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Intraoperative intracardiac thrombosis in a liver transplant patient

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World Journal of Hepatology 2010年第5期2卷 198-200页

作者： Lena Sibulesky Prith Peiris C Burcin Taner David J kramer Juan M Canabal Justin H Nguyen Department of Transplantation Division of Transplant SurgeryMayo ClinicJacksonvilleFL 32224United States Department of Anesthesiology Mayo ClinicJacksonvilleFL 32224United States Departments of Trans-plantation and Critical Care Mayo ClinicJacksonvilleFL32224United States

A 66-year-old female with cryptogenic cirrhosis complicated by ascites,hepatic encephalopathy,variceal bleeding and malnutrition with MELD of 34 underwent orthotopic deceased donor liver transplantation performed with piggyback *** eversion thromboendovenectomy was performed for a portal vein thrombus which resulted in an excellent portal vein *** liver graft was recirculated without any hemodynamic ***,the patient became hypotensive progressing to *** was resuscitated and a transesophageal probe was inserted which revealed a mobile right atrial thrombus and an underfilled poorly contractile right *** patient was noted to be coagulopathic at the *** became progressively more stable with a TEE showing complete resolution of the intracardiac thrombus.

关键词： Liver transplantation Cardiac thrombus Reperfusion injury Coagulopathy Transesophageal echocardiogram

急性和慢性肺损伤的模式及病因:基于非临床性实验证据的剖析(英文)

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中国当代儿科杂志 2014年第5期16卷 448-459页

作者： Matthias C. Hutten Boris W. kramer Department of Pediatrics/Neonatology University Clinic RWTH Aachen Germany Department of Pediatrics/Neonatology Maastricht University Medical Center The Netherlands

满足最基本需求的肺功能是早产儿存活的先决条件。早产儿肺结构和功能欠成熟,常常伴发呼吸窘迫综合征(RDS)。除结构不成熟之外,早产儿肺组织还易因出生前后各种不利状况及因素而受损,进而防碍生后肺部的正常发育,促发非成熟性慢性肺部病... 详细信息

满足最基本需求的肺功能是早产儿存活的先决条件。早产儿肺结构和功能欠成熟,常常伴发呼吸窘迫综合征(RDS)。除结构不成熟之外,早产儿肺组织还易因出生前后各种不利状况及因素而受损,进而防碍生后肺部的正常发育,促发非成熟性慢性肺部病变,导致支气管肺发育不良(BPD)。该文将以由炎症变化而引发并与炎症变化密切相关的肺损伤为重点,全面综述用以探讨早产儿肺部炎症反应机制的各种实验模型,这其中包括用来研究绒毛膜羊膜炎发病机制的模型。人们知道,绒毛膜羊膜炎与早产密切关。从临床角度讲,胎儿宫内接触绒毛膜羊膜炎会导致胎儿肺组织发育异常,进而影响早产儿的肺功能。根据临床数据,有作者认为:暴露于绒毛膜羊膜炎的胎儿其支气管肺发育不良的风险增高,但RDS的风险反而降低。目前有实验数据表明,急性和慢性羊膜炎均可导致胎儿肺部炎症反应。一些研究人员建立了各种动物模型,他们除了借助这些模型来检测肺组织中诸如IL-1之类炎症介质的水平外,他们还用这些模型研究过炎症介质在肺发育成熟过程中的作用。在接触过宫内炎症的动物胎儿,肺组织磷脂酰胆碱的生成量及表面活性蛋白的水平增高,这表明脂酰胆碱表面活性蛋白会影响肺上皮细胞成熟,其影响程度之大小主要取决于暴露炎症因子的时间和剂量以及炎症因子的性质。使用细菌脂多糖(LPS)或解脲活性物作为炎症因子处理实验动物可以模拟人绒毛膜羊膜炎的临床表现。此外,实验数据表明,胎儿似乎具有抗衡并降低炎症反应程度的能力。目前,越来越多的证据表明抗逆内毒素是胎儿炎症调节的一个重要机制。产前用糖皮质激素(GCS)处理孕妇是早产的标准治疗方案,该处理可对胎儿肺组织和免疫细胞的成熟施以复杂的影响。有趣的是,GCS对肺形态和功能的作用与LPS诱导的宫内羊膜炎症反应雷同。然而,动物实验显示,虽然在动物炎症反应和孕妇GCS处理后肺器官在成熟过程度中其构成变化极其相似,但两者存在"质"上的不同,且涉及的分子途径也各异。比如,产前炎症可诱发胎儿肺组织的TGFβ表达增高并激活其下游信号通路,然而产前GCS处理孕妇的效果则相反。尽管这两种干预都有短期益效,但他们均可使肺泡简化,进而导致肺结构异常。在肺发育成熟过程中,即便倍他米松和LPS均能类似程度地减少肺泡壁的厚度,但孕妇产前倍他米松治疗和动物产前LPS诱导动物绒毛膜羊膜炎所激活的其他信号传导通路(比如基质金属蛋白酶MMP)也各不相同。此外,产后治疗干预可能会导致肺部炎症和损伤。包括动物实验在内的诸多研究结果使人们越来越清楚地意识到与药物治疗相关的损伤,进而也对临床治疗方案作过适当的调整。迄今,不少研究人员通过各种动物模型对围产期复苏时子宫炎症对胎儿肺功能和肺感染的作用进行过广泛的研究。比如在机械通气方面,有关呼气末正压(PEEP)对肺功能、肺表面活性剂储存以及肺部炎症介质的正面作用就有不少来自动物模型的研究报道。这些动物模型实验探讨过诸如高频振动通气(HFOV)之类的机械通气技术对肺部的损害作用,其结果支持无论有无表面活性剂替代治疗都应避免机械通气的新治疗理念。补氧可进一步损伤肺组织并引发炎症。越来越多的证据表明,活性氧与细胞生长和发育有交互影响。据此,近年来便产生了下面的假说:支气管肺发育不良是一种由氧自由基所引发的病变。动物实验数据业己揭示氧和肺损伤之间的复杂交互作用,然而其机制尚不十分清楚。产前炎症可能早已引发胎儿肺部氧化应激反应并改变抗氧化能力,这就使得氧气与肺损伤之间的复杂关系变得更为复杂。此外,有动物实验就广泛用于新生婴儿的药物如类固醇、表面活性剂、咖啡因和维生素A对肺部的炎症变化及损伤作用进行过试验。这些实验数据可作为临床试验的依据,尤其在临床数据无法解决有关治疗效果或机制的不确定性情况下更是如此。这方面的一个典型例子就是那个有关慢性肺损伤进展差异原因令人印象深刻、支持"二次打击"假说的附加解释。临床研究暗示早产婴儿生前炎症和生后机械通气可能对支气管发育不良有协同作用。然而,诸如炎症之类的围产期病变和产后不同治疗干预之间的协同效应仍有待进一步确定。精心设计的实验研究将有助于阐明肺损伤、肺部炎症、肺修复及非正常肺发育之间的复杂关系,同时也将有助于确立源于新生婴儿早期肺部发育变异与终身性呼吸功能障碍之间的联系。

关键词：慢性肺损伤实验模型非临床炎症反应机制支气管肺发育不良呼吸窘迫综合征证据病因

Reported Child Health Benefits of Breastfeeding

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Reported Child Health Benefits of Breastfeeding

DEVELOPMENT OF MICROELECTRONICS FOR EUROPE

国际发育与疾病高峰论坛暨第六届儿童保健高层论坛、重庆市儿科年会

作者： Michael S.kramer

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DEVELOPMENT OF MICROELECTRONICS FOR EUROPE

Mossbauer,X-Ray and Magnetic Studies of Black Sand from the Italian Mediterranean Sea

The Third International Conference on Solid State and Integrated Circuit Technology

作者： Roel P.kramer Philips Semiconductors International B.V. Eindhoven The Netherlands

＜正＞ INTEGRATED CIRCUITS A KEY TECHNOLOGYElectronics in a broad sense （components, computers including software and peripherals, office automation, and industrial and consumer electronics） is fast becoming the major industrial activity in Europe, with a turnover in the European Community of 175 billion ECU in 1990, representing about 5% of the Gross Domestic Product.

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World Journal of Nuclear Science and Technology 2013年第3期3卷 91-95页

作者： Saverio Braccini Olivier Pellegrinelli Karl kramer Albert Einstein Center for Fundamental Physics(AEC) Laboratory for High Energy Physics(LHEP)University of BernBernSwitzerland Department of Chemistry and Biochemistry University of BernBernSwitzerland

The study of natural magnetic sands is instrumental to investigate the geological aspects of their formation and of the origin of their territory. In particular, Mossbauer spectroscopy provides unique information on their iron content and on the oxidation state of iron in their mineral composition. The Italian coast on the Mediterranean Sea near Rome is known for the presence of highly magnetic black sands of volcanic origin. A study of the room temperature Mossbauer spectrum, powder X-ray diffraction, energy dispersive X-ray spectroscopy, and magnetic measurements of a sample of black magnetic sand collected on the seashore of the town of Ladispoli is performed. This study reveals magnetite as main constituent with iron in both tetrahedral and octahedral sites. Minor constituents are the iron minerals hematite and ilmenite, the iron containing minerals diopsite, gossular, and allanite, as well as ubiquitous sanidine, quartz, and calcite.

关键词： Mossbauer Spectroscopy X-ray Diffraction (XRD) Energy Dispersive X-ray Spectroscopy (EDS) Magnetic Sands Iron Minerals

Relationships between Features of EmergingAdulthood, Situated Decisions toward PhysicalActivity, and Physical Activity among CollegeStudents: The Moderating Role of ExerciseIntensity Tolerance

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International Journal of Mental Health Promotion 2023年第11期25卷 1209-1217页

作者： Jinghua Chen Zihe Wang Fabian Herold Alyx Taylor Jin Kuang Ting Wang Arthur F.kramer Liye Zou Body-Brain-Mind Laboratory School of PsychologyShenzhen UniversityShenzhen518060China Beijing Chaoyang Hospital Capital Medical UniversityBeijing100020China Research Group Degenerative and Chronic Diseases MovementFaculty of Health Sciences BrandenburgUniversity of PotsdamPotsdam14476Germany School of Rehabilitation Sport and PsychologyAECC University CollegeBournemouthBH52DFUK Center for Cognitive&Brain Health Northeastern UniversityBoston02115-5005USA Beckman Institute University of IllinoisIllinoisUSA

A significant portion of emerging adults do not achieve recommended levels of physical activity (PA). Previous studies observedassociations between features of emerging adulthood and PA levels, while the potential psychological mechanisms that mightexplain this phenomenon are not fully understood. In this context, there is some evidence that situated decisions towardphysical activity (SDPA) and exercise-intensity tolerance might influence PA level. To provide empirical support for thisassumption, the current study investigated whether (i) features of emerging adulthood are linked to SDPA, which, in turn,might affect PA engagement;(ii) exercise-intensity tolerance moderate the relationship between SDPA and PA level;and (iii)SDPA is a mediator of the relationship between features of emerging adulthood and PA levels under the prerequisite thatexercise-intensity tolerance moderates the link between SDPA and PA engagement. In this study a group of 1,706 Chinesecollege students was recruited and asked to complete a set of questionnaires assessing their SDPA, PA levels, exercise-intensitytolerance, and features associated with emerging adulthood, namely Self-exploration, Instability, and Possibility. Our resultsindicated that SDPA positively predicted PA levels and this relationship became stronger when exercise-intensity tolerance wasused as a moderator. Furthermore, it was observed that individuals with a higher level of Instability and a lower level ofPossibility during emerging adulthood exhibited a lower level of SDPA. Taken together, the results of our study providefurther insights on a potential psychological mechanism linking features of emerging adulthood and physical activity.

关键词： Emerging adulthood situated decisions physical activity exercise-intensity tolerance moderated model

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完全母乳喂养的最佳期限

生殖与避孕 2006年第4期26卷 237-246页

作者： kramer MS Kakuma R 胡晓宇单位不详

尽管母乳喂养对健康的好处已被广泛认可，但是对完全母乳喂养最佳期限的见解和建议仍有明显的分歧。在出生3个月以后生氏发育缓慢是发展中国家常会观察到的现象（Waterlow 1979；Whitehead 1984；Shrimpton 2001）。这种生长缓慢一直被... 详细信息

尽管母乳喂养对健康的好处已被广泛认可，但是对完全母乳喂养最佳期限的见解和建议仍有明显的分歧。在出生3个月以后生氏发育缓慢是发展中国家常会观察到的现象（Waterlow 1979；Whitehead 1984；Shrimpton 2001）。这种生长缓慢一直被传统地认为由以下三方面冈素决定：①3-4个月单纯母乳喂养后提供生长所需的热量不足；②在许多发展中国家常用的断奶食品营养质量低下（即低热量和低微量营养素）；及③感染对热量摄入和消耗的负面影响。

关键词：纯母乳喂养期限发展中国家生长缓慢微量营养素发育缓慢营养质量断奶食品热量摄入低热量

Cholangiosepsis Caused by Neutrophilic Cholangitis in Plaque Psoriasis

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Journal of Cosmetics, Dermatological Sciences and Applications 2016年第2期6卷 81-84页

作者： Carina Bergthaler Ludwig kramer Andreas Steiner Paul Sator Department of Dermatology KH Hietzing Vienna Austria Department of Medicine KH Hietzing Vienna Austria

Psoriasis is a common inflammatory skin disease with many comorbid conditions. We present a 37-year-old male patient with a history of plaque psoriasis, status febrilis, violent umbilical pain, elevated inflammatory markers and liver parameters. Blood cultures were tested positive for E. coli. Diagnostic findings indicated that mechanical icterus and cholangiosepsis in the context of neutrophilic cholangitis were caused by inflammatory stenosis. Neutrophilic cholangitis is often found in combination with skin diseases with intense cutaneous infiltration with polymorphonuclear leucocytes and peripherial blood neutrophilia. Interleukin-8 may play a role in the pathogenesis of neutrophilic cholangitis occurring in patients with psoriasis [1]. We showed that complications of psoriasis can also occur at unusual locations. To date no case of neutrophilic cholangitis as an elicitor of cholangiosepsis has been reported.

关键词： Plaque Psoriasis Cholangitis Cholangiosepsis

Concurrency : state models & Java programs

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