2017年 · 第97卷第42期

The treatment concept of modern medicine is gradually changing with the progress of the times. In 2011, four major authoritative institutions in the United States jointly issued the initiative "Towards Precision Medicine", which caused huge repercussions in the academic community. In January 2015, Obama introduced the "Precision Medicine Plan" in his State of the Union address. So far, the concept of precision medicine that advocates "personalized treatment" has been rapidly promoted, and it has served as a pilot symbol in the global scientific research and medical circles to guide the development of human health. Traditional Chinese medicine takes "syndrome differentiation and treatment, holistic view" as its core, and advocates the idea of "adapting measures to people and local conditions", which is unified with the concept of personalized treatment of precision medicine, but there is "macro and micro" opposition in the way of seeking the concept. This paper discusses the relationship between the two in detail.

Obesity has become a major public health problem in today's society^[1]。 Unlike fat stored in subcutaneous tissues, obese people produce excessive serum free fatty acids (FFA), which exceed the oxidative capacity of tissues. They are converted into non-adipose tissues (liver, heart, skeletal muscle, pancreatic islet beta cells) and esterified into triacylglycerol (TG), which accumulates in cells and eventually leads to organ steatosis. The liver is the site most prone to lipid deposition. Intrahepatic fat deposition is defined as non-alcoholic fatty liver disease (NAFLD), which may lead to non-alcoholic steatohepatitis (NASH), cirrhosis, and even liver cancer. Pancreatic fat deposition was first discovered in 1926 and has not received sufficient attention compared to NAFLD. At present, with the gradual deepening of research, it has been found that pancreatic fat deposition can be a risk factor for NAFLD^[2]Nonalcoholic adipose pancreatic disease (NAFPD) can be used to describe this type of disease. In China, the incidence of NAFPD is about 12.9% ~16%^[3,4]Its pathogenesis is still unclear, and it may be a combination of chronic inflammation, endoplasmic reticulum stress, leptin resistance and other factors. NAFPD may be an important manifestation of metabolic syndrome, and is influenced by many factors such as advanced age, gender, race, obesity, hypertension, type 2 diabetes, ALT, etc. The diagnosis of NAFPD mainly depends on imaging, the most commonly used is abdominal ultrasound, but it is easy to be misdiagnosed. Various evidences suggest that NAFPD may be closely related to pancreatic dysfunction, insulin resistance and type 2 diabetes, and may also promote the occurrence of acute pancreatitis and pancreatic cancer, and affect their prognosis; However, the relationship with chronic pancreatitis and pancreatic fibrosis is still unclear. NAFPD is a new concept. At present, there are few studies on the treatment of NAFPD, and it has not attracted widespread attention in China. The purpose of this article is to review the current research on NAFPD and provide help to improve the understanding of NAFPD in clinical practice.

The patient was a 32-year-old male. He was admitted to hospital on 29 Mar 2015 due to swelling of his left lower limb for 2 months. Two months ago, the swelling of the left lower limb appeared without trigger, which was progressively aggravated. The swelling was significantly aggravated after activity, and the movement of the hip joint was mildly limited. There was no discomfort such as pain and paresthesia. MRI showed that neurogenic tumor of left iliac region was waiting to be excluded (Figure 1)。

Pulmonary embolism is a kind of harmful disease, and anticoagulation therapy is its main treatment. At present, the dosage and anticoagulation intensity of anticoagulants related to pulmonary embolism in China mainly follow European and American guidelines, and there is some controversy about whether this is fully applicable to the diagnosis and treatment of Chinese people. Although a variety of new oral anticoagulants are used in clinical practice, warfarin, a traditional anticoagulant, is expected to remain the main drug for Chinese patients with pulmonary embolism for a long time because of its cheap price and suitability for China's national conditions.

As a classic oral anticoagulant, warfarin is commonly used in anticoagulant therapy such as pulmonary thromboembolism, deep vein thrombosis and atrial fibrillation. Various genes influenced the metabolism and effect of warfarin. Vitamin K epoxide reductase complex 1 (VKORC1) and hepatic cytochrome P450 2C9 enzyme (CYP2C9) had the greatest influence on the stable dose of warfarin^[1,2]。 A variety of gene-oriented warfarin dose prediction models have been established internationally, and most of them can only explain about 50% ~60% of the dose difference^[3,4]。 The guidelines do not recommend routine screening for warfarin-related genes, but genetic testing still has implications for assessing patients' sensitivity to warfarin and bleeding risk^[5]。

Diabetic nephropathy (DKD) is one of the most serious chronic complications of diabetes, mainly manifested as albuminuria, which can be accompanied by increased blood pressure and progressive decline in renal function. DKD has become the leading cause of end-stage renal disease (ESRD) in developed countries in Europe and America, and the total number of DKD patients is increasing rapidly in developing countries such as China^[1]。 An observational study^[2]It shows that among the 35.3 million patients hospitalized in China's top three hospitals (2010-2015), since 2011, the proportion of diabetes-related chronic kidney disease (CKD) (0.71%) has exceeded that of glomerulonephritis-related CKD (0.66%), and this trend has become more obvious after 2011. In addition, a similar trend was observed in the general population, with 21.3% of diabetic patients having co-occurring CKD^[2]。 Therefore, diabetes has become the leading cause of CKD in China.

In recent years, nosocomial infections caused by non-tuberculous mycobacteria have gradually increased, especially in immunocompromised patients. However, because the heat exchange water tank system of artificial heart and lung machine (also known as variable temperature water tank, cold and hot interactor, hereinafter referred to as heat exchange water tank system) is polluted in the production process, it has led to the postoperative occurrence of Mycobacterium chimera in heart surgery patients in many countries around the world (Mycobacterium chimaera) infection outbreak case, which has aroused the high attention of many countries, but this incident has not attracted attention in China, and there is a great risk. Therefore, we summarize the cause, development, severity, prevention and control measures and treatment plans of this incident, in order to attract the attention of domestic cardiovascular surgery, cardiology, surgery, anesthesia, infection, hospital infection prevention and control and hospital management, and take measures to actively respond.