2016年 · 第96卷第40期

Breast cancer is the most common malignant tumor in women. According to the World Cancer Report published by the World Health Organization (WHO) in 2012, there are about 1,671,000 cases of breast cancer in the world, accounting for the first new tumor in women^[1]。 According to the data of China's Cancer Registration Center, in 2011, the number of breast cancer cases among women in China was about 249,000, and about 60,000 died every year^[2]。 Most patients with breast cancer are hormone-dependent^[3]This type of patients is sensitive to endocrine drugs, and endocrine therapy is a very effective treatment for postoperative adjuvant therapy for patients with early estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer. The results of a meta-analysis by the Early Breast Cancer Clinical Research Collaborative Group (EBCTCG) in 2005 showed that the risk of recurrence and death in patients with early hormone receptor-positive breast cancer after surgery was reduced by 40% and 32% respectively^[4]。 Another meta-analysis also confirmed that patients with premenopausal hormone receptor positive breast cancer who received tamoxifen adjuvant therapy for 5 years reduced their 15-year recurrence and mortality rates by 13.2% and 9.2%, respectively^[5]。 Therefore, selective estrogen receptor modulators (SERM) have become the standard therapeutic drugs for patients with hormone receptor-positive early breast cancer. With the announcement of the results of large studies such as ATLAS and ATTOM, 10-year SERM drug treatment can further reduce the risk of recurrence and improve survival rate compared with 5-year treatment^[6,7]。 Therefore, the National Comprehensive Cancer Network (NCCN) guidelines, the American Association of Clinical Oncology (ASCO), StGallen and other major guidelines all recommend that patients with hormone receptor-positive early breast cancer can consider a 10-year treatment plan of SERM drugs.

Montgomery T-tubes have been dedicated to otolaryngologists for many years^[1]。 In recent years, due to the rapid development of respiratory interventional technology, tracheotomy is no longer the specialized technology of otolaryngologists, and more and more respiratory doctors can also perform tracheotomy and T-tube placement through respiratory endoscopy. However, due to the late development of this technique in respiratory department, there are still many things that need attention. The experience and experience of applying T-tube placement in our hospital in the past 2 years are summarized as follows.

The 26-year-old male was seen in the emergency department of our hospital on April 15, 2015 due to intermittent fever for half a year, asthma for 2 months, and recurrence and aggravation for 2 days. Six months ago, the patient developed fever without obvious trigger, which mostly fluctuated between 37.0 and 38.5 ℃, and the highest was 40.0 ℃. Occasionally, he had chills and chills, and had no cough or expectoration. He was given "cephalosporins" drugs to fight infection in another hospital, and his body temperature could return to normal. Asthma appeared without obvious trigger 2 months ago, and it worsened after general activity. Fever appeared again 2 days ago, and body temperature fluctuated between 38.0 and 40.0 ℃. There was no chest pain, hemoptysis, and edema of lower limbs. I went to the emergency department of our hospital. Chest CT scan showed multiple nodular shadows in both lungs (FIG. 1A), considering "pneumonia", given cefmetazole and moxifloxacin to fight infection for 2 days, body temperature dropped, asthma gradually worsened, asthma felt immediately after slight activity, check brain natriuretic peptide precursor (proBNP) 3 200 ng/L, the above symptoms were progressively aggravated, with general fatigue, dizziness, multiple transient amaurosis, blood pressure dropped to 75/45 mmHg (1 mmHg =0.133 kPa), mask oxygen inhalation, dopamine boost and other treatments. Transfer to our department for further diagnosis and treatment.

The patient was an 18-year-old female, a high school student. He was admitted to hospital on June 15, 2015 due to "cough, asthma and fatigue for more than 4 months". The patient complained that he had chills, cough and no fever after catching a cold in February 2015. After being treated with antibacterial and antiviral treatment according to "upper respiratory tract infection" in the school hospital, he still had repeated cough. The cough was paroxysmal with a little white sticky sputum. At the beginning of self-complaint, shortness of breath and discomfort appeared after running about 400 m, which could be relieved after rest, and there was no wheezing attack; Later, the symptoms gradually worsened, and I couldn't run, and I felt dyspnea when I walked fast or long distances. He went to the local hospital on April 6. Chest CT showed interstitial pneumonia in both lungs? (FIG. 1A), no improvement after anti-infective treatment (specific regimen unknown); On April 29th, he was hospitalized again in the local hospital. The pulmonary function test results showed: moderate to severe mixed ventilatory dysfunction (mainly obstruction), negative bronchodilation test, mild diffuse dysfunction, and moderately increased ratio of residual gas/total lung volume. Consider the diagnosis: (1) interstitial pneumonia; (2) Both pneumonia. Oral prednisone acetate tablets 25 mg, once a day, started on May 6; Roxithromycin sustained-release capsules 300 mg, once/d. The patient felt that his symptoms improved compared with before and was discharged from hospital on May 11th. Continue oral prednisone acetate tablets reduced by 5 mg every 6 days until discontinuation. One week after stopping the drug, he had a cough again, and he was obviously shortness of breath after walking 400~500 m. He went to our hospital on June 12. Chest CT showed that small pieces of ground glass shadows were visible in the upper lobes of both lungs and the lower lobe of the right lung (FIG. 1B), admitted to our department for dyspnea. The patient has been in good health and loves sports; The environment where he lived was humid, and all students in the same dormitory had symptoms similar to "upper respiratory tract infection" in the same period, but all recovered within one week. The patient has lost 5 kg of weight since the onset of the disease.

A 53-year-old male underwent colonoscopy due to blood in the stool for 1 year, and a huge flaky bulging mass from 2 to 15 cm away from the anal margin was found, and the pathology was villous tubular adenoma. After admission, digital anal diagnosis in the chest and knee position: a flaky soft mass can be palpable 2 cm away from the anal margin, but the upper pole of the mass cannot be palpable. The main body of the mass is located in the posterior wall of the rectum, and the tumor grows circumferentially 3~6 cm away from the anal margin. Endoscopic ultrasound showed that the lesion was confined to the mucosal layer, and it was decided to complete the resection of the tumor by transanal endoscopic microsurgery (TEM) combined with anorectal surgical instruments. Surgical methods: Routine intestinal preparation before operation, intubation and general anesthesia, the patient took the head low and foot high lithotomy position, inserted a TEM proctoscope through the anus to reach the upper pole of the tumor, and submucosal resection from the upper pole of the tumor was performed by TEM surgical system to 6 cm from the anal margin. The TEM operation was terminated, the corresponding instruments were withdrawn, and the German Wolf brand anorectal surgical instrument was used to resect the mucosa from the lower pole of the tumor to the rectum until the two-way convergence completely resected the tumor. The tumor was completely removed and fixed through the anus, and sent for rapid pathological examination. The return was tubular adenoma, and no adenoma cells were found at the circumferential margin and base. After careful hemostasis, adrenaline was sprayed on the wound surface, and the operation was ended. The patient recovered well on the 8th postoperative day and was cured and discharged.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a kind of clinical syndrome that causes repeated apnea and hypopnea at night due to repeated collapse and obstruction of the upper respiratory tract during sleep. It can involve all major systems and organs and cause systemic damage, among which cognitive impairment is one of the important complications^[1]。 Apolipoprotein E (APOE) is one of the main components of very low density lipoproteins, consisting of 299 amino acid residues with 3 alleles: APOE ε 2, APOE ε 3, and APOE ε 4^[2]。 APOE ε 4 gene plays a key role in the cognitive decline of neurodegenerative diseases, especially in Alzheimer's disease (AD). APOE gene also has a certain influence on the cognitive impairment of OSAHS. The research on OSAHS, cognitive impairment and its relationship with APOE genotype combined with domestic and foreign literatures is described as follows.

pituitary adenoma is a benign tumor originating from anterior pituitary cells, accounting for 10% to 15% of intracranial tumors. Accidental tumors are found in non-selective autopsy, accounting for about 20% to 30%. According to the secretory state, it is divided into hormone-secreting (functional) pituitary tumors and non-functional pituitary tumors^[1]。 The main treatments for functional pituitary tumors include surgery, radiotherapy, and medication. Except for prolactin adenoma, surgical treatment is the first choice for other types of pituitary tumors, mainly transsphenoidal resection; Some large tumors that invade the cavernous sinus are difficult to operate and can be treated with drugs. Radiotherapy is an adjuvant treatment^[2]。

Adolescent idiopathic scoliosis (AIS) is a common spinal deformity in women at the peak of puberty, with a reported incidence of 1.0% ~7.5%^[1,2]。 At present, spinal orthopaedic surgery is the most effective treatment strategy for AIS patients with severe deformity. Correct surgical plan can effectively correct spinal deformity, so that patients can obtain good three-dimensional reconstruction of spine immediately^[3]。 However, the natural outcome of AIS patients in the intermediate and long-term follow-up after orthopedic surgery is still inconclusive. This article reviews the previous literature studies evaluating the efficacy of mid-to long-term follow-up (>5 years) after AIS orthopedic surgery, and explores the mid-to long-term surgical efficacy from four aspects: imaging parameters, lung function, complications and quality of life, and compares it with the natural history of AIS, which are summarized below.

From August 19th to 21st, 2016, the 11th National Clinical Forum on Diagnosis and Treatment of Helicobacter Pylori and Digestive Diseases was held in Zhengzhou, Henan, the hinterland of the Central Plains. This forum was co-sponsored by Beijing Branch of Chinese Medical Association, Peking University First Hospital, Chinese Medical Journal, Zhengzhou University Fifth Hospital and China Helicobacter Pylori Information Center. Professor Hu Fulian of Department of Gastroenterology, Peking University First Hospital served as the chairman of the conference, Professor Yang Yunsheng, Dean Zheng Pengyuan and Professor Wang Huahong served as the co-chairmen, and Professor Zhang Xuezhi, Professor Cheng Hong and Professor Yang Guibin served as the executive chairmen.