Hepatic vascular diseases

Hepatic vascular diseases often present with non-specific and subtle histologic changes that could be easily overlooked during the evaluation of liver biopsies and surgical material. A liver biopsy typically samples small vasculature and thus is not a sensitive tool to evaluate the histopathology of large blood vessels. Vascular disease is rarely clinically suggested in the differential diagnosis of a case, and the indication for the liver biopsy is usually “elevated liver enzymes” or “cirrhosis”. Hence, when evaluating liver diseases, pathologists may overlook subtle histopathologic changes associated with vascular disease and instead focus on hepatitis, biliary disease or cirrhosis. Pathologists evaluating liver biopsies should be familiar with vascular diseases and their clinical implications. Recognizing hepatic vascular disorders is critical in order to trigger appropriate medical management. This review provides a brief overview of relatively common hepatic vascular diseases that surgical pathologists may encounter in practice.     

血清γ-谷氨酰转肽酶对淤胆型婴儿肝病的诊断价值

目的探讨血清γ-谷氨酰转肽酶(GGT)活性测定对淤胆型婴儿肝病的诊断价值。方法采集86例淤胆型肝病患儿血清,以80例正常婴儿为对照,常规生化检测,包括血液总胆红素(TBil)、直接胆红素(DBil)、丙氨酸转氨酶(ALT)、谷氨酸转氨酶(AST)、碱性磷酸酶(ALP)、总胆汁酸的活性,对其结果进行比较。结果淤胆型婴儿肝病组TBil增高明显,以DBil增高为主。TBil平均值为176.04μmol/L、DBil平均值为106.42μmol/L,平均DBil值占平均TBil值的60.45%。正常对照组血清GGT测定结果为(26.64±15.92)IU/L,淤胆型婴儿肝病组为(224.53±177.32)IU/L,显著高于正常对照组(P<0.01),异常率为92%。淤胆型婴儿肝病GGT水平与血清中TBil、ALP和TBA水平有一定程度的相关性。结论血清GGT测定对淤胆型婴儿肝病的辅助诊断具有十分重要的意义,具有较高的特异性和敏感性。     

Fatal case of Reye's syndrome associated with H3N2 influenza virus infection and salicylate intake in a 12-year-old patient

We describe a fatal case of Reye's syndrome in a 12-year-old male patient during an influenza A (H3N2) infection for which he received salicylates. In the current situation of the novel A/H1N1 virus pandemic, we believe that it is of high importance to emphasize the risks associated with salicylate intake to avoid the reappearance of Reye's syndrome.     

基于数据挖掘的中医治疗肝病处方用药规律分析

目的:探讨中医治疗肝病的用药规律。方法:收集治疗肝病处方,基于中医传承辅助系统软件构建数据库,进而采用关联规则Apriori算法和复杂系统熵聚类方法,确定处方中各药物和药物组合的使用频次及药物之间的关联规则等。结果:高频次药物包括茯苓、丹参、茵陈、白术、柴胡等;高频次药物组合包括"丹参、茯苓","白术、茯苓","丹参、赤芍"等;置信度为0.6以上的关联规则包括"黄芪-丹参","白术-茯苓","黄芪-茯苓","党参-茯苓"。结论:纳入研究治疗肝病的处方多用健脾渗湿、凉血活血、养阴柔肝、疏肝解郁之品,配伍精巧,符合中医标本兼治的用药原则。     

Bioactivity of sea grass against the malarial fever mosquito Culex quinquefasciatus

ObjectiveTo identify the larvicidal activity of the seagrass extracts against Culex quinquefasciatus (Cx. quinquefasciatus)MethodsSeagrass extracts, Halodule pinifolia (H. pinifolia), Cymodocea serrulata (C. serrulata) and Thalasia testudinum (T. testudinum) were dissolved in dimethylsulfoxide to prepare a graded series of concentration. Batches of 25 early 4th instars larvae of Cx. quinquefasciatus were transferred to 250 mL enamel bowl containing 199 mL of distilled water and 1 mL of plant extracts (0.01 mg−0.1 mg). After 24 h the mortality rate was identified with the formulae [(% of test mortality − % of control mortality)/(100 − % of control mortality)]×100. Each experiment was conducted with three replicates and a concurrent control group. A control group consisted of 1 mL of dimethylsulfoxide and 199 mL of distilled water only.ResultsThe root extract of H. pinifolia showed maximum larvicidal activity with minimum concentration of extract of LC₅₀ value of (0.614±0.006) μg/mL with lower confidence limit-upper confidence limit value of (0.052–0.072) and LC₉₀ value of 0.9120 μg/mL followed by leaf extract of C. serrulata LC₅₀ value of (0.074±0.008) μg/mL and LC₉₀ value of 0.1487 μg/mL. T. testudinum leaf extract showed LC₅₀ value of (0.082±0.006) μg/mL. The regression equation of root and leaf extract of H. pinifolia for 4 th instar larvae of Cx. quinquefasciatus were Y=5.229+1.36x (R²=0.993) and Y=2.369+1.21x (R²=0.878) respectively and analysis of variation was significant at P<0.05 level. The result of the preliminary phytochemical constituents showed the presence of saponin, steroids, terpenoid, phenols, protein and sugars.ConclusionsFrom the present study the ethanolic extracts of seagrass of H. pinifolia possess lead compound for development of larvicidal activity.     

Agomelatine in the Treatment of Major Depressive Disorder: An Assessment of Benefits and Risks

Agomelatine (AGM) was approved for the treatment of major depressive disorder (MDD) in adults by the European Medicines Agency (EMA) in February 2009. It is an analogue of melatonin and features a unique pharmacodynamic profile with agonism on both types of melatonergic receptors (MT1/MT2) and antagonism at serotonergic 5-HT2C receptors. There is, however, an ongoing debate regarding the efficacy and safety of this novel antidepressant agent, originally evoked by claims of a significant publication bias underlying the assessment of AGM being an effective antidepressant. Indeed, two recent comprehensive metaanalyses of published and unpublished clinical trials found evidence for a relevant publication bias. However, due to its statistically significant advantage over placebo based on the results of these metaanalyses AGM must be referred to as an effective antidepressant agent in the acute phase of MDD. However, the effect sizes of AGM in the treatment of MDD were evaluated as being small in comparison to other antidepressant agents. In addition, there is insufficient evidence for the efficacy of AGM in relapse prevention of MDD. Apart from efficacy issues, AGM appears to have the potential to exhibit severe hepatotoxicity (the EMA has identified AGM-associated “hepatotoxic reactions” as a new safety concern in September 2013) that is currently poorly understood. Considering these aspects, it seems inappropriate to evaluate AGM as an antidepressant agent of first choice. Nevertheless, its unique mechanism of action with particular sleep modulating effects may represent a specific treatment strategy for patients with particular characteristics; further studies with thorough characterization of patients are needed to test this hypothesis.     

"Sickle Cell Disease in the Emergency Department: Atypical Complications and Management"

Sickle cell disease is the most common inherited blood disorder in the United States. This disorder of hemoglobin structure leads to a chronic hemolytic anemia and complex chronic disease manifested by sudden, severe, and life-threatening complications. These acute complications can occur in any organ system beginning in early childhood and lasting throughout life. The intermittent nature and acuity of these complications lend the emergency department to be an important site of care. The hallmark of sickle cell disease is the vasoocclusive painful event. Other more "typical" complications include fever, acute chest syndrome, priapism, and ischemic stroke. Children with sickle cell disease can also present with other "atypical" complications that can have devastating consequences if they are unrecognized. Detailed discussion of these "atypical" sickle cell disease complications, organized by organ system involved, will be the focus of this article.     

慢性肝病并蛋白质能量营养不良病人的护理进展

对慢性肝病病人蛋白质能量营养不良的发生率、发生机制及其护理等进行综述。提出应重视病人的营养知识教育 ,制定正确的营养方案 ,以改善病人的营养状态     

基础磷脂治疗乙醇性肝病45例

目的:探讨基础磷脂注射液治疗乙醇性肝病的疗效及安全性.方法:45例乙醇性肝病患者均给予基础磷脂注射液500 mg,加入5%或10%葡萄糖注射液250 mL中缓慢静脉滴注,qd,并辅以其他综合治疗,疗程8周;所有病例均在治疗前及治疗结束后进行常规体检(包括肝脾B超检查),肝肾功能以及血清肝纤维化指标透明质酸(HA)、Ⅲ型前胶原氨基端肽(PⅢP)的检测.结果:治疗结束时,显效率57.8%,有效率28.9%,无效率13.3%.结论:基础磷脂注射液是一种治疗乙醇性肝病安全而有效的药物.     

肝病患者检测血清总胆汁酸的临床意义

目的 探讨血清总胆汁酸（TBA）在常见肝病诊断中的临床意义。方法 利用全自动生化分析仪测定116例肝病患者血清中的TBA水平。结果 肝病患者血清中TBA水平均有明显升高。结论 TBA是肝脏受损的敏感指标，可广泛应用于肝功能检测。