2016年 · 第96卷第31期

With the improvement of China's social and economic development level, people's quality of life has also been greatly improved. For middle-aged and elderly people, they all hope to be happy and healthy and live with dignity in their later years. Faced with the intensifying process of population aging, the consequences of the national family planning policy in the late 20th century and the continuous increase in the number of chronic diseases such as cancer patients and cardiovascular and cerebrovascular diseases, the importance of palliative care is further highlighted at present, which has also become an important direction that needs to be grasped in the reform of China's medical and health system. The core connotation of palliative care lies in attaching importance to the dignity of patients, and trying to relieve the pain of patients and meet the needs of patients' longevity through effective means.

In August 2015, the Journal of Clinical Endocrinology and Metabolism (JCEM) published a new version of the treatment guidelines for Cushing's syndrome (CS) in the United States^[1]。 Compared with the 2008 edition of the guidelines, the new edition focuses on clinical treatment. In order to help clinical work, this article mainly interprets this version of the guide from the perspective of clinicians.

Pilocytic astrocytoma (PA) is a rare and slow-growing glial tumor of the central nervous system. In 2007, the World Health Organization (WHO) classified it as Grade I astrocytoma, accounting for 2.3% of primary central nervous system tumors^[1], accounting for about 8.0% to 23.5% of children's central nervous system tumors^[2]。 PA is usually an astrocytoma with benign localized growth, rarely infiltrates the surrounding brain tissue, and rarely has malignant manifestations, such as anaplasia, meningeal dissemination, and local tumor recurrence is very rare. PA often occurs in children and adolescents, generally single, most occurs in or near the midline in the axis, the cerebellum is the most common, followed by optic pathway, hypothalamic area, diencephalon, brainstem, and adults are more common in supratentorial^[3,4]In this study, the imaging, pathology and clinical manifestations of 13 patients with intraventricular PA confirmed by surgery and pathology were retrospectively analyzed in order to improve the understanding of the disease and the accuracy of diagnosis.

fibromatosis, also known as desmoid fibroma, invasive fibromatosis, and desmoid fibroma, is a rare tumor of unknown etiology that originates from mesenchymal tissue. Intermediate tumor originating from soft tissue fascia and aponeurosis, which grows invasively and is prone to recurrence, is a benign tumor with malignant biological behavior. Foreign literature reports that the incidence rate accounts for about 3% of all soft tissue tumors and 0.03% of all tumors^[1]。 According to its onset site, it is divided into external abdominal type, abdominal wall type and intra-abdominal type. Abdominal wall fibromatosis belongs to abdominal wall type. Because this disease is easy to be misdiagnosed and the coincidence rate of preoperative diagnosis is very low, in order to improve the diagnostic accuracy, this study reviewed the ultrasound graphic data of 7 cases of abdominal wall fibromatosis confirmed by surgery and pathology in Sino-Japanese Friendship Hospital of Jilin University from 2014 to 2016, aiming to improve the diagnostic value of ultrasound for this disease.

The 42-year-old female was admitted to the First Affiliated Hospital of the People's Liberation Army General Hospital for more than 1 year due to intermittent fatigue for 6 years. The patient has been feeling weak since 2009. Because of the positive antinuclear antibody (ANA) test, the patient was given low-dose prednisone and hydroxychloroquine sulfate (HCQ) treatment according to "connective tissue disease". Since May 2014, he has voluntarily reduced urine output, positive urine protein test, ANA and anti-DS-DNA antibody, and was diagnosed as "systemic lupus erythematosus (SLE), lupus nephritis". When prednisone was increased to 20 mg once a day, the above symptoms were improved, and urinary protein did not turn negative. Several months later, the hormone was self-reduced to 10 mg once a day, and at a follow-up in August 2015, the alanine aminotransferase (GPT) was elevated (88.2 U/L) and the serum creatinine was elevated (167.6 μ mol/L). Both eyelid edema and concave edema on the back of both feet with shortness of breath after activity were found 2 weeks before admission. He was admitted to hospital at 10:00 on September 26, 2015 for further diagnosis and treatment. During the course of the disease, the patient had no fever, butterfly erythema, joint swelling and pain, dry mouth, dry eyes and acral Raynaud's phenomenon, and denied the history of repeated abortion. Increased blood pressure was found untreated 4 years ago; Six months ago, MRI of the brain revealed multiple old and subacute cerebral infarctions, which were not treated because there was no discomfort. Physical examination after admission: blood pressure 160/100 mmHg (1 mmHg =0.133 kPa), pulse 88 beats/min, breathing 19 beats/min. There was no yellowing stain in the skin and mucosa of the whole body, slight edema in both eyelids, and no abnormalities in the palpebral conjunctiva and cornea. The thorax was symmetrical without deformity, the breathing sounds of the right middle and lower lungs were weakened, and dry and wet rales were not heard. There was no lifting beat in the precordial area, the rhythm was uniform, the heart rate was 88 beats/min, and no murmur was heard in each valve area. Abdominal examination showed no abnormalities. There was concave edema below both knees, and the pulsation of the dorsal pedis artery was normal. Present tendon reflex, negative Babinsky sign. Hemoglobin was 95 g/L and platelets were 60×10 in out-of-hospital tests in the past week¹²/L. Preliminary diagnosis: SLE, lupus nephritis, chronic renal insufficiency, lupus blood system involvement, hypertension.

Bone marrow mesenchymal stem cells (BMSCs) are a kind of stem cells that exist in bone marrow with multidirectional differentiation potential and self-replication and renewal ability. In recent years, with the development of immunology and transplantation, BMSCs have become a research hotspot because of their immunological properties.

Rapid eye movement sleep behavior disorder (RBD) is abnormal sleep that occurs during REM sleep, with skeletal muscle achalasia and recurrent dream play behavior (DEB), and may be accompanied by increased tonic and/or temporal electromyographic activity during REM^[1]。 REM sleep behavior disorder is divided into idiopathic and secondary types. Multiple observational studies have shown that idiopathic REM sleep behavior disorder (iRBD) is closely related to neurodegenerative diseases associated with α-synucleinopathy, such as Parkinson's disease (PD), multiple system atrophy (MSA) and Lewy body dementia (DLB), while RBD is also superimposed with early symptoms of neurodegenerative diseases^[2]。 Therefore, early intervention and neuroprotective treatment for RBD patients are of great significance for screening, monitoring and delaying the occurrence and development of neurodegenerative diseases.

Aging is widespread in organisms and is a process of time-dependent functional degradation of organism tissues and organs^[1]。 Recent studies have found that hypothalamus, as a key structure in neuroendocrine regulation, plays a leading role in the aging process, and gonadotropin-releasing hormone (GnRH) also occupies a place in this process^[2]。