肺结核合并大咯血的急诊外科治疗

目的探讨肺结核合并咯血的病因、诊断方法及外科治疗措施。方法总结1998年10月至2008年10月治疗的53例肺结核并发大咯血患者,分析其术前临床诊断及外科急诊手术的临床资料。结果本组53例患者中,1例半年后再度发生咯血治疗无效死亡,6例术后1年内发生少量咯血经支气管动脉栓塞治疗后好转,其余患者均恢复较好,未再发生咯血。结论肺结核患者合并咯血病因以合并曲菌感染、支气管扩张、损毁肺为主,患者术前影像资料分析及紧急纤维支气管镜检查为主要诊断方法,急诊外科行肺切除能减少出血和感染扩散的危险,疗效确切、可靠。精密的术前准备、准确的气管插管以保证健肺不受污染、迅速切除病肺是手术成功的关键。

扩血管与缩血管药物联用治疗大咯血疗效观察

目的:探讨联用扩血管与缩血管药物治疗大咯血的疗效。方法:82例大咯血病人随机分为观察组与对照组,观察组联用扩血管药物与缩血管药物治疗,对照组两药选一。结果:观察组显效率为78.0%,总有效率88.6%;对照组显效率为56.1%,总有效率75.6%;两组平均止血天数分别为(3.8±1.5)d和(5.5±1.8)d。两组有效率,平均止血天数比较有显著性差异(P<0.05)。结论:联用扩血管药物与缩血管药物治疗大咯血疗效更佳。

中西医结合治疗老年肺结核咯血的护理体会

目的:分析中西医结合治疗老年肺结核咯血的护理体会。方法:60例肺结核咯血患者,按照不同的护理方法分为实验组(应用辨证施护护理干预方法)与对照组(应用常规护理干预方法),各30例。比较两组患者的护理效果。结果:实验组患者护理满意率显著高于对照组,差异有统计学意义(P<0.05)。实验组不良反应发生率显著低于对照组(P<0.05)。结论:中西医结合治疗老年肺结核咯血的辨证施护护理价值比较高。

Hepatic steatosis and fibrosis: Non-invasive assessment

Chronic liver disease is a major cause of morbidity and mortality worldwide and usually develops over many years, as a result of chronic inflammation and scarring, resulting in end-stage liver disease and its complications. The progression of disease is characterised by ongoing inflammation and consequent fibrosis, although hepatic steatosis is increasingly being recognised as an important pathological feature of disease, rather than being simply an innocent bystander. However, the current gold standard method of quantifying and staging liver disease, histological analysis by liver biopsy, has several limitations and can have associated morbidity and even mortality. Therefore, there is a clear need for safe and noninvasive assessment modalities to determine hepatic steatosis, inflammation and fibrosis. This review covers key mechanisms and the importance of fibrosis and steatosis in the progression of liver disease. We address non-invasive imaging and blood biomarker assessments that can be used as an alternative to information gained on liver biopsy.

Predictors of esophageal varices and first variceal bleeding in liver cirrhosis patients

To assess “predictors” of esophageal varices (EV) and variceal bleeding using non-invasive markers in Albanian patients diagnosed with liver cirrhosis. METHODSOne hundred thirty-nine newly diagnosed cirrhotic patients without variceal bleeding were included in this analysis. Model for end-stage liver disease (MELD), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT), AST to platelet ratio index (APRI), platelet count to spleen diameter (PC/SD), fibrosis-4-index (FIB-4), fibrosis index (FI) and King’s Score were measured for all participants. All patients underwent endoscopic assessment within two days of hospitalization. The major end point was the first esophageal variceal bleeding (EVB) event. The diagnostic performance of “predictors” for the presence of EV and EVB were assessed by sensitivity and specificity values obtained from the receiver operating characteristics procedure. RESULTSFIB-4 was the only strong and significant “predictor” of esophageal varices (multivariable-adjusted OR = 1.57 for one unit increment; 95%CI: 1.15-2.14). Furthermore, a cut-off value of 3.23 for FIB-4 was a significant predictor of esophageal varices, with a sensitivity of 72%, a specificity of 58% and a proportion of area under the curve (AUC) of 66% (P = 0.01). During the follow-up (median: 31.5 mo; interquartile range: 11-59 mo), 34 patients (24%) experienced a first EVB. FIB-4 was a poor predictor of EVB (the AUC was only 51%) for a cut-off value of 5.02. Furthermore, the AUC of AST/ALT, APRI, PC/SD, FI, MELD and King’s Score ranged from 45% to 55%. None of the non-invasive markers turned out to be a useful predictor of EVB. CONCLUSIONDespite the low diagnostic accuracy, FIB-4 appears the most efficient non-invasive liver fibrosis marker which can be used as an initial screening tool for cirrhotic patients.

Study on Vaccination Efficacy against Avian Influenza in Rajshahi, Bangladesh

Vaccines are used in integrated control strategies to guard poultry against H5N1 high-pathogenicity avian influenza （AI）. This study was to evaluate the efficacy of AI vaccine against AI in poultry. About 400 serum samples were collected from the selected 130 farms located at Rajshahi region, Bangladesh. The study was carried out from January, 2013 to January, 2015. The AI vaccine titres were compared in different breed of layer, environmental temperature, feed and egg production. Result showed that the value of titres （mean ± SD） in Hyline brown, Hyline white, Bovans white and Novogen white were 6.71 ± 0.05, 6.67 ± 0.06, 6.79 ± 0.03 and 6.43 ± 0.04, respectively. The highest serum antibody titres were 6.61 ± 0.24 against AI antibody in 〉 26 ℃ environment temperature. The highest and lowest serum antibody value of AI against feed brand （nutrient） were 7.75 ± 0.08 and 5.58 ± 0.22 for Aftab and Quality brand feed, respectively.

Tegafur-uracil-induced rapid development of advanced hepatic fibrosis

Tegafur-uracil has been reported to have only minor adverse effects and is associated with liver injury in 1.79% of Japanese patients. The development of tegafur-uracil-induced hepatic fibrosis with portal hypertension is rare. Here, we report a case of a 74-year-old woman with rapidly developing tegafururacil-induced hepatic fibrosis. The patient had no history of liver disease and had been treated with tegafur-uracil for 8 mo after breast cancer surgery. The patient was admitted to our hospital for abdominal distension and leg edema associated with liver dysfunction. Computed tomography imaging revealed massive ascites and splenomegaly, and a non-invasive assessment of liver fibrosis indicated advanced fibrosis. The histopathological findings revealed periportal fibrosis and bridging fibrosis with septation. The massive ascites resolved after discontinuing tegafururacil. These findings suggest that advanced hepatic fibrosis can develop from a relatively short-term administration of tegafur-uracil and that non-invasive assessment is useful for predicting hepatic fibrosis.

Preoperative detection and localization of small bowel hemangioma: Two case reports

Among the various diagnostic modalities for small bowel hemangioma, video capsule endoscopy (VCE) and double-balloon enteroscopy (DBE) can be recommended as part of the work-up in patients with obscure gastrointestinal bleeding (OGIB). DBE is superior to VCE in the accuracy of diagnosis and therapeutic potential, while in most cases total enteroscopy cannot be achieved through only the antegrade or retrograde DBE procedures. As treatment for small bowel bleeding, especially spout bleeding, localization of the lesion for the decision of DBE insertion facilitates early treatment, such as endoscopic hemostatic clipping, allowing patients to avoid useless transfusion and the worsening of their disease into life-threatening status. Applying endoscopic India ink marking prior to laparoscopic surgical resection is a particularly useful technique for more minimally invasive treatment. We report two cases of small bowel hemangioma found in examinations for OGIB that were treated with combination of laparoscopic and endoscopic modalities.

SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY STUDY OF REGIONAL CEREBRAL BLOOD FLOW IN PATIENTS WITH HEMISPATIAL NEGLECT

Objective.To explore the correlations between the occurrence and severity of neglect and the region,range or extent of the decrease in regional cerebral blood flow(rCBF). Methods. Nineteen dextromanual patients who were diagnosed as unilateral stroke clinically and hemispatial neglect by a neglect test battery received single photon emission computed tomography(SPECT) scans. Results. On images,the damages of patients with neglect were seen most frequently in the frontal cortex,and then in turn in the parietal cortex,occipital cortex,temporal cortex,basal ganglia and thalamus. Most patients with neglect had two or more regions damaged. The most significant region was temporal-parietal-occipi-tal(TPO)junction. The correlation coefficient between rCBF and the severity of neglect was -0.34(t=-1.5,P>0.05),and that between the decrease percentage of rCBF and the severity of neglect was 0.34(t=1.47,P>0.05). The correlation coefficients between the range,number of foci,the flow deficit size and the severity of neglect were 0.71(t=4.13,P<0.01),0.70(t=4.07,P<0.01)and 0.64(t=3.40, P<0.01),respectively. Conclusions. The severity of neglect correlates with rCBF and the decrease percentage of rCBF insignificantly,but correlates positively with the range,number of foci and the flow deficit size significantly. Hemispatial neglect is caused by the damage of multiple sites and combined damage results in more severe neglect.

Constructed Model of Cost/Benefit Analysis Strategy for Stem Corn Borer Sesamia cretica

An integrated pest management model of Cost/Benefit analysis strategy was constructed for stem corn borer Sesamia cretica using complementary control measures of different resistant genotypes of corn with the chemical insecticide diazinon 60%. Based on Cost/Benefit analysis result, the resistant genotype （SAKHA 9433） provides maximum economic value of production at the model point where no spray of insecticide is applied. The applications of one or two sprays do not justify the use of chemical insecticide but rather result in economic loss since the reduction in borer damage value, due to diazinon use, is lower than the cost of control （spray）. However, the applications of one spray for the moderate resistant genotype （IPA 2052） and two sprays for the sensitive genotype （CML 323） during corn growing season would be of value to cover the cost of control （spray） but do not achieve similar economic value of revenue comparing with the resistant genotype.

Severe hepatic trauma: surgical strategies

To probe into effective surgical procedures and improve the outcome of treatment for patients with severe hepatic injury. Methods: A retrospective study involving 113 patients with seve re hepatic trauma (AAST grade IV and V) during the past 12 years was carried out . Ninety eight patients underwent surgical treatment. Surgical interventions in cluding hepatectomy or direct control of bleeding vessels by finger fracture tec hnique with Pringle maneuver, selective ligation of hepatic artery, retrohepatic caval repair with total hepatic vascular occlusion, and perihepatic packing wer e mainly used. Results: In the 98 patients treated operatively, the survival r ate was 69.4 % (68/98). Among 40 patients with juxtahepatic venous injury (JH VI), 15 were cured with the maximum blood transfusion of 12 000 ml. Eight ca ses of Grade IV injury treated nonoperatively were cured. The percentage of fail ure of nonoperative management was 42.9 % (6/14). The overall mortality rate was 32.7 % (37/113), and 57% of the deaths were due to exsanguination. Conclusions: Reasonable surgical procedures based on classifica tion of hepatic injuries can increase the survival rate of severe liver trauma. Accurate perihepatic packing is effective in dealing with JHVI.

The priming induction regimen of HAG as a low dose chemotherapy strategy in AML clonal evolution

Chemotherapy employs chemical substances to interfere with the growth of cancer cells,and is a major treatment strategy in human cancer including acute myeloid leukemia（AML）.Although they often effectively kill fast-dividing tumor cells,

Management of chronic hepatitis B during pregnancy

Chronic hepatitis B is globally prevalent and is a major cause of cirrhosis and hepatocellular carcinoma.Despite immunoprophylaxis against hepatitis B in pregnancy,perinatal transmission still occurs in at least 10%of the children born to a mother with high level of viremia.Decisions regarding hepatitis B therapy during pregnancy must take into account the benefits and safety for both the mother and the unborn baby.In this review,we summarize the current treatment options for chronic hepatitis B with a focus on management during pregnancy and the evidence-based strategies to prevent vertical transmission of hepatitis B virus(HBV).