Volume 90  ·   Issue 48  ·  2010

Objective To evaluate the impact of neoadjuvant hormonal therapy on the permanent transperineal 125I-seed brachytherapy for localized high-risk prostate cancer. Methods Ten patients with T1-T2, localized high-risk prostate cancer were reviewed. The mean level of PSA was (29. 4 ± 12. 6) μg/L (20-50 μg/L) and the mean prostate volume (54 ± 33 ) ml. All cases were sequentially treated on a neoadjuvant hormonal therapy with 1 week of Casodex (50 mg/d) and 3 -10 months( median: 6 months)of Casodex (50 mg/d) with Zoladex (3.6 mg per 4 weeks, SC). Then all patients received the transperineal permanent interstitial 125I-seed implantation brachytherapy by template method. The matched peripheral dose of seed implantation was 145 Gy (median number of 125I seeds: 46), urethral peripheral dose ≤80 Gy and rectal peripheral dose ≤ 60 Gy. The mean operative duration was 1. 75 hours (range: 1 -2. 5 hours ).Results After neoadjuvant hormonal therapy for 3 - 10 months, the PSA level decreased to ( 1. 4 ± 0. 7 )g/L in all patients. The mean prostate volume significantly decreased to (25 ± 10) ml(t-test, P ＜0. 01 ).The Foley tube extracted at Days 3-5 post-brachytherapy. Side effects of mild dysuria (n = 1 ) and urethral irritation ( n = 1 ) were effectively managed by symptomatic treatment. After a median follow-up of 13 months (range: 3 -24), the PSA level was (0.9 ±0.7) μg/L. Conclusion A combination of neoadjuvant hormonal therapy with brachytherapy may lower the PSA level and shrink the prostate volume so as to ensure an effective dose in the target tumor and improve the therapeutic efficacy for localized high-risk prostate cancer.

Objective To explore the methods of reducing the missing report rate of breast cancer in clinical breast examination (CBE). Methods The investigators analyzed the data of abnormal breast physical examination in 2181 females and the missing report rate of breast cancer in various kinds of examination methods. Results Interrogation and inspection reduced the missing report rate by 5% in all cases. And the missing report rate was lowered from 0. 9% to 0. 4% by multi-position joint palpation among 2839 breast foci in abnormal physical examination. Small breast nodules, marginal foci of mammary gland,axillary fossa and mammary areola had the tendency to be missed. Focal thickening of mammary gland was also easily missed. Compared with the control group, the abnormity of interrogation and inspection in the breast cancer group were statistically significant in the operation group ( x2 = 9. 770, P = 0. 002 ). The missing report rate of breast cancer was 3.7% in CBE, 17% in ultrasonography and 19.4% in mammography. Conclusions The methods of reducing the missing report rate of breast cancer in clinical breast examination are as follows: valuing the importance of interrogation and inspection; using different palpation methods on the basis of different breast morphologic features; paying more attention to the marginal foci of mammary gland, axillary fossa and mammary areola; examining closely the focal thickening of mammary gland. Scirrhosity is inadvisable as an independent predictor for malignant tumor. A clinician should avoid an excessive dependence on palpation and instruments.

：Objective To investigatethe clinical features of paraneoplastic syndromes (PNS) in patients with renal, prostateand bladder cancer and conduct a brief prognostic analysis. Methods From 2008 to 2010, 464patients of renal cell carcinoma ( RCC ) confirmed by operation and pathology werereviewed retrospectively. And 562 cases of patients with prostate cancer and 647 withbladder cancer from 2005 to 2010 were also analyzed respectively. Results Among all cases,156 (33.6%)patients were diagnosed with PNS manifesting with anemia, hypertension, fever,polycythemia, Stauffer's syndrome,fatigue, weight loss, anorexia, leukocytosis andhypercalcemia, etc. Two prostate cancer patients had the elevated levels of calcemia andblood glucose respectively. However, no specific clinical presentation in bladder cancerwas found to be associated with PNS in this study. Conclusions RCC is the most frequenturological malignancy with PNS. But prostate cancer with PNS is very uncommon and bladdercancer is extremely rare. Most paraneoplastic signs predicate a poor prognosis for thepatients.

Objective To analyze the risk factors in the patients over 65 years old undergoing offpump coronary artery bypass grafting (OPCAG) as grouped by postoperative creatinine clearance rate (Ccr).Methods A total of 462 consecutive patients over 65 years old undergoing OPCAG from January 2007 to December 2008 were recruited. They were divided into 3 groups by renal functions: normal, minor injury and moderate-severe injury. The risk factors were analyzed by a comparison of postoperative complications,duration of intubation, stay of intensive care unit and mortality rate, et al. Results There was no significant difference between the parameters of preoperative complications, left ventricle ejection fraction (LVEF), left ventricle end diastolic diameter (LNEDD) and lipid level, et al. And the postoperative complications were closely related to the decrease of Ccr and the increases of B-type natriuretic peptide ( BNP), CKMB, total bilirubin (TBIL) and LVEDD ( P ＜0. 01 for each). Conclusions The moderate-severe renal injury ( Ccr ＜ 50ml/min) with the abnormal levels of TBIL, BNP and LVEDD are the risk factors for a worse prognosis in OPCAG patients over 65 years old. Because of the injury of OPCAG, we should pay attention to patients with abnormal renal function (Ccr ＜80 ml/min) to prevent an onset of severe complications.

Objective To explore the clinical experiences, efficacies and postoperative left ventricular remodeling changes of surgical ventricular reconstruction in the treatment of post-infarction left ventricular aneurysm. Methods The investigators reviewed retrospectively the clinical data, operative approaches and follow-up outcomes of consecutive 194 patients with post-infarction left ventricular aneurysm,who underwent surgical ventricular reconstruction between January 1997 and December 2009. There were 54cases in the linear group and 137 cases in the endoventricular patch plasty group. The changes of ventricular remodeling were measured by peri-operative and follow-up echocardiography. Results All patients underwent surgery with a mean cardiopulmonay bypass duration of ( 103 ± 35 ) min and aortic cross clamp duration of (62 ±26)min. There were 8 per-operative deaths with a mortality rate of 2.2%. Angina pectoris of other cases disappeared and heart function greatly improved. After operation, the ventricular remodeling results showed that in the linear group, there was not significant difference in the changes of ventricular remodeling of post-op 2 weeks, 6 months, 1 year and 5 years versus pre-operation. However, in the endoventricular patch group, the changes of ventricular remodeling of post-op 2 weeks and follow-up 6months versus pre-operation were significantly reduced( P ＜0.05). End-systolic volume (LNESV) reduced from ( 129 ± 27 ) ml to ( 65 ± 8 ) ml and end-systolic volume index ( LVESVI ) decreased from ( 104 ± 14 )ml/m2 to (44 ± 6) ml/m2 and the subgroup of LVEF ＜ 35% was the most significant in the changes of LVESV and LVESVI. But LVEF improved significantly at post-operation and follow-up (from preoperation 42% ± 11% to 52% ± 7% during follow-up). Conclusions For patients with infarction left ventricular aneurysm, left ventricular reconstruction is quite effective. The choice of operative approaches is determined ty the size and range of ventricular aneurysm. Both string suture and endoventricular patch plasty technique can yield similarly satisfactory surgical outcomes. After operation, ventricular volume significantly decreases and cardiac function greatly improves.

Objective To determine the rate of BRAF gene mutation and the expression of activated extracellular regulated protein kinases (ERK) in nasal mucosa malignant melanomas and compare the results with those in cutaneous melanomas so as to explore the difference in the pathogenesis between nasal mucosa malignant melanomas and cutaneous melanomas. Methods Twenty nasal mucosa melanomas samples were collected. Genomic DNA was extracted and the BRAF mutation detected by PCR (polymerase chain reaction) and direct sequencing analysis. Total protein was obtained and the activated ERK detected by Western blot. Results BRAF mutation was detected in 5% (1/20) samples of all patients. The mutation rate was much lower than that in cutaneous melanomas. And phosphorylated ERK protein was detected in 60% (12/20). And the result was almost similar to that of cutaneous melanomas. Conclusions The high expression of activated ERK is not caused mainly by BRAF gene mutation in nasal mucosa malignant melanomas. The pathogenic pathways are different between nasal mucosa malignant melanomas and cutaneous melanomas.

Objective To explore the depot-specific mRNA and protein expression of retinolbinding protein 4 (RBP4) in human subcutaneous and omental adipose tissue and investigate their relationship with the serum RRP4 levels, obesity and insulin resistance. Methods A total of 41 subjects with normal glucose regulation were recruited. Among them, there were 29 cases with normal body mass index (BMI) and 12 cases with BMI ≥24 kg/m2. All were prepared to undergone a selective abdominal surgery. The levels of serum RBP4 and fasting insulin ( FINS ) were measured by ELISA ( enzyme-linked immunosorbent assay) and chemiluminescence ELISA kit respectively. Fasting plasma glucose (FPG) was tested by glucose oxidase and the home model insulin resistance index (HOMA-IR) calculated. Real-time PCR (RT-PCR) and Western blot were employed to assess the relative mRNA and protein expression of RBP4 in subcutaneous and omental adipose tissues. The mRNA and protein expression of RBP4 from different fat depots were compared and their correlations with BMI, the serum RBP4 concentrations and HOMA-IR analyzed. Results (1) The serum concentrations of RBP4, FINS and HOMA-IR were significantly higher in overweight and obesity group than those in the normal BMI group [RBP4: (39. 61 ±1.57) mg/L vs (33.40 ± 1.28) mg/L, P ＜0. 01; FINS: (8. 82 ±3.79) mU/L vs (6. 43 ±4. 38) mU/L, P＜0. 05; HOMA-IR:1. 91 ±0. 85 vs 1.36 ±0. 72, P ＜0. 05]. (2) The expression levels of RBP4 mRNA and protein were significantly higher in omental adipose tissues than those in subcutaneous adipose tissue [mRNA: (5. 88 ±2. 37)vs(2. 07 ± 1.66), P ＜0. 01; protein: (0. 76 ±0. 18 vs 0. 15 ±0. 07, P ＜0. 05]and these depots difference in both groups ( P ＜ 0. 05) . Moreover, the overweight patients had the higher expression levels of RBP4 mRNA and protein in omental adipose tissue than normal BMI group (mRNA:7.52±0.58 vs 4.37 ±0.45, P＜0. 01; protein: 0.92 ±0.23 vs 0.57 ±0.13, P ＜0.05). (3) The expressions of both RBP4 mRNA and protein in the omental adipose tissue were positively correlated with BMI, waist circumstance, serum concentrations of RBP4, FINS and HOMA-IR. The expression of was negatively correlated with HOMA-IR ( r = - 0. 635, P ＜ 0. 05 ) in subcutaneous adipose tissue. No correlations were found between the expressions of RBP4 mRNA and protein in subcutaneous adipose tissue with BMI, waist circumstance, serum RBP4 and FINS concentrations. Conclusions There is depot-specific expression of RBP4 in human subcutaneous and omental adipose tissues. A high expression of RBP4 in omental adipose tissue and an elevated level of serum RBP4 may contribute to the pathogenesis of obesity and IR.

Objective To explore the differentially expressed miRNAs in bladder urothelial carcinoma (BUC) in order to provide rationales for further studies of function and mechanism for their actions. Methods Fresh normal(5 samples) and BUC(30 samples) tissues were collected from September 2008 to September 2009 in our hospital and analyzed by miRNA microarray to find differentially expressed miRNAs; RT-PCR (reverse transcription-polymerase chain reaction) of recollected samples and 4 types of cell strain to verify the selected miRNAs. Results In grade Ⅰ , grade Ⅱ , grade Ⅲ, grade Ⅰ + Ⅱ + Ⅲ ,infiltrating and non-infiltrating groups, hsa-miR-29b-1 * was up-regulated while hsa-miR-923 and hsa-miR300 were down-regulated. When the infiltrating BUC group was compared with the non-infiltrating BUC group, there were 7 differentially expressed miRNAs. In collected samples, the result of RT-PCR was consistent with that of miRNA array. In 4 types of cancer cell strains, only the result of T24 was completely consistent with that of miRNA array. Conclusions There are differentially expressed miRNAs between normal bladder mucosa and BUC, infiltration BUC and non-infiltration BUC. The result of T24 cell strain is completely consistent with that of miRNA array.

：Objective To study therelationship between liver fat content (LFC) and liver enzymes in individuals with variousstatuses of glucose metabolism. Methods A total of 109 subjects including with impairedglucose regulation (IGR) ( n = 31 ), newly diagnosed type 2 diabetes (NT2DM) ( n = 31 )and normal glucose tolerance (NGT) (n =47) were recruited. The level of LFC was measuredby 1H magnetic resonance spectroscopy (1H-MRS) to study the relationship between liver fatcontent (LFC) and alanine aminotransferase ( ALT ), aspartate aminotransferase ( AST ),alkaline phosphatase ( AKP ) and γ-glutamyltransferase(GGT).The receiver operating characteristic curve(ROC) was employed to obtain the optimalcut-off point of ALT to predict the occurrence of nonalcoholic fatty liver disease(NAFLD). Results (1)The levels of LFC were progressively raised in NGT, IGR and NT2DMgroups respectively [3.83(2.35-7.59)%, 12.82 (8.10-21.37)% and 21.99 (11.89-34.43)%, P＜0.01];(2) the subjects were divided into four subgroups by the method of LFC quartile. Andquartile subgroups Q1 -4 were associated with the increase of LFC. Waist, BMI, systolicblood pressure, triglyceride, total cholesterol,fasting plasma glucose, OGTT 2 hpostprandial glucose and HOMA-IR had a rising trend from Q2. But HDL-C showed a decliningtrend from Q2; (3) ALT and GGT singnificantly increased from Q3( P ＜0.01 )while AST and AKP significantly increased in Q4( P ＜0. 01 ); (4) adjusted bygender, age and body mass index ( BMI), LFC was positively correlated with AST ( r = 0.329, P ＜ 0. 05 ), ALT ( r = 0. 454)and GGT ( r = 0. 378 ) ( All P ＜ 0. 01 ). But it wasnegatively correlated with AST/ALT ( r = - 0. 364, P ＜ 0. 01 ); (5)the analysis of stepwise regression demonstrated that LFC was apredictor of ALT, AST, GGT and AST/ALT; (6) ALT had a ROCAuc of 0. 813 (male) and 0. 769(female) ( All P ＜ 0. 01 ). The optimal cut-off point of 23. 5 U/L(male) and 17. 5 U/L(female) mightpredict the occurrence of NAFLD. Conclusions Liver enzymes are correlated with LFC even innormal range. The optimal cut-off point of 23. 5 U/L(male)and 17. 5 U/L (female) mightpredict the occurrence of NAFLD. The current used ALT upper limit could underestimate theNAFLD.

：Objective To investigatethe protective effects of hepatotrophic factors (hepatocyte growth-promoting factor andinsulin) on hepatic functions and pathology in rats with portal hypertension afterportacaval shunt. Methods The rats of hepatic cirrhosis with portal hypertension wererandomly assigned into 1 control group, 1 model group and 4 treatment groups ( NS, HGF,INS, HGF + INS). An end-side portacaval shunt was performed in the treatment group. Thehepatotrophic factors were respectively injected into portal vein. After treatment, theserum levels of ALT (alanine aminotransferase), AST (aspartate aminotransferase), HA(hyaluronic acid) and LN (laminin) were determined by radioimmunoassay. And then accordingto the hematoxylin and eosin (H& E) staining results, the tissue slides wereprepared.Results The serum levels of ALT (30. 13 ±4. 12 U/L), AST ( 133. 75 ±21. 18U/L), HA (322. 49 ±52.33 μg/L) and LN (23.89 +5.03μg/L) were lower in the HGF + INS group than those in the NS group ( all P ＜0.01 ); the scores of hepatic fibrosis stages ( 1.63 ±0. 74) and collagen semiquantitativeof Masson stain ( 10. 17 ± 1. 14 × 10 -2 ) were significantly reduced in the HGF + INSgroup than those in the NS group (all P ＜ 0. 01 ). Conclusion The injection of hepatotrophic factorsthrough portal vein after portacaval shunt can improve hepatic functions, reduce thedamages of hepatocyte and improve the degree of hepatic fibrosis.

Objective To study the effect of an acidic region-3 ( AR-3), capable of improving the secretion of heavy chain of coagulation factor Ⅷ ( fⅧ ), on the secretion of protein spicing ligated full-length fⅧ. Methods A pair of vectors was used to deliver intein fused heavy and light chain genes of a full-length tⅧ gene with an additional AR-3 incorporated on the end of heavy chain into cultured 293 cells. The intracellular protein splicing was observed by Western blot. And the secretion of spliced fⅧ and activity in culture supernatant were quantified by enzyme-linked immunosorbent assay (ELISA) and Coatest assay respectively. Results A noticeable spliced fⅧ protein band was observed from the gene co-transfected cells. The culture supernatant displayed a spliced fⅧ of ( 112 ± 18) ng/ml with an activity of (0. 76 ±0. 13) U/ml greater than that of cells co-transfected with AR-3-free heavy chain and light chain genes [(64±11) ng/ml and (0.37±0.05) U/ml]. And a spliced fⅧ of (27±7) ng/ml with an activity of (0. 16 ± 0. 05) U/ml was detected in the culture supernatant from combined cells separately transfected with AR-3-fused heavy chain gene and light gene. Conclusion AR-3 can enhance the fⅧ gene transfer by improving the secretion of intein spliced full-length fⅧ.

Objective To study the effects of B-type natriuretic peptide (BNP) preconditioning on the apoptosis and expressions of bcl-2 and Bax in rat cardiomyocytes during myocardial ischemia-reperfusion.Methods Twenty-one male Sprague-Dawley rats weighing (250 ± 50) g were randomly divided into 3 groups of sham operation ( SHAM ), ischemia-reperfusion (I/R) and B-type natriuretic peptide ( BNP). A rat model of in vivo myocardial ischemia-reperfusion injury was established by ligating the left anterior descending coronary artery for 35 minutes and then reperfusing for 240 minutes. The apoptosis of myocardial cell was determined by terminal deoxynucleotidyl transferase mediated dUTP-biotin nick end-labeling (TUNEL) method. Real-time polymerase chain reaction and Western blot were used to detect the expression changes of bcl-2 and Bax in rat ischemia myocardium. Results The apoptotic indices of SHAM, BNP and L/R groups were 5.4% ±4.2%, 22.5% ±9.5% and 45.2% ±13.0% respectively (P＜0.05). The bcl2 protein expression of SHAM, BNP and I/R groups were 0. 87 ± 0. 09, 0. 70 ± 0. 07 and 0. 38 ± 0. 09respectively ( P ＜ 0. 05). The Bax protein expression of SHAM, BNP and I/R groups were 0.08 ± 0. 04,0. 39 ±0. 09 and 0. 71 ± 0. 18 respectively ( P ＜0. 01 ). The bcl-2/Bax mRNA ratio of SHAN, BNP and I/R groups were 0. 763 ± 0. 154, 0. 099 ± 0. 025 and 0. 022 ± 0. 024 respectively ( P ＜ 0. 05 ). Conclusion The BNP preconditioning can decrease the myocardial apoptosis induced by ischemia-reperfusion injury. The mechanisms may be associated with an elevated expression of bcl-2, an increased ratio of bcl-2/Bax and a lowered expression of Bax.

Objective To investigate the underlying mechanism of ginsenoside Rg1 in the regulation of hematopoietic stem cell (HSC) senescence so as to provide the theoretic and experimental foundations for searching the methods of how to delay its senescence. Methods Sca-1 + HSC was isolated by magnetic cell sorting (MACS) and divided into control, aged, Rg1, Rg1 treatment aged and Rg1 delayed aged groups. The cellular changes were observed by senescence-associated β-galactosidase ( SA-β-Gal ) staining. And cell cycle assay and culture of mixed hematopoietic progenitor cell were used to investigate the effect of ginsenoside Rg1 to delay Sca-1 + HSC senescence. The expressions of p16INK4a, p19Arf, p53 and p21Cipl/Wafl mRNA were detected by reverse transcription-polymerase chain reaction ( RT-PCR ). The expressions of p16INK4a, p21Cipl/Wafl , cyclinD1, cyclinE, CDK2 and CDK4 protein were examined by Western blot. Results In the Rg1 treatment and delayed aged groups, the percentage of positive SA-β-Gal-expressing cells was lower than that of the aged group [30. 1% ± 2. 4%, 21.5% ± 2. 8% vs 69. 5% ± 5. 0%]; the number of cells in G1 phase was lower than that of the aged group [81.4% ± 1. 2%, 78.2% ± 1. 4% vs 87. 5% ±4. 0%]; but the number of colony for the mixed hematopoietic progenitor was higher than that of the aged group [(8. 0 ±2. 2)/104 Sca-1 + HSC, (9. 2 ± 1. 8)/104 Sca-1 + HSC vs (3.0 ± 1. 6)/104 Sca-1 +HSC].As compared with the aged group, the expressions of p16INK4a, p19Arf, p53, p21cipl/Wafl mRNA and p16INK4a,p21Cipl/Wafl, cyclinD1 protein were down-regulated (all P ＜ 0. 01 ) while the expressions of CDK4, CDK2and cyclinE protein up-regulated in Rg1 treatment aged and Rg1 delayed aged groups ( all P ＜0. 01 ). The changes of the Rg1 delayed aged group were significantly marked than those of the Rg1 treatment aged group. Conclusions Rg1 can effectively delay the t-BHP-induced senescence of HSCs. Both p16INK4a-Rb and p19Arf-p53-p21Crp/Wafl may play an important role in the signaling pathway.

Objective To investigate the methylation of 5'-CpG island and expression of RUNX3 in salivary gland adnoid cystic carcinoma cell lines. Methods RT-PCR (reverse transcription-polymerase chain reaction), laser scanning confocal microscope ( LSCM ) and Western blot were used to detect the expression of RUNX3 gene and protein in salivary gland adenoic cystic carcinoma cell lines, ACC-2, ACC3, and ACC-M, before/after a treatment of 5-Aza-dc respectively. Results A weak expression of RUNX3 was found in ACC-2 and ACC-3. And no expression of RUNX3 was found in ACC-3 cell line. After a treatment of 300 nmol/L 5-Aza-dc for 72 hours, the expression of RUNX3 in ACC-2 and ACC-3 cells was enhanced, and in ACC-M was restored. LSCM results showed that the RUNX3 protein was located mainly in the cytoplasm of ACC cell lines. After a treatment of 300 nmol/L 5-Aza-dc for 72 h, both nuclear and cytoplasmic location of RUNX3 positive signals were found in the ACC-2 and ACC-3 cells. However, a weak positive signal was still only found in the cytoplasm of ACC-M cells. Partial methylation in promoter 5'-CpG island of RUNX3 gene was found in all three cell lines. And the methylation degree of CpG island was 50%,75% and 33% in ACC-2, ACC-M and ACC-3 respectively. After a treatment of5-Aza-dc, the RUNX3 gene showed unmethylated status in all three cell lines. Conclusions The methylation of RUNX3 plays an important role in the silencing of RUNX3 expression in ACC cell lines. The cytoplasmic mislocalization of RUNX3 may be correlated with the inhibition of its function in ACC cells.

Periodontitis is a kind of disease that can cause the loss of periodontal tissue (such as gum and jaw), and it is also a common disease that causes patients to lose teeth. The incidence rate in American population is over 20%; It is closely related to some systemic diseases such as diabetes, premature infants, low birth weight infants and cardiovascular diseases.

The patient was an 82-year-old male who was admitted to the hospital on February 13, 2009 due to repeated chest tightness and shortness of breath for one year. He had hypertension for more than 40 years, a history of paroxysmal atrial fibrillation for more than 2 years and a history of smoking for 40 years. Physical examination at admission showed that his blood pressure was 130/90 mm Hg (1 mm Hg =0.133 kPa), the respiratory sounds of both lungs were clear, without dry and wet rales, his heart rate was 68 beats/min, the rhythm was uniform, without pathological murmur, the liver and spleen were not palpable under the costs, and there was no edema in both lower limbs.

The patient was a 53-year-old female who came to the breast surgery department of Peking Union Medical College Hospital on February 18, 2010 due to redness and swelling of the inner and lower skin of the left breast for 20 months and gravel-like calcification of the left mammography target for more than 20 days. In June 2008, the patient developed redness and swelling of the inner and lower skin of the left breast with numbness and itching, tenderness, no tumor, morning stiffness, low fever, fatigue and other discomfort without obvious inducement. No malignant cells were found at puncture in other hospitals, considering "inflammation". After treatment, oral antibiotics and pulse short wave + ultraviolet physiotherapy, the skin redness and swelling aggravated, and new erythema appeared on both eyelids, mandible and neck, considering allergic dermatitis, but anti-allergic treatment was ineffective, and the erythema progressively aggravated and new erythema appeared on the trunk and limbs (Figures 1A ~1C).

Mantle cell lymphoma (MCL) is a rare B-cell non-Hodgkin's lymphoma, accounting for 3% ~10% of NHL in western countries. It occurs in middle-aged and elderly men with a median onset age of 60~65 years and poor prognosis [1-2]. Early treatment with MCP (mitoxantrone, cyclophosphamide, prednisone) or CHOP (cyclophosphamide, vincristine, doxorubicin and prednisone) showed a median survival of less than 3 years.

functional dyspepsia (FD) is a heterogeneous disease, and the complex pathophysiological mechanism leads to a variety of clinical manifestations. It has been proved that delayed gastric emptying, gastric receptivity disorder and visceral hypersensitivity play a certain role in the pathogenesis of FD, and the role of mental and psychological factors in the pathogenesis of FD and the efficacy of mental and psychological intervention have attracted more and more attention.