2015年 · 第95卷第16期

After more than 30 years of development, noninvasive positive pressure ventilation (NPPV) has become one of the main methods for the treatment of sleep disorder of breathing (SDB) in the world. It is precisely because of the widespread application of this technology that the treatment of SDB has made breakthrough progress and spawned an emerging marginal interdisciplinary subject-sleep medicine. In China, sleep medicine started late, and the application of NPPV in SDB treatment was gradually popularized after the 21st century. In recent years, with the development of economy and the improvement of people's awareness, the growth rate of China's non-invasive ventilator market is in a leading position in the world; NPPV technology has been applied gradually to the treatment of respiratory failure in patients with severe acute respiratory syndrome (SARS) and chronic obstructive pulmonary disease, and has achieved good results^[1]。

obstructive sleep apnea (OSA) has been recognized as a serious health problem in modern society and can lead to multi-system impairment^[1]。 If the prevalence of OSA in adults is 2.1% to 4.1%, 28 to 55 million out of 1.34 billion Chinese suffer from OSA^[2,3]。 Estimated as 2 310 sleep monitoring needs per 100,000 people^[4]There are about 31 million people in China to be investigated. The difficulty of obtaining convenient sleep monitoring is one of the important reasons why most patients fail to diagnose and treat in time. Therefore, clinical, simplified and family-based diagnosis technology has received great attention and demand.

With the rapid development of plateau medicine and economic construction, advanced modern inspection instruments and equipment and highly educated talents are constantly introduced into medical laboratories, and more and more new technologies and methods are applied to clinical inspection work. Clinical inspection plays an increasingly important role in clinical diagnosis and treatment. In order to provide stable and reliable testing results for clinical diagnosis and treatment, medical laboratories must establish a comprehensive quality management system, which is the core of ensuring testing quality.

Human beings often have a strong fear and helplessness after encountering major catastrophic events (such as losing a loved one, earthquakes, car accidents, etc.), which can cause anxiety, depression, self-injury or suicidal behavior, and lead to psychological problems such as post-traumatic stress disorder or mental illness; Such diseases are often recurrent, difficult to eradicate, and extremely harmful. At present, the clinical treatment for post-traumatic stress disorder and other related psychological problems and mental illnesses is to constantly expose patients to painful memories, so that they slowly adapt to desensitization. However, this process may aggravate the psychological trauma of patients, which may lead to recurrence or even aggravation of the disease.

A 59-year-old male was admitted to the hospital after physical examination and B-ultrasound showed that the spleen occupied space for 2 weeks. No abdominal pain, no fear of cold, fever, no gingival bleeding. There was no abnormal weight loss. Physical examination: No yellow staining and bleeding spots on the skin, flat abdomen, no varicose veins on the abdominal wall, no intestinal pattern and peristaltic waves. Soft abdomen, no tenderness and rebound pain in the whole abdomen, no muscle guard, no abnormal mass palpable, and no subcostal palpable liver and spleen. Laboratory tests: Hepatitis B surface antibody (HBSAB) positive. Liver and kidney function, complement and immunoglobulin (IgA, IgG, IgM) were normal, tumor indexes were normal, and erythrocyte sedimentation rate and C-reactive protein were normal. Nuclear magnetic resonance (MRI): A round mass with a size of about 3.3 cm ×3.5 cm was seen at the edge of the spleen. T1WI and T2WI showed low signal, and the lesions were unevenly enhanced on enhanced scan. The volume of the liver is not large, and the proportion of each lobe is coordinated; Small round long T1 and long T2 signal foci were found in the parenchyma of liver and kidney, but no enhancement was found in the enhancement scan. The hilar region is well structured. The outer edge of the liver is smooth and neat. The gallbladder is not large, the cyst wall is not thickened, and there is no abnormal signal shadow in the cavity. There were no obvious abnormalities in the shape, size and signal intensity of the pancreas. No enlarged lymph nodes were seen retroperitoneally. Clinical diagnosis: space-occupying mass of the spleen. Multiple small cysts in the liver and kidneys. Laparoscopic splenectomy was performed under general anesthesia. During the operation, the spleen was about 8.0 cm ×6.0 cm in size, soft in texture, and had no obvious adhesion to the surrounding tissues. The completely removed spleen was broken in a bag in the abdominal cavity and isolated from the abdominal cavity. A small incision was made in the posterior lower abdomen and the bag was taken out of the abdominal cavity. Gross pathology: a pile of broken spleen tissue, 12.5 cm ×10.0 cm ×3.8 cm in size, part of the spleen has envelope, and in the gray-red substance, there is a free mass, 4.0 cm ×3.5 cm ×3.0 cm in size, without envelope, the cut surface is tough, and there are multiple dark red circular areas scattered around the gray-white center, with a diameter of 0.4~0.6 cm. Microscopically, hemangiomatous nodular structures were seen in the mass, which resembled granulomatous nodules at low magnification. Hemangioma-like nodules vary in size. The center of the nodule is a rich fissure-like or sinus-like vascular lumen, and the vascular endothelial cells are swollen. Red blood cells can be seen between some vascular lumens, and a naive vascular lumen formed by single cells can be seen. There were proliferative spindle-shaped cells between the vascular lacunae, with unclear cell boundaries and no obvious abnormalities. There were hyaline collagen fibers between nodules, and many lymphocytes and plasma cells infiltrated in the interstitial collagen fibers between nodules, old hemorrhage and hemosiderin deposition. Immunohistochemistry showed that CD34 (+), CD31 (+) and CD8 partial sinus lacunar endothelium (+) in nodular capillaries; Scattered venule-like vessels CD31 (+) between nodules. Intranodular and internodular spindle cells SMA (+), Actin (+). Pathological diagnosis: sclerosing hemangiomatous nodular transformation of the (spleen).

Helicobacter pylori (Helicobacter pylori, HP) a gram-negative microaerobic pathogen. Studies have shown that HP infection is associated with peptic ulcer, gastric mucosa-associated lymphoid tissue lymphoma (MALT), gastric malignant tumors and other gastrointestinal diseases. It has been reported that the infection rate of HP in adults in China reaches 40% ~60%^[1]。 Although the classic triple therapy composed of two antibiotics plus one proton pump inhibitor (PPI) to eradicate HP has achieved remarkable efficacy in the past long-term clinical application, due to the increasing antibiotic resistance rate year by year and the influence of antibiotic-related side effects, the patient compliance is poor, which affects the anti-HP therapeutic effect to a certain extent. The eradication rate of triple therapy is gradually declining, and most reports have been far lower by 80%^[2]。 Therefore, it is particularly important to explore new adjuvant treatment options. In recent years, with the increasing research on microecological preparations, the combined application of probiotic preparations on the basis of triple drugs aims to reduce the side effects of triple therapy and improve the eradication rate of HP, and the adjuvant therapy combined with probiotics has aroused greater interest and attention.

The article "Incidence and Risk Factors of Pulmonary Hypertension in Patients with Congenital Heart Disease" was published in Chinese Medical Journal, Issue 32, 2014^[1]。 Right cardiac catheterization was used as a means to investigate the incidence of pulmonary hypertension in patients with congenital heart disease, and the risk factors of pulmonary hypertension were analyzed. After reading it, I benefited a lot, but I also felt that the English translation of the medical term "pulmonary arterial hypertension" as "pulmonary arterial hypertension" in this article was inappropriate, so I put forward a discussion here.

Thank you very much for your interest in this article. I agree with your letter that "Pulmonary arterial hypertension (PAH)" should be translated as "Pulmonary arterial hypertension" and "Pulmonary hypertension (PH)" should be translated as "Pulmonary arterial hypertension". In this article, the clinical classification of Pulmonary arterial hypertension in patients with congenital heart disease, according to the guidelines of the Nice Conference of the 2013 World Congress on Pulmonary hypertension, belongs to PAH, and its clear English expression is "Pulmonary arterial hypertension associated with congenital heart diseases", which most domestic scholars are used to translating as "congenital heart disease Pulmonary hypertension".

Thrombopoietin (TPO) is produced in the liver and regulates hematopoietic stem cell and megakaryocyte proliferation and differentiation, known as pan-hematopoietic factor. TPO activates downstream signaling pathways through its receptor c – MPL (also known as MPL) and promotes cell survival and proliferation. Because TPO plays an important role in hematopoiesis, alterations in its receptors and hormones lead to the development of diseases: e.g. congenital and acquired thrombocytemia, penia. Dysregulation of TPO expression or functional alteration of c-MPL can lead to aplastic anemia (AA).

Abdominal aortic aneurysm (AAA) is dangerous and is the 10th leading cause of death in men over the age of 60. The number of deaths caused by AAA rupture in the United States is 15,000 per year^[1]。 Known risk factors are male sex, smoking, advanced age, genetic predisposition, abnormal lipid metabolism, and hypertension. The histological manifestations of AAA were massive infiltration of inflammatory cells in the media and adventitia, rupture of elastic fibers and degradation of the media, but the etiology was unknown. Selecting safe, reliable and reproducible animal models plays an important role in understanding the mechanism of AAA occurrence, and also provides reference value for new drugs and surgical methods.

The 2014 World Health Organization (WHO) Global Tuberculosis Report shows that there were more than 480,000 new cases of multidrug-resistant tuberculosis (MDR – TB) worldwide in 2013^[1]。 The chemotherapy regimen of MDR-TB still cannot achieve satisfactory efficacy, and the adverse reactions are large, the treatment cost is high, and the treatment success rate is only 48%. The development and development of new anti-tuberculosis drugs is imminent. Bedaquilin (trade name Snarui, formerly known as TMC-207, also known as R207910) is the first new anti-tuberculosis drug on the market in the past 50 years, and belongs to the diarylquinoline class. In December 2012, the U.S. Food and Drug Administration (FDA) accelerated the approval of bedaquiline for the treatment of MDR-TB. In June 2013, the WHO issued the Interim Strategic Guidance for Bedaquiline in the Treatment of Multidrug-Resistant Tuberculosis.^[2]。 A series of studies have shown that the drug has high anti-tuberculosis activity and good clinical therapeutic effect^[3,4,5,6]。 Its anti-tuberculosis effect and its research progress are summarized as follows.

At present, breast cancer is one of the malignant tumors with the highest incidence rate in women, and its mortality rate is increasing year by year in China, which seriously threatens the life and health of women. Adjuvant treatment of breast cancer can significantly improve the prognosis of patients, but some patients still have primary or secondary drug resistance. It is an urgent problem to clarify the mechanism of drug resistance in adjuvant therapy of breast cancer and find the effective target to reverse drug resistance. Most previous studies have focused on tumor cells themselves, and the role of tumor microenvironment in the development of breast cancer is attracting more and more researchers' attention. Among them, cancer-associated fibroblasts (CAF) are one of the important components in the tumor microenvironment. By secreting higher levels of growth factors, chemokines, matrix metalloproteinases, etc., they can not only promote the occurrence and development of breast cancer, but also induce drug resistance to breast cancer treatment^[1,2]。 Therefore, the new treatment model targeting it will provide new ideas for the comprehensive treatment of breast cancer. At the same time, CAF also plays an important role in the prognosis of breast cancer. This article reviews the effect of CAF on therapeutic resistance in breast cancer and its prognostic value.