2014年 · 第94卷第14期

Prostate cancer is the malignant tumor with the highest incidence in men in Europe and America, and ranks second in male cancer mortality in the United States. The incidence of prostate cancer is positively correlated with age^[1]。 With the extension of population life expectancy, diet structure and lifestyle changes, the incidence of prostate cancer in China is constantly increasing. Currently, the only marker clinically used for screening of prostate cancer and monitoring of relapse after treatment is prostate specific antigen (PSA). Although PSA-based screening allows more early patients to be diagnosed and treated, 23% to 42% of patients found by screening are occult prostate cancer with slow progression, low aggression, and no clinical symptoms. Two prospective studies of whether PSA reduces the risk of death from prostate cancer in the United States and Europe both acknowledge that PSA screening leads to overtreatment in some cases, adding unnecessary pain, injury and financial burden to patients^[2,3]。 Although screening also reduces disease staging, it does not substantially improve the overall fatality rate. Many occult subclinical tumors are diagnosed and treated, shifting the focus of research from previous risk gene susceptibility studies to early diagnosis of aggressive prostate cancer and molecular signature studies of fatal prostate cancer. For patients with biochemical recurrence suggested by elevated PSA after surgery or radiotherapy, there are limited tools to understand the risk of disease progression and guide the course of treatment. The study of high-risk markers of recurrence is of great significance to understand the mechanism of occurrence and exacerbation of prostate cancer, which is conducive to clinicians to better grasp the surgical indications. Positive measures such as strengthening follow-up, adjuvant endocrine therapy or radiotherapy for patients with high-risk of recurrence can benefit patients. Many studies have attempted to identify high-risk markers of prostate cancer progression, but most of them have not achieved the intended purpose, and no markers that can be routinely used in clinical practice have been found. Some views on the research of markers of recurrence and progression of prostate cancer are discussed.

Nasal endoscopy has been introduced in China since the 1980s. In recent years, endoscopic skull base surgery has become a hot spot, and it has been widely carried out, especially the technique of pituitary tumor surgery has become mature. However, the treatment of skull base tumors in children under nasal endoscopy is still rare. Six cases of pediatric skull base tumor resection under nasal endoscopy were jointly performed by the Department of Otolaryngology, Head and Neck Surgery and the Department of Neurosurgery of Tianjin Huanhu Hospital, which are reported as follows.

Recurrent hypoxemia (with or without hypercapnia) due to upper airway obstruction or stenosis during sleep in patients with obstructive sleep apnea syndrome (OSAS); Or sleep structural disorders due to repeated micro-arousals. Epidemiological data show that about 4% of men and 2% of women in adults suffer from OSAS^[1]。 OSAS can lead to pathophysiological changes such as chronic intermittent hypoxia, sleep fragmentation and sympathetic nerve excitation, which can lead to daytime drowsiness, cognitive dysfunction, mental and psychological abnormalities, etc., and can induce cardiovascular diseases such as hypertension, coronary atherosclerotic heart disease, arrhythmia, cardiac insufficiency or heart failure^[2]Cardiovascular comorbidities are the leading causes of disability and death in OSAS. The pathophysiological relationship between OSAS and cardiovascular diseases is complex and diverse. The related mechanisms and treatment progress are reviewed below.

C. difficile infection (Clostridium difficileinfection (CDI) is an infectious disease with the intestinal tract as the main manifestation caused by the excessive proliferation and release of toxins by the intestinal pathogenic Clostridium difficile. The clinical manifestations can range from mild self-healing diarrhea to severe pseudomembranous colitis, sepsis syndrome, toxic megacolon and even intestinal perforation^[1]。 Since the 21st century, the incidence and severity of CDI have been increasing worldwide, especially the emergence and outbreak of high-producing strain of Clostridium difficile (BI/NAP1/027 toxin type III), which makes Clostridium difficile one of the important pathogens related to medical and health^[2]。 Antibiotics have been used to treat CDI for more than 30 years, mainly metronidazole and vancomycin. However, in recent years, the sensitivity of these drugs has decreased, and the recurrence rate after cure is as high as 25% ~60%^[3]So that patients with severe CDI can only undergo subtotal colectomy after failure of antibiotic therapy. Therefore, the correct treatment of CDI and prevention of its recurrence is particularly important, and the development of new methods is imminent.

Colorectal cancer is one of the common malignant tumors in western countries. U.S. cancer statistics show that there are more than 100,000 new cases of colon cancer every year, ranking third among all malignant tumors in incidence and second among all tumors in mortality^[1]。 With the improvement of people's living standard, the change of dietary structure and the influence of environmental factors, the incidence of colorectal cancer in China has also increased obviously. According to the 2007 National Cancer Registry, colorectal cancer has risen to the third highest incidence rate and the fifth highest mortality rate among all malignancies^[2]。