2015年 · 第54卷第05期

Liver disease is a common major disease caused by many factors such as viral infection, overwork, unreasonable diet, mistaken consumption or abuse of drugs, etc. There are more than 20 million patients with chronic hepatitis B alone in China. With the changes of living standards and dietary structure, the incidence of fatty liver disease, alcohol/drug liver disease, autoimmune liver disease, etc. has increased significantly compared with before. Together with other liver diseases such as hepatitis C, there are more than 100 million patients with chronic liver disease. Severe patients such as liver cirrhosis, liver cancer and liver failure are the main people who die from liver disease at present. Further aggravation of liver disease caused by bacterial infection and endotoxemia and other complications are the main direct causes of their death. Although there are many factors leading to the severity of liver disease, and the specific mechanism is not fully understood, the latest research shows that the imbalance of intestinal microecology plays an important role in the severity of liver disease.

It is estimated that nearly one trillion microorganisms, including bacteria, fungi, viruses, phages, etc., live in the human digestive tract, which constitute the microbial system of the human digestive tract, also known as microbiota and microbiome. Microecology is the unity formed by microorganisms and their hosts in the process of evolution. The related research fields include the structure and function of microbiome and its relationship with human body.

inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is a chronic recurrent non-specific intestinal inflammatory disease involved by environmental, genetic, infectious and immune factors. At present, it is believed that intestinal damage caused by abnormal immune response of genetically susceptible individuals to intestinal symbiotic bacteria caused by intestinal microbial stimulation.

colorectal cancer (CRC) is one of the most common malignant tumors. The specific mechanism of its pathogenesis has not been elucidated, but it is generally believed that its occurrence is caused by many factors, including tumor-related gene and protein variation, diet and inflammation. More and more evidence shows that intestinal microecology is also involved in the occurrence and development of CRC. Many studies have deeply explored its mechanism of action. Now, the current research status in this field is described.

The gastrointestinal tract is the most widely exposed part of the body to external antigens, and it is also the largest and most complex microbial storage in the human body. However, why can the gastrointestinal mucosa selectively allow nutrients and drugs in the intestinal lumen to enter and prevent antigens such as bacteria and toxins from entering? In addition to the gastrointestinal mucosal barrier, this is closely related to intestinal mucosal immunity. There is only one stage in life that is insulated from microbes, that is, the fetus in the womb. Therefore, the fetus has no intestinal mucosal immunity. On the contrary, the fetus will face the doom of miscarriage. After birth, under the training of intestinal microorganisms, intestinal mucosal immunity gradually develops and matures, which becomes an important physiological function for the body and microorganisms to live in harmony throughout their lives^[1]。

There are tens of thousands of microorganisms in the human intestine, which are collectively called intestinal microbiota. They contain more than 1,000 species and a total of 100 trillion bacteria, which is more than 100 times the number of cells in the whole human body. They not only play a vital role in maintaining the integrity of the intestinal mucosal barrier and normal immune function, but also help the body absorb vitamins and maintain the dynamic balance of energy. The results of microbial independent gene sequencing and metagenomics analysis showed that Firmicutes, Bacteroides, Actinomycetes, Proteus, Helicobacter and Verruca were the most important bacterial flora in human intestine, among which Firmicutes and Bacteroides accounted for more than 90% of the intestinal flora^[1]。 The types and proportions of intestinal flora are relatively stable among individuals in the population. Due to some reasons such as infection and abuse of antibacterial drugs, the proportions of bacteria in the normal intestinal flora change greatly and exceed the normal range. The resulting disease is called intestinal dysbiosis. At present, intestinal flora imbalance has been found to be related to a variety of diseases, such as obesity, multiple sclerosis, inflammatory bowel disease (IBD), psoriasis and spondyloarthritis (SpA).

October 2014 Proceedings of the International Society for Microbial EcologyISME J(Impact factor 9.267) published online the research completed by Professor Tong Xiaolin's research group from Guang' anmen Hospital of Chinese Academy of Chinese Medical Sciences and Professor Zhao Liping's research group from Shanghai Jiaotong University School of Life Sciences and Technology-"Changes of intestinal flora structure during the treatment of type 2 diabetes mellitus (T2DM) with traditional Chinese medicine compound Ge Gen Qinlian Decoction (GQD)"^[1]。 This is a randomized, double-blind, placebo-controlled clinical study that looked for the first time in a population trial at changes in the intestinal flora of patients with GQD during the treatment of T2DM and its association with diabetes improvement.

List of expert working groups(Sort by surname Chinese pinyin): Ding Yansheng (Department of Cardiology, Peking University First Hospital); Dong Jianzeng (Department of Cardiology, Beijing Anzhen Hospital affiliated to Capital Medical University); Fang Quan (Department of Cardiology, Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences); Guo Jihong (Heart Center, Peking University People's Hospital); Hu Dayi (Heart Center, Peking University People's Hospital); Huawei (Department of Cardiology, Fuwai Cardiovascular Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences); Huang Congxin (Department of Cardiology, People's Hospital of Wuhan University); Huang Dejia (Department of Cardiology, West China Hospital, Sichuan University); Jiang Wenping (Department of Cardiology, The First Affiliated Hospital of Suzhou University); Ke Yuannan (Department of Cardiology, China-Japan Friendship Hospital); Li Chunsheng (Emergency Department, Beijing Chaoyang Hospital affiliated to Capital Medical University); Liu Shaowen (Department of Cardiology, Shanghai First People's Hospital); Lu Yiming (Emergency Department, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine); Ma Changsheng (Department of Cardiology, Beijing Anzhen Hospital affiliated to Capital Medical University); Ma Jian (Department of Cardiology, Fuwai Cardiovascular Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences); Qi Xiangqian (Department of Cardiology, Tianjin TEDA International Cardiovascular Hospital); Sun Genyi (Department of Cardiology, Tianjin Chest Hospital); Wan Zheng (Department of Cardiology, General Hospital of Tianjin Medical University); Wu Shulin (Department of Cardiology, Guangdong People's Hospital, Guangdong Academy of Medical Sciences); Yang Xinchun (Department of Cardiology, Beijing Chaoyang Hospital affiliated to Capital Medical University); Yang Yanzong (Department of Cardiology, First Affiliated Hospital of Dalian Medical University); Yang Yanmin (Acute and Critical Care Center, Fuwai Cardiovascular Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences); Zhan Siyan (Center for Evidence-Based Medicine, Peking University School of Public Health); Zhang Ping (Department of Cardiology, Tsinghua Chang Gung Memorial Hospital, Beijing); Zheng Qiangsun (Department of Cardiology, Tangdu Hospital, Fourth Military Medical University); Zhu Jun (Acute and Critical Care Center, Fuwai Cardiovascular Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences)

The incidence of invasive candida infections, especially candidaemia, has been increasing year by year. From 2000 to 2005, the incidence of candidaemia has increased by 50%^[1]。 ICU patients are the highest risk of candidaemia, accounting for 33% ~55% of all candidaemia patients^[2]。 A global epidemiological study (EPIC II) showed that invasive candida infection was the third highest in ICU, accounting for 17% of all infected patients^[3]。 Among bloodstream infections, Candida is the fourth pathogenic bacterium. Once candidaemia occurs, the mortality rate can be as high as 40% ~70%^[3]It is significantly higher than that of bloodstream infections caused by bacteria, and the treatment course is long and the medical expenses are huge. How to improve the prognosis of patients through reasonable treatment and avoid excessive use of antifungal drugs is a difficult problem that clinicians must face.

Metabolic diseases are a group of diseases closely related to human eating habits. Bad eating habits lead to changes in intestinal flora, and the accompanying bacterial translocation, endotoxemia and systemic low-grade inflammation all promote the occurrence and development of metabolic diseases. This also makes dietary regulation, intake of probiotics and prebiotics, and fecal micro-ecological transplantation (FMT), which is based on regulation of intestinal flora to improve metabolic status, a new way of thinking for the prevention and treatment of such diseases. This field will be reviewed.

irritable bowel syndrome (IBS) is a common functional bowel disease, and its prevalence is 0.82% ~5.67% in the survey of general population in China^[1]The patients presented with abdominal pain or abdominal discomfort with changes in defecation habits and fecal traits, which seriously affected the quality of life and work efficiency of the patients^[2]。 In recent years, the relationship between intestinal infection, small intestinal bacterial overgrowth (SIBO), intestinal flora disorder and IBS has attracted increasing attention. With the development of microecology, microecological regulators such as probiotics and prebiotics are gradually used to regulate intestinal flora in order to maintain the balance of intestinal microecology. The therapeutic value of prebiotics for IBS has been paid more and more attention.

In 1976, a severe pneumonia outbreak at a veterans meeting in Philadelphia, USA, infected hundreds of people and killed 34. A few months later, the pathogenic bacterium-Legionella (Legionella) were isolated and identified. With the rapid development of society and economy, the general popularization of central air conditioning and hot water shower system, Legionella infection has attracted more and more attention in the medical field, and has become an important public health problem faced by modern society. The epidemiology of Legionella and its place in respiratory infections are reviewed below.

Atherosclerotic cardiovascular disease (ASCVD) is a major disease that causes death and affects quality of life in the elderly^[1]。 The prevalence and mortality of ASCVD increases with age. Dyslipidemia is an independent risk factor for ASCVD and its cardiovascular and cerebrovascular events. In recent years, a large number of epidemiological and clinical studies have confirmed that statins are safe and effective lipid-lowering drugs. However, concerns about the benefit of statin use in older adults and the safety of long-term treatment have led to a serious underuse of statin use in older adults^[2,3]。 In 2010, some elderly cardiovascular and cerebrovascular disease experts in China jointly drafted the "Chinese expert consensus on the use of statins in the elderly with dyslipidemia"^[4](Abbreviated as "Consensus on Statins in the Elderly"), which has played a positive role in promoting the management of dyslipidemia in the elderly in China. In order to further strengthen the prevention and treatment of ASCVD in the elderly in China, the 2010 "Statin Consensus for the Elderly" in China was revised for reference to the international lipid management guidelines and clinical evidence issued in recent years.

Recently, we found that some websites fraudulently used the name of "Chinese Journal of Internal Medicine" to call for papers, and promised "authoritative and quick distribution of professional title papers". Therefore, our journal specially reminds all authors that when submitting manuscripts to Chinese Journal of Internal Medicine, they must log on to the homepage of Chinese Medical Association (http: / /www.cma.org.cn/), enter the "Business Center", submit manuscripts in the "Magazine Remote Manuscript Management System", or submit manuscripts through the official website of this journal (http: / /www.emedicine.org.cn), so as not to be fooled. Contact number: 010-85158280. 

AIDS: Acquired immunodeficiency syndrome

[Website] http: / /www.sgim.org/

A randomized controlled trial examined the effect of oral iron administration on hemoglobin recovery after blood donation. Subjects were divided into high and low groups according to their hemoglobin levels, and received ferrous gluconate tablets or placebo respectively. The results showed that oral administration of iron significantly reduced the time to recover the amount of hemoglobin by 80% (JAMA, 2015, 313: 575 – 583).

The patient was a 28-year-old male. He was admitted to our hospital on June 5, 2014 due to "intermittent fever for more than 20 days and disorder of consciousness for 5 days". The patient has been on continuous business trips since mid-May 2014, with tired work and irregular work and rest. On May 19th, fever occurred without obvious trigger, with the highest body temperature of 42.0℃, accompanied by chills, chills and fatigue. The next day, irritability and unsteady walking appeared. Thereafter, the patient had intermittent fever, with a maximum body temperature of 39.5℃. On the morning of June 1, 2014, the patient developed drowsiness and was admitted to the emergency room of our hospital. Blood test routine: WBC 21.5×10⁹/L, neutral 0.86, platelets 475×10⁹/L. CT plain scan of the head (Figure 1): Bilateral cerebral hemispheres occupied multiple rounded spaces, with a sheet-like low-density area in the center, a relatively high-density peripheral ring, and bilateral lateral ventricles compressed and narrowed. CSF pressure measured>330 mmH₂O (1 mmH₂0=0.009 8 kPa). Past history and personal history are not special; There was no history of unclean diet before the onset of the disease, and there was no special history of marriage and childbirth and family history. Physical examination at admission: heart rate 87 beats/min, body temperature 36.7 ℃, blood pressure 124/60 mmHg (1 mmHg =0.133 kPa), blood oxygen saturation 99% (nasal catheter 2 L/min). Confusion, inability to speak, Glasgow score 6. The bilateral pupils are of equal size and round, with a diameter of 4.0 mm, and are sensitive to light reflection. The neck is soft, and scattered phlegm sounds can be heard in both lungs. Bilateral Pap sign was positive and there was no edema in both lower limbs.

The Second Affiliated Hospital of Dalian Medical University (Second Clinical College) was founded in 1958. At present, it has 3,000 beds and 4,514 staff, making it the largest hospital in southern Liaoning. In 2013, it ranked among the top three in the province and the first in Dalian in the operation and management list of public hospitals in Liaoning Province. The hospital vigorously carries out discipline construction, with 94 sub-specialties, seven medical platforms and nine discipline groups. At present, the hospital has entered a stage of rapid development, and it is now planned to recruit leaders of various disciplines of clinical medicine and young and middle-aged backbones from the whole country. Doctor of Medicine, doctoral supervisor, male 50 years old, female under 45 years old, associate professor or above in affiliated hospitals of famous university medical schools and famous medical institutions at home and abroad. Priority will be given to those who are part-time academic members of the professional committee of the Chinese Medical Association or vice-chairmen of provincial societies (academic groups) of the Chinese Medical Association. They have stable research directions and national projects, and have published academic papers in SCI-listed journals with an impact factor of more than 20, or have published papers in SCI-listed journals with an impact factor of more than 7. Priority will be given to and preferential treatment to those who have obtained the national provincial and ministerial talent program (including the national "Thousand Talents Program" distinguished professors, the "Changjiang Scholars Award Program" distinguished professors, the "Science Fund for Outstanding Young Scholars", the national candidates of the "Hundred and Thousand Talents Project" in the new century, the candidates selected from the "Hundred Talents Program" of the Chinese Academy of Sciences, the candidates selected from the "New Century Outstanding Talents Support Program" of the Ministry of Education, the "Climbing Scholars" of colleges and universities, and the candidates selected from the national "Youth Thousand Talents Program"). 2. Recruitment conditions for young and middle-aged academic backbones: Doctor of medicine, under 40 years of age, who has worked in this subject field for more than 5 years, and has the title of attending physician or above in affiliated hospitals of famous university medical schools and famous medical institutions at home and abroad. Have a certain academic part-time job, have a stable research direction and national-level projects, published in SCI included journals academic papers the total impact factor is more than 15, single article is more than 5. Those with development potential can be selected and recruited exceptionally. 3. Recruitment conditions for nursing leaders and academic backbones Master of Nursing, under 40 years old, working in this subject field for more than 5 years, with the title of deputy chief nurse or above in affiliated hospitals of famous university medical schools and famous medical institutions at home and abroad, at the same time, he serves in the provincial branch of Chinese Nursing Association, undertakes projects at or above the provincial level, and publishes academic papers included in SCI with a total impact factor of more than 5. 4. Application Method: Candidates should download the Application Form for High-level Medical Talents of the Second Clinical College of Dalian Medical University from our official website, fill in it in detail, and send it to our hospital's mailbox. Please contact us if you are interested. Contact person: Teacher Qu, Teacher Zhan, Teacher Yu; Tel: 0411-84671236; E-mail: dy2yrs_talent@163.com; For recruitment information, please refer to the hospital website: http: / /www.shdmu.com/

The "Seminar on Cerebrovascular Diseases and Neuroimmune Progress" hosted by the Department of Neurology, Beijing Naval General Hospital will be held in Xining, Qinghai Province from July 22 to 26, 2015. The seminar will invite famous neurological experts in China to introduce the latest progress in cerebrovascular diseases and neuroimmunity at home and abroad in recent years. The seminar will also teach and discuss other hot issues in neurology and neuroimaging characteristics of rare and difficult diseases. The conference is a national medical continuing education project, and 10 points of national Class I credits are awarded. Doctors at all levels are welcome to participate. Address: Department of Neurology, Naval General Hospital, No.6 Fucheng Road, Haidian District, Beijing, 100048. Contact: Qiu Feng, Zhang Fengqun (Tel: 18600310609, 18600310751, 010-68780622); Fax: 010-68780622; Email: 15810390858@163.com. Deadline for registration: May 15, 2014. 

The 12th Beijing International Forum on Digestive Diseases, co-sponsored by National Clinical Medical Research Center for Digestive Diseases, Gastroenterologist Branch of Chinese Medical Doctors Association, Beijing Friendship Hospital affiliated to Capital Medical University, Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Department of Gastroenterology of Capital Medical University and Beijing Digestive Diseases Center, will be held in Beijing from June 12 to 14, 2015, and will conduct extensive discussions on topics related to digestive diseases.

In order to better promote clinical and basic research, enhance independent innovation ability, promote the improvement of diabetes diagnosis and treatment level in China and promote the academic research process of diabetes, the "Young Doctors Diabetes Research Project" sponsored by China International Medical Exchange Foundation and donated by Takeda (China) International Trading Co., Ltd. is aimed at recruiting dipeptidyl peptidase 4 (DPP 4) inhibitor research topics from various hospitals. The relevant matters are hereby announced as follows: