《2015年意大利肝病学会意见书:肝脏疾病与妊娠》摘译

肝脏疾病与妊娠临床上表现为相互影响的重要关系.妊娠相关性肝病是妊娠期肝损伤的最常见原因,并且对母亲和胎儿的生存构成严重威胁.本报告总结了意大利肝病学会(Italian Association for the Study of the Liver,AISF)专家小组对妊娠期肝病管理的意见,主要目的是为临床实践提供妊娠期肝脏疾病的最佳管理建议.报告分为3个部分:(1)妊娠期特发性肝脏疾病;(2)妊娠期发生的肝脏疾病;(3)妊娠合并慢性肝脏疾病.采纳建议的证据分级和推荐强度均采用美国心脏病学院和美国心脏学会实践指南的标准(表1).     

2012年美国实践指南:非酒精性脂肪性肝病诊疗简介

前言 本指南中的推荐建议旨在为临床医师和相关医护人员提供关于非酒精性脂肪性肝病NAFLD诊断、治疗和预防的优先处理方案.AASLD实践指南委员会采纳了推荐分级的评估、制定与评价(GRADE)工作组的分类并稍作修改.GRADE系统中推荐意见的强度分为强(1)或弱(2);证据质量分为高(A)、中(B)或低(C)3级(表1).     

欧洲肝病学会临床实践指南:HCV感染的管理(推荐意见)

<正>欧洲肝病学会(EASL)近期发布了关于HCV感染管理的临床实践指南,并在线发表于《Journal of Hepatology》。作者在此对指南的推荐意见进行翻译,以供临床医生参考。建议分级参考表1。1急性和慢性丙型肝炎的诊断1.1抗-HCV是HCV感染的一线诊断指标(A1)。1.2对于急性丙型肝炎或免疫力低下的患者,HCV RNA检测应列入初始评估(A1)。     

慢性乙型肝炎亚太地区专家共识(2006年6月更新)

为帮助保健提供者遵循有关CHB患者的推荐处理策略,国际主要肝病学术机构,包括亚太肝病学会(APASL)、美国肝病学会(AASLD)及欧洲肝病学会(EASL)等已先后发表了关于CHB治疗的共识或指南。这些共识或指南有助于培训全球内科医师按照循证医学(EBM)的策略处理HBV感染者,减轻HBV感染相关疾病的负担,改善患者的预后。2006年3月,亚太地区ACT-HBV执行委员会成员对文献报告的新信息进行评估,并将之提交新近召开的关于当前CHB处理的国际会议。根据这一评估,指导委员会(成员均为各自领域的专家)建议发布针对2005年亚太地区CHB处理共识的警示报告。一、2005年以来的新资料HBV感染和CHB临床治疗的研究步伐明显加快,因此有大量新信息见诸文献。在亚太共识的最新版本(2005)定稿后,关于拉米夫定和阿德福韦酯长期治疗、恩替卡韦的Ⅲ期临床试验结果、聚乙二醇化干扰素、替比夫定(telbivudine)、恩曲他滨(emtricitabine)等的新资料已见诸文献或大型学术会议的报告。胸腺素α1和干扰素α联合治疗成人患者,干扰素和拉米夫定治疗儿童患者,这些方面的研究结果新近也已出版。此外,应用阿德福韦或恩替卡韦...     

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美国肝病研究协会(AASLD)关于<慢性乙型肝炎的临床实践指南>(以下简称<指南>)再度更新发表[1].其涉及内容主要包括高危人群中乙型肝炎病毒(HBV)感染者筛选,慢性乙型肝炎(CHB)的健康教育和预防,慢性HBV感染的自然史及专业术语,慢性HBV感染者及患者的评估与处理,CHB的抗病毒治疗等5个部分及推荐处理意见共41条.<指南>遵照循证医学原则,广泛引用全球最新文献,在相关证据的基础上提出建议,并根据证据等级来反映推荐意见的推荐强度(见表1).     

如何评判已有慢性肝病患者参加临床药物试验时DILI的发生

<正>本次会议中,如何评价已有慢性肝病患者参加临床药物试验时DILI的发生引起了与会者极大的兴趣,现概括如下。一、如何评估慢性肝病患者的临床药物试验?针对新药上市前临床试验过程中可能出现的DILI,美国食品与药物管理局(FDA)已提供了一整套行之有效的评估框架和操作指南,以避免潜在的中毒性肝损伤的发生。但仍需从以下方面更新:(1)必须具备专业的临床医生和系统的实验室     

2014年美国肝病学会和欧洲肝病学会对慢性肝病时肝性脑病实践指南的建议要点

<正>为了提高肝性脑病(HE)的临床研究水平,从而提高对HE患者的管理水平,欧洲肝病学会(EASL)和美国肝病学会(AASLD)联合发布了2014年慢性肝病时HE的实践指南[1],主要面向内科医生需要,给出了对慢性肝病HE成人患者诊断、治疗和预防方面的建议。指南具有一定的灵活性,这一点与处理每一例患者都必须遵守的诊疗规范不同。该指南的推荐意见基于现有文献的支持证据,采用GRADE     

浅谈胆汁淤积性肝病瘙痒的治疗

正胆汁淤积性肝病导致的瘙痒症状对患者来说常常难以忍受,临床上也缺乏有效的治疗手段。尽管大部分胆汁淤积性肝病都会引起瘙痒,包括原发性胆汁性胆管炎(PBC)、原发性硬化性胆管炎(PSC)、妊娠肝内胆汁淤积症(ICP)、遗传性或药物性胆汁淤积,在研究瘙痒症时我们仍把重点放在PBC。据统计,70%PBC患者存在瘙痒症状,而其中只有极少部分症状严重,这些人通常对药物治疗无应答[1]。现有的临床推荐治疗药     

脂肪性肝病诊疗规范化的专家建议（2019年修订版）

非酒精性脂肪性肝病（NAFLD）已成为我国最常见的慢性肝病。本建议从以下5个方面对NAFLD的规范化诊断和治疗进行了修订：（1）诊治中心/专病门诊的组织架构及功能;（2）筛查和评估：包括筛查对象、初步评估、病因筛查、非酒精性脂肪性肝炎（NASH）和进展性肝纤维化的无创诊断、肝活组织病理学检查以及代谢紊乱和心血管风险评估等;（3）临床处理：包括生活方式（饮食运动减重）调整,合并糖脂代谢紊乱、高血压等特殊人群的处理以及脂肪性肝炎和肝纤维化的药物选择;（4）特殊人群的管理：儿童、妊娠和哺乳期妇女、合并酒精性肝病、慢性HBV和/或HCV感染以及合并自身免疫现象等;（5）监测与随访。本建议旨在优化NAFLD患者的管理流程,指导临床医生制定更为合理的诊疗决策。     

《2015年美国肝病学会、美国感染病学会指南:成人HCV感染的检测、管理和治疗建议》推荐意见

<正>此指南是美国肝病学会(American Association for the Study of Liver Diseases,AASLD)和美国感染病学会(Infections Diseases Society of America,IDSA)最新的关于丙型肝炎的共识意见。作者对指南全文的推荐建议及表格内容进行了翻译,供业内同行参考。推荐建议的分级见表1。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.