简介：十二指肠的损伤由于增加的汽车事故和强烈事件经常越来越不平常却现在看见。十二指肠的损伤的管理能是复杂的，特别当对pancreatic-duodenal-biliary建筑群的巨大的损害同时发生时。甚至病人及时收到手术，多重手术后的复杂并发症和高死亡是普通的。更好知道并且设法十二指肠的损伤，我们由十二指肠的损伤，治疗，诊断和腹部的关键词在PubMed寻找了最近的相关文学。它证明因为诊断和管理是复杂的，死亡高，十二指肠的损伤应该及时并且机智地被对待。并且新技术的申请能帮助改进管理。在这评论，我们讨论了十二指肠的损伤的发生，诊断，管理，和复杂并发症以及死亡。

简介：AbstractHypertension in pregnancy is currently defined as a systolic blood pressure (BP) of 140 mmHg or more, or a diastolic BP of 90 mmHg or more. This level of BP warrants antihypertensive therapy. Treating to a target BP of 135/85 mmHg halves the risk of severe hypertension that is itself associated with adverse maternal and perinatal outcomes, similar in magnitude to preeclampsia. While based on the results of the Control of Hypertension in Pregnancy Study (CHIPS) trial, this finding is consistent with all antihypertensive trials to date. Also, in the CHIPS trial, "tight" BP control also halved the risk of progression to thrombocytopenia and elevated liver enzymes for the mother, without adverse effects for the fetus or newborn. This was true regardless of the gestational age at which BP control was instituted. While methyldopa, labetalol, and nifedipine are the most commonly-recommended oral antihypertensives, it is not clear that one antihypertensive agent has advantages over the others for treatment of non-severe hypertension in pregnancy. No antihypertensives, including renin-angiotensin-aldosterone system (RAAS) inhibitors, have been shown to be teratogenic, although there may be an increase in malformations associated with the underlying condition of chronic hypertension. Atenolol and RAAS inhibitors should not be used once pregnancy is diagnosed, based on fetotoxicity. At present, BP treatment targets used in clinic are the same as those used at home as the differences are quite variable among hypertensive women. For treatment of acute severe hypertension, the most commonly-recommended antihypertensives are oral nifedipine, IV labetalol, and IV hydralazine, although oral agents have also been shown to be effective in the majority of women; while concerns raised about IV hydralazine-induced maternal hypotension and its consequences have not been confirmed, this medication may be an inferior antihypertensive to oral nifedipine. While treatment recommendations are based on evidence, women should be engaged in decision-making, as their values may alter target BP and antihypertensive choice. Future work will clarify the optimal target BP based on home BP measurements; whether BP targets should be lowered further if the definition of hypertension is based on a lower BP; which, if any, antihypertensive medication for non-severe hypertension is better with regards to maternal and perinatal outcomes; and whether factors beyond BP level (such as variability, race, and other physiological variables) should inform antihypertensive therapy in pregnancy.

简介：Theaetiologyandpathogenesisoftype2diabetesremainunclear.Mostpatientsexhibitacombinationoftwomajormetabolicdefects:

简介：Amongallcongenitalheartdisease,Ebsteinanomalyisthelesionwiththewidestspectrumofpresentation.Itcanpresentasearlyastheneonatalperiodwhereimmediateinterventionisoftenneededtotheadultwithnodiscernablesymptoms.Itisalsoonewhereoveralloutcomegreatlyrelatestoageatpresentation.Generally,presentationintheneonatalperiodisassociatedwithpooroutcomeswhilepresentationbeyondtheneonatalperiodhasexcellentoutcomeswithlowoperativemortality.ItisthusapparentthatunderstandingeveryaspectoftheanatomyandphysiologyofEbsteinanomalyandhowitmanifestsclinicallyisparamounttosuccessfultreatment.ThepurposeofthisreviewistooutlinethecurrentconceptsandstrategiesinthesurgicalmanagementofEbsteinanomaly,andtodiscussthecurrentexpertconsensusonhowbesttotacklethiscongenitalheartdiseaseatdifferentagesofdiagnosis.

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简介：Otitismediawitheffusionisoneofthemostcommondiseasesinchildren.Itstreatmentremainscontroversial.ClinicalpracticeguidelinesofOMEallowwatchfulwaitingfor3monthsbeforetreatmentifthechildwithOMEisnotatriskforspeech/language/orlearningproblems.Tympanostomytubeinsertionisthepreferredinitialprocedurewhenachildbecomesasurgicalcandidate.ComplementaryoralternativemedicineisnotrecommendedasatreatmentforOME.ThispaperprovidesasystematicreviewofmanagementofOME,whichwehopewillbehelpfulforclinicians.

简介：Failureofthethyroidglandrequiresthyroidhormonereplacementtherapy,whichisrelativelyeasilyadjustedtoreplicatethenormalphysiologicalstatebymonitoringplasmalevelsofthyroxineand/orthyroid-stimulatinghormone.Incontrast,failureofpancreaticβ-eellsrequiresinsulintherapy,andoptimalreplacementrequiresmonitoring,notoftheabsenthormone(insulin),butofitsmajorsubstmte(glucose).

简介：AbstractIntraamniotic infection (IAI) or chorioamnionitis is a common cause of preterm birth and may cause adverse neonatal outcomes, including neonatal pneumonia, respiratory distress, meningitis, sepsis, and death. Maternal morbidities from intraamniotic infection include dysfunctional labor requiring increased intervention, cesarean birth, postpartum uterine atony with hemorrhage, endometritis, peritonitis, sepsis, adult respiratory distress syndrome and, rarely, death. Chorioamnionitis can result from an ascending infection, iatrogenic causes or transplacental passage from maternal blood-borne infections. The clinical findings of chorioamnionitis include maternal fever (≥38 °C), maternal (>100 beats per minute) and/or fetal tachycardia (>160 beats per minute), maternal leukocytosis on complete blood count (>15 000 cells/mm3), and uterine tenderness and/or purulent and/or foul-smelling amniotic fluid. The management of chorioamnionitis mainly includes antibiotic therapy and delivery. Women with previable preterm premature rupture of membranes should be offered realistic counseling from a multidisciplinary approach. The separation of the mother and the fetus to preserve the life of the mother should prioritize delivery methods that result in a living fetus if possible, with appropriate neonatal resuscitation available.

简介：AsreadersofCancerBiologyandMedicinewellknow,therehasbeenaseismicshiftinhumanmolecularbiologyoverthepastfewyears,asmomentousinitsownwayasthediscoveryofthedouble-helicalstructureofDNAbyWatsonandCrick60yearsago,theelucidationofthegeneticcodeshortlythereafter,theadventofrecombinantDNAandgenecloning

简介：Aim:Tostudytheadvantageofexcisionofthedistalsymptomaticuretericstumpswiththeretroperitoneallaparoscopicapproach.Methods:Fourpatientswhohadfailedtosettletheirsymptomswiththeinitialconservativemanagementwereincludedinthestudy.Allunderwentexcisionofthedistalsymptomaticuretericstumpswiththeretroperitoneallaparoscopicapproachandthenreceivedprophylacticantibiotics.Results:Wehaveachievedbetterresultsthanthosereportedintheliteratureintermsofoperatingtime(mean1h45min),bloodloss(＜10mL),postoperativerecovery(within12h)andhospitalstay(＜48h).Conclusion:Retroperitoneallaparoscopicexcisionisasafe,simpleandeffectivemethodinthemanagementofsymptomaticuretericstumps.

简介：Hypertensionisaleadingriskfactorforcardiovasculardisease,theleadingcauseofdeathandmorbidityinoursocietyandonaglobalscale.Majorcomponentsofcardiovasculardiseaseincludestroke,coronaryarterydisease,heartfailure,andchronickidneydisease,inallofwhichhypertensionplaysamajorrole.Theriskofthesecomplicationsincreasesdirectlyandlinearlywithsystolicbloodpressurestartingat115mmHg.Althoughusuallyasymptomatic,hypertensionisreadilydetectableonphysicalexaminationandisamenabletobothlifestylemodificationandpharmacologictreatmentinmostpatients.However,largeproportionsofthehypertensivepopulationremainundetectedandundertreated.Numerousguidelineshavebeenissuedduringthepastfewdecadestopromotedetectionandoptimaltherapy.Despitetheincreaseinriskwithsystolicbloodpressuregreaterthan115mmHg,thegenerallyacceptedthresholdfordiagnosisandtreatmenthasbeensystolicbloodpressuregreaterthan139mmHganddiastolicbloodpressuregreaterthan80mmHgbecauseuntilrecentlytreatmenttolowerlevelshasbeenassociatedwithanunfavorablerelationbetweenclinicalbenefitandharm.Inthepastseveralyears,newguidelines,advisories,commentaries,andclinicaltrialshaveprovidedevidenceforapotentialchangeincurrentrecommendationsforthemanagementofhypertension.Inthisregard,thelong-awaitedeighthreportoftheJointNationalCommitteeonthePrevention,Detection,Evaluation,andTreatmentofHighBloodPressurerecommendedpatientsolderthan60yearsbetreatedtoasystolicbloodpressureoflessthan150mmHg,whichhasgeneratedconsiderablecontroversyandcaution.ThestrikingfindingsoftheSystolicBloodPressureInterventionTrial(SPRINT)havereceivedconsiderableattentionbecauseofthedemonstrationthatintensivetherapytoatargetsystolicbloodpressurebelow120mmHgdecreasescardiovascularmortalityandmorbiditymorethanlessintensivetreatmenttoatargetsystolicbloodpressurebelow140mmHg

简介：Dizzinessaffectsaleutone-thirdofindividualsovertheageof65years,andisoneofthemostconmlonreasonsfortheelderlytoconsulttheirgeneralpractitioner.Syncopeaffectsatleast20%ofthepopulationatmlnetimeandaccountsforabout6%ofgeneralmedicaladmissionsintheUK.Recurrentsymptomsareparticulas-lydisablingbecausetheyaffectanindividual'sabilitytoworkandtodrive,increasesusceptibilitytofallsandassociateinju-rim,andreduceindependenceintheelderly.

简介：Objective:Tosummarizesurgicaltreatmentsandtheircorrespondingcurativeeffectsonsciaticnerveinjuries.Methods:Surgicaltreatmentsonsciaticnerveinjurywereperformedin28patientsfromJanuary1990toJuly2000.Thetreatmentsincludedneurolysis,neurolysispluspartialnerveanastomosis,nerveanastomosisandnervetransplantation.ThecurativeeffectwasevaluatedaccordingtoSunderlandcriteria.Results:Of28cases,22patientswerefollowedupwithafollow-upperiodof13monthsto5years(average30months).Of22nerves,7wereexcellent,5good,7fairand3poor,withanexcellencerateof54.5%.

简介：Thispaperreviewscurrentrecommendationsontheappropriateevaluationandmanagementofcardiacarrhythmiasinthepregnantpatient.Mostarrhythmiasduringpregnancyarebenignandrequirenointervention.Whenrequired,thedecisiontotreatshouldbebasedonsymptomseverityandtheassociatedrisktomotherandfetusposedbypotentiallyrecurringarrhythmiaepisodesthroughoutthepregnancy.Anytreatmentstrategyinthispatientpopulationhasinherentrisktobothmotherandunbornchild.Beforetheinitiationofanyintervention,documentationofaclinicalarrhythmiaandcorrelationwithclinicalsymptomsshouldbeobtained.Thereisnoroleforempirictherapy.

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简介：Necrotizingpancreatitisisanuncommonyetseriouscomplicationofacutepancreatitiswithmortalityratesreportedupto15%thatreach30%incaseofinfection.Traditionallyopensurgicaldebridementwastheonlytoolinourdisposaltomanagethisseriousclinicalentity.Thisapproachishoweverassociatedwithpooroutcomes.Managementhasnowshiftedawayfromopensurgicaldebridementtoamoreconservativemanagementandminimallyinvasiveapproaches.Contemporaryapproachtopatientswithnecrotizingpancreatitisand/orinfectiouspancreatitisissummarizedinthe3Ds:Delay,DrainandDebride.Patientscanbemanagedintheintensivecareunitandanyinterventionshouldbedelayed.Percutaneousdrainagecanbeutilizedfirstandearlyinthecourseofthedisease,followedbyendoscopicdrainageorvideoassistedretroperitoneoscopicdrainageifnecrosectomyisdeemednecessary.Opensurgeryisnowlessfrequentlyperformedandshouldbereservedforcasesrefractorytoanyotherapproach.Themanagementofnecrotizingpancreatitisthereforerequiresamultidisciplinarydynamicmodelofapproachratherthanbeingasurgicaldisease.

简介：Acupuncture,asacomplementarytherapy,hasbeenusedtomanagethecancerassociatedsymptomsofcancerpatients.Toidentifytheefficacyandsafetyofacupunctureinthemanagementofcancer,thisreviewcriticallyanalysestherelevantpublicationsincludingbothexperimentalandclinicalstudies.Themajorityofstudiessuggestthatacupunctureeffectivelyrelievessomecancerrelatedsymptomssuchascancerpain,andsomeadverseeffectscausedbythecancerconventionaltreatmentssuchasnausea,vomiting,neutropeniaandxerostomia.

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简介：Therearemanycausesofpain.Generallyspeaking,inflammationisthemostcommoncause,followedbyinjury,ulceration,spur,chemicalstimulation,etc..Acupuncturehasitsuniqueeffectivenessoninflammationthatischaracterizedasredness,swelling,warmthandpain,includingneuritisandarthritis.