Volume 97  ·  Issue 42  ·  2017

The treatment concept of modern medicine is gradually changing with the progress of the times. In 2011, four major authoritative institutions in the United States jointly issued the initiative "Towards Precision Medicine", which caused huge repercussions in the academic community. In January 2015, Obama introduced the "Precision Medicine Plan" in his State of the Union address. So far, the concept of precision medicine that advocates "personalized treatment" has been rapidly promoted, and it has served as a pilot symbol in the global scientific research and medical circles to guide the development of human health. Traditional Chinese medicine takes "syndrome differentiation and treatment, holistic view" as its core, and advocates the idea of "adapting measures to people and local conditions", which is unified with the concept of personalized treatment of precision medicine, but there is "macro and micro" opposition in the way of seeking the concept. This paper discusses the relationship between the two in detail.

Obesity has become a major public health problem in today's society^[1]。 Unlike fat stored in subcutaneous tissues, obese people produce excessive serum free fatty acids (FFA), which exceed the oxidative capacity of tissues. They are converted into non-adipose tissues (liver, heart, skeletal muscle, pancreatic islet beta cells) and esterified into triacylglycerol (TG), which accumulates in cells and eventually leads to organ steatosis. The liver is the site most prone to lipid deposition. Intrahepatic fat deposition is defined as non-alcoholic fatty liver disease (NAFLD), which may lead to non-alcoholic steatohepatitis (NASH), cirrhosis, and even liver cancer. Pancreatic fat deposition was first discovered in 1926 and has not received sufficient attention compared to NAFLD. At present, with the gradual deepening of research, it has been found that pancreatic fat deposition can be a risk factor for NAFLD^[2]Nonalcoholic adipose pancreatic disease (NAFPD) can be used to describe this type of disease. In China, the incidence of NAFPD is about 12.9% ~16%^[3,4]Its pathogenesis is still unclear, and it may be a combination of chronic inflammation, endoplasmic reticulum stress, leptin resistance and other factors. NAFPD may be an important manifestation of metabolic syndrome, and is influenced by many factors such as advanced age, gender, race, obesity, hypertension, type 2 diabetes, ALT, etc. The diagnosis of NAFPD mainly depends on imaging, the most commonly used is abdominal ultrasound, but it is easy to be misdiagnosed. Various evidences suggest that NAFPD may be closely related to pancreatic dysfunction, insulin resistance and type 2 diabetes, and may also promote the occurrence of acute pancreatitis and pancreatic cancer, and affect their prognosis; However, the relationship with chronic pancreatitis and pancreatic fibrosis is still unclear. NAFPD is a new concept. At present, there are few studies on the treatment of NAFPD, and it has not attracted widespread attention in China. The purpose of this article is to review the current research on NAFPD and provide help to improve the understanding of NAFPD in clinical practice.

To investigate the effects of recombinant human growth hormone (rhGH) on metabolic parameters in patients with craniopharyngioma surgeries.

Totallys 30 patients with craniopharyngioma were included in this retrospective study. They were divided into growth hormone (GH) group and control group according to whether they received rhGH therapy or not. The following parameters, including body mass index (BMI), weight, waist circumstance, transaminase, fasting blood glucose, lipid profile and high-sensitivity C-reactive protein (hsCRP) were compared after rhGH therapy for 4-6 months.

In GH group, patients were 18-46 (30.0±8.8) years old. The duration after craniopharyngioma surgery was (12.9±5.4) years. Before rhGH therapy, they had got sufficient thyroid and glucocorticoid hormone replacement. After rhGH therapy, the body weight decreased from (92.3±20.1) to (87.6 ±14.6) kg (P=0.190), with a reduction of BMI from (30.1±5.9) to (28.2±3.7) kg/m² (P=0.120). The waist circumference decreased from (104.4±9.4) cm to (98.8±10.6) cm (P=0.002). Alanine aminotransferase (ALT) decreased from (52±34) to (28±19) U/L (P=0.029), with a reduction of aspartate transaminase (AST) from (46±21) to (33±18) U/L (P=0.035) and γ-glutamyl transpeptadase (GGT) from (59±42) to (29±15) U/L ( P=0.02). hsCRP decreased from (5.3±4.9) to (2.3±2.8) mg/L (P=0.006) and triglyceride (TG) decreased from (1.8±0.7) to (1.5±0.6) mmol/L (P=0.028). Fasting blood glucose, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and free fat acid (FFA) were not significantly changed(all P>0.05). In the control group, the above mentioned parameters did not changed significantly during 4-6 months of observational period(allP>0.05).

rhGH therapy improves metabolic parameters in patients after craniopharyngioma surgery by decreasing body weight, waist circumstance and fat deposit in liver, as well as lowering TG and hsCRP levels.

To investigate the role of adrenal vein sampling (AVS) in identifying the subtype of primary aldosteronism (PA).

AVS was performed in 50 patients who were confirmed as PA between September 2010 and September 2016 in Nanjing Drum Tower Hospital. Clinical, biochemical and follow-up data were reviewed retrospectively. Bilaterally simultaneous catheterization without cosyntropin stimulation and contemporaneous cortisol measurement during AVS were used. Selectivity index (SI)≥1.5 suggested that the sample was from the adrenal vein.Lateralization index (LI) ≥2 suggested unilateral disease.Clinical data was further compared and the AVS findings were analyzed.

AVS was successful performed in 41 cases of 50 patients, and the success rate was 82%. According to the results of AVS and postoperative pathology, 41 cases were divided into aldosterone-producing adenoma (APA)/unilateral adrenal hyperplasia (UAH) group (24 cases) and idiopathic hyperaldosteronism (IHA) group (17 cases). Compared with IHA group, patients with APA/UAH showed longer duration of hypertension[10.0 (5.0, 13.0) y vs 4.0 (2.0, 8.0) y, P=0.046], higher proportion of hypokalemia (95.8% vs 64.7%, P=0.009). Furthermore, patients with APA/UAH demonstrated lower plasma renin activity (P=0.089), higher plasma aldosterone concentration and aldosterone to renin ratio (ARR) (both P<0.05). The diagnostic concordance between CT and adrenal vein sampling was only 48.8%(20/41).

The application of bilaterally simultaneous catheterization and contemporaneous cortisol measurement improves success rate and diagnostic accuracy of AVS. AVS is useful in subtype diagnosis of PA with equivocal imaging findings.

To investigate the median effective dose (ED₅₀) of hydromorphone and the appropriate concentration of ropivacaine combined with hydromorphone in epidural labor analgesia.

One hundred and forty nulliparous women undergoing labor selected for delivery with epidural analgesia were enrolled in our hospital from January to June 2016. The first of top 50 women received 0.12% ropivacaine plus 20 μg/ml hydromorphone complex solution, then sequential women were used the modified sequential method to determine the ED ₅₀ and ED₉₅ of hydromorphone. The other 90 women were randomly divided and receieved 0.08% ropivacaine and 15 μg/ml hydromorphone(H1 group), 0.10% ropivacaine and 15 μg/ml hydromorphone (H2 group), 0.12% ropivacaine and 15 μg/ml hydromorphone (group H3) respectively for epidural labor analgesia. In the course of labor, block levels of epidural analgesia, the Bromage scores, analgesia scores and fetal heart rate-uterine concraction were monitored. In addition, onset time of anesthesia, labor time, mode of delivery, cases of increased oxytocin using, neonatal Apgar score, incidence of nausea and vomiting, itching and fetal heart reduction were recorded.

The ED₅₀ and ED₉₅ values of hydromorphone were 10.49 (95% CI: 8.89-11.79) and 15.15 (95% CI: 13.25-22.25) μg/ml respectively. The onset time in group H1 was significantly longer than those in group H2 and H3((14.23±3.82) , ( 11.32±2.16), (10.83±2.56)min, respectively), the difference was statistically significant ( t=5.854, 6.212, all P<0.05). Analgesic VAS score at 30, 60 and 90 min time points in H1 group was significantly higher than that in H2 group and H3 group (allP<0.05). VAS score at withdrawal in H1 group was significantly higher than that in group H3 ( (3.25±0.75) vs (0.27±0.12) ), the difference was statistically significant (t=9.314, P<0.05). VAS scores at the fourth, fifth, sixth contractions after analgesia in H1 group were significantly higher than those in H2 and H3 groups (allP<0.05). The incidence of motor nerve block in group H3 was higher than that in group H1 and group H2 (26.67%, 6.66%, 3.33%, respectively), the difference was statistically significant (χ²=6.413, 4.320, all P<0.05).

0.10% ropivacaine combined with 15 μg/ml hydromorphone has a good analgesic effect, slight motor block, high safety and worthy clinical application for labor analgesia.

To investigate the association of programmed cell death 1(PD-1), T cell immunoglobulin mucin 3 (TIM-3) and triggering receptor expressed on myeloid cells-1 (TREM-1) genes polymorphisms with pulmonary tuberculosis susceptibility.

In this case-control study, peripheral venous blood of 100 pulmonary tuberculosis patients (pulmonary tuberculosis group) in the Jintan People′s Hospital of Changzhou and of community physical examination volunteers (health control group) was collected from Mar 2015 to Sep 2016. A total of 66 single nucleotide polymorphisms (SNP) in PD-1, TIM-3 and TREM1 sequences were selected and SNP genotype and allele frequency were analyzed using the next-generation sequencing technology. Association of these SNP with pulmonary tuberculosis susceptibility was investigated using linkage disequilibrium (LD) analysis and genetic models.

Among these 66 SNP, 24 SNP with Hardy-Weinberg equilibrium P (HWE-P) value <0.001 or minimum allele frequency (MAF) <0.05 were kicked out. The remaining 42 SNP were analyzed with LD analysis and genetic models. There was no significant difference in genotype frequencies between pulmonary tuberculosis group and health control group (all P>0.05). Five SNP (rs41435650, rs28539662, rs13023138, rs75565781, rs36084323) in PD-1 were identified in a significant haplotype (TACGC) between pulmonary tuberculosis group and health control group (P=0.014). Among these haplotypes, strong LD was observed between rs28539662 and rs75565781 (r²=0.871), as well as rs36084323 (r²=0.864). Rs75565781 showed highest correlation with rs36084323 (r²=0.966).

These SNP in PD-1, TIM-3 and TREM-1 genes are not associated with the susceptibility of pulmonary tuberculosis.

To analyze esophageal motility dysfunction in gastroesophageal reflux disease (GERD) with different severity of esophagitis, and the relationship between the esophageal motility dysfunction and the severity of esophagitis.

GERD patients simultaneously undergone endoscopy and high-resolution manometry were divided into four groups: Non-esophagitis (Non-erosive gastroesophageal reflux disease, NERD) group, mild esophagitis group, moderate esophagitis group and severe esophagitis group. The gender and age were matched for each group, and every group consisted of 80 cases. Nonparametric test was used to analyze the differences in HRM parameters, such as upper esophageal sphincter (UES) pressure, lower esophageal sphincter (LES) pressure, LES length, LES-CD (crural diaphragm) separation distance, and the percentage of failed peristalsis of the four groups, and the differences between each two of the groups were also analyzed.

Nonparametric test showed that the LES pressure and length decreased with the severity of esophagitis, and there were statistical differences (P<0.001,P=0.030). The failed peristalsis percentage increased with the severity of esophagitis and the difference was statistically significant (P<0.001). The LES-CD separation distance was increased with the severity of esophagitis and had statistically significance (P<0.001). When comparing the differences between each two of the groups, there were significant differences (P<0.001,P=0.012, P<0.001,P<0.001) between NERD group and severe esophagitis group in the HRM parameters of the lower esophageal sphincter pressure, the LES length, the LES-CD separation distance, and the percentage of ineffective swallowing in the NERD and severe esophagitis group. The detection rate of HH was significantly increased from NERD to severe esophagitis, the detection rate of HH was 6.3% to 82.5% in gastoracopy and 16.3% to 45.0% in HRM, and the diagnostic consistency was fair (Kappa Value: 0.31).

Hypo-dynamic state of esophageal and HH are the main motility characteristics of erosive gastroesophageal reflux disease, Esophageal motility abnormalities increase in parallel with the severity of GERD from NERD to severe esophagitis, these motility disorders may also play important roles in causing esophagitis.

To explore the value of acute gastrointestinal injury (AGI) grades in inflammatory response of critically ill patients.

Ptients with AGI severity from Ⅰ to Ⅳ were randomly selected(20 for each)from July 2014 to June 2015 in ICU of Yantai Yuhuangding Hospital. The expression of NF-κB were detected by immunofluorescence. The expression of TNF-α and IL-6 were detected by enzyme linked immunosorbent assay (ELISA). Procalcitonin (PCT) and C reactive protein (CRP) were measured. Statistical analysis was carried out.

For AGI grade Ⅰ and AGI grade Ⅱ patients, NF- κB p65 were located mainly in cytoplasm. For AGI grade Ⅲ and AGI grade Ⅳ patients, NF-κB p65 were mainly located in the nucleus, indicating that inflammatory stimulation induces nuclear translocation of NF-κB. With the higher grade of AGI, TNF-α and IL-6 secretion increased significantly.For AGI grade Ⅰ to grade Ⅳ patients, TNF-α were expressed as (89.76±19.78)ng/L, (130.54±23.18)ng/L, (224.65±39.02)ng/L, (293.17±36.79)ng/L, and the difference was statistically significant ( P<0.05) respectively. IL-6 were expressed as (45.96±9.62)ng/L, (89.26±12.77)ng/L, (203.71±58.26)ng/L, (331.18±64.28) ng/L, the difference was statistically significant (P<0.05). With the higher grade of AGI, PCT and CRP levels were significantly increased.For AGI grade Ⅰ to grade Ⅳ patients, PCT levels were (2.65±1.78) μg/L, (3.92±2.14) μg/L, (9.92±3.89) μg/L, (27.34±8.45) μg/L, and the difference was statistically significant (P<0.05). CRP levels were (13.82±4.93) mg/L, (32.14±8.97) mg/L, (93.49±25.72) mg/L, (183.05±51.36) mg/L, and the difference between each group was statistically significant (P<0.05).

There is a certain correlation between AGI classification and inflammatory markers in critically ill patients, which shows that gastrointestinal dysfunction may be the promoter and stimulating factor in systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). This provides a clinical basis for judging the severity of inflammatory response in critically ill patients according to AGI grades.

To analyze the clinical significance of anti- ubiquitin C-terminal hydrolase L1(UCHL-1)autoantibodies in neuropsychiatric systemic lupus erythematosus (NPSLE).

Autoantibodies in cerebrospinal fluid specimen of 56 inpatients were detected by using indirect enzyme-linked immunosorbent assay (ELISA) and the fullmedical history and clinical manifestations were analyzed retrospectively.

The levels of anti-UCHL-1 autoantibodies in NPSLE group were significant higher than that in other controls (P<0.05). The positive rate of anti-UCHL-1 autoantibodies in NPSLE group was 23.7% (9/38), which was higher than that in the control groups (0%). A significant difference of anti-UCHL-1 autoantibodies was observed in the patients with blood system involvement (P=0.012). The positive rates of anti-UCHL autoantibodies in the patients with negative SLE related autoantibodies including AnuA, anti-dsDNA, Acl, anti-nRNP, anti-rRNP and anti-Smantibody negative were 41.7%, 29.4%, 29.2%, 25.9%, 25.0%, 25.0%, respectively.The levels of anti-UCHL-1 autoantibodies had a positive correlation with 24-hours proteinuria (r=0.361, P=0.039).

Anti-UCHL-1 autoantibodies had promising value in the diagnosis of neuropsychiatric systemic lupus erythematosus.

To investigate the protein and mRNA expression of KIF2A in ovarian cancer, and to investigate the migration and invasion ability changes in ovarian cancer cell line HO-8910 transfected by KIF2A-siRNA.

Immunohistochemical method was used to detect the expression of KIF2A in 30 cases of ovarian cancer and 20 cases of ovarian normal tissues. The expression of KIF2A mRNA was detected by RT-PCR. The mRNA and protein expression of KIF2A in cell line HO-8910 was detected by RT-PCR and Western blot after transfected by KIF2A-siRNA in vitro. After the transfection, the cell migration and invasion ability were observed by scratch test and transwell experiments.

The expression of KIF2A mRNA and protein in HO-8910 was significantly lower than that in normal ovarian tissue (P<0.05). The capacities of migration and invasion of HO-8910 was suppressed notably after the knockdown of KIF2A (P<0.05).

KIF2A gene expression was increased in ovarian cancer, and knockdown of KIF2A gene can inhibit the migration and invasion of ovarian cancer cells. It suggested that KIF2A gene may be a new target for the development of ovarian cancer.

To investigate the clinical value of tumor size in the evaluation of endocrinological and histological natures regarding adrenal incidentaloma (AI) patients.

A total of 1 941 AI patients who were hospitalized in Department of Endocrinology, Chinese PLA General Hospital between January 1997 and December 2016 were retrospectively reviewed. The demographics of patients, imaging features, functional status and histological results were analyzed.

Of 1 941 patients, 984 (50.70%) were males, and 957 (49.30%) were females. The median age was 52 years old. Endocrine evaluation according to the mass size showed that the proportion of non-functional AI and primary aldosteronism (PA) was declined from 84.55% (558/660) to 27.95% (45/161) and from 6.82% (45/660) to 0, respectively. The highest frequency of subclinical Cushing′s syndrome (SCS), PA and pheochromocytomas were observed in 2.1-4.0, ≤2.0 and 4.0-6.0 cm group, respectively. Histological results showed that in>6 cm group, the frequency of malignancy were sharply increased. Multivariate logistical regression analysis indicated tumor size had a significant association with the presence of malignancy (OR=1.043, 95% CI: 1.033-1.054, P<0.001). A mass size of 4.0 cm was of great value in distinguishing malignant tumors from the benign ones, with a sensitivity of 89.19%, and a specificity of 69.91%.

Mass size was of great value in the endocrinological evaluation, as well as distinguishing malignant tumors from the benign ones in AI patients.

To explore the key points of anesthetic management for renal cell carcinoma combined with inferior vena cava (IVC) tumor thrombus.

Twenty-seven cases of renal cell carcinoma with inferior vena cava (IVC) tumor thrombus underwent radical nephrectomy and inferior caval venous thrombectomy were reviewed retrospectively during January 2014 to January 2017 in our hospital.Analyzed data includs demographics, classification of tumor, perioperative anesthetic management and monitoring approaches, IVC clamping time , vital signs during cardiopulmonary bypass(CPB), estimated blood loss (EBL), usage of blood products, hospitalization time and ICU time , as well as postoperative outcomes.

Clinical staging revealed 5 patients(18.5%) with classⅠtumor thrombus, 11 patients(40.7%) with levelⅡtumor thrombus, 6 patients (22.2%) with level Ⅲ tumor thrombus and 5 patients (18.5%) with level Ⅳ tumor thrombus. All patients had underwent a balanced general anesthesia technique with volatile agents, opioids and muscle relaxants. In addition to standard ASA monitors, all patients had direct arterial pressure and central venous pressure monitoring, and blood warming and infusing system. TEE was utilized in 9(33.3%)patients and in which contains all 5 patients(100%)with level Ⅳ tumor thrombus. Intraoperative TEE guidance resulted in a significant surgical plan modification in 1 patient(11.1%). Compared to patients with class Ⅰ(313 (136, 346) min), classⅡ(302(245, 393)min)and classⅢthrombus tumor(391(272, 505)min), patients with Class Ⅳ had longer operating time (525(481, 647)min, P<0.05). Compared to patients with Class Ⅰ(600(500, 850)ml), Class Ⅱ(1 700(750, 3 000)ml), and Class Ⅲ(1 775(1 500, 3 000)ml), patients with Class Ⅳ had more blood loss(4 000(2 000, 7 000)ml,P<0.05). The clamping time of Class Ⅰ, Class Ⅱ and Class Ⅲ was 8(8, 9)min, 20(13, 26)min and 10(6, 25)min, respectively, and there is no significant difference (P>0.05) within theses group. The probability of pumping norepinephrine of Class Ⅰ(8(8, 9)min), Class Ⅱ(20(13, 26)min), and Class Ⅲ(10(6, 25)min)had no significant difference (χ²=5.147, P>0.05). Perioperative mortality was 7.4%.

The anesthetic management of Inferior vena cava (IVC) tumor thrombus is rather challenging.The preoperative evaluation with accurate classification of the tumor and the intraoperative intense monitoring of vital signs with appropriate reaction are the key points of anesthetic management for this kind of surgery.

Characterization and evaluation of the uncertainty of the reference materials of cholesterol in aqueous solution.

The certified reference material GBW09203b was weighed accurately and dissolved into methyl cyclodextrin aqueous solution to prepare six kinds of candidate reference materials of cholesterol according to the concentration. The materials were tested for homogeneity and stability using routine methods and were evaluated the uncertainty derived from the inhomogeneity and instability. The uncertainty due to measurement was derived from the purity of the raw material, the weighing and the density measurement. The certified values and expanded uncertainties were calculated according to the ISO Guide. The expanded uncertainty of the certified value was the combination of standard uncertainty of measurement, inhomogeneity and instability. The coverage factor, k, was determined from the Student′s t-distribution corresponding to the calculated effective degrees of freedom and 95% level of confidence.

It showed that the six candidate reference materials were homogeneous and were tested to be stable for at least 1 year at -70 ℃ and -20 ℃ using the isochronous stability study. The relative uncertainties due to the inhomogeneity were 0.14%, 0.11%, 0.13%, 0.47%, 0.39% and 0.11%. The relative uncertainty due to the instability was 0.25% at -70 ℃. The uncertainties of measurement were 0.06%, 0.05%, 0.05%, 0.05%, 0.05% and 0.05%.The certified values (reference value ± expanded uncertainty, mmol/L) were as follows: (0.651±0.004), (1.310 ±0.007), (2.574±0.015), (5.210±0.055), (7.710±0.072), (10.242±0.056) mmol/L.

Six kinds of certified reference materials for cholesterol in aqueous solution have been prepared, which were homogeneity, stable and reliable. It showed that the uncertainty of measurement was very small compared with the uncertainty due to inhomogeneity and instability.

The patient was a 32-year-old male. He was admitted to hospital on 29 Mar 2015 due to swelling of his left lower limb for 2 months. Two months ago, the swelling of the left lower limb appeared without trigger, which was progressively aggravated. The swelling was significantly aggravated after activity, and the movement of the hip joint was mildly limited. There was no discomfort such as pain and paresthesia. MRI showed that neurogenic tumor of left iliac region was waiting to be excluded (Figure 1)。

Pulmonary embolism is a kind of harmful disease, and anticoagulation therapy is its main treatment. At present, the dosage and anticoagulation intensity of anticoagulants related to pulmonary embolism in China mainly follow European and American guidelines, and there is some controversy about whether this is fully applicable to the diagnosis and treatment of Chinese people. Although a variety of new oral anticoagulants are used in clinical practice, warfarin, a traditional anticoagulant, is expected to remain the main drug for Chinese patients with pulmonary embolism for a long time because of its cheap price and suitability for China's national conditions.

As a classic oral anticoagulant, warfarin is commonly used in anticoagulant therapy such as pulmonary thromboembolism, deep vein thrombosis and atrial fibrillation. Various genes influenced the metabolism and effect of warfarin. Vitamin K epoxide reductase complex 1 (VKORC1) and hepatic cytochrome P450 2C9 enzyme (CYP2C9) had the greatest influence on the stable dose of warfarin^[1,2]。 A variety of gene-oriented warfarin dose prediction models have been established internationally, and most of them can only explain about 50% ~60% of the dose difference^[3,4]。 The guidelines do not recommend routine screening for warfarin-related genes, but genetic testing still has implications for assessing patients' sensitivity to warfarin and bleeding risk^[5]。

Diabetic nephropathy (DKD) is one of the most serious chronic complications of diabetes, mainly manifested as albuminuria, which can be accompanied by increased blood pressure and progressive decline in renal function. DKD has become the leading cause of end-stage renal disease (ESRD) in developed countries in Europe and America, and the total number of DKD patients is increasing rapidly in developing countries such as China^[1]。 An observational study^[2]It shows that among the 35.3 million patients hospitalized in China's top three hospitals (2010-2015), since 2011, the proportion of diabetes-related chronic kidney disease (CKD) (0.71%) has exceeded that of glomerulonephritis-related CKD (0.66%), and this trend has become more obvious after 2011. In addition, a similar trend was observed in the general population, with 21.3% of diabetic patients having co-occurring CKD^[2]。 Therefore, diabetes has become the leading cause of CKD in China.

In recent years, nosocomial infections caused by non-tuberculous mycobacteria have gradually increased, especially in immunocompromised patients. However, because the heat exchange water tank system of artificial heart and lung machine (also known as variable temperature water tank, cold and hot interactor, hereinafter referred to as heat exchange water tank system) is polluted in the production process, it has led to the postoperative occurrence of Mycobacterium chimera in heart surgery patients in many countries around the world (Mycobacterium chimaera) infection outbreak case, which has aroused the high attention of many countries, but this incident has not attracted attention in China, and there is a great risk. Therefore, we summarize the cause, development, severity, prevention and control measures and treatment plans of this incident, in order to attract the attention of domestic cardiovascular surgery, cardiology, surgery, anesthesia, infection, hospital infection prevention and control and hospital management, and take measures to actively respond.