2014年 · 第94卷第31期

The world is big, divided for a long time will be united, and united for a long time will be divided. Medicine, too. At the beginning of the founding of medicine, all practitioners were general practitioners, and they were not divided into subjects. With the rise of modern medicine, people have learned about the complexity of the human body and that the body is composed of different systems. It is no longer possible for a doctor to master the diagnosis and treatment of various system diseases in the whole body and to conduct various system research. Specialization is the development trend of medicine. With the development of modern medicine, the division of specialties is becoming more and more refined, and there are many chickens and dogs who hear each other and don't interact with each other. However, in the modern society, the medical field has gradually realized that the human body as a whole, each system is organically combined, and integration has become a trend. Pituitary adenoma is to connect the "Consensus on the Diagnosis and Treatment of Pituitary Prolactin Adenoma in China (2014 Edition)"^[1](hereinafter referred to as Consensus) The link between the various disciplines in which the writing experts are involved.

Pituitary prolactin adenoma is one of the common benign intracranial tumors, and it is also a common secretory pituitary adenoma. The incidence rate in adults is about 1/10,000^[1]40% of secretory pituitary adenomas in adults^[2], belongs to the World Health Organization (WHO) Grade I tumor of the central nervous system along with other types of pituitary adenomas^[3]。 On the one hand, pituitary prolactin adenoma can cause some tumor compression symptoms, such as headache, visual field defect, etc. At the same time, due to the particularity of hyperprolactinemia, hypogonadism and its secondary symptoms are often manifested clinically, and most patients come to see a doctor with this as the first symptom. Although the diagnosis and treatment of pituitary prolactin adenoma has become more and more mature at present, there are still many problems in the diagnosis and treatment process due to the particularity of pituitary prolactin adenoma itself. Improper treatment can have catastrophic effects on patients. How to get rational and standardized treatment for patients with pituitary prolactin adenoma has become a problem that must be faced at present. Therefore, only standardized treatment is the guarantee for the best diagnosis and treatment of patients with pituitary prolactin adenoma.

Following the release of the Guidelines for the Diagnosis and Treatment of Acromegaly in China (2013 Edition) in 2013^[1]The China Pituitary Tumor Collaboration Group, together with the Neurosurgery Branch of the Chinese Medical Association and the Endocrinology Branch of the Chinese Medical Association, launched the "Consensus on the Diagnosis and Treatment of Pituitary Prolactin Adenoma in China (2014 Edition)" this year [hereinafter referred to as the Consensus (2014 Edition)]^[2]。 The consensus (2014 edition) places greater emphasis on the importance of pharmacological therapy in the treatment of pituitary prolactin adenomas. In conjunction with the consensus (2014 edition), let's talk about some ideas on the drug treatment of pituitary prolactin adenoma.

Prolactin (PRL) adenoma is the most common functional pituitary adenoma, accounting for about 40% to 45% of adult pituitary functional adenomas. It is more common in female patients aged 20 to 50 years, and the ratio of male to female in adult patients is about 1:10. Standardized diagnosis and treatment of pituitary prolactin adenoma is of great significance for restoring and maintaining normal adenopituitary function and preventing tumor recurrence.

Dopamine receptor agonist (DA) therapy of choice for pituitary prolactin adenomas, including bromocriptine and cabergoline^[1]。 At present, bromocriptine remains the treatment of choice in mainland China^[2,3]。 However, bromocriptine resistance occurs in 10% ~25% of patients, especially for invasive giant prolactin adenomas. The control of some tumors of cavernous sinus has always been a difficult problem in clinical practice^[4,5]。 Cabergoline has the advantages of convenient administration, good tolerance and good curative effect, and is also effective for bromocriptine-resistant patients^[6,7]。 Through the clinical analysis of a case of invasive giant prolactin adenoma drug therapy, this paper discusses its effect, hoping to have guiding significance for future clinical practice.

After the pathogen infects the human body, the occurrence of immune activation is a necessary step for the immune system to activate the immune defense mechanism, and it is a normal process of immune response. However, in the immune response against human immunodeficiency virus (HIV) infection, immune activation not only plays an immune defense role, but also causes damage to the body. Therefore, immune activation in the field of HIV research generally refers to "abnormal" immune activation that produces a negative effect. Virus and host immune response are the two most important factors in the pathogenesis of acquired immunodeficiency syndrome (AIDS) caused by HIV infection. In recent years, on the basis of exploring treatment strategies to inhibit HIV replication, researchers have paid more and more attention to abnormal immune activation, and new evidence continues to suggest that abnormal immune activation is probably a pathogenic mechanism independent of viral replication. Abnormal immune activation has become a potential therapeutic target. Researchers have tried to use immunosuppressants or modulators to reduce the activation level to achieve the purpose of reducing immune damage^[1]。 To explore the influence of abnormal immune activation associated with HIV infection on disease progression and the efficacy of antiviral therapy is of great significance for understanding the pathogenesis of HIV/AIDS and formulating treatment strategies. This article reviews the research progress in related fields.

amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that selectively affects the anterior horn cells of the spinal cord, the motor nucleus of the brainstem, the cortical pyramidal cells and the pyramidal tract. Clinically, there can be symptoms of muscle weakness, muscle atrophy and pyramidal tract signs involved at the same time. The disease is a progressive course, and there is still a lack of specific treatment, and the prognosis is poor. Most patients die of respiratory failure, and the median survival time is only 3~5 years. More and more studies have shown that ALS can not only involve the motor system, but also damage other functions such as cognition. With the abundance of research methods such as neuropsychology, imaging, pathology and molecular biology, people have a deeper understanding of ALS combined with cognitive impairment. This paper summarizes the research status and progress in this area.

The incidence of ovarian Brenner tumor is extremely low. There were only 3 cases of ovarian Brenner tumor confirmed by pathology in Weihai Maternal and Child Health Hospital from 2008 to 2013. The ultrasound characteristics of these 3 cases are summarized as follows.