慢性乙型肝炎患者HBsAg血清清除后肝细胞癌的发生率:需要监测

<正>【据《J Hepatol》2015年5月报道】题:慢性乙型肝炎患者HBsA g血清清除后肝细胞癌的发生率:需要监测(作者Kim GA等)对于HBsA g血清清除的慢性乙型肝炎患者,是否该继续监测肝细胞癌的发生,这方面的研究很少。蔚山大学医学院的Kim GA等回顾性分析了1997-2012年韩国三级医院达到了HBsA g血清清除的829例患者(平均年龄52.3岁,575例男性,98例合并有肝硬化)的资料。他们评估了肝癌的发生率并验证了基于HBsA g血清清除时间点的CU-HCC肝癌风险评分。结果显示在3464随访人年中,19例患者发展为肝癌(年发生     

新《指南》首次提出“临床治愈”

正1强化检测与监测,指导慢性乙型肝炎的管理慢性乙型肝炎是由乙型肝炎病毒(hepatitis B virus,HBV)持续感染引起的肝脏慢性炎症性疾病。2015年10月,最新发布的中国《慢性乙型肝炎防治指南(2015年版)》(简称《指南》)首次提出了"临床治愈"的概念,明确将慢性乙型肝炎患者获得停药后持久应答、HBV DNA低于检测下限、HBsAg消失或抗-HBs阳转、并伴有ALT复常和肝脏组织学基本正常或有轻微病变作为治疗目     

对HBeAg阴性慢性乙型肝炎诊断标准的探讨

HBeAg阴性慢性乙型肝炎按2006年防治指南诊断标准为:血清HBsAg和HBVDNA阳性,HBeAg持续阴性,抗HBe阳性或阴性,血清ALT持续或反复异常,或肝组织学检查有肝炎病变[1].我科自2005年5月至2006年5月收治慢性乙型肝炎368例,其中HBe鲰阴性慢性乙型肝炎198例,占同期住院慢性乙型肝炎55%.血清HBsAg阳性,HBVDNA阴性,ALT持续或反复升高(ALT＞120单位/升)36例,占同期住院慢性乙型肝炎9.7%.本组36例,均已排除其他肝病.     

有关最新慢性乙型肝炎抗病毒治疗文献读后感语

2005年12月中华医学会肝病学分会和传染病学分会制定了"慢性乙型肝炎防治指南"(简称"指南"),对慢性乙型肝炎(CHB)的防治做了原则上的指导.     

核苷(酸)类似物治疗慢性乙型肝炎10例临床分析

本研究对10例用核苷(酸)类似物(NUCs)治疗出现HBsAg阴转或血清学转换的病例资料进行了回顾性分析,现报道如下.一、资料与方法1.病例资料:收集2005年2月至2010年8月于沈阳市第六人民医院入院的10例慢性乙型肝炎(CHB)患者应用NUCs治疗出现HBsAg阴转或血清学转换的患者资料.临床诊断符合2005年慢性乙型肝炎防治指南[11标准.     

干扰素α-2b长疗程治疗HBeAg阳性的慢性乙型肝炎3年随访

我国<慢性乙型肝炎防治指南>[1]推荐:"普通干扰素αHBeAg阳性慢性乙型肝炎患者5MU,每周3次或隔日1次,皮下或肌肉注射,一般疗程为6个月,为提高疗效亦可延长疗程至1年或更长."     

聚乙二醇a干扰素对慢性乙型肝炎患者血清IFN-γ、IL-17、IL-10的影响作用及机制

目的:研究干扰素-g(interferon-g,IFN-γ)、白介素(interleukin,IL)-17与IL-10在慢性乙型肝炎发病中的作用机制,观察聚乙二醇a干扰素(polyethylene glycol interferona,PEG-IFNa)抗病毒治疗对上述细胞因子水平的影响.方法:应用PEG-IFNa治疗的不同时间点抽取慢性乙型肝炎患者及健康对照组静脉血,分离血清,检测血清中乙型肝炎表面抗原(hepatitis B surface antigen,HBsA g)、乙型肝炎病毒脱氧核糖核酸定量(HBV DNA)、谷丙转氨酶(alanine aminotransferase,ALT)以及血清中的IFN-γ、IL-17、IL-10.结果:慢性乙型肝炎患者IFN-γ、IL-17、IL-10的水平均显著高于健康对照组(P0.01).抗病毒治疗后,慢性乙型肝炎患者血清IFN-γ、IL-17和IL-10的水平均较治疗前显著性下降(P0.05).结论:IFN-γ、IL-17、IL-10共同参与了慢性乙型肝炎的发病,此结论对预测抗病毒疗效有指导意义.     

HBsAg血清清除后的维持治疗

正随着核苷(酸)类似物(NAs)的广泛应用和更新换代,越来越多的慢性乙型肝炎(CHB)患者能够实现基本的治疗目标[1],即最大限度地长期抑制HBV复制,从而最终延长生存时间、改善生活质量。HBsA g阴转,伴/不伴抗-HBs血清学转换,代表着HBV复制和病毒蛋白表达均被抑制,是一种最优的治疗终点[2],也被称为已解决的CHB或功能性治愈     

《慢性乙型肝炎防治指南（2010年版）》解读

2010年12月,中华医学会肝病学分会和感染病学分会联合发布了《慢性乙型肝炎防治指南（2010年版）》[《指南（2010年版）》]。《指南（2010年版）》总结了近年来国内外慢性乙型肝炎预防和治疗的最新证据,结合我国慢性乙型肝炎流行和诊疗状况,对慢性乙型肝炎防治的实际问题进行系统阐述。     

中医体质理论在乙型肝炎病毒感染诊治中的价值

正乙型肝炎病毒(HBV)感染呈世界性流行,2006年全国乙型肝炎血清流行病学调查表明,我国1～59岁一般人群乙肝表面抗原(HBsA g)携带率为7.18%,据此推算现有慢性HBV感染者约9300万人,其中慢性乙型肝炎(CHB)患者约2000万例,大量的现症HBV感染者仍是我国一个重大的疾病负担~([1])。中医药以及中西医结合诊治方案在CHB临床实践中一直发挥重要作用~([2]);中医体质学是中医学的一个重要构成,自     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

Interplay between interferon-mediated innate immunity and porcine reproductive and respiratory syndrome virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non-structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp's are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS.     

A Call to Action to Enhance Filovirus Disease Outbreak Preparedness and Response

The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.     

Disease Pandemics and Major Epidemics Arising From New Encounters between Indigenous Viruses and Introduced Crops

Virus disease pandemics and epidemics that occur in the world’s staple food crops pose a major threat to global food security, especially in developing countries with tropical or subtropical climates. Moreover, this threat is escalating rapidly due to increasing difficulties in controlling virus diseases as climate change accelerates and the need to feed the burgeoning global population escalates. One of the main causes of these pandemics and epidemics is the introduction to a new continent of food crops domesticated elsewhere, and their subsequent invasion by damaging virus diseases they never encountered before. This review focusses on providing historical and up-to-date information about pandemics and major epidemics initiated by spillover of indigenous viruses from infected alternative hosts into introduced crops. This spillover requires new encounters at the managed and natural vegetation interface. The principal virus disease pandemic examples described are two (cassava mosaic, cassava brown streak) that threaten food security in sub-Saharan Africa (SSA), and one (tomato yellow leaf curl) doing so globally. A further example describes a virus disease pandemic threatening a major plantation crop producing a vital food export for West Africa (cacao swollen shoot). Also described are two examples of major virus disease epidemics that threaten SSA’s food security (rice yellow mottle, groundnut rosette). In addition, brief accounts are provided of two major maize virus disease epidemics (maize streak in SSA, maize rough dwarf in Mediterranean and Middle Eastern regions), a major rice disease epidemic (rice hoja blanca in the Americas), and damaging tomato tospovirus and begomovirus disease epidemics of tomato that impair food security in different world regions. For each pandemic or major epidemic, the factors involved in driving its initial emergence, and its subsequent increase in importance and geographical distribution, are explained. Finally, clarification is provided over what needs to be done globally to achieve effective management of severe virus disease pandemics and epidemics initiated by spillover events.     

Barrett's Esophagus: Where Do We Stand?

Barrett''s esophagus (BE) is a precursor for esophageal adenocarcinoma, which has an increased incidence rate over the last few decades. Its importance stems from the poor five-year survival of esophageal adenocarcinoma and current data that suggest a survival benefit when surveillance programs are implemented. In this review, we will cover the pathophysiology and natural history of BE and the different endoscopic findings. The prevalence of BE in different geographic areas and the incidence of high-grade dysplasia and adenocarcinoma in this patient population is reviewed. Recent recommendation for screening and surveillance of BE has been covered in this review as well as the efficacy of nonconventional imaging modalities and endoscopic ablation therapies.     

The Technology Transfer from Europe to China in the 17th–18th Centuries: Non-Invasive On-Site XRF and Raman Analyses of Chinese Qing Dynasty Enameled Masterpieces Made Using European Ingredients/Recipes

Two masterpieces of the Qing Dynasty (1644–1912 CE), one in gilded brass (incense burner) decorated with cloisonné enamels stylistically attributed to the end of the Kangxi Emperor’s reign, the other in gold (ewer offered by Napoleon III to the Empress as a birthday present), decorated with both cloisonné and painted enamels bearing the mark of the Qianlong Emperor, were non-invasively studied by optical microscopy, Raman microspectroscopy and X-ray microfluorescence spectroscopy (point measurements and mapping) implemented on-site with mobile instruments. The elemental compositions of the metal substrates and enamels are compared. XRF point measurements and mappings support the identification of the coloring phases and elements obtained by Raman microspectroscopy. Attention was paid to the white (opacifier), blue, yellow, green, and red areas. The demonstration of arsenic-based phases (e.g., lead arsenate apatite) in the blue areas of the ewer, free of manganese, proves the use of cobalt imported from Europe. The high level of potassium confirms the use of smalt as the cobalt source. On the other hand, the significant manganese level indicates the use of Asian cobalt ores for the enamels of the incense burner. The very limited use of the lead pyrochlore pigment (European Naples yellow recipes) in the yellow and soft green cloisonné enamels of the Kangxi incense burner, as well as the use of traditional Chinese recipes for other colors (white, turquoise, dark green, red), reinforces the pioneering character of this object in technical terms at the 17th–18th century turn. The low level of lead in the cloisonné enamels of the incense burner may also be related to the use of European recipes. On the contrary, the Qianlong ewer displays all the enameling techniques imported from Europe to obtain a painted decoration of exceptional quality with the use of complex lead pyrochlore pigments, with or without addition of zinc, as well as cassiterite opacifier.