脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊...脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。展开更多
Pancreatic neuroendocrine tumors(PNETs) are an uncommon malignancy,accounting for a small percentage of all pancreatic malignancies.Due to their insidious course,most PNETs present with metastatic disease.Although rep...Pancreatic neuroendocrine tumors(PNETs) are an uncommon malignancy,accounting for a small percentage of all pancreatic malignancies.Due to their insidious course,most PNETs present with metastatic disease.Although reports in the literature describe PNET metastasis to the liver,lung and brain,to date there are no reports of stage Ⅳ disease involving the breast.Moreover,the lack of consensus regarding classification and treatment of this entity leaves practitioners without standards of practice or a firm base from which to formulate prognosis.In this report,the case of a previously healthy 51-year-old woman with stage Ⅳ PNET is examined.After combined neoadjuvant therapy with 5-fluorouracil,carboplatin,etoposide and radiation,surgical resection revealed metastatic PNET to the breast and lung,with no microscopic evidence of residual disease within the pancreas.An extensive analysis of the presentation,diagnosis,imaging modalities,treatment options,and prognosis is included in the discussion.As demonstrated by our review,there is a need for further studies to delineate inconclusive evidence with respect to subtype classification,treatment and prognosis of PNETs.展开更多
Biliary-colonic fistula is a rare complication after laparoscopic cholecystectomy. We present a case of post-cholecystectomy iatrogenic biliary injury that resulted in a fistula between the common hepatic duct and lar...Biliary-colonic fistula is a rare complication after laparoscopic cholecystectomy. We present a case of post-cholecystectomy iatrogenic biliary injury that resulted in a fistula between the common hepatic duct and large bowel. Magnetic resonance cholangiopancreatography provided good visualization of injury even with concurrent normal level of alkaline phosphatase. Radiologic findings and surgical management of this condition are discussed in detail.展开更多
It requires approximately 800 million dollars(US)and 10 years to successfully bring a drug from the laboratory bench into the clinic(DiMasi et al.,2003).Thus,the breakthrough discovery of today will not be available i...It requires approximately 800 million dollars(US)and 10 years to successfully bring a drug from the laboratory bench into the clinic(DiMasi et al.,2003).Thus,the breakthrough discovery of today will not be available in the clinic for many years,and many dollars,after this initial discovery.One potential way to speed up this drug developmental cycle is by repurposing drugs that have been previously approved for an alternate clinical indication.With this goal in mind,Beachy and colleagues set out to identify a drug with efficacy against tumors that were dependant on the Hedgehog(HH)signaling pathway.They reported in the April issue of a leading cancer research journal that Itraconazole,a commonly used antifungal drug,can be turned against HH’s signaling function(Kim et al.,2010).It has been estimated that 25%of all human tumors may be HH dependent(Teglund et al,2010).展开更多
The fascinating hypothesis that microbes lead to cancer has long been dwelled upon but has only been recently investigated in cancers other than those of stomach and colon.Microbes can affect cancer cells directly thr...The fascinating hypothesis that microbes lead to cancer has long been dwelled upon but has only been recently investigated in cancers other than those of stomach and colon.Microbes can affect cancer cells directly through toxins or metabolites.They also play a significant role in the development and maturation of the immune system and can indirectly affect cancer cells through the immune system.Reliable mouse models and affordable sequencing technologies,have made it possible in current times,to delineate the role of microbes in undermining cancer immune surveillance and indirectly promoting oncogenesis.In this review,we explore the cancer-gut microbiome-immune trialogue,focusing on pancreatic cancer.We review how gut-microbiome interacts with immune system to promote oncogenesis and how modulation of gut-microbiome can be used as an effective therapeutic strategy to reprogram the immune system for augmenting anti-tumor response and enhance immunotherapy efficacy in traditionally resistant pancreatic cancer.展开更多
文摘脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。
文摘Pancreatic neuroendocrine tumors(PNETs) are an uncommon malignancy,accounting for a small percentage of all pancreatic malignancies.Due to their insidious course,most PNETs present with metastatic disease.Although reports in the literature describe PNET metastasis to the liver,lung and brain,to date there are no reports of stage Ⅳ disease involving the breast.Moreover,the lack of consensus regarding classification and treatment of this entity leaves practitioners without standards of practice or a firm base from which to formulate prognosis.In this report,the case of a previously healthy 51-year-old woman with stage Ⅳ PNET is examined.After combined neoadjuvant therapy with 5-fluorouracil,carboplatin,etoposide and radiation,surgical resection revealed metastatic PNET to the breast and lung,with no microscopic evidence of residual disease within the pancreas.An extensive analysis of the presentation,diagnosis,imaging modalities,treatment options,and prognosis is included in the discussion.As demonstrated by our review,there is a need for further studies to delineate inconclusive evidence with respect to subtype classification,treatment and prognosis of PNETs.
文摘Biliary-colonic fistula is a rare complication after laparoscopic cholecystectomy. We present a case of post-cholecystectomy iatrogenic biliary injury that resulted in a fistula between the common hepatic duct and large bowel. Magnetic resonance cholangiopancreatography provided good visualization of injury even with concurrent normal level of alkaline phosphatase. Radiologic findings and surgical management of this condition are discussed in detail.
文摘It requires approximately 800 million dollars(US)and 10 years to successfully bring a drug from the laboratory bench into the clinic(DiMasi et al.,2003).Thus,the breakthrough discovery of today will not be available in the clinic for many years,and many dollars,after this initial discovery.One potential way to speed up this drug developmental cycle is by repurposing drugs that have been previously approved for an alternate clinical indication.With this goal in mind,Beachy and colleagues set out to identify a drug with efficacy against tumors that were dependant on the Hedgehog(HH)signaling pathway.They reported in the April issue of a leading cancer research journal that Itraconazole,a commonly used antifungal drug,can be turned against HH’s signaling function(Kim et al.,2010).It has been estimated that 25%of all human tumors may be HH dependent(Teglund et al,2010).
文摘The fascinating hypothesis that microbes lead to cancer has long been dwelled upon but has only been recently investigated in cancers other than those of stomach and colon.Microbes can affect cancer cells directly through toxins or metabolites.They also play a significant role in the development and maturation of the immune system and can indirectly affect cancer cells through the immune system.Reliable mouse models and affordable sequencing technologies,have made it possible in current times,to delineate the role of microbes in undermining cancer immune surveillance and indirectly promoting oncogenesis.In this review,we explore the cancer-gut microbiome-immune trialogue,focusing on pancreatic cancer.We review how gut-microbiome interacts with immune system to promote oncogenesis and how modulation of gut-microbiome can be used as an effective therapeutic strategy to reprogram the immune system for augmenting anti-tumor response and enhance immunotherapy efficacy in traditionally resistant pancreatic cancer.
