AIM： To study the timing of laparoscopic cholecystectomy for patients with acute cholecystitis. METHODS： Between January 2002 and December 2005, all American Society of Anesthesiologists classification （ASA） Ⅰ ,...AIM： To study the timing of laparoscopic cholecystectomy for patients with acute cholecystitis. METHODS： Between January 2002 and December 2005, all American Society of Anesthesiologists classification （ASA） Ⅰ ,Ⅱ and Ⅲ patients with acute cholecystitis were treated laparoscopically during the urgent （index） admission. The patients were divided into three groups according to the timing of surgery： （1） within the first 3 d, （2） between 4 and 7 d and （3） beyond 7 d from the onset of symptoms. The impact of timing on the conversion rate, morbidity and postoperative hospital stay was studied. RESULTS： One hundred and twenty-nine patients underwent laparoscopic cholecystectomy for acute cholecystitis during the index admission. Thirty six were assigned to group 1, 58 to group 2, and 35 to group 3. The conversion rate and morbidity for the whole cohort of patients were 4.6% and 10.8%, respectively. There was no significant difference in the conversion rate, morbidity and postoperative hospital stay between the three groups.CONCLUSION： Laparoscopic cholecystectomy for acute cholecystitis during the index admission is safe, regardless of the time elapsed from the onset of symptoms. This policy can result in an overall shorter hospitalization.展开更多
AIM:To investigate histological and immunohistochemical differences in hepatitis between autoimmune hepatitis(AIH)and primary biliary cirrhosis(PBC)with AIH features.METHODS:Liver needle biopsies of 41 PBC with AIH fe...AIM:To investigate histological and immunohistochemical differences in hepatitis between autoimmune hepatitis(AIH)and primary biliary cirrhosis(PBC)with AIH features.METHODS:Liver needle biopsies of 41 PBC with AIH features and 43 AIH patients were examined.The activity of periportal and lobular inflammation was scored0(none or minimal activity)to 4(severe),and the degree of hepatitic rosette formation and emperipolesis was semiquantatively scored 0-3.The infiltration of mononuclear cells positive for CD20,CD38,CD3,CD4,and CD8 and positive for immunoglobulins(IgG,IgM,and IgA)at the periportal areas(interface hepatitis)and in the hepatic lobules(lobular hepatitis)were semiquantitatively scored in immunostained liver sections(score 0-6).Serum aspartate aminotransferase(AST),immunoglobulins,and autoantibodies at the time of liver biopsy were correlated with the histological and immunohistochemical scores of individual lesions.RESULTS:Lobular hepatitis,hepatitic rosette formation,and emperipolesis were more extensive and frequent in AIH than in PBC.CD3+,CD4+,and CD8+cell infiltration scores were higher in the hepatic lobules and at the interface in AIH but were also found in PBC.The degree of mononuclear cell infiltration correlated well with the degree of interface and lobular hepatitis in PBC,but to a lesser degree in AIH.CD20+cells were mainly found in the portal tracts and,occasionally,at the interface in both diseases.Elevated AST correlated well with the hepatocyte necroinflammation and mononuclear cell infiltration,specifically CD38+cells in PBC.No correlation existed between autoantibodies and inflammatory cell infiltration in PBC or AIH.While most AIH cases were IgG-predominant at the interface,PBC cases were divided into IgM-predominant,IgM/IgGequal,and IgG-predominant types,with the latter sharing several features with AIH.CONCLUSION:These results suggest that the hepatocellular injuries associated with interface and lobular hepatitis in AIH and PBC with interface hepatitis may not be identical.展开更多
This paper focuses on studying Lie symmetries and conserved quantities of discrete nonholonomic Hamiltonian systems. Firstly, the discrete generalized Hamiltonian canonical equations and discrete energy equation of no...This paper focuses on studying Lie symmetries and conserved quantities of discrete nonholonomic Hamiltonian systems. Firstly, the discrete generalized Hamiltonian canonical equations and discrete energy equation of nonholonomic Hamiltonian systems are derived from discrete Hamiltonian action. Secondly, the determining equations and structure equation of Lie symmetry of the system are obtained. Thirdly, the Lie theorems and the conservation quantities are given for the discrete nonholonomic Hamiltonian systems. Finally, an example is discussed to illustrate the application of the results.展开更多
目的:研究肝再生增强因子(augmenter of liver regeneration,ALR)在乙型肝炎病毒(hepatitis B virus,HBV)相关肝硬化患者中的表达及临床意义.方法:病例来源于我科门诊及住院的慢性乙型肝炎患者,包括性慢性乙型肝炎轻度组(n=196)、代偿...目的:研究肝再生增强因子(augmenter of liver regeneration,ALR)在乙型肝炎病毒(hepatitis B virus,HBV)相关肝硬化患者中的表达及临床意义.方法:病例来源于我科门诊及住院的慢性乙型肝炎患者,包括性慢性乙型肝炎轻度组(n=196)、代偿期肝硬化组(n=69)、失代偿期肝硬化组(n=148);失代偿肝硬化患者根据并发症进一步分为腹水组(n=51)、消化系出血组(n=32)、肝性脑病组(n=27)和慢性肝衰竭组(n=38),其中腹水组分为原发性腹膜炎组(n=9)与非原发性腹膜炎组(n=42).健康对照组(n=200)来源于输血科健康献血者.收集患者血清及临床资料;采用ELISA法检测各组患者血清ALR浓度;瞬时弹性扫描(FibroScan)检测代偿期肝硬化患者肝脏硬度.比较各组间ALR浓度差异,分析ALR浓度与肝硬化及其并发症的关系.结果:ALR浓度在代偿期肝硬化组和失代偿肝硬化组均明显高于健康对照组和慢性乙型肝炎轻度组(P<0.01).在代偿期肝硬化患者ALR浓度(1.54μg/L±0.53μg/L)与肝脏FibroScan值(16.96 kPa±5.6 kPa)负相关(r2=-0.218,F=15.736,P<0.01).失代偿肝硬化组中慢性肝衰竭患者ALR浓度明显高于代偿期肝硬化组(1.73μg/L±0.23μg/L vs 1.54μg/L±0.53μg/L,P=0.012),腹水组患者ALR浓度明显低于代偿期肝硬化组(1.32μg/L±0.64μg/L vs 1.54μg/L±0.53μg/L,P=0.027),原发性腹膜炎组与非原发性腹膜炎组间ALR浓度无显著性差异.ALR血清浓度与肝硬化患者腹水的发生相关,低ALR血清浓度是肝硬化患者发生腹水的危险因素(P=0.031,OR=0.841).结论:ALR在HBV相关肝硬化患者表达明显升高,其水平与肝脏硬度及腹水发生负相关,提示ALR在肝硬化患者增高可能是机体的一种保护机制.展开更多
文摘AIM： To study the timing of laparoscopic cholecystectomy for patients with acute cholecystitis. METHODS： Between January 2002 and December 2005, all American Society of Anesthesiologists classification （ASA） Ⅰ ,Ⅱ and Ⅲ patients with acute cholecystitis were treated laparoscopically during the urgent （index） admission. The patients were divided into three groups according to the timing of surgery： （1） within the first 3 d, （2） between 4 and 7 d and （3） beyond 7 d from the onset of symptoms. The impact of timing on the conversion rate, morbidity and postoperative hospital stay was studied. RESULTS： One hundred and twenty-nine patients underwent laparoscopic cholecystectomy for acute cholecystitis during the index admission. Thirty six were assigned to group 1, 58 to group 2, and 35 to group 3. The conversion rate and morbidity for the whole cohort of patients were 4.6% and 10.8%, respectively. There was no significant difference in the conversion rate, morbidity and postoperative hospital stay between the three groups.CONCLUSION： Laparoscopic cholecystectomy for acute cholecystitis during the index admission is safe, regardless of the time elapsed from the onset of symptoms. This policy can result in an overall shorter hospitalization.
基金Supported by Primary Biliary Cirrhosis Subdivision of Intrac-table Hepatobiliary Diseases Study Group of Japan(Chairman,Hirohito TsubouchiDepartment of Human and Environmental Sciences,Graduate School of Medical and Dental Sciences,Ka-goshima University,Kagoshima,Japan)
文摘AIM:To investigate histological and immunohistochemical differences in hepatitis between autoimmune hepatitis(AIH)and primary biliary cirrhosis(PBC)with AIH features.METHODS:Liver needle biopsies of 41 PBC with AIH features and 43 AIH patients were examined.The activity of periportal and lobular inflammation was scored0(none or minimal activity)to 4(severe),and the degree of hepatitic rosette formation and emperipolesis was semiquantatively scored 0-3.The infiltration of mononuclear cells positive for CD20,CD38,CD3,CD4,and CD8 and positive for immunoglobulins(IgG,IgM,and IgA)at the periportal areas(interface hepatitis)and in the hepatic lobules(lobular hepatitis)were semiquantitatively scored in immunostained liver sections(score 0-6).Serum aspartate aminotransferase(AST),immunoglobulins,and autoantibodies at the time of liver biopsy were correlated with the histological and immunohistochemical scores of individual lesions.RESULTS:Lobular hepatitis,hepatitic rosette formation,and emperipolesis were more extensive and frequent in AIH than in PBC.CD3+,CD4+,and CD8+cell infiltration scores were higher in the hepatic lobules and at the interface in AIH but were also found in PBC.The degree of mononuclear cell infiltration correlated well with the degree of interface and lobular hepatitis in PBC,but to a lesser degree in AIH.CD20+cells were mainly found in the portal tracts and,occasionally,at the interface in both diseases.Elevated AST correlated well with the hepatocyte necroinflammation and mononuclear cell infiltration,specifically CD38+cells in PBC.No correlation existed between autoantibodies and inflammatory cell infiltration in PBC or AIH.While most AIH cases were IgG-predominant at the interface,PBC cases were divided into IgM-predominant,IgM/IgGequal,and IgG-predominant types,with the latter sharing several features with AIH.CONCLUSION:These results suggest that the hepatocellular injuries associated with interface and lobular hepatitis in AIH and PBC with interface hepatitis may not be identical.
基金supported by the National Natural Science Foundations of China (Grant No. 11072218)the Natural Science Foundation of Zhejiang Province of China (Grant No. Y6110314)
文摘This paper focuses on studying Lie symmetries and conserved quantities of discrete nonholonomic Hamiltonian systems. Firstly, the discrete generalized Hamiltonian canonical equations and discrete energy equation of nonholonomic Hamiltonian systems are derived from discrete Hamiltonian action. Secondly, the determining equations and structure equation of Lie symmetry of the system are obtained. Thirdly, the Lie theorems and the conservation quantities are given for the discrete nonholonomic Hamiltonian systems. Finally, an example is discussed to illustrate the application of the results.
文摘目的:研究肝再生增强因子(augmenter of liver regeneration,ALR)在乙型肝炎病毒(hepatitis B virus,HBV)相关肝硬化患者中的表达及临床意义.方法:病例来源于我科门诊及住院的慢性乙型肝炎患者,包括性慢性乙型肝炎轻度组(n=196)、代偿期肝硬化组(n=69)、失代偿期肝硬化组(n=148);失代偿肝硬化患者根据并发症进一步分为腹水组(n=51)、消化系出血组(n=32)、肝性脑病组(n=27)和慢性肝衰竭组(n=38),其中腹水组分为原发性腹膜炎组(n=9)与非原发性腹膜炎组(n=42).健康对照组(n=200)来源于输血科健康献血者.收集患者血清及临床资料;采用ELISA法检测各组患者血清ALR浓度;瞬时弹性扫描(FibroScan)检测代偿期肝硬化患者肝脏硬度.比较各组间ALR浓度差异,分析ALR浓度与肝硬化及其并发症的关系.结果:ALR浓度在代偿期肝硬化组和失代偿肝硬化组均明显高于健康对照组和慢性乙型肝炎轻度组(P<0.01).在代偿期肝硬化患者ALR浓度(1.54μg/L±0.53μg/L)与肝脏FibroScan值(16.96 kPa±5.6 kPa)负相关(r2=-0.218,F=15.736,P<0.01).失代偿肝硬化组中慢性肝衰竭患者ALR浓度明显高于代偿期肝硬化组(1.73μg/L±0.23μg/L vs 1.54μg/L±0.53μg/L,P=0.012),腹水组患者ALR浓度明显低于代偿期肝硬化组(1.32μg/L±0.64μg/L vs 1.54μg/L±0.53μg/L,P=0.027),原发性腹膜炎组与非原发性腹膜炎组间ALR浓度无显著性差异.ALR血清浓度与肝硬化患者腹水的发生相关,低ALR血清浓度是肝硬化患者发生腹水的危险因素(P=0.031,OR=0.841).结论:ALR在HBV相关肝硬化患者表达明显升高,其水平与肝脏硬度及腹水发生负相关,提示ALR在肝硬化患者增高可能是机体的一种保护机制.
