影响肠道准备质量的患者相关因素

目的探讨影响结肠镜检查肠道准备质量的患者相关因素。方法选取行普通结肠镜检查患者223例,采用口服2 L复方聚乙二醇电解质散溶液(PEG)进行肠道准备,记录患者年龄、性别、体重指数、吸烟史、饮酒史、平时便秘情况、糖尿病病史、腹部手术史、服药后排便次数、末次排便性状、末次排便至开始检查时间(等候时间),服药后主动运动情况,肠道准备质量采用波士顿评分量表(BBPS)进行评估,单因素及多因素Logistic回归分析肠道准备质量的影响因素。结果肠道准备不充分率24. 6%,Logistic分析显示平时便秘(OR:2. 939,95%CI:1. 420～6. 084)、末次大便性状浑浊或带渣(OR:2. 319,95%CI:1. 177～4. 570)、服药后未主动运动(OR:1. 986,95%CI:1. 012～3. 889)是肠道准备不充分的危险因素(P0. 05),而服药后排便次数(OR:0. 808,95%CI:0. 708～0. 922)为肠道准备不充分的保护因素(P0. 01)。结论平时便秘、末次大便性状浑浊或带渣、服药后未主动运动是肠道准备不充分的危险因素,对存在危险因素患者进行个体化干预,从而提高肠道准备质量。     

基于不同肠段的结肠镜检查人群肠道准备失败现状及影响因素分析

目的研究不同肠段发生肠道准备失败的现状, 并分析其影响因素。方法选取2021年12月—2023年1月在北京协和医院消化内镜中心进行结肠镜检查的677例患者作为研究对象, 患者均采用3 L聚乙二醇电解质散分次剂量的标准化肠道准备方案, 以波士顿肠道准备评分量表对患者的肠道准备情况进行评估, 并通过Logistic回归模型分析不同肠段发生肠道准备失败的影响因素。结果结肠镜检查人群的肠道准备不合格率为31.5%(213/677), 在肠道准备失败人群中, 仅近端肠道失败占85.4%(182/213), 全肠道失败占14.1%(30/213), 仅远端肠道失败仅占0.5%(1/213)。将仅远端肠道失败与全肠道失败合并为发生远端肠道准备失败, Logistic回归分析结果显示:男性(P=0.001, OR=2.253, 95%CI:1.399～3.629)、门诊患者(P<0.001, OR=4.175, 95%CI:2.410～7.231)、无结直肠癌家族史(P=0.001, OR=2.117, 95%CI:1.365～3.284)以及因诊断行结肠镜检查(P=0.003, OR=1.97...     

结直肠息肉发生的危险因素分析及临床预测模型构建

回顾性分析2020年6月至2022年12月于山西医科大学第二医院行结肠镜检查的1 010例住院患者的临床资料。应用多因素logistic回归分析结直肠息肉的独立危险因素, 并绘制列线图预测结直肠息肉的发生风险。结果显示, 年龄[OR=1.027, 95%置信区间(95%CI)1.016～1.039]、男性(OR=1.447, 95%CI 1.034～2.204)、体重指数(OR=1.054, 95%CI 1.010～1.099)、糖尿病(OR=1.468, 95%CI 1.026～2.101)、非酒精性脂肪性肝病(OR=1.390, 95%CI 1.016～1.903)、吸烟史(OR=1.527, 95%CI 1.049～2.221)和尿酸(OR=1.002, 95%CI 1.000～1.003)均是结直肠息肉发生的独立危险因素(均P<0.05)。列线图模型的受试者操作特征曲线的曲线下面积为0.673, 最佳截断值的约登指数为0.266, 灵敏度为54.4%, 特异度为72.2%。本研究结果表明基于上述危险因素构建的列线图模型对结直肠息肉发生风险的预测和高危人群的临床筛查具有一定...     

困难无镇静结肠镜检查的危险因素

背景:结肠镜检查因其在结直肠疾病筛查、诊断和治疗中的重要意义而得到广泛开展。无镇静检查所致的不适和疼痛是结肠镜检查操作失败的原因之一。目的:分析无镇静结肠镜检查操作难度的影响因素。方法:纳入2017年1月—12月在同济大学附属第十人民医院行无镇静结肠镜检查的18~80岁患者,采集临床资料和既往史,术前在护士帮助下完成艾森克人格问卷。检查由富有经验的内镜医师进行,术后采用渥太华肠道准备评分量表和VAS量表评估肠道准备质量和检查中的疼痛程度。结果:结肠镜检查成功率为97.1%(198/204)。192例完成艾森克人格问卷的患者纳入分析,其中24例被判定为困难结肠镜检查(内镜插入回盲部时间>10 min)。单因素分析显示性别、年龄、体质指数(BMI)、手术史、疼痛程度和艾森克人格问卷E量表(内向/外向)评分与困难结肠镜检查显著相关(P均<0.05)。多因素分析显示,盆腔手术史是困难结肠镜检查的危险因素(OR=6.833,95%CI:2.396~19.488,P<0.001),超重(OR=0.190,95%CI:0.038~0.962,P=0.045)和人格介于内、外向之间(OR=0.367,95%CI:0.150~0.896,P=0.028)则是保护因素。结论:盆腔手术史、低BMI以及内向和外向人格可能增加无镇静结肠镜检查的操作难度。初级内镜医师在行无镇静结肠镜检查前可使用艾森克人格问卷E量表对受检者进行筛选以提高检查成功率。     

基于超声内镜下胃小间质瘤特征表现的诊断预测列线图模型建立

目的建立基于超声内镜下特征表现的胃小间质瘤诊断预测列线图模型。方法回顾性收集2015年6月—2021年8月于同济大学附属同济医院消化内科行内镜下切除的长径<2 cm胃黏膜下肿瘤的189例患者临床病理资料。所有病例通过R软件随机函数按2∶1的比例分为建模组(n=126)和验证组(n=63)。在建模组中采用单因素和多因素Logistic回归分析筛选出超声内镜下诊断胃小间质瘤的独立影响因素, 构建列线图模型。在建模组和验证组中绘制受试者工作特征(receiver operator characteristic, ROC)曲线以评价模型的区分度, 采用Hosmer-Lemeshow检验和校准曲线以评价模型的校准度。结果患者年龄>60岁(OR=2.815, 95%CI:1.148～6.900, P=0.024)、病灶位于贲门/胃底(OR=5.210, 95%CI:1.225～22.165, P=0.025)、起源于固有肌层(OR=6.404, 95%CI:2.262～18.135, P<0.001)、呈腔外生长(OR=6.024, 95%CI:1.252～28.971, P=0...     

浙江省基层2型糖尿病患者糖尿病肾病危险因素的列线图分析

目的探讨基层2型糖尿病患者糖尿病肾病(DN)发病的危险因素以及列线图模型对DN患病风险的预测价值。方法采用横断面研究的方法, 纳入2018年6至8月浙江省17个乡镇和街道符合研究标准的基层2型糖尿病患者1 588例, 年龄(56.8±10.1)岁, 男性占50.06%, 平均病程9年。采集患者的临床资料、生化检测和眼底照相结果;采用logistic回归分析法筛选DN的危险因素, 并应用列线图模型定量分析DN的患病风险。结果 1 588例基层2型糖尿病患者中440例(27.71%)发生DN。logistic回归分析显示糖化血红蛋白(OR=1.159, 95%CI 1.039～1.292)、收缩压(OR=1.041, 95%CI 1.031～1.051)、血清肌酐(OR=1.011, 95%CI 1.004～1.017)、血清球蛋白(OR=1.072, 95%CI 1.039～1.105)、糖尿病视网膜病变(OR=1.463, 95%CI 1.073～1.996)、初中以上学历(OR=2.018, 95%CI 1.466～2.777)、中等强度运动(OR=0.751, 95%CI 0.58...     

肠镜检查前清肠教育对肠道准备质量的影响

目的探讨患者结肠镜检查前进行肠道清洁等级图片教育对于患者肠道准备质量的影响。方法选取2014年1月至2016年12月在我院消化内科住院行结肠镜检查的423例患者。随机分为2组,A组(对照组) 209例,患者肠道准备前给予标准的肠道准备宣教(口头及书面); B组(观察组) 214例,在A组基础上同时给予患者肠道清洁等级图片教育。评价两组患者结肠镜检查过程中肠道清洁质量、息肉检出率及盲肠插管率。肠道清洁质量以波士顿肠道准备评分量表(BBPS)表示,其中BBPS值≥5分表示肠道准备充分。结果 B组患者BBPS值为(6. 63±1. 766)分,中位数为7. 00分,BBPS≥5分患者占90. 7%,A组患者BBPS值为(6. 11±1. 980)分,中位数为6. 00分,BBPS≥5分患者占76. 6%,B组肠道清洁质量明显高于A组(P 0. 05)。B组结直肠息肉检出率为48. 1%,明显高于A组(34. 9%)(P=0. 006)。B组患者盲肠插管率为93. 9%,明显高于A组(83. 3%)(P=0. 001)。结论结肠镜检查前进行肠道清洁等级图片教育可明显提高患者肠道准备质量,提高结直肠息肉检出率及盲肠插管率。     

肠道准备质量的影响因素及其对分段肠道准备质量的影响差异

目的 探究肠道准备质量相关影响因素及其对肠道分段肠道准备质量评分是否存在影响差异。方法 按入排标准纳入从2021年11月至2022年11月在深圳市某三甲医院394名行结肠镜检查的患者,前瞻性地收集患者和结肠镜相关检查数据,采用波士顿肠道准备量表(Boston Bowel Preparation Scale, BBPS)评估肠道准备质量的情况,用多因素Logistic回归分析得出与肠道准备不充分的独立因素,利用趋势卡方检验探究各危险因素对肠道分段肠道准备质量评分是否存在影响差异。结果 肠道准备不充分比率20.8%,息肉或腺瘤检出率为20.3%,采用logistic回归分析结果显示肠道质量欠佳的独立危险因素为未服用西甲硅油(OR=2.236)、摄入聚乙二醇<75%(OR=3.337)、Bristol 1型及2型(OR=3.359)、末次大便有渣(OR=6.664)、检查时间间隔>6小时(OR=2.483)(P值均<0.05)。其中西甲硅油组横结肠、右半结肠肠道准备评分比无西甲硅油组要高(P<0.05),左半结肠肠道准备评分差异无统计学意义;摄入清肠剂剂量>75...     

硫酸镁钠钾口服液用于成人结肠镜检查前肠道准备有效性和安全性的Ⅲ期临床多中心随机对照研究

目的　评价硫酸镁钠钾口服液（oral sulfate solution,OSS）用于成人结肠镜检查前肠道准备的有效性和安全性。方法　采用多中心、随机、研究者单盲、阳性对照、非劣效性临床研究。受试者随机接受结肠镜检查前分次服用共2瓶OSS（177 mL/瓶）或4 L复方聚乙二醇电解质散（Ⅲ）（polyethylene glycol,PEG）的肠道准备方案。主要疗效指标为肠道准备的有效性。波士顿评分量表（Boston bowel preparation scale,BBPS）各节段（右侧结肠、中段结肠和左侧结肠）评分均≥2分定义为有效。次要疗效指标包括受试者的依从性和结肠镜下肠腔气泡评估,同时包括服药后排便间隔时间、服药后大便呈Ⅶ型（Bristol大便分类法）间隔时间、排便次数、结肠镜检查阳性率（息肉、非息肉性隆起、溃疡等检出率）,以及通过不良事件和严重不良事件的发生情况来评估安全性。结果　共4家医院的240名受试者参加研究,其中试验组（OSS组）120例,对照组（PEG组）120例。全分析集（full analysis set,FAS）分析显示OSS组与PEG组的肠道准备成功率分别为92.44%（110/119）和91.60%（109/119）（χ2=0.058,P=0.809）。除FAS分析左侧结肠BBPS评分差异无统计学意义外,FAS和符合方案集（per protocol set,PPS）分析均显示OSS组BBPS总分及各肠段评分均优于PEG组。OSS组的气泡评估满意率高于PEG组（95.80%比89.08%,P=0.025）,两组的依从性、结肠镜检查阳性率和安全性相似。结论　OSS方案的肠道准备质量不低于4 L PEG方案,消泡效果好,安全性相当。     

消化内镜日间手术病房患者入院后行结肠镜肠道准备的可行性研究

目的：探讨患者入住日间病房后行结肠镜肠道准备的可行性。方法：对 2018年5月25日至7月13日在复旦大学附属中山医院内镜日间病房住院行结肠镜诊疗的352例患者进行问卷调查,除8例因第一次肠道准备失败未能完成结肠镜诊疗,分析其余344例患者的资料（包括一般资料、肠道准备相关资料、波士顿肠道准备量表评分）和患者主观感受。采用卡方检验和Logistic回归分析,分析肠道准备质量及其影响因素。结果：消化内镜日间手术病房患者肠道准备不合格发生率为18.0%（62/344）。结肠镜诊疗时间在上午（P=0.005,OR=2.505,95%CI：1.312~4.781）和末次排便性状为黄色有残渣（P=0.045,OR=0.475,95%CI：0.230~0.982）是肠道准备不合格的独立影响因素。患者耐受度88.1%（303/344）,满意度77.9%（268/344）,54.9%（189/344）愿意在必要时再次入住日间病房。结论：消化内镜日间病房患者入院后行结肠镜肠道准备可行但尚未达理想状态。     

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。     

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。     

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。     

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.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.