S-Zorb装置金属密封球阀内件硬化方法及材料选择

主要介绍应用于S-Zorb催化汽油吸附脱硫装置中金属密封耐磨球阀内件硬化所采用的超音速喷涂和渗硼加工等工艺方法,以及各种方法的硬化层硬度、结合强度和热膨胀系数、硬化层厚度或深度等性能参数。

不同方法腹腔穿刺放腹水102例临床观察

目的:对比研究传统腹腔穿刺术放腹水与两种改良的腹腔穿刺术放腹水的安全性、有效性和实用性。方法:将102例肝硬化并腹水患者按其入院顺序分为常规腹腔穿刺术放腹水组、常规腹腔穿刺术加一次性抗返流引流袋放腹水组、深静脉留置针腹腔穿刺术加一次性抗返流引流袋放腹水组。记录其穿刺前后及穿刺过程中患者不适症状、穿刺术后腹水感染率、拔针后穿刺点渗漏、延迟愈合等资料。结果:传统腹腔穿刺放腹水方法的腹腔感染率、伤口延迟愈合率与传统穿刺加抗返流袋方法组比较差异无统计学意义;传统放腹水方法和传统腹腔穿刺加抗返流袋方法与留置针方法腹腔感染及延迟愈合率相比,差异有统计学差异;留置针方法组感染率及伤口延迟愈合率均较另两组高。穿刺术前术中术后患者血压及心率波动情况,传统组术后心率及血压较术前差异有统计学意义,术后血压增高,心率加快;而两组术前与术后心率血压相比差异没有统计学意义。结论:采用传统穿刺方法及抗返流袋的穿刺放腹水法安全、有效、省力,患者术中术后不良反应小,有推广应用的价值。

TST联合聚桂醇硬化治疗Ⅲ、IV度内痔及混合痔40例

目的:探讨选择性痔上黏膜切除术(TST)联合聚桂醇硬化治疗Ⅲ、IV度内痔及混合痔的临床疗效及并发症。方法:选择Ⅲ、IV度内痔和混合痔患者80例,随机分为治疗组和对照组,每组40例;治疗组采用TST+直肠黏膜下注射聚桂醇硬化治疗,对照组行传统的外剥内扎术治疗。观察两组患者手术效果及术后并发症等情况。结果:治疗组患者疗效明显优于对照组,随访1~2年治疗组无1例复发,对照组5例(12.5%)复发,治疗组患者在术后伤口疼痛、出血、尿潴留、伤口水肿及住院天数等方面优于对照组,两组比较差异有统计学意义(P<0.05)。结论:TST联合聚桂醇硬化治疗Ⅲ、IV度内痔及混合痔临床疗效良好,并发症少,复发率低,缩短平均住院日,值得临床应用。

超声引导下单纯性肾囊肿经皮穿刺硬化术55例分析

目的：评价超声引导下单纯性肾囊肿盎皮穿刺硬化术的临床价值。方法：超声引导下对临床诊断为单纯性肾囊肿的患者进行经皮穿刺硬化术的治疗。结果：55例肾囊肿均获得穿刺成功，术后随访1个月～2a，治愈率92％。结论：应用超声引导经皮穿刺硬化术治疗单纯性肾囊肿，方法简便、费用低、痛苦小、疗效确切，是治疗单纯性肾囊肿的首选方法。

食管胃底静脉曲张破裂大出血的内镜下硬化治疗

目的食管胃底静脉曲张破裂大出血内镜下硬化剂治疗的疗效.方法全组共82例,男50例,女32例,年龄18岁～74岁,均为住院患者,经内镜检查确诊为食管静脉重度曲张78例,中度曲张4例,肝功能按Child分级,A级20例,B级46例,C级16例.其中80例为上消化道出血急诊入院,2例为主动申请预防性硬化治疗.按住院先后随机分组,硬化剂选用5%鱼肝油酸钠,1%乙氧硬化醇,82例患者304次内镜下硬化治疗.内镜下单纯静脉内多点、大剂量、快速的注射方法和内镜先端部压迫靶静脉,序贯三点静脉穿刺技巧,与传统的内镜下硬化治疗操作方法进行比较,并经3a随访.结果止血76例(止血率95%),食管静脉曲张消失68例(食管静脉曲张消失率82.9%),54例随访3a,存活率88.9%,与传统方法比较,止血P值>0.5,食管静脉消失P值<0.01,治疗次数3.36次,P值<0.001,平均住院天数56d,P值<0.001.结论内镜下硬化治疗的新方法优于传统的内镜下硬化治疗.

内镜下硬化剂治疗食管静脉曲张出血的临床观察

目的:对比分析内镜下硬化剂治疗方法和介入治疗方法用于食管静脉曲张出血的临床效果,以及2者的优点及区别。方法:对120例经临床明确要进行食管静脉曲张出血的患者随机分为2组,每组分别为60例。对于2组患者分别进行内镜下硬化剂治疗方法治疗和气管插管介入治疗方法,观察其治疗效果。通过两独立样本T检验的方法比较内镜下硬化剂治疗方法和介入治疗方法两种不同治疗方法的病人治疗效果情况。结果:在120例进行食管静脉曲张出血的患者中,内镜下硬化剂治疗方法组60人,感觉效果好者占89.00%,效果差者2.00%,效果一般者9.00%。介入治疗方法组60人,感觉效果好者占76.00%,效果差者3.00%,效果一般者21.00%。经两独立样本T检验,2组之间的治疗效果异有统计学意义(P值为0.038)。结论:在对接受食管静脉曲张出血的患者来说,无论是采用介入治疗方法的方式,其两者的治疗效果均非常可靠,但是,采用内镜下硬化剂治疗方法的治疗方式较介入治疗方法的治疗效果会更好些。因此,在临床实践中,应结合患者的实际病情,采取不同的治疗方式,以达到最好的手术治疗效果,减轻患者的手术痛苦。

间歇性循环荷载下路基细粒土填料永久变形特性及预测模型

实际列车运营条件下相邻列车间存在一定的时间间隔,因此,列车对路基的长期作用由列车通过时的振动加载和无列车通过时的荷载间歇组成,即间歇性循环荷载。为探究路基在列车间歇性动荷载作用下的变形特性,开展了连续加载与间歇加载(单级、多级加载)的动三轴试验,研究了间歇加载下累积塑性应变的发展规律,并提出了相应的累积塑性应变预测模型。研究结果表明,间歇加载提高了试样抵抗荷载的能力、降低了累积塑性变形的发展;间歇加载下试样的累积塑性应变曲线呈"阶段式"增长,不同于连续加载下累积塑性应变曲线"平顺型"发展的特点;基于时间硬化方法对双曲线模型进行改进,并对间歇加载(单级、多级加载)下稳定型和临界型试样的累积塑性应变进行预测,取得了良好的预测效果。研究结果对于深入分析实际列车荷载作用下路基土体的变形特性和沉降预测具有一定的指导意义。

Clinicopathologic characteristics of intrahepatic cholangiocarcinoma in patients with positive serum a-fetoprotein

AIM:To explore clinicopathologic characteristics of intrahepatic cholangiocarcinoma (ICC) in patients with positive serum a-fetoprotein (AFP). METHODS:One hundred and thirty one patients who underwent surgical dissection for pathologically confirmed ICC were divided into a positive AFP (> 20 ng/mL) group (n = 32) and a negative AFP group (n = 99), whose clinicopathologic features were analyzed and compared. RESULTS:The positive rate of HBsAg and liver cirrhosis of the positive AFP group was higher than that of the negative AFP group, while the positive rate of CA19-9 (> 37 U/mL) and the lymph node metastasis rate was lower. CONCLUSION:ICC patients with positive AFP share many clinicopathologic similarities with hepatocellular carcinoma.

Leptin levels in the differential diagnosis between benign and malignant ascites

AIM： To evaluate the role of leptin levels in the differentia diagnosis of ascites. METHODS： Ascitic leptin, TNFα and serum leptin levels were measured in 77 patients with ascites （35 with malignancies, 30 cirrhosis and 12 tuberculosis）. Control serum samples were obtained from 20 healthy subjects. Leptin and TNFα levels were measured by EUSA. Body mass index （BMI） and percentage of body fat （BFM） by skin fold measurement were calculated for all patients and control groups. Peritoneal biopsy, ascites cytology and cultures or biochemical values were used for the diagnosis of patients. RESULTS： In patients with malignancies, the mean serum and ascites leptin levels and their ratios were significantly decreased compared to the other patient groups and controls. In tuberculosis peritonitis, ascitic fluid TNFα levels were significantly higher than malignant ascites and cirrhotic sterile ascites. BMI and BFM values did not distinguish between patients and controls. CONCLUSION： In patients with malignant ascites, levels of leptin and TNFα were significantly lower than in patients with tuberculous ascites.

Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension

AIM: To study the small bowel (SB) mucosa on biopsy in cirrhotic patients with portal hypertension and in non-cirrhotic controls and grade fi ndings according to the Marsh criteria. METHODS: We prospectively enrolled 51 consecutive patients undergoing an upper endoscopy for their routine medical care. Twenty f ive patients with cirrhosis and portal hypertension were compared to 26 controls. We obtained coeliac serology and multiple upper small bowel biopsies on all 51 patients. A GI pathologist interpreted biopsies and graded fi ndings according to the Marsh criteria. We assessed equivalence in Marsh grade between cirrhotic and non-cirrhotic controls using the Mann-Whitney test for equivalence. RESULTS: Gender, ethnicity and age were similar between both groups. Marsh grades were equivalent between the groups. Grade of 0 was present in 96% and grade of 1 was present in 4% of both groups and there was no villus atrophy or decrease in villus/crypt ratio in patients with portal hypertension. CONCLUSION: This study provides evidence for the lack of villus atrophy in patients with cirrhosis and portal hypertension, and supports the continuous reliance on the Marsh criteria when the diagnosis of coeliac disease is to be made in the presence of cirrhosis.

Transient elastography for the assessment of chronic liver disease: Ready for the clinic?

Transient elastography is a recently developed non- invasive technique for the assessment of hepatic fi brosis. The technique has been subject to rigorous evaluation in a number of studies in patients with chronic liver disease of varying aetiology. Transient elastography has been compared with histological assessment of percutaneous liver biopsy, with high sensitivity and specificity for the diagnosis of cirrhosis, and has also been used to assess pre-cirrhotic disease. However, the cut-off values between different histological stages vary substantially in different studies, patient groups and aetiology of liver disease. More recent studies have examined the possible place of transient elastography in clinical practice, including risk stratifi cation for the development of complications of cirrhosis. This review describes the technique of transient elastography and discusses the interpretation of recent studies, emphasizing its applicability in the clinical setting.

Immunohistochemical expression of intrarenal renin angiotensin system components in response to tempol in rats fed a high salt diet

AIM To determine the effect of tempol in normal rats fed high salt on arterial pressure and the balance between antagonist components of the renal renin-angiotensin system.METHODS Sprague-Dawley rats were fed with 8% NaCl high-salt （HS） or 0.4% NaCl （normal-salt, NS） diet for 3 wk, with or without tempol （T） （1 mmol/L, administered in drinking water）. Mean arterial pressure （MAP）, glomerular fltration rate （GFR）, and urinary sodium excretion （UVNa） were measured. We evaluated angiotensin Ⅱ （Ang Ⅱ）, angiotensin 1-7 （Ang 1-7）, angiotensin converting enzyme 2 （ACE2）, mas receptor （MasR）, angiotensin type 1 receptor （AT1R） and angiotensin type 2 receptor （AT2R） in renal tissues by immunohistochemistry.RESULTSThe intake of high sodium produced a slight but signifcant increase in MAP and differentially regulated components of the renal renin-angiotensin system （RAS）. This included an increase in Ang Ⅱ and AT1R, and decrease in ACE-2 staining intensity using immunohistochemistry. Antioxidant supplementation with tempol increased natriuresis and GFR, prevented changes in blood pressure and reversed the imbalance of renal RAS components. This includes a decrease in Ang Ⅱ and AT1R, as increase in AT2, ACE2, Ang （1-7） and MasR staining intensity using immunohistochemistry. In addition, the natriuretic effects of tempol were observed in NS-T group, which showed an increased staining intensity of AT2, ACE2, Ang （1-7） and MasR.CONCLUSION These findings suggest that a high salt diet leads to changes in the homeostasis and balance between opposing components of the renal RAS in hypertension to favour an increase in Ang Ⅱ. Chronic antioxidant supplementation can modulate the balance between the natriuretic and antinatriuretic components of the renal RAS.

Differences in viral kinetics between genotypes 1 and 3 of hepatitis C virus and between cirrhotic and non-cirrhotic patients during antiviral therapy

AIM： TO evaluate the impact of hepatitis C virus （HCV） infection with genotype 1 or 3 and the presence or absence of liver cirrhosis （LC） in the early viral kinetics response to treatment. METHODS： Naive patients （n = 46） treated with interferon-α （IFN-α） and ribavirin and followed up with frequent early HCV-RNA determinations were analysed. Patients were infected with genotype 1 （n = 28, 7 with LC） or 3 （n = 18, 5 with LC）. RESULTS： The first phase decline was larger in genotype 3 patients than in genotype 1 patients （1.72 vs 0.95 log IU/mL, P 〈 0.001）. The second phase slope decline was also larger in genotype 3 patients than in genotype 1 patients （0.87 vs 0.15 log/wk, P 〈 0.001）. Differences were found in both cirrhotic and non-cirrhotic patients. Genotype 1 cirrhotic patients had a slower 2^nd phase slope than non-cirrhotic patients （0.06 vs 0.18 log/wk, P 〈 0,02）. None of genotype 1 cirrhotic patients had a 1^st phase decline larger than 1 log （non-cirrhotic patients： 55%, P 〈 0.02）. A similar trend toward a slower 2nd phase slope was observed in genotype 3 cirrhotic patients but the 1^st phase slope decline was not different. Sustained viral response was higher in genotype 3 patients than in genotype 1 patients ,（72% vs 14%, P 〈 0.001） and in genotype 1 non-cirrhotic patients than in genotype 1 cirrhotic patients （19% vs 0%）. A second phase decline slower than 0.3 log per week was predictive of non-response in all groups. CONCLUSION： Genotype 3 has faster early viral decline than genotype 1. Cirrhosis correlates with a slower 2nd phase decline and possibly with a lower 1^st phase slope decline in genotype 1 patients.

Hepatic encephalopathy in patients with liver cirrhosis:Is there a role of malnutrition?

Hepatic encephalopathy(HE) is a common complica-tion in patients with liver cirrhosis but its pathogenesis remains incompletely understood.Malnutrition is com-monly encountered in patients with liver cirrhosis and it has been reported to affect the quality of life of this group of patients.Experimental studies suggest that low energy intake and poor nutritional status may facil-itate the development of HE but there are scarce data on the potential role of malnutrition in HE in patients with liver cirrhosis.Two recently published studies have evaluated the potential role of malnutrition in the development of HE in cirrhotic patients with conflicting results.In this letter to the editor we briefly present the results of the two studies as well as potential rea-sons for the conflicting results reported.

Collapsing focal segmental glomerulosclerosis: Current concepts

Collapsing focal segmental glomerulosclerosis （cFSGS）, also known as collapsing glomerulopathy is currently classified under the rubric of FSGS. However, its de-fining morphological features are in stark contrast to those observed in most other variants of FSGS. During the early stage of the disease, the lesion is character-ized pathologically by an implosive segmental and/or global collapse of the glomerular capillary tufts, marked hypertrophy and hyperplasia of podocytes, and severe tubulointerstitial disease. With advancement of the disease, segmental and/or global glomerulosclerosis is also observed in association with the collapsing le-sions. The etiology of this enigmatic disorder is still elusive, but a growing list of diseases/conditions is being reported in association with this morphological pattern of renal parenchymal injury. The pathogenesis of cFSGS involves discreet epithelial cell injury leadingto cell cycle dysregulation and a proliferative cellularphenotype. From the clinical perspective, cFSGS is no-torious for its propensity to affect black people, a highincidence and severity of nephrotic syndrome, markedresistance to empirical therapy, and rapid progressionto end-stage renal disease. The lesion has also beenreported in transplanted kidneys either as recurrent orde novo disease, frequently leading to graft loss. Mostcases have been reported in western countries, but the lesion is also being increasingly recognized in the tropi-cal regions. The recent increase in reporting of cFSGS partly refects a true increase in the incidence and part-ly a detection bias. There is no specifc treatment for the disorder at present. Newer insights into the patho-genesis may lead to the development of targeted and specifc therapy in near future. There is an urgent need to increase awareness of the lesion among pathologists and nephrologists, especially those from developing countries, to ensure accurate diagnosis and appropriate managment. With the accumulation of more and more data, it is hoped that the prevailing confusion about the nosological identity of the lesion will also be resolved in a more logical way.

Antiviral therapy in hepatitis C virus cirrhotic patients in compensated and decompensated condition

The main goals of treating cirrhotic patients with antiviral therapy are to attain sustained viral clearance(SVR),halt disease progression,and prevent re-infection of the liver graft.However,while the medical need is great,the use of interferon and ribavirin might expose these patients to severe treated-related side effects as a large proportion of them have pre-existing hematological cytopenias.We have reviewed potential benefits and risks associated with antiviral drugs in patients with liver cirrhosis,due to hepatitis C virus(HCV) infection.In cases presenting with bridging fibrosis or cirrhosis,current regimens of antiviral therapy have attained a 44%-48% rate of SVR.In cirrhotic patients with portal hypertension,the SVR rate was 22% overall,12.5% in patients with genotype 1,and 66.7% in those with genotypes 2 and 3 following therapy with low doses of either Peg-IFN alpha-2b and of ribavirin.In patients with decompensated cirrhosis,full dosages of Peg-IFN alpha-2b and of ribavirin produced a SVR rate of 35% overall,16% in patients with genotype 1 and 4,and 59% in those with genotype 2 and 3.Use of hematological cytokines will either ensure full course of treatment to be accomplished with and prevent development of treatment-associated side effects.Major benefits after HCV eradication were partial recovery of liver metabolic activity,prevention of hepatitis C recurrence after transplantation,and removal of some patients from the waiting list for liver transplant.Several observations highlighted that therapy is inadvisable for individuals with poor hepatic reserve(Child-Pugh-Turcotte score ≥ 10).Although SVR rates are low indecompensated cirrhotics due to hepatitis C,these patients have the most to gain as successful antiviral therapy is potentially lifesaving.

Clinical features and management of primary biliary cirrhosis

Primary biliary cirrhosis(PBC),which is characterised by progressive destruction of intrahepatic bile ducts,is not a rare disease since both prevalence and incidence are increasing during the last years mainly due to the improvement of case finding strategies.The prognosis of the disease has improved due to both the recognition of earlier and indolent cases,and to the wide use of ursodeoxycholic acid(UDCA).New indicators of prog-nosis are available that will be useful especially for the growing number of patients with less severe disease.Most patients are asymptomatic at presentation.Pruri-tus may represent the most distressing symptom and,when UDCA is ineffective,cholestyramine represents the mainstay of treatment.Complications of long-standing cholestasis may be clinically relevant only in very ad-vanced stages.Available data on the effects of UDCA on clinically relevant end points clearly indicate that the drug is able to slow but not to halt the progression of the disease while,in advanced stages,the only thera-peutic option remains liver transplantation.

Liver cirrhosis induced by long-term administration of a daily low dose of amiodarone: A case report

The anti-arrhythmic agent amiodarone （AD） is associated with numerous adverse effects, but serious liver disease is rare. The improved safety of administration of daily low doses of AD has already been established and this regimen is used for long-term medication. Nevertheless, asymptomatic continuous liver injury by AD may increase the risk of step-wise progression of non-alcoholic fatty liver disease. We present an autopsy case of AD-induced liver cirrhosis in a patient who had been treated with a low dose of AD （200 rag/d） daily for 84 too. The patient was a 85-year-old male with a history of ischemic heart disease. Seven years after initiation of treatment with AD, he was admitted with cardiac congestion. The total dose of AD was 528 g. Mild elevation of serum aminotransferase and hepatomegaly were present. Liver biopsy specimens revealed cirrhosis, and under electron microscopy numerous lysosomes with electron-dense, whorled, lamellar inclusions characteristic of a secondary phospholipidosis were observed. Initially, withdrawal of AD led to a slight improvement of serum aminotransferase levels, but unfortunately his general condition deteriorated and he died from complications of pneumonia and renal failure. Long-term administration of daily low doses of AD carries the risk of progression to irreversible liver injury. Therefore, periodic examination of liver function and/or liver biopsy is required for the management of patients receiving long-term treatment with AD.