2018年 · 第98卷第08期

Herpes zoster (HZ) can be accompanied by neuralgia before, when, and after the herpes subsides, which is collectively referred to as herpes zoster-related pain. The pain persists after the herpes resolves and persists for more than 1 month, which is herpetic neuralgia; The pain lasts for more than 3 to 6 months and is postherpetic neuralgia (PHN)^[1]。 The mechanism of herpetic neuralgia is complex, the clinical manifestations are diverse, the treatment methods are different, and the effects are uneven.

A 54-year-old male was admitted to the hospital on 30 August 2016 due to "repeated cough and dyspnea for 5 months and recurrence for 6 days". Five months ago, the patient developed a dry cough with dyspnea. He went to the local hospital and considered "pleural and peritoneal effusion, pericardial effusion", and improved after drainage of pleural effusion. In the past 5 months, he had repeated dyspnea. He was admitted to the local hospital many times, and was given fluid drainage, and biopsy of the lymph node of the left supraclavicular fossa was performed. The pathology showed "granulomatous nodule". In August 2016, the patient had recurrent dyspnea, accompanied by fever, and his body temperature fluctuated from 37.6 to 38.4℃, so he came to the First Affiliated Hospital of Wenzhou Medical University for treatment. Chest enhanced CT showed "right middle lobe atelectasis, both hilar and mediastinal lymph nodes were swollen, pleural effusion on both sides, and pericardial effusion" (FIG. 1A，FIG. 1B), positron emission computed tomography (PET-CT) showed "atelectasis of the right middle lobe with increased metabolism, multiple small lymph nodes in the retroperitoneum, splenic hilum area and left upper and lower diaphragm showed mild increased metabolism, thoracic, abdominal and pericardial effusion, abnormal hypermetabolic nodules in the left ischium, considering inflammatory granuloma or infectious lesions, among which the left ischium lesions are difficult to exclude malignant tumors". For further diagnosis and treatment, it is proposed that "multiple serous effusion" will be admitted to hospital. Past: Hepatitis B "small three yang" for many years, "hypertension" for 4 months, "renal insufficiency" for 3 months, denied tuberculosis and diabetes history, denied eating raw food. Physical examination at admission: body temperature 37.6 ℃, pulse 96 beats/min, breathing 20 beats/min, blood pressure 208/125 mmHg (1 mmHg =0.133 kPa). Lymph nodes with a diameter of about 1.0 cm were palpable in the bilateral neck, and two lymph nodes with a diameter of about 1.5 cm and 2.0 cm were palpable in the left and right inguinal areas, respectively. There is no distension in the jugular vein. After two auscultations, the pulmonary breathing sounds were reduced, and no dry and wet rales were heard. The heart rhythm is uniform, and the heart sound is slightly low and dull. Abdominal swelling, no tenderness rebound pain, mobile voicing positive. Moderate depressed edema of both lower limbs.

The 58-year-old male was seen in the Department of Respiratory Medicine of Jincheng People's Hospital on August 2, 2017, mainly due to intermittent cough for 2 months. Chest CT enhancement results showed: high-density shadow of left lung, considering inflammatory possibility, tuberculous lesion? Multiple old lesions in both lungs. It is recommended to give anti-infective treatment first, elective reexamination of chest CT, and percutaneous lung puncture if necessary to confirm the diagnosis.

An 8-year-old male was seen for "erythema on the cheeks, repeated fever with gingival bleeding for 1 month". In September 2016, erythema on both cheeks appeared without obvious trigger, which was obvious after sunlight, without itching, accompanied by repeated fever, body temperature of about 38℃, repeated gingival bleeding, no cough and expectoration, abdominal pain and diarrhea, joint swelling and pain, skin and other tissue bleeding. The effect of antibiotics was not good, and he was admitted to hospital on October 3 of the same year. Physical examination: butterfly erythema on both cheeks, bleeding from the right lower gum, no dry and wet rales in both lungs, soft abdomen, no tenderness and rebound pain, no obvious swelling of joints, and no edema in both lower limbs.

Many causes can lead to histiocyte damage, including diabetic nephropathy, hypertensive nephropathy, lupus nephritis, drug poisoning and prolonged acute kidney injury, and subsequent histiocyte degeneration, necrosis and inflammatory reaction. When the injury is small, the normal cells around the lesion will start regeneration and repair until the normal structure and function are completely restored^[1]。 However, when a large area of injury occurs or the number of injuries is excessive, it will cause the interstitial extracellular matrix to accumulate and fill the defect of the tissue region, thus causing the inevitable tissue fibrosis^[1]。 Fibrotic disease is a complex pathological process, which is characterized by excessive deposition, generation more than degradation and tissue remodeling of extracellular matrix components, which can lead to apoptosis, proliferation, transdifferentiation of cells, and ultimately failure of multiple organ functions. The main organs in which fibrosis occurs include the heart, lungs, liver and kidneys. In addition, some organs and tissues can also develop fibrosis under pathological conditions, such as skin scar, inflammatory bowel disease, myelodysplasia, etc^[2]。 In developed countries, about half of patients die from fibrosis-related diseases, and the occurrence and progression of fibrosis play an important role in disease mortality^[3]。 Tissue fibrosis can occur in various tissues and organs of human body, causing structural changes and functional failure, and there is still a lack of effective treatment measures. Recent studies have found that epigenetic modification can regulate the occurrence and development of fibrosis^[4,5,6]。 Therefore, targeting epigenetic modification regulatory mechanisms may help to develop anti-fibrotic drugs.

Kidney cancer is one of the most common tumors of the urinary system. In recent years, the incidence of kidney cancer in China has been increasing continuously. The latest statistics show that the new and death cases of kidney cancer rank 15th and 17th in the incidence and mortality of cancer respectively^[1]。 Bilateral renal carcinoma is a special type of renal carcinoma, and its incidence rate is relatively low, accounting for about 1% ~5% of the total renal carcinoma^[2]。 At present, surgery is the main treatment for bilateral renal cancer, including radical nephrectomy and nephron-sparing surgery. Such patients have an increased risk of renal insufficiency and tumor recurrence and metastasis due to the disease of both kidneys and surgical treatment, which aggravates the trauma and burden on the kidneys. In recent years, with the development of molecular biology, researches have shown that renal carcinoma is a multigene-related tumor, but most of the current researches on bilateral renal carcinoma focus on surgical treatment strategy and curative effect analysis^[3,4,5]。 Therefore, the molecular study of double renal carcinoma to explore its etiology and pathogenesis has important guiding significance for clinical diagnosis and treatment. By searching PubMed, Wanfang database and CNKI database, this paper aims to summarize the current molecular research progress related to bilateral renal cancer, so that we can understand bilateral renal cancer more deeply from the molecular level.

In recent years, nebulized inhaled glucocorticoids (ICS) have been recommended for the treatment of bronchiolitis in China^[1]In this regard, we have the following views to discuss with experts and colleagues.