2018年 · 第57卷第10期

In recent years, artificial intelligence (AI) has been combined with medicine and penetrated into various systemic diseases including neurological diseases, showing great application potential in disease diagnosis and risk prediction. In 2017, the State Council promulgated the "New Generation Artificial Intelligence Development Plan", which raised the development of AI technology to the national strategic level and regarded intelligent medical care as one of the key development directions of AI. In the same year, the world's first "Artificial Intelligence Research Center for Neurological Diseases" was established in Beijing Tiantan Hospital. In this issue, Professor Wang Yongjun and Professor Jing Jing of Beijing Tiantan Hospital wrote a monograph "Current Situation and Prospects of Artificial Intelligence Application in the Field of Neuromedicine", believing that the development of AI technology will provide new solutions to solve the uneven distribution of medical resources and uneven level of doctors in China.

"artificial intelligence (AI)" belongs to the category of computer science, that is, using computer technology to simulate human thinking and learning process, and store knowledge. AI technology can assist in early disease diagnosis by analyzing a large amount of medical data, thus greatly improving doctors' diagnosis efficiency, reducing the misdiagnosis rate, and alleviating the current situation of insufficient medical resources. In recent years, the vigorous development of AI technology has penetrated into various systemic diseases including neurological diseases, and has shown great application potential in disease diagnosis and risk prediction. Studies have shown that AI has reached or even exceeded the average diagnostic level of doctors in diagnosing skin cancer, diabetic retinopathy and fundus lesions, assessing the spread of axillary lymph nodes of breast cancer, and predicting autism in children. In view of this, in 2017, the State Council promulgated the "New Generation Artificial Intelligence Development Plan", which raised the development of AI technology to the national strategic level and regarded intelligent medical care as one of the key development directions of AI.

Since the first case of Alzheimer's disease (AD) was reported, human beings have been exploring the field of cognitive impairment for more than a hundred years. Although there is no effective cure for this stubborn disease, the rapid development of science and technology and the close combination of clinical and basic research results have greatly improved the understanding of this disease, and new diagnostic and therapeutic targets are constantly being sought in clinical practice. Among them, tauopathies are a group of neurodegenerative diseases closely related to cognitive dysfunction that have attracted gradual attention in recent years^[1]。

tumefactive demyelinating lesions (TDLs) of the central nervous system (CNS) are diseases that resemble brain tumors in imaging but are characterized by inflammatory demyelinating changes in pathology. Because the lesions seen in TDLs images are large in size, mostly accompanied by peripheral edema, have a space-occupying effect and are mostly enhanced, and are easily confused with brain tumors, hence the name. It is also known as tumor-like inflammatory demyelinating disease (TIDD) or demyelinating pseudotumor (DPT) and is considered to be a relatively specific immune-mediated inflammatory demyelinating lesion^[1]。 For the diagnosis and treatment of TDLs, there are often many clinical problems, such as: the diagnosis basis is unclear and relatively subjective, which easily leads to simple and blind treatment measures; There is also an excessive fear of patients and their families about surgical minimally invasive brain biopsy techniques due to lack of understanding; There are also cases where there is little or inadequate communication between neurological surgery, imaging department and pathology department. Therefore, the author will make an objective evaluation of the related aspects of the insufficient diagnosis of TDLs, and provide improvement measures and suggestions to improve its correct diagnosis level.

The Chinese Society of Hepatology developed the current guidelines on the management of hepatic encephalopathy (HE) in cirrhosis based on the published evidences and panelists' consensus. The guidelines provided recommendations for the diagnosis and management of hepatic encephalopathy including minimal hepatic encephalopathy (MHE) and overt hepatic encephalopathy (OHE) emphasizing the importance on screening MHE in patients with end-stage liver diseases. The guidelines emphasized that early identification and prompt treatment are essential to improve the prognosis of HE. The principles of treatment mainly consist of eliminating precipitating factors, treating hyperammonemia to improve acute neuropsychiatric abnormalities rapidly, primary and secondary prophylaxis.

To establish the experts consensus on the use of methotrexate in the treatment of rheumatic diseases. A consensus development panel was established. The panel of consensus was composed of 45 experts in rheumatology from the group of Chinese Association of Rheumatology and Immunology Physicians. The consensus development panel developed 7 recommendations, including the clinical status and application principles of methotrexate in the treatment of rheumatoid arthritis, optimal dosage and route, dosage adjustment, monitoring, long-term safety and management in the perioperative period and before/during pregnancy. This consensus was intended to standardize the use of methotrexate in rheumatic diseases and improve the management of rheumatoid arthritis and other rheumatic diseases.

necrotizing autoimmune myopathy (NAM) is a new subtype independent of traditional idiopathic inflammatory myopathies such as polymyositis, dermatomyositis and inclusion body myositis. It was added to the classification of inflammatory myopathies by the European Neuromuscular Center in 2004. The clinical manifestations of NAM were symmetric proximal muscle weakness, increased serum creatine kinase levels, electromyography showed myogenic lesions, and skeletal muscle pathology showed necrosis and regeneration of muscle fibers, no or only a small amount of inflammatory cell infiltration^[1], mostly accompanied by some special biomarkers^[2]It can also be secondary to connective tissue diseases, viral infections, statin use, and tumors. The clinicopathological characteristics, diagnosis and treatment of 2 patients with Sjögren's syndrome (SS) complicated with NAM were reported, and analyzed with relevant literature.

30 Jun 2018, Top International Medical JournalsJAMAPublished a study completed by Professor Wang Yongjun's team at Beijing Tiantan Hospital affiliated to Capital Medical University [Wang Y, Li Z, Zhao X, et al. Effect of a multifaceted quality improvement intervention on hospital personnel adherence to performance measures in patients with acute ischemic stroke in China: a randomized clinical trial. JAMA, 2018, 320 (3): 245-254.]. At the same time that the study was published,JAMAProfessor Michael D. Hill from the University of Calgery, Canada, was invited to write a review^[1]。 The research was completed under the funding of the 12th Five-Year National Science and Technology Support Plan of the Ministry of Science and Technology and the Beijing Municipal Science and Technology Commission. Under the guidance of the National Health Commission, Professor Wang Yongjun led the research team of the National Center for Medical Quality Control to carry out this hospital-based cluster randomized controlled study. This study confirms that multiple interventions can improve the quality of stroke care and is the result of a cluster randomized controlled study of improvement of medical quality in the field of cerebrovascular diseases.

1. Treatment principles of acute gout attack.

Bacteria are the most important and most common pathogenic microorganisms of lung infections. At present, the detection of serum procalcitonin (PCT) has become an important biomarker for the diagnosis of pulmonary infection. In clinical work, dynamic detection of patients' serum PCT level, observation and analysis of its changes can assist in the diagnosis of lung bacterial infection, better assess the severity of the disease, judge the prognosis, and guide the rational application of antibacterial drugs. The value of PCT in the diagnosis and treatment of pulmonary infection was discussed in combination with a clinical case.

The wide application of immunohistochemistry in neuropathological diagnosis and research has greatly improved the detection rate of pathological protein deposition in nerve tissue, and the specific labeling of tau protein has promoted the in-depth study of neurodegenerative diseases caused by abnormal tau protein deposition. At present, these diseases with abnormal phosphorylation of tau protein and defects in its encoding genes are collectively referred to as tauopathies, including Pick disease, progressive supranuclear palsy (PSP), cortical basal ganglia degeneration, argyrogranulosis, neurofibrillary tangle-only dementia (NFT-dementia), and the "globular glial tauopathies" (GGT) proposed in recent years^[1]。

Acute respiratory distress syndrome (ARDS) is a common type of acute respiratory failure in severe patients, and the mortality rate of severe ARDS patients is as high as 40%^[1]。 The mechanical ventilation strategy based on the principle of lung protection is an effective means to improve the prognosis of ARDS patients. However, there are significant differences in ventilable lung volumes in different ARDS patients due to different severity of lung lesions^[2]The tidal volume based on the ideal weight setting is not suitable for every ARDS patient. How to realize individualized tidal volume setting is a clinical problem to be solved urgently. 2015 Amato et al.^[3]Studies have shown that reducing driving pressure (DP) can effectively reduce the mortality of ARDS patients, suggesting that driving pressure-oriented tidal volume setting may improve the prognosis of ARDS patients.