2016年 · 第96卷第44期

In recent years, the contradiction between doctors and patients has been deepening. Violent incidents occur frequently, which infringe on the personal rights of doctors, reduce the sense of security of doctors in their practice, and seriously disrupt the medical order. In 2012, Tianjin Wang Yingsheng's case of killing a doctor due to suspicion of improper treatment and the case of killing a doctor in Wenling in 2013 caused a huge sensation in the society. According to the survey, from 2000 to 2013, there were at least more than 150 cases of violent attacks on doctors revealed by the media, resulting in more than 30 casualties. In 2014, the people's courts at all levels nationwide concluded 155 cases of violence against doctors^[1]。 From January to May 2016, there were eight cases of violent attacks on doctors across the country, and seven of them were sentenced to death^[2]。 In addition, disputes such as abuse and threats by patients against doctors are increasing year by year, with 96 percent of the total number of hospitals in the country having experienced patient-doctor disputes resulting in minor violence by 2012. (Figure 1)。

amyloidosis is a group of diseases in which amyloid is deposited in the extracellular matrix, causing tissue and organ damage at the deposition site. It can involve a variety of organs and tissues including kidney, heart, liver, skin and soft tissues, peripheral nerves, lungs, glands, etc. Among them, systemic light chain (AL) amyloidosis is the most common systemic amyloidosis in clinic. With the aging of population and the aggravation of environmental pathogenic factors in China, the incidence of AL type amyloidosis is also showing a trend of increasing year by year^[1]。 The clinical manifestations of these patients are multiple organ involvement, severe disease, rapid progression, difficult treatment and high mortality. At present, there is still a lack of standardized diagnosis and treatment plan for AL amyloidosis in China. In recent years, some guidelines for the diagnosis and treatment of this disease have been published internationally, among which the guidelines for the diagnosis and treatment of AL amyloidosis formulated by the Standards Committee of the British Society of Hematology and the guidelines for the treatment of AL amyloidosis formulated by Mayo Clinic in the United States are the most representative. The Chinese Collaborative Group on Systemic Amyloidosis developed this guideline on the basis of the above international guidelines and combined with domestic clinical practice.

Stress ulcer (SU) is an acute gastric and duodenal mucosal erosion and/or ulcer that occurs in the stress state of the body, such as severe trauma, severe illness or severe psychological disorder, especially in major surgery, shock, extensive burn, intracranial lesions or infection, especially when the liver, lung, kidney and other organs and organs are failed. It can be complicated by gastrointestinal bleeding and perforation, which will worsen the original disease and endanger the life of the patient. It is generally believed that the more serious the primary disease, the higher the incidence of SU^[1]And the more severe the extent. In the case of severe stress such as trauma, shock, severe infection, vital organ failure, acute gastric mucosal erosion and/or ulcer often appear within a few hours to a few days, and the incidence of endoscopy can reach 100%^[2]Therefore, clinically critically ill patients must prevent stress ulcers with drugs.

Community-acquired pneumonia (CAP) is a common lower respiratory tract infection, with an overall mortality rate ranging from 1% to 5%^[1]。 The correct diagnosis and rational treatment of CAP are still the problems that clinicians need to face. Some advances in the diagnosis and treatment of CAP in recent years are summarized as follows.

Helicobacter pylori (Helicobacter pylori, H．pylori) is a spiral, micro-aerobic, gram-negative bacterium parasitic in human gastric mucosa. In 1983, two Australian scholars, Warren and Marsha, first isolated the mucosa from patients with chronic gastritis and duodenal ulcerH.pyloriSince its discovery, it has been a research hotspot in the medical field.H.pyloriAt a time when human infection is extremely common, the Kyoto Consensus hasH.pyloriInfection is defined as an infectious disease that is infected by more than 50% of people worldwideH.pyloriWhere western countriesH.pyloriThe infection rate ranges from 25 to 50 percent, while in developing countries it is even as high as 90 percent^[1]。 Nowadays, numerous studies show that,H.pyloriInfection is closely related to the occurrence and development of some gastrointestinal diseases, including chronic active gastritis, peptic ulcer, gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma (MALT). In 1994, the World Health OrganizationH.pyloriClassified as a class I carcinogen, it is also the only bacterium discovered so far that can cause cancer.H.pyloriThe pathogenic mechanism of infection is very complex, exceptH.pyloriIn addition to its own power device, adhesion characteristics, various virulence factors and host genetic factors causing gastric mucosal injury, there are also relatedH.pyloriThe inflammation caused by infection is related to the immune response. In this paper, the immune cells inH.pyloriThe molecular immunological mechanisms in the pathogenesis of infected gastric mucosa are reviewed.

In the treatment of diabetic patients, hypoglycemia is still a difficult clinical problem and one of the main obstacles to blood sugar control. The American Diabetes Association and the Endocrine Society recommend that diabetic patients should consider the occurrence of hypoglycemia at blood glucose concentrations ≤3.9 mmol/L^[1]。 The body changes caused by hypoglycemia include hypoglycemia symptoms, glucose hormone feedback regulation and cognitive impairment, etc. Among them, hypoglycemia symptoms and hormone feedback regulation occur earlier than cognitive impairment in non-diabetics, and the blood glucose threshold for cognitive impairment is about 2.7~3.1 mmol/L; However, due to repeated hypoglycemia, hypoglycemia symptoms and lower blood sugar threshold regulated by hormone feedback, cognitive impairment in diabetic patients can occur earlier than hypoglycemia symptoms^[2]。 Moreover, hypoglycemia may also lead to behavioral and mood changes. Therefore, deep research on the relationship and mechanism between hypoglycemia and cognitive and behavioral functions in diabetic patients, and early intervention and delay the progression of cognitive and behavioral disorders in patients will help to improve the quality of life of patients, which is also one of the hot research topics at present. This article reviews the research progress of hypoglycemia and impaired cognitive and behavioral functions in diabetic patients.