Oligo-monocytic CMML and other pre-CMML states: Clinical impact,prognostication and management

Chronic myelomonocytic leukemia (CMML) is defined by myelodysplasia, pathologic accumulation of monocytes and a substantial risk to transform to secondary acute myeloid leukemia (sAML). In recent years, minimal diagnostic criteria for classical CMML and CMML-variants were proposed. Moreover, potential pre-stages of CMML and interface conditions have been postulated. Oligomonocytic CMML is a condition where the absolute peripheral blood monocyte count does not reach a diagnostic level but all other criteria for CMML are fulfilled. Among potential pre-stages of CMML, clonal and non-clonal conditions have been described, including idiopathic monocytosis (IMUS) and clonal monocytosis of unknown significance (CMUS). Patients with myelodysplastic syndromes (MDS), clonal cytopenia of unknown significance (CCUS), clonal hematopoiesis of indeterminate potential (CHIP) and idiopathic cytopenia of undetermined significance (ICUS) may also progress to CMML. The current article provides an overview of pre-CMML conditions and oligomonocytic CMML, with special reference to diagnostic criteria, differential diagnoses, clinical outcomes and management.     

《皮肤科学（非肿瘤性皮肤病）中皮肤镜术语和基本参数的标准化：国际皮肤镜协会专家共识》解读

【摘要】 为规范非肿瘤性皮肤病的皮肤镜检查标准，国际皮肤镜协会组织专家制定了《皮肤科学（非肿瘤性皮肤病）中皮肤镜术语和基本参数的标准化：国际皮肤镜协会专家共识》，该共识确定了5个标准化基本参数及31个子项，包括血管（形态和分布）、鳞屑（颜色和分布）、毛囊改变、其他结构（颜色和形态）、特异线索，并总结了它们的曾用名、组织病理学对应关系和主要涉及的疾病。本文通过介绍该共识，为未来相关中文皮肤镜术语及参数规范的制定提供参考，以期更好地规范皮肤镜在皮肤科学中的应用。     

Tricalcium silicate cement sealers: Do the potential benefits of bioactivity justify the drawbacks?

BackgroundGrossman described the ideal properties of root canal sealers. The International Organization for Standardization and American National Standards Institute and American Dental Association have codified some of his requirements in ISO 6876 and ANSI/ADA 57, respectively. In this narrative review, the authors combined the ideal Grossman properties and requirements of these standards, emphasizing the newer tricalcium silicate cement sealers. This chemical matrix for such sealers was developed on the basis of the success of bioactive mineral trioxide aggregate–type (tricalcium silicate cement) materials for enhanced sealing and bioactivity.MethodsThe authors searched the internet and databases using Medical Subject Heading terms and then conducted a narrative review of those articles involving the tricalcium silicate cement endodontic sealers.ResultsNinety-four articles were identified that discussed tricalcium silicate cement sealers. Tricalcium silicate cement sealers are partially antimicrobial and have bioactivity, which may presage improved biological sealing of the root canal system. Most other properties of tricalcium silicate cement sealers are comparable with traditional root canal sealers.ConclusionsWithin the limitations of this review, tricalcium silicate cement endodontic sealers met many of the criteria for ideal properties, such as placement, antimicrobial properties, and bioactivity, but limitations were noted in solubility, dimensional stability (shrinkage and expansion), and retrievability.Practical ImplicationsTricalcium silicate–based cements have been commercialized as bioactive, bioceramic endodontic sealers. Warm, cold, and single-cone obturation techniques are usable, depending on the commercial product. Some sealers can cause discoloration and are not easily retrievable, particularly when used to completely obturate a canal.     

中医药健康旅游等级划分与评定标准研究思路

本文阐述了中医药健康旅游等级划分与评定标准的研究思路,该标准将中医药健康旅游划分为3个等级,分别为中医健康旅游示范区、中医药健康旅游示范基地、中医药健康旅游示范项目。对中医药健康旅游示范区的评定从基础条件、资源与环境、基础设施与公共服务体系、安全与保障措施等5个方面展开;对中医药健康旅游示范基地的评定从基础条件、资源与环境、基础设施与公共服务体系、中医药健康旅游产品体系安全与保障措施等五个方面展开;对中医药健康旅游示范项目的评定从基础条件、自然与环境、基础设施与公共服务体系、中医药健康旅游特色项目分类、实施方案、安全保障、预期成果等7个方面展开。     

回眸2019——聚焦中国结直肠外科的发展与研究

虽然结直肠疾病的手术治疗进展较慢,但借助于近年来微创外科技术、围手术期综合治疗策略和临床研究的进步,中国结直肠外科亦得以快速发展。经肛全直肠系膜切除、盆腔侧方淋巴结清扫、直肠癌新辅助治疗临床完全缓解的“等待与观察”策略、机器人结直肠外科手术等仍然是近年来结直肠外科的热点议题。笔者结合全国性结直肠癌手术病例登记数据库建设以及临床研究等展开论述,以期为同道们梳理结直肠外科的发展脉络,共谋中国结直肠外科的发展。     

从全国结直肠癌手术病例数据库论述结直肠癌外科诊断与治疗的规范化

中国有全世界最大的结直肠癌患者群体,但鲜见来自中国的国际性结直肠癌诊断与治疗指南,或者来自中国的高等级循证医学研究证据。近年来,中国结直肠外科得到快速发展,无论在临床实践还是临床研究方面都取得长足进步,然而还存在诸多不平衡和欠规范之处。2018年中华医学会外科学分会结直肠外科学组牵头建立全国结直肠癌手术病例数据库,通过回顾性及前瞻性研究收集相关数据,并开展统计学分析发现:中国结直肠癌诊断与治疗过程以及数据管理的规范化都亟待提高,临床科研意识亦有待加强。因此,基于中国结直肠癌手术的数据库建设,如何开展中国结直肠癌手术相关临床研究,并获得高等级循证医学研究证据,是中国结直肠外科面临的最严峻考验。     

Common data elements for traumatic brain injury: recommendations from the interagency working group on demographics and clinical assessment

Maas AI, Harrison-Felix CL, Menon D, Adelson PD, Balkin T, Bullock R, Engel DC, Gordon W, Langlois Orman J, Lew HL, Robertson C, Temkin N, Valadka A, Verfaellie M, Wainwright M, Wright DW, Schwab K. Common data elements for traumatic brain injury: recommendations from the Interagency Working Group on Demographics and Clinical Assessment.Comparing results across studies in traumatic brain injury (TBI) has been difficult because of the variability in data coding, definitions, and collection procedures. The global aim of the Working Group on Demographics and Clinical Assessment was to develop recommendations on the coding of clinical and demographic variables for TBI studies applicable across the broad spectrum of TBI, and to classify these as core, supplemental, or emerging. The process was consensus driven, with input from experts over a broad range of disciplines. Special consideration was given to military and pediatric TBI. Categorizing clinical elements as core versus supplemental proved difficult, given the great variation in types of studies and their interests. The data elements are contained in modules, which are grouped together in categories. Three levels of detail for coding data elements were developed: basic, intermediate, and advanced, with the greatest level of detail in the advanced version. In every case, the more detailed coding can be collapsed into the basic version. Templates were produced to summarize coding formats, motivation of choices, and recommendations for procedures. Work is ongoing to include more international participation and to provide an electronic data entry format with pull-down menus and automated data checks. This proposed standardization will facilitate comparison of research findings across studies and encourage high-quality meta-analysis of individual patient data.     

基于证候要素概念构建护理措施要素施护体系的思考

证候是疾病发生、发展过程中的病理概括,任一证候都是由若干"证候要素"组合而成。本研究系统地阐述了中医"证候要素"理论形成的背景、基本内涵、意义及其目前应用研究的现状,强调了该理论对中医辨证论治过程所产生的重要影响。本研究依据中医"证候要素"辨证理论体系的指导思想,将"证候要素"的概念引入中医护理学,定义了"护理措施要素"的概念,将其作为针对病机单元的护理单元,反映了针对证候病机单元的护法护则,并进一步明确了证-护之间的对应关系,尝试探讨基于"护理措施要素"的施护体系,从而提高护理人员的辨证施护能力,促进中医护理的规范化。