简介：Objective:Toinvestigatetheapproachofemergencymanagementforseverepelvicfractureassociatedwithinjuriesofadjacentvisceraandevaluatethetherapeuticeffect.Methods:Thedataof79patientswithseverepelvicfractureassociatedwithinjuriesofadjacentviscerawereretrospectivelystudied,andthestudycoveredaperiodof14years.Results:Toceasemassivebleedingduetopelvicfracture,ligationofinternaliliacarterieswasperformedon33cases,andangioembolizationon8.Of42patientswithcysticor/andurethralinjury,35underwentcystostomyanddelayedreconstruction,and7receivedaprimaryrealignment.Allof17patientswithinjuryofretroperitonealrectumunderwentdivertingcolostomyoftheproximalendofsigmoidwithpresacraldrainage,but4receivedprimaryrepairwithoutcolostomy.In22patientswithintraperitonealcolorectalinjury,19weremanagedwithprimaryrepairoranastomosiswhile3receivedacolostomy.Theoverallmortalityratewas8.86%(7/79);themaincauseswerehemorrhagicshockandassociatedinjury.Thecomplicationsincludedurethro-rectalfistulain4cases,thrombosisofrightcommoniliacarteryin1,ARDSfollowingchesttraumain1,andparaplegiain1.Exceptthepatientwithparaplegia,allofthemwerecured.Conclusions:Promptdiagnosisandpropertreatmentarethekeytosuccess.Devascularizationofinternaliliacarterieswithexternalfixationcageofthepelvis,cystostomyandproximalsigmoidostomyareeffectiveproceduresinemergencytreatmentofthecriticalpatients.

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简介：ObjectivesPercutaneousballoonmitralvalvuloplasty(PBMV)isonewaytoimprovetherheumaticmitralstenosis.Howdoestheprocedureworkingravidaandfetusisnotveryclear.WeanalyzedtheeffectsandsafetyofPBMVoperationonpregnantpatientswithsevererheumaticmitralstenosis.MethodsEightpregnantpatientssufferingfromseveremitralstenosisunderwentfacilitatedPBMVoperationwithInoueballoon,andwerefollowedupfor(2.0±1.1)years.Contentsincludedoutcomeofpregnancy,infantgrowth,hemodynamics,echocardiography,cardiacfunction,mitralvalvesreplacementorrepeatvalvuloplasty.ResultsMitralvalvearea(MVA)before,oneweekandoneyearafterfacilitatedPBMVwere(0.84±0.21)cm2,(1.69±0.23)cm2and(1.51±0.24)cm2respectively.Thetransmitralpressuregradientdroppedfrom(22.1±4.7)mmHgto(9.9±3.1)mmHg(P<0.001)(1mmHg=0.133kPa).AfterfacilitatedPBMV,allpatientsshowedremarkableimmediatesymptomaticandhemodynamicimprovementwithoutseveremitralregurgitation.AllofthesepatientscouldmaintainNewYorkheartassociation(NYHA)ⅠorⅡfor(2.0±1.1)yearsaftertheoperation.TwopatientsdemandedinducedabortionconcerningabouttheteratogeniceffectofX-rayonfetus.Alltheothersixpatientscontinuedtheirgestationandhadfull-termcesareansectionwithoutcomplications.Theirnewbornsdevelopedhealthyandnormallytillnow.ConclusionsFacilitatedPBMVisafeasible,safeandeffectivedeviceforselectedpregnantpatientswithmitralstenosis.Theoperationiswelltoleratedbythefetus.

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简介：AlthoughanassociationbetweenthegroupAbetahemolyticstreptococcusandrheumaticfeverhasbeenrecognizedformorethanhalfacentury,manyimportantissuesaboutthisrelationshipremainincompletelydefined.Theinitiatingpharyngealthroatinfectionand

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简介：目的：才巳握灸法治疗围绝经期综合征的研究概况，总结灸法治疗围绝经期综合征的规律。方法：通过计算机检索，搜集1996年以来灸法治疗围绝经期综合征的临床、实验研究文献，并进行整理、分析。结果与结论：获得符合纳入标准的文献29篇。灸法以隔盐灸和温针灸使用较多；最常用的经脉是任脉、督脉、脾经、肾经；穴位以神阙、关元、命门、隐白使用频率较高。

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简介：AbstractPreterm labor (before 37 weeks’ gestation) is the leading cause of neonatal mortality and morbidity, which can be divided into iatrogenic preterm labor, infectious preterm labor, and spontaneous preterm labor (sPTL). Up to now, there continue to be great difficulties in prediction and prevention of sPTL, owing to multiple risk factors, pathogenesis, and pathologic processes contributing to the event, which have not been fully clarified. Pregnancy maintenance and parturition is a complicated process with continuous maternal-fetal dialogue, in which both maternal and fetal factors participate and affect the outcome of pregnancy, including sPTL. Besides, external factors can also participate in sPTL, individually or through the interaction with internal factors. In this article, we summarize recent studies regarding sPTL from our and other groups, and discuss the risk factors and pathogenesis of preterm birth from both external and internal (maternal and fetal) aspects, so as to provide theoretical evidences for the diagnosis, prevention, and treatment of sPTL in the future.

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简介：Thenasogastrictube(NGT)hasbecomeafrequentlyuseddevicetoalleviategastrointestinalsymptoms.Nasogastrictubesyndrome(NTS)isanuncommonbutpotentiallylife-threateningcomplicationofanindwellingNGT.NTSischaracterizedbyacuteupperairwayobstructionduetobilateralvocalcordparalysis.Wereportacaseofa76-year-oldmanwithNTS,inducedbyanindwellinglongintestinaltube.Hewasadmittedtoourhospitalfortreatmentofsigmoidcoloncancer.Heunderwentsigmoidectomytoreleaseabowelobstruction,andhadalongintestinaltubeinsertedtodecompresstheintestinaltract.Hepresentedacutedyspneafollowingprolongedintestinalintubation,andbronchoscopyshowedbilateralvocalcordparalysis.TheNGTwasremovedimmediately,andtracheotomywasperformed.Thepatientwasfinallydischargedinafullyrecoveredstate.NTSbeconsideredinpatientscomplainingofacuteupperairwayobstruction,notonlywithaNGTinsertedbutalsowithalongintestinaltube.

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简介：Cowdensyndrome(CS),anautosomaldominantdisorder,isoneofaspectrumofclinicaldisordersthathavebeenlinkedtogermlinemutationsinthephosphataseandtensinhomolog(PTEN)gene.Although70-80%ofpatientswithCShaveanidentifiablegermlinePTENmutation,theclinicaldiagnosispresentsmanychallengesbecauseofthephenotypicandgenotypicvariations.Inthepresentstudy,wesequencedtheexonsandthepromoterofPTENgene,mutationsandvariationsinthepromoterandexonswereidentified,andaPTENproteinexpressionnegativeregionwasdeterminedbyimmunohistochemistry(IHC).Inconclusion,anovelpromotermutationwefoundinPTENgenemayturnoffPTENproteinexpressionoccasionally,leadingtothedisorderofPTENanduntypicalCSmanifestations.

简介：Themyelodysplastic/myeloproliferativeneoplasms(MDS/MPNs)areauniquegroupofhematologicmalignanciescharacterizedbyconcomitantmyelodysplasticandmyeloproliferativefeatures.Accordingtothe2008WHOclassification,thecategoryincludesatypicalchronicmyeloidleukemia(aCML),chronicmyelomonocyticleukemia(CMML),juvenilemyelomonocyticleukemia(JMML),MDS/MPN-unclassifiable(MDS/MPN-U),andtheprovisionalentityrefractoryanemiawithringsideroblastsandthrombocytosis(RARS-T).Althoughdiagnosiscurrentlyremainsbasedonclinicopathologicfeatures,theincorporationofnextgenerationplatformshasallowedfortherecentmolecularcharacterizationofthesediseaseswhichhasrevealeduniqueandcomplexmutationalprofilesthatsupporttheirdistinctbiologyandisanticipatedtosoonplayanintegralroleindiagnosis,prognostication,andtreatment.Futuregoalsofresearchshouldincludethedevelopmentofdisease-modifyingtherapies,andfurthergeneticunderstandingofthecategorywilllikelyformthefoundationoftheseefforts.

简介：Children(5-12years)andadolescents(13-19years)withDownsyndrome(DS)possessasetofhealth,anatomical,physiological,cognitive,andpsycho-socialattributespredisposingthemtolimitationsontheirphysicalfitnessandphysicalactivity(PA)capacities.Thepaucityofstudiesandtheirconflictingfindingspreventaclearunderstandingand/orsubstantiationoftheselimitations.Thepurposeofthisarticlewastoreviewthemeasurement,determinantsandpromotionofphysicalfitnessandPAforyouth(i.e.,childrenandadolescents)withDS.TheexistingbodyofresearchindicatesthatyouthwithDS:1)havelowcardiovascularandmuscularfitness/exercisecapacity;2)demonstrateagreaterprevalenceofoverweightandobesity;3)alargeproportiondonotmeettherecommendedamountofdailyaerobicactivity;and4)theirPAlikelydeclinesthroughchildhoodandintoadolescence.Futureresearchshouldfocuson:1)strengthtestingandtrainingprotocols;2)methodologiestodeterminePAlevels;and3)practicalinterventionstoincreasePA.

简介：PatientswithAcuteCoronarySyndrome(ACS)areaclinicalcontinuum-withpatientspresentingwithunstableanginaononeend,withpatientswithSTelevationmyocardialinfarction(STEMI)attheotherendofthespectrum.Inbetweenarethosewithnon-ST

简介：AbstractFat embolism syndrome (FES) is a serious life-threatening manifestation of the fat embolism phenomenon characterized by Bergman’s triad of dyspnea, petechiae and mental confusion. While fat embolization into systemic circulation is common, FES occurs in a meagre 0.05%-3% of patients having isolated long bone fractures. Though visual symptoms are commonly attributed to fat embolism retinopathy and is a later occurrence, it may not always be the case. Cortical blindness has been seldom reported in association with FES, and less so as a presenting complaint. Furthermore, no previous literature has described the same in context of an isolated tibia fracture. We report a 20-year-old gentleman with an isolated right tibia shaft fracture who developed sudden onset diminution of vision in both eyes less than 24 h following trauma with no other complaints. Lack of any remarkable ophthalmoscopic findings or other symptoms left us with a diagnostic conundrum. He later went on to develop altered mentation, hypoxia and generalized tonic-clonic seizures with subsequent MRI revealing multiple cerebral fat emboli also involving both occipital lobes. Supportive measures were instituted and his general condition as well as vision gradually improved following which he underwent plate fixation of the fracture under spinal anaesthesia. The perioperative period was uneventful and he was discharged following staple removal. At one month of follow-up, the patient had no residual visual field defects or neurological deficits. Though FES is rare among isolated tibia fractures, this clinical catastrophe may strike in any unsuspected setting thereby warranting a high index of suspicion to ensure early diagnosis and improved patient outcomes.

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简介：全身的煽动性的反应症候群(先生)和得分系统的概念被骨头的杂志在1992定义。先生在四(发烧或降低体温，tachypnea，心悸亢进，和白细胞增多)被描述为二的出现或更多的临床的标准。Anearly在病人的全身的发炎的诊断和评价对治疗有用选举。这篇论文考察获得系统的先生的申请，它广泛地与严重损害和批评外科的疾病为批评照顾病人的大组被验证了。最近的研究在批评照顾病人作为不利结果的一个重要预兆的参数记录了先生分数。而且，一些研究也给我们上的一个建议岩山引出超载全身的反应。