Volume 92  ·   Issue 37  ·  2012

In the course of clinical practice, ischemia-reperfusion injury events are very common, from interventional therapy, such as percutaneous vascular intervention (PCI): coronary stenting, thrombolytic therapy after acute coronary embolization, cranial and cerebral vascular stent placement and cerebral vascular embolization/thrombolytic therapy, to the clinical course of ischemia-reperfusion injury experienced by patients during surgery, such as various clinical operations completed under cardiopulmonary bypass, organ transplantation, large organ resection, shock, cardiopulmonary resuscitation and large vessel replacement surgery, etc. The above-mentioned events experiencing ischemia-reperfusion injury seriously affect the postoperative outcome, complication rate, mortality rate, survival rate and long-term outcome of transplanted organs of patients. Therefore, it is important to study the mechanism of ischemia-reperfusion injury and effective intervention methods. At present, the mechanism of ischemia-reperfusion injury can be summarized as follows. Intervention from mechanism can reduce the degree of ischemia-reperfusion injury.

the International Association for the Study of Pain (IASP) designates the third Monday of October every year as the International Pain Day, which aims to make the public realize that eliminating Pain and enjoying health are the basic rights of patients. I write this article on the occasion of the International Pain Day, hoping that the majority of medical workers in China will pay attention to Pain science, realize the importance of Pain treatment, and have some understanding of the rapid development of Pain science in China.

Objective To explore the effects of propofol on the PI3K/Akt signaling pathway and the endoplasmic reticulum stress pathway of apoptosis induced by ischemia-reperfusion in isolated rat hearts.Methods Forty isolated rat hearts were completely randomly assigned into 5 different groups:control (C),ischemia/reperfusion (I/R),propofol (P),propofol plus Wortmannin (P + Wort) and Wortmannin (W).The isolated hearts were perfused on a Langendorff apparatus.Except for group C,all hearts were subjected to 30 min global ischemia and 120 min reperfusion.In the P,P + W and W groups,50 μmol/L propofol or 50 μmol/L propofol + 100 nmol/L Wortmannin or 100 nmoL/L Wortmannin were respectively added in the K-H buffer to perfuse for 10 min at pre-ischemia and 20 min at the beginning of reperfusion.The parameters of cardiac function were recorded at pre-ischemia and at the 120 min of reperfusion.The apoptotic index was measured by terminal deoxynucleotidyl transferase dUTP nick end labeling (Tunel).The expressions of caspase-12 and CCAAT/C/EBP homologous protein (chop) were measured by immunohistochemistry while those of Akt and p-Akt (Ser473) detected by Western blot.Results Compared with the I/R group,LVEDP significantly deceased and + dp/dtmax significantly increased,the apoptotic index [(27.89 ± 1.04) ％ vs (33.70 ± 2.20) ％],the expressions of caspase-12 [(0.1728 ± 0.0096) vs (0.2332 ± 0.0114)] and chop [(0.1889 ± 0.0078) vs (0.2407 ± 0.0123)] significantly deceased while that of p-Akt (Ser473) significantly increased in Group P (P ＜ 0.05).Wortmannin abolished the partial protective effects of propofol postconditioning(P ＜ 0.05).Conclusion Propofol perfusion may attenuate the endoplasmic reticulum stress pathway of apoptosis induced by ischemia/reperfusion in isolated rat hearts partly through the PI3K/Akt signal pathway.

Objective To explore the relationship between the protection of hydrogen sulfide (H2S) against hepatic ischemia-reperfusion injury and thioredoxin system in rats.Methods Eighteen adult rats were divided randomly into 3 groups,i.e.sham,ischemia-reperfusion (IR) and sodium hydrogen sulfide (NaHS).The rats in the IR and NaHS groups were subjected to ischemia for 60 min and followed by reperfusion for 6 hours.In the NaHS group,there was an intraperitoneal dosing of NaHS (28 μmol/kg) at 5 min pre-reperfusion.Blood samples were collected for the measurements of alanine transaminase (ALT) and aspartate transaminase (AST).Liver tissue samples were collected for measurements of Trx and TrxR activity by enzyme-linked immunosorbent assay (ELISA),Western blot detection of Trx system proteins and thioredoxin interacting protein (TXNIP) expression.Hematoxylin-eosin staining was used to observe the hepatic histopathological changes.Results Compared with the sham group,increased activities of ALT and AST were found in the IR group,accompanied by aggravated pathological injury.In addition,NaHS administrated at pre-reperfusion could alleviate hepatic injury.Compared with the sham group,the IR group had decreased Trx activity and Trx1 protein expression and increased TXNIP protein expression (P ＜ 0.05)while the NaHS group had increased Trx activity and Trx1 protein expression and decreased TXNIP protein expression (P ＜ 0.05).It indicated that the postconditioning with H2 S could reduce the inhibition of Trx system and boost tissue antioxidant capacity.Conclusion Hydrogen sulfide postconditioning can enhance the cellular Trx system and play a protective role in hepatic ischemia-reperfusion injury.

Objective To explore the effects of ischemic postconditioning on the remnant liver regeneration under ischemic reperfusion after subtotal hepatectomy.Methods A total of 90 male SD rats weighting 230-280 g were randomly divided into 3 groups of simple subtotal hepatectomy (SH),ischemia reperfusion (IR) and ischemic postconditioning (IPO).The left and middle liver lobes were resected.And the remnant liver was treated as follows:blood flow was non-blocked in SH group,but blocked for 30 min in IR group,then reperfused.The IPO group was established by 30-30 s intermittent interruptions of blood flow thrice during the early phase of reperfusion.At 1,6,12,24,48 h respectively,the serum levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),hepatocyte growth factor (HGF) and the positive ratio of proliferating cell nuclear antigen (PCNA) were detected.Also the contents of adenosine triphosphate (ATP),adenosine diphosphate (ADP) and adenosine monophosphate (AMP).were measured and the regenerated liver weight was calculated.Results The activities of ALT and AST in IPO group from 1-48 h were (138±20),(340±22),(770±55),(389±60),(113±25)U/L and (247±31),(509±51),(972 ± 77),(955 ± 159),(222 ± 44)U/L respectively at each timepoint and they were significantly lower than those (294 ± 37),(560 ± 69),(1222 ± 162),(540 ± 40),(161 ± 15)U/L and (439 ± 34),(669 ± 94),(1347 ± 118),(1274 ± 223),(403 ± 68) U/L in IR group (P ＜ 0.05) ; the regenerated liver weight (18.8 ± 3.2,34.0 ± 3.5％) and positive cell ratio of PCNA (43.9 ± 2.7,56.2 ±4.0％) in IPO group at 24 and 48 h were respectively higher than those in IR group ((11.3 ±2.9),(26.8±2.5)％ and (34.5 ±2.8),(48.8± 1.8)％) (P＜0.05); The HGF levels ((261 ±54) and (252 ± 103) pg/ml) at 24 and 48 h in IPO group were significantly higher than those ((99 ± 47) and (70± 19) pg/ml) in IR group (P ＜0.05) ; the contents of ATP in hepatic tissue at 24 and 48 h in IPO group were (22.20 ± 3.6) and (12.87 ± 2.49) μg/g respectively.And they were significantly higher than those in IR group (P ＜ 0.05),but lower than those in SH group (P ＜ 0.05).Conclusion Ischemic postconditioning improves the remnant liver regeneration under ischemic reperfusion after subtotal hepatectomy through its actions of stimulating HGF production and maintaining hepatic energy metabolism.

Objective To explore the effects of cromolyn sodium (CS) on intestinal ischemiareperfusion (IIR) and its relationship with mast cell activation and protease-activated receptor 2 (PAR-2)expression.Methods A total of 32 SD rats were randomly divided into 4 groups:sham-operated (S),intestinal ischemia reperfusion (IIR),CS (a mast cell stabilizer,CS,25 mg/kg) and compound 48/80 (a mast cell degranulator,CP,0.75 mg/kg) (n =8 each).IIR was induced by clamping superior mesenteric artery for 75 min followed by reperfusion for 3 hours.The above agents were intravenously administrated at 5 min pre-reperfusion.Rats were then sacrificed and intestinal issues harvested for histological examinations.The tryptase expression and mast cell count were analyzed by immunohistochemistry.PAR-2 was analyzed by Western blot.Results The Chiu's score (0.75 ± 0.21),mast cell count (10 ± 3),tryptase expression (125 ± 15) and PAR-2 expression (109 ± 10) of group S were the least while those of group CP the most (all P ＜ 0.05).The Chiu's score (2.14 ± 0.64),mast cell count (15 ± 4),tryptase expression (138 ±17) and PAR-2 expression (124 ± 12) of group CS were less than those of groups IIR and CP (all P ＜0.05).Conclusion Cromolyn sodium may reduce IIR injury by stabilizing mast cell membrane and inhibiting the expressions of tryptase and PAR-2.

Objective To evaluate the effects of heart rate (HR) on image quality and radiation dose of "triple rule-out" 320-row-640-slice multidetector computed tomography (MDCT) scan in patients with acute chest pain.Methods Retrospective analyses were performed for the clinical and imaging data of 38 cases with acute chest pain.All patients received 320-row-640-slice MDCT.Scanning program was electrocardiography-gated helical scan of full chest (160 × 0.5 mm).Based upon different heart rates,they were divided into A and B groups (A:n =18,HR ≤65 bpm; B:n =20,HR ＞65 bpm).The results of image quality and radiation dose of pulmonary artery,aorta and coronary artery between A and B group were evaluated respectively.The subjective quality indicators of coronary artery were excellent,good,qualified and poor.Results (1) Overall quality assessment:the mean CT values of ascending aortic root,main pulmonary artery,right coronary artery and left coronary artery were (412 ± 79) HU、(381 ± 107) HU,(408 ±79) HU,(406 ±79) HU respectively; the contrast-noise ratio (CNR) of ascending aorta root was 12 ± 7; excellent stage of subjective quality assessment of coronary artery accounted for 66.13％,good and qualified stage 32.79％ and poor stage 1.08％.The mean radiation dose was 22 ± 3 mSv.(2)The mean CT value between A and B groups of ascending aortic root,main pulmonary artery,right coronary artery and left coronary artery,and CNR of ascending aortic root [(421 ±62) HU vs (404 ±93) HU,(402 ± 103) HU vs (362 ± 110) HU,(417 ±62) HU vs (400 ±92) HU,(417 ±63) HU vs (397 ±92) HU,10 ±3 vs 13 ±8 respectively] were not statistically different (P ＞ 0.05) ; the number of segments of excellent subjective quality assessment and evaluable (excellent,good and qualified) of coronary artery between A and B groups were statistically significant (P =0.001,P =0.019).Group A was better than Group B.But the number of diagnosed segments of Group B still accounted for 97.9％.The radiation doses of two groups were 18 ±6 and 26 ± 5 mSv respectively.Group B was significantly higher than Group A and significant difference existed between two values (P =0.000).Conclusion The "triple rule-out" 320-row-640-slice MDCT scan may acquire high quality images of aorta,pulmonary arteries and coronary arteries for both high and low HR groups.With a low contrast-medium dosage and patient radiation dose,it is ideal for an etiological diagnosis of acute chest pain.Reducing HR further improves image quality and lowers radiation dose.

Objective To explore the sonographic characteristics of autoimmune pancreatitis (AIP).Methods The ultrasonographic features and clinical data of 8 AIP patients were analyzed retrospectively and compared with the findings of computed tomography and magnetic resonance imaging.Results Ultrasound images showed diffuse pancreatic swelling (n =6),focal pancreatic head thickening (n =1) and tail enlargement (n =1).In 7 patients,pancreatic echogenicities were of Grade 1 or less while the other 1 patient Grade 2.Among them,6 showed hyperechoic " pseudocapsule ".And enlarged gallbladder,dilated biliary and pancreatic ducts were seen in 2 patients with jaundice.Conclusion Ultrasonic features play an important role in an early diagnosis of AIP.

Objective To evaluate the objective and subjective effiacies of Le Fort operation and its impact on patients' quality of life before and after operation.Methods A total of 48 patients with pelvic organ prolapse undergoing Le Fort operation from October 2005 to May 2010 were recruited.Their clinical data were retrospectively analyzed and regular follow-ups of pelvic examinations and questionnaires conducted.The questionnaires included pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor distress impact questionnaire-short form 7 (PFIQ-7).Results Forty patients had complete follow-up data.Their mean follow-up period was 22.3 months (range:12-42).Among them,there were recurrence (n =1),new-onset stress uinary incontinence symptoms (n =6) and new-onset colorectal-anal symptoms (n =2).The postoperative scores of PFDI-20,PFIQ-7,UDI-6 and POPDI-6 decreased markedly (P ＜0.05).Conclusion Le Fort operation can significantly improve patients' quality of life and subjective prolapse symptoms and lower urinary tract.However its improvement of colorectal-anal symptoms remains to be defined.

Objective To study the application of allogenic bone and Ostetic artificial bone in double door laminoplasty.Methods From June 2004 to June 2010,a total of 111 patients underwent double door laminoplasty.And allogenic (group A,n =63) and Ostetic artificial (group B,n =48) bones were used.They had spinal stenosis at least several levels or OPLL (Ossification of posterior longitudinal ligament).Their follow-up period was 12 months.Anteroposterior compression ratio was used to evaluate the neurological status.Range-of-movement (ROM) of cervical spine and bone fusion was determined by radiography and computed tomography (CT) during the follow-ups.Results Anteroposterior compression ratio:group A improved from 0.18 preoperation to 0.43 postoperation while group B increased from 0.20preoperation to 0.44 postoperation ; ROM:group A decreased postoperatively to (22.6 ± 3.3) ° from (39.5 ± 6.1) ° while group B decreased postoperatively to (22.9 ± 3.7) ° from (39.3 ± 6.7) °.When Groups A and B were compared,bone fusion between allograft and spinous processes was completed in 73.1％ vs 64.2％,partial fusion in 22.4％ vs 18.7％ and failed in 6.3％ vs 17.1％.Conclusion Uses allogenic and Ostetic artificial bones in double door laminoplasty may achieve an excellent decompression of spinal cord.But the application of allogenic bone yields a higher bone fusion rate after surgery.

Objective To compare the pre-and post-operative radiographic data of a single-level anterior cervical corpectomy and fusion (ACCF)or a two-level anterior cervical discectomy and fusion (ACDF) for patients with two-level cervical spondylotic myelopathy.Methods We retrospectively reviewed the lateral cervical radiographs of 110 patients undergoing a single-level ACCF or a two-level ACDF for the treatment of cervical myelopathy from March 2005 to May 2008.All of them underwent anterior cervical fusion using poly ether ether ketone (PEEK) cage or titanium meshes packed with autogenous bone and fixed-screw titanium plate fixation.A single-level ACCF (group of ACCF,n =48) or a two-level ACDF (group of ACDF,n =62) was performed.The following parameters were analyzed:cervical sagittal alignment,Cobb angles of fusion segments,graft collapse,adjacent-segmental degeneration and rate of bone fusion.Results During a follow-up period of 24-60 months,no significant differences existed in sagittal alignment,adjacent-segmental degeneration and rate of bone fusion between two groups.Graft subsidence and loss of Cobb angles of fusion occurred significantly more during the first 2 months post-operation than after 2 months in each group (P ＜0.01).However,the group of ACCF subsided and lost more than the group of ACDF (P ＜0.05).Caudal endplate subsidence significantly progressed after the first 2 months in the Group of ACCF (P ＜ 0.05).Conclusion Graft subsidence and loss of fusion segmental lordosis of two groups occur mainly in an early post-operation stage (first 2 months).The group of ACDF with PEEK cage is superior to the group of ACCF with titanium meshes in maintaining the height and lordosis of fusion segments.Single-level ACCF with titanium meshes continues subsiding at the caudal endplate of fusion segments even after 2 months.

Objective To assess the current evidence of effectiveness and safety of Single-incision mini-slings (TVT-S) versus transobturator tension-free vaginal tapes (TVT-O/TOT) in the management of female stress urinary incontinence (SUI).Methods Literature searches were conducted for all randomized controlled trials (RCTs) comparing TVT-S and TVT-O/TOT from CNKI,CBM,VIP,MEDLINE,OVID,FMJS and Cochrane Library between November 1996 and November 2011.The Revman 5.1.0 software was used for Meta-analysis according to Cochrane system evaluation method.Results A total of 1545 females in 7 RCTs were included.Meta-analysis showed that no statistical differences existed in the rate of postoperative voiding dysfunction and dyspareunia between TVT-S and TVT-O/TOT (P ＞ 0.05).But the rate of objective cure,re-operation,inner thigh and groin pain and de novo urgency were statistically significant (P ＜ 0.05).Conclusion As compared with TVT-O/TOT,TVT-S procedure is associated with less postoperative inner thigh and groin pain,but a lower objective cure rate and relatively higher rates of de novo urgency and reoperation.

Objective To explore the effects of rehabilitation robot for lower-limb on motor function in hemiplegic patients after stroke.Methods Forty-eight hemiplegic patients were divided randomly into treatment (n =24) and control (n =24) group.The neuro-facilitation technique was applied for both groups.But the treatment group had also rehabilitation robot for lower-limb training of 10-20 min/d,6 d/week for 8 weeks.All patients were assessed with the Fugl-Meyer lower limb (FMA),10 m maximum walking speed (MWS),function ambulation category (FAC)classification and the modified Barthel index (MBI) at the time of beginning and 8 weeks later.Results Prior to intervention,no significant differences in any parameter existed between two groups.Eight weeks later,all assessment scores of FMA (25.7 ±3.5),MWS(52 ± 16),FAC(4.3 ± 1.4)and MBI(82 + 17)were significantly better in the treatment group than those FMA (22.8 ± 3.7),MWS (40 ± 17),FAC (3.4 ± 1.3) and MBI (72 ± 14) in the control group.Conclusion The application of rehabilitation robot for lower-limb may markedly improve the motor function of lower limb,walking ability and activity of daily living.

Objective To explore the diagnostic value of preoperative enhanced computed tomography (CT) plus vascular endothelial growth factor C (VEGF-C) expression in hilar and mediastinal lymph nodes metastasis of non-small cell lung cancer.Methods A total of 87 patients with non-small cell lung cancer (NSCLC) received preoperative chest enhanced CT scans and underwent standard radical operation and systematic lymph node dissection.Pathologic examination was selected as the gold standard to determine lymph node metastasis.The immunohistochemical method was used to detect the expression of VEGF-C.The predicting values of chest enhanced CT,VEGF-C expression and their combination for the diagnosis of hilar and medastinal lymph nodes metastasis were evaluated through comparing the sensitivity,specificity and accuracy.Results The sensitivity of CT scan was 75.0％,specificity 59.6％ and accuracy 66.7％.The positive expression rate of VEGF-C was 78.2％ (68/87) and strong positive rate 13.8％ (12/87).The sensitivity of VEGF-C was 97.5％,specificity 38.3％ and accuracy 65.5％.The combination of CT and VEGF-C had a better accuracy (74.7％) and the sensitivity and specificity were 80.0％ and 70.2％ respectively.Conclusion Compared with CT scan or VEGF-C expression alone,the combination of CT and VEGF-C improves the specificity and accuracy of diagnosing lymph nodes metastasis in NSCLC.If this combination method is employed before therapy,the accuracy of clinical nodal staging may be enhanced.

Objective To explore the HERVWE1 gene expression in the placentas of discordant monozygotic twins and identify its regulation by methylation.Methods Fetuses from 21 pairs of monozygotic discordant twins were marked as "smaller" or "larger" according to birth weight.Placental HERVWE1 mRNA and protein expression profiles were analyzed by quantitative reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC) stain.Methylation profiles of the HERVWE1 promoter region were analyzed by COBRA,MSP-PCR and pyrosequencing assay.Results In discordant twins group,the mean methylation level of the HERVWE1 promoter region decreased in smaller fetuses (P ＜0.05).And there were increased mRNA and protein levels of HERVWE1 in smaller fetuses versus larger counterparts (P ＜0.05).Conclusion In discordant monozygotic twins,the HERVWE1 expression is higher in smaller fetuses and lower in larger counterparts.Methylation of HERVWE1 gene promoter region may participate in the regulation of HERVWE1 gene expression in twins.

Objective To explore the clinical features and prognosis of familial myasthenia gravis (FMG).Methods The clinical data were collected and analyzed for 61 FMG patients from 28 families from February 1998 to March 2009 at the department of neurology,First Affiliated Hospital,Sun Yat-sen University.And they were compared with 257 cases of sporadic myasthenia gravis (MG) by case-control method.Age at onset,gender,Osserman clinical classification,diagnosis,treatment,thymus imaging examination,prognosis and other family members were measured retrospectively.Results (1) The proportion of FMG in Southern China was 2.03％ and it was lower than the other countries.(2) Onset age was younger in FMG than in sporadic MG.Juvenile MG was more common in FMG than in sporadic MG (70.5％ vs 52.1％,P =0.009).(3) Ocular MG was more common in FMG than in sporadic MG (83.6％ vs 62.7％,P =0.002).(4) There was a higher proportion in FMG with thymic hyperplasia than in sporadic MG(98.3％ vs 83.7％,P =0.014).(5) Better prognosis was found in FMG than in sporadic MG.FMG patients had a higher proportion of completely stable remission than sporadic MG (24.5％ vs 11.7％,P =0.009).(6) The so-called "consistency of the same disease" could only be found in families with pure ocular diseases.If the patients with general type MG were present in the family,their pathogenetic conditions and prognosis might vary greatly.Conclusion There characteristics of FMG in south China are different from those of other countries.Their exact inheritance patterns await further explorations.

migraine is a chronic recurrent neurovascular disease, which is a common primary headache in clinic, and its incidence is second only to tension headache. In recent years, with the acceleration of life pace and the increase of work pressure, its incidence is on the rise. Because migraine often occurs in young adults aged 25-55, and less than half of patients can recover to normal life function during the interval, it has a great impact on labor force and quality of life [1]. Especially, chronic migraine is difficult to treat, short interval, easy to cause disability, and can lead to more affective mental disorders [2]. The pathogenesis of migraine is still unclear, among which trigeminal neurovascular theory is the mainstream theory to explain the pathogenesis of migraine at present. brain-derived neurotrophic factor (BDNF) is one of the main members of the neurotrophic factor family. In the past, the research on BDNF mainly focused on its influence on the motor system, Recent studies have found that BDNF plays an important role in the occurrence and development of somatic pain (inflammatory pain, neuropathic pain, cutting pain), and participates in the regulation of pain production and development at different levels in the central and peripheral nervous system [3], and some studies have shown that BDNF is closely related to sex hormones and calcitonin gene-related peptide (CGRP) related to migraine pathogenesis. Therefore, the research on the relationship between BDNF and migraine has attracted much attention.

The number of patients with low back pain (LBP) is increasing with the aging of China's population. Because the pathogenesis of intervertebral disc degeneration is still not very clear at present, it is difficult to simply link intervertebral disc degeneration and low back pain in clinic. At the same time, there is also a lack of definite and reliable clinical evidence for the treatment of intervertebral disc-induced low back pain. Therefore, deep research on the physiological mechanism of intervertebral disc-induced low back pain and its relationship with intervertebral disc degeneration can not only help clinicians and scholars to find exact physiological and biochemical indicators, clarify clinical diagnosis and formulate correct treatment plan, but also help us to find more scientific and effective biological and biomechanical treatment methods, so as to make the future treatment of low back pain more minimally invasive, safe and effective. The main purpose of biological therapy is to restore the physiological structure of degenerated intervertebral disc, At present, it is still unknown whether intervertebral disc repair can relieve lumbar pain in patients. Whether the pain originates from abnormal disc structure is uncertain, so the research on the causes of low back pain in patients with spinal diseases still needs to be deepened. The urgent problems to be solved in the field of intervertebral disc biological therapy include: (1) carrying out different treatment modes for different patients, such as determining the molecular "cocktail" formula for patients with early intervertebral disc degeneration and the cell therapy plan for patients with late intervertebral disc degeneration. (2) clarifying the mechanism of spine-related pain. (3) determining the minimum effective dose and maximum safe dose of each treatment plan.

A 44-year-old female was admitted to Tianjin Medical University General Hospital on February 28, 2011 after coughing for 8 weeks with low fever and hemoptysis for 6 weeks. She developed cough without obvious trigger 8 weeks before admission. She had been admitted to Tianjin Medical University General Hospital due to renal tubular acidosis 4 years ago. She was diagnosed with primary Sjogren's syndrome by serological examination and labial gland biopsy. She took oral prednisone 10 mg/d for the past 3 years. She denied the history of chronic hepatitis and tuberculosis. No history of smoking or drinking. Physical examination showed that her vital signs were normal. The respiratory sounds of both lungs were clear, and no pathological rales were heard. Blood routine: white blood cells 7.38×109/L, neutrophils 0.85, lymphocytes 0.076, red blood cells 4.60×1012/L Platelet count 295×109/L, liver and kidney function normal; Serum potassium 3.2 mmol/L, serum sodium 138 mool/L, serum chloride 108 mmol/L. Immunoglobulin and autoantibodies: IgG 13.7 g/L (7.51~1.560 g/L), complement C3:7.3 g/L (7.9~15.2 g/L), antinuclear antibody 1:100 (granular type), ssA antibody (positive), anti-RO-52 (positive), rheumatoid factor 42 900 IU/L, erythrocyte sedimentation rate 12 mm/1 h, tumor marker screening was negative, tuberculosis antibody was negative, urine routine occult blood and protein were negative. Thoracic CT showed a thin-walled cavity paraspinal of the left lower lung, about 17 mm in diameter, and mural nodules with soft tissue density, 13 mm in diameter, increased interstitial texture of both lungs. Multiple small lymph nodes were seen in the mediastinum. It was considered that the left lobular cavity with mural nodules.