2017年 · 第56卷第02期

With age, the risk of stroke and cognitive impairment increases gradually. In addition to motor and sensory disorders, stroke can also lead to cognitive and behavioral disorders such as anxiety and depression, insomnia, fatigue, apathy, lack of willpower, decreased attention, slow reaction, decreased memory, aphasia, and decreased executive function. At the same time, the cognitive impairment caused by stroke will further aggravate the disability caused by stroke itself. Patients' self-care ability, work ability, social function impairment and mental health defects will all increase the burden on patients, families and society. Studies have shown that the functional recovery and prognosis of stroke patients with cognitive impairment are worse, the functional disability is more serious, the recurrence rate of stroke increases, and the incidence of complications such as bedsores and pneumonia is also significantly higher. In this issue, Professor Xie Hengge of the General Hospital of the People's Liberation Army wrote a monograph "Cognitive impairment should become the focus of comprehensive management after stroke". In the article, it is proposed that post-stroke cognitive impairment (PSCI) should be actively incorporated into comprehensive management after stroke as a key point. Cognitive screening and follow-up observation of stroke patients are effective ways to identify PSCI early. Welcome to Read.

With age, the risk of stroke and cognitive impairment increases gradually. The incidence of stroke increased from 1.8 per 1,000 person-years between 55 and 64 years to 17 per 1,000 person-years after 85 years of age^[1]。 The incidence of dementia increased from 3.1 per 1,000 person-years between 60 and 64 to 175 per 1,000 person-years after 95, doubling every 5 to 6 years^[2]。 Stroke, as the third leading cause of death, is also an important factor causing physical disability and cognitive impairment. Although the incidence of stroke has gradually declined in developed countries in Europe and America, it is still on the rise in developing countries such as China, and the absolute number of disabled and disabled patients caused by stroke has increased unabated. At the same time, the cognitive impairment caused by stroke further aggravates the disability caused by stroke itself, the decline of self-care ability, the decline of work ability, the impairment of social function, and the defect of mental health, all of which increase the burden of patients, families and society. Therefore, cognitive impairment should be a focus of comprehensive management after stroke.

mild cognitive impairment (MCI) is a clinical cognitive impairment syndrome, which is a transitional state between normal aging and dementia, especially Alzheimer's disease (AD). The prevalence of MCI among the elderly over 65 years old in China is as high as 13% ~20%^[1]。 Therefore, how to prevent the progression of MCI to AD has attracted much attention. The 2015 Multi-Channel Joint Intervention to Prevent Alzheimer's Disease (FINGER) study found that after two years of comprehensive intervention such as diet, physical exercise, cardiovascular risk factor management and cognitive training, the overall cognitive function, executive function and information processing speed of high-risk dementia groups were significantly better than those of the control group^[2]。 The report of this result has aroused great interest in the academic community for the application of cognitive training in MCI.

The patient was a 57-year-old male. He was admitted to hospital in March 2016 for the main reason of "unclear speech for 9 months". Since 9 months ago, the patient had unclear speech without obvious trigger, and some words were vague when speaking, but there was no choking, cough and dysphagia after drinking water, no difficulty in limb movement, numbness and pain, no other discomfort, and no weight loss. The symptoms gradually worsened. Five months ago, I felt that my slurred speech was more obvious than before. It worsened after talking for a long time. It could improve slightly after rest, but it could not return to normal. I felt that it was heavier every afternoon. There was no obvious fatigue during chewing, no salivation during sleep at night, and no obvious "flesh jump" in the whole body. He had visited a local hospital and failed to make a definite diagnosis. The above symptoms slowly worsened. In the past month, the patient consciously had a fluid sensation at the corner of his mouth when eating, but there was no obvious salivation. The remaining symptoms were roughly the same as before, and there was no discomfort such as chest tightness and choking. Since the onset of the disease, the patient has had good mental diet and sleep, and the second stool is the same as before, and the weight has lost about 2 kg. Previous sense of smell decreased since childhood, sexual life decreased for 2 years, and history of hypertension for 2 years; Smoking for 20 years, more than 10 cigarettes a day; I have been drinking for more than 20 years, with 500 g/time of liquor at many times and 100~150 g/time of liquor at few times, 3 times/week. I have been abstaining from drinking for 4 months. Deny similar medical history in the family.

The patient was a 17 year old male. In June 2013, a mass in the right cubital fossa appeared, about the size of a peanut, and progressively enlarged to 50 mm ×50 mm. Anti-infective treatment (specifics unknown) was given. After the mass shrank to 20 mm ×20 mm, there was no obvious change, and multiple subcutaneous nodules appeared on the chest and back. Physical examination: body temperature 36.8 ℃, 18 breaths/min, 78 pulses/min, blood pressure 125/81 mmHg (1 mmHg =0.133 kPa). A well-healed surgical incision scar with a length of about 60 mm was seen in the right cubital fossa, and multiple subcutaneous nodules were seen in the chest and back, with a maximum of about 30 mm ×30 mm, protruding from the surface. The local skin was not damaged, the epidermis was slightly reddened, and the superficial lymph nodes of the whole body were not palpable and swollen, and there were no other positive signs. Blood routine, bone marrow puncture, B-ultrasound and CT showed no obvious abnormalities. Skin pathological examination: Skin and subcutaneous tissues were taken, no abnormalities were found in the epidermis, and abnormal cells were densely proliferated and infiltrated in the dermis and subcutaneous tissues with solid distribution. The cell volume was medium, the cytoplasm was small, the nucleus was slightly irregular, the chromatin was fine and granular, the nucleolus was not obvious, the division image was easy to see, and some cytoplasm seemed to have eosinophilic particles. Immunohistochemistry: Bcl-2^＋, CD₂^-, CD₃^-, CD₄⁺, CD₅^-, CD₈^-, CD₁₀^-, CD₂₀^-, Pax5^－, CD₄₃⁺, CD₅₆⁺, GrB^－, Perforin^－, Ki-67^＋, TIA1^－, TDT^－, CD₁₂₃⁺, EBER^－, MPO^－, a small amount of CD₆₈⁺, CD₃₄^-, CD₁₁₇^-Of which Bcl-2 and Ki-67 were both more than 80% positive. The diagnosis was established as a cutaneous blastocytic plasmacytoid dendritic cell tumor. (blastic plasmacytoid dentritic cell neoplasm, BPDCN) has been given HyperCVAD/MA regimen (cyclophosphamide + vincristine + dexamethasone + pirarubicin/methotrexate + cytarabine) chemotherapy since April 2015. After one cycle, the subcutaneous masses in the upper limbs, chest and back disappeared. Color Doppler ultrasound and CT examination were normal, suggesting complete remission, and then 2 courses of HyperCVAD/MA consolidation chemotherapy were given. At the same time, intrathecal drug injection was given to lumbar puncture. In October 2015, I was given VP-16 (etoposide) stem cell mobilization regimen chemotherapy, the regimen was VP-16 600 mg (day 1 to 3), recombinant human granulocyte colony stimulating factor (G-CSF) or granulocyte-macrophage colony stimulating factor (GM-CSF) combined mobilization in due course, and autologous hematopoietic stem cell transplantation pretreated with BEAM regimen (carmustine + etoposide + cytarabine + melphalan) was performed smoothly. Follow-up until July 2016, the patient's condition was stable without recurrence.

March 2016Aging DisA study "Thoracic aortic atherosclerotic complex plaques can independently predict the recurrence of cryptogenic ischemic cerebrovascular disease" completed by the team of Professor Xin Ma, Department of Neurology, Xuanwu Hospital, Capital Medical University was published in the journal [Dong J, Ma X, Qie J, et al. Aortic complex plaque predicts the risk of cryptogenic ischemic cerebrovascular disease recurrence. Aging Dis, 2016, 7 (2): 114-120.]. This study was the first prospective cohort study to evaluate the effect of aortic complex plaque (ACP) on recurrent cerebral ischemic events in Chinese patients with cryptogenic ischemic cerebrovascular disease (CICVD).

According to the World Health Organization (WHO) Diabetes Etiology Typing System 1999, diabetes includes type 1 diabetes, type 2 diabetes, other special types of diabetes and gestational diabetes. Although the incidence of special type of diabetes is low, it is far more complicated than other type 3 diabetes. It is a general term for all diabetes except these 3 types. There are many types, which are roughly divided into eight categories. There is still no certainty about how many types are subdivided. There are standard hereditary diabetes that comply with Mendel's law, such as adult-onset diabetes (MODY) in young adults.^[1]There are also various other diseases such as diabetes secondary to Cushing's syndrome, pheochromocytoma and acromegaly, as well as diabetes caused by the use of a large number of drugs such as steroids, and severe pancreatic diseases can also produce diabetes. The most complicated are various genetic syndromes including diabetes, which are mainly manifested by various growth and development abnormalities, such as Down syndrome, Wolfram syndrome and Prader-Willi syndrome, etc. Diabetes is only a part of the syndrome.

amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease involving both upper and lower motor neurons. It was first reported by French neurologist Jean Martin Charcot in 1874. At present, ALS is considered to be the third common neurodegenerative disease. Its etiology and pathogenesis are still unclear. Among them, 5% to 10% were familial ALS (fALS), and 90% to 95% were sporadic ALS (sALS). The disease often starts in middle age, and its clinical manifestations are characterized by progressive muscular weakness, muscular atrophy, dysarthria, dysphagia, muscle tract fibrillation, active tendon reflex and pyramidal tract sign, with an average survival of 3 to 5 years. Due to the unclear pathogenesis of ALS, highly heterogeneous survival, and the current lack of specific indicators to evaluate patient prognosis, exploring biomarkers that can objectively reflect disease progression is not only beneficial to guiding clinical practice, but also helpful to accurately evaluate drug efficacy. In the past five years, biomarker research has gradually become a hot spot in ALS research, including genetic markers, humoral (cerebrospinal fluid, blood and urine) markers, neuroimaging and electrophysiological markers, etc. Biomarkers or combinations of different markers identified by methods such as metabolomics, proteomics or multiplex immunization may be used for the diagnosis and prediction of ALS^[1]。 There are also routine blood tests that may be associated with ALS progression and prognosis, including serum creatinine^[2]uric acid^[3]Serum ferritin^[2]Neutrophil count,^[4]Dyslipidemia^[5]etc, but mostly only evaluated in a small sample, which has not been further confirmed. The relationship between serum creatinine level and its dynamic changes in ALS patients and the progression and prognosis of ALS is reviewed.

irritable bowel syndrome (IBS) is a common functional gastrointestinal disorders (FGIDs) characterized by abdominal discomfort or abdominal pain accompanied by changes in bowel habits. Based on the recognized Rome III diagnostic criteria, IBS can be further divided into four subtypes: diarrhea predominant irritable bowel syndrome (IBS-D), constipation predominant irritable bowel syndrome (IBS-C), mixed irritable bowel syndrome (IBS-M) and unsubtyped irritable bowel syndrome (IBS-U^[1]。 The pathogenesis of IBS is not fully understood, and there is still a lack of radical cure. The progress of IBS treatment in recent years is summarized.

Patients with cancer often have different degrees of dyslipidemia. The level of blood lipid is closely related to the onset, progression and prognosis of tumor. Different blood lipid components have different significance to tumor. The following is a review of the research progress on the correlation between TG, TC, LDL-C, HDL-C and tumors, which are commonly used indexes of blood lipid monitoring.

Knee Osteoarthritis (KOA) is a chronic joint disease that mainly involves Knee cartilage lesions and eventually involves all tissues around the joint. It is the most common type of Osteoarthritis among the elderly over 65 years old, which seriously affects patients' walking, standing and climbing ability, and greatly reduces patients' quality of life^[1]。 With the aging of the population and the increasing proportion of obese people in the population, the incidence of KOA is increasing year by year, and the global direct or indirect expenditure on its treatment is up to tens of billions of dollars every year, which brings serious challenges to global health and medical treatment^[2,3,4]。 However, there is still a lack of definite drugs to improve KOA. Therefore, exercise therapy with less cost, less side effects and more reliable curative effect has become the research hotspot of medical experts at home and abroad.

"Medically unexplained symptoms" (MUS) are commonly seen in all clinical specialties. The preliminary investigations in China show a prevalence of MUS in 4.15%-18.2% of clinical patients. Based on international and national guidelines and the most advanced studies, a Chinese expert consensus on clinical practice of MUS is reached through three rounds of discussion seminars by 25 experts from various specialties including psychiatry, internal medicine, surgery, gynecology-obstetrics, otorhinolar-yngology and traditional Chinese medicine. Clinical doctors should be alert of patients whose discomfort complaints cannot be explained by organic conditions after thorough physical examination and necessary laboratory tests. MUS should be recognized as early as possible so as to avoid complicating iatrogenic factors. A full bio-psycho-social evaluation of the patient is the basic structure of understanding MUS patients. In clinical practice, a trustful doctor-patient relationship is the first step of successful treatment. Then after a reasonable clinical evaluation, explain to the patient that it is a harmless functional symptom, communicate with the patient and reach an acceptable therapeutic goal, help the patient understand the symptoms in a psycho-somatic aspect and rebuild confidence of getting back to normal life. Patients with mild symptoms can be treated by doctors in various specialties, from whom the patient seeks help. Patients with severe symptoms need multi-disciplinary care including specific psychotherapy. Pharmaceutical treatment includes symptom alleviating drugs and antidepressants. In clinical care of patients with "MUS" , a full bio-psycho-social evaluation, a good doctor-patient relationship, a treatment plan according to the severity of symptoms, and a multi-disciplinary cooperation should be noted and practiced.

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