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中医药对高脂血症的诊疗概况及探讨
高脂血症(Hyperlipidemia, HLP)是由于脂肪代谢或运转异常使血浆胆固醇或甘油三酯超过正常范围的一种病症.现将近年对本病的研究做以总结并对今后诊治思路进行探讨.
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急性原发性闭角型青光眼
Acute primary closed angle glaucoma is fast becoming one of the most important causes of blindness in the 21 st Century. World bhnding statistics show that there are 60 million people suffering from glaucoma. Of these,approximately 6 million are blind and 1.5 million (25%) are due to acute closed angle glaucoma. With the aging population, the number of patients blind from glaucoma will continue to increase.Attacks from acute primary closed angle glaucoma can lead to irreversible blindness to the affected eye.Blindness can be effectively prevented in acute primary closed angle glaucoma because the severity of symptoms will draw the attention of the patient who will then seek for medical care. Therefore, it is essential to educate the public,doctors and healthcare workers about the danger and symptoms of acute glaucoma. With early diagnosis and treatment to the affected eye and laser iridotomy to the fellow eye-bilateral blindness from acute glaucoma can be prevented.This paper highlights important clinical advances in the management of acute primary closed angle glaucoma and also poses several questions for discussion.(1) What evidence is there to suggest that bilateral blindness from acute primary closed angle glaucom is preventable?(2) In what way is Ultrasonic Biomicroscopy (UBM) useful in clinical research in glaucoma?(3) Will UBM be important in clinical diagnosis in primary closed angle glaucoma?(4) What is the scientific basis of treatment in acute primary closed angle glaucoma?(5) What are the essential procedures to preserve vision in chronic primary closed angle glaucoma?(6) What are the reasons for blindness after laser iridotomy?(7) What is the mechanism of laser iridoplasty?(8) What are the reasons why laser iridoplasty should be combined with laser iridotomy?(9) Why there is an intraocular pressure increase in 50% of eyes within 3 months after laser iridoplasty?(10) Can UBM explain the changes in the angle after lens removal in primary closed angle glaucoma?(11) Are there reasons why trabeculectomy is infrequently used in acute glaucoma, yet it is an important procedure in chronic primary closed angle glaucoma?(12) The scientific reasons why laser iridotomy is essential in the fellow eye.
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MR功能成像在肝癌诊断及治疗中的应用
肝癌是具有较高发病率及死亡率的恶性肿瘤之一,早期诊疗对患者生存时间和生活质量都有非常重要的意义.目前医学影像技术尤其MRI在肝癌的评估中扮演重要的角色.但传统MRI是以解剖学为基础的形态学检查,无法反映组织、细胞及分子水平生理生化改变,所以对疾病功能性改变的认识具有局限性[1].随着技术的发展,以磁共振弹性成像(magnetic resonance elastography,MRE)、扩散加权成像(diffusion-weighted imaging,DWI)、灌注加权成像(perfusion-weighted imaging,PWI)和磁共振波谱分析(magnetic resonance spectroscopy,MRS)为代表的功能性成像成为研究的热点.本文将重点对近几年MR功能成像在肝癌诊疗中取得的重要研究进展进行概述.
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超顺磁性氧化铁纳米粒子在原发性肝癌诊断与治疗中的研究进展
原发性肝癌(hepatocellular carcinoma,HCC)是我国常见的恶性肿瘤之一,其发病率居于恶性肿瘤第5位.肝癌患者5年生存率仅有7%,全球每年约有60万以上患者死于肝癌,位居肿瘤相关死亡率的第3位[1].我国是肝癌的高发区,目前发病人数占全球的55%,在肿瘤相关死亡中仅次于肺癌,位居第2.由于HCC早期症状隐匿,合并肝硬化的发生率极高,肝功能储备差,病人就诊时多属中晚期,手术切除率较低,能够手术切除者不足20%,且切除后复发率较高[2].因此,肝癌的早期诊断与治疗面临着巨大的挑战.
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三维重建技术在颅内动脉瘤诊治中的影响因素
三维数字减影(3D-DSA)技术可立体、直观、完整地显示脑动脉瘤的解剖关系,比常规DSA提供更丰富的影像资料,有助于分析复杂的血管解剖结构,为动脉瘤的诊断和治疗提供了佳投照角度,对指导手术夹闭和介入治疗方式的选择具有重要价值[1].但在三维数据的采集过程中,有许多因素会影响到三维重建的结果,进而影响医师对检查结果和手术方式的确定,因此,大家必须对这些影响因素加以重视.笔者对2011-01-2012-11共431例患者进行了三维数据重建,其中共有49次血管经旋转DSA采集后,三维重建图像出现了问题,现将分析结果报告如下.
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时间矫形外科学一门应运而生的新学科(英文)〖
Orthopaedics: as an ancient discipline concerning bones, joints, muscles, tendons and nerves-the skeletal system, has been developing rapidly since more and more progresses in theory and improvements in technology have been employed in orthopaedic practices. A variety of subdisciplines, such as hand surgery, spinal surgery and hip joint surgery, have emerged to meet the demands by the development of special services in the field of orthopaedics. However, the basic conception remains consistent in the principle of diagnosis and treatment of orthopaedic disorders. Taking the clubfoot treatment for an example, the prevailing protocol of surgical treatment is to achieve one-stage correction of all the components of the deformity relying on three-dimensional analysis within the time frame of an operation[1]. The diagnosis aims mainly to identify the pathologic morphology and the related factors, even in terms of three-dimensional architecture, signal transduction at the molecular level and the biologic activity[2-7]. Nevertheless, little is known about the adjustable means and predictable situation for the process of disorder and treatment planning.
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近十年消化性溃疡的临床诊疗进展
消化性溃疡(peptic ulcer,PU)主要指发生在胃和十二指肠的慢性溃疡,即胃溃疡(gastric ulcer,GU)和十二指肠溃疡(duodenal ulcer,DU).文献记载发病率为5%~10%[1].PU占国内胃镜检查人群的10.3%~32.6%[2].据报道,GU的死亡率为9.3%,DU死亡率为5.6%,而急性溃疡为2.5%[3].该病不仅发病率高,更重要的是其有出血、穿孔、幽门梗阻等棘手的并发症[4].DU较PU出血多见,与文献[5]报道一致,饮食、酗酒、吸烟、心理精神因素、药物不良反应是主要原因[6].本文就近年有关消化性溃疡的诊疗做一综述.
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试论模拟诊疗教学法在中西医结合外科学临床教学中的应用
临床实习是临床教学活动中的重要组成部分,是基础课与临床实践之间的桥梁,是医学生向医生过渡的全过程中关键的环节.但由于近年来,医学教育环境发生了重大变化,医患关系的紧张、患者对个人隐私权的日益重视及对实习医师的偏见使得临床教学的效果难以保证.为了解决这一问题,模拟诊疗教学已日益受到人们的重视.本文试就模拟诊疗教学法在中西医结合外科学临床教学中的应用加以探讨.
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骨盆骨折诊治中的问题与思考
骨盆骨折约占全身骨折的3%~8%,是骨科临床常见的损伤~([1]).由于骨盆骨折常由高能量损伤所引起,加之骨盆解剖复杂,治疗效果还远非令人满意,病死率和并发症的发生率较高~([1-3]).特别是伴有血流动力学不稳定的骨盆损伤,病死率可高达40%,更应该引起重视和研究.
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髋臼骨折的诊治难点和对策
髋臼骨折是骨盆骨折的一种特殊类型,具有骨盆骨折所共有的临床特点和治疗要求,即往往是高能量创伤的后果,常伴有多发性内脏、骨骼或关节损伤,在治疗上首先应集中于发现和处理危及生命的各种合并伤等.同时,髋臼骨折又属关节内骨折,也具有关节内骨折所共有的追求满意复位、早期功能锻炼和重建负重与活动双重功能的高要求.髋臼骨折带给骨科医师的严峻挑战,还包括髋臼与整个骨盆环在三维形态和结构上的极不规则性,以及因此带来的对骨折线分布与走向判断上的困难,而这将影响术前计划、手术入路的正确制定和选择.
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我国新生儿黄疸诊治现状和面临的挑战
新生儿黄疸是新生儿期常见的症状之一.可见于50%以上足月儿和80%以上早产儿[1],占住院新生儿的20%~40%.由于新生儿早期胆红素的代谢特点、疾病因素,它既可是生理现象,又可是多种疾病的重要表现,严重者可发生高胆红素脑病而致残,甚至危及生命[2-3].近年来随着围生、新生儿医学的发展,过去的诊疗方法已不适应当今的现状,对传统的诊疗标准和方法提出了异议和挑战.
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Objective: To explore a way of guiding diagnosis and treatment of blunt and penetrating diaphragm injuries. Methods: According to injury violence, 46 chest trauma patients with diaphragm rupture were divided into two groups: a blunt injury group and a penetrating injury group. The injury condition and trauma scores between the two groups were compared and analyzed. Results: The incidence of blunt diaphragm injuries was lower than that of penetrating injuries (1.78% vs 8.53%, P<0.05). In the blunt injury group most patients had multiple injuries. Penetrating injuries developed more quickly than blunt injuries, and resulted in hemorrhagic shock in the early period. Trauma scores showed that there was no significant difference in the Revised Trauma Score (RTS), the Injury Severity Score (ISS) and thoracic Abbreviated Injury Scale (AIS) between the two groups (P>0.05), but the blunt injury group had lower Glasgow Coma Scale (GCS) and abdominal AIS than the penetrating group (P<0.05). Conclusions: Blunt and penetrating diaphragm injuries have different clinical characteristics. So they should be dealt with differently to reduce the incidence of complication and improve prognosis.
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Fractures of the odontoid process in children are rare but account for the majority of all the cervical spine injuries in the infantile and young juvenile groups. The initial radiographic evaluation is often difficult so that the diagnosis-making is delayed or the fractures are missed. The management of the odontoid fractures of adults has long been controversial and varies with different spinal surgeons. By contrast, the diagnosis and treatment of odontoid fractures in skeletally immature children have not been frequently documented and not in details. This paper reviews the clinical characteristics, diagnosis, treatment principles, and long-term outcome of the odontoid fractures in a consecutive series of patients aged 14years or younger.
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Bile duct injury caused by abdominal trauma,usually accompanied with injuries of other abdominal organs, is rarely seen. For the reason of its complexity and often delayed diagnosis and treatment, bile duct injury usually leads to severe complications such as abdominal infection. This paper reports a group of 10 cases of bile duct injury treated in our center in the recent decade.
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应重视老年膝骨性关节炎疼痛的诊疗
膝关节疼痛是临床上很常见的疼痛和疼痛性疾病,常见病因有骨性关节炎、半月板、前后叉韧带及膝关节周围软组织损伤或外伤等,其中膝骨性关节炎是严重影响老年患者生活质量的病症,俗话说年老先老在腿上就是这个道理.正确的诊断和有效的治疗需要熟悉膝关节的解剖和生理学特点,了解膝关节疼痛的病因、病理改变、临床表现、诊断和鉴别诊断,熟悉针对病因和病理生理的治疗方法.