2016年 · 第96卷第34期

In 1998, the Global Initiative to Prevent and Treat Chronic Obstructive Pulmonary Disease (GOLD) was launched in collaboration with the National Institute of Heart, Lung and Blood, the National Institutes of Health and the World Health Organization, and the first report was published in 2001 (GOLD 2001)^[1]。 For more than 10 years, the GOLD Scientific Committee has continuously updated the GOLD report by searching and screening out influential literature and research results. Of the newly retrieved 173 studies from July 2014 to May 2015, 15 were considered to have an impact on the 2015 report. Recently, GOLD 2016 was released online^[2]。 The main updated parts and related literature are interpreted as follows.

Concord centuries, talents have emerged in large numbers, fruitful results. It is worth remembering, worth summing up, and even more worth looking forward to and looking forward to.

Although the industrialization process has promoted the rapid development of China's economy, the ensuing environmental deterioration, especially air pollution and high smoking rate, make the prevention and control of respiratory diseases face severe challenges. Respiratory diseases are the most common among urban and rural residents in China, with the highest mortality rate and the heaviest economic burden. Nebulized inhalation therapy is an important treatment for respiratory diseases. Compared with oral administration, intramuscular injection and intravenous administration, aerosol inhalation therapy is widely used at home and abroad because the drug directly acts on the target organ, has the advantages of rapid onset of action, good curative effect, few systemic adverse reactions, and does not require deliberate cooperation of patients. In China, due to the lack of drugs, equipment and clinical experience, many primary hospitals and even high-level hospitals have many irregularities in aerosol inhalation therapy, which in turn affects the curative effect of patients^[1]。 Based on this, the Respiratory Branch of Chinese Medical Association joined hands with well-known domestic experts in pediatrics, otolaryngology, thoracic surgery and pharmacology to formulate this consensus, in order to better guide medical staff at all levels to carry out standardized aerosol inhalation therapy.

Non-alcoholic fatty liver disease (NAFLD) is a clinicopathological syndrome characterized by diffuse hepatocellular bullous steatosis, including simple fatty liver, non-alcoholic steatohepatitis, cirrhosis, and even hepatocellular carcinoma. Studies have shown a close relationship between NAFLD and type 2 diabetes (T2DM)^[1], NAFLD is associated with insulin resistance^[2,3]。 At present, there are many studies on the factors related to NAFLD, and some studies have shown that hemoglobin is closely related to the occurrence of NAFLD^[4,5]Whether the occurrence of NAFLD is related to hemoglobin levels in patients with type 2 diabetes has not been reported. In this study, the hemoglobin level of type 2 diabetes mellitus with NAFLD was detected, and its correlation with NAFLD was observed, which provided a theoretical basis for screening high-risk groups of NAFLD in diabetic patients and taking intervention measures to reduce the incidence of NAFLD.

A 68-year-old female was admitted to the Department of Nephrology, Peking University First Hospital on June 26, 2015 due to intermittent macroscopic hematuria for 2 months and an increase in serum creatinine for 1 month. The patient started oral warfarin anticoagulation 4 months ago due to atrial fibrillation at a starting dose of 1.5 mg/dose, once/d. Warfarin was spiked to 2.25 mg/d 2 months ago according to the International Normalized Ratio (INR). Macroscopic hematuria with edema of both lower limbs and increased foam in urine occurred 2 months ago. Laboratory test: INR 5.4, urine routine: protein (+), microscopy: red blood cell full field/HP. Warfarin was suspended, and oral "cephalosporin antibiotics" and "Longqing tablets" were taken. After 1 week, hematuria was relieved, and oral warfarin 1.5 mg/d was continued. Laboratory test 1 month ago: serum creatinine 227 μ mol/L, discontinuation of "Irbesartan Hydrochlorothiazide". Macroscopic hematuria appeared again 23 days ago, and it was not diagnosed and treated. 2 weeks ago, I had loss of appetite, no nausea or vomiting, and went to our hospital. Laboratory examination: serum creatinine 246 μ mol/L, urea 17.69 mmol/L, urine routine: protein (+), microscopic examination: red blood cell full field/HP. Warfarin was reduced to 1.5 mg once every other day, and sodium bicarbonate tablets were given 0.5 g/time, 3 times/d. The urine color gradually returned to normal. The outpatient test in our hospital 5 days ago showed that blood creatinine was 233 μ mol/L, urea was 18.65 mmol/L, and INR was 1.25. 1 day ago, the patient adjusted warfarin to 1 mg/d by himself, and was admitted to our department for further diagnosis and treatment. The patient has a history of hypertension for 20 years, and has been orally administered "amlodipine besylate and irbesartan hydrochlorothiazide" for a long time. During physical examination 5 years ago, he was found to be positive for urine protein, but he was not diagnosed and treated. Discovered "arrhythmia, atrial fibrillation" 2 years ago. Physical examination after admission: body temperature 36.5 ℃, pulse 70 beats/min, breathing 18 beats/min, blood pressure 137/85 mmHg (1 mmHg =0.133 kPa); There was no edema on the face and both eyelids, the heart boundary was enlarged, the apical beat was located 0.5 cm outside the midline of the left clavicle of the fifth intercostal bone, the heart rate was 96 beats/min, the heart rhythm was absolutely irregular, the first heart sound was different in intensity, and no murmur and pericardial friction were heard in the auscultation area of each valve. Mild dactyloidal edema of both lower limbs. Preliminary diagnosis: acute kidney injury; arrhythmia, atrial fibrillation; Hypertension grade 3 (very high risk).

Gastric cancer is one of the common malignant tumors in China. According to the 2015 Chinese cancer statistics of the National Cancer Registry Center, the incidence of gastric cancer ranks second among common malignant tumors^[1]。 For a long time, most patients with gastric cancer in China are in the advanced stage when they see a doctor, and the effect of simple surgical treatment is poor. In order to improve the treatment effect of gastric cancer, a new treatment model of perioperative comprehensive treatment based on standardized surgery has been gradually established; Neoadjuvant chemotherapy, as an important element in this model, has received more and more attention. The efficacy and safety of neoadjuvant chemotherapy in advanced gastric cancer have been validated by large clinical trials^[2,3]Its status was gradually established.

Maintenance hemodialysis patients may have various ocular disorders due to primary disease, uremic toxin accumulation or the effects of hemodialysis therapy^[1,2,3]。 Eye disorders such as glaucoma are not uncommon in the population of maintenance hemodialysis patients^[4]。 Multiple case reports describe patients with acute intraocular pressure increase during hemodialysis, accompanied by severe eye pain, headache and other symptoms^[5,6,7,8,9]。 Hyperocular pressure is an important risk factor for the onset and progression of glaucoma^[3,4]。 However, previous clinical studies have not obtained accepted results on the relationship between hemodialysis and intraocular pressure changes, and the related mechanism of intraocular pressure increase during dialysis has not been completely clarified. This article reviews the changes of intraocular pressure during hemodialysis in order to draw more tendentious conclusions.