2017年 · 第97卷第07期

Multiple organ dysfunction syndrome (MODS) can affect almost all organs and systems of a patient, including the immune system. Immune dysfunction is not only an important component of MODS, but also immune inflammatory response disorders play a crucial role in the development of sepsis, acute respiratory distress syndrome, MODS and other critical diseases^[1]。 Studies have shown that systemic inflammatory hyperactivity and immune suppression often exist at the same time in patients with trauma and sepsis. Reflection on the failure of anti-inflammatory therapy in the treatment of sepsis and the deepening of understanding of immunosuppressive mechanisms and the proposal of persistent inflammation, immunosuppression and catabolic syndrome (PICS) make the necessity of exploring the relationship between immunity and inflammation in critical disease immune dysfunction more prominent. It has theoretical value and clinical significance for understanding the pathogenesis of immune dysfunction in critical illness and realizing precise immunomodulatory therapy under the guidance of immune function monitoring.

With the improvement of the display ability of large-scale imaging examination equipment, the problem that the anatomical structure of head and neck is subtle and complicated and difficult to display has been largely solved, and various new technologies have been introduced into the diagnosis and differential diagnosis of head and neck diseases, which can also be better used to explore the etiology of head and neck diseases.

The 53-year-old female was seen in the Third People's Hospital of Xuzhou City, Jiangsu Province in May 2013 due to upper abdominal discomfort for more than one month. Ultrasound found multiple slightly hypoechoic masses in the liver, the largest located 27 mm ×19 mm under the capsule of the left lobe. Upper abdominal CT showed multiple round low-density shadows in the liver parenchyma. The edge of the enhanced scan was slightly enhanced in the arterial phase, and the contrast medium was withdrawn in the venous phase. The lesion was low-density. The diagnostic opinion was that the liver occupied multiple mass, and metastatic lesions were considered. PET-CT examination revealed multiple intrahepatic low-density associates¹⁸Abnormally increased F-FDG metabolism, nodule in the posterior segment of the upper lobe of the right lung¹⁸F-FDG metabolism is slightly increased, and the above changes consider malignant lesions. Suspected thickening of gastric wall in prepyloric region¹⁸F-FDG metabolism is slightly increased, except malignant. To further confirm the diagnosis, he was referred to the Department of Gastroenterology, Affiliated Hospital of Xuzhou Medical University, Jiangsu Province. There were no abnormalities in hematuria, fecal routine, coagulation function, biochemistry and tumor indexes of the patient admitted to hospital. Upper abdominal magnetic resonance revealed multiple circular abnormal signal shadows in the liver, and the periphery was slightly shorter T₁Slightly longer T₂Signal shadow with a slightly longer T in the center₁Long T₂Signal shadow, some boundaries are not clear, diffusion-weighted imaging shows high signal, mild annular enhancement after enhancement, low central enhancement, and nodular enhancement locally. Chest CT revealed multiple nodules in the lungs with high suspicion of distant metastasis. Pathological biopsy under gastroscopy diagnosed as chronic inflammation of mucosa with acute inflammation,¹³C Breath test was positive, and gastric lesions were finally diagnosed as chronic pylori-positive active superficial gastritis, excluding gastric malignancy. Combined with imaging examination (Figure 1) characteristics, the possibility of hepatopulmonary metastatic tumor with unknown primary focus is not excluded. Ultrasound-guided (Philips IU-22, Netherlands) puncture biopsy of left lobe liver lesions revealed abnormal cells (FIG. 2A)。 The results of immunohistochemistry indicated that the epithelial cells were CD31 (+), CD34 (+), CK (individual +), CK19 (-), CK7 (-) and Vimentin (+). Tissue cells CD68 (+), CD163 (+). Ki-67 (2%) (Figure 2B,Figure 2C,Figure 2D)。 Combined with the results of imaging, histopathology and immunohistochemistry, the final diagnosis was liver epithelioid hemangioendothelioma with intrapulmonary metastasis. After communicating with patients and family members, they refused surgery and chose interventional treatment, so they were transferred to the Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical University.

Bisphosphonates have become the most commonly used first-line drugs in the clinical treatment of osteoporosis, which can significantly reduce the risk of osteoporotic fractures, reducing the incidence of spinal fractures by 40% ~70%, and the incidence of hip fractures by 40% ~50%. Commonly used bisphosphonate drugs in clinic include alendronate sodium, risedronate sodium, ibanphosphate sodium and zoledronic acid injection. Some adverse reactions may occur after using bisphosphonates, including gastrointestinal intolerance (nausea, vomiting, etc.), esophagitis, esophageal cancer, esophageal stenosis, jawbone osteonecrosis, arrhythmia, atrial fibrillation, atypical fracture, etc.^[1]。 Among them, atypical fractures have attracted attention in recent years, and are also the most controversial complications. They are defined as non-traumatic or low-traumatic fractures that occur in the subtrochanteric region of the femur or the femoral shaft^[2]。

sudden cardiac death (SCD) refers to unpredictable deaths induced by cardiovascular diseases in a short time. Nearly 90% of them are sudden deaths of arrhythmia type, while very few are sudden deaths of circulatory failure type. Among them, ventricular fibrillation or ventricular tachycardia are the most common. Recent studies have shown that the electrical remodeling of cardiomyocytes is the electrical basis of cardiac arrhythmia. Mitochondrial oxidative stress may cause mitochondrial dysfunction and energy metabolism disorder in cardiomyocytes by altering ion channels, thus inducing electrical remodeling, causing arrhythmia and sudden cardiac death. Therefore, this paper reviews the progress of ion channel dysfunction caused by mitochondrial oxidative stress and the development of SCD.