Co-occurrence of IPMN and malignant IPNB complicated by a pancreatobiliary fistula: A case report and review of the literature

BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB) is pathologically similar to intraductal papillary mucinous neoplasm(IPMN). However, there are several significant differences between them. The rate of IPMN associated with extrapancreatic malignancies has been reported to range from 10%-40%, and it may occasionally be complicated with the presence of fistulas. IPMN associated with malignant IPNB is extremely rare and only nine cases have been reported in the literature.CASE SUMMARY We report a 52-year-old man who presented with recurrent cholangitis for nine months. Computed tomography and magnetic resonance cholangiopancreatography showed the common bile duct stricture with dilated pancreatobiliary duct without other abnormal findings. The underlying pathogenesis could not be identified based on the radiologic images. Endoscopic retrograde cholangiopancreatography revealed a pancreatobiliary fistula with dilated main pancreatic duct, biliary stricture with dilated biliary tree, and mucus discharge from the enlarged orifice of the major papilla. The patient underwent SpyGlass cholangiopancreatoscopy due to a suspected mucin-producing biliary neoplasm and indeterminate main pancreatic duct dilatation. Multiple papillary growing neoplasms with vascular images, with the extent of lesions spreading in the biliopancreatic ductal lumens, were identified by SpyGlass. In addition, the presence of a pancreatobiliary fistula was also identified. The patient was diagnosed as having benign IPMN and malignant IPNB with focal invasion by postoperative pathology. Furthermore, varying histological subtypes were present in both IPMN and IPNB. Pylorus-preserving pancreaticoduodenectomy was performed on the patient with excellent results during the 52 month followup period.CONCLUSION We deemed that pancreatography and SpyGlass allowed for an efficient diagnosis of IPMN with pancreatobiliary fistula, whereas the etiology could not be identified by radiologic imaging.     

小型节能头灯的制做与应用

医院(特别是儿童医院)在日常的诊断和治疗护理工作中,需要在小局部范围、短时间光源照明.目前市场上各种医用头灯存在着价格昂贵,使用不方便;我院医护人员在加05年10月至2007年3月使用我院自行研制的节能头灯,采用现代电子技术,在夜间给病人注射、换药和其他治疗以及查房巡视等小范围用光场合,取得了良好的效果.     

Cervicogenic exophthalmos: Possible etiology and pathogenesis

BACKGROUND Unilateral exophthalmos is often caused by inflammation, neoplasm, infection,metabolic disease, vascular disorder and several other less common conditions.Reflex sympathetic dystrophy related to unilateral exophthalmos has not been reported in the past literature.CASE SUMMARY We describe a 45-year-old female with unilateral exophthalmos caused by reflex sympathetic dystrophy and its unexpected spontaneous disappearance after a standard anterior cervical discectomy and fixation operation with two PEEK interbody cages and a plate. To our surprise, the patient’s left unilateral exophthalmos improved spontaneously in the morning on postoperative day 2-with no relapse, without any further medication, as of seven years. We have named this condition "cervicogenic exophthalmos."CONCLUSION We would inform other clinicians that unilateral exophthalmos was caused not only by inflammation, vascular disorder, infection, neoplasm, or metabolic disease, but also by reflex sympathetic dystrophy related with cervicogenic spondylosis. To the best of our knowledge, ours is the first related case report and use of the term "cervicogenic exophthalmos" after reviewing previous literature.     

Photodynamic therapy as salvage therapy for residual microscopic cancer after ultra-low anterior resection: A case report

BACKGROUND The rate of positive resection margins(R1) in patients with low rectal cancer is substantial. Recommended remedies such as extended resection or chemoradiotherapy have their own serious drawbacks. It has been reported that photodynamic therapy(PDT) as a remedial treatment for esophageal cancer.Colorectal cancer and esophageal cancer has many similarities,however,PDT as a salvage therapy for rectal cancer is rare.CASE SUMMARY Here,we describe a 56-year-old man who was admitted to the hospital due to a 6-mo history of hemafecia,which had been aggravated for 1 mo. Colonoscopy revealed a 3 × 4 cm ulcerated mass in the rectum 4 cm from the anus.Preoperative pathological examination showed villous adenoma,moderate-tohigh-grade dysplasia,good differentiation,and invasion of the mucosal muscle.The patient had R1 after ultra-low anterior resection,but he refused extended resection and experienced severe liver function impairment after 3 cycles of chemotherapy. Ultimately,the patient underwent PDT to remove R1. After five years of follow-up,there was no liver function impairment,recurrence,metastasis,sexual dysfunction,or abnormal defecation function.CONCLUSION This is the first case worldwide in which R1 of rectal cancer were successfully treated by PDT.     

Endodontic management of the maxillary first molars with two root canals: A case report and review of the literature

BACKGROUND The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with only two root canals, which have been rarely reported. We also perform a literature review of maxillary first molar anatomy.CASE SUMMARY The two patients were referred to the hospital after 1) finding a cavity in their tooth with a color change and, 2) a toothache during mastication, respectively.Both of these cases were diagnosed as apical periodontitis by X-ray imaging and cone beam computed tomography(CBCT). Non-surgical endodontic therapy was performed with the assistance of a dental operating microscope(DOM). CBCT showed rare but accurate images of both patients, each with two root canals and two roots in their maxillary first molars. Both roots were located in the buccal in the palatal direction, and each root had only one clear root canal. In addition,each maxillary first molar in both patients was symmetrical to that on the opposing side with only two separate root canals. Non-surgical endodontic therapy was performed with the assistance of a DOM. Finally, the teeth were restored using composite resin and the patients were satisfied with the results.CONCLUSION Making full use of CBCT and DOM would contribute to helping dentists make correct diagnoses and successfully treat teeth with rare root canal morphologies.     

读片窗及答案

病例 男,62岁.以"发现尿黄5天"为主诉入院.无发热、恶心及厌食等伴随症状.查体:血压150/100mmHg,巩膜轻度黄染,腹软无压痛,肝区无叩击痛,肝肋下未触及.实验室检查:血WBC 13.1×109/L,EO 5.2×109/L,占39.7%.TBIL 36.6μmol/L,DBIL 21.5μmol/L,UDBIL 15.1μmol/L.ALT 88U/L,GGT 201U/L.AFP及CEA阴性.HBsAb阳性,其余4项均阴性.     

结合中医理论对上呼吸道感染的护理

上呼吸道感染一年四季均可发病,但以冬春季节为多.此类病人病程一般在10 d以上,易反复,有的甚至迁延不愈达1个月以上,造成门诊输液量增加、交叉感染机会增多,在医治过程中医护人员也易感染.此病虽然不像癌症使人恐惧,但它的发病率高,有的1年内可发病3次～5次,给身体和生活造成很大的不便.此类病人的症状为鼻塞、流涕、喷嚏、咳嗽、咽干、咽痛、头痛、发热、乏力、全身不适等,护理一般采取对症施护:休息、保持室内空气清新、多饮水、清淡饮食等,而应用中医理论施护则更具体、更有效,对于疾病的痊愈会有极大的促进作用.     

伸缩式垂直升降护理机的适用性探讨

昏迷病人、截瘫病人、慢性消耗性疾病及脑卒中后遗症病人常伴有肢体瘫痪而长期卧床,生活不能自理,大小便失禁,易发生压疮,给病人带来极大痛苦,给家属带来繁重的负担[1].为解决这一难题,人们研究了一些护理器械,如"升降护理装置",这种护理装置由铁床、软布带、支架杆、绑绳钢筋、软网布、定滑轮组件、动滑轮组件、万向节连接件和钢丝绳组成.     

世界疼痛日——中国镇痛周暨建立疼痛科新闻发布会隆重召开中华医学会疼痛学分会第七届年会胜利闭幕

世界疼痛日中国镇痛周暨建立疼痛科新闻发布会、中华医学会疼痛学分会第七届年会于2007年10月12～16日在北京九华山庄隆重举行.全国人大副委员长中科院韩启德院士、原全国人大副委员长中科院吴阶平院士、卫生部陈啸宏副部长、卫生部医政司王羽司长、卫生部科教司刘雁飞司长、中华医学会吴明江常务副会长、原卫生部副部长中国医师协会殷大奎会长及有关方面的领导、专家及参加大会的疼痛医学专家代表约五百人参加了新闻发布会.     

多功能病号服在临床中的应用

病人在医院接受治疗时,往往在需要暴露局部治疗部位时,必需脱去整件衣、裤,由于春季、秋季、冬季室内温度低于体温,使病人易着凉、感冒,诱发其他并发症等,引起身体的不适.局部肿瘤放疗病人,指导放疗病人和家属将放疗局部的内衣剪开,露出局部皮肤进行治疗,这样不影响治疗,还可保暖,但这一方法还有待改进.另外住院病人的病号服颜色单调,款式单一,功能缺乏,根本不能满足住院病人的身心及治疗的需要.因此,近几年,通过大量的研究和临床实践,设计出多功能病号服,获国家实用型专利.现将其介绍如下.     

不同吸附体系及因素水平对PCC中4类抗凝蛋白的影响研究

目的 探讨不同吸附体系及其柠檬酸钠、氯化钠、pH、电导4因素对凝血酶原复合物(PCC)中蛋白C、蛋白S、蛋白Z、抗凝血酶收率及比活的影响.方法 选择柠檬酸钠、氯化钠、pH3因素3水平设计正交试验,配制9种PCC平衡吸附体系;凝胶平衡后,吸附血浆,洗涤、洗脱,制备PCC浓缩物;测定浓缩物中蛋白C和S、抗凝血酶活性、蛋白Z含量、总体积及蛋白浓度,获得四类抗凝蛋白收率及比活,比较不同吸附体系收率、比活总趋势;利用正交试验直观分析法分析柠檬酸钠、氯化钠、pH对蛋白C、S和Z收率及比活的影响;测定吸附体系电导率,分析电导率与4类抗凝蛋白收率及比活的关系.结果 不同吸附体系4类抗凝蛋白收率及比活有较大差异,抗凝血酶二者均极低.柠檬酸钠对蛋白C收率及比活、蛋白S收率影响较大;pH对蛋白S比活、蛋白Z收率及比活影响极差分别为:0.120、6.847、0.716,高于其他因素;氯化钠对其影响均最小.柠檬酸钠浓度越低,蛋白C收率及比活越高,蛋白S收率则越低,0.015 mol/L水平蛋白Z收率为49.11％,高于其他水平,而蛋白S和Z比活最低;pH越低,蛋白Z收率则越高,pH7.0水平蛋白C和S收率及比活、蛋白Z比活最高;氯化钠浓度0.075 mol/L水平,蛋白C收率及比活、蛋白S和Z比活分别为:29.37％、0.533 IU/mg、0.401 IU/mg、2.362 μg/mg,均高于其他水平,而蛋白S、Z收率最低.不同电导率条件,蛋白C收率及蛋白Z比活变化较大,其中蛋白Z与S收率、蛋白Z与S比活、蛋白C收率与比活变化趋势基本一致;(10.00±0.20) ms/cm条件,蛋白C、S和Z比活较高.结论 不同吸附体系抗凝血酶收率及比活均极低,蛋白C、S和Z收率及比活间无规律性.氯化钠对蛋白C、S和Z收率及比活影响较小,柠檬酸钠、氯化钠、pH不同水平对蛋白C、S和Z收率影响效应无共性,0.01 mol/L柠檬酸钠,0.075 mol/L氯化钠、pH7.0水平蛋白C、S和Z比活最佳.电导率与四类抗凝蛋白收率及比活间无线性关系.     

超声检查在下肢远端骨折患者肌肉参数及血流动力学改变监测中的应用

目的应用超声测量下肢膝关节以下远端骨折患者股四头肌（股直肌、股中间肌、股外侧肌、股内侧肌）形态结构参数和下肢股动脉血流动力学参数，探讨这些参数随时间变化与废用性肌萎缩之间的关系。 方法选取2018年5月至2019年5月在昆山市周市人民医院就诊的20例需要卧床制动的下肢远端骨折患者，分为观察组患侧、观察组健侧。观察组入院第1、4、7、10天超声检测双侧下肢股直肌面积、股四头肌厚度及股动脉血流频谱参数，共4次，观察这些数据随时间的变化情况。同时，分别将观察组患侧与健侧股动脉血流频谱参数第10天与第1天比较。 结果观察组患侧与健侧4个时间点肌肉厚度数值比较呈逐渐下降趋势，即发生了肌肉萎缩，股直肌厚度及面积比较，差异均有统计学意义（t=4.436、11.506、2.175、5.902、11.784、5.949、16.620、14.069、4.904、5.726、9.787，P均<0.05），股外侧肌厚度比较，差异均有统计学意义（t=4.682、5.978、4.133、4.608、7.092，P均<0.05）、股中间肌厚度比较，差异均有统计学意义（t=3.784、5.669、3.916、10.128、12.271，P均<0.05）、股内侧肌厚度比较，差异均有统计学意义（t=7.166、3.443、4.983、2.978，P均<0.05）；患侧股内侧肌制动后萎缩时间最早，于第4天开始。患侧健侧股动脉血流频谱参数第10天与第1天比较：舒张早期反向血流速度降低，舒张早期反向血流持续时间缩短，差异均有统计学意义（t=5.337、3.246、3.604、2.484，P均<0.05）。患侧股动脉4个时间点数值比较：收缩期峰值速度逐渐下降，舒张早期反向血流速度逐渐降低，舒张早期反向血流持续时间逐渐缩短，差异均有统计学意义（t=2.633、4.711、5.337、4.681、3.246、4.574、2.973、3.604、2.484、2.484，P均<0.05）。 结论超声可以通过肌肉的厚度面积变化和血流动力学改变评估肌肉萎缩情况。     

壳聚糖抗肿瘤缓释药物的特征

背景：肿瘤严重危害人类的健康,应用有效的化学药物治疗具有重要的意义。目的：分析壳聚糖载药缓释系统抗肿瘤的作用机制及治疗效果。方法：分析壳聚糖抗肿瘤药物缓释材料释放药物机制以及抗肿瘤的作用机制,并分析壳聚糖及其衍生物负载多种抗肿瘤药物如阿霉素、表阿霉素、表柔比星、5一氟尿嘧啶、紫杉醇等的特征及抗肿瘤作用效果。结果与结论：壳聚糖抗肿瘤缓释药物材料具有良好的药物缓释性能以及抗肿瘤性能,能够负载各种常用的抗肿瘤药物,可以控制药物释放速率,延长药物作用时间,维持有效的药物浓度,降低药物的毒副作用,并且对肿瘤及组织器官具有靶向性作用,明显提高了化疗药物对肿瘤的治疗作用。     

Nursing Leadership in Genomics for Health and Society

PURPOSE: This article is part of the series regarding genomics and nursing practice, science, education, and policy. Issues in genetic testing, genetic information and the lessons learned through applications of genetic and genomic science are analyzed and discussed. FRAMEWORK: Scientists, scholars, and members of the public have articulated a vision to guide genomics research and scholarship. The three overarching themes of this conceptual framework are genomes to biology, genomes to health, and genomes to society. CONCLUSIONS: Nurses can promote the use of genomic research technologies and information in the context of health, biology, and society, as well as in nursing research, practice, education, and policy.     

伤湿论

目的:探究湿邪致病的特性、湿邪侵袭人体的途径和证候特点及治湿的方法,以期更系统地认识湿邪,从而助益临床湿病的辨治。方法:通过文献研究、临床病案分析、相互探讨来总结湿邪的来源、特性、治法及方药。结果:湿的来源主要有外来之湿和内生之湿,湿邪致病具有易感性和广发性,湿为阴邪,起病隐匿,湿性重浊黏滞,湿邪致病有滞中蒙上及趋下的特性,湿邪易兼它邪为患。结论:通过湿邪入侵机体的途径,辨清湿邪所在部位,在治疗上灵活运用疏风透湿、宣发散表、理气行气、健脾助运、温阳化湿等法,因势利导,谨守病机,可标本兼治。     

尼洛替尼二线与达沙替尼三线对一二线治疗失败的慢性髓性白血病的疗效及影响因素分析

目的:评价尼洛替尼二线与达沙替尼三线对一二线治疗失败的慢性髓性白血病(CML)的疗效,并分析疗效的影响因素.方法:将江苏省昆山市第三人民医院2014年1月-2018牟12月伊马替尼一线治疗失败后采用尼洛替尼二线治疗的83例CML患者设为二线治疗组(简称二线组),尼洛替尼二线治疗失败后采用达沙替尼三线治疗的61例CML患...     

盆腔超声在女童性早熟评估中的价值

目的探讨盆腔超声在女童性早熟及其不同类型评估中的价值。 方法选取2019年8月至2021年8月在浙江大学医学院附属第四医院生长发育门诊临床诊断为中枢性性早熟（CPP）和外周性性早熟（PPP）的女童各30例,并选取同期30例正常女童作为对照组。所有纳入对象均行盆腔超声检查,比较3组女童的年龄、体质量指数、宫体厚度、宫体长径/宫颈长径、子宫体积、卵巢体积、最大卵泡长径的差异,并绘制3组比较有差异的超声参数鉴别CPP、PPP及正常者的ROC曲线,评估各项参数的效能。 结果CPP组宫体厚度、子宫体积、卵巢体积、最大卵泡长径均大于对照组和PPP组（P均＜0.05）。PPP组宫体厚度、子宫体积、卵巢体积、最大卵泡长径均大于对照组（P均＜0.05）。以促性腺激素释放激素（GnRH）激发试验结果为金标准,宫体厚度、子宫体积、卵巢体积、最大卵泡长径鉴别CPP与PPP的ROC曲线下面积为0.900、0.849、0.843、0.755;鉴别CPP与正常女童的ROC曲线下面积为0.941、0.887、0.926、0.769;鉴别PPP与正常女童的ROC曲线下面积为0.814、0.811、0.706、0.813。其中宫体厚度的ROC曲线下面积最大,以宫体厚度＞1.39 cm为截断值,其鉴别女童CPP与PPP的敏感度86.7%,特异度90.0%;以宫体厚度＞1.07 cm为截断值,其鉴别CPP与正常女童的敏感度96.7%,特异度90.0%;以宫体厚度＞0.96 cm为截断值,其鉴别PPP与正常女童的敏感度80.0%,特异度86.7%。 结论盆腔超声多项参数对女童性早熟评估及不同类型的鉴别有较好的临床应用价值,宫体厚度作为一项新的评估参数值得进一步关注,可将这些参数作为性早熟的初筛方法,为临床明确诊断提供可靠依据。     

银屑病患者中趋化素与皮损、肥胖、糖脂代谢及炎症因子的相关性

目的分析趋化素（Chemerin）水平与银屑病（PS）患者皮损严重程度、肥胖、糖脂的代谢紊乱、炎症因子的相关性。 方法选择2019年1月至2020年1月于广西医科大学第一附属医院收治的150例PS患者,根据PS患者是否并发代谢综合征（MS）分为单纯PS组及PSMS组,同期选择于本院查体中心查体的健康人群40例为对照组。测量并记录各组受检者的身高、体重及腰围（WC）,计算身体质量指数（BMI）。采用PS面积与严重程度指数（PASI）量表评估2组患者的皮损严重程度。采集所有受检者空腹静脉血5 ml,采用全自动生化分析仪检测血清甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、空腹血糖（FPG）,采用放射免疫分析法检测血清空腹胰岛素（Fins）、超敏C反应蛋白（hs-CRP）、白介素6（IL-6）,计算胰岛素抵抗指数（HOMA-IR）,采用酶联免疫吸附法检测血清趋化素水平。 结果单纯PS组及PSMS组患者血清趋化素水平明显高于对照组,PSMS组患者血清趋化素水平明显高于单纯PS组（P＜0.01）。单纯PS组及PSMS组患者血清hs-CRP、IL-6水平明显高于对照组,PSMS组患者血清hs-CRP、IL-6水平明显高于单纯PS组（P＜0.01）。单纯PS组及PSMS组患者BMI、WC、TG、TC、LDL-C、Fins及HOMA-IR水平明显高于对照组,PSMS组患者BMI、WC、TG、TC、LDL-C、Fins及HOMA-IR水平明显高于单纯PS组,HDL-C水平明显低于对照组及单纯PS组（P＜0.01）。单纯PS组患者Fins及HOMA-IR水平明显高于对照组,PSMS组患者PASI水平明显高于单纯PS组（P＜0.01）。Pearson线性相关分析得知,趋化素与PASI、BMI、WC、TG、LDL-C、hs-CRP、IL-6均呈明显正相关（P均＜0.05或＜0.01）。进一步以血清趋化素为因变量,将与因变量具有线性关系的PASI、BMI、WC、TG、LDL-C、hs-CRP、IL-6为自变量进行多元逐步回归分析得知,WC、TG、hs-CRP、IL-6对趋化素存在影响（P均＜0.05或＜0.01）。 结论趋化素参与PS的发生及发展过程,其水平的变化与PS患者的病情严重程度、肥胖、糖脂代谢紊乱及炎症反应存在密切联系,为评估PS病情发展及有效治疗PS提供新的思路。     

来曲唑联合米非司酮对子宫肌瘤模型大鼠的消瘤效果及对TIMPs和PTEN蛋白表达的影响

目的 探讨曲唑联合米非司酮对子宫肌瘤模型大鼠的消瘤效果及对基质金属蛋白酶组织抑制因子(TIMPs)和肿瘤抑制蛋白磷酸酶和张力蛋白同源物(PTEN)蛋白表达的影响.方法 40只2月龄成年未孕SD大鼠为研究对象,采用雌孕激素双重造模法建立子宫肌瘤模型,选择成模及正常大鼠共36只,按照实验目的分为4组:模型组仅进行生理盐水干...     

Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

Irritable bowel syndrome (IBS), which is characterized by recurrent abdominal pain and disordered bowel habits, is one of the most common functional bowel disorders. IBS is a substantial burden on both patient health-related quality of life and healthcare costs. Several pathophysiologic mechanisms have been postulated for the occurrence of IBS, including altered gastrointestinal motility, visceral hypersensitivity, changes in gut permeability, immune activation, gut-brain dysregulation, central nervous system dysfunction, and changes in the gut microbiota. Of note, both qualitative and quantitative differences have been observed in the gut microbiota of a population with IBS versus a healthy population. Because of the substantial interest in the gut microbiota and its role as a therapeutic target in IBS, this article provides an overview of specific interventions with the potential to modulate the gut microbiota in IBS, including elimination diets, prebiotics, probiotics, synbiotics, and nonsystemic antibiotics. Although probiotics and synbiotics are generally well tolerated, differences in the composition and concentration of different bacterial species and inclusion or exclusion of prebiotic components varies widely across studies and has prevented strong recommendations on their use in IBS. For nonsystemic antibiotics, rifaximin is indicated in the United States for the treatment of IBS with diarrhea in adults and has been shown to be efficacious and well tolerated in well-designed clinical trials. Overall, more consistent evidence is needed regarding the efficacy and safety of elimination diets, prebiotics, probiotics, and synbiotics for the treatment of patients with IBS. Furthermore, additional well-designed studies are needed that examine alterations in the gut microbiota that occur with these interventions and their potential associations with clinical symptoms of IBS.