医用英语医学文献翻译4(缺5-9整理版)

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学术英语(医学)Unit1~4课文翻译

Unit 1 Text A神经过载与千头万绪的医生患者经常抱怨自己的医生不会聆听他们的诉说。

虽然可能会有那么几个医生确实充耳不闻，但是大多数医生通情达理，还是能够感同身受的人。

我就纳闷为什么即使这些医生似乎成为批评的牺牲品。

我常常想这个问题的成因是不是就是医生所受的神经过载。

有时我感觉像变戏法，大脑千头万绪，事无巨细，不能挂一漏万。

如果病人冷不丁提个要求，即使所提要求十分中肯，也会让我那内心脆弱的平衡乱作一团，就像井然有序同时演出三台节目的大马戏场突然间崩塌了一样。

有一天，我算过一次常规就诊过程中我脑子里有多少想法在翻腾，试图据此弄清楚为了完满完成一项工作，一个医生的脑海机灵转动，需要处理多少个细节。

奥索里奥夫人 56 岁，是我的病人。

她有点超重。

她的糖尿病和高血压一直控制良好，恰到好处。

她的胆固醇偏高，但并没有服用任何药物。

她锻炼不够多，最后一次 DEXA 骨密度检测显示她的骨质变得有点疏松。

尽管她一直没有爽约，按时看病，并能按时做血液化验，但是她形容自己的生活还有压力。

总的说来，她健康良好，在医疗实践中很可能被描述为一个普通患者，并非过于复杂。

以下是整个 20 分钟看病的过程中我脑海中闪过的念头。

她做了血液化验，这是好事。

血糖好点了。

胆固醇不是很好。

可能需要考虑开始服用他汀类药物。

她的肝酶正常吗？她的体重有点增加。

我需要和她谈谈每天吃五种蔬果、每天步行 30 分钟的事。

糖尿病：她早上的血糖水平和晚上的比对结果如何？她最近是否和营养师谈过？她是否看过眼科医生？足科医生呢？她的血压还好，但不是很好。

我是不是应该再加一种降血压的药？药片多了是否让她困惑？更好地控制血压的益处和她可能什么药都不吃带来的风险孰重孰轻？骨密度 DEXA 扫描显示她的骨质有点疏松。

我是否应该让她服用二磷酸盐，因为这可以预防骨质疏松症？而我现在又要给她加一种药丸，而这种药需要详细说明。

也许留到下一次再说吧？她家里的情况怎么样呢？她现在是否有常见的生活压力？亦或她有可能有抑郁症或焦虑症？有没有时间让她做个抑郁问卷调查呢？健康保养：她最后一次乳房 X 光检查是什么时候做的？子宫颈抹片呢？ 50 岁之后是否做过结肠镜检查？过去 10 年间她是否注射过破伤风加强疫苗？她是否符合接种肺炎疫苗的条件？奥索里奥夫人打断了我的思路，告诉我过去的几个月里她一直背痛。

药学英语课文翻译课后翻译节选中英双语对照第四版

本篇包括人卫第四版Unit 3B，Unit4A，5A，8A，10A，12AB，13A等七篇课文Unit 3 Text B The Other Side of Antibiotics抗生素的另一面Antibiotics have eliminated or controlled so many infectious diseases that virtually everyone has benefited from their use at one time or another. Even without such personal experience, however, one would have to be isolated indeed to be unaware of the virtues, real and speculative, of these “miracle” drugs1. The American press, radio, and television have done a good job of reporting the truly remarkable story of successes in the chemical war on germs. What′s more, any shortcomings on their part have been more than made up for by the aggressive public relations activity of the pharmaceutical companies which manufacture and sell antibiotics.抗生素可以消除或控制很多种感染疾病，以致几乎每人生病时都习惯于使用它而受益，但是如果一个人没有这样的亲身经历，他必定是离群索居才会不知道这些“特效药物”或真实或推测的优点。

[整理版]医学英语原文翻译1至5单元

1. 生理学是研究生物体正常功能的一门科学。

它研究生物体如何进行各种活动，如何饮食，如何运动，如何适应不断改变的环境，如何繁殖后代。

这门学科包罗万象，涵盖了生物体整个生命过程。

生理学成功地解释了生物体如何进行日常活动，基于的观点是生物体好比是结构复杂而灵巧的机器，其操作受物理和化学规律控制。

尽管从生物学整个范畴看，生物体某些活动过程是相似的，如基因编码的复制，但许多过程还是某些生物体群组特有的。

鉴于此，将这门学科分成不同部分研究如细菌生理学，植物生理学和动物生理学是有必要的。

Physiology is the study of thefunctions of living matter. It is concerned with how an organism performs its varied activities: how it feeds, how it moves, how it adapts to changing circumstances, how it spawns new generations . The subject is vast and embraces the whole of life. The success of physiology in explaining how organisms perform their daily tasks is based on the notion that they are intricate and exquisite mac hines whose operation is governed by the laws of physics and chemistry. Although some processes are similar across the whole spectrum of biology—the replication of the genetic code for example —many are specific to particular groups of organisms. For this reason it is necessary to divide the subject into various parts such as bacterial physiology, plant physiology, and animal physiology. 2.正如要了解一个动物如何活动，首先需要了解它的构成，要充分了解一个生物体的生理学活动就必须掌握全面的解剖学知识。

医药学类文献双语版：汉译英

介导性shRNA能抑制肺癌细胞中livin沉默基因的表达从而促进SGC-7901细胞凋亡背景—由于肿瘤细胞抑制凋亡增殖,特定凋亡的抑制因素会对于发展新的治疗策略提供一个合理途径。

Livin是一种凋亡抑制蛋白家族成员，在多种恶性肿瘤的表达中具有意义。

但是, 在有关胃癌方面没有可利用的数据。

在本研究中,我们发现livin基因在人类胃癌中的表达并调查了介导的shRNA能抑制肺癌细胞中livin沉默基因的表达，从而促进SGC-7901细胞凋亡。

方法—mRNA及蛋白质livin基因的表达用逆转录聚合酶链反应技术及西方吸干化验进行了分析。

小干扰RNA真核表达载体具体到livin基因采用基因重组、测序核酸。

然后用Lipofectamin2000转染进入SGC-7901细胞。

逆转录聚合酶链反应技术和西方吸干化验用来验证的livin基因在SGC-7901细胞中使沉默基因生效。

所得到的稳定的复制品用G418来筛选。

细胞凋亡用应用流式细胞仪(FCM)来评估。

细胞生长状态和5-FU的50%抑制浓度(IC50)和顺铂都由MTT比色法来决定。

结果—livin mRNA和蛋白质的表达检测40例中有19例(47.5%)有胃癌和SGC-7901细胞。

没有livin基因表达的是在肿瘤邻近组织和良性胃溃疡病灶。

相关发现在livin基因的表达和肿瘤的微小分化和淋巴结转移一样(P < 0.05)。

4个小干扰RNA真核表达矢量具体到基因重组的livin基因建立。

其中之一,能有效地减少livin基因的表达,抑制基因不少于70%(P < 0.01)。

重组的质粒被提取和转染到胃癌细胞。

G418筛选所得到的稳定的复制品被放大讲究。

当livin基因沉默,胃癌细胞的生殖活动明显低于对照组(P < 0.05)。

研究还表明,IC50上的5-Fu和顺铂在胃癌细胞的治疗上是通过shRNA减少以及刺激这些细胞(5-Fu proapoptotic和顺铂)(P < 0.01)。

医学英文翻译文献

英文文献翻译第1 篇 Effects of sevoflurane on dopamine, glutamate and aspartate release in an vitro model of cerebral ischaemia七氟醚对离体脑缺血模型多巴胺、谷氨酸和天冬氨酸释放的影响兴奋性氨基酸和多巴胺的释放在脑缺血后神经损伤中起重要作用。

在当前的研究中，采用离体脑缺血模型观察七氟醚对大鼠皮质纹状体脑片中多巴胺、谷氨酸和天冬氨酸释放量的影响。

脑片以34℃人工脑脊液灌流，缺血发作以去除氧气和降低葡萄糖浓度（从4mmol/l至2mmol/l）≤30分钟模拟。

多巴胺释放量用伏特法原位监测，灌流样本中的谷氨酸和天冬氨酸浓度用带有荧光检测的高效液相色谱法测定。

脑片释放的神经递质在有或无4%七氟醚下测定。

对照组脑片诱导缺血后，平均延迟166s（n=5）后细胞外多巴胺浓度达最大77.0μmol/l。

缺血期4%七氟醚降低多巴胺释放速率，（对照组和七氟醚处理组脑片分别是6.9μmol/l/s和4.73μmol/l/s，p<0.05），没有影响它的起始或量。

兴奋性氨基酸的释放更缓慢。

每个脑片基础（缺血前）谷氨酸和天冬氨酸是94.8nmol/l和69.3nmol/l，没有明显被七氟醚减少。

缺血大大地增加了谷氨酸和天冬氨酸释放量（最大值分别是对照组的244%和489%）。

然而，4%七氟醚明显减少缺血诱导的谷氨酸和天冬氨酸释放量。

总结，七氟醚的神经保护作用与其可以减少缺血引起的兴奋性氨基酸的释放有关，较小程度上与多巴胺也有关。

第2篇The Influence of Mitochondrial K ATP-Channels in the Cardioprotection of Proconditioning and Postconditioning by Sevoflurane in the Rat In Vivo线粒体K ATP通道在离体大鼠七氟醚预处理和后处理中心肌保护作用中的影响挥发性麻醉药引起心肌预处理并也能在给予再灌注的开始保护心脏——一种实践目前被称为后处理。

医用英语医学文献翻译4(缺59整理版)

UNIT 1 TEXT B刷牙，使用牙线，以及每年2次的牙齿检查是口腔卫生保健标准，但是保护你珍珠样洁白的牙齿的好处远比我们知道的还要多。

在一篇评论文章中，塔夫茨大学牙科医学院的一个教员破除了常见的牙科神话，并概述了饮食和营养如何影响儿童，青少年，孕妇，成年人和老年人的口腔健康。

误区1：口腔卫生的不良后果是限制嘴巴准妈妈也许不知道她们所吃的食物会影响到胎儿的牙齿发育。

在怀孕过程中的营养缺乏也许会使未出生的孩子在今后的生活中更容易出现蛀牙。

“在14周到4个月大的时候，缺乏钙，维生素D，维生素A，蛋白质和卡路里会导致口腔软组织缺损，” Carole Palmer说。

Carole Palmer是，教育学博士(EdD)，注册营养师(RD)，塔夫茨大学教授，公共健康和社会服务系营养和口腔健康推进部的负责人。

有数据表明缺乏足够的维生素B6和B12可能是导致患唇裂和阻碍味觉形成的危险因素。

在童年的时候，最普遍的疾病是蛀牙，大约比儿童哮喘高五倍。

“如果一个儿童因为蛀牙而嘴巴受伤，他/她在学校会比较难集中注意力，而且会更喜欢吃容易咀嚼的食物，这些食物含有的营养往往更少些。

甜甜圈和点心这样的食物大多营养品质低下，含糖量高于其他需要咀嚼的富含营养的食物，比如水果和蔬菜，” Palmer说。

“口腔并发症与不良的饮食习惯会造成认知和生长发育问题，以及导致肥胖。

”误区2：吃越多糖，越容易蛀牙这与你吃了多少糖无关，而是糖和牙齿接触的时间有多少。

“食物，比如慢慢溶解的糖果和苏打水在嘴巴里停留的时间会比较久。

这增加了牙齿暴露在口腔细菌由糖产生成的酸中的时间，” Palmer说。

有研究表明，十几岁的青少年大约40%的碳水化合物是由软饮料中摄取的。

这些源源不断地软饮料增加了牙齿腐烂的风险。

无糖碳酸饮料和酸性饮料，比如柠檬水，往往被认为比含糖饮料对牙齿更安全，但是经常食用的话仍会造成牙齿釉质脱矿。

误区3：宝宝因蛀牙失去牙齿是可以的这是常见的误区，认为宝宝因为蛀牙失去牙齿是无关紧要的，因为宝宝的乳牙总会在将来某一天脱落。

医学英语课文翻译

第一单元 A History of TCMText A A History of TCM1.通过考古发掘，中医药的历史可以追溯到数百万年前。

原始人们在基本生存方面花了大部分时间：狩猎、种植植物以获取食物、建造住所、保护自己。

很容易想象，随着时间的推移，他们会尝试大多数当地植物来寻找食物。

经过一段时间，随着口头记载的流传，可以确定哪些植物可以做美食，哪些可以用于建筑，哪些可以影响疾病，和哪些是有毒的。

通过试验和错误，一种原始的草药和饮食疗法在中国逐渐形成。

2.火作为一种取暖，燃料和光的资源在他们的生活中也发挥了关键作用。

他们围坐在火堆周围，我们的祖先发现热的治疗力量是很自然的。

这些力量对像关节炎这类寒湿病的作用特别明显，热量起到迅速缓解的作用。

这是艾灸的艺术的起源,热量的医疗应用适合于多种多样的条件。

3.在他们艰苦的生活中，这些古老的人们一定经历了各种各样的伤害。

痛苦的一个自然的反应是摩擦或按压病变部位。

这种动手的治疗逐渐演变成一个系统的治疗操作。

人们发现按压在身体上特定的穴位有广泛的影响。

他们开始使用磨骨碎片或石片增强感觉，针刺诞生了。

中国传统医学历史的记载4.中医的书面历史发展主要是在过去的3000年。

商朝的考古挖掘揭示了医学著作被刻在占卜的骨头上：早期的巫师，大多数是妇女，使用肩胛骨执行占卜仪式；后来这些骨头也被用于写作。

5.在1973年发现的11篇写在丝绸上的医学文献在某些方面阐明了中国历史早期的复杂实践。

追溯到公元前168年，这些文章讨论饮食、锻炼、艾灸和草药疗法。

,一本广泛混杂萨满魔法的文章（52病方）描述了草药和食物的药理作用。

这个时期还存在着神农的传说，农业的皇帝，他每天品尝100草药来评估他们的性能。

（据说他在调查的过程中已经中毒多次调）6.到公元400年，中国传统医学的基础已具有书面形式。

此时，医学中大多数魔法的方面已经落后；越来越相信自然的力量可以治愈疾病。

最重要的书籍是在公元前300年到公元400年之间编制的黄帝内经。

医学英语教程生物医学课文翻译

医学英语教程生物医学课文翻译生物医学课文翻译：Medical English Tutorial - Biomedical TextbookBiomedical research plays a crucial role in advancing our understanding of human health and developing new treatments for diseases. In this tutorial, we will explore various topics in the field of biomedical sciences.Lesson 1: Introduction to Biomedical ResearchBiomedical research is the investigation of biological processes and diseases at the molecular, cellular, and organismal levels. This lesson will provide an overview of the different research methodologies used in the field, including genome sequencing, proteomics, and animal studies. We will also discuss the ethical considerations associated with biomedical research.Lesson 2: The Human Genome ProjectThe Human Genome Project was a landmark scientific initiative that aimed to map and sequence the entire human genome. This lesson will delve into the history of the project, its impact on biomedical research, and the novel insights gained from analyzing the human genome. We will also explore the future implications of this project in personalized medicine.Lesson 3: Genetics and DiseaseUnderstanding the genetic basis of diseases is crucial for the development of effective treatments. This lesson will focus on the relationship between genetics and common diseases, such as cancer, cardiovascular disorders, and neurodegenerative conditions.We will also discuss the advancements in genetic testing and the potential of gene therapy.Lesson 4: Stem Cells and Regenerative MedicineStem cells have the unique ability to differentiate into various cell types, making them valuable tools in regenerative medicine. This lesson will explore the different types of stem cells, their therapeutic potential, and the current challenges in their clinical application. We will also discuss recent breakthroughs in tissue engineering and organ transplantation.Lesson 5: Drug Discovery and DevelopmentDeveloping new drugs is a complex and rigorous process. In this lesson, we will explore the steps involved in drug discovery, from target identification to preclinical and clinical trials. We will also discuss the role of animal models in drug testing and the importance of drug safety and efficacy.Lesson 6: Biomedical ImagingImaging techniques play a vital role in diagnosing diseases and monitoring treatment efficacy. This lesson will provide an overview of various imaging modalities used in biomedical research, such as X-ray, MRI, and PET. We will also discuss the advancements in imaging technology and their application in precision medicine.Lesson 7: Biomedical EthicsEthical considerations are essential in biomedical research to ensure the welfare of human and animal subjects. This lesson will discuss the ethical principles and guidelines governing biomedicalresearch. We will also explore the ethical dilemmas associated with emerging technologies, such as gene editing and artificial intelligence in healthcare.By the end of this tutorial, you will have a comprehensive understanding of key concepts and advancements in the field of biomedical sciences. This knowledge will enable you to actively engage in discussions and contribute to the ever-evolving field of medical research.。

医学学术英语课文翻译Unit4

第四单元替代医学如果患病而常规疗法不起作用，或者如果患有慢性病症，你可以将传统或替代疗法作为最后的手段。

这种疗法有何好处？西方研究者如何看待这种疗法？本单元回顾了美国替代疗法，讨论了整合医学的未来发展。

TEXT A 融合传统中医和现代西医美国各界都对传统医学和补充医学感兴趣——医疗界、政府部门、媒体和公众。

越来越多的保险公司和管理式医疗机构为传统医学报销，大多数美国医学院开设传统医学课程。

艾森伯格全国研究表明，更多人在接受补充疗法。

为了便于研究替代疗法的有效性，美国国家补充与替代医学中心(NCCAM)于1999年获得五千万美元预算。

意识到需要提升植物药材科学数据的质量和数量，也为了对饮食补充剂安全性和有效性进行系统性评估，同年设立两个研究中心以研究植物药材的生物学作用。

许多患者同时接受传统和现代的疗法，需要将两种医学恰当且平稳地结合。

传统中医(TCM)的理论和技术涵盖了美国称为补充医学的多数做法，在医疗保健体系中日益重要。

若运用得当，传统中医费用合理，技术含量低，安全且有效。

针对针刺、草药、按摩和太极的研究正全球展开，可揭示传统中医的一些理论和实践。

雄心勃勃的研究设计和巨大的患者需求推动传统中医和现代医学在临床层面的结合，而学术研究者和学术机构对两种治疗体系的结合潜力越来越感兴趣。

针刺基于1997年NIH专家共识会议审查的证据，NIH专家共识发展小组保守建议，在多个情形下，针刺可以作为辅助疗法，替代疗法或综合管理方案的一部分。

该小组确认，针刺可用于治疗手术后和化疗引起的恶心和呕吐，也可治疗术后牙痛。

同时也建议针刺作为辅助疗法或可接受的替代疗法治疗成瘾、中风康复、头痛、经痛、网球肘、纤维肌痛、肌筋膜疼痛、骨关节炎、下背痛、腕管综合症和哮喘。

未来针刺临床试验将置于传统中医框架。

和主要以生物医学角度评估疗效的当代临床试验相比，这有可能对针刺疗效进行更恰当更有临床意义的评估。

现行的临床研究的科学严谨必须保持。

医学中英文对照文章

医学中英文对照文章随着信息化社会的高速发展,国民的健康意识不断提高,我国借鉴发达国家先进的健康管理经验,初步形成了具有一定中国国情的健康管理模式,国民参与健康管理的意识大大增强。

下面是小编带来的医学中英文对照文章，欢迎阅读!医学中英文对照文章1美国科学家研究起死回生术A groundbreaking trial to see if it is possible to regenerate the brains of dead people, has won approval from health watchdogs.探究死者大脑能否重获新生的开创性实验已获卫生监管部门批准可以开展。

A biotech company in the US has been granted ethical permission to recruit 20 patients who have been declared clinically dead from a traumatic brain injury, to test whether parts of their central nervous system can be brought back to life.美国一家生物科技公司获得伦理许可，将招募20位因脑创伤被宣布临床死亡的病人，用于测试他们的部分中枢神经系统能否被复苏。

Scientists will use a combination of therapies, whichinclude injecting the brain with stem cells and a cocktail of peptides, as well as deploying lasers and nerve stimulation techniques which have been shown to bring patients out of comas.科学家们将合用多种治疗方法，包括给大脑注入干细胞和混合多肽，以及利用激光和神经刺激技术等等。

医学文献翻译(中英对照)

Current usage of three-dimensional computed tomography angiography for the diagnosis and treatment of ruptured cerebral aneurysmsKenichi Amagasaki MD, Nobuyasu Takeuchi MD, Takashi Sato MD, Toshiyuki Kakizawa MD, Tsuneo Shimizu MD Kanto Neurosurgical Hospital, Kumagaya, Saitama, JapanSummary Our previous study suggested that 3D-CT angiography could replace digital subtraction (DS) angiography in most cases of ruptured cerebral aneurysms, especially in the anterior circulation. This study reviewed our further experience. One hundred and fifty patients with ruptured cerebral aneurysms were treated between November 1998 and March 2002. Only 3D-CT angiography was used for the preoperative work-up study in patients with anterior circulation aneurysms, unless the attending neurosurgeons agreed that DS angiography was required.Both 3D-CT angiography and DS angiography were performed in patients with posterior circulation aneurysms, except for recent cases that were possibly treated with 3D-CT angiography alone. One hundred sixteen (84%) of 138 patients with ruptured anterior circulation aneurysms underwent surgical treatment, but additional DS angiography was required in 22 cases (16%).Only two recent patients were treated surgically with 3D-CT angiography alone in 12 patients with posterior circulation aneurysms. Most patients with ruptured anterior circulation aneurysms could be treated successfully after 3D-CT angiography alone. However, additional DS angiography is still necessary in atypical cases. 3D-CT angiography may be limited to complementary use in patients with ruptured posterior circulation aneurysms.a 2003 Elsevier Ltd. All rights reserved.Keywords: 3D-CT angiography, cerebral aneurysm, subarachnoid haemorrhage, surgeryINTRODUCTIONRecently, three-dimensional computed tomography (3D-CT) angiography has become one of the major tools for the identification of cerebral aneurysms because it is faster, less invasive, and more convenient than cerebral angiography.1–7 Patients with ruptured aneurysms could be treated under diagnoses based on only 3D-CT angiography.5;6 3D-CT angiography has some limitations for the preoperative work-up for ruptured cerebral aneurysms, so additional digital subtraction (DS) angiography is still necessary, especially for aneurysms in the posterior circulation.8 Our previous studysuggested that 3D-CT angiography could replace DS angiography in most patients with ruptured cerebral aneurysms in the anterior circulation.1 This study reviewed our experience of treating ruptured cerebral aneurysms in the anterior and posterior circulations based on 3D-CT angiography in 150 consecutive patients to assess the current usage of 3D-CT angiography.METHODS AND MATERIALPatient populationWe treated 150 patients, 60 men and 90 women aged from 23 to 80 years (mean 57.5 years), with ruptured cerebral aneurysm identified by 3D-CT angiography between November 1998 and March 2002.Managementof casesThe presence of nontraumatic subarachnoid haemorrhage (SAH) was confirmed by CT or lumbar puncture findings of xanthochromic cerebrospinal fluid. 3D-CT angiography was performed routinely in all patients. DS angiography was performed in patients with anterior circulation aneurysms only if additional information was considered necessary following a consensus interpretation of the initial CT and 3D-CT angiography by four neurosurgeons. Patients with rupturedaneurysms in the posterior circulation underwent both 3D-CT angiography and DS angiography except for two recent patients with typical vertebral arteryposterior inferior cerebellar artery (VA-PICA) aneurysm.Typical saccular aneurysms were treated by clipping surgery. Fusiform and dissecting aneurysms were treated by proximal occlusion by either surgery or endovascular treatment with or without bypass surgery. Regrowth of bleeding aneurysms was treated by either surgery or endovascular treatment. Postoperatively, all patients were managed with aggressive prevention and treatment of vasospasm including intra-arterial infusion of papaverine or transluminal angioplasty.3D-CT angiography acquisition and postprocessing CT angiography was performed with a spiral CT scanner (CT-W 3000 AD; Hitachi, Ibaraki, Japan). Acquisition used a standard technique starting at the foramen magnum, with injection of 130 ml of nonionic contrast material (Omnipaque; Daiichi Pharmaceutical,Tokyo, Japan). The source images of each scan were transferred to an off-line computer workstation (VIP station; Teijin System Technology, Japan). Bothvolume-rendered images and maximum intensity projection images of the cerebral arteries were constructed. The anteriorcirculation and posterior circulation were evaluated separately on the volume-rendered images, after a general superior view was obtained. The anterior circulation was evaluated by first observing the anterior communicating artery (ACoA) by rotating the view, and then each side of the carotid system by rotating the image with editing out of the contralateral carotid artery. The posterior circulation was also evaluated by rotating the image but without editing out of any vessel. Once a possible rupture site was found, the view was zoomed and closely rotated with the other vessels edited out. Theaneurysm size was measured on 3D-CT angiography as the larger of the length of the dome or the width of the neck. Manipulation was performed by the scanner technician, with a neurosurgeon to provide editing assistance.DS angiography acquisitionStandard selective three- or four-vessel DS angiograms with frontal, lateral, and oblique projections were obtained. The 3D-CT angiogram was always available as a guide for possible additional DS angiography projections. Aneurysm size was measured with DS angiography when the quality of 3D-CT angiography was inadequate. All patients except elderly patients or patients in severe condition underwent DSangiography postoperatively.Grading of patientsThe clinical conditions of the patients at admission were classified according to the Hunt and Kosnik grade.9 Clinical outcome was determined at 3 months according to the Glasgow OutcomeScale.10RESULTSThe aneurysm locations and sizes are shown in Table 1. One hundred sixteen (84%) of 138 cases of aneurysms in the anterior circulation were treated after only 3D-CT angiography, and 22 cases (16%) required additional DS angiography. Ten of 12 cases of aneurysms in the posterior circulation required both 3D-CT angiography and DS angiography, but two recent cases of typical VA-PICA aneurysm were clipped after only 3D-CT angiography (Fig.1). The first 10 of the 22 cases in the anterior circulation, which required additional DS angiography were described previously, 1 so the most recent 12 patients are listed in Table 2. These recent cases included some atypical aneurysms. Cases 6 and 8 had a fusiform aneurysm of the internal carotid artery (ICA). Additional DS angiography was performed to obtain haemodynamic information. ICA trapping with superficialtemporal artery-middle cerebral artery anastomosis was performed in Case 6 because the atherosclerotic arteries failed to demonstrate the balloon occlusion test (Fig. 2). ICA occlusion by endovascular treatment was performed in Case 8 because the patient could tolerate the balloon occlusion test. Cases 4, 9, and 10 suffered regrowth of bleeding aneurysms after clipping surgery. Clip artifacts prevented evaluation of the ruptured site as well as identification of de novo aneurysms in these cases (Fig. 3). Surgical clipping was performed in Cases 4 and 10 and endovascular treatment in Case 9. Case 11 had an ACoA aneurysm associated with an arteriovenous malformation (AVM) (Fig. 4). DS angiography was performed to evaluate the AVM. Case 12 had a large ICA-posterior communicating artery (PCoA) aneurysm, and additional DS angiography was performed because the PCoA could not be detected by 3D-CT angiography (Fig. 5). Cases 1, 2, 3, 5, and 7 presented with small aneurysms, and DS angiography was performed to exclude other lesions as well as to obtain information about the proximal ICA for patients with supraclinoid type aneurysms.Table 1 Distribution and size of cerebral aneurysms in 150 consecutive patientsSite No. of patientsAnterior circulation 138ICA (supraclinoid) 3ICA bifurcation 1ICA-OphA 3ICA-PCoA 39 (1) ICA fusiform 2ACoA 50Distal ACA 4MCA 36 (1) Posterior circulation 12PCA 1BA tip 3BA-SCA 1BA trunk 1 (1) VA-PICA 3VA dissecting 3 (1) Size (mm)<5 42P5 to <12 99P12 9Number in parentheses indicates patients who underwent endovascular treatment.OphA, ophthalmic artery; ACA, anterior cerebral artery; MCA, middle cerebral artery; PCA, posterior cerebral artery; BA, basilar artery; SCA, superior cerebellar artery.Table 2 Twelve patients with ruptured anterior circulation aneurysms whounderwent additional DS angiographyCase No. Location Size (mm)1 lt. ICA-PCoA 3.12 ACoA 2.23 lt. ICA supraclinoid 1.64 lt. ICA-PCoA 7.85 lt. ICA supraclinoid 2.46 lt. ICA (fusiform) 11.87 lt. ICA-PCoA 3.28 rt. ICA (fusiform) 18.89 lt. MCA 9.610 lt. ICA-PCoA 10.511 ACoA 10.112 lt. ICA-PCoA 18.2The surgical findings correlated well with the 3D-CT angiography or DS angiography. Table 3 shows the condition on admission and outcome at 3 months after surgery. Some patients with good grades on admission died of severe spasm, acute brain swelling, or poor general condition, but these outcomes were not related to the preoperative radiological information. DISCUSSIONThe present study of ruptured aneurysms in both anterior and posterior circulations found that the indications for additional DS angiography in the anterior circulation are similar to that found previously, but we experienced some new atypical cases. Treatment of fusiform aneurysms depends on the haemodynamic information, which could only be obtained by DS angiography. ACoA aneurysm associated with AVM, although the initial CT indicated that the aneurysm had bled, required accurate evaluation of the AVM prior to surgery. Clip artifacts affected 3D-CT angiography in cases of recurrent SAH after clipping surgery, so 3DCT angiography is not indicated for such cases.3D-CT angiography was only of complementary use in most of the 12 cases of posterior circulation aneurysms. Only two cases oftypical VA-PICA aneurysms were treated based on only 3D-CT angiography. Typical basilar artery-superior cerebellar artery and VA-PICA aneurysms can be treated surgically after only 3D-CT angiography. DS angiography should always be performed for basilar tip aneurysms to evaluate the perforating arteries nearby as well as assess the vessel tortuosity for the possibility of endovascular treatment. Treatment of VA dissecting aneurysms needs information about the true and false lumens of the VA which requires DS angiography. The small population of posterior circulation aneurysms in this study indicates that the variation of aneurysms as well as the treatment choices in the posterior circulation require DS angiography in most cases.In our series, most aneurysms measured 5–12 mm, and typical saccular aneurysms of that size could be treated after 3D-CT angiography. However, there were problems with some large aneurysms. DS angiography was not necessary if the neck and nearby arteries of a large aneurysm were clearly detected. DS angiography was necessary in two cases of large aneurysms. A case of large ophthalmic artery aneurysm was located close to the anterior clinoid process.1 Small PCoA aneurysms may not be detected by 3D-CT angiography, but the artery would not bedifficult to observe during the operation. In our case of a large PCoA aneurysm, DS angiography was performed because the large neck would prevent intraoperative observation of the PCoA.Although not experienced in our series, treatment including bypass surgery for some large or giant aneurysms will require the haemodynamic information provided by DS angiography. Some small aneurysms (less than 4 mm) required additional DS angiography. 3D-CT angiography may be better for detecting small aneurysm than DS angiography.11;12 However, we suggest DS angiography is still necessary in the following cases. Firstly, compatibility of the initial CT scan and aneurysm location by 3DCT angiography is important. Patients with ruptured aneurysm and asymmetrical SAH with laterality compatible with the rupture site present no problem. However, we cannot always depend on the initial CT scans if the SAH is diffuse or symmetrical, especially if ACoA aneurysm or basilar tip aneurysm is not found the responsible lesion. DS angiography is more useful to exclude other lesions because of the smooth opacification of the vessels.Secondly, cases with small aneurysm located on the supraclinoid portion require proximal ICA control during the operation. DSangiography is necessary to provide information about the haemodynamics including the cross circulation.Magnetic resonance (MR) angiography is potentially the only modality required for preoperative assessment of ruptured cerebral aneurysms.13 However, MR imaging is time-consuming and access to MR scanners may be restricted. Patients could be in an unstable condition in the very early period of SAH, so that the emergent condition of the patients could be much easier to manage in the CT facility. On the other hand, MR angiography does reduce the use of contrast medium, so is a safe diagnostic tool.MR angiography may be the best modality for diagnosis in patients with good grade presenting several days after the onset, because the risk of rerupture falls with time.3D-CT angiography has been used to analyze the anatomical structures for surgery.14;15 Information about the venous and arterial structures near the aneurysm are preferable, but do not always reflect the findings of DS angiography. Normal anatomical structures, such as perforating arteries and veins, are likely to be encountered during surgery although not detected clearly by 3D-CT angiography.This study of the overall management of ruptured cerebralaneurysms with 3D-CT angiography and additional DS angiography indicates that more patients with anterior circulation aneurysms will be treated after only 3D-CT angiography except for the following cases requiring additional DS angiography: Aneurysms close to bone structures, such as an ICA-ophthalmic artery aneurysm; fusiform aneurysms, and large or giant aneurysms requiring accurate neck information and haemodynamic information for bypass surgery; patients with discrepancies between the distribution of SAH on CT and the location of the aneurysm, especially small aneurysms, to exclude other lesions; small aneurysms located on the supraclinoid portion of ICA, which require information about haemodynamics and proximal ICA control; regrowth of aneurysms that leads clip artifacts; and aneurysms associated with AVM in related locations. A clear conclusion about patients with posterior circulation aneurysms cannot be reached because of the small population. Typical basilar artery-superior cerebellar artery and VA-PICA aneurysms can be treated surgically after only 3D-CT angiography, but 3D-CT angiography may be limited to complementary use for basilar tip aneurysms and other posterior circulation aneurysms because of the need for close observation of nearby perforating arteries and the possibility ofendovascular treatment. Dissecting aneurysm, which is often observed in the VA, requires DS angiography to detect true and false lumens.REFERENCES1. Amagasaki K, Sato T, Kakizawa T, Shimizu T. Treatment of ruptured anterior circulation aneurysm based on computerized tomography angiography: surgical results and indications for additional digital subtraction angiography. J Clin Neurosci 2002; 9: 22–29.2. Anderson GB, Steinke DE, Petruk KC, Ashforth R, Findlay JM. Computed tomographic angiography versus digital subtraction angiography for the diagnosis and early treatment of ruptured intracranial aneurysms. Neurosurgery 1999; 45: 1315–1322.3. Hsiang JN, Liang EY, Lam JM, Zhu XL, Poon WS. The role of computed tomographic angiography in the diagnosis of intracranial aneurysms and emergent aneurysm clipping. Neurosurgery 1996; 38: 481–487.4. Lenhart M, Bretschneider T, Gmeinwieser J, Ullrich OW, Schlaier J, Feuerbach S. Cerebral CT angiography in the diagnosis of acute subarachnoid hemorrhage. Acta Radiol 1997; 38: 791–796.5. Matsumoto M, Sato M, Nakano M et al. Three-dimensionalcomputerized tomography angiography-guided surgery of acutely ruptured cerebral aneurysms. J Neurosurg 2001; 94: 718–727.6. Velthuis BK, Van Leeuwen MS, Witkamp TD, Ramos LM, Van Der Sprenkel JW, Rinkel GJ. Computerized tomography angiography in patients with subarachnoid hemorrhage: from aneurysm detection to treatment without conventional angiography. J Neurosurg 1999; 91: 761–767.7. Zouaoui A, Sahel M, Marro B et al. Three-dimensional computed tomographic angiography in detection of cerebral aneurysms in acute subarachnoid hemorrhage. Neurosurgery 1997; 41: 125–130.8. Carvi y Nievas MN, Haas E, Hollerhage HG, Drathen C. Complementary use of computed tomographic angiography in treatment planning for posterior fossa subarachnoid hemorrhage. Neurosurgery 2002; 50: 1283–1289.9. Hunt WE, Kosnik EJ. Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 1974; 21: 78–79.10. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1: 480–484.11. Hashimoto H, Iida J, Hironaka Y, Okada M, Sakaki T. Use of spiral computerized tomography angiography in patients withsubarachnoid hemorrhage in whom subtraction angiography did not reveal cerebral aneurysms. J Neurosurg 2000; 92: 278–283.12. Takabatake Y, Uno E, Wakamatsu K et al. Thethree-dimensional CT angiography findings of ruptured aneurysms hardly detectable by repeated cerebral angiography. No Shinkei Geka 2000; 28: 237–243 (Jpn).13. Watanabe Z, Kikuchi Y, Izaki K, Watanabe K et al. The usefulness of 3D MR angiography in surgery for ruptured cerebral aneurysms. Surg Neurol 2001; 55: 359–364.14. Kaminogo M, Hayashi H, Ishimaru Het al. Depicting cerebral veins by three-dimensional CT angiography before surgical clipping of aneurysms. AJNR Am J Neuroradiol 2002; 23: 85–91.15. Velthuis BK, van Leeuwen MS, Witkamp TD, Ramos LM, van der Sprenkel JW, Rinkel GJ. Surgical anatomy of the cerebral arteries in patients with subarachnoid hemorrhage: comparison of computerized tomography angiography and digital subtraction angiography. J Neurosurg 2001; 95: 206–212.三维CT血管造影对破裂脑动脉瘤的诊断和治疗的当前应用Kenichi Amagasaki MD, Nobuyasu Takeuchi MD, Takashi Sato MD, Toshiyuki Kakizawa MD, Tsuneo Shimizu MD Kanto Neurosurgical Hospital, Kumagaya, Saitama, Japan摘要我们以往的研究表明，3D-CT血管造影破裂脑动脉瘤大多数情况下，可以取代（DS）的数字减影造影，尤其是前循环的动脉瘤。

医学常用医学专业英文翻译

医学常用医学专业英文翻译Medical Translations in Common Medical SpecialitiesMedical field has a wide array of specialities and sub-disciplines, each with its own unique terminology. In order to maintain effective communication between healthcare professionals and patients, accurate translation of medical terms from English to other languages becomes crucial. This article aims to provide common medical translations in various medical specialities.1. Internal Medicine- Gastroenterology: The study of the digestive system- Gastritis: 胃炎- Hepatitis: 肝炎- Pancreatitis: 胰腺炎- Colonoscopy: 结肠镜检查- Endoscopy: 内窥镜检查- Cardiology: The study of the heart and its diseases- Myocardial infarction: 心肌梗塞- Arrhythmia: 心律不齐- Atherosclerosis: 动脉粥样硬化- Angioplasty: 血管成形术- Echocardiogram: 超声心动图- Endocrinology: The study of the endocrine system and hormonal disorders- Diabetes mellitus: 糖尿病- Hypothyroidism: 甲状腺功能低下- Hyperthyroidism: 甲状腺功能亢进- Insulin resistance: 胰岛素抵抗- Thyroidectomy: 甲状腺切除术2. Pediatrics- Pediatrics: The medical care of infants, children, and adolescents- Vaccination: 疫苗接种- Asthma: 哮喘- Pediatrician: 儿科医生- Growth chart: 儿童生长曲线图- Croup: 喉炎- Neonatology: The care of newborn infants, especially the ill or premature ones- Premature birth: 早产- Neonatal intensive care unit (NICU): 新生儿重症监护室- Respiratory distress syndrome: 呼吸窘迫综合征- Jaundice: 黄疸- Patent ductus arteriosus (PDA): 动脉导管未闭3. Surgery- Orthopedic surgery: The branch of surgery concerning the musculoskeletal system- Fracture: 骨折- Arthroscopy: 关节镜检查- Hip replacement: 髋关节置换- Spinal fusion: 脊柱融合术- Osteoporosis: 骨质疏松症- Neurosurgery: The surgical specialty that deals with the nervous system- Brain tumor: 脑肿瘤- Cerebrovascular accident (CVA): 脑血管意外- Epilepsy: 癫痫- Lumbar puncture: 腰穿- Meningitis: 脑膜炎- Plastic surgery: The branch of surgery concerned with reconstructive or cosmetic surgery- Rhinoplasty: 鼻部整形术- Breast augmentation: 乳房增大手术- Liposuction: 抽脂手术- Facelift: 提眉手术- Scar revision: 疤痕修复手术4. Obstetrics and Gynecology- Obstetrics: The branch of medicine concerned with childbirth and midwifery- Cesarean section: 剖腹产- Miscarriage: 流产- Prenatal care: 产前护理- Labor induction: 人工催生- Ectopic pregnancy: 异位妊娠- Gynecology: The medical practice dealing with the health of the female reproductive system- Pap smear: 宫颈涂片检查- Endometriosis: 子宫内膜异位症- Fibroids: 子宫肌瘤- Menopause: 更年期- Hysterectomy: 子宫切除术These translations are just a few examples of the medical terms in different specialities. It is important to note that accurate translation requires a deep understanding of both the source and target languages, as well as specific medical knowledge. Medical professionals and translators need to work together to ensure effective communication in the field of medicine.。

医药英语教程第四单元课文翻译

Computing from basement to bedside从地下室到床旁的计算The use of computers inareas related to medicine dates from the mid-1960s,and very costly. Their main use-automating simple repetitive tasks was not well suited to the complex nature of medicine,though they had potential user in related areas.An example of this was the use of computers to automate the creation of Index Medicus,an index of articles published in medical journals.Subsequently,the database was made available online, under the name Medline ,increasing speed and efficiency in locating relevant puters also began to be used in laboratories in simple testing and for making results available.在医学史上于上世纪60年代中期计算机的使用是非常昂贵的。

虽然他们在相关领域有潜在用户，但他们的主要用途是简单的重复性任务，不适合复杂性质的药物。

这方面的一个例子是电脑自动索引的创建使用，发表在医学期刊论文索引。

随后，在名称索引下，数据基地提供了可在线使用，提高速度和效率在定位相关文章。

电脑也开始被用于简单的测试和在实验室的制造研发中可用。

医学英语翻译外国文献

Association between IL28B gene polymorphisms and plasmaHCV-RNA levels in HIV/HCV-co-infected patients.Labarga P, Soriano V, Caruz A, Poveda E, Di Lello F, Hernandez-Quero J, Moreno S, Bernal E, Miró JM, Leal M, Gutierrez F, Portilla J, Pineda JA; on behalf of CoRIS.aInfectious Diseases Department, Hospital Carlos III, Madrid, Spain bMolecular Biology Department, Jaen University, Jaen, Spain cInfectious Diseases Unit, Hospital de Valme, Seville, Spain dInfectious Diseases, Hospital San Cecilio, Granada, Spain eInfectious Diseases Service, Hospital Ramón y Cajal, Madrid, Spain fService of Internal Medicine, Hospital Reina Sofía, Murcia, Spain gInfectious Diseases Service, Hospital Clínic, Barcelona, Spain hInfectious Diseases Service, Hospital Virgen del Rocio, Seville, Spain iInfectious Diseases Unit, Hospital de Elche, Elche, Spain jInfectious Diseases Unit, Hospital de Alicante, Alicante, Spain.AbstractBACKGROUND: IL28B polymorphisms influence both the rate of spontaneous hepatitis C virus (HCV) clearance and response to interferon α (IFNα)-based therapy. This observation has been reproduced in HIV-co-infected individuals. Controversy exists about the impact of IL28B alleles on HCV load. METHODS: CoRIS is a nationwide, open cohort of newly diagnosed HIV-1 adults in Spain. In the subset of HCV-co-infected individuals, the relationship between plasma HCV-RNA and IL28B (rs12979860) genotypes was evaluated.RESULTS: A total of 4670 HIV-1-infected patients had been included in CoRIS up to June 2010. All were naive for IFNα. HCV antibodies were reac tive in 895 (19%). Of them, 289 specimens were available and tested positive for plasma HCV-RNA, with median values of 959 900 IU/ml. The rs12979860 genotype distribution in HCV viremic patients was CC 45%, CT 42.2% and TT 12.8%. The median plasma HCV-RNA according to IL28B genotypes was: CC 1 385 000, CT 848 939 and TT 251 189 IU/ml (P = 0.006). The percentage of patients with HCV-RNA more than 600 000 IU/ml was: CC 67.7%, CT 56.6% and TT 35.1% (P = 0.001). In multivariate analysis, IL28B CC/CT genotypes, infection with HCV genotypes 1/4 and prior intravenous drug users were independent predictors of HCV-RNA more than 600000 IU/ml.CONCLUSION: HIV/HCV-co-infected patients with the C allele (CC/CT) at rs12979860 show significantly higher plasma HCV-RNA load than TT carriers. Notably, plasma HCV-RNA levels associated with poorer response to IFNα-based therapy are significantly more frequent in CC/CT than TT carriers. Hypothetically, patients harboring the rs12979860 allele C could display a lower activity of endogenous IFNα, allowing higher HCV replication while keeping an enhanced susceptibility to exogenous IFNα therapy.PMID: 21378537 [PubMed - as supplied by publisher]selected towards the adverse genotypes rs12979860CT/TT compared to non-transplanted HCV-infected patients (p=0.046). Patients with the donor genotype rs12979860CC had higher peak ALT and HCV RNA serum concentrations than those with CT/TT (p=0.04 and 0.06, respectively). No associations were observed between ALT / HCV RNA serum concentrations and recipient genotypes (p>0.3). More important, donor IL28B rs12979860 CC vs. CT/TT genotypes were associated with rapid, complete early, and sustained virologic response (RVR, cEVR, SVR) to treatment with PEG-IFN-α and ribavirin (p=0.003, 0.0012, 0.008, respectively), but weaker associations of recipient genotypes with RVR, cEVR and SVR were observed as well (p=0.0046, 0.115, 0.118, respectively).CONCLUSIONS: We provide evidence for a dominant, but not exclusive impact of the donor rather than the recipient IL28B genetic background on the natural course and treatment outcome of HCV liver graft reinfection.Copyright © 2010. Published by Elsevier B.V.PMID: 21147186 [PubMed - as supplied by publisher]/pubmed/21147186PubMed找以上在此找的Randomized Trial of Stents versus Bypass Surgery for Left Main Coronary Artery DiseaseSeung-Jung Park, M.D., Young-Hak Kim, M.D., Duk-Woo Park, M.D., Sung-Cheol Yun, Ph.D., Jung-Min Ahn, M.D., Hae Geun Song, M.D., Jong-Young Lee, M.D., Won-Jang Kim, M.D., Soo-Jin Kang, M.D., Seung-WhanLee, M.D., Cheol Whan Lee, M.D., Seong-Wook Park, M.D., Cheol-Hyun Chung, M.D., Jae-Won Lee, M.D., Do-Sun Lim, M.D., Seung-Woon Rha, M.D., Sang-Gon Lee, M.D., Hyeon-Cheol Gwon, M.D., Hyo-Soo Kim, M.D., In-Ho Chae, M.D., Yangsoo Jang, M.D., Myung-Ho Jeong, M.D., Seung-Jea Tahk, M.D., and Ki Bae Seung, M.D.April 4, 2011 (10.1056/NEJMoa1100452)AbstractArticleReferencesBACKGROUNDPercutaneous coronary intervention (PCI) is increasingly used to treat unprotected left main coronary artery stenosis, although coronary-artery bypass grafting (CABG) has been considered to be the treatment of choice.Full Text of Background...METHODSWe randomly assigned patients with unprotected left main coronary artery stenosis to undergo CABG (300 patients) or PCI with sirolimus-eluting stents (300 patients). Using a wide margin for noninferiority, we compared the groups with respect to the primary composite end point of major adverse cardiac or cerebrovascular events (death from any cause, myocardial infarction, stroke, or ischemia-driven target-vessel revascularization) at1 year. Event rates at2 years were also compared between the two groups.Full Text of Methods...RESULTSThe primary end point occurred in 26 patients assigned to PCI as compared with 20 patients assigned to CABG (cumulative event rate, 8.7% vs. 6.7%; absolute risk difference,2.0 percentage points; 95% confidence interval [CI], −1.6 to 5.6; P=0.01 for noninferiority).By 2 years, the primary end point had occurred in 36 patients in the PCI group as compared with 24 in the CABG group (cumulative event rate, 12.2% vs. 8.1%; hazard ratio with PCI, 1.50; 95% CI, 0.90 to 2.52; P=0.12). The composite rate of death, myocardial infarction, or stroke at 2 years occurred in 13 and 14 patients in the two groups, respectively (cumulative event rate, 4.4% and 4.7%, respectively; hazard ratio, 0.92; 95% CI, 0.43 to 1.96; P=0.83). Ischemia-driven target-vessel revascularization occurred in 26 patients in the PCI group as compared with 12 patients in the CABG group (cumulative event rate, 9.0% vs. 4.2%; hazard ratio, 2.18; 95% CI, 1.10 to 4.32; P=0.02).Full Text of Results...CONCLUSIONSIn this randomized trial involving patients with unprotected left main coronary artery stenosis, PCI with sirolimus-eluting stents was shown to be noninferior to CABG with respect to major adverse cardiac or cerebrovascular events. However, the noninferiority margin was wide, and the results cannot be considered clinically directive. (Funded by the Cardiovascular Research Foundation, Seoul, Korea, and others; PRECOMBAT number, NCT00422968.)Full Text of Discussion...Read the Full Article...Use of Fibrates in the United States and Canada1.Cynthia A. Jackevicius, PharmD, MSc;2.Jack V. Tu, MD, PhD;3.Joseph S. Ross, MD, MHS;4.Dennis T. Ko, MD, MSc;5.Daniel Carreon, PharmD;6.Harlan M. Krumholz, MD, SM[+] Author Affiliations1.Author Affiliations: Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California (Drs Jackevicius and Carreon); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (Drs Jackevicius, Tu, and Ko); Department of Health Policy, Management, and Evaluation, Faculty of Medicine (Drs Jackevicius and Tu) and Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre (Drs Tu and Ko), University of Toronto, Toronto, Ontario, Canada; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California (Dr Jackevicius); University Health Network, Toronto, Ontario, Canada (Dr Jackevicius); Department of Medicine, Section of General Internal Medicine (Dr Ross), Department of Epidemiology and Public Health, Section of Health Policy and Administration (Dr Krumholz), and Section of Cardiovascular Medicine (Dr Krumholz), Yale UniversitySchool of Medicine, Center for OutcomesResearch and Evaluation, Yale New HavenHospital, New Haven, Connecticut (Drs Rossand Krumholz); and Robert Wood JohnsonClinical Scholars Program, New Haven,Connecticut (Dr Krumholz)AbstractContext Interest in the role of fibrates intensified after the publication of the negative results from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, which assessed therapy with fenofibrate plus statins. The evidence for clinical benefit in outcomes with the use of fibrates is heavily weighted on the use of the older fibrates such as gemfibrozil and clofibrate. Objectives To examine trends in the current use of fibrates and to examine the relationship between differences in the availability and use of brand-name vs generic formulations of fenofibrate and the economic implications in the United States compared with Canada. Design, Setting, and Patients Population-level, observational cohort study using IMS Health data fromthe United States and Canada of patients prescribed fibrates between January 2002 and December 2009. Main Outcome Measures Fibrate prescriptions dispensed and expenditures.Results In the United States, fibrate prescriptions dispensed increased from 336 prescriptions/100 000 population in January 2002 to 730 prescriptions/100 000 population in December 2009, an increase of 117.1% (95% confidence interval [CI], 116.0%-117.9%), whereas in Canada, fibrate prescriptions increased from 402 prescriptions/100 000 population in January 2002 to 474 prescriptions/100 000 population in December 2009, an increase of 18.1% (95% CI, 17.9%-18.3%) (P <.001). In the United States, fenofibrate prescriptions dispensed increased from 150 prescriptions/100 000 population in January 2002 to 440 prescriptions/100 000 population in December 2009, an increase of 159.3% (95% CI, 157.7%-161.0%), comprising 47.9% of total fibrate prescriptions in 2002 and 65.2% in 2009. In Canada, fenofibrate prescriptions increased from 321prescriptions/100 000 population in January 2002 to 429 prescriptions/100 000 population in December 2009. The annual ratio of generic to brand-name fenofibrate use in the United States ranged from 0:1 to 0.09:1 between 2002 and 2008, while the ratio in Canada steadily increased from 0.51:1 to 1.89:1 between 2005 and 2008. In the United States, crude fenofibrate expenditures increased from $11 535/100 000 population/month in 2002 to $44 975/100 000 population/month in 2009, while the rates in Canada declined from $17 695/100 000 population/month in 2002 to $16 112/100 000 population/month in 2009. Fibrate expenditures per 100 000 population were 3-fold higher in 2009 in the United States compared with Canada.Conclusion During the past decade, prescriptions for fibrates (particularly fenofibrate) increased in the United States, while prescriptions for fibrates in Canada remained stable.KEYWORDS:Atazanavir Plus Ritonavir or Efavirenz as Part of a 3-Drug Regimen for Initial Treatment of HIV-1A Randomized Trial+ Author Affiliations1.From Los Angeles Biomedical Research Institute at Harbor-UCLAMedical Center and the University of California, Los Angeles, Los Angeles, California; Harvard School of Public Health, Boston,Massachusetts; University of Miami School of Medicine, Miami,Florida; Brigham and Women's Hospital and Harvard MedicalSchool, Boston, Massachusetts; National Institute of Allergy andInfectious Diseases, Bethesda, Maryland; Social & ScientificSystems, Silver Spring, Maryland; Frontier Science & TechnologyResearch Foundation, Amherst, New York; Stanford University,Palo Alto, California; Bristol-Myers Squibb, Plainsboro, New Jersey;Gilead Sciences, Foster City, California; GlaxoSmithKline, Research Triangle Park, North Carolina; Abbott Laboratories, Abbott Park,Illinois; University of North Carolina, Chapel Hill, North Carolina;University of California, San Diego, San Diego, California; andUniversity of Washington and Harborview Medical Center, Seattle, Washington.AbstractBackground:Limited data compare once-daily options for initial therapy for HIV-1.Objective: To compare time to virologic failure; first grade-3 or -4 sign, symptom, or laboratory abnormality (safety); and change or discontinuation of regimen (tolerability) for atazanavir plus ritonavir with efavirenz-containing initial therapy for HIV-1.Design: A randomized equivalence trial accrued from September 2005 to November 2007, with median follow-up of 138 weeks. Regimens were assigned by using a central computer, stratified by screening HIV-1 RNA level less than 100 000 copies/mL or 100 000 copies/mL or greater; blinding was known only to the site pharmacist. ( registration number: NCT00118898) Setting: 59 AIDS Clinical Trials Group sites in the United States and Puerto Rico. Patients: Antiretroviral-naive patients.Intervention:Open-label atazanavir plus ritonavir or efavirenz, each given with with placebo-controlled abacavir–lamivudine or tenofovir disoproxil fumarate(DF)–emtricitabine.Measurements:Primary outcomes were time to virologic failure, safety, and tolerability events. Secondary end points included proportion of patients with HIV-1 RNA level less than 50 copies/mL, emergence of drug resistance, changes in CD4 cell counts, calculated creatinine clearance, and lipid levels.Results: 463 eligible patients were randomly assigned to receive atazanavir plus ritonavir and 465 were assigned to receive efavirenz, both with abacavir–lamivudine; 322 (70%) and 324 (70%), respectively, completed follow-up. The respective numbers of participants in each group who received tenofovir DF–emtricitabine were 465 and 464; 342 (74%) and 343 (74%) completed follow-up. Primary efficacy was similar in the group that received atazanavir plus ritonavir and and the group that received efavirenz and did not differ according to whether abacavir–lamivudine or tenofovir DF–emtricitabine was also given. Hazard ratios for time to virologic failure were 1.13 (95% CI, 0.82 to 1.56) and 1.01 (CI, 0.70 to 1.46), respectively, although CIs did not meet prespecified criteria for equivalence. The time to safety (P = 0.048) and tolerability (P < 0.001) events was longer in persons given atazanavir plus ritonavir than in those given efavirenz with abacavir–lamivudine but not with tenofovir DF–emtricitabine.Limitations: Neither HLA-B*5701 nor resistance testing was the standard of care when A5202 enrolled patients. The third drugs, atazanavir plus ritonavir and efavirenz, were open-label; the nucleoside reverse transcriptase inhibitors wereprematurely unblinded in the high viral load stratum; and 32% of patients modified or discontinued treatment with their third drug.Conclusion: Atazanavir plus ritonavir and efavirenz have similar antiviral activity when used with abacavir–lamivudine or tenofovir DF–emtricitabine.Primary Funding Source: National Institutes of Health.英国医学杂志Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluationOPEN ACCESS1. J M Green, professor of child psychiatry 16,2. A J Wood, consultant adolescent psychiatrist2,3. M J Kerfoot, honorary professor of mental healthstudies1,4. G Trainor, nurse consultant3,5. C Roberts, reader in biostatistics1,6. J Rothwell, research associate1,7. A Woodham, research assistant1,8. E Ayodeji, lecturer in child and adolescent mentalhealth4,9. B Barrett, lecturer in health economics5,10. S Byford, reader in health economics5,11. R Harrington, professor of child psychiatry (deceased)1 + Author Affiliations1. 1Psychiatry Research Group, University of Manchester,Manchester M13 9PL, UK2. 2Tier 4 Child and Adolescent Mental Health Services,Young People’s Centre, Chester, UK3. 3Greater Manchester West Mental Health NHSFoundation Trust, Manchester4. 4School of Nursing and Midwifery, University of Salford,Salford5. 5Centre for the Economics of Mental Health Institute ofPsychiatry, King’s College London, London, UK6. 6Manchester Biomedical Research Centre andAcademic Health Sciences Centre, Manchester1. Correspondence to: Jonathan Green****************************.uk•Accepted 18 December 2010Next Section AbstractObjective To examine the effectiveness and cost-effectiveness of group therapy for self harm in young people.Design Two arm, single (assessor) blinded parallel randomised allocation trial of a group therapy intervention in addition to routine care, compared with routine care alone. Randomisation was by minimisation controlling for baseline frequency of self harm, presence of conduct disorder, depressive disorder, and severity of psychosocial stress.Participants Adolescents aged 12-17 years with at least two past episodes of self harm within the previous 12 months. Exclusion criteria were: not speaking English, low weight anorexia nervosa, acute psychosis, substantial learning difficulties (defined by need for specialist school), current containment in secure care.Setting Eight child and adolescent mental health services in the northwest UK.Interventions Manual based developmental group therapy programme specifically designed for adolescents who harm themselves, with an acute phase over six weekly sessionsfollowed by a booster phase of weekly groups as long as needed. Details of routine care were gathered from participating centres. Main outcome measures Primary outcome was frequency of subsequent repeated episodes of self harm. Secondary outcomes were severity of subsequent self harm, mood disorder, suicidal ideation, and global functioning. Total costs of health, social care, education, and criminal justice sector services, plus family related costs and productivity losses, were recorded. Results183 adolescents were allocated to each arm (total n=366). Loss to follow-up was low (<4%). On all outcomes the trial cohort as a whole showed significant improvement from baseline to follow-up. On the primary outcome of frequency of self harm, proportional odds ratio of group therapy versus routine care adjusting for relevant baseline variables was 0.99 (95% confidence interval 0.68 to 1.44, P=0.95) at 6 months and 0.88 (0.59 to 1.33, P=0.52) at 1 year. For severity of subsequent self harm the equivalent odds ratios were 0.81 (0.54 to1.20, P=0.29) at 6 months and 0.94 (0.63 to 1.40, P=0.75) at 1 year. Total 1 year costs were higher in the group therapy arm (£21 781) than for routine care (£15 372) but the difference was not significant (95% CI −1416 to 10782, P=0.132).Conclusions The addition of this targeted group therapy programme did not improve self harm outcomes for adolescents who repeatedly self harmed, nor was there evidence of cost effectiveness. The outcomes to end point for the cohort as a whole were better than current clinical expectations.Trial registration ISRCTN 20496110Previous SectionNext Section IntroductionSelf harm in adolescents is a major public health problem in many countries. It is associated with recurrent psychosocial problems12 and poor long term outcome,3 and it may mark an emerging personality disorder.4 Self harm tends to recur; the reported risk of repetition in adolescents ranges from 10% within six months to 42% during a 21-month follow-up, with a median recurrence of 5-15% each year.5 The risk of suicide after self harm in adolescence is around 0.1-0.5% over 10 years26 with retrospective studies reporting a repetition rate of 36% over10-12 years7 and lifetime mortality rates of 4-11%.89 Self harm shows comorbidity with axis I psychiatric disorders in 43% to 70% of cases, with evidence that the number of comorbid conditions is associated with increased risk of a serious suicide attempt.10 Around two thirds of children and adolescentspresenting with self harm score positively for depressive disorders1112131415; suicidal adolescents with chronic and recurrent affective illness are at increased risk of repetition.111617 18 The persistence of major depressive disorder predicts substantially increased risk of further self harm in young adulthood when other factors are controlled.19 The incidence of self harm is increasing in some areas of the UK.20Self harming adolescents contribute substantially to the workload of health services, in terms of both emergency risk assessment and longer term management. A further substantial burden is placed on wider social care and education. At the time of a self harm event, the young person commonly presents to an accident and emergency department; current National Institute for Health and Clinical Excellence (NICE) guidance1 for England and Wales is for overnight medical hospital admission as a minimum response and more lengthy medical or psychiatric admission is often needed in situations of risk or more severe disorder. A follow-up study of young adults who had deliberately poisoned themselves as adolescents21found that their lifetime service costs were significantly greater than those of matched controls. They used more service provided accommodation, special education, and hospital services, incurred greater criminal justicecosts, and received more social security benefits.Despite this large burden, very little is known about the cost-effectiveness of interventions.22 In one of the few studies to date, Byford and colleagues23undertook a cost-effectiveness analysis of a home based social work intervention for children and adolescents who deliberately poisoned themselves. They found no significant differences between the two groups in terms of the main outcome measures or costs, although in a subgroup of children without major depression, suicidal ideation was significantly lower in the intervention group at follow-up with no significant differences in cost.The design and delivery of effective treatments for this group are complex and have to accommodate considerable variations in presentation.1 A subgroup of patients needs emergency inpatient management; the majority require long term treatment approaches in the context of multi-agency partnerships. A Cochrane review of psychosocial and pharmacological treatments for self harm24found continuing uncertainty about which forms of treatment are most effective and insufficient evidence against which to make firm recommendations. Across all age ranges, a promising additional benefit over standard carewas found for problem solving therapy (summary odds ratio across five studies 0.70; 0.45 to 1.11) and provision of an emergency contact card (summary odds ratio across two studies 0.45; 0.19 to 1.07), but neither of these results reached statistical significance. The authors noted a number of key limitations across all studies reviewed. These included insufficient sample sizes, leading to possible type 2 errors in effectiveness estimates; lack of adequate description of the services used as comparison groups; and use of service data (usually further hospital attendance) rather than interview data to define the primary outcome of repetition, which could introduce biases in outcome estimates, owing to variation in service use and the possibility that the intervention itself could alter willingness to seek hospital help.Hawton and colleagues24noted that only two of the studies reviewed focused on adolescent self harm, despite the importance of the problem in this age group and the likelihood that the treatment needs of adolescents differ from those of adults. Trials of adolescent focused treatments are therefore of high priority to inform service provision. Harrington and colleagues15tested a brief family intervention for adolescents (total n=149) against standard aftercare and found no significanteffect on repetition (odds ratio 1.02; 95% CI 0.41 to 2.5; P=0.97). The same group then undertook a developmental group psychotherapy programme designed to focus on the multiple clinical problems typical in this population (depression, experience of abuse, behavioural disorder, substance misuse, poor self esteem and body image, and family conflict and disruption) and to combine effectively with other interventions (pharmacotherapy, individual and family therapies) using a group therapy format that was cost-effective of clinician time. A pilot randomised trial of developmental group psychotherapy compared with routine care in 63 adolescents referred with repeated self harm to child and adolescent mental health services25 showed a significant relative reduction of repeated self harm over 29 weeks of follow-up (2/31 in developmental group psychotherapy versus 10/31 in routine care; odds ratio 6.3; 95% CI 1.4 to 28.7). The total number of self harm episodes per participant during follow-up was also lower for the treatment group (mean 0.6) than for the routine care group (mean 1.8), but this difference was not statistically significant. This trial was one of the few to have suggested effectiveness of an intervention in patients of any age. A replication in northern Australia, with remote supervision from the UK developing team (n=72)26 failedto show a treatment effect. This study, however, recruited from general referrals to child and adolescent mental health services where patients were identified to have self harming behaviour, rather than from specific self harm referrals, and it only recruited 57% of its target for analytical power.The Assessment of Treatment In Suicidal Teenagers (ASSIST) trial reported here was intended as a definitive test of this group intervention using a large sample with a pragmatic design and including a detailed health economic evaluation. Our objective was to use a large parallel group randomised trial to compare the effectiveness and cost-effectiveness of developmental group psychotherapy plus routine care with that of routine care alone for adolescents presenting with repeated self harm in the previous year. We addressed some of the methodological weaknesses in previous studies identified by Hawton and colleagues24by recruiting a large cohort size, making detailed description of routine treatment undertaken, and triangulating two independent interview based ascertainments of the primary outcome rather than using service data on hospital attendance.Previous SectionNext Section MethodsParticipantsParticipating centres were established child and adolescent mental health services teams in the northwest of England, who served substantial geographical areas and were experienced in the assessment and management of young people with self harm. They delivered the developmental group psychotherapy in partnership with the ASSIST research team.Participants were adolescents aged between 12 years and 16 years 11 months who had presented with two or more episodes of self harm during the previous 12 months. In the context of this study “self harm” was deemed to include the non-accidental overdose of drugs or other toxic substances, or non-accidental self inflicted injuries such as scratching, cutting, burning, or strangulation. Exclusion criteria were non-English speakers, severe low weight anorexia nervosa, current psychotic illness, attendance at special learning disability school, current containment in secure care (young people in other forms of looked after care such as adoption, fostering, or non-secure residential units were, however, included).InterventionsExperimental treatmentDevelopmental group psychotherapy was a manual based treatment specifically designed for self harming adolescents.25 The programme integrated techniques from a number of other therapies that have previously been applied to depressed or suicidal adolescents and their families, including cognitive behavioural therapy, dialectical behavioural therapy, and group psychotherapy.152728 Group goals were oriented around themes that previous research suggested were important in adolescents who harm themselves, such as poor peer relationships, bullying, and family problems. Adolescents learned strategies to deal with these difficulties using group based techniques such as role play. The groups had a rolling entry; young people started attending as soon as their initial assessment and randomisation were completed and attendance continued until the young person felt ready to leave. Therapists had a minimum of three years of relevant post-qualifying experience. They had initial training in fidelity to the model from AJW and GT (the original developers of the intervention), who also led subsequent regular supervision, comprising urgent telephone consultation during working hours and attendance at a monthly supervision group. In the base site, developmental group psychotherapy was provided by AJW and GT and included patients considered clinically challenging by。

医学文献翻译(中英对照)

The clinical and cost-effectiveness of Pharmalgen® for the treatment of bee and wasp venom allergy1 TITLE OF PROJECTThe clinical and cost effectiveness of Pharmalgen® for the treatment of bee and wasp venom allergy2 TAR TEAMLiverpool Reviews and Implementation Group (LR i G), University of Liverpool Correspondence to:Rumona Dickson, MsDirector, LR i GUniversity of LiverpoolRoom 2.12Whelan BuildingThe QuadrangleBrownlow HillLiverpoolL69 3GBTel: +44 (0) 151 794 5682Fax: +44 (0)151 794 5585Email:****************.ukFor details of expertise within the TAR team, see section 7.3 PLAIN ENGLISH SUMMARYAllergic reactions to bee and wasp venom may occur in venom-sensitive patients immediately following a sting, and can vary in severity, with initially mild symptoms sometimes progressing to critical conditions within seconds. The most severe systemic allergic reactions (generalised reactions) are known as anaphylaxis, a reaction characterised by abnormally low blood pressure, fainting or collapse, and in extreme reactions these symptoms can cause death.Each year in the UK there are between two and nine deaths from anaphylaxis caused by bee and wasp venom. The immediate treatment for severe allergic reactions to bee and wasp venom cons ists of emergency treatment with drugs to decrease the patient’s response to the venom and support breathing, if required.To avoid further reactions, the use of sensitisation to bee and wasp venom, through a process known as venom immunotherapy (VIT), has been investigated. Venom immunotherapy consists of subcutaneous injections of increasing amounts of venom into patients with a history of anaphylaxis to bee and wasp venom. Pharmalgen® has had UK marketing authorisation for the diagnosis and treatment (using VIT) of allergy to bee venom (using Pharmalgen® Bee Venom) and wasp venom (using Pharmalgen® Wasp Venom) since March 1995, and it is used by more than 40 centres across the UK. This review aims to assess whether using Pharmalgen® in VIT is clinically useful when treating people with a history of severe reaction to bee and wasp stings. The review will compare preventative treatment with Pharmalgen® to other treatment options, including high dose antihistamines, advice on theavoidance of bee and wasp stings and adrenaline auto-injector prescription and training. If suitable data are available, the review will also consider the cost effectiveness of using Pharmalgen® for VIT and other subgroups including children and people at high risk of future stings or severe allergic reactions to future stings.4 DECISION PROBLEM4.1 Clarification of research question and scopePharmalgen® is used for the diagnosis and treatment of immunoglobin E (IgE)-mediated allergy to bee and wasp venom. The aim of this report is to assess whether the use of Pharmalgen® is of clinical value when providing VIT to individuals with a history of severe reaction to bee and wasp venom and whether doing so would be considered cost effective compared with alternative treatment options available in the NHS.4.2 BackgroundBees and wasps form part of the order Hymenoptera (which also includes ants), and within this order the species that cause the most frequent allergic reactions are the Vespidae (wasps, yellow jackets and hornets), and the Apinae (honeybees).1Bee and wasp stings contain allergenic proteins. In wasps, these are predominantly phospholipase A1,2 hyaluronidase2 and antigen 5,3 and in bees are phospholipase A2 and hyaluronidase.4 Following an initial sting, a type 1 hypersensitivity reaction may occur in some individuals which produces the IgE antibody. This sensitises cells to the allergen, and any subsequent exposure to the allergen may cause the allergen to bind to the IgE molecules, which results in an allergic reaction.These allergens typically produce an intense, burning pain followed by erythema (redness) and a small area of oedema (swelling) at the site of the sting. The symptoms produced following a sting can be classified into non-allergic reactions, such as local reactions, and allergic reactions, such as extensive local reactions, anaphylactic systemic reactions and delayed systemic reactions.5-6 Systemic allergic reactions may occur in venom-sensitive patients immediately following a sting,7 and can vary in severity, with initially mild symptoms sometimes progressing to critical conditions within seconds.1The most severe systemic allergic reaction is known as anaphylaxis. Anaphylactic reactions are of rapid onset (typically up to 15 minutes post sting) and can manifest in different ways. Initial symptoms are usually cutaneous followed by hypotension, with light-headedness, fainting or collapse. Some people develop respiratory symptoms due to an asthma-like response or laryngeal oedema. In severe reactions, hypotension, circulatory disturbances, and breathing difficulty can progress to fatal cardio-respiratory arrest.Anaphylaxis occurs more commonly in males and in people under 20 years of age and can be severe and potentially fatal.84.3 EpidemiologyIt is estimated that the prevalence of wasp and bee sting allergy is between 0.4% and 3.3%.9 The incidence of systemic reactions to wasp and bee venom is not reliably known, but estimates range from 0.15-3.3%,10-11 Systemic allergic reactions are reported by up to 3% of adults, and almost 1% of children have a medical history of severe sting reactions.9, 12 After a large local reaction, 5–15% of people will go on to develop a systemic reaction when next stung.13 In people with a mild systemic reaction, the risk of subsequent systemic reactions is thought to be about 18%.13 Hymenoptera venom are one of the three main causes of fatalanaphylaxis in the USA and UK.14-15 Insect stings are the second most frequent cause of anaphylaxis outside of medical settings.16 Between two and nine people in the UK die each year as a result of anaphylaxis due to reactions to wasp and bee stings.17 Once an individual has experienced an anaphylactic reaction, the risk of having a recurrent episode has been estimated to be between 60% and 79%.13In 2000, the register of fatal anaphylactic reactions in the UK from 1992 onwards was reported by Pumphrey to determine the frequency at which classic manifestations of fatal anaphylaxis are present.18 Of the 56 post-mortems carried out, 19 deaths were recorded as reactions to Hymenoptera venom (33.9%). A retrospective study in 2004 examined all deaths from anaphylaxis in the UK between 1992 and 2001, and estimated 22.19% to be reactions to Hymenoptera venom (47/212). This further breaks down into 29/212 (13.68%) as reactions to wasp stings, and 4/212 (1.89%) as reactions to bee stings. The remaining 14/212 were unidentified Hymenoptera stings (6.62%).194.4 Current diagnostic optionsCurrently, individuals can be tested to determine if they are at risk of systemic reactions to bee and wasp venom. The primary diagnostic method for systemic reactions to bee and/or wasp stings is venom skin testing.Skin testing involves intradermal injection with the five Hymenoptera venom protein extracts, with v enom concentrations in the range of 0.001 to 1.0 μg/ml. This establishes the minimum concentration giving a positive result (a reaction occurring in the individual). As venom tests show unexplained variability over time,20 and as negative skin tests can occur following recent anaphylaxis, it is recommended that tests be repeated after 1 to 6 months.21Other methods of diagnosis in patients following an anaphylactic reaction include radioallergosorbent test (RAST), which detects allergen-specific IgE antibodies in serum. This test is less sensitive than skin testing but is useful when skin tests cannot be done, for example in patients with skin conditions.22-234.5 Current treatment optionsPreventative treatments include education on how to avoid bee and wasp venom, and prescription of high dose antihistamines. Patients with a history of moderate local reactions should be provided with an emergency kit,24 containing a H1-blocking antihistamine and a topical corticosteroid for immediate use following a sting. Patients with a history of anaphylaxis should be provided with an emergency kit containing a rapid-acting H1-blocking antihistamine, an oral corticosteroid and an auto-injector for self administration, containing epinephrine.Injected epinephrine (a sympathomimetic drug which acts on both alpha and beta receptors) is regarded as the emergency treatment of choice for cases of acute anaphylaxis as a result of Hymenoptera stings.25 For adults, the recommended dose is between 0.30 mg/ml and 0.50mg/ml I.M, and 0.01 ml/kg I.M. for children. Individuals with a history of anaphylactic reactions are recommended to carry auto injectors containing epinephrine (commonly known as EpiPen®, Adrenaclick®, Anapen® or Twinject®). These are intended for immediateself-administration by individuals with a history of hypersensitivity to Hymenoptera stings and other allergens.Preventive measures following successful treatment of a systemic allergic reaction to Hymenoptera venom consists of either allergen avoidance or specific allergen immunotherapy,known as VIT. Venom immunotherapy is considered to be a safe and effective treatment.26 Currently, VIT can be used with several regimes, including Pharmalgen® (manufactured by ALK Abello, and licensed in the UK), Aquagen® and Alutard SQ® (both manufactured by ALK Abello and unlicensed in the UK but licensed in some parts of Europe), VENOMENHAL® (HAL Allergy, Leiden, Netherlands, unlicensed in the UK), Alyostal® (Stallergenes, Antony Cedex, France, unlicensed in the UK), and Venomil® (Hollister-Stier Laboratories LLC, unlicensed in the UK). Venom immunotherapy is recommended to prevent future systemic reactions. It is recommended that VIT is considered ‘when positive test results for specific IgE antibodies correlate with suspected triggers and patient exposure’.27 Venom immunotherapy consists of subcutaneous injections of increasing amounts of venom, and treatment is divided into two periods: the build up phase and maintenance phase. Venom immunotherapy is now the standard therapy for Hymenoptera sting allergy,28 and is a model for allergen-specific therapy,29-30 with success rates (patients who will remain anaphylaxis free) being reported as more than 98% in some studies.4, 31 There are now 44 centres across the UK which provide VIT to people for bee and wasp sting allergy. Venom immunotherapy is normally discontinued after 3 to 5 years, but modifications may be necessary when treating people with intense allergen exposure (such as beekeepers) or those with individual risk factors for severe reactions. There is no method of assessing which patients will be at risk of further anaphylactic reactions following administration of VIT and those who will remain anaphylaxis free in the long term following VIT.27Local or systemic adverse reactions may occur as a result of VIT. They normally develop within 30 minutes of the injection. Each patient is monitored closely following each injection to check for adverse reactions. Progression to an increased dose only occurs if the previous dose is fully tolerated.4.6 The technologyPharmalgen® is produced by ALK Abello, and has had UK marketing authorisation for the diagnosis (using skin testing/intracutaneous testing) and treatment (using VIT) ofIgE-mediated allergy to bee venom (Pharmalgen® Bee Venom) and wasp venom (Pharmalgen® Wasp Venom) since March 1995 (marketing authorisation number PL10085/0004). The active ingredient is partially purified freeze dried Vespula spp. venom in Pharmalgen® Wasp Venom and freeze dried Apis mellifera venom in Pharmalgen® Bee Venom, each provided in powder form for solution for injection.Before treatment is considered, allergy to bee or wasp venom must be confirmed by case history and diagnosis. Treatment with Pharmalgen® Bee or Wasp Venom is performed by subcutaneous injections. The treatment is carried out in two phases: the initial phase and the maintenance phase.In the build up phase, the dose is increased stepwise until the maintenance dose (the maximum tolerable dose before an allergic reaction) is achieved. ALK Abello recommends the following dosage proposals: conventional, modified rush (clustered) and rush updosing. In conventional updosing, the patient receives one injection every 3-7 days. In modified rush (clustered) updosing, the patient receives 2-4 injections once a week. If necessary this interval may be extended up to two weeks. The 2-4 injections are given with an interval of 30 minutes. In rush updosing, while being hospitalised the patient receives injections with a 2-hour interval. A maximum of four injections per day may be given in the initial phase.The build up phase ends when the individual maintenance dose has been attained and the interval between the injections is increased to 2, 3 and 4 weeks. This is called the maintenance phase, and the maintenance dose is then given every 4 weeks for at least 3 years. Contra-indications to VIT treatment are immunological diseases (e. g. immune complex diseases and immune deficiencies); chronic heart/lung diseases; treatment with β-blockers; severe eczema. Side effects include superficial wheal and flare due to shallow injection; local swelling (which may be immediate or delayed up to 48 hours); mild general reactions such as urticaria, erythema, rhinitis or mild asthma; moderate or severe general reactions such as more severe asthma, angioedema or an anaphylactic reaction with hypotension and respiratory embarrassment; anaphylaxis (often starting with erythema and pruritus, followed by urticaria, angioedema, nasal or pharyngial congestion, wheezing, dyspnoea, nausea, hypotension, syncope, tachycardia or diarrhoea). 324.7 Objectives of the HTA projectThe aim of this review is to assess the clinical and cost effectiveness of Pharmalgen® in providing immunotherapy to individuals with a history of type 1 IgE-mediated systemic allergic reaction to bee and wasp venom. The review will consider the effectiveness of Pharmalgen® when compared to alternative treatment options available in the NHS, including advice on the avoidance of bee and wasp stings, high dose antihistamines and adrenaline auto-injector prescription and training. The review will also examine the existing health economic evidence and identify the key economic issues related to the use of Pharmalgen® in UK clinical practice. If suitable data are available, an economic model will be developed and populated to evaluate if the use of Pharmalgen® for the treatment of bee and wasp venom allergy, within its licensed indication, would be a cost effective use of NHS resources.5 METHODS FOR SYNTHESISING CLINICAL EFFECTIVENESS EVIDENCE5.1 Search strategyThe major electronic databases including Medline, Embase and The Cochrane Library will be searched for relevant published literature. Information on studies in progress, unpublished research or research reported in the grey literature will be sought by searching a range of relevant databases including National Research Register and Controlled Clinical Trials. A sample of the search strategy to be used for MEDLINE is presented inAppendix 1.Bibliographies of previous systematic reviews, retrieved articles and the submissions provided by manufacturers will be searched for further studies.A database of published and unpublished literature will be assembled from systematic searches of electronic sources, hand searching, contacting manufacturers and consultation with experts in the field. The database will be held in the Endnote X4 software package.5.1.1 Inclusion criteriaThe inclusion criteria specified in Table 1 will be applied to all studies after screening. The inclusion criteria were selected to reflect the criteria described in the final scope issued by NICE for the review. However, as there is likely to be a limited amount of RCT data, the inclusion criteria of study design may be expanded to include comparative studies and descriptive cohorts. The clinical and cost effectiveness of Pharmalgen® for the treatment of bee and wasp venom allergy Page 11 of 21Table 1: Inclusion criteria Intervention(s) Pharmalgen® for the treatment of bee and waspvenom allergy,Population(s) People with a history of type 1 IgE-mediatedsystemic allergic reactions to:wasp venom and/or bee venomComparators Alternative treatment options available in theNHS, without venom immunotherapy including:advice on the avoidance of bee and waspvenom,high-dose antihistamines,adrenaline auto-injector prescription andtrainingStudy design Randomised controlled trialsSystematic reviewsOutcomes Outcome measures to be considered include:number and severity of type 1 IgE-mediatedsystemic allergic reactionsmortalityanxiety related to the possibility of future allergicreactionsadverse effects of treatmenthealth-related quality of lifeOther considerations If the evidence allows, considerations will begiven to subgroups of people, according totheir:risk of future stings (as determined, forexample, by occupational exposure)risk of severe allergic reactions to future stings(as determined by such factors as baselinetryptase levels and co-morbidities)If the evidence allows, the appraisal willconsider separately people who have acontraindication to adrenaline.If the evidence allows, the appraisal willconsider children separately.Two reviewers will independently screen all titles and abstracts of papers identified in the initial search. Discrepancies will be resolved by consensus and where necessary a third reviewer will be consulted. Studies deemed to be relevant will be obtained and assessed for inclusion. Where studies do not meet the inclusion criteria they will be excluded.5.1.2 Data extraction strategyData relating to study design, findings and quality will be extracted by one reviewer andindependently checked for accuracy by a second reviewer. Study details will be extracted using a standardised data extraction form. If time permits, attempts will be made to contact authors for missing data. Data from studies presented in multiple publications will be extracted and reported as a single study with all relevant other publications listed.5.1.3 Quality assessment strategyThe quality of the clinical-effectiveness studies will be assessed according to criteria based on the CRD’s guidance for undertaking reviews in healthcare.33-34 The quality of the individual clinical-effectiveness studies will be assessed by one reviewer, and independently checked for agreement by a second. Disagreements will be resolved through consensus and if necessary a third reviewer will be consulted.5.1.4 Methods of analysis/synthesisThe results of the data extraction and quality assessment for each study will be presented in structured tables and as a narrative summary. The possible effects of study quality on the effectiveness data and review findings will be discussed. All summary statistics will be extracted for each outcome and where possible, data will be pooled using a standard meta-analysis.35 Heterogeneity between the studies will be assessed using the I2 test.34 Both fixed and random effects results will be presented as forest plots.6 METHODS FOR SYNTHESISING COST EFFECTIVENESS EVIDENCE The economic section of the report will be presented in two parts. The first will include a standard review of relevant published economic evaluations. If appropriate and data are available, the second will include the development of an economic model. The model will be designed to estimate the cost effectiveness of Pharmalgen® for VIT in individuals with a history of anaphylaxis to bee and wasp venom. This section of the report will also consider budget impact and will take account of available information on current and anticipated patient numbers and service configuration for the treatment of this condition in the NHS.6.1 Systematic review of published economic literatureThe literature review of economic evidence will identify any relevant published cost-minimisation, cost-effectiveness, cost-utility and/or cost-benefit analyses. Economic evaluations/models included in the manufacturer submission(s) will be included in the review and critiqued as appropriate.6.1.1 Search strategyThe search strategies detailed in section 5 will be adapted accordingly to identify studies examining the cost effectiveness of using Pharmalgen® for VIT in patients with a history of allergic reactions to bee or wasp venom. Other searching activities, including electronic searching of online health economic journals and contacting experts in the field will also be undertaken. Full details of the search process will be presented in the final report. The search strategy will be designed to meet the primary objective of identifying economic evaluations for inclusion in the cost-effectiveness literature review. At the same time, the search strategy will be used to identify economic evaluations and other information sources which may include data that can be used to populate a de novo economic model where appropriate. Searching will be undertaken in MEDLINE and EMBASE as well as in the Cochrane Library, which includes the NHS Economic Evaluation Database (NHS EED).6.1.2 Inclusion and exclusionIn addition to the inclusion criteria outlined in Table 1, specific criteria required for thecost-effectiveness review are described in Table 2. In particular, only full economic evaluations that compare two or more options and consider both costs and consequences will be included in the review of published literature. Any economic evaluations/models included in the manufacturer submission(s) will be included as appropriate. Studies that do not meet all of the criteria will be excluded and their bibliographic details listed with reasons for exclusion.Table 2: Additional inclusion criteria (cost effectiveness) Study design Full economic evaluations that consider both costs and consequences(cost-effectiveness analysis, cost-utility analysis, cost-minimisation analysis and cost benefit analysis)Outcomes Incremental cost per life year gainedIncremental cost per quality adjusted lifeyear gained6.1.3 Data extraction strategyData relating to both study design and quality will be extracted by one reviewer and independently checked for accuracy by a second reviewer. Disagreement will be resolved through consensus and, if necessary, a third reviewer will be consulted. If time constraints allow, attempts will be made to contact authors for missing data. Data from multiple publications will be extracted and reported as a single study.6.1.4 Quality assessment strategyThe quality of the cost-effectiveness studies/models will be assessed according to a checklist updated from that developed by Drummond et al.36 This checklist will reflect the criteria for economic evaluation detailed in the methodological guidance developed by NICE.37 The quality of the individual cost-effectiveness studies/models will be assessed by one reviewer, and independently checked for agreement by a second. Disagreements will be resolved through consensus and, if necessary, a third reviewer will be consulted. The information will be tabulated and summarised within the text of the report.6.2 Methods of analysis/synthesis6.2.1 Cost effectiveness review of published literatureIndividual study data and quality assessment will be summarised in structured tables and as a narrative description. Potential effects of study quality will be discussed.To supplement findings from the economic literature review, additional cost and benefit information from other sources, including the manufacturer submission(s) to NICE, will be collated and presented as appropriate.6.2.2 Development of a de novo economic model by the AGa. Cost dataThe primary perspective for the analysis of cost information will be the NHS. Cost data will therefore focus on the marginal direct health service costs associated with the intervention. Quantities of resources used will be identified from consultation with experts, primary data from relevant sources and the reviewed literature. Where possible, unit cost data will be extracted from the literature or obtained from other relevant sources (drug price lists, NHS reference costs and Chartered Institute of Public Finance and Accounting cost databases).Where appropriate costs will be discounted at 3.5% per annum, the rate recommended in NICE guidance to manufacturers and sponsors of submissions. 37b. Assessmentof benefitsA balance sheet will be constructed to list benefits and costs arising from alternative treatment options. LRiG anticipates that the main measures of benefit will be increased QALYs. Where appropriate, effectiveness and other measures of benefit will be discounted at 3.5%, the rate recommended in NICE guidance to manufacturers and sponsors of submissions. 37 b. ModellingThe ability of LRiG to construct an economic model will depend on the data available. Where modelling is appropriate, a summary description of the model and a critical appraisal of key structures, assumptions, resources, data and sensitivity analysis (see Section d) will be presented. In addition, LRiG will provide an assessment of the model’s strengths and weaknesses and discuss the implications of using different assumptions in the model. Reasons for any major discrepancies between the results obtained from assessment group model and the manufacturer model(s) will be explored.The time horizon will be a patient’s lifetime in order to reflect the chronic natu re of the disease.A formal combination of costs and benefits will also be performed, although the type of economic evaluation will only be chosen in light of the variations in outcome identified from the clinical- effectiveness review evidence.If data are available, the results will be presented as incremental cost per QALY ratios for each alternative considered. If sufficient data are not available to construct these measures with reasonable precision, incremental cost-effectiveness analysis or cost-minimisation analysis will be undertaken. Any failure to meet the reference case will be clearly specified and justified, and the likely implications will, as far as possible, be quantified.d. Sensitivity analysisIf appropriate, sensitivity analysis will be applied to LRiG’s model in order to assess the robustness of the results to realistic variations in the levels of the underlying parameter values and key assumptions. Where the overall results are sensitive to a particular variable, the sensitivity analysis will explore the exact nature of the impact of variations.Imprecision inthe principal model cost-effectiveness results with respect to key parameter values will be assessed by use of techniques compatible with the modelling methodology deemed appropriate to the research question and to the potential impact on decision making for specific comparisons (e.g. multi-way sensitivity analysis, cost-effectiveness acceptability curves etc).7 HANDLING THE MANUFACTURER SUBMISSION(S)All data submitted by the drug manufacturers arriving before 22nd March 2011 and meeting the set inclusion criteria will be considered for inclusion in the review. Data arriving after this date will only be considered if time constraints allow. Any economic evaluations included in the manufacturer submission(s) will be assessed. This will include a detailed analysis of the appropriateness of the parametric and structural assumptions involved in any models in the submission and an assessment of how robust the models are to changes in key assumptions. Clarification on specific aspects of the model may be sought from the relevant manufacturer. Any 'commercial in confidence' data taken from a manufacturer submission will be clearly。

医学文献翻译(中英对照)

医学文献翻译（中英对照）

The clinical and cost-effectiveness of Pharmalgen® for the treatment of bee and wasp venom allergy1 TITLE OF PROJECTThe clinical and cost effectiveness of Pharmalgen® for the treatment of bee and wasp venom allergy2 TAR TEAMLiverpool Reviews and Implementation Group (LR i G), University of Liverpool Correspondence to:Rumona Dickson, MsDirector, LR i GUniversity of LiverpoolRoom 2.12Whelan BuildingThe QuadrangleBrownlow HillLiverpoolL69 3GBTel: +44 (0) 151 794 5682Fax: +44 (0)151 794 5585Email:****************.ukFor details of expertise within the TAR team, see section 7.3 PLAIN ENGLISH SUMMARYAllergic reactions to bee and wasp venom may occur in venom-sensitive patients immediately following a sting, and can vary in severity, with initially mild symptoms sometimes progressing to critical conditions within seconds. The most severe systemic allergic reactions (generalised reactions) are known as anaphylaxis, a reaction characterised by abnormally low blood pressure, fainting or collapse, and in extreme reactions these symptoms can cause death.Each year in the UK there are between two and nine deaths from anaphylaxis caused by bee and wasp venom. The immediate treatment for severe allergic reactions to bee and wasp venom cons ists of emergency treatment with drugs to decrease the patient’s response to the venom and support breathing, if required.To avoid further reactions, the use of sensitisation to bee and wasp venom, through a process known as venom immunotherapy (VIT), has been investigated. Venom immunotherapy consists of subcutaneous injections of increasing amounts of venom into patients with a history of anaphylaxis to bee and wasp venom. Pharmalgen® has had UK marketing authorisation for the diagnosis and treatment (using VIT) of allergy to bee venom (using Pharmalgen® Bee Venom) and wasp venom (using Pharmalgen® Wasp Venom) since March 1995, and it is used by more than 40 centres across the UK. This review aims to assess whether using Pharmalgen® in VIT is clinically useful when treating people with a history of severe reaction to bee and wasp stings. The review will compare preventative treatment with Pharmalgen® to other treatment options, including high dose antihistamines, advice on theavoidance of bee and wasp stings and adrenaline auto-injector prescription and training. If suitable data are available, the review will also consider the cost effectiveness of using Pharmalgen® for VIT and other subgroups including children and people at high risk of future stings or severe allergic reactions to future stings.4 DECISION PROBLEM4.1 Clarification of research question and scopePharmalgen® is used for the diagnosis and treatment of immunoglobin E (IgE)-mediated allergy to bee and wasp venom. The aim of this report is to assess whether the use of Pharmalgen® is of clinical value when providing VIT to individuals with a history of severe reaction to bee and wasp venom and whether doing so would be considered cost effective compared with alternative treatment options available in the NHS.4.2 BackgroundBees and wasps form part of the order Hymenoptera (which also includes ants), and within this order the species that cause the most frequent allergic reactions are the Vespidae (wasps, yellow jackets and hornets), and the Apinae (honeybees).1Bee and wasp stings contain allergenic proteins. In wasps, these are predominantly phospholipase A1,2 hyaluronidase2 and antigen 5,3 and in bees are phospholipase A2 and hyaluronidase.4 Following an initial sting, a type 1 hypersensitivity reaction may occur in some individuals which produces the IgE antibody. This sensitises cells to the allergen, and any subsequent exposure to the allergen may cause the allergen to bind to the IgE molecules, which results in an allergic reaction.These allergens typically produce an intense, burning pain followed by erythema (redness) and a small area of oedema (swelling) at the site of the sting. The symptoms produced following a sting can be classified into non-allergic reactions, such as local reactions, and allergic reactions, such as extensive local reactions, anaphylactic systemic reactions and delayed systemic reactions.5-6 Systemic allergic reactions may occur in venom-sensitive patients immediately following a sting,7 and can vary in severity, with initially mild symptoms sometimes progressing to critical conditions within seconds.1The most severe systemic allergic reaction is known as anaphylaxis. Anaphylactic reactions are of rapid onset (typically up to 15 minutes post sting) and can manifest in different ways. Initial symptoms are usually cutaneous followed by hypotension, with light-headedness, fainting or collapse. Some people develop respiratory symptoms due to an asthma-like response or laryngeal oedema. In severe reactions, hypotension, circulatory disturbances, and breathing difficulty can progress to fatal cardio-respiratory arrest.Anaphylaxis occurs more commonly in males and in people under 20 years of age and can be severe and potentially fatal.84.3 EpidemiologyIt is estimated that the prevalence of wasp and bee sting allergy is between 0.4% and 3.3%.9 The incidence of systemic reactions to wasp and bee venom is not reliably known, but estimates range from 0.15-3.3%,10-11 Systemic allergic reactions are reported by up to 3% of adults, and almost 1% of children have a medical history of severe sting reactions.9, 12 After a large local reaction, 5–15% of people will go on to develop a systemic reaction when next stung.13 In people with a mild systemic reaction, the risk of subsequent systemic reactions is thought to be about 18%.13 Hymenoptera venom are one of the three main causes of fatalanaphylaxis in the USA and UK.14-15 Insect stings are the second most frequent cause of anaphylaxis outside of medical settings.16 Between two and nine people in the UK die each year as a result of anaphylaxis due to reactions to wasp and bee stings.17 Once an individual has experienced an anaphylactic reaction, the risk of having a recurrent episode has been estimated to be between 60% and 79%.13In 2000, the register of fatal anaphylactic reactions in the UK from 1992 onwards was reported by Pumphrey to determine the frequency at which classic manifestations of fatal anaphylaxis are present.18 Of the 56 post-mortems carried out, 19 deaths were recorded as reactions to Hymenoptera venom (33.9%). A retrospective study in 2004 examined all deaths from anaphylaxis in the UK between 1992 and 2001, and estimated 22.19% to be reactions to Hymenoptera venom (47/212). This further breaks down into 29/212 (13.68%) as reactions to wasp stings, and 4/212 (1.89%) as reactions to bee stings. The remaining 14/212 were unidentified Hymenoptera stings (6.62%).194.4 Current diagnostic optionsCurrently, individuals can be tested to determine if they are at risk of systemic reactions to bee and wasp venom. The primary diagnostic method for systemic reactions to bee and/or wasp stings is venom skin testing.Skin testing involves intradermal injection with the five Hymenoptera venom protein extracts, with v enom concentrations in the range of 0.001 to 1.0 μg/ml. This establishes the minimum concentration giving a positive result (a reaction occurring in the individual). As venom tests show unexplained variability over time,20 and as negative skin tests can occur following recent anaphylaxis, it is recommended that tests be repeated after 1 to 6 months.21Other methods of diagnosis in patients following an anaphylactic reaction include radioallergosorbent test (RAST), which detects allergen-specific IgE antibodies in serum. This test is less sensitive than skin testing but is useful when skin tests cannot be done, for example in patients with skin conditions.22-234.5 Current treatment optionsPreventative treatments include education on how to avoid bee and wasp venom, and prescription of high dose antihistamines. Patients with a history of moderate local reactions should be provided with an emergency kit,24 containing a H1-blocking antihistamine and a topical corticosteroid for immediate use following a sting. Patients with a history of anaphylaxis should be provided with an emergency kit containing a rapid-acting H1-blocking antihistamine, an oral corticosteroid and an auto-injector for self administration, containing epinephrine.Injected epinephrine (a sympathomimetic drug which acts on both alpha and beta receptors) is regarded as the emergency treatment of choice for cases of acute anaphylaxis as a result of Hymenoptera stings.25 For adults, the recommended dose is between 0.30 mg/ml and 0.50mg/ml I.M, and 0.01 ml/kg I.M. for children. Individuals with a history of anaphylactic reactions are recommended to carry auto injectors containing epinephrine (commonly known as EpiPen®, Adrenaclick®, Anapen® or Twinject®). These are intended for immediateself-administration by individuals with a history of hypersensitivity to Hymenoptera stings and other allergens.Preventive measures following successful treatment of a systemic allergic reaction to Hymenoptera venom consists of either allergen avoidance or specific allergen immunotherapy,known as VIT. Venom immunotherapy is considered to be a safe and effective treatment.26 Currently, VIT can be used with several regimes, including Pharmalgen® (manufactured by ALK Abello, and licensed in the UK), Aquagen® and Alutard SQ® (both manufactured by ALK Abello and unlicensed in the UK but licensed in some parts of Europe), VENOMENHAL® (HAL Allergy, Leiden, Netherlands, unlicensed in the UK), Alyostal® (Stallergenes, Antony Cedex, France, unlicensed in the UK), and Venomil® (Hollister-Stier Laboratories LLC, unlicensed in the UK). Venom immunotherapy is recommended to prevent future systemic reactions. It is recommended that VIT is considered ‘when positive test results for specific IgE antibodies correlate with suspected triggers and patient exposure’.27 Venom immunotherapy consists of subcutaneous injections of increasing amounts of venom, and treatment is divided into two periods: the build up phase and maintenance phase. Venom immunotherapy is now the standard therapy for Hymenoptera sting allergy,28 and is a model for allergen-specific therapy,29-30 with success rates (patients who will remain anaphylaxis free) being reported as more than 98% in some studies.4, 31 There are now 44 centres across the UK which provide VIT to people for bee and wasp sting allergy. Venom immunotherapy is normally discontinued after 3 to 5 years, but modifications may be necessary when treating people with intense allergen exposure (such as beekeepers) or those with individual risk factors for severe reactions. There is no method of assessing which patients will be at risk of further anaphylactic reactions following administration of VIT and those who will remain anaphylaxis free in the long term following VIT.27Local or systemic adverse reactions may occur as a result of VIT. They normally develop within 30 minutes of the injection. Each patient is monitored closely following each injection to check for adverse reactions. Progression to an increased dose only occurs if the previous dose is fully tolerated.4.6 The technologyPharmalgen® is produced by ALK Abello, and has had UK marketing authorisation for the diagnosis (using skin testing/intracutaneous testing) and treatment (using VIT) ofIgE-mediated allergy to bee venom (Pharmalgen® Bee Venom) and wasp venom (Pharmalgen® Wasp Venom) since March 1995 (marketing authorisation number PL10085/0004). The active ingredient is partially purified freeze dried Vespula spp. venom in Pharmalgen® Wasp Venom and freeze dried Apis mellifera venom in Pharmalgen® Bee Venom, each provided in powder form for solution for injection.Before treatment is considered, allergy to bee or wasp venom must be confirmed by case history and diagnosis. Treatment with Pharmalgen® Bee or Wasp Venom is performed by subcutaneous injections. The treatment is carried out in two phases: the initial phase and the maintenance phase.In the build up phase, the dose is increased stepwise until the maintenance dose (the maximum tolerable dose before an allergic reaction) is achieved. ALK Abello recommends the following dosage proposals: conventional, modified rush (clustered) and rush updosing. In conventional updosing, the patient receives one injection every 3-7 days. In modified rush (clustered) updosing, the patient receives 2-4 injections once a week. If necessary this interval may be extended up to two weeks. The 2-4 injections are given with an interval of 30 minutes. In rush updosing, while being hospitalised the patient receives injections with a 2-hour interval. A maximum of four injections per day may be given in the initial phase.The build up phase ends when the individual maintenance dose has been attained and the interval between the injections is increased to 2, 3 and 4 weeks. This is called the maintenance phase, and the maintenance dose is then given every 4 weeks for at least 3 years. Contra-indications to VIT treatment are immunological diseases (e. g. immune complex diseases and immune deficiencies); chronic heart/lung diseases; treatment with β-blockers; severe eczema. Side effects include superficial wheal and flare due to shallow injection; local swelling (which may be immediate or delayed up to 48 hours); mild general reactions such as urticaria, erythema, rhinitis or mild asthma; moderate or severe general reactions such as more severe asthma, angioedema or an anaphylactic reaction with hypotension and respiratory embarrassment; anaphylaxis (often starting with erythema and pruritus, followed by urticaria, angioedema, nasal or pharyngial congestion, wheezing, dyspnoea, nausea, hypotension, syncope, tachycardia or diarrhoea). 324.7 Objectives of the HTA projectThe aim of this review is to assess the clinical and cost effectiveness of Pharmalgen® in providing immunotherapy to individuals with a history of type 1 IgE-mediated systemic allergic reaction to bee and wasp venom. The review will consider the effectiveness of Pharmalgen® when compared to alternative treatment options available in the NHS, including advice on the avoidance of bee and wasp stings, high dose antihistamines and adrenaline auto-injector prescription and training. The review will also examine the existing health economic evidence and identify the key economic issues related to the use of Pharmalgen® in UK clinical practice. If suitable data are available, an economic model will be developed and populated to evaluate if the use of Pharmalgen® for the treatment of bee and wasp venom allergy, within its licensed indication, would be a cost effective use of NHS resources.5 METHODS FOR SYNTHESISING CLINICAL EFFECTIVENESS EVIDENCE5.1 Search strategyThe major electronic databases including Medline, Embase and The Cochrane Library will be searched for relevant published literature. Information on studies in progress, unpublished research or research reported in the grey literature will be sought by searching a range of relevant databases including National Research Register and Controlled Clinical Trials. A sample of the search strategy to be used for MEDLINE is presented inAppendix 1.Bibliographies of previous systematic reviews, retrieved articles and the submissions provided by manufacturers will be searched for further studies.A database of published and unpublished literature will be assembled from systematic searches of electronic sources, hand searching, contacting manufacturers and consultation with experts in the field. The database will be held in the Endnote X4 software package.5.1.1 Inclusion criteriaThe inclusion criteria specified in Table 1 will be applied to all studies after screening. The inclusion criteria were selected to reflect the criteria described in the final scope issued by NICE for the review. However, as there is likely to be a limited amount of RCT data, the inclusion criteria of study design may be expanded to include comparative studies and descriptive cohorts. The clinical and cost effectiveness of Pharmalgen®for the treatment of bee and wasp venom allergy Page 11 of 21Table 1: Inclusion criteria Intervention(s) Pharmalgen® for the treatment of bee and waspvenom allergy,Population(s) People with a history of type 1 IgE-mediatedsystemic allergic reactions to:wasp venom and/or bee venomComparators Alternative treatment options available in theNHS, without venom immunotherapy including:advice on the avoidance of bee and waspvenom,high-dose antihistamines,adrenaline auto-injector prescription andtrainingStudy design Randomised controlled trialsSystematic reviewsOutcomes Outcome measures to be considered include:number and severity of type 1 IgE-mediatedsystemic allergic reactionsmortalityanxiety related to the possibility of future allergicreactionsadverse effects of treatmenthealth-related quality of lifeOther considerations If the evidence allows, considerations will begiven to subgroups of people, according totheir:risk of future stings (as determined, forexample, by occupational exposure)risk of severe allergic reactions to future stings(as determined by such factors as baselinetryptase levels and co-morbidities)If the evidence allows, the appraisal willconsider separately people who have acontraindication to adrenaline.If the evidence allows, the appraisal willconsider children separately.Two reviewers will independently screen all titles and abstracts of papers identified in the initial search. Discrepancies will be resolved by consensus and where necessary a third reviewer will be consulted. Studies deemed to be relevant will be obtained and assessed for inclusion. Where studies do not meet the inclusion criteria they will be excluded.5.1.2 Data extraction strategyData relating to study design, findings and quality will be extracted by one reviewer andindependently checked for accuracy by a second reviewer. Study details will be extracted using a standardised data extraction form. If time permits, attempts will be made to contact authors for missing data. Data from studies presented in multiple publications will be extracted and reported as a single study with all relevant other publications listed.5.1.3 Quality assessment strategyThe quality of the clinical-effectiveness studies will be assessed according to criteria based on the CRD’s guidance for undertaking reviews in healthcare.33-34 The quality of the individual clinical-effectiveness studies will be assessed by one reviewer, and independently checked for agreement by a second. Disagreements will be resolved through consensus and if necessary a third reviewer will be consulted.5.1.4 Methods of analysis/synthesisThe results of the data extraction and quality assessment for each study will be presented in structured tables and as a narrative summary. The possible effects of study quality on the effectiveness data and review findings will be discussed. All summary statistics will be extracted for each outcome and where possible, data will be pooled using a standard meta-analysis.35 Heterogeneity between the studies will be assessed using the I2 test.34 Both fixed and random effects results will be presented as forest plots.6 METHODS FOR SYNTHESISING COST EFFECTIVENESS EVIDENCE The economic section of the report will be presented in two parts. The first will include a standard review of relevant published economic evaluations. If appropriate and data are available, the second will include the development of an economic model. The model will be designed to estimate the cost effectiveness of Pharmalgen® for VIT in individuals with a history of anaphylaxis to bee and wasp venom. This section of the report will also consider budget impact and will take account of available information on current and anticipated patient numbers and service configuration for the treatment of this condition in the NHS.6.1 Systematic review of published economic literatureThe literature review of economic evidence will identify any relevant published cost-minimisation, cost-effectiveness, cost-utility and/or cost-benefit analyses. Economic evaluations/models included in the manufacturer submission(s) will be included in the review and critiqued as appropriate.6.1.1 Search strategyThe search strategies detailed in section 5 will be adapted accordingly to identify studies examining the cost effectiveness of using Pharmalgen® for VIT in patients with a history of allergic reactions to bee or wasp venom. Other searching activities, including electronic searching of online health economic journals and contacting experts in the field will also be undertaken. Full details of the search process will be presented in the final report. The search strategy will be designed to meet the primary objective of identifying economic evaluations for inclusion in the cost-effectiveness literature review. At the same time, the search strategy will be used to identify economic evaluations and other information sources which may include data that can be used to populate a de novo economic model where appropriate. Searching will be undertaken in MEDLINE and EMBASE as well as in the Cochrane Library, which includes the NHS Economic Evaluation Database (NHS EED).6.1.2 Inclusion and exclusionIn addition to the inclusion criteria outlined in Table 1, specific criteria required for thecost-effectiveness review are described in Table 2. In particular, only full economic evaluations that compare two or more options and consider both costs and consequences will be included in the review of published literature. Any economic evaluations/models included in the manufacturer submission(s) will be included as appropriate. Studies that do not meet all of the criteria will be excluded and their bibliographic details listed with reasons for exclusion.Table 2: Additional inclusion criteria (cost effectiveness) Study design Full economic evaluations that consider both costs and consequences(cost-effectiveness analysis, cost-utility analysis, cost-minimisation analysis and cost benefit analysis)Outcomes Incremental cost per life year gainedIncremental cost per quality adjusted lifeyear gained6.1.3 Data extraction strategyData relating to both study design and quality will be extracted by one reviewer and independently checked for accuracy by a second reviewer. Disagreement will be resolved through consensus and, if necessary, a third reviewer will be consulted. If time constraints allow, attempts will be made to contact authors for missing data. Data from multiple publications will be extracted and reported as a single study.6.1.4 Quality assessment strategyThe quality of the cost-effectiveness studies/models will be assessed according to a checklist updated from that developed by Drummond et al.36 This checklist will reflect the criteria for economic evaluation detailed in the methodological guidance developed by NICE.37 The quality of the individual cost-effectiveness studies/models will be assessed by one reviewer, and independently checked for agreement by a second. Disagreements will be resolved through consensus and, if necessary, a third reviewer will be consulted. The information will be tabulated and summarised within the text of the report.6.2 Methods of analysis/synthesis6.2.1 Cost effectiveness review of published literatureIndividual study data and quality assessment will be summarised in structured tables and as a narrative description. Potential effects of study quality will be discussed.To supplement findings from the economic literature review, additional cost and benefit information from other sources, including the manufacturer submission(s) to NICE, will be collated and presented as appropriate.6.2.2 Development of a de novo economic model by the AGa. Cost dataThe primary perspective for the analysis of cost information will be the NHS. Cost data will therefore focus on the marginal direct health service costs associated with the intervention. Quantities of resources used will be identified from consultation with experts, primary data from relevant sources and the reviewed literature. Where possible, unit cost data will be extracted from the literature or obtained from other relevant sources (drug price lists, NHS reference costs and Chartered Institute of Public Finance and Accounting cost databases).Where appropriate costs will be discounted at 3.5% per annum, the rate recommended in NICE guidance to manufacturers and sponsors of submissions. 37b. Assessmentof benefitsA balance sheet will be constructed to list benefits and costs arising from alternative treatment options. LRiG anticipates that the main measures of benefit will be increased QALYs. Where appropriate, effectiveness and other measures of benefit will be discounted at 3.5%, the rate recommended in NICE guidance to manufacturers and sponsors of submissions. 37 b. ModellingThe ability of LRiG to construct an economic model will depend on the data available. Where modelling is appropriate, a summary description of the model and a critical appraisal of key structures, assumptions, resources, data and sensitivity analysis (see Section d) will be presented. In addition, LRiG will provide an assessment of the model’s strengths and weaknesses and discuss the implications of using different assumptions in the model. Reasons for any major discrepancies between the results obtained from assessment group model and the manufacturer model(s) will be explored.The time horizon will be a patient’s lifetime in order to reflect the chronic natu re of the disease.A formal combination of costs and benefits will also be performed, although the type of economic evaluation will only be chosen in light of the variations in outcome identified from the clinical- effectiveness review evidence.If data are available, the results will be presented as incremental cost per QALY ratios for each alternative considered. If sufficient data are not available to construct these measures with reasonable precision, incremental cost-effectiveness analysis or cost-minimisation analysis will be undertaken. Any failure to meet the reference case will be clearly specified and justified, and the likely implications will, as far as possible, be quantified.d. Sensitivity analysisIf appropriate, sensitivity analysis will be applied to LRiG’s model in order to assess the robustness of the results to realistic variations in the levels of the underlying parameter values and key assumptions. Where the overall results are sensitive to a particular variable, the sensitivity analysis will explore the exact nature of the impact of variations.Imprecision inthe principal model cost-effectiveness results with respect to key parameter values will be assessed by use of techniques compatible with the modelling methodology deemed appropriate to the research question and to the potential impact on decision making for specific comparisons (e.g. multi-way sensitivity analysis, cost-effectiveness acceptability curves etc).7 HANDLING THE MANUFACTURER SUBMISSION(S)All data submitted by the drug manufacturers arriving before 22nd March 2011 and meeting the set inclusion criteria will be considered for inclusion in the review. Data arriving after this date will only be considered if time constraints allow. Any economic evaluations included in the manufacturer submission(s) will be assessed. This will include a detailed analysis of the appropriateness of the parametric and structural assumptions involved in any models in the submission and an assessment of how robust the models are to changes in key assumptions. Clarification on specific aspects of the model may be sought from the relevant manufacturer. Any 'commercial in confidence' data taken from a manufacturer submission will be clearly。

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医用英语医学文献翻译4(缺5-9整理版)UNIT 1 TEXT B刷牙，使用牙线，以及每年2次的牙齿检查是口腔卫生保健标准，但是保护你珍珠样洁白的牙齿的好处远比我们知道的还要多。

误区1：口腔卫生的不良后果是限制嘴巴准妈妈也许不知道她们所吃的食物会影响到胎儿的牙齿发育。

在怀孕过程中的营养缺乏也许会使未出生的孩子在今后的生活中更容易出现蛀牙。

“在14周到4个月大的时候，缺乏钙，维生素D，维生素A，蛋白质和卡路里会导致口腔软组织缺损，” Carole Palmer说。

Carole Palmer 是，教育学博士(EdD)，注册营养师(RD)，塔夫茨大学教授，公共健康和社会服务系营养和口腔健康推进部的负责人。

有数据表明缺乏足够的维生素B6和B12可能是导致患唇裂和阻碍味觉形成的危险因素。

在童年的时候，最普遍的疾病是蛀牙，大约比儿童哮喘高五倍。

“如果一个儿童因为蛀牙而嘴巴受伤，他/她在学校会比较难集中注意力，而且会更喜欢吃容易咀嚼的食物，这些食物含有的营养往往更少些。

甜甜圈和点心这样的食物大多营养品质低下，含糖量高于其他需要咀嚼的富含营养的食物，比如水果和蔬菜，” Palmer说。

“口腔并发症与不良的饮食习惯会造成认知和生长发育问题，以及导致肥胖。

”误区2：吃越多糖，越容易蛀牙这与你吃了多少糖无关，而是糖和牙齿接触的时间有多少。

“食物，比如慢慢溶解的糖果和苏打水在嘴巴里停留的时间会比较久。

这增加了牙齿暴露在口腔细菌由糖产生成的酸中的时间，” Palmer说。

有研究表明，十几岁的青少年大约40%的碳水化合物是由软饮料中摄取的。

这些源源不断地软饮料增加了牙齿腐烂的风险。

无糖碳酸饮料和酸性饮料，比如柠檬水，往往被认为比含糖饮料对牙齿更安全，但是经常食用的话仍会造成牙齿釉质脱矿。

误区3：宝宝因蛀牙失去牙齿是可以的这是常见的误区，认为宝宝因为蛀牙失去牙齿是无关紧要的，因为宝宝的乳牙总会在将来某一天脱落。

Palmer指出婴儿牙齿蛀牙可能会损害它们下方的恒牙牙冠的生长。

如果婴儿过早的市区牙齿，恒牙可能会爆发式的错位长出而需要正畸。

误区4：骨质疏松仅仅影响脊柱和臀部骨质疏松可能会导致牙齿脱落。

牙齿是长在脸骨的颌里的，这些同样会受到骨质疏松的影响。

“所以，颌同样会承受缺乏必需营养，比如钙和维生素D的饮食的后果。

”Palmer说。

颌骨，牙龈，嘴唇和软、硬颚不断的在生活中补充它们自己。

良好的饮食习惯是保持口腔颌支持它们最佳结构所必需的。

”误区5：义齿改善一个人的饮食如果假牙不合适，老年人会首选容易咀嚼，营养品质低的食品，如蛋糕或者糕点。

“首先，假牙佩戴者应该确保正确地安装假牙。

与此同时，如果有咀嚼困难或者嘴巴不适，他们仍然可以食用煮熟的蔬菜代替生的蔬菜，食用罐头水果代替生的水果，以及食用碎牛肉代替牛排。

同时，他们应喝大量的水或者嚼无糖口香糖防止口干，”Palmer说。

误区6：牙齿腐烂只是年轻人的问题成年人和老年人，牙龈萎缩会导致牙根腐烂（沿牙齿根部腐烂）。

常用的药物如抗抑郁剂，利尿剂，抗组胺药，以及镇静剂会因减少唾液分泌而增加牙齿腐烂的风险。

“唾液缺乏意味着口腔清洗更缓慢。

这就增加了口腔问题的风险，” Palmer说。

“在这种情况下，经常喝水可以成年人和老年人更容易患上慢性病，比如糖尿病，是患牙周病（从牙龈发炎开始，可以导致牙齿脱落）的危险因素。

“2型糖尿病患者比非糖尿病人有两倍风险患上牙周病。

此外，牙周病会加重糖尿病，所以细致的口腔保健可以帮助改善糖尿病的控制，”Palmer说帮助清洁口腔。

”UNIT 2 TEXT A为什么盲人比有视力的人能更快地理解言语呢？--功能性脑部扫描显示一些盲人脑部发生了重塑，这给了他们超常的听觉理解力,在圣地亚哥，有关超人的书籍充斥着各种页面。

超人的精神超能力，包括他拥有的听觉超能力和阅读超能力，就像他拥有的可以躲避子弹的速度和折断钢铁的力量一样至关重要。

但似乎超人并不是这世上唯一拥有这种快速能力的人。

9月份的圣地亚哥神经科学年会上科学家宣布他们发现了一群真实的个体拥有如超人般的精神能力，这些人就是盲人。

并且，功能性的脑部扫描图像可以展示他们如何获得这些超常的大脑技能。

一种普遍的观念是，盲人加强了他们剩余的感知能力，用来弥补失去的视力。

盲人音乐家们，如Stevie Wonder 和Ray Charles，他们在音乐上的杰出成绩归功于他们高度敏锐的听力。

德国Tübingen大学Hertie临床脑科研究所研究人员的发现支持这种观点。

盲人能够比绝大多数的拥有正常视力的人更容易地理解他人说话。

当我们快速说话的时候，我们每分钟生成6个音节。

那些处于极度活跃状态的广播播音员在喋喋不休的最后，每秒钟也就产生10个音节。

这是正常视力的人们表达的绝对限制。

人类不能超越这个限制。

科学家们用1台电脑合成器以这样的速度生成语言。

“那听上去就像噪音”，Ingo Hertrich 对我说，他是这项研究中的其中一位科学家。

“我完全听不懂，或许听上去更想一些陌生的外国人非常快地对我说话一样。

”Hertrich和他的同事Hermann Ackermann 及Susanne Dietrich三人，想要找出到底这些盲人的大脑里发生了什么，导致他们拥有这种理解极快速度听觉语言的超能力。

他们给盲人及正常视力的人听极快速度的说话声，同时通过脑部扫描仪（功能性核磁成像或MRI核磁共振）检测他们大脑的活跃区域，他们发现，在盲人的大脑皮层中，平时用来处理视觉信息的区域，现在正处理听觉信难怪盲人可以拥有超人般理解快速听力的能力了。

通常，这些位于颅骨后端的大脑区域称为V1区，只负责处理视觉。

对人类来说，视觉是一项很重要的感觉以至于大脑的一大部分被分配来处理视觉信息—-比起其他感觉，处理视觉的皮质区域更广。

对于盲人来说，所有这个区域的大脑能力就浪费了，但不知何故一个盲人的大脑自我修复了，将大脑的听觉中枢与视觉中枢连接起来息。

Ackermann认为大脑重塑来将听力连接到控制视力的区域这件事上，失去视力的年龄似乎是很关键的。

在那些出生时就失去视力的婴儿来说，视觉中枢完全不会对任何听觉或是视觉刺激有反应。

大脑的这个区域在功能上不能连接，因为在生命早期，视觉输入在正确地建立大脑视觉网络的过程中是至关重要的。

然而，年轻一些的人在这种连接成功建立后丧失视力，是可以将听觉信息变更到视觉处理中枢的。

另一方面，年纪大一些的人丧失视力后大脑很少能够重塑，因为视觉体验影响这个过程的关键时期限制在我们生命的早期阶段。

（所有这个研究中的受试者在2岁-15岁之间失去的视力。

）但是，大脑中枢是如何将耳朵和原本连接到眼睛的大脑区域连接起来的呢？事实是，我们的大多数感觉之间拥有相互影响的线路，这被称为交叉模式。

在大脑的听觉和视觉中枢之间有一些联系，因为这两种感觉必须一起工作。

看一个人的嘴唇运动可以帮助理解他所说的话。

我们也需要将视觉和听觉集中注意到同一件事、同一方位，所以视觉和听觉中枢之间有信息的交换。

比如说，控制我们眼球运动的肌肉神经，也连接到大脑的听觉中枢。

这种大脑视觉和听觉中枢的连接在失去视力后会加强。

一些大脑皮质里也控制视觉和听觉的区域，比如纺锤体，在人失去视力后会扩大范围来利用视觉中枢里的闲置网络。

有趣的是，研究人员发现盲人只能利用右侧的视觉中枢来理解快速的语言信息。

Ackermann怀疑这可能是因为右侧大脑专门负责处理低频率的信息，说话就是很典型的一种，但这个假说还没被证实。

这个研究小组正在研究盲人使用左侧大脑视觉中枢来做些什么，并希望能在明年的会议上报告成果。

研究人员们最大的兴趣在大脑中风。

通过研究盲人的大脑如何通过自身修复来代偿失去的功能，研究人员希望能发现新的有用的信息来帮助中风病人康复。

但Ackermann也着重强调了研究的一个重要结论在于帮助盲人。

然而看得见总是更好的，但失去视力的人们也需要特定的超常能力来做得赶得上拥有视力的人。

他发现盲人能够在常人阅读一本书的时间里用文字到言语转换的计算机程序来阅读三本书。

这种超常的能力将使盲人在学校学习中处理大量书本上的文字信息时获益。

或许，这将会开创一种新的工作机会来开发他们的高速阅读技能，用来翻译或者其他诸如对Lois Lane超快速的语言理解力，而我们其他人听起来只不过像是一通胡言乱语。

UNIT 3 TEXT A你知道什么是听，但什么是听力损失？听力损失，或听力障碍（说：我—削减等），当与耳或耳朵的一个或多个部分的问题（“障碍”的意思是不正确或以及它应该工作）。

谁的人有听力损失可能会听到一些声音或什么都没有。

人们也可以用词聋，耳聋或听力困难，当他们谈论听力损失。

3在1000个婴儿出世与听力障碍，是最常见的出生缺陷。

听力问题也会在以后的生活中发展。

怎么听的作品要了解如何以及为什么听力损失发生，它有助于了解耳朵是如何工作的。

耳朵由三个不同的部分：外耳，中耳和内耳的。

这些部件一起工作，所以你能听到声音和过程。

外耳，或羽片（你可以看到的部分），拿起声波的波，然后穿过外耳道。

当声波撞击耳膜在中耳，中耳开始振动。

当耳膜振动，它将三个小骨头在你的耳朵。

这些骨头被称为锤（或锤），砧（或砧骨），和箍筋（或阶段）。

他们帮助声音传向内耳。

振动，然后前往耳蜗，这是充满了液体，内衬表面生有上千条纤毛的细胞。

有两种类型的毛细胞：细胞外和内。

声波振动使得纤毛运动。

外毛细胞以声音信息，扩大它（开大声一点），并调整它的。

内毛细胞发送声音信息到你的听觉神经，然后将其发送给你的大脑，让你听到听力损失的类型有几种不同类型的听力损失：导电性，感官，混合（导电和感官相结合），神经，和中央。

• 导电性（说：坤—DUK- TIV）听力损失。

这种情况通常发生在与外或中耳的一部分的一个问题。

大多数的传导性聋孩子有轻度听力损失，通常是暂时的，在大多数情况下，药物治疗可以帮助。

• 感官（说：森-这些稀土元素）听力损失。

这发生在耳蜗是不是因为微小的毛细胞受损或摧毁正常工作。

根据不同的损失，一个孩子可能：听到最多的声音（虽然他们会听到低沉的）；在安静而不是噪声；只听到一些声音；或者根本听不到声音。

感觉性听力障碍几乎都是永久性的和一个孩子的说话能力通常会受到影响。

• 神经（说：泊UL）听力损失。

发生这种情况时，有从耳蜗到大脑的连接有问题。

神经装置相关的神经，使神经性听力丧失是进行从耳蜗到大脑的神经受损的消息。

• 中央的听力损失。

这发生在耳蜗工作正常，但部分的大脑不。

这是一个不常见的类型及听力损失的治疗更加困难。

是什么原因导致听力损失？听力损失可能发生，因为一个人是天生的部分的耳朵，没有形成正确的和不好的。

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