Objective To report a case of pulmonary alveolar microlithiasis ( PAM) in Peking Union Medical Col-lege Hospital and to summarize the clinical features and genetic characters .Methods The clinical features , ima-ging results , pathology findings and SLC34 A2 gene mutation was analyzed and reported .Results The patient was a 35 years old male, presenting with cough and sputum for 10 years and worsen with short of breath for 3 weeks. Computed tomography of lung and pathology findings support the diagnose of pulmonary alveolar microlithiasis .And a heterozygous mutation c .A910 T in exon 8 of SLE34 A2 gene was discovered through genetic testing .Conclusions Since to the treatment is non-specific in this rare disease , it's significantly important to recognize this disease through early non-specific clinical features but typical imaging findings .And the finding that c .A910 T is more common in Asia population may provide us a potential target for screening and possible genetic engineering therapy .

Objective To investigate the curative effects of the modified coloclysis method on con-stipation in gerontal patients. Methods 80 cases of gerontal patients with constipation were divided into the observation group and the control group with 40 cases in each group.The observation group was treated with modified coloclysis method and traditional coloclysis method was used in the control group. The dura-tion of liquid retention time in enteric cavity, the times of defecation after coloclysis and relapse rate of constipation were recorded and compared. Results The retention time of liquid in enteric cavity was longer, the times of defecation after coleclysis was less and relapse rate of constipation was lower in the ob-servation group than those in the control group. Conclusions The modified coloclysis method to treat gerontal constipation is better than the traditional coleclysis method.

Objective To evaluate the effects of continuous intra-tracheal gas insufflation (TGI) during mechanical ventilation for protecting the juvenile piglets with acute lung injury (ALI) induced by endotoxin. Method Twelve healthy juvenile piglets were anesthetized and mechanically ventilated at 2 cmH2O PEEP with 10 cmH2O peak inspiration pressure. The piglets were challenged with lipopolysaccharide (LPS) and randomly (random number) assigned to two groups (n = 6 each): (1) piglets treated with mechanical ventilation alone (group MV) and (2) piglets treated with TGI by continuous airway flow of 2 L/min (group TGI). FiO2 was set at 0.4 to avoid oxygen toxicity, and the piglets were continuously monitored with an oxygen analyzer. Results Tidal volume, ventilation efficacy index and mean airway pressure were significantly improved in piglets of TGI group (P < 0.01 or P < 0.05). Four hours after ALI, pH decreased to below 7.20 in piglets of MV group, and was higher in piglets of TGI group (P < 0.01). Similarly, PaCO2 was stable and was significantly lower in piglets of TGI group than that in piglets of MV group (P < 0.01). PaO2 and PaO2/FiO2 increased in piglets of TGI group (P < 0.05). There were no significant differences in heart rate, respiraaatory rate, mean arterial pressure, central venous pressure, dynamic lung compliance and mean resistance of airway between two groups. Lung histopathological changes showed severe inflammation,and intra-alveolar hemorrhage and interstitial patchy hemorrhage were ameliorated and the lungs were more homogenously expanded in piglets of TGI group. Conclusions Continuous TGI during MV can significantly improve gas exchange and ventilation efficacy, and may provide a better treatment for acute lung injury.

Objective To evaluate the effects of breathing training (Qigong) on the exercise test, resistance breathing as well as quality of life in chronic obstructive pulmonary disease (COPD) patients and to elucidate its mechanism.Methods Ten patients with COPD were assigned to 16-week rehabilitation program of Qigong. Their lung function was as follows: FEV1 1109±34.4 ml, FEV1/FVC 56.9±6.5%, RV/RV Pred 171.8±46.7%, RV/TLC 58.9±6.5%. The patients did the breathing exercise for 45 minutes twice a day. The efficacy of practice was checked by the respiratory inductive plethysmograph (RIP) once a week. Before and after the program, the patients were examined as follows: 1, Incremental exercise test, subjects exercised on a bicycle ergometer for 6 minutes. The workload (Watt) was increased 1/70 FEV1 (ml) every a minute. The breath rate, tidal volume and oxygen saturation were monitored. 2, Estimating dyspnea, during the incremental exercise test the subjects were asked to quantify their feeling of breathlessness every a minute using a modified Borg scale. Borg score 0.5 was defined as the threshold of dyspnea. 3, Evaluation of quality of life (QOL), a questionnaire of QOL for COPD was used to evaluate the change of QOL contained 4 parts, namely daily activity, social activity, depression and anxiety. 4, Resistance breathing test, the rib cage (RC) and abdominal (AB) belts of the respiratory inductive plethysmograph were positioned around the chest and the abdomen respectively. Tidal volume, breath rate, TCD/VT (TCD; total compartmental displacement) were recorded at resting and resistance breathing with 60% maximal inspiratory pressure as the inspiring pressure load.Results After the program, the breath rates decreased (P<0.05) during incremental exercise test in comparison with those before program. At the fifth degree of workload the heart rate reduced (P<0.05) and oxygen saturation increased (P<0.05). Borg scores improved at the 2nd, 3rd, 4th and 5th degree (P<0.05). The threshold of dyspnea increased from degree 1.7±0.48 to degree 2.4±0.52 (P<0.01). After 16-week training the tidal volume increased at resting (P<0.05). Both breath rate and tidal volume did not change significantly at resistance breathing. Interestingly, TCD/VT decreased significantly (from 1.49±0.19 to 1.27±0.12, P<0.05) during resistance breathing, indicating the improved synchronization of thoracic and abdominal respiration. The scores of QOL were also improved statistically (P<0.001).Conclusions It was suggested that Qigong could improve the breathing pattern at resting and during incremental exercise, abate the extent of paradoxical thoraco-abdominal motion at the resistance breathing. Therefore Qigong could ameliorate dyspnea, raise the threshold of dyspnea. It might be physiological basis of the improvement of QOL in the patients with COPD after the program.

Objective:To investigate the clinical application of Bushen-Liyan Decoction combined with low frequency pulse acupoint electrical stimulation in the treatment of swallowing dysfunction of stroke patients in convalescent stage. Methods:From January 2018 to March 2020, 108 stroke patients with swallowing dysfunction in the Shandong Provincial Third Hospital were selected. They were randomly divided into two groups with 54 in each according to the random number table method. The control group was given low frequency pulse acupoint electrical stimulation on the basis of conventional treatment, and the study group was given Bushen-Liyan Decoction combined with low frequency pulse acupoint electrical stimulation on the basis of conventional treatment. Both groups were treated for 4 weeks. The National Institutes of Health Neurological Deficit Score (NIHSS) was used to assess the degree of neurological impairment, the Wada Drinking Water Test was used to assess the degree of swallowing dysfunction, and Barthel Index was used to assess the ability of daily living. The serum levels of brain-derived neurotrophic factor (BDNF), insulin-like growth factor-1 (IGF-1), VEGF, IL-18, IL-23, SOD and MDA were detected by ELISA. The adverse reactions during the treatment were observed and the clinical efficacy was evaluated.Results:The total effective rate was 92.6% (50/54) in the study group and 72.2% (39/54) in the control group, with significant difference between the two groups( χ2=7.728, P=0.005). After treatment, NIHSS score and Wata’s drinking water test score of the study group were lower than those in the control group ( t=8.383, 9.740, P<0.001), Barthel index of the study group was significantly higher than that of the control group ( t=4.064, P<0.01). The serum BDNF [(8.42 ± 0.72) μg/L vs. (6.69 ± 0.63) μg/L, t=13.288], IGF-1[(142.20 ± 12.29) μg/L vs. (118.35 ± 10.73) μg/L, t=10.742] and VEGF[(151.29 ± 12.26) ng/L vs. (102.21 ± 9.77) ng/L, t=23.006] were significantly higher than those in control group( P<0.01); The serum levels of IL-18, IL-23 and MDA were significantly lower than those in the control group( t=7.892, 9.897, 6.206, P<0.001), and the level of SOD was significantly higher than that of the control group ( t=18.510, P<0.001). During the treatment, no serious adverse events occurred in both groups. Conclusion:Bushen-Liyan Decoction combined with low-frequency pulse acupoint electrical stimulation can reduce the clinical symptoms, inflammatory reaction and brain tissue damage of stroke patients with dysphagia, improve the swallowing function and improve the clinical efficacy.

The oncolytic virus(OV)therapy utilizes natural or genetically modified viruses to specifically target and infect tumor cells,leading to the destruction of cancer cells by the replication of the virus itself.This process also alters the immune microenvironment of the tumor transforming"cold"into"hot",and mobilizes the body's immune system.The effectiveness of oncolytic viruses in anti-tumor therapy depends on factors such as the type of virus,host immunity and route of administration.Immunotherapy aims to activate the immune system and exert anti-tumor effect by relying on autoimmune function.With the development of genetic engineering technology,oncolytic viruses can enhance the anti-tumor effect through gene editing reconstruction,and can be used to treat tumors alone or in combination with other therapies.In view of the limited efficacy of single application of oncolytic virus therapy in clinic,the combination of oncolytic virus therapy and immunotherapy provides a new strategy for tumor treatment.This review started from the types of oncolytic viruses approved in the clinic,characteristics and its anti-tumor mechanisms.At the same time,it combed through the treatment of oncolytic viruses in the clinical trial stage,summarized the combined treatment strategies of oncolytic viruses,especially the combination of tumor immunotherapy represented by immune checkpoint inhibitor(ICI)and adoptive cell therapy(ACT),and put forward some thoughts and prospects of oncolytic viruses in the anti-tumor treatment in combination with the experience accumulated by the project team in the research of oncolytic viruses.

This study reported two women with extreme obesity who underwent metabolic surgery due to their mutations in leptin receptor (LEPR).Genomic DNA was extracted from the anticoagulant blood samples of the two patients and their parents.A panel of genes related to metabolic diseases or whole exon sequencing was screened and the results were confirmed by Sanger sequencing.This is the first time that these three mutations in LEPR were reported.Two patients complained insatiety and early-onset obesity since childhood at clinics.Patient 1 was a 39-year-old woman with height 150 cm,weight 130 kg,and BMI 57.8 kg/m2.Serum leptin level was 156.4 μg/L.A homozygous mutation of c.2317G＞T was found in exon 15 of LEPR gene in patient 1,which was descended from her father and mother respectively.Patient 2 was a 37-year-old woman with height 158 cm,weight 167 kg,and BMI 67 kg/m2.Serum leptin level was 193.4 μg/L.Genetic analysis showed compound heterozygous mutations of c.1482delT and c.1892C ＞ A.Her father showed heterozygous c.1482delT mutation,and her mother carried heterozygous c.1892C ＞ A mutation.Two patients all underwent metabolic surgery with body weight reduction of about 22 kg and 40 kg respectively after first six months.However,the follow-up studies showed that the body weight of patient 1 rebounded to pre-surgery level in two years and patient 2 did not further lose weight in the following six months.