原发性干燥综合征合并原发性胆汁性肝硬化12例临床分析

原发性胆汁性肝硬化（primary biliary cirrhosis,PBC）是一种病因未明的慢性进行性胆汁淤积性肝脏疾病。其病理改变主要以肝内细小胆管的慢性非化脓性破坏、汇管区炎症、慢性胆汁淤积、肝纤维化为特征,最终发展为肝硬化和肝衰竭[1]。研究发现,PBC与干燥综合征（Sj觟gren＇s Syndrome,SS）具有较为密切的相关性,国内外已有多家报道,而原发性干燥综合征（pSS）合并PBC的病例报道较少。为此，笔者总结2005年8月一2012年12月我院诊断为pSS合并PBC12例资料较为完整的病例，并对其临床表现和实验室检查进行分析，现报道如下。

皮层下动脉硬化性脑病38例临床分析

皮层下动脉硬化性脑病是由于脑皮层下白质小动脉硬化,动脉壁透明变性闭塞和栓塞造成自质弥漫性病变,以往只能靠病理诊断,随着CT和MRI的广泛应用,此病在临床上并不十分少见.

动态心电图检测室性心动过速158例临床分析

目的:应用24 h动态心电图(DCG)检查探讨室性心动过速(VT)发生的特征及临床意义。方法:回顾性分析DCG检查出的VT患者158例的临床资料。结果:158例患者中共检出室速2541阵,频率范围在70～250次/min,其中1阵/24 h者110例(占70%)。绝大部分为非持续性室速(<30 s),有6例为持续性室速(3.8%)。VT呈单形性者123例(78.2%)、多形性者35例。76例合并不同程度的ST-T改变,随访中有2例猝死。结论:室速的发生与器质性心脏病合并心肌缺血、心力衰竭、电解质紊乱等情况密切相关,在去除诱因、积极治疗原发病后,大多数室速转归良好。

扩张型心肌病53例临床分析

目的分析、总结及探讨扩张型心肌病(DCM)的临床特点、诊断及治疗方法。方法临床分析53例符合WHO/ISFC DCM诊断标准的症状、体征及检查、治疗、转归。结果 DCM是除冠心病和高血压性心脏病以外导致心力衰竭的病因之一,提高对本病的认识,早期诊断,积极治疗,可改善预后。结论超声心动图在DCM的诊断和鉴别上具有重要价值。DCM的常规治疗包括抗心力衰竭,防治各种心律失常及循环栓塞。以β-受体阻滞剂及ACEI醛固酮拮抗剂为主的治疗可以使DCM严重心力衰竭得以缓解,心力衰竭的非药物疗法,代表了心力衰竭治疗的新方向。

挫伤性前房出血52例临床分析

目的:探讨挫伤性前房出血临床特点及疗效。方法:回顾分析52例挫伤性前房出血住院病例临床资料。结果:本组病例有性别、年龄及职业特点,综合治疗效果佳。结论:挫伤性前房出血应早期住院综合治疗并积极预防并发症。

巨幼细胞性贫血54例临床分析

目的:分析54例巨幼细胞性贫血(MA)病因,临床表现外周血变化贫血程度。方法:经骨髓象检查MA患者54例,同时检测血液常规,胆红素LDH,并对临床及化验结果做回顾性分析。结果:消化系统器质性病变及23例,膳食异常26例,部分患者多种病因并存,三系减少34例(62.9%)。中、重度贫血42例,总胆红素28.42±20.91mmU/L,LDH968.31～778.23U/L。结论:消化系统器质性病变及膳食异常是引发MA的主要原因,发病者以中、老年居多,女性多于男性,贫血多为重度(57.4%),半数以上患者周围血可表现三系列减少经叶酸维性素B12治疗后,绝大部分患者病情均得到明显改善,血三系减少基本恢复正常。

溃疡性结肠炎64例分析

目的总结溃疡性结肠炎的临床特点和治疗情况,提高对本病诊治的认识。方法收集我院2007年1月至2010年8月住院患者64例的相关资料,总结其临床特点及治疗情况。结果 64例住院病例中,男女之比为2:1,平均发病年龄43.6岁,高峰年龄段为20～60岁。主要临床表现为腹泻、粘液血便、腹痛。大肠镜检查以黏膜充血、糜烂、溃疡为主要表现。病变范围以侵犯直肠及直乙结肠者最多。主要予SASP/5-ASA及糖皮质激素治疗。结论 UC患者内镜和病理是诊断UC的主要方法,早期诊断早期治疗是关键,联合治疗是目前的主要方案。

80例原发性脑干损伤临床研究

目的探讨原发性脑干损伤的临床治疗方法。方法选取我院2006年3月～2011年5月收治的80例原发性脑干损伤患者的临床资料,对治疗方案进行分析总结。结果术后症状好转36例,致残17例,其中10例轻中度,7例为重度残疾,植物人状态3例,无效死亡24例。结论原发性脑干损伤患者一般病情较重,患者死亡率较高,及时的采取手术、抗感染、脱水、亚低温、高压氧等治疗方式可有效的降低患者的残疾率和死亡率。

老年患者消化性溃疡并出血或穿孔临床分析

目的通过分析近十余年医院收治的232例老年消化性溃疡并出血或穿孔的临床资料,以加深对本病的认识,提高诊断及治疗水平。方法采用回顾性研究的方法,对2000年1月—2012年6月收治的符合消化性溃疡并出血或穿孔诊断标准的老年患者进行分析。结果 232例老年消化性溃疡中198例合并出血,34例合并穿孔,212例幽门螺杆菌阳性,73例有服用NSAID类药物史,26例恶性溃疡。结论老年性消化性溃疡的发病机制是综合,复杂的,出血及穿孔是常见的两个并发症,由于老年人胃粘膜防御因子减弱,动脉硬化,器官组织退行性变,服用NSAID类药物,加之合并有其他疾病如冠心病,高血压等,导致症状不典型,病变愈合慢,易复发,病情严重,复杂。临床医师对老年患者要高度重视,要加深对本病的认识,提高诊断及治疗水平。

Aptamers Against Viral Hepatitis:from Rational Design to Practical Application

Aptamers are short nucleic acids or peptides that strongly bind to a protein of interest and functionally inhibit a given target protein at the intracellular level. Besides high affinity and specificity, aptamers have several advantages over traditional antibodies. Hence, they have been broadly selected to develop antiviral agents for therapeutic applications against hepatitis B and C viruses (HBV, HCV). This review provides a summary of in vitro selection and characterization of aptamers against viral hepatitis, which is of practical significance in drug discovery.

Lack of specific association between gastric autoimmunity hallmarks and clinical presentations of atrophic body gastritis

AIM： To investigate the possible relationships between gastric autoimmune phenomena and clinical presentations of this disorder, in consecutive atrophic body gastritis patients. METHODS： A total of 140 atrophic body gastritis patients, diagnosed as consecutive outpatients presenting with macrocytic or iron deficiency anemia, or longstanding dyspepsia underwent gastroscopy with antral and body biopsies, assay of intrinsic factor, parietal cells and Helicobacter pylori （ H pylon） antibodies. Gastritis was assessed according to Sydney System. RESULTS： Parietal cell antibodies were equally distributed in all clinical presentations, whereas the positivity of intrinsic factor antibodies （49/140, 35%） was significantly higher in pernicious anemia patients （49.2%） than in iron deficiency （21.1%） and dyspeptic patients （27.8%）. No specific pattern of autoantibodies was related to the clinical presentations of atrophic body gastritis. A positive correlation was obtained between the body atrophy score and the intrinsic factor antibody levels （r=0.2216, P=0.0085）. Associated autoimmune diseases were present in 25/140 （17.9%） patients, but the prevalence of autoimmune diseases was comparable, irrespective of the clinical presentations. CONCLUSION： The so-called hallmarks of gastric autoimmunity, particularly in intrinsic factor antibody cannot be usefully employed in defining an autoimmune pattern in the clinical presentations of ABG.

A CLINICOPATHOLOGICAL ANALYSIS OF 22 CASES OF MULTIPLE MALIGNANT TUMORS

To get a better understanding of the location,pathophysiology,etiology and prognosis of multiple malignant tumors (MPMT),we evaluated the medical records of 22 patients with MPMT.Our results suggested that radiotherapy and chemotherapy might play an important role in the pathogenesis of MPMT and follow up is important in detecting a secondary primary malignant tumor (PMT) at an early stage.Surgical removal of tumors is the first choice therapy for MPMT.

Clostridium difficile-associated diarrhea after living donor liver transplantation

AIM： To assess the incidence and analyze the risk factors for Clostridium difficile-associated diarrhea （CDAD）after living donor liver transplantation （LDLT） in adult.METHODS： The micobiological data and medical records of 242 adult recipients that underwent LDLT at the Tokyo University Hospital were analyzed retrospectively. The independent risk factors for postoperative CDAD were identified.RESULTS： Postoperative CDAD occurred in 11 （5%）patients. Median onset of CDAD was postoperative d 19（range, 5-54）. In the multivariate analyses, male gender （odds ratio, 4.56） and serum creatinine （≥ 1.5 mg/dL,odds ratio, 16.0） independently predicted postoperative CDAD.CONCLUSION： CDAD should be considered in the differential diagnosis of patients with postoperative diarrhea after LDLT.

Focus on acute diarrhoeal disease

Diarrhoea is an alteration of normal bowel movement characterized by an increase in the water content, volume, or frequency of stools. Diarrhoea needs to be classified according to the trends over time （acute or chronic） and to the characteristics of the stools （watery, fatty, inflammatory）. Secretory diarrhoeas, mostly acute and of viral aetiology in more than 70% of cases, are by far the most important subtype of diarrhoeas in terms of frequency, incidence and mortality （over 2.5 million deaths/year in developing countries）. Natural and synthetic opiates such as morphine, codeine, and Ioperamide which react with endogenous opiates （enkephalins, beta-endorphins, dynorphins） mainly act on intestinal motility and slow down transit. An antidiarrhoeal drug developed in recent years, racecadotril, acts as an enkephalinase inhibitor. Clinical studies have shown that it is just as effective as ioperamide in resolving acute diarrhoea but with greater reduction in pain and abdominal distension. Some studies have explored the prevalence of diarrhoea in old age. An epidemiological study carried out in Italy by 133 General Practitioners on 5515 elderly outpatients reported a prevalence of diarrhoea, defined according to the Rome criteria, of 9.1%. Infectious diseases （19%） and drug use （16%） were the most common causes of diarrhoea in old age. Regardless of the cause, the treatment of elderly patients with diarrhoea must include rehydration and nutritional support. Every year, more than 50 million tourists travel from industrialized countries to places where hygiene levels are pool. At least 75% of those travelling for short periods mention health problems, and in particular traveller＇s diarrhoea.

Silencing of UBP43 by shRNA Enhances the Antiviral Activity of Interferon against Hepatitis B Virus

Previous studies have shown that expression of the interferon-sensitive gene （ISG）15 protease UBP43 is increased in the liver biopsy specimens of patients who do not respond to interferon （IFN）-α therapy. We hypothesized that UBP43 might hinder the ability of IFN to inhibit HBV replication. In this study, we investigated whether vector-based siRNA promoted by HI （psiUBP43） could enhance IFN inhibiting HBV replication in cell culture. UBP43 was specifically silenced using shRNA. In HepG2.2.15 cells, the HBeAg and HBV DNA levels were significantly reduced by IFN after transfection of shRNA, imphicated that vector-based siRNA promoted by H1 （psiUBP43） could enhance IFN inhibiting HBV replication in cell culture. These data suggest that UBP43 modulates the anti-HBV type I IFN response, and is a possible therapeutic target for the treatment of HBV infection.

Compression anastomosis clip for gastrointestinal anastomosis

AIM: To investigate the feasibility of compression anastomosis clip (CAC) for gastrointestinal anastomosis proximal to the ileocecal junction. METHODS: Sixty-six patients undergoing gastrointe-stinal anastomosis proximal to the ileocecal junction were randomized into two groups according to the anastomotic method, CAC or stapler. RESULTS: The postoperative recovery of patients in CAC and stapled anastomosis groups was similar. No postoperative complication related to the anastomotic method was found in either group. Both upper gastrointestinal contrast radiography at the early postoperative course and endoscopic examination after a 6-mo follow-up showed a better healing at the compression anastomosis. CONCLUSION: CAC can be used not only in colonic surgery but also in gastrointestinal anastomosis. Our result strongly suggests that CAC anastomosis is safe in various complication circumstances. However, it should be further conf irmed with a larger patient sample.

Treatment of young patients with lupus nephritis using calcineurin inhibitors

Recent advances in the management of lupus nephritis, together with earlier renal biopsy and selective use of aggressive immunosuppressive therapy, have contribut-ed to a favorable outcome in children and adolescents with systemic lupus erythematosus （SLE）. Neverthe-less, we believe that a more effective and less toxic treatment is needed to attain an optimal control of the activity of lupus nephritis. Recent published papers and our experiences regarding treatment of young patients with lupus nephritis using calcineurin inhibitors are re-viewed. Although it has been reported that intermittent monthly pulses of intravenous cyclophosphamide （IVCY） are effective for preserving renal function in adult pa-tients, CPA is a potent immunosuppressive agent thatinduces severe toxicity, including myelo- and gonadal toxicity, and increases the risk of secondary malig-nancy. Thus, treatment for controlling lupus nephritis activity, especially in children and adolescents, remains challenging. Cyclosporine A （CsA） and tacrolimus （Tac） are T-cell-specific calcineurin inhibitors that prevent the activation of helper T cells, thereby inhibiting thetranscription of the early activation genes of interleu-kin （IL）-2 and suppressing T cell-induced activation of tumor necrosis factor-α, IL-1β and IL-6. Therefore, both drugs, which we believe may be less cytotoxic, are attractive therapeutic options for young patients with lupus nephritis. Recently, a multidrug regimen of prednisolone （PDN）, Tac, and mycophenolate mofetile （MMF） has been found effective and relatively safe in adult lupus nephritis. Since the mechanisms of action of MMF and Tac are probably complementary, multidrug therapy for lupus nephritis may be useful. We propose as an alternative to IVCY, a multidrug therapy with mizoribine, which acts very similarly to MMF, and Tac, which has a different mode of action, combined with PDN for pediatric-onset lupus nephritis. We also believe that a multidrug therapy including CsA and Tac may bean attractive option for young patients with SLE and lupus nephritis

Treatment of dyslipidemia in chronic kidney disease: Effectiveness and safety of statins

Several cardiovascular(CV)risk factors may explain the high rate of CV death among patients with chronic kidney disease(CKD).Among them both traditional and uremia-related risk factors are implicated and,moreover,the presence of kidney disease represents"per se"a multiplier of CV risk.Plasma lipid and lipoprotein profiles are changed in quantitative,but above all in qualitative,structural,and functional ways,and lipoprotein metabolism is influenced by the progressive loss of renal function.Statin therapy significantly reduces cholesterol synthesis and both CV morbidity and mortality either directly,by reducing the lipid profile,or via pleiotropic effects;it is supposed to be able to reduce both the progression of CKD and also proteinuria.These observations derive from a post-hoc analysis of large trials conducted in the general population,but not in CKD patients.However,the recently published SHARP trial,including over 9200 patients,either on dialysis or pre-dialysis,showed that simvastatin plus ezetimibe,compared with placebo,was associated with a significant low-density lipoprotein cholesterol reduction and a 17%reduction in major atherosclerotic events.However,no benefit was observed in overall survival nor in preserving renal function in patients treated.These re-cent data reinforce the conviction among nephrologists to consider their patients at high CV risk and that lipid lowering drugs such as statins may represent an important tool in reducing atheromatous coronary disease which,however,represents only a third of CV deaths in patients with CKD.Therefore,statins have no protective effect among the remaining two-thirds of patients who suffer from sudden cardiac death due to arrhythmia or heart failure,prevalent among CKD patients.The safety of statins is demonstrated in CKD by several trials and recently confirmed by the largest SHARP trial,in terms of no increase in cancer incidence,muscle pain,creatine kinase levels,severe rhabdomyolysis,hepatitis,gallstones and pancreatitis;thus confirming the handiness of statins in CKD patients.Here we will review the latest data available concerning the effectiveness and safety of statin therapy in CKD patients.

Role of different imaging modalities of vascular calcification in predicting outcomes in chronic kidney disease

Vascular calcification(VC) is common among patientswith chronic kidney disease(CKD).The severity of VC is associated with increased risk of cardiovascular events and mortality.Risk factors for VC include traditional cardiovascular risk factors as well as CKD-related risk factors such as increased calcium and phosphate load.VC is observed in arteries of all sizes from small arterioles to aorta,both in the intima and the media of arterial wall.Several imaging techniques have been utilized in the evaluation of the extent and the severity of VC.Plain radiographs are simple and readily available but with the limitation of decreased sensitivity and subjective and semi-quantitative quantification methods.Mammography,especially useful among women,offers a unique way to study breast arterial calcification,which is largely a medial-type calcification.Ultrasonography is suitable for calcification in superficial arteries.Analyses of wall thickness and lumen size are also possible.Computed tomography(CT) scan,the gold standard,is the most sensitive technique for evaluation of VC.CT scan of coronary artery calcification is not only useful for cardiovascular risk stratification but also offers an accurate and an objective analysis of the severity and progression.