Volume 92  ·   Issue 10  ·  2012

Helicobacter pylori (Hp) infection is a big problem related to public health. Hp infection is not only closely related to the confirmed upper gastrointestinal tract diseases: chronic gastritis, peptic ulcer, gastric cancer and gastric mucosa-associated lymphoid tissue malignant lymphoma, but also involves many multi-system and multi-disciplinary diseases outside the gastrointestinal tract. China belongs to the country with high Hp infection rate, so the treatment of Hp infection has been the most popular research topic for gastrointestinal workers.

Endocrine therapy is one of the comprehensive therapeutic methods for hormone receptor positive breast cancer, but the appearance of primary and secondary drug resistance limits its efficacy. Nearly 50% of hormone receptor positive breast cancer patients are primary drug resistant to tamoxifen; However, in relapsed and metastatic breast cancer, drug resistance inevitably appears in patients with effective initial treatment, which leads to disease progression [1]. At present, targeted therapy is used on the basis of endocrine therapy to prevent or delay the emergence of drug resistance, and some achievements have been obtained from the mechanism elaboration to clinical trials.

Breast cancer is a malignant tumor with the highest incidence rate in women in China. Besides surgery, radiotherapy and chemotherapy, its treatment is also an effective treatment option for hormone receptor positive early stage breast cancer patients [1]. In recent years, with many large-scale clinical trial reports confirming the value of aromatase inhibitor (AI) in adjuvant therapy, AI is gradually replacing tamoxifen (TAM) in adjuvant endocrine therapy for postmenopausal hormone receptor positive breast cancer patients [1-2]. Such patients will face three problems when choosing the treatment strategy of AI: first, the choice of medication regimen, including initial AI or initial TAM; The second is the choice between different AIs, including steroidal AI and non-steroidal AI; The third is the choice of AI treatment course.

Any clinical treatment should be carried out according to the specific situation of the patient, but in the consensus opinion of Helicobacter pylori (Hp) infection in China [1], individualized treatment has a specific meaning. It refers to the specific analysis of the failure causes and proposed treatment methods for patients who have failed to eradicate Hp for many times, so as to achieve the purpose of eradicating Hp. After first-line treatment, second-line treatment, and even multiple remedial treatments, it is extremely difficult to eradicate Hp in these patients with Hp infection, which is a difficult problem that gastroenterologists often have to face. The reasons for patients' treatment failure are different, and doctors need to analyze the specific factors that may affect the effect of eradication treatment for each patient, and adjust the treatment plan in a targeted manner, so as to improve the success rate of eradication treatment. Now, we talk about how to carry out individualized treatment according to the specific situation of patients in clinical practice from the following aspects.

Helicobacter pylori (Hp) is closely related to upper gastrointestinal diseases such as peptic ulcer, chronic gastritis, gastric cancer, gastric mucosa-associated lymphoid tissue (MALT) lymphoma, etc. Eradication of Hp is an important measure to prevent and treat these diseases. Western medicine triple therapy (such as omeprazole + clarithromycin + amoxicillin, bismuth + amoxicillin + metronidazole, etc.) [1] once made the eradication rate of Hp reach more than 90%, but in recent years, due to the eradication rate of Hp resistance, it has dropped to less than 70%, so it is urgent to explore new treatment schemes. Chinese medicine has the characteristics of less adverse reactions, less drug resistance and will not cause intestinal flora imbalance, so Chinese medicine has certain advantages in the treatment of Hp infection. Therefore, it is a new path worth exploring to seek high-efficiency, low-toxicity and cheap anti-HP therapy from the perspective of Chinese medicine and integrated Chinese and Western medicine.

Since the discovery of Helicobacter pylori (Hp) in 1983, how to successfully eradicate Hp has been a research hotspot in this field, and the relevant consensus opinions are constantly updated. However, the research shows that the success rate of Hp eradication treatment is gradually decreasing. There are many reasons for the failure of Hp eradication, but the resistance of Hp to antibiotics is the most important reason. As the resistance rate of metronidazole and clarithromycin is increasing year by year, the success rate of standard triple therapy containing proton pump inhibitor (PPI), amoxicillin, clarithromycin or metronidazole in the eradication of Hp is mostly lower than 80%, which is difficult to accept [1]. Therefore, it is urgent to find other antibiotics with low resistance rate and determine a new "standard therapy" for Hp eradication treatment.

The discovery of Helicobacter pylori (Hp) is a major event in the history of medicine, and its discovery has made people have a brand-new understanding of the pathogenesis and treatment of upper gastrointestinal diseases such as chronic gastritis and peptic ulcer. In 1989, Krajden et al. [1] and Ferguson et al. [2] successively isolated and cultured Hp from dental plaque and saliva in 1993, and speculated that the oral cavity may be another certain habitat of Hp. Since then, many scholars have used different methods to isolate Hp or detect specific genes of Hp from the oral cavity of HP-positive gastric patients [3-4], indicating that oral Hp has a certain correlation with gastric Hp; Eskandari et al. [6] used PCR to detect Hp in dental plaque of patients without gastric Hp infection. The above findings indicate that human oral environment is also suitable for Hp aggregation and colonization.

According to statistics, the infection rate of Helicobacter pylori (Hp) is 50% in the world population, and the infection rate in China is 60% ~90%. Hp infection can lead to chronic gastritis, peptic ulcer, gastric cancer and mucosa-associated lymphoid tissue lymphoma (MALT) lymphoma. In addition, Hp infection is also an independent risk factor for cardiovascular diseases, unexplained iron deficiency anemia and chronic idiopathic thrombocytopenic purpura [1-2]. Therefore, eradication of Hp is crucial for patients with these diseases.

Objective To comparatively explore the risk factors of axillary lymph node metastasis (ALNM) in Uygur and Han patients with breast cancer.Methods A total of 243 female Han patients and 66 Uygur ones with T1 stage breast cancer were retrospectively studied by single and multi-factorial Logistic regression analysis.Results The rates of ALNM were 43.94％ and 30.86％ in Uygur and Han patients respectively.There was statistic difference between them.Statistic differences existed between these two nationals in gravidity and parity.Multi-Factorial Logistic regression analysis showed that age,gravidity and quadrant of tumor localized were the risk factors of ALNM while estrogen receptor (ER) ( + ) was the protective factor.Conclusions The rate of ALNM in Uygur patients with T1 stage breast cancer is higher than that in Han counterparts. More gravidity is an influencing factor. Younger age,more gravidity and location of tumor are the high risk factors for ALNM while ER ( + ) is the protective factor.

Objective To evaluate the morphology-based criteria for the ultrasonic assessment of axillary lymph node in primary breast cancer.Methods A total of 2256 T0-2N0 patients underwent axillary ultrasound preoperatively.Lymph nodes were classified as normal if no node was found or cortex thickness was even and ＜3 mm; abnormal,( 1 ) if cortex thickness was even but ≥3 mm or (2) focally thickened cortex ≥3 mm or (3) fatty hilum was absent.The patients in the abnormal group underwent ultrasound guided fine-needle aspiration (US-FNA).Except for positive lymph nodes,all the others underwent sentinel lymph node biopsy (SLNB).Results In this series,692 (30.7％ ) were pathologically confirmed positive LNs.Among them,214 (9.5％ ) were identified by US-FNA.And 361 were abnormal according to the above mentioned criteria.The proportions were 11.6％,54.8％ and 33.5％ in Group 1-3 respectively.The sensitivity,specificity,positive and negative predictive values of these criteria alone were 35.8％,92.8％,68.7％ and 76.6％ respectively.Conclusion The present morphology-based criteria for the ultrasonic assessment of lymph node status is both effective and practical in primary breast cancer.

Objective Recombinant human endostatin (rh-Endostatin),a protein modified by an additional nine-amino acid sequence to the N-terminal of endostatin,is a novel antiangiogenesis drug developed in China.The preclinical data suggested that it can inhibit proliferation and migration not only in endothelial cells,but also in some types of tumor cells.Theoretically,antiangiogenesis drugs should also be effective in the therapy of other solid tumors,including breast cancer. Here a prospective,randomized,controlled,phase Ⅱ trial of combining rh-Endostatin and neoadjuvant chemotherapy was performed to evaluate its efficacy and safety profiles in patients with breast cancer.Methods A total of 68 patients with pathologically confirmed breast cancer were randomly assigned to receive the neoadjuvant DE regimen (docetaxel:75 mg/m2,d1,epirubicin:75 mg/m2,d1 ) every 3 weeks with or without rh-Endostatin (7.5 mg/m2,d1 -d14).Surgical resection was performed after 3 cycles of neoadjuvant treatment.The primary end-points were objective response rate (ORR) and pathological complete response rate (PCRR) while the secondary end-points quality of life (QOL) and toxicity.Results Among all of them,64 were assessable for efficacy and 68 for toxicity.The ORRs were 90.9％ (30/33) and 67.7％ (21/31) in the combination and control groups respectively ( P =0.021 ).The stratification analysis showed that rh-Endostatin was more effective in the treatment of pre-menopausal and Eastern Cooperative Oncology Group (ECOG) =0 patients (P＜0.05).The PCRRs were 15.2％ (5/33) and 6.5％ (2/31) in the combination and control groups respectively (P =0.428 ).No significant difference was identified in QOL score and side effects ( P ＞ 0.05).Conclusions Compared with DE regimen alone,the combination of th-Endostatin with DE chemotherapy may achieve a higher ORR with no increased toxicity in breast cancer patients.Thus it can be utilized safely and effectively in the neoadjuvant treatment of breast cancer.

Objective To explore the miRNA differential expression profiles of hyperplastic scar and normal skin so as to further elucidate the pathogenesis of hyperplastic scar and search for new theraputic targets.Methods The total RNA was extracted from 5 human hyperplastic scar and normal skin tissues by Trizol.The specimens were collected from the First Affiliated Hospital of Nanchang University from November 2010 to May 2011,and purified by mirVanaTM miRNA Isolation Kit and then labeled and hybridized by miRNA Complete Labeling and Hyb Kit.The images of hybridization were analyzed by the Feature Extraction (v10.7 ) software and the microarray results confirmed by quantitative real-time reverse transcription-polymerase chain reaction (RT-PCR).Results In hyperplastic scar,92 miRNA genes were up-regulated and 13 down-regulated.The most significantly up-regulated miRNAs were hsa-miR-564 and hsa-miR-936, etc. while hsa-miR-451, hsa-miR-223, hsa-miR-363 and hsa-miR-29b-1 * became significantly down-regulated.The findings of RT-PCR on hsa-miR-21 and hsa-miR-451 ofregulation were in a high concordance with the microarray results.Conclusion Distinct differences of miRNA expression between human hyperplastic scar and normal skin, it may be closely correlated with the formation,development and evolution of hyperplastic scar.

Objective To evaluate the efficacies and toxicity of HAG ( HHT + Ara-C + G-CSF)regimen in patients with high-risk myelodysplastic syndromes(MDS).Methods A total of 97 patients with high-risk MDS received HAG regimen as the induction therapy.Results The comp山ete remission (CR) rate of all the patients was 52.3％ (45/86).The overall response (OR) rate was 66.3％ (57/86).The early mortality rate was 9.3％ (9/97).There was no significant difference in CR rate and OR rate between the patients aged≥ 60 and those ＜60.The OR rate was 29/34,9/12 and 6/13 in patients with favorable karyotype,intermediate karyotype and unfavorable karyotype respectively. The OR rate was higher in patients with favorable karyotype than those with unfavorable karyotype ( P =0.038 ).The major adverse effect was infection.Conclusion HAG regimen provides higher CR rate and OR rate for patients with highrisk MDS.

Objective Coronary flow velocity reserve (CFVR) is an important indicator of coronary endothelial functions and microcirculation.Pulse wave velocity (PWV) reflects the degree of aortic sclerosis and it is an independent predictor of cardiovascular events.The present study was designed to evaluate the correlation of large artery stiffness and CFVR.Methods A total of 101 consecutive subjects were enrolled to measure the brachial-ankle pulse wave velocity (baPWV).According to the presence or absence of higher baPWV ( ＞ 1400 cm/s),they were divided into 2 groups.Transthoracic echocardiography was employed to measure coronary flow velocity in coronary left anterior descending (LAD). Then after an intravenous infusion of adenosine triphosphate,the velocity of blood flow was measured when the vessel was in maximal dilation.The ratio of flow velocity of those in maximal dilation to those at rest was CFVR.Results The subjects with a higher baPWV ( ＞ 1400 cm/s) were markedly elder and had higher risks of hypertension and diabetes.Thus age,hypertension and diabetes contributed to arteriosclerosis.More importantly,the subjects with a higher baPWV ( ＞ 1400 cm/s) had a much lower level of CFVR(2.66:0.74 vs 2.95 +0.76; P＜0.01 )than those with a lower baPWV ( ＜ 1400 cm/s).Furthermore correlation analysis showed that CFVR and baPWV levels were significantly negatively correlated ( r =- 0.35,P ＜ 0.01 ).Conclusions A negative correlation exists between artery stiffness and coronary flow velocity reserve.The increased vascular stiffness may impair coronary endothelial function,cause the dysfunction of coronary microcirculation and raise the risks of cardiovascular events.

Objective To explore the efficacy of Jinghuaweikang capsules plus triple therapy (LACJ) in treatment of Helicobacter pylori (H.pylori) associated gastritis or duodenal ulcer,compare it with bismuth-containing quadruple therapy ( LACB ) and standard triple therapy ( LAC ) and analyze the antibiotic sensitivity of gastric mucosal H.pylori strains from the failed patients.Methods A total of 565 patients with H.pylori infection were recruited from 11 hospitals from January 2010 to June 2011.There were 336 males and 229 females.They underwent gastroendoscopy examination due to upper gastrointestinal symptoms and had never received H.pylori eradication therapies. Duodenal ulcer patients were divided randomly into LACJ therapy group,LACB therapy group and LAC therapy group while gastritis patients LACJ therapy group and LACB therapy group.Group LAC received lansoprazole 30 mg + amoxicillin 1000 mg + clarithromycin 500 mg,twice a day,for 7 d (d1 -7).Group LACJ:LAC therapy plus Jinghuaweikang,3 capsules,twice a day,for 7 d (d1 -7) then Jinghuaweikang,3 capsules,twice a day,for 14 d (d8 -21 ).Group LACB:LAC plus bismuth potassium citrate 220 mg,twice a day,for 7 d (d1 -7) and then bismuth potassium citrate 220 mg,twice a day,for 14 d (d8 -21 ). All duodenal ulcer patients received lansoprazole ( 30 mg,once a day) for 14 days after the first 7-day of treatment ( d 8 - 21 ).At least 28 days after the end of treatment,all patients underwent 13C urea breath test.Gastric mucosa was collected under endoscopy from the failed patients.The detection technique of gene chip was employed to detect antibiotics resistant gene from mucosa. Results The eradication rates of duodenal ulcer patients in groups LACJ,LACB and LAC were as follows:per-protocol ( PP),80.2％ (77/96),89.9％ (89/99) and 72.2％ (70/97) (P =0.007),intention-to-treat ( ITT),78.6％ (77/98),88.1％ (89/101) and 70.0％ (70/100)( P =0.007).No statistical differences existed between groups LACJ and LACB or LAC ( all P ＞ 0.05 ).But there were statistical differences between groups LACB and LAC ( both P =0.002 ).The eradication rates of PP and ITT of chronic gastritis patients in groups 1ACJ and LACB were as follows:75.8％ (97/128),74.6％ (97/130) vs 83.8％ ( 109/130),80.1％ (109/136) ( both P ＞ 0.05).The symptomatic improvements of abdominal pain,burning and acid reflux of duodenal ulcer patients in group LACJ were higher than those in groups LACB and LAC.There were statistical differences between groups LACJ and LAC (all P ＜ 0.05 ).The symptomatic improvements of bloating and belching for chronic gastritis patients in group LACJ were higher than those of group LACB.But no significant difference existed between two groups ( all P ＞0.05 ).Sixty samples of gastric mucosa were collected from the failed patients.The detection rates of antibiotic-resistant gene to clarithromycin and amoxicillin were 60.0％ ( 36/36 ) and 18.3％ ( 11/60 )respectively.Conclusions The efficacy of LACJ for the treatment of H.pyloriinfection patients is similar to LACB and superior to LAC. And the symptomatic improvement of patients is better than the other two regimens.The main cause of treatment failure is antibiotic resistance of H.pyloristrains.

Objective To explore the effects and probable mechanism of CoCl2-induced hypoxic preconditioning on the migration of bone marrow derived mesenchymal stem cells (BMSC). Methods BMSC were cultured by whole bone marrow adherence and identified by surface markers (CD29,CD90 and CD45) with flow cytometry (FCM).The methods of 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and FCM were applied to establish the model of CoC12-induced hypoxic preconditioning.The migratory capacity of BMSC with hypoxic preconditioning was analyzed by the assays of scratch wound healing and transwell migration.The protein and mRNA expressions of HIF-1α and CXCR4 of BMSC were detected by Western blot and real-time polymerase chain reaction (PCR).After silencing HIF-1α by siRNA technique and blocking CXCR4 by its antagonist AMD3100,the changes of migratory capacity of BMSC were also tested.Results Cultured BMSC were uniformly positive for CD29 and CD90 and negative for CD 45.According to the results of MTT and FCM,200 μmol/L CoCl2 and 24 h culture time was the ideal hypoxic preconditioning model of BMSC.The migratory capacity of BMSC in hypoxic preconditioning group was higher than the one in control group( scratch wound healing assay:(0.396 ±0.018)mm vs (0.200 ±0.011 )mm,transwell migration assay:21.0 ± 4.5 vs 8.5 ± 1.7,both P ＜ 0.05 ).The protein and mRNA levels of HIF-1α and CXCR4 of BMSC in hypoxic preconditioning group were significantly higher than in control group.After silencing HIF-1α or blocking CXCR4 by AMD3100,the migratory capacity of BMSC in hypoxicpreconditioning group decreased and had no difference with the control group. Conclusions Hypoxic preconditioning may enhance the migratory capacity of BMSC in vitro.And it is partially attributable to the up-regulation of HIF-1α/CXCR4 axis after preconditioning.

Objective To evaluate the feasibility of genetic modification of mesenchymal stem cells (MSC) with Sonic Hedgehog(Shh) gene.Methods The pcDNA3.l-Shh eukaryotic expression plasmid was constructed and its correctness evaluated by the restriction enzyme analysis and sequencing. MSC were isolated from Wistar rats by density gradient centrifugation and purified,transfected with pcDNA3.1-Shh,blank plasmid pcDNA3.1 ( - ) or pmaxGFP respectively by NucleofectorTM.The protein expression of Shh in MSC was detected by Western blot after 48 hours.Results Correct construction of pcDNA3.1-Shh was identified by the methods of restriction enzyme analysis and nucleotide sequence determination. The expression of green fluorescent protein (GFP) could be observed by fluorescence microscopy after 48 hours.The expression of Shh gene was detected by Western blot.But the MSC transfected with empty plasmid expression was not detected.Conclusions Recombinant Eukaryotic expression plasmid pcDNA3.1-Shh is successfully detected in rat MSC.It may provide experimental rationales for the future gene therapy.

Objective To explore the apoptotic effect of follicular lymphoma and related mechanism induced by YM155 in vitro and provide laboratory rationales for the clinical treatment of follicular of lymphoma with YM155 in the future.Methods SUDHL-4 cells were cultured to logarithmic phase and transferred to 96-well plates.There were a series of YM155 concentration gradients:100,10,1,0.1 and 0 ng/ml and cultured for 24,48 and 72 h.After the addition of CCK-8 reagent for 2 h at each time point,optical density values were obtained from the cell growth inhibition curves depending on time and drug concentration and the half growth inhibition concentration ( IC50 ) values calculated.SUDHL-4 cells were cocultured with YM155 (1 ng/ml) for0,24,48 and72 h respectively.Then flow cytometry (FCM) was used to detect apoptosis.SUDHL-4 cell line was treated with YM155 for 24 and 48 h to extract the total RNA.The mRNA expressions of bcl-2,bcl-xl,bid,bax and survivin gene at the timepoint of 48 h and the survivin mRNA expression at 24 h were detected by reverse transcription-PCR(RT-PCR).The protein expressions of survivin,caspase-9,cleaved caspase-9,caspase-3 and cleaved caspase-3 were detected at each timepoint with Western blot respectively.Results SUDHL-4 cell line showed significant growth inhibition effect depending on time and dose.And the 24,48,72 h IC50 was 6.1,2.7 and 1.2 ng/ml respectively.SUDHL-4 cells stained AnnexinV-FITC and PI examined by FCM demonstrated that the proportion of AnnexinV-FITC positive cells gradually increased with time(17.3％ ±2.1％,35.7％ ±3.3％,54.6％ ±4.3％ vs 2.1％ ± 0.3％,all P ＜0.05). And the results of real-time fluorescent PCR proved that YM155 decreased the expression of survivin gene obviously(24 h:0.72 ± 0.02,48 h:0.56 ± 0.01 vs 1.00,both P ＜ 0.05 ) but had little effects on the gene expressions of bax,bid,bcl-2 and bcl-xl. The Western blot results further confirmed that the protein expressions of survivin and caspase-3 decreased with time while caspase-9 and cleaved caspase-9 showed no obvious changes. But cleaved caspase-3 increased significantly.Conclusions YM155 displays significant apoptotic effects in SUDHL-4 cell lines. The mechanism may be the direct activation of caspase-3 through the down-regulation of survivin.And the apoptotic pathway is probably not regulated by bcl-2 family.

Objective To explore the protective effects and potential mechanisms of 1α,25 (OH)2D3 (VitD3 ) on pancreatic β-cells.Methods The apoptosis of NIT-1 cells was induced by interleukin-1 β(IL-1 β ) and interferon-γ (IFN-γ) in vitro.Then the apoptotic rate of NIT-1 cells was determined by Hoechest33342 staining and Annexin V-FITC/PI flow cytometry.The insulin secretion level of NIT-1 cells was measured by ELISA.The NIT-1 cells were treated with VitD3 at the final concentrations of 10-8 mol/L or underwent transient transfection with vitamin D receptor (VDR)-SiRNA.Results After the treatment of VitD3,the apoptotic rate of NIT-1 cells decreased to 39.7％.There were significant differences in apoptotic rate between the VitD3 treatment and IL-1 β/IFN-γ groups (68.4％) ( P ＜ 0.01 ).Similarly impaired glucose-stimulated insulin secretion (GSIS) of NIT-1 cells recovered ( (7.34 ± 0.21 ) ng/ml ) after the treatment of VitD3 as compared with the IL-1 β/IFN-γ group ( ( 4.88 ± 0.32 ) ng/ml,P ＜ 0.01 ).Moreover,most of the protective effects of VitD3 on pancreatic β-cells could be blocked by the transfection of VDR-SiRNA.Conclusion VitD3 may protect pancreatic β-cells from cytokine-induced apoptosis and impaired insulin secretion through its conjugation with VDR.

Many pathogen infections are related to the occurrence of community-acquired pneumonia (CAP). The role of viruses in the occurrence of pneumonia has attracted more and more attention, especially the emergence of SARS coronavirus, avian influenza virus A (H5N1), and 2009 influenza A (H1N1) virus (pH1N1), which have attracted people's attention again. In the past ten years, some new respiratory viruses have been discovered, such as human metapneumovirus, coronavirus NL63 and HKU1, and human boca virus [1-2]. Compared with the sufficient clinical research abroad, the research on adult viral pneumonia in China mainly focuses on SARS coronavirus, H5N1 and pH1N1, while the research on other respiratory viruses is very few [3]. Recent research on adult viral CAP at home and abroad is summarized as follows.

Hemophagocytic syndrome (HPS), also known as hemophagocytic lymphohistiocytosis (HLH), is a group of syndromes characterized by fever, hepatosplenomegaly, pancytopenia and hemophagy in bone marrow, liver, spleen and lymph nodes. It can be caused by a variety of pathogenic factors, causing abnormal activation and proliferation of lymphoid, monocyte and phagocytic system, secretion of a large number of inflammatory cytokines, thus leading to severe or even fatal inflammatory state. According to different etiologies, HLH can be divided into two categories: primary HLH and acquired HLH. The definition, pathogenesis, diagnosis and differential diagnosis and treatment concept of primary HLH are expounded in this paper.

The patient was an 84-year-old male who was admitted to Xijing Hospital on June 20, 2011 due to "neutrophil elevation for 1 month". The patient was physically examined in another hospital one month ago and found that the total number of white blood cells was 13×109/L, neutrophils were 0.75, and the chest X-ray film showed lung inflammation. After anti-infective treatment with "azithromycin and moxifloxacin hydrochloride" according to pneumonia, the body temperature increased, with a maximum of 38.0℃, mostly in the afternoon. There were no chills, night sweats, hemoptysis, chest tightness and chest pain. About 10 days after treatment, the chest X-ray showed that the lung inflammation subsided and the body temperature returned to normal, but the blood routine showed that the total number of white blood cells and the proportion of neutrophils were still high. The history of bronchiectasis and chronic atrophic gastritis was more than 30 years, and the history of coronary heart disease and cerebral infarction was more than 10 years. He walked into the department and complained of a decrease in appetite and food intake and a weight loss of about 3 kg in the past 2 months.