Cancer genetics in primary care

The cloning of two major breast cancer susceptibility genes, BRCA1 and BRCA2, in 1994 and 1995 and the subsequent development of commercial genetic testing has brought hereditary cancer genetics into the public eye. In addition to DNA-based genetic testing, new strategies and treatments have been developed to provide accurate assessment of cancer risk and to reduce the chances of cancer developing in the future. This increasing scientific and public attention has prompted some cancer patients and their families to find out whether they "have the cancer gene" and has placed more responsibility on primary care clinicians to identify people who should be referred for specialized services of hereditary cancer genetics.     

Pediatric dermatology in primary care medicine

Dermatologic conditions in children pose a special dilemma to primary care physicians. On the one hand, dermatologic problems are so common in childhood that the primary care physician is forced to become involved with many of them; on the other hand, the scope of dermatologic conditions found in children is so broad as to be beyond the skills of most primary care physicians. The secret to managing dermatologic problems in children within a primary care setting is to recognize that a relatively small group of conditions encompass the vast majority of reasons for which a primary care physician will be consulted. By recognizing those conditions and becoming expert in the treatment of those well-defined areas, the primary care physician can perform a true service. Critical to this approach, however, is to establish clear limits and to practice within the framework of one's competence. Recognizing the importance of early referral of those cases that fall outside one's expertise is an important measure of the primary care physician's competence as seen by patients and their families. This article attempts to assist primary care physicians in developing their own set of guidelines.     

Current and future applications of CT coronary calcium assessment

Introduction: Computed tomographic (CT) coronary artery calcium scoring (CAC) has been validated as a well-established screening method for cardiovascular risk stratification and treatment management that is used in addition to traditional risk factors. The purpose of this review is to present an update on current and future applications of CAC.

Areas covered: The topic of CAC is summarized from its introduction to current application with focus on the validation and clinical integration including cardiovascular risk prediction and outcome, cost-effectiveness, impact on downstream medical testing, and the technical advances in scanner and software technology that are shaping the future of CAC. Furthermore, this review aims to provide guidance for the appropriate clinical use of CAC.

Expert commentary: CAC is a well-established screening test in preventive care that is underused in daily clinical practice. The widespread clinical implementation of CAC will be decided by future technical advances in CT image acquisition, cost-effectiveness, and reimbursement status.     

Occupational and environmental medicine and primary care

This article introduces occupational and environmental medicine (OEM) to physicians in other specialties, and especially to primary care physicians, by highlighting the common foundations of OEM practice and primary care practice. These common foundations include careful diagnosis and treatment, appropriate use of consultants, collaboration with non-medical professionals, attention to psychosocial issues, care of the entire family, respect for confidentiality, patient education, preventing disability and maximizing function, diligent patient follow-up, epidemiological thinking, and continuing medical education.     

我国急诊医学的现状与未来

急诊医学是一门新兴的、跨多专业的学科。在临床上它兼备临床各科的诊断、治疗技术，在理论上它必须具备坚实的医学理论基础，目前它的科学研究工作处于起步阶段，但发展十分迅速。本文拟对我国急诊医学的历史进行回顾，对现状进行分析，对未来进行展望和探讨。     

Current and future clinical applications of interferon-gamma in host antimicrobial defense

The T cell-derived macrophage-activating lymphokine, interferon-gamma (IFN-γ), is the most broadly acting antimicrobial-inducing and host defense-enhancing cytokine thus far identified in experimental models of infectious diseases. The activity induced by IFN-γ encompasses all classes of non-viral pathogens including intracellular and extracellular parasites, fungi and bacteria. In man, treatment with immuno-enhancing doses of IFN-γ is safe, well-tolerated and stimulates the antimicrobial mechanisms of blood monocytes, circulating neutrophils and tissue macrophages. Aerosol administration activates alveolar macrophages in a compartmentalized fashion. Monocytes from IFN-γ-treated patients with cancer, leprosy, and AIDS all respond with the activated phenotype, and suppressed monocyte HLA-DR expression in trauma patients can be upregulated by IFN-γ therapy.Thus far, IFN-γ has been recognized as effective in the prophylaxis of chronic granulomatous disease and as adjunctive treatment in at least one systemic intracellular infection, visceral leishmaniasis. Additional trials suggest beneficial effects as prophylaxis in trauma and as treatment in leprosy, cutaneous leishmaniasis, and HIV- and non-HIV-related disseminated atypical mycobacterial infection. IFN-γ is also being tested as a prophylaxis in patients with burns and advanced HIV infection and as an adjunct in drug-resistant tuberculosis.Future antimicrobial applications for IFN-γ include: a) long-term prophylaxis in T cell-deficient states, b) short-term prophylaxis in patients with a reversible host defense defect such as granulocytopenia or immune response suppression induced by trauma or burn injury, and c) adjunctive treatment along with conventional antibiotic therapy for i) nosocomial pneumonia (aerosol administration), ii) opportunistic infections in general, iii) infections which typically respond poorly to available treatment and iv) for infections which require prolonged therapy for cure. In the latter, the addition of IFN-γ may accelerate the response to conventional therapy and permit a clinically important reduction in the duration of treatment while preserving efficacy.     

危重病医学:2011年反思与前瞻

1926年,Johns Hopkins医院神经外科主任Dandy用3张病床创建了美国第一家重症监护病房(ICU).Dandy以惊人的魄力,开拓神经外科手术适应证,成为20世纪初期国际神经外科学的引领人物[1],ICU应运而生.第二次世界大战结束,在岗的护士短缺,手术后危重病患者由麻醉恢复室收治,麻醉科医师大力参与了术后危重患者的监护工作.