2015年 · 第54卷第06期

By 2015, the Chinese Medical Association has gone through a full 100 years, and the Critical Care Medicine Branch of the Chinese Medical Association has also celebrated its first 10th anniversary. Ten years for trees, one hundred years for people. The Critical Care Medicine Branch has thrived in the big family of the Chinese Medical Association, breaking ground and flourishing, becoming another towering tree that can shelter human health from wind and rain. Recalling a century of history and looking back on the ten-year journey, we have inherited the spirit of doctors from generation to generation, carried the benevolence of doctors, and practiced a good journey with fraternity. After a century of ups and downs, the glorious history of the Chinese Medical Association can not be looked down upon, but it is difficult to talk about it comprehensively. As an important milestone in the history of Chinese medicine, the establishment and development of Chinese Medical Association is of epoch-making significance. It is the spokesperson of Chinese medicine, the leader of Chinese doctors, and the escort of life. Under the care of the Chinese Medical Association, the Critical Care Medicine Branch adheres to its purpose, continues to inherit the spirit of doctors, and strives to show the benevolence of doctors.

sepsis is a systemic inflammatory response syndrome caused by infection that can develop into severe sepsis and septic shock. With the aging of the population, the increasing incidence of tumors and the increase of invasive medical treatments, the incidence of sepsis continues to rise. Every year, millions of new sepsis patients are added worldwide, and more than a quarter of them die. According to data released by the Global Sepsis Alliance^[1]The number of deaths due to sepsis exceeds the number of deaths due to prostate cancer, breast cancer and AIDS combined. In the past decade, the incidence of sepsis in developed countries has increased sharply at a rate of 8% ~13% every year; In developing countries, the mortality rate of sepsis remains high. Severe sepsis and septic shock are important clinical problems faced by critical care medicine. The treatment of sepsis is timely. If the correct diagnosis and treatment can be obtained within 1 h of shock, the survival rate of patients will reach more than 80%; If the patient is diagnosed and treated after 6 hours of shock, the survival rate of the patient will drop to 30%. Due to the low public awareness of sepsis, not all sepsis patients can receive correct diagnosis and treatment, and the mortality rate of hospitalized patients is as high as 30% ~60%. The Global Campaign to Save Sepsis (SSC) presents^[2]Through a number of measures, including education and implementation of guidelines, we will strive to achieve a significant improvement in the level of sepsis prevention and control, including striving to reduce the mortality rate of sepsis by 20%, and striving to increase the survival rate of children and adults with sepsis by 10% compared with 2012. At the same time, starting in 2012, the Global Sepsis Alliance has designated September 13 every year as World Sepsis Day to further enhance the awareness of sepsis among the public and professionals.

Brucellosis is a natural epidemic zoonotic disease, with clinical manifestations such as fever, fatigue, hyperhidrosis, joint pain, etc. However, sternoclavicular arthritis as the first manifestation is rarely reported, and it is easy to be misdiagnosed as rheumatoid arthritis, spondyloarthritis, bone tumor and other diseases. Three cases of brucellosis with sternoclavicular arthritis as the first manifestation admitted to our hospital are reported as follows.

Bone myelosuppression is a common adverse reaction of zidovudine, among which anemia and neutropenia are more common^[1]Thrombocytopenia is rarely reported in the literature. The following reports the diagnosis and treatment of a patient with severe thrombocytopenia with hemorrhage and infection caused by zidovudine.

The patient was a 25-year-old male. Surgical treatment was planned for left varicocele and right ureteral calculi. Blood routine, liver and kidney function and hepatitis virus markers were all normal before operation; Coagulation function test: APTT was prolonged to 121.5 s, while plasma prothrombin time (PT), thrombin time (TT), fibrinogen (Fb) and D-dimer quantification were all normal. The prolonged APTT could be corrected by normal plasma mixed with the patient 1:1. Further examination found that the activity of coagulation factor XII (FXII: C) and the content of FXII antigen (FXII: Ag) were severely reduced to 1.4%, and the activities of other coagulation factors (II, V, VII, VIII, IX, X, XI) were normal; Von Willebrand factor activity (vWF:C) and antigen (vWF:Ag) content were normal; Factor VIII antibody, anticardiolipin antibody and antinuclear antibody were all negative. According to the significantly prolonged APTT of the patient, which can be corrected by normal and mixed plasma of the patient, and the contents of FXII:C and FXII:Ag are significantly reduced, the diagnosis of FXII deficiency is made. The patient usually had no obvious bleeding symptoms and no history of long-term drug use. None of the family members were asked to have a history of hemorrhage. The patient's parents were not close relatives, and his father died due to an accident. The APTT of his mother, uncle and sister were all within the normal range.

In the outpatient clinic of internal medicine in primary hospitals, patients who visit for joint pain are often encountered. There are many kinds of diseases that cause joint pain, which can be inflammatory joint diseases, joint involvement of systemic diseases, and joint pain caused by metabolic diseases. The treatment of the above different diseases varies greatly. Therefore, the correct idea of differential diagnosis is very important for the prognosis of patients. The differential diagnosis of arthralgia is now discussed.

bloodstream infections are common nosocomial infections, with a total of 215,000 medical-related bloodstream infections occurring in the United States in 2002^[1]Its incidence rate is about 2.2 cases/100 hospitalized patients. In recent years, its pathogenic bacteria composition has changed significantly. Gram-positive bacterial infection occupies a very important position in the world and China. Among them, Staphylococcus aureus, especially methicillin-resistant Staphylococcus aureus (MRSA) infection is of particular concern, and its morbidity and mortality are high, which seriously threatens human health.

Sepsis is a systemic inflammatory response syndrome (SIRS) caused by infection. In severe cases, it leads to septic shock, multiple organ dysfunction syndrome (MODS), etc. It is the most common cause of death in critically ill patients in ICU^[1]。 In order to guide clinical practice and effectively reduce the mortality rate of sepsis, the International Guidelines for the Treatment of Severe Sepsis and Septic Shock have been updated several times since the issuance of 2004. However, from the perspective of treatment measures, the guidelines have not been fundamentally updated, and the mortality rate of sepsis is still high. Therefore, researchers at home and abroad start from various ways, hoping to find new treatment measures and improve the mortality rate. Hydrogen is a familiar gas. In recent years, it has been found that hydrogen has obvious selective antioxidant effect, which can inhibit excessive inflammatory reaction, reduce secondary tissue and organ damage, and improve the prognosis of patients. The application of hydrogen in sepsis is summarized as follows, in order to comprehensively understand the research progress of hydrogen in the treatment of sepsis.

Acute respiratory distress syndrome (ARDS) is a kind of serious life-threatening respiratory failure syndrome with diffuse injury of pulmonary capillary endothelium and alveolar epithelium as its main pathological features, and its clinical manifestations are progressive respiratory distress and refractory hypoxemia. At present, the main treatment strategies for ARDS are lung protective ventilation and restrictive fluid management. Against the background that many drugs have failed to improve the prognosis of ARDS patients, cell therapy has become the hope for the treatment of ARDS. Among them, mesenchymal stem cells (MSC) have become the ideal cells for the treatment of ARDS due to their multidirectional differentiation potential, low immunogenicity, anti-inflammatory and immunomodulatory properties^[1]。 In recent years, it has also been found that MSC is easily transfected by exogenous genes and stably expressed, which makes the treatment of gene-modified MSC become a research hotspot. The application of genetically modified MSC in ARDS is reviewed below.

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by joint inflammation, synovial hyperplasia, and synovial cell infiltration into surrounding bone and cartilage tissue. Glucocorticoids have powerful anti-inflammatory and immunomodulatory effects, and play an important role in the treatment of RA. However, long-term use of glucocorticoids can cause osteoporosis, diabetes, hypertension, weight gain, bacterial infection, etc. It may be a potential treatment to replicate the beneficial effects of glucocorticoids and remove their adverse effects. As a glucocorticoid-inducing molecule, annexin A1 (ANXA1) can mimic many anti-inflammatory effects of glucocorticoids, and has an inflammatory inhibitory effect in congenital immune response and adaptive immune response. ANXA1 receptor agonists have important anti-inflammatory effects in animal experimental models of RA, which can improve joint inflammatory response and reduce bone destruction. However, other studies have shown that the expression level of ANXA1 in peripheral blood lymphocytes of RA patients is higher than that of healthy controls^[1], ANXA1 has a pro-inflammatory effect^[2,3]。 Therefore, the role of ANXA1 in RA has aroused heated discussion among domestic and foreign researchers, and its progress is reviewed as follows.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a well-recognized method for the radical treatment of hematological malignant tumors, but the recurrence rate after transplantation remains high, and the one-year survival rate of recurrent patients is only 10% ~30%^[1,2]Is the main reason for transplant failure. Existing treatment strategies for post-transplantation recurrence include reduction of immunosuppressants, rescue chemotherapy, radiotherapy, secondary transplantation, donor lymphocyte infusion (DLI), cytokine or cellular immunotherapy, targeted therapy, etc., which have improved the survival rate and prognosis of relapsed patients to a certain extent. However, the above treatment strategies have their own limitations and the efficacy is not satisfactory. Finding new or more effective therapies is still an urgent problem to be solved. Recently, the application of demethylating drugs in leukemia recurrence after hematopoietic stem cell transplantation (HSCT) has been reported in the literature^[3,4,5]。 This paper summarizes and analyzes the research status and the latest progress in this field.

sepsis is a systemic inflammatory response syndrome caused by infection that can develop into severe sepsis and septic shock. Severe sepsis and septic shock are important clinical problems faced by critical care medicine. With the aging of the population, the increasing incidence of tumors and the increase of invasive medical methods, the incidence of sepsis is constantly increasing. Every year, millions of new sepsis patients are added worldwide, and more than 1/4 of them die^{[1,2,3,4,5,6]}。 In 2007, the Critical Care Medicine Branch of Chinese Medical Association formulated the "Guidelines for Hemodynamic Monitoring and Support of Severe Sepsis and Septic Shock in Adults", which provides standards and guidance for the diagnosis and treatment of sepsis. However, with the continuous deepening of research in this field at home and abroad in recent years, in order to better guide the treatment of severe sepsis and septic shock by Chinese critical care medicine workers, the Critical Care Medicine Branch of Chinese Medical Association organized experts to apply evidence-based medicine methods (Appendix^[7,8,9,10]) developed this guide.

The patient was a 47-year-old male. He was admitted to the hospital on 21 May 2012 due to "blood in the stool for 2 days". The patient defecated blood 4 times without inducement 2 days ago, about 200 ml/time, accompanied by lower abdominal pain, dizziness, and palpitation. The blood pressure measured in another hospital was 63/40 mmHg (basal blood pressure 110/80 mmHg, 1 mmHg =0.133 kPa), and the blood pressure increased to 105/60 mmHg after fluid rehydration and blood transfusion treatment. After that, he discharged 300 ml of fresh blood and stools again, and his blood pressure dropped to 80/40 mmHg, accompanied by transient loss of consciousness and twitching of his left upper limb, and was transferred to our hospital. Past history: Cerebral infarction in April 2012, oral aspirin 0.1 g/d. Admission physical examination: body temperature 37℃, pulse 76 beats/min, breathing 18 beats/min, blood pressure 84/56 mmHg; The development is normal, conscious, and the superficial lymph nodes are not swollen; No obvious abnormalities in heart and lung were observed; The abdomen is flat and soft, the right lower abdomen is tender, there is no rebound pain, muscle tension, the liver and spleen are not touched under the costs, the bowel sounds are 4~6 times/min, and the lower limbs are not swollen.

January 2015 Top International Journal of Gastrointestinal and HepatologyGut(Impact factor 13.319) published a study jointly completed by the team of Professor Hou Jinlin from Nanfang Hospital of Southern Medical University and the team of Professor Xia Ningshao from Xiamen University "Baseline hepatitis B virus core antibody quantification can independently predict hepatitis B virus e antigen serological conversion during pegylated interferon or nucleoside (acid) analogue treatment"^[1]。 This study is based on two prospective, randomized controlled study cohorts established by the "Eleventh Five-Year Plan" and "Twelfth Five-Year Plan" major projects led by Professor Hou Jinlin. Through retrospective testing and analysis, it is the first time to evaluate the role of anti-HBc quantification in predicting HBeAg serological conversion during peginterferon (PEG-IFN) or nucleoside (acid) analogue (NUC) treatment in a large sample and high-quality chronic hepatitis B (CHB) cohort.

March 2015J Lipid ResThe study "Effects of smoking and smoking cessation on macrophage cholesterol outflow in patients with coronary heart disease" completed by Professor Yan Xiaowei of Peking Union Medical College Hospital over 3 years was published "[Song W, Wang W, Dou LY, et al. The implication of cigarette smoking and cessation on macrophage cholesterol efflux in coronary artery disease patients. J Lipid Res, 2015, 56 (3): 682 – 691.] 。 This study is a prospective, randomized, parallel-controlled study that looked for the first time at the effects of smoking and smoking cessation on cholesterol efflux mediated by the macrophage adenosine triphosphate binding cassette transporter A1/G1 (ABCA1/G1) in patients with coronary heart disease (CAD).

April 2014Ann Rheum DisThe clinical study "Comparing the efficacy and safety of tripterygium glycosides and methotrexate in the treatment of active rheumatoid arthritis" by the team of Professor Zhang Xuan, Department of Rheumatology and Immunology, Peking Union Medical College Hospital was published online "(TRIFRA study) [Comparison of Tripterygium wilfordii Hook F with methotrexate in the treatment of active rheumatoid arthritis (TRIFRA): a randomized, controlled clinical trial. Ann Rheum Dis, 2014.] 。 This study was a prospective, randomized, controlled third-party blinded study, which was the first to compare the efficacy of tripterygium glycosides alone, methotrexate alone, and the combination of tripterygium glycosides + methotrexate in active rheumatoid arthritis (RA) by non-inferiority test.

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

[Website] http: / /www.atsjournals.org/journal/ajrccm

[Website] http: / /www.thelancet.com/

A few days ago, a randomized, multicenter, clinical trial explored the components of blood products during blood transfusion in patients with severe trauma. The data showed that compared with the ratio of plasma, platelets and red blood cells in 1:1:1 to 1:1:2 during blood transfusion, there was no statistically significant difference between 24 h and 30 d all-cause mortality, but more patients in the 1:1:1 group stopped bleeding within 24 h and fewer patients died due to bleeding (JAMA, 2015, 313: 471-482).

Dr. Wu Yougen:

Editorial Department: