Volume 94  ·   Issue 40  ·  2014

Endoscopic papillary sphincterotomy (EST) has been safe and mature after nearly 40 years of clinical application and development. It is the standard endoscopic treatment for common bile duct stones, biliary pancreatitis and papillary sphincter dysfunction. The early postoperative complications caused by partial or total incision of Oddi sphincter (SO) by EST mainly include acute pancreatitis, hemorrhage, biliary infection, cholecystitis and perforation, etc. The overall incidence rate is 3.4% ~8.3%, and the mortality rate is 0.2% ~0.6%. Complications after EST can be divided into early (≤30 d after EST) and long-term complications (>30 d after EST)^[1]。 EST-related early complications often appear within 24 hours after surgery, which is closely related to EST operation itself, and its prevention and treatment is often the focus of academic attention^[2]。 However, the long-term complications after EST lithotomy for choledocholithiasis are not very clear. This paper discusses the relationship between EST calculus removal and long-term recurrence of bile duct calculi, cholangitis, cholecystitis, liver abscess, pancreatitis, biliary restenosis and biliary malignant tumor.

Haplotype donor stem cell transplantation (haplo-SCT) and umbilical cord blood transplantation (CBT) have developed rapidly in recent years due to the easy availability of donors, and have gradually become the main alternative donors. haplo-SCT has a good graft-versus-leukemia (GVL) effect, but a high incidence of graft-versus-host disease (GVHD) and non-recurrent mortality (NRM) are always constraints. Cord blood transplantation can reduce the occurrence of GVHD while preserving the effect of GVL, but its longer period of bone marrow emptiness and high risk of implantation failure can lead to prolonged hospital stay and increased risk of infection. With the deepening of the understanding of the two in recent years, the transplantation community has started a new exploration, combining the two to achieve complementary advantages, and initially achieved satisfactory curative effects. Foreign countries call it third party donor (TPD) combined hematopoietic stem cell infusion or dual transplant, which means that the hematopoietic stem cells in the same transplant come from two different types of donors, thus differing conceptually from mixed transplantation from the same donor and different graft types (such as bone marrow combined with peripheral blood stem cells) and double stem cell transplantation from the same type and different donors (such as double cord blood transplantation).

Medical litigation is the last and most advantageous barrier to solve medical disputes at present. However, due to the asymmetry of information between doctors and patients, the loopholes of appraisal system, the lack of medical knowledge of judges, the interference of external factors, etc., medical litigation encounters obstacles in its operation. In view of this problem, scholars propose that the expert assistant system can make up for the deficiency of appraisal and speed up the process of medical litigation. This paper analyzes and discusses the implementation status and existing problems of the expert assistant system, in order to enhance the theoretical basis and practical function of the system in medical litigation.

Human embryonic stem cells (ESCs) are a class of highly undifferentiated stem cells isolated from intracellular masses of human embryos at the blastocyst stage, which have self-renewal stability in vitro and maintain normal karyotype and developmental pluripotency, and even participate in the whole ontogeny^[1]。 Using human ESC or human cells, tissues or organs differentiated from it to test the toxicological characteristics or efficacy of various biomedical materials, foods and drugs on human body can better reflect the real condition of human body than using animal or immortalized cells. Therefore, human ESC and its differentiated cells are expected to develop into a novel biosafety assay and drug screening model^[2]。 At present, most studies still use immortalized cell lines or primary cultured cells to evaluate the safety of biological materials^[3,4]There are disadvantages such as abnormal karyotype or large batch differences, respectively. Human ESC-derived fibroblasts (ES-F) have the advantages of stable source, normal karyotype and easy standardization^[5,6]It is expected to become a new model of biosafety evaluation system^[7]。 Standardizing the method of human ESC differentiation into fibroblasts is the key to ensure the reliability of biosafety testing and evaluation models. Therefore, after repeated discussions, the experts of the project team of the key international scientific and technological cooperation project "Creating a new predictive health and safety system based on human embryonic stem cells" of the Ministry of Science and Technology formulated the "Expert Consensus on Differentiation Methods of Human Embryonic Stem Cells to Fibroblasts" (hereinafter referred to as "Consensus"), aiming at standardizing the differentiation method of human ES-F, improving the purity of human ES-F, ensuring the repeatability of the differentiation method, and making it more systematic, standardized and effective in clinical and biosafety evaluation systems.

To explore the therapeutic efficacy of allo-geneic hematopoietic stem cell transplantation (allo-HSCT) for chronic myelogenous leukemia (CML) patients with T315I mutation.

Retrospective analyses were conducted for 4 patients with T315I mutation of CML undergoing allo-HSCT from June 2012 to January 2014, including 2 cases in acceleration phase and 2 in chronic phase. There were 2 males and 2 females with ages from 26 to 45 years. Two patients received HLA-matched sibling allo-geneic peripheral blood stem cell transplantation (allo-PBSCT) while another 2 unrelated cord blood stem cell transplantation (UCBT). No splenomegaly was found before transplantation. One case had F317L mutation. All of them were treated with imatinib before transplantation. And the time from medication to T315I mutation was 20-35 months. All of them were conditioned with myeloablative regimen and received a combination of cyclosporine A (CsA) and mycophenolate mofetil (MMF) for preventing graft-versus-host disease (GVHD).

Myeloid implantation was achieved in all of them. The time of absolute neutrophil count (ANC) ≥0.5×10⁹/L were 10-28 days. One patient whose platelet was not implanted died from severe pulmonary infection at Day 88 post-transplantation. For 3 patients, platelet ≥ 20×10⁹/L were 15-33 days. But the marrow short tandem repeat (STR)-PCR was 100% donor type at the time of 30 days post-transplantation in all patients. One case of UCBT developed pre-implantation immune response syndrome (PES) and one acute GVHD of gradeⅠ at Day 12 after allo-PBSCT. However both were controlled after treatment with methylprednisolone. And 1/3 evaluatable patients developed chronic GVHD. BCR/ABL transcript was detected by qualitative PCR after transplantation. And all BCR/ABL fusion genes turned negative after 30 days of transplantation. Up to the follow-up endpoint, there was no relapse except for one mortality. And the time of disease-free survival was 133, 248 and 704 days respectively.

Allo-HSCT is currently the optimal treatment for T315I mutation of CML. And umbilical cord blood isan ideal donor for those patients without HLA-matched sibling donor.

To analyze the cytomegalovirus (CMV) infection status and the risk factors in patients with long-term survival after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

159 long-term survivors receive allo-HSCT from January 2008 through December 2011 in the Bone Marrow Transplantation Center of Zhejiang University were included, CMV-pp65 antigen in peripheral blood leukocytes was detected by immunofluorescence assay at regular intervals, to retrospectively analyzed the clinical data. Ganciclovir or foscarnet was used for prevent and curative therapy.

A total of 159 patients with long-term survival at 18-66 months after allo-HSCT were investigated. And 8 047 specimens were detected, including 2 553 positive samples. All patients were at least one time positive for CMV-pp65 antigen after allo-HSCT. The CMV antigen positive rate increased gradually from 100 days after transplantation to within 100 days until 1 year while the positive rate decreased, after 1 year. The difference was statistically significant (all P<0.01). The CMV antigen positive rate in patients after non-myeloablative allo-HSCT (NST) and those after myeloablative allo-HSCT were 167/608(27.5%) and 2 386/7 439(32.1%) respectively. The difference was statistically significant (P=0.019). No statistically significant difference existed between those with acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD) (both P>0.05). The CMV antigen positive rate in patients with Ⅰ-Ⅱgrade aGVHD and those with Ⅲ-Ⅳ grade aGVHD were 1 017/3 284(31.0%) and 227/641(35.4%) respectively. And it had statistically significant difference (P=0.027). The CMV antigen positive rate in patients none-used of ATG and those used of ATG were 1 255/3 755 (33.4%) and 1 298/4 292 (30.2%) respectively. And it had statistically significant difference (P=0.002). By Logistic multivariate analysis, the none-use of ATG and Ⅲ-Ⅳ grade aGVHD were the risk factors for CMV antigen positive after allo-HSCT (OR=1.174, 95%CI: 1.068-1.290, P=0.001; OR=1.174, 95%CI: 0.681-0.958, P=0.014).

Regular monitoring of CMV-pp65 antigen after allo-HSCT is quite necessary for prevent and treat CMV infection in a timely manner. The CMV infection in long-term survival patients may be related to the selection of conditioning regimen, it has no obvious correlation with the incidence of GVHD, but it isassociated with the severity of aGVHD.

To evaluate the efficacies of hematopoietic stem cell transplantation (HSCT) for severe aplastic anemia (SAA).

A total of 43 SAA patients (SAA-Ⅰ, n=29; SAA-Ⅱ, n=14) underwent HSCT from 2002 January to 2013 December. There were 22 males and 21 females with a median age of 31 (12-49) years. And 35 patients received HLA-matched sibling HSCT (Sib-HSCT) while another 8 had unrelated donor HSCT (UD-HSCT). The hematopoietic stem cells were collected from bone marrow (n=10), peripheral blood (n=23) and bone marrow & peripheral blood ( n=10). Conditioning regimens were mostly composed of Fludarabine, antihuman thymocyte gloBulin and cyclophosphamide. Cyclosporine and methotrexate (including mycophenolate mofetil for UD) were offered for preventing graft-versus-host disease (GVHD). The median counts of mononuclear cell and CD34⁺ stem cell were 8.1(2.4-13.5)×10⁸/kg and 3.7(2.3-14.7)×10⁶/kg respectively.

Hematopoiesis reconstitution was achieved in 42 patients. The median periods for neutrophils to 0.5×10⁹/L and platelets to 20×10⁹/L were + 10 (+ 8-+ 25) days and + 14 (+ 8-+ 80) days respectively. The median of survival time was not reached. Overall survival (OS) and failure-free survival (FFS) at 5 years had no differences between UD-HSCT and Sib-HSCT groups (OS: 87.6% vs 84.5%, P=0.87; FFS: 86.2% vs 79.5%, P=0.64). The same results also were seen between age ≤ 20 group and > 20 group (OS: 92.0% vs 82.5%, P=0.39; FFS: 91.0% vs 77.3%, P=0.38). The median follow-up time was 17.0(0.4-140.0)months.And 8/43 patients died from thrombotic microangiopathy (TMA) (n=1), TMA associated with capillary leak syndrome (n=1), pulmonary infection (n=3), acute GVHD of grade Ⅳ (n=1) and unknown causes (n=2).

Sib-HSCT is preferred for SAA patients under 40 years. Searching of HLA-matched unrelated donorshould be performed soon after diagnosis if HLA-matched sibling is unavailable.

To evaluate the impact of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) co-activation on the prognosis of allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients.

We retrospectively analyzed 330 consecutive allo-HSCT patients at First Affiliated Hospital of Soochow University from December 2011 to August 2013. CMV and EBV DNA were regularly monitored by quantitative polymerase chain reaction (PCR) from the engraftment of granuloCyte within one year after transplantation. The incidences of viremia and clinical outcomes were analyzed by χ ² test and Kaplan-Meier analysis.

After a median follow-up period of 16 (7-25) months, a total of 113(34.2%)patients were identified with CMV viremia (CMV+ ) alone, 82(24.8%)with EBV viremia (EBV+ ) alone and 32(9.7%)with CMV and EBV co-activation (CMV/EBV+ ). The proportion of patients undergoing HLA mismatched transplantation and ones with acute graft-versus-host disease (aGVHD) in CMV/EBV+ group was significantly higher than CMV+ group or EBV+ group(78.1%(25/32) vs 58.5%(48/82)or 50.4%(57/113), P=0.047, 0.008; 56.3%(18/32)vs 32.9%(27/82)or 34.5%(39/113), P=0.022, 0.026). The incidence of post-transplant lymphoproliferative disorder (PTLD) was similar to EBV+ group (12.5%(4/32) vs 11.0%(9/82), P=0.802) and so did the incidence of CMV disease when compared with CMV+ group (9.4%(3/32) vs 7.1%(8/113), P=0.665). The 2-year overall survival (OS) of CMV+ , EBV+ and CMV/EBV+ groups was 68.7%, 61.5% and 62.4% respectively. And no significant difference existed between CMV/EBV+ and the other two groups (P=0.598, 0.717). However, the 6-month non-relapse mortality (NRM) of CMV/EBV+ group was significantly higher than that of CMV+ or EBV+ group (18.7% vs 8.9%, P=0.036; 18.7% vs 8.1%, P=0.032).

HLA mismatch transplants and aGVHD are frequent in CMV and EBV co-activation group. When compared with EBV+ or CMV+ patients, the CMV/EBV+ patients have similar incidence of PTLD or CMV disease and 2-year OS.However, the 6-month NRM is significantly higher in CMV/EBV+ group. It suggests that CMV andEBV co-activation is a risk factor for early mortality of allo-HSCT patients.

To explore the antitumor effects of DDP-PLLA-CNTs on human cholangiocarcinoma cell line.

DDP-PLLA-CNTs were prepared with the method of ultrasound emulsification.The morphology of DDP-PLLA-CNTs was determined by scanning electron microscope (SEM). And its drug loading and drug release curve in vitro was detected by UV-Vis-NIR spectrophotometer.CCK8 was used to test the cytotoxic effects of DDP-PLLA-CNTs at different concentrations on QBC939 cell proliferation.Flow cytometry was employed to measure the changes of apoptotic rate.

With excellent controlled-release characteristic of in vitro drug release, DDP-PLLA-CNTs inhibited the proliferation and significantly increased the apoptotic rate of QBC939 cell line.

DDP-PLLA-CNTs have drug sustained-release characteristics and can significantly inhibit theproliferation of QBC939 cell line.

To summarize the clinical features and diagnostic and therapeutic experiences of unexpected gallbladder carcinoma (UGC) during or after laparoscopic cholecystectomy (LC) to boost radical resection rate and long-term efficacy.

The clinical data of 64 UGC patients undergoing LC were retrospectively analyzed.

The procedures included LC (n=28) and LC plus radical resection (n=36). The follow-up period was 2-132 months.The inter-group differences were statistically significant in post-operative survival rate (35 vs 46 months, P<0.05). According to the TNM staging system, the post-operative survival rate between two groups for pTis+ pT1a grade was not statistically significant (84 vs 132 months,P>0.05). However the differences for pT1b, pT2 and pT3 grades were statistically significant (43 vs 86 months; 31 vs 52 months; 18 vs 36 months,P<0.05).

Identification of high-risk factors and intraoperative rapid pathologic examination improve radical resection rate.Radical cure via LC may be achieved for pTis and pT1a stages of UGC.For pT1b stage of UGC, optimal surgical procedures need further explorations.For stages pT2 and pT3 of UGC, radicalsurgery should be added for improved long-term efficacies.

To explore the concentration differences of eight conjugated bile acids between patients of cholesterol polyps and adenomatous polyps and determine the differential diagnosis markers for polypoid lesions of gallbladder (PLG).

During the period of March 2013 to November, 18 cholesterol polyps patients, 9 adenomatous polyps ones and 20 simple gallstone disease ones were enrolled.High performance liquid chromatography with ultraviolet detection was used to test 8 conjugated bile acids in sera.

A total of 8 conjugated bile acids were completely dissociated within 10 minutes and the assay was liner in the range of 3.91 to 500.00 mg/L.The correlation coefficients for linear regression were from 0.995 to 0.999 and the detection limits ranged from 3.91 to 7.81 mg/L.The serum level of glycocholic acid (GCA) in adenomatous polyps group (3.48±1.66) mg/L was significantly higher than that in cholesterol polyps group ((2.16±0.71) mg/L, q=5.182, P=0.001) and control group ((2.15±0.45) mg/L, q=5.313, P=0.001). The serum level of glycochenodeoxycholic acid (GCDCA) in adenomatous polyps group (12.67±1.74) mg/L was significantly higher than that in cholesterol polyps group ((10.53±3.04) mg/L, q=3.253, P=0.026) and control group ((10.72±1.58) mg/L, q=3.015, P=0.038). The serum level of taurochenodeoxycholic acid (TCDCA) in adenomatous polyps group ((6.79±2.90) mg/L) was significantly higher than that in cholesterol polyps group ((4.47±2.35) mg/L, q=3.412, P=0.020) and control group ((4.72±2.11) mg/L q=3.091, P=0.034).

The serum levels of GCA, GCDCA and TCDCA in adenomatous polyps patients are higher than those incholesterol polyps counterparts. And these markers may aid the differential diagnosis of PLG.

To explore the thyroid function distribution of different trimesters among normal pregnant women and establish the reference interval for maternal thyroid function during pregnancy in Shenzhen, China.

A prospective study was conducted for healthy pregnant women in first trimester (n=334), second trimester (n=272), third trimester (n=271) and non-pregnant controls (n=77) from December 2012 to June 2013 at our hospital. Free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), triiodothyronine (TT3) and thyroxine (T4) of four groups were measured and analyzed. And the reference intervals for different trimesters were established.

TSH declined in the first trimester and then rose in the second trimester. The reference ranges of TSH for early, middle and late pregnancy were 0.08-4.39, 0.41-4.16 and 0.30-5.46 mIU/L respectively. FT4 and healthy control groups showed no significant difference in the first trimester. But it declined in the second trimester. The reference ranges of FT4 for early, middle and late pregnancy were 7.74-14.58, 6.81-12.00 and 6.36-10.99 pmol/L respectively. FT3 rose slightly in the first trimester and then gradually decreased. The reference ranges of FT3 for early, middle and late pregnancy were 3.59-5.59, 3.34-4.91 and 3.09-4.58 pmol/L respectively.

As compared with healthy control women in Shenzhen, thyroid function indicators of pregnant women show statistically significant differences. And the establishment of indicators of women's thyroidfunction reference intervals for different trimesters has important clinical significance in Shenzhen.

To explore the clinical characteristics and systemic manifestations of sarcoidosis with ocular involvement.

The clinical data of 19 cases of sarcoidosis with ocular involvement confirmed by pathology at Beijing Tongren Hospital from March 2004 to February 2014 were analyzed retrospectively. The ocular manifestations, chest imaging findings, laboratory tests and pathological diagnosis were reviewed. And the clinical features of sarcoidosis with ocular involvement were summarized.

Among them, there were 6 males and 13 females with an average age of (47±14) (16-76) years. The ocular symptoms were the initial presenting manifestations of sarcoidosis in 12 cases while 2 cases presented ocular symptoms during the course of disease. And aother 5 cases without ocular symptoms were confirmed to have ocular involvement by eye examination. The main manifestations of ocular sarcoidosis were uveitis (n=16), chorioretinitis (n=3), retinal vasculitis (n=2), optic neuritis (n=1) and orbital mass (n=3). The key feature of sarcoidosis was bilateral hilar lymphadenopathy (BHL) (14/16) on chest film. The diagnosis in 17 cases was confirmed by biopsy of extra-ocular organs. The positive diagnostic rate of bronchial biopsy was 8/9.

Ocular involvement in sarcoidosis is relatively common due to a variety of ocular manifestations and serious vision impairment in some patients. Ophthalmologic examination is essential in the clinical management of sarcoidosis. Chest imaging and bronchial biopsy are important for the diagnosis ofsarcoidosis with initial ocular manifestations.

To evaluate the ability of pre-anesthesia pleth variability index (PVI) in supine and passive head raising (PHR) position at 30° for predicting hypotension during induction of anesthesia.

From September 2012 to October 2013, 106 patients scheduled for elective surgery under general anesthesia at Third Hangzhou Municipal Hospital with American Society of Anesthesiologists Ⅰ-Ⅱ were recruited. Pre-anesthesia values of blood pressure, heart rate, perfusion index, PVI in supine position and PHR at 30° were recorded. The minimum arterial blood pressure and minimum heart rate during anesthesia induction were recorded.

Blood pressure and heart rate significantly decreased after induction. And the decline ratio of diastolic arterial blood pressure and mean arterial blood pressure were moderately correlated with pre-anesthesia PVI at 30° PHR position with Pearson's coefficients of 0.492 and 0.463 respectively. The receiver-operating characteristic curve demonstrated that pre-anesthesia PVI in PHR at 30° position could predict hypotension during induction with a sensitivity of 67% and a specificity of 62% whereas pre-anesthesia PVI in supine position was non-reliable in predicting hypotension.

Pre-anesthesia PVI in PHR at 30° position may predict hypotension during induction with an acceptable accuracy. And this procedure is probably helpful for assessing high-risk patientssusceptible to severe hypotension during induction.

To explore the effects of extracellular signal-regulated protein kinase 5 signaling pathway in chronic constriction injury (CCI)-induced neuropathic pain above spinal cord level.

The CCI model of neuropathic pain was established. Intracerebroventricular injection of antisense oligonucleotides and immunohistochemical labeling technique were employed. And the heat and mechanical hyperalgesia responses were used to examine the affect of ERK5 in CCI-induced neuropathic pain and the expression of p-CREB (cAMP response-element binding protein) in spinal cord.

The mechanical paw withdrawal reflex threshold and thermal reflex latency became significantly lower in CCI-induced mice. Compared with saline group, mechanical and thermal hyperalgesia significantly decreased and the expression of p-CREB protein decreased at spinal cord in oligonucleotide group.

The ERK5 spinal cord neurons are involved in the regulation of CCI-induced neuropathic pain in mice.And this effect is achieved by adjusting the CREB-dependent gene expression.

To evaluate protective effects of inhaled hydrogen gas (H₂) on cognitive function in a murine model of sepsis-associated encephalopathy (SAE).

A total of 84 male ICR mice, weighing 20-25 g, aged 6-8 weeks, were randomly divided into 4 groups of sham, sham+ H₂, sepsis and sepsis+ H₂. Sepsis was established by cecal ligation and puncture (CLP). Mice in sham+ H₂ and sepsis+ H₂ groups received 2% H₂ inhalation for 1 h at 1 h and 6 h after sham operation or CLP operation respectively. The changes of neurological function and neuronal damage in hippocampal CA1 region were observed at 24 h post-operation. The activities of superoxide dismutase (SOD) and catalase (CAT) and the levels of malondialdehyde (MDA) and 8-iso-prostaglandin F_2α (8-iso-PGF_2α) in sera and hippocampus were detected at 24 h post-operation. The changes of cognitive function were observed by Y-maze test and fear conditional test at days 3 to 14 post-operation.

Compared with sham group, the neurological function significantly declined and neurons in hippocampal CA1 region were significantly damaged; the activities of SOD and CAT markedly decreased while the levels of MDA and 8-iso-PGF_2α markedly increased in sera and hippocampus; the time in new zone and the percentage of freezing time dramatically decreased at days 3 to 14 post-operation in sepsis group(P<0.05). Compared with sepsis group, neurological function significantly improved and damaged neurons in hippocampal CA1 region significantly reduced; the activities of SOD and CAT markedly increased and the levels of MDA and 8-iso-PGF_2α markedly decreased in sera and hippocampus; the time in new zone and the percentage of freezing time dramatically increased at days 3 to 14 post-operations in sepsis+ H₂ group (P<0.05).

H₂ inhalation can significantly alleviate neuronal damage and improve cognitive dysfunction in CLP-induced SAE mice. And it is probably associated with the increased activities of antioxidantenzymes and the reduced levels of oxidative products.

A 71-year-old male was admitted to the hospital on February 8, 2012 due to "poor appetite for more than 2 months". The patient went to the local hospital on February 1, 2012 for "poor appetite". Gastroscopy revealed: malignant tumor of gastric fundus? See also duodenal bulb ulcer. Pathology: gastric body adenocarcinoma; Chronic inflammation of the duodenal mucosa. For further treatment, he was transferred to our hospital. There was no obvious abnormality in physical examination at admission, and the morphology of peripheral blood cells was in the normal range. Blood routine: red blood cells: 4.0×10¹²/L, total number of white blood cells: 7.1×10⁹/L, neutrophils: 3.7×10⁹/L, monocytes 1.2×10⁹/L, lymphocytes 2×10⁹/L, eosinophils 0.2×10⁹/L. Reexamination of gastroscopy: a mass was seen in the duodenal bulb (Figure 1), and ulcers were also seen at the base of the stomach (Figure 2), the mucosa is congested and edematous, brittle and easy to bleed, and the possibility of malignant tumor is considered. Pathology: A large number of naive atypical mononuclear-like cells infiltrated in the superficial mucosa (duodenal bulb), small to medium in size, slightly polygonal, with round or elliptical nucleus and kidney-shaped nucleus, thick nuclear membrane, delicate chromatin, and some nucleolus and nuclear abnormality. A small number of immature eosinophils are scattered between tumor cells. Atypical cell infiltration was observed in the local area of the stomach fundus, and its morphology was similar to that of the abnormal cells in the duodenal bulb biopsy specimens (Figure 3)。 Immunophenotype: Myeloperoxidase (MPO) + + + (Figure 4), CD45 positive; CD138, CD20, CD3, CD79a, CK, κ and λ were all negative. Pathological diagnosis: Granulocytic sarcoma of the fundus of stomach and duodenal bulb. There was no obvious abnormality in blood and bone marrow routine, and the clinical diagnosis was primary solitary granulocytic sarcoma (GS) of fundus and duodenal bulb.

Patients with neurodegenerative diseases often experience various sleep disorders, including insomnia, rapid eye movement sleep behavior disorder (RBD), obstructive sleep apnea syndrome (OSAS), excessive daytime drowsiness, sleep-wake rhythm disorder (CRSD), periodic leg movements, restless leg syndrome, sleep breathing disorder, etc.^[1,2]。 Studies have shown that in neurodegenerative diseases such as Parkinson's disease, Lewy body dementia, and multiple system atrophy, alpha-synuclein abnormally accumulates in neurons and glial cells^[3]However, Alzheimer's disease, frontotemporal dementia, Pick's disease, progressive supranuclear palsy and other neurodegenerative diseases have abnormal tau protein accumulation in nerve cell bodies and dendrites^[4]。 Possible association between sleep apnea and Alzheimer's disease^[5], good sleep quality can attenuate the pathological progression of ApoE4 gene on neuronal fibrous tangles, thus affecting the cognitive function of patients with Alzheimer's disease^[6]。 The treatment of sleep disorders in patients with neurodegenerative diseases is also relatively complex. The mechanism and drug treatment of sleep disorders in neurodegenerative diseases are summarized as follows.

A 37-year-old male, Han nationality, driver, was admitted to hospital for "snoring, extreme sleepiness during the day for more than 1 year, accompanied by waking up during night sleep, and unable to recall for more than 1 month afterwards". Two years ago, the patient had daytime drowsiness, obvious snoring at night, breathing often stopped briefly, and talked in his sleep; But I can work normally during the day. Once in the daytime driving, due to sleepiness accident, did not pay attention to it. Six months ago, his wife found that the patient suddenly got up and walked in the house at night, moving chairs, flowerpots, combing his hair, and scolding the child while slapping the carpet. At that time, the child was not at home, and ten minutes later, he went back to bed to continue sleeping. When he was awakened by his wife, his expression was blank, and he couldn't recall what had just happened. Similar situations occurred almost every night. Zeng suddenly got up in his sleep at night, removed the desk lamp at home, and installed it completely. The whole process lasted for nearly 1 hour. At that time, I could answer my wife's questions simply, and I couldn't recall what happened at night when I got up in the morning. The patient came to see a doctor because he often had 3 to 4 similar manifestations and difficulty in falling asleep after sleeping at night recently. No previous history of epilepsy, brain trauma, and taking sedative and hypnotic drugs. Five years ago, I often drank liquor with friends, up to 100 ml/time. Because of obvious snoring at night after drinking, I have stopped drinking for nearly 2 years. Family history is not special.

A 44-year-old female went to our department in June 2013 due to low white blood cells, red blood cells and platelets caused by partially differentiated acute myeloid leukemia (AML-M2). After consultation with hematology experts in Beijing People's Hospital, she was given mitoxantrone combined with cytarabine on June 5, 2013. During chemotherapy, chemotherapy was stopped due to low hemoglobin and platelets. He died on 25 Aug 2013 due to a severe infection with low leukocytosis.

From August 8 to 10, 2014, Guangzhou welcomed the 9th National Clinical Forum on the Diagnosis and Treatment of Helicobacter Pylori and Digestive Diseases. This forum was hosted by Beijing Branch of Chinese Medical Association and China Helicobacter Pylori Information Center, and co-organized by Peking University First Hospital and Chinese Medical Journal. The conference welcomed more than 600 delegates from all over the country, including more than 100 VIP experts. There are also experts from Portugal and Japan involved in cutting-edge academic exchanges. At the opening ceremony, Professor Hu Fulian, the chairman of the conference, pointed out in his speech: The focus of this forum exchange is to summarize the results and expand the research field of Helicobacter pylori (especially in traditional Chinese medicine and microecology). The rapidly developing website of China Helicobacter pylori Information Center is the further expansion and extension of the forum in time and space. Professor Liu Xinmin, Secretary of the Party Committee of Peking University First Hospital, Professor Ke Yang, Executive Vice President of Peking University, and Professor Jin Dapeng, President of Beijing Medical Association, respectively gave important instructions and speeches to the conference, fully affirming the important role of the conference in promoting the research of Helicobacter pylori in China.