?严正声明?

最近在网络上发现有些单位，未经我刊许可，通过互联网以我刊名义约稿、代理稿件，严重侵犯了我刊权利。现严正警告这些单位，1周内从网上撤销，停止侵权。否则，我刊将保留追究其法律责任的权利。在此，也敬告广大作者、读者，我刊未委托任何单位、网站代理征稿。本刊唯一投稿网站是索医网，也从未设立汇款帐号，汇款途径：邮局地址汇款。     

Cardiac resynchronization therapy: what? Who? When? How?

Cardiac resynchronization therapy is an important and underused tool to help patients with heart failure symptoms, left ventricular systolic dysfunction (LVEF ≤ 35%), and intraventricular conduction system disease (QRS ≥ 120 msec). Cardiac resynchronization therapy paces the heart simultaneously from both right and left ventricles (through the coronary sinus). Approximately three quarters of patients who undergo a successful implant will have some degree of symptomatic improvement and have fewer heart failure hospitalizations. When cardiac resynchronization therapy is combined with a defibrillator, patients may benefit from the added protection against sudden arrhythmic death.     

何时服药 大有讲究——清晨? 空腹? 饭前? 饭后? 睡前?

<正>许多药物经口服吸收时,与同时所进的饮食能发生复杂的化学反应,饮食可干扰药物的吸收、代谢和利用,从而或降低、或增强药物的治疗效果。所以,服药时间大有讲究,有多种选择,有空腹时、有饭前、有饭后、有临睡前等等多种。正确地掌握好服药的最佳时间,了解服药与吃饭、睡觉之间的关系,既能使药物发挥最大疗效,又可减少毒副反应,促进疾病的尽快康复。根据正常人一日三餐的饮食习     

Nierenersatztherapie: Wann? Wie? Wie lange?

The development of continuous modalities (continuous renal replacement therapy, CRRT) revolutionized the use of renal replacement therapy for critically ill patients. Suddenly excellent hemodynamic stability, nearly unlimited fluid removal and unrestricted availability became feasible. Furthermore the newest generation CRRT machines allowed practically unlimited intensity of treatment. Under these conditions initial single centre small randomized controlled trials carried out at the turn of the millennium indicated improved survival by administering CRRT doses equal or above 35?ml/kg body weight/h or daily hemodialysis. These effects, however, could not be reproduced by subsequent large multicenter randomized controlled trials. Consequently current recommendations suggest 25?C30?ml/kg body weight/h actually delivered dose in CRRT or alternate day intermittent hemodialysis. Despite better hemodynamic tolerability of CRRT no trials could prove substantially improved survival over intermittent hemodialysis. Consequently modified intermittent modalities, such as sustained low efficiency dialysis (SLED) show improved acceptance under the pressure of increasing cost constraints. Regional anticoagulation by citrate is on the rise due to increased system survival, reduced risk of bleeding and improved biocompatibility. A reoccurrence of spontaneous diuresis above 450?ml/24?h has been shown to be one of the most reliable early predictors for successful termination of RRT.     

血压的控制目标:高值?低值?最佳值?

有效的血压控制可以降低心脑血管事件,已经成为不争的事实.美国高血压预防、检测、评估与治疗联合委员会(the joint national committee on prevention,detection,evaluation,and treatment of high blood pressure,JNC 7)报告中...     

Stillbirths: Where? When? Why? How to make the data count?

Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible-not counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics. At least 2·65 million stillbirths (uncertainty range 2·08 million to 3·79 million) were estimated worldwide in 2008 (≥1000 g birthweight or ≥28 weeks of gestation). 98% of stillbirths occur in low-income and middle-income countries, and numbers vary from 2·0 per 1000 total births in Finland to more than 40 per 1000 total births in Nigeria and Pakistan. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. In total, an estimated 1·19 million (range 0·82 million to 1·97 million) intrapartum stillbirths occur yearly. Most intrapartum stillbirths are associated with obstetric emergencies, whereas antepartum stillbirths are associated with maternal infections and fetal growth restriction. National estimates of causes of stillbirths are scarce, and multiple (>35) classification systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specific perinatal certificates and revised International Classification of Disease codes, are needed. A simple, programme-relevant stillbirth classification that can be used with verbal autopsy would provide a basis for comparable national estimates. A new focus on all deaths around the time of birth is crucial to inform programmatic investment.     

胸闷?发热?淋巴结肿大

病历摘要患者男性,38岁,汉族,已婚?出生地:上海?自觉胸闷不适?乏力二月,伴咳嗽,少量白痰,发热38℃左右?近一月来胸闷加重,发热39℃以上,纳差?卧床不起,于1996年10月16日来本院急诊?14年前因患肺结核住院,经抗结核治疗痊愈?曾在上海某仪表厂做勤杂工约15年,1992年辞职赴泰国清迈市打工四年,做过导游?否认吸毒及冶游史?无传染病家族史?查体:体温36.4℃,呼吸39次/分,脉搏130次/分,血压12/8kPa?发育正常,营养差,呈恶病质?皮肤无黄染?出血点?皮疹及皮下结节?左锁骨上触及2组肿大淋巴结,分别为2～3只,最大约2cm×2.5cm,最小约1cm×1cm?     

是老年性痴呆?还是铅中毒?

患者,男,66岁,希腊人,在过去的2年里他变得易激动,易生气,间歇性妄想狂,不能做出简单的决定,孤独;有牛皮癣性关节炎病史,Ⅱ型糖尿病,间歇性共济失调步态,双足感觉障碍,关节痛,体重下降40kg,反复腹部不适,便秘,没有老年性痴呆(Alzheimer's)的家族史。住院检查发现有间歇性精神错乱。小范围的脑损害的痕迹,近期记忆力减退,嗜睡,易醒。     

Nierensch?digung durch Methotrexat?

Methotrexate (MTX) in low-doses is an important component of anti-inflammatory therapy of rheumatoid arthritis and other inflammatory joint diseases. In contrast to high-dose administration of MTX in oncology, which can lead to direct tubulus toxicity and subsequent renal failure, renal side-effects are a rare exception for low-dose MTX. The biggest problem under low-dose MTX is that an already limited renal function due to comorbidities or an increasing, sometimes clinically insufficiently monitored renal insufficiency due to comedications, such as non-steroidal antirheumatics (NSAR) and antibiotics, leads to a reduced excretion of MTX and therefore to an accumulation in serum. This is primarily accompanied by gastrointestinal mucositis and bone marrow depression. For this reason low-dose MTX should never be administered once the glomerular filtration rate (GFR) is less than <30?ml/min and only 50% of the original dosage should be administered if the GFR is between 30 and 60?ml/min.     

Brugada综合征?致心律失常性右室心肌病?其他?

男性,37岁。11年中突发心悸三次,伴晕厥一次。心电图可见心房颤动和完全性右束支阻滞;心脏MRI增强可见右室收缩功能降低和右室心尖部运动异常;基因检测有遗传变异。临床诊断:右室心肌病,阵发性心房颤动,完全性右束支阻滞,心源性晕厥。     

4 million neonatal deaths: when? Where? Why?

The proportion of child deaths that occurs in the neonatal period (38% in 2000) is increasing, and the Millennium Development Goal for child survival cannot be met without substantial reductions in neonatal mortality. Every year an estimated 4 million babies die in the first 4 weeks of life (the neonatal period). A similar number are stillborn, and 0.5 million mothers die from pregnancy-related causes. Three-quarters of neonatal deaths happen in the first week--the highest risk of death is on the first day of life. Almost all (99%) neonatal deaths arise in low-income and middle-income countries, yet most epidemiological and other research focuses on the 1% of deaths in rich countries. The highest numbers of neonatal deaths are in south-central Asian countries and the highest rates are generally in sub-Saharan Africa. The countries in these regions (with some exceptions) have made little progress in reducing such deaths in the past 10-15 years. Globally, the main direct causes of neonatal death are estimated to be preterm birth (28%), severe infections (26%), and asphyxia (23%). Neonatal tetanus accounts for a smaller proportion of deaths (7%), but is easily preventable. Low birthweight is an important indirect cause of death. Maternal complications in labour carry a high risk of neonatal death, and poverty is strongly associated with an increased risk. Preventing deaths in newborn babies has not been a focus of child survival or safe motherhood programmes. While we neglect these challenges, 450 newborn children die every hour, mainly from preventable causes, which is unconscionable in the 21st century.