医学文献英文翻译
医学英语文献阅读单词
Unit One1. neuron 神经2. office visit(诊所)就诊3. scan 扫描4. medical practice 行医5. blood pressure 血压6. maintenance(健康)保持7. mammogram 乳房Ｘ线8. physical 身体9. side effect 副作用10. panic 恐慌11. practicing 执业12. transplant 移植13. budget 预算14. tablet 药片15. childproof 防孩子16. randomized 随机17. allocation(随机)分配18. prognosis 预后19. control 对照20. follow-up 跟踪21. ward 病房22. hepatitis 肝炎23. malaise 身体不适24. metabolism 代谢25. liver 肝26.pathophysiology 病理生理27. literature 文献28. investigation 调查29. incidence 率30. epidemiology 流行病学31. bed rest 卧床休息32. hospital stay 住院33. jaundice 黄疸34. course 病程35. intravenous 静脉注射36. diastolic 舒张37. perfusion 灌注38. primary 初级39. bypass(冠脉)旁路40. informed 知情41. humanitarian 人道主义42. the Red Cross 红十字会43. relief 援助44. casualty 人员伤亡45. emergency 紧急Unit Two1. re-emerging 再现2. strain 变种3. vaccine 疫苗4. infectious 传染性的5. emerging 新出现6. prevention 预防7. plague 鼠疫8. pathogenic 病原的9. authorities 机构10. drug resistanc 抗药性11. course 疗程12. scarlet fever 猩红热13. virulence 毒性14. pandemic 大流行15. antigen 抗原16. genetic 基因的17. neurological 神经性18. immunity 免疫力19. infrastructure 基础设施20. case 病例21. swine 猪22. tuberculosis 结核23. morbidity/incidence发病率24. professionals 专业人士25. latent 潜伏26. skin test 皮试27. screening 筛查28. interferon 干扰素29. toxicity 毒性30. curable 可治愈的31. intractable 难治的32. pathogen 病原体33. ulcer 溃疡34. exposure 接触(带病者)35. recombination 重组36. bioterrorism 生物恐怖活动37. foodborne 生物传播Unit Three1. adrenaline 肾上腺素2. residency 实习3. autoimmune 自身免疫4. stamina 持久力5. transient 短暂的6. bedridden 卧床不起7. building block 基本构件8. model 模型9. neurodegeneration神经退化10.excrete 排除(毒素)11.optimize 优化12.load 载量13.relapse 复发14.self-experimentation自我实验15.trial 试验16.neuromuscular 神经肌肉17.therapist 治疗师18.micronutrient 微量营养素19.function 功能20.track 跟踪21.coordination 协调22.cardiovascular 心血管23.rapport 亲密24.synchronization 同步25.contagion 传染26.regulate 调节27.psychobiological 生物心理28.solace 慰藉29.imaging ＭＲＩ30.activate 激活31.mandatory 强制性32.dubious 无把握的33.background 背景34.concept 概念35.regimen 方案plications 并发症37.anti-tumor 抗肿瘤38.standard 标准的39.pharmacological 药理学的40.solubility 溶解性41.in vivo 体内Unit Four1. complementary 补充2. alternative 替代(医学)3. paradigm 模式4. acupuncture 针灸5. adjunct 辅助6. nausea 恶心7. post-operative 术后8. clinical 临床的9. physicaltherapy 理疗10. therapeutic 治疗(方法)11. intervention 干预12. design 设计13. resonance 共振14. emission 发射ＰＥＴ15. analgesia 止痛16. establishment(生物医学)界17. rehabilitation 康复18. licensed 持照(针灸师)19. strategies 策略20. formulas 配方21. wide array 各式各样的22. integrative(中西医)结合23. acute 急性的24. administer 给药25. procedure 程序26. evaluation 评估27. prevalence 患病率28. conventional 传统(疗法)29. evidence-based 循证的30. management(压力)处理31. peripheral 外周／外围32. mechanisms 机制33. reductionistic 还原式的34.cost-effectiveness 效益35. outcomes 结果36. preclinical 临床前37. plausible 可能的38. manipulative 推拿39. homeopathic 顺势40. naturopathic 自然(疗法)41. meditation 冥想Unit Five1. crisis 危机2. symptoms 症状3. vitality 活力4. immune 免疫5. virus 病毒6. lifestyle 生活方式7. robust 健全的8. fragile 脆弱的9. balance 平衡10. spiritual 精神的11. blockages 路障12. repressed 被压抑的13. genuine 真实的(真情实感)14. physiological 心理15. integrated 整合的(十全十美)16. decaying teeth 蛀牙17. nutrition 营养18. waistline 腰围19. bottled 瓶装(水)20. intake 摄入21. appetite 食欲22. protein 蛋白质23. obesity 肥胖症24. lean 精益的(蛋白质)25. dietary 饮食(习惯)26. quality 质量27. dairy 乳制品28. diabetes 糖尿病29. content 含量Unit Six1. nursing home 养老院2. hospice 临终(关怀)3. failure(心)衰4. available around-the-clock24小时随叫随到5. coronary 冠心病6. respond(对治疗有)反应7. facility 机构8. end-of-life 终末期9. comfort 舒适的(护理)10. hospital discharge 出院11. care(症状)护理12. palliative 姑息的13. fatal illness 绝症14. pulmonary 肺的ＣＯＰＤ15. experimental 实验性的16. advisors 顾问17. discontinue 终止18. dialysis 透析19. smear 涂片20. provider 医患关系21. care-as-usual 常规医护22. preventive 预防性23. beaten 常用的off the beatenpath 离开熟路,另辟蹊径24. moldinto the shape 塑形25. renew 重新开始to renew aprescription 照旧处方再开药26. fertilization 授精27. basic 基础的(生物学)28. stem cell 干细胞29. collaborate 合作30. test-tube 试管(婴儿)31. reproductive 生殖的32. hormones 激素33. immature 未成熟的34. empirical 经验(观察)35. pioneering 首创的36. endoscope 内镜37. ethical 伦理的38. concern(社会)关注39. infertile 不孕不育的40. inherited 遗传性的41. fibrosis 纤维化42. dilemmas 困境Unit Seven1. station(护士)站2. life-support 生命维持(系统)3. measures 护理措施4. withdraw 停止(治疗)5. paternalistic 家长式的6. empowerment 授权7. ethicists 伦理学家8. principles 准则9. ideal 理念10.patient-centered以病人为中心的11. autonomy 自主权12. options 选择13. exclusivepurview 专属的(领域)14. emergency 紧急(决定)15. restraint 限制16. anxiety 焦虑17. transgression 违背18. practice(家庭)医疗19. metastases(广泛)转移20. aggressive 积极的21. primary 原发22. follow-up 随访23. record 病历24. embolism 栓塞25. tomography 断层摄像ＣＴ26. infiltrates 浸润27. chest 胸28. lower-lobe 左下叶29. labored(呼吸)困难30. team 团队31. chronic 慢性的32. psychosocial 社会心理33. guidelines 指南34. implement 实施(治疗方案)Unit Eight1. subject 受试对象2. biomedical 生物医学3. therapy 治疗4. protocol 方案5. beneficence 有利6. justice 公正7. autonomous 有自主能力的8. diminished 减弱Diminished autonomy 自主性减弱9. exposed to 面临10. Oath 誓言11. distribution 分配12. consent 同意Informed consent 知情同意13. procedures 程序14. operating 手术台15. obligation 责任16. pediatric 儿科的17. perform 做(手术)18. flow(血)流19. intensive 重症的ＩＣＵ20. adoptive 义(父)21.biological 生(父)22. psychological 心理的23. medical 医学的24. occupational 职业的25. contract 感染性的26. infection 感染27. blood vessel 血管28. circulation 循环29. welfare 安宁30. disapprove 不批准31. protocol 研究计划32. liability 责任Unit Nine1. curriculum 课程2. community 界The medicaleducation community 医学教育界3. expectations 期待4. attributes(个人)品质5. value 看重The place value on 看重6. maladies 疾患7. diagnostic 诊断的8. manifestations 临床表现9. civic mindedness 民本意识10. chatter 闲谈11. manner(临床)举止12. directories 名录13. integral 不可分割的14. underserved 服务匮乏的15. shortage(初级保健)缺乏16. certification 证书17. address 应对(需要)18. basics 基础知识19. teaching 教学(医院)20. academic 学术的21. affiliate with 隶属于22. continuing medicaleducation继续医学教育Unit Ten1. coverage 范围medical coverage 医疗保险支付范围2. Medicaid 医疗救助3. single-payer 单一支付4. subsidize 补贴5. deliver 提供6. duplicative 重复的7. sustained 长期的8. deficits(视力)缺陷9. echocardiogram 超声心动图10. thrombus 血栓11. stroke 中风12. artery 动脉13. intracranial 颅内的14. cerebral 大脑15. bleeding 出血16. brain-stem 脑干17. recovery 恢复18. ventilation 通气19. anticoagulant 抗凝血20. infusions 输液21. surgeon 外科医生22. administrators 管理者23. ambulances 救护车24. elective 可做可不做25. infarction 梗死26. time-critical 时间要求紧迫的27. arrest 停止28. traumatic 外伤的,创伤的29. intervention 介入术30. multi-payer 多家支付的31. universal 全民的32. for-profit 以营利为目的的33. pharmaceutical 制药的34. remedies 治疗方法home-brewed remedy 自创的治疗方法35. out-of-pocket 自掏腰包的。
英语文献常用词及缩写翻译
英语文献常用词及缩写翻译英语文献常用词及缩写翻译Abstracts Abstr 文摘Abbreviation 缩语和略语Acta 学报Advances 进展Annals Anna. 纪事Annual Annu. 年鉴，年度Semi-Annual 半年度Annual Review 年评Appendix Appx 附录Archives 文献集Association Assn 协会Author 作者Bibliography 书目，题录Biological Abstract BA 生物学文摘Bulletin 通报，公告Chemical Abstract CA 化学文摘Citation Cit 引文，题录Classification 分类，分类表College Coll. 学会，学院Compact Disc-Read Only Memory CD-ROM 只读光盘Company Co. 公司Content 目次Co-term 配合词，共同词Cross-references 相互参见Digest 辑要，文摘Directory 名录，指南Dissertations Diss. 学位论文Edition Ed. 版次Editor Ed. 编者、编辑Excerpta Medica EM 荷兰《医学文摘》Encyclopedia 百科全书The Engineering Index Ei 工程索引Et al 等等European Patent Convertion EPC 欧洲专利协定Federation 联合会Gazette 报，公报Guide 指南Handbook 手册Heading 标题词Illustration Illus. 插图Index 索引Cumulative Index 累积索引Index Medicus IM 医学索引Institute Inst. 学会、研究所International Patent Classification IPC 国际专利分类法International Standard Book Number ISBN 国际标准书号International Standard Series Number ISSN 国际标准刊号Journal J. 杂志、刊Issue 期（次）Keyword 关键词Letter Let. 通讯、读者来信List 目录、一览表Manual 手册Medical Literature Analysis and MADLARS 医学文献分析与检索系统Retrieval SystemMedical Subject Headings MeSH 医学主题词表Note 札记Papers 论文Patent Cooperation Treaty PCT 国际专利合作条约Precision Ratio 查准率Press 出版社Procceedings Proc. 会报、会议录Progress 进展Publication Publ. 出版物Recall Ratio 查全率Record 记录、记事Report 报告、报导Review 评论、综述Sciences Abstracts SA 科学文摘Section Sec. 部分、辑、分册See also 参见Selective Dissemination of Information SDI 定题服务Seminars 专家讨论会文集Series Ser. 丛书、辑Society 学会Source 来源、出处Subheadings 副主题词Stop term 禁用词Subject 主题Summary 提要Supplement Suppl. 附刊、增刊。
医学英语文献阅读一(1-8词汇)
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。
卓顶精文2019医学文献翻译(中英对照)
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。
医学英语文献阅读二翻译
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。
医学图像分析外文文献翻译2020
医学图像（影像）分析外文翻译2020英文Medical Image Analysis: Human and MachineRobert NickBryan, Christos Davatzikos,etcINTRODUCTIONImages play a critical role in science and medicine. Until recently, analysis of scientific images, specifically medical images, was an exclusively human task. With the evolution from analog to digital image data and the development of sophisticated computer algorithms, machines (computers) as well as humans can now analyze these images. Though different in many ways, these alternative means of analysis share much in common: we can model the newer computational methods on the older human-observer approaches. In fact, our Perspective holds that radiologists and computers interpret medical images in a similar fashion.Critical to understanding image analysis, whether by human or machine, is an appreciation of what an image is. The universe, including all and any part therein, can be defined as:U=(m,E)(x,y,z)(t)Or, more qualitatively: the universe is mass and energy distributed within a three-dimensional space, varying with time. Scientific observations, whether encoded as numerical measurements or categorical descriptors, reflect information about one or more of these three intrinsic domains of nature. Measurements of mass and energy (m, E) are oftencalled signals. In medical imaging, essentially all our signals reflect measurements of energy. An image can be defined as a rendering of spatially and temporally defined signal measurements, or:I=f(m,E)(x,y,z)(t)Note the parallelism between what the universe is and how it is reflected by an image. In the context of scientific observations, an image is the most complete depiction of observations of nature— or in the case of medicine, the patient and his/her disease. Images and images alone include explicit spatial information, information that is intrinsic and critical to the understanding of most objects of medical interest.HUMAN IMAGE ANALYSISPattern recognition is involved in many, if not most, human decisions. Human image analysis is based upon pattern recognition. In medicine, radiologists use pattern recognition when making a diagnosis. It is the heart of the matter. Pattern recognition has two components: pattern learning and pattern matching. Learning is a training or educational process; radiology trainees are taught the criteria of a normal chest X-ray examination and observe hundreds of normal examinations, eventually establishing a mental pattern of “normal.” Matching involves decision-making; when an unknown chest film is presented for interpretation, the radiologist compares this unknown pattern to their “normal” pattern and makes a decision as to whether or not the case isnormal, or by exclusion, abnormal.One of the most striking aspects of human image analysis is how our visual system deconstructs image data in the central nervous system. The only place in the human head where there is anything resembling a coherent pattern of what we perceive as an image is on the surface of the retina. Even at this early point in the human visual process, the image data are separated into color versus light intensity pathways, and other aspects of the incoming image are emphasized and/or suppressed. The deconstruction of image data proceeds through the primary visual cortex into secondary, and higher, visual cortices where different components of image data, particularly those related to signal (brightness), space (shape), and time (change), are processed in distinct and widely separated anatomic regions of the brain. The anatomic substrate of these cortical patches that process image data is the six layered, cerebral cortex columnar stacks of neurons that make up local neural networks.The deconstruction of image data in the human brain—“what happens where”—is relatively well understood. However, the structures and processes involved in the reintegration of these now disparate data into a coherent pattern of what we perceive remains a mystery. Regardless of how the brain creates a perceived image, the knowledge that it does so by initially deconstructing image data and processing these different data elements by separate anatomic and physiological pathwaysprovides important clues as to how images are analyzed by humans.FINDINGS = OBSERVED KEY FEATURESIn the process of deconstructing image data, the human brain extracts key, or salient, features by separate mechanisms and pathways. These key features (KFs) reveal the most important information. While their number and nature are not fully understood, it is clear that KFs include signal, spatial, and temporal information. They are separately extracted and analyzed with the goal of defining dominant patterns in the image that can be compared to previously learned KF patterns in the process of diagnostic decision-making.Given that analyzing the patterns of KFs of an image is fundamental to human image interpretation, an obvious step in the interpretive process is to define the KFs to be extracted and the patterns thereof learned. This is the learning part of pattern recognition and is a function of image data itself, empirical experience, and task definition. KFs must be contained in the image data, extractable by an observer, and relevant to the decision-making process. Since image data consist of signal, spatial, and temporal information, KFs will likewise reflect one or more of these elements. To extract a KF, a human observer has to be able to see the feature on an image. In a black and white image, a KF cannot be color. Ideally, KFs are easy to see and report, i.e., extract.A KF must make a significant contribution to some decision basedon the image data. Since the ultimate performance metric of medical image interpretation is diagnostic accuracy, KFs of medical images must individually contribute to correct diagnoses. The empirical correlation of image features with specific diagnosis by trial and error observations has been the traditional way to identify KFs on the basis of their contribution to diagnosis. Observed KFs provide the content for the “Findings” section of a radiology report. For brevity and convenience, we will focus on signal and spatial KFs.Medical diagnosis in general and radiological diagnosis in particular is organ based. The brain is analyzed as a sep arate organ from the “head and neck,” which must be separately analyzed and reported. Every organ has its unique set of KFs and disease patterns. The first step in the determination of “normal” requires the learning of a pattern, which in this case consists of the signal and spatial KFs of a normal brain.For medical images, the signal measured by the imaging device is usually invisible to humans, and therefore the detected signal must be encoded as visible light, most commonly as the relative brightness of pixels or voxels. In general, the greater the magnitude of the signal detected by the imaging device, the brighter the depiction of the corresponding voxel in the image. Once again, the first step in image analysis is to extract a KF from the image, in this case relative voxel brightness. An individual image's signal pattern is compared to a learnednormal pattern. If the signal pattern of an unknown case does not match the normal pattern, one or more parts of the diagnostic image must be brighter or darker than the anatomically corresponding normal tissue.The specific nature of an abnormal KF is summarized in the Findings section of the radiology report, preferably using very simple descriptors, such as “Increased” or “Decreased” signal intensity (SI). To reach a specific diagnosis, signal KFs for normal and abnormal tissues must be evaluated, though usually only abnormal KFs are reported. Signal KFs are modality specific. The SIs of different tissues are unique to that modality. For each different signal measured, there is usually a modality specific name (with X-ray images, for example, radiodensity is a name commonly applied to SI, with relative intensities described as increased or decreased).Specific objects within images are initially identified and subsequently characterized on the basis of their signal characteristics. The more unique the signal related to an object, the simpler this task. For example, ventricles and subarachnoid spaces consist of cerebrospinal fluid, which has relatively distinctive SI on computed tomography (CT) and magnetic resonance imaging (MRI). Other than being consistent with the signal of the object of interest (i.e., cerebrospinal fluid), SI is irrelevant to the evaluation of the spatial features of that object. With minima l training, most physicians can easily “extract”, i.e., see anddistinguish signal KFs on the basis of relative visual brightness.The second component of the Findings section of a radiology report relates specifically to spatial components of image data. Spatial analysis is geometric in nature and commonly uses geometric descriptors for spatial KFs. The most important spatial KFs are number, size, shape and anatomic location. A prerequisite for the evaluation of these spatial attributes is identification of the object to which these descriptors will be applied, beginning with the organ of interest.In the case of the brain, we uniquely use surrogate structures, the ventricles and subarachnoid spaces, to evaluate this particular organ's spatial properties. Due to the fixed nature of the adult skull, ventricles and subarachnoid spaces provide an individually normalized metric of an individual's brain size, shape, and position. Fortunately, the ventricles and subarachnoid spaces can easily be observed on CT, MRI, or ultrasound and their spatial attributes easily learned by instruction and repetitive observations of normal examinations.The second step of pattern recognition—pattern matching—is completely dependent on the first step of pattern recognition—pattern learning. Matching is the operative decision-making step of pattern recognition. In terms of ventricles and subarachnoid spaces, the most fundamental spatial pattern discriminator is size, whether or not the ventricles are abnormally large or small. If the ventricles and/orsubarachnoid spaces are enlarged, the differential diagnoses might include hydrocephalus or cerebral atrophy. If they are abnormally small, mass effect is suggested, and the differential diagnosis might include cerebral edema, tumor, or other space occupying lesion. In any case, a KF extracted from any brain scan is the spatial pattern of the ventricles and subarachnoid spaces, this specific pattern is matched against a learned, experience-based, normal pattern, and a decision of normal or abnormal is made.When reporting image features, humans tend to use categorical classification systems rather than numeric systems. Humans will readily, though not always reliably, classify a light source as relatively bright or dark, but only reluctantly attempt to estimate the brightness in lumens or candelas. Humans are not good at generating numbers from a chest film, but they are very good at classifying it as normal or abnormal. If quantitative image measurements are required, radiologists bring additional measurement tools to bear, like a ruler to measure the diameter of a tumor, or a computer to calculate its volume. If pushed for a broader, more dynamic reporting range, a radiologist may incorporate a qualitative modifier, such as “marked,” to an abnormal KF description to indicate the degree of abnormality.Interestingly, and of practical importance, human observers tend to report psychophysiological observations using a scale of no more thanseven. This phenomenon is well documented in George Miller's paper, The Magical Number 7. A comparative scale of seven is reflected in the daily use of such adjective groupings as “mild, moderate, severe”; “possible, probable, definite”; “minimal, moderate, marked.” If an image feature has the possibility of being normal, increased, or decreased, with three degrees of abnormality in each direction, the feature can be described with a scale of seven. While there are other human observer scales, feature rating scales of from two to seven generally suffice and reflect well documented behavior of radiologists.Based on the concept of extracting a limited number of KFs and reporting them with a descriptive scale of limited dynamic range, it is relatively straightforward to develop a highly structured report-generating tool applicable to diagnostic imaging studies. The relative intensity of each imaging modality's detected signal is a KF, potentially reflecting normal or pathological tissue. An accompanying spatial KF of any abnormal signal is its anatomic location. A spatial KF of brain images is the size of the ventricles and subarachnoid spaces, which reflect the presence or absence of mass effect and/or atrophy.IMPRESSION = INFERRED DIFFERENTIAL DIAGNOSISMedical diagnosis is based upon the concept of differential diagnoses, which consist of a list of diseases with similar image findings.A radiographic differential diagnoses is the result of the logicallyconsistent matching of KFs extracted from a medical image to specific diagnosis. KFs are extracted from medical images, summarized by structured descriptive findings as previously described, and a differential diagnostic list consistent with the pattern of extracted features is inferred. This inferential form of pattern matching for differential diagnosis is reflected in such publications as Gamuts of Differential Diagnosis and StatDx. These diagnostic tools consist of a list of diseases and a set of matching image KFs.Differential diagnosis, therefore, is another pattern recognition process based upon the matching of extracted KF patterns to specific diseases. A complete radiographic report incorporates a list of observed KFs summarized in the FINDINGS and a differential diagnosis in the IMPRESSION, which was inferred from the KFs. A normal x-ray CT report might be:Findings•There are no areas of abnormal radiodensity. (Signal features encoded as relative light intensity)•The ventricles and subarachnoid spaces are normal as to size, shape, and position. (Spatial features of the organ of interest, the brain) •Ther e are no craniofacial abnormalities. (Signal/spatial features of another organ)•There is no change from the previous exam. (Temporal feature)Impression•Normal examination of the head. (Logical inference)For an abnormal report, one or more of the KF statements must be modified and the Impression must include one or more inferred diseases.Findings•There is increased radiodensity in the right basal ganglia.•The frontal horn of the right lateral ventricle is abnormally small (compressed).•There are no c raniofacial abnormalities.•The lesion was not evident on the previous exam.Impression•Acute intracerebral hemorrhage.The list of useful KFs is limited by the nature of signal and spatial data and is, we believe, relatively short. While human inference mechanisms are not fully understood, the final diagnostic impression probably reflects rule-based or Bayesian processes, the latter of which deal better with the high degree of uncertainty in medicine and take better advantage of prior knowledge, such as prevalence of disease in a practice.Less experienced radiologists and radiology trainees typically perform image analysis as outlined above, tediously learning and matching normal and abnormal signal and spatial patterns, consciously extracting KFs, and then deducing the best matches between the observedKFs and memorized KF patterns of specific diseases. This linear intellectual process is an example of “thinking slow,” a cognitive process described by Kahneman. However, when a radiologist is fully trained and has sufficient experience, he/she switches from this cognitive mental process to the much quicker “thinking fast,” heuristic mode of most professional practitioners in most fields. Most pattern matching tasks take less than a second to complete. A skilled radiologist makes the normal/abnormal diagnosis of a chest image in less than one second.In his book Outliers, Malcom Gladwell famously concluded that 10,000 hours of training are mandatory to function as a professional. The specific number has been challenged, of course, but it appropriately emphasizes the fact that professionals’ function differently than amateurs. They think fast, and, often, accurately. To achieve success at this level, the professional needs to have seen and performed the relevant task thousands of times—exactly how many thousand, who knows. The neuropsychological processes underlying these “slow” and “fast” mental processes are not clear, but it is hypothesized that higher order pattern matching processes become encoded in brain structure and eventually allow the “ah hah” identification of an “Aunt Minnie” brain stem cavernoma in a fraction of a second on a T1-weighted MRI image.However, humans working in this mode do make mistakes related to well-known biases, including: availability (recent cases seen),representativeness (patterns learned), and anchoring (prevalence). Other psychophysical factors such as mood and fatigue can also affect this process. Slower, cognitive thinking does not have the same faults and biases. The two types of decision-making are complementary and often combined, as in the case of a radiologist interpreting a case of a rare disease that they have not seen or a case with a disease having a more variable KF pattern.COMPUTER IMAGE ANALYSISWhereas humans can analyze analog or digital images, computers can operate only on digital or digitized images, both types of which can be defined as before:I=f((m,E)(x,y,z)(t))Therefore, computers face the same basic image analysis problem as humans and can perform this task similarly. As with human observers, computers can be programmed to deconstruct an image in terms of signal, spatial, and temporal content. It is relatively trivial to develop and implement algorithms that extract the same image KFs from digital data that radiologists extract from analog or digital data. Computers can be trained with pattern recognition techniques to match image KFs with normal and/or disease feature patterns in order to formulate a differential diagnosis.A significant difference between human and computer image analysis is the relative strength in classifying versus quantifying imagefeatures. Humans are very adept at classifying observations but can quantify them only crudely. In contrast, quantitative analysis of scientific measurements is the traditional forte of computers. Until recently, computers tended to use linear algebraic algorithms for image analysis, but with the advent of inexpensive graphics processing unit hardware and neural network algorithms, classification techniques are being widely implemented. Each approach has different strengths and weaknesses for specific applications, but combinations of the two will offer the best solutions for the diverse needs of the clinic.To illustrate these two computational options for image analysis, let us take the task of extracting and reporting the fluid-attenuated inversion recovery (FLAIR) signal KF on brain MRI scans. A traditional quantitative approach might be based on histogram analysis of normal brain FLAIR SIs. After appropriate preprocessing steps, a histogram of SI of brain voxels from MRI scans of a normal population can be described by Gaussian distribution with preliminary ±2 SD normal/abnormal thresholds, as for conventional clinical pathology tests. Those voxels in the >2 SD tail of the distribution can subsequently be classified as Increased SI; the voxels <2 SD as Decreased SI; with the remainder of the voxels labeled as Normal. By this process, each voxel has a number directly reflecting the measurement of SI and a categorical label based on its SI relative to the mean of the distribution of all voxel SIs. While usefulfor many image analysis tasks, this analytical approach has weaknesses in the face of noise, which is present on every image. Differentiating signal from noise is difficult for these linear models.The alternative classification approach requires the labeling, or “annotating,” of brain voxels as Increased, Normal, or Decreased FLAIR SI in a training case set. This labeling is often performed by human experts and is tedious. This training set is then used to build a digital KF pattern of normal and abnormal FLAIR SI. This task can be performed by a convolutional neural network of the 3-D U-Net type, using “deep learning” artificial intelligence algorithm s. After validation on a separate case set, this FLAIR “widget” can be applied to clinical cases to extract the FLAIR KF. These nonlinear, neural network classifiers often handle image noise better than linear models, better separating the “chaff from the wheat.” Note the fundamental difference of the two approaches. One is qualitative, based on the matching of human and computer categorical classification, while the other is quantitative, based on the statistical analysis of a distribution of signal measurements.For most medical images, there is a single signal measured for each image type and, therefore, a separate computational algorithm, or “widget,” is needed for each image type or modality. For a CT scan of the brain, only a single signal widget is needed to measure or classify radiodensity. For a multimodality MRI examination, not only are signalspecific pulse sequences required, but signal specific analytic widgets are necessary for FLAIR, T2, T1, diffusion-weighted imaging, susceptibility, etc. Regardless, rather than a radiologist's often ambiguous free-text report, the computer derived signal KFs are discrete and easily entered into a KF table.It should be noted that KFs reported in this fashion are associated with only one lesion, and this is a significant limitation of this simplistic approach. If there are multiple similar appearing lesions from the same disease (metastasis), this limitation is significantly mitigated by the additional spatial KF of multiplicity. However, if there are multiple lesions from different diseases, separate analysis for each disease must be performed and reported. This is a difficult task even for humans, and is, at present, beyond computational techniques.As with human observers, specific objects within images, such as a tumor, are detected and partially characterized on the basis of their abnormal SI. Lesions that have no abnormal signal are rare and difficult to identify. Once a computer has identified an object by its signal characteristics, whether by classification or numeric methods, the spatial features of the object must also be extracted. This requires spatial operators that combine voxels of related signal characteristics into individual objects that other algorithms must then count, measure, spatially describe, and anatomically localize. These KFs can be enteredinto the spatial components of a KF table.As with radiologists, organ-based analysis is advantageous and easily performed by computers. Requirements for the evaluation of whole organ spatial pattern s are “normal” anatomic atlases and computer algorithms for identifying specific organs and comparing their spatial properties to those of normal atlas templates. Remarkable progress has been made over the past 10 years in the development and use of digital, three-dimensional anatomic templates. Typically, tissue segmentation algorithms are applied, oftentimes relying on machine learning models. Atlas-based deformable registration methods then apply spatial transformations to the image data to bring anatomically corresponding regions into spatial co-registration with the normal atlas. There are numerous sophisticated software programs that perform these functions for evaluating the spatial properties of an organ or lesion. The output of these algorithms are the same spatial KFs reported by radiologists, including the number, size, and shape of organs and lesions and their anatomic locations.The computer, by extracting brain image KFs and reporting them numerically or categorically, can generate a highly structured Findings section of a radiology report that is directly comparable to that generated by a radiologist. The computer's extracted, discrete KFs can also be entered into a computational inference engine, of which there are many.One could use simple, naïve Bayesian networks, which structurally have an independent node for every disease with conditional nodes for each KF. These tools include look-up tables with rows listing all possible diagnoses, columns for all extracted KFs, and cells containing the probabilities of KF states conditioned on each covered disease. Given a set of KFs of a clinical examination, a Bayesian network calculates the probability of each disease and ranks them into the differential diagnoses that can be incorporated into the “Impression” section of the computer report. This is a form of computational pattern recognition resulting from best matches of particular KF patterns with a specific diagnosis.The preceding approach to computer image analysis closely resembles that of the cognitive, slow thinking, human. While the process is relatively transparent and comprehensible, it can be computationally challenging. But as with humans, there are alternative, faster thinking, heuristic computational methods, most commonly based on neural networks, that are a revolution in digital image analysis. The algorithms are usually nonlinear classifiers that are designed to output a single diagnosis, and nothing else. These programs are trained on hundreds or thousands of carefully “annotated” case s, with and without the specified disease. No intermediate states or information are used or generated. In other words, there are no KFs that might inform the basis of a diagnosis, nor is there quantitative output to provide more specific informationabout the disease or to guide clinical management. These “black box” systems resemble human professionals thinking fast, but with little obvious insight. However, an experienced radiologist incorporates thousands of these heuristic black boxes into his/her decision-making, many of which incorporate nonimage data from the electronic medical record, local practice mores, the community, and environment.For a computer algorithm to mimic the radiologist in daily practice, it too must incorporate thousands of widgets and vast quantities of diverse data. Such a task may not be impossible, but it does not seem eminent. Furthermore, a radiologist can, when necessary, switch from heuristics to the deliberative mode and “open” the box to explain why they made a particular diagnosis. This often involves the explication of associated KFs (mass effect) that may simultaneously be important for clinical management (decompression).CONCLUSIONA computer using contemporary computational tools functionally resembling human behavior could, in theory, read in image data as it comes from the scanner, extract KFs, find matching diagnoses, and integrate both into a standardized radiology report. The computer could populate the report with additional quantitative data, including organ/lesion volumetrics and statistical probabilities for the differential diagnosis. We predict that within 10 years this conjecture will be realityin daily radiology practice, with the computer operating at the level of subspecialty fellows. Both will require attending oversight. A combination of slow and fast thinking is important for radiologists and computers.中文医学图像分析：人与机器引言图像（影像）在科学和医疗中起着至关重要的作用。
医学文献翻译(中英对照)
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.。
医用英语医学文献翻译4(缺59整理版)
UNIT 1 TEXT B刷牙，使用牙线，以及每年2次的牙齿检查是口腔卫生保健标准，但是保护你珍珠样洁白的牙齿的好处远比我们知道的还要多。
在一篇评论文章中，塔夫茨大学牙科医学院的一个教员破除了常见的牙科神话，并概述了饮食和营养如何影响儿童，青少年，孕妇，成年人和老年人的口腔健康。
误区1：口腔卫生的不良后果是限制嘴巴准妈妈也许不知道她们所吃的食物会影响到胎儿的牙齿发育。
在怀孕过程中的营养缺乏也许会使未出生的孩子在今后的生活中更容易出现蛀牙。
“在14周到4个月大的时候，缺乏钙，维生素D，维生素A，蛋白质和卡路里会导致口腔软组织缺损，” Carole Palmer说。
Carole Palmer是，教育学博士(EdD)，注册营养师(RD)，塔夫茨大学教授，公共健康和社会服务系营养和口腔健康推进部的负责人。
有数据表明缺乏足够的维生素B6和B12可能是导致患唇裂和阻碍味觉形成的危险因素。
在童年的时候，最普遍的疾病是蛀牙，大约比儿童哮喘高五倍。
“如果一个儿童因为蛀牙而嘴巴受伤，他/她在学校会比较难集中注意力，而且会更喜欢吃容易咀嚼的食物，这些食物含有的营养往往更少些。
甜甜圈和点心这样的食物大多营养品质低下，含糖量高于其他需要咀嚼的富含营养的食物，比如水果和蔬菜，” Palmer说。
“口腔并发症与不良的饮食习惯会造成认知和生长发育问题，以及导致肥胖。
”误区2：吃越多糖，越容易蛀牙这与你吃了多少糖无关，而是糖和牙齿接触的时间有多少。
“食物，比如慢慢溶解的糖果和苏打水在嘴巴里停留的时间会比较久。
这增加了牙齿暴露在口腔细菌由糖产生成的酸中的时间，” Palmer说。
有研究表明，十几岁的青少年大约40%的碳水化合物是由软饮料中摄取的。
这些源源不断地软饮料增加了牙齿腐烂的风险。
无糖碳酸饮料和酸性饮料，比如柠檬水，往往被认为比含糖饮料对牙齿更安全，但是经常食用的话仍会造成牙齿釉质脱矿。
误区3：宝宝因蛀牙失去牙齿是可以的这是常见的误区，认为宝宝因为蛀牙失去牙齿是无关紧要的，因为宝宝的乳牙总会在将来某一天脱落。
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医学文献英文翻译
原文：皮质下缺血性脑血管疾病（subcortical ischemic vascular
disease,SIVD）是一组以小血管病变为主要病因、以皮质下多发性腔隙性梗死和脑白质病变为主要脑部损害的缺血性脑血管病，是引起血管性认知功能损害（vascular cognitive impairment，VCI）最常见的亚型。
SIVD可引起步态障碍，如帕金森样步态、共济失调性步态、走路不稳或无明显诱因的频繁跌倒，有研究表明，步态异常可能是血管性痴呆的早期标志。
本文将从SIVD导致步态障碍的病理机制、步态障碍类型、步态障碍与认知损害关系、步态障碍的分析与评价、治疗等方面进行综述。
翻译：皮质下缺血性脑血管疾病（subcortical ischemic vascular disease,SIVD）是一组以小血管病变为主要病因、以皮质下多发性腔隙性梗死和脑白质病变为主要脑部损害的缺血性脑血管病，是引起血管性认知功能损害（vascular cognitive impairment，VCI）最常见的亚型。
Subcortical ischemic vascular disease（SIVD）is a case of ischemic cerebrovascular disease, the leading cause of which is small vessel lesions, and the subsequent main damages to the brain are subcortical multiple lacunae infarct and leukodystrophy; it is the most common subtype that causes vascular cognitive impairment (VCI).
SIVD可引起步态障碍，如帕金森样步态、共济失调性步态、走路不稳或无明显诱因的频繁跌倒，有研究表明，步态异常可能是血管性痴呆的早期标志。
本文将从SIVD导致步态障碍的病理机制、步态障碍类型、步态障碍与认知损害关系、步态障碍的分析与评价、治疗等方面进行综述。
SIVD can induce gait disorder, such as Parkinson gait, ataxic gait, ataxia or frequent tumbles without obvious causes; research shows that abnormal gait may be early signs of vascular dementia. From the pathological mechanism of gait disorder caused by SIVD, this paper describes the types of gait disorder, the relationship between gait disorder and cognitive impairment and the analysis, evaluation as well as the treatment of gait disorders.。