2015年 · 第54卷第07期

Compared with "cancer", chronic constipation has not attracted the attention of general clinicians, but our online survey shows that 64% of doctors interested in the topic of constipation think that constipation treatment is difficult or very difficult, while only 10% adopt good defecation habits as a means to improve constipation, which fully indicates that reasonable management of chronic constipation should be emphasized.

The causes of chronic constipation include functional constipation, functional defecation disorder (also known as defecation disorder functional constipation), colorectal morphological changes, intestinal inflammation and tumors, diseases of other abdominal and pelvic tissues and organs, systemic diseases and metabolic diseases, and drug factors. Therefore, in the diagnosis of chronic constipation, certain auxiliary examinations should be selected to clarify the etiology diagnosis; For patients who are to be diagnosed as functional constipation, if necessary, auxiliary examination is needed to know their classification and whether they are combined with morphological and structural abnormalities. Targeted selection of auxiliary examination is of great significance to improve the standardized diagnosis and treatment level of chronic constipation.

Chronic constipation is a common digestive disorder that seriously affects people's quality of life. The treatment of chronic constipation includes general treatment such as diet and physical exercise, drug treatment, biofeedback treatment and surgical treatment, among which there are many drugs for the treatment of chronic constipation, and the correct and reasonable choice of drugs is very important for the treatment of chronic constipation.

Chronic constipation is divided into colonic slow transit type, outlet obstruction type and mixed constipation. Outlet obstruction type constipation is divided into internal rectal prolapse, rectocele, pelvic floor muscle spasm syndrome, perineal descent, pelvic floor hernia, solitary rectal ulcer syndrome, internal sphincter retardation^[1]。 The surgical indications and precautions for the syndrome of internal rectal prolapse, rectocele and pelvic floor muscle spasm in slow transit constipation (STC) and outlet obstruction constipation are discussed. At present, the proportion of chronic constipation patients undergoing surgical treatment is not reported in the literature, but according to Roman III Functional Gastrointestinal Diseases and domestic and foreign literature reports, only a very small number of constipation patients undergo surgical treatment^[2,3,4,5]。 Reshef et al.^[3]It is reported that the incidence of constipation in western countries is 20%, and most patients can relieve their symptoms through etiological treatment, dietary modification, exercise and laxative application. The authors also report that 143 patients with STC were performed colectomy in the Department of Colorectal Surgery of Cleveland Medical Center in the United States during the 12 years from 1999 to 2010. Sohn et al.^[4]Total colectomy was performed in 37 patients with STC in the Department of Colorectal Surgery, Ulsan University, Seoul, South Korea during the 15 years from 1994 to 2008. From September 2007 to July 2015, 414 colon transit tests were performed in our center^[5], of which 30 patients with STC underwent total colectomy.

Chronic constipation is a common clinical disease. Community survey data in the United States and Canada show that the prevalence of chronic constipation is as high as 27%^[1,2]； The epidemiological survey in Beijing showed that the prevalence rate was 6.07%^[3]The prevalence rate of the elderly over 60 years old in Guangzhou is 7.3%^[4]。

The patient was an 82-year-old female. He was admitted to hospital on May 27, 2014 due to "skin redness and swelling of both lower limbs with pain for 20 days and fever for 1 day". The patient developed dry mouth, polydipsia and polyuria 30 years ago, and his fasting blood glucose was 15.0 mmol/L. He was diagnosed as "type 2 diabetes" and was given oral medication. Switched to insulin treatment 10 years ago due to poor glycemic control. One year ago, I was hospitalized in our department due to pain in both lower limbs. Physical examination: red and swollen skin before the tibia of the left lower limb, increased skin temperature and tenderness. Lower extremity vascular ultrasound showed that there were multiple plaques in the arteries of both lower extremities, and the stenosis rate was more than 50%. The diagnosis was "type 2 diabetes mellitus with peripheral vascular disease, skin and soft tissue infection of the left lower extremity". At the same time, the hypoglycemic regimen was adjusted, and the improvement was discharged. This time, the patient experienced pain, redness and swelling of both lower limbs again 20 days ago, fever for 1 day, and weight loss of about 3 kg within 1 month.

January 2015J HepatolPublished online, a study by the team of Professor Youming Li of the First Affiliated Hospital of Zhejiang University School of Medicine "The role of xanthine oxidase in nonalcoholic fatty liver disease and hyperuricemia: killing two birds with one stone (Xu C, Wan X, Xu L, et al. Xanthine oxidase in non-alcoholic fatty liver disease and hyperuricemia: one stone hits two birds. J Hepatol, 2015.) "^[1]。 On the basis of revealing the close relationship between non-alcoholic fatty liver disease (NAFLD) and hyperuricemia, this study confirmed for the first time that xanthine oxidase, a rate-limiting enzyme for uric acid synthesis, is a key molecule that regulates NAFLD through cell and mouse experiments, providing a new target for the prevention and treatment of NAFLD.

January 2015 International Journal of Therapeutic DiagnosticsTheranosticsThe study "A new index for predicting the efficacy of peginterferon in the treatment of HBeAg-positive chronic hepatitis B-anti-HBc quantitative detection" was published by Professor Wang Guiqiang of the Department of Infectious Diseases and Liver Disease Center of Peking University First Hospital and Professor Xia Ningshao of Xiamen University National Center for Diagnostic Reagents and Vaccine Engineering Technology [Hou FQ, Song LW, Yuan Q, et al. Quantitative hepatitis B core antibody level is a new predictor for treatment response in HBeAg-positive chronic hepatitis B patients receiving peginterferon. Theranostics, 2015, 5 (3): 218-226.]. This study is a prospective, multicenter, randomized open and positive controlled study that is the first to observe the efficacy of baseline anti-HBc quantitatively predicting peginterferon (PEG-IFN).

Diarrhea is a common clinical symptom. According to the course of the disease, it can be divided into acute diarrhea and chronic diarrhea. Those with a course of less than 2 months are acute diarrhea, and those with a course of more than 2 months are chronic diarrhea. Chronic diarrhea can be caused by a variety of causes, including gastrointestinal diseases and systemic diseases. In clinical work, we often focus on diarrhea, paying attention to inflammatory diseases of the digestive tract and diseases related to the gastrointestinal tract, but behind diarrhea, especially chronic diarrhea, there may be other systemic diseases. If the medical history, laboratory test results and imaging examination are not carefully and meticulously collected and analyzed, missed diagnosis and misdiagnosis may be caused. Here is a case we treated.

Acinetobacter baumannii is widely distributed in hospitals and has become the main pathogen of hospital-acquired infections, mainly causing hospital-acquired pneumonia, especially ventilator-associated pneumonia, bacteremia, urinary tract infection, secondary meningitis, etc. Its risk factors include long hospital stay, low immunity, mechanical ventilation, cardiopulmonary failure, receiving antimicrobial therapy, intravenous catheter, indwelling urinary catheter, etc. According to the results of the China Bacterial Resistance Surveillance Network (CHINET) in 2013, Acinetobacter accounted for 11.97% of the gram-negative bacteria isolated in the hospital, second only to Escherichia coli and Klebsiella sp.^[1]。

Crohn's disease (CD) is a chronic inflammatory disease of unknown etiology that involves the whole thickness of the digestive tract and has a high incidence of complications. Inflixi is a chimeric monoclonal antibody against TNF α in humans and mice. It is the earliest and most widely used new biological agent in clinical practice. It has a strong anti-inflammatory effect and has good curative effect on the induction, remission and maintenance of chronic active CD. A recent article reported the changes in CD surgery rates in Europe, North America, Asia and other countries. Overall, after the birth of new biologics represented by Inflixi, the CD surgery rate dropped significantly^[1]。 Unfortunately, there is a lack of research in this area in China. New biological agents can reduce the rate of CD surgery, mainly because they have significantly changed the timing and indications of CD surgery, and at the same time brought good news to the treatment of special groups. This review aims to summarize their efficacy and provide reference for the correct and timely application of Chinese doctors.

Lung cancer is one of the most common malignant tumors in clinic. In 2014, lung cancer accounted for 13% of new cancer patients worldwide, about 2.2 million people, and lung cancer accounted for 27% of new cancer deaths^[1]。 In China, there are at least 1 million new cases of lung cancer every year. Because early lung cancer is relatively hidden, and the commonly used diagnostic methods such as fiberoptic bronchoscopy and percutaneous lung biopsy are mainly aimed at lung cancer patients with existing imaging changes. Therefore, most patients are already in locally advanced or advanced stage at the time of diagnosis, and miss the opportunity of radical surgical treatment. Although surgery, radiotherapy, chemotherapy and other treatments have made continuous breakthroughs, the 5-year survival rate of lung cancer patients is still less than 15%. Therefore, improving the early diagnosis of lung cancer has become a major problem at present. serum Tumor Makers (sTM) have the advantages of being simple, quick, non-invasive and cost-effective, and are widely used in lung cancer management, auxiliary diagnosis, efficacy evaluation and prognosis prediction. Four common lung cancer-related serological tumor markers, namely carcinoembryonic antigen (CEA), squamous cell antigen (SCC-AG), gastrin-releasing peptide precursor (ProGRP) and cytokeratin 19 fragment (CYFRA21-1), are reviewed as follows.

Rheumatoid arthritis (RA) is a systemic autoimmune disease that mainly affects the synovial membrane of joints, causing joint swelling, pain and stiffness, and even causing joint deformity and disability. The incidence rate in China is about 0.28%, and females are higher than males^[1]。 Compared with healthy people, the mortality rate of RA patients increased by nearly 50%, mainly due to the increase of cardiovascular diseases, especially the occurrence of coronary atherosclerotic heart disease caused by accelerated arteriosclerosis^[2]。 Dyslipidemia is an independent risk factor for cardiovascular events, which can accelerate the onset of arteriosclerosis, which in turn increases the risk of cardiovascular events. In RA patients, blood lipids can be increased, normal or decreased, with varying changes, which may be related to their inflammatory response, drug treatment, etc. The characteristics of blood lipid changes in RA and the influence of inflammation, therapeutic drugs and other factors on blood lipid are summarized as follows.

The patient was a 44-year-old male. He was admitted to the Department of Nephrology of our hospital on May 16, 2014 due to "edema, oliguria and jaundice for 3 months". On 16 February 2014, the patient developed increased foam in urine and mild concave edema of eyelids and lower limbs without obvious trigger. On February 19, 2014, the skin and sclera were yellowed, with deepening urine color and brown color, without fever, chills and low back pain. On February 20, 2014, he visited another hospital. The blood pressure was measured at 160/100 mmHg (1 mmHg =0.133 kPa), and the urine output was reduced to 200 ml/d. Blood test routine: WBC 7.1×10⁹/L, Hb 114 g/L, Platelet count 40×10⁹/L, reticulocytes 0.9%; Urinary routine: protein 3+, occult blood 2+, urobiliogen (–); 24 h urine protein 7.05 g; Biochemistry: albumin (Alb) 38.9 g/L (normal 35-52 g/L), TBil 75.1 μ mol/L (normal 5.1-22.2 μ mol/L), DBil 67 μ mol/L, creatinine (Cr) 201 μ mol/L (normal 94-104 μ mol/L), Urea 12.2 mmol/L (normal 2.78-7.14 mmol/L), lactate dehydrogenase (LDH) 2 147 U/L (normal 0-250 U/L); ESR, C-reactive protein and complement were normal; Blood smear: broken red blood cells visible; Coombs test, sugar water test (–); anti-double stranded DNA antibodies, anti-glomerular basement membrane (GBM) antibodies, anti-neutrophil cytoplasmic antibodies (ANCA), anti-extractable nuclear antigen (ENA) antibodies (-); Renal ultrasound examination showed that the left kidney was normal in size and shape, and the right kidney was increased in volume (12.9 cm ×5.8 cm). Foreign hospital diagnosis: thrombotic microvascular disease kidney damage, plasma exchange therapy (once a week, 2 L each time, 8 times in total) and intravenous methylprednisolone 80 mg, once/d ×3 d → 40 mg, once/d ×10 d → prednisone 40 mg, once/d orally and gradually reduced. On February 24, Cr was re-examined at 812 μ mol/L, and regular hemodialysis (2-3 times/week) was started thereafter. After the above treatment, the patient's jaundice gradually improved, the urine color was pale yellow and clear, and the urine output recovered to 1 200~1 600 ml/d. Hb 90 g/L (intermittent blood transfusion) was re-examined on 30 March, and the platelet count was 107×10⁹/L, Cr 469 μ mol/L, LDH 510 U/L. The patient was admitted to the hospital on oral methylprednisolone 28 mg once a day, regular hemodialysis three times a week, nifedipine controlled-release tablets and sustained-release tablets to reduce blood pressure, and was admitted to the ward on 16 May 2014. Past history: 2 weeks before the onset of the disease, the patient had upper respiratory tract infection such as sore throat and runny nose. Family history: The younger brother suffered from acute kidney injury at the age of 18, and the younger sister died of acute kidney injury at the age of 30. She reported that her younger sister had hemolysis in the course of her disease. Admission physical examination: blood pressure 150/95 mmHg, percussion heart boundary slightly enlarged to the lower left, no murmur in auscultation area of heart valves, clear breathing sounds in both lungs, no abnormalities in abdominal physical examination, mild concave edema in both lower limbs. Admission diagnosis: Thrombotic microangiopathy, acute kidney injury.