Volume 98  ·  Issue 08  ·  2018

Herpes zoster (HZ) can be accompanied by neuralgia before, when, and after the herpes subsides, which is collectively referred to as herpes zoster-related pain. The pain persists after the herpes resolves and persists for more than 1 month, which is herpetic neuralgia; The pain lasts for more than 3 to 6 months and is postherpetic neuralgia (PHN)^[1]。 The mechanism of herpetic neuralgia is complex, the clinical manifestations are diverse, the treatment methods are different, and the effects are uneven.

To evaluate the efficacy of ultrasound guided quadratus lumborum block combined with non-steroidal anti-inflammatory drugs for postoperative analgesia in patients undergoing total hip arthroplasty.

From January to June 2017, sixty American Society of Anesthesiologists (ASA) physical status Ⅰ to Ⅲ patients, aged 55-75 yr, scheduled for total hip arthroplasty, were randomly divided into control group(group N) and quadratus lumborum block (group R). Ultrasound guided quadratus lumborum block was implemented on the affected side at the end of operation.Then 30 ml 0.33% ropivacaine were administrated in group R, while the control group did not receive the same block. A sufentanil patient-controlled analgesia pump was connected to the patient. The rest visual analogue score (VAS) were recorded at 0 h(T₀), 3 h(T₁), 6 h (T₂), 12 h(T₃), 24 h (T₄), 36 h (T₅) and 48 h(T₆) after sugery, the VAS scores on movement were evaluated at T₄, T₅ and T₆ time points.The consumption of sufentanil within each period time were recorded.The maximal flexion and abduction degrees of the hip joint were evaluated at 12, 24, 36 and 48 h after operation. The number of patients for rescue pain relief by intravenous analgesia pump during 24 h and 48 h after surgery were counted in both groups. The postoperative adverse effects and overall satisfaction in the two groups were recorded.

The VAS at rest in group R were 0.8±0.4, 1.0±0.3, 1.2±0.5, 2.0±0.5, 1.7±0.4 , 1.6±0.5 at T₁, T₂, T₃, T₄, T₅, T₆ respectively, and those in group N were 3.0±0.7, 3.5±0.9, 3.8±0.9, 3.3±1.1, 3.3±0.7, 3.0±0.7 at the same time points. The VAS at rest were lower in group R than those in control group at all time points (F=203.090, 216.354, 203.956, 35.548, 96.332, 80.577, all P<0.01). The VAS on movement in group R were 2.7±0.9, 2.9±0.7 , 2.0±0.6 at T₄, T₅, T₆ respectively , and those in group N were 6.0±1.5, 5.8±1.1, 4.5±1.0. The VAS on movement were also lower in group R than those in control group(F=154.561, 143.224, 141.479, all P<0.01). The maximum flexion degrees in group R were (61±12)degrees, (64±10)degrees, (69±15)degrees and(78±19)degrees at 12, 24, 36, 48 h after operation, and those were (45±11) degrees, (49±10)degrees, (52±12)degrees and(60±14)degrees at the same time points. The maximum flexion degrees in group R were increased more than control group at 12, 24, 36, 48 h after operation(F=34.981, 35.575, 52.106, 41.681, all P<0.01). The abduction degrees in group R were(22±6)degrees, (26±6)degrees, (27±8)degrees and(28±7)degrees at 12, 24, 36, 48 h after surgery, and those in group N were (14±5) degrees, (17±6)degrees, (20±6)degrees and(20±5)degrees. The abduction degrees in group R were increased more than those in group N(F=58.974, 33.402, 19.151, 20.575, all P<0.01). The rates of rescue analgesia for pain relief were 10% and 16.7% at 24 h and 48 h after operation respectively in group R, and those were 100% and 100% in group N. Compared to group N, the rates of rescue analgesia for pain relief in group R were significantly decreased (χ²=49.091, 42.857, all P<0.01). The incidences of postoperative nausea and vomiting, pruritus in group R were 3.3% and 3.3% respectively, and those in group N were 23.3% and 20.0%. The incidences of nausea and vomiting, pruritus in group R were lower than those in group N (χ²=5.192, 4.875, all P<0.01). The overall satisfaction scores in group R (3.7 ± 1.0 ) were higher than those (1.9±0.7) in the group N(t=7.841, P<0.01).

The quadratus lumborum block combined with parecoxib sodium for multimodal analgesia after total hip arthroplasty is effective and provides satisfactory analgesia.

To investigate the application of ultrasound-guided continuous serratus plane block with patient-controlled analgesia on postoperation analgesia after thoracoscopic surgery, and influence on postoperative rehabilitation.

Sixty patients scheduled for thoracoscopic surgery were randomly divided into two groups. PCNA group (n=30) received ultrasound guided continuous serratus plane block with patient-controlled nerve analgesia, with continuous infusion of 0.2% ropivacaine and 30 ml of 0.3% ropivacaine for the first does. PCIA group(n=30) received patient-controlled intravenous analgesia, with continuous infusion of sufentanil. Postoperative visual analogue scale (VAS) and prince henry pain scale (PHPS) were recorded at 1 hour (T₁), 4 hour (T₂), 8 hour (T₃), 24 hour (T₄), 2 days (T₅), 3 days (T₆), 4 days (T₇), before discharge (T₈), 30 days (T₉) after surgery. Adverse reactions and the time of postoperative first out-of-bed activity, passage of gas by anus, bowel movement, chest tube removal, discharge was also recorded.

The resting VAS score of T₃, T₄, T₅ in group PCNA and group PCIA were 0(0) vs 0(2.0), 0(0) vs 2.0(2.0), 0(0) vs 0(2.0), the resting VAS score was lower in group PCNA than in group PCIA (Z=-2.524, -3.944, -3.652, P<0.05 orP<0.01). The upper arm activity VAS score of T₂, T₃, T₄, T₅, T₆, T₇ in group PCNA and group PCIA were 0(0) vs 0(2.0), 0(0) vs 2.0(2.5), 0(2.0) vs 2.0(2.0), 0(2.0) vs 2.0(2.0), 0(0) vs 2.0(2.0), 0(0) vs 0(2.0), the upper arm activity VAS score was lower in group PCNA compared with group PCIA (Z=-2.984, -3.915, -4.484, -4.450, -3.422, -2.456, P<0.05 orP<0.01). The coughing VAS score T₃, T₄, T₅, T₆, T₇ in group PCNA and group PCIA were 2.0(2.0) vs 2.0(2.5), 2.0(2.5) vs 4.0(4.0), 2.0(2.5) vs 4.0(4.0), 2.0(2.0) vs 3.0(2.0), 2.0(2.0) vs 2.0(2.0), the coughing VAS score was lower in group PCNA compared with group PCIA (Z=-3.432, -3.410, -2.643, -3.210, -2.746, P<0.05 orP<0.01). The PHPS score was significantly lower in group PCNA at T₃[1.0(1.3) vs 2.0(2.0)], T₄[1.0(2.0) vs 3.0(1.0)], T₅[1.0(1.3) vs 2.0(1.3)], T₆[1.0(1.3) vs 2.0(2.0)], T₇[1.0(1.0) vs 1.0(2.0)] compared to group PCIA (Z=-3.149, -3.662, -3.369, -3.681, -2.815, all P<0.01). And the time of out-of-bed activity, passage of gas by anus of the PCNA group were (20.0± 6.9)h, ( 16.0± 8.0)h, which was advanced more than PCIA group [(23.9± 7.1)h, (34.3± 13.2)h,t=-2.20, -6.47, all P<0.05]. Furthermore, PCNA group had better sleep quality from the 2nd night to the 4th night , and with lower adverse reactions (allP<0.05).

The application of ultrasound-guided continuous serratus plane block after thoracoscopic surgery can reduce postoperative pain and enhance recovery after surgery.

This study aimed to compare dexmedetomidine with remifentanil for conscious sedation in patients undergoing radiofrequency ablation of hepatocellular carcinoma.

Sixty patients, who were aged 41 to 73 years with American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅱ, and scheduled for elective radiofrequency ablation of hepatocellular carcinoma under conscious sedation in National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from January 2014 to June 2016, were allocated randomly to receive dexmedetomidine maintenance regimen(group D, n=30)or remifentanil maintenance regimen(group R, n=30)by random digital table. Subjects in group D received dexmedetomidine at a loading dose of 0.5 μg/kg over 10 min followed by 0.2-1.0 μg·kg ^-1·h^-1 infusion until Ramsay sedation scale reached 3-4. Patients in group R received a loading dose of remifentanil 1 μg/kg followed by remifentanil 4-10 μg·kg ^-1·h^-1 infusion and propofol 1-2 mg·kg^-1·h^-1 infusion until Ramsay sedation scale reached 3-4. Haemodynamic variables, respiratory rate(RR), pulse oxygen saturation (SpO₂)and numeric rating scales(NRS) in each group were collected at entrance(T₀), puncturing(T₁), 15 min after beginning of radiofrequency ablation(T₂), the end of radiofrequency ablation(T₃) and 30 min after operation(T₄). Efficacy of anesthesia, incidences of intraoperative respiratory depression, postoperative nausea and vomiting, patient and surgeon satisfaction were evaluated.

Compared with group D, the arterial blood pressure and heart rate at T₂ [(92.2±15.7)mmHg vs (102.4±16.7)mmHg, (69.7±15.3) beats/min vs (79.4±17.7) beats/min] and respiratory rate at T₁, T₂ and T₃ [(10.1±1.9) breaths/min vs(12.3±1.7) breaths/min, (10.8±1.5) breaths/min vs(13.6±1.6) breaths/min, (13.4±1.6) breaths/min vs(14.5±1.4)breaths/min] were significantly lower in group R (t=-2.437, -2.271, -4.726, -6.993, -2.834, all P<0.05). With less sulfentanil consumption(23.2±8.3)μg vs( 35.5±11.7)μg, group R got less NRS at T₂ and T₃(2.4±1.1) vs(3.5±1.2), (2.4±1.3) vs(3.6±1.1), and higher NRS at T₄(3.4±1.1) vs( 2.1±0.9) than group D(t=-4.696, -3.701, -3.860, 5.010, all P<0.05). Compared with group R, the incidence of intraoperative respiratory depression was significantly lower (23.3% vs 56.7%)and the incidence of inadequate anesthesia(20% vs 0) was significantly higher in group D(χ²=5.625, 4.630, both P<0.05).

Both dexmedetomidine and remifentanil can be successfully used for conscious sedation in patients undergoing radiofrequency ablation of hepatocellular carcinoma. Remifentanil maintenance regimen provides better intraoperative analgesia and operative condition, while dexmedetomidine is superior to remifentanil in reducing intraoperative respiratory depression and postoperative pain.

To investigate the glucose and lipid metabolic disorders in patients with myasthenia gravis (MG) without glucocorticoid therapy, and the relationships between insulin, insulin resistance, muscle strength, serum levels of osteocalcin, 25-hydroxy vitamin D (25OHD) and glucose and lipid metabolism.

A total of 102 MG patients [(40±11) years old, 43 males and 59 females] without glucocorticoid treatment were enrolled in this cross-sectional study. Height, weight and the handgrip of dominant hands were measured. Serum levels of fasting blood glucose (FBG), 2-hour postprandial blood glucose (2 h PBG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS), 2-hour postprandial insulin (2 h PINS), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and osteocalcin, 25OHD were detected. Insulin resistance was assessed using homeostasis model assessment of insulin resistance (HOMA-IR).

The proportion of impaired fasting glucose or impaired glucose tolerance, type 2 diabetes, dyslipidemia, hyperinsulinemia in male and female were 30.0%, 10.0%, 50.0%, 33.3% and 17.5%, 3.5%, 27.7%, 7.1%, respectively. Serum osteocalcin levels in male and female were 2.8 (1.7, 4.4) μg/L and 2.3 (1.3, 3.9) μg/L, respectively. And 25OHD levels in male and female were (93.5±34.9) nmol/L and (81.0±30.5) nmol/L, respectively. Handgrip of male and female was (37.0±9.4) kg and (20.5±6.3) kg. After adjusted for age, FINS ( r=0.619, P<0.001), 2 h PINS (r=0.640, P<0.001), HOMA-IR (r=0.534, P<0.001) were positively correlated with 2 h PBG, and the handgrip was negatively correlated with TC (r=-0.486, P=0.026), LDL-C (r=-0.485, P=0.026) in male. FINS (r=0.352, P=0.008; r=0.300, P=0.026; r=0.646, P<0.001) and 2 h PINS (r=0.278, P=0.040; r=0.518, P<0.001;r=0.382, P=0.006) and HOMA-IR (r=0.695, P<0.001;r=0.583, P<0.001;r=0.818, P<0.001) were positively correlated with FBG, 2 h PBG, HbA1c, and the handgrip were negatively correlated with FBG (r=-0.424, P=0.016), 2 h PINS (r=-0.345, P=0.034) and positively correlated with HDL-C (r=0.389, P=0.037) in female. There was no association between osteocalcin, 25OHD and glucose and lipid metabolism. Multivariate linear regression analysis also found that there were significant relationships between handgrip, insulin, insulin resistance levels and glucose and lipid metabolic disorders.

There was a high proportion of glucose and lipid metabolic disorders in MG patients without glucocorticoid treatment, and the mechanism may be related to insulin resistance induced by muscle weakness.

To discuss the surgical treatment and its effectiveness of odontoid fracture complicated with atlantoaxial dislocation in children with spinal cord injury.

From January 2010 to December 2014, 10 cases of children under 14 years old, with intractable odontoid fracture with atlantoaxial dislocation were enrolled. The mean duration between injury and admission was 8.5 d (range 1-30 d). The surgery was performed using posterior reduction and internal fixation or anterior release combined with posterior fixation. The medical date including preoperative and postoperative neurological function, degree of reduction and fusion.

All cases were followed-up for 12-48 months. The last follow-up X ray and CT examinations showed good reduction and fusion. No fixation failure was observed among all the patients. According to the Frankel, the preoperative neurological function was C in 2 cases, D in 4 cases, and E in 4 cases. At the last follow-up, out of 2 cases with Frankel C improved to D, and the other 8 cases were back to normal.

Diagnosis of odontoid fracture complicated with atlantoaxial dislocation is usually delayed in children. One-stage posterior reduction and internal fixation or anterior release combined with posterior fixation is an effective and safe surgical procedure for such cases.

To explore the diagnosis, therapy and prevention method of chronic sternal osteomyelitis with sinus tract after cardiovascular surgery.

A total of 53 patients with chronic sternal sinus tract after cardiovascular surgery between January 2000 and January 2016. After definite diagnosis by contrast fistulography and CT scanning, all the patients received combined modality therapy including debridement, musculocutaneous flap transplantation and intermediate thickness free skin graft transplantation if necessary.

One patient died of false aneurysm due to the sternal sinus tract infection, there were no peri-operative death for all the left 52 patients. Forty-five patients had primary healing and 7 patients had secondary healing. All the patients became total recovery within 3-12 weeks after operation and maintained well during the 5-18 months′ follow-up.

For the patients with chronic sternal osteomyelitis, operative therapy should be performed as soon as possible once the diagnosis is confirmed. Combined modality therapy including debridement, musculocutaneous flap transplantation and intermediate thickness free skin graft transplantation is confirmed to be effective and secure.

To investigate the significance of the detection of pepsin in saliva and the pharyngeal pH monitoring in the diagnosis of laryngopharyngeal reflux disease(LPRD).

A total of 176 patients (140 patients with simple pharyngitis and 36 patients with space-occupying lesions of larynx) who were suspected to have laryngopharyngeal reflux between February and December 2016 were retrospectively reviewed. All the patients were evaluated with reflux symptom index (RSI), reflux finding score (RFS) and 24-hour pharyngeal pH monitoring(Dx-pH). Saliva of patients was collected and the pepsin in the saliva was measured by enzyme-linked immunosorbent assay (ELISA).

The positive rate of RSI (RSI>13) and/or RFS (RFS>7) was 56.8% (100/176). The positive rate of pepsin in saliva was 40.9% (72/176) and pepsin in saliva collected at the time of onset of symptom was much higher than that at other time points (P<0.001). The positive rate of pepsin in saliva, Ryan score and the pH<6.0 laryngopharyngeal reflux in space-occupying lesions group [55.6%(20/36), 27.8% (10/36), 69.4%(25/36), respectively] were all higher than simple pharyngitis group [37.1% (52/140), 5.0% (7/140), 50% (70/140), respectively] (P=0.045, P<0.001,P=0.037, respectively).

The detection of pepsin in saliva and the pharyngeal pH monitoring reflected different reflux agents, and there was great significance for the diagnosis of LPRD by using two methods together. We found that the weak acid state and consequent pepsin damage played an important role in the occurrence and development of space-occupying lesions of larynx.

To explore the expression of androgen receptor (AR) in the tissues as well as its association with the clinicopathological factors of primary breast cancer patients treated with neoadjuvant chemotherapy (NAC), and analyze the effect of AR in the prediction of pathologic complete response (PCR) rate.

A total of 668 breast cancer patients treated with NAC in Henan Cancer Hospital between March 2014 and June 2017 were retrospectively reviewed. The relationship of AR expression and clinicopathological characteristics was calculated using chi square test. Multivariate analysis using binary Logistic regression was used to analyze correlations of different factors with PCR.

All patients were female, with the age of 20-76 years old. AR was detected in 74.6% of tumors, and significantly correlated with hormone receptor (HR), human epidermalgrowth factor receptor-2 (HER-2), Ki-67, CK5/6, epidermal growth factor receptor (EGFR) and molecular subtypes (all P<0.05). Multivariate analysis showed that AR, HR and HER-2 were independent predictors for PCR (allP<0.05).

The expressions of AR were more frequently in HR positive breast cancer tissues (86.7%), and lowest in triple-negative breast cancer (TNBC) group (23.2%). AR was independent predictor for PCR.

To investigate the clinical outcomes and prognostic factors in patients with pancreatic cancer after surgical resection with curative intent and analyze factors affecting 2-year and 5-year survival of patients.

A total of 469 patients with pancreatic adenocarcinoma undergoing curative resection were included in the study, and the clinical data of these patients were analyzed retrospectively. Univariate and multivariate analyses were performed to examine factors affecting prognosis of these patients. The clinicopathological characteristics of patients who survived for ≤2 years and >2 years as well as ≤5 years and >5 years were compared, respectively.

The multivariate analysis showed that lymphovascular invasion (P=0.024), lymph node metastasis (P<0.001), vascular resection (P=0.002), maximum tumor diameter >2 cm ( P=0.009), poor differentiation (P<0.001) were negative prognosis factors, but postoperative chemotherapy (P<0.001) was an independent positive prognostic factor. Comparison of the patients who survived for ≤2 years and >2 years showed that lymphovascular invasion (P=0.012), lymph node metastasis (P<0.001), vascular resection (P=0.014), maximum tumor diameter>2 cm (P=0.004), poor differentiation (P<0.001), peri-pancreatic fat invasion (P=0.005), absence of postoperative chemotherapy (P<0.001), advanced tumour, node and metastasis (TNM stage) (P<0.001) were associated with 2-year survival. With regard to 5-year survival, lymph node metastasis (P=0.005), poor differentiation (P=0.014) and TNM stage(P=0.025) were associated with it.

Our results suggest that lymphovascular invasion, lymph node metastasis, vascular resection, maximum tumor diameter >2 cm, poor differentiation and absence of postoperative chemotherapy were independent negative prognostic factors. Lymph vascular invasion, lymph node metastasis, vascular resection, maximum tumor diameter >2 cm, poor differentiation, peri-pancreatic fat invasion, absence of postoperative chemotherapy, advanced TNM stage were associated with 2-year survival, and lymph node metastasis, degree of differentiation and TNM stage are important prognosis factors affecting long-term survival of patients.

To investigate the treatment effect of carboxyamidotriazole (CAI) on bleomycin induced lung fibrosis in mice, and the potential mechanism involved.

A total of 45 mice were divided into three groups randomly. Blank control group (blank group): after a one-time tail vein injection of saline solution 0.2 ml, mice were given polyethylene glycol 400 (PEG-400) 0.1 ml/10 g by gavage once daily for 14 days; the bleomycin group (BLM group): after a one-time tail vein injection of bleomycin 150 mg/kg, mice were given PEG-400 solution 0.1 ml/10 g by gavage once daily for 14 days; CAI group: after a one-time tail vein injection of bleomycin 150 mg/kg, mice were given CAI solution 40 mg/kg by gavage once daily for 14 days. All mice were sacrificed on day 28. Observation index: lung coefficient, survival analysis, pathological section and collagen staining of lung tissue, lung hydroxyproline, Transformation growth factor-β₁(TGF-β₁), γ-interferon(IFN-γ), matrix metalloproteinase 9(MMP-9) and tissue inhibitor of matrix metalloproteinasese 1(TIMP-1) content determination in lung homogenate.

On day 28 the lung coefficient of mice in BLM group and CAI group was significantly higher than the blank group, and the BLM group was with the highest (all P<0.05). Degree of pulmonary fibrosis in lung tissue pathological specimens (HE staining) was, from heavy to light, BLM group, CAI group, blank group. The content of hydroxyproline in mice lung homogenate was (0.406±0.020) μg/mg in blank group, (0.722±0.118) μg/mg in BLM group, (0.537±0.071) μg/mg CAI group, respectively (allP<0.05). The content of TGF-β₁ in three groups was (15±5), (60±10), (41±10) ng/ml respectively (all P<0.05). The content of IFN-γ in three groups was (47±5), (126±24), (194±34) pg/ml respectively (allP<0.05). The content of TIMP-1 in three groups was (73±6), (369±58), (246±51) ng/ml respectively (allP<0.05). Comparisons of the content of MMP-9 between each group had no significant difference (P>0.05).

CAI can reduce lung injury induced by bleomycin in mice. The mechanism of action is related to the effects of CAI on cytokines such as TGF-β₁, IFN-γ, MMP-9 and TIMP-1.

To explore the effect of miR-19b on the function of P19CL6 cells and its molecular mechanism.

Overexpression of miR-19b was carried out by transfecting miR-19b plasmid into the P19CL6 cells. MTT assay and flow cytometry were used to determine cell growth and apoptosis, respectively. Western blot was used to detect the expression level of Sox6 in P19CL6 cells. ELISA assay was used to detect the expression levels of apoptosis-related genes (Bax, Bcl-2) in P19CL6 cells at late-stage cardiac differentiation. Further online software TargetScan was used to predict the target genes of miR-19b and verified by dual luciferase reporter assay.

Our data showed that overexpression of miR-19b in P19CL6 cells significantly increased the cell growth rates and the apoptosis inhibition rates. The ratio of apoptosis-related proteins (Bax/Bcl-2) was significantly reduced. Results from the TargetScan and dual luciferase reporter showed that Sox6 is the direct target of miR-19b.

We conclude that miR-19b might promote cell proliferation and inhibits cell apoptosis during the late-stage of cardiac differentiation by targeting Sox6 expression.

To study the treatment of patients hospitalized for asthma exacerbation in China.

This was a retrospective study and involved patients hospitalized for asthma exacerbation in 29 hospitals throughout China during Jan 2013 to Dec 2014. Information of the demographic features, the severity of the exacerbation, the medicine prescribed during the hospitalization and the use of mechanical ventilation were collected and analyzed.

During the study period, there were 3 240 patients hospitalized for asthma exacerbation, and 1 369(42.3%) of them were males 1 871(57.7%)were females. Patients of mild, moderate, severe, and life-threatening exacerbation counted for 41.7%, 37.8%, 19.2% and 1.0%, respectively of the total patients. Of all the patients, 72.6% used bronchodilators by nebulizer, 70.8% used inhaled corticosteroids by nebulizer, 60.5% used intravenous corticosteroids, 17.3% used oral corticosteroids, and 80.5% used antibiotics. The percentages of patients using systemic corticosteroids and antibiotics were higher in patients with more severe exacerbation. In patients with mild exacerbation, there were 74.9% and 52.2% who used antibiotics and systemic corticosteroids, respectively. A total of 73 patients (2.3%) used mechanical ventilation, and 62 of them used noninvasive ventilation, 16 used invasive ventilation, and 5 used both.

Nebulizer therapy has been accepted as the main administration route of medicine in the treatment of asthma exacerbation. A large amount of patients used antibiotics and systemic corticosteroids during hospitalization, indicating there may be some overuse of these medicines.

A 54-year-old male was admitted to the hospital on 30 August 2016 due to "repeated cough and dyspnea for 5 months and recurrence for 6 days". Five months ago, the patient developed a dry cough with dyspnea. He went to the local hospital and considered "pleural and peritoneal effusion, pericardial effusion", and improved after drainage of pleural effusion. In the past 5 months, he had repeated dyspnea. He was admitted to the local hospital many times, and was given fluid drainage, and biopsy of the lymph node of the left supraclavicular fossa was performed. The pathology showed "granulomatous nodule". In August 2016, the patient had recurrent dyspnea, accompanied by fever, and his body temperature fluctuated from 37.6 to 38.4℃, so he came to the First Affiliated Hospital of Wenzhou Medical University for treatment. Chest enhanced CT showed "right middle lobe atelectasis, both hilar and mediastinal lymph nodes were swollen, pleural effusion on both sides, and pericardial effusion" (FIG. 1A，FIG. 1B), positron emission computed tomography (PET-CT) showed "atelectasis of the right middle lobe with increased metabolism, multiple small lymph nodes in the retroperitoneum, splenic hilum area and left upper and lower diaphragm showed mild increased metabolism, thoracic, abdominal and pericardial effusion, abnormal hypermetabolic nodules in the left ischium, considering inflammatory granuloma or infectious lesions, among which the left ischium lesions are difficult to exclude malignant tumors". For further diagnosis and treatment, it is proposed that "multiple serous effusion" will be admitted to hospital. Past: Hepatitis B "small three yang" for many years, "hypertension" for 4 months, "renal insufficiency" for 3 months, denied tuberculosis and diabetes history, denied eating raw food. Physical examination at admission: body temperature 37.6 ℃, pulse 96 beats/min, breathing 20 beats/min, blood pressure 208/125 mmHg (1 mmHg =0.133 kPa). Lymph nodes with a diameter of about 1.0 cm were palpable in the bilateral neck, and two lymph nodes with a diameter of about 1.5 cm and 2.0 cm were palpable in the left and right inguinal areas, respectively. There is no distension in the jugular vein. After two auscultations, the pulmonary breathing sounds were reduced, and no dry and wet rales were heard. The heart rhythm is uniform, and the heart sound is slightly low and dull. Abdominal swelling, no tenderness rebound pain, mobile voicing positive. Moderate depressed edema of both lower limbs.

The 58-year-old male was seen in the Department of Respiratory Medicine of Jincheng People's Hospital on August 2, 2017, mainly due to intermittent cough for 2 months. Chest CT enhancement results showed: high-density shadow of left lung, considering inflammatory possibility, tuberculous lesion? Multiple old lesions in both lungs. It is recommended to give anti-infective treatment first, elective reexamination of chest CT, and percutaneous lung puncture if necessary to confirm the diagnosis.

An 8-year-old male was seen for "erythema on the cheeks, repeated fever with gingival bleeding for 1 month". In September 2016, erythema on both cheeks appeared without obvious trigger, which was obvious after sunlight, without itching, accompanied by repeated fever, body temperature of about 38℃, repeated gingival bleeding, no cough and expectoration, abdominal pain and diarrhea, joint swelling and pain, skin and other tissue bleeding. The effect of antibiotics was not good, and he was admitted to hospital on October 3 of the same year. Physical examination: butterfly erythema on both cheeks, bleeding from the right lower gum, no dry and wet rales in both lungs, soft abdomen, no tenderness and rebound pain, no obvious swelling of joints, and no edema in both lower limbs.

Many causes can lead to histiocyte damage, including diabetic nephropathy, hypertensive nephropathy, lupus nephritis, drug poisoning and prolonged acute kidney injury, and subsequent histiocyte degeneration, necrosis and inflammatory reaction. When the injury is small, the normal cells around the lesion will start regeneration and repair until the normal structure and function are completely restored^[1]。 However, when a large area of injury occurs or the number of injuries is excessive, it will cause the interstitial extracellular matrix to accumulate and fill the defect of the tissue region, thus causing the inevitable tissue fibrosis^[1]。 Fibrotic disease is a complex pathological process, which is characterized by excessive deposition, generation more than degradation and tissue remodeling of extracellular matrix components, which can lead to apoptosis, proliferation, transdifferentiation of cells, and ultimately failure of multiple organ functions. The main organs in which fibrosis occurs include the heart, lungs, liver and kidneys. In addition, some organs and tissues can also develop fibrosis under pathological conditions, such as skin scar, inflammatory bowel disease, myelodysplasia, etc^[2]。 In developed countries, about half of patients die from fibrosis-related diseases, and the occurrence and progression of fibrosis play an important role in disease mortality^[3]。 Tissue fibrosis can occur in various tissues and organs of human body, causing structural changes and functional failure, and there is still a lack of effective treatment measures. Recent studies have found that epigenetic modification can regulate the occurrence and development of fibrosis^[4,5,6]。 Therefore, targeting epigenetic modification regulatory mechanisms may help to develop anti-fibrotic drugs.

Kidney cancer is one of the most common tumors of the urinary system. In recent years, the incidence of kidney cancer in China has been increasing continuously. The latest statistics show that the new and death cases of kidney cancer rank 15th and 17th in the incidence and mortality of cancer respectively^[1]。 Bilateral renal carcinoma is a special type of renal carcinoma, and its incidence rate is relatively low, accounting for about 1% ~5% of the total renal carcinoma^[2]。 At present, surgery is the main treatment for bilateral renal cancer, including radical nephrectomy and nephron-sparing surgery. Such patients have an increased risk of renal insufficiency and tumor recurrence and metastasis due to the disease of both kidneys and surgical treatment, which aggravates the trauma and burden on the kidneys. In recent years, with the development of molecular biology, researches have shown that renal carcinoma is a multigene-related tumor, but most of the current researches on bilateral renal carcinoma focus on surgical treatment strategy and curative effect analysis^[3,4,5]。 Therefore, the molecular study of double renal carcinoma to explore its etiology and pathogenesis has important guiding significance for clinical diagnosis and treatment. By searching PubMed, Wanfang database and CNKI database, this paper aims to summarize the current molecular research progress related to bilateral renal cancer, so that we can understand bilateral renal cancer more deeply from the molecular level.

In recent years, nebulized inhaled glucocorticoids (ICS) have been recommended for the treatment of bronchiolitis in China^[1]In this regard, we have the following views to discuss with experts and colleagues.