双气囊内镜在中消化道疾病诊断中的应用价值研究

目的 探讨双气囊内镜(DBE)在中消化道疾病诊断中的应用价值.方法 对53例行DBE检查的疑似中消化道疾病患者的临床资料进行回顾性分析,总结病变检出情况以及并发症、不良反应发生情况.结果 53例均顺利完成DBE检查,其中单纯经口进镜者26例、单纯经肛进镜者9例、经口+经肛进镜者18例,共46例(86.79％)发现病变,包括上消化道病变3例(5.66％)、中消化道病变41例(77.36％)和下消化道病变2例(3.77％).53例患者均能耐受麻醉及内镜检查,无一例发生消化道出血、穿孔、肠道扭转、肠系膜撕裂、胰腺炎等严重并发症,亦未出现麻醉相关的并发症及意外.部分患者术中出现腹部胀气、一过性腹痛;经口进镜者术中出现不同程度的咽喉部不适或少量鼻腔出血;1例术中因外套管根部硅胶管与气管插管摩擦松脱形成嵌顿,放气并拔出气管插管后松解;术后1d有2例出现轻微腹泻伴低热,于48 h内自然缓解.结论 DBE在中消化道疾病的诊断中具有较好的临床价值,安全性较高.     

超声心动图诊断胎儿双主动脉弓的价值

目的探讨超声心动图诊断胎儿双主动脉弓的临床价值。方法 8例双主动脉弓胎儿,超声对各切面超声特点进行分析。结果超声心动图诊断胎儿双主动脉弓6例,5例为右弓稍大于左弓,1例为左右弓内径基本相同。1例胎儿同时合并其他心内畸形,核型分析为21-三体。左、右侧主动脉弓上分别发出两支头臂动脉。超声心动图漏诊2例,为左弓内径明显小于右弓。结论胎儿双主动脉弓在三血管-气管切面显示,由左弓和右弓包绕气管形成的完全血管环,左弓和右弓上均仅见两支头臂动脉发出。超声心动图对胎儿双主动脉弓早期检出具有重要的临床价值。     

β-catenin与大肠癌干细胞标记物EpCAMhigh／CD44+在大肠癌中的表达及临床意义

目的 探讨Wnt／β-catenin通路对大肠癌干细胞的调节及侵袭转移能力的影响。方法 免疫组化双重染色法检测80例大肠癌患者原发灶及10例肝转移灶组织中大肠癌干细胞标记物EpCAM^high／CD44⁺的表达,免疫组化SP法检测上述组织中Wnt通路关键蛋白β-catenin的表达,分析β-catenin、EpCAM／CD44蛋白在大肠癌组织中的表达与临床病理特征之间的关系及两者的相关性。结果 β-catenin在大肠癌及癌旁正常肠黏膜组织的异常表达率分别为55.0％（44／80）和10.0％（2／20）,差异有统计学意义（P＜0.05）。β-catenin在肝转移灶中的异常表达率为90.0%（9／10）。EpCAM／CD44在大肠癌及癌旁正常肠黏膜组织中的阳性表达率分别为66.3％（53／80）和0（0/20）。大肠癌原发灶中β-catenin的异常表达与性别、年龄、肿瘤大小无关,而与分化程度、浸润深度、Dukes分期及转移密切相关（P＜0.05）;EpCAM^high／CD44⁺表达与性别、肿瘤大小无关,而与年龄、分化程度、浸润深度、Dukes分期及转移密切相关（P＜0.05）。EpCAM／CD44在β-catenin异常表达组中的阳性表达率为84.1％,显著高于在其正常表达组的44.4％,差异有统计学意义（P＜0.05）。经Pearson相关性分析,β-catenin与EpCAM／CD44的表达呈正相关,差异有统计学意义（r=0.417,P=0.000）。结论 Wnt／β-catenin通路的异常激活有可能参与大肠癌干细胞的异常增殖,进而导致肿瘤的复发转移。     

Comparison of efficacy and safety of intralesional triamcinolone and combination of triamcinolone with 5-fluorouracil in the treatment of keloids and hypertrophic scars: Randomised control trial

The treatment of keloid and hypertrophic scar is challenging with no universally accepted mode for permanent ablation. Conventional therapies yield unpredictable results, significant complications and require elaborate hardware.

Heart-hand syndrome

Heart–hand syndromes show substantial clinical and genetic heterogeneity. The unusual case of a patient with a heart–hand syndrome consisting of preaxial polydactylia, postaxial syndactylia, parachute mitral valve, mild subaortic stenosis, and double outlet right ventricle is presented and discussed. The importance of distinguishing Holt–Oram syndrome from its phenocopies and other heart–hand syndromes is underlined.     

Treatment of gastrointestinal bleeding in left ventricular assist devices: A comprehensive review

Left ventricular assist devices(LVAD) are increasingly become common as life prolonging therapy in patients with advanced heart failure. Current devices are now used as definitive treatment in some patients given the improved durability of continuous flow pumps. Unfortunately, continuous flow LVADs are fraught with complications such as gastrointestinal(GI) bleeding that are primarily attributed to the formation of arteriovenous malformations. With frequent GI bleeding, antiplatelet and anticoagulation therapies are usually discontinued increasing the risk of life-threatening events. Small bowel bleeds account for 15%as the source and patients often undergo multiple endoscopic procedures.Treatment strategies include resuscitative measures and endoscopic therapies.Medical treatment is with octreotide. Novel treatment options include thalidomide, angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor blockers, estrogen-based hormonal therapies, doxycycline, desmopressin and bevacizumab. Current research has explored the mechanism of frequent GI bleeds in this population, including destruction of von Willebrand factor,upregulation of tissue factor, vascular endothelial growth factor, tumor necrosis factor-α, tumor growth factor-β, and angiopoetin-2, and downregulation of angiopoetin-1. In addition, healthcare resource utilization is only increasing in this patient population with higher admissions, readmissions, blood product utilization, and endoscopy. While some of the novel endoscopic and medical therapies for LVAD bleeds are still in their development stages, these tools will yet be crucial as the number of LVAD placements will likely only increase in the coming years.     

不同产地冻干地黄中5种重金属及有害元素的含量测定

摘 要 目的： 用火焰原子吸收分光光度计和原子双道荧光光度计分别对不同产地冻干地黄中的Pb、Cd、Cu、As和Hg 5种重金属和有害元素进行检测。方法: 采用硝酸-高氯酸对样品进行消化后,采用原子吸收分光光度法测定Pb、Cd和Cu含量,采用原子荧光光度法测定As和Hg的含量。 结果: 各元素线性关系良好,相关系数均大于0.997 4,平均回收率为97.88%～100.90%,RSD为0.019%～4.20%（n=6）,同时发现10批样品中的4批样品部分重金属和有害元素超过《中国药典》限量标准。 结论:该方法准确度高,操作简便,快捷,适用于冻干地黄中重金属和有害元素的测定。     

Effect of post-transplant double filtration plasmapheresis on recurrent focal and segmental glomerulosclerosis in renal transplant recipients

In the present study, we reviewed the effect of post-transplant double filtration plasmapheresis (DFPP) on recurrent focal segmental glomerulosclerosis (FSGS) in the transplanted kidney allograft. Sixteen patients with post-transplant recurrent FSGS were enrolled in this study. Out of 16 patients with recurrent FSGS after transplantation, five did not receive DFPP and lost their grafts, while 11 did receive DFPP and four of these patients lost their grafts. Seven patients were able to maintain normal renal function for an average observation period of 57.1 +/- 40.7 months (range 7-125 months). In five patients who had a significant reduction in urinary protein after DFPP, the urinary protein level decreased from 26.60 +/- 23.05 g/day (range 3.34-62.6 g/day) to 2.95 +/- 3.42 g/day (range 0.02-8.64 g/day) and renal function was maintained. The beneficial effects of DFPP on graft outcome were more likely to occur if the patients experienced a marked drop in urinary excretion. Thus, post-transplant DFPP appears to be effective for reducing urinary protein levels and improving long-term graft survival. With the small numbers in this trial, however, none of the findings were statistically significant. We recommend the use of post-transplant DFPP to prevent the progression of recurrent FSGS.     

Foreign body in ocular coats causing a pseudo optic nerve head shadow

Small intraocular foreign body in the outer coats of the eye may be wrongly interpreted as optic nerve head on ultrasound imaging. Such errors can be avoided by performing multiple sonography scans in different axes.