2016年 · 第96卷第02期

Prostate cancer (Pca) is a common malignant tumor of the urinary system. In the world, its incidence and mortality rank second and seventh among male malignant tumors, respectively^[1]。 In China, the incidence of Pca has jumped to the first place in male urinary system malignant tumors, reaching 9.92/100,000, and showing an increasing trend year by year^[2]。 Therefore, more early screening, diagnosis and intervention for Pca patients are imminent. Circulating tumor cells (CTCs) were discovered by Ashworth in 1869^[3]In the peripheral blood of a patient who died of cancer, it was found that tumor cells that survived from the primary tumor or metastatic tumor by active or passive way and escaped immune killing. They had similar genetic characteristics and antigen expression to the primary tumor, and were closely related to the metastasis and recurrence of Pca and other cancers. The progress of the new detection methods of CTC and its application in Pca in recent years and related problems will be described as follows.

Influenza (referred to as influenza) virus belongs to Orthomyxoviridae (Orthomyxoviridae), mostly spherical granular, according to the virus nuclear protein and matrix protein antigen divided into three types A, B and C^[1]。 Influenza A virus is divided into several subtypes according to its surface hemagglutinin and neuraminidase. There are 16 subtypes of hemagglutinin (H1~ H16) and 9 subtypes of neuraminidase (N1~ N9)^[1], prevalent in humans are mainly the A H1N1 and A H3N2 subtypes^[2]； Both influenza B and C viruses have only one antigenic subtype, and the host species are limited, so influenza pandemics are less common^[3,4]。

A 60-year-old male was admitted to the hospital on January 22, 2014 due to "dry mouth, polydipsia, polyuria for more than 3 years and bone pain for 3 months". The patient developed dry mouth, polydipsia, and polyuria without obvious trigger since July 2010. He needed to drink water once every 20 minutes, about 200 ml each time. He liked cold drinks, accompanied by increased urine output (>6 L per day), and nocturia 5~6 times/d. In the local hospital, the urine specific gravity was 1.005~1.008, and the serum sodium (Na) was 149.5 mmol/L, and the rest was roughly normal. After the water-free-pressure test, he was diagnosed as "central diabetes insipidus". Desmopressin acetate 1 mg was administered orally every 8 hours, and the symptoms of dry mouth were alleviated, and the urine output was reduced compared with before. In October 2010, I went to our hospital to check the MRI of the saddle area: the short T1 signal in the posterior pituitary lobe was unclear; The pituitary stem was slightly thicker (3.5 mm), consistent with the central diabetes insipidus presentation. In November 2013, the patient developed bone pain, which was obvious in both lower limbs, without redness and swelling, increased skin temperature, accompanied by protuberance of the middle tibia, tenderness, aggravated after activity, and intermittent fever, with a maximum body temperature of about 38 ℃, accompanied by loss of appetite, fatigue, and weight loss (weight loss of about 10 kg in the past year). Blood test routine in local hospital: white blood cell count (WBC) 10.9×10⁹/L, neutrophil percentage (Neut%) 0.702, hemoglobin (HGB) 124.6 g/L, platelets 443×10⁹/L; Blood biochemistry was roughly normal; Urinary routine: specific gravity 1.010, urine protein, urine occult blood, urine white blood cells and urine glucose were all normal; Fecal occult blood negative (-); Erythrocyte sedimentation rate (ESR) 74 mm/1 h, ferritin 409.8 μ g/L (normal value 30.0~400.0 μ g/L), tumor indexes: glycoprotein antigen 724: 12 800 U/L (normal value 0~8 200 U/L), alpha-fetoprotein, glycoprotein antigen 199, carcinoembryonic antigen and prostate specific antigen were not abnormal; Immunoglobulin, complement and thyroid function were normal; Testosterone 1.7 nmol/L (5.6-30.5 nmol/L), prolactin 493.0 mU/L (55.1-383.7 mU/L); Serum cortisol was 206.1 nmol/L (171.0-536.0 nmol/L), adrenocorticotropic hormone (ACTH) was 9.28 ng/L; Right tibia X-ray: low density area of middle right tibia; Bilateral tibial CT: bilateral tibial medullary cavity density uneven, multiple subcortical cystic degeneration, local bone destruction; MRI of sellar region: the posterior pituitary gland is unclear, the pituitary stem is thickened, and the enhancement is uneven in the enhancement scan; Compared with the old film in 2010, the pituitary stem was significantly thicker (6.4 mm) than before. PET-CT: multiple bone density abnormalities and damaged areas within the scan range, increased fluodeoxyglucose uptake, myeloma? Metastasis? Biopsy of the right tibial lesion was performed. Pathology: (right tibial puncture) A large number of lipid-containing histiocytes and scattered lymphoid and plasma cell infiltration were seen in the fibrous tissue of small stripes of hyperplasia, and a few degenerative necrotic tissues and suspected epithelial tissues were seen locally. On January 22, 2014, he was admitted to the hospital with "the causes of polydipsia, polyuria, bone pain and fever to be investigated". Since the onset of the disease, the spirit, appetite and sleep are poor, defecation is normal, nocturia is 3 to 4 times, and the weight has lost about 10 kg in the past year. Previous: Increased blood pressure has occurred in the last 3 months. Personal history: smoked 1 pack/d × more than 20 years, and quit smoking for more than 10 years. Occasionally drinking. The history of marriage and childbirth and family history are not special.

Clinically, the main therapeutic effect of glucocorticoid (GC) is its anti-inflammatory effect. Therefore, the anti-inflammatory mechanism of GC is most valued. The main mechanism of anti-inflammatory effect of GC is gene effect (also called genomic effect). In recent years, it has been recognized that the rapid effect (non-gene effect) is another important mechanism of GS, which is characterized by its rapid onset of action^[1]。 Some scholars have used this mechanism of action of GC for inhalation administration, and believe that high-dose budesonide suspension for inhalation (BIS) can also effectively activate the non-genetic pathway of action of hormones to produce rapid effects. Let's talk about our views here and discuss them with experts and colleagues.

According to the latest Global Asthma Initiative (GINA), bronchial asthma (asthma) is a heterogeneous disease, usually characterized by chronic airway inflammation, including respiratory symptoms such as wheezing, shortness of breath, chest tightness, cough that change over time, and with variable expiratory airflow restriction. Viral infection can both trigger and aggravate asthma^[1]。 It must be mentioned that Mycoplasma pneumoniae (MP), as an atypical pathogen, not only can cause lower respiratory infection, but also is closely related to the occurrence, development and acute exacerbation of asthma. In recent years, more studies have found that the incidence and degree of acute MP infection are higher in patients with asthma or allergic airway inflammation. Therefore, many researchers have devoted themselves to the study of the increased susceptibility of asthma to MP and its mechanism, trying to solve this clinical problem. This article mainly summarizes the relevant new molecular mechanisms at present as follows.

Bronchial asthma (abbreviated as asthma) is a chronic inflammatory disease of the airway involving a variety of cells and cellular components. As the course of the disease prolongs and progresses, the airway can produce irreversible narrowing and remodeling. Compared with adults, children's respiratory tract and lung development are not fully mature, and their sensitivity to air pollutants is higher, so they are the high risk population of asthma. A large sample survey in Europe showed that^[1]Of all asthma cases, 14% can be attributed to exposure to high traffic traffic roads; Assuming a causal relationship between traffic-related air pollution exposure and asthma, 15% of asthma symptom attacks are caused by air pollution exposure. Surveys in our country show^[2]Compared with 2000, the cumulative prevalence of childhood asthma in China has increased by 52.8% and the current prevalence has increased by 50.6% in the past 10 years. Accelerated urbanization, rapid industrial development, and lifestyle changes have aggravated air pollution, which is related to the increase of asthma in children^[3]。 In recent years, air pollution in China is serious, and its adverse health effects have attracted attention all over the world. The adverse effects of air pollution on childhood asthma must be paid attention to.

When a person is in a plateau environment for a long time, due to hypoxia, red blood cell excessive proliferation, blood viscosity increases, and a series of clinical symptoms such as dizziness, headache, shortness of breath, etc., which is called high-altitude polycythemia (HAPC)^[1]。 According to the standard of the 6th International Conference on Altitude Medicine in 2004, for people living at an altitude>2 500 m for a long time, the hemoglobin (Hb)>210 g/L in men and>190 g/L in women should be considered as HAPC, which has great influence on bone marrow hematopoietic system, coagulation function, lung function, immune function, renal function, cardiovascular system, central nervous system, liver, digestive tract and other organs^[2,3]。 The pathogenesis of HAPC is complex and has not been fully understood at present. It is generally believed that the balance of erythropoiesis is the characteristic of physiological hematopoiesis. Any cause of imbalance between mature red blood cells and immature red blood cells, and between erythropoiesis and erythropoiesis death may lead to hematopoietic pathology. HAPC is the result of these balance imbalances. Any link and any factor affecting these balance in the hypoxic environment of plateau may lead to the occurrence of HAPC.