Volume 91  ·   Issue 41  ·  2011

According to the statistics of the World Health Organization, there are more than one million new cases of colorectal cancer in the world every year, and the number of deaths due to colorectal cancer exceeds 500,000 [1]. With the improvement of people's living standard, the westernization of lifestyle and the change of diet structure in China, the incidence of colorectal cancer is increasing year by year, and colorectal cancer has become the top three malignant tumors in Shanghai residents [2].

In recent 30 years, the mortality rate of colorectal cancer in China has increased by 70.7% in 2005 compared with 1991, with an average annual increase of 4.71%. Among the urban population of Beijing and Shanghai, the incidence rate of colorectal cancer has risen to the top 3 of malignant tumors. The long-term survival rate of colorectal cancer is closely related to the tumor stage at the time of diagnosis. According to the 6th edition of cancer stage criteria of American Association for Cancer Research (AJCC), the 5-year survival rate of stage Ⅰ, Ⅱa, Ⅱb, Ⅲa, Ⅲb, Ⅲc and Ⅳ colon cancer in America is 93.2%, 84.7%, 72.2%, 83.4%, 64.1%, 44.3% and 8.1%, respectively [1]. In 2005, the incidence and death of colorectal cancer in China were 172,000 and 99,000, respectively [2], which has surpassed that of the United States, and is still increasing in recent years. Colorectal cancer has become a major social problem. The clinical detection rate of early colorectal cancer in China is significantly lower than that in developed countries. Because of the lack of better prevention methods for colon cancer, Therefore, the best way to reduce the harm of colorectal cancer is to improve the early diagnosis rate. Now, the choices and problems faced by improving the early diagnosis rate of colorectal cancer in China are discussed from the following aspects.

Objective To explore the expression of mammalian target of rapamycin (mTOR) in colon cancer and the inhibitory effect of mTOR siRNA on the proliferation and apoptosis of human colon cancer HT-29 cells.Methods Immunohistochemistry was employed to detect the expression of phosphorylated mTOR (p-mTOR) in colon cancer tissues ( n =50) and normal colon tissues ( n =50) from First Affiliated Hospital of Zhengzhou University (October 2009 to June 2010 ).The correlations were examined between the expression of p-mTOR and such clinical pathological data as colon cancer staging and lymph node metastasis.The oligonucleotide templates of mTOR siRNA were designed and employed to transfect HT-29.The nonsense control groups were established accordingly by siRNA with an insignificant order.And the blank group had no transfection.The protein level of mTOR was measured by Western blotting.The method of MTT was used to detect the cell proliferation.And the method of terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) was employed to detect the apoptosis.Results The expression of p-mTOR was higher in the colon cancer group than the control group [ 60％(30 cases) vs 14％ (7 cases),P ＜0.05 ].And the expression level was correlated with the degree of lymph node metastasis and tumor differentiation ( r =0.311,0.427,both P ＜ 0.05 ).The expression of mTOR protein in the transfection group was lower than the blank and the nonsense control groups (0.39 ± 0.25 vs 1.18 ±0.05,1.46 ± 0.09,both P ＜ 0.05 ).The proliferation was lower than those of the blank and the nonsense control groups (0.275 ± 0.033 vs 0.460 ± 0.028,0.450 ± 0.037,both P ＜ 0.05 ).The apoptotic indices were higher than those of the blank and control groups ( 12.33 ± 1.53 vs 0.33 ±0.31,1.67 ±0.58,both P ＜ 0.05 ).Conclusion The expression of mTOR was higher in colon cancer tissues than that in normal colon tissues.The RNA interference of mTOR in HT-29 cell line can effectively knock down the expression of mTOR so as to significantly inhibit cell proliferation and promote cell apoptosis.

Objective To explore the expression patterns of matrix metalloproteinasel ( MMP-1 ) in colon carcinoma and evaluate its clinical significance.Methods The expression of MMP-1 was detected by SP immunohistochemical method.The tissue microarray samples of 620 colon carcinoma patients were collected and the clinical data reviewed.Results The positive expression rate of MMP-1 in cancer tissue was higher than that of normal tissue [72.5％ (421/581) vs 30.8％ ( 179/581 ),P =0.0001 ].And the difference was statistically significant (P =0.0001 ).The positive rate in stages Ⅰ and Ⅱ [ 77.6％(235/303) ] were higher than stages Ⅲ and Ⅳ [66.9％ (186/278),P=0.0040],the former two stages showed a poor prognosis while the latter two stages a fair prognosis.The results of COX regression showed that a lower expression of MMP-1 ( HR:1.042,95％ CI:0.770 - 1.410,P =0.0001 ),tumor type( HR:0.966,95％ CI:0.571 -1.633,P=0.0150),local infiltration(HR:0.576,95％ CI:0.413-0.805,P=0.0010) and infiltration of bowel wall (HR:0.337,95％ CI:0.197-0.575,P =0.0001 )were significant predictors of colon carcinoma.Conclusion As an independent prognostic factor of colon carcinoma,the expression of MMP-1 in cancer tissue has different prognostic implications according to various stages.

Objective To explore the roles of hairy enhancer of split 1 ( Hes1 ) gene in colorectal cancer and analyze its clinical significance.Methods A total of 146 cases with colorectal cancer at our hospital were collected prospectively and followed up.There were 84 males and 62 females with an average age of (61 ± 11 ) years old.Tissue microarray was prepared and the expression of Notch signal genes were detected by immunohistochemical staining.Results The differential expressions of Hesl were significant among various types [ negative or weakly positive:8％ ( 12/146),positive( + ):77％ ( 112/146 ),positive ( + + ):15％ (22/146) ].Among all,134 were followed up successfully for an average duration of (42 ±13) months.According to the Kaplan-Meier life curve,the overall 1,3 and 5-year survival rates were 93％( 136/146),74％ (108/146) and 67％ (98/146) respectively.The long-term survival rate was correlated with TN M stage and pathological types ( all P =0.000),but not with Hesl ( P =0.267).Conclusion The expression of Hesl is correlated with pathological types and differentiation types.However the long-term survival rate is not correlated with its expression.

Objective To explore the influences of diagnostic modes of colorectal cancer (CRC) on an early diagnosis of CRC.Methods A total of 405 cases were randomly collected from 1798 CRC patients registered at our hospital from January 2000 to December 2010.A retrospective chart review was undertaken for all identified cases.Besides the demographics and tumor features,TNM stage was obtained from medical records and pathological forms.Other collected data were as follows:( 1 ) Type of clinical examinations leading to diagnosis.(2) Diagnostic duration:including patient duration (period from initial symptoms to consulting a doctor and hospitalization duration ( period from patient first seeing a doctor to a confirmed CRC case).(3) Diagnostic delay and its rate:diagnostic delay was identified as the diagnostic duration of over 30 days.We compared the different delay periods of 31 -60,61 -90,91 - 150 and ＞ 150 days and its corresponding tumor stages at diagnosis.(4) Misdiagnosis and its rate:that CRC subjects were diagnosed and treated as other diseases for at least 30 days was identified as misdiagnosis.The t and Mann-Whitney U tests were performed for the quantitative data and x2 test for the qualitative data.Results Among the study subjects,67.2％ (270/402) CRC cases were examined by colonoscopy,17.4 ％ (70/402) cases by CT scan or B ultrasound.The median diagnostic duration of CRC was 90 days (25％ percentile:40 days,75％percentile:210 days).The median patient duration was 30 days and median hospital duration 10 days.The overall misdiagnostic rate of CRC was 27.9％ ( 112/401 ),higher ( 39.7％,48/121 ) in right sited CRC than in left sited CRC (22.9％,63/275 ) ( x2 =11.7,P =0.00).77.7％ (313/403) cases had ＞ 30 days diagnostic delay,50.8％ (156/307) delay attributable to the patients,while 29.0％ (89/307) attributable to hospitals and 20.2％ ( 62/307 ) attributable to both.The diagnostic duration of early-stage CRC and advanced-stage CRC appeared to be in the same length.On the other hand,no difference of TNM stage at the initial diagnosis was found in groups with different diagnostic durations of 31 - 60,61 - 90,91 - 150and ＞ 150 days (all P ＞ 0.05).Conclusion Colonoscopy is the most effective in the diagnosis of CRC.The median diagnostic time of CRC is 90 days.The phenomenon of its diagnostic delay often occurs.However,the delay is not a major cause for its advanced stage and a poor outcome.Its inherent biological characteristics may be more important.

Objective To examine the changing pattern of brain-derived neurotrophic factor (BDNF) in the patients with first-episode generalized anxiety disorder (GAD).Methods The levels of plasma BDNF and the Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) scores were measured in 34 patients with first-episode GAD recruited from our hospital between January and December 2007.At baseline and Week 6,they were treated by paroxetine and compared with 31 healthy participants in the control group.Results The baseline level of BDNF [ (80 ± 51 ) ng/L] in the patients with first-episode GAD was higher than that in the control group and had no significant correlation with HAMA and HAMD scores.But at Week 6,the level of BDNF [(70 ± 49) ng/L] had significant correlations with HAMA and HAMD scores (r=0.4,P=0 and r=0.4,P =0 respectively).At Week 6,the levels of BDNF in the response group (including remission group) and ineffective group were (60 ±42)ng/L and (83 ± 55 ) ng/L respectively.And there was significant difference in the levels of BDNF between the ineffective and control groups.The levels of BDNF in the remission and non-remission groups were (59 ±52) ng/L and (73 ±49) ng/L respectively.And there was significant difference in the levels of BDNF between the non-remission and control groups.Conclusion The pre-treatment levels of plasma BDNF in the patients with first-episode GAD are higher than those of healthy counterparts.But normal levels may be restored if the patients are cured.

Objective To explore the roles of immunological memory in the pathogenesis of myasthenia gravis (MG) by Bacillus Calmette-Guérin(BCG).Methods For this randomized comparative clinical trial,58 newly diagnosed MG patients and 32 age-and-gender-matched healthy controls were analyzed by purified protein derivative (PPD) test.The results were observed after 72 hours.peripheral blood mononuclear cell (PBMC) was collected from the MG patients before and after extended thymectomy and cultured with BCG.After a 72-hour incubation,the level of interferon gamma (IFN-γ) was detected by enzyme-linked immunosorbent assay ( ELISA ).Results In PPD test,the MG patients did not show a markedly higher positive percentage [ 48.3％ ( 28/58 ) vs 65.6％ ( 21/32 ),P =0.114 ].The prethymectomy PBMC had a higher level of IFN-γ than the control group:(650 ± 312 ) pg/ml vs( 346 ± 153 )pg/ml.After extended thymectomy,the level of IFN-γreturned to normal:( 219 ± 113 ) pg/ml.The P value is 0.003,0.001.Conclusion The impairment of immunological memory,may be an important pathogenic cause of relapse in the MG patients.

Objective To explore the pathogenic mechanism,operative techniques and therapeutic efficacy of lumbar degenerative scoliosis.Methods A retrospective analysis was performed for 32 patients ( 14 males and 18 females with a mean age of 67.4 years old) with degenerative lumbar scoliosis undergoing posterior decompression and fusion with pedicle screw system from January 2007 to March 2010.The postoperative outcomes were radiologically evaluated with Oswestry disability index (ODI),Cobb' angle and lumbar lordosis angle.Results All patients received a mean follow-up of 28.5 months ( range:12 - 50).All lumbar joints achieved bony fusion at Month 6 post-operation.No complications occurred due to instrumentation.There was no pseudoarthrosis.The significant differences of ODI existed between preoperation and post-operation[ (60 ± 11 )％ vs (21 ±6)％,P ＜0.01 ],Cobb' angle[ (28 ±9)° vs ( 13 ±5)°,P ＜ 0.01 ] and lumbar lordosis angle[(41 ± 12)° vs (20 ± 10)°,P ＜ 0.01 ].Conclusion Individualized operations should be performed for degenerative lumbar scoliosis patients.Proper lumbar decompression and the reconstruction of coronal and sagittal balances may relieve symptoms and improve the qualitv of life.

Objective To evaluate whether high sensitivity C-reactive protein (hs-CRP) is a predictive factor in the patients with endometrial cancer.Methods The investigators retrospectively analyzed the clinical records of 110 patient with endometrial carcinoma treated at our institution for their initial serum hs-CRP level at pre-operation.Pearson's chi-square was used to evaluate the association of the level of hs-CRP with variables associated with a poor prognosis.COX proportional hazard model was employed to perform univariate and multivariate analyses.Results The median serum level of hs-CRP in the patients with endometrial cancer was 5.58 mg/L( range:0.02 - 140.54 mg/L).The serum level of hsCRP was significantly associated with advanced tumor stage ( P ＜ 0.01 ),lymph node involvement ( P ＜0.05 ) and patient age ( P ＜ 0.05 ).Tumor stage,lymph node involvement,histological grade,postoperative adjuvant therapy and the serum level of hs-CRP were correlated with the overall and disease-free survivals.Tumor stage and the serum level of hs-CRP were independent factors.The rank correlation analysis showed that there was a positive correlation between the serum levels of hs-CRP and CA125 (P ＜0.01 ).Conclusion The serum level of hs-CRP may serve as a prognostic parameter in patients with endometrial cancer.Further studies are warranted to validate its value.

Objective To evaluate the management of acute arterial embolism (AAE) and its prognostic factors.Methods The clinical data of 346 AAE patients treated at our hospital between January 1998 and October 2008 were retrospectively reviewed.The prognostic factors,including age,gender,extremities,location of embolism,ischemic duration,ischemic categories,and therapeutic methods,postoperative complications were evaluated by multivariate Logistic regression analysis.Results There were 210 males and 136 females with a mean age of (63 ± 14) years old.Fifty-six patients occurred in the upper extremities and 290 patients in the lower extremities.The causes included cardiogenic embolism (n =301 ),vasogenic embolism ( n =33 ) and unknown origin ( n =12 ).The duration of ischemia ranged from 1 h to 7 d.Only 44 patients were admitted ≤8 h and the remainder ＞ 8 h.The categories of extremity ischemia were level Ⅰ (n=17),level ⅡA (n=69),level Ⅱb (n=221) and level Ⅲ (n=39).The procedures included embolectomy ( n =280 ),interventional thrombolysis ( n =19 ) and conservative treatment ( n =47).Thirteen patients (3.76％) died of complications during the perioperative periods.And 44(12.72％ ) underwent amputations and 289 (83.53％) had excellent clinical outcome with extremity salvage.During a 5-year follow-up period,38 patients had a recurrent embolism.The Logistic regression analysis showed that ischemic duration,ischemic category,therapeutic methods and complications had significant prognostic influences (all P ＜0.05 ).And other factors such as age,gender,extremities and the location of embolism had insignificant influences (all P ＞ 0.05 ).Conclusion Embolectomy is the firstchoice therapy for AAE with an excellent outcome.Ischemic duration,ischemic grading,surgical treatment and complications have significant prognostic influences.Systematic medical treatments,such as effective anticoagulation,are vital in the prevention of recurrent AAE.

Objective To explore the clinical efficacy of microvascular decompression plus intraoperative monitoring of abnormal muscle response in the treatment of hemifacial spasm.Methods Between 2009 and 2010,a total of 47 patients underwent microvascular decompression for hemifacial spasm.There were 15 males and 32 females with an age range 23 -70 years old.During operations,intermittent electrical pulses were applied to stimulate the zygomatic branch of facial nerve at the spasm side.And evoked potentials were monitored in orbicularis oris.All patients were followed up for 5 - 22 months.Results The abnormal muscle responses were recorded pre-operatively in all 47 patients at the spasm side.In 42 patients,the abnormal muscle responses disappeared at the different stages of operations (4 while opening dura,9 while dissecting arachnoid membrane and 29 while separating responsible vessels).All 42 patients were cured during the follow-up period.In the remaining 5 patients,the abnormal muscle response were still recorded even at the end of operations.Two of 5 patients were free from spasm during the follow-up period while the symptoms of other 3 patients became obviously relieved.Conclusion The combined approaches of microvascular decompression and intraoperative monitoring of abnormal muscle response may assist the identification of responsible vessels and improve the outcomes of hemifacial spasm.

Objective To explore the relationship between the causes and length of posterior malleolar fragment and treatment strategies of adult patients with three types of ankle joint injury.Methods The investigators recruited 233 cases of type C injury,35 cases of type B injury and 91 cases of type A injury.Type A injury referred to simple ankle joint fracture with the involvement of posterior malleolar fragment.Type B injury tibial shaft fracture with ipsilateral ankle joint fracture.And posterior malleolar fracture line was the continuity of tibial shaft fracture line.Type C injury appeared similar to Type B injury,but tibial and malleolar fracture lines were not continued.The ratio between the length of posterior malleolar articular and the total length of articular surface was calculated in theses three types of injuries in sagital CT scan slice.Different treatment regimens were used to manage the posterior malleolar fractures.And visual analogue score (VAS) was introduced to assess the therapeutic outcomes.Results The ratio between the length of posterior malleolar articular and the total length of articular surface decreased from Type A to Type C ( x2 =187.453,P =0.0000).The ratio was ( 34 ± 15 ) ％ for Type A,( 30 ± 9) ％ for Type B and ( 12 ±10 ) ％ for Type C.A follow-up study was performed in Type A injury ( n =58 ),Type B injury ( n =31 ) and Type C injury (n =167) at 12 months.According to VAS score,there was no significant difference between the patients undergoing fixation and not ( all P ＞ 0.05 ).Conclusion Different causes of posterior malleolar fracture results in different sizes of posterior malleolar fragment and strategies of treatment.The anatomic reduction of posterior malleolar fragment remains a key aspect of achieving satisfactory outcomes in all kinds of injury.

Objective To establish an in vitro model of degeneration of human cervical endplate chondrocytes and observe the morphology and phenotypes of endplate chondrocytes in normal and degenerative cervical vertebral endplates.Methods Cartilage endplates of 49 patients were divided into control group ( n =19 ) with cervical vertebral fracture or dislocation and experiment group ( n =30) with cervical spondylotic myelopathy.Endplate chondrocytes were isolated by enzyme digestion and cultured in vitro.The morphological appearances,growth curve and biological characteristics of endplate chondrocytes from normal and degenerative cartilage endplate were observed by inverted phase contrast microscope,HE staining,MTT,teluidine blue staining and reverse transcription-polymerase chain reaction (RT-PCR)respectively.RT-PCR was used to detect the mRNA expression of aggrecan,type Ⅱ collagen and type Ⅰcollagen.Results The endplate chondrocytes expressed aggrecan,type Ⅱ collagen and type Ⅰ collagen.The phenotypes and biological characteristics were similar to those of articular chondrocytes.The morphological appearance of primary endplate chondrocytes in the control group were mostly polygons,nucelus with round or ellipse,sometimes nuclei,vacuolus in intracytoplasm,expressing a high proliferating rate.The cells of the experiment group were fusiform and their proliferating rates decreased.Compared with the control group,the mRNA expression of aggrecan ( 0.695 ± 0.052 vs 0.950 ± 0.032,t =7.263,P =0.002) and type Ⅱ collagen (0.726 ± 0.035,0.907 ± 0.078,t =3.681,P =0.021 ) markedly decreased.And the mRNA expression of type Ⅰ collagen (0.795 ±0.028 vs 0.552 ±0.070,t =-5.560,P =0.005 )increased in the experiment group.Conclusion A degenerative cell model of human cervical endplate chondrocytes has been established successfully in vitro.It may offer the cytological rationales for exploring the mechanism of intervertebral disc degeneration.And the previous restrictions of studying only the model of animal cells shall be resolved.

Objective To evaluate the clinical practicability of integration of functional magnetic resonance imaging (fMRI) data into neuronavigation as a tool to localize the language area and their relationship with the lesion for the preoperative planning,intraoperative guidance and postoperative follow-up study of brain functions during minimally invasive surgeries in or adjacent to functional areas.Methods Eighty eight patients with intracranial lesions located in or adjacent to the functional language area underwent fMRI ( including examinations of lingual and visual function,and motor functions of the limbs and tongue).fMRI data was entered into a neuronavigation system for image fusion and preoperative registration and correction; minimally invasive neurosurgery was performed with fMRI navigation.Results The shortest distance between the lesion and the functional cortex was less than 5 mm in 6 patients and was more than 5 mm but less than 10 mm in another 10 patients,respectively.10 patients were recovered and improved in another 6 between 3 - 6 months after surgery,The follow-up time was between 3 months and 1 year.The morbidity rate was 6.8％ ( 6/88 ).There was no postoperative mortality.Various brain areas were widely activated when the patients were reading and understanding the Chinese words.The unilateral speech functional maps were located in left Brodmann's 9,46,17,18 and 19 areas.Conclusion fMRI-integrated neuronavigation can locate functional language areas and played an important role in intraoperative protection of functional lingual areas,execution of individualized therapeutic regimens,minimization of surgical complications and determination of prognosis.Total surgical resection was safe for lesions ＞ 10 mm from functional lingual areas.

Objective To explore the relationship of spinal ventricular septal angle (SVSA)measured by computer tomographic pulmonary angiography (CTPA) and right cardiac functions,N-terminal brain natriuretic peptide (NT-proBNP)in the patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods Forty-four CTEPH patients,26 males and 18 females aged (52 ± 12) years old on average,at our hospital from January 2008 to January 2010 were retrospectively reviewed.SVSA and such pulmonary artery obstruction indices as Qanadli and Mastora indices were evaluated by two independent radiologists.The parameters of right heart functions were evaluated by echocardiography and right-heart catheterization.The level of NT-proBNP was measured by enzyme linked immunosorbent assay ( ELISA ).Results SVSA was ( 63 t 11 ) ° in CTEPH and ( 40 ± 7 ) ° in the control group.The differences were significant( t =12.320,P =0.000).SVSA had a moderately positive correlation with the level of NTproBNP (r=0.704,P =0.000).A positive correlation existed between SVSA and right atrium transverse diameter (r =0.381,P =0.002 ),right atrium long axis diameter ( r =0.437,P =0.000 ) and right ventricular transverse diameter ( r =0.449,P =0.000) on echocardiography.But there was no correlation between SVSA and right ventricular ejection fraction (r=-0.175,P=0.365,n =24).Also there was a negative correlation between SVSA and cardiac output ( r =- 0.337,P =0.025 ),cardiac index (r =- 0.351,P =0.020 ),right cardiac work ( r =- 0.307,P =0.043) and right ventricular stroke work ( r =-0.384,P =0.010).Conclusion Spinal ventricular septal angle measured on CTPA may serve as a better predictor for evaluating the level of NT-proBNP and right cardiac functions in CTEPH.

Objective To elucidate the difference in both in vivo and ex vivo microwave ablation in a biliary cirrhotic porcine liver model using a cooled-tip antenna.Methods Two months after biliary ductal ligation,liver biopsy was performed to confirm the establishment of biliary cirrhosis in 4 Tibetan miniature pigs.Microwave ablation with cooled-tip antenna was conducted under laparotomy using 70 W for five minutes in the experimental group (4 pigs).The control group (2 pigs) also received microwave ablation using the same settings but no surgery.Both in-vivo and ex-vivo ablations were performed in the two groups.Morphological and pathological characteristics of the ablation areas were compared.Paired comparison among the groups were conducted using t-test.Results In the cirrhotic liver group,after ablation at 70 W for five minutes,the short and long axes and volume of in vivo ablation areas were ( 1.90 ± 0.10) cm,(2.95 ±0.12) cm,and (6.0 ± 0.8) cm3 compared to (2.08 ± 0.08) cm,(3.08 ± 0.75)cm,and (7.0 ±0.5 ) cm3 of ex vivo ablation.In the normal liver group the dates were ( 2.04 ± 0.05 ) cm,( 3.14 ± 0.1 1 ) cm and ( 6.8 ± 0.5 ) cm3 ; ( 2.30 ± 0.18 ) cm,( 3.60 ± 0.08 ) cm and ( 10.0 ± 1.7 ) cm3,respectively.In vivo ablation area was smaller than ex vivo ablation area in terms of short and long axes and volume (P =0.0280.026,0.008,respectively).With the same ablation settings,both in vivo and ex vivo ablation areas in normal pig liver were larger than their counterparts in cirrhotic liver in terms of the short and long axes and volume (P=0.019,P=0.000; P=0.024,P=0.036,respectively),but the differences in the short axes of in vivo and ex vivo ablation areas failed to reach significance.Conclusion Both in vivo and ex vivo ablation areas in biliary cirrhotic pig liver were smaller than their counterparts in normal pig liver suggesting that,the ablation time or power should be relatively prolonged to enlarge the ablation zone within cirrhotic liver in order to prevent incomplete ablation with viable residual tumor.

Multiple sclerosis (MS) is a chronic central nervous system autoimmune demyelinating disease, which mainly affects people aged 20-50 years, and about 2.5 million people worldwide [1]. It is the most common non-traumatic neurological disease in young and middle-aged people. The incidence of sleep disorders in MS is high, and the common sleep disorders include: insomnia, sleep dyskinesia, sleep-related breathing abnormalities, narcolepsy, rapid eye movement (REM) sleep behavior disorder, abnormal sleep-wake rhythm, and excessive sleep during the day. The causes of sleep disorders in MS patients include disease-related (primary) and secondary pain, movement restriction, spasticity, increased nocturia, sleep breathing disorders caused by respiratory muscle or respiratory center involvement, depression and adverse reactions of drug treatment (secondary) [2]. This article will review the incidence, clinical manifestations, influencing factors and treatment of various sleep disorders associated with MS.

Lung cancer is a progressive and heterogeneous disease.Although some progress has been made in the surgical treatment,radiotherapy and chemotherapy of lung cancer,the long-term survival rate of lung cancer patients is still very low.Recent studies have found that compared with ordinary chest X-ray examination,low-dose CT examination can detect more lung nodules and lung cancer (including early lung cancer) (N Engl J Med, 2011, 365:395-409).

The patient was a 30-year-old man who was admitted to the hospital for more than 3 months because a mass was found in the right calf, which was gradually enlarged. Clinical examination showed that the mass was palpable in the middle and back of the right calf, about 10 cm ×8 cm ×5 cm in size, and the central part of the epidermis was dark red about 4 cm, with a small rupture in the middle, and a small amount of pale red liquid flowing out, without tenderness, movable and hard in texture. X-ray plain film showed soft tissue mass shadows on the medial and posterior side of the right tibia, with clear boundaries, small dot-shaped high-density shadows inside it, no abnormalities in the right tibia and fibula, clear surrounding fat space, intact bone cortex, and no periosteum reaction (Figure 1). Magnetic resonance (MR) scan showed that the middle and upper segments of the right calf were obviously raised, and soft tissue mass shadows were seen under the skin and in the muscle groups, lobulated and irregular in shape, with equal length T1 and T2 signal, and twisted and thickened empty blood vessel shadows were seen inside and on the upper edge of the right tibia and fibula. The enhancement showed obvious enhancement of the lesion, local subcutaneous structure invasion, unclear edge, and no abnormalities in the right tibia and fibula.

A 33-year-old male was admitted to the First Hospital of Jilin University on November 29, 2010 with "upper abdominal pain for 4 days, aggravated for 3 days". The patient had intermittent upper abdominal pain after drinking beer (about 1000 ml) 4 days before admission, which was hunger-like pain, no radiating pain, irrelevant to body position and eating, no nausea, vomiting, no acid reflux and ambiguous gas, and the abdominal pain could be relieved by itself. There was no obvious trigger for the aggravation of abdominal pain 3 days before the hospital, which was persistent distension and pain, accompanied by nausea and vomiting, irrelevant to body position and eating, with little exhaust and no defecation. He went to a local municipal hospital and was considered as "pyloric obstruction". The abdominal pain was relieved after "fasting water, antispasmodic, and gastrointestinal decompression". About 1500 ml of green liquid was drained out through gastrointestinal decompression every day. The abdominal distension and pain were relieved after drainage. Admitted to our hospital for further diagnosis and treatment. Past history: suffered from cardia mucosal tear syndrome 1 year ago. Physical examination in hospital: general state is ok, vital signs are normal, no obvious positive signs. Abdominal X-ray plain film showed no abnormality. Combined with the patient's upper abdominal pain and relief of abdominal distension and pain after gastrointestinal decompression and drainage, considering the possibility of "intestinal obstruction", and giving fasting water, gastrointestinal decompression, acid suppression, anti-infection, symptomatic and supportive treatment.

A 32-year-old woman complained of muscle stiffness and weakness in her limbs for 5 years. Five years ago, she gradually felt muscle stiffness and weakness in her limbs, lower limbs were slightly heavy, walking unsteadily, speaking slowly, aggravated when she was nervous, could not squat when going to the toilet, fell many times while walking, broken teeth or dislocated left shoulder joint in severe cases. Two years ago, she relied on a wheelchair, and her upper limbs could still be bent, but her lower limbs could not be bent, and her neck was limited in rotation, accompanied by unclear stuttering and strabismus. One year ago, she complained of inner horror. After walking, she saw acquaintances or was scared, her whole body stiffened and began to tremble, accompanied by muscle pain, which lasted about 5~6 minutes each time, and improved after lying down. After sleeping, she had no attacks, dizziness, headache, loss of consciousness, and no feeling of belting around her body. Recently, the attacks were frequent, about once a day.