Volume 97  ·  Issue 16  ·  2017

In the course of more than 30 years of development, 3D printing technology has promoted the development of construction, machinery manufacturing and other fields with huge advantages. With the progress of materials science and medical imaging, 3D printing technology is gradually applied in the medical field, especially in orthopedics and maxillofacial surgery. In recent years, 3D printed heart models have played a unique role in the teaching, technical training, and treatment plan formulation of cardiovascular disciplines. This paper focuses on the application of 3D printing technology in the field of cardiovascular diseases and explores the potential value of this technology.

Since the endocardial pacing electrode has been widely used, due to its obvious advantages over epicardial pacing electrode in electrode performance and inherent trauma to patients, epicardial pacing electrode has been in the substitute position, and it will only be attempted to be applied when the endocardial pacing electrode cannot be implanted. In recent years, the performance of epicardial pacing electrode has been improved obviously, and the development of modern surgical technology also provides a powerful technical guarantee for the application of epicardial pacing electrode. At present, the application of epicardial pacing electrode is increasing day by day, and in some cases it has become the first choice.

On September 12, 2012, the Ministry of Health released the "Report on the Prevention and Treatment of Birth Defects in China (2012)" in Beijing, pointing out that the birth defect rate in China is about 5.6%^[1]。 With the full liberalization of the national two-child policy, the childbearing age of parents has also increased, and the further increase of birth defect rate is also expected. Therefore, strengthening the detection and prevention of birth defects has become the consensus of relevant government departments and practitioners. However, in the past year, various prenatal diagnoses, including non-invasive chromosomal aneuploidy abnormality detection, have been widely carried out in various medical and third-party testing institutions, so that 2016 is called the "first year of genetic testing" in China, which actually brings a series of problems that need the attention of management departments and industries.

Since Professor Carl Langenbuch successfully performed the world's first open cholecystectomy in 1882, iatrogenic bile duct injury has followed. At present, the incidence of bile duct injury fluctuates around 0.1%^[1]。 With the successful first laparoscopic cholecystectomy performed by Professor Philippe Mouret in 1987, the laparoscopic era was opened. Laparoscopic cholecystectomy has been widely carried out and has become the "gold standard" of cholecystectomy today. At the initial stage of laparoscopy, domestic and foreign studies have shown that the incidence of bile duct injury is high, close to 0.5%^[2,3]However, with the gradual maturity of laparoscopic technique, the rate of bile duct injury caused by laparoscopic cholecystectomy decreased, but still maintained at about 0.2%^[4], higher than open cholecystectomy. Wong Chi Keung^[5]Academicians once said that iatrogenic bile duct injury is the pain of hepatobiliary surgery. Because benign bile duct stenosis caused by biliary tract injury can cause obstructive jaundice, recurrent cholangitis, secondary intrahepatic bile duct stones, biliary cirrhosis, portal hypertension, and even end-stage biliary tract disease, and lose the opportunity of surgery^[6]。 This is a problem that general surgeons and even specialists in hepatobiliary surgery cannot avoid. At present, surgical treatment is the main treatment for traumatic bile duct stenosis, but patients with bile duct injury often undergo one or even several operations, which makes the anatomy more complicated, the rate of surgical complications is high, and the prognosis of patients is seriously affected. Therefore, traumatic bile duct stricture is an eternal issue in hepatobiliary surgery^[7]。

Cardiac troponin (cTn) is the most specific and sensitive marker detectable in blood during myocardial tissue injury^[1]Is the best marker for the diagnosis of acute myocardial infarction (AMI) and for risk stratification of heart disease^[1,2,3]。

To investigate the feasibility of trans-catheter closure of multiple atrial septal defects (ASD) monitored by trans-thoracic echocardiography (TTE) under the guidance of 3D printing heart model.

Between April and August 2016, a total of 21 patients (8 male and 13 female) with multiple ASD in Fuwai Hospital of Chinese Academy of Medical Sciences underwent CT scan and 3-dimensional echocardiography for heart disease model produced by 3D printing technique. The best occlusion program was determined through the simulation test on the model. Percutaneous device closure of multiple ASD was performed follow the predetermined program guided by TTE. Clinical follow-up including electrocardiogram and TTE was arranged at 1 month after the procedure.

The trans-catheter procedure was successful in all 21 patients using a single atrial septal occluder. Mild residual shunt was found in 5 patient in the immediate postoperative period, 3 of them were disappeared during postoperative follow-up. There was no death, vascular damage, arrhythmia, device migration, thromboembolism, valvular dysfunction during the follow-up period.

The use of 3D printing heart model provides a useful reference for transcatheter device closure of multiple ASD achieving through ultrasound-guided intervention technique, which appears to be safe and feasible with good outcomes of short-term follow-up.

To explore short-term clinical outcomes and risk factors associated with in-hospital mortality in patients undergoing off-pump coronary artery bypass grafting (OPCABG) and establish a prediction model for in-hospital mortality.

The clinical data of patients undergoing OPCABG in Beijing Anzhen Hospital between January 2014 and January 2016 was retrospectively studied. Univariate analysis and logistic regression were applied to determine the potential risk factors, and then a prediction model for mortality was confirmed. The calibration and discrimination of the prediction model was finally tested.

A total of 2 546 patients who underwent OPCABG were recruited. In-hospital mortality of OPCABG was 0.7% (17 cases). Seven variables: female, age, left main disease >50%, low left ventricular ejection fraction (LVEF), acute myocardial infarction before surgery, operative status (selective or emergent), moderate concomitant mitral valve regurgitation were independently correlated with OPCABG mortality (all P<0.05). The result of Hosmer-Lemeshow test was χ²=5.912, P=0.676. The area under receiver-operating characteristic curve (ROC) was 0.881.

OPCABG is safe and effective for myocardial revascularization in a short term. The following risk factors are associated with an increased operative mortality of OPCABG: male, age, left main disease >50%, low LVEF, acute myocardial infarction before surgery, operative status (selective or emergent), moderate concomitant mitral valve regurgitation. The prediction model established by above-mentioned potential risk factors was proven to perform well by statistical tests.

To compare the efficacy and safety of percutaneous ventricular septal defect (VSD) closure under solely guidance of echocardiography and fluoroscopy.

The retrospective study was conducted at Fuwai Hospital, between February 2014 and February 2015. The patients were divided into two groups. VSD closure was conducted in 42 patients under solely guidance of echocardiography, and 100 patients who were treated with percutaneous catheter closure under fluoroscopy guidance were selected as a control group. The baseline characteristics, procedural time and complications were recorded and assessed.

There were no significant differences in terms of age, gender and pre-operative echocardiographic characteristics (all P>0.05). Percutaneous VSD closure under traditional fluoroscopy guidance was successful in 95 patients (95%). The procedural time was (54.7±12.5) minutes. The symmetrical occluders diameter was (6.9±1.8) mm. Four patients had postoperative residual shunt, one patient developed left bundle branch block, and 6 patients developed new tricuspid regurgitation. Percutaneous VSD closure under only transthoracic echocardiography (TTE) guidance was successful in 39 patients (93%). Because of delivery catheter passage failure through the defect, one case required conversion to perventricular closure via a small transthoracic incision under transesophageal echocardiography (TEE) guidance. The other two cases underwent surgical repair because of residual shunt with more than 2 mm after closure. The procedural time was (40.3±13.2) minutes. The symmetrical occluders diameter was (6.5±1.2) mm. Four patients had postoperative residual shunt that disappeared after 1 month follow-up, and one patient developed right bundle branch block which disappeared 3 days later. During (9.3±3.6) months follow-up, there were no other complications, such as pericardial effusion, occluder malposition, atrioventricular block, aortic valve regurgitation, and aggravating tricuspid regurgitation in each group. However, the total operation time, diameter of VSD occluder, total mild complications, and the equipment cost in the study group were less than that in the control group (P<0.05).

Percutaneous VSD closure can be successfully performed under sole guidance of echocardiography with outcomes similar to those achieved with fluoroscopy guidance.

To summarize the results and clinical application experience of one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery.

From November 2014 to July 2016, 15 patients (9 males and 6 females) with ages ranging from 50 to 73 (63.5±6.2) years requiring cardiac surgery with bradycardia underwent one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery. All operations were performed under general anesthesia with chest median incision approach. Among them, single chamber pacemaker (n=10) and dual chamber pacemaker (n=5) permanent epicardial pacing leads were implanted. Simultaneous procedures included valve replacement in 7 cases, valve replacement combined with atrial fibrillation ablation in 3 cases, coronary artery bypass grafting in 2 cases, aortic root replacement in 2 cases, and valve replacement combined with coronary artery bypass surgery in 1 case. Their parameters of pacemaker including sensitivity, pacing threshold, pacing impedance were measured during surgery and closely followed up at 1 week and 3, 6 months after surgery.

All 15 patients with epicardial permanent pacemaker implantation in the same period of cardiac surgery were successfully cured and discharged, without any surgical complications. A total of 20 epicardial electrodes were implanted for them including 5 right atrial electrodes and 15 right ventricular electrodes. The postoperative follow-up period ranged from 3 to 22 months. No electrode fracture and surgical wound infection occurred in those patients, and their impedance, sensing and stimulation thresholds were all in normal ranges during follow-up.

For patients with bradycardia who required cardiac surgery, one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery is safe and effective, and the results in the short-term and medium-term are satisfactory, avoiding the risk of staged surgery.

To investigate natural killer (NK) cell quantities and function in patients with immune thrombocytopenia (ITP) .

A total of 66 ITP patients (34 newly diagnosed and 32 in complete remission) were collected from September 2015 to May 2016 in Tianjin Medical University General Hospital, and 30 healthy volunteers were recruited as controls. The percentages of NK cells and their subsets in peripheral blood, the expression of activating receptor (NKp44), inhibitory receptor (NKG2A) and CD16, perforin and granzyme β were detected by flow cytometry. The correlation between the above parameters and patients′ immune status and platelet level were evaluated.

(1)The percentage of CD3^-CD56⁺ NK cells in newly diagnosed patients (10.99%±4.89%)and patients in complete remission (9.73%±6.75%) were significantly lower than that in healthy controls (14.67%±7.24%)(P=0.023, 0.003). The percentage of NK cells Bright subset was significantly lower in the newly diagnosed patients(0.48%±0.23%)and those in complete remission (0.41%±0.33%) than in healthy controls(0.64%±0.32%)(P=0.037, 0.002); the percentage of Dim subset was also significantly lower in the newly diagnosed (10.16%±5.02%) and patients in complete remission (8.07%±5.74%) than in healthy controls(14.16%±7.19%) (P=0.009, 0.007). (2)The proportion of Bright subset in total NK cells in new diagnosed ITP patients (6.48%±4.33%) was significantly higher than that in healthy controls (4.21%±2.70%)(P=0.020); the proportion of Dim NK cells subset in new diagnosed ITP patients (93.51%±4.33%) was significantly lower than that in healthy controls(95.79%±2.70%) (P=0.020). (3)The expression of activating receptor NKp44 in new diagnosed ITP patients was significantly lower than that in complete remission group and healthy controls[0.28%(0.95%)vs 0.61%(2.05%), 0.92%(0.90%); P=0.047, 0.048]; the expression of inhibitory receptor NKG2A in new diagnosed ITP patients was significantly higher than that in healthy controls(42.34%±23.86% vs 29.25%±12.83%, P=0.009). The proportion of CD16 was significantly lower in the newly diagnosed patients than in healthy controls(93.51%±4.33%比95.79%±2.70%, P=0.020). (4)The expression of perforin in the newly diagnosed ITP patients was significantly lower than that in healthy controls [87.52%(25.29%)vs 91.55%(8.29%), P=0.025]; the expression of granzyme β in ITP patients and controls showed no statistically significant difference. (5)The level of NK cells in ITP patients was negatively correlated with CD3 ⁺ CD8⁺ T cells (r=-0.387, P=0.012) and CD5⁺ CD19⁺ B cells in peripheral blood (r=-0.273, P=0.028), positively correlated with the ratio of CD3⁺ CD4⁺ /CD3⁺ CD8⁺ (r=0.358, P=0.028) and peripheral platelet count (r=0.314, P=0.011).

Deceased quantities and impaired total NK function, insufficient suppression of autoreactive T and B cells might play a role in the pathogenesis of ITP.

To analyze the clinical features of Kleine-Levin syndrome (KLS) patients.

Clinical data of 44 patients with KLS of the Sleep Center of Peking University People′s Hospital from January 2002 to July 2013 were systematically reviewed. The predisposing factors and clinical presentations were summarized, and compared with the data from a Western KLS study with a large subjects number. Nocturnal polysomnography (PSG) and multiple sleep latency test (MSLT) were conducted during relapse and remission period, respectively. HLA-DQB1*0602 gene were screened and analyzed.

Among the 44 patients, 28(63.6%) were men and 16(36.4%) were women, with a mean age of (18.3±8.9) years old. Most patients developed the symptoms during adolescence. Infection or fever was the most common trigger for episode. The main clinical presentations were 44(100.0%) hypersomnia, 31(70.5%) forgetfulness, 26(59.1%) decreased appetites, 24(54.5%) juvenile behavior, 18(40.9%) depression, etc. Compared with the Western study, it showed that our patients had decreased instead of increased appetite. The PSG testing did not have remarkable findings. MSLT showed mean sleep latency was significantly shorter during relapse than during remission [(10.4±5.4) vs (15.3±3.4) min, P=0.009]. HLA-DQB1*0602 was positive in 12 of 40(30.0%) patients, which was similar to the data in the Chinese population.

KLS has various clinical characteristics. The presentation of appetite may be different between Chinese and western KLS patients.

To analyze the differential gene expression of patients with idiopathic pulmonary fibrosis and pulmonary hypertension (IPF-PH).

The expression profile data of GSE15197 was downloaded from the Gene Expression Omnibus (GEO) database. Bonferroni algorithm was used to identify the differentially expressed genes of pulmonary tissues from IPF-PH, idiopathic pulmonary arterial hypertension (IPAH) and Normal groups. Principal component analysis was used to extract the principal components of three types of samples and differentially expressed genes were obtained. Gene annotation and gene association analysis were used to analyze gene function and related signaling pathways.

Gene expression profiles of pulmonary tissues from IPF-PH, IPAH and Normal groups were compared and analyzed, and 160 differentially expressed genes were found (P<0.05). Nine principal component were found with the cumulative contribution rate of >0.85, and there were 44 significant differences genes with the loading coefficient >80% in principal component one, which was mainly related to the expression of cilium, gamma-glutamyltransferase, and phospholipase. The signaling pathway of differential expression genes were mainly involved in the biosynthesis of leukotriene biosynthetic process and gamma-glutamyltransferase activity.

The differential gene expression and their functional annotation can provide important clues for the pathogenic genes of IPF-PH, and may provide a theoretical basis for exploring potential biomarkers and drug targets.

To analyze the correlation between anatomy of spermatic vessels and varicocele, providing reference for the preoperative assessment and treatment of varicocele.

A total of 156 patients who underwent microsurgical left subinguinal varicocelectomy at Shanghai General Hospital between May 2015 and July 2016 were included in this study. The severity of varicocele and number of spermatic vessels detected in operations were recorded. According to the number of internal spermatic arteries (ISAs), the patients were divided into three groups: single-ISA group (55 cases), double-ISAs group (63 cases) and multi-ISAs group (38 cases), to analyze the correlation among spermatic vessels and to compare varicocele grade, the volume of testes, the parameter of semen analysis, serum reproductive hormone, surgery time, and hospital stay among the three groups.

The number of ISAs was positively correlated with the ipsilateral internal spermatic veins (ISVs) (r=0.210; P=0.008)and lymphatic vessels (r=0.224; P=0.005); the number of lymphatic vessels was positively correlated with the ipsilateral gubernacular veins (r=0.172; P=0.032)and ISVs (r=0.296; P=0.000) . The number of ISVs in the multi-ISAs group (10.58±4.28) was significantly larger than that in the single-ISA group (8.22±3.10, P=0.003). The number of lymphatic vessels in the multi-ISAs group(4.11±1.90)was also significantly larger than that in the double-ISA group(3.76±1.40, P=0.020) and the single-ISA group(3.13±1.52, P=0.007). The number of ISVs in grade 2 varicocele patients (9.74±3.90) was significantly higher than that in grade 3 varicocele patients (8.33±3.10, P=0.013). No significant differences in varicocele grade, change of pre- and post-operative semen analysis, serum reproductive hormone, the volume of ipsilateral testes, surgery time, and hospital stay were observed among the three groups.

There is a correlation among various kinds of spermatic vessels. Patients with grade 2 varicocele, especially who have multiple ISAs, are likely to have more ISVs and lymphatic vessels. For these patients, surgeons should pay more attention to protect spermatic arteries and lymphatics carefully while ligating varicose veins completely to prevent recurrence and complications.

To explore the expression of mismatch repair (MMR) proteins in sporadic colorectal cancer (SCRC) patients, and its association with clinicopathological characteristics of SCRC.

Patients with histologically confirmed colorectal cancer were consecutively recruited between December 2011 and June 2015 at Sun Yat-sen University Cancer Center. The exclusion criteria included multiple primary colorectal tumors, hereditary colorectal cancer (including Lynch syndrome, familial adenomatous polyposis), and the patients without the MMR proteins status tested. A total of 2 684 patients were included. Correlations of MMR proteins status and patients′ demographics (including gender, age), tumor characteristics (site and differentiation) and TNM staging (excluding 315 SCRC patients receiving neoadjuvant therapy) were investigated.

The percentage of deficient MMR (dMMR) in these SCRC patients was 10.2%, and that of proficient MMR (pMMR) was 89.8%. The dMMR was more likely to be detected in younger (≤59 old years) SCRC patients compared to the elderly (>59 years) [12.7%(179/1 406)vs 7.5%(96/1 278),P<0.001]. The dMMR rate in right colon cancer was significantly higher than that in left colon cancer and rectal cancer [22.7%(151/664)vs 7.2%(69/956)vs 5.2%(55/1 064),P<0.001]. Among the various pathological types of SCRC, mucinous adenocarcinoma showed the highest rate of dMMR (24.4%), and neuroendocrine carcinoma the lowest rate of dMMR (0) (P<0.001). In addition, the proportions of dMMR in stage Ⅰ, stage Ⅱ, stage Ⅲ and stage Ⅳ SCRC were 9.7%, 16.5%, 8.5%, and 3.9%, respectively (P<0.001). There is no significant difference in the proportion of dMMR between male and female (11.0% vs 9.1%,P=0.114).

dMMR status may be most likely to exist in younger (≤59 years) patients with stage Ⅱ right colon mucinous adenocarcinoma among SCRC.

To observe the clinical efficacy and the effects on serum inflammatory factors of early use of ulinastatin in patients with moderately severe or severe acute pancreatitis (MSAP/SAP).

This prospective, randomized, controlled trial was conducted in the First Affiliated Hospital of Soochow University from September 2013 to May 2016. A total of 42 cases were enrolled and assigned into either observation group or conventional treatment group (n=21 each). The conventional treatment group received somatostatin, while the observation group received somatostatin combined with ulinastatin. After treatment, clinical characteristics, serum indicators, clinical complications and serum level of inflammatory factors were analyzed.

Intra-abdominal pressure and relief time of abdominal pain were significantly decreased in observation group [ (10.4±2.1) cmH₂O; (2.5±1.2) d ] compared with the conventional treatment group [ (11.7±2.2) cmH₂O; (3.33± 1.2) d ], P<0.05. White blood cells (WBC) were lower in observation group than those in conventional treatment group [ (11.2±1.8) ×10⁹/L vs (12.5±2.3) ×10⁹/L; P<0.05 ]. After treatment serum levels of interleukin-6 (IL-6), IL-8 and tumor necrosis factor-α(TNF-α) in observation group [ (30.5±3.3), (34.7± 6.5), (22.6±4.0) μg/L] were significantly lower than those in conventional treatment group [ (39.6±4.0), (40.9±3.4), (33.1±6.6) μg/L],P<0.05. There were no differences between the two groups in modified CT severity index (MCTSI), recovery time of defecation, ICU length of stay, serum amylase, C-reactive protein (CRP) and incidence rates of clinical complications.

The early use of ulinastatin in the patients with MSAP/SAP can down-regulated the levels of TNF-α, IL-6 and IL-8, reduce the inflammatory response, decrease intra-abdominal pressure and shorten abdominal pain time. It was beneficial and worthy of wider popularization.

To investigate the feasibility and security of robotic resection of tumor in segment Ⅷ primarily.

The clinicopathologic data of 7 patients who underwent robotic resection of tumor in segment Ⅷ using daVinci robotic system in the Department of Hepato-pancreato-biliary Surgical Oncology, Chinese PLA General Hospital from June 2016 to December 2016 were retrospectively analyzed. The lesion size, the tumor malignance degree mean operation time, intraoperative blood loss and the rate of conversion to laparotomy, postoperative hospital stay, mobidity and motality of all the 7 patients were collected.

All the 7 operations were successfully performed with radical resection.The mean tumor diameter was (4.6±1.2)cm. The mean operation time, intraoperative blood loss and postoperative hospital stay were(120.7±21.7)min, (100±106.7)ml, and(7.3±1.8)days respectively.All the patients were discharged successfully with no severe complications.

According to our experiences, as a new operationmodel of minimally invasive surgery, robotic resection of tumor in segment Ⅷ has manyadvantages in laparoscopic like less trauma, less intraoperative bleeding, light postoperative pain, shorter postoperative hospital stay and so on. There are some certain advantages in exposure of Ⅷ segment under robotic surgery system. Robotic surgery system is safe and feasible for tumorresection of segmentⅧ, andhas clinical promoting value and application prospect.

To develop a mouse model of eosinophilic bronchitis, and explore the effects of eosinophil activation on airway hyperresponsiveness.

A total of 60 female specific pathogen free BALB/c female mice were divided randomly into four groups: polymyxin B group, normal saline group, polymyxin B+ N-methionine leucine phenylalanine (fMLP) group, normal saline+ fMLP group. All the groups were given corresponding nasal drops for 21 days. The former two groups were given 12 μl 0.5% polymyxin B or normal saline once a day by transnasal administration respectively. Besides the above, the latter two groups were given 10 μl fMLP (0.05 mg/ml, dissolved in acetic acid) once by transnasal administration 3 hours after polymyxin B or normal saline administration on the 21st day. Within 24 hours after the last transnasal administration, cells in bronchoalveolar lavage fluid (BALF) were collected and analyzed by absolute different cell counts. Airway responsiveness (inspiratory and expiratory airway resistance and lung compliance) to acetyl choline (Ach) were measured 3 hours after the last transnasal administration in the former two groups and 24 hours after the last transnasal administration in the latter two groups. Eosinophil peroxidase (EPX), eosinophil cationic protein (ECP) and eosinophil chemotactic factor (ECF) levels in serum, BALF and lung tissue were tested by emzyme linked immunosorbent assay (ELISA). HE and Chromotrope 2R staining of lung tissue were used to observe the infiltration of inflammatory cells. The morphology of low-density eosinophils was observed under electron microscope.

The total cell counts of BALF in polymyxin B group were significantly higher than the normal saline group [29.50 (3.25)×10⁴/ml vs 15.25 (2.25)×10⁴/ml, P<0.001], especially eosinophil counts [11.76 (6.02)×10⁴/ml vs 0.12 (1.08)×10⁴/ml, P<0.001]. However, no significant differences of inspiratory and expiratory airway resistance and lung compliance existed in the two groups. Inspiratory and expiratory airway resistance in polymyxin B+ fMLP group were significantly higher, lung compliance significantly lower than those in the other three groups (allP<0.001), and the EPX, ECP, ECF levels in serum, BALF and lung tissue of the polymyxin B+ fMLP group were significantly higher than the other three groups (allP<0.001). There were more inflammatory cells, especially eosinophils in lung tissue of polymyxin B and polymyxin B+ fMLP group. Meanwhile, more activated eosinophils in polymyxin B+ fMLP group were observed by electron microscopy.

A mouse model of eosinophilic bronchitis can be successfully developed by transnasal administration of polymyxin B, and the eosinophil activation plays an important role in the occurrence of airway hyperresponsiveness.

To investigate the effects of natural killer group 2 member D (NKG2D) and its ligands major histocompatibility complex class Ⅰ chain-related molecules A(MICA) on DNT cell killing pancreatic carcinoma.

Antibodies adsorption was used to separate DNT cell from human peripheral blood. Human pancreatic tumor models were established via implanting BXPC-3 cells into nude mice, and then mice were randomly divided mice into 3 groups, blank group, gemcitabine group and DNT group. Mice weights and mice tumor volumes were measured every 5 days. After 40 days mice were euthanized at cervical dislocation method. Tumor weights were measured. Relative tumor volume and tumor inhibition rate were calculated. Western blot and qPCR were used to detect the expressions of NKG2D and MICA in the transplanted tumors of the three groups.

The blank group tumor volume and weight of blank group were significantly larger than those of gemcitabine group and DNT group (858.7±35.7 mg, 251.1±19.7 mg, 278.5±17.3 mg, P<0.001), but there were no significantly difference between DNT group and gemcitabine group. The tumor inhibition rate of gemcitabine and DNT cell were 40.4% and 35.5%. Western blot and qPCR showed that MICA mRNA and protein levels in blank group were significantly higher than those in DNT group (P=0.001, P=0.003). NKG2D mRNA and protein levels in blank group were significantly lower than those in DNT cells group (P<0.001,P=0.001).

DNT cell can significantly inhibit the growth of pancreatic carcinoma in vivo, and the mechanism may be involved in abnormal expressions of MICA and NKG2D.

Intraparenchymal breast lymph nodes are extremely rare structures that can occasionally be found in tissue specimens^[1]There are few domestic related literature reports. One case found in our hospital is reported as follows.

Multiple myeloma (MM) is the second largest tumor of the hematological system, accounting for about 10% to 15% of hematological tumors and 1% of all malignancies. MM is characterized by clonal proliferation of plasma cells and is capable of detecting excess immunoglobulins in blood and urine. The main clinical manifestations are "CRAB" symptoms (increased blood calcium, renal impairment, anemia, bone disease). The main treatments include chemotherapy, radiotherapy, stem cell transplantation, and new therapeutic drugs include protease inhibitors and immunomodulators. Bone pain, hypercalcemia, osteoporosis, osteolytic destruction and pathological fractures in patients with MM due to bone destruction are called myeloma bone disease^[1]。 In the Durie-Salmon staging system, bone lesions are directly related to disease staging and risk stratification^[2]。

Sarcoidosis is a non-caseous necrotizing granulomatous disease of unknown etiology that can simultaneously or successively invade multiple systems, involving more than 90% of the lungs and mediastinum^[1]。 Lung cancer is the leading cause of cancer death in developed countries, and the incidence is increasing worldwide. And both diseases sometimes occur in the same individual. Bonifazi et al.^[2]The meta-analysis summary included 27 268 patients with sarcoidosis and 153 patients with lung cancer in 8 cohort studies. It was found that the risk of lung cancer in patients with sarcoidosis varied, and the risk ratio of sarcoidosis combined with lung cancer decreased year by year with increasing follow-up years. However, there is a high degree of heterogeneity between these studies, so the situation of sarcoidosis combined with lung cancer is more complex. The author searched PubMed, CNKI and Wanfang databases, and found 5 case reports of 6 patients with sarcoidosis or sarcoidosis-like reaction combined with lung cancer in China^[3,4,5,6,7]。 The incidence rate of sarcoidosis or sarcoidosis-like reaction combined with lung cancer is not high, and the clinical understanding is insufficient at present, and the mechanism of its occurrence is unknown, so it is easy to miss or misdiagnose. The epidemiology, possible pathogenesis and pathological characteristics, diagnosis, treatment and prognosis of sarcoidosis complicated with lung cancer are summarized as follows.

Each part of the structure of sperm is closely related to its function. The head holds genetic material, while the tail is an important structure responsible for sperm activity. There are many severe asthenozoospermia that originate from ultrastructural abnormalities in the sperm tail. The tail of normal sperm, like the general flagella, has a "9+2" structure consisting of 9 pairs of peripheral double microtubules and 2 central microtubules; However, what is distinguished from other flagella is that the main sperm segment has outer dense fiber (ODF) and fibrous sheath outside the "9+2" structure, such asFigure 1。 During the clinical examination, we found that most of the sperm tails in some special cases were obviously short, curly or even missing. Usually, the sperm motility rate of these patients was extremely low or even close to 0. Ultrastructural observation of them showed that the tail structure such as fibrous sheath was abnormal. Nowadays, we have named this kind of severe sperm motility disorder caused by abnormal assembly of fibrous sheath and axial filament in sperm tail as fibrous sheath dysplasia (dysplasia of the fibrous sheath, DFS). Recent academic opinions suggest that this syndrome should be more accurately called multiple morphological abnormalities of the sperm flagella (MMAF)^[1], but it has not been recognized by domestic experts, and this article still calls it DFS. Ultrastructural caudal abnormalities associated with DFS are presented differently between cases and even in different spermatozoa of the same case, and data on fertilization, pregnancy and birth rates by assisted reproductive technology in DFS patients are also limited^[2]。 Understanding the different kinds of caudal ultrastructural malformations, genetic basis and existing reproductive outcome data in DFS can help to clarify the etiology, correct diagnosis and treatment.