终末期肝病模型评分在原发性肝癌合并肝硬化脾功能亢进外科治疗中的作用

目的 探讨终末期肝病模型(MELD)评分评估肝储备功能在原发性肝癌合并肝硬化脾功能亢进中确定手术适应证的应用价值.方法 对2001年1月至2007年1月间行肝癌切除联合脾切除(联合术)治疗的40例原发性肝癌合并肝硬化脾功能亢进患者的临床资料进行回顾性分析.通过MELD评分与Child-Pugh分级比较,结合临床资料及术后并发症分析,确定这一方法在评估肝储备功能中的作用.结果 同一Child-Pugh分级的患者MELD评分结果并不一致,在各级别间有交错现象.术后发生肝功能衰竭组(6例)的MELD评分均值为(24.6±6.6).未发生肝功能衰竭组(34例)的MELD评分均值为(16.3±8.5),差异有统计学意义(P<0.05).根据MELD评分分为A组16例(MELD评分<10),B组17例(MELD评分10-20),C组7例(MELD评分>20).A组术后肝功能衰竭发生率为0,B组为11.8%(2/17),C组为57.1%(4/7),差异有统计学意义(P<0.05).根据Child-Pugh分级分为Ⅰ级26例,Ⅱ级14例.Ⅰ级术后肝功能衰竭发生率为15.4%(4/26),Ⅱ级为14.3%(2/14),差异无统计学意义(P>0.05).结论 MELD评分能够较为客观地反映肝储备功能,对外科术式的选择、手术时机的确定有一定的参考作用.     

Problem‐maintaining circles: Case illustrations of formulations that truly guide therapy

The cognitive behaviour therapy (CBT) emphasis on treatment relevance in assessment, and on evidence‐based intervention, has led to an increasing focus on problem maintenance factors (vs. precipitants) in both its models of psychopathology and in its individual case formulations. This article describes the reasons for this growing focus, and presents a generic CBT model based on the functional analysis of “problem‐maintaining circles” (PMCs) of causes. Some samples of the profuse literature implicating PMCs in many psychological disorders are presented, and the utility of PMC‐based functional analysis, case formulation, or modelling of psychopathology is advanced, not only as a guide to selection of therapeutic interventions, but as an alternative to standard psychiatric diagnosis. A sampling of a taxonomy of such PMCs is presented. And finally, the clinical application of PMC‐based functional analysis, case formulation, and treatment selection is illustrated in five case illustrations drawn from a recent clinical caseload.     

Rapid microassays of phagocytosis, bacterial killing, superoxide and hydrogen peroxide production by human neutrophils in vitro

Simple, rapid microassays for simultaneous measurement of phagocytosis, bacterial killing, superoxide and hydrogen peroxide production by human neutrophils in vitro are described. All assays employ 96-well flat bottom tissue culture plates which were incubated on a microtitre plate shaker at 37 degrees C. The separate evaluation of ingestion and intracellular killing of E. coli and S. aureus was based on the incorporation of [3H]uridine into viable extracellular bacteria. There was good correlation between plate counts of viable bacteria and amount of radiolabel incorporation. Phagocytosis and killing can be measured in a maximum of 100 microliter reaction mixture, requiring only 2.5 X 10(5) neutrophils per test and the assay is complete within 60 min. Assay of superoxide production by stimulated neutrophils was based on superoxide-dependent reduction of ferricytochrome c as measured spectrophotometrically at 550 nm in wells of tissue culture plates containing 150 microliter of reaction mixture. The assay requires only 1.25 X 10(5) neutrophils per test and is complete within 50 min. Quantitation of hydrogen peroxide was based on horseradish peroxidase-dependent oxidation of phenol red. The technique is as for superoxide detection except that the reaction must be terminated by the addition of 1 M NaOH at the desired time intervals. None of the assays require sampling during the incubation period. The principal advantages of the described techniques are increased simplicity and speed, requirement of low numbers of neutrophils and applicability to analysis of large number of samples in parallel.     

Hormonally Functional Ovarian Neoplasms

Hormonally functional ovarian neoplasms are those tumors that secrete one or more hormones that are clinically manifested in the patient. The hormone production may have implications for the diagnosis, management, or treatment of the patient. Hormonally functional ovarian neoplasms include tumors that belong to various histologic categories and produce a variety of hormonal effects. Functional ovarian tumors most commonly produce steroid hormones, and such tumors frequently belong in the sec cordstromal and steroid cell categories. In addition, a wide variety of peptide hormones may be produced by ovarian tumors. Although in most instances the neoplastic cells themselves produce the hormones, a wide variety of tumors may induce their stroma to produce steroid hormones. The stroma of ovarian tumors is derived from the ovarian stroma and may, on occasion, resemble specialized ovarian stroma and its derivatives. Cells resembling luteinized stromal cells or luteinized theca cells may be present and appear to be responsible for the resultant hormone secretion.     

Effekte einer Captopriltherapie auf die Natrium- und Wasserausscheidung bei Patienten mit Leberzirrhose und Aszites

Summary Ascites in patients with cirrhosis of the liver frequently is refractory to diuretic treatment. It was postulated that vasoconstriction of the renal cortex, mediated by activation of the renin-angiotensin-aldosterone-system (RAAS), may be one course of the disturbed sodium- and water-excretion in these patients. We therefore investigated in 14 cirrhotic patients with ascites under constant diuretic treatment the effects of low-dose captopril therapy on urinary sodium- and potassium-excretion, body weight, abdominal girth, serum-sodium,-potassium, creatinine-clearance, plasma-renin-activity (PRA), plasma-aldosterone (PA) and mean arterial pressure (MAP). After a control period of 4 days the patients received 2 × 6.25 mg/d captopril for 5 days and 4 × 6.25 mg/d for further 5 days. Treatment was followed by a second control period without captopril.PRA increased significantly after 2 days of captopril treatment. 2 × 6.25 mg/d captopril induced a significant increase in sodium excretion and a significant decrease of body weight. MAP decreased slightly but significantly without clinical signs of hypotension. 4 × 6.25 mg/d captopril resulted in a further reduction of body weight and a further enhancement of sodium excretion. Three days after withdrawal of captopril sodium output was significantly reduced again. Conclusion: In cirrhotic patients low-dose captopril seems to be efficient in the treatment of ascites resistant to diuretics without causing major side effects.

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Abkürzungen ACE Angiotensin-Converting-Enzym - A-II Angiotensin II - C_{H 2 O} Frei-Wasser-Clearance - C_Krea Kreatinin-Clearance - C_Osmo Osmolale Clearance - g Gramm - h Stunde - kg Kilogramm - l/d Liter pro Tag - MAP Mittlerer arterieller Blutdruck - mg Milligramm - mg/d Milligramm pro Tag - ml/min Milliliter pro Minute - mmHg Millimeter Quecksilbersäule (Torr) - mmol/d Millimol pro Tag - NaCl Natriumchlorid - ng/ml/h Nanogramm pro Milliliter und Stunde - PA Plasma-Aldosteron - pg/ml Picogramm pro Milliliter - PRA Plasma-Renin-Aktivität - RAAS Renin-Angiotensin-Aldosteron-System - SEM Standardfehler des Mittelwertes - S_Krea Kreatininkonzentration im Serum - S_Osm Serum-Osmolalität - U_Krea Kreatininkonzentration im Urin - U_Osm Urin-Osmolalität - V Urinminutenvolumen - vgl. vergleiche - µmol/l Micromol pro Liter     

模拟退火算法在图像配准中的应用

近年来 ,脑功能成像技术发展迅速 ,已在脑科学研究中占有重要地位。研究中通常需要将同一被试的多种模式成像结果或同一模式的时间序列结果结合起来分析 ,首先要解决的问题就是几幅图像的严格对齐问题 ,即所谓的图像配准。在模拟退火算法和其它工作的基础之上 ,较好的解决了图像配准中的连续变量全局优化问题 ,通过基于点的配准方法 ,实现了时间序列脑功能图像的高精度配准。     

基因功能预测问题中的样本不平衡处理

应用机器学习进行分类是基因功能预测的一种重要手段。但是许多预测集中的阳性样本过少，会降低功能预测的效果。针对此问题，本研究对结合支持向量机（SVM）算法的几种常用非平衡数据分类方法进行实验比较，包括投票整合分类器和移动分类面等。在此基础上提出通过加权修正投票的整合策略，以提高预测效果。实验结果显示，结合多数类样本限数取样及整合思想的投票整合法预测效果优于移动分类面法，而在投票整合法基础上的加权修正整合方法在所有方法中获得更好更稳定的结果。     

炎症介导的外周神经致敏在感染后肠易激综合征发病中的作用研究

目的： 应用实验性结肠炎动物模型探讨炎症介导的外周神经致敏在肠易激综合征（IBS）内脏高敏感状态发生中的作用。 方法： 应用三硝基苯磺酸（TNBS） 灌肠造成实验性结肠炎动物模型，在炎症的不同时期（灌肠后7 d，21 d,42 d），用免疫组织化学法测定支配远端结肠的脊髓背根神经节初级传入神经元上感觉性神经递质CGRP和感受伤害性刺激的受体VR1的表达,比较炎症不同阶段降钙素基因相关肽（CGRP）和香草酮受体1(VR1) 阳性神经元的比例，以期验证炎症介导的外周神经致敏是否肠易激综合征内脏高敏感状态发生的重要机制。 结果： 炎症急性期（给予TNBS后7 d），支配炎症肠段的脊髓背根神经节初级传入神经元上CGRP和VR1的表达明显高于生理盐水对照组（P<0.05）；而且这种异常增高的表达可以持续存在至炎症消退后,即灌肠后21 d和42 d CGRP和VR1的表达仍高于生理盐水对照组（P<0.05）。 结论： 炎症介导的外周神经致敏是内脏高敏感状态发生的机制之一,这种高敏感状态在炎症消退后一定的时间内可以持续存在,因此炎症介导的外周神经致敏在感染后IBS的发生中具有重要的作用。