必听最新新英格兰医学杂志总述(语音版)及文章精选

原标题：|必听|最新《新英格兰医学杂志》总述(语音版)及文章精选

好一个鼠年！

医师或公共卫生药学专业技术人员天天听，每周坚持下来，一年后就有不一样的感觉。

《英格兰医学杂志》3月20日|语音|

Mar.19th, 2020 (摘要)：

Featuring articles on diskectomy or conservative care for sciatica, no sedation or light sedation in ventilated ICU patients, long-acting therapy to maintain HIV-1 suppression,

A screening program to eliminate hepatitis C in Egypt; a review article on hereditary angioedema;

A case report of a man with shortness of breath, cough, and hypoxemia; and

Perspective articles on universal disease screening and treatment, on when medical care ignores social forces, on opioid prescribing in the midst of crisis, and on the dishonesty of informed consent rituals.

NEJM主编访谈[语音]

Dr. Stephen Morrissey《NEJM》履行主编，访谈 流行症专家Dr. Eric Rubin 和Dr. Lindsey Baden，两位也《 NEJM》副主编和履行修改。

最近一周医界一直在评论关于医治和支撑医治Covid-19感染患者，也争议药物验证办法和老药新用挑选，我们如同在谈同一件工作，又如同各持己见和观念。倾听专家谈论【语音】:

WHO拉响全球公共卫生紧迫警报快两个月了；从美国确诊榜首例Covid-19患者到今日飙升至2万多人确诊，时刻不到一个月时刻。

《新英格兰医学杂志》形象地比方，我们都听了 警报 声响震天响，但谁都没当会儿，直到三周前开端抓瞎了。谈什么亡羊补牢呀！

NEJM精彩论文选读

事例陈述一

事例陈述简述如下(英文)，期望有关医学专家和临床医师细心研读，从中罗致一些阅历。

借此机会表述一观念：微信里一篇文章说“国内医师向美国尖端专家、政界共享抗疫阅历”。说到张文宏、曹彬和彭志勇三位。

坦率讲，他们三位所说的不是阅历，而是阅历！乃至是匆促上阵迎战疫情的惨烈阅历。

Courtney Enix, M.D., Kevin Seitz, M.D., DavidRoach, M.D., Robin Stiller, M.D.

University of Washington Department of Medicine, Harborview Medical Center

Case presentation:

A man in his 6th decade of life with no significant past medical historypresented with acute onset fever and difficulty breathing.

The patient had been in his usual state ofgood health until late 2019, when he experienced a polytraumatic injury,requiring prolonged hospitalization and ultimate discharge to a skilled nursingfacility (SNF) for ongoing rehabilitation. He had been residing at the SNFsince, and in the week leading up to admission started to develop coughproductive of sputum. On day of admission, he developed fevers and tachypneaand was brought in for evaluation.

Physical exam:

On arrival, he was found to be febrile to 40.7°, tachycardic to the 140s, andtachypneic to the low 40s requiring 15L by nonrebreather to maintain an SpO2greater than 90%. The patient was in distress and unable to speak in fullsentences. He was using his accessory ventilatory muscles; breath sounds werecoarse bilaterally. His cardiac rhythm was regular and he was warm and wellperfused.

Pertinent laboratory values:

A venous blood gas revealed a pH of 7.46 and pCO2 of 45 mmHg. Lab work wasremarkable for hypernatremia to 151 mEq/L, hypokalemia to 3.1 mEq/L, creatinineof 1 mg/dL (baseline 0.5mg/dL) and BUN of 39mg/dL. He had a leukocytosis to16K/μL with neutrophilic predominance to 82% and mild leukopenia 0.9K/μL. Hisliver function tests and lactate were normal. Influenza and RSV were negative.

Pertinent imaging:

Chest radiograph demonstrated bilateral patchy opacities but notably improvedfrom prior films in our system from months before this admission. A CTPulmonary Embolism Protocol was obtained, as well, and showed bronchial wallthickening, nodular consolidations and centrilobular nodules favored torepresent endobronchial spread of infection (image attached).

Treatment and Outcomes

Blood and urine cultures were obtained and the patient was started on empiricantibiotics with cefepime, linezolid (due to vancomycin allergy) andazithromycin. He was admitted to the medical intensive care unit (MICU) forongoing management of his respiratory failure. While in the MICU, the patientcontinued to have hypoxemia and tachypnea despite oxygen delivery by high flownasal cannula. A conversation was held with the patient’s wife and durablepower of attorney, who felt that further invasive interventions would not be inline with the patient’s goals of care and he was transitioned to comfort basedmeasures. He was transferred to the acute care medicine service and died twodays later. Post-mortem COVID-19 testing was performed and later confirmed tobe positive.

Lessons learned:

This case highlights the increased risk to individuals who reside in communalsettings, particularly those with other medical comorbidities. Vulnerablepopulations deserve close consideration of COVID-19 testing.

*This case has been reviewed by a NEJMeditor.*

事例陈述二

新冠病毒疫情全球化引发了业界评论：现有公共卫生战略能否阻挡住病毒侵略？

新冠病毒已遍及全球！各国政府以史无前例的规划施行自我阻隔和游览禁令。我国关闭武汉长达两个月之久；意大利也施行了全国限行。紧接着美国让加州整个硅谷和纽约停摆，超越7千多万美国人有必要恪守紧迫法案“自我阻隔”至少15天。

此外，全球各国纷繁暂停世界游览和制止非本国国民入境。但是这样做的意图，并非是下降逝世人数，只是缓慢疫情迸发的曲线(curve)。

从传统流行病学和流行症学视点看，阻隔和游览禁令是对流行症的榜首反响。这些传统东西和战略看来应对高度感染性疾病，如同效果有限，假如用力过大或过度强硬，会拔苗助长，不光阻止不了疫情的延伸，反而完全拖垮了全球经济发展。

观念：宁可过度预备，也不能毫无预备

这是意大利应对此次疫情的惨痛阅历

寻觅医治计划——应对Covid-19病毒感染

金规范临床试验：阴性成果/无明显效果

自我阻隔观念：

当自我阻隔后，你以为是为了维护其他人，或许你自身便是潜在传达源？

在医院里，当你救治患者时是否意识到也在无意中感染了更多其他患者？

据WHO数据计算，在武汉确诊患者中41%是在医院环境中感染播散的。

事例共享：儿童Covid-19感患病例

虽然本陈述中评论的儿童Covid-19感染患者为轻度症状，即65％的儿童患有肺炎，而且以为儿童是低危人群。莫非这是一个过错或失误的判别？

在评述这个事例时，乃至有人揭露质疑我国的临床数据和信息。

共享世界学术期刊观念和沟通热门

曙·光

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