The present and future of intensive medicine / 天津医药

In the past thirty years, intensive medicine has made great development, and it has been playing an active role in hospital medical practice and other emergencies. Intensive medicine has become an indispensable part in rescuing critically ill patients and protecting people's life and health. It has been proved that intensive medicine is capable to adapt to change and to lead the development of the discipline. These changes have greatly improved the prognosis of patients. This article is mainly focused on the four aspects to explore the research status and future development of intensive medicine, including the early recognition of sepsis, acute kidney injury (AKI) and renal replacement therapy (RRT), respiratory failure and mechanical ventilation, hemodynamic monitoring and volume resuscitation. It can be predicted that the future trend of intensive medicine is to foster collaboration between clinical and basic researches, and to make full use of big data and artificial intelligence.

Lung cancer associated paraneoplastic limbic encephalitis: an analysis of 7 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical features, diagnosis and treatment of lung cancer associated paraneoplastic limbic encephalitis (PLE).</p><p><b>METHODS</b>The clinical data of 7 cases of patients with lung cancer associated PLE out of 8927 patients of lung cancer from January 2000 to May 2010 was analyzed retrospectively. All the patients were male, aging from 41 to 54 years with a mean of 48 years. The data including history, physical examination, laboratory tests, diagnosis, treatment and follow-up were collected and analyzed.</p><p><b>RESULTS</b>All the 7 patients had smoking history. All 7 patients had varying short-term memory loss, 6 had epilepsy, 4 had different degrees of mental disorders, and 2 had syndrome of inappropriate secretion of antidiuretic hormone. Malignancies were screened and detected by chest X-ray or CT scan, while the pathological diagnoses were obtained through biopsy or transbronchial needle aspiration through electronic bronchoscope (5/7), biopsy of supraclavicular lymph nodes (1/7) and open pulmonary lobectomy (1/7). The pathological diagnosis included small cell lung cancer in 6 cases, adenocarcinoma of lung in 1 case. During the follow-up, 1 patient was lost, and the mean time of follow-up of the remaining 6 patients was about 11.5 months (ranged from 4 to 21 months). Four patients received early immunosuppressive treatment in terms of corticosteroids, only slight relief of neurological symptoms was seen in 2 patients. However, after chemotherapy (6/6), radiation (3/6), or surgical removal of the tumor (1/6), complete remission (3/6, with negative anti-Hu antibody) or partial remission (3/6, 2 of whom with positive anti-Hu antibody) of neurological symptoms were observed. Till October 2010, 3 patients with poorer tumor stag died ( survival were 4, 10, and 14 months respectively), while the other 3 patients with negative anti-Hu antibody and relative better tumor stag were still in the follow-up (the period were 5, 15, and 21 months).</p><p><b>CONCLUSIONS</b>PLE is a rare disease. In comparison with immunosuppressive therapy, chemotherapy, radiation or surgical removal of the tumor could provide better remission of the neurological symptoms. Positive serum anti-Hu antibody, poorer tumor stag, and together with poorer response to treatments seem to indicate a poorer prognosis.</p>

Surgical treatment of intralobar pulmonary sequestration / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the clinical features, diagnosis, treatment, and outcome of intralobar pulmonary sequestration (ILS).</p><p><b>METHODS</b>Patients who were diagnosed with ILS in our hospital between January 1988 and January 2009 were retrospectively reviewed. We recorded the clinical symptoms, imaging findings, operative technique, complications, and outcome of these patients.</p><p><b>RESULTS</b>Forty-seven patients (25 men and 22 women) with an average age of 32.3 years were enrolled. Forty-two patients had symptoms including cough and hemoptysis. Chest X-ray, computed tomography (CT), magnetic resonance imaging (MRI), and angiography were performed. Thoracotomy was performed in 45 patients, while thoracoscopy was performed in 2 patients. Lobectomy was the most common treatment procedure. Massive bleeding developed in 2 patients due to injury of aberrant supplying artery intraoperatively, 1 patient had atrial fibrillation, 1 patient had thrombosis of upper extremity postoperatively. All patients were confirmed the diagnosis pathologically, 4 accompanied with bronchogenic cyst, 15 with bronchiectasis, 8 with infection, 2 with aspergilloma, and 1 with carcinoid. No late complications occurred.</p><p><b>CONCLUSIONS</b>ILS is rare, surgery is recommended because some patients may have potential severe complications. Contrast enhanced CT and three-dimensional reconstruction is the best diagnostic method. Both thoracotomy and thoracoscopy are appropriate for the selected candidates.</p>