医学文献中英文对照

diabetes neuropathies: update on definitions,diagnostic criteria,estimation of severity,and treatments糖尿病神经病变：更新的定义，诊断标准，估计的严重程度，与治疗Tesfaye S,Boulton A J.Dyck P J,et al.内容概要，博尔顿一·戴克磷，等。

AbstractPreceding the joint meeting of the 19th annual Diabetic Neuropathy Study Group of the European Association for the Study of Diabetes (NEURODIAB) and the 8th International Symposium on Diabetic Neuropathy in Toronto, Canada, 13–18 October 2009, expert panels were convened to provide updates on classification, definitions, diagnostic criteria, and treatments of diabetic peripheral neuropathies (DPNs), autonomic neuropathy, painful DPNs, and structural alterations in DPNs.前联席会议第十九年糖尿病神经病变研究组欧洲糖尿病研究协会（neurodiab）和第八届国际糖尿病神经病变在多伦多，加拿大，–13 18 2009年十月，专家小组召开了提供更新的定义，分类，诊断标准，治疗糖尿病周围神经病变（标准草案），自主神经病变，痛苦的标准草案，和结构改变的标准草案。

A reading course IChapter1TextAprematurely 过早地diagnosis 诊断sub health 亚健康immune system 免疫系统respectively 分别地prevalent 普遍地spearhead 为…带头，为…先锋sustained 可持续的intellectual 知识分子transitional 过度的chronic 慢性的infectious传染的massage 按摩，推拿blood circulation 血液循环textBdefect 缺点，缺陷abnormality 畸形，异常cardiac 心脏的，心脏病的cardiac arrest 心搏停止screening test 筛选试验，屏蔽试验coroner 验尸官autopsy 验尸，尸体解剖ventricular 心室的，脑室的fibrillation 纤维性颤动ventricular fibrillation 心室纤维性颤动hypertrophic 肥厚的cardiomyopathy 心肌症hypertrophic cardiomyopathy 肥大型心肌病myocardium 心肌，心肌层coronary 冠状的artery 动脉compress 压缩，压紧syndrome 综合征inherit 继承，遗传chaotic 混乱的，无秩序的erratic 不稳定的，古怪的commotia cordis 心脏震动red flag 危险信号on the outlook 寻找，警惕着syncope 晕厥exertion 努力，用力seizures 癫痫，痉挛screening 筛选asthma 哮喘，气喘implantable 可移植的，可植入的cardioverter 心律转变器，复律器defibrillator 去纤颤器，电震发生器pacemaker 心律调整器，起搏器arrhythmia 心律不齐，心律失常electrocardiogram 心电图V ocabularysub health亚健康massage 按摩，推拿diagnosis 诊断suffernegativeaccelerateinfectioncirculationhealthcaredefectinheritcardiactriggerabnormalitysurgeryscreeningsignaldisordersyndromeprematurechapter2TextAdrug resistance耐药性Aids 艾滋病tuberculosis 肺结核malaria 疟疾scourge 灾祸，苦难的根源penicillin 盘尼西林antibiotic 抗菌素incentive 动机，刺激institution 公共机构，习俗leadership 领导能力，领导surveillance 监督，监视priority 优先，优先权，优先考虑的事hygience 卫生，卫生学lancet 小刀，柳叶刀haemorrhage 大出血tranexamic acid 氨甲环酸malnutrition 营养不良soaring 高耸的，猛增的depletion 消耗，放血stock 库存，血统textBallergy 过敏症，反感allergic 对…过敏/极讨厌的side effect 副作用sulfa 磺胺的，磺胺药剂的immune 免疫的offending 不愉快的medication 药物，药物治疗adverse 不利的，相反的itchy 发痒的，渴望的rash 皮疹hives 荨麻疹，假膜性喉头炎exposure 暴露，揭露anaphylaxis 过敏性，过敏性反应prescription 药方，指示symptom 征兆，症状wheeze 喘息serum 血清，浆液injection 注射，注射剂foreign 外国的，异质的medical facilities 医疗设施latex 乳胶，乳液application 应用，敷用amoxicillin 阿莫西林，氢氨苄青霉素ampicillin 氨苄西林，氨苄青霉素augmentin 安灭菌，奥格门汀carbenicillin 羧苄青霉素dicloxacillin 双氯西林，双氯青霉素cephalosporin 头孢菌素cefaclor 头孢克洛，氯氨苄青霉素cefadroxil 头孢氢氨苄cefepime 头孢吡肟cefprozil 头孢丙烯cephradine 头孢拉啶，先锋霉素cephalexin 头孢氨苄sulfasalazine 柳氮磺胺吡啶Bactrim 复方新诺明sulfate 硫酸盐insulin 胰岛素manifest 证明，表明iodine 碘，碘酒bloodstream 血液，血液的流动vessel 脉管，血管nausea 恶心，晕船，极端的憎恶vomit 呕吐，吐出dizziness 头晕，头昏眼花V ocabularysymptioninsulinsurveillancedizzinessimmuneallergicresistancemalariasulfaantibioticitchyforeignvomitbloodstreaminjectionhygieneprescriptionasthmahealthcareanaphylaxicchapter3textAhospice 临终关怀，临终关怀医院catch on 变得流行terminally 不治地，晚期地allusion 暗示，提及influential 有影响的decent 体面的，像样的prolong 延长，拖延existence 生存，生活intervention 干预，介入hostile 敌对的，怀敌意的dedicate 致力，献身explicit 明确的，清楚的intervene 干涉，插入palliative 缓和剂，暂时姑息outstrip 超过，胜过expectancy 期望，期待predictable 可预言的geriatrics 老年病学，老年病人succumb屈服，被压垮dementia 痴呆decay 衰败，衰退textBswallow 吞下，咽下stressful 紧张的，有压力的appreciate 欣赏，感激pursue 继续，从事alternative 选择，替换物available 可得到的，可利用的caregiver 照料者，护理者mission 使命，任务knowledgeable 知识渊博的，有见识的approach 接近expertise 专门知识，专家意见incredibly难以置信地distress 使悲痛，使贫困anticipate 预期，期望compassionate 慈悲的，富于同情心的participation 参与，分享excel 优于，胜过，擅长V ocabularyimmortalterminaldementiahospicedecentanxiousexpectancycaregiverpositiveapproachguidancepursuemissioninterventionemotionalgrievefuneralphysicaltubechapter4textAface lift 面部拉皮手术deposit 沉积物cosmetic 美容的，化妆用的endoscopic 内窥镜的，用内窥镜检查的incision 切口，切割contour 轮廓，周线bandage 绷带wrinkle 皱纹crease 折痕，皱纹swelling 肿胀，增大restrict 限制，约束minimal 最小限度的，极小的invasive 侵略性的，攻击性的invasive surgery 侵入性外科手术anesthesia 麻醉sedation 镇静的，镇静剂visibe 明显的，看得见的temple 太阳穴textBlaser 激光remedy 补救，治疗hyperpigmentation 色素沉着过度discolor 使变色，使褪色discoloration 变色dermabrasion 磨去皮肤疤痕之手术，磨皮手术acne 痤疮，粉刺ablative 烧蚀的vaporize 汽化，使…蒸发downtime 停工期collagen 胶原，胶原蛋白pulse 脉冲，脉动rejuvenation 返老还童，恢复活动sagging 松垂的，下沉的vascular 血管的，淋巴管的lesion 病变，损伤antiviral 抗病毒物质antibacterial 抗菌剂，抗菌药complication 并发症intravenous 静脉内的penetrate 渗透，穿透ointment 药膏，软膏petroleum jelly 凡士林，矿油temporary 暂时的，短暂的dormant 休眠的，静止的herpes 疱疹V ocabularyendoscopicmedicationcomplicationantiviralwrinkleanesthesiavascularswellingexposurehyperpigmentationscarinvasiveintravenouspeeldermabrasiondormantincisiondepositlesioncollagenchapter5textAgenetic 遗传的，基因的loom 可怕地出现，令人惊恐的隐现invade 侵入，侵略staple 主要的，常用的biotechnologist 生物工艺学家estimate 估计ingredient 材料，原料reveal 显示，透漏domesticated 家养的toxicity 毒性，毒性作用，毒性反应allergenicity 变应原性，过敏反应antibiotic 抗生的，抗菌的extinction 灭绝hazardous 有危险的，冒险的tangle 纠纷，混乱状态anomaly 异常，反常事物jurisdiction 管辖权haphazard 随便的，无计划的contaminate 污染，弄脏legislation 立法negligence 疏忽，忽视biotechnology 生物技术，生物工艺学textBaccess 使用权，接近或享用的机会temporarily 临时地affordable 负担得起的shortage 缺乏utilize 使用，利用household 家庭的，日常的intellectually 智力上，理智地resource 资源effective 有效的fertilizer 化肥productive 能生产的，多生产的deterioration 恶化undertake 承担，从事resistance 抵抗，反抗cultivate 培养，耕作cubic 立方体的，立方irrigation 灌溉salinisation 盐渍化consequently 因此，结果enhance 提高，加强invest 投资cyclone 旋风，气旋，飓风flee 逃走，消失，消失debris 碎片，残骸prioritise 给予…优先权，按优先顺序处理quarantine 检疫tariff 关税表，收费表subsidise 资助给…补助金deprive使丧失，剥夺V ocabularyorganismtanglecondimentfertilizershortagecontaminateanomalydebrisbacteriaregulateaccesstariffingredientprioritiseextinctiondeteriorationhaphazardirrigationpandemicutilizationchapter6textAwillpower 意志力，毅力illicit 违法的，非法的staggering令人惊讶的deleterious 有毒的，有害的disintegration 分解，瓦解chronic 慢性的，长期的relapse 旧病复发，故态复萌counteract 抵消，中和disruptive 破坏的，分裂性的psychiatric 精神病学的，精神病治疗的diabetes 糖尿病，多尿症reinstate 使恢复，使复原textBgay teen 同性恋青少年acute 严重的，急性的lesbian 女同性恋bisexual 双性恋的transgender 跨性别者，变性人heterosexual 异性的，异性恋的subgroup 子群straight teen 异性恋青少年，非同性恋青少年homophobia 对同性恋的恐惧，对同性恋的憎恶victimization 欺骗，侵害disparity 不同，不一致marginalize 排斥，使处于社会边缘nongovernmental 非政府的harassment 骚扰，烦恼marijuana 大麻，大麻毒品cocaine 可卡因methamphetamine 甲基苯丙胺，冰毒assault 攻击，袭击pseudonym 笔名，假名stigmatization 污辱adolescent 青少年prognosis 预后，预知grim 冷酷的，糟糕的homophobic害怕同性恋的imperative 必要的，紧急的confidential 表示信任的V ocabularyabsueaddictionillicitchronicdeleteriousstaggeringrelapsedisruptivedisintegrationhomophobiabisexualacutedisparityprognosispseudonymassaultimperativeasthmavictimizationchapter7textAeligibility 合格，资格dialysis 透析transplant 移植renal 肾的premium保费eligible 合格的，符合条件的coverage 承保范围labor 分娩，生产delivery 分娩textBbone mass 骨质osteoporosis 骨质疏松cardiovascular 心血管的cholesterol 胆固醇lipid 脂类triglyceride 三酸甘油酯colorectal 结肠直肠的fecal 粪便的，排泄物的occult 隐性的sigmoidoscopy 乙状结肠镜检查colonoscopy 结肠镜检查barium 钡enema 灌肠，灌肠剂dyslipidemia 血脂异常obesity 肥胖gestational 妊娠期的glaucoma 青光眼hepatitis肝炎pelvic 骨盆的cervical 子宫颈的vaginal 阴道的referral 转介，转诊pneumococcal 肺炎球菌的prostate 前列腺rectal 直肠的mammogram 乳房X线照片cessation 停止，休止chapter8textAspinal 脊髓的，脊柱的diverse 不同的，多种多样的gratifying 悦人的，令人满足的assume 承担rehabilitation 康复，修复physical rehabilitation 物理疗法，物理治疗accredited 公认的，经过认证的supervised fieldwork 实习pinpoint 精确地找到，查明per diem 每天，按日textBneurological 神经病学的substantiate 证实aphasia 失语症trigger 引发，引起innately 天赋的，与生俱来的attune to 习惯于bradykinesia 云动徐缓，动作迟缓initiate 开始，发起cadence 节奏，韵律organized 安排有秩序的，做事有条理的cofounder共同创始人synchronize 使同步，使合拍gait 步法，步态strike 大步，步幅moto control 运动控制improvisation 即兴创作，即席演奏cymbal 铙xylophone 木琴therapeutic 治疗的，有益于健康的overlap 重叠，重复retrieval 恢复，取回vouch 保证，证明devastating 毁灭性的neurotransmitter 神经传导物质norepinephrine 去甲肾上腺素，降肾上腺素melatonin 褪黑激素stress hormone 应激激素cortisol 皮质醇diazepam 安定advanced stage 晚期amygdala 杏仁核hippocampus 海马degenerative 退化的，变质的cortex 皮质hub 中心。

Currentusageofthree-dimensionalcomputedtomographyan giographyforthediagnosisandtreatmentofrupturedcereb ralaneurysmsKenichiAmagasakiMD,NobuyasuTakeuchiMD,TakashiSatoMD,Toshiyu kiKakizawaMD,TsuneoShimizuMDKantoNeurosurgicalHospital,Kuma gaya,Saitama,JapanSummaryOurpreviousstudysuggestedthat3D-CTangiographycou ldreplacedigitalsubtraction(DS)angiographyinmostcasesofrupt uredcerebralaneurysms,especiallyintheanteriorcirculation.Th isstudyreviewedourfurtherexperience.Onehundredandfiftypatie ntswithrupturedcerebralaneurysmsweretreatedbetweenNovember1 998andMarch20XX.Only3D-CTangiographywasusedforthepreoperati vework-upstudyinpatientswithanteriorcirculationaneurysms,un lesstheattendingneurosurgeonsagreedthatDSangiographywasrequ ired.Both3D-CTangiographyandDSangiographywereperformedinpati entswithposteriorcirculationaneurysms,exceptforrecentcasest hatwerepossiblytreatedwith3D-CTangiographyalone.Onehundreds ixteen(84%)of138patientswithrupturedanteriorcirculationaneu rysmsunderwentsurgicaltreatment,butadditionalDSangiographyw asrequiredin22cases(16%).Onlytworecentpatientsweretreatedsu rgicallywith3D-CTangiographyalonein12patientswithposteriorc irculationaneurysms.Mostpatientswithrupturedanteriorcircula tionaneurysmscouldbetreatedsuccessfullyafter3D-CTangiograph yalone.However,additionalDSangiographyisstillnecessaryinaty picalcases.3D-CTangiographymaybelimitedtocomplementaryusein patientswithrupturedposteriorcirculationaneurysms.a20XXElsevierLtd.Allrightsreserved.Keywords:3D-CTangiography,cerebralaneurysm,subarachnoidhaem orrhage,surgeryINTRODUCTIONRecently,three-dimensionalcomputedtomography(3D-CT)angiogra phyhasbecomeoneofthemajortoolsfortheidentificationofcerebra laneurysmsbecauseitisfaster,lessinvasive,andmoreconvenientt hancerebralangiography.1–7Patientswithrupturedaneurysmscouldbetreatedunderdiagnosesb asedononly3D-CTangiography.5;63D-CTangiographyhassomelimita tionsforthepreoperativework-upforrupturedcerebralaneurysms,soadditionaldigitalsubtraction(DS)angiographyisstillnecessa ry,especiallyforaneurysmsintheposteriorcirculation.8Ourprev iousstudysuggestedthat3D-CTangiographycouldreplaceDSangiogr aphyinmostpatientswithrupturedcerebralaneurysmsintheanterio rcirculation.1Thisstudyreviewedourexperienceoftreatingruptu redcerebralaneurysmsintheanteriorandposteriorcirculationsba sedon3D-CTangiographyin150consecutivepatientstoassessthecur rentusageof3D-CTangiography.METHODSANDMATERIALPatientpopulationWetreated150patients,60menand90womenagedfrom23to80years(mea n57.5years),withrupturedcerebralaneurysmidentifiedby3D-CTan giographybetweenNovember1998andMarch20XX. Managementofcases Thepresenceofnontraumaticsubarachnoidhaemorrhage(SAH)wascon firmedbyCTorlumbarpuncturefindingsofxanthochromiccerebrospi nalfluid.3D-CTangiographywasperformedroutinelyinallpatients .DSangiographywasperformedinpatientswithanteriorcirculation aneurysmsonlyifadditionalinformationwasconsiderednecessaryf ollowingaconsensusinterpretationoftheinitialCTand3D-CTangio graphybyfourneurosurgeons.Patientswithrupturedaneurysmsinth eposteriorcirculationunderwentboth3D-CTangiographyandDSangi ographyexceptfortworecentpatientswithtypicalvertebralartery posteriorinferiorcerebellarartery(VA-PICA)aneurysm. Typicalsaccularaneurysmsweretreatedbyclippingsurgery. Fusiformanddissectinganeurysmsweretreatedbyproximalocclusio nbyeithersurgeryorendovasculartreatmentwithorwithoutbypasss urgery.Regrowthofbleedinganeurysmswastreatedbyeithersurgery orendovasculartreatment.Postoperatively,allpatientsweremana gedwithaggressivepreventionandtreatmentofvasospasmincluding intra-arterialinfusionofpapaverineortransluminalangioplasty .3D-CTangiographyacquisitionandpostprocessingCTangiographywa sperformedwithaspiralCTscanner(CT-W3000AD;Hitachi,Ibaraki,J apan).Acquisitionusedastandardtechniquestartingattheforamen magnum,withinjectionof130mlofnonioniccontrastmaterial(Omnip aque;DaiichiPharmaceutical,Tokyo,Japan).Thesourceimagesofea chscanweretransferredtoanoff-linecomputerworkstation(VIPstation;TeijinSystemTechnology,Japan).Bothvolume-renderedimage sandmaximumintensityprojectionimagesofthecerebralarterieswe reconstructed.Theanteriorcirculationandposteriorcirculation wereevaluatedseparatelyonthevolume-renderedimages,afteragen eralsuperiorviewwasobtained.Theanteriorcirculationwasevalua tedbyfirstobservingtheanteriorcommunicatingartery(ACoA)byro tatingtheview,andtheneachsideofthecarotidsystembyrotatingth eimagewitheditingoutofthecontralateralcarotidartery.Thepost eriorcirculationwasalsoevaluatedbyrotatingtheimagebutwithou teditingoutofanyvessel.Onceapossiblerupturesitewasfound,the viewwaszoomedandcloselyrotatedwiththeothervesselseditedout. Theaneurysmsizewasmeasuredon3D-CTangiographyasthelargerofth elengthofthedomeorthewidthoftheneck.Manipulationwasperforme dbythescannertechnician,withaneurosurgeontoprovideeditingas sistance.DSangiographyacquisitionStandardselectivethree-orfour-vesselDSangiogramswithfrontal ,lateral,andobliqueprojectionswereobtained.The3D-CTangiogra mwasalwaysavailableasaguideforpossibleadditionalDSangiograp hyprojections.AneurysmsizewasmeasuredwithDSangiographywhent hequalityof3D-CTangiographywasinadequate.Allpatientsexcepte lderlypatientsorpatientsinsevereconditionunderwentDSangiogr aphypostoperatively.Gradingofpatients Theclinicalconditionsofthepatientsatadmissionwereclassified accordingtotheHuntandKosnikgrade.9Clinicaloutcomewasdetermi nedat3monthsaccordingtotheGlasgowOutcomeScale.10RESULTSTheaneurysmlocationsandsizesareshowninTable1.Onehundredsixt een(84%)of138casesofaneurysmsintheanteriorcirculationweretr eatedafteronly3D-CTangiography,and22cases(16%)requiredaddit ionalDSangiography.Tenof12casesofaneurysmsintheposteriorcir culationrequiredboth3D-CTangiographyandDSangiography,buttwo recentcasesoftypicalVA-PICAaneurysmwereclippedafteronly3D-C Tangiography(Fig.1).Thefirst10ofthe22casesintheanteriorcirc ulation,whichrequiredadditionalDSangiographyweredescribedpr eviously,1sothemostrecent12patientsarelistedinTable2.Theserecentcasesincludedsomeatypicalaneurysms.Cases6and8hadafusif ormaneurysmoftheinternalcarotidartery(ICA).AdditionalDSangi ographywasperformedtoobtainhaemodynamicinformation.ICAtrapp ingwithsuperficialtemporalartery-middlecerebralarteryanasto mosiswasperformedinCase6becausetheatheroscleroticarteriesfa iledtodemonstratetheballoonocclusiontest(Fig.2).ICAocclusio nbyendovasculartreatmentwasperformedinCase8becausethepatien tcouldtoleratetheballoonocclusiontest.Cases4,9,and10suffere dregrowthofbleedinganeurysmsafterclippingsurgery.Clipartifa ctspreventedevaluationoftherupturedsiteaswellasidentificati onofdenovoaneurysmsinthesecases(Fig.3).Surgicalclippingwasp erformedinCases4and10andendovasculartreatmentinCase9.Case11 hadanACoAaneurysmassociatedwithanarteriovenousmalformation( AVM)(Fig.4).DSangiographywasperformedtoevaluatetheAVM.Case1 2hadalargeICA-posteriorcommunicatingartery(PCoA)aneurysm,an dadditionalDSangiographywasperformedbecausethePCoAcouldnotb edetectedby3D-CTangiography(Fig.5).Cases1,2,3,5,and7present edwithsmallaneurysms,andDSangiographywasperformedtoexcludeo therlesionsaswellastoobtaininformationabouttheproximalICAfo rpatientswithsupraclinoidtypeaneurysms.Table1Distributionandsizeofcerebralaneurysmsin150consecutiv epatientsSiteNo.ofpatientsAnteriorcirculation 138ICA(supraclinoid) 3ICAbifurcation 1ICA-OphA 3ICA-PCoA 39(1)ICAfusiform 2ACoA 50DistalACA 4MCA 36(1) Posteriorcirculation 12PCA 1BAtip 3BA-SCA 1BAtrunk 1(1)VA-PICA 3VAdissecting 3(1)Size(mm)<5 42P5to<12 99P12 9 Numberinparenthesesindicatespatientswhounderwentendovascula rtreatment.OphA,ophthalmicartery;ACA,anteriorcerebralartery;MCA,middle cerebralartery;PCA,posteriorcerebralartery;BA,basilarartery ;SCA,superiorcerebellarartery.Table2Twelvepatientswithrupturedanteriorcirculationaneurysm swhounderwentadditionalDSangiographyCaseNo. Location Size(mm)1 lt.ICA-PCoA 3.12 ACoA 2.23 lt.ICAsupraclinoid 1.64 lt.ICA-PCoA 7.85 lt.ICAsupraclinoid 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 18.2 Thesurgicalfindingscorrelatedwellwiththe3D-CTangiographyorD Sangiography.Table3showstheconditiononadmissionandoutcomeat 3monthsaftersurgery.Somepatientswithgoodgradesonadmissiondi edofseverespasm,acutebrainswelling,orpoorgeneralcondition,b uttheseoutcomeswerenotrelatedtothepreoperativeradiologicali nformation.DISCUSSION Thepresentstudyofrupturedaneurysmsinbothanteriorandposterio rcirculationsfoundthattheindicationsforadditionalDSangiogra phyintheanteriorcirculationaresimilartothatfoundpreviously, butweexperiencedsomenewatypicalcases.Treatmentoffusiformane urysmsdependsonthehaemodynamicinformation,whichcouldonlybeo。

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 2.12WhelanBuildingThe QuadrangleBrownlow HillLiverpoolL69 3GBTel: +44 (0) 151 794 5682Fax: +44 (0)151 794 5585Email: R.DicksonFor 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 consists 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 withPharmalgen®to other treatment options, including high dose antihistamines, advice on the avoidance 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 ageand 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 fatal anaphylaxis 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 venom concentrati ons 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 aH1-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 0.50 mg/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 immediate self-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 pa tient 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 anincreased 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) of IgE-mediated allergy to bee venom (Pharmalgen®Bee Venom) and wasp venom (Pharmalgen®Wasp Venom) since March 1995 (marketing authorisation number PL 10085/0004). 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 willconsider 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.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 wasp venom 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 inthe NHS, without venom immunotherapyincluding:advice on the avoidance of bee and wasp venom,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 futureallergic reactionsadverse effects of treatmenthealth-related quality of lifeOther considerations If the evidence allows, considerations willbe given to subgroups of people, according totheir:risk of future stings (as determined, forexample, by occupational exposure)risk of severe allergic reactions to futurestings (as determined by such factors asbaseline tryptase 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.Data extraction strategyData relating to study design, findings and quality will be extracted by one reviewer and independently 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.Quality assessment strategyThe quality of the clinical-effectiveness studies will be assessed accordingto 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.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 EVIDENCEThe 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.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).Inclusion and exclusionIn addition to the inclusion criteria outlined in Table 1, specific criteria required for the cost-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 adjustedlife year gainedData 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.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/synthesisCost 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 willbe 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.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. 37 b. 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. 37b. 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 nature 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, incrementalcost-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 marked in the NICE report according to established NICE policy and removed from the subsequent submission to the HTA8 EXPERTISE IN THIS TAR TEAM AND COMPETING INTERESTS OF AUTHORSThis TAR team will be made up of the following individuals:Juliet HockenhullTeam lead /clinical systematicreviewerSenior economic modeller Professor Adrian BagustSystematic reviewer (clinical) Gemma CherrySystematic reviewer (economics) Dr Angela BolandEconomic modeller Dr Carlos Martin SaboridoInformation specialist Dr Yenal DundarMedical statistician James OyeeDirector Ms Rumona DicksonClinical advisor A team of clinical experts will beestablished to address clinicalquestions related to the technologyand to provide feedback on drafts ofthe final report9 REFERENCES1. Freeman T. Hypersensitivity to hymenoptera stings. NEJM. 2004;351:1978-84.。

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)。

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。

医学文献指标的中英文术语对照引言:医学文献是医学研究和临床实践中不可或缺的重要信息来源。

在阅读和理解医学文献时，掌握准确的中英文术语对照是十分必要的。

本文将介绍一些常见的医学文献指标的中英文术语对照，帮助读者更好地理解和应用这些指标。

一、Study Design (研究设计)1. 随机对照试验 (Randomized Controlled Trial, RCT)- 定义:将研究对象随机分为实验组和对照组，对比两组结果以评估干预措施的疗效- 示例: A randomized controlled trial of drug A on patients with hypertension2. 前瞻性队列研究 (Prospective Cohort Study)- 定义:在研究开始之前，根据暴露因素进行观察，随访研究对象并记录结果- 示例: A prospective cohort study of smoking and lung cancer risk3. 横断面研究 (Cross-sectional Study)- 定义:在某个特定时间点上收集数据，不考虑因果关系- 示例: A cross-sectional study of the prevalence of diabetes in a rural community二、Outcome Measures (研究终点指标)1. 死亡率 (Mortality Rate)- 定义:在一定时间内发生死亡的患者数与特定人群总数之比- 示例: The mortality rate of patients with heart failure after one year of follow-up2. 生存率 (Survival Rate)- 定义:在一定时间内生存下来的患者数与特定人群总数之比- 示例: The 5-year survival rate of breast cancer patients receiving chemotherapy3. 病情进展率 (Progression Rate)- 定义:患者疾病进展的速度或患病程度的评估指标- 示例: The progression rate of multiple sclerosis measured by MRI scans三、Statistical Analysis (统计分析)1. 方差分析 (Analysis of Variance, ANOVA)- 定义:用于比较多个组别差异的统计方法- 示例: One-way ANOVA was used to analyze the differences in blood pressure among different age groups2. 相关分析 (Correlation Analysis)- 定义:评估两个变量之间关系的统计方法- 示例: Pearson correlation analysis was performed to examine the association between BMI and blood glucose levels3. 生存分析 (Survival Analysis)- 定义:评估患者生存时间的统计方法，常用于研究肿瘤等疾病- 示例: Kaplan-Meier survival analysis was used to assess the overall survival rates of lung cancer patients四、Evidence Levels (证据级别)1. 临床实证 (Level of Evidence)- 定义:根据研究设计和方法的科学性和可靠性评估研究证据的质量- 示例: This meta-analysis provides high-level evidence for the efficacy of drug B in treating depression2. 系统综述及Meta分析 (Systematic Review and Meta-analysis)- 定义:对多个独立研究进行整体分析和结论汇总的研究方法- 示例: A systematic review and meta-analysis of the effectiveness of acupuncture for chronic pain management3. 专家共识 (Expert Consensus)- 定义:基于专家意见和经验形成的共识性陈述- 示例: The current guidelines are based on expert consensus and clinical experience结论:通过掌握医学文献指标中的中英文术语对照，读者能够更准确地理解和应用这些指标，在医学研究和临床实践中获得准确和可靠的信息支持。

病历中英文对照文献Medical records play a crucial role in the healthcare system, serving as comprehensive documentation of a patient's medical history, treatment, and ongoing care. In an increasingly globalized world, where patients may seek medical attention in different countries or work with healthcare providers from diverse linguistic backgrounds, the need for bilingual medical records has become paramount. This essay will explore the importance of bilingual medical records, the challenges associated with their implementation, and the potential benefits they can offer to both patients and healthcare professionals.One of the primary reasons for the growing demand for bilingual medical records is the increasing mobility of patients. As people travel more frequently for work, education, or leisure, they may find themselves in need of medical care in a country where the primary language differs from their own. Providing these patients with medical records that are easily understood in both their native language and the language of the healthcare system can significantly improve the quality of care they receive. By ensuring that all relevant information is accurately conveyed, healthcare providers can makemore informed decisions, tailor treatments to the patient's specific needs, and reduce the risk of misunderstandings or medical errors.Moreover, the importance of bilingual medical records extends beyond the needs of traveling patients. In many countries, particularly those with diverse immigrant populations, healthcare providers often encounter patients who do not speak the dominant language fluently. In these situations, the availability of bilingual medical records can greatly facilitate communication and ensure that the patient's medical history, symptoms, and treatment preferences are accurately documented and understood by the healthcare team. This can lead to more effective and personalized care, as well as a more positive patient experience.The implementation of bilingual medical records, however, is not without its challenges. One of the primary obstacles is the need for accurate and consistent translation of medical terminology and documentation. Medical language can be highly specialized, with a vast array of technical terms and abbreviations that may not have direct equivalents in other languages. Ensuring the accuracy and consistency of these translations is crucial, as any discrepancies or errors could have serious implications for patient care.Another challenge lies in the standardization and integration of bilingual medical records within existing healthcare systems.Healthcare providers often rely on established electronic medical record (EMR) systems, and the integration of bilingual functionality into these systems can be a complex and resource-intensive process. Factors such as data storage, user interfaces, and data exchange protocols must all be carefully considered to ensure the seamless integration of bilingual medical records.Despite these challenges, the potential benefits of bilingual medical records are significant. By facilitating better communication and understanding between patients and healthcare providers, bilingual medical records can lead to improved health outcomes, reduced medical errors, and enhanced patient satisfaction. Patients who are able to access and understand their medical records in their native language are more likely to be actively engaged in their own healthcare, leading to better adherence to treatment plans and a stronger partnership between the patient and the healthcare team.Moreover, the availability of bilingual medical records can also have broader societal benefits. In regions with diverse immigrant populations, the provision of bilingual medical records can help to address healthcare disparities and ensure that all members of the community have equal access to quality medical care, regardless of their linguistic background. This can contribute to the overall well-being of the population and promote social equity in the healthcare system.In conclusion, the importance of bilingual medical records cannot be overstated. As the world becomes increasingly interconnected, the need for effective communication and understanding between patients and healthcare providers has become more critical than ever. By addressing the challenges associated with the implementation of bilingual medical records and embracing the potential benefits they offer, healthcare systems can strive to provide more inclusive, personalized, and effective care for all patients, regardless of their linguistic background. This commitment to bilingual medical records represents a crucial step towards a more equitable and accessible healthcare system, one that can truly meet the diverse needs of the global community.。

Unit OneText A： Hippocratic Oath, The Medical Ideal1.Perhaps the most enduring --- certainly the most quoted --- tradition in thehistory of medicine is the Hippocratic Oath. Named after the famous Greek physicianHippocrates, this oath was written as a guideline for the medical ethics of doctors.Although the exact words have changed over time, the general content is the same- an oath to respect those who have imparted their knowledge upon the science ofmedicine, and respect to the patients as well as the promise to treat them to thebest of the physicians' ability.或许在医学史上最持久的,被引用最多次的誓言就是”希波克拉底誓言”.这个以古希腊著名医师希波克拉底命名的誓言,被作为医师道德伦理的指导纲领.虽然随着时代的变迁,准确的文字已不可考,但誓言的主旨却始终如一——尊敬那些将毕生知识奉献于医学科学的人，尊重病人，尊重医师尽己所能治愈病人的承诺。

Who was Hippocrates, and Did he Write the Oath?2.For a man considered by many to be the 'Father of Medicine', little is known aboutHippocrates of Cos. He lived circa 460-380 BC, and was the contemporary of Socratesas well as a practising physician. He was certainly held to be the most famousphysician and teacher of medicine in his time. Over 60 treatises of medicine, calledthe Hippocratic Corpus have been attributed to him; however, these treatises hadconflicting contents and were written some time between 510 and 300 BC, and thereforecould not all have been written by him.作为被大家公认的”医学之父”,我们对希波克拉底知之甚少.他生活于约公元前460-380年,作为一名职业医师,与苏格拉底是同代人.在他的时代,他被推举为当时最著名的医师和医学教育者.收录了超过60篇论文的专著——希波克拉底文集,被归于他的名下;但是其中有些论文的内容主旨相冲突,并成文于公元前510-300年,所以不可能都是出自他之手.3.The Oath was named after Hippocrates, certainly, although its penmanship is stillin question. According to authorities in medical history, the contents of the oath suggest that it was penned during the 4th Century BC, whichmakes it possible that Hippocrates had himself written it. Anyway, regardless ofwhether or not Hippocrates himself had written the Hippocratic Oath, the contentsof the oath reflect his views on medical ethics.这个宣言是以希波克拉底命名的，虽然它的作者依然存在疑问。