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Rotator cuff tears. 肩袖撕裂
IF 81.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-02-08 DOI: 10.1038/s41572-024-00492-3
Asheesh Bedi, Julie Bishop, Jay Keener, Drew A Lansdown, Ofer Levy, Peter MacDonald, Nicola Maffulli, Joo Han Oh, Vani J Sabesan, Joaquin Sanchez-Sotelo, Riley J Williams, Brian T Feeley

Rotator cuff tears are the most common upper extremity condition seen by primary care and orthopaedic surgeons, with a spectrum ranging from tendinopathy to full-thickness tears with arthritic change. Some tears are traumatic, but most rotator cuff problems are degenerative. Not all tears are symptomatic and not all progress, and many patients in whom tears become more extensive do not experience symptom worsening. Hence, a standard algorithm for managing patients is challenging. The pathophysiology of rotator cuff tears is complex and encompasses an interplay between the tendon, bone and muscle. Rotator cuff tears begin as degenerative changes within the tendon, with matrix disorganization and inflammatory changes. Subsequently, tears progress to partial-thickness and then full-thickness tears. Muscle quality, as evidenced by the overall size of the muscle and intramuscular fatty infiltration, also influences symptoms, tear progression and the outcomes of surgery. Treatment depends primarily on symptoms, with non-operative management sufficient for most patients with rotator cuff problems. Modern arthroscopic repair techniques have improved recovery, but outcomes are still limited by a lack of understanding of how to improve tendon to bone healing in many patients.

肩袖撕裂是初级保健和矫形外科医生最常见的上肢疾病,其范围从肌腱病变到伴有关节炎变化的全厚撕裂不等。有些撕裂是创伤性的,但大多数肩袖问题是退行性的。并非所有的撕裂都会出现症状,也并非所有的撕裂都会发展,许多撕裂范围更广的患者并不会出现症状恶化。因此,制定治疗患者的标准算法具有挑战性。肩袖撕裂的病理生理学非常复杂,包括肌腱、骨骼和肌肉之间的相互作用。肩袖撕裂最初是肌腱内部的退行性变化,伴有基质紊乱和炎症变化。随后,撕裂发展为部分厚度撕裂,然后是全厚度撕裂。肌肉质量(表现为肌肉的整体大小和肌肉内脂肪浸润)也会影响症状、撕裂进展和手术效果。治疗主要取决于症状,非手术治疗足以治愈大多数肩袖问题患者。现代关节镜修复技术改善了患者的恢复情况,但由于对如何改善许多患者肌腱与骨骼的愈合缺乏了解,治疗效果仍受到限制。
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引用次数: 0
Rotator cuff tears. 肩袖撕裂
IF 81.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-02-08 DOI: 10.1038/s41572-024-00499-w
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引用次数: 0
Perioperative stroke. 围手术期中风。
IF 81.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-18 DOI: 10.1038/s41572-024-00494-1
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引用次数: 0
Perioperative stroke. 围手术期中风。
IF 81.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-18 DOI: 10.1038/s41572-023-00487-6
Jonathon P Fanning, Bruce C V Campbell, Richard Bulbulia, Rebecca F Gottesman, Sang-Bae Ko, Thomas F Floyd, Steven R Messé

Ischaemic or haemorrhagic perioperative stroke (that is, stroke occurring during or within 30 days following surgery) can be a devastating complication following surgery. Incidence is reported in the 0.1-0.7% range in adults undergoing non-cardiac and non-neurological surgery, in the 1-5% range in patients undergoing cardiac surgery and in the 1-10% range following neurological surgery. However, higher rates have been reported when patients are actively assessed and in high-risk populations. Prognosis is significantly worse than stroke occurring in the community, with double the 30-day mortality, greater disability and diminished quality of life among survivors. Considering the annual volume of surgeries performed worldwide, perioperative stroke represents a substantial burden. Despite notable differences in aetiology, patient populations and clinical settings, existing clinical recommendations for perioperative stroke are extrapolated mainly from stroke in the community. Perioperative in-hospital stroke is unique with respect to the stroke occurring in other settings, and it is essential to apply evidence from other settings with caution and to identify existing knowledge gaps in order to effectively guide patient care and future research.

缺血性或出血性围手术期中风(即手术期间或术后 30 天内发生的中风)可能是手术后的一种破坏性并发症。据报道,接受非心脏和非神经系统手术的成人发病率在 0.1-0.7% 之间,接受心脏手术的患者发病率在 1-5% 之间,接受神经系统手术的患者发病率在 1-10% 之间。然而,在对患者进行积极评估时以及在高危人群中,报告的发病率更高。预后比在社区发生的中风要差得多,30 天死亡率高出一倍,幸存者的残疾程度更高,生活质量更低。考虑到全世界每年的手术量,围手术期中风是一个沉重的负担。尽管病因、患者人群和临床环境存在显著差异,但现有的围术期卒中临床建议主要是根据社区卒中推断出来的。院内围术期卒中与其他环境下发生的卒中相比具有独特性,因此必须谨慎应用其他环境下的证据,并找出现有的知识差距,以有效指导患者护理和未来研究。
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引用次数: 0
Publisher Correction: Pulmonary hypertension. 出版商更正:肺动脉高压。
IF 81.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-17 DOI: 10.1038/s41572-024-00493-2
Ana Mocumbi, Marc Humbert, Anita Saxena, Zhi-Cheng Jing, Karen Sliwa, Friedrich Thienemann, Stephen L Archer, Simon Stewart
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引用次数: 0
Pulmonary hypertension. 肺动脉高压
IF 81.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-04 DOI: 10.1038/s41572-023-00491-w
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引用次数: 0
Pulmonary hypertension 肺动脉高压
IF 81.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-04 DOI: 10.1038/s41572-023-00486-7
Ana Mocumbi, Marc Humbert, Anita Saxena, Zhi-Cheng Jing, Karen Sliwa, Friedrich Thienemann, Stephen L. Archer, Simon Stewart

Pulmonary hypertension encompasses a range of conditions directly or indirectly leading to elevated pressures within the pulmonary arteries. Five main groups of pulmonary hypertension are recognized, all defined by a mean pulmonary artery pressure of >20 mmHg: pulmonary arterial hypertension (rare), pulmonary hypertension associated with left-sided heart disease (very common), pulmonary hypertension associated with lung disease (common), pulmonary hypertension associated with pulmonary artery obstructions, usually related to thromboembolic disease (rare), and pulmonary hypertension with unclear and/or multifactorial mechanisms (rare). At least 1% of the world’s population is affected, with a greater burden more likely in low-income and middle-income countries. Across all its forms, pulmonary hypertension is associated with adverse vascular remodelling with obstruction, stiffening and vasoconstriction of the pulmonary vasculature. Without proactive management this leads to hypertrophy and ultimately failure of the right ventricle, the main cause of death. In older individuals, dyspnoea is the most common symptom. Stepwise investigation precedes definitive diagnosis with right heart catheterization. Medical and surgical treatments are approved for pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. There are emerging treatments for other forms of pulmonary hypertension; but current therapy primarily targets the underlying cause. There are still major gaps in basic, clinical and translational knowledge; thus, further research, with a focus on vulnerable populations, is needed to better characterize, detect and effectively treat all forms of pulmonary hypertension.

肺动脉高压包括一系列直接或间接导致肺动脉内压力升高的疾病。肺动脉高压(罕见)、与左侧心脏疾病相关的肺动脉高压(非常常见)、与肺部疾病相关的肺动脉高压(常见)、与肺动脉阻塞相关的肺动脉高压(通常与血栓栓塞性疾病有关)(罕见),以及机制不明和/或多因素的肺动脉高压(罕见)。全世界至少有 1%的人口受到肺动脉高压的影响,而在低收入和中等收入国家,肺动脉高压的发病率更高。各种形式的肺动脉高压都与肺血管阻塞、硬化和血管收缩等不良血管重塑有关。如果不积极治疗,就会导致右心室肥大,最终导致右心室衰竭,这是导致死亡的主要原因。在老年人中,呼吸困难是最常见的症状。在通过右心导管检查明确诊断之前,应进行逐步检查。肺动脉高压和慢性血栓栓塞性肺动脉高压的药物和手术治疗已获批准。其他形式的肺动脉高压也有新的治疗方法,但目前的治疗主要针对潜在病因。在基础、临床和转化知识方面仍存在重大差距;因此,需要进一步开展研究,重点关注易感人群,以更好地描述、检测和有效治疗各种形式的肺动脉高压。
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引用次数: 0
Central neuropathic pain. 中枢神经痛
IF 76.9 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-21 DOI: 10.1038/s41572-023-00484-9
Jan Rosner, Daniel C de Andrade, Karen D Davis, Sylvia M Gustin, John L K Kramer, Rebecca P Seal, Nanna B Finnerup

Central neuropathic pain arises from a lesion or disease of the central somatosensory nervous system such as brain injury, spinal cord injury, stroke, multiple sclerosis or related neuroinflammatory conditions. The incidence of central neuropathic pain differs based on its underlying cause. Individuals with spinal cord injury are at the highest risk; however, central post-stroke pain is the most prevalent form of central neuropathic pain worldwide. The mechanisms that underlie central neuropathic pain are not fully understood, but the pathophysiology likely involves intricate interactions and maladaptive plasticity within spinal circuits and brain circuits associated with nociception and antinociception coupled with neuronal hyperexcitability. Modulation of neuronal activity, neuron-glia and neuro-immune interactions and targeting pain-related alterations in brain connectivity, represent potential therapeutic approaches. Current evidence-based pharmacological treatments include antidepressants and gabapentinoids as first-line options. Non-pharmacological pain management options include self-management strategies, exercise and neuromodulation. A comprehensive pain history and clinical examination form the foundation of central neuropathic pain classification, identification of potential risk factors and stratification of patients for clinical trials. Advanced neurophysiological and neuroimaging techniques hold promise to improve the understanding of mechanisms that underlie central neuropathic pain and as predictive biomarkers of treatment outcome.

中枢性神经病理性疼痛源于中枢躯体感觉神经系统的病变或疾病,如脑损伤、脊髓损伤、中风、多发性硬化症或相关的神经炎症。中枢神经痛的发病率因其潜在病因而异。脊髓损伤患者的风险最高;然而,中风后中枢性疼痛是全球最普遍的中枢神经病理痛形式。中枢性神经病理性疼痛的发病机制尚不完全清楚,但其病理生理学可能涉及脊髓回路和大脑回路中与痛觉和抗痛觉相关的错综复杂的相互作用和不适应的可塑性,以及神经元的过度兴奋性。调节神经元活动、神经元-胶质细胞和神经-免疫相互作用,以及针对大脑连接中与疼痛相关的改变,是潜在的治疗方法。目前以证据为基础的药物治疗包括作为一线选择的抗抑郁药和加巴喷丁类药物。非药物疼痛治疗方法包括自我管理策略、运动和神经调节。全面的疼痛病史和临床检查是中枢神经病理疼痛分类、潜在风险因素识别和临床试验患者分层的基础。先进的神经生理学和神经影像学技术有望加深人们对中枢神经病理痛发病机制的了解,并可作为治疗效果的预测性生物标志物。
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引用次数: 0
Central neuropathic pain. 中枢神经痛
IF 81.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-21 DOI: 10.1038/s41572-023-00489-4
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引用次数: 0
Typhoid fever 伤寒
IF 81.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-14 DOI: 10.1038/s41572-023-00480-z
James E. Meiring, Farhana Khanam, Buddha Basnyat, Richelle C. Charles, John A. Crump, Frederic Debellut, Kathryn E. Holt, Samuel Kariuki, Emmanuel Mugisha, Kathleen M. Neuzil, Christopher M. Parry, Virginia E. Pitzer, Andrew J. Pollard, Firdausi Qadri, Melita A. Gordon

Typhoid fever is an invasive bacterial disease associated with bloodstream infection that causes a high burden of disease in Africa and Asia. Typhoid primarily affects individuals ranging from infants through to young adults. The causative organism, Salmonella enterica subsp. enterica serovar Typhi is transmitted via the faecal–oral route, crossing the intestinal epithelium and disseminating to systemic and intracellular sites, causing an undifferentiated febrile illness. Blood culture remains the practical reference standard for diagnosis of typhoid fever, where culture testing is available, but novel diagnostic modalities are an important priority under investigation. Since 2017, remarkable progress has been made in defining the global burden of both typhoid fever and antimicrobial resistance; in understanding disease pathogenesis and immunological protection through the use of controlled human infection; and in advancing effective vaccination programmes through strategic multipartner collaboration and targeted clinical trials in multiple high-incidence priority settings. This Primer thus offers a timely update of progress and perspective on future priorities for the global scientific community.

伤寒是一种与血液感染相关的侵袭性细菌性疾病,在非洲和亚洲造成很高的疾病负担。伤寒主要影响从婴儿到年轻人的个体。致病菌,肠沙门氏菌亚种。血清型伤寒通过粪口途径传播,穿过肠上皮,传播到全身和细胞内部位,引起未分化的发热性疾病。在可进行培养试验的地方,血培养仍然是诊断伤寒的实用参考标准,但新的诊断方式是正在研究的一个重要优先事项。自2017年以来,在确定伤寒和抗菌素耐药性的全球负担方面取得了显著进展;通过控制人类感染了解疾病发病机制和免疫保护;通过战略性多伙伴合作和在多个高发重点环境中进行有针对性的临床试验,推进有效的疫苗接种规划。因此,这本入门书为全球科学界提供了进展的及时更新和对未来优先事项的看法。
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Nature Reviews Disease Primers
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