南昌市部分人群大肠癌与息肉临床特点调查分析

目的探讨南昌市居民大肠癌与息肉的临床特点。方法选取我院肠道门诊2005年1月至2007年12月就诊的腹泻病例经结肠镜检与病理确诊的大肠癌、息肉患者进行总结分析。结果3年来5073例腹泻患者中共行结肠镜检873例,确诊的大肠癌75例,大肠息肉114例。大肠癌检出率为8.6%,平均发病年龄为64.01岁,好发病年龄为51～70岁,占90.67男∶女为1.6∶1;大肠息肉患者的检出率为13.1%,平均年龄为44.15,男性以61～70岁发病率最高,占18.42%,男∶女为1.65∶1;直、乙结肠是大肠癌与息肉的最常见部位,分别占74.67%和68.42%。结论大肠癌与息肉男性多于女性,直肠和乙状结肠是最常见发生部位。50岁以上的中老年人是大肠癌的高危人群。     

河北省承德地区大肠息肉发生的相关因素调查研究

目的 调查研究河北省承德地区大肠息肉发生的影响因素.方法 采用随机抽样法向2015年1月至2018年10月于中国人民解放军联勤保障部队第九八一医院进行结肠镜检查的3008例人员发放大肠息肉调查问卷,严格按照质控标准回收问卷,统计问卷回收率、大肠息肉检出情况、流行病学特征,并根据肠镜检查结果,将伴有大肠息肉病人作为息肉组(n=532)、将无异常的病人作为对照组(n=2464),进而再根据癌变情况进行分组.比较两组临床资料,分别采用logistic多元回归进行大肠息肉及癌变发生的影响因素分析,统计不同息肉病理类型癌变率.结果 共回收2996份有效问卷,其中532例发生大肠息肉,发生率为17.76％,男女比例为1.4:1;高发年龄范围为>40～60岁,占比48.12％,34.77％病人伴有临床症状,直肠为高发部位(31.11％),腺瘤性息肉最为常见,占57.96％,息肉长径多介于5～10 mm,占比28.75％.大腰围、幽门螺旋杆菌感染、喜食高脂饮食、尿酸>420μmol/L、饮酒史、脂肪肝、胆结石、高脂血症、糖尿病是大肠息肉发生的危险影响因素(P<0.05,OR>1),喜食高纤维食物是大肠息肉发生的保护影响因素(P<0.05,OR<1);幽门螺旋杆菌感染、喜食高脂饮食是大肠息肉病人发生癌变的危险影响因素(P<0.05,OR>1);腺瘤性息肉癌变率高于其他病理类型(P<0.05).结论 河北省承德地区大肠息肉的发生与多种因素相关,高发年龄范围为>40～60岁,高发部位为直肠、乙状结肠,常见病理类型为腺瘤性息肉,且大肠息肉发生的相关因素中,幽门螺旋杆菌感染、喜食高脂饮食与大肠癌发病呈正相关.     

便秘病例结肠镜检查及追踪的回顾性分析

目的通过回顾性研究342例便秘病例的初次结肠镜检查结果,并对其中148例进行结肠镜追踪检查,探索便秘和肠道疾病之间的关系。方法总结分析342例便秘病例的结肠镜检查资料及其中已行1～3次结肠镜复查的148例病例的追踪资料。记录接受首次及追踪结肠镜检查的便秘病例的年龄、性别、镜下发现的大肠疾病;记录便秘病例中发现大肠息肉的病理类型、直径、数目。观察不同时间段结肠镜复查时大肠疾病的检出情况,分析便秘与肠道疾病的关系。结果①342例已行结肠镜检查的便秘病例的常见大肠疾病为大肠炎症、大肠息肉、结肠黑变病及大肠癌。②大肠息肉、大肠癌及结肠黑变病在60岁以上病例组检出率高于60岁以下病例组(P<0.05)。③结肠镜检出的大肠息肉中腺瘤性息肉26例(66.67%),男性便秘病例大肠息肉、大肠癌检出率高于女性(P<0.05)。④148例接受结肠镜追踪检查的病例中,便秘病程大于5年组大肠息肉、大肠癌及结肠黑变病检出率高于病程小于5年组(P<0.05)。结论①便秘病例的相关大肠疾病发病率依次为大肠息肉、大肠癌和结肠黑变病。②与60岁以下病例组相比,60岁以上病例组大肠息肉、大肠癌及结肠黑变病发生率较高。③与便秘病程小于5年组相比,便秘病程大于5年组大肠息肉、大肠癌及结肠黑变病发生率较高。     

某三级综合医院2015-2016年大肠癌临床流行病学特征分析

目的 分析2015-2016年张家口市某三级综合医院大肠癌临床流行病学特征,为大肠癌的早期筛查和诊治提供依据.方法 采用回顾性调查方法,分析2015年1月至2016年12月就诊于张家口市某三级综合医院经病理证实的大肠癌患者1031例,根据年龄分为<40岁、40~60岁、>60岁组,比较不同年龄分组患者的临床特点,主要从发病年龄、病变部位、病理类型、Dukes分期、临床表现、治疗方式、复发及转移等临床及病理特点等方面进行分析.结果 不同年龄分组下,>60岁的患者大肠癌发病率高于<40岁、40~60岁患者.不同年龄分组下的男性患者均多于女性(P<0.05).便血、腹痛是大肠癌最常见的症状,与其他临床症状比较,差异有统计学意义(P<0.05).乙状结肠、直肠是大肠癌最常见的起病部位,与其他部位的大肠癌发病率相比,差异有统计学意义(P<0.05).腺癌、高分化发生率高于其他病理类型及分化程度(P<0.05).CEA、CA199同时阳性共244例,单纯CEA阳性735例,单纯CA199阳性393例,两种标记物均阴性261例,经差异性后额关联性检验比较,发现CEA的阳性检出率优于CA199(P<0.05).结论 大肠癌好发于>60岁的男性人群,临床症状多表现为便血、腹痛,好发于乙状结肠、直肠,同时检测两种标记物可提高大肠癌的早期诊断率.     

非酒精性脂肪肝与结直肠腺瘤性息肉发病相关性分析

目的:探讨非酒精性脂肪肝(NAFLD)和结直肠腺瘤性息肉发病的相关性。方法:选择某院2018年2月～2019年2月完善肠镜检查和相关辅助检查资料完整的住院患者608例,划分为结直肠腺瘤性息肉组290例及正常对照组318例;收集性别、年龄、NAFLD患病率及代谢指标等,比较两组有无差异;采用Logistic回归分析NAFLD是否为结直肠腺瘤性息肉危险因素。结果:结直肠腺瘤性息肉组NAFLD患病率明显高于正常对照组;多因素Logistic回归分析显示,NAFLD是结直肠腺瘤性息肉的独立危险因素(OR:2.16;95%CI:1.50～3.10)。结论:NAFLD与结直肠腺瘤性息肉的发病密切相关。     

大肠息肉的一般特点及其癌变情况分析

目的 探讨大肠息肉的临床及内镜特点.方法 回顾性分析老年人大肠息肉410例的临床资料,分析息肉的大小、部位、形态、病理学及内镜特点及癌变情况.结果 直肠、乙状结肠是息肉的好发部位及主要癌变部位,共检出508颗息肉,分别为腺瘤性息肉257颗(50.50%),炎性息肉206颗(40.69%),增生性息肉45颗(8.91%);23例腺瘤性息肉发生癌变,占息肉总数的4.53%.结论 大部分结肠息肉为腺瘤性息肉,位于左半结肠;大肠息肉具有癌变的潜在恶性.     

大肠息肉的临床特点与息肉恶变相关性分析

目的：探讨大肠息肉的临床特点与息肉恶变的相关性分析。方法选取2006年3月～2014年1月使用内镜中心电子结肠镜所检测大肠息肉患者1482例的资料，根据患者的年龄、部位、病理类型和大小及恶变程度来分析大肠息肉的临床特点与息肉恶变的联系。结果大肠息肉恶变率占4.9%。大肠息肉恶变多发生于男性，发病年龄多在40岁左右，病变部位主要发生在直、乙状结肠；随着息肉的增多，恶变率增加；不同病理类型息肉恶变率不同。结论不同病理类型大肠息肉所表现的临床特点不同，有助于早期诊断大肠息肉的性质，及时地进行干预及治疗，降低大肠癌的发病率。     

医共体模式下大肠癌筛查在基层医院开展的价值研究

目的探讨大肠癌筛查在基层医院开展的应用价值。方法选取湖州第一人民医院医共体埭溪镇中心卫生院所属11个社区卫生服务站2019年8月至2021年6月该地区大肠癌筛查阳性744例患者为观察对象, 患者均行结肠镜检查, 并与活检病理检查对照, 分析最终结果。结果经结肠镜诊断大肠癌27例, 检出率3.62%;检出结肠息肉398例, 息肉检出率53.49%, 好发于60岁以上人群。大肠癌中直肠癌发病率为29.6%, 病理类型腺癌占比(62.90%)最高;大肠息肉检测出腺瘤278例, 腺瘤性息肉检出率37.37%。结论基层医院进行大肠癌早期筛查结合结肠镜检查是发现大肠肿瘤最有效的方法, 能够尽早发现大肠癌, 实现尽早治疗。     

结肠息肉1308例临床分析

目的 探讨结肠息肉的发病特点和临床病理特征.方法 回顾性分析1 308例结肠息肉患者临床和病理资料,包括息肉的发病部位、数目、直径大小、病理分型及其癌变率之间的关系.结果 结肠息肉总检出率14.22%,以直肠肛管发病率最高(30.28%),其次为乙状结肠(22.01%).息肉病理分型腺瘤占50.77%,恶变132例,腺瘤恶变率9.72%,其中绒毛状腺瘤恶变率最高,为25.60%;直径≥1.1厘米以上腺瘤恶变率达25.95%.结论 结肠息肉恶变和其体积、病理类型、异型增生程度密切相关,结肠镜检查发现息肉应完整切除息肉并作全瘤病理检查,以减少结直肠癌发病.     

结肠镜下结直肠息肉患者的临床特征研究

目的研究结肠镜下结直肠息肉患者临床特征、好发年龄及部位,并分析其中相关性。方法收集2008年3月至2013年3月在本院行结肠镜检查的1762例患者,并计算息肉经结肠镜的检出率,搜集息肉患者的临床特征、多发年龄及好发部位进行分析总结,探寻其中相关性。结果 1762例行结肠镜检查的患者经结肠镜发现大肠息肉者为366例,检出率达20.77%,经病理活检证实其中息肉患者为292例,故检出率为16.57%,且结肠镜诊断结肠息肉的准确率高达79.78%。其中,男196例,女96例,男女比例约2:1,且好发年龄为51-65岁(69.96%),经随访统计发现:结直肠息肉患者临床表现主要为腹痛腹胀、腹泻、大便习惯及性状改变、便秘、便血、贫血等,其中便血和腹痛腹胀发生几率最高。部分患者无任何临床表现。此外,结肠镜显示:结直肠息肉分布常见于结肠全曲,其中乙状结肠和直肠的发病率最高(乙状结肠发生率19.95%,直肠发病率为19.72%)。有临床表现患者与无临床表现患者在息肉发生部位的差异无统计学意义(P>0.05)。有便血、贫血症状的患者与无此症状患者的息肉直径的差异有统计学意义(P<0.05)。结论结直肠息肉患者多发年龄为51-65岁(69.96%),且男女比例为2:1,男性多发。临床表现以便血(20.89%)和腹痛腹胀(29.77%)为主,息肉的分布以乙状结肠(19.95%)和直肠(19.72%)为主。且有便血或贫血症状的患者其息肉直径>1.0cm的几率显著高于无此症状的患者。结肠镜检出率为16.57%,且准确率高达79.78%,由于其检出率高且较为安全可靠,无明显禁忌人群和不良反应,多在临床上推广。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.