2017年 · 第56卷第06期

invasive fungal disease (IFD) is an important comorbidity that affects the prognosis of patients with hematological diseases, so standardized and reasonable prevention and treatment is very important. In order to further promote the level of IFD diagnosis and treatment among Chinese hematologists, the China Invasive Fungal Infection Working Group revised the "Diagnostic Criteria and Treatment Principles for Invasive Fungal Infection in Patients with Hematological Diseases/Malignant Tumors" again in 2017. Since 2005 "Diagnostic Criteria and Treatment Principles for Invasive Fungal Infections in Patients with Hematological Diseases/Malignancies (Draft)"^[1]Since its first release, Chinese hematologists have made great improvements in the diagnosis and treatment level and research level in the field of IFD, among which the role of the guidelines has played a major role.

invasive fungal disease (IFD) mostly occurs in immunocompromised people. It is one of the more common opportunistic infections in patients with hematological diseases/cancer after chemotherapy or hematopoietic stem cell transplantation, with a higher mortality rate. With the development of standard dose chemotherapy and hematopoietic stem cell transplantation, the incidence of IFD shows an increasing trend. However, the progress of fungal prevention and treatment has also changed the epidemiological characteristics of IFD. In order to standardize the clinical diagnosis and treatment of IFD and establish a unified platform for IFD clinical research, academia has established and launched a series of guidelines for the diagnosis and treatment of IFD^{[1,2,3,4,5,6]}。 China Invasive Fungal Infection Working Group has formulated and updated the "Diagnostic Criteria and Treatment Principles of Invasive Fungal Diseases in Patients with Hematological Diseases/Malignant Tumors" (hereinafter referred to as IFD Guidelines) according to the update of international academic guidelines and the latest progress of large-sample epidemiological research in China. The concept of undetermined IFD, the inherent logic and clinical significance of imaging diagnosis and diagnosis-driven treatment strategy in China's new revised guidelines are now interpreted.

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The patient was a 14-year-old male. He was admitted to hospital on 26 January 2015 due to a systemic rash for 6 months, aggravated with limb weakness for 1 month. In July 2014, the patient developed flaky red rash on the face, neck, upper arms and lower back without obvious trigger, accompanied by local edema and itching, without desquamation, ulceration and purulent discharge. Red rash on the scalp and behind the ears with itching occurred in November. After December fatigue, myalgia of the limbs with fatigue occurred, and it was difficult to lift the upper arm, squat and stand, and turn over, and the symptoms gradually worsened. At the beginning of January 2015, I had weakness in raising my head, dysphagia, no palpitations, shortness of breath, choking and cough after drinking water. Admitted to our department for further diagnosis and treatment. During the course of the disease, there were dry mouth, red conjunctiva, no low back pain, heel pain, joint swelling and pain, no light allergy, oral ulcer, and hands turning white and purple when exposed to cold. Since the onset of the disease, the patient's spirit and sleep are normal, his appetite is poor, his defecation is normal, and his weight has lost about 4 kg. Past history: Allergic dermatitis in 2010. Family history: His maternal grandmother has a history of joint swelling and pain.

January 3, 2017CirculationA study "Meta-analysis of the effect of gene polymorphism on the efficacy of clopidogrel in the treatment of acute ischemic stroke/transient ischemic attack" led by Professor Wang Yongjun, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University was published online [Pan Y, Chen W, Xu Y, et al. Genetic polymorphisms and clopidogrel efficacy for acute ischemic stroke or transient ischemic attack: a systematic review and meta-analysis. Circulation, 2017, 135 (1): 21 – 33.]. The study confirmed that in clopidogrel-treated patients with acute ischemic stroke/transient ischemic attack (TIA), those with the CYP2C19 loss-of-function allele had a higher risk of stroke and combined vascular events than those without them. The results of this study are a breakthrough in precision medicine research of cerebrovascular diseases, and have important reference value for the rational use of antiplatelet drugs in stroke patients in China in the future.

Epidemiological surveys show that in 2012, the prevalence of diabetes among residents aged 18 and above in China was 9.7%, including 12.3% in urban areas and 8.4% in rural areas, with nearly 100 million people suffering from diabetes^[1]。 Chronic complications caused by diabetes can lead to serious consequences such as blindness, renal failure, stroke, myocardial infarction, amputation, etc. It also leads to a rapid rise in medical expenses, causing a heavy economic burden to the country, family and individual. The awareness rate of diabetes mellitus was 36.1%, the treatment rate was 33.4%, and the control rate was 30.6%^[1]。 Although the Chinese Medical Diabetes Association has published several editions of the "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China" and carried out systematic promotion of the guidelines, the results are not satisfactory. The "National Assessment Study of Cardiovascular Disease Risk Factors-Blood Glucose, Blood Pressure and Blood Lipid in Chinese Patients with Type 2 Diabetes" published by the Society in 2013^[2]It is an investigation and analysis of the control status of blood glucose, blood pressure and blood lipid levels in 25,817 patients with type 2 diabetes in 104 hospitals at different levels in China. The results show that 72% of patients with type 2 diabetes in China are complicated with hypertension and/or dyslipidemia at the same time; The mean levels of glycosylated hemoglobin (HbA1c), blood pressure and TC were 7.6%, 133/79 mmHg (1 mmHg =0.133 kPa) and 5.0 mmol/L, respectively. According to the "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China", 47.7%, 28.4% and 36.1% of patients had blood glucose (HbA1c<7%), blood pressure (<130/80 mmHg) and blood lipids (TC<4.5 mmol/L) control level up to standard; Only 5.6% of patients with type 2 diabetes reached the standard of blood glucose, blood pressure and blood lipid at the same time. We know that patients with type 2 diabetes who also have hypertension and/or dyslipidemia have a 6-fold increased risk of developing cardiovascular disease than patients with diabetes alone. It can be seen that the status quo of metabolic control in diabetic patients in China is not optimistic. On the other hand, in clinical diagnosis and treatment, many irregularities can still be found. The following starts with analyzing the examples of misdiagnosed cases seen in clinical practice, and revisits the standardized diagnosis and treatment of diabetes.

ulcerative colitis (UC) is a chronic non-specific intestinal inflammatory disease. Its etiology and pathogenesis are still not completely clear. Aminosalicylic acid preparations, glucocorticoids (hormones for short), immunosuppressants and biological agents are routine drugs for UC patients. Because some patients have repeated attacks and poor drug control, they have to undergo surgery finally^[1]。 The emergence of selective leukocyte adsorption therapy has brought new ideas to the treatment of UC patients. At present, there are two main devices used in selective leukocyte adsorption therapy in clinic: (1) Adacolumn, which can absorb up to 65% granulocytes, 55% monocytes and a small number of lymphocytes, but has no effect on platelets; (2) Cellsorba, which has a more potent leukocyte removal effect, can absorb almost 100% polymorphonuclear cells, 60% lymphocytes and 30% platelets^[2]。

Lung cancer is the cancer with the highest mortality rate in the world. Most lung cancer patients are in the advanced stage when they see the doctor. Previous systemic treatment based on histological subtypes was mainly platinum-containing double-drug chemotherapy. In the past 10 years, lung cancer has made breakthroughs in the field of targeted therapy. For patients with advanced lung adenocarcinoma with sensitive driver gene mutations [epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) fusion gene], targeted therapy has replaced traditional chemotherapy as the first-line treatment, and there have been new breakthroughs in the field of immunotherapy. Preclinical and early clinical trials are constantly exploring potential targets and new treatment options. Individualized precision treatment based on molecular biology will be the goal and direction of future treatment. The targeted therapy and new targeting mechanisms of lung cancer are summarized as follows.

Osteoarthritis (OA) is a total joint disorder that involves the cartilage and its surrounding tissues, often causing joint pain and swelling that can eventually lead to disability. With the aging of the world population and the increasing obesity, the incidence of OA will increase significantly. In 2005, the incidence of OA in the United States reached 26 million people, and by 2030, 67 million people will have OA. Therefore, studying the epidemiology of OA and searching for the risk factors of OA may provide an important basis for improving the occurrence and development of OA and finding new treatment methods. The epidemiology and risk factors of OA are reviewed systematically.

Invasive fungal disease(IFD) is a common yet highly lethal complication in patients with hematological malignancies receiving chemotherapy or stem cell transplantation, as well as immune suppressive conditions including aplastic anemia and other malignancies. According to the diagnostic criteria, patients are defined as proven, probable, possible and undefined IFD based on the evidence provided by histopathologic/cytologic, culture, radiographic and biomarker examinations. For the management of IFD, the major treatment strategies consist of prophylaxis, empirical, diagnostic-driven and target therapy. The Chinese Invasive Fungal Infection Working Group has developed the Chinese consensus for the diagnosis and treatment of invasive fungal disease based on international guidelines and local experience. Recently, the working group revises the consensus by update international guidelines and clinical studies in China.

Precise evaluation of the structure and function of collateral circulation is vital for individualized management in stroke. By summarizing the most up-to-date evidence, the new concepts and clinical significance of cerebral collaterals are highlighted in the guideline, and clinical recommendations for the evaluation and management strategies of cerebral collateral circulation are provided.

Cardiovascular disease is the leading cause of death for Chinese women, which has not been paid enough attention at present. Chinese women account for 20 percent of 3.5 billion women all over the world. Health promotion and prevention are facing the rigorous challenge. The pathophysiological characteristics, clinical manifestations, disease diagnosis, drug metabolism and prevention strategies of woman cardiovascular diseases are different from those of men in some respects and require special attention. "Consensus for the prevention of cardiovascular diseases in Chinese women" is developed by Women Physician Committee of Chinese College Cardiovascular Physicians and Women′s Health Work Group of Chinese Society of Cardiology, which is aimed at strengthening and promoting prevention of cardiovascular diseases in Chinese women.

Invasive mycosis (IFD) is a disease that is difficult to diagnose, and it is also an important comorbidity that affects the prognosis of patients with hematological diseases. Since the first release of "Diagnostic Criteria and Treatment Principles for Invasive Fungal Infection in Patients with Hematological Diseases/Malignant Tumors (Draft)" in 2005, it has been revised in 2007, 2010 and 2013, which has not only played an important role in promoting the diagnosis and treatment of IFD by Chinese hematologists, but also promoted the clinical research of IFD in China. In 2017, the China Working Group on Invasive Fungal Infections updated the guidelines again, and the full text is published in this issue. The best feature of this edition is that the content of this guideline is recommended accordingly based on research data from Chinese patients with hematological diseases. We specially engaged Professor Huang Xiaojun of Peking University People's Hospital and Professor Hu Jiong of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine to write the articles "The role of guidelines from the evolution of 'diagnostic criteria and treatment principles of invasive fungal diseases in patients with hematological diseases/malignant tumors' in China" and "Diagnosis and treatment of undetermined invasive fungal diseases: interpretation of diagnostic criteria and treatment principles of invasive fungal diseases in patients with hematological diseases/malignant tumors" respectively. Welcome to Read.