2017年 · 第97卷第48期

Neural tube malformation is a congenital disease with high incidence and disability in China, which should be paid great attention to. However, the understanding of spinal neural canal malformation in China is insufficient, and the classification and terminology concepts are confusing or even wrong. In the case of spina bifida, the concepts "open", "closed", "dominant", "recessive" and "cystic" are often confused. According to whether there is nerve tissue exposure and cerebrospinal fluid leakage, it can be broadly divided into open and closed spina bifida. The meaning of open spina bifida is exposure of nerve basal plate and leakage of cerebrospinal fluid; On the contrary, it is closed spina bifida. "Dominant" and "recessive" refer to another pair of concepts, which refer to the presence or absence of spinal membrane or nerve tissue bulging outside the spinal canal through spina bifida to form a cystic mass, which belongs to the category of closed spina bifida. "myelomeningocele" belongs to open spina bifida in international literature^[1]。 However, in domestic reports, "myelomeningocele" is used to name closed spina bifida, which is essentially "lipomyelomeningocele". The result is that the same disease has different names and the same name has different diseases, which will inevitably cause academic fallacies in the aspects of operation timing, curative effect and prognosis, and it is urgent to unify the concept with international common terminology. Internationally, the classification of spinal neural canal malformations is complicated, almost all of which are divided according to embryonic pathology or imaging. According to the pathological classification of embryo, we can understand that different time points and different degrees of disorder in embryo development may lead to corresponding pathological types of spinal neural canal malformation. However, this classification only focuses on disease pathogenesis, but lacks clinical science. According to the classification of magnetic resonance imaging, it can help to understand the location and growth characteristics of deformity lesions, and greatly improve the guidance of disease diagnosis and treatment. However, imaging classification is static and limited after all, and cannot comprehensively reflect the characteristics of disease symptomatology, disease course and therapeutics. Unifying the terminology concept of spinal canal malformation and standardizing the classification standards are conducive to academic exchange and guiding clinical research.

A 60-year-old male was admitted to the Department of General Internal Medicine of Peking Union Medical College Hospital on October 19, 2016 due to "bulging eyeballs, chest tightness and shortness of breath for more than 2 months". In July 2016, the patient consciously had bulging eyeballs, and the external hospital examination showed that the thyroid function was normal; Renal ultrasound: dilation of the pelvis and calyces of both kidneys and dilation of the upper ureter; Enhanced CT of head, thorax, abdomen and pelvis: occupied space behind both eyeballs, with clear boundaries, uneven enhancement, thickened maxillary sinus mucosa on both sides, local atelectasis in the anterior segment of the upper lobe of the right lung, thickened interlobular septum of both lungs, soft tissue shadows around the descending aorta and around the kidneys, pericardium and bilateral pleural effusion. Positron emission computed tomography (PET) -CT showed a soft tissue mass behind both eyeballs, similar in size and morphology, approximately 2.8 cm ×2.5 cm in size, with a standard uptake value (SUV) maximum of 4.4 kBq/ml. No special treatment was given. At the end of August, there was chest tightness and asthma after activity, and I couldn't lie down at night, accompanied by night sweats. Cardiac ultrasound in other hospitals showed a large amount of pericardial effusion, and chest tightness was relieved after 1 200 ml of pericardial effusion drainage on September 5th (no relevant laboratory results were found); Bronchoscopy: No malignant tumor cells were found in the anterior segment of the upper lobe of the right lung, and no abnormalities in the etiology were found. On October 8th, chest tightness and asthma occurred after slight activity. Cardiac ultrasound in outside hospital: massive pericardial effusion. Pericardial puncture (1 200 ml): yellow turbid, peptone, specific gravity>1.018, cell number 230×10⁶Total protein 34.7 g/L (total blood protein 45.8 g/L); Pathology: A small number of heterotypic cells with nuclear mass and dysregulated nuclear-plasma ratio can be seen. Chest tightness was relieved after drainage of pericardial effusion, and then gradually worsened. Reexamination of cardiac ultrasound showed a large amount of pericardial effusion. Admitted to our hospital for further diagnosis and treatment. Spirit, appetite, second stool, poor sleep, weight loss of 10 kg compared with before illness. Past history, personal history, and family history are not special.

Since the launch of the first generation of proton pump inhibitors (PPIs), after years of clinical practice, PPIs have become the drug of choice for the prevention and treatment of most acid-related diseases. Compared to other acid suppressant drugs^[1]PPI has the characteristics of good curative effect, mild adverse reactions, good tolerance of long-term application by patients, and good safety. PPI is mainly metabolized by liver drug enzyme cytochrome P450 (CYP). When combined with other drugs metabolized by the same pathway, it will produce drug-enzyme competitive effects, resulting in enhancement or reduction of drug efficacy and adverse reactions. With the rapid development of molecular biology, human genetics and molecular pharmacology, it has been gradually found that PPI is highly dependent on liver CYP isoenzyme system (mainly CYP2C19 and CYP3A4) in pharmacokinetics, and is mainly affected by CYP2C19 gene polymorphism. This article will focus on the influence of CYP2C19 gene polymorphism on drug metabolism and interaction of PPI in medical treatment.

Although the standardized diagnosis and treatment of lung cancer brings certain survival benefits to patients, lung cancer is still the first type of malignant tumor mortality, so it is urgent to explore new and effective treatment methods. Programmed death receptor-1 (PD-1) antibodies include nivolumab, pembrolizumab, etc. Among them, nivolumab has been approved by the US Food and Drug Administration (FDA) for squamous cell carcinoma and second-line treatment of non-squamous non-small cell lung cancer (on the basis of first-line treatment of platinum combined chemotherapy or bevacizumab combined chemotherapy); In 2016, pembrolizumab was approved for those with programmed death receptor-1 ligand (PD-L1) expression>50% in non-small cell lung cancer (first-line drug) and PD-L1>1% (second-line drug)^[1]。 In addition, the PD-L1 class antibody atezolizumab is the first PD-L1 class antibody approved by the FDA for non-small cell lung cancer (tumor progression after first-line treatment), and is particularly suitable for tumor expression of high levels of PD-L1 or those with more tumor-infiltrating immune cells; durvalumab and avelumab are also suitable for untreated non-small cell lung cancer^[2]。 While patient immunotherapy has achieved encouraging results, we are also concerned about the occurrence of immune-related adverse reactions in some patients. Unlike traditional chemotherapy and targeted therapy, our clinicians do not have much knowledge and experience in this regard. The adverse reactions and management of PD-1/PD-L1 antibodies in the treatment of lung cancer are summarized as follows.

In the field of drug assay, similarity or consistency evaluation is often required, such as quality consistency evaluation of generic drugs, similarity evaluation of biosimilar drugs, linear parallel evaluation of detection methods, etc. At this time, if the conventional difference test is used, the invalid hypothesis is that the difference between the parameters (such as slope, mean, etc.) of the standard and the sample to be tested is 0, and the opposite alternative hypothesis is that the difference is not 0. WhenPWhen the value is greater than a specified threshold value (e.g. 0.05), the conclusion can only be that "there is insufficient evidence to suggest that the two groups are different", but it cannot be considered that "the two groups are not different" or "the two groups are equal or consistent". If you want to answer the question of whether the two groups are equal, the United States Pharmacopoeia (USP) recommends that the equivalence test be more scientifically reliable^[1]。

growth hormone (GH) not only promotes growth, but also promotes fat decomposition, protein synthesis, and affects sugar metabolism. Especially, its influence on the body's nerve function cannot be ignored, but its influence on human life span is still inconclusive. With the increase of age, the function of various organs gradually declines, the incidence of degenerative diseases increases year by year, and the metabolic profile also changes accordingly. At the same time, growth hormone levels in healthy adults decrease slowly with age, and whether this phenomenon accelerates aging is inconclusive. Whether growth hormone supplementation can delay aging is the focus and hot spot of current academic circles. This article reviews the effects of growth hormone on metabolism and aging.