2018年 · 第57卷第01期

In 2017, with the strong support of readers, authors, editorial board members and reviewers of the journal, we successfully completed various editing and publishing tasks, and once again won the title of "One Hundred Outstanding Academic Journals in China". In 2018, we will forge ahead and create new high-quality products. Welcome to stay tuned.

The acute attack of bronchial asthma (hereinafter referred to as asthma) can cause a series of harms to the body, and consume additional medical resources, such as frequent unscheduled medical visits, emergency department and hospitalization, causing a serious socio-economic burden, and is also an important cause of disability and death of asthma. Judging from the current situation, there are still many irregularities in the diagnosis and treatment of acute asthma attacks by doctors at all levels in China due to the influence of various subjective and objective factors. On the one hand, it affects the treatment level and increases the treatment cost^[1]。 In order to better standardize clinicians' treatment of acute asthma attacks, update the concept of disease diagnosis and treatment, and improve the treatment level of acute asthma attacks, the asthma group of Chinese Medical Association Respiratory Disease Branch and China Asthma Alliance organized relevant asthma experts in China to write the "Chinese Expert Consensus on Assessment and Treatment of Acute Attacks of Bronchial Asthma" (hereinafter referred to as the Consensus) on the basis of relevant guidelines at home and abroad^[2]To standardize the treatment of acute asthma attacks and improve the treatment level of acute asthma attacks.

Asthma exacerbations can do a lot of harm to the patients and consume large amounts of medical resources. This consensus is based on the domestic and foreign guidelines and literatures to standardize the evaluation and management of asthma exacerbations in China. Asthma exacerbations are characterized by a progressive increase in symptoms of shortness of breath, cough, wheezing or chest tightness and progressive decrease in lung function, and usually require modification of treatment. Recognizing risk factors and triggering factors of asthma exacerbations is helpful for the prevention and long-term management. Evaluation of asthma exacerbations is based on symptoms, lung function, and arterial blood gas. Management is stratified according to the severity of disease. Different regimens to treat asthma exacerbations are discussed in this consensus. Glucocorticoids should be used properly. Overuse of antibiotics should be avoided. Management of life-threatening asthma is discussed separately. Special attention should be paid in some special respects, such as asthma during peri-operation period, gestation period, and childhood. Diagnosis and management of complications are also of great significance and are discussed in details.

idiopathic hypereosinophilic syndrome (IHES) is a group of rare diseases with persistent increase in peripheral blood or associated tissue eosinophils and multiple organ dysfunction of unknown cause. Because of the different tissues and organs involved, the clinical manifestations are diverse, involving respiratory, skin, nerve, cardiovascular, digestive and other systems, and complicated pulmonary embolism is rare. An example is reported as follows in order to improve the awareness of the disease among clinicians.

October 25, 2017,LancetThe results of the "Early Screening and Comprehensive Intervention Project for High-Risk Groups of Cardiovascular Diseases" organized by Fuwai Hospital of Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, were published online [Lu JP, Lu Y, Wang XC, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1.7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet, published online: 25 October 2017. http: / /dx.doi.org/10.1016/S0140-6736 (17) 32478-9.]. It reveals the outstanding problems of hypertension management in China at present, clarifies the targets that need to be improved urgently, and provides reliable data support for solving these problems as soon as possible.

The patient was a 40-year-old male. The main cause of pituitary tumor was 9 years after operation, nausea, vomiting and anorexia were admitted for 10 days. Nine years ago, I went to a hospital in Beijing for postmarital infertility. The prolactin was checked at 55.2 μ g/L (normal range 2.5~17.0 μ g/L), and there was no obvious headache and vision loss. Cranial magnetic resonance imaging (MRI) showed a hyposignal shadow on the right side of the pituitary gland, with a size of about 12.6 mm ×9.0 mm, with bone collapse in the saddle floor. Considering the possibility of pituitary adenoma, transnasal-sphenoidal pituitary tumor resection was performed, and the postoperative pathological diagnosis was prolactinoma. The prolactin level was normal after multiple postoperative examinations, but pituitary function was not assessed. One year ago, I went to a tertiary hospital in Beijing for fever and wheezing. I found that my blood sodium was low (118 mmol/L). I was discharged after my symptoms improved after treatment with anti-infection and sodium supplementation. Nausea, vomiting and anorexia occurred after catching a cold 10 days ago. The blood pressure was 106/86 mmHg (1 mmHg =0.133 kPa), blood sodium was 121.4 mmol/L, blood potassium was 4.12 mmol/L, and glucose was 4.74 mmol/L. 8:00 and 16:00 serum cortisol both<25.7 nmol/L, corticotropic hormone (ACTH)<1.1 pmol/L; Thyrotropin (TSH) 2.78 mU/L (normal range 0.35-5.5 mU/L), total T₃1.37 nmol/L (normal range 1.01~2.95 nmol/L), free T₃3.18 pmol/L (normal range 2.76~6.30 pmol/L), total T₄94.1 nmol/L (normal range 55.34~160.88 nmol/L), free T₄11.28 pmol/L (normal range 10.42-24.32 pmol/L); Testosterone 8.19 nmol/L (normal range 8.4~28.7 nmol/L), estradiol (E₂) 64.62 pmol/L ( Normal range<353.1 pmol/L), luteinizing hormone (LH) 3.71 IU/L (normal range 1.5-9.3 IU/L), follicle stimulating hormone (FSH) 2.78 IU/L (normal range 1.4-18.1 IU/L), prolactin 2.52 μ g/L (normal range 2.1-17.7 μ g/L); Growth hormone 0.08 μ g/L (normal range 0.06-5.0 μ g/L); Insulin-like growth factor 1 (IGF-1) 28.9 μ g/L; Gonadotropin-releasing hormone (GnRH) stimulation test: LH-15 min 2.74 IU/L, 0 min 2.92 IU/L, 30 min 8.55 IU/L, 60 min 8.68 IU/L, 120 min 6.93 IU/L. Pituitary MRI showed postoperative changes in pituitary tumors and the presence of hyperintensity in the posterior lobes. Diagnosis: (1) Hypopituitary anterior lobe; (2) Postoperative pituitary prolactinoma. The medical history was followed up. In the past 3 years, the physical strength decreased compared with the previous one, and there was no loss of sexual desire and sexual dysfunction. Had a son 4 years after pituitary tumor surgery. Hydrocortisone 100 mg/d was given intravenously for 2 days. After the symptoms improved significantly, it was changed to oral prednisone acetate tablets, which was 2.5 mg twice/d at the time of discharge.

Japanese scholar Dote et al.^[1]A strange type of cardiac emergency was reported from 1990 to 1991, with left ventriculography images resembling those of Japanese octopus-catching jars with narrow necks and wide bases (Figure 1), call it Takotsubo. Since then, similar diseases have been reported and named in various ways, such as temporary apical balloon change, broken heart syndrome, transient left ventricular systolic dysfunction, etc. In 2006, the American Heart Federation (AHA) officially named this disease as stress cardiomyopathy (SCM)^[2]； The European Heart Society (ESC) classified this disease as unclassified cardiomyopathy in 2008^[3]。 In 2015, based on basic experiments and clinical research in recent years, ESC recommended that such diseases should be abandoned after "cardiomyopathy", and "syndrome" should be used to respect originality, that is, Takotsubo syndrome (TS)^[4]。

argyrophilic grain disease (AGD) is one of the important causes of late-onset dementia. Its pathological feature is that there are a large number of argyrophilic grain disease in the brain of dementia patients. 1987 Braak H. and Braak E.^[1]The clinical and pathological characteristics of AGD are described for the first time, and it is considered that it is different from the common Alzheimer's disease (AD) and should be considered as an independent disease entity.

Sphingosine-1-phosphate (S1P) is a biologically active metabolite of sphingomyelin. Sphingomyelin is the main neurosphingolipid on cell membrane, which can be catalyzed by neurophospholipase to produce ceramide, which is quickly catalyzed and hydrolyzed to produce sphingosine, which is then phosphorylated under the action of sphingosine kinase to produce S1P^[1]。 S1P can not only act as a second messenger in cells to activate downstream signaling pathways, affecting cellular metabolism and function, but also be transported extracellularly through the adenosine triphosphate binding cassette transporter superfamily and Spns2 transporter to bind to its receptors^[2,3]。 S1P can be synthesized in most cells, and its degradation is either irreversibly degraded by intracellular S1P lyase to palmataldehyde and phosphocholine, or dephosphorylated by S1P phosphatase to produce sphingosine, thus maintaining the dynamic balance of S1P in vivo^[1]。 Inhibition of S1P lyase activity significantly increased the level of S1P in lymphoid tissue of mice and decreased the difference of S1P concentration between blood and lymphoid tissue^[4]。

November 10th, 2017, is an extremely ordinary weekend for ordinary people, but for China's internal medicine and gastroenterology circles, it is undoubtedly a sad moment worth remembering forever. Professor Liu Xinguang, a famous clinical scientist and expert in the field of gastroenterology in China, the founding president of Gastroenterologist Branch of Chinese Medical Doctors Association, the winner of "Chinese Physician Award" and "Strait Digestive Lifetime Achievement Award", and the former deputy director of the Department of Internal Medicine and the former director of the Department of Gastroenterology of Peking University First Hospital, suffered a sudden heart attack while attending an academic conference. Unfortunately, he drove west at the age of 73. At this extremely sad moment, as a junior and close friend who knew each other, by remembering the snow and mud claws in the journey of more than 30 years of life with Professor Liu, I express my endless sorrow.