丙型肝炎病毒感染所致肝硬化可被一项标准血清生化学指标排除

Objective. Assessment of liver histology is pivotal in prognostication and decision- making regarding therapeutic intervention in patients with chronic hepatitis C virus (HCV). Being an invasive procedure, the liver biopsy is associated with complications, and a non- invasive alternative would be preferable. Material and methods. Sera samples from 179 patients with chronic HCV infection collected at the time of liver biopsy were analyzed using routinely available biochemical markers of liver disease, and liver histology was evaluated using the Ishak protocol. The relationship between the serum biochemical markers and cirrhosis (Ishak stage ≥ 5) as well as bridging fibrosis (Ishak stage ≥ 3) was examined. Results. A strong association was found in the multivariate logistic regression analysis between fibrosis stage and aspartate aminotransferase (AST), platelet count and prothrombin- INR (inte- rnational normalized ratio). An index (the G teborg University Cirrhosis Index (GUCI)) was calculated using these variables: normalized AST × prothrombin- INR × 100/ platelet count ( × 109/l). Using a cut- off value of 1.0, the sensitivity was 80% and the specificity 78% for diagnosis of cirrhosis, and the negative predictive values (NPV) and positive predictive values (PPV)- were 97% and 31% , respectively. The GUCI score proved slightly superior for sensitivity, specificity, NPV, PPV, and the area under the receiver operating characteristic (ROC) curve for prediction of cirrhosis and bridging fibrosis compared with the AST to platelet ratio index (APRI), which has been reported as a predictor of significant fibrosis and cirrhosis. Conclusions. An index using routinely available biochemical markers can with a high degree of accuracy discriminate patients with from those without hepatitis C- related cirrhosis.

南亚人与其他国家个体相比早发心肌梗死的危险因素

背景：南亚人中年轻时急性心肌梗死（AMI）的发生率高于其他国家个体，但原因不明。目的：评价并比较南亚本地人和来自其他国家的个体中危险因素与AMI的关系，尤其关注较年轻AMI。设计、地点和参与者：此标准化病例对照研究于1999年2月至2003年3月间纳入研究对象，包括来自5个南亚国家15所医学中心的1732例首发AMI患者和2204例年龄、性别匹配的对照者，以及来自其他国家的10728例患者和12431例对照者。主要观察指标：AMI与危险因素的关系。结果：南亚首发AMI患者的平均年龄低于其他国家（53．0±11．4岁 vs 58．8±12．2岁；P〈0．001）。

侵入性肺曲霉菌感染导致主动脉-支气管瘘:一种血管内途径修复法

We report the case of an 11-year-old girl with an aortobronchial fistula as a complication from an invasive aspergillosis in the lung. This very rare problem has not been reported in children, to our knowledge. Management of Aspergillus infections of the lung in children and aortobronchial fistulas is reviewed.

胆道闭锁伴左心发育不全综合征:1例病例报道及文献综述

胆道闭锁是一种婴儿胆汁淤积性疾病,有大约20%的病例还伴有其他解剖结构的异常。这些常为内脏定位和偏侧异位的缺陷,可导致内脏异位综合征及复合性心脏缺陷综合征。

苯酚对儿童嵌趾甲切除的影响

Ingrown toenails in children are a common problem with a high recurrence rate. The objective of this retrospective data review was to compare simple excision of the nail matrix with excision plus phenol (EPP) application in the treatment of ingrown toenails. The charts of 69 children who underwent surgical treatment of one or more ingrown toenails from 1994 to 2000 were reviewed. The primary procedure was noted (excision alone EA vs EPP) and dates of recurrences and reoperations were recorded. Parents were then surveyed by phone regarding complications, cosmetic outcome, and overall satisfaction with the procedure. Five scale categories, ranging from “ strongly agree” to “ strongly disagree” , were used, with responses of “ strongly agree” and “ agree” considered as a good outcome. Either Student’ s t test or the χ 2 test (P < .05 considered significant) was used for analysis. Thirty-one patients (45% ) were in the EPP group whereas the remaining 38 had EA. Mean length of follow-up was 4.3 years for the EA group and 2.1 years for the EPP group. There was no difference in age at operation or length of follow-up between the 2 groups. Boys were predominant in both groups. The survey response rate was 50/69 (73% ). The recurrence rate of ingrown toenails in the EA group was 42% vs 4% in the EPP group (P =.003). There were no significant differences in parental response with regard to operative experience (P =.31) and the cosmetic result (P =.13), with most of the respondents (78% ) indicating a good outcome for both questions. The addition of phenol to the surgical excision of ingrown toenail significantly reduced the incidence of recurrence, with similar patient satisfaction and an equivalent cosmetic result.

Blood flow of an Oldroyd-B fluid in a blood vessel incorporating a Brownian stress

The mechanical behavior of non-Newtonian fluids can be modeled by several constitutive differential equations. The Oldroyd model is viewed as one of the successful models for describing the response of a subclass of polymeric liquids, in particular the non-Newtonian behavior exhibited by these fluids. In this paper, we are concerned with the study of the unsteady flows of an incom-pressible viscoelastic fluid of an Oldroyd-B type in a blood vessel acting on a Brownian force. First we derive the orientation stress tensor considering Hookean dumbbells on Brownian configuration fields. Then we reformulate the three-dimensional Oldroyd-B model with the total stress tensor which consists of the isotropic pressure stress tensor, the shear stress tensor, and the orientation stress tensor. Finally we present the numerical simulations of the model and analyze the effect of the orientation stress tensor in the vessel.