Volume 97  ·  Issue 10  ·  2017

Helicobacter pylori (Helicobacter pylori, H．pylori) treatment is the most clinical concern of clinicians. In the currentH.pyloriThe rate of resistance to commonly used antibiotics is increasingly high, while the eradication rate is decreasing^[1,2], current research focuses on how to improveH.pyloriThe eradication rate of^[3]。 So how to challengeH.pyloriDrug resistance and explorationH.pyloriNew therapeutic pathways^[4], has become a hot research topic focused on at present.

Secondary medical service institution, a literal translation of English Step Down facility, refers to a medical service institution between a hospital and a family, including acute rehabilitation centers, long-term acute hospitals, skilled nursing centers, Assisted living facilities, boarding homes, home with home health care, etc. Its function is to meet the different rehabilitation needs of patients at all levels after discharge from hospital to before returning home. Doing so allows for a more rational use of medical resources and expenses. A 1-day hospitalization fee in an American hospital can be 3 to 4 weeks in a skilled nursing home. As far as the author knows, in China, most of these rehabilitation processes are completed in hospitals. Due to the lack of a secondary medical care system and other reasons, the bed turnover rate of Chinese hospitals is low, and the average hospital stay is 2 to 3 times that of the United States, which is very uneconomical. In order to improve the utilization rate of hospitals and meet the needs of social aging, we should vigorously develop the secondary medical system.

Based on evidence-based medical evidence and the clinical experience of many domestic cardiac critical care experts, the Chinese Expert Committee on Severe Cardiac Sedation and Analgesia formulated the Chinese Expert Consensus on Severe Cardiac Sedation and Analgesia. The recommendation strength of the consensus consists of recommendation level and evidence level. Recommended Level: Class I: Proven and/or unanimously recognized as valid; Class II: There are contradictions or different views on the evidence of usefulness and validity; Class IIA: The relevant evidence and/or opinions tend to be useful and valid; Class Ⅱb: the relevant evidence and/or opinions are not sufficiently demonstrated to be useful and effective; Class III: Proven and/or consistently recognized as useless and ineffective and may be harmful in some cases, not recommended. Level of evidence: Level of evidence A: Data from multiple randomized clinical trials or meta-analyses; Evidence Level B: Data from a single randomized clinical trial or multiple non-randomized trials; Evidence Level C: Expert consensus and/or small trial results. At present, the expert consensus on sedation and analgesia has been formulated for comprehensive severe disease. Severe cardiac disease has its own special features and should be listed separately. Because the clinical application is very different in different medical institutions, this consensus is formulated as a clinical reference.

To investigate the characteristics of the rectal potentially malignant nodules in female by digital rectal examination (DRE).

Retrospectively, we collected the medical information and follow-up of rectal nodules cases diagnosed as benign by DRE during the health check-up in our hospital from Jan 2002 to Dec 2015. All nodules were recorded position, size, shape, hardness and mobility. Statistical analysis was performed to select the potentially malignant cases of postoperative pathological diagnosis and disappeared nodules followed up by DRE.

We followed up 190 cases with 195 nodules finally. Twenty-five cases were potentially malignant, including 14 (56.0%) of polyps, 9 (36.0%) neuroendocrine tumors, and 2 (8.0%) gastrointestinal stromal tumors. The sizes of the nodules were <1.0 cm of 23 (92%) cases, among them 12 (48%) cases were ≤0.5 cm, while 23 nodules (92%) were mobile.There were two cases of potentially malignancy in both groups with enlarged and unchanged modules.There were 69 cases of nodules disappeared during follow-up. The size of these nodules were <1.0 cm, 63(91.3%) cases ≤0.5 cm. while 32 (46.4%) were fixed. The univariate analysis showed that the detection rate of potentially malignant group was higher than that of disappeared group in age ( t=-3.691, P<0.01), size (Z=-3.537, P<0.01) and mobility (χ²=13.315, P=0.001). On multivariate analysis, the risk of potentially malignant increased with age (OR=2.324, P=0.004) and the size (OR=1.537, P=0.003) of the nodules. The risk of fixed small nodules (OR=0.081, P=0.020) was lower than that of the mobile nodules. All the above differences were statistically significant.

The risk of potential malignancy increased with age and the size of the nodule in female. The risk of fixed small nodules, which were regard as malignant, was lower than that of mobile nodules. Potential malignancy should exclude in small, enlarged or unchanged nodules during follow-up.

To evaluate the clinical predictive factors for survival prognosis in patients with locally advanced rectal cancer after neoadjuvant chemoradiotheraphy.

The study included 87 patients with middle and lower locally advanced rectal cancer, who underwent neoadjuvant chemoradiotheraphy followed by radical surgery between April 2007 and May 2015. The clinical factors associated with 3-year disease-free survival (DFS) and overall survival (OS) were analyzed.Kaplan-Meier analysis of disease-free survival and overall survival was performed for all patients.

The 3-year DFS was significantly improved in patients with negative lymph node(95.2% vs 69.5%, χ ²=8.642, P=0.003). The 3-year OS was better in the patients with lower serum level of pre- chemoradiotheraphy carcino-embryonic antigen (CEA)(90.9% vs 66.7%, χ ²=8.820, P=0.003). Cox regression multivariate analysis revealed that serum level of pre-chemoradiotheraphy CEA was an independent predictive factor for 3-year OS(P=0.035).

Serum level of pre- chemoradiotheraphy CEA is an independent risk factor for 3-year OS.

To investigate the effect and molecular mechanisms of LSD1 on proliferation and metastasis of colon cancer.

The influence of down-regulated LSD1 expression on proliferation, invasion and apoptosis of colon cancer cells were detected by transwell invasion assay, cell proliferation assay and apoptosis assay, respectively.

Three independent siRNAs targeting LSD1 (siRNA-1554, siRNA-705, and siRNA-1973) were transfected to SW620 cells to detect gene-silencing efficiency, and the result showed that the knockdown effect of siRNA-705 were better than the other two siRNAs at both mRNA and protein levels. Using siRNA-705 and pargyline (2.5 mmol/L), we performed transwell invasion assay, cell proliferation assay and apoptosis assay in SW620 cell lines, and found the significant suppression of invasion and growth. Cell apoptosis were induced by siRNA and pargyline (P<0.05). Interestingly, up-regulation of E-cadherin and down-regulation of N-cadherin were observed after treated with siRNA-705 and pargyline for 72 hours.

Inhibition of LSD1 could impair proliferation and invasiveness, and induce apoptosis of colon cancer cells in vitro. It leads to up-regulation of E-cadherin and down-regulation of N-cadherin. All of above may play important roles in invasion and metastasis of colon cancer.

To evaluate the methodological quality and impacts on outcomes for systematic reviews (SRs) of accelerated rehabilitation versus traditional control for colorectal surgery.

We comprehensively searched six databases and additional websites to collect SRs, or meta-analysis from inception to July 2016. The Overview Quality Assessment Questionnaire (OQAQ) was applied for quality assessment of the included studies, the tools recommended by the Cochrane Collaboration was applied for quality assessment for RCT and CCT and the Newcastle-Ottawa Scale (NOS) was applied to assess observational study. The relative ratios (RRs) and 95% confidence intervals (CIs) were integrated using Review Manager 5.3 software.

Fourteen meta-analyses were included in total. The mean OQAQ score was 3.8 with 95% CI 3.2 to 4.3. Only three meta-analyses were assessed as good quality. Two studies misused statistical models. A total of 42 primary studies referenced by meta-analyses were included, of which, 25 RCTs were levelled grade B and 1 CCT was levelled grade C. An estimated mean NOS score of 16 observation studies was 6.75 (totally scored 9 with 95% CI 6.4 to 7.1), of which, 10 studies scored ≥7 were high quality, 6 studies scored 6 were moderate quality.

Currently, the overall quality of meta-analyses about comparing the effects and safety between accelerated rehabilitation and traditional control for colorectal surgery is fairly poor and the evidence level is lower. Health providers should apply the evidence with caution in clinical practice.

To investigate the risk factors of pulmonary embolism (PE) in senile and non-senile inpatients, and evaluate the predictive value of Caprini risk assessment model in these two populations.

Case control study design was used in this study. All the PE patients diagnosed in West China Hospital of Sichuan University between January 2012 and December 2014 was included and divided into senile PE group (age ≥65 years old) and non-senile PE group (age <65 years old). Age matched controls (senile control group and non-senile control group) were selected from the patients admitted into the same departments during the same time period as PE patients, at a ratio of 2∶1. The risk factors of PE for senile and non-senile inpatients were investigated through comparing senile or non-senile PE patients with corresponding controls. All the subjects were retrospectively evaluated by Caprini risk assessment model, and the associations between risk stratifications and PE risk were analyzed.

A total of 135 senile PE patients and 212 non-senile PE patients were finally included in this study, with average age of (73.58±6.66) years old and (45.60±13.11) years old, respectively. And 233 age-matched senile controls and 418 non-senile controls were also included. The multivariate analysis showed diabetes (OR=4.08, 95%CI: 1.58-10.51, P=0.004) , heart failure (OR=3.67, 95%CI: 1.10-12.20, P=0.034) , swollen legs (OR=10.50, 95%CI: 5.57-19.79, P<0.001) , severe lung disease (OR=2.05, 95%CI: 1.08-3.90, P=0.028) , patient confined to bed (>72 h) (OR=58.33, 95%CI: 7.46-456.17, P<0.001) were independent risk factors of PE in senile patients, while obesity[body mass index (BMI)≥25 kg/m²](OR=2.72, 95%CI: 1.42-5.24, P=0.003), history of deep venous thrombosis (DVT)/PE (OR=17.54, 95%CI: 2.74-112.19, P=0.002) , hip, pelvis, or leg fracture (OR=18.31, 95%CI: 1.97-170.11, P=0.011) , swollen legs (OR=18.53, 95%CI: 11.29-30.40, P<0.001) , severe lung disease (OR=4.11, 95%CI: 2.41-7.00, P<0.001) , patient confined to bed (>72 h) (OR=4.04, 95%CI: 2.03-8.04, P<0.001) were independent risk factors of PE in non-senile patients. Among the senile patients, the risk of PE increased with the increase of Caprini risk levels; compared with Caprini moderate risk, classifications of high risk and highest risk were associated with 4.64-fold (95%CI: 1.05-20.44, P=0.043) and 10.74-fold (95%CI: 2.46-46.94, P=0.002) increased risk of PE, respectively; within the highest subgroup, the per 2-score increase of Caprini score was associated with 3.02-fold (95%CI: 1.76-5.19, P<0.001) increased risk of PE. Among those non-senile patients, the risk of PE for Caprini low risk and high risk patients was not significantly different, compared with Caprini moderate risk patients; however, the highest risk was still associated with 3.94-fold (95%CI: 2.39-6.51, P<0.001) increased risk of PE compared with moderate risk; within this subgroup, the per 2-score increase of Caprini score was associated with 2.13-fold (95%CI: 1.21-3.73, P=0.008) increased risk of PE.

Swollen legs, severe lung disease, confined to bed (>72 h) are common PE risk factors among both senile and non-senile inpatients. Diabetes, heart failure are unique PE risk factors for senile inpatients, while obesity (BMI≥25 kg/m²), history of DVT/PE, hip, pelvis, or leg fracture are unique PE risk factors for non-senile inpatients. The Caprini risk assessment model has better predictive value in senile patients than non-senile patients, while Caprini highest risk classification is companied by significantly increased risk of PE in both populations.

To investigate potential value of fibrin related markers in patients with femoral fracture during perioperative period.

Ninety-five patients were enrolled, including 39 males with (53±24) years old and 56 females with (73±13) years old, of which 44 fracture on caput femoris, 34 collum femoris and 17 shaft of femur. Sampling on the day before operation and 1^st, 3^rd, 5^th days after operation, fibrin monomer (FM), D-dimer(DD), fibrinogen degradation product (FDP) and other coagulation assays were detected by reagents from Stago. Difference in day-to-day and between surgical sites were analyzed with general linear model (repeated measures).

FDP level on pre-operation, 1^st, 3^rd, 5^th day after operation were 7.88(5.19, 12.12), 15.68(9.84, 29.48), 8.44 (6.27, 12.49) and 10.28 (7.56, 14.00) mg/L, the value of fibrin monomer were 5.00 (5.00, 6.03), 9.89(5.04, 30.12), 5.00 (5.00, 6.04) and 5.02(5.00, 5.76) mg/L. The value of D-Dimer were 2.24(1.41, 3.60), 4.78(2.74, 9.18), 2.60(1.79, 3.88) and 2.91(2.20, 3.85) mg/L, respectively, each parameter changs statistically during observation (Z=4.758, 6.027, 3.238 respectively, P<0.05). On the 5th day after surgery, fibrin monomer in patients with venous thrombus embolism (VTE) were higher than that in patients without VTE, 10.18(7.24, 28.11) mg/L vs 5.10(5.00, 6.73) mg/L (Z=-1.580, P<0.05), which showed potential value evaluating of post-operative VTE. No statistical changes were found in prothrombin time or thrombin time (TT) (P>0.05), but activated partial thromboplastin time (APTT) varied from day to day in (38.1±4.9), (40.8±5.2), (45.1±6.2) and (41.9±6.3)s with statistically difference (F=7.127, P<0.05). Similarly, fibrinogen changed statistically in (5.01±0.94), (4.99±1.35), (6.00±1.75), (5.81±1.38)g/L (F=8.927, P<0.05).

Fibrin monomer, additional to markers as D-dimer, shows its value on activated coagulation associated to post-operative thromboembolism for patients receiving femoral surgery.

To evaluate the cost-effectiveness of octreotide long acting release (LAR) vs lanreotide slow release (SR) for the treatment of postoperative acromegalic patients with elevated levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) in China.

A decision tree model was constructed and the treatment impact was projected for one year in Chinese setting. The clinical efficacy measure used was the percentage of patients achieving normalization (control) of either IGF-1 or GH levels. Efficacy of octreotide LAR and lanreotide SR, incidence of comorbidities, impact of acromegaly on health-related quality of life, and drug-related side effects data were obtained from literature. The cost of medication was collected through a chart review from five hospitals in five cities of China. Clinical experts from these hospitals were requested to complete a questionnaire to document the utilization of medical resources, costs of comorbidities, side effects as well as cost of administration. One-way sensitivity analysis was performed to evaluate the robustness of the results.

Compared to lanreotied SR group, the percentage of patients achieving normalization of IGF-1 and GH levels of octreotide LAR group were 10% and 9% higher, respectively. When either IGF-1 or GH control were used as the efficacy measure, patients in the octreotide LAR group exhibit less comorbidities and need less continued treatment with a second operation and radiotherapy than those in lanreotide SR group. When IGF-1 was used as efficacy measure, octreotide LAR not only achieved better efficacy but resulted in overall cost-saving, with a total cost savings of ￥ 3 792 per patient for one year, which demonstrated that octreotide LAR was a dominant cost-saving strategy. When GH control was used as the efficacy measure, octreotide LAR achieved a better overall clinical efficacy with a slightly higher total costs (￥ 4 121 higher per patient per year). Sensitivity analysis didn′t change the conclusion that octreotide LAR remains dominant over lanreotide SR, indicating the robustness of this model.

Octreotide LAR achieved better overall biochemical control compared with lanreotide SR which result in less comorbidity rate, second operation and radiotherapy as well as related costs.

To explore the mechanism of angiotensin-converting enzyme 2 (ACE2) overexpression improving collagen synthesis in lung.

Lung fibroblasts of mice over-expressing ACE2 and the wild type (WT) were cultured in vitro and divided into 5 groups: WT-control, WT-AngiotensinⅡ (AngⅡ), ACE2^{+ /+} -control, ACE2^{+ /+} -AngⅡ and ACE2^{+ /+} -AngⅡ+ A779. The protein relative expression levels of ACE2, collagen Ⅰ, nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4), nucleotide binding and oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3), autophagy-related protein (Beclin1), ubiquitin-binding protein p62 (P62), microtubule-associated proteins light chain 3-Ⅱ (LC3-Ⅱ) were measured by Western blot and triphosadenine (ATP) level was measured by ATP Assay Kit. Fibroblasts over-expressing ACE2 were pretreated with or without the autophagy inhibitor and were separated into 4 groups: ACE2^{+ /+} -control, ACE2^{+ /+} -AngⅡ, ACE2^{+ /+} -AngⅡ+ 3-MA and ACE2^{+ /+} -3-MA. In vivo, random allocation was used to averagely divide mice into four groups: WT-control, WT-Bleomycin (BLM), ACE2^{+ /+} - control, ACE2^{+ /+} -BLM. Wild type and ACE2 over-expressing mice were instilled with bleomycin endotracheally (3.5 mg/kg) or the same volume saline. All mice were sacrificed after 28 days and the lung tissue were used for HE and Masson staining as well as immunohistochemical staining for NOX4, P62 and LC3.

The vimentin in lung fibroblasts isolated from mice was proved to be positive by both immunohistochemical and immunofluorescence. The ACE2 protein level of lung fibroblasts over-expressing ACE2 was higher than the wild type (0.202±0.062 and 0.067±0.040, P<0.05). The protein levels of collagenⅠ, NOX4 and NLRP3 in WT-AngⅡ group were obviously higher than the WT-control group (0.861±0.129 and 0.417±0.076, 0.432±0.036 and 0.318±0.058, 0.367±0.125 and 0.045±0.012, allP<0.05). The difference of collagenⅠand NLRP3 between ACE2^{+ /+} -AngⅡ group and ACE2^{+ /+} -control group had no statistical significance (all P>0.05). CollagenⅠand NOX4 protein level in ACE2^{+ /+} -AngⅡ+ A779 group were observably higher than ACE2^{+ /+} - AngⅡ group (0.707±0.155 and 0.458±0.108, 0.299±0.038 and 0.149±0.090, all P<0.05). The autophagy related protein levels of Beclin1, P62 and LC3-Ⅱ in ACE2^{+ /+} -control group were distinctly higher than WT-control group (0.834±0.051 and 0.274±0.018, 0.467±0.078 and 0.093±0.025, 0.494±0.065 and 0.150±0.054, all P<0.05). However, these protein levels in ACE2^{+ /+} -AngⅡ+ A779 group were lower than ACE2^{+ /+} -AngⅡ group (1.331±0.203 and 1.565±0.069, 0.298±0.096 and 0.438±0.077, 0.464±0.093 and 0.768±0.071, all P<0.05). ACE2^{+ /+} -AngⅡ+ 3-MA group had higher collagenⅠ (0.383±0.125 and 0.032±0.013, P<0.05) and lower LC3-Ⅱ protein level (1.177±0.140 and 1.387±0.183,P<0.05) than AngⅡ group. In bleomycin induced lung fibrosis in mice, ACE2^{+ /+} -BLM mice exhibited milder lung fibrosis and lower NOX4 protein level but higher LC3-Ⅱprotein level compared with WT-BLM mice.

ACE2 over-expression ameliorated collagen synthesis through enhancing autophagy in lung.

To investigate the effect of low dose erythromycin on the proliferation of granulation tissue after tracheal injury.

Forty-two rabbits were randomly divided into 7 groups (n=6 each), group A (saline control group), group B (penicillin group), group C (low dose erythromycin group), group D (low dose erythromycin and penicillin group), group E (budesonide group), group F (low dose erythromycin and budesonide group), group G (low dose erythromycin, penicillin and budesonide group). All rabbits received tracheotomy, and the tracheal mucosa was scraped with a nylon brush 20 times for tracheal stenosis model. Rabbits were treated with corresponding drugs from a week before operation to 9 days after operation. The serum concentrations of transforming growth factor - beta 1 (TGF-β₁), vascular endothelial growth factor (VEGF), interleukin (IL) -6, IL-8 were determined and the tracheal specimens were harvested for measuring degree of stenosis on the 10th day after operation.

Serum concentrations of TGF-β₁ in group A, B, C, D, E, F and G were (17.6±1.3), (18.2±3.1), (13.0±1.1), (14.0±1.0), (21.0±6.1), (13.6± 3.5), (8.2±1.3) ng/L; VEGF were (88.1±4.1), (85.8±4.3), (58.1±6.3), (56.5±2.4), (87.8±2.8), (57.0±3.7), (34.3±6.7) ng/L; IL-6 were (67.8±4.0), (66.1±3.5), (54.1±4.8), (52.1±3.2), (64.6±4.9), (49.4±4.2), (35.9±3.7) ng/L; IL-8 were (112.8±5.2), (116.6±4.1), (88.0±6.2), (85.5±3.5), (114.4±4.6), (82.6±3.8), (55.9±6.0) ng/L, respectively. The serum concentrations of TGF-β₁, VEGF, IL-6 and IL-8 in group C, D, F and G were significantly lower than those in group A, B and E (all P<0.05). Compared with the other groups, the serum concentrations in group G were the lowest (allP<0.05). All 42 rabbits had tracheal stenosis with different degrees of proliferation of granulation tissue. The degree of tracheal stenosis in Group A, B, C, D, E, F and G were (53.3±4.4)%, (48.2±5.0)%, (24.3±4.4)%, (29.5±3.2)%, (47.8±6.5)%, (27.9±3.1)%, (15.6±2.0)%, respectively. The degree of tracheal stenosis in group C, D, F and G was significantly lower than that in group A, B and E, which had statistical differences (allP<0.05). Compared with the other groups, the degree of tracheal stenosis in group G was the lowest (allP<0.05).

Low dose of erythromycin can effectively inhibit the proliferation of granulation tissue after tracheal injury in rabbits. And it has better effectiveness when combined with other antibiotics and hormone.

Diffuse lung disease (DLD) has always been a large class of difficult diseases in respiratory department. It can be diagnosed clinically by combining clinical manifestations, imaging and other auxiliary examinations, and a small part of it can be diagnosed clearly by bronchoalveolar lavage. However, it is generally necessary to confirm the diagnosis by histopathological examination. Although surgical lung biopsy (SLB) has a high diagnostic rate, it is rarely used in practice because of large trauma and high cost. However, traditional transbronchial clamp biopsy (TBFB) and percutaneous lung biopsy are often difficult to obtain exact pathological diagnosis because of the small tissue mass obtained. At the end of 2015, we took the lead in carrying out transbronchial frozen lung biopsy (TBCB) under rigid bronchoscope (abbreviated as rigid bronchoscope) to diagnose diffuse lung disease and interstitial lung disease in China, and achieved good results^[1]。 However, the requirements of hard lens technology are high, and there are not many units that can develop hard lens technology in China, which limits the popularization and application of TBCB technology. In order to solve this problem, we improved the TBCB technology in combination with the literature, so that it can be completed in the conventional bronchoscopy room only under a soft bronchoscope (referred to as soft bronchoscope for short) without the need of hard lens, and achieved the same satisfactory effect as the operation under hard lens in the operating room, effectively solving the problem of popularization and application of TBCB, which is reported below.

A 35-year-old male was admitted to the Department of Gastroenterology of Bozhou People's Hospital on March 20, 2014 due to "upper abdominal discomfort with yellow urine staining for 1 week". After excluding hepatitis, autoimmune hepatitis and acute pancreatitis, he was transferred to the Department of Endocrinology on March 23, 2014. One week before admission, the patient experienced nausea, upper abdominal discomfort, and obvious yellowing of urine. He went to the gastroenterology department of our hospital and checked his liver function: total bilirubin (TBIL) 120.7 μ mol/L (normal reference value: 3.0~25.0 μ mol/L), direct bilirubin (DBIL) 73.4 μ mol/L (normal reference value: 0~8.0 μ mol/L), alanine aminotransferase (ALT) 466 U/L (normal reference value: 3~40 U/L), aspartate aminotransferase (AST) 316 U/L (normal reference value: 4~40 U/L), alkaline phosphatase (ALP) 256 U/L (normal reference value: 15~150 U/L). He was diagnosed with abnormal liver function and admitted to gastroenterology. Blood test routine: white blood cells 3.83×10⁹/L, neutrophils 1.58×10⁹/L, platelets 133×10⁹/L, kidney function, blood glucose, stool routine, virus four items [hepatitis B virus surface antigen (HBsAg), hepatitis C virus antibody (anti-HCV), human immunodeficiency virus antibody (anti-HIV), Treponema pallidum antibody (anti-TP)], hepatitis screening (hepatitis A, D, E, G virus antibody), autoimmune hepatitis antibody were not abnormal, upper abdominal CT: high gallbladder density, full pancreas, pancreatitis was not excluded. Treatments such as protecting liver, lowering enzymes and raising white blood cells are given. Check thyroid function: free triiodothyronine (FT₃)>30.80 pmol/L (normal reference value: 2.70-6.15 pmol/L), free thyroxine (FT₄)>154.8 pmol/L (normal reference value: 10.45-24.38 pmol/L), total triiodothyronine (TT₃)>12.32 nmol/L (0.99-2.88 nmol/L), total thyroxine (TT₄)>387.0 nmol/L (55.47-171.60 nmol/L), and thyroid stimulating hormone (TSH) 0.015 μ mol/L (normal reference value: 0.38-4.34 μ mol/L). Hematuria amylase was re-examined many times, and pancreatitis was excluded and transferred to the endocrinology department. Follow-up medical history: Three months before admission, the patient had no obvious triggers for feeling fearful of heat, hyperhidrosis, palpitation, irritability, eating more and hunger, and increased frequency of stool, 5-6 times/d. It was soft stool, no pus and blood, and tenesmus was heavy, and the weight lost nearly 20 kg in a short period of time, accompanied by obvious fatigue. Deny recent use of drugs that impair liver function. Past history, personal history, marriage and childbirth history, and family history are not special.

A 71-year-old male was seen for "left lower limb weakness for half a month". Three years ago, he underwent stent placement due to left superficial femoral artery (SFA) occlusion, and recovered well after operation. The patient developed left lower limb weakness without inducement. The left SFA color Doppler ultrasound showed that the stent was occluded, which was considered as in-stent restenosis. The patient underwent SilverHawk plaque rotation treatment. First, left SFA angiography showed left SFA and stent occlusion (FIG. 1A，FIG. 1B), the distal segment of SFA was developed through the collateral circulation, and the guidewire smoothly passed through the stent and entered the distal end of SFA (Figure 1C), rotating the DSA tube to confirm that the guidewire is inside the stent; Then, the stent was repeatedly rotated with the SilverHawk plaque rotating system, and the intrastent plaque rotated smoothly during the operation. After withdrawing from the SilverHawk plaque rotating system, the angiography showed severe stenosis at the upper end of the stent (Figure 1D), and then use a balloon to dilate the stenosis site (FIG. 2A), and severe stenosis of the upper end of the stent was still seen on re-angiography (Figure 2B), the magnification of fluoroscopy shows that the upper end of the stent is seriously damaged, the metal wire of the stent collapses, and accumulates in the shape of a "bird's nest" (Figure 2C，Figure 2D), considering that the stent was damaged during SilverHawk plaque rotation, it was decided to place a covered stent for treatment. However, after balloon expansion, the covered stent delivery system could not pass through the damaged site of the stent at all, considering that it was related to the "bird's nest"-like accumulation of damaged metal wires, so the covered stent treatment was abandoned. Because of the good collateral circulation between the deep femoral artery and the lower SFA, the ischemic symptom of the patient's left lower limb was not serious, so the operation was terminated. After 1 month of follow-up, the patient still had left lower limb weakness, but there was no obvious sign of ischemia.

Skeletal muscle has always been regarded as the main motor organ of human body and the main place of glucose and lipid metabolism. It is an important target organ of nervous system and endocrine system. However, in recent years, skeletal muscle as an endocrine organ has attracted more and more attention. genome-scale of metabolic network model (GSMM) analysis shows that liver is the most metabolically active organ in human body, followed by fat and skeletal muscle, and there are a large number of proteins derived from skeletal muscle in the circulation^[1]。 Recent studies have shown that skeletal muscle can produce a large number of secreted proteins, which function through autocrine, paracrine and endocrine forms, and are crucial in the regulation of various physiological and pathophysiological functions. Cytokines or peptides produced by skeletal muscle cells, subsequently released into the blood circulation, and then exert endocrine or paracrine effects in other cells, tissues or organs are named myokines^[2]。 They not only act on the sugar, fat and protein metabolism of skeletal muscle itself, but also act as messengers for dialogue between skeletal muscle and liver, fat, heart and brain, regulating the overall metabolic status.

inflammatory bowel disease (IBD) is a chronic non-specific inflammatory disease of the intestine, mainly including Crohn's disease (CD) and ulcerative colitis (UC). At present, tumor necrosis factor alpha (TNF-α) is considered to be the most important pro-inflammatory factor in the development of IBD. There are mainly two subtypes: membrane-bound tumor necrosis factor alpha (mTNF-α) and soluble tumor necrosis factor alpha (sTNF-α) released by proteolysis of transmembrane type. Its mRNA and/or protein are expressed in the blood of IBD patients^[1]intestinal mucosa^[2]feces^[3]With intestinal tissue culture fluid^[4]Both were adjusted upward. infliximab (IFX) neutralizes sTNF-α and mTNF-α and prevents the induction of function in TNF-α receptor (TNFR) expressing cells, including T cell activation and proliferation, cytokine and chemokine production by monocytes-macrophages, cell recruitment, angiogenesis and extracellular matrix degradation^[5]。 It has been reported that serum IFX concentration is positively correlated with clinical response in patients with IBD^[6,7,8]IFX concentration in gastrointestinal mucosa was significantly correlated with serum levels^[9]And even considered the intestinal tissue IFX concentration to be part of the blood drug concentration. So, for IBD induction remission therapy, which is more important for histological remission: IFX concentration in blood or IFX concentration in intestinal tissue? For patients with obvious diarrhea, if IFX is lost with feces, will it affect the intestinal tissue concentration or even its efficacy? This article will elaborate on this.

Standardized and unified medical science and technology terms are the basis of medical science and technology information exchange. Medical terms are not standardized and united, which directly affects the accurate expression, collection, use and transmission of medical scientific and technological achievements^[1]。