我国丙型和戊型肝炎人群流行病学调查及流行因素的研究

为阐明丙型和戊型肝炎在我国的流行严重度和流行规律，采用描述流行病学、血清流行病学和分子流行病学相结合的研究方法，对两型肝炎的流行特征和流行因素进行了研究。结果发现；一般人群调查近９万人丙型肝炎和戊型肝炎的流行率各为２．２％和９．７％，散 生病毒性肝炎感染比率各为２．１５％和１６．４％。丙型肝炎在我国主要经血传播，与血液接触密切人群中ＨＣＶ感染率高达５０－７０％，慢性化比比例高达４０－６０％，目前供     

Transplantation of human umbilical mesenchymal stem cells attenuates dextran sulfate sodium‐induced colitis in mice

Ulcerative colitis is a major form of inflammatory bowel disease and increases the risk of the development of colorectal carcinoma. The anti‐inflammatory and immunomodulatory properties of mesenchymal stem cells (MSC) make them promising tools for treating immune‐mediated and inflammatory diseases. However, the lack of robust technique for harvesting and expanding of MSC has hampered the use of bone marrow and umbilical cord blood derived MSC in clinical applications. In the present study, we investigated the intestinal protective effects of Wharton's jelly‐derived umbilical MSC (UMSC) on dextran sulfate sodium‐induced colitis in mice. The severity of colitis in mice was assessed using bodyweight loss, stool consistency, rectal bleeding, colon shortening and haematological parameters. Colonic myeloperoxidase and pro‐inflammatory cytokines levels were also measured. Furthermore, the expression of cyclooxygenase 2 and inducible nitric oxide synthase in the colon were detected. In addition, intestinal permeability and tight junction proteins expressions in the colon were examined as well. The results showed that Wharton's jelly‐derived UMSC significantly diminished the severity of colitis, reduced histolopathological score, and decreased myeloperoxidase activity and cytokines levels. Furthermore, the UMSC markedly decreased the expression of cyclooxygenase 2and inducible nitric oxide synthase in the colon. In addition, transplantation of UMSC reduced intestinal permeability and upregulated the expression of tight junction proteins. These results show that the anti‐inflammation and regulation of tight junction proteins by Wharton's jelly‐derived UMSC ameliorates colitis.     

Dickkopf-1 perpetuated synovial fibroblast activation and synovial angiogenesis in rheumatoid arthritis

Clinical Rheumatology - Dickkopf-1 (Dkk-1), a regulatory molecule of the Wnt pathway, is elevated and leads to bone resorption in patients with RA. This study is aimed to investigate the...     

完全腹腔镜根治性膀胱切除术+邢氏原位回肠新膀胱的可行性和疗效

目的探讨完全腹腔镜根治性膀胱切除术+邢氏原位回肠新膀胱的可行性和术后临床效果。方法回顾性分析2013年7月至2019年8月41例行完全腹腔镜根治性膀胱切除术+邢氏原位回肠新膀胱患者的临床资料,其中北京朝阳医院31例,中国医学科学院肿瘤医院10例。年龄平均59(44~78)岁。体质指数平均25.3(20.1~34.7)kg/m^2。Charlson合并症指数评分平均3(2~6)分。术前检查均无尿道狭窄,无尿失禁。核素骨扫描、胸部X线片、B超等检查均未发现远处转移。所有患者行膀胱镜检查取活检或行经尿道膀胱肿瘤切除术,术前病理诊断:肌层浸润性膀胱癌30例(73.2%),非肌层浸润性膀胱癌9例(高危或反复复发)(22.0%),原位癌2例(4.9%)。41例均在全麻下先行腹腔镜根治性膀胱切除术+淋巴结清扫术,之后在体腔内采用邢式原位回肠新膀胱进行尿流改道。距回盲部约30 cm向近端截取末端回肠约60 cm,将已截取的回肠近端10 cm移至远端,作为右侧输入襻,之后将中间40 cm肠管去管化,U形缝合后反折缝合成球形,构建成顺蠕动双输入襻回肠新膀胱即邢式原位回肠新膀胱。记录围手术期相关资料、术后<30 d和30~90 d并发症情况、术后尿控恢复情况(日间、夜间控尿满意均定义为需要尿垫≤1个)及预后。比较手术开展的前21例和后20例患者手术时间、出血量的差异。结果本研究41例手术均顺利完成。总手术时间平均324.9(210~480)min。出血量平均177.6(50~700)ml。腹腔镜根治性膀胱切除术+淋巴结清扫术时间平均105.5(60~178)min,邢氏新膀胱构建时间平均179.7(121~298)min。前21例与后20例的总手术时间[(365.1±61.7)min与(290.9±41.8)min,P<0.01]、邢氏新膀胱构建时间[(211.7±44.5)min与(170.1±29.1)min,P=0.001]和出血量[(207.1±144.3)ml与(128.0±63.2)ml,P=0.001]比较差异均有统计学意义。术后病理诊断尿路上皮癌40例(2例合并原位癌),小细胞癌1例。清扫淋巴结数量中位值为19(11~58)枚。淋巴结阳性7例(17.1%)。切缘阳性3例(7.3%),分别为输尿管切缘阳性1例,膀胱切缘阳性2例。病理分期Ta^T1期16例,T2期10例,T3期13例,T4期2例。41例术后下地时间中位值为1(1~4)d,肠道功能恢复时间中位值为3(1~18)d,术后正常饮食恢复时间中位值为7(3~18)d,引流管留置时间中位值为9(3~23)d,输尿管支架拔除时间中位值为15(13~35)d,尿管拔除时间中位值为20(6~30)d,总住院时间中位值为21(11~35)d,术后住院时间中位值为14(7~29)d。术后1例进入ICU病房。术后<30 d Clavien 1~2级并发症19例(46.3%),分别为低白蛋白血症15例、感染2例、低钾血症1例、不全肠梗阻1例,对症处理后均好转;Clavien 3~4级并发症1例(2.4%),为空肠穿孔行手术治疗治愈。术后30~90 d Clavien 1~2级并发症2例(4.9%),分别为切口感染和低白蛋白血症各1例,对症处理后好转,无Clavien 3~4级并发症。术后随访时间平均17.6(2~64)个月。36例(87.8%)生存,其中2例(4.9%)转移,1例(2.4%)复发;5例(12.2%)死亡,死亡原因分别为骨转移1例、多发转移2例,心脏疾病2例。术后12个月复查血肌酐平均77.2(54.3~104.1)μmol/L;影像学检查40例无肾积水,1例出现肾积水。41例拔除尿管后均能自行排尿,无需导尿,术后12个月37例(90.2%)日间控尿满意,29例(70.7%)夜间控尿满意。结论完全腹腔镜根治性膀胱切除术+邢氏原位回肠新膀胱的构建方法简单,术后并发症少,尿控恢复较满意。     

顶空气相色谱法测定苯妥英钠中有机溶剂残留量

目的：建立苯妥英钠中甲醇等5种残留溶剂的测定方法.方法：采用顶空毛细管气相色谱法测定,水为溶剂,色谱柱为HP-624（30.0 m × 530 μm,3.00 μm）;载气为氮气;检测器为FID;程序升温,初始温度为40℃,维持5 min,以20℃·min-升温至200℃,保持5 min.结果：测得各残留溶剂的线性关系良好（相关系数＞0.997 2）;平均回收率92.1％～100.9％,检测限为0.5～1.2 μg.结论：该法操作简便,重现性好,结果准确可靠,可用于苯妥英钠中5种残留溶剂的测定.     

Lower rate of colonoscopic perforation: 110,785 patients of colonoscopy performed by colorectal surgeons in a large teaching hospital in China

Background

Colonoscopic perforation (CP) has a low incidence rate. However, with the extensive use of colonoscopy, even low incidence rates should be evaluated to identify and address risks. Information on CP is quite limited in China.

Objective

Our study aimed to determine the frequency of CP in colonoscopies performed by surgeons at a large teaching hospital in China over a 12-year period.

Methods

A retrospective review of medical records was performed for all patients who had CPs from 1 January 2000 to 31 December 2012. Iatrogenic perforations were identified mainly by abdominal X-ray or computed tomography scan. Follow-up information of adverse events post-colonoscopy was identified from the colorectal surgery database of our hospital. Patients’ demographic data, colonoscopy procedure information, location of perforation, treatment, and outcome were recorded.

Results

A total of 110,785 diagnostic and therapeutic colonoscopy procedures were performed (86,800 diagnostic cases and 23,985 therapeutic cases) within the 12-year study period. A total of 14 incidents (0.012 %) of CP were reported (seven males and seven females), of which nine cases occurred during diagnostic colonoscopy (0.01 %) and five after therapeutic colonoscopy (three polypectomy cases, one endoscopic mucosal resection, and one endoscopic mucosal dissection). Mean patient age was 67.14 years. One case of CP (7.14 %) after colonoscopy polypectomy was treated using curative colonoscopy endoclips. Other patients underwent operations: six cases (46.15 %) of primary repair, four cases (28.57 %) of resection with anastomosis, and two cases (15.38 %) of resection without anastomosis. No obvious perforation was found in one patient (7.69 %). Surgeons attempted to treat one case laparoscopically but eventually resorted to open surgery. The postoperative course was uncomplicated in eight cases (57.14 %) and complicated in six cases (42.86 %) but without mortality.

Conclusion

CP is a serious but rare complication of colonoscopy. A perforation risk of 0.012 % was found in our study. The optimal management of CP remains controversial. Treatment for CP should be individualized according to the patient’s condition, related devices, and surgical skills of endoscopists or surgeons. Selective measures such as colonoscopy without intravenous sedation and decrease of loop formation can effectively reduce rates of perforation.     

Exploring the genetic pathogenicity of aortic dissection from 72 Han Chinese individuals using next-generation sequencing

Aortic dissection (AD) is a heterogeneous genetic disease with high morbidity and mortality. Although many genes predispose patients to AD, the pathogenic spectrum remains incomplete. This study aims to (a) investigate whether genotype differences exist between Stanford A and B AD individuals, and (b) broaden the pathogenic genetic spectrum of AD and reported novel variants of AD-associated genes. The DNA of 72 unrelated Han Chinese individuals with AD was tested by whole-exome sequencing. Of 142 AD-associated genes, 10 pathogenic variants, and 48 likely pathogenic variants in 36 genes were identified among 39 cases. The diagnostic yield was 54.2%. Of the 58 positive variants, 27 were novel. FBN1 was the most frequently positive gene in both Stanford A and Stanford B. Twenty-seven positive variants from 18 COL family genes were distributed in 36.8% of Stanford A and 6.7% of Stanford B cases. We emphasize that positive variants of COL family genes show distribution predominance and strong pathogenicity in Stanford A, while positive variants of smooth muscle cell pathway genes present distribution advantages mainly in Stanford B cases. Our findings provide a new perspective for both the pathogenic mechanism and the treatment of AD.     

Predictors of Major Bleeding Among Working-Age Adults with Atrial Fibrillation: Evaluating the Effects of Potential Drug-drug Interactions and Switching from Warfarin to Non-vitamin K Oral Anticoagulants

Purpose

This study aims to evaluate the associations between switching from warfarin to non-vitamin K oral anticoagulants (NOACs), exposure to potential drug-drug interactions (DDIs), and major bleeding events in working-age adults with atrial fibrillation (AF).

Methods

We conducted a retrospective cohort study using the claims database of commercially insured working-age adults with AF from 2010 to 2015. Switchers were defined as patients who switched from warfarin to NOAC; non-switchers were defined as those who remained on warfarin. We developed novel methods to calculate the number and proportion of days with potential DDIs with NOAC/warfarin. Multivariate logistic regressions were utilized to evaluate the associations between switching to NOACs, exposure to potential DDIs, and major bleeding events.

Results

Among a total of 4126 patients with AF, we found a significantly lower number of potential DDIs and the average proportion of days with potential DDIs in switchers than non-switchers. The number of potential DDIs (AOR 1.14, 95% CI 1.02–1.27) and the HAS-BLED score (AOR 1.64, 95% CI 1.48–1.82) were significantly and positively associated with the likelihood of a major bleeding event. The proportion of days with potential DDIs was also significantly and positively associated with risk for bleeding (AOR 1.42, 95% CI 1.03, 1.96). We did not find significant associations between switching to NOACs and major bleeding events.

Conclusions

The number and duration of potential DDIs and patients’ comorbidity burden are important factors to consider in the management of bleeding risk in working-age AF adults who take oral anticoagulants.

     

复合α干扰素治疗慢性丙型肝炎疗效与病毒负荷及合并TTV感染关系的随机对照研究

目的评价复合α干扰素(CIFN)治疗慢性丙型肝炎的效果,以及重叠TTV感染对治疗的影响.方法选择29例慢性丙型肝炎患者随机分成3组,A组(8例)给予CIFN15μg,B组(10例)给予CIFNμg,C组(11例,对照组)给予IFN-α2a,3MU,均为3次/周×24周,治疗结束后随访24周,于治疗结束时和随访结束时评价ALT及HCVRNA应答.采用套式聚合酶链反应方法对合并TTV感染情况进行回顾性研究.结果A、B两组治疗结束时及停药24周时的ALT复常率、血清HCVRNA阴转率均较对照组高,因样本量少均未达到统计学意义水平.综合比较CIFN和IPN-α2a的疗效,则前者随访结束时的持久应答率显著高于后者.2种剂量CIFN组间应答反应无明显区别.治疗前血清病毒含量与干扰素应答有关,CIFN对于高病毒负荷组患者的疗效优于IFN-α2a组.合并TTV感染者(8/22,36.4%),重叠感染患者与非重叠感染者对干扰素应答反应无显著差别,8例TTV感染者CIFN治疗后6例血清TTVDNA阴转.结论CIFN治疗慢性丙型肝炎远期疗效及高病毒负荷患者的疗效较好;重叠TTV感染对慢性丙型肝炎干扰素疗效无明显影响.TTV似对CIFN较敏感.     

食管癌放射野外新病灶分析

自 1978年元月至 1981年 12月 ,放射治疗食管癌 112 8例 ,疗后发现放射野外新病灶 6 4例(5 .7% ) ,放射野上下缘新病灶发生率分别为 2 .9% ,1.6 %。第二段癌发生率占 1.2 % ,其中 5 4例进行了再程放疗 ,其 1,2 ,3,5年生存率分别为 5 3.7% ,2 4 .1% ,13.5 % ,5 .8%。结果表明此类病人与局部复发或未控制病例有较大区别 ,再程放疗在减少或避免重复照射的基础上 ,可给予根治性放疗 ,首次放疗时病变两端各延长 3cm的照射野是合理的。