Volume 96  ·  Issue 40  ·  2016

Breast cancer is the most common malignant tumor in women. According to the World Cancer Report published by the World Health Organization (WHO) in 2012, there are about 1,671,000 cases of breast cancer in the world, accounting for the first new tumor in women^[1]。 According to the data of China's Cancer Registration Center, in 2011, the number of breast cancer cases among women in China was about 249,000, and about 60,000 died every year^[2]。 Most patients with breast cancer are hormone-dependent^[3]This type of patients is sensitive to endocrine drugs, and endocrine therapy is a very effective treatment for postoperative adjuvant therapy for patients with early estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer. The results of a meta-analysis by the Early Breast Cancer Clinical Research Collaborative Group (EBCTCG) in 2005 showed that the risk of recurrence and death in patients with early hormone receptor-positive breast cancer after surgery was reduced by 40% and 32% respectively^[4]。 Another meta-analysis also confirmed that patients with premenopausal hormone receptor positive breast cancer who received tamoxifen adjuvant therapy for 5 years reduced their 15-year recurrence and mortality rates by 13.2% and 9.2%, respectively^[5]。 Therefore, selective estrogen receptor modulators (SERM) have become the standard therapeutic drugs for patients with hormone receptor-positive early breast cancer. With the announcement of the results of large studies such as ATLAS and ATTOM, 10-year SERM drug treatment can further reduce the risk of recurrence and improve survival rate compared with 5-year treatment^[6,7]。 Therefore, the National Comprehensive Cancer Network (NCCN) guidelines, the American Association of Clinical Oncology (ASCO), StGallen and other major guidelines all recommend that patients with hormone receptor-positive early breast cancer can consider a 10-year treatment plan of SERM drugs.

To explore the efficacy of Jinhuaweikang capsules plus furazolidone-based triple or quadruple therapy as the rescue treatment for Helicobacter pylori (H.pylori) infection.

This is a prospective randomized controlled multicenter clinical trial. Patients with chronic gastritis from H. pylori infection in whom eradication treatment failed were recruited from 6 hospitals. All patients were divided into 4 groups using stratified randomization: group A1 (PAFJ), receiving pantoprazole 40 mg+ amoxicillin 1 000 mg+ furazolidone 100 mg+ Jinghuaweikang 3 capsules, twice a day for 10 d (d1-10); group A2, PAFJ therapy as in group A1, followed by Jinghuaweikang 3 capsules twice a day for 18 d (d11-28); group B1 (PAFB), receiving pantoprazole 40 mg+ amoxicillin 1 000 mg+ furazolidone 100 mg+ bismuth potassium citrate 220 mg, twice a day for 10 d (d1-10); group B2, PAFB therapy as in group B1, followed by Jinghuaweikang 3 capsules twice a day for 18 d (d11-28). At least 28 days after the end of treatment, all patients underwent ¹³C urea breath test for assessment of H. pylori eradication.

A total of 357 patients, 145 males and 212 females, were recruited, including 90 in group A1, 88 in group A2, 89 in group B1, and 90 in group B2. The eradication rates of H. pylori in groups A1 and A2 were 76.1%(67/88)and 79.6%(70/88) in per-protocol (PP) analysis, 74.4%(67/90) and 79.6%(70/88)in intention-to-treat (ITT) analysis; the rates in groups B1 and B2 were as 85.9%(73/85) and 92.1%(81/88) in PP analysis, 82.0%(73/89) and 90.0%(81/90)in ITT analysis. There were statistically significant differences in PP eradication rates among the 4 groups (P=0.020); there was statistically significant difference between groups A1 and B2, and also between groups A2 and B2 (P=0.003, 0.020), but not between groups A1/A2 and B1 (P>0.05), nor between groups B1 and B2 (P>0.05). No statistically significant differences in ITT eradication rates were found among the 4 groups (P>0.05). The improvement of belching and poor appetite for patients in groups A2 and B2 was better than those in groups A1 and B1.

The efficacy of Jinghuaweikang capsules plus furazolidone-based quadruple therapy is superior to combination with furazolidone-based triple therapy as the rescue treatment of H. pylori, and superior to bismuth-containing quadruple therapy. Extending administration of Jinghuaweikang capsules to 28 days may better improve symptoms of indigestion.

To test the hypothesis that the single nucleotide polymorphisms (SNPs) in HIF-2α gene were associated with the susceptibility of high altitude pulmonary hypertension (HAPH) in Han population in China.

Those Han population who emigrated to plateau (average altitude 3 300 m) and have been lived here for more than 20 years were included as the research subjects, the method of cluster random sampling was used to enroll 49 HAPH patients as the case group (HAPH group) and 39 free of HAPH people as the control group. The Sanger chain termination method was used to detect the SNPs of rs1562453, rs1867785, rs4953361, rs7598371 and rs11125068 in HIF-2α gene.

The genotype and frequencies of rs1562453 were CC (49.0%), CT (46.9%) and TT (4.1%) in the HAPH group, and the locus's genotype and frequencies were CC (76.9%), CT (17.9%) and TT (5.1%) in the control group. The alleles and frequencies of rs1562453 were C (72.4%) and T (27.6%) in the HAPH group, and the locus's alleles and frequencies were C (85.9%) and T (14.1%) in the control group. Their genotypes and alleles frequencies were of significant difference between the two groups (genotypesP=0.017; allele P=0.031). Meanwhile, The genotype and frequencies of rs1867785 were AA (46.9%), AG (46.9%) and GG (6.1%) in the HAPH group, and the locus's genotype and frequencies were AA (74.4%), AG (25.6%) and GG (0.0%) in the control group. The alleles and frequencies of rs1867785 were A (70.4%) and G (29.6%) in the HAPH group, and the locus's alleles and frequencies were A (87.2%) and G (12.8%) in the control group. Their genotypes and alleles frequencies were of significant difference between the two groups (genotypesP=0.020; allele P=0.008). Genotypes frequencies of the rs1562453 and rs1867785 were analyzed by Logistic Regression which showed that the genotypes frequencies of rs1562453 were also of significant difference between two groups (Wald=9.561, P=0.008), CT vs CC (β=1.720,OR=5.580, P=0.011).

The SNPs of rs1562453 in HIF-2α gene may be associated with the development of HAPH among Chinese Han population, and individuals with the genotype CT may be more vulnerable to HAPH than those who carry genotype CC, and allele T may be a risk factor for HAPH.

To explore the clinical features, biopsy results and risk factors of patients underwent prostate biopsy with age≤55, and to help make the proper treatment strategies of this cohort of patients.

The data of patients with age≤55 underwent prostate biopsy between Jan 2011 and Nov 2013 was retrospectively reviewed. Clinical factors including prostate-specific antigen, digital rectal examination, ultrasonography and magnetic resonance imaging were recorded. Biopsy positive results were defined as the presence of prostate cancer and high-grade prostate cancer (Gleason score≥7).

There were all together 82 patients in this cohort, with the median age of 51 years old and median prostate-specific antigen of 8.62 μg/L. Among them 71 patients (86.6%) underwent pre-biopsy magnetic resonance imaging test, with 25 positive (35.2%), 18 suspicious (25.4%) and 28 negative results (39.4%). Pathology confirmed prostate cancer in 26 patients (31.7%), including 23 (28.0%) high-grade prostate cancer. Higher prostate-specific antigen, positive ultrasonography and positive magnetic resonance imaging were risk factors for prostate cancer and high-grade prostate cancer. For patients with prostate-specific antigen between 4 and 10 μg/L, 15.0% were diagnosed with prostate cancer, and positive ultrasound and magnetic resonance imaging were predictive for biopsy results.

The positive rate of prostate biopsy in men younger than 55 years old is 31.7%, and the risk for prostate cancer of this cohort of patients shouldn't be neglected. Prostate-specific antigen value, ultrasonography and magnetic resonance imaging could help predict biopsy results.

To compare the clinicopathological features and prognosis of pancreatic cystic neoplasms (PCN) between male and female patients.

A total of 325 patients with histological confirmed PCN from January 2010 to October 2015 were enrolled. The clinicopathological features, laboratory examination, imaging features, treatment and prognosis were analyzed.

Of the 325 patients diagnosed as PCN, 104 were male and 221 were female. The average age of male patients was significantly higher than that of female patients (55.0±12.7 vs 47.9±13.4 years, P<0.001), however, the average tumor size of male patients was smaller than that of female patients (3.9±2.7 vs 4.9±3.0 cm,P=0.004). The location of PCN in male patients was predominantly located at pancreatic head and neck, and majority of male patients were mucinous cystic neoplasms. 1-year, 3-year and 5-year survival rates of patients with PCN were 98.5%, 92.6%, and 87.5%, respectively. 1-year, 3-year and 5-year survival rates of male patients were 97.8%, 84.9%, and 77.8%, however, those of female patients were 98.8%, 96.5%, and 92.2%, respectively. Female patients had better prognosis than male patients (χ²=5.543, P=0.019). Elevated CA19-9 (χ²=3.843, P=0.050), perineuronal invasion (χ²=6.250, P=0.012) and lymph node metastasis (χ²=4.529, P=0.033) were important prognostic factors for malignant mucinous cystic neoplasm.

Male patients had low incidence of PCN, and were more common for mucinous cystic neoplasm. The long-term outcome of malignant PCN was poor. Even with complete resection, male patients still had worse prognosis. Close follow-up is recommended especially for male patients.

To investigate the expression of p21-activated kinase 1 (PAK1) in bladder cancer and its biological influence on invasion ability of bladder cancer cells.

A total of 54 paraffin-embedded bladder cancer tissue samples and 12 normal bladder tissue specimens were retrieved in Jinshan Hospital Affiliated to Fudan University between January 2009 and December 2012. The expression of PAK1 in these tissues was detected by immunohistochemical staining. The PAK1 mRNA and protein levels were measured in bladder cancer cell lines and human normal bladder epithelial cell line using real-time, fluorescence-based quantitative polymerase chain reaction (RT-PCR) and Western blot, respectively. A stable PAK1 gene silencing bladder cancer cell strain 5637 were successfully constructed. After treatment with PAK1 RNA interference(RNAi), the ability of migration and invasion of the 5637 cell was evaluated using a Transwell system.

The expression of PAK1 proteins was significantly higher in bladder cancer tissues than in normal bladder tissues (28/54 vs 1/12, P<0.05). The overexpression of PAK1 was positively correlated with high histological grade, lymph node metastasis, and tumor size (allP<0.05). The mRNA level and protein level of PAK1 was much higher in bladder cancer cell lines T24, 5637 than human normal urothelial cell line SV-HUC-1.PCR and Western blot showed satisfactory inhibitory effect of PAK1 short hairpin RNA (shRNA) on PAK1 expression in 5637 bladder cancer cells. The number of PAK1 RNAi-treated 5637 cells traversed the membrane was decreased compared with the control group in migration and invasion assays.

Overexpression of PAK1 in bladder cancer tissues may be an important feature of bladder cancer and related with the metastasis and invasion of bladder cancer. The molecular mechanisms involved in regulation of PAK1 expression needs further research.

To investigate the protein expression of A Proliferation-Inducing Ligand (APRIL) in colorectal cancer (CRC) tissue, and its correlation with clinical pathology and prognosis.

One hundred and twenty cases of CRC tissue and related clinical data were collected from the Department of Pathology of Affiliated Hospital of Nantong University. The specimens were made into tissue microarray. The protein expression of APRIL was detected by Envision immunohistochemistry. The relationship of the protein expression of APRIL with clinicopathological parameters and follow-up data were statistically analyzed.

APRIL protein expression positive rate of CRC tissue and cancer adjacent normal mucosal tissue were 83.33% (100/120) and 12.5% (15/120), with a statistical significance (P<0.001). The expression of APRIL was related to TNM staging (χ²=10.222, P=0.006) and the depth of tumor invasion (χ²=5.987, P=0.014). Kaplan-Meier survival curves showed that five years survival rate of high APRIL expression group was lower than that of low APRIL expression group. Univariate survival analysis showed that the expression of APRIL (P<0.001), the degree of tumor differentiation (P=0.033), TNM staging (P<0.001), depth of tumor invasion (P=0.011), lymph node metastasis (P<0.001) and serum CEA (P=0.003) time were associated with postoperative survival. Multivariate COX proportional hazard regression model analysis further revealed the expression of APRIL (P=0.001), the degree of tumor differentiation (P=0.005), TNM staging (P=0.001) and serum CEA (P=0.039) were the independent risk factors for prognosis.

The expression of APRIL in CRC tumor tissue is closely related to TNM stage and depth of tumor invasion. The high expression of APRIL prompts bad prognosis. APRIL is one of the independent prognostic factors in patients with CRC, and could be a potential target for the therapy of CRC.

To evaluate the safety and efficacy of mini-flank incision for open partial nephrectomy for stage T_1b renal tumor.

The data of patients with stage T_1b renal tumor who underwent mini-flank incision for open partial nephrectomy between January 2010 to September 2015 were retrospectively reviewed. The Nephron-sparing surgery (NSS) was performed through mini-flank supra-12th rib incision under general anesthesia.

A total of 47 patients(31 male and 16 female) were enrolled in our study. The median age was 40 years (range 22-67 years). The Zhongshan Score(ZS score) of renal tumors was 6 in 5 cases, 7 in 13 cases, 8 in 12 cases, 9 in 5 cases, 10 in 6 cases, 11 in 2 cases, 12 in 2 cases, 13 in 2 cases. The length of incision was from 7 cm to 9 cm, with an average of 8.1 cm. The operative time was from 70 min to 150 min, with an average of 96 min. The blood loss was from 50 ml to 600 ml, with an average of 135 ml. The warm ischemia time was from 20 min to 35 min, with an average of 28 min. All of the surgery margin were negative. One patient had fluid in surgical region and relieved after the drainage, and one patient had acute myocardial infarction. The hospital stay time was from 5 d to 14 d, with an average of 8 d. The pathological diagnosis included clear cell carcinoma in 37 cases, multilocular cystic renal carcinoma in 1 case, chromophobe cell tumor in 4 cases, and papillary carcinoma in 5 cases. The mean preoperative serum creatinine level was 87 μmol/L(48-150 μmol/L) and with a mean of 91 μmol/L(52-148 μmol/L) at 3 month follow-up after surgery, and there was no difference between the preoperative and postoperative period( P>0.05). A total of 45 out of 47 patients were followed up for 36 to 78 months, with an average of 60 months, and no one had recurrence or metastasis during follow-up.

Mini-flank incision for open partial nephrectomy for renal tumor with stage T_1b is safe and effective, which is worthy of promotion and application for small incision and quick recovery.

To observe the clinical outcome of intramyocardial dissecting hematoma (IDH) after acute myocardial infarction (MI).

The clinical characteristics and outcomes of nine patients with IDH after acute MI in Beijing Anzhen Hospital from 2010 to 2014 were retrospectively assessed, and all the patients were followed up.

The mean age of nine IDH patients (7 males, 2 females) was (61±5) years. One patient was diagnosed as right ventricular IDH and died before surgery because of deteriorated cardiac and renal failure. Eight patients were diagnosed as left ventricular IDH, among whom 1 patient died of perioperative bleeding. The other 7 patients survived, among whom 5 cases were treated medically and 2 cases accepted surgical treatment. After 2-6 years of follow-up, the survived patients had no other complications.

IDH after acute MI was a rare clinical event with a high mortality, and improvement of recognition of this rare condition may reduce its mortality, especially the right ventricular IDH.

To investigate the regulation mechanism of Acanthamoeba-induced immune responses of human corneal epithelial cells in a hypoxia condition.

Telomerase-immortalized human epithelial cells (THCEs) challenged with Acanthamoeba (1×10⁶/ml) were incubated under normoxic (21% O₂) (control group) or hypoxic (1% O₂) (experiment group) conditions respectively. The mRNA of toll-like receptor (TLR4), myeloid differentiation factor 88 (MyD88), nuclear factor kappa-B (NF-κB), tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), interferon-β (IFN-β), and the protein level of TLR4, inhibitor of nuclear factor kappa-Bα (IκBα), phosphorylated extracellular-signal related kinase 1/2 (p-ERK1/2) and phosphorylated IκBα (p-IκBα) were detected. Enzyme-linked immunosorbent assay (ELISA) was used to detect the secretion of the inflammatory cytokines (TNF-α, IL-8 and IFN-β).

The mRNA levels of Acanthamoeba-induced TLR4, MyD88, NF-κB, TNF-α, IFN-β and IL-8 in THCEs under hypoxia was down-regulated by 47%, 41%, 45%, 53%, 36% and 50% respectively, compared to control group. And the protein levels of p-IκBα and p-ERK1/2 were significantly down-regulated by 56% and 55%, respectively, while the protein expression of IκBα was increased. The secretions of TNF-α, IL-8 and IFN-β under hypoxia were reduced by 46%, 28% and 35%, respectively.

Hypoxia might attenuated the inflammatory response of the human corneal epithelial cells against Acanthamoeba infection by suppressing TLR4 signaling.

To investigate whether α-lipoic acid (ALA) regulates autophagy in the pathogenesis of colitis through the mammalian target of rapamycin (mTOR) signaling pathway.

Balb/c mouse colitis model was induced with 2, 4, 6-trinitrobenzenesulfonic acid (TNBS). Male Balb/c mice (22-25 g) were divided into four groups: control group, ALA group, colitis group, and ALA treatment group, with 10 mice in each group. ALA was administered at a dose of 80 mg/kg once a day for 7 days. The colon weight index, the disease activity index (DAI) and the histologic degeneration score (HDS) of colon tissue in each group were calculated. The autophagy gene Beclin-1 mRNA level was detected by RT-PCR. The levels of mTOR, phosphorylated mTOR (p-mTOR), and Beclin-1 proteins were detected by Western blot.

Compared with the control group, there was no statistically significant difference in colon weight index in the ALA group[(9.21±0.57)vs(8.91±0.91)g/kg, P>0.05], but increased in the colitis group [(12.65±1.33)g/kg,P<0.05] and decreased in the ALA treatment group [(10.04±1.02)g/kg,P<0.05]; there were no significant differences in DAI or HDS in the ALA group, but significantly increased in the colitis group, and decreased in the ALA treatment group (allP<0.05). The Beclin-1 mRNA and protein levels showed no significant differences between the control and the ALA groups (1.00±0.12 vs 1.05±0.05, 1.00±0.11 vs 1.00±0.06). However, the expression of Beclin-1 was significantly decreased in the colitis group compared to the control group (0.51±0.07 vs 1.00±0.12, 0.52±0.07 vs 1.00±0.11, bothP<0.05), but significantly increased in the ALA treatment group compared to the colitis group (1.75±0.09 vs 0.51±0.07, 1.82±0.14 vs 0.52±0.07, bothP<0.05). The mTOR total protein levels were not significantly different among the four groups, but the p-mTOR level was significantly higher in the colitis group than in the control group (3.07±0.20 vs 1.00±0.07), and reduced in the ALA treatment group than in the colitis group (1.49±0.11 vs 3.07±0.20) (allP<0.05).

ALA may improve the TNBS-induced colitis in mice by inhibiting the phosphorylation of mTOR to promote autophagy.

To determine the age-related coronary risk factors in Chinese patients with acute myocardial infarction (AMI).

Among 31 provinces, municipalities or autonomous districts in China, from January 1st 2013 to September 30th 2014, 24 394 consecutive AMI patients who were admitted to 107 hospitals were divided into five groups according to age. Cardiovascular risk factors of groupⅠ (<45 years,n=2 307), group Ⅱ (45-54 years, n=4 448), group Ⅲ (55-64 years, n=7 029), group Ⅳ (65-74 years, n=6 147) and group Ⅴ (≥75 years, n=4 463) patients were compared.

Among 24 394 AMI patients [with a mean age of (62.2±13.8) years, 18 162 males], 24.7% patients had three and more conventional modifiable cardiovascular risk factors. ST-elevation myocardial infarction (STEMI) was diagnosed in 18 209 (74.6%) patients. The ratios of female, hypertension and diabetes tended to increase with the increase of age. Young AMI patients were predisposed to smoking, overweight/obesity and hyperglycemia. Nearly 90% patients in group Ⅰ and group Ⅱ were male. The ratio of male patients (92.3% to 58.0%), overweight/obesity (63.9% to 37.4%), current smoking (68.7% to 19.8%), dyslipidemia (9.1% to 4.5%), family history of premature coronary artery disease (CAD) (6.2% to 1.2%) and eating greasy food (86.1% to 66.2%) decreased markedly from group Ⅰ to Ⅴ patients. Proportion of hypertension gradually increased from 34.3% in group Ⅰ patients to 57.9% in group Ⅴ patients. Diabetes was most common to group Ⅳ (65-74 years) patients.

There were different risk factors for AMI patients in different age groups, and young AMI patients were predisposed to live an unhealthy lifestyle.

Montgomery T-tubes have been dedicated to otolaryngologists for many years^[1]。 In recent years, due to the rapid development of respiratory interventional technology, tracheotomy is no longer the specialized technology of otolaryngologists, and more and more respiratory doctors can also perform tracheotomy and T-tube placement through respiratory endoscopy. However, due to the late development of this technique in respiratory department, there are still many things that need attention. The experience and experience of applying T-tube placement in our hospital in the past 2 years are summarized as follows.

The 26-year-old male was seen in the emergency department of our hospital on April 15, 2015 due to intermittent fever for half a year, asthma for 2 months, and recurrence and aggravation for 2 days. Six months ago, the patient developed fever without obvious trigger, which mostly fluctuated between 37.0 and 38.5 ℃, and the highest was 40.0 ℃. Occasionally, he had chills and chills, and had no cough or expectoration. He was given "cephalosporins" drugs to fight infection in another hospital, and his body temperature could return to normal. Asthma appeared without obvious trigger 2 months ago, and it worsened after general activity. Fever appeared again 2 days ago, and body temperature fluctuated between 38.0 and 40.0 ℃. There was no chest pain, hemoptysis, and edema of lower limbs. I went to the emergency department of our hospital. Chest CT scan showed multiple nodular shadows in both lungs (FIG. 1A), considering "pneumonia", given cefmetazole and moxifloxacin to fight infection for 2 days, body temperature dropped, asthma gradually worsened, asthma felt immediately after slight activity, check brain natriuretic peptide precursor (proBNP) 3 200 ng/L, the above symptoms were progressively aggravated, with general fatigue, dizziness, multiple transient amaurosis, blood pressure dropped to 75/45 mmHg (1 mmHg =0.133 kPa), mask oxygen inhalation, dopamine boost and other treatments. Transfer to our department for further diagnosis and treatment.

The patient was an 18-year-old female, a high school student. He was admitted to hospital on June 15, 2015 due to "cough, asthma and fatigue for more than 4 months". The patient complained that he had chills, cough and no fever after catching a cold in February 2015. After being treated with antibacterial and antiviral treatment according to "upper respiratory tract infection" in the school hospital, he still had repeated cough. The cough was paroxysmal with a little white sticky sputum. At the beginning of self-complaint, shortness of breath and discomfort appeared after running about 400 m, which could be relieved after rest, and there was no wheezing attack; Later, the symptoms gradually worsened, and I couldn't run, and I felt dyspnea when I walked fast or long distances. He went to the local hospital on April 6. Chest CT showed interstitial pneumonia in both lungs? (FIG. 1A), no improvement after anti-infective treatment (specific regimen unknown); On April 29th, he was hospitalized again in the local hospital. The pulmonary function test results showed: moderate to severe mixed ventilatory dysfunction (mainly obstruction), negative bronchodilation test, mild diffuse dysfunction, and moderately increased ratio of residual gas/total lung volume. Consider the diagnosis: (1) interstitial pneumonia; (2) Both pneumonia. Oral prednisone acetate tablets 25 mg, once a day, started on May 6; Roxithromycin sustained-release capsules 300 mg, once/d. The patient felt that his symptoms improved compared with before and was discharged from hospital on May 11th. Continue oral prednisone acetate tablets reduced by 5 mg every 6 days until discontinuation. One week after stopping the drug, he had a cough again, and he was obviously shortness of breath after walking 400~500 m. He went to our hospital on June 12. Chest CT showed that small pieces of ground glass shadows were visible in the upper lobes of both lungs and the lower lobe of the right lung (FIG. 1B), admitted to our department for dyspnea. The patient has been in good health and loves sports; The environment where he lived was humid, and all students in the same dormitory had symptoms similar to "upper respiratory tract infection" in the same period, but all recovered within one week. The patient has lost 5 kg of weight since the onset of the disease.

A 53-year-old male underwent colonoscopy due to blood in the stool for 1 year, and a huge flaky bulging mass from 2 to 15 cm away from the anal margin was found, and the pathology was villous tubular adenoma. After admission, digital anal diagnosis in the chest and knee position: a flaky soft mass can be palpable 2 cm away from the anal margin, but the upper pole of the mass cannot be palpable. The main body of the mass is located in the posterior wall of the rectum, and the tumor grows circumferentially 3~6 cm away from the anal margin. Endoscopic ultrasound showed that the lesion was confined to the mucosal layer, and it was decided to complete the resection of the tumor by transanal endoscopic microsurgery (TEM) combined with anorectal surgical instruments. Surgical methods: Routine intestinal preparation before operation, intubation and general anesthesia, the patient took the head low and foot high lithotomy position, inserted a TEM proctoscope through the anus to reach the upper pole of the tumor, and submucosal resection from the upper pole of the tumor was performed by TEM surgical system to 6 cm from the anal margin. The TEM operation was terminated, the corresponding instruments were withdrawn, and the German Wolf brand anorectal surgical instrument was used to resect the mucosa from the lower pole of the tumor to the rectum until the two-way convergence completely resected the tumor. The tumor was completely removed and fixed through the anus, and sent for rapid pathological examination. The return was tubular adenoma, and no adenoma cells were found at the circumferential margin and base. After careful hemostasis, adrenaline was sprayed on the wound surface, and the operation was ended. The patient recovered well on the 8th postoperative day and was cured and discharged.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a kind of clinical syndrome that causes repeated apnea and hypopnea at night due to repeated collapse and obstruction of the upper respiratory tract during sleep. It can involve all major systems and organs and cause systemic damage, among which cognitive impairment is one of the important complications^[1]。 Apolipoprotein E (APOE) is one of the main components of very low density lipoproteins, consisting of 299 amino acid residues with 3 alleles: APOE ε 2, APOE ε 3, and APOE ε 4^[2]。 APOE ε 4 gene plays a key role in the cognitive decline of neurodegenerative diseases, especially in Alzheimer's disease (AD). APOE gene also has a certain influence on the cognitive impairment of OSAHS. The research on OSAHS, cognitive impairment and its relationship with APOE genotype combined with domestic and foreign literatures is described as follows.

pituitary adenoma is a benign tumor originating from anterior pituitary cells, accounting for 10% to 15% of intracranial tumors. Accidental tumors are found in non-selective autopsy, accounting for about 20% to 30%. According to the secretory state, it is divided into hormone-secreting (functional) pituitary tumors and non-functional pituitary tumors^[1]。 The main treatments for functional pituitary tumors include surgery, radiotherapy, and medication. Except for prolactin adenoma, surgical treatment is the first choice for other types of pituitary tumors, mainly transsphenoidal resection; Some large tumors that invade the cavernous sinus are difficult to operate and can be treated with drugs. Radiotherapy is an adjuvant treatment^[2]。

Adolescent idiopathic scoliosis (AIS) is a common spinal deformity in women at the peak of puberty, with a reported incidence of 1.0% ~7.5%^[1,2]。 At present, spinal orthopaedic surgery is the most effective treatment strategy for AIS patients with severe deformity. Correct surgical plan can effectively correct spinal deformity, so that patients can obtain good three-dimensional reconstruction of spine immediately^[3]。 However, the natural outcome of AIS patients in the intermediate and long-term follow-up after orthopedic surgery is still inconclusive. This article reviews the previous literature studies evaluating the efficacy of mid-to long-term follow-up (>5 years) after AIS orthopedic surgery, and explores the mid-to long-term surgical efficacy from four aspects: imaging parameters, lung function, complications and quality of life, and compares it with the natural history of AIS, which are summarized below.

From August 19th to 21st, 2016, the 11th National Clinical Forum on Diagnosis and Treatment of Helicobacter Pylori and Digestive Diseases was held in Zhengzhou, Henan, the hinterland of the Central Plains. This forum was co-sponsored by Beijing Branch of Chinese Medical Association, Peking University First Hospital, Chinese Medical Journal, Zhengzhou University Fifth Hospital and China Helicobacter Pylori Information Center. Professor Hu Fulian of Department of Gastroenterology, Peking University First Hospital served as the chairman of the conference, Professor Yang Yunsheng, Dean Zheng Pengyuan and Professor Wang Huahong served as the co-chairmen, and Professor Zhang Xuezhi, Professor Cheng Hong and Professor Yang Guibin served as the executive chairmen.