BACKGROUND: It is a globally challenging problem to differentially diagnose biliary atresia (BA) from other disease processes causing infantile cholestatic jaundice. The high frequency ultrasonography (HUS) yields muc...BACKGROUND: It is a globally challenging problem to differentially diagnose biliary atresia (BA) from other disease processes causing infantile cholestatic jaundice. The high frequency ultrasonography (HUS) yields much improved spatial resolution and therefore, might show better image in BA diagnostic examination. The present study was to evaluate the HUS on the diagnosis of BA in infants with jaundice. METHODS: Fifty-one infants with neonatal jaundice were scanned with ultrasonography. Images included gallbladder, bile duct, right hepatic artery (RHA), portal vein (PV) and triangular cord (TC) sign, magnetic resonance imaging and additionally laboratory tests and histopathology reports were assessed. RESULTS: Twenty-three BA and 28 non-BA cases were con firmed. The sensitivity, specificity, and accuracy of HUS were 91.3%, 92.9%, and 92.2%, respectively. All of these indices were significantly higher than those of conventional ultrasonography (P【0.01) and MR cholangiopancreatography (P【0.05). The HUS features, included a positive TC sign, an increased RHA diameter and RHA-diameter to portal-vein-diameter ratio (RHA/PV) and abnormal gallbladder, were important in the diagnosis of BA. CONCLUSION: HUS provided better imaging of BA and should be considered as a primary modality in the differential diagnosis of infantile jaundice.展开更多
Introduction: Children with surgically repaired esophageal atresia (EA) show esophageal dysmotility. Due to the performance of high-resolution manometry (HRM), three motility alteration patterns have been described, w...Introduction: Children with surgically repaired esophageal atresia (EA) show esophageal dysmotility. Due to the performance of high-resolution manometry (HRM), three motility alteration patterns have been described, which allowed to know the segmental alterations. Objective: To describe the esophageal motility patterns found through HRM in teenagers with EA and to relate these with the associated esophageal pathology and its severity. Materials and Method: Ten teenagers were included with no history of esophageal blockage or dilations in the last six months, who were orally fed and asymptomatic. Through performance of HRM, we found surgical and endoscopic history, as well as of esophageal biopsies and pH monitoring. Results: We found the following patterns: aperistalsis, pressurization and distal contraction. 70% showed distal contraction, and 100% of esophageal endoscopies and biopsies were normal. 57% of the esophageal pH monitoring analyzed was pathologic. In the pressurization and aperistalsis groups, we observed severe esophagitis and requirement of Nissen antireflux procedure in 100% of the cases. Esophageal pH monitoring analyzed was 100% pathologic. Conclusion: We described the esophageal segmental alterations in teenagers with atresia by means of HRM. The distal contraction group showed better development, without severe esophagitis or requirement of antireflux procedure. Therefore, by performing an HRM in teenagers with EA, we could predict the future esophageal behavior, according to the peristaltic pattern, since there are significant differences among the groups in study.展开更多
利用超高效液相色谱-线性离子阱/静电场轨道阱质谱联用技术(Ultra-high performance liquid chromatography with linear ion trap-orbitrap mass spectrometry,UHPLC-LTQ/Orbitrap-MS)对胆道闭锁患儿(Biliary atresia,BA)和健康婴儿(No...利用超高效液相色谱-线性离子阱/静电场轨道阱质谱联用技术(Ultra-high performance liquid chromatography with linear ion trap-orbitrap mass spectrometry,UHPLC-LTQ/Orbitrap-MS)对胆道闭锁患儿(Biliary atresia,BA)和健康婴儿(Normal control,NC)的尿液进行代谢组学分析,筛选胆道闭锁患儿尿液中的潜在生物标志物。收集了32例胆道闭锁患儿及40例健康婴儿的尿液样本,获得尿液样本的代谢轮廓,通过主成分分析法(Principle component analysis,PCA)及正交偏最小二乘法-判别分析(Orthogonal partial least squares discriminant analysis,OPLS-DA)等多元统计分析,最终筛选并鉴定32种内源性差异代谢物可作为胆道闭锁潜在的生物标记物。涉及丙氨酸、天冬氨酸和谷氨酸代谢,精氨酸和脯氨酸代谢,D-谷氨酸和D-谷氨酰胺代谢,组氨酸代谢,甘氨酸、丝氨酸和苏氨酸代谢通路紊乱。提示在胆道闭锁过程中伴随广泛的蛋白质代谢紊乱。其中,谷氨酸、L-谷氨酰胺、瓜氨酸、脯氨酸、胍基乙酸、5'-甲硫腺苷、ε-(γ-谷氨酰)-赖氨酸等物质表达差异趋势明显,涉及一系列胆道闭锁相关的病理机制。本研究为了解胆道闭锁的发病机制和早期筛查提供了科学依据。展开更多
基金supported by agrant from the New Technology and Service Project of Tongji Hospital(2008057)
文摘BACKGROUND: It is a globally challenging problem to differentially diagnose biliary atresia (BA) from other disease processes causing infantile cholestatic jaundice. The high frequency ultrasonography (HUS) yields much improved spatial resolution and therefore, might show better image in BA diagnostic examination. The present study was to evaluate the HUS on the diagnosis of BA in infants with jaundice. METHODS: Fifty-one infants with neonatal jaundice were scanned with ultrasonography. Images included gallbladder, bile duct, right hepatic artery (RHA), portal vein (PV) and triangular cord (TC) sign, magnetic resonance imaging and additionally laboratory tests and histopathology reports were assessed. RESULTS: Twenty-three BA and 28 non-BA cases were con firmed. The sensitivity, specificity, and accuracy of HUS were 91.3%, 92.9%, and 92.2%, respectively. All of these indices were significantly higher than those of conventional ultrasonography (P【0.01) and MR cholangiopancreatography (P【0.05). The HUS features, included a positive TC sign, an increased RHA diameter and RHA-diameter to portal-vein-diameter ratio (RHA/PV) and abnormal gallbladder, were important in the diagnosis of BA. CONCLUSION: HUS provided better imaging of BA and should be considered as a primary modality in the differential diagnosis of infantile jaundice.
文摘Introduction: Children with surgically repaired esophageal atresia (EA) show esophageal dysmotility. Due to the performance of high-resolution manometry (HRM), three motility alteration patterns have been described, which allowed to know the segmental alterations. Objective: To describe the esophageal motility patterns found through HRM in teenagers with EA and to relate these with the associated esophageal pathology and its severity. Materials and Method: Ten teenagers were included with no history of esophageal blockage or dilations in the last six months, who were orally fed and asymptomatic. Through performance of HRM, we found surgical and endoscopic history, as well as of esophageal biopsies and pH monitoring. Results: We found the following patterns: aperistalsis, pressurization and distal contraction. 70% showed distal contraction, and 100% of esophageal endoscopies and biopsies were normal. 57% of the esophageal pH monitoring analyzed was pathologic. In the pressurization and aperistalsis groups, we observed severe esophagitis and requirement of Nissen antireflux procedure in 100% of the cases. Esophageal pH monitoring analyzed was 100% pathologic. Conclusion: We described the esophageal segmental alterations in teenagers with atresia by means of HRM. The distal contraction group showed better development, without severe esophagitis or requirement of antireflux procedure. Therefore, by performing an HRM in teenagers with EA, we could predict the future esophageal behavior, according to the peristaltic pattern, since there are significant differences among the groups in study.
文摘利用超高效液相色谱-线性离子阱/静电场轨道阱质谱联用技术(Ultra-high performance liquid chromatography with linear ion trap-orbitrap mass spectrometry,UHPLC-LTQ/Orbitrap-MS)对胆道闭锁患儿(Biliary atresia,BA)和健康婴儿(Normal control,NC)的尿液进行代谢组学分析,筛选胆道闭锁患儿尿液中的潜在生物标志物。收集了32例胆道闭锁患儿及40例健康婴儿的尿液样本,获得尿液样本的代谢轮廓,通过主成分分析法(Principle component analysis,PCA)及正交偏最小二乘法-判别分析(Orthogonal partial least squares discriminant analysis,OPLS-DA)等多元统计分析,最终筛选并鉴定32种内源性差异代谢物可作为胆道闭锁潜在的生物标记物。涉及丙氨酸、天冬氨酸和谷氨酸代谢,精氨酸和脯氨酸代谢,D-谷氨酸和D-谷氨酰胺代谢,组氨酸代谢,甘氨酸、丝氨酸和苏氨酸代谢通路紊乱。提示在胆道闭锁过程中伴随广泛的蛋白质代谢紊乱。其中,谷氨酸、L-谷氨酰胺、瓜氨酸、脯氨酸、胍基乙酸、5'-甲硫腺苷、ε-(γ-谷氨酰)-赖氨酸等物质表达差异趋势明显,涉及一系列胆道闭锁相关的病理机制。本研究为了解胆道闭锁的发病机制和早期筛查提供了科学依据。
