2016年 · 第96卷第30期

Continuous positive airway pressure (CPAP) is widely used in clinic as the first choice treatment for obstructive sleep apnea hypopnea syndrome (OSAHS), but its compliance is not ideal^[1]。 The factors affecting adherence include disease and treatment factors, and involve psychological and social factors, etc. Therefore, for each individual, a comprehensive analysis should be carried out based on the bio-psychosocial (BPS) model to propose integrated strategies for coping^[2]。 For a variety of chronic diseases, including OSAHS, integration strategies are essential for improving treatment adherence, and their efficacy, as the ancient Greek philosopher Aristotle said, "the whole is greater than the sum of its parts."^[2]。

In recent years, the outpatient clinic of pituitary-gonadal diseases in the Department of Endocrinology of Peking Union Medical College Hospital often receives such male infertility patients who are repeatedly referred but unknown in diagnosis. Their "sex hormone" levels are close to normal, and they are often diagnosed as "idiopathic male infertility". If you carefully inquire about the medical history and physical examination, it can be found that their height before puberty is significantly higher than that of children of the same age. After adulthood, they often show infertility after marriage, short stature, dark skin, small or unsmooth testicles or even nodular feeling. The levels of blood progesterone and 17-hydroxyprogesterone are high, and they are diagnosed as 21-hydroxylase deficiency (21-hydroxylase deficiency, 21OHD) after further examination.

A 60-year-old female, with intermittent cough and shortness of breath for more than 4 years, and left chest pain for 10 days, went to the outpatient department of respiratory medicine, Xiangya Hospital, Central South University on March 12, 2012. The patient developed shortness of breath without obvious trigger 4 years ago, "cold" and aggravation after activity, which can be relieved after rest, and cough gradually appeared, coughing a small amount of white or yellow phlegm. In the past 4 years, the above-mentioned symptoms have recurred, and the self-reported use of antibiotics and traditional Chinese medicine treatment (details are unknown) has no obvious effect. Ten days ago, there was no obvious trigger for left chest pain, which was pulling-like pain, which could be tolerated, and obviously aggravated after coughing and forced inhalation. The patient did not have cyanosis, fever, night sweats, anorexia, fatigue, hemoptysis, emaciation, etc. since the onset of the disease. Physical examination showed tenderness in the left chest area, but no obvious positive signs of chest were found. Chest X-ray (Figure 1) shows "interstitial lesions and infection of both lungs". High-resolution and plain-scan enhanced three-dimensional CT of lung (Figure 2) shows "enlargement of hilar and mediastinal lymph nodes in both lungs, multiple patches, cystic shadows and small nodules in both lungs, considering the possibility of proliferative lesions of the lymphatic system, lymphoma and lung cancer to be excluded". For further diagnosis and treatment, he was admitted to the respiratory department of Xiangya Hospital of Central South University on March 17, 2012.

A 72-year-old male was admitted to the hospital for "1 1/2 years after gastric cancer surgery, hard mass in the left inguinal area and pain for 3 months". One and a half years ago, the patient underwent "exploratory laparotomy + intestinal adhesion release + extended radical resection of gastric cancer + partial transverse colonectomy + partial left lateral lobectomy" in the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Sun Yat-sen University due to "gastric cancer". The postoperative pathology showed moderately-poorly differentiated adenocarcinoma of the residual stomach. The tumor invaded the left external lobe of the liver and transverse mesocolon, and 20 lymph nodes did not metastasize. The postoperative pathological stage was pT4bN0M0, stage ⅢB. The patient did not undergo chemotherapy after operation. In the past 3 months, the patient developed a mass in the left inguinal area with pain, obvious traction pain in the left inguinal area when walking, accompanied by persistent pain on the lateral side of the left femur, and mild edema of the left lower limb. Physical examination: cachexia physical appearance, no swollen lymph nodes were palpable in the supraclavicle and neck, a raised mass was seen in the left inguinal area, and the surface skin shrunk with orange peel-like changes. Palpation could see a hard cord-like mass and extend outward to the iliac fossa. The size of the mass was about 8 cm ×2 cm ×2 cm, with unclear boundary, fixed position, mild tenderness, and left testis retracted to the head. The left iliac fossa palpated with a hard mass, which was fixed and without tenderness. Mild depressed edema of the left lower limb without varicose veins. Digital rectal examination did not palpate the mass. Preoperative serum carcinoembryonic antigen (CEA): 6.17 μ g/L, CA199>1 200 U/ml. Abdominal CT (FIG. 1A，B), whole body PET-CT (Figure 1C) and MRI (Figure 1D) All examinations considered left spermatic cord metastasis, and no signs of recurrence and metastasis were seen in other parts of the abdominal cavity. Biopsy under local anesthesia was performed, and the pathology was moderately-poorly differentiated adenocarcinoma. Compared with the previous pathology of gastric cancer, the characteristics of the two were consistent. The patient received oral Tigeo chemotherapy (40 mg, twice/d) for 28 d as a course of treatment. After 4 sessions of chemotherapy, chemotherapy was discontinued due to severe toxic side effects, and at the same time, local palliative radiotherapy in the left inguinal area was received for 45 Gy. After 10 months follow-up, the lesions were stable.

A 14-year-old male developed polydipsia, polydipsia and polyuria without obvious trigger one month ago. The urine volume was roughly equivalent to the drinking water volume, and the urine color was clear. The urine specific gravity was checked at the local hospital, 1.005, Yu (-); Water-free-pressure test: 8 hours of water-free urine volume 110-330 ml/h, urine specific gravity 1.003-1.006, urine volume reduced to 15-60 ml/h, urine specific gravity 1.010-1.018 after 5 U of pituitrin administration; Considered for central diabetes insipidus income Peking Union Medical College Hospital. After admission, the relevant examinations were completed: endocrine aspects: the levels of growth hormone (GH), insulin-like growth factor 1 (IGF1), follicle-stimulating hormone (FSH), luteinizing hormone (LH), adrenocorticotropic hormone (ACTH), total blood cortisol (F), 24-h urine free cortisol (UFC), thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) were normal, and blood prolactin (PRL) was 18.14 μ g/L↑ (2.64-13.13); Serum levels of alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and β-chorionic gonadotropin (β-hCG) were normal; Blood angiotensin converting enzyme (ACE) levels were normal; Cerebrospinal fluid routine and biochemistry (-). In terms of imaging, plain pituitary scan + enhanced MRI showed that the pituitary stem was thickened, uniformly and significantly enhanced, and the T1 hyperintensity in the posterior pituitary lobe disappeared (Figure 1)； Chest high-resolution CT + enhancement showed small nodules in the lower lobe of the right lung; Thyroid ultrasound revealed diffuse thyroid lesions; Whole body bone imaging showed no abnormalities. Preliminary diagnosis: sellar germinoma. A biopsy is planned to confirm the diagnosis. Sellar area exploration by nasosphenoidal sinus approach showed tough, gray-white tumor tissue in the saddle during operation, and the blood supply was not abundant; Tumor specimens were retained by forceps for frozen pathological examination. In vivo histopathology report: a small number of tumor tissues with large amount of eosinophilic infiltration, excluding Langerhans histiocytosis "; Paraffin pathology report: lesions consistent with Langerhans histiocytosis" (Figure 2), immunohistochemistry AE1/AE3 (+), CD1a (+), Langerin (+), CD34 (+), CD68 (+), CgA (+), EMA (-), Ki-67 (index 1%), OCT3/4 (-), S-100 (+), SALL-4 (-), Vimentin (+), GFAP (-), Calretinin (-), WT-1 (-). Exact diagnosis: Langerhans histiocytosis (LCH).

Since the 1980s, the application of extracorporeal shock wave therapy (ESWT) has opened a new chapter in physical medicine^[1]Together with CT and MRI, it is known as the three new medical technologies in the 20th century. low intensity of extracorporeal shock wave therapy (LiESWT), as an effective, painless and non-invasive physical therapy, not only effectively removes urinary stones, but also promotes neovascularization and improves microcirculation^[2]Treating male erectile dysfunction (ED)^[3]Relieve chronic pain^[4]and accelerated wound repair^[5]And other aspects have been increasingly paid attention by clinical and scientific research centers at home and abroad. The successful independent research and development of "wide focal spot-low intensity" shock wave therapy instrument in China has also attracted much attention from the world. The new progress of LiESWT, represented by "wide focal spot-low intensity" shock wave therapy, in the field of urological andrological diseases medicine is introduced as follows.

Itraconazole, first synthesized in 1980, is a triazole antifungal agent whose triazole ring is located in the side chain of the molecule and is the active site of itraconazole. Itraconazole can inhibit the ergosterol synthesis mediated by membrane pigment P450 oxidase, which in turn inhibits the growth of fungi^[1]Widely used clinically for a variety of fungal infections. In recent years, it has been found that itraconazole has a variety of non-antifungal effects. Basic research has found that itraconazole has anti-angiogenesis, inhibits Hedgehog (Hh) signaling pathway, induces autophagy, upregulates the expression of hypoxia-inducible factor-1 α, inhibits mammalian target of rapamycin (mTOR), regulates cholesterol transport, inhibits P-glycoprotein, etc. Clinical studies have found that itraconazole is effective for some cancers/tumors, infections and inflammatory diseases, especially for a variety of refractory tumors. This is a systematic review of the progress in the non-antifungal effects of itraconazole associated with human diseases.