2014年 · 第94卷第36期

Bone tissue is a common site of metastasis in advanced malignant tumors, and the incidence of bone metastasis in breast cancer is 75%^[1,2]。 Bone metastases, if not aggressively treated, usually lead to serious bone-related events (SREs)^[3], such as bone pain, pathological fracture, spinal cord compression, hypercalcemia, etc., seriously affect the quality of life and prognosis of patients, and increase the financial burden of patients. Therefore, sufficient attention should be paid to the bone metastasis of breast cancer, and active treatment measures should be taken to relieve pain, prevent and treat SRE, improve the quality of life and prolong the survival time.

High 3rd degree tracheal stenosis refers to tracheal stenosis within 5 cm below the glottis, and the degree of stenosis is between 71% and 99%. It is a rare critical disease in clinic, with high asphyxia and mortality^[1,2]。 The degree of tracheal stenosis in such patients is severe and the location is high. The conventional clinical treatment method is tracheal intubation under general anesthesia and tracheal resection at the stenosis site. However, due to the high degree of tracheal stenosis and stenosis in such patients, there is a risk of failure of tracheal intubation after general anesthesia, which in turn leads to asphyxia and death of the patient. In view of the treatment difficulties and bottlenecks of such patients, this study used regional nerve block (cervical plexus) combined with general anesthesia to treat high tracheal 3rd degree stenosis in two steps, which is reported below.

Juxta-articular myxoma (JAM) is a rare soft tissue tumor, which is generally myxoid, often accompanied by cystic changes and tendon sheath cyst-like changes, and is easily misdiagnosed. The data of 8 patients with JAM diagnosed and treated in Wuxi Second People's Hospital and Ningbo Clinical Pathology Diagnosis Center from January 2006 to August 2013 are reported below.

Glycemic control is at the heart of diabetes treatment. Some prospective studies have demonstrated that reducing glycosylated hemoglobin (HbA1c) can effectively reduce the risk of chronic complications of diabetes^[1]However, HbA1c only reflects mean blood glucose and does not describe the whole picture of blood glucose. Blood glucose fluctuations have attracted widespread attention in recent years and may be an independent risk factor for chronic complications of diabetes mellitus outside mean glucose^[2]。 glucose fluctuation is used to describe the unstable state of blood glucose between peaks and troughs. Related concepts include blood glucose variability (GV) and blood glucose stability (GS). The broad sense of blood glucose fluctuation includes not only the physiological variation of blood glucose in normal people, but also the pathological blood glucose fluctuation. The latter is usually referred to in the literature, and there is no unified standard to define it in the world. China Blood Glucose Monitoring Guidelines Based on the results of a multicenter study, the reference value for physiological blood glucose fluctuations in Chinese adults assessed using the ambulatory blood glucose monitoring system (CGMS) is recommended as the intraday mean blood glucose fluctuation amplitude (MAGE)<3.9 mmol/L and standard deviation (SD)<1.4 mmol/L^[3]。 A study published at the 2014 annual meeting of the American Diabetes Association (ADA) found that blood sugar fluctuations in prediabetes increased significantly, and recommended blood sugar fluctuation parameters as screening indicators in prediabetes; Patients with metabolic syndrome have increased blood glucose fluctuations compared with normal people. As impaired glucose regulation worsens, blood glucose fluctuations are also increasing progressively^[4]。 Abnormal blood glucose fluctuation may be related to chronic complications of diabetes, including acute blood glucose fluctuation and chronic blood glucose variation, which can be evaluated from the aspects of daytime blood glucose variation, intraday blood glucose variation, postprandial blood glucose spike, and long-term HbA1c variation^[5]。 Blood glucose fluctuation is a hot topic in the research field of blood glucose monitoring and control in diabetes, but there are many controversies. This article reviews the related research on the influence of abnormal blood glucose fluctuation on diabetes mellitus and chronic complications.

restless legs syndrome (RLS) is a common neurosensory motor disorder with an incidence rate of 5% ~10%. It is mainly manifested by leg discomfort and desire to move at night. Most patients have insomnia symptoms such as difficulty falling asleep and easy waking up^[1]。 RLS has a high incidence in patients with sleep apnea disorders, especially obstructive sleep apnea hypopnea syndrome (OSAHS)^[2]However, it is not clear whether there is a causal relationship between the two. Nonetheless, since RLS itself can disrupt the structure of sleep, causing impaired daytime function in patients; When RLS is present in patients with OSAHS, it must be treated accordingly. The related research on the relationship between RLS and OSAHS is summarized as follows.

In recent years, with the change of lifestyle, metabolism-related non-alcoholic fatty liver disease (NAFLD) is rapidly developing into the most common chronic liver disease worldwide, which seriously threatens human health. However, at present, the treatment of NAFLD is mainly based on lifestyle intervention, and there is no ideal specific therapeutic drug. Silencing information regulator 1 (SIRT1) is a protein deacetylase found in mammalian cells. Studies have found that it can improve NAFLD liver lesions by improving peripheral insulin resistance, regulating liver fat metabolism, improving oxidative stress and mitochondrial dysfunction, and reducing inflammatory response. It is expected to become a new target for the development of NAFLD therapeutic drugs. This article summarizes the research progress of SIRT1 in the field of NAFLD as follows.

A 47-year-old male was admitted to Xiaogan Central Hospital on April 6, 2014 after taking about 150 ml of blood without obvious trigger a month ago, with chest tightness and discomfort accompanied by cough. Smoked for many years. Physical examination on admission: there was no swelling of supraclavicular lymph nodes, no deformity of thorax, clear breathing sounds in both lungs, and no dry or wet rales were heard; CT examination of the chest showed a mass shadow in the left lower lobe, with the largest transverse diameter of about 6.5 cm ×7.8 cm, lobulation at the edge, calcification inside, no enlarged lymph nodes in the mediastinum, and no abnormalities in bilateral thoracic cavities. CT-guided lung biopsy showed pulmonary salivary gland carcinoma. Left lower lobectomy plus mediastinal lymph node dissection was performed on 11 April under general anesthesia. The resected specimen was 12 cm ×10 cm ×10 cm, and a solid nodular mass with a diameter of 6.5 cm was seen on the section, which was lobulated, gray-white with gray-yellow, and medium. Under HE microscope, the tumor showed expansive growth, without clear envelope, and was located under bronchial mucosa and cartilage (FIG. 1A), partial area recidivism surrounding lung tissue; Tumor cells are mainly composed of spindle cells and round or oval cells with translucent cytoplasm. The nucleus is moderately abnormal, the nucleolus is not obvious, and the spindle cells are arranged in bundles (FIG. 1B)； It mainly forms solid, sheet-like structures, and collagen-rich fibrous stroma in some areas divides the tumor into small nest-like or beam-like structures (Figure 1C)； Squamous epithelial metaplasia can be seen to form keratinized bead structure with calcification, and coagulative necrosis can be seen in 10% of tumor areas; Mitotic images are rare (1/10 high power fields). Immunohistochemistry showed that broad-spectrum CK, Vimentin, P63, S-100, SMA, Calponin, GFAP, CK5/6 and Actin were all positive; About 5% positive for Ki-67; TTF-1, CD10, CK7, HMB45, CD56, Syn, CgA and EMA were all negative. Pathological diagnosis: (Left lower lung) myoepithelial carcinoma with no lymph node metastasis (0/18). No other special treatment was given postoperatively, and the patient was followed up for 2 months. The patient was in good condition.

Case 1, female, 75 years old. He was admitted to the hospital on August 13, 2009 because his right kidney was found to occupy space for 2 days. The patient had no low back pain, no frequent urination, urgency, painful urination and obvious macroscopic hematuria, and no positive findings in physical examination; There were no obvious abnormalities in blood routine, urine routine and blood biochemistry, and the erythrocyte sedimentation rate was: 13 mm/1 h; CT showed a type of round low-density shadow at the lower pole of the right kidney, about 45 mm ×40 mm in size. After enhancement, there was no obvious enhancement in the arterial phase and a little enhancement in the venous phase, and there was no obvious blood supply vessel shadow in it. The diagnosis was that the right kidney occupied space, and renal cancer was considered. Retrolaparoscopic radical resection of right kidney tumor under general anesthesia. During the operation, the tumor was located at the lower pole of the right kidney, slightly protruding from the surface of the kidney, with a size of about 5 cm ×4 cm ×3 cm. The capsule was still intact, in the middle of the mass, and slightly adhered to the surrounding tissues. Macroscopically, the tumor was seen as a mass at the inferior pole of the kidney, 4.5 cm ×4.0 cm ×3.0 cm in size. The section of the mass was gray-yellow-gray-white, solid and medium, close to the renal capsule and renal pelvis; Pathological examination showed that parallel and tightly arranged tubule-like spindle cells were seen in the tumor, and the cells had mild atypia; Immunohistochemistry: Cancer cells expressed CD10 negative (–), vimentin positive (+), E – cadherin (+), kidney-specific cadherin (KSP – cadherin) (–), epithelial cell membrane antigen (EMA) (+), keratin (CK) 7 focal (+), α – formyl-CoA racemase (P504S) (+), tumor proliferation antigen (Ki – 67) approximately 8% (+), CD117 (–), P53 (+). Pathological diagnosis: mucinous tubular and spindle cell carcinoma of the kidney (MTSCC). The patient was followed up for 57 months and survived well.