2014年 · 第94卷第28期

In 2014, the International Alliance Against Epilepsy (ILAE) Working Group released a practical definition of epilepsy based on practical clinical needs^[1]To distinguish it from the definition of epilepsy issued by the ILAE and the International Association of Epileptic Patients (IBE) in 2005^[2,3], referring to the latter as a conceptual definition. Therefore, in the new century, epilepsy has two definitions: a practical definition (hereinafter referred to as the new definition) and a conceptual definition (hereinafter referred to as the old definition). Why is there a new definition of epilepsy, what is the difference between the old and new definitions, how clinically operable is the new definition, and what is the importance of the new definition? Based on the literature and clinical practice, this article tries to make an analysis, to introduce the new definition, looking forward to everyone's heated discussion and in-depth discussion.

At present, chronic obstructive pulmonary disease (COPD) is mainly treated with drugs, including bronchodilators, beta-adrenergic receptor agonists, anticholinergic drugs and inhaled corticosteroids, and oral hormone therapy in acute exacerbation. However, none of these methods can improve the mechanical mechanism of emphysema caused by hyperinflation. For some end-stage patients, the effect of drug therapy is not ideal. Trans-bronchoscopic LVRS developed on the basis of surgical lung volume reduction (LVRS) provides a new option for the treatment of patients with severe emphysema^[1]。 Since November 2012, we have completed 3 trans-bronchoscopic LVRS, but only 1 was successful, which is summarized below.

The patient was a female, 11 years and 5 months old. He was admitted to the Department of Endocrinology of Peking Union Medical College Hospital in March 2014 due to clitoral hypertrophy for 2 years. The patient was the third child and the first birth. The mother had no abnormalities in prenatal examination during pregnancy. Full-term dystocia was converted to caesarean section. There was no asphyxia after birth. She had a birth weight of 3.2 kg and a length of 55 cm. She had a normal baby girl's vulva, small clitoris, no dark skin color and esotropia in both eyes. Height since childhood is taller than children of the same age. 2 and a half years old, diagnosed "hyperopia and amblyopia" in an outside hospital. At 3 years old, he underwent binocular esotropia correction operation, and his visual acuity improved after operation. At 4 years old, the nails of both hands showed spoonlike nail-like changes, which later developed to both toenails. He went to primary school at the age of 7, with above-average grades and good sports scores. At the age of 8, bilateral eyebrows fell off, and then returned to growth and were thicker on their own. From the age of 9, the clitoris gradually became bigger, and occasionally the clitoris was erect. There was pain in both breasts, but the breasts were not enlarged. The height and weight increased significantly faster than those of children of the same age, and the height increased by 8~9 cm every year. After that, the voice gradually became thicker, the pubic hair grew, the appetite was better, the strength was greater than that of girls of the same age, and there were no menstrual cramps and periodic abdominal pain. In February 2014, I went to an outside hospital, and the color ultrasound of the uterus and adnexes showed "hypoechoic nodules behind the bladder, about 2.6 cm ×1.1 cm, shaped like the uterus; bilateral ovaries were not detected; and no obvious mass echoes were found in the pelvic cavity". Color ultrasound of perineal area and bilateral inguinal area "no obvious testicular echo detected; clitoral hypertrophy". The peripheral blood karyotype is "46, XY". In March 2014, I visited the outpatient department of endocrinology of Peking Union Medical College Hospital, and checked the sex hormones: total testosterone 8.1 nmol/L (normal value for women 0.2~3.0 nmol/L), luteinizing hormone (LH) 38.15 U/L, follicle stimulating hormone (FSH) 109.8 U/L, and estradiol 155.6 pmol/L. Prolactin 0.59 nmol/L (normal<0.87 nmol/L). The patient's parents denied that there were androgenic drugs at home, and denied that the patient had a history of taking drugs or health products. Past history, personal history, family history: Nothing special.

Chronic constipation refers to a decrease in the frequency of bowel movements, dry stool, and laborious bowel movements, with a course of at least 6 months. The prevalence rate of chronic constipation in people over 60 years old in China is 7.30% ~20.39%, and the prevalence rate increases significantly with age. The prevalence rate of women is significantly higher than that of men, and the prevalence ratio of men to women is 1:1.77~1:4.59. Functional disorders associated with chronic constipation include functional constipation (FC), functional defecation disorders, and constipation-type irritable bowel syndrome (IBS-C). The pathogenesis of chronic constipation is not clear, and dietary intervention, laxatives and prokinetics are usually used. In recent years, there has been gradual evidence that intestinal flora abnormalities are involved in the pathogenesis of chronic constipation, so the intervention of intestinal flora by microecological preparations to treat chronic constipation has gradually attracted people's attention.

Dyslipid metabolism is considered to be a major risk factor for ischemic cardiovascular disease, especially stroke^[1]。 Many epidemiological studies focused on the correlation between blood lipids and cardiovascular and cerebrovascular diseases^[2,3]。 In 2007, the "Guidelines for the Prevention and Treatment of Dyslipidemia in Chinese Adults" redefined the dyslipidemia of Chinese people with ischemic cardiovascular disease events (including coronary heart disease and stroke) as the joint endpoint^[4]。 The aorta, as the main pipeline connecting the heart with the organs and limbs of the whole body, is also bound to be affected by dyslipidemia and cause disease. As an important unit of aortic disease, the correlation between abdominal aortic aneurysm (AAA) and blood lipids has received more attention. This paper summarizes the research progress in this area.

Insomnia and obstructive sleep apnea (OSA) are two common diseases in sleep medicine^[1,2], associated with hypertension, stroke, cardiovascular death and mortality^[3,4]。 Studies show that 40% to 67.4% of OSA patients have insomnia symptoms^[5], but there are few studies on comorbid OSA in patients with insomnia. 1973, Guilleminault et al.^[6]A case of insomnia comorbid OSA is reported for the first time. However, over the past 40 years, insomnia-related OSA has received little attention compared to OSA-related daytime sleepiness. The comorbidity research of insomnia and OSA is summarized as follows.

A 55-year-old male underwent hepatocellular carcinoma in January 2009. In July 2012, he was treated with radiofrequency ablation once due to recurrence of liver surgery area. In November 2012, palpitation and fatigue gradually worsened. Physical examination at admission: heart rate 90 beats/min, regular rhythm, mild edema of both lower limbs, normal liver function, AFP 9.9 μ g/L, nuclear magnetic resonance (MRI) showed recurrence involving inferior vena cava and right atrial tumor thrombus (7.0 cm ×4.6 cm) after comprehensive treatment of liver cancer. Therefore, gamma-ray stereotactic radiotherapy for recurrent lesions and tumor thrombus in the left inner lobe of the liver was given 3.5 Gy/time ×10 times, and cardiac V30=21%. Six months after radiotherapy, the atrial tumor thrombus was partially remitted (1.8 cm ×2.0 cm), and the atrial tumor thrombus completely disappeared on 12 November 2013 (Figure 1)。 The patient had a higher quality of life with a KPS score of 90.