State of anxiety may be associated with exocrine pancreatic insufficiency in functional dyspepsia patients with pancreatic enzyme abnormalities

We have reported that refractory functional dyspepsia patients with pancreatic enzyme abnormalities (FD-P). We tried to analyze the prevalence of exocrine pancreatic insufficiency (EPI) in FD-P patients to clarify whether the pathophysiology of FD patients including clinical symptoms and quality of life were associated with EPI. We enrolled forty-nine patients presenting with typical symptoms of FD-P patients (n = 20) and asymptomatic patients with pancreatic enzyme abnormalities (AP-P) (n = 29). Five pancreatic enzymes (p-amylase, lipase, elastase-1, trypsin, and PLA2) were measured and STAI-state/-trait and SF-8 were evaluated. Pancreatic exocrine function was analyzed using N-benzoyl-l-tyrosyl-p-aminobenzoic acid (BT-PABA). There were no significant differences in patient background between FD-P and AP-P patients. BT-PABA test scores for FD-P patients (61.67 ± 5.55) were significantly (p = 0.01) lower than in AP-P patients (95.38 ± 2.36). Physical component scale (PCS) in FD-P patients was significantly (p = 0.002) lower than that in AP-P patients. STAI-state was relatively (p = 0.054) associated with BT-PABA test in FD-P and AP-P patients by multiple logistic regression analysis. The prevalence of EPI in FD-P patients was significantly higher than that in AP-P patients and was relatively associated with state of anxiety. Further studies will be needed to clarify how EPI or pancreatic enzyme abnormalities are associated with the pathophysiology of FD-P patients.     

内镜下诊断与治疗慢性胰腺炎17例

目的 探讨内镜下诊断和治疗慢性胰腺炎的价值。方法 对17例慢性胰腺炎均行内镜下逆行胰胆管造影术(ERCP)，并对部分胰管狭窄患者施行塑料支架放置引流术(ERPD)或鼻胰管引流术(ENPD)，对部分胰管内结石行内镜下胰管括约肌切开术(EPS)并行网篮取石。结果 有8例胰管狭窄者放置塑料支架，平均引流时间为276d。5例胰管结石中2例行EPS后网篮取出结石，3例行鼻胰管引流术后手术取出。结论 ERCP可作为有条件医院检查慢性胰腺炎的常规手段，是治疗部分慢性胰腺炎安全有效的方法。     

Alkaline phosphatase and acid lysosomal hydrolases in pancreatic juice and fibroblast cell cultures of patients with chronic calcifying pancreatitis

Abstract. Nine lysosomal enzymes and alkaline phosphatase have been assayed in human pancreatic juice from controls and patients with chronic calcifying pancreatitis. Specific activities were evaluated by a non parametric test (Wilcoxon) with a probability of 2 P .0.5. The values of acid phosphatase, α -glucosidase, β -glucosidase and α -galactosidase are significantly higher in pathological juices; the values of α -mannosidase and β -glucuronidase are also increased in the same patients but at the limit of significance. Alkaline phosphatase, β -hexosaminidase and α -fucosidase follow the same trend but the values are not statistically significant between the two groups of patients. Studies on skin cultures of four patients with chronic calcifying pancreatitis demonstrate that the increased specific activities of lysosomal enzymes in the pathological juices do not correspond to a leakage of these enzymes into the extracellular space as described for cystic fibrosis.     

高频超声鉴别合并胆胰管阻塞的胰头肿块型胰腺炎和胰头癌的价值

目的探讨高频超声对合并胰胆管阻塞的胰头肿块型胰腺炎和胰头癌的鉴别诊断价值。方法对病理证实的16例胰头肿块型胰腺炎（胰腺炎组）与38例胰头癌（胰头癌组）进行高频超声检查,对比观察两组二维声像图和彩色多普勒声像特征及其间的差异。结果病变的形态、边界、内部回声后方衰减及血流信号分级,两组间差异无统计学意义（P〉0．05）。胆总管胰腺段和近端主胰管,胰腺炎组出现“鼠尾征”,检出率分别为93．8％（15／16）和100％（16／16）,胰头癌组则以“截断征”为特征,检出率分别为94．7％（36／38）和97．4％（37／38）,两种征象在两组间差异具有统计学意义（P〈0．001）。结论腹部高频超声可清晰显示胰头痛变部位及病变周围的细微变化,在胰头肿块型胰腺炎与胰头癌鉴别诊断中是一种可行且有效的检查方法。     

胰头部肿块型胰腺炎CT诊断及误诊分析

目的分析胰头部肿块型胰腺炎CT误诊和漏诊原因，提高对胰头部肿块型胰腺炎CT诊断和鉴别诊断能力。方法对15例术前误诊的胰头部胰腺炎病例进行回顾性分析。CT检查采用单排或多排螺旋CT进行扫描，层厚5～8mm或2mm。结果术前CT误诊为胰腺癌的15例胰头部胰腺炎，术后11例经手术病理证实为胰腺炎，4例为穿刺活检证实。结论注意螺旋CT扫描方法，仔细阅片，全面分析，能减少CT对肿块型胰腺炎的误诊率和漏诊率。     

内镜下治疗慢性胰腺炎的临床疗效及对患者腹痛症状改善程度的研究

目的对内镜下治疗慢性胰腺炎(CP)的临床疗效进行观察,并分析患者腹痛症状的改善程度,为临床提供参考依据。方法选择该院2011年7月-2013年6月经内镜下治疗的CP患者81例,观察其疗效、并发症和腹痛情况。结果 81例患者手术均获成功,无死亡病例。术后1周疼痛平均分为(2.29±0.14)分,低于术前(7.13±0.27)分,差异有统计学意义(P0.05)。术后1周无痛、轻度疼痛和中度疼痛分别为46.91%(38/81)、35.80%(29/81)和13.58%(11/81),均高于术前(P0.05)。术后1周重度疼痛为3.70%(3/81),低于术前56.79%(46/81)(P0.05)。术后1周脂肪泻和营养不良分别0.00%(0/81)和7.41%(6/81),均低于术前25.93%(21/81)和37.04%(30/81),差异有统计学意义(P0.05)。术后1周血清淀粉酶平均浓度为(74.18±2.75)u/L,低于术前(182.45±8.32)u/L,差异有统计学意义(P0.05)。结论内镜下治疗CP并发症较少,疗效可靠,具有微创、可重复等优点,可有效治疗慢性胰腺炎患者并能够有效缓解其腹痛。     

改良的早期预警评分在急性胰腺炎中的应用

目的 探讨改良的早期预警评分(MEWS)在急性胰腺炎轻重和病程评估方面的作用.方法 上海交通大学医学院附属仁济医院2006年11月至2007年5月由急诊收入92例急性胰腺炎的患者.急性胰腺炎的诊断采用美国急性胰腺炎临床指南的标准,符合以下三条中的二条:(1)具有急性胰腺炎特征性腹痛;(2)血清淀粉酶≥正常值上限3倍;(3)急性胰腺炎特征性的B超或CT表现.患者本身合并有心肺肝肾功能不全等疾病的排除在外.入院后第1,2,3天记录患者的MEWS评分,观察其分值分布及动态变化.根据MEWS评分分为重危组(MEWS≥4)和一般组(MEWS<4),比较两组患者的病程、器官衰竭发生率和死亡率.对患者入院当天分别行MEWS评分、Rason评分和急性生理与慢性健康评分(APACHEⅡ评分),观察其相关性.统计方法采用相关性分析以及团体t检验.率的比较采用X~2检验.结果 MEWS分值≥4分的患者病程明显长于其他患者,器官衰竭发生率明显增高,且经过处理后分值未能下降的患者死亡率更高.MEWS评分与Rason评分、APACHEⅡ评分呈正相关.结论 MEWS评分可以用来评估急性胰腺炎患者的轻重及预后.MEWS评分简便易行,适合早期筛选危重急性胰腺炎患者.     

早期肠内营养促进重症急性胰腺炎预后效果的系统评价

目的系统评价早期肠内营养对促进重症急性胰腺炎预后效果。方法计算机检索2002年至2012年国内外数据库,纳入比较早期肠内营养与全胃肠外营养对重症急性胰腺炎预后效果的随机对照试验,在对纳入研究的偏倚风险进行评价后,进行Meta分析。结果最终纳入16篇文献,共874例患者。Meta分析结果显示,早期肠内营养组和全胃肠外营养组在腹痛缓解时间、血淀粉酶恢复时间、感染发生率、并发症发生率、病死率、住院时间及住院费用方面比较差异具有统计学意义（P〈0．01或P〈0．05）。结论早期肠内营养有利于重症急性胰腺炎患者病情恢复、改善预后。由于纳入研究方法学质量较低,今后需高质量的大样本随机双盲实验增加论证强度。     

不同敷料应用于慢性伤口治疗中的效果观察

[目的]观察蜂蜜敷料与功能性敷料应用于慢性伤口中的效果。[方法]将96例慢性伤口病人随机分为观察组和对照组各48例,分别使用蜂蜜敷料、功能性敷料处理伤口,观察两组伤口不同时间面积愈合率、换药时间、伤口2次损伤积分及治疗费用。[结果]观察组病人伤口换药第20天及第30天面积愈合率高于对照组、换药时间快于对照组、治疗费用少于对照组(P均<0.05)。[结论]蜂蜜敷料治疗慢性伤口安全有效、经济适用,效果优于功能性敷料,为临床难愈压疮和手术后感染难愈伤口的处理提供有效方法。     

早期肠内营养和延迟肠外营养对急性重症胰腺炎肠源性感染患者预后的影响

目的比较早期肠内营养和延迟肠外营养对急性重症胰腺炎肠源性感染患者预后的影响。方法选择2017年1月至2019年12月我院收治的80例急性重症胰腺炎肠源性感染患者作为研究对象,将其随机分为对照组和观察组,每组40例。所有患者均给予常规治疗。在此基础上,对照组给予延迟肠外营养,观察组给予早期肠内营养。比较两组患者治疗前和治疗2周后的白细胞介素-6(IL-6)、C反应蛋白(CRP)、内毒素以及白细胞水平;比较两组的住院时间、治疗费用及不良反应发生情况。结果治疗后,两组的IL-6、CRP、内毒素及白细胞水平均降低,且观察组低于对照组(P<0.05)。观察组的住院时间和治疗费用均明显少于对照组(P<0.05)。观察组的不良反应总发生率低于对照组(P<0.05)。结论早期肠内营养治疗急性重症胰腺炎肠源性感染可促进患者临床指标恢复,缩短住院时间,减轻患者经济负担,并降低不良反应发生率。     

鼻空肠管早期肠内营养治疗急性重症胰腺炎20例临床护理

目的:探讨经鼻空肠管早期肠内营养(EN)治疗急性重症胰腺炎(SAP)的护理方法.方法:将42例SAP患者随机分为经鼻空肠管早期EN治疗SAP 20例(EN组),全疗程全胃肠外营养(TPN)治疗SAP 22例(TPN组),观察两组治愈率、病死率、细菌或霉菌感染率、住院时间和平均住院费用的差异.结果:EN组患者住院时间、住院费用及细菌或霉菌感染的发生率均低于TPN组(P<0.05).治愈率、病死率两组比较无统计学意义,无一例患者因行EN治疗而加重SAP病情.结论:经鼻空肠管早期EN治疗对SAP是一种安全有效的营养方法,值得临床推广应用.     

Proenkephalin for the early detection of acute kidney injury in hospitalized patients with chronic kidney disease

Background

The early detection of acute kidney injury (AKI) in patients with chronic kidney disease (CKD) is an unmet clinical need. Proenkephalin (PENK) might improve the early detection of AKI.

Methods

One hundred and eleven hospitalized CKD patients undergoing radiographic contrast procedures were enrolled. PENK was measured in a blinded fashion at baseline (before contrast media administration) and on day 1 (after contrast media administration). The potential of PENK levels to predict contrast‐induced AKI was the primary endpoint.

Results

Baseline creatinine and baseline PENK were similar in AKI and no‐AKI patients. In AKI patients, day 1 PENK (198 pmol/L vs 121 pmol/L, P < 0.01) was significantly higher compared to no‐AKI patients. The area under the curve (AUC) for the prediction of AKI by day 1 PENK was 0.79, 95% CI: 0.70‐0.87, similar to serum creatinine: 0.78, 95% CI: 0.61‐0.95. Delta PENK was significantly higher in AKI compared to no‐AKI patients (53 pmol/L vs 1 pmol/L, P < 0.01). The AUC for the prediction of AKI by delta PENK was high (0.92, 95%CI 0.82‐1.00) and remained high for creatinine‐blind AKI (0.94, 95% CI: 0.87‐0.97).

Conclusion

Delta PENK levels improve the early detection of contrast‐induced AKI in CKD patients over serial creatinine sampling. Delta PENK accelerates the detection of creatinine‐blind AKI by 24 hours.     

慢性阻塞性肺疾病稳定期病人的康复治疗

[目的 ]提高慢性阻塞性肺疾病 (COPD )病人呼吸肌的肌力和耐力。 [方法 ]将 10 0例COPD病人随机分为两组 ,观察组 5 0例 ,进行抗阻力深慢腹式呼吸训练 ,对照组 5 0例 ,进行单纯深慢腹式呼吸训练 ,于训练前和训练后 1个月、2个月、3个月分别测定肺功能、12min步行距离和生活质量 ,并对比训练前后的变化。[结果 ]观察组经训练后呼吸肌的肌力、耐力和各项指标的改善程度明显优于对照组。 [结论 ]抗阻力深慢腹式呼吸训练可改善COPD病人的肺功能和生活质量。     

慢性乙型肝炎护肝治疗患者肝硬化危险因素分析

目的:探讨慢性乙型肝炎护肝治疗患者肝硬化发生率及相关危险因素。方法:对252例慢性乙肝护肝治疗患者随访资料进行非条件Logistic回归分析、绘制Kaplan-meier生存曲线。结果:随访13年肝硬化累积发生率为30.5%,共4个因素(HBVDNA,HBeAg,ALT分级、观察时间分级)被纳入回归模型;ALT水平越高,肝硬化累积发生率风险越高(P=0.047)。结论:HBVDNA高水平与HBeAg阴性状态是慢性乙肝护肝治疗患者肝硬化发生的高风险因素。长期护肝治疗可有效地降低ALT升高的慢性乙型肝炎患者肝硬化累积发生风险。     

Disability in chronic migraine patients with medication overuse: treatment effects at 1-year follow-up

OBJECTIVE: To determine (1) the clinical course of a sample of chronic migraine patients with drug overuse 6 and 12 months following in-patient treatment and (2) whether functional impairment, assessed by the Migraine Disability Assessment (MIDAS) questionnaire, improved upon treatment. BACKGROUND: Patients with chronic migraine and medication overuse are particularly difficult to treat (prophylactic medications that otherwise are effective become ineffective; discontinuation of the offending medication can lead to withdrawal headache; physical and emotional dependence can be present, as well as increased psychological involvement; initial treatment gains can be difficult to maintain). METHODS: Of the 106 patients meeting criteria for chronic migraine with medication overuse, 84 went on to complete a structured in-patient treatment, consisting of medication withdrawal and then prophylactic treatment. RESULTS: As a group, the patients were improved at both 6- and 12-month follow-up, with respect to two headache parameters (frequency and medication use) and three measures of functional impact extracted from the MIDAS questionnaire (Total Score, Headache Frequency, and Headache Intensity). CONCLUSION: Chronic migraine accompanied with medication overuse led to the considerable disability prior to treatment. However, notable improvement occurred coincident with the treatment. This suggests that successful treatment has more wide-ranging positive benefits beyond mere symptom reduction. To our knowledge, this is the first investigation where the MIDAS questionnaire has been used prospectively as an outcome measure in patients with chronic migraine and medication overuse to assess disability subsequent to a semi-standardized treatment program.     

伊马替尼治疗早期BCR-ABL转录本水平在251例慢性髓性白血病患者中的预后价值

目的 了解慢性髓性白血病(CML)患者伊马替尼治疗早期BCR-ABL转录本水平的预后价值,为CML患者早期预后评估和治疗选择提供依据.方法 回顾性分析251例接受伊马替尼—线治疗CML慢性期(CML-CP)患者的临床资料,分别比较治疗后3个月及6个月不同BCR-ABL转录本水平患者的无进展生存(PFS)率及总体生存(OS)率,并采用卡方检验及Logistic回归分析方法分析疾病进展的危险因素.结果 伊马替尼治疗3个月BCR-ABL转录本＞10％组(92例)、＞1％～10％组(94例)、≤1％组(65例)的PFS率分别为53.3％、71.3％、86.2％ (P＜0.05),OS率分别为92.4％、96.8％和93.8％ (P＞0.05).伊马替尼治疗后6个月时BCR-ABL转录本＞10％组(22例)、＞1％～10％(50例)组、≤1％(110例)组PFS率分别为27.3％、66.0％和82.7％(P＜0.05),OS率分别为86.4％、94.0％、100％(P＜0.05).Logistic回归分析结果显示3个月及6个月BCR-ABL转录本水平为影响疾病进展的独立危险因素.结论 伊马替尼治疗3个月及6个月BCR-ABL转录本水平对CML患者预后评估具有重要价值.     

电针联合功能性电刺激早期干预对脑梗死后痉挛型构音障碍的疗效研究

目的:探讨早期电针(EA)联合功能性电刺激(FES)对脑梗死痉挛型构音障碍的临床疗效。方法:将180例脑梗死痉挛型构音障碍患者随机分为对照组、治疗组和联合组,对照组予常规药物治疗加灯盏细辛注射液静滴,治疗组在对照组基础上加电针,针刺风池、百会、大椎、翳明、廉泉、外金津玉液,联合组在治疗组基础上加FES治疗,治疗前及治疗2周后采用修改的Barthel指数(MBI)、NIHSS评分和Frenchay构音障碍评价法评定其疗效。结果:经治疗后,对照组、治疗组、联合组的MBI、NIHSS评分均较同组治疗前明显改善(P<0.001),经治疗后联合组的MBI高于对照组和治疗组(P<0.05),NIHSS评分则低于对照组和治疗组,三组间的MBI、NIHSS评分比较差异具有显著性意义(P<0.05);治疗后治疗组和联合组的Frenchay构音障碍评定级别均较治疗前明显改善(P<0.05,P<0.001),差异具有显著性。结论:EA联合FES能有效地改善脑梗死患者构音障碍及日常生活能力。     

早期经小肠喂养管注入中药治疗重症胰腺炎45例

目的总结早期经小肠喂养管给中药的方法治疗重症胰腺炎的疗效。方法回顾性分析本院2005年1月至2010年12月收治的45例急性重症胰腺炎病例,应用中西医结合方法,并早期采用小肠喂养管注入中药的治疗措施。结果 45例患者中8例治愈,33例好转,2例保守治疗无效后经外科干预后转出重症医学科。2例被迫终止治疗。治愈率为18.6%,好转率为76.7%。结论 应用中西医结合治疗方法,早期经小肠喂养管给中药治疗急性重症胰腺炎,疗效满意,值得推荐。     

拉米夫定早期应答不佳加用阿德福韦酯治疗HBeAg阳性慢性乙型肝炎的疗效观察

目的观察早期阿德福韦酯联合拉米夫定治疗拉米夫定应答不佳的HBeAg阳性慢性乙型肝炎(CHB)的病毒学应答疗效。方法选择经拉米夫定治疗12周内HBV-DNA值下降≤2 Log10拷贝/ml或每月HBV-DNA值下降≤1 Log10拷贝/ml连续两月的HBeAg阳性CHB患者15例,均检测病毒耐药变异并给予阿德福韦酯(10 mg,1次/天)联合治疗。分别观察联合治疗12、24及48周的病毒学应答情况。结果 15例患者中11例发生病毒变异,变异发生率73.33%,耐药变异位点以rt M204V/I多见。在联合阿德福韦酯治疗12、24及48周时的HBV-DNA阴转率分别为40%、66.7%及86.7%,在12、48周时差异有统计学意义(P<0.05);联合治疗24周及48周时HBe Ag阴转率分别为13.3%(2/15)及33.3%(5/15)。结论早期筛选出拉米夫定耐药株并联合阿德福韦酯是对拉米夫定应答不佳CHB患者有效的干预策略之一。