Volume 95  ·  Issue 22  ·  2015

Chronic obstructive pulmonary disease (COPD) is a common and frequently occurring clinical disease caused by smoking and biofuel exposure. The main pathophysiological feature is continuous exhaled airflow restriction, and the main pathological change is chronic airway inflammatory reaction. The results of large-scale epidemiological survey in China show that the prevalence of COPD in people over 40 years old is about 8.2%; COPD seriously affects the quality of life of patients, and its high disability rate and high mortality rate bring huge economic burden to patients and society^[1]。 New research estimates that COPD will be the third cause of disease death worldwide by 2030^[2]。 The 2015 COPD Global Initiative pointed out that in EU countries, COPD-related medical expenses will account for 56% of the total expenditure on respiratory-related diseases. Data from the United States show that COPD direct medical expenses reach $29.5 billion, and indirect expenses reach $20.4 billion^[3]。 Therefore, it is of great significance to understand the pathogenesis of COPD in depth for its prevention, treatment and clinical management.

In 1998, with the collaboration of the National Institute of Heart, Lung and Blood, the National Institutes of Health and the World Health Organization, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) was launched to improve the awareness, management and attention of COPD. In 2001, the first report, the Global Initiative for the Diagnosis, Treatment and Prevention of COPD, was published. For more than 10 years, the GOLD Scientific Committee has continuously updated the GOLD report by retrieving and screening out influential research results. Of the 312 newly retrieved academic papers from January to December 2014, the GOLD Scientific Committee considered 31 to have an impact on the GOLD report released in January 2014^[1]。 Based on these latest studies, the GOLD Update Report published in January 2015 has modified and added some contents to the original framework and central content, while there is no change in principle in the definition of COPD, disease assessment, stable phase and exacerbation phase treatment compared with the report published in 2014^[1]。 The GOLD 2015 update report has been published on the GOLD website at www.goldcopd.org, and the updated section is interpreted as follows.

With the comprehensive advancement of China's medical and health system reform, the diversified medical pattern of public medical institutions, non-public medical institutions and domestic and overseas social capital medical institutions has gradually formed, and the health industry is facing rare development opportunities^[1]。 Taking this opportunity, the management of medical laboratories has gradually moved towards standardization and standardization, whether it is the "Evaluation Standards for Tertiary General Hospitals (2011 Edition)" issued by the National Health and Family Planning Commission^[2]And implementation rules, "Administrative Measures for Clinical Laboratories of Medical Institutions"^[3]It is also the Accreditation Guidelines for Quality and Competence of Medical Laboratories (ISO 15189:2012) issued by the National Accreditation Council for Conformity Assessment (CNAS) of China^[4]All put forward clear and detailed requirements for the management, technology, quality and safety of the laboratory. In order to improve the accuracy of test results and resist potential medical risks, each laboratory has established a quality management system according to the requirements of laws, standards or guidelines according to its own actual situation. The whole process of the experiment is analyzed by the theory of systematics to find out the various links that affect the quality of the inspection and make measures to control it^[5]； Writing system documents suitable for themselves to ensure the effectiveness and operational compliance of the quality management system; It can not only cope with various professional inspections, but also meet medical regulations and hospital standards, so that the quality management system is integrated with all tasks^[6]。 Quality management system documents are the foundation and basis for the existence of quality management system^[7]Combined with the practical experience of this laboratory, the author discusses the standardized management, effective control and continuous improvement of quality management system documents as follows.

To explore the role of cortistatin (CST) in rats with chronic obstructive pulmonary disease (COPD).

A total of 16 healthy male Sprague-Dawley rats were randomly divided into control and COPD model groups (n=8 each). The COPD model group received an inhalation of passive smoking while the control group was treated normally. After 4 months, pulmonary function was measured. The differential cell counts of bronchoalveolar lavage fluid (BALF) were detected. Morphology and pathology of lungs were studied via hematoxylin and eosin staining. The levels of CST in lung tissue, serum and BALF were detected by radioimmunoassay.

Compared with the control group, the COPD group had obviously higher airway resistance and neutrophil ratio in BALF [(0.584±0.021) vs (0.653±0.062)mmHg·ml^-1·s^-1, 1.49% vs 0.41%, both P<0.05]. And there were significantly serious inflammation and emphysema in lung tissues. Moreover, the levels of CST increased in serum, BALF and lung tissues [(526±76) vs (453±41)pg/ml, (819±100) vs (619±101)pg/ml, (41±10) vs (20±7)pg/mg, allP<0.05] respectively as compared with the controls.

An elevated level of CST may compensate to exert anti-inflammation effects in COPD rats.

To explore the preventive and therapeutic effects of simvastatin on rats with chronic obstructive pulmonary disease (COPD) and examine the mechanism of airway inflammation and airway mucus hypersecretion.

The rat model of COPD was established by cigarette smoking and an intratracheal injection of lipopolysaccharide (LPS). A total of 18 male Sprague-Dawley rats were randomly divided into control, COPD and simvastatin groups (n=6 each). The control and COPD groups received normal saline once daily via intragastric administration (i.g.) while the simvastatin group had simvastatin (0.5 g/L) 1 ml/100 g once daily via i. g. Pulmonary function was tested and pathological changes in bronchus and lung were observed. The bronchoalveolar lavage fluid (BALF) levels of interleukin-8 (IL-8), interleukin-17 (IL-17) and tumor necrosis factor (TNF)-α were measured by enzyme-linked immunosorbent assay (ELISA). The protein expressions of intercellular adhesion molecule 1 (ICAM-1), nuclear factor κB (NF-κB), mucin 5AC (MUC5AC) and Toll-like receptor 4 (TLR4) in rat airway were detected by immunohistochemical staining. The mRNA and protein expressions of TLR4 and MUC5AC in bronchi and lung tissue were detected by fluorescent real time quantitative polymerase chain reaction (RT-PCR) and Western blot.

The changes of bronchi and lung tissues in COPD group were consistent with typical pathological manifestations of COPD. As compared with the COPD group, the degree of pulmonary pathological damage and the decline of pulmonary function in the simvastatin group were significantly lessened, but still remarkable as compared with the control group. The BALF levels of IL-8, IL-17 and TNF-α in the smvastatin group [(484.4±11.1), (78.9±2.0), (192.7±2.0) ng/L] were significantly lower than those in the COPD group [(605±48.7), (89.9±6.9), (212.6±10.7) ng/L], but still higher than those in the control group [(341.2±21.4), (56.0±2.9), (127.5±9.0) ng/L respectively] (allP<0.01). Compared with COPD group, the expression levels of ICAM-1, NF-κB, MUC5AC and TLR4 protein were significantly lower in the simvastatin group, but still higher than the control group (allP<0.01). Furthermore, the expression levels of mRNA and protein of MUC5AC and TLR4 were significantly lower in the simvastatin group than those in the COPD group (allP<0.05).

In COPD model rats, simvastatin can decrease the levels of IL-8, IL-17 and TNF-α in BALF and inhibit the expression levels of ICAM-1, NF-κB, MUC5AC and TLR4 protein in airway and lung tissue. Thus it plays preventive and therapeutic roles by reducing airway inflammation and airway mucus hypersecretion.

To explore the effects of transplanting bone marrow mesenehymal stem cells (MSCs) on emphysema in rats and elucidate the possible mechanisms.

A total of 24 female Sprague-Dawley rats were randomly divided randomly into 3 groups of control, emphysema and MSCs transplantation (n=8 each). The rat model of emphysema was established by 14-week exposure to cigarette smoking and then MSCs labeled with 4, 6-diamidino-2-phenylindole (DAPI) were injected into recipient rats of MSCs transplantation group via tail veins. At 2 and 4 weeks post-transplantation, engraftment and differentiation of MSCs was determined. At 8 weeks post-transplantation, lung fissure sections were prepared for examining the morphological alterations. The apoptosis of alveolar septal cells was assessed. And the levels of oxidative stress in sera and lung were detected.

At 2 and 4 weeks post-transplantation, MSCs labeled with DAPI could be found in recipient lungs, some of which differentiated into type Ⅱ alveolar epithelial cells. Mean linear intercept was higher in emphysema and MSCs transplantation groups than control group [(111±23) and (90±15) vs (74±10) μm], mean alveolar numbers were lower than control group [(94±22) and (125±15) vs (159±22)/mm ²] (all P<0.05); mean linear intercept was higher and mean alveolar numbers were lower in emphysema group than MSCs transplantation group (bothP<0.05). The apoptotic index of alveolar wall cells in emphysema group was higher than MSCs transplantation group [(13.5±2.5)% vs (4.8±0.7)%,P<0.05]. Malondialdehyde of sera and lung in emphysema and MSCs transplantation groups was higher than control group [(4.3±0.8), (3.7±0.4) vs (3.0±0.4) nmol/ml, (5.4±0.5), (4.8±0.4) vs (4.2±0.6) nmol/mg, allP<0.05]; malondialdehyde of sera and lung in emphysema group was higher than MSCs transplantation group (bothP<0.05). Superoxide dismutase (SOD) of sera and lung in emphysema and MSCs transplantation groups was lower than control group [(8.7±0.8), (9.6±0.7) vs (10.5±0.9) U/ml and (56.3±13.4), (70.2±11.0) vs (84.9±13.0) U/mg, allP<0.05]; SOD of sera and lung in emphysema group was lower than MSCs transplantation group (bothP<0.05).

MSCs transplantation via tail vein may arrest the progression of emphysema in a cigarette-smoke-induced rat model of emphysema through a differentiation of injected MSCs into type Ⅱ alveolar epithelial cells and down-regulations of apoptosis and oxidative stress.

To confirm the feasibility of improving lymph node harvest by injecting methylene blue into inferior mesenteric artery in rectal cancer after neoadjuvant therapy.

Forty two ex vivo specimens were collected from rectal cancer patients with neoadjuvant therapy and radical operation at our hospital. Traditional method with palpation and injection of methylene blue into inferior mesenteric artery were employed. The data of lymph node harvest were analyzed by paired t and chi-square tests.

The average number of detected lymph node in traditional method and methylene blue groups were 6.1±4.3 and 15.2±6.4 respectively (P<0.001). The proportions of lymph nodes <5 mm were 14.1% and 46.7% in traditional method and methylene blue groups respectively (P<0.001). And the injection of methylene blue added 13 extra metastatic lymph nodes and caused a shift to node-positive stage (P=0.89).

Neoadjuvant therapy decrease lymph node retrieval in rectal cancer. Injecting methylene blue into inferior mesenteric artery improves lymph node harvest especially for small nodes and helps to acquire more metastatic nodes for accurate pathological staging.

To investigate the spectrum and antimicrobial resistance of major pathogensthat causing nosocomial infections in China, 2013.

Nosocomial cases as well as pathogens causing bloodstream infections (BSI), hospital-acquired pneumonia (HAP) and intra-abdominal infections (IAI) from 13 teaching hospital around China were collected. The minimum inhibitory concentrations (MICs) were determined by the agar dilution method. The CLSI M100-S23 criteria were used for interpretation.

Of all cases, 1 022 cases were from BSI, 683 from HAP and 674 from IAI.Escherichia coli and Klebsiella pneumoniae were the most prevalent pathogens causing BSI and IAI while Acinetobacter baumanii (34.6%) and Pseudomonas aeruginosa were dominated in HAP. Tigecycline, imipenem and meropenem exhibited high potency against Enterobacteriaceae and the susceptibilities rates were 95.6%, 94.2%and 95.2% respectively.Enterobacteriaceae demonstrated high resistance against cephalosporins (52.3%) and fluoroquinolones (38.9%) but were susceptible to β-lactam+ inhibitor. Of all the Enterobacteriaceae, 30.5% were ESBLs positive and 4.3% were carbapenem resistant.Acinetobacter baumanii showed low susceptibilities to the microbial agents except for tigecycline (90.5%) and colistin (100%). The rate of carbapenem resistant Acinetobacter baumanii was 76.6%. Amikacin, ciprofloxacin, cefepime and piperacillin/tazobactam showed high antibacterial activity against Pseudomonas aeruginosa with susceptible rate 88.5%, 77.6%, 72.7% and 64.5% respectively.The resistant rate to imipenem and meropenem were 42.1% and 32.2%. All Staphylococcus aureus (166 strains) were susceptible to tigecycline, linezolid, daptomycin and glycopeptides. MRSA accounted for 46.9% of all the Staphylococcus aureus. The prevalence of MRSA in IAI (55.2%) and HAP (54.4%) were higher that that in BSI (35.0%). No Enterococcus strains were found resistant to tigecycline, linezolid and daptomycin. VRE was found in Enterococcus faecium, accounting for 1.9% of all Enterococcus faecium strains.

Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa are the most common pathogens causing nosocomial infections. Nosocomial pathogens showed high susceptibilities against tigecycline. For ESBLs-producing Enterobacteriaceae strains, β-lactam+ Inhibitor show high antibacterial activities. Vancomycin, teicoplanin and linezolid exhibit high potency to Staphylococcus aureus and Enterococcus.

To analyze the risk factors of recurrence in patients with Barcelona Clinic Liver Cancer (BCLC) 0-A hepatocellular carcinoma (HCC) after surgical resection.

Retrospective analyses were conducted for 218 patients undergoing surgical resection for BCLC 0-A HCC. A total of 17 clinicopathologic factors possibly influencing the recurrence and survival were selected. And multivariate analysis of these parameters was performed with Cox proportional hazard model. Survival analysis was performed with the Kaplan-Meier method.

The overall 1, 3, 5-year survival rates were 95.9%, 85.3% and 67.6% respectively. The median survival from time of primary resection was 35 months. The overall 1, 3 and 5-year disease-free survival (DFS) rates were 84.4%, 56.5% and 47.0% respectively. Univariate analysis showed that cirrhosis, positive alpha-fetoprotein (AFP), satellite nodules, involvement of hepatic capsule, tumor differentiation and microvascular invasion were associated with recurrence. And Cox multivariate analysis showed that satellite nodules, involvement of hepatic capsule and microvascular invasion were the independent risk factors for recurrence.

Surgical resection is a first option for BCLC 0-A HCC. Satellite nodules, involvement of hepatic capsule and microvascular invasion are independent risk factors for recurrence. Postoperative transarterial chemoembolization does not benefit the survival of patients with risk factors of recurrence.

To evaluate the clinicopathological features of extramammary Paget's disease.

Statistical analyses were performed for the clinicopathological features for 75 cases of extramammary Paget's disease from 2004 to 2013.

Extramammary Paget's disease exhibited a male predominance (5.25∶1). The mean age of onset was (64.23±12.02)years. Single lesion accounted for 92.0%(69/75) and most of them were located in genital area. Pruritus occurred in 61.6%(45/73) patients. Invasive extramammary Paget's disease accounted for 22.7%(17/75). The concordance between clinical and pathological diagnoses was 85.3%(64/75). Among 11 misdiagnosed cases, 7 cases were misdiagnosed as eczema. Comparing Paget cells located in epithelium of adnexa or dermis and those confined to epidermis, significant differences existed in age of onset, course, recurrence rate(allP<0.05), but not in lesion size. Among 67.1%(47/70) of patients undergoing Mohs surgery, 38.3%(18/47) had a complete one-time resection while 61.7%(29/47) required more than twice for thorough resection. The 5-year recurrence rate was 25.0%. The postoperative 5-year recurrence rate of Mohs micrographic surgery (MMS) was 18.0% and the rate of non-MMS 36.5%. From 2011 to 2013, 3 recurrent cases had no radiotherapy. However another 15 cases on radiotherapy were non-recurrent.

With a slow progression, extramammary Paget's disease is more common among elder males. Recurrence rate is associated with the degree of invasion. Thus an early diagnosis is essential. Due to obvious differences between gross and pathological boundaries, Mohs surgery may help to determine the margin. Meanwhile, adding radiotherapy reduces the recurrence rate.

To evaluate the surgical efficacies of primary retroperitoneal schwannoma (PRS) and analyze its risk factors for survival and recurrence.

From January 1993 to December 2012, 109 patients diagnosed with primary retroperitoneal schwannoma were treated at our department.And their clinical data were retrospectively analyzed.

The overall 1, 3, 5-year survival rates of benign PRS were all 100%. Univariate analyses revealed that tumor size and modus operandi of tumor resection were associated with recurrence rate. For malignant PRS, the overall 1, 3, 5-year survival and recurrence rates were 89.6%, 62.1%, 41.4% and 41.4%, 65.5%, 72.4% respectively. Univariate analyses revealed that tumor size, modus operandi of tumor resection and tumor grade were associated with survival rate. Tumor grade was associated with recurrence rate and it was also an independent prognostic factor.

The major management of PRS is complete excision. Benign PRS has an excellent survival rate. And tumor size and modus operandi of tumor resection are associated with recurrence rate. The survival rate of malignant PRS is associated with tumor size, modus operandi of tumor resection and tumor grade. As an independent prognostic factor, tumor grade is associated with recurrence rate.

To explore the clinical effectiveness of minimally invasive treatment of cyst simplex of sublingual gland by the mucosal bridge-tunnel surgery.

A total of 35 patients were enrolled. Minimally invasive treatment of cyst simplex of sublingual gland was performed by mucosa bridge-tunnel surgery. Two parallel incisions were initially made at the apex of cyst of sublingual gland with about 2 mm wide, and then free mucosa flap was obtained from the top of the cyst wall along the incisions. The mucosal tunnel was made by suturing the base of the mucosal stripe at the deepest part of the cyst wall, and the mucosal bridge was formed by suturing two external edges of the incisions.

The follow-up period was 6-48 months. 30 cases(85.7%) were cured and 4 cases(11.4%) were improved with no recurrence except for one loss of follow-up. Totally, patients were satisfied with the treatment.

Mucosal bridge-tunnel surgery is a safe, effective, simple and easy-operating method to the cyst simplex of sublingual gland patients who are undergoing a relapse after treatment with drug injection or palliative care, young, worn with age, with bilateral problem, intolerant to a major surgery, or having a higer expectation to the treatment.

To explore the bacterial diversity and resistance in infection-related skin disorders.

The samples of blood, pyogenic fluid, exudate and skin dander were collected from 54 outpatients of chronic and recurrent skin disease and cultured for positive pathogens in the dermatological department of Peking University Third hospital from March 2010 to May 2011. Also their drug susceptibilities were examined.

Among 63 bacterial strains of 22 species in 12 genus, the pathogens were Staphylococcus epidermidis, Staphylococcus aureus, Micrococcus luteus, group A Streptococcus pyogenes, Staphylococcus agalactiae, Corynebacterium sp., Bacillus subtilis, Bacillus cereus, Acinetobacter baumanii, A. lwoffii, Pseudomonas aeruginosa, Enterobacter cloacae, Rhizobium radiobacter, Sphingomonas paucimobilis, Enterococcus faecalis, Neisseria sicca and Neisseria gonorrhoeae. The percentage of methicillin-resistant coagulase negative staphylococci (MRCNS) was 46.4% (13/28) while the resistant rates of Styphylococci to ampicillin, penicillin, azithromycin, cefoxitin, clindamycin and SMZ-TMP were 88.6% (31/35), 88.6% (31/35), 68.6% (24/35), 37.1 (13/35), 28.6(10/35) and 26.5 (9/34) respectively. Gram negative bacilli were sensitive to ampicillin, amikacin sulfate, ceftazidime.

There are a wide range of pathogenic bacterial species among refractory infection of outpatients. And drug resistance is among the reasons for refractory infections.

To evaluate the clinical efficacies of aromatase inhibitors in the treatment of postmenopausal metastatic breast cancer.

A total of 148 postmenopausal women (including bilateral ovariectomy) with hormone dependent metastatic breast cancer receiving aromatase inhibitors (letrozole, anastrozole or exemestane) were analyzed retrospectively. Their clinical efficacies were evaluated.

The median progression-free survival (PFS) was 6.5 months and the clinical benefit rate 63.5%. And the rates of PFS of patients on first-line and second-line or above treatments were 9.0 (95%CI: 6.95-11.05) and 3.0 months (95%CI: 1.8-10.1) respectively. The clinical benefit rates of two groups were 74.2% and 26.3% respectively.

Aromatase inhibitors are both efficacious and well-tolerated for patients of postmenopausal metastatic breast cancer. It may be recommended as a first-line therapy for postmenopausal women with hormone dependent metastatic breast cancer.

To explore the effects of hydrogen sulfide (H₂S) on colonic contraction of rats at low concentration and ion channel mechanisms.

Organ bath recordings were used to examine the contraction of colonic smooth muscle strips. The whole-cell patch-clamp technique was used to record the currents of L-type calcium and large conductance Ca²⁺ -activated K⁺ (BK_Ca) channels in smooth muscle cells isolated from 30 male Wistar rats.

The H₂S donor NaHS ((1-12)×10^-5mol/L) increased the spontaneous contractions of longitudinal and circular muscle strips in a dose-dependent manner (all P<0.05) and the effect could not be blocked by tetrodotoxin. NaHS (6×10^-5 and 12×10^-5 mol/L) reversibly increased the L-type calcium current (I_{Ca, L}) in a dose-dependent manner. And the peak of I_{Ca, L} at 0 mV increased from (-3.16±0.47) to (-3.33±0.54) and (-3.65±0.66) pA/pF respectively (n=6, both P<0.05). Current-voltage (I-V) curve had no shift after NaHS treatment and H₂S donor caused no change in the curves of steady-state activation. Likewise BK_Ca channel was significantly inhibited by NaHS (6×10^-5 and 12×10^-5 mol/L) in a dose-dependent manner. And IBK_Ca at 60 mV decreased from (16.68±1.23) to (15.26±2.67) and (13.80±3.04) pA/pF respectively(both P<0.05).

H₂S at low concentrations increases the spontaneous contraction of rat colonic smooth muscle in a dose-dependent manner. Such an effect may be due to a direct activation of L-type calcium channel and an inhibition of BK_Ca channel in smooth muscle cells.

To explore the effects of telmisartan on the expressions of adiponectin and adiponectin receptor and its signal transduction pathway AMP-activated protein kinase (AMPK), Akt/endothelial nitric oxide synthase (Akt/e-NOS/NO) and examine the possible protective mechanisms of telmisartan in testis of type 1 diabetic rats.

A total of 27 male Sprague-Dawley rats were randomly divided into normal control (NC, n=8) group and diabetic model (n=19) group. Diabetes was induced by an intraperitoneal injection of streptozotocin (STZ). And 16 established diabetic rats were randomly divided into diabetic control (DM, n=8) and diabetic treated with telmisartan (DT, n=8) groups. Group DT received a lavage of telmisartan while groups NC and DM had an equal volume of normal saline by gavage. At the end of 8-week of telmisartan treatment, the animals were sacrificed after harvesting of blood samples. Bilateral testes were extracted and epididymis was minced for preparing sperm suspension. Blood samples were used to detect the related parameters. Some tresticular tissues were fixed in neutral 40% formaldehyde solution and processed for histological analysis. And the remaining testicular tissues were immediately placed into liquid nitrogen and then stored in a -70 ℃ refrigerator until analyses. The levels of insulin and sex hormone were detected by radioimmunoassay. The levels of adiponectin, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were assayed by enzyme-linked immunosorbent assay (ELISA). The mRNA expression of testicular adiponectin and its receptor was assessed by real-time fluorescent quantitative polymerase chain reaction (PCR). The protein expressions of testicular adiponectin, adiponectin receptor, AMPK, P-AMPK, AKT, P-AKT and e-NOS were analyzed by Western blot.

There was significant pathological changes in testes in group DM than that in group NC. The levels of P-AKT/AKT, e-NOS and NO were significantly increased in group DM than those in group NC [(1.54±0.27) vs(1.00±0.00), (1.56±0.26) vs(1.00±0.00), (1.75±0.28)vs(1.08±0.02)μmol/g, allP<0.05]. The levels of serum adiponectin, testicular adiponectin and its receptor 1, and the ratio of P-AMPK to AMPK significantly decreased in group DM than that in group NC [(622.46±95.86) vs (2 022.07±51.13)ng/ml, (0.66±0.09) vs (1.00±0.00), (0.68±0.05) vs (1.00±0.00), (0.34±0.11) vs(1.00±0.00), allP<0.05]. There was no significant difference in the expression of adiponectin receptor 2 between group DM and NC[(1.02±0.13) vs (1.00±0.00),P>0.05]. After 8-week telmisartan treatment, the pathological changes of testes became alleviated in diabetic rats. The levels of P-AKT/AKT, e-NOS and NO significantly decreased in group DT than those in group DM [(1.24±0.39) vs (1.54±0.27), (1.16±0.47) vs(1.56±0.26), (1.35±0.30) vs (1.75±0.28) μmol/g, allP<0.05]. The serum and testicular levels of adiponectin and testicular adiponectin receptor 1 significantly increased in group DT than those in group DM [(1 051.55±102.55) vs (622.46±95.86), (0.84±0.09) vs (0.66±0.09), (0.80±0.07) vs (0.68±0.05), allP<0.05]. No significant difference existed in the ratio of P-AMPK to AMPK in testes or the expression of adiponectin receptor 2 between group DM and NC [(0.65±0.52) vs (0.34±0.11), (1.02±0.15) vs (1.02±0.13), allP>0.05].

Telmisartan may reduce the injury degree of testes and play protective roles in testicular tissues in diabetic rats by regulating the expressions of adiponectin, adiponectin receptor and the signal pathways mediated by adiponectin receptor.

To systematically review the literature regarding the effectiveness and adverse reaction of epidermal growth factor receptor-monoclonal antibodies (RGFR-mAbs) in improving the prognosis of R/M HNSCC so as to develop evidence-based recommendations for treatment.

Comprehensively searches were performed for the databases of CBM, PubMed, Embase and Cochrane to identify the published studies on the effect of RGFR-mAbs in recurrent and/or metastatic head and neck squamous carcinoma (R/M HNSCC) patients. Primary outcomes included overall survival (OS), progression-free survival (PFS) and overall response rate (ORR). And secondary outcomes included such severe adverse events (grade Ⅲ-Ⅳ) as neutropenia, anemia, thrombocytopenia, skin reactions, hypokalemia, vomiting and hypomagnesemia, etc.

A meta-analysis was conducted for 5 randomized controlled trials involving a total of 1 615 patients. Pooled data suggested the efficacies of EGFR-mAbs in R/M HNSCC patients. And adding EGFR-mAbs to conventional therapy led to significantly improved efficacies for R/M HNSCC (ORR: RR=1.61, 95%CI: 1.34-1.92, P<0.001; PFS:HR=0.68, 95%CI: 0.61-0.76, P<0.001; OS:HR=0.84, 95%CI: 0.75-0.95, P=0.004). Adverse events were comparable between EGFR-mAbs and control groups, except for increased incidence in skin reactions, hypomagnesemia, anorexia, exsiccosis and thrombogenesis.

Existing randomized controlled trials support the efficacies of EGFR-mAbs for R/M HNSCC. During Mabs therapy, skin reactions and hypomagnesemia should be closely monitored.

In the past 10 years or so, cochlear implant (CI) has achieved great success in the auditory rehabilitation of children with non-syndromic sensorineural deafness (NSSNHL). Since its introduction in China, it has gradually been popularized and recognized, and has been carried out on a large scale in medical institutions all over the country. In the process of this development, the etiology of congenital deafness has been deepened, especially the increasingly popular deafness gene screening and identification has found the root cause of deafness for many congenital deaf children. According to the epidemiological investigation results, the main genetic genes of deaf children in China are GJB2, SLC26A4 and mtDNA 12srRNA mutations, and similar characteristics are found in children who receive cochlear implants. In addition, hundreds of deafness genes have been reported, but various deafness-causing mechanisms are still in the exploration stage, and their impact on prognosis is inconclusive. About 20% of patients with hereditary deafness in China are caused by mutations in SLC26A4 gene^[1]This study is based on the observation of the efficacy after CI in patients with non-syndromic hereditary deafness, and preliminarily investigates the correlation between the cause of deafness and prognosis, in order to provide clinical reference data for deafness prevention, treatment and prognosis prediction.

An 85-year-old male was admitted to the hospital on 3 March 2014 due to "abdominal aortic aneurysm found on physical examination for half a month". History of previous hypertension, renal insufficiency, cerebral infarction. Admission physical examination: blood pressure 120/80 mmHg (1 mmHg =0.133 kPa); The abdomen was flat and soft, and a pulsatile mass was palpable on the left of the umbilicus, 4 cm ×3 cm ×2 cm, without tenderness; The bilateral femoral arteries pulsed well. Creatinine 202 μ mol/L, D-dimer 5 410 μ g/L. Total aortic CT angiography (CTA): branch variation of abdominal aorta, splenic artery from abdominal aorta, common hepatic artery from superior mesenteric artery; Infrarenal abdominal aortic aneurysm with mural thrombosis, with a maximum diameter of about 50 mm; Bilateral common iliac artery aneurysms, with a maximum diameter of about 30 mm on the right side and 22 mm on the left side, both accumulated internal iliac artery openings; Aneurysm of the initiation of the right internal iliac artery, stenosis of the initiation of the left internal iliac artery (Figure 1)； Three pairs of slender lumbar arteries can be seen in the aneurysm segment. Carotid ultrasound showed multiple heterogeneous plaque formation in bilateral carotid arteries. Cardiac ultrasound showed a small amount of pericardial effusion, aortic valve calcification with a small amount of regurgitation, and mild pulmonary hypertension.

The patient, a 62-year-old male, was admitted to the Department of Gastroenterology of Tongji Hospital on September 14, 2014 with the main complaint of "nausea and vomiting for 1 week, aggravated with stopping defecation for 3 days". The patient experienced upper abdominal distension and pain accompanied by nausea and vomiting after eating overnight food 1 week before admission. The vomit was stomach contents, brown, and vomiting was severe. The patient vomited after eating, not in the form of a jet, and had nothing to do with activity. After vomiting, the upper abdominal distension and pain could be slightly relieved, accompanied by fatigue. Before admission, the patient was treated with levofloxacin 0.5 g/d ×7 d intravenous drip. The above abdominal discomfort, nausea and vomiting symptoms gradually worsened, and defecation stopped 3 d before admission, with exhaustion. On September 11th, the laboratory examination of our hospital outpatient clinic showed that white blood cells were 12.6×10⁹/L, neutrophil percentage 0.60, neutrophil 7.7×10⁹/L, C-reactive protein 13 mg/L, transaminase, troponin, blood amylase and lipase were normal. He had a history of hypertension for more than 10 years and gallbladder stones for 20 years. Abdominal B-ultrasound showed gallbladder stones (about 30 mm in diameter) during physical examination 1 month before admission, and there was no history of acute cholecystitis. Physical examination at admission: soft abdomen, mild tenderness in the upper abdomen, no rebound pain, and no mass in the abdomen. Liver and spleen were not subcostal, Murphy's sign was negative, there was no percussion pain in the liver and kidney area, abdominal tapping and drum sound, and intestinal sound 4 times/min. After admission, considering the possibility of acute gastroenteritis and incomplete intestinal obstruction, anti-infection (cephalosulbactam, ornidazole), acid suppression (lansoprazole), gastric mucosa protection (aluminum-magnesium plus suspension), nutritional support and other treatments were given. There was no obvious obstruction in the abdominal upright X-ray plain film. On the second day of admission, the patient gradually began to develop right upper abdominal pain with nausea and vomiting. The pain was paroxysmal, without radiation, and the vomit was a large amount of dark green bile. Gastrointestinal decompression was given. The drug treatment plan was the same as before. Gastroscopy on the third day of admission: multiple ulcers in the duodenal bulb (one 0.6 cm ×1.0 cm deep ulcer in the anterior wall of the bulb, one 0.4 cm ×0.5 cm ulcer in the lower wall, and dark green liquid reflux below the descending part); gastric retention; Multiple flaky ulcers of the lower esophagus (Figure 1，Figure 2)。 On the 4th day of admission, enhanced CT of the upper abdomen showed unclear gallbladder, incomplete small intestinal obstruction, and huge stones in the intestine (Figure 3)。 Cholecystoduodenal fistula with calculous small intestinal obstruction was considered and transferred to general surgery. On September 22nd, laparoscopic exploration and jejunolithotomy were performed under general anesthesia. During the operation, a large number of large omental adhesions in the right upper abdomen were fixed at the gallbladder fossa, and the proximal jejunum was obviously dilated. The thickest intestinal tube was about 6 cm in diameter, and the huge stones in the intestinal tract could be reached about 30 cm away from the Trigger's ligament, resulting in intestinal obstruction, obvious local small intestinal edema and emptiness of the distal small intestine. The local small intestine was incised and the stone was removed. The stone was hard in texture and about 6 cm in diameter. After operation, he was treated with fasting, gastrointestinal decompression, anti-infection (cefmetazole), acid suppression (lansoprazole), nutritional support, etc., and was successfully discharged from hospital on October 4, 2014. Discharge diagnosis: (1) Calculous incomplete small intestinal obstruction, cholecystoduodenal fistula; (2) complex ulcer; (3) Grade 1 medium risk group of hypertension.

The continuous innovation of the new generation of sequencing technology has applied gene sequencing technology to the single cell level. At present, the pathogenesis of tumor has not been clearly elucidated. As we all know, malignant tumor is a molecular disease, and its activation of oncogenes and inactivation of tumor suppressor genes caused by gene level changes play a crucial role in its development. Moreover, the development of many tumors will go through different stages, resulting in the existence of different grades and types of tumor cells within a tumor or between multiple tumors. Therefore, using single cell sequencing technology to study malignant tumors in depth, we can find various gene mutations, tumor heterogeneity, drug resistance, etc. that lead to the occurrence and evolution of malignant tumors, so as to help us understand the occurrence, development and evolution of malignant tumors at the individual level.