Volume 95  ·  Issue 32  ·  2015

At present, diabetes is the third major disease in human beings besides cardiovascular and cerebrovascular diseases and malignant tumors. Statistics released by the International Diabetes Federation (IDF) in 2011 show that 10 million new cases of diabetes are added worldwide every year^[1]。 The prevalence of diabetes among people over 20 years old in China has reached 9.7%, with more than 92 million patients, ranking first in the world^[2]。 At present, it is recognized that strict blood sugar control is the most fundamental means to reduce the incidence of diabetic vascular complications. Glycosylated hemoglobin (HbA1c) is a golden index reflecting the level of long-term blood sugar control, and it is also the core index for setting blood sugar control goals. The target for glycemic control recommended by the International Diabetes Federation (IDF) and the European Association for Diabetes Research (EASD) is HbA1c<6.5%^[3]。 The American Association of Diabetes Physicians (ADA) issued guidelines for diabetes prevention and treatment in 2015^[4]And the latest "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2013 Edition)" issued by the Diabetology Branch of Chinese Medical Association^[5]In, three blood glucose control targets were proposed: (1) For most non-pregnant adult patients with type 2 diabetes, the blood glucose control target was HbA1c<7%； (2) Strict glycemic control targets (HbA1c<6.5%, or close to normal) is suitable for type 2 diabetic patients with a short course of diabetes, a long life expectancy, no diabetic complications, and no combined cardiovascular disease, provided there is no hypoglycemia or other adverse reactions; (3) Relatively loose glycemic control targets (such as HbA1c<8%) is suitable for patients with a history of severe hypoglycemia, short life expectancy, obvious diabetic microvascular or macrovascular complications, or severe systemic complications, and a long course of diabetes.

To explore the association between retinopathy and sleep disorder in patients with type 2 diabetes mellitus (T2DM).

A total of 440 patients with T2DM treated from July 2011 to July 2013 in Metabolic Disease Hospital of Tianjin Medical University were divided into 2 groups according to Pittsburgh Sleep Quality Index: non-sleep disorder group (258 cases) and sleep disorder group (182 cases). Biochemical parameters including hepatorenal function, blood lipids, glycosylated hemoglobin (HbA1c), fructosamine and hemorrheology were detected. Oral glucose tolerance test, insulin releasing test and glucagon releasing test were performed to detect the inter-group differences of α-cell and β-cell function after fasting and glucose-load management. The logistic regression analysis was performed to identify the factors relevant to retinopathy.

The ratio of retinopathy was 42.9% in sleep disorder group, which was higher compared to those in non-sleep disorder group (32.6%), P=0.027. The levels of fasting plasma glucose, postprandial blood glucose, HbA1c, fructosamine, systolic blood pressure, diastolic blood pressure and the indicators of hemorrheology (plasma viscosity, erythrocyte aggregation index, erythrocyte rigidity index, fibrinogen) were significantly higher in patients with sleep disorder compared to those without sleep disorder, while the erythrocyte defomation index was significantly lower in sleep disorder group (all P<0.05). The levels of glucagon and glucagon/insulin ratio at each time point as well as area under curve of glucagon were significantly higher in sleep disorder group (allP<0.05). The levels of fasting insulin, homeostasis model assessment for insulin resistance index (HOMA-IR) and area under curve of insulin were significantly higher in patients with sleep disorder compared to those without sleep disorder, while insulin sensitivity index was lower in patients with sleep disorder(allP<0.05). Logistic regression analysis showed that retinopathy was positively related to HbA1c(OR: 1.744–3.249), fibrinogen(OR: 1.687–2.998), systolic blood pressure(OR: 1.152–2.013), HOMA-IR (OR: 1.006–1.389) and sleep disorder(OR: 1.144–2.426), and negatively related to insulin sensitivity index(OR: 0.107–0.784) (all P<0.05).

Sleep disorders may be associated with retinopathy through multiple mechanisms in patients with T2DM.

To explore the association of choroidal thickness variations in type 2 diabetes mellitus (T2DM) patients with diabetic retinopathy (DR) at different stages.

A total of 161 patients with T2DM were included in this study, from October 2012 to June 2014. According to Early Treatment Diabetic Retinopathy Study (ETDRS) criteria, the patients were divided into 5 groups: non–DR without diabetic macular edema (DME) group(DR–/DME– group, 45 eyes), nonproliferative diabetic retinopathy (NPDR) without DME group(NPDR+ /DME– group, 58 eyes), proliferative diabetic retinopathy (PDR) without DME group (PDR+ /DME– group, 12 eyes), NPDR with DME group(NPDR+ /DME+ group, 41 eyes), PDR with DME group (PDR+ /DME+ group, 5 eyes). Meanwhile, 60 normal subjects were enrolled as the control group. All study subjects received optical coherence tomography enhanced depth imaging (EDI–OCT) examination to detect and compare subfoveal choroidal thickness at different stages of DR.

Mean SFCT was (271±36), (270±35), (262±38), (244±36), (229±35) μm respectively in control, DR–/DME–, NPDR+ /DME–, PDR+ /DME–, NPDR+ /DME+ groups. The SFCTs of PDR+ /DME– and NPDR+ /DME+ group were statistically lower than that of control group( P=0.004, P=0.001). The SFCT of PDR+ /DME– group was lower than that of DR–/DME– group(P=0.003), and there was also a significant difference of SFCT between NPDR+ /DME+ and NPDR+ /DME– group(P=0.001). There was linear correlation between SFCT and the logMAR best–corrected visual acuity (r=0.397, P<0.01), but the SFCT was independent of diabetic duration, fasting blood glucose, HbA1c, axial length, diastolic blood pressure (DBP) and systolic blood pressure SBP (r=–0.024, 0.159, 0.089, 0.036, 0.143, 0.057, all P>0.05). There was no significant difference of SFCT among different DME types (F=0.071, P>0.05).

The SFCT decreased with increasing severity of DR. To monitor the SFCT in T2DM patients may be helpful to evaluate the severity of DR and provide a new treatment conception.

To explore the protective effect and its mechanisms of intravitreal injection of ursolic acid (UA) on retinal injury in diabetic retinopathy (DR) mice.

DR model was set up by using alloxan. 60 C57BL/6 male mice (clean animal, aged 12 weeks) were randomly and evenly divided into 6 groups: blank control group, DR model group, positive control group (triamcinolone acetonide), UA intervention groups (low, moderate and high dose). Mice were killed one week after drug intervention and the eyeballs were removed to prepare paraffin section. Retinal new blood vessel was examined by histopathological methods. The mRNA and protein expressions of vascular endothelial growth factor (VEGF), cyclooxygenase 2 (COX–2), and Matrix Metalloproteinase 2 (MMP–2) in retinal tissues were detected by real–time PCR and Western blotting, respectively. The superoxide dismutase (SOD) activity and malondialdehyde (MDA) content were detected by related kits.

The HE and PAS staining showed uniform inner limiting membrane structure and orderly vascular endothelial cells in blank control group, and neovascularization was seldom detected. In DR model group, numerous new blood vessels were formed beyond inner limiting membrane. UA intervention group with low dose had almost the same results with DR group, while the results of UA intervention group with high dose were similar with positive control group, in which the inner limiting membrane structure was uniform and new blood vessels were seldom seen. The mRNA expressions of VEGF, COX–2, and MMP–2 in DR model group were significantly higher than those of blank control group (P<0.001) and UA intervention group with moderate and high dose (P<0.001). The protein expressions of VEGF, COX–2 and MMP–2 in DR model group were significantly higher than those of blank control group (P<0.001) and UA intervention group with low, moderate and high dose (allP<0.05). The MDA content of retinal tissue in DR model group was significantly higher than those of blank control group (P=0.001) and UA intervention groups with moderate and high dose (P=0.026, 0.007). The activity of SOD was significantly lower in DR model group than those of blank control group (P<0.001) and UA intervention groups with low, moderate and high dose (P=0.040, 0.021, 0.003).

UA may inhibit the formation of new blood vessels through reducing the expressions of VEGF, COX–2 and MMP–2 in retinal tissues, and promote a remission from DR by obvious resistance to oxidative stress.

To evaluate the Epstein Barr virus(EBV)positive rate in untreated Hodgkin's lymphoma(HL)and investigate the prognostic significance of EBV status.

A total of 207 previously untreated patients with histologically confirmed Hodgkin's lymphoma were enrolled in the study. The EBV infection status was confirmed through examining EBV–RNA (EBER) or EBV latent membrane protein–1. The correlation of clinical features and EBV infection status was analyzed, also the prognostic significance of EBV infection.

A total of 66 cases were confirmed to be EBV positive Hodgkin's lymphoma(EBV⁺ HL) in all 207 cases, accounting for 31.9%. EBV⁺ HL group had more male patients (46/66, 69.7%) and mixed cellularity subtype (34/66, 51.5%) than EBV negative Hodgkin's lymphoma(EBV^–HL) group. The EBV positive rate had two peaks in age, respectively, in the age of 0–15 year–old and >60 year–old. During a median follow–up period of 35 months, EBV ^–HL was significant better than EBV⁺ HL in overall survival(P=0.001), but no significant difference was found in progression–free survival(P=0.763).

EBV positive is a poor prognostic factor for overall survival time in HL.

To establish an indirect reference interval based on the test results of alanine aminotransferase stored in a laboratory information system.

All alanine aminotransferase results were included for outpatients and physical examinations that were stored in the laboratory information system of Zhongshan Hospital during 2014. The original data were transformed using a Box-Cox transformation to obtain an approximate normal distribution. Outliers were identified and omitted using the Chauvenet and Tukey methods. The indirect reference intervals were obtained by simultaneously applying nonparametric and Hoffmann methods. The reference change value was selected to determine the statistical significance of the observed differences between the calculated and published reference intervals.

The indirect reference intervals for alanine aminotransferase of all groups were 12 to 41 U/L (male, outpatient), 12 to 48 U/L (male, physical examination), 9 to 32 U/L (female, outpatient), and 8 to 35 U/L (female, physical examination), respectively. The absolute differences when compared with the direct results were all smaller than the reference change value of alanine aminotransferase.

The Box-Cox transformation combined with the Hoffmann and Tukey methods is a simple and reliable technique that should be promoted and used by clinical laboratories.

B–cell lymphoma 9 (BCL9) as a co–activator for β–catenin–mediated transcription is highly expressed in tumors. The aim of our study is to investigate the expression of BCL9, and its clinicopathological significance in prostate cancer (PCa).

Immunohistochemistry was conducted to analyze the expression of BCL9 in 98 PCa samples and 20 benign prostate hyperplasia (BPH) samples. The associations of BCL9 expression with clinicopathological features and prognosis in PCa patients were analyzed with various statistical methods, such as chi–square test, Kaplan–Meier method and log–rank test.

The positive rate of BCL9 was 53.1% (52/98) in prostate cancer group, and 25.0% (5/20) in benign group (P=0.022). In addition, BCL9 expression in PCa tissues was significantly associated with Gleason score (P=0.016), and biochemical recurrence (P=0.020). Moreover, Kaplan–Meier survival analysis showed that the higher expression of BCL9 was correlated with shorter biochemical recurrence–free survival (P=0.037). However, BCL9 was not an independent prognostic predictor for biochemical recurrence–free survival in patients with PCa after the multivariate analysis was conducted (Hazard ratio =1.73, P=0.384).

Our study demonstrates the up–regulation of BCL9 is associated with PCa's early diagnosis and malignant degree.

To investigate the expression and pathological mechanism of matrix metalloproteinase (MMP)–9 and hypoxia–inducible factor (HIF)–2α in CD133⁺ lung cancer stem cells.

Sixty–two cases of lung cancer paraffin embedding tissues were collected from the First Affiliated Hospital of Soochow University between January 2009 and December 2009. Immunohistochemistry (IHC) was used for detection of CD133 expression in lung cancer tissues and the clinical significance was analyzed. Real–time polymerase chain reaction (PCR) was used for the investigation of expression of tumor metastasis associated genes, including MMP–1, MMP–2, MMP–9, HIF–1α, HIF–1β, HIF–2α and tissue inhibitor of metalloproteinase (TIMP)–1, TIMP–2, TIMP–3, TIMP–4. Scrambled siRNA or CD133 siRNA were used to transfect the lung cancer cell line A549, then Control–si–A549 cells and CD133–si–A549 cells were generated respectively. PCR was used to analysis CD133, MMP–9 and HIF–2α genes expression and transwell invasion assay was used to study the invasion ability of A549 cells in two groups.

51.6% of lung cancer tissues expressed CD133 (P<0.05); the expression level of CD133 was related to tumor metastasis and patients' survival rate (P<0.05). The gene expression of HIF–2α and MMP–9 were increased in CD133⁺ lung cancer cells compared with CD133^– cancer cells (1.58±0.39 vs 1.10±0.31, 1.67±0.38 vs 1.05±0.21, all P<0.05), whereas no difference was found in gene expression of MMP–1, MMP–2, HIF–1α, HIF–1β and TIMP–1, TIMP–2, TIMP–3, TIMP–4 (allP>0.05). Compared with the Control–si–A549 cell, the expression of CD133, HIF–2α and MMP–9 (0.24±0.10 vs 0.85±0.23, 0.19±0.09 vs 0.54±0.18, 0.31±0.17 vs 1.12±0.31, allP<0.05) in CD133–si–A549 cell were remarkably decreased. The number of CD133–si–A549 cells migrated to below room was significantly smaller than that of Control–si–A549 cells (207±25 vs 82±10,P<0.05).

The CD133⁺ lung cancer stem cell is correlated to the tumor metastasis and patients' survival. CD133⁺ tumor stem cell can promote the tumor invasion and metastasis via the up–regulation of HIF–2α and MMP–9 expression.

To investigate the value of lymph node labeled with carbon nanoparticles in laparoscopic colorectal cancer resection.

The clinical data of 53 patients received laparoscopic radical colorectal surgeries in our department from March 2014 to July 2014 was retrospectively analyzed.Among these patients, carbon nanoparticles were injected into the periphery of the tumor under colonoscopy 1–3 days before the operation (the nanoparticle group) in 26 patients, while 27 patients received operation directly (the control group). The number of cleared lymph nodes, tiny lymph nodes (<5 mm), dyed lymph nodes, and lymph node metastatic rate were compared between the two groups.

The two groups had no statistical difference in basic characteristics; 434 and 340 lymph nodes were dissected in the nanoparticle group and control group respectively.The average number of cleared lymph nodes(16.7±3.2) in the nanoparticle group was significantly higher than that of the control group(12.6±2.3) (P<0.001). Besides, both the average number and ratio of cleared tiny lymph nodes in the nanoparticle group were significant higher than those of the control group(P<0.001). Moreover, the rate of less than 12 detected lymph nodes in the nanoparticle group was markedly lower than that of the control group (0 vs 33.3%,P=0.001). There was no statistical difference in lymph node metastatic rate between the two groups(P=0.693).

Application of lymph node labeled with carbon nanoparticles in laparoscopic colorectal cancer surgery could instruct lymph nodes dissection, improve lymph node detection rate, reduce tumor residual rate, improve the accuracy of pathological staging, and guide the postoperative adjuvant therapy.

To explore the effect of rocuronium on gastric insufflation related to facemask ventilation in general anaesthesia patients.

Eighty patients from June to October 2015 undergoing elective operation under general anaesthesia at Ningbo NO.2 Hospital , ASA Ⅰ or Ⅱ grade, aged 18–65, were enrolled in this study and divided into two groups(n=40): Group R(rocuronium) and Group C(for control). Facemask pressure-controlled ventilation was started after general anaesthesia induced with propofol and remifentanil for a 2 min period while gastric insufflation was detected by ultrasonography of the antrum. The cross-sectional antral area(CSA) was measured using ultrasonography before and after facemask ventilation. Respiratory parameters were also recorded.

Compared to the antral area before FMV, the CSA significantly increased in group R and C after FMV[post-FMV: (579.5±167.3), (508.1±112.2)mm²; pre-FMV(479.4±110.2), (451.2±103.4) mm^2;t=5.938, 4.302, P<0.001]. All the patients were divided into four subgroups according to the gastric insufflation(R+ , R–, C + , C–) and there were significant increases in the values of CSA before and after FMV in groups R+ and C+ [post-FMV(647.7±150.6), (546.2±121.1) mm²; pre-FMV(501.2±113.6), (422.6±101.5) mm^2;t=7.885, 8.719, P<0.001], without any significant increase in groups R– and C–[post-FMV(496.0±150.9), (489.8±105.1) mm²; pre-FMV(452.9±102.8), (465.0±103.3) mm^2;t=1.793, 1.663, P>0.05]. Compared with the group R– , the CSA of group R + significantly increased before and after FMV[group R+ (146.6±87.2) mm^2; group R–(43.1±102.1)mm^2;t=3.458, P<0.001]; compared with the group C– , the CSA of group C + significantly increased before and after FMV[group C+ (123.6±51.1) mm^2; group C–(24.8±77.4) mm^2;t=4.172, P<0.001]; there was no significant difference between the difference value of CSA in groups R+ and C+ before and after FMV(t=0.983, P>0.05). The incidence of gastric insufflation was 55% and 32.5% in group R and C, respectively(χ²=4.114, P<0.05). There was no significant difference in respiratory parameters between group R and C.

The study suggests that rocuronium may promote gastric insufflation related to facemask ventilation(15 cmH₂O PCV)in general anaesthesia patients.

To investigate the clinical characteristics and risk factors of monosomy 7 malignant clonal evolution in patients with severe aplastic anemia (SAA) treated with combined immunosuppressive therapy(IST).

The clinical data of SAA patients treated with IST who had monosomy 7 malignant clonal evolution from October 2004 to January 2012 were analyzed respectively.

Six patients (4.2%) had monosomy 7 clonal evolutions. The median time to monosomy 7 was 36(12–75) months after IST. All 6 patients were diagnosed myelodysplastic syndromes (MDS). Among them, 3 patients transformed to acute myeloid leukemia following MDS. The time was 24, 45 and 51 months after IST. The median following time was 42(17–84) months. Four patients died during the following time. The median time from MDS to death was 9(5–17) months. Among them, three patients died with infection, one died with cerebral hemorrhage. Six patients had the clinical characteristics that they had no response to IST after 6 months, high monocyte percentage in one month after IST combined with recombinant human granulocyte colony stimulating factor (rHu–GCSF) and agranulocytosis in 3 months after IST.

Poor myeloid response to IST suggests malignant clonal hematopoiesis and poor prognosis in SAA patients.

To analyz mitochondrial DNA mutation in one case of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke–like episodes(MELAS).

The patient, a 10–years–old boy, clinically diagnosed as MELAS. The clinical information was collected, and the normal mitochondrial mutations (such as A3243G, A8344G, T8993G/C, G13513A etc)were excluded. PCR–sequencing was used to analyz the whole–mitochondrial genome(16.6 kb), and PCR–RFLP was used to confirm the mutations.

m. G14453A mutation was detected from the patient's peripheral blood and urine, but it was not found in his parents and 100 normal controls. The m. G14453A mutation was confirmed by PCR–RFLP, and mutation ratio of in blood was 56.8% and urine was 72.5%. The activity of complexⅠwas decreased(67.6 nmol·min^–1·mg^–1). This was the first report that m. G14453A mutation could lead to MELAS in China according www.mitomap.org web and NCBI.

m. G14453A mutation is one of the causative mutations in MELAS, but the mechanism of the mutation should be studied in future.

To explore the differential microRNAs (miRNAs) expression profiles between human bone marrow mesenchymal stem cells (hBM–MSCs) and sweat gland–like cells.

The hBM–MSCs were induced to differentiate into osteogenic and adipogenic cells by related osteogenic differentiation basal medium and adipogenic differentiation basal medium respectively. And the results were assayed by oil red O and alizarin red stains respectively. When reaching 70%–80% confluence, primarily cultured sweat gland cells were heat–shocked and co–cultured with hBM–MSCs by a Transwell plate to induce the differentiation of hBM–MSCs. After 10 days, the total RNAs of hBM–MSCs and sweat gland–like cells were extracted, purified, labeled, hybridized and analyzed for predicting miRNAs target genes separately. The microarray results were confirmed by quantitative real–time reverse transcription–polymerase chain reaction (RT–PCR).

There were 68 miRNAs of >double differentiation on expression level between hBM–MSCs and sweat gland–like cells. And 19 miRNAs were up–regulated and 49 miRNAs down–regulated. Moreover, there were 13 miRNAs with >5 folds of differential expression level between hBM–MSCs and sweat gland–like cells, including 5 up–regulated miRNAs (miRNA–132–3p, –4467, –4484, –146a–5p and –6126) and 8 down–regulated miRNAs (miRNA–708–5p, –138–5p, –6812–5p, –138–1–3p, –1281, –3157–3p, –4298 and –4459). There were 18 miRNAs related to regulation of the signaling pathways of sweat gland development, including nuclear factor–kappa B (NF–κB), mitogen–activated protein kinase/extracellular regulated protein kinase (MAPK/Erk), Wnt/beta–Catenin (Wnt/β–Catenin) and ectodysplasin–A1/ectodysplasin–A1 receptor (EDA/EDAR). The results of RT–PCR on miRNA–146a–5p and miRNA–6812–5p had a high concordance with the results of microarray.

There are obvious differentiation miRNAs expression profiles between hBM–MSCs and sweat gland–like cells. And 13 miRNAs >5 folds of differential expression and 18 miRNAs related to sweat gland development may play essential roles in regulated differentiation of hBM–MSCs into sweat gland–like cells.

To investigate the immumodulation ability of exosomes secreted from human umbilical cord–derived mesenchymal stem cells (hUC–MSCs).

hUC–MSCs were isolated and cultured.Exosomes were isolated from the culture media of the third–generation hUC–MSCs.The expression of specific surface marker CD9 and CD81 were detected by Western blot, and the concentration of hUC–MSCs exosomes(hUC–MSCs–ex) was evaluated by BCA assay.CD3/CD28–stimulated peripheral blood mononuclear cells(PBMCs) from healthy donor were co–cultured with different concentration of hUC–MSCs–ex for 72 h. The percentage of Th17 and Treg cells and the proliferation of CD4⁺ and CD8⁺ T cells were detected by flow cytometry.ELISA was used to test the level of IFN–γ, IL–6, TNF–α and TGF–β1.

hUC–MSCs–ex inhibited the proliferation of CD4⁺ and CD8⁺ cells obviously, and increased the proportion of CD4⁺ CD25⁺ FoxP3⁺ Treg cells, with high expression of CD81 and CD9.After CD3/CD28 monoclonal antibody stimulated, the percentage of CD45⁺ CD4⁺ Ki67⁺ and CD45⁺ CD8⁺ Ki67⁺ cells were 85.3%±5.6% and 72.6%±6.3%, respectively. Meanwhile, the level of TGF–β1 were elevated and the level of IFN–γ, IL–6 and TNF–α were decreased (P<0.05).

hUC–MSCs–ex has the immunomodulatory functionin vitro, which could be a new therapeutic agent for the treatment of immune disorders.

To investigate the effect of dust aerosol exposure on lung function and lung histopathology in rats.

According to random number table method, 120 Wistar male rats were divided into untreated control group, treated control group and experimental group, with 40 rats in each group. Experimental group were exposed to the wind tunnel simulation of sandstorm for 5 hours in every day; the untreated control group were put in the standard living environment next to the wind tunnel; the treated control group were exposed to the same wind tunnel simulation of sandstorm for 5 hours in every day, and the speed of wind was the same as the experimental group, but excluding dust. At different time points, the lung function and electron microscopy were performed in all rats.

The level of Dynamic Compliance (Cdyn) ((0.227±0.023), (0.198±0.022) ml/cmH₂O, 1 cmH₂O=0.098 kPa) and forced vital capacity (FVC) ((6.24±0.29), (5.59±0.19) ml) were lower in the experimental group at 90 and 120 days, as compared to the untreated control group (Cdyn: (0.266±0.014), (0.265±0.018) ml/cmH₂O; FVC: (7.15±0.23), (7.17±0.20) ml) and treated control group (Cdyn: (0.269±0.015), (0.264±0.019) ml/cmH₂O; FVC: (7.14±0.19), (7.15±0.21) ml) (all P<0.05). At 120 days, The level of the forced expiratory flow after 50% of the FVC ((12.3±2.2) ml/s) and peak expiratory flow ((25.79±0.42) ml/s) were lower in the experimental group, as compared to the untreated control group ((15.9±2.5), (27.99±0.36) ml/s) and treated control group ((15.8±2.1), (27.90±0.38) ml/s) (allP<0.01). The FVC rate of 0.2 second in the experimental group was higher than that in the untreated control group and treated control group ( (85±5)%, (73±4)%, (73±4)%, allP<0.05). The electron microscopy showed that the lung tissues had no obvious abnormalities at 30, 60, 90 and 120 days in untreated control group and treated control group. But in the experimental group, at 30 days, the endothelial cells of alveolar type Ⅰ cells were swelled and the number of alveolar type Ⅱ cells were increased; at 60 days, alveolar type Ⅱ cells hyperplastic, basement membrane thinned and destructed; at 90 days, the number of alveolar type Ⅱ cells decreased, Lamellar body evacuation; at 120 days, a lot of collagen fiber was formed in the alveolar septa.

The strong sandstorm environmental exposure to a certain period of time can cause the decline of lung function and the damage of lung histopathology in rats. Exposure time was positively correlated with the damage of lung tissue.

To investigate whether the treatment of oxidized low density lipoprotein (ox-LDL) could reduce ceruloplasmin (Cp) expression and then, influence iron efflux in macrophages.

RAW264.7 cells were treated by lipopolysaccharides (LPS), ferric ammonium citrate (FAC), deferoxamine (DFO) and ox-LDL. Biochemical analysis and histological assays were performed to detect the iron-related protein including ferritin (Ft), transferrin receptor(TfR), ferroportin 1 (FPN1) and Cp. And the cholesterol enzyme was used to evaluate cells' cholesterol content.

Western blot showed that protein level of FPN1, Ft increased and protein level of TfR decreased after the treatment of FAC. The mRNA level(t=–5.995, P=0.019) and the oxidative activity (t=–9.875, P=0.001) of Cp increased significantly after the treatment of LPS+ FAC compared to control group. The treatment of ox-LDL could reduce protein level of Cp compared to LPS treated cells and no different protein levels of Ft and Ferroportin was found after the treatment of ox-LDL as shown by Western blot. The protein level, ferroxidase activities (t=6.663, P=0.003) and mRNA levels (t=8.948, P=0.001) of Cp in LPS+ ox-LDL+ FAC group were reduced than LPS+ FAC group. The protein levels of Ft and FPN1 in LPS+ ox-LDL+ FAC group was significant higher than LPS+ FAC group as shown by Western blot.

The findings suggest that the expression of Cp is reduced in foam cells and leads to obstructed iron efflux in iron overloaded foam cells.

To observe the ablation zone and characteristics of microwave ablation with different power and time in the model of porcine kidneys in vitro.

2 450 MHz water circulative–cooling microwave needles were used, and the length of the anterior pole was 1.10 cm. The independent variables were power (50–70 W), time (240–600 s) and ablated with different combinations. The ablation shape, zone and pathological characteristics were observed.

The effective ablation shape was similar to a chestnut and the ablation zone enlarged with the increasing of power and time. When combined with 50 W/480 s, 60 W/300 s, 70 W/240 s, the largest transverse–diameter of the ablated tissue was close to 3.00 cm and the length–diameter was about 3.30 cm. The pathological characteristics indicated that renal tissues of carbonization zone were thoroughly necrotic.Coagulative necrosis was observed in coagulation area, though there were residual profile of glomerulus, renal tubular and vessels, they had lost activity. Most of the tissues in transition zone were normal, however, some cells were swelling because of thermal damage.

Microwave ablation is an emerging thermal therapy which can be safely, effectively used in the treatment of renal tumors that are smaller than 3 cm.

A 51-year-old male was admitted to the Department of Hepatobiliary Surgery of China-Japan Friendship Hospital due to "dull pain in the right upper abdomen with aggravation for 7 months". The abdominal pain was persistent and gradually aggravated, which had nothing to do with eating, and had no accompanying symptoms such as fever and jaundice. Past history: Congenital choledochal cyst-lateral jejunostomy 21 years ago. Six months after operation, subtotal resection of common choledochal cyst, cholecystectomy and common hepatic duct-jejunal Roux-en-Y anastomosis were performed due to recurrent cholangitis. One year after surgery, reflux cholangitis was caused by anastomotic stenosis, and common hepatic duct-jejunal anastomosis resection and reanastomosis were performed. Anastomotic stenosis with intrahepatic bile duct stones was repeated 10 years after operation. Anastomotic incision, right hepatic duct lithotomy, and Y-shaped stent placement in left and right hepatic ducts were performed again.

A 69-year-old female was admitted to the hospital in July 2010 due to repeated melena for 1 year with recurrence for half a day. Minimum hemoglobin was as low as 55 g/L during the period. The patient refused gastroscopy and was given symptomatic and supportive treatment such as hemostasis and blood transfusion. Eight years ago, the patient underwent open left radical nephrectomy and right partial hepatectomy in our hospital due to left kidney cancer and liver cancer. The pathology showed renal clear cell carcinoma and hepatocellular carcinoma. Physical examination at admission: vital signs stable, anemic appearance, accessible surgical scar in upper abdomen. Admission hemoglobin 76 g/L. CT showed: local mass of descending duodenum, adenoma or adenocarcinoma considered, please check further, right liver and left kidney postoperative changes (Figure 1)。 Gastroduodenoscopy and ultrasound gastroscopy revealed: descending duodenal neoplasms (lobulated nodular bulging neoplasms with a diameter of about 4.0 cm) (Figure 2，Figure 3)。 Pathology showed inflammatory necrotic tissue and granulation tissue hyperplasia with fungal infection (descending duodenum). Preoperative diagnosis: Duodenal tumor to be examined, metastatic tumor to be considered first, after radical left nephrectomy, after partial right hepatectomy. After perfect preoperative preparation, duodenal mass resection + intraoperative freezing was proposed. Intraoperative freezing showed metastatic clear cell carcinoma of the kidney (duodenum). Postoperative pathology showed: a piece of gray-red duodenal tissue, 5.0 cm ×3.0 cm ×1.5 cm in size, gray-red gray-yellow in section, soft in texture, and unclear in boundary. Microscopically, part of the tissue surface was covered with duodenal mucosa, part of the tissue surface was necrosis, and granulation tissue proliferation was seen below it. Tumor cells were nest-like or acinar-like distributed, separated by fine fibrous tissue containing capillaries. The cytoplasm of tumor cells was rich and translucent, and the nucleus was small and round (Figure 4)。 Immunohistochemistry showed that tumor cells were positive for vimentin (VM) and epithelial membrane antigen (EMA), partially positive for CD10 and negative for cytokeratin (CK). Pathological diagnosis: (duodenal) metastatic clear cell renal cell carcinoma. At postoperative follow-up, the patient experienced gastrointestinal bleeding again 3 and a half years after operation. The duodenal mass was examined by gastroduodenoscopy and ultrasound gastroscopy, and the biopsy pathology showed abnormal cells. Considering tumor recurrence and metastasis, the patient was given symptomatic and supportive treatment, but later lost to follow-up.

Idiopathic pulmonary fibrosis (IPF) is a chronic fibrotic interstitial pneumonia with unknown etiology and pathogenesis and progressive exacerbation of the disease; The disease often occurs in middle-aged and elderly men, and the clinical manifestations are progressive exertion dyspnea, dry cough, clubbing fingers, bursting sound in both lower lungs, lung histopathology and high-resolution chest CT show interstitial pneumonia vulgaris type, because of the lack of effective treatment, the prognosis is very poor^[1]。

Liver abscess is an infectious disease in which the liver is invaded by pathogens. The pathogens that cause liver abscess in the early stage are mainly roundworms or amoeba. With the improvement of living conditions, Escherichia coli becomes the main pathogen. The first case of Klebsiella pneumoniae liver abscess was officially reported in China in 1982^[1]Subsequently, many reports of Klebsiella pneumoniae liver abscess in Asia and Europe and the United States appeared one after another. At present, the bacterial liver abscess caused by Klebsiella pneumoniae has accounted for 43% ~66% of liver abscesses^[2]。 Studies have found that most of Klebsiella pneumoniae, which causes liver abscess, are highly mucinous and belong to highly virulent strains (hvKP). In an article published in the Lancet journal in 2012, Siu et al^[3]HVKP-induced liver abscess is considered to be a new invasive infectious disease. hvKP can not only cause liver abscess, but also cause metastatic infections, such as bacteremia, meningitis, endophthalmitis and necrotizing fasciitis, which can be life-threatening in severe cases. Li et al.^[4]It was also found that the proportion of hvKP in infections caused by Klebsiella pneumoniae increased from 25.5% in 2010 to 54.5% in 2012, which shows that the significance of hvKP is increasing. In order to improve the clinical and laboratory understanding of hvKP liver abscess, the relevant clinical and experimental research progress is summarized as follows.