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Cholestasis refers to a pathological state of disorders in the formation, secretion, and excretion of bile flow, and liver fibrosis is a process of tissue repair induced by liver injury. Cholestatic liver disease is a chronic liver disease caused by cholestasis, progressive bile duct injury, and persistent intrahepatic inflammation, and it may cause cholangiocyte and hepatocyte injury, which will gradually progress to liver fibrosis. With reference to the current research advances, this article reviews the pathogenesis of cholestasis-induced liver fibrosis and the strategies for blockade.
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Objective To explore thc clinical manifestation of secondary generalized myasthenia gravis(GMG) and analyze the factors affecting the progression from ocular myasthenia gravis(OMG) to GMG.Methods This research constitutes a single-center,retrospectively-collected prospective cohort study.We comprehensively reviewed our self-managed myasthenia gravis (MG) database drawn from personal clinical experience from January 2000 to Junc 2013.Patients underwent series of examination including repetitive nerve stimulation (RNS) tests,measurement of serum acetylcholine receptors antibody and serum muscle-specific tyrosine kinase antibodies,thymus computer tomography scan etc.Patients were treated with pyridostigmine bromide,corticosteroid therapy and (or) thymectomy based on a nonrandomization pattern and they were documented for their respective symptoms of OMG and GMG and date of GMG conversion.Logistic regression analysis was adopted to determine the influencing factors correlated with the development of GMG during the follow-up.Results Totally 770 patients initially diagnosed with OMG were included,among whom 573 (74％) patients remained with OMG (R-OMG group) and 197(26％) patients developed into GMG (GMG group) during the follow-up.(1) In comparison with their R-OMG counterparts,patients with secondary GMG were older at onset; Displayed more frequent RNS abnormality of facial nerve,accessory nerve and ulnar nerve ; Showed higher incidence of thymoma and were less treated by early corticosteroids.(2) For GMG group,81％ (160/197) of them displayed bulbar MG; 67％ (132/197) of GMG conversion occurred within 2 years,and 84％ (166/197) within 5 years.In comparison with the patients with onset of≤ 14-year-old,both of patients with15-49-year-old and≥ 50-year-old displayed higher conversion rate and shorter conversion duration (median:10 years versus 1 year and 6.5 months).(3) RNS abnormality of accessory nerve(OR =6.650,95％ CI 3.547-12.471 ; P ＜ 0.05) and thymoma(OR =7.924,95％ CI 2.554-24.585 ; P ＜ 0.05) were prognostic factors for the development of GMG,while early corticosteroid(OR =0.232,95％ CI 0.119-0.452 ; P ＜ 0.05) predicted the reduction of the risk of generalization.Conclusions Multiple factors including abnormal RNS of proximal limb muscles,thymoma,early corticosteroids therapy and possibly even onset age of over 15-year-old may involve the generalization in patients with OMG at onset.
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ObjectiveTo assess the differences of short- and long-term postintervention status on ocular and systemic symptoms for patients with ocular myasthenia gravis (OMG) after pyridostigmine bromide, corticosteroid, thymectomy, or thymectomy-corticosteroid combination therapy ( combination ).MethodsThis retrospective plus prospective study included 180 OMG patients, whose age of onset ≥ 15 years, treated non-randomly with above therapies separately: thymectomy group (60 cases ), corticosteroid group (39 cases), combination group ( 31 cases ), symptomatic group ( 50 cases ). Postintervention status complying with Myasthenia Gravis Foundation of America (MGFA)complete stable remission ,pharmacologic remission, or minimal manifestations was considered as desirable response, which was used as statistical indicator. Results ①Corticosteroid group showed higher desirable response rates on ptosis, ophthalmoplegia and general weakness at 3-6 months after treatment than other groups, and 42. 1％( 16/38 ) of them at 3 months achieved the desired state of ptosis, higher than the symptomatic group (7/48,14. 6％, ×2 = 8. 200, P = 0. 004 ). ② Ascending ideal rates had been presented in both combination and thymectomy groups since 1 year after treatments, while a little bit higher rate was presented in the former. At the end of observation, 21.7％ ( 13/60 )of patients in thymectomy group achieved complete stable remission.By paired longitudinal comparisons,thymectomy group showed higher ideal rates on ptosis (22/40,55.0％ ), ophthalmoplegia ( 16/27,59. 3％ ) and general weakness (20/40,50. 0％ ) at 2 years than that at 3 months( 11/59,18.6％ ;11/44,25.0％ ;9/60,15.0％ ;P =0. 002, 0. 031,0.000). ③For those patients by symptomatic treatment, the average age of onset was (51.9 ± 18.0) years, higher than that by other 3 therapies (F = 10. 563 ,P =0. 000). ④OMG patients with ophthalmoplegia more likely select corticosteroid or combined therapy. Ophthalmoplegia in combination group was higher than that in symptomatic and surgery groups( ×2 = 12. 939,14. 380, P =0. 000 in both). Ophthalmoplegia in corticosteroid group was higher than that in surgery group ( ×2 = 8. 017, P = 0. 005 ).Conclusions Corticosteroid appears to early overcome ptosis, ocular motor dysfunction and general weakness for patient with OMG in early-to-middle adulthood.Thymectomy andsurgery-corticosteroid combinationtherapies bothshowlong-term effectonthem.
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Objective To probe into the related factors and nursing of nosocomial infection for infectious diseases ward. Methods 2198 cases of patients in infectious diseases ward of our hospital were selected from February 2008 to December 2009, prospective monitoring and retrospective analysis were simultaneously adopted. Results In cases of nosocomial infection, mainly respiratory tract was the infection site, where the upper respiratory tract infection rate was 30.52%, lower respiratory tract infection rate was 28.57%, higher than other parts, there were significant differences. At the same time, nosocomial infection due to indwelling catheter and the irrational use of antibiotics led to higher rates of infection, 19.23%and 17.69%, there were significant differences. In addition, we could see from the age of nosocomial infection, ≤ 3-year-old children and elderly patients ≥ 60 years old had higher infection rate, 9.43% and 9.71%, there were significant differences. Conclusions According to elements features of infectious disease outbreak in hospital ward, to take effective care and prevention measures to reduce the infectious diseases room of the hospital infection will be of great clinical significance.
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Objective To understand the simon and psychological state of HBsAg carriers among the students in university in order to make effective intervention measures. Methods The 5 items of hepatitis B in serum were tested by enzyme linked immunesorbent assay (ELISA) for each new students of grade 2008, and the influencing factor of serum items of hepatitis B were investigated by questionnaire. Symptom checklist 90 was adopted to test the psychological state of the HBsAg carriers. Results The total HBsAg positive rate was 6.77%.The serum maker model of HBV showed seven kinds. The HBsAg positive carder rate had significant difference in different gender, HBV-infected history, blood transfusion history and HBV vaccination history. The HBsAg positive carriers demonstrated evident depression, anxiety, hostility and fear. Conclusions The college students must pay attention to HBV precaution during their stay in university. Health education on HBV and prevention program should be implemented to prevent infection.
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Objective To observe the hematocyte change in patients peripheral blood with severe hepatitis and to investigate its causes and clinical significance.Methods Partial parameters of peripheral blood cell in 65 patients with severe hepatitis and 52 normal individuals were analysed using blood cell counter.Results WBC number in patients with severe hepatitis was significantly higher than that in normal individuals[(8.13±4.33)×109/L vs(6.02±1.07)×109/L,P＜0.01],and PLT,PCT,MPV,PDW,RBC and Hb in the patients with severe hepatitis Were also significantly lower than that in normal individuals(P＜0.01).Conclusions Severe hepatitis can cause the hematocyte changes.It is essential to examine the hematocyte parameters in diagnosis and therapy of severe hepatitis.
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@#ObjectiveTo observe the effect of berneol on sodium valproate passing the blood-brain barrier in rabbits.Methods12 rabbits were randomly divided into the control group and borneol group with 6 animals in each group. All animals were treated with intravenous infusion of sodium valproate until steady state; while the rabbits of the borneol group received oral borneol. The sodium valproate concentration in serum and cerebrospinal fluid (CSF) was determined. The pharmacokinetics parameters obtained from two groups were analyzed. ResultsIn the berneol group, the mean drug concentration in CSF and area under curve increased significantly ( P<0.05) compared with those of the control group, and the time of drug reaching the peak concentration in CSF was 6 hours, the ratio of CSF to plasma also increased significantly ( P<0.05), while the blood concentration not increased.ConclusionBorneol can enhance the permeability of blood-brain barrier to sodium valproate, but has small influence on blood concentration.
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OBJECTIVE:To study the perioperative use of prophylactic antibiotics in a hospital.METHODS:210 surgery patients were sampled randomly from Apr.to Aug.2006 in a hospital and investigated in respect of the perioperative use of prophylactic antibiotics based on the Guiding Principle of the Clinical Application of Antibacterials.RESULTS:Of the 210 cases,the ratio of perioperative use of antibiotics were as high as 98.10%,the application ratio of antibiotics in depuratory operation was 96.97%,and were 100% in other kinds of surgeries.The application ratios of antibacterials 0.5～2 h before surgery,after operation and during operation stood at 25.73%,21.84% and 52.43%,respectively.The average duration of antibiotic use was 3.17 d,with a maximum of 13 d.The duration of antibiotic use in depuratory operation,depuratory-contaminant operation and contaminant operation were 1.40,3.60 and 8.19 d,respectively.Antibacterials used singly totaled 23 kinds,of which,cefuroxime,latamoxef,amoxicillin/potassium clavulanate,cefminox and norvancomycin hydrochloride topped the first 5 places.CONCLUSION:The results show that the rate of application rate of antibiotics in this hospital is on the high side,the preventive medication indications were unclear and the drug use was lack of special aim,the management on which remains to be standardized.