Volume 91  ·   Issue 18  ·  2011

According to the overall requirements of the national medical reform program, Shanghai implemented the standardized training system of residents in 2011. Because of the late start and unbalanced development of residents' training in China, the training system and admission management system have never been established. Problems such as uneven training quality, inability of talents to flow, lack of competition mechanism have always restricted the improvement of the overall quality of clinicians [1]. Through a questionnaire survey of doctors in three top three hospitals in Shanghai, we analyzed the factors affecting the training quality, explored the measures that can be taken, and tried to seek solutions from the perspective of medical consortium for reference.

Objective To analyze the main mortality causes and pathological characteristics of type 2 diabetics with autopsy findings.Methods A total of 165 autopsy reports of type 2 diabetics were retrospectively reviewed and summarized at our institution.And 165 non-diabetics during the same period were analyzed similarly.Results The clinical data showed that type 2 diabetics had a higher risk for coronary heart disease,hypertension,stroke,hyperlipidemia and renal diseases than non-diabetics(P<0.05).The pathological data revealed that the rate of myocardium diseases in type 2 diabetics(69.6%,n=103)was higher than that in non-diabetics(58.6%,n=85).The evaluation of aortosclerotic grading demonstrated that the degree of arteriosclerosis in type 2 diabetics was severer than that in non-diabetics.The organ weight analysis showed the weight of thyroid,heart,liver,kidney,pancreas,adrenal gland and brain had no significant difference between type 2 diabetics and non-diabetics(P>0.05).The three major mortality causes were malignant neoplasms(39.4%,n=65),circulatory system diseases(35.2%,n=58)and respiratory system diseases(9.1%,n=15).Conclusion The onset of malignant tumors,especially gastrointestinal one,should be monitored closely during the prevention and treatment of cardiocerebrovascular diseases and complications.

Objective To evaluate the efficacy and safety of glucocorticoids (GC) plus intravenous immunoglobulin(IVIG)in the initial treatment of Kawasaki disease.Methods Fourteen electronic databases and 3 Japanese magazines were searched.Randomized controlled trials(RCT)describing the useof GC plus IVIG in the initial treatment of Kawasaki disease in children were collected.The data of methodological quality and trial information were extracted by two independent researchers.Cochrane review methodology was used for assessing the trial quality and efficacy.Each dichotomous outcome was measured in terms of odds risk (OR) while continuous outcomes shown as weighted mean differences(WMD).And a meta-analysis was made with RevMan5.0.23.0 software.Results A total of 416 cases in 3 trials were included.There were 209 cases in GC+IVIG group and 207 cases in IVIG group.The incidence of coronary artery lesion(CAL)was not different between GC+IVIG and IVIG groups within 1 month or 1 month posttreatment(OR:0.74,O.69;95%CI:0.23-2.40,O.35-1.38;P=0.62,0.30].The fever duration was shorter in GC+IVIG group than that in IVIG group(WMD:-0.93 d,95％CI:-1.15--O.70,P=O.00).The treatment failure rate was less in GC+IVIG group than IVIG group(9.09％vs 17.48％,OR:0.49,95％CI:O.28-0.86,P=0.01).No difference in adverse events was found between two groups(OR:0.81,95％CI:O.22-3.03,P=0.76).Conclusion There is no evidence to support that GC plus IVIG can further reduce the CAL risk of KD patients.But it may lower the treatment failure rate in KD patients.

：Objective To evaluatethe diagnostic value of fractional exhaled nitric oxide(FeNO)in the diagnosis of chroniccough.Methods A total of 106 subjects with chronic cough and normal chest radiographs wererecruited from October 2009 to September 2010.Based on the management guidelines of theChinese Respiratory Society for cough,the golden standard methods were used to make thedefinite diagnosis of chronic cough,including sputum cell counts,pulmonary functiontests,bronchial hyperresponsiveness,24-h esophageal pH monitoring,skin pricking test andserum immunoglobulin E.All subjects received a FeNO test by a NIOXMINO analyzer.The valuesof FleNO to diagnose cough variant asthma(CVA)from chronic cough and EB from non-asthmacough were respectively assessed by the receiver operatingcharacteristic(ROC)curves.Results Among them,the definite diagnoses were cough variantasthma(CVA,n=39),eosinophilic bronchitis(EB,n=30)and other causes(n=37).The FeNO levels inCVA[(54±21)ppb]](1 ppb=1×109mol/L)were significantly higher than those in EB[(34±17)ppb,P<0.01]andother causes[(21±10)ppb,P<0.01].And the FeNO levels in EB were higher than those inother causes(P<0.01).To diagnose CVA from chronic cough,the optimal FeNO cutoff valuewas 40 ppb with a sensitivity of 75%,a specificity of 86%,a positive predictive value of77%,a negative predictive value of 86%and an accuracy of 81%.To diagnose EB fromnon.asthma chronic cough,the optimal FeNO cutoff value was 31 ppb with a sensitivity of63%,a specificity of 92%.a positive predictive value of 88%,a negative predictive value of92%and an accuracy of 72%respectively.Condusion Thereare significant differences betweenthe FeNO levels of different causes of chronic cough.A marked elevation of FeNO levelhelps to make a final diagnosis of CVA or EB.FeNO test is useful for making the diagnosisand differential diagnosis of chronic cough in clinic practices.

Objective To investigate whether the macrophage inflammatory protein 1 alpha(MIP-1α)and apolipoprotein E(ApoE)gene polymorphisms,either alone or in combination,affect the susceptibility to inflammatory bowel disease(IBD).Methods Genomic DNA of IBD patients with Crohn's disease(CD,n=41)and with ulcerative colitis(UC,n=142)and healthy controls(n=160)was extracted and genotyped for the MIP-1α and ApoE gene polymorphisms by restriction fragment length polymorphism assay.Results MIP-1α-906(TA)6/(TA)6 homozygotes had a significantly elevated risk of UC(OR=1.909,95%CI=1.204-3.028).The carriers of APOF4ε4 were at a significantly higher risk for UC with OR of 2.379(95%CI=1.451-3.896).And a combination of these two loci,MIP-1α-906(TA)6/(TA)6/APOE4ε4 were strongly associated with a higher risk of UC(OR=3.288;95%CI=1.777-6.084).Conclusion The polymorphisms of MIP-1α-906(TA)6/(TA)6 and ApoE are probably independent genetic risk factors for UC.And the coexistence of both may exert an additive effect on the UC risks.

Objective To summarize the sustained dynamic release characteristics of fibrin glue enwrapping cisplatin.Methods In this in vivo study,20 patients received fibrin glue enwrapping cisplatin placed into the abdominal cavity while another 20 patients received cisplatin as the control group.Their peripheral blood and urine samples were collected at a regular interval to determine the concentrations and the pharmacokinetic parameters of cisplatin.Results The peak peripheral blood concentration of cisplatin in the study group was significantly lower than that in the control group[(192.2±33.5)vs(1077.6±176.6)μg/L,P<0.01].And the peak urine concentration of cisplatin Was significantly lower in the study group than that in the control group[(18.6±8.7)vs(55.8±12.7)μg/L,P<0.01].The elimination half-life of cisplatin was 23.32 h and 13.93 h respectively in the study and control groups.The elimination half-life and the area under the curve in peripheral blood and urine samples of the study group were significantly longer than those of the control group(P<O.01).Conclusion The fibrin glue enwrapping cisplatin has the excellent in vivo characteristics of sustained dynamic release.Thus it may prolong the retention of cisplatin in abdominal cavity and lower its concentration in peripheral blood.

Objective To observe the effect of artificial bone implantation of hard cleft palate on the development of maxilla.Methods From January 1997 to December 1999,40 patients with hard cleft palate were randomly divided into two groups:control group and implantation group(n=20 each).The patients in the implantation group received an implantation of compound artiffcial bone of HA-Bone cement.All pailents had a follow-up since 16 years old.A tllree dimensional model was established with computed tomography and rapid prototype technique to analyze the maxilla in three dimension.At the same time,a dentognathic model was employed.Results There were no differences in the results between the three dimensional and dentognathic models.No difference was found in the development of maxilla in length and height between the control and implantation groups.There were marked differences in the development of maxilla in width between two groups(67.6 mm±4.3 mm vs 61.3 1131/1±4.1 mm.63.5 mln±3.9 mm vs 57.3 mm±3.1 mm,26.2 mm±1.8 mm vs 26.4 mm±1.9 mm,all P<0.05).The width of maxilla in the implantation group was markedly wider than that in the control group.Conclusions The application of three dimensional model for evaluating the development of maxilla is both straightforward and accurate.Bone implantation of hard cleft palate is an obvious boost to the development of maxilla in width.It should be included into a comprehensive orthodontic treatment for patients with hard cleft palate.

Objective To investigate the possible genetic associations between the C602A and T1559C polymorphisms of E-selectin(SELE)and essential hypertension.Methods Essential hypertensive patients(n=500)and heathy normotensive subjects(n=930)were screened for the genotypes C602A and TI559C by real-time quantitative polymerase chain reaction after DNA extraction to identify representative variations in the SELE gene.Results Normotensive subjects and hypertensive patients were significantly different with respect to the genotypes CC,CA and AA,26(5.2%),20(4.0%)and 454(90.8%)vs 14(1.5%),53(5.7%)and 863(92.8%)respectively of C602A.And the C-allele frequency was also signiflcantlv different between the NT and EH groups(C,A=7.2%,92.8%vs 4.4%,95.6%).When subgrouped by gender,frequency of CC,CA,AA between normotensive and essential hypertensive males was 14(4.7%、),11(3.7%),272(91.6%)and 10(1.7%),34(5.8%),545(92.5%),which differed significantly(P<0.05),while in female groups,all the frequency of genotypes were significantly different (P<0.01)except CC+CA.The additive model(TT,TC,CC)of the T1559C genotype was significantly different between essential hypertensive and normotensive groups overall,57(11.4%),200(40.0%),43(48.6%)and 66(7.1%),354(38.1%),510(54.8%),respectively.The T-allele of hypertensive patients significantly difiered from normoteasive subjects(T,C=31.4%,68.6%vs 26.1%,73.9%respectively).When subgrouped by gender,between the male NT and EH groups,the TT,TC and CC frequency of Tl559C were 36(5.9%),117(39.4%),144(48.5%)and 35(5.9%),230(39.O%),354(55.0%),and the frequency of T vs C was31.4%vs 68.6%and 26.1%vs 73.9%,which were significantly different(all P<0.01).As in female NT and EH groups,there were not significant differences existed at all.Conclusion C602A and T1559C of SELE are associated with essential hypertension in the Chinese population.and T1559C is closely related with male hypertension other than in females.

Objective To analyze the outcome of platinum analogue-based chemotherapy for advanced esophageal squamous cell carcinoma(ESCC)patients treated in Cancer Hospital of Chinese Academy of Medical Science.The association of response rate or OS and the clinica-lpathological factors were analyzed as well.Methods Clinical data of 134 advanced ESCC were retrospectively analyzed from January 1999 to August 2008 in our hospital.A1l of these chemo-naive patients received platinum analogue-based chemotherapy.The association of response rate or OS and the clinical-pathological factors were analyzed.Results The median age of all the 134 patients was 58 years old.The ratio of male and female was 7.9:1.A total of 450 cycles(median:3 cycles)of chemotherapy was completed.91(67.9%)of these patients received cisplatin.based regimens.The overall response rate was 31.3%,and cisplatin-based regimens were better than other platinum analogue-based regimen,but there was no significant difference (36.3%vs 20.9%,P=0.075).The median follow-up time was 44 months(range 8-120).The median TTP was 4 months(range 1-43),and median survival time was 8 months(range 1-43).The 1 year and 2 year survival rate was 36.2%and 17.5%,respectively.According to univariate analysis,there was a worse prognosis when patients with multiple primary site,well-difierentiated tumor more than one site of metastasis,fail to achieve responses.TTP≤4 months and received less than 2 cycles of chemotherapy. Multivariate analysis showed that TTP≤4 months was the only independent prognostic factor for this group of patients.Conclusions Platinum analogue-based chemotherapy was the standard of care for advanced ESCC.There was a trend to improve the outcomes with platinum analogue combined with new drugs. Randomized trial with large samples was need.

：Objective To compare thediagnostic values of GerdQ questionnaire,24-h pH monitoring and 24-h impedance-pHmonitoring for gastroesophageal reflux disease(GERD)and to analyze the reflux patterns ofBarrett's esophagus(BE),reflux esophagitis(RE)and non-erosive disease(NERD).Methods FromJune 1,2009 to September 30,2010,205 GERD patients were included according to the Montrealconsensus.All were surveyed by a GerdQ questionnaire and underwent 24-h impedance-pHmonitoring The diagnostic sensitivities of GerdQ,24-h pH-DeM and 24-h IMP-pH were comparedand the reflux pattern of BE,RE and NERD analyzed.Results A total of 205 GERD patientsincluding 10 BE,28RE and 167 NERD were recruited.(1)The diagnostic rate of 24-h IMP-pH was74.1%.It was significantly higher than that of GerdQ(51.7%)and 24-h pH-DeM(29.2%).(2)Thediagnostic sensitivities of GerdQ and 24-h pH-DeM for BE and RE were higher than that forNERD.But there were no significant differences of 24-h IMP-pH for three types ofGERD(70.O%,82.1%and 73.1%).(3)There were positive correlations among the scores ofGerdQ,pH-DeM scores and acid scores in IMP-pH(r=0.242,P=0.000;r=0.182.,P=0.009 andr=0.632,P=0.000).(4)Added diagnostic values of IMP-pH were 58.5%and 74.5%respectively inpatients who would have been missed by GeraQ and pH-DeM.(5)The detection rate and score ofacid reflux in RE patients were higher than that of NERD [53.6%vs23.4%,P<0.05;45.6(35.0-67.5)vs 23.1(9.3-35.0),P<0.05].But gas score and separateacid reflux were lower than that in NERD[17(0-194)vs 30(0-500),P<0.05;57.4%VS28.6%,P<0.05].Conclusions Acid reflux plays an important role in RE.The value of GerdQand 24-h pH-DeM and 24-h IMP-pH monitoring were similar for the diagnosis of RE.Weak acidmay be more important for BE and NERD patients than separate acid reflux.And 24-h IMP-pHmonitoring has a distinct advantage in diagnosing these two types.

Objective To explore the effects of sirolimus upon endothelial thrombotic function of human umbilical vein endothelial cells(HUVEC).Methods Sirolimus was added into the in vitro cultured HUVEC at the concentrations of 0(control),0.1,1 and 10 ng/ml.At 2,4,8,12 and 24 h postincubation,the ceils were harvested for determination of tissue factor(TF),plasminogen activator inhibitor (PAI-1),endothelial nitric oxide synthase(eNOS)and thrombomodulin(TM)expression by reverse transcription-polymerase chain reaction(RT-PCR)and Western blot.The clotting functions of HUVEC were assayed by an automated coagulation analyzer.Results Sirolimus induced the expressions of TF and PAI-1 and inhibited the expressions of eNOS and TM in a concentration-dependent manner.The maximal change of mRNA expression was observed at 8 h and remained up to at least 24 h.And the most marked change of protein expression(65%reduction in eNOS expression,52%reduction in TM,1.7-fold increase in PAI-1 and 2.8-fold increase in TF)was at 12 h.The clotting time in sirolimus group(89 s±9 s)was significantly shorter than that in control group(152 s±17 s,P=0.005).Conclusion Sirolimus induces endothelial antithrombotic dysfunction and shortens the clotting time through an elevated expression of prothrombotic genes TF and PAI-1 and a lowered expression of antithrombotic genes eNOS and TM.It may be one of mechanisms of thrombosis after the implantation of sirolimus-eluting stents.

Objective To investigate the changes of collagens Ⅰ and Ⅲ after the addition of hyaluronic acid in the transplantation of porcine acellular dermal matrix.Methods Full-thickness skin defects were created on the dorsa of Japanese white rabbits.And the rabbits were divided randomly into 3 groups:Group A(hyaluronic acid,porcine acellular dermal matrix plus thin skin autografts),Group B (porcine acellular dermal matrix plus thin skin autografts)and Group C (skin autografts).Skin biopsies were performed at Day 50 post-grafting to detect the contents of collagens Ⅰ and Ⅲ by histological examinations,immunohistochemistry method and Western blot.Results The areas of skin graft were(13.34±1.2),(9.5±0.9)and(10.0±1.4)cm2 in Groups A,B and C respectively.Group A was larger than Groups B and C(all P<0.01).There was no statistical difference between Groups B and C(P>0.05).The expressions of collagen Ⅰ were 1894±164,515±38 and 395±43 in Groups A,B and C respectively.Group A was higher than Groups B and C(P<0.01).And the expressions of collagen Ⅲ were 5411±435,874±70 and 2078±175 in Groups A,B and C respectively.Group C was higher than Group B and yet lower than Group A(all P<0.01).The ratios of collagen Ⅰ and collagen Ⅲ in Group A(0.39)and Group B(0.59)were higher than that of Group C(O.19)(all P<0.01).Conclusion The addition of hyaluronic acid may boost the expression of collagens Ⅰ andⅢand decrease the ratio of collagen Ⅰ/collagenⅢ.Thus it facilitates wound healing and basilar membrane remodeling and alleviates the contraction of skin transplant.

Objective To investigate the mechanism of glucocorticoid receptors(GR)participating in morphine tolerance development via the extracellular signal-regulated kinase(ERK)signal pathway.Methods Forty healthy male SD rats were implanted with intrathecal catheters and then randomized into 4 groups:Group C received an intrathecal injection of 10 μl saline,Group M 10μg morphine,Group MR 10μg morphine followed by 2μg GR antagonist RU38486 and Group MD 10μg morphine followed by 4μg GR agonist dexamethasone(DEX)respectively.Each intrathecal drug was administered twice daily for 7 days.Tail-flick test was employed to evaluate the thermal hyperalgesia.After tail-flick test at Day 8,the lumbar intumescentias were isolated by Western blot to examine the protein expressions of Mu opioid receptor(MOR).GR and pERK.And terminal deoxynucleotidyl transferase mediated X-dUTP nick end labeling(TUNEL)stain was performed.Results DEX and RU38486 enhanced and inhibited morphine induced hyperalgesia to heat respectively.Compared with Group M(count of spinal dorsal horn apoptotic cells 5.4±1.1,protein expression:MOR 37±5,GR 20±6,pERK1 39±4,pERK2 41±5),apoptotic cells decreased in Group MR(3.2±0.4)(P<0.01)and increased in Group MD (16.0±1.6)(P<0.01);the protein expressions of MOR(28±5),GR(12±6),pERK1(33±4)and pERK2(34±5)were down-regulated in Group MR(P<0.01)while up-regulated in Group MD(55±6,28±9,49±6,59±5)(P<0.01).Conclusion The activity of glucocorticoid receptors affects the morphine-induced spinal neural apoptosis and the expression of spinal pERK in morphine tolerance.

Objective To evaluate the performance of locked nucleic acid(LNA)probe Real-time polymerase chain reaction(PCR)in the detection of Aspergillus fumigatus(A.fumigatus).Methods All clinically cultured isolates of Aspergillus at our hospital were identified by morphology and DNA sequencing assay.The experimental group consists of A.fumigatus(n=48)while the control group Was made up of A.flavus(n=55),A.versicolor(n=16),A.nidulans(n=10),A.sydowii(n=5)and A.parasiticus (n=1).The clinical samples consisted of A.fumigatus sinusitis tissue(n=20)and bronchoalveolar lavage fluid(n=1).DNA was extracted from all samples.A.fumigatus β-tubulin gene Was targeted with LNA probe Real-time PCR assay.LNA probe Real-time PCR was evaluated with regards to specificity,efficiency,linear dynamic range in PCR amplification and limits of detection.Results All clinical samples were positively amplified.The specificity was 100%and the PCR efficiency 98.2%.Linear dynamic range Was at least six orders of magnitude and the limit of detection 2.5 pg.Conclusion LNA probe Real-time PCR is a promisingly accurate assay of rapidly detecting A.fumigatus practically and cost-efficiently.

A 41-year-old male was transferred to the dermatology department of our hospital on May 21, 2010 with "pemphigus vulgaris, fever to be examined" due to systemic skin rash accompanied by itching for 3 months and fever for 11 days. The patient developed blisters and erosive surface on his back 3 months ago, accompanied by itching, which gradually progressed to the whole body. He was hospitalized in another hospital 1 month ago. After skin pathology and immunofluorescence examination, he was diagnosed as "pemphigus vulgaris". He was treated with glucocorticoids. Initially, the rash did not improve significantly after 5 days, and the hormone dosage was increased to 80 mg intravenous methylprednisolone and 30 mg oral prednisone acetate daily. After more than 10 days of medication, the skin lesions were controlled. 11 days ago, the patient began to have fever, with a maximum body temperature of 40.0℃, accompanied by mild cough and expectoration. The pus culture and blood culture at the skin lesions were all methicillin-resistant Staphylococcus aureus (MRSA). For more than 10 days, he was treated with various antibiotics, including vancomycin, melopenem, linezolid, etc., but his body temperature, cough and expectoration were uncontrolled. Neutrophil cells ranged from 0.70 to 0.90, and no obvious abnormalities were found on chest X-ray and thoracic abdominal CT.

Autophagy was proposed by Ashford and Porter in 1962. It refers to the double membrane shed from the ribosome-free attachment area of the rough endoplasmic reticulum, which envelops part of the cytoplasm and organelles, proteins and other components that need to be degraded in the cell to form autophagosomes, and fuses with lysosomes to form autophagy lysosomes, which degrade the contents enveloped in it, so as to realize the metabolic needs of the cell itself and the renewal of some organelles. Autophagy is regulated by many ways, and is closely related to many diseases such as heart diseases, tumors, neurodegenerative diseases, etc. Apoptosis refers to an active programmed cell death that occurs during the development of cells or under the action of some factors, through the regulation of intracellular genes and their products. When apoptosis occurs, cell membrane shrinks, cell nucleus shrinks and fragments; Then, the cells rupture, and the fragments are wrapped by the cell membrane and remain intact, which are called apoptotic bodies; Finally, apoptotic bodies are engulfed by macrophages, and their components are degraded in lysosomes. Apoptosis is involved in the death of many cells, which is mainly regulated by bcl-2/bax family; Its detection methods include the detection of cysteine protease-3 protein and Bel-2 protein, TUNEL. experiment, electron microscopy observation of apoptotic bodies, etc. Recent studies have found that autophagy and apoptosis are also closely related, and the two cooperate with each other to affect cell transfer. At present, the exact relationship between autophagy and disease and apoptosis is still widely controversial, which is summarized as follows.

Ankylosing spondylitis (AS) is a common arthritic disease with high heredity. Its pathogenesis is still unclear, and there is no effective treatment so far. Therefore, exploring the pathogenesis of AS, searching for susceptibility genes, and providing theoretical basis and therapeutic target for its early diagnosis and individualized treatment are still the hot topics and focuses in this research field. A large number of research data show that the incidence rate of AS is about 0.5% in European Caucasian population, about 0.3% in Chinese population, and almost none in African blacks; In recent years, with the development of AS umbrella genome association study (GWAS), it has been found that in addition to the strong association of major histocompatibility complex (: MHC) genes, many non-MHC gene regions have also been confirmed to be related to AS, such As IL23R, ERAP1, IL1R2, ANTXR2, etc. This makes the study of genetic susceptibility of AS obtain significant progress.

Those who enjoy caffeine by drinking traditional coffee and tea may overlook the benefits of traditional Chinese medicine drinks<The idea that herbal teas offer multiple health benefits is not just folklore, according to an article in Agricultural Research Magazine.

Genome scanning can provide genetic risk assessment for 20~40 common polygenic diseases, but the role of this examination in disease risk assessment is still controversial. Some small sample studies have evaluated the role of genetic examination on anxiety, behavior and clinical manifestations, but the results are not consistent.

The patient was a 62-year-old male with dull pain in the upper abdomen for 1 month. The body mass index (BMI) was 22.1 kg/m2. Gastroscopy showed that the tumor was located in the small curve of the cardia and extended to the proximal angle of the stomach. The size of the tumor was about 6 cm ×5 cm ×5 cm. The pathological diagnosis was "gastric cancer". Barium meal fluoroscopy showed that 2 cm of the lower esophagus near the cardia was also involved by the tumor. CT examination showed no distant organ metastasis, and there was no obvious infiltration between the tumor and surrounding tissues and organs.

A 55-year-old male was admitted to Sichuan Cancer Hospital on June 16, 2008 for coughing for 1 month and coughing up fleshy substances for 10 days. The patient developed irritating dry cough and less phlegm without obvious trigger 1 month ago. The patient coughed up fleshy substances 10 days ago, without hemoptysis, fever and weight loss. The history of tuberculosis was denied. No obvious abnormalities were found on physical examination. Laboratory tests showed that blood routine, liver and kidney function and electrolytes were normal. Hepatitis B surface antigen and human immunodeficiency virus (HIV) antibody were negative. MRI showed that the left wall of the lower trachea was irregularly thickened and occupied space, about 1.5 cm ×1.4 cm, growing into the trachea lumen and infiltrating outside the left wall. The lymph nodes adjacent to the paratrachea and pulmonary artery window were enlarged, the largest was about 2.1 cm ×1.6 cm, which was considered to be tracheal squamous cell carcinoma and metastasized.