Volume 98  ·  Issue 26  ·  2018

Second-generation sequencing (NGS), also known as large-scale parallel sequencing, can sequence millions or even billions of DNA molecules at the same time, achieving the goal of large-scale and high-throughput sequencing, and is a revolutionary progress after Sanger sequencing. At present, in clinical tumor practice, NGS is mainly used to drive gene sequencing, which is an important link in accurate diagnosis and treatment of tumors. On September 17th, 2015, the Chinese Society of Clinical Oncology convened China's representative oncologists, pathology and molecular biology experts and NGS technical experts in Xiamen, established the China Tumor Driven Gene Analysis Alliance (CAGC) and launched the Precision Oncology Research Project (CAGC-POI), which established the organizational framework and content framework of the overall project. The first phase of the CAGC-POI program plans to carry out driver gene profiling based on NGS technology in malignant diseases such as lung cancer, breast cancer, liver cancer, gastric cancer, colorectal cancer and hematopoietic tumors on the basis of preliminary consensus on clinical application of NGS technology. On the basis of the above consensus establishment, the analysis and verification of the variation spectrum of the main six tumor types, and the optimization process, the corresponding practical and experimental research on targeted precise diagnosis and treatment will be carried out in patients with clinically targetable driver genes. Finally, the technical standards and norms of NGS suitable for clinical oncology practice in China are put forward, so as to improve the quality and ability of service for tumor patients.

Helicobacter pylori (Helicobacter pylori，H.pylori) is closely related to the occurrence and development of chronic gastritis, peptic ulcer, gastric cancer and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. In 1994, Helicobacter pylori was listed as a class I carcinogen of gastric cancer by the World Health Organization. The occurrence of gastric cancer is closely related to Helicobacter pylori infection, and the eradication of Helicobacter pylori can reduce the incidence of gastric cancer. China is a country with high infection rate of Helicobacter pylori and high incidence of gastric cancer. Helicobacter pylori infection is not only a clinical problem, but also a major health management problem at the public health level. The formulation of its consensus has great practical significance for the prevention and treatment of Helicobacter pylori-related diseases in China.

To evaluate the diagnostic value of medium dose dexamethasone androgen suppression tests (DAST) in female hyperandrogenism.

DAST results were retrospectively analyzed in 85 cases of women with hyperandrogenism including 55 cases of congenital adrenal hyperplasia (CAH), 10 cases of testosterone-producing tumors and 20 cases of polycystic ovary syndrome (PCOS) between January 1984 and December 2017 in Peking Union Medical College Hospital. The suppression rate of testosterone and 17 hydroxyprogesterone (17OHP) were evaluated. The cut-off point of suppression rates were calculated by receiver operating characteristic (ROC) curve in the differential diagnosis of CAH and non-CAH causes.

The 1-day medium dose DAST was performed simultaneously in 41 cases of CAH patients and the 5-days medium dose DAST was performed simultaneously in 19 cases of CAH patients. The results indicated that the average suppression rate of testosterone were 77.9% and 91.3% (P<0.001) and the average suppression rate of 17OHP was 95.2% and 97.0%, respectively (P=0.220). In patients (41 cases of CAH, 10 cases of testosterone producing tumor and 20 cases of PCOS) with 1-day DAST, the optimal testosterone suppression rate was 61.2% (the sensitivity and specificity was 87.8% and 96.7%, respectively) and the optimal 17OHP suppression rate was 87.1% (the sensitivity and specificity was 95.1% and 93.3%, respectively) in the identification of CAH and non-CAH cases. There is no clinical significance between the testosterone and 17OHP suppression rate in the differential diagnosis of CAH and non-CAH cases.

There was no difference in the suppression rate of 17OHP between the 1-day and 5-days DAST in CAH cases. The sensitivity of suppression rate of 17OHP is equal in the differential diagnosis of hyperandrogenism. One-day approach DAST could be used as functional test for the diagnosis of the etilology of hyperandrogenism (CAH or non-CAH).

To investigate the effect of positive end-expiratory pressure(PEEP) on the cross-sectional area (CSA) of the internal jugular vein (IJV) and anatomic relationship between the IJV and the common carotid artery (CCA) in general anaesthesia of laryngeal mask airway(LMA).

Sixty American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ grade patients undergoing elective operation received general anaesthesia using LMA from May to November 2017, aged 20-65, were included in this study and randomly divided into 4 groups: group P0 (PEEP: 0 cmH₂O), group P5 (PEEP: 5 cmH₂O), group P10 (PEEP: 10 cmH₂O), group P15 (PEEP: 15 cmH₂O). Following the induction of anesthesia, LMA was inserted, and mechanical ventilation was started while the right cervical vessels was imaged by ultrasonography after applying 4 different PEEPs in random order. Measurements were made after 1 min in each PEEP. The CSA, transverse diameter (TD), anteroposterior diameters (AD) of the IJV and the diameter, overlap distance and overlap index of CCA was measured. The arterial blood pressure, heart rate, and vasoactive drugs used were also recorded.

The CSA of group P0, P10 and P15 was (1.36±0.55), (1.80±0.54), (2.02±0.58) cm². The TD was (1.31±0.33), (1.61±0.49), (1.74±0.53) cm. The AD was (1.12±0.20), (1.33±0.30), (1.46±0.32) cm. Compared to group P0, the CSA, TD and AD of IJV in group P10 and P15 were significantly increased (P0/P10: t=7.81, 3.81, 4.30, all P<0.01; P0/P15:t=11.68, 5.40, 6.96, all P<0.01). There was no significant difference in the AD and TD of IJV between group P10 and P15 (allP>0.05), while the CSA of group P15 was bigger than that of group P10 (t=2.17, P<0.05). The overlap distance of group P0, P10 and P15 was (0.51±0.12), (0.62±0.16), (0.66±0.15) cm. The overlap index was (76.80±20.03)%, (91.10±26.13)%, (96.21±25.36)%. Compared to group P0, the overlap distance and overlap index in group P10 and P15 were significantly increased (P0/P10:t=4.49, 3.41, both P<0.01; P0/P15:t=5.91, 4.63, both P<0.01). There was no significant changes in the overlap distance and overlap index between group P10 and P15 (allP>0.05). The MAP of group P15 was lower than that of group P10 [(73.35±9.73 )vs (67.58±12.58) mmHg,t=2.745, P<0.05]. No patients were given atropine or norepinephrine.

The application of PEEP effectively increases the CSA of IJV in general anaesthesia of LMA. At the same time, it also lead to higher overlap index between the IJV and CCA.Ten cmH₂O PEEP provides the best balance between the increase of CSA and the stability of haemodynamics.

To investigate the relationship between intake volume of carbohydrates solution (CHO) and gastric emptying time in termed parturient, thus to optimize fasting time before anesthesia.

This study was a prospective study. From May to July in 2016, a total of 100 termed parturients in Huangyan Hospital of Wenzhou Medical University, were divided into four groups equally by means of random number table: D1 (200 ml), D2 (300 ml), D3 (400 ml) and D4 (500 ml), based on the different intake volume of 12.5% CHO. All the parturients had been fasted preoperatively before the treatment of oral CHO. The cross-sectional area of gastric antrum (CSA) was measured with an ultrasound machine at baseline (T₀), 3 min (T₁), 30 min (T₂), 60 min (T₃), 90 min (T₄), 120 min (T₅) and 150 min (T₆) after oral CHO, respectively. Gastric emptying in this study is defined as CSA at any time point is equal to or less than that at T₀.

Measurement was failed in eight parturients because of poor imaging quality, two each in D1 and D2 group and four in D4 group. The cubic curve was the best model for gastric emptying among several candidate models estimated with SPSS software, with R²>0.9 in all groups. Both the cubic curve and Kaplan-Meier curve indicated that gastric emptying time was prolonged as intake volume increased. Gastric emptying times in D1, D2, D3 and D4 were (76.96±17.69), (96.52±20.14), (109.20±14.70) and (122.86±16.17) min respectively, the difference was significant (F=50.471, P<0.001). All parturients in D1, D2 and D3 group had been in the status of gastric emptying 120 min after oral CHO, and all parturients in D4 group had been in the status of gastric emptying either 150 min after oral CHO.

Gastric emptying time will be within two hours when 400 ml or less oral CHO is taken by termed parturient, and it will be prolonged as intake volume increases.

To investigate the incidence and severity of embolicevents, and degree of postoperative inflammation when pneumoperitoneal pressures 15 mmHg and 12 mmHg were used during laparoscopic hepatectomy.

A computer-generated 1∶1 randomization protocol was used to assign fifty patients to either the 15 mmHg(P15, n=25) or 12 mmHg(P12, n=25) group. Throughout the surgery, air embolisms were detected by transesophageal echocardiography (TEE) and graded based on their size. Vital signs, arterial blood gases (ABG), P_ETCO₂ levels, blood loss, operative time and postoperative hospital stays were monitored. 2 ml blood samples were taken before and after operation finished 0, 12 and 24 h by using EDTA anticoagulated tubes in order to detect the IL-6, TNF-α and IL-10 level in plasma.

CO₂ embolism occurred in 100% of the enrolled patients. The frequencies of severe air embolism were 76%(n=19) in P15 group and 52% (n=13) in P12 group, respectively. The duration of severe embolism episodes in P15 group was much longer than that in P12 group[(58.0±22.6) s vs(36.6±17.8)s, t=3.71, P<0.01]. The incidence of complications in group P15 was 24%, which was higher than that in group P12 of 4%(χ²=4.15, P<0.05). The postoperative pro-inflammatory cytokine IL-6 and TNF-α in group P15 at the point of 12 hour after operation[685.66(435.18-935.52)ng/L, 31.00(18.29-41.15)ng/L]were statistically higher than those in group P12 [480.50(255.28-685.34) ng/L, 21.00(14.87-31.64) ng/L,P<0.05], whereas the anti-inflammatory cytokine IL-10 in P15 group[18.00(5.75-30.55) ng/L]was statistically lower than the P12 group [26.89(15.03-38.00) ng/L,P<0.05]. There was no statistical difference in operative time, blood loss and postoperative hospital stay between the two groups.

The higher pneumoperitoneal pressure during laparoscopic hepatectomy causes more serious gas embolism, prolongs embolic duration and lead to more sever inflammatory response.

To explore the expression of microRNA(miR)-147b in esophageal squamous cell carcinoma (ESCC) and its regulatory roles in cell proliferation, cell cycle and invasion as well as its molecular mechanisms.

Real-time quantitative PCR (qPCR) was used to investigate the expression of miR-147b in ESCC tissues and cells. Negative control (NC) and miR-147b inhibitor were transfected into ESCC EC1 and EC9706 cells, which were divided into two groups: NC group and miR-147b inhibitor group, and qPCR was employed to detect the miR-147 level and CCK-8. Flow cytometry and Transwell chamber were utilized to investigate the effects of miR-147b downregulation on cell proliferation, cell cycle and invasion in ESCC cells. Besides, target genes of miR-147b was confirmed by double luciferase reporter assay. Subsequently, qPCR and Western blot were used to examine the effects of miR-147b downregulation on NDUFA4 expression, and NDUFA4 expression and its correlation with miR-147b were investigated in ESCC tissues.

Relative level of miR-147b in ESCC tissues (3.03±0.27) and cells were markedly higher than that in para-carcinoma tissues (1.00±0.01) and normal esophageal epithelial cell, and the differences had statistical significance (P<0.01), and its high expression was closely associated with clinical staging, invasion depth, histological grading and lymph node metastasis(P<0.05). Importantly, clinical staging, lymph node metastasis and miR-147b may be an independent prognostic factor in ESCC. Moreover, miR-147b downregulation dramatically suppressed cell proliferation, arrested cell cycle in G0/G1 phase and reduced invasion ability in ESCC cells. Most importantly, NDUFA4 was a direct target gene of miR-147b, and miR-147b inhibitor evidently upregulated the expression of NDUFA4. Furthermore, NDUFA4 displayed low expression in ESCC tissues and its expression exhibited negative correlation with miR-147b expression.

The downregulation of miR-147b expression significantly suppresses the proliferation and invasion abilities as well as alters cell cycle distribution in ESCC.

To study the effect and safety of the DA-EPOCH chemotherapy combined with G-CSF and the MA chemotherapy combined with G-CSF on mobilizing and collecting the peripheral blood stem cells and the later hematopoietic recovery.

A total of 40 patients accepted mobilization and collection of peripheral blood stem cells(PBSC) after being treated by DA-EPOCH+ G-CSF and MA+ G-CSF therapy respectively, and performed auto-transfusion. The effect of mobilization, the adverse effects and the hematopoietic recovery after autologous transplantation were analyzed retrospectively.

Two cases in DA-EPOCH group and 1 case in MA group did not achieve the collection goal and required a G-CSF mobilization therapy again. During the DA-EPOCH mobilization therapy, the lowest median WBC was[0.7(0.5, 0.9)]×10⁹/L and the median lowest platelet (PLT) count was[75.0 (53.0, 107.0)]×10⁹/L.Low-grade fever occurred in 7 cases (37.5-38.3 ℃) and platelet transfusion was required in 2 cases. The collection of MNC number was (5.8±1.8)×10⁸/kg, and the median CD34⁺ cell number was[3.7(2.8, 6.7)]×10⁶/kg; for the MA therapy groups, the numbers were[0.4 (0.2, 0.9)]×10⁹/L and[12.0 (6.0, 16.0)]×10⁹/L, respectively. High fever occurred in 8 cases (above 39 ℃). PLT transfusion was required in 15 cases and red blood cell(RBC) transfusion in 4 cases. The collected number of MNC was (6.0±2.9)×10⁸/kg, and CD34⁺ median cell number was[8.5(2.6, 11.2)]×10⁶/kg. There are significant differences between the lowest PLT counts and CD34⁺ cell numbers in the two groups of patients(P<0.05). A peripheral blood leukocyte increase in 10(9, 11) days and platelet implantation in 12(11, 16) days were observed after ASCT by DA-EPOCH therapy. In MA group, the number were 10(9, 11) and 12(11, 15) days. The hematopoietic recovery in both groups were successful, without any statistically difference(P>0.05). No death occurred during the process of transplantation.

DA-EPOCH and MA chemotherapy could effectively mobilize the peripheral blood stem cells in suitable NHL patients.DA-EPOCH chemotherapy was higher in safety and lower in price, and required less transfusion compared with MA therapy.

To investigate the mechanisms of telmisartan on delaying the course of type 2 diabetes.

3T3-L1 preadipocytes were induced to 80% mature adipocytes (control group) and stimulated with 50 ng/ml tumor necrosis factor (TNF-α) for 1 hour (TNF-α group). Then 0.1, 5, 10 μmol/L telmisartan was added to the culture medium for 24 h, respectively(T_0.1,T₅ and T₁₀ group). The cells from each group was collected to detect peroxisome proliferator-activated receptors γ (PPARγ) and its phosphorylation level, as well as upstream kinase cell cycle dependent kinase 5 (CDK5) by Western blot. Adiponectin in the culture supernatant was detected by enzyme-linked immunosorbent assay (ELISA). PPARγ or CDK5 of undifferentiated 3T3-L1 adipocytes were silenced by using targeted short hairpin RNA (shRNA). Through infection of the cells with the retrovirus, stabled PPARγ or CDK5 knockdown cell lines were set up and screened by incubation with puromycin. 3T3-L1 adipocyte cell lines expressing serine mutant PPARγ (S273A, S112A, S186A) were obtained and thus their phosphorate sites were further determined. CDK5 knockdown cell lines were detected by oil red O staining to measure the lipid accumulation and differentiation efficiency. The 10 μmol/L telmisartan was used to treat mature CDK5 knockdown 3T3-L1 adipocytes, Western blot was used to detect PPARγ and its phosphorylation level, and ELISA was used to detect the release of adiponectin in the culture supernatant.

The TNF-α stimulation had no significant effect on the expression of PPARγ in each group (allP>0.05), but it could up-regulate the phosphorylation of PPARγ in the TNF-α group and down-regulate the release of adiponectin (allP<0.05). Compared with TNF-α group, telmisartan can reduce PPARγ phosphorylation levels and up-regulate adiponectin release in different degrees, among which T₅ group and T₁₀ group had statistically significant differences (all P<0.05), but for T_0.1 group, the difference was not significant (P>0.05). Compared with the 3T3-L1 wild type (WT) adipocytes, adiponectin in cell line with only S273A mutant did not respond to TNF-α stimulation and telmisartan intervention. Oil red O staining showed that silencing of CDK5 did not affect the differentiation of 3T3-L1 preadipocytes. Western blot results showed that silencing of CDK5 (shCDK5 group) had no significant effect on PPARγ expression (P>0.05), but it could down-regulate the phosphorylation of PPARγ and up-regulate release of adiponectin, compared with the randomized control group (shCon group) and the differences were statistically significant (allP<0.05).

Telmisartan can alleviate the increased PPARγ phosphorylation and up-regulation of adiponectin content due to TNF-α stimulation. CDK5 mediates the effect of telmisartan on PPARγ signaling pathway in 3T3-L1 adipocytes. Additonally, it also demonstrated the action site of telmisartan was PPARγ Ser 273, and CDK5 is upstream kinases of PPARγ.

To investigate the application of extracorporeal membrane oxygenation (ECMO) in pediatrics in China as well as the outcomes.

Data was conducted by questionnaire to investigate the use of ECMO in children under the age of 18 in China by June 30, 2017. All patients were divided into two age groups: pediatric patients (29 d-18 y) and neonates (1-28 d); Also by the causes of ECMO treating including cardiac, respiratory and extracorporeal cardiopulmonary resuscitation (ECPR). The form included the numbers of ECMO cases, weaned and discharged cases, according to the different ages and causes. In addition, the departments that routinely participate in ECMO management were acquired.

Totally 43 tertiary hospitals were enrolled, of which 30 have implemented ECMO for the children patients (comprising pediatrics and neonates), including 14 general hospitals, 5 cardiothoracic specialty hospitals and 11 children′s or women and children′s hospitals. ECMO for pediatrics and neonates was firstly carried out at mainland China in 2004. To the deadline of investigation, 800 patients were supported with ECMO, among which 658 were pediatrics, much more than 142 of neonates. As to pediatrics, 453 were supported with ECMO for cardiac indications with 287 (63.4%) weaned off and 215 (47.5%) survived to discharge; for respiratory causes, 79 cases were registered with 47 (59.5%) weaned off and 36 (45.6%) discharged; for ECPR, 126 were enrolled with 62 (49.2%) successfully weaned off and 48 (38.1%) discharged. In contrast, neonatal patients undergoing cardiac ECMO contained 79 cases, with 39 (49.4%) weaned off and 26 (32.9%) discharged; due to respiratory causes, 40 neonates were included, with 26 (65.0%) weaned off and 21 (52.5%) discharged; 23 neonatal patients consisted of ECPR cause and 10 (43.5%) of them successfully weaned off, but only 6 (26.1%) finally survived. Among the 30 hospitals conducted ECMO for pediatrics and neonates, the average number of departments for ECMO management is 4.03±1.87.

Although ECMO used for children in mainland China is relatively late, a certain number of cases have been accumulated, and there is still a gap compared with the international standard. Meanwhile, each hospital has preliminarily built up its own ECMO team.

To study the hemoglobin concentration, anemia status and its determinant factors among Chinese rural women of reproductive age in 2012.

This was a cross-sectional study. The data was obtained from the National Free Preconception Health Examination Project (NFPHEP). A total of 712 101 Chinese rural reproductive age women aged 21-49 years old who came from 193 counties of 30 provinces were included. The demographic characteristics were obtained from questionnaires. Hemoglobin concentration was measured using the cyanomethemoglobin method. The definition of anemia we used was recommended by World Health Organization, and was adjusted according to altitude level. The hemoglobin concentration level, the prevalence of anemia and its 95% CI was calculated. Determinant factors of anemia such as demographic characteristics and histories of pregnancy and miscarriage were analyzed using logistic regression.

In 2012, the level of hemoglobin concentration in Chinese rural women of reproductive age was (127.77±13.47) g/L, with the lowest in 21-24 years group, which was (127.54±13.54) g/L, and highest in 35-39 years group, which was (128.39±14.12) g/L. In terms of region, the hemoglobin concentration level was lowest in central south, which was (125.79±12.00) g/L, and highest in southwest, which was (129.91±14.37) g/L. The prevalence of anemia in Chinese rural women of reproductive age was 24.80%, with the highest seen in 21-24 years, which was 25.92% (95% CI: 25.74%-26.11%), and lowest in 30-34 years, which was 23.61% (95% CI: 23.37%-23.85%). The prevalence in northwest (28.31%, 95% CI: 28.01%-28.61%) was the highest among all regions, and the prevalence in east (20.88%, 95% CI: 20.68%-21.09%) was the lowest.

The prevalence of anemia in Chinese rural reproductive age women was 24.80% in 2012. The anemia prevalence was higher among women who were young, had low educational level, and lived in northwest region.

A 25-year-old female was admitted to the Department of Nephrology, Peking University First Hospital on April 17, 2017 due to "microscopic hematuria for 2 months and edema for 2 weeks". Patient 2 months ago (pregnant 16^＋1Week) was examined at the local hospital and showed urine red blood cells + and urine protein negative; One month ago, urine red blood cells + + +, urine white blood cells + +, and urine protein were negative. Two weeks ago (22 weeks of pregnancy), bilateral ankle edema began to appear, and gradually spread to the lumbosacral region, accompanied by chest tightness, asthma, abdominal distension, anorexia, and decreased urine output. 1 week ago, urine routine reexamination showed urine protein + + + and red blood cells + + +; Serum albumin (Alb) was 21 g/L, serum creatinine (Scr) was 80 μ mol/L, serum potassium was 5.7 mmol/L, and urinary tract ultrasound showed that both kidneys were slightly enlarged, but the renal pelvis and ureter were not dilated. Blood biochemistry was re-examined 5 days ago: Alb 20.2 g/L, Scr 113.5 μ mol/L (44-106 μ mol/L), and serum potassium 5.4 mmol/L. The local hospital recommended termination of pregnancy, but the patient and family refused. He went to the outpatient clinic of our hospital 3 days ago and was admitted to the hospital with "nephrotic syndrome, acute kidney injury (AKI)". The patient gained about 15 kg in 2 weeks. Deny fever, rash, mouth ulcer, macroscopic hematuria, increased blood pressure. Past history: Pain in both knees, elbows and interphalangeal joints occurred 1 year ago when the weather changed. Six months ago, after catching cold, the fingertips became cold and white, which was relieved after exposure to heat. History of kidney disease denied. Married, last menstruation 31 October 2016, regular prenatal check-up, pregnant 12^＋1No abnormalities were found in the weekly urine routine, and I am 24 weeks pregnant; The fetus developed well as of 1 week ago. Family history of genetic diseases and similar diseases were denied.

A 38-year-old female was admitted to Peking Union Medical College Hospital on January 22, 2017 due to "fever for 4 months, scleral yellowing and shortness of breath for more than 2 months". The patient developed high fever in November 2016, at night, with a maximum body temperature of 39℃, accompanied by mild cough and no phlegm, and denied chills and chills. Local blood test showed 8.43×10 white blood cells⁹/L, hemoglobin 111 g/L, platelets 92×10⁹/L; Liver function: alanine aminotransferase (ALT) 123 U/L, aspartate aminotransferase (AST) 67 U/L; No abnormalities in renal function were seen; Abdominal ultrasound showed cholestasis of the gallbladder and splenomegaly. Treatment with cephalosporin antibiotics was not effective. On December 5th, we went to the outpatient clinic of rheumatology and immunology of Peking Union Medical College Hospital to check urine routine and sediment (-); erythrocyte sedimentation rate (ESR) 92 mm/1 h, high-sensitivity C-reactive protein 7.24 mg/L; Liver and kidney function: total bilirubin, direct bilirubin (-), ALT 129 U/L, AST 102 U/L, lactate dehydrogenase 1 686 U/L, creatinine 75 μ mol/L; antinuclear antibody (+) S1:160; Weakly positive anti-Sjogren's syndrome antigen A antibody; anti-human globulin assay (+); Anticardiolipin antibody 56 PL-IgG-U/ml (normal<12 PL-IgG-U/ml); Anti-beta₂Glycoprotein 1 116 RU/ml (normal<20 RU/ml); lupus anticoagulants, anti-neutrophil cytoplasmic antibodies, and complement were all (−); T-cell SPOT test for tuberculosis infection (T-SPOT.TB) (-). Connective tissue disease was diagnosed, except systemic lupus erythematosus (SLE). On December 12, the patient was given methylprednisolone 16 mg orally, once per 12 h. The patient's symptoms were relieved, his body temperature returned to normal, and the dose was gradually reduced at a rate of 4 mg per week after 1 week. On December 26, the patient developed scleral yellowing and occasionally shortness of breath. Local reexamination blood routine: white blood cells 0.95×10⁹/L, hemoglobin 50 g/L, platelets 40×10⁹/L, reticulocyte ratio 0.13%; Liver function: total bilirubin 314.3 μ mol/L, direct bilirubin 253.1 μ mol/L, ALT 783.3 U/L, AST 1 662 U/L; Hepatitis virus screening all (-); cytomegalovirus (CMV) -IgM (+); Ferritin>1 500 μ g/L. Check the bone marrow smear: active hyperplasia, obvious reduction of erythroid, relatively obvious granulocyte hyperplasia, obvious poisoning granules, plasma cells, reticulum, phagocytic cells are easy to see, phagocytic blood cells can be seen, and atypical lymphocytes can be seen. It is considered that CMV infection causes hepatic impairment and acute hematopoietic arrest. Blood transfusion, ascending white blood cells, and intravenous infusion of human immunoglobulin 20 g once/d for a total of 3 days, and symptomatic liver protection treatment were given at the same time. Bilirubin and liver function were monitored and gradually returned to normal, but the blood routine results did not improve. During the treatment, low fever was intermittent again, with a maximum body temperature of 38 ℃, and shortness of breath gradually worsened. Sputum hexamine silver staining and acid-fast staining were both (-), and chest CT showed patches in the lower lobe of the right lung. Methylprednisolone was restored to 32 mg orally once a day, and cefoperazone/sulbactam and voriconazole were added successively. The patient's fever progressed to daily high fever, with a maximum body temperature of 39.6℃, accompanied by cough and white phlegm, and the activity tolerance gradually deteriorated. Hospitalization for further diagnosis and treatment. Since the onset of the disease, the spirit is weak, the appetite is poor, the sleep is acceptable, the urine and defecation are normal, and the body weight has decreased by about 5 kg. Past history: Diagnosis of premature ovarian failure in 2010. Deny smoking, drinking history, marriage and childbirth history, menstrual history, family history is no different.

The 5-year-old child was admitted to the pediatric department of our hospital on October 12, 2017 due to "headache for 8 days and abnormal movement for 2 days". The child developed headache without obvious trigger 8 days ago, accompanied by vomiting twice after eating, and went to the local hospital for electroencephalogram to show diffuse theta waves. Considered "infectious encephalitis", the symptoms improved after anti-infective treatment. 2 d ago, the corner of the mouth was crooked to the right, the hands were dancing and the nonsense was talking. Half a day ago, the language was reduced, the answer was unable to be answered, and the walking was unsteady, so I was admitted to our hospital. The child has been built in the past and vaccinated on time. The sister and parents are in good health, and they deny a history of mental illness and convulsions in the family.

Early removal of artificial airway is an important measure to reduce the complications associated with mechanical ventilation. Upper airway patency and better airway protection are the key factors affecting the success of artificial airway removal^[1]Among them, the evaluation of cough ability is an important content to judge the strength of airway protection ability, but there is still a lack of consensus opinions or suggestions on standardized evaluation of cough ability of patients with mechanical ventilation in clinical practice. In recent years, scholars have conducted a lot of clinical research and exploration on the evaluation and clinical significance of cough ability of patients with mechanical ventilation. The evaluation and clinical significance of mechanical ventilation, especially the establishment of artificial airway patients' cough ability are described as follows.

Tobacco harm is one of the most serious public health problems in the world today, with about 7 million deaths attributable to smoking every year^[1]。 As the largest tobacco producer and consumer in the world, smoking has a serious impact on our people. If effective tobacco control measures are not adopted, it is estimated that by 2050, the number of deaths caused by smoking-related diseases in China will reach 3 million every year^[2]。 Tobacco dependence is a chronic disease^[3]。 Smoking is associated with chronic respiratory diseases, cardiovascular and cerebrovascular diseases and the occurrence of many kinds of tumors^[3]It also has a certain influence on cognitive function^[4,5]。

cochlear implants (CI), regarded as the most successful neuroprosthesis, are auditory aids that help patients with severe to extremely severe deafness to recover or regain some sound perception. So far, more than 500,000 deaf patients worldwide have regained their hearing through CI implantation^[1]。 The generation of CI electrical stimulation hearing can be divided into three stages: first, the transmission of acoustic information; The second is the reception of electrical stimulation signals; The third is to perceive or understand the information of electrical stimulation^[2]。 Researchers have paid more and more attention to the help of auditory training to improve the perception of electrical stimulation by CI implants, and further understood and understood the correlation between nervous center and individual performance of CI implants through the study of plasticity of auditory central system. This paper summarizes the status of music perception, music training and its related influencing factors, and the development and adaptation of auditory center of CI implants, aiming to provide reference for the follow-up auditory training research and the objective evaluation method of music perception and training effect.