日本《大肠癌治疗指南（2014年版）》解读

日本大肠癌研究会编纂的《大肠癌治疗指南（2014版）》于2014-01-24发表并在临床应用。《大肠癌治疗指南（2014版）》在内镜治疗、手术治疗、复发大肠癌的治疗、大肠癌血行转移的治疗、化学疗法、放射线疗法、术后随访等方面均有不同的更新,在2010年版《大肠癌治疗指南》文献的基础上,收集了新的日文及英文文献,将循证医学证据等级高的、新的研究成果以及适合的会议记录和方案纳入指南。因此,《大肠癌治疗指南（2014版）》具有时代性和先进性,其不仅在日本本土,在国际上也有重要的影响,充分的掌握其精神和内容,制定符合我国的诊治指南,对于推动我国大肠癌的规范化诊治具有重要意义。     

Evaluation of stress hormones in traumatic brain injury patients with gastrointestinal bleeding

Objective： To evaluate the local risk factors of traumatic brain injury （TBI） patients developing gastrointestinal （GI） bleeding during the early hospitalization in neurosurgery intensive care unit （NICU）. Method： From September 2005 to February 2006, 41 patients admitted to NICU and 13 healthy volunteers were involved in our study. Blood samples at 24 hours, 2-3 days and 5-7 days were obtained from each patient via arterial line at 8 a.m. to measure the concentrations of serum adrenocorticotropic hormone （ACTH）, total cortisol and gastrin. The collected serum was immersed in an ice bath and tested by the Immulite 1000 systems. Data were analyzed by SPSS 11.5. Results： Within 24 hours following TBI, the concentrations of total cortisol, ACTH and gastrin increased proportionally to the severity of injury, especially significant in the experimental group （P〈0.05）. The concentrations of ACTH and gastrin were higher in the GI bleeding positive group than in the GI bleeding negative group, （F=1.413, P=0.253） for ACTH and （F=9.371, P=0.006） for gastrin. GI bleeding had a positive correlation with gastrin concentration （r=0. 312, P〈0.05） and a negative correlation with serum hemoglobin （Hb） （r=-0.420, P〈0.01）. The clinical incidence of GI bleeding was 24.39% （10/41） in the experimental group. Within 24 hours, GI bleeding had a strong correlation with gastrin concentration （OR=26.643, P〈0.05） and hematocrit （Hct） （OR=5.385, P〈0.05）. High ACTH concentration （〉100 pg/ml） increased the frequency of GI bleeding. For patients with severe TBI and treated with routine antacids, the incidence of GI bleeding was 40.91% （9/22） and the mortality rate was 20%（2/10）. Conclusions： Low Glasgow coma scale scores, low Hb, high concentrations of gastrin and ACTH （〉 100 pg/ml） are risk factors and can be predictive values for post-traumatic GI bleeding. Severe TBI patients have high risks of GI bleeding with high mortality.     

“中国器官移植指南和专家共识会”在杭州顺利召开

2014年lO月30日，由浙江大学附属第一医院承办的《中华移植杂志（电子版）》、《国际肝胆胰疾病杂志》联合《中华医学鬻志》等8个编辑部共同主办的“中国器官移植指南与专家共识研讨会”在杭州顺利召开。     

Y chromosome microdeletions in azoospermic patients with Klinefelter＇s syndrome

Aim： To study the occurrence of Y chromosome microdeletions in azoospermic patients with Klinefelter＇s syndrome （KFS）. Methods： Blood and semen samples were collected from azoospermic patients with KFS （n = 14） and a control group of men of proven fertility （n = 13）. Semen analysis was done according to World Health Organization （WHO） guidelines. Blood samples were processed for karyotyping, fluorescent in situ hybridization （FISH） and measurement of plasma follicle stimulating hormone （FSH） by radioimmunoassay. To determine Y chromosome microdeletions, polymerase chain reaction （PCR） of 16 sequence tagged sites （STS） and three genes （DFFRY, XKRY and RBM1 Y） was performed on isolated genomic DNA. Testicular fine needle aspiration cytology （FNAC） was done in selected cases. Results： Y chromosome microdeletions spanning the azoospermia factor （AZF）a and AZFb loci were found in four of the 14 azoospermic patients with KFS. Karyotype and FISH analysis revealed that, of the four cases showing Y chromosome microdeletion, three cases had a 47,XXY/46,XY chromosomal pattern and one case had a 46,XY/47,XXY/48,XXXY/48,XXYY chromosomal pattern. The testicular FNAC of one sample with Y chromosome microdeletion revealed Sertoli cell-only type of morphology. However, no Y chromosome microdeletions were observed in any of the 13 fertile men. All patients with KFS had elevated plasma FSH levels. Conclusion： Patients with KFS may harbor Y chromosome microdeletions and screening for these should be a part of their diagnostic work-up, particularly in those considering assisted reproductive techniques. （Asian JAndrol 2006 Jan; 8： 81-88）     

2013年国际胰腺协会/美国胰腺协会循证医学基础上的急性胰腺炎处理指南解读（一）

自从2002年国际胰腺协会（International Association of Pancreatology,IAP）颁布急性胰腺炎处理指南以来,急性胰腺炎的治疗取得了实质性的进步.在循证医学证据的基础上,国际胰腺协会（IAP）及美国胰腺协会（American Pancreatic Association,APA）合作制订了最新版急性胰腺炎处理指南（IAP/APA evidence-based guidelines for the management of acute Pancreatitis）,全文刊登于2013年7月《Pancreatology》电子版（Pancreatology 13 （2013） e1-e15）.该指南在当前循证医学证据基础上针对急性胰腺炎临床处理的关键方面提供了相应的推荐意见,现就指南中的主要内容做出解读,并建议将这些推荐意见作为当前急性胰腺炎处理的参考标准并指导今后的临床研究.由于篇幅较长,本指南解读拟分3期刊出,供大家参考.     

欧洲新版成人腹股沟疝指南解读

《临床外科杂志》编辑部要求我写一篇“欧洲新版疝和腹壁外科指南解读”。由于我在2011年《临床外科杂志》第19卷第6期发表了一篇《成人腹股沟疝诊治中供参考的一些意见》的文章［1］,该文实际是介绍了欧洲疝学会在2009年发布的《成人腹股沟疝治疗指南》。欧洲疝学会原计划在2012年要根据不断发表的最新文献（RCTs和Meta）再出新修订本,由于各种原因推迟到了今年3月22日上网发表了最新版本：Up-date with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult pa-tients［2］。3月23日文章第一作者Marc Miserez 给我发来了全文。在唐健雄主委的推荐下,基于上述的经过,我接受了编辑部主任黎文的稿约,写就此文望同道们参阅。     

Study of drug control over postoperative hemorrhage after selective caesarean section

Objective: To compare the efficacy and safety of carbetocin and oxytocin in the prevention of postpartum hemorrhage after selective caesarean section. Methods: Two hundred and sixteen pregnant women who were going to deliver by caesarean section were randomly divided into two paralleled and controlled groups, of which the oxytocin group(group A) contained 105 women and the carbetocin group(group B) 111 women. 20 IU of oxytocin was administrated during operation for both groups, 10 IU directly into uterus and 10 IU intravenously. When the operation was over, 20 IU of oxytocin was dripped for group A lasting for 8 hours, while for group B 100μg of carbetocin was immediately injected intravenously for 1 minute. Blood loss as well as hemoglobin alteration was measured for the comparison of the effect of the two drugs. Blood biochemical indicators were introduced for the evaluation of the safety of carbetocin including the function of liver and kidney and the fasting glucose.Results: No significant difference was revealed between the two groups concerning the postpartum hemorrhage within 24 hours, the postpartum hemorrhage incidence and the changes of hemoglobin. There was no significant difference in the change of liver and kidney function, fasting glucose and electrolyte changes as well.Conclusions: Carbetocin has a similar effect and safety of oxytocin in controlling the blood loss of selective caesarean section.     

Effects of tissue-cultured mountain ginseng （Panax ginseng CA Meyer） extract on male patients with erectile dysfunction

Korean ginseng and mountain ginseng （Panax ginseng CA Meyer） are important traditional herbal plants whose ginsenosides are generally accepted as serving to improve sexual functions, such as penile erection. We investigated the effects of tissue-cultured mountain ginseng extract （TMGE） on male patients with erectile dysfunction （ED）. A double-blind, placebo-controlled study was conducted with 143 patients experiencing ED. Over the course of 8 weeks, one group took 1 000 mg of TMGE twice a day, and the other group took 1 000 mg of placebo twice a day. The effects of the TMGE and the placebo were analyzed using the Korean version of the International Index of Erectile Function （IIEF） questionnaire. A total of 86 patients completed 8 weeks of treatment. The scores on the five domains of the IIEF after medication were significantly higher than the baseline scores in the group treated with TMGE （P 〈 0.05）, whereas no significant improvement was observed in the placebo group （P 〉 0.05）. Erectile function and overall satisfaction scores after medication were significantly higher in the TMGE group than in the placebo group （P 〈 0.05）. Erectile function of patients in the TMGE-treated group significantly improved, suggesting that TMGE could be utilized for improving erectile function in male patients.     

Yohimbine in the treatment of orgasmic dysfunction

Aim： To study the effect of yohimbine in the treatment of men with orgasmic dysfunction. Methods： A 20-mg dose of yohimbine was first given to 29 men with orgasmic dysfunction of different aetiology in the clinic. Patients were then allowed to increase the dose at home （titration） under more favourable circumstances. The outcome and side effects were subsequently assessed. Results： The patients were classified into three groups of orgasmic dysfunction： primary complete （13）, primary incomplete （8） and secondary （8）. Nocturnal emissions were present in 75%, 40% and 50% of patients in the above groups, respectively （overall average 62%）. The men presented because of fertility problems （52%） or because they wanted to experience the pleasure of orgasm （48%）. Of the 29 patients who completed the treatment, 16 managed to reach orgasm and were able to ejaculate either during masturbation or sexual intercourse. A further three achieved orgasm, but only with the additional stimulation of a vibrator. A history of preceding nocturnal emissions was present in 69% of the men in whom orgasm was induced but only 50% who failed treatment. Of the patients, two have subsequently fathered children （one set of twins） and another 3 men were also cured. Side effects were not sufficient to cause the men to cease treatment. Conclusion： Yohimbine is a useful treatment option in orgasmic dysfunction.     

成人腹股沟疝诊疗指南（2014年版）

为提高我国疝和腹壁外科的诊疗水平，中华医学会外科学分会疝和腹壁外科学组与中国医师协会外科医师分会疝和腹壁外科医师委员会互相协作，从2013年着手准备，于2014年初组织修订，经过反复讨论，最终完成《成人腹股沟疝诊疗指南（2014年版）》（以下简称为“指南”）。本“指南”的前身为《成人腹股沟疝诊疗指南（2012版）》，本次修订依据国内外近年有关学科的进展和我国的国情，增添了一些条款，还增加了“指南”中的部分附件（腹股沟疝的常规修补方法和腔镜修补方法），目的在于强调腹股沟疝外科治疗的专业化和规范化，进一步提高我国疝外科的治疗水平。     

Hormone abuse in sports： the antidoping perspective

Since ancient times, unethical athletes have attempted to gain an unfair competitive advantage through the use of doping substances. A list of doping substances and methods banned in sports is published yearly by the World AntiDoping Agency （WADA）. A substance or method might be included in the List if it fulfills at least two of the following criteria： enhances sports performance; represents a risk to the athlete＇s health; or violates the spirit of sports. This list, constantly updated to reflect new developments in the pharmaceutical industry as well as doping trends, enumerates the drug types and methods prohibited in and out of competition. Among the substances included are steroidal and peptide hormones and their modulators, stimulants, glucocorticosteroids, β2-agonists, diuretics and masking agents, narcotics, and cannabinoids. Blood doping, tampering, infusions, and gene doping are examples of prohibited methods indicated on the List. From all these, hormones constitute by far the highest number of adverse analytical findings reported by antidoping laboratories. Although to date most are due to anabolic steroids, the advent of molecular biology techniques has made recombinant peptide hormones readily available. These substances are gradually changing the landscape of doping trends. Peptide hormones like erythropoietin （EPO）, human growth hormone （hGH）, insulin, and insulin-like growth factor Ⅰ （IGF-Ⅰ） are presumed to be widely abused for performance enhancement. Furthermore, as there is a paucity of techniques suitable for their detection, peptide hormones are all the more attractive to dishonest athletes. This article will overview the use of hormones as doping substances in sports, focusing mainly on peptide hormones as they represent a pressing challenge to the current fight against doping. Hormones and hormones modulators being developed by the pharmaceutical industry, which could emerge as new doping substances, are also discussed.     

Early microrecanalization of vas deferens following biodegradable graft implantation in bilaterally vasectomized rats

We evaluated a biodegradable graft for reconstruction of rat vasa deferentia with long obstructed or missing segments. A total of 47 Sprague-Dawley rats underwent bilateral vasectomy and were divided into groups according to length of the vas deferens affected （0.5, 1, 1.5 cm）. After 8 weeks, poly-（D,L-lactide） （PDLA） grafts were used to reconnect the vas deferens, Grafts and adjoining vasa deferentia were excised 8 and 12 weeks later and evaluated microscopically. At 8 weeks, microscopic changes included a robust inflammatory response around the grafts. All grafts were still intact but in the early stages of degradation. No microtubules, indicative of vas deferens recanalization, were identified. One specimen showed evidence of healing and neovascularization at the interface zone between the vas deferens and the graft. At 12 weeks, grafts were further degraded but still present. Microscopic evaluation showed decreased inflammation. Seven specimens showed neovascularization at the interface zone; two of these showed distinct epithelialized vas deferens microcanals at the graft edges. One specimen showed a microcanal spanning the entire 0.5-cm graft. A time period of 8 weeks is not ample enough for vas deferens regeneration in the setting of a biodegradable PDLA graft; however, early evidence of re-growth was seen at 12 weeks. A longer healing time should permit further biodegradation of the graft, as well as re-growth and possible eventual reconnection of the vas deferens, allowing passage of sperm. These findings suggest a potential role for biodegradable grafts in the reconstruction ofvas deferens with long obstructed segments.     

老年人乙状结肠癌腹腔镜手术对细胞免疫功能的影响

Objective To investigate the effect of laparoscopic colectomy on T Lymphocytic cell subpopulation, NK cell, lnterleukin-2 （IL-2） and interleukin-6（IL-6） in elderly patients with colon cancer. Methods Thirty elderly patients with colon cancer undergoing eolectomy were randomly divided into laparoscopic colectomy group （groupⅠ n = 15）and open colectomy group（groupⅡ n = 15）. Blood samples were taken before operation and 4 h,8 h,24 h,48 h,168 h after the operation for the determination of T Lymphocytic cell subpopulation （CD3, CD4,CD8,CD4/CD8）, NK cell, Interleukin-2 （IL-2）and Interleukin-6（IL-6）. Results Before operation, there was no significant difference of CD3,CD4,CD8 ,CD4/CD8, NK cell, IL-2 and IL-6 between the two groups. The level of CD3, CD4 and Nk cells were all decreased at postoperative 4 h ,8 h,24 h,48 h in group Ⅰ as compared with baseline value, and were lower than those of basehne value in group Ⅱ. Compared with groupⅠ, the level of CD3 in group Ⅱ was increased at postoperative 8 h,24 h ,48 h, and the level of CD4 was also increased at postoperative 4 h,24 h ,48 h , meanwhile the concentration of NK cell was remarkably high. Compared with baseline value , IL-2 was decreased at postoperative 4 h ,8 h,24 h,48 h in group Ⅰ ,while IL-6 was increased significantly after operation, the tendency was the same in group Ⅱ. IL-2 in group Ⅰwas lower than that of group Ⅱ at postoperative 4 h ,8 h,24 h,48 h, while IL-6 in group Ⅰ was remarkably higher than that of group Ⅱ at postoperative 4 h ,8 h,24 h,48 h. Conclusion The depression of immunological function in elderly patients undergoing laparoscopic colectomy is less than that of open surgery. This might be benificial to the patients with colectomy.     

Effect of hydrocele on appendix testis in children

The purpose of this study was to investigate the effects of an elevated hydrostatic pressure of hydrocele on the structural integrity and steroid receptor expression pattern of the appendix testis in children. Twenty-six testicular appendages were obtained from boys （aged between 13 and 79 months, mean 40 months） who underwent surgical exploration because of hydrocele or congenital inguinal hernia. The tissue sections of testicular appendages were stained with hematoxylin-eosin. Immunohistochemistry and immunofluorescence laser microscopy were performed using monoclonal mouse anti-human receptors against androgen and estrogen receptors. Patients were divided into three groups： group A （n = 8） represented patients with groin hernia without hydrocele, who served as control group; group B （n = 7） represented patients with communicating hydrocele; and group C （n = 11） represented patients with noncommunicating hydrocele. The tissue sections of appendix testis expressed both androgen and estrogen receptors in all patients in groups A and B, and epithelial destruction was not present. The presence of androgen receptor （two of 11, P 〈 0.001） and estrogen receptor （four of 11, P = 0.006） was lower and the number of appendix testes with epithelial destruction was higher （eight of 11, P-- 0.001） in group C. We demonstrated that groin hernia and communicating hydrocele did not influence the receptor expression pattern and the anatomic structure of testicular appendages, whereas noncommunicating hydrocele caused damage as indicated by the absence of steroid receptors and destruction of the epithelial surface. A better understanding of the physiological role of testicular appendages may change the indications of surgical treatment in patients with noncommunicating hydrocele.     

Aberrant methylation of the TDMR of the GTF2AIL promoter does not affect fertilisation rates via TESE in patients with hypospermatogenesis

Increasing evidence shows a relationship between epigenetic regulation and male infertility. The GTF2A1L gene promoter contains the DNA methylation site of a tissue-specific differentially methylated region （TDMR）. Eighty-six patients with non-obstructive azoospermia were assessed for the DNA methylation state of CpG islands in the GTF2AIL promoter using testicular genomic DNA. Based on histological criteria, 26 of the 86 patients had normal spermatogenesis （controls）, 17 had hypospermatogenesis and 26 had a Sertoli cell-only phenotype or tubular sclerosis. GTF2AIL TDMR methylation was significantly lower in testes DNA from control samples than from hypospermatogenic samples （P=0.029）. Patients with hypospermatogenesis were divided into two subgroups： high DNA methylation （HM, n=5） and low DNA methylation （LM, n= 12）. The GTF2AIL TDMR methylation rate differed significantly between the HM and LM groups （P=0.0019）, and GTF2A 1L expression was significantly higher among the LM than in the HM patients （P=0.023）. High TDMR methylation was correlated with low GTF2AIL gene expression levels. Both groups demonstrated relatively good outcomes with respect to sperm retrieval, fertilisation, pregnancy and childbirth rates. We observed that aberrant GTF2AIL gene expression was not correlated with fertilisation rates. The testicular sperm extraction （TESE） technique may be used to overcome male infertility due to aberrant TDMR methvlation.     

Crit.Care Med：败血性休克患者使用多巴胺应慎重

《Critical care medicine》在2012年第3期刊载了一篇文章》Dopamine versus norepinephrine in the treatment of septic shock：A meta-analysis》。这是一项由比利时和西班牙科学家主持进行的Meta分析。研究系统检索了MEDLINE、Embase、Scopus、CENTRAL databases以及Google Scholar等数据库（时间截至2011年7月30日）。最终得出结论：     

成人股骨头坏死诊疗标准专家共识（2012年版）

股骨头坏死（osteonecrosis of the femoral head,ONFH）,又称股骨头缺血性坏死（avascular necrosis of the femoralhead,AVNFH）是骨科常见病。2006年中华医学会骨科学分会关节外科学组和《中华骨科杂志》编辑部组织国内骨坏死专家拟订了《股骨头坏死诊断与治疗的专家建议》,一定程度上规范了股骨头坏死诊断、治疗及评定方法。2012年3月中华医学会骨科分会显微修复学组及中国修复重建外科专业委员会骨缺损及骨坏死学组组织相关专业专家对《股骨头坏死诊断与治疗的专家建议》进行了讨论、修改和补充,推出《成人股骨头坏死诊疗标准专家共识》（2012年版）。     

成人股骨头坏死诊疗标准专家共识（2012年版）

背景股骨头坏死（osteonecrosis of the femoralhead,ONFH）,又称股骨头缺血性坏死（avascularnecrosis of the femoralhem,AVNFH）是骨科常见病。2006年中华医学会骨科学分会关节外科学组和《中华骨科杂志》编辑部组织国内骨坏死专家拟订了《股骨头坏死诊断与治疗的专家建议》,一定程度上规范了股骨头坏死诊断、治疗及评定方法。2012年3月中华医学会骨科分会显微修复学组及中国修复重建外科专业委员会骨缺损及骨坏死学组组织相关专业专家对《股骨头坏死诊断与治疗的专家建议》进行了讨论、修改和补充,推出《成人股骨头坏死诊疗标准专家共识（2012年版）》。