老年人大肠息肉的临床分析

目的 探讨老年人大肠息肉的临床特点及其与癌变的关系。方法 对我院经结肠镜检出的158例老年大肠息肉患者的临床特点进行回顾性分析，对其中120例进行1－6年（平均4．5年）的结肠镜随访，并与青中年组的437例患者相对照。结果 老年人大肠息肉的检出率、癌变率分别为30．0％及23．4％，均显著高于中青年组的10．2％及6．9％（P＜0．01），随年龄增长检出率有逐渐增加的趋势。分布以直肠和乙状结肠多见，但升结肠的癌变率（37．5％）明显高于左半结肠（14．3％，P＜0．05），且直肠、降结肠、横结肠及升结肠的癌变率也显著高于青中年组的同一部位（P＜0．01）；病理类型以腺瘤性息肉为多，占77．6％，也明显高于青中年组的同一病理类型（P＜0．01）。37例癌变息肉均为腺瘤性息肉，其中绒毛状腺瘤的癌变率（56．9％）显著高于管状腺瘤（3．4％，P＜0．01）。息肉体积大（＞2cm)、基底宽、数量多，癌变率高。腺瘤性息肉经内镜下摘除者其癌变率明显低于未摘除者（P＜0．01）。结论 老年人大肠息肉中的腺瘤性息肉的大小、形态、数量及病理类型是其癌变的主要危险因素，老年人应尽量行全结肠检查，检出大肠息肉者应尽可能首选肠镜下摘除，定期随访，减少癌变的机会。     

32例大肠锯齿状腺瘤临床、结肠镜及病理特点分析

目的探讨大肠锯齿状腺瘤患者的临床、结肠镜及病理特点。方法回顾性分析我院2008年4月-2009年12月消化内镜中心及病理科检出的32例大肠锯齿状腺瘤患者的临床、结肠镜及病理特点。结果32例大肠锯齿状腺瘤患者以腹痛就诊者20例（62．5％）,腹泻7例（21．7％）,便血2例（6．2％）,CEA升高体检2例（6．2％）,结肠癌术后复查1例（3．1％）;结肠镜检查病变位于直肠者18例（56．2％）,位于乙状结肠者3例（9．3％）,位于直乙交界处者5例（15．5％）,位于降结肠者2例（6．2％）,位于横结肠者3例（9．3％）,位于升结肠者1例（3．1％）;多发4例（12．5％）,单发28例（87．5％）;腺瘤直径多在1～6mm,最大直径20mm,平均直径9．5mm,32例大肠锯齿状腺瘤中广基息肉（Is）25例（77．3％）,亚蒂息肉（Isp）6例（19．6％）,有蒂息肉（Ip）1例（3．1％）。组织病理学检查为单纯锯齿状腺瘤8例（25．8％）,活检结果为锯齿状腺瘤,低级别上皮内瘤变22例（68．2％）,锯齿状腺瘤,局部高级别上皮内瘤变1例（3．1％）,锯齿状腺瘤,局部恶变1例（3．1％）,手术后病理证实为中分化腺癌。结论大肠锯齿状腺瘤作为一种独立的腺瘤形态与直结肠肿瘤密切相关,应引起重视。     

钛夹对防止结肠大息肉电切时发生出血的比较研究

目的评价钛夹对结肠大息肉电切时预防出血的效果。方法将67例（82颗大息肉）结肠大息肉的病人随机分为对照组及钛夹组。对照组34人，共39颗息肉，息肉平均直径22cm；钛夹组33人，42颗息肉，息肉平均直径2．5cm。先用钛夹钳夹息内的根部，平均每颗息肉1.4个止血夹，然后行息肉电切术。术后观察两组疗效及出血、穿孔发生率。用染色放大结肠镜观察随访。结果对照组一次性息肉完全切除率为100％（39／39），钛夹组为97，6％（41／42，P〉0．05）。对照组病理检查：腺瘤型息肉占92．3％（36／39），其余为增生性息肉。25％的腺瘤性息肉伴轻度非典型增生，2．8％的伴中度非典型增生和2．8％伴有癌变。钛夹组腺瘤性息肉占95．2％，其余为增生性息肉。27．5％的腺瘤性息肉伴有轻度非典型增生，7．5％的伴有中度非典型增生和7．5％的伴有癌变。术后3、6、12个月用染色放大结肠镜观察随访，未见残留癌灶和复发征象。钛夹组出血发生率为0％，明显低于对照组的12．8％（P〈005）。钛夹组无穿孔病例，对照组中1例发生小穿孔，两组无显著性差异（P〉0．05）。结论钛夹钳夹结肠大息内后仍可完整地电切该息肉，包括癌变的息肉，并且比普通电切术减少出血发生率。     

常规电子结肠镜检查中结肠息肉漏诊分析

目的探讨常规电子结肠镜检查中结肠息肉的漏诊情况，包括漏诊率、漏诊息肉大小、分型、部位和病理状况。方法回顾3年间在120d内接受多次结肠镜检查的结肠息肉患者的病例资料，记录患者前2次肠镜检查的息肉数，漏诊息肉数，计算漏诊率。结果符合要求的患者共143例，男92例，女51例，年龄23～82岁；漏诊息肉数共126枚，漏诊率22．5％；在漏诊的息肉中，〈5mm、5～9mm和≥10mm息肉分别占80．2％、18．3％和1．6％，各项间比较差异有统计学意义（P〈0．01）；山田Ⅰ、Ⅱ、Ⅲ和Ⅳ型息肉分别占87．3％、8．7％、3．2％和0．8％，各项间比较差异有统计学意义（P〈0．01）；直肠、乙状结肠、降结肠、横结肠、肝曲、升结肠和盲肠分别占11．1％、27．0％、12．7％、19．1％、10．3％、15．1％和4．8％，各项间比较差异有统计学意义（P〈0．01）；漏诊的晚期腺瘤在漏诊的腺瘤性息肉中占14．8％；漏诊息肉数与基础息肉数间相关分析显示有显著的相关性（r=0．674，P〈0．01）。结论常规电子结肠镜检查中结肠息肉有较高的漏诊率，各段结肠间漏诊率不同，且漏诊息肉绝大多数为〈5mm的Ⅰ型息肉。患者罹患息肉越多，漏诊越多。     

269例结直肠微小息肉内镜、病理特点和处理方式分析

结肠镜检查发现的结直肠息肉以直径≤5mm的微小息肉（DP）最为常见。目前关于DP内镜下处理方式的报道尚少。目的：分析结直肠DP的内镜、病理特点和处理方式,为其临床诊治提供参考。方法：收集2010年1月～2011年4月青岛市市立医院结肠镜检查病例的临床资料．纳人其中发现结直肠息肉并符合DP标准者．凡合并较大息肉（≥6mm）者予以排除。回顾性分析DP的内镜特点、病理性质和处理方式。结果：共纳入结直肠DP病例269例（402枚DP）,占同期息肉检出例数的21．8％,其中180例（66．9％）为单发。43．3％的DP分布于直肠、乙状结肠,60．0％的DP直径〉3mm,绝大多数DP形态为山田I型（53．5％）或山田Ⅱ型（42．0％）。305枚送病理检查的DP中．绝大多数为腺瘤性息肉（50．2％）或炎性息肉（47．5％）：〉3mm的DP为腺瘤性的可能性较大,≤3mm者多为非肿瘤性（P〈0．05）。66．9％的DP系以活检钳钳除：〉3mm、山田Ⅱ＋Ⅲ型和多发DP采用热活检钳钳除或高频电凝切除的可能性较≤3mm、山田I型和单发DP更大（P〈0．05）。结论：对于直径〉3mm的结直肠DP,行内镜下高频电凝切除可能更为有效,并应送病理检查,以免漏诊进展期腺瘤。     

内镜治疗111例胃息肉的临床病理特征分析

背景：胃息肉的检出率逐年增高,其临床症状不明显且有一定癌变倾向。目的：了解胃镜下胃息肉的临床和病理特征。方法：对2010年1月～2013年1月新疆医科大学第一附属医院检出的111例胃息肉患者的内镜、病理资料和手术情况进行回顾性分析。结果：本组老年患者（≥60岁）为胃息肉高发人群（56．8％）;单发性息肉80例（72．1％）,多发性息肉31例（27．9％）;息肉主要位于胃体（52．3％）;息肉直径≤0．5cm多见（69．4％）;息肉类型主要为增生性息肉（40．5％）和炎性息肉（33．3％）。息肉治疗以活检钳钳除30例,内镜黏膜下注射0．9％NaCl溶液联合高频电切摘除54例,内镜下黏膜切除术（EMR）治疗6例,内镜黏膜下剥离术（ESD）治疗4例,余17例行外科手术治疗。12例患者接受随访,其中2例复发。结论：胃息肉直径较小,多为单发;息肉主要位于胃体,以增生性息肉和炎性息肉为主;治疗方式多选择内镜下切除,息肉切除后有复发的可能性,应加强随访。     

233例结直肠腺瘤摘除术后随访和内镜监测的临床分析

目的 了解结直肠腺瘤(CRA)摘除后复发情况和结肠镜监测现状,探讨CRA复发的相关危险因素.方法 收集2005年6月至2009年12月安徽医科大学第一附属医院符合研究标准283例CRA摘除住院患者临床资料并进行随访.统计分析CRA摘除后复发率,结肠镜监测间期和CRA复发的关系及CRA复发的相关危险因素;分析肠镜监测组监测间期、频次,及未行监测的原因.结果 共随访CRA摘除后患者235例,随访率83.0％(235/283),其中生存患者233例,随访时间最短者12个月,最长66个月,随访时间中位数为(35.1±14.2)个月.结肠镜监测组患者115例,监测率为49.4％(115/233),复发率45.0％(50/111),未监测组118例;年龄≥60岁、体重指数≥25kg/m2、多发腺瘤(≥2个)与CRA复发明显相关,差异有统计学意义(x2值分别=4.299、5.291和8.883,P值分别=0.038、0.021和0.027);未监测组患者对CRA需要定期监测的知晓率明显低于监测组,差异有统计学意义(x2=37.819,P＜0.01).结论 CRA摘除术后复发率较高;高龄、高体重指数、多发腺瘤是预测CRA复发的独立危险因素;我院CRA摘除后结肠镜监测率低,主要原因在于患者对CRA摘除后定期监测重要性的认识不足.     

胃息肉的临床病理特征和内镜治疗随访观察

背景：胃息肉是一种常见病,病因不明且有癌变的可能。目的：分析胃息肉的临床、内镜、病理特征和内镜治疗效果。方法：对2006年7月1日～2009年7月1日于空军总医院接受胃镜检查,诊断为增生性息肉、腺瘤性息肉和胃底腺息肉的患者进行回顾性分析。结果：共检出三种常见类型的胃息肉392例,检出率为3.4％,单发283例,多发109例。61．5％的患者位于30～59岁年龄段．53．1％的患者息肉形态为山田Ⅱ型,64．0％的患者息肉最大径≤0．5cm。365例行病理检查者中,增生性、腺瘤性和胃底腺息肉分别占63．6％、5．5％和31．0％,前两者好发于胃窦部,后者好发于胃体、胃底部。383例患者成功接受内镜治疗。75例有随访资料者中20例复发,其中13例为多发息肉。结论：胃息肉内镜下多为山田Ⅱ型,直径较小,多为单发．病理类型上以增生性息肉和胃底腺息肉多见。多发息肉治疗后易复发。     

结直肠癌平均风险人群结肠镜检查的息肉与腺瘤检出率及其年龄分布情况

目的探讨我国结直肠癌平均风险人群结肠镜检查中的息肉检出率和腺瘤检出率及其年龄分布情况,为确定我国结直肠癌筛查起始年龄提供线索和数据支持。方法采用回顾性分析方法,调取2010年3月至2013年2月间进行“体检肠镜”检查的患者资料,按照不同性别、年龄组、肠道准备质量分别计算息肉检出率和腺瘤检出率。各组间率比较采用z。检验。结果共有1928例患者完成体检全结肠镜检查。总的息肉检出率为19．55％[95％CI（17．78％-21．32％）],男性为23．87％,女性为10．00％。40～70岁各年龄组息肉检出率男性均显著高于女性（P〈0．05）。总的腺瘤检出率为11．48％[95％CI（9．69％～13．28％）],男性为14．68％,女性为5．11％。40—70岁各年龄组腺瘤检出率男性均显著高于女性（P〈0．05）。肠道准备优良组息肉检出率显著优于较差组（P〈0．05）。结论息肉检出率和腺瘤检出率均随年龄增长而提高,男性较之女性有更大的息肉、腺瘤发生风险。肠道准备质量对息肉检出率有直接的影响。     

结肠腺瘤摘除后结肠镜随方间期的探讨

提出易导致腺癌复发或癌变的高危特征和因素,延长非高危人的结肠镜随访间期,从而降低医疗费用。方法：行结肠镜下腺癌除术患者504例,随访间期6－48人月,分析年龄、性别、腺癌数量、最大直径和病理类型等因素与腺癌复发的关系。结肠镜复查时发现以下病变者归入高危人群：绒毛管状腺瘤、绒毛状腺瘤、重度不典型增生／原位癌、浸润性癌或腺瘤直径≥1cm及复发腺瘤数≥4。结果：经相关分析,腺瘤复发与原腺瘤数量和大小的增加于相关（P＜0．001）,与年龄、必别、原腺瘤病理类型及结肠镜随访间期等因素无关。结论L：可延长低危人群（首次结肠镜检查仅发现1或2枚腺瘤且直径均＜1cm者）的结肠镜随访间期,从而大大降低低结肠癌监控的费用。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。