2017年 · 第97卷第23期

interventional medicine (interventional medicine) is a new clinical discipline developed from imaging medicine after the 1970s, and it is also one of the most dynamic and fastest developing disciplines in the current medical field. The concept of "interventional medicine" was formally put forward in 1996 at the "Chinese Interventional Medicine Development Strategy and Academic Symposium" organized by the State Science and Technology Commission, the Ministry of Health and the State Medical Administration^[1]。 In recent years, interventional medicine in China has developed rapidly, and the number of interventional specialists, difficult interventional technology projects, minimally invasive interventional diagnosis and treatment, and national scientific research projects have all increased rapidly^[2]。 However, like other emerging disciplines, the system construction of interventional disciplines and medical education is far from keeping up with the progress of interventional diagnosis and treatment. The vague development orientation of disciplines and the lack of independent talent training mechanism have seriously hindered the development of interventional disciplines, which has also led to huge differences in the development of interventional disciplines and uneven medical quality across China. The development of interventional medicine has experienced bumps. This article intends to briefly review the development course and current situation of interventional medicine, and discuss the current situation and future vision of interventional medicine in China.

The patient was a 41-year-old male. One month ago, there was cough, sputum, white sputum, difficult to cough up, no fever, no hemoptysis, no chest tightness, shortness of breath and other discomfort without obvious inducement, and the symptoms did not improve after self-administration of anti-infective and phlegm-reducing drugs. Tuberculosis antibody IgG positive and IgM negative in other hospitals; Check the normal range of tumor markers; WBC 15.8×10⁹/L, neutrophils 84.9%. Related examinations after admission: chest CT (Figure 1): Multiple lymph nodes in the right hilum, mediastinum and right supraclavicle are enlarged, and malignant tumors and lymphomas need to be considered; Emphysema. PET/CT: The uptake of radioactivity in the right supraclavicular, mediastinal and right hilar area was significantly increased, and lymphoma was considered first. Fiberoptic bronchoscopy showed that the right middle bronchus was slightly narrowed, and the mucosa was swollen with a few granular changes. The pathological results of fiber brush showed normal columnar epithelial cells, and no obvious signs of malignant tumor cells were found. Laboratory tests: procalcitonin normal range; Tuberculosis antibody (-), TB infection T cell detection unreactive type, TB infection gamma interferon antigen A and B were in the normal range, eosinophilic count 420/μ L (50.0-300.0/μ L), preoperative immune negative. The patient's symptoms did not improve significantly during 5 days of empirical anti-infective treatment and symptomatic treatment such as cough relief and phlegm resolution, and the body temperature showed intermittent fever during the treatment, up to 39 ℃. After comprehensive consideration, tuberculosis and reactive lymph node enlargement were first ruled out, but lymphoma, hematological diseases and metastases could not be further identified for the time being, and specific infection could not be excluded. One week later, the reexamination of chest CT showed that the right hilar lymph nodes were slightly enlarged, but the mediastinum and right supraclavicular lymph nodes did not change significantly. Lymphocytes, neutrophils and multinucleated giant cells were found in the fine needle aspiration smear of the right supraclavicular lymph node, but no tumor cells were found. Right supraclavicular lymph node resection was performed. Histopathological report: granuloma was composed of a large number of multinucleated giant cells and a large number of chronic inflammatory cells. Some granuloma was necrotic, and spherical capsulated bacteria were seen in multinucleated giant cells. Both PSA and PASM were positive (Figure 3)。 The patient's body temperature returned to normal on the first day after lymph node resection; There was no further increase or fluctuation in body temperature. According to the pathological results, cryptococcal infection was diagnosed, and fluconazole 200 mg was given twice a day. The cough was significantly improved. After 2 months, reexamination of chest CT showed that the right supraclavicular and right hilar lymph nodes were no longer obvious, and the intramediastinal lymph nodes were significantly smaller than before (Figure 2)。

Infection has always been a topic in the Department of Critical Care Medicine (ICU), and sepsis induced by infection is one of the most common diseases in critically ill patients, which has attracted much attention because of its critical condition, high mortality rate and expensive medical expenses. Since the definition and diagnostic criteria of sepsis were put forward, it has gradually been widely accepted and applied in clinical practice. With the deepening of clinical practice and experimental research, clinicians' understanding of organ and cell dysfunction and pathophysiological mechanism in sepsis patients tends to be more perfect and mature, and the definition and diagnostic criteria of sepsis have been revised and updated several times. The latest sepsis is defined as a clinical syndrome in which the host is dysresponsive to infection and develops life-threatening organ dysfunction^[1]。 The new definition of sepsis emphasizes organ dysfunction caused by infection, reflecting a more complex pathophysiological state than in ordinary infected patients. Despite the continuous progress in the understanding and diagnosis and treatment of sepsis, sepsis still brings a huge burden to global medical and health care. A meta-analysis of 27 studies from developed countries showed that the annual incidence of sepsis in the past 10 years was 437/100,000, and the mortality rate was 17%; The annual incidence of severe sepsis is 270/100,000 and the mortality rate is 26%^[2]。 The liver is the largest detoxification organ in human body, which participates in the clearance of inflammatory factors or inflammatory products, and plays an important role in regulating metabolic disorders and maintaining the internal environment of the body. At the same time, the liver is one of the organs most commonly involved in sepsis. The pathogenesis of hepatic dysfunction in sepsis is complex and there is no uniform definition at present^[3]At the same time, due to the lack of reliable indicators, early hepatic dysfunction cannot be detected^[4]。

The implantation of human embryos into the endometrium is a complex sequence of procedures involving many biological mechanisms. The two major factors that affect successful implantation are the quality of the embryo and the receptivity of the endometrium to the embryo. Although the current assisted reproductive technology has made remarkable progress in the treatment of infertility, the application of new controlled superovulation technology, intelligent embryo culture system and ultrasound-guided embryo transfer technology has greatly improved the clinical pregnancy rate. In vitro fertilization and embryo transfer (IVF-ET), the success rate of in vitro fertilization and embryo implantation into the uterus can reach 90%, but the clinical pregnancy rate has not improved accordingly, and has been floating around 40%, and the birth rate is only about 30%^[1,2]。 At present, the important reason for limiting the success of IVF is still the failure of embryo implantation, which may come from the lack of synchronization between embryo and maternal endometrium^[3,4]That is, the endometrium lacks receptivity during the optimal implantation period of the embryo. Endometrial receptivity (ER) refers to the ability of the endometrium to accept the blastocyst and allow the blastocyst to induce a series of changes in the endometrial stroma, and finally implant the endometrium. The endometrium can accept the embryo to the maximum extent, and the time for the embryo to implant smoothly is called the "implantation window" (WOI). The embryo cannot be accepted for implantation too early or too late, that is, the implantation window is closed^[5]。 At present, it is generally believed that the opening time of the implant window is in the mid-luteal phase, and the optimal endometrial receptivity time occurs about 6~8 days after the peak of luteinizing hormone (LH)^[6,7]。 The research progress of endometrial receptivity assessment indexes and clinical application in recent years is reviewed as follows.

cervical spondylotic amyotrophy (CSA) is a special type of cervical spondylotic disease, which is based on the degeneration of the cervical spine, mainly manifested as upper limb muscle atrophy, mainly unilateral, usually without or with mild paresthesia and spinal cord lesions (mainly manifested as lower limb symptoms and abnormal gait)^[1]。 Brain et al^[2]Cervical spondylosis with upper limb muscle atrophy as the main manifestation was reported for the first time, Keegan^[3]It is considered that the selective injury of motor nerve root caused by osteophyte formation caused by cervical degeneration is the main factor of upper limb muscle atrophy in patients with cervical spondylosis, and the phenomenon of upper limb sensorimotor separation, also known as Keegan type cervical spondylosis, is proposed^[1]。 Sobue et al.^[4]The theory of segmental spinal myelopathy was put forward, and the cervical spondylosis characterized by upper limb muscle atrophy was named "amyotrophic cervical spondylosis".

Parkinson's disease (PD) is a common degenerative disease of the central nervous system in middle-aged and elderly people, and its clinical manifestations are divided into two main types of symptoms: dyskinesia and non-dyskinesia. The main symptoms of dyskinesia are tremor, hypomobility, rigidity, postural balance disorder, etc. Non-dyskinetic symptoms include depression, Parkinson's disease psychosis (PDPsy), dementia, sleep disorders, and the like. Compared with movement disorders, non-movement disorders are still lacking effective drug treatments, so they pose different burdens on patients and caregivers^[1]。 PDPsy is more common in intermediate and advanced PD patients, which not only increases the burden on caregivers, but also further reduces the quality of life of patients and increases the mortality rate^[1]； At the same time, most antipsychotics have dopaminergic receptor antagonism, which will aggravate the motor symptoms of patients, which brings difficulties to the treatment of PDPsy. In this paper, the research progress of PDPsy is reviewed.