2015年 · 第95卷第04期

In patients with advanced breast cancer, the incidence of bone metastasis is 65% to 75%, while the first-episode bone metastasis accounts for 27% to 50%. Bone-related events (SREs) such as bone pain and bone injury are common complications of bone metastasis of breast cancer, which seriously affect the quality of life of patients. At the time of clinical study, SREs was defined as: aggravation of bone pain or new bone pain, pathological fracture (vertebral fracture, non-vertebral fracture), vertebral compression or deformation, spinal cord compression, symptoms after bone radiotherapy (due to bone pain or prevention of pathological fracture or spinal cord compression), and hypercalcemia. These are the main factors that affect patients' autonomous activity and quality of life^[1,2,3]。

With the development of medical immunology and molecular biology, cancer treatment is no longer limited to traditional drugs and surgical therapies. From the initial tumor vaccine to the world-renowned chimeric antigen receptor (CAR) modified T cells, cancer immunotherapy is gradually moving to the clinical stage and benefiting cancer patients. The concept of CAR originates from people's further understanding of cancer immunotherapy: that is, immune cells can break through the limitations of MHC to directly recognize and kill cancer cells. 1989 Gross et al.^[1]The concept of CAR is proposed for the first time, which integrates the variable region of monoclonal antibody against tumor cell antigen and T cell receptor (TCR) to redirect the immune response of T cells. With the development of translational medicine, the research of CAR is attracting more people's attention, and it has made major breakthroughs in clinical trials to treat malignant hematological tumors such as leukemia and lymphoma^[2,3]。 In this paper, the composition and development of CAR-T cells, research status, challenges and application prospects are reviewed.

Adult growth hormone deficiency (AGHD) is common in structural or functional damage of the hypothalamus and/or pituitary gland, more common in sellar tumors, followed by cranial surgery and radiotherapy, and can also be caused by pituitary ischemic necrosis, infection or leukemia cell infiltration. Idiopathic, autoimmune hypophysitis and decreased growth hormone (GH) secretion caused by organ function deterioration in the elderly are also common causes of AGHD. According to statistics, there are nearly 50,000 adults with growth hormone deficiency in the United States, and about 6,000 new cases are increasing every year^[1]。 Pituitary Group, Department of Endocrinology, Beijing Tiantan Hospital^[2]Twelve patients with craniopharyngioma 6 months after surgery underwent an insulin tolerance test to evaluate their adenopituitary growth hormone reserve function. It was found that all subjects had complete growth hormone deficiency and none received appropriate growth hormone replacement therapy. Domestic and foreign literature^[1,2]It is reported that the proportion of patients with growth hormone deficiency after pituitary tumor surgery is very high. Although most adult patients with hypopituitary function after pituitary tumor surgery receive different degrees of replacement therapy for pituitary and target gland hormones (such as thyroid hormone, glucocorticoid, sex hormone, etc.), the replacement therapy of growth hormone is often neglected. The physical function and psychological well-being index of AGHD patients decreased significantly compared with the control group of the same age^[1]And deserves more attention.

In recent years, with the development of free donation of remains in various places, this noble cause is gradually on the right track, and countless patients have benefited from it. However, due to the huge clinical demand, more patients are still waiting. According to the statistics of the World Health Organization (WHO), there are more than 10 million burn patients in the world every year. Due to many factors such as population and society, there are many burn patients in China. Many local and systemic problems that occur after burns are closely related to the loss of the skin barrier, and restoration or reconstruction of the skin barrier is the ultimate goal of burn treatment^[1]。 Skin transplantation is one of the main methods for surgical repair of skin loss. The autologous skin source available for transplantation in patients with large area deep burn is limited, and various wound covering materials are often used. Compared with all kinds of skin substitutes such as xenogenic skin, biofilm and synthetic dressings that lack corresponding functional cells and skin accessories, full-thickness xenogenic skin is recognized as the best covering material^[2]。 Allogeneic skin has an irreplaceable position, but the lack of its source has seriously affected the treatment of burn patients.

Surgical pulmonary volume reduction (LVRS) aims to achieve therapeutic objectives by removing emphysema tissue. National Emphysema Treatment Trial (NETT) results suggest that LVRS benefit only in the upper lobe-dominated, low exercise endurance group population^[1]。 However, even among the most skilled surgeons, the postoperative mortality rate of LVRS patients remains high^[2]。 For this reason, scientists are constantly exploring new technologies that are less invasive and can achieve good volume reduction effects. Against this background, trans-bronchoscopic pulmonary volume reduction (BLVR) has emerged and developed rapidly. Its efficacy is comparable to that of LVR, but the risk of complications and death is significantly reduced^[3]。 In view of this, the 2013 and 2014 editions of the Global Chronic Obstructive Pulmonary Disease (COPD) Prevention and Treatment Initiative (GOLD) officially recommended BLVR as a new option for the treatment of COPD. The application of this technology in China started late, and there are few reports^[4]。 The progress of BLVR in the treatment of COPD in recent years is summarized as follows.

The patient was a 15-year-old male. He was admitted to hospital on June 12, 2014 due to "repeated cough and expectoration for 2 months and intermittent hemoptysis for 4 days". Two months ago, the patient had repeated cough and expectoration without obvious trigger. The sputum was white sticky sputum with moderate amount, occasionally accompanied by shortness of breath after activity, without fever, night sweats and chest pain. Four days ago, the patient had hemoptysis once without obvious trigger, which was bright red and dosed about 20 ml, so he went to the local hospital. Chest CT showed tracheal mass, and it was recommended to be transferred to our hospital for further diagnosis and treatment. Deny history of exposure to chemical, radioactive, toxic substances, deny history of smoking.