Volume 90  ·   Issue 18  ·  2010

Targeted tumor therapy refers to a therapeutic method that blocks tumor growth and spread by interfering with specific molecules involved in tumor growth and progression. Targeted therapy of skin tumors began when the US FDA approved rituximab for the treatment of refractory B-cell non-Hodgkin lymphoma in 1997. In recent years, great progress has been made in this field, but it also faces many challenges.

Bladder cancer is the fourth most common malignancy in American men after prostate, lung, and colorectal cancers, with an estimated 68,810 new cases and approximately 14,100 deaths in 2008.

Objective To investigate whether the location of carcinoma in situ (CIS) of bladder cancer could be macroscopically ascertained by instilling pirarubicin (THP) into urinary bladder. Methods 50 mg of THP was dissolved into 50 ml of 5% glucose solution. And the resulting solution was instilled into urinary bladder. After 15 min, the urinary bladder was observed by a cystoscopy. The study group consisted of 51 patients with bladder cancer (37 males, 14 females) and 14 patients with hematuria (8 males, 6 females) , treated at our hospital from December 2007 to June 2008. Results The THP uptake was seen in 67 flat (non-tumorous) areas of bladder mucosa in 37 patients with bladder cancer. Of these, 11 lesions in 7 patients were confirmed to be CIS. The THP uptake was found in 2 flat (non-tumorous) areas of bladder mucosa in 14 patients with hematuria, 1 lesion in 1 patient was confirmed to be CIS. The sensitivity and specificity of THP uptake by CIS were 92. 3% (12/13) and 86. 7% (371/428) respectively. Conclusion This practical method may be employed to ascertain easily the macroscopic location of CIS of bladder caner.

Objective To investigate the in vitro inhibitive effect and apoptotic mechanism of BDI-1 monoclonal antibody targeted SEA on human bladder cancer cell line BIU-87. Methods Human peripheral blood mononuclear cells (PBMC) and human bladder cancer cell line BIU-87 were used as effector and target cells respectively in three experimental groups, control group, SEA group and monoclonal antibody targeted SEA group, treated with different concentrations of SEA and targeted SEA respectively in the latter two. The inhibition rates of target cells were measured by cell counting kit-8 (CCK-8) assay. Apoptosis was determined by fluorescent Hocehst 33258 staining and flow cytometry (FCM). The expression of Bax, Bcl-2proteins and cytokine concentration of co-culture supernatants were detected by Western blot and ELISA respectively. Results Compared with those of control group (from 5.8% ± 3.0% to 16. 5% ± 4. 0% ) and SEA group ( from 20.7% ±2. 1% to 68.6% ±4.0% ), the inhibition rates in targeted SEA group increased significantly (from 3 1. 2% ± 2. 6% to 88.7% ± 3.0% ,P ＜ 0. 05 ). Characteristic changes of apoptosis were observed in both experimental treatment groups, especially in targeted SEA group. FCM also showed more prominent apoptosis induced in targeted SEA group (from 14.6% ± 0.7% to 66.5% ± 3.3% ),significantly higher than those of control group ( from 4. 6% ± 0. 7% to 6. 5% ± 0. 3% ) and SEA group (from 9. 1% ±0. 6% to 29. 9% ± 1.3% ,P ＜0.05 ). In addition, Western blot analysis indicated that the ratio of Bax/Bcl-2 significantly increased to (3. 29 ±0. 34) by targeted SEA treatment at an extremely low concentration, significantly higher than those of SEA group ( 1.21 ±0.05) and control group (0. 45 ±0. 15)( P ＜ 0. 05 ). While at the same time ELISA assay showed no significant difference of IL-2, TNF-α, IFN-γconcentrations between SEA and targeted SEA groups. Conclusion Monoclonal antibody targeted SEA significantly increases the inhibitive effect of BIU-87 cell line possibly through the up-regulation of Bax/Bcl-2 ratio to promote the cellular apoptosis.

Objective To study the effects of capsaicin on the growth of bladder cancer RT4 cell and its potential mechanism. Methods Cell counting kit-8 (CCK-8) assay and flow cytometry were employed to observe the effects of capsaicin (50, 100, 150,200, 250 μmol/L) on cell growth, cell cycle and apoptosis. Capsaicin (0μmol/L) was used as a control. The effects of mRNA and protein of transient receptor potential cation channel subfamily V 1 (TRPV1) on RT4 cells were tested by RT-PCR and immunofluoresence respectively. And the expressions of cell cycle protein P53, P21, CDK2 were detected by Western blot after the treatment of capsaicin. Results 100 μmol/L capsaicin significantly decreased the viability of RT4 cell [82.0% ± 6. 2% vs 100. 0% ± 12.4% ( control ), P = 0. 036] while the cell viability was 7.8% ±2. 9% at 250 μmol/L (P =0. 000). It was in a dose-dependent manner. On the other hand,capsaicin induced the cell cycle arrest of bladder cancer RT4 cells G0/G1 phase in a dose-dependent way.The cell proportion of G0/G1 phase in the control was 37.4% ±5.6% ,however, it was 72.4% ±5. 3% at 250 μ mol/L (P =0. 000). It was showed that TRPV1 mRNA and protein were expressed in RT4 cells.After a 48-hour treatment with capsaicin, the expressions of P53 and P21 were up-regulated in contrary to the expression of CDK2. Conclusion Capsaicin induces the cell cycle arrest of bladder cancer RT4 cells G0/G1 phase and growth inhibition via TRPV1 receptor by modulating the expression of P53, P21 and CDK2.

Objective To explore the clinical presentation, therapy and prognosis study of primary cutaneous anaplastic large cell lymphoma (PCALCL). Methods We reviewed and analyzed ten cases of PCALCL receiving treatment at our hospital from January 1999 to January 2009. Results There were 8 males and 2 females with a median age of 48 years old( range: 22 -69). There were single subcutaneous nodule ( n = 7 ) and multiplenodules ( n = 3 ). And the lesions could be found on head and neck ( n = 5 ),trunk ( n = 3 ) and all over body ( n = 2 ). The lesions appeared red, solid and stable subcutaneous nodules.Partial lesions had a spontaneous regression and new nodules appeared at the same or different sites. Two patients had lymphadenopathy and one had bone involvement with anaplastic lymphoma kinase (ALK)positive and high cell proliferation ratio index ( ki-67 ＞ 80% ). Seven cases with single lesion received surgical excision plus radiotherapy, chemotherapy or radiochemotherapy, one case recurred, six cases survived without disease. Three cases with multiple lesions received systemic chemotherapy mainly in combination with radiotherapy or biotherapy, two cases recurred and one case survived without disease. The median follow-up was 44 months ( range: 9 - 95 ), progression free survival 89% and overall survival 100%. Conclusion PCALCL is found more commonly in males. Visceral and lymph node involvement are rare. The patients with single lesion have a longer disease-free survival than those with multiple lesions after surgical excision in combination with chemotherapy or radiotherapy. Multiple lesions can not be cured.

Objective To clone, prepare probe for and explore the expression levels of KIAA1173 gene in skin squamous cell carcinoma (SSCC)and investigate its expression, clinical and pathological significance. Methods KIAA1173 gene fragment (354 bp) was cloned and its cDNA probe prepared. The expression of KIAA1173 gene in 133 SSCC tissue samples (including 52 specimens of Ⅰ , 37 specimens of Ⅱ, 31 specimens of Ⅲ and 13 specimens of Ⅳ ) and 47 normal controls were examined by in situ hybridization (ISH). And all specimens were embedded in paraffin. Results ISH showed brown positive granules in the cytoplasm of parenchymal cells. The positive rate of KIAA1173 mRNA was 38. 3% (51/133)in SSCC and 93.6% (44/47) in normal controls. The rate was lower in cancer groups than that in normal tissues( x2 =42. 567 ,P ＜0. 01 ). The strongly positive rates were significantly lower in SSCC groups(6. 0% ,8/133) than that in normal control (48.9% ,23/47, x2 = 44. 876, P ＜ 0.01 ). The negative rates of KIAA1173 mRNA were 53.8% (28/52) in SSCC Ⅰ, 62.2% (23/37) in SSCC Ⅱ, 67. 7% (21/31) in SSCC Ⅲ and 76. 9% (10/13) in SSCC Ⅳ ( x2 = 4. 005,P ＞ 0. 05 ). The negative rates of KIAA1173 mRNA in the dys-good differentiation group (70. 5% ,31/44)was higher than that in the good differentiation group (57. 3 % ,51/89), but there was not significant difference between the two groups (x2 = 2. 154, P ＞ 0. 05 ).Conclusion KIAA1173 gene is highly expressed in normal skin, but it becomes down-regulated in SSCC.It may play an important role in the development of SSCC.

Objectiye To describe the clinical characteristics of fatal cases with confirmed A H1N1influenza so as to improve the diagnosis and treatment of this severe disease. Methods We retrospectively analyzed the medical records of 11 fatal cases with A H1 N1 influenza in Tianjin between September 1 and November 4 2009. Results There were 6 males and 5 females with a median age of 25 (21 - 36) years old. Two cases were pregnant women and 3 patients suffered such concurrent disorders as dilated cardiomyopathy, multiple myeloma or atrophic gastritis. Over 3 lung fields were involved on chest imaging studies and the oxygenation index was less than 300 mm Hg at admission. The therapies of oseltamivir and methylprednisolone were administered and mechanical ventilation was initiated within 24 hours. Refractory hypoxemia and a higher level of lactate dehydrogenase were present during treatment. Pneumothorax or mediastinal emphysema occurred in 4 patients, acute renal failure in 1 and pneumopyothorax in 1. The culture of airway secretion at 3 - 7 days after mechanical ventilation showed Staphylococcus aureus in 4 patients and Aspergillus in 2. The progress of disease was so quick that the duration from onset of clinical symptoms to hospitalization was a median of 4 (3 - 6) days and the duration from onset of clinical symptoms to death a median of 12 days. Conclusion The fatal cases with A H1N1 influenza in Tianjin occurred mostly in young individuals and pregnant women. This severe disease had a rapid progression. And bacterial co-infections were quite common. Refractory hypoxemia resulting in respiratory failure was the main mortality reason.

Objective To analyze the characters of bronchial foreign bodies in children and the utilization of bronchoscope in the treatment of bronchial foreign bodies. Methods A total of 246 children were diagnosed with bronchial foreign bodies at our hospital during January 2000 until August 2009. Under local mucosal anesthesia, a bronchoscope was inserted through nasal cavity into bronchi. After identifying the site of foreign body, grasping forceps was guided through bronchoscope to remove the foreign body from airway. Results Among 246 cases, hard nut and skin of melon seed were found ( n = 230, 93.5% ). The most common site of foreign body was in right lower lobe bronchi ( n =98, 38.9% ). The average operative frequency was 1.9 ± 1.3 and one-time extraction ratio 58.5% ( n = 144). The one-time extraction ratio of patients with foreign body obstructed in main bronchi (91. 1% ), right middle lobe (60.0%) and right lower lobe (55. 1% ) was higher than others. The operation frequency of using basket grasping forceps ( 1.4 ±0.9) was lower than those using tooth type forceps (2.1 ± 1.4). And the difference was significant (P = 0. 000). Conclusion For bronchial foreign body in pediatric patients, hard nut and skin of melon seed are the most common foreign bodies. The right and left lower lobe bronchi are the predilection site.Foreign body in main bronchus is the easiest to be removed by grasping forceps. For massive foreign bodies,basket grasping forceps fares better than tooth grasping forceps.

Objective To determine the mutation status of K-ras gene in colorectal cancer and analyze the associations between its mutation status and clinicopathological characteristics in colorectal cancer so as to select the patients likely to benefit from a targeted therapy. Methods A total of 208 colorectal cancer tissue samples were collected from September 2008 to February 2009. DNA was extracted with a genomic DNA miniprep kit. Then PGR was performed with the designed primers and the product directly sequenced by the Sanger method. Then the associations between K-ras mutation status and clinicopathological characteristics in colorectal cancer were analyzed. Results Of 208 cases, 91 cases of Kras gene mutation were detected. The 12 or 13 codon had a mutation rate of 43.8%. There were no significant differences in gender, tumor location, histopathological grading and Duke's stage between the wild and mutated groups. Conclusion Detection of K-ras gene status in colorectal cancer will help to select the patients likely to benefit from the monoclonal antibody therapy of targeting epidermal growth factor receptor.

Objective To investigate the expressions of extracellular matrix metalloproteinase inducer ( CD147 ), matrix metalloproteinases-2 ( MMP-2 ) and matrix metalloproteinases-9 ( MMP-9 ) in human laryngeal carcinoma and study their relationship with invasion, metastasis and prognosis. Methods The EnVision immunohistochemical method was used to detect the expressions of CD147, MMP-2 and MMP-9 in 48 cases of laryngeal carcinoma and 15 cases of laryngitis. The results were compared with their clinical pathological features and prognosis. Results The positive expression rates of CD147, MMP-2 and MMP-9 were significantly higher in laryngeal carcinoma than those in laryngitis ( 87. 5%, 75.0% , 79. 2% vs 26. 7%, 6. 7%, 33.3% ); there was a positive correlation between a high-level expression of CD147,MMP-2, MMP-9 and clinical stage and the status of lymph node metastasis( P ＜ 0. 01 ) ;univatiate analysis indicated that the overall survival rate was higher in patients with a negative expression of CD147, MMP-2,MMP-9 than those with a positive expression ( 83.3%, 83.3%, 90. 0% vs 25.0%, 7.7%, 18. 2% );multivariate analysis showed that MMP-9 was a risk predictor. A higher expression of MMP-9 was associated with a shorter survival time. Conclusion CD147 and MMP-2 play a role in invasion and metastasis of laryngeal carcinoma; increased levels of MMP-2 and MMP-9 are induced by CD147 in laryngeal tumor cells;MMP-9 may be an independent prognostic factor.

Objective To compare the efficacy and safety ventilated with pressure support ventilation ( PSV ) or neurally adjusted ventilatory assist ( NAVA ) in neonates undergoing open-heart surgery with acute lung injury (ALI) in spine and prone positions. Methods Fifteen neonates with a mean age of (15 ±9) days and a mean weight of (3.5 ±0. 6) kg underwent open-heart surgery with ALI from July to December in 2009 were enrolled in this study. After hemodynamic stabilization ventilated with pressure regulated volume control (PRVC-base), all cases were ventilated with PSV and NAVA both in spine (SP)and prone (PP) positions for 60 minutes in a randomized crossover trial respectively. The hemodynamics,blood gas analysis, airway pressure, electrical activity of diaphragm (EAdi) and asynchrony index (AI)during every mode were recorded. Results The heart rate, systolic blood pressure and central venous pressure were stable in every mode. The peak inspiratory pressure and mean airway pressure in every mode had no significant difference but were significantly lower than in PRVC-base either in spine or prone position. The respiratory rate in PSV and NAVA with prone position was more rapid than in spine position and in PRVC-base ( P ＜ 0. 05 ). But there was no significant difference in minute ventilation ( MV ) for each mode. The oxygenation index was higher in NAVA or PSV in both positions versus PRVC-base [(200 ±60)mm Hg in PRVC-base, (272 ±76) mm Hg in PSV-SP, (308±90) mm Hg in PSV-PP, (347 ±84)mm Hg in NAVA-SP and (365 ±87) mm Hg in NAVA-PP respectively, P ＜0. O1]. The oxygenation index was significantly higher in NAVA-PP than in PSV-SP (P ＜0. 05 ) while PaCO2 was in normal range and had no significant difference for any mode. The minimal EAdi in NAVA-PP was significant lower than that in PSV-SP [(0.2±0. 1) μV vs (0.5 ±0.2) μV, P＜0.05]. The AI of NAVA either in spine or in prone position was 0. It was significantly lower than that in PSV-SP [(21.5 ±4. 8 )%, P ＜0. 01] and PSV-PP [(22.4 ± 3.4 ) %, P ＜ 0. 01]. Conclusion Especially in a prone position, NAVA demonstrates a better synchrony in ALI neonates after cardiac surgery. It helps to provide a better oxygenation for the patients.

Objective To explore the methods of evidence-based medicine to determine objectives and evaluate the efficacy of interventional therapy for advanced hepatocellular carcinoma. Methods Clinical questions were raised after a thorough evaluation of the status of interventional therapy. The term of evidence based medicine methods was searched in EBSCO, Cochrane library, Medline (January 1990 -January 2007 ), ACP Journal Club (January 1991 -January 2007 ) and Sumsearch. The searching subjects were hepatocellular carcinoma, interventional therapy, systematic review and meta-analysis etc. Based upon an analysis of the searching results, rational evidence based interventional therapy regimes were made. The survival benefit was studied by comparing with the empirical counterpart of the same period and with the same inclusion criteria. Data and Kaplan-Meier survival analyses were conducted by SPSS version 16. 0software. Results Nine randomized controlled clinical trials related to clinical questions and three systematic reviews were retrieved. A total of 119 cases of hepatocellular carcinoma were included. The evidence-based interventional therapy was performed in 59 cases and empirical interventional therapy in other 60 cases. The 2-year follow-up results confirmed that the evidence-based regimes were more appropriate for advanced hepatocellular carcinoma. The 1 and 2-year overall survival rates in evidence-based interventional therapy group and empirical group were 79. 7% vs 68. 3% and 50. 8% vs 31.7% respectively. And the difference was significant (P＜0. 05). Conclusion Choosing the therapeutic regimes according to evidence-based medicinemethods can increase the clinical efficacy of interventional therapy and achieve survival benefits.

Objective To study the RBP4 mRNA expression between subcutaneous and visceral adipose tissue in obese and type 2 diabetic patients and to investigate the factors that influence RBP4 mRNA expression in Human visceral adipose tissue. Methods 9 individuals with normal weight normal glucose regulation subjects, 9 obesity subjects and 9 type 2 diabetes subjects were enrolled. All of the subjects were prepared to undergone an operation because of nondiabetes disease. Subcutaneous and visceral adipose tissue were taken out as soon as cultured. RT-PCR and Real-time PCR were used to assay the relative expression of RBP4 mRNA. Results RBP4 mRNA level in visceral adipose tissue of obesity group was (2. 10 ± 1.84),and that of type 2 diabetes group was ( 1.54 ± 0. 46 ), both were significantly higher than that in normal weight normal glucose group ( 0. 75 ± 0. 28, P ＜ 0. 01 , P ＜ 0. 05 ). RBP4 mRNA level in subcutaneous adipose tissue of the three groups were ( 1.05 ±0. 15 vs 0. 99 ±0. 14 vs 1.13 ±0. 07), no difference among them(P ＞ 0. 05 ). Insulin, dexamethasone, pioglitazone, free fatty acids can significantly increase RBP4 mRNA expression, compared with the control group, respectively, have an increase of 2. 13 times, 0. 84times, 2. 04 times, 4. 88 times; however, tumor necrosis factor-αt can significantly lower RBP4 mRNA level, compared with the control group decreased by 38%. Conclusion RBP4 mRNA expression in visceral adipose tissue were significantly higher in obesity and type 2 diabetes subjects. In vitro system, RBP4 gene expression in visceral adipose tissue of normal weight normal glucose subjects was regulated by insulin,dexamethasone, pioglitazone, palmitic acid and TNF-α, such factors were also participated in the pathophysiological process of insulin resistance and type 2 diabetes.

Objective To explore the effect of small interfering RNA (siRNA) targeting NF-κB signal pathway on the expression level of tumor necrosis factor α (TNF-α) released by lipopolysaccharides (LPS)-stimulating-macrophages. Methods Human monocytic THP-1 cell was induced by phorbol myristate acetate (PMA) and transformed into macrophage. Two groups of macrophage were infected by siRNA retroviral expression vector specific to NF-κB functional subunit P65 (siRNA group) and Scramble control vector (Scramble control group) constructed by molecular cloning technology. Lipopolysaccharide (50 μg/ml)was used to treat the macrophages continuously. RT-PCR was performed to detect the expression level of NF-κB P65 mRNA and TNF-α mRNA at different time-points of LPS stimulation. Western blotting was used to analyze the protein level of NF-κB P65. Enzyme-linked immunosorbent assay was applied to analyze the expression level of TNF-α released by LPS-stimulated macrophages. Results At Hours 12 and 24 after LPSstimulation, the expression level of NF-κB P65 mRNA in siRNA group (0. 97 ± 0. 02, 0. 89 ± 0. 01 ) was significantly less than that in Scramble control group ( 1.01 ± 0. 03, 0. 97 ± 0. 01, both P ＜ 0. 05 ). At Hours 24 and 72 after LPS stimulation, the expression level of NF-κB P65 protein in siRNA group (0. 95 ±0. 04, 0.94 ±0. 01 ) was obviously less than that in Scramble control group ( 1.07 ± 0. 06, 1.03 ± 0. 05,both P ＜0. 05). At Hours 4, 8, 12 and 24 after LPS stimulation, TNF-α mRNA released by siRNA group macrophages was far less than that by Scramble control group macrophages ( 0.92 ± 0. 02 vs 0. 98 ± 0. 01,0.86±0.02 vs 1.00 ±0.01,0.79 ±0.03 vs 1.01 ±0.01,0.78 ±0.03 vs 1.02±0.01, all P＜0.05). At Hours 2, 4, 8, 24, 36, 48, 54 and 72 after LPS stimulation, the TNF-α content in culture medium supernatant in siRNA group macrophage was less than that in scramble control group (P ＜ 0. 05 ).Conclusion NF-κB P65 siRNA inhibits the functional activity of NF-κB signal pathway in PMA-induced macrophage. Then it blocks the activation of macrophage and the excessive release of TNF-α due to endotoxin stimulation. The RNA interference technology may be applied to prevent and treat excessive inflammatory reaction in acute lung injury.

Objective To investigate the effects of palliative liver resection on metastatic potential and its gene function net of residual hepatocellular carcinoma (HCC) in nude mice model. Methods Orthotopic HCC model was established by implantation of human HCC cell line MHCC97H xenografts with a high metastatic potential. Thirty-six HCC-bearing nude mice were randomized into 3 groups at 14 days postoperation, including palliative resection group ( HCC samples A, B), control group 1 ( sham operation,HCC sample C1 ) and control group 2 (without intervention, HCC sample C2). Six mice in each group were sacrificed by cervical dislocation at 14 days after palliative resection. Oligo tumor metastasis microarray and GEArray expression analysis suite software were employed for gene analysis. The methods of support vector machine (SVM), gene significance analysis and gene correlation degree analysis were used to search the markers capable of differentiating the metastatic potential of HCC. Gene function net was constructed based on special gene clustering analysis and multi-dimensional scale. Real-time PCR was applied to detect the mRNA expression. The remaining mice were sacrificed at 35 days after palliative resection for the examination of pulmonary metastasis. SAS 8.2 software was used for statistical analysis. Results Gene analysis showed that for different gene expression among groups, the density of gene net in palliative group (B, 0.0670) were higher than those in control groups (A, 0.0145; C1, 0.0210; C2, 0.0146), the condensation degree of gene net in residual HCC ( B, 0. 1940) was higher than that in its own control group (A, 0. 0098 ). Human gene metastasis suppressor 1 (MTSS1) that encodes a protein of missing in metastasis B (MIM-B) was situated in the central position of gene function net of residual HCC. The relative MIM-B mRNA expression examined by Real-time PCR was significantly up-regulated in residual HCC (B,0.283 ±0.023) as comparison was made among groups (A, 0. 142 ±0.018; C1, 0. 177 ±0.054; C2,0. 156 ± 0. 017, all P ＜ 0. 05 ). The number of lung metastatic nodules in the palliative group ( 14. 3 ± 4. 7)was more than that in the sham group ( 8. 7 ± 3.6) at 35 days post-resection ( P ＜ 0.01 ). Conclusion Palliative liver resection enhances the pulmonary metastatic potential of residual HCC in nude mice model.MIM-B may be one of the key therapeutic targets for HCC patients.

1. The concept and essence of aging Aging can be defined as the degenerative process of biological system, the irreversible accumulation of degenerative changes in the body and the increase of vulnerability to diseases, which ultimately leads to death [1]. Strehler [2] put forward four characteristics of aging, namely universality, graduality, intrinsic and harmfulness.

mycosis fungoids (MF) is the most common type of cutaneous T-cell lymphoma [1]. The treatment of MF is divided into two types: local treatment and systemic treatment: local treatment is skin-directed therapies (SDT): including topical glucocorticoid, nitrogen mustard, psoralen (8-MOP) plus long-wave ultraviolet irradiation (PUVA) and/or medium-wave ultraviolet irradiation (UVB); Systemic therapy is mainly used for advanced patients, including single application of chemotherapy drugs or combined chemotherapy, in vitro PUVA, etc.

In the Pediatric Asthma Controller Trial (PACT), inhaled fluticasone 100 μ g twice daily was the most effective treatment plan, but more than 50% of children with Asthma still failed to control their disease; During the 48-week course of oral glucocorticoid therapy, 39% of children still experienced at least one acute attack.

A number of clinical trials have fully confirmed the effective role of statins in the secondary prevention of coronary artery disease, including women with coronary artery disease, but the role in the primary prevention of women is still controversial.Mario Petretta et al. conducted a meta-analysis of the effects of statins of different genders on cardiovascular events in the primary prevention, which was published in the International Journal of Cardiology, January 7, 2010 (Int J Cardiol, 2010, 138: 25-31).

A 9-year-old male was admitted to hospital on June 26, 2008 due to diarrhea for 6 years and edema of both lower limbs for 2 years. The child gradually developed diarrhea without inducement 6 years ago, which was a yellow thin stool, about 200 ml each time, 1 to 3 times a day, obvious after greasy diet. Two years ago, concave edema of both lower limbs appeared intermittently, denying abdominal pain, blood in the stool, oliguria, fever, etc.

A 56-year-old female was admitted to the hospital on May 21, 2008 due to distension and pain in the upper abdomen accompanied by vomiting for more than 10 days. Abdominal CT showed a large soft tissue mass in the middle and upper abdomen, and the ileocecal region was moved upward into the transverse colon, appearing as a "sandwich biscuit", considering intussusception. After admission, laparotomy was performed. A bulging mass of 6.5 cm ×6.0 cm was found in the cecum, growing into the cavity, and multiple swollen lymph nodes were touched at the root of the mesenteric membrane, so right hemicolectomy was performed.

The patient was a 58-year-old male who was seen in the Department of Dermatology of Peking Union Medical College Hospital on November 5, 2009 for more than 1 year due to facial erythema. The patient appeared purple-black spots the size of soybeans on the bridge of the nose without obvious trigger more than 1 year ago, and the rash gradually infiltrated into the bilateral nasal wings, cheeks and periorbital area, without obvious self-conscious symptoms.