2018年 · 第98卷第30期

In recent decades, diabetes has been widespread worldwide and its prevalence has been on the rise. The ultimate goal of focusing on diabetes is to reduce chronic complications caused by long-term hyperglycemia, especially cardiovascular events and cardiovascular deaths. However, research in the United States suggests that in the past 30 years or so, a reduction in all-cause death and cardiovascular death has only been observed in male diabetic patients, and no similar phenomenon has been found in women, suggesting that female diabetes may have some gender-related characteristics.

Honesty is an important symbol to measure the degree of civilization and progress of a society. Scientific research integrity is the cornerstone of scientific and technological innovation, the power source to promote the development of scientific undertakings, and an important benchmark to lead the progress of human civilization^[1]。 In 2016, President * made it clear at the highly anticipated National Conference on Science and Technology Innovation, the Academicians' Conference of the two academies, and the National Congress of the China Association for Science and Technology that by 2020, China should rely on scientific and technological innovation to enter the ranks of innovative countries. The national emphasis on scientific research has injected a boost into the development of China's scientific undertakings, and at the same time, it has put forward higher requirements for scientists.

The ideal biomarker for diabetes needs to have high sensitivity and specificity, sufficient stability and convenient to establish standardized detection technology. In particular, sampling has little damage to patients, and significant changes in levels can be keenly detected in the early stage or even in the early stage of the disease, so as to accurately intervene in the early stage of individuals, delay or prevent the occurrence of diseases, and realize the advancement of the prevention and control barrier.

Anemia is more common in preoperative patients. If it is not treated effectively, it will affect the surgery and prognosis of patients. Therefore, timely diagnosis and treatment of preoperative anemia is very important. At present, preoperative anemia is not paid enough attention clinically. Usually, only blood transfusion is used to correct anemia or direct surgery without intervention, which not only increases the risk of perioperative blood transfusion and surgery, but also increases the incidence of postoperative complications and mortality. With the continuous and in-depth understanding of blood management of perioperative patients, relevant consensus and guidelines have been issued at home and abroad. In 2016, the safety and effect evaluation project team of joint replacement surgery released the "Accelerated Rehabilitation of Hip and Knee Arthroplasty in China-Expert Consensus on Diagnosis and Treatment of Perioperative Anemia", which provided guidance for perioperative anemia management in orthopedic surgery. However, preoperative anemia is not only limited to orthopedic surgery patients, but also common in other surgical departments. Therefore, we searched domestic and foreign literatures, combined with published relevant consensus and guidelines, and extensively consulted relevant professional experts to formulate this consensus, aiming at providing a basis for standardized diagnosis and treatment of preoperative anemia (this consensus does not include pediatric surgery patients).

A 21-year-old male was admitted to Peking Union Medical College Hospital on April 27, 2016 due to "intermittent nausea, vomiting and melena for 2 months". In March 2016, intermittent nausea and vomiting began, accompanied by diarrhea and black paste stool more than 10 times/d, with a maximum amount of 500 ml/time. Intermittent hyperthermia with asthenia. The hemoglobin was 34 g/L in other hospitals. Gastroscopy showed a submucosal bulge of the duodenal bulb with a smooth surface. Multiple superficial ulcers of the jejunum with active hemorrhage revealed by oral enteroscopy. Pathology of the jejunal mucosa showed chronic inflammation. Treatment with fluid rehydration, acid suppression, blood transfusion and antibiotics was ineffective. Then I went to our hospital for blood routine: white blood cells 5.9×10⁹/L, lymphocytes 1.28×10⁹/L, hemoglobin 84 g/L, platelets 281×10⁹/L; Serum albumin 26 g/L, erythrocyte sedimentation rate 56 mm/1 h, high-sensitivity C-reactive protein 20.76 mg/L; Anti-nuclear antibody and anti-neutrophil cytoplasmic antibody were both negative; Blood lymphocyte culture plus interferon assay (T. SPOT-TB) A + B: 232 SFC/10⁶MC. March 28 Chest CT (Figure 1): ground glass shadow in the posterior segment of the upper lobe tip of the left lung, multiple patch cord shadows in the left lung; There were many patchy high-density foci in the lateral segment and lower lobe of the right middle lobe, nodular foci in the lower lobe of the right lung and the upper lobe of the left lung, and a small amount of pleural effusion on both sides. Abdominopelvic enhanced CT + small intestine reconstruction (Figure 2): Multiple annular thickening of intestinal wall with abnormal enhancement of mucosal surface and increased mesenteric fat density with multiple swollen lymph nodes in small intestine, terminal ileum and ileocecal region in groups 5 and 6; Splenomegaly; Mild dilatation of left renal pelvis and upper ureter; Abdominopelvic effusion; Intrapelvic calcifications. He was treated with fasting water, fluid rehydration, acid suppression and levofloxacin, but still had fever, so he was admitted to hospital for further diagnosis and treatment. When the disease began, the weight lost 12 kg. Past physical fitness. Personal History: Stay up late for a long time, and work and rest are not regular. Denying a history of exposure to tuberculosis or a family history of tumor. Admission physical examination: body temperature 38.5 ℃, pulse 110 beats/min, body mass index 18.8 kg/m²。 The superficial lymph nodes were not enlarged. The breathing sound of the right lung is thick, with a small amount of wet rales; No murmur heard in the heart; The abdomen was flat, the abdomen was tough, without tenderness and rebound pain, the liver and spleen were not palpable under the costs, and the abdominal mass was not reached. The mobile voiced sound was negative, and the intestinal sound was 4 times/min. Both lower limbs are not swollen.