Volume 91  ·   Issue 20  ·  2011

In recent years, due to the progress in the understanding of the biological characteristics of hematologic diseases, the application of new drugs and the strengthening of supportive treatment, the curative effect of hematologic diseases has been greatly improved. However, the diagnosis and treatment of hematologic diseases still have the following features: (1) There are many choices of treatment strategies; (2) Long treatment cycle and many complications; Therefore, it is of great significance to strengthen the research and development of biomarkers for the treatment of hematologic diseases and establish an early warning and prediction system for the treatment of hematologic diseases, which will guide the rational treatment of hematologic diseases and improve the safety and effectiveness of the treatment.

：Objective To report theefficacy and safety of imatinib plus Hyper-CVAD chemotherapy regimen in the treatment ofpatients with ph chmmosome positive acute lymphocytic leukemia(Ph+ALL).Methods Asequential 2-year and 8-cycle treatment of imatinib plus Hyper-CVAD(A/B program)wasadministrated in 18 Ph+ALL patients treated at our hospital since January 2005 to January2010.And another 18 Ph+ALL patients undergoing no allogeneic hematopoietie stem celltransplantation were selected as controls.Resuits Among 18 patients on chemotherapy,theiraverage age was 33.1 years, the total response rate 100%following induction chemotherapyand the median survival 28.8(8.0-60.0)months.patients,the response rate followinginduction chemotherapy was 100%and the median survival 22.5(4.0-58.0)months.And the1-,2-and 3-year overall survival rates were 66.7%.55.6%and 50.0%respectively.A recentfollow-up showed that 5 patients(27.8%)died from relapse in the chemotherapy group and4(22.2%)in the control group.The overall deaths were 6(33.3%)in the chemotherapy group and9(50.0%)in the control group.Conclusions Imatinib plus Hyper-CVAD chemotherapy regimen isassociated with significantly improved survival rates. Superior to allogeneiehematopoietic stem cell transplantation,it offers a prolonged median response time andsurvival time in Ph+ALL patients.

objective To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT)in the conditionings of different intensities for acute leukemias of ambiguous lineage(ALJAL). Methods A total of 38 ALAL patients were treated with two conditionings of different intensities in our hospital from March 2002 to August 2010. The standard conditioning included TBI+Cy or Bu+Cy,intensified conditioning included Fludarabine+Ara-C+TBI+Cy. Cyelosporine A(CsA)and methotrexate (MTX) were administered in patients with human leukocyte antigen-matched sibling donor. And CsA, MTXplus antihuman thymocyte globulin and/or mycophenolate were used in all patients with HLA-A-mismatched related donor and unrelated donors transplants for graft-versus-host disease(GVHD)prophylaxis. COX regression was used to evaluate the prognostic factors of ALAL Results Among 38 ALAL patients,19received the standard conditioning while another 19 the intensified conditioning. All patients achieved hematopoietic reconstitution. The 5-year overall survival(OS)and the disease-free survival(DFS)were 35. 5%and25. 7%respectivelv. The 5-year OS rates were 20. 2%and48. 1%(P=0. 233)and DFS 6. 5%and 43. 1%(P=0. 031)in the standard and intensified conditioning groups respectively. The 5-year cumulative relapsing incidence was 58. 9%in all patients and 87. 6% vs 30. 4% in the standard and intensifted conditioning groups respectively(P=0. 003). Through a COX regression model for univariate analysis, the intensified conditioning and chronic GVHD were protective factors for DFS (P = 0. 001,0. 031 ). Conclusions The intensified conditioning in ALAL patients undergoing allo-HSCT may improve the long-term patient survival and decrease the relapse of leukemia. The graft versus leukemic effect has some efficacy in ALAL patients undergoing allo-HSCT.

Objective To evaluate preliminarily the significance of detecting the Wilms'tumor (WT1)gene level on monitoring minimal residual disease(MRD)and predicting the clinical outcome in patients of acute leukemia following hematopoietic stem cell transplantation(HSCT).nethods The Mrna expression levels of WT1 and house-keeping gene ABL were dynamically measured with Real-time quantitative reverse transcription polymerase chain reaction(RQ-RT-PCR)on 326 bone marrow samples from 63 post-HSCT patients in our hospital from December 2001 to September 2009.After comparing the WT1 levels of patients with difierent post-transplantation outcomes,the investigators used the receiver operating characteristic(ROC)curve to determine the WT1 threshold so as to predict their clinical relapses.Then different prognoses of WT1 positive and negative patients were analyzed.Results The levels of WT1expression showed significant difierence between the 19 relapsing and 44 non-relapsing patients with the median expression levels of 1270(55-47 596)and 132(0-2959)respectively(P<0.01).In 19relapsing patients,except for 1 patient discontinuing the detection of WT1,10 mortality cases due to recurrence had higher levels of WT1 expression than other 8 patients(P>0.05).According to the ROC curve,the cut-off value of WT1 at 585 could separate 63 patients into the WT1-positive group(>585)and were followed up for 3,4-6,7-9 and 9 months respectively.The cumulative post-HSCT recurrence rates in those WT1-positive cases were 8/8,2/4,2/4 and 3/5(P=0.063)respectively.And the intervention was ineffective.Conclusions WT1 gene may be an independent factor of monitoring MRD.And WT1>585 is a poor post-HSCT prognostic factor for the Patients of acute leukemia.

：Objective To investigatethe expression and its prognostic significance of TOSO in CD19+B cells from Chinesechronic lymphocytic leukemia(CLL)patients.Methods The expression of TOSO was detected byabsolute quantitative reverse transcription-polymeric chain reaction(RT-PCR)in a cohort of85 untreated CLL patients from March 2006 to September 2010.Their status of immunoglobulinheavy chain vailable(IGVH)somatic mutation,ZAP70 and CD38 were analyzed.Resuits Theexpression of TOSO was significantly elevated in CLL patients versus the healthypopulation(8.30 4±2.99 vs 6.63 4±1.22.P=0.036)and other B cell lymphoproliferativediseases(8.30±2.99 vs 7.12±1.13,P:0.023).The expression of TOSO was elevated in the IGVHnou-mutated group versus the mutated group(9.87 4±1.08vs 7.61 4±3.03.P=0.000).Theexpression of TOSO was significantly elevated in Binet stage C patients versus in Binetstage B and Binet stage A patients(9.91 4±3.03 vs 8.73±1.86 vs 7.27 ±-2.83,P=0.000).Theexpression of TOSO rose to(9.37±2.12)in the chemotherapy group.And it was significantlyhigher than that in the observation group(7.19±3.23,P=0.001).At the cut-off point of 55years old,the younger patients had a higher expression of TOSO than the elders(9.10±2.06vs 7.95 4±3.22,P=0.049).The expression of TOSO in ZAP70 and CD38-positive groups had nodifierence with those in the negative groups.Conclusion The over-expressed TOSO in CLLcells iS associated with a progressive disease.It may be an important prognostic factorfor CLL.

Objective To summarize the clinical features of laryngeal neuroendocrine carcinoma (LNEC).Methods The clinical data of all LNEC patients hospitalized during the period of June 1988-December 2010 were analyzed retrospectively.Results Among all LNEC 12 patients as confirmed by pathological examination,there were typical earcinoid(n=1),atypical earcinoid(n=4)(2 with cervical metastasis.1 with paraneoplastic syndrome),small cell neuroendocfine carcinoma(n=7)(1 with adenocarcinoma).All patients with typical and atypical carcinoid underwent surgery.And postoperative radiotherapy was offered for those diagnosed with advanced stage or cervical metastasis.They were followed up for 1-12 years without local recurrence.All patients with laryngeal small cell neumendocrine carcinoma received chemotherapy and radiotherapy.And the follow-up period was 0.5-6 years.One died of pulmonary metastasis within half a year while another died of liver metastasis within 3 years.Conclusions It is important to classify the LNEC patients correctly since their clinical course.treatment and prognosis varies greatly with the diagnosis.For typical and atypical carcinoid of larynx,partial or total laryngectomy and neck dissection may be performed depending on the site and extent of primary tumor.However,for laryngeal small cell neuroendocrine carcinoma,the mainstay of treatment is made up of chemotherapy and radiotherapy.And the prognosis of this type remains very poor.

Objective To evaluate the effect of pretreatment by inhaling specific phosphodiesterase inhibitor on lung injury induced by cardiopulmonary bypass(CPB). Methods From April 2010 to November 2010,30 patients were divided randomly into two groups:control group(n=15)and milrinone group(n=15). In milrinone group,5 mg milrinone diluted by 5 ml normal saline was inhaled per 8 h two days pro-operation. In control group,only 10 ml normal saline was inhaled. Blood samples were drawn from ulnar vein and radial artery pre-operation(To),30 min post-aortic unclamping(T1),at the end of operation (T2),24 h,72 h and 7 d post-operation(T3-T5). The following parameters were determined: TNF-α(tumor necrosis factor-alpha),IL-6(interleukin-6),HSCRP(high-sensitivity C-reactive protein),MDA (malondialdehyde),MPO(myeloperoxidase)level and lencocyte count ratio of venous and arterial blood. And the values of pulmonary vascular resistance(PVR)and oxygenation index(OI)were measured through a Swan-Ganz catheter at the first 5 time points. Results PVR rose while OI declined at post-operation. But the range of above-mentioned indices in milrinone group was significantly smaller than that in control group. And the indices recovered much earlier in milrinone group. The levels of TNF-αIL-6,HSCRP,MDA,MPO and lencoeyte count ratio were not significantly different at To between two groups and increased significantly after CPB in both groups. But the level of TNF-α[(ng/L)was significantly lower at T2,T4,T5 in milrinone group than that in control group(60 ±5 vs 79 ±7,29±6 vs 40 ±8,18 ±5 vs 28±7, all P <0. 05). The levels of IL-6 and MDA were significantly lower at T1 - T4 in milrinone group. The level of HSCRP became elevated post-operatively in both groups and reached its peak at 24 h post-operation,especially in control group. The level of MPO (μg/L)was significantly lower at T2, T3 and T5 (134 ± 20 vs190 ±23,142±28 vs 178 +20,65±9 vs 75 ± 11, all P <0. 05). And the V/A ratio was significantly lower at T1 - T3 in milrinone group than in control group ( 1. 12 ~ 0. 11 vs 1. 37 ± 0. 09,1. 07 ± 0. 07 vs 1. 25 ±0. 07, both P < 0. 01 ). Conclusions Inhaled milrinone may protect the lungs from acute injury induced by CPB. Inhaling milrinone is safe and feasible for the prevention of acute CPB-induced injury.

Objective To explore the expression level and clinical significance of receptor for activated C kinase 1(RACKl)in esophageal squamous cell carcinoma(ESCC).Methods Western Blotting was performed to detect the RACKl expression in ESCC cell lines.Immunohistochemistry was conducted to assay the expression of RACKl and Ki67 in tumor tissues and adjacent normal epithelium from 113 ESCC patients in tissue microarray.The relationship between the RACKI level and such clinieopathologic profiles as age,gender,location,smoking,differentiation degree and TNM(tumor,node,metastasis)stage were analyzed.Results The expression of RACKl protein was significantly downregulated in ESCC tissues as compared with the normal adjacent epithelium(X2=63.363,P<0.01).An upregulated expression of RACKl was observed in 72.5%(29/40)ESCC tissues of patients without a smoking history.And it was significantly higher than that in 46.6%(34/73)of patients with a smoking history(x2=7.040,P=0.008).In addition,the rate of up-regulated of RACKl was significantly higher in stage I andⅡgroup(63.8%,44/69)than that in stage Ⅲ group(43.2%,19/44)(x2=4.616,P=0.032).Moreover.the ESCC tissues with a higher Ki67 score showed a lower level of RACKl than that with a lower Ki67 score(x2=8.261,P=0.016).Conclusions The expression of RACKl is down-regulated in ESCC tissues and it is associated with smoking,The expression of RACKl was associated with smoking,TNM staging and Ki67 score of ESCC.

ObjectJve To explore the mRNA and protein expressions of Runx3 gene in papillary thyroid carcinoma(PTC).Methods Reverse transcription-polymerase chain reaction(RT-PCR)and Western blot were used to detect the Runx3 mRNA and protein levels in 67 human PTC specimens and their matched adjacent non-cancerous epithelium(NCE).Results The relative expression value of Runx3mRNA was 0.31 ±0.07 in PTC vs 0.92 ±0.08 in NCE(t=38.251,P<0.05).In PTC.it was correlated with the tumor pathological grade and lymph node metastasis(x2=5.511,6.492,P<0.05).The integral optical density value of Runx3 protein confirmed was 1012±221 in PTC vs 1993 ±199 in NCE(t=18.413.P<0.05). In PTC,it was correlated with the tumor TNM stage.pathological grade and lymph node metastasis(X2=5.550,9.678,5.070,P<0.05).Furthermore there was a distinct correlation between the mRNA and protein expressions of Runx3 gene(X2=42.699,P<0.05). Conclusions The mRNA and protein expressions of Runx3 gene in PTC were lower than those in NCE.A lower expression of Runx3 gene may play an important role in the carcinogenesis and progression of PTC.

Objective To compare the chemosensitivity of pirarubicin(THP)and epimbicin (EPI)in primary breast cancer(PBC)cells so as to examine tIleir difierential chemosensitivity to THP and EPI by CD-DST(collagen gel droplet embedded culture-drug sensitivity test)system;To detect the differences in the short.term clinical efficacy and side effects between TAC(docetaxel+pirarubicin+cyclophosphamide)and IEC(docetaxel + epirubicin + cyclophosphamide)as the neoadjuvant chemotherapy regimens and the long-term clinical efficacy of CAF ( cyclophosphamide+pirarubicin+fluoroumcil)and CEF(cyclophosphamide+epirubicin+fluorouracil)as the chemotherapy regimens in breast callcer:To evaluate the feasibility of THP as an adjuvant chemotherapeutic regimen in the treatment of breast cancer.Methods From January 2008 to January 2009,a total of 129 fresh breast cancer samples were collected. The differential chemosensitivity of cultured PBC cells to THP and EPI was measured by CD-DST test. And 139 cases of PBC patients in II b-Ⅲ c phase were randomly divided into two groups: TAC and TEC groups. After 4-6 cycles of neoadjuvant chemotherapy, the primary lesion, axiltary lymph nodes and side effects were assessed; The clinical data and survival status of 1241 cases of PBC patients treated at our hospital from 2003 to 2006 were collected and divided into CAF and CEF groups according to their chemotherapeutic regimens. Long-term prognosis was compared between two groups. Results There was no significant difference of chemosensitivity between THP and EPI in PBC cells ( P = 0. 743 ) ; The overall response rate (RR) of neoadjuvant chemotherapy was 87.8% ; there was no significant difference between TAC and TEC groups (P > 0.05 ). No significant differences existed between two groups in such side effects as leukopenia, thrombocytopenia, constipation, cardiotoxity and hepatorenal dysfunction (P > 0. 05 ). The gastrointestinal reactions of nausea and vomiting was less frequent in the TAC group than that in the TEC group (46. 5% vs 66. 2% , P =0. 019) ; There was no significant difference in 5-year disease-free survival rate (79% vs 78% ) and overall survival rate between two groups (85% vs 82%, P >0. 05). Conclusions There were no significant differences in chemosensitivity, clinical efficacy of neoadjuvant chemotherapy, side effects or long-term efficacy between THP and EPI. Both pirarubicin and epirubicin may be used as conventional chemotherapy in breast cancer.

Objective To observe whether the mutant selective windows(MSW)of ciprofloxacin would be reduced after its combination against Pseudomonas aeruginosa in rabbits. Methods Firstly the minimal inhibitory concentration(MIC),mutant prevention concentration(MPC),mutant selective windows (MSW,MPC-MIC)and selective indices(SI,MPC/MIC)of ciprofloxacin and tobramycin were measured in vitro respectively with standard strain ATCC27853. And the MIC was detected for the combination of ciprofloxacin and tobramycin. The rabbit tissue cage model was constructed to determine the pharmacokinetic parameters of ciprofloxacin by HPLC(high performance liquid chromatography). Fifty-five rabbits were randomly divided by a random number table into 11 groups:physiological saline in 1 group,ciprofloxacin alone in 5 groups and ciprofloxacin plus tobramycin in another 5 groups. The rabbits received ciprofloxacin 10 times a day at a 2-hour dosing interval. In 2 dosing groups. the steady state concentrations of ciprofloxacin reached to 0. 25,0. 5,1. 0,2. 0 and 4. 0 me,/L respectively. The dose of tobramycin was 2. 0 mg·kg-1·d-1and its peak concentration reached around 2.0 mg/L. At Day 3,the tissue juice was extracted, diluted and coated on agar plates with ciprofloxacin at a concentration of 0. 25 ms/L so as toobserve the growing condition of mutants. Results Against Pseudomonas aeruginosa,the values of MIC,MPC and SI of ciprofloxacin were 0. 25 mr,/L,4. 0 mg/L and 16 while 0. 25 mg/L,8. 0 mg/L and 32 for tobramycin respectively. Single groups:the mutants were found in 0. 25,0. 5,1. 0 and 2. 0 mg/L groups,but none in 4. 0 mg/L group. The MPC of cipmfloxacin was the same for in vivo and in vitro. Both were at 16. Combination groups: the mutants were only found in the group with a concentration of ciprofloxacin at 0. 25 mg/L while no mutants in the other groups. And MPC was 0. 5 mg/L and MIC 0. 125 mg/L for ciprofloxacin plus tobramycin. And the value of SI was 4. Conclusion The combined use of ciprofloxacin and tobramycin may reduce the mutant selective windows of ciprofloxacin against P. aeruginosa in rabbits so as to reduce the occurrence of mutants to control its drug resistance.

Objective To prepared 125I-103Pd hybrid radioactive seeds and to explore their therapeutic effect on pulmonary carcinomas.nethods The 125I-103Pd hybrid radioactive seeds were prepared by a chemical method of step-by-step coat plating.Pulmonary adenocarcinoma of GLC-82 cells and pulmonary large cell carcinoma of H460 cells were cultured in vitro and then were exposed directly to125I,103pd and125I103pd seeds for 48 hours to observe the killing effects of radiation.GLC-82 and H460 tumor models were established and 20 mice chosen randomly for each model.For each tumor model.there were 4 groups(n=5 each).Then 125I-103pd,125I,103Pd and nonradioactive seeds were implanted into the tumors.Tumor sizes and weights of mice were measured and recorded every 5 days for a 2-month observation.Resuits The125I-103Pd hybrid radioactive seeds were prepared successfully.After a 48-hour radiation from radioactive seeds, the GLC-82 cells within one particulate around 125I,103Pd or1 25I_103Pd seeds were inhibited so as to become swollen and transfiguring.The H460 cells around125I seeds showed no obvious abnormality while those within one Darticalate around 103Pd or125I-103pd seeds were much fewer. No mouse died during the observation period.The radioactive seeds could inhibit the tumors.The radiotherapeutie effects were similar in two tumor modes:125I_103Pd seeds>103Pd seeds≈125I seeds>non-radioactive seeds.H460 tumors grew much faster than GLC-82 tumors.Meanwhile the seeds with the same nuclide were much more effective for GLC-82 tumors than for H460 tumors.Conclusion TheI_l03pd hybrid radioactive seeds are clinically applieable due to their effective inhibitions of tumor growth.

Objective To observe the effect of small interference RNA(Steahh RNAiTM siRNA)of RhoA on the inflammatory response and fibrosis in human mesangial cell(HMC)and explore the role of RhoA/ROCK signaling pathway in the process of diabetic nepropathy.Methods Synchronized HMC were divided into several groups.LipofectamineTM2000 was employed to transfect RhoA-siRNA and RhoA-negative siRNA into the above cells.RhoA-siRNA could inhibit the expression of RhoA.The expressions of RhoA,ROCK-I,fibronectin(FN),connective tissue growth factor(CTGF)and tumor necrosis factor-alpha(TNF-α)were detected by real-time reverse transeription-polymerase chain reaction(RT.PCR)and ELISA(enzyme-linked immunosorbent assay).Resuits (1)The expressions of RhoA,ROCK-I and CTGF mRNA were inhibited by RhoA siRNA transfection in high glucose-induced HMC.The expression of each mRNA was reduced 26%-60%as compared with the high glucose-induced group(P<0.05).(2)After RhoA siRNA transfection and culturing with high glucose for 48 h.FN, the secretions of CTGF and TNF-αsignificantly declined[FN:(1.99±0.04)mg/L vs(4.31±0.13)mg/L,CTGF:(4.98±0.17)ms/L vs(6.06±0.09)mg/L;TNF-α[:(61.17±2.59)ng/L vs(91.76±2.27)ng/L,all P<0.05].The levels of FN and CTGF almost decreased to those of normal glucose-induced HMC.Conclusions The levels of FN,CTGF and TNF-αin higsh glucose-induced HMC may be lowered by inhibiting RhoA through RNA interference and reducing the accumulation of extracellular matrix, glomerular fibrosis and inflammation.Thus it provides a new intervention target for the prevention of diabetic nephropathy.

Objective To investigate the effects of free fatty acid(FFA)on the expression of pancreatic derived factor(PANDER)in β-cells and to explore the possible relationship between PANDER and Akt signaling pathway at the anti-apoptotic effects of glucagon-like peptide-l(GLP-1).Methods β-TC3 cells were cultured in vitro witH palmitic acid(PA)of different concentrations and different time courses.The expression of PANDER mRNA was analyzed by realtime quantitative PCR β-TC3 cells were cultured with vehicle.0.5 mmol/L PA.0.5 mmol/L PA+10 nmol/L GLP-1 and 10nmol/L GLP-1respectively with or without Akti-1/2, a selective inhibitor of Akt, for 12 hours.The protein levels of PANDER, P-Akt and pro-caspase3 were detected by Western blot And cell apoptosis was analyzed by Hoechst33258 staining.Results (1)PA could dose and time dependently increased the expression of PANDER mRNA in β cells(vs control, P<0.05);(2)PA increased the PANDER protein expression [(148±18)%vs control 100%.P<0.05].However,these effects were attenuated by GLP-1 [(70±17)%vs PA group,P<0.01];(3)Akt inhibitor-1/2 alleviated the effects of GLP-1 on PA inducing the expression of PANDER.The expression of PANDER increased significantly in PA+GLP-1+Akti-1/2 group [(249±49)%vs PA+GLP-1 group(110±54)%,P<0.01],and cell apoptosis increased significantly as well[(37.8±1.5)%vs PA+GLP-1 group(20.1±3.5)%,P<0.01].Conclusion PA induces the expression of PANDER and the apoptosis of β cell while GLP-1 counteracts the above effects through an activation of Akt signaling pathway.

Objective To explore the effect of LRP(leukemia related protein)16 on insulin resistance in C2-C12 cells and explore its molecular mechanism.Methods Lipidosome transfection and lentivirus mediated siRNA(small interfering RNA)technology were used to establish LRP 16 overexpression and underexpression cell lines and their corresponding controol cell lines.And 2-deoxy-[3H]-glucose was used to measure the effect of LRP 16 on insulin-stimulated glucose uptake.The effects of LRPl6 on the phosphorylation of IRS(insulin receptor substrate)-1,Akt and the expressions of P13K(085),PPAR (peroxisome proliferator actived receptor)γ and GLUT-4 were detected by Western blot.Luciferase was used to study the effect of LRPl6 on the transcriptional activity of PPARγ Resuits Insulin.stimulated glucose uptake decreased to 46%of the control when LRPl6 was over-expressed ( 4700±97 vs 10 200±347.P<0.01).And the insulin.stimulated glucose uptake was 1.73 fold of control when the expression of LRPl6 was suppressed in C2-C12 cells(17 600±466 vs 10 200 ±91,P<0.05).The overexpression of LRPl6 attenuated the insulin.induced tyrnsine phosphorylation of IRS-1.the phosphorylation of Akt and the expressions of P13 K(085),PPARγ and GLUT-4.But it promoted the insulin-induced phosphorylation of IRS-1 at Ser307 in C2-C12 cells.LRPl6 decreased the transcriptional activity of PPART in a dosedependant manner.The transcriptional activity of PPARγdecreased to 43%and 27%of the control when the doses of pcDNA3.1-16 were 0.4 and 0.5μg(76±11 vs 33±9,P<0.01)and 27%(21±9 vs 76±11,P<0.01). Conclusion LRP16 gene causes insulin resistance in C2-C12 cells by inhibiting the IRS-1signaling and the transcriptional activity of PPARγ.

A 22-year-old female was transferred from another hospital to Sir Run Run Shaw Hospital Emergency Department of Zhejiang University School of Medicine on August 31, 2010 due to recurrent fever for more than 2 months, sudden headache and vomiting for 14 h. The patient developed fever without obvious trigger 2 months before the hospital, mostly at noon every day, with a maximum body temperature of 39.3℃, accompanied by chills, a small amount of white phlegm, occasional bilateral temporal pain, no dizziness, blurred vision, unconsciousness, chest tightness and shortness of breath, and abdominal pain. 　　

obstructive sleep apnea syndrome (OSAS) is an aggravating factor or even initiating factor of some common diseases such as hypertension, diabetes, coronary heart disease, cerebrovascular disease, etc. It can be clinically manifested as obesity, intraday drowsiness and abnormal energy metabolism, which is very harmful to human health [1]. OSAS is a complex pathophysiological process, which can be manifested as intermittent hypoxia and hypercapnia, sleep structure disorders and a series of neurological and endocrine changes. 　　

Venous thromboembolism is a serious development of critically ill patients, and critically ill patients are at high risk of venous thromboembolism. At present, it is uncertain that low molecular weight heparin has advantages over unfractionated heparin in critically ill patients. Thromboembolism prevention trials in critically ill patients conducted by the Canadian Critical Care Trial Group and the New Zealand Critical Care Society Clinical Trial Group (The PROTECT Investigators for the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group, C00k D, Meade M, et al. Dalteparin versus unfraetionated heparin in critically ill patients. N Engl J Med, 2011, 364:1305-1314.) The effects of Dalteparin and unfractionated heparin were compared.

A 57-year-old female patient had intermittent fatigue and upper abdominal fullness for more than 2 months, accompanied by nausea, dizziness, anorexia of oily food, and pruritus all over the body. She had been treated with oral "powerful lithiasis". The liver function examination in the local hospital showed alanine aminotransferase (ALT) 114 U/L, aspartate aminotransferase (AST) 110 U/L, glutamyl transpeptidase (GGT) 1009 U/L, total bilirubin (TBIL) 24.3 pLmol/L and direct bilirubin (DBIL) 15.2 μ mol/L. The abdominal B-ultrasound showed hepatomegaly and rough echo of liver parenchyma, and the diagnosis was "drug-induced liver injury". After 1 week of hepatoprotective treatment with "polyene phosphatidylcholine and compound glycyrrhizin", the symptoms did not improve obviously and were transferred to Naval General Hospital. During the course of the disease, the body weight lost about 3 kg. 　　

An 81-year-old female was admitted to the Department of Cardiology of Peking University Third Hospital on December 20, 2008 with intermittent dyspnea for 13 years and aggravated for 3 days. Thirteen years ago, the patient developed mild palpitations and exertion dyspnea, which rapidly developed into dyspnea at rest or lying down. She was diagnosed as "dilated cardiomyopathy" in another hospital. She was intermittently treated with diuretics and vasodilators, but the effect was not good, and the dyspnea occurred repeatedly. 　　

A 57-year-old male was admitted to the Department of Cardiac Surgery of Peking Union Medical College Hospital on January 7, 2010 due to sudden decrease in right eye visual acuity on the first day after right internal carotid artery endarterectomy combined with coronary artery bypass grafting.