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.
1987年,Wargotz等研究者首次识别了16例具有一致特征的乳腺肿瘤病例。这些病例中的肿瘤细胞不仅极为罕见,而且独特地兼具纤维母细胞和平滑肌细胞的属性,因此被命名为“乳腺肌纤维母细胞瘤(myofibroblastoma, MFB)”。根据相关研究,MFB的典型表现为细胞形态温和,且由呈现肌纤维母细胞分化的梭形细胞构成。文献报道显示,在肌纤维母细胞瘤中,乳腺处的发病率仅为10%左右。截至2017年数据统计,国内所报道病例仅20余例。由于该肿瘤发病率极低,目前对其认识十分有限,且该病缺乏特异临床表现、影像学上存在差异、术前诊断较困难,极易引起误诊。本文报道了一例罕见的乳腺肌纤维母细胞瘤病例,从临床诊治角度出发,总结本次病例经验,提炼关键诊断线索,旨在加深临床医生对乳腺MFB的了解,对于避免误诊误治有重要意义。In 1987, Wargotz et al. identified for the first time 16 cases of breast tumors with consistent features. The tumor cells in these cases are not only extremely rare, but also uniquely possess both fibroblastocyte and smooth muscle cell properties, hence the name “myofibroblastoma (MFB)”. According to studies, MFBs typically appear to have mild cell morphology and consist of spindle-shaped cells that exhibit myofibroblast differentiation. Literature reports show that in myofibroblastoma, the incidence in the breast is only about 10%. As of 2017, only about 20 cases have been reported in China. Due to the extremely low incidence of this tumor, the current understanding of the disease is very limited, and the lack of specific clinical manifestations, differences in imaging, and difficulty in preoperative diagnosis can easily lead to misdiagnosis. From the perspective of clinical diagnosis and treatment, this article summarizes the experience of this case and extracts the key diagnostic clues, aiming to deepen clinicians’ understanding of breast MFB, which is of great significance to avoid misdiagnosis and mistreatment.
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.
急性缺血性脑卒中(AIS)是一种严重影响人类健康相关的疾病,其拥有高发病率和高死亡率,并与吸烟、高脂饮食等不良生活习惯相关,人工智能(AI)比如机器学习(ML)和深度学习(DL),可以实现从临床及辅助检查尤其是成像学检查中提取特征数据,经过算法处理,得出可信结果。近几年AI更多地应用于医院系统的工作中,并成为临床工作及科研项目有力的帮手。本文全面综述了AI预测急性缺血性脑卒中(AIS)患者在经过血管内治疗,尤其是经过血栓切除术治疗后的预后情况,从而实现精准有效的临床管理和护理决策。此外,本文还批判性地评估了现有研究的局限性,并且指出了新的研究方向,最终目标是提高AIS患者的生存率。Acute ischemic stroke (AIS) is a serious human health-related disease that is characterized by elevated morbidity and mortality rates. It is often linked to detrimental lifestyle behaviors, including smoking and high-fat dietary intake. The advent of artificial intelligence (AI), encompassing machine learning (ML) and deep learning (DL) methodologies, facilitates the extraction and analysis of feature data derived from clinical and ancillary assessments, particularly imaging studies. These data are processed through sophisticated algorithms to yield reliable outcomes. In recent years, AI has been increasingly integrated into hospital systems, emerging as a formidable tool in both clinical practice and research initiatives. This paper presents a comprehensive analysis of AI applications in predicting the prognosis of acute ischemic stroke (AIS) patients following endovascular interventions, with a particular focus on thrombectomy procedures. The objective is to enhance the accuracy and efficacy of clinical management and care decision-making processes. Furthermore, the study critically examines the limitations inherent in current research and identifies prospective avenues for future investigation, ultimately aiming to improve the survival outcomes of AIS patients.
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