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肺动脉高压病人的局部和整体双心室功能:心脏MRI研究

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国际医学放射学杂志 2013年第2期 162-162页

作者： M.L. Shehata A.A. Harouni j. Skrok T.A. Basha D. Boyce N. Lechtzin 李宁 Department of Radiology and Radiological Sciences Johns Hopkins University School of Medicine 600 N Wolfe St Nelson Basement MRI 110Baltimore MD

目的探讨慢性肺动脉压力(PAP)增高能否影响双心室局部功能,右心室(RV)整体功能正常的肺动脉高压(PAH)病人是否降低局部心肌功能。材料与方法经知情同意后,35例PAH病人接受右心导管及心脏MR成像检查并与13名健康对照者进行比较。PAH病人... 详细信息

目的探讨慢性肺动脉压力(PAP)增高能否影响双心室局部功能,右心室(RV)整体功能正常的肺动脉高压(PAH)病人是否降低局部心肌功能。材料与方法经知情同意后,35例PAH病人接受右心导管及心脏MR成像检查并与13名健康对照者进行比较。PAH病人与对照组的双心室节段、截面和平均心室收缩期峰值纵向应变值(ELL),以及左心室(LV)周向和右心室(RV)切向压力都进行了比较,并分析各参数与整体功能和右心室导管指数的相关性。使用Spearman相关ρ和Bonferroni校正。采用多元线性回归分析来确定局部心肌功能的预测因素。结果 PAH病人右心室在心底、中部及心尖水平发生纵向收缩减低,在心室中部发生切向收缩减低。平均右室ELL与平均PAP(r=0.62,P<0.0014)及肺血管阻力指数(r=0.77,P<0.0014)呈正相关。在多元线性回归分析中平均PAP是平均RVELL(β=0.19,P=0.005)的预测因素。而LV纵向及周向收缩减低均发生于心底部。左室前间壁ELL与平均PAP增加(r=0.5,P=0.03)和隔偏心指数(r=0.5,P=0.01)呈正相关。右心室整体功能正常的PAH病人,心底及前中室间隔区及右心室中前室壁纵向收缩明显减低(均为P<0.05)。结论 PAH病人的双心室局部功能减低与右心室后负荷[平均PAP和肺血管阻力指数(PVRI)]增加有关。心脏MR成像有助于鉴别右心室整体功能正常的PAH病人的右心室局部功能受损。

关键词：双心室 PAH 局部功能病人右心室心脏肺动脉

学习科学和教学设计背景下的“四元教学设计模式”

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开放学习研究 2019年第3期24卷 48-54,62页

作者：杰伦·j.G.范梅里恩伯尔保罗·A.基尔希纳章褚昀(译) 盛群力(校) 荷兰马斯特里赫特大学荷兰马斯特里赫特6200 荷兰开放大学荷兰海尔伦6419 浙江大学教育学院浙江大学教育学院课程与学习科学系

'四元教学设计模式'(4C/ID)是一种面向综合学习的教学设计方法,即学习旨在实现综合目标,并且同时发展知识、技能和态度,以获得综合能力和专业能力。四元教学设计模式是20世纪80年代后期,由国际著名教学设计专家范梅里恩伯尔教授研发的,... 详细信息

'四元教学设计模式'(4C/ID)是一种面向综合学习的教学设计方法,即学习旨在实现综合目标,并且同时发展知识、技能和态度,以获得综合能力和专业能力。四元教学设计模式是20世纪80年代后期,由国际著名教学设计专家范梅里恩伯尔教授研发的,目前已经成为最有影响力的教学设计模式之一,广泛应用于职业技术教育和普通教育中。四元教学设计包括了学习任务、相关知能、支持程序和专项操练四个要素,实际应用中还可以扩展为十个步骤。这些步骤阐述了教学设计者常用的设计过程,以达成有效果、有效率和有魅力的面向综合学习的学业培养方案。该模式有很强的研究基础,已有数百项实验研究支持4C/ID模式所提出的理论。

关键词：四元教学设计综合学习学习科学扶放有度

SLC26A4 mutation testing for hearing loss associated with enlargement of the vestibular aqueduct

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World j.urnal of Otorhinolaryngology 2013年第2期3卷 26-34页

作者： Taku Ito j.lie Muskett Parna Chattaraj.Byung Yoon Choi Kyu Yup Lee Christopher K Zalewski Kelly A King Xiangming Li Philine Wangemann Thomas Shawker Carmen C Brewer Seth L Alper Andrew j.Griffith Otolaryngology Branch National Institute on Deafness and Other Communication Disorders National Institutes of Health Rockville MD 20850 United States Laboratory of Molecular Genetics National Institute on Deafness and Other Communication Disorders National Institutes of Health Rockville MD 20850 United States Anatomy and Physiology Department Kansas State University Manhattan KS 66506 United States Diagnostic Radiology Department Warren G. Magnuson Clinical Center National Institutes of Health Bethesda MD 20892 United States Renal Division Beth Israel Deaconess Medical Center Harvard Medical School Boston MA 02215 United States

nPendred syndrome （PS） is characterized by autosomal recessive inheritance of goiter associated with a defect of iodide organification, hearing loss, enlargement of the vestibular aqueduct （EVA）, and mutations of the SLC26A4 gene. However, not all EVA patients have PS or SLC26A4 mutations. Two mutant alleles of SLC26A4 are detected in 1/4 of North American or European EVA populations, one mutant allele is detected in another 1/4 of patient populations, and no mutations are de-tected in the other 1/2. The presence of two mutant al-leles of SLC26A4 is associated with abnormal iodide or-ganification, increased thyroid gland volume, increased severity of hearing loss, and bilateral EVA. The pres-ence of a single mutant allele of SLC26A4 is associated with normal iodide organification, normal thyroid gland volume, less severe hearing loss and either bilateral or unilateral EVA. When other underlying correlations are accounted for, the presence of a cochlear malformation or the size of EVA does not have an effect on hearing thresholds. This is consistent with observations of an Slc26a4 mutant mouse model of EVA in which hearing loss is independent of endolymphatic hydrops or in-ner ear malformations. Segregation analyses of EVA in families suggest that the patients carrying one mutant allele of SLC26A4 have a second, undetected mutant allele of SLC26A4, and the probability of a sibling hav-ing EVA is consistent with its segregation as an autoso-mal recessive trait. Patients without any mutations are an etiologically heterogeneous group in which siblings have a lower probability of having EVA. SLC26A4 muta-tion testing can provide prognostic information to guide clinical surveillance and management, as well as the probability of EVA affecting a sibling.

关键词： SLC26A4 Pendred syndrome Genetic test-ing Goiter Hearing loss Vestibular aqueduct Genotype-phenotype correlation

荟萃分析:类固醇激素剂量对脓毒症患者存活率和休克的影响

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世界核心医学期刊文摘（心脏病学分册） 2005年第1期1卷 1-2页

作者： Minneci P.C. Deans K.j. Banks S.M. 任延平 Critical Care Med icine Department National Institutes of Health Building 10 10 Center Drive B ethesda MD 20892 United StatesDr.

Background: Previous meta analyses demonstrated that high dose glucoc orticoi ds were not beneficial in ***, lower dose glucocorticoids have been studied. Purpose: To compare recent trials of glucocorticoids for sepsis with p revious glucocorticoid trials. Data Sources: Systematic MEDLINE search for studi es published between 1988 and 2003. Study Selection: Randomized,controlled trial s of sepsis that examined the effects of glucocorticoids on survival or vasopres sor requirements. Data Extraction: Two investigators independently collected dat a on patient and study characteristics, treatment interventions, and outcomes. D ata Synthesis: The 5 included trials revealed a consistent and beneficial effect of glucocorticoids on survival (12=0%; relative benefit, 1.23, >; P=0.036) and shock reversal (12=0%; relative benefit, 1.71 >; P>; P=0 .008). In comparison with the earlier trials, the more recent trials administere d steroids later after patients met enrollment criteria (median, 23 hours vs. < 2 hours; P=0.02), for longer courses (6 days vs. 1 day; P=0.01), and in lower to tal dosages (hydrocort isone equivalents,1209 mg vs. 23 975 mg; P=0.01) to patie nts with higher control group mortality rates (mean, 57%vs. 34%; P=0.06) who w ere more likely to be vasopressor dependent (100%vs. 65%; P=0.03). The relati onship between steroid dose and survival was linear, characterized by benefit at low doses and increasing harm at higher doses (P=0.02). Limitations: We could n ot analyze time related improvements in medical care and potential bias seconda ry to nonreporting of negative study results. Conclusions: Although short course s of high dose glucocorticoids decreased survival during sepsis, a 5-t

关键词：脓毒症患者存活率类固醇激素荟萃分析加压药资料提取糖皮质激素试验结果随机对照试验肾上腺功能

视神经病变患者的明适应ERGs:与灵长类动物视网膜内层药物阻塞后ERGs的比较

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世界核心医学期刊文摘（眼科学分册） 2005年第2期1卷 37-38页

作者： Rangaswamy N.V. Frishman L.j. Dorotheo E.U. 齐翔云 College of Optometry University of Houston 505 J. Davis Armistead Houston TX 77204-202 0 United States

PURPOSE. To determine whether anterior ischemic optic neuropathy and compressi ve optic neuropathy in humans alter the photopic flash ERG and to investigate th e cellular origins of the waves that are affected by pharmacologic agents in pri mates. METHODS. Photopic flash ERGs were recorded differentially, with DTL elect rodes, between the two eyes of 22 patients with diagnosed optic neuropathy (n=17 , anterior ischemic optic neuropathy AION; n=5, compressive optic neuropathy) and 25 age-matched control subj.cts and in 17 eyes of 13 monkeys (Macaca mulatt a). The stimulus consisted of brief (md) of PmdA; 1.4-6.4 mM; n=7), and cis-2, 3 piperidine dicarboxylic acid (PDA; 3 .3-3.8 mM; n=3). RESULTS. The PhNR amplitude was significantly reduced in both symptomatic (P=3.4×10 -8) and asymptomatic (P=0.036) eyes of patients with AIO N or compressive optic neuropathy (P=0.0054) compared with control subj.cts. The PhNR amplitude in the symptomatic eye showed a moderate correlation with field defects (P mdA, and eliminated a fter PDA in response to the red stimuli. PDA also eliminated the i-

关键词：视神经病变 ERGs 灵长类动物明适应内层神经节细胞开角型青光眼视野缺损压迫性能量范围

皮下注射达利珠单抗治疗非感染性葡萄膜炎的早期评价:多中心非对照干预性病例研究

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世界核心医学期刊文摘（眼科学分册） 2005年第9期1卷 50-51页

作者： Nussenblatt R.B. Peterson j.S. Foster C.S. 王大江 Laboratory of Immunology National Eye Institute Building 10 10 Center Drive BethesdaMD 20892 United States Dr.

Purpose: To assess the feasibility of a study design that may determine whether subcutaneous administration of the interleukin-2 receptor antibody daclizumab can safely reduce the dependence on standard systemic corticosteroids or other immunosuppressive regimens in patients with sight-threatening, noninfectious intermediate uveitis, posterior uveitis, or panuveitis. Design: Prospective, multicenter, nonrandomized, noncomparative, open-label interventional trial. Participants: Fifteen patients, 5 each at 3 clinical centers, with noninfectious intermediate, posterior, or panuveitis, who require a currently stable immunosuppression regimen of systemic corticosteroids and/or other systemic treatments to control noninfectious intraocular inflammation. Methods: After enrollment and baseline ophthalmic evaluations, 2 induction treatments were given 2 weeks apart using subcutaneous (SC) daclizumab at 2 mg/kg. Subcutaneous daclizumab maintenance treatments were then continued every 2 weeks at 1 mg/kg for 6 months. The initial immunosuppression load was tapered over 8 to 12 weeks in a staggered fashion beginning with the first induction treatment. Safety evaluations were performed at each treatment visit, with a primary efficacy evaluation at 12 weeks and a repeat efficacy evaluation at 26 weeks. Main Outcome Measures: Best-corrected visual acuity (Early Treatment of Diabetic Retinopathy Study [ETDRS]method)with a concurrent taper of concomitant systemic immunosuppression medication load (tabulated by use of a weighted scoring system) was assessed; target for success was defined as a 50%or greater reduction in concomitant immunosuppression load by 12 weeks while maintaining visual acuity within 5 ETDRS letters of baseline. Ocular inflammation was assessed at each visit with standardized grading scales. Results: Ten of 15 patients (67%) receiving SC daclizumab treatments every other week successfully achieved the primary efficacy end point of reducing their concomitant immuno

关键词：感染性葡萄膜炎达利珠单抗干预性病例研究免疫抑制疗法感染性眼内炎全色素膜炎眼部炎症视力变化其他免疫抑制剂

晶状体乳化联合可拆除缝线小梁切除术的安全性和有效性

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世界核心医学期刊文摘（眼科学分册） 2006年第5期2卷 17-18页

作者： Stark W.j. Goyal R.K. Awad O. 王静波 600 N Wolfe Street Baltimore MD 21287 United States Dr.

Aim: To evaluate the combined phacoemulsification with acrylic intraocular lens implantation and trabeculectomy with releasable sutures, without the use of antimetabolites, performed by one surgeon. Methods: A retrospective analysis was performed on 251 eyes of 198 patients after a combined phaco/trabeculectomy procedure, followed up for an average of 16 months for vision, intraocular pressure (IOP), and number of glaucoma medications. Cox proportional hazard regression analysis provided measures of relative risk (RR) or hazards ratios and 95%confidence intervals (CIs) associated with the occurrence of several conditions or complications of surgery. Results: Mean preoperative variables were best corrected vision, 0.6 (SD 0.4) logMAR(20/80 Snellen); IOP, 18.7 (4.9)mmHg; and number of glaucoma medications, 1.7 (0.8). Mean postoperative results were best corrected vision, 0.2 (0.4) logMAR (20/32 Snellen); IOP, 15.1 (3.2) mm Hg; and number of glaucoma medications, 0.3 (0.6). Postoperatively, the mean decreases from baseline were 19.2%for IOP and 84.1%for number of glaucoma medications; 85%of eyes required fewer glaucoma medications and 78%of eyes were medication free, with IOP control. There were no significant operative or postoperative complications. Conclusion: Combined phacoemulsification and trabeculectomy with releasable sutures, in the absence of antimetabolites, is a safe, effective, and stable alternative for patients with cataracts and glaucoma.

关键词：小梁切除术后晶状体乳化可拆除缝线安全性联合人工晶状体植入青光眼药物矫正视力抗代谢药物回顾性分析

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智能障碍人群的健康问题管理

英国医学杂志中文版 2009年第2期12卷 96-100页

作者： Henny M j.van Schroj.nstein Lantman-de Valk Patricia Noonan Walsh 张磊(译) 于欣(校) Department of General Practice and Govemor Kremers Centre Maastricht University PO Box.616 6200 MD Maastricht Netherlands Pepij. and Paulus Centre PO Box 40 6100AA EchtNetherlands Centre for Disability Studies (School of Psychology ) University College Dublin Dublin Ireland 北京大学精神卫生研究所

智能障碍人群的健康问题患病率比一般大众高，他们的健康需求经常未被发现和满足。有智能残疾和其他残疾的人也更容易产生伴发的健康问题。在残疾人的生活中改善其健康水平是以下项目的明确目标：美国2010年全民健康行动，英国的全民关... 详细信息

智能障碍人群的健康问题患病率比一般大众高，他们的健康需求经常未被发现和满足。有智能残疾和其他残疾的人也更容易产生伴发的健康问题。在残疾人的生活中改善其健康水平是以下项目的明确目标：美国2010年全民健康行动，英国的全民关爱行动们和一项由欧盟基金支持旨在开发和验证一系列残疾人健康指标的Pomona项目（***）。

关键词：健康问题智能障碍人群管理全民健康残疾人患病率比健康需求

联合性抗逆转录病毒治疗可减轻HIV/AIDS晚期患者中枢神经系统感染

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世界核心医学期刊文摘（神经病学分册） 2005年第3期1卷 20-21页

作者： McArthur j.C. McDermott M.P. McClernon D. 王英鹏 Department of Neurology Johns Hopkins Univ. Sch. of Medici ne 600 N Wolfe St Baltimore MD 21287-7609 United States Dr.

Background: Before the introduction of combination antiretroviral therapy (CAR T), neurological disease correlated with cerebrospinal fluid (CSF) levels of hum an immunodeficiency virus (HIV) RNA. Obj.ctive: To investigate the relationships among HIV RNA levels, immune activation markers, and neurological status in pat ients receiving CART. Design: Multicenter cohort study. Setting: Academic neurol ogy departments. Patients: A total of 371 patients unselected for neurological c omplaints and with CD4 cell counts less than 200/μL or with cognitive symptoms and CD4 cell counts less than 300/μL were enrolled into the Northeastern AIDS D ementia cohort in 1998-2002. Diagnoses of HIV associated dementia (HIV D) and minor cognitive motor disorder (MCmd) were obtained with a computerized algori thm. Plasma and CSF levels of HIV RNA, monocyte chemotactic protein 1, macrophag e colony stimulat ing factor, and tumor necrosis factor αwere quantified. Res ults: The mean±SD age was 41.5±7.2 years, and the mean±SD educational level w as 12.3±2.2 years. Seventy percent of the cohort was black, and 30%were women. The mean±SD CD4 cell count was 136.8±87.9/μL, and CART was used in 71%. Twe nty nine percent of the patients were unimpaired (n=106) , 36%had MCmd (n= 13 3), and 35%had HIV D (n=128). Mean log10 CSF HIV RNA copies per milliliter was 2.6±0.8, with no differences among the neurological groups, even after adj.stm ents for baseline CD4 cell counts and antiretroviral therapy. Cerebrospinal flui d HIV RNA was undetectable in 47%of unimpaired, 46%of MCmd, and 43%of HIV D patients (P=.91). Plasma levels of monocyte chemotactic protein type 1 and tumor necrosis factor αcorrelated weakly with HIV RNA levels but did not distinguish those with neurological deficits. Conclusions: In contrast to observations in i ndividuals not treated with CART, we found no relationship between CSF markers a nd neurological status in this CART using cohort with advanced HIV/AIDS. This w as not explicab

关键词： HIV/AIDS 细胞计数联合性神经病学队列研究基线水平轻度认知障碍免疫激活肿瘤坏死因子α 神经功能状态