Volume 96  ·  Issue 44  ·  2016

In recent years, the contradiction between doctors and patients has been deepening. Violent incidents occur frequently, which infringe on the personal rights of doctors, reduce the sense of security of doctors in their practice, and seriously disrupt the medical order. In 2012, Tianjin Wang Yingsheng's case of killing a doctor due to suspicion of improper treatment and the case of killing a doctor in Wenling in 2013 caused a huge sensation in the society. According to the survey, from 2000 to 2013, there were at least more than 150 cases of violent attacks on doctors revealed by the media, resulting in more than 30 casualties. In 2014, the people's courts at all levels nationwide concluded 155 cases of violence against doctors^[1]。 From January to May 2016, there were eight cases of violent attacks on doctors across the country, and seven of them were sentenced to death^[2]。 In addition, disputes such as abuse and threats by patients against doctors are increasing year by year, with 96 percent of the total number of hospitals in the country having experienced patient-doctor disputes resulting in minor violence by 2012. (Figure 1)。

amyloidosis is a group of diseases in which amyloid is deposited in the extracellular matrix, causing tissue and organ damage at the deposition site. It can involve a variety of organs and tissues including kidney, heart, liver, skin and soft tissues, peripheral nerves, lungs, glands, etc. Among them, systemic light chain (AL) amyloidosis is the most common systemic amyloidosis in clinic. With the aging of population and the aggravation of environmental pathogenic factors in China, the incidence of AL type amyloidosis is also showing a trend of increasing year by year^[1]。 The clinical manifestations of these patients are multiple organ involvement, severe disease, rapid progression, difficult treatment and high mortality. At present, there is still a lack of standardized diagnosis and treatment plan for AL amyloidosis in China. In recent years, some guidelines for the diagnosis and treatment of this disease have been published internationally, among which the guidelines for the diagnosis and treatment of AL amyloidosis formulated by the Standards Committee of the British Society of Hematology and the guidelines for the treatment of AL amyloidosis formulated by Mayo Clinic in the United States are the most representative. The Chinese Collaborative Group on Systemic Amyloidosis developed this guideline on the basis of the above international guidelines and combined with domestic clinical practice.

To compare perioperative outcome of carotid endarterectomy (CEA) between diabetic and non-diabetic patients and discuss the safety of CEA in diabetic patients.

A total of 572 patients with carotid stenosis who underwent CEA from Juanuary 2006 to September 2014 in Peking Union Medical Colloge Hospital were collected and analyzed retrospectively. The patients were distributed into diabetes mellitus (DM) group and non-DM group according to the comorbidities. Their baseline characteristics, intraoperative index and major complications in perioperative period were analyzed and compared.

Of 572 cases, 184 had DM (32.2%). Diabetic patients more frequently had a history of coronary artery disease (30.4% vs 18.6%), peripheral artery disease (39.7% vs 27.3%), and hyperlipemia (50.5% vs 36.6%) than non-diabetic patients (all P<0.05). The incidence of perioperative myocardial infarction (0.5% vs 0.8%), stroke (1.6% vs 1.8%) and death (0.5% vs 0.3%) did not differ between two groups (allP>0.05). Data of follow-up was available in 89.6% of patients, with a median duration of 42 months. The incidence of myocardial infarction (4.3% vs 3.4%), stroke (1.8% vs 1.7%), death (1.1% vs 0.9%), and restenosis (2.9% vs 3.1%) did not differ between two groups (allP>0.05).

DM does not increase the risk of perioperative complications and impair the long-term outcomes after CEA if the patients are appropriately evaluated and treated in perioperative period.

To explore Wnt3a expression in HCC tissues and serum, and to discuss its clinical diagnostic and prognostic value.

The Wnt3a expressions were detected in a total of 186 patients (HCC, liver cirrhosis and chronic Hepatitis) and 40 controls by Elisa, comparing with AFP to evaluate its clinical diagnosis value. Wnt3a expressions in 80 HCC and surrounding tissues were analyzed by IHC, to explore its prognostic value.

Wnt3a with brown staining was mainly distributed in cytosol and of hepatocyte membrane. The higher expression (3-6 scores) was 71.3% in HCC, 13.8% in surrounding tissues, associated with poorly-differentiated grade, liver cirrhosis, HBV infection, higher TNM stage (P<0.05) and 5-year survival rate (P<0.001), identified as independent predictive factors for poor HCC outcome and closely related with lower five-year survival rate. Serum average Wnt3a levels were significantly higher (P<0.001) in the HCC group than those in any other groups of benign liver diseases, with about 4.0, 9.2 and 26.7 times higher than that in the liver cirrhosis, chronic hepatitis and normal control group. Wnt3a expression in HCC were closely related to AFP concentration, liver cirrhosis HBV infection, poor differentiation, TNM stagingand extra- hepatic metastasis (P<0.05). The sensitivity, specificity, accuracy, positive predictive value and negative predictive values were 92.5, 94.3, 93.2, 96.1 and 89.3% at 800 ng/L as cutoff value for Wnt3a. Combining Wnt3a and AFP test, the total sensitivity could rise to 96.3%. The area under ROC curve in Wnt3a (0.994)was higher than in AFP (0.710).

Wnt3a as a critical signal molecule in the Wnt pathway is a new specific marker for HCC diagnosis and prognosis.

To evaluate the association between single nucleotide polymorphisms (SNPs) of RS1799937 located in WT1 gene with complete response to neoadjuvant chemotherapy in breast cancer patients.

171 breast cancer patients with neoadjuvant chemotherapy were investigated to detect the RS1799937 polymorphism by sequenom method. The relationship between RS1799937 polymorphism and pathologic complete response (pCR) were analyzed by χ ² test and Fisher′s exact test analysis. Predictors of pCR were analyzed using multivariate logistic regression analysis.

The frequency of CC, TC and TT genetype of RS1799937 was 50.3%, 41.5% and 8.2%. Of the 171 patients, pCR was achieved in 53 cases(30.9%) with CC allele 23 cases(26.7%), TC allele 23 cases(32.4%) and TT allele 7 cases(50.0%), however no statistical significant difference was observed (χ²= 3.156, P=0.204). RS1799937 polymorphism was associated with pCR in EC-T neoadjuvant therapy (χ²=6.660, P=0.033) but not in PE neoadjuvant therapy (χ²=0.473, P=0.873) cohort. Multivariate logistic regression analysis indicated that RS1799937 polymorphism, targeted therapy and clinical stage were independent predictors of pCR (P<0.05) in EC-T neoadjuvant therapy cohort.

RS1799937 polymorphism was associated with pCR rate only in anthracycline and taxane-based neoadjuvant therapy, breast cancer patients with the rs1799937 TT allele were more likely to achieve pCR.

To evaluate the incidence and factors related to daytime hypercapnia in Han and Uygur patients with obstructive sleep apnea hypopnea syndrome (OSAHS).

There were 221 patients with OSAHS (include 179 Han patients and 42 Uygur patients) in Sleep Center of Department of Respiratory and Critical Care Medicine of Karamay Central Hospital from 2015, Jan to Dec. All the patients underwent polysomnography (PSG), nocturnal oximetry, daytime blood gas analysis, pulmonary function test and Mouth occlusion pressure (P_0.1) results were recorded. The features of hypercapnia was analyzed for patients with OSAHS, and linear regression analysis was used to evaluate the arterial carbon dioxide partial pressure (PaCO₂) levels and related factors.

Daytime hypercapnia occurred in 16.7% (37/221) of the 221 patients with OSAHS. Compare with no hypercapnia groups, the body mass [(31.6±5.6) vs (27.9±1.7) kg/m²], sleep apnea index (AHI) [(40.9±26.3) vs (32.2±20.1) times/h], the percentage of time spent at oxygen saturation below 90 (SIT₉₀) [(38.6±31.9)% vs (23.9±23.6)%], P_0.1 [(3.08±2.86) vs (2.03±1.20) mmHg, 1 mmHg=0.133 kPa] were higher in hypercapnia groups, but the mean nocturnal arterial oxygen saturation (MSaO₂) [(86.0±15.5)% vs (92.0±3.0)%], the nadir arterial oxygen saturation (LSaO₂) [(68.9±13.0)% vs (75.3±9.9)%] and arterial partial pressure of oxygen (PaO₂) [(74.5±23.0) vs (86.1±14.8) were lower in hypercapnia groups (all P<0.05). Compare with Han patients with OSAHS, MSaO₂ and LSaO₂ was lower, PaCO₂ and P_0.1 was higher in Uygur patients (all P<0.05).

Uygur OSAHS patients with hypercapnia have a higher daytime PaCO₂ than the Han counterparts. BMI, AHI, MSaO₂, P_0.1 level are all related with daytime hypercapnia in OSAHS.

To investigate the relationship between related factors of intestinal barrier dysfunction in patients with sepsis or septic shock and severity of the condition.

A prospective observational study was conducted in 31 sepsis patients, 28 septic shock patients, and 21 postoperative patients without sepsis (control group) who were admitted to intensive care unit (ICU) of General Hospital of Ningxia Medical University between November 2015 and June 2016. Blood samples were collected from the patients within 24 hours following admission to ICU. D-lactic acid and endotoxin levels were measured by enzymatic method, serum high-sensitivity C-reactive protein (hsCRP) level by immune scatter turbidimetry. An arterial blood gas (ABG) measurement was carried out every 8 hours within the first 24 hours after admission to ICU, and average arterial blood lactate levels were calculated. Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, Sequential Organ Failure Assessment (SOFA) score of the patients within 24 hours following ICU admission were recorded. The patients with sepsis or septic shock were followed up for 28 days after admission to ICU, and divided into survival group (n=44) and death group (n=15). The patients with sepsis or septic shock were divided into two groups according to the site of infection, i. e. intra-abdominal infection group (n=37) and extra-abdominal infection group (n=22).

(1) In the control, sepsis, and septic shock groups, D-lactic acid [mg/L, M(P₂₅, P₇₅) ] were 11.68(7.49, 14.92), 19.78 (12.25, 34.85), and 32.45 (16.03, 46.95), respectively; endotoxin levels [U/L, M(P₂₅, P₇₅)] were 10.60(7.59, 13.39), 16.12(10.09, 20.23), and 17.31(14.09, 23.77), respectively. The levels of serum D-lactic acid and endotoxin in the patients with sepsis or septic shock were significantly higher than those in the control group (all P<0.01); while no statistically significant differences existed in these two indices between the sepsis and septic shock groups (bothP>0.05). There were no statistically significant differences in serum D-lactic acid and endotoxin levels between the intra-abdominal infection group and the extra-abdominal infection group [20.07(14.70, 38.97)vs 21.65 (14.53, 56.56)mg/L; 17.23(13.38, 20.85)vs 17.17(9.93, 20.81)U/L; bothP>0.05]. There were no statistically significant differences in levels of serum D-lactic acid and endotoxin between the survival group and the death group [21.65(15.11, 39.00) vs 19.78(14.41, 80.93)mg/L; 17.09(12.62, 20.42) vs 19.26(13.22, 26.27)U/L, bothP>0.05]. (2) In the sepsis and septic shock patients, serum D-lactate level was significantly related to mean arterial blood lactate concentration, APACHE Ⅱ score, and SOFA score in the first 24 hours after admission to ICU (r=0.499, 0.447, 0.469, all P<0.01); serum endotoxin level was correlated with hsCRP, APACHE Ⅱ score, and SOFA score (r=0.224, 0.388, 0.393, all P<0.05). (3) Multivariate linear regression analysis showed that D-lactic acid level was independently associated with average arterial blood lactate concentration as well as with SOFA score(R²=0.34, F=19.91, P<0.01), and endotoxin was independently associated with only SOFA score(R²=0.14, F=12.68, P<0.01).

Regardless of the site of infection, patients with sepsis or septic shock often have intestinal barrier injury, which is correlated with the severity of disease, but does not independently affect patient outcome. Tissue hypoperfusion in the early stage of sepsis may be one of the causes of intestinal barrier injury.

To investigate the efficacy and adverse effects of ifosfamide in combination with pegylated liposomal doxorubicin and dexamethasone (CDD) in treating patients with relapsed/refractory multiple myeloma (MM).

The clinical data of 30 relapsed/refractory MM patients treated with CDD regimen in Department of Hematology and Oncology of Beijing Chaoyang Hospital from November 2012 to November 2015 were retrospectively analyzed. The CDD treatment included ifosfamide 0.5-1.0 g/d on d1-4, pegylated liposomal doxorubicin 40-60 mg/d on d1, and dexamethasone 10-20 mg/d on d1-4. One cycle consisted of 21 or 28 days. Efficacy analysis was performed after every two cycles.

(1)The overall response rate (ORR) was 50.0% and the complete remission and near complete remission (CR+ nCR) rate was 10.0%. (2)The ORR of the 23 patients without extramedullary plasmacytoma(EMP)was 43.5% and the CR+ nCR rate was 8.7%. The ORR of the 7 patients with EMP was 5/7 and the CR+ nCR rate was 1/7. There were no statistically significant differences in ORR and CR+ nCR rate between the two groups (both P>0.05). (3)Except for the 5 patients with disease progression, the median progression-free survival (PFS) of the other 25 patients was 8.0 (3.0-25.0) months. The median PFS of the patients without EMP was 8.5 (3.0-25.0) months, that of the patients with EMP was 6.0 (2.0-21.0) months, with no statistically significant difference (P>0.05). The adverse effects included constipation, infection, hyperglycemia, and hemocytopenia, which were controlled by symptomatic treatment and did not affect the chemotherapy.

CDD regimen can be used for the treatment of relapsed/refractory MM, especially in patients with EMP, with good efficacy and tolerance.

To explore the role and the mechanism of Th17/Treg in obstructive sleep apnea hypopnea syndrome (OSAHS).

A total of 100 patients who completed polysomnography (PSG) in the sleep lab of Affiliated Wujiang Hospital of Nantong University from Mar. 2015 to Apr. 2016 were enrolled and divided into four groups (primary snoring as the control group, mild OSAHS, moderate OSAHS and severe OSAHS) according apnea hypopnea index (AHI). The proportion of Th17, Treg (of CD4⁺ T cells) and the expression of interleukin (IL)-17A, IL-6 were detected and the relevant data were analyzed by the correlation analysis and the multiple stepwise regression analysis.

Compared with the control group, the OSAHS patients had higher Th17% [(1.36±0.46)%, (1.68±0.30)%, (2.23±0.03)% vs (1.02±0.22)%], Th17/Treg [(0.22±0.07), (0.28±0.10), (0.29±0.00) vs (0.13±0.03)], IL-17A [(2.53±0.89), (2.99±1.96), (7.77±1.63) vs (1.45±0.78) ng/L], IL-6 [(6.14±4.37), (9.41±4.66), (12.58±6.65) vs (5.44±3.13) ng/L] and lower Treg% [(7.57±0.16)%, (6.46±1.57)%, (6.10±1.19)% vs (8.02±1.45)%] (allP<0.05). A positive correlation could be seen between Th17%, Th17/Treg, IL-17A, IL-6 and AHI, oxygen desaturation index (ODI) respectively, there was a negative correlation between Th17%, Th17/Treg, IL-17A, IL-6 and the lowest oxygen saturation (SpO₂) (all P<0.05). The proportion of Treg had a negative correlation with AHI or ODI and a positive correlation with the lowest SpO₂ (all P<0.05). The lowest SpO₂ was the most important factor which could influence Th17%, Treg% and the radio of Th17/Treg.

There is an imbalance of Th17/Treg in OSAHS. Therefore, Th17 and the relevant inflammatory cytokines may be involved in the occurrence and development of OSAHS.

To evaluate the value and feasibility of preservation of the left colonic artery (LCA) in laparoscopic anterior resection for rectal cancer.

The clinical data of 97 patiens who received laparoscopic anterior resection of rectal cancer from 2009.3 to 2015.3 were randomly divided into two groups, including 52 cases with preservation of LCA and 45 cases without preservation of LCA. The operation time, quantity of bleeding, number of lymph nodes removed around the root of inferior mesenteric artery (IMA), the rate of lymph node metastasis around the root of IMA, the incidence of transverse colostomy and anastomotic leak were compared between the two groups.

All 97 operations were successfully completed by laparoscopic operation. There were significantly statistical differences in operation time, quantity of bleeding and transverse colon stoma between two groups(P<0.05), but no difference in the number of lymph nodes removed and the rate of lymph node metastasis.

The preservation of the left colonic artery in laparoscopic anterior resection of rectal cancer can preserve more supplying vessels for anastomosis and prevent anastomotic leak.

To explore the clinical efficacy of the modified laparoscopic placement of peritoneal dialysis catheters by nephrologists.

A total of 188 patients diagnosed as end-stage renal disease (ESRD) were enrolled, who received catheter and continuous ambulatory peritoneal dialysis (CAPD) therapy from January 2011 to May 2016 in Zhejiang Provincial People′s Hospital. They were divided into group A (with modified laparoscopic placement of peritoneal dialysis catheters, n=59) and group B (with conventional placement of peritoneal dialysis catheter, n=129). The demographic and clinical characteristics, past abdominal operation history, surgery time, hospital stay after operation, expenses for surgery and hospitalization, early and late complications including bleeding, pain, leakage, peritonitis and catheter displacement were observed.

Patients with previous abdominal surgery accounted for 11.9% in group A and 0 in group B(χ²=15.897, P<0.001). The duration of the operation was (38.9±12.8)min in group A and (64.1±12.7)min in group B(t=-6.466 6, P=0.000 0). The cost of the operation was (5 488.4±156.1) yuan in group A and (1 602.7±48.92) yuan in group B (t=257.129, P=0.000 0). Catheter displacement within one month was observed in 0 and 11.6%(χ²=7.455 3, P=0.003), pain in 15.3% and 41.9% (χ²=12.862 2, P=0.000), and catheter displacement after one month in 0 and in 16.3% (χ²=10.812 4, P=0.000) of the patients, respectively in group A and group B. The incidences of peritonitis within one month and beyond one month, leakage, bleeding and so on showed no difference between the two groups(P>0.05).

Placement of PD catheter with laparoscope is suitable for renal failure patients with abdominal operation history and replacement PD catheter. It also has the advantages of shorter surgery time, less pain and lower incidences of catheter displacement, expanding the application of PD. However, bleeding, leakage, hernia and other complications are frequently seen.

To investigate the effects of ammonium pyrrolidine dithiocarbamate (PDTC) on tubulointerstitial inflammatory molecules and autophagy in diabetic nephropathy (DN) rats.

Twenty-four male Sprague-Dawley rats were assigned to DN group (n=6) and DN+ PDTC group (n=6, PDTC, ip, 100 mg·kg^-1·d^-1), all received streptozotocin (STZ) 60 mg/kg intraperitoneally, and the other 12 rats were randomly divided into control group (n=6) and PDTC group (n=6). At the end of 12 weeks, after serum creatine (Scr) and 24-hour urinary protein were determined, rats were sacrificed to determined the renal pathological damages and the changes of nuclear factor (NF)-κB p65, p62, osteopontin (OPN), microtubule associated protein 1 light chain 3 (LC3)-Ⅱ/LC3-Ⅰ, nuclear p-NF-κB p65 by immunohistological stainning and Western blot, and ultrastructural changes of autophagic process was observed by electron microscopy (EM).

Scr was similar among the four groups (P>0.05). The levels of urinary protein in DN group and DN + PDTC group were significantly higher than the other two groups (allP<0.01), but the level of urinary protein in DN + PDTC group was lower than that of DN group (P<0.05). DN + PDTC group had less tubulointerstitial damage compared with DN group (P<0.05). Among the four groups, expressions of p62, p65, OPN of tubulointerstitial area in DN group were significantly higher than that of the other groups (allP<0.05), and Western blot showed that DN+ PDTC group had less expressions of NF-κB p65, nuclear p-p65, OPN and more expresssion of LC3-Ⅱ/LC3-Ⅰ compared with DN group (allP<0.05), which were consistent with the decreased autophagic vacuoles and increased mitochondria dysfunction revealed by EM. Correlation analysis showed that renal LC3-Ⅱ/LC3-Ⅰ was negatively correlated the expressions of nuclear p-p65 and OPN (r=-0.45, P=0.02; r=-0.50, P=0.01), and p62 was positively correlated the expressions of nuclear p-p65 and OPN (r=0.33, P=0.01; r=0.41, P=0.01).

Tubular NF-κB activation is closely related to autophagy dysfunction in DN rats, and PDTC may enhance autophagy activity in tubule cells by blocking NF-κB activity.

To explore the effect of chronic intermittent hypoxia (CIH) on rats hepatic function, and the protective mechanism of adiponectin (Ad).

Sixty healthy male wistar rats were randomly divided into 4 groups: normal control (NC), NC+ Ad, CIH, and CIH+ Ad groups with 15 rats in each. The rats in CIH and CIH+ Ad groups were exposed to an intermittent hypoxic chamber 8 hours per day for 4 months. Meanwhile, the rats in both the NC and NC + Ad groups were housed with normal pressure air. The rats in the NC+ Ad and CIH+ Ad groups were additionally treated with an intravenous injection of Ad (10 μg), twice a week for 4 months. At the end of experiment, comparison among groups was made about plasma levels of aspartate amino transferase (AST), alanine amino transferase (ALT), degrees of endoplasmic reticulum stress (ERS) and mitochondrium associated cellular apoptosis.

No significant difference was detected in all items between NC and NC+ Ad groups (all P>0.05). Plasma hepatic enzyme levels of AST and ALT were significantly higher in CIH group [(319±21) and (113±9) U/L] than those in NC group [(178±19) and (51±9) U/L] and NC+ Ad group [(175±16) and (52±8) U/L] (allP<0.05). Compared NC with NC+ Ad group, there was more remarkable ERS and mitochondrial injury associated cellular apoptosis in hepatic tissues of CIH group. Such pathological changes were less obvious in CIH+ Ad group than in CIH group (allP<0.05).

CIH can induce hepatic injury in rats, while Ad supplement may play a protective role possibly through inhibition of ERS and associated pathways of cellular apoptosis.

Stress ulcer (SU) is an acute gastric and duodenal mucosal erosion and/or ulcer that occurs in the stress state of the body, such as severe trauma, severe illness or severe psychological disorder, especially in major surgery, shock, extensive burn, intracranial lesions or infection, especially when the liver, lung, kidney and other organs and organs are failed. It can be complicated by gastrointestinal bleeding and perforation, which will worsen the original disease and endanger the life of the patient. It is generally believed that the more serious the primary disease, the higher the incidence of SU^[1]And the more severe the extent. In the case of severe stress such as trauma, shock, severe infection, vital organ failure, acute gastric mucosal erosion and/or ulcer often appear within a few hours to a few days, and the incidence of endoscopy can reach 100%^[2]Therefore, clinically critically ill patients must prevent stress ulcers with drugs.

In the treatment of diabetic patients, hypoglycemia is still a difficult clinical problem and one of the main obstacles to blood sugar control. The American Diabetes Association and the Endocrine Society recommend that diabetic patients should consider the occurrence of hypoglycemia at blood glucose concentrations ≤3.9 mmol/L^[1]。 The body changes caused by hypoglycemia include hypoglycemia symptoms, glucose hormone feedback regulation and cognitive impairment, etc. Among them, hypoglycemia symptoms and hormone feedback regulation occur earlier than cognitive impairment in non-diabetics, and the blood glucose threshold for cognitive impairment is about 2.7~3.1 mmol/L; However, due to repeated hypoglycemia, hypoglycemia symptoms and lower blood sugar threshold regulated by hormone feedback, cognitive impairment in diabetic patients can occur earlier than hypoglycemia symptoms^[2]。 Moreover, hypoglycemia may also lead to behavioral and mood changes. Therefore, deep research on the relationship and mechanism between hypoglycemia and cognitive and behavioral functions in diabetic patients, and early intervention and delay the progression of cognitive and behavioral disorders in patients will help to improve the quality of life of patients, which is also one of the hot research topics at present. This article reviews the research progress of hypoglycemia and impaired cognitive and behavioral functions in diabetic patients.

Helicobacter pylori (Helicobacter pylori, H．pylori) is a spiral, micro-aerobic, gram-negative bacterium parasitic in human gastric mucosa. In 1983, two Australian scholars, Warren and Marsha, first isolated the mucosa from patients with chronic gastritis and duodenal ulcerH.pyloriSince its discovery, it has been a research hotspot in the medical field.H.pyloriAt a time when human infection is extremely common, the Kyoto Consensus hasH.pyloriInfection is defined as an infectious disease that is infected by more than 50% of people worldwideH.pyloriWhere western countriesH.pyloriThe infection rate ranges from 25 to 50 percent, while in developing countries it is even as high as 90 percent^[1]。 Nowadays, numerous studies show that,H.pyloriInfection is closely related to the occurrence and development of some gastrointestinal diseases, including chronic active gastritis, peptic ulcer, gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma (MALT). In 1994, the World Health OrganizationH.pyloriClassified as a class I carcinogen, it is also the only bacterium discovered so far that can cause cancer.H.pyloriThe pathogenic mechanism of infection is very complex, exceptH.pyloriIn addition to its own power device, adhesion characteristics, various virulence factors and host genetic factors causing gastric mucosal injury, there are also relatedH.pyloriThe inflammation caused by infection is related to the immune response. In this paper, the immune cells inH.pyloriThe molecular immunological mechanisms in the pathogenesis of infected gastric mucosa are reviewed.

Community-acquired pneumonia (CAP) is a common lower respiratory tract infection, with an overall mortality rate ranging from 1% to 5%^[1]。 The correct diagnosis and rational treatment of CAP are still the problems that clinicians need to face. Some advances in the diagnosis and treatment of CAP in recent years are summarized as follows.