胃肠病领域中的营养学研究

营养 (ｎｕｔｒｉｔｉｏｎ)是指机体吸取各种物质 (营养素 ,ｎｕｔｒｉｅｎｔｓ) ,以供其生长、发育、维持代谢及取代损伤组织所需而进行的生命活动过程。人体消化器官功能的正常发挥和结构完整与良好的营养过程攸息相关。反之 ,机体的营养状态也可能直接或间接地影响消化器官的功能与结构改变。重视与胃肠病学领域有关的营养学研究将会深化消化系统疾病的研究 ,促进诊断与治疗工作的进一步提高。一、膳食营养素对肠道功能与结构的影响及其生物化学与分子学基础的研究膳食中氨基酸是小肠黏膜的主要燃料 ,也是小肠合成谷胱甘肽、含氮氧化物、…     

Targeting intestinal microflora in inflammatory bowel disease

TO THE EDITOR In their recent review article[1], Andoh and Fujiyama examined the various therapeutic approaches targeting intestinal microflora in patients with inflammatory bowel disease (IBD). I would like to provide some additional data to complete and update their comments. First of all, when considering the role of probiotics in 1BD treatment it must be emphasized that, in addition to Bifidobacteria, the Nissle 1917 E. coli strain and cocktails of microorganisms such as VSL # 3 mentioned in the article, other probiotic agents have been tested in the short- and long-term treatment of either ulcerative colitis and Crohn's disease, the results of those studies being reported in major international scientific journals.     

ICU医院获得性急性肝脏损伤的发病情况和易患因素

目的探讨医院获得性急性肝脏损伤（HA-ALI）在ICU中的发病情况和易患因素,并分析影响HA-ALI患者预后的高危因素。方法对综合性ICU收治的患者入院时肝功能正常,在住院期间出现急性肝损伤（ALI）的127例重症患者临床资料进行回顾性分析。结果 ICU中HA-ALI发病率为7.83%,药物、胃肠外营养、机械通气等是常见的易患因素;死亡组患者年龄较大（P〈0.01）,血清白蛋白较低（P〈0.01）;心肺复苏、休克和镇静与麻醉药物的使用,为独立危险因素。结论重症患者HA-ALI发生率较高,一些治疗措施有可能引起或加重ALI,患者的年龄、肝功能状况和休克等因素对患者的预后产生较大的影响。     

Does endothelium agree with the concept of idiopathic hepatic vessel thrombosis？

AIM: To investigate the major steps of thrombogenesis and to identify the differences in these steps between idiopathic patient group and control group.METHODS: Fibrinogenesis was studied by measuring the activated factor VII, total and free levels of tissue factor pathway inhibitor (TFPI). The fibrinolysis step was investigated by determining the global fibrinolytic capacity. The endothelial function was assessed by measuring the levels of soluble adhesion molecules, namely soluble intercellular adhesion molecule 1 (sICAM-1), soluble vascular cell adhesion molecule 1 (sVCAM-1) and soluble E-selectin molecule. The exclusion criteria from “idiopathic” patient group were abdominal surgery, pregnancy, use of oral contraceptives, anti-phospholipid syndrome, Behçet’s disease, cancer, myeloproliferative diseases. The congenital factors like mutations of factor-V Leiden and prothrombin, deficiencies of proteins C and S, antithrombin, hyperhomocysteinemia and hyperfibrinogenemia were ruled out. The total number of patients was reduced from 96 to 9 (7 with portal vein thrombosis, 2 Budd Chiari syndrome) by exclusion criteria.RESULTS: The levels of adhesion molecules sICAM-1, sVCAM-1, free TFPI levels and global fibrinolytic capacity were significantly different (P < 0.05) in the patient group indicating an endothelial dysfunction and a lower fibrinolytic activity.CONCLUSION: These results show that this patient group should be tested by means of endothelial dysfunction and managed differently.     

30年儿内科消化系疾病的住院发病率比较

本文总结儿内科近30年消化系疾病住院总人数6832例,占同期儿内科总住院人数34747的19.66％,故为儿科常见病,多发病。如以发病部位为序、空肠、回肠发病占73.50％,口腔及口周占12.6％,胆肝占5.35％,胃、十二指肠占5.16％。以病因为序,细菌、病毒感染占65.33％,寄生虫占17.94％,先天性占6.98％。以主诉症状为序,腹泻占46.63％,腹痛占31.79％,呕吐占19.71％,腹胀占8.65％,并对腹泻、腹痛,呕吐、便血等进行分析及进一步探讨。30年来传染病明显下降及病情变轻。由于多数医院未成立儿内科消化疾病专科,设备简陋,就目前水平看,基础研究极少,有水平的经验总结不多。不少疾病尚未被认识,本文对儿科消化系疾病进一步研究的方向进行了讨论。     

遗传代谢性肝病

尽管遗传代谢性肝病在临床上并不多见,但因其在遗传性代谢病中占有重要位置,所以越来越受到人们重视。这类疾病通常指由于遗传性酶缺陷所致物质中间代谢紊乱,主要表现肝脏形态结构和(或)功能上病变,常伴有其他脏器的损害。目前认为这类肝病的发生机制有:酶缺陷导致代谢底物或衍生物蓄积,代     

肝脏疾病和心脏疾病之间的相互影响

肝脏疾病和心脏疾病共存有3种形式：即肝脏疾病影响心脏、心脏疾病影响肝脏及同一个病因导致肝脏和心脏损伤,把病人分为上述3种情况,可以缩小内科医生诊断范围,从而使临床诊断更方便。     

累及肺脏的急性胰腺炎29例临床分析

急性胰腺炎(AP)可出现全身多脏器功能损害，其中肺部表现较为常见。我们对我院近年来收治的29例AP患者的血气分析、肺部表现及防治措施进行分析。     

34例急性脑血管病及其肺部与肾脏并发症临床探讨

急性脑血管病及其并发肺部与肾脏病变是较常见,且严重的并发症。我科自1993年1月～1996年10月共观察34例,现总结报告如下。临床资料 一般资料 34例中男16例,女18例。年龄40～84岁,60岁以上30例。既往有高血压史29例,高血脂9例。脑卒中1例,糖尿病6例。34例中出血性脑卒中9例:其中脑出血8例,蛛网膜下腔出血2例(其中1例为脑出血,继发蛛网膜下腔出血)。缺血性脑卒中24例:其中脑梗塞20例,TIA3例,脑栓塞、混合性     

Helicobacter pylori and extragastric diseases: A review

Helicobacter pylori(H. pylori) infection is very common and affects approximately half of the world population. It causes gastric diseases, but some authors have reported an association of H. pylori infection with other systemic manifestations beginning in 1994. The list of potential effects of H. pylori outside the stomach includes a number of extragastric manifestations and we focused on neurological, dermatological, hematologic, ocular, cardiovascular, metabolic, allergic, and hepatobiliary diseases. This review discusses these important reported manifestations that are not related to the gastrointestinal tract.     

牙齿开髓治疗对老年心血管病患者心率、血压、心电图的影响

目的　探讨老年心血管病患者在心电监护下进行牙齿开髓治疗的安全性。　方法　对2 33例患急、慢性牙髓炎同时伴心血管疾病的老年患者 (患病组 )及 32例无心血管病史的老年患者(对照组 )牙齿开髓治疗全过程进行血压、心率、心电图的监测观察。　结果　患病组和对照组局麻时 ,血压分别平均升高 14 / 6、14 / 6mmHg(1mmHg =0 133kPa) ;心率平均加快 4 8、4 1次 /min。术中患病组及对照组血压分别平均升高 16 / 9、19/ 11mmHg ;心率加快 6 4、5 9次 /min。与术前相比 ,差异有显著性 (P <0 0 5 ) ;各组之间在术前、麻醉中、麻醉后 5min、术中、术后心率、血压的变化相比 ,差异无显著性 (P >0 0 5 )。部分老年心血管病患者术中出现心电图改变。　结论　老年心血管疾病患者在心电监护下进行开髓治疗是可行的。     

经内镜微创治疗胆胰疾病的应用价值

目的　探讨经内镜微创治疗胆胰疾病的应用价值。方法　回顾性分析 1995年 7月至 2 0 0 2年 3月经内镜微创治疗胆胰疾病 42 2例次的效果及并发症 ,探讨各种方法的应用价值及优缺点。结果　 42 2例患者分别采取了乳头切开、气囊扩张、机械碎石、取石、鼻胆引流术、胆道放置内支架等治疗 ,其成功率为 94 5 5 %,并发症3 79%。结论　内镜微创治疗胆胰疾病有效、安全且对病人损伤小、可代替部分胆胰疾病的外科手术治疗。     

La transition de la pédiatrie à l’âge adulte : recommandations de prise en charge de la filière des maladies auto-immunes et auto-inflammatoires rares FAI2R

Autoimmune and autoinflammatory diseases (AIDs) are a heterogeneous group of diseases. They can occur in childhood and account for significant morbidity and mortality. Transitioning from pediatric to adult healthcare can be difficult for patients and their families. It can interfere with patient follow-up and management, and eventually lead to complications. Although recommendations exist for the successful transition of patients with chronic diseases, few are specifically adapted to children and adults with AIDs (Suris et al., 2015–Solau-Gervais, 2012). The French working group on transition of the rare autoimmune and autoinflammatory diseases presents its reflections and recommendations for a successful transition. Preparation for transition should start early. Its goals are to empower adolescents by providing them with the knowledge to manage their own care, respond appropriately to changes in their condition, and evolve within the adult healthcare system. This requires the active participation of the patient, his or her family, as well as the pediatric and adult medical teams. The transition process involves multidisciplinary care and dedicated therapeutic education programs. Finally, the identification of medical specialists by region, trained in rare AIDs and accompanied by expert patients, may improve the management of patients with rare AIDs from adolescence to adulthood.     

Involvement of midkine in autoimmune and autoinflammatory diseases

Abstract

Midkine (MK) is a heparin-binding growth factor that markedly expressed during embryogenesis but downregulated to inconsiderable levels in healthy adults. However, MK is upregulated during tissue repair and in many pathologic conditions, mostly malignancies and inflammatory diseases. MK promotes a number of functions in target cells such as migration, proliferation, survival, growth, reproduction and repair, angiogenesis, and gene expression. It acts as a pro-inflammatory cytokine and contributes to chronic inflammation via promoting chemotaxis and tissue infiltration of neutrophils and macrophages. Furthermore, MK upregulated the production of various inflammatory mediators (i.e. interleukin (IL) 6 and IL8). Recent studies have demonstrated strong evidence that MK is involved in the onset and progression of autoimmune rheumatic diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and Sjögren’s syndrome (SS) and other autoimmune conditions such as multiple sclerosis (MS). Additionally, it has been shown that MK is overexpressed in two major clinically defined forms of inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC), which are classified as autoinflammatory diseases. Taken together, MK is involved in the pathogenesis of autoimmune and autoinflammatory diseases and may serve as an indicator and biomarker in these conditions. Furthermore, MK inhibitors are expected to contribute in the management of these diseases.     

Bone Abnormalities in Gastrointestinal and Hepatic Disease

Reviews in Endocrine and Metabolic Disorders -     

22例继发性菌球型肺曲菌病病理与X线对照研究

经手术确诊的继发性菌球型肺曲菌病２２例，在院外均被误诊，而我院术前诊断符合率亦仅为４５．５％。本文就其病理所见与Ｘ线表现对照研究，认为非典型病例是诸多误诊因素中的重要因素。     

Cardiorenal syndromes

Cardiorenal syndromes (CRS) have been subclassified as five defined entities which represent clinical circumstances in which both the heart and the kidney are involved in a bidirectional injury and dysfunction via a final common pathway of cell-to-cell death and accelerated apoptosis mediated by oxidative stress. Types 1 and 2 involve acute and chronic cardiovascular disease (CVD) scenarios leading to acute kidney injury or accelerated chronic kidney disease. Types 2 and 3 describe acute and chronic kidney disease leading primarily to heart failure, although it is possible that acute coronary syndromes, stroke, and arrhythmias could be CVD outcomes in these forms of CRS. Finally, CRS type 5 describes a simultaneous insult to both heart and kidneys, such as sepsis, where both organs are injured simultaneously. Both blood and urine biomarkers are reviewed in this paper and offer a considerable opportunity to enhance the understanding of the pathophysiology and known epidemiology of these recently defined syndromes.