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撰寫(xiě)醫(yī)學(xué)英文論文格式及方法
醫(yī)學(xué)英語(yǔ)論文是醫(yī)學(xué)期刊的常見(jiàn)的文體。根據(jù)英國(guó)TheLancet雜志和香港Hong Kong Medical Journal上所登載的論文以及國(guó)外其它期刊所刊登的文章來(lái)分析,大體包括以下幾個(gè)方面內(nèi)容:標(biāo)題、摘要、引言、方法、結(jié)果、討論、致謝、參考文獻(xiàn)。關(guān)于英語(yǔ)標(biāo)題和摘要的寫(xiě)作格式在本刊2003年第4期上已經(jīng)論述。現(xiàn)就論文的引言、方法、結(jié)果、討論、致謝和參考文獻(xiàn)做一詳細(xì)論述,以饗讀者。
1 引言(Introduction)
引言即是論文的開(kāi)場(chǎng)白。在論文的引言中,作者主要介紹研究的背景和理由,具體說(shuō)明研究的內(nèi)容、目的、特點(diǎn)和意義。論文的背景和理由主要指研究主題的歷史,現(xiàn)狀,進(jìn)展以及仍然存在的問(wèn)題。引言可以對(duì)前人研究的結(jié)果,文獻(xiàn)摘用進(jìn)行評(píng)述,并且敘述作者著手研究的原因及研究的新發(fā)展等。
該部分內(nèi)容在時(shí)態(tài)上常運(yùn)用一般過(guò)去時(shí),一般現(xiàn)在時(shí)及現(xiàn)在完成時(shí)。舉例:
Introduction
The feasibility of ultrasonography for diagnosis of fetal cardiacabnormality was recognised in the early 1980s,and cardiac scanningis gradually being incorporated into fetal screening protocols.Theeffect of the screening process on the incidence and types ofcongenital heartdisease atterm has been difficultto ascertain becausemany pregnant women and infants travel great distances to specialistcentres which are farfrom their health authority.For a single centre,the geographical area from which its fetal referrals arrive is generallynot the same as the area attracting postnatal referrals,and the numberof births that each serves is impossible to define.The BritishPaediatric Cardiac Association(BPCA)undertook a nationalcollaborative study of fetal cardiac screening.The aim was to assessthe effect of fetal diagnosis of congenital heart disease on the patternof serious congenital heart disease at term.
2 方法(Methods)
該部分可依據(jù)所研究的對(duì)象或使用的材料和采用的方法,也可分別稱(chēng)之為:對(duì)象與方法(Subjects and methods or Patients and methods),材料與方法(Materials and methods)。方法部分實(shí)際上是論文的主體,它是對(duì)論文的內(nèi)容和采用的方法作出詳細(xì)的論述。具體的順序?yàn)?首先是所使用的材料或研究的對(duì)象,其次是程序安排,最后是結(jié)果計(jì)算或統(tǒng)計(jì)方法。方法部分一般為回顧性敘述,在時(shí)態(tài)上多采用一般過(guò)去時(shí),偶爾也有用過(guò)去完成時(shí)。不過(guò),假若敘述的是定義,理論,圖表內(nèi)容及數(shù)值,屬于客觀現(xiàn)象,故可采用一般現(xiàn)在時(shí)。舉例:
Patients and methods
The Information and Statistics Department of the Scottish Homeand Health Department collected data on the demographics andlaboratory results of all possible outbreak cases.We collected clinicaldata by reviewing the case notes of all cases admitted to hospital inthe Lanarkshire area.
All confirmed or probable cases ofEscherilchia coli(E coli)0157 infection,identified in the Lanarkshire area during the outbreakperiod,were included in the assessment and analysis.Confirmedcaseswere those in whom the outbreak strain ofE coliO157 wasisolated from stool samples.If stool cultureswere negative atthe locallaboratories,specimens were sent to Scotland'sE colireferencelaboratory in Aberdeen,for the more sensitive isolation method ofimmunomagnetic separation.Probable cases were those with bloodydiarrhoea or haemolytic uraemic syndrome(HUS)/thromboticthrombocytopenic purpura(TTP),an association with food sourcesimplicated in the outbreak,noE coliO157 isolated,and no otherorganism isolated.Adults were defined as patients 15 years of age orolder.
To allow standardisation of diagnosis in the face of a hugeclinical workload,a case definition for HUS and TTP was developedat the beginning of the outbreak.HUS was defined as evidence ofred-cell haemolysis(red-cell fragmentation on blood film and lactatedehydrogenase>1.5 times the upper limitof normal[our laboratory 0～480 IU/L])plus thrombocytopenia(platelets<150×109/L)with rising urea and creatinine concentrations.All three criteria hadto be met before the diagnosis could be made,but not necessarily onthe same blood sample.A diagnosis of TTPwas given to patientswhomet these laboratory criteria and developed new neurologicalsymptoms and signs.One patient was included as having developedHUS despite a minimum platelet count of 228×109/L(on death).
He had bloody diarrhoea,an association with an implicated foodsource,acute renal failure,the criteria for red-cell haemolysis,and afalling platelet count.
In the assessment of premorbid illness,medical historiesincluded as relevant were ischaemic heart disease,cardiac failure,hypertention,cerebrovascular disease,renal disease,diabetes,andimmunosuppression.Pulmonary oedemawas diagnosed on clinical andradiological evidence.
TPE was performed at three centres with three Cobe SpectraApheresis Systems(Cobe Laboratories Ltd,Gloucester,UK)and aBaxter Fenwal CS-3000 Plus Cell Separator(Baxter Healthcare,Newberry,UK).Plasma was exchanged with 2.0～2.4 Lfresh frozenplasma or cryosupernatant in refractory patients.The anticoagulantused was ACD-A.A combination of central and peripheral venousaccess was used.Intravenous hydrocortisone was given with eachexchange.Intravenous prostacyclin was also given to cases receivingTPE,at doses between 40 mg/h and 200 mg/h,where tolerated.Datawere analysed by means of SPSS(version 7.5).
3 結(jié)果(Results)。
結(jié)果部分是指作者在實(shí)驗(yàn)過(guò)程中對(duì)實(shí)驗(yàn)所獲得的結(jié)果進(jìn)行客觀的評(píng)述,也可以說(shuō)是對(duì)實(shí)驗(yàn)結(jié)果作出歸納。而且結(jié)果部分只是系統(tǒng)地介紹與主題研究緊密相關(guān)的數(shù)據(jù),例如,顯著的差異性,P值等,其結(jié)果部分是對(duì)過(guò)去的實(shí)驗(yàn)作出歸納概述,在時(shí)態(tài)上通常運(yùn)用一般過(guò)去時(shí)。舉例:
Results
There were 262 cases ofE coliO157 infection in theLanarkshire area:200 confirmed cases and 62 probable cases.Themedian age of all affected was 53 years,but there were highernumbers at the extremes of age.47%(124/262)of infectedindividualswere over 55 years of age.13(5%)people died.In 10cases death was associated with the systemic complications ofE coliO157 infection.
28(11%)of the Lanarkshire cases ofE coliO157 met thediagnostic criteria forHUS/TTP.Casesmet the criteria forHUS/TTPa median of 7 days(range 4～15)after the onset of gastrointestinalsymptoms.A further eight cases had evidence of thromboticmicroangiopathy but did not meet the criteria for HUS/TTP and werenot eligible for TPE.22(79%)cases with HUS/TTP were adultsand six(21%)were children.The median age of adults whodeveloped HUS/TTP was 71 years and the median age of children 6years.The demographics,clinical features,treatment,laboratoryresults,and outcome of the adult cases with HUS/TTP are shown intable 1.Blood results are taken from the day that the diagnosticcriteria for HUS/TTP were met,before TPE in cases so treated.
The mortality rate in adults with HUS/TTP was 45%(ten of22).Seven of 12 cases aged over 70 years and three of ten aged 70years or less died.There were no deaths in children.Necropsiesweredone for all cases who died.Causes of death in patients with HUS/TTPwere acute renal failure secondary to HUS(two cases),cardiacarrest(two cases),intracerebral haemorrhage,cerebral infarction,acute myocardial infarction,multiple organ failure,hepatorenalsyndrome secondary to macronodular cirrhosis and septic shock.
TPE was used in 16 of the 22 adultpatientswithHUS/TTP.Forpatients treated with TPE later received haemodialysis,because ofdeteriorating renal function.Patients who did not receive TPE wereeither too unwell to tolerate the procedure or died before TPE couldbe carried out.
In all 16 cases treated with TPE,the first exchange was firstdone within 24h of the criteria for HUS/TTP being met.Theminimum number of changes was one,the maximum 16,and themedian six.Patients underwent a total of 107 procedures,and 1100units of fresh frozen plasmawere used.Two patients proved refractoryto treatment with fresh frozen plasma,after five and six exchanges,but were successfully treated by additional TPE with cryosupernatantas the exchange fluid.Five of the 16(31%)TPE-treated patientsdied,four of eight aged over 70 years and one of eight aged 70 yearsor less.Premorbid illness,neurological features,treatment withciprofloxacin or prostacyclin,and the laboratory severity of HUS/TTPwere not associated with death,although the number of caseswas toosmall to allow statistical conclusion.
The most frequent complication associated with plasma exchangewas pulmonary oedema,which was diagnosed on clinical andradiological grounds in 11 cases.Pulmonary oedema was not confinedto patients undergoing TPE;three of six HUS/TTP cases not treatedwith TPE had pulmonary oedema.Hypocalcaemia(calcium<2.12mmol/L)occurred in 15 of the 16 patients treated with TPE.
Although severe(minimum serum calcium 1.32mmol/L)in manycases,intravenous magnesium was given when appropriate and noclinical effects were observed.Other complications associated withTPEwere line infectionwithmeticillin-resistantStaphylococcus aureusand extravasation infusion.
4 討論(Discussion)
討論部分也稱(chēng)之為結(jié)論(Conclusion),或者評(píng)論(Comments)。作者在該部分中要采用歸納,分析,推理,對(duì)比的方法來(lái)對(duì)自己的實(shí)驗(yàn)所涉及到問(wèn)題進(jìn)行探討,從而得出自己的結(jié)論或者提出自己的建議,是作者闡述自己觀點(diǎn)的重要部分;也是閱讀論文應(yīng)注意的地方。并且作者要簡(jiǎn)明扼要的引出論文所要討論的主題,接著把自己的實(shí)驗(yàn)數(shù)據(jù)、結(jié)果與前人研究的實(shí)驗(yàn)數(shù)據(jù)、結(jié)果進(jìn)行對(duì)比,并以推理、比較等方法來(lái)分析其異同性;最后用一句或一段文字引出結(jié)論或提出建議等。時(shí)態(tài)運(yùn)用上多采用一般過(guò)去時(shí)和一般現(xiàn)在時(shí)。舉例:
Discussion
HUS/TTP used to be a rare disease in adults,with an estimatedfrequency of one case per million per year.In 50%of cases it wasassociated with pregnancy,malignant hypertension,HIV infection,cancer,or chemotherapy,and the remainderof caseswere familial orof unknown cause.In 1986 the first association of HUS/TTP withEcoliO157 infection was made and the incidence of the disorder hassince continued to rise in parallel with the global rise inE coliO157infections.After exposure toE coliO157,between 3%and 7%ofall patients progress to overt HUS/TTP.The incidence of HUS/TTPis highest in children and elderly people.
The course and prognosis of HUS/TTP differ substantiallybetween adults and children.Children with HUS develop acute renalfailure precipitately and the treatment of choice is dialysis,which isinitiated when the child becomes oliguric.Most children respond todialysis,and mortality rates of less than 5%are nowreported.In thecentral Scotland outbreak there were no deaths in children.Adultsseem to develop neurological or cardiovascular complications beforethe onset of oliguria.Neurological features are associated withincreased mortality,and neurological and cardiovascularcomplications of HUS/TTP were the most frequent causes of death inthe central Scotland outbreak.
Plasma exchange is an expensive(￡2500 per person treated inour hospital)and intensive procedure.Its effectiveness in thetreatment of HUS/TTP induced byE coliO157 needs to be showndefinitively in a multicentre,randomised controlled trial.However,for a disease with very high mortality and just one potentiallybeneficial treatment option,a trial thatwithholds this optionwould behard to justify.It would also be extremely difficult to organise sincecases ofE coliO157 occur sporadically.There will always be anunavoidable selection bias within such a trial,with patients who areexcluded from treatment because they have contraindications to TPEorwho die before treatment can be initiated.
If 5%of all cases ofEcoliO157 develop HUS/TTP,we wouldexpect about 40 adult cases of HUS/TTP per year in the UK(datafrom the Communicable Disease Surveillance Centre and ScottishCentre for Infection and Environmental Health).We suggest that anational register be established for adult cases of HUS/TTP,ascurrently operates for cases in children.This database would enablemonitoring of treatment and outcomes in adults,providing definitiveevidence of the effectiveness of TPEwithin about 5 years.
There is no evidence from our experience that TPE is harmful.
A national register of HUS/TTP secondary toE coliO157 coulddefine the role of TPE in the treatment of this serious disorder.
5 致謝(Acknowledgements)
這是指作者在論文寫(xiě)作過(guò)程中,對(duì)那些給予提供幫助、贊助、批評(píng)或建議的個(gè)人或單位表示謝意。在這一部分中,通常采用一般現(xiàn)在時(shí),一句話概括出來(lái)。舉例:
AcknowledgementsWe thank AK R Chaudhuri and W HWatson for their clinicalcontribution;the renal physicians and haematoligists at GlasgowRoyal Infirmary and Stobhill Hospital for clinical assistance in themanagement of cases;M Drummond for data collection;and theCentral ScotlandE coliO157 Research Group for the laboratorydatabase.
6 參考文獻(xiàn)(References)
這一部分是指作者在寫(xiě)作過(guò)程中所參閱的參考文獻(xiàn)或引用其他作者的語(yǔ)句、論述、或觀點(diǎn)、看法等。一般于文后列出參考書(shū)目,期刊或文獻(xiàn),并列出文章、書(shū)籍、文獻(xiàn)、編者的姓名、期刊號(hào)與出版日期及頁(yè)碼等。
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