2017年 · 第97卷第25期

At present, the prevalence of hyperuricemia in China continues to increase, reaching 8.4% ~13.3%^[1,2], showing a younger trend. The kidney is an important organ of uric acid metabolism in human body. Hyperuricemia is one of the most common complications of chronic kidney disease (CKD). About 90% of patients with hyperuricemia and gout are caused by glomerular filtration and/or renal tubular secretion dysfunction. At the same time, hyperuricemia can aggravate the progression of kidney disease and the occurrence of cardiovascular and cerebrovascular complications, and is an independent risk factor for the occurrence and development of CKD, cardiovascular and cerebrovascular diseases and metabolic diseases. For every 60 μ mol/L (1 mg/dl) increase in blood uric acid, the risk of kidney disease increased by 7% to 11%^[3]14% increased risk of renal function deterioration^[4]。 Blood uric acid levels ≥420 μ mol/L (7.0 mg/dl) in men and ≥360 μ mol/L (6.0 mg/dl) in women increased the risk of developing end-stage kidney disease 4-fold and 9-fold, respectively^[5]。 With the decrease of glomerular filtration rate, the prevalence of hyperuricemia in CKD patients gradually increased, fluctuating from 40% to 70%^[6]； Patients with CKD stages 3 to 5 with hyperuricemia have a higher risk of rapid progression of kidney disease and renal replacement therapy. For every 60 μ mol/L (1 mg/dl) increase in blood uric acid level in patients with CKD stages 3 to 4, the risk of cardiovascular death increased by 16%, while the risk of all-cause death increased by 17%^[6,7]。 Therefore, strengthening and standardizing the diagnosis and treatment of renal disease hyperuricemia is of great significance for delaying the progression and complications of renal disease and improving the prognosis of patients.

With the increasing pressure of competition in modern society, mental pressure has become a new pathogen, and mental illness has become a major public health problem. Anxiety and depression are common among general hospital patients. Foreign studies have found that more than 50% of community medical patients have anxiety, depression or somatization symptoms^[1]The prevalence rate of patients attending general hospitals in China was 16.5% who met any diagnosis of anxiety disorder (anxiety disorder), depressive disorder (depression), anxiety and comorbidity of depression^[2]。 These psychological problems also exist in large numbers in rheumatology patients. In the past, we paid more attention to organic rheumatism that can be accompanied by anxiety and depression. At the same time, anxiety and depression can also cause functional rheumatism symptoms, such as chronic pain, fear of wind and cold, and tingling sensation, and many patients go to rheumatology department for medical treatment only because of such symptoms^[3]。 Because of the lack of awareness of anxiety and depression causing functional rheumatism symptoms in the past, such patients are often missed or misdiagnosed. Therefore, it is very important for rheumatologists to identify functional rheumatism symptoms. On this basis, we should also master the basic treatment methods for functional rheumatism symptoms, which will help to relieve the disease as soon as possible, enhance patients' confidence in diagnosis and treatment, and reduce the possibility of transferring to multiple subjects or even delaying the disease.

With the improvement of people's living standard and the change of lifestyle, the prevalence of hyperuricemia is increasing year by year, which has become an important public health problem in China. kidney disease is an important cause of hyperuricemia, and hyperuricemia is also one of the most common complications of chronic kidney disease (CKD). Hyperuricemia can aggravate the progression of kidney disease and the occurrence of cardiovascular and cerebrovascular complications, and is an independent risk factor for the occurrence and development of CKD, cardiovascular and cerebrovascular diseases and metabolic diseases. At present, there is still a lack of clinical practice guidelines for the diagnosis and treatment of renal disease hyperuricemia in China. To this end, we formulated the Practical Guidelines for the Diagnosis and Treatment of Hyperuricemia in Kidney Diseases in China (2017 Edition) around the epidemiology, pathogenesis, diagnosis, assessment and treatment of hyperuricemia in kidney diseases, so as to guide the more standardized clinical treatment of hyperuricemia in patients with kidney diseases.

Cerebral arteriovenous malformation (AVM) is a vascular disease that often occurs in young adults and often starts with hemorrhage and epilepsy^[1]。 In longitudinal fissure arteriovenous malformation, due to tortuous blood supply arteries, anterior cerebral, pericallosal arteries and marginal callosal arteries participate in blood supply, the risk of cumulative functional blood vessels by interventional embolization is greater, and the technical difficulty is also greater. Longitudinal fissure deformity is located deep in the longitudinal fissure, with limited surgical space and limited visual field. From January 2014 to January 2016, Beijing Chaoyang Hospital and Beijing Tiantan Hospital used different approaches combined with intraoperative real-time ultrasound to treat 6 cases of longitudinal fissure cerebral arteriovenous malformation. The results are reported below.

The patient was a 33-year-old female. There was severe headache with nausea and vomiting for more than 7 days without obvious trigger. The headache was persistent, and there was no limb movement and sensory impairment. He went to a local hospital and got better after giving "mannitol". He came to the First Affiliated Hospital of Zhengzhou University for further treatment. Physical examination: The patient is conscious, poor spirit, poor appetite and poor sleep. Magnetic resonance examination: the left frontotemporal tissue structure and signal were disordered, the local bone showed discontinuity, and a strip of long T was seen under the inner plate of the skull₁Long T₂Signals. The left temporoparietal lobe showed mass-like mixed isotes₁Long T₂Signal, locally visible patchy short T₁Signal (FIG. 1A，FIG. 1B), diffusion-weighted imaging (DWI) (b =1 000 s/m²) The diffusion part was limited and showed obvious high signal, and large patches of long T could be seen around it₁Long T₂In the edema zone, the left lateral ventricle and the third ventricle were narrowed and deviated to the right under compression, the midbrain showed compression changes, the left lateral fissure pool became shallow, and the midline structure of the brain deviated to the right. Patchy long T is visible in bilateral frontal lobes₂Signal shadow, black water image is high signal. After intravenous injection of Gd-DTPA, the left temporoparietal lobe lesions showed obvious irregular wreath-like enhancement, and the enhancement range was 4.1 cm ×3.9 cm ×4.2 cm (anterior-posterior diameter × left-right diameter × superior-inferior diameter) (FIGS. 1C ~ E), linear enhancement was seen adjacent to the dura mater. Preliminary diagnosis: oligodendroglioma. Surgical procedure and pathology: During the operation, the left temporal lobe and temporal pole were gray-white with edema. The temporal pole was removed below the lateral fissure, and there was a mass deep in the lateral fissure of the left temporal lobe. The tumor was cystic, tough in texture, with clear tumor border and abundant blood supply. The size of the removed tumor was 4 cm ×4 cm ×5 cm. Pathology: Microscopically, endothelial cells of different shapes and sizes can be seen to form irregular and mutually anastomotic vascular lumens, and the size and shape of the vascular lumens are also uneven, showing fissures or expanding into sinuses. Immunohistochemical staining: GFAP (Focus +), Oligo-2 (Focus +), S-100 (Focus +), EMA (−), Ki-67 (+20%), CD34 (Focus +), CD31 (+). Pathological diagnosis: angiosarcoma (Figure 2)。

At present, the surgical treatment of lumbar degenerative diseases includes traditional pedicle screw internal fixation and non-fusion interspinous process elastic fixation. Although spinal fusion is the gold standard of lumbar surgical treatment, its complications such as high incidence of adjacent segment degeneration have attracted extensive attention^[1]。 The interspinous process distractor is also not perfect, and problems such as high risk of spinous process fracture and loose implant have also appeared one after another. Aiming at the shortcomings of the existing schemes, a new type of interlaminar dynamic fixation device-Intraspine came into being. This paper summarizes the design concept, biomechanics and clinical research progress of IntraSPINE.

The incidence of delirium in the Department of Critical Care Medicine (ICU) remains high, and the various complications caused by delirium and the increased mortality rate of patients should be paid enough attention by clinicians. Routine ICU delirium monitoring and prevention, early prevention, early detection and early treatment of ICU delirium can not only reduce the incidence of delirium and shorten the duration of delirium, but also effectively improve the clinical prognosis of patients and reduce the social and economic burden. The non-drug and drug-induced preventive measures of delirium in ICU are reviewed and the effective methods to predict delirium are prospected. By predicting the probability of delirium, early intervention measures can be carried out to reduce the incidence of delirium in ICU.

Parkinson's Disease (PD) is a neurological Disease whose incidence rate is second only to Alzheimer's Disease. According to statistics, the incidence rate of PD in the global population reaches 0.3%, while the prevalence rate in the elderly over 60 years old reaches 1%, and the incidence rate in the population over 80 years old reaches 3%^[1,2]。 Parkinson's disease mainly causes movement disorders such as resting tremor, myotonia, bradykinesia and abnormal posture and gait, accompanied by a large number of non-motor symptoms. The prevalence and incidence of Parkinson's disease increased exponentially with the increase of age. With the arrival of aging society, the increase of aging population led to the global prevalence of Parkinson's disease showing an obvious upward trend^[2,3]。 Chen et al.^[4]Studies have shown that patients with Parkinson's disease have a higher risk of falling, and 8 years of follow-up of patients with Parkinson's disease found that the incidence of hip fractures was as high as 10.4%. Meanwhile, Karadsheh et al.^[5]Studies have shown that Parkinson's disease is an independent risk factor for higher 5-year mortality and reoperation rates in patients with femoral neck fractures. Therefore, it is important to understand the risk factors of hip fracture in patients with Parkinson's disease and master the perioperative management.