2016年 · 第55卷第07期

Inflammatory bowel disease (IBD) has gradually become a common digestive disease in China. Although the diagnosis and treatment of IBD in China has been greatly improved in recent years, there is still a lack of enough attention to the health services of IBD patients, and there is a big gap with western developed countries. In view of the complex and changeable clinical characteristics of IBD, a highly specialized multidisciplinary collaborative team is required for diagnosis and treatment, comprehensive health services are required, and long-term follow-up is required. Only high-level IBD centers are likely to meet these needs. In recent years, some IBD diagnosis and treatment centers recognized by peers and patients have gradually formed in China, but the survey shows that the diagnosis and treatment conditions and levels of IBD diagnosis and treatment centers are quite different. In order to promote the healthy development of existing IBD diagnosis and treatment centers and to promote the establishment of new IBD diagnosis and treatment centers, it is urgent to put forward a set of basic quality control indicators of IBD diagnosis and treatment centers in China. Since 2015, the IBD group of the Gastroenterology Branch of the Chinese Medical Association has organized domestic IBD experts to formulate a "consensus on establishing quality control indicators of inflammatory bowel disease diagnosis and treatment centers in China", and the final results were published in this issue of the Chinese Journal of Internal Medicine. In this issue, Professor Qian Jiaming and Professor Li Ji from the Department of Gastroenterology of Peking Union Medical College Hospital are invited to write a monograph "The quality control of inflammatory bowel disease diagnosis and treatment centers in China should be ruled". Welcome to Read.

Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is a chronic non-specific autoimmune disease of the gut. Because it mainly affects young and middle-aged people, the disease is prolonged, the complications are complicated, the treatment is difficult, and some treatment drugs are expensive, it has become an important disease burden in Western developed countries^[1]。 In the United States, for example, there were about 1 million IBD patients in 2004, incurring more than $6 billion in direct medical expenses^[2]。 IBD is still a rare disease in my country. However, in view of the increasing trend of IBD incidence in my country, referring to the prevalence rate of western developed countries (about 0.1%), it is expected that the number of IBD patients in my country will reach 1.5 million in 2025. With the advent of the era of high-priced biologics, it will surely cause a huge disease burden^[1,3]。 How to deal with the upcoming challenges? Combined with the characteristics and experience of IBD patients in China, it should be the only way to set up IBD diagnosis and treatment centers, formulate the quality control standards of Chinese people's own IBD diagnosis and treatment centers, and assist the country to formulate health strategies suitable for national conditions.

Nutritional therapy is an important topic in inflammatory bowel disease (IBD). China's "Expert Consensus on Nutritional Support Treatment of Inflammatory Bowel Disease (2013 · Shenzhen)"^[1]The nutritional support treatment was discussed in detail in. At present, enteral nutrition (EN) therapy is considered to improve nutritional status in ulcerative colitis (UC), and cannot induce or maintain remission; In patients with Crohn's disease (CD), EN can not only improve the nutritional status of patients, avoid nutritional risks, but also induce and maintain remission, promote mucosal healing and improve the natural course of the disease. In addition, preoperative EN can also optimize patients' perioperative status, reduce surgical complications and delay recurrence.

General internal medicine is the general practice in the field of internal medicine and is the foundation of all clinical medicine. The common practice in the world is that medical school graduates have three years of general internal medicine training first, and then according to personal wishes and market demand, some graduates directly engage in medical services, and some are further trained into various specialists in internal medicine. However, in major hospitals in China, they usually set specialties first, then rotate in sub-specialties for several years, and then return to the specialties. Although they have been rotated in various sub-specialties of internal medicine, the physicians trained in this way generally lack the vision of large internal medicine, and general internal medicine has its name. This time, the national general practitioner training base is mainly located in some super-large hospitals. If this problem is not taken seriously, its task of training qualified doctors at the grass-roots level may not be implemented. Based on the training experience of internal medicine residents in the United States, the author talks about some problems of standardized training of internal medicine residents in China, hoping to arouse the attention of internal medicine colleagues to the construction of general internal medicine.

A 35-year-old male was admitted to the hospital on 26 September 2014 due to "intermittent dull pain in the upper abdomen, fatigue with weight loss for 2 years". The patient has intermittent dull pain in the upper abdomen for the past 2 years, accompanied by fatigue and weight loss. Abdominal enhanced CT: Multiple round soft tissue nodules were seen at the mesenteric root, adjacent to the abdominal aorta and adjacent to bilateral iliac vessels, and slightly enhanced after enhancement. In August 2014, he underwent exploratory laparotomy + mesenteric mass resection and biopsy in a foreign hospital. Diffuse and multiple masses on the mesentery were seen during the operation, with a maximum size of about 5.0 cm ×5.0 cm, which was cystic with turbid cystic fluid inside (Figure 1)。 Since the onset of the disease, there has been no fever, subcutaneous nodules, etc. Past physical fitness. Long history of heavy drinking. Admission physical examination: general condition is good, no abnormalities in heart and lung; Deep tenderness in the upper abdomen and periumbilical area, and weakened intestinal sounds. Laboratory tests : ALT 111 U/L, AST 74 U/L; ESR, high-sensitivity C-reactive protein, complement, immunoglobulin and IgG₄All normal; Tuberculin test (-), blood TB-specific lymphocyte interferon (a + B) 0 SFC/10⁶Mononuclear cells (i.e., no specific lymphocytes releasing IFN γ were detected after stimulation by libraries A and B of antigen peptides encoded by the Mycobacterium tuberculosis-specific RD1 gene, suggesting that tuberculosis infection is not supported). Abdominal enhanced CT + three-dimensional reconstruction: the fat density in the mesenteric area was increased, the gap was blurred, and there were multiple round masses at the mesenteric root, which was consistent with panniculitis and abdominopelvic effusion. Pathology consultation: (Mesenteric) omental tissue, a large number of histiocytes and lymphocytes infiltrate with follicular formation, inflammatory necrosis and exudates can be seen, and local fibrous hyperplasia, suggesting chronic inflammation with local acute inflammation. Immunohistochemistry: S-100 fraction (+), CD₆₈(+), CD₃(+), CD₂₀(+), CD₁₃₈(Scattered +), SMA (Spindle +), Calretinin (-), AE1/AE3 (-), CD₂₁(follicle +) with a Ki-67 index of 10%. Mesenteric panniculitis was diagnosed. After treatment with prednisone 40 mg/d for 1 month, the patient's abdominal pain was relieved, and abdominal CT was re-examined (Figure 2), showing that the original mesenteric mass was significantly reduced, the fat density in the mesenteric area was increased, the gap blurred was significantly reduced, and the original peritoneal effusion was absorbed. The dose of prednisone was gradually reduced. After 1 year, the patients were followed up without abdominal pain and other discomfort symptoms ALT 48-85 U/L, AST 29-48 U/L.

POEMS syndrome is a rare paraneoplastic syndrome caused by underlying plasma cell abnormalities^[1], is a clonal plasma cell disease. The main clinical manifestations include polyneuropathy (P), organomegaly (O), endocrinopathy (E), monoclonal gammopathy (M), and skin changes (S). Endocrine system abnormality is a characteristic manifestation of POEMS syndrome^[2]A case of POEMS syndrome with multiple endocrine gland abnormalities as the main manifestation is reported below, and it is differentiated from other multiple endocrine diseases to improve the understanding of POEMS syndrome and its endocrine manifestations.

fibrocalculous pancreatic diabetes (FCPD) is a rare subtype of special type of diabetes. Its etiology, pathogenesis, clinical manifestations, diagnosis, treatment and prognosis are special, and it is of great significance for its early diagnosis and correct treatment. At present, there are few domestic literature reports on FCPD, especially in Xinjiang, so clinicians still lack sufficient understanding of FCPD. A case of FCPD diagnosed and treated in the Department of Endocrinology and Metabolism of the Second People's Hospital of Kashgar, Xinjiang is reported as follows, aiming at improving clinicians' understanding of this disease.

March 3, 2016 Official Journal of the European Organization for Crohn's Disease and Colitis (ECCO)Journal of Crohn's and Colitis(Impact factor 6.234) published online a study by the team of Professor Zhu Weiming, Department of General Surgery, Nanjing General Hospital, Nanjing Military Region, "Effect of non-digestible polysaccharide diet on intestinal epithelial barrier function in IL-10 knockout mice" (Wang H, Shi P, Zuo L, et al. Dietary non-digestible polysaccharides ameliorates intestinal epithelial barrier dysfunction in IL-10 knockout mice. J Crohns Colitis, 2016.). In this study, the internationally recognized IL-10 knockout Crohn's disease (CD) model mice were used as the research object, and a special multi-fiber complex was added to the normal diet to match the fiber content in a healthy diet. The effect of this fiber complex on the intestinal epithelial barrier function of IL-10 knockout mice and related mechanisms were observed for the first time, providing a new horizon for the treatment of CD.

With the rapid development of global economy, the incidence of endocrine and metabolic diseases is increasing rapidly. On December 1, 2015, the 7th edition of the International Diabetes Federation (IDF) "Diabetes Map" released data that showed that worldwide, 1 in 11 adults has diabetes (a total of 415 million). Type 2 diabetes is no longer just a "patent" in developed countries. With increasing urbanization and changes in diet and lifestyle, IDF estimates that 75% of people with diabetes live in low-and middle-income countries^[1]。 Chinese data show that the prevalence of diabetes among Chinese adults over the age of 20 is 9.7%, including 10.5% men and 8.8% women. The total diabetic population is 92.4 million, the prevalence of prediabetes is 15.5%, and an estimated 148 million people are prediabetic. In cities, the prevalence of diabetes exceeds 10% regardless of economic development^[2]。 In addition, the incidence of diabetes increases with economic development, especially among people who are overweight and obese. The incidence of thyroid diseases such as hyperthyroidism (hyperthyroidism) and hypothyroidism is also increasing year by year^[3,4,5,6,7]。

Eosinophilic esophagitis (EoE) is a chronic disease mediated by immunity. The inflammation can involve the whole thickness of the esophagus, and the clinical manifestations are dysphagia, food imprisonment, vomiting, etc^[1]It can also be manifested as symptoms of gastroesophageal reflux disease (GERD) such as heartburn and acid reflux^[2]。 EoE can occur in all age groups, more in males, and more often in summer^[3]。 The prevalence of EoE has increased rapidly since the disease was first reported in 1977^[4]The US reached 50.6/100,000^[5]There are relatively few data in Asia, with a reported prevalence rate of 0.34% in China^[6]。

idiopathic membranous nephropathy (IMN) is an antibody-mediated autoimmune glomerular disease characterized by thickening of the glomerular basement membrane and deposition of dense complexes on the epithelial side of the capillary haptics. In primary glomerulonephritis, IMN is the most common pathological type, accounting for about 9.89% to 29.4%^[1,2,3,4]。 Relevant studies suggest that the incidence of IMN is increasing year by year, although it is mainly in the elderly^[1,5]But there are also many young and middle-aged people. Over the years, numerous studies have focused on exploring treatment options for IMN. At present, it is believed that the initial treatment of IMN should be mainly angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB). The Global Organization to Improve the Prognosis of Kidney Disease (KDIGO) recommends the addition of glucocorticoids and immunosuppressants only for those who have failed conservative treatment with ACEI and/or ARB for 6 months (urinary protein greater than 4 g/24 h and greater than 50% of baseline, or with elevated serum creatinine)^[6]Can effectively increase the remission rate of IMN, but the recurrence rate is high, and the side effects occur frequently^[7]。 With antiphospholipase A₂Receptor (PLA₂R) Antibodies^[8]platelet reactive protein 7A domain (THSD7A) antibody,^[9]In patients with IMN, the pathogenic role of B cells in IMN has gradually become recognized, and rituximab has also begun to be used in the treatment of IMN. The progress of rituximab in the treatment of primary membranous nephropathy is reviewed below to further elaborate the principle, efficacy and treatment plan of rituximab.

Acinetobacter baumannii is a gram-negative aerobic bacterium, which is widely distributed in water, soil, hospital environment and human skin surface. It has strong vitality and clonal transmission ability, and is easy to form cross-infection and spread widely^[1,2], has become one of the main pathogenic bacteria of severe infection^[3], seriously affecting the prognosis of patients. Previous studies have shown that the mortality rate of severely ill patients infected with Acinetobacter baumannii is as high as 70%^[4]。 Innate immunity, as the first line of defense against infection immunity, plays an important role in anti-infection immunity. Unlike other gram-negative conditional pathogens such as Escherichia coli and Klebsiella pneumoniae, Acinetobacter baumannii has been considered a less virulent opportunistic pathogen^[5,6]The number of inflammatory cytokines produced and the degree of inflammatory response caused are different from those of other pathogenic bacteria. Therefore, the innate immune response initiated after Acinetobacter baumannii infection may also differ from other pathogenic bacteria. The research progress of the body's innate immune response during Acinetobacter baumannii infection is summarized as follows.

Atherosclerotic cardiovascular disease is the leading cause of death and disability in Chinese people. Standardized antithrombotic therapy is an important measure to reduce cardiovascular disease events. Both antiplatelet and anticoagulant therapy inevitably bring bleeding complications, and gastrointestinal bleeding is the most important and common. Hemorrhage as an independent risk factor for death in patients with coronary heart disease^[1]。 Therefore, prevention of gastrointestinal tract injury and gastrointestinal bleeding is very important for patients treated with long-term antithrombotic therapy. The editorial board of Chinese Journal of Internal Medicine organized experts in cardiology and gastroenterology to publish the Chinese Expert Consensus on the Prevention and Treatment of Digestive Tract Injury with Antiplatelet Drugs in 2009^[2], and updated in 2012^[3], providing very practical guidance suggestions for clinicians. In view of the continuous emergence of new antiplatelet and anticoagulant drugs, experts from the two disciplines met again in January 2016 to discuss the latest progress in this field, and suggested the following core issues.

inflammatory bowel disease (IBD) mainly includes ulcerative colitis (UC) and Crohn's disease (CD). In recent years, the incidence of IBD has increased significantly in China^[1]It has gradually become a common digestive disease in China. With the increasing attention of Chinese doctors and medical researchers to this disease, the diagnosis and treatment technology of IBD in China has been greatly improved in more than ten years, but there is still lack of enough attention to improve health services for IBD patients, and there is a big gap with Western developed countries. The establishment of IBD diagnosis and treatment centers in some hospitals in major cities in China has become an inevitable trend to improve the health services for IBD patients. In view of the clinical characteristics of IBD, which is complex and variable over a long course of disease, as well as the distribution characteristics of scattered pathogens, a highly specialized multi-disciplinary team (MDT) is required for diagnosis and treatment, comprehensive health services, and long-term follow-up. Only high-level IBD centers are likely to meet these needs^[2]。 In fact, in recent years, some IBD diagnosis and treatment centers recognized by peers and patients have gradually formed in some big cities in China. China has a vast territory and a large population, so it is urgent to gradually establish and improve IBD diagnosis and treatment centers in all regions and provinces in China. However, the survey shows that the diagnosis and treatment conditions and levels of IBD in major hospitals in China are quite different. Therefore, with reference to the international advanced level and combined with the current situation in China and various places, a set of basic quality control indicators of IBD diagnosis and treatment centers in China are put forward, which will not only promote the development of existing IBD diagnosis and treatment centers, but also promote the establishment of new IBD diagnosis and treatment centers.

Thrombolytic therapy recanalizes blood vessels by dissolving fresh thrombus in arterial or venous blood vessels, thereby partially or completely restoring blood perfusion of tissues and organs, minimizing damage to tissues and organs, and achieving the goal of alleviating patient symptoms and improving patient prognosis.

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