2014年 · 第94卷第46期

With the continuous improvement of people's living standards, the incidence of arteriosclerosis obliterans is getting higher and higher. Lower extremity arteriosclerosis obliterans mainly occur in femoropopliteal artery and inferior genicular artery. Previous studies of our research group have shown that arteriosclerosis obliterans without diabetes mainly occur in the superficial femoral artery and its proximate arteries, while arteriosclerosis obliterans of lower limbs in diabetic patients mainly occur in the superficial femoral artery and its distant arteries; Inferior genicular artery lesions first involve the anterior tibial artery, followed by the posterior tibial artery, and finally the peroneal artery^[1,2]。 This is slightly different from foreign sources^[3,4]Foreign studies have shown that the inferior genicular artery first involves the posterior tibial artery, followed by the anterior tibial artery, and finally the peroneal artery.

According to statistics, the prevalence of constipation in adults in China is 3% ~17%^[1]The prevalence of chronic constipation is 4% ~6%^[1,2,3,4]。 The Guidelines for Diagnosis and Treatment of Chronic Constipation were formulated at the National Constipation Symposium in Nanchang in 2003, and revised twice in 2007 and 2013^[5]。 Because of the special physiological structure of pregnant women and gynecological patients, the prevalence of constipation is higher than that of the general population. The prevalence of constipation in pregnant women reported abroad ranged from 11% to 38% and varied with different stages of pregnancy^[6,7,8,9]。

A 39-year-old male was admitted to the Department of Cardiology of Peking Union Medical College Hospital on May 4, 2014 due to "edema of both lower limbs for 3 years, cough for nearly 2 years, and asthma after activity for more than 1 year". In July 2011, the patient developed symmetrical concave edema of both lower limbs, which was light in the morning and heavy in the evening. The examination showed elevated liver enzymes and bilirubin, and abdominal CT showed "cirrhosis". After liver protection treatment, the edema of both lower limbs did not improve. In October 2012, intermittent dry cough began to appear, the coagulation function was normal, the antinuclear antibody was weakly positive, the chest CT showed "interstitial pneumonia", the abdominal CT showed "cirrhosis and portal hypertension, the main portal vein and its branches were slender, and thrombosis in the lumen, and peripheral cavernous change"; Echocardiography "left ventricular ejection fraction (LVEF) 63%, whole heart enlargement (left atrium 48 mm, right atrium 55 mm ×58 mm, left ventricle 66 mm, right ventricle 29 mm), ventricular septal thickening (13 mm), mild mitral and tricuspid valve regurgitation, abnormal left ventricular filling". In February 2013, I experienced impaired activity tolerance, shortness of breath and wheezing after climbing 4 floors. In November 2013, the serum albumin was decreased and the coagulation time was prolonged (details unknown). The diagnosis was "connective tissue disease? Interstitial pneumonia, cardiodilation, and decompensated cirrhosis". Methylprednisolone was administered orally, 24 mg, once/d, and then decreased by 4 mg every week after 1 month (2 months in total). After the patient's activity, the symptoms of asthma were obviously aggravated. He climbed 2 floors and walked hundreds of meters on the flat ground and felt asthma. Cough, cough of white phlegm, edema of both lower limbs were also aggravated than before, and edema of the waist and both upper limbs appeared. After albumin, plasma and diuretic treatment, the edema was relieved, and the asthma was still progressively aggravated after activity. In March 2014, the echocardiogram of a foreign hospital showed "LVEF 61%, whole heart was large, and there was a small amount of mitral and tricuspid valve regurgitation", and it was recommended to see a superior hospital. In April 2014, the blood gas examination in our hospital outpatient clinic: pH 7.482, arterial oxygen partial pressure (PaO₂) 38.8 mmHg (1 mmHg =0.133 kPa), arterial oxygen saturation (SaO₂) 72.0%, alveolar-arterial oxygen partial pressure difference 72.1 mmHg, arterial blood carbon dioxide partial pressure (PaCO₂) 32.6 mmHg; Brain natriuretic peptide 74 ng/L. The lung passed through imaging for the first time: multiple patchy perfusion decreased in both lungs, and the extrapulmonary shunt rate was 39.0%. It was considered that there was right-to-left lung shunt, which was in line with hepatopulmonary syndrome. Admitted to hospital for further treatment.

A 2.5-year-old male was admitted to the hospital on July 31, 2013 due to "cough and shortness of breath for 1 month, aggravated for 2 days". The child developed a cough 1 month ago, which was not serious, occasionally shortness of breath, obvious after activity, no cyanosis, no wheezing, no fever, night sweats, and weight loss, but it was not paid attention to. Two days ago, the child had aggravated cough, paroxysmal cough, cough 4-5 times, obvious shortness of breath, no cyanosis, accompanied by fever, body temperature 38.8℃ (ear temperature), came to the emergency room of our hospital, and was treated with nasal tube oxygen, ceftriaxone anti-infection, ambroxol to reduce phlegm, human albumin support, etc. CT showed: two lung infection with bilateral pleural effusion, thoracic and abdominal B-ultrasound showed: peritoneal effusion, bilateral pleural effusion, with "multiple serous effusion, tuberculosis possible" admission to hospital. The family denied that the child had a history of contact with tuberculosis patients and had been vaccinated with BCG.

The patient, a 29-year-old female, was sent to the local hospital at 8 o'clock on May 5, 2013. After eating "instant noodles" for 15 minutes, she developed skin itching and congestion all over her body, accompanied by nausea and vomiting, without obvious asthma, cyanosis, fever, etc., and then lost consciousness. After more than 10 minutes, she was sent to the local hospital. Her blood pressure was measured at 60/30 mmHg (1 mmHg =0.133 kPa), and she was given dopamine and fluid rehydration. During the installation of ECG monitoring, she developed cardiac arrest. After artificial cardiopulmonary resuscitation and fluid rehydration treatment, her heartbeat recovered (details are unknown). After about 30 minutes, she was transferred to the local superior hospital. Her blood pressure was measured at 80/60 mmHg, and she was given tracheal intubation, intravenous dopamine, methylprednisolone and a large amount of fluid rehydration. The patient's blood pressure could be maintained at about 110/90 mmHg, her vital signs were stable, and the rash gradually subsided, but she was still unconscious, and she showed positive binocular gaze and bilateral pathological signs. CT examination of the head showed "mild cerebral edema", so she was transferred to the intensive care unit (ICU) of our hospital. Past history: The patient is a Shandong native, a farmer, who has used buckwheat peel pillows for a long time. He has intermittently had clear nose and sneezing in the morning for more than 10 years. He has attacks in all seasons, and it is aggravated from August to September. He has no wheezing and no regular treatment. He denies the history of pet raising, family history of allergic diseases and history of drug allergy. Diagnosis: The cause of shock is to be investigated, anaphylactic shock is likely, intracranial edema, allergic rhinitis.

Lung cancer is the leading cause of cancer-related death, with 85% of newly diagnosed lung cancers each year being non-small cell lung cancer (NSCLC)^[1]Of which adenocarcinoma and squamous cell carcinoma account for 50% and 30% respectively^[2]。 In recent decade, with the development of molecular biology, targeted therapy has become one of the important therapeutic methods for advanced NSCLC^[3]Molecular targeting drugs represented by epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) have made great progress in the treatment of NSCLC. The data on the efficacy of EGFR-TKI mostly comes from the study of lung adenocarcinoma, and there is no clear independent study in lung squamous cell carcinoma. It makes one wonder: What is the use of EGFR-TKI in lung squamous cell carcinoma? At present, the standard treatment plan for advanced lung squamous cell carcinoma is still platinum-based two-drug chemotherapy, and the treatment method is relatively limited. Although the chemotherapy regimen has been continuously updated and developed in the past 30 years, its efficacy seems to have reached a bottleneck state. The objective response rate is only 30% ~40%, and the median survival time for stage IIIB and IV lung squamous cell carcinoma is only 1 year^[4]。 Most patients with advanced lung squamous cell carcinoma have fewer treatment options and drugs to choose from after first-line and second-line chemotherapy, and due to the lack of evidence-based medical evidence of the efficacy of molecular targeted drugs on lung squamous cell carcinoma, it is urgent to explore the targeted therapy of lung squamous cell carcinoma.

dermoscopy was born in the 19th century. It is a non-invasive and non-invasive examination method. It can not only provide a light source and magnify the skin lesions, but also show the superficial layers of the epidermis and dermis through the cuticle of the epidermis, and observe the fine structures invisible to the naked eye, such as pigments and vascular structures^[1]。 Because most of the structures visible under dermatoscopy have a certain correspondence with histopathological manifestations, dermatoscopy is considered to be a bridge between clinical (gross structure) and histopathological examination (microstructure). Dermatoscopy was initially used in the diagnosis of pigmented tumors, especially in the differentiation between malignant melanoma and benign pigmented nevus, which improved the accuracy of the diagnosis of pigmented tumors, especially malignant melanoma, and also reduced the unnecessary resection of benign pigmented tumors. At present, the research in this field has been very mature^[2]。 In recent years, dermoscopy has been extended to a wider range of fields, such as benign or malignant non-pigmented skin tumors, vascular diseases, bacterial and viral infectious diseases, and inflammatory skin diseases. Dermoscopes are widely used in clinical practice and are called "stethoscopes" for dermatologists. This article mainly reviews the application of dermatoscopy in non-pigmented skin disorders (NPSD), especially inflammatory skin diseases and non-pigmented skin tumors.

Most deaths in patients with gastric cancer are caused by metastasis. Invasion and metastasis are the main characteristics of gastric carcinogenesis and development. Previous studies have focused on the effects of molecular pathological changes on a series of biological behaviors such as proliferation, invasion and metastasis of gastric cancer cells. Although some progress has been made, no molecular markers have been found that can predict the invasion and metastasis of gastric cancer. In recent years, a large amount of evidence indicates that the occurrence and metastasis of tumor are closely related to the microenvironment in which tumor cells are located. extracellular matrix (ECM), as a component of tumor microenvironment, plays an important role in the proliferation and invasion of gastric cancer: on the one hand, ECM acts as a defense barrier of the body, controlling the proliferation, differentiation and distant migration of tumor cells; On the other hand, the remodeled ECM constructs a loose "soil" for tumor invasion, resulting in high proliferation, poor differentiation, apoptosis inhibition, invasion and metastasis of tumor cells. Recent studies have shown that ECM can be involved in regulating the biological properties of cancer stem cells (CSCs), such as "dry" maintenance and self-renewal^[1,2]。 Therefore, defining the specific role of ECM protein in the tumor microenvironment and the signaling pathways involved in cell-extracellular matrix interactions will help discover new therapeutic strategies to prevent and treat gastric cancer metastasis.

The patient was a 36-year-old male with skin nodules on the face, trunk and limbs for more than 4 years. Since 2010, the patient has developed skin-colored skin nodules in both upper limbs without obvious trigger, which gradually expanded to the whole body within six months without itching, pain, ulceration and pus discharge. No fever, joint swelling and pain, fatigue, photosensitivity, oral ulcer, etc. In 2011, he visited a local hospital and was treated with methylprednisolone, leflunomide, tripterygium wilfordii, total angelic glycosides capsules and thymopentin injection successively, but there was no significant change. The posterior part of the nodule gradually changed from skin color to purple-red, and yellow liquid could be seen flowing out after scratching the nodule. History of systemic disease denied. A family genetic history is denied. Personal history, marriage and childbirth history are not special.

A 77-year-old male was admitted due to paroxysmal precordial pain, chest tightness and shortness of breath for 4 years, aggravated for 2 days. Previous history of hypertension 1 year, highest unknown, acceptable drug control, previous smoking 30 years. "Intermediate aortic syndrome" was diagnosed 3 months ago.