Cumulative risk of developing polyps or malignancy at the ileal pouch-anal anastomosis in patients with familial adenomatous polyposis

Restorative proctocolectomy with an ileal pouch-anal anastomosis is performed in an increasing number of patients with familial adenomatous polyposis (FAP). Two techniques are currently used to construct an ileal pouch-anal anastomosis: (1) a double-stapled anastomosis between the pouch and the anal canal and (2) mucosectomy with a hand-sewn iteoanal anastomosis at the dentate line. Although this procedure is thought to abolish the risk of colorectal adenoma, an increasing number of case reports have been published concerning the development of adenoma at the anastomotic site. The purpose of this study was to evaluate the overall cumulative risk of developing adenomatous polyps after ileal pouch-anal anastomosis and to compare the cumulative risk after either anastomotic technique. A total of 126 consecutive FAP patients undergoing a restorative proctocolectomy were identified from polyposis registries in The Netherlands, Denmark, Italy, Germany, and New York. Life-table analysis was used to calculate the cumulative risk of developing polyps in 97 patients with at least 1 year of endoscopic follow-up (median 66 months, range 12 to 188 months). A double-stapled anastomosis was used in 35 patients, whereas in 62 patients a handsewn anastomosis with a mucosectomy was performed. In 13 patients polyps developed at the anastomotic site, four with severe and four with moderate dysplasia. None of the patients developed a carcinoma at the anastomotic site. The cumulative risk of developing a polyp at the anastomotic site was 8% (95% confidence interval 2% to 14%) at 3.5 years and 18% (95% confidence interval 8% to 28%) at 7 years, respectively. The risk of developing a polyp at the anastomotic site within 7 years was 31 % for patients with a double-stapled vs. 10% for patients with a hand-sewn anastomosis with mucosectomy (P = 0.03 [log-rank test]). Because FAP patients undergoing a restorative proctocolectomy with either a double-stapled or hand-sewn anastomosis have a substantial risk of developing adenomatous polyps at the anastomotic site, lifelong endoscopic surveillance is mandatory in both groups. Presented at the Thirty-Ninth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, La., May 17–20, 1998.     

Effect of nutritional route on colonic anastomotic healing in the rat

Although early enteral feeding has been shown to benefit cutaneous healing when compared to parenteral feeding, the effect of the route of nutritional support in gastrointestinal anastomotic healing has not been defined. The aim of the present study was to determine whether the route of nutritional support influences colonic anastomotic healing. Twenty male Sprague-Dawley rats weighing 270 to 290 grams underwent identical surgical manipulation consisting of central venous catheterization, gastrostomy insertion, and distal colonic anastomosis (single-layer, inverted). Identical nutrient infusates composed of 4.25% amino acids, 25% dextrose, and vitamins were administered, with half the animals receiving the infusions via the gastrostomy and the other half via the venous catheter. Animals were killed 5 days after surgery. There were no differences in nutritional parameters between the parenterally and enterally fed groups. Colonic anastomotic bursting pressure was significantly higher in the enterally fed group (180 ±6 vs. 150±11 mm Hg; P<0.01). The measured insoluble collagen and total protein content in anastootic tissue were enhanced in the enterally supported group. The fraction of soluble (newly synthesized) collagen did not differ between the two groups. The data demonstrate that the route of nutrient administration influences colonic anastomotic healing. The preservation of colonic structural collagen in the enteral group may improve the ability of the gut to hold sutures and thus enhance anastomotic healing. Presented at the Thirty-Ninth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, La., May 17–20, 1998.     

Universal screening for Lynch syndrome in a large consecutive cohort of Chinese colorectal cancer patients: High prevalence and unique molecular features

The prevalence of Lynch syndrome (LS) varies significantly in different populations, suggesting that ethnic features might play an important role. We enrolled 3330 consecutive Chinese patients who had surgical resection for newly diagnosed colorectal cancer. Universal screening for LS was implemented, including immunohistochemistry for mismatch repair (MMR) proteins, BRAF^V600E mutation test and germline sequencing. Among the 3250 eligible patients, MMR protein deficiency (dMMR) was detected in 330 (10.2%) patients. Ninety-three patients (2.9%) were diagnosed with LS. Nine (9.7%) patients with LS fulfilled Amsterdam criteria II and 76 (81.7%) met the revised Bethesda guidelines. Only 15 (9.7%) patients with absence of MLH1 on IHC had BRAF^V600E mutation. One third (33/99) of the MMR gene mutations have not been reported previously. The age of onset indicates risk of LS in patients with dMMR tumors. For patients older than 65 years, only 2 patients (5.7%) fulfilling revised Bethesda guidelines were diagnosed with LS. Selective sequencing of all cases with dMMR diagnosed at or below age 65 years and only of those dMMR cases older than 65 years who fulfill revised Bethesda guidelines results in 8.2% fewer cases requiring germline testing without missing any LS diagnoses. While the prevalence of LS in Chinese patients is similar to that of Western populations, the spectrum of constitutional mutations and frequency of BRAF^V600E mutation is different. Patients older than 65 years who do not meet the revised Bethesda guidelines have a low risk of LS, suggesting germline sequencing might not be necessary in this population.     

肝癌患者血清外泌体内miR-665的表达及临床意义

[摘 要] 目的 探讨肝癌患者血清来源的外泌体内miR-665与肝癌临床病理指标及预后的关系。方法 采用试剂盒方法提取患者血清内的外泌体并用透射电镜观察验证。然后利用RT-PCR方法检测30例肝癌患者和10例体检者血清来源的外泌体内miR-665的表达水平,进行对照研究,探讨临床病理指标和预后的关系。结果 血清提取的外泌体呈囊泡状,直径约30～150 nm。肝癌患者血清来源的外泌体miR-665较正常体检者表达水平明显升高,中位表达水平是对照组的8.3倍。外泌体miR-665高表达与患者肿瘤大小（>5 cm） （P=0.0042）、有包膜浸润（P=0.0197）以及临床TNM分期（III～IV期） （P=0.0276）成明显相关,与患者年龄、性别、HBsAg以及AFP水平未见明显相关性（P > 0.05）,外泌体miR-665高表达组患者生存期较低表达组更短（P=0.036）。结论 肝癌患者血清中外泌体miR-665水平升高与肝癌进展相关,测定血清外泌体内miR-665的水平可能有助于肝癌的临床诊断和预后判断。     

心脏瓣膜病合并感染性心内膜炎的外科治疗

目的探讨心脏瓣膜心内膜炎的临床特点、手术时机选择和围术期处理。方法回顾分析26例心脏瓣膜病合并感染性心内膜炎的临床表现、治疗经过和临床预后。结果术前死于恶性心力衰竭1例,术后随访25例,随访时间3个月～6年,无术后死亡,无再发感染。结论心脏瓣膜病合并感染性心内膜炎外科治疗风险大,死亡率高,正确掌握手术指征、术中彻底清除感染灶和围术期正确处理是治疗的关键。     

Results of the influenza virus surveillance in wild birds in Western part of Mongolia

ObjectiveTo present results of virological study of wild birds inhabiting Western Mongolia.MethodsOver a period of 2003–2008, we isolated 13 influenza A viruses: H1N1, H3N6, H13N8 and H4N6 subtypes. We did not isolate any H5N1 subtype, that still cause epizooty in wild birds and poultry.ResultsWe revealed taxonomic and ecological heterogeneity of the birds involved in maintenance of circulation of influenza viruses in the given territory. Influenza viruses were isolated from birds of 6 orders; among them there are species preferring water and semi-aquatic biotopes, one species preferring dry plain region, and also one species which can inhabit both dry and water biotopes.ConclusionsRepresentatives of all main orders of Western Mongolia avifauna are involved in support of influenza A virus circulation, highly pathogenic H5N1 influenza viruses were registered in Mongolia thus it's necessary to continue permanent influenza virus surveillance in wild birds' populations.     

口内支抗与微型种植体支抗近中移动下颌磨牙效果比较

目的：研究安氏I类错（牙合）患者中,分别采用微型种植体作支抗与口内前牙作支抗近移下颌磨牙进行比较,以评价两种方法的各自特点。方法：将24例成人患者随机分成两组,分别采用两种方法近移下颌磨牙。测量下颌第二磨牙在移动速度和近远中方向、垂直方向的位置变化,以衡量磨牙的位置改变,并通过下颌中切牙的位置变化,评价支抗强弱。结果：种植体作支抗组下颌第二磨牙平均近中移动8.5mm,疗程10.4个月,平均移动速度0.82mm/月,磨牙长轴向近中倾斜2.5°,磨牙垂直向压低0.28mm,下颌中切牙位置无改变。对照组下颌第二磨牙平均近中移动7.8mm,疗程10.2个月,平均移动速度0.76mm/月,磨牙长轴向近中倾斜角度7.5°,磨牙垂直向压低0.06mm,下颌中切牙发生舌向倾斜9.5°。下颌中切牙切端向舌侧移动了3.0mm。结论：两种方法比较,种植体的支抗更强,未见前牙支抗丧失。二者磨牙的移动方式有所区别。     

利用微型种植体支抗压低下颌磨牙的临床研究

目的研究安氏Ⅰ类错患者中,采用微型种植体作支抗,压低下颌磨牙的临床效果及其作用特点。方法选择12例成人患者,将24枚微型种植体植于下颌第一磨牙近、远中的颊侧牙槽骨内,Ni-Ti螺旋弹簧拉长后分别连接于下颌第一磨牙带环颊侧,来压低下颌第一磨牙。测量磨牙的压低量、颊舌向的位置变化、近远中倾斜度以及磨牙移动的速度,并通过治疗前后的X线片对比以观察磨牙牙根有无吸收,牙周膜腔的变化情况。通过测量下颌第二磨牙与下颌中切牙的位置变化来衡量支抗强弱。结果下颌第一磨牙平均压低3.5mm,疗程5.2个月,平均移动速度0.67mm/月;磨牙牙冠近颊尖、远颊尖分别颊向移动1.2mm、1.3mm。磨牙牙根没有吸收,牙周膜腔宽度没有改变。下颌第二磨牙与下颌中切牙的位置没有改变。结论所有下颌磨牙均被压低到了恰当的位置,为对颌牙的修复治疗提供了足够的间隙。同时该方法临床操作简单易行,适于推广。     

308-nm准分子激光联合他克莫司软膏治疗面部白癜风656例疗效评价

目的：评价308nm准分子激光联合他克莫司软膏治疗面部白癜风的疗效。方法：对656例面部白癜风患者照射308nm准分子激光联合外用他克莫司软膏。他克莫司软膏每日2次,308nm准分子激光每周治疗1-2次,共治疗30次。末次治疗后随访1年。结果：1630块白斑中,总有效率为47.12%,病程<2年皮损总有效率为58.10%高于病程≥2年皮损的16.60%,两组差异具有统计学意义(P<0.001)。眼周皮损疗效最佳,总有效率为54.96%,口周皮损疗效最差,总有效率为40.22%,差异有统计学意义（P<0.0001）。结论：308 nm准分子激光联合他克莫司软膏治疗面部白癜风的疗效与病期和皮损部位有关。