stereopsis visions (P = 0.000). Binocular vision deteriorated as anisometropia increased (P <0.05). The short distance stereopsis visions of LASIK-treated myopic anisometropia were better than that of glasses-corrected patients (P < 0.05). Conclusion The operation of LASIK can improve the visual quality and resume the binocular vision. LASIK can correct anisometropia and its therapeutic efficacy deserves to confirm.

Objective To investigate the impact of intervention program upon improvement of utilization quality of carbapenems and glycopeptides. Methods Multifaceted intervention program of carbapenems and glycopeptides was conducted at our hospital. It involved written justification forms, expert consultation committee meetings, audit, feedback and re-feedback. From November 1,2007 until October 31,2008, retrospective audit and feedback were performed on all patients dosed with carbapenenms or glycopeptides. Case reports were reviewed and data of ratio of appropriate antibiotic use, length of hospital stay, total cost, mortality and rate of vancomycin-resistant Enterococci (VRE) were collected and compared between the first and second half year of antibiotic intervention program. Results A total of 397 cases were reviewed, 75 cases discussed at expert committee meetings and 58 feedback letters delivered to responsible doctors. The consumption of both carbapenems and glycopeptides decreased. The appropriate use of carbapenems and glycopeptides increased from 37.8% (45/119) to 53.5% (48/127, P <0.05) and from 45.6% (36/79) to 63.9% (46/72, P < 0.05) respectively. The total cost and mortality of patients dosed with glyopeptides decreased from a median of RMB 65 700 (30 300 - 146 900) yuan to 55 700 (36 700 -90 900) yuan, and from 39.2% to 26.4% respectively. The rate of VRE decreased from 5.63% in 2007 to 3.80% during the second half year of 2008. Conclusion Antibiotic intervention program of carbapenems and glycopeptides is effective in decreasing the inappropriate antibiotic use.

Objective To investigate the feasibility of employing double transplantations of autologous bone marrow mesenchymal stem cells (BMSC) and umbilical cord mesenchymal stem cells (UMSC) in the treatment of progressive muscular dystrophy (PMD). Methods A total of 82 cases were treated by the double transplantations of BMSC and CB-MSC. They were diagnosed by clinical manifestations, CK, LDH, genetic analysis, electromyography, MRI and pathologic examination of biopsied muscle specimens from July 2007 to July 2008. Control group was self-made at before and after treatment and cases were followed up for 3-12 months, treatment method: Eighty-two patients underwent the double transplantations of bone mesenchymal stem cell (BMSC) and human umbilical cord blood MSC(CB-MSC). ① BMSC:80-150ml bone marrow sample was collected through a puncture at bilateral posterior superior lilac spine. Ficoll density gradient centrifuge was employed to separate individual monocyte for induced differentiation. ② CB-MSC: 80-160ml umbilical cord blood was harvested and processed likewise as above. ③Stem cell transplantation: Both BMSC and CB-MSC were collected and prepared into 1×108/ml and 1×107/ml cell suspension respectively. They were transplanted in divided does into the extremity muscle and vein. The clinical and laboratory parameters were monitored at 3, 6, 9 and 12 months. Results It was found that 31 cases(37.8%)obtained a remarkable efficacy, 37 cases(45.1%)were effective and 14 cases (17.1%)had no change. Total effective rate was 82.9%. Seventy patients(85.4%)felt limbs warmly, appetite improved, gained weight, had better appetite and action were nimble. Activity of daily living scale (ADL) in 72 patients (87.8%) increased as compared with pre-treatment (P < 0.01). LDH decreased at post-treatment [(475±223) u/L vs (410±216) u/L, P < 0.05, t = 6.650]. Creatine kinase [(2952±2259) u/L vs(2841±2092) u/L,P =0.223,t = 1.094] and creatine [(26±12) μmol/L vs(25±11) μmol/L,P=0.306, t = 1.029] decreased slightly. Adherence to therapy among Children and no adverse reaction was reported during the course of treatment. Conclusion The double transplantation of BMSC and CB-MSC is convenient, safe and effective in the treatment of progressive muscular dystrophy and can be considered as a new therapy of PMD. MSC represents a possible tool of cellular therapeutics for PMD.

Objective To explore the clinical features and disease spectrums for ANCA (anti-neutrophil cytoplasmic antibodies) -associated vasculitis (AAV) and to improve its cognition. Methods Clinical features of 190 cases of patients with AAV hospitalized from 1998 to 2008 were reviewed retrospectively. According to the result of ANCA test, the patients were divided into two groups, cytoplasmic ANCA (C-ANCA) positive and perinuclear ANCA (P-ANCA) positive. The authors compared the differences of disease spectrums, clinical manifestations and laboratory tests between two groups. The relative mortality factors were also analyzed. Results The authors studied 92 males and 98 females with an age range of 8 -89 (59±18) years old. There were 156 cases aged 40 -80 years old (82.1%) and 162 patients (85.3%) were of primary AAV including 146 cases of P-ANCA positive and 16 cases of C-ANCA positive. There were 28 patients with secondary AAV including 18 cases of connective tissue disease, 7 cases of prorylthiouracil induction, 1 case each of idiopathic thrombocytopenic purpura, lung cancer and endometrial carcinoma. There were 25 cases of P-ANCA positive and 3 cases of C-ANCA positive in secondary AAV. There were 171 cases (90.0%) in P-ANCA group and 19 cases (10.0%) in C-ANCA group. The number of organ involvement was 2.53 in C-ANCA group and 1.92 in P-ANCA group. Gastrointestinal tract, joint, upper respiratory tract and ocular involvement was more in C-ANCA group than in P-ANCA group. Oral and auricular involvement was more in P-ANCA group than in C-ANCA group. The involvement difference was of statistic significance in upper respiratory tract, joint and eye (all P < 0.05). Renal and pulmonary involvement in P-ANCA group was similar to C-ANCA group. There were 3 mortality cases in C-ANCA group and 22 in P-ANCA group. Respiratory failure and multiple organ dysfunctions were relative mortality factors. Conclusions AAV is observed in elders with multiple organ involvement. The number of organ involvement in C-ANCA group is more than that in P-ANCA group. P-ANCA positive patients are more than c-ANCA patients. The disease spectrum is different in these two groups. Secondary AAV is more in P-ANCA group than in C-ANCA group. Clinical manifestations, laboratory tests and type of ANCA are helpful for the diagnosis of AAV.

Objective To investigate the immunological features of fulminant type 1 diabetes. Methods Twenty patients with fulminant type 1 diabetes (FID) were recruited based upon the criteria proposed by Hanafusa, and 40 patients with classical type 1 diabetes were matched with age, gender and duration for comparison. GADA, IA2A and ZnTSA were determined with radioligand assay, and GAD-reactive T cells were measured by enzyme-linked immunospot(ELISPOT) assay. The HLA-DQ were analyzed by sequence-based genotyping (SBT). Results Eight of 20 patients with F1D were antobody-positive, including 7 GADA positive,4 ZnTSA positive, and 3 both GADA and ZnT8A positive. The index of 3 GADA positive patients were less than 0.4 at first visit, two turned to be negative by two or three years. While the GADA index of the patient was 0.343 at onset and increased to 1.467 three years later. Among subjects with F1D(3/6) and classical type 1 diabetes (3/6), were recorded significant GAD-stimulated responses by ELISPOT assay. The frequencies of HLA-DQA1 * O102-DQB1 * 0601 and DQA1 * 03-DQB1 * 0401 were significantly higher in F1D than those in classical type 1 diabetes (P =0.005, P =0.035, respectively). Conclusion Humoral and cellular immunoreactivity and susceptible HLA-DQ genotype exsisted in part of F1D patients, indicating autoimmunity may involve in the pathogenesis of F1D.

Objective To observe the effects of different concentrations of glucose and insulin in cell differentiation from bone marrow stem cells (BMSC) into osteoblasts (OB) and explore the acting mechanism of glucose and insulin in bone metabolism. Methods The in vitro technique of cell culture was employed to separate, purify and cultivate BMSC from the tibia and femur of rats. Then the BMSCs were differentiated into osteoblasts under the inductions of different glucose concentrations (5.6, 25, 50 mmol/L) with or without the addition of insulin (0.6 μg/ml). Later the calcium nodule cell ratio of osteoblasts in alizarin red stain was observed microscopically to assay the mRNA expression of OB markers - ALP, BGP and Runx2 by real-time PCR. Results With the increasing glucose concentrations, the number of red calcium nodules obviously decreased. PCR showed that the mRNA expression of ALP, BGP and transcription factor Runx2 decreased too. The difference was significant (P <0.05). The differentiation of OB decreased with with the increasing glucose concentrations. The cell number of red calcium nodules obviously increased in the same glucose concentration groups. The mRNA expression of ALP, BGP and Runx2 also increased (P <0.01). It hinted that insulin could enhance the differentiation of OB. Conclusion Glucose can inhibit the differentiation from BMSC into OB. The inhibition is more sensitive along with the concentration increments. This may be one of the pathogenesises of diabetic osteoporosis. Insulin can enhance the differentiation from BMSC into OB. In addition, it can improve the inhibition of differentiation from BMSC into OB because of a high concentration of glucose.

Objective To develop a series of experimental animal models of myoclonus with different origins consistent with myoclonus seizure in clinic setting. Methods GABAA antagonist SR95531 was microinjected into the primary motor cortex (PMC), corpus striatum, nucleus reticular of the thalamus (NRT) to induce myoclonus (EMG burst of myoclonus≤400 ms). The behavior characteristics including latency, peak time, duration of seizure peak, maximal seizure frequency and total duration were observed. EMGs and ictal EEGs were recorded synchronously. The origin of myoclonus and its correlation with epileptic discharges were further confirmed by jerk-locked back averaging (JLA). A group of rats were pretreated with VPA, CZP and CBZ at the doses corresponding to their EC50. Myoclonus was induced at the time when the drug level was within their effective anticonvulsion concentration. The changes of behaviors and neuroelectrophysiological characteristics of myoclonus after pretreatment of AEDs were observed. Results (1) The myoclonus originating from PMC had the shortest latency and time to reach its peak as well as the longest duration of peak duration [(2.2±0.4)、(15.0±2.5)、(98±12) min]. The myoclonus originating from PMC and corpus striatum usually started from forelimb contralateral to injection. On the contrary, the myoclonus arising from NRT affeeted mainly the limb ipsilateral to the microinjection. (2) The EMG burst duration of myoclonus was(70±14) ms (PMC), (120±28) ms (corpus striatum) and (174±58) ms (NRT) respectively (F = 9.48, P < 0.01). All of them were accompanied with synchronic and regular spike or sharp discharges in EEG. (3) All the myoclonus originating from PMC, corpus striatum and NRT acquired time-locked cortical waves in average were ahead of their synchronous EMG (12.1±2.9) ms, (17.1±4.3)ms and(29.0±6.1)ms respectively. (4) Under EC50 concentration of those AEDs: VPA and CZP decreased the maximal seizure frequency of myoclonus originating from PMC, corpus striatum and NRT respectively(P <0. 01 or P <0.05);the duration of peak time and the total time of myoclonus arising from PMC and corpus striatum were shortened notably, but there was no significant influence of NRT upon myoclonus. The duration of peak time and total time of myoclonus seizures were remarkably extended by CBZ (P < 0.01 or P < 0.05). Conclusion A series of experimental myaclonus models of different origins are successfully established. They are consistent with the mechanism, behavior, neuroelectrophysiological and pharmacodynamic characteristics of clinic myoclonus.

Objective To clone a novel diabetic angiopathy related protein gene- C5orf21 and study its roles in diabetic macroangiopathy. Methods The open reading frame (ORF) of C5orf21 gene was cloned into vector from human aortic tissues by a RT-PCR-based approach and identified by enzyme-cutting and sequencing. The structure and function of C5orf21 gene and protein were further analyzed by bioinformatics technology. The mRNA expression of C5orf21 gene in human tissues and in vascular cells was analyzed by RT-PCR. RT-PCR was used to observe the effect of high glucose, low-density lipoprotein (LDL) and free fatty acid (FFA) upon the expression of C5orf21 gene in macrophnges. Results C5orf21 gene was successfully inserted into plh-ive vector and identified for the first time at the level of mRNA. There are five C5orf21 gene splice variants in human aortic tissue and their length of ORF are 1251, 1113, 894, 810 and 810 bp respectively. Two kinds of splice variants have yet to be included in GenBank database. Two kinds of splice variants have the same ORF and their differences are mainly in the bases in the 5' untranslated region. Bioinformatics analysis found that C5orf21 gene was located in chromosome 5q15 and C5orf21 protein contained Arb2 domain associated with histone H3 lysine 9 methylation. C5orf21 gene was normally expressed in many tissues. Fat and aortic tissues had the highest expression. The expression of C5orf21 gene could be detected in human aortic endothelial cell, aortic smooth muscle cell and macrophages. High glucose, LDL and FFA (esp. high glucose) up-regulated the expression of C5orf21 gene in macrophage. Conclusion C5orf21 gene contains five splice variants and it is identified for the first time at the level of mRNA. The changes of C5orf21 gene expression are correlated with diabetic macroangiopathy.

Children's obstructive sleep apnea hypopnea syndrome (OSAHS) refers to a series of pathophysiological changes caused by frequent partial or total upper airway obstruction during sleep, which disturbs the normal ventilation and sleep structure of children [1]. The clinical manifestations are: sleep snoring, mouth breathing, holding breath, repeated awakening, enuresis, hyperactivity, hyperhidrosis, etc. Occasionally, daytime sleepiness occurs.

The combination of radiotherapy plus long-term androgen inhibitors (≥2 years) can improve the overall survival of locally progressive prostate cancer. The results of a trial conducted by the European Organization for Cancer Research and Treatment (EORTC) to compare the advantages and disadvantages of radiotherapy plus long-term androgen inhibitors and radiotherapy plus short-term androgen inhibitors in the treatment of locally progressive prostate cancer were published in the New England Journal of Medicine, June 11, 2009 (N Engl JMed, 2009, 360:2516-2527).

There is a negative correlation between circulating sex-binding globulin levels and insulin resistance, but it remains uncertain whether it can predict the risk of developing type 2 diabetes.In a nested case-control study published in the New England Journal of Medicine on August 7, 2009 (N Engl J Med, 2009, 361:10.1056/NEJMoa0804381), postmenopausal women without hormone therapy (359 patients recently diagnosed with type 2 diabetes and 359 controls) at the Women's Health Research Center were selected to detect the plasma levels of sex-binding globulin and two polymorphic genes encoding sex-binding globulin, SHBG, which are fully related to protein levels, and randomly analyzed by Mendelian inheritance rule.

A 27-year-old male suffered from abdominal pain and diarrhea for half a year.Loose stool with slight pus and blood, 5~7 times/d, up to 10 times/d. Lower abdominal pain, reduced pain after defecation, and a history of ophthalmitis and ankylosing spondylitis.Colonoscopy showed that the mucosa of the terminal ileum and the whole colon was rough, congested and edematous, with some flaky erosion and deep ulcer, and mucosal hyperplasia-like changes were seen, mainly in the terminal ileum, cecum and ascending colon, occupying the lumen for 1 week, with mucus attached to the surface (Figure 1); Histological examination of mucosal biopsy showed chronic inflammation of mucosal tissue with necrosis, inflammatory exudation and granulation tissue hyperplasia in terminal ileum and ileocecal region. Combined with medical history and multifocal lesions, the disease was diagnosed as active stage of Crohn's disease. After oral administration of prednisone (25mg/d), sulfasalazine (4.0 g/d), methotrexate (MTX) and cyclophosphamide (CTX) for half a year, the disease still did not resolve, and the activity index of Crohn's disease (CDAI) was 237. After obtaining informed consent of patients, allogeneic bone marrow mesenchymal stem cell transplantation (MSCT) was performed.

Sponsored by Renji Hospital, Shanghai Institute of Digestive Diseases and Department of Gastroenterology, Johns Hopkins University Hospital, and co-organized by the European Society of Gastroenterology and Endoscopy (EAGE), American College of Gastroenterology (ACG), International Digestive Oncology Federation (IDCA), International Esophagitis Classification Working Group (IWGCO) and Asia-Pacific Society of Gastroenterology (APAGE), the 6th Shanghai International Gastroenterology Conference was held at Shanghai International Convention Center from July 1 to 4, 2009. More than 500 domestic and foreign experts attended the conference, including more than 70 foreign experts. Professor Meinhard Classen, Professor Guido NTrytgat and Professor Eamonn Quigley, the recent three presidents of World Gastroenterology Society, attended the conference and gave special presentations. The whole conference covered the clinical frontiers in the fields of gastrointestinal diseases, hepatology, digestive tumors and digestive endoscopy, and hot issues including basic research such as stem cells.