Incidence,pattern, and african variations of common benign disorders of the esophagus: Experience from Nigeria

As a result of the dearth and cost of specialized personnel and investigative facilities, noncommunicable diseases have aroused no real epidemiologic interest in many parts of Africa, and consequently reports on some diseases have been sporadic and often lacking in detail. Therefore a comprehensive study of benign lesions of the esophagus, such as achalasia, hiatal hernia, and the gastroesophageal reflux complex including peptic stricture, was undertaken among Nigerians resident in the African environment. Striking variations from known patterns became evident. Answers were sought for the peculiarities in the manifestation and natural history of these disorders.     

Transmesenteric small bowel plication or intraluminal tube stenting. Indications and contraindications.

Controversy exists as to the efficacy of transmesenteric intestinal plication or long tube stenting of the small bowel in the treatment of severe intestinal adhesions and in late small bowel obstruction.We reviewed our experience with these procedures over a 12 year period with complete follow-up data on 92 per cent of the patients. There were 28 modified Childs-Phillips plications and 37 intraluminal tube decompressions and stenting. For comparison we reviewed 107 cases of small bowel obstruction treated by simple lysis of adhesions.Three deaths and one small bowel fistula were associated with the modified Childs-Phillips procedure; none was directly related to the plication. Three patients required reoperation within the 1st postoperative week for technical reasons. No late operations for recurrent small bowel obstruction were required.One death and one reoperation for bowel obstruction were associated with but not directly related to the Baker tube stenting.Four deaths were associated with simple lysis. Seven patients required reoperation for late recurrent small bowel obstruction.Modified Childs-Phillips transmesenteric plication using nonabsorbable sutures is recommended in cases of severe visceral and parietal peritoneal damage but not in cases of distention and severe ileus of the small bowel or acute generalized peritonitis.Baker tube jejunostomy with decompression and splinting of the small bowel is recommended with massive distention and ileus of the small bowel. Peritonitis is not a contraindication. In our experience fewer short-term complications have occurred after long tube decompression and stenting than after modified Childs-Phillips plication. Measures to avoid these complications are presented. With proper indications, modified Childs-Phillips plication and intraluminal tube stenting are safe and efficient in preventing reobstruction.     

National Lipid Association Scientific Statement on the use of icosapent ethyl in statin-treated patients with elevated triglycerides and high or very-high ASCVD risk

Representatives from the National Lipid Association (NLA) participated in the development of the 2018 American Heart Association/American College of Cardiology/Multisociety Guideline on the Management of Blood Cholesterol, which reaffirmed that lifestyle changes and statin treatment are therapeutic cornerstones for atherosclerotic cardiovascular disease (ASCVD) risk reduction. It also updated prior recommendations to incorporate newer data demonstrating ASCVD risk reduction with ezetimibe and proprotein convertase subtilisin kexin type 9 inhibitors as adjuncts to statin therapy for patients at high and very-high ASCVD risk. The 2018 Guideline was finalized shortly before full results were available from a randomized, placebo-controlled cardiovascular outcomes trial [Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT)] that examined the effects of icosapent ethyl (IPE) 4 g/d on major adverse cardiovascular events in selected high- or very high-risk, statin-treated patients with elevated triglycerides. The primary outcome variable of first major adverse cardiovascular event (cardiovascular death, myocardial infarction, stroke, coronary revascularization and hospitalization for unstable angina) was reduced by 25% (95% confidence interval 17%–32%, P < .001). REDUCE-IT served as the primary basis for the NLA's review of evidence for the use of IPE for ASCVD risk reduction. Based on this review, the NLA position is that for patients aged ≥45 years with clinical ASCVD, or aged ≥50 years with diabetes mellitus requiring medication plus ≥1 additional risk factor, with fasting triglycerides 135 to 499 mg/dL on high-intensity or maximally tolerated statin therapy (±ezetimibe), treatment with IPE is recommended for ASCVD risk reduction (evidence rating: class I; evidence level: B-R).     

青岛地区健康成年人尿酸排泄分数正常值的建立及分析

背景: 目前国内缺少关于尿酸排泄分数(fraction excretion of uric acid,FEUA)正常值建立及不同性别、年龄间差异的研究。 目的: 建立青岛地区健康成年人尿酸排泄分数的正常参考值。 设计、时间及地点：调查分析,2007-08/2008-08在青岛大学医学院附属医院完成。 对象: 选择2007-08/2008-08青岛地区连续居住5年以上的20~70岁的健康者581人,其中男279人,女302人。按年龄分为21~30岁61人,男32人,女29人;31~40岁92人,男40人,女52人;41~50岁173人,男82人,女91人;51~60岁169人,男88人,女81人;>60岁86人,男37人,女49人。 方法:用特定Sysmex chemix-180型全自动生化分析仪测定581例健康成年人的空腹血清及12 h尿中尿酸、肌酐浓度,计算尿酸排泄分数,用SPSS16.0软件进行统计学处理。 主要观察指标：①正常成年人的一般资料及生化指标比较。②血尿酸、尿酸排泄分数性别间比较及尿酸排泄分数的参考值范围。③血尿酸、尿酸排泄分数在不同年龄组间的比较。 结果: 男性血尿酸高于女性,而尿酸排泄分数低于女性,差异均有显著性意义(P < 0.05)。各年龄组间尿酸排泄分数差异无显著性意义(P > 0.05)。女性尿酸排泄分数参考值范围为4.039%~10.613%,男性为3.447%~9.915%。 结论: 初步建立了青岛地区健康成年人尿酸排泄分数的正常参考值。应分别建立男女性尿酸排泄分数正常参考值及促尿酸排泄治疗标准,为高尿酸血症防治工作提供参考。     

De Novo Malignancy Following Adult-to-Adult Living Donor Liver Transplantation Focusing on Posttransplantation Lymphoproliferative Disorder

Objective

In patients with living donor liver transplantation (LDLT), late-onset complications sometimes develop because of long-term use of immunosuppressive drugs. One of the immunosuppressive drug-related complications is de novo malignancies resulting in reduced survival.

Living Related Renal Transplantation Using a Saphenous Vein Graft: A Case Report

We report a case of living related renal transplantation that used the recipient's saphenous vein as a graft to extend the length of the right donor renal vein.A 41-year-old woman underwent ABO-incompatible living related renal transplantation from her 74-year-old mother in November 2014.A retroperitoneal laparoscopic right donor nephrectomy was performed, because the right kidney showed a cyst on preoperative computed tomography.As the right kidney after donor nephrectomy had a short renal vein and the kidney was large at 280 g, anastomosis with the external iliac vein was difficult. Therefore, we obtained the recipient's 15-cm-long right saphenous vein and created a 1 cm saphenous vein graft. We anastomosed 1 side of the saphenous vein graft to the allograft renal vein in bench surgery and performed end-to-side anastomosis of the other end to the recipient's external iliac vein. The allograft renal artery was used to perform end-to-end anastomosis to the recipient's internal iliac artery. Allograft kidney function was good after transplantation.When the longer axis of the renal graft vein is short, as in the right kidney, a saphenous vein graft may be useful.     

外源Smad7转染肝星状细胞及对转化生长因子β1和Ⅰ、Ⅲ型胶原mRNA表达的影响

背景：Smad7是转化生长因子β信号转导途径的主要抑制性蛋白,具有抗纤维化的作用。 目的：构建并鉴定大鼠Smad7真核表达质粒,观察外源Smad7可否有效转染肝星状细胞T6,并进一步研究其对转化生长因子β及Ⅰ、Ⅲ型胶原mRNA 表达水平的影响。 设计、地点：基因重组及细胞观察实验,于新疆石河子大学医学院第一附属医院完成。 材料：pcDNA3.1(+)质粒为课题组保留;大肠杆菌DH5α系石河子大学医学院新疆地方与民族高发病教育部重点实验室所赠;肝星状细胞T6细胞由中国医学科学院肿瘤医院肿瘤研究所提供品。 方法：采用基因重组技术将Smad7cDNA插入真核表达载体pcDNA3.1(+),构建大鼠Smad7真核表达质粒。脂质体介导转染肝星状细胞T6细胞,分为正常对照、空质粒及转染组,G418筛选,挑取阳性细胞。 主要观察指标：反转录-聚合酶链反应法检测各组中Smad7、转化生长因子β及Ⅰ、Ⅲ型胶原mRNA的表达水平。 结果：酶切和测序结果证实Smad7真核表达质粒构建成功。Smad7转染组与正常对照组、空质粒组比较：Smad7 mRNA表达显著增加(P < 0.01);转化生长因子β、Ⅰ型胶原mRNA表达减少(P < 0.01);Ⅲ型胶原mRNA表达差异无显著性意义(P > 0.05)。正常对照组、空质粒组Smad7、转化生长因子β及Ⅰ、Ⅲ型胶原mRNA表达差异无显著性意义(P值均> 0.05)。 结论：大鼠Smad7真核表达质粒构建成功,外源Smad7转染肝星状细胞T6细胞后可有效表达,并能降低转化生长因子β及Ⅰ型胶原mRNA 表达水平。     

Mechanical bowel obstruction: Review of 316 cases in benin city

A retrospective study of 316 patients with a diagnosis of intestinal obstruction admitted to the University of Benin Teaching Hospital over a 5 year period is presented. The overall mortality was 10.6 percent. Attention is called to the unacceptably high morbidity and mortality associated with volvulus in this and other series. Because the most common cause of intestinal obstruction in Africa is strangulation, a preventable complication of inguinal hernia, the clinician has a unique opportunity to significantly decrease the incidence of intestinal obstruction in Africa. Finally, our study confirms that the single most important antecedent of a grave prognosis in intestinal obstruction is late presentation of the patient.