ResearchPad - expert-opinion https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Precision Medicine in Interventional Cardiology]]> https://www.researchpad.co/article/N79f2abce-8fa7-4d06-a544-d186b32d0572 Precision medicine has recently become widely advocated. It revolves around the individual patient, taking into account genetic, biomarker, phenotypic or psychosocial characteristics and uses biological, mechanical and/or personal variables to optimise individual therapy. In silico testing, such as the Virtual Physiological Human project, is being promoted to predict risk and to test treatments and medical devices. It combines artificial intelligence and computational modelling to select the best therapeutic option for the individual patient.

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<![CDATA[微课在胸腔外科临床教学中的应用]]> https://www.researchpad.co/article/5c052955d5eed0c48489efd5 当前,随着网络信息技术的飞速发展,微课这一新的教学模式在现代教学活动中发挥越来越重要的作用,其短小精悍的教学内容能快捷、方便、反复获取,提高了学生学习效率和自主学习能力。胸腔外科临床教学尚处于摸索发展阶段,需要不断深化改革,引入适应社会发展且适合学员学习特点的新的教学模式以提升临床教学效果。本文就“微课”的概念、特点及优势进行阐述,同时对其在胸腔外科教学过程中应用进行探讨和思考,以进一步促进微课在胸腔外科临床教学中合理应用。

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<![CDATA[恶性胸腺瘤侵犯上腔静脉的外科治疗]]> https://www.researchpad.co/article/5c05294ad5eed0c48489ed53 恶性胸腺瘤侵犯上腔静脉在临床上较常见,但其外科治疗相关总结经验较少。本文详细介绍了恶性胸腺瘤侵犯上腔静脉外科治疗的发展历史与治疗现状,结合典型病例对恶性胸腺瘤合并上腔静脉综合征的影像学表征进行了探讨,重点描述了以外科手术为主的恶性胸腺瘤侵犯上腔静脉的综合治疗方法。该手术复杂程度高,手术风险大,为便于广大年轻医生的学习了解与实践操作,作者系统介绍了恶性胸腺瘤联合上腔静脉切除的4种手术方法,希望对年轻医生的学习应用有所裨益。

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<![CDATA[胸壁骨性重建的研究进展]]> https://www.researchpad.co/article/5c05294cd5eed0c48489edd9 肿瘤切除或外伤等多种因素均有可能导致胸壁缺损,骨性胸壁缺损的重建依旧是胸外科手术的重点和难点。随着材料学的不断进展,越来越多的新材料运用于骨性胸壁重建,一定程度上推动了胸壁外科的发展。但是,目前临床上常用的重建材料尚无一种能完全满足临床工作的需要。随着计算机技术的高速发展,3D打印技术也逐步运用于临床,个性化治疗理念逐步深入人心。个性化治疗配合新材料的使用极有希望克服现有材料的不足,使胸壁外科达到一个新高度。因此,本文对缺损胸壁重建的发展和现状做一综述,并对其发展方向做一积极展望。

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<![CDATA[胸腺肿瘤微创手术研究进展]]> https://www.researchpad.co/article/5c052948d5eed0c48489ece9 手术是胸腺肿瘤最重要的治疗方式。近年来,胸腺肿瘤的微创手术在国内外获得迅速推广。微创手术目前主要用于早期胸腺肿瘤的外科治疗,已有证据表明,微创手术可有效减少手术创伤、有效加快患者的术后恢复以及降低术后疼痛,并且目前已有一定临床证据初步证实其肿瘤学效果与开放手术相当。同时随着外科技术的不断进步,在保证外科学和肿瘤学原则的前提下,微创手术有可能使包括局部进展期、诱导治疗后以及复发转移的患者从中获益。

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<![CDATA[肺部磨玻璃结节的诊治策略]]> https://www.researchpad.co/article/5c0528fed5eed0c48489db82 肺部磨玻璃结节(ground glass nodule, GGN)是一种影像学表现,可能是肺部恶性肿瘤或良性病变。目前对于肺部磨玻璃结节的诊疗仍存在争议。2017年Fleischner协会和美国国立综合癌症网络(National Comprehensive Cancer Network, NCCN)都更新了GGN诊疗的指南,与之前的版本相比,手术或活检的指征更严,随访的间隔时间更长。临床工作中,GGN的大小、实性成分大小、动态随访变化和CT值都是判断手术介入时机的因素。GGN的诊疗中还存在一些误区:抗生素的使用、正电子发射型计算机断层显像(positron emission tomographycomputed tomography, PET-CT)检查、贴近胸膜的纯GGN和进入GGN的血管都是值得注意的问题。总之,GGN是一种发展缓慢的病灶,可以安全地进行随访。

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<![CDATA[多灶性磨玻璃影肺腺癌的临床及分子特征]]> https://www.researchpad.co/article/5c0528f1d5eed0c48489d8d7 随着人们对肺癌早期筛查的重视,肺多发磨玻璃影(multiple ground glass opacities, GGOs)的检出率逐年增高,以GGOs为表现的多灶肺腺癌也逐渐成为临床研究热点。其更多见于女性、非吸烟者,且无论是自然病程还是手术后的患者均有极佳预后。独特的临床特征提示其很可能是相对独立的一种疾病形式。从分子遗传学路径对其的探究发现,同一个体内的多个病灶间极可能有截然不同的克隆性特征,因此遗传异质性(genetic heterogeneity)是以GGOs为表现多灶肺腺癌最显著的分子遗传学特征。此特征可辅助原发多灶肺腺癌与肺癌肺内转移的鉴别诊断,也提示了对病灶进行分子遗传学检测的治疗意义。部分呈现出遗传相似性的GGOs病灶为气腔播散转移(spread through air spaces, STAS)理论提供了新的证据。

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<![CDATA[纵隔淋巴结清扫在肺癌诊疗中的共识与争议]]> https://www.researchpad.co/article/5c0528ebd5eed0c48489d727 淋巴结转移是肺癌的重要转移途径,淋巴结清扫术已成为肺癌的标准术式,同时也决定着肺癌的分期、预后及治疗策略。在临床实践中肺癌淋巴结的清扫方式各有不同,从选择性的淋巴结采样到扩大的淋巴结清扫,目前各种清扫方式存在着很大的争议,本文就目前的纵隔淋巴结清扫方式的共识及争议进行综述,为今后开展多中心临床研究提供参考。

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<![CDATA[National Institute for the Infectious Diseases “L. Spallanzani” IRCCS. Recommendations for COVID-19 Clinical Management]]> https://www.researchpad.co/article/N261ae944-7f8e-47a1-8dbe-1b5aeca076a6

On January 9 2020, the World Health Organization (WHO) declared the identification, by Chinese Health authorities, of a novel coronavirus, further classified as SARS-CoV-2 responsible of a disease (COVID-19) ranging from asymptomatic cases to severe respiratory involvement. On March 9 2020, WHO declared COVID-19 a global pandemic. Italy is the second most affected country by COVID-19 infection after China. The “L. Spallanzani” National Institute for the Infectious Diseases, IRCCS, Rome, Italy, has been the first Italian hospital to admit and manage patients affected by COVID-19. Hereby, we show our recommendations for the management of COVID-19 patients, based on very limited clinical evidences; they should be considered as expert opinions, which may be modified according to newly produced literature data.

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<![CDATA[New threat: 2019 Novel Coronavirus Infection and Infection Control Perspective in Turkey]]> https://www.researchpad.co/article/N344c2f1c-c7dc-4b1b-9a90-32a43a4bfe4d ]]> <![CDATA[Use of 5α-reductase inhibitor and delay in prostate cancer diagnosis and treatment]]> https://www.researchpad.co/article/N24500c2f-fbc2-4f07-a2b3-0255a525be9a ]]> <![CDATA[Asthma and hypercapnic respiratory failure]]> https://www.researchpad.co/article/N763bf0f8-9261-4af5-b1c8-7879612fca95

A 40-year-old, male non-smoker was diagnosed with asthma 6 years ago. He now presents with a 1-week history of worsening breathlessness with fever, cough, and purulent expectoration. He has had >10 emergency department visits and two admissions to hospital in the last 3 months. At each admission, he received bronchodilators and systemic steroids resulting in rapid improvement within 24 h. However, in the current presentation, the patient has no relief with corticosteroids and bronchodilators. His pulse is 140 per min, respiratory rate is 40 per min, blood pressure is 90/60 mmHg and room air oxygen saturation is 80%. Arterial blood gas (ABG) analysis shows hypercapnic respiratory failure. In view this respiratory failure, the patient is intubated and mechanical ventilation initiated. A chest radiograph is shown in figure 1. The therapy initiated includes bronchodilators, a systemic steroid, antibiotics and supportive care.

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<![CDATA[Lung cancer incidence and mortality with extended follow-up in the National LungScreening Trial]]> https://www.researchpad.co/article/N0b0bde67-6ac6-4eb0-9c68-799abe71e7ab

Since lung cancer (LC) is still the leading cause of cancer deaths worldwide [1], early detection through screening represents an important opportunity to improve LC survival and is a priority area for cancer care. The National Lung Screening Trial (NLST) aimed to compare low-dose helical computed tomography (LDCT) with chest radiography in LC screening of current or former heavy smokers. The trial found a relative reduction in mortality from LC of 20% in those who had undergone LDCT screening. LC screening has regained prominence in the thoracic oncology literature with the completion of NELSON and other European trials, which support the role of LC screening in achieving early diagnosis and reducing mortality. A growing number of implementation pilots are providing an impetus towards organised, national programmes for LC screening, which are in need of long-term follow-up data such as those presented in this study.

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<![CDATA[Recurrent pneumothorax, skin lesions and frequent urination]]> https://www.researchpad.co/article/N06c5d5a9-caec-4d2f-a8ae-804a0426b4fa

A 25-year-old male is admitted with complaints of dry cough for the past 5 years, and increased thirst, urinary frequency and output for the past 18 months. He also complains of shortness of breath on climbing a flight of stairs, and itchy lesions on the scalp and back for the past 2–3 months. There is no history of bone pain or abdominal pain. He has history of bilateral recurrent pneumothoraxes, twice on the right and once on the left side, in the past month. Pleurodesis with povidone iodine is performed on left side and the patient is transferred to your hospital with persistent right pneumothorax with air leak, with an intercostal drainage tube in situ. The patient is a never-smoker with no family history of pneumothorax. On general examination, he has small papules, 1–2 mm in diameter, with scaling over scalp and back. Onycholysis, onychoschisis and subungual splinter haemorrhages are present (figure 1).

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<![CDATA[Insight into the structure and tasks of the Early Career Members Committee of the European Respiratory Society]]> https://www.researchpad.co/article/N1c19ca24-394d-4c0c-a9d1-4eb481ccfd33

The Early Career Members Committee (ECMC) of the European Respiratory Society (ERS) consists of 14 members, one Early Career Member (ECM) representative per assembly. In September 2019, seven recently elected representatives joined the ECMC. An overview is given of the tasks performed by each representative within the ECMC (table 1). In addition, a short summary about the content of these tasks is provided.

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<![CDATA[An unusual disease with an interesting sign]]> https://www.researchpad.co/article/N9888e657-356b-4b0a-97d6-ed36a90e61fd

A 78-year-old male presented at the emergency room complaining of dry cough, fever up to 38.5 °C and malaise for 1 month. He had visited a general practitioner and received amoxicillin 500 mg three times a day for 7 days for a presumed chest infection, without improvement. He had a history of diabetes and arterial blood hypertension, for which he was receiving metformin 1000 mg twice a day and amlodipine 10 mg a day for 7 years. He reported no alcohol abuse and was an ex-smoker of 20 pack-years (quit 30 years ago). He had no recent hospitalisations or any medical interventions.

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<![CDATA[The STELVIO trial, a game changer for bronchoscopic lung volume reduction in patients with severe emphysema]]> https://www.researchpad.co/article/Na9a61c63-9ff1-494f-9328-dd5bc0b6a92c

Chronic obstructive pulmonary disease (COPD) is characterised by persistent respiratory symptoms and airflow limitation, which is caused by small airway disease (bronchiolitis) and alveolar destruction (emphysema) [1]. Patients primarily suffering from severe emphysema are often limited in exercise capacity due to the consequences of hyperinflation [2].

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<![CDATA[Clinical implications of ANCA positivity in idiopathic pulmonary fibrosis patients]]> https://www.researchpad.co/article/N83272b0b-711c-41bf-9ab1-0dae269ded58

The diagnostic process of idiopathic interstitial pneumonias (IIPs) is complex and the underlying mechanisms that participate in these diseases still need to be fully understood. In 2015, the European Respiratory Society/American Thoracic Society Task Force on Undifferentiated Forms of Connective Tissue Disease-Associated Interstitial Lung Disease introduced the term “interstitial pneumonia with autoimmune features” (IPAF) to identify subjects with IIP and features suggesting background autoimmunity but not characterisable connective tissue disease (CTD) [1]. The need for a proper clinical, serological and morphological assessment of IIP was highlighted to identify potential subjects with IPAF and CTD-ILD. However, the measurement of anti-neutrophil cytoplasmic antibodies (ANCAs) is not included in the definition of IPAF and ANCA serological testing is only recommended in idiopathic pulmonary fibrosis (IPF) when a clinical suspicion of vasculitis exists [2]. As current research evaluates the prognostic relevance of autoimmune features in IIP, the clinical importance of ANCA positivity still needs to be determined.

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<![CDATA[Pregnancy-adapted YEARS algorithm: can YEARS do more for pregnant women?]]> https://www.researchpad.co/article/N004b5d2e-168f-47b9-9a29-15b161c02f07

Venous thromboembolism (VTE), as a term that encompasses pulmonary embolism (PE) and deep vein thrombosis (DVT), is one of the leading causes of maternal morbidity and mortality [1], especially in developed countries, where PE takes second place after complications of hypertensive disorders [2]. When compared to non-pregnant women of similar age, pregnant women have an approximately four to five times higher risk of VTE [3], with an incidence of 1 in 1000 pregnancies [4]. Approximately 20–25% of VTE cases are caused by PE and 75–80% of cases are caused by DVT [5]. About 60% of DVT occurs antepartum, with the highest risk of antepartum pregnancy-associated VTE being in the third trimester.However, about 60% of PE occurs postpartum [3].

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<![CDATA[Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience]]> https://www.researchpad.co/article/N75fecddb-4d37-4da5-8369-e844cd8034bd

Abstract

Acne vulgaris affects more than 80% of adolescents and young adults and forms a substantial proportion of the dermatologist’s and general practitioner’s caseload. Severity of symptoms varies but may result in facial scarring and psychological repercussions. Oral isotretinoin is highly effective but can only be prescribed by specialists. Side effects are recognized and mostly predictable, ranging from cosmetic effects to teratogenicity. These can affect patients’ quality of life and treatment adherence. This article provides a commentary on 4 key areas: the use of oral isotretinoin vs oral antibiotics, including the importance of early recognition of nonresponse to treatment, the psychological effects of acne and isotretinoin treatment, the side effects of isotretinoin therapy, and cosmetic treatment options that can help alleviate predictable side effects. The authors, who have all participated in various international expert groups, draw on relevant literature and their extensive professional experience with oral isotretinoin in the treatment of acne. The aim of this article is to provide an informative and practical approach to managing oral isotretinoin treatment in patients with acne, to help optimize treatment of this skin disease.

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