Volume 96  ·  Issue 04  ·  2016

"Consensus" and "personalized treatment" are two different concepts literally, but there is a deep internal connection between them. If it is understood or used incorrectly, it may lead to improper treatment of patients. What is "consensus"? From the meaning of the word analysis, "consensus" itself contains dissent, otherwise there will be no "consensus" two words appear. Now there is a "consensus" on the treatment of many diseases. The so-called "consensus" refers to the "consensus" reached by "presenting" those "clinical issues" that exist in dispute according to their evidence-based medical evidence level, and then deciding their "recommendation level". Because "consensus" is a "consensus" opinion with high-level evidence-based medical evidence and recommended and recognized by most experts, it plays an important guiding role for clinicians, especially for grass-roots doctors. However, there are still different opinions on the application of the "consensus", because the "consensus" only meets a large number of people and does not cover all people. Therefore, the "consensus" cannot be applied mechanically, and it cannot be applied to one thousand people, and one medicine for ten thousand people. What about these patients who do not meet the "consensus" opinion? Then "personalized treatment" should be carried out according to the specific situation of the patient.

The clear indication for treatment is Helicobacter pylori (Helicobacter pylori，H.pylori) The prerequisite for rational treatment, alsoH.pyloriThe key to prevention and control. aboutH.pyloriThe indications for eradication are still controversial on some issues, but with the continuous enrichment of large-scale randomized controlled clinical trials and other evidence-based medical data, new consensus has been reached on many issues.H.pyloriThe indications for eradication are expanding. Recently published World Health Organization/International Agency for Research on Cancer (WHO/IARC) Working Group Report "Strategies to Eradicate Helicobacter Pylori Infection and Prevent Gastric Cancer"^[1](IARC Working Group Report) and "Kyoto Global Consensus on Helicobacter Pylori Gastritis"^[2](Kyoto Consensus for short) willH.pyloriThe extension of eradication therapy to the general population has caused confusion among clinicians. This article discusses this issue, hoping to be beneficial to the majority of doctors.

Modern Western medicine draws on the analysis method of reductionism in natural science, and tries to reduce human body and disease to various material entities at different levels, so as to explore the true meaning of life and uncover the essence of disease, which makes medicine embark on the development road of constant specialization and specialization. This development mode based on division has greatly promoted the explosive growth of medical knowledge, also adapted to the needs of the whole social division of labor, improved the level of human diagnosis and treatment of diseases and improved their own health. However, under the new historical conditions, in the face of changes in disease spectrum, the arrival of aging, drastic changes in natural environment and changes in lifestyle, more and more medical workers and researchers realize that modern medicine needs to be transformed urgently, otherwise medical knowledge will be fragmented, medical practice will become mechanized, and far from the core value of people-oriented.

China's basic medical insurance coverage rate has increased from 30% in 2003 to more than 95% in 2014; The proportion of medical insurance reimbursement for individual hospitalized patients also rose to 47% in 2012^[1]。 The widespread diagnosis and treatment behavior that neglects the medical cost and medical outcome has caused new problems such as waste of medical resources and intensification of the contradiction between doctors and patients. The guidelines for clinical diagnosis and treatment (referred to as guidelines) provide reasonable, safe, standardized and economical guidelines for medical services in developed countries. After 2000, some domestic clinicians translated foreign clinical diagnosis and treatment guidelines and introduced them into domestic use; At the same time, there are also domestic academic groups to formulate guidelines for relevant clinical disciplines^[2]。 Because domestic experts are not familiar with the methods and principles of formulating clinical diagnosis and treatment guidelines, the quality of guidelines is generally low. Some scholars studied 327 clinical diagnosis and treatment guidelines from 2006 to 2010, and found that there are common defects in the formulation of clinical diagnosis and treatment guidelines in China, such as irregular methodology, opaque process, non-compliant procedures and non-declaration of conflict of interest^[3,4]。 Therefore, the guiding role of the guidelines on clinical diagnosis and treatment has been negatively affected. In 2008 and 2013, it was reported that the development of high-quality clinical diagnosis and treatment guidelines required the development of "<Guidelines for Clinical Diagnosis and Treatment>^[5,6]。 After 2 years of investigation, research and review of relevant domestic and foreign literature published by relevant branches of Chinese Medical Association^{[7,8,9,10,11]}, have the following basic understanding, and are willing to discuss with domestic medical experts.

acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) refers to bleeding caused by non-variceal disorders of the gastrointestinal tract above the Trigger's ligament, including bleeding of the pancreatic duct or bile duct and bleeding caused by disorders near the anastomosis after gastrojejunostomy. A systematic review of 93 clinical studies showed an annual incidence rate of (19.4-57.0) /100,000, a rebleeding rate of 13.9% and a mortality rate of 8.6% 7 days after onset^[1]。

To observe the effects and safety of quadruple regimens including domestically manufactured rabeprazole used as first line/initial therapy for Helicobacter pylori(H.pylori) eradication in gastritis and duodenal ulcer patients, and to investigate the effects of extended use of bismuth after the quadruple therapy on eradication of H. pylori.

From January to August 2013, 430 patients with chronic gastritis or duodenal ulcer who were confirmed as H. pylori positive in gastroscopy for upper gastrointestinal symptoms were enrolled from 12 centers in China for initial treatment using quadruple regimens for H. pylori eradication. The study was a prospective, multicenter, randomized double-blinded double-dummy parallel-controlled clinical trial. The 310 chronic gastritis patients were divided into 2 groups: group A1 was given quadruple regime (rabeprazole+ amoxicillin+ clarithromycin+ bismuth potassium citrate) for 10 days followed by bismuth-placebo for 21 days; group A2 was given the quadruple regimen for 10 days and then bismuth potassium citrate for 21 days. The duodenal ulcer patients were given the quadruple for 10 days, then rabeprazole for 14 days. All the patients took ¹³C urea breath test to detect H. pylori 28 days after medicine withdrawal.

Altogether 428 cases were enrolled and 404 completed the trial. The total eradication rate in the chronic gastritis patients was 85.1% (262/308, intention-to-treat (ITT)analysis), which was 81.7% (125/153, ITT) in the A1 group and 88.4% (137/155, ITT) in the A2 group; the eradication rate in the duodenal ulcer patients was 85.8% (103/120, ITT). No severe adverse effects were reported. The symptoms (pain, burning sensation, reflux, belching, nausea, and vomiting) improvement status was similar among A1 and A2 groups.

The quadruple regimen using rabeprazole manufactured in China and administered for 10 days as first line/initial therapy in chronic gastritis and duodenal ulcer patients could achieve good H. pylori eradication rate. The extended use of bismuth after 10-day quadruple regimen might further improve the eradication rate. The regimens containing proton-pump inhibitor and bismuth may be well tolerated and safe in clinical application.

To evaluate the accuracy and effectiveness of Helicobacter pylori(H.pylori)antibody detection kit (immunoblot) in typing H. pylori strains, and to investigate the relationship between characteristics of H. pylori strains and clinical outcomes.

A total of 378 patients with upper gastrointestinal symptoms who had received gastroscopy and had pathological results within the period from March to August 2012 were collected from 6 centers in China.In all the patients, H. pylori antibody detection kit was used to detect and type serum H. pylori antibodies.The sensitivity, specificity, and accuracy of immunoblot in diagnosing H. pylori infection were evaluation in comparison to ¹³C urea breath test (UBT) as the"gold standard". The results were also compared with those colloidal gold method.The relationship betweenH. pylori typing and clinical conditions was analyzed.

Totally 378 patients were enrolled, in which 257 had H. pylori-positive ¹³C UBT results, and 121 were negative.With ¹³C UBT as the"gold standard", the sensitivity, specificity, positive predictive value, negative predictive value, and concordance rate ofH. pylori antibodies detection kit(immunoblot)were 97.7%, 86.8%, 94.0%, 94.6%, and 94.2%, respectively; the sensitivity, specificity, positive predictive value, negative predictive value, and concordance rate of colloidal gold method were 84.4%, 92.6%, 96.0%, 73.7%, and 87.0%, respectively.In patients diagnosed as H. pylori-positive by ¹³C UBT and immunoblot, 93.0%(53/57) in H. pylori eradication failure patients and 93.8%(182/194)in untreated patients were infected with type Ⅰ H. pylori as detected by immunoblot, with no statistically significant difference (P=0.764). The type Ⅰ strains positive rate was 94.2%(65/69), 89.9%(62/69)and 98.2% (55/56) in non-atrophy gastritis, atrophy gastritis, and duodenal ulcer untreated patients, respectively, the positive rate of type Ⅰ strains higher in duodenal ulcer cases than in gastritis ones, but with no statistically significant difference(P=0.185).

Compared with the"gold standard"¹³C UBT, the accuracy of H. pylori antibody detection kit (immunoblot) and that of colloidal gold method are both fairly high.Different H. pylori strains may have significantly different potential in causing diseases, as typeⅠtrain appeared to be more virulent than type Ⅱ strain, especially in causing peptic ulcer.There was no obvious difference between eradication failure and untreated patients in terms of positive rate of type Ⅰ H. pylori strains, hence further study is needed to explore the relationship between type Ⅰ H. pylori and eradication rates.

To evaluate the resistance of Helicobacter pylori (H.pylori) clinical isolates to various antibiotics, in order to guide rational drug use in Hebei Province.

From January 2014 to July 2015, 260 patients with H. pylori infection who had not received eradication treatment were enrolled in Third Hospital of Hebei Medical University. Gastric mucosa biopsy tissue samples were collected from these patients before treatment for isolation and culture of H. pylori. Kirby-Bauer method was used to detect drug-resistance rate of the H. pylori clinical isolates to metronidazole, clarithromycin, amoxicillin, levofloxacin, and furazolidone.

A total of 155 H. pylori strains were isolated from tissue samples of the 260 patients (positive rate, 59.6%). The drug-resistance rate of H. pylori isolated to metronidazole, clarithromycin, amoxicillin, levofloxacin, and furazolidone was 94.2%(146/155), 21.3%(33/155), 2.6%(4/155), 5.8% (9/155), and 1.9%(3/155), respectively. There was no statistically significant difference in positive culture rate and drug-resistance rate between different sex, age, and disease category(all P>0.05).

In Hebei Province, the resistance rates of H. pylori to metronidazole and clarithromycin appear to be higher than those to amoxicillin, levofloxacin, and furazolidone.

To explore the risk factors associated with long-term mortality and the predictive value of Charlson comorbidity index (CCI) for long-term mortality in patients with pulmonary embolism (PE).

A total of 234 patients with confirmed PE from the medical departments of West China Hospital of Sichuan University from January 2010 and December 2012 were enrolled, and these meeting the inclusion criteria were followed-up for 2 years after discharge. The long-term mortality was calculated and univariate and multivariate analysis were performed to identify the risk factors associated with long-term mortality of PE. All the patients were assessed the comorbidity burden with the CCI, and survival analysis was used to study its value in predicting long-term mortality in patients with PE.

A total of 176 PE patients were finally included in this study, and 53 patients died during the follow-up period, with 2 years' mortality 30.1%. The univariate analysis showed diabetes (P=0.034), malignant neoplasm (P=0.001), chronic lung disease (P=0.035), liver disease (P=0.048), in bed for a long time (P=0.049), inappropriate anticoagulant therapy (P=0.016) were associated with the long-term mortality of PE patients. Among these risk factors, the multivariate analysis revealed malignant neoplasm (OR=9.28, 95%CI: 2.85-31.00, P=0.003), chronic lung disease (OR=2.96, 95%CI: 1.15-7.62, P=0.024), inappropriate anticoagulant therapy (OR=4.08, 95%CI: 1.64-10.20, P=0.003) were the independent risk factors. The median CCI scores for died PE patients during follow-up was higher than that for the survived PE patients ((2(1, 3) vs 1(0, 2), P<0.001); PE patients with one and more comorbidities (CCI≥1) were associated with 2.61-fold increased risk of long-term mortality compared with patients with no comorbidity (CCI=0) (95%CI: 1.14-6.00, P=0.024). The per 1-score increase of CCI was associated with 1.76-fold increased risk of long-term mortality in PE patients (95%CI: 1.04-2.97, P=0.035). Survival analysis showed that the 2-year cumulative survival of PE patients with CCI score≥1 was significant lower than that of patients with CCI=0 (46.7% vs 78.5%, P=0.003).

Malignant neoplasm, chronic lung disease and inappropriate anticoagulant therapy are independent risk factors of long-term mortality in patients with PE. The CCI can predict long-term mortality risk among patients with PE and the risk increases with the increase of comorbidites patients have.

To compare cardiac adverse events, clinical outcomes and mid-and-long-term effects among massive and sub-massive pulmonary embolism (PE) patients under different periodswho received thrombus fragmentation by pigtail catheter.

Two groups of patients who receivedthrombusfragmentation bypigtail catheter in different periods were analyzed retrospectively. Group E: 38 cases received therapy from July 2004 to October 2009 with local anesthesia; Group P: 64 cases with general anesthesia from March 2010 to December 2014. All patients were confirmedPEby CT and angiography. Parts of patients with deep vein thrombosis (DVT) received inferior vena cava filter placement 3 days later. The patients were followed up for 6-24 months after discharge. Cardiac adverse events, clinical outcomes during the thrombusfragmentation process, and mid-and-long-term effects were compared between the two groups.

There were no significant differences in preoperative clinical data betweenthe two groups (P>0.05). Compared with group E, clinical warning events were significantly improved in group P (odds ratio(OR): 1.24, 98.3, 1.45, 2.50; P<0.05). Within group P, there were significant differences inarterial oxygen partial pressure (PaO₂) [(98.3±8.7)vs(81.3±7.1)], mean pulmonary artery pressure (mPAP) [(25.3±7.9)vs(37.2±7.6)], heart rate (HR) [(94.3±7)vs(122±9)], airway resistance [(16.7±1.6)vs (22.5±2.1)] and mean arterial pressure (MAP) [(53.4±7)vs(42.5±6)] before and after thrombus fragmentationtreatment (P<0.05). The incidence of congestive heart failure and pulmonary arterial hypertension associated with chronic pulmonary thromboembolism (CPEPH) during follow-up were significantly different between group P andgroup E (P<0.05).

Thrombus fragmentation by pigtail catheter with intraoperativeprecise management under general anesthesia can reduce cardiac adverse events andimprove the mid-and-long-term effects among PE patients.

The study aimed to discuss whether the time interval between bilateral primary breast cancers (BPBC)and the endocrine therapy status after thefirst primary cancer could influence the prognosis and consistency of the biological indicators.

Clinical data of 133 patients with BPBC in cancer institute and hospital of Tianjin medical university from January 2005 to December 2008 were retrospectively analyzed. The patients were divided into two groups according to the time interval and the endocrine therapy. The consistency of hormone receptor and human epidermal growth factor receptor-2 (HER-2) expression between the bilateral tumors and the prognosis of BPBC in different groups were analyzed.

With the extension of time interval, the consistent rate of biological indicators between the bilateral tumorshas decreased.The consistent rate of estrogen receptor (ER)was higher than that of progestin hormone (PR) in each group. When the time interval was six or less months, ER and HER-2 had the consistency and correlation between the two primary cancers(P≤0.05). In patients who did not receiveendocrine therapyafter the first cancer, the consistent rates of the biological indicators were higher and ER had betterconsistency and correlation(P≤0.05). Time interval and endocrine therapy hadno effecton the overall survival of the patients.

With the extension of the time interval, the consistency of the biological indicators in BPBChas decreased.ER and HER-2 of the bilateral tumorshad a high similarity in patients whose time interval wasno more than 6 months.Endocrine therapy could also affect the consistency of the biological indicators.However, these two factors were not associated with prognosis in patients with BPBC.

To evaluate the outcome of the endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAA) in patients over 80 years old and analyze the factors that influence its long-term curative effect.

Follow-up visits and analysis were conducted from January 2004 to December 2013 on a total of 96 AAA patients aged over 80 years old who had been treated with EVAR and thus met the inclusion criteria. The primary focus of the study was all-cause mortality and secondary focuses included the rate of intervention-related complications, the rate of secondary interventions and procedural data. The Kaplan-Meier survival curve was used to analyze the long-term survival rate and the cumulative probability of intervention-related complications. The Cox proportional hazards regression model was used to analyze factors that could influence the long-term survival rate.

Effective follow-up visits were conducted on 76 patients (79.2%). The patients were tracked for an average of 3.63 years, with the longest follow-up lasting 10.34 years. During the study, 27 deaths occurred and the all-cause mortality rate was 28.1%. Furthermore, 8 cases of intervention-related complications (8.3%) were observed, including endoleaks and spinal cord ischemia. A total of 6 secondary interventions were conducted on 6 patients, with the rate of secondary interventions being 6.3%. The five-year cumulative survival rate was 64% (95%CI: 0.53-0.78) and the ten-year cumulative survival rate was 35%(95%CI: 0.15-0.84). The Cox proportional hazards model showed that an ASA classification of Ⅲ/Ⅳ (HR=8.45, 95%CI: 1.26-56.55, P<0.05), smoking (HR=2.08, 95%CI: 0.70-2.63, P<0.05) and cerebrovascular diseases (HR=2.96, 95%CI: 1.06-8.25, P<0.05) could significantly increase the risk of the long-term all-cause mortality of an AAA patient treated with EVAR. While hypertension could significantly decrease the risk (HR=0.25, 95%CI: 0.10-0.66, P<0.05).

EVAR is safe for senior patients with AAA though personalized preoperative assessment is very important.

To compare the costs and effectiveness of treatments for benign prostatic hyperplasia (BPH), including pharmaceuticals (finasteride, tamsulosin, combined therapy), transurethral 2 micron laser resection of the prostate and transurethral resection of the prostate (TURP).

Since July 2007 to June 2009, a total of 790 patients with BPH were prospectively collected in this study, including 390 outpatients with pharmaceuticals who were randomly classified into 3 groups of finasteride, tamsulosin and combined therapy, 140 inpatients with transurethral 2 micron laser resection of the prostate and 260 inpatients with TURP. The costs and effectiveness of each group were compared.

Prostate volume of finasteride group was decreased after three months of medication, of tamsulosin group no change, of combined therapy group was decreased after one month of medication. Maximum flow rate (MFR) of three groups was higher after one month of medication. International prostate symptom score (IPSS) and quality of life (QOL) score were decreased after one month of medication and further decreased 3 months, 6 months after the medicine, the difference was statistically significant. The effective rate of three pharmaceutical groups after 6 months of treatment was 84%, 89% and 89%, respectively. The cost of operative group was lower than 5-year cost of pharmaceutical group.

Tamsulosin combined with finasteride is the better pharmaceutical option for BPH patients and the transurethral 2 micron laser resection of the prostate, the cost of which is lower than pharmaceuticals, is a safe and effective surgery.

To evaluate the effects of laparoscopic surgery under total intravenous anesthesia (TIVA) on outcomes of heterotopic pregnancies which need to receive laparoscopic procedures.

The data of 108 cases of pregnant women in Center of Reproductive Medicine, Peking University Third Hospital were retrospectively analyzed, and divided into two groups according to whether received surgery. Surgery group : 48 pregnant women after in vitro fertilization-embryo transfer (IVF-ET) were diagnosed as heterotopic pregnancies and received laparoscopic procedures under TIVA. Control group: 60 normal pregnant women after IVF-ET. The miscarriage rate, pregnant complications rate, premature birth rate, live birth rate, delivery weeks and cesarean section rate of two groups were compared. Meanwhile, the newborn's weight, male rate, birth defect rate and Apgar score in 1 min and 5 min of the two groups were compared.

The miscarriage rate, pregnant complications rate, premature birth rate, cesarean section rate, male rate of surgery group were 14.6%, 16.7%, 4.2%, 82.9%, 51.2% respectively, which were 15.0%, 18.3%, 6.7%, 84.3%, 52.9% in control group respectively. There were no significant difference between the two groups (χ²=-0.072, -0.241, -0.569, -0.442, -0.163, P>0.05). The delivery weeks and newborn's weight of surgery group were (38.3±1.7)weeks and(3 394.9±460.7)g respectively , which were (37.9±1.5) weeks and (3 406.3±512.6 )g in control group. There were no significant difference between the two groups (t=1.083, -0.111, P>0.05). The 1 min Apgar score and 5 min Apgar score of surgery group were 9.6(9.0-10.0), 10(10-10) scores and were 9.5(9.0-10.0), 10(10-10) scores in control group.There were no significant difference between the two groups (Z=-0.418, 0.000, P>0.05). The live birth rate of two groups were both 100%, and the birth defect rate were both 0.

Laparoscopic surgery under TIVA has no effect on the outcome of heterotopic pregnancies.

To investigate the roles of PI3K in bone cancer pain, the present study was performed to demonstrate the changes of pain-related behavior and the production of IL-1β, IL-6 and TNF-α after intrathecal injection of wortmannin (antagonist of PI3K receptors) in rat model.

A total of 44 SD rats were randomly divided into 4 groups, sham group (group S), sham + wormannin group (group SW), cancer group (group A), cancer + wortmannin group (group AW). Group S and group W were injected with 10 μl Hank's solution into left tibial medullary cavity; group A and group AW received injections of Walker 256 mammary cancer cells(10 μl, 2×10 cells/ml) into the same place to establish the model of bone cancer pain. In the meantime intratheacal catheterization was performed between L3 and L4 vertrbra on the rats of every group. Nine days after the operation, group S and group A received a single intratheacal injection of saline (0.9%, 10 μl), group SW and group AW received intratheacal wortmannin 0.5 μg/10 μl. Mechanical withdrawal thresholds were measured on the left hind paw before and every 10 min after intrathecal injection. Then the L4-L6 sections of spinal cord 30 min after injection were collected to determine the expression of IL-1β, IL-6 and TNF-α.

At 30 min post-injection, mechanical withdrawal thresholds of groups S, SW, A and AW were (30.1±4.3), (31.7±1.3), (17.2±2.0), (24.8±2.3) g respectively at Day 9 postinoculation (F=22.403, P<0.01), the mechanical withdrawal thresholds in group AW increased obviously versus group A. The expressions of TNF-α in groups S, SW, A and AW were (84.5±6.3), (78.7±12.5), (110.5±7.3), (57.8±4.6) pg/ml. Compared with groups S and W, the expression of TNF-α in group A showed a significant upregulation (F=28.119, P<0.01).

An intrathecal injection of wortmannin may alleviate hyperalgesia, and inhibit the up-regulated expression of spinal cord inflammatory cytokines TNF-α in rats with bone cancer. PI3K may be involved in the development of bone cancer pain by regulating the expressions of TNF-α.

To investigate the effects of fine particulate matter with a mean aerodynamic diameter ≤2.5 μm (PM2.5) collected from Lanzhou city on phagocytic function of alveolar macrophages (AM) in chronic obstructive pulmonary disease (COPD) mice.

Forty male mice were randomly divided into four groups: healthy group, healthy PM2.5 group, COPD group and COPD PM2.5 group. COPD mice were established by cigarette smoking. PM2.5 (10 mg/kg) collected by air sampler was intratracheally instilled in healthy PM2.5 group and COPD PM2.5 group. Mice were sacrificed after 14 days, and alveolar macrophages (AM) were isolated. Mean fluorescence intensity (MFI) and the positive percent of alveolar macrophages engulfing flurescein isothiocyanate-labeled Escherichia coli (FITC-E.coli) (AM%) were detected by flow cytometry. Total antioxidative capacity (TAC) was measured by O-phenanthroline colorimetry. Malondialdehyde (MDA) was measured by thiobarbiturieacid colorimetry and myeloperoxidase (MPO) was measured by O-dianisidine colorimetry.

The peak inspiratory flow (PIF), peak expiratory flow (PEF) and dynamic compliance (Cdyn) of COPD group were significantly lower than healthy control group. The pathology of COPD group showed disruption of alveolar septa, formation of emphysema, and that the number of alveoli had a significant reduction. The MFI and AM% in COPD group were significant lower than healthy group (14.1±1.7 vs 43.2±6.1, 9.2%±2.3% vs 69.1%±8.3%)(all P<0.01). Comparing to healthy group and COPD group, the MFI and AM% in healthy PM2.5 group (20.3±4.5, 40.4%±4.4%) and COPD PM2.5 group (7.5±1.3, 6.0%±2.2%) were respectively lowered. The level of TAC in COPD group was significantly lower than healthy group [(3.10±0.64) vs (15.43±0.69)U/mg], the levels of MDA and MPO in COPD group were higher than healthy group[(2.72±0.13) vs (1.31±0.16) nmol/mg, (1.63±0.11) vs (0.92±0.13)U/g] (allP<0.01). In both healthy PM2.5 group and COPD PM2.5 group, the levels of TAC [(6.75±1.06), (2.34±0.61) U/mg] were lower than their corresponding control group; while the levels of MDA [(1.96±0.31), (3.20±0.19) nmol/mg] and the levels of MPO [(1.01±0.19), (1.74±0.13) U/g] were increased (allP<0.01). For the COPD group at baseline and after the intervention of PM2.5, the MFI and AM% showed positive correlation with the levels of TAC, and negative correlation with the levels of MDA , and negative correlation with the levels of MPO (allP<0.05). For health group at baseline and after the intervention PM2.5, the above relationships still existed (allP<0.05).

PM2.5 can damage phagocytosis of AM and exacerbate oxidative stress in COPD mice, and AM phagocytosis impairment by PM2.5 is closely associated with oxidative stress.

To quantitatively evaluate the evolution of the tumor perfusion in A549 lung adenocarcinoma transplantation model induced by antiangiogenic treatment.

To establish the preclinical transplantation model of lung adenocarcinoma, 60 BALB/c nu/nu mice was inoculated with A549 cell lines via axilla. Sixty mice were randomly divided into 2 groups. The treatment group was treated with intravenous Bevacizumab (10 mg/kg weight, in a single injection), and the control group received saline only in the same dose. Five times of volume perfusion CT (VPCT) scan was performed before treatment, and on the second, forth, sixth and tenth days of treatment, respectively. The values of blood flow (BF) in the A549 tumors were measured after scanning. The microvessel density (MVD), vessel maturity index (VMI) in the tumors were determined using multiplexed QDs-based immunohistochemical staining.

Comparing the values of BF, VMI and MVD between the two groups on the same day before treatment, the values of BF, VMI and MVD of the treatment group were (13.5±1.5) ml·(100 ml)^-1·min^-1, 0.14±0.04, (45.7±16.5)/HPF, respectively, and those in the control group were (13.4±1.6) ml·(100 ml)^-1·min^-1 , 0.14±0.05, (48.0±7.0) /HPF , respectively. There was no significant difference between the two groups (all P>0.05). And on the second, forth, sixth, tenth days of treatment, the values of BF of the treatment group were (17.9±7.3), (32.2±6.9), (18.5±2.4) and (13.8±1.8) ml·(100 ml)^-1·min^-1, respectively, and those in the control group were (10.5±0.6), (9.6±0.8), (5.7±1.2) and (1.9±1.0) ml·(100 ml)^-1·min^-1, respectively. The values of VMI of the treatment group were 1.17±0.22, 3.25±0.23, 2.94±0.31 and 1.07±0.18, respectively, and those in the control group were 0.12±0.03, 0.13±0.03, 0.15±0.03, and 0.13±0.03, respectively. The values of MVD of the treatment group were (38.0±6.3), (24.3±5.4), (15.2±3.4) and (13.5±4.7)/HPF, respectively, and those in the control group were (44.8±5.9), (48.0±12.8), (41.8±5.7) and (45.7±20.3)/HPF, respectively. In treated mice, BF and VMI were significantly higher than those in the control group (all P<0.01). BF and VMI increased from day2, and reached the peak at day4 (P<0.01), then decreased at day6, however the value of BF at day6 was still higher than that in the baseline (P<0.01) and decreased to the baseline level at day10; while the value of VMI was still higher than that in the baseline at day10. And on the forth, sixth, tenth days of treatment, in treated mice, the values of MVD were significantly lower than those in the control group and the baseline level before treatment (allP<0.01). In control mice, BF decreased (allP<0.01) with the time, while MVD and VMI had no changes.

The tumor perfusion and vessel maturity are transiently increased in A549 lung adenocarcinoma transplantation model induced by antiangiogenic treatment. VPCT is helpful to quantify the evolution of the tumor perfusion and then evaluate the functional changes of tumor vessel maturity.

As a complex and multidisciplinary disease, the study of pulmonary hypertension has made important progress in the past half century. The first edition of the guidelines for primary pulmonary hypertension was published in 1993^[1]。 Most of the clinical evidence of the first edition of the guidelines comes from expert consensus. With the advancement of research, a large amount of evidence-based medical evidence continues to emerge, and on this basis, the guidelines for pulmonary hypertension have been repeatedly updated in Europe and North America, and the rigor of the guidelines and the formulation methodology have been continuously improved. In 2015, the European Society of Cardiology/European Society of Respiratory Diseases (ESC/ERS) jointly published the latest edition of the Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension^[2,3]。 The methodology and main changes in its formulation process are described below.

Renal artery stenosis is a renal vascular disease caused by many causes, among which atherosclerotic renal artery stenosis (ARAS) is the most common cause. About 7% of people over 65 have ARAS^[1]。 In China, atherosclerosis has become the leading cause of renal artery stenosis, accounting for about 70%^[2]。 ARAS is an important risk factor for renovascular hypertension and chronic renal insufficiency. It is a progressive disease with occult onset. 10% to 15% of patients will eventually progress to refractory hypertension or severe renal insufficiency^[3,4]。 ARAS will affect the body to varying degrees. Due to insufficient blood supply to the kidney, the baroreceptor of the renal entrance glomerulus is stimulated, which will activate the renin-angiotensin-aldosterone system, further affecting the systemic circulation, endocrine and urinary systems, resulting in a series of changes such as left ventricular remodeling, hypertension and vascular remodeling^[5]。 Therefore, it is necessary to treat ARAS with clinical symptoms appropriately to effectively relieve ARAS and delay the progression of the disease. The main methods of treatment include drug therapy, surgical therapy and percutaneous interventional therapy. Since 1991, Kuhn et al.^[6]After the first use of renal artery stenting instead of balloon dilatation, percutaneous renal artery intervention began to develop rapidly due to its obvious advantages over balloon dilatation. During 1995 – 1998 alone, approximately 700 patients underwent renal artery stenting. With the more and more mature technology of percutaneous interventional therapy, with less trauma and obvious effect of improving renal vascular blood supply, it has gradually replaced traditional surgical treatment and become the first choice treatment for refractory hypertension and renal insufficiency caused by ARAS. However, in patients with ARAS, there has been a large controversy about the choice of percutaneous interventional therapy versus drug therapy. What do you think of the results of many large center studies in recent years? Which patients are suitable for interventional therapy? How should relevant clinical studies be carried out in the future? This paper summarizes the above problems.