2017年 · 第97卷第04期

Tumor treatment decision-making has undergone a transformation from empirical medicine, evidence-based medicine to precision medicine. The maturity of clinical trials, the progress of omics technology and the emergence of big data analysis tools are the core elements that promote the development of previous medicine^[1]。 Traditional clinical studies, especially randomized controlled studies (RCTs), have optimized treatment plans, promoted the formulation and revision of treatment guidelines, and brought thinking about new medical strategies, but their extrapolation efficacy in the real world still needs to be tested. Real-world research (RWS) emerged as the times require to build a big data platform with small randomization to improve clinical treatment decision-making.

Accelerated rehabilitation surgery (ERAS) refers to the optimization of multimodal perioperative pathways and the adoption of effective measures proved by evidence-based medical evidence to alleviate the psychological and physiological traumatic stress response of patients to accelerate the recovery of preoperative body composition and organ function, and achieve the goal of early rehabilitation. Through the integration of perioperative intervention measures to promote the recovery of postoperative organ function, reduce complications, shorten hospital stay, reduce the risk of readmission and death. The concept of ERAS started from general surgery, but in recent years, it has been extended to other surgical specialties and even the whole medical and health industry, but it is still the most convincing in its application in colorectal surgery. Today, the development of ERAS is no longer a discussion of whether the ERAS treatment model is superior to traditional perioperative management, but how to further standardize, optimize and implement the related strategies of ERAS^[1]。 Although ERAS has developed rapidly, it has encountered some practical problems in the process of clinical application, including traditional habits and some questions that ERAS is still difficult to solve. While seeing the achievements of ERAS, we should also see some existing problems and future research directions.

In 2015, the British Biotechnology and Biological Sciences Research Council (BBSRC) issued the Strategic Research Framework 2015-2020 for Biosciences in the Health Field, proposing four development directions for Biosciences in the Health Field: lifelong health, nutrition and health, integrated health and health Biotechnology. This paper will interpret and analyze the plan, in order to provide reference and reference for the related work in China.

Diabetic foot is one of the serious chronic complications that lead to disability and death of diabetic patients in China. Its incidence is high, the treatment is difficult and the cost is huge. At present, China mainly refers to the guidelines formulated by international podiatrists and the American diabetic foot group. However, because China's diabetic foot has its own characteristics, China Medical Care International Exchange Promotion Association organized national podiatry experts to draft guidelines for the diagnosis and treatment of diabetic foot.

Venous thromboembolism (VTE) ranks first among preventable and controllable fatal causes in hospital^[1]。 Although the death risk of fatal pulmonary embolism is high, the morbidity can be significantly reduced by correct medical intervention, so the prevention and treatment of venous thromboembolism has been highly paid attention to in clinical work in recent years. However, the misconception and perception of venous thromboembolism also brings new problems to clinical work. This study summarized the clinical characteristics of 98 cases of solitary intermuscular vein thrombosis of lower limbs, pointed out some misunderstandings in the current prevention and treatment of VTE, and provided reference for the prevention and treatment of VTE.

A 38-year-old male was admitted to Guangdong Nongken Central Hospital on May 30, 2015 mainly due to high fever, coma, convulsions, shortness of breath and anuria for 4 h. At 3 o'clock in the afternoon, when working in the open air in a high temperature and high humidity environment, I complained of dizziness, palpitation, nausea and fatigue. Then I collapsed, refused to respond, and my limbs twitched and vomited. I was sent to the local hospital for emergency department nearby. At that time, the body temperature was as high as 42℃, and he was given emergency physical cooling with ice pack, intravenous injection of dexamethasone 10 mg and fluid rehydration treatment. The body temperature dropped, but he was comatose with shortness of breath and anuria. No hemorrhage or infarction was found on brain CT scan, so he was transferred to our hospital. Usually introverted, likes sweet drinks, rarely drinks water. Deny history of diagnosis and treatment of other diseases. Physical examination: Body temperature: 39.3 ℃, blood pressure: 106/68 mmHg (1 mmHg =0.133 kPa), heart rate: 142 beats/min, breathing: 35 beats/min, blood oxygen saturation 54%, deep coma, dry and burning skin, severe edema of conjunctiva in both eyes, harmonic heart rhythm, coarse breathing sound in both lungs, cyanosis of lips and extremities, and no edema in both lower limbs. Auxiliary examination: white blood cells 17.2×10⁹/L, hemoglobin 117 g/L, platelets 79×10⁹/L. Reexamination after 6 h: white blood cells 7.6×10⁹/L, hemoglobin 139 g/L, platelets 25×10⁹/L. Urinary specific gravity>1.030, urine occult blood + + +. Gastric vomit occult blood + +. Blood sodium 133 mmol/L, blood potassium 2.67 mmol/L, blood calcium 1.78 mmol/L, blood phosphorus 0.28 mmol/L, urea nitrogen 8.4 mmol/L, creatinine 237 μ mol/L, uric acid 735 μ mol/L, blood glucose 20.10 mmol/L, albumin 32 g/L, globulin 19 g/L. There was no abnormality in bilirubin, aspartate aminotransferase 161 U/L (reference value: 8-40 U/L), alanine aminotransferase 93 U/L (reference value: 0-40 U/L), γ-glutamyltransferase 75 U/L (reference value: 7-45 U/L), alkaline phosphatase 75 U/L (reference value: 45-125 U/L), creatine kinase 8 480 U/L (reference value: 24-194 U/L), creatine kinase isoenzyme 480 U/L (reference value: 0-25 U/L), lactate dehydrogenase 652 U/L (reference value: 109-245 U/L), C-reactive protein 14.1 mg/L (reference value: 0-8 mg/L). High-flow mask oxygen inhalation (8 L/min), oxygen concentration in inhaled air (FiO₂) Blood gas at 53%: pH 7.34, partial pressure of carbon dioxide 46.5 mmHg, partial pressure of oxygen (PaO₂) 30.8 mmHg, HCO₃^-26 mmol/L, Blood oxygen saturation 56%. Oxygenation index (PaO₂/FiO₂) 58.1 mmHg (reference value: 400-500 mmHg). Plasma prothrombin time 13.6 s, international normalized ratio 1.15, activated partial prothrombin time 27.0 s, fibrinogen 1.50 g/L, D-dimer 2 270 μ g/L. Hepatitis viruses of various types (-). Electrocardiogram: Sinus tachycardia with mild changes in ST. Abdominal color ultrasound: liver enlargement and fatty liver. CT scan of the brain: extensive diffuse swelling of the gyrus. CT scan of the chest: sign of infection and edema in both lungs. Diagnosis: exertion heat stroke with multiple organ dysfunction syndrome (MODS), acute cerebral edema, severe acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), rhabdomyolysis, acute renal failure, acute liver damage, hypothalamic-pituitary-adrenal axis (HPA axis) hypofunction, pneumonia, stress ulcer, stress hyperglycemia?

The cytokine signaling inhibitor molecule (SOCS) 3 protein is a member of the SOCS protein family. SOCS protein feedback regulates cytokine responses, thereby regulating immune balance. Many studies have shown that SOCS3 protein is overexpressed in patients with allergic asthma, which plays an important role in the pathogenesis of asthma by affecting the differentiation of helper T lymphocytes (Th) and the airway infiltration of eosinophils. The mechanism of down-regulating SOCS3 protein in regulating immune balance in asthma is reviewed below.