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EGFR Expression Is Unreliable to decide for Cetuximab Treatment in Patients with metastatic Colorectal Cancer: Results from “ERBITUX-OUEST”

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Open Journal of Internal m.d.cine 2016年第2期6卷 56-67页

作者： Jean-Philippe metges Erick Gamelin Alain Volant Olivier Capitain Jean-François Ramée Jean-luc Raoul Jean-Yves douillard Pierre-luc Etienne Isabelle Cumin Olivier dupuis Roger Faroux marie-Aude Coulon Philippe deguiral Karine Bideau Nacr Eddine Achour Alain Gourlaouen Corinne Alleaume Annie Wdowik laurent miglianico Yann Touchefeu Vincent Klein Alain Penchet ludovic Rosenfeld daniel martin Claire Stampfli Jean-Jacques Auger Alain Bargain murielle Broyer-Petit Jérome Chettrit louis-Rémi de Ybarlucea Serge Eloit Pierre marie Girardot Nathalie Heresbach Christian laboisse Eric lavoine Gilles lemasson Claire magois Sophie michalak Norbert Padilla Joseph Politis Frédéric Staroz Bruno Turlin Arnaud Uguen Viorel Vasiliu Véronique Verriele Fanny marhuenda delphine déniel lagadec Christian Riché Françoise Grudé Observatoire dédié au Cancer des régions Bretagne et Pays de la loire France Centre Hospitalier Régional Universitaire (CHRU) Brest France Institut de Cancérologie de l’Ouest (ICO) Paul Papin Angers France Centre Catherine de Sienne Nantes France CRlCC Eugène marquis Rennes France ICO René Gauducheau Nantes France Centre CARIO-HCPA Plérin France Centre Hospitalier Bretagne Sud (CHBS) Lorient France Clinique Victor Hugo Le Mans France Centre Hospitalier départemental (CHd) La Roche-sur-Yon France CH Le Mans France Clinique mutualiste de l’Estuaire Saint-Nazaire France CHIC Quimper France Clinique Pasteur lanroze Brest France CH MORLAIX France CH Saint-Brieuc France CHBA Vannes France CHP Saint-Grégoire France CHU Nantes France Hopital Privé Océane Vannes France Clinique Saint-michel et Sainte-Anne Quimper France Pole Santé Sarthe et loire La Flèche France Polyclinique du maine Laval France Polyclinique Sud Quimper France CH laval France Polyclinique Cesson Sévigné France laboratoire d’anatomie et de cytologie pathologiques Cholet France Cabinet d’anatomie et de cytologie pathologiques Saint-Malo France laboratoire d’anatomie et de cytologie pathologiques Lorient France Institut d’histopathologie Nantes France laboratoire de Pathologie m.d.cale Laval France ARmOR Pathologie Plérin France laboratoire d’anatomie et de cytologie pathologiques Rennes France laboratoire d’anatomie et de cytologie pathologiques Angers France laboratoire Analyses Biologie Glasgow Brest France CHU Angers France Centre d’anatomie et de cytologie pathologiques Le Mans France Cabinet d’anatomie et de cytologie pathologiques Vannes France laboratoire d’anatomie et de cytologie pathologiques Quimper France CHU Rennes France

Purpose: Although controversial, assessment of epidermal growth factor receptor (EGFR) expression is required for the approved indications of Cetuximab in metastatic colorectal cancer (mCRC). With the objective of improving patient selection, “ERBITUX-OUEST” study aim.d.at analyzing EGFR status in a large cohort of mCRC patients who received cetuximab without preliminary EGFR screening, and assessing the correlation between EGFR status and response to treatment retrospectively. Patients and methods: 332 patients treated with Irinotecan Cetuximab based regimen after progression on irinotecan or oxaliplatin therapy were included. EGFR status was assessed using three available immunohistochemistry (IHC) tests and in situ hybridization in case of negativity. Clinical outcomes of EGFR-positive and EGFR-non-detected (or considered as negative with at least one test) patients were compared. Results: Of the 332 samples centrally screened, 194 were classified as full-positive (i.e., EGFR-positive for all three tests), 86 as full-negative, and 52 as discordant. One third of the 131 negative samples with FdA approved test should be reclassified as positive with at least one of the two others tests. Regarding results from FdA approved test only, neither objective response rate (ORR), progression-free survival (PFS) nor overall survival (OS) differed significantly between EGFR-negative and EGFR-positive patients (P = 0.788, 0.326 and 0.888, respectively). Similarly, comparison of full-negative to other groups did not show any significant difference in terms of ORR (P = 0.507), PFS (P = 0.222) or OS (P = 0.686). Conclusion: These data strongly argue against mCRC patients selection for Cetuximab treatment based on EGFR expression as measured by currently available IHC technics.

关键词： metastatic Colorectal Cancer Cetuximab EGFR Expression

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菜籽蛋白在人体内呈现的低消化性和高代谢利用率(英文)

菜籽蛋白在人体内呈现的低消化性和高代谢利用率(英文)

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第十二届国际油菜大会

作者： Cécile Bos Gheorghe Airinei Franois mariotti Robert Benamouzig Serge Berot Jacques Evrard Evelyne Fenart daniel Tome Claire Gaudichon department of Nutrition Physiology and Ingestive Behavior Unité mixte de recherche 914 Institut National de la Recherche Agronomique/Institut National Agronomique Paris-GrignonParisFrance department of Nutrition Physiology and Ingestive Behavior Unité mixte de recherche 914 Institut National de la Recherche Agronomique/Institut National Agronomique Paris-GrignonParisFrance Assistance Publique-Höpitaux de ParisClinical Investigation CentreCRNH Ile-de-France （Human Nutrition Research Centre） Avicenne HospitalBobignyFrance department of Nutrition Physiology and Ingestive Behavior Unité mixte de recherche 914 Institut National de la Recherche Agronomique/Institut National Agronomique Paris-GrignonParisFrance Assistance Publique-Höpitaux de Paris Clinical Investigation CentreCRNH Ile-de-France （Human Nutrition Research Centre） Avicenne HospitalBobignyFrance INRA Unité de recherche BiopolymèresInteractions AssemblagesNantesFrance CETIOm rue MongeParc industriel 33600 Pessac France ONIdOl （National agency for oilseeds development） 12 avenue GeorgeV 75008 ParisFrance department of Nutrition Physiology and Ingestive Behavior Unité mixte de recherche 914 Institut National de la Recherche Agronomique/Institut National Agronomique Paris-GrignonParisFrance department of Nutrition Physiology and Ingestive Behavior Unité mixte de recherche 914 Institut National de la Recherche Agronomique/Institut National Agronomique Paris-GrignonParisFrance

目前菜籽蛋白（Brassica napus l.）只用于动物饲料,尽管它对于人类营养也有很大的潜力。我们试图通过测量15N-菜籽蛋白在人类肠内真实消化率和餐后蛋白纯利用率评估油菜籽蛋白营养品质。每位志愿者肠内配备一肠内管在空肠水平（n=5）... 详细信息

目前菜籽蛋白（Brassica napus l.）只用于动物饲料,尽管它对于人类营养也有很大的潜力。我们试图通过测量15N-菜籽蛋白在人类肠内真实消化率和餐后蛋白纯利用率评估油菜籽蛋白营养品质。每位志愿者肠内配备一肠内管在空肠水平（n=5）或回肠水平（n=7）时摄入含27.3g15N菜籽蛋白和2.93mJ的能量成分。由餐后定期采得的肠液、尿、血样来定量摄入的N水平。菜籽蛋白肠内真实消化率84.0±8.8%。摄入的N在n=5时多数是未消化蛋白形式。芥菜型油菜和甘蓝型油菜蛋白片断都对蛋白水解有抗性。肠内N损失为2.2g/d。通过饮食摄入的氨水平没有显著增加。餐后N的分配:尿中的尿素和氨为5.4±1.8%,汗液中的尿素为8.2±3.4%,血浆蛋白中为7.7±2.0%。菜籽餐后蛋白纯利用率（NPPU）为70.5±9.6%。postprandial biological value较高:83.8±4.6%。菜籽蛋白在人体肠内不仅比其它植物蛋白消化率低,而且去氨比率低。因此,从菜籽摄入的氮在人体内保持力高,与奶蛋白氮相同。得出结论:菜籽蛋白对人类营养有很大潜力。

关键词： protein quality rapeseed protein ileal digestibility biological value humans

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基于高流速lC的蛋白质组学分析平台

基于高流速LC的蛋白质组学分析平台

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中国化学会第22届全国色谱学术报告会及仪器展览会

作者： Yangyang Bian Runsheng Zheng Yun-Chien Chang Jana Zecha Stephanie Heinzlmeir daniel P.Zolg Oleksandr Boychenko mike Baynham Bernhard Kuster Technical University of munich 郑州大学第一附属医院 Thermo Fisher Scientific

虽然纳升级液相色谱(nano-lC)长久以来一直是蛋白质组学研究领域的主流分离技术,但其在分析通量和稳定性方面存在着不足,使得大量样品的蛋白质组学分析仍然极具挑战性1。在本研究中,我们以Ultimate 3000 RSlCnano液相色谱系统和Q Exacti... 详细信息

虽然纳升级液相色谱(nano-lC)长久以来一直是蛋白质组学研究领域的主流分离技术,但其在分析通量和稳定性方面存在着不足,使得大量样品的蛋白质组学分析仍然极具挑战性1。在本研究中,我们以Ultimate 3000 RSlCnano液相色谱系统和Q Exactive HF-X质谱仪为基础,使用1.0mm i.d.x 150 mm C18色谱柱在50μl/min的流速下进行多肽的分离分析,搭建了一个基于高流速lC的蛋白质组学分析平台。

关键词：高流速lC 深度蛋白质组学临床蛋白质组学

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Common workflows for computing material properties using different quantum engines

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npj Computational materials 2021年第1期7卷 1202-1213页

作者： Sebastiaan P.Huber Emanuele Bosoni marnik Bercx Jens Bröder Augustin degomme Vladimir dikan Kristjan Eimre Espen Flage-larsen Alberto Garcia luigi Genovese dominik Gresch Conrad Johnston Guido Petretto Samuel Poncé Gian-marco Rignanese Christopher J.Sewell Berend Smit Vasily Tseplyaev martin Uhrin daniel Wortmann Aliaksandr V.Yakutovich Austin Zadoks Pezhman Zarabadi-Poor Bonan Zhu Nicola marzari Giovanni Pizzi Theory and Simulation of materials(THEOS)and National Centre for Computational design and discovery of Novel materials(mARVEl) École Polytechnique Fédérale de LausanneLausanneSwitzerland Institut de Ciència de materials de Barcelona ICMAB-CSICBellaterraSpain Peter Grünberg Institut and Institute for Advanced Simulation Forschungszentrum JülichJülichGermany department of Physics RWTH Aachen UniversityAachenGermany CEA IRIG-MEM-L_SimUniv.Grenoble-AlpesGrenobleFrance Nanotech@surfaces laboratory Swiss Federal Laboratories for Materials Science and Technology(Empa)DübendorfSwitzerland SINTEF Industry Materials PhysicsOsloNorway department of Physics University of OsloOsloNorway microsoft Station Q University of CaliforniaSanta BarbaraCAUSA Atomistic Simulation Centre School of Mathematics and PhysicsQueen’s University BelfastBelfastUK UClouvain Institut de la Matière Condensée et des Nanosciences(IMCN)Louvain-la-NeuveBelgium laboratory of molecular Simulation(lSmO) Institut des sciences et ingénierie chimiques(ISIC)École Polytechnique Fédérale de Lausanne(EPFL)ValaisSionSwitzerland department of Chemistry Claverton DownUniversity of BathBathUK The Faraday Institution DidcotUK department of Chemistry University College LondonLondonUK

The prediction of material properties based on density-functional theory has become routinely common,thanks,in part,to the steady increase in the number and robustness of available simulation *** plurality of codes and methods is both a boon and a *** providing great opportunities for cross-verification,these packages adopt different methods,algorithms,and paradigms,making it challenging to choose,master,and efficiently use *** demonstrate how developing common interfaces for workflows that automatically compute material properties greatly simplifies interoperability and *** introduce design rules for reusable,code-agnostic,workflow interfaces to compute well-defined material properties,which we implement for eleven quantum engines and use to compute various material *** implementation encodes carefully selected simulation parameters and workflow logic,making the implementer’s expertise of the quantum engine directly available to *** workflows are m.d. available as open-source and full reproducibility of the workflows is guaranteed through the use of the AiidA infrastructure.

关键词： quantum routine material

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门诊手术麻醉协会关于手术后恶心呕吐的处理指南

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麻醉与镇痛 2008年第6期4卷 12-26,43页

作者： Tong J. Gan, md Tricia A. meyer, Pharmd, mS Christian C. Apfel, md, Phd Frances Chung, FRCPC Peter J. davis, md Ashraf S. Habib, mB, FRCA Vallire d. Hooper,mSN, RN, CPAN, FAAN Anthony l. Kovac,md Peter Kranke, md, Phd, mBA Paul myles, md Beverly K. Philip, md Gregory Samsa, Phd daniel I. Sessler, md James Temo, CRNA, mSN, mBA martin R. Tramer, md, dPhil Craig Vander Kolk,md mehernoor Watcha, md 谢郭豪(译) 方向明(校) department of Anesthesiology Duke University Medical Center Durham North Carolina Consultant Anesthesiologist University of Wuerzburg WuerzburgGermany department of Anesthesia and Perioperative Care UCSF Medical Center at Mt. Zion San FranciscoCalifornia department of Anesthesia University of Toronto Toronto Canada department of Anesthesi-ology and Pediatrics University of Pittsburgh School of Medicine Pittsburgh Pennsylvania School of Nurs-ing Medical College of Georgia Augusta Georgia department of Anesthesiology University of KansasMedical Center Kansas City Kansas Consultant Anesthesiologist University of Wuerzburg WuerzburgGermam department of Anesthesia and Perioperative m.d.cine Alfred Hospital Monash University Mel-bourne Australia department of Anesthesiology Perioperative and Pain Medicine Brigham and Women'sHospital Harvard Medical School Boston Massachusetts department of Biometry and Bioinformatics Duke University Medical Center Durham North Carolina department of OUTCOmES RESEARCH TheCleveland Clinic Cleveland Ohio duke University Nurse Anesthetist Program Durham North Caro-lina division of Anesthesiology Geneva University Hospitals and Faculty of Medicine Geneva Switzer-land department of Surgery Division of Plastic Surgery Johns Hopkins University School of Medicine Bal-timore Maryland department of Anesthesiology Texas Children's Hospital Houston Texas 不详

本指南是在门诊手术麻醉协会发起下，由国际专家组编撰而成。该专家组成员涉及与手术后恶心、呕吐（PONV）相关的多个学科，他们审慎的评估了当前关于PONV的医学文献，为PONV高风险的成年及儿童外科手术患者提供了循证医学的参考工具。... 详细信息

本指南是在门诊手术麻醉协会发起下，由国际专家组编撰而成。该专家组成员涉及与手术后恶心、呕吐（PONV）相关的多个学科，他们审慎的评估了当前关于PONV的医学文献，为PONV高风险的成年及儿童外科手术患者提供了循证医学的参考工具。指南的重点是识别成人及儿童患者中发生PONV的危险因素；推荐降低PONV基础风险的方法；甄别出对PONV进行预防性治疗最为有效的单一药物及联合用药方案；推荐对已发生的PONV的治疗方法；并为具有较高PONV风险的患者提供了处理流程。

关键词：手术后恶心呕吐手术麻醉指南协会门诊 PONV 外科手术患者联合用药方案

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Pharmacological Tie2 activation in kidney transplantation

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World Journal of Transplantation 2016年第3期6卷 573-582页

作者： Kristina Thamm Florence Njau Paul Van Slyke daniel J dumont Joon-Keun Park Hermann Haller Sascha david department of Nephrology and Hypertension Medical School Hannover Vasomune Therapeutics Inc Biological Sciences Sunnybrook Research Institute

AIm To investigate the therapeutic potential of vasculotide(VT)- a Tie2 activating therapeutic- in kidney *** We perform.d.a murine mHC-mismatched renal transplant m.d.l(C57Bl/6 male into Balb/c female) with 60 min cold and 30 min warm ischemia time. 500 ng VT was administered i.p. to donor mice 1 h before organ removal. In addition, recipients received 500 ng VT i.p. directly and 3 d after surgery. Survival was monitored and remaining animals were sacrificed 28 d after transplantation. In this m.d.l, we analyzed:(1) organ function;(2) Kaplan-meier survival;(3) organ damage(periodic acid Schiff staining) via semi-quantitative scoring [0-4(0 = no injury/inflammation to 4 = very severe injury/inflammation)];(4) expression of renal endothelial adhesion molecules(ICAm-1) viaimmunofluorescence(IF) staining, immunoblotting and q PCR;(5) infiltration of inflammatory cells(IF Gr-1, F4/80); and(6) fibrosis via staining of α-smooth muscle actin(αSmA), Sirius red staining and immunoblotting of Sm.d. *** Exogenous activation of Tie2 with VT resulted in diminished expression of peritubular and glomerular endothelial adhesion molecules. Consequently, infiltration of inflammatory cells(analyzed as ICAm-1, Gr-1 and F4/80 positive cells) was reduced in VT-treated mice compared to controls. Additionally, VT was protective against fibrogenesis after kidney transplantation. Trends towards lower serum creatinine(vehicle: 142 ± 17 μmol/l vs VT: 94 ± 23 μmol/l), urea(vehicle: 76 ± 5 mmol/l vs VT: 60 ± 8 mmol/l) and lactate dehydrogenase(vehicle: 1288 ± 383 iU vs VT: 870 ± 275 iU) were observed on day 6 after transplantation. Kaplan-meier survival analysis showed improved survival rates in the VT-treated mice that did not reach statistical significance(27% vs 54%, P = 0.24, n = 11 per group). Exogenous activation of Tie2 via VT might reduce infiltration of inflammatory cells into renal tissue thereby protecting the transplant from early graft dysfunction

关键词： Vasculotide Tie2 Kidney transplantation Endothelium Angiopoietin

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Single vs dual(en bloc) kidney transplants from.d.nors ≤ 5 years of age: A single center experience

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World Journal of Transplantation 2016年第1期6卷 239-248页

作者： Yousef Al-Shraideh Umar Farooq Hany El-Hennawy Alan C Farney Am.d.a Palanisamy Jeffrey Rogers Giuseppe Orlando muhamm.d.Khan Amber Reeves-daniel William.d.ares Scott Kaczmorski michael d Gautreaux Samy S Iskandar Gloria Hairston Elizabeth Brim margaret mangus Robert J Stratta department of Surgery Wake Forest School of Medicine department of Internal m.d.cine Wake Forest School of Medicine department of Pharmacy Wake Forest School of Medicine department of Pathology Wake Forest School of Medicine

AIm: To compare outcomes between single and dual en bloc(EB) kidney transplants(KT) from small pediatric donors. mETHOdS: monocentric nonprospective review of KTs from pediatric donors ≤ 5 years of age. dual EB KT was defined as keeping both donor kidneys attached tothe inferior vena cava and aorta, which were then used as venous and arterial conduits for the subsequent transplant into a single recipient. donor age was less useful than either donor weight or kidney size in decision-making for kidney utilization as kidneys from.d.nors dneys m in length were not transplanted. Post-transplant management strategies were standardized in all ***: From 2002-2015, 59 KTs were perform.d.including 34 dual EB and 25 single KTs. mean age of donors(17 mo vs 38 mo, P mean weight(11.0 kg vs 17.4 kg, P = 0.046) and male donors(50% vs 84%, P = 0.01) were lower in the dual EB compared to the single KT group, respectively. mean cold ischemia time(21 h), kidney donor profile index(KdPI; 73% vs 62%) and levels of serum creatinine(SCr, 0.37 mg/d l vs 0.49 mg/d l, all P = NS) were comparable in the dual EB and single KT groups, respectively. Actuarial graft and patient survival rates at 5-years follow-up were comparable. There was one case of thrombosis resulting in graft loss in each group. delayed graft function incidence(12% dual EB vs 20% single KT, P = NS) was slightly lower in dual EB KT recipients. Initial duration of hospital stay(mean 5.4 d vs 5.6 d) and the one-year incidences of acute rejection(6% vs 16%), operative complications(3% vs 4%), and major infection were comparable in the dual EB and single KT groups, respectively(all P = NS). mean 12 mo SCr and abbreviated mdRd levels were 1.17 mg/d l vs 1.35 mg/d l and 72.5 m l/min per 1.73 m^2 vs 60.5 m l/min per 1.73 m^2(both P = NS) in the dual EB and single KT groups, respectively. CONClUSION: By transplanting kidneys from young pediatric donors into adult recipients, one can effectively

关键词： donor age donor weight En bloc kidney transplant Kidney donor profile index Single kidney transplant Small pediatric donor

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2010年类风湿关节炎分类标准——美国风湿病学会和欧洲抗风湿病联盟的联合倡议

2010年类风湿关节炎分类标准——美国风湿病学会和欧洲抗风湿病联...

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贵州省医学会风湿病学分会第四届学术年会

作者： daniel Aletaha Tuhina Neogi Alan J Silman Julia Funovits david T Felson Clifton O Bingham Ⅲ Neal S Birnbaum Gerd R Burmester Vivian P Bykerk marc d Cohen Bernard Combe Karen H Costenbader maxime dougados Paul Emery Gianfranco Ferraccioli Johanna mW Hazes Kathryn Hobbs Tom WJ Huizinga Arthur Kavanaugh Jonathan Kay Tore K Kvien Timothy laing Philip mease Henri A menard larry W moreland Raymond l Naden Theodore Pincus Josef S Smolen Ewa Stanislawska-Biernat deborah Symmons Paul P Tak Katherine S Upchurch Jiri Vencovsky Frederick Wolfe Gillian Hawker 季兰岚邓雪蓉赵明田真张卓莉 m.d.cal University of Vienna ViennaAustria Boston University School of m.d.cine BostonMassachusettsUSA

目的 :在早期类风湿关节炎(rheumatoid arthritis,RA)的诊断中,1987年美国风湿病学会(AmericanCollege of Rheumatology,ACR;旧称AmericanRheumatism Association,ARA)的诊断标准因为缺乏敏感度而受到质疑。本研究的目的是建立新的RA分类标准。方法 :由ACR和欧洲抗风湿病联盟(Europeanleague Against Rheumatism,EUlAR)共同组成的工作小组,分三个阶段建立RA新的分类标准。研究的目标人群是初发的未分化关节炎患者,主要研究目的是寻找能够预测这些病人发展为RA的危险因素,并将RA疾病特点定义为持续性和/或侵蚀性关节炎。结果 :在新的分类标准中,确诊RA至少需要一个关节有明确的滑膜炎表现,除外其他可能导致滑膜炎症的疾病,同时以下四项评分的总分≥6分(最高10分):受累关节的数量和部位(0-5分)、血清学自身抗体异常(0-3分)、急性期反应物升高(0-1分)和症状持续时间(共分两级;0-1分)。结论 :既往诊断RA比较依赖骨破坏这一RA晚期表现,而新的分类标准着重于疾病早期表现而不是晚期特点,将疾病特点重新定义为持续性和/或侵蚀性滑膜炎。这一新标准的推出将再次强调了RA早期诊断的必要性以及早期有效治疗对于预防或减少不良后遗症的发生具有重要意义。

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一个基于深度学习的眼病和肺炎两大类疾病的AI诊断系统

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科学新闻 2019年第2期 33-33页

作者： daniel S.Kermany michael Goldbaum Wenjia Cai Carolina C.S.Valentim Huiying liang Sally l.Baxter Alex mcKeown Ge Yang Xiaokang Wu Fangbing Yan Justin dong m.d. K.Prasadha Jacqueline Pei magdalene Y.l.Ting Jie Zhu Christina li Sierra Hewett Jason dong Ian Ziyar Alexander Shi Runze Zhang Rui Hou William Shi Xin Fu Yaou duan Viet A.N. Huu Cindy Wen Edward d. Zhang Charlotte l. Zhang Oulan li Xiaobo Wang michael A. Singer Xiaodong Sun Jie Xu Ali Tafreshi m. Anthony lewis Huimin Xia 张康美国加州大学圣地亚哥分校人类基因组医学研究所

文章简介本研究开发了一个基于深度学习框架能诊断致盲性视网膜疾病的人工智能(AI)诊断工具。而且,该AI诊断工具还可用于诊断小儿肺炎。这是一项将AI应用于医疗领域的重磅研究成果,有望高精确诊断多种可治疗性疾病。在眼科治疗中,视网膜... 详细信息

文章简介本研究开发了一个基于深度学习框架能诊断致盲性视网膜疾病的人工智能(AI)诊断工具。而且,该AI诊断工具还可用于诊断小儿肺炎。这是一项将AI应用于医疗领域的重磅研究成果,有望高精确诊断多种可治疗性疾病。在眼科治疗中,视网膜OCT(光学相干断层扫描)

关键词： AI 深度学习

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将卒中纳入心血管风险预测工具美国心脏协会／美国卒中协会对医疗卫生专业人员的声明

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国际脑血管病杂志 2012年第11期20卷 801-828页

作者： daniel T. lackland mitchell S.V. Elkind Ralph d'Agostino Sr mandip S. dhamoon david C. Goff Jr Randall T. Higashida leslie A. mcClure Pamela H. mitchell Ralph l. Sacco Cathy A. Sila Sidney C. Smith Jr david Tanne david l. Tirschwell Emmanuel Touze lawrence R. Wechsler 4:~ 尤寿江(译) 于海龙(译) 刘慧慧(译) 张霞(译) 刘春风(译) 代表美国心脏协会卒中委员会、流行病学和预防委员会、心血管放射学和介入委员会、心血管护理委员会、周围血管病委员会以及医疗质量和转归研究委员会苏州大学附属第二医院神经内科 215004

背景和目的目前美国针对心血管事件风险预测以及一级和二级预防的指南声明均使用绝对风险估计值来识别血管事件高危患者以及可从特定干预措施中获益的患者。然而，这些指南并未明确地包括卒中患者。本指南对现有证据和争论进行概述以支... 详细信息

背景和目的目前美国针对心血管事件风险预测以及一级和二级预防的指南声明均使用绝对风险估计值来识别血管事件高危患者以及可从特定干预措施中获益的患者。然而，这些指南并未明确地包括卒中患者。本指南对现有证据和争论进行概述以支持：（1）将卒中（尤其是动脉粥样硬化性卒中）患者纳入心血管病绝对风险增高的患者群体；（2）将卒中纳入血管性疾病风险预测工具的转归预测因素。方法和结果写作组成员由委员会联合主席基于先前在相关领域的研究成果来提名，并得到美国心脏协会（American Heart Association，AHA）卒中委员会科学声明监督委员会以及文稿监督委员会的批准。作者采用系统文献回顾（覆盖1980年1月至2010年3月期间的文献）并参考以往公布的指南、个人资料以及专家观点，以归纳现有证据，提出当前知识的不足，并根据AHA标准对适当的问题制定推荐意见。所有写作组成员均有机会对推荐意见进行评论并批准了最终版本。经广泛的AHA内部同行评议以及卒中委员会领导阶层和科学声明监督委员会的审阅后，最终获得AHA科学咨询和协调委员会的批准。将卒中患者（尤其是动脉粥样硬化性卒中患者）纳入冠状动脉和心血管病绝对高危人群的原因如下。首先，有证据显示，缺血性卒中患者发生致死性和非致死性心肌梗死或猝死的绝对风险增高，10年绝对风险≥20％，这一风险阈值已被一些指南用于定义冠状动脉疾病风险等危症。其次，纳入动脉粥样硬化性卒中的原因与纳入糖尿病、周围血管病、慢性肾脏病以及其他动脉粥样硬化性疾病的原因相同，尽管尚缺乏在所有人群或患者中风险增高的统一证据。再次，缺血性卒中的大动脉粥样硬化性卒中亚型与其他这些疾病的病理生理学机制相同。将卒中纳入高危因素将导致高危人群的数量扩大约10％。然而，由于卒中的异质性，尚不确定其他卒中亚型，包括出血性卒中以及非动脉粥样硬化性卒中亚型，是否应被视为具有相同水平的风险，因此有待进一步研究。鉴于卒中对残疾和死亡的影响、卒中与其他血管性疾病预防措施的相似性以及卒中在某些人群中较冠状动脉疾病更高的重要性，将卒中、心肌梗死和猝死纳入心血管事件风险预测工具的转归预测因素是合适的。美国以外的指南常常将卒中患者纳入心血管高危人群，并将卒中作为心脏终点的一个相关转归事件。结论动脉粥样硬化性卒中患者应被纳入会进一步发生冠状动脉粥样硬化事件的高危患者（10年≥20％）。是否应纳入非动脉粥样硬化卒中亚型尚不确定。对于一级预防，缺血性卒中应被纳入绝对风险评估方案的心血管疾病转归事件。将动脉粥样硬化性卒中作为一个高危因素或者更宽泛地将缺血性卒中视作一种转归事件纳入，可能对心血管病的预防具有重要意义，因为被评定为高危风险的患者数量将大幅增加。

关键词： AHA科学声明心血管疾病危险性评估风险预测卒中

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