2017年 · 第97卷第34期

Malignant tumor is one of the major diseases that endanger human health^[1]Different tumors often have different manifestations from molecular level changes to tissue and organ invasion; Even the same tumor, at different stages of onset and among different individuals, can exhibit gene level differences^[2]。 Gene detection technology based on molecular level provides more information for tumor diagnosis, and has attracted more and more clinical attention. According to the source of test samples, tumor molecular diagnostic techniques are divided into traditional "tissue biopsy" and emerging "liquid biopsy". Tissue biopsy requires surgery or puncture to obtain the tissue of the representative part of the tumor, which is poor reproducible and relatively traumatic, and has certain limitations for clinical dynamic monitoring and risk assessment. Liquid biopsy has the advantages of being minimally invasive, sampling multiple times, and dynamically reflecting the changes of tumor gene profile, and has increasingly become one of the methods of tumor precision medicine.

Primary liver cancer is a malignant tumor with the fifth highest incidence among men, the third highest among women and the third highest fatality rate. It is highly prevalent in South Africa and East Asia. In recent years, the incidence rate has been increasing year by year in Europe and America^[1]。 At present, radical liver resection and liver transplantation are the most effective treatment methods, but due to the lack of early diagnosis, only about 10% to 20% of liver cancer patients can get the opportunity of surgical intervention^[2]。 For the remaining patients, treatment methods include transcatheter arterial chemoembolization, radiofrequency ablation, chemoradiotherapy, targeted drugs (sorafenib), etc. The lack of effective early diagnosis and monitoring of efficacy in antitumor therapy hinder the improvement of overall survival (OS) in patients with liver cancer. At present, serological, imaging and clinical pathological examinations are mainly performed for patients with liver cancer in clinic, but no method can provide complete information about patients' diagnosis, prognosis and treatment effect. Therefore, there is an urgent need for a means that can integrate the early detection of liver cancer, predict the risk of recurrence, and detect the efficacy of anti-tumor drugs in real time.

allergic bronchopulmonary aspergillosis (ABPA) is an allergic pulmonary disease caused by Aspergillus fumigatus sensitization, which manifests as chronic bronchial asthma (asthma for short) and recurrent pulmonary shadows, which may be accompanied by bronchiectasis. The disease is relatively rare and is often misdiagnosed or missed clinically^[1]； However, early diagnosis and timely administration of systemic glucocorticoid (hormone for short) treatment can control the disease and prevent the occurrence of irreversible lung damage^[2,3]。 In rare cases, other fungi can also cause similar manifestations to ABPA, collectively referred to as allergic bronchopulmonary mycosis (ABPM).

A 47-year-old male was admitted to the Department of Endocrinology and Metabolism of Weihai Municipal Hospital on June 28, 2016 due to "neck thickening and palpitations for 7 years". The patient self-complained that 7 years ago, he found that his neck was thickened, often palpitations, fatigue and excessive sweating. The symptoms were sometimes severe and sometimes mild, which could be relieved by itself and aggravated after activity and drinking. And have had paroxysmal atrial fibrillation and persistent atrial fibrillation. Coronary stenosis was confirmed by coronary angiography in a local hospital, and coronary stenting was performed after atrial fibrillation was controlled. The atrial fibrillation was in remission for several months but did not completely disappear. Later, he was diagnosed with "hyperthyroidism" (hyperthyroidism) in a hospital in Beijing. He was given methimazole 10 mg, 3 times/d orally, and propranolol 10 mg, 3 times/d orally for 2 months. Except for palpitations, other symptoms were not significantly improved. Since the onset of the disease, there was no hand trembling, no increase in the frequency of stool, no feeling of cold and constipation, and no obvious change in weight. The patient complained that every time after taking methimazole, free triiodothyronine (FT₃) and free thyroxine (FT₄) did not decrease to normal, but thyroid stimulating hormone (TSH) increased, and the goiter was obviously enlarged, but the goiter shrank after stopping the drug. After taking the medication for more than 1 year, FT was reexamined multiple times₃FT₄All elevated, TSH normal or elevated. Later, he was suspected to be "pituitary TSH tumor", and pituitary magnetic resonance imaging (MRI) was performed, but no space-occupying lesions were found. He had a somatostatin radionuclide scan in Peking Union Medical College Hospital, and no abnormalities were found. He returned to the local area and continued to take propranolol treatment and intermittently took methimazole treatment until now. Past history: The patient had poor concentration since childhood, poor computational power and mathematics scores. Family history: His father is 155 cm tall and weighs 60 kg. He complained of being easily sleepy, relatively slow in reaction and poor in mathematics when he went to school. At home visit, the heart rate was 84 beats/min, the rhythm was homogeneous, and there was no murmur.

Renal anemia is one of the most common complications in patients with chronic kidney disease (CKD), and it is also the main factor that increases all-cause mortality in patients with CKD^[1]。 It is generally believed that the reduction of erythropoietin (EPO) synthesis is the most important factor causing anemia, and inflammation and abnormal iron metabolism can also aggravate anemia. At present, erythropoiesis stimulator (ESA) combined with iron is the "gold standard" for the treatment of renal anemia^[2]。 However, ESA has the risk of increasing cardiovascular and cerebrovascular events, so exploring new drugs for the treatment of renal anemia has become a hot topic. A series of recent clinical trials have found that hypoxia-inducible factor (HIF) stabilizers can significantly improve anemia in patients with CKD. This paper introduces the characteristics and functions of HIF stabilizers.

Recent studies have found that tubulointerstitial lesions in diabetes mellitus are probably the early lesions of diabetic nephropathy (DN), and the severity of the lesions is closely related to the progression and prognosis of DN^[1,2,3]。 Our recent study also found that urinary N-acetyl-β-glucosaminidase (NAG) was significantly elevated at 8 weeks after success in the diabetic rat model, and pathology at 12 weeks showed extensive vacuoloid degeneration of the renal tubules with renal interstitial inflammatory cell infiltration but only slight glomerular lesions^[4]。 This suggests that diabetic tubulointerstitial disease may occupy the primary position in the development of early DN. The possible mechanism and research progress of early diabetic tubulointerstitial disease are summarized as follows.

Distal deep vein thrombosis (DVT) is also known as calf DVT, subpopliteal DVT. This type of disease is relatively common, accounting for more than 30% to 50% of lower limb DVT diagnosed by ultrasound^[1,2]。 Lack of standardized treatment regimens compared to proximal DVT and pulmonary embolism^[3]。 The proportion of distal DVT extending to the proximal vein and the incidence of pulmonary embolism vary greatly from study to study, so the diagnosis and treatment also vary greatly^[1,4,5]。 Therefore, it is necessary to discuss the necessity of systemic diagnosis and anticoagulation therapy for distal DVT, especially those without risk factors for DVT extension and recurrence (hospitalization, past history of thrombotic disease, combined tumors), so as to better understand the disease and guide clinical practice.

acute on chronic liver failure (ACLF) is the most common type of liver failure. It was first proposed at the 2009 Asia-Pacific Annual Conference on liver Diseases and updated in 2014: ACLF refers to the onset of chronic liver disease (existing or undiagnosed) due to acute inducing effects, with clinical manifestations of jaundice [serum bilirubin ≥5 mg/dl (85 mmol/L)] and coagulation dysfunction [international standard ratio (INR) ≥1.5 or prothrombin activity (PTA)<40%], complicated with ascites and/or hepatic encephalopathy within 4 weeks^[1]。 According to the diagnostic criteria of the chronic liver failure consortium organ failure score (CLIF-C OFs), the proportion of ACLF in patients with liver cirrhosis is about 24% ~40%^[2]。 At present, viral liver disease, alcoholic liver disease or combined viral and alcohol liver disease are believed to be the main causes of ACLF based on chronic liver disease^[3]。 The disease has a high mortality rate, poor prognosis, and no effective treatment except liver transplantation, so it has received widespread attention. Due to the limited treatment methods, how to judge the prognosis early in the process of disease progression and strengthen intervention in time is of great significance to change clinical outcome and improve patient survival rate.