F1000 medicine reports最新文献

The inflammatory and immunologic processes responsible for asthma can produce permanently fixed obstructive lung disease unresponsive to medical therapy. This can be manifested clinically by the failure of a childhood asthmatic to reach full expected lung capacity at adulthood and by an accelerated decline in pulmonary capacity in adults. Recent studies have furthered our insight into the pathologic processes underlying these changes and the potential effects of therapy to prevent them.

New understanding of the underlying pathology of the thrombotic microangiopathies has resulted in guidelines for the investigation and management of atypical haemolytic uraemic syndrome in children and adults and the prospect of new therapies, which are in clinical trial. Patients should be investigated for defects in complement pathways and a trial of plasma exchange is indicated.

Chronic obstructive pulmonary disease is a highly prevalent, underdiagnosed, and undertreated chronic lung disease. Early and appropriate treatment may help modify the course of the disease with respect to exacerbation timing and frequency, quality of life, and mortality. Steady progress continues to be made in understanding the disease pathogenesis and treatment modalities, and there is some evidence that outcomes are improving.

The foundation for adult health is laid in utero and requires a healthy placenta. A common manifestation of abnormal placental development is impaired fetal growth. While placental pathology is the final common denominator in many cases of fetal growth restriction, a variety of discreet lesions have been described involving both the maternal and fetal circulations at their confluence in the placenta. Detailed examination of the placenta provides a means of elucidating the pathophysiology of poor fetal growth. This is an essential step in developing effective strategies for the prediction, prevention, and possible treatment of the growth restricted fetus.

Continuous positive airway pressure (CPAP) is the leading treatment for obstructive sleep apnoea (OSA), a prevalent disorder of breathing in sleep strongly associated with obesity. OSA has serious adverse health, social and community effects arising from disturbed breathing, loud snoring, poor quality sleep and cardiovascular sequelae. When used appropriately, CPAP treatment is highly effective in normalising breathing and sleep, improving symptoms and lowering adverse event risk. However, patients do not necessarily accept, tolerate or comply with treatment, with many factors influencing CPAP uptake and longer term use. Although knowledge to address challenges affecting CPAP adherence and CPAP mask and machine technologies continue to improve incrementally, optimising CPAP treatment adherence is an ongoing challenge in sleep medicine.

Revascularization remains the most intuitive strategy to reverse ischemic injury associated with arterial occlusion in acute stroke. Revascularization may lead to opening of an occluded artery, or recanalization, yet restoration of downstream flow, or reperfusion, may not ensue. Revascularization strategies and novel devices continue to broaden options for the treatment of acute stroke, but it is increasingly apparent that selection criteria to identify ideal cases are needed to refine triage and minimize adverse events. The results of recent work on reperfusion may rapidly alter routine clinical practice for evolving ischemia in the brain.

Skilled management of sick premature babies and very young children has resulted in numerous exposures of their brains to a variety of anesthetic agents designed to achieve the substantial depth of neuronal inhibition required for complete loss of consciousness and insensitivity to pain. Unfortunately, our recent animal findings suggest that commonly used general anesthetics are damaging to developing neurons and cause significant neuronal deletion in vulnerable brain regions. In addition, emerging animal and human data suggest an association between early exposure to general anesthesia and long-term impairment of cognitive development. Consequently, the prudence of frequent anesthesia exposure of this population is now being scrutinized. It is important to note that on the basis of currently available information, there are still considerable differences of opinion regarding the clinical relevance of the animal findings. Since there is insufficient evidence establishing a clear association between animal and human findings, it would be premature to suggest major changes in current clinical practice.

Research into the pathophysiological mechanisms of spinal cord injury (SCI) has resulted in a classification scheme of primary and secondary injury. Primary injury refers to the destructive nature of the initial impact and the subsequent shearing, penetrating, and compressive forces that injure the delicate neural tissue. Secondary injury refers to a complex array of pathophysiologial processes - including ischemia, inflammation, excitotoxicity, and oxidative cell damage - that contribute to the ultimate loss of neural tissue. While our understanding of secondary mechanisms improves with continued research, novel treatments for SCI are currently being developed with a foundation rooted in halting deleterious secondary mechanisms. In this article, we will review the current evidence for surgical decompression as a treatment for SCI. Emerging evidence and a growing consensus among surgeons are in support of early surgical intervention to help minimize the secondary damage caused by compression of the spinal cord after trauma.

Tissue engineering is an exciting and rapidly evolving technology. In this review, we discuss the recent progress made in the field of urethral reconstruction and consider the clinical implications and further advancement of these endeavours.

Advances in clinical lipidology during the last 18 months include the establishment of high-sensitivity C-reactive protein (hsCRP) as an important risk marker for cardiovascular disease. Determining hsCRP levels should help the clinician single out patients at particularly high risk. However, more research needs to be done in this area. Furthermore, statins do not seem to be of benefit in patients with severe congestive heart failure, on chronic hemodialysis, or with aortic stenosis. Next, plasma triglyceride levels are now considered an important risk marker for cardiovascular disease, but the therapeutic benefits related to lowering triglyceride levels remain difficult to achieve. Also, nicotinic acid has gained more interest partly because recent studies have demonstrated positive effects on atherosclerosis development and partly because the side effect of flushing seems to be partially avoidable with the concomitant administration of laropiprant. Both the raising of high-density lipoprotein cholesterol by nicotinic acid and the additional lowering of low-density lipoprotein cholesterol by ezetimibe and eprotirome will need to demonstrate hard endpoint reductions in large-scale intervention trials. Trials of niacin/laropiprant (the AIM-HIGH and HPS2-THRIVE studies) and ezetimibe (the IMPROVE-IT study) are already under way.