Volume 95  ·   Issue 06  ·  2015

Primary hepatocellular carcinoma (HCC) is one of the common malignant tumors, and its mortality rate is the third among common cancers worldwide, and the second highest in China. 85% of HCC in China is caused by chronic hepatitis B virus (HBV) infection. The annual incidence of HCC in patients with HBV-related cirrhosis is 3% ~5%, and about one third of the disease will eventually develop into HCC in the course of the disease. Surgical resection is the most important radical treatment for HCC, but the recurrence rate is as high as 70% within 5 years after surgery, which is a major obstacle to further improve the curative effect^[1]。 Up to now, there is still a lack of clinical adjuvant therapeutic drugs that can effectively control postoperative recurrence.

Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and acute pulmonary thromboembolism (acute pulmonary embolism, APE). APE is a kind of disease that seriously threatens human life and health. About 300,000 patients die of APE every year in the United States, of which about 1/3 are sudden deaths^[1]。 Anticoagulation therapy plays an important role in the treatment of APE. Some large-scale clinical trials in recent years have provided evidence-based medical evidence for the use of novel oral anticoagulants (NOACs) in pulmonary embolism^[2,3]。 NOACs are not only not inferior to warfarin in APE anticoagulant effectiveness, but also appear to be superior to warfarin in safety endpoint events such as major bleeding. To this end, the 2014 European Society of Cardiology (ESC) APE guidelines made the first comprehensive recommendation on the use of NOACs in APE (Level of Evidence: IB)^[4]。 At present, the NOACs that have been marketed in my country include dabigatran etexilate and rivaroxaban, and their indications are to prevent venous thrombosis after orthopedic surgery. A few doctors in China have started to use these NOACs to treat APE, but due to insufficient experience in their use, the treatment is still not standardized. This article focuses on the application of NOACs in the treatment of APE according to the 2014 ESCAPE diagnosis and treatment guidelines.

To explore the prevention and treatment of complications for full-covered self-expanding removable metal stents (FCSERMS) in malignant obstructive jaundice.

The clinical data were analyzed retrospectively for 45 cases undergoing endoscopic biliary FCSERMS drainage for malignant obstructive jaundice from May 2012 to March 2014.

Among them, 45 cases were successful one time. The parameters of liver function improved significantly with a jaundice efficiency of 91.1%. There were 4 dead cases. Among 19 cases of early complications, hyperamylasemia (n=8), acute mild pancreatitis (n=4), acute cholecystitis (n=2) and hemobilia (n=1) recovered after conservative treatments. Acute suppurative cholecystitis (n=2) and acute obstructive suppurative cholangitis (n=2) were cured by percutaneous transhepatic cholangial drainage (PTCD) and percutaneous transhepatic gallbladder drainage (PTGBD). And late complications of obstructive jaundice (n=3), acute suppurative cholecystitis (n=4), acute cholangitis (n=2), hepatophyma (n=2) and acute pancreatitis (n=1) were cured by endoscopic retrograde cholangiopancreatography (ERCP), PTCD and PTGBD.

Various complications are associated with FCSERMS in malignant obstructive jaundice. However, positive and effective prevention and proper treatment reduce the incidence of complications.

To explore the application value of computer-assisted preoperative planning of hilar cholangiocarcinoma.

Retrospective analyses were conducted for the clinical data of 47 patients with hilar cholangiocarcinoma undergoing radical resection plus hemihepatectomy from January to December 2013. According to whether computer-assisted preoperative planning was used, they were divided two groups of computer-assisted surgical planning (CASP) and without computer-assisted surgical planning (WCASP). Then we analyzed the data including preoperative examinations, preoperative planning, intraoperative findings and postoperative complications.

There were 31 cases of hilar vascular invasion by tumor. Among 29 cases of CASP, left hepatic artery originated from left gastric artery (n=6), right posterior bile duct drained into left hepatic bile duct (n=1) and right posterior bile duct run into common hepatic bile duct (n=2). The mean operative duration of CASP was (6.5±1.3) h and the mean volume of intraoperative bleeding (672.0±214.3) ml; while the mean operative duration of WCASP was (7.9±2.9) h and the mean volume of intraoperative bleeding (870.0±330.1) ml. By statistical analysis, the inter-group differences of mean operative duration had statistical difference (P=0.028) and the inter-group differences of mean volume of intraoperative bleeding had statistical difference (P=0.016). The ratio of first negative test in group CASP was higher than that of group WCASP and the inter-group differences had statistical significance (P=0.043). But the inter-group rate of postoperative complications had no significant difference (P=0.419).

The computer-assisted surgical planning system provides accurate information so that an optimal surgical protocol may be designed by surgeons. And it has great application values in preoperative surgical planning for hilar cholangiocarcinoma and enjoys wide prospects in precise liver surgery.

To explore the expression of TPX2 and its significance in hepatocellular carcinoma (HCC) tissue and examine the relationship between TPX2 and clinicopathological characteristics of HCC.

Reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemical staining were used to compare the expression of TPX2 in tumor and adjacent non-tumoral tissues.

The TPX2 mRNA expression was higher in tumor tissues than that in non-tumoral counterparts (30/50) (P<0.05). The positive rate of TPX2 protein in tumor tissues was significantly higher than that in non-tumoral counterparts (56.0% vs 16.0%) (P<0.05). The expression of TPX2 mRNA and protein were correlated with metastasis, recurrence and time of recurrence after curative resection (P<0.05).

An over-expression of TPX2 may be risk factor of metastasis and recurrence after curative resection so that it is a potential biomarker for early diagnosis and prognosis of HCC.

To explore the efficacies and complications of Ahmed glaucoma valve implantation for treating refractory glaucoma.

A retrospective study of case series was conducted for 24 patients (26 eyes) with refractory glaucoma from February 2001 to July 2008 at our hospital. Ahmed glaucoma valve implantation was performed. Pre- and post-operative best spectacle-corrected visual acuity (BSCVA), intraocular pressure (IOP), number of medications and complications were recorded and analyzed. The follow-up period was 58-159 months.

The post-operative values of IOP were 13.02+ /-6.79, 11.43+ /-5.24 and 18.56+ /-6.43 mmHg at 1 day, 1 month and the last follow-up respectively. There were significant difference when compared with pre-operative IOP (37.59+ /-10.76 mmHg, P<0.01). And 65.38% of eyes maintained or gained ≥1 line of BSCVA. But there was no significant difference with pre-operative BSCVA (P=0.110). Twenty eyes required anti-glaucoma drugs after glaucoma valve implantation and the average number of medication was 1.72+ /-0.98. There was significant difference with the pre-operative medication number 2.7±0.7 (P=0.001). The surgical success rate was 73.1%. And the causes of failure were endophthalmitis, corneal endothelial decompensation, persistent conjunctival wound non-healing, glaucoma valve exposure and loss of light perception. Early postoperative complications were ocular hypotony, shallow anterior chamber, hyphema, transient high IOP and tube occlusion. And long-term complications included encapsulated cyst formation, tube exposure, corneal endothelial decompensation and endophthalmitis.

Ahmed glaucoma valve implantation is efficacious for refractory glaucoma. However, clinicians should pay attention to the prevention and treatment of complications.

To investigate the application value of xTAG^® gastrointestinal pathogen panel (xTAG^®GPP) multiplex PCR in the early diagnosis of infectious diarrhea, and understand the epidemiology of intestinal diarrhea pathogens.

Five hundred and ninety two specimens were collected in outpatient of Tongren Hospital, Capital Medical University, from 1st Oct 2013 to 30th Sep 2014, comparing the xTAG^®GPP multiplex PCR assay with the traditional methods (culture, rapid enzyme immunoassay chromatography, microscopic examination, Real-time PCR) and mading the statistical analysis.

The positive rate of 592 patients with diarrhea specimens was 47.8% (283/592), the proportion of male and female was 1∶1.02, the average age was 31years. The virus detection rate was 18.1%, Rotavirus A was the most common organism detected (8.8%), concentrated in winter, popular in children. Secondly, Norovirus GⅠ/GⅡ (8.4%), Adenovirus 40/41 was five cases. The positive rate of bacteria was 35.5%, Enterotoxigenic E. coli (8.4%, 50/592) was most frequently detected in summer, common in young adults. The other pathogens were Campylobacter 7.7%, Salmonella 7.0%, Clostridium difficile toxinA/B 3.5%, Shigella 3.3%, E.coli O157 3.3% and Shiga toxin-producing E. coli LT/ST 1.7%. None of Yersinia enterocolitica and Vibrio cholerae was detected. There were ten samples with parasitic (1.7%), five samples were positive for Cryptosporidium, three for Entamoeba histolytica and two for Giardia. All of them did not have obvious distribution followed by season and population. Totally 242 (40.8%) infected specimens with single pathogen were detected. There were 41 (6.9%) co-infections samples, including two pathogens 36 cases (6.1%), three pathogens in 5 cases (0.8%).

xTAG^® GPP multiplex PCR is simple, sensitive, specific and can be used as a quick way to diagnose the infectious diarrhea. Diarrhea pathogen has significant characteristics with the season and crowd.

To explore the diversity of mutations in survival motor neuron gene 1 (SMN1) by analyzing seven cases of partial deletion of SMN1 gene.

Seven patients suspected spinal muscular atrophy (SMA) were recruited from 2011 to 2013. Multiplex ligation-dependent probe amplification (MLPA) for genetic testing of SMA was based on the commercially available SALSA MLPA kit P021-A2. Then the data were analyzed by the software Coffalyser. Negative control samples were chosen with two copies of SMN1 and SMN2. Positive control samples were chosen with zero copies of SMN1 and two copies of SMN2. According to the product description (www.mlpa.com): for exon 7 and 8 of SMN1 and SMN2: a ratio of <0.7 indicates 1 copy, a ratio of 0.7-1.3 2 copies, a ratio of 1.3-1.7 3 copies and a ratio of 1.7-2.3 4 copies. For exon 1, 4, 6, 8 of SMN gene (SMN1+ SMN2): a ratio <0.4 indicates 1 copy, a ratio of 4.0-0.6 2 copies, a ratio of 0.7-0.9 3 copies and a ratio of 0.9-1.1 4 copies. All samples were analyzed in duplicate.

Using MLPA for clinical diagnostics, two types of partial deletions of SMN1were identified in 7 patients. Since exon 8 is not translated and has no effect on the function of SMN protein, exons 1, 4, 6, 7 were targeted. One had an isolated deletion of exon 7 while the other ones were caused by the deletions of exon 1, 4 and 7. These mutations were not detected by conventional diagnostic methods. Both types of partial deletions of SMN1 gene contained a deletion of exon 7.

Two types of partial deletions of SMN1 gene indicate that the structure of SMN gene is unstable leading to a variety of mutation forms. But the major cause of SMA lies in a deletion of exon 7 of SMN1 gene.

To evaluate the clinicopathological features and outcomes of lymphoma in pregnancy.

A total of 21 patients with lymphoma in pregnancy were diagnosed and treated at our hospital between January 1999 and January 2012. The clinicopathological data were analyzed retrospectively.

There were 11 cases of Hodgkin's lymphoma (HL) and 10 cases of nodular sclerosis classical Hodgkin's lymphoma (NSCHL). And, among 10 cases of non-Hodgkin's lymphomas (NHL), there were diffuse large B cell lymphoma (n=6), B-cell lymphoma, non-classifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma (n=1), small lymphocytic lymphoma (n=1), anaplastic large cell lymphoma with anaplastic lymphoma kinase (ALK) positive (n=1) and T-cell lymphoblastic lymphoma (n=1). The median age was 26 (22-35) years. Superficial lymphadenopathy was more common in HL than in NHL (10/11 vs 3/10, P=0.008). At diagnosis, bulky disease and extranodal involvement were more prevalent in NHL than in HL (8/10 vs 2/11, P=0.009; 7/10 vs 2/11, P=0.030). All patients received chemotherapy and those with early stages also had combined radiotherapy. Ten patients with HL and 6 patients with NHL achieved complete remission. During a median follow-up of 90 months for HL, the 5-year progression-free survival (PFS) and overall survival (OS) rates were 87.5% and 100% respectively. And during a median follow-up of 31 months for NHL, the 2-year PFS and OS rates were 66.7% and 77.8% respectively. The values of PFS and OS of NHL were inferior to those of HL (P=0.073 and P=0.066 respectively). One case of HL and 1 case of NHL received chemotherapy in the second trimester. The patients and their children experienced good outcomes.

NSCHL is the most prevalent subtype of HL during pregnancy. B cell lymphoma and aggressive subtypes are most common for NHL during pregnancy. The outcomes of NHL are inferior to those of HL during pregnancy.

To explore the characteristics of oxygen uptake efficiency (OUE) in patients with pulmonary hypertension (PH) and analyze the correlation between OUE and exercise capacity.

A total of 76 PH patients and 29 healthy controls at Shanghai Pulmonary Hospital between October 2010 and January 2014 were evaluated. All PH patients were classified into 4 groups according to the World Health Organization functional class (WHO-FC). Pulmonary function and cardiopulmonary exercise tests were performed in all subjects.

Compared with health control, the PH patients had lower forced vital capacity (FVC) of expected value (%pre), forced expiratory volume in one second (FEV₁)%pre and FEV₁/FVC ((81.9±15.5)% vs (88.6±14.1)%, (75.0±16.4)% vs (85.2±17.2)% and (78.3±9.3)% vs (88.3±7.3)%, all P<0.05). Compared with control group, there were also significant reductions in oxygen uptake efficiency slope (OUES), oxygen uptake efficiency plateau (OUEP) and OUE at the anaerobic threshold ((1.14±0.42) vs (2.32±0.34) (L/min)/lg (L/min), (27±5) vs (37±4) ml/L, (24±6) vs (34±5) ml/L, allP<0.05). No significant differences existed in OUES, OUEP and OUE at the anaerobic threshold in PH patients between WHO-FC Ⅰand WHO-FC Ⅱ groups. There were significant differences in OUE among other groups (allP<0.05). And OUES, OUEP and OUE at the anaerobic threshold were correlated positively with exercise tolerance in PH patients.

OUE significantly declines in PH patients compared with normal subjects and it is correlated positively with exercise capacity.

To investigate the role of FOXO3a in process of hydrogen-rich saline attenuating global cerebral ischemia-reperfusion (I/R) injury in rats.

Seventy-two male Sprague Dawley rats, weighing 280-320 g, were randomly divided into six groups (n=12 each) : sham operation group (group Ⅰ), cerebral ischemia-reperfusion group (group Ⅱ), hydrogen-rich saline group (group Ⅲ), vehicle group (group Ⅳ), JNK inhibitor SP600125 group (group Ⅴ), JNK inhibitor+ hydrogen-rich saline group (group Ⅵ). Global cerebral I/R was produced by transesophageal pacing inducing cardiac arrest (CA) method. Cardiopulmonary resuscitation (CPR) and mechanical ventilation was implemented at the end of 4 min for CA. In groups Ⅲ and Ⅵ, hydrogen-rich saline 5 ml/kg was intraperitoneally immediately and 6 hours after reperfusion, while equel volume of nomal saline was injected in the other four groups. The rats in groups Ⅴ and Ⅵ received intracerebroventricular injection of JNK inhibitor SP600125 10 μl 30 min before ischemia, while group Ⅳ received intracerebroventricular injection of equal volume of DMSO. Neuro Deficit Score (NDS) was evaluated at 24 h of reperfusion. Then rats were sacrificed, and the global brain tissues were obtained and stained with HE for examination of the changes in pyramidal cells in the CA1 region of hippocampus. The bilateral hippocampi were romoved for detection of the expression of p-JNK, JNK and FOXO3a using Western Blotting.

Compared with group Ⅰ, the expression of p-JNK, nuclear FOXO3a and the level of NDS were significantly up-regulated, and the number of pyramidal cells and was decreased in group Ⅱ and Ⅳ. Compared with group Ⅱ, the expression of p-JNK, nuclear FOXO3a and the level of NDS were significantly down-regulated, and the number of pyramidal cells was increased in group Ⅲ, Ⅴ and Ⅵ.

Hydrogen-rich saline can attenuate global cerebral I/R injure through inhibiting JNK, reducing the expression of FOXO3a.

To investigate specific proteins in ultraviolet (UV)-induced acute damage of human fibroblasts using proteinchip with surface enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS).

CM10 Proteinchip and SELDI-TOF-MS were used for detecting protein samples of non-irradiated group, UVA (2.5 J/cm²)-irradiated group and UVB (100 mJ/cm²)-irradiated group of normal human fibroblasts.

Ten protein peaks were down-regulated and 8 protein peaks up-regulated in fibroblasts after UV irradiation. By searching in SWISS-PROT and TrEMBLE databases, the peaks of 11 320.1 and 8 574.3 accorded with those of caspase-7 precursor and cytochrome C oxidase polypeptide VIc precursor proteins.

As a quick and convenient high-throughout proteomic analytic method, SELDI-TOF-MS plus proteinchip offers a unique platform for detecting dermal photodamage.

To explore the effects of soluble programmed death ligand 1 (sPD-L1) on the proliferation of T lymphocytes and its mechanism.

T lymphocytes were isolated from healthy human peripheral blood and activated by phytohemagglutinin (PHA). The experiment had group A: resting T lymphocytes, group B: activated T lymphocytes, group C: activated T lymphocytes+ sPD-L1Ig, group D: activated T lymphocytes+ sPD-L1Ig+ membrance-bound immunoglobulin (mIgG) and group E: activated T lymphocytes+ sPD-L1Ig+ anti-PD-L1 antibody (2H11). The absorbance value (A) of T lymphocytes in each group was measured by cell counting kit (CCK-8). The cell cycle and apoptosis of T lymphocytes induced by sPD-L1 were measured by flow cytometry. And the phosphorylation level of programmed death 1 (PD-1) signaling motif tyrosine was measured by Western blot. Furthermore, the amounts of signal adaptor molecule Src homology 2 domain-containing tyrosine phosphatase (SHP)-1 and SHP-2 were quantified by immunoprecipitation. And the exciting mechanism of sPD-L1 was explored for PD-1 inhibitory signals.

CCK-8 study showed that A values in each group were 0.42±0.03, 1.20±0.06, 0.87±0.05, 0.78±0.05 and 1.11±0.09 respectively when the concentration of sPD-L1Ig was 250 ng/ml. The proliferation of T lymphocytes in group C significantly decreased compared with group B (t=3.946, P=0.017) while group E significantly increased compared with group D (t=3.139, P=0.035). The percentage of cell number in G₁ phase of the above-mentioned 5 groups were (94.49±0.50)%, (79.22±0.50)%, (89.62±0.33)%, (92.89±0.80)% and (87.94±0.87)% respectively and group C significantly increased compared with group B (t=17.310, P<0.001). The apoptotic rate of the above-mentioned five groups were (35.77±1.82)%, (35.20±2.70)%, (62.77±0.24)%, (64.47±0.44)% and (36.80±3.53)% respectively. And apoptotic rate in group C significantly increased compared with group B (t=10.160, P=0.001) while group E significantly decreased compared with group D (t=7.790, P=0.002). The expressions of SHP-1 and SHP-2 showed no inter-group difference (all P>0.05). However, the expressions of p-SHP-1 and p-SHP-2 in group C was higher than those in group B (t=10.790, P<0.001;t=13.051, P<0.001) while the expression of p-SHP-1 decreased in group E compared with group D (t=3.361, P=0.028).

Soluble PD-L1 can effectively inhibit the proliferation of T lymphocytes. The phosphorylation of SHP-1 and SHP-2 contributes to the inhibitory signaling of PD-1/sPD-L1 pathway. And anti-PD-L1 blocking antibody may partially restore the proliferation of T lymphocytes through a down-regulated expression of p-SHP-1.

To explore the effects of intra-PAG injection of ZIP on sensory and affective components of pain.

For determining the role of ZIP on pain-induced aversion, the effects of intra-PAG injection of ZIP on formalin-induced conditioned place avoidance (F-CPA) was investigated. To determine the role of ZIP on pain perception, formalin-induced inflammatory pain model was established and the effects of intra-PAG injection of ZIP on formalin-induced nociceptive behaviors was investigated.

In the NS-treated rats, the time in the pain-paired compartment during the test session was significantly shorter than that during the preconditioning session 2 and 24 hours after administration of the drug at both 1 and 7 day post-training (Group NS-1 d-2 h: (465.1±40.6) vs (133.8±29.4) s (P<0.001); Group NS-7 d-2 h: (432.3±43.7) vs (150.5±26.6) s (P<0.01); Group NS-1 d-24 h: (500.5±20.6) vs (107.0±15.7) s (P<0.001); Group NS-7 d-24 h: (450.8±27.4) vs (129.4±21.1) s (P<0.001)). On the contrary, in the ZIP-treated rats, no significant differences were observed in the time in the pain-paired compartment between the post-conditioning and pre-conditioning sessions at the same time-points. CPA scores also showed the attenuation of F-CPA by intra-PAG injection of ZIP in comparison to the saline-injected rats (P<0.05). Compared with the intra-PAG saline-injected group, intra-PAG microinjection of ZIP did not affect the formalin-induced nociceptive behaviors (P>0.05).

The study suggests that PAG contributes to pain-related aversion in rats, and the mechanism of pain emotion encoding in PAG may attribute to the activation of targets of ZIP.

The 43-year-old female was admitted to the Department of Nephrology of Peking Union Medical College Hospital in June 2013 due to repeated purpura for more than 1 year, oliguria for 2 months, abdominal pain and bloody stool for 1 week. The patient developed purpura-like rash on both calves in March 2012. He went to the local hospital and was given dexamethasone and anti-allergic treatment. Later, due to hepatitis B, he was stopped and changed to entecavir antiviral therapy, and his platelets returned to normal. After recurrent rash, bone marrow puncture examination was negative. In April 2013, he developed oliguria with edema, multiple joint swelling and pain with numbness in the extremities. Routine urine check, red blood cells + +, urine protein + + +. In June 2013, daily upper abdominal colic began to occur, and blood stools were discharged 12 to 13 times, 50 to 100 ml each time. The local hospital checked the white blood cells 15.6×10⁹/L, neutrophils 0.718, platelets 69×10⁹/L, albumin 28 g/L. Gastroscopy showed an ulcer on the anterior wall of the duodenal bulb, which was relieved after fasting and water, fluid rehydration and anti-infection treatment. In June 2013, he came to the emergency department of our hospital and was transferred to the nephrology department for further treatment. Past history: Hepatitis B Xiaosanyang was found in physical examination in 2003, and he was treated with traditional Chinese medicine. In 2012, he started antiviral treatment. After admission, the relevant examinations were completed. Blood routine: white blood cells 7.8×10⁹/L, neutrophils 0.897, hemoglobin (Hb) 82 g/L, platelets 139×10⁹/L; Urinary routine: 200 red blood cells/μ L, urine protein 0.3-3.0 g/L; 24-h urine protein quantitation was 3.22-4.69 g; Fecal routine occult blood (+); Alanine aminotransferase (ALT) 17 U/L, albumin 26 g/L, creatinine 164 μ mol/L, urea 35.19 mmol/L, uric acid 1 060 μ mol/L; Coagulation function: Plasma prothrombin time assay (PT) 17.0 s, activated partial thromboplastin time (APTT) 25.6 s, D-Dimer (D-Dimer) 10.22 mg/L, fibrinogen (Fbg) 2.48 g/L; Complement C3 0.111 g/L, complement C4 0.001 g/L, IgG 2.14 g/L, IgA and IgM normal, rheumatoid factor (RF) 324.4 U/ml; anti-soluble antigen (ENA), anti-glomerular basement membrane antibody (anti-GBM) negative (-); Anticardiolipin antibody (ACL), anti-beta₂-Glycoprotein I antibody (anti-beta₂-gpI antibody), lupus anticoagulant (LA) (-); cytomegalovirus (CMV), Epstein-Barr virus (EBV) (-); Serum protein electrophoresis monoclonal immunoglobulin percentage (M protein %) 0.6%, M protein quantitation 0.30 g/L; Blood free light chain κ 27.1 mg/L increased (↑), λ 10.1 mg/L, κ/λ 2.68 ↑; Immunofixation electrophoresis: IgA kappa type M protein (+); Cryoglobulin (CG) (+). Hepatitis B surface antibody (HBsAg), hepatitis B core antibody (HBcAb), hepatitis B e antibody (HBeAb) (+), hepatitis B virus DNA (HBV DNA) 49 U/ml. Hepatitis C virus antibody (HCV Ab) (–). Three items of liver fibrosis: hyaluronic acid, type III procollagen peptide N-terminal, and type IV collagen (–). Renal vein, portal system, vein ultrasound of both upper limbs, lower limbs (–). Abdominopelvic CT: low-density shadow of the liver, considering the possibility of cyst, splenomegaly, increased peripancreatic fat density with multiple cord shadows, and multiple small lymph nodes retroperitoneal. Bone scan: roughly normal. Bone puncture + bone marrow biopsy: approximately normal. Admission diagnosis: acute kidney injury, cryoglobulinemia? Purpura nephritis? Multiple peripheral neuropathy, gastrointestinal hemorrhage, chronic HBV infection, duodenal ulcer.

In recent years, with the application of spiral CT technology and the publication of the results of low-dose CT early lung cancer screening research, the number of chest CT examinations in healthy physical examination population is increasing day by day, and the detection rate of pulmonary ground glass density nodules (GGN) is also increasing year by year^[1]。 GGN is a special type of small pulmonary nodule. It appears as a round or oval cloud-like thin density-increased shadow on the pulmonary window of high resolution CT (HRCT). The bronchial vascular texture in the lesion is still recognizable, and the solid components in the lesion are not visible or only visible on the mediastinal window. GGN can be divided into pure GGN (pGGN) and partially solid GGN according to whether solid components can be seen in the mediastinal window^[2]。 The retrospective data of physical examination in our hospital showed that the number of chest CT examinations increased from 1 019 cases/year to 26 108 cases/year from 2005 to 2013, among which the detection rate of GGN accounted for about 1.19%, especially single pGGN (86%). Different from the high malignant proportion of partially solid GGN (63%) requiring aggressive surgical resection^[3]The vast majority of pGGN need long-term follow-up to dynamically observe the changes of lesions to clarify the nature of lesions, but the follow-up time and follow-up interval of CT are still lacking standards. How to follow up the unknown single pGGN found by physical examination is a new problem faced by health management. The research results of pGGN at home and abroad in recent years are summarized as follows.

Antibiotic-associated diarrhea (AAD) is diarrhea that occurs after the application of antibiotics and cannot be explained by other causes^[1]。 With the widespread application of antibiotics, especially broad-spectrum antibiotics, the occurrence of AAD is very common, accounting for 5% to 25% of all antibiotic-treated patients^[2]。 Microecological preparations have significant curative effects on the prevention and treatment of AAD. In recent years, the research and development and clinical application of some new microecological preparations, as well as the development of microecological research technology, have made new progress in clinical and basic research of AAD.

particulate matter 2.5 (PM2.5) refers to particulate matter in the atmosphere having a diameter of ≤2.5 μ m, also known as pulmonary particulate matter. On average, the human body inhales about 10 000 L of air every day. PM2.5 can enter the human body through the respiratory system with the inhaled air and cause a series of pathophysiological changes^[1,2,3,4,5]。 The peripheral vascular system affected by PM2.5 has both systemic effects and special effects on blood vessels. From this perspective, this paper tries to review the mechanism of PM2.5 leading to peripheral vascular disease.

Chronic thromboembolic pulmonary hypertension (CTEPH) refers to an increase in pulmonary artery pressure due to one or repeated pulmonary embolism that blocks the pulmonary vascular bed, increasing blood flow resistance. Clinical studies have shown that the incidence of CTEPH is increasing year by year. CTEPH has become a public health problem of great concern because of its hidden onset, rapid progression and high mortality^[1,2]。 In recent years, research on the mechanism of CTEPH has increased day by day, but the lack of animal models and clinical specimens has hindered the research progress of the mechanism of occurrence and development of CTEPH. Therefore, it is particularly important to establish animal models that are simple to operate, high success rate, low price, objective and practical, and can transform basic research results into CTEPH diseases. Moreover, it has positive practical significance for deeply exploring the pathogenic mechanism of the disease, fully understanding the natural course of the disease, perfecting the diagnostic technology, establishing effective intervention measures, prolonging survival and reducing mortality. This paper briefly introduces and evaluates the methods of constructing CTEPH experimental animal models at home and abroad in recent years.

A 59-year-old female, farmer, with chest tightness, shortness of breath and dry cough for 3 months as the main complaints, went to the local health center on February 5, 2010. Chest X-ray showed a large amount of pleural effusion in the left chest. 300 ml was extracted by puncture, adenosine deaminase (ADA) 50 U/L, and white blood cells 400×10⁶/L, pleural effusion, serum alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), nerve-specific enolase (NSE), etc. were all normal, erythrocyte sedimentation rate (ESR) was 80 mm/1 h, pure protein derivative tuberculin (PPD) test was positive, and pleural effusion was tested at 50-80 U/L after multiple extractions. Considering the possibility of left tuberculous pleural effusion, the patient was given oral anti-tuberculosis treatment with isoniazid 0.3 g once/d, rifampicin 0.45 g once/d, pyrazinamide 0.5 g three times/d, and ethambutol 0.75 g once/d. Symptoms such as chest tightness and dry cough improved once, and continued anti-tuberculosis treatment for 3 months after discharge. During the treatment, the condition tended to worsen, and he could not lie down, and his weight gradually lost. He visited our hospital on June 9, 2010. The outpatient reexamination of chest X-ray showed that the trachea and mediastinum shifted to the right, and high-density shadows were seen in the left middle and lower lungs, considering left pleural effusion or occupying space (Figure 1), admitted to hospital with "left lung occupying space to be examined". Past history, personal history, and family history are not special.