卒中后抑郁是一种常见的卒中并发症,对患者的康复和生活质量有着显著影响。约三分一卒中患者伴有糖尿病,而糖尿病可加剧卒中后抑郁的风险,两者之间在病理生理学上存在相互促进的关系。本文将探讨糖尿病与卒中后抑郁之间的病理生理学联系,并从药物治疗的角度进行分析,旨在为合并糖尿病的卒中后抑郁患者提供预防和诊治参考。Post-stroke depression is a common complication of stroke, significantly affecting patients’ recovery and quality of life. Approximately one-third of stroke patients are diagnosed with diabetes, and diabetes can exacerbate the risk of post-stroke depression. There is a mutually reinforcing relationship between the two in terms of pathophysiology. This article will explore the pathophysiological connection between diabetes and post-stroke depression and analyze it from the perspective of drug therapy, aiming to provide prevention and treatment references for patients with post-stroke depression who also have diabetes.
腹膜炎是全球重症监护病房患者败血症的第二大死亡原因,脓毒血症的早期预测对于及时干预并最终改善预后至关重要。本研究基于新型的机器学习算法,建立并验证腹膜炎患者发展为脓毒血症的预测模型,研究结果提示机器学习模型可以成为预测腹膜炎患者预测脓毒血症的可靠工具,并且,随机森林算法模型具有最佳的预测性能,这种机器学习方法可用于帮助临床医生对于高风险因素的认识并早期干预以降低死亡率。Peritonitis is the second leading cause of sepsis-related mortality in intensive care unit (ICU) patients worldwide. Early prediction of sepsis is critical for timely intervention and ultimately improving prognosis. This study established and validated a predictive model for the development of sepsis in peritonitis patients using novel machine learning algorithms. The findings suggest that machine learning models can be a reliable tool for predicting sepsis in peritonitis patients. Among them, the random forest algorithm model showed the best predictive performance. This machine learning approach can help clinicians recognize high-risk factors and intervene early to reduce mortality.
目前,国内尚无关于九价人乳头瘤病毒疫苗导致药物性肝损伤的报道,但这一问题应引起临床医师的高度重视。现报道1例中年女性患者,在接种九价HPV疫苗第二针后出现乏力、纳差、巩膜及皮肤黄染,经护肝、利胆等对症支持治疗后症状好转,但临床医生未能及时说服患者完善相关检查进一步排查药物性肝损伤,致患者继续接种第三针,出现肝损慢性化、严重化。经进一步的护肝、利胆、营养支持等对症支持治疗并随访5个月,患者肝脏功能已恢复正常。通过该病例以期提高临床对药物性肝损伤的认知及诊治水平。At present, there is no report on drug-induced liver injury caused by nine-valent human papillomavirus vaccine in China, but this problem should be highly valued by clinicians. It is reported that a middle-aged female patient suffered from fatigue, poor appetite, yellow staining of sclera and skin after the second dose of nine-valent HPV vaccine. After symptomatic support treatment such as protecting the liver and promoting gallbladder function, the symptoms improved, but the clinician failed to persuade the patient to improve the relevant examination in time to further investigate the drug-induced liver injury, resulting in the patient continuing to receive the third dose, resulting in chronic and severe liver damage. After further symptomatic support treatment such as liver protection, choleretic and nutritional support and follow-up for 5 months, the liver function of the patient has returned to normal. Through this case, we hope to improve the clinical cognition, diagnosis and treatment of drug-induced liver injury.
原发性胆汁性肝硬化(Primary Biliary Cholangitis, PBC)和自身免疫性肝炎(Autoimmune Hepatitis, AIH)是不同的自身免疫性慢性肝病,这2种疾病在同一患者中共存称为重叠综合征。干燥综合征(Sjögren Syndrome, SS)是自身免疫性肝病(Autoimmune Liver Disease, AILD)最常并发的肝外自身免疫病。本文报告了一例AIH-PBC重叠综合征合并SS的病例,探讨其临床表现、诊断和治疗策略。Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) are two common clinical autoimmune liver diseases, and some patients have both diseases;this feature is called AIH-PBC overlap syndrome. Sjögren syndrome is one of the most common extrahepatic autoimmune diseases among patients with autoimmune liver diseases. This article presents the case report of an elderly female patient who was diagnosed with AIH-PBC overlap syndrome combined with Sjögren syndrome, and discusses its clinical presentation, diagnosis and treatment strategies.
在缺血性卒中的多种风险原因中,高脂血症特别是高胆固醇血症始终占有着很关键的地位,通过降低血浆中胆固醇特别是低密度脂蛋白胆固醇的水平,可以很有效地减少缺血性卒中发生的风险,这一观点已是世界神经科专家的普遍共识。他汀类药物是缺血性卒中二级预防的基石,被广泛应用于临床,然而,他汀类药物也有其自身的局限性。首先,如果他汀类药物剂量增加一倍,其降脂效果仅增加6%,这使得许多患者仅靠他汀类药物很难达到LDL-C目标。其次,有些患者不能耐受他汀类药物,这一现象在接受大剂量他汀类药物治疗的中国患者中尤为明显。近几年新上市的新型降脂药物–前蛋白转化酶枯草溶菌素9 (proprotein convertase subtilisin/kexin type 9, PCSK9)抑制剂则为缺血性卒中的治疗提供了新的策略。Among the myriad risk factors for ischemic stroke, hyperlipidemia, particularly hypercholesterolemia, consistently holds a pivotal role. The reduction of plasma cholesterol levels, notably low-density lipoprotein cholesterol (LDL-C), has been recognized as an effective strategy to mitigate the risk of ischemic stroke. This perspective has garnered widespread acceptance among neurology experts globally. Statins, as the mainstay of secondary prevention for ischemic stroke, are extensively utilized in clinical settings. However, statins are not without their inherent limitations. Firstly, the lipid-lowering efficacy of statins plateaus with increased dosage;doubling the dose results in a mere 6% increase in cholesterol reduction, making it challenging for many patients to achieve their LDL-C targets with statin monotherapy. Secondly, statin intolerance is not uncommon, with a pronounced incidence observed among Chinese patients undergoing high-dose statin therapy. In this context, the advent of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, a novel class of lipid-lowering agents, offers a promising alternative for the management of ischemic stroke, presenting a new therapeutic horizon in the field.
1例以腹泻为主要表现的肠气囊肿症(pneumatosis cystoides intestinalis, PCI)患者,患者既往糖尿病20余年,一直在规律服用“阿卡波糖”降糖治疗,完善腹部影像学及内镜检查后明确诊断为肠气囊肿症。采用调整降糖方案、高压氧疗2次/天(共5天)、抑酸保护胃黏膜、调节肠道菌群等支持治疗后患者腹泻、腹痛好转。半年后返院复查肠镜未见异常。肠气囊肿症是临床上一种少见的疾病,其临床表现多样,无特异性,为提高临床医生对本病的认识水平,笔者总结了1例以腹泻为主要表现的肠气囊肿症的诊治经过,现报道如下。A patient with diarrhea as the main manifestation of pneumatosis cystoides intestinalis (PCI), who has had diabetes for more than 20 years, has been taking acarbose as hypoglycemic therapy regularly. She was diagnosed with pneumatosis cystoides intestinalis after abdominal imaging and endoscopic examination. The patient’s diarrhea and abdominal pain were improved after treatment with adjusted hypoglycemic regimen, hyperbaric oxygen therapy twice a day (5 days in total), acid inhibition to protect gastric mucosa, and regulation of intestinal flora. Six months later, she returned to the hospital and rechecked the colonoscopy. Pneumatosis cystoides intestinalis is a rare disease in the clinic, and its clinical manifestations are diverse and non-specific. In order to improve the understanding level of clinicians, the author summarized the diagnosis and treatment of 1 case of pneumatosis cystoides intestinalis with diarrhea as the main manifestation, and reported as follows.
子宫内膜癌的发病年龄呈现出日益年轻化的趋势,该病症在临床表现上缺乏特异性,其症状往往与失调性子宫出血高度相似,这使得两者在初步诊断时容易相互混淆。对于患有多囊卵巢综合征的女性而言,如果同时合并子宫内膜癌,漏诊和误诊的风险会进一步增加。本文报道2例多囊卵巢综合征合并年轻子宫内膜癌患者,1例患者行宫腔镜切除病灶并联合孕激素治疗、醋酸甲羟孕酮联合二甲双胍治疗,另1例行腹腔镜下全子宫 + 双侧输卵管切除术,保留了卵巢功能。回顾性分析病例资料并复习相关文献,总结其临床特点、组织病理学表现、诊断、治疗及预后,以期提高临床对年轻型子宫内膜癌的警惕。In recent years, endometrial cancer is becoming younger and younger, and is similar to dysfunctional uterine bleeding due to the lack of specificity in clinical presentation. If endometrial cancer is combined with polycystic ovary syndrome, it is more likely to be underdiagnosed or misdiagnosed. In this paper, we report two cases of polycystic ovary syndrome combined with endometrial cancer in young patients, one patient underwent hysteroscopic resection of the lesion and combined progesterone therapy, medroxyprogesterone acetate combined with metformin therapy, and the another underwent Laparoscopic total uterus + bilateral salpingo-oophorectomy, which preserved the function of the ovaries. We retrospectively analyzed the case data and reviewed the relevant literature to summarize the clinical features, histopathological manifestations, diagnosis, treatment and prognosis in order to increase clinical alertness to young endometrial cancer.
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