Volume 94  ·   Issue 36  ·  2014

Bone tissue is a common site of metastasis in advanced malignant tumors, and the incidence of bone metastasis in breast cancer is 75%^[1,2]。 Bone metastases, if not aggressively treated, usually lead to serious bone-related events (SREs)^[3], such as bone pain, pathological fracture, spinal cord compression, hypercalcemia, etc., seriously affect the quality of life and prognosis of patients, and increase the financial burden of patients. Therefore, sufficient attention should be paid to the bone metastasis of breast cancer, and active treatment measures should be taken to relieve pain, prevent and treat SRE, improve the quality of life and prolong the survival time.

To explore the prognostic value of applying a semi-automated detection system for detecting circulating tumor cells (CTC) for different stages and various subtypes of breast cancer.

Immunomagnetic separation and immunofluorescent staining were employed to detect the expressions of CTC and CTC HER-2. Chi-square test, univariate and multivariate analyses were used to examine the correlations between CTC and clinical characteristics.

CTC was detected in 57.5% (138/240) of metastatic breast cancer (MBC). CTC enumeration, HER-2 status, number of metastasis and bone metastasis were relevant (P<0.05). CTC was detected in 23.1% (6/26) of early-stage breast cancer (EBC). CTC enumeration, pathological type, estrogen receptor (ER), progesterone receptor (PR), Ki-67, tumor size and lymph node metastasis were irrelevant (P>0.05). HER-2-positive MBC detected less CTC than HER-2-negative(χ²=12.296, P<0.001). CTC HER-2 expression was different between HER-2-positive and negative patients in 99 MBC cases (χ²=8.082, P=0.004).

CTC enumeration is different for various stages and different subtypes of breast cancer. CTC enumeration and bone metastasis are relevant. CTC detection in EBC may predict tumor relapse. And CTC HER-2 expression is different between HER-2-positive and negative MBC patients.

To explore the prognosis of occult breast cancer.

From January 1978 to December 2008, retrospective analyses were conducted for 205 female patients with axillary lymph node metastasis from an unknown primary source.

During a median follow-up time of 61 (4-158) months, the 5 and 10-year rates of disease-free survival (DFS) were 63.5% and 39.8% respectively. The median overall survival (OS) was 10 years. And the 5 and 10-year OS were 79.8% and 49.4% respectively. Significant differences existed in medical history, family history, estrogen receptor (ER), human epidermal growth factor receptor-2(HER-2), infiltration of soft tissue, surgical option, neoadjuvant chemotherapy, chemotherapy, and radiotherapy with DFS of occult breast cancer (P<0.05). The most important determinants of DFS and OS were ER, infiltration of soft tissue and neoadjuvant chemotherapy (P<0.05).

Radical mastectomy should be performed instead of modified radical mastectomy to improve the patient quality of life.

To explore the roles of Y box-binding protein 1 (YB-1) in breast cancer cell proliferation.

Twenty cases of surgical removal of breast cancer tissue (diagnosed with invasive ductal carcinoma, stage Ⅱ, by postoperative paraffin pathology) and normal breast tissues adjacent to carcinoma were collected during June 2013 to August 2013.Quantitative real-time PCR (qRT-PCR) was performed to detect the YB1 mRNA levels.Cultured mammary epithelial cells (HBL-100) and breast cancer cells (MCF7, MDA-MB-231 & SK-BR-3 cells) were harvested and qRT-PCR was performed to detect the YB1 mRNA levels.SK-BR-3 cells were stimulated with various concentrations of PDGF-BB and YB1 expression levels were detected by qRT-PCR.Down-regulation or over-expression of YB1 by si-YB1 or Ad-GFP-YB1 was detected in SK-BR-3 cells.And MTS cell proliferation assay kit was used to detect cell proliferation.

YB1 mRNA levels were significantly higher in breast cancer tissues and MDA-MB-231 and SK-BR-3 breast cancer cell lines than that in adjacent normal breast tissues and HBL-100 mammary epithelial cells respectively (P<0.05). YB1 expression levels increased in PDGF-BB stimulated SK-BR-3 cells in a dose-dependent manner.

A down-regulation of endogenous YB1 decreases and an over-expression of exogenous YB1 promotes the proliferation activity in SK-BR-3 cells.

To explore the neuromuscular effects of cisatracurium besylate in morbidly obese patients when dosed according to real body weight under total intravenous anesthesia with propofol.

Thirty-six ASA Ⅰ-Ⅱ patients aged 18-65 years scheduled for elective procedures at our hospital during July 2012 to December 2012 were allocated into 2 groups according to body mass index (normal weight: body mass index: <24, overweight: body mass index >28). Anesthesia was induced with target-controlled infusion of propofol (Cp 3 μg/ml) and remifentanil (Ce 3-5 ng/ml). A bolus of cisatracurium 0.2 mg/kg was administered intravenously over 5-10 s as soon as a patient lost consciousness. Neuromuscular block was monitored with TOF-Watch SX (Oaganon, the Netherlands). Single stimulation (0.1 Hz) was applied to ulnar nerve at wrist. The maximal degree of neuromuscular block, onset time, clinical duration and recovery index were recorded. They were intubated and mechanically ventilated when neuromuscular block reached the maximal degree. The intubation condition was evaluated.

The average onset time was (164±25) s in obese group versus (201±48) s in normal weight group. And there was significant difference between groups(t=2.83, P<0.05). The clinical duration was (68.4±9.6) min in obese group versus (62.0±6.5) min in normal weight group. And there was significant difference between groups (t=2.33, P<0.05). The recovery index was (15.6±4.7) min in obese group versus (10.8±4.2) min in normal weight group. And there was significant difference between groups (t=3.03, P<0.05). Also 75% recovery time was (83.9±11.5) min in obese group versus (73.0±9.2) min in normal weight group. And there was significant difference between groups (t=2.94, P<0.05). But no differences existed in intubation conditions.

When dosed according to real body weight, onset time of cisatracurium is shorter while clinical duration and recovery index are prolonged in morbidly obese patients compared with normal weight counterparts.

To analyze the clinical characteristics, treatment and prognosis of hemophagocytic lymphohistiocytosis (HLH) patients with Epstein-Barr viremia(EBV).

A retrospective study was conducted to analyze the clinical data of 80 HLH patients aged ≥14 years with EBV-DNA >1 000 copies/ml in peripheral blood from 2008 to 2013.

There were EBV-HLH (n=46), HLH-associated lymphoma (n=30) and primary HLH (n=4). Among the relevant laboratory parameters, inter-group statistical differences existed only in alanine transaminase (ALT) and aspartate aminotransferase (AST) (P=0.021, 0.035). The median follow-up period was 2.0 (0.5-20.0) months. And the 1-month, 3-month, 6-month and 12-month overall survival rates were 58.8%, 37.5%, 29.7% and 19.6% respectively.

HLH patients with EBV have a pernicious clinical course with a poor prognosis. And it makes little sense for distinguishing HLH-associated lymphoma from EBV-HLH through routine laboratory tests.

To explore the clinical characteristics and prognostic factors of pulmonary tuberculosis with concurrent lung cancer.

Comprehensive analyses were conducted for 58 cases of pulmonary tuberculosis patients with lung cancer. Their clinical symptoms, signs and imaging results were analyzed between January 1998 and January 2005 at Qingdao Chest Hospital. Kaplan-Meier method was utilized to calculate their survival rates. Nine prognostic characteristics were analyzed. Single factor analysis was performed with Logrank test and multi-factor analysis with Cox regression model.

The initial symptoms were cough, chest tightness, fever and hemoptysis. Chest radiology showed the coexistence of two diseases was 36 in the same lobe and 22 in different lobes. And there were pulmonary nodules (n=24), cavities (n=19), infiltration (n=8) and atelectasis (n=7). According to the pathological characteristics, there were squamous carcinoma (n=33), adenocarcinoma (n=17), small cell carcinoma (n=4) and unidentified (n=4) respectively. The TNM stages were Ⅰ (n=13), Ⅱ(n=22), Ⅲ (n=16) and Ⅳ (n=7) respectively. The median survival period was 24 months. And the 1, 3, 5-year survival rates were 65.5%, 65.5% and 29.0% respectively. Single factor analysis showed that lung cancer TNM staging (P=0.000) and tuberculosis activity (P=0.024) were significantly associated with patient prognosis. And multi-factor analysis showed that lung cancer TNM staging (RR=2.629, 95%CI: 1.759-3.928, P=0.000) and tuberculosis activity (RR=1.885, 95%CI: 1.023-3.471, P=0.042) were relatively independent prognostic factors.

The clinical and radiological characteristics contribute jointly to early diagnosis and therapy of tuberculosis with concurrent lung cancer. And TNM staging of lung cancer and activity of tuberculosis are major prognostic factors.

To describe the dermoscopic patterns of plaque psoriasis and chronic eczema and explore the roles of dermoscopy in their diagnosis and differential diagnosis.

A total of 68 patients with plaque psoriasis or chronic eczema were recruited from our department from December 2013 to May 2014 to undergo dermoscopic and histopathological examinations. Dermoscopic features of vascular morphology, vascular arrangement, background color, scale color and scale distribution were evaluated. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for predefined dermoscopic criteria in relation to the diagnosis of plaque psoriasis.

Thirty-one patients with plaque psoriasis and 37 patients with chronic eczema were included. Dotted vessels in a regular arrangement (sensitivity 80.6%, specificity 73.0%) over a light red background (sensitivity 71.0%, specificity 75.7%) and white scales (sensitivity 71.0%, specificity 83.8%) were highly predictive for the diagnosis of plaque psoriasis. And chronic eczema more commonly showed yellow scales and dotted vessels in a patchy arrangement over a dull red background. Characteristic vascular structures of hairpin vessels and red loops were also found to be highly specific (91.9%, 94.6%) for the diagnosis of psoriasis.

Plaque psoriasis shows specific dermoscopic patterns compared with chronic eczema. And dermoscopy is valuable in the diagnosis and differential diagnosis of psoriasis.

To explore the association of 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone (PTH) with metabolic syndrome (MS) and its components in aged males.

For this cross-sectional study, 1 729 aged males aged over 60 years were selected from participants in a routine annual health examination at our hospital from May to June 2012. Their mean age was 75±10 years. Height, weight, blood pressure, blood glucose, blood lipids, alkaline phosphatase, calcium, phosphorus, 25(OH)D and PTH were measured. And the associations of 25(OH)D and PTH with the presence of MS and its components were analyzed.

The prevalence of MS was 22.0%. The PTH levels were significantly higher in the MS and abnormal blood glucose and HDL-C group than in their control group [(42±16) vs (40±17), (42±16) vs (40±17), (47±18) vs (40±16) ng/L respectively, P<0.05]. However, there were no significant differences of 25(OH)D between these groups. The prevalence of MS showed a gradual increase according to the PTH quintiles (P<0.05). When comparing the subjects in the highest and lowest quintile of PTH, the former group demonstrated a 1.51-fold increase in odds ratio for MS after adjusting for 25(OH)D levels and other confounding factors. Logistic regression analysis showed that the PTH level was an independent influencing factor for MS in aged males (OR=1.007, 95%CI: 1.000-1.014, P=0.047). The levels of 25(OH)D were not associated with MS in the regression model(OR=1.004, 95%CI: 0.992-1.016, P=0.538).

In aged males, the elevated level of PTH is a risk factor for the prevalence of MS. However, there was no association between 25(OH)D and MS.

To explore the correlation of gene polymorphism of interleukin 4 receptor alpha chain (IL-4Rα) and total serum IgE levels in children of bronchial asthma in Guiyang area.

A total of 160 asthmatic children at Affiliated Hospital, Guiyang Medical College from August 2010 to February 2011 were selected as asthma group. There were 96 males and 64 females with an average age of (6.9±3.3) years. During the same period, 143 healthy children from outpatient physical examination center of this hospital were chosen as control group. There were 75 males and 68 females with an average age of (4.9±3.9) years. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and allele-specific polymerase chain reaction (AS-PCR) were used to determine the polymorphisms of Q576R on exon 12 and I75V on exon 5 of IL-4Rα in both groups. The total serum IgE levels were determined by enzyme-linked immune sorbent assay (ELISA). Comparisons of two groups were made for genotype and allele frequency, serum total IgE and different genotypes, different groups of total serum IgE levels.

Three genotypes of AA, AG and GG existed on Q576R and I75V loci between two groups. The genotypic frequencies of two loci had significant differences in two groups (χ²=30.972, 16.776, both P<0.001). The subjects with variant allele on Q576R and I75V loci had higher risks for asthma than those without variant allele (χ²=33.236, 13.845, both P<0.001). The total serum levels of IgE in asthma group were higher than those in control group ((312±297) vs (61±48) U/ml,t=9.959, P<0.001). However, these three genotypes of two loci showed no significant inter-group difference (allP>0.05). In mutation allele carriers and non-carriers of Q576R locus, total IgE levels showed no significant difference (t=-0.028, 1.279; P=0.978, 0.203). Differences in total IgE levels between I75V polymorphic variant allele carriers and non-carriers were also not statistically significant in control group (t=-0.763, P=0.447). However, in asthma group, total IgE levels of I75V polymorphic variant allele carriers were significantly higher than those of non-carriers (t=-2.112, P=0.036).

The 576 and 75 loci of IL-4Rα are important candidate genes of asthmatic children in Guiyang area. And the serum total IgE levels of variant allele G at 75 locus in IL-4Rα are higher than those without it.

To explore the role of hypemethylation of DLC-1 gene in the pathogenesis of multiple myeloma (MM) and examine the effects of arsenic trioxide (As₂O₃)-induced demethylation of DLC-1 gene in U266 cell line.

The methylation status of DLC-1 gene was detected by methylation specific PCR (MSP) in MM patients from 2008 to 2012. And the expression of DLC-1 gene mRNA was determined by reverse transcription-polymerase chain reaction (RT-PCR). Methylation statuses of DLC-1 gene exposed to As₂O₃ were detected by bisulfite sequencing PCR (BSP). And the mRNA expressions of DLC-1 and DNA methyltransferase (DNMT1, T3a and 3b) were determined by real-time fluorescence quantitative PCR (RTFQ-PCR).

Hypermethylation of CpG island of DLC-1 gene was observed in 37/52 (71.15%) MM patients. DLC-1 gene was not expressed after methylation. As₂O₃ could induce DLC-1 gene demethylation. After 72-houe treatments of 0.5, 1.0 and 2.0 μmol/L As ₂O_3,the methylation rate of DLC-1 gene dropped from 95.38% to 63.07%, 30.00% and 7.69%. As compared with the untreated group, the expression of DLC-1 gene mRNA increased to (1.60±0.09), (3.66±0.17) and (5.29±0.15) folds after exposures(all P<0.05). And As₂O₃ could induce the expression of DNMT1, DNMT3a, DNMT3b gene mRNA(all P<0.05).

Methylation of DLC-1 gene is essential in the pathogenesis of MM and may provide a new diagnostic technique and drug target for the treatment of MM. And As₂O₃ may activate the expression of DLC-1 gene through demethylation.

To explore the effects of hemoglobin on inducible nitric oxide synthase (iNOS) after intracerebral hemorrhage.

A total of 60 male Sprague-Dawley rats were randomized into hemoglobin (Hb) and sham-operated groups (n=30 each). And each group was divided further into 6 subgroups (6 h, 12 h, 24 h, 48 h, 3 d and 7 d). At each timepoint, their neurological behaviors were observed. The expression and distribution of iNOS in perihematomal brain tissue were detected by immunohistochemical staining. The mean optical density of iNOS was assessed and semiquantitatively analyzed.

After Hb injection, there was an onset of limb dysfunction. The Bederson score in Hb group increased significantly versus sham group (P<0.05). At 6 hours post-injection, immunoreactivity of iNOS was obviously observed in astrocytes and inflammatory cells. In some cases, iNOS reactivity was detected in endothelial cells. Maximal expression occurred at 12 hours. The iNOS expression stay at high levels till 48 hours (P<0.05, versus sham group) and then slowly diminished at 3 and 7 days. The iNOS expression was correlated significantly with the score of neurological behavior (r=0.641, P<0.05).

After intracerebral hemorrhage, hemoglobin induces the expression of iNOS and participates in the course of brain edema.

To explore the effect of hesperetin (HES) on collagen expression in cardiac fibroblasts in vitro induced by angiotensin Ⅱ (AngⅡ).

Cell growth was determined by trypan blue staining, reactive oxygen species (ROS) generation by microplate reader, the expressions of collagen Ⅰ, Ⅲ and matrix metalloproteinase 1 (MMP-1) by real-time polymerase chain reaction (PCR) and cell proliferation by cell counting kit-8.

HES and AngⅡ+ HES had no effect on cellular activity.AngⅡ significantly increased ROS generation (1.70±0.12 vs 1, P<0.01), gene expression of collagen Ⅰ, Ⅲ both increased (1.31±0.08 vs 1, 1.40±0.09 vs 1, bothP<0.01) while MMP-1 decreased (0.68±0.03 vs 1,P<0.01). Ang Ⅱ also induced the proliferation of fibroblasts (1.91±0.18 vs 1,P<0.01). While HES (25, 50, 100 μmol/L) or NAC (1 mmol/L) reversed these effects during co-treating with AngⅡ, ROS decreased versus the Ang Ⅱ group(1.37±0.05, 1.16±0.08, 1.07±0.07, 1.12±0.07 vs 1.70±0.12, allP<0.01) , gene expression of collagenⅠ, Ⅲ also decreased (1.22±0.08 and 1.27±0.07, 1.14±0.07 and 1.00±0.06, 1.02±0.06 and 0.99±0.05, 1.08±0.07 and 1.09±0.06 vs 1.31±0.08 and 1.40±0.09, allP<0.01), MMP-1 increased (0.76±0.05, 0.88±0.07, 1.01±0.08, 0.96±0.07 vs 0.68±0.03,P<0.01) versus the Ang Ⅱ group. Cell proliferation was also inhibited (1.42±0.07, 1.38±0.03, 1.07±0.15, 1.16±0.11 vs 1.91±0.18, allP<0.01). NAC had the same effect with HES.

HES inhibits the synthesis of collagen and the Ang Ⅱ-induced proliferation of fibroblast through suppressing the ROS generation.

To explore the effects of cervical sympathetic block (CSB) on facial nerve regeneration in rats and seek the optimal timing of treatment.

A total of 72 adult Sprague-Dawley rats were divided randomly into 4 groups of sham-operation (sham), model control (NS), CSB1 and CSB2 (n=18 each). Except for sham group, the model of peripheral facial paralysis was established for three other groups.After treating facial nerves injury with CSB at different timepoints, the behavioral changes of rats were observed.Electroneurography (ENoG) of injured nerves was performed and the expressions of glial cell derived neurotrophic factor (GDNF) of facial nerve nucleus were detected at different stages.

The facial whisker movement function scores in sham, NS, CSB1 and CSB2 groups were 3.87±0.35, 0.50±0.52, 1.07±0.62 and 0.81±0.42 (F=2.934, P=0.035) at Day 7, 3.85±0.37, 0.91±0.52, 1.57±0.65 and 1.07±0.62 (F=2.537, P=0.038) at Day 14 and 3.85±0.37, 1.71±0.47, 3.00±0.68 and 2.36±0.49 (F=3.627, P=0.024) at Day 28.At Day 7, LatSD and AmpSD were not detected in NS, CSB1 and CSB2 groups.However, at Day 14, the values of LatSD were (1.26±0.19), (6.67±0.36), (4.67±0.36) and (6.17±0.36) ms, showing a significant difference (F=3.052, P=0.024) and AmpSD (6.42±1.93), (2.16±1.87), (4.16±1.80) and (3.66±1.40) mv, also a significance (F=3.634, P=0.021). And at Day 28, LatSD were (1.31±0.17), (3.17±0.19), (1.93±0.12) and (2.60±0.22) ms (F=2.729, P=0.032) and AmpSD (6.82±2.30), (4.72±5.23), (6.22±3.50) and (5.82±4.10) mv (F=3.827, P=0.019). The expression quantities of GDNF in 4 groups produced significant differences at Day 7 (4.67±0.81, 13.52±0.58, 26.17±1.01 and 14.86±1.03, F=3.637, P=0.028), Day 14 (5.67±0.57, 24.41±2.86, 26.52±1.36 and 25.48±1.42, F=2.946, P=0.031) and Day 28 (5.37±0.92, 26.64±1.68, 27.38±1.66 and 25.69±1.99, F=4.273, P=0.012).

During early stage of facial nerve injury, the treatment of CSB may increase the expression of GDNF of facial nerve nucleus at early stage and thus accelerate the recovery of facial nerve injury in rats.

High 3rd degree tracheal stenosis refers to tracheal stenosis within 5 cm below the glottis, and the degree of stenosis is between 71% and 99%. It is a rare critical disease in clinic, with high asphyxia and mortality^[1,2]。 The degree of tracheal stenosis in such patients is severe and the location is high. The conventional clinical treatment method is tracheal intubation under general anesthesia and tracheal resection at the stenosis site. However, due to the high degree of tracheal stenosis and stenosis in such patients, there is a risk of failure of tracheal intubation after general anesthesia, which in turn leads to asphyxia and death of the patient. In view of the treatment difficulties and bottlenecks of such patients, this study used regional nerve block (cervical plexus) combined with general anesthesia to treat high tracheal 3rd degree stenosis in two steps, which is reported below.

Juxta-articular myxoma (JAM) is a rare soft tissue tumor, which is generally myxoid, often accompanied by cystic changes and tendon sheath cyst-like changes, and is easily misdiagnosed. The data of 8 patients with JAM diagnosed and treated in Wuxi Second People's Hospital and Ningbo Clinical Pathology Diagnosis Center from January 2006 to August 2013 are reported below.

Glycemic control is at the heart of diabetes treatment. Some prospective studies have demonstrated that reducing glycosylated hemoglobin (HbA1c) can effectively reduce the risk of chronic complications of diabetes^[1]However, HbA1c only reflects mean blood glucose and does not describe the whole picture of blood glucose. Blood glucose fluctuations have attracted widespread attention in recent years and may be an independent risk factor for chronic complications of diabetes mellitus outside mean glucose^[2]。 glucose fluctuation is used to describe the unstable state of blood glucose between peaks and troughs. Related concepts include blood glucose variability (GV) and blood glucose stability (GS). The broad sense of blood glucose fluctuation includes not only the physiological variation of blood glucose in normal people, but also the pathological blood glucose fluctuation. The latter is usually referred to in the literature, and there is no unified standard to define it in the world. China Blood Glucose Monitoring Guidelines Based on the results of a multicenter study, the reference value for physiological blood glucose fluctuations in Chinese adults assessed using the ambulatory blood glucose monitoring system (CGMS) is recommended as the intraday mean blood glucose fluctuation amplitude (MAGE)<3.9 mmol/L and standard deviation (SD)<1.4 mmol/L^[3]。 A study published at the 2014 annual meeting of the American Diabetes Association (ADA) found that blood sugar fluctuations in prediabetes increased significantly, and recommended blood sugar fluctuation parameters as screening indicators in prediabetes; Patients with metabolic syndrome have increased blood glucose fluctuations compared with normal people. As impaired glucose regulation worsens, blood glucose fluctuations are also increasing progressively^[4]。 Abnormal blood glucose fluctuation may be related to chronic complications of diabetes, including acute blood glucose fluctuation and chronic blood glucose variation, which can be evaluated from the aspects of daytime blood glucose variation, intraday blood glucose variation, postprandial blood glucose spike, and long-term HbA1c variation^[5]。 Blood glucose fluctuation is a hot topic in the research field of blood glucose monitoring and control in diabetes, but there are many controversies. This article reviews the related research on the influence of abnormal blood glucose fluctuation on diabetes mellitus and chronic complications.

restless legs syndrome (RLS) is a common neurosensory motor disorder with an incidence rate of 5% ~10%. It is mainly manifested by leg discomfort and desire to move at night. Most patients have insomnia symptoms such as difficulty falling asleep and easy waking up^[1]。 RLS has a high incidence in patients with sleep apnea disorders, especially obstructive sleep apnea hypopnea syndrome (OSAHS)^[2]However, it is not clear whether there is a causal relationship between the two. Nonetheless, since RLS itself can disrupt the structure of sleep, causing impaired daytime function in patients; When RLS is present in patients with OSAHS, it must be treated accordingly. The related research on the relationship between RLS and OSAHS is summarized as follows.

In recent years, with the change of lifestyle, metabolism-related non-alcoholic fatty liver disease (NAFLD) is rapidly developing into the most common chronic liver disease worldwide, which seriously threatens human health. However, at present, the treatment of NAFLD is mainly based on lifestyle intervention, and there is no ideal specific therapeutic drug. Silencing information regulator 1 (SIRT1) is a protein deacetylase found in mammalian cells. Studies have found that it can improve NAFLD liver lesions by improving peripheral insulin resistance, regulating liver fat metabolism, improving oxidative stress and mitochondrial dysfunction, and reducing inflammatory response. It is expected to become a new target for the development of NAFLD therapeutic drugs. This article summarizes the research progress of SIRT1 in the field of NAFLD as follows.

A 47-year-old male was admitted to Xiaogan Central Hospital on April 6, 2014 after taking about 150 ml of blood without obvious trigger a month ago, with chest tightness and discomfort accompanied by cough. Smoked for many years. Physical examination on admission: there was no swelling of supraclavicular lymph nodes, no deformity of thorax, clear breathing sounds in both lungs, and no dry or wet rales were heard; CT examination of the chest showed a mass shadow in the left lower lobe, with the largest transverse diameter of about 6.5 cm ×7.8 cm, lobulation at the edge, calcification inside, no enlarged lymph nodes in the mediastinum, and no abnormalities in bilateral thoracic cavities. CT-guided lung biopsy showed pulmonary salivary gland carcinoma. Left lower lobectomy plus mediastinal lymph node dissection was performed on 11 April under general anesthesia. The resected specimen was 12 cm ×10 cm ×10 cm, and a solid nodular mass with a diameter of 6.5 cm was seen on the section, which was lobulated, gray-white with gray-yellow, and medium. Under HE microscope, the tumor showed expansive growth, without clear envelope, and was located under bronchial mucosa and cartilage (FIG. 1A), partial area recidivism surrounding lung tissue; Tumor cells are mainly composed of spindle cells and round or oval cells with translucent cytoplasm. The nucleus is moderately abnormal, the nucleolus is not obvious, and the spindle cells are arranged in bundles (FIG. 1B)； It mainly forms solid, sheet-like structures, and collagen-rich fibrous stroma in some areas divides the tumor into small nest-like or beam-like structures (Figure 1C)； Squamous epithelial metaplasia can be seen to form keratinized bead structure with calcification, and coagulative necrosis can be seen in 10% of tumor areas; Mitotic images are rare (1/10 high power fields). Immunohistochemistry showed that broad-spectrum CK, Vimentin, P63, S-100, SMA, Calponin, GFAP, CK5/6 and Actin were all positive; About 5% positive for Ki-67; TTF-1, CD10, CK7, HMB45, CD56, Syn, CgA and EMA were all negative. Pathological diagnosis: (Left lower lung) myoepithelial carcinoma with no lymph node metastasis (0/18). No other special treatment was given postoperatively, and the patient was followed up for 2 months. The patient was in good condition.

Case 1, female, 75 years old. He was admitted to the hospital on August 13, 2009 because his right kidney was found to occupy space for 2 days. The patient had no low back pain, no frequent urination, urgency, painful urination and obvious macroscopic hematuria, and no positive findings in physical examination; There were no obvious abnormalities in blood routine, urine routine and blood biochemistry, and the erythrocyte sedimentation rate was: 13 mm/1 h; CT showed a type of round low-density shadow at the lower pole of the right kidney, about 45 mm ×40 mm in size. After enhancement, there was no obvious enhancement in the arterial phase and a little enhancement in the venous phase, and there was no obvious blood supply vessel shadow in it. The diagnosis was that the right kidney occupied space, and renal cancer was considered. Retrolaparoscopic radical resection of right kidney tumor under general anesthesia. During the operation, the tumor was located at the lower pole of the right kidney, slightly protruding from the surface of the kidney, with a size of about 5 cm ×4 cm ×3 cm. The capsule was still intact, in the middle of the mass, and slightly adhered to the surrounding tissues. Macroscopically, the tumor was seen as a mass at the inferior pole of the kidney, 4.5 cm ×4.0 cm ×3.0 cm in size. The section of the mass was gray-yellow-gray-white, solid and medium, close to the renal capsule and renal pelvis; Pathological examination showed that parallel and tightly arranged tubule-like spindle cells were seen in the tumor, and the cells had mild atypia; Immunohistochemistry: Cancer cells expressed CD10 negative (–), vimentin positive (+), E – cadherin (+), kidney-specific cadherin (KSP – cadherin) (–), epithelial cell membrane antigen (EMA) (+), keratin (CK) 7 focal (+), α – formyl-CoA racemase (P504S) (+), tumor proliferation antigen (Ki – 67) approximately 8% (+), CD117 (–), P53 (+). Pathological diagnosis: mucinous tubular and spindle cell carcinoma of the kidney (MTSCC). The patient was followed up for 57 months and survived well.