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在了解及处理坚持用药的情况较差时,医生往往遇到很多困难。困扰医生的一个主要问题是,如何护理患有急性或危及生命的疾病而不能长期坚持治疗的儿童。对医生来说,更难的是如何了解父母何时不能为子女提供适当的护理。近30%~70%的患慢性疾病者,因为治疗时间长、服用的药物种类多及症状时有缓解而不能坚持用药。临床经验表明,患有慢性疾病,如囊性纤维化、癫痫、哮喘、糖尿病患者坚持用药的情况较差。  相似文献   
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Intracranial pressure (ICP) monitored shortly after admission over a period of 1 h in 31 children with tuberculous meningitis (TBM) was significantly higher (median 22.5 mm Hg, range 8.4–50.9 mmHg) in 19 children with laboratory evidence of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) than in 12 children without such evidence (median 16.2 mmHg, range 5.8–42.5 mmHg; P = 0.027). Neither plasma nor cerebrospinal fluid arginine vasopressin (AVP) was related to ICP (r = 0.33 and 0.13 respectively). Mean arterial pressure (MAP) was measured in 23 children and a moderate correlation was found with plasma AVP (r = 0.62; P = 0.0019). In TBM, plasma AVP may be secreted as a response to raised ICP in an effort to raise MAP and maintain cerebral perfusion pressure. In this setting excess fluid may be inappropriately retained, leading to hyponatremia and hypo-osmolemia.  相似文献   
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A total of 15 mixtures involving 9 different stocks attributed to the 19/20, 32 and 39 major clonal genotypes of Trypanosoma cruzi were used to infect third-instar nymphs of Triatoma infestans via an artificial feeding device. Three biological parameters were considered: (1) the percentage of infected insects (%II), (2) the number of flagellates per insect (NFI), and (3) the percentage of trypomastigotes per insect (%DIF). Genetic characterization by both multilocus enzyme electrophoresis (MLEE) and random amplification of polymorphic DNA (RAPD) indicated that in almost all cases (87%), mixtures remained present after completion of the whole cycle in the insect vector. Two lines of comparison were performed: (1) pure clonal genotypes versus corresponding mixed clonal genotypes and (2) the␣actual behavior of mixed clonal genotypes versus the expected behavior of the theoretical mixture (i.e. the␣arithmetic mean of the results observed for each of the two clonal genotypes taken separately). Statistical analyses of the variables were made difficult because of the presence of large standard deviations. Nevertheless, in several cases, mixtures differed significantly from pure clonal genotypes, and in one case the actual mixture differed significantly from the theoretical mixture. In some cases, interaction (either potentialization or reciprocal inhibition) could be suspected. Received: 10 March 1997 / Accepted: 21 September 1997  相似文献   
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Background

Peritoneal metastases (PM) are a form of metastatic spread affecting approximately 5-15% of colon cancer patients. The attitude towards management of peritoneal metastases has evolved from therapeutic nihilism towards a more comprehensive and multidisciplinary approach, in large part due to the development of cytoreductive surgery (CRS), usually coupled with heated intraperitoneal chemotherapy (HIPEC), along with the constant improvement of systemic chemotherapy of colorectal cancer. Several landmark studies, including 5 randomized controlled trials have marked the development and refinement of surgical approaches to treating colorectal cancer peritoneal metastases.

Methods

This review article focuses on these landmark studies and their influence in 4 key areas: the evidence supporting surgical resection of peritoneal metastases, the identification and standardization of important prognostic variables influencing patient selection, the role of surgery and intraperitoneal chemotherapy in prevention of colorectal PM and the role of intraperitoneal chemotherapy as an adjuvant to surgical resection.

Results

These landmark studies indicate that surgical resection of colorectal PM should be considered as a therapeutic option in appropriately selected patients and when adequate surgical expertise is available. Standardized prognostic variables including the Peritoneal Cancer Index and the Completeness of Cytoreduction Score should be used for evaluating both indications and outcomes.

Conclusions

Current evidence does not support the use of second look surgery with oxaliplatin HIPEC or prophylactic oxaliplatin HIPEC in patients with high risk colon cancer nor the use of oxaliplatin HIPEC with CRS of colorectal PM.

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Summary The effects of kainic acid lesions and chronic haloperidol treatment on rat striatal dopaminergic presynaptic receptors were studied. Following the -butyrolactone-induced inhibition of dopaminergic impulse flow, and after dopa decarboxylase inhibition, dopa accumulation and its reversal by dopamine agonists was measured in vivo.3H-apomorphine (a dopamine receptor ligand with purported presynaptic specificity) was used for in vitro binding experiments. Presynaptic dopamine receptors, as assessed by both methods, were unaffected by intrastriatal kainic acid injection 5–6 days before sacrifice. Seven days after termination of chronic haloperidol treatment (28 days, 0.5 mg/kg/day s.c.) both an increased apomorphine response using the dopa accumulation method and an increase in3H-apomorphine binding were observed, indicating the development of presynaptic dopamine receptor supersensitivity.  相似文献   
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