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简介：ＰＡＴＩＥＮＴＭＯＮＩＴＯＲＩＮＧＳＹＳＴＥＭＰＡＴＩＥＮＴＭＯＮＩＴＯＲＩＮＧＳＹＳＴＥＭＨａｕＧｕｉｆｅｎ；ＬｉｕＧｕａｎｇｒｏｎｇ（ＣｈｉｎｅｓｅＰＬＡ．ＧｅｎｅｒａｌＨｏｓｐｉｔａｌ１００８５３，Ｂｅｉｊｉｎｇ，Ｃｈｉｎａ）ＳｕｃｈａｓＰａｔ...

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简介：Clinicaldecision-makingiswhatallcardiovascularphysiciansdo.Thepurposeofdecision-makingistomakethediagnosis,decideonappropriatetherapyandestimatetheprognosisoftheindividualpatient.Regardingtheprognosis,populationprognosticdataisusedbutthismayormaynotapplytotheindividualpatient.LVfunction,nomatterhowitisdeterminedseemstocorrelatebestwithprognosis.Butweneedtorememberthatprognosticationoftheindividualis,atbest,aneducatedguess.

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简介：Objective:Toevaluatetheauditoryfunctionofanindividualwithgeneticallyconfirmedhemochromatosis.Methods:A57yearoldmalewithmildlyimpairedsounddetectionthresholdsunderwentarangeofbehavioural,electroacousticandelectrophysiologicassessments.Theseincludedtherecordingofotoacousticemissionsandauditorybrainstemresponses,measurementofmonauraltemporalresolutionandevaluationofbinauralspeechprocessing.Findingsforthispatientweresubsequentlycomparedwiththoseof80healthycontrolswithsimilaraudiometricthresholds.Results:Thepatientshowedthethreecardinalfeaturesofauditoryneuropathy,presentingwithevidenceofnormalcochlearouterhaircellfunction,disruptedneuralactivityintheauditorynerve/brainstemandimpairedtemporalprocessing.Hisfunctionalhearingability(speechperception)wassignificantlyaffectedandsuggestedareducedcapacitytouselocalizationcuestosegregatesignalsinthepresenceofbackgroundnoise.Conclusion:Wepresentthefirstcaseofanindividualwithhemochromatosisandauditoryneuropathy.Thefindingsforthispatienthighlighttheneedforcarefulevaluationofauditoryfunctioninindividualswiththedisorder.

简介：Inprimarymitralregurgitationthereareanatomicabnormalitiesofthemitralvalvecausingbackwardflow,placingahemodynamicburdenontheleftventricle.Ifthisburdenissevereandprolonged,itleadstoleftventriculardamage,heartfailure,anddeath.Thepreferredtherapyisrestorationofmitralcompetencethroughmitralvalverepair,whichissaferthanmitralvalvereplacement.Whenrepairisperformedinatimelyfashion,lifespancanbereturnedtothatofanormalindividual.Triggersfortimelyrepairincludetheonsetofsymptomsandevidenceofleftventriculardysfunctionasdeterminedbyejectionfractionfallingtoward60%and/orend-systolicdimensionincreasingtoward40mm.

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简介：瞄准：有希望地在年轻病人学习发生和尖锐憩室炎的自然科学。方法：与尖锐憩室炎的诊断在我们在2000年1月之间的医院就医到2005年2月的207个病人的一个总数被包括。他们的人口统计的特征，病历，physical，X光线照相术、内视镜的调查结果以及治疗被记录。病人们被跟随为第一年的每6瞬间并且以后每年。结果：吝啬的病人的年龄是61(范围27-92)年。25个病人(12%)比45年年轻。尖锐憩室炎是显著地，在在年轻年龄组的男性之中流行的更多作为与老年相比组织(19/25，76%对61/182，33%，分别地P=0.0001)。复杂并发症更经常发生在年轻年龄组；32%对13%，(P=0.002)。在后续期间，6个病人(28%)在老年组作为与87个病人(55%)相比在年轻年龄组仍然保持无征状(P=0.024)。作为结果，sigmoidectomies是被执行两次经常在年轻年龄组(38%对13%，P=0.002)。结论：在年轻病人的憩室炎有男优势，有复杂并发症和更高的再发率的更高的率的一堂更好攻击的功课。一条更早外科的途径可能与尖锐憩室炎在年轻病人被考虑。

简介：Accordingtothemostrecentepidemiologicaldata,theprevalenceofhypertensionrangedfromabout25%inChineselivingeitherinthemainlandorinTaiwanandKoreans,toapproximately40%inMongolians.Thecontrolrateofhypertensionwasabout35%inKoreansandJapanese,24%inMongolians,andlessthan10%inChinese.Fourplacebo-controlledtrialsinChinaunequivocallyprovedthatantihypertensivetherapymaypreventstrokeandothercardiovascularcomplicationsinhypertensionorpatientswithahistoryofstrokeortransientischemicattack.Fouractively-controlledtrialsinJapandidnotshowsignificantdifferencebetweenvariousclassesorcombinationsofantihypertensivedrugs.TwotrialsthatcomparedintensivewithlessintensivebloodpressurecontrolinelderlyJapanesehypertensivepatientsdidnotshowfurtherbenefitofcontrollingsystolicbloodpressuretoalevelbelow140mmHgincomparisonwithbloodpressurecontroltoalevelof140mmHgorabove.Thesetrialsthatcomparedvariousclassesofantihypertensivedrugsorintensivewithlessintensivebloodpressurecontroloftenhadsmallsamplesizeandhenceinadequatepowertodetectmodestormoderatebenefit.ThereisstillaneedforhighqualityoutcometrialdatainEastAsians.

简介：在激进的前列腺切除术(RP)或外部横梁放射治疗(EBRT)以后的健康相关的quality-of-life(HRQOL)没在与疾病风险层化的关系与oncological结果一起被学习。而且，这些治疗途径的长期的结果没被学习。我们回顾地分析了在收到RP的连续病人之间的oncological结果(n=86)并且EBRT(n=76)为局部性的前列腺癌症。HRQOL和功能的结果能在62RP(79%)和54EBRT(79%)被估计在一个3年的后续时期上的病人(中部：41个月)用医药结果学习，短Form-36(SF-36)和加利福尼亚大学洛杉机前列腺癌症索引(UCLA一种总线标准)。5年的生物化学的没有前进的幸存没在RP和EBRT组之间不同为低风险(74.6%对75.0%，P=0.931)并且中间风险(61.3%对71.1%，P=0.691)病人。为高风险的病人，没有前进的幸存比在EBRT组(79.7%)在RP组(45.1%)是更低的(P=0.002)。一般HRQOL在二个组之间是可比较的。关于功能的结果，RP组比EBRT组在尿功能和不太尿的麻烦和性麻烦上报导了更低的分数(P<0.001，P<0.05并且P<0.001，分别地)。与风险层化，在RP组的低风险、中间风险的病人在EBRT组比病人报导了更差的尿功能(P<0.001为各个)。在EBRT组的高风险的病人的性功能比一样的风险RP病人的好(P<0.001)。生物化学的复发没在任何一个组与UCLA一种总线标准分数被联系。在结论，低--可以在长期的后续期间向与RP对待的中间风险的病人汇报相对减少的尿功能。病人在治疗以后的HRQOL没取决于生物化学的复发。

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简介：AbstractParotidectomy is the mainstay treatment for tumors of the parotid gland. In an effort to improve clinical outcomes, several modern surgical techniques and perioperative interventions have been evaluated and refined. This review discusses current and actively debated perioperative interventions aimed at improving patient safety and the quality of parotidectomy. Relevant high-impact literature pertaining to preoperative diagnostic modalities, intraoperative surgical techniques, and postoperative care will be described.

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简介：Theearlydiagnosisofcardiacruptureisoneofthekeyfactorsforasuccessfuloutcome.However,theaccuratediagnosisisoftendifficultintheearlystageofinjury,especiallywhensomeobviousseverewoundsarefoundinotherregionsofthebody,1,2fortheyareeasytodisguisethesymptomoftheheart.Wereportacasewithcardiacruptureandlivertraumacausedbytrafficaccident.

简介：Managementofrheumaticmitralregurgitationinawomancontemplatingpregnancypresentsuniquechallengesfortheclinician.Whentaskedwithtakingcareofthistypeofpatient,attentionneedstobepaidtothepatient’sfunctionalstatustodetermineifsymptomsarepresent.Inadditiontothisclinicalassessment,transthoracicechocardiographyisalsocritical.Itprovidesinsightintotheetiologyofthemitralregurgitation,assessesforthepresenceofconcomitantmitralstenosisorothervalvularabnormalities,characterizestheseverityofmitralregurgitationthroughanintegrativeapproachandidentifieshighriskfindingsincludingprogressiveleftventricular(LV)dilationandLVdysfunction.SurgicalinterventionisrecommendedforsymptomaticpatientsandinasymptomaticpatientswithevidenceofprogressiveLVdilationandaLVejectionfractionoflessthan60%.Whilethepresenceofpulmonaryhypertensionandatrialfibrillationhavebeenshowntoberiskfactorsindegenerativemitralregurgitation,thesamehasnotbeendemonstratedinrheumaticmitralvalvedisease.Whilemitralregurgitationmaybereasonablywelltoleratedduringpregnancy,symptomaticpatientsareathigherriskforadversematernalandfetaloutcomes,andtherefore,itisrecommendedthatmitralvalvesurgerybeperformedpriortopregnancy.Oncethedecisionhasbeenmadetoproceedtosurgery,mitralrepair,performedataHeartValveCenterofExcellenceisrecommendedifpossibleduetoimprovedoutcomes.Mitralvalverepairispossiblein>80%casesofrheumaticmitralregurgitation.Ifrepairisnotpossible,replacementwitheitherabioprostheticormechanicalvalvearereasonableoptions.Thereareadvantagesanddisadvantagestoeachapproachandthechoiceofprosthesisshouldbeashareddecisionbetweenthepatientandhertreatmentteam.

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简介：AbstractPurpose:Fingertip injuries are common in industrial production activities as well as in domestic work. Loss of pulp hampers daily life activities. Functional and aesthetic aspects are important in fingertip reconstruction. The bone is usually exposed along with soft tissue loss. Therefore to reconstruct the pulp flap with adequate bulk is required.Methods:We reported a case series of 12 patients with the injury over the volar aspect of distal phalanx of the index or middle finger. In all cases, laterally based thenar flap was chosen. The flap donor site was closed primarily in most of cases, while 4 patients required skin graft. The flap was detached between 2-3 weeks. Functional assessment was done using static and dynamic 2-point discrimination and range of motion at each joint. The aesthetic outcome was assessed through questionnaire. The results were analyzed using the unpaired t-test (SPSS version 21).Results:Partial necrosis occurred in 2 cases while rest of flaps survived successfully. Static 2-point discrimination ranged from 6-10 mm, mean 8.6 mm; and dynamic 2-point discrimination ranged from 8-10 mm, mean 8.9 mm. The mean satisfaction score was (4.0 ± 0.55).Conclusion:Thenar flap is a good choice for reconstruction of the finger pulp as it provides the bulk with good functional and aesthetic outcome.

简介：客观：调查创伤的有三个尖头的不足的外科的治疗的最佳的时间和过程。方法：从1984年5月到2004年9月，八个病人为创伤的有三个尖头的阀门不足经历了操作。所有病人，男性，从7～67年变老[中部：38年，意味着：（38。5±18。1)年]。在损伤和操作之间的间隔从1个月到20年[中部：19个月，意味着：(52.5±80.3)月)]。Inseven病人，有三个尖头的不足被归因在三个病人包括车辆事故弄钝胸损伤，另外的病人是一处stab创伤。诊断是证实的byechocardiography。在病人的外科手术前的心脏的功能作为纽约HeartAssociation(NYHA)班Ⅱ-Ⅳ被分类。在手术期间，有三个尖头的阀门的前面的传单完全或部分在所有病人由于索的破裂被乱摆。氏族的传单的索的破裂在一个病人被发现。前面的传单在二个病人被穿孔。Septalleaflet被缩回并且支持者到在二个病人的室的中隔。阀门修理为所有病人被打算。最后，阀门修理在3个病人成功地被执行，有三个尖头的代替在5个病人被执行。结果：没有早或迟了的死亡发生了。与follow-upthrough为7-129月的临床的表明和回响心动描记法[中部：39个月，平均数:(53.4±42.8)月]，所有病人作为NYHA班Ⅰ被分类，没有任何changes.Conclusions：创伤的有三个尖头的不足的令人满意的治疗能被外科的治疗获得。更早的外科可以增加有三个尖头的阀门修理的可行性并且阻止恰好室的功能的恶化。

简介：lObjectiveTalar身体破裂是稀罕的并且有差的处理结果。学习是报导关上的talardomefractures.MethodsEight的长期的外科的治疗结果的这的目的关上了talar身体破裂，在我们的水平与小碎片cancellous螺丝钉或Herbert螺丝钉由开的减小和内部固定对待我损伤中心回顾地被分析。脚(antero以后、侧面、倾斜的看法)和脚关节的外科手术前、手术后的拍(antero以后，侧面并且榫眼看法)被获得。病人被跟随在上面放射学地并且机能上地(脚功能索引，FFI)在3以后，星期，6个星期，3个月，6个月然后annually.ResultsThere是五压碎破裂并且三砍破裂(二sagittal砍并且一个花冠砍)，与5年的平均后续。没有早复杂并发症在这些病人被注意。迟了的复杂并发症在四个病人在talar身体的六个病人和osteonecrosis包括了subtalar/ankle关节的osteoarthrosis。在功能的评价以后，在5年以后的吝啬的FFI是104.63个点，更坏的结果在压碎损害和花冠被注意砍破裂。Sagittal砍破裂有对通过手术对待的talar身体破裂随后的复杂并发症是的好功能、放射学的outcome.ConclusionsLate不可避免尽管准确减小和僵硬固定被完成，因此，病人们应当关于不利结果被建议。尽管压碎和花冠砍，破裂有差的结果，sagittal损害在长期的评估上有好预后。