肝硬化患者胆囊运动功能的超声研究

应用实时超声技术，观察了30例肝硬化患者和20例正常人液体脂餐后的胆囊运动功能。结果如下：肝硬化组和对照组空腹胆囊容积分别为53．59±32．49ml和20．95±6．88ml（P＜0．01）；剩余容积分别为18．13±13．41ml和7．59±3．32ml（P＜0．001）；胆囊排空率分别为62．4±20％和63．48±11．62％（P＞0．05）；胆囊排空时间分别为98．5±30．15min和45．5±17．61min（P＜0．001）；餐后胆囊收缩频率分别为1．14±0．37次／10min和3．56±0．85次／10min（P＜0．001）；胆囊收缩幅度分别为0．12±0．06和0．13±0．04（P＞0．05）、结果发明．肝硬化患者存在胆囊张力低下和运动障碍。推测胆囊运动功能障碍在肝硬化患者胆囊结石的发病机制中可能起了一定作用。     

经口内镜下肌切开术治疗贲门失弛缓症的中长期疗效

【目的】探讨经口内镜下肌切开术（POEM ）治疗贲门失弛缓症（AC ）的中长期疗效。【方法】应用POEM治疗133例AC患者,术后定期随访,收集患者一般情况、症状评分、并发症、复发、内镜及钡餐检查等资料。【结果】133例患者均成功完成手术,平均操作时间为58．8 min ,隧道长度平均为13．5 cm ,肌切开长度平均为10．4 cm。术后患者症状明显缓解,Eckardt评分较术前明显降低（6．4 vs 0．5,P ＜0．001）;食管直径较术前显著缩小（59．0mmvs32．4mm,P ＜0．001）;并发症发生率为6．8％（9／133）,其中气肿发生率为4．5％（6／133）;平均随访19．3个月,99．2％（132／133）有效,随访期内无一例复发。【结论】POEM 治疗AC可获得满意的中长期疗效,其远期疗效及并发症仍有待于进一步随访评估。     

幽门螺杆菌CagA+感染与球部溃疡产生的关系

【目的】为了解幽门螺杆菌（H．pylori）产毒株（CagA^＋株）感染与十二指肠球部溃疡发生的关系。【方法】58例胃镜检查患者,分成十二指肠球部溃疡（DU）与非溃疡消化不良（NUD）两组,用ELISA方法检测血清CagA抗体（CagA-IgG）滴度并用目测法定性。时两组检测结果进行比较分析。【结果】DU组CagA-IgG光密度值及CagA^＋菌株感染率均高于NUD组,差异有显著性（P〈0．05）。【结论】CagA^＋H．pylori感染与DU产生有关。     

幽门螺杆菌CagA+株感染对胃液EGF的影响

【目的】了解幽门螺杆菌（Hp）产毒株（CagA）感染对胃液表皮生长因子（EGF）浓度的影响及其与十二指肠球部溃疡（DU）发生的关系。【方法】158例DU与非溃疡消化不良（NUD）患者，用ELISA方法检测其血清CagA抗体（CagA-IgG）滴度并用目测法定性，并测定胃液EGF浓度。【结果】CagA^＋者胃液EGF浓度显著低于CagA^-者，且差异有显著性（P〈0．01）。【结论】CagA^＋株Hp感染使胃液EGF水平降低。     

双镜联合微创保胆取石术与腹腔镜胆囊切除术治疗胆囊结石的临床疗效比较

【目的】对比研究双镜联合微创保胆取石术与腹腔镜胆囊切除术（LC ）治疗胆囊结石的临床效果。【方法】回顾性分析2010年3月至2012年3月本院收治的96例胆囊结石患者的临床资料。按照手术方式的不同,分为双镜联合微创保胆取石术组（双镜组）和仅作LC手术的对照组,每组48例。对比观察两组患者治疗的临床效果及其并发症。【结果】双镜组和对照组的手术时间、切口感染、胆漏、胆囊结石复发率、胃肠道功能恢复时间、住院时间比较差异无统计学意义（ P ＞0．05）;双镜组的腹胀、腹泻及消化不良症状的发生率明显少于对照组（ P ＜0．05）。【结论】两种术式治疗胆囊结石均安全、有效、并发症少;但双镜术式保留了胆囊的生理功能,与LC术式比较并发症发生率更低。     

熊果酸对人前列腺癌DU145细胞增殖及凋亡的影响

【目的】探讨熊果酸对人前列腺癌DU145细胞增殖及凋亡的影响。【方法】常规培养前列腺癌细胞系DU145,采用不同浓度熊果酸干预48 h ,细胞增殖与毒性分析（CCK‐8）法检测DU145细胞增殖;流式细胞术检测DU145细胞的凋亡率;Western blot检测DU145细胞p‐Akt及bcl‐2蛋白表达;实时定量聚合酶链式反应（qRT‐PCR）检测 PTEN mRNA 表达。【结果】细胞增殖抑制试验显示熊果酸呈浓度依赖性抑制DU145细胞生长;0、10、20μmol／L药物处理细胞48 h后其早期凋亡率分别为（2．15±0．24）％、（13．52±1．83）％及（16．69±2．56）％,晚期凋亡率分别为（3．28±0．53）％、（18．47±2．64）％及（23．70±1．99）％,差异均有统计学意义（ P ＜0．05）;与空白对照组相比,熊果酸作用的DU145细胞p‐Akt及bcl‐2蛋白表达水平均降低（均 P ＜0．05）,PTEN mRNA表达水平上升（ P ＜0．05）。【结论】熊果酸能够浓度依赖地抑制DU145细胞增殖,其机制可能是通过抑制PT EN／P13K／Akt信号转导通路来实现的。     

保胆取石手术适应证的初步探讨

【目的】探讨胆囊收缩功能障碍及缩胆囊素（CCK）A受体（AR）与胆囊结石的关系,为临床明确保胆手术适应证提供理论依据。【方法】B超测量息肉组、结石组胆囊的胆囊壁厚度,长、宽、横径,计算胆囊收缩率,酶免疫组织化学法染色,观察胆囊壁中CCK-AR分子蛋白表达水平。【结果】①结石组胆囊壁厚度明显高于息肉组（ P ＜0．05）;②结石组胆囊收缩率明显低于息肉组（ P ＜0．05）。③结石组胆囊收缩率与胆囊壁厚度二者呈显著负相关。④结石组平滑肌CCK-AR低于息肉组（ P＜0．01）。⑤结石组患者的胆囊收缩率与平滑肌CCK-AR蛋白表达阳性细胞数二者呈显著正相关。【结论】①胆囊收缩功能障碍与CCK-AR减少有关。②胆囊结石患者胆囊壁厚度与胆囊收缩功能成明显负相关。③保胆手取石术的基本条件是胆囊收缩率＞50％,胆囊壁厚度＜0．30 cm。     

小剂量瑞芬太尼在腹腔镜胆囊切除术气管拔管期的应用

【目的】观察拔管期持续泵注小剂量瑞芬太尼对腹腔镜胆囊切除术气管拔管的影响。【方法180例AsAI～Ⅱ级择期腹腔镜胆囊切除术患者,随机分为两组,每组40例。瑞芬太尼组（I组）：胆囊管切除后采用小剂量瑞芬太尼持续泵注;异氟醚组（Ⅱ纽）：胆囊管切除后采用单纯异氟醚吸入的麻醉方法。麻醉诱导均为芬太尼0．001mg／kg,丙泊酚1～2mg／kg,咪唑安定0．08～0．1mg／kg,维库溴铵0．8mg／kg,麻醉维持采用吸入异氟醚以及持续泵注瑞芬太尼0．05～2．0μg／（kg·min）,丙泊酚2．0～2．5mg／（kg·min）。胆囊管切除后Ⅱ组停用瑞芬太尼,吸入0．5％～1．5％异氟醚,I组持续泵注0．15肛g／（kg·min）瑞芬太尼,待有拔管指征时,拔除气管导管。记录麻醉前、拔管前1min、拔管即刻、拔管后3min的SBP,DBP及HR及清醒时间,拔管时间和躁动发生率。【结果】两组患者年龄、手术时间、麻醉时间、手术方式及术前血压、心率均无显著性差异（P〉0．05）,I组拔管后心血管反应平稳,清醒时间拔管时间与Ⅱ组时间无显著差异（P〉0．05）,躁动率I组与Ⅱ组比有显著差异（P〈0．05）。【结论】小剂量瑞芬太尼用于腹腔镜胆囊切除术,拔管期不延长拔管时间,心血管系统平稳,躁动发生率低,优于吸入麻醉。     

肝胆功能显像的定量分析在评价胆道疾病中的价值

20例正常人 ,6 3例肝胆患者进行99mTc -EHIDA动态功能显像定量分析 ,利用 90分钟的动态图象 ,建立肝感兴趣区的时间放射性曲线 ,计算肝脏泌胆分数 (HEF) ,半排时间 (TEX) ,高峰时间 (Tup)利用脂餐刺激内源性cck释放 ,计算排胆分数 (GBEF) ,排胆期 (GBEP) ,排胆率 (GBER)。结果 :正常受试者与胆汁淤积组肝脏泌胆功能 ,胆囊运动功能测定的比较 ,显示正常人与胆汁淤积组之间有显示差异 ,P <0 0 5 ;胆汁淤积组GBEP、GBEF、GBER、HEF均较正常人明显降低 ,Tex、Tup明显延长 ;手术前后肝脏 (HEF)胆囊 (GBEF)的比较显示手术后肝 ,胆功能明显改善 ;核素显像与B超比较 ,除胆石症B超诊断准确率明显高于核素显像 ,胆管炎 ,慢性胰腺炎 (胆源性 ) ,胆道肿瘤差别不大 ;胆道畸形 ,Oddi括约肌功能梗阻核素显像显示高于B超。因此 ,肝胆功能显像的定量分析在诊断胆道疾病上具有重要意义     

双层螺旋CT仿真内镜成像技术对胆囊炎的诊断价值

【目的】探讨双层螺旋CT仿真内窥镜成像技术（CTVE）对胆囊炎的诊断价值。【方法】选取2013年9月至2014年9月本院收治的高度疑似胆囊炎患者138例。本研究取得患者及家属的知情同意并签署知情同意书后,对患者行常规彩超检查后采用双层螺旋CT仿真内镜成像检查,对胆囊大小、胆囊壁及胆囊内改变、胆囊周围改变等结果结合手术病理结果进行对比分析。【结果】138例患者病理诊断为胆囊炎,CTVE在胆囊容量、宽径、纵径、囊壁和胆总管检测中优于常规彩超,差异均有统计学意义（P〈0．05）;两种测量方法在胆囊大小、囊壁及胆囊管改变的比较均有差异,差异均有统计学意义（P〈0．05）;CT仿真内镜成像与常规彩超在诊断胆囊炎合并胆囊结石、泥沙样结石,胆囊内回声改变、对均匀回声和不均匀回声的诊断方面比较均有差异（均P〈0．05）;常规彩超确诊胆囊炎确诊率为93．48％;CTVE确诊胆囊炎135确诊率为97．83％,两组确诊率差异显著（P〈0．05）。【结论】CTVE不仅可以为临床提供准确的胆囊测量数据,还能对胆囊进行全面的、仿真地观察,对胆囊炎的诊断具有很高的临床应用价值。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

Recalcitrant giant orf recurrence after amputation: A case report and review of the literature

Orf is caused by a parapoxvirus. We present a recurrent, giant digital orf case in a female patient with a history of hairy cell leukemia. In spite of shave excision, the lesion progressed and recurred after digital amputation. Treatment with topical imiquimod cream and systemic subcutaneous interferon alfa‐2a was successful.