2018年 · 第57卷第12期

The number of dementia patients among people aged 60 and over in my country ranks first in the world, accounting for 1/4 of the world, of which Alzheimer's disease accounts for about 75%. However, at present, there is no Chinese standard for the diagnosis of dementia. The adoption of international standards is affected by factors such as different language and cultural environment, inconsistent biomarker detection technology and unbalanced allocation of medical resources, which leads to low diagnosis rate, high missed diagnosis rate and low acceptance of standardized treatment in China. The diagnosis and treatment level is seriously lagging behind that of western developed countries. It is very necessary to establish a standardized system for dementia screening and diagnosis in China. China's academic groups have successively formulated guidelines or consensus for the screening and diagnosis of dementia, which has gradually improved the effectiveness of dementia screening. However, there are few guidelines and consensus with independent intellectual property rights that reflect the characteristics of Chinese language and culture and are compatible with China's clinical environment. From the application point of view, diagnostic guidelines usually provide general principles of practice, screening protocols usually provide specific conditions of practice, and the "framework" is in between. It is the product of combining principled diagnostic guidelines with operational localized screening protocols, and it is an innovative practice guidance mode to solve the demand of clinical screening in China. It is not only highly applicable, but also easy to use. This issue published the "Dementia Screening and Assessment Framework for Chinese Population" formulated by Alzheimer's Disease Branch of China Geriatric Health Care Association, and specially appointed Professor Wang Luning of PLA General Hospital to write a monograph "Establishing a Standardized System for Dementia Screening and Diagnosis Suitable for China's Clinical Environment", hoping to provide Chinese solutions for dementia screening and diagnosis. The screening and diagnosis framework for Alzheimer's disease and vascular dementia will be published one after another.

The number of dementia patients among people aged 60 and above in my country ranks first in the world, accounting for 1/4 of the world, of which Alzheimer's disease (AD) accounts for about 75%, and the number of patients is the total number of dementia patients in European countries^[1,2]。 However, there is no Chinese standard for the diagnosis of dementia, and the adoption of international standards is affected by factors such as different language and cultural environment, inconsistent biomarker detection technology and unbalanced allocation of medical resources. The low diagnosis rate, high missed diagnosis rate and low standardized treatment rate of dementia in China make the level of dementia diagnosis and treatment in China lags behind that of high-income countries such as the United States, Britain and the Netherlands^[3,4,5,6,7]。 Therefore, it is necessary to establish a standardized system for dementia screening and diagnosis in China to standardize the diagnosis and treatment behavior of dementia in China and improve the diagnosis rate and accuracy level.

(AIDS) is an important public health problem in China. In 2005, the first edition of the guidelines for the diagnosis and treatment of AIDS was formulated by the AIDS Professional Group of Society of Infectious Diseases of Chinese Medical Association, which was updated twice in 2011 and 2015. The fourth edition of the guidelines in 2018 is revised on the basis of national clinical practice and the latest research studies. The new research progress in opportunistic infections and human immunodeficency virus(HIV) associated cancers, antiretroviral therapy, HIV post-exposure prophylaxis, and prevention of mother to child transmission were updated in these guidelines. In the 2018 edition, pre-exposure prophylaxis is mentioned for the first time. The strategy of whole course management of HIV infection is put forward in the current version, which needs the participation of multidisciplinary team in prophylaxis, early diagnosis, individualized treatment and humanistic care.

The prevalence of diabetes in China was 10.4%, and the rates of awareness, treatment and glycemic control of diabetes in China were 38.6%, 35.6% and 33.0%, respectively. There are rigorous challenges existing in terms of diabetes prevention and glycemic control, especially in primary medical care. Under the guidance of National Health Commission of the People's Republic of China and Chinese Medical Association, National Office for Primary Diabetes Care has developed this guideline to improve the ability of primary health facilities and provide standardized basic public health and medical services thoughout the country. The guideline is applicable to healthcare providers in primary care for type 2 diabetic patients over 18 years of age. The main contents include basic requirements for management, workflow of health management, diagnosis, treatment, identification and management of diabetic acute complications and chronic complications, referral, and long-term follow-up.

There are no standard diagnostic criteria for Alzheimer′s disease (AD) in China. The copied international criteria has led to a high rate of missed diagnosis due to issues such as translation and cultural discrepancy. Under the principles of semantic equivalence, content equivalence and performance equivalence, the research group of Alzheimer′s Disease Chinese (ADC) adopted several effective methods, such as two-way translation, content conversion, performance evaluation, etc. to systematically study the cognitive, behavioral, functional, and general assessment techniques in dementia screening and diagnosis, as well as their screening thresholds and diagnostic values. We also established a dementia screening and assessment framework in clinical practice through systematic reviews and group consensus. It has improved the early diagnosis rate of dementia in China, been accepted by home and abroad academic institutions, which is of great significance for early diagnosis and treatment of dementia.

October 2017EBioMedicineThe journal published the study "Non-invasive early warning effect of relative abundance of faecal symbiotic clostridium on early and advanced colorectal tumors: an exploration and validation cohort-based study" led by Professor Fang Jingyuan, Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine^[1]。 This study is based on a multi-center clinical cohort study, from which it explored and verified the role of the relative abundance of fecal symbiotic Clostridium (Cs) in the non-invasive early warning of early and advanced colorectal cancer, and combined with the relative abundance of fecal nucleated Fusobacterium (Fn) and fecal occult blood test (FIT) and other indicators to establish a comprehensive model, and verified that the model has stronger early warning efficacy than the existing FIT and serum carcinoembryonic antigen (CEA).

1. What are the common complications and concomitant diseases of gout?

diabetic foot (DF) has a high disability and mortality rate, which is one of the main reasons for hospitalization of diabetic patients^[1]。 In China, the annual incidence of diabetic foot is as high as 8.1%^[2]。 Current multidisciplinary collaboration is advocated for the treatment of diabetic foot^[3]However, the number of diabetic foot diagnosis and treatment centers with multidisciplinary collaborative diagnosis and treatment in China is limited, which is far from meeting so many diabetic foot patients; The diagnosis and treatment of diabetic foot has the advantages of visualization (such as the size and depth of foot ulcer wound, whether it is infected, X-ray manifestations of bone tissue infection, and angiography of vascular lesions), objective examination data (such as blood sugar, blood lipid, blood pressure, liver and kidney function, nutritional indicators), and real-time operation guidance in different places. Therefore, the status of telemedicine is particularly important in the policy environment of implementing graded diagnosis and treatment and two-way referral of chronic diseases in China. The following is a brief review of the application of telemedicine in the diagnosis and treatment of diabetic foot.

Osteomalacia is a mineralization disorder. Because the skeletal matrix cannot mineralize properly, it leads to pseudo-fractures, fractures and skeletal deformities. Hypophosphatous osteomalacia is a more common clinical type, characterized by excessive phosphorus excretion from the kidneys and decreased blood phosphorus, resulting in the inability of bone to mineralize normally. There are many causes leading to hypophosphate osteomalacia, which can be divided into hereditary, neoplastic and acquired^[1]。 At present, it has been clarified that hereditary or neoplastic hypophosphate osteomalacia has a common abnormality of fibroblast growth factor 23 (FGF23) -dependent pathway, that is, reduced degradation of FGF23 or excessive secretion of FGF23, resulting in excessive blood FGF23 levels, inhibition of 1-alpha hydroxylase and sodium-phosphate co-transporter activities, resulting in excessive urinary phosphorus excretion, presenting hypophosphatemia and osteomalacia. Acquired hypophosphatous osteomalacia refers to certain diseases or drugs. The former is the most common cause of renal tubular damage caused by autoimmune diseases such as Sjogren's syndrome; The latter refers to the occurrence of renal tubular acidosis, Fanconi syndrome, hypophosphatemia, etc. after long-term use of some drugs, and osteomalacia occurs over time. One of the more common clinical drugs that cause osteomalacia is adefovir dipivoxil against hepatitis B virus (hereinafter referred to as hepatitis B) virus. Now, the serious adverse reactions such as renal tubular damage and hypophosphatemia osteomalacia caused by this drug, as well as the mechanism and management of the occurrence, are described, aiming to attract the attention of clinicians.

Anti-melanoma differentiation-associated gene 5 (MDA5) antibody is a myositis-specific antibody discovered in recent years, which is more common in patients with dermatomyositis (DM). Interstitial lung disease (ILD) is a common pulmonary manifestation of DM. Recent studies have shown that serum anti-MDA5 antibodies are closely related to DM-related ILD. In order to improve the understanding and diagnosis and treatment level of anti-MDA5 antibody-positive DM patients, the progress of related diagnosis and treatment of this disease is summarized as follows.