橡皮圈腔内牵拉法在内镜黏膜下剥离术中辅助价值研究

目的　评价橡皮圈腔内牵拉法用于内镜黏膜下剥离术（endoscopic submucosal dissection,ESD） 中的有效性及安全性。方法　纳入2016年1月—2019年12月因直肠内分泌瘤就诊于首都医科大学附属北京友谊医院的49例患者,其中2016年1月—2018年5月行常规ESD的患者32例（非牵拉组）,2018年6月—2019年12月行橡皮圈腔内牵拉ESD的患者17例（牵拉组）,比较2组患者基本信息、ESD手术时间、并发症等指标。结果　牵拉组和非牵拉组在年龄、性别及病变大小方面差异均无统计学意义（P均>0.05）。牵拉组ESD操作时间为（13.76±5.71） min,非牵拉组ESD操作时间为（22.99±10.32） min,两者差异有统计学意义（t=-3.408,P=0.001）。牵拉组未发生术后并发症,非牵拉组有3例出现穿孔,但穿孔发生率差异无统计学意义（P=0.542）。结论　橡皮圈腔内牵拉法辅助ESD,可以安全完成ESD操作并有效提高剥离效率。     

原位肝脏移植术后胆瘘的类型与治疗

目的探讨原位肝脏移植术后胆瘘的类型、方法选择及不同方式的治疗结果。方法回顾性分析2000年1月—2019年3月于西安交通大学第一附属医院住院治疗的24例肝移植术后胆瘘患者资料。根据是否合并狭窄将胆瘘分为4型。患者均接受内镜或介入治疗,包括经内镜鼻胆管引流术（endoscopic nasobiliary drainage,ENBD）、经内镜胆道内支架放置术（endoscopic retrograde biliary drainage,ERBD）或经皮经肝胆道引流术（percuteneous transhepatic cholangial drainage,PTCD）。观察指标为胆瘘发现时间、胆瘘位置、 经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)及PTCD并发症、腹腔或胆道引流管拔出时间、新发胆道狭窄等。结果24例胆瘘于肝移植术后（46.5±36.6） d（6~122 d）发现。Ⅰ～Ⅳ型胆瘘分别有6例、14例、2例和2例。22例胆瘘治愈,总体治愈率91.7%。24例均首先接受ERCP,技术成功率及治愈率分别为87.5%（21/24）和85.7%（18/21）。Ⅰ～Ⅳ型胆瘘ERCP的治愈率分别为6/6、84.6%(11/13)、1/2和0,ENBD与ERBD的胆瘘治愈比列分别为8/10和6/8。5例ERCP未成功者接受PTCD治疗,成功及临床治愈比例分别为4/5和3/4。术后胆道感染发生率为33.3%（8/24）,Ⅱ型胆瘘胆管炎发生率高于Ⅰ型 [35.7%(5/14)比16.7%(1/6)],合并非吻合口狭窄者比合并吻合口狭窄者更易发生胆管炎[83.3%(5/6)比16.7%(3/18)]。结论原位肝移植术后胆瘘首选ERCP,次选PTCD。Ⅰ～Ⅳ型胆瘘分别优选ENBD、ENBD联合ERBD、ENBD及PTCD治疗。     

内镜诊治胃微小神经内分泌肿瘤一例

超过60%的胃神经内分泌肿瘤（gastric neuroendocrine neoplasms,G-NENs）内镜下病变表现为多发病灶,可为息肉样隆起、黏膜下来源的肿瘤,或为丘疹、糜烂、溃疡性病灶,病变多局限于黏膜层或黏膜下层,病灶多数<10 mm,平均5 mm。1型G-NENs中,约22%病例内镜下并无任何肉眼可见的病灶,只有通过胃体、胃底的盲检,显微镜下才能发现病灶,即微小类癌。本例患者胃镜下并无任何肉眼可见的隆起型病灶,因一次随机活检,才得以发现病变。本文结合该例病变内镜下表现及其临床特征,以提升诊断G-NENs的经验。     

Human identification performed with skull’s sphenoid sinus based on deep learning

Human identification plays a significant role in the investigations of disasters and criminal cases. Human identification could be achieved quickly and efficiently via 3D sphenoid sinus models by customized convolutional neural networks. In this retrospective study, a deep learning neural network was proposed to achieve human identification of 1475 noncontrast thin-slice CT scans. A total of 732 patients were retrieved and studied (82% for model training and 18% for testing). By establishing an individual recognition framework, the anonymous sphenoid sinus model was matched and cross-tested, and the performance of the framework also was evaluated on the test set using the recognition rate, ROC curve and identification speed. Finally, manual matching was performed based on the framework results in the test set. Out of a total of 732 subjects (mean age 46.45 years ± 14.92 (SD); 349 women), 600 subjects were trained, and 132 subjects were tested. The present automatic human identification has achieved Rank 1 and Rank 5 accuracy values of 93.94% and 99.24%, respectively, in the test set. In addition, all the identifications were completed within 55 s, which manifested the inference speed of the test set. We used the comparison results of the MVSS-Net to exclude sphenoid sinus models with low similarity and carried out traditional visual comparisons of the CT anatomical aspects of the sphenoid sinus of 132 individuals with an accuracy of 100%. The customized deep learning framework achieves reliable and fast human identification based on a 3D sphenoid sinus and can assist forensic radiologists in human identification accuracy.

     

HBV感染者血清中HBVcccDNA、HBeAg及HBV DNA的关系

探讨HBV感染者血清HBVcccDNA与血清HBV DNA及HBeAg的关系。分别以PER分子信标技术和ELISA方法对非HBV相关肝炎、HBV健康携带者、急性乙型肝炎（AHB）、慢性乙型肝炎（CHB）、乙肝肝硬化、乙肝患者血清中HBVcccDNA HBV DNA含量及HBeAg进行了检测。HBVcccDNA仅见于HBV DNA阳性血清中；HBeAg阳性组的HBVcccDNA阳性率显著高于HBeAg阴性组（P〈0．05）；145例HBV DNA阳性患者中，HBVcccDNA阳性组HBVD—NA水平显著高于HBVcccDNA阴性组（P〈0．01）。血清HBVcccDNA可能是乙肝病毒在患者体内大量复制的血清标志。     

大肠癌IFN-γ基因+874位点的单核苷酸多态性

目的：探讨中国浙江地区汉族人群中IFN-γ基因 874位点多态性分布,分析其与大肠癌的相关性.方法：应用突变特异性扩增系统(ARMS)- PCR对健康者132例和大肠癌患者92例IFN-γ基因 874位点多态性进行分析,并将PCR产物克隆及测序鉴定.结果：大肠癌患者IFN-γ 874位点AA基因型频率为70.6%,显著高于正常人中的57.6% (P＜0.05).进一步分析显示IFN-γ 874位点AA基因型与患者的年龄、性别、肿瘤部位、Dukes分期无关.结论：IFN-γ 874位点AA基因型可能与大肠癌的发生相关.     

内镜密集与非密集套扎治疗重度食管静脉曲张256例

目的:观察内镜密集套扎治疗重度食管静脉曲张的效果.方法:肝硬化门脉高压患者256例,分为2组:A组为密集套扎组130例,B组为非密集套扎组(标准组)126例.分组标准以一次套扎圈<6个为非密集套扎组,>8个为密集套扎组.采用6连发套扎器行内镜治疗.结果:A组首次平均每例患者结扎10.9个点,首次结扎2 wk后复查食管静脉曲张基本治愈(曲张静脉基本消除率)者39例,显效者有43例,有效者20例,无效者7例,总有效率93.58%.平均结扎1.6次.B组食管静脉曲张基本治愈(曲张静脉基本消除率)者7例,显效者有58例,有效者40例,无效者7例,总有效率93.75%,平均结扎2次.结论:食管静脉曲张采用密集套扎法进行连续EVL治疗,静脉曲张消失率高,减少套扎次数,是有效的治疗食管静脉曲张的可靠方法.     

药师对本院中成药重复使用的干预效果

目的:探讨药师干预对中成药重复使用的效果,促进中成药的合理使用。方法:选取我院2018年6—12月使用中成药的患者299例为对照组,2019年1—6月使用中成药的患者301例为干预组。对照组采用常规的处方点评,干预组通过完善中成药重复用药点评细则、规范培训点评中药师、加大临床监测力度和中成药合理用药宣教等药学干预手段进行点评,对比干预前后中成药重复使用率。结果:与对照组比较,干预后我院中成药重复使用率由干预前46.15%(138/299)下降至13.95%(42/301),差异有统计学意义(P<0.05);干预前本院中成药重复使用排名前10位的组合中,9组的重复使用率在药师干预后明显下降,仅参芪扶正注射液和复方黄芪益气口服液组合的重复使用率由干预前的1.34%(4/299)上升至3.99%(12/301)。结论:药师干预有效降低我院中成药的重复使用率,促进中成药的合理使用,但仍存在重复用药情况,还需干预。     

Differential diagnosis of coronavirus disease 2019 pneumonia or influenza A pneumonia by clinical characteristics and laboratory findings

BackgroundPneumonia caused by the 2019 novel Coronavirus (COVID‐2019) shares overlapping signs and symptoms, laboratory findings, imaging features with influenza A pneumonia. We aimed to identify their clinical characteristics to help early diagnosis.MethodsWe retrospectively retrieved data for laboratory‐confirmed patients admitted with COVID‐19–induced or influenza A–induced pneumonia from electronic medical records in Ningbo First Hospital, China. We recorded patients'' epidemiological and clinical features, as well as radiologic and laboratory findings.ResultsThe median age of influenza A cohort was higher and it exhibited higher temperature and higher proportion of pleural effusion. COVID‐19 cohort exhibited higher proportions of fatigue, diarrhea and ground‐glass opacity and higher levels of lymphocyte percentage, absolute lymphocyte count, red‐cell count, hemoglobin and albumin and presented lower levels of monocytes, c‐reactive protein, aspartate aminotransferase, alkaline phosphatase, serum creatinine. Multivariate logistic regression analyses showed that fatigue, ground‐glass opacity, and higher level of albumin were independent risk factors for COVID‐19 pneumonia, while older age, higher temperature, and higher level of monocyte count were independent risk factors for influenza A pneumonia.ConclusionsIn terms of COVID‐19 pneumonia and influenza A pneumonia, fatigue, ground‐glass opacity, and higher level of albumin tend to be helpful for diagnosis of COVID‐19 pneumonia, while older age, higher temperature, and higher level of monocyte count tend to be helpful for the diagnosis of influenza A pneumonia.