Volume 94  ·   Issue 06  ·  2014

With the acceleration of modern life rhythm and the change of lifestyle, various sleep disorders have become a prominent medical and public health problem^[1,2]。 Internationally, after more than 30 years of development, sleep medicine, an emerging marginal interdisciplinary subject mainly focused on the diagnosis and treatment of sleep diseases, has been formed and gradually developed^[3]。 With the continuous improvement of understanding, strengthening the diagnosis and treatment of sleep breathing disorders has become an important link in the discipline construction of sleep medicine in China.

To explore the effects of continuous positive airway pressure (CPAP) treatment on the serum levels of associated inflammatory factors in patients with overlap syndrome (OS).

Seventy-four patients with obstructive sleep apnea syndrome (OSAS) or chronic obstructive pulmonary disease (COPD) or overlap syndrome (OS) were recruited from Department of Respirology and Affiliated Sleep Center of our hospital from March 2012 to September 2013.They were divided into OSAS (n=25), COPD (n=26) and OS (n=23) groups according to the results of polysomnography (PSG) and spirometry.By enzyme linked immunosorbent assay (ELISA), the serum levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and asymmetric dimethylarginine (ADMA) were measured and compared before and at Day 30 post-CPAP in OSAS and OS groups.

At pre-CPAP, there was no statistical difference in serum levels of CRP ((7.2±6.6), (8.4±6.8), (8.5±7.9) mg/L) and TNF-α ((33±13), (52±34), (41±33) ng/L) among OSAS, COPD and OS groups (allP>0.05). However, serum ADMA level in OSAS group were significantly lower than those in COPD group ((0.50±0.08) vs (0.71±0.31) μmol/L,P=0.002). Compared with before and at Day 30 post-CPAP, although no significant difference existed in serum levels of ADMA (all P>0.05), at Day 30 post-CPAP there were significantly lower serum levels of CRP ((4.5±4.2) and (5.5±4.1) mg/L) and TNF-α levels ((31±9) and (35±24) ng/L) than those pre-CPAP in OSAS and OS groups respectively (allP<0.05). No significant difference existed between OSAS and OS groups (allP>0.05).

CPAP treatment significantly reduces the serum levels of CRP and TNF-α so as to improve inflammation responses in OS and OSAS patients.

To evaluate the effects of continuous positive airway pressure (CPAP) on daytime sleepiness in patients with severe obstructive sleep apnea syndrome (OSAS).

Retrospective evaluations were performed for 70 consecutive patients at the medical sleep center, West China Hospital, Sichuan University from May 2013 to October 2013.They were all diagnosed with severe OSAS and underwent overnight CPAP titration.Their mean age and body mass index (BMI) were (42.7±8.4) years and (29.2±4.2) kg/m² respectively.The sleep structure, hypoxia and objective sleepiness was compared between baseline and CPAP titration.And correspondence analysis was performed between multiple sleep latency tests (MSLT) and other sleep and expiratory parameters.

Comparing to the baseline polysomnogram (PSG) levels, CPAP titration significantly decreased apnea hypopnea index (AHI) ((4.4±2.7) vs (67.7±18.9)/h), significantly shortened the longest apnea time (24.0(16.5, 29.6) vs 61.3(51.0, 74.8) s) and raised the lowest oxygen saturation ((84.8±8.8)% vs (54.4±18.7)%). Furthermore, the percentage of stage 3 (N₃%) (18.2(12.5, 25.6)% vs 2.4(0.1, 8.2)%), the percentage of stage rapid eye movement (REM) sleep (REM%) ((22.3±7.7)% vs (12.7±5.8)%) and sleep perception improved significantly (89.1(88.3, 91.2)% vs 82.7(82.7, 87.0)%, all P<0.05). Furthermore, CPAP also significantly improved their mean sleep latency of multiple sleep latency test (MSLT) ((8.5±3.8) vs (4.8±2.3) min,P<0.05); the mean sleep latency of MSLT was negatively correlated with AHI, the percentage of stage 1 (N₁%) and the longest apnea (r=-0.501, -0.308, -0.309, -0.501, all P<0.01); but positively correlated with REM%, N₃%, mean oxygen saturation and minimal oxygen saturation during CPAP titration (r=0.235, 0.394, 0.398, 0.440, all P<0.05).

CPAP significantly improves nocturnal oxygen desaturation, sleep architecture and objective sleepiness in patients with severe OSAS.

To evaluate the clinical value of transcutaneous carbon dioxide (TcPCO₂) measurement during sleep respiratory monitoring.

A total of 29 patients were prospectively recruited.Their age range was (49.5±12.9) years and body mass index (BMI) (28.2±3.6) kg/m².All of them underwent polysomnography (PSG) at Sleep Center, Peking University People′s Hospital during the period of January-August 2013.TcPCO₂ signal was entered into PSG systems and TcPCO₂ (TCM4, Radiometer, Demark) measured simultaneously.Arterial blood gas (ABG) analysis for arterial pressure of CO₂ (PaCO₂) was undertaken to validate TcPCO₂ measurement.The data were statistically analyzed by Pearson′s product-moment correlation.Dynamic change of TcPCO₂ was monitored during rapid eye movement (REM) and non-rapid eye movement (NREM) sleep stages.The effect of noninvasive positive airway pressure ventilation (NPPV) treatment on TcPCO₂ during sleep was also observed.

TcPCO₂ (44.2±4.0) mmHg (1 mmHg=0.133 kPa) was highly correlated with PaCO₂ (43.2±4.7) mmHg (Pearson′s correlation, r=0.896, P=0.000), TcPCO₂ (45.8±5.4) mmHg level during wakefulness correlated significantly with that during N₁, N₂, N₃ and REM sleep stages (r=0.658, 0.871, 0.898, 0.775; P=0.009, 0.000, 0.003, 0.000). TcPCO₂ levels during different sleep stages were all higher than that of wakefulness.However, TcPCO₂ levels did not differ between two sleep stages.During both NREM and REM, elevated TcPCO₂ returned to the level during wakefulness on NPPV treatment.

Continuous monitoring of PCO₂ is well-tolerated during PSG testing.And the signal is stable.During whole night sleep, TcPCO₂ monitoring provides more accurate and clinically acceptable estimation of PaCO₂ so that it helps to titrate the NPPV pressure levels.

To explore the association between serum lipoprotein lipase (LPL) level and dyslipidemia in patients with obstructive sleep apnea syndromes (OSAS).

Overnight polysomnography (PSG) was performed for 158 patients with snoring at our Sleep Center from June 2011 to April 2013.Based on the results of apnea-hypopnea index (AHI) assessment, they were divided into 4 groups: primary snoring (AHI<5/h,n=26), mild (5/h≤AHI≤15/h, n=23), moderate (15/h<AHI≤30/h,n=31) and severe (AHI>30/h,n=78) OSAS.According to body mass index (BMI), primary snoring group was further divided into normal BMI and overweight (obese) groups.The level of LPL was determined by enzyme-linked immunosorbent assay (ELISA) and the correlations were observed with OSAS, blood total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and very low density lipoprotein (VLDL). In normal weight OSAS patients, the relationship was analyzed between different conditions, plasma lipid and serum LPL.In 49 OSAS groups, the level of LPL was observed after 6-month continuous positive airflow pressure (CPAP).

From a comparison of four groups, it was found that AHI, night blood lowest oxygen saturation (L-SaO₂) and time ratio of lowest SaO₂<90% (TS90%) had statistical significance (allP<0.01). The serum LPL gradually decreased in four groups.Compared with primary snoring group, there was a significant increase of serum LPL level in severe OSAS group ((37±15) vs (45±17) μg/L,P=0.022). And severe OSAS group had significantly higher serum levels of TC, TG and LDL (P=0.025, 0.001, 0.049). HDL of OSAS group was significantly lower than that of primary snoring group (all P<0.05). Additionally, after adjustment for BMI and age, serum LPL levels showed significant negative correlations with TC and LDL(r=0.221, 0.199). Serum LPL level was negative correlated with AHI and TS90 % and oxygen decrease index (ODI) (r=0.231, 0.228, 0.184). Compared with normal BMI patients, there was a significant increase of VLDL ((0.77±0.30) vs (0.46±0.23) mmol/L, P=0.034) and decrease of LPL ((37±10) vs (523±23) μg/L, P=0.047) in weight (obesity) in primary snoring group.Compared with primary snoring group in normal BMI groups, there was a significant increase of TG, VLDL and decrease of LPL, HDL in OSAS group (all P<0.05). The level of LPL significantly increased after 6-month CPAP ((60±6) vs (38±3) μg/L,P=0.001).

Serum LPL and plasma lipid decrease in OSAS patients.And serum LPL level is correlated significantly with the severity of OSAS and nocturnal hypoxia.Thus LPL may play some roles in dyslipidemia of OSAS patients.

To explore the therapeutic feasibility, safety and efficacy of semi-sitting astride position for extracorporeal shock wave lithotripsy (SWL) of urethral calculi.

A total of 7 male cases of urethral calculi from November 1997 to August 2013 were enrolled.Their age range was 24-52 years.There were anterior (n=1) and posterior (n=6) urethral calculi.The diameter range of stone was 0.5 cm×0.5 cm to 1.0 cm×2.0 cm.BH-VG twin-pulse low-energy SWL was employed with a semi-sitting astride position.The average frequency was 2 500 (1 800-3 500) times.And the treatment voltage was 3-8 kV.

Both stone fragmentation rate and stone-free rate 1 hour post-SWL was 100%.No severe complications occurred.

Semi-sitting astride position SWL is simple, safe, effective and feasible for posterior urethral calculi.

To explore the computed tomographic (CT) manifestations and their values in the diagnosis of intrahepatic cholangiocarcinoma (IHC) and improve the understanding of IHC.

A total of 58 IHC patients confirmed pathologically from January 2006 to December 2012 were reviewed.

On plain CT scans, all lesions were of low density with lower density region (n=37), retraction of liver capsule (n=11), dilation of intrahepatic biliary duct (n=22), bile duct calculus (n=13) and atrophy of liver lobe (n=14). On enhanced scans, most tumor showed obvious circular enhancement on arterial phase, stripe and network enhancement of internal region on portal phase and obvious enhancement on delayed phase.

CT manifestations of intrahepatic cholangiocarcinoma are specific for its diagnosis.

To explore the changes of outcome and morbidity in extremely low birth weight (ELBW) infants.

A retrospective study was performed for ELBW infants admitted into Children′s Hospital, Fudan University within 24 hours after birth from January 2007 to December 2011.The maternal and neonatal data were collected by reviewing the medical charts and entered into the dataset.

A total of 105 ELBW infants (54 males, 51 females) were enrolled.The average gestational age was (28.4±2.6)weeks and birth weight was (860±121)g.Neonatal respiratory syndrome (NRDS) (n=89, 84.8%), apnea(n=58, 55.2%), sepsis(n=47, 44.8%)and patent ductus arteriosus (n=46, 43.8%) remained their major complications.Sepsis was the commonest cause of mortality (7/17) excluding social factors.The incidence of extrauterine growth restriction (46/51, 90.2%) was significantly high at discharge.And the use of antenatal steroids was merely 40.8% (42/103) in ELBW infants at a gestation age under 34 weeks.

The number of ELBW infants has increased dramatically.Antenatal steroids, noninvasive respiratory support, prevention of infections and optimal nutrition supports are key factors of improving the survival rate, short and long-term outcomes of ELBW infants.

To review our experience in the diagnosis and treatment of pancreatic cystic neoplasms (PCN).

The clinicopathological data of PCN were retrospectively analyzed and the relevant medical literatures reviewed.

A total of 139 cases were treated at our hospital.There were serous cystic neoplasm (n=38, SCN), mucinous cystic neoplasm (n=32, MCN), intraductal papillary mucinous neoplasm (n=9, IPMN) and solid pseudopapillary neoplasms (n=60, SPN). The male-to-female ratio was 1∶3.63.The average age of disease onset was 46.1 years old.And 46.3% of them had no symptom at diagnosis.Among symptomatic ones, there were stomach ache (43.4%), location in body and tail of pancreas (58.2%) and solitary (99.5%). The accuracy of ultrasound type B, computed tomography (CT) and magnetic resonance imaging (MRI) were above 80%.The 5-year survival rate of benign PCNs was 100%.The 1, 3, 5-year survival rates of resected malignant PCNs were 70.2%, 47.9% and 39.5% respectively.However, the 5-year survival rate of those undergoing palliative surgery was only 16.7%.

PCNs are more common in females.And the most common clinical presentation is stomach ache.Most PCNs are solitary tumors located in body and tail of pancreas and may be detected by imaging examinations.The prognosis is excellent for benign PCNs and malignant ones undergoing radical resection.However, the prognosis of those undergoing palliative surgery remains poor.

To explore the effects of seven kinds of hemoglobin variants on two HbA1c detection methods.

Twenty-five hemoglobin variant samples (Hb D, S, Q, G, J, E & F) and 40 control samples were from February 2012 to April 2013 collected.All samples were tested by ion exchange-high performance liquid chromatography system (IE-HPLC) and affinity chromatogragh-high performance liquid chromatography (AC-HPLC) respectively.We compared the coincidence between HbA1c results of two instruments and blood glucose and observed the difference between variant and control groups for two methods using statistic software SPSS 19.0.

A high consistency existed between IE-HPLC and AC-HPLC in the control group with no hemoglobin variants(6.68%±1.87% vs 6.64%±1.99%, P>0.05). For the hemoglobin variants group, the results of HbA1c via IE-HPLC were interfered by hemoglobin variants(3.57%±3.51%比4.95%±0.57%,P<0.05). However, HbA1c detection of AC-HPLC had no interference with hemoglobin variants and it demonstrated an excellent correlation with blood glucose.

The results of HbA1c in blood samples containing common hemoglobin variants may be interfered on IE-HPLC to be falsely lower or higher.Only detecting glycated hemoglobin with strong specificity, AC-HPLC is well-correlated with blood glucose and its results are not interfered by common variant hemoglobin.

To analyze the trends of colorectal polyps for age ≥50 years male healthcare patients during a long-term colonoscopic follow-up.

Endoscopic and pathological reports of age ≥50 years male healthcare patients undergoing colonoscopy from April 1983 to April 2013 were retrospectively reviewed and their general data collected.The proportion of different histological types, the distribution at different anatomic sites and the trends of size and number of colorectal polyps during different follow-up years were analyzed.

A total of 3 746 colonoscopy reports of 501 age ≥50 years healthcare cases were collected.After initial colonoscopic screening and polypectomy, 501, 371, 251 and 106 cases were followed up to the 5^th, 10^th, 15^th and 20^th years.Their mean age was (74±9) years.And their mean age of initial colonoscopic screening and polypectomy was (66±8)years.During a follow-up period of 54-348 months, each of them underwent(7±5)colonoscopies.A total of 9 006 polyps were detected and 3 986 polyps confirmed pathologically.And 2 608 polyps(65.43%) belonged to adenomas.Among them, 4 638 (51.50%) polyps were located in descending colon and rectum while 1 314 (14.59%) in ascending colon and cecum.In a descending trend, the sizes of initial colonoscopy, 5^th, 10^th, 15^th and 20^th year were 0.44±0.03, 0.07±0.01, 0.07±0.01, 0.12±0.03 and 0.07±0.01 respectively during the follow-up period (all P<0.05). Also the numbers were in a descending trend, initial colonoscopy, 5^th, 10^th and 20^th year were 3.08±0.19, 0.77±0.09, 0.83±0.10 and 1.03±0.20 respectively during the follow-up period (all P<0.05). The numbers of four different pathological types of polyps were all in a descending trend compared with initial colonoscopy.And the numbers peaked around 2^nd, 5^th, 7^th, 10^th, 11^th, 15^th, 18^th and 19^th year of follow-up.Statistical differences existed between tubular adenoma and tubule-villous adenoma, inflammatory polyps and hyperplastic polyps in mean number in the same follow-up year(all P<0.05). The number of colorectal polyps in different anatomic sites was different in the same follow-up year(allP<0.05).

The mean age of initial colonoscopic screening and polypectomy is 66 years.And the main histological type of colorectal polyps is adenoma.Rectum, sigmoid and descending colon are the major sites of colorectal polyps.During the follow-up, the size and number of colorectal polyps are both in a descending trend and the number changes with years.The recurrence of colorectal polyps has pathological and anatomical disparities during follow-up years.

To identify the risk factors in interstitial cystitis/painful bladder syndrome (IC/PBS) patients with lower urinary tract symptoms (LUTS) without urinary tract infection or benign prostate hyperplasia in China.

A total of 954 outpatients with LUTS presenting for care to urology clinics at 8 hospitals throughout China from November 20, 2008 to August 24, 2012 were surveyed with a standardized questionnaire and validated outcome measures.The definitions for IC/PBS based on the O′Leary-Sant interstitial cystitis symptom and problem indices were used.The possible risk factors was analyzed with the Fisher′s exact and Pearson chi-square tests.And multivariate predictive models were developed with binary Logistic regression methods.

There were 491 females and 463 males.And 44.7% (427/954) met the criteria for IC/PBS.There was significant gender difference(51.7% (254/491) vs 37.4% (173/463), P<0.05). After adjusting for confounding factors, bladder pain was significantly associated with stimulatory foods (OR: 81.16, 95%CI: 11.50-590.00, P=0.001)and anorectal disease (OR: 54.90, 95%CI: 9.52-401.00, P=0.001) in females.Caffeine beverage intake (OR: 4.29, 95%CI: 1.86-9.86, P=0.001) was the only modifiable association according to multivariate analysis of males.

Stimulatory foods, anorectal disease and caffeine beverages are potential risk factors for IC/PBS.Further studies are necessary to determine their roles in the pathogenesis of this disorder.

To explore the risk factors for infection in lupus nephritis (LN) and identify the correlation of ImmuKnow adenosine triphosphate (ATP) value with the development of infections.

We respectively followed up 96 patients from January 2006 to December 2012 and all infectious episodes were recorded. The amount of ATP produced by CD4⁺ T cells was measured by ImmuKnow assay and compared with the results of 27 healthy controls. Multivariate Logistic regression analysis was used to evaluate possible risk factors associated with infection in LN patients.

Among them, the incidence of infection was 22.68%. The mean CD4⁺ T cell ATP level was significantly lower in LN patients with infection (258±112)mg/L compared to both healthy controls(521±257)mg/L(P<0.01) and LN patients without infection(437±193)mg/L (P<0.05). A cutoff CD4⁺ T cell ATP value of 300 mg/L predicted infection in LN patients with a specificity of 77% and a sensitivity of 77%. Multivariate Logistic analysis revealed that lower CD4⁺ T cell ATP level (<300 mg/L), higher prednisone dosage (≥20 mg/d) and hyperglycemia (>10 mmol/L) were the independent predictors of infection. And the correspondingOR values were 3.47(P<0.01), 1.17(P=0.03) and 1.33 (P=0.02) respectively.

ImmuKnow assay may be effective in identifying the elevated risk of infection in LN patients. And larger studies are required to establish the clinical advantages of this assay in LN treatment.

To retrospectively analyze the auditory and speech development of young children with bilateral congenital aural atresia after using bone-anchored hearing aid (BAHA) softband.

From August 2010 to January 2013, a total of 12 patients aged at a range of 3 months to 6 years with bilateral aural atresia using BAHA softband were divided into under 4-year-old group (n=7, an average age of 14 months) and over 4-year-old group (n=5, an average age of 77 months). The air and bone auditory thresholds of the under 4-year-old group were assessed by auditory brainstem response (ABR). The Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) was used to evaluate early auditory development.Soundfield pure tone audiometry (PTA) was applied in the over 4-year-old group.The Standard Chinese lexical neighborhood test (LNT) was conducted to evaluate the speech discrimination scores unaided and aided for 6, 12 and 24 months.

For the under 4-year-old group, the unaided air and bone conduction hearing thresholds were 70-90(73±12) and 15-25(21±4) dB nHL respectively.IT-MAIS score improved significantly after using softband for 6 months in comparisons with unaided situations.The average hearing threshold of patients in the over 4-year-old group was (63±6) dB HL unaided versus (31±4)dB HL aided.The average decline in pure-tone threshold was (32±3)dB HL with BAHA softbands and LNT demonstrated improvements in the speech discrimination score.The differences of paired comparison were significant (all P<0.05).

The hearing ability of children with bilateral congenital aural atresia improves significantly after using BAHA softband.And its application at a young age can guarantee a relatively normal hearing development and avoid oral communication impairment.

To explore the effects of HOXA10 gene expression in undescended and descended testis.

Twenty-four male Sprague Dawley rats were surgically prepared for unilateral cryptorchidism model.Their undescended and descended testes were removed at days 7 (infancy period, group B7) and 60 (sexual maturity period, group B60) post-operation.And contralateral descended testis served as controls (group A7, group A60). The expression of HOXA10 with histologic changes in experimental cryptorchidism were detected with one-step real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemisty.

Compared with the control group, the levels of HOXA10 gene for groups B7 and B60 decreased markedly to 0.78±0.11(P<0.01)and 0.56±0.03(P<0.01)respectively.However the levels of HOXA10 gene and protein in group B60 were significantly lower than those in group B7 (P<0.01).

There is a lower expression of HOXA10 in undescended testes than in normally developed counterparts.And the expression of HOXA10 decreases with the elapsing time of cryptorchidism.

To explore the effects of GLP-1 receptor analog liraglutide on the expression of local renin-angiotensin system (RAS), TGF-β1 and collagen type Ⅲ in pulmonary tissue of diabetic rats.

Thirty male Wistar rats were divided into normal (N), diabetic (DM) and liraglutide treatment (LR) groups according to the table of random number.Diabetes mellitus was induced by feeding with a high-sugar and high-fat diet and a low-dose injection of streptozotocin into caudal vein for 8 weeks.After successful modeling, liraglutide (400 μg·kg ^-1·d^-1) was administered by a subcutaneous injection for 12 weeks in LR group.At Week 12, the mRNA expression levels of AT₁R and TGF-β1 were detected by real-time quantitative polymerase chain reaction (RT-qPCR), the protein expression of AngⅡ was detected by enzyme-linked immunosorbent assay (ELISA) and the protein expression levels of AT₁R and transforming growth factor-beta 1 (TGF-β1) were detected by Western blotting (WB). Collagen type Ⅲ was detected by immunohistochemistry.

The expressions of AT₁R, AngⅡ, TGF-β1 and collagen type Ⅲ increased in DM group than those of N group (P<0.05). The expressions of AT₁R, AngⅡ, TGF-β1 and collagen type Ⅲ were lower in LR group than those of DM group(RT-qPCR of AT₁R: 0.08±0.04 vs 0.32±0.16, WB of AT₁R: 1.20±0.11 vs 1.32±0.05; ELISA of AngⅡ: (2.78±0.56) vs (4.04±0.13) ng/L; RT-qPCR of TGF-β1: 0.21±0.11 vs 0.64±0.16, WB of TGF-β1: 1.01±0.15 vs 1.19±0.13; mean optical density of Col Ⅲ: 0.11±0.04 vs 0.27±0.04, positive area ratio of Col Ⅲ: 0.056±0.023 vs 0.090±0.026, allP<0.05).

Liraglutide plays a role of organ protection by inhibiting the expression of TGF-β1 of pulmonary tissue of diabetic rats.And it may be related with a down-regulation of local RAS.

To explore the relationship between mesenchymal stem cells (MSCs) and liver cancer recurrence after liver transplantation in mice.

The recurrent murine model of hepatocellular carcinoma (HCC) after liver transplantation was established by transplanting tumor cells of hind paw pads.MSCs labeled with green fluorescent protein (GFP) were injected into the marrow cavity of 615 mice after successful modeling.And the proliferation of MSCs in marrow cavity was observed under stereoscopic fluorescence microscope.MSCs labeled with red fluorescent protein (RFP) were injected into tail vein of mice during tumor dissection.The migration of GFP and RFP- labeled MSCs were tracked before and after tumor recurrence.After recurrence, the mice were sacrificed and the recurrent lesions harvested for conforming pathological type by biopsy.

The rate of success modeling was 37.5%.Both gross morphology and pathological examination corresponded to typical HCC manifestations.Thirty mice were detected by GFP/RFP fluorescence for a recurrence of HCC.The outcomes were GFP+ RFP (n=4), GFP (n=1) and neither (n=25).

The presence of MSCs in host may be one of important reasons for recurrent HCC after liver transplantation.It helps to support the traditional view of residual tumor cells mediating the relapse and metastasis of HCC.

The 81-year-old male was seen at the local county hospital on November 17, 2012 due to repeated left lower abdominal dull pain with fever for 3 days. Three days before the visit, the patient developed dull pain in the left lower abdomen without obvious inducement, accompanied by fever, frequent urination, urgency and painful urination. He complained of obvious fever in the afternoon and night, accompanied by chills, without chills, diarrhea and blood in the stool. Physical examination: left lower abdominal tenderness and rebound pain, blood routine showed: white blood cells 28.8×10⁹/L, neutrophils 0.899, hemoglobin 107 g/L, C-reactive protein (CRP) 156 mg/L; Urine routine: occult blood (±), protein (+); Abdominal B-ultrasound showed: right kidney cyst, large prostate, suggesting peritoneal effusion; Whole abdominal CT showed a soft tissue mass in the left lower abdomen, which was closely related to the small intestine. The diagnosis was: abdominal pain to be examined: small bowel tumor considered; Urinary tract infections. After symptomatic treatment such as anti-infection and analgesia, urinary tract symptoms were relieved, but abdominal pain and fever still existed, so I went to the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine for treatment on November 21st. Physical examination on admission: abdominal swelling, left lower abdominal tenderness, rebound pain, no muscle tension, no obvious mass, bowel sounds 3~4 times/min, and positive buckle pain in left kidney area. Blood routine on November 21: white blood cells 29.5×10⁹/L, neutrophils 0.903, hemoglobin 96 g/L, platelets 250×10⁹/L; CRP 138.84 mg/L; Blood biochemistry: albumin 32.30 g/L, alkaline phosphatase 572 U/L, gamma-glutamyltransferase 324 U/L; Tumors: Serum ferritin 1 029.3 μ g/L, squamous cell carcinoma antigen (SCC) 3.40 μ g/L, carcinoembryonic antigen 3.4 μ g/L, sugar chain antigen 19-9 (CA19-9) 12.55×10³U/L, alpha-fetoprotein 2.16 μ g/L; Erythrocyte sedimentation rate (ESR) 87 mm/1 h; There was no abnormality in urine and fecal routine; Chest X-ray showed increased texture in both lungs; Gastroscopy showed no abnormalities; Total abdominal CT plain scan + enhanced (Figure 1) showed that the left lower abdominal sac had solid mass occupation: about 7.1 cm ×6.3 cm ×9.9 cm in size, uneven enhancement after enhancement, blurred fat space between the surrounding intestines, small lymph nodes at the retroperitoneal and mesenteric roots, accompanied by abdominal and pelvic effusion. In order to understand the origin of this abdominal cavity, B-ultrasound of left lower abdomen was performed on November 22 (Figure 2) A regular hypoechoic mass can be seen in the left iliac fossa, about 10.2 cm ×6.2 cm ×6.9 cm in size, with envelope, uneven internal echoes, several irregular small dark areas, and obvious blood flow signals can be seen around and inside. The possibility of retroperitoneal origin is not ruled out, and the occupation of space fluctuates with respiratory movement. In order to understand the relationship between abdominal cavity occupation and intestinal tract, colonoscopy of large intestine on November 24th showed no obvious abnormality; In order to further understand the relationship between abdominal cavity occupation and small intestine, small intestine aerobarium angiography was performed on November 26 (Figure 3) See Group 3 small intestinal external indentation, and dynamically visible contrast medium running along this notch, no sign of leakage outside the intestinal lumen, which clearly confirms that the occupation of space is not related to the intestinal lumen.

Corticosteroids are widely used in various clinical departments, but steroid-related muscle lesions are rare in clinic. With the continuous deepening of research on steroid myopathy at home and abroad in recent years, in order to improve clinicians' identification of such diseases, this article summarizes the related knowledge of steroid myopathy as follows.

Portal vein obstruction is a relatively rare class of hepatic vascular diseases^[1]Its main pathogenesis includes thrombosis, liver cancer invasion, and external compression^[2]。 A Danish study reported that the incidence of portal vein obstruction was less than 4 in 1 million^[3]； Another Swedish study analyzed 23 796 autopsies from 1970 to 1982 and showed a prevalence of up to 1%^[4]。 Growth and development are significantly delayed in children with portal vein occlusion^[5]； For adult patients, portal hypertension complications are more difficult^[6]。 Recent research evidence also suggests that portal vein occlusion will significantly increase the risk of variceal bleeding and death in patients with liver cirrhosis^[7]。 In this paper, the definition, etiology, evolution and treatment strategies of portal vein occlusion are reviewed.

Continuous positive airway pressure (CPAP) is considered the preferred treatment for moderate to severe obstructive sleep apnea syndrome (OSAS). However, in some patients diagnosed with OSAS via polysomnography (PSG) monitoring, the main type of apnea events changed from obstructive to central after the first CPAP pressure titration or longer CPAP treatment. Morgenthaler et al.^[1]For the first time, this phenomenon was defined as complex sleep apnea syndrome (CompSAS), that is, after CPAP titration, while the obstructive respiratory event was substantially eliminated, the residual central apnea index (CAI) ≥5 times/h or Chen-Shi breathing became the dominant respiratory pattern.

A 26-year-old pregnant woman was admitted to Ningbo Women's and Children's Hospital on February 15, 2008 due to the discovery of fetal malformation for 3 days after 31 weeks of menopause. The patient usually has regular menstruation, the cycle is about 30 days, the menstrual period is 3 to 4 days, and there is no obvious nausea and vomiting in the first trimester of pregnancy. The local hospital established a perinatal health care register, and no obvious abnormalities were found in private complaint. 3 days ago, B-ultrasound examination of prenatal examination in Ningbo Women and Children's Hospital showed intrauterine singleton breech pregnancy, fetal survival, amniotic fluid index 5, single umbilical artery, and multiple fetal malformations. On the 7th day of admission, a dead baby with multiple breech deformities was delivered by intrauterine injection of ethacridine (Rivanol). Fetal necropsy findings: malformed fetus, sex unknown. The body length is 30 cm and the body weight is 1.15 kg. Bilateral upper limb deformity, short forearm, absence of both palms, absence of thumb, index finger and middle finger. The legs below the hips are not separated and formed, and they are fused into a vertebral body shape, which resembles a mermaid and is 11 cm long. The umbilical cord is 15 cm long and 0.7 cm in diameter, with a single umbilical artery. There were no obvious abnormalities in the structures of both lungs, heart, liver and spleen, pancreas was absent, esophagus to ileocecal region was normal, sigmoid colon to rectal atresia, no anus, bilateral polycystic kidney and double hydronephrosis, double ureters and bladder were absent, and reproductive system was absent. Absence of pelvis on X-ray of fetal skeleton after delivery, fusion malformation of both lower limbs, only a single femur and a single tibia, spina bifida with abnormal curvature (Figure 1)。 Microscopic examination revealed immature development of each organ, but coincided with the gestational month. Autopsy report: mermaid body sequence sign.

A 40-year-old male was seen in Shaoxing People's Hospital on May 23, 2010 because his liver occupied space for 7 days on physical examination. Previous history of chronic hepatitis B for 20 years. Physical examination: There was no yellowing stain on the skin and sclera of the whole body, no liver palms and spider nevus, flat and soft abdomen, no tenderness and rebound pain, no palpation of the liver and spleen under the costs, no percussion pain in the liver area, and negative mobile voicing. Laboratory tests: hepatitis B virus surface antigen 451.5 μ g/L, hepatitis B virus core antibody 3.7 PEI U/ml, alpha-fetoprotein 4 539.2 μ g/L, sugar chain antigen 242 value 28.5 U/ml, high sensitivity C-reactive protein 172.7 mg/L, alanine aminotransferase 329.9 U/L, aspartate transferase 139.4 U/L. CT showed that the liver capsule was smooth, and irregular low-density shadows were seen in the area under the junction of V and VI segments of the liver, with uneven internal density and unclear boundary, with a size of about 21 mm ×21 mm; After enhancement scan, the arterial phase lesions showed uneven enhancement; No obvious lymph node enlargement was observed, and a malignant tumor of the liver was considered. On June 2, 2010, the right liver tumor was resected under general anesthesia. During the operation, the liver showed small nodular changes, and a mass of about 20 mm was seen between the VI segment of the right liver. Partial hepatic lobectomy specimens, 86 mm ×73 mm ×42 mm in size, showed a gray-white mass 23 mm ×19 mm in size, soft in texture, without capsule. Microscopically: the tumor has unclear boundaries and grows infiltratively in surrounding normal liver tissue; Tumor cells have obvious atypia, large volume, abundant cytoplasm and eosinophilia; The nucleus is large, round or oval, vacuolate, and the nucleolus is distinct, like a somatic cell (FIG. 1A)； The tumor cells showed small focal, nest-like and glandular duct-like structures, in which a large number of mature lymphocytes infiltrated (FIG. 1B)。 Immunohistochemistry: CK7, CK19 (FIG. 2A), CK8/18, Hepatocyte (Figure 2B) positive, whereas AFP, CEA negative; In situ hybridization was negative for EBER. Pathological diagnosis: (right) mixed hepatocellular and cholangiocellular lymphopithelioma-like carcinoma of the liver.