Volume 92  ·   Issue 44  ·  2012

The innovation and progress of life science and technology have made great contributions to people's prevention, diagnosis and treatment of diseases, improvement of life quality, and also produced great social influence.At the same time, some uncertainties, risks and even negative effects have appeared or been exposed one after another, such as surrogacy, clinical trials of new drugs, genetic research involving human body, biological sample bank, social behavior research, ethical issues of transferring human genes to animals, sharing of human genome research data and gene patents, developing genome-led medicine and protecting human rights, genetic discrimination, life science and technology crimes. Therefore, it is of great significance to actively think and explore the regulation at the level of legal system and the construction of ethical governance mechanism in life science field.

On October 17th, 2012, the 42nd ICS Annual Meeting sponsored by the International Urinary Control Association (ICS), China Rehabilitation Research Center and other units was grandly opened at the National Convention Center in Beijing. This year, the ICS Annual Meeting settled in Asia for the first time, and Beijing was lucky to be the first Asian city to host the ICS Annual Meeting. More than 140 internationally renowned experts and nearly 2,000 clinical or basic medical workers from more than 60 countries participated in this 3d grand meeting. This ICS Annual Meeting has various forms and rich contents. ICS education courses comprehensively show the latest progress and cutting-edge information in the field of urine control. In the "Meet with Experts" activity, 48 well-known experts had face-to-face exchanges and discussions around 24 topics in 3d. In addition, Academic activities such as the 11th Physical Therapy Roundtable, Neurourological Progress Roundtable, Pelvic Floor Function Training Session, Nursing Forum and Urinary Incontinence Public Forum were also added. The pathogenesis and possible drug targets of neurogenic bladder and overactive bladder (OAB) diseases are hot spots in basic research in the field of urine control at present. Minagawa et al. of University Hospital of Antwerp, Belgium pointed out that the transient voltage receptor cation channel A1 can activate the A (O) -and C fibers of the mechanosensitive afferent nerves of the bladder in mice, and may become the therapeutic target of OAB in the future.

Objective To explore the preventive effects of modified chitosan medical anti-adhesion membrane on postoperative intra-abdominal adhesion.Methods A total of 86 patients with obstructive colorectal carcinoma undergoing emergent colostomy and second-stage anastomosis were randomly divided into 2 groups (n =43 each).In the research group modified chitosan medical anti-adhesion membrane were put both at the area of operation and under the incision before abdomen closing,but not so in the control group.The recovery procedures were recorded including gut movement,degree and duration of abdominal pain and cases of adhesive ileus.During the reopening of abdominal cavities 3 to 6 months later,intestinal anastomosis was performed.And adhesive severity was graded blindly and the level of hydroxyproline measured within injured posterior peritoneum and adhesive tissue.Results As compared with the control,postoperative abdominal pain was weaker; the recovery of gut motor function and eating better ((3.3 ± 1.0)vs(4.2±1.1)days,P＜0.05),the incidence of adhesive ileus lower (1(2.3％) vs4(9.3％),P＜0.05),adhesion significantly lighter and the hydroxyproline level lower ((0.832 ± 0.071) vs (1.375 ±0.108) μg/mg protein,P ＜ 0.05) in the research group.Conclusion Modified chitosan medical antiadhesion membrane has preventive effects on postoperative intra-abdominal adhesion so as to decrease the incidence of adhesive ileus.

Objective To explore the efficacies of treating infants with congeniital anorectal malformation by drawing from rectal muscle sheath of blind bag out of previous sagittal approach (modified Mollard procedure).Methods Retrospective analyses of postoperative anus control and bowel movements were conducted for 172 patients with high anorectal malformation.The procedures included modified Mollard (n =68,modified group),Pena (n =64,Pena group) and abdominal perineal anus forming (n =40,abdominoperineal group).The tensions of external sphincter and puborectalis were gauged by digital rectal examination and the perianal degree of fecal pollution was assessed by defecography.Results Among them,28 boys and 18 girls had a good postoperative control of defecation in the modified group(P =0.004).The ratios of postoperative external anal sphincter was strong were 73.5％ (50/68) and 85.9％ (55/64)respectively in the modified and Pena groups and they were higher than that of abdominal perineal group at 55.0％ (22/40) (both P ＜ 0.05).The difference in the former two groups was not statistically significant (P =0.196).The incidence of constipation in the modified group was less than that in the Pena group (13.2％ (9/68) vs 31.3％ (20/64),P =0.012).Conclusion Modified Mollard procedure may avoid repeated operations,offer a better control of bowel function,ease patient suffering and improve their postoperative quality-of-life.

Objective To analyze the outcomes of lung resection and off-pump coronary artery bypass grafting (OPCAB) synchronously for the patients with lung tumor and concurrent coronary heart disease.Methods Twenty-two patients with lung tumor and concurrent coronary heart disease underwent combined surgical interventions between January 2003 and December 2011.They included 20 males and 2 females with a mean age of (65 ± 4) years.The TNM stage of lung cancer was predominantly at stages Ⅰ and Ⅱ.A majority of them had two and three-vessel disease.The tests of cardiothoracic functions were normal.The biopsy of lung tumor was carried out initially through sternotomy approach.Then OPCAB was performed.Finally lung resection was carried out according to the pathological results of lung tumor.Results All patients survived.The average number of anastomosed coronary vessels was 2.3.After myocardial revascularization through a sternotomy approach,the procedures included lobectomy and partial lung resections through sternotomy only (n =11),lobectomy through a lateral thoractomy approach (n =9)and lobectomy and bypass to left anterior descending (LAD) through left thoracotomy only (n =2).Neither death nor new MI occurred during the perioperative period.The mean stay in-hospital was (17 ± 7)days and mean ooperative duration (233 ± 41) min.The diagnoses were non-small cell lung cancer (n =18) and benign tumor (n =4).The most frequent complications were cardiac arrhythmias,atelectasis and pulmonary infections.All of them were followed up for 10-60 months.Within this period,4 patients died from cancer recurrence.Conclusion The combined procedure of OPCABG grafting and pulmonary resection is a safe and effective treatment option for patients with lung cancer and concurrent coronary heart disease.

Objective To explore the clinical application of laparoscopic anatomical right hemihepatectomy in the treatment of liver tumor.Methods From October 2007 to October 2011,16 cases of laparoscopic anatomical right hemihepatectomy were performed.The data of operative duration,blood loss volume and postoperative complications,etc,were analyzed retrospectively.Parenchyma was transected with a laparoscopic ultrasonic scalpel and ligature and accomplished with an endoscopic linear stapler.Results Among them,postoperative pathologic examinations revealed primary liver carcinoma (n =7),liver hernoangioma (n =6),colon carcinoma with liver metastasis (n =2) and pancreatic non-function neuroendocrine carcinoma with liver metastasis (n =1).The mean volume of blood loss was 550 (200-1550) ml,mean surgical time 310 (260-450) minutes and mean postoperative hospital stay 7 (5-14)days.Postoperative complications included 3 cases of bile leakage recovered after 2-3 weeks by appropriate draining.The patients with malignant tumor were followed up for 15(12-52) months.Recurrence occurred in 4 cases and another 2 died of recurrence and metastasis.Conclusions Laparoscopic anatomical right hemihepatectomy is a safe,feasible and effective procedure for the treatment of benign liver disease and malignant liver neoplasms in properly selected patients.It should be recommended for radical resection of hepatocellular carcinoma.

Objective To explore the clinical application of laparoscopic distal pancreatectomy (LDP) in hepatobiliary operations.Methods The clinical data of LDP from 25 cases from June 2008 to December 2011 were retrospectively analyzed.Among them,9 patients underwent LDP with excision of spleen while another 16 patients had LDP with preservation of spleen.And during the same period,42 patients undergoing open distal pancreatectomy were selected into the control group.And the patient data of two groups were compared.Results All of them underwent successfully LDP.Among 16 patients with preservation of spleen,11 patients undergone the Kimura procedure while another 5 undergone the Warshaw operation.The operative duration was (4.5 ± 1.2) hours,volume of blood loss (256 ± 188) ml,length of incision (4.6 ± 0.9) cm,mean time of oral food taking (1.5 ± 0.9) days and mean postoperative hospital stay (7.1 ± 1.9) days.Pathological examinations showed benign tumor (n =20),malignant tumor (n =4)and borderline tumor (n =1).The mean data of LDP group was significantly less than that of open distal pancreatectomy group in terms of anal exsufflation time,length of incision,postoperative hospital stay time and complication rate,etc.(P ＜ 0.05).Four patients were diagnosed of post-LDP pancreatic fistula (3 A level vs 1 B level) and all of them became cured after conservative treatment.There was no mortality.Conclusion As a safe and feasible procedure,LDP is worthy of wider applications.

Objective To explore the significance of succinate dehydrogenase B (SDHB) mutation and EPAS1 overexpression in Zuckerkandl paragangliomas (PGL) and examine their correlations with malignant infiltration and metastasis.Methods From March 2008 to July 2011,the clinical profiles of 16 Zuckerkandl PGL patients were analyzed retrospectively.For increased diagnostic specificity,a complex immunohistochemical panel of tissue microarray was performed for SDHB,EPAS1 and MIB-1.Positive expression identified as a granular cytoplasmic staining.Greater than or equal to 50％ as strongly positive (+++),1％ to 10％ as weakly positive (+).Results Tissue microarray immunohistochemical staining showed SDHB immunoreactivity in the cytoplasm,whereas EPAS1 and MIB-1 in the nuclear of tumor cells.Positive expression of EPAS1 in which 13 cases of Zuckerkandl PGL.And high expression strongly associated with malignancy.SDHB mutation of 7 cases are all EPAS1 positive staining.Non-gene mutation 9 cases tumor specimens,6 cases were EPAS1 positive expression (P ＜ 0.05).CgA positive expression in 11 cases benign Zuckerkandl PGL,strongly positive in 4 malignant cases (4/4).MIB-1 below 1％ in 12 cases of benign Zuckerkandl PGL.And in 4 malignant cases,MIB-1 was about 3％.Malignant neoplasms had significantly higher EPAS1,CgA and MIB-1 expression compared to benign counterparts (P ＜ 0.05).Conclusions The SDHB mutation causes the EPAS1 over expression in PGL and correlation with higher positive expression of CgA and MIB-1.It may be one of the mechanisms of malignant invasiveness and metastasis in PGL.

Objective To identify and analyze a putative pathogenicity island (PAI) Uu146-Uu170 of Ureaplasma urealyticum (Uu) and explore the relationship between PAI and infertility.Methods Fifty-one Uu isolates were collected from healthy females,57 isolates from sterile females with fallopian tube disease,42 isolates from healthy males and 38 isolates from sterile males.Biovar-typing was performed based on the gene of multiple-banded antigen (MBA).The distribution of PAI was analyzed by PCR.The association of clinical phenotype with biovar type and PAI distribution was calculated by Fisher's exact test.Results In female healthy group and female disease group,biovar type 1 account for 68.6％ (35/51) and 73.7％ (42/57),whereas the positive rate of PAI were 15.7％ (8/51) and 12.3％ (7/57) in the two groups,both difference were not statistically significant.In male healthy group and male disease group,biovar type 1 account for 71.4％ (30/42) and 65.8％ (25/38),whereas the positive rate of PAI were 21.4％ (9/42) and 18.4％ (7/38) in the two groups,both difference were not statistically significant.The positive rate of PAI in biovar type 2 was significantly higher than that in biovar type 1 in the fallopian tube disease and male infertility groups (5/15 vs 2/42,5/13 vs 2/25,both P ＜ 0.05) whereas no significant difference was found between two biovar types in normal groups (both P ＞ 0.05).Conclusions There is insufficient evidence that Uu with presence of PAI is more pathogenic to cause infertility.The Uu strain of biovar type 2 with PAI Uu146-Uu170 may be associated with infertility.

Objective To evaluate the interventional effects of different management programs on the outcomes of stable chronic obstructive pulmonary disease (COPD) patients.Methods Systemic education,follow-up and control groups were divided according to the frequency of follow-ups and the profile of participating in educations.A total of 157 patients were enrolled into the COPD database from May 2002 to May 2010.They were interviewed face-to-face at our department.The investigation contained general conditions,the frequency of acute exacerbations (AE) the previous year,COPD Assessment Test (CAT),Modified British Medical Research Council Dyspnea Scale (mMRC) and spirometric classification.A combined assessment was conducted.Results The frequency of AE and rate of AE ＜ once the previous year in systemic education group was 0.9 ± 1.1 and 71.2％,1.0 ± 0.8 and 68.6％ in follow-up group and 1.4 ± 1.1 and 44.4％ in control group.And the frequency of AE in systemic education and follow-up groups was significantly less than that in control group (P ＜ 0.05).Rate of AE ＜ once in systemic education and follow-up groups was significantly higher than that in control group (P ＜0.01).CAT and rate of CAT≤20 in systemic education,follow-up and control groups were 10.0 ±5.0 and 96.2％,11.1 ±6.0 and 88.2％,15.3 ± 6.8 and 64.8％ respectively.CAT in systemic education and follow-up groups was significantly lower than that in control group (P ＜0.01).Rate of CAT≤20 in systemic education and follow-up groups was significantly higher than that in control group (P ＜ 0.01).mMRC in systemic education,follow-up and control groups was 1.5 ± 0.8,1.6 ± 0.9 and 2.1 ± 1.0 respectively.mMRC in systemic education and follow-up groups was significantly lower than that in control group (P ＜ 0.05).Combined assessment showed that no significant difference existed in Types A and B among three groups (P ＞ 0.05).Type C in the systemic education group was significantly higher than that of the control (P ＜ 0.05).Type D in the systemic education and follow-up groups was significantly lower than that of the control (P ＜ 0.01).Conclusion Long-term systemic education and follow-up management program can reduce the frequency of AE of COPD effectively and improve the health status of COPD patients.

Objective To conduct a contrast study of postoperative cardiac output and oxygen metabolism in infants with congenital heart disease undergoing cardiopulmonary bypass.Methods Retrospective analysis was conducted for 55 case of congenital heart disease from January 2006 to January 2009 at our hospital.There were 34 males and 21 females.And they were divided into simple group (n =30) and complex group (n =25).In the simple group,all had pulmonary arterial hypertension and there were simple ventricular septal defect (VSD) (n =15),atrial septal defect (ASD) + VSD (n =9) and ASD + VSD + patent ductus arteriosus (PDA) (n =6) ; in the complex group,there were tetrology of Fallot (TOF) (n =12),double outlet of right ventricular with pulmonary stenosis (DORV) (n =8) and total anomalous pulmonary vein connection (TAPVC) (n =5).All completed cardiopulmonary bypass procedures under venous injection and inhalation anesthesia.Cardiac outputs were measured by the thermodilution method with a 4 F Swan-Ganz floating catheter at operation completion and postoperative 4,8,12,24,48,72 h.Arterial and mixed venous blood specimens were collected through radial artery and floating catheter for blood gas analysis.The parameters of cardiac index (CI),oxygen supply index (DO2I),oxygen consumption index (VO2I) and oxygen intake rate (O2ER) were calculated with PHLIPS M: 8007 A.Results (1) At postoperative 8 h,ScVO2 was minimal (simple group 68％ ± 14％ ; complex group 65％ ±9％) ; and postoperative 12 h CI (L · min-1 · m-2) bottomed out (simple group 3.29 ±0.65 ;complex group 2.88±0.54); DO2I(492 ± 153) ml · min-1 · m-2 and VO2I(138 ±45) ml · min-1 · m-2were minimal in complex group.(2) DO2I,VO2I,O2ER and ScVO2 changed with CI and simple group was higher than complex group.(3) Postoperative CI showed a positive correlation with DO2I,VO2I,ScVO2 and a negative correlation with O2ER.Conclusions The postoperative cardiac output decreases and oxygen metabolism becomes disordered in congenital heart disease.It is most obvious at postoperative 12 h.And complex CHD is more serious.Cardiac output should be actively boosted to improve tissue oxygen metabolism during an early postoperative period.

Objective To observe and evaluate the effectiveness of a new modified fully-covered retrievable esophageal stent in preventing restenosis at the proximal end of the stent.Methods From January 2008 to October 2011,380 consecutive patients who underwent placement of a conventional stent or a new modified stent for benign or malignant dysphagia were divided into two groups: conventional stent group 193 patients (male137,female 56) and modified stent group 187 patients (male 125,female 62).The granulation formation and restenosis rate one month after stenting were evaluated.Data such as patient demographics,outcomes and complications were collected.The results were statistically analyzed by Student t test,chi-squared test,Fisher's exact probability or rank sum test.A P-value less than 0.05 was considered statistically significant.Results All stents were successfully implanted.They were highly effective in palliating dysphagia.The dysphagia score decreased from 3 (1) to 0 (1) in conventional stent group (P ＜0.01),and that from 4(1) to 0 (1) in modified stent group (P ＜ 0.01).The modified stent group were superior to the conventional stent group in severe granulation formation rate (0 vs 4.7％(9/193),P =0.004) and restenosis rate (2.7％ (5/187) vs 7.3％ (14/193),P =0.041) within one month after stenting,and the modified stent was easier to retrieve.Postoperative remission rate of dysphagia,and complications such as chest pain,bleeding,perforation,stent migration had no statistical differences between the two groups (all P ＞ 0.05).Conclusions The new modified fully-covered retrievable esophageal stent can significantly reduce granulation formation at the proximal end of the stent.Using of this stent seems to be a better choice in treating patient of dysphagia,with lower restenosis rate and easier to retrieve.

Objective To evaluate the effects of modification of transferrin on cytotoxicity and intracellular delivery of paclitaxel loaded Poly (lactide-co-glycolide) (PLGA) nanoparticle (NPs).Methods PLGA NPs were formulated with microemulsion method,Polyvinyl alcohol (PVA) was used as surfactant (PVA NPs).Transferrin (Tf) was used to modify the NPs (Tf NPs).The cytotoxicity of paclitaxel solution and paclitaxel loaded PVA NPs and Tf NPs were measured in bladder cancer cell line J-82.The intracellular delivery of two kinds of NPs was measured.Results The half maximal inhibitory concentration (IC50) of paclitaxel loaded PVA NPs and Tf NPs was (44 ± 7) and (49 ± 11) ng/ml respectively and significantly lower than that of paclitaxel solution,which was (81 ± 18) ng/ml (both P ＜ 0.05).The uptake of PVA NPs and Tf NPs by J-82 cells after 2 hours was (89 ± 19) μg/mg cellular protein and (76 ± 16)μg/mg cellular protein.The uptake of two kinds of NPs had no significantly difference.The intracellular level of NPs decreased significantly upon the withdrawal of NPs in medium.However,it became stable 2 hours later and 11.3％ PVA NPs and 18.0％ Tf NPs remained.The intracellular level of PVA NPs and Tf NPs had no significantly difference at any timepoint.NPs were distributed in cytoplasm after endosytosis.Conclusions PLGA NPs can significantly improve the anti-neoplasmic effect of paclitaxel on bladder cancer.However,modification of Tf does not change the intracellular dynamics.

Objective To explore the effect and mechanism of lipopolysaccharides (LPS)-induced CD11b+Gr-1 + myeloid-derived suppressor cells (MDSCs) on airway inflammation in asthmatic mice.Methods A total of 34 female BALB/c mice were selected.Among them,4 mice received an intraperitoneal injection of LPS for inducing the accumulation of MDSCs.And the MDSCs were separated with CD11b immunomagnetic beads from spleen extract.Another 30 mice were randomly divided into normal control,asthmatic and cell treatment groups.The mice in the asthmatic and cell treatment groups were sensitized with ovalbumin by a combination of intraperitoneal injection and challenges to establish the murine asthmatic model.At Days 14 and 21 post-sensitization,the mice in cell treatment group received an intravenous injection of LPS-induced MDSCs.At 24 hours after the last allergen challenge,the number of inflammatory cells were counted and morphological identification of leucocytes in bronchoalveolar lavage fluid (BALF) was performed to analyze the degree of airway inflammation in conjunctions with pathological sections.The BALF and serum levels of interleukin-13 were measured by enzyme-linked immunosorbnent assay (ELISA).The number of CD4 + CD25 + Foxp3 + regulatory T cells (Tregs) in peripheral blood was measured by flow cytometry.Results The total number of cells,the percentage of neutrophils and eosinophils of BALF in the cell treatment group [(17.0 ± 8.3) × 104/ml,11.1％ ± 2.0％,9.8％ ±2.9％] were significantly lower than those in the asthmatic group [(36.0 ± 15.9) × 104/ml,20.8％ ±4.0％,14.1％ ±4.2％] (P=0.000,0.000,0.011).Compared to the asthmatic group,the BALF and serum levels of IL-13 were significantly lower [(34.7 ±7.1) vs (105.0 ±9.0) ng/L,(34.0 ±4.7) vs(48.1 ± 6.1) ng/L] (both P =0.000) and the number of CD4 + CD25 + Foxp3 + regulatory T cells increased in peripheral blood (8.0％ ± 1.3％ vs 5.1％ ± 2.1％,P =0.002) and airway inflammation was significantly relieved in the cell treatment group.Conclusion LPS-induced MDSCs may improve airway inflammation through up-regulating Tregs in peripheral blood and suppressing Th2 effector function in asthmatic mice.

Objective To investigate the roles of E-cadherin (E-cad) in enhancing the in vitro differentiation of hepatocytes from murine embryonic stem cells (ESCs).Methods Exogenous E-cad was transfected into BALB/c murine ESCs to enable its stable expression.Then hepatic differentiation from E-cad-ESCs was induced by such growth factors as hepatocyte growth factor (HGF),fibroblast growth factor (FGF) and transforming growth factor (TGF).And the expressions of hepatic markers ALB,TAT,Cyp7a1and urea were detected.The morphology of hepatic differentiation was observed under microscopy.Results E-cad expression gradually decreased in normal ESC differentiation,but was stably expressed in E-cad-ESCs.In E-cad-ESC group,hepatic markers ALB,TAT and CYP7a1 were expressed earlier or higher than that in normal ESC group,and the concentrations of ALB and urea were significantly higher than that in normal ESC group.The adhesion of the differentiated E-cad-ESCs was significantly enhanced compared with the normal ESCs.They maintained close connections and multidimensional growth.Cell number of hepatocytes from ESC increased significantly in E-cad-ESC group.Conclusion E-cad enhances the hepatic differentiation of ESC by increasing the number of differentiated cells and increasing the synthetic capacity of ALB and urea.

The patient, a 40-year-old female, went to the Department of Hematology, Fuxing Hospital affiliated to Capital Medical University on June 10, 2011 due to fever and fatigue for 10 days and pancytopenia for 2 days. He was in good health. Physical examination after admission: vital signs were stable, anemic appearance, needle-like scattered bleeding spots were seen in both upper limbs, chest and abdomen, and superficial lymph nodes were not swollen. There were no positive findings in heart, lung and abdomen, and no edema in both lower limbs. Blood routine after admission: white blood cells 3.5×109/L, hemoglobin 50 g/L, platelets 38×109/L; Albumin 41.2 g/L, alanine aminotransferase 36.4 U/L, serum creatinine 72 μ mol/L, fibrinogen 1.21 g/L. Peripheral leukocyte classification: promyelocytes 0.42. Bone marrow cytology: promyelocytes accounted for 78.0%. The primary diagnosis was acute promyelocytic leukemia (APL). Perfect bone marrow peroxidase staining (+); Immunotyping of myeloid leukemia: abnormal phenotype 69.37%, expressing CD117, CD33, CD9, CD13, myeloid naïve cells; Karyotype: 46, XX [10]; Fusion genes: Promyelocytic leukemia gene (PML) and retinoic acid receptor gene (RAR α) were fused, PML-RAR α/ABL 56.00% (long type); Fluorescence in situ hybridization: PML-RAR α fusion signal was visible. APL with PML-RAR α was confirmed [1].

In 1993, Hamers-Casterman et al. [1] first reported that there was not only a conventional antibody composed of two heavy chains and two light chains, but also a heavy chain antibody with natural deficiency of light chains in camel serum.Although the heavy chain antibody lacked the light chain, its ability to recognize and bind antigen was not affected, which indicated that the heavy chain variable region (VHH) of the heavy chain antibody alone formed a complete antigen binding site.

Epstein-Barr virus (EBV) -associated lymphoproliferative diseases (EBV + LPD) are diseases with long-term fever, lymph node, hepatosplenomegaly and rash as the main manifestations. The main cells involved are T lymphocytes and natural killer (NK) cells, and the mortality rate is very high. Because it mainly occurs in East Asia, such as China and Japan, and is rarely reported in western countries, the understanding of this disease has been insufficiently clear for a long time, and it is more difficult to put forward reliable treatment schemes [1]. In the classification scheme of lymphatic and hematopoietic tissue diseases published by WHO (2008) [2], although a "childhood EBV-positive T lymphoproliferative disease" has been involved and proposed, there is no mention of whether adults have this disease at all. There are two types of childhood EBV-positive T lymphoproliferative disease mentioned in WHO classification: vaccinated vesicular disease-like lymphoma and systemic childhood EBV-positive T lymphoproliferative disease. Direct threat to the life of children and adolescents.

Nonalcoholic fatty liver disease (NAFLD) is a pathological syndrome characterized by abnormal liver triglyceride aggregation and inflammatory infiltration. An epidemiological investigation in 2009 showed that the prevalence of NAFLD in China has increased year by year in the past 10 years, exceeding 15% [1]. At present, the pathogenesis of NAFLD is still unclear, and ectopic lipid deposition and insulin resistance are two important mechanisms of pathogenesis. Recent studies have shown that patatin-like phosphoresterase domain protein 3 (PNPLA3) can promote lipid synthesis and participate in the regulation of insulin signaling pathway, and its gene polymorphism is closely related to the pathogenesis of NAFLD. At present, PNPLA3 has become a hot spot in the study of the pathogenesis of NAFLD. The author reviews many studies on the relationship between PNPLA3 and NAFLD in recent years and the possible mechanisms involved, and reviews its possible role in the pathogenesis of NAFLD.

The patient, a 24-year-old man, was admitted to Sir Run Run Shaw Hospital Respiratory Medicine Department on December 8, 2011 due to repeated cough accompanied by skin itching for more than 1 year. Physical examination: multiple wheels were seen on the skin of the whole body, accompanied by itching, scattered punctate rash and skin scratches were seen on the trunk, and multiple swollen lymph nodes could be palpable under bilateral axillaries, the largest of which was about 2.0 cm ×1.5 cm, tough in texture, mobile, and no tenderness. Blood eosinophils were 0.451 (absolute count 5.54×109/L), IgE 1949 U/ml. The histopathological examination of bone marrow puncture showed that bone marrow tissue proliferation was obviously active, the proportion of eosinophils was increased, and the fusion genes JAK2, BCR/ABL, FIP1L1/PDGFR α and ETV6-PDGF β were negative. The pulmonary ventilation function was normal, the bronchial challenge test was positive, and the bronchodilation test was positive after the challenge test. The pathological examination of left axillary lymph node resection showed eosinophilic lymphoid granuloma. The diagnosis was: Kimura disease and bronchial asthma. Methylprednisolone 60 mg was given intravenously, once/d. After 1 week of treatment, the skin itching symptoms improved, and the axillary lymph nodes shrank rapidly. Because the patient coughed intermittently, which was aggravated after inhalation of cold air, montelukast tablets 10 mg were added, once/night, and blood eosinophils 0.002 (absolute count 0.02×109/L) and IgE 2086 U/ml were re-examined.

The patient, a 14-year-old female, was admitted to the hospital on September 8, 2011 due to sudden severe distension and pain in the left waist for 3 days. She was in good health and had no symptoms such as frequent urination, urgency, painful urination and macroscopic hematuria. Physical examination: a mass of about 7.0 cm in diameter in the left upper abdomen was palpated, and there was no percussion pain in the left kidney area. Abdominal color Doppler ultrasound showed a huge solid mass of about 11.2 cm ×5.3 cm in the left kidney, with uneven internal echoes and unclear boundaries, liquid dark areas and abundant blood supply. The inner diameter of the left renal artery was 4.0 mm, and there was no obvious change in blood flow, and no obvious sign of renal artery stenosis was observed. The blood flow in the left kidney of the inferior vena cava showed a return to the heart, and there was an influence of respiration on blood flow velocity. CT showed that the left kidney occupied a huge space, uneven enhancement, and irregular low-density areas were visible. The abdominal aorta, bilateral common iliac and external iliac arteries, both renal arteries and both renal veins showed well in the whole course. Considering nephroblastoma, radical left nephrectomy was performed under general anesthesia on September 15. During the operation, diffuse enlargement of the left kidney was observed, adhering to surrounding tissues, with unclear boundaries. The adhesion was bluntly separated, The left kidney and ureter were completely removed, and some left adrenal glands and regional lymph nodes were sent for pathological examination. Gross examination: A 9.5 cm ×6.0 cm mass was found in the left kidney specimen, with unclear boundary, gray-brown (partly dark red) and slightly soft texture.