2015年 · 第54卷第12期

2015 is coming to an end. I would like to sincerely thank the editorial board, reviewers and specially invited experts of Chinese Journal of Internal Medicine for their hard work, as well as the authors and readers for their support and love for our journal over the years. In 2016, we will continue to make progress and better serve the majority of physicians.

This journal publishes the article "Prehospital risk factors level and prehospital treatment control status of inpatients with stroke in China", an achievement of the 12th Five-Year National Science and Technology Support Plan. This study is a multi-center cross-sectional study involving 41 hospitals in 25 provinces and cities across China. From January to May 2011, 20 570 stroke patients in all cooperative hospitals (all tertiary hospitals) were continuously collected. About 3/4 of them were primary stroke, 1/4 were recurrent stroke, and 82.9% were ischemic stroke. Therefore, we can analyze the status of primary and secondary prevention in hospitalized stroke patients in China.

Clinically, the incidence of globus hysteria is high, and it is often accompanied by anxiety and depression^[1,2]The efficacy of conventional anti-reflux therapy is not good. In recent years, studies have shown that low-dose Amitriptyline (AMT) has good curative effect on globus hysteria^[3]。 In this study, patients with refractory globus hysteria who were not effective in conventional treatment in gastroenterology and otolaryngology departments were studied. The comprehensive efficacy and adverse reactions of antidepressant Paroxetine (PAR) and low-dose AMT in the treatment of refractory globus hysteria were comprehensively compared and analyzed.

Myelodysplastic syndrome (MDS) is a malignant clonal disease of hematopoietic stem cells characterized by ineffective hematopoiesis, refractory cytopenia, and high risk of conversion to acute myeloid leukemia (AML). Studying the immune abnormalities of MDS and improving the immunological pathogenesis of MDS can provide laboratory evidence for immunotherapy of MDS patients. At present, it is believed that immune dysregulation may be the cause of ineffective hematopoiesis and bone marrow failure in the early stage of MDS, while immune escape of malignant clonal cells is the main cause in the late stage of MDS^[1]。 Previous research reports pay more attention to the immune changes of peripheral blood of MDS patients, while bone marrow is the hematopoietic microenvironment and immune microenvironment. It is more meaningful to study the changes of immune microenvironment in bone marrow of MDS patients for the immunopathogenesis of MDS. Initial CD₄^＋T cells can differentiate into different subtypes, including Th1, Th2, Th17 and Treg cells (regulatory T cells), etc^[2]。 Treg cells are important in regulating immune responses and maintaining autoimmune tolerance^[3], Th17 cells play an important role in tumorigenesis and progression, tolerance and rejection of bone marrow transplantation^[3,4]。 Since Foxp3 and retinoic acid-dependent orphan receptor γ T (ROR γ T) are characteristic transcription factors of Treg cells and Th17 cells, respectively, the bone marrow of MDS patients was extracted in this study by detecting CD in the bone marrow₄^＋Changes in the levels of specific transcription factors Foxp3 and ROR γ T of T cells to evaluate bone marrow CD₄^＋Treg and Th17 subsets in T cells were changed, and their association with disease risk and prognosis was further analyzed.

The cause of systemic lupus erythematosus (SLE) has not been fully elucidated, but may be related to genetic, environmental factors and immune system abnormalities. Immune cell dysfunction of antigen presenting cells, T cells, B cells, regulatory T cells and regulatory B cells is also closely related to the pathogenesis of SLE^[1]。 Regulatory B cell reduction or dysfunction may contribute to SLE^[2,3]rheumatoid arthritis,^[4]and ANCA-associated vasculitis^[5]Isorheumatic diseases. Noh and Lee^[6]It is pointed out that the function of regulatory B cells may be similar to that of regulatory T cells. The abnormal number or function of regulatory B cells expressing IL-10 can cause insufficient immunosuppression and lead to the occurrence and development of SLE^[2,7]。 This study preliminarily observed peripheral blood CD in patients with SLE₁₉⁺Foxp3⁺CD₁₉⁺TGF β⁺Regulatory B cell expression provides a new perspective for the understanding of the pathogenesis of SLE and a possible new target for the treatment of SLE in the future.

The patient was a 23-year-old female, unmarried, Han nationality. He was admitted to hospital on November 27, 2014 with "progressive involuntary lip smacking, tongue biting, unstable walking for more than 2 years, accompanied by two limb twitches". Two years before admission (July 2012), the patient began to have involuntary lip smacking, involuntary tongue hyperactivity, tongue biting, tongue sticking out, accompanied by tongue and mouth ulcers, dysphagia of saliva and water swallowing, choking and cough in drinking and eating, and affected pronunciation and eating. The above symptoms can be aggravated when mental stress is absent, and there is no dizziness or headache. Symptoms such as involuntary lip smacking and tongue biting when sleeping disappear. The family thinks it is a bad lifestyle habit and does not seek medical treatment. In October 2013, the above symptoms aggravated, gradually appearing a feeling of weakness in both lower limbs, unstable gait, easy to fall sideways when walking, and uncoordinated movements similar to dancing (someone once complained that the patient's walking gait was like dancing), and occasionally involuntary twitching of lower limbs. There was no obvious fluctuation in the above symptoms, and there was no phenomenon of light in the morning and heavy in the evening. The patient went to the local hospital for diagnosis and treatment, and was diagnosed with dystonia. He was given oral traditional Chinese medicine and acupuncture treatment, but the symptoms did not improve. On December 2013 and November 25, 2014, the patient experienced two limb twitches, foaming at the mouth, both eyes looking up, and unconscious, which lasted for 2 to 5 minutes and then relieved. After the onset of the disease, the patient had no fever and chills, no cough and sputum, no abdominal pain and distension, normal sleep, and normal urine and defecation. Past history, allergy history, personal history and menstrual history have no special records, and he is unmarried. Family history: His parents deny close marriage, there is no similar disease in the family, and his sister has a history of simple ocular myasthenia gravis.

The patient was a 25-year-old female. He was admitted to the hospital on November 16, 2012 due to "menopause for 9 months and irregular lower abdominal pain for 1 d". The patient has repeated epistaxis and skin ecchymosis since childhood. In 2010, coagulation factor VII (FVII) was checked in Peking Union Medical College Hospital: C was 4% (reference value 50% ~150%), and hereditary coagulation factor VII deficiency was diagnosed. Recombinant human coagulation factor VII (rFVIA) and prothrombin complex (PCC) were intermittently treated until pregnancy. At 50 days of menopause, there was no inducement to discharge blood clots from the vagina, and there was no abdominal pain. It improved after giving progesterone capsules and vitamin E oral to protect the fetus. Epistaxis once in 60 days of pregnancy, improved after compression. Admission physical examination: vital signs were stable, blood routine and biochemistry were roughly normal. Coagulation function test: prothrombin time (PT) 28.8 s (reference value 11.0~15.5 s), 1:1 normal plasma immediately and warm bath for 2 h can be corrected to normal; The international normalized ratio of prothrombin (PT-INR) was 2.70 (reference values 0.76-1.20). Fetal ultrasound: intrauterine pregnancy, cephalic position, placental grade II ~ III. Clinical diagnosis: intrauterine pregnancy 38^＋2Weeks, pregnancy 1 delivery 0; Hereditary coagulation factor VII deficiency.

June 29, 2015J Neurol Neurosurg PsychiatryThe clinical study "Natural history and clinical characteristics of Chinese patients with sporadic amyotrophic lateral sclerosis" by the team of Professor Fan Dongsheng of the Third Hospital of Peking University and the team of Professor Siyan Zhan of the Department of Epidemiology and Health Statistics of Peking University School of Public Health was published online [Chen L, Zhang B, Chen R, et al. Natural history and clinical features of sporadic amyotrophic lateral sclerosis in China. J Neurol Neurosurg Psychiatry, 2015, 86 (10): 1075 – 1081]. This study is a 10-year prospective cohort study, which for the first time comprehensively and systematically describes the natural medical history and clinical characteristics of patients with sporadic amyotrophic lateral sclerosis (ALS) in mainland China, suggesting that patients with different phenotypes and different genders differ in many aspects, and analyzing the factors that may affect the prognosis of ALS patients in China.

In January 2014,J Clin Endocrinol MetabA double-blind, randomized, placebo-controlled, multicenter clinical trial (REDUCES study) was published, which was led by Professor Tong Xiaolin from Guang' anmen Hospital of Chinese Academy of Chinese Medical Sciences and jointly completed by 11 centers in China [Lian F, Li G, Chen X, et al. Chinese herbal medicine Tianqi reduces progression from impaired glucose tolerance to diabetes: a double-blind, randomized, placebo-controlled, multicenter trial. J Clin Endocrinol Metab, 2014, 99 (2): 648 – 655.]. The REDUCES study was the first to observe the effect of traditional Chinese medicine on slowing the progression to diabetes in patients with impaired glucose tolerance (IGT).

Clostridium difficile (Clostridium difficile), also known as Clostridium difficile, is an obligately anaerobic gram-positive bacillus widely found in nature and in human and animal feces. It has strong spore resistance and is insensitive to general disinfectants. It can survive for up to 6 months in hospital environment and in the hands of medical staff^[1]。 Clostridium difficile belongs to the normal flora of human intestine, but when patients have intestinal flora imbalance due to various reasons, Clostridium difficile overgrows and releases toxins, which can cause Clostridium difficile infection (Clostridium difficileinfection, CDI). Mild patients may show mild to moderate diarrhea, and severe pseudomembranous enteritis or even death in severe patients^[2]。 The incidence, recurrence and mortality of CDI have increased significantly worldwide over the past 20 years, possibly associated with the widespread use of antibiotics and the prevalence of highly virulent strains such as BI/NAP1/027 (ribosome type 027)^[3]。 The treatment of recurrent CDI is particularly difficult, and fecal bacteria transplantation has shown a good efficacy in the treatment of recurrent CDI, which has attracted the attention of researchers and medical workers around the world.

Histiocytosis is a group of diseases characterized by abnormal proliferation of histiocytes (monocytes-macrophages), which are roughly divided into Langerhans cell histiocytosis (LCH), non-Langerhans cell histiocytosis (NLCH) and malignant histiocytosis. LCH originates from dendritic cells and was once called histiocytosis X and eosinophilic granuloma, among others. NLCH is a benign proliferative disease of cells with macrophage differentiation characteristics, including three main types: skin lesion, skin and multi-system involvement, and primary extracutaneous tissue involvement^[1]Wherein NLCH involving the central nervous system (CNS) is mainly cutaneous and multisystem involvement, primary extracutaneous tissue involvement type, including Rosai-Dorfman disease (RDD), Erdheim-Chester disease (ECD), juvenile xanthogranuloma (JXG), adult xanthogranuloma (AXG), and disseminated xanthoma (XD). RDD, ECD and JXG are the relatively common NLCH, and their diagnosis and differential diagnosis almost completely rely on pathological examination. In recent years, with the extensive development of biopsy surgery for difficult and frequently occurring lesions of nervous system, the probability of finding such diseases in clinical diagnosis is gradually increasing. Now, the clinical, imaging and pathological manifestations of such diseases are reviewed.

acute kidney injury (AKI) is a clinical syndrome caused by the rapid decline or loss of renal filtration function in a short period of time caused by different reasons. The clinical manifestations are mainly related to volume overload, hyperkalemia, acidosis and other metabolic wastes and retention of body fluids. Severe cases need dialysis treatment. AKI involves multiple clinical disciplines, with a mortality rate of 20% ~50% in hospital, and a high prevalence of long-term cardiovascular and cerebrovascular diseases and end-stage kidney diseases in surviving patients^[1]。 Organization to Improve Global Kidney Disease Prognosis 2012 (kidney disease improving global disease, KDIGO) in the RIFLE (risk, injury, failure, loss, end-stage renal disease) criteria^[2]and AKIN (acute kidney injury network) criteria^[3]Based on this, AKI was defined as: ≥26.5 μ mol/L increase in serum creatinine (Scr) within 48 h or>50% increase in Scr within 7 d, or urine output<0.5 ml·kg^–1• h^–1More than 6 consecutive hours^[4]。

Staphylococcus aureus (Staphylococcus aureus) infection is becoming increasingly serious. In ICU, Staphylococcus aureus attaches to the surface of medical materials such as tracheal intubation, arteriovenous catheter and urinary catheter, causing serious infections such as pneumonia, osteomyelitis and toxic shock syndrome, which endanger patients' lives. Methicillin-resistant Staphylococcus aureus (MRSA) has multiple drug resistance, which makes the prevention and treatment of MRSA infection a difficult problem. According to the data of China Bacterial Resistance Surveillance (CHINET) in 2013, Staphylococcus aureus accounted for 9.61% of the total isolated strains, among which the average detection rate of MRSA in Staphylococcus aureus was 45.2%, and the highest rate was 72%^[1,2]。 There is a quorum sensing system (QS system) in Staphylococcus aureus, which is inseparably related to bacterial drug resistance. Regulation of biofilm formation by QS system is an important factor for bacteria to acquire drug resistance^[3]。 When the density of bacteria increases to a certain extent, it will secrete a variety of related proteases, interconnect and cooperate with each other, regulate the degradation of biofilm, and make bacteria change to planktonic state^[4]； Bacteria in a planktonic state can restore susceptibility to antimicrobial drugs^[5]。 The correlation between drug resistance of Staphylococcus aureus and biofilm was summarized, and the prospect of MRSA treatment was prospected.

multiple myeloma (MM) is a malignant disease with abnormal proliferation of clonal plasma cells. It is the second most common malignant tumor in the hematology system. It mostly occurs in the elderly and is still incurable. With the continuous advent of new drugs and the improvement of detection methods, the diagnosis and treatment of MM have been continuously improved and perfected. Therefore, the update of China's MM diagnosis and treatment guidelines every two years is of great significance to improve the diagnosis and treatment level of MM in China.

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