2016年 · 第55卷第11期

Spondyloarthritis (SpA) is a group of chronic inflammatory diseases that mainly involve the axial bone, peripheral joints and tendon attachment points. Among them, ankylosing spondylitis (AS) is the prototype of this group of diseases, and radiological sacroiliitis is the key to confirm the diagnosis, that is, it meets the AS New York criteria revised in 1984. However, some patients with AS do not develop visible radiological changes even 10 years after the first clinical symptoms, so delays in diagnosis and treatment are very common. In order to identify this disease earlier, the International Spondyloarthritis Association proposed a new central axis SpA classification standard (hereinafter referred to as the 2009 standard) in 2009. The 2009 criteria played a positive role in the diagnosis of early axial SpA during the 5 years of clinical use, but it was also found that overdiagnosis and missed diagnosis occurred according to the 2009 criteria. Therefore, some rheumatologists questioned whether the 2009 criteria were obsolete? Are adjustments needed? For this reason, I invited Professor Wang Yanyan and Professor Huang Feng to write a monograph "Is the classification standard of axial spondyloarthritis proposed by the International Spondyloarthritis Association in 2009 obsolete?", This issue is elaborated in order to facilitate a better understanding and more rational use of the standard by clinicians.

Spondyloarthritis (SpA) is a group of chronic inflammatory diseases that mainly involve the axial bone, peripheral joints and tendon attachment points. Among them, ankylosing spondylitis (AS) is the prototype of this group of diseases, and radiological sacroiliitis is the key to confirm the diagnosis, that is, it meets the 1984 AS New York revised criteria. However, some patients with AS do not develop visible radiological changes even 10 years after the first clinical symptoms, so delays in diagnosis and treatment are very common. In order to identify this type of disease earlier, in 2009 the International Spondyloarthritis Association (ASAS) proposed a new central axis SpA classification standard (hereinafter referred to as the 2009 standard). The 2009 criteria played a positive role in the diagnosis of early axial SpA during the 5 years of clinical use, but it was also found that overdiagnosis and missed diagnosis occurred according to the 2009 criteria. Therefore, some rheumatologists questioned whether the 2009 criteria were obsolete? Are adjustments needed? This issue is now expounded to help clinicians better understand and use the 2009 standard more reasonably.

Gout is a classical and ancient rheumatism, which is a crystalline arthritis caused by the deposition of monosodium urate in the joints. It is directly related to hyperuricemia caused by disorder of purine metabolism and/or reduced uric acid excretion, and belongs to the category of metabolic rheumatism. Clinically, it is manifested as acute episodic joint swelling and pain, often accompanied by elevated blood uric acid level. Clinically, it can not only cause joint structure destruction and disability, but also involve important organs and cause organ function abnormalities, such as irreversible damage to kidney function, which eventually leads to renal failure. It is often accompanied by hyperlipidemia, hypertension, diabetes, arteriosclerosis and coronary heart disease, etc.^[1,2,3]。 When gout attacks, patients will experience severe pain, which is called "the king of pain". According to Data from the Chinese Rheumatism Data Center (CRDC), during a gout attack, 79% of patients will not be able to persist in normal work due to pain and hospitalization, which seriously affects the quality of work and life of patients. The resulting economic and social burden cannot be ignored. Therefore, it is necessary to strengthen the long-term management of gout patients and actively control and reduce the acute attack of gout. In recent years, with the rapid increase of the incidence of gout in China, gout has become a common clinical problem. However, due to the insufficient understanding of gout, it is not uncommon to misdiagnose and misdiagnose it in clinic. In addition, since most gout patients are asymptomatic in the intermittent period of gout attack, the treatment of intermittent period of gout attack is often neglected by patients, so it is necessary to standardize the diagnosis, treatment and management of gout.

With the advancement of medical theory and the development of ultrasound technology, critical ultrasonography is playing an indispensable role in the clinical practice of critical care medicine. The reason why critical ultrasound is becoming more and more important is that on the one hand, due to the development of its own technology, ultrasound can involve a wider range and depth of the body and obtain more accurate data. More importantly, it has the foundation of critical care medicine theory, so that the clinical application of ultrasound technology not only moves from body structure to function, but also from diagnosis to monitoring and treatment. The combined application of ultrasound technology with other hemodynamic indexes not only makes the understanding and mastery of the disease enter a new field, but also makes the treatment of severe cases more accurate and effective. Critical ultrasound is a problem-oriented and multi-objective integrated dynamic evaluation process for critically ill patients using ultrasound technology under the guidance of critical care medicine theory. It is an important means to determine the direction of critical treatment, especially hemodynamic treatment, and guide fine adjustment^[1]。

The patient was a 28-year-old male. He was admitted to the hospital on February 19, 2012 with "abdominal pain and diarrhea for 8 years, aggravated for 1 week". In 2004, the patient developed persistent dull pain in the left lower abdomen, accompanied by diarrhea, which was yellow paste or purulent and bloody stool, 4 to 5 times/d. Colonoscopy was entered into the transverse colon, and diffuse congestion, edema and erosion of the colonic mucosa were seen. The diagnosis was "ulcerative colitis", and the symptoms were improved after treatment with prednisone 40 mg/d and sulfasalazine 4 g/d. One month later, the daily dose of prednisone was reduced by 2.5 mg per week. In April 2005, the symptoms resolved and the above drugs were discontinued. In August 2005, the patient developed fever, left lower abdominal pain, mucus, pus and blood in stool more than 10 times/d, which were relieved after being treated with mesalazine and anti-infection. In December 2005, it was aggravated again, with pain in the left wrist, sternoclavicular joint and lumbosacral region. The symptoms were relieved after receiving prednisone 60 mg/d. Irregular reduction of prednisone (60 mg/d ×3 weeks, 40 mg/d ×3 weeks, 30 mg/d ×2 weeks, 20 mg/d ×2 months). In February 2006, ESR was 4 mm/1 h, CRP was 9 mg/L, Hb was 148 g/L, and serum albumin was 41 g/L. Colonoscopy showed no abnormalities at the end of the ileum, irregular ulcers in the cecum, peripheral mucosal erosion, multiple scars and polyps in the ascending colon, a large number of polyps and multiple shallow ulcers in the middle of the transverse colon to the descending colon, the surface of the ulcer was covered with yellow and white coating and pus and blood secretion, local intestinal stenosis and slight stiffness, and no abnormalities were found in the mucosa from the colon to the rectum 50 cm away from the anus. The pathology of colonic mucosa biopsy showed: inflammatory exudate, granulation tissue and acute and chronic inflammation of colonic mucosa, and crypt abscess. Barium enema showed that the splenic flexure of colon, transverse colon and liver flexure showed lead tube-like changes, the intestinal lumen became thin and stiff, and multiple polyps. Considering the possibility of inflammatory bowel disease (IBD) and ulcerative colitis (UC), we continued to take sulfasalazine and prednisone 20-40 mg/d without regular follow-up.

May 2016J Acquir Immune Defic SyndrA study on antiviral treatment of HIV and HBV co-infected patients led by Professor Li Taisheng of Department of Infectious Diseases, Peking Union Medical College Hospital was published. "Lamivudine-based antiviral regimen can effectively treat HIV and HBV co-infected patients with baseline HBV DNA less than 20 000 IU/ml" [Li Y, Xie J, Han Y, et al. Lamivudine monotherapy-based cART is effective for HBV treatment in HIV/HBV co-infection when baseline HBV DNA<20 000 IU/ml. J Acquir Immune Defic Syndr, 2016, 72 (1): 39-45.]. This study, funded by the 12th Five-Year Science and Technology Major Project (2012ZX10001003-001) and the National Natural Science Foundation of China (87361120391), reported the appropriate treatment plan for HIV and HBV co-infected patients in China for the first time, and provided a certain basis for the selection of active antiretroviral therapy (ART) regimen for HIV and HBV co-infection in areas with limited resources.

When it comes to the severity of diabetes, most doctors first think of acute complications such as ketoacidosis and non-ketotic hyperosmolar syndrome. Indeed, these two kinds of severe diseases are common in emergency departments. However, infection is often overlooked as one of the important triggers or direct causes of these critical diseases in diabetic patients. In fact, the severe illness of diabetes often starts with infection, and the severe illness itself will lead to uncontrolled blood sugar and aggravate the infection, forming a vicious circle that makes the difficulty of diagnosis and treatment skyrocket. Diabetic patients themselves are prone to various infections, and patients with poor blood sugar control are more common and more serious. Infection not only induces acute complications of diabetes, but also is an important cause of death in diabetic patients.

The seminar on difficult cases jointly organized by the Internal Medicine Branch of Chinese Medical Association and Peking Union Medical College Hospital was held in the Academic Hall of Peking Union Medical College Hospital on May 14th, 2016. More than 700 physicians from all over the country attended the meeting.

Parkinson's disease (PD) is a common neurodegenerative disease. Its typical motor symptoms include quiescent tremor, myotonia, bradykinesia and abnormal posture and gait. In recent years, non-motor symptoms including sleep disorders have received increasing attention. Daytime drowsiness is one of the most common sleep disorders in PD. Daytime drowsiness is mainly characterized by inappropriate or unintentional drowsiness during daytime awakening, which can occur in any scene, and its prevalence is about 50%. Daytime drowsiness has a serious impact on patients' quality of life and even society, especially significantly increasing the risk of traffic accidents in PD patients. A large sample study found that 11% of PD patients had been involved in traffic accidents in the past 5 years^[1]。 Daytime drowsiness is a pre-exercise symptom of PD and can occur approximately 10 years before the onset of motor symptoms^[2]。 This paper summarizes its pathogenesis, diagnosis and treatment.

Gout is a crystal-associated arthropathy caused by monosodium urate (MSU) deposition, which is directly related to hyperuricemia caused by purine metabolism disorder and/or decreased uric acid excretion, and belongs to the category of metabolic rheumatism. Gout can be complicated by renal disease, and in severe cases, joint destruction and renal function damage can occur. It is often accompanied by hyperlipidemia, hypertension, diabetes, arteriosclerosis and coronary heart disease.^[1,2,3]。

As the role of critical ultrasound in the diagnosis and treatment of critical diseases is increasingly recognized and understood, it has been widely accepted and applied. Doctors specializing in critical care medicine began to face various problems in the implementation process, which highlighted the need for academic development system construction and quality control of critical care ultrasound. To this end, the Group of Experts developed this consensus based on years of experience in application and promotion, from basic ideas to implementation norms.

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