Volume 97  ·  Issue 22  ·  2017

Benign prostatic hyperplasia (BPH) is a common and frequently occurring disease in elderly men with progressive dysuria as the main clinical feature. The clinical symptoms of BPH are mainly frequent urination, urgency, urinary incontinence, etc., collectively referred to as lower urinary tract symptoms (LUTS). As we all know, the normal urination of men is coordinated by the contraction of the bladder detrusor and the opening of the sphincter of the prostate. Unfortunately, the surgical determination of prostatic hyperplasia has been mainly based on the size of the prostate and symptoms such as LUTS for a long time, and the assessment of bladder function damage caused by BPH has been ignored, or the assessment of bladder function has not been taken into account in the surgical determination. According to statistics, at least 50% of middle-aged and elderly men over 50 years old suffer from BPH, which significantly reduces their quality of life^[1]。 Since the 1990s, alpha adrenergic receptor blockers have been used as the first-line treatment for LUTS secondary to BPH. Today, despite the rapid changes in drugs, surgical treatment of benign prostatic hyperplasia is a better choice when patients voluntarily require or due to poor drug treatment effect, intractable urinary retention, urinary tract obstruction, etc. Moreover, clinical statistical studies have shown that surgical treatment of prostatic hyperplasia is less expensive than drug treatment^[2]。

To systematically evaluate the quality of clinical practice guidelines for the diagnosis and treatment of benign prostatic hyperplasia (BPH), and to compare the context of recommendations in order to provide references for clinical application.

We searched databases such as the National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN) and World Health Organization (WHO), PubMed, Embase, CNKI, VIP, WanFang Data, CBM, and Medlive from their establishment until August 13, 2016, to collect evidence-based guidelines and/or consensus on BPH.

Methodological quality of included guidelines was assessed according to the AGREE Ⅱ instrument, and differences and similarities among recommendations were compared.

A total of 15 guidelines were included. According to the AGREE Ⅱ instrument, the score of scope and purpose, stakeholder involvement, rigour of formulate, clarity of presentation, applicability, and editorial independence was 72%, 38%, 30%, 58%, 16%, and 40%, respectively. The recommendations of different guidelines were basically similar, only with conflicts in some areas.

The quality of included guidelines remains to be unified, the context of them can provide valuable implications for development or improvement.

To determine the best timing of discontinuance of intermittent endocrine therapy for prostate cancer (PCa).

From February 2012 to September 2014, 120 PCa patients confirmed by biopsy at the Department of Urology Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, were included. They were divided into high-, moderate- and low-risk groups according to EAU Guidelines in 2015. All patients received intermittent endocrine therapy. When the serum level of prostate-specific antigen (PSA) dropped to 0.2 μg/L, the medication was not discontinued until 3 months later for the observation group; however, the medication was immediately discontinued after reaching the above-mentioned threshold for the control group. When the PSA level during the period of medication discontinuance increased to 4 μg/L, another course of intermittent endocrine therapy was administered until the occurrence of the failure event. The Cox proportional regression model was used to compare the difference between the two groups in the androgen-independent signs, progression of PCa and severe adverse events.

After correction for multiple confounding factors, including severity grading before treatment, average duration of medication, average duration of medication discontinuance and the number of courses of therapy, it was found that the medication scheme adopted in the observation group was a protective factor against androgen-independent signs in the high-risk PCa patients (HR: 0.535, 95% CI: 0.458-0.612; P<0.001); it was also a protective factor against disease progression for the high- and moderate-risk patients (high-risk group,HR: 0.387, 95% CI: 0.297-0.477; P<0.001; moderate-risk group,HR: 0.697, 95% CI: 0.581-0.813; P<0.001). However, there was no significant difference in the incidence of severe adverse events among PCa patients treated by different medication schemes (HR: 1.003, 95% CI: 0.906-1.100; P=0.798). The medication scheme adopted in the observation group was an independent risk factor for severe adverse events in the low-risk PCa patients (HR: 1.489, 95% CI: 1.305-1.673; P<0.001).

As compared with the scheme of immediately discontinuing the medication after reaching the indicator threshold, maintenance medication for another 3 months was beneficial for the high- and moderate-risk PCa cases. The maintenance medication could reduce the androgen-independent signs and disease progression, without increasing the risk of severe adverse events. However, for the low-risk patients, there was no major difference between the two medication schemes, immediate discontinuance and maintenance medication for another 3 months. Instead, further medication may bring about a higher risk of severe adverse events.

To systematically compare the differences in the detection rate of prostate cancer with fusion targeting biopsy and systemic biopsy.

A computer-based search of PubMed, Medline, China Biomedical Literature Database and Wanfang database (from the beginning of establishment of library to October 2016) on the detection rate of prostate cancer by fusion targeting biopsy and systemic biopsy was performed manually.The inclusion and exclusion criteria were formulated by 2 reviewers, and the data were extracted and evaluated respectively. RevMan5.3 software was used to analyze the detection rate of prostate cancer by two biopsy methods.

A total of 15 related clinical studies were included, 5 337 cases were enrolled in the study, including 2 667 cases of targeted fusion biopsy and 2 670 cases of routine systemic biopsy. The results showed that the overall detection rate of prostate cancer in targeting fusion biopsy was significantly higher than that of conventional systemic biopsy (OR=1.16, 95% CI 1.04-1.30, P=0.007). The detection rates of prostate cancer with different risk grades by two biopsy methods were conducted. We found that targeted fusion biopsy had a significant advantage compared with conventional system biopsy (OR=1.37, 95% CI 1.19-1.58, P<0.05) in middle and high risk prostate cancer with Gleason ≥ 7 points. In low-risk prostate cancer patients with Gleason score <7, the detection rate of prostate cancer by targeted fusion biopsy was lower (OR=0.76, 95% CI 0.65-0.89, P<0.05) than that of conventional systemic biopsy.

Targeted fusion biopsy was significantly better than systemic biopsy in the overall detection rate of prostate cancer and the detection rate of the middle and high risk prostate cancer with Gleason ≥7 points. However, systemic biopsy performed better in patients with Gleason<7 points of low-risk prostate cancer.

To investigate current status and problems of anticoagulant proteins assay in domestic laboratories so as to provide suggestions for implementing the standardization and quality improvement.

Two hundred and seventy-four laboratories those had developed or prepared to do anticoagulant proteins assay were selected from one thousand and five hundred participants in the national coagulation screening External Quality Assessment(EQA) program by an internet survey and then a questionnaire and quality control materials were sent to them to carry out a further survey. The questionnaire information was analyzed statistically. The results of quality control materials were grouped by the reagents and the average, median, standard deviation(s), coefficient variation(CV) of each group were calculated. The deviations or percentage deviations were determined by comparing the results of each laboratory to the target defined as the peer-group median after exclusion of outliers, and then the pass rates were calculated based on the criterion of RCPA, DGKL and the allowable total error based on biological variation.

Two hundred and thirty-five questionnaires were collected. The number of laboratories testing antithrombin(AT), protein C(PC) and protein S(PS) activity were 194, 63 and 50 respectively. The instruments and reagents were mainly from abroad (more than 96%), the matching rate of which were above 94%. For AT, PC and PS activity testing, there were 30.4%, 33.3%, 34.0% of laboratories did not perform verification assays respectively, and 8.8%, 7.9%, 14.0% of laboratories did not renew calibration curve when the reagent lots were changed. 11.3%, 17.5%, 16.0% of laboratories didn′t run internal quality control, and 34.9%, 26.9%, 21.4% of laboratories only performed a single level of quality control. 4.1% of laboratories set the reference intervals of AT activity according to different age groups, and the percentage of that of PC and PS activity were 1.6% and 2.0%. 16.0% of laboratories set the reference interval of PS activity by sex. For normal control materials, the CV of AT, PC and PS activity results were 5.7%-12.9%, 4.2%-7.7% and 18.4%-33.1% while the CV for abnormal level were 13.3%-38.3%, 6.1%-14.4% and 31.5%-34.5% respectively. The pass rate was different when it was judged by different criteria. A suitable criterion for each item should be selected according to the concentration level of quality control materials.

The comparability between laboratory results are not satisfactory and in order to promote quality improvement, it is necessary to develop guidelines, organize trainings and establish a national EQA scheme.

To compare the mortality, survival rate and the therapeutic efficacy between mitral valve repair and replacement as treatment for severe ischemic mitral regurgitation (IMR), and explore the middle- and long-term outcomes.

Between January 2000 and January 2016, 378 patients with severe IMR underwent coronary artery bypass grafting (CABG) combined with mitral valve repair (n=162) or mitral valve replacement (n=216) in the Department of Cardiovascular Surgery of Nanjing First Hospital. Clinical data, in-hospital morbidity and mortality of patients were retrospectively reviewed. The patients were followed up for the long term survival rate, heart function and re-admission.

No statistically significant differences of baseline data and operation details were found between the two groups except for left ventricular end-diastolic diameter[(61.3±10.2)mm in replacement group vs (56.2±9.0)mm in repair group, P<0.001]. Seven patients died during the perioperative period, with a total operation mortality of 1.9%.No significant difference of mortality was found between the two groups (5 cases in the replacement group and 2 cases in the repair group). The early outcome after the surgery showed that the rate of low cardiac output and ventricular arrhythmia of patients were significantly higher in the replacement group compared with the repair group (bothP<0.05). The mortality of patients received mitral valve replacement was better than who received mitral valve repair when left ventricular end-diastolic diameter was over 65 mm (5.9% vs 10.0%,P=0.036). No significant differences were observed between the two groups in the middle- and -long term survival rate (87% for replacement group vs 85% for repair group, P=0.568). The follow-up time was 1-85 (52.8±21.5) months and the follow-up rate was 93%. The rate of valve-related complications was significantly higher in the repair group compared with the replacement group (8.82% vs 3.82%, P=0.003).

We should choose the surgical methods carefully (replacement or repair) for severe IMR patients according to degree of left ventricular remodeling and pathological changes of mitral valve. Mitral valve replacement with preservation of the subvalvular apparatus is a safe and effective surgical alternative for mitral valve repair, especially for patients with complications or complex reflux.

To investigate the long-term outcomes of off-pump coronary artery bypass grafting (OPCABG).

Clinical data of 1 129 consecutive patients ( 937 males and 192 females) with coronary artery disease receiving OPCABG at Department of Cardiovascular Surgery, Chinese PLA General Hospital between January 2000 and December 2015 was retrospectively analyzed.The age of patients ranged from 29 to 83 years, with a mean age of (62.0±9.6) years. The follow-up data of the patients, including the graft patency and repeated revascularization rate, were analyzed.

Of the 1 129 patients analyzed, 1 059 cases (93.8%) were available for follow-up for 29-192 months[with a mean time of (95.6±34.1) months]. The 5-year, 10-year, 15-year and 16-year graft patency rate of arterial graft was 96.1%, 95.4%, 93.7% and 93.2%, respectively. The 5-year, 10-year, 15-year and 16-year graft patency rate of venous graft was 92.8%, 81.4%, 70.9% and 68.3%, respectively. During the follow-up, 69 (6.11%) patients underwent repeated revascularization procedures.

OPCABG is safe and effective with a good long-term graft patency rate.

To explore the role of the segmental lymph node dissection in the pathologic staging of non-small cell lung cancer.

A total of 370 consecutive non-small cell lung cancer patients who underwent radical resection between August 2008 and July 2016 were retrospectively reviewed. All the operations were performed by the same group of surgeons. The relationship of the segmental lymph nodes with pathological stages after radical resection was analyzed in order to explore the role of the lymph node dissection in the pathologic staging of non-small cell lung cancer (using the 7th edition of the American Joint Committee on Cancer and Union for International Cancer Control TNM classification for lung cancer ).

The detection rates of hilar nodes, interlobar nodes, lobar nodes and segmental nodes were 69.7%, 86.8%, 84.0%, 67.0%, respectively. The metastasis rates of hilar nodes, interlobar nodes, lobar nodes and segmental nodes were 6.5%, 10.8%, 15.7% and 10.3%, respectively. There were 238 cases of N0 disease, 62 cases of N1 disease, 69 cases of N2 disease and 1 case of N3 disease. If the analysis of segmental lymph nodes had been omitted, 16 patients (25.8% of N1 disease) would have been down-staged to N0, and 5 cases of multiple-station N1 disease would have been misdiagnosed as single-station N1 disease, 2 patients would have been misdiagnosed as N2 disease with skip metastases.

Segmental nodes play an important role in the accurate staging of non-small cell lung cancer.

To investigate the influence of different anesthetic techniques on the prognosis of hepatocellular carcinoma (HCC)after hepatectomy.

A total of 185 consecutive patients with HCC confirmed underwent surgery in Cancer Hospital, Chinese Academy of Medical Sciences were recruited from January 2006 to January 2008. The patients were assessed as American Society of Anesthesiologists (ASA)Ⅰ-Ⅲ, with body mass index (BMI) (22.8±4.6)kg/m². There were 169 males, with an average age of 56 years old and 16 females, with an average age of 53 years old. According to the different anesthesia methods, 185 patients were divided into two groups: total intravenous anesthesia group (TIVA) (n=53) and intravenous-inhalation combined anesthesia group (n=132). Postoperative pain and adverse reactions were compared in recent follow-up, prognosis were compared in long-term follow-up.

Recent follow-up showed that the NRS scores 2 hours after operation in TIVA group was 2.0 (0-2.0), whereas those in intravenous-inhalation combined anesthesia group was 3.0 (1.0-3.0). The pain in TIVA groups was significantly lower than that in intravenous-inhalation combined anesthesia group (Z=-3.261, P=0.001). But for 24 hours after operation, the NRS scores in these two groups were 3.0 (2.0-5.0) and 3.0 (3.0-4.0), respectively. There was no significant difference in the two groups (Z=-0.035, P=0.972). In addition, there was no significant difference between the two groups in the incidence of sedation, nausea/vomiting, restlessness and other adverse reactions (all P>0.05). Long-term follow-up indicated that anesthetic techniques have no correlation with HCC prognosis in Kaplan-Meier analysis and Cox′s regression analysis.

There is no significant effect of two anesthesia methods on the long-term prognosis of HCC.

To investigate risk factors of rupture of internal carotid artery resection during carotid body tumor resection and to summarize our treatment experience.

During the period from 1991 to 2016, rupture of internal carotid artery occurred in 27 patients (28 tumors) during surgical resection of carotid body tumor in the First Affiliated Hospital of Sun Yat-sen University. Their clinical and follow-up data were retrospectively collected and analyzed. For all patients underwent surgical resection during this period, Logistic regression analysis was used to investigate the risk factors of intraoperative rupture of internal carotid artery.

Of these 28 tumors, there were 15 (53.6%) tumors with diameter≥5 cm and 20 (71.4%) Shamblin Ⅲ tumors. Intraoperatively, shunt was applied for 8 (28.6%) cases. Thirteen (46.4%) patients underwent ligation of external carotid artery, while 2 (7.1%) patients accepted resection of cranial nerves. Direct closure/patchplasty, autologous vessels or graft reconstruction was used in 16, 10 and 2 cases, respectively. Postoperatively, stroke occurred in 4(14.3%) cases and cranial nerve deficit in 15 (53.6%) cases. During a median length of 36 (14-125) months, cranial nerve deficit persisted in 5 cases. Follow-up radiologic examination indicated 3 (10.7%) cases of targeted vessel occlusion. However, no new-onset stroke was identified. Among all patients underwent surgical resection of carotid body tumor, female (OR=3.650, P=0.012), age≤25 years old (OR=3.710, P=0.013) and Shamblin Ⅲ tumor (OR=4.631, P=0.008) increase the risks of intraoperative carotid artery rupture.

Shamblin Ⅲ tumor is the predictor of rupture of internal carotid artery. Intraoperative, properly increased blood pressure, intraoperative heparinization and use of shunt for those cases without well-compensated cranial collateral arteries are likely to decreasing the incidence of stroke.

To evaluate the value of radial and ulnar arteries hemodynamic changes by ultrasound in patients with primary palmar hyperhidrosis after thoracic sympathetic block.

This was a prospective study, from January 2016 to September 2016, 23 patients with primary palmar hyperhidrosis were admitted to the First Hospital of Jiaxing City, Zhejiang Province, 92 arteries of these patients who underwent thoracic sympathetic block were enrolled into this study. Diameters, peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) of the radial and ulnar arteries were examined one day before and after the operation by color Doppler ultrasound. Spectral waveforms of these arteries were observed, and palms temperature (T), oxygen saturation (SpO₂), perfusion index (PI) were also measured. Diameters, PSV, EDV, RI, T, SpO₂ and PI of the patients with PH were compared before and after the surgery. The effect of operation was also evaluated.

Before surgery, diameters and EDV of the radial and ulnar arteries of the patients with PH were(2.12±0.36) mm, (1.50±0.32) mm, (4.90±1.84) cm/s, (4.71±1.65) cm/s, respectively, after surgery, the diameter of the RA, UA and EDV were (2.45±0.54) mm, (1.87±0.44) mm, (9.37±1.69) cm/s and (9.12±1.54) cm/s, which were significantly increased.Before surgery, RI of the RA and UA of the patients were (0.85±0.05), (0.97±0.07) , respectively, after surgery, RI of the RA and UA were (0.57±0.04), (0.64±0.09), respectively, which were significantly decreased after surgery. The difference was statistically significant (t=-5.23, -2.33, -19.80, -14.68, 3.31, 3.48, all P<0.01). Before surgery, PSV of the RA and UA of the patients were (46.38±15.12) cm/s, (45.60±14.88) cm/s , respectively, after surgery, PSV of the RA and UA were (46.93±16.02) cm/s, (46.19±15.30) cm/s , respectively. The difference was not statistically significant (t=-0.23, -1.39, all P>0.05). Before surgery, T, SpO₂ and PI of the patients were(29.7±1.04) ℃, (93.24±2.23) %, (1.11±0.13) % , respectively, after surgery, T, SpO₂ and PI of the patients were (35.09±1.21) ℃, (98.10±1.34) %, (4.77±1.22)% , respectively. The difference was statistically significant (t=-20.174, -1.140, -23.601, all P<0.05). The symptoms of hyperhidrosis of the patients were disappeared immediately after the surgery in both hands. All of the patients were cured within 3 months and there was no severe complications.

Thoracic sympathetic block increase Diameters and EDV but decrease RI of the radial and ulnar arteries of the patients with PH and increase the palms temperature. Artery diameters, EDV, and RI measured by ultrasound can be used as parameters to evaluate the effect of thoracic sympathetic block in patients with PH. It′s objective, non-invasive and convenient.

To evaluate the efficacy of clindamycin-primaquine as the salvage treatment for pneumocystis pneumonia (PCP) in non-HIV-infected patients.

Clinical data of non-HIV-infected patients with PCP who were treated with clindamycin-primaquine as the salvage treatment in Peking University First Hospital from Jan 2010 to May 2016 were collected and reviewed in this retrospective study. Clinical outcomes were analyzed to evaluate the efficacy of clindamycin-primaquine as a salvage treatment.

A total of 19 non-HIV-infected patients with PCP were included. The average age was 44.6±16.1 years old. All patients had a history of glucocorticoids usage, and presented with fever, nonproductive cough and progressive dyspnea. The diagnoses were confirmed by positive methenamine silver staining in the induced sputum or bronchoalveolar lavage fluid. The reasons for the change of treatment were either failure of the first line therapy (13 cases) or severe adverse effects of the original treatment (6 cases). Ten patients were cured with the salvage treatment, while nine patients died. Four of thirteen patients who were switched due to treatment failure responded to clindamycin-primaquine treatment, while all the 6 patients who switched the treatment due to the severe adverse effects of trimethoprim-sulfamethoxazole were cured, the difference was statistically significant (P=0.011). Adverse reactions occurred in 3 cases, all of which were methemoglobinemia.

In non-HIV-infected patients with PCP who have failed or can not tolerate the first-line therapy, clindamycin-primaquine may still be effective as a salvage treatment.

To explore the effect of implanting short stent in root of aorta for the treatment of Stanford type A aortic dissection.

Clinical data of 39 patients with Stanford type A aortic dissection who underwent surgical procedure at the Department of Cardiovascular Surgery of Luoyang Central Hospital Affiliated to Zhengzhou University, between January 2013 and December 2015 were retrospectively analyzed. There were 31 males and 8 females aged 27 to 75 (49.3±10.3) years. All patients received short stent implanting in aortic root, total arch replacement and stented elephant trunk implantation were performed at the same time.

All the operations were successfully performed. Two patients died during hospitalization. Four patients underwent reexploration for postoperative bleeding. Postoperative mortality was 5.1%(2/39). Follow-up duration was 3 to 24 months, with a median time of 14 months. One patient died of lung infection, gastrointestinal bleeding and renal faliure during follow-up.

Patients with aortic intimal tear located at higher root of aorta may be suitable for short stent implanting, and the procedure has satisfactory clinical outcomes.

To evaluate the role of water-soluble C₆₀ fullerenes in mice model of lung injury and fibrosis that induced by bleomycin.

A total of 20 healthy C57BL/6J mice were randomly divided into normal control group, bleomycin group, high dose C₆₀ group, low dose C₆₀ group, each group with 5 mice. Mice were induced pulmonary fibrosis by intratracheal injection of bleomycin except the normal control group, which was induced by saline instead. In low dose C₆₀ group and high dose C₆₀ group, 1 mg·kg^-1·d^-1 and 10 mg·kg^-1·d^-1 water-soluble C₆₀ fullerenes was injected into mice intraperitoneally every day, which began from one day before intratracheal instillation of bleomycin until the end of observation. Saline was given to mice in the same way in normal control and bleomycin group. This study investigated the variation of weight and survival rate of mice for 14 d. HE-staining and Masson′s trichrome staining were used to assess the severity of fibrosis according to the method proposed by Ashcroft at 14th day. Total lung collagen content was determined by hydroxyproline assay. The changes of transforming growth factor-β₁ (TGF-β₁) and tumor necrosis factor α (TNF-α) in plasma, bronchial alveolar lavage fluid (BALF) and lung tissue were measured by enzyme-linked immunosorbent assay (ELISA). And, the amount of reactive oxygen species (ROS) was tested by 2, 7-dichlorofuorescin diacetate (DCFH-DA), and determined by the ratio of fluorescence intensity and protein content (OD/μg).

C₆₀ can protect mice that injured by bleomycin from weight loss. According the method proposed by Ashcroft et al.HE and Masson′s trichrome staining showed that collagen deposition in lung tissue were markedly attenuated in C₆₀ (1 mg·kg^-1·d^-1 and 10 mg·kg^-1·d^-1) treated mice compared with bleomycin model mice[(4.08±0.52), (3.00±0.41) vs (6.75±0.75) points, both P<0.01]. In low dose C₆₀ group and high dose C₆₀ group, the content of hydroxyproline in lung tissue were significantly lower than that in bleomycin group[(0.36±0.06), (0.35±0.08) vs (0.55±0.16) μg/mg, both P<0.05]. The level of TGF-β₁ in BALF and lung tissue were also decreased in mice treated with C₆₀ (10 mg·kg^-1·d^-1) compared with bleomycin model mice, but the difference had no statistical significance[(9.38±5.32) vs (23.60±8.96) pg/ml, (2.89±0.35) vs (6.44±2.95) pg/mg, both P>0.05]. Also, in high dose C₆₀ group, the content of TNF-α in plasma, BALF and lung tissue were significantly lower than those in bleomycin group[(4.56±0.73) vs (7.21±2.26) pg/ml, (34.58±23.30) vs (151.00±27.34) pg/ml, (22.99±5.83) vs (122.90±22.04) pg/mg, allP<0.05]. In addition, Compared with bleomycin group, ROS in lung tissue was significantly decreased after treatment with C₆₀ (10 mg·kg^-1·d^-1)[(19.68±0.91) vs (22.92±1.71) OD/μg,P<0.05].

Water-soluble C₆₀ fullerenes reduce the severity of pulmonary fibrosis induced by bleomycin in mice.

To study the homology of Legionella pneumophila (LP) strains which were isolated from clinical specimens and environmental water.

Twenty-two Legionella strains were collected in which 2 strains were isolated from 2 cases of LP infection patients, and others were isolated from domestic water or air conditioning cooling tower water of 2 hospitals and 13 companies from July 2012 to September 2014 in Shenyang. They were recovered and analyzed by the pulse field gel electrophoresis (PFGE) with AscⅠ restriction enzymes. Data were cluster analyzed using SPSS 19.0.

Twenty of 22 strains were LP1, and others were LP7 and LP8. Twenty-two strains could be divided into 14 genotypes, and 7 strains belonged to SYC banding pattern. The same bacterial serotype presented with different genotypes. Different bacterial serotypes and genotypes of LP strains can be found in the same place, and homology could be observed between LP strains isolated from cooling tower water and domestic water within the same hospital.

In Shenyang area, LP strains which are isolated from clinical cases and environmental water have the characteristics of gene polymorphism. Legionella strains isolated from different water system in the same hospital have homology.

A 36-year-old male was admitted to the Department of Nephrology, Peking University First Hospital on July 9, 2015 due to fatigue and anorexia for more than 2 months, bilateral calf muscle pain with decreased urine output for 6 days. The patient developed anorexia without obvious trigger 2 months ago, nausea, abdominal distension, intermittent or small amount of vomiting after eating, accompanied by fatigue, no abdominal pain, diarrhea, no changes in urine output and urine color, and did not see a doctor. In the past 6 days, the patient had aggravated fatigue and anorexia, inability to move, accompanied by bilateral calf muscle pain, and conscious urine output decreased compared with before, and the degree of reduction was not clearly described. Three days ago, blood pressure was 90/60 mmHg (1 mmHg =0.133 kPa), blood creatinine (Scr) 702 μ mol/L, blood urea nitrogen (BUN) 36.08 mmol/L, blood potassium 2.10 mmol/L, blood sodium 131 mmol/L, blood chlorine 48 mmol/L, and blood HCO were checked in the emergency department of our hospital₃^－68.6 mmol/L, creatine kinase (CK) 737 U/L (reference: 25-195 U/L), blood myoglobin 451 μ g/L (reference:<100 μ g/L); Urinary pH 8.0, urine specific gravity 1.010, urine protein trace, urine sediment microscopy negative; Blood gas analysis showed pH 7.57, partial pressure of carbon dioxide (PCO₂) 83 mmHg, oxygen partial pressure (PO₂) 109 mmHg, lactic acid (Lac) 10.2 mmol/L, HCO₃^－>60 mmol/L. Chest X-ray showed elevation of the left diaphragm. After gastrointestinal decompression, about 3,000 ml of coffee-colored substance was drained, and the occult blood of the drained substance was negative. Considering "rhabdomyolysis, acute kidney injury (AKI)", after symptomatic fluid rehydration and correction of electrolyte disorder treatment for 3 days, he was transferred to the nephrology ward. The patient has lost about 10 kg of weight in the last two months since the onset of the disease. He has a history of epilepsy for more than 20 years, with 3 to 4 seizures a year and no regular treatment. Drinking history for more than 10 years, 250~400 ml/d. Repair of gastric perforation after alcohol consumption 6 years ago. History of hypertension, diabetes, kidney disease denied. Family history of genetic diseases and similar diseases were denied.

A 41-year-old male was admitted to the hospital in June 2016 due to discomfort in the right upper abdomen and gallbladder stones found by ultrasound for 3 years, and acute cholecystitis with intermittent episodes of vomiting and diarrhea for 1 year. In January 2005, the patient underwent combined pancreas-kidney transplantation in our hospital due to "type 1 diabetic nephropathy with renal failure". The operation went smoothly, and routine oral anti-rejection drugs were taken after the operation and regular review was performed. The patient has developed chronic renal dysfunction in the past 5 years, manifested by creatinine maintained at about 200 μ mol/L, normal urine output, chronic rejection excluded by renal puncture pathology, and suspected FK506 toxicity (tacrolimus capsules, Zhejiang Hisun Pharmaceutical, batch number: H20160047). At present, FK506 has been discontinued, and oral Mifu (Beijing Novartis Pharmaceutical Co., Ltd., batch number: H20160051) is used alone to maintain immunosuppression. The function of the transplanted pancreas and blood glucose levels have been normal for 11 years. The general condition of the patient was acceptable when he was admitted to hospital, and no obvious abnormalities in the heart and lungs were found. The abdomen was flat and soft, with tenderness in the right upper abdomen, no muscle tension and rebound pain, surgical scars in the lower abdomen, normal intestinal sounds, negative mobile voices, and mild depressed edema in both lower limbs. Auxiliary test: white blood cells 4.5×10⁹/L, neutrophils 0.62, amylase 188 U/L, lipase 376 U/L, creatinine 275 μ mol/L, urinary albumin ALB 87.2 mg/L. Abdominal ultrasound showed: gallbladder swelling and multiple gallbladder stones. The blood flow of the transplanted pancreas and kidney was not abnormal, and the ultrasonography of liver, gallbladder, pancreas and spleen was not abnormal.

Craniopharyngioma is a benign tumor that originates from the squamous epithelial cells remaining in the cranial buccal sac during the development of pituitary embryo. Most of them are located on the saddle, and a few are in the saddle or protruding in the third ventricle. The space-occupying effect of tumor often affects the structure and function of hypothalamus, pituitary gland and optic chiasm. The incidence rate is 0.5-2.0 per million person-years, and 30%-50% of the disease occurs in childhood or adolescence. The clinical manifestations include increased intracranial pressure, visual field impairment and endocrine dysfunction^[1]。 According to the World Health Organization classification^[2]There are two distinct subtypes of craniopharyngiomas: adamantinomatous craniopharyngioma (ACP) and papillary craniopharyngioma (PCP), both previously identified on the basis of histology and epidemiology. Recent studies have shown that these two subtypes have different molecular bases, providing strong evidence for the origin and molecular etiological pathogenesis of craniopharyngioma, and confirming the different characteristics of the two subtypes as well as related molecular drug therapeutic targets^[3,4]。

Most patients with prostate cancer in China are in advanced stage when they see a doctor, and most of them use salvage treatments, such as endocrine therapy and chemotherapy, to prolong survival time and relieve symptoms^[1,2]。 Adenovirus-mediated gene therapy and viral therapy as tumor biotherapeutic approaches have potential tumor cell inhibition effects. Wild-type adenovirus lacks tumor targeting and can infect normal tissue cells, resulting in side effects and toxicity in human body. In early studies, many prostate tissue-specific biomolecules have been discovered. After inserting their gene promoters upstream of adenovirus therapeutic genes, the expression of downstream therapeutic genes can be restricted to tumor cells to play a role in tumor targeting, including prostate specific antigen (PSA), human kallikrein 2 (hK2), prostate basic protein (PB), prostate specific membrane antigen (PSMA), etc. With the deepening of research on tumor biomarkers, it will be found that the gene promoter of highly expressed biomolecules in a variety of tumor tissues including prostate cancer has the same tumor targeting effect after recombination with adenovirus. The significance of these prostate cancer-related biomolecules in tumor targeting is discussed as follows.

Publishing ethics is a work involving journal editors and publishers and publishing authors, universities and research institutions. This work is crucial. Publication ethics ensure that credibility of scientific research published worldwide and are central to the development of public policy and to the solution of the most pressing issues facing the general population, from public health protection to climate change mitigation^[1]。 The most important thing for this work is international cooperation. In the words of Ginny Barbour, Chair of the Publication Ethics Committee (COPE): "We need to be responsible for the integrity of the articles we publish, and it is not just the work of editors". More than 120 delegates from all over the world attended this COPE seminar. The important views of experts who gave keynote speeches at the COPE Symposium-China Forum held in Beijing on March 26, 2017 are introduced as follows.