Volume 95  ·  Issue 26  ·  2015

As early as the 1980s, some foreign doctors reported that individual children had multiple paraganglioma with polycythemia and malignant hypertension^[1,2]The tumor still recurred multiple times after surgical resection. In 2012, Pacak and Zhuang reported two similar patients and systematically summarized the disease and elucidated its molecular mechanism. Since then, its mystery was uncovered, so it was named "Pacak-Zhuang syndrome"^[3]。

After more than 20 years of development, although Zhejiang Province has initially established a standardized training system for residents, due to the lack of rigid regulations on teachers' admission, it only makes simple requirements in terms of academic qualifications and professional titles, which leads to inconsistent teachers' quality in various training bases, which affects the goal of homogenization of standardized training for residents in the whole province. To this end, Zhejiang Province launched a large-scale standardized training of residents in 2013, stipulating that all clinical training bases, community practice bases and theoretical teachers need to participate in teacher training. Through a series of teacher training courses and training behaviors, we will build a high-level, high-quality teacher team that is suitable for the development of standardized training of residents. The practice process of teacher training for standardized training of residents is described as follows.

To determine risk factors of overt/non-overt disseminated intravascular coagulation (DIC) in abdominal aortic aneurysm (AAA) patients undergoing endovascular aneurysm repair (EVAR).

In a retrospective study, 117 patients undergoing selective EVAR for AAA were investigated for overt/non-overt DIC from June 1st 2013 to December 31 2014. The following parameters were reviewed: D-dimer, Platelet count, fibrinogen and prothrombin time (PT) at before operation and 1, 2, and 7 days after operation. Non-overt DIC was defined as International Society on Thrombosis and Hemostasis (ISTH) score between 2 and 5, and overt DIC score ≥5. Factors associated with overt/non-overt DIC were identified by stepwise Logistic regression.

Among 117 patients, who received EVAR for AAA, 3 patients (2.5%) were diagnosed as overt DIC and 31 patients (26.5%) were diagnosed as non-overt DIC. Univariate analysis showed significant risk factors for overt/non-overt DIC were aging, operating duration, blood loss, renal dysfunction and endoleak (P<0.05). Stepwise Logistic regression showed that independent risk factors for overt/non-overt DIC were endoleak (B=2.118, SE=0.917, Wald=5.335, P=0.021), renal dysfunction (B=2.135, SE=0.797, Wald=7.183, P=0.007) and operating duration (B=0.021, SE=0.006, Wald=11.126, P=0.001).

Independent risk factors for non-overt DIC in patients who received EVAR for AAA are endoleak, renal dysfunction and operating duration.

To compare the efficacies of endoscopic harvesting saphenous vein as sequential graft by pedicled and scheltoned technique.

From June 2013 to December 2013, a total of 93 patients undergoing coronary artery bypass with endoscopic vein harvesting in shank were recruited. Saphenous veins were harvested by pedicled method in group A (n=46) and scheltoned method in group B (n=47). Harvesting method was decided by a random number for each patient. Saphenous veins were used as sequential grafts during off-pump coronary artery bypass. Inter-group comparisons were made in time for harvesting, time for repairing, venous injuries and perioperative effect of saphenous vein. The postoperative follow-up period was 30 days. Early failure of saphenous vein graft was evaluated with coronary computed tomography (CT) angiography.

All saphenous veins in shank were harvested successfully. No significant difference existed in vein length. In groups A and B, average time for harvesting was (21.7±5.6) and (27.4±6.4) min (P<0.05) and time for repairing (7.2±2.7) and (10.6±4.4) min respectively (P<0.05). No severe injury resulted in non-using of saphenous in both groups. The repair rates of saphenous vein were 10.9% and 38.3% respectively (P<0.05). For each repaired saphenous vein, the average number of locations was (1.6±0.5) and (3.1±1.0) sites respectively (P<0.05). All patients were discharged uneventfully. There was no perioperative onset of myocardial infarction or malignant arrhythmia. For groups A and B, 89.1% and 93.6% were followed up for 1 month post-operation. No angina, myocardial infarction or heart failure occurred. For groups A and B, 32 and 37 cases were re-examined on CT coronary angiography and all saphenous vein grafts maintained patency.

Pedicled method is more safe and reliable for endoscopic saphenous vein harvesting. It can ensure the quality of sequential graft, shorten harvesting time and reduce the risks of vein injury.

To investigate the incidence and analyze the factors related to bone loss after renal transplantation, in order to guide the intervention of it.

We picked up 263 cases of renal transplantation outpatients with well graft function from February to May 2014 according to random number table. Bone mineral density(BMD)were examined by quantitative ultrasound and other demographic information and clinical data were collected. According to the diagnostic criteria of the osteoporosis established by WHO, the selected patients were divided into osteoporosis group (n=62) and normal group (n=63), univariate analysis and Logistic regression analysis were used to determine related factors responsible for bone loss after renal transplantation.

The percentage of bone loss in renal transplant recipients was 76.05% (200/263). Logistic regression analysis revealed the risk factors of osteoporosis in renal transplant recipients were age older than 50 years old(P=0.01), parent fractured hip history(P=0.00), high dose of corticosteroid(P=0.02). Compared with those not being treated with calcitriol, patients intake calcitriol see 8.80% decreased incidence of bone loss.

A high incidence of bone loss is found in renal transplant recipients. Age, parent fractured hip history, corticosteroid dose are related factors of osteoporosis in renal transplant recipients. Calcitriol is effective in preventing and treating bone loss in renal transplant recipients.

To investigate the expression of CD22 and its downstream signal molecule spleen tyrosine kinase(SYK) and their phosphorylation of B lymphocytes in patients with immune related pancytopenia(IRP), and to explore the role of CD22 in pathogenesis of IRP.

The expression of CD22, SYK and their phosphorylation, along with the expression of IgG and IgM, which obtained from B lymphocytes in peripheral blood of 46 patients with IRP(22 new diagnosed and 24 remitted patients returned to normal after treatment), 22 healthy controls and 12 chronic lymphocytic leukemia(CLL) patients from February to December 2014 were analyzed by flow cytometry. And the mRNA expression of CD22 in peripheral blood mononuclear cell was determined by real-time quantitative PCR.

The ratios of CD22⁺ cells and phosphorylated CD22(pCD22)⁺ cells of B lymphocytes in new diagnosed group(60.03%±20.94%, 71.32%±11.16%) were significantly higher than those in remission group(46.92%±20.04%, 55.82%±14.42%), normal control group(46.86%±17.78%, 53.28%±14.76%) and CLL group(39.74%±18.96%, 59.07%±17.09%)(all P<0.05). The ratios of phosphorylated SYK(pSYK)⁺ cells in the four groups had the same trend (all P<0.05). The ratio of pCD22⁺ cells/pSYK⁺ cells in new diagnosed group was significantly lower than that in normal control group and CLL group (27.39(5.06-102.70) vs 55.95(15.25-298.53), 56.92(5.60-228.96), both P<0.05), and pCD22⁺ cells positively correlated to pSYK⁺ cells(r=0.341, P<0.05). The expression of IgG in new diagnosed group and remission group was significantly higher than that in normal control group , and the expression of IgM in new diagnosed group was significantly higher than that in normal control group and CLL group(allP<0.05). The expression levels of CD22 mRNA in new diagnosed group was significantly higher than that in remission group, normal control group and CLL group (allP<0.05).

The BCR signal pathway of B lymphocyte in IRP patients is enhanced, and the quantity and function of CD22 are increased, while which are still insufficient to inhibit B cell proliferation, and these may have some relationships with the pathogenesis of IRP.

To explore the mutation status of epidermal growth factor receptor (EGFR) fusion gene and microtubule associated protein like 4-anaplastic lymphoma kinase (EML4-ALK) fusion gene in superficial lymph nodes of non-small cell lung cancer (NSCLC).

The technique of fluorescent quantitative polymerase chain reaction (FQ-PCR) was employed for detecting the mutation rate of EGFR gene and EML4-ALK fusion gene for 40 cases of superficial lymph node tissue of NSCLC inpatients at General Military Hospital of Beijing PLA Command from February 2013 to November 2014. And then the correlations were analyzed between EML4-ALK fusion gene and EGFR gene with clinical features and the clinical efficacies of targeted therapy.

The mutation rate of EGFR gene was 35% (14/40) and 50% (10/20) in non-smokers and 46.7% (14/30) in adenocarcinoma patients. The mutation distribution was as follows: exon 18 (n=1), exon 19 (n=8) and exon 21 (n=5). The mutation rate of EML4-ALK fusion gene was 2.5% (1/40). EGFR gene mutation was predominantly present in non-smokers (P<0.05) and adenocarcinoma (P<0.01) while no significant difference existed between gender, age or stage (P>0.05). Those on a targeted therapy had a disease control rate of 93.3%.

Both EGFR gene and EML4-ALK fusion gene may be detected in superficial lymph nodes of NSCLC patients. The mutation rate of EGFR gene is high in adenocarcinoma and non-smokers while EML4-ALK fusion gene has a low mutation rate.

To explore the effects of high-flux hemodialysis (HFHD) on fibroblast growth factor 23 (FGF-23) and micro-inflammatory state in end-stage renal diseases (ESRD) patients to understand the advantages of HFHD in reducing complications in ESRD patients.

A total of 60 subjects sheduled for hemodialysis at our hospital in 2012 were randomly divided into two groups of 3-month HFHD and 3-month low-flux hemodialysis (LFHD) (n=30 each). The levels of serum factors, such as FGF-23, were observed before and after 3-month hemodialysis to evaluate the hemodialysis sufficiency of two groups and analyze the effects of FGF-23 related factors as well as different kinds of hemodialysis on micro-inflammatory state, biochemical indices and dialysis sufficiency.

Before hemodialysis, no inter-group statistical difference (P>0.05) existed in age, gender, basic disease, nutrition and levels of hemoglobin (Hb), albumin (ALB), estimated glomerular filtration rate (eGFR), Ca²⁺ , P^3-, parathyroid hormone (PTH) and FGF-23 before treatment. After 3-month hemodialysis in two groups, there were a negative correlation between FGF-23, Ca²⁺ or 1, 25-(OH)₂VitD₃, a positive correlation between FGF-23 and ALB, P^3-, PTH, C-reactive protein (CRP) or interleukin-6 (IL-6) and a negative correlation between FGF 23 and HFHD group (P<0.05) and no significant correlation between FGF-23 and Hb or KT/V (P<0.05). Variance analyses were conducted for each factor before and after hemodialysis, indicating that Hb, ALB and Ca²⁺ significantly increased in both groups after 3-month hemodialysis (P<0.05) and 1, 25-(OH)₂VitD₃ significantly elevated in HFHD group (P<0.05) but not in LFHD (P>0.05). Serum phosphate significantly decreased after 3-month hemodialysis in both groups (P<0.05) and CRP, IL-6, PTH and FGF-23 significantly decreased in HFHD group (P<0.05), but not in LFHD group (P>0.05). The levels of P^3-, CRP, IL-6, PTH and FGF-23 after 3-month hemodialysis were significantly lower in HFHD group than those in LFHD group (P<0.05) while the levels of Hb and 1, 25-(OH)₂VitD₃ after 3-month hemodialysis were significantly elevated in HFHD group compared with those in LFHD group (P<0.05). And no significant inter-group difference existed in the levels of Ca²⁺ , ALB and KT/V.

Compared with LFHD, HFHD is superior in treating anemia and improving nutrition. And HFHD can better decrease FGF-23, correct calcium and phosphorous metabolic disorder and improve micro-inflammatory state.

To establish and verify the reference intervals for leukocyte differential count in peripheral blood by CytoDiff flow cytometry.

Leukocyte differentiation count was analyzed by using hematology analyzer, CytoDiff flow cytometry and morphology differential count in 278 healthy controls, 550 flagged and 102 unflagged samples. The reference intervals of leukocyte parameters were established and verified according to the healthy controls. Then the correlations of five leukocytes were analyzed among hematology analyzer, CytoDiff flow cytometry and morphology differential count.Lymphocyte subsets were analyzed and compared between healthy controls and patients with different diseases. The CytoDiff flow cytometric blast counts were explored to analyze the clinical diagnostic efficiency compared to morphology differential count as a reference method.

CytoDiff flow cytometry can differentiate the leukocyte into 16 parameters, including percentage and absolute count, therefore 32 parameters in total. Among these parameters, 18 parameters had significant difference between male and female (P<0.05), and the others had no difference (P>0.05). Except the CD16^pos monocyte, there were no difference among ages in other parameters. The correlation between hematology analyzer, CytoDiff flow cytometry and morphology differential count were good for neutrophils, lymphocytes, monocytes, basophils and eosinophils in healthy controls and clinical samples. When the cutoff value of the ratio of T+ NK and B lymphocyte was set at 1.0 by ROC, the sensitivity was 90.9% and specificity was 99.8% for diagnosing the chronic lymphocyte leukemia (CLL). When the cutoff value of blast count by CytoDiff flow cytometry was set at 1% , the sensitivity was 100%, specificity was 96.1% and accuracy was 96.2% by morphology differential blast count for the reference method.

Establish and verify the reference interval of leukocyte differential count in peripheral blood by CytoDiff flow cytometry in the adults of Beijing region. CytoDiff flow cytometry provide more parameters than hematology analyzer and morphology differential count, and therefore have excellent clinical diagnostic efficiency, especially for CLL and blasts from acute leukemia.

To compare the risk factors and resistance characterizations between the Community-associated (CA) and Hospital-associated (HA) bloodstream infections (BSIs) caused by extended-spectrum β-lactamase-producing(ESBLs) Escherichia coli. Infections control strategy must be made for the spread of CA E. Coli.

Fifty-one samples of ESBLs-producing BSI E. Coli were collected in 3201 hospital affiliated of Xi'an jiaotong University School of Medicine from 2008 to 2013. Antimicrobial agents susceptibility test and ESBLs confirmation test were determined by K-B method. PFGE was used to investigate the clonality of clinical isolates. PCR amplification and sequencing were used to screen ESBLs genes. Plasmid conjugation assay was used by filter mating. An S1-PFGE assay on plasmid and southern blot were performed to determine the plasmid molecular size and resistance genes location.

There were 27 community-associated samples, while 24 hospital-associated samples in 51. And patients with community-acquired infections were increasing year by year. Also there was a significant difference between patients with urinary tract infection and cancer in CA and HA. Cases of urinary tract infection were mainly CA, reaching to 18.40 of OR value, and from 2.161 to 156.7 of 95% confidence interval. While Cases of cancer gave priority to HA, OR value was 0.147 7 with 0.034 85 to 0.626 30 of 95% confidence interval. PFGE results did not support the evidence of clone dissemination. Among 51 strains, 26 TEM genotype, including 12 CA strains, 12 SHV genotype, including 5 CA strains, 21 CTX-M-1 genotype, including 10 CA strains , and 25 CTX-M-9 genotype. including 13 CA strains. All ESBLs resistant genotypes were no significant differences in the two groups.

Urinary tract infection is risk factor for community-aassociated bloodstream infection caused by E. Coli relatively. Degree of drug resistance of ESBLs-producing E. Coli isolated from Community-Associated Bloodstream Infections is close to Hospital-Associated. So the public health control measures are needed to prevent the further spread of CA ESBLs-producing E. Coli.

To explore the clinical characteristics of retroperitoneal malignant fibrous histiocytoma (MFH) and to retrospectively evaluate the outcome of treatment and identify prognostic factors for survival time.

The records of 38 patients with retroperitoneal malignant fibrous histiocytoma(MFH) managed with surgery from March 2000 to August 2013 were retrospectively reviewed.

All patients received surgical resection, including 23 primary tumors and 15 recurrent tumors.20 patients received radical resection, 18 cases received palliative resection. The 19 patients(95%) received complete resection got tumor recurrence.The overall 1-, 3-, 5-year survival rate were 62.9%, 35.2% and 4.4% and the median survival time was 15.5(1-157) months. Log-rank test indicated that tumor grade (χ²=10.667, P<0.01)and radical surgery(χ²=18.476, P<0.01) were associated with postoperative survival time. The difference between gender(χ²=3.329, P=0 .068), age(χ²=0.426, P=0.514), removal of the joint organs(χ²=3.725, P=0.054), blood transfusion(χ²=0.044, P=0.833), tumor size(χ²=1.647, P=0.199), tumor metastasis(χ²=0.345, P=0.557), adjuvant therapy(χ²=1.992, P=0.158), recurrent disease(χ²=0.163, P=0.640)got no statistical significance.Multivariate analysis indicated that radical surgery and tumor grade were prognostic indicators for retroperitoneal malignant fibrous histiocytoma(RR=4.888, P=0.001; HR=4.436, P=0.006).

Malignant fibrous histiocytoma (MFH) has high malignant degree and is difficult to treat. The prognosis is poor. Complete resection remains the main method for retroperitoneal malignant fibrous histiocytoma.It often requires the resection of other adjacent organs in order to reach the goal of radical resection. Incomplete resection and high grade(grade 3)predict shorter postoperative survival time.

To explore the regulatory mechanism of Siah1 in the pathogenesis of hypoxic pulmonary hypertension (HPH) in rats.

According to the random number table, 40 adult male Wistar rats were randomly divided into 5 groups (n=8 each). And the animals were exposed to normoxia or hypoxia for 3, 7, 14 or 21 days respectively. The HPH model was established by normobaric intermittent hypoxia. Mean pulmonary arterial pressure (mPAP), ratio of vascular wall area to total vascular area (WA%), ratio of vascular lumen area to total vascular area (LA%) and right ventricle hypertrophy index (RVHI) were measured. The mRNA and protein relative levels of hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) were detected byin situ hybridization and immunohistochemistry respectively. Reverse transcriptase-polymerase chain reaction (RT-PCR) and in situ hybridization were used to determine the relative expressions of mRNA of hypoxia-inducible factor-1 (FIH) and Siah1. Immunohistochemistry and Western blot were employed to determine the relative expressions of proteins of FIH and Siah1.

The levels of mPAP, WA% and LA% were significantly higher after 7-day hypoxia than those in normoxic control ((21.3±1.6) vs (15.9±1.3) mmHg (1 mmHg=0.133 kPa), (41.4±2.8)% vs (35.0±2.2)%, (58.6±2.8)% vs (65.0±2.2)%, all P<0.05). The level of RVHI was significantly higher after 14-day hypoxia than that in normoxic control ((27.0±1.8)% vs (3.2±2.1) %,P<0.05). The relative expression of HIF-1α mRNA was significantly higher after 14-day hypoxia than that in normoxic control (0.188±0.014 vs 0.150±0.014,P<0.05). The relative expression of HIF-1α protein was significantly higher after 3-day hypoxia than that in normoxic control (0.186±0.014 vs 0.067±0.008,P<0.05). The relative levels of VEGF mRNA and protein were significantly higher after 7-day hypoxia than those in normoxic control (0.152±0.019 vs 0.057±0.007, 0.176±0.017 vs 0.083±0.010, bothP<0.05). The relative expression of FIH mRNA had little changes after exposure to hypoxia compared with normoxia. However the related expression of FIH protein was markedly lower after 7-day hypoxia than that in normoxic control (0.166±0.015 vs 0.200±0.017,P<0.05). The relative levels of Siah1 mRNA and protein were markedly higher after 7-day hypoxia than those in normoxic control (0.144±0.014 vs 0.067±0.010, 0.136±0.017 vs 0.084±0.019, bothP<0.05). Linear correlation analysis showed that HIF-1α protein was positively correlated with the relative levels of VEGF mRNA and VEGF protein (r=0.545, 0.523, both P<0.01) while FIH protein was negatively correlated with the relative levels of VEGF mRNA and VEGF protein (r=-0.785, -0.788, both P<0.01). There was a positive correlation between the relative levels of Siah1 mRNA and Siah1 protein (r=0.823, P<0.01) while a negative correlation existed between the relative levels of Siah1 protein and FIH protein (r=-0.671, P<0.01).

Under chronic hypoxia, Siah1 is transcriptionally induced in pulmonary arterioles and it facilitates the degradation and decline of FIH in rats. And deceased FIH protein in pulmonary arterioles under hypoxia may attenuate its inhibitory effect on the transactivational activity of HIF-1α and promote the transactivation of such HIF-1α target gene as VEGF. Thus it is probably implicated in the pathogenesis of HPH.

To explore the effects of chemerin on the proliferation of 3T3-L1 preadipocytes and elucidate its possible mechanism.

Recombinant lentivirus-mediated silencing or over-expression of chemerin gene were constructed in 3T3-L1 cells. The proliferation of 3T3-L1 cells was examined by the assays of methyl thiazolyl tetrazolium (MTT) and 5-bromo-2-deoxyuridine (BrdU) incorporation. The expressions of chemerin, ERK1, ERK2 and cyclinD1 in 3T3-L1 cells were detected by real-time reverse transcriptase-polymerase chain reaction (RT-PCR). The protein levels of chemerin, ERK1/2 and p-ERK1/2 were detected by Western blot.

MTT and BrdU results showed that absorbance (A) value and BrdU incorporation increased in chemerin over-expression group compared with over-expression control group [1.09±0.08 vs 0.90±0.09, (126.5±14.6)% vs (100.0±7.0)%, both P<0.05]. The increase ofA value and BrdU incorporation in chemerin over-expression group could be inhibited by PD98059, a blocker of ERK1/2 signal pathway. A value (0.91±0.13) and BrdU incorporation [(104.3±10.7)%] decreased compared with over-expression group (P<0.05). They also decreased in chemerin gene silencing group compared to silencing control group[0.72±0.11 vs 0.90±0.09, (77.6±11.8)% vs (99.7±6.3)%, bothP<0.05]. Quantitative real-time PCR revealed that over-expression group had a higher expression in chemerin, ERK1, ERK2 and cyclinD1 than over-expression control group (2.77±0.31 vs 1.01±0.12, 1.39±0.19 vs 0.76±0.30, 1.46±0.14 vs 0.88±0.14, 1.44±0.17 vs 1.03±0.15, allP<0.05). Chemerin gene silencing group had lower expressions of chemerin, ERK1, ERK2 and cyclinD1 than silencing control group (0.35±0.12 vs 1.25±0.31, 0.64±0.15 vs 1.03±0.14, 0.56±0.10 vs 1.06±0.29, 0.66±0.13 vs 1.09±0.19, allP<0.05). Western blot showed that the expressiond of chemerin, ERK1/2 and p-ERK1/2 increased in chemerin over-expression group versus over-expression control group (2.18±0.32 vs 1.18±0.14, 1.37±0.05 vs 0.97±0.12, 1.06±0.09 vs 0.56±0.08, allP<0.05). The expressiond of chemerin, ERK1/2 and p-ERK1/2 decreased in chemerin gene silencing group versus silencing control group (1.00±0.07 vs 1.40±0.17, 0.87±0.15 vs 1.20±0.12, 0.49±0.07 vs 0.91±0.11, allP<0.05).

Chemerin may promote the proliferation of 3T3-L1 cells. And it may be achieved via an up-regulated expression of ERK1/2.

To investigate the effects of Toll like receptor (TLR)signaling activation on the malignant biological behavior of gastric cancer cell lines.

RT-PCR was employed to detect the basal expression of TLRs in the gastric cancer cell lines. According to the basal RNA expression, the proteic expression of TLR4 of the cell lines was examined using Western blot analysis. BGC823 and AGS cell lines were chosen for investigating the effects of TLR4 signaling activation on the biological behavior due to the high level of TLR4 proteic expression.

TLR4 RNA expression was higher than any other TLRs in the gastric cancer cell lines. Higher relative proteic expression of TLR4 was observed in BGC823(1.41±0.05)and AGS(1.22±0.05)(all P<0.05). Activation of the TLR4 signaling pathway by LPS increased proliferation, migration and invasion of BGC823 and AGS cell lines (allP<0.05).

TLR4 may participate in the metastasis of gastric cancer through promotes the malignant biological behavior of gastric cancer cell, and may be a potential therapeutic target.

To compare the survival results of liver transplantation with radical resection for klatskin tumor based on the published literatures.

We retrieved Medline for articles on treatment of klatskin tumor published from January 1996 to December 2014, and choose the literatures including liver transplantation and radical resection. Review Manager 5.0 software was used to perform the Meta-analysis of the extracted data.

After performing meta-analysis of 11 studies including 676 patients, we found comparable patient survival rate between liver transplantation group and radical resection group (1-year RR: 1.00, 95%CI: 0.82-1.23, P=0.97; 3-year RR: 1.15, 95%CI: 0.75-1.77, P=0.51, 5-year RR: 1.37, 95%CI: 0.74-2.53, P=0.32, respectively). No statistical significance of overall survival rate were shown between this 2 groups whether in short-term or long-time, but the total survival trends show the long-time survival of LT group is better than that of RR group which has the potential longer survival time.

Liver transplantation was equivalent to radical resection for klatskin tumor treatment in terms of patient survival, with potential higher long-term patient survival rate and lower recurrence.especially for the patients with unrespectable KT or insufficient liver function, LT is superior for clinical outcome.

Electron density deposition disease (DDD) mainly occurs in children and adolescents^[1]With limited reports at home and abroad. The clinical data of 4 patients with DDD confirmed by renal biopsy in the Second Xiangya Hospital of Central South University from January 2004 to December 2013 are reported below.

Craniocerebral trauma is a serious and critical disease in clinical practice. Its characteristics such as rapid change of disease, many complications, high rate of disability and mortality have attracted great attention in clinical practice^[1,2]。 For patients with craniocerebral trauma who have coma symptoms after operation, treatment should be carried out immediately, otherwise it will lead to serious consequences. Some data show that both hyperbaric oxygen (HBO) and right median nerve electrical stimulation (RMNS) can have a better effect on the recovery of postoperative neurological function in patients with craniocerebral trauma^[3]。 In order to explore the feasibility of HBO combined with RMNS therapy and the important value of neurological recovery after craniocerebral trauma, the clinical data and treatment effect of 62 patients with craniocerebral trauma admitted to our hospital from October 2011 to July 2013 were analyzed to evaluate the clinical value of HBO combined with RMNS therapy.

A 24-year-old male was admitted to the Department of Gastroenterology of Peking Union Medical College Hospital in April 2014 due to fever and multiple serous effusion for 2 months. The patient developed fever 2 months ago, accompanied by cough and chest tightness, with a peak body temperature of 38~39℃. The local hospital checked the serum anti-tuberculosis antibody positive, and found pleural and peritoneal effusion. Isoniazid, rifampicin, ethambutol and pyrazinamide were given quadruple anti-tuberculosis treatment for 1.5 months (during which the drug was discontinued for 1 week due to abnormal liver function). The symptoms gradually worsened, and there was skin pigmentation throughout the body, numbness at the fingertips of both hands, and blurred vision. Pleural and peritoneal effusion puncture and drainage were submitted for examination and revealed "exudate". The patient suffered from poor spirit, diet and sleep, and lost 15 kg of weight. Past history, marriage and childbirth history is not special. Personal History: The patient was from a rural area of Inner Mongolia and worked in electric welding. Family history: My mother suffered from "tuberculous pleurisy" more than 20 years ago, and she was recently active. She took rifampicin orally by herself. Physical examination: The skin of the whole body is pigmented and rough, the nails of both hands are white, a small hemangioma can be seen on the back, and multiple swollen lymph nodes can be palpable in the neck, axilla and groin on both sides, 1.0~1.5 cm in size, tough in texture, without obvious fusion. Bilateral breast symmetry, abnormal development, no tenderness, no palpable mass. The breathing sound of both lungs was thick, and the breathing sound of both lower lungs was reduced; The heart rhythm is uniform, the heart sound is strong, and there is no murmur in the precordial area; The abdomen is obviously swollen, the intestinal sound is normal, the mobile voiced sound is positive, the touch is tough, and there is a feeling of kneading the dough; No edema in both lower limbs; No neck ankylosis.

The patient, a 62-year-old female, developed right lumbar distension and pain without obvious trigger 3 days ago, without radiation pain, accompanied by nausea, and CT showed that the lower pole of the right kidney occupied space. She was seen in Shaoxing People's Hospital of Zhejiang Province on December 19, 2014. Physical examination: No percussion pain in bilateral kidney area, no tenderness in ureteral indentation. There were no abnormal findings in urine routine, and the flow red blood cell count was 197.4/μ L (normal range 0-40/μ L); There were no abnormal findings in oncology; Abdominal B-ultrasound: A hypoechoic substantial mass of 54 mm ×42 mm ×37 mm in size was detected at the lower pole of the right kidney, which protruded locally to the outside of the capsule and had irregular shape (Figure 1)； CT: A mass of about 45.7 mm ×37.4 mm in size was seen at the lower pole of the right kidney. The CT value of plain scan was about 40 HU, showing isodensity; The arterial phase was mildly enhanced, with a CT value of about 60 HU, seeming to see a pseudocapsule, and compression of the right pelvis and calyces. On December 22, he underwent "radical resection of right nephrocarcinoma" under general anesthesia and was sent for pathological examination. Gross specimen examination: the size of the right nephrectomy specimen was 140 mm ×70 mm ×60 mm, and the size of the lower pole mass was 45 mm ×40 mm ×25 mm. The section surface was gray-white and gray-yellow, partially yellow and granular, and the boundary with the surrounding kidney tissue was still clear (Figure 2)； Morphological characteristics of HE: The renal parenchyma is partially destroyed and replaced by a large number of proliferating fibrous tissue. A large number of lymphoid and plasma cell infiltration can be seen between spindle cells, which is similar to the morphological changes of inflammatory myofibroblastoma. Multiple abscesses are formed in multifocal chronic suppurative inflammation. Actinomycete mass can be seen in the center of the abscess, and the mass is surrounded by eosin radially parallel clusters (FIG. 3A，FIG. 3B)。 Pathological diagnosis: actinomycosis of the right kidney.

A 67-year-old male was admitted for "repeated vomiting for 3.5 months with emaciation". In May 2014, he came to Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine for treatment due to "repeated vomiting for 0.5 months". The vomit is the stomach content, and the amount is about 500-1 000 ml each time, 1-2 times a day. Physical examination: Vibrating water sound was accessible in the left upper abdomen, and no obvious abnormalities were found. Laboratory tests showed no abnormalities. Enhanced CT of the abdomen showed gastric cavity dilation. Gastroscopy: gastric cavity dilatation, a large amount of food residue and mucosal edema can be seen; The pyloric foramen is deformed, but it contracts well; Deep concave ulcers with a diameter of 0.8 cm were seen on the anterior and posterior walls of the duodenal bulb, respectively, with white coating on the surface, obvious congestion and edema in the peripheral mucosa, narrow junction between the bulb and the descending bulb, and the lens body barely passed through, but the descending mucosa was no different. The diagnosis was "multiple ulcer of the duodenal bulb with pyloric insufficiency obstruction" (Figure 1)。 "Inflammation" was reported by biopsy of the large curvature of the gastric antrum. The clinical diagnosis was pyloric obstruction and duodenal ulcer. He was given conservative treatment such as acid suppression and radical cure of Helicobacter pylori for 1 week, and the symptoms were relieved and he was discharged.

The main clinical manifestations of acute respiratory distress syndrome (ARDS) are refractory hypoxemia and respiratory distress. Mechanical ventilation is an important treatment for ARDS. Due to the strong respiratory distress in ARDS patients, coupled with the possible hypercapnia and alveolar collapse caused by low tidal volume ventilation strategy, the Black-Burke reflex is enhanced, and the human-machine asynchrony phenomenon is more likely to occur.