Fully automated diagnostic system with artificial intelligence using endocytoscopy to identify the presence of histologic inflammation associated with ulcerative colitis (with video)

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医用纤维蛋白胶在甲状腺手术中的应用

目的探讨医用纤维蛋白胶在甲状腺手术中的应用价值。方法将79例甲状腺手术患者随机分成实验组（44例）和对照组（35例）。实验组行甲状腺切除术，同时在手术创面喷洒医用纤维蛋白胶5ml，对照组行甲状腺切除术，术中不用医用纤维蛋白胶，两组均放置引流管。观察两组术后总引流量、第1天引流量、拔管时间、伤口感染和拆线时间等情况。结果实验组术后皮下总引流量、第1天引流量和拔管时间均少于对照组（P〈0．05）。两组间伤VI感染发生率、拆线时间无明显差别（P〉0．05）。结论应用医用纤维蛋白胶可有效地减少甲状腺术后创面渗液，促进创面愈合。     

Long-Term Outlook after Successful Fibrin Glue Ablation of Cryptoglandular Transsphincteric Fistula-in-Ano

Purpose

Initial success rates for fibrin glue ablation of cryptoglandular transsphincteric fistulas have been disappointing. We examined long-term outcomes after initially successful fibrin glue ablation of cryptoglandular transsphincteric fistulas.

Methods

Retrospective review identified 36 adult patients with cryptoglandular transsphincteric fistula Tisseel VH® fibrin glue ablation that was performed from May 2000 to March 2005. Fibrin glue ablations were performed under supervision of fellowship-trained colorectal surgeons. Follow-up interval was based on time until recurrence of fistula or time of last fistula-free evaluation.

Results

Twenty-four men and 12 women patients had a mean age of 50 (range, 27–85) years. Twenty patients responded to initial fibrin glue ablation treatment. Two additional patients healed with secondary fibrin glue ablation. Sixty-six percent (22/33 patients) of cryptoglandular transsphincteric fistulas were closed at three months. Eleven patients failed fibrin glue ablation at a mean of 33 (range, 6–41) days. Seventeen of 22 short-term success patients (3 months) were available for long-term follow-up. Ninety-four percent (16/17 patients) remained healed at final long-term follow-up. The remaining patient recurred just before the six-month follow-up.

Conclusions

Despite the suboptimal early success rate of fibrin glue ablation for cryptoglandular transsphincteric fistulas, when a fistula does close for at least six months this appears to be a durable closure. A single patient recurred after appearing healed at the three-month check.

     

Molecular defects in mucosal serotonin content and decreased serotonin reuptake transporter in ulcerative colitis and irritable bowel syndrome

BACKGROUND & AIMS: Serotonin (5-HT) is a critical signaling molecule in the gut. 5-HT released from enterochromaffin cells initiates peristaltic, secretory, vasodilatory, vagal, and nociceptive reflexes. Despite being pathophysiologically divergent, ulcerative colitis (UC) and irritable bowel syndrome (IBS) are both associated with clinical symptoms that include alterations in the normal patterns of motility, secretion, and sensation. Our aim was to test whether enteric 5-HT signaling is defective in these disorders. METHODS: Rectal biopsy specimens were obtained from healthy controls and patients with UC, IBS with diarrhea (IBS-D), and IBS with constipation (IBS-C). Key elements of 5-HT signaling, including measures of 5-HT content, release, and reuptake, were analyzed with these samples. RESULTS: Mucosal 5-HT, tryptophan hydroxylase 1 messenger RNA, serotonin transporter messenger RNA, and serotonin transporter immunoreactivity were all significantly reduced in UC, IBS-C, and IBS-D. The enterochromaffin cell population was decreased in severe UC samples but was unchanged in IBS-C and IBS-D. When 5-HT release was investigated under basal and mechanical stimulation conditions, no changes were detected in any of the groups relative to controls. CONCLUSIONS: These data show that UC and IBS are associated with similar molecular changes in serotonergic signaling mechanisms. While UC and IBS have distinct pathophysiologic properties, these data suggest that shared defects in 5-HT signaling may underlie the altered motility, secretion, and sensation. These findings represent the first demonstration of significant molecular alterations specific to the gut in patients with IBS and support the assertion that disordered gastrointestinal function in IBS involves changes intrinsic to the bowel.     

纤维蛋白胶运用于翼状胬肉手术的临床观察

目的:观察纤维蛋白胶运用于翼状胬肉切除联合自体结膜移植术的临床效果。方法:选取60例60眼原发性鼻侧翼状胬肉患者随机分为试验组(纤维蛋白胶组)和对照组(缝线组)各30例30眼。行翼状胬肉切除联合自体结膜移植术,试验组采用纤维蛋白胶粘合固定植片,对照组采用10-0尼龙线缝合固定植片。术后随访6mo,观察手术时间、术后疼痛、异物感、并发症以及复发。结果:试验组手术时间(24.5±6.5min)较对照组(35.2±5.4min)短,两组差异有统计学意义(P<0.05)。术后患者疼痛和异物感试验组较对照组减轻(P<0.05)。两组均未发生术后严重并发症,试验组结膜下出血发生率低于控制组(P<0.05),6mo时纤维蛋白胶组1例(3%)复发,缝线组3例(10%)复发。结论:纤维蛋白胶运用于翼状胬肉手术固定结膜植片能减轻患者术后不适,减少手术时间及术后并发症,是一种安全有效的方法。     

Risk analysis of main mycotoxins occurring in food for children: An overview

Mycotoxins are secondary metabolites produced by fungi contaminating the food chain that are toxic to animals and humans. Children up to 12 years old are recognized as a potentially vulnerable subgroup with respect to consumption of these contaminants. Apart from having a higher exposure per kg body weight, they have a different physiology from that of adults. Therefore they may be more sensitive to neurotoxic, endocrine and immunological effects. For these reasons, a specific and up-to-date risk analysis for this category is of great interest.In this review, an accurate analysis of the main mycotoxins occurring in food intended for children (deoxynivalenol, aflatoxins, ochratoxins, patulin and fumonisins) is presented. In particular, known mechanisms of toxicity and levels of exposure and bioaccessibility in children are shown. In addition, recent discoveries about the strategies of mycotoxins managing are discussed.     

Calendering as a direct shaping tool for the continuous production of fixed-dose combination products via co-extrusion

In this study calendering is used as a downstream technique to shape monolithic co-extruded fixed-dose combination products in a continuous way. Co-extrudates with a metoprolol tartrate-loaded sustained-release core and a hydrochlorothiazide-loaded immediate-release coat were produced and immediately shaped into a monolithic drug delivery system via calendering, using chilled rolls with tablet-shaped cavities. In vitro metoprolol tartrate release from the ethylcellulose core of the calendered tablets was prolonged in comparison with the sustained release of a multiparticulate dosage form, prepared manually by cutting co-extrudates into mini-matrices. Analysis of the dosage forms using X-ray micro-computed tomography only detected small differences between the pore structure of the core of the calendered tablet and the mini-matrices. Diffusion path length was shown to be the main mechanism behind the release kinetics. Terahertz pulsed imaging visualized that adhesion between the core and coat of the calendered tablet was not complete and a gradient in coat thickness (varying from 200 to 600 μm) was observed. Modulated differential scanning calorimetry and X-ray diffraction indicated that the solid-state properties of both drugs were not affected by the calendering procedure.     

重组结核杆菌融合蛋白(EC)用于诊断结核分枝杆菌感染的有效性和安全性系统评价

目的: 系统评价重组结核杆菌融合蛋白(EC)相较于结核菌素纯蛋白衍生物(TB-PPD)用于诊断结核分枝杆菌(Mycobacterium tuberculosis,MTB)感染的有效性和安全性。方法: 检索临床指南数据库、生物医学文献数据库、卫生行政部门和行业协会官方网站及不良反应监测官方网站,检索时间均自建库截止到2022年2月。英文检索词:Recombinant Mycobacterium tuberculosis fusion protein、CFP10/ESAT6;中文检索词:重组结核分枝杆菌融合蛋白、重组结核杆菌融合蛋白、宜卡、CFP10/ESAT6。收集重组结核杆菌融合蛋白(EC)和结核菌素纯蛋白衍生物(TB-PPD)诊断MTB感染有效性和安全性的指南、共识、团体标准、系统评价和原始研究等。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险,根据异质性大小采用Meta分析或描述性分析。结果: 纳入指南2部、专家共识3篇、团体标准2部,均指出重组结核杆菌融合蛋白(EC)和结核菌素纯蛋白衍生物(TB-PPD)可用于诊断MTB感染和结核病辅助诊断。纳入系统评价1篇,结果显示,重组结核杆菌融合蛋白(EC)皮肤试验共招募参与者887名,其敏感度为86.06%(95%CI:82.39%~89.07%)。纳入原始研究4篇,均为随机对照试验,有效性Meta分析结果显示,不区分人群,重组结核杆菌融合蛋白(EC)和结核菌素纯蛋白衍生物(TB-PPD)的敏感度(89.3% vs. 90.4%)和阴性似然比(0.177 vs. 0.220)的差异无统计学意义,重组结核杆菌融合蛋白(EC)的特异度(85.5% vs. 47.3%)、诊断比值比(42.238 vs. 8.040)、阳性似然比(6.048 vs. 1.710)、阳性预测值(66.0% vs. 35.1%)、阴性预测值(96.2% vs. 94.0%)优于结核菌素纯蛋白衍生物(TB-PPD),差异有统计学意义。安全性结果显示,重组结核杆菌融合蛋白(EC)和结核菌素纯蛋白衍生物(TB-PPD)不良事件均为局部瘙痒和疼痛,均未发生严重不良事件。结论: 重组结核杆菌融合蛋白(EC)可用于MTB感染诊断、辅助结核病诊断,相较于结核菌素纯蛋白衍生物(TB-PPD),其有效性表现更优。     

经静脉途径应用Eval胶联合弹簧圈栓塞治疗海绵窦区硬脑膜动静脉瘘

目的 探讨经静脉入路应用Eval胶联合弹簧圈栓塞治疗海绵窦区硬脑膜动静脉瘘（CS-DAVF）的安全性和有效性。方法 回顾性分析2015年1月至2020年10月收治的17例CS-DAVF的临床资料。所有病人均经静脉入路应用Eval胶联合弹簧圈栓塞治疗。结果 术后即刻DSA显示,17例CS-DAVF均完全栓塞。术后早期出现治疗相关并发症5 例（29.41%）,其中头痛2例,动眼神经麻痹2例,外展神经麻痹1 例。术后随访3~24个月,平均7.3个月;改良Rankin量表评分0分16 例,1分1例（遗留动眼神经麻痹）。结论 经静脉入路使用Eval胶联合弹簧圈栓塞治疗CS-DAVF,效果良好,治愈率高,并发症少。     

纤维蛋白凝胶对上颌扩弓成骨矿化的影响

目的 研究原位注射纤维蛋白凝胶对SD大鼠上颌扩弓成骨矿化的影响。方法 体外实验中,将大鼠骨髓间充质细胞（rBMSCs）在不同凝血酶浓度制备的纤维蛋白凝胶环境下进行共培养,通过CCK-8、 ALP染色和活性定量以及茜素红染色,检测梯度浓度凝血酶制备的纤维蛋白凝胶降解产物对rBMSCs细胞增殖和成骨分化的影响。将rBMSCs分别采用共培养、二维表面培养和三维培养方法与纤维蛋白凝胶进行结合,观察细胞形态和黏附情况。体内实验中,构建SD大鼠上颌扩弓模型（n=12）,以100 g作为扩弓力,扩弓7 d,随机分为2组,每组6只,将仅配戴14 d保持器作为对照组（R组）,将原位注射纤维蛋白凝胶联合配戴14 d保持器作为实验组（R+FG组）,通过显微CT（Micro-CT）三维重建和分析,比较新生骨量和骨矿化密度的差异。通过H-E染色、Masson三色染色、TRAP染色和顺序荧光染色,观察腭中缝的组织学差异。采用GraphPad Prism 8.0.1软件包对数据进行统计学分析。结果 体外实验结果显示,纤维蛋白凝胶降解产物对rBMSCs细胞增殖和成骨分化无显著影响（P>0.05）,且以上述3种方式培养的rBMSCs均具有良好的细胞延展性。体内实验结果显示,实验组新生骨量（P<0.001）和骨小梁矿化密度（P<0.01）较对照组显著提升,腭中缝内可见大量矿化程度更高的新生骨小梁组织;破骨细胞数量减少,矿化沉积速率显著加快（P<0.001）。结论 纤维蛋白凝胶降解产物对rBMSCs增殖、分化无影响。SD大鼠上颌扩弓后,腭中缝组织可通过原位注射纤维蛋白凝胶,促进新骨生成和矿化速率,抑制破骨细胞分化。