简介:Symptomatichepato-diaphragmaticinterpositionofabowellooporChilaiditi'ssyndromeisapeculiaranatomicalconditionmostoftenfoundbychance.Itsdescribedsymptomsrangefromintermittent,mildabdominalpainanddyspepsiatoacuteintestinalobstruction.Wereportacaseofhepato-diaphragmaticmigrationofthehepaticflexureofthecolonassociatedtoanunusual,heretoforeunreported,angina-likepainexclusivelyevokedbytheleftlateraldecubitus.Tomaximizethechanceofobservinganatomicalchangesindifferentpostures,computedtomographyofthechestandabdomenwasperformedafterairinsufflationintothecolon.Whilefrankherniationintothechestwasexcluded,thescanshowedthatthehepaticflexure-withtheinterpositionofthediaphragm-cameincontactwiththerightsideoftheheartintheleftlateral,butnotinthesupine,decubitus.Thisfindingwasreproducedbyechocardiographywhichalsoshowedvirtuallyunalteredhemodynamicsafterthechangeofposture.ECG,leftandrightventricularglobalandregionalfunctionaswellascardiacinjurymarkersalsoremainedunchangedduringthemaneuver,indicatingthatthepainevokedbythelatterwasunlikelyduetomyocardialischemia.ThiscasesuggeststhatChilaiditi'ssyndromeshouldbeincludedamongthepossible,althoughrare,causesofunexplainedangina-likesymptoms.
简介:煽动性的肠疾病(IBD)经常与象眼的神经炎那样的extraintestinal表明(EIM)被联系(在上)尽管这到目前为止在仅仅一些成年病人被描述了,所有谁与Crohns疾病(CD)被影响。而且,在上并且demyelinating疾病比的被表明了在IBD病人更经常在控制人口。在我们的当前的案例报告,我们与活跃CD描述一个孩子开发了突然的盲目由于在那上双边不与任何已知的原因有关,并且那即时对类固醇的高剂量作出回应。调查和临床的后续到目前为止在这个病人排除了demyelinating疾病的发展。到我们的知识,这是第一份报告在上在有CD的一个小儿科的病人。对这个案例的可能的解释包括活跃的肠疾病的阵发性的EIM,联系自体免疫的混乱例如一周期性孤立在上,多重硬化的第一表明,或能出现在以后的后续的另一demyelinating疾病。
简介:流行病学的研究为长期的肝炎B的一个原因的角色提供了压到优势的证据在hepatocellular癌(HCC)的发展的病毒(HBV)感染。然而,HBV感染的致病和联系HBV的HCC的carcinogenesis仍然是逃犯的。这评论将在涉及HBV相关的肝carcinogenesis的机制上总结当前的知识。在肿瘤形成的HBV的角色出现到复杂,并且可以包含直接、间接的机制。进主人染色体的HBVDNA的集成发生在同种细胞的肿瘤的早步扩大,和它被显示了提高主人chromosomal不稳定性,导致大转换复制,删除和chromosomaltranslocations。chromosomal改变的率在HBV相关的肿瘤显著地被增加,这被显示出。病毒的规章的HBVx蛋白质的延长表示可以贡献调整表明小径的细胞的抄写,蛋白质降级,增长,和apoptotic,并且它在hepatocellular癌的发展起一个关键作用。
简介:AIM:Toinvestigatethelifetimeriskofdevelopmentofesophagealadenocarcinomaand/orhigh-gradedysplasiainpatientsdiagnosedwithBarrett’sesophagus.METHODS:DatawereextractedfromtheUnitedKingdomNationalBarrett’sOesophagusRegistryondateofdiagnosis,patientageandgenderof7877patientsfromwhohadbeenregisteredfrom35UnitedKingdomcenters.LifeexpectancywasevaluatedfromUnitedKingdomNationalStatisticsdatabasedupongenderandageatyearatdiagnosis.Thesedatawerethenusedwithpublishedestimatesofannualadenocarcinomaandhigh-gradedysplasiaincidencesfrommetaanalysesandlargepopulation-basedstudiestoestimateoveralllifetimeriskofdevelopmentofthesestudyendpoints.RESULTS:ThemeanageatdiagnosisofBarrett’sesophaguswas61.6yearsinmalesand67.3yearsinfemales.Themeanlifeexpectancyatdiagnosiswas23.1yearsinmales,20.7yearsinfemalesand22.2yearsoverall.Usingdatafrompublishedmeta-analyses,thelifetimeriskofdevelopmentofadenocarcinomawasbetween1in8and1in14andthelifetimeriskofhigh-gradedysplasiaoradenocarcinomawas1in5to1in6.Usingdatafrom3largerecentpopulation-basedcohortstudiesthelifetimeriskofadenocarcinomawasbetween1in10and1in37andofthecombinedendpointofhigh-gradedysplasiaandadenocarcinomawasbetween1in8and1in20.AgeatBarrett’sesophagusdiagnosisisreducingandlifeexpectancyisincreasing,whichwillpartiallycounter-balancelowerannualcancerincidence.CONCLUSION:Thereisasignificantlifetimeriskofdevelopmentofhigh-gradedysplasiaandadenocarcinomainBarrett’sesophagus.
简介:Hirschsprungs疾病是现场发生在1:5000的先天的混乱出生。它被伤寒神经原的缺席沿着胃肠的道的一个可变区域描述。Hirschsprungs疾病作为multigenic混乱被分类,因为一样的显型在多重不同基因与变化被联系。而且,Hirschsprungs疾病的遗传高度复杂、不严格地孟德尔。在Hirschsprungs疾病观察的phenotypic可变性和不完全的外显率也建议修饰词基因的参与。这里,我们总结基于人和动物研究位于Hirschsprungs疾病下面的遗传的当前的知识,集中于修饰词基因的主要原因的基因,他们的相互作用,和角色。
简介:胃癌是中国最常见的恶性肿瘤,但临床上包括进展期胃癌在内的误判和漏诊情况严重,特别是浅表扩散型早期胃癌、弥漫浸润型胃癌(皮革胃)和形似胃炎样胃癌。本文介绍这几种胃癌的特点及提高诊断正确性的方法和经验。
简介:肝炎B病毒(HBV)感染是使世界范围的3.5亿个人担心的一个全球公共健康问题。有长期的肝炎B(CHB)的个人在开发肝肝硬化,肝的补偿不全和hepatocellular癌的增加的风险。为了维持,无法发现的病毒的负担减少长期的感染复杂并发症。没有治疗,根除HBV感染。当前的药是昂贵的,与不利事件被联系,并且具有有限功效。当前的指南试着标准化临床的实践。不过,争吵与CHB关于无征状的病人的管理留下,并且什么是肝炎Be抗原(HBeAg)与正常丙氨酸aminotransferase积极是病毒的负担的截止价值区分HBeAg否定的CHB病人和不活跃的搬运人。我们详细讨论DNA水平为什么独自不是足够的开始CHB的治疗。
简介:Thisarticlediscussestheadequatetreatmentofearlygallbladdercancer(T1a,T1b)andisbasedonpublishedstudiesextendingovernearly3decades.Randomizedstudiesandmetaanalysescomparingdifferentsurgicaltreatmentsdonotexist.Theliteratureshowsthatinupto20%ofpatientslymphnodemetastasisarefoundinT1bgallbladdercancer.Duetohighmalignancywithearlyangiolymphaticspreadandresistancetochemotherapyandradiationontheonehand,andtherelativelowoperativeriskofextendedcholecystectomy(cholecystectomyandregionallymphadenectomy)ontheotherhand,webelievethatthisprocedureismandatoryinearlygallbladdercancer.
简介:瞄准:在首先有教养的人的胎儿的hepatocytes(HFH)调查肝炎B(HBV)的感染和复制。方法:人的胎儿的hepatocytes在没有浆液的中等、HBV积极的浆液是有教养的被增加进媒介学习hepatocytes的危险性到HBV感染。上层清液为ELISA被收集HBsAg和HBeAg的试金,和为HBV-DNA的量的荧光PCR试金日报。白朊和HBcAg,CK8和CK18表情被免疫组织化学在有教养的hepatocytes检测。lactatedehydrogenate(LDH)的内容被测量发现房间膜的正直。结果:一个稳定的hepatocyte文化系统被建立。HBV能感染hepatocytes并且复制,并且HBcAg表示能被免疫组织化学在象hepatocyte一样房间检测。在上层清液的HBV-DNA能从d被检测2到d18并且HBsAg和HBeAg在d3-d上是积极的18在HBV感染以后。在媒介的HBV从d增加了0到d6并且当房间日益增多地正在松开他们的hepatocyte显型,随后减少了。结论:HBV能感染人的胎儿的hepato-cytes并且复制。这个在试管内模型在与人的HBV入口联系进房间和随后的复制的早事件上允许详细研究。
简介:AIM:Toevaluatetherelationshipbetweenthiopu-rineS-methyltransferase(TPMT)polymorphismsandthiopurine-inducedadversedrugreactions(ADRs)ininflammatoryboweldisease(IBD).METHODS:EligiblearticlesthatcomparedthefrequencyofTPMTpolymorphismsamongthiopurine-tolerantand-intolerantadultIBDpatientswereincluded.StatisticalanalysiswasperformedwithReviewManager5.0.Sub-analysis/sensitivityanalysiswasalsoperformed.RESULTS:Ninestudiesthatinvestigatedatotalof1309participantsmetourinclusioncriteria.Theinci-denceofTPMTgenemutationwasincreased2.93-fold(95%CI:1.68-5.09,P=0.0001)and5.93-fold(95%CI:2.96-11.88,P<0.00001),respectively,inIBDpatientswiththiopurine-inducedoverallADRsandbonemarrowtoxicity(BMT),comparedwithcontrols.TheORforTPMTgenemutationinIBDpatientswiththiopurine-inducedhepatotoxicityandpancreatitiswas1.51(95%CI:0.54-4.19,P=0.43)and1.02(95%CI:0.26-3.99,P=0.98)vscontrols,respectively.CONCLUSION:Thismeta-analysissuggeststhattheTPMTpolymorphismsareassociatedwiththiopurine-inducedoverallADRsandBMT,butnotwithhepatotoxicityandpancreatitis.
简介:HepatitisB(HB)virus(HBV)infection,whichcauseslivercirrhosisandhepatocellularcarcinoma,isendemicworldwide.HepatitisBvaccinesbecamecommerciallyavailableinthe1980s.TheWorldHealthOrganizationrecommendedtheintegrationoftheHBvaccineintothenationalimmunisationprogramsinallcountries.HBVpreventionstrategiesareclassifiedintothreegroups:(1)universalvaccinationalone;(2)universalvaccinationwithscreeningofpregnantwomenplusHBimmuneglobulin(HBIG)atbirth;and(3)selectivevaccinationwithscreeningofpregnantwomenplusHBIGatbirth.Mostlow-incomecountrieshaveadopteduniversalvaccineprogramswithoutscreeningofpregnantwomen.However,HBvaccinesarenotwidelyusedinlow-incomecountries.TheGlobalAllianceforVaccineandImmunizationwaslaunchedin2000,andby2012,theglobalcoverageofathree-doseHBvaccinehadincreasedto79%.Thenextchallengesaretofurtherincreasethecoveragerate,closethegapbetweenrecommendationsandroutinepractices,approachhighriskindividuals,screenandtreatchronicallyinfectedindividuals,andpreventbreakthroughinfections.ToeradicateHBVinfections,strenuouseffortsarerequiredtoovercomesocioeconomicbarrierstotheHBvaccine;thistaskisexpectedtotakeseveraldecadestocomplete.
简介:瞄准:由transfecting观察肝炎B复制和表示的抑制基于向量的小干扰RNA(siRNA)pGenesil-HBVX指向HBVX基因区域进HepG2.2.15房间。方法:pGenesil-HBVX被构造并且transfected进经由lipofection的HepG2.2.15房间。HBV抗原分泌物被决定在由解决时间的immunofluorometric试金(TRFIA)的transfection以后的24,48,和72h。HBV复制被荧光检验细胞质的病毒的蛋白质的量的PCR,和表示被免疫组织化学决定。结果:进上层清液的HBsAg和HBeAg的分泌物被发现被28.5%和32.2%禁止(P<0.01),并且在38.67%(P<0.05)并且42.86%(P<0.01)在在pGenesil-HBVXtransfection以后的48h和72h分别地。为细胞质的HBsAg染色的Immunohistochemical在HepG2.2.15房间显示出类似的衰落在transfection以后的48h。在文化上层清液以内的HBV染色体的数字显著地也被减少48h和由荧光PCR确定了的72hpost-transfection(P<0.05)。结论:在HepG2.2.15房间,HBV复制和表示被指向编码区域的HBVX的基于向量的siRNApGenesil-HBVX禁止。