Volume 97  ·  Issue 44  ·  2017

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.

To analyze the clinical features of acute diffuse pulmonary exudative disorders.

The data were collected from patients who were hospitalized in respiratory intensive care unit (RICU) of Beijing Chaoyang Hospital affiliated to the Capital Medical University during January 2009 to December 2011, and had acute clinical course with imaging findings of diffuse pulmonary infiltrated shadows (similar to acute respiratory distress syndrome (ARDS)). The causes of disease and clinical features were analyzed.

A total of 86 patients with acute diffuse pulmonary exudative disorders were included. Sixty-two (72.1%) were males, with a mean age of (58.6±16.4) years old; 24(27.9%) were females, with a mean age of (48.2±18.3) years old. The duration of the disease before administration was (11.5±5.2) days, and RICU stay was (15.5±9.5) days, with hospital mortality of 40.7% and the average hospitalization cost of 101 thousand RMB. The main cause was infection, which occurred in 53 cases (61.6%) (virus in 21 cases, bacteria in 14 cases, fungus in 11 cases, pneumocystis in 15 cases and others in 3 cases, mixed infection in 11 cases). Interstitial pneumonia occurred in 12 cases (idiopathic interstitial pneumonia in 9 cases: cryptogenic organizing pneumonia in 3 cases, the acute exacerbation of idiopathic pulmonary fibrosis in 3 cases, nonspecific interstitial pneumonia in 1 case, acute interstitial pneumonia in 2 cases, and connective tissue disease in 3 cases), aspiration pneumonia in 10 cases, acute left heart failure in 6 cases, and exogenous pulmonary ARDS in 5 cases.

The main cause of acute diffuse pulmonary exudative disorders is pulmonary infection, followed by interstitial pneumonia. The hospital mortality and hospitalization cost are high.

To investigate the effects of remifentanil infusion on emergence and recovery characteristics of patients with thoracoscopic lobectomy following general anaesthesia with sevoflurane.

One hundred patients, who were aged 37 to 65 years with American Society of Anesthesiologists (ASA) physical status 1-2, and scheduled for elective thoracoscopic lobectomy under general anaesthesia in National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from February 2016 to August 2016, were allocated to receive sevoflurane maintenance regimen(group S, n=50)or sevoflurane/remifentanil maintenance regimen(group SR, n=50)by random digital table. After routine induction and intubation, anaesthesia was maintained with 2% sevoflurane in group S and 1.5% sevoflurane/remifentanil(continuous intravenous injection at rate of 4 μg·kg ^-1·h^-1)coadministration in group SR respectively, with intermittent intravenous infusion of sulfentanil. Haemodynamic variables were collected at different time points and compared between two groups. Awaking time and extubation time, incidences of serious coughing and agitation were evaluated during emergence.Postoperative pain, nausea and cather-related bladder discomfort(CRBD)were evaluated in post anesthesia care unit.

Compared with group S, the arterial blood pressure and heart rate were significantly lower in group SR at extubation(all P<0.05). Time to awaking and to extubation in group SR were (4.2±2.1) min and (4.8±3.1)min respectively, in group S were (12.7±3.4) min and (15.4±4.1)min.The difference between two groups were statistically significant (t=-15.040, 14.582, all P<0.05). The incidences of serious coughing and agitation in group S were 48% and 58%, which were greater than those of group SR(6% and 10%). The difference were statistically significant(χ²=20.294, 23.574, all P<0.05). The NRS and incidence of complaining CRBD were similar in both groups(allP>0.05).

Compared with sevoflurane maintenence, coadministration of remifentanil and sevoflurane maintenance regimen provides better emergence and recovery which are characterized by faster awakening and extubation with a lower incidence of emergence coughing and agitation.

To investigate the application and best cut-off value of Chinese version of Addenbrooke′s cognitive examination-Ⅲ(ACE-Ⅲ) in type 2 diabetes mellitus (T2DM) patients with mild cognitive impairment.

A total of 18 T2DM patients with normal cognitive function (NCI group) and 40 T2DM patients with mild cognitive impairment (MCI group) treated in outpatient clinic or ward of Department of Neurology and Endocrinology in Fujian Medical University Union Hospital between January 2015 and February 2016 were enrolled. Mini Mental State Scale (MMSE), Montreal cognitive assessment scale (MoCA), Activity of Daily Living Scale (ADL) and the Chinese version of ACE-Ⅲ were used to assess cognitive function of subjects and to assess the value of ACE-Ⅲ in the diagnosis of T2DM patients with mild cognitive impairment.

The Cronbach′s alpha of the Chinese version of ACE-Ⅲ is 0.768. ACE-Ⅲ and MoCA were correlative (r=0.768, P<0.001). The area under the receiver operating characteristic (ROC) curve for ACE-Ⅲ was 0.906 (95%CI: 0.827-0.985). When the cut-off value for diagnosis was 87.5, the maximum Youden index was 0.769, with a sensitivity of 0.825 and a specificity of 0.944. Patients in MCI group got a lower score in the sub-items of attention/orientation, memory, verbal fluency, language and visual space of ACE-Ⅲ compared to those in NCI group, and the differences were statistically significant (t=5.336, P<0.001;t=5.530, P<0.001;t=4.556, P<0.001;t=5.301, P<0.001;t=2.821, P=0.008).

The Chinese version of ACE-Ⅲ had good internal consistency reliability, and it could effectively detect impairment of general cognitive function and single cognitive domains in T2DM patients.

To identify risk factors that influence the massive drainage after posterior spinal orthopaedic surgery for adolescent scoliosis.

A total of 1 461 patients from 11 to 18 years old diagnosed with adolescent scoliosis who underwent first posterior spinal orthopaedic surgery in affiliated Drum Tower Hospital, Medical School of Nanjing University between November 2010 and October 2015 were retrospectively reviewed. Patients were categorized on the basis of massive or normal drainage, with the boundary 30^th percentile of drainage/estimated blood volume. Preoperative factors including age, gender, body mass index(BMI), ASA physical status, diagnostic type of scoliosis, main Cobb angle, laboratory tests, intraoperative factors including the number of fusion level and screws, tranexamic acid used or not, use of osteotomy and thoracoplasty, use of cell salvage technology, duration of operation, the volume of urine output, blood loss, fluid therapy and transfusion, postoperative factors including the length of hospital stay, number of transfusion, the volume of drainage, time of drain were collected. Univariate and multivariate analyses were used to determine risk factors which were independently associated with massive drainage.

The average drainage was (856.3±333.4)ml. 479(32.8%) patients had massive drainage(drainage≥30% of drainage/estimated blood volume). Multivariate analysis identified risk factors of massive drainage: BMI<17.63 kg/m², odds ratio(OR)=2.90, preoperative platelet count<190×10⁹/L (OR=1.67), preoperative main Cobb angle≥55 degrees(OR=1.66), number of fusion levels≥11(OR=2.33), number of screws≥15(OR=1.73), use of osteotomy(OR=1.54), intraoperative volume of crystalloids≥35.63 ml/kg(OR=1.40), intraoperative volume of colloids≥28.92 ml/kg(OR=1.82), intraoperative volume of transfusion≥19.55 ml/kg(OR=1.72), while the use of tranexamic acid(OR=0.26) was the only protective factor.

BMI<17.63 kg/m^2, preoperative platelet count<190×10⁹/L, preoperative main Cobb angle≥55 degrees, number of fusion levels≥11, number of screws≥15, use of osteotomy, intraoperative volume of crystalloids≥35.63 ml/kg, intraoperative volume of colloids≥28.92 ml/kg, intraoperative volume of transfusion≥19.55 ml/kg were risk factors associated with massive drainage after posterior spinal orthopaedic surgery for adolescent scoliosis, while the use of tranexamic acid could decrease the possibility of massive drainage.

To evaluate the efficacy and safety of neoadjuvant dose-dense or standard schedule chemotherapy with anthracyclines and taxanes for Luminal B (HER2-)Breast Cancer.

From January 2010 to December 2014, 168 Luminal B (HER2-) breast cancer patients with stageⅡA-ⅢC confirmed by pathology were randomly assigned to receive one of the following regimens: (group A) concurrent TEC× 4 every 3 weeks, ( group B ) sequential EC× 4-T × 4 every 3 weeks, (group C ) dose-dense TEC× 4 every 2 weeks with G-CSF, (group D) sequential EC× 4(dose-dense)-T × 4 with dose-dense every 2 weeks .

A total of 168 patients completed the neoadjuvant chemotherapy as planned. The pathologic complete response (pCR) was 16.8% in the 4 groups.The pCR were 30.9% and 26.1% in the group C and group D respectively, significantly higher than patients with group A and group B(9.5%and 7.1%) ( P<0.05). Median follow-up was 43 months (IQR 3-63). The 3-year disease free survival (DFS) rate was 64.7%, 55.5%, 87.8% and 92.1% and the 3-year overall survival(OS)rate was 79.4%, 77.7%, 95.1%, 97.3% in the 4 groups respectively. Patients in the dose-dense group had better 3-year DFS and 3-year OS than those with the regular group.The side-effects could be evaluated in 154 patients.The incidence of neutropenia was 29.2% and 21.9% in the group C and group D versus 65.7%and 51.3% in the regular group(P<0.05), the incidence of nervous toxicity was 54.2%, 18.9%, 60.0%, 26.8% in the 4 groups respectively. The incidence of nervous toxicity in the dose-dense group was lower than that in the regular regimen group(P<0.05).

Neoadjuvant dose-dense chemotherapy with anthracyclines and taxanes for Luminal B (HER2-)Breast Cancer was effective and can improve the pCR, DFS and OS.Comparing the two dose dense regimens, sequentially with anthracyclines and taxanes, the incidence of nervous toxicity were lower.

To find a suitable method for the determination of citric acid in the urine of patients with stones, in order to provide a new method and basis for the prevention and treatment of stone.

Liquid chromatography tandem mass spectrometry was used to analyze the citric acid in urine directly. And the accuracy, stability, repeatability and other indicators of the results were detected.

The results showed a good linear relationship with the concentration of citric acid in urine. y=50.31x+ 0.002 6 (R²=0.994 21). The results were stable, reproducible [intra-day (Coefficient of Variance) CV ≈1% and inter-day CV<10%], and the accuracy of which was comparable with that of the enzyme method (n=20, R=0.97).

Using the method of this study to detect the content of citric acid in urine has the advantages of simple operation, good repeatability, accurate results, and low price. So it is worth to be popularized and applied in clinical practice.

To investigate the curative effect of Deanxit combined with Shuganjieyu capsule on the treatment of refractory gastroesophageal reflux disease.

A total of 125 patients with refractory gastroesophageal reflux disease who had failed in standard lansolazole capsule treatment in the Department of Gastroenterology, First People′s Hospital of Neijiang were selected. According to the symptom scores and mood scores of gastroesophageal reflux disease, patients were randomly and double-blindly divided into five groups. Group A(Lansoprazole Capsules + Mosapride Citrate + Deanxit), B(Lansoprazole Capsules + Mosapride Citrate + Shuganjieyu capsule), C(Lansoprazole Capsules + Mosapride Citrate+ Deanxit + Shuganjieyu capsule) and D(Deanxit) groups are study groups, the other was control group (Lansoprazole Capsules + Mosapride Citrate). The scores of symptoms and mood were compared after 4 weeks and 8 weeks of treatment.

The clinical symptoms score, HAMA and HAMD scores were significantly lower in the all study groups in comparison to the control group after 4 weeks and 8 weeks therapy. The clinical symptoms score, HAMA and HAMD scores in group C were significantly lower than those in group A and B (P<0.05), while the difference between group A and B was not statistically significant(P>0.05). The HAMA and HAMD scores of group D were significantly higher than those of group A, B, C and control group, and the differences were statistically significant (P<0.05). The total effective rate of study groups were significantly higher than those of the control group, and the difference was statistically significant (P<0.05). The total effective rate of group C was significantly higher than that of group A and B (χ²=6.47, P<0.05). The total effective rate of group A at the end of the 8th week was significantly higher than that of group B (χ²=6.52, P<0.05). The total effective rate of group D at the end of the 4th and 8th week was significantly lower than those of the group A, B, C and control group, the difference was statistically significant (χ²=5.85, P<0.05).

Deanxit combined with Shuganjieyu capsule is significantly effective in treatment of refractory gastroesophageal reflux disease, which can effectively improve the total treatment efficiency, reduce the symptom scores and mood scores of gastroesophageal reflux disease patients.

To explore the effects of oxycodone combined with dexmedetomidine in percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinomas.

Sixty patients who underwent percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinomas were randomly divided into fentanyl group (group A) and oxycodone group( group B), with 30 patients in each group. Patients in group A were injected with fentanyl (2 μg/kg), and patients in group B were injected with oxycodone (0.2 mg/kg). All the patients were injected with dexmedetomidine, with a loading dose of 0.5 μg/kg for 10 minutes and a continuous infusion rate of 0.2 μg·kg ^-1·h^-1 until the end of the operation. The changes of heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SPO₂) and bispectral index (BIS) were monitored at different time points: time when patients entering the operating room (T0), the beginning of operation (T1), 10 minutes after operation (T2), the end of operation (T3), 15 minutes after the end of operation (T4). The incidence of side effects (nausea and vomiting, respiratory depression and body movements) was assessed. The visual analogue scale (VAS) scores were also recorded at T0, T3 and an hour postoperatively.

Five patients of Group A had the body movements during the operation, and it was improved after injecting with fentanyl 2 μg/kg. Compared with T0, HR in two groups decreased significantly at T2 ( P<0.05). At each time point, the difference of MAP, HR, SPO₂ and BIS was not statistically significant in two groups. The incidence of Nausea and vomiting, body movements was lower in group B than that in group A(P<0.05). The VAS scores were lower in group B than that in group A at T3 and an hour postoperatively (P<0.05).

The combination of oxycodone and dexmedetomidine can be used safely and effectively in percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinomas, and it shows more effective analgesia and less side-effects.

To investigate the effect of methylation status of breast cancer metastasis suppressor gene 1 (BRMS1) on the expression of breast cancer and the biological behavior of cancer cells in triple-negative breast cancer (TNBC).

The expression of BRMS1 in TNBC tissues and corresponding non-malignant tissues and its relationship with clinicopathological parameters were detected by immunohistochemistry. The mRNA and protein expression of BRMS1 in normal breast epithelial cells and TNBC cells were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting. The methylation specific polymerase chain reaction (MSP) was used to detect the methylation status of BRMS1 in each cell. These cells were treated with demethylated preparations (5-Aza-dC) to re-activate BRMS1 expression. Using tumor cell invasion assay to detect influence of BRMS1 demethylation on the invasion capacity of cancer cells. The data were statistically analyzed.

The positive expression rate of BRMS1 protein in TNBC tissues was significantly lower than that in corresponding non-malignant tissues (χ²= 6.635, P<0.05). The mRNA expression level of BRMS1 in patients with lymph node metastasis was significantly lower than those with no lymph node metastasis (P=0.018). The down-regulation of BRMS1 expression was related to the methylation of DNA promoter, which was statistically significant (χ²=14.68, P<0.05). The mRNA and protein expression of BRMS1 was also correlated with tumor size and TNM staging (P=0.000-0.003). After using 5-Aza-dC, the number of cells with invasive capacity was significantly lower than those of the control group (t=3.262-10.72, P<0.05).

The decrease of BRMS1 expression in TNBC cells is related to the methylation of DNA. Demethylation can inhibit the invasion of breast cancer cells.

To investigate the impact of the implementation of Beijing Tobacco Control Regulation on outpatient visits for smoking cessation in Beijing Chaoyang Hospital.

The outpatient visits and the proportion of returned cases to the total outpatient visits for smoking cessation in Beijing Chaoyang Hospital in past five years (2012-2016) that was before and after the implementation of Beijing Tobacco Control Regulation (June 1^st, 2015) were analyzed. Time series seasonal index method was used to analyze seasonal variations in the outpatient visits.

From the implementation of Beijing Tobacco Control Regulation to December 31^th, 2016, the average monthly outpatient visits for smoking cessation was significantly increased compared to that before the implementation [(101±37) vs (48±17), t=-7.486, P<0.001]. Meanwhile, the proportion of returned cases to the total outpatient visits was also significantly increased compared to that before the implementation [30.4% (582/1 912) vs 8.2% (161/1 966); χ²=309.8, P<0.001]. In addition, there were seasonal fluctuations in the number of outpatients from 2012 to 2016 , during which the outpatient visits started to increase in the second and third quarter (summer and fall) and peaked in June, but became less in the first and fourth quarter (spring and winter), and reached its nadir in January.

With the implementation of Beijing Tobacco Control Regulation, the outpatient visits for smoking cessation have increased. Moreover, there is seasonal fluctuation in the outpatient visits for smoking cessation.

To explore a relationship between screening and incidence for colorectal cancer (CRC).

Medline, Scopus, BIOSIS Previews, and the Cochrane Library were searched for studies, which included any randomized controlled trial (RCT) about CRC screening with a report on using endoscopy in screening arms and a usual care in control arms.

Nine qualified trials, four one-time and five two-or-more-time screening programs, were included in this review with 997 131 persons randomized and a median follow-up of 10-28 years. In an intention-to-screen analysis, screening was associated with a reduced incidence of advanced CRCs by 10%-60%. Compared with control groups, incidence of CRC firstly increased and then decreased following a screening procedure. Five RCT with six screening arms reported incidences at different follow-up time points, and the incidence ratios at the last time of follow-up were 0.96 (95%CI: 0.86-1.06), 0.80 (95%CI: 0.70-0.92), 1.02 (95%CI: 0.91-1.14), 0.80 (95%CI: 0.70-0.90), 0.83 (95%CI: 0.73-0.94) and 0.94 (95%CI: 0.85-1.05) at the 9.0th, 10.9th, 13.0th, 18.0th, 18.0th, and 19.5th year after baseline, respectively. Compared with population-based screening, people in the hospital/clinic-based screenings had more benefits from CRC incidence reduction, particularly for those with high endoscopy rates, more lesions detected and resected by screening.

This study indicates that screening is likely associated with reduction of CRC incidence after 10 years since baseline screening, and this reduction seems to be highly affected by CRC risk of population screened, screening procedure program, and compliance to screening program including accepting endoscopy.

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 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.

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.

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]。

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]。

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.

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.