Volume 98  ·  Issue 01  ·  2018

In November 1915, Chinese Medical Journal was officially published. Dr. Wu Liande, the founder and first editor-in-chief of this journal, clearly pointed out in Volume 1, No. 1: "Those with weak spirit cannot seek the country, and those with weak courage cannot strive for strength". We should "make medical science progressively prosperous and health perfect day by day."^[1]。 As a conference journal of the Chinese Medical Association, for more than 100 years, through the unremitting efforts of several generations, the Chinese Medical Journal has always adhered to the purpose of spreading medical academic ideas, adhered to the principle of high-quality and high-standard article selection and publication, adhered to the national health needs as the guide, insisted on serving readers and medical scientific and technological personnel, continuously promoted international medical science and technology exchanges, and continuously promoted the development of Chinese medical science and technology. It has formed the characteristics of running a journal with strong scientific nature, high authority, great influence and wide coverage, and published a number of important original documents that are milestones in the history of Chinese medical development, witnessing the magnificent journey of Chinese medical and health workers to strengthen the country with medicine and protect people's health with science and technology^[2,3,4]。

Craniopharyngioma is a common histologically benign intracranial tumor^[1]。 Because the volume of the cranial cavity is relatively fixed, if the tumor is removed without surgical treatment, its space-occupying and compressive effects often lead to the dysfunction of the central nervous system and endocrine system of patients, which is life-threatening. Therefore, surgical treatment is the most commonly used and effective method for the treatment of craniopharyngioma in clinic. With the improvement of surgical skills of neurosurgeons and the improvement of various surgical instruments, experienced doctors have been able to completely remove tumors, so that patients can survive tumor-free for a long time. However, on the whole, there is still a tendency at home and abroad to not pursue long-term tumor-free survival, but only to prolong survival time. Almost all treatment methods for benign and malignant tumors, such as total tumor resection, subtotal tumor resection and radiotherapy and chemotherapy, are used for the treatment of craniopharyngioma. Different medical institutions have different strategies for treating craniopharyngioma, and a considerable proportion of doctors still adopt conservative treatment (radiotherapy, internal irradiation therapy and chemotherapy) strategies. In some neurosurgical centers, due to their rich clinical experience, the total resection rate of craniopharyngioma is more than 80%, and the surgical mortality rate is about 2%^[2,3,4,5]。 This suggests that neurosurgeons should be more responsible, and the treatment of craniopharyngioma should aim at total tumor resection and prevention of recurrence.

With the advancement of microneurosurgical techniques and the deepening of understanding of the origin and growth pattern of craniopharyngioma, radical surgical resection has become possible. A large number of cases have been reported, and the overall survival rates of patients with craniopharyngioma reached more than 90% and 80% at 5 and 10 years after surgery, respectively. Therefore, the current focus on the prognosis of craniopharyngioma patients is not only to improve the survival rate, but also to improve the quality of life of patients. It is reported in the literature that the incidence of hypopituitarism in patients with craniopharyngioma is 68% ~100% on the growth hormone axis, 60% ~80% on the gonadal axis, and 55% ~88% on the corticotropic hormone axis; The thyroid hormone axis is 39%-85%; Posterior pituitary dysfunction was 25% ~86%^[1,2,3,4]。 The level of endocrine function after surgical treatment of craniopharyngioma is the basic factor that determines the quality of life of patients. Under high-quality endocrine replacement therapy, not only can they survive for a long time, but some patients can continue to grow and develop, and even retain fertility. However, the differences in tumor types and treatment levels lead to huge and complicated individual differences in endocrine status. The application of various hormones in patients with hypothalamic-hypopituitary function of craniopharyngioma is still very irregular, and the interaction between hormones is difficult to grasp. Therefore, in order to improve the long-term quality of life of patients with craniopharyngioma, it is particularly necessary to formulate a long-term endocrine therapy expert consensus.

The perioperative management of craniopharyngioma is complicated, and the occurrence of various postoperative complications is the most important factor leading to early postoperative death of craniopharyngioma, and also an important factor affecting the neurological function and quality of life of patients^[1]。 Usually, neurosurgeons have insufficient knowledge and experience in the monitoring and treatment of postoperative internal environment and organ function, while intensive care doctors and even neurointensive care doctors lack understanding of the pathogenesis, anatomical basis and surgical factors of postoperative pathophysiological changes of craniopharyngioma, so there are certain difficulties in the perioperative management of craniopharyngioma. Therefore, the Pediatric Neurosurgery Group of the Neurosurgery Branch of the Chinese Medical Association, together with experts in neurosurgery, neurocritical care, critical care medicine and endocrinology, jointly formulated the Chinese Expert Consensus on Perioperative Management of Craniopharyngioma (2017) (hereinafter referred to as the Consensus), in order to improve the level of perioperative treatment of craniopharyngioma and improve the prognosis of patients.

To investigate the pituitary hormone changes of patients with craniopharyngioma of different growth patterns during perioperative period and follow up time.

Retrospective studies were performed on 212 cases of primary craniopharyngioma patient who received total tumor excision surgery in our hospital from January 2001 to May 2012. The characteristics of pituitary hormone and associated clinical manifestation during preoperative, perioperative and postoperative periods were analyzed according to the QST surgical classification.

One hundred and seventy-seven (83.5%) of patients present preoperative hypopituitarism, 36 of them were panhypopituitarism. The hypopituitarism condition was exacerbated during the early stage of post-operation period. The abnormal rates of HPA and HPT during the follow up were 60.1% and 58.3% respectively and hormone replacement treatment was needed for these patients. Craniopharyngioma of different growth patterns showed diversities in the characteristics of hypopituitarism.

QST surgical classification was closely associated with the pattern of hypopituitarism, it can help to optimize treatment and prognosis estimation, and could be important criterion for improving the clinical practice of neuroendocrine monitoring, treatment and health education of patients with craniopharyngioma.

To explore the correlation between the parameters of the new generation of Acoustic Cardiography and brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and cardiac function grading in the diagnosis of heart failure.

One hundred and sixty-eight inpatients, who were hospitalized in Department of Cardiology, Haikou People′s Hospital from May 2016 to July 2017, were enrolled as heart failure group, including NYHA class Ⅰ(n=29), NYHA class Ⅱ(n=40), NYHA class Ⅲ(n=64), NYHA class Ⅳ (n=35). And eighty-seven patients with normal cardiac function were selected as healthy control group. The data of the two groups were analyzed after the Acoustic Cardiography test, BNP determination and LVEF examination.

The differences in QRS duration, electromechanical activation time (EMAT), EMAT%, systolic dysfunction index (SDI), third heart sound (S3) and other indicators among the groups with different levels of cardiac function were statistically significant (P<0.05). The difference in left ventricular systolic time (LVST) between the cardiac function grade Ⅰ and healthy group was not significant (P>0.05), while the differences among the rest groups were significant. There was a positive correlation between QRS duration, EMAT%, SDI, S3 and BNP (t=9.46, 11.38, 12.14, 9.67, respectively, P<0.05); LVST and BNP were negatively correlated (t=-14.27, P<0.05). There was a negative correlation between QRS duration, EMAT%, SDI, S3 and LVEF (t=11.24, -8.764, -2.393, -0.579, respectively, P<0.05). There was a positive correlation between LVST and LVEF (t=23.48, P<0.05). There was a positive correlation between QRS duration, EMAT%, SDI, S3 and cardiac function grading (β=0.003, 0.234, 0.419, 0.352, respectively,P<0.05). There was a negative correlation between LVST and cardiac function grade (β=-0.021,P<0.05).

The parameters of the Acoustic Cardiography test (EMAT%, EMAT, SDI, S3 ) are closely related to BNP, LVEF and cardiac function grading, and can be used as assistant indexes for the diagnosis and evaluation of heart failure.

To investigate the feasibility of low tube voltage, low contrast medium concentration, injection rate and volume (quadri-low) combined with automatic tube current modulation (ATCM) and iterative model reconstruction (IMR) technology in head and neck CT angiography (CTA).

A total of 70 patients whose body mass index (BMI)<25 kg/m² underwent head and neck CTA and digital subtraction angiography (DSA) from January to July 2017 were enrolled in this prospective study. According to random number table, patients were divided into two groups: group A (n=35) was scanned according to the protocol of 120 kV, 150 mAs, 50 ml and 5 ml/s iopromide (370 mg/ml) and filtered back projection (FBP) reconstruction; group B (n=35) was scanned with 80 kV, ATCM with mean tube current of 100 mAs, 30 ml and 3 ml/s iohexol (300 mg/ml) and IMR; the other parameters kept consistent between the two groups. The maximum transverse neck diameter at the level of the hyoid bone, artery CT value and image noise were measured, signal to noise ratio (SNR), contrast to noise ratio (CNR) and figure of merit (FOM) were calculated, and the image quality was evaluated subjectively and compared with those reconstructed by DSA. Scan length, volume CT dose index (CTDIvol) and dose length product (DLP) were recorded, and the effective dose (ED) was calculated. The chi-square and independent-sample t tests were used to compare the inter-group differences in these aforementioned data.

No significant difference was found in general information between the two groups. No significant difference existed in artery CT value, image noise, SNR and CNR between the two groups (t=-1.170-1.365, all P>0.05); however, the FOM of group B (74±40) was significantly higher than that in group A (12±4) (Z=-7.195, P=0.000). The image quality of the two groups met the requirement of clinical diagnosis[(4.1±0.7) vs (4.2±0.8) points, Z=-0.592, P>0.05], no significant difference was found in subjective evaluation and diagnostic efficacy. The CTDIvol, DLP and ED in group B were all significantly lower than those in group A (Z=-7.728, -7.202, -7.206, all P<0.05). The iodine load and iodine delivery rate (IDR) of group B was lower than that of group A (18.5 g vs 9.0 g, 1.85 mg/s vs 0.90 mg/s), and they were reduced for 51.4% in group B.

For patients of BMI <25 kg/m ^2, low tube voltage, low contrast medium concentration, injection rate and volume combined with ATCM and IMR technology can significantly decrease radiation dose, iodine load and IDR while maintain the image quality in head and neck CTA examination.

To explore the relationship between creatinine reduction ratio (CRR) and delayed graft function among kidney transplant recipients from donor of cardiac death (DCD). To define the value of CRR to predict delayed graft function (DGF) in early post-transplant period.

86 patients were included, who received renal transplantation from DCD during Jan 1^st 2011 to Jun 30^th 2016. We performed a retrospective study and collected creatinine data within 3 days post-operation and marked them with Cr1, Cr2 , Cr3, and then calculated creatinine reduction ratio day-2 (CRR 2) =(Cr1-Cr2)/Cr1×100% and creatinine reduction ratio day-3 (CRR 3)=[(Cr1-Cr2)/Cr1+ (Cr2-Cr3)/Cr2]/2×100%. Patients were divided into two groups by DGF or not. We compared the CRR differenc between DGF group and no DGF group, and drew the receiver operating characteristic curve (ROC curve) to find out the cut-off value to predict delayed graft function.

Among 86 patients, DGF appeared in 17 patients. The incidence of DGF was 19.8%. The CRR 2 of patients in no DGF group was (37.5±17.4)% while patients in DGF group was (2.0±24.8)% (P<0.001). The CRR 3 of patients in no DGF group was (32.5±13.1)%, while patients in DGF group was (6.8±17.1)% (P<0.001). Acorrding to ROC curve, when cut-off value of CRR 2 was defined as <20.7%, the predicted value of DGF was the best, sensitivity was 85.5%, specificity was 76.5%, and area under the curve was 0.876. In the same way, when CRR 3 was defined as <17.6%, sensitivity was 89.9%, specificity was 76.5%, area under the curve was 0.872.

It is reliable to predict DGF by CRR during early post-operative period. CRR shows high sensitivity and specificity and it is simple. It could guide the adjustion of immunosuppressive regimen, prevent early rejection and improve prognosis.

To assess the morphological parameters of the piriformis muscle through magnetic resonance imaging(MRI) so as to further elucidate the pathogenesis of piriformis syndrome (PS).

From September 2015 to October 2016, 30 suspected PS patients and 30 normal controls were enrolled in this study from the Nanfang Hospital, Southern Medical University. The possible causative factors of the PS in the patients were obtained, and the PS patients were divided into subgroups according to the anatomic site of the tender regions. The parameters of the maximum thickness (cm), area (cm²) and the volume (cm³) of the piriformis muscle of both groups were measured by MRI and were statistically compared between the groups with the independent-sample t test so as to investigate the pathogenesis of injured sciatic nerve.

Twenty-six patients were verified with PS, unhealthy sitting postures presented in 16 patients (61.5%) and no trauma history was recorded in these patients. Fifteen cases (57.7%) with tenderness located at the suprapiriformis foramen region (SPF group, n=15), 11 patients (42.3%) with tenderness at the piriformis muscle (PM group, n=11). The thickness, area and volume of the pathological side piriformis muscle in the PM group were all significantly higher than the corresponding indexes in the control group[(2.24±0.46) vs (1.66±0.30) cm, (14.4±2.2) vs (8.8±2.1) cm^2, (23.9±3.8) vs (15.2±2.6) cm^3, respectively, t=4.699, 7.437, 8.291, all P<0.05]and were all higher remarkably than those in the SPF group[(1.62±0.20) cm, (8.7±1.6) cm^2, (14.1±4.8) cm^3, respectively, t=4.640, 7.631, 5.589, all P<0.05]. No significant difference was observed in the up-mentioned indexes between the SPF and the control group (t=-0.439, -0.102, -1.083, all P>0.05).

Tender region at the buttock indicates the lesion site in the PS patients. The PS patients with tenderness at the suprapiriformis region might originate from another pathogenesis independent of piriformis muscle compression, the injury of the sciatic nerve or its branch maybe due to the indirect crush by the soft tissue of the suprapiriformis region under an unhealthy sitting posture.

microRNA targeted to chronic myeloid leukemia Bcr-Abl oncogene were screened using the deacetylase inhibitor suberoylanilide hydroxamic acid (SAHA).

The proliferation inhibition effect of SAHA on chronic myeloid leukemia K562 cell was detected by MTS method, and the optimal concentration of SAHA reaction was determined. Western blot was used to detect the level of PARP protein, and making sure whether SAHA induced apoptosis of K562 cell. Effect of SAHA on Bcr-Abl Gene Transcription in K562 Cells was determined by Fluorescence Quantitative PCR. The online software Target Scan and real-time fluorescence quantitative PCR was used to screen Bcr-Abl-targeted microRNA. The viability of K562 cells and Bcr-Abl transcription levels were detected by MTS method and quantitative PCR respectively after selected microRNA were transfected into K562 cell.

SAHA significantly inhibited the proliferation of K562 cells and induced apoptosis, meanwhile SAHA significantly down-regulated the transcriptional level of Bcr-Abl gene. After treatment of K562 cells with SAHA, two microRNA, miR-192 and miR-6816, which could target Bcr-Abl, were screened by Target Scan and quantitative PCR. Additionally, SAHA induced the miRNAs to up-regulate 14.5 and 5.2 times, respectively. Transfection of miR-192 and miR-6816 to K562 cells significantly inhibited K562 cell viability and down-regulated the transcriptional level of Bcr-Abl gene.

Acetylation inhibitor SAHA promoted the expression of miR-192 and miR-6816 in K562 cells by acetylation regulation, miR-192 and miR-6816 further down-regulated the transcription of Bcr-Abl gene, thereby inhibiting K562 cell proliferation and induced apoptosis.

To investigate the expression changes of high mobility group box-1 (HMGB1) and the 2B receptor of N- methyl -D- aspartate receptor (NR2B) in status epilepticus (SE).

(1) Primary hippocampal neurons from SD rats with 16 to 18 days of fetal age were cultured in vitro for 7 days, and exposed to Mg²⁺ free media for 3 hours. Those cultured neurons were randomly divided into control group and intermittent hypoxia group. (2) SD rats with similar weight were selected and randomly divided into control group and SE model group. The rat model with SE was established by an intraperitoneal injection of lithium chloride-piloearpine (LI-PILO). Real-time PCR technique was used to detect the expression of HMGB1 and NR2B mRNA.

In Sombati′s cell model cultured in normal concentration of oxygen, the HMGB1 mRNA expression levels were 0.005 01±0.000 54, 0.026 76±0.003 75, 0.003 52±0.000 33, and the NR2B mRNA expression levels were 0.008 84±0.000 69, 0.012 23±0.000 90, 0.029 11±0.000 71, respectively, at 2, 4 and 6 h; compared with the expressions of HMGB1 and NR2B mRNA at the same time points of Sombatis cell model groups, the differences were also significant (all P<0.05). After the successful establishment of epilepsy model, the HMGB1 mRNA expression levels were 0.000 11±0.000 09, 0.000 18±0.000 01, 0.000 11±0.000 01, and the NR2B mRNA expression levels were 0.196 12±0.009 41, 0.232 11±0.006 27, 0.272 48±0.005 84, respectively, at 6, 8 and 10 h; compared with the expressions of HMGB1 and NR2B mRNA at the same time points of control groups, the differences were all significant (allP<0.05).

HMGB1 mRNA expression levels increase at 2, 4 h, decrease at 6 h in the Sombati′s cell model in normal oxygen culture, while increase at 6, 8 h, and decrease at 10 h in LI-PILO induced rat model with SE; the NR2B mRNA relative expression increases with time in both the Sombati′s cell model in normal oxygen culture and rat model of SE.

connective tissue disease (CTD), including systemic lupus erythematosus (SLE), primary Sjogren's syndrome (PSS), etc., is a systemic disease in which the body's immune system produces an immune response to its own muscles, joints, skin and other connective tissues and causes damage to multi-system functions, including the central and peripheral nervous systems^[1]。 The incidence of peripheral neuropathy (PN) associated with CTD varies greatly in previous literature reports, ranging from 1.5% to 45% for SLE and 7.5% to 45% for PSS^[2,3]。 At present, it is believed that the main mechanism of PN is that CTD can induce inflammatory reaction of small vessels, leading to inflammatory occlusion of small vessels, thus causing peripheral nerve dystrophy and functional impairment. Other special causes such as rheumatoid arthritis and sarcoidosis, such as multiple nodules, can also cause the occurrence of PN^[1]。 In order to better understand the clinical and electrophysiological characteristics of CTD-related PN, this study retrospectively analyzed the clinical data of 13 patients with CTD-related PN, and summarized their clinical and electrophysiological characteristics.

A 48-year-old male was admitted to the Department of Gastroenterology of Peking Union Medical College Hospital for "repeated abdominal pain and melena for more than 6 years". In August 2011, I developed lower abdominal cramps without trigger, with visual analogue scale (VAS) of 5 to 6 points, accompanied by abdominal distension, nausea, and thin strips of melena, 1 to 2 times/d, with a volume of about 300 ml, which relieved spontaneously after 3 to 4 days, and then attacked once every 2 months without diagnosis and treatment. In April 2012, abdominal pain worsened with post-activity fatigue. In the first hospitalization in our hospital, the hemoglobin was checked at 90 g/L (iron 4 indicated iron deficiency anemia), and the occult blood in the stool was continuously positive. Erythrocyte sedimentation rate, high-sensitivity C-reactive protein and lactate dehydrogenase were normal. Tuberculin test, lymphocyte culture plus interferon assay (T-SPOT.TB), cytomegalovirus DNA and fecal pathogen culture were all negative. Anti-nuclear antibody, anti-extractable nuclear antigen antibody and anti-neutrophil cytoplasmic antibody were all negative. No obvious abnormalities were found in gastroscopy, colonoscopy and small intestine air barium double angiography. Abdominopelvic enhanced CT + small intestine reconstruction: Group 3 had localized thickening of distal small intestine with abnormal enhancement of mucosal surface, about 2.5 cm long, rough serosal surface and slightly narrow intestinal lumen; There were more mesenteric vascular shadows, multiple small lymph nodes on the mesenteric side, multiple lymph nodes at the mesenteric root, retroperitoneal and bilateral inguinal areas. Capsule endoscopy showed large exudation of jejunum (small intestine of groups 2 and 3), mild mucosal edema, active bleeding, seemingly mucosal bulge, surface ulcer, covered with white coating; Another ulcer was seen in the jejunum, covered with white coating, and there was no congestion and edema in the surrounding mucosa; The end of the ileum is scattered with multiple small protuberances with a white surface. Transoral enteroscopy showed multiple mucosal erosion and worm-like ulcers from the horizontal part of the duodenum to the middle of the jejunum, some of which were covered with thin white coating, some of which had a little red bleeding on the surface, and there was no obvious congestion and edema in the mucosa around the lesion. There were no abnormalities in the interlesional mucosa (Figure 1)。 The pathology of mucosal biopsy of jejunal ulcer showed chronic inflammation of small intestinal mucosa, high hyperplasia of lymphoid tissue, CD20 (+), CD3 (+). Clinically, Crohn's disease is not excluded, and Podesian 1 g is administered orally 4 times/d. After discharge, abdominal pain and melena were still intermittently attacked, but the frequency of attacks was reduced to once every 3 months. The monitoring of occult blood in stool was intermittently positive, and the hemoglobin was normal. In October 2013, the abdominopelvic enhanced CT + small intestine reconstruction was reviewed: the distal lesions of small intestine in group 3 were reduced compared with the previous. Since September 2015, the frequency of abdominal pain and melena attacks increased to once every 1 to 2 months, and there was no follow-up. At the beginning of March 2017, the patient suffered from sudden severe abdominal pain around the umbilical cord, accompanied by nausea, vomiting of stomach contents, and cessation of exhaustion and defecation. He went to the emergency department of our hospital for an upright abdominal plain film showing intestinal obstruction. Fasting water, gastrointestinal decompression, etc., abdominal pain is relieved, and spontaneous defecation is restored. Past history and family history are no different. Personal history: Smoking for more than 10 years, 4~5 cigarettes/d, and quit smoking for more than 7 years. Physical examination at admission: body temperature 36.5 ℃, pulse 78 beats/min, breathing 20 beats/min, blood pressure 118/71 mmHg (1 mmHg =0.133 kPa), clear breathing sounds in both lungs, no murmur in each valve area of the heart, flat abdomen, no gastrointestinal pattern and peristaltic wave, soft abdomen, deep tenderness in the right lower abdomen, no rebound pain, no mass, and intestinal sounds 5 times/min.

A 58-year-old female was diagnosed with "hyperthyroidism (hyperthyroidism)" in May 2003, with fatigue, intermittent tremor in both hands, and poor drug control. On March 12, 2017, free triiodothyronine (FT3) 14.4 pmol/L (reference value: 3.1~6.8 pmol/L, the same below), free thyroxine (FT4) 102.0 pmol/L (12.0~21.9 pmol/L), thyroid stimulating hormone (TSH) were detected.<0.005 mU/L (0.27-4.2 mU/L); Liver function examination showed: γ-glutamyl transpeptidase (GGT) 85.04 U/L (7-45 U/L), and iodine-131 was treated on March 20, 2017. On March 25, 2017, nausea, vomiting and diarrhea occurred without obvious trigger, and then chest tightness and chest pain gradually appeared, located in the precordial area, radiating to the shoulders and back, accompanied by sweating. For further diagnosis and treatment, I went to the emergency department of Cangzhou People's Hospital affiliated to Southern Medical University. Three items of myocardium were examined: creatine kinase isoenzyme (CK-MB) 82.00 μ g/L (0-2.03 μ g/L), myoglobin (Myo) 483.8 μ g/L (0-61.5 μ g/L), and troponin I (cTnI) 39.400 μ g/L (0-0.034 μ g/L); Glucose:>36.89 mmol/L, the patient's family refused to undergo emergency percutaneous coronary intervention (PCI), and was immediately admitted to the CCU ward of our department with "acute coronary syndrome". Previous history of "type 2 diabetes" for 7 years, self-complaint of blood sugar control, denial of bad habits of tobacco and alcohol, other medical history is not special.

A 49-year-old female was admitted to the hospital on December 8, 2016 with the main complaint of "chest tightness and asthma after left lower lung cancer operation for 1 week". One week before admission, the patient underwent "anatomical radical resection of left lower lobe adenocarcinoma" under general anesthesia with double lumen tracheal intubation in a local hospital due to left lower lung adenocarcinoma. The surgical records showed that the patient's lung fissure was well developed. After awakening from anesthesia, he complained of chest tightness and asthma. After treatment with cephalosporin antibiotics (specificity unknown), the symptoms were not significantly relieved after anti-infection, phlegm-resolving and bronchodilating drugs. After coming to our hospital, in order to rule out the possibility of pulmonary artery embolism, pulmonary artery CT angiography (CTA) was examined. The results showed that the main trunk of the left pulmonary artery was visible, but the branches of the arteries were not visible. The main pulmonary artery, the main trunk and all branches of the right pulmonary artery showed good results. There was no obvious stenosis and dilation of the lumen, and no clear filling defect was found in the lumen. Soft tissue density and gas density shadows were seen in the left chest cavity and lung. Bronchoscopy showed that severe mucosal congestion and edema could be seen from the end of the left main bronchus to the stump of the left upper lobe and left lower lobe, and a large amount of bloody secretion could be seen in the bronchial lumen of the left upper lobe to obstruct the lumen. After washing, the left upper lobe bronchial lumen was narrowed, and the left lower lobe bronchial stump was occluded (Figure 1)。 Thoracic ultrasonography showed no obvious effusion in bilateral pleural cavities. Arterial blood gas analysis at 4 L/min oxygen inhalation by nasal catheter showed: partial pressure of arterial oxygen 70.10 mmHg (1 mmHg =0.133 kPa), partial pressure of arterial carbon dioxide 50.8 mmHg and pH 7.40. Blood routine results: Red blood cell count 26.1×10⁹/L, neutrophil percentage 90.2%, red blood cell count 2.81×10¹²/L, hemoglobin 86 g/L. D-dimer 1.34 mg/L. Procalcitonin 0.325 μ g/L, erythrocyte sedimentation rate 115.00 mm/1 h, C-reactive protein 88.00 mg/L. Based on the examination results, considering the possibility of pulmonary torsion, the patient was in critical condition, and exploratory thoracotomy was performed in the emergency department on the second day after admission. Intraoperative observations: There was no obvious adhesion in the left pleural cavity, there was more bloody effusion, some of which were organized, purulent coating was formed on the top of the chest, and the pericardium and mediastinal pleura were congested, edema and thickened. The upper lobe of the left lung was transposed clockwise by 270 degrees with the hilar structure as the midline. Except for the tongue segment located on the outside of the thoracic aorta, the texture was slightly soft, and other parts of the upper lobe of the left lung were congested, swollen and consolidated, which was black-purple. The lower lobe bronchial stump healed well. Intraoperatively, it was considered that infarct-like changes had occurred in the upper lobe of the left lung, so it was resected, with a size of approximately 20 cm ×12 cm ×8 cm. The lung tissue was incised with a sharp knife, and old blood and a small amount of purulent secretion exudated in the cross section. Postoperative pathological results showed extensive lung tissue infarction with suppurative inflammation. The patient recovered well after surgery and was discharged smoothly.

A 67-year-old male was admitted to the Department of General Surgery of Shuyang County People's Hospital on August 6, 2017 due to the discovery of "a mass in the left lower back for 3 months and recent enlargement". One year ago, the patient went to Jiangsu Cancer Hospital due to discomfort after eating. After gastroscopy, the pathological diagnosis was gastric cardia adenocarcinoma. Preoperative tumor markers were detected: carcinoembryonic antigen (CEA) was elevated to 19.49 μ g/L, and carbohydrate antigen 125 (CA-125), carbohydrate antigen 199 (CA-199), carbohydrate antigen 153 (CA-153) and alpha-fetoprotein (AFP) were all normal. Surgical resection was performed on July 27, 2016. During the operation, the tumor was found to be located in the gastric cardia, invading the diaphragm and pancreas, adhering to the omentum, and there was no ascites. Surgical resection of the stomach was performed, and anastomosis under the gastric arch was performed. The postoperative pathological diagnosis was gastric cardia ulcer type mucinous adenocarcinoma, 5.0 cm ×5.0 cm ×2.5 cm in size, infiltrating the full thickness and extraserous adipose tissue, invading the nerve, tumor thrombus was found in the vessel, and adjacent lymph nodes metastasized (2/9). No cancer metastasis was found in 1 paraarterial lymph node of the left gastric artery and 1 inferior pulmonary ligament lymph node. Postoperatively, CEA decreased to normal by laboratory tumor markers, and he was treated with oxaliplatin 200 mg, tegafur regimen 0.4 mg, and doxorubicin 60 mg for 3 cycles of chemotherapy. Due to IV° bone marrow suppression, he was intolerable, and the treatment was not continued thereafter. Three months ago, I accidentally discovered a lump the size of a "pigeon egg" in my left low back. I sometimes had dull pain and discomfort, but I didn't pay attention to it. Recently, the lump increased significantly, so I came to the hospital for treatment. Physical examination: A raised mass 5.0 cm ×3.0 cm in size was palpated subcutaneously on the left lower back, with tenderness, hard texture, unclear boundary and poor mobility. B-ultrasound examination showed that a hypoechoic mass with a size of 4.72 cm ×2.41 cm was seen subcutaneously on the left lower back (Figure 1)。 Clinical diagnosis: fibroma or epidermal cyst of left low back. The mass was resected under local anesthesia, and the mass was located between muscles, hard in texture, unclear in boundary with surrounding tissues, and poor mobility. After operation, the mass was removed and sent for pathological examination after blunt-sharp combination and separation along the edge of the mass.

Peripheral tissue generally includes skin, subcutaneous tissue, muscle, etc. In the process of shock development, in order to ensure the blood perfusion of important organs such as heart and brain, peripheral tissue perfusion will be sacrificed at the earliest and resuscitated at the last. In recent years, the value of peripheral tissue perfusion in shock resuscitation has been paid more and more attention^[1]。 This paper summarizes the application and progress of peripheral tissue perfusion in shock resuscitation.

The most important indications for lung transplantation are idiopathic pulmonary interstitial fibrosis, chronic obstructive pulmonary disease, bronchiectasis, tuberculosis and pulmonary hypertension. According to the 2016 report of the International Heart and Lung Transplant Association (ISHLT), 55,795 lung transplantations have been completed worldwide. The survival rates of 3 months, 1 year, 3 years, 5 years and 10 years after lung transplantation are 89%, 80%, 65%, 54% and 32% respectively^[1]。 At present, the shortage of donor lungs is the biggest difficulty faced by lung transplantation. Organ donation in China is in the initial stage. Many potential donor lungs often lack adequate maintenance, and barotrauma, pulmonary edema and pulmonary infection often occur, which leads to the degradation of donor lung quality, resulting in donation failure. Or the quality of the donor lung is average, and it is used clinically as a marginal donor lung, which increases the risk of postoperative primary graft loss, acute lung injury, chronic rejection, etc.