胃增生性息肉与自身免疫性化生性萎缩性胃炎的相关性分析

目的 探讨胃增生性息肉与自身免疫性化生性萎缩性胃炎的相关性。方法 回顾性分析2011年1月—2017年6月于首都医科大学附属北京友谊医院内镜中心行内镜切除术的56例胃增生性息肉患者,包括17例伴肿瘤性改变和39例不伴肿瘤性改变的患者,分析患者血清学、内镜表现和病理的特点。结果 男22例、女34例,年龄（61.88±9.01）岁。空腹胃泌素升高率50.0%（28/56）,血清抗壁细胞抗体（anti-parietal cell antibody,PCA）阳性率62.5%（35/56）,贫血率37.5%（21/56）,幽门螺旋杆菌阴性率64.3%（36/56）。与血清PCA阴性患者相比,血清PCA阳性患者以女性多见（P=0.034）,易发生高胃泌素血症（P＜0.001）、贫血（P=0.001）、多发GHPs（P=0.019）,且以血清铁缺乏为主（P=0.044）。35例血清PCA阳性患者共108枚息肉,胃底、体91枚（84.３%）、胃窦17枚（15.7%,P=0.005）;21例贫血患者共63枚息肉,胃底、体54枚（85.7%）、胃窦9枚（14.3%,P=0.075）。56例患者共142枚增生性息肉,73.2%（104/142）为带蒂息肉,69.0%（98/142）为“草莓状”息肉。17例伴肿瘤性改变中,6例高分化腺癌、2例中分化腺癌、3例高级别异型增生、6例低级别异型增生。结论 胃增生性息肉与自身免疫性化生性萎缩性胃炎有关,可能在其基础上向肿瘤性改变转化。     

Expression of miR-1304 in patients with esophageal carcinoma and risk factors for recurrence

BACKGROUND Esophageal carcinoma is a malignant gastrointestinal tumor with a very poor prognosis.MicroRNA(miR)-1304 is a newly discovered non-coding RNA,which shows differential expression in other cancers,and its clinical value in esophageal carcinoma remains unclear.AIM To explore the expression of miR-1304 in patients with esophageal carcinoma and its clinical value.METHODS The expression of miR-1304 in patients with esophageal carcinoma was analyzed based on the data on miR in esophageal carcinoma downloaded from The Cancer Genome Atlas database.Quantitative real-time polymerase chain reaction was adopted to determine the expression of miR-1304 in the tissues and serum of patients.The clinical diagnostic value of miR-1304 and independent factors for recurrence and prognosis of esophageal carcinoma were then analyzed.The potential target genes of miR-1304 were predicted,and then analyzed based on gene ontology,Kyoto Encyclopedia of Genes,and Genomes,and protein-protein interaction.RESULTS The expression of miR-1304 in the tissues and serum of patients with esophageal carcinoma increased,and was also increased according to the database.Patients with high expression of miR-1304 suffered increased rates of tumor≥3 cm,low differentiation and stage II+III.miR-1304 had a diagnostic value in identifying esophageal carcinoma,tumor size,differentiation and TNM stage.Tumor size,differentiation,TNM stage,and miR-1304 were independent risk factors for recurrence of esophageal carcinoma,and they had certain predictive and diagnostic value for the recurrence of esophageal carcinoma.Seventy-eight patients showed a 3-year survival rate of 38.46%,and patients with high expression of miR-1304 had a relatively lower survival rate.Multivariate analysis revealed that tumor size,differentiation,recurrence and miR-1304 were independent factors for the prognosis of patients.MiRTarBase,miRDB,and Targetscan predicted 20 target genes in total.Gene ontology enrichment analysis found 18 functions with aP<0.05,and Kyoto Encyclopedia of Genes,and Genomes analysis found 11 signal pathways with aP<0.05.String analysis of protein co-expression found 269 relationship pairs,of which co-expression with epidermal growth factor was the most common.CONCLUSION miR-1304 can be used as a potential indicator for the diagnosis and recurrence of esophageal carcinoma and for survival of patients with this disease.     

星状神经节阻滞对重症急性胰腺炎患者肺损伤的影响*

目的 探讨星状神经节阻滞对重症急性胰腺炎（SAP）合并急性肺损伤（ALI）患者炎症介质及功能的影响。方法 选取2016年6月—2018年12月河北北方学院附属第一医院重症医学科确诊SAP患者34例,随机分为常规治疗组（对照组）19例和超声引导下星状神经节阻滞组（SGB组）15例。对照组予禁食、水等常规治疗,而SGB组在常规治疗基础上行超声引导下星状神经节阻滞。酶联免疫吸附试验检测TNF-α、IL-1β、IL-6、IL-10的变化,血液细胞分析法检测CRP和WBC的水平。观察两组在治疗前后肺水指数、氧合指数、治疗后ICU住院时间及呼吸机拔管时间的差异,以及入院0?h（T0）、第3天（SGB治疗后2?d,T1）、第7天（SGB治疗后6?d,T2）和第15天（SGB治疗后14?d,T3）时间点炎症介质的改变。结果 治疗前两组患者肺水指数和氧合指数比较,差异无统计学意义（P?>0.05）。治疗2周后SGB组的肺水指数较对照组下降（P?<0.05）,氧合指数较对照组升高（P?<0.05）,SGB组ICU住院时间、呼吸机拔管时间较对照组缩短（P?<0.05）。不同时间点间IL-6、TNF-α、IL-1β、IL-10、WBC和CRP有差异（P?<0.05）;两组患者IL-6、TNF-α、IL-1β、CRP和IL-10有差异（P?<0.05）;两组患者TNF-α、IL-1β、IL-10、WBC、CRP随时间变化趋势有差异（P?<0.05）。结论 SGB有可能减轻SAPALI的炎症反应而利于改善肺损伤。     

经颅磁刺激联合ESDM对孤独症患儿的疗效分析*

目的 探讨经颅磁刺激联合早期介入丹佛康复训练模式（ESDM）对孤独症患儿的治疗效果。方法 采用巢式病例对照研究法,以确诊孤独症为研究起点,以治疗6个月为研究终点,选取2016年1月—2018年6月徐州市儿童医院确诊并治疗的孤独症患儿患者92例作为研究对象。分为常规康复组（常规康复训练治疗）和颅磁丹佛组（经颅磁刺激联合ESDM治疗）,每组46例。对比分析常规康复组和颅磁丹佛组的韦氏儿童认知功能（WISC）评分、儿童孤独症症状（CARS）评分、孤独症行为（ABC）评分及临床疗效的差异。结果 治疗后常规康复组和颅磁丹佛组的WISC和ABC评分较治疗前提高（P?<0.05）,颅磁丹佛组升幅更大（P?<0.05）;治疗后常规康复组和颅磁丹佛组的CARS评分较治疗前降低（P?<0.05）,颅磁丹佛组降幅更大（P?<0.05）;颅磁丹佛组治疗有效率（84.78%）优于常规康复组（65.22%）（P?<0.05）。结论 经颅磁刺激联合ESDM能更有效地改善孤独症症状,在小儿孤独症治疗中的临床价值确切。     

Clinical outcomes of spontaneous bacterial peritonitis due to extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumoniae: a retrospective cohort study

Purpose

The aim of this study was to (1) evaluate the clinical outcomes of spontaneous bacterial peritonitis (SBP) due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli or Klebsiella pneumoniae (EK) and (2) investigate the relationship between the adequacy of initial antibiotic treatments and patient outcomes.

Methods

We conducted a retrospective cohort study of cirrhotic patients with SBP caused by EK. We evaluated the 30-day mortality rate and used Cox proportional hazard models to identify risk factors for mortality.

Results

Between January 2006 and December 2012, a total of 231 episodes of SBP due to EK were recorded. Among them, 52 were caused by ESBL-producing EK (ESBL-EK). The 30-day mortality rate was significantly higher in patients with SBP due to ESBL-EK than in those with non-ESBL-producing EK (non-ESBL-EK) (34.6 vs. 18.4 %, respectively; p = 0.013). Multivariate analysis revealed that ESBL production [adjusted HR (aHR) 1.82, 95 % confidence interval (CI) 1.00–3.31], nosocomial infection (aHR 2.24, 95 % CI 1.26–3.95), septic shock (aHR 4.84, 95 % CI 2.70–8.65), higher Child-Pugh score (aHR 1.57, 95 % CI 1.28–1.92), and higher Charlson comorbidity index (aHR 1.37, 95 % CI 1.15–1.64) were independent risk factors for 30-day mortality in the total cohort. When we analyzed patients with SBP due to ESBL-EK separately, septic shock (aHR 3.64, 95 % CI 1.40–9.77), accompanying bacteremia (aHR 3.71, 95 % CI 1.37–10.08), and hepatocellular carcinoma (aHR 3.21, 95 % CI 1.20–8.56) were independent risk factors.

Conclusions

Both 7- and 30-day mortalities for SBP due to ESBL-EK were significantly higher than for SBP due to non-ESBL-EK. Initial antibiotic choice was not associated with poor clinical outcomes in patients with SBP due to ESBL-EK.     

左心房收缩期应变和应变率对心脏再同步治疗疗效的影响

背景　左心房功能是心脏整体功能的重要组成部分,左心房容积能够独立影响心脏再同步治疗（CRT）疗效。目的　本研究试图通过二维斑点追踪技术量化评价左心房功能,评价左心房收缩期应变（Sa）和应变率（SRa）对CRT疗效的影响。方法　回顾性选取2015年5月-2018年1月因心力衰竭于中国科学技术大学附属第一医院心内科行CRT的患者共121例。CRT有反应定义为CRT术后6个月左心室收缩末期容积（LVESV）缩小≥15%,反之为无反应。根据CRT疗效将患者分为有反应组和无反应组。CRT术前和术后6个月应用二维斑点追踪技术评价左心房Sa和SRa,评价基线左心房Sa和SRa对CRT疗效的影响。结果　CRT术后共有70例（57.9%）患者纳入有反应组,51例（42.1%）患者纳入无反应组。有反应组术后6个月Sa和SRa较术前明显改善（P<0.05）。Spearman秩相关分析显示Sa与SRa呈负相关（rs=-0.770,P<0.001）。多因素Logistic回归分析显示SRa（OR=5.039,P=0.020）和Sa（OR=1.094,P=0.010）是CRT疗效的影响因素,其他影响因素包括左束支传导阻滞（OR=4.913,P=0.002）、QRS时限（OR=1.041,P=0.005）、E/A（OR=0.309,P=0.008）和肺动脉收缩压（OR=0.950,P=0.013）。结论　基线Sa和SRa是CRT疗效的独立预测因素,CRT术后有反应者左心房收缩功能改善。     

Benefits of PEGylation in the early post-transplant period of intraportal islet transplantation as assessed by magnetic resonance imaging of labeled islets

While a few studies have demonstrated the benefit of PEGylation in islet transplantation, most have employed renal subcapsular models and none have performed direct comparisons of islet mass in intraportal islet transplantation using islet magnetic resonance imaging (MRI). In this study, our aim was to demonstrate the benefit of PEGylation in the early post-transplant period of intraportal islet transplantation with a novel algorithm for islet MRI. Islets were PEGylated after ferucarbotran labeling in a rat syngeneic intraportal islet transplantation model followed by comparisons of post-transplant glycemic levels in recipient rats infused with PEGylated (n = 12) and non-PEGylated (n = 13) islets. The total area of hypointense spots and the number of hypointense spots larger than 1.758 mm² of PEGylated and non-PEGylated islets were quantitatively compared. The total area of hypointense spots (P < 0.05) and the number of hypointense spots larger than 1.758 mm² (P < 0.05) were higher in the PEGylated islet group 7 and 14 days post translation (DPT). These results translated into better post-transplant outcomes in the PEGylated islet group 28 DPT. In validation experiments, MRI parameters obtained 1, 7, and 14 DPT predicted normoglycemia 4 wk post-transplantation. We directly demonstrated the benefit of islet PEGylation in protection against nonspecific islet destruction in the early post-transplant period of intraportal islet transplantation using a novel algorithm for islet MRI. This novel algorithm could serve as a useful tool to demonstrate such benefit in future clinical trials of islet transplantation using PEGylated islets.     

Clinical Outcomes Associated with Treatment Modalities for Gastrointestinal Bezoars

Background/Aims

With technical and instrumental advances, the endoscopic removal of bezoars is now more common than conventional surgical removal. We investigated the clinical outcomes in a patient cohort with gastrointestinal bezoars removed using different treatment modalities.

Methods

Between June 1989 and March 2012, 93 patients with gastrointestinal bezoars underwent endoscopic or surgical procedures at the Asan Medical Center. These patients were divided into endoscopic (n=39) and surgical (n=54) treatment groups in accordance with the initial treatment modality. The clinical feature and outcomes of these two groups were analyzed retrospectively.

Results

The median follow-up period was 13 months (interquartile range [IQR], 0 to 77 months) in 93 patients with a median age of 60 years (IQR, 50 to 73 years). Among the initial symptoms, abdominal pain was the most common chief complaint (72.1%). The bezoars were commonly located in the stomach (82.1%) in the endoscopic treatment group and in the small bowel (66.7%) in the surgical treatment group. The success rates of endoscopic and surgical treatment were 89.7% and 98.1%, and the complication rates were 12.8% and 33.3%, respectively.

Conclusions

Endoscopic removal of a gastrointestinal bezoar is an effective treatment modality; however, surgical removal is needed in some cases.     

Clinically Useful Diagnostic Tool of Contrast Enhanced Ultrasonography for Focal Liver Masses: Comparison to Computed Tomography and Magnetic Resonance Imaging

Background/Aims

To evaluate the diagnostic value of contrast (SonoVue®) enhancement ultrasonography (CEUS) and to compare this method with computed tomography (CT) and magnetic resonance imaging (MRI) in evaluating liver masses.

Methods

CEUS (n=50), CT (n=47), and MRI (n=43) were performed on 50 liver masses in 48 patients for baseline mass characterization. The most likely impression for each modality and the final diagnosis, based on the combined biopsy results (n=14), angiography findings (n=36), and clinical course, were determined. The diagnostic value of CEUS was compared to those of CT and MRI.

Results

The final diagnosis of the masses was hepatocellular carcinoma (n=43), hemangioma (n=3), benign adenoma (n=2), eosinophilic abscess (n=1), and liver metastasis (n=1). The overall diagnostic agreement with the final diagnosis was substantial for CEUS, CT, and MRI, with κ values of 0.621, 0.763, and 0.784, respectively. The sensitivity, specificity, and accuracy were 83.3%, 87.5%, and 84.0%, respectively, for CEUS; 95.0%, 87.5%, and 93.8%, respectively, for CT; and 94.6%, 83.3%, and 93.0%, respectively for MRI. After excluding the lesions with poor acoustic sonographic windows, the sensitivity, specificity, and accuracy for CEUS were 94.6%, 87.5%, and 93.3%, respectively, with a κ value of 0.765.

Conclusions

If an appropriate acoustic window is available, CEUS is comparable to CT and MRI for the diagnosis of liver masses.