2018年 · 第57卷第03期

Traditional clinical trials are often conducted in specific populations and backgrounds, which can help doctors more accurately understand the mechanism of action of treatment measures on target diseases and reduce bias. However, such specific populations and treatment measures are not the actual situation of clinical work. In order to prove the inherent effectiveness of these treatment measures and control the bias caused by confounding factors, the exploration of their universal applicability has to be sacrificed, which makes the study subjects included in the trial and the people who may receive treatment in the future are very different. The term "real-world research" is widely used in the field of medical product development and healthcare, and is more valued by healthcare investors and related policy makers. Real-world data is not just big data, but also emphasizes the integration of multiple data sources from the real world. With the continuous development of mobile technology and big data analysis, the mobile medical model based on "Internet plus" makes it possible for a country with a vast territory and a large population like China to carry out "real world research". Invited Professor Huang Feng to write "Mobile Healthcare Leads Real World Research", and published an article "Human Leukocyte Antigen-B in Patients with Ankylosing Spondylitis" conducted by the team using the Spondyloarthritis (SpA) Intelligent Mobility Management System (SMSP)₂₇A comparative clinical study of molecular carrying status: real-world data based on an intelligent mobile management system for spondyloarthritis ".

The synthesis of real-world data composed of multiple information sources is an important innovation in the medical and health field. American Health Innovation Excellence Network (NEHI)^[1]Speaking of, real-world data is not just big data, but also emphasizes the integration of multiple data sources from the real world, including electronic health records, claim bills, disease registration systems and information collected from platforms such as personal health devices and mobile medical applications. It is an important supplement to traditional medical research. This view is also cited in the New England Journal of Medicine^[2]。 At present, the term "real-world research" is widely used in the field of medical product development and medical and health care, and is more valued by medical investors and related policy makers. The U.S. Food and Drug Administration has made it clear that medical research is in the midst of a data revolution in an amendment to the Prescription Drug Use Charges Act, proposing to "use real-world evidence to evaluate the safety and efficacy of drugs."^[3]。 However, large-scale real-world research is very difficult, especially for traditional medical research based on paper media, which will consume huge manpower and financial resources. With the continuous development of mobile technology and big data analysis, the mobile medical model based on "Internet plus" makes it possible for a country with a vast territory and a large population like China to carry out "real world research". The intelligent mobile management system (SMSP) for spondyloarthritis (SpA) published in this issue is the earliest prospective cohort study in China to electronically collect information about SpA/ankylosing spondylitis (AS) patients using mobile medical methods, exploring the need and experience of real-world data through mobile medical technology.

Analgesia and sedation therapy has become an important part of ICU cluster therapy. Why should we implement analgesia and sedation therapy for severe patients? Is it as simple as just making patients more comfortable? Is this the primary purpose of analgesic and sedative treatment? In recent years, individualized and titrated sedation strategies have become the focus. We should not only pay attention to whether the depth of analgesia and sedation reaches the standard, but also pay attention to the hemodynamic effects of analgesia and sedation.

Reporting standards are the key research areas of evidence-based medicine, which play a crucial role in improving the quality and transparency of research reporting^[1,2]。 reporting specifications for randomized controlled trials were first proposed by the CONSORT (consolidated standards of reporting trials) group in 1996 and updated in 2010^[3,4]At present, it has been published in the Chinese Journal of Internal Medicine,JAMA、Lancet、BMJMany well-known medical journals have introduced manuscripts. Since then, research groups have formulated reporting specifications for systematic evaluation, observational studies, diagnostic tests, case reports and animal tests. However, in the field of health care, there has been no internationally accepted standard for how to standardize reporting practice guidelines.

Ankylosing spondylitis (AS) is a chronic inflammatory disease. Involvement of axial joints including sacroiliac joints is the main clinical manifestation of the disease. Peripheral joint involvement, tendinitis, dactylitis, etc., mainly major joints of lower limbs, will also occur. Extra-articular damage mainly includes ocular involvement such AS acute anterior uveitis (AAU), intestinal manifestations, especially inflammatory bowel disease (IBD): ulcerative colitis (UC), Crohn's disease (CD), psoriasis-like skin lesions, etc. also often occur. On the one hand, the appearance of these extra-articular damages suggests that AS is also a systemic inflammatory disease, and on the other hand, it also reminds clinicians to pay close attention to these extra-articular manifestations and give active treatment during treatment. In 2016, the guidelines of the International Society for Spondyloarthritis (ASAS) /European Anti-Rheumatic Alliance (EULAR) pointed out that we should be vigilant and pay attention to the treatment of extra-articular manifestations of AS, and actively improve the extra-articular damage of AS patients to achieve the comprehensive standard of AS treatment.

Rheumatoid arthritis (RA) is a common chronic systemic autoimmune disease mainly involved in joints. Besides joints, tissues or organs such as lungs, heart and nervous system can also be involved, which increases the disability and fatality of the disease. The course of RA can last for decades, and there are currently more than 5 million RA patients in China, which brings a huge burden to patients, families and society^[1]。

June 2017International Journal of CardiologyA study on the clinical characteristics and prognosis of pulmonary hypertension (PAH) associated with connective tissue disease (CTD) organized by Professor Zeng Xiaofeng, Department of Rheumatology and Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (Zhao J, Wang Q, Liu Y, et al. Clinical characteristics and survival of pulmonary arterial hypertension associated with three major connective tissue diseases: a cohort study in China [J]. Int J Cardiol, 2017, 236:432-437.), was a single-center prospective cohort observational study comparing the clinical features and prognostic differences of three major CTD-related PAHs.

Fever is the most common complaint of patients, and there are many reasons for fever. However, fever in the elderly is often atypical, which increases the difficulty of diagnosis and differential diagnosis. fever of unknown origins (FUO) refers to fever ≥3 weeks, body temperature ≥38.3℃ multiple times, after ≥1 week of complete medical history inquiry, physical examination and routine laboratory tests still not confirmed the diagnosis^[1]and excluding human immunodeficiency virus (HIV) infection or concomitant other immunodeficiency diseases. FUO is not uncommon in the clinical practice of physicians and is extremely clinically challenging.

Helicobacter pylori (Helicobacter pyloriHp) is a microaerobic, spiral pathogenic bacterium that colonizes the gastric mucosa. Patients with Hp infection are difficult to heal themselves, and if not treated, they can become infected for life. A large number of studies have shown that Hp infection is closely related to the pathogenesis of chronic gastritis, peptic ulcer, gastric mucosa-associated lymphoid tissue lymphoma and gastric cancer^[1]。 In 1994, the WHO classified Hp as a Class I carcinogen. Eradication of Hp can significantly reduce gastric mucosal inflammation, promote ulcer healing and prevent gastric cancer. The "Kyoto Global Consensus Report on Helicobacter Pylori Gastritis" defines Hp gastritis as an infectious (infectious) disease. Unless there are counterbalancing factors, Hp should be eradicated in those who are positive for Hp^[2]。

Intragastric ulcerative lesion is a common clinical disease of digestive tract. It refers to the localized defect and ulceration of the surface tissue of gastric mucosa. The shallow ones only involve the muscular layer of mucosa, and the deeper ones can reach the muscular layer or serosa layer^[1,2,3]。 A variety of gastric diseases can be manifested as ulcers under endoscopy, such as peptic ulcer, gastric cancer, lymphoma, gastric stromal tumor with ulcer manifestations, etc. Understanding the characteristics and morphological changes of such diseases is helpful to improve the diagnosis and treatment level of clinicians, especially for the differentiation of benign and malignant ulcers, which is conducive to the early selection of appropriate treatment plans. The progress of clinical diagnosis and treatment of major gastric ulcerative diseases is reviewed.