简介：Acutepancreatitisduringpregnancyisarareevent,andcanbeassociatedwithhighmaternalmortalityandfetalloss.Gallstonediseaseisthoughttobethemostcommoncausativefactorofacutepancreatitis,but,inmanycases,thecauseremainsunclear.Wereportacaseofa36-year-oldwomanat35wkofgestation,whopresentedwithseverepainconfinedtotheupperabdomenandradiatingtotheback.Thepatientwasdiagnosedwithacuteidiopathicpancreatitis,whichwasmanagedconservatively;sherecoveredwithinseveraldaysandthendeliveredahealthybaby.Thereforeitisimportanttoconsideracutepancreatitiswhenapregnantwomanpresentswithupperabdominalpain,nauseaandvomitinginordertoimprovefetalandmaternaloutcomesforpatientswithacutepancreatitis.

简介：Enteralnutritionhasbeenstronglyrecommendedbymajorscientificsocietiesforthenutritionalmanagementofpatientswithacutepancreatitis.Providingsevereacutepancreatitispatientswithenteralnutritionwithinthefirst24-48hofhospitaladmissioncanhelpimproveoutcomescomparedtoparenteralnutritionandnofeeding.Newresearchisfocusinginonwhenandwhattofeedtobestimproveoutcomesforacutepancreatitispatients.Earlyenteralnutritionhavethepotentialtomodulatetheimmuneresponses.Despitethisconsistentevidenceofearlyenteralnutritioninpatientswithacutepancreatitis,clinicalpracticecontinuestovaryduetoindividualclinicianpreference.Achievingtheimmunemodulatingeffectsofenteralnutritionheavilydependonproperplacementofthefeedingtubeandmanaginganytubefeedingassociatedcomplications.Thecurrentarticlereviewstheimmunemodulatingeffectsofenteralnutritionandpro-andprebioticsandsuggestssomepracticaltoolsthathelpimprovethepatientadherenceandtolerancetothetubefeeding.Properselectionofthetypeofthetube,closemonitoringofthetubeforitsplacement,patencyandsecuringitsproperplacementandroutinecheckingthegastricresidualvolumecouldallhelpimprovetheoutcome.Usingpeptide-basedandhighmediumchaintriglyceridesfeedingformulashelpimprovingfeedingtolerance.

简介：Theuseofenteralfeedingaspartofthemanagementofacutepancreatitisdatesbackalmosttwodecades.Thisreviewdescribestheindicationsforandlimitationsofenteralfeedingforthetreatmentofacutepancreatitisusingup-to-dateevidence-baseddata.Asystematicreviewwascarriedouttoanalysecurrentdataontheuseofenteralnutritioninthemanagementofacutepancreatitis.Relevantliteraturewasanalysedfromtheviewpointsofenteralvsparenteralfeeding,earlyvsdelayedenteralnutrition,nasogastricvsnasojejunalfeeding,andearlyoraldietandimmunonutrition,particularlyglutamineandprobioticsupplementation.Finally,currentapplicableguidelinesandtheeffectsoftheseguidelinesonclinicalpracticearediscussed.Thelatestmeta-analysessuggestthatenteralnutritionsignificantlyreducesthemortalityrateofsevereacutepancreatitiscomparedtoparenteralfeeding.Tomaintaingutbarrierfunctionandpreventearlybacterialtranslocation,enteralfeedingshouldbecommencedwithinthefirst24hofhospitaladmission.Also,thesafetyofnasogastricfeeding,whicheasestheadministrationofenteralnutrientsintheclinicalsetting,islikelyequaltonasojejunalfeeding.Furthermore,anearlylow-fatoraldietispotentiallybeneficialinpatientswithmildpancreatitis.Despitetheinitialencouragingresults,thecurrentevidencedoesnotsupporttheuseofimmunoenhancednutrientsorprobioticsinpatientswithacutepancreatitis.

简介：Acutepancreatitis(AP)isafrequentdiseasewithdegreesofincreasingseverityresponsibleforhighmorbidity.Despitecontinuousimprovementincare,mortalityremainssignificant.Becausehypovolemia,togetherwithmicrocirculatorydysfunctionleadtopooroutcome,fluidtherapyremainsacornerstoneofthesupportivetreatment.However,poorclinicalevidenceactuallysupporttheaggressivefluidtherapyrecommendedinrecentguidelinessinceavailabledataarecontroversial.Fluidmanagementremainsunclearandleadstocurrentheterogeneouspractice.DifferentstrategiesmayhelptoimprovefluidresuscitationinAP.Ononehand,integrationoffluidtherapyinaglobalhemodynamicresuscitationhasbeendemonstratedtoimproveoutcomeinsurgicalorsepticpatients.Tailoredfluidadministrationafterearlyidentificationofpatientswithhigh-riskofpooroutcomepresentinginadequatetissueoxygenationisamajorpartofthisstrategy.Ontheotherhand,newdecisionparametershavebeendevelopedrecentlytoimprovesafetyandefficiencyoffluidtherapyincriticallyillpatients.Inthisreview,weproposeapersonalizedstrategyintegratingthesenewconceptsintheearlyfluidmanagementofAP.ThisnewapproachpavesthewaytoawiderangeofclinicalstudiesinthefieldofAP.

简介：丙肝在全球保健上强加重要负担。长期的感染与典型地在肝硬化，机关失败和癌症表明的肝的进步发炎被联系。由精致的避免策略的优点，丙肝病毒(HCV)作为一个坚持的人的病毒成功。它有一个非凡的能力破坏使它能建立长期的感染和联系的肝疾病的有免疫力的反应。Chemokines是低分子的重量调停的趋化性的肽进纸巾的煽动性的房间和进lymphatics和外部血的背的招募。因此，他们对受动器和规章的有免疫力的房间的时间、空间的分发中央。在chemokines和他们的血缘的受体帮助之间的相互作用塑造有免疫力的反应因此，在感染的结果上有主要影响。然而，chemokines包括HCV由病毒为调整代表一个目标。HCV被知道并且可以因此由通过改变的白血球在vivo破坏有免疫力的反应启用它的幸存趋化性导致损害病毒的清理和长期的低档发炎的建立在vitro调制chemokine表示。在这评论，在尖锐、长期的HCV感染的chemokines的角色被描述，一个特别重音作为有免疫力的颠覆的一个工具放了在chemokine调整上。我们提供一在里面部分的深度讨论在调停由chemokines玩了肝的纤维变性当在预示的药为这些chemoattractants探讨潜在的应用时。

简介：<正>DearSir,Weherebyreportacaseofbilateralacuteangleclosureglaucomasecondarytoasystemicdecongestantcontainingpseudoephedrinefreelyavailableoverthecounter.Acuteangleclosureglaucomaisanocularemergency.Delayedrecognitionandtreatmentinevitablyleadstopermanentvisualimpairment.Acuteangleclosureoccursasaresultofobstructiontoaqueousdrainagebyblockageofthetrabecularmeshworkbytheiris.Typicalpresentingsymptomsincludeacuteonsetofocularpain,headacheandblurredvision.Onclinicalexamination,itischaracterizedbyamarkedlyraisedIOPofabove21mmHgtogetherwith

简介：AIM:Todiscussandcomparethefundusautofluorescence(FAF)andopticalcoherencetomography(OCT)inacuteorchroniccentralserouschorioretinopathy(CSCR).METHODS:Medicalrecordsof100casesofCSCRwerereviewed.Acuteandchroniccaseswereevaluatedaccordingtothedurationofdecreasedvisualacuity,serousretinaldetachment(RD)andfocalleakageonfluoresceinangiography(FA).Chi-squaretestwasusedforstatisticalanalysis.RESULTS:Fortycaseshadacuteand60caseshadchronicCSCR.FAFshowedfocalhypo-autofluorescencein34(85%)andiso-autofluorescencein6(15%)ofacutecasesandhypo-autofluorescencein51(85%),hyperautofluorescencein6(10%)andiso-autofluorescencein3(5%)ofchroniccases.OCTshowedserousRDwithdistinctborderscorrelatedwithFAFfindings(hypoautofluorescence)inallacuteCSCRcases.InchronicCSCRgroup,OCTshowedserousRDwithindistinctborderscorrelatedwithFAFfindings.ThedifferencesbetweentheOCTandFAFfindingsofthetwogroupsweresignificant(P=0.000).CONCLUSION:OCTandFAFfindingscansupporttheclinicalobservationsindifferentialdiagnosisofacuteandchronicCSCRandhelpclinicianstoevaluateretinalpigmentepithelium,outersegmentsofphotoreceptorsandthecomponentsofserousRD.

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简介：cytokine发信号的Suppressor(SOCS)1在有免疫力的反应和力量起一个关键作用贡献与glucocorticoid对待的肝失败的预测。我们招募了接受glucocorticoid治疗和30健康控制在外部血mononuclear房间在SOCS1的transcriptional水平上决定glucocorticoid的潜在的效果的47个acute-on-chronic肝炎B肝失败(ACHBLF)病人。在glucocorticoid治疗的第三和八分之二十天，SOCS1表示否定地为结束阶段肝疾病与模型一起被相关(吞没)分数。Interleukin-6(IL-6)和肿瘤坏死factor-α；(TNF-α；)层次统计上更低，当SOCS1抄写水平在预告的处理和处理以后的ACHBLF病人两个都比非幸存者在幸存者是更高的时。在ACHBLF病人的SOCS1倡导者的methylation率比在由methylation特定的聚合酶链反应决定了的健康控制病人高。在methylated倡导者的SOCS1的mRNA水平是比从与unmethylatedSOCS1倡导者一起的病人显著地低的。干扰素(IFN)-γ-responsive和STAT1依赖的基因表示在幸存者是更高的并且戏剧性地在glucocorticoid治疗以后与SOCS1的升起的表示被减少。没有methylation，死亡率比为那些在methylated病人是显著地更高的。而且，我们在六发现了五熬过病人在治疗以后在八分之二十天显示了demethylatedSOCS1，当那个数字在非幸存者在10是3时。这些调查结果建议没有SOCS1methylation的ACHBLF病人可以有有利回答到corticosteroid治疗。

简介：T房间受体贝它链的侧面变量(TRBV)基因通常与病毒感染或癌症在题目扭曲。融化的基因光谱模式(GMSP)能被用来决定TRBV基因家庭的侧面。从从尖锐肝炎B病毒感染(AHI)恢复了的题目在外部血淋巴细胞探索TRBV家庭的肖像，外部血mononuclear房间(PBMC)被分开并且进一步排序+和CD8+T房间子集进CD4。TRBV的分子的特征补足的决定区域3(CDR3)主题用GMSP分析被决定。当GMSP侧面显示出一座单个山峰时，monoclonally扩展的TRBV基因被克隆并且定序。多重TRBV基因的扭曲的扩大在CD4+和CD8+T房间子集和PBMC之中被观察。在CD8+T房间子集的monoclonally扩展的TRBV基因的频率比CD4+T房间子集和PBMC的显著地高。比作TRBV基因家庭，TRBV11，BV15和BV20的另外的成员主要在恢复AHI题目在外部血淋巴细胞的全部剧目被表示。TRBV5.1和BV20CDR3的相对保存的氨基酸主题也在CD4+和CD8+T房间子集被检测。这些结果在恢复AHI题目表明多重偏导的TRBV家庭的存在。特别从CD8+T房间子集，TRBV11，BV15和BV20可能与有AHI的题目的致病相关。有相对保存的CDR3主题的优先地选择的TRBV5.1和BV20可以是为长期的HBV感染的个性化的处理的潜在的目标。