2018年 · 第57卷第04期

Epidemiological surveys show that the prevalence of adult diabetes in China has reached 10.9%, and the number of patients is estimated to be 114 million. Poor blood sugar control is easy to cause many chronic complications such as blindness, renal failure, amputation, myocardial infarction and stroke, which is the main cause of disability and death in diabetic patients. Blood glucose monitoring is an important part of diabetes management. It plays an important role in evaluating patients' blood glucose control, adjusting treatment plans and lifestyle, etc. It has become an indispensable tool in diabetes prevention and control at present. In recent years, blood glucose monitoring technology has developed rapidly, and new technologies have emerged one after another, forming the current clinical comprehensive monitoring system of "point" (self-blood glucose monitoring), "line" (real-time continuous glucose monitoring) and "surface" (glycosylated hemoglobin and glycosylated albumin). However, there are some problems in clinical practice, such as irregular use, inadequate mastery of new technologies, inaccurate mastery of indications and even blind abuse. For this reason, we invited Professor Zhou Jian and Professor Jia Weiping to write a monograph "The Role of Blood Glucose Monitoring Technology in Diabetes Management and Problems Needing Attention" to explain the problems and solutions existing in the clinical application of diabetes monitoring system. Welcome to read.

Diabetes has become the third largest chronic non-communicable disease after cardiovascular diseases and tumors, and the prevalence rate of diabetes in adults in China has reached 10.9%^[1]The number of sick people is estimated at 114 million. Poor blood sugar control is easy to cause many chronic complications such as blindness, renal failure, amputation, myocardial infarction and stroke, which is the main cause of disability and death in diabetic patients. Blood glucose monitoring is an important part of diabetes management. It plays an important role in evaluating patients' blood glucose control, adjusting treatment plans and lifestyle, etc. It has become an indispensable tool in diabetes prevention and control at present. The Diabetes Control and Complications Study (DCCT) found that intensive self-monitoring of blood glucose (SMBG, ≥4 times/d, adjust the treatment plan according to the monitoring results) combined with intensive insulin therapy can delay the occurrence and development of chronic complications in patients with type 1 diabetes compared with once-daily SMBG combined with 1~2 insulin injections^[2]。 Recent studies have also shown that for adult type 1 diabetes patients with glycosylated hemoglobin (HbA1c) ≥7%, if the real-time continuous glucose monitoring (CGM) system is frequently used, it can further reduce the HbA1c level without increasing the risk of hypoglycemia. With the rapid development of blood glucose monitoring technology, new technologies emerge one after another, forming the current clinical comprehensive monitoring system of "point" (SMBG), "line" (CGM) and "surface" [HbA1c, glycosylated albumin (GA)], which greatly promotes the blood glucose management of diabetic patients. However, there are also problems in clinical practice such as irregular use, inaccurate mastery of indications and even blind abuse. Therefore, it is necessary to analyze and summarize the advantages, disadvantages, problems needing attention and future development trends of various blood glucose monitoring methods in clinical application, so as to provide guidance for clinical norms and scientific application.

Recent studies suggest that hypertension is a cardiovascular syndrome with genetic factors and environmental factors acting together and accompanied by metabolic changes. 28.6% of adults in the United States have high blood pressure^[1]In 2012, the prevalence of adult hypertension in China was 25.2%, and the number of patients was 270 million^[2]。 Most of hypertensive patients are essential hypertension (EH), but 15% of adults, 30% of<Secondary hypertension in 40-year-old adults and>50% of children^[3,4,5,6]。 When abnormal hormones secreted by the endocrine metabolic system and dysfunction of regulation occur, it is accompanied by endocrine hypertension caused by related hormones. At least 15 endocrine diseases are known to increase blood pressure, some of which are hypertension that can be cured by surgery or treated with special drugs to achieve blood pressure control^[7]。

Rheumatoid arthritis (RA) is a disabling and teratogenic systemic rheumatism mainly involving the synovial membrane of the joint^[1]Seriously threatens the health of our citizens. It is estimated that the average incidence of RA in China is 0.4%. According to this calculation, there are currently more than 5 million RA patients in China, which is one of the most common diffuse connective tissue diseases. In recent years, with the in-depth understanding of the pathogenesis of RA and the continuous emergence of large-scale high-quality clinical research evidence, it has been proved that early diagnosis and early treatment are the basics of blocking or delaying the destruction of joint structure, preventing the development of joint deformity, and improving the prognosis. "Strict monitoring" and "standard treatment" of the disease are the specific measures and ways to achieve this goal, that is, it is necessary to continuously evaluate the disease activity of RA patients, adjust the treatment plan according to the disease activity, so as to achieve remission or low disease activity of patients, so as to delay or block the progression of the disease, finally avoid joint destruction and deformity, and improve the long-term prognosis of patients. Based on this, many international rheumatology professional academic organizations have successively formulated guidelines for the diagnosis and treatment of RA, which provide guiding suggestions for rheumatologists to implement new treatment concepts and standardize treatment behaviors in clinical practice. In the past 30 years, although China's rheumatology specialty has made great progress, and the Rheumatology Branch of Chinese Medical Association also released the first RA diagnosis and treatment guidelines in 2010, due to obvious shortcomings in the formation methods and research evidence, it can no longer reflect the progress of RA diagnosis and treatment, and it is no longer suitable for the current development level of rheumatology in China. Therefore, the Rheumatology Branch of the Chinese Medical Association formulated the 2018 RA diagnosis and treatment guidelines in my country.

To develop a new evidence-based diagnosis, treatment guideline for rheumatoid arthritis (RA) in China.A multidisciplinary guideline development group was established. The grading of recommendations assessment, development and evaluation (GRADE) system was used to rate the quality of evidence and the strength of recommendations. Recommendations were derived from evidence body, the balance of benefits and harmsand patient's values and preferences.The guideline development group developed 10 recommendations for the diagnosis and treatment of RA. The guideline covered the classification criteria, disease activity monitoring and assessing, antirheumatic drugs (DMARDs) and glucocorticoids with treat-to-target approach of RA.This rheumatoid arthritis guideline was intended to serve as a tool for clinicians and patients for best decisions-making in China.

Example 1The patient was a 42-year-old female. He was admitted to hospital due to "intermittent abdominal distension for 8 years and blood in the stool for 1 day". The patient developed fatigue and abdominal distension 8 years ago, and was diagnosed as "portal hypertension, portal vein thrombosis, splenic vein thrombosis and superior mesenteric vein thrombosis" after relevant examinations. After the patient repeatedly experienced peritoneal effusion, pleural effusion, and intermittent diuretic treatment; Shortness of breath occurred 1 month ago and worsened after activity. Blood in the stool appeared 1 d ago, with a volume of about 1 000 ml, dark red, accompanied by palpitation, sweating, and transient loss of consciousness, and was admitted to the hospital for treatment emergency. Physical examination: Poor mental state, clear consciousness, anemic appearance, pale palpebral conjunctiva, heart rate 130 beats/min, blood pressure 80/50 mmHg (1 mmHg =0.133 kPa), disappearance of auscultation breathing sounds in the lower lobe of the right lung; Abdominal distension, no tenderness in the whole abdomen, no rebound pain and muscle tension, about 6 cm under the spleen and costs, positive mobile voicing, and mild edema of both lower limbs. Auxiliary examination: Blood routine showed 40.75×10 white blood cells⁹/L, red blood cells 5.48×10¹²/L, hemoglobin 126 g/L, platelets 458×10⁹/L; Liver biochemical indexes: albumin 16 g/L, cholinesterase 903 U/L, but no obvious abnormalities were observed; Coagulation routine: prothrombin time (PT) 18.7 s, prothrombin activity (PTA) 49%, fibrinogen 1.55 g/L; No abnormalities were found in hepatitis B, hepatitis C, autoimmunity and other related examinations; Abdominal CT plain scan + three-phase enhanced examination showed: liver cirrhosis, splenomegaly, ascites; Portal hypertension with extensive collateral circulation opening in lower esophagus, gastric wall and abdominal cavity; The main trunk of the portal vein is unclear, and the abnormal enhancement shadow around the running area of the portal vein and the extrahepatic biliary tract is considered. Right pleural effusion with partial atelectasis in the lower lobe of the right lung (Figure 1）。

meningioangiomatosis (MA) is a rare disease occurring in the cranium. Its clinical manifestations and imaging have no obvious characteristics. Pathologically, it is manifested by meningeal epithelial cells or fibroblasts proliferating around small blood vessels in the cortex. MA can be combined with oligodendroglioma, encephalocele, meningioma, etc. MA with meningioma is more common, but MA with meningioma occurring paraventricularly has not been reported at home and abroad, and it is easy to be misdiagnosed or missed clinically. A case of paraventricular MA with meningioma diagnosed and treated in the Department of Neurology of Naval General Hospital is reported as follows.

November 20, 2017,HypertensionA prospective study headed by Professor Li Qifu, Department of Endocrinology, First Affiliated Hospital, Chongqing Medical University, "Comparison of diagnostic value of confirmatory tests for primary hyperaldosteronism" was published online [Song Y, Yang SM, He WW, et al. Confirmatory tests for the diagnosis of primary aldosteronism: a prospective diagnostic accuracy study. Hypertension, 2018, 71 (1): 118-124.]. This is the first diagnostic study in the world to cover three confirmatory tests for primary hyperaldosteronism (primary aldosteronism). This study confirmed the good diagnostic efficiency of captopril test (CCT) for the first time, established the important position of CCT in the diagnosis of primary aldehyde, and put forward better judgment criteria for CCT, which has important guiding significance for clinical practice and guideline formulation of clinicians at home and abroad.

Myocarditis is an inflammatory lesion of the heart muscle. It is common in children and adolescents in clinic, while adult myocarditis is often missed and misdiagnosed. On the one hand, because the prodromal symptoms of patients are often confused with the symptoms of respiratory or digestive tract infection, on the other hand, the cardiac manifestations are very variable, from mild symptoms to rapid heart failure (heart failure), shock and even sudden death, and also need to be distinguished from other heart diseases, so early identification, diagnosis and treatment are challenging. The following combs the ideas and lessons learned about the diagnosis and treatment of adult myocarditis from the diagnosis and treatment process of two patients, and provides help for clinical practice.

Pituitary stem is an important structure that constitutes the hypothalamus-pituitary system and realizes its precise regulation of human endocrine function and maintains homeostasis of internal environment. With the extensive application of sellar magnetic resonance imaging (MRI) and related research, it has been found that pituitary stalk thickening (PST) is one of the important causes of abnormal regulation of hypothalamus-pituitary system. However, due to the special anatomical position of the pituitary stem, the hidden onset of related diseases, the wide etiology and the diverse course of disease, it brings many difficulties and challenges to clinical diagnosis and treatment. The etiology and diagnosis of PST will be described below.

ulcerative colitis (UC) is a chronic inflammatory change of colorectal mucosa and one of the precancerous diseases of colorectal cancer. The intestinal mucosa of patients with colitis-associated colorectal cancer (CAC) mostly shows chronic inflammation ➝ low grade intraepithelial neoplasia (LGD) ➝ high grade intraepithelial neoplasia (HGD) ➝ The evolution of CAC. The inflammatory environment and the molecular changes caused by it play an important role in the development of carcinogenesis. Regular colorectoscopy is helpful for early detection and treatment of dysplasia and early cancer lesions, and is an effective means to reduce the incidence and mortality of CAC. Drug prevention and treatment of CAC also has its application prospect. The number of patients with inflammatory bowel disease in China is increasing year by year, and the course of the disease is gradually increasing, which requires further strengthening the prevention and treatment of CAC. The purpose of this review is to summarize the risk factors, pathological mechanisms and prevention methods related to the occurrence and development of CAC, and to discuss the possible progress in future prevention and treatment.

Inflammation is a set of complex biological responses of tissue cells to various harmful stimuli such as pathogens, damaged cells and irritants. Various cells and cytokines participate in various stages of inflammatory response, aiming at removing pathogenic microorganisms and necrotic tissues and realizing the repair of damaged tissues. midkine (MK) is a heparin-binding growth factor, which is significantly elevated in a variety of inflammatory diseases and plays a wide role in the development of inflammation, including promoting leukocyte recruitment, T cell activation, B cell proliferation and neovascularization, etc., and has bactericidal activity. The function and mechanism of MK in the development of inflammation are reviewed as follows, and it is prospected as a target of anti-inflammatory therapy.