2018年 · 第57卷第09期

Critical care medicine is a discipline that studies the characteristics and regularity of the development process of any injury or disease causing the body to die, and treats severe diseases. Severe illness is different from the traditional concept of "disease". The disease can be caused by the corresponding etiology; Severe illness is caused by injury or disease. Severe illness must have its own cause, but the cause here is clearly different from the cause of those diseases. Where does critical care start? Professor Liu Dawei's monograph "Causes and Treatment of Severe Diseases: 'Aim First, Shoot Later'" explains this problem well.

Where does critical care start? It always seems to be brought up intentionally or unintentionally, or often involved in discussions. "Critical care is organ support treatment""ICU just applies some equipment and methods to replace organ functions""As long as it is supported, don't worry about anything else", which sounds like "just shoot first, don't aim". All these are not only deep-seated academic problems, but also subject orientation problems.

With the rapid development of critical care medicine, the mortality rate of critically ill patients is significantly reduced, but the long-term prognosis of ICU patients is not optimistic. Studies have shown that critically ill patients have different degrees of physical and psychological problems after being transferred out of ICU, and their 1-year and 2-year survival rates are much lower than those of discharged patients in general wards^[1]Even family members have related mental and psychological problems, and more than 50% of transferred patients need professional guidance and treatment. A study of acute respiratory distress syndrome (ARDS) found that the mortality rate of patients 1 year after discharge was as high as 42%, much higher than the mortality rate in hospital (24%)^[2]。 About 2/3 of ICU patients have physical function, mental psychology and cognitive function impairment after recovery and discharge, so it is also called post intensive care syndrome (PICS)^[3,4,5,6]It seriously affects the quality of life of patients and greatly increases the burden on families and society. Therefore, paying attention to the long-term prognosis of ICU patients has extremely far-reaching clinical and social significance. Opening a post-ICU outpatient clinic to provide continuous medical services for ICU patients after discharge has become a new focus of critical care medicine!

In the past 10 years or so, nephrology is one of the most rapidly progressing disciplines in clinical medicine. From the birth of the concept of chronic kidney disease (CKD) in 2002 to the introduction of the concept of acute kidney injury in 2004, the understanding of kidney disease has changed with each passing day, and subversive changes have taken place. The medical community is gradually recognizing that kidney disease is a common global public health problem closely related to other clinical disciplines^[1]。 Since then, the epidemiological study of CKD has become a new hot spot in the research of kidney diseases worldwide. In developed countries such as the United States and Canada, a nationwide CKD monitoring network has been established to facilitate comprehensive and real-time monitoring of kidney diseases. The knowledge of the prevalence and disease burden of CKD in China is relatively scarce, and there are few population studies. There is still a lack of a nationwide kidney disease surveillance system and important data related to the disease burden^[2]。 At the same time, compared with other specialties, kidney disease has the characteristics of unbalanced specialty construction and great heterogeneity in diagnosis and treatment, resulting in great patient mobility. It is difficult for traditional research to comprehensively explore the disease characteristics, disease spectrum changes and influencing factors of kidney diseases in China. This requires the concept and technology of health and medical big data to maximize the use of existing multi-source data, improve the efficiency and quality of overall disease diagnosis and treatment, and help the prevention and control of kidney disease burden.

According to the national survey data over the past five years, there are about 50.16 million elderly diabetic patients (≥60 years old) in China. With the increase in the total number of the elderly, this number will be expected to increase. Among the elderly patients, most of them are newly diagnosed, and are associated with a number of risk factors for cardiovascular diseases at the time of initial diagnosis. Those who were with young-onset have a long-term clinical course, and often complicated with diabetic chronic complications and potential organ dysfunctions. Most of the elderly diabetic patients in China are with poor glycemic control. The diabetes-related complications have become one of the major reasons for the senile death. It is well accepted that early diagnosis and reasonable treatment could reduce the occurrence of diabetic complications, and the disability and fatal cardiovascular and cerebrovascular events. Thus, it is recommended, in the consensus, to conduct a comprehensive assessment of the glycemic control, metabolic cardiovascular risk factors, diabetes complications, multiple organ functions of the elderly patients, as well as their intelligence and physical fitness. Personalized control targets on blood glucose, pressure, lipids, uric acid and body weight would be established based on the assessment of each patient and consideration of the balance between benefits and risks in order to achieve the goal of early detection, early diagnosis, early treatment and early target reaching. Moreover, it is also recommended, in the consensus, to focus on the basic treatments (diets, exercises, self-monitoring and management), initiate suitable hypoglycemic drugs with complementary mechanisms when needed, and take into consideration of management of multiple cardiovascular risk factors and drug usage together with the caution of mutual interactions of multiple drugs.

Dengue is the most prevalent and rapidly spreading mosquito-borne viral disease. As a dengue non-endemic country, China has experienced several dengue outbreaks in recent years. However, dengue patients in China displayed distinct clinical characteristics compared to patients in endemic countries. To standardize the diagnosis and treatment of dengue fever, the experts of the Society of Infectious Diseases, Society of Tropical Medicine and Parasitology of Chinese Medical Association, and the Society of Emergency Medicine, China Association of Chinese Medicine have reached this guideline based on guidelines for diagnosis, treatment, prevention and control of dengue (World Health Organization, 2009); guidelines for diagnosis and treatment of dengue (National Health and Family Planning Commission of the People's Republic of China, 2014, Edition 2), health industry standard of the People's Republic of China "diagnosis for dengue fever (WS216-2018)" and systemic reports on dengue. The guideline includes 8 aspects: introduction, terminology, epidemiology and prevention, etiology and pathogenesis, clinical features, diagnosis, treatment and problems to be solved.

February 2018, in the British Medical Journal (BMJ) Published online a review article on "Big Data and Medical Research in China" written by Professor Zhang Luxia and Researcher Wang Haibo of Peking University Health and Medical Big Data Research Center and Academician Zhan Qimin, Executive Vice President of Peking University and Director of Peking University School of Medicine [Zhang L, Wang H, Li Q, et al. Big data and medical research in China. BMJ, 2018, 360: j5910], The current situation of health and medical big data in China and the opportunity of using big data to promote medical research in China are discussed.

1. What are the general principles of non-drug treatment for gout patients?

The diagnosis of infectious fever is an important link in the diagnosis and differential diagnosis of fever. The detection of inflammatory indexes such as white blood cell count (WBC) and biomarkers including C-reactive protein (CRP) and procalcitonin (PCT) are common diagnostic indexes^[1]。 Clinical studies have confirmed that PCT can increase in the early stage of systemic inflammatory response caused by bacterial infection, and its concentration is positively correlated with the severity of infection. It returns to normal after the infection disappears. Therefore, it is of great value for early diagnosis of severe bacterial infection, judging the severity of the disease, prognosis, evaluating anti-infective efficacy and guiding the application of antibacterial drugs. Combined with the specific diagnosis and treatment process of a case of infectious disease, the practical application and value of PCT in the diagnosis and treatment of infectious diseases are discussed.

autoimmune hemolytic anemia (AIHA) is a heterogeneous disease in which autoantibodies mediate the destruction of red blood cells. In recent years, the research on the role of complement in the destruction of red blood cells has been gradually deepened, and it has been confirmed that complement plays an important role in AIHA. The role of complement in the destruction of AIHA erythrocytes and the characteristics of new complement inhibitors are described.

In recent years, intestinal flora has gradually become the research hotspot of gastrointestinal tract and even systemic diseases. The human body and intestinal microecology can be regarded as a super organism. The intestinal flora forms a complex and close connection with the human body in the process of long-term mutual benefit and symbiosis, and participates in the basic physiological processes of human body such as substance metabolism, immune regulation and biological barrier, and plays an important role in inflammatory bowel disease, colorectal cancer and other diseases^[1,2]。 Helicobacter pylori (Helicobacter pylori, Hp) is closely related to gastritis, gastric cancer and other diseases has become a consensus, while the influence of other microorganisms in the stomach on gastric-related diseases and human health has been paid little attention. In recent years, some research results show that the diversity and complexity of gastric microecology far exceed our imagination. Whether gastric microorganisms play a similar role in maintaining human-micro-ecological dynamic balance as other parts of intestinal flora is still unclear.