Clinical application of wireless capsule endoscopy

BACKGROUND: Diagnostic modalities for identifying lesions within the small bowel have been quite limited. Wireless capsule endoscopy (WCE) is a new, innovative technique that can detect very small mucosal lesions in the entire small bowel and can be used in the outpatient setting. The present study explored the diagnostic value, tolerance and safety of WCE in the identification of small bowel pathology that was not detected with conventional small bowel imaging studies. METHODS: From May through September 2002, 15 patients with suspected small bowel diseases were prospectively examined, Of them, 12 presented with persistent obscure gastrointestinal bleeding and negative findings on upper endoscopy, colonoscopy, small bowel radiography, and bleeding‐scan scintig‐raphy or mesenteric angiography. RESULTS: Wireless capsule endoscopy identified pathologic small bowel findings in 11 of the 15 patients (73%): angioectasias, Dieulafoy's lesion, polypoid lesion, submucosal mass, Crohn's disease, carcinoid tumor, lipoma, aphthous ulcer, and hemorrhagic gastritis; four of the patients had two lesions. The images displayed were considered to be good. The capsule endoscopes remained in the stomach for an average of 82 min (range 6?311 min) and the mean transit time in the small bowel was 248 min (range 104?396 min). The mean time of recording was 7 h 29 min (from 5 h to 8 h 30 min). The mean time to reach the cecum was 336 min (180?470 min). The average number of the images transmitted by the capsule was 57 919 and the average time the physician took to review the images transmitted by the capsule was 82 min (range 30?120 min). The average time of elimination of the capsule was 33 h (range 24?48 h). All 15 patients reported that the capsule was easy to swallow, painless, and preferable to conventional endoscopy. No complications were observed. CONCLUSIONS: Wireless capsule endoscopy is safe, well tolerated, and useful for identifying occult lesions of the small bowel, especially in patients who present with obscure gastrointestinal bleeding.     

球囊拉伤致家兔动脉粥样硬化斑块破裂及血栓形成

为建立动脉粥样硬化的兔模型并用药物触发造成斑块破裂及血栓形成，将60只雄性纯种新西兰兔随机平均分成三组：球囊损伤 高脂(1％胆固醇)组、高脂喂养组及普通饲料喂养组．喂养3个月后分别给予鲁塞尔蝰蛇毒和组胺药物触发以造成斑块破裂及血栓形成。结果发现，球囊损伤 高脂组与高脂喂养组均形成动脉粥样硬化斑块，其中球囊损伤 高脂组所形成的粥样斑块为具有较大脂质核的软斑块；药物触发后球囊损伤 高脂组存活的18只中有11只共15处发生斑块破裂及血栓形成；高脂喂养组中的19只经药物触发后仅5只共7处发生斑块破裂及血栓形成；普通饲料喂养组中未见斑块破裂及血栓形成。结果提示，在构建的动脉粥样硬化斑块的动物模型基础上，应用药物触发后能够造成斑块破裂及血栓形成。     

南京市区老年人便秘患病率及其与亚健康症状关系的调查

目的 为了解南京市老年人便秘现状，以及探讨便秘与亚健康的关系。方法 采用整群抽样方法，对南京市2个街道(20个居委会)和1个老年公寓60岁以上3731名老年人进行便秘与亚健康调查。结果 南京市老年人便秘患病率为24.0％，并随年龄增长其患病率增高(P＜0．01)。根据32项亚健康症状调查，便秘组(男性：28项；女性：23项)亚健康症状的发生率均高于非便秘组；前10位亚健康症状中，皮肤瘙痒和皮肤干燥为便秘者易发生的亚健康症状；便秘者平均个体有3种以上亚健康症状者(64．6％)明显高于非便秘组(42.7％，P＜0.01)。结论 老年人便秘的患病率较高，便秘者较易发生亚健康症状。防治老年人便秘，对预防亚健康症状的发生及增进老年人健康非常重要。     

蒲公英提取物体外抗毛囊蠕形螨活性及皮肤安全性的实验研究

目的 探讨蒲公英治疗蠕形螨病的应用价值。 方法 将粉碎的蒲公英浸泡于80％乙醇中12 h，然后85 ℃回流提取蒲公英提取液，同法制备百部提取液。取蠕形螨感染者面部皮脂，分离并鉴定蠕形螨备用。设蒲公英实验组，百部对照组和生理盐水对照组，每组蠕形螨15只，进行体外抗螨实验。pH仪测定蒲公英提取物pH值。设蒲公英试验组和75%乙醇对照组，应用健康家兔进行皮肤刺激实验和急性皮肤毒性试验。 结果 蒲公英提取物的体外杀螨时间为（1.50±0.65） min，显著短于百部提取物的体外杀螨时间（3.53±1.04） min（P＜0.01），生理盐水组螨死亡时间大于120 min。蒲公英提取物的pH值为5.00±0.28，对家兔完整皮肤的刺激评分为0，破损皮肤的刺激评分为0.3，无明显毒性。 结论 蒲公英提取物具有较强的体外抗毛囊蠕形螨活性且具有皮肤安全性。     

自制气囊分离器在经腹腔镜完全腹膜外腹股沟疝修补术中的临床应用

目的探讨自制气囊分离器在经腹腔镜完全腹膜外腹股沟疝修补术(TEP)中的安全性和有效性。方法回顾性分析2011年1月-2013年10月该科163例TEP术式治疗腹股沟疝患者的临床资料,将腹膜前间隙建立的气囊扩张法与镜推法两种方式进行比较。结果观察组(气囊扩张法组)的手术时间、术中出血量明显少于对照组(镜推法组),两组术后并发症上比较差异有显著性。结论自制气囊分离器在TEP术式中应用安全有效,能明显缩短手术时间,对降低复发率等亦有帮助,值得推广。     

腹腔灌洗液中CK20m RNA水平与结直肠癌不同术式的研究

目的探讨腹腔灌洗液中CK20m RNA的临床意义以及腹腔镜直肠癌根治术的临床应用价值。方法选择49例直肠癌手术患者,利用RT-PCR技术分别检测以上患者腹腔灌洗液中CK20m RNA表达,从而探究CK20m RNA的临床价值以及评价腹腔镜直肠癌根治术的临床实用性。结果 10例良性病变腹部手术组患者腹腔灌洗液中CK20m RNA无明显表达。39例结直肠癌患者腹腔灌洗液中可见CK20m RNA表达,术前、术中以及术后的总表达率为40.2%(47/117),且术前、术中以及术后CK20m RNA的表达率比较差异无显著性(P0.05)。17例开腹手术组和22例腹腔手术组术前、术中以及术后CK20m RNA阳性表达率的比较差异无显著性(P0.05)。结论腹腔镜结直肠癌根治术治疗结直肠癌安全有效,与开腹手术相比并不增加癌细胞局部种植的风险。     

The factors associated with longitudinal changes in liver stiffness in patients with chronic hepatitis B

Background/Aims

Liver stiffness (LS) as assessed by transient elastography (TE) can change longitudinally in patients with chronic hepatitis B (CHB). The aim of this study was to identify the factors that improve LS.

Methods

Between April 2007 and December 2012, 151 patients with CHB who underwent two TE procedures with an interval of about 2 years were enrolled. Ninety-six of the 151 patients were treated with nucleos(t)ide analogues [the antiviral therapy (+) group], while the remaining 55 patients were not [the antiviral therapy (-) group]. The two groups of patients were stratified according to whether they exhibited an improvement or a deterioration in LS during the study period (defined as an LS change of ≤0 or >0 kPa, respectively, over a 1-year period), and their data were compared.

Results

No differences were observed between the antiviral therapy (+) and (-) groups with respect to either their clinical characteristics or their initial LS. The observed LS improvement was significantly greater in the antiviral therapy (+) group than in the antiviral therapy (-) group (-3.0 vs. 0.98 kPa, P=0.011). In the antiviral therapy (+) group, the initial LS was higher in the LS improvement group (n=63) than in the LS deterioration group (n=33; 7.9 vs. 4.8 kPa, P<0.001). However, there were no differences in any other clinical characteristic. In the antiviral therapy (-) group, the initial LS was also higher in the LS improvement group (n=29) than in the LS deterioration group (n=26; 8.3 vs. 6.5 kPa, P=0.021), with no differences in any other clinical characteristic.

Conclusions

A higher initial LS was the only factor associated with LS improvement in patients with CHB in this study.     

Converting diameter measurements of Pinus radiata taken at different breast heights

Two compatible conversion factors for converting diameter measurements taken at different breast heights were derived for Pinus radiata using taper data from more than 3000 trees. The two breast heights used for conversion were 1.3 and 1.4 m above ground, as defined in Australia and New Zealand, two major radiata-growing countries in the world. The conversion factors were estimated through three alternative statistical methods including simple least squares regression, seemingly unrelated regression and errors-in-variables models. The three sets of estimates were almost identical and had similar conversion accuracy, although the second method was slightly better. The conversion factors were more accurate than overbark taper equations used for the same purpose. The factor was 0.9916 for converting diameter measured at 1.3 to that at 1.4 m above ground, and the inverse of this value, 1.0084, was for the vice versa. When calculating tree and stand volume and biomass using equations with diameter at a different breast height as a predictor to that of the input data, the bias, either over or under estimation, could be between 1.67% and 2.00% without conversion. These conversion factors will facilitate the sharing of data among radiata growing countries with different definitions of breast height, but more importantly it will help correct the bias in stand volume and biomass estimation caused by the seemingly negligible difference in breast height when software for forest resource management and decision support developed in one country is applied in another. Such bias when accumulated over a large management area may not be financially insignificant for an astute forest management agency.