Volume 94  ·   Issue 30  ·  2014

lung cancer is the most common malignant tumor in the world, and the mortality rate ranks first among cancers. Among them, non-small cell lung cancer (NSCLC) accounts for more than 85% of lung cancer, and most of the patients are advanced at the time of consultation^[1]。

In recent years, the treatment of advanced lung cancer, especially non-small cell lung cancer (NSCLC), has gradually shifted to individualization. Protein-encoding genes that play an important role in cell proliferation and survival are mutated in some tumors, and targeted mutations can induce cell death, which is currently recognized as one of the effective therapeutic strategies. Among them, the most widely known gene and clinically beneficial gene is epidermal growth factor receptor (EGFR)^[1]。 In lung cancer, EGFR-active mutations mainly occur in exons encoding kinase regions (exons 18-21)^[2]。 First-generation EGFR tyrosine kinase inhibitor (TKI) drugs such as gefitinib, erlotinib and icotinib reversibly compete with the adenosine triphosphate (ATP) binding site of EGFR, blocking its signal transmission, thereby achieving a therapeutic effect.

To explore the therapeutic efficacy and safety of chemotherapy subsequent epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in advanced non-small cell lung cancer (NSCLC) patients with EGFR-TKI acquired resistance.

The clinical features of 36 advanced NSCLC patients with EGFR-TKI acquired resistance from Affiliated Zhongshan Hospital, Fudan University between May 2006 and April 2014 were retrospectively reviewed. Twenty-seven of them received chemotherapy subsequent EGFR-TKI and another 9 chemotherapy alone. The short-term response, progression-free survival and side effects of two groups were compared.

The objective response rates of chemotherapy subsequent EGFR-TKI and chemotherapy alone groups were 7.4% and 0 (P=0.557), disease control rates 81.5% and 44.4% (P=0.046) and median progression-free survival 3.3 and 2.5 months, respectively (P=0.587). No significant differences existed in the rates of side effects between two groups (P>0.05).

The disease control rates of chemotherapy subsequent EGFR-TKI group are higher than chemotherapy alone group, but there is no survival benefit. And the side effects of subsequent therapy are tolerable.

To compare the clinical efficacies of gefitinib versus paclitaxel/carboplatin in patients with advanced pulmonary adenocarcinoma.

A total of 51 advanced pulmonary adenocarcinoma patients were recruited from Guangdong General Hospital during October 2006 to September 2007. Eligible patients were ≥18 years old, either non-smokers or former light smokers and receiving no prior chemotherapy or biological/immunological therapy. According to performance status, smoking status and gender, they were selected with dynamic equilibrium randomized method 1∶1 to receive first-line gefitinib (250 mg/d) in gefitinib arm or carboplatin/paclitaxel (carboplatin, area under the curve 5 mg·ml^-1·min^-1, 21-day cycle; paclitaxel, 200 mg/m², 21-day cycle in chemotherapy arm. The primary endpoint was progression free survival (PFS). And the secondary endpoints were objective response rate (ORR) and overall survival (OS).

They were randomized into gefitinib arm (n=25) and paclitaxel/carboplatin arm (n=26). The median PFS was 4.2 months in gefitinib arm and 8.3 months in paclitaxel/carboplatin arm (P=0.422); ORR 36.0% in gefitinib arm and 42.3% in paclitaxel/carboplatin arm (P=0.645); Median OS 14.4 months in gefitinib arm and 15.0 months in paclitaxel/carboplatin arm (P=0.290). Multifactorial Cox regression analysis showed that age (P=0.004), epidermal growth factor receptor (EGFR) gene mutation status (P=0.012) and subsequent treatments (platinum-based chemotherapy, P=0.001; EGFR-tyrosine kinase inhibitors (TKI), P=0.005) were the significant predictors of OS.

No significant differences exist in terms of efficacy and survival between first-line gefitinib and paclitaxel/carboplatin for Chinese patients with pulmonary adenocarcinoma who are non-smokers or former light smokers. And age, EGFR gene mutation status and subsequent treatments are significant predictor of OS. However, first-line gefitinib should not be recommended for advanced non-small cell lung cancer (NSCLC) patients only based on clinical factors, due to a very small sample-size in our study.

To explore the clinicopathological features associated with epidermal growth factor receptor (EGFR) gene mutation in non-small cell lung cancer (NSCLC) patients.

In this series, 677 NSCLC patients at lung disease center during June 2010 through July 2013 were included. The EGFR gene type was determined through pyrosequencing assay. The factors associated with EGFR gene mutation were explored by comparing their clinicopathological features.

Among them, 313 (46.2%) patients had mutant EGFR. It happened more frequently in females (60.4% vs 33.3%), non-smoker (54.8% vs 32.4%), stagesⅠa-Ⅲa (51.1% vs 38.6%), well-differentiated (81.1% vs 46.1%) and adenocarcinoma (50.7% vs 15.3%) patients than in males, smoker, stages Ⅲb-Ⅳ, poorly differentiated and non-adenocarcinoma counterparts (all P<0.05). However, the mutation rate was lower in patients with AB blood type (25.0%) than those with other blood types (type A 49.4%, type B 46.0%, type O 50.0%) (allP<0.05). The patients with mutant EGFR gene had a higher level of serum carcino-embryonic antigen (CEA) than those with wild-type EGFR gene (114.5 vs 41.8 μg/L,P=0.038).

The female, non-smoker, stagesⅠa-Ⅲa, well-differentiated and adenocarcinoma patients of NSCLC have significantly higher incidence of EGFR gene mutation while mutation is rare in those with AB blood type. And pathology, differentiation and blood type are independent factors affecting EGFR mutation.

To explore the relevance of carcinoembryonic antigen (CEA) level and efficacy of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in advanced non-small cell lung cancer (NSCLC) harboring EGFR mutations.

Between September 2010 and December 2013, 170 NSCLC patients harboring EGFR mutations receiving EGFR-TKI treatment at pulmonary medicine department of Shanghai Chest hospital were retrospectively screened. They were screened for clinical characteristics, efficacy of EGFR-TKI, and tumor markers (CEA/cytokerantin-19-fragment CYFRA21-1) at an initial diagnosis. The cutoff value for CEA was 5 μg/L.

The overall objective response rate (ORR) was 37.6% and disease control rate (DCR) 90.0%. Those with high CEA levels (>5 μg/L) had better DCR (94.3% vs 80.4%,P=0.022). Univariate analysis showed that patients with high CEA levels (≥20 μg/L) had significantly longer progression-free survival (PFS) than those with low CEA level ( HR=1.444, 95%CI: 1.036-2.014, P=0.030). HR value increased with rising CEA levels. No significant difference in PFS existed between high-CYFRA21-1 and normal-CYFRA21-1 groups (HR=1.167, 95%CI: 0.840-1.622, P=0.357). Close follow-ups were conducted for 51 patients on EGFR-TKI treatment. And their CEA levels was tested within one month after treatment. The patients in descending type group had longer PFS than other two types (HR=7.344, 95%CI: 2.903-18.578, P<0.001).

CEA level has a close correlation with the efficacy of EGFR-TKI treatment. And a high CEA level may be a predictive marker for better response and longer PFS in advanced NSCLC.

To explore the application of three-dimensional (3D) high-definition (HD) laparoscopy in radical operation for stomach carcinoma.

A total of 12 cases of radical operation for stomach carcinoma were performed under 3D laparoscopy. The procedures included total gastrectomy (n=6) and distal gastrectomy (n=6). The operative duration, intraoperative blood loss, number of lymph node harvested, postoperative first flatus day and time of food intake were recorded and analyzed.

All cases were successfully operated without complications. The operative duration was 180-210 min, blood loss 50-150 ml, number of lymph node harvested 32-54 and postoperative first faltus day 1-3 days. Also all cases could take fluids at Days 4-5 postoperation.

3D laparoscopic radical operation for gastric cancer may be performed safely and effectively with decreased surgical difficulties.

To identify a non-enterotoxigenic strain of Bacteroides fragilis.

B. fragilis was isolated from the feces of a healthy full-term infant in July 2012 and identified by morphological characteristics and culture conditions, physiological and biochemical test, drug sensitivity test, 16 s rRNA gene sequencing and short and long-term toxicity tests.

The isolated bacterial strain was similar to B. fragilis in terms of morphological characteristics, culture conditions and physiological and biochemical features. The results of 16s rRNA gene sequencing demonstrated that the nucleoids of newly-isolated strain were up to 99% identical to those of standard stain of B. fragilis NCTC9343 (GenBank). The drug sensitivity test revealed that it was not sensitive to cefradine, amoxicillin, gentamicin, sulfamethoxazole and trimethoprim. And the acute and long-term toxicity tests were negative.

The isolated bacteria is a non-enterotoxigenic strain of B. fragilis.

To explore the diagnostic and therapeutic measures of massive hemorrhage after percutaneous nephrolithotomy (PCNL) unresponsive to conservative treatment.

The clinical data of 36 cases of massive hemorrhage occurring after PCNL from January 2010 to January 2014 at our hospital were analyzed. There were 21 males and 15 females with an average age of 46.7 years. There were left (n=22) and right (n=14) cases. Severe hemorrhage had an average onset of Days 3-4 (range, 1 to 7) after PCNL. Clinical manifestations included a drainage of fresh red blood liquids out of kidney fistula accompanied by red gross hematuria. Conservative measures were ineffective.

On computed tomography angiography (CTA), pseudoaneurysm (n=22) and arteriovenous fistula (n=5) were found. Digital subtraction angiography (DSA) and coil embolization were successfully performed in 27 cases whose hemorrhage stopped in 1-3 days after embolization and kidney function returned to normal. Another 9 cases had no obvious hemorrhage on CTA. And venous hemorrhage was considered and conservative treatment succeeded.

Renal arterial CTA is an ideal for assessing massive hemorrhage after PCNL unresponsive to conservative treatment. DSA and coil embolization are the preferred treatments.

To characterize the clinical characteristics of drug hypersensitivity syndrome (DHS).

The clinical characteristics of 10 DHS patients admitted into our hospital were analyzed retrospectively. And the occurrence patterns of DHS were summarized.

There were 4 males and 6 females with an age range of 17 to 66 years. Suspected drugs were anticonvulsants (n=5), allopurinol (n=2), antibiotics (n=1), acetaminophen (n=1) and unknown (n=1). All cases developed skin rashes with fever within 14 to 60 days (n=10). Lymphadenopathy was observed (n=6). Morbilliform eruption was most common skin rash (n=6); facial swelling was also appeared (n=7). Eosinophilia was observed in all cases (n=10). Liver involvement was common (n=9). Autoimmune antibodies abnormality was uncommon; viral infection was complication in several cases. Glucocorticoids were applied in all cases (n=10), 3 severe cases were administrated with intravenous immunoglobulin (IVIg). The clinical outcomes included discharging with recovery (n=7), later diagnosed of non-Hodgkin lymphoma (n=2) and in-hospital death (n=1).

The clinical manifestations of DHS are complicated. And the common reactive drugs include anticonvulsants, allopurinol, antiinflammatory drugs and antibiotics. Some cases may be misdiagnosed and long-term follow-ups are required.

To explore the RET reference values of newborns in Beijing Area and the relationship between the RET and the day ages of newborns.

2 759 (1 404 males and 1 355 females) healthy newborns (born in Beijing Tongren Hospital from January 2007 to December 2012 with 4.31 average day age) were selected, the RET percentage was counted with XE-2100 (adjusted before in use), after the inverse sine transformation of variable's square root, Statistical results show as±s, the reference value refers to bilateral ±1.96 s. The sample was divided into nine groups according to different day ages. Independent sample t served to test and compare the RET difference between two genders newborns, single-factor analysis of variance served to compare the RET difference of the different day ages newborns'groups, Bonferroni adjustment method served to apply the pairwise comparisons. SPSS 18 was used for statistical analysis between males and females across nine age groups.

The normal RET reference values of male and female newborns separately were 2.408%-3.438%, 2.740%-3.912%. RET of male newborns was lower than that of female newborns, the difference was statistically significant (t=-2.564, P<0.05). The RET difference of different day ages of male and female newborns was statistically significant (F=138.105, P<0.01). The comparison of the same day newborns proves that there is RET difference between the male, female newborns of fifth day groups, respectively (2.656 ± 0.067)%, (3.295 ± 0.149)%, there is statistically significant(t=-2.219, P<0.05). Newborns' RET vary with day ages, and there is obvious peak value.

There is RET difference between the male and female newborns, which vary with day ages. The study on the RET reference values of newborns of different genders or different day ages contributes to the clinical disease diagnosis and treatment as reference.

To explore the clinicopathological characteristics of epithelial angiomyolipoma (EAML) and examine the clinical efficacy and prognosis of laparoscopic radio frequency ablation assisted enucleation.

The clinicopathological data of 7 patients with renal EAML undergoing laparoscopic radio frequency ablation assisted enucleation were reviewed from April 2009 to June 2012. And the clinical efficacy and prognosis of laparoscopic radio frequency ablation assisted enucleation were analyzed.

Laparoscopic radio frequency ablation assisted enucleation was successfully performed in all cases without postoperative bleeding, ureteral obstruction, chronic renal insufficiency or urinary leakage. The mean operative duration was 110 min. Renal pedicles were blocked in 4 patients with a mean blockage time of 9 min. The mean intraoperative bleeding was 90 ml. No blood transfusion was required. The absolute bedrest time was 1-3 days and the drainage tube implanted for 3.8 days. Postoperative pathology showed that all cases were EAML. Immunohistochemistry showed HMB-45(+ ) and small muscle action(+ ) and creatine kinase(-) in epithelioid cells. During a mean follow-up period of 1.8 years, none of them had local tumor recurrence, chronic renal insufficiency or other complications.

Renal EAML is a rare subtype of angiomyolipoma without specific clinical and imaging features. And its definite confirmation depends on pathology. Laparoscopic radio frequency ablation assisted enucleation is both safe and effective in the treatment of renal EAML with pseudocapsule.

To explore retrospectively the risk factors of non-sentinel lymph node (NSLN) metastasis in breast cancer patients with sentinel lymph node metastasis ≤2 and examine the likelihood of non-sentinel lymph node prediction.

A sentinel lymph node biopsy database containing 455 breast cancer patients admitted between July 2005 and February 2012 at Beijing Cancer Hospital was analyzed retrospectively. The patients had ≤2 positive sentinel lymph node and complete axillary lymph node dissection.

The SLNS (+ )/SLNS ratio (P=0.001), histological grade (P=0.075), size of mass (P=0.023) and onset age (P=0.074) were correlated with NSLN metastases. Only SLNS (+ )/SLNS(OR 0.502 95% CI 0.322-0.7844), histological grade ratio (histological grade ratio Ⅱ, Ⅲ and others vs grade Ⅰ OR 2.696, 2.102, 3.662)were significant independent predictors for NSLN metastases. The ROC value was 0.62 (0.56, 0.68).

For ≤ 2 positive sentinel lymph nodes of breast cancer, ratio of SLNS (+ )/SLNS and histological grading are independent factors affecting NSLN metastases. However, the results remain unsatisfactory for predicting the status of NSLN.

To compare the clinical efficacy and safety of solifenacin versus tolterodine in patients with overactive bladder (OAB).

Literature searches were performed with PubMed, EMBASE, Ovid and Google Scholar databases, Wanfang and CNKI from inception to October 2013 for comparative studies assessing solifenacin and tolterodine for OAB. The data were extracted and evaluated by two reviewers independently according to the Cochrane Handbook for Systematic Reviews. Meta-analyses were conducted with RevMan 5.2.

A total of 7 studies involving 1 805 patients were retrieved. Compared with tolterodine immediate release (IR), the number of urgency episodes and urge incontinence episodes in 24 h and the rate of dry mouth were significantly lower in patients on solifenacin (RR=-0.34, 95%CI: -0.50--0.18, P=0.00; RR=-0.29, 95%CI: -0.55--0.04, P=0.03; RR= 0.58, 95%CI: 0.41-0.83, P=0.00) and the rate of constipation was higher in those on solifenacin (RR=2.72, 95%CI: 1.38-5.39, P=0.00). No significant differences existed between tolterodine IR and solifenacin in mean micturition volume per voiding and micturitions episodes in 24 h (P=0.05, 0.08). Between solifenacin and tolterodine extended release (ER), the number of urgency episodes, micturition and urge incontinence episodes in 24 h and mean micturition volume per voiding were not statistically different (all P>0.05). The incidence of major adverse events, such as dry mouth, constipation and blurred vision, was not significantly different (allP>0.05). And most adverse events were mild.

Solifenacin is superior to tolterodine IR in treating OAB symptoms. However the rate of constipation is higher for solifenacin. Both solifenacin and tolterodine ER have similar therapeutic efficacies and adverse events.

To observe the myocardial protective effect of Danhong Injection evaluated by velocity vector imaging (VVI) in patients with unstable angina pectoris after percutaneous coronary intervention (PCI) and elucidate its possible mechanism.

A total of 120 patients were randomized into Danhong (DG, n=60) or control (CG, n=60) groups. The patients in CG group received regular medication according to the guidelines while those in DG group regular medication plus Danhong Injection before and after PCI. During PCI, 40 ml Danhong Injection was administrated intravenously. The levels of CK-MB and cTnT were tested before and 24 hours after PCI. And VVI was performed before and 24 hours after PCI.

After treatment with Danhong injection, the serum level of MB isoenzyme of creatine kinase (CK-MB) and cardiac troponin T (cTnT) in DG were lower than those in CG (18.19±10.23 vs 25.12±11.91, 0.079±0.007 vs 0.132±0.011, P<0.05). Meanwhile, strain and strain rate of interventricular septum apex, anterior apex, inferior basement and inferior middle segment were better in DG than those in CG (26.01±7.94 vs 23.25±6.68, 20.91±7.55 vs 18.79±8.45, 18.10±7.31 vs 16.89±6.05, 21.16±6.42 vs 18.37±6.54,P<0.05; 1.93±0.79 vs 1.69±0.63, 1.86±0.72 vs 1.63±0.68, 1.51±0.80 vs 1.25±0.54, 1.50±0.45 vs 1.33±0.32,P<0.05 respectively).

Peri-procedual Danhong injection can ameliorate myocardial injury and improve segmental systolic function.

To explore the expression of CCDC67 mRNA between papillary thyroid carcinoma (PTC) and adjacent normal tissues.

Reverse transcription-polymerase chain reaction (RT-PCR) was employed to detect the expression of CCDC67 mRNA in 48 cases of papillary thyroid carcinoma and their matched adjacent non-cancerous epithelium and cell lines of thyroid carcinoma.

There was no expression of CCDC67 mRNA in SW579 and TPC-1 cell line. All cases had the expression of CCDC67 in adjacent normal tissues while the expression of CCDC67 mRNA was down-regulated significantly, only 39.6% (19/48) in 48 cases of thyroid carcinoma. In PTC, the expression rates of CCDC67 mRNA in stage Ⅰ-Ⅱ and Ⅲ-Ⅳ were 60% (12/20) and 25% (7/28) and 24.1% (7/29) and 63.2% (12/19) in the lymph node metastasis and non-metastasis groups respectively. Also the expression rates of CCDC67 mRNA in Grades Ⅰ and Ⅱ were 61.1% (11/18) and 26.7% (8/30) respectively. And there was significant difference between two groups (P<0.05).

The down-regulated expression of CCDC67 is one of reasons for inactivation of PTC. And it may play an important role in carcinogenesis and progression of PTC.

To explore the functional changes of T lymphocyte from PD-1^-/- mice and the effects on atherogenic immune responses.

PD-1^-/- mice were mated with ApoE^-/- mice to obtain PD-1^-/-ApoE^-/- mice. PD-1^{+ /+} ApoE^-/- mice were used as control. Both groups had a high-lipid diet for 12 weeks. Then the samples of aortic sinuses were harvested for oil-red and immunohistochemical stains. Samples of spleen and sera were obtained. Numbers of lymphocytes in spleen were evaluated by flow cytometry (FACS). And the cells of proliferation were also measured. The intracellular and serum cytokines were detected by enzyme-linked immunosorbent assay (ELISA).

After a 12-week high-lipid diet, aortic root revealed more lesions in PD-1^-/-ApoE^-/- mice than in PD-1^{+ /+} ApoE^-/- controls ((0.51±0.08) vs (0.29±0.06) mm^2,t=2.36, P<0.01)). There was a significant increase in CD3 T cells in the lesions of PD-1^-/-ApoE^-/- mice ((154.88±36.64)/mm² vs (59.38±25.28)/mm^2,t=2.14, P<0.01). In PD-1^-/-ApoE^-/- mice, the numbers of total cells ((8.59±0.55)×10⁷) and cells in CD4⁺ and CD8⁺ T lymphocyte subsets ((1.53±0.18)×10⁷ and (1.41±0.15)×10⁷), increased significantly than those in control mice ((6.29±0.39)×10^7, (0.94±0.10)×10⁷ and (0.70±0.09)×10⁷ respectively, t=3.43, 2.88, 4.03, all P<0.05). Same changes were detected in both CD3⁺ CD62L^- and CD3⁺ CD25⁺ cells. PD-1 deficiency in both CD4⁺ and CD8⁺ T cells resulted in enhanced proliferation by either macrophages or dendritic cells as antigen presenting cells (APCs). The supernatant levels of interleukin-2 (IL-2) ((53.38±5.94) pg/ml), interferon-γ (IFN-γ) ((114.50±9.69) pg/ml) and tumor necrosis factor-α (TNF-α) ((326.00±22.25) pg/ml ) from PD-1^-/- T cells co-cultured with CD3 were significantly higher than those of control T cells ((15.63±2.23), (33.25±4.16) and (64.50±8.17) pg/ml respectively, t=5.95, 7.70, 11.03, all P<0.01). However, only the serum levels of TNF-α increased in PD-1^-/-ApoE^-/- mice compared with control.

PD-1 deficiency in T cells increase markedly immune responses. And it is one of the mechanisms in atherogenesis.

Traditional indicators for monitoring infection include white blood cell count and classification, C-reactive protein (CRP) and procalcitonin (PCT), etc. However, patients with hematological diseases, especially patients with leukemia or aplastic anemia, often have abnormalities in the number or classification of white blood cells. Once such patients are co-infected, they lack effective judgment indicators, and due to low autoimmune function, patients lack specific clinical manifestations. Although CRP and PCT have certain suggestive significance, the above indicators have many influencing factors and lack specificity. In recent years, CD64 has been widely used in pediatrics and patients with severe infection as an index for monitoring infection^[1,2]In this study, the value of neutrophil CD64 positive index in the diagnosis of infection in patients with hematological diseases was discussed.

miRNA is a class of non-coding small molecule RNA with a length of 21 to 24 nucleotides^[1,2]。 miRNA is a group of short sequence RNAs that do not encode proteins and has high evolutionary conservation, gene expression sequence and tissue specificity among various species. Previous studies suggest that the regulation of target genes by miRNA is at the post-transcriptional level, and the expression of target genes is down-regulated by two mechanisms: transcript cleavage or translational suppression^[3], divided into three types according to the mode of action^[4,5]: (1) If the miRNA cannot be completely paired with the target mRNA, it inhibits gene expression at the translational level. This miRNA is the most widely discovered type at present; (2) miRNA is completely paired with target mRNA, its action mode and function are the same as small interfering RNA (siRNA), and it participates in the cleavage of some specific mRNA in vivo; (3) has the characteristics of the above two modes of action: when it is completely complementary and bound to the target gene, it can directly cleave the target mRNA; when it is incompletely paired and bound to the 3'-end non-coding region of the target gene mRNA, it inhibits the translation of the target gene, and the miRNA regulates the growth, development and disease occurrence process of the body through the above mechanism.

Therapeutic angiogenesis, that is, the application of various methods and means to promote the formation of new blood vessels and the establishment of collateral circulation of ischemic limbs, provides a brand-new idea for the treatment of ischemic diseases of limbs. At present, this concept has gradually moved from laboratory to clinical^[1,2]And achieved certain clinical results, but the research on the mechanism of therapeutic angiogenesis still needs to be further deepened. More and more studies have found that neurological factors play an important role in therapeutic angiogenesis. This study reviews the progress in this area.

Globally, respiratory diseases including bronchial asthma (abbreviated asthma) and chronic obstructive pulmonary disease (abbreviated COPD) are increasing. The typical diagnosis of asthma is based on the characteristics of the patient's symptoms and the signs at the time of attack. For those with atypical symptoms, pulmonary function indicators are needed. Pulmonary function measurement is the gold standard for the diagnosis of COPD, but only the severity of airflow restriction is insufficient to describe the whole picture of COPD, and it is difficult to measure lung function in severe patients.

The patient, a 23-year-old male with previous health, was admitted to the hospital on 4 May 2011 due to paroxysmal abdominal pain for 8 h. The patient developed abdominal pain without obvious trigger 8 h ago, which was paroxysmal and severe, and could be relieved when the body was bent forward and sitting. There was no nausea and vomiting, no fear of cold and fever, and no stop of anal exhaustion and defecation. Physical examination: body temperature 37.2℃, pulse 90 beats/min, blood pressure 126/78 mmHg (1 mmHg =0.133 kPa), painful face, harmonic heart rhythm, no murmur, clear respiratory sounds in the lungs, no dry and wet rales, soft abdomen, sausage-like mass about 4 cm ×5 cm in the right lower abdomen, no pressing pain and rebound pain, negative Murphy sign (-), unpalpable subcostal liver and spleen, mobile voiced sound (-), intestinal sound 5 times/min. Laboratory test: white blood cells 10.9×10⁹/L, and no abnormalities were found in the rest of the tests. Abdominal B-ultrasound revealed intussusception. Admission diagnosis: acute intussusception. After admission, the relevant examinations were completed, and the contraindications of operation were excluded. Emergency exploratory laparotomy was performed on the same day. Intussusception mass was found in the ileocecal region, 25 cm away from the terminal ileum, and Meckel's diverticulum with a size of 3 cm ×2 cm ×1 cm on the contralateral edge of the mesangium. Meckel's diverticulectomy and ileoileal anastomosis were performed. Postoperative pathology showed that ectopic pancreatic tissue was seen in the ileum wall and serosa (Figure 1)。 The patient recovered well after symptomatic treatment such as anti-infection and nutritional fluid rehydration, and the abdominal pain disappeared. He was discharged 10 days later. Follow-up for 3 years, the condition is good.

A 14-year-old female was admitted for "progressive redness and swelling of the left eye with visual acuity decrease for 2 months". The patient had been treated outside the hospital with unknown details and poor results. The patient did not complain of other discomfort and had no history of illness or trauma. Eye examination: the visual acuity of the right eye is 1.0, the visual acuity of the left eye is 0.4, and the intraocular pressure of both eyes is normal. The left eye was displaced to the lower temporal, and the intraocular and upward turning of the eyeball was limited. Mild edema of left eyelid, conjunctival congestion and edema with left facial swelling (FIGS. 1A, B)。 Relative afferent pupillary disturbance and retinal edema in the left eye. A/B ultrasound showed left intraorbital inflammatory pseudotumor (Figure 1C)。 Magnetic resonance imaging (MRI) revealed left intraorbital inflammatory pseudotumor and left mumps inflammation (Figure 1D, E)。 According to the above clinical manifestations and signs, the preliminary diagnosis was: inflammatory pseudotumor in the left orbit. Blood routine after admission showed white blood cell count 2.5×10⁹/L, neutrophil percentage 0.384, lymphocyte percentage 0.55, hemoglobin 112 g/L, residual value in the normal range; Liver function tests showed alanine aminotransferase 191 IU/L and aspartate aminotransferase 237 IU/L. Due to the abnormal blood routine and liver function of the patient, systemic hormone therapy is not considered for the time being. First, local anti-inflammatory therapy (diclofenac sodium and levofloxacin eye drops, 4 times a day), white blood cell elevation and liver protection therapy are given. At the same time, systemic examination is improved to find out the causes of abnormal blood and liver function. Systemic examination revealed left parotid lymph node enlargement and hepatosplenomegaly, blood amylase was normal, and mumps was ruled out after consultation in the infectious diseases department. Within 1 week, the visual acuity of the patient's left eye dropped to 0.2, facial swelling and redness and swelling of the left eye intensified, the conjunctiva above the nose protruding beyond the palpebral fissure, and a yellow-white mass was visible under the conjunctiva (FIGS. 2A ~ C)。 A/B ultrasound showed obvious enlargement of intraorbital mass, choroidal edema and superior temporal retinal edema (Figure 2D, E)。 Reexamination of blood routine showed white blood cell count 6.7×10⁹/L, neutrophil percentage 0.567, lymphocyte percentage 0.377, hemoglobin 135 g/L. Although imaging tests support inflammatory changes, the possibility of malignant lesions is considered in view of the rapid progression of the lesion and unexplained lymph node, hepatosplenomegaly and hemogram, liver function abnormalities. Bone marrow biopsy showed no obvious abnormal changes in bone marrow tissue. To clarify the nature of the mass, subconjunctival lesion biopsy was performed under local anesthesia, and a yellow-white solid mass of 2.0 cm ×2.0 cm ×0.3 cm was cut, and cytological examination and immunohistochemistry (tumor cell LCA^＋, CD3^＋, TIA-1^＋Ki-67>90%; the remaining negative or indeterminate) suggesting a pathological diagnosis of T-cell lymphoblastic lymphoma (LBL) (Figure 3)。 Eventually, the patient was referred to the hematology department for radiotherapy and chemotherapy. Within 6 months of follow-up, the left intraorbital lymphoma continued to spread and more lymph nodes were involved throughout the body, which was lost to follow-up six months later.