Volume 97  ·  Issue 26  ·  2017

Chronic inflammatory diseases of the upper and lower airways refer to chronic diseases in which inflammation involves the upper and/or lower airways, including: (1) diseases dominated by the upper airways: such as allergic rhinitis (AR), non-allergic rhinitis (NAR), chronic rhinosinusitis (CRS), upper airway cough syndrome (UACS), nasal polyposis, adenoid hypertrophy, etc.; (2) The following airway-dominated diseases: such as bronchial asthma (asthma for short), bronchiectasis (bronchiectasis for short), chronic obstructive pulmonary disease (COPD for short), chronic cough, diffuse panbronchiolitis (DPB); (3) Upper-lower airway inflammation coexisting diseases: such as aspirin asthma (AIA), immobile ciliary syndrome, sinobronchial syndrome (SBS), allergic bronchopulmonary aspergillosis (ABPA), cystic fibrosis, necrotizing granulomatous vasculitis, allergic granulomatous vasculitis (Churg-Strauss syndrome, CSS), recurrent polychondritis, etc. The coexisting diseases of upper and lower airway inflammation are mostly related to genetic factors. Although the incidence in China is not as high as that of Europeans or Caucasians, it is not uncommon.

To explore the biomarkers that applied to pulmonary acute respiratory distress syndrome (ARDS) and extrapulmonary ARDS respectively.

A total of 49 eligible patients with ARDS were selected from Department of Respiratory intensive care unite (ICU) , Department of General ICU and Department of Emergency ICU, the Second Affiliated Hospital of Nanchang University, during April 2015 and February 2016, and divided into pulmonary ARDS group (n=26) and extrapulmonary ARDS group (n=23) according to primary causes. Totally 19 cases from healthy examination personnel were served as control. Acute physiology and chronic health evaluation Ⅲ (APACHE Ⅲ) score and lung injury score of all hospitalized patients were completed within 24 hours after the diagnosis of ARDS and the serum levels of angiogenin2 (Ang-2) , surfactant protein D (SP-D), soluble receptor for advanced glycation end products (sRAGE), Krebs von den Lungen-6 (KL-6) were measured. Then the 28-day outcomes were observed. The serum levels of the biomarkers were compared between each group and correlation analysis was conducted between different indexes. Finally, The relationship between the four biomarkers and the outcome of each group was analyzed.

The serum level of Ang-2 in pulmonary ARDS group and extrapulmonary ARDS group was significantly higher than that in control group[1 462 (569, 3 638) and 4 568 (2 236, 8 457) vs 460 (389, 578) ng/L, all P<0.05], and the serum level of Ang-2 was significantly higher in extrapulmonary ARDS group than that in pulmonary ARDS group (P<0.05). The serum level of SP-D in pulmonary ARDS group and extrapulmonary ARDS group was significantly higher than that in control group[5.9 (2.5, 22.7) mg/L and 3.7 (1.7, 6.5) vs 1.9 (0.6, 4.4) mg/L, allP<0.05], and the serum level of SP-D was significantly higher in pulmonary ARDS group than that in extrapulmonary ARDS group (P<0.05). The serum level of sRAGE in pulmonary ARDS group and extrapulmonary ARDS group was significantly higher than that in control group[238 (101, 583) and 229 (114, 443) vs 117 (88, 176) ng/L, allP<0.05]. The serum level of KL-6 in pulmonary ARDS group was significantly higher than that in control group[10 435 (3 401, 17 607) vs 4 780 (3 962, 5 320) U/L,P<0.05]. Increased serum levels of SP-D (OR=1.089, 95% CI: 1.001-1.085) and KL-6 (OR=1.206, 95% CI: 1.016-1.432) at the early stage were the independent prognostic factors for the 28-day mortality for pulmonary ARDS. Advanced age (OR=2.622, 95% CI: 1.046-6.574) was the independent prognostic factor for the 28-day mortality for extrapulmonary ARDS.

SP-D and KL-6 may be the serum biomarkers of pulmonary ARDS and Ang-2 may be the serum biomarker of extrapulmonary ARDS.

To investigate the oncologic outcome and PSA kinetics of localized high-risk prostate cancer (PCa) patients treated with combination strategy of radiation therapy (RT) and maximal androgen blockade (MAB).

We retrospectively reviewed the clinical data of 320 localized PCa patients undergoing RT+ MAB from 2001 to 2015. And radiation treatment protocol consisted of permanent prostate brachytherapy (PPB) at 110 Gy and EBRT at 45 Gy/23 fractions.

The median follow-up time was 90 (range: 12-186) months. And 117 (36.6%) cases underwent MAB + external-beam radiotherapy (EBRT), and other 203 (63.4%) cases received MAB+ EBRT+ PPB. Multivariate Cox regression analyses showed that PSA kinetics were positive indicators of oncologic outcomes. Furthermore, PSA kinetics were aberrantly improved by supplemental PPB to MAB+ EBRT as following, PSA nadir (1.3±0.7)μg/L vs(0.11±0.06)μg/L, time of PSA decrease to nadir (7.5±1.8)months vs (3.2±2.1)months, PSA doubling time (15.6±4.2)months vs (22.6±6.1)months, PSA decreasing amplitude (84.6±6.2)%vs(95.8±3.4)%. Additionally, the median time of several important oncologic events in MAB+ EBRT+ PPB group were also prolonged than that in MAB+ EBRT group as following, overall survival (12.3 years vs 9.1 years,P<0.001), biochemical recurrence-free survival (9.8 years vs 6.5 years,P<0.001), skeletal-related event (10.4years vs 8.2 years,P<0.001), and cytotoxic chemotherapy (11.6 years vs 8.8 years,P=0.007).

MAB+ EBRT+ PPB is extremely effective combination strategy for localized high-risk PCa patients, and PPB plays the important synergistic role in improving PSA kinetics, which are independent predictor for oncologic outcomes.

To evaluate whether early postoperative serum uric acid level can predict postoperative acute renal injury (AKI) among patients undergoing coronary artery bypass grafting (CABG).

The study retrospectively enrolled 1 306 patients undergoing CABG in Fuwai Hospital between September 2012 and December 2013. The patients were divided into 5 groups by the concentrations of serum uric acid measured on the morning of the first postoperative day, and uric acid categories were as follow: less than 195 μmol/L (Q1 group, 262 cases), 195-236 μmol/L (Q2 group, 263 cases), 237-280 μmol/L (Q3 group, 260 cases), 281-336 μmol/L (Q4 group, 261 cases), more than 336 μmol/L (Q5 group, 260 cases). The primary end points were AKI (RIFLE criteria), severe AKI (AKI≥stage Ⅰ), postoperative continuous renal replacement therapy (CRRT) requirement, in-hospital death, length of stay in hospital and intensive care unit(ICU). The area under the receiver-operating characteristic (ROC) curve (AUC) was used to determine the ability of the early postoperative serum uric acid level as a risk factor for postoperative AKI prediction.

Among the 1 306 patients enrolled in the study, AKI was found in 335 patients (25.65%). After adjusting for variables that were different between the 5 groups, the Q5 group had significantly higher risk of AKI, AKI≥ stage Ⅰ and the requirement of CRRT (P<0.01). The ROC for the outcome of postoperative AKI had an AUC of 0.648 (95%CI: 0.612-0.683) when serum creatinine levels alone were used and 0.722 (95% CI: 0.688-0.755) when serum uric acid levels alone were used (both P<0.001). Early postoperative serum uric acid was a better predictor than serum creatinine(P<0.001).

The serum uric acid concentration within 12 hours after operation is an independent predictor of postoperative AKI in patients undergoing CABG, which could be used to identify patients at high risk for AKI.

To evaluate the efficacy of oral nattokinase (NK) in the reduction of common carotid artery intimal medial thickness (CCA-IMT) and carotid artery plaque size and in lowering blood lipids, and to explore the underlying mechanism of actions of NK and its potential clinical use.

All enrolled patients were from the Out-Patient Clinic of the Department of TCM at the 3^rd Affiliated Hospital of Sun Yat-sen University. Using randomised picking method, all patients were randomly assigned to one of two groups, NK and Statin (ST) group. NK Group-patients were given NK at a daily dose of 6 000 FU and ST Group-patients were treated with statin (simvastatin 20 mg) daily. The treatment course was 26 weeks. CCA-IMT, carotid plaque size and blood lipid profile of the patients were measured before and after treatment.

A total of 82 patients were enrolled in the study and 76 patients (NK 39, ST 37) completed the study. Following the treatments for 26 weeks, there was a significant reduction in CCA-IMT and carotid plaque size in both groups compared with the baseline before treatment. The carotid plaque size and CCA-IMT reduced from(0.25±0.12)cm² to (0.16±0.10)cm² and from (1.13±0.12)mm to (1.01±0.11)mm, repectively. The reduction in the NK group was significantly profound (P<0.01, 36.6% reduction in plaque size in NK group versus 11.5% change in ST group). Both treatments reduced total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG). While the reduction in both groups was shown to be statistically significant (P<0.01), the reduction of TC, LDL-C and TG in ST group was significantly greater (P<0.05). In addition, NK significantly increased the level of high-density lipoprotein cholesterol (HDL-C) (P<0.05), in contrast, HDL-C in the ST group did not change. The lipid lowering effect observed in the NK group was not correlated to the reduction of CCA-IMT and carotid artery plaque size (r=0.35, P=0.09).

Our findings from this pioneer clinical study suggests that daily NK supplementation is an effective way to manage the progression of atherosclerosis and potentially may be a better alternative to statins which are commonly used to reduce atherosclerosis and further to prevent cardiovascular attack and stroke in patients. The mechanism underlying the reduction of carotid atherosclerosis by NK may be independent from its lipid-lowering effect, which is different from that of statins.

To find a suitable method for the determination of oxalic acid in the urine of patients with stones, in order to provide a new method and basis for the prevention and treatment of stone.

Liquid chromatography combined with tandem mass spectrometry was used to analyze oxalic acid in urine directly.The accuracy, stability, repeatability and other indicators of the results were tested.

The results showed a good linear relationship with the concentration of oxalic acid in urine. y=58.524x-15.246 (R²=0.979 02). The results were stable, reproducible (the intra-day and inter-day coefficient of variation was less than 10% and 15%, respectively), and the accuracy was comparable with that of the enzyme method (N=20, R=0.93).

Using the method of this study to detect the content of oxalic acid in urine has the advantages of simple operation, good repeatability, accurate results, and low price. It is worth to be popularized and applied in clinical practice.

To evaluate the efficacy of PVD chemo-regimen (Pegaspargase, vincristine and dexamethasone) combined with intensity-modulated radiotherapy (IMRT) for patients with early-stage extranodal nasal NK/T-cell lymphoma (ENKL).

Clinical data of 52 patients with early-stage ENKL were collected during May 2010 and June 2015 in Department of Lymphoma, Cancer Hospital of Guizhou Medical University, and these patients firstly received a concurrent chemoradiotherapy of two-cycle of PVD and IMRT (gross tumor volume primary: 12.6-59.4 Gy) and then 2 to 4 cycles of PVD as subsequent chemotherapy, the efficacy and adverse responses were retrospectively analyzed and observed.

Follow-up stopped until December 2015, complete remission was seen in 44 cases (84.6%) and partial remission 7 cases (13.5%), out of 52 cases. A total of 1 case died of progression disease during treatment and within 1 year after treatment, 1 case died of pulmonary infection within 1 week after treatment, 2 cases survived with tumor; so the objective response rate and clinical benefit rate were both 98.1%, 1-year, 2-year and 3-year overall survival rates and progression free survival rates were all 93.6%, 1-year and 2-year disease free survival rates were both 90.3%; the correlation analysis showed that the radiotherapy dose was related to the curative effect (P<0.05). Short term adverse responses were observed in 6 cases (11.5%) with grade 3 leucocytopenia, in 5 cases (9.6%) with grade 3-4 dyslipidemia and in 2 cases (3.8%) with grade 3 hypoalbuminemia during chemoradiotherapy. All the patients had different degrees of radiation oral mucositis and radiation dermatitis.

For early-stage ENKL, a concurrent chemoradiotherapy of PVD regimen and IMRT have a good therapeutic effect and adverse response can be tolerated.

To investigate whether Glabridin had a beneficial effect on 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine(MPTP) induced parkinson disease (PD) in mice, and explore the possible underlying mechanisms.

Forty C57BL/6N mice were randomly assigned into control group, MPTP group, Glabridin therapy(MPTP+ GLA)group, Levodopa therapy(MPTP+ LD)group, with 10 in each group. PD model was induced by intraperitoneal administration of MPTP(20 mg/kg). The mice in MPTP+ GLA group, MPTP+ LD group and control group were gavaged by glabridin (50 mg/kg), levodopa (40 mg/kg), and equal volume of normal saline, respectively. The behavioral changes of each group were observed and Y-type electric maze test was performed. The levels of tumor necrosis factor-α (TNF-α) and interleukin-18 (IL-18) were assayed by enzyme-linked immunosorbent assay (ELISA). Malondialdehyde (MDA), and superoxide dismutase (SOD) were analyzed. The protein expression of tyrosine hydroxylase (TH) and extracellular signal regulated protein kinase (ERK) protein expression of hippocampus tissue was detected using immunohistochemical techniques. TH and pERK protein expression of hippocampus tissue were detected by Western blotting.

Mice in MPTP group showed typical behavior of PD, and the ability of learning and memory was significantly lower than those in the control group. Compared with MPTP group, the expressions of TNF-α and IL-18 were suppressed by GLA in hippocampus[TNF-α(μg/L): 84.04±18.66 vs 106.53±28.54; IL-18(μg/L): 42.34±6.01 vs 58.42±8.39]. The levels of MDA in hippocampus were down-regulated significantly in groups administrated with GLA[MDA(nmol/mgprot): 2.64±0.52vs 3.78±0.31], while the SOD level increased after GLA administration[SOD(U/mgprot): 93.45±9.59 vs 77.83±8.98]. The results of immunohistochemistry showed the expression of TH protein in MPTP group was significantly decreased compared with that in control group, while the p-ERK protein in MPTP group was significantly increased. In MPTP+ GLA group and MPTP+ LD group, the expression of TH protein was significantly higher than that in MPTP group, and the expression of p-ERK protein was significantly lower than that in MPTP group. Western blot results showed that compared with control group, the expression of TH was significantly decreased, and p-ERK protein in hippocampus was significantly higherin MPTP group. The expression of TH protein was significantly higher in MPTP+ GLA group than that in MPTP group, while the expression of p-ERK protein were inhibited by GLA in MPTP-induced PD mice.

Traditional Chinese medicine glabridin can protect the learning and memory ability of PD mice induced by MPTP by inhibition of the ERK signal pathway, antioxidation and reduction of inflammation.

The 17-year-old male was seen in the Department of Nephrology, Peking University First Hospital on March 18, 2016 due to "polydipsia, polydipsia for 1 year, and elevated serum creatinine with hypernatremia for 3 months". The patient began to have polydipsia and polydipsia 1 year ago, drinking about 3-4 L/d of water, excessive urine output (specifics unknown), and no edema. The local hospital was diagnosed as "psychotic polydipsia", and it is recommended to appropriately limit the amount of water drinking. After taking Chinese herbal medicine for more than 3 months (to 8 months ago), he complained that during this period, his blood pressure was normal, urine output and appetite did not change significantly, and polydipsia and polydipsia improved slightly. Blood pressure 124/74 mmHg (1 mmHg =0.133 kPa) and urine specific gravity were measured six months ago<1.005, urine protein negative, urine glucose negative, urine sediment normal. Serum creatinine was 101.9 μ mol/L (normal reference value: 62-106 μ mol/L), blood urea nitrogen (BUN) was 3.28 mmol/L, blood uric acid was 631 μ mol/L (normal reference value: 150-420 μ mol/L), and the electrolyte was not checked. Benzbromarone 50 mg/time, once/d was given. On re-examination 3 months ago, it was found that serum creatinine increased by 120 μ mol/L (normal reference value: 20-115 μ mol/L), BUN 5.3 mmol/L, serum uric acid 576 μ mol/L, serum cystatin C (CysC) 1.4 mg/L, and serum albumin (ALB) 48.9 g/L; Erythrocyte sedimentation rate (ESR) 82 mm/1 h; Blood sodium 158 mmol/L, blood chloride 117.7 mmol/L, blood potassium 4.63 mmol/L, blood calcium 2.53 mmol/L, blood phosphorus 1.54 mmol/L, blood HCO₃^－24.8 mmol/L. White blood cells 10.7×10⁹/L, hemoglobin 110 g/L, platelets 156×10⁹/L. The urine specific gravity was 1.005, and the urine protein and red blood cells were negative. The urine volume was 2.6 L/d, urinary sodium was 29.3 mmol/L, urinary chloride was 22.7 mmol/L, and urinary potassium was 20.77 mmol/d. Blood immunoglobulin and complement were normal, and antinuclear antibody spectrum was negative. According to the above situation, the local hospital suspected the diagnosis of "renal tubulointerstitial disease, which is likely to be caused by Chinese herbal medicine", and no special treatment was given. It is recommended to continue to monitor the changes in renal function. The patient's thirst lessened and continued to intentionally self-control the amount of water he consumed. After that, serum creatinine fluctuated between 134 and 151 μ mol/L (normal reference value:<115 μ mol/L), BUN 15.8-9.3 mmol/L, blood uric acid 425-511 μ mol/L, blood sodium 163-174 mmol/L, blood chloride 125-133 mmol/L, blood potassium 4.89 mmol/L, blood HCO₃^－22.0 mmol/L. The blood pressure was 101/76 mmHg during the observation period, the urine volume was not recorded, and the spirit, sleep and appetite were good, but the weight decreased by 9 kg during the 2-month period.

The 51-year-old female was admitted to the Department of Endocrinology and Metabolism of Tianjin Medical University General Hospital on July 15, 2016 due to "bilateral knee pain for more than 2 years". Previously, blood pressure was found to rise for more than 10 days without treatment. Right knee arthroplasty was performed in an external hospital 10 days before admission. The patient developed bilateral knee joint pain without obvious trigger 2 years ago, which was aggravated during activity, without fever and swelling. The patient had difficulty walking, accompanied by thirst, increased nocturia and other symptoms, without nausea, vomiting, dizziness, fatigue and other discomfort. He was diagnosed with bilateral knee synovitis and osteoporosis in an external hospital, and underwent right knee arthroplasty. One week ago, the patient came to the outpatient department of our hospital. The laboratory test showed that parathyroid hormone (PTH) was 1 216.47 ng/L (reference value: 10.37~68.84 ng/L), blood calcium was 3.02 mmol/L (reference value: 2.15~2.55 mmol/L), urinary calcium was 4.03 mmol/L (reference value: 2.5~7.5 mmol/L), urinary phosphorus was 16.3 mmol/L (reference value: 23~48 mmol/L), no abdominal and lumbar pain, no digestive diseases, no skin itching and other discomfort. The patient is married at appropriate age, and the spouse and children are in good health. A family genetic history is denied.

The patient was a 52-year-old male, right-handed, with a history of diabetes for 6 years and a history of smoking and drinking for more than 30 years. On August 24, 2015, he was admitted to the First Affiliated Hospital of Dalian Medical University with the main complaint of "progressive naming disorder for 4 years, aggravated with irritability for 2 years". Four years ago, family members found that the patient had difficulty in naming, mainly manifested by difficulty in naming unfamiliar things, but they could describe their uses, their ability to understand daily life was still normal, and general daily communication was acceptable. In the past 2 years, the patient's language barrier has progressively aggravated, and his listening and comprehension ability has gradually declined, mainly manifested by difficulty in naming unfamiliar things, and inability to call acquaintances by name; Can't fully understand what others are saying, can do the job, but have difficulty communicating with colleagues; Unable to fully understand the meaning of the newspaper, dysphoria to writing less commonly used words. His memory, attention and orientation have not decreased significantly, and he can still take care of himself in daily life. He can play cards and other daily activities. With the progressive aggravation of language barrier, patients gradually appear not to like to communicate with others, lazy, depressed, irritable and anxious. In the past six months, irritability and anxiety have increased due to family affairs. Cognitive function examination: Visual space, executive function, attention and orientation were not significantly affected, language and abstraction function were slightly impaired, and naming function was significantly impaired. The impairment of naming function is mainly manifested by knowing the purpose and properties of objects but not being able to name them. The impairment of language and abstraction ability is mainly manifested by the inability to retell and summarize a kind of words. Other neurological examinations showed no obvious positive localization signs. Improve head MRI, EEG, MOCA, WAB, blood routine, rheumatism immunity, folic acid, vitamin B₁₂, thyroid function test, liver and kidney function, blood glucose, blood lipids, chest X-ray and other related auxiliary examinations, but the patient refused to undergo PET or SPECT examination and MRI review for personal reasons.

The patient, a 50-year-old man, has been engaged in electric welding for 10 years. On November 21, 2015, he was admitted to the hospital with the main complaint of "head confusion for 17 days, aggravated with diplopia for 13 days". On November 4, he developed head confusion after fatigue, abnormal mental behavior (manifested as sleepiness, indifference, dislike of communication, preference to eat sweets and sugar cakes three times a day), diplopia, poor speech, dysphagia, choking and coughing after drinking water, weakness of limbs (manifested as difficulty going up and down stairs, unable to hold things), and no epileptic seizures. Since the onset of the disease, the patient has increased sleep and anorexia, and his body weight has decreased by about 5 kg. Past history: Hypertension history for more than 1 month. Personal history: Smoking for more than 20 years, about 20 cigarettes/d. Physical examination of nervous system: clear consciousness, poor spirit, poor speech, normal memory, computing power and orientation power. Diplopia in both eyes, spontaneous horizontal nystagmus on the left side, spontaneous upper right rotating nystagmus on the right side, and large nystagmus amplitude. The right corner of the mouth is lowered, the bilateral nasolabial folds are symmetrical, the soft palate is weak to the right, the uvula vertically deviates to the left, the right pharyngeal reflex disappears, and the extension of the tongue deviates to the right. The proximal muscle strength of both limbs was grade 5, the distal muscle strength was grade 3, the tendon reflex of both upper limbs was symmetrical, the knee reflex of both lower limbs was weakened, the right ankle reflex disappeared, and the left ankle reflex was weakened. The right Babinski sign was positive, the left Babinski sign was suspected positive, the right needle sensation was weaker than the left, Romberg sign (+), and there were no obvious positive signs. CT scan of the admitted chest showed multiple patches and blurred high-density shadows in both lungs, and consolidation in the middle lobe of the right lung. Cranial MRI plain scan + enhancement showed no obvious abnormalities (Figure 1)。 Results of lumbar puncture showed: pressure 105 mmH₂O (1 mmH₂0=0.009 8 kPa); Total number of cells 400 (normal value<100), no malignant cells were seen; Protein 0.66 g/L (normal value 0.15-0.45 g/L). Antibody detection of autoimmune encephalitis showed that anti-N-methyl D-aspartate receptor (NMDAR) antibody was positive in cerebrospinal fluid and negative in serum. After the treatment with human immunoglobulin and methylprednisolone sodium succinate on the same day, the patient's head was confused and limb weakness was aggravated (manifested as inability to get out of bed, inability to hold a pen and chopsticks, and inability to take care of himself), but diplopia, poor speech, dysphagia, choking and coughing after drinking water were all better than before. On December 2, the thyroid function examination showed that the thyroglobulin antibody was 154.3 U/ml (normal value 0-60 U/ml) and the thyroid peroxidase antibody was 261.3 U/ml (normal value 0-60 U/ml). The results of serum paraneoplastic antibody profiles showed: anti-RI antibody (+) and anti-Hu (+). Immediate chest CT enhancement showed irregular soft tissue mass shadow in the right hilum with mild uneven enhancement, suggesting that the middle lobe of the right lung occupied space, lung cancer was possible, and lymph node metastasis in the mediastinum and right hilum was observed. Fiberoptic bronchoscopic biopsy revealed small cell malignancy. Then the patients underwent 4 and 6 courses of chemotherapy after reexamination of chest CT enhancement, respectively, showed that the space occupied by the right hilar was reduced compared with the previous, and the soft tissue mass shadow at the right hilar was significantly reduced compared with the previous. At this time, anti-NMDAR antibody in cerebrospinal fluid was weakly positive; head¹⁸F-FDG-PET showed increased radioactivity uptake in bilateral frontal, temporal and parietal cortices with multiple basically symmetrical distributions (Figure 1)。

Mixed pheochromocytoma is a mixed tumor of pheochromocytoma and ganglioneuroma, ganglioneuroblastoma, neuroblastoma or peripheral nerve schwannoma, also known as combined pheochromocytoma, compound or mixed adrenal medulla tumor, which is mostly reported as a case at home and abroad. The diagnosis and treatment process of a case of pheochromocytoma complicated with ganglioneuroma is now sorted out, hoping to be helpful to understand the disease.

Primary extrahepatic portal vein obstruction (EHPVO) refers to the obstruction of the main trunk of the extrahepatic portal vein or cavernous degeneration of the portal vein caused by non-cirrhotic and non-neoplastic causes, with or without obstruction of its branches. Isolated intrahepatic portal vein, mesenteric, and splenic vein obstruction does not belong to the category of extrahepatic portal vein obstruction^[1,2,3]。 Primary EHPVO is a common cause of non-cirrhotic portal hypertension in developing countries (54%)^[1,2,4]It is also the most common cause of upper gastrointestinal bleeding in children (68% ~84%)^[1,5,6]。 However, the disease is less common in Western countries, accounting for only about 11% of the causes of portal hypertension^[1,6]。

There are many factors that lead to the formation of hypertrophic scars (HTS), and local mechanical stress is the main cause. HTS formation is a mechanical stress-induced intracellular adaptive behavior^[1]。 Mechanical stress acts on the tissue after injury, and the extracellular matrix changes its chemical composition and stiffness, initiating the repair process^[2]。 When integrin binds to specific ligands in extracellular matrix, it causes a large number of cytoskeletal proteins to recruit in cells to form adhesion spots. The formation and deformation of adhesion spots are the initiation of mechanical signal transmission. The LINC complex is located on the nuclear membrane and is a molecular structure that connects the cytoskeleton with the nuclear skeleton. Cytoskeletal proteins form a complex molecular structure network with LINC complex and nuclear skeleton, which mechanically combine the extracellular matrix and nucleus to transmit mechanical signals from the extracellular to the chromatin in the nucleus, causing the expression changes of target genes^[3]。 At the same time, mechanical stress also activates transforming growth factor (TGF) -β in the latent state in the extracellular matrix through integrin, and TGF-β enters the nucleus through the nuclear pore complex with the help of Smad, causing changes in target gene expression^[4]。 The mechanism by which mechanical stress leads to hypertrophic scarring is described below.

Noise is an important hazardous factor in production and life, which can cause health problems such as elevated blood pressure, poor mental condition, insomnia, troubles, anxiety, tinnitus and noise-induced hearing loss. According to statistics, about 1/3 of the world's population suffers from various hazards caused by noise^[1]。 Noise hazard is a key concern in the field of labor hygiene and environmental hygiene, and many research results have been produced. However, the research is mostly concentrated on factories, transportation, military, etc., and the research on hospital noise is less. This paper summarizes the research progress of hospital noise in order to provide new ideas for hospital noise research.

Currently, the global incidence of atrial fibrillation (AF) ranges from 1.5% to 2.0%. AF increases the risk of stroke, so long-term anticoagulant therapy is required for patients with AF. When AF patients have a history of heart failure (HF), chronic renal insufficiency (CKD), diabetes, stroke/transient cerebral ischemia, coronary heart disease, or are elderly, their risk of stroke and death will increase accordingly^[1]。 Rivaroxaban is a new type of oral anticoagulant, which has the characteristics of fixed dose, rapid onset of action and no need for routine coagulation monitoring. This review will focus on the overview of the study of rivaroxaban in special populations with AF (with history of HF, CKD, diabetes, stroke/transient cerebral ischemia, coronary heart disease, etc., or elderly).