原发性胆汁性肝硬化72例临床分析

目的分析原发性胆汁性肝硬化（PBC）的临床特征,提高对该病的认识。方法回顾性分析72例原发性胆汁性肝硬化患者的临床表现、生化指标及免疫学指标。结果 72例原发性胆汁性肝硬化患者中女性与男性之比为6：1,临床主要表现为右上腹不适、乏力、尿黄等,所有患者均有不同程度的肝功能异常,以血清碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（γ-GT）升高为主,伴有胆红素升高。66例（91.7%）患者的抗线粒体抗体（AMA）、63例（87.5%）AMA亚型M2阳性。结论 PBC主要发病于中年女性,主要表现为右上腹不适、乏力及程度不同的黄疸,血清ALP、GT水平升高,AMA及AMA-M2亚型抗体阳性,血清IgM、IgG升高。     

原发性胆汁性肝硬化50例临床分析

目的 对50例原发性胆汁性肝硬化(PBC)患者的临床特征及病理特点进行回顾性研究,以提高对该病的认识.方法 对临床/病理确诊为PBC患者的临床特征、各项生化指标和组织学特点进行总结.结果 50例PBC患者中女性占88%(44/50),确诊时平均年龄44.9岁.最常见的临床症状为乏力(68%,34/50),其次为纳差(48%,24/50)、瘙痒(26%,13/50),最主要的体征包括黄疸(64%,32/50)、脾大(48%,24/50)、肝掌(28%,14/50).患者血清碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(γ-GT)明显升高,但随着病程逐渐发展,这2项指标逐渐下降,到晚期下降明显.32例患者(64%)胆红素有不同程度的升高,大部分患者丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)表现为轻-中度升高.41例患者(80.2%)抗线粒体抗体(AMA)/AMA-M2亚型抗体阳性.共有32例患者行肝脏穿刺病理检查,其中87.5%为早期(Ⅰ、Ⅱ期),12.5%为晚期(Ⅲ、Ⅳ期).结论 PBC主要累及中老年女性,主要表现为乏力、纳差、瘙痒,早期血清ALP和γ-GT水平升高,AMA及AMA-M2亚型抗体阳性.PBC应尽早明确诊断并及时治疗.     

原发性胆汁性肝硬化合并多发性肌炎1例报告

原发性胆汁性肝硬化（primary biliary cirrhosis,PBC）是一种以肝脏为首要靶器官的慢性进展性自身免疫性疾病,患者的抗线粒体抗体（antimitochondrial antibodies,AMA）阳性率〉95％,AMA攻击聚集于PBC患者胆管上皮内的丙酮酸脱氢酶E2成分,其病变主要为肝内细小胆管的进行性非化脓性破坏性炎症,有长期持续性肝内胆汁淤积,     

原发性胆汁性肝硬化患者63例血清内毒素的变化

目的 探讨原发性胆汁性肝硬化(PBC)患者病程进展中血清内毒素(LPS)变化的意义及其与血生化之间的关系.方法 对63例经肝穿病理确诊为PBC患者的临床特征、血生化指标和血清自身抗体指标进行分析,将检查组织分为早期组(相当于Ⅰ、Ⅱ期)和晚期组(相当于Ⅲ、Ⅳ期),并与30例健康成人作比较.应用鲎试剂微量基质法对63例PBC患者血清进行内毒素水平检测.结果 63例PBC患者中男女比例为1∶8,平均年龄为43.5岁,黄疸、乏力症状明显,抗线粒体抗体(AMA)阳性率为70.3%,血清γ-GGT、ALP和胆红素显著升高,与早期组比较,晚期组血清AST、ALT水平有所降低,差异有显著性(P＜0.05),但总胆红素和直接胆红素均明显升高(P＜0.01);PBC患者血清内毒素水平明显升高,与正常对照组比较差异显著(P＜0.05),且随疾病进展而增加;在早期组及晚期组LPS水平与ALP、TB、DB呈正相关,早期组r值分别为0.543,.568,.533(P均＜0.01),晚期组r值分别为0.614,.502,.513(P＜0.01或0.05).结论 血清LPS水平与PBC的发病及疾病进展有一定的相关性;对于血清AMA阴性的PBC病例,肝穿刺病理确诊是必要的.     

胆汁淤积的PTC和ERCP诊断

胆汁淤积（即阻塞性黄疸）是肝胆胰疾病常见的临床表现之一，其主要特点是黄疸。对胆汁淤积进行治疗前，首先必须搞清以下两个问题，即：（1）胆汁淤积的部位：是发生在肝内还是肝外？在肝内者称肝内胆汁淤积，常需内科保守治疗，故又称内科黄疸，在肝外者称肝外胆汁淤积，常需外科手术处理，故又称外科黄疸；（2）究系何病所致：无论是肝内或吁外胆汁淤积，均应明确病因，以便有针对性地进行治疗。引起胆汁淤积的病因很多，根据病史、临床表现以及实验室、B型超声、核素扫描、CT扫描和磁共振等检查，约80％以上的患者可获得正确诊断，但…     

Graves病初诊肝功能异常的临床研究

 目的 了解Graves病初诊患者中合并肝功能异常的发病率,探讨其相关因素及内科疗效.方法 对135例Graves病初诊患者进行甲状腺功能、甲状腺自身抗体及肝功能等检查.抗甲状腺功能亢进症(甲亢)及保肝治疗2个月后,对上述患者进行随访.结果 (1) Graves病初诊患者合并肝功能异常的发生率为37.8%,肝功能指标多为轻度升高,且以ALP升高者最多(28.9%).(2)合并肝功能异常者的FT3、FT4水平均高于肝功能正常者.(3)治疗2个月后,甲状腺功能已恢复正常的77例中,90.9%肝功能正常;转归为亚临床甲亢或仍为临床甲亢患者中,肝功能异常率分别为43.2%和60.0%.结论 初诊甲亢患者合并肝功能异常发病率高,但多预后良好,肝功能轻中度异常不应成为ATD治疗的禁忌.     

OGDC-E2和BCOADA-E2的二联体检测在原发性胆汁性肝硬化中的意义

目的通过重组表达抗原OGDC-E2和BCOADC-E2的二联体融合蛋白(B0),并用于检测自身抗体及临床意义。方法重组表达的融合蛋白(B0),通过Ni-NTA亲和柱纯化,经过免疫印迹法(IBT)和酶链免疫吸附(ELISA)法检测56份PBC患者血清,以48份自身免疫病患者、50份其他肝病患者、70例正常人血清为对照组。结果56例确诊的PBC患者中,42例阳性,阳性率为75.0%。而健康体检者和疾病对照组血清中的M2抗体均为阴性。结论通过用重组表达的二连体B0检测PBC患者血清中的M2抗体,具有一定的特异性及敏感性,为临床进一步研究PBC,辅助诊断提供一些辅助参考。     

肝源性糖尿病38例临床分析

目的总结分析肝源性糖尿病的临床特点。方法对依据诊断标准确诊的38例肝源性糖尿病的临床表现,实验室检查结果以及治疗与转归进行分析。结果38例均有不同程度的乏力,食欲减退,恶心等症状,45.9%有黄疸,56.8%有腹水,只有2例有轻微多饮、多尿、多食症状。34.2%肝病与糖尿病同时出现,65.8%糖尿病在肝病后出现。62.2%血糖轻度升高,重度升高者只占10.8%,尿糖均阳性。多数患者血糖及尿糖随肝功能恢复而逐渐下降至正常。结论肝源性糖尿病多以隐性发病,临床症状较轻,预防较好。     

早期原发性胆汁性肝硬化1例

女性，81岁。因肝功能异常7年，于2003年10月24日入院，既往有冠心病病史。自诉口干、眼干，全身瘙痒，偶有纳差、乏力，无黄疸、发热，无腹痛。无特殊可疑用药病史。B超示：肝囊肿、胆囊外形欠规则，脾胰肾未见异常；腹部CT未见异常。给予保肝治疗肝功能无明显好转而来我院。查体：心肺腹未见异常。外送血至协和医院查自身抗体：抗核抗体( )，其中核包膜型1：320；抗线粒体抗体( )1：，320；抗线粒体M2亚型抗体( )，余指标阴性。遂确诊为     

原发性肝癌侵犯胆道26例术前误诊分析

晚期肝癌病人 19%～ 4 0 %出现黄疸[1] ,其主要原因为癌细胞对肝实质的广泛破坏、肝功能衰竭及肝癌对胆管的压迫 ,而由肝癌侵犯胆管并形成胆管内癌栓导致的阻塞性黄疸在临床上则较少见 ,属黄疸型或淤胆型肝癌[2～ 4 ] 。1984年 1月～ 1999年 12月 ,本院经手术证实此型肝癌 3 9例 ,术前误诊 2 6例。1　临床资料1 1　一般情况　男 3 4例 ,女 5例 ,男女比例为 7∶1;年龄 2 6～ 75岁 ,平均 4 1 5岁 ;病程 1周～ 3年。术前行甲胎球蛋白 (ＡＦＰ)检查 3 6例 ,阳性 2 4例(66 7% ) ;ＨＢｓＡｇ检查 3 5例 ,阳性 2 3例 (65 7% ) ;Ｂ超检查 3 4例 ,有…     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）