Volume 95  ·  Issue 38  ·  2015

With the development of individualized medicine and the concept of "precision medicine", tumor targeted therapy has developed rapidly, and clinical research has gradually discovered and confirmed more gene mutations related to targeted therapy.

Primary hepatocellular carcinoma (HCC) is one of the common malignant tumors in China. Its occurrence often originates from liver cirrhosis caused by underlying liver diseases, and the degree of liver cirrhosis directly affects the treatment mode of tumor. Therefore, the factors that affect the prognosis of HCC, besides the tumor itself, should also consider the basic function of the liver. At present, there is no uniform staging system for HCC. Among them, the Barcelona Clinical Liver Cancer Staging System (BCLC) comprehensively considers liver function, tumor condition and basic physical condition, and corresponds staging with treatment and prognosis. It is recommended by the American Association for the Research of Liver Diseases (AASLD) and the European Association for the Research of Liver (EASL)^[1,2]。

Through the promotion of standardized diagnosis and treatment in China, the overall control level of bronchial asthma (asthma) has been improved to a certain extent, but there are still a few patients who are still unable to achieve good control even after using high-dose inhaled glucocorticoids including combination therapy. This part of patients is usually considered to be severe asthma^[1]。 3% ~5% of asthma patients are severe asthma, and the frequency of emergency treatment and hospitalization is 15 times and 20 times that of mild to moderate asthma, respectively, which are the main reasons for increasing the cost of asthma treatment, disability and death^[2]。 Severe asthma creates a huge social and economic burden. Due to the increasing burden of asthma disease, in 2008, China listed bronchial asthma as one of the key chronic respiratory diseases for prevention and treatment, and listed it as the respiratory diseases mainly controlled by the "Healthy China 2020" prevention and treatment plan. Therefore, improving the diagnosis and treatment level of severe asthma is of great significance to improve the overall control level and prognosis of asthma, and reduce the medical cost^[2,3,4]。

In recent years, the incidence and acute exacerbation rate of bronchial asthma (asthma) have increased significantly, and the interaction between environmental factors and genetic genes is the main cause of its incidence. With the acceleration of urbanization and industrialization in China, the deterioration of environment, especially air quality, inevitably occurs, which is closely related to the occurrence and deterioration of asthma. External environmental factors include indoor and outdoor air pollution, inhaled allergens, food allergies, etc. Outdoor air pollution mainly comes from traffic pollution (such as automobile exhaust, dust, etc.) and waste after fuel combustion (such as coal or fuel oil for power generation and heating, wheat straw combustion, etc.), while indoor air pollution comes from tobacco smoke, household biofuels (cooking, heating and candles, etc.), indoor decorations and outdoor polluted air entering the room. Controlling indoor and outdoor environmental factors is an important part of asthma management.

Currently, the treatment regimen based on inhaled glucocorticoids (ICS) recommended by the Global Asthma Initiative (GINA) can achieve good or acceptable clinical control of asthma for most patients with bronchial asthma (asthma). However, some severe asthma or refractory asthma still fail to achieve basic asthma control. Expert Consensus on Diagnosis and Management of Refractory Asthma in China^[1]This group of patients is called "refractory asthma". "International Guidelines for Severe Asthma" jointly published by the European Respiratory Society (ERS) and the American Thoracic Association (ATS) in 2014^[2]This group of patients is referred to as "severe asthma". Severe asthma accounts for 5% to 10% of asthma population. Although the proportion is not high, the proportion of acute exacerbation of severe asthma requiring emergency medical treatment or hospitalization is 15 to 20 times that of mild to moderate asthma, and the health resources consumed account for almost 50% of asthma^[1]。 Moreover, there is still no good treatment for severe asthma at present, and the development of medicine has not yet met the needs of these patients.

Bronchial asthma is referred to as asthma. The 2014 Global Asthma Management and Prevention Strategy (GINA) mentioned in the management of refractory asthma and severe asthma that these asthma patients need to be examined for the presence of comorbidities, including chronic sinusitis, obesity, gastroesophageal reflux (GERD), obstructive sleep apnea (OSA), and other psychological and physiological diseases; The presence of comorbidities may aggravate the symptoms of asthma or make it difficult to control asthma, and it is possible to bring asthma under control by treating these comorbidities^[1]。 Both asthma and OSA are common respiratory diseases, and the incidence of both diseases is increasing year by year. Asthma patients are prone to night snoring and apnea, and the proportion of patients with asthma in OSA is also significantly higher than that in normal people. Therefore, the coexistence of two diseases is not a accidental phenomenon. Is there a common predisposing and aggravating factor in their pathogenesis? And does the treatment of one disease affect the symptoms of the other? Compared with the overlapping syndrome of chronic obstructive pulmonary disease combined with OSA, some foreign scholars have called asthma combined with OSA "alternative overlapping syndrome"^[2]。 In-depth discussion and study of the relationship between the two will play an important role in guiding clinical work.

Bronchial asthma (asthma) is a heterogeneous disease^[1,2]It is a common chronic airway inflammatory disease, which seriously endangers human health. More than a decade ago, scholars began to notice the heterogeneity of asthma, identifying different asthma subtypes, called phenotypes, through the "visible features" of asthma. Although the phenotype of asthma is related to its clinical manifestations, triggers and treatment responses, it is not directly related to the pathogenesis of asthma, which cannot reflect the heterogeneity of asthma well, and cannot meet the requirements of highly individualized asthma treatment. Scholars began to distinguish asthma subtypes from the molecular mechanism and treatment response of asthma, believing that this distinguishing asthma subtypes is more conducive to the individualized treatment of asthma, and put forward the concept of "endogenous type". At present, endogenous type has gradually become the research hotspot of individualized medicine for asthma. How asthma research has changed from phenotype to endotype in recent years is introduced below.

acute pancreatitis (AP) is a common clinical emergency, and its incidence is increasing year by year, especially severe AP is dangerous in onset and has a high mortality rate. The 2012 update of AP Atlanta's diagnostic criteria has attracted much attention^[1]In recent years, our country has promulgated AP diagnosis and treatment guidelines for internal medicine, surgery, emergency medicine and integrated traditional Chinese and western medicine^[2,3,4,5]It has played an important role in standardizing the clinical treatment of AP.

To describe the clinicopathological characteristics and prognosis of intrahepatic biliary cystic tumor (IBCT) and compare the difference betwwen male and female patients.

11 male and 45 female patients with histological confirmed IBCT from January 2003 to April 2014 were envolved. clinical characteristics, laboratory examination , radiological features, treatment method and prognosis were analyzed.

The mean age of male patients with IBCT was significantly older than that of female patients (54.9±10.1 years vs 46.2±12.9 years, P=0.041). There were no significant differences in radiological features between male and female patients except for mural nodules (10/11 vs 15/45, P=0.001). Intrahepatic biliary cystadenocarcinoma (IBC) was more common in male patients than female patients (8/11 vs 16/45, P=0.041). Male patients had worse prognosis than female patients (P=0.014). 1–year, 3–year, and 5–year survival of male patients was 90.9%, 45.5%, 30.3%, respectively. However, 1–year, 3–year, and 5–year survival of female patients was 94.8%, 82.7%, 78.6%.

Male patients had low incidence of IBCT, and were more common for IBC. Even with complete resection, the long–term survival was still poor, close follow–up were recommended especially for male patients.

To investigate the safety and efficacy of hepatic resection for those patients with large/multinodular hepatocellular carcinoma (HCC) or those involving macrovascular invasion (MVI).

PubMed was systematically searched for studies examining the safety and efficacy of hepatic resection for treatment of HCC involving a single large tumor (>5 cm) or multiple tumors (>2), or those involving MVI.

The identified 52 studies involving 14 922 patients that investigated the use of hepatic resection for large/multinodular HCC, and 25 studies with 4 412 patients that investigated hepatic resection for HCC with MVI. Median in–hospital mortality of patients with either type of HCC was significantly lower in Asian studies (2.7%) than in non–Asian studies (7.3%, P<0.001). Median overall survival rate was significantly higher for all Asian patients with large/multinodular HCC than for all non–Asian patients both at the time of 1 year (81% vs 65%,P<0.001) and 5 years (42% vs 32%,P<0.001). However, median overall survival rate was similar for Asian and non–Asian patients with HCC involving MVI at the time of 1 year (50% vs 52%,P=0.46) and 5 years (18% vs 15%, P=0.95). There was an increasing trend in 5–year overall survival in patients with either type of HCC.

Hepatic resection is reasonably safe and effective for the treatment of large/multinodular HCC and HCC with MVI. The available evidence argues for expanding the indications for hepatic resection in official treatment guidelines.

To investigate protective effect of isoglycyrrhizinate combinated with verapamil on liver ischemia–reperfusion injury after semi–hepatectomy in rats.

Male SD rats were randomly divided into five groups: false operation (group A); rats subjected to 50%hepatectomy and 45 min of hepatic ischemia(group B); rats subjected to 50%hepatectomy and 45 min of hepatic ischemia, and treated with isoglycyrrhizinate (group C); rats subjected to 50%hepatectomy and 45 min of hepatic ischemia, and treated with verapamil (group D); rats subjected to 50%hepatectomy and 45 min of hepatic ischemia, and treated with isoglycyrrhizinate and verapamil (group E). Liver function, as well as morphology, SOD activity, FasL, caspase 3, and β–catenin expression of rats were analyzed.

Compared to group B, the levels of serum ALT of group E were significantly lower (P<0.05), SOD activity of liver tissue (98.8±7.1) were significantly higher(P<0.01), pathological changes were milder, FasL gene (1.327±0.193) and protein (0.010 9±0.001 4) expression were significantly lower (P<0.01). Caspase 3 protein expression levels (0.141 0±0.005 3) were significantly lower (P<0.001), β–catenin protein expression levels (0.079 1±0.008 2) were higher significantly(P<0.01).

Isoglycyrrhizinate combinated with verapamil can effectively reduce rats liver ischemia–reperfusion injury.The protective effect on liver cells may be mediated by inhibiting apoptosis caused by Fas/FasL system, increasing β–catenin protein expression, promoting liver regeneration and relieving liver peroxidation damage.

To analyze the risk factors affecting BK virus associated nephropathy(BKVAN) after kidney transplantation.

Three screening methods for BKVAN including quantitative PCR assay for BK virus(BKV) DNA load in urine and plasma and quantitative assay of urine cytology concurrently with renal transplant biopsies for the evaluation of 615 patients from January 2006 to December 2014 were used. The renal allograft biopsy specimens were analyzed by routine histologic examination, immunohistochemistry and classified into three categories of BKVAN. Potential variables were analyzed by Logistic regression model multivariate analysis to assess and rank BKVAN related risk factors.

The positive rate of urine decoy cell , BKV viruria and viremia in 615 renal recipients were 13.7%(84/615), 29.3%(180/615), and 8.8%(54/615), respectively. BKVAN were diagnosed in 49 recipients. The incidence and the median level of the number of the decoy cell, BK viral load in urine and plasma were higher in the BKVAN group than those in non–BKVAN group (all P<0.05). Tacrolimus (Tac) combined with mycophenolic acid (MPA) protocol (OR=12.4, P=0.001) and severe pneumonia post–transplant (OR=3.7, P=0.001) were the independent risk factors impacting on BKVAN in renal recipients.

The renal recipients with high level of BKV replication, whose immunosuppressant protocol include Tac and MPA, should be suspected the diagnosis of BKVAN.

To explore the feasibility of different doses of dexmedetomidine for quiet extubation during anesthesia recovery in hypertensive patients monitored with Narcotrend.

A total of 120 hypertensive patients scheduled for thyroid surgery from August 2012 to June 2014 in the Second Affiliated Hospital of Wenzhou Medical University, were randomly divided into 6 groups (n=20 each). Dexmedetomidine 0.4 (group M1), 0.6 (group M2), 0.8 (group M3) or 1.0 (group M4) μg·kg ^–1·h^–1, remifentanil 0.1 μg·kg ^–1·min^–1 (group R) and normal saline (group S) were infused for half an hour before the end of surgery, and extubation was carried out when Narcotrend index (NI) values were ≥80 in each group. Data of heart rate (HR), systolic blood pressure (SBP) and minimal alveolar concentration (MAC) of sevoflurane were observed and recorded at the time of baseline (T₀), half an hour (T₁) and 15 min (T₂) before the end of surgery, stopping sevoflurane (T₃), before extubation (T₄), 1 min (T₅), 5 min (T₆) and 10 min(T₇) after extubation. Extubation time, recovery time and related adverse reactions were also recorded.

Compared with T₀, SBP and HR at T₄ to T₇ in four M groups were significantly lower (all P<0.05). SBP and HR at T₆, T₇ in group R were significantly lower than at T₀ (all P<0.05). SBP at T₆, T₇ and HR at T₄ to T₇ in group R were significantly lower than that of group S (all P<0.05). SBP and HR at T₄ to T₇ in four M groups were significantly lower than that of group S and group R (all P<0.05). The values of MAC of sevoflurane at T₂ and T₃ in group R and M2–4 were significantly lower than at T₁ and that of group S (all P<0.05). Recovery time in group M3 [(19.1±2.8) min] and group M4 [(20.6±4.1) min] were significantly longer compared with other four groups (allP<0.05). The percentage of cough grade at levelⅠandⅡin each M group and group R during extubation was significantly higher than that in group S (85%, 85%, 90%, 95%, 80% vs 45%, allP<0.05).

Dexmedetomidine could be safely used in hypertensive patients monitored with Narcotrend for quiet extubation during anesthesia recovery, but larger doses of dexmedetomidine may prolong the recovery time.

To explore risk factors for coronary artery calcification (CAC) inpatients with end-stage renal disease (ESRD).

A total of 53 ESRD patients undergoing regular hemodialysis (3 times a week) from August 2014 to March 2015 in the Fourth Hospital of Hebei Medical University were enrolled in the study. The patients were divided into the negative control group (13 cases) and three positive groups (11 mild calcification cases, 12 moderate calcification cases and 17 severe calcification cases) based on coronary artery calcification score (CACs). Clinical data of all patients at study entry were collected. Arterial blood samples were also collected at the start of the first hemodialysis (HD) session of the week to measure the levels of serum albumin, uric acid, calcium (Ca), phosphorus (P), magnesium, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), C reactive protein(CRP), beta-2 microglobulin(β₂-MG), free parathyroid hormone (iPTH), alkaline phosphatase, fibrinogen, hemoglobin (HGB) and ferritin. Meanwhile, levels of blood pH were detected after collecting pre- and post-HD blood samples to calculate ΔpH (post-HD pH subtracted pre-HD pH). Logistic regression analysis was performed to analyze the correlation of CACs with clinical data and previously-reported blood biochemical indicators, followed by analysis of the incidence of CAC and influential factors in ESRD patients.

Severity of CAC was positively correlated with age(r=0.269), HD duration (r=0.341), serum calcium (r=0.358), serum phosphorus (r=0.186) and pre-HD pH (r=0.275), but negatively correlated with serum albumin (r=–0.192) and ΔpH ( r=–0.302), all P<0.05. Logistic regression analysis revealed that age, HD duration, serum phosphorus level and ΔpH were independent risk factors for CAC in ESRD patients (P<0.05). In CAC positive groups, CAC was predominantly involved in the left anterior descending artery (P<0.05,P<0.01 andP<0.01 in mild, moderate and severe calcification group, respectively).

CAC in ESRD patients seems to be affected by multiple factors, such as age, HD duration, serum phosphorus level and ΔpH. Moreover, ΔpH affects CAC mainly by pre-HD pH. Furthermore, left anterior descending artery is predominantly affected by CAC in ESRD patients.

To investigate the analgesic efficacy and safety of intercostal nerve cryoanalgesia after video–assisted thoracoscopic surgery (VATS).

This was a prospective randomized controlled study. From May 2014 to April 2015, 80 patients who would undergoing selective surgery performed by the same surgeon team were chosen, and were randomly divided into cryoanalgesia group and intravenous analgesia group by a random number table. Visual analogue scale (VAS) at resting and movement were measured on postoperative 4 h, 1 d, 2 d, 3 d, and the amount of supplemental morphine use and adverse reactions were recorded; plasma concentration of cortisol, blood glucose, C–reactive protein (CRP) and interleukin–6 (IL–6) were detected on preoperative and postoperative 4 h, 1 d, 2 d.

Seventy–one patients with complete test process were included in the statistical analysis, including cryoanalgesia group (35 cases) and intravenous group (36 cases). No statistical differences were found in terms of age, gender, body mass index (BMI) between the two groups. VAS scores of cryoanalgesia group at movement on postoperative 4 h, 1 d, 2 d, 3 d were 5(5, 7), 4(3, 6), 3(3, 4), 3(0, 3), and in intravenous group were 5(5, 6), 5(3, 5), 3(3, 4), 2(0, 3), respectively, but there was no statistically different between two groups(P>0.05). Resting VAS scores of cryoanalgesia group on postoperative 4 h, 1 d, 2 d, 3 d were 3(2, 4), 0(0, 3), 0(0, 0), 0(0, 0), and in intravenous group were 3(0.5, 4), 2(0, 3), 0(0, 1.5), 0(0, 0) respectively, but there was no statistically different between two groups(P>0.05). Resting analgesic effectiveness (VAS≤5) of cryoanalgesia group were 91.4%, and in intravenous group were 97.2%, respectively. Median of morphine dosage was equal between two groups on postoperative 4 h, 1 d, 2 d, cumulative amount of morphine of cryoanalgesia group was higher than intravenous group, but the difference between the two groups was not statistically significant. Incidence of nausea and vomiting for intravenous group was 36.1%, significantly higher than cryoanalgesia group (17.1%, χ²=4.148, P<0.05). The change of plasma concentration of cortisol, C–response protein(CRP), interleuken–6(IL–6) was noticeable, but there was no statistical significance in each time point.

The analgesic effect of both Intercostal nerve cryoanalgesia and intravenous analgesia after VATS is almost the same.Compare with intravenous analgesia, incidence of the adverse reactions of cryoanalgesia is lower, and there is no increasing in the stress response.

In recent years, due to the increasing incidence of tumor, the research on oncology in all countries in the world is changing with each passing day. Continuing medical education has also become an important part of medical education. In 1972, the American Medical Association defined Continuing Medical Education ("CME") as an educational activity that meets the professional needs of physicians, patients, the public and the Medical profession, and that maintains, develops and enhances the knowledge, skills, professional qualities and interpersonal relationships of physicians^[1]。 Continuing medical education to promote the development of medicine is the driving force for the hospital to advance and expand its business, and it is an effective way for medical staff to obtain new theories, new knowledge and new technologies and improve their comprehensive quality. Strengthening continuing medical education and cultivating learning talents can effectively improve the overall medical level of society and improve the quality of medical services^[2]。

To investigate the effect of antimicrobial peptide cathelicidin secreted by non-tumorous cells in lung tumor growth.

CRAMP^–/– mice and WT mice were used to establish a lung cancer model via tail vein injection of Lewis lung carcinoma cells (LLC1). Lung was weighted and tumor number on the lung surface was counted. Kaplan-Meier (K-M) survival curve was used to analyze survival rate of mice. Expression of cathelicidin, Ki-67 and CD68 in the tumor tissue was measured by immunohistochemical analysis. BALF cells were stained with Diff Quik and percentages of leukocyte types were determined by light microscopy.

Cathelicidin was high expression in inflammatory cells of tumor tissue, whereas weak expression in tumor cells. The lung weight and number of tumor in CRAMP^–/– mice were (0.25±0.04)g and (9.60± 2.25), respectively, which were significantly lower than those of WT mice (0.65±0.05)g and (23.40± 2.68). The difference was statistically significant (t=6.07, 3.95, all P<0.05 ). And Kaplan-Meier survival analysis showed median survival time of CRAMP^–/– mice was 49(46–51)d, which was longer than 34(28–39) d of WT mice (χ²=12.00, P<0.05). And the positive rate of Ki-67 tumor cells was significant reduced from(35.80±2.96)% in WT mice to(18.80±2.38)% in CRAMP^–/– groups(t=4.48, P<0.05). The total cell number as well as the number of lymphocytes, neutrophils, and macrophages in BALFs of CRAMP^–/– mice were (4.72±0.86)×10^4, (0.08±0.02)×10^4, (0.05±0.02)×10⁴ and (4.60±0.84)×10^4, respectively, while of WT mice were (16.18±1.61)×10^4, (0.32±0.05)×10^4, (0.20±0.05)×10⁴ and (15.66±1.57)×10⁴. All of them had significant difference(t=6.28, 4.39, 3.00, 6.20, all P<0.05 ). In addition, the infiltration of macrophages into lung tumors was decreased in CRAMP^–/– mice compared to WT mice, from (15.53±2.28)/high power field to (6.77±3.12)/high power field (t=3.41, P<0.05).

Non-tumor cells secreted cathelicidin promotes tumor cell proliferation and lung tumor growth. Recruitment of inflammatory cells such as macrophages into the tumor microenvironment may be the main mechanism of action.

To investigate the role of mRNA binding protein Human–antigen R (HuR) in the over–expression of α–Smooth muscle actin (α–SMA) stimulated by Platelet–derived Growth Factor (PDGF) in cultured human bronchia smooth muscle cells.

Human bronchia smooth muscle cells cultured in vitro were divided into 0, 6, 12 and 24 h groups according to the time of PDGF treatment. Total HuR protein and total α–SMA protein expression were detected by Western blot. Total HuR mRNA and total α–SMA mRNA level were determined by quantitative real time–polymerase chain reaction. RNA interference technology was used to down–regulate HuR protein level to study the protective effect of HuR in PDGF–stimulated α–SMA protein expression.

PDGF up–regulated the expression of HuR in a time–dependent manner. The relative expression levels of whole–cell HuR protein and mRNA in 0, 6, 12, 24 h groups were 0.23±0.09, 0.42±0.11, 0.93±0.21, 1.37±0.28; 1.00±0.00, 1.09±0.03, 1.16±0.03, 1.27±0.02 (all P<0.05). The relative expression levels of α–SMA protein and mRNA in 0, 6, 12, 24 h group also showed an increase trend marked in a time–dependent manner (1.03±0.08, 1.20±0.09, 1.39±0.11, 1.58±0.10; 1.00±0.00, 1.17±0.02, 1.23±0.02, 1.45±0.03; allP<0.05). Using RNA interference technology to down–regulate HuR protein level, there was a decrease in α–SMA protein expression.

PDGF stimulation can increase the expression of HuR and α–SMA in the smooth muscle cells, and HuR protein is involved in the expression of α–SMA protein stimulated by PDGF.

From August 21 to 23, 2015, the 10th National Clinical Forum on the Diagnosis and Treatment of Helicobacter Pylori and Digestive Diseases, which lasted for three days, came to a close in a tense and enthusiastic, happy and exciting atmosphere in Changping District, Beijing. This forum was co-sponsored by Beijing Branch of Chinese Medical Association, Peking University First Hospital, Chinese Medical Journal and China Helicobacter Pylori Information Center. This year coincides with the 100th anniversary of the founding of Peking University First Hospital, the 100th anniversary of the founding of Chinese Medical Journal, the 10th anniversary of the founding of this forum and the anniversary of Helicobacter pylori (H.pylori) Discoverer won the Nobel Prize 10th anniversary, celebrating "Double Ten Double Hundred" together.

The patient, a 70-year-old male, was admitted for 3 weeks of pain and discomfort in the middle and upper abdomen and 1 week of jaundice. Physical examination: The skin and sclera were yellow stained, and the apical pulsation point was located on the right side. Past physical fitness. Liver function showed: total bilirubin (TBIL): 121.7 μ mol/L, indirect bilirubin (IBIL): 82.6 μ mol/L. Tumor markers indicated: CA19-9>1 000 U/ml, carcinoembryonic antigen (CEA): 7.44 μ g/L. Abdominal enhanced CT showed (Figure 1): Abdominal visceral inversion, considering pancreatic head tumor, local compression and narrowing of the superior mesenteric vein. Magnetic resonance cholangiopancreatography (MRCP) showed a signal shadow of soft tissue mass in the pancreatic head area, considering pancreatic cancer, and dilatation of intrahepatic and extrahepatic bile ducts. Positron emission computed tomography (PET-CT) showed that the soft tissue density of the pancreatic head was about 3.2 cm ×3.8 cm, the FDG uptake was increased locally, and the maximum SUV value was about 3.8, considering pancreatic head cancer. Chest X-ray showed (Figure 2): dextrocardiac. Diagnosis: (1) Pancreatic head cancer is likely; (2) obstructive jaundice; (3) Complete visceral inversion. Whipple was performed under general anesthesia on 11 Sep 2013. Operation: The operator routinely stood on the right side of the patient, entered the abdomen through the left rectus abdominis incision, and exploration showed that the whole abdominal cavity was visceral inversion, the liver and gallbladder were located in the left upper abdomen, and the stomach and spleen were located in the right upper abdomen. Through the "reverse" Kocher incision, the pancreatic head and duodenum were freed, the pancreas was exposed, and the portal vein, superior mesenteric vein, common hepatic artery, and gastroduodenal artery were carefully identified. The tumor is located in the pancreatic head area, approximately 4.0 cm ×3.4 cm, surrounding the lower segment of the common bile duct and invading the superior mesenteric vein – portal vein confluence. During the operation, the invaded portal vein and tumor were completely resected, and the portal vein was reconstructed by liver sickle ligament. Child's method to reconstruct the digestive tract. The patient recovered smoothly. Postoperative pathology showed: well differentiated adenocarcinoma of the lower common bile duct, invading the pancreas; Lymph node metastatic carcinoma (2/15). The reexamination of abdominal enhanced CT at 18 days after operation showed that the lumen was partially narrowed after portal vein reconstruction. The patient developed grade IV myelosuppression after 1 cycle of chemotherapy with Genze + Xeloda regimen and was unable to continue chemotherapy. Six months after the operation, the patient developed massive peritoneal effusion and died in June 2014. The overall survival time was 9 months.

In recent years, the role of vitamin D outside bone metabolism has been paid attention to. Many studies have shown that vitamin D plays a certain role in the occurrence, disease severity, disease progression and drug response of asthma. The relationship between vitamin D and asthma and its related mechanisms are reviewed.

Cardiovascular disease (CVD) has become the leading cause of human death^[1]Therefore, exploring reliable markers with high sensitivity and specificity is of great significance for early diagnosis, timely treatment and prognosis of CVD. MicroRNAs (miRNAs) are a class of conserved endogenous non-coding single-stranded small molecule RNAs that regulate gene expression at the post-transcriptional level by specifically binding to the 3' untranslated region of miRNAs^[2]。 miRNAs can exist in peripheral circulation, such as blood components such as plasma, and circulating miRNAs can stably exist in harsh environmental conditions such as boiling, extreme pH, long-term storage at room temperature, and repeated freeze-thaw, and even be immune from the degradation of endogenous ribonuclease^[3,4]。 Moreover, circulating miRNAs meet the conditions that should be met by an ideal biomarker^[5]Such as high disease sensitivity and specificity and rapid and accurate early detection. Currently, circulating miRNAs have shown unique value in the early diagnosis and prognosis of many kinds of tumors^[4,6]The research as a potential marker of cardiovascular disease has also become a hot spot in the cardiovascular field, and specific circulating miRNA profiles of various cardiovascular diseases have been discovered. In this paper, the basic situation of miRNAs, the research on the association between circulating miRNAs and CVD, and the existing problems and prospects are reviewed.