原发性醛固酮增多症的诊断和治疗

随着检测技术和认识的提高,原发性醛固酮增多症的检出率越来越高,已经成为继发性高血压中最常见的原因.血浆醛固酮和肾素比值是筛查和诊断的重要指标,肾上腺静脉取血对定位诊断和决定治疗方案十分重要.     

肾上腺外组织合成醛固酮的研究与思维方法

1　传统对肾素 -血管紧张素 -醛固酮系统的认识及困惑长时间以来 ,人们一直认为机体内只存在惟一的醛固酮合成途径 ,即肾小球旁器分泌释放肾素 ,激活肝脏产生的血管紧张素原 ,生成血管紧张素Ⅰ ,十肽的血管紧张素Ⅰ在循环中血管紧张素转化酶作用下生成八肽的血管紧张素Ⅱ ;血管紧张素Ⅱ是系统中的重要部分 ,强有力地刺激肾上腺皮质球状带分泌醛固酮。醛固酮作为最重要的潴钠激素 ,在高血压的发病中占重要位置。尽管如此 ,人们发现血浆醛固酮的降低并不与靶器官功能的改善相平行。自1995年以来已有若干个实验报道长期使用血管紧张素转化酶抑…     

原发性醛固酮增多症的临床实践与分析

探讨原发性醛固酮增多症(原醛)临床特点及诊治方面的经验,以早期诊断、根治,改善预后。对确诊的原醛53例临床资料(临床特征、实验室检查、影像学检查、病理类型、治疗情况)进行回顾性研究。男女比为1：1.65,30～49岁年龄段最多。50.9%高血压首发,15.1%低钾血症首发,并发高心痛9.4%,尿毒症1.9%,脑卒中13.2%。肾素-血管紧张素-醛固酮(RAA)系统激素检查,血浆醛固酮/血浆肾素活性比值(ARR)＞200者80.7%,ARR＞400者占半数,血浆醛固酮(PAC)＞140pg/ml者占84.6%。CT及MRI阳性率高。术后病理肾上腺皮质腺瘤占85%,结节性增生占15%(其中原发性肾上腺增生占12.5%)。手术后血压及血钾均较前改善,非手术者口服安体舒通有效。原醛是可治性内分泌性高血压之一,建议高血压和/或低血钾者应常规检查RAA系统激素,并争取行影像学检查,以使原醛得到早期诊治,改善预后。     

原发性醛固酮增多症的临床实践与分析

探讨原发性醛固酮增多症(原醛)临床特点及诊治方面的经验,以早期诊断、根治,改善预后.对确诊的原醛53例临床资料(临床特征、实验室检查、影像学检查、病理类型、治疗情况)进行回顾性研究.男女比为1:1.65,30～49岁年龄段最多.50.9%高血压首发,15.1%低钾血症首发,并发高心病9.4%,尿毒症1.9%,脑卒中13.2%.肾素-血管紧张素-醛固酮(RAA)系统激素检查,血浆醛固酮/血浆肾素活性比值(ARR)＞200者80.7%,ARR＞400者占半数,血浆醛固酮(PAC)＞140pg/ml者占84.6%.CT及MRI阳性率高.术后病理肾上腺皮质腺瘤占85%,结节性增生占15%(其中原发性肾上腺增生占12.5%).手术后血压及血钾均较前改善,非手术者口服安体舒通有效.原醛是可治性内分泌性高血压之一,建议高血压和/或低血钾者应常规检查RAA系统激素,并争取行影像学检查,以使原醛得到早期诊治,改善预后.     

RAAS激活与老年高血压合并抑郁的关系

探讨老年高血压合并抑郁患者肾素-血管紧张素-醛固酮系统( RAAS)的变化及二者之间的关系.入选原发性高血压病患者210例,其中高血压合并抑郁组(80倒)、高血压不合并抑郁组(130例),两组检测血糖、血肌酐、血脂等指标,用放射免疫分析法测定血浆肾素、血管紧张素Ⅱ、醛固酮水平.结果两组在性别、年龄、血糖、血脂等方面无统计学差异,高血压合并抑郁组肾素、血管紧张素及醛固酮水平均显著高于高血压不合并抑郁组.高血压合并抑郁组血浆肾素(r=0.283,P＜0.01)、血管紧张素Ⅱ(r=0.312,P＜0.01)、醛固酮水平(r=0.276,P＜0.01)与HAMD量表总分呈正相关.RAAS系统激活与老年高血压合并抑郁关系密切,这对老年高血压合并抑郁患者的治疗提供了一定的临床价值.     

应用批判性思维法探讨内分泌学临床思维的建立

应用内分泌学中常见的肾上腺皮质腺瘤所致原发性醛固酮增多症,甲状腺功能减退所致垂体腺瘤样增生等。典型病例探讨批判性思维法做为一种重要的思维方式,在内分泌学复杂的临床诊疗过程中的应用,力争做到思维与客观实际相一致,逐渐培养科学的内分泌学临床思维模式。     

阻塞性睡眠呼吸暂停低通气综合征导致高血压的机制

阻塞性睡眠呼吸暂停低通气综合征是重要的继发性高血压病因之一,该综合征导致血压增高的原因主要有睡眠分裂、频繁的低氧血症和高碳酸血症导致的高交感神经兴奋,呼吸暂停发生时胸腔负压的增加和回心血量的增加以及内分泌功能的失调如醛固酮的高分泌,超重肥胖和慢性非特异性炎症反应的参与,是多种升压机制共同参与的结果.     

骨桥蛋白在心肌梗死后心力衰竭中研究进展

骨桥蛋白是一种糖基化的多功能蛋白,其具有激活细胞内信号传导、参与炎症细胞的趋化聚集、促进肿瘤的生长迁移等多种生物学功能。近年来研究表明其在心肌梗死后的炎症反应、心室重塑、细胞外基质沉积及肾素-血管紧张素-醛固酮系统的过度激活中具有重要的作用,同时其与心肌梗死后心力衰竭的严重程度及顸后亦密切相关。本文就骨桥蛋白在心肌梗死后心力衰竭中研究进展做一综述。     

认知诊断模型发展及其应用方法述评

认知心理学和心理测量学结合派生出的认知诊断理论, 利用现代统计方法和计算机技术作为工具, 诊断被试的认知结构和认知过程。认知诊断有多种模型, 不同的模型有不同的特点及应用条件。模型的选择和认知诊断方法的应用对认知诊断的结果有重要的影响, 因此在选择模型之时需要了解各种认知诊断模型的发展过程及优缺点。     

疾病诊断谁说了算：临床诊断？影像诊断？

影像诊断是临床诊断的一个重要组成部分,与问诊、体格检查、实验室检查等一同构成临床诊断。影像诊断不能脱离临床诊断工作而单独存在,影像诊断的结论是否正确需要其他非影像学证据的支撑,其结论不能脱离症状、体征而存在。影像诊断专注于分析图像特征、从图像中寻找诊断证据,不需要采纳其他非影像学证据完善其结论;由于影像诊断是完全来源于图像分析,因而具有不可避免的局限性。影像诊断和其他诊断技术的融合推动了临床诊治技术的进步。     

Consider the source: One step in assessing premise acceptability

Premise acceptability is conceptually connected to presumption. To say that a premise is acceptable just when there is a presumption in its favor is to give a first approximation to this connection. A number of popular principles of presumption suggest that whether there is a presumption for a premise, belief, or claim depends on the sources which vouch for it. Sources consist of internal belief-generating mechanisms and external testimony. Alvin Plantinga's notion of warrant lays down four conditions upon a source for the belief which it generates to be warranted. We argue that there is a presumption for a premise, belief, or claim if and only if there is a presumption of warrant for that premise,belief or claim. This amounts to the thesis that there is a presumption for a belief from a challenger's point of view if and only if there is a presumption from that person's point of view that her cognitive faculties which have generated the belief have been functioning properly, in an appropriate cognitive environment, in accord with a segment of her design plan aimed at the truth, and that these faculties are reliable. In light of our argument for this thesis, we may legitimately claim that one way to determine that there is a presumption for a belief is to determine that there is a presumption of warrant for that belief, and thus that in determining whether there is a presumption for a belief or premise, we may consider the source.     

Task-defined associations are mode specific for selection of relevant dimension but mode independent for selection of location mapping

When compatible and incompatible mappings of a location-relevant task are mixed, or a location-relevant task is mixed with a task for which stimulus location is irrelevant, the benefit of the compatible mapping is eliminated for physical locations and enhanced for location words. Two experiments examined the influence of presenting the location information for the mixed conditions in different stimulus modes (physical location or word). Experiment 1 showed that the effects of mixing location-relevant and location-irrelevant tasks on the spatial compatibility and Simon effects are reduced when the location information is presented in different modes for the two tasks. Experiment 2 showed, in contrast, that the mode distinction had little influence on the effects of mixed compatible and incompatible mappings for location-relevant tasks: The compatibility effect was eliminated for physical locations and enhanced for words, as when there is no mode distinction. Thus, when location is relevant for one task and colour for the other, the task-defined associations of locations to responses are mode specific, but when location is relevant for both tasks, the associations are mode independent.     

Gender differs: Modelling knowledge sharing from a perspective of social network ties

The present paper proposes a model of knowledge sharing, in which coworker congruence, outcome interdependence, perceived organizational support, and procedural justice influence knowledge sharing indirectly through the mediation of instrumental ties and expressive ties, and examined gender differences in causal connections within the model. In a sample of employees in Taiwan, it was shown that the influence of instrumental ties on knowledge sharing is stronger for females than for males; the influence of expressive ties on knowledge sharing is stronger for males than for females; the influence of coworker congruence on expressive ties is stronger for females than for males; the influence of outcome interdependence on instrumental ties is stronger for females than for males; and the influence of perceived organizational support on instrumental ties is stronger for males than for females.     

立体视觉的心理物理和VEP比较研究

心理物理试验是研究立体视觉的主要方法。70年代VEP开始用于体视研究,并取得许多结果。由于VEP信号复杂,这些结果不能令人满意。本文使用心理物理试验和VEP对比方法对体视加以研究。我们的结果是:VEP波形中第一个正峰与刺激图形的亮度有关;N_2峰和P_3峰的潜伏期对判断体视存在与否有重要价值;本试验确定N_2峰潜伏期在体视存在时约为240ms—280ms,无体视存在时约为290ms—310ms;P_3峰潜伏期在体视存在时约为280ms—310ms,无体视存在时约为340ms—360ms;体视存在时的VEP与无体视存在时的VEP的互相关系数小于0.1;有体视的VEP其功率谱密度在8Hz附近有一峰;心理物理试验中使用强制选择得到的结果从VEP波形比较中可以确认是可靠的;有体视的VEP其N_2和P_3的潜伏期随视差变化呈现规律性改变。     

Topics and cases for online education in engineering

When considering offering online education for engineering ethics instruction, making choices necessary for the effective development and delivery of an engineering ethics curriculum is an important first step. Selecting the topics and types of cases for the most effective ethics education of engineering students is a vital step in preparing an effective program. Examples are presented for topics which are considered good candidates for online presentation, and the adaptability of these topics for web-based instruction is discussed. Types of cases which are useful in engineering ethics education are presented. Methods of teaching applied ethics, as well as ideas for web-based ethics course design are suggested. The market for web-based instruction is discussed.     

Bunched sequential information

It is known that the logic BI of bunched implications is a logic of resources. Many studies have reported on the applications of BI to computer science. In this paper, an extension BIS of BI by adding a sequence modal operator is introduced and studied in order to formalize more fine-grained resource-sensitive reasoning. By the sequence modal operator of BIS, we can appropriately express “sequential information” in resource-sensitive reasoning. A Gentzen-type sequent calculus SBIS for BIS is introduced, and the cut-elimination and decidability theorems for SBIS are proved. An extension of the Grothendieck topological semantics for BI is introduced for BIS, and the completeness theorem with respect to this semantics is proved. The cut-elimination, decidability and completeness theorems for SBIS and BIS are proved using some theorems for embedding BIS into BI.     

神经美学视角的审美愉悦加工机制

审美对象特有的刺激属性会唤起观赏者特定的情绪或情感反应。个体在欣赏自然、艺术品和其他人类作品时会产生审美愉悦体验。审美愉悦-兴趣模型(PIA)认为, 审美愉悦体验包含审美过程中自动化加工阶段的审美愉悦和控制加工阶段的审美兴趣。近年来, 神经美学研究表明, 负责愉悦和奖赏的眶额叶皮层在审美过程中广泛激活, 是自动化加工阶段初级审美愉悦奖赏的神经基础, 而审美过程中纹状体亚回路中不同的连接和功能作用与两个阶段中审美愉悦的产生都有关联; 上述结果支持了审美愉悦-兴趣模型。但审美高峰体验时默认模式网络(DMN)相关脑区的激活和负责控制与理性思维的外侧前额叶皮层等脑区的失活, 提示在PIA模型强调的自动化加工阶段审美愉悦和控制加工阶段审美兴趣之上, 还有整合升华阶段的审美沉浸愉悦, PIA模型需得到进一步的扩展。未来研究应进一步检验审美愉悦认知加工模型及神经机制, 探索审美对创造力的影响机制和神经基础, 探讨不同审美经验愉悦机制的异同。     

Systemic psychotherapy as an intervention for post‐traumatic stress responses: an introduction,theoretical rationale and overview of developments in an emerging field of interest

The purpose of this article is to critically examine the literature to provide a rationale for including systemic family therapy (SFT) in the psycho‐social treatment of people suffering the impact of post‐traumatic stress (PTS). Attention is drawn to the relatively underdeveloped academic literature on PTS and the family. The impact of PTS is conceptualized within a psycho‐social framework and the current evidence base for psycho‐social interventions for PTS responses is described, highlighting the opportunity and need to undergird this area of daily practice. The impact of PTS on the family at multiple levels is identified, emphasizing its recursive nature. The case for SFT is articulated and a range of models of family intervention for PTS briefly reviewed, concluding with an emphasis on Walsh's key processes in family resilience as a framework for practice.     

Estimating the imputed social cost of errors of measurement

If a loss function is available specifying the social cost of an error of measurement in the score on a unidimensional test, an asymptotic method, based on item response theory, is developed for optimal test design for a specified target population of examinees. Since in the real world such loss functions are not available, it is more useful to reverse this process; thus a method is developed for finding the loss function for which a given test is an optimally designed test for the target population. An illustrative application is presented for one operational test.This work was supported in part by contract N00014-80-C-0402, project designation NR 150-453 between the Office of Naval Research and Educational Testing Service. Reproduction in whole or in part is permitted for any purpose of the United States Government.