Volume 92  ·   Issue 26  ·  2012

Pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) are collectively called venous thromboembolism (VTE). Because of their high morbidity and mortality, they have attracted widespread attention in the international medical community and society. More than 600,000 cases of fatal and non-fatal symptomatic VTE occur in the United States every year, and 296,400 deaths related to VTE reach 296,400. Among the fatal cases, 60% of patients are missed, and only 7% of patients get timely and correct diagnosis and treatment. Therefore, strengthening prevention, early diagnosis and standardized treatment are the keys to reduce the disability and mortality rate related to VTE.

Pulmonary ventilation perfusion (V/Q) imaging entered the clinic in the late 1960s. It is a mature imaging examination for diagnosing pulmonary embolism. It directly displays the perfusion defect of pulmonary tissue caused by pulmonary artery occlusion to diagnose pulmonary embolism, and determines the location and extent of pulmonary embolism. Compared with traditional plane V/Q imaging, the newly developed V/Q tomography (V/Q SPECT) is more accurate in diagnosing pulmonary embolism, and can find more peripheral pulmonary embolism lesions. The sensitivity and specificity were 96% ~99% and 91% ~98% in diagnosing pulmonary embolism [1-4].

Pulmonary embolism is a common disease in Europe and America, it is the third most common acute cardiovascular disease after myocardial infarction and stroke; The mortality rate of untreated patients with pulmonary embolism is as high as 30%, and if diagnosed and treated in time, the mortality rate will decrease to 2% ~10% [1]. For a long time, this disease has been considered as a rare disease in China, and there is no accurate epidemiological data in China. However, with the improvement of clinicians' awareness of pulmonary embolism diagnosis and the rapid development of imaging examination technology, according to the experience and preliminary statistics of some domestic hospitals, the number of pulmonary embolism diagnosis in most large hospitals has increased significantly compared with 10 years ago.

Many evidences show that chronic thromboembolic pulmonary hypertension (CTEPH) is a continuation of the natural course of deep vein thrombosis and pulmonary thromboembolism (PTE). It is a serious life-threatening disease due to one or more repeated thromboembolic events, which causes the pulmonary vascular bed to be blocked, the pulmonary blood flow resistance to be increased, the pulmonary artery pressure to be increased progressively, and finally leads to right heart failure.

Acute pulmonary thromboembolism (PTE) is a common disease that seriously endangers human health [1]. Its clinical manifestations not only depend on the degree of mechanical obstruction of pulmonary artery by embolus (size, number of thrombi, extent of embolism site) and onset speed, but also related to the cardiopulmonary function of patients. Therefore, its symptoms vary in severity and clinical manifestations, including dyspnea/hypoxemia, syncope, chest pain, hemoptysis, acute pulmonary heart disease, right ventricular dysfunction, hypotension/shock and even sudden death. Because of the different prognosis of PTE with different clinical manifestations, people have paid great attention to the risk stratification and treatment strategies of acute PTE in recent years [2-5]. Patients with stable hemodynamics but with right ventricular dysfunction and or myocardial injury are classified as medium-risk (sub-large area) acute PTE according to the risk stratification of acute PTE. In addition to the poor prognosis of high-risk acute PTE patients with shock or hypotension, the mortality rate of medium-risk acute PTE patients is also higher, and death often occurs within 2 weeks after the diagnosis of the disease [3-5].

Objective To evaluate the necessity of routine nasogastric decompression after radical gastrectomy for gastric cancer with systematic review and Meta-analysis.Methods The literature databases prior to September 2011 were extensively searched to retrieve the randomized controlled trials (RCT) with a relevance of study goal.The inclusion and exclusion criteria were formulated.After quality evaluation,the data were extracted.The Cochrane collaboration RevMan 5.1 version software was used for Metaanalysis.Results Seven RCT studies fulfilled the inclusion criteria for Meta-analysis.The total sample size of these studies was 871 cases.Those without a nasogastric tube routinely inserted experienced a marginal earlier time to flatus [weighted mean difference (WMD) =0.10 days,95％ confidence interval (CI)0.00-0.30,P=0.05],a significant earlier time to oral diet [WMD =0.43 days,95％ CI0.25-0.61,P ＜0.01],a significant shorter hospital stay [WMD =0.60 days,95％ CI 0.15-1.18,P =0.01 ) and a marginal decrease in pulmonary complications [relative risk (RR) =1.30,95％ CI 1.00-1.68,P =0.05)].The postoperative rates of anastomotic leakage,morbidity and mortality were similar between two groups.Conclusion Except for severe vomiting or abdominal distension,nasogastric tubes should not be used routinely in gastric cancer patients undergoing radical surgery.

Objective To explore the risk factors of Clostridium difficile-associated diarrhea (CDAD) in children.Methods From December 2010 to March 2011,the hospitalized diarrheal patients under 18 years old at Beijing Children's Hospital were tested for Clostridium difficile.The CDAD+ patients were selected and their fecal specimens were PCR-positive for tcdA and (or) tcdB genes.And the patients with healthcare facility-associated-CDAD (HCFA-CDAD) were selected from the group of CDAD +.The CDAD patients were selected and their fecal specimens were PCR-negative for tcdA and (or) tcdB genes.And the 1:3 matched controls per case were selected from those hospitalized patients without diarrhea at the same department with similar diseases during the same period.The potential predictors of CDAD included age,gender,co-morbidities,prior hospitalization,the administration ofC.difficile-active antibiotics during prior 24 hours,recent (＜ 1 month) exposure to antibiotics or acid-blocking medications or nonsteroidal antiinflammatory drug (NSAID),C-reactive protein (CRP) and white blood cell (WBC),etc.Multivariate Logistic regression models were created to identify the independent predictors of CDAD.Results Among 93PCR tests,35 were positive in fecal samples.There were HCFA-CDAD (n =30) and CDAD-(n =58).Thirty-five CDAD+ hospitalized patients were compared with 105 controls.According to multivariate analyses,the predictors of CDAD included prior hospitalization (P ＜0.01,OR =0.002),CRP(P =0.008,OR =3.465),NSAID (P=0.015,OR=13.950) and WBC (P=0.003,OR =8.063).Conclusion The administration of NSAID,elevated CRP and abnormal WBC are significantly associated with CDAD.

Objective To analyze the potential risk factors of early (≤ 30 days) postoperative pulmonary infection after pediatric living donor liver transplantation (LDLT) and explore the feasible preventive and therapeutic measures.Methods Without preoperative respiratory disease,the clinical data of 36 cases undergoing LDLT at Children's Hospital of Chongqing Medical University between June 2006 and December 2009 were analyzed retrospectively so as to evaluate the incidence,prognosis and risk factors of early postoperative pulmonary infection.Univariate analysis was performed to determine the relative risk factors for postoperative pneumonia.And significant factors (P ＜ 0.05 ) were then used for multivariate Logistic regression analysis.Results Twenty-four recipients suffered from early postoperative pulmonary infection at an incidence of 67％ (24/36).The mortality rate in the pediatric patients who developed pulmonary infection was 17％ (4/24).In univariate analysis,age ≤ 1 year,high Child-Pugh scores,hemoglobin ＜ 90 g/L,congenital heart disease,mechanical ventilation ＞ 12 hours,intraoperative transfusion ＞ 150 ml/kg and indwelling gastric tube ＞3 days were of statistical significance (all P ＜0.05).Multivariate Logistic regression analysis showed age ≤ 1 year,intraoperative transfusion ＞ 150 ml/kg and indwelling gastric tube ＞ 3 days were independent risk factors for post-LDLT pneumonia (all P ＜ 0.05 ).Conclusions Pulmonary infection is an important factor of decreasing the survival rate during the early postoperative stage.To reduce the incidence of postoperative pulmonary infection and guarantee a successful transplantation,should improve the preoperative physical condition,restrict intraoperative fluid infusion with stable hemodynamics and strengthen gastric tube management.

Objective To ascertain the epididymal sperm nuclear maturity in obstructive azoospermia (OA) patients.Methods A total of 81 infertile males from andriatry clinic of Renji hospital were selected,including 32 OA patients (OA group) and 49 asthenospermia patients (asthenospermia group).Another 32 fertile males were recruited for the control group.All semen samples of the asthenospermia and control groups underwent computer aided semen analysis (CASA).For the OA group,sperm specimens were collected by percutaneous epididymal sperm aspiration (PESA) and semen analyses completed by manual method.Further acridine orange test and aniline blue stain assay were performed.The results were processed with SPSS 15.0.Results No statistically significant differences existed in semen volume and sperm density between the asthenospermia and control groups (both P ＞ 0.05 ).The OA group was significantly lower than the control group in sperm density (P ＜ 0.01 ).The asthenospermia and OA groups were also significantly lower than the control group in sperm motility (both P ＜ 0.O1 ).As to the percentage of grade a + b sperm,the asthenospermia group was also significantly lower than the control group (P＜0.01).Compared with the control group (81％ ±9％,85％ ±8％),the negative rate of acridine orange test and aniline blue assay of OA (57％ ±20％,64％ ±20％ ) and asthenospermia group (62％ ±19％,67％ ± 15％ ) were statistically lower (all P ＜ O.05 ).Conclusions Tbe sperm nuclear maturity is lower in the asthenospermia and OA groups than that in the control group.Male fertility should be further improved.

Objective To explore the differences of urodynamic parameters and lower urinary symptoms between detrusor hyperactivity with impaired contractility (DHIC) patients and DHIC patients with bladder outlet obstruction (BOO) and evaluate the effects and risks of anticholinergic medications in these palients.Methods A retrospective analysis was performed in 56 DHIC patients at our hospital between February 2000 to February 2011.Among them,19 patients wcre complicated with BOO.Urodynamic studies were conducted and lower urinary symptoms assessed in all patients.Then the urodynamic parameters and lower urinary symptoms scores were compared between the DHIC and DHIC plus BOO patients.Among them,27 received anticholinergic medications and there were 11 BOO patients.After 2-month anticholinergic medications,the differences of lower urinary symptom score were analyzed and anticholinergic-induced retention was also investigated.Results As compared with the DHIC patients,the DHIC plus BOO patients had a higher post-voiding residual urine (70 (23-106)vs 20 (10-81) ml,P =0.02),higher total international prognostic scoring system (IPSS ) score (25.6 ± 3.9 vs 22.1 ± 4.1,P =0.00) and higher total voiding symptom score (15.3 ± 2.9 vs 1 1.8 ± 3.3,P =0.00).After 2-month anticholinergic medications,the IPSS score of DHIC plus BOO patients decreased from 25.7 ±4.6 to 23.6 ±4.9(P =0.01 ),2/11 patients developed urinary retention.The IPSS scores of DHIC patients decreased from 22.8±4.7 to 21.4 ±4.6(P=0.01)and none had urinary retention.Conclusions The DHIC plus BOO patients have more aggravated bladder empting and more severe lower urinary symptoms especially during voiding phase.Anticholinergic medications may alleviate the lower urinary symptoms in DHIC and DHIC plus BOO patients.But anticholinergic-induced retention is common among the DHIC plus BOOpatients.

Objective To decipher the characteristics of real-life glucose profiles in normal glucose tolerance (NGT) persons by continuous glucose monitoring system (CGMS).Methods Forty NGT subjects confirmed by oral glucose tolerance test (OGTT) completed a 3-day period of glucose monitoring via CGMS.Results The values of 24 h mean blood glucose (MBG),standard deviation of MBG (SDBG),mean amplitude of glycemic excursions (MAGE ),largest amplitude of glycemic excursions (LAGE) and means of daily differences (MODD ) were 6.0 ± 0.7,0.9 ± 0.1,1.9 ± 0.8,2.9 ± 1.4 and 1.1 ± 0.1mmol/L respectively.Two of them experienced asymptomatic hypoglycemia defined as glucose concentration ＜2.8 mmol/L And 72.5％ (29/40) subjects reached glucose concentrations ＞ 7.8 mmol/L for 5.2 ± 4.6hours.In addition to higher glucose concentration(FPG:5.0 ±0.4 vs 4.8 ±0.3 mmol/L,MBG:6.4 ±0.7vs 5.7 ± 0.5 mmol/L),the subjects with glucose concentrations ＞ 7.8 mmol/L showed more dramatic glucose excursion represented by higher SDBG (1.1 ± 0.3 vs 0.6 ± 0.2 mmol/L),MAGE (2.3 ± 1.1 vs 1.1 ±0.3 mmol/L),LAGE (3.3 ± 1.2 vs 2.0 ± 1.0 mmol/L) and MODD (1.2 ±0.4 vs 0.9 ±0.3 mmol/L)versus those with glucose concentrations within 7.8 mmol/L Conclusion CGMS provides more detailed information of real-life glucose profiles in NGT subjects.And 72.5％ NGT subjects in the present study spent a considerable amount of time at pre-diabetic or even diabetic glucose levels characterized by more predominant glucose excursion.

Objective To detect the differential expressions of miRNAs in left atrial appendage (LAA) in patients with atrial fibrillation (AF).Methods Left atrial samples were collected from nonvalvular AF patients and healthy controls.The miRNA transcriptome was analyzed by microarray and verified by real-time reverse transcription-polymerase chain reaction.Computational prediction identified the AF-related miRNAs and its target gene.In the meantime,construction of reporter plasmids and reporter assays were performed to test whether miRNA could represses the Luciferase activity of 3' untranslated regions of its target gene.Results MiR-155,miR-142-3p,miR-19b,miR-223,miR-146b-5p,miR-486-5p,miR-301b,miR-193b,miR-519b were found to be up-regulated by ＞2 folds whereas miR-193a-5p wasdown-regulated.In particular,the level of miR-155 increased by 5.78 folds in AF patients versus healthycontrols (9.42 ± 4.74 vs 1.63 ±0.65).Furthermore,computational prediction identified CACNAICencoding Cav1.2 as a direct target of miR-155.In the meantime,the construction of reporter plasmids andreporter assays showed that miR-155 repressed the Luciferase activity of 3' untranslated regions ofCACNAIC.Conclusion In LAA sample of nonvalvular AF,there is an expression of AF-related miRNAsincluding miR-155.And it reveals a potential link between the reglation of Cav1.2 and miR-155 in electricremodeling of AF.

Objectives To observe the expression of cellular retinol-binding protein-1 (CRBP-1) in pulmonary tissues after rat myocardial infarction (MI) and uncover the role of CRBP-I on the pulmonary structural remodeling.Methods MI was produced in male Wistar rats by left coronary ligation.Rats were sacrificed to obtain the lung at the 3rd,6th,15th,30th,and 45th day after operation.After weighted,the rat lungs were fixed in 4％ formalin and embedded in paraffin.Sections were cut and stained with hematoxylin and eosin (HE),Masson's trichrome (MT),rabbit anti-CRBP-I antibody.Results Thirty-nine Wistar rats survived and developed MI.Pulmonary tissue sections with HE and MT staining showed a remarkable lung structural remodeling.The content of pulmonary tissue collagen at the 30rd was higher than in the sham group (8.4％ ± 3.6 vs 4.5％ ± 2.6,P ＜ 0.001 ).CRBP-1 expression was detected on the alveolar septa at the 3rd day after operation,and peaked at the 15th day (43.8 ± 7.4).Then the CRBP-1expression decreased,and arrived at the level of the 3rd day.Conclusions We demonstrate that CRBP-1 is expressed temporal on the alveolar septa after rat MI.It indicates a potential relationship between CRBP-1 and lung structure remodeling process after MI.

Objective To establish and evaluate an acute pulmonary embolism (APTE) model by selective thromboembolism of lower left pulmonary artery in minipig.Methods Through intervention technique,a guiding catheter was inserted via femoral vein into pulmonary artery.And quantitative autologous venous thrombus was irjected into the selected lower left pulmonary arteries in 8 mínípìgs.Thus the intended APTE model was established by selective thromboembolism of lower left pulmonary artery.Hemodynamic parameters were monitored.And computed tomography (CT) and macroscopic dissection were performed to evaluate the minipig APTE model.Results The measurements of mean pulmonary artery pressure(MPAP,mm Hg,1 mm Hg =0.133 kPa) and pulmonary capillary wedge pressure (PCWP,mm Hg)immediately increased significantly after thromboembolism versus the baseline values(MPAP:42.0± 3.4 vs 20.2 ± 3.0,PCWP:8 ± 2 vs 4 ± 3,both P ＜ 0.05 ) and stayed at a higher level during the following 2 h.No significant difference existed between the value of cardiac output (CO) at 2 h postthromboembolism and its baseline counterpart.Moreover,systemic arterial pressure (SAP,mm Hg)and heart rate (HR,beats/min) significantly increased after embolism versus the baseline values (SAP:102 ±12 vs 80 ± 7,H R:119 ± 22 vs 86 ± 14,P =0.008 ).Pulmonary arteriography,CT scan and gross anatomy all demonstrated that the selected lower left pulmonary arteries was successfully embolized.Conclusion The establishment of APTE model hy selective thromboembolism of lower left pulmonary artery is feasible,well-controlled and stable in minipigs.

Objective To explore the interventional effects of atorvastatin and CoQ10 on myocardial energy metabolism in rabbits with hypercholesterolemia.Methods Forty male New Zealand white rabbits were randomly divided into 5 groups:i.e.normal control,high cholesterol,statin,coenzyme Q10 1 and coenzyme Q10 2.After feeding for 6 weeks,the fasting blood samples were collected through ear marginal vein and the serum level of total cholesterol was determined.Myocardium was sampled for ultrastructures by electron microscopy; high-performance liquid chromatography (HPLC) was used to measure myocardial mitochondria adenosine triphosphate (ATP) and coenzyme CoQ10.Ultraviolet spectrophotometry was used to measure the activities of mitochondrial complexes Ⅱ and Ⅳ.Results In high cholesterol group,myocardial fibers were arrayed disorderly with partial rupture and dissolution.There was mitochondrial swelling with disorderly and fuzzy cristae.As compared with the controls,the activities of mitochondrial respiratory chain complexes Ⅱand Ⅳ declined (5.39 ±0.53 vs 12.95±0.99,1.89 ±0.26 vs6.65 ±0.95,P＜0.01),the contents of mitochondrial ATP and CoQ10 decreased (0.17 ± 0.05 vs 0.44 ± 0.06,0.09 ± 0.02 vs 0.25 ±0.04,P ＜0.01 ) ; for statin group versus high cholesterol group,the activities of mitochondrial respiratory chain complexes Ⅱ and Ⅳ increased (9.12 ± 1.19 vs 5.39 ± 0.53,4.61 ± 0.52 vs 1.89 ± 0.26,P ＜0.01 ) ; the content differences of mitochondrial ATP and CoQ10 were statistically insignificant.For CoQ10 1group versus statin group,the differences of respiratory chain complexes Ⅱ and Ⅳ were statistically insignificant; the contents of mitochondria ATP and CoQ10 increased (0.35 ±0.03 vs 0.16 ±0.04,0.17±0.02 vs 0.07 ± 0.02,P ＜ 0.01 ).For coenzyme Q10 2 group versus coenzyme Q10 1 group,none of the indices was statistically significant.Conclusion High cholesterol can cause myocardial ultrastructural changes and impaired mitochondrial energy metabolism.Atorvastatin reduces the myocardial structural damage and the combination of atorvastatin and CoQ10 may further improve the myocardial mitochondrial energy metabolism.

Objective To explore the synergistic effects on proliferation and apoptosis by targeted suppression of epidermal growth factor receptor (EGFR) in combination with blockade of Hedgehog signaling pathways in pancreatic cancer cells and examine the synergistic mechanism of Hedgehog and EGFR signaling pathways.Methods The sequences of RNA interference targeting EGFR gene were designed,synthesized and cloned into the pFU-GW-RNAi vector.And a stable transfection cell line was obtained by transfecting the human Panc-1 ceUs with lentivírus.The expressions of Shh and Glil were tested by real-time polymerase chain reaction (PCR).The antiproliferative effect was examined by the assays of colony formation and methyl thiazolyl tetrazolium (MTT).Fluorescence activated cell sorter (FACS) was applied to assay the apoptotic rate in all experimental groups.Western blot was applied to detect the phosphorylation levds of ERK and AKT.In vivo nude mice tumorigenicity model was used to test the effect of growth inhibition.Results The RNAi technology with lentivirus could restrain the expression of EGFR gene.After the blocking of EGFR and Hedgehog signaling pathways by RNAi silencing,the chemosensitivity to cyclopamine significantly increased in human pancreatic cancer cells.The half-inhibitory concentration (IC 50) of cyclopamine declined from (2.978 ± 0.336 ) to (1.698 ± 0.057 ) μmol/L (P ＜ 0.05 ).The prophase apoptotic rate of co-treated group was as high as 38.75％ and it was significantly higher than the RNAi silencing EGFR (17.65％ ) and control groups (3.02％ ) (P ＜ 0.05 ).The results of tumor xenografts assay showed that the tumor volume of co-treated group (394.8 ± 87.5 mm3) was significantly lowerthanthat of simple EGFR RNAi (594.7 ± 86.1 mm3 ) and single cyclopamine treated group (77 1.3 ±82.9 mm3 ) ; the combination treatment could also produce obviously synergistic antiproliferative effect in colony formation assays.After RNAi silencing EGFR,the phosphorylation levels of ERK and AKT decreased significantly versus the control group.Further reduction was obtained with the combined use of cyclopamine in the co-treated group.Conclusion The blocking of EGFR and Hedgehog signaling pathways by RNAi silencing may further inhibit cell proliferation and increase apoptosis in vivo and in vitro in human pancreatic cancer cells.The synergism of Hh and EGFR signaling pathways may be correlated with the phosphorylation levels of ERK and AKT.

Objective To construct a breast cancer cell line MD-MB-231 stably overexpressing RSK4 gene and study its in vivo effects on tumor tumorigenesis.Methods The MD-MB-231 cells were transfected with pcDNA 3.1/Neo and pcDNA3.1/Neo-RSK4 by lipofectamin transfection respectively.The stable expression of RSK4 (MR11 and MR12) and control vector (MN10 and MN11) were inoculated into severe combined immunodeficiency (SCID) mice subcutis to establish a model of human breast cancer in SCID mice.The xenograft tumor growth,invasion and metastasis were observed after 6-10 weeks.Results The stable cell lines MR11,MR12 and MN10,MN11 were screened successfully.We constructed the human breast cancer transplanted model and dissected SCID mice.After 6 weeks,SCID mice subcutis of the MN10/MN11 group yielded 10/10 metastatic tumors versus 6/10 and 7/10 in the MR11/MR12 group respectively.MR11 and MR12 showed much smaller tumor sizes and significantly reduced tumor volume and weight versus MN10 and MN11 (P ＜0.001 ).In the control group,visceral metastasis developed in 80％(8/10) of mice while in metastasis developed in 40％ (4/10) of mice injected with RSK4-overexpressing MDA-MB-231 cells.Histological examination of hematoxylin and eosin-stained paraffin sections of lungs revealed numerous metastases in mice injected with vector control cells whereas RSK4-overexpressing cells showed markedly decreased metastatic lesions.Conclusion Transplanted human breast cancer in SCID mice closely correlates with the disease course of clinical tumor patients.Overexpression of RSK4 can inhibit tumor growth of transplanted human breast cancer in SCID mice.

More and more evidences show that peroxisome proliferator-activated receptor γ (PPAR-γ) coactivator 1 α (PGC-1 α) is closely related to the pathogenesis of type 2 diabetes mellitus. The relationship between its gene polymorphism and type 2 diabetes mellitus has been deeply studied [1]. At the same time, it is also involved in various metabolic pathways related to the pathogenesis of diabetes mellitus, including glucose homeostasis in skeletal muscle and liver, insulin secretion from β cells, insulin sensitivity of peripheral target tissues, mitochondrial biosynthesis and oxidative phosphorylation, fatty acid oxidation, etc. As an important research hotspot, the important role of mitochondrial function and morphology in the pathogenesis of type 2 diabetes mellitus has been fully understood. This paper focuses on the research on mitochondrial function and morphology and type 2 diabetes mellitus, and emphasizes on the important role of PGC-1 α in it, aiming at clarifying its important role in the pathogenesis of diabetes mellitus, and providing new ideas for better research on the pathogenesis of diabetes mellitus. It provides a new intervention target for effective prevention and treatment of diabetes.

FIP1L1-PDGFRA fusion gene (F/P) was identified for the first time in hypereosinophilic syndrome (HES) [1], and its incidence is 14% ~60%: F/P gene encodes the solidified activated tyrosine kinase-F/P fusion protein, which promotes the clonal proliferation of eosinophils, so it is called F/P-positive chronic eosinophil leukemia [F/P (+) CEL]. Compared with other F/P (-) HES, F/P (+) CEL presents an aggressive clinical phenotype, and nearly half of patients have heart and lung damage, and in severe cases, it is fatal [1]. Recently, it has been found that F/P (+) CEL mice, besides significant eosinophil infiltration into organs, F/P gene can also induce mast cell infiltration and activation and lead to lethal tissue fibrosis [3]. Therefore, revealing the molecular mechanism of F/P action has become a hot spot in CEL research.

The patient, a 48-year-old female, was admitted to the hospital on October 24, 2011 due to the discovery of a mass in her right breast 1 week ago. The patient accidentally discovered a mass in her right breast 1 week ago, without pain and other symptoms. One year ago, she underwent cholecystectomy due to calculous cholecystitis and acute pancreatitis. There was no history of other surgery and trauma, no history of thyroid, ovarian, uterine and breast diseases, no bad habits such as tobacco and alcohol, normal menstrual history, and no family history of breast cancer. Specialist situation: both breasts were symmetrical, the nipple had no depression and discharge, and the skin had no "orange peel-like" changes. A mass of about 2.5 cm ×1.0 cm was touched at 1.5 cm away from the nipple at about 1 o'clock in the right breast, with irregular shape, hard texture, clear border, no tenderness, acceptable mobility, and no obvious adhesion to the skin and base.

The patient was a 63-year-old male with "dull pain in the lower abdomen for more than 1 month, accompanied by vomiting and progressive reduction of urine output for 4 days". He was admitted to the Third Affiliated Hospital of Sun Yat-sen University after emergency department. He had no previous hematospermia and no history of urinary tract infection. Physical examination showed tenderness at the tenderness points of bilateral upper and middle ureters, tenderness in the right lower abdomen and bladder area, and active induration was palpable above the left testis. The blood creatinine was 727.9 μ mol/L (normal value 31.8~116 μ mol/L), blood urea nitrogen was 19.76 mmol/L (normal value 2.4~8.2 mmol/L in our hospital), and prostate-specific progen (PSA) was 0.481 μ g, /L. Ultrasound and magnetic resonance examination showed tumors in the seminal vesicle area and metastases to the lymph nodes parailiac arteries on both sides of the pelvic cavity. Multiple lymph node metastases in left spermatic cord, right parapharyngeal space, mediastinum, bilateral iliac vessels and rectal bladder depression "(Figure 1). To further confirm the diagnosis, transrectal seminal cyst biopsy was performed under the guidance of B-ultrasound. The pathological report: the seminal cyst was diffuse large B non-Hodgkin lymphoma (DLBCL), non-germinal center subtype (NGCB). After 1 course of treatment, the patient's urine output and serum creatinine level returned to normal, and the mass was significantly smaller than before. After removing the nephrostomy tube, the patient could urinate spontaneously from the bladder and urethra, and the daily urine output was normal. After 6 courses of treatment, the condition reached complete remission. After 3 months of discharge, the tumor did not relapse and the serum creatinine level was normal.