2016年 · 第96卷第01期

The 100th anniversary of the Chinese Medical Journal in 2015. In the past 100 years, this magazine has experienced ups and downs, and through the hard work of generations of sages, the magazine has developed from the initial small 32-format quarterly magazine to a large 16-format weekly magazine with 80 pages per issue since January 2005. The citation frequency and influence factors of the magazine rank among the forefront of domestic comprehensive medical journals. In the past 100 years, Chinese Medical Journal has witnessed the history of the development of medical science in China and recorded a wonderful chapter of medical development; Tens of thousands of papers reflect the changes in the disease spectrum in our country; It also shows the essence of Chinese medicine to the world.

Pituitary growth hormone (GH) adenoma causes excessive growth of soft tissue and hypertrophy of internal organs due to excessive secretion of GH, resulting in cardiovascular, metabolic and respiratory complications, which seriously affect the quality of life of patients^[1]。 Surgery is the preferred treatment. Because part of the tumor grows to the cavernous sinus, surrounds the internal carotid artery or the tumor is a huge adenoma, it is difficult to remove the tumor completely by surgery. The overall biochemical remission rate of surgery is about 60%^[1]。 Some patients cannot achieve effective biochemical control even through surgery, drugs and radiotherapy^[1]。 This study retrospectively summarizes the experience of 2 cases of pituitary refractory pituitary growth hormone adenomas in preoperative drug therapy, biochemical control and clinical symptom relief after surgical tumor reduction combined with drug therapy, which are reported below.

In 2013, the author wrote an article "IgG4-related diseases and unnamed diseases from 'non-infectious non-tumoral inflammation'", and put forward a new idea of diagnosis and treatment of difficult immune diseases such as "non-infectious non-tumoral inflammation", which triggered readers to deepen their understanding of rheumatology and immunology diseases, clinical understanding of immune inflammation, and challenges to difficult inflammatory diseases and even unnamed diseases. Clinically, many diseases are indeed related to inflammation, such as infectious inflammation, tumor inflammation, immune inflammation and physical and chemical damage inflammation. In these difficult cases, pathological examination or clinical features show "inflammation", but no specific cause can be found, and it is difficult to make a specific diagnosis. In this regard, if we grasp the pathological feature of "inflammation" and carry out screening, identification and treatment, we can often get a successful shortcut.

Following the successful application of positron emission tomography/computed tomography (PET/CT) in clinical practice, the research and development of positron emission tomography/magnetic resonance imaging (PET/MRI) has become increasingly hot. As a new multimodal imaging device, PET/MRI realizes the real-time fusion of anatomical structure and functional/metabolic/biochemical images. Compared with CT, MRI has higher soft tissue resolution, can provide image information such as function and metabolism through special sequences, and MRI has no ionizing radiation. It is especially suitable for children, pregnant women and patients who need repeated imaging examinations^[1]。 It is foreseeable that PET/MRI will show important value and unique superiority in the assessment of various pathophysiological states. This paper briefly introduces the recent progress of PET/MRI and its clinical application in recent years.

Acute respiratory distress syndrome (ARDS) is a common syndrome in the Department of Critical Care Medicine (ICU). This type of patient can benefit from mechanical ventilation, but if used incorrectly, it can also lead to ventilator-related lung injury (VILI) and increase the mortality rate. VILI not only aggravates lung lesions, but also causes a systemic inflammatory response that leads to involvement of extrapulmonary organs^[1]。 Ventilation mode, ventilation time, tension (pressure and volume) produced by ventilation, and the cause, time, degree of lesion and underlying disease of lung injury were all related to VILI^[2]。 Studies have demonstrated that a protective pulmonary ventilation strategy with low tidal volume/low plateau pressure and appropriate positive end-expiratory pressure (PEEP) can reduce the incidence of VILI and improve survival in patients with ARDS^[3,4,5]。 However, other research results in recent years have also raised questions about existing protective lung ventilation strategies.

With the development of vascular imaging technology, the detection rate of unruptured intracranial aneurysms (UIAs) has increased significantly. UIAs refers to aneurysms that have no history of ruptured bleeding or are not directly related to bleeding, including asymptomatic aneurysms found accidentally, unruptured aneurysms among multiple aneurysms, etc.^[1]。 Once detected, the problem for clinicians is to assess the risk of rupture and develop individualized management strategies. Currently, the management protocol of UIAs includes: conservative observation and surgical intervention. However, most UIAs have no positive clinical symptoms, so the risk of aneurysm rupture and the advantages and disadvantages of surgery should be carefully weighed when making decisions.