中国抗癌协会神经内分泌肿瘤诊治指南（2022年版）

神经内分泌肿瘤（neuroendocrine neoplasm,NEN）是一类起源于肽能神经元和神经内分泌细胞,具有神经内分泌分化并表达神经内分泌标志物的少见肿瘤,可发生于全身各处,以肺及胃肠胰NEN（gastroenteropancreatic neuroendocrine neoplasm, GEP-NEN）最常见。国内外研究数据均提示,NEN的发病率在不断上升。美国流行病学调查结果显示,与其他类型肿瘤相比,NEN的发病率上升趋势更为显著。中国抗癌协会神经内分泌肿瘤专委会在现有循证医学证据基础上,结合已有国内外指南和共识,制订了首版中国抗癌协会神经内分泌肿瘤诊治指南,为临床工作者提供参考。     

Consensus recommendations on altered sensory functioning in Phelan-McDermid syndrome

Altered sensory functioning is often observed in individuals with SHANK3 related Phelan-McDermid syndrome (PMS). Compared to typically developing individuals and individuals with an autism spectrum disorder, it has been suggested that there are distinctive features of sensory functioning in PMS. More hyporeactivity symptoms and less hyperreactivity and sensory seeking behaviour are seen, particularly in the auditory domain. Hypersensitivity to touch, possible overheating or turning red easily and reduced pain response are often seen.In this paper the current literature on sensory functioning in PMS is reviewed and recommendations for caregivers, based on consensus within the European PMS consortium, are given.     

Threshold and non-threshold chemical carcinogens: A survey of the present regulatory landscape

For the proper regulation of a carcinogenic material it is necessary to fully understand its mode of action, and in particular whether it demonstrates a threshold of effect. This paper explores our present understanding of carcinogenicity and the mechanisms underlying the carcinogenic response. The concepts of genotoxic and non-genotoxic and threshold and non-threshold carcinogens are fully described. We provide summary tables of the types of cancer considered to be associated with exposure to a number of carcinogens and the available evidence relating to whether carcinogenicity occurs through a threshold or non-threshold mechanism. In light of these observations we consider how different regulatory bodies approach the question of chemical carcinogenesis, looking in particular at the definitions and methodologies used to derive Occupational Exposure Levels (OELs) for carcinogens. We conclude that unless proper differentiation is made between threshold and non-threshold carcinogens, inappropriate risk management measures may be put in place - and lead also to difficulties in translating carcinogenicity research findings into appropriate health policies. We recommend that clear differentiation between threshold and non-threshold carcinogens should be made by all expert groups and regulatory bodies dealing with carcinogen classification and risk assessment.     

Do Poison Center Guidelines Adversely Affect Patient Outcomes as Triage Referral Values Increase?

Abstract

Background.?The purpose of this study was to determine whether patient outcomes were adversely affected as healthcare referral values increased for two common poisonings: acute, unintentional acetaminophen (APAP) poisonings and acute, unintentional iron (Fe) poisonings. We hypothesized that symptom rates would increase with high referral values. Methods.?Qualifying 1997 exposures were separated by substance (APAP or Fe) and then further stratified into three healthcare referral value ranges. Symptomatic and asymptomatic patients were totaled for each stratum. Expected vs. observed distributions of symptomatic and asymptomatic patients across triage referral strata for a given substance and treatment location were compared using chi‐square test for independence. The Wilcoxon–Mann–Whitney test was used to compare the distribution of patients across referral strata for home vs. healthcare facility locations for a specific substance. Results.?There were no statistically significant differences in the distribution of symptomatic patients within referral value strata for APAP or for Fe. There was also no difference in distribution of symptomatic patients across strata when comparing home vs. healthcare facility for APAP and Fe. Conclusion.?Referral values as high as 201 mg/kg for APAP and 61 mg/kg for Fe do not appear to adversely affect patient outcomes.     

基于全科医生视角的《2020年美国风湿病学会痛风治疗指南》解读

近年来，国内外痛风治疗指南不断更新，使痛风诊治逐渐变得规范。随着《2020年美国风湿病学会痛风治疗指南》的公布，一些模糊的概念越来越清晰。痛风作为一种常见病、多发病，全科医生在痛风的治疗中起着至关重要的作用。本文将从全科医生的角度论述《2020年美国风湿病学会痛风治疗指南》，并与我国最新版痛风治疗指南进行对比，为全科医生诊治痛风提供参考建议。     

Refractory ceramic fiber (RCF) toxicity and epidemiology: A review

This paper provides a review of the relevant literature on refractory ceramic fibers (RCFs), summarizing relevant data and information on the manufacture, processing, applications, potential occupational exposure, toxicology, epidemiology, risk analysis, and risk management. RCFs are amorphous fibers used for high-temperature insulation applications. RCFs are less durable/biopersistent than amphibole asbestos, but more durable/biopersistent than many other synthetic vitreous fibers (SVFs). Moreover, as produced/used, some RCFs are respirable. Toxicology studies with rodents using various exposure methods have shown that RCFs can cause fibrosis, lung cancer, and mesothelioma. Interpretation of these animal studies is difficult for various reasons (e.g., overload in chronic inhalation bioassays). Epidemiological studies of occupationally exposed cohorts in Europe and the United States have demonstrated measurable effects (e.g., mild respiratory symptoms and pleural plaques) but no disease (i.e., no interstitial fibrosis, no excess lung cancer, and no mesothelioma) to date. The RCF industry, working cooperatively with various government agencies in the United States, has developed a comprehensive product stewardship program (PSP) to identify and control risks associated with occupational exposure. One provision of the PSP is the adoption of a voluntary recommended exposure guideline (REG) of 0.5 fibers/milliliter (f/ml). Selected on the basis of prudence and demonstrated feasibility, compliance with the REG should reduce risks to levels between 0.073/1000 and 1.2/1000, based on extrapolations from chronic animal inhalation studies.     

围手术期低氧血症患者的无创呼吸支持治疗:欧洲麻醉学会与欧洲重症监护医学会联合指南解读

低氧血症是外科患者术后常见并发症,严重者可危及患者生命。氧疗是处理低氧血症患者最常用且有效的方法,鉴于常规氧疗(conventional oxygen therapy,COT)并不能有效预防低氧血症,故应提倡更有效的无创呼吸支持治疗以防治围手术期低氧血症,但相关规范并不完善。近期,欧洲麻醉学会(European Society of Anaesthesiology,ESA)与欧洲重症监护医学会(European Society of Intensive Care Medicine,ESICM)联合发布《围手术期低氧血症患者无创呼吸支持治疗的ESA/ESICM联合指南》,涵盖五大临床问题,并对COT、经鼻高流量氧疗(high flow nasal cannula,HFNC)、无创正压通气(noninvasive positive pressure ventilation,NIPPV)和持续气道正压(continuous positive airway pressure,CPAP)的有效性进行比较和推荐,共给出19条具体建议。该指南对指导临床正确选用无创呼吸支持治疗提供了重要依据,对有效治疗围手术期低氧血症具有重要意义。临床医师也应及早识别围手术期低氧血症的高危患者,术中积极实践肺保护性通气策略,以降低患者肺部并发症风险,从而预防围手术期低氧血症。     

中国脑血管病影像应用指南2019

影像技术在脑血管病诊疗和研究中的重要地位不言而喻。2016年中华医学会神经病学分会及其脑血管病学组发布了中国脑血管病影像应用指南。由于影像技术的迅猛发展以及临床应用的循证医学证据的不断涌现,旧版已经不能满足临床需要。在2019新版指南中,我们对大家已熟悉的应用领域进行了精简,重点介绍了CT和MRI应用的新领域以及一些新技术及其后处理的新方法,如脑出血血肿早期扩大的平扫CT征、高分辨血管壁MRI的应用、定量磁化率成像、血流动力学成像技术等,为临床和科研的应用提供有用的工具。