Volume 91  ·   Issue 40  ·  2011

Lung cancer is a malignant tumor with the first mortality rate in the world, and it is also a serious disease that threatens our people's health. According to the prediction of the World Health Organization (WHO), by 2025, the number of new lung cancer deaths in China will exceed 1 million every year, and the number of patients will rank first in the world. More seriously, 2/3 of patients have lost the chance of surgery when diagnosed, and those WHO have the chance of surgery often have recurrence and metastasis after surgery. If metastasis and recurrence of lung cancer can be detected in time and controlled effectively, the 5-year survival rate of lung cancer patients will exceed 88%. Therefore, early diagnosis, comprehensive treatment and prevention and treatment of recurrence and metastasis are the key to improve the prognosis of lung cancer patients.

The connotation of modern public health is relatively wide, and it has already broken through the traditional biomedical mode of disease prevention and treatment as the center, and emphasizes the overall health of body and mind [1]. In 2003, Vice Premier Wu Yi of the State Council put forward the Chinese definition of public health for the first time at the National Health Work Conference: "Public health is to organize the society to make joint efforts to improve environmental sanitation conditions, prevent and control the epidemic of infectious diseases and other diseases, cultivate good hygiene habits and civilized lifestyle, and provide medical and health services, so as to prevent diseases and promote health" [2].

Objective To investigate the expression and prognostic value of vacuole membrane protein 1(VMP1)in non-small-cell lung cancer(NSCLC).Methods The clinical data and survival status of 78 NSCLC patients were collected.Their paraffin-embedded tissues were detected immunohistochemically with a custom-made rabbit anti-human VMP1 polyclonal antibody.And the clinical significance of VMP1 expression and its relationship with the overall survival rate were analyzed statistically.Results The positive expression of VMP1 could only be observed in cytoplasm of cancer cells.Among 78 patients,40 (51.3％)patients were stained VMP1-positive.The positive rate of VMP1 had a correlation with clinical stage(x2 =6.829,P ＜ 0.05),but not with gender,age,pathological type,gross classification and differentiation grade(P ＞ 0.05).The overall 1-and 3-year survival rate was 94.9％ and 66.3％respectively.The overall estimated survival time was 37.2 months(95％ CI:33.7-40.8).The expression of VMP1 had significant influence on the survival rate(x2 =6.192,P ＜0.05).The VMPl-positive patients lived shorter with an estimated survival time of 29.0 months(95 ％ CI:25.0-33.0).VMP1 expression and clinical stage were independent risk factors of influencing the survival rate.Conclusion The detection of VMP1 in resected NSCLC tumor tissues may be helpful for prognostic prediction.NSCLC patients with VMP1-positive or late clinical stage have a worse prognosis.

Objective To investigate tumor vascularity by dual source volume perfusion computed tomography(VPCT)in advanced lung adenocarcinoma with positive EGFR-mutant and determine whether any of the VPCT parameters would predict the tumor response to gefitinib.Methods Twelve patients(5 males and 7 females,Median age:53 years,range:36-69 years)with advanced lung adenocarcinoma received VPCT scan.All patients with positive EGFR-mutant were confirmed by pathological biopsy.After a 6-week therapy of gefitinib,VPCT was repeated and the short-term effect evaluated by the RECIST criteria.The VPCT parameters(blood volume,blood flow and permeability surface)of 12 patients were compared with their differentiation grade and short-term effect.Results Short-term effects were poor in those cases in whom BF increased after a 6-week of targeted therapy(P =0.030).BF and PS at pre-therapy were negatively correlated with differentiation grade(r =-0.603,-0.694,P =0.038,0.012).There was a negative correlation between the rate of BF decline and differentiation grade(r =-0.686,P =0.029); a negative correlation existed between the trend of BF and RECIST criteria(r =-0.707,P =0.010).But there was no significant correlation with differentiation grade(P =0.059).If the BF decline was considered effective,the dual source VPCT could predict the effect of RECIST criteria.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of VPCT was 100％,66.7％,83.3％,75％ and 100％ respectively.Conclusion Dual source VPCT of advanced lung adenocarcinoma can assess effectively tumor vascularity and perfusion changes after the therapy of gefitinib.It is important in evaluating the response of targeted therapy in lung cancer.

Objective To explore the values of low-dose computed tomography(LDCT)in the screening of high-risk populations for early lung cancer through a meta-analysis of the relevant literature.Methods PubMed,EBSCO,Cochrane and other databases were searched with key words.And the studies were selected by the inclusion and exclusion criteria.The baseline data were collected and analyzed by statistical software.Results Ten random controlled trials(RCTs)were selected.Compared to the chest X ray(CXR)screening and no screening controls,LDCT screening had an odds ratio(OR)of 3.705,95％ CI 3.527-3.891.And in the subgroup analysis,a higher number of stage Ⅰ lung cancer was detected(OR4.464,95％ CI 2.860-6.969)by LDCT.Moreover,LDCT screening showed an increased detection of adenocarcinoma in lung cancer(OR 4.652,95％ CI 2.877-7.522).Conclusion LDCT is superior to CXR in the early detection of lung cancer,especially stage Ⅰ and adenocarcinoma.

Objective To assess the diagnostic and therapeutic status of non-respiratory physicians managing chronic obstructive pulmonary disease(COPD)for patients with lung cancer at general hospitals to promote a standardized regimen.Methods Through a retrospective survey from January 2009 to December 2010 at our hospital,the data of clinical features,pulmonary function test results and information of therapy for lung cancer patients with COPD admitted at non-respiratory departments(mostly of thoracic surgery)were collected.Results A total of 240 lung cancer patients with COPD were admitted.Five patients were diagnosed as COPD with a diagnostic rate of 2.1％.And 210 cases of patients were stable.According to GOLD guidelines in 2010,only 50 cases were treated with adequate drugs(23.8％).Among another 30 patients with acute exacerbation,the following therapies were administrated:selective bronchodilator(n =13,43.3％),antibiotics(n=26,86.7％)and glucocorticoids(n=1,3.3％).Conclusion Underdiagnosis and inadequate treatment of COPD in lung cancer patients by non-respiratory physicians are too serious to be neglected.

Objective To explore the diagnosis and treatment of cystic renal cell carcinoma.Methods A total of 14 cases of cystic renal cell carcinoma were reviewed and analyzed.Their age range was 40 to 71 years old.Preoperative CT(computed tomography)scan revealed renal cyst-relative masses in 14 cases.The lesions were accompanied by calcification(n =4)and with septa(n =8).The preoperative diagnosis was a complex cystic mass in all but 2.Intraoperative pathological examination was undertaken in 12 cases.The findings were malignant cystic renal clear cell carcinoma(n =10),renal cyst(n =1)and multi-cell renal cyst(n =1).The procedures included radical nephrectomy(n =6),retroperitoneal laparoscopic radical nephrectomy(n =4),retroperitoneal laparoscopic partial nephrectomy(n =2),retroperitoneal laparoscopic cyst unroofed plus radical nephrectomy(n =1)and retroperitoneal laparoscopic partial nephrectomy plus radical nephrectomy(n =1).Results All 14 cases were confirmed postoperatively as cystic renal clear cell carcinoma.All patients received a mean follow-up period of 26 months(range:4-72).Their overall results were excellent with no evidence of neoplastic recurrence or metastasis.Conclusion Preoperative CT scan may aid the diagnosis of cystic renal clear cell carcinoma.Intraoperative pathological examination should be performed in suspected cases.Nephron-sparing surgery is indicated.Its prognosis is generally favorable.

Objective To explore the significance of WIF-1 gene promoter methylation and the expression of β-catenin in acute leukemia(AL)patients.Methods The method of methylation specific polymerase chain reaction was employed to detect the status of WIF-1 gene methylation in 55 acute leukemia patientsand normal controls from January 2009 to June 2010 in our hospital.The expression of β-catenin was measured by flow cytometry.Results The methylation of WIF-1 gene promoter was found in 32.7％(18/55)AL patients.And the percentage was significantly higher than that of the controls(0).The patients with the methylation of WIF-1 gene had a lower complete remission rate(38.9％,7/18)for the first chemotherapy than those without(81.1％,30/37)(P ＜ 0.05).The expressions of β-catenin in methylation AL patients and those with non-methylation were 17.5％ ± 3.3％ and 15.4％ ± 3.6％ respectively.And they were significantly higher than the controls(10.5％ ± 1.5％,P ＜0.05).The expression of β-catenin was higher in positive methylation patients than those negative ones(P ＜ 0.05).Conclusion The methylation of WIF-1 gene promoter and β-catenin may be involved in the abnormal activation of Wnt/β-catenin signal in acute leukemia.

Objective To access the predictive values of glycemic lability index(GLI)as an indicator of glucose variability in the prognosis of critically ill patients.Methods A prospective study of 72 critically ill patients admitted into intensive care unit(ICU)were performed.Capillary glucose was measured on admission and every 2 hrs afterward during the first 24 hrs.GLI,mean amplitude of glycemic excursion(MAGE),largest amplitude of glycemic excursions(LAGE),mean,standard deviation(SD)and coefficient of variability(CV)were calculated respectively.The 30 day mortality was selected as the end-point.Receiver operating curve(ROC)was drawn to explore the association between each indicator of glucose variability and prognosis.The subjects were subsequently divided into 4 subgroups according to the median of mean and GLI.The 30-day mortality was then compared between the subgroups.Results Thirtyone of 72 patients died with a mortality rate of 43.1％.The area under the curve(AUC)of GLI(0.798 ±0.051)was superior to that of MAGE(0.785 ±0.053),LAGE(0.772 ±0.056),SD(0.761 ±0.056),CV(0.729 ± 0.059)and mean(0.670 ± 0.065)under the determination of ROC respectively.GLI was significantly correlated with APACHE Ⅱ(acute physiology and chronic health evaluation Ⅱ)score assessed during the first 24 hrs after admission(R2 =0.787,P ＜ 0.001).With the rise of GLI value,the 30-day mortality also increased gradually.Subgroup analysis demonstrated that the duration of mechanical ventilation,the incidence of multiple organ failure(MOF),the utilization rate of CRRT(continuous renal replacement therapy),the staying length of ICU and the 30 mortality rate was(3.3 ±4.4)d,41.6％,12.5％,(4.6 ± 4.5)d and 16.7％ respectively in the low mean + low GLI subgroup.They decreased obviously compared to the low mean + high GLI,high mean + low GLI and high mean + high GLI groups.Therefore the low mean + low GLI subgroup had the best prognosis while the high mean + high GLI subgroup worst.Conclusion GLI of the first 24hrs after ICU admission can serve as an indictor of glucose variability.And it is significantly correlated with the patient prognosis.

Objective To evaluate the value of wavelet index(WLI)in general anesthesia through a comparison of WLI with bispectral index(BIS).Methods A total of 53 patients scheduled for elective surgery with ASA(American Society of Anesthesiologists)Ⅰ-Ⅱ were selected to undergo generalanesthesia.The monitoring probes of BIS,WLI and muscle relaxation were connected in awaking patients.The values of WLI and BIS were recorded at 10 min(T1)entering OR(operating room),immediate before anesthesia induction(T2),when the OAA/S(observer's assessment of alertness/sedation)score declined gradually to 5(T3),4(T4),3(T5),2(T6),1(T7)after the infusion of propofol,after vecuronium given when the TOF value decreased to 100(T8),75(T9),50(T10),25(T11),0(T12)after the injection of vecuronium,tracheal intubation(T13),1 min(T14),3 min(T15)and 5 min(T16)after the completion of tracheal intubation,immediate before initiating surgical procedure(T17),beginning the operation(T18),1 min(T19),3 min(T20),5 min(T21)post-operation,skin suturing(T22),end of surgery(T23),tracheal extubation(T24),1 min(T25)and 5 min(T26)cd post-extubation,immediate before exiting OR (T27).Results The value of WLI at T10-T13,T22-T27 was more than BIS(P ＜ 0.05).The BlandAltman analysis showed that WLI was accepted comparing with BIS during the period of anesthesia.The bias was-2.99,95％ limits of agreement-29.97％ to 21.56％.The correlation coefficients of OAA/S score with BIS and WLI were:rBIs =0.884,rWLI =0.757(P =0.000).Conclusion WLI index is feasible for monitoring the depth of general anesthesia.

Objective To evaluate the influences of different aspiration results by Diver C.E.aspiration thrombectomy catheter on myocardium perfusion and clinical outcomes during emergency PCI (percutaneous coronary intervention)for the patients with acute ST segment elevation myocardial infarction (STEMI).Methods The patients undergoing emergent PCI and using Diver C.E.aspiration thrombectomy catheter with STEMI from July 2008 to February 2011 were enrolled into the study group.According to the aspiration results,they were divided into 2 groups:aspiration-positive group(n =38)and aspirationnegative group(n =28).And those undergoing routine PCI alone during the same period were enrolled into the control group(n =66).The baseline profiles,immediate post-operative CAG(coronary angiography)and follow-up data were compared.Results No significant baseline differences existed among 3 groups.Compared with the control group,all parameters significantly improved in the aspiration-positive group.But in the aspiration-negative group,the differences of slow flow/no-reflow and major adverse cardiovascular events(MACE)were insignificant(P ＞ 0.05).Compared with the aspiration-negative group,cTFC(29 ± 9vs 35 ± 11 frames,P ＜ 0.05),ST segment(90％ ± 20％ vs 76％ ± 25％,P ＜ 0.05)and the peak serum levels of CK-MB(creatine kinase-MB)and TnT(tropnin-T)[CK-MB:(201 ± 86)U/L vs(264 ± 93)U/L,P＜0.05; TnT:(41 ±21)μg/L vs(60±24)μg/L,P＜0.05]decreased significantly.But the differences in slow flow/no-reflow and MACE were insignificant(P ＞ 0.05).Conclusion Application of Diver CE.during emergent PCI i.s both safe and efficacious for STEMI patients with heavier thrombus burden.It may improve distal myocardium perfusion and abate myocardial damage.The patients with positive aspiration results have better clinical outcome.But the efficacy of aspiration-negative patients needs further evaluations.

Objective To explore the clinical therapeutic efficacies of combined three-dimensional conformal radiotherapy(3DCRT)plus transcatheter arterial chemoembolization(TACE)for portal vein tumor thrombus(PVTT)in hepatocellular carcinoma(HCC).Methods A total of 145 HCC patients with tumor thrombus in portal vein were divided randomly into 2 groups.Group A(n =64)was treated with surgical intervention alone while group B(n =81)underwent 3DCRT plus TACE.The gross tumor volume (GTV)was defined as PVTT only.Results Survival rates of group A at year 1 and 2 were 40.3％ and 21.9％ with a mean survival time(MST)of 15.2 months while that of group B were 41.2％ and 22.5％with a MST of 15.8 months.The total effective rates of groups A and B was 40.6％(28/64)and 44.4％ (36/81)respectively.Conclusion The therapeutic efficacy of 3DCRT plus TACE is similar to that of surgical intervention.

Objective To explore the distribution characteristics of apolipoprotein A5(ApoA5)gene c.553G ＞ T polymorphism and the relationship of serum lipid in Chinese Han and Uighur populations in Xinjiang,China.Methods The genotypes of ApoA5 gene c.553G ＞ T polymorphism were detected in 406 Uighur and 527 Han people by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP).Results The frequencies of GG,GT and TT genotypes of ApoA5 gene c.553G ＞ T were 378 (93.1％),27(6.7％)and 1(0.25％)patients in Uighurs versus 478(90.7％)patients,49(9.3％)patients and 0％ in Hans.There was no significant difference in the distribution of genotypes between two groups(P ＞0.05).In both groups,individuals with T allele(TT + GT genotype)had a higher level of serum triglyceride than those with GG genotype.After adjusting for gender,age,smoking,alcoholism,body mass index,blood pressure and blood lipid,non-conditional logistic regression analyses revealed that individuals with T allele(TT + GT genotype)in both groups had an elevated risk of HTG versus the GG genotype(OR =3.31,95％ CI:1.31-8.36 in Uighurs vs OR =3.98,95％ CI:1.81-8.74 in Hans).Conclusion The mutation of c.553G ＞ T polymorphism of ApoA5 gene is associated with the level of serum triglyceride in Uighur and Han populations of Xinjiang.And T allele may be a risk factor of hypertriglyceridemia.

Objective To explore the immediate effects of inhaled aerosolized iloprost on right heart function in adult patients with pulmonary arterial hypertension(PAH).Methods A total of 30 PAH patients were recruited.Right heart catheterization and echocardiography were performed before and immediately after the inhalation of iloprost(20 μg).Results After inhalation,the values of mean pulmonary artery pressure(PAPm)and pulmonary vascular resistances(PVR)decreased markedly(42.5 ±9.6 to 34.4 ±11.9 mm Hg,P＜0.001; 9.6±5.7 Wood unit to7.1 ±4.8 Wood unit,P＜0.001).And the value of tricuspid annular systolic motion peak velocity(TASm)increased markedly[(10.7 ± 2.1)cm/s vs(11.9 ± 2.5)cm/s,P ＜ 0.01].The baseline level of TASm was higher in acute responders than non-responders[(12.0 ± 2.2)cm/s vs(10.1 ± 1.8)cm/s,P =0.01]and TASm increased markedly after inhalation in non-responders[(10.1 ± 1.8)cm/s vs(11.6 ± 2.3)cn/s,P ＜ 0.01].Conclusion The inhalation of iloprost decreases the levels of PAPm and PVR and improve right heart functions in adult PAH patients.For non-responders,right heart function is worse and more benefits may be achieved after the inhalation of iloprost.

Objective To explore the effects of tumor-suppressing gene wild type PTEN on the cell proliferation,apoptosis and the possible regulations of apoptosis-related molecules Survivin,Xiap and Smac gene in human chronic myeloid leukemia(CML)and cell line K562 cells.Methods(1)The recombinant adenovirus containing green fluorescent protein(GFP)and PTEN(Ad-PTEN-GFP)or empty vector(AdGFP)was transfected into K562 cells.The growth of K562 cells was observed by MTT assay while cell cycle and apoptotic rate were assessed by flow cytometry(FCM).PTEN,Survivin,Xiap and Smac mRNA levels were detected by real-time fluorescent relative-quantification reverse transcriptional PCR(FQ-PCR)while PTEN protein levels analyzed by Western blot.(2)The expression levels of PTEN,Survivin,Xiap and Smac mRNA were detected in 10 chronic myelogenous leukemia(CML)patients in chronic phase(CML-CP),10 CML patients in blast crises(CML-BC)and 10 normal control marrow mononuclear cells(MMNC).Results The growth of K562 cells was suppressed markedly.And the maximal growth inhibition rate was 38.6％ after the tranfection of PTEN.Survivin,Xiap,Smac mRNA expression levels were down-regulated by around 6.14,7.44 and 2.95 folds respectively(0.0700 ±0.0059,0.0089 ±0.0006,0.0600 ±0.0039 vs 0.4370 ± 0.0790,0.0661 ± 0.0072,0.1580 ± 0.0078 vs 0.4530 ± 0.0810,0.0700 ± 0.0079.0.1770 ±0.0085,all P ＜ 0.01).The mRNA expression level of PTEN in CML-BC patients was lower than that in CML-CP patients and normal control.But Survivin,Xiap,Smae mRNA expression levels were higher in CML-BC patients than those in CML-CP and normal control.Conclusion The over-expression of PTEN gene may inhibit the proliferation of K562 cells and promote cell apoptosis via the regulation of Survivin,Xiap and Smac genes.

Objective To explore the actions of keratinocyte growth factor(KGF)in leukemic mice allogeneic umbilical cord blood cell transplantation(UCBT)and elucidate its mechanism.Methods Peripheral blood drawn from the litters of C57BL/6 females was used as umbilical cord blood(UCB)graft.BALB/c mice were randomly divided into 7 groups(n =12 each).The grouping was as follows.Control group 1,inoculated with leukemia.Control group 2,inoculated with leukemia at-4 d and total body irradiation(TBI)treatment.Control group 3,TBI treatment and reconstituted with 2 × 106 UCB-TNCs.Control group 4,injected with PBS subcutaneously,TBI treatment and reconstituted with UCB-TNCs with platelet transfusion.Control group 5,inoculated with leukemia,injected with PBS subcutaneously,TBI treatment and reconstituted with UCB-TNCs with platelet transfusion.Experiment group 1,injected with KGF subcutaneously,TBI treatment and reconstituted with UCB-TNCs with platelet transfusion.Experiment group 2,inoculated with leukemia,injected with KGF subcutaneously,TBI treatment and reconstituted with UCB-TNCs with platelet transfusion.The survival status,pathohistological changes,splenic lymphoid cell subsets and thymic output post-UCBT were compared between groups.Results The survival time of control group 1 was(11.1 ± 1.5)days and all died of leukemia.The survival time of control group 2 was(11.5 ±2.5)days and all died of aplasia.Five of 12 mice of control group 3 survived for 100 days and 7 mice died of visceral hemorrhage.Four of 12 mice of control group 5 survived for 100 days and 8 mice died of leukemia with a survival rate of 33.3％.Nine of 12 mice of experiment group 2 survived for 100 days and 3 mice died of leukemia with a survival rate of 75.0％.The survival was prolonged in experiment group 2 mice as compared with that of control group 5 mice(x2 =4.996,P =0.0254).The splenic T,NK and B cell counts in control group 4 mice at +35 d were(9.32 ±0.48)× 106,(1.59 ±0.11)× 106 and(18.74 ±2.01)× 106 respectively.While in group 6 mice at + 35 d were(13.20 ± 1.14)× 106,(1.75 ± 0.12)×106 and(20.36 ±±0.86)× 106 respectively.The counts of T cell and NK cell of group 6 were higher than those of group 4(both P ＜ 0.05).The level of signal joint T-Cell receptor excision circles(sjTRECs)in control group 4 mice was(167 ± 17)copies per l05 cells while that of experiment group 1 mice(228 ±24)copies per 105 cells.They were higher than that of control mice(P =0.002).Conclusion Hematopoietic stem/precursor cells are abundant in full-term murine fetal peripheral blood.The infusion of KGF reduces the post-UCBT relapse of leukemia through the enhancement of thymic output.

A 53-year-old male suffered from weakness and numbness in his limbs for 8 months, aggravated with chills and hirsutism for 2 months. He was admitted to the Department of Endocrinology of the Third Affiliated Hospital of Sun Yat-sen University on November 17, 2009. Eight months ago, the patient developed weakness and numbness in his limbs without obvious inducement, mainly in both lower limbs, accompanied by skin tightness and swelling in his limbs. Six months ago, he developed edema in both lower limbs. He went to a tertiary hospital in other places. Electromyography showed peripheral nerve damage, and thyroid function showed an increase in thyroid stimulating hormone (TSH), and a decrease in free triiodothyronine (FT3) and free thyroxine (FT4). He was diagnosed as hypothyroidism. He was treated with levothyroxine sodium, calcium carbonate vitamin D3 tablets and vitamin B1 orally, but the symptoms did not improve.

spontaneous pneumothorax is more common in tall and thin people, mostly primary spontaneous pneumothorax (PSP). It is generally believed that PSP is related to subpleural bullous rupture, and the cause is mostly congenital pulmonary dysplasia. PSP is a common disease, which is more common in young people and thin people, and is more common in men under 40 years old. According to literature reports, the annual incidence rate of men is 7.4~18.0/100,000, and that of women is 1.2~6.0/100,000. Moreover, smoking and low body mass index (BMI) are the risk factors of PSP [1-4].

The mortality rate of lung cancer is the highest among malignant tumors, among which non-small cell lung cancer (NSCLC) is the most common pathological type. Most of the patients with NSCLC are in the middle and late stage when they go to the doctor, and the best opportunity for surgical treatment is lost. In recent years, people have developed targeted drugs based on the molecular mechanism of lung cancer development, in order to treat lung cancer at the molecular level. However, due to individual genome differences and tumor heterogeneity, different populations may exhibit different curative effects and adverse reactions to the same drug.

A new meta-analysis revealed that the anticancer drug sunitinib increases the relative risk of new congestive heart failure (CHF) by 2-fold and the risk of severe CHF by 3-fold.The scope of clinical use of sunitinib is expanding.There are more than 300 clinical trials ongoing to study sunitinib for the treatment of more than 30 tumors.Sunitinib is currently approved for the treatment of metastatic renal cell carcinoma (RCC) and imatinib-resistant gastrointestinal stromal tumors (GIST).

A 24-year-old woman, G2P0, 29+6 weeks pregnant, was admitted to the hospital with the main complaint of "chest tightness, breath-holding and hemoptysis for more than half a month". The patient was diagnosed as "congenital heart disease" since childhood, but no diagnosis and treatment. Physical activity was not restricted before pregnancy, and there was no chest tightness and cyanosis after activity. In the past 2 weeks, she developed chest tightness, breath-holding and hemoptysis, accompanied by edema of both lower limbs and inability to lie down. Physical examination: body temperature 37.1℃, pulse 116 beats/min, breathing 26 beats/min, blood pressure 120/80 mm Hg (1 mm Hg =0.133 kPa), SpO2 45%, cyanosis at the lips and extremities, grade 4 systolic murmur could be heard at the apex of the heart, the first and second auscultation areas of the pulmonary valve and the aortic valve, and the intercostal area 3~4 at the left margin of the sternum, coarse breathing sound in both lungs, and wet rales could be heard at the base of the lungs.