Volume 95  ·  Issue 30  ·  2015

In the past ten years, through the vigorous promotion of many insightful people and the joint efforts of domestic medical colleagues, the diagnosis and treatment of pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) in China has undergone great changes, and the majority of patients have also benefited deeply from it; At the same time, scholars in related fields in China have carried out a series of research work, which has greatly promoted the prevention and treatment of PTE-DVT^[1,2]。 More and more researchers have looked at DVT and PTE as a whole-venous thromboembolism (VTE). As a clinical disease that is most likely to be prevented, it is very important to establish and improve the comprehensive prevention and treatment management system in hospitals.

The technical requirements for the diagnosis of pulmonary thromboembolism (PTE) are high, and the diagnosis method is not suitable for all patients; If the hospital does not have multiple PTE diagnosis technologies, it will affect the diagnosis and treatment of patients. A survey of standardized diagnosis and treatment of PTE in 10 secondary hospitals and 8 tertiary hospitals in Beijing found that 86% of PTE patients were diagnosed by CT pulmonary angiography (CTPA), and CTPA has become the main diagnosis technology of PTE; At the same time, it was found that most secondary hospitals did not have pulmonary ventilation/perfusion imaging and magnetic resonance examination techniques^[1]。 Clinically, 24.4% of patients had at least one contraindication to CTPA test^[2]Some secondary hospitals cannot make a clear diagnosis of PTE for these patients. In addition, how to judge whether they are PTE and get timely treatment for those who cannot undergo confirmation examination due to critical illness is also an important issue for us. Based on this, we initially set the PTE treatment strategy for the primary hospitals that cannot conduct confirmation examination, and elaborate it in the following levels.

The "intestinal micro-ecosystem" of the human body is composed of the intestine and huge microbial community. It is an extremely large and complex micro-ecosystem, containing 15 000~36 000 bacteria species. These bacteria together constitute the dynamic balance of gastrointestinal micro-ecology, participate in the metabolism of human material and energy, regulate the expression of human genes, regulate immunity and nutrition. Intestinal microbiosis is closely related to many diseases, such as obesity, type 2 diabetes, inflammatory bowel disease, and cardiovascular disease, among others. Previous studies have observed changes in intestinal microecology in patients with chronic kidney disease (CKD), and intestinal microecological dysregulation may further accelerate the progression of kidney disease and induce CKD-related complications^[1]。 The relationship between intestinal micro-ecology and kidney disease is described as follows.

To explore the effects of thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-PA) in patients with cardiac arrest from suspected pulmonary thromboembolism (PTE).

A total of 12 hospitalized patients with cardiac arrest from suspected pulmonary embolism at Beijing Chaoyang Hospital from January 2010 to June 2014 were retrospectively studied. Thrombolysis was given only as a single dose of 50 mg of rt-PA during cardiopulmonary resuscitation. And their clinical features, effocacies and outcomes of thrombolysis were analyzed.

There were 6 males and 6 females with a mean age of (54.8±18.6)(16-81) years. Seven patients were hospitalized in surgery ward while another 6 perioperatively. The mean time of resuscitation before thrombolysis was (47.8±26.0) (17-90) min. Nine patients regained spontaneous circulation. The mean time of restored spontaneous circulation was (15.8±5.4) (5-20). The 24-hour survival rate was 8/12. Four patients had bleeding complications, but only 2 life-threatening major cases. Four patients obtained a long-term survival.

For suspected PTE patients with sudden cardiac arrest, thrombolysis therapy with 50 mg of rt-PA may restore spontaneous circulation and boost 24-hour survival rate.

To elucidate the relationship between three common variation loci of von Willebrand factor (VWF) gene (rs216321, rs216325 and rs1800378) and pulmonary thromboembolism.

A total of 95 patients with definite pulmonary thromboembolism (PTE) at Beijing Chaoyang Hospital and Beijing Hospital during November 2008 to March 2012 served as PTE group while 90 healthy subjects at Beijing Hospital during the same period as control group. Fasting venous blood samples were collected for extracting genomic DNA. Three common variation loci with single nucleotide polymorphism were rs216321 (T/C), rs216325 (G/A) and rs1800378 (T/C) and their minor allele frequency was over 0.05 in VWF gene. The method of polymerase chain reaction (PCR)-Sanger was employed for sequencing. The differences of alleleic and genotypic frequencies between PTE and control groups were compared for each locus. And the correlations of their haplotypes with PTE were analyzed.

The distributions of rs216325(G/A) and rs1800378 (T/C) in VWF gene had significant difference between PTE and control groups (P=0.039, 0.006). And rs216325 with genotype AA was positively correlated with PTE occurrence (r=1.914, P=0.047). And rs1800378 with genotype TT was also positively correlated with PTE occurrence (r=0.282, P=0.008). The distributions of haplotype TGT had significant differences between PTE and control groups. This haplotype was positively correlated with PTE occurrence (r=0.239, P<0.001).

The rs216325 and rs1800378 loci variations in VWF gene are associated with PTE, rs216325 with genotype AA and rs1800378 with genotype TT. And haplotype TGT indicates a high risk of PTE onset.

To evaluate the potential utility of a renal function adjusted D-dimer cut-off value for improving the exclusion of pulmonary embolism.

Retrospective analyses were performed for 1 784 inpatients and outpatients with low and moderate probability of pulmonary embolism at Anzhen Hospital from January 2011 to June 2013. The Well's score was used. The diagnoses of pulmonary embolism were confirmed by computed tomography pulmonary angiogram and ventilation-perfusion scan. Based upon estimated glomerular filtration rate (GFR), they were divided into three subgroups of normal renal function, mild renal impairment and moderate renal impairment. Negative D-dimer was defined as a level of age-standardized D-dimer value <500 μg/L. The proportions of patients with negative D-dimer and the utility of D-dimer for ruling out pulmonary embolism were compared between three subgroups. A new D-dimer cut-off point in patients with renal impairment was developed by receiver operating characteristics (ROC) curves and the effect of diagnostic efficiency of ruling out pulmonary embolism with renal function adjusted D-dimer cut-off was assessed.

The medians of D-dimer of three subgroups with normal renal function, mild renal impairment and moderate renal impairment were 291.5, 995.5 and 1 901.5 μg/L ( P<0.001) respectively. The sensitivity of negative D-dimer for ruling out pulmonary embolism was 99%-100% and the specificity 70%, 42% and 23% in three subgroups. The number of patients needed to test (NNT) for one negative test of D-dimer in three subgroups of different renal function was 3.32, 3.58 and 3.95 respectively. The new D-dimer cut-off value increased to 1.2 and 1.75 times of old one in patients with mild and moderate renal impairments and the proportion of patients with a negative D-dimer level rose from 48.7% to 53.0% as compared with old D-dimer cut-off value. The sensitivity and specificity of negative D-dimer for ruling out pulmonary embolism was 98% and 62% with the new cut-off value versus 99% and 57% with the old cut-off value and the NNT of D-dimer for ruling out pulmonary embolism declined from 3.52 to 3.34.

The renal function adjusted D-dimer cut-off point can improve the diagnostic efficiency of D-dimer test for ruling out pulmonary embolism.

To explore the effect of patient-controlled intravenous analgesia (PCIA) with dexmedetomidine and sufentanil on early postoperative cognition in elderly patients after spine surgery.

One hundred fifty-two patients aged more than 60 yr with ASA I-Ⅲ undergoing elective spine surgery were randomly assigned into two groups: Group S received PCIA with only sufentanil (n=77); Group D received PCIA with dexmedetomidine and sufentanil (n=75). The severity of pain at rest and upon movement was measured at 1, 2, 6, 12, 24 and 48 h after surgery using the 11-point numerical rating scale (NRS). Delirium was assessed daily within three days after surgery via the confusion assessment method. Cognitive function was measured at the day before surgery and at one week after surgery using a battery of neuropsychologic tests including Digit Span (forward and backward) subtests and Visual Retention and Paired Associate Verbal Learning subtests of Wechsler Memory Scale, Stroop Color Word Interference Test, Digit Symbol Substitution subtest of Wechsler Adult Intelligence Scale (DSST) and Trail Making Test (Part A).

The NRS scores at rest and upon movement at 6 to 48 h after surgery were lower in Group D than those in Group S (P<0.05). Postoperative delirium (POD) was present in 8 (10.4%) patients in Group S and 3 (4.0%) patients in Group D (χ²=4.206, P>0.05). Two patients with POD in Group S were treated with risperidone. Postoperative cognitive dysfunction (POCD) was present in 15 (19.5%) patients in Group S and 6 (8.0%) patients in Group D (χ²=4.206, P<0.05). Compared with the preoperative baselines, the scores of Digit Span backward, Visual Retention and DSST were significantly lower (3.7±1.3 vs 4.1±1.1, 7.7±2.0 vs 8.8±1.8, 25.2±7.8 vs 28.2±7.6;t=2.132, 3.585, 2.427, respectively, P<0.05) and the time to complete Stroop test was significantly longer in Group S (56.9±14.8 vs 50.2±14.7,t=-2.822, P<0.05), while only the score of Digit Span backward was significantly lower in Group D (3.6±1.2 vs 4.0±1.2,t=2.144, P<0.05).

Dexmedetomidine combined with sufentanil in postoperative PCIA can result in superior analgesia and improve early postoperative cognitive function.

To evaluate the efficiency of the internal carotid artery (ICA) occlusion in treatment of head and neck diseases.

To retrospectively analyze 28 cases related with the ICA. According to the result of balloon test occlusion (BTO) and cerebral angiogram, the balloon, spring coil or glue were used to block the fistula or haemorrhage, sometimes even to embolism the related ICA.

Twenty-six cases and 2 cases presented negative and positive in total 28 cases in BTO. Of the 26 patients, 22 were succeed in ICA occlusion. The clinical symptoms disappeared in some patients, and the others had the related tumor or foreign body being resected. Two cases (glomus jugulare tumors and intractable epistaxis after Juvenile nasopharyngeal angiofibroma surgery in 1 case respectively) presented delayed cerebral infarction. With the thrombolysis anticoagulant therapy, the clinical symptoms in the former disappeared and in the later reduced. The balloon was let out in 1 case with the embolism the distal middle cerebral artery branches. However, the patient did not show any symptoms during the operation and observation period. One case with intractable epistaxis in nasopharygeal cancer after radiotherapy was dead. In emergency, the left ICA was blocked, then bleeding reduced with the left hemisphere presented extensive cerebral embolism. However, he died in nasal bleeding in three days.

ICA occlusion was an efficient method to save the life. Moreover, the patient's tolerance and collateral circulation should be evaluated in detail before the operation.

To explore the expressions of the cytokeratin 7 (CK7), cytokeratin 20 (CK20), SOX10 and cadual type homeobox transcription factor 2 (CDX2) in primary adenocarcinoma of the sinonasal tract, and evaluate their diagnostic values.

A total of 41 paraffin-embeded specimens of primary adenocarcinoma of the sinonasal tract treated in Beijing Tongren Hospital of Capital Medical University were selected from May 2002 to January 2015. All cases were confirmed by histology and clinical data, including 12 cases of non-intestinal sinonasal adenocarcinomas (non-ITACs), 10 cases of intestinal sinonasal adenocarcinomas (ITACs) and 19 cases of salivary gland-type adenocarcinomas (including 12 cases of adenoid cystic carcinomas, 3 cases of polymorphous low grade adenocarcinomas, 2 cases of mucinous adenocarcinomas and 2 cases of acinar cell carcinomas). Expressions of CK7, CK20, SOX10 and CDX2 were assessed by immunohistochemistry staining method.

Nuclear staining for CDX2 was identified in all the ITACs, including diffuse nuclear staining in 8 cases and partial nuclear staining in 2 cases. Cytoplasmic staining for CK20 was identified in 9 cases of ITACs, and partial cytoplasmic staining was found in 1 case of non-ITACs, while CK20 was negative in all other adenocarcinomas.Seven cases of ITACs were negative for CK7, while CK7 was positive in all other adenocarcinomas. CK7, but not CDX2 and CK20, was expressed in normal sinonasal epithelium. SOX10 was negative in 10 cases of ITACs and 2 cases of non-ITACs, and positive in all other adenocarcinomas. The sensitivity of CK7-, CK20+ , SOX10- and CDX2+ in primary ITACs of the sinonasal tract were 70.0%, 90.0%, 100%, 100%, respectively, and the specificity were 100%, 96.8%, 93.5%, 100%, respectively.

Expressions of CK7-, CK20+ , SOX10- and CDX2+ have high sensitivity and specificity in ITACs and can be used as a reliable diagnostic marker for primary intestinal-type adenocarcinoma of the sinonasal tract. Additionally, diagnostic value of CDX2 in primary intestinal-type adenocarcinoma of the sinonasal tract is superior to CK20, CK7 and SOX10.

To explore the association of vitamin D receptor ApaⅠ and TaqⅠ gene polymorphisms with pigmented pretibial patches (PPPs) in type 2 diabetes mellitus (T2DM) patients.

A total of 233 patients with T2DM were enrolled. Patients were assigned to PPPs group (n=106) or non-PPPs (n=127) according to the presence of PPPs. Allelic and genotypic comparisons of VDR-TaqⅠ and VDR-ApaⅠ between the different groups were evaluated by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).

The genotype and allele gene frequency were similar at ApaⅠ in two groups (P>0.05). The PPPs group showed a higher frequency of TT allele at TaqⅠ in the T2DM (95%) when compared to that of non-PPPs group (87%), while the frequency of Tt and tt allele were lower in PPPs group than non-PPPs group in T2DM (5% vs 13%, allP<0.05). The frequency of T allele were higher at TaqⅠ in PPPs group (98%) than non-PPPs group (93%) in T2DM, while PPPs had a lower frequency of t allele (2% vs 7%, allP<0.05).

It seems that gene polymorphisms of VDR-TaqⅠ, not VDR-ApaⅠ, contributes to the risk of PPPs in T2DM patients in the Han nationality in Tianjin area.

To elucidate the glycoprotein non-metastatic melanoma protein B(Gpnmb) expression in clear-cell renal cell carcinoma (ccRCC) and to determine its potential prognostic relevance.

A total of 12 pairs of ccRCC tissue specimens were collected from patients undergoing surgery in our hospital from March 2009 to March 2012.Gpnmb expression were determined by immunohistochemistry and correlated with clinical variables. Survival analysis was carried out for another 43 evaluable patients.

The expression level of Gpnmb was significantly higher in metastatic ccRCCs than that in matched primary samples((6.36±4.01) vs (3.14±2.38) scores, P=0.036). The high expression of Gpnmb was not affected by age, gender, clinical stage and pathological grade (all P>0.05). Kaplan-Meier analysis disclosed significant differences in overall survival for patients with higher and lower average Gpnmb expression levels(P=0.020). Cox regression analysis revealed that a high Gpnmb protein expression level in the tumor cell could be identified as an independent poor prognostic marker of overall survival in ccRCC patients(P=0.049).

Over expression of Gpnmb in tumour cell predicts a poor prognosis of patients with ccRCC.

To evaluate the efficacy and safety of sorafenib in Chinese patients with advanced renal cell carcinoma.

The data of 174 advanced renal cell carcinoma patients orally taking sorafenib in our single center from October 2006 to October 2013 was retrospectively collected. Progression free survival (PFS), overall survival (OS) of these patients and drug-related side effects were analyzed.

Disease control rate was 92% for the whole group. The median PFS of patients taking standard dose (400 mg bid) was (8.0±0.6) months, the median PFS of patients taking increased dose (600 mg bid) after progression was (5.0±1.0) months, the median PFS of patients taking increased dose (800 mg bid) after second-progression was (2.0±0.4) months. The median OS was (24.0±2.8) months. The common side effects included hand-foot reaction (70%), fatigue (57.4%), diarrhea (45.2%), rash (39.9%) and hypertension (21.8%).

Sorafenib has good efficacy and safety in Chinese patients with advanced renal cell carcinoma. Increased dose could bring clinical benefit after standard dose failed.

To compare the validity and safety between holmium: YAG laser and traditional surgery in partial nephrectomy.

A total of 28 patients were divided into two groups (holmium: YAG laser group without renal artery clamping and traditional surgery group with renal artery clamping). The intraoperative blood loss, total operative time, renal artery clamping time, postoperative hospital stay, separated renal function, postoperative complications and depth of tissue injury were recorded.

The intraoperative blood loss, total operative time, renal artery clamping time, postoperative hospital stay, separated renal function, postoperative complications and depth of tissue injury were 80 ml, 77 min, 0 min, 7.4 days, 35 ml/min, 0, 0.9 cm, respectively, in holmium: YAG laser group. And in traditional surgery group were 69 ml, 111 min, 25.5 min, 7.3 days, 34 ml/min, 0, 2.0 cm, respectively. The differences of total operative time, renal artery clamping time and depth of tissue injury between two groups were statistically significant. The others were not statistically significant.

Holmium: YAG laser is effective and safe in partial nephrectomy. It can decrease the total operative time, minimize the warm ischemia time and enlarge the extent of surgical excision.

To evaluate the clinical efficacy of tricuspid valve(TV) annuloplasty with MC3 valve ring for management of functional tricuspid regurgitation(FTR).

A total of 85 patients who accepted TV annuloplasty with MC3 valve ring for management of FTR were retrospectively analyzed, of which included moderate tricuspid regurgitation(TR)(45 cases) and severe TR(40 cases). The ratio of regurgitant area to RA area, right atrium and ventricular transverse diameter, annulus diameter were measured by echocardiography at three different stages: before, early stage and 1 year after operation.

At early stage after operation, there were 81 cases of mild TR, 4 cases of moderate TR. At 1 year after operation, there were 82 cases of mild TR , 3 cases of moderate TR. Compared with the results of pre-operation, the ratio of regurgitant area to RA area, right atrium transverse diameter, annulus diamete and right ventricular transverse diameter at early stage and 1 year after operation were significantly reduced ((14.9±4.6)% and(13.1±4.3)% vs(37.7±8.2)%, (37.2±4.9)and(29.6±5.6)vs(42.5±6.1)mm , (27.3±1.0)and(27.2±1.0)vs(32.2±2.4)mm, (35.5±3.7)and(28.1±4.0)vs(36.9±3.4)mm, all P<0.05). The ratio of regurgitant area to RA area, right atrium and ventricular transverse diameter at early stage after operation were significantly reduced than at 1 year after operation(allP<0.05), but there was no significant difference in the annulus diameter between early stage and 1 year after operation(P>0.05). No complications occurred during follow-up.

TV annuloplasty with MC3 valve ring is effective for the management of FTR.

To investigate the effect of tolerogenic dendritic cells (Tol-DC) generated by Rapamycin (Rapa) on the differentiation of Treg/Th17 cells and explore the possible mechanism of tolerance induction.

DC progenitors from mouse bone marrow were propagated with granulocyte-macrophage colony-stimulating factor (GM-CSF) plus interleukin (IL)-4 stimulation for 6 days in the presence or absence of Rapa (20 ng/ml). During DC culture, morphology of cell was observed under electron microscope. Cell surface expression of CD11c, CD40 and CD80 was analyzed by flow cytometry. The antigen-presenting function of DC was determined by one-way mixed leukocyte reactions.In vivo, the recipient BALB/c mice receiving transplantation of skin allograft from C57BL/6 mice were divided into control, Rapa, immature DC (imDC) and Tol-DC group. The survival time of the skin allograft was observed and Treg/Th17 cells were analyzed by flow cytometry in each group.

The immunephenotypic analysis showed that in comparison with those in the control group and the LPS group the expression of the co-stimulatory molecules CD40 and CD80 were significantly lower in the Rapa-group and Rapa+ LPS group. The ability to stimulate proliferation of T cells of the same genotype in the Rapa-group was significantly inhibited (P<0.01). In thein vivo experiment, the mice's survival time remarkably prolonged, the percentage of Treg cells was enhanced and Th17 cells was reduced in the mice's spleen in Tol-DC group.

Tol-DC generated by Rapamycin can significantly induce immune tolerance through up-regulate Tregs and down-regulate Th17 cells. The present study highlights the therapeutic potential of preventing allograft rejection using in vitro-generated Tol-DCs, which can be loaded with donor antigen, and potentially used to promote organ transplant tolerance.

To explore the expression of miRNA-135b in a variety of breast cancer cell lines and its function on the proliferation, invasion and migration in triple-negative breast cancer cell lines by targeting adenomatous polyposis coli (APC).

Quantitative real-time (RT) - PCR was used to detect the expression of miRNA-135b in seven breast cancer cell lines and one normal breast cell line. The three-negative breast cancer cell lines MDA-MB-231 and MDA-MB-468 with miRNA-135b high-expression were divided into three groups: the normal growth group, the negative control group (transfected with negative counter-part) and the experimental group (transfected with miRNA-135b inhibitors). RT- PCR and Western blot were used to explore the expression of APC. The proliferation was detected by Cell Counting Kit-8(CCK-8) method and the invasion and migration were detected by Transwell method.

The levels of miRNA-135b were higher in triple-negative breast cancer cell lines than other types, especially MDA-MB-231(P=0.001) and MDA-MB-468(P=0.036). Compared with normal growth group and negative control group, the mRNA and protein of APC were up-regulated in experimental group MDA-MB-231(P=0.013, P=0.021), MDA-MB-468(P=0.017, P=0.014). CCK-8 results showed that the proliferation rate of experimental group was decreased compared with negative control and normal growth group MDA-MB-231 (P=0.00 ), MDA-MB-468(P=0.01). The invasion and migration ability of MDA-MB-231 (P=0.002, P=0.00) and MDA-MB-468 (P=0.01, P=0.00) were obviously decreased after transfected miRNA-135b inhibitors.

The expressions of miRNA-135b were higher in most triple-negative breast cancer cell lines than others. miRNA-135b could promote the proliferation, invasion and migration in triple-negative breast cancer cell lines MDA-MB-231 and MDA-MB-468, and APC was one of the target genes of miRNA- 135b by participating in the process of regulation.

To explore the proteomic differences among with and without curcumin treatment of vincristine-resistance HCT-8/VCR cells of human colon carcinoma by using mass spectrometry and two-dimensional gel electrophore-sis(2-DE).

The total proteins of the both groups were extracted from serum were run in immobilized pH gradient isoelectic focusing (IPG-IEF)at the first dimension.The proteins pots in gels were visualized by silver staining protocol, scanned by using a molecular imager GS-800 calibrated densitometer. The differentially expressed proteins were identified and analyzed by PDQuest 8.0 software.The diferentially displayed protein spots were searched and identifiyed by Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF-MS), the interested proteins were further validated by RT-PCR and Western blot.

The 2-DE HCT-8/VCR cells patterns were acquired with clear background, well-resolution and reproduction. And 1 070±96 protein spots were detected in control HCT-8/VCR cells and 1 030±69 in curcumin-treated HCT-8/VCR cells.Twenty-nine differential protein spots were found to be differentially expressed. Glutathione S-transferase pi1 gene (GSTP1), a diferentiaI expression protein was identified which one of these proteins. RT-PCR and Western blotting results showed that the expressions of GSTP1 mRNA(0.49±0.09)and protein(0.29±0.07)in curcumin-treated group were significantly lower than in control group(GSTP1 mRNA 1.19±0.21 and protein 0.70±0.13, both P<0.05), indicating that curcumin down regulated these expressions.

The suppression of GSTP1 by curcumin could enhance the vincristine chemosensitivity in HCT-8/VCR.GSTP1 overexpression may be involved in the vincristine -resistance of human colon carcinoma cells.

To investigate the effect of substance P(SP) on the spontaneous contractile activity of smooth muscle cells, the large-conductance calcium-activated potassium channel currents(I_BKCa) and the L-type calcium channel currents(I_CaL) in rat smooth muscle cells of the proximal colon.

A total of 24 healthy male Wista rats were used in this test. The change of smooth muscle strips spontaneous contraction of rat proximal colon after adding SP was recorded by a physiological signal stystem (RM6240). The I_BKCa and I_CaL were measured via the whole cell patch-clamp technique.

The longitudinal muscle contraction was obviously increased concentration-dependently after adding different concentrations of SP(10^-7-10^-6 mol/L), so as the circular muscle while adding SP(10^-8-10^-6 mol/L) (all P<0.05). Compared with the control group,I_BKCa was decreased after adding SP(10^-6mol/L). Under the stimulating voltage of 60 mV, the I_BKCa current density was (11.71 ± 1.65) pA/pF, which was significantly lower compared with the control group (14.42 ± 2.89) pA/pF (P<0.05). TheI_CaL was apparently increased. Under the stimulating voltage of 0 mV, the I_CaL currents density was (-5.04 ± 0.67) pA/pF, compared with the control group (-4.25 ± 0.46) pA/pF, which was significantly increased (P<0.01).

SP can promote the spontaneous contractile activity of colon smooth muscle of rats in vitro.And SP decrease I_BKCa representatively while apparently increase I_CaL. That is probably one of the mechanism SP regulate the gastrointestinal motility.

A 63-year-old male was admitted to hospital in July 2013 due to swelling, pain and discomfort of the right testis for more than 3 months. Physical examination: the superficial lymph nodes of the whole body were not swollen; The right scrotum was obviously enlarged, with a solid mass of about 6.0 cm ×5.0 cm ×4.0 cm palpable inside, hard in texture, smooth on surface, no tenderness, unclear testicular palpation, negative light transmission test (-), and the right spermatic cord was obviously thickened, with a solid mass of about 4.0 cm ×3.0 cm ×2.5 cm palpable inside, hard in texture; There were no obvious abnormalities in the left testis and spermatic cord. Laboratory tests; Human chorionic gonadotropin, alpha-fetoprotein, carbohydrate antigen, malignant tumor specific growth factor, alkaline phosphatase and lactate dehydrogenase were all normal. Chest X-ray showed no abnormalities. B-ultrasound examination of the scrotum showed: a 5.0 cm ×4.0 cm solid mass was seen in the right testis, which was quasi-round, with clear boundaries, varying internal echo intensity and several colorful blood flows; The right spermatic cord is thickened, and a hypoechoic mass about 3.2 cm ×2.4 cm in size can be seen inside it, with clear borders. CT examination showed that there was a massive lesion in the right testis, about 4.8 cm ×4.0 cm in size, with uneven signal, and the boundary between the lesion and the surrounding tissues was still clear. Enhanced scan showed that the space-occupying lesion in the right testis was obviously uneven and enhanced, with non-enhanced areas in it; A massive lesion about 3.2 cm ×2.5 cm in size was seen in the right spermatic cord, and the enhanced scan showed that the lesion showed obvious uneven enhancement (Figure 1)； No obvious enlarged lymph nodes were found in the abdominopelvic cavity. Diagnosis of right testicular and spermatic cord tumor. Right inguinal exploration plus radical orchiectomy and spermatic cordectomy were performed under epidural anesthesia, and the operation was smooth. Pathological report: The size of the testis is about 6.0 cm ×4.0 cm ×4.0 cm, and a mass is seen during incision, with a maximum diameter of 5.0 cm. The incision surface is gray-white, hard in texture, clear in boundary, and some areas are gray-brown. A nodule can be seen at the distance of the spermatic cord 5.0 cm from the testis, and the texture of the incision surface is the same as that of the testis; Under light microscope, the basic structure of the testis was destroyed, and a large number of lymphoid cells diffusely infiltrated and grown in the tissue, lymphoepithelial lesions and mitotic images were visible (Figure 2)； Immunohistochemical staining showed that leukocyte common antigen (LCA) was positive (+ +), Bcl-2 (+ +), CD20 (+ +) (Figure 3), CD3 (background cell +), tumor cell high proliferative activity (Ki-67) (>95% +) (Figure 4), B cell specific activator protein (PAX-5) (+ /−), CD5, desmin (desmin), human placental alkaline phosphatase (PLAP), myeloperoxidase (MPO), CD34, CD10 (−). Pathological diagnosis: (right testis, spermatic cord) malignant tumor, considered as diffuse, large cell malignant lymphoma, B cell origin. Bone marrow biopsy (-). Six courses of postoperative local radiotherapy plus CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy were followed up for 18 months without tumor recurrence or metastasis.

A 46-year-old male was examined in a hospital before admission. Blood routine showed that white blood cells were 1.8×10⁹/L, hemoglobin 117 g/L, platelets 77×10⁹/L, accompanied by mild fatigue, no fever, cough, no petechia, ecchymosis, not taken seriously. Bone marrow examination in other hospital showed obvious active hyperplasia, with 32% blastocytes, so he was admitted to hospital. Bone marrow smear examination after admission revealed acute myeloid leukemia (type M6). Induction therapy was given with decitabine 35 mg/d ×7 days. On the first day after chemotherapy, the patient developed fever with a body temperature of 38.2℃. Multiple pulmonary nodules were seen on chest CT, and the results of intravenous catheter and blood culture were negative. After 3 days of anti-infective treatment with piperacillin/tazobactam combined with vancomycin, the body temperature gradually decreased. On the 4th day after chemotherapy, blood routine showed agranulocytosis and leukocytes 0.45×10⁹/L. On the 12th day after chemotherapy, the body temperature increased again, reaching a maximum of 39.2 ℃. Blood cultures for 3 consecutive days showed that Trichospora asassii was positive. Voriconazole 4 mg/kg (6 mg/kg on the first day every 12 hours) was given empirically, and the patient's body temperature did not drop. Adjust the medication and give liposomal amphotericin B 3 mg·kg^-1• d^-1。 On the 15th day after chemotherapy, serum creatinine increased from 60.4 μ mol/L to 199.8 μ mol/L, and liposomal amphotericin B decreased to 2 mg kg^-1• d^-1Combined with caspofungin 50 mg/d (70 mg on the first day) and granulocyte colony stimulating factor (G-CSF) 300 g/d to stimulate bone marrow hematopoiesis. On the 17th day after chemotherapy, the body temperature was controlled, and on the 19th day, granulocytic hematopoiesis was restored and the body temperature dropped to normal. At the same time, re-examination of bone marrow showed complete remission and renal function gradually improved. Antifungal treatment with liposomal amphotericin B combined with caspofungin continued for 3 weeks. Re-examination of chest CT showed complete dissipation of lung lesions, and voriconazole (200 mg, administered once every 12 hours) was used orally. The patient continued with consolidation chemotherapy and underwent hematopoietic stem cell transplantation 3 months later. Multiple reexaminations showed negative results for Trichosporidium asachi.

Medically, the area above 3 000 m above sea level is called plateau. The plateau area in China is vast, mainly including Qinghai-Tibet Plateau, Yunnan-Guizhou Plateau, Loess Plateau and Inner Mongolia Plateau, and its main environmental characteristics are low oxygen, low pressure and high altitude. Regardless of whether people have lived for generations or have rushed into the plateau, their system functions, metabolic levels and blood components may be reversibly or irreversibly damaged by hypobaric hypoxia^[1]。

With the development of western economy and tourism, more and more people live in the plateau. How to improve the health level of the plateau residents is an important subject. The plateau environment is a special living environment. Living on the plateau, not only may suffer from acute and chronic altitude sickness, but also other diseases are affected by the environment, which has different characteristics from the plain. The respiratory system is an open system, which is greatly influenced by the plateau environment. The relevant research is summarized as follows.

Ultrasound has the advantages of safety, portability, repeatability and real-time dynamic observation. In recent years, its clinical application in anesthesiology has gradually expanded, including guided arteriovenous puncture, nerve block, airway management, etc. Airway management is an important part of anesthesia, emergency medicine and intensive care unit work. Improper airway management will lead to aggravation of patients' condition and increased mortality. In recent years, ultrasound has shown great potential in airway management in anesthesiology department, with high clinical application value, and there is still great room for development. The application and recent progress of ultrasound in airway management are reviewed.