Dubin-Johnson综合征和Rotor综合征的形态学鉴别

Dubin-Johnson综合征系体质性黄疸,临床少见,易与Rotor综合征混淆。临床资料:葛某,女,27岁。1979年开始皮肤、巩膜黄染,无诱因或其它症状。尿三胆、尿胆原重度增加;尿胆素、胆红素阳性。肝功能II40u,VDB速性反应,胆红素量4.6mg%,1分钟胆红素2.77mg%。病理检查:肝穿肝组织长1.2cm,色调灰暗;HBsAg阴性(维多利亚蓝)。肝轻度脂肪变性,少数肝细胞见褐色颗粒,胆小管轻度扩张,枯否细胞增生。     

Dubin-Johnson综合征1例报告

通过回顾性分析1例Dubin-Johnson综合征(DIS)临床资料,探讨Dubin-Johnson综合征的发病机制、临床表现、临床病理特征、鉴别诊断、治疗及预后。Dubin-Johnson综合征是一种良性病变,明确此病的诊断有赖于肝脏穿刺活检病理检查,肝细胞内有较多的粗糙的深棕色色素颗粒。此病发病率较低,临床上少见,因此易造成误诊,应增加对该病的认识,提高临床诊疗技术。     

先天性非溶血性黄疸的临床病理与中医证候特征

目的 分析先天性非溶血性黄疸的临床表现及病理特征,探讨中医证候、肝穿刺活检病理对临床诊断的指导意义。方法 收集2014年4月至2019年10月河南中医药大学第一附属医院及北京佑安医院收治的以血清胆红素异常为主要表现的32例非病毒性、非溶血性黄疸患者,分为间接胆红素(IBIL)升高组和直接胆红素(DBIL)升高组,回顾性分析其病理特征、中医证候、肝功能及基因变化特点。结果 IBIL升高组：Crigler-Najjar综合征Ⅱ型(CNS-Ⅱ)的血清IBIL高于Gilbert综合征(P<0.05);7例CNS-Ⅱ中2例出现纤维化;UGT1A1基因检测发现新的碱基突变点c.1471 G>A。DBIL升高组：Dubin-Johnson综合征特异的组织学表现为肝细胞质内棕黑色色素颗粒;进行性家族性肝内胆汁淤积症2型(PFIC2)组织学表现为淤胆明显且出现桥接纤维化。中医证候：IBIL升高组和DBIL升高组阳黄比率分别为44.44%、40.00%,阴黄比率分别为55.56%、60.00%,两组的阴黄占比均多于阳黄,但两组之间差异无统计学意义(P>0.05)。结论 超声引导下经皮肝穿...     

Dubin-Johnson氏综合征(一例报告及文献复习)

本文报告一例慢性间歇性黄疸患者。黄疸的出现与感染或劳累饮酒有关,有血中结合与非结合胆色素增多,尿三胆阳性、胆囊造影不显影BSP试验180分钟仍有滞留,肝功能接近正常。症状除黄疸外,无其他不适。经剖腹探查肝组织检查发现肝内有黑色素样颗粒,符合Dubin-Johnson氏综合征的病变。结合本例复习了国内外有关Dubin-Johnson氏综合征的部分文献,对此病的临床表现、病理特点、发病机理、诊断作了简单的讨论。     

Gilbert综合征21例临床分析

目的探讨Gilbert综合征的临床特征、诱发因素、实验室检查特点及肝组织病理特点。方法对21例Gilbert综合征患者的临床表现、诱发因素、实验室检查特点及肝组织病理特点进行了回顾性分析,并进行2年随访。结果 21例患者均有皮肤巩膜黄染,乏力15例,食欲不振13例,肝区或腹部不适9例,恶心4例;劳累14例,饮酒13例,饥饿11例,应激9例,感染7例,受凉7例。结论 Gilbert综合征以慢性、间歇性、轻度高非结合胆红素血症为特征,临床诊断缺乏特异性,肝穿刺活检术为诊断金指标,且预后良好。     

经皮肝穿活检对不明原因肝性黄疸的诊断价值

目的：探讨经皮肝穿刺活体组织检查术对不明原因肝细胞性黄疸的诊断意义：方法：１９９０年以来收住的肝细胞性黄疸３４例,平均住院２周以上,经常规方法来明确诊断,实施经皮肝穿活检术。结果：３４例穿刺刺肝活检均获得组织标本,作出病理诊断,除１０例有穿刺部位一过性疼痛无其它严重并发症发生;结论：不明原因的肝细胞性黄疸临床诊断困难时,应用经皮肝穿活检术有重要价值。应用时要做好术前准备,把握技术要点,严格除外手术     

超声引导下肝脏穿刺107例的临床分析

目的观察肝穿刺活体组织病理检查技术在临床的应用情况,探讨超声引导下经皮肝脏穿刺活检的临床价值和意义。方法采用PHILIPS-HD11超声仪、3.5 MHz探头、Bard活检枪及活检针对107例肝病患者的肝脏进行穿刺,对穿刺组织进行病理检查。结果 107例患者均穿刺成功,病理学检查诊断为慢性乙型肝炎53例,肝硬化28例,非酒精性脂肪肝8例,酒精性肝病5例,自身免疫性肝硬化性胆管炎1例,血色素病1例,原因不明慢性肝炎10例,D-J综合征并成人特发性胆管缺失综合征1例。结论超声引导下肝脏穿刺活检术是一项微创、安全、方便的检查方法,能确定肝脏损害的病理性质,对指导临床诊断和治疗有重要的临床价值。     

14例Dubin-Johnson综合征临床病理特征分析及文献复习

目的 通过对14例肝脏Dubin-Johnson综合征临床病理特征分析,并文献复习,加强对该疾病的认识,为临床病理诊断提供一定经验.方法 收集2010年-2017年新疆医科大学第一附属医院病理科明确诊断为Dubin-Johnson综合征14例,回顾分析14例Dubin-Johnson综合征临床特征、实验室检查和组织学形...     

Clinical value of ultrasound-guided percutaneous liver biopsy.

目的 探讨超声引导下经皮肝脏穿刺活检的临床价值.方法 在超声引导下,用Bard活检枪及18G活检针经皮对142例患者肝脏进行穿刺取肝组织进行病理学检查.根据组织病理学检查结果计算影像学诊断的符合率,总结操作经验及分析不良反应.结果 142例患者均穿刺成功,获取肝组织302块.无出血、胆汁漏及气胸等严重并发症发生.36例肝细胞癌和9例肝内胆管癌手术后病理与活检病理结果一致.活检前影像学诊断总符合率为61.3％ (87/142),与组织病理学检查结果(100％)比较差异有统计学意义(P＜ 0.001).结论 超声引导下肝脏穿刺活检安全有效、适应证广、结果可靠,具有重要临床应用价值.     

1例Gilbert综合征病例分析

目的:是探讨Gilbert综合征临床症状及体征、肝组织病理特点。方法:对本院收治的1例Gilbert综合征患者的临床及病理资料进行分析。结果:是患者临床症状轻微,体征不明显,甚至部分患者无异常体征,肝组织病理变化轻,以血清间接胆红素反复升高为主要表现,饥饿试验和苯巴比妥治疗试验有助于诊断,肝穿刺活检术为诊断金指标,而且基因检测尿苷二磷酸葡萄糖醛酸转移酶同工酶UGT1A1基因启动子区突变也可确诊。结论:Gil-bert综合征临床症状轻微,预后好,可不治疗。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.