19 颅内出血史
根据最初的 FDA 标签和2013年AHA/ASA指南,颅内出血史是静脉阿替普酶治疗缺血性卒中的一项额外禁忌证或排除标准。最近修订后的标签仅将近期 ICH 列为一项警告,并且在禁忌证中删除了ICH史。与前面讨论的静脉阿替普酶治...19 颅内出血史
根据最初的 FDA 标签和2013年AHA/ASA指南,颅内出血史是静脉阿替普酶治疗缺血性卒中的一项额外禁忌证或排除标准。最近修订后的标签仅将近期 ICH 列为一项警告,并且在禁忌证中删除了ICH史。与前面讨论的静脉阿替普酶治疗排除标准相似,文献回顾仅在大样本回顾性研究中发现了少量这类病例。缺乏相关数据可能是修订后的FDA 标签不再将 ICH 史作为禁忌证而仅将近期ICH 列为一项警告的原因。在这种情况下,FDA 如何定义“近期”一词尚不清楚。有趣的是,对在静脉阿替普酶治疗前通过 MRI 检测脑微出血（ cerebral microbleed, CMBs）存在情况进行的研究可为这个卒中亚组患者提供更多的见解。从病理生理学角度,这种微出血的原因尚不清楚,可能反映再灌注损伤或脑血管自动调节功能破坏。因此,在静脉阿替普酶治疗后出现这些损害可能没有意义或是人为信号。展开更多
AIM:To study secretion patterns of proand anti-in-flammatory cytokines, and activation of various cellular subsets of leukocytes in peripheral blood.METHODS: We have conducted a prospective obser-vational study. One h...AIM:To study secretion patterns of proand anti-in-flammatory cytokines, and activation of various cellular subsets of leukocytes in peripheral blood.METHODS: We have conducted a prospective obser-vational study. One hundred and eight patients with a diagnosis of acute pancreatitis and onset of the disease within last 72 h were included in this study. The mRNA expression of 25 different types of cytokines in white blood cells was determined by quantitative real time polymerase chain reaction. Levels of 8 different cytokines in blood serum were measured by enzymelinked immunosorbent assay. Clinical data and cytokine expression results were subjected to statistical analysis.RESULTS: Severe and necrotizing acute pancreatitis (AP) is characterized by the significant depletion of circulating lymphocytes. Severe acute pancreatitis is as-sociated with a typical systemic inflammatory response syndrome and over-expression of pro-inflammatory cy-tokines [interleukin (IL)-6, IL-8, macrophage migration inhibitory factor (MIF)]. Serum IL-6 and MIF concentra-tions are the best discriminators of severe and necrotiz-ing AP as well as possible fatal outcome during the early course of the disease. CONCLUSION: Deregulation of cellular immune sys-tem is a key event leading to severe and necrotizing AP. IL-6 and MIF could be used as early predictors of complications.展开更多
We study the symmetric positive semidefinite solution of the matrix equation AX_1A^T + BX_2B^T=C. where A is a given real m×n matrix. B is a given real m×p matrix, and C is a given real m×m matrix, with...We study the symmetric positive semidefinite solution of the matrix equation AX_1A^T + BX_2B^T=C. where A is a given real m×n matrix. B is a given real m×p matrix, and C is a given real m×m matrix, with m, n, p positive integers: and the bisymmetric positive semidefinite solution of the matrix equation D^T XD=C, where D is a given real n×m matrix. C is a given real m×m matrix, with m. n positive integers. By making use of the generalized singular value decomposition, we derive general analytic formulae, and present necessary and sufficient conditions for guaranteeing the existence of these solutions.展开更多
治疗药物监测(Therapeutic drug monitoring,TDM),如通过定量测定血清或血浆药物浓度指导用药剂量优化,已经成为对患者进行精神药物治疗的很有价值的工具。在患者用药依从性难以判断、药物耐受性不佳、治疗剂量下无效以及可能存在药代...治疗药物监测(Therapeutic drug monitoring,TDM),如通过定量测定血清或血浆药物浓度指导用药剂量优化,已经成为对患者进行精神药物治疗的很有价值的工具。在患者用药依从性难以判断、药物耐受性不佳、治疗剂量下无效以及可能存在药代动力学药物-药物相互作用等情况下,测定药物浓度是很有用的。在精神科,有可能明显获益于TDM的主要患者群体包括儿童、孕妇、老年患者、智力障碍患者、涉及司法的患者、已知或怀疑携带药代动力学相关基因变异的患者,以及合并躯体疾病影响药代动力学的患者。然而,只有将TDM充分整合到临床治疗过程中去,才能发挥其优化药物治疗的潜在优势。为了促进TDM的合理应用,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了精神药物治疗药物监测指南。之后,随着知识不断更新,又有许多可能需要进行TDM的新药上市。因此,本次更新将神经精神药物的种类扩展到了128种,并将其TDM必要性划分为从"强烈推荐"到"可能有用"的四个等级。经过大量细致且全面的文献检索与分门别类的汇总整理,将基于循证医学理念的"治疗参考浓度范围"和"剂量相关参考浓度范围"呈现给大家。本共识指南引入了"实验室警戒浓度"的新概念,即实验室需要马上告知治疗医生的药物浓度上限。本共识指南还给出了诸如药物作为细胞色素P450酶的底物和抑制剂的性质,代谢物与母药浓度比值的常见范围,以及与结果解释相关的内容,还提供了何时将TDM与遗传药理学检测相结合的建议。遵循本指南,有助于改善许多患者精神药物治疗的效果,特别是那些存在药代动力学异常的患者。TDM是一门交叉学科,有时针对看起来不一致的数据,需要多学科坦诚地讨论,只有这样,患者才能从这种合作中展开更多
AIM: To assess the management and outcome of hilar cholangiocarcinoma (Klatskin tumor) in a single tertiary referral center.METHODS: The notes of all patients with a diagnosis of hilar cholangiocarcinoma referred to o...AIM: To assess the management and outcome of hilar cholangiocarcinoma (Klatskin tumor) in a single tertiary referral center.METHODS: The notes of all patients with a diagnosis of hilar cholangiocarcinoma referred to our unit for over an 8-year period were identified and retrospectively reviewed. Presentation, management and outcome were assessed.RESULTS: Seventy-five patients were identified. The median age was 64 years (range 34-84 years). Male to female ratio was 1:1. Eighty-nine percent of patients presented with jaundice. Most patients referred were under Bismuth classification 3a, 3b or 4. Seventy patients required biliary drainage, 65 patients required 152percutaneous drainage procedures, and 25 had other complications. Forty-one patients had 51 endoscopic drainage procedures performed (15 failed). Of these,36 subsequently required percutaneous drainage. The median number of drainage procedures for all patients was three, 18 patients underwent resection (24%), nine had major complications and three died post-operatively.The 5-year survival rate was 4.2% for all patients, 21%for resected patients and 0% for those who did not undergo resection (P = 0.0021). The median number of admissions after diagnosis in resected patients was two and three in non-resected patients (P＜0.05).Twelve patients had external-beam radiotherapy, seven brachytherapy, and eight chemotherapy. There was no significant benefit in terms of survival (P = 0.46) or hospital admissions.CONCLUSION: Resection increases survival but carries the risk of significant morbidity and mortality.Percutaneous biliary drainage is almost always necessary and endoscopic drainage should be avoided if possible.展开更多
Soil samples were collected from different rubber fields in twenty-five plotsselected randomly in the Experimental Farm of the Chinese Academy of Tropical Agriculture Scienceslocated in Hainan, China, to analyse the e...Soil samples were collected from different rubber fields in twenty-five plotsselected randomly in the Experimental Farm of the Chinese Academy of Tropical Agriculture Scienceslocated in Hainan, China, to analyse the ecological effect of rubber cultivation. The results showedthat in the tropical rubber farm, soil microbial biomass C (MBC) and total organic C (TOC) wererelatively low in the content but highly correlated with each other. After rubber tapping, soil MBCof mature rubber fields decreased significantly, by 55.5 percent. compared with immature rubberfields. Soil TOC also decreased but the difference was not significant. Ratios of MBC to TOCdecreased significantly. The decreasing trend of MBC stopped at about ten years of rubbercultivation. After this period, soil MBC increased relatively while soil TOC still kept indecreasing. Soil MBC changes could be measured to predict the tendency of soil organic matterchanges due to management practices in a tropical rubber farm several years before the changes insoil TOC become detectable.展开更多
IL-23/IL-17 axis is an important regulator in various inflammatory diseases. However, the role of IL-23 in allergic airway inflammation is not well understood. In this study, we show that in an allergen-induced asthma...IL-23/IL-17 axis is an important regulator in various inflammatory diseases. However, the role of IL-23 in allergic airway inflammation is not well understood. In this study, we show that in an allergen-induced asthma model, mice with transgenic overexpression of IL-23R exhibited increased airway infiltration of eosinophils and Th2 cytokine production, whereas those deficient in IL-23 displayed reduced airway inflammation. In vitro, IL-23-IL-23R signaling promoted GATA-3 expression and enhanced Th2 cytokine expression. Conversely, in the absence of this signal, Th2 cell differentiation was partially inhibited. Therefore, IL-23 signaling may regulate allergic asthma through modulation of Th2 cell differentiation.展开更多
A novel radar-based system for longwall coal mine machine localisation is described. The system, based on a radar-ranging sensor and designed to localise mining equipment with respect to the mine tunnel gate road infr...A novel radar-based system for longwall coal mine machine localisation is described. The system, based on a radar-ranging sensor and designed to localise mining equipment with respect to the mine tunnel gate road infrastructure, is developed and trialled in an underground coal mine. The challenges of reliable sensing in the mine environment are considered, and the use of a radar sensor for localisation is justified. The difficulties of achieving reliable positioning using only the radar sensor are examined. Several probabilistic data processing techniques are explored in order to estimate two key localisation parameters from a single radar signal, namely along-track position and across-track position, with respect to the gate road structures. For the case of across-track position, a conventional Kalman filter approach is sufficient to achieve a reliable estimate. However for along-track position estimation, specific infrastructure elements on the gate road rib-wall must be identified by a tracking algorithm. Due to complexities associated with this data processing problem, a novel visual analytics approach was explored in a 3D interactive display to facilitate identification of significant features for use in a classifier algorithm. Based on the classifier output, identified elements are used as location waypoints to provide a robust and accurate mining equipment localisation estimate.展开更多
Tourette syndrome(TS) is a neurodevelopmental disorder characterized by multiple chronic motor and vocal tics beginning in childhood. Several studies describe the association between TS and attention deficit hyperacti...Tourette syndrome(TS) is a neurodevelopmental disorder characterized by multiple chronic motor and vocal tics beginning in childhood. Several studies describe the association between TS and attention deficit hyperactivity disorder(ADHD). Fifty percent of children diagnosed with ADHD have comorbid tic disorder. ADHD related symptoms have been reported in 35% to 90% of children with TS. Since ADHD is the most prevalent comorbid condition with TS and those with concomitant TS and ADHD present with considerable psychosocial and behavioral impairments, it is essential for clinicians to be familiar with these diagnoses and their management. This paper highlights the association between treating ADHD with stimulants and the development of tic disorders. The two cases discussed underscore the fact that children with TS may present with ADHD symptomatology prior to the appearance of any TS related symptoms. Appropriate management of TS in a patient diagnosed with ADHD can lead to quality of life improvements and a reduction in psychosocial impairments.展开更多
文摘AIM:To study secretion patterns of proand anti-in-flammatory cytokines, and activation of various cellular subsets of leukocytes in peripheral blood.METHODS: We have conducted a prospective obser-vational study. One hundred and eight patients with a diagnosis of acute pancreatitis and onset of the disease within last 72 h were included in this study. The mRNA expression of 25 different types of cytokines in white blood cells was determined by quantitative real time polymerase chain reaction. Levels of 8 different cytokines in blood serum were measured by enzymelinked immunosorbent assay. Clinical data and cytokine expression results were subjected to statistical analysis.RESULTS: Severe and necrotizing acute pancreatitis (AP) is characterized by the significant depletion of circulating lymphocytes. Severe acute pancreatitis is as-sociated with a typical systemic inflammatory response syndrome and over-expression of pro-inflammatory cy-tokines [interleukin (IL)-6, IL-8, macrophage migration inhibitory factor (MIF)]. Serum IL-6 and MIF concentra-tions are the best discriminators of severe and necrotiz-ing AP as well as possible fatal outcome during the early course of the disease. CONCLUSION: Deregulation of cellular immune sys-tem is a key event leading to severe and necrotizing AP. IL-6 and MIF could be used as early predictors of complications.
基金Subsidized by the Special Funds for Major State Basic Research Projects G1999032803
文摘We study the symmetric positive semidefinite solution of the matrix equation AX_1A^T + BX_2B^T=C. where A is a given real m×n matrix. B is a given real m×p matrix, and C is a given real m×m matrix, with m, n, p positive integers: and the bisymmetric positive semidefinite solution of the matrix equation D^T XD=C, where D is a given real n×m matrix. C is a given real m×m matrix, with m. n positive integers. By making use of the generalized singular value decomposition, we derive general analytic formulae, and present necessary and sufficient conditions for guaranteeing the existence of these solutions.
文摘治疗药物监测(Therapeutic drug monitoring,TDM),如通过定量测定血清或血浆药物浓度指导用药剂量优化,已经成为对患者进行精神药物治疗的很有价值的工具。在患者用药依从性难以判断、药物耐受性不佳、治疗剂量下无效以及可能存在药代动力学药物-药物相互作用等情况下,测定药物浓度是很有用的。在精神科,有可能明显获益于TDM的主要患者群体包括儿童、孕妇、老年患者、智力障碍患者、涉及司法的患者、已知或怀疑携带药代动力学相关基因变异的患者,以及合并躯体疾病影响药代动力学的患者。然而,只有将TDM充分整合到临床治疗过程中去,才能发挥其优化药物治疗的潜在优势。为了促进TDM的合理应用,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了精神药物治疗药物监测指南。之后,随着知识不断更新,又有许多可能需要进行TDM的新药上市。因此,本次更新将神经精神药物的种类扩展到了128种,并将其TDM必要性划分为从"强烈推荐"到"可能有用"的四个等级。经过大量细致且全面的文献检索与分门别类的汇总整理,将基于循证医学理念的"治疗参考浓度范围"和"剂量相关参考浓度范围"呈现给大家。本共识指南引入了"实验室警戒浓度"的新概念,即实验室需要马上告知治疗医生的药物浓度上限。本共识指南还给出了诸如药物作为细胞色素P450酶的底物和抑制剂的性质,代谢物与母药浓度比值的常见范围,以及与结果解释相关的内容,还提供了何时将TDM与遗传药理学检测相结合的建议。遵循本指南,有助于改善许多患者精神药物治疗的效果,特别是那些存在药代动力学异常的患者。TDM是一门交叉学科,有时针对看起来不一致的数据,需要多学科坦诚地讨论,只有这样,患者才能从这种合作中
文摘AIM: To assess the management and outcome of hilar cholangiocarcinoma (Klatskin tumor) in a single tertiary referral center.METHODS: The notes of all patients with a diagnosis of hilar cholangiocarcinoma referred to our unit for over an 8-year period were identified and retrospectively reviewed. Presentation, management and outcome were assessed.RESULTS: Seventy-five patients were identified. The median age was 64 years (range 34-84 years). Male to female ratio was 1:1. Eighty-nine percent of patients presented with jaundice. Most patients referred were under Bismuth classification 3a, 3b or 4. Seventy patients required biliary drainage, 65 patients required 152percutaneous drainage procedures, and 25 had other complications. Forty-one patients had 51 endoscopic drainage procedures performed (15 failed). Of these,36 subsequently required percutaneous drainage. The median number of drainage procedures for all patients was three, 18 patients underwent resection (24%), nine had major complications and three died post-operatively.The 5-year survival rate was 4.2% for all patients, 21%for resected patients and 0% for those who did not undergo resection (P = 0.0021). The median number of admissions after diagnosis in resected patients was two and three in non-resected patients (P＜0.05).Twelve patients had external-beam radiotherapy, seven brachytherapy, and eight chemotherapy. There was no significant benefit in terms of survival (P = 0.46) or hospital admissions.CONCLUSION: Resection increases survival but carries the risk of significant morbidity and mortality.Percutaneous biliary drainage is almost always necessary and endoscopic drainage should be avoided if possible.
基金Project supported by the National Key Basic Research Support Foundation of China (No. G1999011809)the United Nations Development Programme (UNDP, No. CPR/96/105).
文摘Soil samples were collected from different rubber fields in twenty-five plotsselected randomly in the Experimental Farm of the Chinese Academy of Tropical Agriculture Scienceslocated in Hainan, China, to analyse the ecological effect of rubber cultivation. The results showedthat in the tropical rubber farm, soil microbial biomass C (MBC) and total organic C (TOC) wererelatively low in the content but highly correlated with each other. After rubber tapping, soil MBCof mature rubber fields decreased significantly, by 55.5 percent. compared with immature rubberfields. Soil TOC also decreased but the difference was not significant. Ratios of MBC to TOCdecreased significantly. The decreasing trend of MBC stopped at about ten years of rubbercultivation. After this period, soil MBC increased relatively while soil TOC still kept indecreasing. Soil MBC changes could be measured to predict the tendency of soil organic matterchanges due to management practices in a tropical rubber farm several years before the changes insoil TOC become detectable.
文摘IL-23/IL-17 axis is an important regulator in various inflammatory diseases. However, the role of IL-23 in allergic airway inflammation is not well understood. In this study, we show that in an allergen-induced asthma model, mice with transgenic overexpression of IL-23R exhibited increased airway infiltration of eosinophils and Th2 cytokine production, whereas those deficient in IL-23 displayed reduced airway inflammation. In vitro, IL-23-IL-23R signaling promoted GATA-3 expression and enhanced Th2 cytokine expression. Conversely, in the absence of this signal, Th2 cell differentiation was partially inhibited. Therefore, IL-23 signaling may regulate allergic asthma through modulation of Th2 cell differentiation.
文摘A novel radar-based system for longwall coal mine machine localisation is described. The system, based on a radar-ranging sensor and designed to localise mining equipment with respect to the mine tunnel gate road infrastructure, is developed and trialled in an underground coal mine. The challenges of reliable sensing in the mine environment are considered, and the use of a radar sensor for localisation is justified. The difficulties of achieving reliable positioning using only the radar sensor are examined. Several probabilistic data processing techniques are explored in order to estimate two key localisation parameters from a single radar signal, namely along-track position and across-track position, with respect to the gate road structures. For the case of across-track position, a conventional Kalman filter approach is sufficient to achieve a reliable estimate. However for along-track position estimation, specific infrastructure elements on the gate road rib-wall must be identified by a tracking algorithm. Due to complexities associated with this data processing problem, a novel visual analytics approach was explored in a 3D interactive display to facilitate identification of significant features for use in a classifier algorithm. Based on the classifier output, identified elements are used as location waypoints to provide a robust and accurate mining equipment localisation estimate.
文摘Tourette syndrome(TS) is a neurodevelopmental disorder characterized by multiple chronic motor and vocal tics beginning in childhood. Several studies describe the association between TS and attention deficit hyperactivity disorder(ADHD). Fifty percent of children diagnosed with ADHD have comorbid tic disorder. ADHD related symptoms have been reported in 35% to 90% of children with TS. Since ADHD is the most prevalent comorbid condition with TS and those with concomitant TS and ADHD present with considerable psychosocial and behavioral impairments, it is essential for clinicians to be familiar with these diagnoses and their management. This paper highlights the association between treating ADHD with stimulants and the development of tic disorders. The two cases discussed underscore the fact that children with TS may present with ADHD symptomatology prior to the appearance of any TS related symptoms. Appropriate management of TS in a patient diagnosed with ADHD can lead to quality of life improvements and a reduction in psychosocial impairments.
