慢性胰腺炎外科治疗的研究进展

慢性胰腺炎（ chronic pancreatitis, CP）为胰腺炎症性疾病,以胰腺实质发生慢性持续性炎性损害、纤维化及可能导致的胰管扩张、胰管结石或钙化等不可逆性的形态改变为其特征,可引起顽固性疼痛和永久性内、外分泌功能丢失。CP的病因及病理机制复杂、胰腺组织及其功能损害程度轻重小一,以饮食调整及药物治疗为基础的内科治疗,可使部分患者的症状得到有效缓解,但确有一部分患者因内科治疗及内镜治疗难以奏效而最终需外科手术干预     

慢性胰腺炎的治疗策略

慢性胰腺炎（chronic pancreatitis,CP）是由于各种不同病因引起胰腺组织和功能的持续性损害,其病理表现为胰腺实质进行性、不可逆性的纤维化,可导致胰管扩张、胰管结石或钙化等不可逆性的形态改变,常引起顽固性疼痛和永久性内、外分泌功能丧失。治疗包括去除病因,缓解疼痛,改善胰腺的内外分泌功能,内镜或手术治疗。     

慢性胰腺炎药物治疗研究进展

慢性胰腺炎(CP)是一种胰腺组织慢性进行性炎症性疾病, 胰腺实质受到损伤并被纤维组织取代。胰腺纤维化与胰管结石是CP的特征性病理表现, CP患者常伴有疼痛、胰腺内外分泌功能不全等症状, 药物治疗在CP的全病程管理中起重要作用。针对CP患者疼痛的症状目前主要遵循止痛药物选择由弱到强的三阶梯治疗原则, 抗氧化剂和神经调节剂对疼痛有一定疗效。针对胰腺外分泌功能不全, 通过口服胰酶替代治疗与服用相应缺乏的维生素进行补充。针对胰腺内分泌功能不全, 通过二甲双胍和胰岛素等降糖药有效治疗3c型糖尿病。此外, 体内外研究显示部分药物可有效抗纤维化, 柠檬酸等药物可溶解胰腺结石, 胰管内输注乙酸可进行"胰腺化学切除术", 以上研究为CP的治疗带来了新的思路, 但仍需后续深入研究明确新型药物治疗方式对CP患者的疗效, 以进一步有效推动CP精准化治疗。     

慢性胰腺炎疼痛治疗的研究进展

慢性胰腺炎(CP)是一种持续进展的非自限性疾病,主要以炎性反应、纤维化、胰腺腺泡及胰岛细胞的缺失为特征。持久反复的疼痛是CP患者最突出的临床表现,减轻疼痛、提高生活质量仍是临床医生所面临的巨大挑战。目前临床上尚无根治性治疗手段,治疗目标往往围绕缓解疼痛来进行,主要治疗手段包括内科药物治疗、内镜治疗及手术治疗。此文就CP疼痛的治疗进展作一综述。     

胰管支架在胰腺疾病中的应用

1983年Seigal等率先经内镜引导下胰管内放置塑料支架治疗慢性胰腺炎胰管狭窄,此后胰管支架因其良好的引流效果、微创以及并发症少而逐渐应用于多种胰腺疾病的治疗. 一、慢性胰腺炎 慢性胰腺炎(CP)是指各种原因造成的胰腺局部的、节段性的或弥漫性的慢性进行性炎症,使胰腺组织的功能长期损伤,胰腺呈部分或广泛纤维化,主要的病理生理改变是胰管压力升高.胰管狭窄和胰管结石可以导致胰管内的压力增高,并引起腹痛等相关临床症状.正常胰管内压力在16～18 mmHg(1 mmHg=0.133kPa),CP伴有胰管扩张的患者咦管压力在18～48 mmHg[1].     

慢性胰腺炎诊治指南(2012,上海)

慢性胰腺炎(chronic pancreatitis,CP)是指各种病因引起的胰腺组织和功能不可逆的慢性炎症性疾病,其病理特征为胰腺腺泡萎缩、破坏和间质纤维化.临床以反复发作的上腹部疼痛和(或)胰腺外、内分泌功能不全为主要表现,可伴有胰腺实质钙化、胰管扩张、胰管结石和胰腺假性囊肿形成等.     

十二指肠镜植入胰管支架治疗慢性胰腺炎疗效回顾

慢性胰腺炎(chronic pancreatic,CP)是指由于不同病因引起胰腺局部或弥漫性组织损害,导致胰腺内、外分泌功能不全的疾病,病理特征为胰腺纤维化.约90%的CP患者主要症状是反复发作的腹痛,因此缓解腹痛是治疗CP最重要的目标之一.目前慢性胰腺炎腹痛的机制仍不明确,多数观点认为是多因素作用的结果,包括急性炎症刺激,慢性炎症致胰腺导管和胰腺组织压力升高,胰周炎症(如十二指肠炎和腹膜后炎症),并发症(如胆总管梗阻、假性囊肿)致胰管压力升高,胰腺神经源性炎症及其他因素等.     

十二指肠镜植入胰管支架治疗慢性胰腺炎疗效回顾

慢性胰腺炎(chronic pancreatic,CP)是指由于不同病因引起胰腺局部或弥漫性组织损害,导致胰腺内、外分泌功能不全的疾病,病理特征为胰腺纤维化.约90%的CP患者主要症状是反复发作的腹痛,因此缓解腹痛是治疗CP最重要的目标之一.目前慢性胰腺炎腹痛的机制仍不明确,多数观点认为是多因素作用的结果,包括急性炎症刺激,慢性炎症致胰腺导管和胰腺组织压力升高,胰周炎症(如十二指肠炎和腹膜后炎症),并发症(如胆总管梗阻、假性囊肿)致胰管压力升高,胰腺神经源性炎症及其他因素等.     

慢性胰腺炎的治疗现状

慢性胰腺炎(CP)是由多种病因引起的胰腺组织结构和功能持续性损害,临床主要表现为反复发作的腹痛,内外分泌功能不全如脂肪泻、糖尿病等。CP的治疗十分复杂,且十分棘手,目前尚无十分理想的治疗方案。其治疗主要着眼于控制腹痛,解除胰管梗阻,纠正消化吸收不良,及并发症的控制,保护残存的胰腺功能。当出现急性胰腺炎发作时,按急性胰腺炎治疗方案治疗。下面就近几年CP的治疗现状,按内科综合治疗,内镜下治疗及手术治疗作一综述。 1 内科综合治疗 1.1 病因治疗由于CP是一多病因疾病,积极查找引起CP的病因,分别给以祛除或对症治疗,如戒酒,     

慢性胰腺炎外科治疗

慢性胰腺炎(chronic pancreatitis,CP)的基本病理改变是胰腺组织纤维化,胰腺逐渐变硬变细或呈不规则的结节样硬化,可有大小不等的假性囊肿,胰管扩张和胰管钙化或结石形成.近年来随着医疗科技的迅速发展,对传统治疗手段的改进,使CP的治疗得到了很大的进展.     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

Use of fab fragments of digoxin-specific antibodies in the therapy of massive digoxin poisoning

A case of massive digoxin ingestion with multiple arrhythmias, consisting of high grade A-V block and ventricular ectopy not responsive to lidocaine, is described. The arrhythmias ceased following administration of digoxin-specific Fab fragments. The patient improved and was transferred to the psychiatric unit.     

Comparison of intravenous and oral routes of theophylline loading in acute asthma

In a prospective, randomized clinical trial, 19 patients with an acute exacerbation of asthma were given a loading dose of aminophylline by the IV (n = 10) or oral route (n = 9) of administration following treatment with epinephrine. Plasma concentrations of theophylline were measured prior to giving the loading dose, and one, two, three, and 24 to 48 hours later. Therapeutic effectiveness was evaluated by analyzing spirometric measurements prior to giving the loading dose, and one, three, and 24 to 48 hours later. Side effects also were recorded. In the IV group, the mean peak plasma theophylline concentration was 15.1 micrograms/mL one hour after loading, and in the oral group the mean peak serum theophylline concentration was 14.2 micrograms/mL three hours after loading. There was no correlation between theophylline concentrations and normalized change in spirometric values. There was no significant difference in spirometric values between the IV and oral groups. Nausea was slightly more common in the IV group. We conclude that there is no therapeutic advantage to giving a loading dose of aminophylline by the IV route rather than orally in patients with mild-to-moderate exacerbation of asthma initially treated with epinephrine.     

Application of Granular Biocomposites Based on Homogenised Peat for Absorption of Oil Products

Among the various methods for collecting oil spills and oil products, including from the water surface, one of the most effective is the use of sorbents. In this work, three-component bio-based composite granular adsorbents were produced and studied for oil products’ pollution collection. A bio-based binder made of peat, devulcanised crumb rubber from used tyres, and part fly ash as cenospheres were used for absorbent production. The structure, surface morphology, porosity, mechanical properties, and sorption kinetics of the obtained samples were studied. Composite hydrophobicity and sorption capacity to oil products, such as diesel fuel (DF) and motor oil (MO), were determined. The obtained pellets are characterised by a sufficiently pronounced ability to absorb oil products such as DF. As the amount of CR in the granules increases, the diesel absorption capacity increases significantly. The case of 30-70-0 is almost three times higher than the granules from homogenised peat. The increase in q is due to two factors: the pronounced surface hydrophobicity of the samples (Θ = 152°) and a heterogeneous porous granule structure. The presence of the cenosphere in the biocomposite reduces its surface hydrophobicity while increasing the diesel absorption capacity. Relatively rapid realisation of the maximum saturation by the MO was noted. In common, the designed absorbent shows up to 0.7 g·g⁻¹ sorption capacity for MO and up to 1.55 g·g⁻¹ sorption capacity for diesel. A possible mechanism of DF absorption and the limiting stages of the process approximated for different kinetic models are discussed. The Weber–Morris diffusion model is used to primarily distinguish the limiting effect of the external and internal diffusion of the adsorbate on the absorption process.     

Role of microRNA in regulation of myeloma-related angiogenesis and survival

Multiple myeloma (MM) is a malignant disease caused by clonal proliferation of plasma cells that result in monoclonal gammopathy and severe end organ damage. Despite the uniform clinical signs, the disease is very diverse in terms of the nature and sequence of the underlying molecular events. Multiple cellular processes are involved in helping the malignant cells to remain viable and maintain proliferative properties in the hypoxic microenvironment of the bone marrow. Specifically, the process of angiogenesis, triggered by the interactions between the malignant MM cells and the stroma cells around them, was found to be critical for MM progression. In this review we highlight the current understanding about the epigenetic regulation of the proliferation and apoptosis of MM cells and its dependency on angiogenesis in the bone marrow that is carried out by different microRNAs.     

RNA-Seq在老年神经退行性疾病研究中的应用

阿尔茨海默病及帕金森病是老年人最常见的两种神经退行性疾病,但其发病机制及治疗是研究的热点。随着高通量测序技术的进步及成本的下降,RNA-Seq也成为神经退行性疾病机制研究及生物标志物发现的有力手段。RNA-Seq相对于microarray具有高灵敏度、高准确性、高重复性以及噪声低等优势,在阿尔茨海默病及帕金森病研究中有较为广泛的应用,包括检测差异表达基因,可变剪接、新长链非编码RNA预测分析和miRNAs调控等,但是容易受病理复杂性及样本等因素影响。目前阿尔茨海默病及帕金森病转录组研究相比于癌症等还不够深入,在临床诊断及治疗应用还面临较大挑战。但是随着新技术及新方法的发展,RNA-Seq将进一步推动神经退行性相关疾病的研究和临床转化。     

安徽巢湖市丝虫病控制、消除历程和监测报告

【摘要】 目的  回顾并总结巢湖市丝虫病的流行、控制,以及消除丝虫病的历程。 方法  统计分析1970~1989年在该市采取以消灭传染源、切断传播途径为主的防治策略,以及展开大规模防治的各个阶段。 结果  1989年,采用分层整群抽样调查方法调查,微丝蚴率下降至0.032%,以行政村为单位,微丝蚴率已控制在1.0%以下,达到卫生部规定的基本消灭丝虫病标准;1991年,经省级调查考核,认定全市已达到卫生部规定的基本消灭丝虫病标准。1996年,省级审评确认已达到卫生部颁布的消灭丝虫病标准。经过10年的监测和跟踪治疗,到2005年,全市丝虫病病原学监测未查见微丝蚴阳性者,解剖镜检人房内淡色库蚊1 348只,蚊体内均未查见人体幼丝虫。 结论  巢湖市达到了消除丝虫病的标准。     

Advanced Evaluation of the Freeze–Thaw Damage of Concrete Based on the Fracture Tests

This paper presents the results of an experimental program aimed at the assessment of the freeze–thaw (F–T) resistance of concrete based on the evaluation of fracture tests accompanied by acoustic emission measurements. Two concretes of similar mechanical characteristics were manufactured for the experiment. The main difference between the C1 and C2 concrete was in the total number of air voids and in the A300 parameter, where both parameters were higher for C1 by about 35% and 52%, respectively. The evaluation of the fracture characteristics was performed on the basis of experimentally recorded load–deflection and load–crack mouth opening displacement diagrams using two different approaches: linear fracture mechanics completed with the effective crack model and the double-K model. The results show that both approaches gave similar results, especially if the nonlinear behavior before the peak load was considered. According to the results, it can be stated that continuous AE measurement is beneficial for the assessment of the extent of concrete deterioration, and it suitably supplements the fracture test evaluation. A comparison of the results of fracture tests with the resonance method and splitting tensile strength test shows that all testing methods led to the same conclusion, i.e., the C1 concrete was more F–T-resistant than C2. However, the fracture test evaluation provided more detailed information about the internal structure deterioration due to the F–T exposure.     

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation

The role of the external and internal anal sphincters in the mechanism of anal continence is presented. The external sphincter induces continence by 1) preventing internal sphincter relaxation, what I have called the “voluntary inhibition action,” and 2) mechanical compression of the rectal neck and anal canal proper. The mechanism of both actions is described. The internal sphincter plays a significant role not only in involuntary, but also in voluntary, continence. The importance of this role in the correction of anal incontinence is clarified. “Stress defecation,” a condition which follows internal sphincter damage, is discussed. A “single loop continence” theory is presented, based on the fact that each of the three loops of the external sphincter has its own innervation, attachment, and direction of muscle bundles; each loop thus acts as a separate sphincter. The clinical application of this theory is presented.