Massive hemoptysis is one of the most dreaded of all respiratory emergencies and can have a variety of underlying causes. It is mostly caused by bleeding from bronchial circulation. Bronchial artery embolization is now considered to be the treatment of choice for acute massive hemoptysis. Bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis. However, nonbronchial systemic arteries can be a significant source of massive hemoptysis and a cause of recurrence after successful BAE. So knowledge of the bronchial artery anatomy, together with an understanding of the pathophysiologic features of massive hemoptysis, are essential for planning and performing BAE in affected patients. In addition, interventional radiologists should be familiar with the techniques, results, efficacy, safety and possible complications of BAE and with the characteristics of the various embolic agents. Bronchial arterial catheterisation in human via a percutaneous approach has been practiced for 32 years (1973) in the world and 20 years (1986) in China, initially for direct chemotherapy treatment for bronchial malignancies and then for the embolization of patients with massive haemoptysis. A review of clinical experience to evaluate technique,embolic materials,outcome and complications of BAE is presented.

Symposia Report Immunoglobulin G for the Treatment of Chronic Pain:Report of an Expert Workshop

背景:慢性疼痛的治疗效果仍不理想.尽管现在治疗慢性疼痛的药物种类较多,但许多患者对疗效仍不满意或诉药物的副作用太大.越来越多的证据表明,免疫系统参与了伤害性和神经病理性慢性疼痛的病理过程.设计:在英国利物浦的专题会议上,专家们出示了免疫系统参与慢性疼痛的证据.近来的研究表明,静脉(IVIg)或皮下(SCIg)注射免疫调节药物——多价免疫球蛋白(IgG)可缓解外周神经病理性疼痛和其他疼痛性疾病.专题会议讨论了IVIg和SCIg治疗的适应证、效价比及其副作用.结果:IgG可缓解某些伤害性和神经病理性慢性疼痛,如糖尿病、干燥综合征、纤维肌痛症、复杂性区域疼痛综合征、小儿麻痹后遗症和继发于病理性自身抗体的疼痛.结论:IgG对某些慢性疼痛具有一定的治疗前景.IgG是一种相对安全的治疗方法,副作用少而轻,但价格较贵.今后有必要对IgG治疗顽固性疼痛进行随机对照研究和预测性临床试验.

The 1990's have brought a significant promise and the hope for a better and brighter future in the new millennium for patients with inflammatory bowel disease (I3D). A better understanding of the pathophysiology of IBD symptoms has led to newer treatnent modalities and streamlining of therapy for specific subsets of patients. ULCERATIVE COUTISThe treatnent for ulcerative colitis (UC) is aimed at modulating the inflammatory response. The drugs which are found to be effective are sulfasalazine (Azulfidine, Salazopyrin) and its 5ASA derivatives, glucocorticosteroids, immunomodulators/immunosuppressants, and other new potential drugs (Table 1).

多发性骨髓瘤肾损伤诊治专家共识

Renal impairment (RI) is a common complication of multiple myeloma (MM), whichis presented as chronic kidney disease (CKD) or acute kidney injury (AKI).The typical pathologicalfeature is cast nephropathy.Presently international system staging (ISS) is used in evaluating MM.Althoughthe classic Durie-Salmon staging system could be still used in clinical practice , it may miss out some patientswith renal impairment.For evaluations of RI in MM patients with CKD, it′s recommended to assess theestimated glomerular filtration rate (eGFR) by creatinine based formula CKD-epidemiology collaboration(EPI) or modification of diet in renal disease (MDRD) and to stage the renal injuries according to 2013Kidney Disease Improving Global Outcomes (KDIGO) CKD guidelines.For MM patients with AKI, KDIGOAKI guidelines is recommended for evaluation.Renal biopsy is not a routine procedure in all MM patients .It′s necessary for patients presenting with glomerular injuries such as albuminuria >1 g/24 h to eliminateimmunoglobulin associated amyloidosis (AL) and monoclonal immunoglobulin deposition disease (MIDD).The effective treatment of MM can reduce serum light chain concentration and improve renal function .Thebasis of the RI treatment in MM is bortizomib-based regimen, which does not require dosage adjustment inpatients with dialysis or renal insufficiency.Thalidomide and lenalidomide are two major immunomodulatorsin MM treatment.Thalidomide can be used effectively in RI patients without dosage adjustment whilelenalidomide should be used cautiously in patients with mild or moderate RI with dosage adjustment andserum toxicity surveillance. High-dose therapy ( HDT) and autologous peripheral blood stem celltransplantation (APBSCT) can be therapeutical options for RI patients younger than 65 y, and they shouldbe considered more prudently in patients with severe renal insufficiency (GFR <30 ml/min).For patientswho are not suitable for the treatment mentioned above , they can be treated with conventional chemotherapy ,including VAD (vincristine, adriamycin and dexamethasone ), MP (mephalan and prednisolone) and highdosedexamethasone regimen.Adequate hydration (at least 3 litres of fluid intake a day or 2 L· m-2 · d-1 )and correcting reversible causes of RI are key points for the supportive care .Renal replacement therapy(more often hemodialysis) should be started in patients with severe AKI and end stage renal disease(ESRD).High flux or high cut-off membrane are recommended because routine hemodialysis could notremove the serum free light chain (sFLC) effectively.Plasmapheresis (PE) is recommended for patientswith hyperviscosity syndrome or cast nephropathy presented with AKI , which may help to increase thedialysis-independency.

肝硬化肝性脑病诊疗指南

The Chinese Society of Hepatology developed the current guidelines on the management of hepatic encephalopathy (HE) in cirrhosis based on the published evidences and panelists'' consensus. The guidelines provided recommendations for the diagnosis and management of hepatic encephalopathy including minimal hepatic encephalopathy (MHE) and overt hepatic encephalopathy (OHE) emphasizing the importance on screening MHE in patients with end-stage liver diseases. The guidelines emphasized that early identification and prompt treatment are essential to improve the prognosis of HE. The principles of treatment mainly consist of eliminating precipitating factors, treating hyperammonemia to improve acute neuropsychiatric abnormalities rapidly, primary and secondary prophylaxis.

2018中国类风湿关节炎诊疗指南

To develop a new evidence-based diagnosis,treatment guideline for rheumatoid arthritis (RA) in China.A multidisciplinary guideline development group was established.The grading of recommendations assessment,development and evaluation (GRADE) system was used to rate the quality of evidence and the strength of recommendations.Recommendations were derived from evidence body,the balance of benefits and harmsand patient's values and preferences.The guideline development group developed 10 recommendations for the diagnosis and treatment of RA.The guideline covered the classification criteria,disease activity monitoring and assessing,antirheumatic drugs (DMARDs) and glucocorticoids with treat-to-target approach of RA.This rheumatoid arthritis guideline was intended to serve as a tool for clinicians and patients for best decisions-making in China.

非甾体消炎药相关消化道溃疡与溃疡并发症的预防与治疗规范建议

非甾体消炎药（ NSAIDs）是一大类不含糖皮质激素而具有抗炎、镇痛、解热作用的药物，其临床应用极为广泛，主要用于多种疼痛的对症治疗，改善风湿性疾病的炎性症状，近年来也用于预防心脑血管疾病等，是仅次于抗感染药物的第二大类药物。然而使用NSAIDs可能导致消化道、心血管、肾脏、肝脏、中枢神经系统和血液系统等的不良反应，其中消化道不良反应常见。 NSAIDs胃肠道副作用不仅危害患者健康，增加病死率，且大大增加了医疗费用。因此提高NSAIDs胃肠道安全性是临床医生需要关注的问题。

肱骨小头冠状面骨折治疗进展

肱骨小头冠状面骨折是肱骨小头前半部分的冠状面劈裂骨折，可累及肱骨滑车的外侧髁凸，并不越过滑车中线。肱骨小头冠状面骨折在临床上比较少见，由于此骨折属于关节内骨折，如果处理不当，会严重影响肘关节的功能，故在临床上具有非常重要的治疗意义。近年来，随着对肱骨小头冠状面骨折认识的加深，新固定材料和新技术也不断涌现。现就肱骨小头冠状面骨折的治疗进展综述如下。

退行性脊柱侧凸的新研究进展

退行性脊柱侧凸(degenerativescoliosis)是一类成年人中出现的脊柱畸形，即在人体骨骼成熟以后，冠状面正直的脊柱出现侧方弯曲，Cobb’s角＞10°[1]，但不包括由脊柱器质性病变如外伤、肿瘤等导致的脊柱侧凸。病变脊柱以腰段为多见，少部分也可累及胸腰段，常伴随有腰椎前凸减少、椎体侧方滑移及椎管或神经根管狭窄等病变。与青年特发性脊柱侧凸不同，此病主要引起患者腰背部顽固性疼痛、跛行、神经根性症状等，严重影响患者的工作与生活。老年人为此病的高发人群，随着全球人口老龄化的进展，老年人群比例逐年升高，退行性脊柱侧凸的发病率也明显增加[2]。于是，对此类疾病的诊治手段及其疗效便成为临床医师与患者们共同关注的焦点。现就近年来对退行性脊柱侧凸相关的研究进行回顾、综述，以求能全面、详实地介绍此类疾患，探索更加科学、有效的治疗方法。

New development of breast cancer histological evaluation related to determination of therapeutic option for the patients

Breast cancer is a heterogenous disease with molecular alterations, cellularcomposition, and clinical outcome.The more we know about the tumor characteristics underlying the heterogeneity of the disease, the greater the opportunity to refine treatment options.Great emphasis has been placed uponhistopathological characteristics of breast carcinoma cells in order to define bettertreatment options for breast cancer patients[1-2].

兔急性脑梗死介入治疗动物模型的建立

AIM: To establish a model of cerebral infarction in order to study the interventional treatment.METHODS: An improved 3.0F SP Cobra catheter was introduced to the internal carotid artery by puncturing the femoral artery. After internal carotid arteriography thrombus was injected to embolize its MCA. 3 hours later, clinic observe and computed tomography was examined to analyze results.RESULTS: Clinic observation confirmed that the rabbit had some nerve defect symptoms and CT exam proved cerebral infarction.CONCLUSION: This technique is convenient for application and the model can meet the standard of study of clinical interventional treatment.

黄芪和大青叶对病毒性心肌炎小鼠的保护作用

Objective To investigate perfect therapeutic measure of Chinese traditional herbs through observing curative effect of single dose traditional Chinese medicine on murine viral myocarditis(VMC).Method Balb/C mice were inoculated intraperitoneally with diluted solution of coxsackievirus B3(CVB3) ,and then were divided into three groups randomly:infected control group,Mongolian milkvetch root treated group;Indigowood treated group.The mice were put to death and their hearts were examined on day 3,5,7,10,14,21 post inoculated,and were stained with hemotoxylin and eosin(HE) to observe myocardial lesions and to estimate myocardial histopathological scores,simultaneously to separate virus from myocardium.In addition,we observed myocardial ultrastructure by electron microscopy on 7th day post inoculated.Result Compared with infected control group,myocardial histopathological scores of both Mongolian milkvetch root treated group from 5th day to 21st day post inoculated and Indigowood treated group on 5th day and 7th day post inoculated showed significant decrease(P< 0.05).Conclusion Mongolian milkvetch root could protect myocardial cells.

冠心病电生理紊乱及基因、细胞疗法

Liver fibrosis is a primary cause of liver cirrhosis, and even hepatocarcinoma. Recently, the usage of mesenchymal stem cells (MSCs) has been investigated to improve liver ifbrosis. It has been reported that the differentiation, proliferation and migration of MSCs can be regulated by traditional Chinese medicine treatment;however, the mechanisms are still unclear. In this article, the authors review the characteristics of MSCs such as multidirectional differentiation and homing, and its application in animal experiments and clinical trials. The authors also list areas that need further investigation, and look at the future prospects of clinical application of MSCs.

Recent phase I studies have reported single-agent activities of poly (ADP-ribose) polymerase (PARP) inhibitor in sporadic and in BRCA-mutant prostate cancers. Two of the most common genetic alterations in prostate cancer, ETS gene rearrangement and loss of PTEN, have been linked to increased sensitivity to PARP inhibitor in preclinical models. Emerging evidence also suggests that PARP1 plays an important role in mediating the transcriptional activities of androgen receptor (AR) and ETS gene rearrangement. In this article, the preclinical work and early-phase clinical trials in developing PARP inhibitor-based therapy as a new treatment paradigm for metastatic prostate cancer are reviewed.

支气管针吸活检技术的临床应用

Transbronchial needle aspiration(TBNA) is able to provide definitive answers for a wide variety of pulmonary benign and malignant diseases including infectious diseases,cystic lesions, granulomatous diseases, pulmonary and mediastinal mass, etc. It's proved particularly revolutionary to stage bronchogenic carcinoma during routine flexible bronchoscopy. What's more, TBNA is an extremely safe procedure with no reported major complications. This review introduces the techniques about identifying the target, obtaining the specimen and preparing and interpreting the specimen when conducting TBNA. The complications, a through unusual, and major limitations are also touched in this review.

Clinical challenges in the ataxias

Ataxias are rare diseases and the etiologic heterogeneity make individual entities even rarer. There are still substantial numbers of patients who are still poorly understood. Available assessment techniques still point to large numbers of patients needed for clinical trials and the need for cooperative efforts, better assessment tools and novel trial designs. Better understanding of neural circuitry abnormalities may lead to more effective symptomatic therapy. Opportunities exist for targeting at risk individuals for effective therapies but how this can be done is not clear. Preventive strategies may become feasible in many ataxias.

Therapeutic thrombolysis is an immense opportunity in acute stroke care. For the first time, there is a treatment that has a high probability of being effective if given early enough to patients with acute ischemic stroke.

Studies over the past decades have uncovered fusion genes, a class of oncogenes that provide immense diagnostic and therapeutic advantages because of their tumor-specific expression. Originally associated with hemotologic cancers, fusion genes have recently been discovered in a wide array of solid tumors, including sarcomas, carcinomas, and tumors of the central nervous system. Fusion genes are attractive as both therapeutic targets and diagnostic tools due to their inherent expression in tumor tissue alone. Therefore, the discovery and elucidation of fusion genes in various cancer types may provide more effective therapies in the future for cancer patients.

Features Associated with Recurrence of Idiopathic Orbital Inflammatory Pseudotumor

Purpose: To explore factors which lead to recurrence of idiopathic orbital inflammatory pseudotumor (IOIP).Methods: Idiopathic orbital inflammatory pseudotumor in 209 cases between Jan 1,1978 and Dec 31, 1999 in our hospital was evaluated retrospectively. The comparison of clinical and pathological parameters between patients with at least one episode of recurrence and those with no recurrence at all was performed and analyzed using logistic regression method.Results: Follow-up results (with a mean follow-up time of 3.4 years, ranging from 0.5 year to 21.0 years) showed that the recurrence rate of IOIP was 41%. Sex and proptosis were associated with the recurrence of IOIP. Male gender was more likely to relapse than female counterparts, with the male being 52% and female being 25%.The severer the proptosis is, the higher the rate of recurrence. Among the clinical subtypes of IOIP, the rate of recurrence (17%) in cases with dacryoadinitis was the lowest, followed by anterior local orbital mass (44%), posterior orbital mass (54%),myositis (75%) and diffuse subtype (100%). However, the clinical subtypes did not show significant relationship with the recurrence of IOIP.Conclusions: Male gender and severe proptosis are associated with a higher recurrent rate in patients with IOIP.