2018年·第98卷第42期

Natural fructose is found in ripe fruits, honey and a small amount of vegetables such as carrots, onions, sweet potatoes and chili powder. In addition, sucrose, which is ubiquitous in plants, is also broken down and converted into fructose. Fructose is the main component in human food, which is mainly metabolized by the liver. After metabolism, it becomes the substrate of glycolysis or gluconeogenesis. Since fructose does not increase fasting blood glucose levels and does not require insulin metabolism, intravenous administration is effective in ameliorating diabetic ketosis. Fructose syrup has entered the food industry in large quantities as a substitute for sugar since the 1960s, resulting in a large increase in fructose intake per capita, that is, a high fructose diet. However, subsequent studies found that a high fructose diet can increase the levels of plasma triacylglycerides, free fatty acids, uric acid, etc., and induce heart, brain, kidney and vascular diseases. Recent studies have revealed that metabolic syndrome induced by high fructose diet may be related to abnormal intestinal microecology, disruption of intestinal barrier and inflammatory response of the body. To this end, this article will focus on the interaction of fructose with intestinal microecology and its impact on chronic kidney disease (CKD).

Protein-energy wasting (PEW) has been shown to be a strong predictor of poor prognosis in maintenance hemodialysis (MHD) patients. PEW is present in 18% to 48% of patients with chronic kidney disease (CKD), and this proportion can be as high as 75% of patients with MHD, and it is closely related to dialysis-related complications and high mortality^[1]。 Therefore, it is important to attach importance to the assessment of protein energy consumption for the therapeutic goals and clinical prognosis of dialysis patients.

stress ulcer (SU) refers to acute gastrointestinal mucosal erosion, ulcer and other lesions that occur under various stress states such as severe trauma, critical illness or severe mental illness. In severe cases, it can be complicated by gastrointestinal bleeding or even perforation, which can aggravate and worsen the original disease and increase the mortality rate. Therefore, prevention of SU is a link that cannot be ignored in the treatment of critically ill patients. SU can be manifested as acute gastric mucosal lesions, acute erosive gastritis, acute hemorrhagic gastritis, peptic ulcer, etc. under endoscopy.

bone marrow failure (BMF) is a group of diseases mainly caused by hematopoietic stem/progenitor cell damage. Its clinical manifestations are complex and diverse, including hereditary and acquired. Acquired bone marrow failure diseases mainly include myelodysplastic syndrome (MDS), aplastic anemia (AA), pure red blood cell aplasia (PRCA), paroxysmal nocturnal hemoglobinuria (PNH), large granular lymphocytic leukemia (LGL) and primary myelofibrosis (PMF), etc., which together show progressive and persistent bone marrow failure, and most patients will develop refractory anemia. This consensus focuses on the therapeutic application of recombinant human erythropoietin (rHu EPO) in acquired bone marrow failure diseases.

A 44-year-old female was admitted to the hospital on December 9, 2017 due to "hearing loss in both ears, pus discharge for more than 1 month, fever, cough and expectoration for more than 20 days". In mid-October 2017, he complained of hearing loss, headache, fever in his right ear, body temperature of 38.5 ℃, accompanied by chills, chills, cough, cough of yellow purulent phlegm, phlegm is not easy to cough up, smelly, and then pus appeared in both ears, which was yellow-green pus, viscous, not much, accompanied by pain, no discomfort such as hemoptysis, night sweats, chest tightness, chest pain, etc., and was hospitalized in the Department of Otolaryngology of the local people's hospital.⁹Neutrophils 0.850/L. C-reactive protein>200 mg/L, purulent secretion culture of left ear: Pseudomonas aeruginosa, chest CT examination considering infection of both lungs and multiple abscess formation; Nasopharyngeal magnetic resonance: (1) nasopharyngeal mass, it is recommended to enhance scanning for further examination; (2) bilateral otomastoiditis; (3) Thickening of nasal mucosa of ethmoid sinus and effusion of sphenoid sinus. The pathology of nasopharyngeal biopsy showed chronic inflammation of the nasal mucosa. After administration of piperacillin, sulbactam and metronidazole against infection, the body temperature fluctuated in 38.5~39℃, cough and sputum increased, cough was accompanied by chest tightness and shortness of breath when it was severe, cough was more yellow-green thick purulent sputum with a foul smell, the amount was about 150~250 ml/d, and it was found that the frontal lines on the left forehead were reduced, the eyelids were difficult to close, the corners of the mouth were skewed to the right, the speech was vague, eating or drinking water was easy to leak out, the sputum cultured Pseudomonas aeruginosa and Candida albicans, and no acid-fast bacilli were found. Meropenem combined with diflucon was given for anti-infective treatment, but the symptoms were not improved. Reexamination of chest CT showed that the lesions of both lungs progressed compared with before. The patient went to the First Affiliated Hospital of Guangxi Medical University for further diagnosis and treatment, and was admitted to the Department of Respiratory Medicine with "multiple abscesses in both lungs". Since the onset of the disease, the body mass has decreased by about 3 kg. Past physical health, denying the history of infectious diseases and tobacco and alcohol addiction.

A 37-year-old male developed cough and sputum with chest tightness without obvious trigger 2 months ago. The cough was paroxysmal, and the sputum was mostly yellow sputum, but the amount was not much. The sputum appeared intermittently with blood, but the amount was not much, and the color was bright red, occasionally dark red. The symptoms of chest tightness were mild, aggravated after activity, and relieved after rest. After repeated symptomatic treatment such as anti-infection and cough relief outside the hospital for 2 months, the symptoms were not significantly relieved. In the past, he underwent resection of right inguinal schwannoma in the Fourth Hospital of Jilin University 15 years ago, and resection of posterior bladder schwannoma in China Medical University 5 years ago. There was no family history of neurofibroma or schwannoma. The patient drank alcohol intermittently for 15 years, about 2 times/week, 250 g/time; Denial of smoking history.

In recent years, a large number of studies have found that malnutrition is an important reason that affects the long-term survival rate and quality of life of patients with chronic kidney disease. In 2008, the International Society for Renal Nutrition and Metabolism proposed a new concept, "protein energy wasting", to reflect the nutritional status of patients with chronic kidney disease. Protein energy consumption refers to the state of nutritional deficiency in patients with chronic kidney disease due to insufficient intake, increased body demand or additional loss of nutrition, resulting in protein and/or energy failing to meet the body's metabolic demand.

Maliasis is a class of zoonotic infectious diseases caused by Burholderia mallei (Bp). Southeast Asia, centered in Thailand, and northern Australia are the two major endemic areas. In tropical developing countries, melioidosis is a potential emerging infectious disease. Southern China is considered to be a high endemic area of melioidosis. Due to the convenience of transportation, the development of tourism and other factors, melioidosis has been reported in other provinces in China. Malix is known as "like hundreds of diseases", and it is very similar to tuberculosis in clinical manifestations, pathology and imaging features, especially when pulmonary infection is very similar to pulmonary tuberculosis. It is difficult to correctly diagnose malx in areas with high incidence of tuberculosis; Nervous system infection can be misdiagnosed as malignant tumor^[1]； Skin and soft tissue infections are also easily misdiagnosed as Staphylococcus aureus infections, so gangrene is often missed, thus delaying the opportunity of treatment. In addition, Bp is naturally resistant to a variety of antibiotics such as penicillin, ampicillin, first and second generation cephalosporins, macrolides, aminoglycosides, polymyxin, etc. Although quinolone antibiotics have slight antibacterial activity in vitro, the treatment failure rate is high, so the types of drugs selected for the treatment of mallei are limited. At present, the reference standard for domestic drug susceptibility test is the American Clinical and Laboratory Standards Committee (CLSI). In this standard, the only antibiotics for Bp are amoxicillin/clavulanic acid, ceftazidime, imipenem, doxycycline, tetracycline and compound sulfamethylazole^[2]。 Moreover, the mortality rate of human infected with rhinoid varies from 30% to 80%, and even if it is effectively controlled, rhinoid has a high recurrence rate^[3]In order to avoid recurrence, a long course of treatment is required. The clinical and laboratory research progress of mallex is summarized as follows.