Hepatocellular carcinoma in patients with chronic hepatitis C virus infection without cirrhosis

AIM:To investigate and characterise patients with chronic hepatitis C virus(HCV) infection presenting with hepatocellular carcinoma(HCC) in the absence of cirrhosis.METHODS:Patients with chronic hepatitis C infection without cirrhosis presenting with HCC over a 2-year period were identified.The clinical case notes,blood test results and histological specimens were reviewed to identify whether additional risk factors for the development of HCC were present.RESULTS:Six patients(five male,one female) with chronic hepatitis C infection without cirrhosis presented to a single centre with HCC over a 2-year period.Five patients were treated by surgical resection and one patient underwent liver transplantation.Evaluation of generous histological specimens confirmed the presence of HCC and the absence of cirrhosis in all cases.The degree of fibrosis of the background liver was staged as mild(n = 1),moderate(n = 4) or bridging fibrosis(n = 1).Review of the clinical case notes revealed that all cases had an additional risk factor for the development of HCC(four had evidence of past hepatitis B virus infection;two had a history of excessive alcohol consumption;a further patient had prolonged exposure to immune suppression).CONCLUSION:HCC does occur in patients with non-cirrhotic HCV infection who have other risk factors for hepatocarcinogenesis.

成人慢性疾病的发育性起源

Low birthweight is now known to be associated with increased rates of coronary heart disease and the related disorders stroke, hypertension and non-insulin- dependent diabetes. These associations have been extensively replicated in studi es in different countries and are not the result of confounding variables. They extend across the normal range of birthweight and depend on lower birthweights i n relation to the duration of gestation rather than the effects of premature bir th. The associations are thought to be consequences of developmental plasticity, the phenomenon by which one genotype can give rise to a range of different phys iological or morphological states in response to different environmental conditi ons during development. Recent observations have shown that impaired growth in i nfancy and rapid childhood weight gain exacerbate the effects of impaired prenat al growth. Coronary heart disease and the disorders related to it arise through a series of interactions between environmental influences and the pathways of de velopment that preceded them. These diseases are the product of branching pathwa ys of development in which the branchings are triggered by the environment befor e and after birth.

儿童期永久性听力损害早期诊断后患儿语言能力的研究

BACKGROUND: Children with bilateral permanent hearing impairment often have impaired language and speech abilities. However, the effects of universal newborns creening for permanent bilateral childhood hearing impairment and the effects of confirmation of hearing impairment by nine months of age on subsequent verbal abilities are uncertain. METHODS: We studied 120 children with bilateral permanent hearing impairment identified from a large birth cohort in southern England,at a mean of 7.9 years of age. Of the 120 children, 61 were born during periods with universal newborn screening and 57 had hearing impairment that was confirmed by nine months of age. The primary outcomes were languageas compared with nonverbal ability and speech expressed as z scores (the number of standard deviations by which the score differed from the mean score among 63 age-matched children with normal hearing),adjusted for the severity of the hearing impairment and for maternal education. RESULTS: Confirmation of hearing impairment by nine months of age was associated with higher adjusted mean z scores for language as compared with nonverbal ability (adjusted mean difference for receptive language, 0.82; 95 percent confidence interval,0.31 to 1.33; and adjusted mean difference for expressive language, 0.70; 95 percent confidence interval, 0.13 to 1.26). Birth during periods with universal newborns creening was also associated with higher adjusted z scores for receptive language as compared with nonverbal ability (adjusted mean difference, 0.60; 95 percent confidence interval, 0.07 to 1.13), although the z scores for expressive language as compared with nonverbal ability were not significantly higher. Speech scores did not differ significantly between those who were exposed to newborn screening or early confirmation and those who were not. CONCLUSIONS: Early detection of childhood hearing impairment was associated with higher scores for language but not for speech in midchildhood.

在电生理检查结果阴性的有症状患者中,可植入性循环事件记录仪可检测出快速心律失常

Background: Implantable loop recorders(ILR) are a valuable tool in the investigation of syncope and compare favourably with non-invasive and intracardiac electrophysiological assessment of bradycardia. They are known to detect tachyarrhythmias but have not been shown to add to the diagnostic yield of electrophysiological testing in symptomatic patients. Methods: We prospectively studied the first 41 patients(aged 48±19 years) in whom ILR were used at our institution after negative electrophysiological studies(EPS).All patients were symptomatic with palpitations(11), syncope(22)-or both(8). Nine patients had known structural heart disease(two ischaemic, four cardiomyopathy, two valvular and one congenital). Patients were assessed according to demographic factors, symptoms and investigations. Loop recordings were analysed and assessed according to conventional criteria. Results: Among 41 patients in whom electrophysiological studies had failed to demonstrate arrhythmias, six were found to have clinically significant tachyarrhythmias(four ventricular and two supraventricular). Conclusion: ILR diagnose prognostically significant tachyarrhythmias in symptomatic patients with negative electrophysiological studies.

全面性新生儿筛查对于儿童期永久性听力损害的诊断意义:一项 8年的对照随访试验

An 8-year follow-up study of the birth cohort of babies enrolled in the Wess ex controlled trial of universal newborn screening (UNS) for permanent childhood hearing impairment (PCHI) was undertaken to establish whether UNS would increas e the proportion of all true cases of PCHI in children aged 7-9 years who are r eferred early. The proportion referred before 6 months of age increased from 11 of 35 (31%) children with true PCHI born during periods without UNS to 23 of 31 (74%) born during periods with UNS (difference 43%, 95%CI 19-60). UNS leads to early referral of PCHI.

水中分娩与标准加强法用于第一产程难产的效果比较:随机对照试验

目的 评价第一产程水中分娩对初产妇硬膜外镇痛率和手术分娩率的影响。 设计 随机对照试验。 地点 南英格兰大学教学医院。 参与者 99例低并发症风险的难产(活跃期宫颈扩张<1厘米／小时)初产妇。 干预 浸入分娩池水中或标准处理难产的加强法(羊膜穿破术和静点催产素)。 主要结局测定 第一级:硬膜外镇痛率和手术分娩率。第二级:采用羊膜穿破术和催产素的加强率、产程长度、母婴发病率包括感染、母亲的疼痛分数,以及母亲对护理的满意度。 结果 随机分至水中分娩的妇女较加强组者有较低的硬膜外镇痛率(47％比66％,相对风险0.71[95％可信限0.49-1.01),需治疗的病人数目(NNT)为51。两组的手术分娩率没有差别[49％比50％,0.98(0.65-1.47),NNT98],但前者接受加强法[71％比96％,0.74(0.59-0.88),NNT4]或任何形式的产科干预(羊膜穿破术、催产素、硬膜外或手术分娩)明显减少[80％比98％,0.81(0.67-0.92),NNT5]。水中分娩组有更多的新生儿收入新生儿病房(6比0,P=0.013),但Apgar评分、感染率或脐血pH无差异。 结论 在助产士护理下的水中分娩对产程进展缓慢者也许是一种选择,它可降低对产科干预的需求,并提供了一个可供选择的处理疼痛的方法。