Volume 91  ·   Issue 21  ·  2011

highly active antiretroviral therapy (HAART), commonly known as "cocktail therapy", is the most effective treatment for HIV infection that has been proven at present [1]. The latest international research shows that the average life span of HIV/AIDS patients can be prolonged by decades under effective antiviral therapy, and AIDS has become a chronic disease that cannot be cured but can be controlled for a long time like hypertension and diabetes. Due to the development of antiviral therapy, the mortality rate of AIDS patients in China has dropped significantly in recent years [2], but there are also a series of severe challenges and difficulties in antiviral therapy in China. Now I will talk about my own experience on how to improve the success rate of antiviral therapy.

Objective To evaluate the coreceptor usage characters and evolution of human immunodeficiency virus-1 ( HIV-1 ) primary infection. Methods A total of 12 HIV-1 primary infection cases were recruited from a high-risk population for this prospective cohort trial. The blood samples were collected at the earliest time after infection and after a viral setpoint respectively. RNA was extracted from plasma. The env genes were amplified through reverse transcription-PCR (RT-PCR) and nested PCR. And the env fragments were ligated to T vector and then sequenced. The pattern of coreceptor usage was predicted with five different online tools. Results Among them, 11 were predicted as CCR5 virus transmission and 1 as CXCR4 virus transmission. The viruses in 1 case were detected as a switch of coreceptor usage from CCR5 to CXCR4. The consistency of five different prediction rules was 88. 3%. Conclusion Although the CCR5 usage virus is predominant in primary infection through sexual transmission, CXCR4 usage virus can also be detected. A switch of coreceptor usage may happen within the first year post-infection. Adopting multiple rules may improve the efficiency and validity for the prediction of coreceptor usage based on genotypes.

Objective To examine the prevalence of drug resistance mutations among the treatmentnaive HIV ( human immunodeficiency virus) infectors living in Beijing so as to provide the basal information for clinical antiviral treatment. Methods HIV pol genes from plasma samples of 150 treatment-naive HIV-infected patients were amplified, sequenced and phylogenetically analyzed. And the drug-resistance associated mutations in protease and reverse transcriptase regions were analyzed with Stanford University HIV Drug Resistance Database. Results A total of 111 pol gene sequences were obtained. The overall prevalence of drug resistance was 8.1% (9/111) , corresponding to 3.6% (4/111) for protease inhibitors,1.8% (2/111) for nucleoside reverse transcriptase inhibitors and 3.6% (4/111) for non-nucleoside reverse transcriptase inhibitors. No drug resistance mutation was identified in 17 intravenous drug users. Conclusion The prevalence of drug resistance is relatively high in the newly confirmed HIV infectors in Beijing. Regular surveillance and monitoring of drug-resistant HIV should be implemented.

Objective To investigate the change regularity of peripheral blood mononuclear cell ( PBMC) mtDNA ( mitochondrial deoxyribonucleic acid) content and its association with HIV-LD ( human immunodeficiency virus-related lipodystrophy ) in HAART ( highly active antiretroviral therapy). Methods At baseline, Months 6 and 24 of therapy, the cryopreserved PBMC were collected from 33 patients on a regular follow-up at our clinic. Among them, 17 had HIV-LD. Then total DNA was extracted and mtDNA content quantified by real-time PCR (polymerase chain reaction). Results The HIV/AIDS patients had a lower content of PBMC mtDNA (2-△△Ct) than the healthy controls at baseline (9.578 vs 17. 195, P ＜0.01). The mtDNA content was lower in the HIV-LD group than that in the no LD (NLD) group at each timepoint of therapy (13.619 vs5.775, 6.360 vs 1.387, 7. 170 vs 1.266, all P＜0.05). In the HIV-LD group, the half- and 2-year PBMC mtDNA content was markedly lower than those at baseline (both P ＜0. 05 ). And the change of mtDNA content (within half a year) was earlier than the onset of clinical HIV-LD at one year later. In the NLD group, the PBMC mtDNA content have an insignificant change after therapy.The mtDNA content decreased significantly in stavudine (d4T)-containing regimen group after treatment (P ＜0. 01) , but showed no significant change in zidovudine ( AZT) -containing regimen group after therapy.Conclusion The decreased content of PBMC mtDNA after HIV infection and during HAART therapy is associated with HIV-LD. Nucleoside reverse transcriptase inhibitor, especially d4T, plays an important role in the progression of HIV-LD.

：Objective To analyze theoccurring rules of human immunodeficiency virus (HIV)drug resistance under an uniquetherapy model among HIV-1 infected individuals on antiretroviral therapy (ART) in ruralareas of Henan, China. Methods A cohort of 75 individuals on an ART regimen of zidovudine(ZDV) , dideoxyinosine (ddI) and nevirapine (NVP) was established in March 2003. A totalof 12 surveillances were conducted and 788 person-times were studied until 2010. Theparameters of CD4 cell count and viral load (VL) were tested in each survey. And genotypicresistance testing was performed in patients with a failure of viral suppression. Survivalanalysis was used to estimate the occurrence time of resistance. Results The cumulativemortality rate was 16% (12/75) in the cohort. And the cumulative resistance rate was 88%(66/75) from 2004 to 2010. The rate of resistance reached 54. 7% and the probability fromsusceptibility to drugs developing resistance decreased drastically from 100% to 45. 3%within the first 1 year of initiation. The occurrence time of resistance for half ofindividuals in the cohort was at 12.0 months(95% CI 8. 6 - 17. 0)after initiation, 25. 1months(95%C/19.0-33. 3)in those whose VL was less than 4. 0 lgU/ml and 4. 8 months (95% CI4.1 - 5. 6) at VL ＞ 4. 0 lgU/ml during the first investigation. The individuals with an earlyoccurrence of resistance within 12 months carried high risks for afailure of viralsuppression and a decrease of CD4 counts. Conclusion The occurrence of resistance riseswith the course of therapy. And the greatest probability for resistance is within thefirst 1 year of initial therapy. A high level of VL has a significant impact on thedevelopment of resistance. Preventing the occurrence of resistance during the initialtherapy remains a key goal.

Objective To summarize the clinical characteristics of Good's syndrome so as to standardize its diagnostic and therapeutic strategy. Methods Ten cases of Good's syndrome treated at our hospital from January 2000 to January 2011 were analyzed retrospectively. Their clinical manifestations,accessory examinations, treatment and prognosis were evaluated. Results There were 3 males and 7 females with an average age of (49 ± 11) years old. Their major symptoms were pulmonary infection (n = 6), diarrhea (n =4), involvement of central nervous system (CNS) (n=4) and polyarticular pain (n = 3). Hypogammaglobulinaemia and abnormal subsets of lymphocytes were the most common laboratory changes. Besides imaging studies revealed that all of them were diagnosed as thymoma. No significant efficacy was observed after thymoma resection. Clinical improvements were demonstrated after the treatment with regular intravenously administered immunoglobulin (IVIG) in 4 of them. Eight patients were followed up. Four of them died from pulmonary infection and involvement of CNS. Conclusion As a rare disease in adults, Good's syndrome is characterized by thymoma associated with immunodeficiency and a lack of specific clinical manifestations. IVIG at regular intervals is the most effective way of improving the clinical symptoms and reducing the patient mortality. However, the prognosis remains poor since most patients fail to receive a regular therapy of IVIG.

Objective To explore the application of intracranial electrodes (IE) for temporal lobe epilepsy ( TLE) surgery and assess the clinical utility of intracranial video electroencephalography (IVEEG). Methods The clinical data of 60 TLE patients undergoing implantation of IE were reviewed retrospectively. Cortical subdural strip, grids and depth electrodes were implanted by sphenotresia, bone disc craniototny or stereotactic technology. Results The implanted electrodes were as follows; frontaltemporal lobe cortical strip (n = 34), frontal-anterior temporal-occipitotemporal lobe cortical strip (n =7),bilateral temporal lobe cortical strip (n = 7), combined temporal lobe strip & depth (n =1) , anterior temporal-occipitotemporal junction cortical strip (n=3) and combined strip & grid (n=2). The following procedures were performed: anterior temporal lobectomy ( ATL) (n =50), combined ATL & frontal focal cortical resection (n = 7), combined ATL & callosotomy (n = 1 ) and combined neocortex epileptogenic focus resection & amygdalohippocampectomy ( n = 2 ). Conclusion IVEEG is effective and important for the localization of epileptogenic focus in patients with intractable temporal lobe epilepsy.

Objective To investigate the current status of treatment goals for blood pressure, serum lipids and blood glucose in the elderly patients (＞65 years old) with coronary heart disease (CHD) in China and to identify their associated factors. Methods In this cross-sectional survey, the CHD subjects aged ＞65 years old were recruited from 66 hospitals in Beijing, Shanghai, Tianjin, Guangdong, Zhejiang and Xinjiang from June 2006 to January 2007. Results A total of 2420 participants, including 1441 males and 979 females. Their mean age was (73 ± 6) years. The targeted blood pressure was systolic blood pressure ＜ 130 mm Hg( 1 mm Hg =0.133 kPa) and diastolic blood pressure ＜80 mm Hg. And the success rate was 24.8% (559/2420). The blood pressure achievement rate among the females was 21.8%(213/979). And it was lower than 26. 8% (386/1441 ) among the males (P ＜0.01). The serum lipids goal of achievement was LDL-C ( low density lipoprotein-cholesterol) ＜ 2.6 mmol/L for the high-risk patients and LDL-C ＜ 2.07 mmol/L especially for the super-high-risk patients. The success rate for achieving the target LDL-C level was 36. 5% (884 cases). The LDL-C achievement rate among the females was 28. 7% (281 cases). And it was obviously lower than 41. 8% (603 cases) among the males (P ＜0.01). The success rate for achieving the target LDL-C level increased with aging ( P ＜ 0. 05). The blood glucose goal of achievement was FPG ( fasting plasma glucose) ＞ 4.4 mmol/L and FPG ＜ 6. 1 mmol/L The success rate for achieving the target blood glucose level was 61. 0% (1476/2420). Binary logistic regression analysis indicated that the independent risk factors of achieving the blood pressure target for the elderly CHD patients were female, history of hypertension, diuretics and nifedipine. The odds ratio (OR) of these risk factors were 1. 245 [95% confidence interval (CI): 1. 016 - 1. 527], 2. 889 (95% CI: 2. 319 -3. 599),0.689 (95% CI: 0.538 -0.883), 0.405 (95%CI: 0. 170-0.964) respectively. The independent risk factors of achieving the serum lipids target for the elderly CHD patients were female, the duration of hypertension of 10 -20 years, the duration of hypertension of 20 -30 years, diabetic history or dyslipidemia and therapeutic lifestyle change (TLC). The OR of these risk factors were 1.750 (95% CI: 1. 252 -2.445), 3.988 (95%CI: 1.951 -8.152), 2.158 (95%CI: 1.075-4.333), 3.026 (95%CI: 1.986-4.610), 2.166 (95% CI: 1.549 -3.030) and 0.493 (95%CI: 0.302 -0.805) respectively. The independent risk factors of achieving the blood glucose target for the elderly CHD patients were diabetic history, TLC, diuretics, calcium channel blocker ( CCB) and hypoglycemic drugs. The OR of these risk factors were 3. 191 (95% CI: 2. 259 - 4. 507), 0. 690 (95% CI: 0. 528 - 0. 902 ) , 1. 507 (95% CI:1.150-1.975), 0.718 (95%CI: 0.579 -0.890) and 0.477 (95%CI: 0.235 -0.969) respectively.Conclusion In the present survey, the achievement rates of blood pressure, serum lipids and blood glucose are low in the elderly CHD patients, especially in females. There has been a huge gap between the treatment guidelines and clinical practices in China. We should carry out different strategies according to different conditions to enhance the health and life quality for the elderly CHD patients.

Objective To explore the clinical effect of pockets embedding in duodenal stump closure after gastrectomy for gastric cancer. Methods A total of 2034 patients undergoing gastrectomy from January 1995 to December 2009 at our hospital were reviewed. Among them, Group A ( n = 465 ) underwent pockets embedding for duodenal stump, Group B (n =835) line-cutting stapler and hand-sewing while Group C (re = 734) double layer hand-sewing. The operation cost, processing time of duodenal stump,recent post-operative complications (within 1 month), blood loss volume and post-operative recovery status were compared between 3 groups. Results No patient died of operation. Ninety-five cases (4. 7% )suffered recent post-operative complications. The most frequent complications included wound infection (36 cases, 37.9%), intra-abdominal hemorrhage (18 cases, 18.9%) and anastomotic leakage (14 cases,14.7% ). There was no significant difference in intra-abdominal bleeding, anastomotic leakage, abdominal infection, wound infection or duodenal stump leakage among 3 groups. There was no duodenal stump leakage in Group A. The difference was apparent in comparisons with Groups B (6 cases, 0. 72% ) and C (5 cases,0.68%). The operation costs of Groups A [(9902 ±312)RMB] and C [(9896 ±281)RMB] were significantly lower than that of Group B [(13 129 ± 237) RMB, P =0. 0001]. And there was no difference between Groups A and C. The processing time of duodenal stump in Groups A [(7. 1 ±0. 9) min] and B [(7.6±0. 8)min] were lower than that of Group C [(11.5 ±1.4)min, P=0.0001]. And there was no difference between Groups A and B. There was no significant difference in blood loss volume or postoperative recovery status among 3 groups. Conclusion The post-gastrotomic closure of duodenal stump with pockets embedding for gastric cancer has a short operation time, a low operation cost and a low rate ofduodenal stump leakage. It is a simple, prompt, promising and safe surgical procedure for gastric neoplasms.

Objective To evaluate the effect of conservative fluid management on the outcomes in patients with acute lung injury (ALI). Methods Randomized controlled trials (RCTs) and cohort trials on conservative fluid management from January 1, 1990 to May 20, 2010 were retrieved by electronic and manual searching. A meta-analysis of effect of conservative fluid management on the outcomes in ALI patients was conducted by the methods as recommended by the Cochrane Collaboration. Results Four RCTs involving 594 cases in conservative fluid management group and 584 in conventional fluid management group were included into the Meta-analysis. Compared with the conventional fluid management group, there was no beneficial effect of conservative fluid management strategy on mortality in ALI patients (P = 0. 16) .However, the duration of mechanical ventilation was shortened while the incidence of renal failure remained unchanged. Three retrospective cohort trials involving 296 cases in conservative fluid management group and 750 in conventional fluid management group were included into the meta-analysis. As compared with the conventional fluid management strategy, conservative fluid management strategy had improved the patient outcomes (P ＜0.001). Conclusion No beneficial effect of conservative fluid management strategy on the mortality is observed in the ALI patients. And the ventilator-free durations become elongated. However,further trials of a larger sample size and a higher quality are warranted.

Objective To detect the cartilage changes of hip joint with osteonecrosis of femoral head (ONFH) in stages Ⅱ and Ⅲ and provide evidence for understanding cartilage changes of femoral head of osteonecrosis before collapse. Methods The cartilage changes of ONFH were determined by delayed gadolinium enhanced magnetic resonance imaging of cartilage (dGEMRIC). According to ARCO classification of ONFH, the samples were divided into three groups: Group A, 11 hips, stageⅡ; Group B,13 hips, stage Ⅲ; Group C, 10 hips, normal. All participates underwent the tests by dGEMRIC. And the data of T1Gd were collected and analyzed. Results The values of T1Gd were 420 ±60 (Group A) ,361 ±54(Group B) and 538 ±26 (Group C) respectively. There was a significant difference among three groups.The values of T1Gd in the ONFH patients were lower than their healthy counterparts. The values of T1Gd of Group B was 14% lower than those of Group A. And the difference was significant statistically. Conclusion Cartilage of the femoral head undergoes abnormal metabolic changes before collapse. There is a loss of GAG in the cartilage and it aggravates with the worsening of ONFH.

Objective To investigate the effects of Shenfu (SF) injection on hemodynamics and plasma E-selectin concentrations in elderly patients undergoing total hip replacement (THR). Methods A total of 24 ASA Ⅱ/Ⅲ patients aged 65 to 85 years old were divided equally into two groups (n = 12). In Group S, SF injection was administered by peripheral intravenous infusion at initially 0. 2 ml/kg and then patients received a post-operative regimen of patient-controlled epidural analgesia (PCEA). Blood samples were taken pre-operation ( T0), immediately post-operation (T3) and 24 hours post-operation (T4) so as to detect the levels of E-selectin at these time points.mean arterial pressure (MAP) , heart rate (HR) and central venous pressure (CVP) were continuously monitored and recorded at T0, 15 min post-anesthesia (T1 ), 30 min post-anesthesia (T2) and T3. Results The concentrations of E-selectin in Group N increased at T3 and T4 while those decreased in Group S [(119 ± 23 ) mg/L and(109 ± 23) mg/L vs (86 ±15)mg/L,(83 ±15)mg/L and (83 ±12)mg/L vs(92 ±37)mg/ L, all P＜0. 01]. As compared with Group S, they were significantly higher in Group N (P ＜ 0. 05 or 0. 01). There was no significant difference in CVP, HR and MAP between two groups. Conclusion The activation of vascular endothelial cells is manifested by an elevated plasma concentration of E-selectin in the elderly patients undergoing THR. SF injection can inhibit the activation and exert no significant effects on the hemodynamics.

Objective To identify the expression and significance of protease-activated receptor-2 (PAR-2) and mast cell ( MC) in the rat model of small intestinal mucosal damage by a short-term administration of diclofenac. Methods Twenty-four SD-rats were divided into 2 groups ( control group and model group, 12 rats each) by random digit table. The rats in the control group were treated with 1 ml distilled water per 250 g, once a day while those in the model group diclofenac 7. 5 mg/kg per day. Their terminal ileum was harvested at Day 5 after an intraperitoneal injection. Toluidine blue dyeing was employed to determine the distribution of MC and its count in intestinal mucous membrane. Immunohistochemistry,Western blot and real-time PCR (polymerase chain reaction) were employed analyze the location, expression and change of PAR-2 mRNA in intestinal mucous membrane. Results The count of MC was obviously higher in the model group than that in the control group( 10. 3 ±2. 2 vs 4. 2 ± 1. 2, P ＜0.05 ). PAR-2 was expressed on the mucous surface, recesses epidermis and lamina propria inflammatory cells. And positive dyes were located within cytoplasm. As compared with the control group, the expression of PAR-2 mRNA was higher(2. 63 ±0. 26 vs 1, P ＜0. 05)and its protein expression higher in the model group(24. 3 ±2.4 vs 17. 5 ±3. 5, P＜0. 05). Conclusion Both PAR-2 and mast cell are involved in the pathogenesis of small intestinal mucosa injury induced by diclofenac in rats. PAR-2 may be activated by tryptase released from mast cells and participate in the pathogenesis of small intestinal injury as induced by non-steroidal antiinflammatory drugs.

Objective To test the nickel-titanium (Ni-Ti) shape memory alloys of vertebral body reduction fixator with assisted distraction bar for the treatment of traumatic and osteoporotic vertebral body fracture. Methods A Ni-Ti shape memory alloys of vertebral body reduction fixator with assisted distraction bar was implanted into the compressed fracture specimens through vertebral pedicle with the radiographic monitoring to reduce the collapsed endplate as well as distract the compressed vertebral fracture. Radiographic film and computed tomographic reconstruction technique were employed to evaluate the effects of reduction and distraction. A biomechanic test machine was used to measure the fatigue and the stability of deformation of fixation segments. Results Relying on the effect of temperature shape memory,such an assembly could basically reduce the collapsed endplate as well as distract the compressed vertebral fracture. And when unsatisfied results of reduction and distraction occurred, its superflexibility could provide additional distraction strength. Conclusion A Ni-Ti shape memory alloys of vertebral body reduction fixator with assisted distraction bar may provide effective endplate reduction, restore the vertebral height and the immediate biomechanic spinal stability. So the above assembly is indicated for the treatment of traumatic and osteoporotic vertebral body fracture.

Objective To assess the effects of ischemic postconditioning, remote ischemic postconditioning and naloxone postconditioning on focal cerebral ischemia-reperfusion injury in rats.Methods A total of 110 adult SD rats were randomly divided into 5 groups (n =22 each). The focal cerebral ischemia-reperfusion injury was induced by a 90-minute occlusion of right middle cerebral artery (MCA) and a 24-hour reperfusion sequentially. Group 1 was of ischemia-reperfusion control; Group 2 ischemic postconditioning induced by three 30-second cycles of MCA occlusion followed by a 30-second reperfusion; Group 3 remote ischemic postconditioning performed via a transient occlusion of right femoralartery at 5 min before the initiatlon of reperfusion:Group 4 naloxone posteonditioning with naloxone 10 mg/kg intraperitoneaUy injected at the initiation of reperfusion;Group 5 combined ischemic,remote ischernic & naloxone postconditioning performed simultaneously in accordance with the methods used in Groups 2,3 & 4.The neumlogie deftcit scores(NDS)were obtained at 2 h & 24 h post-reperfusion.At 24 h post-reperfusion.the anesthetized rat was sacrificed by decapitation and the brain rapidly extracted to asseSS the size ofcerebral infaret(n=10),detect the cerebral expression of microtubule-associated protein2(MAP2)(n=6),measure the plasma volume of cerebral tissues and quantify the diameter and segment artery at 5 min before the initiation of reperfusion; Group 4 naloxone postconditioning with naloxone 10 mg/kg intraperitoneally injected at the initiation of reperfusion; Group 5 combined ischemic, remote ischemic & naloxone postconditioning performed simultaneously in accordance with the methods used in Groups 2, 3 & 4. The neurologic deficit scores ( NDS) were obtained at 2 h & 24 h post-reperfusion. At 24 h post-reperfusion, the anesthetized rat was sacrificed by decapitation and the brain rapidly extracted to assess the size of cerebral infarct (n = 10), detect the cerebral expression of microtubule-associated protein2 ( MAP2) (n =6) , measure the plasma volume of cerebral tissues and quantify the diameter and segment length of cerebral microvessel (n = 6 ). Results There were no significant differences in the heart rate (HR) and mean arterial pressure (MAP) among the above five groups at all observed time points (P ＞ 0. 05). At 24 h post-reperfusion, the percentage of ischemic cerebral infarct size was 43% ±6% , 31% ±4% , 32% ±5% , 28% ±6% & 21% ±7% in ipsilateral hemisphere area (i. e. , cerebral infarct severity)in Groups 1-5 respectively. Compared with Group 1, the levels of NDS and cerebral infarct severity significantly decreased at ischemic side in Groups 2-5 ( P ＜ 0. 05 ). And the cerebral expression of MAP2,plasma volume of cerebral tissues, diameter and segment length of cerebral microvessel significantly increased at the ischemic side (all P＜0. 05). However, there were no significant differences in the abovementioned parameters at ischemic side among Groups 2, 3 and 4 (all P ＞0. 05). The parameters of NDS,cerebral infarct severity, cerebral expression of MAP2 and plasma volume of cerebral tissues in the ischemic side significantly increased in Group 5 compared with Groups 1,2,3 and 4 (all P ＜ 0. 05). The diameter and segment length of cerebral microvessel at ischemic side were not different among Groups 2,3,4 and 5 (all P＞0. 05). Conclusion In focal cerebral ischemia-reperfusion rats, ischemic, remote ischemic and naloxone postconditioning may produce significant neuroprotective effects of reduced cerebral infarct severity and improved neurologic dysfunctions. A combination of three postconditioning approaches enhances the above neuroprotective effects.

Medical Record Abstract The patient was a 42-year-old female who was admitted to Peking Union Medical College Hospital on May 31, 2010 because her hands turned white when exposed to cold for 2 years, her skin turned hard for 1 year, and she suffered headache for 1 and a half months. Two years ago, the patient developed white, purple and red finger tips when exposed to cold with pain, which could be relieved by keeping warm, but the symptoms were aggravated in winter. She was accompanied by pain in both knees and elbow joints, without swelling and morning stiffness, with mild acid reflux, heartburn, anorexia, occasional vomiting of stomach contents after eating, and no dysphagia. One year ago, the skin on the face, back of hands and forearms began to become tight and hard, and gradually appeared weakness and weight loss, and the symptoms continued to aggravate. Two months ago, nausea and vomiting aggravated, and gastroscopy in another hospital showed "superficial gastritis, ulcer and erosion (details unknown)".

Proton pump inhibitor (PPI) is a kind of important drugs for the treatment of gastroesophageal reflux disease, chronic gastritis, peptic ulcer and other diseases, and is widely used to eradicate Helicobacter pylori (Hp) infection; With the widespread application of non-steroidal anti-inflammatory drugs (NSAIDs) and the increasing risk of adverse gastrointestinal reactions, PPI has become one of the common indications for PPI. PPI has significant curative effect, but it also produces a series of adverse reactions, such as secondary infection, osteoporosis, hypergastrinemia, excessive acid-secreting cell proliferation, gastric fundus polyp formation, etc. Recently, Japanese scholar Hagiwara et al. found through Mongolian gerbil model that long-term use of PPI after Hp infection can aggravate atrophic gastritis and promote the occurrence of gastric adenocarcinoma, which may be related to the progression of atrophic gastritis<Digestive Tract>Journal (Gut, 2011, 60, 624-630).

A 30-year-old woman was admitted to the hospital mainly for fever, cough for 3 months, episodic confusion and headache for 15 days. The patient developed fever 3 months ago (3 months of pregnancy), and the erythrocyte sedimentation rate was 80 mm/h in the local hospital, and the chest X-ray showed miliary tuberculosis in both lungs. Tuberculin test (PPD) (+ + +) was examined, and "peritoneal effusion and pelvic effusion" were found. The diagnosis was (1) miliary tuberculosis and (2) tuberculous peritonitis, and anti-tuberculosis treatment was given. Fifteen days ago, the patient suddenly developed symptoms such as straight eyes, closed teeth, urinary incontinence and confusion, which lasted for 7~8 minutes, accompanied by headache. The above symptoms attacked twice, and came to our hospital for further diagnosis and treatment. The patient denied the history of infectious diseases such as hepatitis and tuberculosis. After admission, the physical examination of cervical rigidity (+), and no positive signs were found in the remaining physical examinations.

A 24-year-old woman was admitted to Peking Union Medical College Hospital in May 2010 due to intermittent fever for 8 months, lower limb myalgia for 7 months, and left limb numbness and weakness for 4 months. The patient developed fever after catching cold in September 2009, with a maximum body temperature of 39℃, and attacks occurred once every few days. In October, she developed severe medial myalgia of both calves. The blood test in the local hospital was normal, with erythrocyte sedimentation rate (ESR) 58mm/1 h, anti-streptococcal hemolysin "O" 800U/ml, and protease 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA) positive.

A 30-year-old female was admitted to Peking Union Medical College Hospital on April 30, 2010 due to fever, joint pain for 7 months, abdominal distension and abdominal pain for 20 days, and stopping defecation for 4 days. The patient developed fever without trigger 7 months ago, with the highest body temperature of 39℃, accompanied by swelling and pain of the metacarpophalangeal joints and proximal interphalangeal joints of both hands, accompanied by fatigue, without myalgia, muscle weakness, holding breath, decreased urine output and edema. Antinuclear antibody, anti-double-stranded DNA antibody (+) and creatine kinase 3000 U/L were examined in other hospitals; He was diagnosed as "systemic lupus erythematosus (SLE) and myositis". After 20 days of intravenous injection of hormone (amount unknown), he was changed to asesone 40 mg once daily and leflunomide 10 mg once daily, and the symptoms were significantly relieved. 20 days ago, when asesone was reduced to 8 mg once daily, he developed lower abdominal distension and pain, followed by total abdominal distension and pain, accompanied by nausea and vomiting of stomach contents. 4 days ago, he stopped exhausting and defecating, and fever again, with the highest body temperature of 37.7℃.

A 69-year-old female was admitted to the Department of Neurosurgery of Chengdu Third People's Hospital in June 2010 with limited abduction of her left eye, double vision for more than 40 years, left facial numbness and degeneration of masticatory function for 5 years. The patient developed double vision 40 years ago, without other discomfort. She had been treated in ophthalmology departments of many hospitals, and all of them were treated with strabismus in her left eye, but the symptoms did not improve. Five years ago, the patient began to develop strip-like numbness in the left upper and mandible facial regions, accompanied by left mandibular occlusal weakness. Magnetic resonance imaging (MRI) of the head showed that the left parasellar occupied a huge space, closely related to the cavernous sinus and surrounding the internal carotid artery, and was diagnosed as trigeminal schwannoma. Considering the risk of surgery, she was treated with gamma knife 4 years ago. After 2 months of gamma knife treatment, the numbness in the left face was significantly widened with progressive left masticatory muscle atrophy. In the past year, the patient's left masticatory muscle atrophy and complete loss of function.