2014年 · 第94卷第30期

lung cancer is the most common malignant tumor in the world, and the mortality rate ranks first among cancers. Among them, non-small cell lung cancer (NSCLC) accounts for more than 85% of lung cancer, and most of the patients are advanced at the time of consultation^[1]。

In recent years, the treatment of advanced lung cancer, especially non-small cell lung cancer (NSCLC), has gradually shifted to individualization. Protein-encoding genes that play an important role in cell proliferation and survival are mutated in some tumors, and targeted mutations can induce cell death, which is currently recognized as one of the effective therapeutic strategies. Among them, the most widely known gene and clinically beneficial gene is epidermal growth factor receptor (EGFR)^[1]。 In lung cancer, EGFR-active mutations mainly occur in exons encoding kinase regions (exons 18-21)^[2]。 First-generation EGFR tyrosine kinase inhibitor (TKI) drugs such as gefitinib, erlotinib and icotinib reversibly compete with the adenosine triphosphate (ATP) binding site of EGFR, blocking its signal transmission, thereby achieving a therapeutic effect.

Traditional indicators for monitoring infection include white blood cell count and classification, C-reactive protein (CRP) and procalcitonin (PCT), etc. However, patients with hematological diseases, especially patients with leukemia or aplastic anemia, often have abnormalities in the number or classification of white blood cells. Once such patients are co-infected, they lack effective judgment indicators, and due to low autoimmune function, patients lack specific clinical manifestations. Although CRP and PCT have certain suggestive significance, the above indicators have many influencing factors and lack specificity. In recent years, CD64 has been widely used in pediatrics and patients with severe infection as an index for monitoring infection^[1,2]In this study, the value of neutrophil CD64 positive index in the diagnosis of infection in patients with hematological diseases was discussed.

miRNA is a class of non-coding small molecule RNA with a length of 21 to 24 nucleotides^[1,2]。 miRNA is a group of short sequence RNAs that do not encode proteins and has high evolutionary conservation, gene expression sequence and tissue specificity among various species. Previous studies suggest that the regulation of target genes by miRNA is at the post-transcriptional level, and the expression of target genes is down-regulated by two mechanisms: transcript cleavage or translational suppression^[3], divided into three types according to the mode of action^[4,5]: (1) If the miRNA cannot be completely paired with the target mRNA, it inhibits gene expression at the translational level. This miRNA is the most widely discovered type at present; (2) miRNA is completely paired with target mRNA, its action mode and function are the same as small interfering RNA (siRNA), and it participates in the cleavage of some specific mRNA in vivo; (3) has the characteristics of the above two modes of action: when it is completely complementary and bound to the target gene, it can directly cleave the target mRNA; when it is incompletely paired and bound to the 3'-end non-coding region of the target gene mRNA, it inhibits the translation of the target gene, and the miRNA regulates the growth, development and disease occurrence process of the body through the above mechanism.

Therapeutic angiogenesis, that is, the application of various methods and means to promote the formation of new blood vessels and the establishment of collateral circulation of ischemic limbs, provides a brand-new idea for the treatment of ischemic diseases of limbs. At present, this concept has gradually moved from laboratory to clinical^[1,2]And achieved certain clinical results, but the research on the mechanism of therapeutic angiogenesis still needs to be further deepened. More and more studies have found that neurological factors play an important role in therapeutic angiogenesis. This study reviews the progress in this area.

Globally, respiratory diseases including bronchial asthma (abbreviated asthma) and chronic obstructive pulmonary disease (abbreviated COPD) are increasing. The typical diagnosis of asthma is based on the characteristics of the patient's symptoms and the signs at the time of attack. For those with atypical symptoms, pulmonary function indicators are needed. Pulmonary function measurement is the gold standard for the diagnosis of COPD, but only the severity of airflow restriction is insufficient to describe the whole picture of COPD, and it is difficult to measure lung function in severe patients.

The patient, a 23-year-old male with previous health, was admitted to the hospital on 4 May 2011 due to paroxysmal abdominal pain for 8 h. The patient developed abdominal pain without obvious trigger 8 h ago, which was paroxysmal and severe, and could be relieved when the body was bent forward and sitting. There was no nausea and vomiting, no fear of cold and fever, and no stop of anal exhaustion and defecation. Physical examination: body temperature 37.2℃, pulse 90 beats/min, blood pressure 126/78 mmHg (1 mmHg =0.133 kPa), painful face, harmonic heart rhythm, no murmur, clear respiratory sounds in the lungs, no dry and wet rales, soft abdomen, sausage-like mass about 4 cm ×5 cm in the right lower abdomen, no pressing pain and rebound pain, negative Murphy sign (-), unpalpable subcostal liver and spleen, mobile voiced sound (-), intestinal sound 5 times/min. Laboratory test: white blood cells 10.9×10⁹/L, and no abnormalities were found in the rest of the tests. Abdominal B-ultrasound revealed intussusception. Admission diagnosis: acute intussusception. After admission, the relevant examinations were completed, and the contraindications of operation were excluded. Emergency exploratory laparotomy was performed on the same day. Intussusception mass was found in the ileocecal region, 25 cm away from the terminal ileum, and Meckel's diverticulum with a size of 3 cm ×2 cm ×1 cm on the contralateral edge of the mesangium. Meckel's diverticulectomy and ileoileal anastomosis were performed. Postoperative pathology showed that ectopic pancreatic tissue was seen in the ileum wall and serosa (Figure 1)。 The patient recovered well after symptomatic treatment such as anti-infection and nutritional fluid rehydration, and the abdominal pain disappeared. He was discharged 10 days later. Follow-up for 3 years, the condition is good.

A 14-year-old female was admitted for "progressive redness and swelling of the left eye with visual acuity decrease for 2 months". The patient had been treated outside the hospital with unknown details and poor results. The patient did not complain of other discomfort and had no history of illness or trauma. Eye examination: the visual acuity of the right eye is 1.0, the visual acuity of the left eye is 0.4, and the intraocular pressure of both eyes is normal. The left eye was displaced to the lower temporal, and the intraocular and upward turning of the eyeball was limited. Mild edema of left eyelid, conjunctival congestion and edema with left facial swelling (FIGS. 1A, B)。 Relative afferent pupillary disturbance and retinal edema in the left eye. A/B ultrasound showed left intraorbital inflammatory pseudotumor (Figure 1C)。 Magnetic resonance imaging (MRI) revealed left intraorbital inflammatory pseudotumor and left mumps inflammation (Figure 1D, E)。 According to the above clinical manifestations and signs, the preliminary diagnosis was: inflammatory pseudotumor in the left orbit. Blood routine after admission showed white blood cell count 2.5×10⁹/L, neutrophil percentage 0.384, lymphocyte percentage 0.55, hemoglobin 112 g/L, residual value in the normal range; Liver function tests showed alanine aminotransferase 191 IU/L and aspartate aminotransferase 237 IU/L. Due to the abnormal blood routine and liver function of the patient, systemic hormone therapy is not considered for the time being. First, local anti-inflammatory therapy (diclofenac sodium and levofloxacin eye drops, 4 times a day), white blood cell elevation and liver protection therapy are given. At the same time, systemic examination is improved to find out the causes of abnormal blood and liver function. Systemic examination revealed left parotid lymph node enlargement and hepatosplenomegaly, blood amylase was normal, and mumps was ruled out after consultation in the infectious diseases department. Within 1 week, the visual acuity of the patient's left eye dropped to 0.2, facial swelling and redness and swelling of the left eye intensified, the conjunctiva above the nose protruding beyond the palpebral fissure, and a yellow-white mass was visible under the conjunctiva (FIGS. 2A ~ C)。 A/B ultrasound showed obvious enlargement of intraorbital mass, choroidal edema and superior temporal retinal edema (Figure 2D, E)。 Reexamination of blood routine showed white blood cell count 6.7×10⁹/L, neutrophil percentage 0.567, lymphocyte percentage 0.377, hemoglobin 135 g/L. Although imaging tests support inflammatory changes, the possibility of malignant lesions is considered in view of the rapid progression of the lesion and unexplained lymph node, hepatosplenomegaly and hemogram, liver function abnormalities. Bone marrow biopsy showed no obvious abnormal changes in bone marrow tissue. To clarify the nature of the mass, subconjunctival lesion biopsy was performed under local anesthesia, and a yellow-white solid mass of 2.0 cm ×2.0 cm ×0.3 cm was cut, and cytological examination and immunohistochemistry (tumor cell LCA^＋, CD3^＋, TIA-1^＋Ki-67>90%; the remaining negative or indeterminate) suggesting a pathological diagnosis of T-cell lymphoblastic lymphoma (LBL) (Figure 3)。 Eventually, the patient was referred to the hematology department for radiotherapy and chemotherapy. Within 6 months of follow-up, the left intraorbital lymphoma continued to spread and more lymph nodes were involved throughout the body, which was lost to follow-up six months later.