MDT

MDT
  • 文章类型: Journal Article
    背景:近年来,甲状腺结节的发病率明显增加。治疗甲状腺结节的方法多种多样,而消融治疗是治疗甲状腺结节的重要方法之一。然而,目前甲状腺结节消融治疗存在许多并发症和不足,尤其是甲状腺癌结节的不完全消融,这限制了消融技术的进一步应用。在本文中,我们报告了2例甲状腺结节不完全消融术,其中一人由于消融后的焦虑而接受了手术治疗,术后病理证实仍有甲状腺乳头状癌残留,另一名患者在消融后接受了手术,但是由于颈部淋巴结转移在短时间内再次访问了我们的医疗机构,在根治性颈淋巴结清扫术后,病理证实为多发颈淋巴结转移。手术后进行放射性核素治疗,两名患者目前正在接受内分泌抑制治疗,病情稳定无复发迹象.
    结论:甲状腺癌结节的不完全消融限制了消融治疗的发展,使消融治疗成为一把双刃剑。准则和专家共识可以指导其发展,但是它们需要与时俱进,多学科诊断团队可以帮助筛选最合适的患者。只有更规范地使用这项技术,使用最合适的技术,治疗最合适的病人,可以使越来越多的患者受益。
    BACKGROUND: In recent years, the incidence of thyroid nodules has increased significantly. There are various ways to treat thyroid nodules, and ablation therapy is one of the important ways to treat thyroid nodules. However, there are many complications and deficiencies in the current ablation treatment of thyroid nodules, especially the incomplete ablation of thyroid cancer nodules, which limits the further application of ablation technology. In this paper, we report two cases of incomplete ablation of thyroid nodules, one of which underwent surgical treatment due to anxiety after ablation, and the postoperative pathology confirmed that there was still residual papillary thyroid carcinoma, and the other patient underwent an operation after ablation, but visited our medical institution again due to cervical lymph node metastasis in a short period of time, and after radical cervical lymph node dissection, pathology confirmed multiple cervical lymph node metastasis. Radionuclide therapy was performed after surgery, and two patients are currently receiving endocrine suppression therapy, and their condition is stable with no signs of recurrence.
    CONCLUSIONS: The incomplete ablation of thyroid cancer nodules limits the development of ablation therapy, making ablation treatment a double-edged sword. Guidelines and expert consensus can guide their development, but they need to evolve with the times, and a multidisciplinary diagnostic team can help screen the most suitable patients. Only by using this technology more standardly, using the most appropriate technology, and treating the most suitable patients, can benefit more and more patients.
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  • 文章类型: Journal Article
    目的:牙科材料科学是口腔医学的基础学科之一,涵盖临床领域,如正畸,口腔修复术,还有牙髓.由于其广泛的知识基础,专业性强,范围广,牙科材料科学的教学提出了挑战。本研究旨在通过比较不同教学方法的效果,加强牙科材料科学在口腔教学中的应用。
    方法:本研究项目经西安交通大学人体研究委员会评估,被批准为豁免研究。西安交通大学口腔医院第一年和第二年的56名临床口腔医学学生被选中进行研究。第一年的队列是非教学改革班,而二年级队列形成了教学改革班。通过问卷调查和期末考试结果评估教学改革的影响。
    结果:对教改班学生的问卷调查表明,他们对专业课程的兴趣和对教学的总体满意度有了明显的提高。此外,期末考试结果显示,教学改革班学生的优秀率明显高于非教学改革班学生,没有学生不及格。
    结论:采用多样化的教学模式可以提高牙科材料学教学的质量和效果,为改进这门学科的教学提供了一种新的方法。
    OBJECTIVE: Dental materials science is one of the fundamental disciplines in stomatology, encompassing clinical areas such as orthodontics, prosthodontics, and endodontics. Due to its extensive knowledge base, strong professional nature, and wide scope, teaching dental materials science presents a challenge. This study aimed to enhance the application of dental materials science in oral teaching by comparing the effectiveness of different teaching methods.
    METHODS: This research project was evaluated by the Xi\'an Jiaotong University Committee on Human Subjects Research and approved as exempt research. A total of 56 clinical stomatology students from the first year and second year cohorts at the Stomatology Hospital of Xi\'an Jiaotong University were selected for the study. The first year cohort served as the nonteaching reform class, while the second year cohort formed the teaching reform class. The impact of the teaching reform was assessed through a questionnaire survey and final examination results.
    RESULTS: The questionnaire survey of students in the teaching reform class indicated a significant improvement in their interest in professional courses and overall satisfaction with the teaching. Additionally, the final examination results revealed a significantly greater rate of excellence among students in the teaching reform class than among those in the nonteaching reform class, with no students failing.
    CONCLUSIONS: The use of diverse teaching modes can enhance the quality and effectiveness of dental materials science instruction, offering a new approach for improving teaching in this discipline.
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  • 文章类型: Journal Article
    中国临床肿瘤学会人工智能系统(CSCOAI)是利用中国乳腺癌数据开发的临床决策支持系统。我们的研究探讨了CSCOAI提供的乳腺癌治疗建议与其在临床环境中的实际应用之间的一致性。
    回顾性分析2017年1月至2022年12月在安徽医科大学第二附属医院接受治疗的537例乳腺癌患者。熟练的高级肿瘤学研究人员将患者数据手动输入到CSCOAI系统中。通过使我们的治疗方案与CSCOAI建议中的分类系统保持一致,定义了“一致”和“不一致”治疗类别。最初显示不一致的病例接受了医院多学科治疗(MDT)小组的第二次评估。当MDTS的治疗建议处于“一致”类别时,就达到了一致性。
    在所有乳腺癌患者的实际治疗方案和CSCOAI建议之间观察到令人印象深刻的80.4%的一致性。值得注意的是,与II期患者(76.06%,P=0.023)。此外,浸润性导管癌和小叶癌之间存在显着一致性(88.46%)。有趣的是,与其他分子亚型相比,三阴性乳腺癌(TNBC)的一致性率高(87.50%)。将MDT推荐的治疗方法与CSCOAI决策进行对比时,达成了总体92.4%的协议。此外,Logistic多变量分析强调了年龄的统计学意义,月经状态,肿瘤类型,分子亚型,肿瘤大小,和TNM阶段影响一致性。
    在乳腺癌治疗领域,CSCOAI提供的建议与MDT提供的建议之间的一致性占主导地位。CSCOAI可以成为乳腺癌治疗决策的有用工具。
    UNASSIGNED: The Chinese Society of Clinical Oncology Artificial Intelligence System (CSCO AI) serves as a clinical decision support system developed utilizing Chinese breast cancer data. Our study delved into the congruence between breast cancer treatment recommendations provided by CSCO AI and their practical application in clinical settings.
    UNASSIGNED: A retrospective analysis encompassed 537 breast cancer patients treated at the Second Affiliated Hospital of Anhui Medical University between January 2017 and December 2022. Proficient senior oncology researchers manually input patient data into the CSCO AI system. \"Consistent\" and \"Inconsistent\" treatment categories were defined by aligning our treatment protocols with the classification system in the CSCO AI recommendations. Cases that initially showed inconsistency underwent a second evaluation by the Multi-Disciplinary Treatment (MDT) team at the hospital. Concordance was achieved when MDTs\' treatment suggestions were in the \'Consistent\' categories.
    UNASSIGNED: An impressive 80.4% concurrence was observed between actual treatment protocols and CSCO AI recommendations across all breast cancer patients. Notably, the alignment was markedly higher for stage I (85.02%) and stage III (88.46%) patients in contrast to stage II patients (76.06%, P=0.023). Moreover, there was a significant concordance between invasive ductal carcinoma and lobular carcinoma (88.46%). Interestingly, triple-negative breast cancer (TNBC) exhibited a high concordance rate (87.50%) compared to other molecular subtypes. When contrasting MDT-recommended treatments with CSCO AI decisions, an overall 92.4% agreement was established. Furthermore, a logistic multivariate analysis highlighted the statistical significance of age, menstrual status, tumor type, molecular subtype, tumor size, and TNM stage in influencing consistency.
    UNASSIGNED: In the realm of breast cancer treatment, the alignment between recommendations offered by CSCO AI and those from MDT is predominant. CSCO AI can be a useful tool for breast cancer treatment decisions.
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  • 文章类型: Journal Article
    背景:多学科团队(MDT)方法可以最大程度地减少多发性创伤患者的发病率和死亡率。该项目评估了英国骨科协会目前在多大程度上满足了针对体弱骨科患者的创伤管理指南标准。
    方法:在2022年3月1日至2022年3月14日的2周捕获期内,对多家医疗机构的所有创伤和骨科患者进行了回顾性分析。收集的数据包括年龄,性别,损伤,停留时间和专业输入日期。
    结果:共纳入27家医院的1,050名患者。中位年龄是80岁,560(53.3%)的所有骨折是股骨颈骨折。在1,050名患者中,870例(82.9%)接受手术治疗。不同专业参与的中位数为3;645(61.4%)进行了正畸(OG)审查。在主要创伤中心(MTC),93.3%有OG输入,与非MTC的66.3%相比。输入最多的专业是放射学,塑料具有最低的输入。
    结论:需要一种标准化的MDT方法来优化骨科创伤患者的护理和康复。有关专业参与的结果差异很大,需要加以解决,以最大程度地减少这一脆弱的患者队列所接受的护理差异。
    BACKGROUND: A multidisciplinary team (MDT) approach to polytrauma patients minimises morbidity and mortality. This project assesses the extent to which British Orthopaedic Association Standards for Trauma guidelines for the management of the frail Orthopaedic patient are currently being met.
    METHODS: A retrospective analysis was performed of all Trauma and Orthopaedic patients in multiple medical institutions over a 2-week capture period from 1 March 2022 until 14 March 2022 inclusive. Data collected included age, sex, injury, length of stay and dates of speciality input.
    RESULTS: A total of 1,050 patients were included from 27 hospitals. The median age was 80 years, with 560 (53.3%) of all fractures being neck of femur fractures. Of the 1,050 patients, 870 (82.9%) were managed operatively. The median number of different speciality involvements was 3; 645 (61.4%) had an orthogeriatric (OG) review. In major trauma centres (MTC), 93.3% had OG input, compared with 66.3% in non-MTC. The speciality with the greatest input was Radiology, with Plastics having the lowest input.
    CONCLUSIONS: A standardised MDT approach is needed to optimise care and recovery in orthopaedic trauma patients. The difference in results regarding speciality involvement is substantial and needs to be addressed to minimise disparities in care received by this vulnerable cohort of patients.
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  • 文章类型: Journal Article
    印第安纳大学牙科学院TMJ研究所是一个多学科诊所,旨在支持患有挑战性颞下颌关节紊乱病的患者的管理。牙科专业人士,医学,物理治疗,和社会工作协作创建一个定制的,对患者护理的跨专业共识。与传统相比,孤立的医疗保健模型,诊断为TMJ功能障碍的患者是否对通过跨专业方法获得的护理质量感到满意?这项研究的目的是使用5点Likert量表患者问卷确定研究所的患者满意度。共发放问卷93份,收集问卷84份。总共有43%的患者在该研究所旅行了50英里以上。“强烈同意”是每个提示的最多选择的响应。例外是患者是否更愿意与每位临床医生单独会面,“强烈不同意”或“不同意”是最受欢迎的回应,这表明跨专业方法是首选。患者提供的结果和评论表明,大多数被诊断为TMJ功能障碍的患者对TMJ研究所使用的跨专业方法非常满意。我们的研究表明,积极的患者满意度是评估跨专业的质量和疗效的重要因素,以患者为中心的临床模型。
    The Indiana University School of Dentistry TMJ Institute is a multidisciplinary clinic designed to support the management of patients with challenging temporomandibular disorders. Professionals across dentistry, medicine, physical therapy, and social work collaborate to create a customised, interprofessional consensus to patient care. Compared with traditional, siloed healthcare models, are patients diagnosed with TMJ dysfunction satisfied with the quality of care received from an interprofessional approach? The objective of this study is to determine the level of patient satisfaction at the Institute using a 5-Point Likert scale patient questionnaire. A total of 93 questionnaires were distributed and 84 were collected. A total of 43% of patients travelled over 50 miles to be seen at the Institute. \'Strongly agree\' was the most selected response for each prompt. The exception was whether patients preferred to meet with each clinician individually, to which \'strongly disagree\' or \'disagree\' was the most popular response, indicating that an interprofessional approach was preferred. The results and comments provided by patients revealed that most patients diagnosed with TMJ dysfunction were highly satisfied with the interprofessional approach used at the TMJ Institute. Our study suggests that positive patient satisfaction is an important factor in assessing the quality and efficacy of interprofessional, patient-centred clinic models.
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  • 文章类型: Journal Article
    背景:在AEGEAN试验中,新辅助durvalumab加铂类化疗(D+CT),然后辅助durvalumab,与单独的新辅助化疗相比,可切除NSCLC患者的病理完全缓解(pCR)率和无事件生存期(EFS)显着提高。在太平洋试验中,巩固durvalumab显着改善了化疗后无法切除的III期NSCLC患者的无进展生存期(PFS)和总生存期(OS)。化学免疫疗法的强烈病理和临床结果引起了人们对其使用的兴趣,以使具有临界可切除NSCLC的患者能够接受手术。此外,对于最初认为可切除但后来在新辅助治疗期间无法切除/无法手术的患者,应探索放化疗后的巩固免疫治疗。
    方法:MDT-BRIDGE(NCT05925530)是一个多中心,第二阶段,~140例EGFR/ALK野生型患者的非随机研究,IIB-IIIB(N2)期非小细胞肺癌。在基线多学科小组(MDT)评估以确定可切除/临界可切除状态之后,所有患者每3周接受2个周期的新辅助D+CT,其次是MDT重新评估可切除性。认为可切除的患者接受1-2个额外的D+CT周期,然后进行手术(队列1)。认为不可切除的患者接受标准护理放化疗(队列2)。不符合手术条件的队列1患者可以进入队列2。手术或放化疗后,患者接受durvalumab辅助治疗或巩固治疗1年.主要终点是所有患者的切除率。其他终点包括基线可切除/临界可切除状态的切除率,切除结果,EFS/PFS,操作系统,pCR率,手术前后循环肿瘤DNA动力学(包括与临床结果的相关性),和安全。
    结论:报名于2024年2月开始;预计在2026年4月完成初选。
    BACKGROUND: In the AEGEAN trial, neoadjuvant durvalumab plus platinum-based chemotherapy (D+CT) followed by adjuvant durvalumab, versus neoadjuvant chemotherapy alone, significantly improved pathological complete response (pCR) rate and event-free survival (EFS) in patients with resectable NSCLC. In the PACIFIC trial, consolidation durvalumab significantly improved progression-free (PFS) and overall survival (OS) for patients with unresectable stage III NSCLC after chemoradiotherapy. Strong pathological and clinical outcomes with chemoimmunotherapy have generated interest in its use to enable patients with borderline-resectable NSCLC to undergo surgery. Additionally, for patients initially deemed resectable but who later become unresectable/inoperable during neoadjuvant treatment, consolidation immunotherapy after chemoradiotherapy should be explored.
    METHODS: MDT-BRIDGE (NCT05925530) is a multicenter, phase II, non-randomized study in ∼140 patients with EGFR/ALK wild-type, stage IIB-IIIB (N2) NSCLC. Following baseline multidisciplinary team (MDT) assessment to determine resectable/borderline-resectable status, all patients receive 2 cycles of neoadjuvant D+CT every 3 weeks, followed by MDT reassessment of resectability. Patients deemed resectable receive 1-2 additional cycles of D+CT followed by surgery (Cohort 1). Patients deemed unresectable receive standard-of-care chemoradiotherapy (Cohort 2). Cohort 1 patients who become ineligible for surgery can enter Cohort 2. Following surgery or chemoradiotherapy, patients receive adjuvant or consolidation durvalumab for 1 year. The primary endpoint is resection rate in all patients. Additional endpoints include resection rates by baseline resectable/borderline-resectable status, resection outcomes, EFS/PFS, OS, pCR rate, circulating tumor DNA dynamics pre- and post-surgery (including correlation with clinical outcomes), and safety.
    CONCLUSIONS: Enrollment began in February 2024; primary completion is anticipated in April 2026.
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  • 文章类型: Journal Article
    本文介绍了参与卫生和社会护理项目工作时获得的领导和管理知识以及经验的综合。第一部分对卫生和社会护理服务的领导和管理进行了批判性评估,专注于病房环境中的多学科团队。第二部分使用适当的反思模型对项目期间的个人领导和管理经验进行了批判性反思,总结了作为注册护士的经验教训并将其应用于未来的实践。一系列与领导力相关的理论和框架,对管理和团队工作进行了批判性评估,并提出了对当今医疗保健系统中政治和经济观点的批判性理解。
    This article presents a synthesis of the leadership and management knowledge and experience gained while participating in project work in health and social care. The first part presents a critical evaluation of leadership and management across health and social care services, with a focus on a multidisciplinary team in a ward setting. The second part presents a critical reflection on a personal leadership and management experience during the project using an appropriate model of reflection, a synthesis of lessons learnt and application to future practice as a registered nurse. A range of theories and frameworks related to leadership, management and team working are critically evaluated and a critical understanding of both political and economic perspectives within today\'s healthcare system is presented.
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  • 文章类型: Journal Article
    甲状腺结节的发病率逐年上升。手术治疗有效,但通常会导致严重的创伤,喉返神经损伤,甲状旁腺功能减退,和其他并发症。近年来,甲状腺结节消融治疗甲状腺疾病取得了重大突破,尽管其应用仍存在争议。目的是回顾甲状腺结节消融的发展历史和研究现状,为今后的研究提供参考。对甲状腺结节消融的文献进行了综述,分析其优缺点。甲状腺结节消融治疗甲状腺良性病变的疗效值得关注,但是治疗适应症松懈和过度医疗等问题仍然存在。在治疗甲状腺恶性病变方面已取得初步成功,特别是甲状腺乳头状微小癌(PTMC)。然而,疗效有待进一步随访验证。
    The incidence of thyroid nodules is rising annually. Surgical treatment is effective, but often results in significant trauma, recurrent laryngeal nerve injury, hypoparathyroidism, and other complications. Recent years have seen significant breakthroughs in thyroid nodule ablation for treating thyroid diseases, although its application remains controversial. The objective was to review the development history and current research status of thyroid nodule ablation to provide a reference for future studies. The literature on thyroid nodule ablation was reviewed, analysing its advantages and disadvantages. The therapeutic effect of thyroid nodule ablation in treating benign thyroid lesions is noteworthy, but issues such as lax treatment indications and excessive medical treatment persist. Initial success has been achieved in treating thyroid malignant lesions, particularly papillary thyroid microcarcinoma (PTMC). However, the curative effect requires further follow-up verification.
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  • 文章类型: Case Reports
    肺泡横纹肌肉瘤是一种严重恶性软组织肉瘤,主要影响儿童和青少年。然而,在这种肿瘤导致上肢局部骨破坏的情况下,医学领域缺乏关于最佳手术方法的共识。
    一名17岁男性左前臂有肿块,CT和MRI显示肿块穿透尺骨皮质,浸润髓质,导致形成偏心的跨心室肿瘤病灶。相当大的肿瘤影响了前臂的掌侧肌肉以及尺骨骨髓,对尺动脉和静脉施加压力。穿刺活检证实肿块为肺泡横纹肌肉瘤。经过两个疗程的新辅助化疗,肿瘤被广泛切除。在手术过程中,使用带有血管蒂的自体腓骨进行重建。在术后随访中,未观察到肿瘤局部复发.此外,患者在左前臂保留了令人满意的腕关节屈曲和内旋功能。
    肺泡横纹肌肉瘤是一种罕见且高度侵袭性的软组织肉瘤。科学管理需要多学科的方法,化疗与手术相结合。如果肿瘤侵入骨腔,应该仔细考虑肿瘤切除的边界,截骨的范围,以及设计手术计划时肌肉骨骼重建的方法。通过报告我们自己的病例并彻底回顾以前的临床经验,我们旨在为这种特殊疾病的治疗提供有价值的见解。
    UNASSIGNED: Alveolar Rhabdomyosarcoma is a profoundly malignant soft-tissue sarcoma that predominantly affects children and adolescents. However, the medical field lacks consensus regarding the optimal surgical approach to be undertaken in cases where this tumor causes local bone destruction in the upper limb.
    UNASSIGNED: A 17-year-old male presented a mass in his left forearm and CT and MRI indicated that the mass had penetrated the ulnar cortex and infiltrating the medulla, resulting in the formation of an eccentric trans-ventricular tumor focus. The sizable tumor affected the volar muscles of the forearm as well as the ulnar bone marrow, exerting pressure on the ulnar artery and vein. It was confirmed by needle biopsy that the mass is alveolar rhabdomyosarcoma. Following two courses of neoadjuvant chemotherapy, the tumor was widely excised en bloc. Autologous fibula with a vascular pedicle was utilized for reconstruction during the procedure. In the postoperative follow-up, no local recurrence of the tumor was observed. Furthermore, the patient retained satisfactory wrist flexion and pronation function in the left forearm.
    UNASSIGNED: Alveolar rhabdomyosarcoma is an uncommon and highly aggressive form of soft tissue sarcoma. Scientific management necessitates a multidisciplinary approach, combining chemotherapy with surgery. In cases where the tumor invaded into compartment of the bone, careful consideration should be given to the boundaries of tumor resection, the extent of osteotomy, and the approach to musculoskeletal reconstruction when designing the surgical plan. Through reporting our own case and thoroughly reviewing previous clinical experiences, we aim to provide valuable insights for the treatment of this particular disease.
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  • 文章类型: Case Reports
    我们报告一例新生儿Carmi综合征。
    分享我们在Carmi综合征病例诊断方面的经验教训。
    Carmi综合征是一种极其罕见的常染色体隐性遗传病,其特征是幽门闭锁和交界性大疱性表皮松解症并存,大约28%的患者患有先天性皮肤发育不全。在这种情况下,一名足月男性新生儿在医院通过剖宫产分娩出生到G4P2+1L1经产妇,与4000mLII°胎粪染色羊水非血缘婚姻.他被发现小腿和其他部位大面积皮肤脱落,有分散的水疱和双侧小耳畸形。腹部X线平片显示胃气泡大,远端无气体。由于未知原因,母亲先前有宫内胎儿丢失。皮肤科医生诊断新生儿患有巴特综合症,而儿科外科医生诊断为先天性幽门闭锁(CPA)。父母拒绝进一步治疗,新生儿在出生后约30小时去世。
    新生儿出生后约30小时死亡。
    这个案例的教训:①。排除PA患者的Carmi综合征,并区分Bart综合征和Carmi综合征患者的皮肤异常表现。②.对于罕见和/或严重的疾病,应建立多学科小组(MDT)。③.在随后的生育之前,遗传咨询和产前诊断是必要的。④.如果发现某些指标,则可以考虑终止妊娠。
    UNASSIGNED: We report a case of Carmi Syndrome in a neonate.
    UNASSIGNED: To share our lessons in diagnosis of the case of Carmi Syndrome.
    UNASSIGNED: Carmi Syndrome is an extremely rare autosomal recessive genetic disorder characterized the coexistence of pyloric atresia and junctional epidermolysis bullosa, and with aplasia cutis congenita in approximately 28% patients. In this case, a full-term male neonate was born to a G4P2+1L1 multipara through cesarean section delivery in hospital in a non-consanguineous marriage with 4000mL of II°meconium-stained amniotic fluid. He was found extensive skin loss over lower legs and other parts, with scattered blisters and bilateral microtia. Plain abdominal X-ray revealed a large gastric air bubble with no gas distally. The mother had an intrauterine fetal loss previously for reasons unknown. The dermatologist diagnosed the newborn with Bart Syndrome, while the pediatric surgeon diagnosed congenital pyloric atresia(CPA). The parents refused further treatment and the neonate passed away about 30 hours after birth.
    UNASSIGNED: The neonate passed away about 30 hours after birth.
    UNASSIGNED: Lessons from this case:①.Rule out Carmi Syndrome in patients with PA, and differentiate Bart syndrome and Carmi Syndrome in patients with abnormal skin manifestations. ②. For rare and/or severe diseases, multidisciplinary teams(MDTs) should be establish. ③. Genetic counseling and prenatal diagnosis are necessary prior to subsequent childbearings. ④.Termination of pregnancy might be contemplated if certain indicators are revealed.
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