2018年 · 第98卷第18期

At the end of 2017, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines (3rd Edition) made a magnificent debut in Chinese version. Once again, it has attracted the attention of Chinese clinical oncology doctors. Looking back at the more than 10 years of NCCN clinical practice guidelines in China, domestic experts refer to the latest evidence-based medical evidence and timely update the recommendations of the guidelines, which has become the most important theoretical basis for guiding and standardizing the clinical diagnosis and treatment of cancer in China.

Precision medicine is a new medical model and interdisciplinary field for preventing and treating diseases. At present, the domestic definition of it is "according to the clinical information of patients and population cohort information, applying modern genetic technology, molecular imaging technology and bio-information technology, combined with the living environment and mode of patients, to achieve accurate disease classification and diagnosis, and formulate personalized disease prevention and treatment plans"^[1]。 Because the development and technology transformation of precision medicine require large-scale samples and multi-departmental participation, and the benefits of precision medicine extensively include healthy people and patient groups, it is necessary to consider health equity as an important issue when formulating precision medicine development plans and policies.

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), is a global healthcare problem^[1,2]。 The risk of occurrence of VTE in hospital is related to patients' hospitalization, surgery and other treatment measures, and other risk factors (such as advanced age, obesity, bed rest, comorbidities, etc.). It is often complicated by other diseases, which is an important cause of unexpected death of patients in hospital, and has become a serious problem faced by hospital administrators and clinical medical staff^[3]。 Research data at home and abroad show that 40% ~60% of patients with surgery and non-surgery are at risk of VTE, while the prevention rate of high-risk groups is very low, and the prevention rate in Asian countries is even lower^[4,5,6,7]。 Early identification of high-risk patients with VTE and timely prevention can significantly reduce the occurrence of VTE in hospitals.

Hemophagocytic syndrome (HPS), also known as hemophagocytic lymphohistiocytosis (HLH), is a critical disease in which cytotoxic T cells and natural killer (NK) cells are over-activated due to various inducements, and stimulate the activation of macrophages and secrete a large number of inflammatory cytokines. Lymphoma is one of the important causes of HLH, and its incidence increases with age. In order to improve the knowledge and understanding of lymphoma-related HLH among hematologists and oncologists and provide standardized clinical practice guidance, the Lymphoma Professional Committee of China Anti-Cancer Association organized relevant domestic experts to demonstrate, extensively solicited the opinions of domestic and foreign experts, and reached the following consensus on the diagnostic procedures, laboratory tests, diagnostic criteria and treatment principles of lymphoma-related HLH.

In recent years, with the increasing application of on-site rapid detection (POCT), a variety of different POCT devices have emerged, including handheld POCT analyzer and small desktop computers. The handheld POCT analyzer is mainly based on microfluidic chip technology, which centrally embodies the ideal of transferring the functions of the analytical laboratory to the chip, namely the Chip Laboratory (LOC), which has fast analysis speed, can perform multiple tests on a single platform, use a single-person test card, and use brand-new tubing and electrodes for each test. With the development of science and technology, handheld POCT detection platform has supplemented a variety of quality control schemes and systems, and has gradually occupied an important position in the POCT field^[1,2]。 At present, the management norms of POCT in China are basically established according to the product characteristics and quality control requirements of small desktop computers. Therefore, it is necessary to formulate more practical classification management methods according to different types of POCT equipment. The purpose of this consensus is to develop management specifications for clinical application and quality control of handheld POCT with microfluidic chip technology.

A 56-year-old male was diagnosed with pancreatic cancer with multiple lung metastases in a foreign hospital in May 2015. In June 2015, he started to receive 6 cycles of chemotherapy with gemcitabine combined with tegio and nimozumab, and the efficacy was stable. After several months of discontinuation, it was replaced with oxaliplatin combined with irinotecan and 5-fluorouracil in January 2016 for 4 cycles of chemotherapy. The efficacy was stable, and the last chemotherapy time was March 2016. The tumor did not shrink during both chemotherapy sessions, and the tumor progressed slowly between drug withdrawals. In May 2016, the patient went to our hospital after CT reexamination showed tumor progression. Patients are advised to have pancreatic cancer biopsy specimens for tumor gene testing. The sequencing results showed that the patient's tumor carried MCL1 (Myeloid cell leukemia-1) gene amplification and SPTA1 gene mutation. No gene abnormalities such as KRAS, SMAD4, CDKN2A and TP53 were found, and no fusion gene was found. In view of the fact that among the targeted drugs that have been marketed in China, only sorafenib has a certain inhibitory effect on MCL1, it is recommended that patients try the drug, but patients give up for economic reasons. The last visit date was June 1, 2016. The patient was in poor general condition and later lost to follow-up.

Bronchial asthma (asthma for short) is a common chronic airway inflammatory disease that seriously affects people's health. In the past 20 years, the incidence and mortality of asthma in children and adults have continued to increase at a rate of 20% to 50% every 10 years. The epidemiological survey of asthma prevalence and risk factors in China (CARE) shows that the prevalence of asthma among adults in China is 1.24%^[1]Of which severe asthma accounted for 5.99%^[2]； Moreover, the emergency treatment rate and hospitalization rate of severe asthma patients far exceed that of other asthma patients, which is one of the important reasons for the increase of asthma treatment cost^[3]。