Volume 94  ·   Issue 46  ·  2014

With the continuous improvement of people's living standards, the incidence of arteriosclerosis obliterans is getting higher and higher. Lower extremity arteriosclerosis obliterans mainly occur in femoropopliteal artery and inferior genicular artery. Previous studies of our research group have shown that arteriosclerosis obliterans without diabetes mainly occur in the superficial femoral artery and its proximate arteries, while arteriosclerosis obliterans of lower limbs in diabetic patients mainly occur in the superficial femoral artery and its distant arteries; Inferior genicular artery lesions first involve the anterior tibial artery, followed by the posterior tibial artery, and finally the peroneal artery^[1,2]。 This is slightly different from foreign sources^[3,4]Foreign studies have shown that the inferior genicular artery first involves the posterior tibial artery, followed by the anterior tibial artery, and finally the peroneal artery.

According to statistics, the prevalence of constipation in adults in China is 3% ~17%^[1]The prevalence of chronic constipation is 4% ~6%^[1,2,3,4]。 The Guidelines for Diagnosis and Treatment of Chronic Constipation were formulated at the National Constipation Symposium in Nanchang in 2003, and revised twice in 2007 and 2013^[5]。 Because of the special physiological structure of pregnant women and gynecological patients, the prevalence of constipation is higher than that of the general population. The prevalence of constipation in pregnant women reported abroad ranged from 11% to 38% and varied with different stages of pregnancy^[6,7,8,9]。

To explore the tolerability and safety of sorafenib for patients with advanced renal cell carcinoma.

Among 63 cases of advanced renal cell carcinoma, there were 45 males and 18 females with a median age of 57 years. And 48 patients had recurrence or metastasis after nephrectomy. And cytokine therapy was offered for 36 of them before recurrence or metastasis. Postoperative recurrence or metastasis occurred <1 year ( n=11) and ≥1 year (n=37). And 15 cases of primary non-resectable renal lesions received biopsy. The pathological types were clear cell carcinoma (n=49) and papillary carcinoma (n=14). The pre-dosing Karnofsky performance scores were all ≥ 70 points. Sorafenib was used as a first-line single drug at 400 mg twice daily until disease progression or an onset of intolerable adverse reactions.

Follow-ups ended in February 2013. The median follow-up period was 20 (6-42) months. Twenty-four patients died. The outcomes were complete remission (n=2), partial remission (n=8), stable disease (n=30) and disease progression (n=23). The overall objective response rate was 15.9%(10/63)and disease control rate 63.5%(40/63). Hand-foot skin reaction (70.0%), alopecia (62.5%), rash (52.5%), diarrhea (37.5%), loss of appetite (32.5%) and fatigue (27.5%) were noted. Most adverse reactions occurred at 2-4 weeks and subsided after symptomatic measures. And medication was not disrupted.

Sorafenib has a high disease control rate for advanced renal cell carcinoma. And its adverse reactions are generally mild and similar to those reported in the literature. It has excellent profiles of tolerability and safety.

To summarize the experiences of resecting cardiac muscularis propria benign tumors though esophageal submucosal tunnel and examine the occurrence rate of complications.

A total of 17 cases of cardiac muscularis propria benign tumor as diagnosed by endoscopy and endoscopic ultrasonography underwent endoscopic submucosal tunnel dissection from January 2012 to October 2013. And the appearances of lesions and the operative complications were recorded and analyzed.

All lesions were successfully resected with a mean diameter of 1.6 (0.8-3.5) cm. There was no recurrence. The mean operative duration was 43 (26-105) min. The appearances of lesions were regular (n=5) and irregular (n=12). There was no instance of severe bleeding or perforation. Resection of muscularis propria was performed for 3 cases. The complications included pneumoderm (n=3) and pneumoperitoneum (n=3). All the above cases were discharged after conservative treatment.

Endoscopic submucosal tunnel dissection is safe, reliable, convenient and fast for cardiac muscularis propria tumors method.

To explore the relationship between vascular endothelial growth factor (VEGF) and the onset of psoriasis.

The intensity and site expression of VEGF in 34 psoriatic lesions and skin samples of 21 normal controls were observed by immunohistochemistory from December 2011 to May 2013. And the serum levels of VEGF in 70 psoriasis vulgaris and 39 normal controls were measured by enzyme-linked immunosorbent assay (ELISA).

The expression of VEGF in psoriatic lesions was much higher than that in normal controls(χ²=13.34, P<0.01). The serum level of VEGF in psoriasis vulgaris was higher than that in normal controls ((501±13)vs(413±5)ng/L,t=2.32, P<0.01). The serum level of VEGF in psoriasis vulgaris with PASI score >10 was higher than that with PASI score ≤10((530±18)vs(451±8)ng/L,t=2.18, P<0.01).

VEGF may play a role in the pathogenesis of psoriasis.

To explore the neural mechanisms of attention-deficit hyperactivity disorder (ADHD) through analyzing the intensity of functional connection between bilateral hemispheres of children with ADHD by resting-state functional magnetic resonance imaging (rs-fMRI).

The approach of voxel-mirrored homotopic connectivity (VMHC) was employed to analyze 31 school-age and 31 ADHD children by rs-fMRI scans.

Positively activated brain regions were visualized when comparing ADHD and normal children, suggesting that ADHD children's VMHC scores were higher in bilateral frontal lobe (t=5.81), bilateral occipital lobe (t=5.82) and bilateral cerebellar posterior lobe (t=6.17). Statistically significant differences existed between two groups (FDR correction, Q<0.01).

The increased intensity of functional connection between bilateral prefrontal lobes in children with ADHD reflects attention disorder and leads to a decline of working memory .The strengthening of bilateral occipital lobes slows down memory process. And the increased intensity of cerebellar connections may damage neural circuits and aggravate ADHD symptoms.

To explore the reliability of preserving intercostobrachial nerve (ICBN) during axillary lymph node dissection for breast carcinoma.

A total of 57 patients with breast carcinoma undergoing routine operations were analyzed. The extirpated ICBN and ambient tissues were tested by hematoxylin and eosin staining to observe the pathological changes under microscope. If there was an infiltration of carcinoma, 4 immunohistochemical markers, including human mammaglobin (hMAM), were tested in related tissue.

Among them, no microscopic infiltration of carcinoma was found in 55 cases. In 27 cases with axillary lymph node metastasis, 1 case had an infiltration of carcinoma and carcinoma cells were present in tissues around ICBN in another case. Immunohistochemistry showed that hMAM, GCDFP-15, estrogen receptor (ER) and progesterone receptor (PR) were all positive in infiltrated ICBN. And carcinoma cells in tissues around ICBN expressed ER, PR and hMAM positively and GCDFP-15 negatively.

Unless intercostobrachial nerves and enlarged lymph nodes adhere heavily, preserving ICBN is feasible for breast carcinoma surgery.

To explore the clinical efficacy and safety of percutaneous renal access anterograde flexible ureteroscope plus retrograde balloon dilation in the treatment of complex lower ureterostenosis.

Under ultrasonic guidance, renal calices were successfully punctured for 78 patients with lower ureterostenosis. Then the tract was gradually expanded to 24 F with a metal dilator. Afterward upper ureter was expanded with a flexible ureteroscope sheath. Upon an insertion of guide wire into bladder, a 21 F balloon dilator was retrogradely placed in the narrow segment and maintained for 5 min. Then a D-J stent was antegradely deployed along the guide wire. And the clinical efficacy and safety were followed up.

6 F or 7/12 F D-J stent was successfully placed in 47 patients with unilateral ureterostenosis and 31 with bilateral ureterostenosis. The D-J stent was removed after 3 months. During a follow-up period of 3-9 months, 72 patients had gradually reduced hydronephrosis with an effective rate of 92.31%. Hydronephrosis remained unchanged or aggravated in 6 patients requiring regular replacement of D-J stent.

For complex middle or lower ureterostenosis, percutaneous renal access anterograde flexible ureteroscope plus retrograde balloon dilatation can reverse infection, hydronephrosis, renal dysfunction and other complications. And it is safe, effective and mini-invasive.

To explore the relationship between histomorphological factors and lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC).

A total of 153 paraffin-embedded specimens of PTC treated at Beijing Tongren Hospital, Capital Medical University were collected from January 1, 2006 to December 31, 2013 and assessed by hematoxylin and eosin staining. The tumor growth patterns (infiltrative tumor border, lateral tubular growth and intraglandular dissemination), histomorphological characteristics (hobnail features, loss of cohesiveness/polarity (LOCP) and micropapillary structures) and several clinicopathological parameters were evaluated for their values in LNM.

Among them, there were infiltrative tumor border (n=128), lateral tubular growth (n=34), intraglandular dissemination (n=30), extrathyroidal extensions (n=53), hobnail features (n=37), LOCP (n=59) and micropapillary structures (n=70). According to univariate analysis, patient age < 45 years, tumor size of 10 mm or more, infiltratve tumor border, lateral tubular growth, intraglandular dissemination, hobnail features, LOCP and micropapillary structures predicted LNM for PTC ( P<0.05); whereas gender, multifocality and extrathyroidal extensions did not (P>0.05). According to multivariated analysis, tumor size of 1 cm or more, infiltratve tumor border, hobnail features, LOCP and micropapillary structures were independent predictive factors of LNM for PTC (P<0.05). After a median follow-up period of 42 months, 4/82 patients suffered from locoregional recurrence. The estimated 5-year locoregional recurrence was 4.88%. Among 4 logcoregional recurrence cases, 3 involved in lymph nodes and 1 in remaining thyroid. Among 3 lymph node metastasis cases, there were hobnail feature (n=1), LOCP (n=1) and LOCP and micropapillary structure (n=1). None of hobnail feature, LOCP or micropapillary structure was found in recurrent case of remaining thyroid.

Correlated with lymph node metastasis in PTC, hobnail features, LOCP and micropapillary structures may be used as independent predictive factors of LNM so as to improve treatment and follow-up strategies for PTC.

To the evaluate chemo-responsiveness in patients with obesity hypoventilation syndrome (OHS) and respiratory failure (RF).

A total of 14 OHS and RF patients with a mean body mass index (BMI) of (34.3±2.68) kg/m² hospitalized between January 2009 to December 2011 were recruited. Lung function test (LFT), polysomnograghy (PSG), arterial blood gases (ABG) before and after voluntary hyperventilation maneuver and respiratory responses to hypoxia (ΔVE/ΔSpO₂) and hypercapnia (ΔVE/ΔPaCO₂) were measured. Ten of them received bi-level positive airway pressure (BiPAP) for 1 week and pre and post-treatment ABG were compared.

All of them fulfilled the criteria of type Ⅱ respiratory failure. PSG sleep study indicated a mean sleep apnea hypopnea index of (66.6±30.1) times/h and LFT revealed a predicted FEV₁/FVC% over 70%, excluding chronic obstruction pulmonary disease. Voluntary hyperventilation maneuver induced significant improvements in PaO₂ (52.5±7.6 vs 81.3±11.1 mmHg (1 mmHg=0.133 kPa, P=0.001) and PaCO₂ (50.4±5.3 vs 43.2±1.9 mmHg, P=0.001). RF was reversed in all patients. As compared with normal controls, all patients had decreased ΔVE/ΔSpO ₂ ((-0.11±0.08) vs (-0.38±0.04) L·min^-1·%SpO₂^-1, P<0.001) and ΔVE/ΔPaCO₂ (0.31(0.18, 0.66) vs 1.20(0.82, 1.50) L·min^-1·mmHg^-1,P<0.001). One-week BiPAP therapy induced significant improvement of sleep disordered breathing and daytime ABGs without any change of BMI in 10 patients. And PaCO₂ was normalized in 8/10 patients.

OHS patients have sleep disordered breathing and depressed chemo-responsiveness. Voluntary hyperventilation maneuver may reverse the "unwilling breathing" type of RF. Non-invasive ventilation treatment may improve nocturnal sleep apnea and daytime ABG abnormality.

To compare the value of Qanadli versus Mastora pulmonary embolism index in evaluating straddle-type pulmonary embolism by computed tomography (CT).

The clinical data were collected for 38 hospitalized patients with straddle-type pulmonary embolism diagnosed by CT pulmonary angiography (CTPA) from January 2011 to May 2014. There were 20 males and 18 females with an average age of (59.2±17.4 years). And the serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer were recorded. And Qanadli and Mastora pulmonary embolism indices were used to independently determine the CT embolism indices. Difference and correlation between Quandli and Mastora pulmonary embolism index were analyzed. And the relations between Qanadli score, Mastora score and serum parameters and right heart function parameters were analyzed.

Qanadli score of 38 patients was 20.0±0.0 while Mastora score 80.9±26.1. No significant correlation existed between Qanadli and Mastora scores. Median serum D-dimer level was 708.5 (9.6, 1 025.5) μg/L and median NT-proBNP 1 358.5 (576.7, 3 047.3) ng/L. Qanadli score was not statistically significantly correlated with serum D-dimer or NT-proBNP level. Mastora score was not correlated with serum D-dimer level statistically significantly, but it was positively correlated with the level of NT-proBNP ( r=0.495, P=0.010). No significant correlation existed between Qanadli score and right atrial diameter, right ventricular/left ventricular diameter ratio on CTPA. Mastora score was positively correlated with right atrial diameter/left atrial diameter ratio (r=0.627, P<0.001) and right ventricular diameter/left ventricular diameter ratio on CTPA (r=0.628, P<0.001). The Mastora score was not significantly correlated with main pulmonary artery diameter and main pulmonary artery diameter/ascending aorta diameter ratio on CTPA.

Mastora pulmonary embolism index is better than Qanadli pulmonary embolism index in evaluating straddle-type pulmonary embolism. Correlated with right ventricular function, the former reflects pulmonary embolic load and change of right heart function.

To investigate the early-recurrence prediction value of preoperative alpha-1-fucosidase (AFU) for hepatocellular carcinoma (HCC) patients undergoing curative resection.

A retrospective training set data from January to July, 2012 including 116 patients and a prospective validation set from August 2012 to December 2012 including 68 patients were used to validate the predictive value of preoperative AFU. Difference of recurrence rates between low and high AFU populations in all HCC or early-HCC subgroups were compared via Kaplan-Meier curves and Log-rank tests. Univariate and multivariate analyses were used to identify the recurrent prediction value of preoperative serum AFU.

Based on retrospective training data, AFU=25.00 U/L was set as the optimal cutoff point to stratify HCC patients into high (>25.00 U/L) and low (≤25.00 U/L) groups. Patients with high preoperative AFU showed significant low tumor-free survival not only in whole patients group (mean 12.50 months vs.not reached;P<0.01) but also in early-HCC (mean 10.25 months vs.not reached,P<0.01) and AFP negative subgroups (mean 13.20 months vs not reached,P<0.01). Univariate and multivariate analyses revealed the AFU was an independent predictor for tumor recurrence (OR=1.72, 95%CI: 1.00-2.96, P=0.04). The prospective validation data confirmed the predictive value of preoperative AFU in HCC (OR=2.22, 95%CI: 0.67-7.37, P=0.04). Furthermore, patients with high preoperative AFU were prone to have bigger tumor and form vascular invasion.

Preoperative AFU is a powerful prognostic indicator for HCC and 25.00 U/L might be an optimal recurrence prediction cutoff value for patients in Zhongshan hospital.

To explore the mechanism of Bailemian capsules in the treatment of insomnia.

A total of 50 imprinting control region (ICR) mice were randomly divided into 5 groups of normal control, model, high, medium and low-dose Bailemian capsules. After oral administration of Bailemian capsules for 14 consecutive days, except for control group, the other four groups received an injection of chlorobenzene alanine (PCPA) for murine modeling of insomnia. Then murine behaviors were observed and the brain tissue levels of serotonin (5-HT) and γ-aminobutyric acid (GABA) were detected. Another two batches of ICR mice ( n=50 each) were randomly divided into 5 groups of normal control, diazepam, high, medium and low-dose Bailemian capsules. After 14-hour fasting, except for normal control group, an intragastric dose of Bailemian was offered. Before dosing and at 30, 60, 120, 240 min, general behaviors within 5 min were recorded. For another batch, at 30 min after an intraperitoneal injection of pentobarbital sodium 25 mg/kg, disappearance of righting reflex as sleep index was used to observe the proportion of mice within 15 min in terms of sleep, sleep latency and total sleep time.

In middle and high-dose groups, insomnia symptoms improved significantly. The contents of 5-HT and GABA in brain tissue were significantly higher than those of model group ((164.6±12.8), (193.2±25.6) vs (147.1±15.5) ng/ml and (15.4±1.3), (17.0±1.3) vs (12.6±1.4) mol/L) (all P<0.05). And the number of activities at 120 min was significantly less than that of normal control group ((91.3±10.4), (78.5±12.7) vs (150.7±10.8) times) (bothP<0.05). Low, medium and high-dose Bailemian capsules could improve the proportion of mice within 15 min sleep. And sleep latency was shorter than that of normal control group ((8.9±0.6), (7.3±0.6), (2.1±0.3) vs 0 min) and total sleep time longer than that of normal control group ((76.7±7.1), (85.1±7.1), (110.0±22.9) vs 0 min) (allP<0.05).

The mechanism of Bailemian capsules for treating the symptoms of insomnia may be related with the elevated brain contents of 5-HT and GABA.

To study the virulence and mechanism of carbapenem resistance of a clinical isolate of carbapenem-resistant K1 serotype Klebsiella pneumonia strain.

Identification of isolate was carried out with VITEK-2 compact system.Antimicrobial susceptibility was determined by E-test; Metallo β-lactamases and carbapenemases screening were conducted by imipenem-EDTA double disc synergy test and modified Hodge test, respectively.Specific polymerehse chain reaction (PCR) and DNA sequencing were preformed to detect the virulence genes including K1, K2, K5, K20, K54, K57, magA, rmpA, wcaG and a series of β-lactamase resistence genes.Conjunction experiment was also performed.The plasmids of transconjugants were submitted to PCR-based replicon typing (PBRT) method.Molecular typing was performed by multilocus sequence typing (MLST).

Antimicrobial susceptibility testing revealed that the Klebsiella pneumonia strain was resistant to most of the antibiotics used in clinic.Phynotype confirmary rest revealed the production of carbapanemases, while Metallo β-lactamases were negative; PCR and DNA sequencing confirmed the isolate was positive for blaKPC-2, blaCTX-M-15, blaTEM-1, blaSHV-1 and virulence genes K1, magA, rmpA, wcaG simultaneously; blaKPC-2 was transferred from donor to Escherichia EC600 by conjunction experiment, while no virulence genes were found in the transconjugants.PBRT revealed that Frep plasmid was found in transconjugants.MLST analysis revealed that this strain belonged to ST23.

K1 serotype Klebsiella pneumonia strain carries virulence genes and carbapenem resistance gene blaKPC-2, noteworthily the carbapenem resistance genes can be transferred through horizontal transmission on plasmids.

To investigate the role of active efflux pumps in mediating the resistance of Acinetobacter baumannii to tigecycline.

The in vitro susceptibility of Acinetobacter baumannii to tigecycline was determined by broth microdilution method. Minimal inhibitory concentrations (MICs) of tigecycline against Acinetobacter baumannii strains were determined by broth microdilution method with or without efflux pump inhibitors of Carbonylcyanide-m-chlorophenylhydrazone (CCCP). Efflux pumps genes including adeB, adeJ and abeM were amplified by polymerase chain reaction (PCR) and sequenced. The expression levels of these genes were measured using quantitative real-time transcription- polymerase chain reaction (RT-PCR). The modulating gene adeR and adeS were detected by PCR amplification, deoxyribonucleic acid (DNA) sequencing were performed with specific primers and were compared with the published sequence online.

The sensitive rate of Acinetobacter baumannii to tigecycline was 22.39% (15/67), active efflux of drugs existed. The adeB gene was positive in 88.06% (59/67) out of 67 Acinetobacter baumannii strains, and adeJ and abeM were 100% positive. adeB and adeJ genes expression in clinical isolates of resistant Acinetobacter baumannii increased 17.88-fold and 6.07-fold than sensitive strains, respectively. AbeM gene expression in resistant strains had not significant increase. The sequence of adeR and adeS genes in clinical isolates of sensitive and resistant strains were the same except several point mutations.

Efflux pump systems of AdeABC and AdeIJK may play a role in Acinetobacter baumannii resistant to tigecycline in western China, AbeM may be irrelevant to it. The point mutations of adeR and adeS may not up-regulate the transcription activities of adeB in this study.

To explore the value of self-designed fluorescent in situ hybridization (FISH) polyclonal break-apart probes specific for TFE3 gene in the diagnosis of Xp11.2 translocation renal cell carcinoma.

All tissue samples were collected from 2006 to 2013, including Xp11.2 translocation renal cell carcinoma (n=10), renal clear cell carcinoma (n=10) and renal papillary cell carcinoma (n=10). FISH was conducted for paraffin-embedded tumor tissue sections with probes. The types of fluorescence were observed by fluorescent microscopy to determine the existence or non-existence of translocated TFE3 gene.

All sections were successfully probed. The split red and green signals within a single nucleus were detected simultaneously in 9 cases of Xp11.2 translocation renal cell carcinoma as diagnosed by traditional pathological and immunohistochemical methods. And it was consistent with the initial diagnosis. Detection of fusion signal in 1/10 and negative FISH result did not conform to the initial diagnosis. The fluorescent types of renal clear cell carcinoma and renal papillary cell carcinoma were all fusion signals. FISH tests were negative for renal clear and papillary cell carcinomas.

Xp11.2 translocation renal cell carcinomas diagnosed by traditional pathological and immunohistochemical methods are sometimes misdiagnosed. Detecting the translocation of TFE3 gene with FISH polyclonal break-apart probes is both accurate and reliable for diagnosing Xp11.2 translocation renal cell carcinoma.

A 2.5-year-old male was admitted to the hospital on July 31, 2013 due to "cough and shortness of breath for 1 month, aggravated for 2 days". The child developed a cough 1 month ago, which was not serious, occasionally shortness of breath, obvious after activity, no cyanosis, no wheezing, no fever, night sweats, and weight loss, but it was not paid attention to. Two days ago, the child had aggravated cough, paroxysmal cough, cough 4-5 times, obvious shortness of breath, no cyanosis, accompanied by fever, body temperature 38.8℃ (ear temperature), came to the emergency room of our hospital, and was treated with nasal tube oxygen, ceftriaxone anti-infection, ambroxol to reduce phlegm, human albumin support, etc. CT showed: two lung infection with bilateral pleural effusion, thoracic and abdominal B-ultrasound showed: peritoneal effusion, bilateral pleural effusion, with "multiple serous effusion, tuberculosis possible" admission to hospital. The family denied that the child had a history of contact with tuberculosis patients and had been vaccinated with BCG.

A 39-year-old male was admitted to the Department of Cardiology of Peking Union Medical College Hospital on May 4, 2014 due to "edema of both lower limbs for 3 years, cough for nearly 2 years, and asthma after activity for more than 1 year". In July 2011, the patient developed symmetrical concave edema of both lower limbs, which was light in the morning and heavy in the evening. The examination showed elevated liver enzymes and bilirubin, and abdominal CT showed "cirrhosis". After liver protection treatment, the edema of both lower limbs did not improve. In October 2012, intermittent dry cough began to appear, the coagulation function was normal, the antinuclear antibody was weakly positive, the chest CT showed "interstitial pneumonia", the abdominal CT showed "cirrhosis and portal hypertension, the main portal vein and its branches were slender, and thrombosis in the lumen, and peripheral cavernous change"; Echocardiography "left ventricular ejection fraction (LVEF) 63%, whole heart enlargement (left atrium 48 mm, right atrium 55 mm ×58 mm, left ventricle 66 mm, right ventricle 29 mm), ventricular septal thickening (13 mm), mild mitral and tricuspid valve regurgitation, abnormal left ventricular filling". In February 2013, I experienced impaired activity tolerance, shortness of breath and wheezing after climbing 4 floors. In November 2013, the serum albumin was decreased and the coagulation time was prolonged (details unknown). The diagnosis was "connective tissue disease? Interstitial pneumonia, cardiodilation, and decompensated cirrhosis". Methylprednisolone was administered orally, 24 mg, once/d, and then decreased by 4 mg every week after 1 month (2 months in total). After the patient's activity, the symptoms of asthma were obviously aggravated. He climbed 2 floors and walked hundreds of meters on the flat ground and felt asthma. Cough, cough of white phlegm, edema of both lower limbs were also aggravated than before, and edema of the waist and both upper limbs appeared. After albumin, plasma and diuretic treatment, the edema was relieved, and the asthma was still progressively aggravated after activity. In March 2014, the echocardiogram of a foreign hospital showed "LVEF 61%, whole heart was large, and there was a small amount of mitral and tricuspid valve regurgitation", and it was recommended to see a superior hospital. In April 2014, the blood gas examination in our hospital outpatient clinic: pH 7.482, arterial oxygen partial pressure (PaO₂) 38.8 mmHg (1 mmHg =0.133 kPa), arterial oxygen saturation (SaO₂) 72.0%, alveolar-arterial oxygen partial pressure difference 72.1 mmHg, arterial blood carbon dioxide partial pressure (PaCO₂) 32.6 mmHg; Brain natriuretic peptide 74 ng/L. The lung passed through imaging for the first time: multiple patchy perfusion decreased in both lungs, and the extrapulmonary shunt rate was 39.0%. It was considered that there was right-to-left lung shunt, which was in line with hepatopulmonary syndrome. Admitted to hospital for further treatment.

The patient, a 29-year-old female, was sent to the local hospital at 8 o'clock on May 5, 2013. After eating "instant noodles" for 15 minutes, she developed skin itching and congestion all over her body, accompanied by nausea and vomiting, without obvious asthma, cyanosis, fever, etc., and then lost consciousness. After more than 10 minutes, she was sent to the local hospital. Her blood pressure was measured at 60/30 mmHg (1 mmHg =0.133 kPa), and she was given dopamine and fluid rehydration. During the installation of ECG monitoring, she developed cardiac arrest. After artificial cardiopulmonary resuscitation and fluid rehydration treatment, her heartbeat recovered (details are unknown). After about 30 minutes, she was transferred to the local superior hospital. Her blood pressure was measured at 80/60 mmHg, and she was given tracheal intubation, intravenous dopamine, methylprednisolone and a large amount of fluid rehydration. The patient's blood pressure could be maintained at about 110/90 mmHg, her vital signs were stable, and the rash gradually subsided, but she was still unconscious, and she showed positive binocular gaze and bilateral pathological signs. CT examination of the head showed "mild cerebral edema", so she was transferred to the intensive care unit (ICU) of our hospital. Past history: The patient is a Shandong native, a farmer, who has used buckwheat peel pillows for a long time. He has intermittently had clear nose and sneezing in the morning for more than 10 years. He has attacks in all seasons, and it is aggravated from August to September. He has no wheezing and no regular treatment. He denies the history of pet raising, family history of allergic diseases and history of drug allergy. Diagnosis: The cause of shock is to be investigated, anaphylactic shock is likely, intracranial edema, allergic rhinitis.

Most deaths in patients with gastric cancer are caused by metastasis. Invasion and metastasis are the main characteristics of gastric carcinogenesis and development. Previous studies have focused on the effects of molecular pathological changes on a series of biological behaviors such as proliferation, invasion and metastasis of gastric cancer cells. Although some progress has been made, no molecular markers have been found that can predict the invasion and metastasis of gastric cancer. In recent years, a large amount of evidence indicates that the occurrence and metastasis of tumor are closely related to the microenvironment in which tumor cells are located. extracellular matrix (ECM), as a component of tumor microenvironment, plays an important role in the proliferation and invasion of gastric cancer: on the one hand, ECM acts as a defense barrier of the body, controlling the proliferation, differentiation and distant migration of tumor cells; On the other hand, the remodeled ECM constructs a loose "soil" for tumor invasion, resulting in high proliferation, poor differentiation, apoptosis inhibition, invasion and metastasis of tumor cells. Recent studies have shown that ECM can be involved in regulating the biological properties of cancer stem cells (CSCs), such as "dry" maintenance and self-renewal^[1,2]。 Therefore, defining the specific role of ECM protein in the tumor microenvironment and the signaling pathways involved in cell-extracellular matrix interactions will help discover new therapeutic strategies to prevent and treat gastric cancer metastasis.

dermoscopy was born in the 19th century. It is a non-invasive and non-invasive examination method. It can not only provide a light source and magnify the skin lesions, but also show the superficial layers of the epidermis and dermis through the cuticle of the epidermis, and observe the fine structures invisible to the naked eye, such as pigments and vascular structures^[1]。 Because most of the structures visible under dermatoscopy have a certain correspondence with histopathological manifestations, dermatoscopy is considered to be a bridge between clinical (gross structure) and histopathological examination (microstructure). Dermatoscopy was initially used in the diagnosis of pigmented tumors, especially in the differentiation between malignant melanoma and benign pigmented nevus, which improved the accuracy of the diagnosis of pigmented tumors, especially malignant melanoma, and also reduced the unnecessary resection of benign pigmented tumors. At present, the research in this field has been very mature^[2]。 In recent years, dermoscopy has been extended to a wider range of fields, such as benign or malignant non-pigmented skin tumors, vascular diseases, bacterial and viral infectious diseases, and inflammatory skin diseases. Dermoscopes are widely used in clinical practice and are called "stethoscopes" for dermatologists. This article mainly reviews the application of dermatoscopy in non-pigmented skin disorders (NPSD), especially inflammatory skin diseases and non-pigmented skin tumors.

Lung cancer is the leading cause of cancer-related death, with 85% of newly diagnosed lung cancers each year being non-small cell lung cancer (NSCLC)^[1]Of which adenocarcinoma and squamous cell carcinoma account for 50% and 30% respectively^[2]。 In recent decade, with the development of molecular biology, targeted therapy has become one of the important therapeutic methods for advanced NSCLC^[3]Molecular targeting drugs represented by epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) have made great progress in the treatment of NSCLC. The data on the efficacy of EGFR-TKI mostly comes from the study of lung adenocarcinoma, and there is no clear independent study in lung squamous cell carcinoma. It makes one wonder: What is the use of EGFR-TKI in lung squamous cell carcinoma? At present, the standard treatment plan for advanced lung squamous cell carcinoma is still platinum-based two-drug chemotherapy, and the treatment method is relatively limited. Although the chemotherapy regimen has been continuously updated and developed in the past 30 years, its efficacy seems to have reached a bottleneck state. The objective response rate is only 30% ~40%, and the median survival time for stage IIIB and IV lung squamous cell carcinoma is only 1 year^[4]。 Most patients with advanced lung squamous cell carcinoma have fewer treatment options and drugs to choose from after first-line and second-line chemotherapy, and due to the lack of evidence-based medical evidence of the efficacy of molecular targeted drugs on lung squamous cell carcinoma, it is urgent to explore the targeted therapy of lung squamous cell carcinoma.

A 77-year-old male was admitted due to paroxysmal precordial pain, chest tightness and shortness of breath for 4 years, aggravated for 2 days. Previous history of hypertension 1 year, highest unknown, acceptable drug control, previous smoking 30 years. "Intermediate aortic syndrome" was diagnosed 3 months ago.

The patient was a 36-year-old male with skin nodules on the face, trunk and limbs for more than 4 years. Since 2010, the patient has developed skin-colored skin nodules in both upper limbs without obvious trigger, which gradually expanded to the whole body within six months without itching, pain, ulceration and pus discharge. No fever, joint swelling and pain, fatigue, photosensitivity, oral ulcer, etc. In 2011, he visited a local hospital and was treated with methylprednisolone, leflunomide, tripterygium wilfordii, total angelic glycosides capsules and thymopentin injection successively, but there was no significant change. The posterior part of the nodule gradually changed from skin color to purple-red, and yellow liquid could be seen flowing out after scratching the nodule. History of systemic disease denied. A family genetic history is denied. Personal history, marriage and childbirth history are not special.