Volume 96  ·  Issue 24  ·  2016

Precision medicine refers to "tailored" medical treatment for patients using information such as their genetic composition, living environment and lifestyle, in order to obtain ideal therapeutic effects, reduce unnecessary treatment and avoid adverse reactions^[1]。 "Precision medicine" is not a brand-new concept, it originates from "individualized medicine", but due to the rapid development of biological databases, detection methods (proteomics, genomics, metabolomics, etc.) and bioinformatics analysis, the application of "precision medicine" is more widely. Precision medicine has involved pharmacogenomics, tumor diagnosis and treatment, genetic diseases, infectious diseases, cardiovascular diseases, respiratory diseases, nervous system diseases and many other aspects^[2]。 The U.S. Precision Medicine Plan released in early 2015 has two main goals. The short-term goal is more and better cancer treatments, and the long-term goal is research on the entire health and disease field^[3]。

Bone marrow cell morphology and bone marrow biopsy belong to the category of cell morphology and histopathological examination medicine, which largely depends on the subjectivity of the examiner, and is influenced by many factors such as the level of the examiner, the quality of the specimen and the examination method. It is necessary to combine a large amount of clinical data to make a comprehensive and accurate judgment. With the continuous improvement of the widespread and accuracy of high-throughput omics and targeted marker detection applications, the reliance of disease diagnosis on traditional morphological tests has decreased, making the two-way communication between morphological tests and clinical practice increasingly neglected. However, bone marrow cell morphology and bone marrow biopsy still play an irreplaceable role in the diagnosis and prognosis of blood system and related diseases. Some diseases have similar bone marrow cell morphology or bone marrow biopsy, but the clinical diagnosis is completely different; Some diseases have similar clinical manifestations, and the morphology of bone marrow cells or bone marrow biopsy is very different^[1]。 Therefore, two-way communication with the clinic is essential in the whole process of bone marrow cell morphology and bone marrow biopsy examination (before, during and after examination). The broad laboratory and clinical communication is not limited to the dialogue between clinicians and laboratory personnel, but also includes the communication between laboratory personnel and patients or family members, information on application forms, results of relevant laboratory items and interpretation of results.

The mechanism of thrombosis and hemostasis in the body involves various systems such as vascular endothelium, platelets, coagulation, anticoagulation, fibrinolysis and hemorheology, and changes in the quantity and/or function of each component will cause different degrees of thrombotic or hemorrhagic diseases. With the rapid development of laboratory medicine towards automation, specialization and informatization, and the development and application of new technologies and methods such as molecular biology and proteomics, laboratory testing of thrombosis and hemostasis plays an important role in the diagnosis and differential diagnosis of diseases, and the monitoring of efficacy of anticoagulant and thrombolytic drugs, and the clinical dependence on test results increases. However, due to the dynamic changes in the occurrence and development of thrombotic and hemorrhagic diseases, there are many influencing factors in the detection of thrombosis and hemostasis. It is very important for the laboratory to improve the internal quality control (IQC) and external quality assurance (EQA) procedures and speed up the standardization process. At the same time, it is very important to establish an active and effective communication mechanism with the clinic to ensure the reliability of the test results.

Communication is the process of passing information, thoughts, and emotions between individuals or groups for a set goal, and reaching a common agreement. It has three main elements: having a clear goal; Reach a mutual agreement; Communicate information, thoughts and emotions. The hospital is an institution composed of multiple departments. As a medical technology platform to provide services for all clinical departments and patients in the hospital, the laboratory department has the same goal as the clinical departments, that is, to provide high-quality and efficient services for patients. Therefore, it is extremely important to adopt multi-faceted communication based on the common agreement reached on this goal^[1,2]。 The International Organization for Standardization (ISO) clearly states the importance and specific requirements of clinical communication in the accreditation of medical laboratories. This article summarizes the experience of communication with clinical in the process of medical laboratory accreditation in recent years.

To investigate the prevalence and clinical features of small intestinal bacterial overgrowth (SIBO) in diarrhea-predominant irritable bowel syndrome (IBS-D) patients detected by hydrogen and methane in lactulose breath test (LBT), and to study the effects of rifaximin in IBS-D patients.

Consecutive patients with IBS-D who met Rome Ⅲ criteria, and gender- and age-matched healthy volunteers were enrolled from March 2015 to January 2016 in Peking University Third Hospital. All the ISB-D patients underwent LBT to detect the prevalence of SIBO. The clinical and LBT features of IBS with SIBO (IBS-P group) and without SIBO (IBS-N group) were analyzed. The effects of rifaximin therapy (0.4 g, twice per day for 4 weeks) in IBS-D patients were evaluated by comparing changes in clinical features and LBT results after treatment.

(1) Eighty-four IBS-D patients and 22 healthy controls were enrolled. The prevalence of SIBO in IBS-D patients was 41.67% (35/84), with 27 (77.14%) only hydrogen-positive, 5 (14.29%) methane-positive, and 3 (8.57%) both methane- and hydrogen-positive. (2) The body mass index (BMI) in the IBS-P group was lower than in the IBS-N group [(21.61±0.57) vs (23.44±0.54) kg/m^2,P<0.05], the maximum stool frequency was also less than in the IBS-N group [(3.85±0.23) vs (4.88±0.35) times/day,P<0.05]. (3) No significant difference was found in oro-cecal transit time (OCTT) among IBS-P, IBS-N and healthy controls. The hydrogen concentration in small intestinal and colonic sections in breath of the IBS-P group was higher than that of both healthy controls and the IBS-N group, while methane concentration in small intestinal and colonic sections (160 min) was higher than that of the IBS-N group (allP<0.05). (4) There was no linear relationship between mean hydrogen and methane concentrations in LBT among the IBS-P, the IBS-N and healthy control groups (allr<0.35,P>0.05). (5) Totally 13 IBS-P patients received rifaximin therapy, in whom the symptoms of abdomen pain, bloating, fecal consistency, stool frequency, and stool satisfactory were significantly improved after treatment (allP<0.05); 8 IBS-N patients received rifaximin therapy, in whom fecal consistency, stool frequency, and satisfactory were significantly improved (allP<0.05). (6) And 5/13 of the IBS-P patients receiving rifaximin presented negative LBT results after rifaximin therapy, with lower hydrogen concentration at all the time points, especially in colonic section (120 min) [(34.54±7.32) ×10^-6 vs (52.23±9.40) ×10^-6,P<0.05] and lower methane concentration especially in small intestinal section (80 min) [(8.54±0.95) ×10^-6 vs (11.31±0.94) ×10^-6,P<0.05].

About 41.67% of the IBS-D patients meeting Rome Ⅲ criteria have SIBO, which can be better screened by combining hydrogen and methane in LBT compared with only hydrogen in LBT. SIBO can affect nutritional status in IBS-D patients. Rifaximin can improve the systematic symptoms of IBS-D patients with SIBO, also reduce hydrogen and methane concentration in breath, while only improving diarrhea in IBS-D patients without SIBO. Some differences in gut microbiota may exist between IBS-D with and without SIBO.

To evaluate the impact of extended-spectrum β-lactamase (ESBL) on clinical outcome and medical cost in patients with bloodstream infection (BSI) due to Klebsiella pneumoniae.

A retrospective study was conducted in patients admitted into Changhai Hospital between January 2013 and December 2014, who suffered from BSI due to Klebsiella pneumoniae during hospitalization. Patients were divided into two groups according to whether Klebsiella pneumoniae produced ESBL (ESBL positive group and ESBL negative group). They were matched with propensity score matching method in a 1∶1 ratio and then multiple regression model was used to analyze the impact of ESBL on clinical outcome and medical cost. Clinical outcome was evaluated by 30-day mortality post BSI; medical cost was evaluated by total length of stay (LOS), post-BSI LOS, total hospital cost and antimicrobial cost.

Before matching, the two groups were significantly different in age, nosocomial infection rate, LOS before BSI and surgical rate during hospitalization (all P<0.05). The ESBL-positive group had higher 30-day mortality post BSI (21.3% vs 8.7%,P=0.054), and higher total LOS [25.0(12.0, 33.0) vs 16.0(10.0, 23.0) d, P=0.015], post-BSI LOS [16.0(9.0, 26.0) vs 10.0(5.0, 16.0) d, P=0.006], total hospital cost [69 409(40 605, 198 021) vs 45 683(28 448, 67 000) ￥, P<0.001] and antimicrobial cost [10 279(4 815, 25 500) vs 3 783(1 596, 11 879) ￥,P<0.001]. After matching, the two groups had no significant differences in clinical characteristics such as sex, age, nosocomial infection rate, LOS before BSI, APACHEⅡ score, Charlson Comorbidity Index, underlying diseases and surgical rate during hospitalization (allP>0.05). Multiple regression analysis indicated that ESBL could significantly increase the total LOS, post-BSI LOS, total hospital cost and antimicrobial cost (allP<0.001), but did not increase the 30-day mortality post BSI (P=0.910).

ESBL can significantly increase the medical cost in patients with BSI due to Klebsiella pneumoniae but does not increase the 30-day mortality post BSI.

To evaluate the effects of intranasal midazolam premedication on children who undergoing inhaled induction of anesthesia with sevoflurane.

One hundred American Society of Anesthesiologists(ASA)Ⅰ-Ⅱ children undergoing elective operations in Tianjin Medical University Cancer Institute and Hospital from June 2014 to June 2015 were randomly assigned into 2 groups, and 50 cases in each group. Patients received different intranasal premedication giving 30 min before anesthesia: midazolam 0.3 mg/kg (control group) and normal saline (placebo group) 2 ml. The following data were observed: the anxiety scores of the children in the preoperative interview (T1), before intranasal premedication (T2), during the induction room play (T3) and in the beginning of sevoflurane-inhaled induction (T4) using Modified Yale Preoperative Anxiety Scale (m-YPAS); the satisfaction scores of parents when children entering the operating room using Visual Analogue Scale (VAS); and the cooperation scores of the children receiving the sevoflurane-inhaled induction using Induction Compliance Checklist (ICC). The process of induction, the induction of sevoflurane and adverse incident were recorded.

The scores of m-YPAS of the induction room play (T3) and in the beginning of sevoflurane-inhaled induction (T4) of the control group were (26.48±9.04) and (40.88±17.31)scores, while those of the placebo group were (32.38±10.67) and (56.50±20.02) scores. The m-YPAS scores of the control group were significantly lower than those of the placebo group (t=2.983, 4.173, all P<0.05). The VAS of the control group and placebo group were (6.55±1.55) and (8.18±1.46) scores, the VAS of the control group was significantly lower than that of the placebo group (t=5.504, P<0.05). The total time of induction of the control group was (84.35±22.47)s, which was significantly shorter than that of the placebo group((104.21±31.05)s,t=3.664, P<0.05). The scores of m-YPAS in the preoperative interview (T1), before intranasal premedication (T2), the scores of ICC, the time of closing eyes and excitement phase of 2 groups had no significant difference (allP>0.05). There was no adverse incident happened in both groups.

Intranasal midazolam provided as premedication can reduce the anxiety for children undergoing inhaled induction of anesthesia with sevoflurane, and shorten the time of induction. It's a safe and effective method for premedication of pediatric anesthesia.

To explore the changing trend and clinical significance of disease spectrum of biliary surgery among 30 years in PLA General Hospital.

We retrospectively analyzed the clinical data of 21 189 consecutive patients with biliary diseases in PLA General Hospital between January 1985 and December 2014 according to the inclusion criteria. Taking 5 years as a research group, all patients were divided into 6 groups, and then the 30 years of the disease spectrum of biliary surgery was described.

(1) From January 1985 to December 2014, the PLA General Hospital performed 21 189 cases of patients with biliary surgery diseases, including 9 460 cases of male, 11 729 cases of female (female∶male=1.24∶1). The average age was 52.1±13.5 years old (6-98 years). (2) Of the all cases, the most patients was cholelithiasis, accounting for 65.26%, and gallbladder stones accounting for 53.61%. The following disease was cholangiocarcinoma, accounting for 12.79%, and hilar cholangiocarcinoma accounting for 5.95%. (3) From the perspective of disease spectrum changing trend, the proportion of patients with cholelithiasis were decreased gradually, from 74.9% to 65.2%, while the proportion of patients with cholangiocarcinoma showed a gradual upward trend, rising from 6% to 14% (P<0.05); and the proportion of bile duct cystic dilatation and gallbladder carcinoma shared a gradual increase(P<0.05), however, the variation of proportion of gallbladder polyps and biliary stricture were not statistically significant (P>0.05). (4) In patients with cholelithiasis, the proportion of patients with gallbladder stones increased gradually from 71.9% to 82%, while the proportion of patients with bile duct stones decreased gradually from 28.1% to 18%. There was no statistical significance in the proportion of different types of cholangiocarcinoma patients (P>0.05) (40% of the patients with hilar cholangiocarcinoma, 25% of the intrahepatic cholangiocarcinoma, and 35% of the extrahepatic cholangiocarcinoma).

With the time changing, the disease spectrum of biliary surgery has also changed. The proportion of patients with cholelithiasis, especially the patients with bile duct stones, was declining gradually, and the proportion of patients with cholangiocarcinoma was increasing gradually.

To investigate the clinical possibility of low ligation of inferior mesenteric artery (IMA) and lymph nodes dissection in laparoscopic low anterior resection.

Data was collected retrospectively from 216 patients who underwent laparoscopic low anterior resection in our hospital from June 2011 to January 2015.Patients were divided into control group (132 cases) and observation group (84 cases). The observation group was treated with low ligation of IMA and lymph nodes dissection, and the control group was cured by high ligation of IMA and lymph nodes dissection. We analyzed the operation time, the number of lymph nodes dissection, the number of lymph nodes removed around the root of IMA, the rate of lymph node metastasis around the root of IMA, the incidence of anastomotic leakage and the ventilation time after the operation.

There was no significant difference between the two group in the pre-operative data, operation time, the number of lymph nodes dissection the number of lymph nodes removed around the root of IMA, the rate of lymph node metastasis around the root of IMA and the incidence of anastomotic leakage (P>0.05). The observation group were significantly better than the control group the in the ventilation time after the operation (P<0.05). The follow up time was 12 to 67 months. The median follow up time was 37 months. One patient in observation group died of cardiovascular disease. One patient in control group died of metastatic carcinoma.

Detection of low ligation of inferior mesenteric artery and lymph nodes dissection in laparoscopic low anterior resection is safe and practicable, which should be widely applied.

To conduct analysis and prenatal diagnosis on 11 couples carrying Thailand deletion (--^THΑI) α-thalassemia 1, so as to provide information for clinical genetic counseling on α-thalassemia 1.

Altogether 11 Thailand deletion (--^THΑI) α-thalassemia 1 families were collected from Fujian Maternal and Children Health Hospital from May 2009 to September 2015. Gap-polymerase chain reaction (gap-PCR) and reverse dot blot (RDB) technology were used to detect the thalassemia mutations in the couples and fetuses.

In one family, Thailand deletion α-thalassemia 1 was detected in both the pregnant woman and her husband. In 10 families, Thailand deletion α-thalassemia 1 was detected in either the pregnant women or the husband, while the spouses had α-thalassemia heterozygote (1 combined with β thalassemia heterozygote). Thailand deletion α-thalassemia 1 family members all had lower mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). In prenatal diagnosis of the 12 fetuses, 4 fetuses were found with hemoglobin(Hb) Bart's hydrops fetalis syndrome, 5 were with α-thalassemia heterozygote, and 3 were normal.

For couples with positive hematological phenotype but normal results in routine genetic examination of α-thalassemia, attention should be paid especially for with a history of having babies of hydrops fetalis syndrome or hemoglobin H disease. It is necessary to consider the possibility of the rare Thailand deletion (-- ^THΑI) α-thalassemia 1. Prenatal diagnosis for high-risk families plays an important role.

Urachal carcinoma is a kind of urogenital tract malignancy with a very low incidence. The objective of this study was to observe the clinical presentation, pathological condition, treatment method and outcome of patients with urachal carcinoma.

A retrospective analysis of thirty-six cases of urachal carcinoma diagnosed over a period of 10 years from 2003 to 2013 was carried out. All pathologic specimens were reviewed by two separate pathologists. Clinical and histological features, treatment condition, patient follow-up and survival outcome was reviewed and calculated.

The mean age at diagnosis was 53 years. Of the thirty-six patients, twenty-five were male. All patients underwent partial cystectomy with bilateral pelvic lymph node dissection. All cases were adenocarcinoma, including 20 mucinous adenocarcinoma, 7 moderately differentiated adenocarcinoma, 5 poorly differentiated adenocarcinoma, 1 signet ring cell carcinoma, 3 hybrid adenocarcinoma. The Sheldon pathologic stage was stage Ⅱ in 11, Ⅲ in 16 and Ⅳa in 9 cases. All patients received medical oncological therapy. The median follow-up period was 27 months. The median overall survival was 36 months. One-year survival rate was 70% and five-year survival rate was 28%.

Urachal carcinomas are rare and usually at locally advanced stage at diagnosis with a high tendency of metastases. Surgery is a key method of primary treatment and medical oncological therapy may play a role in decreasing the chances of recurrence which still needs to be explained by prospective clinical trials.

To investigate varying patterns of intracranial pressure(ICP)after giant meningioma resection and analyze the causes of the variation of ICP in different postoperative phases.

Clinical data, surgical approachs and the ICP monitoring data of 7 patients with giant meningioma in different positions who were admitted to the First Affiliated Hospital of Soochow University from October 2013 to July 2014 and received microsurgical resection via different approachs were analysed retrospectively. The tumour locations were in convexity(n=1), olfactory groove(n=1), sphenoidal ridge(n=2), parasagittal(n=1), falx(n=1), petroclival(n=1) and resected via longitudinal fissure approach, subfrontal approach, extensive pterional approach, subtemporal approach. ICP monitoring probe was placed subdurally and average monitoring time was 9 days. Dehydrating agent was administered in all cases postoperatively.

Tumors were totally resected (Simpson Grade Ⅰ or Ⅱ ) in all patients. The increase of ICP was observed on the 3^rd day, peaked on the 4^th day and reduced to normal on the 5^th-7^th day. Decompressive craniectomy and tracheotomy were performed in one case due to consciousness deterioration, severe brain edema and continuous ICP augment on the third day after operation. All the patients recovered well except for the cerebrospinal fluid rhinorrhea occurring in one case postoperatively, whose symptom ameliorated significantly after conservative treatment.

ICP monitoring exerts an important role on the postoperative management of giant meningioma. Simultaneously, The summary of vast ICP monitoring data concerning to giant meningioma provides the evidence and experience for protecting neurological function via abundant preoperative preparations, reasonable operative approach, careful postoperative management.

To investigate the regulation effect of β-catenin pathway on transforming growth factor beta1 (TGF-β ₁) induced pulmonary pro-fibrosis.

The rat alveolar typeⅡ cells (RLE-6TN) were divided into four groups: A1.control group; B1.TGF-β₁ group was treated with 5 μg/L TGF-β ₁; C1.pcDNA+ TGF-β₁ group was transiently transfected with eukaryotic expression vector pcDNA3.0 (pcDNA) and followed by TGF-β₁ treatment (5 μg/L); D1.F-(β-TrCP)-Ecad+ TGF-β ₁ group was transiently transfected with β-catenin protein knockout vector [F-(β-TrCP)-Ecad] and followed by TGF-β ₁ treatment (5 μg/L). After 24 hours, cells were observed under the inverted phase contrast microscope, then the expressions of E-cadherin, α-smooth muscle actin (α-SMA) and fibronectin (Fn) in each group were measured by Western blot and the mRNA levels of Snail which was the downstream profibrotic transcription production in cell culture supernatants of each group were detected by real-time fluorescence quantification-polymerase chain reaction (RT-PCR) .The rat alveolar macrophages (CRL-2192) were divided into five groups: A2.control group; B2.Interferon gamma (IFN-γ) group was treated by 20 μg/L IFN-γ; C2.TGF-β ₁+ IFN-γ group was treated by 20 μg/L IFN-γ with 10 μg/L TGF-β₁; D2.F-(β-TrCP)-Ecad+ TGF-β₁+ IFN-γ group was transfected with F-(β-TrCP)-Ecad and other dispose was the same as group C2; E2.WTβ-catenin+ TGF-β₁+ IFN-γ group was transfected with WTβ-catenin and other dispose was the same as group C2.After 24 hours, protein levels of β-catenin in group A2, B2, C2 were determined by Western blot.Inducible nitric oxide synthase (iNOS) mRNA levels of each group were detected by RT-PCR.

The RLE-6TN cells of group B1, C1 showed a change in morphology to spindle-shaped cells, the cells of group D1 maintained a cobblestone morphology. Protein expressions of the fibroblast markers α-SMA and Fn, and mRNA expressions of the downstream profibrotic transcription production Snail of group B1, C1 were significantly higher than group A1, while protein expressions of the epithelial marker E-cadherin were significantly lower.The protein expressions of α-SMA, Fn and mRNA expressions Snail of group D1 were significantly lower than group C1 (0.352±0.076 vs 0.937±0.303, 0.319±0.072 vs 0.903±0.211, 3.675±0.642 vs 9.708±2.031), while the protein expressions of E-cadherin were significantly higher (1.482±0.227 vs 0.604±0.121) (all P<0.05). The steady state protein levels of β-catenin in CRL-2192 cells was low and β-catenin protein expressions of CRL-2192 cells in group A2, B2 and C2 had no significantly statistical differences.The mRNA expressions of iNOS of group B2 cells were significantly higher than group A2, C2, D2, E2 (64.95±4.47 vs 9.87±0.73, 21.32±2.41, 18.35±3.61, 22.87±3.14) (allP<0.01), the expressions of iNOS of group C2, D2, E2 were all higher than group A2 (allP<0.05), but there were no significant differences among group C2, D2 and E2.

Inhibition of β-catenin pathway inhibits TGF-β ₁-induced epithelial-mesenchymal transition (EMT) and has no effect on its anti-inflammation effect.Therefore, β-catenin pathway regulates the pulmonary pro-fibrosis effect of TGF-β ₁.

To observe the influence of lumbar sympathetic ganglion radiofrequency thermocoagulation on the activation of spinal microglia in rats with diabetic neuropathic pain (DNP).

Thirty-six painful diabetic Sprague-Dawley rats induced by 60 mg/kg streptozotocin (STZ) intraperitoneal injection were randomly divided into diabetic neuropathic pain group (group DNP, n=12), Sham operation group (group Sham, n=12) and radiofrequency thermocoagulation group (group R, n=12). Meanwhile another 12 age-matched rats were allocated as normal control group (group N), rats in group N received intraperitoneal injection of equal volume of normal saline. Twenty-eight days after STZ injection, rats in group R received L₃ lumbar sympathetic ganglia radiofrequency thermocoagulation on the left side under X-ray guideline after anesthesia with damage time 60 s and damage temperature 60 ℃. Rats in group Sham received puncture positioning, but not thermocoagulation therapy. The mechanical paw withdrawal threshold (PWT) were performed before STZ injection, 7, 14, 21, 28 days after STZ injection and 1, 3, 5, 7, 14 days after radiofrequency thermocoagulation, respectively. Blood glucose were performed before STZ injection, 3, 28 days after STZ injection and 1, 14days after radiofrequency thermocoagulation. After the final behavioral testing, L₃-L₅ spinal cord tissues were removed to exam the expression of microglia marker OX42 by Western blotting and immunofluorescence technique, and the changes in the expression of inflammation factor IL-1β, IL-6, TNF-α were detected by ELISA technique.

Compared with group N, after 14, 21, 28 days of STZ injection and 1, 3, 5, 7, 14 days of radiofrequency thermocoagulation, the PWT of group DNP and group Sham decreased significantly (P<0.05); Before radiofrequency thermocoagulation, the PWT of rats in group DNP was (3.84±0.83) g, the PWT of rats in group R was (4.45±0.88) g, there was no statistically significant difference between group DNP and group R (t=1.514, P>0.05), but after radiofrequency thermocoagulation, compared with DNP group, the PWT of rats in group R increased significantly (P<0.05), and lasted to 14 d after radiofrequency thermocoagulation. The ratio of spinal microglia marker OX42 and GAPDH, the expression of inflammation factor IL-1β, IL-6, and TNF-α in group N were 0.074±0.023, (35.93±6.16) pg/ml, (92.11±13.23) pg/ml, and (169.50±22.64) pg/ml, respectively. The ratio of spinal microglia marker OX42 and GAPDH, the expression of inflammation factor IL-1β, IL-6, and TNF-α in group DNP were 1.023±0.185, (73.82±9.25) pg/ml, (155.33±21.82) pg/ml, and (298.30±33.21) pg/ml, respectively. The ratio of spinal microglia marker OX42 and GAPDH, the expression of inflammation factor IL-1β, IL-6, and TNF-α in group Sham were 0.951±0.103, (73.00±7.54) pg/ml, (151.02±24.26) pg/ml, and (294.01±36.37) pg/ml, respectively. The ratio of spinal microglia marker OX42 and GAPDH, the expression of inflammation factor IL-1β, IL-6, and TNF-α in group R were 0.563±0.019, (51.81±7.36) pg/ml, (123.24±16.13) pg/ml, and (229.23±29.16) pg/ml, respectively. Compared with group N, the expression of spinal microglia marker OX42 and inflammation factor IL-1β, IL-6, and TNF-α in group DNP, group Sham and group R increased significantly (F=7.501, 348.698, 568.021, 145.110, all P<0.05). Compared with DNP group, the expression of spinal microglia marker OX42 and inflammation factor IL-1β, IL-6, and TNF-α of group R reduced significantly (allP<0.05).

The lumbar sympathetic ganglion radiofrequency thermocoagulation can alleviate diabetic neuropathic pain. The mechanism may relate with the inhibition of spinal microglia activation and the lower expression of inflammation factor.

A 68-year-old female was admitted to Peking Union Medical College Hospital on March 30, 2014 due to "numbness of limbs for 4 years, aggravation with weakness of both lower limbs for 3 months". Since 2010, the patient has experienced numbness in the limbs without trigger, accompanied by fatigue, feeling of stepping on cotton, without affecting activity, without myalgia and muscle atrophy. The effect of neurotrophic drugs and acupuncture treatment is not good. In May 2011, lumbar puncture was performed in a foreign hospital. The cerebrospinal fluid paraneoplastic neurological syndrome antibody (anti-Hu.Yo.RI antibody) and oligoclonal zone (OB) were negative (-), and the myelin basic protein (MBP) was increased (12.42 μ g/L), and the IgG synthesis rate was increased (85.5 mg/24 h). Electromyography showed peripheral neurogenic damage of upper and lower limbs: the incubation period of each wave of motor evoked potential (MEP) recorded in right tibialis anterior muscle and abductor pinky muscle was prolonged, and the central conduction time was normal; The sensory conduction velocity of bilateral tibial nerve was not measured, the motor incubation period was prolonged, the conduction velocity was slowed down, and the wave amplitude was reduced; The sensory conduction velocity of right median nerve and ulnar nerve was not measured, the motor incubation period was prolonged, and the conduction velocity was slowed down; Bilateral tibial nerve H reflex, not detected by F-wave measurement. No abnormalities were found on head CT; Lumbar spine MRI: L_2～3, L_4～5, S₁Herniated disc. He was diagnosed as "chronic inflammatory demyelinating peripheral neuropathy" and was treated with intravenous human immunoglobulin (IVIG): IVIG 25 g/d ×5 d ×1 time/month ×2 months → IVIG 10 g/d ×3 d ×1 time/month ×6 months → IVIG 25 g/d ×5 d ×1 time/3 months ×2 years; In August 2012, prednisone 50 mg/d was added, and the dose was gradually reduced in early 2013. From August to September 2013, the blood test routine was normal; Erythrocyte sedimentation rate (ESR) 46 mm/1 h; Cerebrospinal fluid examination: Cerebrospinal fluid protein (CSF-Pro) 755 mg/L, other biochemistry and routine were normal. In the past 3 months, the numbness of the limbs still gradually worsened, the scope expanded, accompanied by weakness of both lower limbs, and inability to stand up after squatting. Since the onset of the disease, the general condition is good. Past history, personal history, menstrual marriage and childbirth history are not special. Family history: father died of pulmonary heart disease, mother died of gastric cancer. Physical examination: stable vital signs, walking into the ward on crutches, untouched superficial lymph nodes in the whole body, no special findings in the heart and lungs, no tenderness in the chest and ribs, no enlargement of the liver and spleen, muscle strength of both upper limbs grade V, muscle strength of both lower limbs grade IV, no tenderness in the muscles, hypotactile sensation below the elbow of both upper limbs and below the knee of both lower limbs, disappearance of tendon reflex of the limbs, no pathological reflex, meningeal irritation sign (-).

Lymph node enlargement is a common outpatient disease in primary hospitals. Lymph node puncture needle aspiration cytology is the first choice for primary outpatient doctors because of its quick and simple advantage, and it is an important means for early outpatient examination of patients with lymphoproliferative diseases and tumor metastasis. In the early stage of HIV and Treponema pallidum infection, immune cells of the body proliferate and activate to resist the invasion of HIV and Treponema pallidum. Therefore, lymph node enlargement is one of the important clinical manifestations. The cytological characteristics of lymph nodes in two patients with HIV infection and syphilis infection with lymph node enlargement as the first manifestation found in the 148th Hospital of the People's Liberation Army in recent years are reported as follows, aiming at providing clinical diagnosis basis for early diagnosis and prevention of spread of such patients.

A 60-year-old woman underwent simple right mastectomy in our hospital 9 months before admission. The postoperative pathology was considered as one of the following three types: atypical metaplastic carcinoma, well-differentiated extraosseous osteosarcoma and ossifying fasciitis. Immunohistochemical staining showed Actin (partial +), Desmin (-), S-100 (-), CK, CK-H and P63 (scattered minority +), CK-L and CK18 (-), Ki-67: 15%. It was recommended to go to another hospital for consultation of pathological results, but the diagnosis could not be confirmed due to the patient's reasons. Five months after the operation, a tumor was found at the right surgical incision without obvious trigger, the size was about 4.0 cm ×4.0 cm, painless, and the local skin was red and swollen. Subsequently, the mass gradually increased and he was re-admitted at an interval of 4 months. Physical examination showed that there was a 4.13 cm ×5.17 cm mass at the surgical incision of the right chest wall, with blurred boundary, small mobility, fixed to the pectoralis major muscle, hard texture and no tenderness. Blood biochemistry showed alkaline phosphatase: 188 U/L. Tumor markers [carcinoembryonic antigen (CEA), CA-153, CA-125, CA-199] were all normal. Chest enhanced CT examination showed a round soft tissue mass on the right chest wall, and the boundary between the lower edge of the lesion and the pectoralis major muscle was unclear. Most short diameters were seen in the bilateral axillary and mediastinum<1 cm lymph node shadow; The nodule in the lower lobe of the right lung was about 0.7 cm in diameter, and its nature was to be determined; Chest ultrasonography showed a 3.4 cm ×2.4 cm mixed echo nodule in the right chest wall, with unclear boundary and irregular shape, and abundant blood flow signals in it; Hypoechoic lymph nodes of approximately 1.7 cm ×0.9 cm were visible in the right axilla. The pathology of hollow core needle biopsy showed that spindle cells and multinucleated giant cells with active proliferation were seen, which were considered to be mesenchymal tumors (Figure 1，Figure 2，Figure 3，Figure 4)。

Virtual reality (Virtual reality) technology came into being in the 1960s of the 20th century. Its core is to generate a realistic Virtual environment with visual, auditory and tactile sensations by using various technologies, interact with the objects in it, and produce the feeling and experience of visiting the real environment in person^[1]。 Military application is the driving force to promote the development of virtual reality technology. Foreign military has developed many military simulation systems based on this technology, which can simulate actual combat to the greatest extent with low cost and realistic effect, quickly and effectively train officers and soldiers to use weapons and equipment, adapt to battlefield environment, and train military doctors and health workers in combat trauma treatment skills^[2,3]Improve the strategic and tactical accomplishments of commanders^[4]。 The application and prospect of virtual reality technology in the field of military medicine are described as follows.

At present, the effective methods for treating non-small cell lung cancer (NSCLC) mainly include surgical resection, radiotherapy, chemotherapy and molecular targeted therapy. Although these methods are effective, they also have limitations and subsequent risks, including recurrence, metastasis, drug resistance and serious side effects. In recent years, with its unique advantages, tumor immunotherapy has entered people's field of vision and attracted more and more attention, and its corresponding basic research has made rapid progress. Programmed death factor 1 (PD-1) and programmed death factor ligand 1 (PD-L1), as the "star molecules" in tumor immunity, have naturally become one of the focus of research.

Pancreatic cancer is one of the most common malignant tumors in humans. Early diagnosis is very difficult. Its mortality rate is very high, and the average 5-year survival rate is less than 5%^[1]。 Statistics released by the World Health Organization show that the incidence of pancreatic cancer in the world ranks 13th among malignant tumors, but its fatality rate is the fourth^[2]。 It is difficult to diagnose CT, ultrasound and other imaging examinations commonly used in clinical practice<2 cm pancreatic tumor, and the symptoms associated with pancreatic cancer (e.g. jaundice, abdominal pain, weight loss, etc.) usually do not appear in the early stage of pancreatic cancer. When symptoms appear, 85% of patients have developed lymph node or distant metastasis, and more than 80% of pancreatic cancer is diagnosed in advanced stage, losing the opportunity for surgery, and the median survival time is about 8 months^[3,4,5,6]。 In China, with the change of environment and people's lifestyle, the prevalence of pancreatic cancer is increasing year by year^[7]。 In the past 40 years, the mortality rate of gastric cancer, lung cancer, colon cancer and prostate cancer has gradually decreased, but the overall mortality rate of pancreatic cancer has not changed significantly, indicating that the diagnosis and treatment of pancreatic cancer still need to be greatly improved^[2]。 Pancreatic cancer has the lowest relative survival rate among all cancers. The median survival time after surgical resection and adjuvant chemotherapy is about 20 months in 10% ~15% of pancreatic cancer patients with localized lesions; tumor<The 5-year survival rate of pancreatic cancer patients with 2 cm and no lymph nodes or extrapancreatic metastasis after surgical resection was 30% to 60%; If the tumor<1 cm, the postoperative 5-year survival rate can be as high as 75%^[8,9]。 Recent data from genome sequencing of primary and metastatic pancreatic cancer suggest that pancreatic cancer development is a slow process^[10]。 The development of convenient and practical serum markers has important clinical significance for the screening of early pancreatic cancer^[11]。 In recent years, domestic and foreign scholars have found that compared with normal pancreas, benign pancreatic lesions and malignant tumors of other tissue origin, anti-mucin 1 antibody (PAM4) has high specificity and sensitivity to pancreatic cancer, and may be used as a molecular marker for early diagnosis of pancreatic cancer in the future, and its application in antibody targeted imaging technology and pancreatic cancer treatment has also received wide attention.

inflammatory bowel disease (IBD) is a group of chronic non-specific inflammatory diseases of the intestine of unknown etiology, including ulcerative colitis (UC) and Corhn's disease (CD). Among them, UC lesions are mainly limited to the mucosa and submucosa of the large intestine, and the clinical manifestations are diarrhea, mucus, pus and bloody stool, and abdominal pain. The severity of the disease varies, mostly with a recurrent chronic course. Studies have shown that the risk of developing colorectal cancer in UC is more than 10 times that in healthy people, and it gradually increases with the length and intensity of the disease^[1]Therefore, understanding the pathogenesis of UC is crucial for the prevention and treatment of UC and UC-related colorectal cancer. The concept of "inflammasome" was developed by Martinon et al.^[2]First proposed in 2002, they found that the complex formed by NOD-like receptors (NLR) P1, apoptosis-associated speck-like protein containing CARD (ASC) and cysteine-containing aspartate proteolytic enzyme (caspase) can activate caspase, thus promoting the maturation and secretion of cytokines interleukin (IL) -1 β and IL-18, and participating in inflammatory response. At present, it is believed that the dysregulation of inflammasomes plays a certain role in the pathogenesis of UC. This paper reviews its role in the pathogenesis of UC.