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<論文紹介:NEJM January 24, 2020. DOI: 10.1056/NEJMoa2001017.他>

NEJMがとても役立ちますよ、ということを以前お話ししましたが、
最新の話題を紹介します。

通常のNEJM掲載論文ではなく、2020年1月24日にメールで緊急速報配信された論文をまず紹介します。

中国武漢で発生した新型コロナウイルスのOutbreakに関するお話です。

BRIEF REPORT:A Novel Coronavirus from Patients with Pneumonia in China, 2019. (January 24, 2020. DOI: 10.1056/NEJMoa2001017)」

中国のCDCがすぐさま新規コロナウイルス(2019-nCoVと命名)の核酸配列を確定し,ウイルスも分離したという報告です。
臨床経過とともに、胸部単純X線写真も掲載されています。
本論文に関するPerspectiveとEditorial、続報も次々に速報配信されています。

Lancetにも2020年1月24日に新規コロナウイルス感染の臨床症状の速報がでています。
鼻汁・咽頭痛・くしゃみなどの上気道症状が無い。
ほぼすべての人に放射線画像で両側肺浸潤影所見ありとのことです。

最新号からは、下記論文を紹介します。

ORIGINAL ARTICLE: Conservative versus Interventional Treatment for Spontaneous Pneumothorax.(NEJM 2020;382:405-415.)」

中等度以上の気胸の治療が保存的でも結構大丈夫だよ、というお話です。
This trial provides modest evidence that conservative management was noninferior to interventional management for radiographic resolution of moderate-to-large primary spontaneous pneumothorax within 8 weeks. Conservative management spared 85% of the patients from an invasive intervention and incurred fewer days in the hospital or off from work, lower rates of surgery, and a lower risk of serious adverse events or pneumothorax recurrence than interventional management.

ORIGINAL ARTICLE: Fatal Cytomegalovirus Infection in an Adult with Inherited NOS2 Deficiency.(NEJM 2020;382:437-445)」

健常人に生じた致死的急性CMV感染症の1例報告から論じられている原著論文です。本例では遺伝性NOS2欠損とともにCD4 lymphopeniaがありました。
Human NOS2 is important for protective immunity against CMV but is apparently otherwise redundant for defense against many common pathogens that infected our patient during his lifetime.

ついでに、最近のNEJM論文も紹介します。

Case 3-2020: A 44-Year-Old Man with Weight Loss, Diarrhea, and Abdominal Pain.(NEJM 2020;382:365-374.)」

画像からは難しく感じます。
やはりHistoryが最も大切ですね。

Case 2-2020: A 64-Year-Old Man with Fever and Respiratory Failure.(NEJM 2020;382:276-285.)」

これも、画像からは難しく感じます。
Historyが大切ですね。

CORRESPONDENCE: Extracorporeal Photopheresis for Colitis Induced by Checkpoint-Inhibitor Therapy. (NEJM 2020;382:294-296)」

Checkpoint-Inhibitor Therapyの副作用結腸炎にこのような治療法が効くなんて!

Perspective: Machine Learning and the Cancer-Diagnosis Problem — No Gold Standard.(NEJM 2019;381:2285-2287.)」

癌診断における機械学習の問題点を、とても鋭くついています。
The gold-standard problem is evident in studies of interobserver agreement among pathologists.
There are certain clinical scenarios in which machine-learning categorization will be more complex than the distinction between “cancer” and “not cancer.

Case 38-2019: A 20-Year-Old Man with Dyspnea and Abnormalities on Chest Imaging.(NEJM 2019;381:2353-2363.)」

トレンディーな内容で、鑑別も素晴らしくとても勉強になると思いますよ。

他のNEJM関連は、こちら。
(かなり数がたまったので今後はリンクははりません。ご了承ください。
内容を記載しますので、ご関心があればリンク先アドレスをコピペしてご参照ください。)

(https://ocu-radiology.jp/news/news-2601/):
Identification of Anonymous MRI Research Participants with Face-Recognition Software.
Cerebellar form of Creutzfeldt–Jakob disease.
Adenovirus meningoencephalitis.
Imaging of Vaping-Associated Lung Disease.

(https://ocu-radiology.jp/news/news-2550/):
Interstitial lung disease associated with FLNA mutation.
Spondyloarthritis in patients with inflammatory bowel disease (Crohn’s disease).
Inhaled GM-CSF for Pulmonary Alveolar Proteinosis.

(https://ocu-radiology.jp/news/news-2464/):
Pregnant woman with Acute suppurative appendicitis and periappendicitis.
Pheochromocytoma and Paraganglioma.
Drug-Induced Liver Injury.
New Guidelines for Statistical Reporting in the Journal.

(https://ocu-radiology.jp/news/news-2436/):
Leber’s hereditary optic neuropathy.
Kelch-like Protein 11 Antibodies in Seminoma-Associated Paraneoplastic Encephalitis.
Intestinal tuberculosis.

(https://ocu-radiology.jp/news/news-2403/):
Anaplastic carcinoma arising in association with intestinal-type mucinous carcinoma of the ovary.
(いわゆる Mucinous cystic tumours with mural nodules)
West Nile virus encephalitis/West Nile virus meningoencephalitis.

(https://ocu-radiology.jp/news/news-2371):
Systemic lupus erythematosus.
Contrast-Associated Acute Kidney Injury.
Mesenchymal Hamartoma of the Liver and DICER1 Syndrome.
Metastatic postpubertal immature teratoma.
Machine Learning in Medicine.

(https://ocu-radiology.jp/news/news-2148/):
Idiopathic pulmonary fibrosis.
Pulmonary alveolar proteinosis.
Mucinous Ovarian Carcinoma.
Ocular syphilis.

(https://ocu-radiology.jp/news/news-2115/):
Herpes simplex virus lymphadenitis, Chronic lymphocytic leukemia.
Perforation of the sigmoid colon by a foreign body (toothpick) that caused a fistula to the right common iliac artery.
Powassan virus encephalitis.

(https://ocu-radiology.jp/news/news-2037/):
Papulonecrotic tuberculid (cutaneous tuberculosis).
Hepatobiliary Tuberculosis.
Sudden death caused by pulmonary fat embolism in a patient with miliary tuberculosis.

(https://ocu-radiology.jp/news/news-1974/):
眼窩領域Granulomatosis with polyangiitis, Susac’s syndrome.
Clostridium perfringens bacteremia with a hepatic abscess.
Osteoblastic and Osteolytic Spine Metastases by Using SWI.

(https://ocu-radiology.jp/news/news-1921/):
The t(6;11) TFEB translocation variant of renal-cell carcinoma.
比較的新しい病理組織概念でUncommonな腎腫瘤の復習.

(https://ocu-radiology.jp/news/news-1901/):
Pulmonary adenocarcinoma, hypercoagulable state with nonbacterial thrombotic endocarditis.
BK Virus–Progressive Multifocal Leukoencephalopathy.

(https://ocu-radiology.jp/news/news-1843/):
Anti–N-methyl-d-aspartate (NMDA) receptor encephalitis.
The drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, associated with human herpesvirus 6.
Acute Viral Encephalitis. 特にarbovirus encephalitisについて.

(https://ocu-radiology.jp/news/news-1793/):
Vitamin C deficiency (scurvy).“bachelor scurvy”
Vitamin B6, folate, zinc, and selenium deficiencies.
Alcohol-use disorder.
Multiple vitamin deficiencies.

(https://ocu-radiology.jp/news/news-1681/):
Polyarteritis nodosa. HBVとの関連.

(https://ocu-radiology.jp/news/news-1605/):
Membranous nephropathy, PLA2R type. IgG4との関連性など.
Idiopathic Pulmonary Fibrosis.

(https://ocu-radiology.jp/news/news-1588/):
Giant-cell myocarditis.
Takotsubo cardiomyopathy and catecholamine-induced crisis due to pheochromocytoma.
Fulminant Myocarditis with Combination Immune Checkpoint Blockade.

(https://ocu-radiology.jp/news/news-1462/):
Homocystinuriaの様々な表現型:Cystathionine β-synthase deficiency, Methylenetetrahydrofolate reductase deficiency.
Primary Sjögren’s Syndrome.
Antibody-Mediated Encephalitis.

(https://ocu-radiology.jp/news/news-1374/):
Immune-Related Adverse Events Associated with Immune Checkpoint Blockade.
Multiple Sclerosis. Neuromyelitis Optica Spectrum Disorders.
Adenovirus infection, disseminated.

(https://ocu-radiology.jp/news/news-1253/):
Biotin–thiamine–responsive basal ganglia disease.

(https://ocu-radiology.jp/news/news-1109/):
好酸球増多症(Eosinophilia)について.

(https://ocu-radiology.jp/news/news-897/):
Copper deficiency. Zincとの関連.

(https://ocu-radiology.jp/news/news-891/):
Takayasu’s arteritis.
Atypical immunoblastic reaction that was consistent with primary Epstein–Barr virus infection.

(https://ocu-radiology.jp/news/news-783/):
NEJMの紹介、Case Recordsの変遷についての私見.