Volume 94  ·   Issue 04  ·  2014

Breast cancer is the most common malignancy in women. According to incomplete statistics, by 2015, the incidence of breast cancer in China was about 53.87/100,000 in urban women and 40.14/100,000 in rural women^[1]。 Although the effects of standardized treatment and comprehensive treatment are also very obvious, due to the differences in professional and technical level of various hospitals in China, there are treatment misunderstandings in daily clinical work, among which the excessive surgery and the deficiency of postoperative radiotherapy are the main ones. Now I will talk about some views for peers' reference.

The prevalence of chronic kidney disease (CKD) in China is 10.8%, and it is estimated that there are 119.5 million CKD patients^[1]。 As the population ages and the prevalence of hypertension and diabetes increases, the prevalence of CKD will rise further. Progression of CKD will lead to end-stage renal disease (ESRD), namely uremia. According to the prevalence of ESRD in Europe, America, Japan, Thailand and other countries, it is estimated that the number of ESRD patients in China is 1 million to 2 million. At present, China has the largest population of CKD and uremia patients in the world. The high disability rate and mortality rate of uremia are not only harmful, but also consume huge health resources due to the high treatment cost. China is still a developing country, and the medical security system is not perfect. Many uremic patients can't get effective treatment due to economic reasons. Many uremic patients' families are poor and return to poverty due to illness. Therefore, how to prevent and treat the occurrence of CKD, how to delay the progression of CKD, reduce the occurrence of uremia, and improve the treatment rate and social return rate have become important public health problems in China.

To explore retrospectively the influence of differential protein intake on renal prognosis for progressive chronic kidney disease (CKD).

A total of 159 chronic kidney disease patients at stages 2, 3 and 4 were enrolled and a questionnaire survey was conducted from January 2009 to July 2012. They were followed monthly and their clinical data collected, including primary disease, blood pressure, body mass index and adverse events. Laboratory tests were performed every 3 months, including biochemical parameters, protein-energy malnutrition (PEM), diet reviews and daily protein intake (DPI). A simplified MDRD formula was employed to evaluate the level of estimated glomerular filtration rate (eGFR). According to the level of DPI, they were divided into 3 groups of very low protein diet (VLPD): DPI≤0.6 g·kg^-1·d^-1, low-protein diet (LPD): DPI >0.6-<0.8 g·kg ^-1·d^-1 and normal-protein diet (NPD): DPI≥0.8 g·kg^-1·d^-1.

Among them, 4 cases (2.50%) progressed to uremia stage and received renal replacement therapy, 2(1.25%) experienced rapid decline in renal function, 9(5.66%) were hospitalized from cardio-cerebral diseases and the 2-year kidney survival rate was 97.5%. At the end of study, among 9 patients of PEM, 2 subjects had a serum level of albumin under 32 g/L and another 7 with a BMI<20 kg/m². No significant difference existed in PEM among different stages of CKD. There was no significant correlation between DPI and Δ GFR (all P>0.05).

Within a certain range, differential protein intake may not significantly affect the prognosis of kidney for progressive CKD patients.

To explore the effects of core-binding factor α1 (Cbfα-1) gene silenced by siRNA on osteogenic differentiation and calcification of vascular smooth muscle cells (VSMC) induced by high phosphate in vitro.

VSMC were cultured in vitro and passaged 3 to 8 times. Four pairs of Cbfα-1 siRNA were designed and synthesized. Transfection was performed with cationic lipid vectors (Lipofectamine 2000). Transfection conditions were optimized by the FAM fluorescent labeling-siRNA to screen effective siRNA sequences by reverse transcription-polymerase chain reaction (RT-PCR). After transfection with effective siRNA sequences, VSMCs were divided into 4 groups: (1) normal phosphate (Pi 1.3 mmol/L); (2) high phosphate (Pi 2.6 mmol/L); (3) siRNA transfection: high phosphate+ Cbfα-1-siRNA; (4) negative transfection control: high phosphate+ negative control siRNA. Cbfα-1 and osteopontin (OPN) mRNA and protein expression were detected by RT-PCR and Western blotting. Calcium deposition was visualized by Alizarin stain method.

The transfection efficiency was around 55% with a concentration of Cbfα-1 siRNA 100 nmol/L and Lipo 8 μl/ well. Cbfα-1 siRNA 1952 was chosen as the effective sequence with a suppression ratio up to 81.8%. At 24 and 48 h post-transfection, the expression of Cbfα-1 mRNA was significantly lower in siRNA transfection group than that in high phosphate group(0.335±0.059 vs 0.714±0.106, 0.574±0.036 vs 0.726±0.086, allP<0.01). At 48 and 72 h post-transfection, the expression of Cbfα-1 protein in siRNA transfection group was significantly lower than that in high phosphate group (bothP<0.01). While Cbfα-1 gene was silenced by siRNA in siRNA transfection group, the mRNA and protein expression of OPN significantly declined(allP<0.05)and calcium deposition in cell layers decreased.

Cbfα-1 siRNA can effectively inhibit the expression of Cbfα-1 mRNA and protein in VSMC and thus suppress the transformation of VSMC into osteoblast-like cells and calcification induced by high phosphate. Cbfα-1 may become a potential therapeutic target in vascular calcification of chronic kidney disease.

To explore tubulointerstitial nephritis antigen(TIN-ag)expression of chronic kidney disease(CKD)patients′ renal tissue and the correlation to clinical phenotype.

Through digital drawing lots, a total of 77 CKD patients from October 2012 to February 2013 at our department were randomly selected. All of them underwent biopsy. Based upon their pathological findings, they were divided into 2 groups of minimal change disease (MCD) and non-minimal change disease (NMCD). The stains of hematoxylin and eosin and Masson were used to observe renal pathological changes and immunofluorescence for detecting the TIN-ag expression of kidney tissue. The serum levels of creatinine, blood urea nitrogen, estimated glomerular filtration rate (eGFR), 24-hour urine output, 24-hour urine protein, α1-microglobulin, β2-microglobulin, pathological casts, N-acetyl-beta-glucosaminidase (NAG), specific gravity and other clinical parameters were monitored to examine their relationship between renal tissue TIN-ag expression.

TIN-ag expression was distinct in renal tubular basement membrane of MCD patients while weak in primary focal segmental glomerulosclerosis (FSGS)(n=16), IgA nephropathy (n=23), MN (n=14) and LN (n=15) renal tissue. Immunofluorescence quantitative analysis showed that tubular TIN-ag fluorescence intensity of NMCD group was significantly lower than that of MCD group (4.84(3.02, 10.73) vs 20.79(8.19, 37.00), P<0.01). In addition, TIN-ag expression in renal interstitial collagen area deposition of 0 grade group was higher than that of collagen area deposition 1-3 grades group (allP<0.05). Serum α1-microglobulin and pathological urine cast, 24-hour urine protein of CKD patients were negatively correlated with kidney tubules TIN-ag expression (r=-0.312, -0.298, -0.214, all P<0.05). Serum creatinine, blood urea nitrogen, serum β2-microglobulin and eGFR of CKD patients had no significant correlations with TIN-ag expression (P>0.05). TIN-ag expression of CKD patients with lower expression levels of NAG was significantly higher than that of normal levels of NAG expression. TIN-ag expression of low urine specific gravity group was lower than that of normal urine specific gravity group (P<0.05).

TIN-ag expression of renal tissue tubule basement membrane in NMCD group is significantly lower than that in MCD group. TIN-ag expression is negatively correlated with renal tissue fibrosis. Expression of serum α1-microglobulin and concentrations of urinary pathology tube, 24-hour urine protein, NAG expression and urine specific gravity are negatively correlated with renal tissue TIN-ag expression in CKD patients.

To evaluate the efficacy, biological behaviors and safety of aromatase inhibitors in early male breast cancer.

A total of 12 male breast cancer patients of stages Ⅰ and Ⅱ took aromatase inhibitors. Their levels of estradiol were measured before and after medication. Another 12 patients received tamoxifen as controls. The recurrence, mortality and side effects were monitored and analyzed.

Their 5-year disease-free survival rates were 69.4%, 77.0% and 5-year overall survival rates 75.0%, 83.4% respectively. No drug withdrawal occurred because of side effects. No inter-group statistical significance existed in estrogen receptor (9 vs 10 cases), progesterone receptor (10 vs 9 cases ), human epidermal growth factor receptor 2 (2 vs 3 cases ), stage T, N, M and disease-free survival rate, disease related 5-year overall survival rate (both P>0.05). There was statistical difference in the level of estradiol before and after medication. The level of estradiol was initially <5 ng/L in one patient, but rose during disease progression.

The efficacy of aromatase inhibitors and tamoxifen in early male breast cancer patients is comparable. And the activity of aromatase inhibitors is correlated with a significantly reduced level of E₂ level. Some patients may develop secondary resistance.

To explore the clinical characteristics and prognosis of ductal carcinoma in situ (DCIS) and early stage ductal breast cancer with invasive depth≤1 cm.

Follow-up analyses were performed for the clinical data of 57 patients with DCIS, 46 with pT_1mic and 74 with pT_1a-b breast cancer treated or consulted at our hospital. Single factor analysis was used to examine their prognostic factors.

Among them, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2(HER-2) positive rate and visual tumor size (2.0(0.1-7.0) vs 2.0(0.5-10.0) vs 2.0(0.3-10.0) cm)had no statistical differences between 3 groups (all P>0.05). After median follow-up periods of 63, 38, 59 months, 12 patients suffered recurrence and metastasis and the rate of each group had no statistical differences. For pT_1a-b patients with positive hormone receptor, endocrine therapy markedly reduced the risk of recurrence and metastasis(P=0.024). pT_1mic,pT_1a-b patients on chemotherapy had higher or comparable recurrence rate versus those without. And DCIS patients on chemotherapy had a much higher recurrence rate(P=0.016). In pT_1a-b group, HER-2 positive patients had higher recurrence and metastasis rates. Yet there was a decreasing tendency after Herceptin treatment.

Chemotherapy without proper indications may not improve the prognosis of DCIS, pT_1mic and pT_1a-b patients. Endocrine therapy is the crucial prognostic factor of patients with positive hormone receptor. Use of Herceptin for HER-2-positive patients is probably significant.

To explore the prediction value for dynamic changes of circulating tumor cell (CTC) in therapeutic response and prognosis of Chinese metastatic breast cancer patients.

A total of 300 metastatic breast cancer patients from six breast cancer centers in China were included from March 2010 to January 2011.The CTC levels of metastatic breast cancer patients were detected with a CellSearch system before starting a new systemic therapy (baseline) and after 3-4, 6-8 weeks. The progression-free survival (PFS) of different groups according to dynamic changes of CTC was estimated by the Kaplan-Meier method and compared with Log-Rank test.

The median follow-up time was 36.86 weeks. The median PFS of patients with ≥5 CTCs/7.5 ml at baseline but with <5 CTCs/7.5 ml after treatment of 3-4 weeks was significantly prolonged than that those with persistent ≥5 CTCs/7.5 ml at the same timepoint (30.4 vs 14.1 weeks, P=0.010). Furthermore, the median PFS of former had no significant statistic difference with those with<5 CTCs/7.5 ml at baseline (30.4 vs 42.0 weeks,P=0.780). The analysis result of PFS for three groups according to CTC of 6-8 weeks treatment was consistent with that according to CTC of 3-4 weeks. The median PFS of patients with ≥5 CTCs/7.5 ml at baseline but with<5 CTCs/7.5 ml after treatment of 6-8 weeks was significantly prolonged than that those with persistent ≥5 CTCs/7.5 ml at the same time point (33.4 vs 8.9 weeks,P=0.000). The median PFS of former had no significant statistic difference with those with <5 CTCs/7.5 ml at baseline(33.4 vs 42.0 weeks, P=0.950).

The dynamic changes of CTC levels during therapy may predict an improvement of progression disease risk and has significance in therapeutic efficacy monitoring.

To explore the clinical characteristics and prognosis of estrogen receptor/progesterone receptor (ER/PR) positive breast cancer (luminal subtype) patients with liver metastases.

A total of 182 patients with liver metastasis from luminal subtype breast cancer between January 2000 and December 2011 were retrospectively reviewed. Their clinical characteristics, treatments and prognosis were collected and analyzed.

Their median age was 47 years and 118 patients were younger than 50 years old. The median disease-free survival (DFS) after primary operation of breast cancer was 19.5 months. All patients received first-line chemotherapy for liver metastases. Overall response (CR+ PR) rate was 60.4%(110/182). Progression-free survival (PFS) and overall survival (OS) were 8 and 23 months respectively. The median OS was extended by 7 months in younger patients (≤50) than in older ones (>50) (P<0.05). In addition, PFS and OS were also extended by 3 and 7 months in patients with complete and partial responses than those who had stable and progressive diseases (P<0.05). No difference existed in PFS and OS with or without capecitabine-based regimens(bothP>0.05).

Age and response to treatment are independent prognostic factors for ER and/or PR positive breast cancer patients with liver metastasis.

To explore the safety in inguinal incarcerated hernia repair without use of antibiotics.

Retrospective statistical analysis was performed for a total 326 patients with inguinal incarcerated hernia repair at our hospital from January 2011 to July 2013. They were divided into 2 groups of non-using (n=192) and using (n=134) antibiotics. Statistical analysis of early postoperative infection was performed for two groups.

The total incision infection had no statistical difference between two groups (7.29%(14/192)vs 3.73%(5/134), 0.52%(1/192) vs 1.49%(2/134), both P>0.05). Further comparison of leukocyte count and neutrophil count at Day 3 showed no inter-group statistical difference ((7.9±0.6)×10⁹ vs(7.8±0.7)×10⁹/L, (4.9±0.5)×10⁹ vs(5.0±0.5)×10⁹/L; U=1.344, 1.777; P=0.180, 0.077).

It is unnecessary to use preventive antibiotics in patients undergoing tension-free repair with incarcerated inguinal hernia without high-risk infection or bowel necrosis.

To retrospectively analyze the survival of renal cell carcinoma patients with bone metastases, evaluate the effect of treatment and identify the prognostic factors in these patients.

A total of 66 renal cell carcinoma patients with bone metastases treated at our hospital between October 1990 and October 2010 were divided into 3 groups: solitary bone metastasis referred for radical surgery (n=19); palliative surgery for solitary/multiple bone metastasis (n=31); extraosseous metastasis without orthopedic surgery (n=16). The effects of different variables on survival were determined according to the Kaplan-Meier method and Log-Rank test.And Cox proportional hazard regression model was used to estimate the prognostic factors.

Their mean follow-up period was 25 (6-68) months.The survival significantly improved if bone metastases were solitary (45 vs 29 and 13 months, both P<0.01), there was no vertebral bone involvement (31 vs 10 months,P<0.01) and radical surgery was performed (50 vs 28 and 13 months, bothP<0.01). Age, gender, tumor size, alkaline phosphatase and lactate dehydrogenase had no effect on survival (allP>0.05). Based on Cox regression analysis, survival was influenced by the number of metastasis foci(RR=0.259, 95%CI: 0.075-0.897), type of procedure (RR=17.845, 95%CI: 4.246-74.992)and vertebral bone involvement (RR=4.526, 95%CI: 1.896-10.803)(all P<0.05).

Surgery is a better option for achieving local tumor control, providing good function and increasing the survival of patients with bone metastases.And radical resection is indicated for the patients with a solitary metastasis.

To explore the risks of long-term proton pump inhibitors (PPI) use.

A total of 79 study subjects were selected from patients seeking health care at outpatient gastroenterology clinic at Peking University People′s Hospital during January 2011 to June 2013. Long-term PPI use was defined as taking PPI for at least one year. They were divided into study (n=79) and control (n=47) groups after matching for age and gender. The study group had 43 females and 36 males with an average age of (63±10) years. And the control group had 28 females and 19 males with an average age of (63±9) years. Data collected were demographic characteristics, clinical diagnosis, detailed dosing information of PPI. serum hemochrome, serum gastrin, vitamin B_12,serum iron, magnesium, calcium, copper, zinc, bone density of hip joint and lumbar vertebra L_1-4.Statistic analysis was performed with SPSS software (t and χ ² test).

The medium duration of PPI use was 3.07(1-15) years. Daily usage was a full or half amount of pharmaceutical directed dosage. Questionnaires regarding appetite, defecation, infection, ostalgia change in long-term PPI use indicated: among them, 77(97.5%) cases had no appetite change and 2 (2.5%) improved. And 73 cases (92.4%) had no change or 2 cases improved (2.5%) in bowel movements habits while another 4 cases (5.1%) changed into loose stools. Lung or intestinal infection was not found. No case had an onset of ostalgia related with PPI intake. Among PPI users, 14 cases (17.7%) appeared to have gastric polyps. T value of total bone density of hip and inter-hip was -0.93±1.04 and -0.61±0.91 respectively in the study group. And both were lower than those in the control group (-0.44±1.12, -0.19±0.94; t=-2.49, -2.35; P=0.014, 0.021). No statistical differences existed in T value of neck of hip, as well as total T value and T value of each L_1-4 between study and control groups (all P>0.05). Higher serum Mg compared to control group ((1.03±0.08) vs (0.97±0.07) mmol/L,t=4.13, P=0.000). No difference of serum calcium, copper, iron, zinc, vitamin B_12,folic acid and Hb, MCV, MCH between study and control groups (all P>0.05). Higher serum gastrin versus normal range and controls were found in the study group ((108±28) vs 100 vs (79±26) ng/L,t=2.56, 5.78; both P<0.05). Taking manual routine dosage have higher hip and lumbar osteoporosis than half-dosage, and bone density decreased and normal bone density ratios are lower(allP<0.05).

Long-term use of PPI with small or average dosage may slightly decrease hip density and increase serum gastrin. However, there is little effect on vitamin B₁₂ and minerals.

To explore the major influencing factors for asthmatics with anxiety and depression.

A total of 176 physician-diagnosed asthmatics were confirmed from March 2011 to March 2012 at First Affiliated Hospital of Zhengzhou University. And 144 were finally screened to examine their demographic characteristics and clinical features. Their status of anxiety and depression and the levels of control were evaluated with the scores of self-rating anxiety scale (SAS), self-rating depressive scale (SDS) and asthma control test (ACT). Firstly, asthma with anxiety and asthma with depression as a dependent variable, general demographics and clinical characteristics as independent variables, single-factor analysis revealed the relevant factors of asthma with anxiety and depression; secondly, multi-variable Logistic regression analysis was performed to examine the major influencing factors of anxiety and depression in asthmatics based on the relevant factors as independent variables.

Multiple variables Logistic regression showed that residing place (rural vs city/town, OR=0.28); control levels (partly controlled vs uncontrolled, OR=0.22; control vs non-control, OR=0.10); severity (secondary vs first level, OR=1.42; third vs first level, OR=2.32; forth vs first level, OR=3.12) were the major influencing factors of anxiety (all P<0.05). Meanwhile, age (31-45 vs ≤30 years,OR=11.35; >45 vs ≤30 years, OR=18.73); level of education (junior high vs primary school and below, OR=3.30; high/secondary vs primary school and below, OR=3.52; college and above vs primary school and below, OR=3.60), medical history (1-3 years vs <1 year, OR=2.68; >3 years vs <1 year, OR=3.01); control levels (partial control vs uncontrolled, OR=0.25; controlled vs uncontrol, OR=0.18) were the major influencing factors of depression (all P<0.05).

Rural dwelling, poorly controlled and severe asthmatics are more likely to associate with anxiety. And depression moods are more common in those with an elder age, a long course of disease, higher education and poor control.

To explore the clinical and laboratory characteristics for large granular lymphocytic leukemia (LGL).

A total of 35 LGL patients were retrospectively analyzed from March 2004 to May 2013 at our department.

Their median age of diagnosis was 51 years. The anemia-related symptoms included splenomegaly (n=11, 31.4%). And one patient (2.8%) with a history of rheumatoid arthritis. Anemia was the most frequent hematological abnormality (n=27, 77.1%). The range of LGL count in peripheral blood was(0.82-23.7)×10⁹/L. Among them, 19 patients (54.2%) showed the CD3⁺ CD57⁺ CD56^-indolent LGL phenotype. Two patients showed complex karyotype. T cell receptor β chain variable region (TCRVβ) analysis was positive in 8 patients. The median overall survival of aggressive LGL patients was significant shorter than that of indolent patient(16 months vs not reached, P=0.000). Univariate analysis showed the median overall survival of patients with B symptom was significant shorter than that without B symptom (19 vs 45 months, P=0.039); the median overall survival of patients with thrombacytopenia was significant shorter than that with platelet normal (16 vs 42 months, P=0.000). Multivariate analysis showed B symptom(P=0.736)and thrombocytopenia(P=0.977)at diagnosis were not prognostic factors.

Chinese LGL patient with rheumatoid arthritis is infrequent compared with foreign reports. TCRVβ analysis is important for its diagnosis. The overall survival of aggressive LGL patients is signicantly inferior to indolent patients, and need earlier intensive therapy in order to achieve longer survival.

To explore the protective effect of pituitrin on the development of paraquat-induced lung injury in rats.

Sixty healthy Sprague Dawley female rats were randomized into 3 groups of control, paraquat and treatment (80 mg/kg, intragastric) groups (n=20 each) Each group was divicled into 4, 6, 12 and 24 h subgroups (n=5 each). The treatment group received pituitrin, injection via internal jugular vein 30 minutes after paraquat dosing. As controls, control and paraquat groups were injected with an equal volume of saline. The paraquat content in serum and lung tissue was measured by high-performance liquid chromatography-mass spectrometry (HPLC-MS). And the levels of tumor necrosis factor-alpha (TNF-α) in sera and nuclear factor-kappa B (NF-κB) in lung tissue and the content of protein in bronchoalveolar lavage (BAL) fluid were detected at various timepoints. Lung wet-to-dry weight ratio (W/D) was recorded after pituitrin dosing. In addition, pathological changes were also observed.

The highest drug concentration of paraquat in lung tissue was far lower in the treatment group than that in the paraquat group ((7.67±0.91) vs (13.27±0.95) μg/g, P=0.002). There were the same result in sera ((1 695±274) vs (5 377±576) ng/ml, P=0.003). The area under the concentration-time curve in the treatment group was significantly lower than that in the paraquat group (10 482 vs 43 441, P=0.000). The levels of NF-κB in lung tissue and TNF-α in sera in the treatment group were lower than those in the paraquat group (TNF-α: 24 h: (1.85±0.22) vs (2.59±0.13) ng/ml,P=0.020; NF-κB: 24 h: (88.0±2.7) vs (101.8±2.8)ng/g,P=0.003). And there was a decrease in the content of protein in BAL fluid in the treatment group versus the paraquat group (BALF protein: 24 h: (125.9±4.2) vs (192.7±6.5)μg/ml,P=0.003), lung W/D significantly decreased in the treatment group versus the paraquat group (12 h: 3.50±0.14 vs 3.73±0.15, P=0.043; 24 h: 3.41±0.06 vs 3.61±0.09, P=0.047). In addition, when compared with the paraquat group, the pituitrin-treated rats showed a mitigation of inflammatory response in lungs and reduced pulmonary edema.

Pituitrin treatment decreases the content of paraquat in sera and lung homogenate in intoxicated rats and alleviates lung injury so that it may become a useful adjuvant in the treatment of acute lung injury.

To explore the effect of Xuebijing plus methylprednisolone in a rat model of pulmonary fibrosis induced by bleomycin.

Eighty Wister rats were randomly divided into 5 groups of control, model control, Xuebijing, methylprednisolone and combined treatment (Xuebijing plus methylprednisolone). Pulmonary fibrosis model was induced by an intra-tracheal injection of bleomycin. The treatment groups were administrated with 4.5 ml·kg^-1·d^-1 Xuebijing and 4.5 ml·kg^-1·d^-1 physiologic saline, 4.5 ml·kg^-1·d^-1 methylprednisolone and 4.5 ml·kg^-1·d^-1 physiologic saline, or 4.5 ml·kg^-1·d^-1 methylprednisolone and 4.5 ml·kg^-1·d^-1 Xuebijing respectively by intraperitoneal injection. And the control and model control groups received 9 ml·kg^-1·d^-1 physiological saline. The animals were sacrificed at Days 14 and 28 respectively. The degrees of lung inflammation and pulmonary fibrosis were detected by hematoxylin & eosin and Masson staining. The serum levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were assessed by enzyme-linked immunosorbent assay (ELISA). The expression of transforming growth factor-β ₁ (TGF-β₁) in lung tissue was evaluated by immunohistochemical staining.

Compared between the combined treatment and model control groups, at Days 14 and 28, the degree of alveolitis ((1.09±0.30) vs (2.03±0.25) and (0.75±0.27) vs (1.78±0.36) ng/L), the degree of pulmonary fibrosis((0.91±0.19 )vs (1.34±0.23) and (0.75±0.27) vs (1.78±0.36)). The expression of TGF-β₁ in lung tissue ((12.11±3.06)% vs (17.70±2.70)% & (10.96±2.53)% vs (16.72±2.20)%). And the serum level of TNF-α ((68.39±9.28) vs (90.94±11.16) ng/L & (67.14±10.88) vs (81.73±7.23) ng/L) all significantly decreased (all P<0.05). At Day 14, the serum level of IL-6 in the combined treatment group significantly decreased as compared with the model control group ((199±31)vs (250±43)ng/L,P=0.036). At Day 28, no statistic difference was found ((192±25)vs (227±24)ng/L, P=0.058).

The combined treatment of methylprednisolone and Xuebijing is more effective in a rat model of pulmonary fibrosis. And its mechanism is associated with the reduced levels of IL-6 and TNF-α and TGF-β₁ expression in lung tissue.

To explore whether the stimulation of interleukin-6 (IL-6) could induce Barrett′s esophagus cells (CP-D) to undergo epithelial-mesenchymal transition (EMT).

IL-6 was used to treat CP-D cell line at the concentrations of 0, 10, 20, 50 and 100 μg/L. The cell morphological changes were observed after 24 hour. Reverse transcription (RT)-PCR, wound healing assay and transwell assay was used to test the migratory potentials of CP-D cell. Western blot and immunofluorescence methods were performed to detect the expression of E-cadherin and vimentin.

After 24-hour exposure of IL-6, CP-D cell lost its polarity and had reduced cell-to-cell adhesion connection. Wound healing assay showed the number of migrating cells was 131±22 in 0 μg/L group, lesser than 10, 20, 50 and 100 μg/L group (328±47, 347±59, 483±62, 492±55, all P<0.05). Transwell experiments indicated that IL-6 could enhance the invasiveness of CP-D(62±11, 67±15, 97±12, 99±13 vs 13±5, allP<0.05). Real-time RT-PCR revealed that increasing concentrations of IL-6 led to a reduction of E-cadherin mRNA expression and an enhancement of vimentin mRNA expression. And significant differences were detected between 20 and 50 μg/L (0.79±0.07 vs 0.47±0.16,P= 0.012; 1.43±0.15 vs 1.78±0.37, P= 0.026). The results of Western blotting were consistent with those of real-time RT-PCR. It indicated that 50 μg/L was the most optimal concentration of IL-6 for inducing EMT in CP-D.

IL-6 stimulation may induce CP-D to undergo EMT. As a result, its invasiveness and migration capacity becomes enhanced so as to lead to malignant transformation.

gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the digestive system^[1,2,3,4]Most of them are believed to originate from gastrointestinal pacemaker interstitial cells of Cajal (ICC) or their precursor cells. Gain-of-function mutations occurred mainly by c-kit (85%) and platelet-derived growth factor receptor alpha (PDGFRA, 7%) genes^[5,6]Type III receptor tyrosine kinase KIT and PDGFRA autophosphorylation, abnormal activation of downstream signaling pathways, uncontrolled cell proliferation and inhibited apoptosis. GIST has the potential of non-directional differentiation, and there is no clear boundary between benign and malignant. At present, risk grading, including tumor site, size, number of mitosis and whether rupture occurs during operation, is commonly used to assess the prognosis of disease^[7]。 The most common treatment for primary GIST is surgical resection. The use of imatinib mesylate has ushered in a new era of molecular targeted therapy for GIST, which can keep 80% of patients with metastatic or recurrent GIST stable. But only<3% of patients achieved complete remission and required lifetime treatment^[8,9]。 Approximately 50% of patients develop secondary resistance within 2 years of initial treatment with imatinib. On the other hand, wild-type and PDGFRA D842V-mutated GISTs were insensitive to imatinib treatment. Therefore, gene mutations cannot fully explain the diverse biological manifestations of GIST, and KIT inhibitors alone cannot completely cure GIST. Other types of epigenetic changes, including DNA hypomethylation, DNA hypermethylation, abnormal expression of microRNA (miRNA) and chromosome modification, are also involved in GIST tumorigenesis, and play an important role in the diagnosis, treatment and prognosis of GIST^[10]。 The research progress of miRNA in GIST is summarized as follows.

Autoimmune disease refers to a kind of disease in which the immune system is hyperfunctional, producing antibodies or sensitized lymphocytes to destroy and damage its own tissues and cell components, resulting in tissue damage and organ dysfunction. It has the characteristics of high incidence, complex mechanism, sensitive treatment but difficult to cure, poor prognosis and long course of disease. telomere (telomere) is a special structure at the end of linear chromosome. In recent years, it has been found that telomere shortening of T lymphocytes exists in autoimmune diseases.

After Madkilbp first proposed the cancer stem cell (TSC) hypothesis, researchers have successively discovered the existence of TSC in malignant tumors such as acute myeloid leukemia, breast cancer, central nervous system malignancies, and colon cancer. Among them, breast cancer stem cells (BCSCs) are highly correlated with the occurrence, development, recurrence, metastasis and multidrug resistance of breast cancer^[1]。 Breast cancer is a hormone-dependent tumor, and endocrine therapy has been widely used in patients with positive estrogen receptor (ER) and/or progesterone receptor (PR)^[2]More and more studies have found that BCSCs are of great significance for the development and screening of targeted endocrine therapy drugs. Recent advances in the regulation of the number and function of BCSCs by binding hormones as exogenous regulators are reviewed.

A 19-year-old male, 14 years after perineal flame burns, was admitted on 17 May 2011 due to perineal scar contracture deformity. The patient reported that the scrotum was not empty before the burn. After the burn healed, a fixed mass in the right inguinal area and a movable mass in the left inguinal area were found, which sometimes could not be touched. Physical examination at admission: extensive scars in the lower abdomen, perineum and upper segments of both thighs. Pelvic asymmetry on both sides, right hip deformity, right hip joint straightening, limited abduction, right lower limb shortening 18 cm compared with the contralateral, right upper thigh circumference significantly reduced compared with the contralateral, and left thigh abduction limited. The penis and scrotum are hidden in the annular scar fossa, which affects the examination. An oval mass can be palpable in the left and right inguinal areas, which causes deep pressure pain. Physical examination on day 2 of admission did not reveal a mass in the left inguinal area. Pelvic CT scan showed: a well-bounded, isodensity shadow was seen behind the penis, near the midline of the root of the left thigh, and subcutaneously in the right inguinal area, respectively, and dislocation of the right hip joint (Figure 1)。 Ultrasound examination showed that the medial upper left thigh and the right inguinal area were detected with isoechoic, rounded shape; Testicular volume measured by ultrasound was 6.98 ml in the left testis and 4.53 ml in the right testis (Figure 2)。 There was no obvious abnormality in the physical and chemical characteristics of semen, and no sperm was seen under the microscope after centrifugation; Sex hormone test was normal. On May 26, 2011, perineal scar release and skin grafting were performed. After operation, the left testis did not rise again and was located in the scrotum, and the right testis was located in the right inguinal area. The penis was fully exposed, the erectile function was improved, and a smaller scrotum was visible, which was oval, and the abduction of both thighs was partially improved. One year after operation, the size, texture and semen examination of left and right testis showed no obvious change compared with those before operation, and the detection of sex hormone, human chorionic gonadotropin and alpha-fetoprotein were all normal. Percutaneous testicular biopsy in the right inguinal area: Remaining seminiferous tubules and completely fibrotic seminiferous tubules were found. Spermatogenic cells at all levels of the remaining seminiferous tubules completely disappeared, sertoli cells proliferated, basement membrane thickened, and no abnormal cells were found (Figure 3)。 Left testicular puncture failed. It is proposed to perform right descending testicular fixation or right cryptorchidectomy as soon as possible.

On November 2-3, 2013, China Non-invasive Ventilation Summit was held in Tianjin. During the meeting (November 2nd), the "Chinese Non-invasive Ventilation Expert Symposium" was held. The seminar was chaired by Professor He Quanying, head of the Sleep Apnea Group of the Respiratory Branch of Chinese Medical Association, attended by many experts from the Critical Care Group, Sleep Apnea Group, Respiratory Therapy Group and China Sleep Research Association of the Respiratory Branch, and Professor Wang Chen, chairman of the Respiratory Branch of Chinese Medical Association, attended and guided. The meeting held extensive and in-depth discussions on the current situation and problems, development strategies and specific implementation steps in the field of non-invasive ventilation in China.