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POSSUM、p-POSSUM和Cr-POSSUM:在美国医疗保健系统进行的有关结肠癌切除术预后的研究

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世界核心医学期刊文摘（胃肠病学分册） 2005年第2期1卷 9-10页

作者： Senagore A.J. Warmuth A.J. Delaney C.P. 郝筱倩 Department of Colorectal Surgery Cleveland Clinic Foundation 9500 Euclid Avenue Clevelan d OH 44195United StatesDr.

PURPOSE: The Physiologic and Operative Severity Score for the enUmeration of M ortality and morbidity (POSSUM), Portsmouth revision (p)-POSSUM, and colorectal (Cr)-POSSUM scoring systems were developed as audit tools for comparing outcomes in surgical and colorectal patients on the basis of operati ve risk assessment. The aim of this study was to evaluate the applicability of t hese systems to a cohort of colon cancer patients undergoing surgery in the Unit ed States. METHODS: POSSUM factors from 890 consecutive patients undergoing majo r surgical procedures for colon cancer in nine United States hospitals over a tw o-year period from January 2000 through December 2001 were prospectively collec ted. The observed over the expected hospital mortality was compared by means of the POSSUM, p-POSSUM, and Cr-POSSUM scoring systems. The effect of missing dat a on the utility of this process for outcome assessment was assessed with three methods for data imputation. RESULTS: The number of resections per institution r anged from 13 to 437. The observed mortality rate ranged from 0.8 percent to 15. 4 percent among the institutions, with an overall operative mortality of 2.3 per cent. The POSSUM, p-POSSUM, and Cr-POSSUM predicted mortality was 10.7 percent , 11.2 percent, and 4.9 percent, respectively. The POSSUM and p-POSSUM models o verpredicted mortality in all institutions (P 1 in three ins titutions. The calculations were unaffected by the various methods of inserting missing data. CONCLUSION: An apparent overprediction of mortality for colon canc er resection was evident with all three POSSUM variants. This implies that a cal ibration process is required for use of these variants in the United States heal th care system. Missing data may be treated as normal values without influencing outcome. The Cr-POSSUM appeared to be the most promising audit tool for colore ctal cancer

关键词： p-POSSUM 结肠癌切除术 Cr-POSSUM 美国医疗保健系统结肠癌患者结直肠癌手术总体死亡率住院死亡率外科患者

新型Spider单孔腹腔镜平台下猪肾部分切除术

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第二军医大学学报 2011年第10期32卷 1061-1064页

作者：杨波王辉清 Riccardo Autorino 肖亮王林辉许传亮 Jihad H.Kaouk 孙颖浩第二军医大学长海医院泌尿外科 Section of Laparoscopic and Robotic Surgery Glickman Urological & Kidney InstituteCleveland Clinic9500Euclid Avenue Q1044195-ClevelandOhioUSA

目的在新型Spider单孔腹腔镜平台下进行猪肾部分切除术,评估新型Spider单孔腹腔镜平台的操作特点及人机工程学特性。方法猪麻醉固定后切开2cm长的皮肤切口,按Spider平台置入法建立通道。接气腹并置入5mm观察镜,调整好角度后,固定在床边... 详细信息

目的在新型Spider单孔腹腔镜平台下进行猪肾部分切除术,评估新型Spider单孔腹腔镜平台的操作特点及人机工程学特性。方法猪麻醉固定后切开2cm长的皮肤切口,按Spider平台置入法建立通道。接气腹并置入5mm观察镜,调整好角度后,固定在床边悬挂架上。按常规手术方式行肾脏部分切除术,其中肾脏缺损以2-0V-loc带倒刺的可吸收缝线连续全层缝合。结果成功完成猪左肾部分切除术2例,手术时间为100、102min,肾脏温缺血23、28min,出血20～50ml,开放肾动脉后肾实质无继发性出血。结论 Spider单孔腹腔镜平台下猪肾部分切除术安全可行,较好地解决了单孔腹腔镜"交叉操作"的难题,器械碰撞干扰明显减少。但仍存在诸多缺陷,尤其是依靠内鞘管带动的可弯器械无法提供足够的牵拉力量,使得术中视野显露不够满意。

关键词：单孔腹腔镜手术外科器械肾部分切除术

应用DNA芯片数据挖掘复杂疾病相关基因的集成决策方法

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中国科学（C辑） 2004年第2期34卷 195-202页

作者：李霞饶绍奇张田文郭政张庆普 K.L.Moser E.J.Topol 哈尔滨工业大学计算机科学系 Department of Molecular Cardiology the Cleveland Clinic Foundation9500 Euclid AvenueClevelandOH44195USA Department of Molecular Cardiologythe Cleveland Clinic Foundation9500 Euclid AvenueClevelandOH44195USA 哈尔滨医科大学生物医学工程学教研室与生物信息学研究室 Department of Medicine Institute of Human GeneticsUniversity of MinnesotaMN55455USA

DNA芯片技术的迅速发展,可同时检测成千上万个基因的表达谱数据,为生命科学家们从一个全新的角度阐明生命的本质提供了可能性.目前,基因表达谱分析的工作大多集中在对癌症等疾病分类、疾病亚型识别等方面,而从这些基因表达谱信息中挖掘... 详细信息

DNA芯片技术的迅速发展,可同时检测成千上万个基因的表达谱数据,为生命科学家们从一个全新的角度阐明生命的本质提供了可能性.目前,基因表达谱分析的工作大多集中在对癌症等疾病分类、疾病亚型识别等方面,而从这些基因表达谱信息中挖掘反映疾病本质特征的相关基因,是一项在后基因组时代更具挑战意义的科学研究,基因挖掘由于缺少理想的数据挖掘技术而被忽视.我们提出了一种新颖的特征基因挖掘的集成决策方法,目的在于解决三个重要的生物学问题:生物学分类及疾病分型、复杂疾病相关基因深度挖掘和目标驱使的基因网络构建.我们成功地将此集成决策方法应用于一套结肠癌DNA表达谱数据,结果显示这一新颖的特征基因挖掘技术在应用DNA芯片数据分析、挖掘复杂疾病相关基因等方面具有很高的价值.

关键词： DNA芯片数据挖掘基因表达谱集成决策递归分类树特征识别复杂疾病

极低体重儿延长通气的疗效:死亡率及18个月后的神经发育状况

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世界核心医学期刊文摘（儿科学分册） 2006年第1期2卷 22-23页

作者： Walsh M.C. Morris B.H. Wrage L.A. 朱新菊 Rainbow Babies and Ch ildrens Hospital Mailstop 6010 11100 Euclid Avenue Cleveland OH 44106-6010 United States Dr.

Objective: To compare duration of ventilation to mortality and adverse neurode velopmental outcomes among extremely low birth weight (ELBW; 501-1000 g) infant s. Study design: Retrospective analysis of prospectively collected data from 536 4 infants with a birthweight of 501 to 1000 g born at National Institute of Chil d Health and Human Development (NICHD)-Neonatal Research Network centers from 1 995 to 1998. The main outcome measures were: survival, duration of mechanical ve ntilation, and neurodevelopmental outcome. Results: Overall survival was 71%. T he median duration of ventilation for survivors was 23 days; 75%were free of me chanical ventilation by 39 days, and 7%were ventilated for ≥60 days. Of those ventilated for ≥60 days, 24%survived without impairment. Of those ventilated f or ≥90 days, only 7%survived without impairment. Of those ventilated ≥120 day s, all survivors were impaired. Conclusions: The prognosis for ELBW with protrac ted ventilation remains grim. The cohort who remain intubated have diminished su rvival and high rates of impairment. Parents of these infants should be informed of changes in prognosis as the time of ventilation increases.

关键词：极低体重儿神经发育机械性通气存活者人类发展学持续时间缺陷发生率研究设计

直接注射组织纤溶酶原激活剂治疗视网膜下黄斑部出血

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世界核心医学期刊文摘（眼科学分册） 2006年第9期2卷 30-31页

作者： Singh R. P. Patel C. Sears J. 王静波(译) 不详 Vitreo-Retinal Service Cole Eye Institute Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland OH 44195 United States

Background/aims:Recent studies on the treatment of acute subretinal macular haemorrhage have shown that the volume of the clot and the time to evacuation have strong prognostic factors for visual outcome.A novel technique for surgical evacuation of these lesions involves direct injection of tissue plasminogen activator(t-PA)into the haematoma using pars plana *** aim of this study was to evaluate the clinical outcomes of this recently described ***:17 consecutive patients with subretinal macular haemorrhages caused by age related macular degeneration were *** demographics,acuities,and fluorescein angiograms were obtained for all *** patients underwent complete three port pars plana vitrectomy to enable direct cannulation of the subretinal space and injection of 48 μ g of t-PA,partial fluid-air exchange,1 hour face up supine positioning postoperatively,followed by upright positioning ***:88% of patients within the study had stabilisation or improvement of visual *** patients had total clearing of the macular haemorrhage and eight patients had subtotal *** patients had recurrence of the haemorrhage after the procedure and one patient underwent repair for retinal *** lesions demonstrated similar outcomes to classic or predominately classic *** patients required no therapy after the study to treat subfoveal ***:This study represents one of the largest case series to date showing that direct injection of subretinal t-PA with air-fluid exchange only and no intraoperative clot lysis period can have favourable results.

关键词：组织纤溶酶原激活剂黄斑部出血视网膜下直接注射治疗隐匿性病灶老年性黄斑变性荧光素血管造影

多发性硬化症患者巴氯芬鞘内注射后癫痫的发生率

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世界核心医学期刊文摘（神经病学分册） 2005年第9期1卷 50-51页

作者： Schuele S.U. Kellinghaus C. Shook S.J. 王英鹏 Department of Neurology/S91 Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland OH 44195 United StatesDr.

Oral and intrathecal baclofen (ITB) have been associated with epileptic seizures. The authors observed a higher incidence of epileptic seizures in 99 patients with multiple sclerosis (MS)-treated with ITB vs a matched control group (7%vs 1%, p < 0.05). Three patients with MS on ITB developed status epilepticus. Seizures were often associated with additional triggering factors.

关键词：多发性硬化症巴氯芬鞘内注射癫痫持续状态触发因素

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回肠袋-直肠吻合术后的阴道分娩:一个警示

世界核心医学期刊文摘（胃肠病学分册） 2006年第2期2卷 13-14页

作者： Remzi F.H. Gorgun E. Bast J. 张诗峰 Cleveland Clinic Foundation Department of Colorectal Surgery/A30 9500 Euclid Avenue Cleveland OH 44195 United States Dr.

PURPOSE: This study was designed to evaluate the impact of childbirth on anal sphincter integrity and function, functional outcome, and quality of life in females with restorative proctocolectomy and ileal pouch- anal anastomosis. METHODS: The patients who had at least one live birth after ileal pouch- anal anastomosis were asked to return for a comprehensive assessment. They were asked to complete the following questionnaires: the Short Form- 36, Cleveland Global Quality of Life scale, American Society of Colorectal Surgeons fecal incontinence severity index, and time trade- off method. Additionally, anal sphincter integrity (endosonography) and manometric pressures were measured by a medical physician blinded to the delivery technique. Anal sphincter physiology also was evaluated with electromyography and pudendal nerve function by nerve terminal motor latency technique. RESULTS: Of 110 eligible females who had at least one live birth after ileal pouch- anal anastomosis, 57 participated in the study by returning for clinical evaluation to the clinic and 25 others by returning the quality of life and functional outcome questionnaires. Patients were classified into two groups: patients who had only cesarean section delivery after ileal pouch- anal anastomosis (n = 62) and patients who had at least one vaginal delivery after ileal pouch- anal anastomosis (n = 20). The mean follow- up from the date of the most recent delivery was 4.9 years. The vaginal delivery group had significantly higher incidence of an anterior sphincter defect by anal endosonography (50 percent)vs. cesarean section delivery group (13 percent; P = 0.012). The mean squeeze anal pressure was significantly higher in the patients who had only cesarean section delivery (150 mmHg)after restorative proctocolectomy than patients who had at least one vaginal delivery (120 mmHg) after restorative proctocolectomy (P = 0.049). Quality of life evaluated by time trade- off method also was significantly better

关键词：回肠袋直肠吻合术阴道分娩剖宫产分娩整体生活质量结肠切除术结肠直肠超声内镜检查大便失禁

一种新型的外周性Mu阿片受体拮抗剂,爱维莫潘用于大型腹部术后肠梗阻治疗的Ⅲ期临床试验

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世界核心医学期刊文摘（胃肠病学分册） 2005年第11期1卷 6-7页

作者： Delaney C.P. Weese J.L. Hyman N.H. 陈云茹 Department of Colorectal Surgery/A30 Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland OH 44195 United StatesDr.

PURPOSE: Postoperative ileus presents significant clinical challenges that potentially prolong hospital stay, contribute to readmission, and increase morbidity. There is no approved treatment for postoperative ileus. Alvimopan is a novel, peripherally acting, mu opioid receptor antagonist currently in development for the management of postoperative ileus. METHODS: Patients undergoing partial colectomy or simple or radical hysterectomy were randomized to receive alvimopan 6 mg (n = 152), alvimopan 12 mg (n = 146), or placebo (n = 153) orally 2 hours before surgery and twice daily thereafter until discharge or for up to seven days. The primary efficacy end point, time to return of gastrointestinal function, was a composite measure of passage of flatus or stool and tolerating solid food. Secondary end points included time to the hospital discharge order written. Adverse events were monitored throughout the study. RESULTS: Mean time to gastrointestinal recovery was significantly reduced in patients treated with alvimopan 6 mg vs. placebo (hazard ratio = 1.45; P = 0.003), with a smaller reduction seen with alvimopan 12 mg (hazard ratio = 1.28; P = 0.059). Mean time to the hospital discharge order written was significantly accelerated in patients treated with alvimopan 6 mg (hazard ratio = 1.50; P < 0.001). The most common treatment-emergent adverse events across all treatment groups were nausea, vomiting, and hypotension; the incidence of nausea and vomiting was reduced by 53 percent in the alvimopan 12-mg group. CONCLUSIONS: In patients undergoing major abdominal surgery, alvimopan accelerated gastrointestinal recovery and time to the hospital discharge order written compared with placebo and was well tolerated.

关键词：术后肠梗阻 Mu 阿片受体拮抗剂外周性 Ⅲ期临床试验结肠切除术肠道功能安慰剂子宫根治术固体食物

Soft Computing for Fast Multidisciplinary Design Optimization

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Soft Computing for Fast Multidisciplinary Design Optimizatio...