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Objective: To explore the diagnostic and therapeutic approach of integrated traditional Chinese and western medicine (TCM-WM) on infectious multiple organs dysfunction syndrome/multiple system and organ failure (MODS/MSOF) for elevating the successful rate of rescuing the patients. Methods: Diagnosis with western medicine and Syndrome Differentiation of TCM in 225 in-patients of acute infectious disease complicated with MODS/MSOF were conducted, and TCM treatment, based on western medical comprehensive treatment, was given to observe the effect and explore the mechanism of the TCM-WM therapy. Results: Up to the end of 1998, 161 cases of the 225 cases were successfully cured and 64 died, the mortality being 28.4%. Among them, 58 out of 140 cases of MSOF died, the mortality was accounted for 41.4%. In 106 cases conformed to the diagnostic criteria of MSOF proposed by Professor Knaus WA, USA, 52 cases were cured successfully and 54 died, the mortality being 50.94%. Conclusion:TCM-WM treatment could elevate the therapeutic effect in treating MODS, the mechanism might be through improving the hemodynamic and hemorrheologic condition of patients to relieve nail-fold microcirculation disorder; influencing the levels of cytokine and inflammatory mediator, so as to alleviate the systemic inflammatory reaction, it might also abate the inhibited condition of gastro-intestinal motility, alleviate the intestinal flora imbalance, prevent intestinal bacteria and endotoxin malposition, and protect cells from peroxidation.
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慢性疲劳综合征定义及诊断标准的变迁
自Galvanit[1]在1786年首次提及"疲劳"一词以来,医学界对疲劳的研究渐渐展开来.随着疲劳研究的深入及分类研究(如癌性疲劳[2]、帕金森性疲劳[3])的细化,一组以慢性疲劳为主要特征的症候群逐渐被认识.1869年,Beard[4]认为神经的能量可以被耗竭,首次提出"神经衰弱"这一概念,他描述的疾病与今天的慢性疲劳综合征(chronic fatigue syndrome,CFS)非常相似.此后,相继有流行性肌痛性脑脊髓炎、慢性EB病毒综合征、慢性单核细胞增多症等疾病的提出,其描述的症状都和CFS相类似.
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应重视冠心病脂类危险水平和糖尿病与代谢综合征实验诊断标准的临床应用
20世纪80年代以来我国经济迅速发展、人民生活水平不断提高,一部分人的生活方式也有所改变,城市人口中冠心病、糖尿病、超重/肥胖、代谢综合征等所谓"富贵病"的患病率明显增多.以北京近郊农民为例,随着城市化进度的加速,生活水平普遍提高后,健康教育与营养卫生知识相对滞后,使上述代谢病与血脂水平有超过市内居民的趋势.针对这种新形势,在检验医学方面,临床化学的任务自然会不断加重,有关专业人员必须知识更新,进一步做好心血管病及相关代谢病的实验室诊断工作.
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骨质疏松症诊断标准的探讨
本文目的是再次讨论骨质疏松的诊断标准问题.骨质疏松症的诊断以骨密度DXA检测为金标准.1994年世界卫生组织(WHO)推荐的骨质疏松诊断标准为:患者骨密度低于同性别人群峰值骨量均值2.5个标准差以上,或减少30%以上.这个标准的T值是根据年轻白人妇女计算的,但是对于不同地区是不能固守这一标准的.有研究调查我国部分地区骨质疏松症总患病率为32.3%(2.0 SD)和14.9%(2.5 SD),2种骨密度诊断标准计算骨质疏松症患病率差异有显著性,若以2.5 SD为标准很可能造成漏诊.该研究者还发现骨质疏松症的患病率在老年远高于年轻人.而WHO采用的是白人年轻女性的数据库,它是否适用就更值得推敲.另有研究者以骨密度低于-2.0 SD标准,推算杭州市妇女骨质疏松的发病率为29.5%.认为以-2.0 SD为标准可以相对早期发现骨质疏松.还有研究对于高原的藏族人群进行检测,也得出同样结论.有研究者推算我国各个DXA仪器之间的换算公式,发现上述换算公式基本上与日本推出的相同,但是与美国推出的换算公式有差异.这都证明WHO骨密度诊断标准是否适用于黄种人是有疑问的.国内有研究者以BMD<-2.0 SD为诊断标准,结合以骨代谢生化指标,认为能全面合理评价骨转换.还有研究者对目前国内使用骨密度检测方法进行统计分析,发现60岁骨量丢失率有18%左右,70岁阶段达到22%左右.这个患病百分率比较符合中国人的实际情况.按照世界上基本通用的换算方法,1.0 SD约等于10%~12%的骨量丢失百分率,因此建议男性骨质疏松诊断标准为骨量丢失率达到25%或2.0 SD,实际诊断年龄在70岁以上.如果采用2.5 SD,中国人患病诊断时间会推迟到70岁以后,尤其是男性要推迟到90岁以后.骨质疏松症的研究关键是正确合理的诊断,不同种族、不同国家或地区有不同的诊断标准.1994年以前全世界都执行WHO1985年提出的峰值骨量丢失2.0个标准差诊断为骨质疏松症.1994年WHO提出了白人妇女小于-2.5 SD为骨质疏松,但也明确指出该标准仅适用于欧美白人妇女.以Orimo为首的日本骨代谢学会制定了日本人群的骨质疏松诊断标准:骨密度在同性别青年人平均值30%以下为骨质疏松,丢失20%~30%为骨量减少.1999年中国老年学学会骨质疏松委员会诊断学组建议骨质疏松的诊断标准为骨量丢失百分率达到25%,或者说2.0 SD.对于国外也有学者倾向于采用-2.0 SD的标准来评价骨质疏松症.有研究发现不同国家间,和每国内部不同人群和人种的骨密度是明显不同的.非洲和拉丁美洲人种的骨密度高于白种人,而白种人的骨密度则高于黄种人.总结:1、国内外人群间骨密度的差异是公认的,我国人群骨密度是低于制定国际标准的白种人的,有倾向以T值低于-2.0 SD为骨密度诊断标准.但是大规模的流行病学调查比较研究还很少,有必要进一步提供更确切的骨质疏松诊断更改的流行病学依据.2、以2.0 SD为标准可以减少骨质疏松的漏诊,对于流行病学人群调查筛选病例,进行危险因素分析和对骨质疏松高危人群进行干预实验尤为有必要.3、如果加强国内和国际间多单位的联合研究,可以提高标准制定的科学性和权威性.
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新生儿窒息诊断研究进展和新诊断标准的建议
新生儿出生窒息是产科常见急症,是产前或产程中窒息在出生后的表现和继续,故目前国际上对这一连续的病理过程统称围产期窒息(perinatal asphyxia).
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简评多发性硬化诊断的McDonald标准(2010)和缓解期治疗进展
临床上广泛应用的多发性硬化(multiple sclerosis,MS)McDonald诊断标准制定于2001年,分别于2005年和2010年进行了修改.2010年5月国际MS诊断组在爱尔兰都柏林举行会议,讨论了McDonald诊断标准的应用问题,研讨了McDonald诊断标准在欧洲、亚洲、拉丁美洲MS患者及儿童患者中的应用,并提出了新的修改意见,制定了新的诊断标准(表1)[1].
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DECODE研究
糖尿病流行病学:欧洲糖尿病诊断标准的合作分析(Diabetes Epidemiology:Collabora tive Analysis of Diagnostic Criteria in Europe,DECODE),是由欧洲糖尿病流行病学研究组组织的,参加国家有丹麦、芬兰、法国、意大利、荷兰、瑞典、英国、马尔他.是一项关于糖尿病诊断标准的大型循证医学研究.
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自身免疫性胰腺炎研究进展
自身免疫性胰腺炎(autoimmune pancreatitis, AIP)是慢性胰腺炎的一种特殊类型,以阻塞性黄疸、胰腺肿大伴胰管狭窄、淋巴浆细胞浸润及纤维化为主要特点,是一种对激素治疗敏感的胰腺良性病变。新 AIP 国际共识诊断标准(International Consensus Diagnostic Criteria,ICDC)[1]将 AIP 分为两个亚型。其中1型相对常见,病灶以 IgG4阳性细胞浸润为主要特点,累及胰腺本身及外周多个器官,为淋巴浆细胞硬化性胰腺炎(lymphoplasma-cytic clerosing pancreatitis,LPSP);2型是特发导管中心性慢性胰腺炎(idiopathic duct-centric chronic pancreatitis,IDCP),它很少有 IgG4阳性细胞浸润,临床诊断比较困难[2]。如今,随着人们对该病认识程度的加深及相关检测技术的提高,发现 AIP有时很难与胰腺癌、胆管癌等疾病鉴别,以至于部分病例被误诊,进而被给予不必要的手术治疗。因此,本文就AIP的发病机制、临床表现、影像学以及血清学特点作一综述,并重点阐述近年来有关 AIP的诊疗进展。
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DSM-5中关于精神分裂症诊断标准修改的建议
目前对于精神分裂症的概念源自19世纪末埃米尔·克雷丕林对早发性痴呆的阐述及20世纪早、中期尤金·布洛鲁勒和柯特·施耐德的贡献.克雷丕林主要是根据病程(逐步恶化)和结局(痴呆或"精神迟钝")识别出早发性痴呆.尤金·布鲁勒重新命名为"精神分裂症",描述了一系列基本症状,认为它们是精神分裂症的独特症状,并始终存在,但认为其病程和结局是可以变化的.柯特·施耐德认为共情性的交流受损是精神分裂症的基本缺陷,并定义了11个首级症状,认为可用于诊断精神分裂症.
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光接触过敏原与黄褐斑的相关性研究
目的 探讨常见光接触过敏原与黄褐斑之间的相关性.方法 依循英国光学皮肤病研究组推荐的光斑贴试验操作步骤,从国家化妆品光感性皮炎诊断标准(GB17149.6-1997)、国家化妆品接触性皮炎诊断标准(GB17149.2-1997)及国家职业性皮肤病诊断标准(GBZ18-2002)中筛选出20种常见过敏原.对50例黄褐斑患者及30例正常人对照进行光斑贴试验.结果 50例黄褐斑患者中光斑贴试验阳性24例占48.0%,30例正常人对照中光斑贴试验阳性7例占23.33%,黄褐斑患者光斑贴阳性率显著高于对照组(P<0.05).结论 黄褐斑患者光斑贴试验阳性率高于正常人.
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左前分支传导阻滞心电图诊断标准的再探讨
左前分支传导阻滞(LAFB)是一种较常见的心电图异常,其诊断标准早已引起人们的关注,但目前意见尚未统一.该文对武汉市中心医院388例经心电图与心电向量图确诊的LAFB资料进行整理分析,探讨LAFB的心电图诊断标准.
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先天性大网膜囊肿的诊断(附5例分析)
先天性大网膜囊肿为一罕见病,我院自1957年至1983年共收治5例.其中,巨大型4例,曾误诊为腹水、结核性腹膜炎、巨大卵巢囊肿等.另1例因有急腹症表现,误认为急性阑尾炎穿孔.经过进一步检查均明确诊断并经手术治愈,病理检查证实为大网膜囊状淋巴管瘤.现就诊断问题,结合临床资料报告于下:
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川崎病诊断标准的变迁
川崎病( Kawasaki disease,KD)是一种主要发生在5岁以下儿童的急性自限性血管炎综合征.它可引起全身多系统受累,尤以冠状动脉为甚,已取代风湿热成为儿童后天性心脏病常见病因[1].KD的病因不明,缺乏特异性诊断方法,诊断主要依靠临床表现,因而正确掌握临床诊断标准对KD的早期诊断有重要意义.现就不同KD诊断标准做一总结及介绍.
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Objective: The objective of this study was to investigate the diagnostic methods of high altitude de-acclimatization syndrome and to formulate diagnostic criteria.
Methods: This study was conducted using epidemiological surveys and a multi-center randomized controlled clinical trial. A total of 3,011 subjects were studied, and the following indices were collected after their return to low altitude areas from the plateau: general health status, blood, urine and stool samples, myocardial enzyme levels, liver and kidney function, nerve function, sex hormone levels, microalbuminuria, electrocardiogram (ECG), echocardiography, pulmonary function, and hemorheological markers. These data were compared to those of randomized healthy subjects in the same age range who lived at the same altitude to determine the characteristics of high altitude de-acclimatization syndrome. Based on these characteristics, diagnostic criteria for high altitude de-acclimatization syndrome were formulated.
Results: This study demonstrated that the incidence of high altitude de-acclimatization syndrome was 84.36%. Sixty percent of the cases were mild, 30% were medium, and 10% were severe. The incidence was higher among those who returned to a place of lower altitude, resided at a high altitude for a longer period of time, or engaged in heavy labor while at high altitude. Patients with high altitude de-acclimatization syndrome manifested hematological abnormalities and abnormal ventricular function, notably a right ventricular diastolic function, which recovered to baseline function after one to five years. Exposure to long-term hypoxia often caused obvious changes in cardiac morphology, i.e., left and right ventricular hypertrophy, particularly within the right ventricle. In addition, patients with high altitude de-acclimatization syndrome often presented with low blood pressure, low pulse pressure, and microalbuminuria. A few patients presented with occult blood in their feces. The diagnosis of high altitude de-acclimatization syndrome can be made if a patient who recently returns to the plain from the plateau complains of dizziness, weakness, sleepiness, chest tightness, edema, memory loss, and other symptoms and signs that do not alleviate under short-term rehabilitation or symptomatic treatment, and if organic diseases of the heart, lung, kidney, and other organs have been excluded.
Conclusion: The diagnosis of high altitude de-acclimatization syndrome should be made after a comprehensive analysis of the patient's clinical symptoms and signs.