经腹体外牵引装置辅助内镜下阑尾切除1例

以往慢性阑尾炎反复发作通常首选手术治疗，近年来随着内镜技术的不断发展，经自然腔道内镜手术逐步应用于阑尾疾病的治疗。本文报道了1例内镜下的阑尾切除手术，术中引入经腹壁穿刺体外牵引装置进行辅助，使得内镜下阑尾切除的效率及安全性均获得明显提高。     

Melatonin functions as a broad-spectrum antifungal by targeting a conserved pathogen protein kinase

Melatonin is a low-cost natural small indole molecule with versatile biological functions. However, melatonin's fungicidal potential has not been fully exploited, and the mechanism remains elusive. Here, we report that melatonin broadly inhibited 13 plant pathogens. In the rice blast fungal pathogen Magnaporthe oryzae, melatonin inhibited fungal growth, formation of infection-specific structures named appressoria, and plant infection, reducing disease severity. Melatonin entered fungal cells efficiently and colocalized with the critical mitogen-activated protein kinase named Mps1, suppressing phosphorylation of Mps1. Melatonin's affinity for Mps1 via two hydrogen bonds was demonstrated using surface plasmon resonance and chemical modifications. To improve melatonin's efficiency, we obtained 20 melatonin derivatives. Tert-butyloxycarbonyl melatonin showed a 25-fold increase in fungicidal activities, demonstrating the feasibility of chemical modifications in melatonin modification. Our study demonstrated the broad-spectrum fungicidal effect of melatonin by suppressing Mps1 as one of the targets. Through further systematic modifications, developing an eco-friendly melatonin derivative of commercial values for agricultural applications appears promising.     

上海郊区自然人群队列和生物样本库建设

城镇化建设导致人口聚集、环境危险因素暴露风险增加和居民生活方式的改变, 人群间健康差异等问题也更加凸显。为了深入研究城镇化快速发展过程中居民慢性非传染性疾病(慢性病)的发病特点及变化趋势, 分析环境、生活方式和遗传等因素与主要慢性病的关系, 为慢性病的精准防控提供科学依据, 复旦大学公共卫生学院依托上海市"高峰学科建设项目", 自2016年4月起在城镇化快速发展的上海市松江、嘉定、闵行和徐汇区启动了"上海郊区自然人群队列和生物样本库"(SSACB)建设工作, 招募69 116名20～74岁常住居民作为队列成员。队列采用流行病学调查、体格检查和实验室检测等方法收集成员基本资料, 采集血、尿等标本建立生物标本库, 建立包括队列成员电子医疗病历系统、慢性病管理系统、肿瘤登记系统、传染病报告系统和死亡登记系统在内的区域健康信息共享平台。本文围绕SSACB队列设计理念、建设进程以及今后发展目标进行阐述。     

穴位贴敷联合指法扩肛治疗脑出血术后便秘临床研究

目的：观察在常规干预措施基础上应用穴位贴敷联合指法扩肛治疗脑出血术后便秘的效果。方法：将244例脑出血术后肠道气滞型便秘患者随机分成对照组、联合组各122例。2组患者均实施脑出血术后及便秘的常规干预措施，对照组加用指法扩肛，联合组以穴位贴敷联合指法扩肛进行治疗，2组均治疗2周。治疗前后评定2组患者的便秘症状评分、便秘患者生活质量量表（PAC-QOL）评分，检测肛肠动力学指标[肛管最大收缩压（MSP）、肛管静息压（ARP）]，比较2组的临床疗效。结果：治疗后，联合组临床疗效总有效率93.33%，高于对照组82.50%,2组比较，差异有统计学意义（P<0.05）。2组排便间隔时间、排便用时、排便性状、排便难度、便意评分均较治疗前降低（P<0.05），联合组5项评分值均低于对照组（P<0.05）。2组MSP、ARP均较治疗前增加（P<0.05），联合组2项指标值均高于对照组（P<0.05）。2组PAC-QOL生理、社会心理、忧虑、满意度评分均较治疗前减少（P<0.05），联合组4项评分值均低于对照组（P<0.05）。结论：在常规干预措施基础上应用穴位...     

内镜下贲门缩窄术治疗胃食管反流病安全性分析

目的探究贲门缩窄术治疗胃食管反流病的临床安全性。方法回顾性分析2013年8月至2016年8月于中国人民解放军总医院消化科进行贲门缩窄术治疗的47例胃食管反流病患者的临床资料。结果所有47例患者成功进行了贲门缩窄术，手术成功率100％。无术后发热、穿孔病例。患者术后7例出现胸骨后疼痛不适、2例出现进食哽噎感、1例出现少量咳血，该10例患者均无需特殊治疗，症状于2 d内自行好转。22例（46.8％）患者手术当天即可进流食、39例（82.9％）患者术后第1天进流食或半流食、43例（91.5％）患者于术后第2天恢复进食流食或半流食。术后仅9例患者预防性使用了抗生素。结论贲门缩窄术治疗胃食管反流病安全有效，且术后恢复快，住院时间短。     

Per-oral endoscopic myotomy is safe and effective for pediatric patients with achalasia: A long-term follow-up study

BACKGROUND Per-oral endoscopic myotomy(POEM) is emerging as a prefer treatment option for pediatric achalasia. However, data are limited on the long-term efficacy of POEM in children and adolescents with achalasia.AIM To evaluate the safety and long-term efficacy of POEM for pediatric patients with achalasia and compare those outcomes with adult patients.METHODS This retrospective cohort study was conducted in patients with achalasia who underwent POEM. Patients aged under 18 years were included...