2013年 · 第126卷第12期

Both chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis are leading causes of morbidity and mortality,and therefore the most important challenges to public health in China.A large,populationbased survey showed that the prevalence of COPD was 8.2％ (men,12.4％;women,5.1％) in adults 40 years of age or older,1 and even higher in Chinese rural areas where biomass fuels are the main sources of energy for cooking,heating,and other household needs in poorly ventilated dwellings.2 Under-diagnosis and under-treatment of COPD in these areas was another serious concern.2 It is also notable that pulmonary tuberculosis is highly prevalent in rural areas,which may share common risk factors with COPD.A systemic review by Lin et al3 showed that smoking was also an independent risk factor for tuberculosis and suggested a positive association between indoor air pollution and the disease.Cigarette smoking is the leading risk factor for COPD,but the prevalence of COPD in non-smokers is as high as 6.6％,and it is estimated that 25％-45％ COPD patients are neversmokers.4 Biomass fuel and occupational exposure are two major risk factors in never-smokers,and accumulating evidence suggests that tuberculosis is another significant risk factor for COPD.Facing the colliding epidemics of tuberculosis,tobacco smoking and COPD in developing countries,5 it is of urgent need to address the impact of tuberculosis on COPD,as well as the risk of tuberculosis in COPD patients。

China has markedly increased infectious disease surveillance efforts after the outbreak of severe acute respiratory syndrome (SARS) in 2003.1 When the first pneumonia cases with unknown etiology from Shanghai were reported to the National Health and Family Planning Commission and the China Center of Disease Control and Prevention (CDC) in March 2013,our Chinese doctors and scientists show more confident to face the emerging infectious disease than 10 years ago.The marker is that we independently made the discovery that the pneumonia occurring in Shanghai,Jiangsu,Anhui and Zhejiang was caused by a novel reassortant avian-origin influenza A (H7N9)

Abstract：Background Bacteria-induced respiratory infection has been long considered to be the major cause of acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Therefore,a clear picture about the distribution and drug-resistance of pathogenic bacteria in the lower airways should be helpful for treatment of the disease.So far,data on this topic among Chinese are lacking.Methods A surveillance study was performed in consecutive patients with AECOPD at five areas in China between October 2006 and April 2008.The sputum from these patients was cultured and isolated for bacteria.Agar dilution method was used to determine the minimal inhibitory concentrations (MICs) of levofloxacin and other 15 antibiotics against these strains.Results Three hundred and fifty-nine pathogenic bacterial strains were isolated among 884 patients with AECOPD.The predominant bacteria were Pseudomonas aeruginosa (21.7％),Klebsiella pneumoniae (12.3％),Haemophilus influenzae (14.2％) and Streptococcus pneumoniae (11.7％),followed by Haemophilus parainfluenzae (9.5％),Acinetobacter baumannii (7.8％),Moraxella catarrhalis (6.4％) and Escherichia coli (3.6％).The majority of bacterial pathogens isolated in this study were susceptible to fluoroquinolones,ceftazidime,cefepime and imipenem.Conclusions Gram-negative bacilli are the leading pathogens in patients with AECOPD in China.Haemophilus parainfluenzae may be one of the most important pathogens in AECOPD.This study provides evidence for local surveillance of AECOPD pathogens and appropriate choice of antimicrobials in China。

Abstract：Background Cyclooxygenase-2 (COX-2) is overexpressed during airway inflammation in chronic obstructive pulmonary disease (COPD) patients.Single nucleotide polymorphisms (SNPs) in the COX-2 promoter might contribute to differential COX-2 expression and subsequent interindividual variability in susceptibility to COPD.We investigated the association between COX-2 (-765G＞C,-1195G＞A) polymorphisms and COPD susceptibility in Japanese and Chinese patients.Methods COX-2 genotypes were determined by polymerase chain reaction,restriction fragment length polymorphism in 230 COPD patients (103 Japanese and 127 Chinese) and 273 healthy controls (129 Japanese and 144 Chinese).Results The frequency of-1195AA homozygote was significantly higher than the controls in Chinese COPD (adjusted OR=2.43,95％ CI 1.14-4.19),Japanese COPD (adjusted OR=-2.25,95％ Cl 1.06-4.76) and combined COPD groups (adjusted OR=2.26,95％ CI 1.34-3.99).There was no difference in COX-2-765G＞C polymorphism between COPD and control groups in either Japanese or Chinese,while more Chinese individuals carried the-765C allele than Japanese in both groups (15.3％ vs.2.9％ in COPD,18.8％ vs.5.5％ in control).Chinese individuals with the haplotype-765G:-1195A were at higher risk for COPD (adjusted OR=1.93,95％ CI 1.05-3.55).Conclusions The COX-2-1195AA genotype is associated with increased risk for COPD in both Japanese and Chinese individuals.Although COX-2-765G＞C polymorphism was not associated with COPD in either ethnic group,the-765C allele frequency was higher in Chinese than Japanese and haplotype-765G-1195A may confer susceptibility to COPD in Chinese。

Abstract：Background The 2009 pandemic H1 N1 (pH1N1) influenza showed that relatively young adults accounted for the highest rates of hospital admission and death.In preparation for pH1N1,the aim of the study is to identify factors associated with the mortality of patients with 2009 pH1N1 infection,especially for young patients without chronic medical conditions.Methods Retrospective observational study of 2151 severe or critical adult cases (-≥14 years old) admitted to a hospital with pH1N1 influenza from September 1,2009 to December 31,2009 from 426 hospitals of 27 Chinese provinces.A confirmed case was a person whose pH1N1 virus infection was verified by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR).Severe and critical cases were defined according to the H1N1 2009 Clinical guidelines (Third Edition,2009) released by the Ministry of Health of China.Results Among the 2151 patients,the mean age was 34.0 years.Two hundred and ninty-three (13.6％) died during hospital stay.One thousand four hundred and forty-two patients (67.0％) had no comorbidities and 189 (13.1％) of them died.Pregnancy (OR 8.03),pneumonia (OR 8.91),dyspnea (OR 3.95),central nervous system (CNS) symptom (OR 1.55),higher APACHE (Acute Physiology and Chronic Health Evaluation) Ⅱ score (OR 1.06),Alanine aminotransferase (ALT) (OR 1.002),and the lactate dehydrogenase (LDH) level (OR 1.001) were independent risk factors for death among adults without chronic medical conditions.Higher APACHE Ⅱ score (OR 1.08) and age (OR 1.06) were independent risk factors for death among adults with respiratory diseases.A multivariate analysis showed an association between mortality and CNS symptoms (OR 2.66),higher APACHE Ⅱ score (OR 1.03),ALT (OR 1.006),and LDH level (OR 1.002) in patients with cardiovascular diseases.Dyspnea (OR 11.32) was an independent risk factor for patient death in patients with diabetes mellitus.Conclusion Clinical knowledge of identified prognostic factors for mortality may aid in the management of adult influenza infection。

Abstract：Background Evidence has demonstrated that the distal lung,which includes airways of ＜2 mm in diameter and lung parenchyma,constitutes an important component of asthma pathology.Cysteinyl leukotrienes (CysLTs) are potent proinflammatory mediators and bronchoconstrictors involved in the asthmatic process.Guidelines recommend the leukotriene-modifying agents for asthma treatment.We hypothesized that a leukotriene receptor antagonist with an inhaled corticosteroid (ICS) and long-acting β2 agonist (LABA) combination would improve small airways function in moderate-tosevere asthmatics evaluated by physiological tests and high-resolution computed tomography (HRCT) analysis.This study was performed at a tertiary university hospital in Beijing.Methods This was a randomized,double-blind,parallel study performed in 38 patients with moderate-to-severe asthma treated with salmeterol/fluticasone (SFC) plus montelukast (SFC+M) or SFC plus placebo over 24 weeks.Small airway function was assessed by physiological studies and HRCT image analysis.Results Montelukast significantly improved air trapping as expressed by the residual volume (RV)/total lung capacity (TLC).Over 24 weeks of treatment,RV/TLC was improved by (15.41±6.67)％ in patients receiving SFC+M while RV/TLC was decreased by (8.57±10.26)％ in patients receiving SFC alone,the difference between the two groups was significant (P=0.02).There was a trend towards a significant difference in forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) in the SFC+M group compared to that in the SFC group ((17.87±8.17)％ vs.(12.28±9.20)％,P=0.056).There was no significant change in percentage wall area (WA％) after 24 weeks of add-on treatment with montelukast.Patients receiving SFC+M showed significant improvement in the ratio of CT-determined values at full expiration to those at full inspiration (E/I ratio) (0.894±0.005 vs.0.871±0.003,P=0.002).Conclusion We have shown,using lung function tests and HRCT image technique,that add-on therapy with montelukast improves distal lung function reflected by air trapping,but not airway wall thickness in moderate-to-severe asthma.(ClinicalTrials.gov number,NCT00699062)

Abstract：Background Gefitinib is widely used in the treatment of advanced non-small cell lung cancer (NSCLC).However,only a small number of reports have described initial failure sites in patients treated with gefitinib.The aim of this study was to investigate survival,recurrence sites,and treatment after recurrence in these patients.Methods A retrospective review was conducted of all patients with stage Ⅲ/Ⅳ NSCLC treated with gefitinib in Peking Union Medical College Hospital from October 2002 to September 2011.Patient characteristics,initial failure sites,associated clinical factors,and subsequent therapy were included in the analysis of prognostic factors.Results A total of 316 patients were identified The median progress free survival (PFS) and overall survival (OS) times were 238 days and 468 days,respectively.The median survival time after progression was 145 days.The sites of initial failure were lung (62.34％),bone (17.72％),central nerve system (CNS,16.14％),liver (9.49％),and others (7.19％).Patients with single-site progression or multi-site progression were 81.01％ and 18.99％,respectively.Progression-free survival time was associated with lung and bone failure.Additionally,the median survival time after progression was lower in patients with multi-site progression and liver progression.Other initial failure sites displayed no relationship with survival,including CNS failure.Subsequent therapy may affect survival after progression.In patients receiving continuous epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy,chemotherapy,radiotherapy,and retreatment with EGFR-TKIs,survival time after progression was prolonged compared with the best supportive care.Conclusions Our data suggest that patients receiving gefltinib should be closely monitored regarding lung metastasis during follow-up.Liver metastases and multi-site progression were poor prognostic factors.After failure with gefltinib,patients may benefit from radiotherapy,chemotherapy,continuous EGFR-TKI therapy and re-treatment with EGFR-TKIs。

Abstract：Background Angiogenesis is an essential step for tumor development and metastasis.The cell adhesion molecule αvβ3 integrin plays an important role in angiogenesis and is a specific marker of tumor angiogenesis.A novel αvβ3 integrintargeted magnetic resonance (MR) imaging contrast agent utilizing Arg-Gly-Asp (RGD) and ultrasmall superparamagnetic iron oxide particles (USPIO) (referred to as RGD-USPIO) was designed and its uptake by endothelial cells was assessed both in vitro and in vivo to evaluate the angiogenic profile of lung cancer.Methods USPIO were coated with-NH3+ and conjugated with RGD peptides.Prussian blue staining was performed to evaluate the specific uptake of RGD-USPIO by human umbilical vein endothelial cells (HUVECs).Targeted uptake and subcellular localization of RGD-USPIO in HUVECs were confirmed by transmission electron microscopy (TEM).The ability of RGD-USPIO to noninvasively assess αvβ3 integrin positive vessels in lung adenocarcinoma A549 tumor xenografts was evaluated with a 4.7T MR scanner.Immunohistochemistry was used to detect αvβ3 integrin expression and vessel distribution in A549 tumor xenografts.Results HUVECs internalized RGD-USPIO significantly more than plain USPIO.The uptake of RGD-USPIO by HUVECs could be competitively inhibited by addition of free RGD.A significant decrease in T2 signal intensity (SI) was observed at the periphery of A549 tumor xenografts at 30 minutes (P ＜0.05) and 2 hours (P ＜0.01) after RGD-USPIO was injected via the tail vein.Angiogenic blood vessels were mainly distributed in the periphery of tumor xenografts with positive αvβ3 integrin expression.Conclusions RGD-USPIO could specifically label αvβ3 integrin and be taken up by HUVECs.This molecular MR imaging contrast agent can specifically evaluate the angiogenic profile of lung cancer using a 4.7T MR scanner。

Abstract：Background Recent studies have shown that T helper type-2 (Th2) cells can induce the apoptosis of CD4+CD25+ Treg cells or resist the immunosuppressive effect of Treg cells.We hypothesize that an imbalance of Th2/Treg is present in patients with allergic asthma.Methods Twenty-two patients with mild asthma,17 patients with moderate to severe asthma,and 20 healthy donors were enrolled.All patients were allergic to house dust mites.The proportion of peripheral blood CD4+CD25+ Treg cells and Th2 cells were determined by flow cytometry.The concentration of interleukin (IL)-10,transforming growth factor (TGF)-β and IL-4 in plasma was determined by enzyme linked immunosorbent assay.In these subjects,peripheral blood mononuclear cells from 17 mild asthmatic patients,13 moderate to severe asthmatic patients and 14 healthy donors were acquired and expression of forkhead box P3 (Foxp3) and GATA-3 mRNA was detected by reverse-transcriptase polymerase chain reaction.Results Compared with healthy donors and patients with mild asthma,the percent of CD4+CD25+ Treg cells and plasma IL-10 levels were decreased in patients with moderate to severe asthma.There were no significant differences in Foxp3 mRNA expression among three groups,but a downward trend seen among patients with asthma.However,the percent of Th2 cells,IL-4 levels and expression of GATA-3 mRNA was markedly higher in patients with mild and moderate to severe asthma than in the control group.The ratio of Th2/Treg and their cytokines was increased in allergic asthma,especially for moderate to severe asthma.The ratio of GATA-3/Foxp3 mRNA was also increased in allergic asthma.In patients with moderate to severe asthma,the percentage of peripheral blood Treg cells was negatively correlated to the percentage of Th2 cells and IL-4 levels.Conclusions The decline of CD4+CD25+ Treg cells in patients with moderate to severe asthma may play an important role in progress of the disease.Furthermore,the deficiency of CD4+CD25+ Treg cells was associated with the overexpression of Th2 response。

Abstract：Background Pulmonary embolism (PE) is a common and often fatal disease.Early after pulmonary thromboembolism,inflammation and associated intimal hyperplasia occur within the pulmonary arteries,similar to what is observed with chronic thromboembolic pulmonary hypertension.This study tested the hypothesis that thrombolytic and anticoagulant agents would have anti-inflammatory effects or inhibit intimal hyperplasia of involved pulmonary arteries.Methods Seventy-two male New Zealand white rabbits were randomly divided into two groups (54 rabbits in the PE group and 18 in the sham group).Experimental PE was induced in 54 rabbits by femoral vein injection of autologous blood clots and confirmed with pulmonary angiography,and other 18 rabbits underwent sham operations.Fifty-four rabbits in the PE group were randomly divided into three groups:a control group (treated with normal saline),a low-molecularweight heparin (LMWH) group (treated with LMWH),and a urokinase (UK) group (treated with UK).Arterial blood gas was analyzed at 2,7,and 28 days (n=6 per time point by random group division),then lung tissues were removed and were analyzed for pro-inflammatory cytokines and chemokines,and were stained for intimal hyperplasia.Results The overall survival of rabbits undergoing PE was 100％.PE distribution detected on digital signal angiography (DSA) and histopathology was shown in 67％ of rabbits (36/54) in the bilateral low lobar pulmonary arteries (PAs).The results showed that alveolar-arterial partial pressure of oxygen (PO2) difference (PA-aO2) significantly increased and PO2 decreased in the control group compared with the sham group.Compared with controls,the UK group had a decreased level of PA-aO2 on day 2 (P ＜0.05),however,there was no significant difference in the LMWH group.Compared with controls,the LMWH group had a decreased level of monocyte chemoattractant protein-1 (MCP-1) in affected tissue and serum samples on days 7 and 28 (P ＜0.05),and the UK group had decreased levels on days 2 and 7 (P ＜0.05).Compared with sham group,all PE groups had an increased level of interleukin-13 (IL-13) and transforming growth factor-β (TGF-β) in unaffected lung tissue samples at days 2 and 7.IL-13 in affected lung tissue in the LMWH group was decreased at all time points compared with controls (P ＜0.05).However,TGF-β in affected lung tissue of the LMWH and UK groups increased at day 28.There was less intimal hyperplasia in involved pulmonary arteries at days 7 and 28 in the LMWH group compared with controls; there was no statistical difference in the UK group compared with controls.Conclusions UK treatment can rapidly improve the V/Q mismatch in PE and appears a short-term anti-inflammatory benefit.However,LMWH maybe inhibit the later local inflammatory reaction and reduce intimal hyperplasia。

Abstract：Background Cyanotic congenital heart defects with decreased pulmonary blood flow due to lung ischemia,hypoxia,and others lead to infant morbidity and mortality more than acyanotic heart disease does.Despite the great effort of medical research,their genetic link and underlying microRNAs molecular mechanisms remain obscure.In this study,we aimed to investigate microRNAs regulation during cyanotic defects in lung of immature piglets.Methods Cyanotic piglet model was induced by main pulmonary artery-left atrium shunt with distal pulmonary artery banding.Four weeks later,hemodynamic parameters confirmed the development of cyanotic defects and pulmonary lobe RNA was extracted from all animals.We studied the repertoire of porcine lung microRNAs by Solexa deep sequencing technology and quantified highly expressed microRNAs by microarray hybridization.Furthermore,we quantitated selected microRNAs from cyanotic and control piglets by quantitative RT-PCR.Results After surgical procedure 4 weeks later,the cyanotic model produced lower arterial oxygen tension,arterial oxygen saturation,and higher arterial carbon dioxide tension,hematocrit and hemoglobin concentration than controls (all P ＜0.05).In 1273 miRNAs expressed in the immature piglets lungs,2 most abundant microRNAs (miR-370 and miR-320) demonstrated significant difference between cyanotic and control group (all P ＜0.05).Conclusion Our results extended lung microRNA profile in immature piglets and suggested that miR-370 and miR-320 are significantly up-regulated in cyanotic lung tissues。

Abstract：Background The hygiene hypothesis has been proposed to explain the pathogenesis of asthma.Allergen exposure was shown to inhibit asthma in an animal model.But the optimal timing of allergen exposure remains unclear.This study aims to explore the time effcct of allergen exposure and the possible mechanisms.Methods Neonate Wistar rats were randomly divided into asthma group,control group and day 1,day 3,day 7,and day 14 groups.The day 1,day 3,day 7 and day 14 groups were injected with ovalbumin (OVA) subcutaneously on days 1,3,7 and 14 after birth,respectively.Six weeks later,all groups,except the control group,were sensitized and stimulated with OVA to make the asthma model.We observed the pulmonary pathologic changes,detected the regulatory T cells,and CD28 expression level in thymus and spleen by flow cytometry.Results The asthmatic inflammation in the day 1,day 3 and day 7 groups,but not the day 14 group,was alleviated.The asthma group and day 14 group had lower proportions of regulatory T cells in the thymus compared with the control group,day 1,day 3,and day 7 groups.There was no significant difference in the CD28 expression levels on the regulatory and conventional T cells among groups.But the control group and the day 1,day 3,and day 7 groups had relatively higher proportions of CD28 positive regulatory T cells in the thymus than the day 14 group and the asthma group.Conclusions There is a “time-window” for early allergen exposure.The impairment of regulatory T cells may promote the development of asthma.Allergen exposure in the “time-window” can make the thymus produce normal quantity of regulatory cells.The CD28 signal on regulatory T cells may participate in the production of regulatory T cells。

Abstract：Background Although neuroradiological findings of M(o)bius syndrome have been reported as a result of brain and brainstem abnormalities,magnetic resonance imaging (MRI) now permits the direct imaging of the cranial nerve (CN) and branches in the orbits.This study presents the MRI findings in patients with sporadic M(o)bius syndrome.Methods Prospectively,CNs were imaged in the cistern using head coils and three dimensional fast imaging employing steady-state acquisition (3D-FIESTA),yielding a 0.5 mm2 resolution in planes of 0.8 mm thickness in seven patients with sporadic M(o)bius syndrome.The cavernous and intraorbital segment of the CN and the extraocular muscles (EOMs) were imaged with T1 weighting in all patients.The cavernous segment was imaged in coronal planes,while the intraorbit in quasicoronal planes were imaged using surface coils.Intraorbital resolution was 0.16 mm2 within 2.0 mm thick planes.Results In the seven patients,the CN were absent or showed hypoplasia in the cistern,cavernous sinus,and orbit.Abducens (CN Ⅵ) and facial (CN Ⅶ) nerves were absent on the affected sides.Unilateral CN IX (glossopharyngeal nerve) in two cases displayed dysplasia.Branches from the inferior division of CN Ⅲ were observed to innervate the lateral rectus (LR) bilaterally in three cases and unilaterally in one case,and had intimate continuity with the LR muscle in two cases bilaterally and two cases unilaterally.Hypoplasia of EOMs was shown in five cases.Dysplasia of the medulla on the left side was found in one patient.Conclusions Direct imaging of CNs and EOMs by MRI is useful in diagnosis of M(o)bius syndrome.It can directly demonstrate the abnormalities of the CN and orbital structures.The absence or hypoplasia of CN Ⅵ and CN Ⅶ may be the most common radiologic features in sporadic M(o)bius syndrome,and hypoplasia of CN IX may be an associated feature.The abnormality of EOMs and aberrant innervations in the orbit should be observed,and may be important for the study of the etiology。

Abstract：Background Human piebaldism is a rare autosomal dominant condition characterized by congenital white forelock and depigmented patches of skin,typically on the forehead,anterior trunk and extremities.Mutations in the KIT gene have been proposed to be responsible for the underlying changes in this disorder.The aim of this study was to identify gene mutation in a Chinese family with piebaldism.Methods A Chinese family with piebaldism presenting with white forelock and large depigmented skin macules on the abdomen,arms and legs was collected.DNA was isolated from peripheral blood of the family members.The encoding exons with flanking intron regions of the KIT gene were analyzed by polymerase chain reactions (PCR) and direct DNA sequencing.Besides,DNA extracted from 100 ethnically matched population individuals was as controls.Results A heterozygous missense mutation c.2590T＞C was identified in the patients of the family.This mutation converted a serine residue to proline (p.Ser864Pro).The mutation was not found in their unaffected family members or normal controis.Conclusion A novel missense mutation c.2590 T＞C was found and it might play a significant role in the piebaldism phenotype in the family。

Abstract：Objective To review the mechanisms by which HIV evades different components of the host immune system.Data sources This review is based on data obtained from published articles from 1991 to 2012.To perform the PubMed literature search,the following key words were input:HIV and immune evasion.Study selection Articles containing information related to HIV immune evasion were selected.Results Although HIV is able to induce vigorous antiviral immune responses,viral replication cannot be fully controlled,and neither pre-existing infected cells nor latent HIV infection can be completely eradicated.Like many other enveloped viruses,HIV can escape recognition by the innate and adaptive immune systems.Recent findings have demonstrated that HIV can also successfully evade host restriction factors,the components of intrinsic immune system,such as APOBEC3G (apolipoprotein B mRNA-editing enzyme,catalytic polypeptide-like 3G),TRIM5α (tripartite motif 5-α),tetherin,and SAMHD1 (SAM-domain HD-domain containing protein).Conclusions HIV immune evasion plays an important role in HIV pathcgenesis.Fully understanding the tactics deployed by HIV to evade various components of the host immune systems will allow for the development of novel strategies aimed toward the prevention and cure of HIV/AIDS。

Atrial fibrillation is the most common clinically important cardiac arrhythmia accounting for 20％ to 25％ of strokes and is a common cause of congestive heart failure.1,2 With the aging population and changing demographics,atrial fibrillation has become an epidemic affecting 2.66 million people in the United States.The prevalence of atrial fibrillation is estimated to increase by 5 fold to 12 million by 2050.3 The diagnosis and treatment of atrial fibrillation represent a significant health care burden of $15.7 billion per year.4 Treatment of atrial fibrillation using antiarrhythmic drugs has been disappointing,while radiofrequency ablation approaches have limitations,including unclear long-term efficacy.Innovation in treatment is needed and pursuit of novel modalities of therapy requires fundamental knowledge in the molecular mechanisms that lead to atrial fibrillation,including electrical remodeling in atrial fibrillation。

The diagnosis and treatment of pelvic ring disruption has significantly changed over the past 30 years.It was not until the 1980s that the concept of damage control surgery was applied in the management of severely traumatized patients.The contents of damage control surgery mainly include three phases:the initial stage,the goal of severe pelvic trauma treatment is using simple surgical techniques to control life-threatening bleeding;the second stage,the physiological disturbances of the patients were corrected by ICU resuscitation;and the third stage,the definitive surgery performed for the injuries.1 About 10％ to 20％ of patients with severe unstable pelvic fracture also present with hemodynamic instability,and the mortality rate of them can be as high as 40％.2-4 Although hemodynamic resuscitation techniques have made great progress,some patients do not respond or poorly respond to resuscitation treatment.In this case,according to the principle of damage control,timely and decisively implement of appropriate as well as effective surgical hemostasis is necessary.What's more,any surgical intervention must be considered immediately life-saving.The first step to control the hemorrhage is to restore pelvic stability and compress pelvis volume;now external fixator or C-clamp is often used,in order to reduce bleeding,and use some surgical options further to control the bleeding。

Lung cancer is the leading cancer in terms of incidence and mortality in China and its incidence in China is predicted to increase in the next 20 years.1 The majority of the lung cancer patients are diagnosed with advanced stage disease,for which chemotherapy or targeted therapies are the mainstay palliative treatments.Before the identification of single-driver mutations,like the epidermal growth factor receptor (EGFR) mutation,platinum-based doublet was the standard first line treatment for advanced stage nonsmall cell lung cancer (NSCLC) patients with a good performance status (PS).However,patient prognosis remains poor and the modest treatment efficacy seems to have reached a plateau despite newer generation of platinum doublets.2 The recommendation for the duration of first line platinum doublet treatment is 4-6 cycles.3 The paradigm was based on the fact that a protracted course of chemotherapy did not prolong survival but introduced cumulative toxicities.4,5 The use of maintenance therapy (MT),defined by Grossi et al6 as the prolongation of chemotherapy with the administration of additional drugs at the end of a defined number of initial chemotherapy cycles after achieving maximum tumor response,was not considered as a standard option in the past。

To the editor:Unilateral absence of a pulmonary artery (UAPA) is a rare congenital malformation,most frequently accompanied by cardiovascular anomalies.While the most common clinical symptoms of UAPA are recurrent respiratory infections and dyspnea,hemoptysis is unusual。

To the editor:Mucosa-associated lymphoid tissue (MALT) lymphoma is a low grade B-cell extra-nodal lymphoma from margtnal zone.Lung location is rare and represents 3％-4％ of all cases.1 There is no uniform treatment for pulmonary-MALT (p-MALT) lymphoma.This is the report of p-MALT without any extra-pulmonary lesions of MALT lymphoma that was regressed with clarithromycin (CAM) (500 mg/d) treatment in China。

To the editor:A 12-month-old boy presenting with a three-month history of precocious puberty was admitted to our department in December 2009.Apart from an unremarkable medical history,he was found to have pubic hair and noted to be more aggressive than other children of his age.Physical examination revealed a premature penile development (stage 3 according to Tanner stages)1 and slight development of pubic hair (stage 3),but without any development of laryngeal prominence.The patient had no focal neurological deficit。