急性肺损伤生物标志物研究进展

急性肺损伤是-临床常见的呼吸系统急危重症,是多个危险因素直接或间接引起肺部损伤的连续病理过程,低氧血症为其特征,其发病机制复杂,病亡率高,目前临床上仍缺乏有效的早期诊断方法,严重影响了疾病的预后,因此需寻找一个简单有效的诊断方法,如血清生物标志物的测定等来帮助本病的诊断以取得更好的疗效.     

ARDS诊断——“柏林标准”的价值与意义

急性呼吸窘迫综合征(ARDS)病死率高,其早期准确的诊断是有效治疗的前提.然而,当前ARDS诊断标准的准确性备受质疑,临床迫切需要便捷可靠严谨的诊断标准.“柏林标准”从起病时间、氧合指数、肺水肿的来源及胸部影像学表现四个方面对ARDS进行诊断,是既往诊断标准的总结与延伸,其有效性及准确性已被证实,对于临床诊疗和科学研究有重大意义.     

早期大肠癌内镜下治疗与手术治疗的比较

大肠癌是常见的恶性肿瘤,提高其总体疗效的有效途径是早期诊断和治疗.外科手术和内镜下治疗是目前临床上常用的治疗早期大肠癌的有效方法.针对两者的优缺点,本文利用比较治疗学相关原理和方法,从其适应证、疗效、并发症及费用等方面进行比较,以获得启示,为临床实践提供指导.     

早期大肠癌内镜下治疗与手术治疗的比较

大肠癌是常见的恶性肿瘤,提高其总体疗效的有效途径是早期诊断和治疗。外科手术和内镜下治疗是目前临床上常用的治疗早期大肠癌的有效方法。针对两者的优缺点,本文利用比较治疗学相关原理和方法,从其适应证、疗效、并发症及费用等方面进行比较,以获得启示,为临床实践提供指导。     

帕金森病早期诊断之生物学标记物

帕金森病是老年人神经系统变性疾病之一,也是老年人最常见的锥体外系疾病,以黑质多巴胺能神经元变性、缺失以及路易小体形成为其主要病理特征。其临床症状主要包括运动症状及非运动症状。目前对于帕金森病仍缺乏最直接有效的诊断方法,常导致帕金森病患者错过最佳的早期诊断时机,故近年来研究发现血液生物化学标记物、脑脊液生物化学标记物、功能神经影像学、基因学等有望成为帕金森病早期诊断的新方法,故本文将对此逐一进行介绍。     

病理诊断的局限及其应对措施

病理诊断是诊断疾病的基本方法之一,是许多疾病的最终诊断,被许多人称为临床诊断的"金标准".但由于病理诊断技术存在的一些主观和客观因素的影响,病理诊断也存在局限性,并且这些诊断的局限常常会引起误诊漏诊和医患纠纷.如何能在工作中尽可能地克服病理诊断的局限,使其更好地为临床和患者服务.结合临床病理实践的具体工作,对病理诊断的局限性进行简要分析,并提出相关的应对措施.     

论反向性思维在呼吸困难诊断中的意义

论反向性思维在呼吸困难诊断中的意义浙江省台州医院内一科（３１７０００）冯加喜在临床实践中,误诊是常见的,造成误诊的原因是复杂的,但临床思维的偏差是造成误诊的主要原因之一。反向性思维是减少误诊的有效方法。所谓反向性思维,就是在初步诊断的基础上,再找出反...     

病理诊断的局限及其应对措施

病理诊断是诊断疾病的基本方法之一,是许多疾病的最终诊断,被许多人称为临床诊断的“金标准”。但由于病理诊断技术存在的一些主观和客观因素的影响,病理诊断也存在局限性,并且这些诊断的局限常常会引起误诊漏诊和医患纠纷。如何能在工作中尽可能地克服病理诊断的局限,使其更好地为临床和患者服务。结合临床病理实践的具体工作,对病理诊断的局限性进行简要分析,并提出相关的应对措施。     

疾病诊断谁说了算：临床诊断？影像诊断？

影像诊断是临床诊断的一个重要组成部分,与问诊、体格检查、实验室检查等一同构成临床诊断。影像诊断不能脱离临床诊断工作而单独存在,影像诊断的结论是否正确需要其他非影像学证据的支撑,其结论不能脱离症状、体征而存在。影像诊断专注于分析图像特征、从图像中寻找诊断证据,不需要采纳其他非影像学证据完善其结论;由于影像诊断是完全来源于图像分析,因而具有不可避免的局限性。影像诊断和其他诊断技术的融合推动了临床诊治技术的进步。     

功能性胃肠病诊断方法现状分析

功能性胃肠病是一种存在消化道症状,但无法用器质性病变或生化异常来解释的消化道功能性疾病.在消化系统疾病中发病率非常高,严重影响了人们的生活质量.目前临床诊断功能性胃肠病主要依据国际公认的以症状学为诊断依据的罗马Ⅲ诊断标准.但因其病因、发病机制以及病理生理基础并未完全明确,罗马Ⅲ并不是诊断的完美金标准.针对这些环节,国际国内开展了各种各样的检查方法.笔者综述了目前临床上常用的诊断方法以及存在的主要问题,以期协助指导临床诊断及治疗.     

体外循环所致炎性肺损伤机制及保护进展

肺损伤是体外循环心内直视手术的主要并发症之一。肺损伤的机制十分复杂,主要是全身炎性反应和缺血/再灌注损伤所致。肺保护的方法多种多样,其目的是降低全身炎性反应,减轻或避免缺血/再灌注损伤。本文探讨体外循环肺损伤的机制和保护进展。     

急性呼吸窘迫综合征肺泡塌陷与肺复张的意义

大量肺泡塌陷是急性呼吸窘迫综合征(ARDS)病理生理改变的基础,可导致顽固性低氧血症、肺泡表面活性物质丢失、呼气气流受限、去复张性肺损伤、肺部感染和生物性肺损伤。积极的实施肺开放策略,实现塌陷肺泡的复张具有重要的临床意义。肺复张导致肺泡过度膨胀、循环干扰,以及肺泡难以复张因素的存在,使肺泡完全复张可能并不必要。在避免肺泡塌陷危害与肺复张的局限性之间寻求平衡,才能使肺复张确立其在ARDS治疗中的恰当地位。     

酒精性肝损伤的防治思考

酒精性肝损伤已成为继病毒性肝炎后的主要肝损伤病因,因此酒精性肝病的防治已经成为重要的医疗课题。其病因、发病机制、病理改变及治疗等有其独特的特点,用哲学的方法对其进行科学、全面的分析,可有助于对该病的认识和研究,指导我们从总体考虑,更为合理、有效地防治酒精性肝损害。     

The enduring impact of violence against children

More than one billion children – half of all children in the world – are exposed to violence every year. The violence children are exposed to includes both direct experiences of physical, sexual, and emotional abuse, as well as indirectly witnessing violence in their homes, schools, and communities. What these various forms of violence share, based on a review of the literature, is their enduring potential for life-long consequences. These consequences include increases in the risks of injury, HIV, sexually transmitted infections, mental health problems, reproductive health problems, and non-communicable diseases, including cardiovascular disease, cancer, chronic lung disease, and diabetes. Studies addressing biologic underpinnings of such consequences demonstrate that violence-associated toxic stress may cause damage to the nervous, endocrine, circulatory, musculo-skeletal, reproductive, respiratory, and immune systems. Furthermore, rigorous economic evaluations suggest that costs associated with the consequences of violence against children exceed $120 billion in the U.S. and account for up to 3.5% of the GDP in sub-regions of East Asia. The expanding literature confirming the mechanisms of consequences and the associated costs of violence against children has been accompanied by growing evidence on effective approaches to prevention. Moreover, the expanding evidence on prevention has been accompanied by a growing determination on the part of global leaders to accelerate action. Thus, as part of the Post-2015 Sustainable Development agenda, the UN has issued a call-to-action: to eliminate violence against children. This unprecedented UN call may foster new investments, to fuel new progress for protecting children around the world from violence and its preventable consequences.     

浅谈ICU中肺损伤与急性呼吸窘迫综合征的防治

ICU中危重病人较多,急性肺损伤(ALI)与急性呼吸窘迫综合征(ARDS)较普通病房更为常见,常可由严重的感染、误吸、脓毒症、创伤、反复输血以及弥散性血管内凝血等因素引起,病理生理过程十分复杂,治疗也很困难,须从多个方面综合考虑,才能提高病人的生存率,挽救病人生命。     

红斑性肢痛症合并周围神经损害1例诊治分析

红斑性肢痛症是一种罕见的临床综合征,以肢端皮肤间歇性皮温升高、发红、肿胀及烧灼样痛为特点,病变主要累及四肢末端,尤以下肢多见,多呈对称分布,较少见于面部和耳部.其症状常因运动和遇热而加重,休息和遇冷而减轻.临床上常分为原发性和继发性两大类,其中原发性红斑性肢痛症,多认为与编码Nav1.7亚单位的SCN9A基因突变有关.目前该病发病机制尚不明确,治疗上缺乏确切有效的治疗方案,临床易误诊误治.本文报道了红斑性肢痛症合并周围神经损害1例,以期提高对该病的认识.     

Causal Attributions Predict Willingness to Support the Allocation of Funding to Lung Cancer Treatment Programs

Lung cancer patients may experience stigmatization as a result of the link between their disease and smoking, such as lack of public support for funding lung cancer treatment programs. This study examines whether causal attributions for the contraction of lung cancer predict the stigmatization of individuals with the disease by investigating willingness to support the allocation of funds to hypothetical lung cancer treatment programs. Participants were 766 undergraduate students. The findings indicate that participants who made causal attributions preferred to support the allocation of funding to programs that value the lives of breast cancer patients, rather than lung cancer patients. These findings have implications for understanding the influence of causal attributions on the stigmatization of lung cancer.     

Coenzyme Q10: a review of its promise as a neuroprotectant

Coenzyme Q10 (CoQ10) is a powerful antioxidant that buffers the potential adverse consequences of free radicals produced during oxidative phosphorylation in the inner mitochondrial membrane. Oxidative stress, resulting in glutathione loss and oxidative DNA and protein damage, has been implicated in many neurodegenerative disorders, including Alzheimer's disease, Parkinson's disease, and Huntington's disease. Experimental studies in animal models suggest that CoQ10 may protect against neuronal damage that is produced by ischemia, atherosclerosis and toxic injury. Though most have tended to be pilot studies, there are published preliminary clinical trials showing that CoQ10 may offer promise in many brain disorders. For example, a 16-month randomized, placebo-controlled pilot trial in 80 subjects with mild Parkinson's disease found significant benefits for oral CoQ10 1,200 mg/day to slow functional deterioration. However, to date, there are no published clinical trials of CoQ10 in Alzheimer's disease. Available data suggests that oral CoQ10 seems to be relatively safe and tolerated across the range of 300-2,400 mg/day. Randomized controlled trials are warranted to confirm CoQ10's safety and promise as a clinically effective neuroprotectant.     

ARDS液体管理：远非定论 尚需探索

急性肺损伤(ALI)和ARDS的特征改变是非心源性的肺水肿。几十年对这类患者液体管理是一个十分棘手的难题。目前趋向于两种液体管理策略,即非限制性液体管理策略或限制性或保守性液体管理策略。FACTT研究发表提供了ALI/ARDS管理的迄今最新的、最重要的证据,倾向限制性液体管理策略,但是孰是孰非尚未定论,还有很大争议,需要更多的研究、探索。     

Personality predictors of the time course for lung cancer onset

Numerous findings suggest that personality is linked to the incidence and experience of negative health outcomes. More specifically, trait negative affect is negatively related to a number of health outcomes. The current study expands our understanding of the link between personality and disease by examining the time course for lung cancer onset. In a sample of patients who had recently undergone surgical resection for lung cancer, a variety of negative affect related personality variables were assessed to determine their relationship with age at surgery. After controlling for smoking behavior, it was found that trait negative affect was associated with time course for lung cancer onset, such that those with higher (vs. lower) levels of trait negative affect manifested lung cancer earlier in their lives. Thus, trait negative affect represents an independent risk factor among those prone to lung cancer (i.e., smokers).