Does urgent balloon-assisted enteroscopy impact rebleeding and short-term mortality in overt obscure gastrointestinal bleeding?

Abstract

Background and aims

The diagnostic yield (DY) and therapeutic yield (TY) of balloon-assisted enteroscopy (BAE) in overt obscure gastrointestinal bleeding (OGIB) is higher in the first 72?h. This study aimed to evaluate if this higher DY and TY after urgent BAE impacted the rebleeding rate, time to rebleed and short-term mortality.     

Immune senescence and cancer in elderly patients: Results from an exploratory study

Background

The challenge of immune senescence has never been addressed in elderly cancer patients. This study compares the thymic output and peripheral blood telomere length in ≥ 70 year old cancer patients.

Patients and methods

Fifty-two elderly cancer patients and 39 age-matched controls without personal history of cancer were enrolled. All patients underwent a Comprehensive Geriatric Assessment (CGA), from which a multidimensional prognostic index (MPI) score was calculated. Peripheral blood samples were studied for naïve and recent thymic emigrant (RTE) CD4⁺ and CD8⁺ cells by flow cytometry. T-cell receptor rearrangement excision circle (TREC) levels, telomere length and telomerase activity in peripheral blood cells were quantified by real-time PCR.

Results

The percentages of CD8⁺ naïve and CD8⁺ RTE cells and TREC levels were significantly lower in cancer patients than in controls (p = 0.003, p = 0.004, p = 0.031, respectively). Telomere lengths in peripheral blood cells were significantly shorter in cancer patients than in controls (p = 0.046) and did not correlate with age in patients, whereas it did in controls (r = − 0.354, p = 0.031). Short telomere (≤ median)/low TREC (≤ median) profile was associated with higher risk of cancer (OR = 3.68 [95% CI 1.22–11.11]; p = 0.021). Neither unfitness on CGA nor MPI score were significantly related to thymic output or telomere length in either group.

Conclusions

Immune senescence is significantly worse in elderly cancer patients than in age-matched controls. The low thymic output and the shorter telomeres in peripheral blood cells of cancer patients may reflect a pre-existing condition which facilitates the onset of malignancies in elderly people.     

颅内破裂动脉瘤栓塞后再出血分析

目的分析颅内破裂动脉瘤栓塞后再出血的发生率及其可能的影响因素。方法随访285例破裂动脉瘤病人，随访时间2-72个月，平均28.1个月，通过书信，电信以及门诊的方式进行随访，内容以询问病人症状，体征为主，重点在于动脉 瘤栓塞后是否再出血。结果4例病人发生动脉瘤再次破裂出血，再出血率为1.4%，其中不全栓塞3例，大动脉瘤2例。结论颅内破裂动脉瘤应用弹簧圈栓塞后再出血发生率大大降低，再出血主要发生于不全栓塞的动脉瘤和何种较大的动脉瘤。     

加压包扎预防继发性前房积血

目的 :探讨加压包扎挫伤性前房积血 (BTH)眼预防继发性前房出血 (REB)的效果。方法 :回顾性研究 ,根据是否采用加压包扎治疗将年龄大于 6岁的BTH患者分为两治疗组 :包扎组和对照组 ,前者 72例 72眼 ,给予绷带加压包扎前房出血眼 ,另眼加纱布块遮盖 ;对照组 39例 39眼 ,给予双眼纱块遮盖 ,其他治疗原则相同。统计观察 7天内REB的例数。结果 :加压包扎组发生REB 9例 ,发生率是 15 .0 %。对照组发生REB者11例 ,发生率为 2 8.2 % ,两组REB发生率的差异有统计学显著性意义 (P <0 .0 5 ,χ2 =4 .2 2 )。结论 :加压包扎BTH眼预防REB效果显著。     

Headache of recent onset in adults: a prospective population-based study

One hundred consecutive adult patients with headache of recent onset were prospectively studied. Every patient was examined by craneal CT scan. Their mean age was 46 years (range 17–82). Neurological examination was normal in 80 patients. Organic headache represented 39% of the entire group, and 26% of them had a normal neurological examination. The yield of CT scan in patients with headaches and a normal neurological examination was 22.5% (95% IC: 14%-33%); of which we encountered the following pathologies: intracranial tumors (13), hydrocephalus (2), arachnoid cyst (1), toxoplasmic abscess (1) and parenchymal hemorrhage (1). The clinical characteristics of the headache on their own was insufficient to rule out the possibility of an intracranial tumor. Neuroimaging studies should be performed in all adult patients with non-vascular headache of recent onset, and previously headache-free individuals.     

Morphometric evidence for a striking B-cell reduction at the clinical onset of type 1 diabetes

Summary The distribution and volume of the pancreatic endocrine cells were studied in a case of type 1 diabetes with a duration of approximately 7 days. Immunocytochemical techniques combined with morphometry were used. The PP-cell rich lobe, making up about 10% of the total pancreatic volume, was not included in this study. The volume density and the absolute volume of the B-cells was found to be reduced to about one third to one seventh of the values determined in four controls of similar age and/or pancreatic volume. The A-cell volume was also diminished whereas the D- and PP-cell volume remained constant. As B-cell necroses could not be detected and insulitis was in the initial stages of development it is concluded that the destruction of B-cells proceeds slowly in type 1 diabetes. In the majority of cases it probably starts years before the clinical onset of the disease.Dedicated to Prof. Dr. J. Kracht in honour of his sixtieth birthdayPresented in part at the eighteenth annual EASD meeting in Budapest 1982Supported by Deutsche Forschungsgemeinschaft, SFB 34, Hamburg     

Effect of two inhibitors of dopamine β-hydroxylase on maturation of memory in mice

Bitemporal injections of puromycin that primarily affect the hippocampal-entorhinal cortical areas suppress memory of maze-learning in mice for 3 days after training but are ineffective 6 or more days after training. At these later times, injections affecting widespread areas of the brain in addition to the hippocampal-entorhinal area are necessary for amnesia. These observations are interpreted to indicate that the locus of the memory trace has enlarged at 6 days to include other parts of the central nervous system in addition to the hippocampal-entorhinal area. To produce an imbalance of neurotransmitters and so to test their importance in enlargement of the memory trace's locus, we treated mice for 7 days after training with inhibitors of dopamine β-hydroxylase. These mice, unlike untreated controls, developed amnesia after bitemporal injections of puromycin. In view of additional control experiments, we interpret these results to suggest that an imbalance of suppresses the normal enlargement of the locus of the memory trace.     

Variation in the Nicotinic Acetylcholine Receptor Gene Cluster CHRNA5�CCHRNA3�CCHRNB4 and Its Interaction with Recent Tobacco Use Influence Cognitive Flexibility

Variants in the CHRNA5–CHRNA3–CHRNB4 gene cluster have been associated with nicotine dependence (ND) and ND-related traits. To evaluate a potential underlying mechanism for this association, we investigated the effects of 10 variants in this gene cluster and their interactive effects as a result of recent smoking on cognitive flexibility, a possible mediator of genetic effects in smokers. Cognitive flexibility of 466 European Americans (EAs; 360 current smokers) and 805 African Americans (AAs; 635 current smokers) was assessed using the Wisconsin Card Sorting Test. The main effects of variants and haplotypes and their interaction with recent smoking on cognitive flexibility were examined using multivariate analysis of variance and the haplotype analysis program HAPSTAT. In EAs, the major alleles of five variants (CHRNA5-rs3841324–22 bp-insertion-allele, CHRNA5-rs615470-C-allele, CHRNA3-rs6495307-C-allele, CHRNA3-rs2869546-T-allele, and CHRNB4-rs11637890-C-allele) were associated with significantly greater perseverative responses (P=0.003–0.017) and perseverative errors (P=0.004–0.026; recessive effect). Among EAs homozygous for the major alleles of each of these five variants, current smokers made fewer perseverative responses and perseverative errors than did past smokers. Significant interactive effects of four variants (rs3841324, rs615470, rs6495307, and rs2869546) and current smoking on cognitive flexibility were observed (perseverative responses (P=0.010–0.044); perseverative errors (P=0.017–0.050)). However, in AAs, 10 variants in this gene cluster showed no apparent effects on cognitive flexibility. These findings suggest that variation in the CHRNA5–CHRNA3–CHRNB4 gene cluster influences cognitive flexibility differentially in AAs and EAs and that current smoking moderates this effect. These findings could account in part for differences in ND risk associated with these variants in AAs and EAs.     

血管内介入技术在腹部手术后近期再出血诊治中的临床应用

目的探讨血管内介入技术在腹部手术后近期再出血诊治中的临床应用价值。方法山西省人民医院2010年12月至2012年12月腹部手术后近期再出血病例10例,均在输血、补液、纠正休克的同时,采用Selding’s技术行血管造影术,确定出血动脉,并立即行出血动脉栓塞术。结果10例患者均通过血管造影发现出血动脉,并进行了栓塞术。共行血管造影11次,栓塞治疗10次,共用弹簧圈（直径2—8mrla）48枚。聚乙烯醇颗粒3g.10例患者当时均获得良好的止血效果。9例随访30d均未复发;1例胰十二指肠切除术后1周,胃十二指肠动脉残端出血,行胃十二指肠动脉残端及肝总动脉不锈钢圈栓塞术后,血压上升维持正常水平,但心率持续较快,维持在130-140次／min,可疑仍有活动性出血,24h后再次行腹部血管造影未发现异常,家属放弃治疗。结论血管内介入技术是一种安全、有效、实用的对腹部手术后近期再出血诊治手段。