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Methods A nested RT-PCR was used for detecting one fragment of SARS-CoV RNA in oropharyngeal swabs from 3 SARS probable patients ,4 SARS suspect patients and other 27 patients with fever in Hangzhou, and the nested RT-PCR product from one SARS probable patient was sequenced.Meanwhile in these 3 SARS probable patients, other three RT-PCR methods, including a hemi -nested RT-PCR targeted for another fragment of SARS-CoV RNA, a real-time RT -PCR and a modified nested real-time RT-PCR, were employed to detect SARS-Co V RNA.Results Two positives were found in the 3 SARS pro bable patients, and none positive in 4 SARS suspect patients and other 27 patien ts with fever, using the nested RT-PCR.

方法对2003年杭州市3例严重急性呼吸综合征临床确诊患者、4例疑似和27名医学观察者的咽拭子标本用巢式实时RT-PCR检测SARS-CoV核酸,对阳性扩增产物进行核酸序列测定,同时对3例患者的标本应用半巢式RT-PCR检测另一位点SARS-CoV核酸片段,并应用常规实时RT-PCR技术及改良实时RT-PCR技术进行检测。

Objective To investigate the clinical features, causes of blindness and diagnosis of Vogt Koyanagi Harada syndrome Methods The data of 157 patients with VKH syndrome were reviewed and analyzed Patients were carefully examined with slit lamp, ophthalmoscope, three mirror lens, fundus fluorescein angiography, indocyanine green angiography and HLA typing Results Headache was noted in 73 5% of these patients Simultaneous involvement of both eyes occurred in 80 8% of these patients Chroiditis,papilledema and edema of the retina adjacent to the optic nerve were noted in 100% of these patients in the posterior uveitis stage, whereas recurrent granulomatous anterior uveitis (98 4%),"sunset glow" fundus (95 8%) and Dalen Fuchs nodules (71 2%) were the common ocular findings in the recurrent anterior uveitis stage The common causes of blindness were papillitis, exudative retinal detachment and complicated cataract in the posterior uveitis stage, anterior uveal involvement stage and its recurrent stage Poliosis (36 3%) and alopecia (35 0%) were the most common extraocular findings Early irregular patches of fluorescence, followed by localized hyperfluorescent spots were the typical findings of FFA Dilation of choroidal vessels and leakage of ICG from the choroidal vessels were the common ICGA findings The prevalence of HLA DR4 and HLA DRw53 in patients (54 9% and 71 8% respectively) was significantly higher than that in controls (14 7% and 38 2% respectively) Conclusions VKH syndrome is characterized by chroiditis, papillitis or neuroretinitis in the posterior uveitis stage, followed by a generalized uveitis with a typical recurrent granulomatous anterior uveitis Extraocular findings and relevant examinations including FFA, ICGA and HLA typing are helpful to the diagnosis of VKH syndrome

目的探讨Vogt-Koyanagi-Harada综合征患者的临床特征、盲目原因及诊断等有关问题。方法对在1996年1月至2000年12月间就诊资料完整的157例VKH综合征患者进行回顾性分析,并对裂隙灯、眼底镜、三面镜、荧光素眼底血管造影(fundus fluorescein angiography,FFA)、吲哚青绿血管造影(indocyanine green angiography,ICGA)及人类白细胞抗原分型等检查结果进行分析。结果 VKH综合征最常见的前驱症状为头痛(102例,73.5%),双眼同时患病118例(80.8%);后葡萄膜炎期眼部主要表现为脉络膜炎、视乳头及附近视网膜水肿(100.0%);前葡萄膜炎反复发作期眼部表现为复发性肉芽肿性前葡萄膜炎(128例,98.4%)、晚霞状眼底改变(95.8%)及Dalen-Fuchs结节(71.2%);后葡萄膜炎期、前葡萄膜受累期及前葡萄膜炎反复发作期导致盲目的主要原因分别为视乳头炎、视网膜脱离及并发性白内障;毛发变白(36.3%)及脱发(35.0%)是最常见的眼外表现;炎症活动期FFA典型表现为斑驳状高荧光,ICGA发现脉络膜血管扩张、通透性增高等改变;VKH综合征患者HLA-DR4及HLA-DRw53的阳性率(54.9%及71.8%)显著高于正常对照组(14.7%及38.2%)。结论 VKH综合征患者在后葡萄膜炎期眼部典型表现为双侧脉络膜炎、视乳头炎或神经视网膜炎,随后出现以反复发作的肉芽肿性前葡萄膜炎为特征的全葡萄膜炎。眼外症状及相关的辅助检查包括FFA、ICGA 及HLA分型等有助于VKH综合征的诊断。

Immediate postoperative complications within one week include perinasal swelling (60 patients), perinasal pain (32 patients), perinasal ecchymosis (26 patients), periorbital swelling (6 patients) and epiphora (3 patients). Most of the complications disappeared within 3 months except intermittent tingling sensation in one patient and residual deformity in three patients.

手术后1周内并发症包括鼻周肿胀60名,鼻周疼痛32名,鼻周瘀青26名,眼周肿胀感6名,溢泪3名。3个月后仍存在的术后并发症包括间歇性刺痛感1名以及矫正后之残余性变形3名。

According to the echocardiography,enlarged internal diameter of left ventricle was found in 8 patients and short-axis fractional shortening of left ventricle 5% in 3 patients.Six out of the above 8 patients presented with shortening of accerlerating time,decreasing of accerlerating time/right ventricular ejective time value and moving forward of spectral peak in different degrees.All patients were given antianginal drugs such as β-recepter blockers,nitrate preparations and part by angiotensin converting enzyme inhibitor,diuretics and digoxin,The illncss of 29 patients were gradually controlled within one week.Three patients with AD were complicated by acute left heart failure.No obvious changes in FS of left ventricle were found on echocardiography by bed.

测量肺动脉瓣口血流频谱,左心室内径增大的8例中有6例出现不同程度的血流加速时间缩短,血流加速时间/右心室射血时间比值减小,频谱峰值前移。31例均给予β受体阻滞剂、硝酸酯类等抗心绞痛治疗,部分给予血管紧张素转换酶抑制剂、利尿剂和地高辛,其中29例在1周内卧位型心绞痛逐步得到控制。3例卧位型心绞痛发作时合并急性左心衰竭者,在床旁观察超声心动图,发现左心室短轴缩短率无显著变化,给予利尿剂、减轻前后负荷等治疗,急性左心衰竭得以纠正。

Small intestinal biopsies showed subepithelial collagen deposition with varying degrees of villous atrophy and varying numbers of intraepithelial lymphocytes. Four patients had previous biopsies showing enteropathic changes without collagen deposition. Seven cases were associated with collagenous colitis and 1 also had features of lymphocytic colitis. Three patients also had collagen deposition in gastric biopsies. One case was associated with lymphocytic gastritis. Celiac disease (CD, gluten-sensitive enteropathy) was documented in 4 patients. Five patients made a clinical improvement with combinations of a gluten-free diet and immunosuppressive therapy. Two patients died of complications of malnutrition and 1 of another illness. Clonal T-cell populations were identified in 5 of 6 cases tested. Four of these patients improved clinically after treatment but 1 has died. Collagenous sprue evolved on a background of CD in 4 cases. There was no history of CD in others and these cases may be the result of a biologic insult other than gluten sensitivity.

小肠活检表现为上皮下胶原沉积,绒毛萎缩程度不一,上皮内淋巴细胞浸润数量不等。4例患者以往曾做过活检,表现为其他肠病改变,并没有胶原沉积。7例患者合并胶原性结肠炎,且1例还有淋巴细胞性结肠炎的特征。3例患者胃活检也发现有胶原沉积。1例患者合并淋巴细胞性胃炎。4例患者有乳糜泻(CD,谷蛋白敏感性肠病)病史。5例患者经无麸质饮食和免疫抑制治疗后,临床症状有所改善。2例患者因营养不良合并另一种疾病而死亡。6例患者做了T细胞受体基因重排,其中5例发现有克隆性T细胞群,这5例中有4例治疗后临床症状加重,且1例死亡。4例患者在CD的基础上病发胶原性口炎性腹泻;其余患者无CD病史,他们的发病也许是生物源性损害,而非谷蛋白敏感。

Results Of all 41 cases 9 patients were biliary tract injury ,9 patients with biliary fistulas , 8 patients with bleeding after surgery , 4 patients with injury of gastrointestinal tract, 4 patients with calculus of bile duct, 4 patients with complicating gastroenteric tumor,3 patients with unexpected carcinoma of gallbladder .

结果 胆管损伤9例,胆漏9例,术后出血8例,胃肠道损伤4例,胆管结石4例,合并胃肠道肿瘤4例,意外胆囊癌3例,1例死于多器官功能障碍综合症,2例预后不良,其余愈合良好。

Results: Thrombus within right ventricle and main pulmonary artery was detected in 6 patients, right atrium and RV enlargement was found in 19 patients, right ventricular hypokinesis was found in 21 patients, hypokinesis of interventricular septum was detected in 13 patients, MPA and right pulmonary arterial dilation was found in 22 patients, marked tricuspid regurgitation was detected in 23 patients, pulmonary hypertension was found in 23 patients.

右心异常改变者26例(包括超声直接检出血栓的6例),其中右房室增大19例;右室收缩功能减退21例;室间隔左移、左室短轴切面室间隔向左室膨突呈&D&型改变1例;室间隔运动幅度减低13例;主肺动脉及右肺动脉增宽22例;三尖瓣中量以上返流23例;肺动脉收缩压增高23例,范围在33~81mmHg (62.87±23.46 mmHg),治疗后肺动脉压明显下降,范围在21~52 mmHg (34.26±13.52 mmHg)。

The patients include 10 patients(20 eyes) of VogtKoyanagiHarada syndrome, 1 patients(2 eyes) of Behcet diseases, 11 patients(21 eyes) of other uveitis, 5 patients (9 eyes) of papolloedema, 2 patients(2 eyes) of choroidal tumor, 2 patients(4 eyes) of, hypotony with macular degeneration, 1 patient(2 eyes) of,Graves diseases, 1 patient (1 eye) of,blunt trauma and 1 patient(1 eye) of uveal effusion syndrome.

其中伏格特-小柳-原田综合征10例20只眼,Behccet病1例2只眼,其他类型葡萄膜炎11例21眼,视盘水肿5例9只眼,脉络膜肿瘤2例2只眼,低眼压性黄斑病变2例4只眼,Graves眼病1例2只眼,眼钝挫伤1例1只眼,脉络膜渗漏综合征1例1只眼。

Patients with extraocular muscles thickening and 3 patients with tendon involvement 16 patients with orbital lipotrophy 3 patients extraocular muscles thickening accompany by superior ophthalmic vein enlargement. 1 patients extraocular muscles thickening accompany by optic never thickening 2 patients extraocular muscles thickening accompany by lacrimal gland augmentation 39 patients with eyelid swelling.

结果 58例甲状腺相关性眼病眼球突出CT影像观察,单纯眼外肌肌腹肥厚(n=54,肌腹及肌键、肌止点均受累及(n=3);眶脂肪增多(n=16);眼外肌肥厚伴眼上静脉增粗(n=3);眼外肌肥大伴视神经增粗(n=1);眼肌肥大伴泪腺增大(n=2);眼睑肿胀(n=39)。

Of the patients tested using CDC technology, 17 (3.8%) had a panel reactive antibody higher than 10% and 8 patients (1.83%) had a PRA higher than 25% for class I antibodies. Class I sensitized patients, defined as patients with a PRA higher than 10%, had significantly lower survival rates than class I nonsensitized patients ( P =.0035). Class I nonsensitized patients had survival rates of 79.4% at 1 year posttransplant, 63.2% at 3 years, and 45.4% at 5 years. Sensitized patients had 1, 3, and 5 year survival rates of 64.7%, 28.8%, and 9.6%, respectively.

使用CDC检测的病患之中,有17位(3.8%)群体反应抗体第一类抗体高於10%、有8位(1.83%) PRA超过25%,第一类抗体敏感病患定义为PRA高於10%者,相较於第一类抗体不敏感病患、存活率显著降低(P =。0035);第一类抗体不敏感病患移植后一年之存活率为79.4%、3年存活率为63.2%、5年存活率为45.4%;第一类抗体敏感病患移植后一年、3年、5年之存活率分别为64.7%、28.8%、9.6%。

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