Background:Post-transplant lymphoproliferative disorder(PTLD)is a lethal complication after pediatric liver transplantation,but information regarding risk factors for the development of PTLD remains unclear.This study...Background:Post-transplant lymphoproliferative disorder(PTLD)is a lethal complication after pediatric liver transplantation,but information regarding risk factors for the development of PTLD remains unclear.This study was to identify characteristics and risk factors of PTLD.Methods:A total of 705 pediatric patients who underwent liver transplantation between January 2017 and October 2018 were studied.Impact of clinical characteristics and Epstein-Barr virus(EBV)infection on the development of PTLD was evaluated.In addition,ImmuKnow assay was adopted in partial patients to analyze the immune status.Results:Twenty-five(3.5%)patients suffered from PLTD with a median time of 6 months(3–14 months)after transplantation.Extremely high tacrolimus(TAC)level was found in 2 fatal cases at PTLD onset.EBV infection was found in 468(66.4%)patients.A higher peak EBV DNA loads(>9590 copies/mL)within 3 months was a significant indicator for the onset of PTLD.In addition,the ImmuKnow assay demonstrated that overall immune response was significantly lower in patients with EBV infection and PTLD(P<0.0001).The cumulative incidence of PTLD was also higher in patients with lower ATP value(≤187 ng/mL,P<0.05).Conclusions:A careful monitoring of EBV DNA loads and tacrolimus concentration might be supportive in prevention of PTLD in pediatric patients after liver transplantation.In addition,application of the ImmuKnow assay may provide guidance in reducing immunosuppressive agents in treatment of PTLD.展开更多
Achalasia cardia is one of the common causes of motor dysphagia.Though the disease was first described more than 300 years ago,exact pathogenesis of this condition still remains enigmatic.Pathophysiologically,achalasi...Achalasia cardia is one of the common causes of motor dysphagia.Though the disease was first described more than 300 years ago,exact pathogenesis of this condition still remains enigmatic.Pathophysiologically,achalasia cardia is caused by loss of inhibitory ganglion in the myenteric plexus of the esophagus.In the initial stage,degeneration of inhibitory nerves in the esophagus results in unopposed action of excitatory neurotransmitters such as acetylcholine,resulting in high amplitude non-peristaltic contractions(vigorous achalasia);progressive loss of cholinergic neurons over time results in dilation and low amplitude simultaneous contractions in the esophageal body(classic achalasia).Since the initial description,several studies have attempted to explore initiating agents that may cause the disease,such as viral infection,other environmental factors,autoimmunity,and genetic factors.Though Chagas disease,which mimics achalasia,is caused by an infective agent,available evidence suggests that infection may not be an independent cause of primary achalasia.A genetic basis for achalasia is supported by reports showing occurrence of disease in monozygotic twins,siblings and other first-degree relatives and occurrence in association with other genetic diseases such as Down's syndrome and Parkinson's disease.Polymorphisms in genes encoding for nitric oxide synthase,receptors for vasoactive intestinal peptide,interleukin 23 and the ALADIN gene have been reported.However,studies on larger numbers of patients and controls from different ethnic groups are needed before definite conclusions can be obtained.Currently,the disease is believed to be multi-factorial,with autoimmune mechanisms triggered by infection in a genetically predisposed individual leading to degeneration of inhibitory ganglia in the wall of the esophagus.展开更多
目的：分析针刺联合言语康复训练治疗脑卒中后构音障碍的临床效果。方法选取88例脑卒中后构音障碍患者作为研究对象，并以随机数字表法将其分为两组，即对照组与治疗组，每组44例。对照组采用言语康复训练进行治疗，治疗组采用针刺联合...目的：分析针刺联合言语康复训练治疗脑卒中后构音障碍的临床效果。方法选取88例脑卒中后构音障碍患者作为研究对象，并以随机数字表法将其分为两组，即对照组与治疗组，每组44例。对照组采用言语康复训练进行治疗，治疗组采用针刺联合言语康复训练进行治疗。治疗结束后，将两组患者的构音疗效、a 项数以及不良反应发生情况进行观察并对比。结果对照组痊愈率（9．09％）与治疗总有效率（77.27％）均明显低于治疗组的（25．00％，97．73％），组间差异均有统计学意义（χ2＝3．94、8．42，均 P ＜0.05）。治疗前，两组患者的 a 项数差异无统计学意义（P ＞0．05），治疗后对照组的 a 项数（7．39±3．67）明显比治疗组（16.32±7．83）低（t ＝4．20，P ＜0．05）；两组不良反应发生率差异无统计学意义（χ2＝3．11，P ＞0.05）。结论对于脑卒中后构音障碍患者而言，针刺联合言语康复训练的治疗效果极佳，而且该方法能够增多患者的 a 项数，并具有较高的安全性，值得广泛地运用于临床治疗中。展开更多
Bloating is one of the most common and bothersome symptoms complained by a large proportion of patients. This symptom has been described with various definitions, such as sensation of a distended abdomen or an abdomin...Bloating is one of the most common and bothersome symptoms complained by a large proportion of patients. This symptom has been described with various definitions, such as sensation of a distended abdomen or an abdominal tension or even excessive gas in the abdomen, although bloating should probably be defined as the feeling (e.g. a subjective sensation) of increased pressure within the abdomen. It is usually associated with functional gastrointestinal disorders, like irritable bowel syndrome, but when bloating is not part of another functional bowel or gastrointestinal disorder it is included as an independent entity in Rome III criteria named functional bloating. In terms of diagnosis, major difficulties are due to the lack of measurable parameters to assess and grade this symptom. In addition, it is still unclear to what extent the individual patient complaint of subjective bloating correlates with the objective evidence of abdominal distension. In fact, despite its clinical, social and economic relevance, bloating lacks a clear pathophysiology explanation, and an effective management endorsement, turning this common symptom into a true challenge for both patients and clinicians. Different theories on bloating etiology call into questions an increased luminal contents (gas, stools, liquid or fat) and/or an impaired abdominal empting and/or an altered intra-abdominal volume displacement (abdomino-phrenic theory) and/or an increased perception of intestinal stimuli with a subsequent use of empirical treatments (diet modifications, antibiotics and/or probiotics, prokinetic drugs, antispasmodics, gas reducing agents and tricyclic antidepressants). In this review, our aim was to review the latest knowledge on bloating physiopathology and therapeutic options trying to shed lights on those processes where a clinician could intervene to modify disease course.展开更多
大便失禁及排便障碍等肛直肠功能性疾病在临床上十分常见,单纯依靠症状的诊断准确率不高,熟练应用肛门直肠功能检测显得较为重要。目前临床上对于各检测方法的认识和应用尚不统一,国际肛直肠生理工作组(the international anorectal phy...大便失禁及排便障碍等肛直肠功能性疾病在临床上十分常见,单纯依靠症状的诊断准确率不高,熟练应用肛门直肠功能检测显得较为重要。目前临床上对于各检测方法的认识和应用尚不统一,国际肛直肠生理工作组(the international anorectal physiology working group,IAPWG)分别于2018和2019年颁布了《肛门直肠功能评估进展》共识意见和《肛门直肠功能障碍的标准化检测方案和伦敦分型》(简称《伦敦共识》),旨在提供各肛直肠检测方法的适应证、操作流程、临床应用、优势及局限性,并在客观检查的基础上对肛门直肠功能障碍进行了分型。IAPWG提出,肛门直肠测压主要用于评估肛门运动功能,肛内超声适用于评估肛门结构,肛直肠感觉运动检测包括球囊扩张试验等,球囊逼出试验、排粪造影则为常见的两项排便试验。单项检测尚不能完全明确大便失禁或排便障碍的原因,需综合评估患者的肛门直肠结构、感觉及运动功能。患者的异常检测结果主要包括直肠肛门抑制反射消失、肛门张力和收缩力降低、直肠低敏感和高敏感。肛门直肠功能障碍的伦敦分型主要包括4个部分:①直肠肛门抑制反射异常;②肛门张力及收缩力异常;③肛门直肠协调障碍;④直肠感觉异常。《伦敦共识》可以为肛门直肠功能检测的操作方法和结果阐释提供依据,有助于检测流程的标准化和检测结果的规范化。展开更多
基金supported by grants from Shanghai Munici-pal Hospital Three-year-Project for Clinical Skills’ Promotion and Innovation(16CR1003A)Shanghai Jiaotong University School of Medicine(DLY201606)National Natural Science Foundation of China(81670602)
文摘Background:Post-transplant lymphoproliferative disorder(PTLD)is a lethal complication after pediatric liver transplantation,but information regarding risk factors for the development of PTLD remains unclear.This study was to identify characteristics and risk factors of PTLD.Methods:A total of 705 pediatric patients who underwent liver transplantation between January 2017 and October 2018 were studied.Impact of clinical characteristics and Epstein-Barr virus(EBV)infection on the development of PTLD was evaluated.In addition,ImmuKnow assay was adopted in partial patients to analyze the immune status.Results:Twenty-five(3.5%)patients suffered from PLTD with a median time of 6 months(3–14 months)after transplantation.Extremely high tacrolimus(TAC)level was found in 2 fatal cases at PTLD onset.EBV infection was found in 468(66.4%)patients.A higher peak EBV DNA loads(>9590 copies/mL)within 3 months was a significant indicator for the onset of PTLD.In addition,the ImmuKnow assay demonstrated that overall immune response was significantly lower in patients with EBV infection and PTLD(P<0.0001).The cumulative incidence of PTLD was also higher in patients with lower ATP value(≤187 ng/mL,P<0.05).Conclusions:A careful monitoring of EBV DNA loads and tacrolimus concentration might be supportive in prevention of PTLD in pediatric patients after liver transplantation.In addition,application of the ImmuKnow assay may provide guidance in reducing immunosuppressive agents in treatment of PTLD.
文摘Achalasia cardia is one of the common causes of motor dysphagia.Though the disease was first described more than 300 years ago,exact pathogenesis of this condition still remains enigmatic.Pathophysiologically,achalasia cardia is caused by loss of inhibitory ganglion in the myenteric plexus of the esophagus.In the initial stage,degeneration of inhibitory nerves in the esophagus results in unopposed action of excitatory neurotransmitters such as acetylcholine,resulting in high amplitude non-peristaltic contractions(vigorous achalasia);progressive loss of cholinergic neurons over time results in dilation and low amplitude simultaneous contractions in the esophageal body(classic achalasia).Since the initial description,several studies have attempted to explore initiating agents that may cause the disease,such as viral infection,other environmental factors,autoimmunity,and genetic factors.Though Chagas disease,which mimics achalasia,is caused by an infective agent,available evidence suggests that infection may not be an independent cause of primary achalasia.A genetic basis for achalasia is supported by reports showing occurrence of disease in monozygotic twins,siblings and other first-degree relatives and occurrence in association with other genetic diseases such as Down's syndrome and Parkinson's disease.Polymorphisms in genes encoding for nitric oxide synthase,receptors for vasoactive intestinal peptide,interleukin 23 and the ALADIN gene have been reported.However,studies on larger numbers of patients and controls from different ethnic groups are needed before definite conclusions can be obtained.Currently,the disease is believed to be multi-factorial,with autoimmune mechanisms triggered by infection in a genetically predisposed individual leading to degeneration of inhibitory ganglia in the wall of the esophagus.
文摘目的：分析针刺联合言语康复训练治疗脑卒中后构音障碍的临床效果。方法选取88例脑卒中后构音障碍患者作为研究对象，并以随机数字表法将其分为两组，即对照组与治疗组，每组44例。对照组采用言语康复训练进行治疗，治疗组采用针刺联合言语康复训练进行治疗。治疗结束后，将两组患者的构音疗效、a 项数以及不良反应发生情况进行观察并对比。结果对照组痊愈率（9．09％）与治疗总有效率（77.27％）均明显低于治疗组的（25．00％，97．73％），组间差异均有统计学意义（χ2＝3．94、8．42，均 P ＜0.05）。治疗前，两组患者的 a 项数差异无统计学意义（P ＞0．05），治疗后对照组的 a 项数（7．39±3．67）明显比治疗组（16.32±7．83）低（t ＝4．20，P ＜0．05）；两组不良反应发生率差异无统计学意义（χ2＝3．11，P ＞0.05）。结论对于脑卒中后构音障碍患者而言，针刺联合言语康复训练的治疗效果极佳，而且该方法能够增多患者的 a 项数，并具有较高的安全性，值得广泛地运用于临床治疗中。
文摘Bloating is one of the most common and bothersome symptoms complained by a large proportion of patients. This symptom has been described with various definitions, such as sensation of a distended abdomen or an abdominal tension or even excessive gas in the abdomen, although bloating should probably be defined as the feeling (e.g. a subjective sensation) of increased pressure within the abdomen. It is usually associated with functional gastrointestinal disorders, like irritable bowel syndrome, but when bloating is not part of another functional bowel or gastrointestinal disorder it is included as an independent entity in Rome III criteria named functional bloating. In terms of diagnosis, major difficulties are due to the lack of measurable parameters to assess and grade this symptom. In addition, it is still unclear to what extent the individual patient complaint of subjective bloating correlates with the objective evidence of abdominal distension. In fact, despite its clinical, social and economic relevance, bloating lacks a clear pathophysiology explanation, and an effective management endorsement, turning this common symptom into a true challenge for both patients and clinicians. Different theories on bloating etiology call into questions an increased luminal contents (gas, stools, liquid or fat) and/or an impaired abdominal empting and/or an altered intra-abdominal volume displacement (abdomino-phrenic theory) and/or an increased perception of intestinal stimuli with a subsequent use of empirical treatments (diet modifications, antibiotics and/or probiotics, prokinetic drugs, antispasmodics, gas reducing agents and tricyclic antidepressants). In this review, our aim was to review the latest knowledge on bloating physiopathology and therapeutic options trying to shed lights on those processes where a clinician could intervene to modify disease course.
文摘大便失禁及排便障碍等肛直肠功能性疾病在临床上十分常见,单纯依靠症状的诊断准确率不高,熟练应用肛门直肠功能检测显得较为重要。目前临床上对于各检测方法的认识和应用尚不统一,国际肛直肠生理工作组(the international anorectal physiology working group,IAPWG)分别于2018和2019年颁布了《肛门直肠功能评估进展》共识意见和《肛门直肠功能障碍的标准化检测方案和伦敦分型》(简称《伦敦共识》),旨在提供各肛直肠检测方法的适应证、操作流程、临床应用、优势及局限性,并在客观检查的基础上对肛门直肠功能障碍进行了分型。IAPWG提出,肛门直肠测压主要用于评估肛门运动功能,肛内超声适用于评估肛门结构,肛直肠感觉运动检测包括球囊扩张试验等,球囊逼出试验、排粪造影则为常见的两项排便试验。单项检测尚不能完全明确大便失禁或排便障碍的原因,需综合评估患者的肛门直肠结构、感觉及运动功能。患者的异常检测结果主要包括直肠肛门抑制反射消失、肛门张力和收缩力降低、直肠低敏感和高敏感。肛门直肠功能障碍的伦敦分型主要包括4个部分:①直肠肛门抑制反射异常;②肛门张力及收缩力异常;③肛门直肠协调障碍;④直肠感觉异常。《伦敦共识》可以为肛门直肠功能检测的操作方法和结果阐释提供依据,有助于检测流程的标准化和检测结果的规范化。
