Volume 92  ·   Issue 48  ·  2012

Objective To explore the clinical characteristic and therapeutic strategies of acute appendicitis after radical gastrectomy for gastric carcinoma.Methods The clinical data of 31 patients with acute appendicitis after radical gastrectomy for gastric carcinoma from January 2006 to January 2012 was analyzed retrospectively.The profiles of previous operations,symptoms,physical signs,disease duration,progression time,examination results,peri-operative complications,results of bacterial culture and use of antibiotics were used to evaluate the clinical characteristics and therapeutic strategies.Results There were 19 males and 12 females with a mean age of (61 ±4) years.Gastric cancer postoperative acute appendicitis lacked typical symptoms.The presenting symptoms were persistent and progressive severe right lower abdominal pains (n =31,100.0％),associated,with fever (n =27,87.1％) nausea or vomiting (n =11,35.5％),abdominal distension (n =9,29.0％),intestinal obstruction (n =21,67.7％) and abdominal purulent exudate (n =31,100.0％).The average onset time from abdominal pain to peritonitis was (15 ± 4) hours.Perforated appendix occurred in 16 cases (51.6％).Seven patients had no increase of the total number of WBC or percentage of neutrophils (22.6％).Exploratory laparotomy was performed in 17 cases,and the rate of delayed diagnosis was 54.8％.And 31 patients were cured by surgery and anti-infection treatment.There was no intraoperative death.Conclusions Because of rapidly spreading abdominal infection,peritonitis occurs early with a high incidence rate.Early diagnosis,early operation and rational use of antibiotics are the most important therapeutic modalities of acute postoperative appendicitis in patients with gastric cancer.

Objective To compare the accuracy,stability and sample cross-contamination of two independent methods of detecting the percentage of reticulated platelets in peripheral blood and establish a local normal reference range so as to provide methodological rationales in clinical laboratory.Methods The percentages of reticulated platelets in peripheral blood of a healthy population were measured by Sysmex XE-5000 blood cell analyzer with polymethyl oxazine staining and flow cytometer with thiazole orange staining respectively.The correlation between the results of two methods was analyzed by Spearman's nonparametric correlation.Information about stability was obtained from measurements of the percentages of reticulated platelets in peripheral blood at designated timepoints.The analyses of accuracy,sample cross contamination and local normal reference range were performed routinely.Results The coefficient of variation (CV) of data was lower (16.2％) than that from flow cytometer (35.1％).The sample cross-contaminations of two methods were the same at around 5％.The percentage of reticulated platelets in peripheral blood was stable and consistent whereas the results of flow cytometer fluctuated at different timepoints within 4 h after blood sampling.The correlation of results obtained from two methods was significant (P ＜ 0.01,r2 =0.923).The local normal reference range was 1.0％-7.5％ for Sysmex XE-5000 versus 3.0％-10.5％ for flow cytometer.Conclusions Fully automalic blood cell analyze is more advanced than flow cytometer for its simple operation and stable data.And the former is an ideal first-choice for detecting the percentage of reticulated platelets in peripheral blood.

Objective To evaluate the cosmetic outcomes of applying pedicle fat flap below breast fold for repairing inferior quadrant defect in breast-conserving surgery.Methods From May 2009 to July 2011,18 cases of breast cancer at our hospital were recruited.All cases underwent breast-conserving procedures and achieved negative margin by frozen section examination.Then pedicle fat flap below breast fold was applied to reshape breast defect.All of them were of females with a median age of 43 years (range:33-59).The median tumor size was 2.5 cm (range:2.0-3.0).All tumors were located at the inferior quadrant of breast.All of them received whole breast radiotherapy and adjuvant chemotherapy.And 10 cases with positive estrogen receptor had adjuvant endocrine therapy.They were followed up at one-month postoperatively.Upon the completion of chemotherapy and radiotherapy,then follow-up was once every 4 months.The cosmetic outcomes and disease relapse were observed.Results All pedicle fat flaps survived without necrosis.After a median follow-up period of 15 months,all survived disease-free.Fat liquefaction was observed in 2 cases.The whole breast radiotherapy had no significant effect on pedicle fat flap.The rate of good cosmetics was 88.9％.And their subjective satisfactory rate was 100.0％.Conclusion Both satisfactory aesthetic outcome and good efficacy are obtained with pedicle fat flap below breast fold for tumors located at the inferior quadrant of breast.

Objective To prospectively explore the prevalence of nutritional risks and undernutrition,obesity and the application of nutritional support in First Affiliated Hospital of Chongqing Medical University and compare the data with those of big hospitals in Beijing.Methods A total of 2255 inpatients from the department of gastroenterology,gastrointestinal surgery,neurology and respiratory medicine at our hospital were consecutively recruited from June to October 2011.Nutritional Risk Screening 2002(NRS2002) was performed at 24 h post-admission.And nutritional support was examined during the period of hospitalization.Results Among them,2166 patients (96.1％) received NRS2002.The overall prevalence of nutritional risk was 29.5％ (638/2166),undernutrition 12.2％ (265/2166)and the incidence of obesity 2.4％ (52/2166).For the patients at nutritional risks,only 9.2％ (59/638) of them received nutrition support.The nutrition support of gastrointestinal surgery department was higer than Beijing,and that of neurology department was lower than Beijing.For those not at nutritional risks,1.0％ (16/1528)received nutritional support.And that of 4 dcpartment were all lower than Beijing (all P ＜ 0.01).Conclusions The nutritional risk patients on nutritional support rates is lower at First Affiliated Hospital of Chongqing Medical University and excessive use ofparenteral nutrition support seems routine.The Chinese Society for Parenteral and Enteral Nutrition (CSPEN) guidelines of rational nutrition support should be vigorously promoted.

Objective To explore the characteristics of body composition among male and female adults with different body weights.Methods A total of 61 379 healthy adults (39 855 males and 21 527 females) were referred to our health examination center between May 2005 and February 2011,Body mass index (BMI) and body composition contents of fat,water,muscle,protein and mineral salt were measured by anthropometric measurements and bioelectrical impedance analysis (BIA).The data were analyzed among groups divided by gender,age and BMI.Results (Ⅰ) The prevalence of overweight and obesity defined by BMI was significantly higher in the male group than the female of the same age group under 70 years old (all P＜0.01).(2) Within a certain age range (＜60 in males,＜70 in females),the prevalence of both overweight and obesity defined by BMI increased with age (all P ＜ 0.01).(3)The fat mass percentage was significantly higher in females than in males of the same age group.The difference became more and more significant with advancing age.And the most significant difference was found in the upper 70 years old group (fat mass rate of males vs females,24％ ±7％ vs 36％ ±6％,P＜0.01).(4) Body fat mass percentage progressively elevated with increases of BMI while there was a decreasing trend of other body composition contents.The total male subjects had higher percentage of muscle,water and mineral salt than females (percentage of muscle,water and mineral salt of males vs females,0.708 ± 0.066 vs 0.664 ±0.063,0.520 ± 0.044 vs 0.474 ± 0.042,0.040 ± 0.004 vs 0.036 ± 0.004,all P ＜ 0.01) while the percentage of protein was higher in the total female group (P ＜ 0.01).Conclusions Females has more fat mass than males under the same BMI.So it is more reasonable to introduce adiposity for the evaluation of obesity,especially in females.

Objective To explore the clinicopathological significance of the expression of carbonic anhydrase Ⅰ (CA Ⅰ) and carbonic anhydrase Ⅱ (CA Ⅱ) protein and mRNA levels in pancreatic ductal adenocarcinoma (PDAC).Methods The expression of CA Ⅰ and CA Ⅱ protein in 57 pairs of paraffinembedded PDAC specimens and adjacent non-cancerous pancreatic tissues were detected by immunohistochemistry.The relationship between the protein expression and clinicopathological characters was analyzed.Western blot and quantitative real-time polymerase chain reaction (QRT-PCR) were used to examine the expression of CA Ⅰ and CA Ⅱ protein and mRNA levels in 16 paired fresh PDAC specimens,adjacent non-cancerous pancreatic tissucs and 3 different differentiated pancreatic cancer cells (PANC-1,BxPC-3 & SW1990).Results The expression of CA Ⅰ protein was higher in PDAC compared with that in paired non-cancerous pancreatic tissues (t =2.395,P =0.020),whereas,CA Ⅱ expression was significantly lower in PDAC than that in paired non-cancerous pancreatic tissues (t =4.296,P =0.000).The expression of CA Ⅰ and CAⅡ protein had a positive correlation with tumor differentiation (x2 =7.557,P =0.023; x2 =7.822,P =0.020) and CA Ⅰ showed a direct negative correlation with vascular invasion (x2 =6.349,P =0.012).Univariate and multivariate analysis with clinicopathological characters revealed that the CA Ⅱ expression was an independent prognostic indicator for PDAC patients (P =0.017 ; P =0.011respectively).No significant difference of CA Ⅰ mRNA and protein expression existed between PDAC and adjacent normal pancreatic tissues (t =1.619,P =0.126; t =1.352,P =0.197) as detected by Western blot and QRT-PCR,but the expression of CA Ⅱ mRNA and protein levels was much lower in PDAC than that in paired non-cancerous pancreatic tissues,respectively (t =3.360,P =0.004 ; t =2.934,P =0.010).Moreover,the mRNA and protein expression of CA Ⅰ and CA Ⅱ gradually increased with the better differentiation degree of pancreatic cancer cells.Conclusions CA Ⅰ is up-regulated and CA Ⅱ downregulated in PDAC.Both of them are correlated with tumor differentiation.CA Ⅱ expression is an independent prognostic indicator for PDAC patients.

Objective To determine the relationship between N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and angiographic no-reflow phenomenon in patients with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PCI).Methods The data of 106 consecutive AMI patients undergoing primary PCI were collected and analyzed retrospectively.NT-proBNP was obtained pre-PCI at admission.According to the NT-proBNP level,they were divided into normal and elevated NT-proBNP groups.The no-reflow phenomenon was defined as an angiographic outcome of Thrombolysis In Myocardial Infaretion (TIMI) grade ＜3 without accompanying mechanical factors.Results The patients with elevated NT-proBNP on admission had a higher incidence of no-reflow phenomenon than those with NT-proBNP level.Compared to normal reflow counterparts,no-reflow patients had a higher NT-proBNP level [1883 ng/L(484 ～ 5500 ng/L) vs 220 ng/L(87 ～ 926 ng/L) P =0.046].Multivariate analysis showed that a high NT-proBNP level (NT-proBNP ＞ 1765 ng/L) on admission was an independent predictor of no-reflow.This cut-off value yielded a sensitivity of 60.0％ and a specificity of 87.5％ respectively.ConcIusion The NT-proBNP level on admission may be a prognostic biomarker in the prediction of the development of angiographic "no-reflow" phenomenon after primary PCI for AMI patients.

Objective To evaluate the safety of solifenacin and tolterodine in the treatment of overactive bladder (OAB).Methods Studies on the solifenacin,tolterodine and OAB were searched and those fulfilling the inclusion criteria were selected.RevMan 5.0 software was used to perform meta-analysis.Three studies were included with an overall sample size of 1013 cases.The experimental group of solifenacin contained 517 cases while the control group had 496 cases.Results The incidence rates of overall adverse event,dry mouth,constipation and blurred vision of the experimental group (solifenacin 5 mg once per day)was 26.69％ (138/517),10.64％ (55/517),5.42％ (28/517) and 6.55％ (26/397) while those of the control group (toherodine 2 mg twice per day) 33.27％ (165/496),16.73％ (83/496),2.22％(11/496) and 4.20％ (16/381) respectively.There was no statistically significant difference in overall adverse event (RR =0.76,95％ CI:0.52-1.12,P =0.170) and blurred vision (RR =1.59,95 ％ CI:0.88-2.90,P =0.130) between two groups.However,the incidence rate of key antimuscarinic adverse events such as dry mouth (RR =0.63,95 ％ CI:0.46-0.87,P =0.005) and constipation (RR =2.38,95％ CI:1.21-4.66,P =0.010) showed statistically significant difference.Conclusions Dry mouth is the most common adverse event of solifenacin (5 mg once per day) and tolterodine (2 mg twice per day).Solifenacin has a lower incidence rate of dry mouth and a higher rate of constipation than tolterodine.A clinical physician should consider the incidence of adverse events during treating OAB,especially for those patients prone to constipation.

Objective To explore the clinical features of types 3 and 7 adenovirus pneumonia in children and compare the difference between two types.Methods A total of 47 patients with adenovirus pneumonia at our hospital from January 2009 to June 2011 were reviewed.According to the serological types,they were divided into two groups:type 3 (n =19) and type 7 (n =28).Two groups were analyzed statistically with regards to age,gender,clinical presentation,critical scores,laboratory examinations,radiographic findings,lung function changes,complications and prognosis respectively.Results For types 3 and 7 adenovirus pneumonia,the median age of onset were 1.8 and 1.1 years old respectively.The male-to-female ratio were 14∶5 and 20∶8 respectively.As compared with type 3,type 7 had the longer fever time ((18±10)vs (11 ±7)days,P =0.010),the higher critical proportion (13/28(46.4％) vs 3/19 (15.8％),P =0.031),the longer hospital stays ((28 ± 17) vs (15 ± 6) days,P =0.003)),the higher proportion of involved lung ≥ 3 lobes (22/28 (78.6％) vs 4/19 (21.1％),P =0.000),the lower oxygenation index ((192 ±85)vs(256 ±79)mm Hg,1 mm Hg =0.133 kPa,P =0.011),the higher proportion of mechanical ventilation (17/28(60.7％)vs 5/19(26.3％),P =0.020) and the higher proportion of multiple organ dysfunction syndrome (16/28(57.1％)vs 5/19(26.3％),P =0.037).In type 7,organ dysfuction was more obvious,particularly in nervous system,blood system and enzyme changes.Three cases of type 7 had pulmonary sequela with small airway disease.Conclusion With more severe clinical manifestations,laboratory parameters and imaging data than type 3,type 7 adenovirus pneumonia in children is more likely to cause pulmonary sequela.

Objective To employ micro-CT equipment for nondestructive three-dimensional (3D) imaging of internal ear.Methods The guinea pigs were anesthetized by napental and bilateral cochleas harvested.Cochlea was fixed in glutaraldehyde before scanning of micro-CT.Two-dimensional (2D) images were acquired for a 3D model of reconstruction.Results The 2D images was distinct enough to visualize vestibular gallery,scala media,scala tympani,Reissner's membrane,velum,organ of Corti and spiral ganglion,etc.The 3D structure model was excellent for viewing and free to revolve in any axial direction.Conclusions Micro-CT may allow nondestructive three-dimensional imaging of internal ear.As compared with the traditional method of morphology,this approach is able to save samples,easy to operate and has a high resolution.And it is more easily popularized than the synchrotron radiation approach.

Objective To explore the effects of Rho-kinase inhibitor on cardiac hypertrophy of left ventricle in spontaneously hypertensive rats (SHR).Methods SHRs (n =30) were randomly divided into 5 groups (n =6 each):SHR control group,5 mg/kg fasudil group (SHRL),10 mg/kg fasudil group (SHRM),20 mg/kg fasudil group (SHRH) and nifedipine group (XBDP,10 mg/kg).Six male WistarKyoto rats were selected as normal control group (WKY group).Systolic blood pressure (SBP) was measured before and after treatment every 2 weeks.The hypertrophic parameters of left ventricular weight index (LVWI) and cardiomyocyte transverse diameter (TDM) were measured.In addition,the expression levels of Rho kinase mRNA and protein in cardiomyocytes were observed by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot.Results The levels of LVWI and TDM in WKY group were significantly lower than those in SHR control group [(2.98 ± 0.05) vs (3.16 ± 0.08) mg/g,(18.18 ±0.75)vs(21.32 ± 1.25) μm,P ＜ 0.01].After 8 weeks,the levels of LVWI and TDM in three fasudil groups were markedly lower than those in SHR control group [SHRL group:(3.12 ± 0.05) mg/g,SHRM group:(3.10±0.07) mg/g,SHRH group:(3.08 ±0.09) mg/g vs SHR control group:(3.16 ±0.08)mg/g,SHRL group:(20.11 ±1.15) μm,SHRM group:(19.63±1.62) μm,SHRH group:(18.91 ±1.05) μm vs SHR control group:(21.32 ± 1.25) μm,P ＜ 0.05 or P ＜ 0.01].But the levels of LVWI and TDM were not different between SHR control and XBDP groups [(3.14 ± 0.08) mg/g,(21.42 ±1.23) μm,P ＞ 0.05].Compared with SHR control group,the expression of Rho kinase mRNA and protein in cardiomyocytes significantly decreased in three fasudil groups [SHRL group mRNA:(0.45 ± 0.08),SHRM group mRNA:(0.37 ± 0.07),SHRH group mRNA:(0.32 ± 0.07) vs SHR control group mRNA:(0.63 ±0.07),SHRL group protein:0.78 ±0.11),SHRM group protein:(0.73 ±0.10),SHRH group protein:(0.68 ±0.10) vs SHR control group protein:(0.90 ± 0.1),P ＜0.05 or P ＜0.01],but showed no obvious change in XBDP group [mRNA:(0.56 ± 0.07),protein:(0.85 ± 0.10),P ＞ 0.05].Conclusions Rho kinase inhibitor may significantly down-regulate the expression of Rho kinase in cardiomyocytes of SHR.The mechanism is probably due to the favorable effects of Rho kinase inhibitor in the prevention of cardiac hypertrophy of left ventricle.

Objective To explore a new efficient purification method of hepatocellular carcinoma (HCC) stem cells and identify their features.Methods Human hepatocellular carcinoma cell line SMMC-7721 was cultured in sphere-culture system of polyhema-treated dish and tumor stem cell specific medium.Upon the formation of cellular sphere,the cells were inoculated subcutaneously into immunocompromised mice and received the interventions of different concentrations of cisplatin.Then the drug-resistant cells were purified and re-cultured in TSC medium.Finally the stem cell markers and tumor stem cell markers were determined through real-time polymerase chain reaction (PCR),immunofluorescence method and flow cytometry.Results Through the double filter of TSC medium and cisplatin-resistance,SMMC-7721 stem cells could be grown in a suspended form and formed spheres in TSC medium.The stem cell markers (NANOG,OCT-4,SOX-2 and Notch) and tumor stem cell markers (CD24,90.0％ ; CD133,6.1％ ;CD90,4.8％) were all over-expressed in purified cancer stem cells as compared with ordinary cells.And the over-expression of CD24 was the most obvious.Conclusions The combination of in vitro cell culture with TSC medium,in vivo proliferation and cisplatin resistance test is a new efficient method of purifying hepatocellular carcinoma stem cells.Tumor stem cell with stem cell characteristics and an over-expression of CD24 may be cloned from SMMC-7721.

Objective To explore the effects of aerosolized earthworm fibrinolytic enzyme (EFE)on bleomycin-induced pulmonary fibrosis in rats.Methods A total of 72 male SD rats were divided randomly into 3 groups of bleomycin (BLM) group with intratracheal BLM (5 mg/kg),control group with the same dose of normal saline,then after both receiving aerosolization of normal saline once daily instead of EFE,EFE group with EFE (2500 U/kg) by aerosolization once daily after BLM instllation.Lung histopathology,immunohistochemistry for transforming growth factor β1 (TGF-β1),lung hydroxyproline contents,levels of urokinase PA (uPA),tissue plasminogen activator (tPA) and PA inhibitorl (PAI-1) in lung and blood were observed at Days 7,14 and 28 of experiment,respectively.Results Compared with BLM group,pulmonary fibrosis improved and the TGF-β1 expression of lung tissue decreased (P ＜ 0.01).Hydroxyproline content of lung tissue decreased in EFE group compared with BLM group ((5.8 ± 2.5)vs (9.6±1.3),(6.7 ±1.4) vs (9.7 ±1.5),(7.5 ±1.2) vs (9.7± 1.4)mg/L,P＜0.01).Compared with BLM group,the uPA levels of lung were elevated in EFE group at Days 7 and 14 ((1.04 ± 0.36) vs (0.72 ± 0.11),(0.90 ± 0.09) vs (0.75 ± 0.08) μg/L,P ＜ 0.05).Moreover,the plasma levels uPA of increased at Days 14 and 28 ((0.32 ±0.04) vs (0.25 ±0.02),(0.36 ±0.05) vs (0.28 ±0.04) μg/L,P ＜ 0.05).Consistently,conpared with BLM group,the tPA levels of lung increased in EFE group ((4.70±0.87) vs (3.01 ±0.62),(5.72 ±0.37) vs (3.00 ±0.51),(6.73 ± 1.12)vs (3.18 ± 0.38) μg/L,P ＜ 0.01) and the plasma levels of tPA also increased ((3.40 ± 0.36) vs (1.79 ±0.38),(3.17±0.37) vs (2.18±0.17),(3.85±0.56) vs (2.80±1.06) μg/L,P＜0.01).However,compared with BLM group,the PAI-1 levels of lung decreased in EFE group ((6.04 ±0.81) vs (8.52±1.01),(6.78±0.81) vs (9.81 ±1.73),(7.63 +0.99) vs (11.44±2.54),P＜0.05) and the plasma levels of PAI-1 also decreased in EFE group ((4.82 ±0.42) vs (6.89 ±0.84),(5.73 ±0.40) vs (7.30 ±1.09),(5.64±0.87) vs (7.98±1.10) μg/L,P＜0.05).Conclusions Earthworm fibrinolytic enzyme may decrease bleomycin-induced pulmonary fibrosis and TGF-β1 expression while increasing fibrinolytic activation.And fibrinolytic strategies are probably useful for the therapy of fibrotic lung diseases.

Lung cancer is the first major cancer in China [1], with high morbidity and mortality, difficult early diagnosis, and unsatisfactory comprehensive therapeutic effect. Research data show [2] that the 5-year survival rate of lung cancer after surgical treatment is about 30% ~42%. Clinically, after pathological diagnosis, 80% of lung cancer cases have lost the opportunity of surgical treatment in advanced stage. In non-small cell lung cancer (NSCLC), even for stage II lesions, the 5-year survival rate after complete surgical resection is only 24% ~55%. The occurrence and development of lung cancer is a continuous process involving many kinds of oncogene changes. At present, many kinds of oncogenes and analgesic genes have been found to be related to lung cancer, but the markers that can be used for early diagnosis and molecular diagnosis are not clear. Therefore, it is urgent to explore the change process and related mechanism of lung cancer related genes and take targeted individualized targeted therapy measures in the diagnosis and treatment of lung cancer.

Tuberculosis is an ancient disease. About 2 billion people are infected by Mycobacterium tuberculosis worldwide. There are about 20 million tuberculosis patients, about 9 million new cases every year, and the number of deaths reaches 3 million [1]. Multidrug-resistant pulmonary tuberculosis (MDR-PTB) refers to the Mycobacterium tuberculosis (MTB) excreted by tuberculosis patients, including at least two drugs resistant to rifampicin and isoniazid; Extensively drug-resistant pulmonary tuberculosis (XDR-PTB) is a tuberculosis in which, on the basis of MDR-PTB, it is also resistant to one of fluoroquinolones and at least one of the following three injectable drugs: capreomycin, kanamycin and amikamycin [2].

irritable bowel syndrome (IBS) is one of the common functional gastrointestinal diseases in clinic.Patients are presented with abdominal pain, abdominal discomfort accompanied by changes in defecation habit and fecal characteristics, and the symptoms persist or repeat, which seriously affects the quality of life of patients. About half of IBS patients have mental and psychological disorders, and mental and psychological factors play an important role in the pathogenesis of IBS. Antidepressant and anxiety drugs can effectively relieve intestinal symptoms while improving the mood of IBS patients. Antidepressant and anxiety treatment of IBS, especially for patients with mental and psychological disorders and intractable IBS, is very important.

Linezolid has shown an in vitro effect against multidrug-resistant and extensively drug-resistant Mycobacterium tuberculosis. A recent prospective, randomized controlled study found that linezolid is effective in the treatment of chronic refractory extensively drug-resistant tuberculosis (N Engl J Med, 2012, 367:1508-1518). This study included 41 patients with pulmonary tuberculosis who were positive for extensively drug-resistant Mycobacterium tuberculosis in sputum culture and had poor efficacy against all available anti-tuberculosis drugs within 6 months before entering the study. The patients were randomly divided into either immediate (21 cases) or delayed linezolid 2 months later (20 cases) at a dose of 600 mg/d and were on other anti-tuberculosis treatments unchanged.

The patient was a 58-year-old female. She was admitted to the hospital on February 15, 2012 due to paroxysmal right upper abdominal pain for 1 week. Physical examination: the skin and sclera of the whole body were slightly yellow, the whole abdomen was flat and soft, no tenderness, no rebound pain, no mass, and no difference., Liver function: alanine aminotransferase 213 U/L, aspartate aminotransferase 177 U/L, alkaline phosphatase 1171 U/L, R-glutamyl transpeptidase 1262 U/L, total bilirubin 21.3 μ mol/L, direct bilirubin 8.8 μ mol/L. Tumor markers: CA-199336.1 kU/L, CA-50 38.46 kU/L, AFP 1.88 μ g/L. Pre-transfusion test: HBsAg (-), HBsAb (+), HBeAg (-), HBeAb (+), HBcAb (+). MRCP/abdominal enhanced CT (Figure 1): liver cirrhosis, intrahepatic and extrahepatic bile duct widening, intrahepatic bile duct widening in the left lobe of the liver, soft tissue signal shadow was seen in the hilum, about 1.6 cm in diameter, and the proximal end of the common bile duct was partially truncated

The patient was a 49-year-old, Han nationality, married, farmer in Lingshui Li Autonomous County, Hainan Province, who farmed all the year round. He was admitted to hospital on May 26, 2012. He complained of diarrhea for 8 days, abdominal distension for 4 days, unconsciousness with hypoxemia for more than 2 hours. He underwent surgical treatment for testicular hydrocele 20 years ago, and was diagnosed with pemphigus in another hospital 2 months ago. He had no other medical history or allergy history. The patient had diarrhea without obvious trigger since May 17, with yellow watery stool, about 30~50 ml each time, 10 times/d, no fever, chills, nausea, vomiting, abdominal distension, diarrhea, abdominal pain, melena, mucus, pus and bloody stool; The symptoms of diarrhea lasted for 4 days without relief.