瞬时弹性成像对慢性肝病肝纤维化的诊断价值

目的评价瞬时弹性成像(TE)对慢性肝病肝纤维化的诊断价值。方法分析100例本科就诊的慢性肝病肝纤维化患者,肝组织病理活检确定肝纤维化分期,同时100例患者均行实时组织弹性成像(RTE)与TE检测,比较两者与慢性肝病肝纤维化分期的相关性以及诊断肝纤维化与肝硬化的受试者工作特征曲线(ROC)曲线下面积。结果 TE与肝纤维化病理分期高度相关(r=0.763),RTE与肝纤维化病理分期中度相关(r=0.476),前者相关性显著高于后者(P=0.001);诊断肝纤维化的ROC曲线比较,TE的ROC曲线下面积(0.901)显著高于RTE的曲线下面积(0.738)(P=0.004);诊断肝硬化的ROC曲线比较,TE的曲线下面积(0.923)显著高于RTE的曲线下面积(0.791)(P=0.001)。结论TE较RTE对慢性肝病肝纤维化的诊断效能更高,但由于TE实际操作较RTE要求更高,推广程度低于RTE。     

弹性成像技术在慢性肝病诊断中应用的美国共识

正慢性乙型肝炎(CHB)、慢性丙型肝炎(CHC)、非酒精性脂肪性肝病(NAFLD)和酒精性肝病(ALD)是全球肝硬化和肝病死亡的主要病因。早期识别那些发生肝脏并发症高风险的慢性肝病主要是肝硬化患者,可以促进对这类患者的及时有效的管理,从而改善患者预后。考虑到肝活检等有创检测的风险和可能的抽样误差,用于肝纤维化评估的非侵入性的成像模式已在全球得到推广使用。最近,美国胃肠病学院(AGA)系统综述了肝纤维化无     

FibroScan评估酒精性肝病肝纤维化程度的诊断价值

目的探讨瞬时弹性成像技术(FibroScan)在评估酒精性肝病肝纤维化程度中的应用价值。方法对60例酒精性肝病患者采用FibroScan测量肝脏硬度,获得FibroScan弹性值(FS值),同时对患者进行肝活组织检查.以病理结果为金标准,分析FS值与酒精性肝纤维化分期的相关性。用受试者工作特征(receiver operatmg charateristic,R()C)曲线评估FibroScan对酒精性肝病的诊断价值。结果酒精性肝病患者肝纤维化分期S0~S4的FS值分别为S0:(5.31±1.06)kPa、S1:(7.91±2.81)kPa、S2:(9.81±3.39)kPa、S3:(14.66±4.31)kPa、S4:(19.81±6.02)kPa。组间差异有统计学意义(P0.(5)。进一步分析显示FS值与肝纤维化分期呈正相关性(r=0.706,P0.05)。肝纤维化程度≥S1、≥S2、≥S3和S4的ROC曲线下面积分别为0.833、0.871、0.906和0.919。结论 Fibroscan作为一种无创技术,能够较准确地定量评估酒精性肝病肝纤维化程度。     

乙型肝炎相关肝纤维化和肝硬化无创回归模型的研究进展

基于病因特点的肝纤维化程度和肝硬化的无创诊断是目前慢性肝病疾病状态评估研究的热点之一.慢性乙型肝炎(CHB)及其所致的肝硬化、肝细胞癌和肝脏失代偿是目前我国肝病临床实践的主要病种,其发展过程和病理特点与慢性丙型肝炎及其他慢性肝病如代谢性肝病、酒精性肝病、药物性肝病、自身免疫性肝病、遗传性肝病等不完全相同.     

抗肝纤维化的适应患者与治疗时机

1．肝纤维化治疗对象包括大多数慢性肝病患者，病因治疗与抗纤维化治疗同样重要：肝纤维化是存在于许多慢性肝病的共同病理特征，因此大多数慢性肝炎与肝硬化患者都有进行肝纤维化治疗的必要。肝纤维化治疗策略包含去除病因、抗炎症与免疫调节、抑制肝星状细胞（HSC）活化及其胶原代谢、刺激肝细胞再生等多方面，实际是一种广义的抗肝纤维化综合疗法，几乎适合于有慢性肝病，包括慢性病毒性乙型或丙型肝炎、慢性酒精性肝炎、非酒精性脂肪肝与肝硬化等，     

重视肝纤维化的诊治

肝纤维化是各种病因引起慢性反复肝损伤后的疤痕修复反应,是肝硬化发生的早期、可逆阶段。概述了肝纤维化与肝硬化的区别和慢性肝病的分期方法,重点论述了肝纤维化早期诊治的重要性,介绍了目前早期诊断评估方法以及肝纤维化的药物开发与治疗进展。强调肝纤维化患者的诊断及治疗对防止肝病进展为失代偿期肝硬化具有重要意义。     

丙型肝炎肝纤维化诊治进展

丙型肝炎肝纤维化是丙型肝炎进展至肝硬化的关键病理过程,其诊断方法除常规肝脏活体组织检查及肝纤维化标志物检测外,无创性诊断方法包括影像学检查新技术及无创性诊断模型的研究取得重要进展,使丙型肝炎肝纤维化的诊断准确率及对治疗反应的预测效果显著提高.在抗病毒治疗基础上的中西医结合治疗可能成为未来防治丙型肝炎肝纤维化的发展方向.     

瞬时弹性成像与实时组织弹性成像评估肝纤维化的比较

目的 对比分析瞬时弹性成像和实时组织弹性成像评估慢性肝病肝纤维化的价值.方法 对92例行肝组织学检查的慢性肝病患者同时行瞬时弹性成像和实时组织弹性成像检查,以肝组织病理学检查结果为金标准,比较瞬时弹性成像和实时组织弹性成像与肝纤维化病理分期的相关系数、诊断肝纤维化的受试者工作特征曲线下面积. 结果 瞬时弹性成像与肝纤维化病理分期的相关系数(r=0.755,95％ CI0.651 ～ 0.831,P=0.000)高于实时组织弹性成像(r=0.481,95％CI0.306 ～ 0.624,P=0.000),Z=3.07,P=0.002.瞬时弹性成像和实时组织弹性成像诊断肝纤维化(S≥2)、肝硬化(S=4)的受试者工作特征曲线下面积分别为0.903和0.740、0.915和0.786,瞬时弹性成像高于实时组织弹性成像(P值分别为0.003和0.020). 结论 瞬时弹性成像诊断慢性肝病肝纤维化效能优于实时组织弹性成像,但后者与二维超声图像融合,具有广泛的应用前景.     

肝纤维化无创诊断研究进展及其临床应用

肝纤维化是各种病因所致慢性肝损伤引起的细胞外基质的过度积聚,最终可能发展成肝硬化.对慢性肝病肝纤维化程度的评估尤为重要,是判断病情、决定是否进行治疗及随访疗效的关键环节.肝脏活体组织检查(肝活检)目前仍被认为是诊断肝纤维化的“金标准”,但由于其有创性,可引起危及生命的并发症,即使可能性很低,仍然限制了它的进一步应用.近年来发展起来的无创性肝纤维化诊断方法逐渐成为国内外学者关注的热点,这些方法完全不同却又相互补充,包括生物学途径,如检测各种肝纤维化的血清学标志物水平;也包括一些物理途径,如通过超声或磁共振弹性成像方法来评价肝组织硬度.这些无创诊断方法首先用于并且确证于慢性丙型肝炎患者,目前正逐渐扩展至其他慢性肝病,如慢性乙型肝炎、非酒精性脂肪性肝病和自身免疫性肝病等,从而降低了肝活检的需求.本文就肝纤维化无创诊断的优缺点和临床应用等方面进行综述.     

重视肝硬化患者的综合治疗与长期管理

肝硬化是慢性乙型肝炎、丙型肝炎、酒精性及非酒精性脂肪性肝病等多种慢性肝病的共同结局,主要表现为肝细胞功能障碍和门静脉高压症及其并发症。结合病史,可根据内镜、影像、生化、血液学指标做出肝硬化的临床诊断。肝硬化的诊断应尽可能明确病因、疾病分期和肝功能分级;治疗应尽可能包括病因治疗、综合支持治疗和针对各种并发症的治疗措施,并对患者进行长期随访和监测,以达到延缓疾病进展、延长生存期和提高生活质量的目标。     

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.     

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.     

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.     

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.