2014年 · 第94卷第04期

Breast cancer is the most common malignancy in women. According to incomplete statistics, by 2015, the incidence of breast cancer in China was about 53.87/100,000 in urban women and 40.14/100,000 in rural women^[1]。 Although the effects of standardized treatment and comprehensive treatment are also very obvious, due to the differences in professional and technical level of various hospitals in China, there are treatment misunderstandings in daily clinical work, among which the excessive surgery and the deficiency of postoperative radiotherapy are the main ones. Now I will talk about some views for peers' reference.

The prevalence of chronic kidney disease (CKD) in China is 10.8%, and it is estimated that there are 119.5 million CKD patients^[1]。 As the population ages and the prevalence of hypertension and diabetes increases, the prevalence of CKD will rise further. Progression of CKD will lead to end-stage renal disease (ESRD), namely uremia. According to the prevalence of ESRD in Europe, America, Japan, Thailand and other countries, it is estimated that the number of ESRD patients in China is 1 million to 2 million. At present, China has the largest population of CKD and uremia patients in the world. The high disability rate and mortality rate of uremia are not only harmful, but also consume huge health resources due to the high treatment cost. China is still a developing country, and the medical security system is not perfect. Many uremic patients can't get effective treatment due to economic reasons. Many uremic patients' families are poor and return to poverty due to illness. Therefore, how to prevent and treat the occurrence of CKD, how to delay the progression of CKD, reduce the occurrence of uremia, and improve the treatment rate and social return rate have become important public health problems in China.

gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the digestive system^[1,2,3,4]Most of them are believed to originate from gastrointestinal pacemaker interstitial cells of Cajal (ICC) or their precursor cells. Gain-of-function mutations occurred mainly by c-kit (85%) and platelet-derived growth factor receptor alpha (PDGFRA, 7%) genes^[5,6]Type III receptor tyrosine kinase KIT and PDGFRA autophosphorylation, abnormal activation of downstream signaling pathways, uncontrolled cell proliferation and inhibited apoptosis. GIST has the potential of non-directional differentiation, and there is no clear boundary between benign and malignant. At present, risk grading, including tumor site, size, number of mitosis and whether rupture occurs during operation, is commonly used to assess the prognosis of disease^[7]。 The most common treatment for primary GIST is surgical resection. The use of imatinib mesylate has ushered in a new era of molecular targeted therapy for GIST, which can keep 80% of patients with metastatic or recurrent GIST stable. But only<3% of patients achieved complete remission and required lifetime treatment^[8,9]。 Approximately 50% of patients develop secondary resistance within 2 years of initial treatment with imatinib. On the other hand, wild-type and PDGFRA D842V-mutated GISTs were insensitive to imatinib treatment. Therefore, gene mutations cannot fully explain the diverse biological manifestations of GIST, and KIT inhibitors alone cannot completely cure GIST. Other types of epigenetic changes, including DNA hypomethylation, DNA hypermethylation, abnormal expression of microRNA (miRNA) and chromosome modification, are also involved in GIST tumorigenesis, and play an important role in the diagnosis, treatment and prognosis of GIST^[10]。 The research progress of miRNA in GIST is summarized as follows.

Autoimmune disease refers to a kind of disease in which the immune system is hyperfunctional, producing antibodies or sensitized lymphocytes to destroy and damage its own tissues and cell components, resulting in tissue damage and organ dysfunction. It has the characteristics of high incidence, complex mechanism, sensitive treatment but difficult to cure, poor prognosis and long course of disease. telomere (telomere) is a special structure at the end of linear chromosome. In recent years, it has been found that telomere shortening of T lymphocytes exists in autoimmune diseases.

After Madkilbp first proposed the cancer stem cell (TSC) hypothesis, researchers have successively discovered the existence of TSC in malignant tumors such as acute myeloid leukemia, breast cancer, central nervous system malignancies, and colon cancer. Among them, breast cancer stem cells (BCSCs) are highly correlated with the occurrence, development, recurrence, metastasis and multidrug resistance of breast cancer^[1]。 Breast cancer is a hormone-dependent tumor, and endocrine therapy has been widely used in patients with positive estrogen receptor (ER) and/or progesterone receptor (PR)^[2]More and more studies have found that BCSCs are of great significance for the development and screening of targeted endocrine therapy drugs. Recent advances in the regulation of the number and function of BCSCs by binding hormones as exogenous regulators are reviewed.

A 19-year-old male, 14 years after perineal flame burns, was admitted on 17 May 2011 due to perineal scar contracture deformity. The patient reported that the scrotum was not empty before the burn. After the burn healed, a fixed mass in the right inguinal area and a movable mass in the left inguinal area were found, which sometimes could not be touched. Physical examination at admission: extensive scars in the lower abdomen, perineum and upper segments of both thighs. Pelvic asymmetry on both sides, right hip deformity, right hip joint straightening, limited abduction, right lower limb shortening 18 cm compared with the contralateral, right upper thigh circumference significantly reduced compared with the contralateral, and left thigh abduction limited. The penis and scrotum are hidden in the annular scar fossa, which affects the examination. An oval mass can be palpable in the left and right inguinal areas, which causes deep pressure pain. Physical examination on day 2 of admission did not reveal a mass in the left inguinal area. Pelvic CT scan showed: a well-bounded, isodensity shadow was seen behind the penis, near the midline of the root of the left thigh, and subcutaneously in the right inguinal area, respectively, and dislocation of the right hip joint (Figure 1)。 Ultrasound examination showed that the medial upper left thigh and the right inguinal area were detected with isoechoic, rounded shape; Testicular volume measured by ultrasound was 6.98 ml in the left testis and 4.53 ml in the right testis (Figure 2)。 There was no obvious abnormality in the physical and chemical characteristics of semen, and no sperm was seen under the microscope after centrifugation; Sex hormone test was normal. On May 26, 2011, perineal scar release and skin grafting were performed. After operation, the left testis did not rise again and was located in the scrotum, and the right testis was located in the right inguinal area. The penis was fully exposed, the erectile function was improved, and a smaller scrotum was visible, which was oval, and the abduction of both thighs was partially improved. One year after operation, the size, texture and semen examination of left and right testis showed no obvious change compared with those before operation, and the detection of sex hormone, human chorionic gonadotropin and alpha-fetoprotein were all normal. Percutaneous testicular biopsy in the right inguinal area: Remaining seminiferous tubules and completely fibrotic seminiferous tubules were found. Spermatogenic cells at all levels of the remaining seminiferous tubules completely disappeared, sertoli cells proliferated, basement membrane thickened, and no abnormal cells were found (Figure 3)。 Left testicular puncture failed. It is proposed to perform right descending testicular fixation or right cryptorchidectomy as soon as possible.

On November 2-3, 2013, China Non-invasive Ventilation Summit was held in Tianjin. During the meeting (November 2nd), the "Chinese Non-invasive Ventilation Expert Symposium" was held. The seminar was chaired by Professor He Quanying, head of the Sleep Apnea Group of the Respiratory Branch of Chinese Medical Association, attended by many experts from the Critical Care Group, Sleep Apnea Group, Respiratory Therapy Group and China Sleep Research Association of the Respiratory Branch, and Professor Wang Chen, chairman of the Respiratory Branch of Chinese Medical Association, attended and guided. The meeting held extensive and in-depth discussions on the current situation and problems, development strategies and specific implementation steps in the field of non-invasive ventilation in China.