慢性便秘继发肠系膜上动脉压迫综合征(李氏三联征)的诊断与治疗

目的归纳按“李氏三联征”概念指导诊断和治疗慢性便秘继发肠系膜上动脉压迫综合征(SMAS)的经验。方法“李氏三联征”的概念包括:(1)临床症状:便秘、营养不良、上消化道梗阻(呕吐、进食困难)三联症状;(2)解剖学表现:具有横结肠下垂、脾曲升高和肠系膜上动脉压迫三联解剖异常;(3)治疗:均给予肠内营养支持、胸膝位、菌群移植三联治疗。根据“李氏三联征”概念,采用描述性病例系列研究方法,前瞻性纳入2014年6月至2018年11月期间,同济大学附属第十人民医院和东部战区总医院收治的78例慢性便秘继发SMAS患者的病例资料,包括基本信息、症状体征、影像学资料、营养指标、胃肠生活质量指数和Wexner排粪评分,按上述“李氏三联征”的标准进行评估和治疗,对临床症状和解剖学特征指标进行随访,记录治疗后1、3、6和12个月的变化。结果治疗前所有患者均有“李氏三联征”特征,均存在严重便秘、营养不良及上消化道梗阻的临床表现,均具有肠系膜上动脉压迫征象和明显的脾曲升高的解剖学表现。经肠内营养支持、胸膝位及菌群移植三联治疗后,69例(88.5%)症状明显改善,9例治疗无效行手术治疗。69例非手术患者经12个月随访,结果显示,所有患者均恢复正常进食,1个月后便秘相关指标改善,至12个月后时,每周自主排粪次数从治疗前(1.0±0.8)次增加至(5.0±1.6)次,胃肠生活质量指数由治疗前(52.7±8.5)分增加至(93.2±7.5)分,Wexner排粪评分由治疗前(19.1±2.5)分下降至(6.2±2.1)分,差异均有统计学意义(均P<0.001)。随访1个月后营养指标改善,至12个月后时,体质指数从治疗前(17.9±1.8)kg/m2增加至(21.0±1.3)kg/m2,总蛋白由(65.2±5.7)g/L增加至(68.3±4.2)g/L,白蛋白从(32.1±5.1)g/L增加至(40.4±3.0)g/L,纤维蛋白原从(1.9±0.5)g/L增加至(2.4±0.5)g/L,前白蛋白从(163.2±5.3)mg/L增加至(259.1±45.6)mg/L;差异均有统计学意义(均P<0.001)。上消化道造影及肠系膜上动脉成像均显示十二指肠受压征象解除,肠系膜上动脉与腹主动脉夹角从治疗前(17.4±3.8)°增加至(37.8±5.8)°(t=-22.26,P<0.001)。结论慢性便秘继发SMAS患者具有“李氏三联征”的异常三联临床症状和解剖学表现时,应给予肠内营养支持、胸膝位及菌群移植三联治疗。     

A GWAS-supported variant interacting with diabetes predicts risk of atherothrombotic stroke in Han Chinese population

Background: A recent genome-wide association study has identified that rs4376531 variant conferred risk of atherothrombotic stroke (AS) in a Japanese population. This study was to explore the association in Han Chinese population.

Methods: A total of 1036 cases and 643 healthy controls were enrolled. We genotyped rs4376531 variant with SNPscan. Multivariate logistic regression analysis was used to determine the association of genetic variation with risk of AS. Interaction analysis was examined by SNPStats web tool.

Results: After adjusting for gender, age, body mass index (BMI), hypertension, diabetes and smoking, compared with CC genotype, we observed that GC and GG/GC genotypes were associated with a significantly decreased risk of AS (OR?=?0.76, 95% CI?=?0.58–0.99 and OR?=?0.76, 95% CI?=?0.58–0.98, respectively). The decreased risk was more obvious among subgroups with high BMI (OR?=?0.63, 95% CI?=?0.45–0.88), no hypertension (OR?=?0.66, 95% CI?=?0.46–0.94), diabetes (OR?=?0.33, 95% CI?=?0.17–0.64), and smoking (OR?=?0.65, 95% CI?=?0.44–0.95) in the dominant model (GG/GC vs CC). Interaction analysis also revealed that compared with non-diabetic patients with CC genotype, diabetic patients with CC genotype had a 4.48-fold (OR?=?4.48; 95% CI?=?2.98–6.72) increased risk of AS.

Conclusion: Our data suggested that GC and GG/GC of rs4376531 contributed to a decreased risk of AS while CC genotype, interacting with diabetes, increased the stroke risk in Han Chinese population.     

A randomized,controlled, multicenter contraceptive efficacy clinical trial of the intravas device,a nonocclusive surgical male sterilization

Because of unavoidable complications of vasectomy, this study was undertaken to assess the efficacy and safety of male sterilization with a nonobstructive intravas device （IVD） implanted into the vas lumen by a mini-surgical method compared with no-scalpel vasectomy （NSV）. IVDs were categorized into two types： IVD-B has a tail used for fixing to the vas deferens （fixed wing） whereas IVD-A does not. A multicenter prospective randomized controlled clinical trial was conducted in China. The study was comprised of 1459 male volunteers seeking vasectomy who were randomly assigned to the IVD-A （n = 487）, IVD-B （n = 485） or NSV （n = 487） groups and underwent operation. Follow-up included visits at the 3rd-6TM and 12~ postoperative months, The assessments of the subjects involved regular physical examinations （including general and andrological examinations） and semen analysis. The subjects＇ partners also underwent monitoring for pregnancy by monthly interviews regarding menstruation and if necessary, urine tests, There were no significant differences in pregnancy rates （0.65% for IVD-A, 0 for IVD-B and 0.21% for NSV） among the three groups （P 〉 0.05）. The cumulative rates of complications at the 12th postoperative month were zero, 0.9% and 1.7% in the three groups, respectively. In conclusion, IVD male sterilization exhibits a low risk of long-term adverse events and was found to be effective as a male sterilization method, similar to the NSV technique. IVD male sterilization is expected to be a novel contraceptive method.     

Detection of Platelet-Monocyte Aggregates by the ADAM? Image Cytometer

Background: Inappropriate platelet activation is known to be associated with various thrombotic disorders. Platelet-monocyte aggregates (PMAs), whose formation is mediated by platelet surface P-selectin (CD62P), can be used as a reliable marker to detect platelet activation. Previous studies have generally detected PMAs through flow cytometry-based approaches. Recently, the ADAM^® image cytometer (Nanoentek Inc., Seoul, Korea) was developed for image-based cellular analysis. In this study, we detected PMAs with the ADAM^® cytometer, evaluated the reproducibility of the measurements made by the ADAM^® cytometer, and compared the abilities of the ADAM^® cytometer and a flow cytometric assay to detect PMAs.Methods: Whole blood samples were collected from patients. Within 5 minutes of collection, anticoagulated whole blood samples were fixed in 10% paraformaldehyde and 5% glyoxal. Nineteen clinical specimens were collected; each was analyzed three times with the ADAM^® cytometer in order to assess the reproducibility of its measurements. To compare the ability of the ADAM^® cytometer with that of a flow cytometer to detect PMAs, each cytometer was used for 23 clinical samples and the correlation of the measurements was determined.Results: The PMA measurements made by the ADAM^® cytometer showed good reproducibility (CV < 10% for all specimens). Moreover, the PMA measurements made by the ADAM^® cytometer exhibited a high correlation with those made by a flow cytometric assay (R = 0.944).Conclusions: The ADAM^® cytometer is a suitable alternative method to the flow cytometry-based assays. Since the ADAM cytometer does not need specialized instrument knowledge or software proficiency (unlike flow cytometry), the ADAM^® cytometer can be used as a rapid and reliable POCT device to measure platelet activation in peripheral blood. This, in turn, will provide valuable information regarding patient propensities to thrombotic diseases.     

肾移植女性受者妊娠管理的研究进展

综述妊娠对女性肾移植患者的影响，肾移植术后妊娠的管理（妊娠前风险提示、妊娠前风险评估、妊娠期免疫抑制剂的应用、妊娠期产检及移植肾功能随访、分娩及麻醉方式的选择、产后喂养方式），肾移植术后多胎妊娠受者的现状等。旨在总结近年来国内外对肾移植术后患者妊娠管理的经验，提升移植专科护理人员对术后妊娠群体的关注度，为有妊娠意愿的肾移植术后患者提供支持。