第002例──尿黄并乏力腹胀及腹痛原因待查

1病例摘要患者男,16岁,主因"尿黄3个月,乏力腹胀2周,加重伴腹痛3天"入院。患者3个月前无明显诱因出现尿色发黄,口服护肝片等保肝药物治疗,未检测肝功能。尿黄逐渐加深,2周前感乏力腹胀逐渐加重,尿量减少。因腹痛3天,伴腹泻来诊,门诊以"肝硬化原因待查"收入院。     

肝衰竭合并肾上腺皮质功能不全1例

患者,男,53岁,因＂乏力、纳差、尿黄10 d＂入院。患者10 d前无明显诱因出现四肢乏力、食欲减退,伴尿黄。无发热、呕吐,无腹痛、腹泻,患者未在意,未到医院诊治,因上述症状继续加重,到我院门诊就诊,查肝功能明显异常（TBil 63.1μmol/L,Alb 41 g/L,ALT675 U/L,AST604 U/L）,门诊以＂肝功能异常原因＂收入院。近3月患者体重下降5 kg。既往史：     

肝朗格汉斯组织细胞增多症1例

1病例介绍 患者男性,23岁,因＂间断乏力3年,加重伴尿黄2月余＂于2010年7月1日入院。患者3年前无明显诱因出现乏力、消瘦,未予诊治。1年前体检发现肺部阴影、肝功能异常（具体数值不详）,于外院诊为＂继发性肺结核＂,予抗结核药物治疗8个月,后因疗效不佳停药。2月前,患者自觉乏力症状加重伴尿黄,于多家医院诊疗,查肝功能显著异常,     

原发性胆汁性胆管炎合并神经纤维瘤1例报告

正1病例资料患者女性,46岁,因"尿黄、目黄1年,加重伴乏力5个月"于2014年12月11日收入吉林大学第一医院。入院前1年无明显诱因出现尿黄、目黄,未系统诊治,入院5个月前上述症状加重,并伴乏力,无皮肤瘙痒,无灰白便,既往发现皮肤肿物40余年,否认癫痫病史及相关神经系统疾病,否认家族性疾病史。     

非甲-戊型肝炎相关性再生障碍性贫血1例

患者,男性,45岁,因＂乏力、纳差2月,尿黄7d＂于2010年8月27日入住我院肝病科。患者于入院前2月无明显诱因下感全身疲乏,懒于活动,胃纳差,食欲减退,饭量减少为原1/3,厌油腻饮食,无腹胀或腹痛,无恶心、呕吐,无返酸、嗳气,     

尿性腹水伴发急性肾衰竭1例

患者男,74岁,因“乏力、食欲不振伴腹胀1周,尿少2d”入院。患者于1周前无明显诱因出现乏力,食欲不振,伴腹胀,无腹痛、恶心、呕吐。2d前出现尿量减少,并伴有腹部明显隆起。病程中无水肿、血压增高,无发热、皮疹、关节疼痛、     

氟他胺引起暴发性肝衰竭一例

患者男,78岁,因乏力,纳差,腹胀2周,伴恶心,眼黄,尿黄进行性加重1周入院。患者2003年7月初开始无诱因逐渐出现乏力,纳差,厌油腻,腹胀不适,并进行性加重,1周后发现皮肤、巩膜黄染,小便呈茶色。无皮肤瘙痒,无发热,无腹痛、腹泻,无皮疹,无白陶土样大便,无恶心、呕吐。否认输血及血制品史;否认病前明显不洁饮食及生食海鲜史,否认与肝炎患者密切接触史。     

肺腺癌腹腔转移误诊为酒精性肝硬化失代偿期1例

患者,男,59岁,因腹胀伴全身乏力、尿少半年,于2004年1月29日入院.患者有长期嗜酒史,半年前无明显诱因出现渐进性腹胀,腹围逐渐增大,伴全身乏力、尿少,无肝区疼痛,无恶心、呕吐,无呕血黑便.     

以亚急性肝功能衰竭和视神经炎为表现的肝豆状核变性1例

患者男性,27岁,汉族。因“乏力、尿黄2月”入院。患者2个月前无明显诱因出现四肢乏力,伴尿黄。无发热,无恶心、呕吐,无腹痛、腹泻,无明显纳差。患者未在意,未到医院诊治,患者上述症状无明显缓解,尿色进行性加深,于5d前到福建某医院就诊,查肝功能明显异常（总胆红素250μmol／L）,为进一步治疗,3d前回到当地县医院就诊,查肝功能异常（总胆红素367．5μmol／L）,行保肝、退黄、对症等治疗,患者腹胀无缓解,做肝胆脾B超示：1、肝硬化,脾大,2、腹腔大量积液。     

1例慢加亚急性肝衰竭临床诊治剖析

1病例介绍患者男性,40岁,主因＂乙肝表面抗原阳性20年,乏力纳差1个月,尿黄、眼黄10余天＂于2010年2月23日收住首都医科大学附属北京佑安医院重症肝病科。患者1990年体检发现乙肝表面抗原阳性,肝功能正常,未治疗。2010年1月23日无明显诱因出现乏力、纳差,未在意。2月15日饮白酒7～8两后自觉乏力、纳差加重,并出现眼黄、尿黄如浓茶色,     

Composite Fe3O4-MXene-Carbon Nanotube Electrodes for Supercapacitors Prepared Using the New Colloidal Method

MXenes, such as Ti₃C₂T_x, are promising materials for electrodes of supercapacitors (SCs). Colloidal techniques have potential for the fabrication of advanced Ti₃C₂T_x composites with high areal capacitance (C_S). This paper reports the fabrication of Ti₃C₂T_X-Fe₃O₄-multiwalled carbon nanotube (CNT) electrodes, which show C_S of 5.52 F cm⁻² in the negative potential range in 0.5 M Na₂SO₄ electrolyte. Good capacitive performance is achieved at a mass loading of 35 mg cm⁻² due to the use of Celestine blue (CB) as a co-dispersant for individual materials. The mechanisms of CB adsorption on Ti₃C₂T_X, Fe₃O₄, and CNTs and their electrostatic co-dispersion are discussed. The comparison of the capacitive behavior of Ti₃C₂T_X-Fe₃O₄-CNT electrodes with Ti₃C₂T_X-CNT and Fe₃O₄-CNT electrodes for the same active mass, electrode thickness and CNT content reveals a synergistic effect of the individual capacitive materials, which is observed due to the use of CB. The high C_S of Ti₃C₂T_X-Fe₃O₄-CNT composites makes them promising materials for application in negative electrodes of asymmetric SC devices.     

Hypercoagulability in Cushing’s syndrome: the role of specific haemostatic and fibrinolytic markers

Objective Hypercoagulability is a commonly described complication in patients with Cushing’s syndrome. Recent clinical studies have indicated various abnormalities of coagulation and fibrinolysis parameters which may be related to that phenomenon. The aim of this study was to investigate the mechanisms underlying the hypercoagulable state in patients with Cushing’s syndrome. Research methods and procedures A wide range of serum markers involved in the processes of blood coagulation and fibrinolysis was measured in a group of 33 patients with Cushing’s syndrome and 31 healthy controls. No participant was taking medication which could influence the result or had known diseases, except hypertension and diabetes, which could affect blood coagulation or fibrinolysis parameters. Results Patients with Cushing’s syndrome had higher levels of clotting factors II (P = 0.003), V (P < 0.001), VIII (P < 0.001), IX (P < 0.001), XI (P < 0.001) and XII (P = 0.019), protein C (P < 0.001), protein S (P < 0.001), C1-inhibitor (P < 0.001) and plasminogen activator inhibitor-1 (PAI-1) (P = 0.004). The activity of fibrinolytic markers, plasminogen (P < 0.001), antithrombin (P < 0.001) and antithrombin antigen (P = 0.001) was also increased in the patient group. Conclusion The study has demonstrated hypercoagulability in patients with Cushing’s syndrome manifest as increased prothrombotic activity and compensatory activation of the fibrinolytic system. We propose the introduction of thromboprophylaxis in the preoperative and early postoperative periods, combined with a close follow-up in order to prevent possible thromboembolic events in patients with Cushing’s syndrome.     

Correlation of TIMI risk score with angiographic extent and severity of coronary artery disease in non-ST-elevation acute coronary syndromes

Aim of study

To determine whether the TIMI risk score correlates with the angiographic extent and severity of coronary artery disease in patients with non-ST-elevation acute coronary syndrome undergoing cardiac catheterization.

Patients and method

We conducted a retrospective review of 239 medical records of patients who underwent coronary angiography secondary to non-ST-elevation acute coronary syndrome between 2002 and 2006. Patients were classified into three groups according to TIMI risk score: TIMI scores 0 to 2 (group 1: n = 121), 3 to 4 (group 2: n = 100), and 5 to 7 (group 3: n = 18). We compared the coronary angiography findings of the three groups.

Results

Patients of group 1 had a greater likelihood of normal or non significant CAD than patients of group 2 (36.3 % vs 13 %, P < 0.001) and than patients of group 3 (36.3 % vs 0 %, P = 0.002). One-vessel disease was found more often in patients with TIMI score 0 to 2 than in patients with TIMI score 5 to 7 (28.9 % vs 0 %; P = 0.01), and in patients with TIMI score 3 to 4 than in those with score 5 to 7 (35 % vs 0 %, P = 0.006). However, 1-vessel disease was found in patients of group 1 as often as in patients of group 2. The frequency of two-vessel disease was similar whatever the level of TIMI score was low, intermediate or high. Three-vessel or left main disease was more likely found in patients of group 3 than in patients of group 2 (66.7 % vs 26 %; P = 0.01), and than patients of group 1 (66.7 % vs 13.2 %; P < 0.001). Chronic coronary occlusions and coronary calcifications were also more likely found in patients with TIMI score 5 to 7.

Conclusion

In patients with non-ST-elevation acute coronary syndrome undergoing cardiac catheterization, the TIMI risk score correlated with the extent and severity of coronary artery disease.     

Determination of the PIC700 Ceramic’s Complex Piezo-Dielectric and Elastic Matrices from Manageable Aspect Ratio Resonators

Achieving good piezoelectric properties, such as the widely reported d₃₃ charge coefficient, is a good starting point in establishing the potential applicability of piezoceramics. However, piezoceramics are only completely characterized by consistent piezoelectric-elastic-dielectric material coefficient matrices in complex form, i.e., including all losses. These matrices, which define the various alternative forms of the constitutive equations of piezoelectricity, are required for reliable virtual prototyping in the design of new devices. To meet this need, ten precise and accurate piezoelectric dielectric and elastic coefficients of the material, including all losses, must be determined for each alternative. Due to the difficulties arising from the coupling of modes when using the resonance method, this complete set of parameters is scarcely reported. Bi_0.5Na_0.5TiO₃-based solid solutions are already commercially available in Europe and Japan. Here, we report a case study of the determination of these sets of material coefficients (d_iα, g_iα, e_iα and h_iα; s^E,D_αβ and c^E,D_αβ; ε^T_ik and ε^S_ik; and β^T_ik and β^S_ik), including all losses, of the commercial PIC700 eco-piezoceramic. Plate, disk, and cylinder ceramic resonators of a manageable aspect ratio were used to obtain all the material coefficients. The validation procedure of the matrices is also given by FEA modeling of the considered resonators.     

Fuhrmanolepis beskydensis n.sp. (Cestoda: Dilepididae) from woodcock Scolopax rusticola L.(Aves, Charadriformes) in Slovakia with comments on sytematics and nomenclature of the genus Fuhrmanolepis Spassky et Spasskaya, 1965

Summary   Fuhrma n olepis beskydensis n.sp. from woodcock, Scolopax rusticola L. in Slovakia is described based upon light microscope observation. The medium sized species possess a single crown of 21‘diorchid’ (wrench-shaped) hooks, 28–30 μm long. Irregularly alternating genital pores were combined with abnormal multiple shifting of pores within the lateral margins of strobila. Number of testes 18–25. Cirrus-sac and evaginated cirrus are 115–135 × 7–12 and 26 × 6–11 μm, respectively. The species is differentiated from closely related congeneric taxons and some other morphologically similar dilepidids. An attention is being paid to taxonomy and nomenclature of Fuhrma n olepis Spassky et Spaskaja, 1965 regarding an emendation of mentioned genus to Fuhrma nn olepis by Bona (1994a) and modification of its diagnosis.     

Local immunity and metastasis of colorectal carcinoma

The subsets of tumor-infiltrating lymphocytes (TIL) and prostaglandin (PG) E ₂ were measured in the resected tissues of 32 colorectal cancers without metastasis and 14 with metastasis in order to investigate the local immunity in metastasis of colorectal carcinoma. Subsets of TIL (Leu 1, Leu 2a, Leu 3a, Leu 10, Leu 1 1b, IL-2 receptor) were detected by immunohistochemical staining of frozen tissues. The number of positive cells was counted and expressed as number positive per 250 × 250 m ².The numbers of T cells (Leu 1) and natural killer cells (Leu 11b) were larger in early cancers and decreased in parallel with the presence of metastasis (control [n=9]: 89±28, 6±4; early cancers [n=9]: 269±112 ^*,76±56 ^*;advanced cancers without metastasis [n=11]: 182±80 ^*,56±59 ^*;advanced cancers with metastasis [n=11]: 76±42 ^*,26±21; values are mean ± SD; ^* P < 0.05, ANOVA). The level of PG E ₂ from the draining vein (V) measured by radioimmunoassay was higher than that from the feeding artery (A) (119.1±14.3 vs. 15.4±1.9 pg/ml; P <0.001). The PG E ₂ V/A ratio of cancers with metastasis was significantly higher than that of those without metastasis (132±2.4 vs. 5.6 ±0.8; P <0.001). TIL was decreased in parallel with the increase of PG E ₂ V/A ratio. We conclude that TIL and PG E ₂ may play an important role in metastasis of colorectal carcinoma and that PG E ₂ has an adverse effect in suppressing local immunity and enhancing metastasis.Supported by grants from the Japanese Ministry of Science, Education, and Culture (60570619 and 63480299).Read at the meeting of The American Society of Colon and Rectal Surgeon, Boston, Massachusetts, May 12 to 17, 1991.     

Effect of a physical training program using the Pilates method on flexibility in elderly subjects

The adaptations of the human body resulting from the aging process especially loss of flexibility can increase the risk of falls and the risk of developing other health conditions. Exercise training, in particular the Pilates exercise method, has become an important form of physical activity that minimizes the deleterious effects of aging on flexibility. Few studies have evaluated the effect of this training method on body flexibility among elderly. We aimed to evaluate the effects of physical training using the Pilates method on body flexibility of elderly individuals. Eighteen elderly women and two elderly men (aged 70 ± 4 years) followed a 10-week Pilates training program. Individuals were recruited from the local community via open invitations. At study entry, none of them had limited mobility (walking requiring the use of walkers or canes). Furthermore, those with neurologic, muscular, or psychiatric disorders as well as those using an assistive device for ambulation were excluded secondary to limited participation. Flexibility assessment tests (flexion, extension, right and left tilt, and right and left rotation of the cervical and thoracolumbar spine; flexion, extension, abduction, and lateral and medial right and left rotation of the glenohumeral joint; flexion, extension, abduction, adduction, and lateral and medial rotation of the right and left hip; and flexion of the right and left knee) were performed by a blinded evaluator using a flexometer before and after the training period. All assessments were carried out at the same time of day. There was an observed increase in flexion (22.86 %; p < 0.001), extension (10.49 %; p < 0.036), and rotation to the left side (20.45 %; p < 0.019) of the cervical spine; flexion (16.45 %; p < 0.001), extension (23.74 %; p = 0.006), lateral bending right (39.52 %; p < 0.001) and left (38.02 %; p < 0.001), and right rotation (24.85 %; p < 0.001) and left (24.24 %; p < 0.001) of the thoracolumbar spine; flexion (right—8.80 %, p = 0.034; left—7.03 %, p = 0.050), abduction (right—20.69 %, p < 0.001; left—16.26 %, p = 0.005), and external rotation (right—116.07 % and left—143 %; p < 0.001 for both directions) of the glenohumeral joint; flexion (right—15.83 %, p = 0.050; left—9.55 %, p = 0.047) of the hips; and bending (right—14.20 %, p = 0.006; left—15.20 %, p = 0.017) the knees. The joint with the greatest magnitude of improvement was the thoracolumbar spine. Thus, this type of training may minimize the deleterious effects of aging and may improve the functionality of elderly individuals, which would reduce the likelihood of accidents (especially falls).     

Modulation of L-type Ca2+ channel current density and inactivation by β-adrenergic stimulation during murine cardiac embryogenesis

Background  L-type Ca²⁺ current (I _CaL) is a key regulatory and functional element during early embryonic cardiomyogenesis. As the embryonic heart underlies hormonal modulation, e.g. catecholamines, we aimed at studying effects of β-adrenergic stimulation on I _CaL densities and inactivation kinetics during murine heart development. Methods   I _CaL was recorded applying the whole-cell patch-clamp technique in ventricular myocytes of early embryonic (EDS, E9.5–11.5) and late developmental, fetal (LDS, E16.5–18.5) stages as well as adult cardiomyocytes. To distinguish between Ca²⁺-(CDI) and voltage-dependent inactivation (VDI), Ca²⁺ was replaced with Ba²⁺ in the extracellular recording solution. The β-adrenergic signaling pathway was simulated by applying isoproterenol (Iso). Results  Basal current densities showed an increase of I _CaL during development (EDS: −9.61 ± 1.97 pA/pF, n = 9; LDS: −13.2 ± 4.26 pA/pF, n = 12; adult: −16.1 ± 4.63 pA/pF, n = 5). Iso (1 μM) enhanced I _CaL density with low effects at EDS (17.1 ± 3.58%, n = 8, P > 0.05) but strong effects at LDS (74.1 ± 3.77%, n = 8, P < 0.01) and in adults (90.6 ± 7.01%, n = 6, P < 0.001). The current availability was significantly higher at LDS as compared to EDS and elevated after application of Iso. In the presence of Ca²⁺, the fast phase of I _CaL inactivation (τ_f) was significantly enhanced by Iso at LDS. The slow phase of inactivation (τ_s) was unaltered at both developmental stages. However, VDI was significantly reduced under Iso in LDS and adult cardiomyocytes. Conclusion  These results imply that β-adrenergic modulation becomes of importance especially during fetal heart development. CDI and VDI of I _CaL are modulated by β-adrenergic stimulation in fetal but not in early embryonic mouse cardiomyocytes. Furthermore our data suggest important changes of the L-type Ca²⁺ channel protein, and/or maturation of the Ca²⁺-induced Ca²⁺ release (CICR) machinery. Returned for 1. Revision: 7 March 2008 1. Revision received: 8 March 2008 Returned for 2. Revision: 15 August 2008 2. Revision received: 20 September 2008     

Effects of α tocopherol and β carotene supplements on symptoms, progression, and prognosis of angina pectoris

Objective—To evaluate the effects of α tocopherol and β carotene supplements on recurrence and progression of angina symptoms, and incidence of major coronary events in men with angina pectoris.
Design—Placebo controlled clinical trial.
Setting—The Finnish α tocopherol β carotene cancer prevention study primarily undertaken to examine the effects of α tocopherol and β carotene on cancer.
Subjects—Male smokers aged 50-69 years who had angina pectoris in the Rose chest pain questionnaire at baseline (n = 1795).
Interventions—α tocopherol (vitamin E) 50 mg/day, β carotene 20 mg/day or both, or placebo in 2 × 2 factorial design.
Main outcome measures—Recurrence of angina pectoris at annual follow up visits when the questionnaire was readministered; progression from mild to severe angina; incidence of major coronary events (non-fatal myocardial infarction and fatal coronary heart disease).
Results—There were 2513 recurrences of angina pectoris during follow up (median 4 years). Compared to placebo, the odds ratios for recurrence in the active treatment groups were: α tocopherol only 1.06 (95% confidence interval (CI) 0.85 to 1.33), α tocopherol and β carotene 1.02 (0.82 to 1.27), β carotene only 1.06 (0.84 to 1.33). There were no significant differences in progression to severe angina among the groups given supplements or placebo. Altogether 314 major coronary events were observed during follow up (median 5.5 years) and the risk for them did not differ significantly among the groups given supplements or placebo.
Conclusions—There was no evidence of beneficial effects for α tocopherol or β carotene supplements in male smokers with angina pectoris, indicating no basis for therapeutic or preventive use of these agents in such patients.

Keywords: antioxidants;  angina pectoris;  prevention;  vitamin supplements