Volume 90  ·   Issue 02  ·  2010

Helicobaeler pylori (Hp) has been discovered for more than 27 years. Because Hp infection is closely related not only to gastrointestinal diseases but also to some extragastrointestinal diseases, it has been widely paid attention to. The research on the treatment of Hp infection has become a hot spot in this field, and it is also the most concerned and interested clinical problem for clinicians.

Objective To evaluated the efficacy of 9-day moxifloxacin-based triple therapy as firstor second-line treatment to eradicate Helicobacter pylori (H. pylori). Methods Three hundred and thirteen H. pylori-positive patients without previous treatment (Group A), 51 Hp-positive patients with once-failed treatment (Group B) and 32 with twice-failed treatment (Group C) were recruited to receive moxifloxacin,esomeprazole and tinidazole (MET) for 9 days. H. pylori status was re-assessed 4 weeks after the end of therapy by urea breath test. The eradication rate and its 95% confidence interval (95% CI) were calculated in intention-to-treat (ITT) and per-protocol (PP) analyses respectively. Results In ITT analysis, the Hperadication rate was 89.8% (95% CI: 86.7%-93.0%) in Group A, 81.2% (75.3%-90.9%) in Group B and 81.2% (66. 1%-92. 6% ) in Group C,among which no significant difference was observed (χ~2 =4. 339, P ＞0. 05 ). However, in PP analysis there was a significant difference among them [ 93. 9%(90. 9%-96. 4% ) in Group A, 84. 8% (79. 1%-93.6% ) in Group B and 81.2% (66. 1%-92. 6% )in Group C ( χ~2 = 9. 294, P ＜0. 01 ＝ ＝. The rates were significantly lower respectively in Group B ( χ~2 =4. 885, P＜0. 05 ＝ and in Group C (χ~2 = 7. 023, P＜ 0. 01 ＝ than that observed in Group A according to PP analysis. But there was no significant difference between the patients with first-treated active ulceration and with first-treated gastritis ( χ~2 = 1. 670, P ＞ 0. 05 in ITT, or χ~2 = 0. 030, P ＞ 0. 05 in PP analysis).Eradication rate in patients with 3rd-treated gastritis was lower than that in patients with first-treated gastritis according to PP analysis (χ~2= 8. 076, P ＜ 0. 01 ＝. The compliance rate was 95. 99% in all patients.Conclusion Nine-day moxifloxacin-based triple therapy provides an optimal eradication rate with a good compliance as first-line or second-line eradication of Hp.

Objective To evaluate the efficacy and tolerability of moxifloxacin-based triple therapy as an alternative second-line treatment for Helicobacter pylori (H. priori)infection. Methods A total of 109 patients, in whom the initial standard PPI triple therapy had failed to eradicate Hpinfection, were included.Patients were randomized to one of the following 7-day treatment regimens: (1) rabeprazole 10 mg twice a day, moxifloxacin 400 mg/day and amoxicillin 1000 mg twice a day; and (2) rabeprazole 10 mg twice a day, bismuth salts 150 mg three times a day; clarithromycin 500 mg twice a day, metronidazole 400 mg twice a day. The eradication rates and side-effect rates of these two regimens were compared. Results The eradication rates were 75.5% (40/53) and 83.3% (40/48) with moxifloxacin-based triple therapy, and 62. 5% (35/56) and 71.4% (35/49) with bismuth-based quadruple therapy by intention-to-treat and perprotocol analyses (both P ＞ 0. 05 ) respectively. Conclusions The 7-day moxifloxacin-based triple therapy has a high eradication rate with fewer side-effects. This regimen can be a safe and effective option as secondline treatment for H. priori infection.

Objective To compare efficacy and tolerability of 7-day standard triple therapy versus 7-day levofloxacin-based triple therapy in first-line treatment for Helicobacter pylori ( H. pylori) infection.Methods Three hundred consecutive H. pylori positive patients were randomized to receive: clarithromycin,amoxicillin, lansoprazole (Group A: n = 150) ; or amoxicillin, levofloxacin, lansoprazole (Group B: n =150). H. pylori status was rechecked by ~(13)C-urea breath test 4 weeks after the end of therapy. Results The eradication rates in intention to treat (ITT) and per protocol (PP) analyses were: Group A, 74. 5% ( 111/149) and 78. 2% (111/142) ; and Group B, 82.4% (122/148) and 83.0% (122/147). Although the eradication rate achieved with levofloxacin-based triple therapy was higher than that with standard therapies in either ITT or PP analysis, but no significantly difference was found between the two triple therapies. The incidence of side effects was similar among groups. Conclusions A 7-day levofloxacin-based triple therapy can achieve higher H. pylori eradication rate than standard regimen. The levofloxacin-based regimen can be one effective therapy for the first-line anti-H, pylori treatment.

Objective To evaluate the efficacy of Chinese patent medicine wenweishu (温胃舒)/yangweishu(养胃舒) in the treatment of Helicobacter pylori ( H. priori ) positive patients with chronic gastritis and peptic ulcer. Methods A randomized, controlled and multicenter trial was conducted in 642H. pylori positive patients with chronic gastritis or peptic ulcer. They were randomized to three groups : PCM group (n = 222, pantoprazole 40 mg twice a day, clarithromycin 500 mg twice a day, metronidazole 400 mg twice a day, for 7 days) ; PCM plus wenweishu(温胃舒) group (n = 196) ; and PCM plus yangweishu(养胃舒) group (n =224).~(14)C breath test was performed 4 weeks after therapy. For the patients with gastric ulcer, ulcer healing was determined by endoscopy after therapy. Results Intention-to-treat H. pylori eradication rate for PCM group, PCM plus wenweishu(温胃舒) group, and PCM plus yangweishu(养胃舒)group were 57. 2% ( 127/222), 62. 2% ( 122/196), 60. 3% ( 135/224), respectively (P =0. 295, 0. 512). Per-protocol H. pylori eradication rates were 62. 3% ( 127/204), 70. 1% (122/174), 65.2% ( 135/207), respectively ( P = 0. 108, 0. 532 ). Per-protocol analysis gastric ulcer healing rate were 61.9% ( 13/21 ) 100.0% (18/18) ,86.4% ( 19/22 ) respectively. The healing rate in PCM plus wenweishu ( 温胃舒)groups was statistically significantly higher than the rate in PCM group (P = 0. 004). The rates of symptom relief in PCM plus wenweishu (温胃舒) groups and PCM plus yangweishu (养胃舒) were statistically significantly higher than the rate in PCM group ( both P＜0. 01 ). Side-effects were rare and comparable between groups. Conclusion Although PCM combined with wenweishu(温胃舒) or yangweishu(养胃舒) in the treatment of H. pylori positive patients with chronic gastritis and peptic ulcer can not reach a significantly higher eradication rate, it can increase the rates of both gastric ulcer healing and symptom relief.

Objective To measure the rate of high-risk group and the detection rate of colorectal cancer (CRC) in communities in Guangdong province and to provide scientific rationales for formulating mass screening plans in high-risk group. Methods Mass survey was conducted by questionnaire combined fecal occult blood test (FOBT) in Huizhou region, Guangdong Province, to sort out the high-risk population of CRC. Then the high-risk population was screened by colonoscopy and pathology to identify CRC. The differences were compared by direct expenditure which was used to calculate screening cost. Results A total of 68 953 people were surveyed. There were 940 people in high-risk group (detection rate: 1.36% ), 3118 in immunity FOBT positive group (detection rate: 4. 52% ), Merging aforementioned two groups, there were 3870 in population at risk (detection rate: 5.61% ). The CRC detection rate in high-risk group, immunity FOBT positive group, population at risk and average-risk group was 506. 3/10~5, 314. 3/10~5, 315.9/10~5 and 17.7/10~5 respectively. The positive predictive value of CRC screening scheme by high-risk group questionnaire-colonoscopy was 0. 43% while CRC screening scheme by FOBT-colonoscopy 0. 22%. In terms of direct expenditure of CRC per case in high-risk group and immunity FOBT positive group was 47 834. 5 yuan and 82 303.6 yuan. The latter was 1.7 times than that of the former. Conclusions The scheme of questionnaire combined FOBT for CRC is an effective way in mass survey. The scheme by high-risk group questionnaire-colonoscopy has a much better cost-effectiveness than that of the scheme by FOBT-colonoscopy so that it should be one of the preferred methods for individual screening in high-risk group.

Objective To investigate the correlation between the tumor vascular invasion and the change of cardio-pulmonary exercise function in patients with lung cancer. Methods The cardio-pulmonary xercise test was performed in 405 patients with lung cancer (293 with vascular invasion and 112 without).The peak load indices examined included maximal work power (measured value/predicted value, W% ),maximal oxygen uptake per weight ( VO_2/kg), anaerobic threshold ( AT), maximal oxygen pulse (measured value/predicted value, VO_2/HR% ), maximal minute ventilation V_E), maximal breath reserve (BR),maximal breath frequency(BF) and maximal tidal volume during expiration (VTex). Results ( 1 ) W%,VO_2/kg, AT,VO_2/ HR% of patients with vascular invasion [ (73 ± 18)%, ( 17 ±5)ml · min~(-1) ·kg~(-1),(51 ± 14) %, (79 ± 18 ) % respectively ] decreased than those without vascular invasion [ ( 86 ± 20 ) %,(19 ±5) ml ·main~(-1)· kg~(-1), (55±14)%, (88 ±20)% respectively, all P＜0.01 ) while BF increased [ (32. 1 ±6. 1 )/min vs (30. 6±5.1 )/min, P＜0. 05). (2) The patients were divided according to TNM stage, number, kind of tumor vascular invasion and its relationship with tumor, W% ,VO_2/HR% decreased in the groups of 1-, 2- and ≥-3-vessel invasion versus the control group (P ＜0. 01 ), AT decreased in the groups of 1- and ≥3-vessel invasion versus the control group (P ＜0. 05, P ＜0. 01 ),VO_2/kg decreased in the groups of 2- and ≥3-vessel invasion versus the control group ( P ＜0. 05, P ＜0. 01 ), VO_2/kg decreased in the group of ≥3-vessel invasion versus 1- and 2-vessel invasion (P ＜0. 05 or P ＜0.01 ), VO_2/HR%decreased in the group of ≥3-vessel invasion versus 1-vessel invasion (P ＜0. 01 ), VTex decreased in the group of ≥ 3-vessel invasion versus the control group and 1-vessel invasion (P ＜ 0. 05 ). There was correlation between VO_2/HR% and the number of tumor invaded vessels (r =0. 220, P ＜0. 01 ). Conclusions The amount of oxygen uptake, exercise ability and cardiac function during exercise decrease in patients of lung cancer with tumor vascular invasion. The main reason is the number of the invaded vessels.

Objective To study the role of ~(125)I seed implantation in the treatment of unresectable pancreatic cancer. Methods From April 2004 to march 2006, 66 untreated patients with locally advanced pancreatic cancer (LAPC) were randomized into two groups : Group A : ~(125)I seeds implantation ( n = 31 ) and Group B : control (n = 34). The objective tumor response, clinical benefit response, toxicity, complications and survival of two groups were observed. Results In Group A, the overall response rate ( PR + NC) was 80. 6%. Clinical benefit response rate was 54. 8%. No toxicity was observed. Gastrointestinal hemorrhage and pancreatic fistula occurred in 1 patient respectively in Group A. The survival rates of 6 and 12 months were 56. 0% vs 31.4% and 16. 8% vs 2.9% respectively in two groups(P＜0. 05). The median survival time of two groups was 8. 0 months vs 4. 0 months ( P ＜ 0. 05 ). Conclusion ~(125)I seed implantation is a simple, safe and effective method in the treatment of locally advanced pancreatic cancer.

Objective To study the clinical symptoms, diagnosis and treatment of eosinophilic gastroenteritis (EG). Methods A total of 44 eases of EG admitted to our hospital were studied respectively in clinical manifestations, laboratory examinations, endoscopic signs and treatment. Results (1) The presenting symptoms of EG patients was abdominal pain. (2) The endoscopic signs of EG were mucosal pathological changes of hyperemia, erosion and hyperplasia. A certain number of eosinophilic granulocytes were detected in pathological examination. (3)The hormones were effective and had quick onsets. While,based on different clinical symptoms, the traditional medicine was dosed by oral administration and intestinal enema. In TCM group (n =22), 20 patients had a relief of clinical symptoms, 4 cases of recurrence and 16 of cure. In comparison, in hormone group ( n = 18 ), 17 patients had a relief of clinical symptoms, 6 cases of recurrence and 12 of cure. The results showed that two groups had no statistical difference in relief of clinical symptoms, recurrence and hormonal cure ( all P ＞0. 05 ). But it will be more readily accepted.Conclusions The incidence of EG is low in clinical practice because of its non-specific clinical and endoscopic manifestations. An elevated count of ensinophilic graunlocytes in peripheral blood, ascitic fluid and tissues of mucous membrane are key diagnostic points. The hormonal treatment is both fast and effective. But traditional medicine will have a brighter clinical prospect.

Objective To investigate the early diagnosis and treatment of invasive pulmonary aspergillosis (IPA) infection following kidney transplantation. Methods A retrospective analysis was carried out in 16 IPA patients after kidney transplantation from January 2002 to March 2008. There were 7 males and 9 females with a mean age of 42. 9 years old. The prevalence of IPA was 2. 21%. The induction therapy was given to 12 patients, 5 with CD25 monoclonal antibody and 7 with anti-thymocyte globulin (ATG). All 6 with acute pre-infection rejection were given the methylprednisolone sodium or ATG therapy. Results The intervals between transplantation and diagnosis were largely within 3 months.Persistent or intermittent fever was the main pest-operative symptom High resolution computed tomography (HRCT) of thorax and bronchoalveolar lavage fluid (BALF) for culture were the main evidence of clinical diagnosis. Amphotericin B(0. 15 -0. 5 mg· kg~(-1)· ~ d(-1) )might be the major treatment for IPA because of its satisfactory initial therapeutic effect. The mortality rate was 7/16 (43.75%). Of the 9 surviving patients,8 were treated before the test results were available. Conclusions The clinical symptoms of IPA following kidney transplantation are atypical in the early stage so that it is easy to misdiagnose and a high mortality rate ensues. Major risk factors for IPA include administration of ATG, CD25 monoclonal antibody and steroid boluses for prevention or treatment of allograft rejection; prolonged broad-spectrum antibiotic use after transplantation and environmental factors. Early diagnosis and empirical use of antifungal agents while waiting for a definitive diagnosis are imperative in achieving a favorable outcome.

Objective To investigate the safety and efficacy of percutaneous coronary intervention (PCI) in patients with low left ventricular ejection fraction (LVEF) and complex small coronary artery lesions. Methods Complete or partial post-PCI revascularization of coronary artery was employed in 16 patients with a low LVEF and complex small coronary artery lesions who were unsuitable for CABG ( coronary artery bypass grafting). All cases were observed with regards to immediate success rate of operation,complication, hospitalization duration, improvement of cardiac function and LVEF and major adverse cardiac events (including cardiac death, myocardial infarction and target lesion revascularization) at 12 months postoperation. Results All cases were successfully treated without death and severe complications while the hospitalization duration was (11 ± 5) days. The follow-up survey at 12 months post-operation showed that no major adverse cardiac event occurred, the post-operative improvement of cardiac function was from Ⅲ-Ⅳ grade toⅠ-Ⅱgrade, the improvement of LVEF was from 25%-45% [(29 ± 8)%] to 32%-48% [(37 ±7) % ], left ventricular end diastolic diameter ( LVDd ) was shortened from 52-79 (66 ± 11 )mm to 49.68(58±8)mm. The reexamination of 14 cases by coronary angiography at 12 months post-operation showed that there was no intra-stent thrombosis while 20%-40% intra-stent restenosis occurred in 2 cases. Conclusion For patients with a low LVEF and complex small coronary artery lesions, PCI is a safe and effective method to lower the mortality rate of CHD patients with heart failure and improve the long-term patient prognosis.

Objective To compare and evaluate the cost and effectiveness between recombinant human tissue-type plasminogen activator ( rt-PA ) 50 ms and 100 mg regimen for the treatment acute pulmonary thromoembolism (PTE). Methods Based on a randomized clinical trial data, 118 cases were enrolled, 65 cases in group 50 mg and 53 cases in group 100 mg, which showed the similar efficacy and safety of rt-PA 50 mg and 100 mg. Progressive improvement in pulmonary artery obstructions was found to be similarly significant in both treatment groups, but there was no significant differences between the two groups (89. 1% vs 89. 6% ,χ~2 =0. 007,P=0. 936). The rates of adverse events in two groups were same as well ( 17% vs 32% ,χ~2 =3.704,P =0. 054). We compared the cost direcdy and the cost-effective rate of the two groups. Based the cost saving of indiviual patient, prevalence rate of acute PTE, and co-pay rate of reimbursement, we calculated the cost saving of societal and payer's perspective. Results The cost of group 50 mg is 6352 RMB/person,and the cost of group 100 mg is 12 704 RMB/person. The cost-effect rates of the two groups were 7129 and 14 179 separately. With the same effect, each patient in 50 mg group can save 7050 RMB. If the PTE patients in China were treated with rt-PA 50 mg instead of 100 mg, the society cost saving would be 443 604 624 RMB. Conclusion rt-PA 50 mg/2 h regimen, compared with 100 mg/2 h,can not only provide similar efficacy and safety, but also show a good health economic saving.

Objective To explore a chemotherapeutic regimen suitable for non-small cell lung cancer (NSCLC) in elderly patients. Methods A total of 68 elderly patients with NSCLC (stage Ⅲb/Ⅳ )were equally and randomly divided into single-agent and combinded groups. Patients in single-agent group received gemcitabine 1000 mg/m~2 at Days 1 and 8 for a 21-day cycle. Those in combined group received gemcitabine 1000 mg/m~2 at Days 1 and 8 in combination carboplatin AUC5 at Day 2 for a 21-day cycle. The drugs were intravenously administered. All patients received 3 cycles of treatment. Results In single-agent and combined groups, CR 1 and 1, PR 12 and 13, response rates 38% and 41% were respectively observed. There was no statistically significant difference between two groups ( P ＞ 0. 05 ). The 1-year and 2-year survival rates of single-agent and combined groups were 31% vs 32% and 12% vs 14% with a median survival of 9. 9 and 9. 8 months without a statistically significant difference ( P ＞ 0. 05 ). The rates of leucopenia and thrombecytopenia (Ⅲ -Ⅳ degree) were 47% and 38% in combined group and they were higher than 24% and 15% in single-agent group with a statistically significant difference (P ＜0. 05 ). The observer scale of lung cancer symptom scale showed that the post-treatment scores of appetite, fatigue and pain significantly improved in single-agent group while no improvement was observed in combined group.Also the scores of appetite, fatigue and pain of single-agent group were higher than those of combined group after chemotherapy ( P ＜ 0. 05 ) . Conclusion Single-agent gemcitabine regimen is more suitable for advanced NSCLC in elderly patients.

Objective To investigate the effect of anti-cancer drugs on the expression of B-cell integration cluster (BIC) RNA/miRNA-155 in human pancreatic cancer PANC-1 cells. Methods PANC-1cells were treated with different concentrations of anti-cancer drugs. Total RNA of the treated cells were harvested and the expression levels of BIC RNA and mature miR-155 were quantified by using Taqman FAM/MGB probes on a real-time PCR system. Relative quantification was carried out using the △△Ct method. A P13K-related kinases inhibitor was used to determine whether these kinases were involved in the regulation of BIC RNA. Results The expression of BIC RNA was strongly induced by anti-cancer drugs.When PANC-1 cells were treated by gemcitabine with concentrations of 1.0, 2. 5, 5.0, 10. 0 mg/L for 48 h and 72 h, the level of BIC RNA (48 h: 37. 1 ± 4. 1,29. 0± 5.7, 21.0 ± 7.6, 40. 4 ± 9.0,72 h : 27. 7 ±3. 1,43.1± 1.2, 31.8 ± 5.4, 23. 1 ± 1.4) were signifcantly higher than that of the control (48 h : 1.6 ±1.1,72 h: 1.0 ± 0. 1, all P ＜ 0. 05 ). 5-FU (10 mg/L, 48 h) and bleomycin (100 mg/L, 48 h) also induced BIC RNA up-regulation (5. 2 ± 1.1 vs 1.7 ±0.7 ,11.5 ±0.7 vs 1.7 ±0.7, both P ＜0.05).When PANC-1 cells treated with 1.0,2. 5,5.0,10. 0 mg/L gemcitabine for 72 h, the level of miR-155(2. 21 ± 0. 40,1.86 ± 0. 03,2. 47± 0. 04,3.24 ± 0. 05 ) also higher than that of the control ( 1.11 ± 0. 09, P ＜0. 05 ) , while no change was observed when the cells only treated for 48 h. Further study showed gemcitsbine-induced BIC RNA up-regulation was inhibited by wortmannin, a specific PI3K inhibitor, the expression levels of BIC RNA of 1 μmol/L wortmannin + 5 mg/L gemcitabine group and 10 μmoL/L wortmannin + 5 mg/L gemcitabine group were 5.34 ± 1.11 and 1.26± 0. 07, lower than that of 5 mg/L gemcitabine group ( 11.82 ± 3.11, P ＜ 0. 05 ). Conclusions BIC RNA is strongly induced by anti-cancer drugs in PANC-1 cells and the levels of miR-155 also slightly increase. PI3K pathway is involved in gemcitabine-induced BIC RNA up-regulation.

Objective To set up islet perifusion system, a new method to evaluate first-phase insulin secretory function of β-cell in vitro. Methods Islet perifusion system was set up, including perifusion framework, waterbath system, infusion pump system, afferent system, islet capsule, and efferent system. Kinetics of insulin release in vitro was studied using the perifusion system. Pancreatic islets were isolated as mentioned above and used freshly after isolation. Size-matched 50 islets were placed in each column. Then the columns were gently closed with the top adaptors, immersed in vertical position and controlled temperature in the water bath at 37 ℃. The perifnsion medium was maintained at 37 ℃ in a water bath. And all columns were perifused in parallel at a flow rate of 0.5 ml/min with KRBB (2.8 mmol/Lglucose) at 37℃. After 60 min static incubation with KRBB (2. 8 mmol/L glucose), the islets were stimulated in the continuous presence of a high concentration of 16. 7 mmol/L glucose. Samples were collected every 20-second until 2 min, every 1 min until 5 min, thereafter every 5 min until 30 min. Samples were immediately stocked at - 80 ℃ until further analysis. Insulin concentration was measured with an insulin RIA kit. Results An Islet perifusion system was established successfully, and kinetic curves of insulin secretion of db/m and db/db mice were traced out. Conclusion An established islet perifusion system, could be widely used to evaluate insulin secretory function of β-cell in in vitro research of diabetes.

The patient was a 47-year-old male. He was admitted to the Department of Respiratory Medicine of Peking Union Medical College Hospital on April 8, 2008 due to "cough and active shortness of breath for 2 years and aggravated for 2 weeks". At the beginning of 2006, the patient developed cough and shortness of breath without obvious trigger, which aggravated after upright movement and relieved after resting in the lying position. There was no discomfort such as fever or fatigue. He was admitted to the local hospital. The electrocardiogram, cardiac ultrasound and coronary angiography were all normal. The chest CT showed "ground glass shadow in both upper lungs, thickened subpleural lobular septum in both lower lungs, and pulmonary interstitial fibrosis was not excluded". He was treated with acetylcysteine effervescent tablets (Fulushi) and roxithromycin, but the symptoms were not improved.

Chronic obstructive pulmonary disease (COPD) is a disease characterized by irreversible airflow injury. At present, there is no effective treatment, so early detection and timely treatment are particularly important. Pulmonary function is a recognized method to confirm COPD, but it cannot detect early lesions. High resolution CT (HRCT) can determine and quantify the degree of emphysema lesions. The method is accurate and repeatable, and can be used for follow-up of patients, but patients need to receive certain radiation. Hyperpolarized 3He magnetic resonance imaging (HP3He MRI) is a new method to evaluate emphysema in recent years.

The annual incidence of venous thromboembolism is 0.1% ~0.2%, which is the third leading cause of death in vascular diseases after myocardial infarction and stroke. At present, the standard treatment is parenteral anticoagulation as early as possible for 5~7 days, and then vitamin K antagonist treatment for at least 3 months. Vitamin K antagonist treatment requires monitoring of international standardized ratio (INR), and interactions with various foods and other drugs. dabigatran etexilate (dabigatran etexilate) is an oral thrombin inhibitor, which can be rapidly converted into active drugs by widely existing esterases, and administered at a fixed dose without monitoring of coagulation function. Dr. Schulman and others from McMaster University in Canada compared the therapeutic effects of dabigatran etexilate and warfarin on acute venous thromboembolism. The results of the study were published on the website of New England Journal of Medicine (www.nejm.org) on December 6, 2009.

Chemotherapy (chemotherapy) has been an important method for tumor treatment since it was applied in clinic in the middle of the 20th century, but it has not been able to kill all tumor cells until now. Even in cases with complete remission, residual carcinoma often exists, which will become the root cause of recurrence in the future [1]. It is the key to improve the curative effect to study the invasive changes and mechanism of residual carcinoma after chemotherapy, and to find effective countermeasures to reduce the metastasis and recurrence of tumor after chemotherapy.

Hepatocellular hepatocellular carcinoma (HCC, abbreviated as hepatocellular carcinoma) is a malignant tumor with obvious ethnic clustering and regional differences.According to the data published by the American Cancer Society (ACS) at the end of 2007, the annual increase of hepatocellular carcinoma in the world is 667,000, with 598,000 deaths, and 55% of new hepatocellular carcinoma occurs in China.At present, the 5-year survival rate of hepatocellular carcinoma is less than 10%, and it is the second highest malignant tumor after pancreatic carcinoma (4.4%). At the same time, liver cancer is poorly sensitive to most current chemotherapy drugs, and most of them occur in the liver with basic lesions, which largely leads to the high mortality of liver cancer. The occurrence of liver cancer is a process involving multiple genes and synergistic action of multiple environmental factors. The evolution of normal hepatocytes to hepatocellular cancer cells and the final metastasis need to go through multiple pathological stages and involve multiple molecular events [2].

Asthma is a chronic airway inflammatory disease characterized by dendritic cell (DC) -mediated type II helper T cell (Th2) dominant immunity [1]. The incidence of asthma and allergic diseases in the world is increasing year by year, especially in developed countries. This phenomenon is partly attributed to the hygiene hypothesis, that is, the cleaner the environment, the less environmental exposure to lipopolysaccharide (LPS), the main active component of bacterial endotoxin in early life, and LPS can drive the immune response of host from Th2 to Th1 to shift immune response [2]. However, there is a susceptibility to environmental exposure in different individuals, which is currently believed to depend on individual genetic factors. As the main receptor for recognizing LPS, Toll-like receptor 4 (TLR4) mediates innate immunity and connects with acquired immunity, which is closely related to allergic asthma [3]. This paper briefly reviews the relationship between TLR4 transmembrane signal transduction, Th2 dominant immunity and TLR4 gene polymorphism-immune-environment interaction and asthma pathogenesis.

A 24-year-old male was admitted to the hospital on December 1, 2008. He had a history of bronchial asthma for 10 years, a history of exposure to talc powder, and a small amount of smoking. He had thirst and polydipsia after catching a cold 3 months before admission, and liked cold drinks. He drank about 10~15 L of water every day, drinking water once every 1~3 h, and his urine volume was about 8~15 L per day. He lost about 5 kgo of weight with loss of appetite, and had a rash on the inner thigh. He had no headache, dizziness and blurred vision, no bone pain, fatigue, hemoptysis, or chest pain. He was admitted to an external hospital in November 2008. Chest X-ray showed miliary density increased shadows scattered in both lung fields. Chest CT showed that the texture of both lungs was increased, disordered and interwoven into a grid shape, accompanied by multiple small cystic translucent areas, and nodular dense shadows were seen under the tracheal carina in the mediastinum. The impression was "pulmonary fibrosis, mediastinal lymph node calcification" (Figure 1). Pituitary MRI scan and enhancement showed thickening of the pituitary stem. Pelvic X-ray showed limitations in the right ilium (above the acetabulum), left ilium, acetabulum, and femoral head There were multiple circular light-transmitting areas of different sizes, which overlapped with each other, and the sclerotic edge was visible, which was impressed as "consistent with the changes of Langerhans' cells". The pineal calcification was visible in the skull at the anterolateral X-ray.

The 3rd International Forum on Gastrointestinal Repair and Reconstruction Surgery, sponsored by the Surgeon Branch of Chinese Medical Physicians Association, and organized by the West China Hospital of Sichuan University and the Editorial Committee of Chinese Medical Journal of Chinese Medical Association, was held in West China Hospital of Sichuan University from September 11 to 13, 2009.