柳叶刀中文版精选全文






《世界临床医学》柳叶刀中文版保持原刊风格和特色，发扬原版刊的品牌优势，选择适合中国国情及中国读者需求的新颖、实用信息，帮助中国医生了解世界医学进展最前沿。	柳叶刀中文版免费全文 \| 期刊介绍 \| 本期目录 \| 订购指南本期免费全文 Volume 4, Issue 11 中文标题: 乳腺癌术中定向放疗与术后全乳放疗的疗效比较（TARGIT-A试验）：一项国际多中心、前瞻性、非劣效性... 英文标题: Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial 作者: Jayant S Vaidya, David J Joseph, Jeffrey S Tobias,... 全文: 背　景　保乳术后90%的乳腺癌复发仍然会在手术切除区域发生，即使乳腺其他区域存在多中心癌灶时也是如此。因此，对一部分特定患者而言，手术中对瘤床区进行放射治疗可能是适当的。本研究比较了术中定向放疗与传统的术后全乳外照射的疗效。方　法　在安全试用Intrabeam进行术中定向单次剂量放疗这一新技术后，TARGIT-A试验于2000年3月24日启动。这是一项前瞻性、随机、非劣效性...

往期免费全文 [栏目介绍]

2010

Volume 4 , Issue 11

乳腺癌术中定向放疗与术后全乳放疗的疗效比较（TARGIT-A试验）：一项国际多中心、前瞻性、非劣效性Ⅲ期随机试验
Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial

Volume 4 , Issue 10

重组戊型肝炎病毒疫苗对健康成人的有效性和安全性：一项大型、随机、双盲、安慰剂对照III期试验
Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase

Volume 4 , Issue 9

利拉鲁肽与西他列汀治疗二甲双胍血糖控制不良2型糖尿病：一项26周、随机、平行组、开放标记试验
Liraglutide versus sitagliptin for patients with type 2 diabetes who did not have adequate glycaemic control with metformin: a 26-week, randomised, parallel-group, open-label trial

Volume 4 , Issue 8

急性心肌梗死患者入院前行远端缺血预适应作为血管成形术的补充及其对心肌挽救的影响：一项随机研究
Remote ischaemic conditioning before hospital admission, as a complement to angioplasty, and effect on myocardial salvage in patients with acute myocardial infarction: a randomised trial

Volume 4 , Issue 7

拟行有创性治疗的急性冠状动脉综合征患者应用替卡格雷与氯吡格雷的比较（PLATO）：一项随机双盲研究
Comparison of ticagrelor with clopidogrel in patients with a planed invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study

Volume 4 , Issue 6

新辅助化疗联合与不联合曲妥珠单抗对HER-2阳性局部晚期乳腺癌的疗效（NOAH试验）：一项伴HER-2阴性平行队列的优效性随机对照试验
Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort

Volume 4 , Issue 5

冠心病患者心脏除颤器植入术前稳定性室性心动过速导管消融术（VTACH）：一项多中心随机对照试验
Catheter ablation of stable ventricular tachycardia before deﬁbrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial

Volume 4 , Issue 4

2008年中国5岁以下儿童死亡原因
Causes of deaths in children younger than 5 years in China in 2008

Volume 4 , Issue 3

18个中低收入国家儿童残疾筛查、营养和早期教育状况分析：UNICEF第3轮多指标类集调查结果（2005—2006年）
Child disability screening, nutrition, and early learning in 18 countries with low and middle incomes: data from the third round of UNICEF’s Multiple Indicator Cluster Survey (2005–06)

Volume 4 , Issue 2

剂量密集紫杉醇联合卡铂治疗晚期卵巢癌：一项开放标记的III期随机对照试验
Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial

Volume 4 , Issue 1

未患糖尿病的高血压患者中常规与严格控制收缩压的比较（Cardio-Sis）：一项开放性随机试验
Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis): an open-label randomised trial

2009

Volume 3 , Issue 12

美国1例严重毁容患者的近全颜面移植
Near-total human face transplantation for a severely disfigured patient in the USA

Volume 3 , Issue 11

癌症的单克隆抗体免疫治疗
Monoclonal antibodies for cancer immunotherapy

Volume 3 , Issue 10

行非紧急经皮冠状动脉介入治疗的患者使用SCH530348的安全性和耐受性：一项随机、双盲、安慰剂对照II期研究
Safety and tolerability of SCH 530348 in patients undergoing non-urgent percutaneous coronary intervention: a randomised, double-blind, placebo-controlled phase II study

Volume 3 , Issue 9

普拉格雷与氯吡格雷用于拟行PCI的ST段抬高型心肌梗死患者的比较（TRITON-TIMI 38）：一项双盲、随机对照研究
Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial

Volume 3 , Issue 8

人类异体颜面移植：一项2年随访研究
Human facial allotransplantation: a 2-year follow-up study

Volume 3 , Issue 7

应用抑酸剂、H2受体拮抗剂和质子泵抑制剂升序或降序治疗新发消化不良的效果与成本效益分析（DIAMOND研究）：一项基于初级保健的随机对照试经验
Effect and cost-effectiveness of step-up versus step-down treatment with antacids, H₂-receptor antagonists, and proton pump inhibitors in patients with new onset dyspepsia (DIAMOND study): a primary-care-based randomised controlled trial

Volume 3 , Issue 6

GALA 临床试验：未能定论的回答
The GALA trial: answers it gives, answers it does not

Volume 3 , Issue 5

急性缺血性卒中发病3～4.5 h行阿替普酶溶栓治疗（SITS-ISTR）：一项观察性研究
Thrombolysis with alteplase 3-4.5 h after acute ischaemic stroke (SITS-ISTR): an observational study

Volume 3 , Issue 4

血管紧张素受体阻断剂替米沙坦对不耐受血管紧张素转换酶抑制剂的高危患者心血管事件的作用：一项随机对照试验
Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial

Volume 3 , Issue 3

一项关于瑞舒伐他汀在慢性心力衰竭患者中效应的随机、双盲、安慰剂对照试验：GISSI-HF试验
Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial

Volume 3 , Issue 2

组织工程气管临床移植
Clinical transplantation of a tissue-engineered airway

Volume 3 , Issue 1

在稳定型冠心病伴左室收缩功能障碍的患者中应用伊伐布雷定（BEAUTIFUL）：一项随机、双盲、安慰剂对照试验
Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial

2008

Volume 2 , Issue 12

心率作为冠心病与左室收缩障碍患者的预后危险因素（BEAUTIFUL）：一项随机、对照试验的一个亚组分析
Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial

Volume 2 , Issue 11

Dimebon对轻中度阿尔茨海默病患者认知、日常活动、行为和总体功能的影响：一项随机、双盲、安慰剂对照研究
Effect of dimebon on cognition, activities of daily living, behaviour, and global function in patients with mild-to-moderate Alzheimer's disease: a randomised, double-blind, placebo-controlled study

Volume 2 , Issue 10

胰岛素强化治疗对新诊断2型糖尿病患者B细胞功能和血糖控制的影响：一项多中心、随机、平行组研究
Effect of intensive insulin therapy on β-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial

Volume 2 , Issue 9

肝硬化
Liver cirrhosis

Volume 2 , Issue 8

儿童肾血管性高血压
Renovascular hypertension in children

Volume 2 , Issue 7

前列腺癌
Prostate cancer

Volume 2 , Issue 6

静脉注射甲氧基聚乙二醇促红细胞生成素-β对慢性肾病透析患者血红蛋白浓度的稳定作用：一项随机非劣效性试验（MAXIMA）
Intravenous methoxy polyethylene glycol-epoetin beta for haemoglobin control in patients with chronic kidney disease who are on dialysis: a randomised non-inferiority trial (MAXIMA)

Volume 2 , Issue 5

对雌激素受体缺乏乳腺癌进行辅助化疗：随机试验的患者水平荟萃分析
Adjuvant chemotherapy in oestrogen-receptor-poor breast cancer: patient-level meta-analysis of randomised trials

Volume 2 , Issue 4

他汀类药物在临床实践中的安全性
The safety of statins in clinical practice

Volume 2 , Issue 3

登革热
Dengue

Volume 2 , Issue 2

主要心脏事件高危或低危患者中药物洗脱支架的成本-效益：BASKET试验的18个月分析
Cost-effectiveness of drug-eluting stents in patients at high or low risk of major cardiac events in the Basel Stent KostenEffektivitäts Trial (BASKET): an 18-month analysis

Volume 2 , Issue 1

婴儿急性淋巴细胞白血病治疗方案(Interfant-99 ) ：一项多中心随机临床试验及观察研究
A treatment protocol for infantsyounger than 1 year with acute lymphoblastic leukaemia (Interfant-99): an observational study and a multicentre randomized trial

2007

Volume 1 , Issue 6

预防性二价L1病毒样颗粒佐剂疫苗在对抗年轻女性感染16与18型人乳头瘤病毒中的效应：一项III期、双盲、随机对照试验的期中分析
Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blin

Volume 1 , Issue 5

他莫昔芬治疗2-3 年后改用依西美坦或持续使用他莫昔芬治疗的存活性与安全性研究（依西美坦协作组研究）：一项随机、对照试验
Survival and safety of exemestane versus tamoxifen after 2-3 years' tamoxifen treatment (Intergroup Exemestane Study): a randomised controlled trial

Volume 1 , Issue 4

阿司匹林在结肠直肠癌远期发病风险中的效用：随机试验和观察性研究的一致性证据
Effect of aspirin on long-term risk of colorectal cancer : consistent evidence from randomised and observational studies

Volume 1 , Issue 3

SITS-MOST 中应用阿替普酶对急性缺血性卒中进行溶栓治疗：一项观察研究
Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study ( SITS-MOST ) : an observational study

Volume 1 , Issue 2

HER2 阳性乳腺癌辅助化疗后应用曲妥单抗治疗的2年随访研究：一项随机对照试验
2 - year follow - up of trastuzumab after adjuvant chemotherapy in HER2 -positive breast Cancer : a randomized controlled trial

Volume 1 , Issue 1

6-硫鸟嘌呤与 6-巯基嘌呤对儿童淋巴细胞白血病患者毒性及疗效的对比、随机试验
Toxicity and efficacy of 6-thioguanine versus 6-mercaptopurine in childhood lymphoblastic leukaemia : a randomised trial

2006

Volume 3 , Issue 6

连续性静脉血液透析滤过与间歇性血液透析对多器官功能障碍：综合征伴急性肾衰患者的疗效比较：一项多中心随机试验
Continuous venovenous heamodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial

Volume 3 , Issue 5

中性粒细胞在脓毒症引起多器官功能衰竭中的作用
Neutrophils in development of multiple organ failure in sepsis

Volume 3 , Issue 4

ACTIVE W：氯吡格雷加阿司匹林与单用口服抗凝药物治疗房颤的随机、对照试验
Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events ( ACTIVE W ) : a randomized

Volume 3 , Issue 3

多奈哌齐治疗重度阿尔茨海默病的双盲、平行组、安慰剂对照研究
Donepezil in patients with severe Alzheimer's disease: double-blind, parallel-group, placebo-controlled study

Volume 3 , Issue 2

自体骨髓干细胞移植治疗 ST 段抬高型心肌梗死患者的双盲、随机对照试验
Autologous bone marrow-derived stem-cell transfer in patients with ST-segment elevation myocardial infarction:double-blind, randomised controlled trial

Volume 3 , Issue 1

氯吡格雷联合阿司匹林对45852例急性心肌梗死患者的疗效评价：一项随机、安慰剂对照试验
Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction : randomised placebo-controlled trial

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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