一、英译汉
不给糖就捣蛋英文A 30-year-old woman prented to the office with a complaint of intermittent episodes of pain, stiffness, and swelling in both hands and wrists for approximately 1 year. The episodes lasted for veral weeks and then resolved. More recently, she noticed similar symptoms in her knees and ankles. Joints pain and stiffness were making it harder for her to get out of bed in the morning and were interfering with her ability to perform her duties at work. The joint stiffness usually lasted for veral hours before improving. She also reported malai and easy fatigability for the past few months, but she denied having fever, chills, skin rashes, and weight loss. Physical examination revealed a well-developed woman, with blood pressure 120/70 mmHg, heart rate 82 bpm , and respiratory rate 14 breaths per minute. Her skin did not reveal any rashes. Her head, neck, cardiovascular, chest, and abdominal examinations were negative. There was no hepatosplenomegaly. The joint examination revealed the prence of bilateral swelling, redness and tenderness of most proximal interphalangeal(PIP) joints, the wrists , and knees.
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二、汉译英
你可能会出现下列症状和体征:1、关节肿胀、疼痛、局部发热；2、晨僵，常超过1个小时；3、手臂包块(类风湿结节)；4、疲劳或体重减轻。早期类风湿关节炎以影响手足的小关节常见，如掌指关节、近端指间关节。随病情发展，症状常蔓延至腕、肘、肩、膝和踝部。大多数情况下，类似的关节症状会在身体两侧出现，我们称之为“对称性”。类风湿关节炎的严重程度因患者不同有所差异，而同一患者的病情也常反复。最终可导致关节变形和功能受限。employer
三、阅读写作
Adult-ont Still’s dia (AOSD) is an uncommon systemic inflammatory dia of unknown aetiology. Although its clinical picture tends to be very heteroge- neous, it typically prents with spiking fever, arthritis or arthralgia, an evanescent rash and leukocytosis. Up to 80% of AOSD cas can be controlled with corticosteroids ; however, reports on cas unresponsive to cortico- steroids, conventional dia modifying drugs and biolog- ical agents, including anti-IL1 inhibitors, are emerging. We prent a ca of AOSD with vere poylarthritis unrespon- sive to corticosteroids, methotrexate, anakinra
and etaner- cept, but successfully stabilid with a humanized monoclonal anti-IL-6 receptor antibody, tocilizumab.
A 35-year old man prented with a fever of up to 40°C, vere arthralgia and myalgia, and a palpable hepatomeg- aly. Laboratory tests showed leukocytosis (up to 23 × 109/l; normal, 4–10 × 109考研政治预测/l; 16.5 × 109remain是什么意思/l granulocytes), elevated liver enzymes (AST 3.40 μkat/l; normal, <0.5 μkat/l; ALT, 2.61 μkat/l; normal, <0.42 μkat/l; CRP 237 mg/l; normal, <5 mg/l) and feritin (13,871 μg/l; normal 20– 300 μg/l), while RF, ACPA, ANA, ENA, ANCA, anti- DNA and ACE were all negative. An abdominal ultrasound confirmed hepatosplenomegaly, and there were bilateral pleural effusion and enlarged mediastinal and hilar lymph nodes visible on the chest CT scan. All microbiologic tests including a Quantiferon-TB gold test were negative, while a mediastinal lymph node biopsy revealed reactive changes. He was diagnod with AOSD by fulfilling three major and three minor criteria described by Yamaguchi et al. while other inflammatory, infective or neoplastic caus were excluded. Initial parenteral methylprednisolone (80 mg daily) had failed to produce a significant clinical respon. Six weeks later, anakinra (100 mg daily subcu- taneously) was introduced. An excellent clinical and laboratory improvement followed; however, 2 months later the dia flared-up again with a fever of up to 38°C, elevated CRP (98 mg/l) and for the first time polyarthritis. Methotrexate (25 mg weekly) was added to the anakinra (100 mg subcutaneously daily), and methylprednisolone (8 mg daily) without success. Thereafter, we discontinued anakinra and introduced an anti TNF-alpha agent (etaner- cept, 50 mg subcutaneously weekly). The administration of methotrexate (25 mg weekly) and methylprednisolone (8 mg daily) was continued. After 3 months of treatment, thegunlock>不过如此是什么意思 polyarthritis affecting small joints, wrists and left knee and tenosynovitis of the extensor carpi radialis muscles persisted. Laboratory tests showed an incread dimentation rate (SR, 67 mm/h; normal <15 mm/h), elevated CRP (100 mg/l), leukocytosis (12.3×10英语免费翻译9/l, 10.1 × 109/l granulocytes) and elevated IL-6 (33 pg/ml, normal <8 pg/ml). We discontinued etanercept and after obtaining a written patient informed connt, we started to administer tocilizumab 8 mg/kg intravenously every 4 weeks, with methotrexate (15 mg weekly) and methyl- prednisolone (8 mg daily) as concomitant therapy. The clinical status improved remarkably within days and his laboratory tests normalid completely by the fifth tocilizumab administration. After 7 months of tocilizumab treatment, he is doing well, currently maintained on tocilizumab 8 mg/kg every 4 weeks, methotrexate 7.5 mg weekly and methylprednisolone 3 mg daily.
Discussion
Various cytokines, IL-1b and IL-6 among them, are believed to play a major role in AOSD [1]. Although corticosteroids currently remain the first line therapy for AOSD patients, followed by traditional DMARDs, refractory cas prent an incentive for developing new effective therapeutic options. Four cas of successful tocilizumab treatment in refractive AOSD patients have been described up to now (Table 1). In one of them, other biological agents, including anakinra as in our patient, were tried before tocilizumab. The initial tocilizumab dosing ranged from 4 mg/kg weekly to 8 mg/kg fortnightly， and we expanded this interval to 8 mg/kg monthly, which is the approved tocilizumab dosing in RA patients. As far as we know, this is the first reported ca of a refractive AOSD patient, who responded well to tocilizumab treatment administered once monthly from the very beginning. We obrved a rapid and stable clinical and laboratory improve- ment. Our patient received tocilizumab primarily for refractive polyarthritis which emerged while being treated with anakinra. Pascual and co-workers had already suggested that for patients with juvenile idiopathic arthritis (JIA), who share some characteristics with AOSD
迪士尼少儿英语
patients, anakinra might be less effective for the articular pha of the dia . Recent data suggest that the risk/benefit ratio for tocilizumab appears to be favourable in JIA . Therefore, it ems reasonable to suggest that for anakinra refractive AOSD patients with arthritis, tocilizumab could be the drug of choice. All in all, our ca offers further support to the clinical benefit of anti-IL-6 treatment in AOSD patients. 冬天裙子搭配
