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Hagen-Poiseuille's law:The link between cirrhosis,liver stiffness,portal hypertension and hepatic decompensation

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World Journal of Hepatology 2015年第1期7卷 28-32页

作者： Gerond Lake-Bakaar muneeb ahmed Amy Evenson Alan Bonder Salomao Faintuch Vinay Sundaram Liver Tumor Center Department of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA 02215United States

The onset of hepatic decompensation in cirrhosis heralds an accelerated downhill course with poor outcome. The sole predictor of this decompensationin cirrhosis is increased hepatic vein to portal vein gradient hepatic venous pressure gradient(HVPG). Surrogate markers of liver function or hepatic reserve appear to be less relevant. The hepatic sinusoids become less elastic and more rigid as liver fibrosis and cirrhosis progress. We propose that the HagenPoiseuille's law,which applies to rigid,but not elastic vessels,determines the pressure-flow characteristics in the sinusoids. In the rigid cirrhotic liver,HVPG rises dramatically with any change in net surface area or radius,r4 of the vasculature that follows surgical resection. This review relates liver stiffness to the risk of decompensation in patients with cirrhosis. The liver has a unique dual blood supply comprising a low pressure portal vein and high pressure hepatic artery. We compare the complexity of autoregulation in the normal elastic liver with that in the rigid cirrhotic liver. Therapeutic modalities to reduce portal pressure may reduce the risk of hepatic decompensation and improve outcomes in cirrhosis.

关键词： Portal hypertension Liver stiffness Hagen-Poiseuille's law

Current-fed Quasi Z-source Inverter-topology and Control

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Current-fed Quasi Z-source Inverter-topology and Control

作者： muneeb ahmed 山东科技大学

学位级别：硕士

电流型准阻抗源逆变器是对阻抗源逆变器的一个发展,它与传统阻抗源逆变器的不同之处包括元件额定值较低、电源应力减小、控制容易。传统电流源逆变器有两个主要的问题:单向功率流和只能升压而不能降压,这使得它在许多场合的应用受到限制... 详细信息

电流型准阻抗源逆变器是对阻抗源逆变器的一个发展,它与传统阻抗源逆变器的不同之处包括元件额定值较低、电源应力减小、控制容易。传统电流源逆变器有两个主要的问题:单向功率流和只能升压而不能降压,这使得它在许多场合的应用受到限制,如混合电动汽车、通用变频调速系统等。因其独特的电路结构,电流型准阻抗源逆变器可以通过在传统零状态期间插入独特的开路零状态实现降压功能,这大大提高了逆变器的可靠性,提供了诱人的单级逆变功率变换可实现升降压的功能。在输入电压大范围变化的场合,这种逆变器是一种非常有竞争力的电路拓扑。本论文从电流型准阻抗源逆变器的拓扑结构、工作原理开始讨论,主要研究了其调制方法,包括空间矢量控制方法及其FPGA数字实现,同时也涉及到了该逆变器的设计方法。提出了三种具有不同升压比的PWM控制方法,为了减小开关损耗,提出了一种改进的SVPWM控制方法,并对该方法与通用的方法进行了对比。论文对电流型准阻抗源逆变器的新特点,包括优越的升降压功能、较高的可靠性、较小的无源元件定额以及独特的可再生反馈能力等进行了综合研究。论文最后给出了一些仿真结果,以验证理论分析的正确性。

关键词：电流源逆变器脉冲宽度调制电流型准阻抗源逆变器空间矢量脉冲宽度调制

Ten-year survival of hepatocellular carcinoma patients undergoing radiofrequency ablation as a first-line treatment

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World Journal of Gastroenterology 2016年第10期22卷 2993-3005页

作者： Wei Yang Kun Yan S Nahum Goldberg muneeb ahmed Jung-Chieh Lee Wei Wu Zhong-Yi Zhang Song Wang Min-Hua Chen Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education) Department of UltrasoundPeking University Cancer Hospital and Institute Division of Image-guided Therapy Department of RadiologyHadassah Hebrew University Medical Center Laboratory for Minimally Invasive Tumor Therapies Department of RadiologyBeth Israel Deaconess Medical Center/Harvard Medical School

AIM: To investigate the long-term survival and prognostic factors in hepatocellular carcinoma(HCC) patients undergoing radiofrequency ablation(RFA) as a first-line ***: From 2000 to 2013, 316 consecutivepatients with 404 HCC(1.0-5.0 cm; mean: 3.2 ± 1.1 cm) underwent ultrasonography-guided percutaneous RFA as a first-line treatment. There were 250 males and 66 females with an average age of 60.1 ± 10.8 years(24-87 years). Patients were followed for 1 year to > 10 years after RFA(234, 181, 136, and 71 for 3, 5, 7, and 10 years, respectively). Overall local response rates and long-term survival rates were assessed. Survival results were generated using Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression model. RESULTS: In total, 548 RFA sessions were performed and major complications occurred in 10 sessions(1.8%). Local tumor progression and/or new tumor development were observed in 43.3%(132/305) of the patients during the follow-up period. Overall 5-and 10-year survival rates were 49.7% and 28.4%, respectively. Based on multivariate analysis, three factors were identified as independent prognostic factors for overall survival: Child-Pugh classification(HR = 4.054, P < 0.001), portal vein hypertension(HR = 2.743, P = 0.002), and tumor number(HR = 2.693, P = 0.003). The local progression-free 5- and 10-year survival rates were 42.7% and 19.5%. In addition to the Child-Pugh classification and the number of tumors, the number of RFA sessions(HR = 1.550, P = 0.002) was associated with local progression-free ***: RFA can achieve acceptable outcomes for HCC patients as a first-line treatment, especially for patients with Child-Pugh class A, patients with a single tumor and patients without portal vein hypertension.

关键词： Radiofrequency ablation Hepatocellular carcinoma Percutaneous Ultrasonography-guided Long term survi

Utility of liver biopsy in predicting clinical outcomes after percutaneous angioplasty for hepatic venous obstruction in liver transplant patients

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World Journal of Hepatology 2015年第14期7卷 1884-1893页

作者： Ammar Sarwar Edward Ahn Ian Brennan Olga R Brook Salomao Faintuch Raza Malik Khalid Khwaja muneeb ahmed Divison of Vascular and Interventional Radiology Beth Israel Deaconess Medical Center/Harvard Medical School Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical Center/Harvard Medical School Division of Transplant Surgery Beth Israel Deaconess Medical Center/Harvard Medical School

AIM: To determine utility of transplant liver biopsy in evaluating efficacy of percutaneous transluminal angioplasty(PTA) for hepatic venous obstruction(HVOO). METHODS: Adult liver transplant patients treated with PTA for HVOO(2003-2013) at a single institution were reviewed for pre/post-PTA imaging findings, manometry(gradient with right atrium), presence of HVOO on prePTA and post-PTA early and late biopsy(EB and LB, 60 d after PTA), and clinical outcome, defined as good(no clinical issues, non-HVOO-related death) or poor(surgical correction, recurrent HVOO, or HVOOrelated death). RESULTS: Fifteen patients meeting inclusion criteria underwent 21 PTA, 658 ± 1293 d after *** procedures with pre-PTA biopsy(n = 19), no difference was seen between pre-PTA gradient in 13/19 procedures with HVOO on biopsy and 6/19 procedures without HVOO(8 ± 2.4 mm Hg vs 6.8 ± 4.3 mm Hg; P = 0.35). Post-PTA, 10/21 livers had EB(29 ± 21 d) and 9/21 livers had LB(153 ± 81 d). On clinical follow-up(392 ± 773 d), HVOO on LB resulted in poor outcomes and absence of HVOO on LB resulted good outcomes. Patients with HVOO on EB(3/7 good, 4/7 poor) and no HVOO on EB(2/3 good, 1/3 poor) had mixed outcomes. CONCLUSION: Negative liver biopsy greater than 60 d after PTA accurately identifies patients with good clinical outcomes.

关键词： Hepatic venous outflow obstruction Livertransplantation Post-transplant biopsy Angioplasty

Portal vein thrombosis following percutaneous transhepatic cholangiography-An unusual presentation of Prothrombin (Factor Ⅱ) gene mutation

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World Journal of Radiology 2012年第5期4卷 224-227页

作者： Ian M Brennan muneeb ahmed Section of Interventional Radiology Department of Radiology Beth Israel Deaconess Medical Center/Harvard Medical School Boston MA 02215 United States

Portal vein thrombosis is an uncommonly reported complication of percutaneous transhepatic cholangiography (PTC). A thorough review of the available literature shows no reported cases. In this case, a 29 year old female presented on two separate occasions with portal vein thrombosis following PTC without drain placement. This unusual complication of image guided percutaneous biliary access is unreported in the literature and prompted evaluation of the patient's coagulation parameters. A thrombophilia screen demonstrated a mutation in the Prothrombin (Factor Ⅱ) gene. A thorough literature review shows no reported cases of portal vein thrombosis following percutaneous biliary access, is an unusual complication, and should raise suspicion of an underlying pro-coagulant state.

关键词： Percutaneous transhepatic cholangiography Portal vein thrombosis Prothrombin gene mutation Hereditary thrombophilia

共识指南和循证指南中基于低质量证据的强推荐及其合理性的经验性分析

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英国医学杂志中文版 2022年第3期25卷 142-149页

作者：姚亮 Muhammad muneeb ahmed Gordon H Guyatt 闫沛静惠旭王琪杨克虎田金徽 Benjamin Djulbegovic 李紫珺(译) 郭珂(译) 姚亮(校) 王琪(校) 田金徽(校) 杨克虎(校) Department of Health Research Methods Evidenceand ImpactMcMaster UniversityHamiltonONCanada Michael G DeGroote School of Medicine McMaster UniversityHamiltonONCanada Department of Medicine McMaster UniversityHamiltonONCanada 四川大学华西公共卫生学院四川大学华西第四医院流行病与卫生统计学系兰州大学循证医学中心 Beckman Research Institute Department of Computational and Quantitative MedicineCity of HopeDuarteCAUSA 兰州大学公共卫生学院循证社会科学研究中心加拿大麦克马斯特大学

目的探讨共识指南及循证指南的证据质量与推荐强度是否一致。研究设计经验性分析。数据来源美国心脏病学会/美国心脏协会(ACC/AHA)和美国临床肿瘤学会(ASCO)于2021年3月27日前制订的指南。指南选择纳入推荐意见符合以下标准的指南:明确... 详细信息

目的探讨共识指南及循证指南的证据质量与推荐强度是否一致。研究设计经验性分析。数据来源美国心脏病学会/美国心脏协会(ACC/AHA)和美国临床肿瘤学会(ASCO)于2021年3月27日前制订的指南。指南选择纳入推荐意见符合以下标准的指南:明确报告循证或共识意见、推荐意见独立于指南全文、报告证据质量和推荐强度。数据提取由2名研究人员独立提取资料,提取内容包括:推荐意见类型(共识意见或循证意见)、制订推荐意见的分级系统、推荐强度和证据质量。研究团队统计了低质量证据强推荐和不合理的低质量证据强推荐(不符合GRADE标准)的数量。结果本研究共纳入12部ACC/AHA指南中的1434条推荐意见以及69部ASCO指南中的1094条推荐意见。ACC/AHA指南共有504条基于低质量证据的推荐意见,其中200条(40%)是共识意见,304条(60%)是循证意见;ASCO指南中包含404条基于低质量证据的推荐意见,其中292条(72%)是共识意见,112条(28%)是循证意见。ACC/AHA和ASCO制订的指南中,共识指南比循证指南出现了更多基于低质量证据的强推荐,ACC/AHA[比值比(0R)=2.1,95%可信区间(CI)(1.5-3.1)],ASCO[OR=2.9,95%CI(1.1-7.8)],以及更多不合理的低质量证据强推荐,ACC/AHA[OR=2.6,95%CI(1.7-3.7)],ASCO[OR=5.1,95%CI(1.6-16.0)]。结论与循证指南相比,共识指南更容易形成不符合循证医学基本原则的推荐意见。确保证据质量与推荐强度的一致性和合理性是制订可信赖指南的关键。

关键词：美国心脏病学会美国心脏协会循证指南证据质量共识意见循证医学推荐意见比值比

以解决复杂工程问题为导向的工科课程教学模式研究

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安庆师范大学学报（自然科学版） 2021年第4期27卷 101-106页

作者：赵秀栩木尼布付钰武汉理工大学机电工程学院湖北武汉430070

针对目前在工科学生中普遍存在的解决复杂工程问题能力不足这一突出问题,提出一种新的课程教学模式。该模式以解决复杂工程问题为目标设计课程教学与实践活动内容,对课程教学过程、方法以及课程考核评价方法等进行全面改进,以期通过复... 详细信息

针对目前在工科学生中普遍存在的解决复杂工程问题能力不足这一突出问题,提出一种新的课程教学模式。该模式以解决复杂工程问题为目标设计课程教学与实践活动内容,对课程教学过程、方法以及课程考核评价方法等进行全面改进,以期通过复杂工程问题实现对不同课程的知识进行有效集成的目标。按照这一思路,以工业工程专业的"单元制造理论与方法"课程为例进行了实际应用,研究结果表明,这种教学模式能够有效地促进学生对本专业其他所学课程知识的掌握和综合应用,提高了学生对复杂工程问题进行分析和解决的能力。

关键词：工科课程复杂工程问题教学模式设计能力培养

Dynamic Hand Gesture Recognition Using 3D-CNN and LSTM Networks

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Computers, Materials & Continua 2022年第3期70卷 4675-4690页

作者： muneeb Ur Rehman Fawad ahmed Muhammad Attique Khan Usman Tariq Faisal Abdulaziz Alfouzan Nouf M.Alzahrani Jawad Ahmad Department of Electrical Engineering HITEC University TaxilaPakistan Department of Computer Science HITEC University TaxilaPakistan College of Computer Engineering and Sciences Prince Sattam Bin Abdulaziz UniversityAl-KhrajSaudi Arabia Department of Forensic Sciences College of Criminal JusticeNaif Arab University for Security SciencesRiyadhSaudi Arabia Department of Information Technology Albaha UniversityAlbahaSaudi Arabia School of Computing Edinburgh Napier UniversityUK

Recognition of dynamic hand gestures in real-time is a difficult task because the system can never know when or from where the gesture starts and ends in a video *** researchers have been working on visionbased gesture recognition due to its various *** paper proposes a deep learning architecture based on the combination of a 3D Convolutional Neural Network(3D-CNN)and a Long Short-Term Memory(LSTM)*** proposed architecture extracts spatial-temporal information from video sequences input while avoiding extensive *** 3D-CNN is used for the extraction of spectral and spatial features which are then given to the LSTM network through which classification is carried *** proposed model is a light-weight architecture with only 3.7 million training *** model has been evaluated on 15 classes from the 20BN-jester dataset available *** model was trained on 2000 video-clips per class which were separated into 80%training and 20%validation *** accuracy of 99%and 97%was achieved on training and testing data,*** further show that the combination of 3D-CNN with LSTM gives superior results as compared to MobileNetv2+LSTM.

关键词： Convolutional neural networks 3D-CNN LSTM spatiotemporal jester real-time hand gesture recognition

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印度“千月”餐厅

现代装饰 2012年第4期 102-105页

作者： Lalita Tharani Mujib ahmed muneeb Mazhar Shaoukath Vineeta Parekh 代照 Collaborative Architecture

本寨是CollaborativeArchitecture对一家商务酒店进行重新设计的一部分，旨在对这个已经非常有名的餐馆进行室内建筑的精心重构，以赢得新的形象和更多食客，同时也希望为酒店带来更多客人。进入餐厅．首先可以看到等候区，其设计十分... 详细信息

本寨是CollaborativeArchitecture对一家商务酒店进行重新设计的一部分，旨在对这个已经非常有名的餐馆进行室内建筑的精心重构，以赢得新的形象和更多食客，同时也希望为酒店带来更多客人。进入餐厅．首先可以看到等候区，其设计十分醒目．与用餐空间分开．可以从这里看到内部的景象。餐厅内部空间布局灵活，经过改造后，使用率变得更为合理．并且，原本的八人和六人餐桌被更换为四人与两人座的餐桌，方便桌位组合，适应不同规模团体的就餐需求。

关键词：餐厅印度商务酒店空间布局室内建筑使用率设计餐桌