The significant increase in mortality after tuberculosis (TB) progression to severe disease is a major obstacle to achieving the goal of ending the TB epidemic by 2035. Up to now, there is no clear definition and diagnostic criteria for adult severe tuberculosis at home or abroad, which has a significant adverse impact on the early diagnosis and timely treatment of patients with severe tuberculosis. In order to improve the treatment level of patients with severe pulmonary tuberculosis, reduce mortality and improve prognosis. The Professional Committee of Tuberculosis Science of the Chinese Society of Research Hospitals and Shenzhen Third People's Hospital/National Clinical Medical Research Center of Infectious Diseases/Shenzhen Tuberculosis Clinical Medical Research Center led the formulation of "Guidelines for definition and diagnosis of severe pulmonary tuberculosis in adults in China (2023)", aiming to guide and standardize the definition and diagnosis of severe tuberculosis. So as to improve the level of diagnosis and treatment of severe pulmonary tuberculosis in our country, to maximize the benefit of patients.
Through summarizing the definition, concept, and development of patient registry, and also retrieving ClinicalTrials.gov, we introduce its application areas, application range, disease, research number. Based on the application situation, we present the challenges faced now and future development of direction.
ObjectiveTo summarize the terms and definitions related to neurofibromatosis type 1 (NF1) with a view to standardizing and unifying the existing terminology system. Methods To review the research literature related to NF1 at home and abroad, and to summarize the expressions of the disease and related terms. Results There are still some limitations in the current knowledge of NF1, especially in the expression of the terminology, and there are discrepancies in the description and naming of NF1-related features in different medical literatures and clinical guides. There are differences in the description and naming of NF1-related features in different medical literature and clinical guidelines. Through a systematic review of the literature, this paper provides a detailed compendium and summary of the terms and definitions of NF1-related clinical manifestations, pathological features, and genetic types, and further standardizes and unifies existing diagnostic criteria and terminology systems. ConclusionThe terms and definitions of NF1-related clinical manifestations are summarized to enhance the knowledge of clinicians and researchers related to NF1.
Hypothyroidism is one of the focuses of attention in the field of thyroid surgery, but postoperative hypoparathyroidism has always been an unavoidable complication for surgeons. Currently, there is still controversy over the definition and classification of postoperative hypoparathyroidism, and there are significant differences in the definition and incidence of permanent hypoparathyroidism among different studies. The author provides preliminary suggestions and ideas for the diagnosis and definition of hypoparathyroidism based on relevant guidelines, literature, and clinical experience, in order to provide more accurate diagnosis and treatment plans for postoperative hypoparathyroidism.
ObjectiveTo systematically review the current status of doctor-patient conflicts in China.MethodsWe searched CNKI and CSSCI databases to collect literatures about the doctor-patient conflicts from inception to April 23rd, 2017. The literatures were categorized by the published time, the high-frequency vocabulary, the citation frequency, the researching discipline, the researching facility, the quality of literature, the theme of literature and so on. The current research status of the doctor-patient conflicts was analyzed.ResultsA total of 226 literatures were included, in which 72 defined and classified the doctor-patient conflicts, 122 analyzed the causing reasons of doctor-patient conflicts, and 160 analyzed the governance paths of doctor-patient conflicts. The research disciplinary vision was limited to the policies, regulations and the medical education and so on, and the researches in psychology or economics disciplinary vision were insufficient. The medical and comprehensive universities were the main research units of the studies of the doctor-patient conflicts. The frequency and quality of the researches about doctor-patient conflicts were low.ConclusionThe classified studies of doctor-patient conflicts are insufficient, so the scientific and manageable classified criterions are needed in the further studies. Systematic studies in influential factors of doctor-patient conflicts are insufficient, so the occurring mechanisms of conflicts are needed to be done by systematical researches on patient-centered way. The studies of governance paths of doctor-patient conflicts are insufficient, so the strategies of classified and systematical management which according to the different conflicting forms and entire process of the conflict occurrence should be put forward.
Objective To further comprehend the definition， molecular mechanism， and clinical significance of perineural invasion （PNI） so as to explore new therapy for the tumors. Methods The literatures about the definition， molecular mechanism， and clinical study of PNI were reviewed and analyzed. Results At present， widely accepted definition of PNI was that at least 33% of the circumference of the nerve should be surrounded by tumor cells or tumor cells within any of three layers of the nerve sheath. The newest theory on molecular mechanism of PNI was that PNI was more like infiltration， invasion， not just diffusion. “Path of low-resistance” and “Reciprocal signaling interactions” were the main theories. More recently， the studies had demonstrated that “Reciprocal signaling interactions” could more clearly explain the mechanism of PNI. Stromal elements， including fibroblasts， seemed to play a key role in the complex signaling interactions driving PNI. Neurotrophins and axonal guidance molecules had been implicated in promoting the progress of PNI. PNI was a prognosis index in the cancers of the head and neck， stomach， pancreas， colon and rectum， and prostate， which was positive indicated that the patients would have a poor prognosis and a low 5-year survival rate. Conclusions The mechanism of PNI is very complex， and its clear mechanism is still undefined. Keeping on researching the mechanism of PNI could provide theoretical foundation to disclose the mechanism and the therapy of PNI.
目的 评估国际抗癫痫联盟（ILAE）耐药癫痫定义专家共识在发展中国家、发展中地区应用的可行性及应用中存在的问题。 方法 2010年12月9日－2011年2月18日，连续登记癫痫专科门诊患者409例。共纳入183例患者，根据ILAE耐药癫痫新定义对每位纳入患者癫痫分类进行评估。 结果 耐药癫痫患者18例（8.7%），临床治愈患者29例（14.1%），不能判断为159例（77.2%）。入组患者共涉及癫痫药物治疗方案321项。根据ILAE定义步骤一分类为不确定的治疗方案共有199项（62.00%），其中数量最多的为服药剂量＜50% WHO限定日剂量有157例（78.89%）。 结论 由于治疗剂量未能够达到国际统一标准，大量患者分类不明确，使得该共识应用面临巨大挑战，但目前为止该共识对于发展中地区耐药癫痫治疗有很强的指导促进意义，对未来耐药癫痫的早期识别有非常大的应用潜力。
ObjectivesTo summarize the latest advances about definition, classification, and TNM stage of adenocarcinoma of esophagogastric junction (AEG).MethodThe available guidelines, consensuses, international conference proceedings, and clinical studies were reviewed and summarized.ResultsThe AEG trended to be an independent entity of malignant tumor at the special location. The previous misunderstanding of AEG definitions from the WHO needed to be corrected and unified in China. The Siewert classification was still a practical clinical approach to guiding treatment strategy, while the new draft of JGCA classification needed to be evaluated and verified in the clinical practice. By contrast, the 8th edition AJCC/UICC classification was relatively controversial in the guiding treatment strategies, mainly due to the staging system, surgical approach, and extent of lymphadenectomy of Siewert Ⅱ type AEG. Based on the available research results, the TNM staging system of the 8th edition of gastric cancer tended to be more reasonable for the Siewert Ⅱ and Ⅲ types AEG.ConclusionWith increasing incidence of AEG, more experimental and clinical studies on AEG are ongoing, and it is expected to have more optimized classification and exclusive staging system for AEG in future.
Since the COVID-19 outbreak, the number of studies using rapid reviews (RR) for rapid evidence-based decision-making has been increasing. RR can significantly improve the timeliness of evidence and play an important role in decision making. To clarify the definition of RR and standardize its application, the Cochrane RR Methodology Group defined RR in 2021 and published the evidence-based guidelines for RR methodology. To promote researchers' understanding of RR, standardize the application of RR methodology, and improve the overall quality of this type of research, this paper introduced the development history of RR and interpreted the definition, characteristics and methodological content of RR.