Volume 95  ·  Issue 09  ·  2015

The epidemic situation of multi-drug resistant bacteria (including multi-drug resistant organisms (MDR) and pan-drug resistant (XDR)) in nosocomia is becoming increasingly severe, and it has become a global problem affecting healthcare safety^[1]。 The epidemiological data showed that the incidence of multidrug resistance was significantly higher in the ICU isolates of Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Escherichia coli (the four most common multidrug resistant gram-negative bacilli^[2,3,4,5]Severe patients with MDR bacterial infection not only increase the incidence of complications, prolong ICU stay, increase medical expenses, but also significantly increase the mortality rate^[6,7]。 Therefore, it is a major challenge for ICU physicians to understand the risk factors related to MDR bacterial infection in ICU and explore effective prevention and control measures.

Since the European Society of Critical Care Medicine (ESICM), the American Society of Critical Care Medicine (SCCM) and the International Sepsis Foundation (ISF) jointly issued the Barcelona Declaration in 2002, severe infection and septic shock have become one of the most important missions faced by global critical care medicine. Over the past decade, despite some progress in this area, global guidelines for the treatment of severe infections and septic shock were published and updated in 2004, 2008 and 2012, respectively^[1,2,3]These guidelines summarize important research results in this field worldwide, standardize clinical behavior, and improve the level of clinical treatment. However, at the same time, the incidence of severe infection and septic shock still shows a rapid upward trend, and the mortality rate is still as high as 25%^[4,5,6]。 In the treatment of severe infection and septic shock, successful control of infection is one of the most important factors to determine prognosis. Only when the infection is successfully controlled can the tissue deperfusion and shock be completely corrected and the damaged organ function can be recovered. The following focuses on several common myths in anti-infective treatment of severe infection and septic shock.

Posterior circulation ischemic stroke accounts for 25% to 40% of strokes, and 70% of posterior circulation ischemic stroke is caused by arterial-arterial embolism. The vertebral artery origin (VAO) is one of the most important causes of posterior circulation ischemia because of hemodynamic disorders and other reasons where atherosclerosis is easily formed^[1]。 Studies have shown that 9% to 33% of patients with posterior circulation ischemia have vertebral artery origin stenosis (VAOS) or occlusion^[2,3]。 Using the annual incidence of the New England Posterior Circulation Ischemia Registry, 10,000 to 20,000 patients with posterior circulation ischemia in the United States are caused by VAOS each year^[4]。 However, the diagnosis and treatment of VAOS has not attracted enough attention. In order to further improve the understanding of symptomatic atherosclerotic VAOS and standardize its diagnosis and treatment, especially endovascular treatment, the Interventional Group of Stroke Prevention and Control Committee of Chinese Association of Preventive Medicine organized experts from domestic neurology, neurosurgery and vascular interventional departments to write this consensus.

To explore the epidemiological characteristics, bacterial composition and risk factors for patients with catheter–related bloodstream infection (CRBSI) in intensive care unit (ICU).

A prospective survey was conduced for 2 605 ICU patients during January 2010 to December 2013. The clinical data of CRBSI and non–CRBSI patients were compared and their relevant risk factors analyzed.

Among them, there were 1 773 cases of arteriovenous catheterization. And 94 cases (5.3%) had CRBSI. The 1 000–day catheter infection rate was 9.8. The mortality rates of CRBSI and non–CRBSI patients were 23.4% and 10.7% respectively. And the difference was statistically significant (χ²=14.38, P<0.01). The occurrence of CRBSI was a risk factor for mortality. Logistic regression analysis showed that the occurrence of CRBSI was 3.33 folds for venous catheterization time >6 days over ≤6 days (95%CI: 2.04–5.56), 2.50 folds for trauma patients over non–trauma ones (95% CI: 1.49–4.17), 2.98 folds for malignant tumors patients over non–malignant tumors ones (95% CI: 1.61–5.51) and 4.32 folds for diabetics over non–diabetics (95% CI: 2.07–9.01). For different sites of arteriovenous catheterization, the occurrences of CRBSI were not statistically significant. For CRBSI patients with blood culture, the positive microorganisms were gram–negative bacteria (61.7%), gram–positive bacteria (26%) and fungi (12.3%).

The occurrence of CRBSI is a risk factor for mortality. And diabetes, trauma and arteriovenous catheterization time> 6 days are risk factors for CRBSI. Comprehensive preventive measures should be taken to reduce the incidence of CRBSI.

To explore the incidence and species distribution of catheter–related bloodstream infection (CRBSI) in intensive care unit (ICU) at our hospital and analyze the risk factors for CRBSI.

Hospitalized patients microbiologically diagnosed as CRBSI were recruited from January 2012 to June 2013. And the clinical data were collected retrospectively and analyzed by software IBM SPSS 19.0.

Among 67 patients diagnosed as nosocomial CRBSI, 24 cases (35.8%) died while 43 survived. And a total of 81 strains were detected, including 42 Gram–positive (G⁺) bacteria (51.9%), 36 Gram–negative (G^–) bacteria (44.4%) and 3 fungi (3.7%). The predominant pathogenic G⁺ and G^– bacteria were Staphylococcus epidermidis and Acinetobacter baumannii respectively. With multiple Logistic regressions, age ≥65 years, higher acute physiology & chronic health evaluation Ⅱ (APACHEⅡ) score and polymicrobial CRBSI were independent predictors of worse outcomes.

The recent prevalent pathogens of CRBSI in ICU are S. epidermidis and A. baumannii. Advanced age, disease severity and polymicrobial CRBSI are significant independent risk factor of mortality for CRBSI patients in ICU.

To explore the protective effects of target blood glucose control on cardiac dysfunction in septic patients.

For this prospective and randomized interventional study, a total of 90 septic patients were divided into group A (blood glucose levels of 4.4 to 6.1 mmol/L), group B (6.1 to 8.3 mmol/L) and group C (8.3 to 10.0 mmol/L) (n=30 each). And 30 non–septic subjects were selected into control group. Serial transthoracic echocardiogram (TTEs) was performed to measure left ventricle ejection fraction (LVEF) and ratio of blood flow velocity of mitral annulus during early diastole (E) and atrial contraction (A) before and 1, 3, 7 days after blood glucose control with insulin therapy. The plasma level of brain natriuretic peptide (BNP) was detected by enzyme–linked immunosorbent assay (ELISA). The patient records were reviewed to obtain information about demographics, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores, incidence of hypoglycemia and 28–days survival rates.

No significant inter–group improvement existed in mean values of LVEFs (P=0.184). And E/As differed among the groups and there was statistical difference between groups A and C (P=0.005). There was a increasing trend for the levels of BNP of groups A, B and C. And comparison of group A with group B/C had statistical variability (P_AB=0.028, P_Ac=0.000). LVEFs had no variation (P₁=0.310, P₃=0.174) while E/A and BNP were significantly higher or lower in group A than those in others at Day 1 and 3 (P=0.005). The LVEFs were similar at Day 7 and E/As and BNPs of groups A, B and C showed statistical differences. The variation of E/As with time differed between groups A, B and C.

Maintaining a target blood glucose of 4.4 to 6.1 mmol/L may improve cardiac dysfunction. Furthermore, it has more significant improvement of diastolic dysfunction than systolic counterpart. Combined utilization of LVEF, E/A and BNP is better in evaluating critical ill patients with sepsis–induced cardiomyopathy under target blood glucose control. It suggests that a glucose level of 4.4 to 6.1 mmol/L may benefit cardiac consistent dysfunction in septic patients during 7 days after treatment.

A 32-year-old female, Yi nationality, was admitted to the 42nd Hospital of the People's Liberation Army on April 18, 2013 due to the discovery of vaginal mass for 4 years. The patient usually has regular menstruation and no menstrual pain. Pregnancy 8 delivered 3, spontaneous abortion and induced abortion were 5 times in total. A live female baby was delivered naturally 7 years ago, a twin male baby was delivered naturally 4 years ago, and a live male baby was delivered by caesarean section 2 years ago. Six months ago, he performed "ovarian cyst surgery" in a local hospital (details unknown). Half a month ago, an out-of-hospital ultrasound revealed another pelvic cyst. Gynecological examination after admission: normal vulvar development, married and delivered. The vagina is smooth, and a cystic mass of about 8 cm can be palpable in the middle and upper part of the right side wall, and the mass is more obvious when exerting force. The cervix is smooth, the uterus is anterior, often large, medium in quality, active, without tenderness, and there are no abnormalities in the bilateral adnexal areas. Out-of-hospital and post-admission color ultrasound showed that the right side of the pelvic cavity occupied cystic space (76 mm ×73 mm thin echo light spot), considering ovarian chocolate cyst? (Figure 1)。 Admission diagnosis: (1) Right vaginal wall cyst; (2) Right ovarian chocolate cyst? The intravaginal mass has been considered for 4 years before surgery, and the pelvic cyst detected by ultrasound is the possibility that the vaginal wall mass grows towards the pelvic cavity. Cyst removal of the right vaginal wall was performed on 22 Apr 2013 under general anesthesia after routine preoperative preparation. At the same time preparing for an exploratory laparotomy. During the operation, the middle and upper segment of the right side wall of the vagina was incised about 7 cm long. After part of the cyst was exposed, the cyst wall was incised about 2 cm. It was seen that the cyst was filled with gray-white bean dregs-like substance. After about 100 g of content was aspirated to reduce the cyst volume, the cyst wall incision was clipped and the cyst was completely stripped. The cyst cavity is closed by intermittent suturing with 3/0 absorbable thread. Because the cyst cavity is large, a rubber drainage strip is installed; The right vaginal wall was sutured intermittently with 2/0 absorbable thread. There was no palpable mass in the pelvic cavity in double diagnosis. Vaginal tamponade with large gauze compression to stop bleeding, and the operation was completed. Digital rectal examination was normal. The procedure went smoothly with about 150 ml of bleeding. Pathological diagnosis: epidermal cyst (middle and upper segment of the right wall of the vagina),Figure 2。 The postoperative recovery was smooth, pelvic ultrasound reexamination showed no abnormalities, and the hospital was discharged 5 days after operation. Discharge diagnosis: epidermal cyst of the right vaginal wall. After 2 months of follow-up, the patient had no discomfort, pelvic ultrasound showed no abnormalities, and the vaginal mucosal wound healed well.

To quantify serum uric acid (UA) levels in autoimmune myelopathy (AMs) patients and analyze the clinical relevance.

Blood samples from hospitalized patients with AMs (n=69) in acute phase and other neurological disorders (n=50) between September 2009 and December 2013 and healthy subjects (n=50) were used to detect UA level by enzymatic calorimetric method. Expanded disability status scale (EDSS) and spinal MRI-T2 imaging were used for clinical and imaging severity evaluations. And serum AQP4 anitbody and other antibodies were tested.

Serum UA level in AMs patients ((223±76) μmol/L) was lower than in controls ((325±53) μmol/L and(324±48) μmol/L, P<0.001); for clinical relevance analysis, serum UA levels in females ((208±64) μmol/L), age ≥40 years ((185±64) μmol/L), EDSS score≥4.5 ((179±59) μmol/L), transverse lesion ((179±56) μmol/L) and neuromyelitis optica/spectrum disorders ((199±70) μmol/L) were lower than in males ((252±88) μmol/L,P<0.05), age <40 years ((266±66) μmol/L,P<0.001), EDSS score <4.5 ((257±70) μmol/L,P<0.001), non-transverse lesion ((274±64) μmol/L,P<0.001) and multiple sclerosis ((261±69) μmol/L,P<0.05). An inverse correlation existed between UA level and involved spinal segments (r=–0.665, P<0.001); status of serum antibodies and associated diseases showed no significant differences.

Serum UA level is low and shows strong relevance with clinical and imaging severity in AMs patients. And UA is recommended as a biomarker of AMs.

To explore the magnetic resonance spectroscopy characteristics of lenticular nucleus in Bipolar Ⅱ disorder and its relation with cognitive function.

Thirty Bipolar Ⅱ disorder patients in hospital from 2012 September to 2013 April and twenty healthy controls were evaluated with Multi-Voxel ¹H-MRS scans on lenticular nucleus to assess the NAA, Cho, Cr and MI. All subjects were assessed for attention using the Stroop Test and executive function by Wisconsin card sorting test.

NAA, Cho, Cr in right lenticular nucleus and Cr in left lenticular nucleus were lower than healthy controls(P<0.05). The patients showed significant cognitive impairment in all aspects of Stroop Test and Wisconsin card sorting test (P<0.05). NAA in right lenticular nucleus was positively correlated with correct number of Stroop-CW.

Neural dysfunction in right lenticular nucleus of Bipolar Ⅱ disorder may influence attention function. Cellular energy metabolism rate was reduced in bilateral lenticular nucleus.

To evaluate the distribution, diagnosis, indication and modus operandi of surgical treatment and prognostic factors for patients with lung metastatic tumors.

The clinical features were collected for 329 surgical patients with lung metastatic tumors during March 1998 and December 2013. Survival analysis was also performed by Log–rank test and Cox–regression analysis.

The origins were epithelial tissue tumors (n=278), sarcomas (n=32), germ cell tumors (n=3), malignant melanoma (n=3) and miscellaneous tumors (n=13). Their 1, 3 and 5–year survival rates were 85.1%, 50.9% and 37.1% respectively with a median survival time of 38 months. Log–rank survival analysis showed that resection extent (P=0.004), lymph node dissection (P=0.017) and radical operation (P<0.01) were significantly associated with patient survival. And multi–variable Cox–regression analysis showed that lymph node dissection and radical operation were two independent prognostic factors.

For lung metastatic tumor patients with well–controlled primary malignancy and non–metastasis of other organs, radical resection should be performed with minimal resection extent. And routine systematic lymph node dissection is not recommended. The necessity of lymph node dissection should be determined by radiological evaluations and surgical explorations.

To summarize the clinical features and laboratory data of 77 patients with hemophagocytic syndrome (HPS).

A total of 77 patients of HPS were continuously collected from 2007 to 2014 at our hospital. Their underlying diseases, clinical features, laboratory data, therapy and prognosis were analyzed.

Their The patients aged from 3 months to 85 years. The gender ratio was roughly equal. Primary HPS was diagnosed in only 5 cases by gene detection Another 72 cases belonged to secondary HPS. The causes were infection (n=28), hematologic neoplasm (n=25), autoimmune diseases (AID, n=11) and unknown (n=8). HPS was the initial symptom in nearly half cases of hematologic neoplasm and AID. HPS was characterized by high fever (100%), hypersplenomegaly (81.8%) and lymphadenopathy (40.3%). Laboratory data showed cytopenia (94.8%), serum ferritin elevation (93.2%), hypofibrinogenemia (61.8%), hemophagocytosis in bone marrow (78.1%) and hypertriglyceridemia (55.3%). Low NK–cell activity (95.2%) and elevation of sCD25 (100%) were specific manifestations in HPS. Pulmonary infection (36.4%) and hepatic malfunction (33.3%) were common. Approximately 70% were treated with HLH–2004. Pulse–dose corticosteroid therapy (methylprdnisolone 200–500 mg/d) was used in 8 AID patients. And 14 patients died and 10 withdrew treatment because of exacerbation. Five had complications of DIC and another 5 progressed into MODS. Neoplasm (52.0%) had the highest mortality in secondary HPS. And infection (25.0%) and AID (18.2%) followed.

Sometimes HPS occurs simultaneously with autoimmune disease or neoplasm. Relevant laboratory tests for suspected patients may aid an early diagnosis. Presence of DIC or MODS in HPS is possibly correlated with a poor prognosis and a high mortality.

To explore the association between endometriosis stage, characteristics of endometriotic lesions and severity of dysmenorrhoea.

The clinical data were collected from 140 patients with laparoscopically diagnosed endometriosis between May 2013 and December 2013. They were scored by visual analogue scale (VAS) according to their preoperative dysmenorrhoea. Endometriotic lesions were recorded by their anatomical distributions. And endometriosis was staged and scored according to the score of Revised American Fertility Society (r–AFS). The relationship between dysmenorrhoea and endometriosis stage as well as endometriotic foci was analyzed. Chi–square test and Logistic regression were used for statistical analyses.

Among them, there were 95 (67.86%) patients with dysmenorrhoea and 45(32.14%) without dysmenorrhoea. No significant inter–group difference existed in age (P>0.05). The interval from menarche to the onset of dysmenorrhoea was (8±9) years and duration of dysmenorrhoea (2.3±1.5) days each month. A correlation existed between endometriosis stage and severity of dysmenorrhoea (χ²=20.677, P<0.05). A strong association was found between posterior cul–de–sac obliteration and severity of dysmenorrhoea (χ²=8.471, P<0.05). No significant difference was found for ovarian endometriomas, ovarian adhesion, superficial peritoneal lesions and deep infiltrating endometriosis in non– and minimal dysmenorrhoea groups with moderate and severe dysmenorrhoea (P>0.05). Posterior cul–de–sac obliteration was an independent influencing factor for dysmenorrhoea. The odds ratio (OR) was 3.291 and 95% confidence interval (CI) 1.453–7.454. However, no relevance existed between ovarian endometriomas and dysmenorrhoea by Logistic analysis.

The severity of dysmenorrhoea has close correlation with posterior cul–de–sac obliteration. However, there is a weak relevance with ovarian endometreaiomas.

To explore the inter and intra-fractional setup variations of HexaPOD evo RT 6-degree-of-freedom treatment couch plus kilovoltage (KV) cone-beam computed tomography (CBCT) in patients with primary cervical cancer and calculate the proper margins of CTV for clinical use.

From May 2013 to April 2014, 16 consecutive patients with primary cervical cancer were enrolled. Elekta AXESSE™ image guided radiation therapy (IGRT) modalities and vacuum pad were employed. All patents were treated in a prone position after Lac light correction. Then daily CBCT scans prior to were performed treatment delivery, another CBCT scan after 6D couch online correction and a third one after each treatment. After automatic registration to planning CT, three translational X, Y, Z and three rotational Rx, Ry, Rz shifts were analyzed for intra and inter-fraction assessments and CTV margins.

CBCT plus 6D couch could reduce the inter-fraction errors of X (t=3.87, P=0.000), Z (t=–7.92, P=0.000), Rx (t=3.05, P=0.003), Ry (t=–6.87, P=0.000) statistically and Ry was significantly different between pre and post-treatment (t=3.242, P=0.002). As to intra-fraction variations, the CTV margins were 2.74 mm, 3.9 mm and 2.87 mm on X, Y and Z directions respectively.

Corrections with CBCT and HexaPOD evo RT 6D may considerably reduce the translational and rotational setup variations and gain lower PTV volume for intact cervical cancer. Thus it protects normal tissues better and improves the accuracy of high-precision treatments.

To explore the validity of high intensive focused ultrasound (HIFU) in the treatment of uterus myoma and adenomyoma.

A total of 166 patients with uterus myoma and adenomyoma received HIFU treatment from July 2011 to November 2013 at our hospital. The follow–ups were conducted at 1, 3, 6 month post–treatment. Their status of clinical symptoms, tumor volume, blood flow and efficacy of HIFU were evaluated.

Menstrual blood decreased after treatment. The levels of hemoglobin all returned to normal in anemic patients and dysmenorrhea showed great improvement. Ultrasound showed that uterine ablation lesions significantly diminished after treatment. The effective rate was 71.8% at 1 month, 86.1% at 3 month and 95.4% at 6 month post–treatment and blood flow within ablation lesions decreased after treatment. None of unacceptable side effects occurred.

HIFU treatment of uterus myoma and adenomyoma is both feasible and safe with fewer side effects.

To explore the molecular mechanisms by which interleukin-1β (IL-1β) regulates the expression of cytosolic phospholipase A2 (cPLA₂) and cyclooxygenase-2 (COX-2) in human neuroglioma cell.

H4 neuroglioma cells were treated with IL-1β (2.5 μg/L) for different timepoints up to 72 h. For MAPK study, cells were incubated for 1 h with MAPK inhibitors, SB203580 and PD98059 and subsequently stimulated with IL-1β (1 μg/L) for 24 h. Northern and Western blot were used to determine the protein expressions of cPLA₂ and COX-2 respectively. And the content of PGE₂ in supernatant was determined by enzyme-linked immunosorbent assay (ELISA).

A dose of 2.5 μg/L IL-1β induced the protein expressions of cPLA ₂ and COX-2 and a subsequent release of PGE₂ in a time-dependent manner. And the expressions of cPLA₂ and COX-2 peaked at 24 h after stimulation (P<0.05). The expression of PGE₂ increased 250 folds after a 72 h culture. Both SB203580 and PD98059 inhibitors reduced IL-1β-induced PGE₂ production while SB203580 alone reduced the expressions of both cPLA₂ and COX-2.

IL-1β induces the expressions of cPLA₂ and COX-2 and affects COX-2 at the post-translational level by modulating PGE₂ production through the signal transduction pathways of p38 and p42/44 MAPKs.

To evaluate the associations between the occurrence of congenital heart diseases (CHDs) in children and exposures to peri–conceptional multiple nongenetic risk factors.

For this age–matched case–control study, standardized data were collected from 435 families of children with CHD and 574 families of non–malformed children. The questionnaires were conducted on multiple nongenetic risk factors including paternal characteristics and conditions, maternal therapeutic drug exposure, housing renovation, hair perming and dyeing and parental occupational exposure.

The CHD infants weighed less than control group (P<0.01). However two groups had no significant differences in age, height, parental age or heart rate. Educational levels of parents had a negative correlation with CHD. Conotruncal defect and simple ventricular septum defect were the most common cardiac abnormalities. Therapeutic drug exposure, viral infection and occupational exposure all had a high level of correlation with conotruncal defect (OR=6.74, OR=3.73, OR=2.82 respectively). And ventricular septum defect was associated with therapeutic drug exposure, home decoration, hair perming and dyeing and parental exposure of work environment (OR=2.77, OR=1.76, OR=1.89 respectively).

Multiple nongenetic risk factors may contribute to the occurrence of CHD.

Patient 1, a 40-year-old female, was seen for 8 years with polycystic spleen discovery and half a year with enlarged spleen. Physical examination: soft abdomen, palpable subcostal spleen, 5 cm for A and B lines, 10 cm for A and C lines, +10 cm for D and E lines, soft texture, no tenderness, negative for Murphy's sign. Ultrasound findings: The spleen thickness diameter was 9.4 cm, the long diameter was 18.2 cm, and the subcostal diameter was 6.5 cm. The inner boundary of the spleen reached the level of the midline of the left clavicle. Multiple cystic anechoic, honeycomb-shaped, larger long diameter was 3.1 cm (Figure 1)。 Ultrasound revealed: splenomegaly, polycystic spleen. Intraoperative findings: A huge spleen was seen in the abdominal cavity, 20 cm ×15 cm, soft in texture, with uneven surface and vesicular changes, and no obvious adhesion to the surrounding tissues. Splenectomy was performed. Postoperative pathological diagnosis: splenic lymphangioma.

allergic rhinitis (AR) is one of the most common allergic diseases, which has a high prevalence and affects a large number of people, especially children are susceptible to AR^[1]。 Patients with AR are prone to mental and behavioral disorders, and their mental and behavioral disorders can in turn affect the development and prognosis of AR patients. AR was once considered a psychosomatic disease^[2]。 With the gradual recognition of AR, people not only recognize the new concept of "one airway, one disease"^[3]But also gradually recognized the intrinsic connection between AR and mental and behavioral disorders. This article expounds the characteristics of mental and behavioral disorders associated with AR patients, biological factors of susceptibility, biological mechanisms and possible treatment options, and proposes that the mental and behavioral disorders associated with AR patients should be actively treated on the basis of anti-allergic treatment.

Pancreatic cancer is a highly malignant and rapidly progressing tumor of the digestive tract, with the fourth highest mortality rate among all cancers in the western developed countries^[1]It has the characteristics of frequent recurrence and early metastasis^[2]。 Patients with pancreatic cancer have an extremely poor prognosis, with a 5-year survival rate of less than 5%. The pathogenesis of pancreatic cancer is hidden and the mortality rate is high. The main reasons are closely related to the early lymphatic and hematological metastasis and peripheral nerve invasion^[3]。 Studies have reported that pancreatic cancer cells have the biological characteristics of neurotropic growth. Once pancreatic cancer occurs nerve invasion, its mortality rate can reach 90%. Dai et al.^[4]Studies have reported that the incidence of perineural invasion (PNI) in pancreatic cancer ranges from 64% to 100%. The occurrence of PNI may be related to the anatomical structure of peripancreatic nerves, the interaction of neurofactors and the in vivo environment. In recent years, a variety of conventional imaging methods and molecular imaging techniques have been used to reveal the degree and status of PNI from different angles and levels, so as to further evaluate the development of pancreatic cancer, so as to improve the survival of patients.

Growth hormone (GH) has an anti-insulin (Ins) effect, while its action on insulin-like growth factor-1 (IGF-1) produced by the liver has insulin-like properties. Clinically, both adults with GH deficiency and patients with acromegaly caused by GH excessive secretion have a tendency to insulin resistance, indicating that the effect of GH on the effect of Ins is very complex. There may be different mechanisms by which too high or too low GH levels lead to insulin resistance. With the widespread application of recombinant human growth hormone (rhGH) in adults with growth hormone deficiency (AGHD) in recent years, its influence on insulin sensitivity has been increasingly paid attention to while improving the body composition, bone mineral density, cardiovascular risk factors, etc. Studies have shown that low-dose GH therapy can improve insulin resistance in patients with AGHD^[1]。 This article will review the relationship between rhGH therapy and insulin sensitivity.

Cervical invasive squamous cell carcinoma (SCC) goes through a long cycle from the development to the development of cervical intraepithelial neoplasia (CIN). Therefore, the early diagnosis and treatment of SCC have become the focus of attention. The transition from epithelial cells to mesenchymal cells (EMT) is closely related to the occurrence and development of malignant tumors derived from epithelial cells. Multiple steps work together to complete the process of EMT, causing the transformation of epithelial cells to mesenchymal cells, and the polarity and mobility of cells have corresponding changes^[1,2]。 In the course of EMT, an important marker is the decrease of E-cadherin expression^[1,2]。 High mobility group protein 1 (HMGB1) has been associated with invasion and metastasis of a variety of tumors. HMGB1 can activate mitogenic activated protein kinase (MAPK), nuclear transcription factor (NF-κ B) and other pathways. These signaling pathways have been shown to be related to EMT. It is speculated that HMGB1 promotes EMT in cervical cancer through NF-κ B pathway, promotes the development of "CIN-cervical cancer", and ultimately leads to invasive cervical cancer.