2015年 · 第95卷第37期

Neutropenia is the main dose-limiting toxicity of cytotoxic chemotherapy drugs in patients with malignant tumors during chemotherapy. The degree and duration of the reduction are related to the increased risk of infection^[1,2]。 febrile neutropenia (FN) is commonly defined as an absolute neutrophil count (ANC) of less than 0.5×10⁹/L, or ANC less than 1.0×10⁹/L and is expected to be less than 0.5×10 within 48 h⁹/L, with a single intraoral temperature ≥38.3 ℃ or ≥38.0 ℃ for more than 1 h, or axillary temperature>38.5 ℃ for more than 1 h^[3]。 Patients with FN may reduce the dose of chemotherapy drugs or delay the treatment, thus reducing the clinical efficacy, and may also develop serious infection or even death. It may also increase the cost of diagnosis and treatment, which in turn leads to an increase in medical expenses.

A 22-year-old male was admitted to Xuanwu Hospital for the first time on July 31, 2014, mainly due to intermittent fever and headache for 2 weeks and trance for 7 days. On July 17, 2014, the patient developed fever without obvious trigger. The body temperature was measured at about 38℃, accompanied by headache. The headache was whole brain distension and pain, which was tolerable. There was no abdominal pain, diarrhea, cough or expectoration. The body temperature returned to normal after oral antibiotic treatment (details unknown), and the headache also improved slightly. Jul 24, 2014 · Sudden trance at work, lack of memory of what is happening around me, want to speak expressively but can't speak, and occasionally understand simple instructions. Visit the local hospital immediately, check lumbar puncture, CSF pressure 300 mmH₂O (1 mmH₂O =0.0098 kPa), White blood cells 372×10⁶/L, monocytes 0.2, multinucleated cells 0.8, glucose 1.1 mmol/L, protein 8.06 g/L, chloride 108 mmol/L, acyclovir 0.5 g intravenous drip, once/18 h antiviral, ceftriaxone 2 g intravenous drip, once/d anti-inflammatory, mannitol 125 ml intravenous drip, once/8 h intracranial pressure lowering, the patient's consciousness gradually improved after 3 days, and he could communicate and cooperate with physical examination, but the remaining memory loss and slow response. Later, he went to the 309 Hospital of the People's Liberation Army. The tuberculin (PPD) test result was negative for the exception of "tuberculous meningoencephalitis", and the lumbar puncture was re-examined: pressure 220 mmH₂O, white blood cells 239×10⁶/L, monocytes 0.92, multinucleated cells 0.08, glucose 2.15 mmol/L, protein 1.99 g/L, chloride 107 mmol/L, adenosine deaminase (ADA): 38.3 U/L, tuberculosis antibody negative, mixed lymphocyte culture negative, Mycobacterium tuberculosis test negative, tuberculosis infection was not considered, and anti-viral and anti-inflammatory treatment was continued. On July 31, 2014, he went to Xuanwu Hospital and was admitted to Shennei Group 11.

A 74-year-old female was admitted to the Department of Neurology, Institute of Field Surgery, Third Affiliated Hospital, Third Military Medical University in March 2014 due to recurrent dizziness, unstable walking, leftward tilt and blurred vision. Past History: Hypertension; Diabetes free. Family history is not special. Parents have died. No history of drug allergy. No history of head trauma. Admission physical examination: heart rate 81 beats/min, breathing 20 beats/min, blood pressure 142/85 mmHg (1 mmHg =0.133 kPa), clear consciousness, quick thinking, clear speech, cranial nerve (–), muscle strength of limbs grade 5, symmetric tendon reflex of limbs; Accurate finger nose, flexible rotation, Romberg sign (–), no abnormality in acupuncture pain examination, bilateral pathological sign (–). Preliminary diagnosis: (1) posterior circulation ischemic attack; (2) Grade 3 hypertension, high risk. The patient was scheduled to undergo head and neck CT angiography (CTA) examination.

As an important component of small veseel disease (SVD), leukoaraiosis (LA), also known as white matter lesions (WMLs) or white matter hyperintensities (WMHs), refers to spotty or patchy changes in periventricular or subcortical white matter caused by various causes, showing low density on CT and low density on MRI-T₁The weighted image shows an isosignal or a low signal, T₂High signal changes are present on weighted images and fluid-attenuated inversion recovery images (FLAIR^[1]。 It is currently believed that LA is one of the major imaging changes causing vascular cognitive impairment (VCI)^[2]However, the mechanism of its occurrence is still unclear, and it is also a hot topic of current research. In this paper, the neural mechanism of LA occurrence will be expounded from several aspects, such as chronic ischemia/hypoperfusion theory, blood-brain barrier disruption theory, endothelial dysfunction theory, inflammatory response theory, genetic theory and venous abnormality theory, so as to provide some theoretical basis for clinical diagnosis and treatment.

Heart failure (heart failure) has the characteristics of high morbidity, high mortality and high cost. Data from the United States show that central failure has exceeded 5.1 million people over the age of 20, and 825,000 new heart failure and 58,000 deaths among people over the age of 45 each year, costing $30.7 billion^[1]。 The American Heart Association (AHA) predicts that the incidence of heart failure will increase by 46% from 2012 to 2030, and more than 8 million people over the age of 18 will suffer from central failure^[2]。 With the change of lifestyle, the aging of the population and the increasing incidence of heart failure causes such as myocardial infarction, China is also facing the huge burden brought by heart failure. At present, there are 4.2 million patients with heart failure in China, and the incidence of central failure in people aged 35-74 is 0.9%^[3]。 Heart failure has now become an important burden of chronic diseases worldwide.

Human glioma is the most common intracranial tumor, derived from glial cells of brain tissue^[1,2]。 Identification of glioma-related genes will provide new ideas for glioma treatment^[3,4,5,6]CXCR4 has been shown to play an important role in the development of gliomas. The mechanisms of action of CXCR4 receptors in glioma survival, migration, invasion, proliferation, angiogenesis and immunomodulation are reviewed below.