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Sequencing of high-efficacy disease-modifying therapies in multiple sclerosis: perspectives and approaches
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作者 Francois Grand'Maison Michael Yeung +5 位作者 Sarah A. Morrow Liesly Lee Francois Emond Brian J. Ward Pierre Laneuville Robyn Schecter 《Neural Regeneration Research》 SCIE CAS CSCD 2018年第11期1871-1874,共4页
Multiple sclerosis(MS) is characterized by chronic inflammation in conjunction with neurodegeneration within the central nervous system. Most individuals with MS begin with a relapsing remitting course that later tr... Multiple sclerosis(MS) is characterized by chronic inflammation in conjunction with neurodegeneration within the central nervous system. Most individuals with MS begin with a relapsing remitting course that later transitions to secondary progressive MS. Currently available disease-modifying therapies(DMTs) for relapsing MS have been demonstrated to reduce disease activity, however most patients require a change in therapy over the course of their disease. Treatment goals include the prevention of relapses and disability accumulation and to achieve this objective requires careful planning. Sequencing of DMTs for individual patients should be designed in such a way to maximize disease control and minimize risk based on the mechanism of action, pharmacokinetic and pharmacodynamic properties of each therapy. This includes the DMT patients are being switched from to those they are being switched to. The reversibility of immune system effects should be a key consideration for DMT sequence selection. This feature varies across DMTs and should factor more prominently in decision making as newer treatments become available for the prevention of disability accumulation in patients with progressive MS. In this short review, we discuss the landscape of existing therapies with an eye to the future when planning for optimal DMT sequencing. While no cure exists for MS, efforts are being directed toward research in neuroregeneration with the hope for positive outcomes. 展开更多
关键词 relapsing multiple sclerosis high efficacy disease-modifying therapies treatment optimization treatment sequencing therapeutic inertia sub-optimal treatment progressive disease immune effects
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一项关于阻塞性睡眠呼吸暂停患者中生理性起搏的前瞻性随机交叉试验
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作者 Krahn A.D Yee R +1 位作者 Erickson M.K. 王亭忠 《世界核心医学期刊文摘(心脏病学分册)》 2006年第5期48-49,共2页
OBJECTIVES: This study was designed to assess the impact of prevention of bradycardia with physiologic pacing on the severity of obstructive sleep apnea. BACKGROUND: Apneic episodes during sleep are associated with sl... OBJECTIVES: This study was designed to assess the impact of prevention of bradycardia with physiologic pacing on the severity of obstructive sleep apnea. BACKGROUND: Apneic episodes during sleep are associated with slowing of the heart rate during apnea and tachycardia with subsequent arousal. Patients with permanent pacemakers may have reduced episodes of sleep apnea when their pacemaker rate is set faster than their spontaneous nocturnal heart rate. METHODS: We conducted a prospective, randomized, single-blind crossover trial of temporary atrial pacing in obstructive sleep apnea to reduce the apnea hypopnea index(AHI). Fifteen patients(age 60± 13 years, 12 men) with moderate to severe obstructive sleep apnea(AHI 34± 14) underwent insertion of an externalized atrial permanent pacing system via the left subclavian vein. Patients underwent overnight respiratory sleep studies in hospital, during atrial pacing at 75 beats/min, and with pacing turned off. The order of pacing mode was randomized, with crossover the subsequent night to the other mode. Patients were blinded to pacing mode, and the analysis of sleep recordings was blind to pacing mode. RESULTS: Pacing was tolerated without complications in all patients. Overnight physiologic pacing did not affect the AHI(pacing 39± 21/h vs. control 42± 21/h, p=0.23, 95% confidence interval- 9.3 to 2.5 for difference), desaturation time(pacing 3.8± 6.0% vs. control 3.5± 4.3% , p=0.70), or the minimum SaO2(pacing 75± 10% vs. control 77± 11% , p=0.38). There was a borderline significant reduction in circulatory time with pacing(pacing 23.4± 3.2 s vs. control 25.5± 4.4 s, p=0.09). CONCLUSIONS: Temporary atrial pacing does not appear to improve respiratory manifestations of obstructive sleep apnea. Permanent atrial pacing in this patient population does not appear to be justified. 展开更多
关键词 重度阻塞性睡眠呼吸暂停 永久性起搏器植入患者 随机交叉试验 生理性起搏 呼吸暂停低通气指数 经左锁骨下静脉 心率变慢 心房起搏 起搏器频率 永久起搏器
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最佳出院计划:重组组织型纤溶酶原激活剂治疗急性卒中后长时间住院的临床预测因素
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作者 Saposnik G. Webster F. +2 位作者 O’ Callaghan C. Hachinski V. 邓剑平 《世界核心医学期刊文摘(神经病学分册)》 2005年第6期59-60,共2页
Background and Purpose - The length of stay (LOS) is the main cost- determining factor for inpatients with acute stroke. Although studies have identified variables associated with LOS, few have analyzed predictors of ... Background and Purpose - The length of stay (LOS) is the main cost- determining factor for inpatients with acute stroke. Although studies have identified variables associated with LOS, few have analyzed predictors of longer stay after receiving thrombolytic therapy for acute stroke. Methods - We studied all consecutive acute stroke patients receiving intravenous recombinant tissue plasminogen activator (rtPA) admitted to the London Health Sciences Center, in London, Ontario, Canada, from 1999 to 2003. Longer stay was defined as LOS ≥ 7days after admission. Demographic as well as baseline clinical, laboratory, and imaging variables were analyzed to identify predictors of LOS. Significant variables were entered into a multivariate logistic regression analysis. Results - Among 216 acute stroke patients receiving rtPA, the median LOS was 6 days. LOS was >7 days in 102 (49% ) patients. Age ≥ 70 (odds ratio [OR], 2.2; 95% CI, 1.2 to 4.0), lack of improvement at 24 hours (OR, 2.5; 95% CI, 1.4 to 4.4), prestroke modified Rankin Scale ≥ 2 (OR, 2.4; 95% CI, 1.2 to 4.9), baseline National Institutes of Health Stroke Scale score ≥ 15 (OR, 9.4; 95% CI, 3.2 to 27.6), cortical involvement (OR, 2.2; 95% CI, 1.2 to 3.9), and new infarction on the control computed tomography (CT; OR, 2.8; 95% CI, 1.4 to 5.9) were independent predictors of longer stay. Conclusions - Lack of improvement at 24 hours after rtPA, cortical involvement, and new infarction on the 24- hour CT scan are relevant variables that can independently affect the LOS. These new variables may be useful for establishing policy in relation to the organization and planning of the health care system. 展开更多
关键词 急性卒中 临床预测 出院计划 国立卫生院 静脉内注射 影像学 人口统计 多变量 安大略
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贝叶斯框架下的非参数估计Graph Cuts分割算法 被引量:7
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作者 蒋建国 郭艳蓉 +3 位作者 郝世杰 詹曙 李鸿 Ian Ross 《中国图象图形学报》 CSCD 北大核心 2011年第6期947-952,共6页
假设图像中各像素灰度值是具有一定概率分布的随机变量,由贝叶斯定理,正确分割观测图像等价于求出具有最大后验概率的实际图像估计。在此框架下,提出了一种改进型Graph Cuts图像分割算法。与传统GraphCuts分割算法相比,该算法在模型建... 假设图像中各像素灰度值是具有一定概率分布的随机变量,由贝叶斯定理,正确分割观测图像等价于求出具有最大后验概率的实际图像估计。在此框架下,提出了一种改进型Graph Cuts图像分割算法。与传统GraphCuts分割算法相比,该算法在模型建立上有两个方面的改进:1)将模糊C均值聚类引入数据约束能量函数来得到各像素在某个标记下的概率,改善了收敛性能;2)使用非参数方法估计图像的统计分布,然后用此统计量构成图像分割的先验概率,并保证分割结果的局部平滑。由于非参数估计是由样本直接估计得到的结果,特别适用于小样本和分布函数不恒定的情况,因此拓展了算法的适用范围。实验结果表明,改进算法在遥感图像分割和医学图像分割中均提高了分割精度,证明了该算法的有效性。 展开更多
关键词 GRAPH CUTS 贝叶斯图像分割 模糊C均值 非参数估计
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结合改进型主动外观模型与马尔科夫随机场的椎间盘核磁共振图像分析 被引量:2
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作者 郝世杰 詹曙 +2 位作者 蒋建国 李鸿 Ian Ross 《生物医学工程学杂志》 EI CAS CSCD 北大核心 2010年第1期6-9,15,共5页
针对目前腰部医学图像处理较少涉及分割并量化分析软组织的现状,提出一种腰部核磁共振图像(magnet-ic resonance imaging,MRI)中椎间盘分割及定量分析的算法:首先用改进的基于独立分量分析的主动外观模型(in-dependent component analys... 针对目前腰部医学图像处理较少涉及分割并量化分析软组织的现状,提出一种腰部核磁共振图像(magnet-ic resonance imaging,MRI)中椎间盘分割及定量分析的算法:首先用改进的基于独立分量分析的主动外观模型(in-dependent component analysis based active appearance model,ICA-AAM)分割椎体,并基于最小描述长度(minimumdescription length,MDL)准则获得腰部弯曲曲线;利用上述分割结果,结合椎间盘成像特点和局部图像灰度投影,进一步实现基于马尔科夫随机场(Markov random field,MRF)的椎间盘快速无监督分割;通过分割结果判断并定量计算椎间盘突出程度。实验表明该算法快速有效,可以辅助医生诊断、治疗腰椎间盘突出等疾病。 展开更多
关键词 医学图像处理与分析 腰部核磁共振图像 基于独立分量分析的主动外观模型 马尔科夫随机场
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