Volume 96  ·  Issue 32  ·  2016

adenocarcinoma of esophagogastric junction (AEG) refers to an adenocarcinoma lesion originating from the glandular epithelium of the upper gastrointestinal tract and invading the esophagogastric junction. At present, scholars in the East and West still have controversies about how to define AEG^[1]。 As the incidence of distal gastric cancer decreased, the incidence of AEG increased year by year^[2],And because that biological behavior of AEG is different from that of esophageal cancer and gastric cancer in the true sense^[3]Therefore, more scholars began to pay attention to this special type of malignant tumor. Radical surgery combined with perioperative chemoradiotherapy is still the main treatment for AEG, but the prognosis is still poor^[4]。 Because of the special anatomical position of AEG, there are still many controversies in the surgical diagnosis and treatment. Therefore, clarifying the related problems is of great benefit to the clinical diagnosis and treatment of AEG, especially reasonable classification, staging, surgical methods, esophageal and gastric resection range and lymph node dissection range, which are of great significance to the quality of life and prognosis of patients.

In the development of diabetes, the function of islet beta cells is progressively lost, which ultimately leads to the worsening of hyperglycemia and the occurrence of various complications. One of the most important strategies for treating diabetes is to restore the total amount of functional beta cells. At present, the commonly used strategies are as follows: (1) islet transplantation or pancreatic transplantation; (2) inducing pluripotent stem cells (including embryonic stem cells and induced pluripotent stem cells) or various types of adult stem cells (such as mesenchymal stem cells, liver precursor cells, etc.) to differentiate into insulin-secreting cells in vitro and then performing cell transplantation to supplement the number of pancreatic islet cells; (3) promoting the direct transdifferentiation of adult stem cells (such as pancreatic stem cells, etc.) into islet-like cells in vivo, and restoring the total amount of β cells; (4) Transforming terminally differentiated cells (such as fibroblasts, etc.) directly into β cells in vivo or in vitro^[1]。

Diabetic foot refers to foot infection, ulcer and/or deep tissue destruction associated with local nerve abnormalities and distal peripheral vascular lesions of lower limbs in diabetic patients. It is one of the four major complications of diabetes. It is a common result of neuropathy and vascular lesions in diabetic lower limbs. The specific pathogenesis of diabetic foot has not been fully elucidated at present, but the existing studies have shown that diabetic peripheral neuropathy (DPN) is one of the most important initiating risk factors of diabetic foot^[1]Infection and ischemia are the key factors affecting the healing and amputation rate of diabetic foot ulcer^[2]。 Recent research results show that the prevalence of peripheral neuropathy and peripheral vascular disease in Chinese patients with diabetic foot ulcer is 73.7% and 48.9%, respectively, much higher than that in non-diabetic people^[3]。 Many studies at home and abroad have confirmed that peripheral neuropathy is one of the important causes of diabetic foot ulcer^[3,4]。

By the end of 2014, there were 2,374,900 practicing physicians, 2,892,500 practicing (assistant) physicians and 3,004,100 registered nurses in China^[1]。 Medical staff are not only angels in white who save lives and heal the wounded, but also a huge innovative group in China, who can discover good treatment methods and new technologies in clinical practice. In reality, a large number of hospitals have applied for patents, and many medical staff appear in patent application materials and patent authorization certificates as inventors.

This study aimed to determine the correlation of Uygur gastric cancer and the polymorphism effects of vitamin D receptor gene FokⅠ on C-reactive protein and D-dimer.

Method of random sampling was used to select 147 Uygur patients with gastric cancer who admitted at Tumor Hospital of Xinjing Medical University (Group A) and 151 healthy controls with the same nationality (Group B). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to determine FokⅠ loci polymorphism in both groups to identify the gastric cancer susceptibility gene. All patients were divided into Group FF (Group a) and Group Ff+ ff (Group b) by PCR-RFLP according to the f-gene carrier to compare the expression level of C-reactive protein and D-dimer.

The expression frequency of the f allelic gene of patients with gastric cancer was higher than that of healthy control patients (57.8% vs 47.4%, P<0.05). The carriers of the f allelic gene (Ff+ ff) had increased risk of gastric cancer (OR=2.85). Measurement levels of C-reactive protein and D-dimer in the f allelic gene group were higher than those of the non-f allelic gene group (4.72±1.65 vs 2.81±0.93, and 2.79±1.21 vs 1.09±0.65, respectively), and the differences were statistically significant (P<0.05).

The FokⅠ loci polymorphism of vitamin D receptor gene was related to gastric cancer susceptibility in Uygur. f allelic gene may be one of the risk factors of gastric cancer in Uygur. Moreover, f allelic gene may be a factor that increased the level of C-reactive protein and D-dimer in Uygur patients with gastric cancer.

To analyze the correlation between glycolipids metabolism and clinicopathologic features in patients with gastric cancer.

Glycolipids metabolism and clinicopathologic features of 443 gastric cancer patients were collected, and their correlation was analyzed.

Compared to gastric cancer patients with normal levels of glycolipids metabolism, there were less male patients who were with low level of total cholesterol (TCH)(χ²=7.676, P<0.05), and the number of male patients with low level of high-density lipoprotein (HDL) (χ²=7.520) and apoA1 (χ²=6.253) was higher (both P<0.05). Serum TCH level showed a negative correlation with age of patients (r=-0.116), tumor size (r=-0.117) and TNM stage (r=-0.111) (P<0.05); serum HDL level was negatively correlated with tumor diameter (r=-0.094), the number of metastatic lymph nodes (r=-0.106), primary tumor invasion depth (r=-0.112), metastatic lymph nodes stage (r=-0.102) and TNM stage (r=-0.107) (P<0.05); serum LDL was negatively correlated with age of patients (r=-0.116) (P<0.05); serum LPa was positively correlated with tumor size (r=0.170), the number of metastatic lymph nodes (r=0.151), primary tumor invasion depth (r=0.160), metastatic lymph nodes stage (r=0.153) and TNM stage (r=0.115) (P<0.05); apoA1 was negatively correlated with distant metastasis (r=-0.168) and TNM stage (r=-0.120) (P<0.05); and apoB was negatively correlated with distant metastases (r=-0.132, P<0.05). Levels of blood glucose and TG had no significant association with clinicopathological features of gastric cancer patients (P>0.05).

Low lipid metabolism but high level of LPa may be the metabolic characteristics of gastric cancer progression. Monitoring the changes of serum lipids levels could be valuable for the prognosis of patients with gastric cancer.

To study the significance and effect of methylation status of sex determining region Y-box 2 (SOX2) gene promoter, and to investigate the effect of demethylation on the cell proliferation and invasion in BGC-823 gastric cancer cells.

Methylation-specific PCR (MSP) was used to assess the role of 5-aza-2'-deoxycytidine (5-Aza-CdR) in the methylation of SOX2 promoter in the BGC-823 cell lines treated with different concentration of 5-Aza-CdR. We mapped the expression of SOX2 in the BGC-823 cell lines by the quantitative real-time PCR (qPCR) and Western blotting before and after treatment of 5-Aza-CdR. The survival of BGC-823 cells were detected by MTT assay. The invasion and migration of BGC-823 cells were investigated by transwell methods, and the migration of BGC-823 cells was also assessed by the scratch assay exposed to 5-Aza-CdR or vehicle control. Model of transplanted tumor on nude mouse were used to study the anticancer effect of 5-Aza-CdRin vivo by qPCR, Western blotting and immunohistochemistry.

The methyltransferase inhibitor 5-Aza-CdR restored the loss of SOX2 expression in BGC-823 cell lines in a dose-dependent manner. The mRNA and protein expression of SOX2 had significant difference between the gastric cancer tissues and normal gastric mucosa (mRNA levels: 22.80±0.36 vs 20.36±0.45, P<0.05; protein levels: 0.49±0.01 vs 0.91±0.28,P<0.05). It also had significant difference among the BGC-823 cell lines treated with 5-Aza-CdR of the different concentrations (0, 1 and 10 μmol/L) (mRNA levels: 22.99±0.42 vs 21.78±0.41 vs 20.51±0.47,P<0.05; protein levels: 0.65±0.19 vs 0.73±0.13 vs 0.83±0.14,P<0.05). Compared with the control group (5-Aza-CdR concentration of 0 μmol/L), the survival rates of BGC-823 cell lines were significantly decreased in treatment groups (5-Aza-CdR concentrations of 1, 10 and 20 μmol/L, allP<0.05). Restored expression of SOX2 in the BGC-823 cell lines inhibited cell proliferation, colony formation and cell migration (P<0.05). Model of transplanted tumor on nude mouse in the 5-Aza-CdR group eventually had the smaller tumor size, the lighter tumor weight and the longer survival time than these in the PBS group [(286.6±37.5) vs (540.7±42.6)mm^3,P<0.05; (325.2±32.2) vs (694.7±36.1)mg,P<0.05; (22.5±1.0) vs (18.7±1.6) d,P<0.05]. Meanwhile, the 5-Aza-CdR group increased the SOX2 protein expression levels and immunohistochemistry scores (0.96±0.25 vs 0.73±0.15,P<0.05; 6.23±0.45 vs 3.76±0.43,P<0.05).

The SOX2 gene promotor is in the status of methylation in the BGC-823 cell. The recovery expression of SOX2 inhibits cell proliferation, invasion and the development of transplanted tumor in nude mice through DNA methyltransferase inhibition. It could suggest a new approach for the treatment of gastric cancer.

To compare the therapeutic effects between sitagliptin and voglibose both with sensor-augmented insulin pump (SAP) in newly diagnosed type 2 diabetes mellitus (T2DM).

Fifty-six newly diagnosed hospitalized T2DM patients in Department of Endocrinology of the First Affiliated Hospital of Dalian Medical University, with hemoglobin A1c (HbA1c) value of 9%-11%, were randomized into the sitagliptin (S) group (n=28) and the voglibose (V) group (n=28) by block randomisation. Participants in S group received sitagliptin 100 mg per day, and V group received voglibose 0.2 mg for 3 times per day. All patients were treated with SAP for 9 days. Real-time continuous glucose monitoring (RT-CGM) was used. Glucose variability parameters were observed. The research has been approved by the ethics committee of the First Affiliated Hospital of Dalian Medical University(KY2014-08).

No significant differences were observed in baseline characteristics between the two groups (all P>0.05). In V group and S group, fasting blood glucose (FPG) [(6.4±1.1) vs (11.4±3.0) mmol/L,P=0.008; (5.5±0.8) vs (11.0±2.1) mmol/L, P<0.001], mean blood glucose(MBG) [(7.5±0.8) vs (12.0±1.1) mmol/L,P=0.045; (6.7±0.7) vs (12.5±1.3) mmol/L, P=0.002], standard deviation of blood glucose (SDBG) (P=0.023, 0.036) decreased and homeostasis model assessment (HOMA)-β (P=0.002, 0.001) increased significantly after 9 days therapy. The mean of daily differences (MODD)(P=0.027), coefficient of variation-FPG (CV-FPG) (P=0.033) and HOMA-IR (P=0.039) in S group significantly decreased, while postprandial glycemic excursion (PPGE)(P=0.003, 0.026, 0.011, 3 meals respectively)and the low glycemic index(LBGI)(P=0.025) in V group decreased, the peak postprandial level of glucose(Δt)was longer compared with before (P=0.028, 0.026, 0.030, 3 meals respectively). After therapy, PPGE in V group significantly became lower than those in S group (P=0.041, 0.032, 0.036, 3 meals respectively), while FPG and MBG in S group were significantly lower than those in V group (P=0.041, 0.039).

Sitagliptin or voglibose combined with SAP can improve glucose control and protect islet function for patients with newly diagnosed T2DM. Sitagliptin has advantages in controlling MBG and FPG compared with voglibose. Voglibose has more striking advantages in reducing the postprandial blood glucose fluctuation.

To evaluate the impact of continuous subcutaneous insulin infusion (CSII) on β-cell function assessment.

One hundred and twenty-five patients with type 2 diabetes (T2DM) admitted to Third Affiliated Hospital of Sun Yat-sen University treated with CSII were enrolled from May to December 2015. Blood samples were collected to measure their fasting blood glucose, haemoglobin A1c, blood lipids and plasma C peptide levels (fasting, 30 min and 120 min after a mixed meal) on the next day of their admission before CSII started. When patients achieved the target of fasting capillary glucose ≤ 7.0 mmol/L, C-peptide levels (0 min, 30 min and 120 min after a mixed meal) were measured. Then CSII were stopped at 10 pm with the same tests repeated on the next day.

Compared with those measured before CSII [0 min: (0.35±0.20) nmol/L, 30 min: (0.57±0.31) nmol/L, 120 min: (0.84±0.54) nmol/L], C-peptide levels after stopping CSII at all time points [0 min: (0.41±0.16) nmol/L, 30 min: (0.71±0.33) nmol/L, 120 min: (1.37±0.75) nmol/L] increased (P=0.015, P=0.005, P<0.001) even glucose control was achieved, but significantly decreased immediately before CSII was stopped [0 min: (0.23±0.13)nmol/L, 30 min: (0.39±0.26) nmol/L, 120 min: (0.67± 0.50) nmol/L] (P<0.001,P<0.001,P=0.023). The C-peptide after stopping CSII increased to 141% (0 min), 127% (30 min) and 219% (120 min) respectively compared to those before stopping CSII.

CSII therapy should be stopped for accurate evaluation of β-cell function due to its"β-cell rest"effect in T2DM.

To systematically evaluate the efficacy and safety of insulin degludec for diabetes mellitus (DM).

Databases including Cochrane Library, PubMed, Embase, Wanfang Data, China Biology Medicine disc (CBM) and China National Knowledge Infrastructure (CNKI) were searched electronically for randomized controlled trials (RCTs) meeting including criteria and the methodological quality of studies was assessed. Then meta-analysis was performed using RevMan 5.0 software.

Twelve RCTs with 6 527 patients were included into our study: 4 358 patients in degludec group and 2 169 patients in control group. Compared with insulin glargine, insulin degludec was more effective in reducing fasting blood glucose (MD=-0.40, 95%CI: -0.65--0.16, P=0.001), but less effective in improving levels of glycated hemoglobin (MD=0.13, 95%CI: 0.08-0.17, P<0.001). There was no significant difference in the incidence rate of adverse events in two groups (OR=0.98, 95%CI: 0.87-1.10, P=0.700), but incidence rate of nocturnal hypoglycaemia was significantly lower in insulin degludec group (OR=0.82, 95%CI: 0.72-0.94, P=0.004).

Insulin degludec is non-inferior to other basal insulin in reducing levels of blood glucose, but insulin degludec can obviously reduce the incidence rate of nocturnal hypoglycaemia, so it is safer than other basal insulin. The long-term efficacy and safety should be further studied .

To investigate the difference in severity and clinical outcomes between hypertriglyceridemic pancreatitis (HTGP) and acute pancreatitis (AP) of other causes, and to analyze the correlation between the serum triglyceride (TG) level <24 h after onset and the disease severity.

Patients were selected from the AP database of the First Affiliated Hospital of Nanchang University, who were admitted between January 2005 and December 2013, aged ≥18 and ≤85 years, excluding pregnant or lactating women. Severity and etiology of AP were classified according to the latest relevant guidelines. The severity and clinical outcomes of HTGP patients (HTGP group) were compared with those of patients with AP of other causes (non-HTGP group). Among the HTGP patients, those admitted within 24 hours of onset were selected for comparison of serum TG levels on the first day of hospitalization day among patients with mild, moderate, and severe HTGP, and the correlation between the serum TG level and the severity was analyzed.

Altogether 3 558 AP patients were selected, of which 623 (17.5%) were HTGP, and 2 935 (82.5%)were non-HTGP patients. Compared with the non-HTGP group, the HTGP group had higher incidence of pancreatic necrosis (28.3% vs 18.1%), infected pancreatic necrosis (6.1% vs 3.7%), organ failure(35.8% vs 29.1%), and persistent organ failure(24.4% vs 16.5%), with all the differences being statistically significant (all P<0.01). The mortality and average stay in intensive care unit were also higher in the HTGP group than in the non-HTGP group (allP<0.05). There were 291 patients with HTGP who were admitted to hospital within 24 hours of onset. The serum TG levels <24 h after onset were (9.38±9.00) mmol/L, (11.90±9.02) mmol/L, and (16.47±11.75) mmol/L in patients with mild, moderate, and severe HTGP, respectively (P<0.01). Spearman's correlation analysis showed a positive correlation between TG level <24 h after onset and disease severity (r=0.26, P<0.01).

Compared with AP of other causes, HTGP patients have more severe clinical course and worse clinical outcomes. The serum TG level within 24 hours of onset may be positively correlated with the severity of HTGP.

To compare the preliminary clinical outcomes of fenestration discectomy associated with annulus repair (FDAR) and fenestration discectomy (FD) for lumbar disc herniation in the adolescents.

The data of 26 adolescent patients with single segment lumbar disc herniation who were admitted to the Department of Orthopedics, Xuzhou Central Hospital from October 2012 to October 2014 were retrospectively studied. All patients were divided into 2 groups, including 12 patients undergoing FDAR and 14 patients undergoing FD respectively. The factors including the length of skin incision, amount of intraoperative bleeding, operation time and duration of hospitalization were compared. The indentation of dura were measured from MRI. Pfirrmann grading system was used for assessment of lumbar disc degeneration preoperatively and 1 year later. The visual analogue scale (VAS), the oswestry disability index (ODI) and Japanese Orthopedic Association (JOA) scores were used to measure the clinical outcomes. Simultaneously, surgical complications, and postoperative recurrence of lumbar disc herniation were recorded.

There were no significant differences in the observational factors such as the skin incision length, amount of intraoperative bleeding, operation time, and duration of hospitalization between the FDAR and FD groups (P>0.05). The indentation of the dura significantly reduced after surgery in each group [FDAR: (7.3±2.6) vs (1.3±0.8) mm; FD: (7.4±3.1) vs (2.9±0.7) mm; bothP<0.05]. The postoperative lumbar disc degeneration in FDAR group was the same as that of in FD group. The postoperative VAS scores and ODI scores at each follow-up time point in both groups were significantly improved when compared with the preoperative ones (P<0.05). There were no statistically significant differences between the 2 groups in the JOA score improvement rate (FDAR: 88.5%, FD: 87.2%;P>0.05). According to the modified MacNab criteria, there were no statistically significant differences between the 2 groups in the excellent and good rate (FDAR: 89.3%, FD: 88.5%;P>0.05). There were no dural tears, disc space infection, hematoma formation in the spinal canal and other serious complications in both groups. But there was one patient regaining the back and leg pain in the FD group, whereas recovering by conservative treatment.

The preliminary clinical efficacy of both FDAR and FD in the treatment of single segment lumbar disc herniation in the adolescents is satisfactory.

To study the impact of anti-HER2 therapy and response of primary tumor on distant disease free survival (DDFS) of the patients with HER2-positive breast cancer.

The clinical data of the patients with HER2-positive breast cancer treated with neoadjuvant systemic therapy were analyzed retrospectively.

Patients treated with preoperative anti-HER2 therapy and chemotherapy had a significant improved pathological complete response (pCR) rate (48.4%) compared with those treated with preoperative chemotherapy (17.2%) (P=0.000). The median follow-up period was 62(6-160) months. The 5-year DDFS in patients with anti-HER2 therapy and patients without anti-HER2 therapy was 93.5% and 83.3% respectively (P=0.006). The 5-year DDFS in patients achieving a pCR and patients not achieving a pCR was 94.7% and 82.6% respectively(P=0.001). Among patients achieving a pCR, anti-HER2 therapy did not improve DDFS significantly (P=0.960). Benefits of anti-HER2 therapy in DDFS among patients without a pCR achieved statistical significance (P=0.028).

Combination of neoadjuvant anti-HER2 therapy and chemotherapy resulted in a higher pCR rate in HER2-overexpressing primary breast cancer. Patients treated with neoadjuvant systemic therapy who achieved a pCR have excellent outcome regardless of whether they received anti-HER2 therapy.

To analyze the correlation of lymph node metastasis with clinicopathological parameters and outcomes of colorectal adenocarcinoma, and to explore its clinicopathological significance.

The lymph node metastasis and clinicopathological features of 133 colorectal adenocarcinoma patients whose specimens were interpreted in Department of Pathology of Beijing Tongren Hospital between February 2011 and August 2015 were retrospectively analyzed. The relationship between the lymph node metastasis and clinicopathological features as well as outcomes was also analyzed according to the follow-up data of these patients.

Among the 133 cases, 69 had lymph node metastasis, and the other 64 had no lymph node metastasis. Compared with the non-lymph node metastasis group, the lymph node metastasis group had higher prevalence of neural invasion (20.29% vs 3.13%) and vascular invasion (36.23% vs 3.13%), deeper tumor invasion (beyond the serosa: 1.45% vs 0), lower tumor differentiation (poorly differentiated: 26.09% vs 14.06%), higher mortality (11.59% vs 1.56%) and distant metastasis (17.39% vs 4.69%) (all P<0.05). In the lymph node metastasis group, intra-group comparison among patients of different lymph node N staging (N0, N1a, N1b, N2a, N2b) also showed statistically significant differences in neural invasion, vascular invasion, circumferential resection margin, maximum diameter of the tumor, depth of tumor invasion, tumor differentiation, survival, and distant metastasis (allP<0.05). There were no statistically significant differences between the patients with lymph node metastases <12 and those with lymph node metastases ≥12 in these clinicopathological parameters(allP>0.05).

Presence/absence of lymph node metastasis and lymph node stage may be correlated with neural invasion, vascular invasion, depth of tumor invasion, tumor differentiation, survival, and distant metastasis. However, no marked relationship was detected of the number of lymph node metastases (<12 or ≥12) with clinicopathological parameters and outcomes.

To evaluate the effect and double-J stent indwelling time in the treatment of acute upper urinary tract infection caused by ureteral calculi.

A prospective non-randomized controlled study was carried out. From January 2011 to August 2015, a total of 142 patients treated in Department of Urology of Shanghai First People's Hospital for ureteral calculi with systematic inflammatory response syndrome were divided into double-J stent indwelling 7 days group (n=63) and double-J stent indwelling > 7 days group ( n=79). The preoperative routine blood test, urinalysis, and urine culture, the urinalysis and urine culture immediately after double-J indwelling, and the routine blood test, urinalysis, and urine culture 7 days after indwelling were compared between the two groups. Postoperative complications after lithotripsy were analyzed.

There were no statistically significant differences in preoperative blood white blood cell (WBC) count, urine WBC count, and positive bacterial culture between the two groups (all P>0.05). Seven days after double-J stent indwelling, significant improvement was seen in both the 7 d group and the >7 d group in blood WBC count, urine WBC count, and positive urine culture [(8.1±1.7) vs (14.8±3.1) ×10⁹/L, (356±44) vs (3 077±643)/μl, 1.6% vs 52.4%; (7.9±1.1) vs (15.1±3.8) ×10⁹/L, (363±52) vs (3 122±805)/μl, 3.8% vs 48.1%], and infection was managed effectively, while no statistically significant inter-group differences were observed. There was no significant difference in stone clearance rate between the two groups (96.8% vs 96.2%,P>0.05). There was no significant difference in the incidence of postoperative complications, especially infectious complications (allP>0.05).

Indwelling double-J stents for 7 days could effectively manage the infection in patients with acute upper urinary tract infection secondary to ureteral calculi. These patients can be treated with lithotripsy safely. The time of double-J stent indwelling could be shortened.

To investigate the correlation between pulmonary artery pressure (PAP) and the expression level of Egl nine homologue 1 (EGLN1) gene or its protein in lung tissue of rats at different altitudes.

Totally 121 male Wistar rats were randomly divided into low altitude group (n=11), moderate altitude group and high altitude group, the rats in moderate altitude and high altitude group were further divided into 1^st day, 3^rd days, 7^th days, 15^th day and 30^th day group according to the exposure time to hypoxic environment, each group 11 rats. The low altitude group, the PAP of rats were determined by physiological signal acquisition system, and tissue samples were collected in liquid nitrogen container for storage at an altitude of 498 m area. Moderate altitude group rats were placed in altitude of 2 260 meters of natural environment, 5 high altitude groups rats were placed in the hypobaric hypoxic chamber, simulating altitude of 4 500 meters. The PAP of rats in moderate altitude group and high altitude group were also determined by physiological signal acquisition system, and tissue samples were collected when rats were exposed to hypoxia at 1^st, 3^rd, 7^th, 15^th and 30^th day; Western blot was used to determine expression levels of EGLN1 protein, and person correlation analysis was used to analyze whether the protein was related to the formation of pulmonary arterial hypertension (PH) under hypoxia. Real-time quantitive PCR method determined expression levels of EGLN1 mRNA in lung tissues, and the relative expression method was used to analyze PCR data, and finally assess whether the EGLN1 gene was the initial cause of the formation of PH during hypoxia.

The mean PAP of rats was (20.0±3.2) mmHg (1 mmHg=0.133 kPa) in low altitude group; in moderate altitude group, mean PAP began to increase slightly when rats were exposed to hypoxia on the 15^th day and reached at (22.7±4.1) mmHg on hypoxic 30^th day, but compared with the low altitude group, there was no statistical difference (P> 0.05); the mean PAP of rats in high altitude group began to rise on the 7^th day (28.7±7.7) mmHg, which was higher than that in low altitude group (P<0.05), and significantly increased to (42.3±9.1) mmHg (P<0.001) on hypoxic 30^th day; it was significantly proportional with exposure to hypoxic time, and compared to low altitude group and moderate altitude group, there was significant difference (P<0.05). EGLN1 protein expression in the lung tissue of rats had no significant difference between the low altitude group and moderate altitude group, and its expression level in the high altitude group were significantly decreased, furthermore, the expression level decreased with the increase of hypoxia exposure time (P<0.05); PAP and EGLN1 protein expression levels showed a negative correlation (r=-0.662). The transcription level of mRNA EGLN1 in high altitude group was significantly increased under hypobaric hypoxia, it was 72 times more than that of the moderate altitude group, and nearly 300 times than that of the low altitude group, respectively (both P<0.001=.

EGLN1 gene expression in lung tissue of rat is affected by hypoxia, the expression level increases with the increase of the altitude; but the protein expression level, in contrast with gene expression level, is decreased with the increase of altitude and is significantly negatively correlated with mean PAP.

A 46-year-old female was admitted to the First Affiliated Hospital of Suzhou University on October 18, 2013 due to left chest and back pain for 20 days and wheezing for 3 days. 20 days ago, the patient felt left chest and back pain without obvious trigger, no cough and sputum, no fever, no chest tightness and shortness of breath, which was not paid attention to. Before the onset of the disease, he had symptoms such as nasal congestion and bloody purulent discharge. On October 10, 2013, he went to the local hospital for a chest X-ray (Figure 1) indicates left lung infection. He was admitted to a local hospital for treatment. The erythrocyte sedimentation rate (ESR) was 110 mm/1 h after hospitalization; Blood routine: white blood cells 10.20×10⁹/L, eosinophil count 0.60×10⁹/L, the proportion of eosinophils was 5.8%. Cefuroxime, levofloxacin and other anti-infective treatments were given. October 13 Chest CT (Figure 2) shows mass shadows in the anterior segment of the left upper lobe and the dorsal segment of the left lower lobe with exudation. The pulmonary lesions were worse than before, and there was fever, with the highest body temperature of 38.2℃, and complained of joint pain, mainly pain in the left elbow joint and right knee joint, without rash, nausea and vomiting, chest tightness and palpitation. On October 17, I started to develop scleritis in both eyes, right shoulder pain, and nocturnal asthma symptoms. Reexamination of blood routine: white blood cells 11.93×10⁹/L, eosinophil count 1.18×10⁹/L, the eosinophil ratio was 9.9%. On the 17th, methylprednisolone was given intravenously (80 mg/d), and moxifloxacin and cefoperazone/sulbactam were changed for anti-infective treatment. Ocular symptoms and asthma symptoms were improved, but symptoms such as chest tightness and shortness of breath were aggravated. Admitted to our department on October 18th. Previous history of anemia with a course of several years. Individual marriage and childbirth and family history are not special.

A 48-year-old female was admitted for 6 months due to repeated oral ulcers. "Fungal infection" was considered in the outside hospital, but the treatment was ineffective. The ulcer gradually increased, accompanied by oral albuginea and pain, affecting eating and speaking, and losing weight, so he went to the stomatology department of our hospital and underwent left tongue tip ulcer resection. The pathology showed: (left tongue tip) B-cell non-Hodgkin's lymphoma, tending to diffuse large B-cell lymphoma (DLBCL) (Figure 1), was admitted to the lymphoma department of our hospital on August 27, 2014. He has been suffering from systemic lupus erythematosus for 25 years and has been treated with drugs (mycophenolate mofetil capsules, methylprednisolone tablets, etc.). Type 2 diabetes was diagnosed 3 months ago. Cerebral infarction was diagnosed 1 month ago.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease mainly manifested by dyspnea, fatigue and decreased activity endurance. It is mainly due to repeated pulmonary thromboembolism and inability to dissolve, which leads to pulmonary vascular remodeling, progressive increase of pulmonary vascular resistance, pulmonary hypertension and right ventricular insufficiency. The two-year cumulative incidence of CTEPH after acute symptomatic pulmonary embolism has been reported to be 0.1% to 9.1%^[1]The reason for such a large deviation in the incidence rate is due to different judgment criteria. There are currently no data on the exact population incidence rate. Some data show that the incidence rate is about 5/1 million people per year^[2]。 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^[3]。 The diagnostic process and treatment strategies for CTEPH according to the guidelines are described below.

Hepatitis C virus (HCV) is a very common blood-borne infectious disease. According to statistics, the infection rate in the United States is about 1.0% to 1.5%^[1]。 Hematopoietic stem cell transplantation (HCT) is currently widely used to treat patients with hematological diseases. According to a prospective study by the European Hematopoietic and Bone Marrow Transplantation Group, 6.0% of HCT recipients are screened for HCV-RNA positive^[2]。 The diagnosis and treatment of HCV in HCT recipients is unique. These patients have a higher risk of liver disease progression and viral replication. HCV diagnosis is more difficult, and there is no uniform guideline to standardize treatment standards^[3]。 In the past decade or so, the treatment of HCV infection is mainly peginterferon combined with ribavirin. However, studies have shown that the sustained virologic response rate (SVR) and tolerability of this regimen in cancer and hematopoietic stem cell transplantation (HCT) patients are poor, and because nearly 30% of HCT patients have contraindications for peginterferon and ribavirin treatment, the application of this regimen in HCT patients is greatly limited^[4]。 In recent years, due to the emergence of new direct-acting antiviral agents (DAA), interferon combination therapy is gradually being eliminated, changing the treatment mode of HCV infection in the general population. However, there are few studies on the diagnosis and treatment of HCV infection in HCT donors and recipients. Therefore, this article summarizes the early screening and treatment of HCV infection in HCT donors and recipients to provide guidance for clinicians.