Volume 92  ·   Issue 32  ·  2012

functional gastrointestinal disorders (FGID) are very common clinical diseases. Although there is a lack of organic or metabolic diseases that can explain the symptoms of FGID, patients experience the pain of the disease, seriously affect the quality of life, and consume huge medical resources. In recent years, it has attracted widespread and close attention of the society [1].

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea-hypopnea syndrome (OSAHS) are two common chronic respiratory diseases, which are called overlapping syndrome (OS) when they coexist. Epidemiological investigations have found that the prevalence of OS in adult men is about 1%, although asymptomatic lower respiratory tract obstruction and sleep apnea are much more likely to coexist [1-2].

Objective To explore the symptomatic features and psychosocial factors in patients with belching disorders.Methods At Peking Union Medical College Hospital Outpatient Clinic from September 2010 to January 2011, 21 consecutive patients with repetitive belching were profiled by symptom questionnaires,including general demographics, spectrum of symptoms, disease course,predisposing factors,previous treatment,psychosocial factors,mental status and personality traits, etc. Pearson's correlation analysis and exact probability were used.Results Among them,20 patients fulfilled the Rome Ⅲ criteria of belching disorders.There were 5 males and 15 females with an age range of (49 ± 10)years.Among them,the belching patterns were daily (n =18),meal-related (n =16),spontaneous (n =15),controllable (n =16) and symptomatic overlapping (n =17).The most common symptoms were functional dyspepsia (FD) ( n =13 ) and gastroesophageal reflux disease (GERD) (n =11 ).Sixteen patients experienced mental stimulation/negative events and 13 patients were related to family tension,work stress and overwork.There were 12 patients with anxiety and/or depression and 8 with neurotic personality.The number of overlapping symptoms was related to anxiety states ( r =0.47,t =2.14,P ＜ 0.05 ). But the severity of belching was unrelated to with or without depression and anxiety state (P =0.096).Conclusions There are a variety of clinical manifestations in patients with belching disorders. Belching disorders is often related to emotional change and environmental stress and accompanied by abnormal mental and personality characteristics. Belching may be an abnormal behavior reaction to gastrointestinal discomfort symptoms.The psychological and social factors probably play an important role in the pathogenesis of belching disorders.

Objective To examine the relationship between inflammation and the comorbidity of mental disorders with irritable bowel syndrome (IBS) by comparing intestinal mucosa inflammatory biomarkers in patients with and without mental disorders.Methods A total of 43 consecutive IBS patients fulfilling the Rome Ⅲ criteria and 15 volunteers serving as controls without digestive symptoms were recruited and interviewed with Composite International Diagnostic Interview (CIDI) by the well-trained staff and thus classified as with or without mental disorders.All subjects underwent colonoscopy and biopsies were acquired from the mucosa of distal ileum and colon. CD3 + lymphocytes,mast cells,5-HT positive cells and (indoleamine 2,3-dioxygenase) IDO positive cells were identified immunohistologically in mucosa biopsies in volunteers (n =13 ),IBS patients without mental disorder (n =24 ) and IBS patients with mental disorder ( n =19).Results The incidence of mental disorders in IBS patients was significantly higher than that in the volunteers (19/43 vs 2/15,P =0.012),including 9 patients with anxiety disorders and 8 with mood disorders.( 1 ) The number of mast cells in IBS patients with mental disorder and that in IBS patients without mental disorder has no statistical significance ( ( 16.7 ± 3.6 )/HP vs ( 15.4 ± 3.1 )/HP in distal ileum,( 12.8 ±2.2)/HP vs ( 12.3 ± 2.5 )/HP in sigmoid,both P ＞ 0.05 ).Similar results were seen in 5-HT positive cells ( (3.7 ± 0.9 )/HP vs (3.4 ± 0.8 )/HP in distal ileum,(6.1 ± 1.8 )/HP vs(5.2 ± 1.8 )/HP in sigmoid,both P ＞ 0.05).In distal ileum,the number of CD3 + cells in IBS patients with mental disorder has no statistical significance with that in the IBS patients without mental disorder ( (62 ± 16)/HP vs(55 ±22)/HP,P ＞ 0.05 ).Similar results were seen in IDO positive cells (6 (2,8)/HP vs 2 (1,5)/HP,P ＞0.05 ).(2) The number of IDO positive cells from distal ileum in IBS patients with anxiety disorder was significantly higher than that in the IBS patients without mental disorder ( 6 ( 4,8 ) vs 2 ( 1,5 ),P =0.018).The number of mast cells from distal ileum in the IBS patients with mood disorder were significantlyhigher than that in those without mental disorders ( ( 18.3 ± 3.2)/HP vs ( 15.4 ± 3.1 )/HP,P =0.032).Conclusions Mental disorders in the IBS patients may be associated with intestinal mucosal inflammation.The activation of IDO may cause the comorbidity of IBS with anxiety disorder while the activation of mast cells probably leads to the comorbidity of IBS with mood disorder.

Objective To survey the emotional and sleeping status of patients with chronic constipation (CC) and analyze the relationship between psychological status and constipated symptoms.Methods From January 2009 to April 2010,5 centers and 25 stratified hospitals were selected as the representatives of different regions of mainland China. The CC questionnaires including constipated symptoms,emotional and sleeping status,previous treatments and self-reported impact of constipation on health status,etc.Questionnaires were completed by well-trained physicians or investigators during face-to-face interviews.CC was diagnosed in accordance with the Rome Ⅲ criteria.Results A total of 909 valid questionnaires analyzed. There were 258 males and 651 females with a mean age of (49 ± 19) years.41.5％ (377 cases)reported " tense feelings" and 38.3％ (348 cases) "felt downcast" over the past 3 months.The patients feeling tense and (or) downcast "frequently" and "most of time" were around 11.3 ％ ( 103 cases) and 9.4％ ( 85 cases).And 43.8％ ( 398 cases) patients reported sleeping disorders over the past 3 months.Regional differences existed in the comorbidities of psychological and sleeping disorders in CC patients,especially in those from tertiary hospitals.And it was the highest in Beijing area for tense feelings and downcast. The sleeping disorders were the most common in the patients from secondary hospitals,of which 66.1％ ( 37/56 ) and 65.0％ ( 39/60 ) were from Wuhan and Xi' an respectively.They were higher than Beijing and Guangzhou (39.7％ (23/58),29.0％ (9/31),all P =0.001 ).The patients from rural primary clinics suffered more sleeping disorders than those from urban primary cares (P =0.026).About 35.0％ (318 cases)and 28.4％ (258 cases)patients reported their constipation was related with emotional and sleeping disorders.The comorbidities of psychological and sleeping disorders were more common in severe constipated patients than mild and moderate counterparts and resulted in more hospital visits( both P =0.000).Conclusions The CC patients often have the comorbidities of psychological and sleeping disorders with regional differences. The patients from the hospitals at various levels may present different spectrums of comorbidities of psychological and sleeping disorders. And the severity of CC influences the moods,sleeps and hospital visits.

Objective To explore the association of age,gender and urinary diversion category with postoperative complications of radical cystectomy. Methods A total of 374 patients with bladder cancer undergoing modified radical cystectomy and urinary diversion between March 2000 and June 2011 were retrospectively reviewed. Their demographic, perioperative and complication data were recorded. And multivariable Logistic regression was used to investigate the predictors of perioperative complications.Results Among them,38.8％ (145/374) received ileal conduit,47.9％ (179/374) orthotopic ileal neobladder and 13.4％ (50/374) orthotopic colonic neobladder.The overall perioperative complication rate was 37.4％ (140/374).And 21.4％ (80/374)experienced at least one complication within Day 90 postoperation while 16.3 ％ (61/374)had the long-term complications ( ＞ Day 90).There was no significant association between patients age (P =0.15) and perioperative complications or between gender (P =0.16)and complication.Urinary diversion( OR =0.26,95％ CI:0.16 - 0.43 ) was the only variable significantly associated with the perioperative urinary complications.Conclusion The categories of urinary diversion may be used as a single predictor for complications after radical cystectomy.

Objective To explore the applications of karyotypic analysis in the diagnosis and prognosis of myelodysplastic syndrome (MDS).Methods Chromosomal analysis was performed with short-term cell cultures and R-banding techniques in 129 MDS patients.And the technique of FISII was employed for clinical follow-ups in 28 MDS patients. Based on the result of abnormal karyotype,the patients were divided into three groups:low risk group,intermediate risk and high risk group.The leukemia transformation time and survival time between these three groups were compare. Results Among them,52 patients (40.3％ ) had numeral karyotypic abnormalities of chromosomes and structural alterations. Complex abnormal karyotype was the most common and accounted for 30.8％ ( 16 cases).The frequencies of 20q-and +8 were 19.2％ (10 cases) and 15.4％ (8 cases)respectively.Six cases were positive by FISH,however,of whom,were negative for conventional cytogenetics.The follow-up data were available in 88 patients with a median follow up duration of 11 (3,60)months,27 cases (30.7％ ) progressed to acute leukemia.The rate of leukemia transformation were 27.8％ (15/54),23.5％ (4/17) and 47.1％ (8/17) in the low,intermediate and high risk groups respectively.The median durations of leukemic transformation were ＞60(14,＞60),48(35,＞60) and 7 (6,12) months in the low,intermediate and high-risk groups and the median survival times were 26 ( 15, ＞ 60),21 ( 14,35 ) and 10 ( 6,13 ) months respectively.The median durations of leukemic transformation and median survival periods in the high-risk groups were shorter than those in the low and intermediate risk groups ( all P ＜ 0.05 ).Conclusion Karyotypic analysis has important values in the diagnosis and prognosis of MDS.

Objective To apply different types and concentrations of T&T olfactometer odorants to exam smell function and explore the clinical characteristics of partial olfactory dysfunction.Methods From March 2007 to May 2008,a total of 24 patients with olfactory dysfunction were examined by medical and psychiatric history enquiry,physical examination,smell testing and medical imaging.Olfactory function of each nostril was assessed separately by T&T olfactometer. The test contained five kinds of odorants at different concentrations.Recognition threshold (RT) scores for all five odorants and for each individual odorant were measured in all patients.Results Among them,total RT scores were normal while single odorant testing yielded only significant higher RT scores for one or two odorants.For patients who suffered partial olfactory dysfunction,51.4％ are for pleasant odors,while the rest are for unpleasant odors.Conclusion Normal total RT scores and abnormal single RT scores of T&T olfactometer are present in partial olfactory dysfunction.As a special clinical manifestation of olfactory disorder,it may be easily ignored in smell testing.

Objective To explore the recipient's reproduction after liver transplantation (LT) and assess the outcomes of their offspring.Methods We retrospectively analyzed the reproduction status of 13 post-LT patients among 336 post-LT recipients during a follow-up period.Physical and intellectual status of their offspring were evaluated by developmental index and Denever developmental screening test. Results A total of 16 children were mothered or fathered by 13 LT patients.Two female patients mothered a boy and a girl.Ten male patients fathered 6 male and 8 female children while another male fathered a child at 28 gestational weeks.Eleven patients fathered the first gestation 21 mon (medium) since LT,and fathered 15 pregnancies.Twelve of 14 deliveries had a mean gestation age of(38.2± 1.8 )weeks,with a mean birth weight of (3.1 ±0.5)kg.Among 12 newborns,3 were premature and 2 of a low birth weight.Two female patients delivered 2 babies with a gestation age of 37.3 and 40.4 weeks,a birth weight of 2.7 and 3.4 kg,and anoxia neonatorum in one case. No deformity was found.Thirteen of 16 children had almost normal developmental indices and ten had almost normal Denever developmental screening. Conclusion Post-LT patients of reproductive age are able to reproduce offspring.The short-term development of their offspring is relatively normal.

Objective To prospectively evaluate the utility of detecting bronchoalveolar lavage fluid (BALF) Aspergillus galactomannan antigen (GM) in the diagnosis of pulmonary aspergillosis.Methods From August 2008 to April 2012,121 patients suspected of pulmonary aspergillosis were recruited and classified into pulmonary aspergillosis group (n =57) and non-pulmonary disease group (n =64) according to the 2008 diagnostic criteria and classification of European Organization for Research and Treatment of Cancer / National Institute of Mycoses Study Group (EORTC/MSG).The absorbency (A) and I value of GM in the patients' serum and BALF were detected by enzyme-linked immunosorbent assay (ELISA).And their values were compared and analyzed. Results Twenty cases were confirmed by pathological examinations and 37 cases by clinical diagnosis in the pulmonary aspergillosis group.The mean rank of GM's I value in the serum and BALF samples was 88.21 and 86.49.And they significantly increased compared with the non-pulmonary aspergillosis group (36.77,38.30) (P ＜0.01 ).At a different serum GM threshold I =0.5,0.8,1.0,the sensitivities were 0.842,0.649 and 0.228 ; the specificities 0.906,0.938,0.929 ;the positive predictive values 0.889,0.902,0.984 and the negative predictive values 0.866,0.750,0.589 respectively.And at a different BALF GM threshold I =0.5,0.8,1.0,the sensitivities were 0.930,0.657,0.561 ; the specificities 0.766,0.922,0.969 ; the positive predictive values 0.779,0.884,0.941and the negative predictive values 0.925,0.756,0.713 respectively.Conclusion The detection of GM in BALF may be employed for the clinical diagnosis of pulmonary aspergillosis.

Objective To explore the expression pattenn of microRNA (miRNA) in T cells of peripheral blood mononuclear cell (PBMC) from patients with primary biliary cirrhosis (PBC).Methods The expression profile of miRNA in T cells of PBMC was determined by microarray assay and validated by real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR).Results In comparison with the healthy controls,23 miRNA were down-regulated and 2 miRNA had a higher expression ( all P ＜0.05). As revealed by qRT-PCR,the expressions of miR-346,miR-17-5p,miR-20a and miR-let-7b decreased obviously while miR-451 and miR-129 became up-regulated.The results were in agreement with those of microarray. Conclusions The PBC patients and healthy controls have significantly different expression profiles of microRNA in T cells of PBMC. The differential expression of microRNA may be involved in the pathogenesis of PBC.

Objective To summarize the clinical experiences on correction of congenital heart disease with robotic technology at a single center.Methods Between January 2007 and May 2012,this retrospective study recruited 160 consecutive patients undergoing robotic surgery for congenital heart diseases.There were 74 males and 86 females with a median age of 35 years ( range:11 - 62 ). The procedures included secundum-type atrial septal defect repair ( n =130),ostium primum defect repair ( n =1 ),perimembranous ventricular septal defect repair ( n =21 ),mitral valve repair for anterior leaflet cleft ( n =7 ) and mitral valve repair plus left atrial myxoma resection ( n =1 ).Cardiopulmonary bypass graft was established through cannulation of right femoral artery,vein and right internal jugular vein under the guidance of transesophageal ultrasound. Myocardial protection was performed with cold blood cardioplegic solution or HTK solution and a transthoracic Chitwood clamp was used to occlude ascending aorta.Via three 8-mm ports and one 15-mm port in right chest,the microscopic instruments were manipulated to complete defect closure or mitral valve plasty,utilizing da Vinci S or da Vinci SI robotic system. Echocardiography was performed intraoperatively and at pre-discharge.Routine follow-ups were conducted.The clinical data of operating time,cardiopulmonary bypass time and follow-up examinations were retrospectively analyzed.Results All cases were treated successfully without a conversion into median sternotomy. No operative mortality or severe surgical complications were observed. Seventy-six cases of secundum-type atrial septal defect were completed on beating heart.The learning curves were noted for operating time of beating heart group and cross clamp time of arrest heart group. No residual shunt,malignant arrhythmia or mitral valve regurgitation was detected on intraoperative or postoperative echocardiography and during a median follow-up period of (29.1 ± 16.3) months.Conclusion Robotic minimal access is technically feasible and it may be applied in selectivc paticnts with atrial septel defect,perimembranous ventricular septal defect and mitral valve cleft.

Objective To evaluate the effects of selenium (Se) supplementation on concentrations of thyroid peroxidase antibodies (TPOAb) and TPOAb IgG subclasses in autoimmune thyroiditis (AIT) patients with different thyroid functional status.Methods A blind and placebo-controlled prospective study was performed for a total of 134 cases with AIT and thyroid peroxidase antibodies above 300 U/ml.Their mean age was 41 years ( range:15 -70). All of them were recruited from Department of Endocrinology,First Affiliated Hospital of China Medical University from June 2008 to June 2009 and divided into 2 groups according to thyroid function:euthyroidism or subclinical hypothyroidism (n =89) and hypothyroidism (n =45 ).Then they were randomized into 2 groups:selenium-treated and placebo-treated. And 49 cases in subclinical autoimmune thyroiditis group and 28 cases in hypothyroidism group received 200 μg oral selenium yeast daily for 6 months while others placebo. Serum concentrations of TPOAb,TPOAb IgG subclasses,thyroid-stimulating hormone ( TSH),free thyroxine ( FT4 ) and Se were measured at baseline and after 3 and 6 months of follow-up.Results The TPOAb levels showed an overall decrease of 4.3％ at 3 months and of 12.6％ at 6 months (both P ＜ 0.05 ) post-supplementation in subclinical autoimmune thyroiditis patients.In overt hypothyroidism patients,the overall decrease of TPOAb concentrations was 21.9％ at 3 months and 20.4％ at 6 months ( both P ＜ 0.05) compared with those at pre-treatment.The predominant TPOAb IgG subclasses in sera from the AIT patients were IgG1,IgG3 and IgG4 and the positive percentages 72％,41％and 72％ respectively.The positive rate and concentrations of IgG3 in the patients with hypothyroidism were significantly higher than those of subclinical autoimmune thyroiditis ( P ＜ 0.05 ). Significant decreases in IgG1 and IgG3 levels were noted in subclinical autoimmune thyroiditis group at 6 months postsupplementation (P ＜ 0.05 ). IgG1 levels in overt hypothyroidism decreased significantly compared with those at pre-supplementation ( P ＜ 0.05 ).In all patients with supplementation (n =77),the TPOAb levels decreased in 52 at 6 months while increase or no change occurred in 25. The positive percentage and concentrations of IgG1 in patients whose TPOAb levels decreased at 6 months post-supplementation were markedly higher than those whose TPOAb levels increased ( P ＜ 0.05 ). Conclusion Se is effective in reducing TPOAb concentrations and the predominant decreasing TPOAb IgG subclasses are IgG1 and IgG3.And a high level of IgG1 subclass may explain the difficult decline of TPOAb.

Objective To explore the role of heme oxygenase-1 (HO-1) in the apoptosis of mesenchymal stem cells (MSCs).Methods The method of reverse transcription PCR (RT-PCR) was employed to detect the expression of HO-1 mRNA in bone marrow MSCs. Morphologic observations,flow cytometry Annexin-V and DNA analysis were used to detect apoptosis and determine the content of DNA of MSCs after a 12-hour treatment of Znpp-Ⅸ,a Ho-1 special inhibitor.Results HO-1 mRNA was expressed in normal bone marrow MSCs. After culturing Znpp-Ⅸ for 12 h,MSCs showed volume reduction and membrane shrinkage.The cells of apoptotic Annexin V +/PI- increased significantly (61.21％ ± 5.28％ vs 7.48％ ± 0.69％,P ＜ 0.05 ). The peak of apoptosis was distinct on the distribution graph of DNA (21.36％ ±0.49％ vs 1.02％ ±0.05％,P ＜0.05).Conclusion HO-1 plays an anti-apoptotic role in human bone marrow mesenchymal stem cells.

Objective To explore the effects of the expression of Wnt/β-catenin signaling factor mRNA during drynaria total flavonoids on the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs).Methods The BMSCs were isolated from SD rats by whole bone marrow culture method and purified by passage.And the P3 BMSCs were intervened with 100 μg/ml drynaria total flavonoids.At Day 21,mineralized staining was performed. At Days 7,14,21 and 28 post-intervention,the activity ofalkaline phosphatase (ALP) was detected and polymerase chain reaction (PCR) used to detect theexpressions of Wnt/β-catenin signaling pathway related factors β-catenin,LEF-1 and cycline D mRNA.Results At each timepoint post-intervention,comparing the ALP activity in cell supematant between two group,the drynaria total flavonoids group was higher than the blank control group (7 d:11.10 ± 0.08 vs 1.61 ±0.14; 14 d:24.62±0.34 vs 1.64±0.04; 21 d:18.41 ±0.06 vs 1.53 ±0.04; 28 d:14.9 ±0.14vs 1.52 ±0.04; all P ＜ 0.01 ).At Day 21,upon staining with alizarin red,the drynaria total flavonoids group was positive while the blank control group negative.At Day 14,the expression of β-catenin mRNA was higher in the drynaria total flavonoids group higher than that in the blank control group (0.357 ±0.063 vs 0.174 ±0.013,P ＜0.05).At Day 7,the expressions of LEF-1 and cycline D mRNA were higher in the drynaria total flavonoids group than those in the blank control group ( LEF-1 0.0611 ± 0.0002 vs 0.0345 ±0.0131 ; cycline D 0.1510 ± 0.0255 vs 0.0718 ± 0.0294,all P ＜ 0.05 ).Conclusion Drynaria total flavonoids induce BMSCs to differentiate into osteoblasts.And it is accompanied with the altered expression of Wnt/β-catenin signaling pathway related factor mRNA.

Objective To explore the mechanisms of mucus hypersecretion in airway of rats induced by the synergies between cold air and cigarette smoke inhalation and understand the intervention effects of saussurea and budesonide in this process. Methods A total of 70 SD rats were randomly divided into 7 groups.Group A:control; Group B:cold stimulation group receiving cold air inhalation for 3 h daily for 40 d; Group C:cigarette smoke inhalation group receiving cigarette smoke inhalation for 0.5h daily for 40 d;Group D:cigarette smoke inhalation + cold stimulation group; Group E:cigarette smoke inhalation + cold stimulation + saussurea (0.8 mg/kg saussurea intraperitoneally injected once daily for 40 d) ; Group F:cigarette smoke inhalation + cold stimulation + inhaled budesonide (0.5 mg/kg inhaled once daily for 40 d) ; Group G:cigarette smoke inhalation + cold stimulation + saussurea + inhaled budesonide.The relative quantities of TRPM8 mRNA within bronchial epithelium of each group were detected by real-time polymerase chain reaction (PCR) and TRPM8 protein was detected by immunohistochemical assay and Western blot.The levels of mucin (MUC) 5AC,interleukin 8 (IL-8) and tumor necrosis factor alpha (TNF-α) in bronchoalveolar lavage fluid (BALF) were detected by enzyme-linked immunosorbent assay.Results TRPM8 mRNA of groups A-G were 1.00 ±0.00,0.98 ±0.07,2.27 ±0.29,2.31 ±0.30,1.55 ±0.38,1.66 ± 0.40 and 1.31 ± 0.23 ; TRPM8 protein 0.16 ± 0.05,0.16 ± 0.04,0.22 ± 0.06,0.25 ±0.05,0.17 ±0.04,0.18 ±0.03,0.15 ±0.05,0.25 ±0.04,0.24 ±0.03,0.58 ±0.06,0.56 ±0.09,0.41 ±0.09,0.39 ±0.07 and 0.20 ±0.06 respectively.TRPM8 mRNA and protein of groups C and D were significantly higher than those of group A.And groups E,F and G were significantly lower than those of group D (allP＜0.05).In BALF of groups A-G,MUC5AC were (57±6),(69±5),(66±4),(185 ±43),(142 ±30),(147 ±36) and (60 ±11) μg/mg,IL-8 (58 ±14),(146 ±38),(134 ±29),(379 ±101),(262 ±67),(294 ±70) and (81 ±27) ng/L,TNF-α(153 ±28),(208 ±90),(274 ±64),(600 ± 113),(458 ±96),(498 ±84) and (169 ±65) ng/L respectively.The values of groups B,C and D were significantly higher than those of group A ( all P ＜ 0.05 ) while groups E,F and G were significantly lower than those of group D ( all P ＜ 0.05).Cigarette smoke inhalation and cold stimulation synergistically enhanced the expression of MUC5AC,IL-8 and TNF-α. Saussurea and inhaled budesonide synergistically inhibited the expression of MUC5AC,IL-8 and TNF-α. Conclusions Cold air inhalation evokes the release of proinflammatory cytokines and MUC5AC via activated TRPM8 channel up-regulated by cigarette smoke inhalation.Saussurea and inhaled budesonide synergistically inhibits the above mentioned process.

Medical Record Abstract A 77-year-old male was admitted to China-Japan Friendship Hospital on May 26, 2011 due to "chest tightness after activity for 6 months and intermittent blood in stool for 4 months". The patient began to have chest tightness and shortness of breath after exertion 6 months ago. The dynamic electrocardiogram in another hospital showed that sinus rhythm and ST-T were changed, which was considered coronary heart disease, and the symptoms were alleviated after administration of nitrate drugs. The patient had bloody stool without inducement 4 months ago, once a day, about 50~80 ml each time, no mucus and purulent secretion, lasting for 3 days, accompanied by dizziness, palpitations, cold sweat, no fever, hemoptysis, chest pain, night sweats, and the symptoms improved after 6 days of treatment with hemostasis and acid suppression drugs.

Colorectal cancer is one of the most common malignant tumors. There are more than 1.2 million new cases of colorectal cancer in the world every year, ranking third among malignant tumors in men. Among women, the incidence rate is second only to breast cancer [1], and more than 1/2 of them are colon cancer.

High Altitude Deterioration (HADT) is a series of syndromes caused by long-term exposure to High Altitude hypoxia and the gradual decline of the function of multiple organs in the body [3-4].

Humanistic quality refers to a person's inner quality which is formed by knowledge, ability, idea, emotion, will and other factors, which is manifested as personality, temperament and cultivation. Humanistic quality education is to internalize excellent cultural achievements into personality, temperament and cultivation through knowledge transmission, environmental influence and self-practice, and become a relatively stable inner quality of human beings. Humanistic quality of medical students has its own specific requirements, medical skill is a benevolent art, and physicians are benevolent scholars, so they should respect, understand, comfort and care for people; Medicine is a benevolent science, and it needs profound cultural heritage and profound life experience to truly master it.

From the end of the 19th century to the end of the 1970s, in order to overcome the drawbacks of liberal capitalism, strengthen the government's monopoly on the public economy, promote the nationalization of important industries such as public utilities, and establish and perfect the public finance system, many developed countries in the West have achieved the equalization of public services which are closely related to people's lives, such as compulsory education, basic medical care and social security.

Not long ago, I submitted an article to China × × × × magazine on the Internet. Nearly 3 months after submitting the article (83 days, the review cycle of this magazine is within 3 months), I received a rejection email from the editorial department: "Thank you for submitting the article! I am very sorry that the masterpiece failed to pass the final review. The reviewers thought that the content was average and nothing new. Therefore, I am not prepared to adopt it." I can't accept this: "Your magazine is a three-review system, and 'the content is average and nothing new' should be rejected at the preliminary review stage. I don't know why it should be finally reviewed"? The next day, I received a response from the responsible editor: "Sorry, I made a mistake in my busy.

The patient, a 60-year-old farmer, was admitted to the respiratory department of the First Affiliated Hospital of Zhejiang University School of Medicine on August 11, 2010 due to "repeated cough and expectoration, fever accompanied by chest tightness and shortness of breath for 5 months". The patient developed cough, expectoration and fever in February 2010, with the highest body temperature of 38.7℃. Chest CT showed large consolidation in the left lower lung and multiple patches on both lungs (Figure 1), and blood gas analysis showed pH 7.32, PCO2 87 mm Hg (1 mm Hg =0.133 kPa) and PO2 56 mm Hg. She was admitted to another hospital with "severe pneumonia and type II respiratory failure". She was given mechanical ventilation by tracheal intubation, and the treatment of anti-infection, expectorant and asthma was improved. She was discharged on April 25, 2010.