2015年 · 第95卷第14期

Standardized training of residents is an integral part of clinical medical education. Without standardized training, it is impossible to generally create qualified clinicians. In 2013, 64 years after the founding of the People's Republic of China, China finally officially launched the establishment of a national standardized training system for residents, which provided a fundamental institutional guarantee for cultivating qualified and excellent clinicians.

Since the 21st century, human beings have made great breakthroughs in the basic research of molecules, genes, proteins and other omics. Due to the integration of clinical and scientific research, the connection of microscopic to macroscopic, and the in-depth development of translational medicine, there have been major breakthroughs in cutting-edge technologies such as stem cells, brain science, synthetic biology, ultra-high-resolution in vivo imaging, nano-resolution observation of molecule positioning in cells, and molecular machines, which have achieved epoch-making changes in disease diagnosis^[1]。 In particular, the national economic take-off, the deepening of policies for benefiting the people, the formation of the concept of big health, and the development of evidence-based medicine and translational medicine have shown new ideas, new ideas and new models for the construction of hospital laboratory departments, and provided a rare opportunity for the rapid development of laboratory medicine in China. Looking back on the history of 30 years' development, summarizing experience and analyzing problems is of great significance for speeding up the pace of discipline construction, improving management ability and academic level.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with a high incidence in young women of reproductive age. With the in-depth research on the pathogenesis of SLE and the progress of treatment, the long-term survival of patients has been significantly improved. At present, the 20-year survival rate of SLE patients has reached more than 60%. Therefore, with the prolongation of patients' survival time, fertility has become a clinical problem that clinicians must face. However, due to the characteristics of SLE disease itself, the interaction between hormone levels and changes in immune function during pregnancy occurs, which makes the pregnancy of SLE patients a pathological process. Although the pregnancy outcome of these patients has improved significantly with the improvement of SLE treatment, and the fetal loss rate has dropped from 43% in the 20th century to 17%, the incidence of preterm birth, stillbirth, intrauterine growth retardation, preeclampsia and eclampsia in SLE patients is much higher than that in normal people^[1,2]。 Therefore, strengthening and standardizing the management of this high-risk group and improving the maternal and infant survival rate are not only the actual needs of the majority of SLE patients, but also in line with the purpose of building a harmonious society in China, so it is very necessary. However, there is no large-scale prospective clinical study of pregnancy in SLE patients in China, only some retrospective clinical observations and summaries. Therefore, on the basis of referring to foreign guidelines and recommendations on SLE pregnancy and combining with the actual situation in China, we wrote and published the Perinatal Management Recommendations of Chinese Patients with Systemic Lupus Erythematosus (hereinafter referred to as the Recommendations)^[3]The aim is to strengthen and standardize the pregnancy management of this high-risk group, and through multidisciplinary collaboration, reduce the pregnancy complications of these patients, so that they can successfully complete the pregnancy process, conceive healthy fetuses and enjoy family happiness.

Diabetes mellitus is a clinical syndrome caused by the combination of genetic and environmental factors, with disorder of glucose metabolism and elevated blood glucose as the main manifestations. Absolute or relative deficiency of insulin is the main pathophysiological feature of diabetes mellitus. Related biomarkers that can predict or directly reflect islet beta cell damage will contribute to early intervention in diabetic patients, thereby improving quality of life and prolonging life span. In recent years, international scholars have conducted in-depth research on new indexes that directly reflect pancreatic islet β cell damage on the basis of traditional indexes, and made some progress. Biomarkers for evaluating islet beta cell damage are described below.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease, which is mainly affected by women in reproductive age. With the improvement of SLE diagnosis and treatment, the survival rate of SLE patients has been greatly improved in the past 20 years. According to statistics, the 20-year survival rate of SLE patients has reached more than 60%. Because the fertility itself of female SLE patients does not differ from that of non-SLE women of the same age, marriage and childbirth have become an important clinical problem as the survival time of these patients increases. However, due to the role of sex hormones in the pathogenesis of SLE, patients with SLE will relapse or aggravate during pregnancy. About 1/3 of patients finally terminate their pregnancy by cesarean section, and nearly 1/3 of patients have premature delivery. More than 20% of patients develop eclampsia, and nearly 30% of SLE patients have intrauterine growth retardation (IUGR) in their fetuses.^[1]。 Therefore, the pregnancy of SLE patients is itself a high-risk pregnancy. In addition, more than half of SLE patients will have recurrence or aggravation during pregnancy, endangering the safety of the fetus and pregnant women. The maternal and infant mortality rate of pregnant patients with SLE in China is as high as 8.9%^[2]。 Therefore, it is very important and necessary to standardize the perinatal management of SLE patients to improve the pregnancy success rate and reduce the maternal and infant mortality rate of SLE patients. China Systemic Lupus Erythematosus Research Collaborative Group, based on the relevant research data published internationally and management recommendations, combined with the actual situation in China, formulated this recommendation (Table 1), aiming to strengthen the pregnancy management of SLE patients and improve the pregnancy success rate and maternal and infant survival rate of SLE patients in China.

Transcatheter mitral valve repair is a new type of transcatheter heart valve implantation and repair. Compared with traditional thoracotomy, mitral valve repair and replacement have the advantages of less trauma and quicker recovery^[1]。 It is suitable for elderly patients with high risk of surgery or obvious contraindications for surgery^[2]。 Since 2013, 11 cases have been completed in our hospital. Now, the perioperative anesthesia management of 11 patients is retrospectively summarized, in order to improve the anesthesia management level of such operations.

translational medicine (translational medicine) is a new concept in the health field proposed by the National Institutes of Health (NIH) in 2003. It is a systematic project with patient-centered, clinical problem-oriented, achievement application as the goal and multidisciplinary cross-integration. Scholars at Harvard Medical School proposed in 2005 that "translational medicine is not an isolated idea or idea that can be applied at any time, but an idea that needs everyone's attention, and it should be the basis of a modern understanding of health provision"^[1]While "health supply" is a big concept involving many subjects related to human health^[2]。 For many years, the Chinese Medical Association has been exploring medical continuing education methods suitable for the characteristics of medical profession. In recent years, it has promoted translational medicine practice in all aspects of the development of academic conferences according to this concept, and achieved good results. As one of the methods widely praised by trainees, on-site operation demonstration has played a very good role in promoting and publicizing the development of translational medicine.