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中医对发作性睡病的认识
发作性睡病(narcolepsy)作为综合征早由Gelineau在1880年提出[1],1934年Daniels提出白天嗜睡、猝倒、睡眠麻痹和入睡前幻觉是目前临床常说的"四联症"[2].日间嗜睡是先出现的症状,猝倒是发作性睡病的特有症状,约70%的患者会出现猝倒.国际睡眠障碍分类标准(international classification of sleep disorder,ICSD)将发作性睡病分为猝倒型发作性睡病和非猝倒型发作性睡病,并且为两个独立的亚型,此外还有继发性发作性睡病[3].发作性睡病的发病率为0.03%~0.05%,常见青少年期发病,约10%的病例发生在10岁之前,第二个发病高峰年龄是接近40岁时,5%的病例发生于50岁之后.本病发病率虽不高,但对患者本人、社会影响却较大[4].
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中医学"数量"表述的分类、特征及英译
中医学"数量"表述呈现模糊性、隐含性、层级性、夸张性、直显性的特征,其内涵和外延体现了中医学整体思维和辨证思维的认知方式.中医学"数量"的正确分类和英译将有助于中医药文化的跨文化交流.
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淋巴瘤的治疗与病理分类:进展与困惑
病理学是临床医学诊断与治疗的基础.半个世纪以来淋巴瘤的病理学发展变化很大,淋巴瘤病理分类的完善和诊治的进步,成为病理学促进临床医学发展的典范,彰显了病理医师在临床诊疗中的重要地位.
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EB病毒淋巴增殖性疾病国际分类的新进展
EB病毒(BV)淋巴增殖性疾病国际分类会议于2008年9月8-9日在美国华盛顿Bethesda的美国国家卫生研究院(NIH)召开.会议由国家癌症研究所(NCI)、国家过敏和传染病研究院(NIAID)和NIH少见病办公室联合主办.Elaine S.Jaffe和Jeffrey Cohen教授是会议组织者,共有40人参加会议,其中包括14位病理学家和26位病毒学家、免疫学家、感染病学家、血液病学家和肿瘤学家(图1).
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WHO分类和NCCN指南在淋巴瘤病理诊断中的应用体会
一、WHO分类和NCCN指南是临床和病理沟通的桥梁2008版淋巴瘤WHO分类吸收了近年来病理、临床和基础的新研究成果[1],在2001版的基础上将原来淋巴瘤的30余种类型,扩展到60余种,在给人们带来惊喜的同时,也带来些许惶惑.
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淋巴瘤病理诊断与分类的国内现状及思考
由于淋巴组织的结构特殊和所含细胞的异质性强,淋巴瘤的诊断长期以来是诊断病理的难点之一.国际上对淋巴瘤的认识和分类已经历了一个多世纪的研究和探讨.许多国际上著名的学者如Rappaport等和Lennert等用了一生的精力,虽对淋巴瘤的诊断和分类做出了贡献,但并没有真正地认识到淋巴瘤的本质.
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脊髓损伤继发性神经病理性疼痛
流行病学研究表明,脊髓损伤(spinal cord injury,SCI)每年的发生率约为每百万人25例(其中17例为外伤性SCI,8例为非外伤性SCI)[1].国际神经病学分类标准(International Standards for Neurological Classification,ISNC)推荐采用美国脊柱损伤协会(American Spinal Injury Association,ASIA)功能缺损评分(AIS)对SCI进行分级.
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再解读慢性肾脏病的分期体系
2002年,美国肾脏病基金会(NKF)肾脏病生存质量指导(K/DOQI)工作组组织撰写了肾脏病/透析临床实践指南[1],首次正式提出了慢性肾脏病(CKD)的定义和分期,涵盖了慢性肾脏疾病的临床评估、分级和危险分层等各个方面.2004-2006年,经过提高肾脏病整体预后工作组(KDIGO)的再次修改及确认,CKD成为对各种原因所致慢性肾脏疾病(病程3个月以上)的统称,被普遍应用于各种肾脏病及非肾脏病的国际学术期刊,并被录入国际疾病分类代码(ICD)第9版,成为正式疾病的分类名词.人们对CKD的关注程度因而大幅提高,这一新的概念体系不但大大推动了CKD的流行病学研究,而且对公共卫生政策产生了深远的影响[2].
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一种新的贲门失弛缓的内镜下分型
我们以前对贲门失弛缓的治疗是采取注射肉毒素、扩张或外科手术的方法.长久以来贲门失弛缓的分型有X线的分型与动力的分型,没有内镜下的分型,但随着经口内镜下肌切开术( peroral endoscopic myotomy,POEM )的进行,我们发现,越来越多的患者不能进行POEM .
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儿童急性淋巴细胞白血病基因学分型和调控网络
"儿童急性淋巴细胞白血病基因学分型和调控网络( Gene expression-based classification and regulatory networks of pediatric acute lymphoblastic leukemia)"一文发表在Blood杂志.儿童急性淋巴细胞白血病(ALL)的合理规范治疗依赖于精确的诊断分型,本研究报道了用Affymetrix全基因组表达谱芯片对儿童ALL的基因学诊断分型研究.首先利用国外已发表的535例儿童ALL芯片数据,用基于递归支持向量机的递归特征筛选法(SVM-RFE)对此数据进行了生物学信息分析,筛选出62个与临床亚型密切相关的标志基因,用此构建的分类模型能准确将儿童ALL分成6个亚型即BCR-ABL、Hyperdiploid>50、TEL-AML1、E2A-PBX1、MLL和T-ALL,分类效果与常规形态学(morphology)、免疫学(immunology)、细胞遗传学(cytogenetics)和分子生物学(molecular biology)即MICM的分类符合率达97.6%.
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3-N-butylphthalide is an effective drug for acute ischemic stroke. However, its effects on chronic cerebral ischemia-induced neuronal injury remain poorly understood. Therefore, this study li-gated bilateral carotid arteries in 15-month-old rats to simulate chronic cerebral ischemia in aged humans. Aged rats were then intragastrically administered 3-n-butylphthalide. 3-N-butylphtha-lide administration improved the neuronal morphology in the cerebral cortex and hippocampus of rats with chronic cerebral ischemia, increased choline acetyltransferase activity, and decreased malondialdehyde and amyloid beta levels, and greatly improved cognitive function. These findings suggest that 3-n-butylphthalide alleviates oxidative stress caused by chronic cerebral ischemia, improves cholinergic function, and inhibits amyloid beta accumulation, thereby im-proving cerebral neuronal injury and cognitive deifcits.
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Depression is closely linked to the morphology and functional abnormalities of multiple brain regions;however, its topological structure throughout the whole brain remains unclear. We col-lected resting-state functional MRI data from 36 ifrst-onset unmedicated depression patients and 27 healthy controls. The resting-state functional connectivity was constructed using the Auto-mated Anatomical Labeling template with a partial correlation method. The metrics calculation and statistical analysis were performed using complex network theory. The results showed that both depressive patients and healthy controls presented typical small-world attributes. Compared with healthy controls, characteristic path length was signiifcantly shorter in depressive patients, suggesting development toward randomization. Patients with depression showed apparently abnormal node attributes at key areas in cortical-striatal-pallidal-thalamic circuits. In addition, right hippocampus and right thalamus were closely linked with the severity of depression. We se-lected 270 local attributes as the classiifcation features and their P values were regarded as criteria for statistically significant differences. An artificial neural network algorithm was applied for classiifcation research. The results showed that brain network metrics could be used as an effec-tive feature in machine learning research, which brings about a reasonable application prospect for brain network metrics. The present study also highlighted a signiifcant positive correlation between the importance of the attributes and the intergroup differences;that is, the more sig-niifcant the differences in node attributes, the stronger their contribution to the classiifcation. Experimental ifndings indicate that statistical signiifcance is an effective quantitative indicator of the selection of brain network metrics and can assist the clinical diagnosis of depression.
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The automatic detection and identification of electroencephalogram waves play an important role in the prediction, diagnosis and treatment of epileptic seizures. In this study, a nonlinear dynamics index-approximate entropy and a support vector machine that has strong generalization ability were applied to classify electroencephalogram signals at epileptic interictal and ictal periods. Our aim was to verify whether approximate entropy waves can be effectively applied to the automatic real-time detection of epilepsy in the electroencephalogram, and to explore its generalization ability as a classifier trained using a nonlinear dynamics index. Four patients presenting with partial epi-leptic seizures were included in this study. They were al diagnosed with neocortex localized epi-lepsy and epileptic foci were clearly observed by electroencephalogram. The electroencephalogram data form the four involved patients were segmented and the characteristic values of each segment, that is, the approximate entropy, were extracted. The support vector machine classifier was con-structed with the approximate entropy extracted from one epileptic case, and then electroence-phalogram waves of the other three cases were classified, reaching a 93.33%accuracy rate. Our findings suggest that the use of approximate entropy al ows the automatic real-time detection of electroencephalogram data in epileptic cases. The combination of approximate entropy and support vector machines shows good generalization ability for the classification of electroencephalogram signals for epilepsy.
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Although ultrasound measurements have been used in previous studies on carpal tunnel syn-drome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately relfects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5–17 MHz was used to assess 77 pa-tients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Signiifcant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-section-al areas of the median nerve was 1.29 between mild and more severe (moderate and severe) carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% speciifcity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% speciifcity. These results suggest that the inlet-to-outlet ratio relfected the severity of carpal tunnel syndrome.
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DSM-V物质相关障碍诊断分类及标准的解读与比较
美国<精神疾病诊断与统计手册>(The Diagnostic and Statistical Manual of Mental Disorders,DSM)与世界卫生组织的国际疾病与相关健康问题统计分类(International Statistical Classification of Diseases and Related Health Problems,ICD)中精神和行为障碍部分类似,是国际公认并被很多国家接受作为精神疾病分类和临床诊断标准.其第五版(DSM-V)的诊断标准的征求意见稿已经发布,现就其中涉及物质相关障碍的一些情况介绍如下.
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十二指肠类癌分类、诊断及治疗
类癌是一种少见的神经内分泌系统肿瘤,其组织分化较好、生长缓慢,呈低度恶性,因其细胞颗粒有亲银特性,又称嗜银细胞瘤.类癌发病率为1/10万~2/10万,超过70%发生在消化道[1],但因诊断率低,实际发病率可能更高.胃肠道类癌起源于肠腺管基部的嗜银细胞,发病率占胃肠道肿瘤的0.4%~1.8%,十二指肠类癌仅占胃肠道类癌的1.3%[2],占十二指肠恶性肿瘤的3.0%[3].其发病缓慢,早期无特异性的临床表现,诊断困难,误诊率高,随着肿瘤进展可出现类癌综合征.现对十二指肠类癌进行阐述,以提高对其认识.
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消化道浅表性瘤变的巴黎分型(更新版)
Background and Study Aims:Neoplastic lesions in the digestive-tract mucosa are termed “superficial” when the depth of invasion is limited to the mucosa and submucosa.The endoscopic appearance has a predictive value for invasion into the submucosa,which is critical for the risk of nodal metastases.
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食管、胃和结肠浅表性瘤变的巴黎分型
An international group of endoscopists,surgeons,and pathologists gathered in Paris for an intensive workshop designed to explore the utility and clinical relevance of the Japanese endoscopic classification of superficial neoplastic lesions of the GI tract.This report summarizes the conclusions of the workshop and proposes a general framework for the endoscopic classification of superficial lesions of the esophagus,stomach,and colon.The clinical relevance of this classification is demonstrated in tables that show the relative proportion of each subtype in the esophagus,stomach,and colon,assessing the risk of submucosal invasion and the risk of lymph node metastases.
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Objective To study the clinical characteristics of 2952 patients with epilepsy who had received drug treatment from the neurology outpatient clinics of eight major hospitals in Hong Kong.Methods Retrospective review of outpatient records.Results 1601 (54.3%) males and 1351 (45.7%) females with a median age of 35.8 years (range, 10-94.8) were studied. Seizure types included generalized tonic-clonic in 80.7% of patients, complex partial in 28.3%, simple partial in 14.4%, atypical absence in 2.6% and myoclonic in 1.4%, and 30.4% of patients had more than one seizure type. EEG, CT brain, MRI brain and neuropsychological evaluation were obtained in 81.2%, 61.7%, 17.0% and 2.2% of patients, respectively. The etiology of epilepsy was cryptogenic in 59.9%, symptomatic in 35.1% and idiopathic in 3.9%; the commonest were intracranial infection, cerebral vascular disease, cranial trauma and perinatal insult. Phenytoin, carbamazepine and valproate were the most frequently used drugs and 25.9% of patients were taking more than two drugs. 48.3% of patients had active seizures in the past six months and 26.4% were considered to have unsatisfactory control of their epilepsy. Medical refractoriness of epilepsy was associated with a history of perinatal insult, intracranial infection, congenital brain malformation, intracranial neoplasm, cerebral vascular disease, hippocampal sclerosis, mental retardation and a history of status epilepticus (P<0.05). Conclusion In this local cohort of adult patients with epilepsy under specialist care, there were a considerable number of patients falling into the category of cryptogenic epilepsy. Risk factors associated with medical refractoriness are similar to previous studies.
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大肠癌高危人群分级筛查方案的应用
在世界范围内,大肠癌年发病近120万例,发病率在男性恶性肿瘤中排第4位,在女性恶性肿瘤中排第3位~([1]).据美国癌症学会估计,2009年美国有146 970例大肠癌新发患者,并有49 920例患者死于大肠癌~([2]).在我国,2002年大肠癌年龄标化发病率为男性13.6/10万人,女性9.2/10万人~([3]).