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Cardiovascular Biomarkers 心血管生物标记
Pub Date : 2018-08-20 DOI: 10.2310/tywc.1405
P. Gandhi, James L. Januzzi Jr
The value of circulating biomarkers to care for patients with cardiovascular disease has grown significantly over the last few decades. The majority of clinical data focus on the use of natriuretic peptides (NPs) for the diagnosis, prognosis, and management of patients with heart failure (HF) and troponin measurements in patients with suspected or proven acute coronary syndrome (ACS). Part of the reason for the slow adoption of biomarkers beyond these two classes has been limitation in the optimal modes of application of new assays. Future studies are needed to clarify the use of biomarkers, with the ultimate goal of simplifying the diagnosis, prognosis, and patient care of complex cardiovascular conditions. This chapter reviews the use of established biomarkers for HF, ACS, and atrial fibrillation (AF). Tables include a summary of emerging and established cardiovascular biomarkers, characteristics of B-type natriuretic peptide and amino-terminal pro-B-type natriuretic peptide, cutoff points for NP measurement, differential diagnosis of elevated NP concentrations, biomarkers in HF with preserved ejection fraction, summary of NP management trials, third universal definition of myocardial infarction, and guidelines for recommendations of biomarkers in HF. Figures depict the various causes of NP release, the complex mechanism of troponin release in patients with HF, the ischemic and nonischemic etiologies of troponin release, timing of biomarker release during myocardial infarction, and the biomarkers involved in the pathogenesis of AF. Algorithms demonstrate evaluating outpatients with dyspnea in the clinic using NPs in their workup and the use of troponin to assist with determining an appropriate management strategy for a patient with ACS.This review contains 7 highly rendered figures, 8 tables, and 202 references.
在过去的几十年里,循环生物标志物对心血管疾病患者的护理价值显著增长。大多数临床数据集中在利钠肽(NPs)用于心力衰竭(HF)患者的诊断、预后和管理以及疑似或确诊急性冠脉综合征(ACS)患者的肌钙蛋白测量。这两类之外的生物标记物采用缓慢的部分原因是新测定法的最佳应用模式受到限制。未来的研究需要明确生物标志物的用途,最终目标是简化复杂心血管疾病的诊断、预后和患者护理。本章回顾了HF、ACS和房颤(AF)的生物标志物的使用。表格包括新出现的和已建立的心血管生物标志物的总结,b型利钠肽和氨基末端前b型利钠肽的特征,NP测量的截止点,NP浓度升高的鉴别诊断,保留射血分数的心衰生物标志物,NP管理试验总结,心肌梗死的第三个通用定义,以及心衰生物标志物的推荐指南。图中描述了NP释放的各种原因,心衰患者肌钙蛋白释放的复杂机制,肌钙蛋白释放的缺血性和非缺血性病因,心肌梗死期间生物标志物释放的时间,以及与房颤发病机制相关的生物标志物。算法证明了在临床中使用NP评估门诊呼吸困难患者,并使用肌钙蛋白来帮助确定ACS患者的适当管理策略。这篇综述包含7个高度渲染的图,8个表和202个参考文献。
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引用次数: 5
Metabolic Alkalosis 代谢性碱中毒
Pub Date : 2018-08-20 DOI: 10.2310/tywc.12002
F. Chebib
Metabolic alkalosis is a common clinical problem encountered by the nephrologist. An understanding of the pathogenesis of this electrolyte disorder, which includes a generative and a maintenance phase, is essential to elucidating the etiology and deciding on the appropriate treatment. Metabolic alkalosis is characterized by an increase in pH, a decrease in [H+], and an increase in [HCO3–]. The generative phase of metabolic alkalosis involves either loss of acid (e.g., gastrointestinal losses), gain of bicarbonate (e.g., antacids), or cellular shift (e.g., hypokalemia). The maintenance phase involves impairment of the renal handling of bicarbonate (decreased glomerular filtration, increased bicarbonate tubular reabsorption). We discuss the different etiologies, such as chloride depletion (e.g., vomiting), potassium depletion (e.g., primary hyperaldosteronism), and hypercalcemic states (e.g., milk-alkali syndrome). This review also discusses the symptoms, diagnosis, and prognosis of metabolic alkalosis. A diagnostic algorithm based on volume status and urine electrolytes will help differentiate the different etiologies. Treatment options are summarized based on chloride-sensitive or chloride-resistant metabolic alkalosis.This review contains 5 figures, 3 tables and 12 references Key words: chloride resistance, chloride sensitivity, generative phase, maintenance phase, metabolic alkalosis, syndromes with metabolic alkalosis
代谢性碱中毒是肾脏科医生经常遇到的临床问题。了解这种电解质紊乱的发病机制,包括生成和维持阶段,对于阐明病因和决定适当的治疗是必不可少的。代谢性碱中毒的特点是pH升高,[H+]减少,[HCO3 -]增加。代谢性碱中毒的生成阶段包括酸的损失(如胃肠道损失)、碳酸氢盐的获得(如抗酸剂)或细胞移位(如低钾血症)。维持期包括肾脏对碳酸氢盐处理的损害(肾小球滤过减少,碳酸氢盐小管重吸收增加)。我们讨论了不同的病因,如氯化物消耗(如呕吐)、钾消耗(如原发性高醛固酮增多症)和高钙血症(如乳碱综合征)。本文还讨论了代谢性碱中毒的症状、诊断和预后。基于容量状态和尿电解质的诊断算法将有助于区分不同的病因。根据氯敏感或耐氯代谢性碱中毒的治疗方案进行了总结。关键词:氯耐药性,氯敏感性,生成期,维持期,代谢性碱中毒,代谢性碱中毒综合征
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引用次数: 0
Breast Cancer 乳腺癌
Pub Date : 2018-08-19 DOI: 10.2310/tywc.1183
N. Davidson
Invasive breast cancer, the most common nonskin cancer in women in the United States, will be diagnosed in 235,000 women in this country in 2013 and is expected to result in approximately 40,000 deaths. Incidence and mortality reached a plateau and appear to be dropping in both the United States and parts of western Europe. This decline has been attributed to several factors, such as early detection through the use of screening mammography and appropriate use of systemic adjuvant therapy, as well as decreased use of hormone replacement therapy. However, the global burden of breast cancer remains great, and global breast cancer incidence increased from 641,000 in 1980 to 1,643,000 in 2010, an annual rate of increase of 3.1%. This chapter examines the etiology, epidemiology, prevention, screening, staging, and prognosis of breast cancer. The diagnoses and treatments of the four stages of breast cancer are also included. Figures include algorithms used for the systemic treatment of stage IV breast cancer and hormone therapy for women with stage IV breast cancer. Tables describe selected outcomes from the National Surgical Adjuvant Breast and Bowel Project (NSABP) P-1 and P-2 chemoprevention trials, tamoxifen chemoprevention trials for breast cancer, the TNM staging system and stage groupings for breast cancer, some commonly used adjuvant chemotherapy regimens, an algorithm for suggested treatment for patients with operable breast cancer from the 2011 St. Gallen consensus conference, guidelines for surveillance of asymptomatic early breast cancer survivors from the American Society of Clinical Oncology, and newer agents for metastatic breast cancer commercially available in the United States.This review contains 2 highly rendered figures, 8 tables, and 108 references.
浸润性乳腺癌是美国女性中最常见的非皮肤癌,2013年美国将有23.5万名女性被诊断出患有浸润性乳腺癌,预计将导致约4万人死亡。在美国和西欧部分地区,发病率和死亡率达到了一个平稳期,似乎正在下降。这种下降归因于几个因素,例如通过使用筛查乳房x光检查早期发现和适当使用全身辅助治疗,以及减少使用激素替代疗法。然而,全球乳腺癌负担仍然很大,全球乳腺癌发病率从1980年的64.1万例增加到2010年的164.3万例,年增长率为3.1%。本章探讨乳腺癌的病因、流行病学、预防、筛查、分期和预后。同时也包括了乳腺癌的四个阶段的诊断和治疗。数据包括用于四期乳腺癌全身治疗和四期乳腺癌女性激素治疗的算法。表格描述了国家手术辅助乳腺和肠项目(NSABP) P-1和P-2化学预防试验的选择结果,乳腺癌的他莫昔芬化学预防试验,乳腺癌的TNM分期系统和分期分组,一些常用的辅助化疗方案,2011年圣加仑共识会议上可手术乳腺癌患者的建议治疗算法。来自美国临床肿瘤学会的无症状早期乳腺癌幸存者监测指南,以及美国市售的转移性乳腺癌新药。这篇综述包含2个高度渲染的图,8个表和108个参考文献。
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引用次数: 0
Scleroderma and Related Disorders 硬皮病及相关疾病
Pub Date : 2018-08-19 DOI: 10.1016/b978-0-323-55408-4.50023-9
K. Phillips
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引用次数: 0
Postoperative Pain Management 术后疼痛处理
Pub Date : 2018-08-19 DOI: 10.2310/tywc.2021
Abhishek D. Parmar
The aim of this review is to provide practical clinical information on modern pain management options to guide the clinician on evidence-based practices, optimizing the treatment of pain and avoiding practices that may lead to potential abuse. Postoperative pain management is an essential component of any surgeon’s practice and has clear implications for surgical outcomes, patient satisfaction, and population health. Understanding options within a multimodal approach to pain management in the acute setting is a key determinant to improving outcomes for our patients. This review discusses multimodal analgesic options, including a variety of pain medications (opiates, antiinflammatory medications, and patient-controlled analgesia) and techniques (epidural catheter placement, regional nerve blocks) to be used in tandem. Lastly, best possible practices to avoid opiate abuse are discussed.This review contains 4 figures, 5 tables, 1 video and 96 references.Key words: antiinflammatories, epidural, narcotics, patient-controlled analgesia, postoperative pain, regional nerve block
本综述的目的是为现代疼痛管理方案提供实用的临床信息,以指导临床医生进行循证实践,优化疼痛治疗并避免可能导致潜在滥用的实践。术后疼痛管理是任何外科医生实践的重要组成部分,对手术结果、患者满意度和人群健康有着明确的影响。了解急性疼痛管理的多模式方法中的选择是改善患者预后的关键决定因素。这篇综述讨论了多种镇痛选择,包括多种疼痛药物(阿片类药物,抗炎药物和患者控制镇痛)和技术(硬膜外导管放置,区域神经阻滞)串联使用。最后,讨论了避免阿片类药物滥用的最佳可能做法。本综述包含图4张,表5张,视频1段,参考文献96篇。关键词:抗炎药,硬膜外麻醉,患者自控镇痛,术后疼痛,局部神经阻滞
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引用次数: 0
Cervical Cancer Screening 子宫颈癌普查
Pub Date : 2018-08-19 DOI: 10.2310/tywc.19006
Huma Farid
Since the Papanicolaou (Pap) smear became implemented as a screening tool for cervical cancer, the mortality from cervical cancer has sharply declined in the United States. The discovery of the human papillomavirus (HPV) as the causative agent in the progression from dysplasia of the cervix to cervical cancer has changed the types of screening offered to women and the management of abnormal Pap smears. The management of abnormal Pap smears has changed depending on the age of the woman, with women under the age of 24 years being managed more conservatively given the low rates of cervical cancer in this age group and the high rates of regression of HPV and cytologic abnormalities. Colposcopy remains the first line in evaluation of an abnormal Pap smear, with excisional treatment reserved for high-grade dysplasias with a high risk of progression to cervical cancer. Treatment for cervical dysplasia is highly effective, but even after treatment, there is an increased risk of recurrence or progression to cervical cancer for up to 20 years, and these women should be followed closely.This review contains 18 figures, 3 tables and 53 referencesKey words: cervical cancer screening, high-grade cervical dysplasia, human papillomavirus, low-grade cervical dysplasia, management of abnormal Pap smears, Pap smear, recurrence of cervical dysplasia, treatment of dysplasia
自从巴氏涂片作为宫颈癌的筛查工具实施以来,美国宫颈癌的死亡率急剧下降。人类乳头瘤病毒(HPV)是导致子宫颈发育不良发展为宫颈癌的病原体,这一发现改变了向妇女提供的筛查类型和异常子宫颈抹片检查的处理方法。异常子宫颈抹片检查的处理因妇女的年龄而异,24岁以下妇女的处理更为保守,因为该年龄组宫颈癌发病率低,而人乳头瘤病毒和细胞学异常的消退率高。阴道镜检查仍然是评估异常巴氏涂片的第一线方法,切除治疗保留给高度发育不良且进展为宫颈癌的高风险患者。宫颈发育不良的治疗非常有效,但即使在治疗后,复发或发展为宫颈癌的风险也会增加,最长可达20年,这些妇女应密切随访。关键词:宫颈癌筛查、高级别宫颈发育不良、人乳头瘤病毒、低级别宫颈发育不良、异常子宫颈抹片检查的处理、子宫颈抹片检查、宫颈发育不良复发、异常增生的治疗
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引用次数: 0
Preconception Care 孕前保健
Pub Date : 2018-08-19 DOI: 10.2310/tywc.19018
L. Bookman, T. Mupombwa
The goal of preconception care is to optimize the health and knowledge of every woman prior to pregnancy. Inquiring about plans for pregnancy can occur at any patient encounter, not just at a scheduled preconception care visit, because many women do not present for care until they are already pregnant. Identifying medical, social, environmental, and psychological risks prior to pregnancy can lead to interventions that may enhance the health of both mother and baby. Relevant preconception issues discussed in this review include medications; medical, surgical, mental health, and social history, including substance use and intimate partner violence; immunization recommendations; nutrition; genetic screening; and infectious disease.This review contains 2 figures, 3 tables and 51 referencesKey words: depression, diabetes, exercise, hypertension, immunizations, intimate partner violence, nutrition, preconception care, reproductive life plan, thyroid disease
孕前护理的目标是优化每个妇女在怀孕前的健康和知识。询问怀孕计划可以在任何病人就诊时进行,而不仅仅是在预定的孕前保健就诊时,因为许多妇女直到怀孕后才来就诊。在怀孕前确定医疗、社会、环境和心理风险,可采取干预措施,增进母婴健康。本综述中讨论的相关孕前问题包括药物治疗;医疗、外科、精神健康和社会历史,包括药物使用和亲密伴侣暴力;免疫接种的建议;营养;遗传筛查;还有传染病。关键词:抑郁症、糖尿病、运动、高血压、免疫、亲密伴侣暴力、营养、孕前保健、生殖生活计划、甲状腺疾病
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引用次数: 0
Pediatric Minor Head Injury and Concussion 儿童轻微头部损伤和脑震荡
Pub Date : 2018-08-19 DOI: 10.2310/tywc.4415
C. Scarboro, Simone L. Lawson
Head injury is one of the most common reasons children present to the emergency department (ED) and the leading cause of pediatric death and disability. Head injuries can range from having no neurologic deficits to death. Management in the ED centers on determining if there is a serious brain injury and preventing secondary brain injury. In most cases of mild traumatic brain injury, serious injuries can be ruled out based on the history of the injury, associated symptoms, and clinical assessment. Concussion is a common presentation of head injury and encompasses a wide range of symptoms. Computed tomography should be used judiciously, and extensive research has led to algorithms to aid in this decision. Prior to discharge from the ED, parents will often have questions about when their child may resume normal activity. This is a decision that most often will involve the patient’s primary care provider or a concussion specialist as the ED provider is unable to follow progression or resolution of symptoms. However, the ED provider should be able to provide anticipatory guidance. Key words: computed tomography, concussion, head injury, mild traumatic brain injury, traumatic brain injury
头部损伤是儿童到急诊科就诊的最常见原因之一,也是儿童死亡和残疾的主要原因。头部损伤的范围可以从没有神经功能缺陷到死亡。急诊科的管理重点是确定是否有严重的脑损伤和预防继发性脑损伤。在大多数轻度创伤性脑损伤病例中,可根据损伤史、相关症状和临床评估排除严重损伤。脑震荡是一种常见的头部损伤的表现,包括广泛的症状。计算机断层扫描应该明智地使用,广泛的研究已经导致算法来帮助这个决定。在从急诊室出院之前,父母通常会有关于孩子何时可以恢复正常活动的问题。这通常需要患者的初级保健医生或脑震荡专家做出决定,因为急诊科医生无法跟踪症状的进展或消退。然而,ED提供者应该能够提供预期的指导。关键词:计算机断层扫描,脑震荡,颅脑损伤,轻度创伤性脑损伤,创伤性脑损伤
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引用次数: 0
Tumor Immunology 肿瘤免疫学
Pub Date : 2018-08-19 DOI: 10.2310/tywc.1180
Rachel L. G. Maus, Haidong Dong, S. Markovic
The immune system has effectively evolved to protect the host against foreign invaders, including bacterial, viral, and parasitic infiltrates. Less clear has been the interaction and the protective effects the immune system mounts against its own infiltrates: cancer cells. Here we consider the dynamic interactions between cancer and the associated host immune response by highlighting the key players involved in engaging an effective antitumor immune response and the mechanisms responsible for enabling the evolution of cancer cells to escape immunosurveillance. By developing an appreciation for the dual function of the immune system in the setting of cancer biology, we also consider the clever strategies that have been employed to uncover tumor targets, including tumor-associated antigens and the mechanisms for enhancing or reengaging the immune system to mount an effective antitumor immune response. Finally, we incorporate these key findings into the context of immunotherapy, a rapidly evolving field aimed at combating tumor escape by enabling the host immune system to regain its tumor-eradicating functions.This review contains 5 figures, 9 tables and 60 referencesKey words: adoptive T cell therapy, checkpoint inhibitors, cytokine therapy, immunotherapy, neutralizing antibodies, tumor immunity, tumor microenvironment, vaccines 
免疫系统已经有效地进化,以保护宿主免受外来入侵者的侵害,包括细菌、病毒和寄生虫的渗透。不太清楚的是它们之间的相互作用,以及免疫系统对自身浸润物——癌细胞——的保护作用。在这里,我们通过强调参与有效抗肿瘤免疫反应的关键参与者和负责使癌细胞进化逃避免疫监视的机制,来考虑癌症和相关宿主免疫反应之间的动态相互作用。通过对免疫系统在癌症生物学背景下的双重功能的认识,我们还考虑了用于发现肿瘤靶点的聪明策略,包括肿瘤相关抗原和增强或重新参与免疫系统以建立有效抗肿瘤免疫反应的机制。最后,我们将这些关键发现纳入免疫治疗的背景下,这是一个快速发展的领域,旨在通过使宿主免疫系统恢复其肿瘤根除功能来对抗肿瘤逃逸。关键词:过继性T细胞治疗,检查点抑制剂,细胞因子治疗,免疫治疗,中和抗体,肿瘤免疫,肿瘤微环境,疫苗
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引用次数: 0
Genitourinary Trauma 泌尿生殖器的创伤
Pub Date : 2018-08-19 DOI: 10.1007/978-1-4471-6359-6_18
D. Lakoff, Adam D Hill
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引用次数: 0
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DeckerMed Transitional Year Weekly Curriculum™
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