2017年 · 第97卷第44期

Serum thyroid-stimulating hormone (TSH) levels exceed the upper limit of the normal reference range, and free thyroxine (FT₄) and is often defined as subclinical hypothyroidism (SCH). Clinical work found that TSH levels in some SCH patients were still higher than normal after thyroxine replacement therapy, but these patients did not have pituitary TSH tumors and other causes^[1]； Other patients with SCH could return to normal TSH levels without replacement therapy. So, what are the causes of elevated TSH levels in these patients? For elevated TSH levels and FT₄Should patients within the normal range be managed differently based on different reasons? Should the concept of simply elevated serum TSH (ITE) be independent of SCH? Based on the above questions, this paper expounds the recent research progress on the regulatory mechanism of hypothalamus-pituitary-thyroid (HPT) axis, the epidemiological study of serum TSH elevation, and the relationship between TSH elevation and aging, obesity and sleep disorders, aiming at exploring the differential diagnosis and related management strategies of ITE and SCH.

Lichen sclerosus atrophic (LS) is a chronic skin disease mediated by inflammatory cells with unknown etiology. It occurs around the anus and genitals. It is more common in women and less common in men. There are two peaks of incidence in men, namely, old age and prepuberty. However, LS in children has been neglected by clinicians for a long time, and there are few reports on LS in boys' external genitals in China^[1]。 This study was intended to explore the single-center clinical experience of external genital LS in children.

A 51-year-old female was admitted to the hospital on February 27, 2015 due to "repeated coughing and wheezing for more than 1 year and recurrent aggravation for 10 days". I complained of cough without obvious trigger in October 2013, showing paroxysmal dry cough, wheezing, obvious at night, and speech cannot be continuous in severe cases. He visited the local hospital many times, and the pulmonary function test showed moderate obstructive ventilatory dysfunction, bronchodilatation test and challenge test were positive, and the absolute value of eosinophils (EOS) was (3.77~6.44) ×10⁹/L. Once diagnosed with "bronchial asthma" (abbreviated as asthma), intravenous glucocorticoids (abbreviated as hormones) and other treatment, the symptoms can improve. In the past year, I have been regularly inhaling salmeterol/ticasone powder inhalation (50 μ g/250 μ g) or budesonide/formoterol powder inhalation (160 μ g/4.5 μ g), but the control is not good. I was hospitalized more than 10 times repeatedly, and I can improve quickly after every systemic application of hormones. Ten days ago, the patient's symptoms recurred and worsened, accompanied by rash and itching on the back, and gradually appeared numbness at the fingertips of both upper limbs. The clinic admitted to our department with "asthma". Since the onset of the disease, occasional fever, no obvious weight loss, no joint pain and mucosal ulcer. No special past history, no history of drug and food allergies.

A 55-year-old female was admitted to hospital on March 14, 2016 due to low back pain for more than 4 years, lymph node swelling for 5 months and fatigue for 1 month. At the end of 2011, the patient developed low back pain without obvious trigger, radiating to the right lower limb, without fever, dizziness, fatigue, epistaxis, etc., and denied that masses could be palpable on the body surface. MRI of lumbar spine performed in other hospitals showed abnormal metabolism of lumbar 3 vertebrae, and metastasis of malignant lesions was not considered. Monoclonal immunoglobulinemia was considered after blood and bone marrow tests (details unknown) and was not treated. By October 2012, blood routine showed mild anemia (details unknown), and immunofixation electrophoresis IgM κ (+). Bone scans showed no significant abnormalities. Bone marrow smear showed that plasma cells accounted for 14.5%, showing lymphoid cells, irregular cell bodies, round nuclei, fine chromatin, little plasma volume, and some flame color. Flow cytometry analysis: 7.13% cells expressed CD20, CD19, κ; Partially expressing CD25, CD103, CD38; It does not express CD5, CD10, CD23, λ, FMC7, IgM, CD11c, CD138, CD56, and is a malignant monoclonal mature B cell. 0.4% of the cells expressed C κ, CD138 and CD19, some expressed CD38, but not C λ and CD56, which were monoclonal plasma cells. Bone marrow biopsy showed that more than 90% were lymphoid cells, local mild hyperplasia of fibrous tissue (+), immunohistochemistry: CD28 (-), CD138 (+), CD79 α (+ + +), CD19 (-), CD20 (+ + +), κ (-), λ (-), IgM (+), IgG (±), PAX-5 (+). Waldenstrom's macroglobulinemia (WM) is considered. From January to April 2013, CP regimen chemotherapy was administered four times, specifically cyclophosphamide 1.2 g on day 1 and prednisone 60 mg on days 1 to 5. After chemotherapy, IgM κ (+) was still observed after reexamination of immunofixation electrophoresis. Considering the poor treatment effect, bortezomib + dexamethasone regimen chemotherapy was performed once on April 24, 2013 (details unknown). Self-reported that after reexamination of immune fixation electrophoresis, it turned negative, and did not see a doctor again. By October 2015, the patient had left neck and supraclavicular lymph node enlargement without obvious trigger. Blood routine showed that hemoglobin (Hb) was 107 g/L, and the rest was normal. β 2 microglobulin (β 2-MG) 2.78 mg/L. Cervical lymph node biopsy was performed considering non-Hodgkin's B-cell lymphoma, low grade, predisposing to marginal zone B-cell lymphoma, immunohistochemistry: CD3 (-), CD20 (+), Ki-67 index 30%, κ scattered (+), λ scattered (+), CD138 (-), CyclinD1 (-), Bcl-6 (+), Bcl-2 (+), CD10 (-), CD38 (-), CD5 (-). Not treated. By March 2016, the patient experienced fatigue, significantly decreased activity tolerance, and again experienced right lumbar pain radiating to the right lower limb with numbness. No fever, night sweats, epistaxis, syncope, blurred vision, hearing loss, etc. Blood routine white blood cell count (WBC) 2.92×10⁹/L, Hb 61 g/L, platelet count (PLT) 75×10⁹/L. β 2-MG 5.4 mg/L. Abdominal enhanced CT revealed multiple lymph node enlargement in retroperitoneum, pelvic cavity and groin. The right iliac vessel running area occupies the space, considering the possibility of enlarged lymph nodes. Admitted to hospital for further treatment.

Hematopoietic stem cell transplantation (HSCT) has undergone more than 60 years of development, from initially bringing high mortality to an effective treatment for malignant diseases. Symptom improvement in autologous and allogeneic HSCT patients in recent years has benefited from improvements in supportive care and HSCT techniques^[1]Long-term postoperative survival is increased, and its late complications such as osteoporosis caused by osteopenia are receiving increasing attention. Osteoporosis is a disease with fragile fracture as a clinical symptom caused by bone mass loss, and this review includes bone mass loss mechanisms, bone mass loss after autologous HSCT, bone mass loss after allogeneic HSCT, bone mass loss after HSCT in children, and prevention and treatment of such complications.

Multiple myeloma (MM) is a hematopoietic malignant tumor with abnormal plasma cell proliferation and infiltration as the main clinical features. Recent studies have found that MM cells cause changes in the bone marrow microenvironment through complex gene and epigenetic abnormalities, thus affecting the clinical progress of the tumor and directly affecting the prognosis of patients^[1]。

Breast cancer is currently the number one malignant tumor that threatens women's health. There are about 270,000 new breast cancer patients in China every year, and about 70,000 deaths^[1]The median age of onset was 45 to 55 years old^[2]。 Even in early-stage patients who have received standard treatment, 30% to 40% are still at risk of recurrence, and the 5-year survival rate of recurrent metastatic breast cancer is only 20%^[3]。

From August 25 to 27, 2017, the 12th National Clinical Forum on the Diagnosis and Treatment of Helicobacter Pylori and Digestive Diseases and the First National Summit Forum on the Integration of Traditional Chinese and Western Medicine of Helicobacter Pylori and Gastrointestinal Ecology were successfully held in Beijing. This forum is co-sponsored by Beijing Branch of Chinese Medical Association, Chinese Medical Journal of Chinese Medical Association, Peking University First Hospital, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University and China Helicobacter Pylori Information Center. Academician Fan Daiming, President Ke Yang, President Jin Dapeng, Director Chen Xinshi and Professor Zhang Shengsheng attended the opening ceremony and highly praised the forum. Professor Hu Fulian, chairman of the conference, pointed out at the opening ceremony: With the support of experts, the National Clinical Forum on the Diagnosis and Treatment of Helicobacter Pylori and Digestive Diseases has reached its 12th session and made many achievements. At the same time of this forum, the First National Summit Forum on the Integration of Traditional Chinese and Western Medicine with Helicobacter Pylori and Gastrointestinal Ecology was established. On the original basis, it gave full play to the advantages of the integration of traditional Chinese and western medicine, joined hands, explored, innovated, seeked truth, and continued to deepen, entering a new stage.