Volume 97  ·  Issue 48  ·  2017

Neural tube malformation is a congenital disease with high incidence and disability in China, which should be paid great attention to. However, the understanding of spinal neural canal malformation in China is insufficient, and the classification and terminology concepts are confusing or even wrong. In the case of spina bifida, the concepts "open", "closed", "dominant", "recessive" and "cystic" are often confused. According to whether there is nerve tissue exposure and cerebrospinal fluid leakage, it can be broadly divided into open and closed spina bifida. The meaning of open spina bifida is exposure of nerve basal plate and leakage of cerebrospinal fluid; On the contrary, it is closed spina bifida. "Dominant" and "recessive" refer to another pair of concepts, which refer to the presence or absence of spinal membrane or nerve tissue bulging outside the spinal canal through spina bifida to form a cystic mass, which belongs to the category of closed spina bifida. "myelomeningocele" belongs to open spina bifida in international literature^[1]。 However, in domestic reports, "myelomeningocele" is used to name closed spina bifida, which is essentially "lipomyelomeningocele". The result is that the same disease has different names and the same name has different diseases, which will inevitably cause academic fallacies in the aspects of operation timing, curative effect and prognosis, and it is urgent to unify the concept with international common terminology. Internationally, the classification of spinal neural canal malformations is complicated, almost all of which are divided according to embryonic pathology or imaging. According to the pathological classification of embryo, we can understand that different time points and different degrees of disorder in embryo development may lead to corresponding pathological types of spinal neural canal malformation. However, this classification only focuses on disease pathogenesis, but lacks clinical science. According to the classification of magnetic resonance imaging, it can help to understand the location and growth characteristics of deformity lesions, and greatly improve the guidance of disease diagnosis and treatment. However, imaging classification is static and limited after all, and cannot comprehensively reflect the characteristics of disease symptomatology, disease course and therapeutics. Unifying the terminology concept of spinal canal malformation and standardizing the classification standards are conducive to academic exchange and guiding clinical research.

To explore the gender differences of rapid-eye-movement (REM) related obstructive sleep apnea-hypopnea syndrome (OSAHS).

Consecutive patients with primary complaint of snoring from Sleep Medicine Center of West China Hospital between January 2016 and November 2016 were included in the study. All participants underwent one night polysomnography (PSG) and Epworth sleep scale (ESS) was estimated. The patients diagnosed with OSAHS were classified as REM related OSAHS (REM-OSAHS group) and non-rapid-eye-movement (NREM) related OSAHS (NREM-OSAHS group) based on the PSG parameters. And the gender differences of demographic and polysomnograpic characteristics in both groups were compared. The associations between apnea-hypopnea index (AHI) and body mass index (BMI), neck circumference and waist circumference among patients with OSAHS were explored by multiple linear regression analysis.

A total of 1 258 patients were diagnosed with OSAHS. There were 997 (79.3%) male and 261 (20.7%) female among these patients, the mean age was (46.4±12.0) years old and mean BMI was (26.6±3.4) kg/m². There were 236 patients (18.8%) classified into REM-OSAHS group, and 1 022 patients (81.2%) classified into NREM-OSAHS group; the proportion of REM-OSAHS in female was significantly higher than that in male (34.1% vs 14.7%, P<0.001). After controlling for age, drinking, smoking, hypnotics, coffee, strong tea and sleep related parameters, in NREM-OSAHS group, AHI was positively correlated with BMI, neck circumference and waist circumference (P<0.001) both in male and female. In REM-OSAHS group, AHI was positively correlated with BMI, neck circumference and waist circumference in female (P<0.05), but only significantly correlated with BMI and waist circumference in male (P<0.05).

REM-OSAHS is commonly seen in female OSAHS patients. Evaluation of the influences of anthropometric data on the severity of REM-OSAHS should consider the impact of gender.

To analyse the biomechanical effects on adjacent segments of different growing-rod (GR) fixation in early onset scoliosis through a finite element analysis method.

A severe early-onset scoliosis patient was selected and the pre-operation and post-GR-operation (Upper instrumented levels: T₄, T₅. Lower instrumented levels: L₃, L₄) whole spine 3-dimentional CT scan data were collected to build the finite models. Based on the different models, biomechanical differences on adjacent segments were analysed.

The stress on the adjacent structures decreased after the GR surgery compared with the pre-operation. Compared with the single GR, stress on T₃ vertebrae decreased by 6.2%, stress on T_3/4 disc decreased by 6.7%, stress on T_3/4 ligament decreased by 27.7%, stress on T₆ vertebrae decreased by 16.9%, stress on T_5/6 disc decreased by 1.2%, stress on T_5/6 ligament decreased by 40.4%, stress on L₂ vertebrae decreased by 32.6%, stress on L_2/3 disc decreased by 30%, stress on L_2/3 ligament decreased by 15.6%, stress on L₅ vertebrae decreased by 1.2%, stress on L_4/5 disc decreased by 15.7%, stress on L_4/5 ligament decreased by 100.0% in dual GR structure. The application of hook (s) on the upper instrumented vertebrae (s) decreased the stress on the cranial adjacent segment. Stress on T₃ vertebrae decreased by 2.8% and 2.2%, stress on T_3/4 disc decreased by 2.4% and 1.5%, stress on T_3/4 ligament decreased by 3.6% and 5.7% in single GR and dual GR models separately when the hook (s) were utilized. In the meanwhile, the stress on the adjacent segment was more concentrated in the single GR model.

Dual-rod growing-rod and the application of hook (s) on the upper instrumented vertebrae could reduce the stress on the adjacent segments more effectively in patients with early onset scoliosis.

To investigate the clinical phenotype and genotype characteristics of a Chinese hereditary factor Ⅺ deficiency pedigree.

The activated partial thromboplastin time (APTT), prothrombin time (PT), FⅪ activity (FⅪ: C) were measured by clotting method using automatic coagulation analyzer. The FⅪ antigen (FⅪ: Ag) was assayed by enzyme-linked immunosorbent assay (ELISA). Fifteen exons of F11 from the proband and his pedigree members were amplified by polymerase chain reaction (PCR), then sequenced. Pymol software was used to analyze the novel mutations.

APTT, FⅪ: C and FⅪ: Ag of proband was 74.2 s, 4.0% and 2.9%, respectively. For his older sister, APTT, FⅪ: C and FⅪ: Ag was 67.1 s, 3.0% and 1.8%, respectively. APTT, FⅪ: C and FⅪ: Ag of healthy controls were 34.5 s, 100.0% and 100.0%. FⅪ: C of proband′s father, mother and brother were 72.0%, 62.0%, and 78.0%, respectively. FⅪ: Ag of them were 50.0%, 43.0%, and 51.8%, respectively. The other coagulant parameters of the proband and his pedigree were all in the normal range. Sequence analysis showed two heterozygous gene mutations in F11 of the proband and his older sister. One was a deletion of T at nucleotide 1 491 in exon 12, resulting in a frameshift. A substitution of leucine 465 by tryptophan and a terminal coden after 7 amino acid: F11NM_13142c.1491delT (p.Leu465Trp.fs*7). The other was a G to A substitution at nucleotide 1 815 in exon 15, resulting in a substitution of glycine 573 by aspartic acid: F11 NM_13142c.1815G>A (p.Gly573Asp). F11NM_13142c.1491delT (p.Leu465Trp.fs*7) heterozygotes were found both in the proband′s father and his brother while p. Gly573Asp heterozygote was only found in his mother. F11 of the proband′s uncle was wild.

The novel compound heterozygous mutations of F11NM_13142c.1491delT (p.Leu465Trp.fs*7) and F11 NM_13142 c. 1815G>A (p.Gly573Asp) are responsible for FⅪ deficiency to the proband, which induced the decrease of FⅪ: C and FⅪ: Ag.

To investigate the association between serum adipocyte fatty acid binding protein (A-FABP) level and insulin resistance in patients with obstructive sleep apnea syndromes (OSAS).

Eighty patients with snoring were monitored by overnight polysomnography (PSG) from September 2015 to July 2017, and there were 59 males and 21 females, aged from 22 to 77 years old (mean age 47±14 years old). Based on the apnea-hypopnea index (AHI), these patients were divided into three groups: primary snoring group (AHI<5/h,n=19), mild-moderate OSAS groups (5/h≤AHI≤30/h, n=23) and severe OSAS groups (AHI>30/h,n=38). The levels of A-FABP, the fasting plasma glucose (FPG), fasting insulin (FINS) and insulin resistance index (IRI) were compared between the primary snoring group and OSAS patients with different severities, and the correlations between serum A-FABP and IRI as well as PSG parameters were further evaluated using partial correlation analysis.

Compared with the primary snoring group [(15.6±3.5) μg/L] and mild-moderate group [(17.4±4.3) μg/L], there was a significant increase of the serum A-FABP level in the severe OSAS group [(21.4±4.6) μg/L]( P=0.001, P=0.025). Additionally, after adjustment for BMI and age, serum A-FABP level showed significant positive correlations with FINS and IRI (r=0.478, P<0.001;r=0.356, P=0.035); serum A-FABP level was positively correlated with AHI and the arterial oxygen saturation (SaO₂) < 90% time ratio in night (TS90%) ( r=0.251, P=0.041 and r=0.271, P=0.035). Nevertheless, serum A-FABP level showed significant negative correlation with the lowest SaO₂ and the mean SaO₂ (r=-0.244, P=0.038 and r=-0.280, P=0.018).

Insulin resistance and the increased level of serum A-FABP are common in OSAS patients, the level of serum A-FABP is significantly correlated with insulin resistance and nocturnal intermittent hypoxia, both of which suggest that A-FABP plays a potential role in insulin resistance in patients with OSAS.

To determine the dose-response relationship of ropivacaine for epidural block in early herpes zoster by CT guided.

From January 2015 to February 2017, according to the principle of completely random digital table, 80 patients with early herpes zoster who were prepared for epidural block were divided into 4 groups(each group 20 patients): in group A the concentration of ropivacaine was 0.08%, in group B was 0.10%, in group C was 0.12% and in group D was 0.14%.Under CT guidance, epidural puncture was performed in the relevant section, mixing liquid 5.0 ml (with 10% iodohydrin)were injected into epidural gap.CT scan showed that the mixing liquid covered the relevant spinal nerve segmental.The numeric rating scale(NRS) values before treatment and at 30 minutes, the incidence of adverse reactions were recorded, and the treatment were evaluated. The response to ropivacaine for epidural block in early herpes zoster was defined as positive when the NRS values was less than or equal to one.The ED₅₀, ED₉₅ and 95% confidence interval (CI) of ropivacaine for epidural block in early herpes zoster guided by CT were calculated by probit analysis.

The NRS values before treatment were 5.00(4.00, 6.00), 5.00(4.25, 6.00), 5.50(5.00, 6.00) and 5.00(4.00, 6.00), the difference was no significant(Z=2.576, P=0.462). The NRS values at 30 minutes decreased and the effective rate of the treatment increased(χ²=8.371, P=0.004), following ropivacaine dose gradient increasing, they were 1.50(1.00, 2.00), 1.00(1.00, 2.00), 0.50(0.00, 1.00) and 0.00(0.00, 1.00), the difference was statistically significant (Z=17.421, P=0.001). There was one case in group C and four cases in group D were hypoesthesia, others were no significant adverse reactions occurred. The ED₅₀ and ED₉₅ (95%CI) of ropivacaine for epidural block in early herpes zoster guided by CT were 0.078%(0.015%-0.095%)and 0.157%(0.133%-0.271%), respectively.

Ropivacaine for epidural block in early herpes zoster guided by CT is effective for neuropathic pain, with no significant adverse reactions.

To observe the effect of low dose naloxone combinewith ropivacaine for supraclavicular brachial plexus block.

Seventy patients undergoing elective upper limb surgery were randomly divided into two groups, ropivacaine group (Group R, n=35) and naloxone group (Group N, n=35). An ultrasound guided technique was used in both two groups.The onset and duration time of sensory and motor blockade, visual analog score(VAS)of 3, 6, 12, 18, 24 h postoperatively, time of first request fordezocine, total amount of dezocine needed, incidence of nausea and vomiting postoperatively(PONV) and patients′ satisfaction score for analgesia in 24 h after surgery were measured.At the same time, blood samples were taken before anesthesia, 6 h, 24 h after operation for inspecting the concentration of β-endorphin(β-EP)in plasma.

The duration of sensory and motor blockade, time of first request for dezocine in Group N were 736.0(713.5, 836.5), 514.5(491.3, 572.8), 708.5(683.2, 877.0)min, which were all prolonged compared to Group R(522.0(469.5, 606.5), 401.0(370.0, 458.5), 570.0(435.0, 618.5)min)(Z=-6.844, -6.758, -6.700, all P<0.01). The 6, 12, 18 h postoperatively VAS of Group N were 0, 5.0(3.0, 5.8), 5.0(5.0, 6.0)point. Among which the 6, 12 h postoperatively VAS of Group N were lower than that of Group R(1.0(1.0, 3.5), 6.0(6.0, 7.0)point)(Z=-6.596, -4.864, all P<0.01), while the 18 h postoperatively VAS was higher than that of Group R (5.0(4.0, 5.0)point)(Z=-2.603, P<0.01). Total amount of dezocine needed in Group N in 24 h after surgery was 7.5(5.0, 10.0)mg, which was lower than that of Group R(10.0(10.0, 15.0)mg)(Z=-3.449, P<0.01). The incidence of PONV after surgery in Group N was 21.9%, which was lower than that of Group R(45.5%)(χ²=4.034, P<0.05). Ptients′ satisfaction score for analgesia in 24 h after surgery in Group N was 8.0(7.0, 8.0)point, which was higher than that of Group R(7.0(6.0, 7.0)point)(Z=-3.509, P<0.01). At 6 h postoperatively , the concentration of plasma β-EP in Group N was(113.34±12.36)μg/L, lower than that of Group R((147.14±11.65)μg/L)(t=-7.694, P<0.01).

Low dose naloxone combine with ropivacaine for supraclavicular brachial plexus block, prolong the duration of sensory and motor blockade without affecting the onset time.

To investigate the effect of intravenous supplementation with high-dose L-carnitinen on hemodialysis tolerance in uremic patients with severe heart disease (ischemic heart disease, congestive heart disease and arrhythmia).

Between March 2012 and March 2017, 5 gram L-carnitine was given after the completion of each hemodialysis treatment (3-4 times a week) over a period of two weeks in 29 maintenance hemodialysis patients with severe heart diseases manifested by frequently symptomatic hypotension, chest tightness, wheezing, palpitation, chest pain and other symptoms during hemodialysis. The hemodialysis duration, heart functional classification (New York Heart Association Functional Classification, NYHA ), blood pressure and arrhythmia were analyzed before and after the treatment.

The duration of hemodialysis was significantly prolonged after treatment [from 2.0-3.5 (2.6±0.4)h to 3.0-4.0 (3.8±0.4) h, t=10.66, P<0.01]. Cardiac function was improved (Z=-4.74, P<0.01). The hypotension and arrhythmia during dialysis was improved.

High-dose of intravenous L-carnitine supplementation can improve hemodialysis tolerance and the symptoms of heart failure, arrhythmia, ischemic cardiac disease in hemodialysis patients with severe heart diseases.

To investigate the risk factors of ultrasound lung comets and its impact on the survivals of patients undergoing hemodialysis.

One hundred and forty-two patients on hemodialysis (Male 76, female 66) were divided into three groups according to the score of lung comets (mild: ≤14 comets; moderate: 15 to 30 comets; severe: >30 comets). Seventy-two healthy subjects examined by lung ultrasound serve as a control. Pulmonary artery systolic pressure and left ventricular ejection fraction (LVEF) were assessed by Doppler ultrasonography. High-sensitivity C-reactive protein (hsCRP) and tumor necrosis factor (TNF)-α were measured by the automatic analyzer and enzyme-linked immunosorbent assay.

With the increasing age of the patients, lung comets scores increased (P<0.05). There were significant differences in TNF-α (P<0.05), interdialytic weight gain (IDWG) (P<0.05), pulmonary artery systolic pressure and LVEF (P<0.05) among three groups. In multivariate linear regression, the lung comets score was positively related to multiple clinical variables including New York Heart Association (NYHA) classification (P=0.023), hsCRP (P=0.042), TNF-α (P<0.001), IDWG (P=0.031), and pulmonary artery systolic pressure (P<0.001). In the multivariate Cox proportional hazards models, lung comets score was independent risk factor for death (P=0.001). In Kaplan-Meier survival analysis, the risk of all-cause mortality increased in parallel with lung comets score, and patients with lung comets score (>30 comets) were at highest risk of death among all three groups (log-rank test χ²=12.73, P=0.001).

Lung comets is associated with inflammation, pulmonary artery systolic pressure/volume overload and heart function. Lung comets score represents the alterations of heart function and it may serve as a powerful predictor of all-cause mortality for hemodialysis patients.

To explore the association between small dense low-density lipoprotein cholesterol (sdLDL-C) and carotid atherosclerosis.

1 578 subjects were enrolled in an annual health check-up program in aerospace center hospital from 2016 to 2017, and these patients were divided into 471 cases (men 343 and women 128) with carotid atherosclerosis (subjects with increased carotid artery intima-media thickness or carotid atherosclerosis plaque) and 1 107 cases (men 567 and women 540) with non- carotid atherosclerosis according to ultrasonography. Serum sdLDL-C levels were measured by peroxidase assay.

Serum sdLDL-C was significantly higher in carotid atherosclerosis group (1.11±0.44) mmol/L than that in non-carotid group (0.88±0.40) mmol/L, with significant difference (t=9.856, P<0.001). Stratified by quartiles of sdLDL-C (Q1-Q4), the prevalence of carotid atherosclerosis was significantly increased trend along with increased sdLDL-C levels (P<0.001). In multivariate Logistic regression analysis, after adjustment for age, sex and other traditional atherosclerosis risk factors, comparing Q4 with Q1, the odd ratio of prevalence of carotid atherosclerosis was 5.164, and 95% confidence interval(CI) was 2.833-9.413. While the sdLDL-C threshold was 0.727 mmol/L as the optimal cut-off point, the clinical sensitivity and specificity of sdLDL-C for screening carotid atherosclerosis were 80.5% and 41.4%, respectively.

Serum sdLDL-C was an independent risk factor of carotid atherosclerosis. sdLDL-C may be a potentially useful risk marker in early screening for carotid atherosclerosis.

To analyze the sperm morphological characteristics of multiple morphological abnormalities of the sperm flagella (MMAF), and to analyze their common features and subtypes.

Twenty-eight patients with abnormal morphology of flagella were analyzed by semen analysis. The morphological characteristics were analyzed by scanning electron microscopy and transmission electron microscopy. Histological observation of one case of testicular tissue was performed.

Of the 28 patients, only 13 patients (46.4%) had motile spermatozoa, 12 of which had a sperm motility rate of <10% and a sperm survival rate of 9.0%-80.0%. Under light and scanning electron microscope, sperm with absent, short, coiled, bent and irregular width flagella or their combinations were observed. Transmission electron microscopy showed structural abnormalities of sperm fibrous sheath, mitochondrial sheath. Loss rate of central microtubule was 41.4%-84.6%. The semen of the 2 patients with the absence or presence of the kinetic protein arm and both the inner and lateral motilin arms missing had no motile spermatozoa. There was no statistically significant difference in the proportion of flagellar malformations between the two groups of patients (without motile sperm vs with motile spermatozoa).

MMAF is a kind of sperm flagella specific abnormalities. Initially diagnosis can be carried out using light microscopy. Clear diagnosis could be conduct using transmission electron microscopy, and the central microtubule loss of the sperm could be seen as the main feature of the flagella abnormalities. Through the morphological analysis and research, MMAF could be precisely classified, which provide a strong basis for the diagnosis.

To investigate the expression and significance of autophagy in rabbit model of tracheal stenosis.

A total of 18 rabbits were equally divided into 3 groups (blank control group, saline group, erythromycin group) in accordance with the random number table. After rabbit model of tracheal stenosis was established, no treatment was done with blank control group. Saline group was atomized with saline (0.54 mg/kg, 2 times/day), and erythromycin group was fed on erythromycin (7.5 mg/kg, 2 times/day) for 7 days before and 10 days after the operation. On the eleventh day, rabbits were executed, and their trachea were collected. The proportion of collagen fiber area of tracheal lamina propria (LP) and epithelium (EP) was assessed by Masson staining. The mRNA of autophagy associated gene-3 (ATG3) and autophagy associated gene-5 (ATG5) of tracheal mucosa were assessed by Real-Time Polymerase Chain Reaction (RT-PCR). The protein of microtubule-associated protein 1 light chain β ₃ (LC3B), ATG3 and ATG5 were assessed by Western blot.

The proportion of collagen fiber area of tracheal LP and EP of blank control group was (6.79±0.67)%, saline group was (40.55±5.40)%, erythromycin group was (27.48±0.43)%. The differences between any two groups was all statistically significant (all P<0.01). The relative value of ATG3 mRNA and ATG5 mRNA in saline group were significantly lower than blank control group (allP<0.01). Those value in erythromycin group were significantly higher than the saline group (allP<0.01). The protein levels of LC3B-Ⅱ/Ⅰ, ATG3 and ATG5 in saline group were significantly lower than blank control group (allP<0.01). After low dose of erythromycin intervention, all the protein levels were significantly higher than the saline group (allP<0.01).

The expression of autophagy is decreased in rabbit model of trachea stenosis. Low dose of erythromycin could increase the expression of autophagy and at the same time alleviate the degree of fibrosis of the tracheal mucosa. Autophagy may alleviate tracheal fibrosis through up-regulating its expression level and play a protective role.

To investigate the effect and mechanism of hyperbaric oxygen combined with radioactive seed implantation in the treatment of esophageal squamous cell carcinoma.

Subcutaneous tumor model of esophageal squamous cell carcinoma using TE-8 cells was established. Tumor bearing Balb/c(nu/nu) mice (60 mice) were divided into four groups, Cont group that treated with normal oxygen level, HBO group that treated with hyperbaric oxygen, RSI group that treated with radioactive seed implantation, and HBO+ RSI group that treated with hyperbaric oxygen combined with radioactive seed implantation. Tumor volume ratio and mean survival time of tumor bearing mice were observed. Pathological changes of tumor tissue after treatment were observed by hematoxylin eosin (HE) staining. Enzyme linked immunosorbent assay kit was used to detect oxidative stress. Apoptosis related proteins were detected by Western blot.

After treatment, the tumor volume ratio of HBO+ RSI group was 3.51±0.80 and was significantly lower than that of Cont group, HBO group, and RSI group (P<0.05). The mean survival time of HBO+ RSI group tumor bearing mice was 62 d and was significantly longer than that in Cont group, HBO group, and RSI group (P<0.05). HE staining showed that the pathological changes of tumor tissues were most obvious in HBO+ RSI group. After treatment, the MDA and Bax levels in nude mice of HBO+ RSI group were significantly higher than those in Cont group, HBO group and RSI group, but the levels of GSH, SOD and Bcl-2 were significantly lower than those of Cont group, HBO group and RSI group (P<0.05).

Hyperbaric oxygen combined with radioactive seed implantation could slow tumor growth and increase survival time of tumor bearing mice. The possible mechanism is that hyperbaric oxygen combined with radioactive seed implantation can improve the oxidative stress response and the expression of apoptosis protein in tumor bearing nude mice.

A 60-year-old male was admitted to the Department of General Internal Medicine of Peking Union Medical College Hospital on October 19, 2016 due to "bulging eyeballs, chest tightness and shortness of breath for more than 2 months". In July 2016, the patient consciously had bulging eyeballs, and the external hospital examination showed that the thyroid function was normal; Renal ultrasound: dilation of the pelvis and calyces of both kidneys and dilation of the upper ureter; Enhanced CT of head, thorax, abdomen and pelvis: occupied space behind both eyeballs, with clear boundaries, uneven enhancement, thickened maxillary sinus mucosa on both sides, local atelectasis in the anterior segment of the upper lobe of the right lung, thickened interlobular septum of both lungs, soft tissue shadows around the descending aorta and around the kidneys, pericardium and bilateral pleural effusion. Positron emission computed tomography (PET) -CT showed a soft tissue mass behind both eyeballs, similar in size and morphology, approximately 2.8 cm ×2.5 cm in size, with a standard uptake value (SUV) maximum of 4.4 kBq/ml. No special treatment was given. At the end of August, there was chest tightness and asthma after activity, and I couldn't lie down at night, accompanied by night sweats. Cardiac ultrasound in other hospitals showed a large amount of pericardial effusion, and chest tightness was relieved after 1 200 ml of pericardial effusion drainage on September 5th (no relevant laboratory results were found); Bronchoscopy: No malignant tumor cells were found in the anterior segment of the upper lobe of the right lung, and no abnormalities in the etiology were found. On October 8th, chest tightness and asthma occurred after slight activity. Cardiac ultrasound in outside hospital: massive pericardial effusion. Pericardial puncture (1 200 ml): yellow turbid, peptone, specific gravity>1.018, cell number 230×10⁶Total protein 34.7 g/L (total blood protein 45.8 g/L); Pathology: A small number of heterotypic cells with nuclear mass and dysregulated nuclear-plasma ratio can be seen. Chest tightness was relieved after drainage of pericardial effusion, and then gradually worsened. Reexamination of cardiac ultrasound showed a large amount of pericardial effusion. Admitted to our hospital for further diagnosis and treatment. Spirit, appetite, second stool, poor sleep, weight loss of 10 kg compared with before illness. Past history, personal history, and family history are not special.

Since the launch of the first generation of proton pump inhibitors (PPIs), after years of clinical practice, PPIs have become the drug of choice for the prevention and treatment of most acid-related diseases. Compared to other acid suppressant drugs^[1]PPI has the characteristics of good curative effect, mild adverse reactions, good tolerance of long-term application by patients, and good safety. PPI is mainly metabolized by liver drug enzyme cytochrome P450 (CYP). When combined with other drugs metabolized by the same pathway, it will produce drug-enzyme competitive effects, resulting in enhancement or reduction of drug efficacy and adverse reactions. With the rapid development of molecular biology, human genetics and molecular pharmacology, it has been gradually found that PPI is highly dependent on liver CYP isoenzyme system (mainly CYP2C19 and CYP3A4) in pharmacokinetics, and is mainly affected by CYP2C19 gene polymorphism. This article will focus on the influence of CYP2C19 gene polymorphism on drug metabolism and interaction of PPI in medical treatment.

Although the standardized diagnosis and treatment of lung cancer brings certain survival benefits to patients, lung cancer is still the first type of malignant tumor mortality, so it is urgent to explore new and effective treatment methods. Programmed death receptor-1 (PD-1) antibodies include nivolumab, pembrolizumab, etc. Among them, nivolumab has been approved by the US Food and Drug Administration (FDA) for squamous cell carcinoma and second-line treatment of non-squamous non-small cell lung cancer (on the basis of first-line treatment of platinum combined chemotherapy or bevacizumab combined chemotherapy); In 2016, pembrolizumab was approved for those with programmed death receptor-1 ligand (PD-L1) expression>50% in non-small cell lung cancer (first-line drug) and PD-L1>1% (second-line drug)^[1]。 In addition, the PD-L1 class antibody atezolizumab is the first PD-L1 class antibody approved by the FDA for non-small cell lung cancer (tumor progression after first-line treatment), and is particularly suitable for tumor expression of high levels of PD-L1 or those with more tumor-infiltrating immune cells; durvalumab and avelumab are also suitable for untreated non-small cell lung cancer^[2]。 While patient immunotherapy has achieved encouraging results, we are also concerned about the occurrence of immune-related adverse reactions in some patients. Unlike traditional chemotherapy and targeted therapy, our clinicians do not have much knowledge and experience in this regard. The adverse reactions and management of PD-1/PD-L1 antibodies in the treatment of lung cancer are summarized as follows.

In the field of drug assay, similarity or consistency evaluation is often required, such as quality consistency evaluation of generic drugs, similarity evaluation of biosimilar drugs, linear parallel evaluation of detection methods, etc. At this time, if the conventional difference test is used, the invalid hypothesis is that the difference between the parameters (such as slope, mean, etc.) of the standard and the sample to be tested is 0, and the opposite alternative hypothesis is that the difference is not 0. WhenPWhen the value is greater than a specified threshold value (e.g. 0.05), the conclusion can only be that "there is insufficient evidence to suggest that the two groups are different", but it cannot be considered that "the two groups are not different" or "the two groups are equal or consistent". If you want to answer the question of whether the two groups are equal, the United States Pharmacopoeia (USP) recommends that the equivalence test be more scientifically reliable^[1]。

growth hormone (GH) not only promotes growth, but also promotes fat decomposition, protein synthesis, and affects sugar metabolism. Especially, its influence on the body's nerve function cannot be ignored, but its influence on human life span is still inconclusive. With the increase of age, the function of various organs gradually declines, the incidence of degenerative diseases increases year by year, and the metabolic profile also changes accordingly. At the same time, growth hormone levels in healthy adults decrease slowly with age, and whether this phenomenon accelerates aging is inconclusive. Whether growth hormone supplementation can delay aging is the focus and hot spot of current academic circles. This article reviews the effects of growth hormone on metabolism and aging.