Volume 90  ·   Issue 06  ·  2010

At present, the occurrence of invasive fungal disease (IFD) is still on the rise, and new pathogens and drug-resistant strains are constantly appearing, which brings difficulties in diagnosis and treatment, and many clinical disciplines are facing arduous challenges. However, it is exciting that medical workers in China have fully recognized the harm of IFD, actively responded to the challenges, and actively explored the clinical epidemiology, diagnosis and treatment of IFD. Several related papers published in this issue are from the clinical front line, reflecting the vigorous development of clinical mycology in China.

With the progress of history and society, people's understanding of the basic concepts of public health has become more and more profound. In our long-term public health practice, the exploration of the basic concepts of public health has also experienced a process of deepening cognition and sublimation in theory. Compared with the extremely rich public health practice in our country, the exploration and research of the basic concepts of public health in China in the past is less. Even the experts engaged in public health, there are not many people who can accurately understand what public health is. Our public health school basically teaches "preventive medicine", not "public health" in the real sense.

The incidence of invasive fungal infections (IFI) is increasing year by year. Severe patients are the high risk population of IFI due to their critical condition and many high risk factors of IFI. Once IFI occurs, it will seriously affect the prognosis of patients. Although the new antifungal drugs provide new options for the treatment of IFI, the mortality rate is still as high as more than 50%. However, delayed treatment will further affect the prognosis of patients ~ ([1]). How to improve the early diagnosis and treatment of IFI in severe patients is a huge challenge for clinicians.

Objective To conduct a restrospective analysis of the invasive fungal infection (IFI) in surgical intensive care unit (SICU). Methods The IFI data of the patients who were admitted in SICU during January 2003 to December 2008 was retrospectively analyzed. A total of 3743 patients were admitted into SICU. Among them, 271 patient's SICU duration was more than 48 hours, who had fungi examination. Results Seventy-five patients were diagnosed IFI, the morbidity was 2.00% (75/3743), the incidence of fungemia was 0.27% (10/3743), the mortality of IFI patients was 49.33% (37/75). The morbidity rate of each year was almost the same. The mortality of 2007 and 2008 was higher than before (both P<0.05). Thirty-four of all the 75 IFI patients got urinary tract infected, 37 got fungal pneumonia, 10 got fungemia, 1 got catheter-related fungal infection, 2 got fungal infection in abdomen, 2 got biliary tract infected. Eighty-six fungi strains which caused fungal infection were spotted. Candida albicans was the most common isolate (46.51%). Other isolates were Candida glabrata (22.09%), Candida tropicalis (13.95%), Candida parapsilosis (8.14%), Candida krusei (3.49%), Trichosporon (4.65%), Aspergillus (1.16%). Assist ventilation, combination of bacterial infection, treatment by broad spectum antibiotics or more than three kinds of antibiotics were the most important risk factors of IFI in SICU. Prophylactic antifungal treatment may be useful. Conclusion The morbidity of IFI in our SICU was comparatively low, and the same of the incidence of fungemia. The mortality of IFI patients was markedly high. The main sites of infection were lung and urinary tract, and the pathogenic fungi strains were mostly Candidas. Assist ventilation, combination of bacterial infection, broad spectum antibiotics treatment were the most important risk factors of IFI in SICU.

Objective To evaluate the efficacy and safety of low-dose amphotericin B (<0.7 mg·kg~(-1)·d~(-1)) and flucytosine in patients with non-AIDS-associated cryptococcal meningitis. Methods In non-AIDS patients with cryptococcal meningitis admitted to Huashan Hospital, Fudan University in Shanghai from January 1998 to December 2007, 31 were initially treated with low-dose amphotericin B and flucytosine for more than 1 week. The clinical characteristics, clinical responses, drug-related adverse reactions and outcome of these patients were retrospectively evaluated. Results Among the 31 patients enrolled in this study, 8 patients had one or more predisposing factors. Headache, fever, meningeal irritation and vomiting were common clinical symptoms and signs when cryptococcal meningitis was diagnosed. The result of cranial CT scan and/or MRI showed abnormality in 22 cases (78.6%). When the therapy of low-dose amphotericin B and flucytosine ended, the complete response rate was 19.4% (6/31), partial response rate was 54.8% (17/31), and total effective rate was 74.2%. Except for 1 patient lost to follow-up, the 1-year attributable and all-cause mortality among the remaining 30 patients were 0 (0/30) and 10.0% (3/30) respectively. On the other hand, 26 (83.9%) patients had amphotericin B-related adverse reactions, including renal impairment, liver injury, arrhythmia, and anemia, etc. However, most of these reactions were tolerable. Conclusion Low-dose amphotericin B and flucytosine can be used in non-AIDS-associated cryptococcal meningitis with both acceptable efficacy and safety.

Objective To evaluate the role of real-time polymerase chain reaction (real-time PCR) assay combined with serum galactomannan (GM) detection in the diagnosis of invasive aspergillosis(IA) with hematological malignancies or hematopoietic stem cell transplantation. Methods Eighty patients were enrolled. PCR and GM were performed simultaneously on 205 serum samples. The agreement between these two assays and the diagnostic value of the combination were analyzed. Results There were 5 proven IA ,20 probable IA,34 possible IA and 21 non-IA. Agreement between real-time PCR and GM was 77.5%. When both positive,the positive predictive value could reach 100% ;when both negative , the negative predictive value could reach 90.9%. Conclusion PCR agrees well with GM. When these two assays are combined, invasive aspergillosis can be diagnosed more accurately.

Objective To evaluate the performance of the galactomannan emzyme immunoassay (GM test) and (1,3 ) β-D-glucan assay (G test) for the diagnosis of invasive fungal infection (IFI). Methods A retrospective study was performed in 115 hospitalized patients at Peking University First Hospital who were at risk of IFI. Patients were diagnosed as IFI according to revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated at different cutoff values for two assays respectively. Two tests were combined to evaluate the changes of sensitivity, specificity, PPV and NPV. Results The best sensitivity (54. 5%, 63.6% )and specificity(77.9% ,69.2% ) were obtained with the cutoff values of 0.5 and 20×10~3 pg/Lin GM test and G test respectively. The PPV were 20.7% and 17.9%, and the NPV were 94.2% and 94.7% respectively. The sensitivity increased to 90.9% and the specificity was 52.9% after a combined utility of two tests. Conclusion The GM test and G tests are both useful in diagnosis of IFI with the cutoff values of0.5 and 20×10~3 pg/L. A better sensitivity is acquired if there is a combined utility of two tests.

Objective To assess the diagnostic and therapeutic modality preferences of physician implementation of the Chinese Clinical Practice Guidelines for Benign Prostatic Hyperplasia (BPH) for geriatric BPH patients. Methods This cross-sectional survey was conducted at 33 medical centers located in 11 different cities in China (4 in north; 7 in south ). A total of 190 physicians were requested to record their preferences in diagnostic tests and treatment options for elderly BPH cases. Results The physician response rate was 97.4%. Respondents generally selected those practices consistent with the guidelines, but their preferences for recommended tests varied. The use of medical history, ultrasonography and urinalysis was higher (>90.0%) and that of uroflowmetry was lower (31.2%). In addition, the rate of use of recommended tests was higher among physicians in the north than those in the south. Drug therapy was the preferred treatment option. The proportion of drug treatment increased with the severity of symptoms in elder patients. In the south, the proportion of drug treatment in severe cases increased to 82.6% versus 61.9% in mild cases. In the north, the proportion of rug treatment in severe cases increased to 83.5% versus 54.6% in mild cases. Conclusion This study provides insights into the physician preferences of diagnosis and treatment. The physicians generally comply with the BPH clinical practice guidelines. It may also serve as a practical reference for updating and improving the Chinese Clinical Practice Guidelines for BPH.

Objective To revaluate the value and the methods of intraoperative facial nerve monitoring in parotid gland surgery. Methods Sixty-five cases received intraoperative facial nerve monitoring in parotidectomy (test group) since 2000-2008. The facial nerve was identified through centraltrunk method (n=18), branch method (n=35) and mixed method (n=12). Most patients accepted general anesthesia by incubation. The operating duration and minimum electronic stimulation threshold values of EMG in evoked facial muscle were recorded. Facial nerve was identified though branch method (n=44) and no intraoperative facial nerve monitoring was performed in parotidectomy (control group). Results There were four cases (6.1%) of mild temporary paralysis and no permanent post-operative paralysis of facial nerve in the test group. The average operating duration was 1.8 hour. The minimum reactive electronic stimulation threshold of EMG in evoked facial muscle was 0.08mA. The range of suitable electronic stimulation threshold of EMG was from 0.2mA to 1.0mA. While there were nine cases (20.5%) of mild temporary paralysis and two cases (4.5%) of permanent post-operative paralysis of facial nerve in the control group and the average operating duration was 3.0 hours. Conclusion Intraoperative facial nerve monitoring (IFNM) in parotidectomy can assist a surgeon to confirm and identify the facial nerve and exercise precautions so as to shorten operating duration and prevent potential surgical complications.

Objective To investigate the effect of hemoglobin Alc(HbAlc) and glycated albumin (GA) on serum CA199 in diabetic patients. Methods 29 NGT matched control subjects and 371 hospitalized diabetic patients were enrolled. Diabetic patients were divided into satisfactory group (<6.5%), general group(6.5%-7.5%)and dissatisfactory group(>7.5%) by the level of HbAlc. The levels of serum CA199 among three groups were compared. The relationship between HbAlc and CA199, GA and CA199 was analysed. Multiple stepwise regression analysis was performed to compare the effect of different variables on CA199 as the independent variables were sex,age, duration, TC, TG, HDL, LDL, FBG, PBG, HbAlc and GA. Results (1) CA199 level of the group of HbAlc above 7.5% was significantly higher than the group of HbAlc between 6.5% and 7.5% and the group of HbAlc less than 6.5%. (2) The coefficient of correlation between HbAlc and CA199 was 0.394(P=0.000), and that was 0.381 between GA and CA199 (P=0.000). (3) Multiple stepwise regression analysis show standard regression coefficient of HbAlc is 0.364 (P=0.000). Conclusion (1)CA199 level of diabetic patient in poor glucose control was significantly higher than the patient in good control. ( 2 ) CA199 was positively correlated with FBG, PBG, HbAlc and GA. (3) HbAlc is the independent risk factor of CA199. The elevated CA199 in diabetic patient has close relationship with poor glucose control in a long period.

Objective To explore the expression of B7-H1/PD-1 and the localization of these proteins in human sinus mucosa of chronic rhinosinusitis (CRS). Methods Twenty-eight patients with CRS (17 with nasal polyps (CRSwNP) and 11 without (CRSsNP) ) and 11 control patients were recruited. B7-H1/PD-1 expressions in sinus mucosa among these 3 groups were detected by immunofluorescent staining, real-time quantitative PCR and Western blot. Flow cytometry was also employed to identify the type of B7-H1 or PD-1 positive cells in nasal polyps. Results Compared with normal mucosa, B7-H1/PD-1 mRNA was highly expressed in sinonasal mucosa of CRSwNP and CRSsNP ( P<0.01). There was no difference between CRSwNP and CRSsNP (P>0.05). The protein level of B7-H1/PD-1 was similar to mRNA level. As indicated by immunofluorescent assay, B7-H1 was mainly expressed in sinonasal epithelial cells, submucosal gland cells and inflammatory cells within the subepithelial layer while PD-1 was expressed in inflammatory cells within the subepithelial layer. The B7-H1 or PD-1 positive cells in nasal polyps were partially CDI9~+ B cells and CD3~+ T cells respectively. Conclusion B7-H1/PD-1 is up-regulated in sinus mucosa of CRS. B7-H1/PD-1 may play an important role in the pathogenesis of CRS.

Objective To evaluate the feasibility and clinical efficacy of totally laparoscopic gastrectomy (TLG) for gastric cancer. Methods The investigators retrospectively analyzed 37 cases undergoing TLG for gastric cancer from March 2007 to April 2009 at Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University. Results All 37 cases underwent successful TLG. There was neither transfer to open nor laparoscopic assisted surgery. Twenty-nine cases underwent distal gastrectomy with Billroth Ⅱ reconstruction, 8 cases total gastrectomy with Roux-en-Y reconstruction, including 5 cases with end-to-side esophageal jejunostomy and 3 cases with side-to-side esophageal jejunostomy. Nineteen cases assisted by intraoperative gastroscopy for tumor locating. The operation duration was 210-355 min [mean (284±43) min]. The blood loss was 80-450 ml [mean (175±62) ml]. The number of dissected lymph nodes was 18-55 [mean (31±9) ]. Two cases had post-operative complications, with 1 case of pulmonary infection recovering well after symptomatic treatment and 1 case of temporary delayed gastric emptying recovering well after gastrointestinal decompression for 6 days. No mortality was reported. The hospital stay was 6-14 d [mean (9±2) d]. There was no recurrence during the follow-up period of 2-25 months. Conclusions For surgeons with rich experiences of laparoscopic surgery, TLG for gastric cancer is both safe and feasible. The short-term efficacy of TLG is satisfactory. Furthermore, TLG conforms more to the concept of minimally invasive surgery and the principle of tumor-free technique.

Objective Adventitia plays an important role in vascular injury diseases. Nitric oxide (NO) from inducible nitric oxide synthase (iNOS) is involved in many cardiovascular diseases, iNOS/NO pathway is activated in aorta of spontaneously hypertensive rats (SHRs). The role of aldosterone in L-arginine (L-Arg) /iNOS/NO pathway of aortic adventitia is uncertain. We investigated the effect of aldosterone antagonist spironolactone on adventitial L-Arg/iNOS/NO pathway in SHRs. Methods Twenty male SHR(10 weeks old, 220-280 g) were randomly divided into 2 groups (10 in each) : untreated or treated with the aldosterone receptor antagonist, spironolactone (20 mg/kg per day) for 6 weeks. Age-matched Wistar-Kyoto rats (WKY) were used as control. Systolic blood pressure (tail-cuff method) was measured weekly. Six weeks later, the rats were sacrificed. The whole aorta was collected and aortic adventitia was isolated, iNOS activity, [~3H]-L-Arg transport assay of aortic adventitia were carried out by isotope-labeled L-arginine conversion rate measurement, and measurement of nitrate/nitrite(NOx), an index of NO production of aortic adventitia was assayed with the Gfiess reaction. Results iNOS activity, [~3H]-L-Arg transport and NO production were greatly increased in aortic adventitia of SHR[ (12.55±2.27) pmol·mg~(-1)·min~(-1), (0.88±0.19) pmol·mg~(-1)·min~(-1) and(2.07±0.39) μmol/L) ] compare versus WKY[(5.96±1.87) pmol·mg~(-1)·min~(-1),(0.51±0.15) pmol·mg~(-1)·min~(-1) and(1.55±0.32) μmol/L,P<0.01], and decreased significantly by spironolactone treatment [ (8.32±1.84) pmol·mg~(-1)·min~(-1),(0.61±0.15) pmol·mg~(-1)·min~(-1) and (1.64±0.27) μmol/L, P<0.01 ]. Conclusion L-Arg/iNOS/NO is activated in aortic adventitia of SHR. Spironolactone can inhibit the activation of L-Arg/iNOS/NOpathway. Aldosterone may play an important role in some cardiovascular diseases such as atherosclerosisthrough iNOS/NO pathway.

Objective To confirm the key inducing factor of excessive apoptosis in immature brain under the exposure of exogenous glucocorticosteroid and observe the characteristics of mitochondrial oxidative stress and intracellular [Ca~(2+)] i overload as compared to healthy adult rats. Methods A total of 192 healthy Sprague-Dawley (SD) rats selected for the study were divided into three groups including PD7, PD15 and PD60 corresponding human age stages including full-term newborn, one-year infant and adult respectively. To mimic the therapeutic regime for infantile spasms, 8 rats in each group was treaded with prednisone (6 mg· kg~(-1)·d~(-1)), ACTH (150 U·m~(-2)·d~(-1)), normal saline for4 days and drug withdrawal for 3 weeks.Rats were deeply anesthetized and sacrificed by decapitation. The mitochondrial concentrations of GSH, SOD, MDA, Na~+ -K~+-ATPase and intracellular [Ca~(2+)i] were all determined by spectrophotometer. The cellular NMDA-Rl expression was measured by immunohistochemistry. Results Both prednisone and ACTH caused neuron reduced and TUNEL-positive cell increased in the frontal lobe, specially in PD7 group of prednisone, that were 77.7±4.7 neurons per VF (control group: 102.3±5.9) (P=0.002), 114.8± 8.14 (control group: 56.3±5.6) (P=0.029) respectively. The mitochondrial levels of GSH, SOD and Na~+ -K~+ -ATPase decreased after prednisone and ACTH administration at different level in different age groups whereas the concentration of MDA increased. These changes were significant in PD7 group after prednisone administration, that were 158.3±6.1 mg/gprot of GSH (control group: 225.1±9.5 mg/gprot) (P=0.006), 155.8±4.3 U/mgprot of SOD (control group: 228.1±9.2 U/mgprot) (P=0.006), 14.6± 3.5 U/mgprot of Na~+ -K~+ -ATPase (control group : 20.8±5.5 U/mgprot) and 10.4±0.9 nmol/mgprot of MDA (control group: 4.8±1.9 nmol/mgprot) (all P<0.01). [Ca~(2+)] i level in neuron increased, specially in PD7 group after prednisone administration, that was 164.6±11.9 nmol/L (control group: 125.8±6.03 nmol/L) (P=0.003). Similar to [Ca~(2+)] i changes, the density of NMDA-R1 also increased mostly in PD7 group after prednisone administration, that was 0.36±0.03 (control group: 0.21±0.05) while that was only 0.18±0.05 in PD60 group (control group: 0.15±0.02). At 3 weeks pest-dosing, all of them returned to normal level. Conclusion Dysfunctions of oxidation and antioxidation in mitochondria of immature neurocytes are induced by prednisone or ACTH within the therapeutic levels. Enhanced expressions of NMDA-R1, Bax and superoxide contribute to excessive apoptosis of immature neurocytes induced by exogenous glucocorticosteroid. The possible determining factors for immature brain is more vulnerable to exogenous glucocorticosteroid damage. It may be associated with the physiologically high intracellular level of calcium concentration and NMDA-R1 expression.

Objective To develop a series of high metastatic models of human gastric malignant lymphoma in nude mice by orthotopic transplantation. Methods Two histologically intact primary and hepatic metastatic fragments derived from surgical specimen of a patient with primary gastric lymphoma were implanted into the submucosa of stomach in nude mice. Highly metastatic and specific organ metastatic models were screened by selective orthotopic passage in nude mice. Transplantability, invasion, metastasis, morphological characteristics (light microscopy, electron microscopy and immunohistochemistry), karyotypic analysis and DNA content of orthotopically transplanted tumors were studied. Results Primary and hepatic metastatic fragments of primary gastric lymphoma were successfully transplanted in nude mice. Two nude mouse models of human primary gastric lymphoma, termed HGBL-0304 (hepatic metastasis model) and HGBL-0305 (high metastasis model), were developed, exhibiting different metastasis biology. Histopathology of transplanted tumors showed primary gastric diffuse large B cell lymphoma. Two models have been maintained for 45 generations by orthotopic passage in nude mice. A total of 419 nude mice were used for transplantation. The growth rate and resuscitation rate of liquid nitrogen cryopreservation of transplanted tumors were both 100%. Significant difference in metastasis biology was exhibited in four aspects of metastasis time, organ metastatic rate, the extent of hepatic metastasis and survival of cancer-bearing mice. The metastatic rates of liver, spleen, lymph nodes and peritoneal seeding in HGBL-O304 and HGBL-0305 models were 100% and 69.5%, 94.3% and 55.6%, 62.6% and 45.7%, and 43.5% and 30.5%. The onset time for metastases of liver, spleen, lymph nodes and peritoneal seeding was 2 w and 5 w, 3 w and 6 w, 2 w and 3 w, 3 w and 6 w respectively. The extent of hepatic metastasis in HGBL-0304 and HGBL-0305 models displayed diffuse involvement of the whole liver and mainly right lobe invasion of liver respectively. The mean survival time of HGBL-0304 and HGBL-O305 models was 54.3d and 106.9 d respectively. Conclusion Surgical orthotopic implantation combined with in vivo selective passage screening is an effective method for establishing highly metastatic and specific organ metastatic models of human malignant lymphoma in nude mice. The study is the first time to establish hepatic metastasis and high metastasis nude mouse models of human primary gastric lymphoma with the same original patient and different potentials of invasion and metastasis.

Objective To explore the effect of over-expression of tight junction protein claudin-6 upon the biological characters of breast cancer cell line MCF-7. Methods The MCF-7 subline expressing a high level of claudin-6 was established by transfection with a pcDNA3. l-claudin-6 expression vector. The expression of claudin-6 in mRNA and its protein level were confirmed by RT-PCR, Western blot and immunofluorescent assays. Then the effect of claudin-6 upon cell proliferation was examined by MTT assay. Colony-forming assays were used to examine 2-D and 3-D colony-forming capacities. Invasive and migratory traits of claudin-6 expressing cells were determined by Boyden chamber invasion assay and monolayer wound-healing assay. The structure and function of tight junctions in both parental and claudin-6 expression MCF-7 cells were evaluated by measuring transepithelial electrical resistance. Results Immunofluorescent assays showed that transfected cells expressed claudin-6 on their membrane. Cells with a high level expression of claudin-6 grew slowly than control cells. Anchorage-independent growth, invasive and migratory traits also decreased substantially in cells with claudin-6 expression; whereas the transepithelial electrical resistance increased in the claudin-6 transfected cells. Conclusion The up-regulation of claudin-6 expression in MCF-7 breast cancer cells suppresses their malignant phenotypes with a correlation with the restoration of tight junction integrity. Claudin-6 may function as a cancer suppressor whose down-regulation contributes to the malignant progression of certain types of breast cancers.

Objective To investigate the migration and distribution of CTL (cytotoxic T lymphocyte) and CIK (cytokine-induced killer) cells in gastric tumor model. Methods Subcutaneous gastric tumor model was established by BGC-823 cancer cells in nude mice. Both CTL and CIK cells were labeled with~(99)Tc~m directly and then inoculated into nude mice with subcutaneous tumor by intravenous injection separately. Three mice of each group were evaluated by single-photon emission computerized tomography (SPECT) at 1 h, 6 h and 24 h post-inoculation. After SPECT imaging,3 mice in each group were sacrificed and got samples of the tumor, liver, spleen, kidney, lung, intestine, etc. The tissue samples were weighed and radioactivity was determined with a well-type scintillation counter. The accumulation of labeled CTL and CIK cells in tissues were expressed as % ID/g (percentage activity of injection dose per gram of tissue) and T/NT (tumor/non-tumor) values were analyzed. Results The tracing of both cells in SPECT showed a clear migration path away from the injection point to solid tumor, and can be detected in all organs and tissues such as liver, spleen, kidney, lung and intestine, etc not long after injection. The % ID/g peak values of CTL in organs from the highest to the lowest were as follows: tumor (7.79±0.46), liver (4.12±0.51), intestine (2.71±0.16), kidney (1.44±0.25), spleen (1.24±0.12), kidney (1.12±0.11), and all the T/NTs were above 1. The % ID/g peak values of CIK cells in organs from the highest to the lowest were as follows: liver (6.64±0.67), tumor (5.47±0.87), intestine (3.55±0.23), kidney (2.34±0.41), spleen (1.45±0.17), lung (1.27±0.21), and T/NTs>1 except for liver. After injection, the % ID/g values of tumor in CTL group were 2.35±0.28 (1 h), 4.58±0.52 (6 h) and 7.79±0.46 (24 h) respectively while the % ID/g values of tumor in CIK group 2.23±0.46 (1 h), 3.25±0.70 (6 h) and 5.47±0.87 (24 h) respectively. At 24 h point, the % ID/g of CTL in tumor was much higher than CIK cells (P<0.05). Conclusion The definite directional tumor-targeting capacity of CTL and CIK cells in tumor-bearing nude mice is promising.

Hair loss caused by various causes is more common, and there is no effective treatment method except hair transplantation at present. Hair transplantation is only the redistribution and distribution of original hair, and no new hair follicles are produced, so it is not suitable for the treatment of large area hair loss. If new hair follicles can be induced, especially if hair follicles can be constructed in vitro, then this problem will be easily solved.

Takayasu arteritis was the main cause of renal artery stenosis in young patients. According to the data of our hospital, Takayasu arteritis was the main cause before 2000 (52.13%); After 2000, atherosclerosis was the main cause (70.17%). Behcet's disease involving the cardiovascular system was not uncommon, but it was mainly tumor-like dilatation, and renal artery stenosis was rare.

Case 1: A 23-year-old male, unmarried, was admitted to hospital because it was found that the left testis occupied space for 1 week. Physical examination showed that the patient had no gynecomastia, and there was a medium-hard mass of about 2cm in the upper part of the left testis. Serum alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and testosterone (4.43 μ g/L) were normal. Scrotal B-ultrasound showed a 2.2 cm ×1.5 cm hypoechoic substantial mass in the left testis, with clear boundaries and blood flow signals at the periphery.

Sponsored by Cardiovascular Human Therapy Training Center of Chinese Medical Association and Hangzhou Medical Association, and undertaken by Hangzhou First People's Hospital, Zhejiang Provincial People's Hospital, Hangzhou Normal University Affiliated Hospital and Hangzhou Nursing Association<The 3rd National Symposium on Severe and Difficult Cardiovascular Cases was held in Hangzhou on November 6-8, 2009.