胃癌的早期诊断

胃癌是全世界最常见的恶性肿瘤之一，居癌症病死率第二位。胃癌在全世界范围内的总体5年生存率约为20％。早期胃癌经治疗后5年生存率大于90％，总体复发率为1.5％～13.7％；而进展期胃癌术后5年生存率仅30％～40％，总体复发率高达50％～70％。因此，早期诊断是改善患者预后的关键。早期胃癌癌细胞浸润仅限于黏膜层和黏膜下层，癌肿范围及有无淋巴结转移不论。我国胃癌病例以进展期为主（约占90％），早期胃癌诊断率仅约10％。     

早期胃癌的内镜特点分析

早期胃癌（EGC）指不论病变大小、淋巴结有无转移，局限于黏膜层和黏膜下层的胃癌，其5年生存率达90％左右，而晚期胃癌在20％以下。发现和诊断EGC是胃镜检查的主要目的，现总结我院近3年来发现的55例EGC的内镜特点，报告如下。     

分化不良型早期胃癌淋巴结转移的危险因素分析

目的评估分化不良型早期胃癌患者淋巴结转移的危险因素,探讨其内镜治疗的可能性。方法回顾性分析2002年9月-2008年12月经手术证实的100例分化不良型早期胃癌患者,对其年龄、性别、肿瘤大小、部位、大体类型、溃疡、组织学类型、浸润深度及淋巴管肿瘤浸润与淋巴结转移的关系进行单因素和多因素分析。结果分化不良型早期胃癌的淋巴结转移率达18．00％。多变量分析显示肿瘤大小（〉2cm）、侵犯至黏膜下层、淋巴管肿瘤浸润均是分化不良型早期胃癌淋巴结转移的独立危险因素（P〈0．05）。肿瘤大小和淋巴管肿瘤浸润是分化不良型黏膜内早期胃癌的淋巴结转移的独立危险因素。在直径≤2cm且无淋巴管肿瘤浸润的分化不良型黏膜内早期胃癌中未发现淋巴结转移。结论直径≤2cm且无淋巴管肿瘤浸润的分化不良型黏膜内癌患者可考虑内镜治疗,术后需密切随访。     

老年早期胃癌临床病理特点及预后因素分析

目的探讨老年早期胃癌的临床病理特征和预后因素，为老年早期胃癌的诊断和治疗提供理论依据。方法回顾性分析该院57例老年早期胃癌患者的临床病理资料及预后。结果老年早期胃癌最常见症状是上腹不适和隐痛。3年和5年生存率为100．0％和91．8％。胃镜病理活检确诊率为94．6％。胃上部黏膜下癌3例，淋巴结转移限于第1站；胃中部黏膜下癌10例，其中胃左动脉旁淋巴结转移4例；胃下部黏膜下癌20例，其中左动脉旁淋巴结转移3例、肝总动脉旁淋巴结转移4例、腹腔动脉旁淋巴结转移1例。癌浸润深度和组织学分型是老年人早期胃癌独立的预后因素（P=0．001）。结论早期诊断、早期治疗是提高生存率的关键。浸润深度和组织学分型是老年早期胃癌独立的预后因素。建议对老年早期胃癌组织学分型分化差且侵及黏膜下层者宜行D1＋根治术式。     

早期胃癌的腹腔镜治疗

胃癌是我国最常见的恶性肿瘤之一,其早期诊断和治疔是提高疗效的关键。早期胃癌是指病变仅限于黏膜及黏膜下层,而不论病变的范用和有无淋巴结转移,早期胃癌术后5年生存率可达94％～96％。1994年日本Kitano报道了首例腹腔镜辅助远端胃切除术治疗早期胃癌,经过10余年的发展,腹腔镜手术在早期胃癌治疗上已经成熟,它与开腹手术近、远期疗效相当,2004年日本胃癌协会将腹腔镜胃癌根治术作为IA期胃癌的标准治疗方案之一。本文重点介绍以下3个方面：①早期胃癌腹腔镜治疗的术式和适应证;②早期胃癌腹腔镜治疗的安全性和根治性评价;③我国早期胃癌腹腔镜治疗的现状和展望。     

早期胃癌淋巴结转移影响因素分析

背景：手术是早期胃癌的首选治疗方法。淋巴结转移是早期胃癌的关键预后因素,术中淋巴结清扫虽可降低术后复发率,但清扫过度可能导致患者术后生活质量降低。目的：分析早期胃癌淋巴结转移的独立危险因素。方法：1982年1月～2009年2月于上海市长宁区中心医院行胃癌根治术且淋巴结清扫〉15枚的376例早期胃癌患者纳入研究,分析性别、年龄以及6项肿瘤临床病理特征与淋巴结转移之间的关系。结果：单因素分析显示．肿瘤≥2cm、大体类型为隆起型、黏膜下浸润、分化差和有淋巴管癌栓与早期胃癌淋巴结转移有关,而性别、年龄和肿瘤部位与淋巴结转移之间无明显相关性。多因素logistic回归显示肿瘤大小、浸润深度和分化程度是早期胃癌淋巴结转移的独立危险因素。结论：临床医师术前可通过内镜超声、CT和活检病理检查确定早期胃癌的淋巴结肿大情况以及肿瘤大小、浸润深度和组织学类型．据此推测有无淋巴结转移倾向．从而选择合理的手术方式和术中淋巴结清扫范围。     

黏膜内早期胃癌淋巴结转移危险因素以及内镜下治疗适应证的探讨

背景:内镜黏膜下剥离术已成为部分无淋巴结转移的早期胃癌的首选治疗手段,不同病理类型黏膜内早期胃癌的内镜下治疗适应证仍有争议。目的:探讨黏膜内早期胃癌淋巴结转移与临床病理因素的关系,以及不同病理类型的内镜下治疗适应证。方法:回顾性分析2009年3月—2016年12月于安徽省立医院行胃癌根治术的325例黏膜内早期胃癌患者的临床资料,采用单因素和二分类Logistic回归分析探讨黏膜内早期胃癌淋巴结转移的危险因素,并分析不同病理类型早期胃癌的淋巴结转移风险。结果:肿瘤直径 2 cm、病理类型为未分化型或混合型、存在溃疡、脉管浸润是黏膜内早期胃癌淋巴结转移的独立危险因素。无溃疡或肿瘤直径≤3 cm、有溃疡的分化型黏膜内早期胃癌的淋巴结转移风险均小于1%。肿瘤直径≤2 cm、无溃疡的未分化型黏膜内早期胃癌的淋巴结转移风险为2. 7%,其他未分化型和混合型黏膜内早期胃癌的淋巴结转移风险较高(8. 6%～22. 2%)。结论:临床病理因素对早期胃癌淋巴结转移具有预测价值,无溃疡或肿瘤直径≤3 cm、有溃疡的分化型黏膜内早期胃癌的淋巴结转移风险极低,或可成为内镜黏膜下剥离术的绝对适应证。     

内镜下黏膜剥离术及外科手术治疗137例早期胃癌的临床分析

[目的]分析我院137例早期胃癌患者的临床表现,肿瘤部位、大小、内镜形态、病理学分型、淋巴结转移等,比较内镜下黏膜剥离术(ESD)与外科手术治疗早期胃癌术后病理特征及疗效的差异,有助于选择合适的治疗方案。[方法]将2005年1月~2015年6月我院进行治疗的137例早期胃癌患者行回顾性分析和总结。应用χ2检验及独立样本t检验进行统计学分析。[结果]2005年1月~2015年6月共诊断新发早期胃癌137例,淋巴结转移率为7.30%(10/137),其中黏膜内癌转移率为2.36%(2/85),黏膜下癌转移率为15.38%(8/52)。经单因素χ2检验提示浸润深度与组织学分型及淋巴结转移相关,ESD术后并发症及住院费用、住院天数显著低于外科手术。[结论]目前经外科治疗的早期胃癌中接近一半的患者可经ESD治愈。早期胃癌患者中仍有部分患者术后病理见淋巴结转移且与肿瘤的黏膜浸润深度相关。胃镜下诊断胃癌需要熟练掌握其特征并善于结合病理活检。ESD早期胃癌治疗存在其优越性,在诊断淋巴结转移方面需要进一步完善。     

胃肠道平滑肌肿瘤预后因素的探讨

对７０例胃肠道平滑肌肿瘤的预后进行了探讨。按照作者的标准，诊断为良性的肿瘤患者，除２例死于其它疾患外，余者均健在。胃与肠的临界性肿瘤的５年生存率分别为８７％、４０％（Ｐ＜０．０５），胃与肠恶性肿瘤的５年生存率分别为６８％、５０％（Ｐ＞０．０５）。发生腹膜后浸润的肿瘤患者均于术后３９个月内死亡。手术或尸检证实有转移的病例中，２９％发生了淋巴结转移。     

胃黏液祛除剂——链霉蛋白酶在上消化道内镜诊疗中的应用价值

早期胃癌（earlygastriccancer，EGC）定义为垂直方向的浸润不超过黏膜下层而无论有无转移的胃癌…。在日本，早期胃癌占所有胃癌患者的比例高达40％一60％，然而在我国及欧美还不足15％”0。目前多数学者认为，无论部位、大小及基因类型，EGC是可以治愈的疾病，早期切除病变部位后患者的5年生存率高达90％以上，然而，进展期胃癌患者的5年生存率仅10％一20％”’。     

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.     

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。     

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。     

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.     

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.