胶囊内镜在无症状人群体检中的应用价值

目的探讨胶囊内镜在无症状人群体检中的应用价值。方法回顾性分析2013年3月至2014年9月期间282例无症状体检者在爱康国宾体检中心采用胶囊内镜行消化道检查的临床资料,观察胶囊内镜检查的耐受性、安全性、消化道各段运行时间以及病变检出情况。结果 282例受检者中,276例(97.9%)顺利完成胶囊内镜检查,66.3%(183/276)发现消化道病变,57.6%(159/276)检出小肠病变,所检出小肠病变以淋巴管扩张、非特异性小肠炎(充血、糜烂、散在浅溃疡)、十二指肠炎、十二指肠糜烂、毛细血管扩张等多见。胶囊在胃内平均运行时间为(55.0±72.7)min,在小肠内平均运行时间为(243.6±102.6)min。检查过程中,受检者无不适感。受检者均于检查后72 h内排出胶囊。结论小肠病变在无症状人群中的检出率并不低,胶囊内镜作为一种无创、简便、安全、有效的消化道检查手段,应用于无症状人群的体检中,有助于小肠病变的早期检出,为小肠疾病的早期诊断、早期治疗提供有力依据。     

胶囊内镜诊断疑难消化道疾病的价值

目的探讨胶囊内镜在疑难消化道疾病中的诊断价值和安全性。方法对不明原因的消化道出血,腹痛和慢性腹泻患者进行Pillcam胶囊内镜检查,部分患者行传统检查(胃镜、结肠镜和全消化道钡餐)以进行对比分析。结果 135例受检者在胶囊内镜检查过程中无任何不适和并发症,均顺利完成检查,胶囊1~4 d自然排出,食管通过平均时间为2.46 min,胃通过平均时间为37.80 min,小肠通过平均时间为275.82 min,其中3例胶囊未达结肠。所得图像清晰,所检出的疾病包括食管静脉曲张、慢性胃炎、十二指肠溃疡、小肠炎、克罗恩病、血管畸形、息肉和间质瘤等。结论胶囊内镜检查安全,无痛苦,对病变检出率高,定位较准确,对小肠疾病和上消化道病变有较高的诊断价值。     

胶囊内镜诊断消化道疾病102例

目的:探讨胶囊内镜在消化道疾病中的诊断价值和安全性.方法:对不明原因的消化道出血.腹痛和慢性腹泻患者进行Pillcam胶囊内镜检查.部分患者行传统检查(胃镜、结肠镜和全消化道钡餐),进行对比分析.结果:102例受检者在胶囊内镜检查过程中无任何不适和并发症,均顺利完成检查.胶囊1-4 d自然排出,食道排空平均时间2.46 min,胃排空平均时间37.8 min,小肠转运时间平均275.82 min,其中,5例胶囊未达结肠.所得图像清晰,检出食道静咏曲张、慢性胃炎、十二指肠溃疡、小肠炎症、克罗恩病、血管畸形、息肉和间质瘤等.结论:胶囊内镜检查无痛苦,成功率高,对病变检出率高,定位较准确.与其他方法相比.对小肠疾病和上消化道病变有较好的诊断价值.     

国产与进口胶囊内镜796例临床应用分析

目的探讨国产胶囊内镜与进口胶囊内镜对小肠疾病的诊断价值及安全性。方法选择2003～2018年我院行了胶囊内镜检查患者796例,根据胶囊内镜的不同分为两组。A组414例患者采用以色列M2A胶囊内镜检查,病因包括不明原因消化道出血194例,不明原因慢性腹泻87例,不明原因腹痛90例,不明原因贫血43例;B组382例患者采用国产OMOM胶囊内镜,包括不明原因消化道出血173例,不明原因慢性腹泻97例,不明原因腹痛85例,不明原因贫血27例。结果 A组共411例完成检查,B组共381例完成检查,检查总成功率为99.50%(792/796)。A组全小肠检查成功率为86.71%(359/414);B组全小肠检查成功率为95.03%(363/382)。A组不明原因消化道出血患者病变检出率为80.41%(156/194),不明原因腹泻患者病变检出率为68.97%(60/87),不明原因腹痛患者病变检出率为63.33%(57/90),不明原因贫血患者病变检出率为55.81%(24/43)。B组不明原因消化道出血患者病变检出率为85.55%(148/173),不明原因腹泻患者病变检出率为61.86%(60/97),不明原因腹痛患者病变检出率为60.00%(51/85),不明原因贫血患者病变检出率为55.56%(15/27)。A组病变检出率为71.74%(297/414),B组病变检出率为71.73%(274/382),两组检出率差异无统计学意义(P 0.05)。结论胶囊内镜对小肠疾病有较高诊断价值,国产OMOM胶囊内镜的检出率与诊断率与M2A胶囊内镜相当。     

胃肠动力药物在60例小肠胶囊内镜检查中的作用观察

目的 探讨胃肠动力药物对胶囊内镜检查中胶囊通过胃的时间、通过全小肠的时间的影响。方法收集2011年10月至2012年10月在我院行小肠胶囊内镜检查的60例患者,平均分成三组,A组检查前10min口服多潘立酮10mg,B组检查前10min口服莫沙比利10mg,C组检查前不服用任何药物。结果A组胶囊平均通过胃时间为24min±15min,B组平均通过胃时间为27min±20min,C组平均通过胃时间为45min±33min,多潘立酮、莫沙必利可以缩短胶囊在胃内的停留时间（P〈0．05）;A组胶囊平均通过小肠时间为6h±1h50min,B组平均通过小肠时间为3h40min±2h11min,C组平均通过小肠时间为6h30min±2h12min,B组与A组比较、B组与C组比较差异有统计学意义（P〈0．05）,A组与C组比较差异无统计学意义（P〉0．05）。结论胶囊内镜检查前给予口服胃肠动力药可缩短胶囊在胃内的停留时间;胶囊内镜检查前给予口服莫沙必利可缩短胶囊通过全小肠的时间。     

术前肌注甲氧氯普胺在胶囊内镜检查中的作用分析

[目的]探讨胶囊内镜检查术中检查前患者肌注甲氧氯普胺的临床价值。[方法]170例疑似小肠疾病患者采用随机数字表法均分入观察组和对照组,检查当日2组肠道准备相同,观察组术前肌注甲氧氯普胺;比较2组胶囊内镜胃转运和小肠转运时间以及病变检出率的差异。[结果]观察组平均胃转运时间为(20.1±5.2)min,明显低于对照组的(36.2±7.6)min(P0.05);平均小肠转运时间为(258±4.9)min,明显低于对照组的(264±3.5)min(P0.05);小肠病变检出率为80%,明显高于对照组的60%(P0.05)。[结论]胶囊内镜检查前患者肌注甲氧氯普胺具有缩短检查时间及提高病变检出率的效果。     

术前口服伊托必利在胶囊内镜检查中的作用分析

目的 探讨胶囊内镜检查前患者口服伊托必利的临床价值.方法 40例疑似小肠疾病患者采用随机数字表法均分入观察组和对照组,观察组术前1d口服盐酸伊托必利片,检查当日两组肠道准备相同,比较两组小肠清洁度、胶囊内镜胃转运和小肠转运时间以及病变检出率的差异.结果 观察组小肠清洁度优良率为80％ (16/20),明显优于对照组的45％ (9/20) (P ＜0.05).观察组平均胃转运时间为31 min,明显短于对照组的56 min(P ＜0.05);平均小肠转运时间为251 min,明显短于对照组的327 min(P＜0.05).观察组小肠病变检出率为60％ (12/20),明显高于对照组的40％(8/20) (P ＜0.05).结论 胶囊内镜检查前患者口服伊托必利具有较好的临床价值.     

禁食12小时和聚乙二醇方案对显性小肠出血患者胶囊内镜检查肠道准备效果比较

目的 探讨禁食12小时与聚乙二醇方案对胶囊内镜肠道准备的有效性。方法 采用回顾性、单中心研究,纳入102例为检测可疑的活动性显性小肠出血来源行胶囊内镜检查的患者。A组63例患者采用2L聚乙二醇方案;B组39例患者在检查前禁食12小时。主要终点是病变检出率和诊断率,次要终点是临床结局、胶囊内镜完成率、运转时间和图像质量。结果A组发现阳性病变38例(60.3%),B组18例(46.2%)。两组患者的诊断率差异无统计学意义(47.6%vs. 51.3%;P=0.719)。A组胶囊内镜图像质量明显优于B组(57.2%vs. 38.5%;P=0.0012)。A组平均小肠运转时间短于B组(400 min vs. 519 min;P=0.01)。两组患者进一步治疗方法及预后差异无统计学意义(均P>0.05)。结论 与禁食12小时相比,2L PEG方案虽然提高了胶囊内镜图像质量,但并没有提高诊断率和改善临床结局。     

磁控胶囊内镜与胃镜检查在体检人群中临床应用价值比较

目的比较磁控胶囊内镜与胃镜的优劣性,探讨磁控胶囊内镜对上消化道疾病诊断的灵敏性和准确性,以及在体检个体中的应用价值。方法本研究通过回顾性研究,分析了南京医科大学第一附属医院2015年10月至2018年10月分别接受胃镜检查和磁控胶囊内镜检查的两组体检个体的相关临床资料,分析上消化道疾病发现率,经磁控胶囊内镜检查后追加胃镜情况,以及两组个体检查的舒适度、安全性。结果磁控胶囊内镜组205例中共检出11例食管病变,51例胃部病变,37例十二指肠病变;胃镜组314例中共检出65例食管病变,63例胃部病变,65例十二指肠病变,磁控胶囊内镜组除检出胃和十二指肠病变外,还检出了空回肠甚至结肠病变。磁控胶囊内镜运行到空回肠有149例,其中检出病变有38例,运行到结肠有106例,结肠腔内由于肠道准备不足,见大量粪渣及粪水,严重影响视野,无法观察。两组上消化道检查结果对比,除食管处观察情况差异有统计学意义(P0.05),其他各部位差异均无统计学意义(P0.05),磁控胶囊内镜具有更好的舒适度及耐受性,甚至能检查出胃镜无法检出的下消化道疾病。磁控胶囊内镜组中有28例受检者在检查结束后行胃镜复查或有关治疗,其中18例胃息肉患者在胃镜下行内镜下摘除术,7例胃溃疡行胃镜复查,病理证实为良性溃疡,3例胃部黏膜下隆起性病变中2例诊断为胃间质瘤,1例为脾脏压迫。结论磁控胶囊内镜在体检人群中的应用价值不低于胃镜,且更易被人群所接受。     

链霉蛋白酶服药时间对胃镜视野清晰度的影响

目的探讨链霉蛋白酶服药时间对胃镜视野清晰度的影响。方法将450例患者随机分为三组:A组患者在检查前15min口服温水和利多卡因胶浆;B组患者在检查前15 min口服链霉蛋白酶、碳酸氢钠和利多卡因胶浆;C组患者在检查前30 min口服链霉蛋白酶、碳酸氢钠和利多卡因胶浆;比较三组患者的不适程度、胃镜视野清晰度、微小病变检出率。结果在胃底、胃体、胃窦,胃镜视野清晰度在三组间比较及两两比较差异有统计学意义(P0.05),C组评分低于B组,B组评分低于A组(得分越低视野越清晰)。在食管、十二指肠,胃镜视野清晰度B组、C组与A组比较差异有统计学意义(P0.05),B组与C组比较差异无统计学意义(P0.05),B组、C组的评分均低于A组;B组、C组患者不适程度轻、微小病变(溃疡、糜烂、息肉样增生)特别是癌前期病变检出率高于A组,差异有统计学意义(P0.05),但B组与C组比较差异无统计学意义(P0.05)。结论胃镜检查前联合应用链霉蛋白酶可以有效改善胃镜视野清晰度,检查前30 min应用效果更好。     

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.     

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.     

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.     

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。     

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.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.     

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.