2018年 · 第98卷第04期

Chronic obstructive pulmonary disease (COPD for short) is one of the important chronic non-communicable diseases in China and even the world. It keeps pace with hypertension, coronary heart disease and diabetes, and ranks at the forefront of diseases with great harm to social and economic burden. The prevalence rate of people ≥40 years old in China is 8.2%^[1]It is estimated that the number of COPD patients in China is over 40 million, and due to the combined or separate effects of many factors, such as the presence of a large number of smokers, the large exposure of biofuels in rural and remote areas, and the long-term persistence of air pollution, it is predicted that the prevalence of COPD will further increase for a long time in the future. Therefore, we should actively respond to this disease that seriously endangers people's health, scientific understanding, early detection and early prevention. At the same time, we should actively develop therapeutic drugs targeting new targets and new mechanisms, as well as explore and develop new uses of drugs that have been marketed, especially to develop methods and drugs that are suitable for China's national conditions for the treatment of COPD, which are effective, safe, cheap and convenient to use.

Endocrine therapy is the main means of adjuvant and advanced treatment of hormone receptor (HR) positive breast cancer. In recent decades, endocrine therapy drugs have been continuously innovating and developing, from the earliest selective estrogen receptor modulator (SERM) drug therapy to the establishment of aromatase inhibitor (AI) era to the arrival of AI + era, the treatment model has been changing^[1]。 This article will elaborate on the progress of endocrine therapy in postmenopausal breast cancer in combination with the latest drug development and clinical research.

Chronic obstructive pulmonary disease (COPD) is an important global public health problem because of its high morbidity and mortality, great harm and heavy burden. COPD currently occupies the fourth most common cause of death in the world, and is expected to rise to the third place by 2020, and the economic burden accounts for the fifth place among all diseases^[1]。 The prevalence of COPD among people ≥40 years old in China is as high as 8.2%^[2]。 Therefore, scientific understanding, early detection, early prevention and effective, economical and standardized drug treatment are a significant and difficult challenge in clinical practice.

Cockett syndrome is the left iliac vein is compressed by the right iliac artery across its front and the long-term pushing of the fifth lumbar vertebra behind, causing intravascular proliferation, adhesion, fibrous band formation, etc., resulting in vascular stenosis or even occlusion, resulting in increased venous pressure and return obstacle in the left lower limb, and easy to form deep vein thrombosis^[1,2,3]。 The treatment of iliac vein stenosis has been mentioned in the course of treatment of Cockett syndrome with deep vein thrombosis of lower limbs. In the past, considering that left iliac vein stenosis has the function of "natural filter", which can prevent large thrombosis from falling off, we first placed a catheter for thrombolysis, and then considered balloon dilation and stent placement after the thrombosis was dissolved. It was found that the thrombolysis time was long, and the iliofemoral vein thrombosis was difficult to dissolve, so patients often needed to place two stents. Then we tried to change the surgical methods. In the first stage, we used balloon to dilate the iliac vein and place a catheter for thrombolysis, and in the second stage, we considered stent placement to compare the clinical effects of the two different surgical methods.

A 59-year-old female was admitted to hospital on July 27, 2017 because of "enlarged hands and feet, facial changes for more than 3 years, and the saddle area was found to occupy space for 5 months". Since 2014, the patient has gradually developed enlarged hands and feet, thickened joints, thickened lips, and ugly face. The shoe size has increased from 36 to 38, and the weight has increased by about 5 kg. Not treated. During the physical examination in February 2017, magnetic resonance imaging (MRI) of the head showed "sellar area occupation", and the patient went to the Department of Neurosurgery of Peking Union Medical College Hospital in July 2017. Since the onset of the disease, the spirit, appetite and sleep are good. He had been hypertensive for more than 10 years, with the highest blood pressure of 170/110 mmHg (1 mmHg =0.133 kPa). He took 2.5 mg of "Shoubishan" daily, and his blood pressure was controlled at about 120/70 mmHg. The patient reported that the younger brother's face in the family had similar changes.

A 38-year-old female was admitted to the Department of Nephrology, Peking University People's Hospital on May 18, 2017 due to "intermittent edema and fatigue of both lower limbs for 3 years". Three years ago, the patient began to have concave edema of both lower limbs, fatigue, repeated lower limb twitching, bone pain, increased foam in urine, no deepening urine color, and increased nocturia without obvious trigger. After many visits to other hospitals, the laboratory tests showed a small amount of proteinuria, renal glycosuria, hypokalemia, hypophosphatemia, hypouricemia, metabolic acidosis, hypocalcemia, renal insufficiency, iron deficiency anemia, blood alkaline phosphatase increase, immunoglobulin M (IgM) increase, anti-mitochondrial antibody subtype M2 (AMA-M2) positive, and bone mineral density examination showed osteoporosis. After treatment with acid correction, calcium supplementation, anti-osteoporosis, potassium supplementation and urinary protein reduction, the bone pain improved, but other symptoms and laboratory indexes never returned to normal. After stopping the drug, the bone pain recurred, so we came to our hospital for further diagnosis and treatment. Since the onset of the disease, the patient has no dry mouth, dry eyes, no flaky tooth loss, rampant dental caries, no swelling of the parotid and lacrimal glands, no emaciation and night sweats.

Chronic obstructive pulmonary disease (COPD) is one of the chronic diseases with high morbidity and mortality in the world. It brings a heavy mental and economic burden to individuals, families and society, and has become one of the major public health problems in the world. Therefore, it is of great significance to strengthen the prevention and treatment of COPD. A large number of clinical trials related to COPD have been carried out all over the world, among which statistical analysis methods play a very crucial role in clinical trials. In order to allow clinicians to better interpret the results of clinical trials and standardize clinical trials, so as to provide high-quality research evidence for clinical practice, the commonly used evaluation indicators and statistical analysis methods involved in clinical trials of COPD are introduced below.

Bone density is the amount of bone minerals contained in a unit area of bone, which can reflect the metabolism of human bone. Reduced bone mineral density is a common complication in patients with chronic kidney disease (CKD). It is an early stage of osteoporosis and can eventually lead to fracture^[1]。 A large number of studies have proved that fracture can increase the mortality, disability rate and social medical expenses of CKD patients. Therefore, it is very important to evaluate bone quality early to judge the risk of fracture. Bone biopsy is the gold standard for evaluating bone quality, but its application is limited because it is an invasive test and expensive. Therefore, non-invasive bone density detection is more recommended in clinic. Kidney Disease: Improving Global Outcomes (KDIGO) 2017 edition of CKD-mineral and bone Disease (CKD-MBD) guidelines^[2]It is pointed out that bone mineral density detection has predictive value for the risk of fracture in patients with advanced CKD, and it is necessary to pay attention to bone mineral density detection in patients with CKD in all stages. The causes, molecular mechanisms and detection methods of bone mineral density decrease in CKD are reviewed as follows.

The classical theory holds that Type 1 Diabetes (T1D) is a disorder of glucose metabolism caused by massive destruction of pancreatic islet β cells caused by autoimmunity, thus absolutely reducing the amount of insulin secretion. Obvious "three more and one less" symptoms and the onset of diabetic ketosis or ketoacidosis are often regarded as their typical first clinical manifestations. Once T1D patients are diagnosed, except for some patients who experience the "honeymoon period" (referring to some newly diagnosed diabetic patients who have acceptable islet function and can control blood sugar well without insulin within a few months of diabetes diagnosis, this period generally does not exceed half a year), they all need lifelong insulin therapy to maintain their lives, which seriously affects the patient's health and quality of life. Studies have shown that in the past 30 years, the incidence of T1D has increased several times. At present, the incidence of T1D in children in Europe is increasing at a rate of 3% to 5% per year. At the same time, with the in-depth research on the pathogenesis of T1D in recent years, some progress has been made in the prediction and prevention of T1D. In this paper, the latest research on T1D prediction and other aspects will be reviewed in order to provide clues for the development of T1D prediction and prevention research in China.