2017年 · 第97卷第30期

Bronchial asthma (asthma for short) is a common chronic respiratory diseases. The prevalence of asthma is increasing due to the global industrialization and urbanization, environmental pollution and climate change. The disease burden of asthma is manifested both as an increase in the socio-economic burden caused by the loss of labor force and as a consumption of health resources. The acute attack of asthma is an important reason that leads patients to miss work and study, which affects the quality of life and increases the economic burden. Although most asthma patients require only outpatient visits, the proportion of costs incurred by emergency or hospitalization for acute asthma attacks is high.

In vivo confocal microscopy (IVCM) is a non-invasive examination technique, which uses laser as the light source, and has the advantages of high resolution (1 μ m) and high definition. Through continuous confocal scanning, the images of tissues and cells of the cornea can be clearly obtained in vivo. It is one of the important research methods to explore the pathological mechanism of disease from the cellular level^[1]。 In this study, 50 patients with viral keratitis clinically diagnosed between August 2014 and May 2015 were collected. By using confocal corneal microscopy (HRT), the morphological changes of cells in each layer of patients with epithelial keratitis, stromal keratitis and endothelial keratitis before and after treatment were observed, so as to provide morphological basis for further exploring the pathogenesis and outcome of keratitis.

The patient was a male, born in February 1995. He was admitted to the Department of Endocrinology, Huashan Hospital affiliated to Fudan University on July 29, 2014 due to "polydipsia, polydipsia and polyuria for 9 months, aggravated for more than 1 month". In October 2013 (18 years old), he developed polydipsia, polydipsia and polyuria without obvious trigger. He drank 6,000~8,000 ml of water daily, urinated more than 10 times, nocturia 4~5 times, about 250 ml each time, and had pale urine color. One week later, he developed paroxysmal pain in the left chest and occasionally headache, but there were no other symptoms such as diplopia, blurred vision, rash, and swollen lymph nodes. The chest X-ray examination of the patient at the local hospital revealed left rib lesions. In February 2014, single photon emission computed tomography (SPECT) examination performed in a foreign hospital revealed a lesion of the left fifth rib, which was considered as a malignant bone tumor. "Tumor resection of the left fifth rib + wedge resection of the left upper lobe of the lung" was performed. The pathology considered "eosinophilic granuloma" of the left fifth rib, involving the surrounding soft tissue (Figure 1)。 After operation, the patient consciously relieved the symptoms of polyuria (consciously improved dry mouth, reduced urine output, and nocturia reduced to 0~1 times), and no further diagnosis and treatment of eosinophilic granuloma and polyuria was made. In June 2014, the symptoms of polydipsia and polyuria recurred and worsened, accompanied by fatigue, soreness in both lower limbs, and insomnia. In July 2014, enhanced pituitary magnetic resonance imaging (MRI) in external hospitals showed thickening of the pituitary stem (Figure 2), combined with the symptoms of polyuria, was diagnosed as central diabetes insipidus, and was treated with mass coagulation (desmopressin acetate) 0.1 mg/time, 2 times/d, and the symptoms of polydipsia and polyuria were significantly improved. In order to further clarify the diagnosis and follow-up treatment plan, the patient was admitted to our department in July 2014.

A 52-year-old female was admitted to the Second Affiliated Hospital of Fujian Medical University with the main complaint of "left upper limb weakness for 2 days". The patient had left upper limb weakness without obvious trigger before admission, accompanied by asthma when climbing stairs, weak legs, slow walking with supports when walking on a flat road, left upper limb weakness persisted without relief, and the remaining symptoms were relieved after a few minutes of rest. The outpatient clinic improved the head CT: considering the possibility of cerebral infarction, it is planned to be admitted to the hospital for "cerebral infarction". Usually, intermittent bloody stools are not regularly diagnosed and treated. Physical examination: vital signs stable. The skin and mucosa of the whole body were not pale, and the superficial lymph nodes of the whole body were not palpable and swollen. No tenderness in sternum, physical examination of heart, lung and abdomen (-). Improve the diagnosis after blood routine, complete set of coagulation, complete set of biochemistry, tumor markers, color ultrasound, MRI, CT and other related examinations: (1) ethylenediaminetetraacetic acid (EDTA) -related pseudoleukopenia; (2) cerebral infarction; (3) Colon cancer is incomplete intestinal obstruction and has multiple metastases throughout the body (liver, spleen, right adrenal gland, etc.); (4) The cause of myocardial injury to be investigated: ① Acute coronary syndrome? ② Infection related? (5) Anemia, thrombocytopenia, abnormal coagulation: diffuse intravascular coagulation? Tumor bone metastasis? (6) Pulmonary infection.

In the treatment of patients with acute myocardial infarction, reperfusion therapy such as thrombolysis and percutaneous coronary intervention (PCI) is an effective therapeutic strategy to reduce myocardial cell death. However, reperfusion therapy can trigger myocardial ischemia-reperfusion injury (MIRI) while saving ischemic myocardium. MIRI means that after myocardial tissue is ischemic or hypoxic for a period of time, the restoration of blood supply will aggravate the injury caused by original ischemia and hypoxia or cause new injury. This may be related to increased oxygen free radical production, increased inflammation, calcium overload and mitochondrial switching pore opening during revascularization^[1]。

Tuberculosis remains the world's most serious public health problem that threatens people's health^[1]。 At present, the course of chemotherapy for newly treated sensitive pulmonary tuberculosis is 6 to 9 months. The longer the course of tuberculosis treatment, the higher the rate of irregular medication. This irregular medication not only reduces the cure rate, but also easily makes Mycobacterium tuberculosis develop drug resistance. Shortening the course of treatment is the main means to ensure regular medication and obtain high efficiency. In recent years, some progress has been made in the research of shortening the course of treatment for tuberculosis, which is now reviewed below.