Arnold G Smith MD The Diagnosis And Treatment Of The Sacro-Iliac Joint As A Cause Of Low Ba
医学英语unit1课文diagnosis

医学英语unit1课文diagnosisthe prevention and preventive treatment of disease治病求本treatment aiming at the root cause of disease扶正祛邪strengthening healthy qi and dispelling pathogens Examples of therapeutic principles调整阴阳regulating yin and yang三因制宜(因时、因地、因人制宜)treating diseases in accordance with three conditions" (i. e. the climatic and seasonal condition, geographic localities and the patient's constitution)《黄帝内经》Huangdi NeijingYellow Emperor's ClassicThe Yellow Emperor's Inner Canon of Medicine The Inner Canon of MedicineThe Inner Canon of Medicine The Inner CanonThe Yellow Emperor's Canon Huangdi's Classic on MedicineCommon TCM Text Names and their English Translations《素问》Su WenBasic Questions Simple Questions Essential Questions Plain Questions《神农本草经》Shengnong Bencao JingDivine Husbandman's Classic of Materia Medica Shennong’s Materia Medica/ Shennongs Herbal Divine Farmer's Herbal Common TCM Text Names and their English Translations《伤寒杂病论》Shanghan Za Bing LunTreatise on Cold-Induced and Miscellaneous Diseases.《针灸甲乙经》Zhenjiu Jiayi JingClassic of the ABC's of Acupuncture and Moxibustion The Systematized Canon of Acupuncture and Moxibution Common TCM Text Names and their English Translations《伤寒论》Shang Han LunTreatise on Cold-Induced Diseases Discussion of Cold-induced DisordersTreatise on Cold--Induced Febrile Diseases Treatise on Injury by Cold 《诸病源候论》Zhu Bing Yuan Hou LunTreatise on The Origins and Symptoms DiseaseCommon TCM Text Names and their English Translations《金匮要略》Jin Gui Yao LÜeSynopsis of the Golden Chamber Synopsis of the Golden CabinetSynopsis of Prescriptions from the Golden Chamber Essentials from the Golden CabinetCommon TCM Text Names and their English Translations《外台秘要》Wai Tai Mi YaoArcane Essentials from the Imperial Library Secrets of a Frontier official《千金要方》Qian Jin Yao FangEssential Formulas Worth A Thousand Ducats Thousand Ducat Prescriptions(Formulas)Prescriptions Worth a Thousand Pieces of Gold Prescriptions Worth a Thousand Ducats《千金翼方》Qian Jin Yi FangSupplement to Formulas Worth A Thousand Ducats《类经》Lei JingThe Classic of Categories。
【精品】翻译综合

一个抑制肿瘤的连续模型-------艾丽斯H伯杰,阿尔弗雷德G. Knudson 与皮埃尔保罗潘多尔菲今年,也就是2011 年,标志着视网膜母细胞瘤的统计分析的第四十周年,首次提供了证据表明,肿瘤的发生,可以由两个突变发起。
这项工作提供了“二次打击”的假说,为解释隐性抑癌基因(TSGs)在显性遗传的癌症易感性综合征中的作用奠定了基础。
然而,四十年后,我们已经知道,即使是部分失活的肿瘤抑制基因也可以致使肿瘤的发生。
在这里,我们分析这方面的证据,并提出了一个关于肿瘤抑制基因功能的连续模型来全方位的解释肿瘤抑制基因在癌症过程中的突变。
虽然在1900 年之前癌症的遗传倾向已经被人认知,但是,是在19 世纪曾一度被忽视的孟德尔的遗传规律被重新发现之后,癌症的遗传倾向才更趋于合理化。
到那时,人们也知道,肿瘤细胞中的染色体模式是不正常的。
接下来对癌症遗传学的理解做出贡献的人是波威利,他提出,一些染色体可能刺激细胞分裂,其他的一些染色体 a 可能会抑制细胞分裂,但他的想法长期被忽视。
现在我们知道,这两种类型的基因,都是存在的。
在这次研究中,我们总结了后一种类型基因的研究历史,抑癌基因(TSGs),以及能够支持完全和部分失活的肿瘤抑制基因在癌症的发病中的作用的证据。
我们将抑制肿瘤的连续模型与经典的“二次打击”假说相结合,用来说明肿瘤抑制基因微妙的剂量效应,同时我们也讨论的“二次打击”假说的例外,如“专性的单倍剂量不足”,指出部分损失的抑癌基因比完全损失的更具致癌性。
这个连续模型突出了微妙的调控肿瘤抑制基因表达或活动的重要性,如微RNA(miRNA)的监管和调控。
最后,我们讨论了这种模式在┲⒌恼锒虾椭瘟乒 讨械挠跋臁!岸 未蚧鳌奔偎?第一个能够表明基因的异常可以导致癌症的发生的证据源自1960 年费城慢性粒细胞白血病细胞的染色体的发现。
后来,在1973 年,人们发现这个染色体是是第9 号和第22 号染色体异位的结果,并在1977 年,在急性早幼粒细胞白血病患者中第15 号和第17 号染色体易位被识别出来。
Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease D

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STAGNARO-GREEN ET AL.
force was essential to ensuring widespread acceptance and adoption of the developed guidelines.
The clinical guidelines task force commenced its activities in late 2009. The guidelines are divided into the following nine areas: 1) thyroid function tests, 2) hypothyroidism, 3) thyrotoxicosis, 4) iodine, 5) thyroid antibodies and miscarriage/ preterm delivery, 6) thyroid nodules and cancer, 7) postpartum thyroiditis, 8) recommendations on screening for thyroid disease during pregnancy, and 9) areas for future research. Each section consists of a series of questions germane to the clinician, followed by a discussion of the questions and concluding with recommendations.
Knowledge regarding the interaction between the thyroid and pregnancy/the postpartum period is advancing at a rapid pace. Only recently has a TSH of 2.5 mIU/L been accepted as the upper limit of normal for TSH in the first trimester. This has important implications in regards to interpretation of the literature as well as a critical impact for the clinical diagnosis of hypothyroidism. Although it is well accepted that overt hypothyroidism and overt hyperthyroidism have a deleterious impact on pregnancy, studies are now focusing on the potential impact of subclinical hypothyroidism and subclinical hyperthyroidism on maternal and fetal health, the association between miscarriage and preterm delivery in euthyroid women positive for TPO and/or Tg antibody, and the prevalence and long-term impact of postpartum thyroiditis. Recently completed prospective randomized studies have begun to produce critically needed data on the impact of treating thyroid disease on the mother, fetus, and the future intellect of the unborn child.
贵阳地区孕妇人群脊髓性肌萎缩症携带者筛查及产前诊断

贵阳地区孕妇人群脊髓性肌萎缩症携带者筛查及产前诊断作者:李媛媛罗振元胡莉黄盛文来源:《医学食疗与健康》2021年第12期【摘要】目的:调查贵阳地区孕妇人群脊髓性肌萎缩症(SMA)携带率,并对高风险的孕妇行产前基因诊断,防止SMA患儿的出生。
方法:应用多重荧光定量PCR技术对524例孕妇的SMN1基因外显子7和8的拷贝数进行检测,筛查出SMA携带者,并计算携带者的频率。
对携带者的配偶进行筛查,并为双方均为携带者的夫妇提供产前诊断。
结果:在524例孕妇中,共检出SMA携带者12例,携带比例为1/44,检出率2.29%.,其中SMN1基因外顯子7单一缺失的携带者2例(占16.7%),外显子7合并外显子8缺失携带者10例(占83.3%),未检测出同为SMA携带者的夫妇。
曾经生育过SMA患儿的1对夫妇均为SMN1基因外显子7合并外显子8杂合缺失携带者。
对高风险胎儿进行产前基因诊断,确诊为SMN1纯合缺失胎儿。
结论:初步获得了贵阳地区孕妇人群SMA的携带率为1/44。
SMA携带者筛查可为遗传咨询和产前诊断提供依据,对于优生优育、有效预防SMA胎儿的出生具有重要的临床意义。
【关键词】脊髓性肌萎缩症;携带者筛查;运动神经元存活基因;产前诊断【中图分类号】R714.55 【文献标识码】A 【文章编号】2096-5249(2021)12-0191-02脊髓性肌萎缩症(spinal muscular atrophy, SMA)是一种儿童致死性神经系统疾病,为常染色体隐性遗传[1]。
SMA的人群发病率约为1/6000~1/10000,携带率为1/40~1/60[2]。
SMA 致病基因是位于5号染色体长臂l区3带(5q13)的运动神经元存活基因(survival motor neuron,SMN)。
端粒侧的SMN1和中心粒侧的SMN2,是两个相邻的高度同源的SMN基因,两个基因序列之间仅有5个碱基的差异。
主要功能基因为SMN1,修饰基因SMN2一定程度上可以缓解SMA的严重程度。
英研究阿尔茨海默氏症与糖尿病间关系

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合征在内的众 多疾病的治愈方法 。 承 担主要研究的 巴希尔教授和 布朗教授将研究大脑的哪一 个确切部位对认知记忆产生影响 , 以 及认知记忆正 常的人的脑细胞是如何处理信息的。
另一 个 由戴 维教授 率领 的研 究 小组 则 开 展 对 甘 丙肽 的研 究 。 【
甘 丙肽是 存在于体 内痛觉神经 的一 种小 分子 蛋 白。 如 果神经 系统 损伤 , 大 脑 内部神经 甘丙 肽 的 含量 至 少 会增加 1 0 0 倍 。 这 对 由 外伤 (如 道 路 交通 事故 ) 和糖 尿病 引起 的痛感神经 综合征 的潜 在治疗可能会有重要的意义 。
(医学专业英语)14.diagnosis and treatment

Neoplasia—abnormal and uncontrolled growth of tissue. Immune disorders—failures of the immune system,
allergies, and autoimmune diseases, in which the body makes antibodies to its own tissues, fall into this category.
Metabolic disorders—resulting from lack of enzymes or other factors needed for cellular functions.Many hereditary disorders fall into this category.
Malnutrition caused by inadequate intake of nutrients or inability of the body to absorb and use
Mental and emotional disorders—disorders that affect the mind and adaptation of an individual to his or her environment.
The cause of a disease is its etiology , although many diseases have multiple interacting causes. An acute disease is sudden and severe and of short duration. A chronic disease is of long duration and progresses slowly.
英语专业课外读书书目中文审阅批注

英语专业课外读书书目一、英国文学Kingsley Amis Lucky JimJane Austen Pride and Prejudice ….Arnold Bennett The Old Wives’ TaleElizabeth Bowen The Death of the HeartCharlotte Bronte Jane Eyre ….Emily Bronte Wuthering HeightsAnthony Burgess A Clockwork OrangeSamuel Butler The Way of All FleshA.S. Byatt PossessionLewis Carroll Alice’s Adventures in WonderlandAngela Carter The Company of WolvesAgatha Christie Murder on the Orient Express ….Ivy Compton-Burnett A Family and a FortuneJoseph Conrad Heart of Darkness, Lord JimDaniel Defoe Robinson CrusoeCharles Dickens David Copperfield ….Sir Arthur C. Ddyle Adventure of Sherlock Holmes ….Margaret Drabble The WaterfallDaphne Du Maurier Rebecca …George Eliot Middlemarch …E.M.Forster Howards End, A Passage to India ….John Fowles The French Lieutenant’s WomanJohn Galsworthy The Man of PropertyWilliam Golding Lord of the Flies ….Graham Greene The Human FactorThomas Hardy Tess of the D’Urbervilles, Jude the Obscure Aldous Huxley After Many a SummerHenry James Daisy Miller ….James Joyce A Portrait of the Artist as a Young Man Rudyard Kipling KimCharles Lamb Tales from ShakespeareD. H. Lawrence Sons and Lovers ….John Le Carred The Spy Who Came in from the ColdDoris Lessing The Grass Is SingingDavid Lodge Nice WorkW. Somerset Maugham The Moon and Sixpence, Of Human Bondage …. Iris Murddoch The Black PrinceGeorge Orwell Nineteen Eighty-four, Animal Farm …. Salman Rushdie Midnight ChildrenSir Walter Scott IvanhoeC. P. Snow The AffairMuriel Spark The Prime of Miss Jean BrodieRobert Louis Stevenson Treasure Island ….Jonathan Swift Gulliver’s TravelsWilliam M. Thackeray Vanity FairEvelyn Waugh A Handful of DustH. G. Wells The Invisible Man ….Oscar Wilde The Picture of Dorian Gray ….Virginia Woolf Mrs Dalloway, To the Lighthouse ….二、美国文学Sherwood Anderson The Book of the Grotesque ….James Baldwin Go Tell It on the Mountain ….Saul Bellow Seize the Day, Henderson the Rain King William S. Burroughs The Naked LunchWilla Cather My AntoniaKate Chopin The AwakeningStephen Crane The Red Badge of CourageTheodore Dreiser Sister Carrie, An American Tragedy ….Ralph Ellison Invisible ManWilliam Faulkner Go Down, Moses, The Sound and the Fury …. F. Scott Fitzgerald The Great Gatsby ….Alex Haley RootsNathaniel Hawthorne The Scarlet Letter ….Joseph Heller Catch-22Ernest Hemingway The Sun Also Rises, The Old Man and the Sea …. James Jones From Here to EternityMaxine Hong Kingston The Woman WarriorHarper lee To Kill a MockingbirdSinclair Lewis Main Street ….Jack London The Call of the Wild, Martin Eden ….Norman Mailer The Naked and the DeadCarson McCullers The Heart Is a Lonely HunterJames A. Michener CentennialMargaret Mitchell Gone with the WindToni Morrison The Bluest EyeVladimir Nabokov LolitaFrank Norris The OctopusJ. D. Salinger The Catcher in the Rye ….Erich Segal Man, Woman and ChildUpton Sinclair The JungleJohn Steinbeck The Grapes of Wrath ….Harriet Beecher Stowe Uncle Tom’s CabinWilliam Styron Sophie’s ChoiceMark Twain The Adventures of Huckleberry Finn …. Alice Walker The Color PurpleRobert Penn Warren All the King’s MenEdith Wharton The Age of InnocenceThornton Wilder The Bridge of San Luis ReyThomas Wolfe Look Homeward, AngelHerman Wouk The Winds of War, War and Remembrance…. Richard Wright Native SonDan Brown The Da Vinci Code….Arthur Hailey The Final Diagnosis, Hotel….Gillian Flynn Gone GirlIsaac Asimov Foundation, I Robot….三、加拿大文学Morley Callaghan That Summer in ParisNorthrop Frye The Great CodeMargaret Laurence The Stone AngelStephen Leacock Sunshine Sketches of a Little Town Malcolm Lowry Under the V olcanoHugh MacLennan The Watch That Ends the NightL. M. Montgomery Anne of Green Gables四、澳大利亚文学Martin Boyd Lucinda BrayfordPeter Carey Oscar and LucindaMiles Franklin My Brilliant CareerThomas Keneally Sh indler’s ArkAlex Miller The Ancestor GameHenry Handel Richardson The Fortunes of Richard MahonyChristina Stead The Man Who Loved ChildrenRandolph Stow To the IslandsPatrick White V oss, The Tree of Man五、中国文化Yung Ming My Life in China and AmericaChiang Monlin Tides from the WestTcheng Ki Tong The Chinese Painted by ThemselvesKu Hung Ming The Spirit of the Chinese PeopleFei Hsiao Tung Peasant Life in ChinaLin Yu Tang My Country and My PeopleA Retrospective of Chinese Literature: Classical PoetryA Retrospective of Chinese Literature: Classical ProseA Retrospective of Chinese Literature: Classical FictionA Retrospective of Chinese Literature: Modern PoetryA Retrospective of Chinese Literature: Modern Prose A Retrospective of Chinese Literature: Modern Fiction。
医学英语临床医学课后习题答案 - 1257891214

Unit 1 Task1.1Across4. –graphy6. mono-8. –scopy10. laparo-11. disease13. spleen14. diagnosisDown1. angio-2. endo-3. dys-5. Physio7.sym/n-9. radio-12. stetho-Task 1.41.urinalysis尿分析2.prognosis 预后3.biopsy活组织检查4.percussion叩诊5.posture体位6.mortality死亡率7.lesion病灶8.tenderness触痛9.urography尿路造影术10.auscultation听诊Task1.81. D2. C3. A4. D5. A6. B7. B8. C9. D10.BTask1.101.diagnostic3.signs4.imaging5.differential6.interview7.family8.physical9.posture10.chronic11.lesion12.palpation13.lymph14.enlargement15.morbidity16.stress17.disorder18.bipolar19.screening20.analyzer21.analysis22.tolerance23.genetic24.histological25.resonance26.contrast27.veins28.current29.fetus30.clinical31.predict32.bystanders33.monoxide34.advantage35.set36.page37.wit’s38.frame39.under-promise40.critically41.allergic42.idea43.presentation44.disposition45.achievement47.randomUnit2 Task2.1Across1.mammo-7. trans-9. osteoporosis10. immune-12. diarrheaDown1.antacid2.micro-3.litho-4.ange-5.insomnia8. non-10. -itis11. pharmaco-13. hyper-Task2.41.malnutrition营养不良2.hepatitis肝炎3.alleviate减轻4.dehydration脱水5.nausea恶心6.hypertension高血压7.sedentary久坐的8.therapeutics疗法9.analgesic止痛的10.insomnia失眠Task2.81. D2. B3. A4. D5. A6. B7. D8. D9. C10.B1.alleviate2.preventive3.primary4.infectious5.immunizations6.risk7.infarction8.lifestyle9.cholesterol10.lipoprotein11.inflamed/inflammatory12.analgesic13.moderate14.nausea15.gastrointestinal16.obstruction17.migraine18.antiemetic19.diarrhea20.hygiene21.pills22.marrow23.preparations24.diabetes25.anesthetic26.synthetic27.reconstructive28.transplantation29.survival30.identical31.radicals32.antidepressant33.behavioral34.modification35.antibiotics36.array37.pharmaceutical38.therapeutic39.opportunity40.bankrupt41.racial42.reflexively43.shelter44.cost-benefit45.necessitate46.process47.practice48.traditional49.sort50.at large51.access52.siblings53.frugal54.initiate55.indicators56.interventions57.sustainable58.universal59.optimize60.reimbursement61.diminish62.turnUnit5 Task5.1Across5.oncology8.bene-9.para-10.osteoma11.neo-12.onco-13.-osis14.meta-Down1.lipo-2.hypo-3.thrombo-4.–cyte5.–oma6.leukocyte7.benign10.-ogenesisTask5.41.metastasis转移2.carcinogenesis癌发生3.anorexia厌食4.osteoma骨瘤5.benign良性的6.indigestion消化不良7.neoplasm赘生物,肿瘤8.noninvasive非侵害的9.oncology肿瘤学10.immunotherapy免疫疗法Task5.81. C2. B3. B4. C5. A6. B7. D8. A9. D10.BTask5.101.circulatory2.benign3.biochemical4.infiltrate5.manifestations6.noninvasive7.in situ8.cancerous9.advanced10.count11.excisional12.aspiration13.inhibitor14.screening15.experimental16.metastatic17.on call18.effusions19.hold20.hypoalbuminemia21.rhythmic22.take23.onset24.durable26.ventilator27.circumstances28.futility29.rationaleUnit7 Task7.1Across2.-necrosis4.-malacia9.ad-11.dystrophy13.osteo-14.myo-Down1.-desis3.-plasty5.ab-6.abduction7.myopathy8.musculo10.-trophy12.-pathyTask7.41.hypertrophy肥大2.myotonia肌僵直3.dystrophy营养不良4.arthrodesis关节固定术5.articulation关节6.pronation旋前7.thorax胸廓8.denervation去神经9.involuntary不随意的10.myopathy肌病Task7.81. C2. D3. B4. A5. C6. D7. A9. B10.BTask7.101.muscular2.cardiac/heart3.contraction4.atrophy5.spasm6.denervation7.autoimmune8.cartilages9.connective10.spinal/vertebral11.gliding12.metabolic13.fracturepound15.impacted16.twisting17.reduce18.stabilize19.functioning20.intensive21.tolerance22.accredited23.screened24.overall25.status26.physiological27.reference28.appropriate29.referral30.adverse31.readily32.severity33.burden34.mortality35.disturbances36.outcomes37.arterial38.converging39.underlying40.detectableUnit8 Task8.1Across2.inter-6.schizo-10.meso-11.bi-12.neuroglia13.de-14.tri-Down1.cerebellum3.neuron4.glosso-5.patho-7.hemi-8. myelino-9.cerebro-12.neuro-Task8.41.synapse突触2.cerebellum小脑3.receptor受体4.neuron神经元5.brainstem脑干6.neurotransmitter神经递质7.dendrite树突8.hemisphere半球9.dementia痴呆10.ganglion神经节Task8.101.peripheral2.sensory3.cerebrospinal4.fissure5.cortex6.temporal7.cord8.matter9.dorsal10.ventral11.cranial12.olfactory13.trochlear14.parasympathetic15.deterioration16.gray17.obsolete18.impulses19.parlance20.psychiatric21.treatment-resistant22.remission23.relapse24.tolerated25.hypomanic26.sham27.antidepressant28.electroconvulsive29.par30.trial31.effect32.hemorrhage33.rope34.therapyUnit9Task9.1Across2.ante-7.thyro-9.vasopressin10.estro-13.andro-14.estrogen15.acro-16.adreno-Downcto3.gluco-4.hyperplasia5.juven-6.somato-8.vaso-11.-tropin12.gonado-Task9.41.immune免疫的2.adrenaline肾上腺素3.medulla髓质ctation泌乳5.calcitonin降钙素6.oxytocin催产素7.pancreas胰腺8.acromegaly肢端肥大症9.estrogen雌激素10.somatotropin生长激素Task9.81. B2. D3. D4. B5. C6. B7. D8. C9. B10.ATask9.101.endocrine2.immune3.ductless4.exocrine5.pituitary6.characteristics7.uterine8.concentration9.breast-feeding10.melanin11.secretion12.amino acids13.uptake14.circadian15.inhibitory16.feedback17.hypofunction18.intolerance19.supplementation20.purification21.unappreciated22.credited23.life-sustaining24.Hollywood-like25.nowhere26.incredulous27.emeritus28.award-winning29.retrospect30.collective31.ballotsndslide33.synthetically34.gestational35.detriment36.transient37.nondiabetic38.radioimmunoassay39.bind40.activateUnit12 Task12.1Across2. oro3. pneuma6. cost7. pnea8. alve9. fibrosis11. nas12. silic13. dyspneaDown1. bronchi4. extra5. ectasis7. pleurisy10. mycinTask 12.41. hemoptysis咯血2. larynx喉3. sputum痰4. pleura胸膜5. inspiration吸气6. glottis声门7. trachea气管8. dyspnea呼吸困难9. thymus胸腺10. alveolus肺泡Task12.81. B2. A3. B4. B5. C6. D7. A8. B9. D 10. A Task12.101. respiratory2. cavity3. alveolar4. intercostal5. pharynx6. gas-exchanging7. serous8. pleura9. visceral10. extracellular11. expiration12. bronchial13. abscess14. bronchitis15. emphysema16. whooping17. embolism18. edema19. outbreaks20. pave21. pathogenic22. avian23. severe24. pandemic25. public26. surveillance27. member28. vaccine29. tropical30. polymerase31. sensitivity32. identify33. on-site34. pharmaceutical35. antiviral36. immunocompromised37. administered38. resistance39. aforementioned40. shortage41. backed42. effect43. toll44. expertise45. practical46. recession47. pneumonia48. emergencyUnit 14 Task 14.1Across1. osmo5. electr8. gastritis9. coli10. noct11. fibrDown2. mucous3. erythro4. pept6. bili7. peptic8. gastr9. cystTask 14.41. appetite食欲2. esophagus食管3. jaundice黄疸4. ulcer溃疡5. chyme食糜6. pancreas胰腺7. gallbladder胆囊8. cecum盲肠9. pylorus幽门10. bilirubinTask 14.81. B2. B3. A4. C5. B6. D7. A8. C9. C 10. DTask 14.101. digestive2. intestine3. bile4. swallowing5. bud6. nasal7. carbohydrates8. fudus9. mucosa10. descending11. hepatic12. common13. reflux14. ulcer15. appetite16. fecal-oral17. sanitation18. fallacies19. tale20. misconceptions21. spicy22. aggravate23. relieve24. celiac25. vague26. abdominal27. nonspecific28. absorption29. movement30. habitual31. irritable32. functional33. characterized34. constipation35. organic36. complications37. colon38. uncommon39. ulcerative40. Crohn's41. psychological42. storage43. reaction44. steatohepatitis45. ostomy46. erectile47. sexual48. bear。
脑白质疏松症的研究进展

脑白质疏松症的研究进展杨茜【摘要】Leukoaraiosis ( LA) is a common neuroimaging finding associated with cerebral ischemia belonging to one type of SVD. LA has manifestations of cognitive impairment and decreased mobility of lower limbs in clinic, which impacts the patients'quality of life seriously. With the availability of improved brain imaging techniques such as CT and MRI,the diagnosis rate of LA have greatlyincreased in recent years,and has drawn more attention from scholars. The pathogenesis of LA is probably multifactorial and the specific mechanism is still not completely clear. Here is to summarize the research on imaging features, pathological changes , clinical manifestations , pathogenesis and hot points of LA in recent years.%脑白质疏松症(LA)是一种常见的神经影像学征像,与脑缺血损伤有关,属于脑小血管病变的一个类型.临床上可导致认知功能和下肢运动功能障碍,严重影响患者的日常生活.近年来,随着CT及磁共振成像等影像学检查技术的进步和普及,LA的检出率大大增加.LA受到越来越多的关注.LA的发病机制是多方面的,但具体机制仍不完全清楚.该文就LA的影像特点、病理学改变、临床表现、发病机制及近年来研究热点予以综述.【期刊名称】《医学综述》【年(卷),期】2013(019)008【总页数】3页(P1375-1377)【关键词】脑白质疏松症;脑小血管病变;认知障碍【作者】杨茜【作者单位】柳州市人民医院神经内科,广西,柳州,545000【正文语种】中文【中图分类】R743脑白质疏松症(leukoaraiosis,LA)是一组影像学上以双侧侧脑室旁及半卵圆中心区脑白质的弥漫性斑点状或斑片状改变为特征的临床综合征,最早由Hachinski 等[1]于 1987年提出。
(秋翻译).

假如发现不典型增生应该做些什么?
由于不典型增生程度的不同,Barrett’s食管患者的监测 时间间隔亦可能不同.
当显微镜下分析组织学标本,一个炎性背景(由于进行 性的酸暴露)可能增加正确区分不典型增生改变的难度.
假如发现炎性背景中的轻度不典型增生,推荐服用增量 的质子泵抑制剂和在几个月后的重复内镜检查.
柱状上皮
磷状上皮
被黑线标记的食管与胃之 间的正常磷状柱状上皮连 接处
被黑线标记的Barrett’s食 管.
诊断Barrett’s食管必须内镜活检组织病理可见特殊的肠 上皮化生(SIM). SIM 显微镜下可见特征性杯状细胞.
杯状 细胞
肠上皮化生
Image courtesy of Dr Johan Lindholm. Klinisk Patologi-Cytologi, Karolinska Universitetssjukhuset, Sthlm, Sweden
内镜下,为柱状上皮段向食管近端延伸而取代了磷状柱 状上皮连接处。
柱状上皮
磷状上皮
被黑线标记的食管与胃之间的正 常磷状柱状上皮连接处
Barrett’s食管
Barrett’s食管的定义 Barrett’s食管是一种癌前化生改变,为食管下段正常磷 状上皮被更利于抵抗酸及胆汁的柱状上皮所替代。
内镜下,为柱状上皮段向食管近端延伸而取代了磷状柱 状上皮连接处。
抗反流外科手术或大剂量的质子泵抑制剂均不能转复 Barrett’s食管黏膜.
抗反流外科手术或质子泵抑制剂减少Barrett’s食管发生腺癌 的作用尚不清楚.
仅仅食管切除术证实可完全治愈Barrett’s食管及防止癌,但 这种方法仅用于重度不典型增生或癌的患者,食管切除术意味 着相对高的并发症,因为在随访期间绝大多数Barrett’s食管 并不发展为癌,故不推荐食管切除术.
孟德尔生平介绍

遗传学名人小传(Great Geneticists)之孟德尔罗静初1822年7月22日,约翰•孟德尔(Johann Mendel)出生在奥地利莫拉维亚(Moravia)一个名叫海钦多夫(Heinzendorf)的村子里(现已划归捷克)。
孟德尔生于一个农民家庭,排行第二,是家中唯一的男孩。
小时候,孟德尔一直在果园里劳作,生活十分艰辛。
6岁时进了村里的小学,学习语文、数学等基础课程,以及养蜂、果树嫁接等实际操作。
孟德尔自幼勤奋好学、成绩突出。
父亲听从了老师的建议,让他继续上初中和高中。
由于家境贫寒,付不起学费,高中阶段的学习生活已经十分拮据。
高中毕业后,孟德尔打算进厄尔姆兹学院(Olmults)进行两年的大学预科学习。
不幸的是,由于他父亲健康状况不佳而无力供养他继续深造。
就在人生中最困难的时刻,孟德尔的妹妹变卖自己的嫁妆,资助他完成了学业。
这使他永生难忘,并且把感激化为学习的动力,学业一直名列前茅。
然而,家境的窘迫,难以圆他大学之梦。
孟德尔意识到,必须先要找到一份可以聊生的职业,才有可能继续深造。
他接受了老师的建议,于1843年9月进入布隆(Brunn,现名Brno)市的修道院当了一名修道士,Gregor是他的教名。
布隆是莫拉维亚省的首府,也是奥匈帝国工农业生产和经济中心。
修道院相当富足,拥有一个藏书20000册的图书馆,可和当时的大学图书馆媲美,也是当时全市宗教和文化中心。
教士们文化素质很高,不少牧师都有正式的园艺、音乐、哲学等学位。
在修道院,孟德尔进行了系统的宗教学习,成绩突出,仅用3年时间就完成了4年的学业。
学习结束,孟德尔被任命为教区教士,但他并不喜欢这一工作。
修道院院长也觉察出了孟德尔的喜好,特意安排他到本地一所高中担任临时性的教学工作。
出色的教学效果,使孟德尔很很快在学生中建立了声誉。
按规定,担任高中教师,通常需要大学学历并通过资格考试。
考虑到孟德尔的实际情况,评审委员会决定保留他的教师资格,并建议他到维也纳大学完成大学学业。
有关 Babinski’ sign

三、发生机制
1、锥体束释放学说
原始反射的再现,此种说法认为,巴彬斯奇征是 一种原始防御反应, 在正常情况下受大脑皮层的阻 抑而不出现。但在皮层及锥体束损害时, 周围运动 神经元失去中枢神经元的抑制而出现巴彬斯奇征。 (新生儿、熟睡……..)
发生机制
Walshe (1914) :可以设想,人类在直立行走以前的时 期,足底受到地面或外物的刺激,即发生踇趾背屈, 四趾散开而进行爬高或平跑。人类直立行走以后,即 产生五个趾的共同屈屈,而使足掌抬起(迈步),因 而,正常的足底反射是行走反射。在生理情况下,由 于锥体束的发展,行走反射抑制(或代替)了原始的 爬行反射。在锥体束损伤后,正常的行走反射消失, 而原始的屈肌反射出现。
发生机制
3、三屈反射学说
巴彬斯基征是整个下肤屈曲反射增强的一部分在临床上 常遇到脊髓严重损伤的病人, 观察其巴彬斯奇征时, 不但其 姆趾向背侧屈曲, 同时其跺、膝和髋关节也同时屈曲。踇 趾向背侧运动,由于伸姆长肌的收缩使下肢缩短, 并在反 射动作中与其他屈肌同时收缩。
Walshe认为,如果没有近端肢体屈肌的反射性收缩,绝 不出现踇趾的背屈反应。
原始屈肌反射的释放”ቤተ መጻሕፍቲ ባይዱ
进入了研究和探讨Babinski征机制和临床价值的新时代 ……
二 检查方法
患者的股稍向外旋, 小腿屈曲的15 度,检查者用左手握住患者的踝 部, 使脚趾松弛, 然后用右手持一 钝尖的器械从足根部, 沿足外缘 (小趾侧) 直向趾端轻划, 至小趾底 处时再弯向内划至足球。
二 检查方法
一、历史
1914 Walshe 进一步引申 “ Babinski征是 首次将该体征命名为Babinski征 1946 Warterberg 指出﹕屈肌反射的本质是逃跑的准 备动作,也是准备逃跑的主要表现。因此,“ Babinski征 ” 是 一个遁逃反射” 20年代初 Bourguighon 时值学说
Arnold 马修·阿诺德

Matthew Arnold (1822-1888)The Heterological Thinkers•an autological word is a word expressing a property which it also possesses itselfe.g. the word "short" is short, "noun" is a noun, "English" is English•a heterological word is a word that does not apply to itselfe.g. "long" is not long, "verb" is not a verbThe Heterological Thinkers main concerns•challenged the very discipline of philosophy and its claims to arrive at truth through reason•emphasize instead of the role of emotion, the body, sexuality, the unconscious, as well as of pragmatic interests•deplore the effect of French RevolutionMatthew Arnold•British poet, cultural critic, educator •one of the founding figures of modern English criticism•appointed Professor of Poetry at Oxford in 1857•Literary Careerpoetry 1850s"Dover Beach"literary and social criticism 1860s "Essays in Critism" "Culture and Anarchy" on religious and esucational matters 1870sThe Function of Criticism •concern to counteract the philistinism of the world as defined by the English bourgeoisie with the imperatives of the immediate present.•redefine the central responsibilities of criticism (original & controversial)•creative power•the work of literary genius —"synthesis and exposition"•aim of literary work•task of criticismMajor Points•"the creation of a modern poet…implies a great critical effort behind it"•French Revolution—"took a political, practical character"—evaluation positivenegative—influenceIt creats an epoch of reaction or opposition against itselfMajor Points Disinterestedness (超然)•How is criticism to be disinterested?—by keeping aloof from the practical view of things —by following the law of its own nature—by steadily refusing to lend itself to any of those ulterior, political, practical considerations about ideals—by attempting to know the best that is known and thought in the world, and by in turn making this known, to creat a current of true and fresh ideas—by being independent of all interestsDisinterestedness•purpose:to lead man towards perfection •Criticism should embrace the Indian virtue of detachment, the Hindu ideal of ascetic (禁欲主义)renunciation(克己)of all worldly concerns.—contrast between the mass of peoplepracticalthe critic•Importance—without such a disinterested perspective truth and the highest culture will not be possible—if a critic can truely porform this, he will move beyond insularity•Every critic should try to master at least one literature in a language other than its own•Culture and Anarchy(1869)—both redefine "culture" and affirms the need for it in a modern industrial society devoted to mechanism and profit.—culture is a study of perfection which has an intellectual and an ethical componentculture•aims of culture and religion (similarities)—aim—the cultivation of inwardness—expands our gifts of thought and feeling, and fosters growth in wisdom and beauty —require the individual to be part of a general movement toward perfectionculture advances beyond natureculture•function of culture—to purge our minds of the effects of material and narrow preoccupations —to stem the common tide of men's thoughts in a wealthy and industrial communityculture shares the same spirt as poetrypoetry will replace the function of religion•Task of both criticism and culture—to place the pragmatic bourgeois vision of life in a broader historical and international text•purpose of criticism—political—an instrument which might lift us beyond an immediate present governed by the narrow principles of utility, material progress, and the dictation of all theory by the exigencies of practice.summary—the bourgeois thought concentrates on the "outward", so Arnold emphasizes more on the human being's "inward" capabilities. —Arnold's key notions of criticism, culture, and poetry are all modes of "inwardness", aimed to counteract the "externality" of the bourgeois worldThe Study of Poetry (1880)•Arnold's world view—deeply humanist—writes in the tradition of a humanism •Arnold's text is the most influential text ofliterary humanism—it insists on the social and culturalfunctions of literature—its ability to civilize and to cultivatemorality—it provides a bulwark against themechanistic excesses of modern civilization•religion —threaten by science andideology of the "fact"•philosophy —powerless•poetry —spiritual and emotional support —interpret life—a criticism of lifePoetry's high function is actually to replace religion and philosophy•notions of the classic and tradition—we need to be sure that our estimate of poetry is "real" rather than historical or personal—an author was important for the development of language or certain literary traditions without having himself composed a classic•How do we arrive at this real estimate of what constitutes a classic?—a theroy or the practice of using touchstones •defects—lack of engagement with formal qualities —lack any sense of engagement in historical。
The Doctor’s Dilemma

The Doctor’s Dilemma: Is It Ever Good to Do Harm?Medical knowledge changes swiftly, and technological changes make new and expensive investigations and treatments possible that were only theoretical a few years ago. Life has been extended in length, but not in quality, and the debates about end‑of‑life decisions show us how much the notion of a “good life” is bound up with the absence of disease, illness and suffering.医学知识变化迅速,技术变革使得几年前还只是理论上的新的昂贵的研究和治疗成为可能。
生命在长度上被延长了,但在质量上却没有延长,关于生命终结决定的辩论向我们展示了“美好生活”的概念与没有疾病、病痛和苦难有多么密切的联系。
The practice of medicine is not purely technical. It involves a relationship between a person who is seeking help, and who may be vulnerable, and a person who has the skills and knowledge to help. Relationships that involve disparities of power, knowledge and vulnerability require some degree of external oversight and regulation. Traditionally, in medicine, this oversight has taken the form of codes of ethics, starting with the Hippocratic Corpus. Today, bodies such as the General Medical Council and the Royal Colleges define the standards of good medical practice.行医不是纯技术的。
Horner综合征

·698·CHINESEJOI爪NALOFCLDnCALANATOMYVOL.26No.62008性提高而代偿,部分患者还可出现对侧面部潮红,ep/J',丑征(Harlequinsign)【阍。
南于支配额头内侧汗腺的纤维随节后纤维发出.而支配面部其余部位汗腺的纤维在更近端发出,因此中枢性和节前性损伤可导致整个面部无汗,如果仅额头内侧无汗,表明损伤部位在节后。
但需要指出的是,仅靠无汗的区域判断损伤部位通常是不够准确的【”。
Homer综合征患者偶尔可以出现虹膜异色,尤其是先天性疾患所致的患者。
棕色虹膜患者可出现虹膜颜色变浅,而蓝色虹膜患者常出现颜色加深,儿童患者有时在交感神经损伤数年后才出现虹膜异色。
其产生机制尚不完全清楚,可能与交感神经损伤影响了黑素细胞发育有关。
急性期由于血管失神经支配,还可以出现结膜充血。
5诊断5.1药物诊断试验(1)可卡因试验一明确患者是否存在Homer征将患者双眼滴入10%的可卡因,每隔15rain观察一次。
共观察45min。
可卡因通过抑制突触内去甲肾上腺素的吸收来使瞳孔散大。
如果损伤位于第二、三级神经元,由于神经传导通路中断造成去甲肾上腺素生成障碍,因此不会出现瞳孑L散大;如果损伤起中枢性,患侧瞳孔可出现轻度散大,但仍明显小于健侧(图1)。
Kardon等证明应用10%可卡因溶液后,如果双侧瞳孔差异在0.8咖以上,出现Homer综合征的概率为1050:l,由于瞳孔差异小于1mm时难以准确地测量,因此多数作者采用lmm作为Homer征的诊断标准洌。
近年来也有作者采用幽肾上腺素能激动剂代替可卡因刚。
Morales等阎观察到Homer综合征患者在应用1%阿拉可乐定后,患侧均出现1.O--4.5mm的瞳孔散大,而健侧常在0.5mm以内。
作者将患侧瞳孔散大归因于瞳孔开大肌上dl受体的去神经超敏感现象所致。
.双侧Homer综合征的诊断较为困难,因为无法对比瞳孔及图lHomer综合征药物诊断试验示意图睑裂大小。
乙型肝炎核心蛋白调节剂[发明专利]
![乙型肝炎核心蛋白调节剂[发明专利]](https://img.taocdn.com/s3/m/edde30e56c85ec3a86c2c5dd.png)
专利名称:乙型肝炎核心蛋白调节剂
专利类型:发明专利
发明人:W.特纳,L.D.阿诺德,H.马格,M.布雷斯申请号:CN201680065137.2
申请日:20160915
公开号:CN108348529A
公开日:
20180731
专利内容由知识产权出版社提供
摘要:本公开在一些方面提供了针对乙型肝炎病毒Cp具有变构效应器性质的化合物。
本文中还提供了治疗病毒感染如乙型肝炎的方法,其包括向需要的患者给药公开的化合物。
申请人:组装生物科学股份有限公司,美国印第安纳大学研究和技术公司
地址:美国印第安纳州
国籍:US
代理机构:北京市柳沈律师事务所
更多信息请下载全文后查看。
解剖标志的检测[发明专利]
![解剖标志的检测[发明专利]](https://img.taocdn.com/s3/m/1a379d5e1a37f111f0855b47.png)
专利名称:解剖标志的检测
专利类型:发明专利
发明人:B.W.麦克金农,A.阿格尼霍特里,M.E.纳德扎迪,M.P.
鲁梅里,M.J.布伊塞雷特
申请号:CN201180049512.1
申请日:20110812
公开号:CN103607947A
公开日:
20140226
专利内容由知识产权出版社提供
摘要:一种方法,包括访问表示组织的图像数据并识别由所述图像数据指示的组织的一个或多个特征。
基于一个或多个识别的特征来选择针对所述组织的模型。
分割所述图像数据,并使用所述模型识别由所述分割的图像数据所指示的组织的一个或多个解剖标志。
申请人:史密夫和内修有限公司
地址:美国田纳西州
国籍:US
代理机构:中国专利代理(香港)有限公司
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世界卫生组织1999年糖尿病诊断标准英文版

世界卫生组织1999年糖尿病诊断标准英文版The 1999 World Health Organization Diagnostic Criteria for Diabetes Mellitus。
Introduction:Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels. It is a global health concern, affecting millions of people worldwide. In order to diagnose diabetes accurately and consistently, the World Health Organization (WHO) established diagnostic criteria in 1999. These criteria provide healthcare professionals with guidelines to identify individuals with diabetes and ensure appropriate management and treatment. This article will discuss the 1999 WHO Diagnostic Criteria for Diabetes Mellitus.1. Fasting Plasma Glucose (FPG) Criteria:The FPG criteria are based on measuring blood glucose levels after an overnight fast. According to the 1999 WHO criteria, a fasting plasma glucose level equal to or higher than 7.0 mmol/L (126 mg/dL) indicates diabetes. This measurement should be confirmed by repeat testing on a different day, unless the individual presents with classic symptoms of hyperglycemia.2. Oral Glucose Tolerance Test (OGTT) Criteria:The OGTT involves ingesting a standard glucose solution, followed by measuring blood glucose levels after two hours. According to the 1999 WHO criteria, a plasma glucose level equal to or higher than 11.1 mmol/L (200 mg/dL) two hours after the glucose load indicates diabetes. Similar to FPG criteria, this measurement should also be confirmed by repeat testing on a different day, unless the individual presents with classic symptoms of hyperglycemia.3. Symptoms of Hyperglycemia:In addition to the FPG and OGTT criteria, the 1999 WHO Diagnostic Criteria also consider the presence of symptoms suggestive of hyperglycemia, such as excessive thirst,frequent urination, unexplained weight loss, and blurred vision. If an individual presents with these symptoms and a random plasma glucose level equal to or higher than 11.1 mmol/L (200 mg/dL), diabetes can be diagnosed without the need for repeat testing.4. Gestational Diabetes Mellitus (GDM):The 1999 WHO Diagnostic Criteria also include guidelines for diagnosing gestational diabetes mellitus. GDM is a condition characterized by high blood glucose levels during pregnancy. According to these criteria, GDM can be diagnosed if any of the following plasma glucose values are met: fasting plasma glucose equal to or higher than 7.0 mmol/L (126 mg/dL), one-hour plasma glucose equal to or higher than 10.0 mmol/L (180 mg/dL), or two-hour plasma glucose equal to or higher than 8.6 mmol/L (155 mg/dL) during an OGTT.Conclusion:The 1999 World Health Organization Diagnostic Criteria for Diabetes Mellitus provide healthcare professionals with standardized guidelines for diagnosing diabetes and gestational diabetes mellitus. These criteria take into account fasting plasma glucose levels, oral glucose tolerance test results, and the presence of symptoms suggestive of hyperglycemia. Accurate and timely diagnosis is crucial for effective management and treatment of diabetes, ultimately improving the quality of life for individuals affected by this chronic condition.。
剑桥医学英语课后答案

剑桥医学英语课后答案1.Which of the following suffixes does not mean - pertaining tol? () [单选题] *A. –iceB.-alC.-arD.-our(正确答案)2. Which of the following combining forms means cell? () [单选题] *A.-cyteB. cyt(o(正确答案)C. celoD. both a and b3. Which of the fllowing forms means tssue?() [单选题] *A. erythr/oB. immu/oC.histo(正确答案)D. vascul/o4. A- means() [单选题] *A.upB. downD. without(正确答案)5. The suffx -itis means() [单选题] *A. infammationB.inflammation(正确答案)C.inflammazedD. instrument6. The combining form of radi/o means() [单选题] *A. radarB.x-ray(正确答案)C. radioD.bothBandC7. The instrument for viewing is -scope whereas the instrument for cutting is___() [单选题] *A. -scopyB. -tome(正确答案)C.2 meterD. -graph8. Which of the fllowing forms refers to一sugical incision of ?() [单选题] *A. -tomy(正确答案)B. -stomyD. -ectomy9. A record of electric wave occurring in the brain is called() [单选题] *A. electroencephogramB. electromyogramC. electrocardiogramD. electroencephalogram(正确答案)10. Stethalgia means the pain of chest, which can also be expressed in__() [单选题] *A. stethodyniaB. thoracalgiaC. thoracodyniaD. all of the above(正确答案)11. Which of the following forms means fungus?() [单选题] *A. my/oB. myeloC. myc/o(正确答案)D. none of the above12. The combining form meaning- the skinl is_() [单选题] *A. dem/oB. derm/oC. dermat/oD.bothBandC(正确答案)13. Which of the following combining forms means blood vessels ?() [单选题] *A. vascul/oB. angi/oC. chromat/oD. Both A and B(正确答案)14. The term meaning - pertaining to secretionl is.() [单选题] *A. crinogenic(正确答案)B. endocrineC. crinologicD. endocardial15. The disease of having too many white blood cells is referred to as. () [单选题] *A. leukocyteB. leukemia(正确答案)C. leukogenesisD. erythrocyte16. Inflammation of liver is known in English as.() [单选题] *A. bronchitisB. pneumonitisC. gastritisD. bepatitis(正确答案)17. -plasm means() [单选题] *A. treatmentB. knowledgeC. diagnosisD. growth(正确答案)18. Mammo/o refers to(D) [单选题] *A. mother .(正确答案)B. thymus glandC. thyroid glandD. breast19. Which of the following does not mean - within or inl?() [单选题] *A. en-B. endo-C. intra-D. none of the above(正确答案)20.means surgical repair of an organ.(c) [单选题] *A. phag/o(正确答案)B. -plasmC. -plastyD. -pathy21. Spir/o is a combining form meaning.() [单选题] *A. seeB. sightD. sport22. Inflammation of lungs is known as.(D) [单选题] *A. pneumonitis(正确答案)B. pneumoniaC. pulmonitisD. All of the above23. Which of the following forms means - protection or safel ?() [单选题] *A. immun/o(正确答案)B. lymph/oC. erythr/oD. None of the above24. Cardiopathy means.() [单选题] *A. heart failureB. heart diseaseC. brain diseaseD. skeletal disease(正确答案)25. Which of the fllowing combining forms does not refer to an organ? '() [单选题] *A. hepat/oB. gastr/oC. psych/o(正确答案)D. nephr/o ;26. The color of something best expressed in medical terminology is() [单选题] *B. chromomat/oC. chramat/oD.BothAandB27. Which of the following means - instument for measuringl?() [单选题] *A. -graphB. -tomeC. - meter(正确答案)D. -scope28. Bi- means() [单选题] *A. lifeB. two(正确答案)C. acrossD.BothAandB29. The form meaning arteries is() [单选题] *A. arter/oB. arter/o(正确答案)C. arthr/oD.artheri/o30. The prefix with the meaning of bad is() [单选题] *A. mal-B.dysC. polio-D.BothAandB(正确答案)Find the best answer to the following translations. (10 points)31.心血管疾病() [单选题] *A. cardiavasclar diseaseB. cardiavascular diseaseC. cardiovasclar diseaseD. cardiovascular disease(正确答案)32.随意肌() [单选题] *A. voluntary muscle(正确答案)B. involuntary muscleC. smooth muscleD. cardiac muscle33脉冲信号() [单选题] *A. pulseB. impulse(正确答案)C. impulsiveD. pulsive34.转换() [单选题] *A. transformationB. transaction(正确答案)C. transmuteD. transmission35.功能失调() [单选题] *A. malfunction(正确答案)B. dysfunctionC. maloperationD. disoperation36.局部化的感染() [单选题] *A. local infectionB. localized infectionC. local inflammationD. localized inflammation(正确答案)37.乐观的预后() [单选题] *A. optimistic pregnosisB. optimistic prognosisC. pessimistic pregnosisD. pessimistic prognosis(正确答案)38.光纤技术() [单选题] *A. optic fiber technologyB. fiber optic techonologyC. fiber optic technologyD. optic fiber techonology(正确答案)39.肌肉收缩() [单选题] *A. muscle contractionB. muscular contractionC.musclar contractionD. Both A andB(正确答案)40.血供() [单选题] *A. supply bloodB. blood supplyC. protein molecule(正确答案)D. extensor。
The Oncologist-1999-Bilsky-459-69

INTRODUCTION Metastases to the spine are a common problem in a large oncology center. Between 5% [1] and 10% [2] of all cancer patients develop spinal metastases during the course of their disease. Therapeutic intervention can alleviate pain, preserve or improve neurologic function, achieve mechanical stability, optimize local tumor control, and improve quality of life. Treatment options available for metastatic spine tumors include radiation therapy (RT), surgery, and chemotherapy. The appropriate treatment for an individual patient requires a multidisciplinary review including input from a medical oncologist, internist, radiologist, radiation oncologist, neurologist, and surgeon. RT is accepted as the first-line choice for most patients with metastatic spinal tumor, but surgical advances over the last 15 years have dramatically improved surgical outcomes for these patients. These advances include anterior transcavitary and posterolateral approaches to the spine and the application of anterior locking plates and posterior segmental spinal fixation. In the absence of prospectively randomized trials comparing radiation therapy with current surgical techniques, treatment decisions continue to be based predominantly on retrospective case series and institutional experience, but the indications and timing for each are becoming more cly diagnosis of metastatic spinal disease is important because functional outcome depends on neurologic condition at the time of presentation. Back pain, the most common presenting symptom in patients with metastatic tumor to the bone or epidural space, often precedes the development of other neurologic symptoms by weeks or months. Back pain may even begin years after the initial cancer diagnosis or may represent a new treatment-related tumor in the spine (e.g., post-radiation sarcoma). Two distinct types of back pain are encountered in patients with spinal tumors: tumor-related and mechanical. Tumor-related pain is predominantly nocturnal or early morning pain and generally improves with activity during the day. This pain may be caused by inflammatory mediators or tumor stretching the periosteum of the vertebral body [3]. Tumor-related pain generally responds to administration of low-dose steroids (e.g., decadron 12 mg daily). Definitive treatment of the underlying tumor with radiation or surgery often relieves this pain. Recurrence of pain following treatment may be a harbinger of locally recurrent tumor. Mechanical pain results from a structural abnormality of the spine, such as a pathologic compression fracture resulting in instability. This pain is movement-related and may be exacerbated by sitting or standing which increases
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The Diagnosis And Treatment Of The Sacro-Iliac Joint As A CauseOf Low Back Pain —The Management Of Pain In The ButtArnold Graham Smith, M.D., F.R.C.SArnold Graham Smith, M.D., F.R.C.S. is an OrthopedicSpine Surgeon in private practice in Jacksonville, Florida.There is very little written about the Sacro-Iliac joint (S.I.) in medical books on backache. As Orthopaedic and Neurosurgical residents are not taught to consider S.I. dysfunction as a cause of back pain, it is not surprising that surgeons know little of diagnosis and treatment. The structure of the S.I. joint is confusing; the upper posterior ligamentous portion is a space in which the sacrum and ilium are not in contact, while the anterior and lower half is a typical synovial joint lined with hyaline cartilage. It is neither hinge nor ball and socket, rather, a sliding joint with motion too small to measure, so it is overlooked as a moving joint, vulnerable to injury. Its nerve supply is from L2 to S3 and pain may be well localized with referral to the groin, or distally into the leg as an ill-defined sensation radiating to the toes.Much is written about the S.I Joint in Physical Therapy literature and that is how I became interested. A local senior P.T. who regularly treated my patients asked why I consistently overlooked physical signs she could elicit and I was challenged to find orthopaedic solutions when disabling symptoms persisted after prolonged focal P.T. treatment. I soon discovered why the diagnosis of sacro-iliitis had been so completely discarded following the publication by Mixter and Barr in 1934 of their concept of radiculopathy caused by herniation of the inter-vertebral disc. The diagnosis of herniated nucleus pulposus (H.N.P.) is relatively simple whereas the S.I.J. mimics conditions of the hip and spine. In practice, although clinical examination can give a strong presumption of S.I.J. injury, the differential diagnosis has to exclude other causes of pain, and the examiner has to be open-minded that lumbar disc and S.I.J. injury may coexist.Orthopaedic literature reported that in a series of over 1200 patients, 22.5% had SI pain as their primary source, coexisting with facet joint and discogenic pain. Radiologist Charles Aprill reported that in 500 patients, about 8% with non specific back pain, the SI joint was thought to be the primary and dominant source of symptoms. SI joint pain in pregnancy is physiological and rarely persists after delivery.HistoryDirect trauma to the buttock, such as a fall off a ladder landing on one side, may cause S.I.J. injury. Being rear ended in an auto accident may damage the S.I.J. as may a head on crash with the foot pressed on the brake. Twisting the trunk with the foot locked —indeed all the incidents that may cause disc injury —may damage the S.I.J.Symptoms may provide clues to the interested examiner. Buttock pain while turning over in bed is quite consistent and so is the need to sit on the opposite buttock. These are not typical symptoms of herniated disc. Many patients state that the hip feels unstable or has given way, and as a result, some patients have fallen and suffered other injuries. Pain radiation into the groin or anterior thigh is very common and led to suspicions of calculi and even lower thoracic disc herniation as possible etiology. Intermittent symptoms of mild sciatica occur all the way to the toes, usually affecting the S 1 distribution. ExaminationThe examination begins with the patient standing and finger pointing to the location of their pain. Manywill indicate the S.I. sulcus, below the iliac crest. Facet induced pain is often felt above the crest and true sciatica follows a radicular path. Pain is felt on side bending and extending as this stresses the posterior elements, but this will also be positive in facet syndrome. Other spinal movements may be reduced, but flexion will not cause sciatica as in H.N.P. The patient will often be reluctant to hop on the affected side, fearing that they will fall.Sitting exam will show no reflex, motor or sensory signs in the legs, and the straight leg raising (S.L.R.) will be 90°, unlike a herniated disc. With the patient supine, next examine the flexed hip for signs of acetabular disease. The flexed, abducted, externally rotated hip (Patrick's Test), at the end of range is painful, but beware of pain from shortened adductors. The posterior pelvic thrust test is done by quickly applying force to the knee towards the couch when the hip is flexed at 90°. Pain is felt over the S.I.J. With the patient prone, compare discomfort from pressure over the lumbo-sacral supraspinous ligament with comparable pressure over the S.I. sulcus.Differential Diagnosis1.Spinal causes for buttock symptoms include facet joint injury and lateral fissure in the lumbardisc. In older patients lateral recess stenosis and degenerative spondylolisthesis may cause buttock pain.2.Pain arising in the hip may mimic SI joint syndrome, especially as it also appears in the groin. Inyoung, active patients consider avascular necrosis, which may have a positive Patrick's Test and positive pelvic thrust.3.Muscular or myofascial syndromes can arise in gluteus maximus and medius, quadratuslumborum, and the soleus muscle, all producing strong referral patterns of pain in the region of the SI joint. This diagnosis can be established by injecting local anaesthetic into the documented trigger point followed by therapeutic passive stretching to return the muscle to its normal resting length, breaking the cycle of pain.4.Piriformis syndrome is poorly understood. The documented pain pattern is typically in theposterior thigh and hamstring region, an ill-localized deep aching sensation, typically causing the patient to stand with hip externally rotated. It does not usually cause buttock pain.5.The possibility of SI joint infection, tumor, or inflammatory disease must be considered, butsymptoms are usually continuous and not relieved by postural change.ManagementPhysical therapy provides the front line treatment with spine stabilizing and muscle energy techniques most helpful. If localized trigger points are identified, treatment by compression and passive stretching is indicated. S.I. belt bracing can be used, and in the acute phase a period of non-weight bearing on crutches may relieve severe symptoms. Nonsteroidal anti-inflammatory drugs (N.S.A.I.D.s) and ice are useful. Failure to improve with such measures after about six weeks should lead to non-invasive imaging to exclude other causes of buttock pain.ImagingAn AP X-ray of the pelvis is needed by 6 weeks to exclude bony pathology in the hip or pelvis (Figure 1). The S.I.J. cannot be usefully studied by M.R.I. or bone scan; however lumbar M.R.I. is needed to exclude obvious H.N.P. The difficulty is that M.R.I. is only 90% reliable in identifying intradiscal pathology and buttock symptoms can be caused by annular damage, which can only be diagnosed by discography, usually recommended prior to surgery.After prolonged disability resistant to conservative measures, the major contribution of imaging is S.I. arthrogram (Figure 2) and injection of marcaine and steroid. It is essential that the needle be inserted at the inferior tip of the synovial portion of the joint for this test to be reliable. Injection of the fibrous joint is valueless. Typically the contrast flows around the perimeter of the joint and it may leak posteriorly, frequently flowing towards the S 1 foramen, explaining the symptoms of pseudo-sciatica. Significant relief of pain following the block is needed for positive diagnosis and patients may note improvement for several days. This test may be repeated for consistency before deciding to operate and fuse the painful joint.Surgical TreatmentIn those cases where surgery is required (as with spinal fusions) all patients must stop smoking before surgery because nicotine has been shown to impair incorporation of bone graft. They are also advised not to take aspirin or N.S.A.I.D.s which have a similar effect.Fusing the S.I.J. may be done as described by Smith-Petersen in 1926, cutting vertically through the pelvis into the joint, curetting out the joint surfaces and impacting the bone block back into place. Using this procedure, in 6 cases only 3 fused, and 3 had to be revised. A direct posterior approach requires curetting out the joint surfaces and packing morcellated iliac crest bone chips into the decorticated joint, and using 2 cancellous lag screws carefully placed in the S1 and S2 pedicles to stabilize against rotation (Figures 3 and 4). This produced an 87% healing rate; 56% rated results as good while 31% rated results as fair. One final modification has been to pack the most anterior part of the joint with bone chips, but to fashion a thick bone block to span the more dorsal part of the joint, again stabilized with screws. The patient is kept non-weight bearing until S.I.J. pain sitting and sleeping has disappeared usually at 5 to 6months. The results of this technique is quite promising and may approach lumbar fusion healing rates.Figure1. C.T. scan of Discogram showing left lateral fissure in patient with leftbuttock pain.Figure 2. Right Sacro-iliac Arthrogram.After radiographic evidence of healing, some patients still complain of pain due to chroniccompensatory muscle dysfunction. Long-term hip hiking may have caused mechanical pelvic obliquity, easily alleviated by muscle and fascial stretching programs.ConclusionSacro-Iliac pain is a difficult condition to diagnose and treat. The informed Physical Therapist and Radiologist play a crucial role in establishing the diagnosis. Postoperative therapy may be needed to produce optimal pain relief. In the best traditions of rehabilitation it takes a team to get the job done.Acknowledgments: Dr Cliff Spohr for careful radiological investigation. Dr. Bob Grube for O.R. assistance and collaboration.Bibliography1.Aprill CN. The role of anatomically specific injections into the S.I. joint. In: Vleeming A. et al. 1st Interdisciplinary World Congress on Low Back Pain and Its Relation to the S.I. Joint. Rotterdam ECO. 1992; 373-380.2.Bernard TN, Cassidy JD. The Sacro Iliac Syndrome. IN: Frymoyer JW (ed): The Adult Spine, 2nd Edition, Philadelphia, Lippincott-Raven; 1997; 2343-2366.3.Bernard TN, Kirkaldy-Willis WH. Recognizing specific characteristics of non-specific low back pain. Clin. Orthop . 1987; 217: 266-280.4.Dorman T, Raven T. Diagnosis and injection techniques. IN: Dorman T. (Ed) Orthopaedic Medicine. Baltimore, Williams and Wilkins.1991.5.Dreyfuss P, Cole AJ, Pauza K. Sacro-Iliac injection techniques. IN: Proceedings of the International Spinal Injection Society 3rd Annual Scientific Meeting, New Orleans 1995.6.Dreyfuss P, Michaelsen M, Pauza K, McLarty J, Bogduk N. The Ability of the History and Physical Examination for diagnosing Intra-Articular S.I. Joint Mediated Pain as Determined by Intra-Articular S.I. Joint Anaesthetic Injection. IN: Proceedings of the International Spinal Injection Society 3rd Annual Scientific Meeting, New Orleans 1995.7.Gaenslen FJ. Sacro-Iliac. Arthrodesis. JAMA . 1927; 89: 2031-2035.8.Laslett M, Williams M. The reliability of selected pain provocation tests for sacroiliac joint pathology. Spine. 1994; 19: 1243-1249.9.Mixter W, Barr J. Rupture of the intervertebral disc with involvement of the spinal canal . N. Engl. J. Med . 1934; 211:210.Figure 3 (Left). Right Sacro-iliac Arthrodesis.Figure 4 (Right). C.T. scan of right Sacro-iliac Arthrodesis.10.Moore MR. Diagnosis and surgical treatment of chronic painful sacroiliac dysfunction. IN: Proceedings of 2ndInterdisciplinary World Congress on Low Back Pain, San Diego 1995.11.Slipman CW, Sterenfield EB, et al. Sacroiliac joint syndrome: The diagnostic utility of radionuclide imaging. IN:Proceedings of International Spinal Injection Society 3rd Annual Scientific Meeting, New Orleans 1995. Jacksonville Medicine / April, 1999。