2018年 · 第57卷第02期

Inflammatory bowel disease (IBD) is a chronic non-specific inflammatory disease that occurs in the gastrointestinal tract. It has the characteristics of recurrent and prolonged disease, which seriously affects the quality of life of patients. Because the etiology is still unclear, there is no effective prevention method for this disease, and the treatment of some refractory patients is difficult. In recent years, more and more studies on the pathophysiological pathogenesis of IBD have been conducted, which is a hot spot in gastroenterology research. The results of basic research and clinical translation research of IBD have also played an important guiding role in clinical diagnosis and treatment, which is reflected in disease diagnosis, disease classification, drug selection, targeted therapy, efficacy prediction, disease status assessment, prognosis outcome and recurrence prediction, etc. At present, the IBD research in China has made great progress, but there is still a certain gap with the western developed countries. In this issue, Professor Liu Zhanju of the Tenth Affiliated People's Hospital of Tongji University is invited to write an article "Current status of basic research and clinical translation challenges of inflammatory bowel disease in China". Welcome to Read.

inflammatory bowel diseases (IBD) are chronic non-specific inflammatory diseases that occur in the gastrointestinal tract of unknown causes, mainly including ulcerative colitis (UC) and Crohn's disease (CD). It is often manifested as abdominal pain, diarrhea, mucus, pus and bloody stool, intestinal obstruction and intestinal perforation, and even cancer. Due to the recurrence and prolongation of the disease, the quality of life and daily work of patients are seriously affected.

Gastric cancer has become one of the important public health issues endangering people's health in China. Currently, endoscopic submucosal dissection (ESD) has been used as the curative procedure of early gastric cancer without lymph node metastasis. Endoscopic resection has several advantages, including less invasiveness, permitting en bloc, histologically completed resection, accurate pathological diagnosis, lower recurrent rate and rapid recovery. The perioperative period of ESD is the time of a patient's endoscopic operative procedure; more specifically, it includes ward admission, indication, contraindication, preoperative preparation, endoscopic operation, postoperative complications, recovery and the disposal of specimen. The aim of this guideline is to assist endoscopists in providing standardized operation to patients, as well as managing perioperative complications.

Xuezhikang, a Chinese traditional medicine, contains natural statin and is effective on dyslipidemia by inhibiting cholesterol synthesis. Xuezhikang therapy for 8 weeks in patients with hyperlipidemia reduced total cholesterol (TC) by 23%, low density lipoprotein cholesterol (LDL-C) by 28.5% and triglyceride(TG) by 36.5%, and increased high density lipoprotein cholesterol (HDL-C) by 19.6%, respectively. Data from China Coronary Secondary Prevention Study (CCSPS) showed that treatment with Xuezhikang lowered the risks of major coronary events, death from coronary heart disease, and all cause death in patients with myocardial infarction, indicating that Xuezhikang can be used in the primary and secondary prevention of cardiovascular disease.

pancreatic disease, panniculitis, and polyarthritis are called PPP syndrome when they manifest in the same patient. Boswell and Baylin^[1]It was first proposed in 1973 that panniculitis and polyarthritis can occur earlier than or concurrently with pancreatic disease. The etiology of PPP syndrome includes pancreatitis, pancreatic cancer, pancreatic trauma, rupture, pancreatic pseudocyst, subclinical pancreatic disease, etc. It can occur at any age, and is easily ignored or misdiagnosed because of unobvious abdominal signs. It has serious chronic sequelae and high mortality rate. The mortality rate of pancreatitis is about 24%, and the mortality rate of pancreatic cancer is about 74%^[2]。 There are a small number of reports of PPP syndrome abroad, and even fewer reports at home. A case of PPP syndrome in our hospital is reported.

The patient was 16 years old, female of social gender. He was admitted to the hospital on September 6, 2016 for "primary amenorrhea" and "abnormal sexual differentiation (pseudohermaphroditism)". The patient delivered naturally at term, with unknown weight at birth and no birth injury; Since birth, there is no history of head trauma and high fever infection, and there is no difference in height and intellectual development from children of the same age. Up to now, there is no breast development and no menstrual cramps. Denying a genetic history in the family. The parents are not close relatives, the patient's mother (43 years old) and sister (23 years old) have chromosomes of 46 XX, menstruation is normal, and the sister is married and gives birth. Admission physical examination: height 165 cm, weight 47 kg, upper volume 73 cm, lower volume 92 cm, body mass index (BMI) 17.3 kg/㎡, slightly thin body shape, multiple acne on facial skin, and vellus hair on lips. Mild appearance of Adam's apple. Unpalpable enlargement of the thyroid. There were no positive signs in heart, lung and abdomen examinations. Breast Tanner stage I. The pubic hair is dense and irregular in shape, and the axillary hair is sparse. The testis can be palpable in the bilateral inguinal area. Vulvar development is abnormal, clitoral hypertrophy shows a protrusion about 2.0 cm ×2.0 cm in size, which is small penis-like, soft in texture, without tenderness, the urethral opening is separated from the vaginal opening, and the vagina can be detected by gynecological digital examination, which can accommodate one finger. Thyroid function, liver and kidney function, blood electrolytes, blood lipids and blood glucose were normal, and angiotensin Ⅰ (AⅠ), angiotensin Ⅱ (AⅡ), renin activity (PRA), aldosterone (AID), 17 α hydroxyprogesterone (17 α-OHP), growth hormone (GH), 24-h urinary 17-hydroxycorticosteroid (17-OH), 17-ketocorticosteroid (17-KS) and vanillyl amygdalic acid (VMA) were all normal. The sex hormone examination of the patient and her mother and sister is presented inTable 1。 The patient did not respond to the human chorionic gonadotropin (HCG) stimulation test (Table 2）。 B-ultrasound showed: (1) Congenital absence of uterus. (2) Solid hypoechoic area of vulva (penis may). CT findings: bilateral cryptorchidism was considered; Perineum see deliberate penis display, the shape is short; No exact uterus and bilateral appendages were found in the pelvic cavity; No obvious abnormalities were seen in bilateral adrenal glands. The wrist bone age film is normal. Bone density test was normal. A pituitary magnetic resonance imaging (MRI) scan revealed hyperplasia of the pituitary gland. Chromosome examination: 46XY, the patient's ZFX gene and ZFY gene were amplified, and the SRY gene was amplified. Molecular genetic test report: The patient (proband) detected two genetic variants: c.277+5G>A; p.? Heterozygous, inherited from the father; c. 277G>A; p. (Glu93Lys) heterozygous, inherited from the mother. His sister was tested and found to be the same as the patient, carrying the above two heterozygous gene mutations, and the patient's niece was tested for the above two loci genes, and it was found to carry one of the heterozygous mutations: c. 277G>A; p. (Glu93Lys) (Figure 1，Figure 2）。

November 2017 International authoritative journal in the field of endoscopyEndoscopyPublished a study led by Professor Li Yanqing and Professor Zuo Xiuli of Qilu Hospital of Shandong University, jointly completed by four domestic medical centers (Qilu Hospital of Shandong University, Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology, Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology, and the First Affiliated Hospital of Zhejiang University), "Multicenter, randomized controlled study of confocal laser microendoscopy in vivo diagnosis of gastric mucosa intestinal metaplasia and gastric tumors^[1]". This study is the first prospective, multicenter, randomized controlled study in the world to evaluate the clinical value of confocal laser microendoscopy (pCLE) in the in vivo diagnosis of gastric mucosal intestinal metaplasia (GIM), gastric mucosal intraepithelial neoplasia (GIN), and early gastric cancer (EGC).

acute pancreatitis (AP) refers to the activation of pancreatic enzymes caused by various reasons, followed by local inflammatory reaction of the pancreas, with or without systemic complications. Throughout the epidemiological data of various countries, the incidence of AP in the world is about (13~45) /100,000, which is the first cause of digestive diseases admitted to hospital, and there is a continuous increase trend^[1]。 AP can be divided into three categories according to the severity of the disease: (1) mild acute pancreatitis (MAP); (2) Moderate severe acute pancreatitis (moderately severe acute pancreatitis, MSAP); (3) Severe acute pancreatitis (severe acute pancreatitis, SAP). Patients with SAP often develop persistent organ failure (>48 h) at the early stage of the disease, with a high mortality rate (30% ~50%) and dangerous disease. Successful treatment of SAP patients is the key to improve the prognosis of AP^[2,3]。

acute pancreatitis (AP) is a common disease with high morbidity and mortality in the world. hypertriglyceridemia (HTG) has become the second most common cause of AP in China. Currently, the AP caused by HTG is called hypertriglyceridemic pancreatitis (HTGP)^[1]。 Compared with AP caused by other etiologies, HTGP has the characteristics of severe disease and recurrence, and its diagnosis and treatment also have its special characteristics. The epidemiology, pathogenesis, clinical characteristics, diagnosis and treatment of HTGP in recent years are introduced and evaluated in detail, so as to improve clinicians' understanding and diagnosis and treatment level of HTGP.

Standardized training for residents (referred to as residence training for short) has been carried out in an all-round way across the country. We have noticed that the standardized training program for residents of internal medicine, both nationwide and in Beijing^[1,2]All of them use wards as the main training places, and outpatient clinics are not included in the required rotation plan. The Department of Internal Medicine of Peking Union Medical College Hospital, as the forerunner of residential training in China, has been developing residential training for nearly 100 years^[3]In the early years, there was a relatively perfect resident clinic. Later, due to various reasons, residents no longer routinely rotated out-patient clinics. As the outpatient clinic is an indispensable place for clinical teaching, Union Medical College has made efforts to restore the resident teaching clinic since 2017, and sent a special person as an instructor to teach the teaching clinic.

monoclonal gammopathy of renal significance (MGRS) is a group of monoclonal immunoglobulins (M proteins) produced by proliferative diseases of B lymphocytes and plasma cells. Although it does not meet the diagnostic criteria for multiple myeloma (MM), Waldenstrom's macroglobulinemia (WM), chronic lymphocytic leukemia (CLL) or lymphoma, M protein-related kidney damage has occurred. The concept of MGRS was proposed in 2012 by the International Kidney and Monoclonal Immunoglobulinopathy Research Group (IKMG)^[1]。