2018年 · 第98卷第13期

Dementia is a clinical syndrome with cognitive dysfunction and decreased ability to do daily activities as the main manifestations, and mild cognitive impairment is an intermediate stage between normal aging and dementia. China's epidemiological survey shows that the total prevalence of dementia among people aged 65 and above is 5.14% ~7.3%^[1]The prevalence of mild cognitive impairment was as high as 20.8%^[2]。 According to this calculation, there are about 8 million patients with dementia and about 24 million patients with mild cognitive impairment among the elderly in China, which pose a huge challenge to China's social and economic development. However, the number and level of memory clinics and dementia specialists in general hospitals in China are far from meeting the needs of the rapid increase of dementia patients in the aging society^[3]。

Hyperuricemia is an abnormal increase in blood uric acid levels due to abnormal purine metabolism in the body. When the concentration of uric acid in the body exceeds its solubility, uric acid is easily precipitated to form urate crystals, which are deposited in the joints and surrounding tissues, causing gouty arthritis. Acute attack of gout is a typical acute inflammatory reaction, mainly manifested by redness, swelling, heat, pain and functional limitation of the affected joint and its surrounding tissues. In addition to gouty arthritis, increased blood uric acid is also closely related to diabetes, metabolic syndrome, hypertension, coronary heart disease and heart failure. Therefore, in addition to the acute inflammatory response during an acute gout attack, the process of uric acid metabolism is also involved in the chronic inflammatory response in a variety of diseases.

dementia is a syndrome that centers on acquired cognitive impairment and leads to a significant decrease in the ability of daily living, learning, working and social interaction. Patients' cognitive impairment involves memory, learning, orientation, understanding, judgment, calculation, language, visual-spatial function, analysis and problem-solving abilities, and is often accompanied by mental, behavioral and personality abnormalities at a certain stage of the disease course. Dementia is described as a "neurocognitive disorder" in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) of the American College of Psychiatry. World Health Organization's International Classification of Diseases, 10th Edition (the International Statistical Classification of Diseases and Related Health Problems 10th Revision, ICD-10) The diagnosis of dementia needs to be confirmed by medical history inquiry and neuropsychological examination to confirm mental decline.

The diagnosis of Alzheimer's disease (AD) has made great progress in the past three decades. In terms of diagnosis, new standards are continuously introduced, which greatly improve the accuracy of diagnosis. However, the treatment is still based on improving symptoms, preventing the further development of dementia, maintaining residual brain function, and reducing complications.

The linear no threshold (LNT) model in the field of radiation protection was proposed by Hermann Muller (1946 Nobel Prize in Physiology or Medicine), and has been used by countries around the world to formulate radiation safety guidelines, regulations and policies. The theory is that there is no safe level of radiation in the world, and ionizing radiation can induce cancer no matter how small the dose. Therefore, although 95% of medical radiographic images (X-ray, CT, PET) involved radiation doses below 20 mSv [author's note: to avoid confusion for readers, the radiation dose unit of different studies is unified as "mSv" (millisieverts). The average background radiation of the Earth is 2 to 3 mSv per year], according to the LNT model, these radiations still induce cancer, forming the iatrogenic cancer risk theory. However, the gene mutation rate caused by LNT model in the range of low-dose ionizing radiation is not supported by scientific data, and only extrapolated from the gene mutation rate caused by high-dose radiation. In addition, many studies on the biological effects of low-dose ionizing radiation have been published in recent years, which makes more and more people question the correctness of LNT model applied to low-dose ionizing radiation range, including the field of medical radiography.

autophagy is a basic metabolic process for cells to maintain their homeostasis, which is crucial for the removal of proteins, organelles and other substances that need to be degraded in healthy cells and the reuse of useful components. Dysfunctional autophagy is related to a series of diseases such as tumors, neurodegenerative diseases, cardiovascular diseases, blood diseases, endocrine and autoimmune diseases. Recent studies have shown that autophagy is involved in the development of lymphocytes and plays an important role in maintaining immune system homeostasis and function. Rheumatism refers to a group of diseases that mainly involve bones, joints and soft tissues. It is closely related to the autoimmune system and can cause joint inflammation and damage to various tissues and organs. A deeper understanding of the regulatory role of autophagy will deepen the understanding of the pathogenesis of rheumatism and provide new therapeutic targets. In this paper, the mechanism of autophagy, the relationship between autophagy and immune system, and its relationship with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), osteoarthritis and other common rheumatic diseases are reviewed as follows.

painful diabetic peripheral neuropathy (pDPN or painful diabetic neuropathy, PDN) is a typical peripheral neuropathic pain in diabetic peripheral neuropathy (DPN) characterized by pain symptoms. With the exploration of diabetic peripheral neuropathy and pain related fields, pDPN has gradually been recognized by the medical science community from basic research to clinical practice. From 2008 to 2013, the international community published a series of related diagnosis and treatment guidelines^[1,2,3,4]And expert consensus^[5]In the field of physician continuing education and patient management, it provides clinical management norms for this disease. In 2012, the Neurology Branch of Chinese Medical Association published the "Consensus on Diagnosis and Treatment of Painful Peripheral Neuropathy", which introduced the characteristics, diagnosis process and treatment recommendations of pDPN as a typical type of painful peripheral neuropathy^[6]。 At present, the relevant data of relevant specialists in China on pDPN disease and their cognition of diagnosis and treatment are unknown. We summarize the relevant data surveys of specialists and patients' cognition of diseases or diagnosis and treatment in Europe, America and other Asian countries in recent years, in order to attract everyone's attention to pDPN disease and further promote the standardized diagnosis and treatment of pDPN.

Artificial joint replacement is the main method to reconstruct joint function. periprosthetic joint infection (PJI) is a serious complication after prosthetic replacement, which will seriously affect the prognosis^[1]It brings a huge economic and psychological burden to patients, and will improve the postoperative mortality rate of patients. The diagnostic criteria of PJI proposed by the American Musculoskeletal Infection Association (MSIS) in 2011 have been internationally recognized^[2]However, in clinical practice, some patients with PJI do not fully meet the MSIS criteria, and comprehensive evaluation by clinical workers is required. This article reviews the progress of PJI diagnosis and its influencing factors.