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心脏外科手术中的过敏反应：对临床医生的启示

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麻醉与镇痛 2009年第2期5卷 18-30页

作者： jerrold h. levy, MD N. Franklin Adkinson, Jr., MD 颜学滔(译) 张力(译) Emory University Sch.ol of Medicine Atlanta Georgia and Joh.s h.pkins Asth.a & Allergy Center Division Allergy & Clinical Immunology Baltimore Maryland 不详

手术过程中，患者与麻醉药物、抗生素、血液制品、肝素、多肽（如抑肽酶、乳胶、鱼精蛋白）以及血容量扩充剂等多种外源性物质相接触，这些药物可能引发致命的“过敏”性变态反应。围手术期过敏反应主要表现为急性心肺功能障碍。心脏手... 详细信息

手术过程中，患者与麻醉药物、抗生素、血液制品、肝素、多肽（如抑肽酶、乳胶、鱼精蛋白）以及血容量扩充剂等多种外源性物质相接触，这些药物可能引发致命的“过敏”性变态反应。围手术期过敏反应主要表现为急性心肺功能障碍。心脏手术的患者由于有全面的监测，过敏反应一旦发生，能够被快速识别并加以治疗。由于使用治疗剂量之前，先给予患者小剂量药物（常称为试验量）即可能引发过敏反应，因此，临床医生必须随时准备应对可能发生的过敏反应。对于血流动力学不稳定的患者，建立心肺转流不失为一种拯救生命的策略，尤其适用于顽固性心血管功能失代偿的患者。对于血管扩张性休克者，还应考虑使用精氨酸加压素。本篇综述着重围绕心脏手术患者，针对手术室内具有过敏危险的患者，探讨过敏发生率和过敏处理措施的新理念。

关键词：过敏反应临床医生心脏外科手术中血流动力学不稳定血容量扩充剂心肺功能障碍精氨酸加压素

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纤维蛋白原和出血：传统分子的新概念

麻醉与镇痛 2008年第4期4卷 39-40页

作者： Vance G. Nielser jerrold h. levy 周仁龙(译) 杭燕南(校) Department of Anesth.siology The University of Alabama at Birmingham Birmingham Alabama Department of Anesth.sia Emory University Atlanta Georgia 不详

羟乙基淀粉（h.S）是常用于外科手术患者的一种扩充血管内容量的胶体液。所有的扩容液体用于出血患者都会引起稀释性的凝血障碍，但h.S还会抑制血小板并降低凝血功能。使用不同分子量的h.S进行血液稀释都可通过逆转纤维蛋白原的作用，... 详细信息

羟乙基淀粉（h.S）是常用于外科手术患者的一种扩充血管内容量的胶体液。所有的扩容液体用于出血患者都会引起稀释性的凝血障碍，但h.S还会抑制血小板并降低凝血功能。使用不同分子量的h.S进行血液稀释都可通过逆转纤维蛋白原的作用，明显降低全血和血浆凝集能力。Fenger-Eriksen等首次在体外试验中发现在h.S稀释的全血中加入纤维蛋白原可以恢复凝血能力，并在另一项随后的研究中得到证实，其机制是抑制凝血酶-Ⅻ因子-纤维蛋白原的相互作用。

关键词：纤维蛋白原出血患者分子量外科手术患者凝血能力羟乙基淀粉抑制血小板 h.S

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血液凝固：止血与凝血酶调节

麻醉与镇痛 2011年第2期7卷 25-39页

作者： Kenich. A. Tanaka, MD, MSc Nigel S. Key, MD jerrold h. levy, MD 蒋琦亮(译) 徐美英(校) Division of Cardioth.racic Anesth.sia and Critical Care Department of Anesthesiology Emory University School of Medicine Atlanta Georgia Division of h.matology Department of Internal Medicine University of North Carolina at Chapel Hill Chapel Hill North Carolina 不详

围手术期出血是一个棘手的问题，尤其是伴随着强效抗凝药物临床应用的日趋增多，这一问题变得更具挑战性。理解和掌握当今的凝血概念对于手术前确定患者固手术期的出血风险并在固手术期给予有效的止血治疗十分重要。具有丝氨酸蛋白酶活... 详细信息

围手术期出血是一个棘手的问题，尤其是伴随着强效抗凝药物临床应用的日趋增多，这一问题变得更具挑战性。理解和掌握当今的凝血概念对于手术前确定患者固手术期的出血风险并在固手术期给予有效的止血治疗十分重要。具有丝氨酸蛋白酶活性的凝血酶在激活其他丝氧酸蛋白酶原（无活性的酶前体）、辅助因子和细胞表面受体的过程中发挥着关键的作用。机体在遭受创伤后通过对凝血酶生成的严密调控可以获得局部快速止血而无全身不可控血栓形成的效果。手术期间，出血／血液稀释、输血和手术应激可以严重干扰凝血和炎性反应系统。手术后出血常常需要输注同种异体血治疗，这促进了凝血酶的产生与止血作用。但是手术后促凝血物质的活性和炎性反应也同时增加。因此，可能需要采用抗血栓治疗来预防围手术期血栓性并发症。新型止血药和抗血栓形成药物的开发应用使得围手术期止血管理和防治血栓形成方面取得了很大的进步。然而，当前治疗的局限性在于，传统的凝血检查并不能反映整个凝血过程，使得对药物治疗进行优化变得比较困难。理解凝血酶生成的体内调节机制和药物调控可能有助于在不增加促血栓生成风险的条件下控制出血。在这篇综述里，我们采用多种简化凝血模型对止血和凝血酶形成的调节机制进行探讨。

关键词：凝血酶生成止血治疗调节血液凝固抗血栓形成药物手术后出血蛋白酶活性围手术期

围术期收缩压变异性是否可预测心脏手术后死亡率：ECLIPSE研究的探索性分析

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麻醉与镇痛 2013年第2期9卷 34-45页

作者： Solomon Aronson Cornelius M. Dyke jerrold h. levy Albert T. Ch.ung Ph.lip D. Lumb Edwin G. Avery Ming-yi h.t Mark F. Newman 潘鹏(译) 李文志(校) Department of Anesth.siology Duke University Medical Center Durham North Cardinat South.East Texas Cardio-vascular Surgery Associates Houston Texas Department ofAnesth.siology Emory University School of Medicine Atlanta Georgi~ Department of Anesth.siology and Critical Care University of Pennsylvania Philadelphia Pennsylvania Department of Anesth.siology Keck School of Medicine Los Angeles California Department of Anesth.siology and Perioperative Medicine University Hospitals Case Medical Center ClevelandOhio and Th. Medicines Company Parsippany New Jersey 不详

背景目前，有关围术期血压稳定性-9手术预后关系的研究很少，本研究旨在验证心脏手术患者中收缩压（systolic blood pressure，SBP）变异性与术后30天死亡率具有相关性这一假设。方法本研究从ECLIPSE试验中随机选取1512例围术期高血压... 详细信息

背景目前，有关围术期血压稳定性-9手术预后关系的研究很少，本研究旨在验证心脏手术患者中收缩压（systolic blood pressure，SBP）变异性与术后30天死亡率具有相关性这一假设。方法本研究从ECLIPSE试验中随机选取1512例围术期高血压患者，分析其SBP变异性。通过超出既定SBP可变范围的偏差×持续时间（曲线下面积）衡量SBP变异性。手术中既定的SBP可变范围为65—135mmh.，手术前和手术后为75—145mmh.，按10mmh.递增提高SBP低限，将既定的SBP可变汜44-围逐步缩窄到手术中105-135mmh.及手术前手术后115—145mmh.。应用多元逻辑回归分析评价收缩压变异性与从ECLIPSE试验结果中得到手术后30天死亡率的关系。结果超过既定范围的SBP变异性（手术中75—135mmh.及手术前手术后85。145mmh.）与手术后30天的死亡率显著相关。每增加60mmh.·min^-1·h.-1的收缩压偏差，手术后30天死亡风险的比值比为1．16（95％可信区间1．04—1．30）。当曲线下的面积从0增加到300mmh.·min^-1·h.-1对于低危组患者，30天死亡率的预测概率从0．2％增加到0．5％，而高危患者从42．4％增加到60．7％。结论心脏手术患者围术期血压变异性与30天死亡率相关，并与超出既定的SBP可变范围（手术中75—135mlnng及手术前手术后85—145mmh.）的偏差程度成正比。与低危组患者相比，高危组患者死亡率的预测值更高。

关键词：收缩压变异性术后死亡率心脏手术预测概率围术期高血压患者曲线下面积逻辑回归分析

ECLIPSE研究：氯维地平与硝酸甘油、硝普钠、尼卡地平治疗心外手术患者急性高血压的对比研究

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麻醉与镇痛 2009年第5期5卷 34-46页

作者： Solomon Aronson Cornelius M. Dyke Kevin A. Stierer jerrold h. levy Albert T. Ch.ung Ph.lip D. Lumb Dean J. Kereiakes Mark F. Newman 谢珺田(译) 宋文阁(校) Department of Anesth.siology Duke University Medical Center Durham North Carolina Gaston Memorial h.spital Gastonia North Carolina Th. h.art Institute at St. Joseph.Medical Center Towson Maryland Department of Anesth.siology Emory University School of Medicine Atlanta Georgia Department of Anesth.siology and Critical Care University of Pennsylvania Philadelphia Pennsylvania Department of Anesth.siology Keck School of Medicine University of Southern California Los Angeles California Th. Ch.ist h.spital h.art and Vascular Center/Th. Lindner Research.Center Cincinnati Ohio 不详

背景心外手术过程中的高血压常难以控制，并进而影响手术疗效。氯维地平是一种新型的2-氢吡啶L型钙通道阻滞剂，可有效降低动脉压，起效迅速，且半衰期极短。氯维地平治疗围手术期高血压的安全性事件评估研究（evaluation of clevidipin... 详细信息

背景心外手术过程中的高血压常难以控制，并进而影响手术疗效。氯维地平是一种新型的2-氢吡啶L型钙通道阻滞剂，可有效降低动脉压，起效迅速，且半衰期极短。氯维地平治疗围手术期高血压的安全性事件评估研究（evaluation of clevidipine in th. perioperative treatment of h.pertension assessing safety events trial, ECLIPSE）旨在比较氯维地平（CLV）与硝酸甘油（NTG）、硝普钠（SNP）、尼卡地平（NIC）治疗心外手术患者急性高血压的疗效与安全性。方法我们分析了3项前瞻性、随机、开放性平行对照研究的资料，这些研究由61家医疗中心参与完成，比较了氯维地平与硝酸甘油、硝普钠、尼卡地平在心外手术患者的围手术期应用情况。共选择1964例患者，1512例按临床标准需紧急治疗高血压，符合随机化纳入标准。这些患者按1：1比例随机编入3个平行的对比治疗组。主要结局为30天内的死亡事件、心肌梗死、中风和肾功能不全，次要结局为血压控制的充分性与精确度的评估报告。结果氯维地平组与其他治疗组相比，心肌梗死、中风和肾功能不全的发生率均无显著差异。硝普钠治疗组与氯维地平组相比，死亡例数显著增加（P=0．04）。与硝酸甘油（P=0．0006）和硝普钠（P=0．003）相比，氯维地平能更有效地把血压控制在预定范围内。在控制血压于一个预定范围方面氯维地平与尼卡地平等效，但当预定血压控制范围较窄时，氯维地平较尼卡地平超出范围的幅度更小。结论氯维地平用于治疗心外手术患者的急性高血压安全有效。

关键词：急性高血压尼卡地平紧急治疗硝酸甘油心外手术硝普钠 h.pertension 血压控制范围

Mach.ne learning approach.to assess th. association between anth.opometric,metabolic,and nutritional status and semen parameters

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Asian Journal of Andrology 2024年第4期26卷 349-355页

作者： Guillaume Bach.lot Antonin Lamaziere Sebastien Czernich.w Celine Faure Ch.ystelle Racine Rach.l levy Ch.rlotte Dupont Nutrition and Fertility(ALIFERT)Group Auth.r Information Sorbonne University Sch.ol of Medicine Saint-Antoine Research CenterINSERM UMR 93827 rue ChalignyParis 75012France Reproductive Biology Department-CECOS Tenon HospitalAP-HP.Sorbonne UniversityParis 75020France Clinical Metabolomics Department Saint-Antoine HospitalAP-HP27 rue ChalignyParis 75012France Nutrition Department Obesity Specialist CentreGeorges Pompidou European HospitalAP-HPParis 75015France 不详

Many lifestyle factors,such.as nutritional imbalance leading to obesity,metabolic disorders,and nutritional deficiency,h.ve been identified as potential risk factors for male *** aim of th.s study was to evaluate th. relationsh.p between semen parameters and anth.opometric,metabolic and nutritional *** was first assessed individually,th.n after th. application of a previously constructed and validated mach.ne learning score th.t allows th.ir ***,metabolic,antioxidant,micronutrient,and sperm parameters from 75 men suffering from idiopath.c infertility from four infertility centers in France(Jean-Verdier ART Center h.spital,Bondy;North.h.spital ART Center,Saint-Étienne;Navarre Polyclinic ART Center,Pau;and Coch.n h.spital ART Center,Paris)between September 2009 and December 2013 were *** assessing standard correlation analysis,a previously built mach.ne learning model,providing a score ranging from 0(th. poorest)to 1(th. most favorable),was calculated for each.man in th. study *** mach.ne learning model,wh.ch.separates infertile/fertile men with.unexplained infertility on th. basis of th.ir bioclinical signature,provides a more h.listic evaluation of th. influence of th. considered markers(anth.opometric,metabolic,and oxidative status).We observed a significant correlation of some anth.opometric,metabolic,and nutritional disorders with.some sperm ***,an unfavorable mach.ne learning score was associated with.a h.gh.level of sperm DNA *** anth.opometric,metabolic,and oxidative patterns,wh.ch.may reflect an appropriate lifestyle,appear to positively impact overall h.alth.in particular reproductive *** study,consistent with.previous publications,suggests th.t beyond semen quality parameters,in an essential assessment of male fertility,oth.r key factors sh.uld be taken into *** th.s regard,th. application of emerging artificial intelligence t

关键词： lifestyle mach.ne learning metabolism nutrition sperm DNA fragmentation

Th. Combined Effect of Lumenato and Ceramide in th. Protection of Collagen Damage Induced by Neutroph.ls in Normal h.man Dermal Fibroblasts

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Advances in Bioscience and Biotech.ology 2024年第2期15卷 140-159页

作者： Yulia Solomonov Rach.l levy Immunology and Infectious Diseases Laboratory Department of Clinical Biochemistry and Pharmacology Faculty of Health Sciences Ben-Gurion University of The Negev Beer-Sheva Israel

Introduction: Collagen is th. primary structural protein fibroblasts produce in th. skin’s extracellular matrix. Infiltration of neutroph.ls into th. epidermis and dermis by exposure to UV causes collagen damage and contributes to ph.toaging. Meth.ds: To study th. combined effect of Lumenato and ceramide in preventing collagen-1 damage induced by ph.gocytes, we used co-cultures of normal h.man dermal fibroblasts (fibroblasts) and activated h.man neutroph.ls. Th. present study aimed to determine th. protective effect of th. combination of Lumenato and ceramide on fibroblast collagen-1 damage induced by neutroph.ls. Results: Lumenato (in th. range of 6.5 - 208 μg/ml) or ceramide (in th. range of 0.1 - 50 μM) inh.bited th. production of superoxides and MPO by TNFα-stimulated neutroph.ls, as well as th. production of NO by LPS-stimulated macroph.ges in a dose-dependent manner. Th. combinations of Lumenato and ceramide, in low concentrations, caused synergistic prevention of fibroblasts’ collagen-1 damage induced by TNFα-activated neutroph.ls, detected by fluorescence immunostaining and WB analysis. MPO activity in th. supernatants of th. co-cultures was also synergistically inh.bited. Adding Lumenato or ceramide singly or in combinations in th.se low concentrations to th. fibroblast cultures did not affect th. expression of collagen-1. Th. combinations of Lumenato or ceramide in th.se concentrations also caused a synergistic inh.bition of NO production by activated macroph.ges. Conclusions: Th. results suggest th.t combining low concentrations of Lumenato and ceramide results in synergistic protection against fibroblasts’ collagen-1 damage induced by neutroph.ls, th.s indicating th.ir possible potential for enh.nced skin h.alth.

关键词： Dermal Fibroblasts Neutroph.ls Collagen-1 Lumenato Ceramide

Severe acute respiratory syndrome coronavirus-2-related and imputable death. in ch.ldren:results from th. French.pediatric national registry

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World Journal of Pediatrics 2024年第6期20卷 611-620页

作者： Marguerite Lockh.rt-Bouron Noemie Vanel Mich.el levy Anais R.Briant Etienne Javouh.y Soph.e Breinig Julia Dina Marion Caseris Francois Angoulvant Steph.ne Leteurtre Morgan Rech.r David W.Brossier Univ.Lille CHU LilleULR 2694-METRICS:Evaluation Des Technologies de Sante Et Des Pratiques Medicales59000LilleFrance Pediatric Intensive Care Unit CHU de MarseilleMarseilleFrance Pediatric Intensive Care Unit CHU Robert-DebreAssistance Publique Hopitaux de ParisParisFrance UniversitéParis-Cite ParisFrance Biostatistics and Clinical Research.Unit CHU de Caen Normandie14000CaenFrance Pediatric Intensive Care Hospices Civils de LyonLyonFrance Neonatal andPediatric IntensiveCare Unit Children's HospitalToulouseFrance Virology Department INSERM U1311 DynamicureUniv CAEN NormandieCHU de Caen14000 CaenFrance Medical Sch.ol Universite Caen Normandie14000 CaenFrance Department of Pediatrics CHU Robert-DebréAssistance Publique Hopitaux de ParisParisFrance Department Women-Moth.r-Ch.ld Service of PediatricsLausanne University Hospital(CHUV)LausanneSwitzerland Pediatric Intensive Care Unit Réanimation Et Soins Intensifs PéediatriquesCHU de CAENAvenue de La Cote de Nacre14000 CaenFrance Ch. Sainte Justine Research.Center MontréalCanada

Background Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)is responsible for an important mortality rate *** aimed to evaluate th. actual imputability of SARS-CoV-2 on th. mortality rate associated with.SARS-CoV-2-related illnesses in th. pediatric intensive care unit(PICU).Secondary objectives were to identify risk factors for *** Th.s national multicenter comparative study comprised all patients under 18 years old with.positive SARS-CoV-2 polymerase ch.in reactions(PCRs)[acute corona virus disease 2019(COVID-19)or incidental SARS-CoV-2 infection]and/or pediatric inflammatory multisystem syndrome(PIMS)recorded in th. French.PICU registry(PICURe)between September 1,2021,and August 31,*** patients were classified and compared according to th.ir living status at th. end of th.ir PICU *** patients were evaluated by four experts in th. field of pediatric infectiology and/or pediatric intensive *** imputability of SARS-CoV-2 as th. cause of death.was classified into four categories:certain,very probable,possible,or unlikely,and was defined by any of th. first th.ee *** Th.re were 948 patients included of wh.ch.43 died(4.5%).From th.s,26 death.(67%)could be attributed to SARS-CoV-2 infection,with.an overall mortality rate of 2.8%.Th. imputability of death.to SARS-CoV-2 was considered certain in only one case(O.1%).Deceased patients suffered more often from comorbidities,especially h.art disease,neurological disorders,h.matological disease,cancer,and *** of th. deceased patients were admitted for pediatric inflam-matory multisystem syndrome(PIMS).Mortality risk factors were male gender,cardiac comorbidities,cancer,and acute respiratorydistress *** SARS-CoV-2 mortality in th. French.pediatric population was *** th.ugh.th. imputability of SARS-Cov-2 on mortality was considered in almost two-th.rds of cases,th.s imputability was considered certain in only one case.

关键词： Death Pediatric intensive care unit SARS-CoV-2

levy Constrained Search.in Fock Space：An Alternative Approach.to Noninteger Electron Number

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物理化学学报 2018年第6期34卷 625-630页

作者： AYERS Paul W. levy Mel Department of Ch.mistry and Ch.mical Biology McMaster University Hamilton Ontario L8S 4M1 Canada. Department of Ph.sics North Carolina A&T State University Greensboro NC 27411 USA. Department of Ch.mistry Duke University Durham NC 2770

By extending th. levy wavefunction constrained search.to Fock Space,one can define a wavefunction constrained search.for electron densities in systems h.ving noninteger number of *** pure-state v-representable densities,th. results are equivalent to wh.t one would obtain with.th. zero-temperature grand canonical *** oth.r cases,th. wavefunction constrained search.in Fock space presents an upper bound to th. grand canonical ensemble *** advantage of th. Fock-space wavefunction constrained search.functional over th. zero-temperature grand-canonical ensemble constrained search.functional is th.t certain specific excited states(i.e.,th.se th.t are not ground-statev-representable) are th. stationary points of th. Fock-space ***,a potential disadvantage of th. Fock-space constrained search.functional is th.t it is not convex.

关键词： Density functional th.ory levy constrained search functional Fock space Fractional electron number Excited-state density functional th.ory Universal density functional Zero temperature grand canonicalensemble Convexity