Clinical Focus

The year in clinical cardiology 2017

Cui Wei， Liu Demin， Geng Xue

2018, 33(1): 1-10. doi:10.3969/j.issn.1004-583X.2018.01.001

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A lot of advances in both clinical cardiology and basic research were seen in the year 2017， especially in hypertension， heart failure， coronary artery disease， lipid lowering， and cardiac arrhythmias. This review focuses on the target of hypertension control， drug treatment of chronic heart failure and coronary artery disease， novel lipidlowering drugs， and device treatment for cardiac arrhythmias.

Advances on cerebrovascular disease researches in 2017

Chen Junmin， Shang Wenyan， Li Yao， Wang Xiayue， Liu Xiaoxia， Wang Huijuan， Zhang Xiangjian

2018, 33(1): 11-15. doi:10.3969/j.issn.1004-583X.2018.01.002

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Significant progress has been made in the clinical researches on cerebrovascular diseases in 2017. The article reviews the treatment of acute ischemic stroke， such as thrombolytic drugs， antiplatelet drugs， anticoagulationdrugs，endovascular therapy， and neural stem cell therapy.

Major advances in respiratory diseases during 2017

Yuan Boyun， Gong Xiaowei， Yuan Yadong

2018, 33(1): 16-22. doi:10.3969/j.issn.1004-583X.2018.01.003

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In 2017， domestic and foreign scholars have given a thorough investigation into the fields of both clinical and basic research in the respiratory system disease， which not only updated the relevant guide， but also reached consensus in the issues and some clinical difficult problems. Now we will review the advances in respiratory diseases in 2017.

Clinical advances of digestive diseases in 2017

Wang Dong， Luo Yuxin， Yin Fengrong， Zhang Xiaolan

2018, 33(1): 23-31. doi:10.3969/j.issn.1004-583X.2018.01.004

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In 2017， gastroenterology related guidelines and consenses have been well revised， updated or newly made， covering the maximum variety and updates of the digestive diseases. Clinical consensuses in China provide great convenience to diagnose and treat diseases. This paper will focus on Helicobacter pylori gastritis， gastroesophageal reflux disease， Barrett’s esophagus， inflammatory bowel disease， virus hepatitis， autoimmune liver disease and pancreatic disease. We review the diagnosis and treatment of digestive diseases for gastroenterologists by summarizing the advances of above diseases.

Major research advances in chronic kidney disease of 2017

Xu Jinsheng， He Lei， Zhang Shenglei

2018, 33(1): 32-39. doi:10.3969/j.issn.1004-583X.2018.01.005

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In 2017， a great number of important basic and clinical studies have emerged in the domestic and international nephrology community， making kidney disease better able to be prevented， diagnozed and treated. In particular， a series of guidelines and expert consensus were published or updated， so better regulated the diagnosis and treatment of clinical physicians in the nephrology department， and benefited the patients with kidney disease. Major research progresses and guidelines on chronic kidney disease at domestic and abroad in 2017 were summarized.

Clinical advances on neoplastic haematologic disorders in 2017

Ren Jinhai， Guo Xiaonan

2018, 33(1): 40-45. doi:10.3969/j.issn.1004-583X.2018.01.006

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The year 2017 experiences much progress in the diagnosis and treatment of haematologic malignancies， which is mainly reflected in the further study of molecular markers and more applications in accurate diagnosis and risk stratification. More molecular targeted drugs are used in clinical treatment， and good effects are obtained. Immunotherapy， especially chimeric antigen receptor T cell immunotherapy produced significant effect in the treatment of refractory relapse B cell malignant tumor.

Clinical advances in endocrine and metabolic disease in 2017

Wang Mian， Zhang Lihui， Su Shengou

2018, 33(1): 46-53. doi:10.3969/j.issn.1004-583X.2018.01.007

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In 2017， clinical endocrine metabolism achieved a lot of progresses， not only important guides to update， also large clinical trial results， covering multiple endocrine metabolic disease. This review summarized the important contents in diabetes， thyroid， osteoporosis and hyperuricemia.

Major advances in clinical research of rheumatic diseases of 2017

Gao Lixia， Guo Huifang

2018, 33(1): 54-59,65. doi:10.3969/j.issn.1004-583X.2018.01.008

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In 2017， the diagnostic criteria of systemic lupus erythematosus，idiopathic inflammatory myopathies and antineutrophil cytoplasmic antibody associated vasculitis have been renewed. Multiple management guidelines， for example rheumatoid arthritis， Sjogren's syndrome spondyloarthritis and gout etc， have been published and refined. The use of antirheumatic drugs become more and more detailed， and the adverse reaction of glucocorticoid and nonsteroidal antiinflammatory drugs has also aroused great concern. And then， domestic expert consensus have been introduced. The diagnosis and treatment strategy of rheumatic diseases become more and more abundant， and the management methods also become more and more standard.

Clinical advances in infectious diseases in 2017

Liu Xiaomeng， Zhao Caiyan

2018, 33(1): 60-65. doi:10.3969/j.issn.1004-583X.2018.01.009

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Much progress has been made in the field of infectious diseases in 2017. In the area of prevention and treatment of viral hepatitis， WHO has set the overall goal of eliminating viral hepatitis as a major public health threat by 2030. Along with renewing in natural history of HBV infection， definition of functional cure， and new agents for treatment of chronic hepatitis B in 2017， the European Association of Hepatology has updated the hepatitis B guidelines，new antihepatitis C virus drugs have been listed. This article summarizes the latest research results of infectious diseases in 2017.

Risk factors of deep venous thrombosis

Song Weia， Yang Jianpingb， Fang Qingbob，Ge Xiaohub

2018, 33(1): 66-70. doi:10.3969/j.issn.1004-583X.2018.01.010

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Objective To explore the risk factors of the deep venous thrombosis(DVT). Methods A casecontrol study was carried on DVT patients and healthy population in People's Hospital of Xinjiang Uygur Automous Region， the risk factors for the disease were explored through questionnaire and laboratory examination， synthetic analysis was made in the risk factors by logistic regression model. Results Fruit intake(P<0.01)， pregnancy/puerperium(P<0.05)， ATⅢ(P<0.05)， protein C(P<0.05)， Hcy(P<0.05) and folic acid(P<0.05) had statistic difference between two groups. After screening the discovery with multiariable logistic regression analysis， BMI(χ2=5.59，P=0.018，OR=1.082， 95%CI=1.0141.154)， gestation(χ2=9.002， P=0.003， OR=5.038， 95%CI=1.75214.490)， plasma levels of ATⅢ(χ2=54.135，P<0.01，OR=0.937，95%CI=0.9200.953) and Hcy(χ2=20.384，P<0.001，OR=1.084，95%CI=1.0471.122) were independent risk factors for DVT. Conclusion The plasma concentration of ATⅢ and Hcy are closely related with DVT. Fruit intake， pregnancy/puerperium and serum folate concentration are the influence factors of DVT.

Efficacy and safety of intravenous injection of esmololin in treatment of chronic obstructive pulmonary disease with rapid atrial fibrillation

Cui Rong， Cai Shanhua， Li Bing， Liu Guotian， An Shuchang

2018, 33(1): 71-74. doi:10.3969/j.issn.1004-583X.2018.01.011

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Objective To observe the clinical efficacy and safety of intravenous injection of Esmolol in the treatment of chronic obstructive pulmonary disease(COPD) with rapid atrial fibrillation. Methods A total of 25 COPD patients with rapid atrial fibrillation were treated with intravenous injection of esmolol and sequentially with oral betaloc， and 33 cases of the control group were given intravenous injection of amiodarone and sequential oral amiodarone. The therapy effects on arrhythmia， blood pressure， heart rate and arterial blood gas were observed between two groups.Results After the intervention group and control group were intravenously injected with esmolol and amiodarone respectively， the arrhythmia was significantly reduced with the difference of 92% vs 93.9% in the effective rate. Both groups resulted in decreased blood pressure but there were no need to use vasoactive drugs to maintain. For the safety， there were no severe adverse events in the intervention group. In the control group， two patients with amiodarone experienced severe bradycardia (<50 beats/min). There were no notable exacerbations in respiratory failure between two groups.Conclusion Esmolol is safe and effective in the treatment of COPD with rapid atrial fibrillation， which can effectively control the ventricular rate and will not lead to respiratory failure exacerbations.

Efficacy of carvedilol in treatment of dilated cardiomyopathy: a meta analysis

Yang Jing， Li Bin

2018, 33(1): 75-81. doi:10.3969/j.issn.1004-583X.2018.01.012

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Objective To evaluate the efficacy of carvedilol in treatment of dilated cardiomyopathy.Methods The PubMed， the Cochrane Central Register of Controlled Trials（CENTRAL）， Clinical Trials.gov (https://clinicaltrials.gov/)， WanFang Data， CNKI， CBM and VIP database were retrieved to collect randomized controlled trials of carvedilol in the treatment of dilated cardiomyopathy before October 2016. RevMan5.3 software was used to analyze the data. Results A total of 810 patients (9 randomized controlled trials) were included. In the metaanalysis， the left ventricular ejection fraction (MD=8.03，95%CI=6.479.58，P<0.01) was significantly higher in the carvedilol group compared to placebo group， the heart rate (MD=-9.21，95%CI=-11.81-2.40，P<0.003)， left ventricular end diastolic diameter (MD=-7.11， 95%CI=-11.81-2.40，P<0.003) and mortality (OR=0.33， 95%CI=-18.612.85，P=0.15) were significantly lower in the carvedilol group compared to placebo group， systolic blood pressure (MD=-7.88，95%CI=-18.612.85，P=0.15， and diastolic blood pressure (MD=-1.15，95%CI=-5.483.17，P=0.60) were similar between the carvedilol group and placebo group. Conclusion In patients with dilated cardiomyopathy， carvedilol can improve left ventricular ejection fraction， decrease left ventricular end diastolic diameter and improve heart function furthermore. Meanwhile carvedilol can slow down heart rate and reduce mortality， while blood pressure was not significantly affected.However， its impact on mortality still needs further study.

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