寒冷—束缚应激对大鼠结肠运动的后续效应

对大鼠结肠收缩活动及排粪质量的观察发现，持续6小时的寒冷束缚应激引起其结肠动力显著增强，应激解除后60小时仍未恢复。应激尚可改变进食和P物质等生理性刺激引起的结肠动力反应。提示应激扰乱结肠运动的后续效应是多方面的，进一步支持应激与功能性肠病的可能联系。     

Multiple soft fibromas of the lid

Fibromas are benign tumors that are composed of fibrous or connective tissue. They can grow in all organs, arising from mesenchymal tissue (a type of loose connective tissue). The term “fibroblastic” or “fibromatous” is used to describe tumors like the fibroma. This 69-year-old male presented to us with giant, multiple, very slowly progressive, painless, noninflammatory, soft, trans-illuminant, pedunculated lid swellings with a two decade history. There were no other swellings on the body. He was clinically normal on systemic examination except for the immature cataracts in both eyes. The diagnosis was confirmed on histopathology. Simple excision removed all the soft fibromas virtually leaving no scar. A review of literature world-wide using Medline Plus/PubMed revealed this to be the only reported case of multiple giant soft fibromas of the lid.     

CO2激光喉显微手术与电子喉镜手术治疗声带息肉效果比较

目的：比较支撑喉镜下CO2激光显微手术与电子喉镜下手术治疗声带息肉的临床疗效。方法选取2014年1月至2015年1月芜湖市第二人民医院收治的144例声带息肉行支撑喉镜下CO2激光显微手术患者(激光组)及同期门诊75例电子喉镜下手术的声带息肉患者(喉镜组),比较分析两组患者的临床治疗效果。结果激光组显效120例,有效19例,无效5例,总有效率为96．52%;喉镜组治愈60例,有效12例,无效3例,总有效率为96．00%。两组总有效率比较,差异无统计学意义( P>0．05)。结论声带息肉的手术方式应根据患者的自愿、声带息肉的基底部以及声门暴露情况选择不同的手术。     

An orally administrated nucleotide-delivery vehicle targeting colonic macrophages for the treatment of inflammatory bowel disease

Tumor necrosis factor-alpha (TNF-α) plays a central role in the pathogenesis of inflammatory bowel disease (IBD). Anti-TNF-α therapies have shown protective effects against colitis, but an efficient tool for target suppression of its secretion - ideally via oral administration - remains in urgent demand. In the colon tissue, TNF-α is mainly secreted by the colonic macrophages. Here, we report an orally-administrated microspheric vehicle that can target the colonic macrophages and suppress the local expression of TNF-α for IBD treatment. This vehicle is formed by cationic konjac glucomannan (cKGM), phytagel and an antisense oligonucleotide against TNF-α. It was given to dextran sodium sulfate (DSS) colitic mice via gastric perfusion. The unique swelling properties of cKGM enabled the spontaneous release of cKGM& antisense nucleotide (ASO) nano-complex from the phytagel scaffold into the colon lumen, where the ASO was transferred into colonic macrophages via receptor-mediated phagocytosis. The treatment significantly decreased the local level of TNF-α and alleviated the symptoms of colitis in the mice. In summary, our study demonstrates a convenient, orally-administrated drug delivery system that effectively targets colonic macrophages for suppression of TNF-α expression. It may represent a promising therapeutic approach in the treatment of IBD.     

临床路径在胃息肉內镜下粘膜切除术中的应用效果评价

目的 评价临床护理路径在胃息肉內镜下粘膜切除术(EMR)中的应用效果。方法 选择2011年9月-2013年9月之间行胃息肉內镜下EMR手术的患者120例,随机分为实验组和对照组,每组60例,实验组采用预先制定的临床护理路径表实施护理,对照组采用常规护理。对两组患者并发症发生情况和护理满意度进行测评。结果 实验组并发症的发生率低于对照组,两组并发症发生率比较差异有统计学意义(P<0.05)。护理满意度的测评得分有差异,有统计学意义(P<0.05)。结论 采用预先制定的临床护理路径表实施护理,可以提高胃息肉EMR治疗的疗效和安全性,减少出血,穿孔并发症,同时使护患关系更密切,提高患者满意度,节省了护士大量时间,大大提高了工作效率,缩短了病人平均住院天数,降低了住院费用。     

Early infective complications and late recurrent cancer in stapled colonic anastomoses

Between 1978 and 1981, 73 patients with colonic or rectal cancer were randomized to have their anastomoses made by either a single interrupted layer of braided polyester sutures, or by a circular stapling instrument. Of these operations, 20 were considered to have been palliative, the remaining 53 being potentially curative. The incidence of local recurrence in the latter group was analyzed in relation to initial septic and anastomotic complications. The 53 patients were followed for a median of 36 months (range, 1 to 87); 24 were alive and well and 22 had died of disseminated cancer or unrelated causes. Seven patients died with local recurrent disease proved at laparotomy or autopsy after a median of 33 months (range, 3 to 72). Thirty anastomoses were stapled and 23 sutured; of the seven patients who died with local recurrent disease, six had stapled anastomoses (Fisher's exact probability F₂=0.12; log rank chi-square=3.53, 0.05<P<0.10). Two patients who died with locally recurrent disease had had clinically apparent anastomotic leads and one other patient had had a radiologically demonstrated leak. This compares with a total of seven leaks (clinical or radiologic) in the remaining group of 46 patients with no recurrence (Fisher's exact probability F₂=0.11). These results tend to support the hypothesis that anastomotic leaks may lead to locally recurrent disease, particularly after stapled anastomoses Supported by the Scarborough Research Fund.     

大肠息肉部位、大小、形态等与病理分型的关系

目的探讨大肠息肉部位、大小、形态、数目部与病理类型的关系。方法经结肠镜检查诊断200例结肠息肉情况与病理检查进行分析。结果在≤1cm的息肉中以炎性息内较多见，在〉lcm的息肉中以腺瘤性息肉较多见。息肉恶变均发生在1cm以上，尤其是〉2cm的息肉。在有蒂息肉中以炎性较多见，均为良性，无蒂息肉中以腺瘤性较多见。最常发生于直肠和乙状结肠的息肉以炎性较多见；近端结肠的息肉，腺瘤性相对较多。单发息肉中多数是炎性息肉，多发息肉中多数是腺瘤性息肉。结论大肠息肉的部位和大小与病理类型有关。     

Healing of colonic anastomoses: Comparative experimental study of glued,manually sutured,and stapled anastomoses

In 10 pigs a nonsutured, glued colonic anastomosis was constructed with a modified stapling device without staples and compared with an EEA-stapled anastomosis and a one-layer-sutured anastomosis concerning radiologic appearance, breaking strength, circulation, and collagen concentration.¹⁴¹Ce-labeled microspheres were used for measurements of the anastomotic blood flow before the animals were sacrificed on the 4th postoperative day. The breaking strength was recorded and an anastomotic index calculated. No leakage was found. The anastomotic width did not differ between the groups, but the interindividual variation was more prominent in the sutured group. The handsewn and stapled anastomoses were stronger than the glued anastomosis (P=0.0009 and 0.0054, respectively). There was an increase in the anastomotic circulation in all of the anastomoses, but no differences were seen between groups. The collagen concentration was independent of the technique used.