Volume 99 ·  Issue 02 ·  2019

With the widespread application of CT screening technology, more and more small pulmonary nodules have been found clinically. These small nodules have different sizes, shapes and densities, or are single or multiple. How to evaluate the nature of small nodules and give appropriate medical advice is very important for patients. This article interprets the NCCN guidelines, the Fleischner Society guidelines and the Chinese expert consensus on the treatment strategies of pulmonary nodules and the Chinese expert consensus on the diagnosis and treatment of pulmonary nodules. Combined with the current research progress, it puts forward its own thinking on the problems existing in the treatment of pulmonary nodules, in order to provide reference for the scientific treatment of small pulmonary nodules.

The pathogenesis of refractory immune diseases is complex, and clinical treatment is difficult. Leukocyte adsorption technology can reduce the immune attack of inflammatory cells and their released substances on the body by removing activated leukocytes in the blood, thereby alleviating and improving symptoms, and can be used in a variety of immune diseases including inflammatory bowel disease, rheumatic disease and kidney disease. Evidence-based medical evidence has shown that it is effective for a variety of refractory immune diseases and can reduce the use of glucocorticoids and immunosuppressants. Leukocyte adsorption technology is still in the research stage in the field of kidney disease, and its indications, clinical efficacy, therapeutic intensity and safety need more large-sample, multi-center clinical trials to clarify.

Primary carnitine deficiency (PCD), also known as primary carnitine malabsorption (CUD), or carnitine transport disorder (CTD), is a disease in which high-affinity sodium-dependent carnitine transporter (OCTN2) protein function is defective due to SLC22A5 gene mutation, increased carnitine excretion in urine, and carnitine deficiency in blood, tissues and cells, thus causing defect in fatty acid β oxidation. There were clear ethnic differences in the prevalence of PCD. The reported prevalence in the United States ranged from 1 in 20 000 to 70 000^[1]Japan is 1/40 000^[2]Australia is 1/120 000^[3]The disease has the highest prevalence in the Faroe Islands at 1 in 300^[4]The prevalence of neonatal screening PCD reported in China is approximately 1/20 000 to 45 000^[5,6]。 China Shanghai Xinhua Hospital reported an incidence rate of 1/34 571. Zhejiang New Screening Center screened nearly 2.13 million newborns and confirmed 101 children with PCD, with a prevalence rate of 1/21 089. Because the clinical manifestations of PCD are heterogeneous and non-specific, it is easy to be misdiagnosed or missed, and some patients may have no abnormal manifestations for life. Patients who develop the disease are potentially fatal untreated. The drug treatment effect of this disease is definite, and the prognosis of patients treated with L-carnitine supplementation before irreversible organ function is good. Early diagnosis and early treatment can significantly improve the prognosis, so many countries and regions have listed it as a neonatal screening disease^[7]。

To investigate the clinical outcomes of advanced non-small cell lung cancer (NSCLC) treated by apatinib regimens and the influence of VEGFR2-906T>C polymorphism.

A total of 109 patients with advanced NSCLC who were treated by apatinib after three and more lines from March 2015 to December 2017 in the Department of Oncology of the First Affiliated Hospital of Zhengzhou University were included in this study. Overall response rates were evaluated after 2 cycles, then progression free survival (PFS) and overall survival (OS) were investigated, and safety data were recorded. Additionally, peripheral blood and the biopsy tissue specimens of some NSCLC patients were collected for the genotyping of genetic variation and VEGFR2 gene mRNA expression, respectively. The association between genotype and other characteristics and VEGFR2 gene mRNA expression were analyzed. The univariate analysis of genotypes and prognosis was carried out by Kaplan-Meier survival analysis, and multivariate analysis were adjusted by Cox regression analysis.

The treatment effect could be evaluated in all the 109 patients, among them, complete remission (CR) 0 case, partial remission (PR) 19 case, stable disease (SD) 58 case, progression disease (PD) 32 case. Overall response rate (ORR) was 17.43%, disease control rate (DCR) was 70.64%, median PFS was 4.35 months, median OS was 8.35 months. Of the polymorphisms analyzed, only -906T>C was of clinical significance. The prevalence of -906T>C in VEGFR2 among the study population were as follows: TT genotype 64 cases (58.72%), TC genotype 37 cases (33.94%), CC genotype 8 cases (7.34%), minor allele frequency of -906T>C was 0.24. The distribution of three genotypes was in accordance with Hardy-Weinberg Equilibrium (P=0.418). CC and TC genotype patients were merged in the comparison of clinical outcomes. The analysis of patients with different genotypes found that the ORR of CC/TC genotypes and TT genotypes were 13.33% and 20.31% (P=0.377), respectively. And the median PFS of patients with CC/TC genotype and TT genotype were 3.25 and 5.35 months, respectively, which was statistically significant (P=0.007). In terms of OS, the median OS of the two genotypes were 7.35 and 9.15 (P=0.014), respectively. Adjusted in multivariate Cox regression analysis of PFS, TC/CC genotypes were an independent factor for PFS (OR=1.83, P=0.015). The correlation between -906T>C and adverse reactions was not found in the safety analysis. Additionally, of the 69 biopsy tissue specimens, gene expression analysis was conducted. And the results show that the mRNA expression of VEGFR2 in cancer tissues of the patients with CC/TC genotypes were significantly higher than those of the TT genotype patients (P<0.001).

Apatinib is safe and effective for patients with advanced non-small cell in multiline therapy. VEGFR2 -906T>C CC/TC genotype has a worse effect on apatinib multiline treatment in patients with advanced NSCLC.

To investigate the expression of programmed death 1(PD-1) and programmed death ligand 1 (PD-L1) on T lymphocyte and monocyte from peripheral blood of advanced non-small-cell lung cancer (NSCLC) patients and its potential role in immune escape of NSCLC.

Forty-eight patients with advanced NSCLC (Lung Cancer Group) were included from the Department of Respiratory Diseases in The Second Affiliated Hospital of Soochow University from June 2014 to June 2015. Thirty-six healthy volunteers who received health examination at the same time, matching in sex, age were also enrolled as controls. The expression of PD-1 on peripheral blood CD4⁺T cells and CD8⁺T cells and PD-L1 on monocytes were detected by flow cytometry. Patients who received chemotherapy alone for 2-4 cycles and received sequential sampling were assessed with Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1). Seven cases of patients with significant response to treatment were selected as partial response (PR) group and ten patients with poor response to treatment were treated as progression disease(PD) group. The differences in the expression of PD-1 on the surface of CD4⁺T cells, CD8⁺T cells, and PD-L1 on the surface of monocyte before and after treatment were analyzed.

Compared with healthy control group, PD-1 expression level on both CD4⁺ T and CD8⁺ T cells from peripheral blood in lung cancer group were significantly increased [(25.9±7.4)% vs (20.6±6.2)%, (19.9±9.8)% vs (14.0±5.6)%, both P<0.05]. A higher level of PD-L1 expression on monocyte in lung cancer group was also found compared with the control group [(33.1±15.1)% vs (13.6±5.3)%, P<0.001]. The expression level of PD-1 on CD4⁺T and CD8⁺T cells and PD-L1 on monocytes in lung cancer group with good response to treatment was relatively lower than the baseline level of before treatment [(22.8±8.5)% vs (25.9±7.8)%, (17.1±8.4)% vs (20.4±8.6)%, (18.1±6.9)% vs (31.3±13.2)%, all P<0.05], but in lung cancer group with poor response to treatment, it was higher than the baseline level of before treatment [(33.5±6.5)% vs (23.9±4.2)%, (25.2±9.1)% vs (19.1±8.8)%, (43.1±18.3)% vs (29.7±10.6)%, all P<0.05].

Abnormal expression of PD-1 and PD-L1 exists in T cells and monocytes respectively, prompting PD-1/PD-L1 pathway may inhibit T cell proliferation during the interaction of T cell and monocyte, which may lead to non-small cell lung cancer immune escape.

To evaluate the diagnostic efficiency of combination of CT multiplane 3D reconstruction (CT-3DR), radial endobronchial ultrasound (R-EBUS), and rapid on-site evaluation (ROSE) for peripheral solitary pulmonary nodules (SPN).

A total of 176 patients with peripheral solitary pulmonary nodule were included from the Nanjing Chest Hospital from March 2016 to March 2017. According to different methods, all the patients were divided into four groups: EG (i.e. R-EBUS+Guiding sheath (GS))group, CTE (i.e. CT-3DR+R-EBUS) group, RE (i.e. ROSE+R-EBUS) group, and triad (i.e. CT-3DR+ROSE+R-EBUS) group. Sampling was performed by transbronchial lung biopsy. The diagnostic yield and complications, procedure time and influencing factors in these four groups were retrospectively analyzed. The value of ROSE and combination of CT-3DR+ROSE+R-EBUS in diagnosis for SPN also was evaluated.

The diagnostic yield for total SPNs among four groups were 70.5% in EG group, 70.0% in CTE group, 69.0% in RE group and 74.0% in triad group, respectively. There was no significant difference among four groups (all P>0.05). The procedure time of EG group, CTE group, RE group and triad group were (34.0±6.3), (26.6±6.8), (27.2±7.8) and (19.4±5.4) min, respectively. The procedure time was the shortest in triad group compared with the other three groups (all P<0.001) and the time of CTE and RE groups were significantly shorter than the EG group (both P<0.001). The coincidence rates of CT-3DR navigation position with target bronchus were 87.5% in CTE group and 90.0% in triad group with no significant difference between these two groups (P>0.05). The diagnostic yield was higher for SPNs with their major diameter ≥2 cm than those with their major diameter<2 cm in all four groups (all P<0.05). The positive diagnostic yield was higher with ultrasonic probe located within SPN lesion than the probe adjacent to or deviated the lesion in all four groups (all P<0.05). In EG and RE groups, for those SPNs with the distance between the lesion and pleura≥2 cm, the diagnostic yield were higher than those withe the distance<2 cm (P<0.05) but no similar phenomenon was observed in CTE and triad groups. No significant correlation was detected between the diagnostic yield and the density of SPN lesions among four groups (all P>0.05). ROSE was used in RE and triad groups. The coincidence rate of ROSE with histopathology was 82.6% and the value of Kappa was 0.608. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of ROSE were 0.818, 0.846, 0.931 and 0.647, respectively.

CT-3DR navigation and ROSE help to improve the diagnostic efficiency of R-EBUS for SPN. Combination of CT-3DR, R-EBUS and ROSE is of diagnostic value for peripheral SPN and with significant shortening of procedure time.

To investigate the influence of polymorphisms of vascular endothelial growth factor receptor-2(VEGFR2) on clinical outcomes and safety of advanced non-small-cell lung cancer (NSCLC) treated by first line Bevacizumab plus chemotherapy regimens.

A total of 148 patients with advanced NSCLC who were treated by bevacizumab based first line regimens from January 2013 to January 2017 in the Department of Oncology of the First Affiliated Hospital of Zhengzhou University were included in this study. Peripheral blood and the biopsy tissue specimens of the NSCLC patients were collected for the genotyping of genetic variation and VEGFR2 mRNA expression, respectively. The association between genotype and other characteristics and VEGFR2 mRNA expression were analyzed. The univariate analysis of genotypes and prognosis was carried out by Kaplan-Meier survival analysis, and multivariate analysis were adjusted by Cox regression analysis.

Of the polymorphisms analyzed, only 889C>T was of clinical significance. Located in the coding region, the prevalence of 889C>T in VEGFR2 among the study population were as follows: CC genotype 108 cases (72.97%), CT genotype 36 cases (24.32%), TT genotype 4 cases (2.71%), minor allele frequency of 889C>T was 0.15. The distribution of three genotypes was in accordance with Hardy-Weinberg Equilibrium (P=0.636). TT and CT genotype patients were merged in the comparison of clinical outcomes. The analysis of patients with different genotypes found that the objective response rates (ORR) of CT/TT genotypes and CC genotypes were 40.00% and 48.15% (P=0.377), respectively. And the median progression free survival (mPFS) of patients with CT/TT genotype and CC genotype were 6.1 and 8.7 months, respectively, which was statistically significant (P=0.002). In terms of overall survival (OS), the median overall survival (mOS) of the two genotypes were 18.7 and 21.4 months (P=0.012), respectively. Adjusted in multivariate analysis, 889C>T were an independent factor for progression free survival (OR=1.96, P=0.014). No association between the 889C>T and adverse reactions was found in the safety analysis. Of the 69 biopsy tissue specimens, gene expression analysis showed that the mRNA expression of VEGFR2 in cancer tissues of the patients with CT/TT genotypes were significantly higher than those of the CC genotype patients (P<0.001).

The polymorphism 889C>T of VEGFR2 may have worse influence on clinical outcomes of advanced NSCLC treated by first line bevacizumab plus chemotherapy regimens, while no significant impact on safety.

To assess the oncologic outcomes of radical nephroureterectomy (RUN) combined with adjuvant chemotherapy (ACT) in patients with high risk upper tract urothelial carcinoma (UTUC).

One-hundred-thirty-four individuals with high-risk UTUC who underwent RUN with or without ACT were evaluated. Cox proportional hazard model and Kaplan-Meier analysis were used to determine overall and cancer specific survival in the cohort.

The median follow-up duration was 24 months (range: 6-36) in the RUN group (n=61) and 18 months (range: 6-36) in the RUN+ACT group (n=73). Median time of overall survival (OS) and cancer specific survival (CSS) showed much better in RUN+ACT group than in RUN group, but the differences were not reached the significant standard. The further analysis in lymph node positive cohort displayed that median times of oncologic events were prolonged in the RUN+ACT group compared with the RUN group: OS (30.1 mon vs 18.0 mon, P=0.083) and CSS (29.2 mon vs 18.6 mon, P=0.047). Additionally in T3/T4 cohort, the significant growth in the median times of OS (25.2 mon vs 12.6 mon, P=0.038) and CSS (31.3 mon vs 18.9 mon, P=0.044) were observed in combination treatment group.

ACT could play the important synergistic role in improving the OS and CSS of RUN treated UTUC patients with lymph node-positive or stage of T3/T4.

To analyze the influence of different thyroid stimulating hormone (TSH) cut-offs to diagnose subclinical hypothyroidism (SCH) in the first trimester of gestation.

A total of 896 pregnant women were enrolled in Peking University International Hospital between October 2016 and March 2018. Among them, 421 pregnant women with single fetus who were conformed to the criteria of National Academy of Clinical Biochemistry (NACB), without adverse pregnancy outcomes and obstetric complications, were selected to establish their self-sequential longitudinal reference ranges of thyroid function. Then, SCH was diagnosed in the first trimester, using different TSH cutoffs, such as the upper limit of the first trimester-specific reference range, 4.0 mU/L recommended by the 2017 Guidelines of American Thyroid Association (ATA), 5.17 mU/L (Roche reagent) recommended by 2012 Guidelines of Chinese Society of Endocrinology and Chinese Society of Perinatal Medicine, and 2.5 mU/L recommended by 2011 Guidelines of ATA, respectively.

The TSH reference range was 0.12-4.16 mU/L in the first trimester. Using TSH>4.16, 4.0, 5.17 and 2.5 mU/L to diagnose SCH in the first trimester, the prevalence rates were 4.35% (39/896), 5.92% (53/896), 1.56% (14/896) and 20.87% (187/896), respectively. There was no statistically significant difference between the prevalence rates of SCH using the TSH upper reference limit of 4.0 mU/L and 4.16 mU/L (P=0.134). When TSH was defined as>4.0 mU/L to diagnose SCH, the sensitivity, specificity and Youden index was 97.4%, 98.2%, and 0.956, respectively.

The TSH upper reference limit of 4.0 mU/L recommended by 2017 Guidelines of ATA can be used as a cut-off to diagnose SCH in first trimester for the areas without trimester-specific reference ranges for TSH in China.

To summarize the application experience of Ai Tong (Chinese Shang Ring) disposable oval circumcision anastomat in pediatric urology.

A retrospective study of 1 481 cases of pediatric urology using a disposable oval circumcision anastomat at Xuzhou Children′s Hospital from October 2014 to December 2017 was performed. The average age at the time of surgery was 5.2 (2-14 years) years. Among them, there were 1 226 cases of phimosis, 32 cases of scar phimosis in chronic infection, 23 cases of phimosis or redundant prepuce with urethral duplication, 29 cases of foreskin trauma, 35 cases of phimosis or redundant prepuce with urethral cyst, 3 cases of phimosis or redundant prepuce with urethral stricture, 108 cases of phimosis or redundant prepuce with webbed penis, 6 cases of phimosis with penile downward bending, 4 cases of phimosis with short frenulum preputii, and 15 cases of relatively normal foreskin development, I° and II° hypospadias with unapparent penile downward bending, and megalourethra with complete foreskin hypospadias.

All operations were completed successfully. The postoperative circumcision time was less than 5 days on 2 cases(0.1%), and was longer than 25 days on 9 cases(0.6%). The average postoperative circumcision time was 13.2 days. During a follow-up period of 3 months, except for 2 cases (0.1%) of frenulum preputii edema, all other cases had a satisfactory foreskin appearance. They had no obvious foreskin scar hyperplasia, the foreskin cutting edge was neat, the foreskin ligament was intact, the foreskin was left and right symmetrical, and the foreskin was preserved in the absence of erection to cover the coronary sulcus to 1/3 of the glans. All children with hypospadias had no urethral stricture and urethral fistula, and the penis was satisfactory.

Ai Tong (Chinese Shang Ring) disposable oval circumcision anastomat is satisfactory in the treatment of various diseases of pediatric urology. With a low incidence of postoperative complications, it may be easy to carry out this procedure at grass-roots hospital.

To investigate the effect of hypoxia-inducible factor 2α (HIF-2α) gene on the expression of Forkhead box M1 (FoxM1) protein in the proliferation of hypoxic rat pulmonary artery smooth muscle cells (PASMC).

HIF-2α overexpression lentiviral vector (LV-HIF-2α) and silencing RNA (siRNA) were constructed and transfected into rat PASMC under normoxia and hypoxia, respectively. The PASMC under normoxia were classified into normoxic control group, normoxia + LV-HIF-2α empty group, normoxia + LV-HIF-2α group; the PASMC under hypoxia were classified into hypoxic control group, hypoxia + siRNA-HIF-2α empty group, hypoxia + siRNA-HIF-2α group. The expression of HIF-2α and its downstream proteins FoxM1, cyclin D1 and Aurora A expressions were detected by Western blot. 5-Ethyny-2′-deoxyuridine (EdU) cell proliferation assay was used to evaluate the effect of overexpression and inhibition of HIF-2α expression on the proliferation of rat PASMC.

The expression of HIF-2α in normoxia + LV-HIF-2α group was significantly higher than that in normoxic control group and normoxia+LV-HIF-2α empty group (0.17±0.02 vs 0.09±0.01 and 0.07±0.00), while the expression of HIF-2α in PASMC of hypoxia + siRNA-HIF-2α group was significantly lower than that of hypoxic control group and hypoxia + siRNA-HIF-2α empty group (0.28±0.01 vs 0.35±0.02 and 0.30±0.01) (allP<0.05); the expression of FoxM1 protein, cyclinD1 and cell proliferation-related Aurora A protein in normoxia+LV-HIF-2α group were significantly higher than that in normoxic control group and normoxia+LV-HIF-2α empty group (0.40±0.03 vs 0.24±0.01 and 0.30±0.01, 0.22±0.02 vs 0.09±0.01 and 0.08±0.02, 0.29±0.02 vs 0.04±0.01 and 0.07±0.01, respectively) (allP<0.05); the expressions of FoxM1 protein, cyclinD1 and Aurora A protein in hypoxia + siRNA-HIF-2α group were significantly lower than those in hypoxic control group and hypoxia + siRNA-HIF-2α empty group (0.23±0.01 vs 0.36±0.02 and 0.32±0.01, 0.15±0.01 vs 0.31±0.01 and 0.28±0.03, 0.14±0.02 vs 0.33±0.03 and 0.27±0.02, respectively) (allP<0.05); the positive expression rate of EdU in the normoxic control group was significantly lower than that in the normoxia+LV-HIF-2α group [(30.77±2.43)% vs (55.56±3.01)%], while the hypoxic control group was significantly higher than the hypoxic+siRNA-HIF-2α group [(65.28±3.21)% vs (44.64±2.78)%] (bothP<0.05).

HIF-2α up-regulates the expression of FoxM1 and promotes the proliferation of pulmonary artery smooth muscle cells in hypoxic rats.

To discuss the effect of chronic restraint stress (CRS) on esophageal hypersensitivity and inflammation, as well as the impact of oxidative stress in a murine model.

20 male SPF mice were randomly divided into two groups, CRS and normal control(NC) group. Then the mice in CRS group were submitted to 2 h per day of restraint stress for a period of 14 days. For the rest of the time, mice in both groups were given free drinking and eating in the same environment. Histopathological changes of esophageal tissue were observed using HE staining and analyzed by histological damaging score. The esophageal expression levels of transient receptor potential vanilloid (TRPV-1) and nicotinamide adenine dinucleotide phosphate oxidase 4(NOX-4) were detected by immunohistochemical staining. Further more, protein expression level of TRPV-1 was also observed by Western blotting. In addition, mRNA expression levels of TRPV-1, oxidant/antioxidant enzymes and related cytokines in esophageal tissues were detected by real time PCR.

HE staining for esophageal tissues revealed that histopathological changes including basal cell hyperplasia, infiltration of neutrophils and plasmocytes were observed in stressed mice, while there was no distinct changes observed in non-stressed mice. Histological damaging scores for epithelial damage and submucosal inflammatory cells were higher in CRS group, and the differences were statistically significant(all P<0.05). Immunohistochemical staining revealed that positive cells for TRPV-1 and NOX-4 were observed in majority of samples, but the number of positive cells and density were higher in CRS mice. Western blotting showed that the expression levels of TRPV-1 protein in CRS mice was higher than that of NC mice (1.0±0.0 vs 1.6±0.2; t=-7.06, P<0.001). RT-PCR showed that mRNA expression levels of TRPV1 and NOX-4 in CRS group were higher than those in NC group (1.0±0.0 vs 2.0±0.2, 1.0±0.0 vs 2.0±0.2; t=-13.44, -14.32, all P<0.001). Moreover, mRNA expression levels of antioxidant enzymes, such as Mn-SOD and Cu Zn-SOD, were higher in stressed mice (1.0±0.0 vs 0.7±0.1, 1.0±0.0 vs 0.7±0.1), and the differences were statistically significant (t=8.39,7.36, all P<0.05). The mRNA expression levels of important cytokines, such as MCP-1, IL-8, TNF-α, in stressed mice were overexpressed comparing to non-stressed mice (1.0±0.0 vs 2.4±0.4, 1.0±0.0 vs 1.8±0.2, 1.0±0.0 vs 2.5±0.4), and the differences were statistically significant (t=-10.06, -13.24, -12.40, all P<0.001).

Chronic stress may result in esophageal hypersensitivity through activation of TRPV1, and may also cause esophageal inflammation. Stress-induced oxidative stress may contribute to the formation of esophageal hypersensitivity.

To construct computational fluid model of type B aortic dissection using patient-specific reverse engineering and fluid-structure interaction, and evaluate the application of computational fluid model on aortic remodeling of type B aortic dissection.

Consecutive computed tomographic angiograph data was acquired from a patient with type B aortic dissection at initial diagnosis, 1 week and 6 years after endovascular repair of primary tear entry and 3 months after endovascular repair of distal tear erosion. Three-dimensional model of aortic dissection was reversely reconstructed by Mimics, and then the model was smoothened by Geomagic. Computational fluid dynamic numerical simulation was performed in ANSYS by the means of two-way fluid-structure interaction, and the relation between blood dynamic characteristic and thrombosed remodeling of type B aortic dissection was evaluated.

The computational fluid model of type B aortic dissection using patient-specific reverse engineering and fluid-structure interaction method was successfully constructed. Local peak of blood pressure on the convex surface of junction at aortic arch and descending aorta was found. The wall stress was much higher at the false lumen than that at the true lumen, and the peak of wall stress converged on the edge and tear entry of false lumen. After the exclusion of proximal tear entry, the blood streamline was decreased significantly and flowed reversely. Blood flow in the remaining false lumen was retrograded from the entry at left iliac artery and formed turbulence at the top of false lumen, which was benefit for dissection thrombus remodeling. The higher pressure at the false lumen was associated with the new formation of aortic aneurysm at the distal tear.

The computational fluid model of aortic dissection based on patient-specific reverse engineering and fluid-structure interaction method can successfully reveal the relatively truly blood dynamic and wall pressure characteristic of type B aortic dissection.

This article reports a case of small intestinal lipomatosis diagnosed and treated in the Department of Gastrointestinal Surgery of Liaocheng People's Hospital of Shandong Province. The patient was operated on intestinal obstruction in another hospital 20 years ago. The medical record records: There were several polypoid lesions in the intestinal lumen, about 4 cm ×5 cm in size, and 60 cm of the diseased small intestine was removed without pathological examination. Abdominal pain and abdominal distension disappeared after operation. After a full meal 7 days ago, abdominal distension was aggravated, accompanied by abdominal pain, nausea, and the frequency of defecation and exhaustion decreased. After conservative treatment failed, surgical treatment showed that the intestinal tube was abnormal between 130 cm above the ileocecal valve and 150 cm below the duodenojejunal flexure, the intestinal lumen was dilated, with a maximum diameter of about 12 cm, the intestinal wall was thickened, folded and twisted, and the intestinal lumen was densely covered with round, oval or irregular soft masses of different sizes. The lesion and the mesenteric fat above it (near the intestinal tube) were proliferated, and the lesion was excised, and proximal and distal small intestinal anastomosis was performed. Pathological diagnosis: small intestinal lipomatosis, postoperative rehabilitation and discharge.

Perioperative complications are an important factor affecting the postoperative quality of life and economic costs of surgical patients. Current methods used to assess perioperative risk are mostly based on resting state, and have limited value for predicting perioperative risk. Cardiopulmonary exercise test, as a comprehensive test that can assess the cardiopulmonary function of patients, has attracted gradual attention for its role in perioperative risk assessment and postoperative management. This article will introduce the perioperative cardiopulmonary exercise test in non-cardiac surgery from four aspects: common indexes, risk assessment, clinical decision-making, summary and prospect.

The incidence and mortality of lung cancer rank among the forefront of malignant tumors. Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) has opened a new era of treatment of non-small cell lung cancer. Rare mutations in EGFR gene are EGFR mutations other than classical mutations, and their effects on EGFR-TKI targeted therapy are largely different, which has attracted increasing attention. In this paper, the main categories of rare mutations of EGFR gene and targeted therapy are reviewed in recent years, so as to provide enlightenment for clinical treatment and research.

This article mainly reports the 11th International Conference on Peritoneal Surface Tumors and the Biennial Meeting of the International Cooperation Group Alliance on Peritoneal Surface Tumors (hereinafter referred to as the International Congress on Peritoneal Cancer) held in Paris, France from September 9 to 11, 2018. Nearly 900 experts from all over the world attended the event. Focusing on the core topic of tumor cytoreductive surgery (CRS) plus intraperitoneal hyperthermia chemotherapy (HIPEC), the conference comprehensively demonstrated the latest progress in clinical research, translational research and basic research.

The information of the member units of the expert group in the article "Expert Consensus of Anlotinib Hydrochloride in the Treatment of Advanced Non-small Cell Lung Cancer" in Volume 98, Issue 44, 2018 is incorrectly laid out, and the correction is as follows: Zhou Jianying (Department of Respiratory Medicine, the First Affiliated Hospital of Zhejiang University); Zhao Qiong (Department of Thoracic Oncology, Hangzhou Cancer Hospital). Apologies to both experts!