2016年 · 第55卷第05期

The causes of lung cancer are complex and the tumor heterogeneity is high. Today's diagnosis and treatment of diseases has entered the era of precision medicine, and the treatment of lung cancer needs to be determined according to histopathological subtypes and specific tumor driver gene mutations. Due to the lack of specific clinical symptoms in the early stage of lung cancer, most patients are already in the middle and late stage when they see a doctor, and they lose the best opportunity for surgery. For these patients, minimally invasive methods should be attempted to obtain small biopsy tissue and/or cytology samples to establish the diagnosis. At present, the most commonly used methods for sampling small samples of lung cancer in clinical practice include transbronchial luminal sampling and percutaneous lung biopsy. Although these two methods have been widely used in clinical practice in China, there are still some controversies about the important details involved in the process of sampling materials and before and after sampling materials, and it is necessary to determine a systematic and standardized process. In this regard, this issue published the "Chinese Expert Consensus on Issues Related to Small Sample Sampling of Lung Cancer" jointly formulated by the Respiratory Branch of Chinese Medical Association and China Lung Cancer Prevention and Treatment Alliance, and invited Professor Bai Chong and Professor Wang Chen to write a monograph "It is imperative to standardize and promote small sample sampling of lung cancer", hoping to give guidance to clinical work. Welcome to read and learn from.

The causes of lung cancer are complex and the tumor is highly heterogeneous. Even if the pathological type is the same, the evolution of the disease and the response to treatment of patients may be very different. Today, the diagnosis and treatment of diseases has entered the era of precision medicine. The treatment of lung cancer needs to be determined according to histopathological subtypes and specific tumor driver gene mutations. Due to the lack of specific clinical symptoms in the early stage of lung cancer, most patients are already in the middle and late stage when they see a doctor, and they lose the best opportunity for surgery. Therefore, minimally invasive methods should be used to obtain small biopsy tissue and/or cytology samples to establish a diagnosis and minimize damage to the patient. At present, the most commonly used methods for sampling small samples of lung cancer in clinical practice include transbronchial luminal sampling and percutaneous lung biopsy. Although these two methods have been widely used in China, there are still controversies about small sample biopsy or re-biopsy of clinically suspected and/or confirmed lung cancer, as well as important details involved in the process of sampling and before and after sampling, and there is still a lack of systematic and standardized guidelines for operators to follow and learn from. Therefore, the "Chinese Expert Consensus on Issues Related to Sampling Small Samples of Lung Cancer" was formulated, hoping to standardize the operation of sampling small samples of lung cancer. Due to the particularities of the nature of malignant lesions and prognostic assessment, some of the issues involved in this consensus may not be fully applicable in the sampling of benign pulmonary lesions.

primary thyroid lymphoma (PTL) is very rare, accounting for 2% of all lymphomas^[1], accounting for 2% to 5% of thyroid malignant tumors^[2]。 Pedersen and Pedersen^[3]The statistical incidence of thyroid lymphoma was 2.06/10 per year⁶。 PTL lacks specific symptoms and signs in clinic, and is easily misdiagnosed as thyroid cancer, chronic lymphocytic thyroiditis or other diseases. Missed diagnosis and misdiagnosis are common. This study retrospectively analyzed the relevant data of 8 patients with primary thyroid lymphoma diagnosed and treated in Longyan First Hospital affiliated to Fujian Medical University from January 2009 to June 2015, and summarized their clinical manifestations and diagnosis and treatment characteristics, in order to improve clinicians' understanding of this disease and avoid misdiagnosis and mistreatment.

December 1, 2015 Proceedings of the American Society of Clinical OncologyJ Clin Oncol(Impact factor 18.48) published the clinical study "Prevention and treatment of granulocyte-macrophage colony stimulating factor on invasive mycosis in allogeneic hematopoietic stem cell transplantation recipients [Wan L, Zhang Y, Lai Y, et al. Effect of granulocyte-macrophage colony-stimulating factor on prevention and treatment of invasive fungal disease in recipients of allogeneic stem-cell transplantation: a prospective multicenter randomized phase IV trial. J Clin Oncol, 2015, 33 (34): 3999-4006.] ". This is a prospective, multicenter, randomized, controlled clinical study that demonstrates that granulocyte-macrophage colony-stimulating factor (GM-CSF) can effectively prevent and treat fungal infection in hematopoietic stem cell transplantation recipients and reduce infection-related mortality, which is of great significance for improving the survival of hematopoietic stem cell transplantation patients.

Insulin therapy is an integral part of pharmacological treatment of diabetes. Patients with type 1 diabetes require lifelong insulin replacement therapy, and patients with type 2 diabetes also require insulin therapy as islet cell function declines. Inappropriate use of insulin often occurs in clinical work. The following is a summary and analysis of the common misunderstandings of insulin application combined with clinical cases.

upper gastrointestinal hemorrhage (UGIH) is a difficult problem in clinical work. Among the various etiologies, peptic ulcer remains the leading cause of UGIH. With the development of acid suppressant drugs, anti-Helicobacter pylori (Hp) therapy, and endoscopic hemostasis technology, most UGIH patients have been controlled or cured without surgery. Effective intragastric pH control is an important means to prevent and treat UGIH. At present, basic research has elucidated the mechanism of intragastric pH control on the treatment of ulcer bleeding. Clinically, the intragastric pH value is controlled by inhibiting gastric acid secretion to prevent and treat ulcer-caused bleeding, and the choice and use methods of drugs are compared. Even in endoscopically treated UGIH patients, intragastric pH control still plays a very important role^[1]。

Rheumatoid arthritis (RA) is a chronic and systemic autoimmune disease with erosive and symmetrical polyarthritis as the main manifestation. The prevalence of RA in mainland China is about 0.2% ~0.4%, and it is more common in women, with a male-female ratio of about 1:3. RA can occur at any age, with some patients in childbearing age. Studies have found that some female RA patients tend to stabilize or spontaneously improve during pregnancy^[1]However, some patients are still in an active state. Active RA during pregnancy not only affects maternal health, but also increases the incidence of neonatal preterm birth, low birth weight, and perinatal mortality^[1,2]。 Active control of the disease before or during pregnancy can avoid the occurrence of adverse reactions such as premature delivery. At present, biological agents play a great role in controlling the condition of RA, which can prevent or delay the destruction of joints and improve the physical function of patients. In recent years, there have been increasing reports on the treatment of RA patients with biological agents during pregnancy. Now, the application of commonly used biological agents, such as infliximab, etanercept, rituximab, etc., in RA patients during pregnancy is summarized as follows.

Although the relationship between bronchial asthma (hereinafter referred to as asthma) and eosinophil airway inflammation has been recognized for many years, it has not been regarded as an important pathogenesis of asthma until more than 20 years^[1]。 With the development of non-invasive eosinophilic airway inflammation assessment methods such as induced sputum cytology differential count examination and exhaled nitric oxide measurement, airway inflammation can be assessed in almost all patients, and we have a better understanding of eosinophilic airway inflammation response. Eosinophilic airway inflammation can occur in many different airway diseases, which is closely related to the reactivity of glucocorticoid (hereinafter referred to as hormone) treatment and the risk of acute exacerbation of airway diseases. However, the relationship between eosinophil inflammatory phenotype and cough and airway hyperresponsiveness, and the different clinical characteristics of airway diseases although they have the same inflammatory phenotype still need to be explored in depth. It is precisely because of the complexity of inflammatory response in patients with airway diseases that brings difficulties to clinical diagnosis and treatment. At present, the efficacy of anti-inflammatory therapy is not always satisfactory. It is of great clinical significance to fully understand the phenotype of eosinophil airway inflammation and explore new therapeutic targets.

Lung cancer is a malignant tumor with the highest morbidity and mortality in the world. 75% of lung cancer patients are in the middle and late stage at the time of initial diagnosis and cannot be treated by surgery^[1]。 For patients with advanced lung cancer, minimally invasive methods should be used to establish the diagnosis and make accurate pathological diagnosis, molecular typing and staging to guide the next step of treatment. Nearly 80% of patients with advanced lung cancer are diagnosed by small sample biopsy tissue^[2]。 At present, the treatment of lung cancer has entered the era of precision treatment, and the choice of protocols and drugs is jointly formulated according to its histological subtypes and molecular test results. Therefore, it is necessary to obtain sufficient and high-quality samples for accurate histological and molecular diagnosis, which requires close collaboration between multiple disciplines. In addition, rebiopsy or multi-site biopsy can be performed on some diagnosed lung cancer patients to clarify their disease evolution and molecular changes.

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The patient was a 66-year-old female. Due to "general bone pain", he was admitted to the hematology department of our hospital on November 3, 2015. Since February 2015, the patient had systemic bone pain without obvious trigger, mainly pain in the lower back, legs, knees and feet, accompanied by fatigue, anorexia, low fever in the afternoon, body temperature of 37.2℃, and no morning stiffness. Routine blood tests in the local hospital showed mild anemia, increased globulin, normal thyroid function and tumor markers. IgG (+), IgA (+) and light chain kappa were positive by serum immunofixation electrophoresis. MRI of thoracolumbar spine showed multiple abnormal signals in thoracolumbar spine and lumbar degeneration. Whole body bone radionuclide imaging (ECT) scan: abnormal radionuclide concentration in bilateral sacroiliac joint and left knee joint (excluding lumbar 1 vertebral compression lesion, chronic sacroiliac joint inflammation and left knee joint inflammation). The diagnosis was "bone and joint degeneration, not excluding plasmacytoma", and symptomatic and supportive treatment was given, but the effect was not good. In April 2015, the patient went to a tertiary class A hospital for treatment. M protein identification: IgA 5.49 g/L, IgG 21.9 g/L, light chain kappa quantification 17.1 g/L, light chain lambda quantification 8.41 g/L. Serum protein electrophoresis: M protein component accounted for 6.77%. The quantity of urine light chain kappa was 22.7 mg/L, and the quantity of light chain lambda was 50 mg/L. IgM, IgE and IgD were normal. Serum immunofixation electrophoresis: monoclonal IgA-λ components were observed in the beta region and IgG-κ components were observed in the gamma region. Urinary immunoelectrophoresis was negative. Serum free light chain κ 15.2 mg/L, λ 28 mg/L, κ/λ =0.542 8. Beta₂Microglobulin 2.9 mg/L, Hb 96 g/L, PLT 325×10⁹/L. Multiple bone marrow puncture cytology examination of plasma cells 2.5% ~6%, naive plasma cells less than 2%. Pathological examination of bone marrow showed mature plasma cells, but no monoclonal plasma cells were found. Bone marrow immunotyping (13 Apr 2015): abnormal cell populations occupied 0.57% of nuclear cells and partially expressed CD₂₇, cKAPPA, cLAMBDA, does not express CD₁₉CD₅₆CD₈₁CD₂₀₀CD₂₀CD₁₁₇CD₂₈, is an abnormal plasma cell phenotype, cKAPPA/cLAMBDA =6.24.