Volume 92  ·   Issue 22  ·  2012

In order to strengthen the construction of scientific ethics and academic norms, maintain the integrity of scientific research work and academic activities, create a good academic atmosphere for academic journals, improve the professional ethics level of scientific and technological workers and the editors and publishers of scientific and technological journals in China, ensure the healthy development of scientific and technological undertakings in China, and make positive contributions to the construction of an innovative country, we solemnly issue a joint statement.

With the rapid development of science and technology in our country, the international influence of Chinese scientific papers is constantly increasing, and the importance of strengthening the moral norms of sci-tech journals is increasingly evident. As journalists, we know that trust, fairness and responsibility are the guarantee of the benign operation of society, and academic integrity is the basic guarantee of scientific research and its development. It is the inevitable responsibility of Chinese sci-tech journals to strengthen scientific moral norms, promote scientific research integrity, maintain the seriousness of academic activities, and create a good academic atmosphere. Today, China Association for Science and Technology issued the Joint Statement of Science and Technology Journals of National Societies affiliated to China Association for Science and Technology on Strengthening the Scientific Ethics Norms of Sci-tech Journals and Creating a Good Academic Atmosphere, which is just at the right time.

Although the pathogenesis of pulmonary arterial hypertension is not completely understood at present, studies in the past 20 years have shown that various pathogenic factors act on pulmonary blood vessels, causing pulmonary vascular injury, causing cytokine imbalance between vasoconstriction or proliferation and vasodilation or anti-proliferation, pulmonary arteriole remodeling, pulmonary arteriole occlusion, and finally pulmonary arterial hypertension. At present, it is clear that the imbalance of endothelin, nitric oxide and prostacyclin is an important cause of pulmonary arterial hypertension formation. Targeted drugs for the treatment of pulmonary arterial hypertension have been developed for their synthetic and metabolic pathways, and some drugs for other pathways of pulmonary arterial hypertension are also being developed. The application of these drugs aims at correcting the imbalance of pulmonary vascular cytokines, inhibiting remodeling, thus delaying or reversing pulmonary arteriole occlusion and reducing pulmonary vascular resistance. The combination of targeted drugs and traditional therapeutic drugs has greatly enriched the drug treatment of pulmonary arterial hypertension, The exercise tolerance, quality of life and survival rate of patients with pulmonary hypertension were significantly improved.

Objective To describe an efficient and effective method of using Olympus TURis button plasma vaporization electrode plus loop electrode for transurethral vapor enucleation and resection of prostate.Methods Between July 2011 and October 2011,the investigators performed transurethral vapor enucleation and resection of prostate using Olympus TURis button plasma vaporization electrode plus loop electrode in 16 consecutive patients at our institution. The parameters of prostate weight,International Prostate Symptom Score (IPSS),quality of life (QOL),operative duration,blood loss volume,catherization period,duration of hospitalization,perioperative complications and the weight of enucleated tissue were evaluated. IPSS and QOL were recorded during the follow-up.Results No patient had significant blood loss or signs of transurethral resection syndrome.The mean patient age was 67.3 ± 8.1years.Mean preoperative prostate weight was 49 ±24 g ( range:19 -91 ) and mean resected tissue weight 36 ± 16 g ( range:10 - 50).Serious complications were not observed.Operative duration was 116 ± 31minutes,mean catheter time 4.9 ± 1.8 days and the duration of hospitalization was 16.6 ± 5.5 days.Transurethral vapor enucleation and resection of prostate induced significant,pronounced,immediate and lasting improvement in IPSS ( 15.6 ± 6.8 vs 6.7 ± 2.4,P ＜ 0.01 ) and QOL ( 3.4 ± 1.4 vs 1.6 ± 0.6,P ＜0.01 ).Conclusion Transurethral vapor enucleation and resection of prostate with Olympus TURis plasma button electrode is a safe,effective and thorough surgical method in the treatment of benign prostatic hyperplasia.

Objective To explore the diagnosis and treatment of focal nodular hyperplasia (FNH)of liver.Methods The clinical data were retrospectively analyzed for 26 cases with confirmed FNH of liver from January 2006 to July 2011.Enhanced computed tomography and magnetic resonance imaging were performed.Results Among them,22 cases underwent surgical resection,including left hemihepatectomy ( n =4),left lateral lobe hepatectomy ( n =5) and partial hepatectomy ( n =13).The pathological diagnosis was FNH.Most tumors were of soft texture.The gross surface was brown or yellow-brown in color.Central scar and radiating fibrous septas were spotted in some cases.There was no recurrence during a follow-up period of 4 months to 5 years.Serial observations were conducted for 4 cases with a follow-up period of 2 -4 years.No growth was observed.Conclusions Enhanced CT and MRIare important diagnostic tools.The confirmed cases may be followed up.Surgical resection is effective with an excellent prognosis.

Objective To explore the clinicopathological characteristics of aggressive angiomyxoma (AAM) so as to boost the level of diagnosis and treatment.Methods Seven cases of aggressive angiomyxoma were studied with light microscope and immunohistochemistry.Antibody of Vimentin,Desmin,CD34,smooth muscle actin ( SMA ),estrogen receptor (ER),progesterone receptor ( PR ),androgen receptor (AR),S-100,p53 and Ki67 were used.Results There were 3 males and 4 females with an average age of 43.1 years.Three patients had urinary compressive complaints while others were symptomfree.All underwent surgical resection. Three patients were recurrent after operation. The tumor was generally nodular and its cut surface appeared jelly-like.Histologically,on myxoid stroma background,it was composed of a mixture of spindle and stellar cells without atypical cell and mitosis.There were varioussized vessels with thin to thick walls.The scattered muscle-like cells had a perivascular distribution.Immunohistochemistry showed tha(t) tumor cells were positive for Vimentin( + )7/7,Desmin( + )7/7,CD34 ( + )3/7,SMA( + )2/7,ER( + )6/7,p53( + )4/7,Ki67( + ) 1％ -8％ and negative for PR,AR and S-100.Conclusions As a rare soft tissue tumor,AAM extremely rare in males.Owing to its local invasion and high recurrence,extensive resection and long-term follow-up are necessary.

Objective To evaluate the effects of domestic rosuvastatin tablets on coronary plaque in the patients with mild-to-moderate coronary artery stenosis through virtual histology-intravascular ultrasound (VH-IVUS).Methods Eighty-three patients with mild-to-moderate coronary artery stenosis of acute coronary syndrome( ACS)were enrolled and randomized into test group (domestic rosuvastatin,10 mg/day,n =42) or control group ( CRESTOR,10 mg/day,n =41 ).The serum lipid levels,diameter stenosis (DS)on quantitative coronary angiography (QCA),MLA (minimal lumen area),plaque burden and component of target lesion on VH-IVUS were evaluated at baseline and at 6-month follow-up.Results After 6 months,the levels of total cholesterol (TC),low density lipoprotein cholesterol (LDL-C) and triglyceride (TG)significantly decreased while the high density lipoprotein cholesterol (HDL-C) level significantly increased in two groups( P ＜ 0.05 ).VH-IVUS analysis showed that the proportion of necrotic core significantly decreased ( domestic rosuvastatin:14.8％ ± 7.0％ vs 22.6％ ± 7.5 ％,P ＜ 0.05,crestor:14.9％ ± 7.1％ vs 23.1％±7.7％,P ＜0.05) and the proportion of fibrous tissue significantly increased ( domestic rosuvastatin:51.5％ ±9.9％ vs44.5％ ±9.7％,P＜0.05,crestor:51.4％ ±10.1％ vs 44.3％ ±9.8％,P＜0.05)in two groups.There were no significant changes in DS,plaque burden,MLA or the proportion of dense calcium and fibro-fatty tissue of target lesion in two groups( P ＞ 0.05 ).And no significant differences existed in serum lipid levels,DS,MLA,plaque burden and component between two group( P ＞0.05 ).Conclusion The 6-month treatment of rosuvastatin may stabilize the atherosclerosis plaque and prevent its progression in patients with mild-to-moderate coronary artery stenosis.

Objective To explore the risk factors of contrast-induced nephropathy (CIN) in patients after coronary artery intervention.Methods A total of 637 patients undergoing diagnostic coronary angiography or percutaneous coronary intervention were enrolled.They were divided into the CIN and nonCIN groups according to the changes in serum creatinine levels within 48 hours after coronary artery intervention.Then the relevant risk factors of CIN were analyzed.Results Among them,CIN occurred in 49 patients with an incidence of 7.7％.The patients with diabetes and renal insufficiency had higher incidence of CIN at 15.5％ and 22.5％ respectively.Logistic regression analysis showed that the risk factors of CIN included advanced age, smoking, diabetes, renal insufficiency, hypercholesterolemia and hyperuricemia.Conclusion For the patients of coronary artery intervention,the major risk factors of CIN are advanced age,diabetes and renal insufficiency.

Objective To explore the clinical characteristics of ischemic bowel disease (IBD) in young and middle-aged patients ( aged under 65 years old).Methods A total of 33 young and middle-aged IBD patients from January 1997 to July 2011 at Department of Gastroenterology,Renmin Hospital of Wuhan University were studied retrospectively.Results Among them,4 patients underwent surgical procedures while 29 patients received conservative medical management.All became cured after correct treatment.The disease with a nighttime onset took up 36.4％ (12/33).Among them,21.2％ (7/33)took oral contraceptives previously.Patients with no specific pre-existing condition accounted for 39.4％ ( 13/33 ).Abdominal pain and hematochezia were the chief complaints of all patients.The laboratory findings were nonspecific.The radiographic examination remained a major diagnostic tool.And 51.5％ ( 17/33 ) patients had typical colonoscopic manifestations.Conclusion More attentiou should be paid to young and middle-aged patients with claasic abdominal pain,hematochezia and a lack of baseline cardiovascular disease.

Objective To explore the clinical significance of trefoil factor 1 ( TFF1 ) protein expression and serum pepsinogen(PG) concentration in benign and malignant gastric ulcers.Methods The TFF1 protein expression was evaluated by immunohistochemistry in biopsies of gastric mucosa from 18 normal controls,25 patients with gastric ulcer and 13 patients with ulcerative gastric cancer at our hospital during January to June 2011. The serum concentrations of PG Ⅰ and PG Ⅱ were detected by enzyme-linked immunosorbent assay (ELISA) and PG/PG Ⅱ (PGR) was subsequently calculated.Results The expression of TFF1 protein increased significantly in ulcerative and peripheral gastric mocusa and peripheral mocusa of gastric cancers versus that in normal controls and the ulcerocancer group ( 3.04％ ± 0.20％,3.00％ ±0.20％,3.23％ ±0.26％ vs 1.67％ ± 0.18％,0.46％ ±0.18％,all P ＜0.01 ).The elevated expression of TFF1 increased the risk of gastric ulcer ( OR:1.365,95％ CI:1.065 - 1.749,P =0.014) while the down-regulation of TFF1 significantly increased the risk of ulcerocancer ( OR:3.067,95％ CI:1.391 -6.757,P =0.005).The serum levels of PG Ⅰ and PG Ⅱ in gastric ulcer group were significantly higher than that in normal control and ulcerocancer group( (150 ±27),(28 ±9) vs (121 ±22).(17 ±7),(79 ±12),(20 ± 5 )μg/L,all P ＜ 0.01 ).The PG Ⅰ level and PGR decreased significantly in the ulcerocancer group versus normal control (both P＜0.01).But there was no statistical difference in PGⅡ (P＞0.05).Receiver operating characteristic curve analysis revealed that PG Ⅰ and PGR were valuable for the diagnosis of malignant gastric cancer with an area under curve of 0.975 and 0.914 respectively.Conclusions The expression of TFF1 protein increases in gastric ulcer but decreases in gastric ulcerocancer.The elevated serum levels of PG Ⅰ and PG Ⅱ indicate benign ulcer while a marked decline of serum PG Ⅰ and PGR serves as a risk signal of malignant gastric ulcer.The evaluation of expression profiles of TFF1 protein and PGs is helpful for the differentiation of benign gastric ulcer from malignant ulcerocancer.

Objective To detect the presence of antibodies to cyclic eitrullinated peptides (antiCCP) in patients with chronic hepatitis B virus (HBV) infection and evaluate its potential clinical significance.Methods Serum samples of 280 patients with chronic HBV infection and 40 healthy controls were collected from May 2011 to October 2011 and tested for anti-CCP and IgM-rheumatoid factor (RF).Anti-CCP was detected by ELISA and RF by immunonephelometry.All of 280 patients with chronic HBV infection were divided into 3 groups according to joint symptoms:asymptomatic group,HBV-associated arthropathy group and HBV concomitant RA group.Meanwhile,according to liver disease,they were divided into 3 groups:carrier group,chronic hepatitis group and cirrhosis group.Results The positive rates of anti-CCP and RF were 5.7％ and 13.9％ in patients with chronic HBV infection respectively.Anti-CCP was detected in 3 of 265 non-RA (1.1％) and 13 of 15 RA patients (86.7％ ).And RF were detected in 27 of 265 non-RA ( 10.2％ ) and 12 of 15 RA patients (80.0％ ).Twelve of 15 RA patients were positive for both anti-CCP and RF.The specificity of anti-CCP for RA was 98.9％ in chronic HBV infection while the specificity of RF 89.8％ ( P ＜0.01 ).Compared with the positive detection rates of anti-CCP and RF among liver disease subgroups,no significant difference existed between the subgroups.The levels of anti-CCP and RF in HBV concomitant RA group were statistically higher than those in asymptomatic group,HBV-associated arthropathy group and healthy controls ( all P ＜ 0.01 ).The level of RF in patients with HBV-associated arthropathy group was higher than that in asymptomatic group ( U =6017,P ＜ 0.05 ).Conclusion It is better to detect anti-CCP than RF to discriminate non-RA from concomitant RA in patients with chronic HBV infection.

Objective To study the technical feasibility of simplified total arch replacement via stented elephant trunk fenestration in the treatment of acute Stanford type A aortic dissection.Methods A total of 42 consecutive patients with acute type A aortic dissection underwent total aortic arch replacement plus fenestrate stented elephant trunk implantation under hypothermic cardiopulmonary bypass and bilateral antegrade cerebral perfusion between August 2008 to February 2011. The aortic arch was accessed longitudinally.Transection of aortic arch was performed between left common carotid artery and left subclavian artery.A stented elephant trunk was inserted in descending aorta.Then the reconstruction of left subclavian artery was made by fenestration in stented elephant trunk.Finally 3-branched graft was used to complete the reconstruction of aortic arch.Results Operations were performed successfully.The mean cardiopulmonary bypass (CPB) time was (156 ±42) min,mean aortic cross-damp time (91 ± 18) min,mean circulatory arrest time (20 ± 5 ) min and mean antegrade cerebral perfusion (ACP) time (33 ± 7 )min.No postoperative death occurred.The incidence of temporary neurological dysfunction was 4.8％ (2/42).They underwent neither re-exploration for postoperative hemorrhage nor hoarseness due to recurrent nerve palsy.Left radial arterial pulses were palpable in all of them.None had sensory deficit and dyskinesia of left arm.All their angiographic findings showed complete patency of left subclavian artery.There was neither space nor blood flow around the stented elephant trunk.The false lumen of descending aorta around elephant trunk closed and obliterated in all cases.Conclusions The above-mentioned technique of modified total aortic arch replacement provides a distinct operative field and may achieve simple but reliable anastomosis with less bleeding.Thus aortic arch replacement becomes easier and more effective.

Objective To compare the chemotherapeutic efficacies of third-generation plus platinum doublets in advanced non-small cell lung cancer (NSCLC) patients.Methods A total of 1112 patients were diagnosed as advanced NSCLC at Chinese Academy of Medical Science and Cancer Hospital from January 2005 to August 2009.Their clinical efficacies and regimen compositions were retrospectively analyzed.All calculations were performed by SPSS 17.0.Results Differences in objective response rate (ORR) existed among four third-generation agents ( paclitaxel,gemcitabine,vinorelbine and docetaxel)plus platinum doublets. Their ORRs were 35.6％,35.4％,25.9％ and 37.4％ respectively (x2 =16.331,P =0.001 ).And vinorelbine doublets had the lowest ORR ( all P ＜0.01 ).The ORRs of cisplatin and carboplatin doublets were 35.2％ and 33.5％ respectively.There was no difference in ORR among them ( x2 =0.352,P =0.569 ).Subgroup analysis showed that the ORRs of four third generation plus platinum doublets were 34.8％,35.3％,23.2％ and 37.1％ in non-agers.And the vinorelbine doublets performed the worst.In the patients with squamous-cell lung cancer,the ORRs of paclitaxel and gemcitabine doublets were 45.5％ and 28.4％ respectively.And the paclitaxel doublets had the better performance ( x2 =5.250,P =0.026).When combined with carboplatin,the ORRs of four doublets were 36.2％,16.7％,15.4％and 32.0％ respectively.And the paclitaxel regimen was more effective than the gemcitabine and vinorelbine regimens (P =0.018 and P =0.034). The influences of subsequent therapy were nullified when the progression-free survival (PFS) was analyzed.The PFSs of these doublets were ( 3.67 ± 0.19 ),( 2.95 ±0.18),(3.05 ± 0.36) and (3.40 ± 0.37 ) months respectively.There was no difference among them.Pairwise comparisons showed that the mean PFS of patients on paclitaxel doublets was longer than those on gemcitabine doublets.And their PFSs were (3.67 ±0.19) and (2.95 ±0.18) months respectively (x2 =7.037,P =0.008 ).The PFSs of cisplatin and carboplatin doublets were ( 3.05 ± 0.14 ) and ( 3.65 ±0.20) months respectively.The patients on carboplatin doublets had a longer PFS than that of those on cisplatin doublets (x2 =6.012,P =0.014).Conclusions No difference exist in ORRs among different third-generation plus platinum doublets.But as the first-line treatment of advanced NSCLC,carboplatin doublets is superior to cisplatin doublets in terms of PFS.

Objective To establish a nude murine model of human primary hepatic lymphoma (PHL) with surgical orthoiopic implantation of histologically intact human tumor tissue and in vivo continuous orthotopic passage.Methods Histologically intact lymphoma tissues harvested intraoperatively from a PHL patient were othotopically transplanted into liver parenchyma of nude mice and in vivo continuous orthotopic passage in nude mice was used to develop a nude murine model mimicking the biological characteristics of PHL patients.Histopathology (light microscopy and immunohistochemistry),serological test,karyotypic analysis and flow cytometry were used to explore the tumorgenecity, invasion and metastasis.Results An orthotopic nude murine model of PHL,named HLBL-0102,was successfully developed.Histopathology of transplanted tumors showed primary hepatic lymphoma ( diffuse large B cell )stained positive for CD20,CD79a and MUM1.Serological test in tumor-bearing mice indicated that alphafetal protein (AFP) was negative and hepatitis B surface antigen (HBsAg) positive.The serum level of lactate dehydrogenase ( LDH ) was elevated to an average of ( ( 1223 ± 258 ) vs ( 124 ± 54) U/L,P ＜ 0.01 ).The chromosomal number of transplanted tumors was between 55 and 59.The DNA index (DI) of 1.7 ±0.2indicated heteroploid.So far HLBL-0102 model has been passed for 42 generations in nude mice.A total of 320 nude mice were used for transplantation. The growth rate and resuscitation rate of liquid nitrogen cryopreservation of transplanted tumors were both 100％.The transplanted tumors grew invasively in the liver of nude mice and destroyed adjacent liver tissues and bile ducts,veins and arteries of portal area.There was no involvement of other tissues,organs and distal lymph nodes.Conclusion An orthotopically transplanted model has been successfully established for human primary hepatic lymphoma in nude mice.

Objective To explore the changes of inferior collicular (IC) neurons after noise exposure cochlea injury in guinea pig to elucidate the encoding mechanism of pure tones,observe the changes of IG gamma-amino butyric acid (GABA) after cochlear damage by acoustic trauma and understand the possible mechanism of symptoms such as noise-induced tinnitus,hyperacusis and loudness recruitment.Methods The responses of IC neurons to pure tone stimuli were observed in guinea pig at Day 1 and Days 11 -21 after cochlear damage induced by noise exposure.And the IC neurons of normal guinea pig were assigned as the controls.Reverse transcription-polymerase chain reaction (RT-PCR) was used to measure the concentrations of GABAA and GABAB receptors.Results ( 1 ) The types of frequency reaction area (FRA) in the experiment group were the same as those in the control group(V-shape 84.8％,W-shape 8.9％,N-shape 6.3％ ).But the percentages of types were markedly different at Day 1 ( V-shape 63.9％,W-shape 18.1％,N-shape,18.1％ ) and Days 11-21 (V-shape 84.2％,W-shape 12.3％,N-shape 3.5％ ) after noise exposure.(2) After noise exposure,there was a marked fault in characteristic frequency (CF) and depth function map corresponding to 4 kHz( noise frequency).The rake ratio of CF and depth linear function map in the experiment group was lower than that of the control group.The control group,Day 1 and Days 11 -21 after noise exposure,the rake ratios were 6.6,5.8,5.2 respectively.(3) GABAA/GABAB receptors decreased markedly at Days 1,11 and 21 post-exposure compared to normal controls.And the values increased gradually with the prolonged time after exposure.The above findings conformed to the changes of electrophysiology of IC.Conclusions After acoustic trauma,the responses of IC neurons to pure tone stimuli change with the elongation of time.It may be explained by the changes of IC GABA receptors after noise exposure.

Objective To assess whether the occurrence of coronary artery lesion was correlated with the changes of endothelial progenitor cell (EPC) number and function in murine model of Kawasaki disease (KD).Methods Lactobacillus casei cell wall extract (LCWE) was prepared and then C57BL/6 mice received a single intraperitoneal injection of LCWE for inducing KD.Twenty-four mice were categorized randomly into 3 groups:KD model group at Day 14 post-injection,KD model group at Day 56 post-injection and control group with an intraperitoneal injection of phosphate buffered solution (n =8 each).The number of circulating EPC was defined as CD34 + Flk-1 + CD45 - from mice.Meanwhile,bone warrow mononuclear cells were cultured in vitro to expand EPC for functional analysis. After 7 days of culturing,EPC were inoculated onto culture plate and thiazolyl blue assay was used to measure the absorbance value by enzyme labeling instrument to evaluate the proliferation.The adhesion of EPC was performed by replating cells on fibronectin coated dishes and then counting the number of adherent cells.The migration of EPC was assayed by Transwell.Results Focal inflammatory infiltrate was evident in coronary artery trunk and a series of branches at Day 14 post-injection.The inflammatory cell infiltrate consisted of mononuclear lymphocytes.The number of circulating EPC were significantly lower in the Day 14 LCWE-treating murine model versus the controls (0.017％ ±0.008％ vs 0.028％ ±0.007％,P ＜0.01 ).Disruption of elastin was consistently observed at Day 56 post-injection.And there was no apparent recovery in number of EPC (0.016％ ±0.007％,P ＜ 0.01 ). When bone marrow mononuclear cells were cultured in vitro,the colony-forming ability of EPC decreased in the KD model group at Day 14 post-injection versus the controls.Test of proliferating ability showed that the absorbance was 0.39 ±0.11 in MTT experiment and decreased than the controls (0.61 ±0.14,P ＜ 0.01 ).Adhesion and migration were also down-regulated versus the controls ((3.1 ±:0.6) and (3.2±0.6) vs (6.4±1.2) and (6.2±0.5) cells/HPF,both P＜0.01).In the KD model group at Day 56 post-injection,the colony-forming ability of EPC was not recovered significantly.Proliferation ability,adhesion and migration were still decreased compared to the controls (0.38 ±0.09,(3.12 ±0.56) cells/HPF and (3.29 ±0.63 ) cells/HPF,all P ＜ 0.01 ).Conclusion The occurrence of coronary artery lesion may be correlated with the down-regulation of EPC number and function in murine model of KD.

Medical Record Abstract A 45-year-old male was admitted to hospital on April 26, 2011 due to numbness of limbs for 1 year, abdominal distension and yellowing skin for 2 months. In April 2010, the patient developed numbness of limbs, decreased appetite and dull abdominal pain after eating, accompanied by darkening of skin color and decreased libido without obvious trigger. Ultrasound showed gallbladder stones, and the symptoms did not improve after cholecystectomy on November 13, 2010. Since February 2011, the patient developed abdominal distension, accompanied by yellowing skin and yellowing urine color. Blood routine: white blood cells 15.82×109/L, hemoglobin 125 g/L, platelets 395×109/L; Urine routine: bilirubin positive (+ + +), residual negative (-); Fecal routine and occult blood (-). Liver and kidney function: alanine aminotransferase 25 U/L, aspartate aminotransferase 102 U/L, total bilirubin 114.81 μ mol/L, direct bilirubin 101.14 mol/L, alkaline phosphatase 1540 U/L, γ glutamyltransferase 423 U/L, creatinine 59 μ mol/L, urea nitrogen 3.38 mmol/L, total protein 58 g/L, albumin 25 g/L, blood calcium 2.05 mmol/L. Anti-hepatitis A virus-IgM antibody, hepatitis B virus surface antigen, anti-hepatitis C virus antibody, anti-nuclear antibody spectrum, anti-mitochondrial antibody, anti-smooth muscle antibody, anti-liver and kidney microsomal antibody L, anti-hepatocyte cytoplasmic antigen L antibody, anti-liver-pancreatic antibody/anti-soluble liver antigen antibody were all negative; The time of prothrombin was 16.3 s, the time of activated partial thromboplastin was 44.2 s, and the time of fibrinogen was 1.36 g/L; Ultrasound showed hepatomegaly, splenomegaly, ascites, common bile duct 6 mm, no intrahepatic and extrahepatic bile duct dilatation; The abdominal puncture showed yellow turbid ascites, the cells were 600×106/L, 90% mononuclear, 10% multinuclear.

In 2008, the World Health Organization put forward the MPOWER strategy to control tobacco epidemic, in which M stands for monitoring tobacco use and prevention policies, P stands for protecting people from tobacco smoke, 0 stands for providing tobacco cessation help, W stands for warning tobacco harm, E stands for enforcing regulations prohibiting tobacco advertising, promotion and sponsorship, and R stands for raising tobacco tax.

There are many differences between malignant tumors and normal tissues, among which, one significant difference is reflected in energy metabolism.The energy supply of human cells mainly comes from glucose metabolism.Glucose metabolism can supply energy adenosine triphosphate (ATP) through mitochondrial oxidative phosphorylation and glycolysis.Eighty years ago, Otto Warburg discovered that compared with normal cells, tumor cells choose to convert pyruvate into lactic acid even under the condition of sufficient oxygen supply, instead of glycolysis pathway of oxidative phosphorylation of pyruvate in mitochondria as the main way of capacity production. This phenomenon is called "Warburg effect" [1]. Compared with mitochondrial aerobic metabolism, glycolysis metabolism is a relatively inefficient capacity production process. Tumor cells can change their metabolic form from oxidative phosphorylation to glycolysis with inefficient capacity production without the presence of oxygen. This abnormality of energy metabolism has been confirmed in many tumors and has become an important characteristic of tumor cells [2].

The incidence of suicide and cardiovascular disease in advanced cancer patients increases within a few weeks after the diagnosis, but the results of previous studies are mostly interfered by factors such as the progression of cancer itself and the toxic and side effects related to treatment, simply because the knowledge of cancer diagnosis affects the psychological stress of patients and leads to serious consequences, there are few research data. Recently, a large sample retrospective cohort study explored the relationship between the knowledge of cancer diagnosis and the serious consequences related to the increase of mental stress in the short term after diagnosis (N Engl J Med, 2012, 366: 1310-1318.).

The patient, a 77-year-old man, came to the Department of Otolaryngology and Head and Neck Surgery of Beijing Tongren Hospital affiliated to Capital Medical University on September 5, 2011 due to pus in his right ear for 4 months. The patient developed pus in his right ear without obvious trigger 4 months before his visit, which was light yellow, thin, without bloodshot, odorless, without earache or ringing. There was no acute or chronic diseases such as tuberculosis and hepatitis in the past and contact history. Physical examination: body temperature 36.7℃, heart rate 78 beats/min, unpalpable superficial lymph nodes in the whole body, slightly swollen right external auditory canal, intact tympanic membrane, slightly inverted, and light cone disappeared. Laboratory tests were all in the normal range. No abnormalities were found on nasopharyngeal fiberoscopy, no abnormalities were found on chest orthographic radiography, and pure tone audiometry showed total deafness in the right ear. Temporal bone CT showed soft tissue shadows in the air chamber, mastoid cavity and tympanic chamber of the right temporal bone, incomplete bone walls of the squamous and mastoid regions, and no abnormal changes were found in the shape, density, position and hammer anvil joint of the ossiculae (Figure 1), showing right middle ear mastoiditis; MRI showed that large irregular shapes of isoTI mixed with T2 signal shadows were seen in the mastoid of the right middle ear, involving the right middle fossa and posterior fossa, and the meninges in the corresponding areas were thickened and strengthened. After enhancement, the lesions were unevenly enhanced, suggesting mastoiditis of the right middle ear with extensive surrounding infiltration (Figure 2). Preoperative discussion results: inflammatory lesions of the middle ear mastoid (tuberculosis cannot be excluded).

A 46-year-old male was admitted to the hospital on September 17, 2010 due to cough for 1 month and headache for 2 weeks. The patient developed cough without obvious trigger 1 month ago, accompanied by a little white sticky sputum, without fear of cold, fever, chest tightness, chest pain, hemoptysis, shortness of breath, etc., but was not diagnosed and treated; Two weeks ago, he developed persistent head distension and pain, occasional nausea, no vomiting and limb mobility impairment. The chest X-ray of the local hospital showed a patchy high-density shadow in the inner zone of the right lower lung and under the hilar. For further diagnosis and treatment, he came to the outpatient clinic of our hospital and was admitted to the hospital with "lung shadow". The patient was in good health. Physical examination: weight loss, palpable swelling of the superficial lymph nodes in the whole body, clear breathing sounds in both lungs, dry and wet rales at the end, and no abnormalities were found in neurological examination.