Volume 89  ·   Issue 39  ·  2009

Infectious systemic inflammatory response (sepsis) has been the most popular topic in the field of critical care medicine in recent twenty years. Since Bone et al. [1] put forward the concept of systemic inflammatory response syndrome (SIRS) in 1992, and clearly defined the concept of SIRS-sepsis-severe sepsis-septic shock and its relationship, many clinical specialties in various countries, especially critical care medicine specialties, issued the Barcelona Declaration in 2002 after 10 years, and officially launched the global "survival sepsis campaign (SSC)". After more than one year of repeated discussion and consensus, the relevant guidelines for SSC were formulated in 2004 [2], and further revised in early 2008 [3].

Objective To determine the optimal timing of treating acute renal failure(ARF)patients in intensive care unit(ICU)with RIFLE(risk of renal failure,iniury to the kidney,failure of kidney function.loss of kidney function and end-stage renal failure)classification using continuous tenal replacement therapy(CRRT).And to evaluate the association between mortality and RIFLE classification in the same patients.Methods Clinical data were collected from 103 ARF patients in ICU from 2000 to 2007.Results The 30-days hospital mortality rate was 45.6%.The 30 days' hospital mortality rates of RIFLE-R.RIFLE-I and RIFLE-F were 25.0%,20.0%and 57.3%respectively.Condusion Survival rate of ARF patients can be manifestly elevated if CRRT is performed before RIFLE-F.The patients in RIFLE-F category have a significantly higher mortality than RIFLE-R and-I patients.The RIFLE criteria is fit for ARF classification system

Objective To evaluate the effect of Xue Bijing injection in related proinflammatory factors and blood coagulation factors of vascular endothelial cell in severe septic patients.Methods Fiftytwo patients were randomly divided into Xue Bijing injection treatment group(Group B)and control group (Group A).Both groups were treated with routine integration treatment,and additionally,patients in Group B received Xue Bijing injection 100 ml intravenous once a day for 7 days while those in Group A received an equal quantity of normal saline as placebo.The changes of VCAM-1,ICAM-1,NO,AT-Ⅲ,TM,TPA,VWF and PAI-1 in blood serum were tested at Day 0.3.7.And the mortality was calculated at Day 28.Results The 28-day mortality rate was 32.1%(9/28)in Group B while that of Group A was 62.5% (15/24).There was a significant difierence between two groups(P＜0.05).The concentrations of blood serum VCAM-1 and ICAM-1 were significantly lower in Group B than Group A.And the concentrations of blood serum NO,AT-Ⅲ,TM,TPA,VWF and PAI-1 were significantly higher in Group B than Group A.Conclusion Xue Bijing iniection improves a patient's condition and reduces 28-day mortality of severe septic Datients.The reason may be that it can stabilize vascular endothelial cell to improve serious inflammatory reaction and blood coagulation dysfunction.

Objective To investigate the relationship of stress index and positive end-expimtory pressure(PEEP)in patients with acute respiratory distress syndrome(ARDS)and to determine the relationship of stress index.lung recruitment,oxygenation and respiration mechanics.Methotis Fourteen ARDS patients were enrolled.During volume control ventilation with constant inspiratory flow.the pressuretime(P-t)curve was fitted to a power equation:P=a×timeb +c,where coefficient b(stress index) describes the shape of curve:b=1,straight curve;b＜1,progressive increase in slope;and b＞1,progressive decrease in slope.Positive end-expiratory pressure(PEEP)was set to obtain b value between 0.9 and 1.1 after application of a recruiting maneuver(RM).PEEP was changed to obtain 0.6＜b＜0.8 and 1.1＜b＜1.3.The sequence of experimental conditions was random.Recruited volume(RV)was measured by static pressure-volume curve method.Hemodynamics,pulmonary mechanics and gas exchange were observed simultaneously.Results PEEP at b＜1,b=1 and b＞1 were(8.3±1.5)cm H2O,(15.0±1.9)cm H2O and(18.4±1.9)cm H2O respectively with a significant difierence(P＜0.001).At b=1 and b＞1,the partial arterial oxygen tension(PaO2/FiO2)[(350±113)mm Hg,(338±124 mm Hg)]were higher than that[165±60)mm Hg]of pre-RM(P＜0.05).the plateau pressure(Pplat)at b=1[(29±4)cm H2O]and b＞1[(33±7)cm H2O]post-RM were significantly higher than that at b＜1 [(22±4)cm H2O](P＜0.05);the Pplat at b＞1 was higher than that[(25±16)cm H2O]pre-RM (P＜0.05).Compared with the static pulmonary compliance(Cst)at b=1[(39±11)ml/cm H2O],Cst at h＞1[(26±7)ml/cm H2O]decreased significantly(P＜0.05).The RV at b;1 and b＞1[(402±204)ml,(588±269)ml]were significantly higher than that at pre-RM and b＜1[(136±111)ml,(175±122)m1](P＜0.05).At pre-RM,b＜1,b=1 and b＞1,HR,mean arterial pressure(MAP) and lactate showed no significant difference(P＞0.05).Conclusion Stress index at post-RM can be an excellent method of PEEP titration for ARDS patients.

Objective To characterize the clinical patterns of expression,laboratory serologic parameters and lymphomatous histological characteristics in patients with primary Sj(o)gren's syndrome (pSS) who subsequently developed non-Hodgkin's lymphoma (NHL).Methods The authors analyzed 9 pSS patients (8 females,1 male) who developed NHL.Five patients had received glucocorticoids,four of whom had received at least one immunosuppressive drags (methotrexate,glucosidorum tripterygll totornm,cyclophosphamide and imuran).A protocol form was used to record the main characteristics of pSS and NHL.Results Eight patients fulfilled the American-European Consensus Criteria (AECC).The main SS manifestations were painless parotid enlargement (n = 7),six of whom were unilateral;the main immunologic features were positive rheumatoid factor (RF) in all examined patients and hyperimmunoglobulinemia (n = 7).The main manifestations of NHL were splenomegaly (n = 7) and lymphadenopathy (n = 5).The main histological subtypes were mucosa-associated lymphoid tissue (MALT) lymphoma (n =4) and diffuse large B cell lymphoma (n =2).None of the patients with MALT lymphoma had a nodal primary location.Eight patients had an extranedal primary location,most frequently in salivary gland (n =4) and lung (n = 4).Conclusion Patients with pSS and NHL are clinically characterized by a high frequency of painless unilateral parotid enlargement,splenomegaly,lymphadenopathy,an immunologic pattern dominated by the presence of high-titer RF and hyperimmunoglobulinemia,a predominance of MALT lymphomas and an elevated frequency of primary extranodal involvement.

Objective To clarify the change of serum thyroid hormone levels during periopreation period of coronary artery bypass grafts (CABG).Methods The levels of serum thyroid hormones (TT3,TT4,FT3,FT4,TSH,rT3) were measured by chemical-luminal and RIA in 62 patients at certain time in perioperation period,as well as 30 normal volunteers on a fasting basis.SPSS 10.0 was used for statistic analysis.Results The levels of serum thyroid hormones had no significant difference between controls and patients before CABG.At 10 min and 60 rain after giving heparin,serum TT4,FT4 levels in patients during operation elevated significantly than before (P ＜ 0.01),however,at 2 h after operation,serum TT3,TT4,FT3,FT4,rT3,TSH levels had no significam changes.Serum TT3,TT4,FT3,FT4,TSH levels at 24 h and 72 h after operation were significantly lower in patients than before CABG (P ＜ 0.01).Especially at 24 h,serum TT3,FT3 levels decreased by 52.7% and 46.6% than before respectively,while serum rT3 levels increased significantly(P ＜ 0.01) and serum TT3,rT3 levels decreased significantly (P ＜ 0.01).The serum TT4,FT3,FT4,TSH levels didn't return to normal at 7 d after operation.Conclusion Elevated serum TT4,FT4 levels are present in acute period in patients accepted CABG.Decreased serum T3 and FT3 levels after CABG may indicate a bad prediction.

Objective To determine the pathological features and clinical implications of atypical glandular cells of undetermined significance (AGC) in cervical cytological results.Methods All 87 cases of cervical cytological examinations with AGC were identified by a computerized database in our patient population.The authors analyzed the cervical histopathological results by colposcopic biopsy,dilatation and curettage(D&C),cervical loop electrosurgical excision procedure (LEEP)and follow-ups.Results (1) Thirty-five cases (40.23%) had cervical and endometrial neoplasic findings:ten glandular lesions (11.49%) and squamous lesion was present in 25 patients (28.74%).(2) Among 61 patients with Pap smears subclassified as "AGC-not otherwise specified",there were 18 pathological abnormalities.Sixteen patients with AGC as "favor intraepithelial neoplasia" were of 9 pathological abnormalities.Ten patients with AGC as "adenocarcinoma in situ" or "adenocarcinoma" were of 6 pathological abnormalities.(3) 100% of patients with AGC had both of colposcopic and cytologic follow-ups:1 case CIN1,1 case CIN2 and 1 case CIN3.(4) One of 10 patients was younger than 35 years old with CGIN1 and the other 9 patient aged over 35 years old had a greater diversity of glandular lesions.Conclusion A finding of AGC requires both colposcopy and an aggressive workup because of a high rate of cancer and precancerous lesions.The onset of disease is age-related.Women aged over 35 years old has a greater diversity of glandular lesions and account for most cases of cervical and endometrial adenocarcinoma.

Objective To evaluate the surgical outcome of hypertrophic obstructive cardiomyopathy (HOCM).Methods From October 1996 to December 2007,54 HOCM patients underwent surgical treatment.There were 37 males and 17 females ranging from 6 to 68 years old (36±16) with body weight 27-83 (60±14) kg.Operation was performed under general anesthesia and cardiopulmonary bypass (CPB) with the moderate systemic temperature and low volume blood flow.The concomitant operations included coronary artery bypass grafting in 5 cases,mitral valve plasty in 5 cases,mitral valve replacement in 9 cases,tricuspid valve plnsty in 2 cases,aortic valve replacement in 4 cases and closure of patent ductus arteriosus in 2 cases.Preoperative and postoperative left ventricular (LV),left ventricular outflow tract (LVOT),left atrium (LA),mitral valve function and value of LVEF were evaluated by transesophageal echocardiograph examination.Results The time of CPB and aortic occlusion were 40 to 290 minutes (107±52) and 27 to 195 min (70±36 min) respectively.The endotracheal intubation durations were 5 to 21 hours (14±15) and ICU duration 11 to 183 hours (45±34).Comparing with the pre-operative echocardiographic parameters,the size of left atrium (42±8 vs 35±7),pressure gradients through LVOT (106±44 mm Hg vs 24±19 mm Hg),the thickness of septum (27±6 nun vs 19±5 mm) and the value of EF (70±10 vs 61±9) obviously decreased postoperatively(P ＜ 0.05).The surviving patients had either no mitral valve regurgitation or only mild mitral valve regurgitation.Four (7.4%) patients died during the perioperative period.The cause of death included severe low cardiac output,heart failure,severe ventricular arrhythmias and severe acute renal failure.There were 4 patients with a complete AV block postoperatively and 3 were implanted permanent pacemakers.The left bandle branch block or left anterior hemiblock were found in 26 cases,intraventricular conduction defect in 6 cases and type Ⅰ AV block in 4 eases.All surviving patients were in NYHA functional class Ⅰ /Ⅱ during the follow-up of 1 month to 10 years.Conclusion Surgical outcome for HOCM patients is satisfactory.Most HOCM patients achieve such a satisfactory relief of LV outflow tract obstruction as to lead a better life.

Objective To investigate the illness perception of cancer patients as well as the difference of illness perception between cancer patients and diabetics so as to help them to derive meaning from illness experiences and facilitate posttraumatic growth.Methods A sample of 210 Chinese cancer patients and 71 diabetics was recruited from the same hospital and CIPQ-R completed.Results Cancer patients had higher consequences [F(1,275) = 23.32,P ＜0.001,η2 =0.08]and emotional representation [F(1,275) = 25.95,P ＜ 0.001,η2 = 0.09];as well as less perceived controls over illness as compared with diabetics.Among the cancer patients,those with a better understanding about the meaning of illness tended to report more positive changes.Conclusion Illness perception is one of the important cognitive components affecting posttraumatic growth of cancer patients.Helping patients to derive meaning from their illness experiences facilitates the posttraumatic growth after cancer diagnosis.

Objiective To assess the efficacy of UKA versus HTO in the treatment of unicompartmental knee osteoarthritis.Methods Comparative studies of UKA and HTO were retrieved from the domestic and foreign literatures and included for a meta-analysis.Resuits Seven eligible randomized controlled trials included 196 UKAs and 219 HTOs.The result of Meta-analysis indicated that the ratio for an excellent outcome was higher in UKA than HTO.The combined OR was 2.43,95%CI(1.46,4.05)(P=0.0006).The risks of revision and complications were lower in UKA than HTO.The combined OR was 0.47 and 0.24 and 95%CI(0.23,0.97),(0.10,0.56).Conclusion UKA reduces the risk of postoperative revision and complications and provides excellent outcomes.

Objective To summarize the experiences of prophylaxis and management of early period acute renal failure(ARF)after orthotopic liver transplantation(OLTx).Methods The clinical data of 516 patients from January 2004 to December 2006 at our hospital undergoing allograft orthotopic liver transplantation.41 8 males and 98 females,aged 43(8-76)years old,were collected to analyze the incidence of early ARF.Results Of these patients,106(20.5%)experienced early ARF,including 21 mild,40 mederate and 45 severe cases.The integrated control treatment including retrieving prerenal factors,adjusting immunosuppressive schedule,drug therapy and blood purification were taken to cure ARF and 21 patients of severe ARF needed continuous renal replacement therapy(CRRT).Of 106 patients,37 (34.9%)died within 1 month post-OLT.The one month post-OIX survival rate of patients with MELD (model for end-stage liver disease)score Iess than 20 fared better than thase whose MELD score between 20 to 30 and MELD score over 30.Conclusion The prophylaxis and management of early post-OLT ARF is a systemic procedure from preoperative assessment to postoperative management.The significant steps of preventing and curing ARF within perioperative procedure of OLTx include preoperative evaluation of patient renal function.various intra-operative measures for protecting renal function.reducing renal funotion impairment due to drug toxicity after OLT and CRRT treatment if needed.

Objective To investigate the association between metabolic syndrome(MS)and stroke severity in at-admission patients with acute ischemic nonembolic stroke and to study the impact of MS upon prognosis:and to assess the relative influence of each of five components of MS upon the risk of stroke severity.Methods The consecutive cases of ischemic stroke were prospectively registered in neurology wards from March 2006 to March 2008.Only those patients with an onset of stroke within 24 hours were included.The outcomes were followed up at the end of 3 months after stroke onset.MS was defined according to the Chinese Diabetes Society criteria.Logistic regression was used to estimate the correlation of MS and prognosis.Results A total of 342 patients with acute isehemic non-embolic stroke within 24 hours from onset were included.Eighty six patients(50 males,36 females)had MS.The prevalence of individual components of MS was significantly higher in patients with MS as compared with those without.The delay from onset of symptoms to hospital admission and MS were associated with severe stroke in multiple logistic regression model(RR=2.45,95% CI,1.14-5.27;RR=1.85,95% CI,1.06-6.25 respectively).Analysis of the association between the development risk of sever stroke showed that hyperglycemia and low triglyceride level had associations with severe stroke(RR=3.02,95% CI,1.75-8.59;RR=0.85,95%CI,0.24-0.96 respectively).MS was not an independent predictor for case fatality and poor outcome 3 months after stroke onset(all P＞0.05).Conclusion Not an independent predictor for mortality and poor outcome at 3 menths after stroke onset.MS is an independent predictor for the severity of stroke and there is a hisher development risk of severe stroke.Among MS components,hyperglycemia and low triglyceride level are correlated with the development risk of severe stroke.This finding has important clinical implication and confirms the importance of glycemic control during acute phase of ischemic stroke.

：Objective To assess thesubooccipital median transcerebellomedullary fissure keyhole approach in a cadaver modelby using a neuronavigation system and explore its feasibility and operativeindications.Methods Six 10%formaldehyde-fixed adult cadaveric head and neck specimensinjected with colored latex were chosen for the study.First the suboccipital mediantranscerebellomedullary fissure keyhole approach was performed and the anatomicalstructures were observed under operative microscope.The exposed floor area of the fourthventricle and the vertical and transverse angles at the point where the line between thelateral apertures crossing the median sulcus,vertical angle at the apertures of midbrainaqueduct and the obex were measured with the aid of a frameless stereotactic navigationdevice.Parameters were compared with those when C1 posterior arch wag removed.and alsowith those under conventional approach with or without C1 arch.Results By means ofadjusting specimen positions and the angle of operative microscope,as tela choroidea andinferior medullary velum were dissected gradually,the structures of floor,lateral recessesand lateral apertures of the fourth ventrical.vermian and aperture of midbrain aquductwere exposed.There were no significant difference in the exposed floor area of the fourthyentricle between the keyhole approach and conventional approach(P=0.06),and the C1 archremoral can't increase the exposed area(P=0.84).The conventional approach have widerangles than the keyhole approach(P＜0.01),and the C1 arch removalincreased the vertical angle(P＜0.05),but not the horizontalangle(P＞0.05).ConclusionThe suboccipital median transcerebellomedullary fissure keyhole approach can exposesimilar anatomic architectures as that of the conventional approach.Thus it can be used toremove the tamons located in the fourth ventricle.dorsum of pons and medullary oblongataand cerebellar vermis.

Objective To investigate the effects of preemptive analgesia with flurbiprofen on the blood sugar and Interleukin-6 of patients after radical excision of breast cancer.Methods A total of 60 ASA Ⅰ-Ⅱpatients scheduled for radicul excision of breast cancer were randomly assigned to three groups:group A,B and C(n=20 each),patients of group A and C received intravenous flurbiprofen 100 mg before or at the end of surgery respectively.Blood samples were collected from the patients before anaesthesia induction and 1,6,24 h after surgery for the determination of blood sugar and serum interleukin-6 concentration.Analgesic efficacy was assessed after surgery based on visual analog scales(VAS).Results The blood sugar and serum interleukin-6 concertration of the patients in three groups at different time points after surgery were significantly higher than those before surgery,and increased gradually in group B,and there were very significant difference between the time point of 1 h and 24 h after surgery(P＜0.01),but there were no increasing trend for those of group A and C.The blood sugar and serunl interleukin-6 concentration of the patient of group A weresignificantly lower than those of group B and C(P＜0.01 or 0.05).The highest VAS of group A and C at different time points after surgery were significantly lower than that of group B(P＜0.05).Conclusion Preemptive analgesia with flurbiprofen 100 mg can effectively suppress the elevation of blood sugar and serum interleukin-6 concentration after radical excision of breast cancer,and is better than postoperation analgesia.

Objective To observe the effects of radiofrequency ablation in porcine liver ex vivo with "wet" RITA UniBlate unipolar electrode,evaluate the morphologic characteristic of the ablated zones and explore the impact upon the ablation lesions of time,temperature and set power of "wet" monopolar electrodes.Methods The maximal effective ablation electrode length of this "wet" unipolar electrode is 2.5 em.According to ablation time,temperature and power respectively,the experiment was divided into three major groups of A,B,C (11 sub-groups).The investigators observed the morphological characteristics of ablation lesions,measured the longitudinal and transverse distance of ablation beyond the electrode tip and calculated the volume of ablation lesion.Statistical analysis was performed with one-way ANOVA upon the above-mentioned four parameters.And the pathological examinations were made with HE staining.Results (1) All of ablated zones were ellipsoid.The cross-section of ablation lesions appeared to have 3 zones from the inside out:central zone,coagulated zone,hemorrhage and edema zone.(2) When ablating time and temperature increased to 15 min and 103 ℃ respectively,the ablated zones peaked:longitudinal diameter,transverse diameter,ablation distance beyond electrode tip and volume of each ablated zone was (3.49±0.09) cm,(2.40±0.13) cm,(0.79±0.09) cm and (10.6±1.3) cm3 respectively.With power as a variable,different sizes between ablated zones showed no statistical significance.(3) The morphology of ablated zones became irregular when the electrodes were located around larger blood vessels.Conclusion The ablating time and temperature are the major factors of affecting the size of radiofrequency ablation lesion with RITA "wet" unipelar electrode.

Objective To explore feasibility for entrance of the contrast agent Sonovue and Feridex into the aortal wall.Methods 17 male Japanese giant ears rabbits (common grade),including 11 atherosclerosis (AS) animal models fed with food containing high-content lipid and normal animals fed with common food as control.Respectively,10 animals in the AS group and 6 animals in the normal group were selected in a random way to undergo ultrasound-mediated microbubble destruction (UMMD) and no ultrasound-mediated microbubble destruction (-UMMD) half and half.One animal was administrated with double doses of Feridex.After general anesthesia,MR plain scan and intravenous injection of Feridex 100 μmol Fe/kg,immediately ultrasound focused on the front wall of the aortic arch,which underwent UMMD at the pressure of 3.5 Mpa with MI1.2 while 10 ml solution (Sonovue+ normal saline) was injected intravenously at the speed of 0.5 ml/min FOR 20 min.3T magnetic resonance (MR) was performed with a moderately T2 * weighted gradient sequence.Enhanced scan were performed for 1 h,24 h,48 h,72 h and after killing the animal, then the specimen were delivered to conduct optical and electronic microscope examination.Variance test for the re-measured data was adopted to verify the data obtained in every group.Results The effect of UMMD group on SPIO particles entrance into the aortal wall is of marked significance (P=0.0004) statistically.The effect of UMMD on distribution in the vessel wall is of statistical significance (P =0.01),more particles in the dventitia.Gas or microbubbles were found to enter into the intima,media of the aorta,and verified by Oil Red O staining.After staining the findings of iron particle in the cell and out of the cell are different.Conclusions UMMD may facilitate entrance of those SPIO particles with a bigger diameter and microbublles into the aortal walL This discovery may provide a new solution for penetration of complex macromolecule probes and gene-carried drug through the tunica intima of the aorta.

Objective To transfer multidrug resistance gene (mdr1) into human placental mesenchymal stem cells (P-MSCs) by retroviral vector and assess the effects of mdr1 gene transduction upon biological features of P-MSCs.Methods Human P-MSCs were isolated from trypsin-digested term placentas and then transduced by reconstructed retroviral vector containing mdr1 gene and green fluorescent protein (GFP) reporter gene.Flow cytometric analysis was employed to determine the immunophenotypes of transfected P-MSCs.And the proliferation and cell cycle were detected by methyl thiazolyl tetrazolium and propidium iodide staining.Uhrastructures of transfected P-MSCs were observed and different induction conditions used to direct the cells to differentiate into adipocytes and osteoblasts.Results The transfected PMSCs still expressed stem cell markers such as CD29,CD44 and CD73.The mean cumulative time of population doubling was 23.9 hours.The cellular cycle retained the proliferative characterization of stem cells.Ultrastructural features of transfected P-MSCs included increased surface microvilli,abundant mitochondria and slightly swollen rough endoplasmic reticulum.Furthermore these transfected cells demonstrated osteogenic and adipogenic differentiation potentials under appropriate conditions.Conclusion The mdr1 gene transduction by retroviral vector in vitro has no significant effect upon biological characteristics of P-MSCs.It might provide experimental references for the application of P-MSCs in high-dose tumor chemotherapy.

Objective To explore the effects of N-acetylcysteine (NAC) upon the methylglyoxal (MG)-induced injury of hippocampal neuronal cells.Methods Primary cultures of 1-day-old SD rat hippocampal neuron were exposed to MG and/or NAC for 24 h respectively.Apoptosis was quantified by flow cytometer using annexin V-FITC and propidium iodide (PI) staining.The level of intracellular reactive oxygen species (ROS) was measured by an oxidant-sensitive dye 2,7-dichorofluoresin diacetate (DCFH).The protein and mRNA levels of BDNF and TrkB were assayed with Western blot and real-time reversetranscription polymerase chain reaction (RT-PCR) respectively.Results After a 24 h cell incubation with 100 μmol/L MG,the ratio of apoptotic cells in MG group (8.80±0.31)% significantly increased versus the control group (1.60±0.15)% and MG + NAC group (4.83±0.31)% respectively.The level of intracellular oxidation of MG group (10 229±946) also significantly increased versus the NAC group (2118±320),control group (4265±82),MG + NAC group (3886±415) and pretreated NAC + MG group (2997±606).MG increased the cellular levels of BDNF but decreased the TrkB mRNA and protein expression significantly.However,NAC significantly decreased the BDNF and increased the TrkB mRNA and protein expression in rat hippocampal neuron after MG induction.All these differences were considered statistically significant.Conclusion MG-induced neurotoxicity in hippocampal neurons is mediated by oxidative stress and it can impair the BDNF/TrkB signal pathway.Antioxidant NAC has protective effect upon MG-induced neurotoxicity through its antiapoptotic action and its antioxidant effect on ROS level.And it works partly by activating the BDNF/TrkB signal pathway.

The patient was a 31-year-old male with a weight loss of 20 days. Physical examination showed that a mass of 6 cm ×6 cm in the upper abdomen was palpable, with tough texture, poor mobility and no tenderness; A 3cm ×3cm lymph node was palpable in the left supraclavicular area, which was tough in texture, poor in mobility, no tenderness, no female breast development characteristics, and bilateral testicles were normal. A lobulated mass was found in the right front of the spine at the level of the renal hilum on plain abdominal CT scan, with a clear boundary and a size of about 10.9 cm ×6.6cm. It showed isolow mixed density, mixed with small patch-like slightly higher density shadows, and the CT value was 12~52 HU (Figure 1A).

A 55-year-old female was admitted to Peking Union Medical College Hospital for 1 month after her visual acuity decreased in her left eye for 2 months. On January 8, 2004, the patient went to the ophthalmology clinic of a hospital in Beijing because of sudden blurred vision in her left eye for 10 days. The visual acuity was R: 1.2, L: 0.2, intraocular pressure (1 mm Hg =0.133 kPa): R: 21.1 mm Hg, L: 19.3 mm Hg; Double anterior segment (1), crystalline opacity, vitreous transparency, peripheral ciliary opacity of the crystalline. Suspected senile cataract, vitamin C, E and B2 were given orally.