Auxiliary partial liver transplantation for acute liver failure using "high risk" grafts: Case report

Acute liver failure(ALF) is a reversible disorder that is associated with an abrupt loss of hepatic mass, rapidly progressive encephalopathy and devastating complications. Despite its high mortality, an emergency liver transplantation nowadays forms an integral part in ALF management and has substantially improved the outcomes of ALF. Here, we report the case of a 32-year-old female patient who was admitted with grade Ⅳ hepatic encephalopathy(coma) following drug-induced ALF. We performed an emergency auxiliary partial orthotopic liver transplantation with a "high risk" graft(liver macrovesicular steatosis approximately 40%) from a living donor. The patient was discharged on postoperative day 57 with normal liver function. Weaning from immunosuppression was achieved 9 mo after transplantation. A follow-up using CT scan showed a remarkable increase in native liver volume and gradual loss of the graft. More than 6 years after the transplantation, the female now has a 4-year-old child and has returned to work full-time without any neurological sequelae.     

35例原发性十二指肠癌的诊断及治疗分析

目的总结原发性十二指肠癌的诊治经验,提高其诊治水平。方法回顾分析2001年1月～2007年12月我院经内镜及手术确诊的35例原发性十二指肠癌患者的临床资料。结果本组病例肿瘤位于十二指肠球部6例;十二指肠降部26例;十二指肠水平部3例。其中乳头状腺癌8例、管状腺癌23例、黏液腺癌2例,类癌1例,恶性间质瘤1例。胃镜确诊率为77.4%;上消化道钡餐造影确诊率为52.4%。CT确诊率为46.7%;B超确诊率为10.3%;MRCP确诊率为6.9%。行胰十二指肠切除术22例,十二指肠乳头切除、乳头成形术6例,胃空肠吻合术3例,单纯肿物切除术1例,姑息性旁路手术2例。结论原发性十二指肠癌发病部位以十二指肠降部尤其乳头周围部为多,病理以腺癌为主;本病诊断首选内镜检查,其次是十二指肠气钡双重造影;手术切除尤其是胰十二指肠切除术是最常用、最可靠的治疗方法。     

基于数据挖掘的《证治汇补》治疗脾胃病用药规律研究

目的:基于数据挖掘研究《证治汇补》治疗脾胃病的用药规律,以期为中医治疗脾胃病提供依据。方法:运用中医传承辅助平台V2.5软件对《证治汇补》中治疗脾胃病的有效方剂进行性味归经分布、频次统计、组方规律、核心组合、新方的分析。结果:共收集有效方剂137首,涉及中药159味,使用频次≥10的药物25味,以性温、味辛、归脾经类药物最多;支持度个数设置为18,置信数为0.6,得到常用药对及组合15个;基于软件复杂熵层次聚类方法,得到用于新方聚类的核心组合32组,聚合成新方16首。结论:《证治汇补》中治疗脾胃病以温补脾阳为主,用药方面以辛温药升阳行气为主,辅以甘性药滋补和中、调和药性。     

Regional frequency variation during human ventricular fibrillation

Quantifying the regional frequency variation in ventricular fibrillation (VF) may lead to focal strategies in treating human VF. We hypothesized that during human VF there are quantifiable regional frequency variations in the ventricles and they relate to underlying fixed myocardial substrate. In eight myopathic human hearts, we studied 35 VF episodes. The electrograms during VF were acquired simultaneously from the epicardium and endocardium using 2 electrode arrays each consisting of 112 electrodes. Regional characterization was performed using a ratio parameter derived from the dominant frequency analysis of the electrograms. The findings were related to the anatomical substrate using bipolar voltage maps. The results of the analysis indicate that LV had a larger dominant frequency (DF) span than RV (p=0.0111) while there was no significant difference (p=0.1488) in the DF span between LV freewall (FW) and septum (SE). Correlation of areas of abnormal myocardium with the dominant frequency feature matched only in 50% of the cases indicating that ion channel heterogeneity and time-varying physiological factors may play an important role in maintaining VF.     

1,6-二磷酸果糖对辅助性肝移植肝脏保护的实验研究

目的 探讨1,6-二磷酸果糖对辅助性肝移植肝脏保护的效果.方法 复制辅助性肝移植模型,随机将配成12对的幼猪分为生理盐水对照组和10%1,6-二磷酸果糖实验组,每组12只.分别于手术开始(T0)、切肝前30 min(T1)、切肝期30min(T2)、再灌注后15min(T3)、再灌注后60min(T4)、手术结束(Ts)各时点采外周动脉血测定丙二醛(malondiaIdehyde,MDA)及超氧化物歧化酶(superoxide dismutase,SOD)、谷胱甘肽过氧化酶(glutathione peroxidase,GSH-PX)活性和总抗氧化能力(totalantioxidative,T-AOC)的血浆浓度,术后取肝脏组织观察其病理变化.结果 1,6-二磷酸果糖组MDA只在T5时点明显升高(P<0.05),GSH-PX各时点与基础值比较无明显升高(P>0.05).SOD各时点与基础值比较明显增高(P<0.05),T-AOC在T3、T4和T5比基础值明显升高(P<0.05),且比对照组相同时点差异也有统计学意义(P<0.05).实验组肝脏损伤损害较轻.结论 1,6-二磷酸果糖为糖酵解中高能中间代谢产物,能改善细胞能量代谢,稳定细胞膜,抑制氧自由基的产生,从而对辅助性肝移植肝脏缺血/再灌注损伤有一定的保护作用.     

一种中医辨证多标记学习算法的设计及实现

临床上中医辨证结果往往出现多个证型兼夹的情况，针对多证型的建模属于典型的多标记学习问题。传统的多标记学习算法不同标签之间相互独立，而兼夹证型中的各个证型（标签）之间存在紧密联系，传统的多标记学习算法无法解决这一问题。本文设计一种基于依赖树的中医辨证多标记学习算法ML_RDT，分别寻找特征和标签对应的最优依赖树，并以标签依赖树对特征依赖树的预测结果进行修正，解决了标签之间的关联问题。将ML_RDT与经典的多标签学习算法（ML_KNN、ML_RBF、BP_MLL）进行对比，并在中医数据集进行实验，结果显示：ML_RDT的Hamming loss为0.0311 ± 0.0042，One error为0.0396 ± 0.0210，Coverage为0.0205 ± 0.0020，Ranking loss为0.0114 ± 0.0031、Average precision为0.9522 ± 0.0103，表现优于其他算法。ML_RDT能够较好地完成中医辨证的多标签分类问题，具有较好的推广和应用前景。