OMOM胶囊内镜在无症状人群体检中的应用

目的 探讨OMOM胶囊内镜在无症状人群体检中应用价值.方法 受检者为2005年8月-2010年3月到北京军区总医院消化内科进行胶囊内镜检查的无症状体检人群,受检者按就诊的时间顺序随机分为研究组(A组)、对照组(B组)、自身对照组(C组).A组受检者按一定体位进行胶囊内镜检查,送服胶囊后立即依次平卧位3 min,左侧卧位3 min,右侧卧位3 min,半卧位3min,观察食管黏膜情况,再观察胃依次左侧卧位10 min,平卧位10 min,右侧卧位10 min,站立位10 min,随后可自由活动,直至胶囊内镜排出体外.B组受检者按常规要求进行胶囊内镜检查.C组受检者进行胶囊内镜检查后即安排胃镜和结肠镜检查.结果 A组和B组胶囊内镜食管运行平均时间和胃排空平均时间差异均有统计学意义(P＜0.05);但A组和B组胶囊内镜排出平均时间差异无统计学意义(P＞0.05).A组和C组胶囊内镜食管运行平均时间和排出平均时间差异均有统计学意义(P＜0.05);但A组和C组胶囊内镜胃排空平均时间差异无统计学意义(P＞0.05).90例A组受检者中检出消化道病变者28例,检出率31.11％;160例B组受检者中检出消化道病变者42例,检出率26.25％;110例C组受检者中检出消化道病变者43例,检出率39.09％.A组和B组食管病变检出率比较差异具有统计学意义(P＜0.05).结论 胶囊内镜在特定体位下可以提高食管及胃病变检出率.胶囊内镜检查可以指导胃镜及结肠镜检查能更有效提高消化道疾病检出率,用于无症状人群体检无疑是一种安全、无创、无痛苦的消化道检查方法.     

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。     

磁控胶囊胃镜人工智能标注方法的建立与评价

目的:探索磁控胶囊胃镜人工智能标注胶囊胃镜图片的方法,以提升内镜医师的工作效率并减少人工智能阅片盲区。方法:按照磁控胶囊胃镜相关共识意见,由10名内镜医师和1名有医学背景的磁控胶囊胃镜研发人员对深圳市资福医疗技术有限公司2020年3月至8月招募的本公司35名磁控胶囊胃镜受检者(以下简称受检者)共14 775幅磁控胶囊胃...     

超细胃镜的临床应用价值探讨

目的:探讨超细胃镜的诊疗价值。方法:应用超细电子胃镜经鼻插入检查32例(A1组),经口插入检查50例(A2组),小儿经口插入检查10例(B组),经鼻内镜监视下食管金属支架置入术23例(C组)。与同期常规电子胃镜经口插入检查300例(D组)对比研究。结果:所有受检病例均成功进行了上消化道检查,A1组29例(90.6%)呈轻度反应,3例(9.3%)呈中度反应;A2组41例(82.0%)呈轻度反应,6例(12.0%)呈中度反应,3例(6.0%)反应较大,呈重度;D组30例(10.0%)反应轻度,97例(32.3%)反应中度,173例(57.7%)反应重度。A1组与A2组无统计学差异(P>0.05),A1和A2组与D组差异有统计学意义(P<0.05)。小儿经口插入超细胃镜检查10例与经鼻内镜监视下食管金属支架置入术23例,均获成功。结论:超细电子胃镜较普通胃镜检查安全性高,患者痛苦小;尤其适于小儿上消化道疾病的检查;同时超细电子胃镜易于通过普通内镜不能通过的狭窄食管,可经鼻内镜监视下行食管金属支架置入术治疗,值得临床推广应用。     

磁控胶囊内镜对小肠克罗恩病早期诊断的临床研究

目的探讨磁控胶囊内镜对小肠克罗恩病(CD)早期诊断的临床应用价值。 方法选择2015年8月至2017年2月临床怀疑小肠CD经上海交通大学医学院附属瑞金医院卢湾分院消化内科行磁控胶囊内镜检查的203例小肠CD高危患者进行磁控胶囊内镜检查,根据检查结果参照De Bona等^{[ 6 ]}的标准进行分组,随访各组治疗情况、病情进展及转归。 结果A组17例符合确诊标准;B组87例符合可疑标准,随访1～2年后,7例确诊为CD;C组67例符合非特异性肠炎。B组和C组治疗前后各项炎症指标比较有统计学意义,提示治疗有效。 结论磁控胶囊内镜对小肠CD早期诊断具有一定的临床应用价值,能够早期用于指导治疗,改善疾病的预后。     

《中国磁控胶囊胃镜临床应用指南(2021, 上海)》解读

2021年12月《中国磁控胶囊胃镜临床应用指南(2021, 上海)》正式发布, 新指南对原有2017年版专家共识进行修订增补, 根据标准原则规范流程制定, 细化明确了磁控胶囊胃镜的定义范畴、临床适应证与禁忌证、检查过程与质控要点、局限与优化方向等内容。本文将对新指南的特点与重点内容进行简要说明与解读, 以便医务人员更好地理解运用。     

胰岛素联合六味安消胶囊治疗糖尿病胃轻瘫疗效观察

将120例糖尿病胃轻瘫患者随机分为胰岛素联合六味安消胶囊治疗组(A组)、胰岛素治疗组(B组)、六味安消胶囊治疗组(C组)和对照组(D组),各30例,分别给予相应治疗1个月.结果:A组总有效率为70.00%,明显高于B(56.67%)、C(56.33%)、D(20.00%)组,P均<0.05.治疗后A组胃动素水平明显低于B、C、D组,P均<0.05.认为胰岛素联合六味安消胶囊是治疗糖尿病胃轻瘫的有效方法.     

贲门失弛缓症经胃镜球囊扩张治疗的随访研究

贲门失弛缓症是原发性食管运动障碍性疾病，临床主要表现为吞咽困难、胸骨后疼痛和反食等。我们对18例贲门失弛缓症患者经胃镜下定位进行球囊扩张治疗，并于扩张术前后测量下食管括约肌压力(LESP)、下食管括约肌松弛残余压力(LESRP)和吞咽时下食管括约肌松弛率(LESRR)，研究扩张前后下食管括约肌动力学特征及其近、远期疗效。     

微卡辅助治疗菌阳肺结核的近期效果观察

目的　评价微卡(Vaccae)治疗菌阳肺结核的临床疗效。方法 169例初治菌阳肺结核和90例复治菌阳肺结核,随机分为A、B、C、D组,A组(85例)、B组(84例)采用2HRZS(E)/4HR方案;C组(45例)、D组(45例)采用3HRZA(E)/6HR方案;A、C 2组加用微卡。观察治疗后肺部病灶吸收、痰菌阴转情况。结果 3个月末痰菌阴转率:A、B组分别为80.0%和65.5%,C、D组分别为71.1%和62.2%;疗程结束时痰菌阴转率A、B组分别为97.6%和84.5%,C、D组分别为95.6%和77.8%。疗程结束时胸部X线显著吸收率:A、B组分别为90.6%和75.0%,C、D组分别为82.2%和60.0%。空洞闭合:A、B、C、D组分别为85.9%、64.3%、77.8%、57.7%。结论 微卡辅助治疗菌阳肺结核能提高痰菌阴转率,促进肺部病灶吸收,提高免疫细胞活性,是一种较好的免疫制剂,建议推广使用。     

幽门螺杆菌感染对消化性溃疡患者胃G,D细胞的影响

目的 探讨幽门螺杆菌(Hp)感染对溃疡患者胃G,D细胞的影响.方法 活动性十二指肠溃疡(DU)患者77例根据Hp情况分为A组(Hp根除组)51例,男37例,女14例,年龄35岁±13岁,成功根除Hp;B组(Hp持续阳性组)12例,男9例,女3例,年龄35岁±10岁,未根除Hp;C组(Hp阴性组)14例,男9例,女5例,年龄38岁±12岁.D组为Hp阳性的功能性消化不良(FD)25例,男15例,女10例,年龄38岁±13岁,成功根除Hp.在治疗之前及疗程结束之后1 mo再复查内镜,了解溃疡愈合和Hp感染情况,并取胃窦粘膜查G,D细胞数量(ABC法免疫组化)、促胃液素(Gas)和生长抑素(SST)基因表达(α-32PdATP掺入RT-PCR).结果 治疗后各DU组溃疡灶均愈合.各组胃窦G细胞数量无统计学差异(P＞0.05).Hp阳性组的D细胞数量(个/nlm2,A组9.3±2.4,B组11.9±5.3,D组12.9±5.9)低于Hp阴性患者(C组19.2±5.6个/mm2,P＜0.05),Hp根除之后D细胞数量增多(A组18.5±5.6,D组20.3±7.1个/mm2,P＜0.01),未根除Hp的B组D细胞数量依然较低(10.6±6.4个/mm2).A,D两组间的D细胞数量、G/D细胞比值均接近.治疗前各DU组Gas基因表达水平(A/gq,A组424±152,B组435±114,C组368±184)高于FD组(D组216±95 A/Bq,P＜0.01),Hp阳性DU组(A,B组)与Hp阴性DU组(C组)的差异无统计学意义(P＞0.05).治疗后不论Hp是否被根除,各DU组(A,B,C组)Gas基因表达有下降趋势,但无统计学差异(P＞0.05),D组在Hp被根除后Gas基因表达水平(113±73 A/Bq)低于根除前(P＜0.05).治疗前FD组SST基因表达水平(D组180±65 A/Bq)高于各溃疡组,Hp阴性的溃疡组(C组120±48 A/Bq)高于Hp阳性溃疡组(A/Bq,A组65±22,B组77±23,P＜0.05);治疗后各组SST基因表达均增加(P＜0.01),但其他组相比Hp持续阳性的B组SST基因表达水平仍然低下(A组324±144,B组147±47,C组541±197,D组369±144 A/Bq,P＜0.05).结论 Hp感染不影响胃G细胞数量,但使D细胞数量减少,SST基因表达下降,Gas基因表达增多;溃疡灶可抑制SST基因表达,刺激促胃液素过度释放.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.