羔羊“醉酒症”的病原研究及防治

近年来,山东省及周边省份多地羔羊出现整窝大面积不明病因的瘫痪症,行走摇摆似醉酒状,在临床上俗称“醉酒症”。为探究该病的病因,通过临床解剖、病料采集、病原的分离鉴定、动物回归试验,首次确定羔羊“醉酒症”的病原为A型产气荚膜梭菌,并制定了快速治疗和预防该病的综合防控方案,能够在24 h内快速控制并彻底杜绝羔羊“醉酒症”的发生。

酒中毒性幻觉妄想症78例分析

酒精中毒性精神障碍中的酒中毒性幻觉症病期可长达数周至6个月,而酒中毒性妄想症病程迁延,且无意识障碍,故此两症临床上易与精神分裂症混淆,国外有学者提出酒中毒性幻觉症可伴有被动体验,这与精神分裂症难以区别[1]。国内这方面的报道少见。

酒中毒幻觉妄想症在入院初期的戒断症状

目的 探讨酒中毒幻觉妄想症在入院初期的酒戒断反应。方法 以 46例符合 CCMD-2 -R酒中毒幻觉症或妄想症诊断条件者为对象 ,评定入院 2 4小时内、3天内、7天内的精神症状和躯体症状出现率 ,比较各阶段症状的差异性。结果 精神症状中行为紊乱、冲动性、意识清晰度、睡眠障碍在入院 2 4小时后较 2 4小时内出现有意义增多 (P<0 .0 5 )。躯体症状中也反映 T、P、R及心慌烦躁、恶心呕吐、出汗、指颤等伴随渴望饮酒而在入院 72小时内呈高峰期 (P<0 .0 5 )。结论 酒中毒幻觉妄想症在入院初期即使已投用抗精神病药物或苯二氮艹卓类药物后 ,也可呈现出或轻或重的戒断反应 。

女性酒中毒性幻觉妄想症1例报告

患者,女性,48岁,土族,住院号2573,离异。患者饮酒33年,近13年来每日饮酒1.5～2斤,曾因眠差、自语、疑夫外遇、行为紊乱先后于1993年、1995年两次住我院。每次住院查体都有双上肢明显震颤,平衡征阳性。精检:患者意识清,定向正常,有言语性幻听,生动幻视,对自身躯体结构的感知综合障碍,有被害、嫉妒妄想,情感淡漠,行为紊乱,自知力丧失。每次住院肝功能GPT均升高,后一次EEG轻度异常。每次住院后即戒酒,给予小剂量奋乃静,补充大量维生素。

内观认知与综合干预疗法治疗酒依赖症复饮患者的对比研究

目的:对内观认知和以反复线索暴露为基础的综合干预疗法治疗酒依赖症复饮患者的疗效进行对比研究。方法:以60例酒依赖症复饮患者为研究对象分为综合干预组与内观认知组。在进行常规治疗基础上,综合干预组患者32例,采取以反复线索暴露为基础的综合干预治疗;内观认知组患者28例,采用内观认知疗法进行治疗。比较两组患者的治疗效果。结果:治疗后,两组患者的强制性饮酒问卷评分均明显改善(P<0.01);内观认知组患者强制性饮酒问卷评分较综合干预组降低更为显著(P<0.05),且症状自评量表评分较综合干预组降低更为显著,其中总分、躯体化、强迫等项目评分降低更为显著(P<0.05)。治疗后,内观认知组患者个人和社会功能量表评分较综合干预组无明显差异(P>0.05)。结论:内观认知疗法与以反复线索暴露为基础的综合干预疗法可以有效提高酒依赖症复饮患者的疗效,且无明显差异。

穴位刺激治疗酒依赖症1168例临床报告

目的:探讨穴位刺激对酒依赖患者戒酒的作用。方法:随机调取2001年-2006年,均采取电针体穴、贴压耳穴方法戒酒的1168例患者临床资料进行分析。结果:治疗一次即成功戒断者达32.5%;治疗一疗程,成功戒断率为77.9%;两疗程治愈率78.5%,总有效率97%。结论:穴位刺激对酒精损害的人体器官有良好的调节作用;对醒酒和预防酗酒复发也有较好的效果。此法经济、速效、无毒副作用。

“酒厥症”概述

“酒厥症”概述宋一亭酒厥及与之相关的病症在临床并不少见。这类病症主要是由于一次饮酒过量或长期纵酒无节所致。自《黄帝内经》以来，几乎历代文献都有因饮酒而伤身致病的记载，从病名、病因、病机、临床表现，乃至诊断、治疗、预后等均有详尽的描述和记载。１．命名《...

酒中毒性妄想症与偏执型精神分裂症对照分析

酒中毒性妄想症与偏执型精神分裂症妄想症状相似，易误诊。为帮助鉴别诊断，作者随机抽取同期住我院的上述两种疾病各32例对照分析。发现前者有长期大量饮酒史、幻觉症状较常见，情感不协调较少见，有神经症状者较多见，部分有部分自知力，后者全部情感不协调和无自知力，前者有抗精神病药物用量明显少，缓解快等特点。因此，长期大量饮酒史、情感障碍和幻觉症状是二者的鉴别诊断依据，抗精神病药用量少，缓解快是补充依据。

饮酒对慢性肝炎肝纤维化指标及转归的影响

目的:探讨饮酒对慢性肝炎肝纤维化指标及治疗效果的影响。方法:选择有饮酒史慢性肝炎患者76例(观察组),研究分析其血清肝纤维化指标、门静脉直径及治疗效果与非饮酒患者(对照组)的差异。结果:具有饮酒史的慢性肝炎患者血清肝纤维化指标透明质酸(HA)和层连蛋白(LN)明显高于非饮酒患者(295.33±49.55,149.85±36.04,P<0.001;163.21±16.15,136.63±11.76,P<0.001),观察组患者门静脉平均直径大于对照组〔(1.32±0.16)cm,(1.22±0.24)cm,P<0.05〕,观察组治愈好转率明显低于对照组(P<0.05)。结论:饮酒的慢性肝炎患者肝脏纤维化进程快、肝脏储备能力较差,对治疗反应较差,病死率较高。

少讲“面子”力渡难关

当前,我国改革面临的困难,原因是多方面的。但是,我认为,传统观念的影响,讲面子,摆阔气,好攀比,穷讲究,打肿脸充胖子,也是一个方面的原因。近年来,一些人滋长了讲面子的风气,急功近利, '超前消费'。大兴计划外的楼堂馆所禁而不止。

Muscle hematoma:A critically important complication of alcoholic liver cirrhosis

An iliopsoas hematoma can occur either spontaneously or secondary to trauma or bleeding tendency due to hemophilia and anticoagulant therapy.Although liver cirrhosis is commonly associated with coagulopathy, iliopsoas hematoma is very rare.We herein,present a case of bilateral iliopsoas hematoma in a patient with alcoholic cirrhosis,and review the literature on muscle hematoma associated with cirrhosis.A 56-year-old man with alcoholic cirrhosis was admitted in a state of shock with anemia.The cause of anemia could not be detected,and the patient was treated conservatively. The site of bleeding was not detected with either gastroduodenal endoscopy or upper abdominal computed tomography,the latter of which did not include the iliopsoas muscle.He died on the 10th day of admission and bilateral iliopsoas hematomas were found on autopsy.An iron stain was positive in the iliopsoas muscle.Eight cases of muscle hematoma associated with cirrhosis,including the present case, were found in a review of the literature.Four of these cases involved the rectus abdominis muscle,3 involved the iliopsoas muscle and 1 involved combined muscles.Alcoholic cirrhosis accounted for 75%of the cases.One case(12.5%)was associated with virus- related cirrhosis,and another with combined virus- and alcohol-related cirrhosis.The mortality rate was 75%despite early diagnosis and low risk scores for cirrhosis.Muscle hematoma in patients with cirrhosis isclosely related to alcoholism,and the mortality rate of the condition is extremely high.In conclusion,muscle hematoma should be recognized as an important complication of cirrhosis.

Association between thrombotic risk factors and extent of fibrosis in patients with non-alcoholic fatty liver diseases

AIM: To evaluate the prevalence of genetic and acquired prothrombotic risk factors and their association with the extent of fibrosis and fatty infiltration in patients with non-alcoholic fatty liver disease (NAFLD).METHODS: Forty-four patients with chronic hepatitis (28 men and 16 women, with mean age of 45±11 and 49±12 years, respectively) constituted the patient population of this study. The groups were divided as follows: 15 patients with fatty liver (FL); 15 with non-alcoholic steatohepatitis (NASH); 14 with chronic viral hepatitis (CH) diagnosed by histology and liver technetium scan or ultrasound; and 10 healthy individuals. Thrombophilic, coagulation factors and genetic mutations were diagnosed by standard hemostatic and molecular coagulation assays.RESULTS: Activated protein C (APC) resistance and protein S were the most prevalent thrombotic risk factors (6% and 10% in NAFLD vs 21% and 14% in CH; P＜0.01 and P＜0.05, respectively). One thrombotic risk factor was identified in 41% of patients (23% mild fibrosis, 18% severe fibrosis) and two thrombotic risk factors in 6% of patients with NAFLD and severe fibrosis. While no differences in APC ratio, lupus anticoagulant, fibrinogen, factor V Leiden,prothrombin, and MTHFR mutation were found. Protein S levels were significantly lower in NASH patients than in patients with FL alone (92±19 vs106±2, P＜0.01). Protein C levels were markedly higher in patients with NAFLD and mild or severe fibrosis as compared to the patients with CH, respectively (128±40 vs96±14, P＜0.001 or 129±36 vs 88±13, P＜0.01).CONCLUSION: Up to 46% of patients with NAFLD may have thrombotic risk factors, and the presence of thrombotic risk factors is correlated with the extent of hepatic fibrosis,suggesting a crucial role of the coagulation system in the pathogenesis of hepatic fibrosis.

Pathogenesis and management issues for non-alcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) has, although it is a very common disorder, only relatively recently gained broader interest among physicians and scientists. Fatty liver has been documented in up to 10 to 15 percent of normal individuals and 70 to 80 percent of obese individuals. Although the pathophysiology of NAFLD is still subject to intensive research, several players and mechanisms have been suggested based on the substantial evidence. Excessive hepatocyte triglyceride accumulation resulting from insulin resistance is the first step in the proposed 'two hit' model of the pathogenesis of NAFLD. Oxidative stress resulting from mitochondrial fatty acids oxidation, NF-κB-dependent inflammatory cytokine expression and adipocytokines are all considered to be the potential factors causing second hits which lead to hepatocyte injury, inflammation and fibrosis. Although it was initially believed that NAFLD is a completely benign disorder, histologic follow-up studies have showed that fibrosis progression occurs in about a third of patients. A small number of patients with NAFLD eventually ends up with end-stage liver disease and even hepatocellular carcinoma. Although liver biopsy is currently the only way to confirm the NAFLD diagnosis and distinguish between fatty liver alone and NASH, no guidelines or firm recommendations can still be made as for when and in whom it is necessary. Increased physical activity, gradual weight reduction and in selected cases bariatric surgery remain the mainstay of NAFLD therapy. Studies with pharmacologic agents are showing promising results, but available data are still insufficient to make specific recommendations; their use therefore remains highly individual.

Role of cytokines and chemokines in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) includes a variety of histological conditions (ranging from liver steatosis and steatohepatitis, to fibrosis and hepatocarcinoma) that are characterized by an increased fat content within the liver. The accumulation/deposition of fat within the liver is essential for diagnosis of NAFLD and might be associated with alterations in the hepatic and systemic inflammatory state. Although it is still unclear if each histological entity represents a different disease or rather steps of the same disease, inflammatory processes in NAFLD might influence its pathophysiology and prognosis. In particular, non-alcoholic steatohepatitis (the most inflamed condition in NAFLDs, which more frequently evolves towards chronic and serious liver diseases) is characterized by a marked activation of inflammatory cells and the upregulation of several soluble inflammatory mediators. Among several mediators, cytokines and chemokines might play a pivotal active role in NAFLD and are considered as potential therapeutic targets. In this review, we will update evidence from both basic research and clinical studies on the potential role of cytokines and chemokines in the pathophysiology of NAFLD.

Inhibition of hepatic interleukin-18 production by rosiglitazone in a rat model of nonalcoholic fatty liver disease

AIM:To investigate the effects of rosiglitazone(RGZ) on expression of interleukin-18(IL-18) and caspase-1 in liver of non-alcoholic fatty liver disease(NAFLD) rats.METHODS:Twenty-eight Sprague-Dawley(SD) rats were randomly divided into control,NAFLD,and RGZ treated NAFLD groups.A NAFLD rat model of NAFLD was established by feeding the animals with a high-fat diet for 12 wk.The NAFLD animals were treated with RGZ or vehicle for the last 4 wk(week 9-12) and then sacrificed to obtain liver tissues.Histological changes were analyzed with HE,oil red O and Masson's trichrome staining.Expressions of IL-18 and caspase-1 were detected using immunohistochemical staining and semi-quantitative reverse-transcription polymerase chain reaction(RT-PCR) analysis.RESULTS:The expression levels of both IL-18 and caspase-1 were higher in the liver of NAFLD group than in the control group.Steatosis,inflammation and fibrosis,found in the liver of NAFLD rats,were significantly improved 4 wk after RGZ treatment.The elevated hepatic IL-18 and caspase-1 expressions in NAFLD group were also significantly attenuated after RGZ treatment.CONCLUSION:RGZ treatment can ameliorate increased hepatic IL-18 production and histological changes in liver of NAFLD rats.The beneficial effects of RGZ on NAFLD may be partly due to its inhibitory effect on hepatic IL-18 production.

Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients.

A substantial proportion of patients with irritable bowel syndrome(IBS) associate their symptoms with the ingestion of specific foods. Therefore, in recent years, scientific research has increasingly focused on the role of diet in IBS and dietary management is now considered an important tool in IBS treatment. This article reviews the main dietary approaches in IBS emphasizing evidence from experimental and observational studies and summarizing the main diet and lifestyle recommendations provided by dietary guidelines and scientific literature. Despite the limited evidence for a beneficial role, general advice on healthy eating and lifestyle is recommended as the first-line approach in the dietary management of IBS. Standard recommendations include adhering to a regular meal pattern, reducing intake of insoluble fibers, alcohol, caffeine, spicy foods, and fat, as well as performing regular physical activity and ensuring a good hydration. Second-line dietary approach should be considered where IBS symptoms persist and recommendations include following a low FODMAP diet, to be delivered only by a healthcare professional with expertise in dietary management. The efficacy of this diet is supported by a growing body of evidence. In contrast, the role of lactose or gluten dietary restriction in the treatment of IBS remains subject to ongoing research with a lack of high-quality evidence. Likewise, further clinical trials are needed to conclude the efficacy of probiotics on IBS symptoms.

Non-alcoholic fatty liver disease and the metabolic syndrome:An update

Sedentary lifestyle and poor dietary choices are leading to a weight gain epidemic in westernized countries, subsequently increasing the risk for developing the metabolic syndrome and nonalcoholic fatty liver disease (NAFLD). NAFLD is estimated to affect approximate 30% of the general US population and is considered the hepatic manifestation of the metabolic syndrome. Recent findings linking the components of the metabolic syndrome with NAFLD and the progression to nonalcoholic steatohepatitis (NASH) will be reviewed; in particular, the role of visceral adipose tissue, insulin resistance, and adipocytokines in the exacerbation of these conditions. While no therapy has been proven effective for treating NAFLD/NASH, common recommendations will be discussed.

Clinical features and natural history of cryptogenic cirrhosis compared to hepatitis C virus-related cirrhosis

To characterize natural history of cryptogenic cirrhosis (CC) and compare its clinical features and outcomes to those of hepatitis C virus (HCV)-related cirrhosis.METHODSA prospective cohort of 102 consecutive patients at their first diagnosis of CC were enrolled in this study. The clinical data and outcomes were compared to an age- and Child-Pugh class-matched cohort of 110 patients with HCV-related cirrhosis. Diagnosis of cirrhosis was based on compatible clinical and laboratory parameters, ultrasound/endoscopic parameters and, whenever possible, on histological grounds and transient elastography. All cases of cirrhosis without a definite etiology were enrolled in the CC group. The parameters assessed were: (1) severity of liver disease at the time of first diagnosis; (2) liver decompensation during follow-up; (3) hepatocellular carcinoma (HCC); (4) orthotopic liver transplantation; and (5) death. The independent associated factors were evaluated by multiple logistic regression analysis, and survival and its determinants by the Kaplan-Meier model, log-rank test and Cox regression.RESULTSAt the first observation, median age was 66 and 65 years and male gender was 36% and 58% for CC and HCV cirrhosis, respectively. CC showed Child-Pugh class A/B/C of 47%/31%/22%, respectively. Compared to HCV cirrhosis, CC exhibited a significantly higher prevalence of metabolic syndrome (12% vs 54%, respectively), overweight/obesity, high BMI, impaired glucose tolerance, high blood pressure, dyslipidemia, hyperuricemia, cardiovascular diseases, extrahepatic cancer, and gallstones. Over a median period of 42 mo of follow-up, liver decompensation, HCC development and death for CC and HCV-related cirrhosis were 60.8%, and 54.4%, 16.7% and 17.2%, 39.2% and 30%, respectively. The median survival was 60 mo for CC. Independent predictors of death were age and Child-Pugh class at diagnosis. CC showed an approximately twofold higher incidence of HCC in Child-Pugh class A.CONCLUSIONUndiagnosed nonalcoholic fatty liver disease has an etiologic role in CC that is associated with a poor prognosis, early HCC development, high risk of cardiovascular disease and extrahepatic cancer.

Liver biopsy in a district general hospital:Changes over two decades

AIM： To study liver biopsy practice over two decades in a district general hospital in the United Kingdom.METHODS： We identified all patients who had at least one liver biopsy between 1986 and 2006 from the databases of the radiology and gastroenterology departments. Subjects with incomplete clinical data were excluded from the study.RESULTS： A total of 103 liver biopsies were performed. Clinical data was available for 88 patients, with 95 biopsies. Between 1986 and 1996, 18 （95%） out of the 19 liver biopsies performed were blind and 6 （33%） were for primary biliary cirrhosis. Between 1996 and 2006, 14 （18%） out of 76 biopsies were blind; and the indications were abnormal liver tests （33%）, hepatitis C （12%） and targeted-biopsies （11%）. Liver biopsies were unhelpful in 5 （50） subjects. Pain was the most common complication of liver biopsy （5%）. No biopsy-related mortality was reported. There was a trend towards more technical failures and complications with the blind biopsy technique.CONCLUSION： Liver biopsies performed in small district hospitals are safe and useful for diagnostic and staging purposes. Abnormal liver tests, non-alcoholic fatty liver disease and targeted biopsies are increasingly common indications. Ultrasound-guided liver biopsies are now the preferred method and are associated with fewer complications.