新型冠状病毒肺炎疫情中医护人员个人防护装备的选择与使用

个人防护设备(personal protective equipment,PPE)是控制院内感染的必要装备,可有效降低医护人员职业暴露的风险。 目前,新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫情引起国际高度关注,国内已确诊7万多例患者,死亡人数超过 2 700 人。此外,医护人员的感染超过 3 000 多例,这给医护人员(尤其是为COVID-19患者提供近距离诊疗和护理的医务人员),带来了新的风险和挑战。 本文从PPE的应用标准,正确穿、脱方法及预防防护后暴露的注意事项进行汇总和讨论。     

慢性肝病患者会员制管理方法的探讨

探索慢性肝病患者的管理方式,通过肝病患者的管理提高患者治疗的依从性,从而提高患者的治疗效果,改善患者生活质量,降低肝病患者死亡率,为患者提供更完善的医疗管理服务,为慢性疾病的管理提供新的思路。

     

Restoration of the immune balance by autologous bone marrow transplantation in juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is one of the most frequent autoimmune diseases in childhood and is characterized by chronic inflammation of the synovial fluid in joints. Several drugs are available for the treatment of JIA, including various biological agents that interfere with critical cytokine pathways. Though very effective in suppressing disease activity, none of these drugs can cure the disease and induce a lasting medication free remission. A small proportion of JIA patients will become or are unresponsive to any form of medical treatment. For these severely ill patients autologous bone marrow transplantation (aBMT) is a last resort treatment. aBMT is remarkably effective in suppressing disease activity, with beneficial outcome reported in around 70% of these previously refractory patients. Moreover aBMT is the only treatment that can induce a lasting medication-free-disease remission in these patients. In the very long term (after 7 years of remission) however, some disease relapses are observed, with the disease returning in a less severe form compared to prior aBMT. The exact mechanism of how aBMT is inducing this lasting disease remission is still largely unknown, but data from both animal models and humans suggest a prominent role for regulatory T cells. In this review we reviewed the current views of the cellular mechanisms that lay beneath disease induction of JIA and the disease remission caused by aBMT therapy.     

Molecular understanding of chronic pancreatitis: a perspective on the future.

Despite the recent development of medical imaging technology, chronic pancreatitis can only be diagnosed when the disease is fully established. This is due to the lack of specific and sensitive markers for this disease. The discovery of mutations in the cationic trypsinogen gene in patients with hereditary pancreatitis and a high incidence of mutations in the cystic fibrosis transmembrane conductance regulator gene in patients with chronic pancreatitis might be important clues to understanding the molecular mechanisms of this disease. The interaction between ethanol and ion channels might be the missing link between alcohol ingestion and chronic pancreatitis.     

Cumulative radiation dose estimates from medical imaging in paediatric patients with non-oncologic chronic illnesses. A systematic review

Paediatric patients with non-oncologic chronic illnesses often require ongoing care that may result in repeated imaging and exposure to ionizing radiation from both diagnostic and interventional procedures. In this study the scientific literature on cumulative effective dose (CED) of radiation accrued from medical imaging among specific cohorts of paediatric, non-oncologic chronic patients (inflammatory bowel disease, cystic fibrosis, congenital heart disease, shunt-treated hydrocephalus, hemophilia, spinal dysraphism) was systematically reviewed.We conducted PubMed/Medline, Scopus and EMBASE searches of peer-reviewed papers on CED from diagnostic and therapeutic radiological examinations. No time restriction was introduced in the search. Only studies reporting CEDs accrued for a period >1 year were included.We found that the annual CED was relatively low (<3 mSv/year) in cystic fibrosis, congenital heart disease, patients with cerebrospinal fluid shunts and hemophilia, while being moderate (>3–20 mSv/year) in Crohn's patients.This extra yearly radiation exposure accrues over the lifetime and can reach high values (>100 mSv) in selected cohorts of paediatric chronic patients.     

Role of the nonhuman primate for research related to women's health

This overview of the current status of medical problems that affect women is related to current studies on pathophysiology and therapeutic interventions using nonhuman primates to demonstrate the utility of the primate model for the study of disease processes in women. The current medical literature on women's health is compared with the literature on nonhuman primate research. The findings reviewed in the articles of ILAR Journal Volume 45 Issue 2 of 2004 are evaluated in the context of the scope and problems associated with disease entities in women. Nonhuman primate research with known information regarding women's disease is discussed, and the utility of the animal model for the study of human disease is highlighted, based on its significant relevance due to similarities of nonhuman primate and human subjects' physiology, metabolism, and responses to therapeutic interventions. Additional advantages of the animal model include the ability to control the experimental environment and the capacity to perform chronic study procedures. These findings allow us to utilize the nonhuman primate as the most relevant model in the animal world for the study of human disease processes.     

Special considerations in the treatment of patients with bipolar disorder and medical co-morbidities

BACKGROUND: The pharmacological treatment of bipolar disorder has dramatically improved with multiple classes of agents being used as mood-stabilizers, including lithium, anticonvulsants, and atypical antipsychotics. However, the use of these medications is not without risk, particularly when a patient with bipolar disorder also has comorbid medical illness. As the physician who likely has the most contact with patients with bipolar disorder, psychiatrists must have a high index of suspicion for medical illness, as well as a basic knowledge of the risks associated with the use of medications in this patient population. METHODS: A review of the literature was conducted and papers addressing this topic were selected by the authors. RESULTS AND DISCUSSION: Common medical comorbidities and treatment-emergent illnesses, including obesity, diabetes mellitus, dyslipidemia, cardiac disease, hepatic disease, renal disease, pulmonary disease and cancer are reviewed with respect to concomitant use of mood stabilizers. Guidance to clinicians regarding effective monitoring and treatment is offered. CONCLUSIONS: Mood-stabilizing medications are necessary in treating patients with bipolar disorder and often must be used in the face of medical illness. Their safe use is possible, but requires increased vigilance in monitoring for treatment-emergent illnesses and effects on comorbid medical illness.     

Chronic epididymitis: a practical approach to understanding and managing a difficult urologic enigma

Many patients with unilateral or bilateral testicular, epididymal, or scrotal pain as their sole presenting symptom receive a diagnosis of "chronic epididymitis." This common clinical entity is diagnosed and treated by practicing urologists but essentially ignored by academic urologists. This article defines chronic epididymitis, reviews current knowledge regarding its etiology, and describes appropriate physical examination and clinical testing for patients with the condition. The recently developed Chronic Epididymitis Symptom Index is presented, which can be used for baseline evaluation and follow-up of patients with chronic epididymitis, both in clinical practice and in research treatment trials. Treatment options, from watchful waiting to medical therapy to epididymectomy, are reviewed.     

Major depression and recent physical or sexual abuse increase readmissions among high-utilising primary care patients

Objective To investigate whether current major depression and past physical/sexual victimisation is associated with recurrent general hospital admissions.Method Ninety-six inner-city primary care patients with a history of high medical service utilisation completed the PRIME-MD and the Abuse Assessment Screen; medical records were reviewed to assess reasons for re-hospitalisations. We compared hospitalisation rates over the preceding 12 months between those subjects with and without major depression and those with and without histories of abuse.Results Compared to non-abused subjects, patients with past-year abuse showed significantly increased past-year hospitalisations (3.2 versus 1.8, P = 0.007). Re-admissions were related to chronic disease management and were not because of acute physical effects of trauma. Analysis of variance revealed that major depressive disorder and past-year abuse history interacted to increase an association with re-admissions.Conclusions Past-year abuse was independently associated with increased hospital admissions. Psychological effects of recent abuse combined with depression may particularly increase rates of medical/surgical hospitalisations.     

Traumatic Rupture of the Spleen with Delayed Intraperitoneal Hemorrhage During Pregnancy

The extent of anatomical involvement (rectosigmoid, left colon, entire colon, segmental, and enterocolon) and clinical behaviour (acute fulminating, recurrent colitis, and chronic continuous colitis) must be considered in assessing the prognosis and management of patients with ulcerative colitis. The severity of symptoms and signs is highly variable. It ranges from the virtually asymptomatic patient with mild proctitis to the patient with acute fulminating colitis with arthritis, skin lesions and “toxic megacolon” who constitutes a medical emergency. Consequently, there is no single therapeutic formula to be applied in this disease. Treatment is reviewed with reference to the recent literature.     

Visceral pathology of hereditary tyrosinemia type I.

The major pathological findings in 23 patients with hereditary tyrosinemia type I seen at the Hôpital Sainte-Justine over a 23-year period are reviewed in combination with findings in the literature. Hepatic and renal alterations are given special emphasis. Hepatic changes differ in the acute and chronic forms of the disease. The former is characterized by alterations shared by several hepatopathies of infancy, whereas the latter is characterized by established cirrhosis, frequently of a mixed macro- and micronodular type, with a frightening propensity for the development of hepatocellular carcinoma. Renal changes reflect tubular injury, resulting in Fanconi syndrome, with tubular dilatation, nephrocalcinosis, and involution of epithelial cells. A significant proportion of patients also reveal some degree of glomerulosclerosis and interstitial fibrosis, indicating at least the need for careful assessment and follow-up of renal function, particularly in light of the adverse renal effects of immunosuppressive regimens used in liver transplantation.     

Molecular,immunological and clinical properties of mutated hepatitis B viruses

Hepatitis B virus (HBV) is at the origin of severe liver diseases like chronic active hepatitis, liver cirrhosis and hepatocellular carcinoma. There are some groups of patients with high risk of generation of HBV mutants: infected infants, immunosupressed individuals (including hemodialysis patients), patients treated with interferon and lamivudine for chronic HBV infection. These groups are the target for molecular investigations reviewed in this paper. The emergence of lamivudine- or other antiviral-resistant variants, rises concern regarding long term use of these drugs. Infection or immunization with one HBV subtype confers immunity to all subtypes. However, reinfection or reactivation of latent HBV infection with HBV mutants have been reported in patients undergoing transplant and those infected with HIV. Mutations of the viral genome which are not replicative incompetent can be selected in further course of infection or under prolonged antiviral treatment and might maintain the liver disease. Four open reading frames (ORF) which are called S-gene, C-gene, X-gene and P-gene were identified within the HBV genome. Mutations may affect each of the ORFs. Mutated S-genes were described to be responsible for HBV-infections in successfully vaccinated persons, mutated C-genes were found to provoke severe chronic liver diseases, mutated X-genes could cause serious medical problemes in blood donors by escaping the conventional test systems and mutated P-genes were considered to be the reason for chemotherapeutic drug resistance. This paper reviews molecular, immunological and clinical aspects of the HBV mutants.     

基因技术在治疗2型糖尿病中的应用*

2型糖尿病(type 2 diabetes mellitus, T2DM)是一类由于胰岛β细胞损伤和机体对胰岛素耐受引发的慢性代谢性疾病,其快速增长的患病率和并发症所带来的高病死率已成为人类面临的医学难题。目前,T2DM主要是以降糖药物及胰岛素增敏剂等药物进行治疗,但是这类药物会产生严重的副作用,而且不能长期良好控制血糖和防止各种慢性并发症。因此,基因治疗是未来医疗发展的主要方向。基因治疗不仅可以靶向调控血糖水平进而提高降糖的效果,而且能够减少糖代谢异常引起的并发症,保护组织器官免受损伤。在认识传统药物治疗糖尿病的基础上,综述了基因技术在治疗T2DM中的应用,讨论了基因技术治疗T2DM的意义及存在的问题。基因技术的应用不仅有利于T2DM的预防和个体化治疗,同时也为糖尿病并发症提供了新的治疗途径。     

Leishmania tropica infection in hamsters and a review of the animal pathogenicity of this species.

Four strains of Leishmania tropica s. st. from Afghanistan were found to be constantly infective to the golden hamster (Mesocricetus auratus), whether inoculated as culture promastigotes from early passages or as amastigotes from the cutaneous lesions. In total, 66 amastigote passages were carried out over 6 passage generations. The footpad lesions were chronic and nonulcerative infiltrates; their evolution is described up to 15 months. No self-healing was observed. Balb/c mice and gerbils were not susceptible. Earlier studies on L. tropica s. st. in laboratory animals, principally by Soviet and French workers, are critically reviewed. This new experimental model of chronic cutaneous leishmaniasis is of special interest for studies on the immunology and chemotherapy of the disease. Some advantages over the commonly used L. major model are discussed.     

Surgical Management of Regional Enteritis

The present-day concepts concerning the surgical management of regional enteritis are reviewed and the multitude of problems that may arise in surgical treatment are discussed. The primary treatment of regional enteritis remains medical. Surgical intervention is necessary only for the complications of intractability, obstruction, fistula, abscess formation, anal and rectal complications, massive hemorrhage and perforation. To ensure the best possible results, medical treatment should continue after surgery. A perfect operation for this disease does not exist. Operations for regional enteritis can now be performed with a mortality rate of less than 2%, and although the recurrence rate following surgery averages approximately 30%, the disease is well controlled in the majority of patients with medical and/or surgical treatment.     

The burden of genetic disease on inpatient care in a children's hospital

The important role of genetics in pediatric illness has been increasingly recognized, but the true impact has not been well delineated. An important study of pediatric inpatient admissions to a children's hospital in 1978 found a genetic basis for disease in just less than half of admitted patients. We sought to update this study in light of current hospitalization practices and new knowledge about genetics. We systematically reviewed the records of 5,747 consecutive admissions (4,224 individuals), representing 98% of patients admitted in 1996 to Rainbow Babies and Children's Hospital (Cleveland, OH). Each patient was assigned to one of five groups on the basis of the presence or absence of an underlying chronic medical condition and whether that condition had a genetic basis or susceptibility. An underlying disorder with a significant genetic component was found in 71% of admitted children. The vast majority (96%) of underlying chronic disorders in children in this study were either clearly genetic or had a genetic susceptibility. Total charges for 1996 were >$62 million, of which $50 million (81%) was accounted for by disorders with a genetic determinant. The 34% of admissions with clearly genetic underlying disorders accounted for 50% (>$31 million) of the total hospital charges. The mean length of stay was 40% longer for individuals with an underlying disease with a genetic basis than for those with no underlying disease. Charges and length of stay were similar for children with underlying chronic disorders, regardless of the cause. This study begins to quantify the enormous impact of genetic disease on inpatient pediatrics and the health care system. Additional study and frank public discourse are needed to understand the implications on the future health care workforce and on the utilization of health care resources.     

Manganese neurotoxicity: A bioinorganic chemist’s perspective

Manganese is an essential metal for life, yet chronic exposure to this metal can cause a neurodegenerative disease named manganism, with symptoms that resemble Parkinson’s disease. Mn accumulates in the striatum and damages this brain structure that controls motor function; however, the molecular mechanisms underlying this neurodegenerative disease are poorly understood. In this short review, a summary of the current knowledge on the mechanisms involved in Mn neurotoxicity is given, with a special emphasis on the features that suggest specific protein-manganese interactions. The mechanisms of Mn uptake into the brain are discussed, displaying its similarities to Fe metabolism. Cellular trafficking of Mn is also reviewed, pointing out at its connection to Ca homeostasis, and its relevance for understanding Mn-induced neuronal death. The main purpose of this review is to provide a glimpse of an unexplored bioinorganic facet of a Mn-induced neurodegenerative disease.     

Pharmacogenetic approaches to the treatment of alcohol addiction

Addictive disorders are partly heritable, chronic, relapsing conditions that account for a tremendous disease burden. Currently available addiction pharmacotherapies are only moderately successful, continue to be viewed with considerable scepticism outside the scientific community and have not become widely adopted as treatments. More effective medical treatments are needed to transform addiction treatment and address currently unmet medical needs. Emerging evidence from alcoholism research suggests that no single advance can be expected to fundamentally change treatment outcomes. Rather, studies of opioid, corticotropin-releasing factor, GABA and serotonin systems suggest that incremental advances in treatment outcomes will result from an improved understanding of the genetic heterogeneity among patients with alcohol addiction, and the development of personalized treatments.     

Implications for the role of endogenous nitric oxide inhibitors in hemodialysis hypotension

Hypotensive episodes during hemodialysis in patients with end-stage renal disease in the absence of inadequate maintenance of the plasma volume, preexistence of cardiovascular disease, or autonomic nervous system dysfunction is accompanied by increase in the plasma concentrations of the end-products of nitric oxide metabolism, above the levels expected based on the reduction of urea. Factors that can influence the synthesis of nitric oxide or the regulation of the effects of this free radical in patients with chronic renal failure are reviewed. Convergence of these factors and their interactions during the hemodialysis procedure are discussed as the basis for the generation of excessive amounts of nitric oxide that serves as an important contributing factor in the development of symptomatic hypotension.     

Reversing disability of irreversible lung disease.

Pulmonary rehabilitation is a comprehensive multifaceted team approach for integrating medical management, coping skills, self-management techniques, and exercise reconditioning. It provides patients with chronic lung disease the ability to adapt and live full and nearly normal lives. These changes are possible because the overall disability includes significant reversible components: Patients have bronchospasm, infection, and cor pulmonale; they respond to progressively impaired lungs by progressive inactivity, leading to physical deconditioning. Both factors contribute to dyspnea. Because patients naturally fear dyspnea, they panic easily. During panic, their work of breathing may increase and respiratory failure may result. Pulmonary rehabilitation provides good medical management; provides exercises to increase strength, endurance, and tolerance to dyspnea; and trains patients in panic control. These programs have not been shown to lengthen life span or improve static lung function. They increase exercise performance and render patients functional, independent, and subject to fewer hospital admissions. Pulmonary rehabilitation is the only approach to chronic lung disease short of lung transplantation that improves the long-term outlook for these patients.