肺癌术后合并新型冠状病毒肺炎临床诊治1例报告

2019年12月起,新型冠状病毒肺炎(novel coronavirus pneumonia,NCP)首发于中国武汉。目前全球多个国家均已有确诊病例。该病传播迅速,且存在明确的人际传播。但对于围手术期,尤其是胸外科,NCP患者则尚未见报道。本例病案主要描述了1例肺癌围手术期合并NCP患者从术前检查到术后最终确诊的诊治全过程,包括患者术前症状体征及实验室检查、术后发热症状及胸部CT影像演变过程和相应治疗防护措施以及确诊后的诊治流程等,为胸外科围手术期合并NCP患者的诊断、治疗及特殊防护提供经验。     

Orofacial Pain--Part II: Assessment and management of vascular, neurovascular, idiopathic, secondary, and psychogenic causes

Chronic orofacial pain is a common health complaint faced by health practitioners today and constitutes a challenging diagnostic problem that often requires a multidisciplinary approach to diagnosis and treatment. The previous article by the same authors in this issue discussed the major clinical characteristics and the treatment of various musculoskeletal and neuropathic orofacial pain conditions. This second article presents aspects of vascular, neurovascular, and idiopathic orofacial pain, as well as orofacial pain due to various local, distant, or systemic diseases and psychogenic orofacial pain. The emphasis in this article is on the general differential diagnosis and various therapeutic regimens of each of these conditions. An accurate diagnosis is the key to successful treatment of chronic orofacial pain. Given that for many of the entities discussed in this article no curative treatment is available, current standards of management are emphasized. A comprehensive reference section has been included for those who wish to gain further information on a particular entity.     

Overview of non-Hodgkin's lymphoma

OBJECTIVES: To provide an overview of non-Hodgkin's lymphoma (NHL). DATA SOURCES: Review and research articles. CONCLUSION: NHLs are divided primarily into two main categories based on their rate of growth: aggressive and indolent. Within these two groups are various subtypes that have various clinical features. Prognostic features have been useful in determining the potential outcome of treatment of patients with NHL. IMPLICATIONS FOR NURSING PRACTICE: Nurses play an important role in the education of patients regarding the type of lymphoma they have and the steps necessary to make an accurate diagnosis, which is important in determining the appropriate treatment.     

基于MRI分析终末期肾病脑损伤机制研究进展

终末期肾病（ESRD）可导致神经系统多种严重并发症,以急性脑血管病和认知功能损伤最为常见。近年来,多种MRI新技术已用于阐明ESRD脑损伤的潜在神经病理学机制,并取得一定进展,对早期诊断及治疗疾病具有重要意义。本文就MRI分析ESRD脑损伤发生机制的研究进展进行综述。     

胆囊癌影像学研究进展

胆囊癌是胆道系统最常见的恶性肿瘤,由于胆囊癌起病隐匿,许多患者在发现时已属晚期,外科手术是治疗胆囊癌的有效手段,且早期胆囊癌有通过外科手术治愈的可能,所以胆囊癌的早期诊断对治疗和预后起着关键作用。由于胆囊是常规组织学活检难以到达的器官,所以影像学检查在胆囊癌的诊断、分期及随访中起到了重要作用。本文就各种影像学检查在胆囊癌的研究进展作一综述。     

Cushing's syndrome: update of diagnosis and management

Although considerable advances have been made in the understanding of Cushing's syndrome in the recent past, many difficulties persist in the diagnosis and management of patients with hypercortisolism. Precision in the diagnosis of Cushing's syndrome and the differentiation of its various forms have gradually improved, but a substantial number of cases have laboratory or radiologic findings that can be misleading or at least difficult to interpret. Furthermore, other conditions may mimic Cushing's syndrome and add to the diagnostic difficulties. Surgical extirpation of primary adrenal lesions that cause the hypercortisolism or of the neoplasms responsible for the ectopic production of adrenocorticotropic hormone remains the treatment of choice for these problems. Currently, transsphenoidal surgical exploration is the treatment of choice for Cushing's disease.     

人工智能在影像医学中的实际应用

在医疗领域影像医学是人工智能的主要应用方向之一。在日常诊疗工作中,影像检查的临床需求量巨大,但影像科医师数量的增长和临床经验的积累远不及影像数据的增长速度,AI与影像数据交叉融合,可减轻影像科医师处理海量影像数据的压力。目前,基于超声、X线、CT和MRI数据以深度学习技术为核心,已研发了多种AI辅助影像的定量分析算法,在临床得到广泛的应用,实现了疾病的早期诊断、精准治疗、疗效评估和预测,显著提高影像科医师处理影像信息的效率和准确性,可为临床诊疗提供定量依据。     

血清KL-6 水平检测在临床间质性肺病诊断中的研究进展

间质性肺病（interstitial lung disease，ILD）是一大类疾病，有病因繁多、发病机制复杂、诊断及治疗困难等特点。近年来，该病的发病率逐年上升。因早期症状和体征缺乏特异度，该病的诊断仍具挑战性。多项研究表明血清涎液化糖链抗原-6（krebs von den lungen-6，KL-6）与该病的发生、发展有密切关系，且具有操作简单、灵敏度及特异度高、成本低等优势，对间质性肺病诊断、预后判定及动态监测具有一定临床价值，目前国内尚无血清KL-6 用于诊断间质性肺病阈值的相关指南或专家共识，因此该文着重阐述血清KL-6 水平检测在临床间质性肺病诊断中的研究进展。     

DNA methylation markers: a versatile diagnostic tool for routine clinical use

In recent years, several new options have been introduced for the treatment of various neoplasias. Biomarkers are urgently needed to improve diagnosis and treatment selection. DNA metlhylation biomarkers unite these desirable characteristics because they relate to key aspects of tumor biology and can be measured reliably on routinely available patient specimens. Recent improvements in DNA methylation marker discovery and efforts to transfer these into routine clinical use are summarized in this review.     

Environmental medicine: introduction and overview

Human health and longevity have long been known to depend on a complex interplay between hereditary and nonhereditary determinants. The latter include various lifestyle factors, as well as physical and chemical agents encountered in air, food, water, consumer products, the workplace, and the environment at large. Knowledge of these determinants is becoming increasingly important to the physician and other members of society in the maintenance of human health and in the diagnosis and treatment of the diseases of modern life.     

The microbiology of paranasal sinus infections: diagnosis and management.

Study of the bacteriology of sinusitis and its diagnosis and treatment has been difficult. One problem is the anatomy of the paranasal sinuses; all communicate with a bacteriologically contaminated cavity. Access to all but the frontal sinus involves traversing either the nasal or oral cavity, both of which are teeming with aerobic and anaerobic bacteria. The criteria used to establish the diagnosis of sinusitis has varied widely. There are a number of examination techniques available, but none are foolproof. Therefore, patient populations may not be comparable. The absolute elimination of the possibility of contamination of culture specimens is impossible. Investigators have taken cultures in several ways: of the purulent secretions within the nose, of the contents lavaged from the sinus into the nose, of material aspirated from the sinus, and of tissue removed from the sinus. In most studies prior to 1974, anaerobic cultures were not performed. Studies of various treatment programs have used differing criteria to monitor the progress of treatment. No single method is completely reliable. Clinical signs and symptoms, radiologic appearance, the results of irrigation, and thermography have been used to follow patients. Many studies have used multiple therapeutic maneuvers concurrently, for example, antibiotics, lavage, and a decongestant. In some there were no controls. Because of these problems, as is true in many clinical areas of investigation, meaningful comparisons of various studies are difficult. Despite this, there are some areas of consensus in the literature.     

Das Sakroiliakalgelenk und die sakroiliakale Dysfunktion

Sacroiliac dysfunction (SD), i.e. the pain resulting from the sacroiliac joint and the periarticular structure, is classified in the many available publications as part of deep lying back pain. The diagnostic procedure and treatment of SD are, however, controversially discussed and there is no consensus in the literature. Just like all other methods in manual medicine, diagnostic and therapeutic techniques must be evaluated by scientific criteria with respect to the sacroiliac joint. For the diagnosis of SD, tests such as the pain provocation test and motility check or palpation tests are available. The reliability of the provocation test is much higher than the motility test and a good level of reliability and validity can be attained using several pain provocation tests. The effectiveness of local manual therapeutic treatment techniques for SD has been demonstrated in various studies and no differences between manipulation and mobilization have been demonstrated. In this article the anatomical characteristics, epidemiology, etiology and pathogenesis as well as the differential diagnosis using various diagnostic procedures and treatment options of SD will be described with respect to the individual evidence-based grading present.     

上海市公共卫生临床中心新型冠状病毒肺炎疫情下脊柱外科临床诊疗规范

新型冠状病毒肺炎(COVID-19)传染性较强,虽此病以轻症为主,但仍有一定病死率。尽管世界各国都采取相应措施,但COVID-19患者数量仍持续增加,疫情形势依然严峻,截至2月26日全国累计确诊78 191例,死亡2 718例。今后需要手术治疗的患者中难免会有COVID-19患者,外科医护及相关人员在积极救治患者的同时,自身防护也非常重要,应避免发生因手术导致医护交叉感染。为规范脊柱外科患者合并这一新发传染病的诊治,特制定上海市公共卫生临床中心关于"脊柱外科患者合并COVID-19"的诊疗规范。     

Depression and dysthymia

The advances made in the 1980s and 1990s have yielded many advances in the diagnosis and treatment of depression and dysthymia. Skill of the clinician is important in sorting out the diagnosis, taking care to consider the various medical conditions that can cause depression or disguise themselves as depression. Depressive disorders are highly treatable conditions. Clinicians must overcome the stigma associated with these disorders to alleviate the pain and suffering of those afflicted. The advances in treatment have been enormous and continue to grow. The keys to these treatments lie in continuing to acquire the knowledge to unlock all of the causes of depression. An appendix follows listing medications commonly used in the treatment of depression or for other conditions in patients under treatment for depression.     

临床患者血流真菌感染的实验诊断及治疗研究进展

近年来,随着临床广谱抗真菌药物的使用、各种免疫抑制剂、各类导管插管以及介入治疗等新型技术的发展,使得真菌引起的血流感染屡见不鲜,患者的死亡率明显升高,真菌的耐药率也在不断上升。如何对真菌引起的血流感染进行早期快速、准确的诊治是目前临床医生亟待解决的关键问题,现笔者对真菌血流感染的病原学、最新诊断和治疗方法等方面进行陈述。     

Acute aortic dissection in women: challenges and opportunities

Acute aortic dissection (AAD) is a severe and potentially fatal disease which requires rapid diagnosis and appropriate treatment in order to improve survival. The variable and sometimes non-specific presentation of this rare condition makes it a continued diagnostic challenge for even the best of clinicians. Multiple clinical factors have been studied for their role in increasing the risk of AAD. While the complete pathophysiology of the condition is not known, contemporary research has shed light on many important factors that might lead to the development of aortic aneurysms and AAD. Despite continued research in this area, there is scant research looking at gender-related differences in the epidemiology, presentation, treatment and outcomes of patients with AAD. This review first revisits lessons about gender-related differences seen in various cardiovascular diseases, and then critically examines the data on gender-related differences in AAD diagnosis, management and outcomes. A summary of the pathophysiology and possible reasons for gender-specific differences in the development of aneurysms and dissections is also provided.     

巨噬细胞在心肌梗死中作用的研究进展

自2019年12月份以来,2019 新型冠状病毒(2019 novel coronavirus,2019-nCoV)肺炎在武汉局部爆发,波及全国,蔓延世界。该疾病传染性较强,虽此病以轻症为主,但仍有一定死亡率,尽管世界各国都采取相应措施,但是COVID-19感染者数量仍然持续增加,疫情形势依然严峻,截止2月26日全国累计确诊78191人,死亡2718人,在目前及以后需要手术治疗的患者中难免会有COVID-19感染者,但是外科医护及相关人员在积极救治患者的同时自身防护非常重要,因手术导致医护交叉感染的发生应避免发生。为规范脊柱外科患者合并这一新发传染病的诊治,特制订上海市公共卫生临床中心关于“脊柱外科患者合并COVID-19感染”的诊疗建议方案。     

Exosomes in esophageal cancer: A review on tumorigenesis,diagnosis and therapeutic potential

Exosomes are nanovesicles secreted from various types of cells and can be isolated from various bodily fluids, such as blood and urine. The number and molecular contents, including proteins and RNA of exosomes, have been shown to reflect their parental cell origins, characteristics and biological behaviors. An increasing number of studies have demonstrated that exosomes play a role in the course of tumorigenesis, diagnosis, treatment and prognosis, although its precise functions in tumors are still unclear. Moreover, owing to a lack of a standard approach, exosomes and its contents have not yet been put into clinical practice successfully. This review aims to summarize the current knowledge on exosomes and its contents in esophageal cancer as well as the current limitations/challenges in its clinical application, which may provide a basis for an all-around understanding of the implementation of exosomes and exosomal contents in the surveillance and therapy of esophageal cancer.     

Tumor-related hyponatremia

Hyponatremia is an important and common electrolyte disorder in tumor patients and one that has been reported in association with a number of different primary diagnoses. The correct diagnosis of the pathophysiological basis for each patient is important because it significantly alters the treatment approach. In this article, we review the epidemiology and presentation of patients with hyponatremia, the pathophysiologic groups for the disorder with respect to sodium and water balance and the diagnostic measures for determining the correct pathophysiologic groups. We then present the various treatment options based on the pathophysiologic groups including a mathematical approach to the use of hypertonic saline in management. In cancer patients, hyponatremia is a serious comorbidity that requires particular attention as its treatment varies by pathophysiologic groups, and its consequences can have a deleterious effect on the patient's health.