2014年 · 第94卷第22期

Pulmonary hypertension is a hemodynamic abnormality with elevated pulmonary artery pressure, which often leads to increased right ventricular load and right ventricular dysfunction, thus causing a series of clinical manifestations. In the past, when pulmonary hypertension was mentioned, it was often thought that it was rare and had a very poor prognosis. In fact, this view was very one-sided. On the one hand, pulmonary hypertension can be derived from the lesions of the pulmonary blood vessels themselves, such as idiopathic pulmonary hypertension (IPAH), or secondary to other heart, lung or systemic diseases, which is not uncommon in clinic; On the other hand, great progress has been made in the treatment of pulmonary hypertension in recent years. With the standardization of diagnosis and treatment, the prognosis of patients with pulmonary hypertension has been greatly improved.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a type of pulmonary hypertension characterized by intravascular thrombotic obstruction, luminal stenosis or occlusion. It belongs to the fourth category of pulmonary hypertension and is also a type of pulmonary hypertension that can be cured potentially. Organized thrombosis and pulmonary vascular remodeling are considered to be the main components of CTEPH. The interaction between them is not only the key link in the pathogenesis of CTEPH, but also closely related to the severity, treatment choice and prognosis of CTEPH^[1]。 Therefore, the interaction mechanism between thrombosis and pulmonary vascular remodeling, how to accurately diagnose and evaluate thrombosis and vascular remodeling, and explore the corresponding medical and surgical treatment methods have attracted much attention in the clinical research of CTEPH in recent years, which is briefly described below.

"The 8th Beijing Five Continents International Conference on Cardiovascular Diseases (FICC 2014) and the 30th Anniversary Celebration of Beijing Anzhen Hospital Affiliated to Capital Medical University" were held at Beijing International Convention Center on April 11-13, 2014. The conference was jointly sponsored by Beijing Anzhen Hospital affiliated to Capital Medical University, Beijing Institute of Cardiopulmonary and Vascular Diseases, and Beijing Wu Yingkai Medical Development Foundation. With the theme of "Co-gathering, Integration and Win-win", the conference highlighted the latest progress in the diagnosis, treatment and prevention of cardiovascular diseases and related fields.

The Ommaya sac was originally used as a device for intratumoral chemotherapy of craniopharyngioma. The purpose of therapy was achieved by direct injection of drugs into the ventricles or cystic tumors^[1]。 In recent years, the clinical application of Ommaya sac has gradually expanded. This study summarized the treatment of ventricular hemorrhage, hydrocephalus, intracranial infection, subdural effusion and other diseases by Ommaya sac placement in the Department of Surgery of the First People's Hospital of Taicang City, Jiangsu Province since June 2008, and achieved good curative results. The summary report is as follows.

functional gastrointestinal diseases (FGIDs) refer to the presence of digestive tract symptoms but cannot be explained by organic lesions or biochemical abnormalities. Clinically, non-erosive reflux disease (NERD), functional dyspepsia (FD), irritable bowel syndrome (IBS) and functional constipation are the most common^[1,2]。 FGIDs often have a long medical history, recurrent attacks, seek medical treatment everywhere, and there is no specific drug for treatment, which seriously affects the quality of life of patients and consumes a lot of health resources. In recent years, FGIDs have received increasing attention, but their exact pathogenesis is unclear. The research progress of functional gastrointestinal diseases in recent years is introduced as follows.

Human albumin has been used clinically for decades to maintain colloidal osmotic pressure and blood volume. However, the results of crystalline fluid supplementation and albumin supplementation in critically ill patients are not consistent. Results from a recent large-scale, multicenter, open, randomized controlled trial showed that maintaining serum albumin levels ≥30 g/L did not improve the prognosis of patients with severe sepsis (Caironi P, Tognoni G, Masson S, et al. Albumin replacement in patients with severe sepsis or septic shock [J]. N Engl J Med, 2014, 370: 1412 – 1421.).

In European and American countries, the incidence of bladder cancer ranks fourth among malignant tumors in men, after prostate cancer, lung cancer and colon cancer, and after the 10th among malignant tumors in women^[1]。 There were approximately 73,510 new cases of bladder cancer (55,600 males and 17,910 females) and 14,880 deaths (10,510 males and 4,370 females) in the United States in 2012^[2]。 The incidence of bladder cancer is increasing in some cities in China^[3]。 Moreover, the fatality rate of bladder cancer in urban residents is significantly higher than that in rural areas. In 2009, the age-standardized mortality rate of bladder cancer in urban residents in China was 3.79/100,000 for men and 1.30/100,000 for women; In rural areas, the rate is 2.42/100,000 for men and 0.81/100,000 for women^[4]。 For the same stage of bladder cancer, the prognosis of women is worse than that of men. The incidence of bladder cancer in men is higher than that in women due to smoking habits and occupational factors. Sex hormones may be an important reason for this outcome^[5]。 Non-muscle invasive bladder cancer (NMIBC) accounts for 70% of all bladder tumors, and is the population of bladder cancer patients faced in most clinical work.

Pulmonary hypertension is a kind of disease characterized by progressive increase of pulmonary vascular resistance, and its disability and mortality rate are high. Due to the lack of specific clinical symptoms, missed diagnosis and misdiagnosis often occur in clinical diagnosis and treatment. Right cardiac catheterization is the gold standard in the diagnosis of pulmonary hypertension, but its invasive nature limits its clinical application. Although transthoracic color ultrasound can estimate pulmonary artery pressure noninvasively, it is easily affected by operator experience and so on^[1]。 Seeking non-invasive, convenient and accurate examination to reflect the disease progress of pulmonary hypertension is one of the research hotspots in recent years. Among them, pulmonary hypertension-related biomarkers have become the focus of research. The clinical applications of the most important biomarkers at present are summarized as follows.

Hematopoietic stem/progenitor cell (HSPC) mutations are closely related to the occurrence and development of myelodysplastic syndrome (MDS)^[1]。 MDS is accompanied by a variety of cytogenetic and molecular defects, which lead to a high degree of heterogeneity in MDS^[2,3]。 Due to the heterogeneity of MDS, no single model can mimic the phenotype of MDS as a whole. Animal models are effective tools and useful preclinical experimental platforms for simulating and studying human diseases. Therefore, it is very important to establish a mouse model of MDS to study its pathogenesis, treatment and prognosis.

A 39-year-old female was admitted on 19 October 2004. The left breast mass was found for half a year, occasionally tingling; The whole body is covered with coffee stains of varying sizes and soft nodules the size of soybeans near skin color, without any discomfort, and has a medical history of more than 20 years. Specialist physical examination: A 4.0 cm ×3.5 cm mass was accessible in the upper quadrant of the left breast, hard in texture, unclear in boundary, fixed, and no swollen lymph nodes were found under both axillaries and above and below the clavicle. Mammography X-ray examination and ultrasound revealed space-occupying lesions in the left breast. Pathological diagnosis of biopsy in an outside hospital in 1993: neurofibromatosis without any treatment. Invasive lobular carcinoma of left breast (Figure 1)。 Diagnosis: Left breast cancer (T₂N₀M₀), clinical stage: stage I. No history of neurofibroma was found among their relatives and a family history of breast cancer was denied. Modified radical mastectomy for left breast cancer was performed on 21 October 2004. Postoperative pathology: invasive lobular carcinoma of left breast, axillary lymph nodes 0/12 (–), ER (+), PR (+), C – erbB – 2 (–). After operation, he was treated with CMF regimen chemotherapy for 6 cycles and tamoxifen endocrine therapy, but he was cured and discharged without radiotherapy. No recurrence of breast cancer was observed after 9 years of follow-up.