Volume 97  ·  Issue 24  ·  2017

In 2011, the American Academy of Sciences, the American Academy of Engineering, the National Institutes of Health and the American Science Council jointly launched the initiative "Towards Precision Medicine" for the first time^[1]。 But what really attracted widespread attention to precision medicine was the "Precision Medicine Plan" proposed by then-US President Barack Obama in his State of the Union address in 2015. The plan suggested that the government increase funding for medical research, promote individualized genomics research, and develop individual medical plans for patients with cancer and other diseases based on personal genetic information. Precision medicine is based on individualized medicine, applying modern genetic technology, molecular imaging technology, and bioinformation technology to achieve accurate classification and diagnosis of tumors, and formulate personalized tumor prevention, diagnosis and treatment plans^[2]。 Precision medicine is a new medical category that integrates traditional medical methods and modern scientific and technological means, scientifically understands human body functions and the nature of diseases, and maximizes individual and social health benefits with the most effective, safest and economical medical services. Personalized treatment plans tailored to the individual characteristics of each patient are the vision of precision medicine clinical applications.

Insomnia is a common sleep problem. Among adults, 10% ~15% meet the diagnostic criteria of insomnia, and the course of the disease is chronic. Nearly half of severe insomnia can last for more than 10 years^[1]。 Insomnia seriously damages the physical and mental health of patients, affects the quality of life of patients, and even induces accidents such as traffic accidents and endangers personal and public safety, which constitutes a serious burden for individuals and society^[2]。 Domestic and foreign sleep medicine experts have published a number of diagnosis and treatment guidelines related to insomnia, but the time is relatively old, and most of them are only for adults, which fail to cover special groups such as children, the elderly and pregnant women, and pay less attention to related contents such as traditional Chinese medicine and physical therapy. To this end, in October 2015, China Sleep Research Association held a meeting in Beijing, inviting sleep medicine experts from many large tertiary hospitals in China, covering many departments related to sleep medicine (including psychiatry, psychology, neurology, respiratory department, pediatrics, traditional Chinese medicine, etc.) to set up an expert committee on guideline formulation to compile guidelines for the diagnosis and treatment of insomnia suitable for national conditions. After repeated and full demonstration, combined with the existing clinical experience and the latest research results at home and abroad, especially the evidence of evidence-based medicine, the expert group completed the writing of the guide in one year. This guide aims to provide a standardized framework for the diagnosis and treatment of insomnia for clinicians, caregivers, pharmacists and psychologists, especially those related to sleep medicine.

Circulating tumor cells (CTC) have become an important part of liquid biopsy, which have underwent a process from simple counting to molecular typing and genotyping. To this end, we used Cellcollector to verify the effectiveness and safety of CTC detection in patients with breast tumor, and to conduct the following analysis.

One hundred and ninety patients who received treatment in six leading Chinese cancer centers were involved from April to August in 2016. Among which, 127 patients were diagnosed as metastatic breast cancer, and the other 63 patients as benign breast tumors.

In metastatic breast cancer group, 74.8%(95/127) were CTC positive. While in benign tumor group, they were all CTC negative patients. The area under the Receiver Operating Characteristic curve were 0.832(95%CI: 0.784-0.879). The sensitivity of Cellcollector was 74.8%, specificity was 100% (Youden index 0.748). A total of 117 patients in MBC groups received a second detection of Cellcollector after 3-4 weeks, among which 44.4% (52/117) were CTC positive patients. The incidence of adverse events and severe adverse events in MBC was 66.9%(85/127) and 39.8% (53/127). Furthermore, we used Cellcollector to perform the HER2 testing and gene sequencing.

In vivo isolation of CTCs overcomes blood volume limitations compared to other approaches. The further application of molecular typing and gene typing might help to implement CTC-based "liquid biopsies" into clinical decision making.

To evaluate the performance of T cell enzyme-linked immuno-spot assay (T-SPOT) on peripheral blood in combination with adenosine deaminase (ADA) on pleural fluid for diagnosis of tuberculous (TB) pleurisy within different age groups.

The data of patients with pleural effusion from the Department of Pulmonary and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University from April 2012 to November 2016 were retrospectively analyzed, and the diagnoses of these patients were histopathologically confirmed through medical thoracoscopy. The cases who had confirmed diagnosis, in the same time, received peripheral blood T-SPOT.TB were enrolled. The performance of peripheral blood T-SPOT.TB in combination with pleural fluid ADA on diagnosing TB pleurisy in the younger patients (16-59 years old) and elderly patients (≥60 years old) were analyzed respectively. The sensitivity, specificity and the receiver operating characteristic (ROC) curve were adopted for statistical analysis.

A total of 448 cases were finally enrolled, 341(76.1%) confirmed with TB pleurisy, 224 males, 117 females, (47±19) years old; and 107 (23.9%) classified as non-TB pleurisy, 65 males, 42 females, (61±14) years old. There were 285 cases who were classified as younger group, and the other 163 cases were classified as elderly group. The sensitivity and specificity of peripheral blood T-SPOT.TB were 85.4% (204/239) and 71.7% (33/46) in the younger patients, 76.5% (78/102) and 59.0% (36/61) respectively in the elderly patients. The sensitivity of peripheral blood T-SPOT.TB in the younger patients was significantly higher than that in the elderly patients (P=0.047). The sensitivity and specificity were 99.2% and 95.7% in combination with peripheral blood T-SPOT.TB and pleural fluid ADA respectively in the younger patients. The area under ROC curve (AUC) of T-SPOT.TB in the younger patients was 0.833, AUC of T-SPOT.TB combined with ADA was 0.911. The combination test of 2 tests had the sensitivity of 96.1% and the specificity of 90.2% respectively in the elderly patients. The AUC of T-SPOT.TB in the elderly patients was 0.747, AUC of T-SPOT.TB combined with ADA was 0.911.

Peripheral blood T-SPOT.TB combined with pleural fluid ADA can improve the diagnostic performance for TB pleurisy with different ages, especially for elderly patients who can′t tolerate pleural biopsy.

To study the surgical treatment of chronic type B dissection with aortic arch involvement using Sun′s procedure.

Between February 2009 and December 2015, 29 patients [20 males, 9 females, with a mean age of (41±12) years, range 24-64 years] with type B dissection with aortic arch involvement underwent Sun′s procedure. Sixteen patient had a history of hypertension. Marfan syndrome was observed in 9 cases, coronary artery disease in 3 cases, mitral regurgitation in 3 patients, cerebrovascular disease in one patient. Twenty-two patients suffered proximal aortic arch disease, 4 cases experienced history of aortic root procedure and 2 subjects had history of pregnancy. Four patients had aortic arch malformation.

One case suffered from massive cerebral infarction after surgery and died in another hospital. Concomitant procedures included mitral valve replacement in 3 cases, coronary artery bypass grafting in 3 patients, reconstruction of the right aberrant subclavian artery in one patient. Ventilator support exceeding 24 hours obseved in 2 patients. One of them recieved continuous renal replacement therapy and recovered before discharge. Spinal cord injury was obseved in one case, brain infarction in one patient and pericardial drainage in one case. Two patients required tracheotomy. During 12-94 (43±23) months′ follow-up, thoracoabdominal aortic replacment was performed in 4 patients, thoracic endovascular aortic repair (TEVAR) in 2 subjects and repair of perivalvular leakage in one patient.

Sun′s procedure obtained satisfactory results in patients with chronic type B dissection with aortic arch involvement. Concomitant repair of proximal aortic arch lesions and distal type B dissection can be adopted using Sun′s procedure.

To analyze the relevant factors for diabetic retinopathy.

The data of type 2 diabetes mellitus patients undergoing general examination and ophthalmology specialist consultation were collected from the inpatients of Department of Endocrinology in Beijing Airport Hospital between 2013 and 2016, and the relevant factors of diabetic retinopathy were retrospectively analyzed.

A total of 432 cases were analyzed, including 168 cases of non-diabetic retinopathy and 264 cases of diabetic retinopathy. In the non-diabetic retinopathy group, there were 88 cases of male and 80 cases of female, with an mean age of (57.0± 13.6) years old. Meanwhile, the diabetic group had 142 cases of male and 122 cases of female, with an mean age of (62.7±10.4) years old. Univariate logistic regression analysis showed that age and glycosylated hemoglobin value were significantly higher in the diabetic retinopathy group than those of the non-diabetic retinopathy group, and the incidence of diabetic peripheral neuropathy, carotid plaque and central retinal thickness was significantly higher than that of the non-diabetic retinopathy group. Multivariate logistic regression analysis displayed that carotid plaque (OR=9.922, 95%CI: 3.700-26.603, P<0.001) and thinning of central retinal thickness (OR=9.639, 95%CI: 3.604-25.781, P<0.001) were independently associated with diabetic retinopathy.

Carotid plaque is an independent risk factor for diabetic retinopathy, and thinning of central retinal thickness may indicate the progression of retinopathy. Therefore, patients with these two signs need to be observed more closely in clinical practice.

To assess the validity of Caprini risk assessment model in prediction of venous thromboembolism in Chinese hospitalized patients in a general hospital.

Medical record review was performed in Beijing Shijitan Hosital for all eligible hospitalized patients who underwent screening for venous thromboembolism between January and December 2015. The Caprini score of patients with or without venous thromboemboilism and incidence of venous thromboembolism in patients with various Caprini risk levels, surgery and medical patients was compared.

A total of 6 966 inpatients were enrolled. Three hundred and ninety-six patients developed venous thromboembolism. The Caprini median score of patients with venous thromboemboilism was 5 (3-7), which higher than 3(2-5) of patients without venous thromboembolism(Z=-13.68, P<0.01). Incidence of venous thromboembolism of patients in low, moderate, high, highest risk level was 1.0%, 1.8%, 5.7%, 10.6%, respectively. There was no statistically significant difference of incidence between low and moderate risk patients (OR=1.88, 95%CI: 0.89-3.99, P>0.05), but significant difference between moderate and high risk (OR=3.23, 95%CI: 2.06-5.06, P<0.01), high and highest risk patients (OR=1.97, 95%CI: 1.59-2.45, P<0.01). There was no incidence difference of venous thromboembolism between surgery and medical patients in the same Caprini level of low (χ²=3.58 , P>0.05), moderate(χ²=2.89, P>0.05), high(χ²=0.46, P>0.05), highest risk(χ²=1.61, P>0.05).

Caprini risk assessment model can effectively predict the occurence of venous thromboembolism in Chinese hospitalized patients with high risk of VTE(Caprini score >2)in a general hospital.

To retrospectively analyze the clinical characteristics of patients with acute fatty liver of pregnancy (AFLP), and to discuss perioperative and anesthetic management.

A retrospective review was conducted on the records of pregnant patients with a diagnosis of acute fatty liver of pregnancy in Peking University Third Hospital from January 2007 to December 2015. 12 cases were identified. The clinical features, preoperative laboratory findings, types of delivery, anesthetic techniques for cesarean section, and the outcomes of parturients and fetus were collected and analyzed.

Among the 12 cases, 91.7% were primigravid, 50% had twin pregnancies, and one was diagnosed with concomitant preeclampsia. The common clinical features included nausea (6 cases, 54.5%), vomiting (5 cases, 45.5%), jaundice (5 cases, 45.5%), malaise (3 cases, 27.3%), epigastric discomfort (2 cases, 18.2%), anorexia (2 cases, 18.2%) and regurgitation (1 case, 9.1%). Laboratory tests mainly showed impaired hepatic function and hypoglycemia. Cesarean deliveries were performed in 10 of the 11 patients diagnosed antepartum. Cesarean section was performed under neuraxial anesthesia (1 case) or general anesthesia (9 cases). The patient transferred to our center after delivery and diagnosed postpartum died. All the patients diagnosed antepartum survived. 6 out of the 18 fetuses were transferred to the pediatric department due to preterm, low birth weight, intrauterine restriction or asphyxiation, and were all survived.

AFLP is one of the most severe complications in parturients. Prognosis can be improved with early diagnosis and prompt termination of pregnancy. Hepatic function, coagulation status and urgency of delivery should be well considered to choose the appropriate anesthetic method, and anesthetic management should be individualized.

To investigate the clinical efficacy of atomization inhalation combined with oral administration of oseltamivir in treatment of human infection with H7N9 avian influenza.

To analyze the clinical data of 4 patients hospitalized from Mar 6th 2017 to Apr 12th 2017 with avian influenza(H7N9) infection treated by conventional therapy(oseltamivir, 150 mg, po, Bid) plus with oseltamivir inhalation(75 mg dissolved in 20 ml N. S, Bid) and administered with antibacterial treatment, blood purification and immunomodulators.

Undergoing these comprehensive therapies, Bronchial lavage fluid and pharynx of 1 case was negative for H7N9 RNA after 24 h, 2 cases negative for H7N9 after 3 d and 1 case negative for H7N9 RNA after 4 d. All patients were cured and discharged without any complications.

Aseltamivir inhalation combined with oral treatment can significantly shorten the time of virus nucleic acid turning negative, improve the efficacy of anti avian influenza virus H7N9, and increase the cure rate of avian influenza H7N9 infection patients.

To investigated the therapeutic effects of Tubastatin A Hcl, a selective HDAC6 inhibitor, on airway inflammation in acute mice bronchial asthma (asthma) model.

A total of 48 BALB/C mice were randomly divided into control group, asthma group, dexamethasone group and Tubastatin A Hcl group with 12 mice in each group. Then the airway hyperresponsiveness was assessed in each group; total cell number, different cell number, levels of Interleukin (IL)-4, IL-5 and Interferon-γ (IFN-γ) in the bronchoalveolar lavage fluid (BALF) were detected; the lung tissues of each group were stained with HE to observe the inflammatory cells infiltration. AB-PAS was used to observe the goblet cell metaplasia in tracheal epithelium. Masson staining was used to observe the collagen deposition in lung tissue.

The airway reactivity in Tubastatin A Hcl group was significantly lower than that in asthma group [(4.18±0.94) vs (6.02±0.47), P<0.05]; in the Tubastatin A Hcl group, the total inflammatory cells [(57.0±5.7)×10⁴/ml vs (87.0±5.6)×10⁴/ml], eosinophil cells [(6.8±1.7)×10⁴/ml vs (12.3±3.5)×10⁴/ml] and levels of IL-4 [(19.3±2.7) vs (26.2±3.2)ng/ml] in BALF were obviously lower than those of asthma group (allP<0.05); IL-5 in Tubastatin A Hcl group was lower and IFN-γ was higher than that of asthma group, while there were no significant differences (bothP>0.05). The degree of inflammatory cells infiltrations around the airway and vascular, number of inflammatory cells [(9.80±2.42) vs (20.67±7.53)], score of inflammation [(2.20±0.70) vs (3.60±0.68) points, ], and percentage of goblet cell metaplasia [(50.46±5.03)% vs (71.06±5.38)%] in the lung tissue of Tubastatin A Hcl group were lower than that of asthma group (allP<0.05). Although collagen deposition in the lung tissue of Tubastatin A Hcl group was lower than asthma group, there were no significant differences (P>0.05). However, all of the above results in the dexamethasone group were slightly better than Tubastatin A Hcl group, which had no significant differences (P>0.05).

Tubastatin A Hcl can effectively alleviate the level of airway inflammation in acute asthma, but its anti-inflammatory effect is limited, which is not as significant as dexamethasone.

To explore the mechanism of cytoskeleton and PI3Kδ-RhoA in fine particulate matter deteriorating phagocytosis defect of alveolar macrophage (AM) in chronic obstructive pulmonary disease (COPD) mice.

Forty mice were randomly divided into four groups: health control group, COPD group, health PM2.5 group, COPD PM2.5 group and with ten in each group. A mouse model of COPD was established by cigarette smoke exposure, and health PM2.5 group and COPD PM2.5 group mice were given PM2.5 (588 μg/m ³) aerosol inhalation for 90 days. AM were isolated from lung tissue by discontinuous density gradient centrifugation. Mean fluorescence intensity (MFI) and the percent of alveolar macrophage engulfing flurescein isothiocyanate-labeled Escherichia coli (FITC-E.coli) AM (AM%) were detected by flow cytometry. The mRNA and protein expression were measured by real time polymerase chain reaction (RT-PCR) and Western blot. The activity of RhoA was measured by GTPase linked immunosorbent assay (G-LISA) Kit. Cytoskeleton was observed by laser scanning confocal microscopy.

The MFI and the AM% in COPD group [4 512±517, (32.19±4.57)%] and health PM2.5 group [7 631±585, (50.78±4.58)%] were significantly lower than those in health control group [9 857±1 042, (68.53±2.88)%], while those in COPD PM2.5 group [3 121±393, (21.90±2.58)%] were lower than those in COPD group (allP<0.01). The mRNA and protein of PI3Kδ in COPD group (3.41±0.54, 0.84±0.08)and health PM2.5 group (1.52±0.35, 0.71±0.11) were higher than those in health control group (1.00±0.00, 0.57±0.07) (allP<0.05), and in COPD PM2.5 group (5.53±0.42, 1.17±0.25), the above parameters were remarkably increased as compared to those in COPD group (allP<0.01). The mRNA, protein and activity of RhoA in COPD group (0.70±0.07, 0.41±0.10, 0.70±0.06) and health PM2.5 group (0.84±0.06, 0.46±0.11, 0.87±0.07) were lower than those in health control group (1.00±0.00, 0.56±0.09, 1.19±0.09) (allP<0.05), and above parameters of COPD PM2.5 group (0.42±0.05, 0.31±0.06, 0.44±0.04) were significantly lower than COPD group (allP<0.01). Cytoskeleton of AM: long and dense filopodia and membrane fold could been seen clearly around the AM of health control group; in COPD group and health PM2.5 group, short and sparse filopodia and slightly deformed AM can been seen. Filopodia remarkably decreased and rigid cells with impaired capacity of engulfing FITC-E.coli can be generally observed in COPD PM2.5 group. Negative correlations were existed between PI3Kδ mRNA, protein and RhoA mRNA, protein, activity in all groups (allP<0.01). Negative correlations were existed between PI3Kδ mRNA, protein and MFI, and positive correlations were existed between RhoA mRNA, protein, activity and MFI in all groups (allP<0.05).

Fine particulate matter (PM2.5) can deteriorate the phagocytosis of AM from COPD mice through over activating PI3Kδ and inhibiting the activity of RhoA then causing cytoskeleton abnormal rearrangement.

The residual roots and crowns of maxillary molars should be removed and restored without retention. Because of its special anatomical structure, many methods such as crown splitting and knocking are assisted, which increases the risk of maxillary sinus injury and patients' anxiety. At present, high-speed turbines are mostly used in clinical practice for root removal and tooth extraction, which can effectively alleviate this situation. However, this machine is easy to cause damage to the soft and hard tissues around the surgical area, and cases of subcutaneous emphysema have been reported^[1,2]。 Because of its selective cutting of mineralized tissue, ultrasonic osteotome is a cutting equipment widely used in bone tissue surgery in recent years. The new generation of ultrasonic osteotome has added a special cutting head for tooth extraction, which can realize accurate and efficient cutting of tooth root, which is conducive to the protection of soft and hard tissues around the affected tooth. In this study, ultrasonic osteotome was used to perform maxillary molar surgical extraction, and compared with high-speed turbine in the aspects of operation time, patients' intraoperative anxiety, postoperative pain, and the change of alveolar bone width and height, to evaluate the application effect of ultrasonic osteotome in maxillary molar extraction.

A 16-year-old female was admitted to the Department of Endocrinology of Huashan Hospital affiliated to Fudan University in June 2016 due to worsening headache after octreotide acetate microspheres (Shanlong) injection. Menarche in 2011, irregular menstruation, paroxysmal headache with prolonged menstrual cycle in September 2013, local hospital checked fasting blood glucose increased (specific value unknown), cranial magnetic resonance imaging (MRI) found no abnormality. Oral metformin tablets were given for treatment, and blood sugar control was normal. Paroxysmal headache aggravated in January 2014, unable to sleep at the time of attack [Visual Analog Scale (VAS) score 9 points], without nausea and vomiting. Thick hands and feet, hypertrophic lips, weight 73 kg, height 172 cm (father, mother, sister height 169, 162, 156 cm, genetic height 162.5 cm, respectively) were noted in April 2014; Weight gain of 20 kg and height gain of 10 cm in 1 year. Pituitary MRI enhancement (Figure 1) It was found that the sellar region occupied space (2.6 cm ×1.3 cm), invaded the cavernous sinus to the left and surrounded the internal carotid artery, considering an invasive pituitary tumor. Random growth hormone (GH) 166.92 μ g/L, insulin-like growth factor 1 (IGF-1) 1 208 μ g/L (reference value: 220.0-996.0 μ g/L), oral glucose tolerance test (OGTT) indicated that GH could not be inhibited (GH trough value 77.31 μ g/L), and glucose tolerance was impaired (IGT). An aggressive pituitary GH tumor with IGT and thyroid nodules was diagnosed. Treatment with somatostatin analogue (SSA) octreotide acetate microspheres (Shanlong) (20 mg, intramuscular injection every 4 weeks) for 3 months did not alleviate the headache. Randomized GH 79.62 μ g/L, IGF-1 772 μ g/L, pituitary MRI lesions showed no significant reduction (Figure 2)。 In August 2014, transnasal sphenoidal pituitary tumor surgery was performed. The pathology showed GH tumor with high cell proliferation index (MIB-1:8%), suggesting atypical pituitary GH tumor (sellar area). In November 2014 (3 months after surgery), the GH was 13.5 μ g/L, and the IGF-1 was 908 μ g/L, indicating that the biochemistry was not in remission; MRI enhancement showed residual pituitary tumor (Figure 3)。 Octreotide acetate microspheres 20 mg were injected intramuscularly again every 4 weeks. Reexamination of OGTT test 3 months after SSA treatment (January 2015) showed IGT, GH trough decreased to 15.12 μ g/L, and IGF-1 remained at 716 μ g/L; Colonoscopy showed multiple polyps in the colon, and biopsy pathology showed villous adenoma (transverse colon). Colonoscopy polyp removal was performed. In February 2015, it was changed to octreotide acetate microspheres 30 mg intramuscular injection every 4 weeks. The patient's headache did not relieve after treatment. Within 1 week after octreotide acetate microsphere injection, the headache worsened and toothache occurred, but no abnormalities were found in the dental examination. Head chills, fatigue and drowsiness, persistent menopause. Diet therapy can control blood sugar, no further weight gain, and normal blood pressure. In June 2015, he came to the multidisciplinary outpatient clinic of pituitary disease of Huashan Hospital affiliated to Fudan University for further treatment.

A 37-year-old female was admitted to the Department of Otolaryngology and Head and Neck Surgery of the First Affiliated Hospital of Nanchang University for "accidentally eating fish bones for 3 months and finding a neck mass for more than 1 month". The patient accidentally ate fish bone while eating 3 months ago. At that time, he felt pharyngeal pain, which was aggravated when swallowing. There was no dysphagia, no cough, hemoptysis, no blood in sputum, and no sternal tenderness. Then he went to the local hospital and was given a lateral X-ray of the neck, which showed foreign body in the esophagus. Gastroscopic foreign body removal was recommended, but it was not adopted. There was no obvious pain after swallowing rice and drinking vinegar at home, and no examination and treatment were performed thereafter. I accidentally discovered a mass on my neck 1 month ago, the size of my thumb (Figure 1), there was a slight tingling sensation after neck activity, no fever, no hoarseness and other discomfort, so I went to our hospital for treatment. Since the onset of the disease, the mental diet is OK, the urine and defecation are normal, and the weight has not changed significantly. He was usually healthy, but denied the history of surgery and neck trauma.

Pulmonary hypertension is a common clinical condition with complex etiology, which can be caused by a variety of cardiac, pulmonary or pulmonary vascular diseases. When pulmonary hypertension occurs, the pulmonary circulatory resistance increases, the right heart load increases, and finally leads to right heart failure, which causes a series of clinical manifestations^[1,2,3,4]。 The occurrence of pulmonary hypertension is related to the dysfunction of endothelial damage of pulmonary minor arteries, which leads to abnormal production of vasoactive substances and cytokines and directly acts on vascular smooth muscle, further promoting vasoconstriction. In addition, the hyperproliferation of smooth muscle cells in the pulmonary artery, the remodeling of extracellular matrix and the activation of inflammatory cells can all contribute to the development of this disease. Endothelin-1, phosphodiesterase, nitric oxide, and cycloprostaglandin signaling pathways are involved in the development of this disease, and many drugs have been developed targeting these targets. It has been found that lipid oxidation is involved in many pathophysiological processes of pulmonary hypertension, such as proliferation of smooth muscle cells, apoptosis of endothelial cells, and inflammatory response^[5]。 The role of oxidative stress and lipid oxidation in the development of various types of pulmonary hypertension and the related mechanisms, as well as the potential therapeutic effects of high density lipoprotein mimetic peptide and microRNA (miR) -193 with high affinity for oxidized lipids on the disease were discussed in this paper.

Consumption hypothyroidism is a rare form of hypothyroidism caused by thyroid hormones in the body being inactivated too quickly and exceeding the rate of normal thyroid synthesis. As a paraneoplastic syndrome, it is most often accompanied by giant infantile hemangioendothelioma, in addition it has been reported in some non-vascular tumors such as fibromas, gastrointestinal stromal tumors. In recent years, it has been found that tyrosine kinase inhibitor (TKI) treatment may also cause this disease.

The results of the Human Genome Project show that less than 2% of RNA in human genes encode proteins, and the rest are non-coding RNA (ncRNA). According to the length of the ncRNA, the ncRNA is divided into small non-coding RNA and long non-coding RNA (lncRNA), the latter of which has a base length between 200 and 100 000 nt^[1]。 lncRNA is widely found in the nucleus and cytoplasm of eukaryotic organisms, lacking an obvious open reading frame, and having no or little protein coding function. Studies show that^[2]lncRNA can be involved in the pathophysiological processes of many diseases through many different mechanisms such as transcriptional interference, X chromosome inactivation, genomic imprinting, and intranuclear trafficking. It has been shown that lncRNA expression profiles change with disease progression^[3]At the same time, lncRNA can exist in peripheral blood, such as plasma, serum, etc., and circulating lncRNA can stably exist in harsh environments such as repeated freezing and thawing, long-term storage at room temperature and acid-base treatment, and can even be protected from the degradation of endogenous ribozymes^[4,5]。 At present, circulating lncRNA has shown unique value in the early diagnosis and prognosis of many diseases, and its research as a potential marker of various diseases has also become a research hotspot. In this paper, the progress and problems of circulating lncRNA in disease diagnosis are reviewed.

The report shows that in 2015, the number of new cases of gastric cancer in China was about 679,000, and the number of deaths due to gastric cancer was about 498,000^[1]。 Tumor drug resistance, recurrence and metastasis are important factors that threaten the life of gastric cancer patients, while the heterogeneity of tumor cells produced by tumor stem cells is considered to be one of the possible causes of tumor drug resistance, recurrence and metastasis^[2]。 Gastric cancer is a kind of heterogeneous tumor. High-throughput gene sequencing of gastric cancer samples classifies gastric cancer into four categories: microsatellite unstable, Epstein-Barr virus infected, genome stable and chromosome unstable^[3]。 It is generally believed that there are stochastic models and hierarchical models for the production of tumor cell heterogeneity^[4]。 The random mutation model is derived from the clonal evolution hypothesis of tumorigenesis, which refers to a series of gene changes related to proliferation and differentiation in normal cells, including overexpression of proto-oncogenes and downregulation of tumor suppressor genes, which can lead to the occurrence of tumor cells, and then produce tumor cells carrying different gene imprints^[5]。 The hierarchical model is derived from the theory of cancer stem cells, which believes that tumors can be produced by a small number of cells (cancer stem cells). This group of cells is similar to normal human stem cells, and has the ability of self-renewal and infinite differentiation and proliferation. The upstream cancer stem cells re-differentiate the downstream progenitor cells, and then produce differentiated tumor cells with relatively weak proliferation ability^[6]。 However, these two theories are inadequate in explaining the malignant biology of tumors, so it is possible to integrate these two theories to understand tumorigenesis.