2010年 · 第123卷第12期

The term chronic obstructive pulmonary disease (COPD) has been well known and the disease extensively studied for more than a decade in China, but only recently has great progress been made in the epidemiology and management of this highly prevalent disease in this country. Historically, beginning in the early 1960s, long before the definition of COPD was widely accepted, a great number of studies that included traditional Chinese medicine had been performed on chronic bronchitis, emphysema, and related respiratory failure and cor pulmonale。

Abstract：Background Chronic obstructive pulmonary disease (COPD) has a variable natural history and not all individuals follow the same course. This study aimed to identify the prevalence and characteristics of asymptomatic COPD patients from a population-based survey in China.Methods A multistage cluster sampling strategy was used in a population from seven different provinces/cities. All residents (over 40 years old) were interviewed with a standardized questionnaire and spirometry.Post-bronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of less than 70% was defined as the diagnostic criterion of COPD. All COPD patients screened were divided into symptomatic group and asymptomatic group according to the presence or absence of chronic respiratory symptoms. Socio-demographic,personal and exposure variables were collected and analyzed.Results Among the 1668 patients who were diagnosed with COPD from the 25 627 sampling subjects, 589 (35.3%)were asymptomatic. The age, sex, body mass index (BMI),rural and urban distributions, smoking habit and education levels were similar in the two groups. A total of 64.7% of the asymptomatic patients had no comorbidities. Cardiovascular diseases and lung cancer were more common among symptomatic COPD patients than asymptomatic group.Asymptomatic COPD group were less likely to present with poor ventilation in the kitchen, a family history of respiratory disease and recurrent childhood cough. Asymptomatic COPD patients had significantly higher FEV1 (73.1% vs. 61.0%), FVC (91.9% vs. 82.0%), and a higher ratio of FEV1/FVC (62.9% vs.58.7%) (all P <0.001) than symptomatic group. More asymptomatic patients were underdiagnosed (91.9% vs.54.3%, P<0.001) than symptomatic patients.Conclusions This large population-based survey confirmed a high prevalence of asymptomatic COPD patients in China. More use of spirometry screening test may be important to the early detection of COPD。

Abstract：Background Chronic obstructive pulmonary disease (COPD) is thought to be an inflammatory immune response disease. In most cases, the disease is caused by cigarette smoke, but it has been demonstrated that only 10% to 20% of smokers will definitely suffer from COPD. Dendritic cells (DCs) are considered to be the promoter of immune responses.However, the underlying mechanisms involved are still unrevealed. In this study, we aimed to investigate the quantitative differentiation of pulmonary DC in smokers with or without COPD to explore the possible role of DCs in smokers suffering COPD.Methods Peripheral lung specimens from non-smokers without airflow obstruction (control group, n=7), smokers without airflow obstruction (smoker group, n=7) and patients with COPD (COPD group, n=7) were investigated to detect the quantity of S-100 and CD1a positive cells by immunohistochemical or immunofluorescent assay.Results In smokers with COPD, the number of S-100+ DCs was higher than in the controls and smokers without COPD (P <0.01 and P <0.05) and there was a higher number of S-100+ DCs in smokers with COPD than in smokers without COPD, but without a significant difference (P >0.05). An inverse correlation was found between the number of DCs and forced expiratory volume in the first second (FEV1)% pred (r=-0.75, P <0.05), which was also found between the number of DCs and FEV1/forced vital capacity (FVC) (r=-0.72, P <0.05). The mean number of CD1a+ DCs, increased from non-smokers to non-COPD smokers to COPD patients, with significant differences between each group (P <0.01).Conclusions The quantity of DCs significantly increased in smokers with COPD compared with non-smokers or smokers without COPD. The results suggest that DCs may play an important role in the pathogenesis of smoking-induced COPD, and the upregulation of DCs may be a potential maker to identify the smokers who have more liability to suffer from COPD。

Abstract：Background There are few reports discussing the surgical pathological characteristics of superficial endobronchial lung cancer (SELC) defined as cancer growth limited to the bronchial wall. Its prognosis and corresponding TNM staging have not been fully clarified. Little is known as to whether T status is impacted by the existence of associated atelectasis or pneumonia (which might be controversial, indicating either T1 or T2), and circumstantial invasion depth.Methods Between 1988 and 2007, 81 out of 8817 surgically treated patients met SELC criteria; there was no detectable invasion beyond the bronchial wall. A retrospective review was performed and follow-up information was collected.Results The overall five-year survival rate of 81 patients was 85.6%; for NOM0 (n=67), N1M0 (n=7) and N2M0 (n=7)patients, they were 89.3%, 75.0% and 60.0%, respectively. Intraluminal tumor size measured from 0.4 to 3.0 cm;obstructive atelectasis or pneumonia was noted in 14 patients. The presence of tumor-associated obstructive atelectasis or pneumonia did not have a significant impact upon prognosis (P=0.96), nor did the greatest diameter of the tumor (P=0.70). Histology showed carcinoma in situ (level one) in 13 cases; invasion of the submucosal layer (level two) in 12,involvement of the muscular layer (level three) in 20, invasion into the space between the muscular layer and cartilage (level four) in 21, and bronchial cartilage infiltration in 15 (level five). In cases without lymphnode metastases, five-year survival was 100% for the first three levels and 84.0% and 61.3% for the level four and level five.Conclusions Relative to TNM-based prognostic data, superficial endobronchial lung cancer exhibits increased five-year survival rates, and therefore should be placed at the forefront among tumors in the T1 class, regardless of tumor size or the presence of secondary obstructive atelectasis or pneumonia. Lymphnode metastasis is associated with a worse prognosis. Survival is negatively impacted by tumor infiltration depth into the bronchial wall.

Abstract：Background Acute exacerbation of chronic obstructive pulmonary disease (COPD) is always associated with a high incidence and mortality. Because of the presence of some concomitant risk factors such as immobilization, bronchial superinfection, patients who are admitted for acute exacerbations of COPD are generally considered to be at moderate risk for the development of venous thromboembolism. In this study, we investigated the prevalence and the clinical manifestations of deep venous thrombosis (DVT) in patients with acute exacerbation of COPD.Methods From March 2007 to March 2009, 520 consecutive patients were included in this study. On admission, color Doppler ultrasound of lower extremities in all cases was performed for diagnosing DVT. Patients with DVT were compared with those without DVT from such aspects as demographics, symptoms, physical signs and risk factors.Results Among the 520 patients, DVT was found in 46 cases (9.7%). In patients with DVT, the duration of hospitalization was longer (P=0.01), and the mechanical ventilation requirement increased (P <0.001). Other indicators for patients with more possibility of DVT were immobility exceeding 3 days (P <0.001); pneumonia as concomitance (P=0.01); respiratory failure type Ⅱ (P=0.013); current smoking (P=0.001). Lower extremity pain was more common in DVT cases in comparison to those without DVT (34.8% vs. 15.2%, P=0.01 ).Conclusions The acute exacerbation of COPD patients, who were immobilized for over 3 days, complicated by pneumonia and had respiratory failure type Ⅱ, had a higher risk of DVT. In addition, DVT detection awareness should be increased in cases that had a lower extremity pain。

Abstract：Background Percutaneous coronary intervention (PCI) is a well-established method for managing coronary diseases.However, the increasing use of PCI has led to an increased incidence of acute cerebrovascular accidents (CVA) related to PCI. In this study, we investigated the characteristics and risk factors of CVA after PCI in patients with known stroke history.Methods Between January 1, 2005 and March 1, 2009, 621 patients with a history of stroke underwent a total of 665 PCI procedures and were included in this retrospective study. Demographic and clinical characteristics, previous medications, procedures, neurologic deficits, location of lesion and in-hospital clinical outcomes of patients who developed a CVA after the cardiac catheterization laboratory visit and before discharge were reviewed.Results Acute CVA was diagnosed in 53 (8.5%) patients during the operation or the perioperative pedod. Seventeen patients suffered from transient ischemic attack, thirty-four patients suffered from cerebral infarction and two patients suffered from cerebral hemorrhage. The risk factors for CVA after PCI in stroke patients were: admission with an acute coronary syndrome, use of an intra-aortic balloon pump, urgent or emergency procedures, diabetes mellitus, and poor left ventricular systolic function, arterial fibrillation, previous myocardial infarction, dyslipidemia, tobacco use, and no/irregular use of anti-platelet medications.Conclusions The incidence of CVA during and after PCI in patients with history of stroke is much higher than that in patients without history of stroke. Patients with atrial fibrillation, previous myocardial infarction, diabetes mellitus,dyslipidemia, tobacco use, and no or irregular use of anti-platelet medications were at higher risk for recurrent stroke.This study showed a strong association between acute coronary syndromes and in-hospital stroke after PCI。

Abstract：Background Wavelet index (WLI) is a new parameter for monitoring depth of anesthesia based on Wavelet analysis.We observed the change of WLI and bispectral index (BIS) in patients regain of consciousness (ROC) in the absence of frontalis electromyographic (EMG) interference. The aim of this study was to compare the ability of WLI and BIS for reflecting ROC in patients undergone surgery.Methods Twelve patients who were scheduled for maxillofacial surgeries were enrolled in the study. BIS and WLI values were monitored continually. After being given midazolam and remifentanil, patients were asked to squeeze the investigator's hand ever 30 seconds. Patients were continuously given propofol until loss of consciousness (LOC1).Tunstall's isolated forearm technique was used to test the surgical consciousness in patients. After total muscle relaxation,endotracheal intubations were performed, and the patients were connected to a ventilator. Then, propofol was withdrawn until the patients showed regain of consciousness (ROC1) and an awareness reaction. After the command test, patients were readministered with propofol until loss of consciousness (LOC2). After surgery, all of the sedatives were withdrawn,and the patients were let to regain consciousness (ROC2).Results The BIS values of twelve patients at ROC1 after using muscle relaxant were much lower than those at LOC1 and ROC2 without using muscle relaxant, showing statistical significance (P <0.05). Meanwhile, the WLI values of twelve patients at ROC1 after using muscle relaxant were much higher than those at LOC1 and equal to ROC2 without using muscle relaxant, showing statistical significances (P <0.05) between ROC1 and LOC1.Conclusions This study showed that under muscle relaxation or facial paralysis, when there is no EMG signal, BIS can not accurately reflect regain of consciousness in surgical patients, but WLI can reflect it accurately. So WLI may have advantages for reflecting state of consciousness in surgical patients。

Abstract：Background Recent studies suggest that bone marrow adipose tissue might play a role in the pathogenesis of osteoporosis. There are inconsistent findings on the relationship among marrow fat content, bone mineral density and apparent diffusion coefficient (ADC). This study aimed to prospectively explore the efficacy of MR spectroscopy (MRS)and diffusion-weighted MR imaging (DWI) in detecting vertebral marrow changes in postmenopausal women with varying bone densities.Methods Both MRS and DWI of the lumber spine were performed in 102 postmenopausal women (mean age,(67.3±6.5) years; range, 55-83 years), who underwent dual X-ray absorptiometry. Marrow fat content and ADC were compared and correlated among three groups: 24 with normal bone density, 31 with osteopenia and 47 with osteoporosis.Results Vertebral marrow fat content was significantly increased in the osteoporotic group ((65.60±7.68)%, P <0.001)and the osteopenic group ((57.68±6.45)%, P <0.001), when compared with the normal bone density group ((51.67±3.27)%). ADC values were significantly decreased in the osteoporotic group ((0.39±0.03)×10-3mm2/s, P <0.001)and in the osteopenic group ((0.42±0.02)×10-3mm2/s, P <0.001), when compared with the normal bone density group ((0.47±0.03)×10-3 mm2/s). The marrow fat content negatively correlated with both bone density (r=-0.731, P <0.001)and marrow ADC (r=-0.572, P <0.001). The bone density positively correlated with the ADC values (r=0.802, P<0.001).Conclusions Postmenopausal women experience a corresponding increase in vertebral marrow fat content as the bone density decreases. Marrow fat content and ADC correlate to the bone density. MRS and DWI may indirectly assess the early bone marrow changes in postmenopausal women。

Abstract：Background Kawasaki disease (KD) is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2%-3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first infarction.This study aimed to evaluate the efficacy of coronary artery bypass grafting (CABG) in patients with KD.Methods Eight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient (mean 2.5±0.8). Various bypass grafts were used in patients, i.e. the left internal mammary artery (LIMA) in 3 patients, bilateral internal mammary artery (IMA) in 2 patients, LIMA plus gastroepiploic artery (GEA) in 1 patient and total saphenous vein grafts (SVGs) in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass (CPB), after being supported with intra-aortic balloon pump (IABP), the patient was weaned from CPB successfully.Results One patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months (mean 27 months),clincal angina disappeared or improved. Cardiac function was in Class Ⅰ-Ⅱ (NYHA).Conclusion CABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up。

Abstract：Background Traditional Chinese medicine has been used widely for many years in China to treat acute pancreatitis.We have investigated the effects of Dachengqi decoction on intestinal mucosal permeability and outcome in patients with severe acute pancreatitis (SAP).Methods Forty patients with sustained SAP that required admission to the surgical intensive care unit were enrolled prospectively in the study. All of these patients were divided randomly into the Dachengqi decoction group (n=20) and control group (n=20) on admission. Intestinal permeability was assessed by measuring absorption of two metabolically inert markers, lactulose (L) and mannitol (M), which were administered orally. Serum concentrations of endotoxin (lipopolysaccharide, LPS) and the ratio of lactulose to mannitol in urine (L/M) were detected in all patients.Results Compared with those in the control group, urinary L/M ratio decreased significantly in the Dachengqi decoction group on the 7th day after admission (P=0.001). Also, serum concentrations of LPS were reduced on the 5th and 7th day after admission (P=0.006, P=0.008, respectively). Incidence of multiple organ dysfunction syndrome (MODS) and pancreatic infection was significantly lower in the Dachengqi decoction group compared with those in the control group (P=0.038, P=0.025, respectively).Conclusion Dachengqi decoction may promote the recovery of intestinal mucosal permeability and decrease the incidence of MODS and pancreatic infection in patients with SAP。

Abstract：Background Experimental evidence indicates that cyclooxygenase-2 (COX-2) plays a critical role in blastocyst implantation; however, little is known of the role of COX-2 in unexplained recurrent spontaneous abortion (URSA).Methods We evaluated the expression level and potential signaling pathway of COX-2 in 30 cases of URSA who were excluded the abnormality of chromosomes, anatomy, endocrine, infectious, autoimmune diseases and in 30 normal pregnancies.Results The mRNA and the protein expression level of COX-2 in the URSA group (-0.238±0.848, 0.368±0.089,respectively) were significantly lower than that in the control group (1.943±3.845, 1.046±0.108, respectively) (both, P<0.01). The expression of prostaglandins PGF2a, PGD2, PGE2, and PGI2, in the URSA group ((2326.0±295.6) pg/ml,(2164.0±240.5) pg/ml, (238.7±26.4) pg/ml, (2337.0±263.0) pg/ml, respectively) were significantly lower than that in the control group ((3450.0±421.7) pg/ml, (3174.0±415.6) pg/ml, (323.5±43.8) pg/ml, (3623.0±460.4) pg/ml, respectively) (P<0.05). The mRNA expression level of PPARβ and RXRa (0.859±0.653, -0.172±0.752, respectively) in URSA group was significantly lower than that in the control group (1.554±1.735, 0.777±2.482, respectively) (both P <0.05). The mRNA and protein expression levels of vascular endothelial growth factor-A (VEGF-A) in the URSA group (2.010±1.522, 0.35±0.46)was significantly lower than that in the control group (4.569±2.430, 0.750±0.350) (both P <0.05).Conclusions COX-2 and the COX-2-derived PGI2 signaling pathway possibly play an important role in successful embryo implantation, and their decreased expression may result in URSA. The decreased expression may influence the expression of VEGF-A which interferes with placental angiogenesis causing failure of embryo implantation, leading to spontaneous abortion。

Abstract：Background 131Ⅰ therapy is recognized as the simplest, safest, least expensive, and most effective treatment, and accepted by more and more patients. However its curative effect is influenced by many factors, therefore there are some difficulties for doctors to establish individual treatment strategy. The aims of this study were to determine the incidence of early and late hypothyroidism after 131Ⅰ treatment for Graves' disease (GD) and to compare their correlation, to observe and analyze the influential factors and to understand the predictabilities of them.Methods Five hundred GD patients (144 males, 356 females; age (41.2±12.3) years) received 131Ⅰ treatment for the first time. The therapeutic procedure was carried out as the following: undergoing 131Ⅰ uptake test to obtain maximum of thyroid uptake value and effective half-life (EHL) time; estimating the thyroid's weight by ultrasonography; determination of thyroid hormones and correlative antibodies; pre-therapy physical examination; thyroid imaging; calculating 131Ⅰtherapeutic dosage; per os uptake of the determined 131Ⅰ dosage; follow-up appraisal of curative effect. The observing parameters included age, gender, thyroid weight, GD duration, condition of onset, state of disease, course of treatment, EHL time, maximum of thyroid uptake value, 131Ⅰ dosage and titer of correlative antibodies. We sorted out the data and used both univariate and multivariate analysis to evaluate them statistically.Results The incidence rates of early and late hypothyroidism were 33.2% and 6.6% respectively after 131Ⅰ treatment and approximately 22.2% cases of late hypothyroidism developed from early hypothyroidism. The influential factors of early hypothyroidism included course of GD, the highest thyroid uptake ratio of 131Ⅰ, EHL time and thyroid microsome antibody (TMAb), etc. A multivariate analysis on late hypothyroidism showed that female patients, with recurrence after anti-thyroid drug treatment and higher thyroid weight, had lower possibility of late hypothyroidism after 131Ⅰ therapy.Conclusions The incidence of early hypothyroidism is higher than that of late hypothyroidism. The highest thyroid uptake ratio of 131Ⅰ, EHL and TMAb will increase the possibility of early hypothyroidism, while GD course is the protective factor. Higher 131Ⅰ dosage, longer EHL and higher TMAb titer will also increase the possibility of late hypothyroidism. The multi-perspective and multi-factor analysis has the benefit to establish individualized treatment strategy。

Abstract：Background Hyperphosphatemia in renal failure has been identified as a major role in the pathogenesis of hyperparathyroidism that is independent of changes in serum calcium and 1,25(OH)2D3. The aim of this study was to evaluate the expression of parathyroid Pit-1 in hyperphosphatemia-induced secondary hyperparathyroidism (SHPT) of chronic renal failure (CRF) rats.Methods Wistar rats with CRF induced by 5/6 nephrectomy were ramdomly fed with diet containing 1.2% inorganic phosphate (Pi, high phosphate (HP) group, n=9) or 0.2% Pi (low phosphate (LP) group, n=9) for 10 weeks starting from the fourth week after the surgery. Another 7 nephrectomy rats with HP diet were intraperitoneally injected with phosphonoformic acid (PFA, the specific inhibitor of Pit-1, HP+PFA group) 0.15 g/kg every other day for 10 weeks starting from HP diet. Another 6 HP rats injected with the same amount of normal saline as the control of the HP+PFA group (HP+saline group). At the same time, 9 rats with sham surgery received HP diet as the controls. At the 4th week and 14th week, blood was taken for measurement of serum creatinine (SCr), serum calcium (SCa), serum phosphorus (SPi),1,25(OH)2D3 and intact parathyroid hormone (iPTH). At the 14th week, two parathroid glands (PTGs) of each rat were removed by microsurgery, one gland for immunohistochemistry analysis of proliferating cell nuclear antigen (PCNA), the other one for detection of Pit-1 by Western blotting, and for the measurement of Pit-1 mRNA and PTH mRNA by real-time quantitative polymerase chain reaction.Results In nephrectomy rats, high dierary phosphate induced a marked increase in serum phosphate, iPTH, PTH mRNA and PCNA parathyroid cells, accompanying Pit-1 and its mRNA in parathyroid gland increased significantly.However, serum Ca and 1,25(OH)2D3 remained unchanged. PFA decreased Pit-1 and its mRNA levels to reduce intact PTH, PTH mRNA and PCNA-positive parathyroid cells.Conclusions Expression of parathyroid Pit-1 in hyperphosphatemia-induced SHPT of CRF rats was upregulated. Pit-1 may mediate the stimulation to parathyroid gland by hyperphosphatemia。

Abstract：Background Endoscopic treatment for urethral stricture, including cold knife and laser, poses a major challenge to clinical practice. Both the benefits and drawbacks of these two treatments remain controversial. This article aimed to compare the efficacy and safety of laser and cold knife urethrotomy for urethral stricture.Methods We searched PubMed (1966-2009), Embase (1980-2009), Cochrane Central Register of Controlled Trials (CCRCT, 2009 No.1) and Chinese Biomedical Literature Database (CBM) for laser and cold knife urethrotomy as treatment for male urethral stenosis, looking in the English literatures. Two reviewers independently screened the literatures and extracted information. Chi-square test was used for statistical analysis with SPSS15.0.Results A total of 44 articles, including of 3230 cases was retrieved. Success rate of patients treated with laser was 74.9% compared with 68.5% for cold knife, with very similar clinical results despite a statistically significant difference (P=0.004). The trend in success rate at a different follow-up time was similar between the two groups. No significant difference in success rate was found between the groups of repeat operation for recurrence cases, first P=0.090 and second P=0.459. The shorter the stricture length was (<1 cm), the higher the success rate was (P <0.0001). No significant difference in success rate between the laser and cold knife groups was found in neither bulbar nor membranous urethra, bulbar P=0.660 and membranous P=0.477. The rates of urinary incontinence, urinary extravasation, and urinary tract infection showed no significant difference (P=0.259, P=0.938, P=0.653, respectively).Conclusions Success rates for laser and cold knife were very similar despite being statistically different, with the groups having a similar trend in success rates at different follow-up time. Stricture location and history of endoscopic intervention did impact treatment outcome but was not significantly different. The two groups showed no significant difference in major complications。

Abstract：Obstructive sleep apnea (OSA), which is the most common sleep-related breathing disorder and characterized by recurrent collapse of the upper airway,causes repeated arousals from sleep, decreased oxygen saturation of the blood, and excessive daytime sleepiness.Patients with OSA are at increased risk of cardiovascular and cerebrovascular disease, type 2 diabetes, cognitive impairment, and depression.1,2 Currently, continuous positive airway pressure (CPAP) had been identified as the standard treatment for patients with OSA. CPAP shows significant improvements in objective and subjective sleepiness and several quality3 of life assessments, cognitive function and depression.3 However,reports of non-adherence to CPAP therapy range from 29% to 83%, and one of the reasons of non-adherence is the comorbidity of depression.4

Abstract：Asthma is a worldwide prevalent disease that is a considerable health burden in many countries.1 In recent years, the airway epithelium is increasingly recognized as a central contributor to the pathogenesis of asthma.2 One of the most highly induced genes in epithelial cells in experimental allergic airway disease is the third murine calcium-activated chloride channel homologue (mclca3, alias gob-5). Its human homology protein is hCLCA1,3,4 which has been identified as clinically relevant molecules in diseases with secretory dysfunctions including asthma and cystic fibrosis. In initial studies, mclca3 was thought to be a member of calcium-activated chloride channel (CaCCs) family,whereas some new interesting reports suggest that the two mclca3 cleavage products cannot form an anion channel on their own but may instead act as extracellular signaling molecules with as yet unknown functions and interacting partners.5

Abstract：It is known that opioids produce postoperative analgesia,while it can also cause, especially in large doses, side effects like nausea, vomiting, constipation, syncope, skin itching, urinary retention and even respiratory inhibition.These factors have all greatly limited its clinical use for treating postoperative pain. Meanwhile, non-steroidal anti-inflammatory drags (NSAIDs) play an increasingly important role in postoperative analgesia. Some studies suggest that NSAIDS may be neural protective in cerebral ischemic conditions.1 Flurbiprofen axetil, which utilizes a lipid microsphere drag delivery system, may promote accumulation of flurbiprofen granular at inflammatory lesion sites and absorption by inflammatory cells,2 both factors which help to effectively target therapy. Parecoxib is the first selective cyclooxygenase-2 (COX-2) inhibitor available for intravenous injection, which is beneficial to patients susceptible to NSAIDs3 and those prone to gastrointestinal disturbances like perforation, ulcers, and bleeding.4 This investigation assesses the analgesic effect of parecoxib and flurbiprofen axetil for patients undergoing laparoscopic cholecystectomy and their influence on platelet aggregation in order to offer some guidance for clinic practice。

Endometriosis is a common disease in premenopausal women involving pelvic organs specially. However endometriosis that affects the appendix is rarely seen except appendiceal endometriosis that mimics acute appendicitis. In a patient with acute appendicitis we diagnosed and operated on, histopathological examination of the appendix revealed appendiceal endometriosis which caused symptoms。

Alveolar soft part sarcoma (ASPS) is a rare tumor that was originally named by Christopherson in 1952.1Until now, fewer than 200 cases have been described in the literature. The ASPS on the uterine cervix is a very rare malignant tumor of the female reproductive organs.Including the first case described by Flint et al2 in 1985,there have been only a few cases reported to date, of which two were in China, and there is a lack of insightful analysis of treatment options. Therefore, to raise awareness of this disease, we performed a detailed literature review, which includes a case encountered by ourselves。

Sarcoidosis is a systemic granulomatous disease of unknown cause. It commonly affects young to middle-aged adults and frequently presents with bilateral hilar lymphadenopathy, pulmonary infiltration, and ocular and skin lesions. Pleural involvement is relatively uncommon. Pneumothorax is a rare complication of sarcoidosis, occurring usually in the late fibrotic stages of the disease with associated bullous changes. There are only scattered case reports on pneumothorax as the first manifestation of sarcoidosis in medical literature. The present case study reports a young man who presented first with recurrent spontaneous pneumothorax during the early stage and relapse of sarcoidosis。