Volume 96  ·  Issue 22  ·  2016

Integration is the characteristic of the development of the times, and it is also a magic weapon to solve epoch-making problems. Medicine has experienced rapid development for thousands of years, especially in recent decades, and has made great contributions to human health. However, with the changes of nature, society and environment and mankind's pursuit of survival, longevity and health, coupled with the detailed planning and refinement of specialties, the fragmentation of medical knowledge has a double-edged sword impact on the development of medicine, and medicine has also encountered unprecedented problems. As medical historian Roy Porter wrote in Cambridge History of Medicine in 2000: "In the Western world, people have never lived so long or so healthy, and medicine has never been so successful, but paradoxically, medicine has never attracted more intense suspicion and dissatisfaction than it is today." Human beings must review and summarize the history of medical development, and at the same time put forward the direction and road of future medical development. Therefore, the concept and practice of Holistic Integrative Medicine (HIM) came into being^[1]。

Patients with advanced breast cancer (ABC) have their own particularities in the choice of treatment options and efficacy, and there is still a lack of recognized standard treatment options. How to help patients make correct treatment choices is the challenge faced by every oncologist. The overall median survival of patients with advanced breast cancer is 2 to 3 years, and the situation varies between molecular subtypes. For patients with human epidermal growth factor receptor 2 (HER2) -positive advanced breast cancer, anti-HER2 therapy altered the natural course of HER2-positive breast cancer and significantly prolonged survival; However, for patients with triple-negative advanced breast cancer, the overall prognosis has not improved significantly; In addition, for the most common hormone receptor (HR) -positive advanced breast cancer patients, a variety of therapeutic drugs have been added in recent years, such as fulvestrant, CDK4/6 inhibitors, etc.^[1,2]。 In 2016, under the advocacy of the Breast Cancer Professional Committee of China Anti-Cancer Association, domestic experts in breast cancer pathology and imaging diagnosis and treatment analyzed, summarized and discussed the research data of advanced breast cancer treatment at home and abroad. After repeated discussions and many revisions, the "Chinese Expert Consensus on Clinical Diagnosis and Treatment of Advanced Breast Cancer 2016" was formulated. It should be emphasized that this consensus is a diagnosis and treatment recommendation for application in China, and each region may need to make necessary adjustments according to the basic principles of modern oncology, that is, multidisciplinary and individualized comprehensive treatment based on the particularity of advanced disease and the individual differences of each patient.

To clarify the specific target of severe aplastic anemia (SAA) immune attack via identifying the target cells of cytotoxic T cell attacks and the expression of apoptosis ligand on each department and each stage of bone marrow hematopoietic cells.

A total of 15 SAA patients and 15 normal controls were recruited in the Department of Hematology, Tianjin Medical University General Hospital between March 2011 and March 2012. Factor associated suicide(Fas) protein expression of CD34⁺ , CD14⁺ , CD33⁺ , and GlycoA⁺ cells in bone marrow was detected by flow cytometry. The CD8⁺ T cells of SAA patients and CD3^- bone marrow mononuclear cells (BMMNC) of controls were sorted by immunomagnetic separation and co-cultured for 72 hours. The apoptosis rate of CD34⁺ , CD14⁺ , CD33⁺ , and GlycoA⁺ cells were measured with flow cytometry.

The expression of Fas protein in CD34⁺ cells in SAA patients (46.59%± 27.60%) was significantly higher than that in control group (8.89%±7.28%, P<0.01). The expressions of Fas protein in CD14⁺ , CD33⁺ and GlycoA⁺ cells in SAA group(29.29%±9.23%, 46.88%±14.30%, 15.15%±9.26%) were lower than those in control group(51.25%±38.36%, 72.06%±39.88%, 50.38%±39.88%, all P<0.05). The apoptosis rates of CD34⁺ , CD33⁺ and CD14⁺ cells in the experimental group (CD8⁺ T cells of SAA patients co-cultured with CD3^- BMMNC of controls: 55.43%±20.50%, 38.13%±20.10%, 61.87%±21.65%)were significantly higher than those of the control group (CD8⁺ T cells of controls co-cultured with CD3^- BMMNC of controls: 35.02%±13.95%, 23.44%±10.33%, 37.04%±22.41%, all P<0.05).

Cytotoxic T cells in SAA patients may have a killing effect on hematopoietic stem/progenitor cells, and granulocytic and macrophagocytic cells from normal bone marrow. Moreover, Fas/Fas ligand-mediated apoptosis may play an important role in the immune pathogenesis of SAA. CD34⁺ cells show markedly increased Fas protein expression, which may be the main target cells in the process of immune injury in SAA patients.

To investigate the clinicopathological characteristics of 4 subtypes of breast cancer, Luminal A, Luminal B, human epidermal growth factor receptor 2(HER2), triple-negative and their associated prognostic factors.

The clinical characteristics and prognosis of 102 patients with breast cancer who treated in Wuhan University Renmin Hospital from January 2011 to November 2012 were retrospectively analyzed.

The proportion of each subtype was Luminal A 27.5%, Luminal B 35.3%, HER2 14.7%, and triple-negative 22.5%. The age range was from 22 to 75 years old, with median age of 48.0 years old. All patients underwent surgery and 98 cases were also treated with chemotherapy/endocrine+ Herceptin therapy (96.1%)after surgery. The tumor size, histological grade, and lymph node metastasis had significant difference in different subtypes of breast cancer (P<0.05). Further analysis showed the proportion of HER2 tumor≤2 cm (4, 26.7%)had a tendency of smaller than that in luminal A(20, 71.4%) or triple negative(16, 69.6%) (P=0.009>0.008,P=0.019>0.008). Histological Ⅲ grade proportion in patients with HER2 subtype (8, 53.3%) was in greater tendency than that with Luminal A subtype(23, 82.1%) (P=0.039>0.008). The proportion of patients with no metastatic lymph nodes in triple negative subtype(7, 30.4%) had a tendency of smaller than that in HER2 subtype(7, 46.7%) or Luminal B subtype(17, 47.2%)(P=0.019>0.008,P=0.016>0.008). There were no significant differences in age of onset, menstruation status, operation, family cancer history, and the risk of recurrence and metastasis in different subtypes (P>0.05). In Luminal A subtype, three-years overall survival rate was 100%, and one-, two-, three-year event-free survival rate were all 92.9%. In Luminal B subtype, three-year overall survival rate was 100%, event-free survival rate at one-, two- and three-year were all 97.2%. In HER2 subtype, three-year overall survival rate was 100%, one-, two- and three-year event-free survival rate were 100%, 100%, and 93.3%, respectively. The 1, 2, 3 years overall survival rate of triple-negative subtype were 100%, 95.7%, and 95.7%, respectively. One-, two- and three-year event-free survival rate of triple-negative subtype were 95.7%, 91.3%, and 90.0% respectively. Whether triple negative subtype, recurrence risk, age of onset, menstrual status, tumor size, histological grade, lymph node metastasis, surgery, breast cancer or other family history of cancer were not significantly related with three-year event-free survival rate (P>0.05).

Luminal subtype had the largest proportion and better prognosis. The proportion of tumor >2 cm and histological grade Ⅲ in patients with HER2 subtype was larger, and three-year event-free survival rate of this patients was lower. Triple-negative subtype had a greater tendency of lymph node metastasis and the lowest three-year event-free survival. Tumor size, histological grade and lymph node metastasis may be the important factors for the prognosis of breast cancer.

To evaluate the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in stage Ⅰ and stage Ⅱ of sarcoidosis.

There were 55 patients of sarcoidosis selected from January 2012 to October 2014 in the First Affiliated Hospital of Soochow University. The diagnostic positive rate and the positive rate in stage Ⅰ and Ⅱ patients with sarcoidosis through EBUS-TBNA, conventional transbronchial needle aspiration (cTBNA), endobronchial biopsy (EBB) combined with transbronchial lung biopsy (TBLB) were calculated. The positive rate of single lymph node puncture and the positive rate of different size of lymph node were compared. The difference of the positive rate of lymph nodes in different stations was checked. By calculating the diagnostic yield of EBUS-TBNA in sarcoidosis patients, the practicality and safety of EBUS-TBNA in diagnosing stage Ⅰ or stage Ⅱ sarcoidosis was assessed.

Among 55 patients, 46 patients obtained positive results through EBUS-TBNA or cTBNA. There were 18 patients who had only received EBUS-TBNA among a total of 55 patients diagnosed with sarcoidosis, positive results appeared in 17 cases, while cTBNA was 9/15. There were 20 cases diagnosed in which both had EBUS-TBNA and cTBNA. The diagnostic rate of cTBNA combined with EBB and TBLB was 25/26, while combined with EBUS-TBNA was 21/21. Totally 90 lymph nodes were punctured by EBUS-TBNA, in which 65 lymph nodes got the positive results (65/90) while 49 lymph nodes got the positive results by TBNA in 93 punctured lymph nodes (49/93). The diagnostic positive rate in the lymph nodes with a short diameter ≥2 cm was 33/37 by EBUS-TBNA, while it was 12/19 in those whose short diameter 1-<2 cm. By cTBNA, the diagnostic positive rate was 15/26 and 11/28. No serious adverse events occurred.

The diagnosis of sarcoidosis in stage Ⅰ and stage Ⅱ by EBUS-TBNA is safe and effective, while choosing the most noticeable swelling lymph node to puncture is recommended. Combining the EBUS-TBNA with traditional bronchoscope technology can obtain a further higher diagnostic efficiency.

To verify the reliability and feasibility of Hoffmann method in establishing pediatric reference intervals (RI) of erythrocyte count.

Three hundreds and ninty-two thousands of hospital-based data for erythrocyte count of children aged in 1 to 17, measured by the Sysmex Xs-800i, was collected from Beijing Children's Hospital during January to December 2014. Outliers were removed using the Dixon method, then Hoffmann method was conducted to establish the gender and age stratified pediatric RIs of erythrocyte count. The erythrocyte count of 2 217 healthy children, recruited from Beijing Children's Hospital and Liaocheng Children's Hospital in Shandong province, was conducted as normal reference to verify the reliability of Hoffmann method in establishing RIs and to compare with existing RIs.

In 4 subgroups as following, male aging 1 to 12 years, male aging 13 to 17 years, female aging 1 to 12 years, female aging 13 to 17 years, the RIs of erythrocyte count established using Hoffmann method were (4.1-5.4)×10¹²/L, (4.4-5.7)×10¹²/L, (4.0-5.3)×10¹²/L, (4.0-5.3)×10¹²/L, respectively. The verification results in 2 217 healthy children showed that the proportions of out of range in four subgroups were 6.17%, 8.81%, 6.22%, 7.78%, respectively.

Hoffmann method produce reliable RIs according with the actual situation in healthy children, which is also convenient and is worth popularizing in clinical practice.

To investigate the clinical significance of the three-step approach in laparoscopic hemihepatectomy.

A total of 32 patients received laparoscopic hemihepatectomy with the three-step approach in Yijishan Hospital affiliated to Wannan Medical College between Aug 2013 and Oct 2015. All patients underwent thin slice CT scan and hemihepatectomy was imitated with the imagic explorer, preoperatively. The vessel distribution was observed at the section and the three-step approach was used in the hemihepatectomy. Pre- and post-operative data were collected and analyzed retrospectively.

The length of middle hepatic vein (MHV) was (59.1±12.9) mm and the number of branchs to the left and right lobe were 3.07±0.78 and 3.11±0.64 respectively. The distance between the first branch of MHV and the diaphragmatic surface was (28.07±3.74) mm and the distance between MHV and the visceral surface was (14.4±4.3) mm. The laparoscopic surgeries (left hemihepatectomy in 28 and right hemihepatectomy in 4) were performed successfully in all cases with the three-step approach, without any conversion to the open surgeries. The operation time was (165±42) min in left hemihepatectomy and (305±50) min in right hemihepatectomy. The intraoperative blood loss was (242±65) ml in left hemihepatectomy and (695±122)ml in right hemihepatectomy. All the patients recovered well without severe complications except for bile leakage in 3 patients who were cured with drainage. The postoperative hospital stay was (7.96±1.8) d.

the distribution of vessel is regional at the section of hemihepatectomy and the three-step approach based on this feature is safe and effective in laparoscopic hemihepatectomy, which can shorten the operation time and reduce the difficulty of operation.

To compare two different regimens of continuous ultrasound-guided fascia iliaca compartment block (FICB) for postoperative analgesia after total hip arthroplasty (THA).

Approved by the Peking University Third Hospital ethics committee, sixty patients undergoing selective single total hip replacement in Peking University Third Hospital from May.2015 to Mar.2016 were included. Before neuraxial block, continuous ultrasound-guided FICB were administered. Patients were randomly divided into the continuous infusion group(n=30) and the automated intermittent boluses group(n=30). 10 ml/h of 0.2% ropivacaine was continuously infused for 48 hours in the continuous infusion group. 10 ml of 0.2% ropivacaine was automated injected every 60 mins in the automated intermittent boluses group. Numerical Rating Pain Scale(NRPS)was used to assess pain intensity at 4, 8, 12, 24, 36, 48 h after block at rest and during functional exercise. The usage of pethidine postoperatively, the incidence of opioid related adverse effect and patient satisfaction scores at 48 h were also recorded.

The pain score at rest 8, 12, 24, 36 h of the automated intermittent boluses group were 2 (1-3), 2 (1-3), 2 (1-3), 2 (1-3) score, which were lower than the continuous infusion group: 4 (2-6), 3 (2-5), 4 (3-5), 2 (1-4) score, the differences were statistically significant (Z=-6.493, -6.267, -6.235, -3.244, all P<0.05). The pain score during active and passive functional exercise at 8, 12, 24, 36 h of the automated intermittent boluses group were 4 (3-5), 4 (3-5), 2 (1-3), 1(0-3) score, which were lower than the continuous infusion group: 6 (4-7), 5 (4-7), 4 (2-6), 4 (2-5) score, the differences were statistically significant (Z=-6.499, -6.499, -5.081, -6.667, all P<0.05). The usage of pethidine postoperatively and the incidence of opioid related adverse effect of the automated intermittent boluses group were 10.0% and 3.3%, which were lower than the continuous infusion group: 33.3% and 26.7% , the differences were statistically significant (χ²=5.057, 4.500, all P<0.05). Patient satisfaction score at 48 h of the automated intermittent boluses group was (8.3±0.7)score, which was higher than the continuous infusion group: (7.4±0.7)score, the difference was statistically significant (t=-5.632, P<0.05).

Both regimens can provide effective analgesia after total hip arthroplasty. Compared with the continuous infusion group, the automated intermittent boluses group for continuous fascia iliaca block can provide better analgesic effect , with less remedial analgesia.

To study the clinical, histopathological and therapeutic features of Sweet syndrome with myelodysplastic syndrome (MDS).

The clinical data of 3 patients with Sweet syndrome and MDS diagnosed at Peking Union Medical College Hospital between October 1988 and November 2015 were reviewed. The laboratory test results, histopathological findings, and therapeutic regimens of these patients were analyzed retrospectively.

The three cases were 29, 49 and 49 years old, respectively, including 2 females and 1 male. Two patients presented with Sweet syndrome before the onset of MDS, the other one patient developed Sweet syndrome and MDS simultaneously. The rash of all of these patients manifested as red painful papules in face, trunk and limbs, as well as edematous plaques and nodules. Histopathological examination of skin confirmed the diagnosis of Sweet syndrome. Complete blood count showed cytopenia of at least one lineage. Bone marrow cytology showed dysplasia of hematopoietic cells with abnormal high proportion of myeloblasts. Bone marrow pathology results were normal in 2 patients, while hypoplasia of hematopoietic tissue with excess adipose tissue was found in 1 patient. All the patients were treated with corticosteroid or immunosuppressants and skin lesions alleviated. But relapse was common in process of corticosteroid reduction.

Sweet syndrome may be a precursor of MDS. The clinical manifestations, histopathological and hematological findings of these rare cases are characteristic. Corticosteroid indicates short-term response. The patients who had recurrent skin lesions should be further examined to exclude MDS.

To evaluated the 3 sedation regimen for patients with septic shock.

The randomized controlled trial wan conducted. Forty-five patients with septic shock were assigned to 3 groups (midazolam group, propofol group, and dexmedetomidine group) randomly. The basic characteristics of patients, the duration of mechanical ventilation, the length of stay in the ICU, the death rate for 28 days and the regulatory cell (Treg) in peripheral blood were observed. The control group for Treg test was consisted of 20 healthy volunteers.

There were no significant differences between the groups in the death rate for 28 days and the duration of mechanical ventilation. The length of stay in the ICU in dexmedetomidine group was shorter than that in midazolam group(15.21±5.55 vs.19.67±5.7 days, P<0.05). The Treg of 3 groups was higher than that of control group (11.82±4.93 vs.3.69±1.71, 11.30±3.42 vs. 3.69±1.71, 12.83±6.17 vs. 3.69±1.71) at the first day of ICU. The Treg after 3 ICU days in dexmedetomidine group and the Treg after 5 ICU days in propofol group and in midazolam group have no difference with control group.

For the patients with septic shock, dexmedetomidine could decrease the length of stay in the ICU and the duration of immune suppression.

To investigate expression changes and role of Gα11 protein in the processes of muscularization of non-muscular pulmonary arterioles and effect of sildenafil intervention in rats with pulmonary arterial hypertension (PAH).

Thirty SD rats were randomly divided into three groups, including normal control group, monocrotaline (MCT) group and sildenafil group; PAH model was prepared with 50 mg/kg MCT treatment for 4 weeks in the MCT group, and these rats were treated by 25 mg/kg sildenafil for 2 weeks after PAH formation in the sildenafil group, and the normal control group were treated with the equal amounts of physiological saline instead of monocrotaline; pulmonary artery pressure was measured with jugular vein catheterization; hematoxylin and eosin (HE) staining method was used to detect the pulmonary arteriolar morphology and vascular tissue parameters; expression of the target Gα11 protein, vascular smooth muscle marker osteopontin (OPN) and proliferation marker proliferating cell nuclear antigen (PCNA) was detected by Western blot.

Pulmonary artery mean pressure (mPAP), non-muscular pulmonary arterioles wall thickness index (TI) and area index (AI) of the MCT group were higher than those of the normal control group[(27.43±3.97) vs (11.93±1.52) mmHg (1 mmHg=0.133 kPa), 0.49±0.07 vs 0.31±0.09 and 0.74±0.05 vs 0.45±0.10](all P<0.05), and meanwhile the expression levels of Gα11 and the related proteins including OPN and PCNA were significantly enhanced. mPAP, TI and AI[(18.59±1.44) mmHg, 0.39±0.09 and 0.56±0.04]of the sildenafil group were all lower than those of the MCT group (allP<0.05), and furthermore, expressions of Gα11, OPN and PCNA also reduced in line with these changes.

Gα11 protein plays a role in the development of PAH and pulmonary non-muscular arteriole muscularization, and sildenafil effectively suppresses PAH and pulmonary vascular remodeling by inhibiting Gα11 expression.

To investigate the characteristics and outcomes of necrotizing enterocolitis (NEC) in Chinese term infants population.

A national neonatal necrotizing enterocolitis network was established. Neonates as having necrotizing enterocolitis with gestation age ≥37 weeks were identified if they met the accepted diagnostic criterion during the study period from Jan 1^st 2011 to Dec 31^st 2011. The data of maternal and neonates' characteristics, the comorbidities, the clinical interventions prior to NEC, the clinical courses and radiology results, the medical and surgical treatment and the outcomes were collected. SPSS 19.0 software was used to do statistic analysis. Logistic-regression models were used to analyze the risk factors for death in infants with NEC, odds ratio (OR) and 95% confidence interval (CI) were calculated.

There were 231 067 newborn infants, 164 307 of them were term infants, admitted to 95 hospitals in main land China. There were 718 term infants were diagnosed as necrotizing enterocolitis with the incidence of 0.44%. There were 294 term infants cases identified as ≥stage 2 necrotizing enterocolitis for the analysis, including 193 cases of stage 2 and 101 cases of stage 3.The mean gestation age was (39.0±1.3) weeks, and the mean birth weight was(3 087.4±548.3)g. The percentage of small for gestation age was 20.4%. The onset age of NEC was 5 (2-11)d. The percentage of cases received breast milk feeding was 23.7%. The most common comorbidities were sepsis (9.5%, 28/294), asphyxia (9.5%, 28/294), pneumonia (7.8%, 23/294) and congenital megacolon (7.5%, 22/294). The bowel perforation rate was 13.9%. The rate of cases who received surgical treatment was 25.2%(76.6% small intestinal necrosis and 65.8% small intestinal perforation). The mortality rate was 28.9%(the mortality rate were 20.7% and 44.6% in stage 2 and stage 3 NEC, respectively). Noninvasive continuous positive airway pressure treatment for NEC (OR=5.278, 95% CI: 2.058-13.533, P<0.01) and NEC staging 3 (OR=3.156, 95% CI: 1.766-5.642, P<0.01) were statistically significantly associated with mortality of NEC.

The term infants with necrotizing enterocolitis usually have the underlying comorbidities. The breastmilk feeding rate is low. Necrotizing enterocolitis remains high mortality in term neonates in Chinese neonatal units. Noninvasive continuous positive airway pressure treatment for NEC is statistically significantly associated with mortality of NEC.

This study aimed to evaluate the safety and efficacy of preoperative induction therapy using a single high dose (9 mg/kg) of antithymocyte globulin-Fresenius S (ATG-F) for patients undergoing renal transplantation.

Randomized controlled clinical trials (RCTs) on the safety and efficacy of preoperative induction therapy using a single high dose of ATG-F for patients undergoing renal transplantation were searched in Cochrane Library, PubMed, EMBASE covering a period from the beginning of databases to July 2015. The meta-analysis was conducted using RevMan 5.2.

Five RCTs with 346 patients were included in this study. The meta-analysis showed that the incidences of acute rejection for the patients with renal transplantation were 20.6% (37/180) in the induction therapy group using a single high dose of ATG and 42.8% (71/166) in the control group, with a combined relative risk (RR) of 0.49 and 95% confidence interval (CI) of[0.36, 0.69](P<0.000 1). The patient survival rate (1 year:RR=1.02, 95% CI[0.98, 1.06], P=0.43; 5 years: RR=1.01, 95% CI[0.94, 1.08], P=0.83) and the graft survival rate (RR=1.04, 95% CI[0.97, 1.12], P=0.24) of the two groups were similar. The incidences of CMV infection, urinary tract infection, and malignant tumor were also similar in the two groups.

The induction therapy using a single high dose of ATG-F significantly reduced the incidence of acute rejection after transplantation and showed no increased incidence of urinary tract infection, CMV infection, or malignant tumor. The results of our meta-analysis suggest that the application of a high dose of ATG-F may be a safe and effective induction therapy.

glutaric aciduria type Ⅰ (GAⅠ) is a rare autosomal recessive disease^[1]It is an organic acid metabolism abnormality disease caused by a pathogenic mutation of a gene encoding glutaryl-CoA dehydrogenase (GCDH) localized on chromosome 19, resulting in a change in its activity. More than 200 types of gene mutations have been reported^[2]。 The incidence of glutaric acidemia is about 1/100,000 reported in foreign literature^[3]Domestic studies have reported that the incidence of GAⅠ is 1/64 708^[4]。 The clinical manifestations of glutaric acidemia are obviously heterogeneous^[5]Which are characterized by macrocephaly, brain atrophy, and acute dystonia secondary to striatal degeneration just after birth or shortly after birth. Macrocephaly is its earliest clinical symptom^[6]。 The disease can be treated with a protein-restricted diet, vitamin B12 supplementation, and carnitine supplementation. Most patients can improve their clinical symptoms to varying degrees after treatment. In this study, the gene mutation of GCDH gene was detected in 3 patients with glutaric acidemia who attended the prenatal diagnosis center of our hospital, which is reported below.

A 56-year-old male was admitted to the hospital mainly because of "cyanosis of extremities exposed to cold for 14 years, splenomegaly for 8 years and bone pain for 20 days". Since 1998, the patient has developed cyanosis of fingers, nose tips and earlobes when exposed to cold. Multiple examinations in other hospitals revealed "mild anemia", which was not treated. In 2004, splenomegaly was accidentally discovered, without fever, night sweats, rash, weight loss and other discomfort. B-ultrasound examination in another hospital showed "moderate spleen enlargement", positive anti-human globulin test (Coombs test) (+), negative autoantibody (-), and no special treatment was given. At the end of 2011, the patient intermittently experienced abdominal fullness and dull pain in the left abdomen, and the spleen showed an increasing trend when monitored by abdominal ultrasound. In mid-to-late October 2012, the patient developed pain at the shoulder end of the left clavicle without obvious trigger, which was persistent, with limited uplift and abduction of the upper limb, accompanied by night sweats, and no fear of cold, fever, weight loss, fatigue and other discomfort. Visited the outpatient clinic of our hospital, and routine blood test: white blood cell count (WBC) 12.2×10⁹/L, neutrophil percentage (NEUT%) 0.404, lymphocyte percentage (LY%) 0.544, hemoglobin (HGB) 92 g/L, mean erythrocyte volume (MCV) 93.9 fl, mean erythrocyte hemoglobin content (MCH) 29.5 pg, platelets (PLT) 143×10⁹/L; Reticulocyte percentage (RET%) 0.035. Fecal routine + occult blood normal. Liver function: total bilirubin (TBil) 33.8 μ mol/L, direct bilirubin (DBil) 9.0 μ mol/L, alanine aminotransferase (ALT) 45 U/L, lactate dehydrogenase (LDH) 517 U/L. Blood smear: red blood cells gathered in piles, no broken red blood cells were seen. Income ward for further treatment. Past History: Past physical fitness. Personal history: denial of picky eating, denial of smoking, drinking, exposure to toxic drugs and radioactive materials, denial of blood transfusion history. The history of marriage and childbirth and family history are no different.

The diagnosis and treatment of pulmonary hypertension is relatively complex, often involving multiple disciplines, and has become an international medical and health care problem. Improving the awareness of prevention and treatment of pulmonary hypertension, standardizing its diagnosis and treatment methods, and strengthening the basic and clinical research of pulmonary hypertension are the key points to improve its diagnosis and treatment level. The European Society of Cardiology/European Society of Respiratory Diseases (ESC/ERS) published a new edition of the Diagnostic and Treatment Guidelines for Pulmonary Hypertension at the end of August 2015^[1]This paper introduces the cutting-edge knowledge of epidemiology and genetics, and summarizes this part briefly.

Pulmonary hypertension (PH) is a disease or pathophysiological syndrome in which pulmonary artery pressure is abnormally elevated due to known or unknown causes^[1]It can be derived from pulmonary vascular disease itself or secondary to other cardiopulmonary diseases. The etiology is wide, the early clinical manifestations lack specificity, and the diagnosis is difficult. The improvement of pathology and etiology identification technology has promoted the clinical diagnosis level of PH. The European Society of Cardiology/European Society of Respiratory Diseases (ESC/ERS) published the latest edition of the Diagnostic and Treatment Guidelines for Pulmonary Hypertension in August 2015^[2], and addresses the updated diagnostic process in a separate section. Brand-new screening strategies are presented in the web appendix. The diagnosis of PH requires comprehensive evaluation and discussion by experts in cardiovascular, respiratory, rheumatic immune, imaging and other disciplines. Especially for patients with complex etiology, early referral, communication between multidisciplinary experts and collaborative diagnosis and treatment are more important.

With the deepening of research on the pathogenesis of pulmonary hypertension (PH), various new targeted drugs emerge one after another, and the quality of life and 5-year survival rate of PH patients are significantly improved. New drugs also raise some questions for clinicians that must be faced directly: how to evaluate the patient's condition and rationally use new targeted drugs? The 2015 European Society of Cardiology/European Society of Respiration (ESC/ERS) Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension specifically addressed the above issues^[1]。 Combined with domestic clinical practice, the relevant contents are expounded from the angles of clinical evaluation, clinical follow-up opportunity and strategy. Because the results of relevant studies are mainly derived from arterial PH (PAH), the contents described above are mainly applicable to patients with PAH.

pulmonary hypertension includes five categories: pulmonary arterial hypertension (PAH), pulmonary hypertension associated with left heart disease, pulmonary hypertension associated with pulmonary disease or hypoxia, chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary hypertension with unknown mechanism. Various types of pulmonary hypertension are treated with different methods. For example, for disease-related pulmonary hypertension, the primary disease is mainly treated, and pulmonary thromboendarterectomy is the first choice for CTEPH. For PAH, due to the deepening understanding of its pathogenesis, a series of drugs targeting different mechanisms of action have been developed. Therefore, the treatment of PAH has changed greatly in the past decade, with increasing therapeutic drugs and complicated treatment options. 2015 European Society of Cardiology/European Society of Respiratory Diseases (ESC/ERS) Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension^[1]The treatment strategy of PAH is recommended in detail in, and the treatment of PAH is now interpreted as follows.

2005 Volpe^[1]The concept of premature infant encephalopathy (EOP) was put forward to summarize the injuries of white matter, gray matter, ventricles and other parts of the brain caused by various inducements and the clinical manifestations after various injuries, as well as the neurological sequelae such as cerebral palsy, mental retardation and epilepsy in premature infants. Paraventricular leukomalacia (PVL) is the most severe form of brain injury in premature infants and an important factor in cerebral palsy^[2]The reduction of brain tissue caused by PVL may further lead to enlargement of ventricles and subarachnoid space, gray matter lesions, gyral dysplasia, etc^[3]。 Past research has shown^[4]Hypoxia and prenatal infection are the main risk factors of premature infant encephalopathy, but recent studies have found that postnatal infection/inflammation of premature infants is also closely related to premature infant encephalopathy, which is considered as one of the important causes of premature infant encephalopathy, which has attracted great attention of scholars. This article reviews the research progress on the correlation between postnatal infection/inflammation and brain injury in premature infants.