Volume 97  ·  Issue 32  ·  2017

Accelerated Rehabilitation Surgery (ERAS) is the application of a series of perioperative procedures and methods supported by evidence-based medical evidence to achieve the goals of reducing surgical stress, reducing complication rate and accelerating recovery^[1-2]。 It was first developed by Swedish doctors Wilmore and Kehlet^[3]In 2001, the application of ERAS in gastrointestinal surgery is the most successful, and in 2006, the ERAS protocol for colorectal surgery has become the basis and basis of today's ERAS^[4]。 Today, the concept of ERAS has covered all aspects of the patient's perioperative period, including preoperative education, perioperative care, optimized anesthesia and surgical procedures, postoperative labor pain, early mobilization and intestinal function recovery, etc. Its core contents mainly include five aspects: (1) optimizing analgesia, (2) early postoperative activity, (3) early postoperative eating and drinking; (4) Avoid or reduce gastrointestinal decompression, (5) Controlled fluid rehydration^[5]。

If a medical institution "violates laws, administrative regulations, rules and other regulations relating to diagnosis and treatment", it is presumed to be at fault under Article 58 of the Tort Liability Act. However, there is no clear legal definition of "diagnosis and treatment norms", and it has not appeared in the legal norms before the promulgation of the Tort Liability Law. Because it is the first application in the legal level of our country, it is difficult to be recognized as a strict legal term at present. Theory and practice are therefore controversial in understanding.

To analyze clinical feature and treatment outcome of young patients with high-risk diffuse large B cell lymphoma.

A total of 122 young patients with high-risk diffuse large B cell lymphoma who were treated in Third Hospital of Peking University during the period from January 2000 to April 2015 were retrospectively analyzed, and the clinical features, laboratory data were included in Kaplan-Meier and prognostic analysis.

In our center, the incidence of young high-risk DLBCL was 27.1% in all DLBCL patients, median age was 44.0 years, 99.2% patients belong to Ⅲ and Ⅳstage, 50% patients had more than two extranodal organs involvement, and the higher proliferation index(Ki-67≥80%) was present in 63.1% of patients, Immunohistochemistry showed that 36.7% patients in 30 cases were double-expressed DLBCL. The overall response rate(ORR) for the whole group was 79.4%, the complete response rate was 39.7% , the 3, 5-year progression free survival rate was 59.8% and 57.0%, the 3, 5-year overall survival rate was 63.5% and 57.8%, respectively. 44.3% patients were refractory-relapsed DLBCL. Rituximab can improve the survival of patients and 3-year overall survival rate was 75.2% vs 46.1%(P=0.001). High-dose chemotherapy was superior to CHOP regimen which 3-year overall survival rate was 84.6% vs 54.1%(P=0.006). Compared with chemotherapy group , auto-hematopoietic stem cell transplantation can improve prognosis of patients and 3-year overall survival rate was 93.4% vs 48.3%(P<0.001). The level of Ki-67, B symptom, ECOG score, the level of LDH, WBC and albumin, ESR level, anemia, rituximab therapy, initial regimens, ASCT, initial treatment outcome and refractory-relapsed were predictive of overall survival. Multivariate analysis indicated that albumin level(RR=5.462, P=0.019), initial treatment outcome(RR=34.863, P<0.001) and refractory-relapsed (RR=24.374, P<0.001)were independent prognostic risk factors.

Young patients with high-risk DLBCL were highly aggressive in clinical and pathological features . Rituximab and high-dose regimens can improve the survival of patients.

To explore the clinical and pathological differences between papillary thyroid carcinoma (PTC) with Graves′ disease (GD) and PTC with Hashimoto′s thyroiditis (HT).

A total of 33 PTC patients with GD and 132 PTC patients with HT in the First Affiliated Hospital of China Medical University from January 2009 to December 2015 were enrolled. The clinical and histopathological data were analyzed.

The average serum concentration of thyroid stimulating hormone (TSH) of PTCs with GD was significantly lower than PTCs with HT [0.01 (0, 0.10) mU/L vs 2.28(1.51, 3.14) mU/L, P<0.001]. However, there was no significant difference between the two groups in nodule diameter [(15.7±7.0) mm vs (13.5±7.8)mm,P=0.14], percentage of lymph node metastasis (LNM) [33.3%(11/33) vs 39.4%(52/132), P=0.52], TNM stage Ⅲ-Ⅳ disease [12.1%(4/33) vs 11.4% (15/132), P=1.00], papillary thyroid micro-carcinoma (PTMC) [60.6% (20/33) vs 60.6%(80/132), P=1.00]and classic PTC in all its variant patterns [81.8%(27/33) vs 75.0%(99/132), P=0.36]. The age (P<0.01,OR=0.95, 95%CI: 0.92-0.98) and PTMC (P<0.01,OR=0.30, 95%CI: 0.13-0.67), rather than TSH (P=0.08) were independently correlated with LNM. Recurrence rate of PTC with GD was significantly lower than PTC with HT (log-rank test, P=0.03). In Cox proportional hazards regression model, variant pattern of PTC was independently correlated with recurrence rate (P<0.05).

GD with PTC wasn′t different from HT concomitant with PTC, except for thyroid function test. In addition, recurrence rate of PTC with GD was lower than that of PTC with HT after controlling TSH in the same level.

To analyze the drug resistance of Escherichia coli (E.coli) from bloodstream infection (BSI) and the predictors of mortality in E. coli bloodstream infection (BSI).

The clinical data of 139 E. coli BSI cases diagnosed from January 2012 to December 2015 in The Second Affiliated Hospital of Zhejiang University School of Medicine, Lanxi Branch (Lanxi People′s Hospital), Zhejiang Province, were retrospectively analyzed. The antimicrobial susceptibility testing was performed using Vitek 2 system. Extended-spectrum beta-lactamases (ESBLs) were detected by disk diffusion confirmatory testing. The factors associated with ESBLs-producing strains were identified by univariate analysis. Multivariate analysis was used to identify independent predictors of infection mortality by applying Logistic regression.

42.4% of E. coli isolates were ESBLs-producing. The resistant rate of imipenem was 0.7%. The percent of ESBLs in hospital-acquired infection was higher than that in community-acquired infection but without statistical significance (48.7% versus 40.0%, P=0.350). Univariate analysis suggested that the percent of ESBLs-producing strains in BSI happened on ≥15 d after admission and in BSI of biliary tract infection source was 76.9% and 68.0%, which were much higher than those in BSI happened on <15 d after admission and in BSI of non-biliary tract infection source (34.6% and 36.8%, P=0.013 and 0.004). The overall mortality of E. coli BSI was 13.7%. Multivariate Logistic regression analysis indicated that Sequential Organ Failure Assessment (SOFA ) score (OR=1.393, P<0.001), ceftazidime non-susceptibility (OR=4.444, P=0.018) and liver cirrhosis (OR=13.513, P=0.001) were independent risk factors of mortality.

The frequency of ESBLs-producing E. coli was high in primary hospital of Zhejiang Province. SOFA score, ceftazidime non-susceptibility and cirrhosis were predictors of poor outcome in E. coli BSI.

To assess the changes of retinal microvasculature in patients with obstructive sleep apnea syndrome (OSAS) evaluated by optical coherence tomography (OCTA).

Adult OSAS patients who visited Beijing Tongren Hospital from Jan 2016 to Apr 2016 and complained of snoring were included in this study. The patients′ general information, results of polysomnography, and OCTA parameters were collected. Patients were divided into three groups according to their apnea hypopnea index (AHI) results: Mild-moderate group, AHI≤30/h; Severe group, 30/h<AHI≤60/h; Extremely severe group, AHI>60/h, and clinical characteristics, polysomnography and OCTA parameters among the three groups were compared.

A total of 27 patients were included in this study with 21 males (77.8%) and 6 females (22.2%). Mean age was (41.7±10.0) years, and the mean body mass index was (27.9±4.5) kg/m^2; Neck circumference was 31-48 cm, mean (39.8±4.3) cm; 8 patients (29.6%) suffered from hypertension that could be controlled; Epworth sleepiness scale scored 1-18 points and mean (8.5±4.4) scores; AHI ranged between 5.5 and 92.1/h with a mean of (46.4±28.6)/h. There were 9 (33.3%), 7 (25.9%), and 11 (40.7%) patients in mild-moderate group, severe group, and extremely severe group, respectively. Compared with severe group, the optic nerve head and radial peripapillary capillaries (RPC) peripapillary vascular density in extremely severe group were significantly decreased (62.4%±1.9% vs 60.3%±1.9%, P=0.041; 64.7%±1.7% vs 62.2%±2.3%, P=0.036).

OCTA has rapid, safe, and objective characteristics in assessing the retinal microvascular changes in OSAS patients. Retinal microvascular damage in patients with OSAS is associated with the disease severity. Reduction of retinal microvascular density in patients with OSAS may be associated with intermittent hypoxia.

To evaluate the value of open surgery repair and endovascular aortic repair in the treatment of abdominal aortic aneurysm which implicate visceral arteries.

From January 2012 to October 2016, 26 patients were reviewed. According to the treatment, they were divided into open surgery group (n=7) and endovascular repair group(n=19). Then, the characteristics and relative data of follow-up of the two groups were analysis.

In open surgery group, there were 7 patients. All of them were men, median age 58(41-62) years and 1 patient were older than 75 years. And in endovascular repair group, there were 19 patients(14 men) of median age 72(66-76) years, 8 patients were older than 75 years. Patients in endovascular repair group were significantly older than who were in open surgery group (Z=-13.06, P<0.05). Complications of open surgery group and endovascular repair group were 57.14% and 15.79% respectively. There was no statistically significant difference (χ²=3.13, P>0.05). During follow-up, the diameters of aneurysm which planted stents were smaller than before.

In the treatment of abdominal aortic aneurysm implicated visceral arteries, open surgery is mainly suitable for the patients with low-risk. But the rate of complications was high. By contrast, endovascular aortic repair with small trauma and high safety, has becoming the first choice.

To evaluate the effects of combining dexmedetomidine with lidocaine cream on extubation reaction in pediatric tonsillectomy.

Eighty children scheduled for tonsillectomy from January to June 2016 in the Lanzhou University Second Hospital, were randomly divided into group C (controll group), group D (dexmedetomidine group), group L (lidocaine cream group)and group R (combing dexmedetomidine with lidocaine group) by digital random table method (n=20). In group D and R, dexmedetomidine 1 μg/kg was injected intravenously after general anesthesia induction, and the same volume of normal saline was given in group L and C. Meanwhile, the children in group L and R were intubated with endotracheal tube coated with compound lidocaine cream at first third, while the children were intubated with endotracheal tube coated with liquid paraffin in group D and C. Heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP) and saturation of pulse oximetry(SPO ₂) were recorded at the time of baseline(T0), before(T1) and immediately (T2) extubation, 1(T3), 5(T4), 10(T5)minutes after extubation. The time of spontaneous breathing recovery and extubation were recorded. Cough score, agitation score and adverse reactions were evaluated during the peri-extubation period.

During extubation, HR were (86.70±6.53), (89.30±4.93), (86.00±4.05) beats per minute at T1, T2, T3 respectively in group D, and they were (90.35±6.60), (91.20±6.44), (90.20±5.43) beats per minute in group L and were (85.70±8.67), (88.10±8.75), (86.95±7.73) beats per minute in group R. HR were (96.15±10.16), (97.75±10.93), (94.35±7.26) beats per minute at T1, T2, T3 respectively in group C. HR were significantly lower in group D, R and L than that in group C at T1, T2, T3(F=6.754, 5.655, 7.191, all P<0.05). Cough score were (1.80±0.70), (1.55±0.69), (1.25±0.44) in group D, L and R respectively. All of them were significantly lower than that in group C(2.45±1.05) (F=0.614, P<0.05). Cough score were significantly lower in group R than that in group D(P<0.05). Agitation score were (1.95±0.83), (1.75±0.72) in group D and R respectively, and they were significantly lower than that in group C(2.90±1.21)(F=9.245, P<0.05). Agitation incidence were 20%, 15% respectively in group D and R, and they were significantly lower than that in group C(60%) (χ²=21.554, P<0.05).

Combining dexmedetomidine with lidocaine cream can effectively alleviate stress and cough reaction during extubation in pediatric tonsillectomy.

To evaluate the efficacy of patient-controlled intravenous analgesia (PCIA)with hydromorphone hydrochloride plusflurbiprofen axetil after endoscopic sinus surgery(ESS).

One hundred patients of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for ESS under total intraveous anesthesia with postoperative PCIA in Beijing Tongren Hospital from October 2015 to April 2016 were randomly divided into 3 groups according to the different formula of PCIA pumpin each group: Group A (hydromorphone hydrochloride 1 μg·kg ^-1·h^-1+ flurbiprofen axetil 200 mg), Group B(hydromorphone hydrochloride 2 μg·kg ^-1·h^-1), Group C( hydromorphone hydrochloride 1 μg·kg ^-1·h^-1). The dosage of PCIA in each group was calculated for 50 h, and was diluted in 100 ml normal saline. All the pump was set up background infusion at a rate of 2 ml/h with a 2 ml bolus dose and a 15 min lock-time.Visual analogue scale (VAS) and Ramsay sedation scores at time points of postoperative 1, 4, 8, 12, 24, 48 h, the number of attempts to press bolus and rate of adverse effects within 48 h were recorded. The differences were compared among the groups.

VAS at postoperative 1, 4, 8, 12 h in Group A was (1.9±0.6), (1.8±0.6), (1.6±0.6), and (1.2±0.4) respectively, in Group B was (1.8±0.4), (1.7±0.7), (1.6±0.6), and (1.3±0.5) respectively, in Group C was (2.5±0.9), (1.7±0.7), (1.6±0.6), and (1.3±0.5) respectively. The difference among each group were statistically significant (F=8.661, 3.105, 4.903, 13.846, P<0.05). VAS in Group A was similar to that in Group B(P>0.05), but was lower than that in Group C(P<0.05). The number of attempts to press bolus within 48 h in group A was 1.4±1.0, which was less than in Group C(2.2±1.8 ,P<0.05). Ramsay sedation score at postoperative 1, 4, 8 h in Group A was (2.4±0.6), (2.2±0.6), and (2.2±0.4) respectively, in Group B was (2.8±0.7), (2.6±0.7), and (2.4±0.6) respectively, in Group C was (2.3±0.6), (2.1±0.4), and (2.1±0.2) respectively. The difference among each group were statistically significant (F=5.660, 6.782, 7.141, P<0.05). Ramsay sedation score in group A was similar to that in Group C(P>0.05), but was lower than that in Group B(P<0.05). The total rate of adverse effects in Group A was 8.8%, which was similar to that in Group C (9.1%, χ²=0.001, P>0.05), but was significantly lower than that in Group B (42.5%, χ²=9.99, P<0.05).

1 μg·kg ^-1·h^-1 hydromorphone hydrochloride plus 200 mg flurbiprofen axetil is effective on PCIA for patients after ESS and can reduce the dosage of hydromorphone hydrochloride and the rate of adverse effects as well.

To investigate the significance of monitoring the gradients between transcutaneous PCO₂ and end-tidal PCO₂ [P(c-et)CO₂] in patients with septic shock.

Thirty-five mechanically ventilated patients with early septic shock were enrolled as the study group and 18 non-septic shock patients with stable hemodynamics as the control group between May 2014 and October 2016. The patients with septic shock were treated by early goal-directed therapy (EGDT) within 6 hours since hospitalization. The differences of baseline level of P(c-et)CO₂ and arterial lactate concentration (LAC) between the two groups and the variations of these indexes after EGDT in the study group were compared respectively.

The baseline levels of P(c-et)CO₂ and LAC in patients with septic shock were significantly higher than those of the control group [(26.0±16.2) mmHg vs (11.0±5.6) mmHg (1 mmHg=0.133 kPa) and (4.0±1.7) mmol/L vs (1.6±0.6)mmol/L, all P=0.000]. The area under receiver operator characteristic (ROC) curve (AUC) for baseline P(c-et)CO₂ and LAC was 0.924 (95%CI: 0.851-0.996) and 0.931 (95%CI: 0.872-1.000), respectively. P(c-et)CO₂ >12.6 mmHg and LAC >2.5 mmol/L could discriminate septic shock patients from those without shock with the same sensibility of 97% and the specificity of 83% and 78% respectively. With regard to the prognosis (Day 28) of the patients with septic shock, AUC for baseline P(c-et)CO ₂ and LAC was 0.709 (95%CI: 0.533-0.886) and 0.714 (95%CI: 0.545-0.883), respectively. P(c-et)CO₂ >20.0 mmHg and LAC>3.6 mmol/L could discriminate survivors from non-survivors with the same sensibility of 92% and the same specificity of 76%. All the patients in the study group completed EGDT within 6 hours after admission, 20 (57.1%) passed EGDT and 17 (85.0%) survived, 15 (42.9%) failed EGDT and 4 (26.7%) survived, and the survival rates were significantly different ( F=9.844, P=0.001). After EGDT, P(c-et)CO₂ (21.0±9.5 mmHg) and LAC(3.3±2.5 mmol/L)reduced significantly compared with the baselines (P=0.008 and P=0.046), and the associated AUC was 0.905(95%CI: 0.792-1.000) and 0.747 (95%CI: 0.576-0.917)respectively. P(c-et)CO₂ > 16.5 mmHg and LAC > 3.1 mmol/L could discriminate survivors from non-survivors with the sensibility of 97% and 91%, and the specificity of 78% and 69%, respectively.

P(c-et)CO₂ >12.6 mmHg could play the same role as LAC in recognizing early septic shock. EGDT was an effective therapy for the septic shock and P(c-et)CO ₂ reflected efficacy. P(c-et)CO₂>20 mmHg before EGDT and >16.5 mmHg after EGDT both could predict the 28 d prognosis of patients with septic shock, and the effect of the former was equal to that of LAC, but the latter was better than LAC.

To compare the treatment effects between negative pressure wound therapy (NPWT) and traditional therapy in diabetic patients with foot ulcers.

Diabetic patients with foot ulcers were selected from Endocrinology Ward between January 2015 and December 2016. All the patients were consecutively selected to receive NPWT in addition to the traditional therapy. Each patient receiving NPWT was individually matched with a patient receiving only traditional therapy and selected as the control group. Patients were controlled in both groups for age, sex and history of diabetes, hemoglobin A1c (HbA1c) level, and severity of the ulcer. Each patient received therapy for 3 months and was evaluated at the end of treatment. Treatment efficacy was evaluated by examining the lesion area before and after the therapy. Outcomes were compared between the two groups using the Chi square test.

A total of 62 patients were included in the study, with 31 cases in each group.Three months later, in the NPWT group, 26 patients had good therapeutic effects, 5 patients had poor efficacy, and 4 patients underwent the surgical treatment. While in the control group, only 18 patients had good therapeutic effects, 13 patients had poor efficacy, and 6 patients underwent surgical treatment. The effective percentage was significantly higher in NPWT group than that of the control group(P<0.05).

NPWT can effectively improve the healing process of patients with diabetic foot ulcers in 3 months.

To explore the effects of chronic intermittent hypoxia (CIH) on left ventricular myocardial contractibility in a rabbit model of obstructive sleep apnea (OSA).

Based on random number table, twenty-four rabbits were randomly divided into three groups: operation, sham, and control groups, each with 8 rabbits. The rabbit model for OSA in operation group was established by repeatedly closing the airway and then reopening it. Upper airway obstructions were conducted on rabbits every day, which were alternately closed for 15 s and then reopened for 75 s in a 90 s-long cycle, for 8 h each day over 3 months. The sham rabbits were subjected to the same surgical procedure but no airway obstructions were applied. The control animals were subjected to no intervention. The blood pressure, left ventricular function parameters were assessed before and after the experiment. And the relative expressions of myosin heavy chain α/β (α-MHC and β-MHC) mRNAs in myocardium were observed for all rabbits by real time fluorescent quantitative polymerase chain reaction 3 months later.

After 3 months, all rabbits in the operation group manifested sleepiness and the blood pressure rose gradually [(114.25±4.20) vs (93.88±2.10) mmHg, P<0.01]. Compared with the sham operation and the control groups, the left ventricular end-systolic volume [(6.05±1.62) vs (2.83±0.49) and (2.74±0.32) ml,P<0.001] and the left ventricular end-diastolic volume [(1.61±0.78) vs (0.83±0.13) and (0.82±0.10) ml] in operation group were obviously higher, the left ventricular ejection fraction [(63.9±4.2) % vs (74.3±2.5) % and (75.8±3.8) %], left ventricular fractional shortening [(32.2±2.1) % vs (41.8±1.8) % and (42.1±1.8) %] and stroke volume [(1.46±0.13) vs (1.93±0.21) and (1.98±0.24) ml/s] were decreased (allP<0.001). Besides, the maximal rate of the increase of left ventricular pressure [(4 154±360) vs (6 802±492) and (6 759±206) mmHg/s], the maximal rate of the decrease of left ventricular pressure [(4 994±621) vs (6 330±314) and (6 591±225) mmHg/s] in the operation group decreased markedly, left ventricular end diastolic pressure (LVEDP) increased [(6.5±1.6) vs (3.3±0.8) and (3.2±0.9) mmHg] (allP<0.001). The relative expression of α-MHC mRNA in left ventricular myocardial tissue was lower and the relative expression of β-MHC mRNA was higher in operation group than those in the sham operation and the control groups (P<0.05). There were no significant difference in the relevant indicators of cardiac function, and in the relative expressions of α-MHC mRNA and the β-MHC mRNA between the control group and the sham operation group (P>0.05).

Repeated intermittent hypoxia can induce hypertension and myocardial contractibility damage in OSA model rabbit simulating upper airway obstruction.

To observe the degradation process of biodegradable magnesium alloy stent (BMAS) in vivo in order to evaluate its degradation time and biological safety.

Twenty-four male New Zealand white rabbits were divided into two groups: group A (n=12) and group B (n=12). The BMAS (a total of 12) was implanted in the infrarenal aorta of each rabbit in group A, while group B was the control group, without treatment. Color Doppler ultrasound was used at the 1, 2, 3, 4 months postoperatively to observe the degradation process of stents in group A. The arterial blood samples and main organs of two groups were also collected for biochemical examination and biosafety. Degradation assessment included transmission X-ray tomography (XRT), scanning electron microscope (SEM) and energy dispersion spectrum (EDS).

The XRT showed that the morphology of the stent was basically intact at 1 month after implantation, then scaffold composites were gradually degraded and absorbed. Degradation was basically completed at 4 months after operation. The early degradation products were Mg²⁺ , then gradually replaced by Ca²⁺ , P and other inorganic composition. There was no obvious adverse reactions in group A during the 4 months follow-up period. There was no statistical difference between the two groups in blood biochemical and pathological results (all P>0.05).

BMAS can be degraded within 4 months in the abdominal aorta of rabbit, and the main degradation products are Ca²⁺ and P, with good biosafety.

To investigate the spinal analgesic mechanism of minocycline in formalin-induced inflammatory pain.

Behavioral test: Male Sprague-Dawley rats(3-5-week old) were randomly assigned into four groups: control, model, vehicle-controlled and minocycline group. Ten percent neutral formalin was injected subcutaneously into the right hind paw dorsum of the rats in model, vehicle-controlled and minocycline group. Normal saline was injected subcutaneously into the right hind paw dorsum of the rats in control group. Before 1 h of formalin injection, the rats in vehicle-controlled and minocycline group received intraperitoneal injection of saline and minocycline, respectively. Licking and lifting time was observed as the behavior results of inflammatory pain. Electrophysiologic experiment: In vitro spinal cord parasagittal slices were prepared from the same rats as above. The effect of minocycline on spontaneous inhibitory postsynaptic currents(sIPSCs) of substantia gelatinosa(SG) neurons was observed using whole-cell patch-clamp technique.

Compared with the control group, the licking and lifting time in the model group was significantly increased. Compared with the vehicle-controlled group, the licking and lifting time in the minocycline group was significantly decreased. Minocycline significantly increased the frequency(t=9.32, P<0.05)but not the amplitude(t=1.54, P>0.05) of sIPSCs of SG neurons, the frequency of sIPSCs of control and minocycline group were (2.5±0.3)Hz and (5.2±0.6)Hz, respectively. When calcium was removed from the extracellular solution, the frequency before and after minocycline perfusion were (0.9±0.1)Hz and (0.9±0.1)Hz, respectively, the amplitude before and after minocycline perfusion were (18.2±0.7)pA and (18.5± 0.6)pA, respectively, the difference of frequency or amplitude was not statistically significant(t=0.32, 0.82, all P>0.05). However, minocycline still increased the frequency of sIPSCs when glutamate receptor antagonists 6-Cyano-7-nitroquinoxaline-2, 3-dione(CNQX) and D-(-)-2-Amino-5-phosphonopentanoic acid(APV) were included in extracellular solution(t=13.51, P<0.05), the frequency of sIPSCs were (2.0±0.1)Hz and (4.3±0.4)Hz, respectively. Minocycline still increased the frequency of IPSCs when voltage-gated sodium channel blocker tetrodotoxin(TTX) were included in extracellular solution(t=8.67, P<0.05), the frequency of IPSCs were (2.2±0.2)Hz and (5.2±0.5)Hz.

Minocycline can attenuate formalin-induced inflammatory pain which may be associated with its increase in the inhibitory synaptic transmission of SG neurons.

Well-functioning hemodialysis pathway is the lifeline of uremic patients, and it is the basic guarantee for patients to undergo regular dialysis to maintain their life. At present, the types of clinical application include autologous arteriovenous fistula, grafted arteriovenous fistula and deep vein catheterization. Central venous patency is necessary to establish any of the aforementioned hemodialysis pathways. For example, repeated deep vein catheterization can cause severe stenosis or occlusion of the relevant central veins of the upper and lower limbs, which makes uremic patients unable to establish hemodialysis pathways by conventional methods and fall into the desperate situation of unsustainable hemodialysis. In this study, the hemodialysis pathway was established by artificial blood vessels in the way of deep femoral artery-deep femoral artery bridging, so that the hemodialysis can continue in these patients with depleted central venous resources, which is reported below.

The patient was a female, born in October 1987, and went to the Department of Endocrinology of Peking Union Medical College Hospital on July 7, 2015 due to the discovery of "karyotype abnormality". The patient was the first birth, the first birth, the full-term natural delivery, the mother's pregnancy period was smooth, and there was no history of special drug use. Birth weight 2.9 kg, length 50 cm. It is a female vulva at birth and is raised as a girl since childhood. Speaking, walking, and height growth rates are similar to those of the same age. Intellectual development is normal. At the age of 10, he developed edema and proteinuria of both lower limbs. He was diagnosed as "nephrotic syndrome" in another hospital. He was treated with glucocorticoids, but his renal function still progressively declined, so he was treated with peritoneal dialysis. At the age of 13, he underwent one kidney transplantation in a local hospital. Postoperatively, his renal function returned to normal, and he was followed up regularly. There was no immune rejection and no recurrence of nephrotic syndrome. The patient has not had spontaneous puberty and has not been diagnosed and treated. At the age of 18, he was admitted to a foreign hospital for "breast development and primary amenorrhea", suspected of "Turner syndrome", and was given estrogen and progesterone replacement therapy for 3 months. During the medication, he had regular vaginal bleeding. After that, the patient stopped taking the drug on his own without further diagnosis and treatment. At the age of 28, the patient went to another hospital again because he had no menstrual cramps, and the karyotype was 46, XY. In order to clarify the cause, he was referred to our hospital for treatment. The patient had no siblings, parents who were not closely married, and had no family history of similar diseases. Physical examination: Height 160 cm, weight 73 kg, body mass index (BMI) 28.5 kg/m², uniformly obese, blood pressure 120/80 mmHg (1 mmHg =0.133 kPa), female appearance, without pigmentation of skin and mucous membranes throughout the body. There are no moles on the face, the hairline is not low, there are no neck webs, and there is no elbow valgus. No axillary hair. Bilateral breast Tanner stage II. There was no significant pigmentation of the skin in the perineal area, and no mass was palpable in the inguinal area. Pubic hair Tanner stage II. The female vulva, the clitoris is not large, the labia majora and minora are poorly developed, and the vagina can be detected, about 8 cm long. No skeletal deformities.

The patient Wang Moumou, male, 48 years old, unmarried, came to the hospital for emergency department due to "acute urinary retention". The patient complained of swelling and pain at the base of the penis, accompanied by thinning of urine and dysuria for 1 h, and incarceration of the nut at the base of the penis for 16 h. Physical examination, the patient's general condition is OK, middle-aged male, anxious face, abdominal examination of liver and spleen is not reached, lower abdomen is swollen, bladder is flat and umbilical, and knocking is void. Penis examination showed that the penis was obviously swollen and purple, with a six-sided nut incarcerated at the base of the penis, and the penis distally from the nut was obviously edematous, with a diameter of 8 cm and a length of 12 cm, and the head of the penis was dark purple. Patients were admitted and diagnosed as follows: (1) Metal nut incarceration at the base of penis; (2) Acute urinary retention.

Patient, male, 67 years old. The main reason was that the bladder mass was found on physical examination and was admitted to hospital for 1 day. There was no macroscopic hematuria, no bladder irritation signs such as frequent urination, urgency and painful urination. No low back pain, fever, nausea, vomiting, dysuria and other discomfort. For further diagnosis and treatment, we came to our hospital. Color ultrasound examination of urinary tract showed that there was a substantial nodule in the right posterior wall of bladder-considering the possibility of cancer. The outpatient clinic was admitted to the hospital with "bladder mass". Previous history of hypertension for 2 years, treatment with oral antihypertensive drugs, poor blood pressure control. After admission, pelvic plain scan + enhanced CT examination showed that the soft tissue mass of the right posterior wall of the bladder was about 1.5 cm ×1.5 cm, and the mass was uniformly enhanced after enhanced scan (Figure 1)。 Physical examination: body temperature 36.6 ℃, pulse 80 beats/min, breathing 20 beats/min, blood pressure 160/95 mmHg (1 mmHg =0.133 kPa), clear mind, no positive signs in heart, lung and abdomen, no percussion pain in both kidney areas, no tenderness and rebound pain in the running area of both ureters, no swelling and no tenderness in the suprapubic bladder area.

Immune checkpoint inhibitors such as programmed death factor-1 (PD-1) /programmed death ligand-1 (PD-L1) are a hot spot in the field of cancer therapy today. Because of its strong specificity, wide applicability and long-lasting effect, it has become a standard or emerging treatment for malignant melanoma (MM), non-small cell lung cancer (NSCLC), bladder cancer, head and neck squamous cell carcinoma, colorectal cancer (CRC), renal cell carcinoma (RCC) and gastric cancer^[1]。 Among unselected patients receiving immune-targeted therapy, only some patients had significant improvements in objective response rate (ORR) and survival outcome. Therefore, how to accurately select clinically beneficial patients has become an urgent problem to be solved in the clinical application of such preparations. At present, researchers have begun to extensively search for biomarkers (BMs) related to efficacy as treatment predictors, hoping to provide references for clinical decision-making.

Vascular access is the "lifeline" of hemodialysis patients, and autologous arteriovenous fistula is recognized as the best vascular access^[1,2]。 The establishment of arteriovenous fistula causes iatrogenic arteriovenous short circuit. Its high flow and low resistance blood flow environment will affect the original blood flow state of cardiovascular system and induce adaptive ventricular remodeling^[3,4]。 High output heart failure is a rare complication of autologous arteriovenous fistula, and it is more common in arteriovenous fistula with high blood flow^[5,7]。 The pathogenesis of autologous arteriovenous fistula-associated high-output heart failure and its correlation with autologous arteriovenous fistula flow are unclear, but patients with high-output heart failure have a poor prognosis^[8]The disease requires clinical attention.

Recent studies have found that brown fat exists in adults^[1]。 Another study found that in addition to white fat and brown fat, there is a third kind of fat tissue in the body, namely beige fat, which exists in the distribution position of white fat, but has similar characteristics and heat-producing function of brown fat, so it is also called white fat browning^[2]。 The browning of white fat has the function of regulating body metabolism and protecting cardiovascular diseases, which provides a new idea for the treatment of metabolic diseases such as obesity and diabetes. In this paper, the role of white fat browning in metabolic regulation and cardiovascular protection, the regulatory factors of white fat browning and its potential clinical application are described.