Volume 98  ·  Issue 30  ·  2018

In recent decades, diabetes has been widespread worldwide and its prevalence has been on the rise. The ultimate goal of focusing on diabetes is to reduce chronic complications caused by long-term hyperglycemia, especially cardiovascular events and cardiovascular deaths. However, research in the United States suggests that in the past 30 years or so, a reduction in all-cause death and cardiovascular death has only been observed in male diabetic patients, and no similar phenomenon has been found in women, suggesting that female diabetes may have some gender-related characteristics.

Honesty is an important symbol to measure the degree of civilization and progress of a society. Scientific research integrity is the cornerstone of scientific and technological innovation, the power source to promote the development of scientific undertakings, and an important benchmark to lead the progress of human civilization^[1]。 In 2016, President * made it clear at the highly anticipated National Conference on Science and Technology Innovation, the Academicians' Conference of the two academies, and the National Congress of the China Association for Science and Technology that by 2020, China should rely on scientific and technological innovation to enter the ranks of innovative countries. The national emphasis on scientific research has injected a boost into the development of China's scientific undertakings, and at the same time, it has put forward higher requirements for scientists.

The ideal biomarker for diabetes needs to have high sensitivity and specificity, sufficient stability and convenient to establish standardized detection technology. In particular, sampling has little damage to patients, and significant changes in levels can be keenly detected in the early stage or even in the early stage of the disease, so as to accurately intervene in the early stage of individuals, delay or prevent the occurrence of diseases, and realize the advancement of the prevention and control barrier.

Anemia is more common in preoperative patients. If it is not treated effectively, it will affect the surgery and prognosis of patients. Therefore, timely diagnosis and treatment of preoperative anemia is very important. At present, preoperative anemia is not paid enough attention clinically. Usually, only blood transfusion is used to correct anemia or direct surgery without intervention, which not only increases the risk of perioperative blood transfusion and surgery, but also increases the incidence of postoperative complications and mortality. With the continuous and in-depth understanding of blood management of perioperative patients, relevant consensus and guidelines have been issued at home and abroad. In 2016, the safety and effect evaluation project team of joint replacement surgery released the "Accelerated Rehabilitation of Hip and Knee Arthroplasty in China-Expert Consensus on Diagnosis and Treatment of Perioperative Anemia", which provided guidance for perioperative anemia management in orthopedic surgery. However, preoperative anemia is not only limited to orthopedic surgery patients, but also common in other surgical departments. Therefore, we searched domestic and foreign literatures, combined with published relevant consensus and guidelines, and extensively consulted relevant professional experts to formulate this consensus, aiming at providing a basis for standardized diagnosis and treatment of preoperative anemia (this consensus does not include pediatric surgery patients).

To develop a specific and sensitive method to detect serum unmethylated insulin (INS) DNA for monitoring pancreatic beta cell death and evaluate its clinical practice value.

This study validated and modified the Akirav method and the Husseiny method. Six type 1 diabetes mellitus (T1DM) patients, who were diagnosed with T1DM in the Second Xiangya Hospital, Central South University between February 2014 and February 2015, and another 8 sex- and age-matched healthy controls, were enrolled in the study. Patients′ serum samples were examined by the modified Akirav method.

Methylation-independent PCR of the Akirav method cannot amplify the specific product. The efficiency of primers for quantitative methylation-specific PCR used in Husseiny method was (76.98±2.88)%, which was lower than 80% (recommend efficiency), resulting in poor reliability. This study applied primers for the Husseiny method into the procedures of the Akirav method.The results showed that the level of unmethylated INS DNA in T1DM group is significantly higher than that in the healthy controls[demethylation index: 0.039(0.028-0.083) vs 0.016(0.003-0.029), P=0.005].

The modified Akirav method can effectively detect the level of unmethylated INS DNA. The level of unmethylated INS DNA in T1DM patients is higher than that in the healthy controls.

To investigate the relationship between non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) in patients with latent autoimmune diabetes in adults (LADA).

A total of 223 hospitalized patients were recruited between January 2007 and June 2009 in Department of Endocrinology and Metabolism of the Sixth People′s Hospital Affiliated to Shanghai Jiaotong University. Finally, 142 patients with complete clinical data and without history of drinking were included in this study. According to the Chinese Medical Association′s Guidelines of NAFLD, based on the result of ultrasound, all subjects were divided into two groups including patients with LADA and NAFLD (n=37) and patients with LADA but without NAFLD (n=105). Clinical data including diabetes duration, history of smoking and medications, height, weight, blood pressure, blood lipids, blood glucose, C-peptide, and liver and kidney function were collected. The prevalence and components of MetS were compared between two groups. The association between MetS and NAFLD was also explored.

After adjusting for age and sex, compared with the subjects without NAFLD, the subjects with NAFLD were older and had higher percentage of hypertension, and had higher body mass index[(26.5±3.7) kg/m² vs (21.9±3.1) kg/m²], waist-hip ratio(0.92±0.06 vs 0.86±0.07), low density lipoprotein cholesterol[(3.26±0.72) mmol/L vs (2.70±0.87) mmol/L], C-reactive protein, fasting C-peptide, 2 h postprandial C-peptide, systolic blood pressure, diastolic blood pressure, alanine aminotransferase and triglyceride (allP<0.05). But they had lower high-density lipoprotein cholesterol[(1.17±0.43) mmol/L vs (1.35±0.40) mmol/L]and HbA1c[(8.83±2.14) % vs (10.02±2.79)%](bothP<0.05). In addition, after adjusting for age and sex, compared with the patients with LADA but without NAFLD, the prevalence of MetS in the patients with LADA and NAFLD was obviously higher (97.3% vs 47.6%,P<0.001), and the proportion of the patients with four (32.4% vs 16.2%,P<0.001) and five (43.2% vs 5.7%,P<0.001) components of MetS in the patients with LADA and NAFLD was also significantly increased than that in the patients with LADA but without NAFLD. Binary regression analysis showed that NAFLD was an independent factor associated with MetS in the patients with LADA after correcting other confounding factors (P<0.001).

Compared with the patients with LADA but without NAFLD, the prevalence of MetS was obviously higher, and had more serious metabolic disorder in the patients with LADA and NAFLD. The presence of NAFLD was an independent factor associated with MetS in the patients with LADA.

To analyze the related factors of diabetic nephropathy in inpatients with type 1 diabetes mellitus (T1DM).

A total of 300 patients with T1DM who were treated in the Department of Endocrinology of Anhui Provincial Hospital between 2014 and 2016 were analyzed retrospectively. All the patients were divided into two groups according to their urine albumin-to-creatinine ratio: non-diabetic nephropathy group (n=193) and diabetic nephropathy group (n=107). Multivariate logistic regression analysis was adopted to analyze the factors related to diabetic nephropathy in T1DM, including the age, diabetic duration, body mass index (BMI) and glycosylated hemoglobin (HbA1c) of the two groups.

Age, diabetes duration, HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, triglyceride and uric acid (UA) of diabetic nephropathy group were higher than those of non-diabetic nephropathy group (all P<0.05). The total bilirubin, hemoglobin (Hb) and albumin in non-diabetic nephropathy group were higher than those in diabetic nephropathy group (P<0.05). The proportion of women in diabetic nephropathy group was higher than non-diabetic nephropathy group (62.6% vs 42.0%,P=0.001). Multivariate logistic regression analysis showed that diabetes duration (OR=2.142, 95% CI: 1.011-4.539), HbA1c (OR=1.262, 95% CI: 1.090-1.462), DBP (OR=1.048, 95% CI: 1.001-1.096), UA (OR=1.005, 95% CI: 1.001-1.009) and Hb (OR=0.952, 95% CI: 0.929-0.975) were independent related factors for diabetic nephropathy.

Positive controlling of blood pressure, blood glucose, hyperuricemia and correcting anemia may reduce the incidence of diabetic nephropathy in T1DM patients.

To study the role of chemerin in the development and progression of non-alcoholic fatty liver disease (NAFLD) rats complicated with prediabetes and explore the effect of sitagliptin on the expression of chemerin.

The model of NAFLD and prediabetic rats was established. The rats were then randomly divided into normal group, model group and intervention group. Sitagliptin intervention was performed for 8 weeks after 8 weeks′s feeding with high-fat diet. After that, the level of blood glucose, insulin and chemerin was measured. Cytological changes of liver, omentum and epididymal adipose tissue were observed by HE staining. The distribution of chemerin in the tissues was observed by immunohistochemistry. The mRNA and protein expression of chemerin and chemokine-like receptor 1 (chemR23) in liver and adipose tissue were detected by RT-PCR and Western blotting.

After 8 weeks of sitagliptin treatment, compared with the normal group(n=8), serum chemerin in the model group (n=6) increased[(35.19±3.86) ng/L vs (29.90±2.17) ng/L, P=0.046)]. Serum chemerin in the intervention group (n=6) was lower than that of the normal group[(23.20±1.89) ng/L vs (29.90±2.17) ng/L, P=0.013)]. Compared with the normal group, the mRNA and protein expression of chemerin in the liver and omentum adipose tissue of the model group increased (P<0.05). The expression amount of the omental adipose tissue was more than that of the liver(P<0.05). The mRNA expression of chemR23 both in liver and omental adipose tissue increased (P<0.05), and the expression amount of the liver was more than that of omental adipose tissue. The levels of fasting blood glucose[(5.72 ±1.36)mmol/L vs(3.77±0.77)mmol/L,P=0.002], total cholesterol[(1.53±0.09)mmol/L vs (1.23±0.17)mmol/L, P=0.032], aspartate aminotransferase[(319.8±104.4)U/L vs (195.0±25.0) U/L, P=0.016]in the model group were significantly higher than those in the normal group. The differences between the intervention group and the normal group was not significant. But the level of fasting blood glucose[(4.33±0.39)mmol/L vs (5.72±1.36)mmol/L, P=0.019], total cholesterol[(1.23±0.17)mmol/L vs (1.53±0.09)mmol/L, P=0.047]and aspartate aminotransferase[(198.4±22.8)U/L vs (319.8±104.4)U/L, P=0.014)]of the intervention group was significantly lower than those of the model group.

Increasing expression of serum chemerin is consistent with hepatic steatosis, suggesting that chemerin can serve as a serological warning indicator for NAFLD complicated with pre-diabetes. Sitagliptin affects the mRNA and protein expression of chemerin and its receptor chemR23 in steatosis liver. This may provide a research direction for the pathophysiology and treatment of NAFLD.

To analyze the epidemiological characteristics of Pneumocystis jirovecii infection and colonization in non-AIDS patients.

From January 2010 to December 2017, bronchoalveolar lavage fluid (BALF) was detected by Grocott′s methenamine silver (GMS) staining and real-time fluorescence quantitative PCR (qPCR) in non-AIDS patients with bronchoscopic alveolar lavage at Peking University First Hospital. At the same time, Pneumocystis jirovecii was detected in the environment of the hospital.

Within 8 years, Pneumocystis jirovecii were detected in BALF of a total of 1 407 non-AIDS patients. GMS staining was performed in all these 1 407 cases, of which 114 (8.10%) cases were with Pneumocystis jirovecii infection and 3 (0.21%) cases with colonization. There were totally 946 non-AIDS immunocompromised patients, of which 113 (11.95%) cases were infected and 2 (0.21%) cases with colonization; there were 461 non-AIDS immunocompetent patients, of which only 1 (0.22%) case was infected and 1 (0.22%) case with colonization. GMS staining and qPCR were both performed in 196 cases, of which 36 (18.37%) cases were infected and 33 (16.84%) cases with colonization. There were totally 175 non-AIDS immunocompromised patients, of which 36 (20.57%) cases were infected and 30 (17.14%) cases with colonization; there were 21 non-AIDS immunocompetent patients, of which no one was infected and 3 (14.29%) cases with colonization. By means of GMS staining and qPCR, no Pneumocystis jiroveci were detected in the environment of Peking University First Hospital.

Pneumocystis pneumonia is rare in immunocompetent patients, but not in non-AIDS immunocompromised patients. And colonization is rare in both of them. There may be no Pneumocystis jiroveci in the environment.

To analyze the gene sequencing in eight patients with Glanzmann′s thromboasthenia(GT), and combined with clinical manifestations and laboratory findings to investigate the molecular mechanism of GT.

Eight patients who were diagnosed as GT based on platelet aggregation test and flow cytometry were enrolled, as well as 4 pedigrees. Next-generation sequencing was used to analyze all the exons and flanking sequences of αⅡ band β3 gene and also platelet-type bleeding disorders related genes. Gene polymorphism was excluded by retrievaling HGMD and PubMed databases and relative literature. Mutations were confirmed by sanger sequencing.

All the eight patients had relatively normal platelet counts and coagulation profiles. But their platelet response to ADP was impaired, and their platelet response to ristocetin was relatively normal. Flow cytometry showed that of the 8 patients, platelet surface αⅡb/β3 was lower than 5% of the normal value in 5 cases, and in 2 cases was 5% to 20% of normal value, and in 1 case there was no significant platelet surface αⅡb/β3 reduction compared with normal level. Gene analysis revealed that five mutations in ITGA2B gene were identified, including c. 1750C>T(p.Arg584Ter), c.1882C>T(p.Arg628Ter), c.814G>C(p.Val272Leu), c.2333A>C(p.Gln778Pro), c.432G>A(p.Trp144Ter). Six mutations in ITGB3 gene, including c. 719G>A(p.Arg240Gln), c.2248C>T(p.Arg750Ter), c.1495T>C(p.Cys499Arg), c.1728delC(p.Ser577ProfsTer92), c.877C>T(p.Gln293Ter), c. 1260G>A were identified. In addition, mutations in genes such as RUNX1, HPS4, MYH9, ACTN1, HPS3 and SETBP1 were identified in patients with GT.

Rather than homozygous mutations, heterozygous mutations, especially compound heterozygous mutations, are more common in patients with GT. The pathogenesis of GT may relate to gene mutations such as RUNX1 in addition to the ITGA2B gene and the ITGB3 gene.

To evaluate the accuracy of contrast-enhanced ultrasound(CEUS) scanning in identifying vulnerable plaque in carotid artery.

The study included a total of 25 patients who suffered from carotid artery stenosis and underwent carotid endarterectomy from January 2016 to December 2017 in Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University. Preoperative carotid artery contrast enhanced ultrasound and High-resolution MRI were performed to all patients to determine whether the plaques were stable. All patients then underwent carotid endarterectomy, during which, plaques were completely removed. Biopsies were performed using HE staining and CD31, CD34 and SMA immunohistochemistry was used to identify the plaques properties, including the thickness and integrity of the fiber cap, neovascular endothelium, hemorrhage, and inflammatory cells in the removed plaques.The results of these tests were compared with the diagnosis through the pre-operative imaging.

Among twenty-five cases, the pre-operative CEUS revealed sixteen with unstable plaques and nine with stable plaques. Meanwhile the post-operation pathology confirmed seventeen cases with unstable plaque components. The sensitivity of CEUS in the identification of carotid vulnerable plaque was 88.2%(15/17), the specificity was 87.5%(7/8), and the overall diagnostic accuracy was 88%(22/25). The sensitivity, specificity and overall diagnostic accuracy of high resolution MR for vulnerable plaque identification were 83.3%(10/12), 71.4%(5/7), 78.9%(15/19), respectively. There were no significant difference between two groups(χ²=0.003, P>0.05).

The sensitivity, specificity and overall diagnostic accuracy of the CEUS for vulnerable plaque identification are high.Therefore, CEUS is recommended as one of the pre-operative diagnostic method for unstable plaque in carotid stenosis.

To investigate the effect of interleukin (IL)-7 on anti-tumor activity of CD8⁺ T cells in non-small cell lung cancer (NSCLC) patients.

Twenty-seven NSCLC patients and ten healthy controls were included from Zhengzhou Central Hospital between January 2017 and July 2017. Plasma, peripheral blood mononuclear cells (PBMCs), and bronchial alveolar lavage fluid (BALF) (both tumor site and non-tumor site) were collect from NSCLC patients, while plasma and PBMCs were also collected from healthy controls. IL-7 level and IL-7 receptor α (CD127) mRNA relative expression was measured. Purified CD8 ⁺ T cells and primary NSCLC cells were stimulated with recombinant IL-7. Cellular proliferation, cytokines secretion, and protein expression in IL-7 signaling pathway were investigated. Direct/indirect contact coculture system of CD8⁺ T cells and primary NSCLC cells was also used to assess the cytolytic and noncytolytic activity after IL-7 stimulation.

Plasma IL-7 level was significantly reduced in NSCLC patients compared with normal controls[1 731 (1 364, 2 536) vs 2 686 (1 692, 4 786) ng/L, P=0.023). IL-7 level in BALF isolated from tumor site was also remarkably down-regulated compared with non-tumor site in NSCLC patients[1 045 (562, 1 550) vs 1 599 (1 166, 2 107) ng/L, P=0.006 9). There was no statistical difference of CD127 mRNA between the two groups. Recombinant IL-7 stimulation did not affect cellular proliferation and cytokines production in primary NSCLC cells, however, remarkably increased cellular proliferation, interferon (IFN)-γ/tumor necrosis factor (TNF)-α secretion, and signal transducers and activators of transcription 5 (STAT5) phosphorylation and suppressor of cytokine signaling 3 (SOCS3) expression of CD8⁺ T cells from NSCLC patients. IL-7 stimulation also significantly enhanced the cytolytic and noncytolytic function of CD8⁺ T cells on primary NSCLC cells.

IL-7 enhances anti-tumor activity of CD8⁺ T cells in NSCLC patients.

To investigate the clinicopathological and immunohistochemistrical features of secretory carcinoma of the breast (SCB), as well as its diagnosis and prognosis.

Five cases of SCB were collected and specimens were fully drawn. Microscopic pathology examinations and immunohistochemistry(SP method)were performed.

Five cases were all female patients aged from 31 to 54 years old (with an average age of 38 years), and all patients initially presented with the painless breast lump, often near the areola. Macroscopically, all the tumors were relatively circumscribed, with a mean diameter of 2.1 cm(1.2-3.0 cm). Histologically, the tumors revealed different patterns (microcystic, solid, ductal, and so forth) and appeared large amounts of intracellular and extracellular eosinophilic PAS- and AB-PAS- positive secretory materials, as well as the granular eosinophilic cytoplasm. Immunohistochemistrically, the tumor cells were strongly positive for epithelial membrane antigen (EMA) and S-100. Three cases had negative expression for estrogen receptor (ER) and progesterone (PR), and two cases had weakly focal expression. Human epidermal growth factor receptor 2 (HER2) and P53 were negative, while only one case had weakly focal expression. The tumors were positive for CK7, CK5/6, CD10, but they were negative for CEA, smooth muscle actin (SMA) and P63 . The proliferation index of Ki-67 was 5%-8%. There was no patient with metastasis of the tumor in axillary lymph node. Except 1 case lost follow-up, and the rest had no recurrence or distant metastasis.

SCB is very rare, with low malignancy, and has better prognosis, but it is usually classified as triple-negative breast cancer because of the immune phenotype. The correct diagnosis of this lesion depends on clinical characteristics, morphology and immunohistochemistry.

To analyze and summarize the surgical experience of robotic-assisted laparoscopic partial nephrectomy (RAPN) for treating renal hilar tumors, and assess the efficacy and safety of this surgery.

The clinical data of 22 renal hilar tumor patients who underwent RAPN in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine between September 2015 and September 2017 was analyzed. The patients included 19 males and 3 females, with an average age of (55.6 ±13.0) years old and the age range was 28-75 years. In 13 cases, the tumors were in left kidney, and 9 in the right. There were 10 large tumors (>4 cm diameter), the average tumor size was (3.7±1.9) cm. Preoperative glomerular filtration rate was normal in all cases.

The surgery was successfully finished in all of the cases, with no conversion to open surgery. The mean duration of the surgery was 80-270 min, with an average of (134.7±44.5) min. The blood loss was 80-500 ml, with an average of (135.9±130.7) ml, and none of the cases needed intraoperative blood transfusion. The warm ischemia time was 8-25 min, with an average of (18.2±4.0) min. The postoperative length of hospitalization was 7-23 d, with an average of (11.5±4.1) d. Serious gross hematuria occurred in 1 patient, and paroxysmal atrial fibrillation occurred in 1 patient after surgery. The post-operative pathology showed renal clear cell carcinoma in 18 cases, papillary renal cell carcinoma in 2 cases, chromophobe cell carcinoma in 1 case and well differentiated neuroendocrine tumor in 1 case. The tumor resection margin was negative in all cases. Neither local recurrence nor metastasis was observed during a follow-up of 1 to 15 months. Renal function of all the patients was in normal range.

RAPN is a safe, useful approach and a minimally invasive operation for treating renal hilar tumors and it owns crucial advantages in complete and accurate resection of the renal hilar tumors and the reconstruction of the kidney.

To study embryonic stem cell (ESC) differentiation into liver tissue structure from the perspective of epithelial mesenchymal transition (EMT).

ESC of Balb/c mice was selected to induced into hepatic cell using hepatocyte growth factor (HGF), fibroblast growth factor (FGF) in vitro, and at the time points of metaphase (13 d) and maturity (17 d) of differentiation, dynamic inhibition of Wnt/β-catenin signal was made to reduce the level of EMT. Finally, three-dimensional organization structure growth of the differentiation cells was observed in the differentiation system.Expressions of the liver cells vascular markers[albumin (Alb) and vascular endothelial growth factor (VEGFR)]were detected.

During the differentiation of ESC, the level of early EMT in the experimental group and the control group was not significantly different. The level of mid-late EMT in the experiment group was significantly lower than the control group. On the day 18 and 20 of differentiation, the relative mRNA expression level of E-cadherin was 0.61±0.15 and 0.47±0.05 in the experimental group, and 0.07±0.05 and 0 in the control group, respectively.The expression level of ALB/AFP/CK8/CK19 in the experimental group was generally higher than that of the control group in the same period, while CD31/VEGFR1 markers in the experimental group decreased more slowly in the late period of differentiation compared with the control group. In the supernatant of ESC culture, the Alb of the experimental group could be detected onday 7, and the concentration was (0.32±0.02) mg/L, while Alb in the control group was (0.19±0.05) mg/L. Urea in the experimental group could be detected on the day 13, and the concentration was (8.7 ±1.0) μmol/L, and the urea concentration of the control group was (3.1±1.2) μmol/L. The concentration of Alb and urea in the culture supernatant of ESC differentiation system increased significantly with the prolongation of the differentiation time, and the Alb and urea concentrations in the experimental group were significantly higher than those in the control group at the same time period. In addition, the differentiated cells in the experimental group could maintain the growth of three-dimensional tissue, while the differentiated cells in the control group eventually showed a single cell state. The expression of hepatic and vascular cell markers could be detected in the experimental group. Immunofluorescence results showed that the hepatocytes and vascular structures were tightly arranged. HE staining showed the formation of hepatic lobular structure, while the control group had no vascular component markers.

The differentiation of ESC into liver tissue can be effectively promoted by decreasing the level of EMT at the mid-late stage of ESC differentiation.

To evaluate the preliminary efficacy and safety of argon plasma coagulation (APC) plus medical adhesive via thoracoscopy in the treatment of spontaneous pneumothorax caused by subpleural blebs.

Data of totally 51 patients of spontaneous pneumothorax with subpleural blebs treated in Pneumology Department of Rizhao Hospital of Traditional Chinese Medicine from July 2015 to July 2017 were retrospectively analyzed. Among the 51 patients, 59 target bullae were found, 1.2 per patient on average, with the diameter ranging from 0.5 to 5 cm and an average diameter of 2.6 cm. A total of 21 patients were treated with APC, and the rest 30 were treated with APC plus partially sprayed medical adhesive (APC+ group). The rate of air leakage discontinuance within 24 hours after operation, the rate of air leakage discontinuance within one week after operation, the disappearance rate of target subpleural blebs on CT scans one week after operation, and the rate of significantly shrunken target subpleural blebs and wall thickness, as well as the incidence of postoperative complications, including fever, chest pain, pleural effusion, hemorrhage, and infection after operation were observed and compared between the two groups.

The air leakage discontinuance rate in APC+ group was significantly higher than that in APC group 24 hours after operation (90.0% vs 52.4%, P<0.05), and the rate in APC+ group was also significantly higher than that in APC group one week after operation (96.7% vs 66.8%,P<0.05). There was no significant difference in the disappearance rate of target subpleural blebs on CT scans one week after operation and the incidence of significantly shrunken target subpleural blebs and wall thickness (bothP>0.05). There was no significant difference in the incidence of postoperative complications such as fever, chest pain and pleural effusion (allP>0.05).

The treatment of spontaneous pneumothorax with subpleural blebs by APC plus medical adhesive is safe and effective.

A 21-year-old male was admitted to Peking Union Medical College Hospital on April 27, 2016 due to "intermittent nausea, vomiting and melena for 2 months". In March 2016, intermittent nausea and vomiting began, accompanied by diarrhea and black paste stool more than 10 times/d, with a maximum amount of 500 ml/time. Intermittent hyperthermia with asthenia. The hemoglobin was 34 g/L in other hospitals. Gastroscopy showed a submucosal bulge of the duodenal bulb with a smooth surface. Multiple superficial ulcers of the jejunum with active hemorrhage revealed by oral enteroscopy. Pathology of the jejunal mucosa showed chronic inflammation. Treatment with fluid rehydration, acid suppression, blood transfusion and antibiotics was ineffective. Then I went to our hospital for blood routine: white blood cells 5.9×10⁹/L, lymphocytes 1.28×10⁹/L, hemoglobin 84 g/L, platelets 281×10⁹/L; Serum albumin 26 g/L, erythrocyte sedimentation rate 56 mm/1 h, high-sensitivity C-reactive protein 20.76 mg/L; Anti-nuclear antibody and anti-neutrophil cytoplasmic antibody were both negative; Blood lymphocyte culture plus interferon assay (T. SPOT-TB) A + B: 232 SFC/10⁶MC. March 28 Chest CT (Figure 1): ground glass shadow in the posterior segment of the upper lobe tip of the left lung, multiple patch cord shadows in the left lung; There were many patchy high-density foci in the lateral segment and lower lobe of the right middle lobe, nodular foci in the lower lobe of the right lung and the upper lobe of the left lung, and a small amount of pleural effusion on both sides. Abdominopelvic enhanced CT + small intestine reconstruction (Figure 2): Multiple annular thickening of intestinal wall with abnormal enhancement of mucosal surface and increased mesenteric fat density with multiple swollen lymph nodes in small intestine, terminal ileum and ileocecal region in groups 5 and 6; Splenomegaly; Mild dilatation of left renal pelvis and upper ureter; Abdominopelvic effusion; Intrapelvic calcifications. He was treated with fasting water, fluid rehydration, acid suppression and levofloxacin, but still had fever, so he was admitted to hospital for further diagnosis and treatment. When the disease began, the weight lost 12 kg. Past physical fitness. Personal History: Stay up late for a long time, and work and rest are not regular. Denying a history of exposure to tuberculosis or a family history of tumor. Admission physical examination: body temperature 38.5 ℃, pulse 110 beats/min, body mass index 18.8 kg/m²。 The superficial lymph nodes were not enlarged. The breathing sound of the right lung is thick, with a small amount of wet rales; No murmur heard in the heart; The abdomen was flat, the abdomen was tough, without tenderness and rebound pain, the liver and spleen were not palpable under the costs, and the abdominal mass was not reached. The mobile voiced sound was negative, and the intestinal sound was 4 times/min. Both lower limbs are not swollen.