Volume 92  ·   Issue 27  ·  2012

Chronic hepatitis B virus (HBV) is one of the main diseases affecting the health of the population in China. There are about 93 million chronic hepatitis B virus (HBV) infected patients in China, among which about 20 million patients with chronic hepatitis B virus [1-2]. Long-term replication of HBV leads to liver fibrosis, cirrhosis and even liver cancer. The occurrence of hepatitis B cirrhosis is positively correlated with the high HBV DNA level in patients, and the annual incidence of liver cancer in patients with liver cirrhosis is 3% ~6% [1]. Therefore, antiviral therapy in patients with HBV virus plays an important role in preventing the progression of the disease. Several articles published in this issue on hepatitis B analyzed and discussed from the detection of drug resistance sites in patients with HBV virus to the occurrence of liver fibrosis and liver cancer, which illustrated the importance of the detection of drug resistance sites in the course of antiviral therapy.

Objective To explore the relationship between the expression of NF-κB p65 and hepatic fibrosis in chronic hepatitis B (CHB) patients.Methods Sixty CHB patients with hepatic fibrosis underwent liver biopsy to determine the stages of liver fibrosis ( S0 - S4).The distribution and expression of collagens Ⅰ,Ⅲ and NF-κB p65 in different stages of fibrosis in liver tissue were observed by immunohistochemistry and the results analyzed statistically.Results The expression of NF-κB p65 was positively correlated with the stage of hepatic fibrosis.That was S4 ＞ S3 ＞ S2 ＞ S1 (S0) ( P ＜ 0.01 ).And it was also positively correlated with the expression of collagens Ⅰ and Ⅲ ( P ＜ 0.01 ).Conclusion The elevated expression of NF-κB p65 is closely associated with the occurrence and development of hepatic fibrosis.Its mechanism is probably related with the increased secretion of collagens Ⅰ and Ⅲ after theactivation of hepatic stellate cell.

Objective To explore the variations of gene S in hepatitis B viruses of hepatitis B patients and provide experimental evidences for the mutation analysis of viral gene.Methods The virus DNA load in hepatitis B patient donors was detected by real-time polymerase chain reaction (PCR) and gene sequence analysis.And a comparison was made with standard strain by the software DNAstar.Results ① Gene S was successfully amplified and sequenced in 15 hepatitis B patients.Three samples had I→T mutation at residue 126 in HBsAg “a” antigenic determinant.② Sixteen hepatitis B patients had 67 nucleotide mutations,including 14 residues in PreS1 and 6 residues in PreS2.Mutations nt 3036 T→C,nt 3039 T→G,nt 3066 C→T and L88V existed in PreS1 gene in all samples.Conclusion HBV genome is susceptible to nucleotide mutations.Some residues have geographically restricted mutations in gene S region.And understanding the significance of these mutations may help clarify the pathogenesis of hepatitis B and provide new experimental evidence for its gene diagnosis and prevention.

Objective To explore the clinical characteristics of hepatic B virus (HBV) mutations related to adefovir dipivoxil (ADV) among patients with chronic HBV infection in eastern Zhejiang province and provide some reference values on normative usage of antiviral drugs.Methods The data of chronic HBV-infected patients with HBV mutations related to ADV ( n =88 ) and non-mutation ( n =202 ) from June 2008 to August 2010 were analyzed retrospectively.The gene resistance mutations of HBV P region were analyzed by gene sequencing.And the HBV genotypes,HBV serum markers,HBV DNA levels and liver imaging findings were also analyzed.Results There were 9 cases with pre-existing mutations in 88 patients.The mutated sites were multiple and complicated.And the mutated sites related to other antiviral drugs were all accompanied by ADV-related mutations.The single mutated site was mostly at rtA181T (46.59％ ) and at rtV214A ( 11.36％ ).There were 27 cases (30.68％ ) with ≥ two mutated sites.The constituent ratios of males,end-stage liver diseases,complicated nonalcoholic fatty liver disease (NAFLD) and HBV genotype C infection in the mutation group were higher than those in the non-mutation group ( P ＜0.01,＜0.01,0.019,0.045).The average ages in the mutation group were also higher than those in the non-mutation group ( P ＜0.001 ).But the constituent ratios of HBeAg positivity and the levels of HBV DNAwere lower ( P =0.002,0.02 ).Conclusion There may be some cases with pre-existing ADV-related mutations in ADV treatment-naive patients.The mutated sites occur at multiple loci,mostly at rtA181T and rtV214A.The male patients and those with a longer history of HBV infection,HBeAg negativity,HBV genotype C infection,illness progression and complicated NAFLD may be more susceptible to mutation.It is important for patients to accept and implement standardized regimens of antiviral drugs so as to prevent resistance and avoid salvage therapy.

Objective To explore the relationship between serum HBV DNA load and hepatocellular carcinogenesis in Qidong HBsAg carriers.Methods In 1997,477 HBsAg carriers and 477 age,gender and residence matched HBsAg negative controls were enrolled as a prospective cohort in Qidong city.The entry serum samples were detected for the levels of HBeAg and HBV DNA.The relationship between baseline HBV DNA load and hepatocellular carcinoma (HCC) during the follow-up period from June 1997 to June 2011 were analyzed.Results The total observed person-years (PY) were 12 200.Eightyseven patients developed HCC with an incidence of 1498/100 000 PY in the HBsAg positive group versus 6 with an incidence of 94/100 000 PY ( P =0.000) in the HBsAg negative group.The relative risk (RR) was 15.96.No significant difference existed between the incidences of other tumors in two groups ( P =0.161 ).Compared with the HBsAg negative group,the RR of HCC was 11.38(95％ CI 4.87 -26.62,P ＜0.01 ) in the HBsAg +/HBeAg - group and 29.08 ( 95％ CI 12.37 - 68.37,P ＜ 0.01 ) in the HBsAg + /HBeAg + group; 5.80(95％ CI 2.29 - 14.70,P ＜0.01 ) in the HBsAg +/HBV DNA - group and 27.75 (95％ CI 12.07 -63.81,P ＜0.01 )in the HBsAg +/HBV DNA + group.In HBsAg positive subjects,while the HBV DNA load was classified into 5 levels namely 250-104,104-,105-,106- and ≥107 copies/ml,the relative risks for HCC at each level were 2.84 ( 95％ CI 1.44 - 5.61,P ＜ 0.01 ),5.75 (95％ CI 2.77 -11.95,P＜0.01),9.05(95％ CI 4.71-17.41,P＜0.01),6.39(95％ CI 2.79-14.64,P＜0.01)and 4.35 (95％ CI 2.21 - 8.56,P ＜ 0.01 ) respectively versus the ＜ 250 copies/ml group.Conclusion HBV DNA is an important risk predictor of hepatocellular carcinoma.The HBsAg carriers with the serum loads of HBV DNA between 105 - 106 copies/ml are most likely to present with HCC.

Objective To explore the diagnostic features of collecting duct carcinoma (CDC).Methods A total of 7 CDC patients were retrospectively examined by multi-slice computed tomography (MSCT).The relevant diagnostic parameters were assessed.Results All lesions were located in renal medulla.Among them,infiltrations extended to renal calyx ( n =3 ) and cortex ( n =5 ).There were indistinct boundaries (capsule sign) on enhanced phase (n =6) and pre-capsule (n =1 ).On non-enhanced CT,CDC attenuation was greater than normal renal cortex or medulla (43.8 ±5.3 vs 37.6 ±5.1 or 32.6 ±4.1,P ＜0.05 ).The degree of enhancement was less than normal renal cortex and medulla during all enhanced phases (P ＜ 0.05 or 0.01 ).Excellent consistency existed between CT appearances of CDC and pathological characteristics.Conclusion Dynamic contrast enhanced-CT can show distinct imaging features of CDC correlated with pathological characteristics so as to allow a better differential diagnosis.

Objective To explore the roles of computed tomography (CT) in the diagnosis and treatment of complex atlas pillow deformity.Methods From January 2010 to February 2012,the preoperative and postoperative CT imaging findings were collected from 32 cases of complicated atlas pillow deformity undergoing surgical treatment at Henan Provincial People′s Hospital.There were 18 males and 14 females with a mean age of 36.8 years ( range:23 - 65 ).The average duration of disease was 4.5 years (range:0.25 -10).Results In 32 cases,a definite diagnosis was established preoperatively by coronary sagittal CT scans and 3-dimensional reconstruction.And CT re-examinations were performed to review the postoperative curative efficacies.Conclusion CT imaging examination is of vital importance in the diagnosis,personalized surgical procedures and prognostic evaluation of complex craniocervical junction deformity.

Objective To evaluate the feasibility of Apneic anesthesia with intermittent ventilation (AAIV) during laryngeal papillomatosis removal in children.Methods The clinical data of 30 patients with laryngeal papillomatosis treated in the Tong Ren Hospital of Capital University of Medical Sciences,between 10 -12 2011 were analyzed.Thirty ASA physical status Ⅰ or Ⅱ patients who were scheduled for elective surgery.The patients were ventilated with 100％ oxygen and the period of intermittent apnea were guided by pulse oximetry,the endotracheal tube was removed when SpO2 was 100％ and reinserted when SpO2 was 95％.Result The average duration of apnea was (232 ±32) s.This technique provided a good visualization and immobile field for operation.No significant complications have occurred with AAIV.Conclusion Apneic anesthesia with intermittent ventilation could be used without any serious adverse outcome for juvenile-onset recurrent laryngeal papillomatosis,232 seconds can provided for surgery every AAIV.

Objective To evaluate the efficacies of arthroscopic debridement and removal of osteophyma for olecroanon and olecranon fossa plasty for posterior impingement of elbow joint.Methods Between 1999 and 2008,a total of 21 cases were diagnosed with osteoarthritis and posterior elbow impingement.There were 15 males and 6 females.And there were 16 right and 15 left cases.They included volleyball players (n =7),tennis players ( n =7 ),golf enthusiasts ( n =4) and fencers ( n =3 ).The average duration of onset-operation was 3.5 years ( range:2.5 - 8 ).Arthroscopic exploration revealed synovial hyperplasia hypertrophy,cartilage degeneration and olecranon fossa hyperplasia with deformed olecranon fossa.Debridement and plasty were performed.Loose bodies were removed from elbow joint in 6 patients.Partial resection of posterior olecranon tip was performed and osteophytes or fibrous tissue removed in this area.Dynamic observation showed no posterior elbow impingement.Results Postoperative follow-up was conducted in 19 cases and 2 cases became lost to follow-up.The average follow-up period was 25.3 months (range:18 -42).All patients were evaluated preoperatively and postoperatively with the Hospital for Special Surgery Elbow Assessment Scale.The outcomes were excellent ( n =12 ),good ( n =7 ) and fair ( n =2).Postoperative patients elbow swelling and pain relieve,sports and life function returns to normal,elbow flexion and rotating mobility obviously improved.With the elbow radiological films to measure the range of motion,the average range of motion was 90.5° preoperatively and improved to 130° postoperatively.There was significant improvement in all cases.Conclusion Posterior elbow impingement is caused by hyperextension trauma and elbow overuse during specific sporting activities.Arthroscopic debridement and olecroanon or olecranon fossa plasty demonstrates excellent results for posterior impingement of elbow joint.

Objective To explore the relevant influencing factors of surgical outcomes for closed tibial pilon fractures.Methods From April 2005 to May 2011,52 consecutive closed tibial pilon fractures were treated by the same surgical team.There were 35 males and 17 females with a mean age of 40.0 years.According to the Ruedi-Allgower classification,the fracture types included type Ⅰ (n =13),type Ⅱ (n =22) and type Ⅲ (n =17 ).All patients were evaluated by the scores of American Orthopedic Foot and Ankle Society (AOFAS) and Burwell-Chamley.Postoperative complications were also recorded.The primary influencing factors of clinical outcomes were determined with regards to fracture types,reduction,complications and outcomes.Results The average follow-up period was 14.1 months (range:6 -28 ).The mean healing time was 5.5 months ( range:4.0 - 11 ).The reduction status:anatomical ( n =20),functional ( n =24) and poor ( n =8).Ankle function was excellent (n =12),good ( n =26),fair ( n =9) and poor ( n =5 ).Incidence of complication was 30.8％ ( n =16 ),including incision skin necrosis ( n =5 ),superficial soft tissue infection ( n =4 ),deep infection ( n =1 ) and posttraumatic arthrosis ( n =6).No significant differences ( P ＞ 0.05 ) existed in the occurrence of incision skin necrosis,superficial infection and deep infection between the outcomes of excellent/good and fair/poor groups while posttraumatic arthrosis rate had significant difference ( P =0.005 ) between two groups.The quality of reduction was an independent risk factor of final clinical outcomes.Conclusion The quality of reduction,types of fracture and occurrence of posttraumatic arthrosis are risk factors of final outcomes for closed tibial pilon fractures.

Objectives To discuss diagnosis and surgical management of penetrating cervical vascular trauma.Methods A retrospective clinical analysis of 22 penetrating carotid artery injuries.Results Twenty-two patients presented 32 vascular injuries,including innominate artery ( n =1 ),innominate vein ( n =2),subclavian artery ( n =6 ),subclavian vein ( n =2 ),common carotid artery ( n =3 ),internal carotid artery (n =3),external carotid artery (n=4),jugular vein (n =8) and vertebral artery (n=4).There were 12 patients with stab wounds,2 with blast wound and 8 with iatrogenic injuries.Of these,there were 12 zone-1 injuries (38％),19 zonge-2 injuries (59％) and 1 zonge-3 injury (3％).The distribution of 4 vertebral artery injuries were V1 (n =1 ),V2 (n =2) and V3 (n =1 ).All patient received surgical and endovascular managements and got survival.Conclusions Patients with penetrating cervical vascular injuries have high rate of mortality.Emergent surgical exploration is necessary for patients with hard signs of vascular injury such as hemodynamic instability,exsanguinating hemorrhage,or expanding hematoma.Those patients that are hemodynamically stable and who are without respiratory compromise should undergo further diagnostic imaging evaluation.

Objective To explore the association between single nucleotide polymorphisms (SNPs) in Pen 2 gene and late onset Alzheimer′s disease (LOAD) in North Chinese population.Methods The genotypes of ApoE and Pen2 gene were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and direct sequencing respectively in 480 LOAD patients and 480 healthy controls.The strength of association between polymorphisms and AD was estimated with odds ratios (OR).Results The genotype of IVS2 + 335T ＜ A was obtained.There was an association between IVS2 +335T ＜ A and apolipoprotein E (ApoE) genotypes ( P =0.002).In the subjects with APOEε 4 allele,there were significant differences in the distribution of alleles ( P =0.003 ) and genotypes ( P =0.007 ) between AD and control groups.The ORs (95％ confidence interval (CI)) of allele A and T/A + A/A genotypes were 4.720 ( 1.517 - 10.654) and 3.886 ( 1.381 - 10.932) respectively with allele T and genotype T/T as references.Conclusion An association exists between IVS2 + 335T ＜ A and the development of LOAD in APoEε 4 carriers within the northern Chinese population.And allele A of Pen 2 gene may increase the risk for LOAD.

Objective To explore the change characteristics of regional cerebral blood flow (rCBF) and its correlation with curative efficacy in patients with obsessive-compulsive disorder (OCD).Methods The images of rCBF and computed tomography (CT) were acquired from 30 OCD and 30 normal controls by single photon emission computed tomography (SPECT) and CT.The tomographic data of rCBF were normalized,smoothed and statistically processed with the statistical parametric mapping (SPM) software with two-sample Z-test.And the OCD grade was evaluated with the Y-BOCS at pre- and post-medication.Results The abnormal results of CT were not found.The SPM Z-test showed that the sections of higher rCBF in the OCD patients were predominantly located in basal ganglia and occipital lobe compared with the normal controls ( P ＜ 0.001 ).The scores of Y-BOCS in 30 patients were markedly lower at post-medication than those at pre-medication (24 ± 7 vs 11 ± 6,P ＜ 0.001 ).At post-medication,the scores of Y-BOCS with higher rCBF in basal ganglia and occipital lobe were higher than those in basal ganglia or occipital lobe (P ＜ 0.05 ).Conclusion The OCD patients have higher rCBF in basal ganglia and occipital lobe.The curative efficacy of OCD with higher rCBF in basal ganglia and occipital lobe is worse than that in basal ganglia or occipital lobe.

Objective To investigate the effects of transcutaneous electrical stimulation of auricular Shenmen point on postoperative nausea and vomiting and patient-controlled epidural analgesia in cesarean section.Methods After IRB approval and informed consent,one hundred and eighty singleton primiparas undergoing elective cesarean section,in Qingdao Municipal Hospital,and Qingdao Hiser Medical Center,from November 2011 to March 2012,were randomly assigned to three groups:transcutaneous electrical stimulation of auricular Shenmen point group ( group A,n =60),transcutaneous electrical stimulation of auricular Eye point group (group B,n =60 ) and control group (group C,n =60 ).Women of group A received transcutaneous electrical stimulation of auricular Shenmen point (frequency 1.5 HZ ) at the time of preoperation,4,10 and 22 hours of postoperation for 30 minutes.The strength was controlled by themselves.Women of group B received stimulation of auricular Eye point as group A.Women of group C received pressurization and connected line were the same with group A,but without electrical stimulation.The following indexes was observed:the incidence of postoperative nausea and vomiting (PONV) for 48 hours; the rate of metoclopramide; the visual analogue scale (VAS) score of rest pain,uterine contration pain and dynamic pain at the time of postoperation for 6,12,24 and 48 hours ( T1 - T4 ) ; the total number and effective compressions number of patient-controlled epidural analgesia ( PCEA ) ; the dose of analgesia mixture; the anal exhaust time; the volume of postoperative bleeding for 6 hours of postoperation and the other side effects.Results Compared with group B and group C,the incidence of PONV,the rate of metoclopramide,the VAS score at the time T1 -T4,the total number and effective compressions number of PCEA,the ratio of the total number with effective compressions number and the dose of analgesia mixture were decreased in group A ( P ＜ 0.05 ),but no defference compared group B with group C ( P ＞ 0.05 ).The anal exhaust time and the volume of postoperative bleeding for 6 hours of postoperaton were no difference in the three groups ( P ＞ 0.05 ).No other side effects were observed.Conclusion Transcutaneous electrical stimulation of auricular Shenmen point can reduce the incidence of PONV and improves analgesia effect of PCEA in postoperation of cesarean section.

Objective To investigate the effects of dexmedetomidine combined with fentanyl in patients undergoing anesthesia induction by sevoflurane.Method Eighty patients for elective endotracheal intubation under general anesthesia operations were randomly and double-blindly divided into Dex combined with fentanyl group (Group DF) and the fentanyl group (Group F) from April 2011 to September 2011 at the Fourth Affiliated Hospital of Harbin Medical University,and there were 40 cases in each group.The investigation was approved by all the patients and by the Ethics Committee of the hospital.In group DF,each patient was pumped in the 0.5 μg/kg Dex by vein befor 10 minutes of anesthesia induction and group F were given the same amount of normal saline,and tidal volume method was used to induce anesthesia of sevoflurane.All the patients were given 2 μg/kg fentanyl and 0.1 mg/kg vecuronium by tracheal intubation and the MAP and HR and adverse reactions were observed before anesthesia induction (T0 ),before endotracheal intubation ( T1 ),at the moment of tracheal intubation ( T2 ),after 1 minutes of tracheal intubation (T3 ),after 3 minutes of tracheal intubation (T4) and after 5 minutes of tracheal intubation (T5).Result The loss of eyelash reflex time of group DF is shorter ( P ＜ 0.05 ),adverse reaction is less ( P ＜ 0.05 ) and the number of adding atropine case is higher than that of group F ( P ＜ 0.05 ),the MAP of the two groups after induction of other moments are lower than that of T0 ( P ＜ 0.05 ) ; MAP of group F at T1 is lower than that of T0,T2,T3 and group DF ( P ＜ 0.05 ) ; T1 of group DF is lower than that of T0 ( P ＜0.05 ),the HR after induction of group DF is lower than that of T0 and F group ( P ＜ 0.05 ),and that of T2 and T4 are higher than that of T1(P＜0.05); HR of group F at T1 is lower than that of T2 and T3 (P ＜0.05).Conclusion Dexmedetomidine in combination with fentanyl can inhibit stress response of tracheal intubation of sevoflurane induction efficiently and stabilize hemodynamics.

Objective To explore the injury of vascular endothelium in male castrated rats.Methods A total of 30 eight-week-old adult male SD rats were randomly divided into 3 groups:control ( n =8 ) ; castration ( n =11 ) ( low androgen) and replacement ( n =11 ) ( androgen dosing after castration).After 10 weeks of treatment or castration,the rats were sacrificed to obtain aortic specimens.Arterial morphological changes were observed by hematoxylin and eosin staining and electron microscope.Endothelial cell chromatin degradation was detected by the assay of terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL).The mRNA level of bcl-2 was analyzed by reverse transcription-polymerase chain reaction (RT-PCR).Results Compared with the control group,the arterial structure was disorderly and had shedding of endothelium in the castration group.More apoptotic endothelial cells were found in the castration group(61％ ±20％ )than the other two groups (P ＜0.05).Compared with the control group,the bcl-2 mRNA level decreased significantly in the castration group ( P ＜ 0.05 ).However no significant difference existed in the replacement group ( P ＞ 0.05 ).Conclusion Low androgen may damage the structure of vascular endothelium in male castrated rats.

Objective To explore the effects of curcumin on paclitaxel resistance reversal of SKOV3-TR30 cell line and its mechanism.Methods The ( 3-( 4,5-dimethylthiazol-2-yl )-2,5-diphenyltetrazolium bromide) MTT assay was performed to determine the sensitivity of curcumin-treated SKOV3-TR30 cells to paclitaxel.The cell cycle distribution of SKOV3-TR30 was analyzed by flow cytometry.And the expression level of glycogen synthase kinase-3 ( GSK-3 ) protein was detected by Western blot.Results IC50 of paclitaxel in SKOV3-TR30 decreased with a treatment of curcumin.And the reversal times was 3.0.Flow cytometric analysis of curcumin-treated SKOV3-TR30 cells demonstrated a distinct G2-M phase block ( 78.5 ± 6.4) ％ after a 12-hour treatment of paclitaxel versus SKOV3-TR30 cells without curcumin.There was a lack of G2-M phase arrest ( only 27.0％ ± 2.9％ ).The expression of GSK-3 protein in SKOV3-TR30 cells decreased with the 12 and 24-hour treatments of curcumin.Conclusion Curcumin can partially reverse the paclitaxel-resistance of SKOV3-TR30 cells through a down-regulation of GSK-3.

Multiple sclerosis (MS) is the most common demyelinating disease of central nervous system in young adults. There are about 2 million patients worldwide, and about 85% of MS patients are relapsing-remitting multiple sclerosis (RR-MS). Although its etiology is still unknown, it is certain that there is neuronal deletion in this type of patients. Therefore, if a biomarker can be found, it will provide an important basis for its disease progression and even treatment. N-acetyl-L-aspartic acid (NAA) is the highest content in neurons. Therefore, Dr. Rigotti DJ et al. studied the changes of NAA concentration in proton nuclear magnetic spectroscopy (H-MRS) in RR-MS patients for 2 years to verify the following hypotheses: (1) RR-MS patients showed a decrease in the concentration of N-acetyl-L-aspartic acid (WBNAA) in the whole brain; (2) Decreased WBNAA concentrations were more sensitive than clinical manifestations. The results were published in the May 1, 2012 issue of Neurology (2012, 78: 1383-1389).

Echinococcosis is a common zoonotic parasitic disease that seriously endangers human health [1]. Because it is found that surgical method is difficult to cure bone hydatidosis, and the effect of drug treatment is not good [2]. On the basis of radiotherapy of bone hydatidosis animal model [3], after discussion and approval of hospital ethics committee and informed consent of patients, we carried out radiotherapy for bone hydatidosis patients, and obtained clinical safety and preliminary efficacy observation results.

The patient was a 63-year-old female who was admitted to the hospital on July 9, 2010 due to "repeated convulsions accompanied by poor speech expression for half a year and recurrent for 1h". On January 9, 2010, the patient suddenly lost consciousness and fell while doing housework, and developed a generalized tonic-clonic seizure, accompanied by closure of teeth, binocular gaze, and facial cyanosis, of unknown duration. Subsequently, she became clear, accompanied by vomiting of stomach contents, which was not jet-like, and developed poor speech expression, could only speak a single word, and could understand the speech of family members. There was no headache or limb weakness. Before the onset of the disease, she had cough and expectoration. She was rushed to a local county-level hospital for hospitalization. CT examination of the head showed small patchy hemorrhage in the left frontoparietal lobe and a small amount of subarachnoid hemorrhage. After admission, the patient developed frequent epileptic seizures, the disorder of consciousness gradually aggravated to shallow coma, and the right limb was completely hemiplegic.

A 45-year-old female was admitted to the hospital with upper abdominal pain and discomfort for more than 1 year. The patient developed upper abdominal pain without obvious trigger 1 year ago, and the attack showed persistent dull pain, accompanied by radiating pain in the lower back, mostly midnight pain, and the pain was slightly relieved after eating. Occasionally, she had belching and acid regurgitation, no abdominal distension, no nausea, vomiting, no fear of cold, cough, and no melena. Recently, the feeling symptoms were aggravated, and the pathological report of gastroscopy in an outside hospital showed that there was a mucus lake-like structure in the fibrous connective tissue of inflammatory necrosis of the gastric angle, and the patient was admitted for further treatment.

The prevention and treatment of childhood blindness is an important item in the "Vision 2020: Enjoying the Right to See" initiated by the World Health Organization [1]. Surveys in many provinces in China show that the incidence of visual impairment in children aged 0-6 is 1.1‰, of which congenital cataract accounts for 14.1% [2]. Considering that China is a developing country with a large population, the prevention and treatment of childhood cataract is very arduous, especially in the treatment of congenital cataract, there are still many controversial issues that deserve our consideration.

Rett syndrome (RS) is a disease that affects the neuropsychiatric development of children. It was first reported by Andreas Rett in 1966. In recent years, it has been found that the disease is widespread in all countries in the world with a high incidence rate. It has been paid attention by the international medical community, and it was officially named as Rett syndrome at the International Conference in Vienna in 1984. The role of Rett syndrome and MeCP2 in neurodevelopment is summarized as follows.

A 75-year-old male was admitted to the hospital on August 5, 2011 due to "sudden syncope for 3h". The patient suddenly fainted when he got up on August 5, 2011, lost consciousness and refused to respond to his call. The symptoms lasted for about 3 minutes, accompanied by cold sweat all over the body, no nausea and vomiting, no limb twitching, no closure of teeth, no palpitation and chest tightness. He had a history of hypertension for 5 years. He usually took "amlodipine besylate and reserpine" orally, and his blood pressure was controlled ominously. Physical examination at admission: blood pressure 140/80 mm Hg (1 mm Hg =0.133 kPa), apathy, slightly dull response, symmetric nasolabial folds and frontal lines, tongue extension in the center, soft neck, no obvious abnormalities in muscle strength, muscle tone, sensation and mutaxia of limbs, and no bilateral Babinski was drawn out.

A 28-year-old male was admitted to Yishui Central Hospital of Linyi City, Shandong Province on May 22, 2011 due to sudden disadvantage of left limb movement for 2h. He was in good health before. Physical examination: clear consciousness, eyes staring to the right, bilateral pupils of equal size and round, 3 mm in diameter, sensitive to light, shallow left nasolabial fold, right tongue extension, soft neck, left limb muscle strength grade 0, right limb muscle strength grade V, normal muscle tone of bilateral limbs, mild depressed edema of bilateral lower limbs, bilateral Babinski sign (-).

A 36-year-old female was admitted to Peking Union Medical College Hospital on June 20, 2011 due to polyarticular swelling and pain for 12 years, chest tightness and shortness of breath after activity for 1 year. In 1999, she developed symmetrical polyarticular swelling and pain in the whole body, involving the distal interphalangeal joints, proximal interphalangeal joints and metacarpophalangeal joints of both hands, metatarsophalangeal joints of both feet, bilateral wrist, elbow, shoulder, ankle, knee, hip and temporomandibular joints, accompanied by morning stiffness for about 15 min. Examination in other hospitals showed an increase in erythrocyte sedimentation rate (ESR) and negative rheumatoid factor (RF), and she was diagnosed as rheumatoid arthritis (RA). The joint swelling and pain improved with intermittent treatment of prednisone and non-steroidal anti-inflammatory drugs. In 2008, she gradually developed joint deformation in both hands. In the past year, she developed chest tightness and shortness of breath after activity intermittently. Coronary angiography in other hospitals showed "left main disease". The patient had no rash, photosensitivity and oral ulcer.