青年人胃癌40例的临床,内镜及病理分析

４０例青年人胃癌，占同期我院胃镜检出胃癌６９９例的５．７％。男性２６例，女性１４例。３１～３５岁为１５例（３７．５％），最小年龄为１５岁。早期胃癌３例（７．５％），进展期癌３７例。手术切除率为４２．５％。５年生存率为１５％（６／４０）。本组发现５例胃癌与十二指肠溃疡共存。本文分析了青年人胃癌的特点与预后差的主要原因，并讨论了青年人胃癌与胃溃疡关系以及与十二指肠溃疡共存问题。     

Efficacy of balloon tamponade in treatment of bleeding gastric and esophageal varices

The efficacy and complications of esophageal tamponade as the first procedure in the routine management of acute variceal hemorrhage were evaluated in 151 consecutive bleeding episodes treated at a specialized unit. The Sengstaken-Blakemore tube was employed in the 118 cases in which emergency endoscopy demonstrated bleeding esophageal varices, and the Linton-Nachlas balloon in the 33 cases with bleeding from gastric varices. Hemostasis lasting at least 24 hr was obtained in 91.5% of cases treated with the Sengstaken-Blakemore balloon and in 88% of those treated with the Linton-Nachlas balloon. Permanent hemostasis was obtained in 47.7% of all cases. The only severe complication noted in these 151 episodes of bleeding treated by tamponade was pulmonary aspiration, which was detected in 10% of cases. This complication was related to the presence and degree of encephalopathy (P less than 0.001) and was prevented by orotracheal intubation prior to tamponade. These results indicate that balloon tamponade continues to be a reliable and valuable method to arrest bleeding from esophagogastric varices.     

Oxidative metabolism of the human eosinophil

We have compared the oxidative metabolism of human eosinophils (80%-90% purity) to that of neutrophils. Hexose monophosphate (HMP) shunt activity of eosinophils was higher than that of neutrophils under either resting or phagocytizing conditions. Eosinophil HMP shunt activity also was stimulated by phorbol myristate acetate, a membrane- active agent. Eosinophils showed a marked incorporation of 125I into trichloroacetic acid-insoluble material under resting conditions, which increased markedly during phagocytosis. Eosinophils likewise showed a greater reduction of nitroblue tetrazolium dye during phagocytosis than did neutrophils. Measurement of other parameters of oxidative metabolism indicated that eosinophils generated superoxide anion following phagocytosis and also elicited a burst of chemiluminescence similar to that observed during phagocytosis by neutrophils. Measurement of NADPH oxidase activity demonstrated that this enzyme was 3-6 times more active in fractions isolated from eosinophils than in corresponding fractions isolated from neutrophils; this was observed over a range of substrate concentrations. The eosinophil enzyme sedimented differently than the neutrophil enzyme with differential centrifugation; neither showed sedimentation characteristics of peroxidase. These data indicate that eosinophils possess a similar, although in some ways more potent, oxidative burst than neutrophils and are consistent with a role for NADPH oxidase in the initiation of that burst.     

Corticotropin-releasing hormone antagonists possess anti-inflammatory effects in the mouse ileum

BACKGROUND & AIMS: Corticotropin-releasing hormone (CRH) released at local sites of inflammation promotes inflammation in the periphery. We investigated its effects in the intestinal responses caused by toxin A from Clostridium difficile, the causative agent of antibiotic-associated colitis. METHODS: Ileal loops were injected with 10 microg of toxin A, and enterotoxic responses were measured at various time points. RESULTS: Pretreatment of mice with 2.5 microg/kg of the CRH receptor antagonist alpha-helical CRH((9-41)) that blocks both CRH receptor subtypes reduced toxin A-mediated ileal secretion, epithelial cell damage, mucosal edema, neutrophil infiltration, and mucosal content of interleukin 1 beta and tumor necrosis factor alpha. Pretreatment with the specific CRH(1) receptor antagonist antalarmin (20 mg/kg, IP) also inhibited toxin A-induced fluid secretion and toxin A-associated histologic changes. CRH messenger RNA and protein were increased in mouse ileum 30 minutes after intraluminal toxin A administration. In situ hybridization and immunohistochemistry demonstrated that toxin A at 1 hour caused a substantial increase in the expression of both CRH receptor subtypes in the ileal mucosa. CONCLUSIONS: Peripheral CRH may play a proinflammatory role in toxin A-induced intestinal secretion and inflammation and that CRH(1) receptor, at least in part, is important in the mediation of these responses.     

Stimulatory and entraining effect of melatonin on tuberoinfundibular dopaminergic neuron activity and inhibition on prolactin secretion

The aims of the present study were to determine if melatonin exerts an effect on prolactin (PRL) secretion via the tuberoinfundibular dopaminergic (TIDA) neurons and if endogenous or exogenous melatonin has an entraining effect on the rhythmic changes of TIDA neuronal activity and PRL secretion. Melatonin given in the morning (10:00 h), dose- (0.01-1 mg/kg, ip) and time- (at 15 and 60 min, but not at 30 min) dependently stimulated TIDA neuronal activity in ovariectomized (OVX), estrogen-treated rats as determined by 3,4-dihydroxyphenylacetic acid (DOPAC) levels in the median eminence (ME). Serum PRL was concurrently inhibited by the injection. Melatonin administered in the afternoon (15:00 h) was even more effective in stimulating the lowered TIDA neuronal activity and inhibiting the increased PRL level than that given in the morning (10:00 h). S-20098, a melatonin agonist was also effective in stimulating the TIDA neurons. In contrast, S-20928, a putative melatonin antagonist, while it had no effect by itself, blocked the effect of S-20098. Although S-20928 failed to prevent melatonin's effect on ME DOPAC levels, six interspaced injections of S-20928, from 18:00 to 01:30 h, significantly blocked the increase of ME DOPAC levels at 03:00 h, indicating that the endogenous melatonin may play a role. We further used rats that received daily injection of melatonin (1 mg/kg, ip) at 18:00 h for 10 days and found that the injection augmented basal TIDA neuronal activity at 11:00 h and blunted the afternoon PRL surge. In all, melatonin can have an inhibitory effect on PRL secretion by stimulating the TIDA neurons, and it may help to entrain the circadian rhythms of both TIDA neuronal activity and PRL secretion.     

透明晶体摘除联合人工晶体植入术后术眼波前像差的变化及意义

目的：探讨透明晶体摘除联合人工晶体植入术对术眼波前像差及成像质量的影响。方法：对行透明晶体摘除联合人工晶体植入术后12个月以上的28例远视眼患者及未行手术治疗的23例远视眼患者进行了波前像差和角膜地形图的检测，比较分析了4．2mm和6mm瞳孔直径者3～6阶(高阶)像差的均方根值和Zernike4阶球面像差的变化。结果：手术组高阶像差的均方根值比对照组增高40％。手术组全眼、角膜和眼内部(包括晶体和角膜后面)的高阶像差均方根值和球面像差与矫正的屈光度无关。结论：透明晶体摘除联合人工晶体植人术增加了术眼的波前像差，降低了眼的成像质量。     

应用巨噬细胞移动抑制试验观察小鼠血吸虫病细胞免疫

本文报告用改进的巨噬细胞移动抑制试验观察小鼠感染日本血吸虫后对植物血凝素(PHA)、血吸虫成虫抗原(AW)的应答能力。结果表明小鼠感染日本血吸虫后4～20d内,对PHA的应答能力基本正常,而33d后对PHA的应答能力减弱。小鼠感染血吸虫后其淋巴细胞对AW的应答能力在2周内(淋巴结淋巴细胞)和6周内(脾淋巴细胞)应答正常,之后,分别于3和8周开始应答能力减弱,14周后的应答能力均恢复正常。上述结果提示日本血吸虫感染小鼠后淋巴细胞对PHA和AW的应答能力可能存在暂时性免疫抑制现象,特别是在感染早期抑制作用较为明显。     

江西景德镇市人体寄生虫分布调查报告

按照全国人体寄生虫分布调查实施细则规定和方法，于１９８８年４月共调查了江西景德镇市蛟潭区所属４个乡的１０个自然村抽样点人口计２０６８人。查明当地存在１４种人体寄生虫，总感染率高达８７．５％。感染１种和同时感染２、３、４种寄生虫的人数分别占总感染人数的６２．５％、３２．１％、４．９％和０．４％，并证实当地为卫氏并殖吸虫疫源地。调查结果表明，当地人群寄生虫感染十分普遍，由此而导致的公共卫生问题，应当引起卫生及防疫部门的高度警惕和重视。     

幽门螺杆菌对十二指肠球部溃疡患者生长抑素的影响

应用放免法测定23例十二指肠球部溃疡(其中17例Hp阳性,6例Hp阴性)患者血浆及胃窦组织生长抑素含量(SS),9例Hp阴性的浅表性胃炎为对照组。结果:3组血浆SS含量无明显差异(P>0.05);十二指肠球部溃疡Hp阳性组和Hp阴性组胃窦组织SS分别为7.05±1.67pg/mg湿重和8.35±3.2pg/mg湿重,与对照组(14.55±1.8pg/mg湿重)相比有显著性差异(P<0.002,P<0.05),但Hp阳性组十二指肠球部溃疡与Hp阴性组相比无明显差异。结论:胃窦生长抑素降低与十二指肠球部溃疡胃酸分泌异常有关,而Hp似与之无关联。     

Thirty-Day Post-Discharge Outcomes Following COVID-19 Infection

BackgroundThe clinical course of COVID-19 includes multiple disease phases. Data describing post-hospital discharge outcomes may provide insight into disease course. Studies describing post-hospitalization outcomes of adults following COVID-19 infection are limited to electronic medical record review, which may underestimate the incidence of outcomes.ObjectiveTo determine 30-day post-hospitalization outcomes following COVID-19 infection.DesignRetrospective cohort studySettingQuaternary referral hospital and community hospital in New York City.ParticipantsCOVID-19 infected patients discharged alive from the emergency department (ED) or hospital between March 3 and May 15, 2020.MeasurementOutcomes included return to an ED, re-hospitalization, and mortality within 30 days of hospital discharge.ResultsThirty-day follow-up data were successfully collected on 94.6% of eligible patients. Among 1344 patients, 16.5% returned to an ED, 9.8% were re-hospitalized, and 2.4% died. Among patients who returned to the ED, 50.0% (108/216) went to a different hospital from the hospital of the index presentation, and 61.1% (132/216) of those who returned were re-hospitalized. In Cox models adjusted for variables selected using the lasso method, age (HR 1.01 per year [95% CI 1.00–1.02]), diabetes (1.54 [1.06–2.23]), and the need for inpatient dialysis (3.78 [2.23–6.43]) during the index presentation were independently associated with a higher re-hospitalization rate. Older age (HR 1.08 [1.05–1.11]) and Asian race (2.89 [1.27–6.61]) were significantly associated with mortality.ConclusionsAmong patients discharged alive following their index presentation for COVID-19, risk for returning to a hospital within 30 days of discharge was substantial. These patients merit close post-discharge follow-up to optimize outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06924-0.KEY WORDS: COVID-19, mortality, re-admission, discharge