Volume 92  ·   Issue 04  ·  2012

In recent years, disasters occur frequently in China, and various natural disasters and man-made disasters seriously endanger people's lives and property safety. The development of disaster medicine is of great significance for disaster rescue. Compared with other types of trauma, the characteristics of burn specialty are more distinct. Because of the limited daily treatment capacity of burn centers, the emergency treatment of mass burn patients in disaster rescue often needs multi-party support. Many developed countries have established a burn patient treatment system and a rescue personnel training system for disaster medicine rescue, which play an important role in the rescue of burn patients in sudden disaster events. This paper mainly introduces the training mode and application effect of burn patient treatment in disaster rescue abroad, the establishment and operation mode of burn professional rescue team, and provides reference for the treatment of burn patients in disaster rescue in China.

Diabetic patients are at high risk of lower extremity arterial disease (also known as peripheral arterial disease, PAD). A large-scale cross-sectional study in primary hospitals in the United States was conducted to prospectively evaluate the incidence of PAD in patients aged ≥70 years or 50-69 years with a history of smoking or diabetes. The results showed that the detection rate of PAD in this population was 29% [1]. Clinical studies in China over 50 years of age with at least one cardiovascular risk factor have confirmed that about 20% of diabetic patients with at least one cardiovascular risk factor have PAD [2]. PAD is a marker of systemic arteriosclerosis, with high morbidity and mortality. The 5-year mortality rate of PAD patients is 70% ~80%. More than 70% of PAD patients have cardiovascular and cerebrovascular diseases. The multi-society expert consensus on the diagnosis and treatment of transatlantic peripheral artery in 2007 and the 2010 China Guidelines for the Prevention and Treatment of Type 2 Diabetes both pointed out that the therapeutic objectives of PAD include improving the symptoms of lower extremity ischemia and reducing the risk of cardiovascular events. For patients with obvious limitation of physical activity, the main goals of treatment are to relieve symptoms, improve exercise tolerance, The main medical drugs are as follows.

Peripheral arterial disease (PAD) is one of the most serious chronic complications of diabetes mellitus, and its prevalence is closely related to age, disease course, blood glucose control level, hypertension and lipid metabolism disorder [1-3]; In diabetic foot disease, 62% of foot ulcers are related to ischemia, 46% of amputations are related to ischemia, and lower limb ischemia reduces limb resistance to infection. Therefore, PAD is the most common cause of refractory foot ulcers, pain and amputation, and it is also the main factor that determines whether the wound can heal, whether the limb needs to be amputated and the plane of amputation.

Objective To evaluate the association of a high ankle brachial index (ABI) with microvascular diseases of diabetes and to compare its strength with that of a low ABI.Methods ABI was obtained in 3293 patients undergoing the screening of chronic complications at the Diabetic Center,No.306 Hospital of PLA during the period of September 2003 to June 2010.The patient profiles and laboratory data were reviewed.The associations of ABI with microvascular diseases of diabetes were determined by univariate and stepwise Logistic regression analysis. Results ABI was normalin 3060 patients. 44 had ABI measurements ＜0.7,139 had ABI measurements between 0.7 -0.9,and 50 had ABI measurements ＞1.3.Multivariate analysis indicated that the factors significantly associated with a high ABI were smoking (OR:2.605; 95％ CI: 1.458 -4.656,P =0.001 ) and systolic blood pressure (OR: 1.019; 95％ CI:1.005 - 1.033,P =0.006).The conditions of nephropathy,neuropathy and retinopathy were not associated with a high ABI.Conclusion Diabetics with a high ABI carry not more adverse atherosclerotic risk factors and suffer no more severe microvascular diabetic complications than those with a normal ABI.

Objective To explore the variance of mean platelet volume (MPV) in subjects with normal glucose tolerance (NGT),impaired glucose regulation (IGR) and type 2 diabetes mellitus (T2DM) and risk factors of MPV changes and analyze the relationship between MPV and diabetic peripheral artery disease (PAD). Methods A total of 173 subjects were enrolled into this observational cross-sectional study.They were divided into 3 groups: NGT (n =41),IGR (n =41) and T2DM (n=91). Blood pressure (BP),platelet count (PLT),mean platelet volume (MPV) and such fasting serum lipids as triglycerides (TG),total cholesterol ( TC ),high density lipoprotein ( HDL-C),low density lipoprotein (LDL-C),fast plasma glucose (FPG) and serum uric acid (UA) were determined.HbA1c and ankle/brachial index (ABI) were also measured.Results ( 1 ) The MPV level was highest in the T2DM group ( 12.3 ± 1.5 ) fl.And it was significantly higher in the IGR group than in the NGT group (9.7 ± 0.9 vs 8.0 ±0.9) fl (P ＜0.01 ).It was significantly higher in diabetics with HbA1c≥7％ ( 13.2 ± 1.9) fl than in patients those with HbA1c 7％ ( 11.8 ± 1.7 ) fl ( P ＜ 0.0 1 ) ; ( 2 ) Stepwise multiple regression analysis showed that age,serum creatinine,LDL-C and fasting plasma glucose (FPG) were important influencing factors of MPV (adjusted R2 =0.891 ) ; (3) Multiple Logistic regression analysis indicated that MPV was an important risk factor of PAD.Conclusion The MPV level in T2DM is significantly higher than that in NGT and IGR subjects.FPG,LDL-C,age and serum creatinine are important contributors to MPV.And MPV is an important risk factor of PAD.

Objective To examine the distribution patterns of pathogens isolated from the patients with diabetic foot ulcers and explore the risk factors for infections of methicillin-resistant S.aureus (MRSA)or methicillin-resistant S.epidermidis (MRSE).Methods A total of 388 diabetic-foot patients hospitalized at Tianjin Metabolic Diseases Hospital between January 2008 and June 2010 were recruited.The distribution profiles of pathogens isolated from diabetic foot ulcers were summarized. The patients with S. aureus infections were divided into MRSA and MSSA groups while those with S.epidermidis infections into MRSE and MSSE groups. The clinical features of these patients were compared between all groups. Logistic regression was employed to identify the risk factors for the MRSA/MRSE infections.Results A total of 362 pathogens were isolated from them.And the Gram-positive bacteria were the most predominant (57.2％,207/362),followed by Gram-negative bacilli (39.2％,142/362 ) and true fungi ( 3.6％,13/362 ).The three most frequently isolated pathogens were S. aureus ( 27.1％ ),S. epidermidis ( 18.8％ ) and Pseudomonas aeruginosa (15.5％). Statistically significant differences existed in antibiotic usage in 6 months prior to hospitalization,course of ulcer,ulcer size,deep ulcer,osteomyelitis,hypertension,anemia,hypoproteinemia and erythrocyte sedimentation rate between the patients infected with MRSA and MSSA (P ＜ 0.05 ). The MRSE infection was correlated with recurrent ulcer, osteomyelitis,hypoproteinemia,HbA1c and lower total serum protein (P ＜0.05).Multiple Logistic regression analysis revealed that antibiotic usage in 6 months prior to hospitalization,long course of ulcer,osteomyelitis,hypertension and hypoproteinemia were risk factors for the MRSA infection.And HbA1c was a risk factor for the MRSE infection.Conclusion In the present study,the Gram-positive cocci are the main pathogens isolated from diabetic foot ulcers. And S. aureus and S. epidermidis are the most frequently isolated pathogens.Antibiotic usage in 6 months prior to hospitalization,long course of ulcer,osteomyelitis,hypertension and hypoproteinemia are risk factors for the MRSA infection.And HbA1c is a risk factor for the MRSE infection.

Objective To explore the clinical characteristics,medical costs and its influencing factors in diabetics with amputation.Methods The data of diabetic amputation for the whole year of 2010 at 39 central municipal Class 3A hospitals all across China were retrospectively analyzed according to a unified protocol,including demographic characteristics, diabetic complications, classification of diabetic foot disease,level and prognosis of amputation and medical costs at hospitals.Results Among them,28.2 ％ of all amputated patients or 39.5％ of non-traumatic patients were diabetics.There were 313 males and 162 females.The average age and duration of diabetes were (66 ± 12) years and ( 130 ±94) months.The level of HbA1c was 8.9％ ± 2.4％. Among all amputated diabetics,the concurrent conditions included neuropathy ( 50.1％ ),peripheral artery disease ( 74.8％ ),nephropathy ( 28.4％ ) and retinopathy (25.9％).The patients with foot ulcer at Wagner 4 (50.3％ ) were more common.Among them,67.5％ had minor amputation with a median hospitalization stay of 33.0 (24.0 -45.O)days and a medical cost of 26 138( 16 155 - 46 021 ) yuan RMB. The duration of diabetes,diabetic complications,severity and location of ulcers and amputation level influenced their hospitalization durations and medical costs.Conclusion The patients with diabetes and amputation are elder with more chronic diabetic complications and uncontrolled hyperglycemia. Most of them have complications of local gangrene and require minor amputation at admission.Their hospital stays are longer and medical costs higher significantly correlated with diabetic complications,severity and location of foot ulcers and level of amputations.

Objective To investigate the features and the treatment of skin and soft-tissue defects caused by 5 · 12 Wenchuan Earthquake.Methods From May 12 to June 7 in 2008,37 injured persons (43 wounds) were treated in West China Hospital,including 20 males and 17 females with a mean age of 40 years old ( range: 2 - 85).The wound locations included head ( n =2),trunk ( n =3 ),upper arm ( n =5 ),forearm ( n =5 ),thigh ( n =13 ) and lower extremity ( n =15 ).Their sizes ranged from 5 cm × 4 cm -27 cm ×20 cm.In 19 cases (51.3％),the bacterial culture results of wound secretion were positive.After thorough debridement and supportive treatment,the wounds were covered by hydropathic dressings.When the infections were under control and granulation tissues grew well,the method of either skin grafting (41 wounds) or flap transposition (2 wounds) was employed to repair the wounds.The survival rate of skin flaps or free skin was used to evaluate the therapeutic efficacy.Results From Days 6 - 15 post-admission,the wounds were repaired by skin grafting or flap transposition. All free skin grafts and flaps achieved an excellent survival.Two flaps survived completely,33 grafts survived ＞95％ and other 8 grafts ＞90％.The stay of hospitalization lasted for 12 - 23 days. None of the patients had any symptom of severe systemic infections and all survived. Conclusions Skin and soft-tissue defect wounds caused by earthquake are usually present in extremities and head. And there is a high incidence of local infections and severecontaminations. Early debridement,symptomatic supports and suturing by skin or flap transposition may repair the wounds as early as possible and contribute to a rapid recovery of patients.

Objective To explore the surgical managements of open wounds from 5 · 12 Wenchuan Earthquake.Methods In this report,fifty one patients with open wounds were treated after transported into West China Hospital from May 12 to 26 in 2008 after 5 · 12 Wenchuan Earthquake.Among 51 cases,open wounds were due to open fractures (n =8),fasciotomy (n =6),exposed bone (n =8) and defects of skin and soft tissue (n =29).All cases had wound infections.Sixty operations were performed,including muscle and myocutaneous flap ( n =4 ),skin grafting ( n =30 ),NPWT ( negative pressure wound therapy ) ( n =2 )and debridement ( n =24 ). Results Four cases of muscle and myocutaneous flaps survived with an excellent blood circulation.And 30 cases of skin grafting had a survival rate of over 90％,2 cases of NPWT and 24 cases of debridement required further treatment.Conclusion With adequate surgical managements,open wound healing from an earthquake may be accelerated and the functions maximally preserved.

Objective To compare the safety and feasibility of natural orifice transumbilical endoscopic surgery (NOTES) versus conventional laparoscopic surgery in renal cyst deroofing.Methods From May 2010 to August 2011,8 cases of renal cysts underwent cyst deroofing by the technique of NOTES (Triport) (group A) and 14 cases by conventional laparoscopic surgery (Group B) respectively.The data of patient age,cyst size,operative duration,estimated blood loss,intra-operative complications,drainage duration,post-operative pain score (VAPS) and post-operative hospital stay were recorded and analyzed.Results The average cyst sizes of groups A and B were 6.6 ± 2.4 and 7.0 ± 2.5 cm.There was no conversion to open surgery in neither groups and no conversion to standard laparoscopic surgery in group A.The operative duration,estimated blood volume,VAPS and post-operative hospital stay of both groups were 49 vs 35 min,12 vs 10 ml,0 vs 1 and 4 vs 5 days respectively.The drainage duration was 1 day for both groups.No severe complication,secondary hemorrhage or wound infection occurred in neither groups.As judged by both surgeons and patients,the post-operative cosmetic appearances of group A were better than those of group B.Conclusion The cyst deroofing by NOTES is a safe and feasible option for the treatment of renal cysts. As compared with conventional laparoscopic surgery,NOTES may achieve better cosmetic effects with smaller wounds.

Objective To evaluate the predictors and reasons for readmission into cardiac intensive care unit (ICU).Methods A total of 4978 patients underwent cardiac surgery between January 2008 and August 2010.The perioperative risk factors for readmission were analyzed by multivariate regression.And the reasons,outcomes and therapy were analyzed. Results Among them,139 patients required ICU readmission.There were 80 males and 59 females with a mean age of 50.3 years ( range: 9 - 78 ).Their median length of first and second stays were 2.00 ( 1.00 - 4.00 ) and 3.00 ( 1.00 - 5.00 ) days respectively.The median interval from ICU discharge to ICU readmission was 3 ( 2.00 - 6.75 ) days and the median hospital stay 24.00 ( 16.00 - 41.25 ) days. Readmitted patients had a higher mortality rate than those requiring no readmission (9.4％ vs 0.4％,P ＜0.01 ).The major reasons for readmission were respiratory (n =69,49.6％ ) and circulatory complications ( n =33,23.7％ ). Multivariate analysis showed that NYHA (New York Heart Association) classification (95％ CI: 1.091 -3.176,P =0.023 )and the length of initial ICU stay ( 95％ CI: 1.105 - 1.251,P ＜ 0.01 ) were independent risk factors of readmission.Conclusion NYHA classification and the length of first ICU stay are independent risk factors of readmission.Respiratory complications are the most common reasons for readmission.

Objective To explore the congenital ear malformation (CEM)-specific quality of life (QOL) and examine the effects of total ear reconstruction surgery for QOL of CEM patients.Methods A self-composed QOL scale was used for 129 patients with congenital external and middle ear malformation.All patients were requested to fill in the QOL scale before and 1 month after ear reconstruction surgery.Results The level of QOL varied according to the degree of ear malformation.The total QOL score of patients with unilateral and bilateral CEM was 28.5 ± 18.4 and 51.6 ± 23.6,respectively. The total QOL score of patients pre- and post-operation was 21.0 ± 14.0 and 14.2 ± 9.7 respectively. Physiological functions,psychological status and social interactions of the patients were of statistical significance after ear reconstruction surgery compared to that of at pre-operation. Conclusion Congenital ear malformationspecific QOL scale can show sensitively the changes of QOL of CEM patients.And ear reconstruction surgery is beneficial for the patients.

Objective To explore the expression and clinical significance of Slug,E-cadherin and N-cadherin in gastrointestinal stromal tumors (GIST).Methods Seventy eight GIST specimens removed surgically from 2004 to 2007 were collected from the Department of Gastrointestinal Surgery at Guizhou Provincial People's Hospital.There were 48 males and 30 females with an age range of 28 -87 years old.The expressions of Slug,E-cadherin and N-cadherin in GIST were determined by immunohistochemistry.And the correlations with their clinicopathologic characteristics were analyzed.Results The positive rates of Slug,E-cadherin and N-cadherin in GIST were 53.8％ (42/78),35.9％ (28/78) and 75.6％ (59/78) respectively.And the differences were statistically significant (x2 =24.98,P ＜ 0.05 ).Slug was expressed markedly higher in the cases of GIST with distant metastasis or distant metastasis and local invasion: 75％ (18/24) vs 44.4％ (24/54),63.6％ (28/44) vs41.2％ (14/34),both P＜0.05.And E-cadherin was expressed markedly lower in the cases of GIST with distant metastasis: 16.7％ (4/24) vs 44.4％ (24/54), P ＜ 0.05. The expression of N-cadherin was not significantly different between its clinicopathological characteristics ( allP ＞0.05 ).The expression of Slug correlated negatively with that of Ecadherin (rs =-0.267,P =0.018).But it had no correlation with that of N-cadherin (rs =0.056,P =0.625).Conclusion Slug is expressed markedly higher while E-cadherin markedly lower in metastatic GIST,and both are closely correlated with the metastasis of GIST.

Objective To retrospectively explore the clinical efficacies and applicability of anatomical vascular occlusion (AVO) in hepatectomy for grand primary hepatocarcinoma at different locations. Methods A total of 212 grand primary hepatocarcinoma cases undergoing hepatectomy were divided into 2 groups by vascular occlusion in the process of resection: AVO group (n =97) and Pringle group (Pringle maneuver,n =115).According to whether or not tumor was adjacent to main vessels,the cases were divided into 2 types: centrally ( n =98 ) and peripherally ( n =114 ) located lesions. And the perioperative outcomes were compared between 2 groups totally and by types respectively. Results No significance existed between the AVO and Pringle groups in the demographic characteristics and tumor background (P ＞0.05 ).For total cases,there were no significant differences between 2 groups regarding the intraoperative blood loss volume ( (632 ± 437 ) ml vs (546 ± 549) ml,P =0.217 ) and the blood transfusion requirement (44.3％ vs 33.0％,P =0.092 ).The AVO group showed significantly better postoperative liver functions in terms of serum levels of total bilirubin and aminotransferase ( P ＞0.05 ).But no significant difference was found between 2 groups in the postoperative complication rate ( 18.6％ vs 22.6％,P=0.469) and hospital stay duration ((10.5 ±4.8) vs (11.8 ±5.6) days,P=0.087).In centrally located lesions: the AVO group showed a significantly smaller intraoperative blood loss volume ( (722 ±492) ml vs ( 1032 ±618) ml,P =0.007) and blood transfusion requirement (45.6％ vs 68.3％,P =0.026).Also the AVO group showed significantly better postoperative liver functions in terms of serum levels of total bilirubin and aminotransferase ( P ＜ 0.01 ). As a consequence,the AVO group had a significantly lower postoperative complication rate ( 19.3％ vs 39.0％,P =0.031 ) and a shorter hospital stay duration ( ( 10.7 ±5.0) days vs ( 13.0 ±6.2) days,P =0.042).In peripheral located lesions: there were significantly larger intraoperative blood loss volume(504 ± 307 vs 278 ± 237 ml,P =0.000 ) and blood transfusion requirement (42.5％ vs 13.5％,P =0.001 ) in the AVO group. The postoperative liver functions (total bilirubin and aminotransferase levels,P ＞0.05),postoperative complication rate (17.5％vs 13.5％,P =0.808) and hospital stay duration ( ( 10.3 ±4.6) days vs ( 11.1 ±5.1 ) days,P =0.429)showed no significant differences between 2 groups.Conclusion The technique of AVO is unsuitable for all types of grand hepatocarcinoma. Whether or not the tumor is adjacent to main vessels is an important consideration of choosing the vascular control technique.Considering the risk of vascular damage in the process of hepatectomy,the AVO technique is indicated for the resection of central lesions but not for peripheral lesions.

Objective To clarify the pathogencity-related genes and its mutations in an oculocutaneous albinism (OCA) patient from a consanguineous marriage family. Methods Polymerase chain reaction (PCR) and automatic DNA sequencing methods,chromosome walking by PCR amplification techniques (PCR-Walking),multiplex PCR in a single PCR tube with 3 primers bridging the breakpoint (Gap-PCR) and bioinformatic analysis were employed for screening the mutations and identifying the novel mutation in the patient and his family.Results A pathogenic deletion of 6365 bp was found in MATP gene with a range of c.562-1118 ( ± 2 ) to c.885 + 4923 ( ± 2).The patient was homozygous for deletion mutation.Conclusion A large deletion mutation was first detected and identified in OCA4.

Objective To explore the prevalence and mutation pattern of H221Y at reverse transcriptase (RT) among the subtype B' of human immunodeficiency virusl ( HIV-1 ) in antiviral therapyfailure patients.Methods A total of 1363 sequences,comprising of 1205 therapy-failure individuals and 158 therapy-naive individuals,were submitted to the Stanford HIV drug resistance database (SHDB) to analyze the frequency and mutation pattern of H221Y.Results The prevalence of mutation H221Y in the therapy-failure population was significantly higher than that of the therapy-naive (6.59％ vs 0.60％ ) ( x2 =6.59,P =0.027).The emergence of H221Y usually accompanied the position mutations of T215,M184,K103 and Y181 of RT,and the pattern of TAMs/H221Y/Y181C/I was common.Frequency of H221Y in the regimen of AZT/ddI/NVP was more popular than the other 4 regimens ( 14.6％ vs 3.5％,4.9％,2.3％,2.6％,all P ＜0.01 ).Conclusion With a unique mutation pattern,H221Y has a low prevalence in the individuals of first-line therapy-failure patients.

Objective To explore the clinical efficacy and safety of oral alendronate in children with osteogenesis imperfecta(OI).Methods Eleven OI children were recruited from August 2008 to April 2011 at Shanghai Institute of Pediatric Research to receive alendronate for a duration of( 1.7 ± 0.3 ) years.The growth,fracture incidence,physical activity,the quality of daily life and safety parameters were evaluated.Results All patients obtained marked improvement.The rates of bone fractures decreased more remarkably than that at pre-treatment (0 - 1.2 fractures per year vs 0.5 - 5.0 fractures per year,medium 0 vs 1.40 fractures per year) ( P =0.003).Their levels of physical activities improved significantly ( median level from 4 to 3,P =0.004).There was significant post-treatment improvement in the self-care activity scores (median score from 43 to 73,P =0.003 ). The bone density of lumbar vertebrae,long bones and metaphysis improved at post-treatment.The radiographic examinations revealed the thickness of bone cortex.The change in height did not show any significant difference.No change was found in the serum levels of calcium,phosphorus,parathyroid hormone,alkaline phosphate or other biochemical markers. No adverse reaction occurred throughout treatment. Conclusion Oral alendronate treatment reduces the incidence of bone fracture and improves physical activity and life quality in OI children,and as a well-tolerated regimen,it is both safe and effective in clinical practice.

Gremlin is a member of the cysteine knot superfamily and an endogenous antagonist of bone morphogenetic protein (BMP), which plays an important role in the regulation of embryonic development, growth and differentiation. Recent studies suggest that Gremlin may be related to epithelial cell transdifferentiation. The latest studies on the role of Gremlin in epithelial cell transdifferentiation are reviewed as follows. 1. Biological characteristics of Gremlin Gremlin belongs to the BMP antagonist family. It is a highly conserved secreted protein, which contains potential nuclear localization sites, N-linked glycosylation sites and some phosphorylation sites. It is soluble and binding to cells [1] Gremlin encodes three proteins, named Gremlin1, Gremlin2 and Gremlin3, respectively. The human Gremlin1 gene is located on chromosome 15 There is a cysteine-rich repeat in the gene coding sequence.Gremlin2 gene is located on chromosome 1q43, encoding a 168 amino acid protein, and there is a cysteine knot with 8 amino acid loops at the C terminus.Human Gremlin3 gene is located on chromosome 19q13.2, and its amino acid sequence is 61.9% homologous to mouse CKTSF 1B3 (DANTE) molecule [2].

The World Health Organization (WHO) defines a disaster as any event that can cause damage to facilities, serious economic losses, casualties, deterioration of health status and health service conditions. If its scale exceeds the capacity of the area where the event occurred and special assistance has to be sought from outside the area, it can be called a disaster [1]. Major disasters often cause mass casualty incidents (MCI), and the number of casualties and medical resources needed for treatment are seriously unbalanced [2-3]. The May 12 Wenchuan earthquake in 2008 caused about 69,000 deaths, 374,000 injuries and 17,000 missing. The Great East Japan Earthquake and its tsunami in 2011 caused about 12,000 deaths and 15,000 missing. Because of the complex distribution of casualties, types and conditions of MCI, high fatality and disability rate, and huge social cost [4], it is urgent to improve the ability of MCI to cope with and treat the casualties.

Sponsored by the Smoking and Disease Control Committee of China Tobacco Control Association, the Cardiovascular Disease Branch of Chinese Medical Association and Hangzhou Medical Association, undertaken by the Cardiovascular Disease Branch of Hangzhou Medical Association, Hangzhou First People's Hospital and Shaoxing People's Hospital, and co-organized by the Cardiovascular Disease Branch of Zhejiang Medical Association, Zhejiang Hospital, Zhejiang People's Hospital and Shaoxing Medical Association. It was held in Hangzhou from December 2 to 4, 2011. Professor Hu Dayi, chairman of the Smoking and Disease Control Committee of China Tobacco Control Association, served as the chairman of the conference, and Professor Wang Ningfu, standing committee member, served as the executive chairman of the conference. A total of 1,020 delegates and experts participated in the conference. At the same time, the conference set up an academic forum on tobacco control and cardiovascular disease prevention, a forum on smoking cessation skills training, a forum on patient education and a forum for young doctors. More than 120 experts gave special reports at the conference and participated in case analysis and discussion.

A male child was born on October 15, 2004 in a local hospital in Jiading, Shanghai. He had caesarean section. After birth, hypospadias and external genital malformation were found. He was transferred to Pediatric Hospital affiliated to Fudan University for treatment. In October 2005, the chromosome examination was 46, XY, and laparoscopic left testicular pull-down fixation was performed. In April 2006, the child developed eyelid edema and urinary foam, and the urinary routine protein was positive (+ + +). Bilateral renal puncture biopsy showed focal bulbar and segmental sclerosing glomerulopathy. Hormone shock therapy was given, but the effect was not good, so he was considered to be hormone resistant. Starting from March 2009, the urine output of the child gradually decreased, urine foam still existed, and creatinine was 500 μ mol/L. The peritoneal dialysis tube was placed in June. After one time of peritoneal dialysis, the lumen was blocked with wound exudation, and the peritoneal dialysis tube was pulled out. In July 2009, the peritoneal dialysis tube was re-placed. Peritoneal dialysis was performed on August 10. A little milky white liquid was drawn out during the 0 cycle of peritoneal dialysis. The peritoneal dialysis fluid was positive for chyle test. Chyloabdomen was considered, and the peritoneal dialysis was stopped. Hemodialysis was performed on August 13, every week The diagnosis was Denys-Drash syndrome, uremia, chyloabdomen, hyperlipidemia and moderate anemia. For further diagnosis and treatment, the mother of the child wanted to donate one kidney for kidney transplantation and was admitted to the Department of Urology, Zhongshan Hospital affiliated to Fudan University. The genital examination of the child showed scrotal deformity, unpalpable testis, penis deformity, phimosis, and urethral opening located below the penis. On October 26, 2009, the patient underwent bilateral radical nephrectomy + right cryptorchidectomy + living donor kidney transplantation under general anesthesia. The left kidney size was 9.5 cm ×3.5 cm ×3.0 cm, and the right kidney size was 6.0 cm ×4.0 cm ×3.0 cm. The right cryptorchidectomy was detected, located at the level of abdominal aorta bifurcation, about 1.5 cm ×1.0 cm ×0.7 cm. The patient was resected. The donor renal vein and inferior vena cava were anastomosed end-to-side by fixed-point method, and the donor renal artery and abdominal aorta were anastomosed end-to-side by two fixed-point methods. After opening the artery and vein, the blood flow at the anastomosis was smooth and the kidney was red. The donor ureter and the left ureter of the patient were anastomosed end-to-end by two fixed-point methods. The patient recovered well after operation. The patient was given a triple immunosuppressant regimen: tacrolimus 3 mg/d, mycophenolate 0.5 g/d, methylprednisolone was administered intraoperatively and 1 week postoperatively, the dose was decreased, and the dose was changed to oral administration 1 week later, and the dose was gradually decreased. After 1 month, the hormone was stopped. A large number of lymphocytes and plasma cells infiltrated in the renal interstitium, and no development of seminiferous tubules was observed in cryptorchidism. The creatinine decreased to normal at 7 days after operation, and the creatinine was 36 μ mol/L at the time of discharge. The child was followed up for more than 1 year and 11 months. The transplanted kidney had good function and good growth and development.

The patient was a 56-year-old male. In 2009, he was found to have diffuse large B-cell lymphoma (DLBCL) in the left tonsil. He was treated with CHOP regimen (cyclophosphamide + doxorubicin + vincristine + prednisone) for 6 times in the local hospital, and he recovered after chemotherapy. Before the third chemotherapy, he underwent bone marrow puncture examination, and no obvious abnormalities were found in the bone marrow image. In April 2011, the patient was examined in our hospital due to lower abdominal pain for 1 month with abdominal mass. CT in our hospital showed intestinal obstruction, and then underwent exploratory laparotomy + small intestinal malignant lymphoma resection + intestinal decompression surgery. The pathological routine diagnosis results were: (small intestine) non-Hodgkin's lymphoma (NHL) -DLBCL (Figure 1), and the immunohistochemical results showed activated B-cell type (ABC type), negative margins at both ends, and 3 of the 27 periintestinal lymph nodes were involved. In June 2011, in order to seek further treatment, he came to the hematology department of our hospital, and the outpatient clinic planned to be admitted to the hospital with "NHL". Physical examination at admission: clear, poor spirit, moderate anemia, no yellowing stains or bleeding spots on the skin, sclera and mucosa. Ulcers and white spots were visible in the oral mucosa. The right side is small, about 1.5 cm ×1.0 cm, tough in texture, and the degree of sphincter is acceptable. There are no obvious swollen lymph nodes in the submandibular and neck on both sides. There is no tenderness in the sternum. A surgical incision of about 8 cm in length can be seen in the middle of the abdomen, and the healing is acceptable. There is no special cardiopulmonary auscultation. The abdomen is flat and soft, without tenderness and rebound pain, and the liver, spleen and subcostal area is not reached. Blood routine: hemoglobin 59 g/L, red blood cells 2 02×1012/L, average red blood cell volume 86.2 fl, average red blood cell hemoglobin concentration 34.3 g/L, red blood cell distribution width 18.2%, white blood cells 6.7×109/L, platelets 18×109/L, reticulocyte count 0.0117. Blood and bone marrow cytology examination: blood smear manually classified blast cells 0.750 (abundant cytoplasm, containing a few granules, irregular nucleus, nucleolus can be seen, Figure 2A); Bone marrow cell proliferation was obviously active, blasts were 0 855, some blasts had irregular nuclei, and granulation was observed in the cytoplasm (Figure 2B). Sudan black (SBB) staining was strongly positive (92%) (Figure 2C), peroxidase (POX) staining was strongly positive (86%), chloroacetate AS-D naphtholesterase staining was positive (82%), and α-butyrate naphtholesterase staining was negative. Bone marrow biopsy: bone marrow proliferation was extremely active, and blasts were diffusely distributed (Figure 2D). Immunohistochemistry showed MPO, CD19, CD22 positive (+ +), CD7, CD3 negative. Bone marrow flow immunotyping results: CD33, cMPO, CD13, CD15, CD19, CyCD22, CD117, CD34, HLA-DR positive (+), CD14, CD20, CD10, CD7, CD2, CD3, CD56, CD61 negative. Cytogenetic detection: long arm deletion of chromosome 7 (7q-). Combined with medical history and related examinations, clinical

The patient was a 41-year-old male with previous health. Physical examination and gastroscopy showed esophageal bulge lesions for 20 days. He was admitted to Taizhou Hospital in Zhejiang Province on August 4, 2011. Before admission, the physical examination and gastroscopy in our hospital showed chronic superficial gastritis with erosion and esophageal bulge lesions, so he was admitted as "esophageal bulge lesions". At admission, the patient had no feeling of eating difficulty, no nausea, vomiting, no hematemesis and melena. Physical examination: general condition was acceptable, superficial lymph nodes were not reached, cardiopulmonary auscultation was not special, the abdomen was flat and soft, no tenderness and rebound pain, and no mass was reached. There were no abnormalities in blood biochemistry, tumor series and blood coagulation series. Gastroscopy showed a bulge lesion 32~38 cm away from the incisors, with a size of 6 cm ×1 cm, a smooth and bright surface, soft and elastic texture, and a pale yellow appearance (Figure 1). Micro-probe endoscopic ultrasound examination (12 MHz) showed a honeycomb-like hypoechoic structure located in the submucosa, with uneven internal echoes, clear boundaries and intact muscle layer (Figure 2). Consider the esophageal submucosal lesion: cyst Esophageal CT showed that an oval soft tissue density nodule was seen in the esophageal lumen at the level of the lower esophagus equivalent to the posterior edge of the left ventricle, with smooth boundary and uniform density. The CT value of plain scan was 16 HU, the posterior edge was close to the posterior wall of the esophagus (Figure 3), and the CT value was 38 HU (Figure 4), and the outer edge of the esophagus was smooth. On August 5, 2011, endoscopic treatment was performed. First, an injection needle was inserted into the tumor and aspirated, but no liquid flowed out. Then, the bottom of the lesion was injected with physiological saline indigo rouge, and then the lesion was removed in pieces with a snare. The surgically removed specimen was formed into a honeycomb-like sac structure, and gel-like matter was seen in the sac (Figure 5). The operation was smooth, and the wound surface was smooth and no obvious bleeding was observed. Postoperative pathology showed that the section was partially bundle-shaped, covered with squamous epithelium under the microscope, and the malformed vessels in the interstitium were proliferated and partially dilated, and the content was stained with eosin (Figure 6). He was discharged from hospital 5 days after operation, and there was no obvious discomfort after telephone follow-up 3 months later.