Pulmonary embolism with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease. The incidence of COPD is growing annually in China, and it is a significant and growing public health burden. Multivariate analysis showed that COPD was one of the independent risk factors for the occurrence of pulmonary embolism (PE), and the incidence of PE was significantly higher in COPD patients than in normal subjects. However, PE is often overlooked in patients with acute exacerbation of COPD (AECOPD) because there are many similarities in clinical symptoms between PE and AECOPD, which are difficult to distinguish, resulting in the failure of timely treatment and poor prognosis. Therefore, it is of great significance to understand the clinical manifestations, diagnosis, and treatment of COPD combined with PE for making a more accurate diagnosis, providing timely and effective treatment, and improving the prognosis of such patients.     

儿科遗传性疾病临床教学的探索与实践

遗传性疾病是儿科学教学大纲规定的必学内容,主要包括染色体病和遗传性代谢病,虽然其发病率低,但其致残率高,早期诊断和治疗具有重要意义。由于其较罕见,临床上漏诊、误诊率高。提高医学生对于此类疾病的认知,掌握最新的诊断和治疗技术,对于提高遗传性疾病的整体诊治水平,具有重大意义。我们精选教学内容,选择一种最常见的染色体疾病—21-三体综合征作为重点讲解内容;遗传代谢病病种类繁多,早期确诊干预治疗,可以减轻损伤,降低并发症,我们选择苯丙酮尿症、肝豆状核变性作为重点讲解内容,课堂教学及课外教学等多种教学方法结合,使得教学精彩生动,让学生们对知识要点掌握得更牢固,加强医学生人文素质培养等,对遗传性疾病的临床教学进行了探索与实践。遗传性疾病发病率低、病种多、临床表现复杂,如何利用现有的一切资源,发挥临床专业教师的主导作用和医学生的主观能动性,提高该类疾病的总体诊治能力,还需要进一步探索。     

阿托伐他汀对COPD并PH慢性炎症反应的影响

目的分析阿托伐他汀对慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者慢性炎症反应的影响。方法选取2017年2月-2018年2月在我院接受治疗的COPD并PH患者60例为本次研究对象,根据信封法将患者分为对照组、观察组,对照组接受常规治疗,观察组在常规治疗基础上应用阿托伐他汀治疗,比较分析治疗前后两组患者炎症因子水平。结果治疗前,两组患者TNF-α、hs-CRP、PASP水平均无明显差异,治疗后两组患者炎症因子水平均降低,但观察组低于对照组(P<0.05)。结论在常规治疗基础上应用阿托伐他汀治疗COPD并PH,能有效抑制炎症反应,降低肺动脉压。     

Air pollution and chronic obstructive pulmonary disease

There is considerable epidemiological evidence indicating that air pollution has adverse effects on human health and is closely related to respiratory diseases, including chronic obstructive pulmonary disease (COPD). These effects, which can be divided into short- and long-term effects, can manifest as an exacerbation of existing symptoms, impaired lung function, and increased hospitalization and mortality rates. Long-term exposure to air with a high concentration of pollutants may also increase the incidence of COPD. The combined effects of different pollutants may become more complex in the future; hence, there is a need for more intensive research on specific at-risk populations, and formulating corresponding protective strategies is crucial. We aimed to review the epidemiological evidence on the effect of air pollution on COPD, the possible pathophysiological mechanisms underlying this effect, as well as protective measures against the effects of air pollutants in patients with COPD.     

Renewed vision on pulmonary rehabilitation service delivery for chronic obstructive pulmonary disease management beyond COVID-19

Pulmonary rehabilitation (PR) is a cornerstone management for chronic obstructive pulmonary disease (COPD). International respiratory societies defined PR is more than “just an exercise program”; it is a comprehensive care delivered by a team of dedicated healthcare professionals with a strong emphasis on long-term health-enhancing Behaviors. However, “Uncertainty” exists with varied reasons for the political and geographical barriers of referral, uptake, attendance, and completion of PR in both primary and secondary care. Besides, COVID-19 pandemic has sparked many global controversies and challenges on pulmonary rehabilitation service delivery. Post-COVID-19 guidelines emphasize on integrated care rehabilitation for patients with COPD. Thus, this concise review intends to understand the gaps in United Kingdom healthcare policies, practices, and PR services resources. To date, there is no clear consensus on PR integrated care model pathway to address the unmet needs, measure the health and social care disparities; adds to the disease burden of COPD. Based on the culmination of evidence, this perspective offers a theoretical framework of PR integrated service model, a pathway to deliver high-value personalized care to patients with COPD.     

阿尔茨海默病早期诊断:影像学和体液生物标志物研究前沿和新动态

阿尔茨海默病(Alzheimer’s disease,AD)是一种由多种因素引起的脑神经退变性疾病。由于尚无准确的早期诊断,常使AD患者错过早期治疗的时机,成为制约有效防控AD的瓶颈问题。近年来,AD体液和影像学生物标志物的研究为解决这一问题带来了新的希望,其中以包括脑脊液(cerebrospinal fluid,CSF)中的β-淀粉样蛋白和tau的体液生物标志物以及淀粉样蛋白成像(amyloid positron emission tomography,amyloid PET)、葡萄糖代谢成像(fludeoxyglucose F 18injection,FDG-PET)和磁共振成像(magnetic resonance imaging,MRI)获得的影像学生物标志物研究最为成熟。及时确诊临床前AD或无症状AD,将会为有效防控带来主动。本文涵盖了影像学、生物化学和分子生物学等方面AD核心生物标志物和潜在的候选生物标志物的研究进展,而外周体液标志物以及无创性检测方法是本领域的发展方向。     

肺康复训练对COPD患者治疗效果的研究

目的研究肺康复训练对COPD患者血液流变学及凝血功能的影响。方法选取无锡市同仁康复医院从2016年6月—2018年6月的稳定期COPD患者40例参加本次研究,符合入选标准32例,其中2例患者由于感染加重后转院无法进行进一步康复治疗,故最终入组人数30例,观察比较其结果。结果患者进行肺康复训练后8周血浆粘度、高切全血粘度、低切全血粘度均显著低于入院时(P<0.05)。患者进行肺康复训练后8周PT、APTT、TT、Fib均显著高于入院时,D-D均显著低于入院时(P<0.05)。结论COPD患者进行肺康复后,血液流变学显示血液粘稠度明显改善,凝血指标改善明显,特别是D-二聚体的降低,能够降低COPD患者肺栓塞的发病率,降低死亡率,对该疾病的预后有较好的价值。     

血液肿瘤细胞标记物在胃癌早期的诊断

在现代社会,作为消化道恶性肿瘤之一的胃癌(gastric cancer,GC)具有较高的发病率和致死率,就目前的数据统计来看,每年的新发病率约为1万人次,而5年生存率小于30%。统计分析当前的胃癌治疗发现,在检测技术提升和治疗技术进步的情况下患者的预后可以有效改善,但是部分患者在确诊的时候已经属于晚期,因此,早期诊断对于胃癌患者的预后改善起着非常重要的作用。对胃癌诊断做具体的分析,诊断中利用的一种重要辅助手段是血液生物学指标的检测,而血液肿瘤细胞标记物CTC、ctDNA在胃癌的早期诊断当中有非常明显的指向性作用,其对于诊断结果的准确性提升有显著的意义,所以文章就血液肿瘤细胞标记物CTC、ctDNA在胃癌的早期诊断当中的具体研究成果等进行总结,旨在为诊断提供理论参考。     

Ambient air quality and the risk for Chronic Obstructive Pulmonary Disease among Metro Manila Development Authority traffic enforcers in Metro Manila: An exploratory study

BackgroundAir pollution and poor ambient air quality are significantly related to multiple health risks. One associated disease is chronic obstructive pulmonary disease (COPD), a preventable disease with several contributing factors and one of the leading causes of morbidity/mortality locally and globally. A potentially high-risk population are traffic enforcers who are constantly exposed to air pollution. In the Philippines, the MMDA has the widest coverage in traffic management. The study determined the risk of COPD among Metro Manila Development Authority (MMDA) traffic enforcers in relation to ambient air quality level, as well as identified other factors that increase the risk of developing COPD.MethodsFifty-two MMDA traffic enforcers deployed in PM_2.5 air quality sensor areas in Metro Manila from 2016 to 2018 were recruited through stratified sampling. The International Primary Airways Guidelines (IPAG) questionnaire was utilized to measure risk of COPD. Respiratory health and working history were obtained through questionnaires. Department of environment and natural resources provided PM_2.5 ambient air quality data which aided in the construction of the Exposure-Month Index. Ordinal logistic regression was used to examine the association of PM_2.5 together with the relevant factors and the risk of COPD.ResultsWe found statistically significant associations between PM_2.5 and COPD among high risk category [odds risk (OR): 1.24, 95% confidence interval (CI): 1.07–1.44]. Age (Moderate, OR: 1.16, 95% CI: 0.98–1.38 and High, OR: 10.06, 95% CI: 4.02–25.17) and chest pain (Moderate, OR: 68.65, 95% CI: 1.71–2.75 × 10³) were potential risk factors, whereas body mass index (BMI) (OR: 0.05, 95% CI: 0.01–0.53) exhibited protective effect.ConclusionsExposure to PM_2.5 was associated with an increased risk of COPD among high-risk category MMDA traffic enforcers. Age and chest pain were potential risk factors to risk of COPD, whereas BMI exhibited a potential protective effect. Results of this study can be used for clinical management of high-risk populations, such that of MMDA traffic enforcers.     

噻托溴铵联合沙美特罗替卡松气雾剂治疗COPD的临床研究

目的慢性阻塞性肺疾病患者通过噻托溴铵与沙美特罗替卡松气雾剂(舒利迭)进行联合治疗,对患者的临床治疗效果进行研究分析。方法以医院于2017年1月—2018年1月期间的收治的慢性阻塞性肺疾病患者60例作为研究对象,然后将患者以随机数字表法进行分组,分成30例对照组和30例观察组,对照组患者通过单纯的药物治疗,观察组患者通过联合药物治疗,对两组患者的治疗总有效率以及肺功能情况[(FEV1)、(FEV1/FVC)]以及呼吸困难评分进行研究比较,评价联合治疗方法的治疗效果。结果治疗组患者的肺功能测定结果以及呼吸困难评价结果优良于对照组患者,组间差异具有统计学意义,P<0.05;观察组患者的治疗总有效率为93.3%(28/30)高于对照组患者70.0%(21/30),P<0.05。结论COPD患者通过噻托溴铵联合沙美特罗替卡松气雾剂治疗,治疗效果显著,临床症状明显改善。     

Optimal management of coronary artery disease in cancer patients

Owing to early diagnosis and rapid development of treatments for cancers, the five-year survival rate of all cancer types has markedly improved worldwide. Over time, however, there has been an increase in the number of cancer patients who develop coronary artery disease (CAD) due to different causes. First, many risk factors are shared between cancer and CAD. Second, inflammation and oxidative stress are common underlying pathogeneses in both disorders. Lastly, cancer therapy can result in endothelial injury, coronary artery spasm, and coagulation, thereby increasing the risk of CAD. As more cancer patients are being diagnosed with CAD, specialized cardiac care should be established to minimize the cardiovascular mortality of cancer survivors.     

The era of clinical application of gene diagnosis in cardiovascular diseases is coming

Gene diagnosis refers to the use of genetic testing in the diagnosis of inheritable conditions, which has gradually been applied in clinical practice with the completion of the gene sequencing efforts of the Human Genome Project and the advancement of gene detection technology. In the specialty field of cardiology, monogenic cardiovascular diseases are defined as monogenic inherited diseases with cardiovascular damage as the only phenotype, or accompanied by cardiovascular damage. Although the incidence of such diseases is relatively low, in the country of China with its vast population of 1.33 billion, the sheer volume of patients with monogenic cardiovascular diseases is alarming. With early onset, severe symptoms, and poor prognosis, delays in diagnosis and treatment of monogenic cardiovascular diseases often have serious consequences. Gene testing is perfectly suited for early diagnosis of monogenic cardiovascular diseases, especially for “pre-symptomatic” diagnosis. In this article, we generally review the characteristics of common monogenic cardiovascular diseases, summarize the progress of the standardized application of gene testing technology in clinical practice, describe the applicable population and condition of genetic testing for different monogenic cardiovascular diseases, analyze the practicality of genetic diagnosis of these inheritable conditions, and provide guidance on identifying suitable candidates for gene diagnosis. In conclusion, gene diagnosis provides new insights into the way physicians diagnose diseases, and is well-positioned to guide clinical decision making and treatment, especially in cardiology.     

特布他林与糖皮质激素联合用于COPD治疗的疗效

目的对慢性阻塞性肺疾病患者采用特布他林联合糖皮质激素治疗的效果进行观察和比较。方法选择我院2018年2月-2019年2月收治的慢性阻塞性肺疾病患者80例纳入研究,按照硬币法予以随机分组处理,将这些患者划分为参照组(n=40)和试验组(n=40)。分别采用不同方式对参照组和试验组患者进行治疗,完成治疗后,比较两组患者的治疗效果。结果在总有效率方面,试验组为95.0%,参照组为77.5%,试验组明显高于参照组(P <0.05)。试验组与参照组在治疗前的血气指标比较没有统计学差异(P> 0.05),在治疗后,试验组的血气指标较之于参照组明显更好(P <0.05)。结论采用特布他林联合糖皮质激素治疗慢性阻塞性肺疾病患者具有很好的效果,值得临床应用。     

新发突发传染性疾病疫情初期临床研究设计与实施的思考

临床试验方案是开展临床试验的核心，是保证临床试验结果科学性、可靠性和准确性的重要依据。在新发突发传染病疫情初期，由于临床诊疗的紧迫性、临床研究的必要性、疾病认知的不充分、研究环境的特殊性、社会环境变化的可能性和研究团队的不顺应性等问题，临床研究方案的设计具有独特性。通过结合临床试验方案设计的准则和疫情初期的实际情况，对新发突发传染病初期临床试验方案设计和实施中几个关键内容进行了简要分析，以期为临床试验方案设计提供参考     

以胜任力为导向的CBL教学法在传染病专业临床教学中应用效果探讨

传染病专业因多种病源、涉及多器官系统、诊断困难等特点，其临床教学具有特殊性，对专业学位研究生的临床带教提出挑战，针对未明确诊断的传染病病例，如何既能够确保学生避免感染，又充分调动学生学习的积极性和主动性，提高传染病专业临床专业学位研究生临床工作胜任力，建立相应的教学模式是本专业要解决的课题。结论，在传染病专业临床教学中采用以案例为基础（case-based learning，CBL) 教学法，该方法可促进学生对传染病学知识的掌握、培养学生的学习积极性和主动性、提高临床思维能力。     

茚达特罗格隆溴铵治疗COPD稳定期的临床研究

目的 探究茚达特罗格隆溴铵治疗慢性阻塞性肺疾病(COPD)稳定期的效果及对炎症因子的影响.方法 选择阳江市第三人民医院内科2020年1月—2021年1月收治的COPD稳定期患者248例,采用抛硬币法分为常规组与联合组(124例每组),常规组采用孟鲁司特治疗,联合组在常规组基础上联合应用茚达特罗格隆溴铵治疗,疗程均为3个...     

卒中的TCD相关进展

脑卒中作为临床工作中一类较为常见的局部脑组织缺血缺氧性疾病,其中以缺血性脑卒作为最重要的脑卒中类型,具有着较高的发病率,该病的发生率以及复发率通常能够受到颅内动脉狭窄的影响。通过使用经颅多普勒超声技术检查颅内狭窄具有着较高的诊断特异性,并在颅内狭窄等其他缺血性脑血管病诊断方面具有着较高的应用价值。本研究现通过从经颅多普勒超声(transcranial doppler,TCD)的角度出发,用于早期发现早期的脑血管狭窄,并对缺血性脑卒中的预后进行判断,从而更好的完成对缺血性脑卒中患者脑血管动力学指标的诊断,并对经颅多普勒超声技术的优缺点进行统一的综述。     

多索茶碱联合布地奈德治疗AE‐COPD的效果

目的探讨多索茶碱联合布地奈德治疗慢性阻塞性肺疾病急性加重期(AE‐COPD)的效果。方法选取2016年3月—2018年4月126例AE‐COPD患者,按就诊顺序分为观察组(n=63)和对照组(n=63),对照组采用布地奈德进行治疗,观察组采用多索茶碱联合布地奈德进行治疗,对比两组患者肺功能、炎症因子变化。结果治疗后,观察组FEV1、FEV1/FVC明显高于对照组,差异有统计学意义(P<0.05);治疗后,观察组IL-8、CRP均低于对照组,两组具有明显统计学意义(P<0.05)。结论多索茶碱联合布地奈德治疗AE‐COPD的效果显著,可有效改善患者肺功能、炎症因子。     

多层螺旋CT在急性阑尾炎中的诊断意义

目的评价多层螺旋CT在急性阑尾炎中的诊断意义。方法抽取2017年7月-2018年2月本院收治的80例疑似急性阑尾炎患者开展研究,在手术病理确诊前,所有患者均行多层螺旋CT检查与超声检查诊断,并以手术病理检查作为金标准,分析多层螺旋CT诊断急性阑尾炎病理类型意义。结果手术病理检查确诊为急性阑尾炎者62例。多层螺旋CT诊断出急性阑尾炎者60例;超声诊断出出急性阑尾炎者49例。多层螺旋CT诊断符合度与金标准相比,差异无统计学意义P>0.05;多层螺旋CT检查与超声诊断符合率相比,差异有统计学意义,P<0.05。结论多层螺旋CT在急性阑尾炎诊断中,可有效辨证病情,为临床诊治提供有效的参考依据。     

Application of artificial intelligence in digital chest radiography reading for pulmonary tuberculosis screening

Currently, the diagnosis of tuberculosis (TB) is mainly based on the comprehensive consideration of the patient’s symptoms and signs, laboratory examinations and chest radiography (CXR). CXR plays a pivotal role to support the early diagnosis of TB, especially when used for TB screening and differential diagnosis. However, high cost of CXR hardware and shortage of certified radiologists poses a major challenge for CXR application in TB screening in resource limited settings. The latest development of artificial intelligence (AI) combined with the accumulation of a large number of medical images provides new opportunities for the establishment of computer-aided detection (CAD) systems in the medical applications, especially in the era of deep learning (DL) technology. Several CAD solutions are now commercially available and there is growing evidence demonstrate their value in imaging diagnosis. Recently, WHO published a rapid communication which stated that CAD may be used as an alternative to human reader interpretation of plain digital CXRs for screening and triage of TB.