Volume 97  ·  Issue 12  ·  2017

In the history of medical development, case reports have occupied an important position and promoted the progress and development of medicine. But from the second half of the 20th century, case reporting began to decline, and medical journal editors seemed more willing to publish articles on evidence-based medicine research, while enthusiasm for case reporting gradually waned. This has caused heated discussions in the medical community: opponents believe that the quality of case reports is not high and only focuses on strange events, which may be misleading to clinical research; Proponents argue that case reporting is essential in the development of medicine, and that the ability to obtain detailed information on individual patients should be an important supplement to evidence-based medicine^[1,2]。 Either way, case reports are still very low in the evidence hierarchy. After a period of decline, beginning in the late 1990s, researchers' interest in case reporting was rekindled. In 1995, The Lancet (Lancet) magazine has opened a new chapter dedicated to case reporting. In 2007, the first international medical journal to publish only case reports was published. In the following years, similar magazines appeared^[1]。 Then, what is the position of case report in medical research, what are the advantages and disadvantages, and how can we write a case report well? We will go into more detail below.

UNESCO divides medical scientific research into three categories: basic research, applied research and experimental development research. Among them, applied research is an innovative exploration to apply research results to clinical work. Clinical observation research and field investigation research in medical research both belong to this category, and it is also a relatively simple, convenient and widely used method in clinical research. Case report is to explain rare diseases or new diagnosis or treatment methods by observing and studying special clinical cases. The Sleep Medicine Center of West China Hospital, while conducting some prospective and retrospective studies, also focuses on collecting and exploring special clinical cases, which have been reported in the international academic field^{[1,2,3,4,5,6]}。 Some cases have been published in journals with important academic influence, such asBiol Psychiatry^[6]AndThorax^[2]Etc. These cases are summarized and discussed as follows.

During the "Twelfth Five-Year Plan" period, the Ministry of Science and Technology launched the "Demonstration and Application Research of Collaborative Network Construction of Clinical Medical Research" project, which led the development direction of clinical medical research in China with the demonstration of collaborative research network construction^[1]。 Recently organized national-level projects such as "13th Five-Year Plan", "Key Project for Prevention and Control of Major Chronic Non-communicable Diseases", "Key Project for Precision Medicine Research", "Key Project for Prevention and Control of Reproductive Health and Major Birth Defects", etc., take clinical medicine collaborative research as the guiding principle for the top-level design and organization of special projects, further expanding and extending the application scope of "collaborative research". What exactly is clinical medical collaborative research, what are its basic characteristics, how is its positioning, how is it different from previous clinical research, and what is its significance? In the process of thinking and answering these questions, the author found that as a new clinical research model, clinical medical collaborative research has unique theories, methods and technologies, which need to be combed and summarized in order to better understand and organize the implementation, so that China's clinical research can better and faster adapt to the national strategy of innovation-driven development.

In recent years, the rapid development of hospital digital construction makes hospital information system increasingly become an effective means to improve the quality of medical service and enhance the ability of hospital management. However, there are some shortcomings in its rapid development, such as the existence of information islands between different systems, the business system cannot meet the increasing needs of users for data analysis and data mining, and it cannot provide necessary auxiliary decision support for hospital management and development. In 2009, the state introduced a new medical reform plan, in which the establishment of a practical and shared medical and health information system was proposed for the first time. Based on the analysis of related technologies and business functions of the hospital decision support system, this paper discusses the key technologies and concrete implementation methods of designing and developing the decision support system with data sharing, data analysis and data mining functions, as well as the changes brought by the operation management decision-making of the medical industry.

Hip fracture is a common traumatic disease in elderly patients. Such patients are often accompanied by multiple coexisting diseases and comorbidities, improper anesthesia and perioperative management, and significantly increased postoperative complications and mortality. This guidance is based on relevant literature, expert consensus and guidelines^[1,2,3,4]Formulate and put forward several recommendations to improve patient outcomes, including timing of surgery, preoperative evaluation and preparation, prevention of deep vein thrombosis, selection of anesthesia and analgesia protocols, intraoperative respiratory and circulatory management, and postoperative rehabilitation plan, so as to strengthen the perioperative management of this type of patients^[3]。

To examine the association between subjective sleepiness and objective sleepiness in Chinese obstructive sleep apnea hypopnea syndrome (OSAHS) patients.

A total of 1 660 patients meeting the diagnostic criteria of OSAHS based on overnight polysomnography from West China Hospital, Sichuan University in the period from Jul 2010 to Jul 2014 were enrolled in the study. The Epworth Sleepiness Scale (ESS) and Multiple Sleep Latency Test (MSLT) were to evaluate subjective and objective sleepiness, respectively. The subjects were categorized into quartiles [A (0-4) (n=406), B (5-7) (n=325), C (8-12) (n=443), D(13-24) (n=486) groups] based on the ESS score distribution. Survival analysis was used to characterize the association between the ESS score and the mean sleep latency (MSL).

The apnea hypopnea index (AHI) in D group was higher than other three groups [(58.7±26.1) vs (36.8±24.2), (42.6±26.7), (45.7±26.6) events/h, all P<0.05]. The mean sleep latency in D group was shorter than other three groups [(8.0±4.6) vs (10.9±4.4), (10.3±4.8), (9.4±4.5) min, allP<0.05]. The Kaplan-Meier survivor functions across the ESS score quartiles were distinct and fourth quartiles were progressively associated with a greater tendency for falling asleep (χ²=77.76, P<0.001 by Log-rank test) in the daytime (The percentages of awaking patients in fourth quartiles were progressively lower at the same time). The adjusted hazard ratios for sleep onset during the MSLT for the group B, C and D were 1.05 (95%CI: 0.90-1.22), 1.22 (95%CI: 1.07-1.40), and 1.38 (95%CI: 1.20-1.60), respectively, comparing to group A.

Subjective report of daytime sleepiness is consistent with the objective sleepiness in OSAHS patients.

To evaluate the accuracy of Berlin questionnaire in the screening of patients with obstructive sleep apnea (OSA), after using different body mass index (BMI) cutoff values.

The data were collected from September, 2011 to May, 2012 at the Sleep Medicine Center of West China Hospital, Sichuan University (Chengdu, China). A total of 350 consecutive patients (302 males and 48 females, 19-68 years old, average (42.9±11.0) years old) with suspected OSA who underwent an overnight polysomnography (PSG) were recruited into this study. Berlin questionnaire was completed. Based on the severity of OSA which were determined by apnea-hypopnea index (AHI), the patients were classified into four groups of primary snoring (<5 events/h), mild (5-<15 events/h), moderate (15-<30 events/h) and severe OSA (≥30 events/h). Sensitivity, specificity, positive predictive values, negative predictive values and the area under the receiver operating characteristics curve of Berlin questionnaire with different BMI cutoff values were calculated.

In patients with BMI≥30 kg/m^2, to diagnose mild-moderate-severe (AHI≥5 events/h), moderate-severe (AHI≥15 events/h), and severe (AHI≥30 events/h) OSA, the sensitivity of Berlin questionnaire were 69.2%, 71.6%, and 76.6%; the negative predictive values were 15.7%, 33.0%, and 56.5%, respectively. In patients with BMI≥24 kg/m^2, questionnaire had the highest sensitivity (94.3%, 94.8%, and 96.7%, respectively) and negative predictive values (28.0%, 44.0%, and 72.0%, respectively).

When BMI cutoff values gradually declines, the sensitivity and negative predictive values of Berlin questionnaire increase, but the specificity and positive predictive values decline. The accuracy of Berlin questionnaire possibly is related to BMI cutoff values.

To investigate the incidence of treatment-emergent central sleep apnea (TE-CSA), the characteristics of demography and the influencing factors in patients with obstructive sleep apnea syndrome (OSAS) after initial continuous positive airway pressure (CPAP) titration at high altitude.

Clinical data of 297 patients with OSAS which living in plateau areas (1 000 meters or more above sea level) were retrospectively analyzed in this study from January to December, 2015. All of these patients taken an overnight CPAP titration in the Sleep Medicine Center of First People′s Hospital of Yunnan Province. They were classified as with TE-CSA group and non TE-CSA group according to the outcome of CPAP titration. Comparisons of demographic characteristic, parameters of polysomnography in CPAP titration night, lung function test and blood gas analysis were made between the two groups, respectively, and statistical analysis was carried.

The incidence of TE-CSA was 16.5% (49/297) after initial CPAP titration at high altitude, which was higher in male patients (18.2% vs 6.8%, P=0.061). The incidence of TE-CSA decreased with the increase of age and body mass index (BMI), and the decrease of resident altitude. Multivariate Logistic regression analysis showed that the resident altitude, mixed apnea index (MAI), forced expiratory volume in 1 second (FEV₁) and forced vital capacity (FVC) ratio, functional residual capacity (RV) and total lung capacity (TLC) ratio were the main factors affecting the occurrence of TE-CSA. Among them, the increase of resident altitude and MAI were risk factors [OR=1.16(1.02, 1.32), 1.05(1.01, 1.09)]. The increase of FEV₁/FVC and RV/TLC were protective factors [OR=0.94(0.89, 0.98), 0.94(0.88, 0.99)].

The incidence of TE-CSA is high at high altitude area, and the increase of resident altitude and MAI are the risk factors for TE-CSA.

To investigate the effect of obstructive sleep apnea (OSA) on sleep architecture in acute ischemic stroke (AIS) patients.

Seventy AIS patients with polysomnography examination from June 2014 to April 2016 were included in the Second Affiliated Hospital of Soochow University. Twenty-seven healthy controls during the same period were chosen as control group. According to apnea-hypopnea index (AHI), AIS patients were divided into AIS group (AHI<5/h) and AIS+ OSA group (AHI≥5/h). Their general conditions, Neurological function defect (national institutes of health stroke scale, NIHSS) on admission and at discharge and self-care ability (modified Rankin Scale, mRS) at discharge and 3 months later (mRS score <2 reflected good prognosis, and mRS score≥2 reflected unfavorable prognosis) were collected.

Fifty-two patients (74.3%) had OSA in total seventy AIS patients. Total sleep time (TST) was significantly shorter and sleep efficiency (SE) was lower in AIS group than the control group (P=0.007, 0.008, respectively). AIS+ OSA group had longer non-rapid eye movement (NREM)1 than control group [24.9(21.3) vs 14.3(10.6), P=0.044]. Compared with AIS group, AIS+ OSA group had shorter NREM3 [13.0(13.2) vs 19.6(12.8), P=0.039]. There was no significant difference between the infarct location of AIS group and AIS+ OSA group. However, AIS+ OSA group had higher mRS score observed at 3 months through follow-up visit than AIS group (P=0.027). Spearman correlation analysis showed a positive correlation between unfavorable prognosis of stroke at 3 months and atrial fibrillation, the oxygen desaturation index (ODI), percentage of oxygen saturation <90% of total recording time (TS90%), AHI, the longest time of apnea and hypopnea, respiratory related microarousal and NIHSS, while a negative correlation between unfavorable prognosis of stroke and NREM3, lowest nocturnal oxygen saturation (L-SaO ₂). On Logistic analysis, the unfavorable prognosis was independently predicted by AHI and NIHSS.

Sleep architecture of cerebral infarction patients are disturbed with its characteristic of shorter total sleep time and lower sleep efficiency. Cerebral infarction patients with OSA have longer NREM1 and shorter NREM3.

To compare the efficacy and safety of colorectal resection combined with simultaneous radiofrequency ablation (RFA) in the treatment of synchronous colorectal liver metastases(SCRLM).

This retrospective study involved the patients admitted between January 1st 2010 and September 1st 2013. A total of 20 patients who underwent colorectal resection combined with simultaneous RFA of SCRLM were enrolled. Those patients (RFA group) were matched with 20 patients (Resection group) who underwent simultaneous resections of colorectal cancer and SCRLM based on the propensity scores. Perioperative parameters and survival outcomes were compared between the two groups.

The RFA and Resection groups were comparable in demographics, cancer characteristics and chemotherapy treatment (all P>0.05). The estimated blood loss and intraoperative blood transfusions in the RFA group were significantly lower than those in the resection group [150.00(100.00-200.00) vs 200.00(112.50-650.00), 1 vs 7, allP>0.05]. The postoperative stay in the RFA group was significantly shorter than that in laparoscopic group [8.50(8.00-10.75) vs 11.00(8.25-14.25),P=0.043]. There was no significant difference in postoperative complications (P>0.05). The 3-year disease free survival rate was 14.00% in the RFA group, and 31.20% in the Resection group (P=0.047). However, the 3-year overall rates were similar between the two groups (P>0.05).

Compared with simultaneous resections of colorectal cancer and SCRLM resections, colorectal resection combined with simultaneous RFA of SCRLM was associated with less surgical blood loss and shorter hospitalization. Although inferior to simultaneous resections of colorectal cancer and SCRLM resections in survival outcomes, this approach extends the capability of delivering potentially curative treatment for colorectal cancer patients with unresectable SCRLM.

To assess the factors associated with outcome of patients undergoing extracorporeal membrane oxygenation (ECMO) in a large ECMO center.

Patients aged >18 years who received ECMO support for postcardiotomy cardiogenic shock were identified between January 2011 and December 2015. One hundred and seventy-seven patients (64.8%) successfully weaned from ECMO. These patients were divided into two groups depending on whether they could survive to hospital discharge: the survival group (group S, n=119) and death group (group D, n=58). Multivariate logistic regression was performed to identify risk factors independently associated with in-hospital mortality.

Compared to those from group D, patients in group S exhibited a younger age[(53.4±11.7) vs (58.9±11.5) years], a lower inotrope score at the beginning of ECMO [25(15, 60) vs 35.0(23, 60)], a lower average platelets transfusion [4.0(2.0, 5.2) vs 5.0(3.0, 7.2)U] (allP<0.05). There were shorter duration of ECMO support [95.0(73.0, 131.0) vs 120.0(95.8, 160.2) h], shorter ventilation time [137.0(70.0, 236.8) vs 215.0(164.0, 305.0) h], shorter stay in ICU [182.0(140.0, 236.0) vs 259.0(207.0, 382.0) h] and longer hospital stay after weaned from ECMO [14(11, 24) vs 8(4, 16) d] in group S patients compared to those in group D (allP<0.05). Age>65 years (P=0.046), neurologic complications (P<0.001) and lower extremity ischemia (P<0.001) during ECMO support, left ventricular ejection fraction<35% (P=0.011) and central venous pressure (CVP)>12 cmH₂O(P=0.018) when weaned from ECMO, and the multi-organ function failure (P<0.001) after weaned from ECMO were independently associated with in-hospital mortality.

Neurologic complications and lower extremity ischemia that occurred during ECMO, multi-organ function failure after weaned from ECMO had a significant impact on in-hospital mortality. Further studies are needed to prevent neurologic complications and lower extremity ischemia in these patients. Interventions that could reduce these complications may improve outcome.

To investigate the effect of intravenous infusion with lidocaine on rapid recovery of laparoscopic cholecystectomy.

This study was a prospective randomized controlled trial. From February to August 2016 in Affiliated Yiwu Hospital of Wenzhou Medical University, 60 patients scheduled for laparoscopic cholecystectomy under general anesthesia were involved and randomly divided into control group (n=30) and lidocaine group (n=30). Patients in lidocaine group received lidocaine 1.5 mg/kg intravenously before induction and followed by 2.0 mg·kg^-1·h^-1 to the end of surgery. Patients in control group received equal volumes of saline intravenously. Anesthesia induction in both groups were given intravenous midazolam 0.03 mg/kg, sufentanil 0.2 μg/kg, propofol 2.0 mg/kg and cisatracuium 0.2 mg/kg. Anesthesia was maintained with propofol 0.05-0.20 mg·kg ^-1·min^-1 and remifentanil 0.1-0.5 μg·kg ^-1·min^-1 for laryngeal mask airway which bispectral index (BIS) value maintained at 40-60. BIS, heart rate(HR) and mean arterial pressure(MAP) were recorded before anesthesia induction, before and immediately after laryngeal mask implantation, intraoperative 30 min and anesthesia awake. Pain scores were assessed using visual analogue scales (VAS) at postoperation immediately, 30 min during postanesthesia care unit (PACU), 2, 6, 12, and 24 h after surgery. The time of PACU retention, postoperative ambulation, first intestine venting and discharge were recorded. The dosage of propofol and remifentanil, the frequency of sufentanil used, the incidence of postoperative nausea and vomiting were also recorded. Patient satisfaction was evaluated by using Simple Restoration Quality Score (QoR-9).

BIS values before and after laryngeal mask implantation in lidocaine group were 50.50±3.47 and 54.63±1.25 respectively, which was lower than those in control group(54.30±4.78, 55.80±2.33; t=3.542, 2.423, all P<0.05). The VAS score at postoperation immediately, PACU 30 min, postoperative 2, 6, 12 h in lidocaine group were 2.76±0.97, 2.37±0.93, 2.10±1.12, 1.76±0.97, 1.20±0.76 respectively, which was lower than those in control group (3.83±1.34, 3.27±1.26, 3.06±1.20, 2.63±0.88, 1.90±0.84;t=3.528, 3.154, 3.217, 3.603, 3.372, all P<0.05 ). The frequency of additional sufentanil at postoperation immediately and PACU 30 min in lidocaine group was 5(17%), 3(10%), which were less than those in control group(12(40%), 9(30%); χ²=4.022, 3.950, all P<0.05). The dosage of propofol and remifentanil in lidocaine group were (4.33±0.75) mg·kg^-1·h^-1 and (9.00±1.66) μg·kg ^-1·h^-1 respectively, which were less than those in control group ((5.20±1.39) mg·kg^-1·h^-1 and (10.43±2.20) μg·kg ^-1·h^-1;t= 2.982, 2.842, all P<0.05). The time of PACU retention, postoperative ambulation and first intestine venting were (39.90 ± 8.06) min, (11.93±1.68) h and (10.16±1.05) h respectively in lidocaine group, which were shorter than those in control group ((48.23±10.04) min, (13.16±1.58) h and (11.13±1.30) h;t=3.514, 2.931, 3.156, all P<0.05). The QoR-9 score in lidocaine group was 15.60±1.07, which was higher than that in control group(14.73±0.74,t=-3.649, P<0.05). There was no significant difference in the incidence of postoperative nausea/vomiting and the discharge time between two groups (allP>0.05).

Intravenous infusion of lidocaine can effectively reduce the dosages of propofol and remifentanil, postoperative early VAS score, postoperative ambulation time and first intestine venting time which could improve the satisfaction of patients.

To investigate the clinical manifestation, diagnosis, treatment and outcome of simultaneous occurrence of renal cell carcinoma and urothelial carcinoma.

Twenty-four consecutive patients with synchronous renal cell carcinoma and urothelial carcinoma treated in our center from March 2005 to December 2015 were retrospectively reviewed. Their clinical, pathological and prognostic features were evaluated. Kaplan-Meier curves were used to estimate overall survival.

Patient′ age was range from 48 to 79 yrs (median 69.5). Fourteen patients presented with macroscopic hematuria, and 10 patients were asymptomatic. B-ultrasound, computed tomography (CT) and cystoscopy initially indicated renal cell carcinoma concurrent with ipsilateral upper urinary tract urothelial carcinoma (UTUC) in 4 cases, renal cell carcinoma concurrent with bladder tumor in 16 cases, renal cell carcinoma concurrent with both ipsilateral UTUC and bladder tumor in 1 case, renal cell carcinoma in 2 cases and ureter carcinoma in 1 case. Different treatments were performed. The median follow-up time after surgery was 22.5 months. For patients with synchronous renal cell carcinoma and bladder tumor, there was no significant survival difference between patients treated with partial nephrectomy or radical nephrectomy. During follow up, 3 patients died of renal cell carcinoma, 3 patients died of non-oncological disease and 1 patient died of ureter carcinoma. The 3-year overall survival rate was 82.7%. For patients with synchronous renal cell carcinoma and bladder tumor, there was no significant survival difference between patients treated with partial nephrectomy or radical nephrectomy (P=0.874).

Concurrence of renal cell carcinoma and urothelial carcinoma is clinically rare. Treatments should be individualized. The prognosis for a patient with synchronous renal cell carcinoma and urothelial carcinoma is associated with the more aggressive one.

A 15-year-old male was admitted to the First Hospital of Jilin University on April 17, 2016 with "sudden abdominal pain for 1 d". Abdominal examination: tenderness in the lower abdomen with mild rebound pain and muscle tension. Whole abdominal CT showed that the distal ileum in the pelvic cavity was twisted and arranged in concentric circles, which was considered to be small intestinal obstruction, not excluding intussusception (Figure 1)。 Clinical diagnosis: intussusception. On the same day, an exploratory laparotomy was performed under general anesthesia in the emergency department. During the operation, about 100 ml of pelvic bloody exudation was found. After the exudation was sucked, further exploration was found. The distal ileum and mesangium were inserted into the distal intestinal tube, with a length of about 40 cm and could not be returned. The distal end of the intussusception intestinal tube was about 15 cm away from the ileocecal part, and the proximal intestinal tube was obviously dilated without a clear tumor. Intraoperative diagnosis of "small intestinal intussusception (ileum-ileum type)", partial small intestinal resection and intestinal anastomosis were performed. Postoperative pathological report: Pancreatic acins and ducts can be seen in the submucosa and muscle layer of ileum intestine, which is consistent with ectopic pancreas (Figure 2)。 Local mucosal epithelial loss, accompanied by a large number of acute and chronic inflammatory cell infiltration, part of the intestinal wall accompanied by bleeding, showed incomplete intestinal obstruction changes, and 4 mesenteric lymph nodes reactive hyperplasia.

A 48-year-old female was admitted to the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Bengbu Medical College on June 29, 2016 with "intermittent chest tightness and palpitation for 5 months and aggravation for 3 days". The patient developed chest tightness and asthma after activity 5 months ago, no precordial pain, no radiation pain, chest tightness aggravated after activity, accompanied by nocturnal paroxysmal dyspnea, and went to the local hospital on February 4, 2016. Pericardial puncture was guided by B-ultrasound, and a total of 1 200 ml of bloody noncoagulable fluid was drained before and after. No tumor cells were found in two pericardial effusions. Biochemistry of pericardial effusion: adenosine deaminase 8.4 U/L, albumin 48 g/L, lactate dehydrogenase 181.5 U/L. On April 27, 2016, the above symptoms reappeared, and he went to the First Affiliated Hospital of Anhui Medical University. Cardiac ultrasound showed that left ventricular ejection fraction (LVEF) was 61%, no segmental movement abnormalities of left ventricular wall were found, a liquid dark area of about 7.5 mm deep was seen in the anterior wall of right ventricle, and a liquid dark area of about 9.3 mm deep was seen in the posterior wall of left ventricle. After cardiotonic diuretic treatment, he was improved and discharged. Three days ago, the patient had the above symptoms aggravated again after activity, and came to our hospital for treatment. He had poor diet and sleep, normal urination and defecation, and no obvious weight loss.

Obstructive sleep apnea syndrome (OSAS) is a sleep disorder characterized by repeated occlusion of the upper airway during sleep, resulting in intermittent hypoxia and frequent micro-arousal. It is one of the most common sleep disorders, with a prevalence of 6% ~17% in the general population^[1]。 The structural or functional abnormalities of the upper airway are one of the causes of OSAS, and local inflammation of the airway will aggravate the structural and functional abnormalities, further aggravating OSAS. Local airway inflammation in OSAS patients is the result of mechanical injury caused by repeated airway closure and snoring, intermittent hypoxia and systemic inflammation associated with obesity. A large number of studies have shown that local airway inflammation plays an important role in the pathogenesis of OSAS. At present, the detection of airway inflammation in OSAS patients is only at the experimental level, and it has not been used for clinical diagnosis, treatment and follow-up.

Clinical research is a simple scientific research carried out in a complex clinical environment. The contradiction between scientificity and feasibility is prominent. It is particularly important to obtain theory, method and technical support from the perspective of research methods. Although the existing quantitative research methods have solved many problems in clinical research, some problems can not be solved well by quantitative research or qualitative research alone, and there are still limitations. mixed methods research (MMR) is the third research paradigm that combines quantitative research and qualitative research. This method can help researchers solve some problems that cannot be completely, reasonably and comprehensively explained by qualitative or quantitative research alone. At present, although some domestic scholars have used both qualitative and quantitative research methods in research projects, they generally only combine the data obtained by the two methods simply or analyze and publish them separately, and rarely publish research design articles that organically combine them. Clinical research can apply this method to provide more scientific and feasible methodological help for clinical research design, implementation and evaluation, in order to improve the quality of clinical research. This paper introduces the progress of the application of mixed methods in clinical research, and discusses its value and application prospect in improving clinical research.

The prevalence of Obstructive sleep apnea hypopnea syndrome (OSAHS) is about 4% in men and about 2% in women^[1]。 Its pathogenesis involves inflammatory reaction, oxidative stress, immune dysfunction, metabolic abnormalities and so on. Chronic intermittent hypoxia is an important pathophysiological mechanism. In recent years, the biomarkers of OSAHS have received extensive attention^[2]。 The research progress of OSAHS-related serological markers is summarized as follows.

Renal cell carcinoma (RCC) is one of the most common tumors in urology, accounting for 2% ~3% of all malignant tumors in adults^[1]20% to 40% of kidney cancer patients undergoing radical nephrectomy will gradually relapse or metastasize^[2]。 For patients with metastatic advanced renal cell carcinoma, integrated therapy combined with targeted therapy is the main treatment mode. Immunotherapy research for renal cancer was once progressing slowly. In recent years, with the research progress of Programmed cell death 1 receptor (PD-1) /Programmed cell death 1 ligand 1 (PD-L1) pathway, its related targeted therapy has opened a new chapter for renal cancer immunotherapy. Progress in immunotherapy of renal cancer related to the PD-1/PD-L1 pathway is reviewed below.