胃食管高级别上皮内瘤变内镜切除术前后病理结果对比研究

目的 比较胃、食管高级别上皮内瘤变病灶内镜活检与内镜切除标本病理诊断的异同.方法 选取近4年间147例内镜活检诊断为胃、食管黏膜高级别上皮内瘤变、经内镜下切除（EMR或ESD）患者的资料,对切除前后的病理结果进行对照分析.结果 147例患者活检病理均诊断胃、食管上皮内瘤变,其中胃41例,食管106例;内镜术后97例（66%）维持上皮内瘤变诊断,50例（34%）诊断为癌,且有11例已经侵犯到黏膜下层.病理分型腺癌34例,鳞癌16例,其中低-中分化癌22例（44%）.结论 内镜活检诊断胃、食管高级别上皮内瘤变的病例超过三分之一已经癌变,应该采取积极的治疗措施.     

内镜黏膜下剥离术在治疗胃上皮内瘤变中的应用与评价

目的探讨胃上皮内瘤变行内镜黏膜下剥离术(ESD)的可行性、必要性及疗效。方法对50例内镜下有明确病灶,表现为浅表病变,活检病理为上皮内瘤变的患者,行ESD切除病灶,对比术前术后病理结果,并内镜随访。结果 34例术前活检病理为低级别上皮内瘤变的病灶ESD术后病理诊断为低级别上皮内瘤变22例、高级别上皮内瘤变6例、黏膜内癌4例、黏膜下浅层癌2例。16例术前活检病理为高级别上皮内瘤变的病灶ESD术后病理诊断为慢性炎症肠上皮化生1例、高级别上皮内瘤变5例、黏膜内癌3例、黏膜下层癌7例。结论 ESD治疗内镜下有明确病灶的上皮内瘤变可及时发现早期胃癌,并有效预防胃癌的发生、发展。     

内镜碘染色在早期食管病变中的诊断价值

目的评价内镜下食管碘染色在诊断高危人群食管黏膜异型增生与早期食管癌诊断中的意义及应用价值。方法选择食管肿瘤高发区的高危人群,对其中内镜下的食管糜烂等病变116人,进行碘染色。根据染色后食管黏膜的颜色变化,可疑病灶进行有针对性地活检送病理检查。结果 116例患者食管黏膜碘染色后有不着色区或明显淡染区,病理显示85例为轻度不典型增生,15例为中度不典型增生,12例为重度不典型增生,早期食管癌4例。结论内镜下食管碘染色在早期食管癌及异型增生的诊断中敏感性高,漏诊率低,人群的顺应性较好,在食管高危人群的早期病变诊断中具有较高的应用价值。     

内镜下碘染色用于江苏淮安地区食管疾病筛查1983例研究

目的探讨内镜下碘染色在食管癌高发区的食管早癌内镜筛查中的重要临床价值。 方法2014至2016年在江苏省淮安市清浦区武墩镇及盐河镇等对1983例40～60岁人群进行食管癌内镜筛查,对比碘染色前后食管黏膜颜色和形态的变化,并对黏膜染色异常者行活检病理检查。 结果740例患者共835处病灶接受食管组织活检,有273例于碘染色前发现(白光状态下),碘染色后再发现562例。其中碘染后新发现5例黏膜内癌,205例各种异型增生,2组比较差异有统计学意义(P<0.05),表明碘染色后食管癌及癌前病变的检出率明显高于染色前。 结论内镜下食管黏膜碘染色可明显提高筛查过程中食管癌及癌前病变的检出率,且因其价格低廉,操作简单,值得临床推广应用。     

食管早期癌及上皮内瘤变内镜黏膜下剥离术16例临床分析

目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)对食管早期癌及上皮内瘤变的治疗效果。方法回顾分析16例食管早期癌及上皮内瘤变行ESD患者的临床资料。常规内镜发现病灶,卢戈氏液(Lugol’s solution)染色和超声内镜检查,确定病变边界、范围和深度,无禁忌证患者均在气管插管静脉麻醉条件下行ESD。术后1、3、6个月内镜复查评估治疗效果。结果本组16例患者22处病变成功完成ESD治疗,手术成功率91.67%(22/24)。术后病理示6例12处高级别上皮内瘤变与术前诊断相符,3例原诊断为高级别上皮内瘤变共3处,其中2处为黏膜内癌,1处为原位癌。术前3例共3处黏膜内癌,2例共2处原位癌ESD术后病理与术前相符。2例高级别上皮内瘤变因术中出血及操作时间过长未能成功实施ESD。结论 ESD是治疗食管早期癌及上皮内瘤变的有效方法,其优势为创伤小、疗效好、恢复快。     

窄带成像技术与碘染色诊断早期食管癌及癌前病变的对比研究

目的 探讨窄带成像技术(NBI)对食管癌及癌前病变的诊断价值.方法 对2008年5月至11月北京友谊医院4056例患者进行常规内镜、NBI、碘染色检查食管,筛查到82例114处病变,对这些病变行NBI结合放大内镜检查并靶向取活检.比较3种检查方法对病灶的诊断价值,井比较IPCL分型与病理的一致性.结果 与NBI和碘染色相比,常规內镜对早期食管癌及癌前病变较易漏诊,尤其是平坦型病变.NBI和碘染色对病灶的检出率均较高(78.0%和79.8%),高级别黏膜內瘤变均主要表现为NBIⅡ级(80.4%)和碘染色I级(85.7%),低级别黏膜内瘤变主要表现为碘染色Ⅱ/Ⅲ级(66.0%),但NBI对其不具有特异性.高级别黏膜内瘤变以IPCL形态Ⅳ、V型表现为主(92.9%),低级别黏膜内瘤变以IPCLⅡ、Ⅲ型表现为主(89.4%),IPCL形态分型与病理诊断之间具有较好的一致性.结论 碘染色及NBI对早期食管癌及癌前病变均有较高的检出率;NBI结合放大內镜观察IPCL形态,可能成为早期食管癌內镜下治疗及术后是否复发的重要依据.     

内镜下碘染色诊断早期食管癌的临床研究

目的 探讨内镜下碘染色对早期食管癌及癌前病变的诊断价值.方法 将内镜下有可疑食管病变的220例患者随机分为染色组和对照组各110例.用Lugol液对染色组进行食管黏膜染色检查,并对不染色和浅染色区进行病理活检.对照组不行Lugol液染色,仅根据临床经验进行病理活检.结果 染色组不着色或浅着色69例(62.7%),活检发现食管癌14例(12.7%),其中早期食管癌3例,鳞状上皮异型增生9例(8.1%);对照组110例活检发现食管癌2例(1.8%),轻中度异型增生4例(3.6%).两组食管癌诊断率的差异有统计学意义.结论 内镜下碘染色能减少食管黏膜活检误差,提高食管癌诊断率,有助于发现早期食管癌及其癌前病变.     

食管上皮内瘤变内镜活检与术后标本病理结果差异分析

[目的]分析比较上皮内瘤变或早期食管癌(early esophageal cancer,EEC)患者内镜活检与内镜切除术后病理差异。[方法]收集经内镜活检诊断的182处食管上皮内瘤变或EEC病变患者的临床资料,对比术前后病理结果,分析患者临床及内镜特点,探索发生术后病理升级的危险因素。[结果]活检提示食管低级别上皮内瘤变(lowgrade intraepithelial neoplasia,LGIN)43处,高级别上皮内瘤变(high-grade intraepithelial neoplasia,HGIN)112例,EEC27处。术前活检与金标准比较总体符合率为68.7%(125/182),病理升级率为31.3%(57/182);LGIN组符合率为37.2%(16/43),HGIN组为73.2%(82/112),EEC组为100%(27/27),差异有统计学意义(P0.01)。病变表面有结节、联合碘染色或窄带成像技术(narrow-band imaging,NBI)或超声内镜(endoscopic ultrasound,EUS)的靶向取检以及标本最长径与术后病理升级有关(P0.05)。[结论]内镜活检对于食管上皮内瘤变及EEC的病理诊断存在局限性,活检诊断LGIN发生术后病理升级较为多见,因此对于表面有结节及长径较长的病灶,联合碘染色或NBI或EUS进行靶向取检对提高术前评估准确性有重要的临床价值。     

内镜窄带成像技术对早期食管癌及癌前病变的诊断价值

目的 探讨内镜窄带成像技术(NBI)诊断早期食管癌及癌前病变的价值.方法 90例经内镜检查病理诊断的早期食管癌及癌前病变患者,共138个病变,分别在普通模式和NBI模式下观察食管黏膜.用普通放大及NBI放大观察病变的腺管开口形态及毛细血管结构形态,然后应用1.2%碘液行全食管染色,对所有NBI阳性及碘染色阳性部位均取活检,所有病变均以病理结果作为诊断标准,再将病变NBI分级、碘染色分级分别与病理诊断结果对比.结果 普通模式下发现病变104个(75.4%),NBI模式下发现病变120个(87.0%),碘染色发现病变138个(100.0%).NBI模式对病变的检出率高于普通模式(P＜0.05),而低于碘染色(P＜0.01),但NBI模式对高级别黏膜内瘤变的检出率与碘染色无明显差别(P＞0.05),主要差别在于NBI模式对低级别黏膜内瘤变的检出率低于碘染色(P＜0.01).结论 NBI可清晰显示早期食管癌、癌前病变的腺管开口及毛细血管结构形态,明显优于普通内镜,NBl技术与碘染色技术的有机结合可在更大程度上提高早期食管癌、癌前病变的诊断率.     

醋酸染色后NBI内镜下大肠腺瘤和早期大肠癌的微形态特征

目的分析醋酸染色后窄带成像(NBI)内镜下大肠腺瘤和早期大肠癌的黏膜表面腺管形态(pit)、微血管形态(cp)、黏膜白化时间的特征,评价其预测低级别上皮内瘤变、高级别上皮内瘤变和早期癌的价值。方法用醋酸染色后NBI的方法观察大肠可疑病变,根据pit分型、cp分型、黏膜白化时间预测病变为低级别上皮内瘤变、高级别上皮内瘤变和早期癌,并与病理结果对照判断其敏感度、特异度、准确率、阳性预测值、阴性预测值。结果入选106例病例。pit分型ⅢL或Ⅳ型,联合cp分型Ⅱ型和醋酸白化时间31～60 s预测低级别上皮内瘤变敏感度、特异度、准确率分别为87.2%、89.3%、87.7%;pit分型ⅤI型,联合cp分型ⅢA型和醋酸白化时间6～30 s预测高级别上皮内瘤变和早期癌的敏感度、特异度、准确率分别为82.1%、83.3%、83.0%。结论醋酸染色后NBI观察大肠可疑病灶的微形态,两种方法结合,取长补短,能清晰显示病灶pit和cp,具有视野清晰、价格低廉、操作简单、无毒的优点,对鉴别低级别上皮内瘤变、高级别上皮内瘤变和早期癌有较高价值,值得推广应用。     

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.     

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。     

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.     

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。