Medicine (Abingdon, England : UK ed.)最新文献

英文中文

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-11-01 DOI: 10.1016/j.mpmed.2025.08.006

Kos De Silva, Dan Fitzpatrick, Courtney Kipps

Sport and exercise medicine (SEM) is a relatively new specialism in the UK National Health Service (NHS). As the NHS long-term plan continues to emphasize preventive health and cost-effective care, integrating SEM physicians into patient management pathways offers a strategic approach to achieving these goals. With training in musculoskeletal medicine, exercise medicine, sports and team care, SEM specialists can play a role in promoting physical activity and exercise on both an individual and a population level to improve health and treat long-term conditions. Beyond preventive health, SEM contributes to reducing the burden of musculoskeletal conditions on public healthcare services. An SEM physician's role extends from treating sport and physical activity-related injuries to guiding patients in maintaining or regaining physical activity. Musculoskeletal injuries inevitably limit physical activity levels, while timely interventions from an SEM physician can minimize these adverse effects and improve overall health outcomes. SEM physicians can translate the lessons learned from elite sport and apply evidence-based strategies to benefit the wider population. This chapter explores key topics in SEM, from injuries to exercise medicine.

运动和运动医学（SEM）是英国国民健康服务（NHS）的一个相对较新的专业。由于NHS长期计划继续强调预防性健康和具有成本效益的护理，将SEM医生整合到患者管理途径中提供了实现这些目标的战略方法。通过肌肉骨骼医学、运动医学、运动和团队护理方面的培训，SEM专家可以在促进个人和人群的身体活动和锻炼方面发挥作用，以改善健康和治疗长期疾病。除了预防保健外，扫描电镜还有助于减轻肌肉骨骼疾病对公共医疗保健服务的负担。扫描电镜医生的角色从治疗运动和身体活动相关的伤害延伸到指导患者保持或恢复身体活动。肌肉骨骼损伤不可避免地限制了身体活动水平，而扫描电镜医生的及时干预可以最大限度地减少这些不利影响并改善整体健康状况。SEM医生可以从精英运动中吸取经验教训，并应用基于证据的策略来造福更广泛的人群。本章探讨了从损伤到运动医学等SEM中的关键主题。

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引用次数: 0

The rheumatological examination 风湿病检查

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-11-01 DOI: 10.1016/j.mpmed.2025.08.009

Lucy Maltas, Rebecca Batten, David Coady

Musculoskeletal disorders are the most common cause of disability in the UK. They are associated with significant morbidity and polypharmacy, particularly in an ageing population with multiple co-morbidities. Two programmes of examination that have been developed are a screening assessment (Gait, Arms, Legs, Spine (GALS)) and a more in-depth Regional Examination of the Musculoskeletal System (REMS). These programmes provide a structured assessment, which enables competent and confident examination skills, ensuring an accurate diagnosis.

肌肉骨骼疾病是英国最常见的致残原因。它们与严重的发病率和多重用药有关，特别是在患有多种合并症的老龄化人口中。已经制定的两个检查计划是筛查评估（步态，手臂，腿，脊柱（GALS））和更深入的肌肉骨骼系统区域检查（REMS）。这些方案提供了一个结构化的评估，使其能够胜任和自信的检查技能，确保准确的诊断。

引用次数: 0

Self-assessment/CPD answers 自我评价/ CPD答案

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-11-01 DOI: 10.1016/j.mpmed.2025.09.003

引用次数: 0

Adult-onset Still's disease 成人发病的斯蒂尔氏病

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-11-01 DOI: 10.1016/j.mpmed.2025.09.001

Christopher Saleh

Adult-onset Still's disease (AOSD) is a rare autoinflammatory condition characterized by daily high fever, joint pain and a salmon-pink rash. Diagnosis is challenging because of symptom overlap with infections, malignancy and other rheumatological disease. AOSD is a diagnosis of exclusion. The clinical presentation can follow a monophasic, intermittent or chronic pattern, with macrophage activation syndrome being a life-threatening complication. Management depends on disease severity, ranging from non-steroidal anti-inflammatory agents and low-dose glucocorticoids for mild cases to high-dose glucocorticoids and biologic agents. Early referral to rheumatology services is important to confirm the diagnosis and optimize treatment. The prognosis is generally favourable, although relapse is common, particularly with chronic disease patterns or in individuals with significant organ involvement. Close follow-up is necessary to monitor disease activity and response to treatment.

成人发病斯蒂尔氏病（AOSD）是一种罕见的自身炎症性疾病，其特征是每日发高烧，关节疼痛和鲑鱼粉红色皮疹。诊断是具有挑战性的，因为症状重叠感染，恶性肿瘤和其他风湿病。AOSD是一种排除性诊断。临床表现可为单相、间歇性或慢性模式，巨噬细胞激活综合征是危及生命的并发症。治疗取决于疾病的严重程度，从非甾体抗炎药和用于轻度病例的低剂量糖皮质激素到高剂量糖皮质激素和生物制剂。早期转诊到风湿病服务是重要的，以确认诊断和优化治疗。虽然复发是常见的，特别是慢性疾病模式或有重要器官受累的个体，但预后通常是良好的。密切随访是监测疾病活动和治疗反应的必要条件。

引用次数: 0

Rheumatic immune-mediated complications of checkpoint inhibitors 风湿病免疫介导的检查点抑制剂并发症

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-11-01 DOI: 10.1016/j.mpmed.2025.08.010

Rhiju Shaunak Chatterjee, Rosalind Benson

Immune checkpoint inhibitors (ICIs) are immunotherapies that improve cancer survival by activating the immune system to recognize the tumour. Most patients tolerate immunotherapy, but 1 in 3–4 experience immune-related adverse events (irAEs) resulting from an autoimmune-like inflammation in healthy organs. Rheumatological irAEs include inflammatory arthritis, myositis, polymyalgia rheumatica, giant cell arteritis, small-vessel vasculitis, psoriasis, Sjӧgren's disease, systemic sclerosis and systemic lupus erythematous (SLE). Individuals with pre-existing rheumatological conditions commonly experience flares of their condition when treated with ICIs. Rheumatological irAEs often present similarly to classical rheumatological conditions. However, ICI-induced myositis, which can be particularly rapid and severe, can present with ocular, bulbar, neck and diaphragm weakness and concomitant myasthenia gravis and myocarditis. Typical investigation findings with rheumatological irAEs include raised inflammatory markers, although the autoantibody screen is often negative. Ultrasonography or magnetic resonance imaging can confirm an inflammatory process. Management principles are based on disease severity. Treatment ranges from anti-inflammatory agents to inpatient management with intravenous methylprednisolone with additional disease-modifying antirheumatic drugs or immunosuppressants. Careful collaboration with oncologists is advised, and in some cases ICIs are discontinued.

免疫检查点抑制剂（ICIs）是一种通过激活免疫系统识别肿瘤来提高癌症生存率的免疫疗法。大多数患者耐受免疫治疗，但1 / 3的患者会经历由健康器官自身免疫样炎症引起的免疫相关不良事件（irAEs）。风湿性关节炎包括炎性关节炎、肌炎、风湿性多肌痛、巨细胞动脉炎、小血管炎、牛皮癣、Sjӧgren病、系统性硬化症和系统性红斑狼疮（SLE）。已有风湿病的个体在使用ICIs治疗时通常会出现病情发作。风湿病irae通常表现与经典风湿病相似。然而，ici引起的肌炎可特别迅速和严重，可表现为眼、球、颈和膈肌无力，并伴有重症肌无力和心肌炎。风湿病irAEs的典型调查结果包括炎症标志物升高，尽管自身抗体筛查通常为阴性。超声或磁共振成像可以确认炎症过程。管理原则以疾病严重程度为基础。治疗范围从消炎药到住院治疗，静脉注射甲基强的松龙和其他改善疾病的抗风湿药物或免疫抑制剂。建议与肿瘤学家密切合作，在某些情况下停止使用ICIs。

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引用次数: 0

Rheumatology: introduction 风湿病学:介绍

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-11-01 DOI: 10.1016/j.mpmed.2025.08.003

Pippa Watson, Rosalind Benson

引用次数: 0

Synovial fluid tests 滑液试验

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-11-01 DOI: 10.1016/j.mpmed.2025.08.005

Zoe Syrimi, Muddassir Shaikh

Synovial fluid (SF) analysis provides valuable information to help clinicians determine the underlying cause of a joint effusion. The differential diagnosis of a swollen joint is broad and includes septic arthritis, crystal arthritis, rheumatoid arthritis, osteoarthritis and haemarthrosis. This article discusses the procedure of joint aspiration, including indications, contraindications and potential risks. It then discusses the routine tests performed on SF, including gross analysis, Gram staining and bacterial culture, white cell count and crystal analysis and how to interpret the results. Also discussed are newer molecular diagnostics tests that can help in cases where suspicion of septic arthritis is high, but SF culture is negative.

滑液（SF）分析提供有价值的信息，帮助临床医生确定关节积液的根本原因。关节肿胀的鉴别诊断很广泛，包括脓毒性关节炎、水晶关节炎、类风湿关节炎、骨关节炎和血关节病。本文讨论了关节抽吸的手术过程，包括适应症、禁忌症和潜在风险。然后讨论了SF的常规检查，包括大体分析、革兰氏染色和细菌培养、白细胞计数和晶体分析，以及如何解释结果。还讨论了新的分子诊断测试，可以帮助在脓毒性关节炎的怀疑很高，但SF培养是阴性的情况下。

引用次数: 0

Mpox Mpox

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-11-01 DOI: 10.1016/j.mpmed.2025.09.002

Matthew Jayne, Niall Ahmad, Christopher Ward

Mpox is a disease caused by infection with monkeypox virus. This virus has triggered two global public health emergencies since 2022. It has two genetic clades, the 2022–2023 West African outbreak being associated with clade II and the outbreak declared in August 2024 associated with clade I and Central Africa. Transmission can be zoonotic or human-to-human, with the recent global spread linked to sexual activity. It is most associated with its characteristic papulovesicular rash and mild systemic symptoms but can also cause anorectal or pharyngeal disease at the site of inoculation, or progress to severe multiorgan disease. Diagnosis is made based on epidemiological risk and clinical presentation but can be confirmed by polymerase chain reaction. Disease is self-limiting in most patients although antivirals, including tecovirimat, cidofovir and brincidofovir, have been used in severe cases. Infection control, vaccination of high-risk groups and a coordinated global approach are critical for controlling transmission.

猴痘是一种由猴痘病毒感染引起的疾病。自2022年以来，这种病毒引发了两次全球突发公共卫生事件。它有两个遗传进化支，2022-2023年西非暴发与II进化支有关，2024年8月宣布的暴发与I进化支和中非有关。传播可以是人畜共患或人与人之间的传播，最近的全球传播与性活动有关。它与特征性丘疹和轻度全身性症状最相关，但也可引起接种部位的肛肠或咽疾病，或发展为严重的多器官疾病。根据流行病学风险和临床表现作出诊断，但可通过聚合酶链反应确诊。在大多数患者中，疾病是自限性的，尽管在严重病例中使用了抗病毒药物，包括替可维玛、西多福韦和布里多福韦。感染控制、高危人群疫苗接种和协调一致的全球方法对控制传播至关重要。

引用次数: 0

Multiple endocrine neoplasia 多发性内分泌瘤

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-10-01 DOI: 10.1016/j.mpmed.2025.07.002

Paul J. Newey

Multiple endocrine neoplasia (MEN) describes the occurrence of tumours affecting two or more endocrine glands in one individual. Two main forms are recognized: type 1 (MEN1) and type 2 (MEN2). MEN1 is characterized by the combined occurrence of parathyroid, pituitary and pancreatic neuroendocrine tumours, whereas MEN2 features medullary thyroid cancer in association with phaeochromocytoma and parathyroid tumours. Although both MEN1 and MEN2 are autosomal dominant disorders, they have contrasting molecular aetiologies: MEN1 results from inactivating germline mutations of the MEN1 tumour suppressor gene, whereas MEN2 results from activating mutations in the RET proto-oncogene. The clinical features arising in each condition relate to the location of tumour development and/or hormonal hypersecretion, while treatment approaches aim to minimize morbidity and mortality, and preserve quality of life. Genetic testing is a key component of management, both to confirm the diagnosis in affected individuals, and to identify family members who are at risk of disease but may be asymptomatic. It is recommended that those ‘at risk’ of developing MEN1 or MEN2 (i.e. mutation carriers) undergo periodic clinical, biochemical and radiological surveillance for the early identification and/or treatment of tumours. Here, a brief overview of MEN1 and MEN2 is provided.

多发性内分泌瘤（Multiple endocrine neoplasia， MEN）是指在一个个体中发生影响两个或多个内分泌腺的肿瘤。主要有两种类型：1型（MEN1）和2型（MEN2）。MEN1以甲状旁腺、垂体和胰腺神经内分泌肿瘤合并发生为特征，而MEN2以甲状腺髓样癌合并嗜铬细胞瘤和甲状旁腺肿瘤为特征。尽管MEN1和MEN2都是常染色体显性遗传病，但它们具有不同的分子病因：MEN1是由MEN1肿瘤抑制基因的种系突变失活引起的，而MEN2是由RET原癌基因的激活突变引起的。每种情况下出现的临床特征与肿瘤发展的位置和/或激素分泌过多有关，而治疗方法旨在降低发病率和死亡率，并保持生活质量。基因检测是管理的关键组成部分，既可以确认受影响个体的诊断，也可以确定有患病风险但可能无症状的家庭成员。建议那些有患MEN1或MEN2风险的人（即突变携带者）定期接受临床、生化和放射监测，以便及早发现和/或治疗肿瘤。这里提供了MEN1和MEN2的简要概述。

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引用次数: 0

Disorders of puberty 青春期障碍

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-10-01 DOI: 10.1016/j.mpmed.2025.07.001

Emile Hendriks, Philippa Prentice, Mabrouka Al Towati, Rachel Williams

Puberty is the process of development of adult secondary sexual characteristics. Disorders of puberty can be classified into early (precocious) and late (delayed) puberty. Early (precocious) puberty can be secondary to either activation of the hypothalamus–pituitary–gonadal axis (gonadotropin dependent or central) or altered regulation of sex hormone production in the gonads, adrenal glands or other tissues (gonadotropin independent or peripheral). Delayed puberty is most often constitutional, but hypogonadotropic (central) and hypergonadotropic (peripheral) hypogonadism should be considered. This article discusses the clinical and biochemical features of normal and abnormal puberty.

青春期是成人第二性征发育的过程。青春期障碍可分为早熟和晚发。青春期早期（性早熟）可能继发于下丘脑-垂体-性腺轴（促性腺激素依赖性或中枢性）的激活或性腺、肾上腺或其他组织（促性腺激素独立性或外周性）性激素分泌调节的改变。青春期延迟通常是体质性的，但应考虑促性腺功能低下（中枢性）和促性腺功能亢进（外周性）性腺功能低下。本文讨论了青春期正常与异常的临床及生化特征。

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