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致命性肺栓塞的6岁儿童

世界核心医学期刊文摘（儿科学分册） 2005年第11期1卷 22-22页

作者： sridhar A.V. Chakraborty s. 郭战宏 Department of Child Health Robert Kilpatrick Clinical Sciences Building University Hospitals of Leicester NHS Trust Leicester LE2 7LX United Kingdom

Pulmonary thromboembolism is rarely recognized in young children, even in hospital settings. All current management decisions for children with deep vein thrombosis (DVT) are directly extrapolated from treatment recommendations for adults with no further validation. We report the case of a 6-y-old child presenting with deep vein thrombosis of the leg veins and fatal pulmonary embolism. The fatal outcome in our case highlights the need for more epidemiological studies in children, not only to predict the recurrence of pulmonary emboli but also to prepare standard treatment guidelines for the management of DVT and pulmonary emboli in children. We speculate that there may be a role for temporary inferior vena cava filters in young children with extensive DVT of the legs. Conclusions: This case highlights the need for more epidemiological studies to predict the recurrence of pulmonary emboli and effective guidelines for the management of paediatric DVT and pulmonary emboli in children.

关键词：肺栓塞深静脉血栓形成下肢静脉处理决策流行病学研究治疗建议下腔静脉

影响Cavaterm(tm)plus子宫内膜去除术治疗结局的因素

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世界核心医学期刊文摘（妇产科学分册） 2006年第3期2卷 27-27页

作者： Julian s. Habiba M. 柳蕴 University Hospitals of Leicester Leicester Royal Infirmary Robert Kilpatrick Clinical Sciences Building P.O. Box 65 Leicester LE2 7LX United Kingdom

Objective: To study treatment outcome using the modified technique: Cavaterm(tm) plus. study design: Retrospective postal questionnaire, in a large teaching hospital. One hundred and twenty-eight women with menorrhagia were treated between February 2001 and April 2003. Data were collected prospectively for the duration of the procedure and alternatives offered. Followup questionnaire was distributed during November 2003 to assess menstrual status. Multiple binary logistic regression was performed to assess factors influencing success. Results: The mean follow up was 72 weeks, 103 patients (80.5%) completed the questionnaire. In 26 (25.2%) cases, there were one or more important deviations from recommended procedure. Twenty (19.4%) women had procedure-related amenorrhoea, 6 (5.8%) had spotting, 35 (34%) had light, and 26 (25.2%) had moderate bleeding. Eleven (10.7%) had a hysterectomy. The risk of failure was inversely related to age (OR 0.778, 95%CI 0.669-0.905), was higher in women who prior to surgery had longer duration of bleeding (OR 1.29, 95%CI 1.1-1.52), and when recommended selection or operative procedureswere not followed (OR 5.056, 95%CI 1.097-23.3). Conclusion: Cavaterm (tm) plus is associated with high patient satisfaction. The technique remains a good choice for women wishing to avoid hysterectomy, but there is a need to observe determinants of poor outcome.

关键词：子宫内膜 Cavaterm tm)plus 中度出血轻度出血月经过多出血持续时间失败风险子

Gastrointestinal bleeding in a patient with a continuous-flow biventricular assist device

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World Journal of Radiology 2016年第4期8卷 428-433页

作者： Raymond V Mirasol Jason J Tholany Hasini Reddy Billie s Fyfe-Kirschner Christina L Cheng Issam F Moubarak John L Nosher Department of Internal Medicine Jersey Shore University Medical Center Department of Radiology Rutgers Robert Wood Johnson Medical School Department of Pathology Robert Wood Johnson University Hospital Department of surgery Robert Wood Johnson University Hospital

The association between continuous-flow left ventricular assist devices(CF-LVADs)and gastrointestinal(GI)bleeding from angiodysplasia is well ***,the association between continuous-flow biventricular assist devices(CF-BIVADs)and bleeding angiodysplasia is less *** report a case of GI bleeding from a patient with a *** location of GI bleeding was identified by nuclear red blood cell bleeding *** vascular malformation leading to the bleed was identified and localized on angiography and then by *** intensity of bleeding,reflected by number of units of packed red blood cells needed for normalization of hemoglobin,as well as the time to onset of bleeding after transplantation,are similar to that seen in the literature for CF-LVADs and pulsatile *** angiography only detected a dilated late draining vein,pathology demonstrated the presence of both arterial and venous dilation in the submucosa,vascular abnormalities characteristic of a late arteriovenous malformation.

关键词： Continuous-flow ventricular assist devices Angiodysplasia Gastrointestinal bleeding Angiography Heart failure

Development of a Functional Assessment of Chronic Illness Therapy item library and primary symptom list for the assessment of patient-reported adverse events associated with immune checkpoint modulators

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Journal of Cancer Metastasis and Treatment 2020年第1期6卷 74-87页

作者： Kimberly A.Webster Mary L.O’Connor Aaron R.Hansen sheetal Kircher Heather s.L.Jim Adam P.Dicker Monika Janda Kari Ala-leppilampi Clifton O.Bingham III Josephine Feliciano Norah Lynn Henry Laurie E.steffen McLouth David Cella Department of Medical social sciences Northwestern University Feinberg School of MedicineChicagoIL 60611USA Princess Margaret Cancer Center University Health NetworkToronto M5G 1Z5Canada robert H Lurie Comprehensive Cancer Center Northwestern UniversityChicagoIL 60611USA Department of Health Outcomes and Behavior Moffitt Cancer CenterTampaFL 33612USA Department of Radiation Oncology Sidney Kimmel Medical College and Cancer Center at Thomas Jefferson UniversityPhiladelphiaPA 19107USA Centre for Health services Research The University of QueenslandQLD 4102Australia Applied Health Research Centre Li Ka Shing Knowledge InstituteSt Michael’s HospitalToronto M5B 1W8Canada Divisions of Rheumatology and Allergy and Clinical Immunology Johns Hopkins UniversityBaltimoreMD 21224USA Johns Hopkins University sidney Kimmel Comprehensive Cancer Center BaltimoreMD 21231USA University of Michigan Rogel Cancer Center Ann ArborMI 48109USA Department of Behavioral science Center for Health Equity Transformation and Markey Cancer CenterUniversity of Kentucky College of MedicineLexingtonKY 40536USA

Aim:To develop a comprehensive item library of patient-reported,immunotherapy-related adverse events(irAEs)that draws from and expands on the Functional Assessment of Chronic Illness Therapy(FACIT)Measurement ***:Literature review and iterative expert *** on a literature review of irAEs,we developed a framework of immunotherapy classes and their associated *** experts then reviewed iterations of symptom summaries and item maps linked to the immunotherapy *** provided content review and feedback was shared across experts until consensus was *** iterative process facilitated creation of a Primary symptom List associated with immune checkpoint modulators(ICMs),drawn from the larger set of *** FACIT items were mapped to the symptom list,and new items were written as needed to create the item ***:The full item library of irAEs is comprised of 239 items,covering 142 unique symptoms across 75 inflammatory reactions/immune conditions.A subset of 66 items comprises a Primary symptom List considered most common/relevant to ICM *** includes gastrointestinal,skin,pulmonary,neurologic,musculoskeletal,and multiple miscellaneous and constitutional ***:The FACIT Immunotherapy Item Library is a compilation of 239 self-report items that capture the wide range of AEs experienced by people receiving immune treatments.A subset of 66 items comprises a Primary symptom List meant for ICM *** of items selected from this library is encouraged in clinical research and clinical practice evaluation.

关键词： Immunotherapy immune checkpoint modulators quality of life immune-related adverse events patient reported outcomes cancer oncology

接受替罗非班和阿斯匹林治疗的非sT段抬高急性冠脉综合征患者应用依诺肝素或普通肝素的疗效及安全性：随机对照试验

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美国医学会杂志（中文版） 2005年第4期24卷 204-208页

作者： Michael A．Blazing James A. de Lemos Harvey D. White Keith A. A. Fox Freek W. A. Verheugt Diego Ardissino Peter M. DiBattiste Joarme Palmisano David W. Bilheimer steven M. snapinn Karen E. Ramsey Laura H. Gardner Vic Hasselblad Marc A. Pfeffer Eldrin F. Lewis Eugene Braunwald robert M. Califf 王淑敏（译）胡大一（校） Duke clinical Research Institute Durham NC Donald W. Reynolds Cardiovascular Clinical Research Center University of Texas Southwestern Medical Center Dallas Department of Cardiology Green Lane Hospital Auckland New Zealand Department of Cardiology Research University of Edinburgh Edinburgh Scotland Department of Interventional Cardiology University Medical Center Nijmegen the Netherlands Division of Cardiology Ospedale Maggiore Parma Italy Merck＆Company Whitehouse Station NJ Department of Medicine Harvard Medical SchoolBrigham and Women＇s Hospital Boston Mass 不详

背景：对于非sT段抬高急性冠脉综合征（acute coronary syndromes，ACs）患者而言，与单独应用普通肝素相比，依诺肝素或者血小板糖蛋白Ⅱb／Ⅲa受体拮抗剂替罗非班与普通肝素联合应用都显示出较好的疗效。目前，尚不清楚依诺肝素和替... 详细信息

背景：对于非sT段抬高急性冠脉综合征（acute coronary syndromes，ACs）患者而言，与单独应用普通肝素相比，依诺肝素或者血小板糖蛋白Ⅱb／Ⅲa受体拮抗剂替罗非班与普通肝素联合应用都显示出较好的疗效。目前，尚不清楚依诺肝素和替罗非班联合应用是否像普通肝素和替罗非班标准联合方案一样安全有效。目的：在非sT段抬高的ACs患者中评价依诺肝素和替罗非班联合疗法与普通肝素和替罗非班联合方案的疗效及安全性。设计、地点及参试者：国际前瞻性、开标（open—label）、随机、非劣势（noninferiority）试验。在接受替罗非班和阿斯匹林治疗的非sT段抬高ACs患者中分别给予依诺肝素1mg／kg（n=2026）每12小时一次或经体重校正的静脉普通肝素（n=1961），然后进行比较。这项A to Z试验的A阶段试验是于1999年12月至2002年5月进行的。主要观察指标：意向治疗人群7天时死亡、再发心肌梗死和难治性缺血的发生情况，该意向治疗人群是根据优效性和非劣势原则确定的。应用“心肌梗死溶栓治疗试验”（Thrombolysis in Myocardial Infarction，TIMI）中之出血分级系统，通过监测出血发生率判定用药安全性。结果：在治疗第7天时，随机分配至依诺肝素组的2018例患者中有169例（8．4％）发生死亡、心肌梗死或者难治性缺血，而普通肝素组的1952例患者中有184例（9．4％）发生上述事件（风险比[hazard ratio，HR]为0．88，95％可信区间[confidence interval，CI]为0．71～1．08）。该结果符合预先设定的非劣势标准。除死亡外，所有一级和二级复合终点事件分析结果均提示，依诺肝素更为有益。死亡仅见于1％的患者（依诺肝素组23例，普通肝素组17例）。任何TIMI分级的出血发生率都很低（依诺肝素组为3．0％，普通肝素组为2．2％；P=0．13）。最差情况分析（合并了两种独立的出血判定策略）表明，采用依诺肝素每治疗200例患者就会发生一次TIMI严重出血。结论：对于接受替罗非班和阿斯匹林治疗的非sT段抬高ACs患者而言，依诺肝素是除普通普通肝素之外的另一种适当选择。依诺肝素可使一级终点相对减少12％，绝对减少1％，符合非劣势标准。该结果与以往未联用糖蛋白Ⅱb／Ⅲa受体拮抗剂的试验一致。

关键词：非sT段抬高急性冠脉综合征随机对照试验用药安全性依诺肝素普通肝素替罗非班治疗人群阿斯匹林血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂

CODE-EHR:临床研究中运用结构化电子医疗记录的最佳实践框架

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英国医学杂志中文版 2022年第12期25卷 721-729页

作者： Dipak Kotecha Folkert W Asselbergs stephan Achenbach stefan DAnker Dan Atars Colin Baigent Amitava Banerjee Birgit Beger Cunnar Brobert Barbara Casadei Cinzia Ceccarelli Martin R Cowie Filippo Crea Maureen Cronin spiros Denaxas Andrea Derix Donna Fitzsimons Martin Fredriksson Chris PGale Georgios V Ckoutos Wim Goettsch Harry Hemingway Martin Ingvaris Adrian Jonas's robert Kazmierski susanne Logstrup R Thomas Lumbers Thomas F Lischer Paul McGreavy leana L Pina Lothar Roesiga Carl steinbeisser Mats sundgren Benoit Tyl Chislaine van Thiel Kees van Bochove Panos EVardas Tiago Villanueva Marilena Vrana Wim Weber Franz Weidinger stephan Windecker Angela Wood Diederick E Grobbee 创新药物计划BigData@Heart联盟欧洲心脏病协会 CODE-EHR国际共识小组宋奇繁(译) 汪奕名(译) 不详重庆医药高等专科学校

改善患者生存质量是全球临床医学的发展目标,大数据是实现其发展的关键所在。技术进步使结构化电子医疗记录得以常规化,也可能会改善缺失重要临床证据的问题。虽然大数据及其相关分析在新冠大流行期间发挥了重要作用,但也存在严重的缺... 详细信息

改善患者生存质量是全球临床医学的发展目标,大数据是实现其发展的关键所在。技术进步使结构化电子医疗记录得以常规化,也可能会改善缺失重要临床证据的问题。虽然大数据及其相关分析在新冠大流行期间发挥了重要作用,但也存在严重的缺陷。证实、核验、数据隐私以及对科学研究社会责任的践行是一项重要挑战。欧洲心脏病协会和BigData@Heart联盟已经收集了包括患者代表、临床医生、科研人员、监管机构、期刊编辑和企业代表在内的多元化国际参与者,提出了CODE-EHR的最低标准框架。为改进研究设计、提高信息透明度提供方法手段,同时为实现医疗保健数据的稳健并能够有效运用制定了技术路线图。

关键词：大数据数据隐私 CODE 技术路线图科研人员信息透明度医疗保健最低标准

偏头痛患者光幻视阈值的变异性高于对照者:一项连续经颅磁刺激研究

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世界核心医学期刊文摘(神经病学分册) 2006年第10期 19-19页

作者： Antal A. Arlt s. Nitsche M.A. 刘凯 Department of Clinical Neurophysiology Georg- August University of Gttingen Robert Koch Strafle 40 37075 Gttingen Germany Dr.

The aim of this study was to characterize the temporal course of phosphene thresholds (PT) using transcranial magnetic stimulation (TMs) in control subjects and in subjects with migraine and to observe whether changes in PT over time can predict a subsequent migraine attack. PTs were measured in 16 migraineurs nine with aura (MA) and seven without aura (MoA) and nine controls five times over an approximately 10- week period. Mean PTs were not significantly different between migraineurs and controls; however, there was a trend in MA showing lower thresholds. The minimum threshold values were also smaller in MA subjects than in MoA or control subjects. Generally, PTs had higher variance in migraineurs than in controls, revealing a significant increase in standard deviation of PTs in MA subjects. There was no significant difference of thresholds from the first to the last stimulation in controls and in MoA subjects, but the 3rd, 4th and 5th measurements of MA subjects were significantly lower than their first measurements. Four migraineurs experienced headache within 1 day after one of the measurements. They had either very low or very high PTs compared with the PT values which were not followed by a migraine attack. Our results imply that migraineurs show a higher variability among PT measurements over time than controls, revealing unstable excitability levels in these patients. Additionally, both particularly high and low PTs might predict a subsequent headache in some individuals.

关键词：偏头痛 PT 脑病磁刺激变异性患者经颅阈值门槛值

卒中一级预防指南美国心脏协会／美国卒中协会对医疗专业人员的声明

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国际脑血管病杂志 2015年第7期23卷 403-439页

作者： James F. Meschia Cheryl Bushnell Bernadette Boden-Albala Lynne T. Braun Dawn M. Bravata seemant Chaturvedi Mark A. Creager robert H. Eckel Mitchell s.V. Elkind Myriam Fornage Larry B Goldstein steven M. Greenberg susanna E. Horvath Costantino Iadecola Edward C. Jauch Wesley s. Moore John A. Wilson 李迪高一鹭陈政弘霍晓川孙海欣孙冬玲茹小娟江滨代表美国心脏协会卒中委员会、心血管和卒中护理委员会、临床心脏病学委员会、功能基因组学和生物转化委员会以及高血压委员会北京市神经外科研究所首都医科大学首都医科大学附属北京天坛医院临床流行病学北京市重点实验室 100050

这份更新版指南旨在为既往无卒中或短暂性脑缺血发作史的人群提供适时的综合性卒中预防循证建议，包括危险因素控制、头颈部动脉粥样硬化性疾病的干预方法以及预防血栓形成和血栓栓塞性卒中的抗栓治疗。此外，本指南还提供了针对遗传和... 详细信息

这份更新版指南旨在为既往无卒中或短暂性脑缺血发作史的人群提供适时的综合性卒中预防循证建议，包括危险因素控制、头颈部动脉粥样硬化性疾病的干预方法以及预防血栓形成和血栓栓塞性卒中的抗栓治疗。此外，本指南还提供了针对遗传和药理学检测以及在其他特殊情况下（包括镰状细胞疾病和卵圆孔未闭）进行卒中预防的建议。

关键词： AHA/AsA科学声明 AF 糖尿病高脂血症高血压颅内动脉瘤缺血预防与控制吸烟卒中

对比-增强宽频谐波超声影像:一种定量评估克罗恩病患者肠壁血供的新技术

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世界核心医学期刊文摘（胃肠病学分册） 2006年第1期2卷 61-61页

作者： Kratzer W. schmidt s.A. Mittrach C. 成虹 Abteilung Innere Medizin I Universitt Ulm Robert-Koch-Str. 8 DE-89081 Ulm Germany

Objective. To assess the possibility of quantitative determination of bowel wall vascularity using contrast-enhanced (sonoVue ) wideband harmonic imaging ultrasound and the HDI-Lab software in patients with Crohn’ s disease. Material andmethods. Twenty-one patients (13 F, 8 M, average age 33.8 ± 12.7 years, range 21-60 years) with histologically confirmed Crohn’ s disease and bowel wall thickness≥ 5mm were recruited for the study. All ultrasound examinations were performed using a Philips HDI 5000 scanner. Bowel wall vascularity was determined at the site of maximum bowel wall thickness at baseline and at 30, 60, 90 and 120 s following application of the contrast enhancer sonoVue (1.2 ml) using the HDI-Lab software. Results. The mean length of bowel segments exhibiting increased wall thickness was 122.3 mm (range: 23-350 ± 74.7 mm), with a mean wall thickness of 7.6 ± 1.2 mm. Onset of echo enhancement secondary to contrast medium application was observed after an average 13.4 s (range 7-19 ± 4.2 s).Echo intensity corresponding to *** vascularity was measured 30 s after application of contrast medium. Maximum average contrast medium uptake was 217.5% (range 118-466 ± 100.1% ). Conclusions. It is possible to quantify bowel wall vascularity accurately in patients with Crohn’ s disease using contrast-enhanced pulse inversion ultrasound (low-MI).

关键词：克罗恩病谐波超声血供超声检查肠壁厚度肠壁血管血流分布情况软件支持造影剂组织学确诊