Reduction of alkaline reflux gastritis and marginal ulcer by modified Braun enteroenterostomy in gastroenterologic reconstruction after pancreaticoduodenectomy

Background

The incidence of alkaline reflux gastritis (ARG) after pancreaticoduodenectomy (PD) is high. Although Braun enteroenterostomy (BEE) may reduce ARG, BEE may result in marginal ulcers (MUs) due to the additional anastomotic stoma. We conducted this study to compare clinical outcomes of using a modified BEE (MBEE) with traditional gastrojejunostomy (TGJ), by inducting a purse-string suture instead of an additional anastomotic stoma.

Materials and methods

All 62 patients underwent standard PD at the Department of Hepatobiliopancreatic Surgery of West China Hospital between January 1, 2008 and January 31, 2012. Demographics, perioperative and postoperative factors, and follow-up morbidity were compared in those patients who underwent MBEE (n = 32, three patients were lost to follow-up) to those who underwent TGJ (n = 30, nine patients were lost to follow-up).

Results

Patients who underwent the MBEE experienced a decrease in total morbidity including ARG and MUs, relative to those who underwent TGJ (24.1% versus 58.3%, P = 0.011). With regard to the MBEE group, the total ARG rate was statistically significantly lower compared with the TGJ group (13.8% versus 37.5%, P = 0.046). In addition, the incidence of MUs was reduced.

Conclusions

In patients undergoing PD, the MBEE was safely performed with significantly more patients having reduced incidence of ARG and related sequela compared with those who underwent TGJ. These results support further study of patients undergoing gastroenterostomy after resection of the distal stomach in larger, randomized studies.     

姜黄素单羰基类似物的研究进展

目的总结近几年来姜黄素单羰基类似物在合成、稳定性及药理活性方面的研究进展。方法通过检索查找相关文献。结果合成的姜黄素单羰基类似物不仅稳定性有所提高,且其药理活性也有所提高。结论姜黄素单羰基类似物具有进一步的研究价值和良好的应用前景。     

人血小板上蕲蛇毒受体的定位研究

采用单克隆抗体抑制实验、酶水解法及血小板α－颗粒膜蛋白（ＧＭＰ１４０）检测等技术研究人血小板上中国蕲蛇毒（ＣＡＡＶ）受体的定位。结果发现：抗血小板糖蛋白Ⅰｂ（ＧＰⅠｂ）单克隆抗体ＳＺ－２、ＨＩＰ１显著抑制１２５Ｉ－ＣＡＡＶ和血小板特异性结合并呈浓度依赖性，最大抑制率分别为９４．７％±２．０％和８３．０％±２．９％；随糜蛋白酶水解血小板浓度和作用时间不断增加，血小板膜上的ＧＰⅠｂ不断被酶解去掉，１２５Ｉ－ＣＡＡＶ与血小板特异结合率不断下降，从８９．４％降至４．４％；抗ＧＰⅠｂ单抗ＨＩＰ１显著抑制ＣＡＡＶ活化的血小板表面ＧＭＰ１４０的表达，抑制程度与ＨＩＰ１浓度呈负相关（ｒ＝－０．９９２）。研究结果证明ＣＡＡＶ受体位于人血小板膜的ＧＰⅠｂ上。ＣＡＡＶ通过与人血小板上受体ＧＰⅠｂ结合而发挥其生物效应     

2～14岁赴美移民申请人结核病筛查结果分析

〔目的〕对2~14岁赴美移民申请人结核病筛查的结果进行分析,为早期发现潜伏结核感染、肺结核患者及结核病防控提供参考依据。〔方法〕对2009年7月—2010年3月期间在广东国际旅行卫生保健中心体检的2747名2~14岁赴美移民申请人进行结核病筛查,所有申请人均进行结核菌素皮试(TST);若TST≥10mm或申请人有疑似结核的体征或症状,应进行X线胸片检查;若胸片所见疑似结核或有疑似结核的体征或症状的,进行结核分枝杆菌实验室检测。〔结果〕TST皮试结果显示阳性率为47.40%,阴性率52.60%,其中中度阳性者624名,占总人数的22.72%,强阳性者25名,占总人数的0.91%。阴性率随年龄增长逐渐下降,阳性与中度阳性率随年龄增长逐渐上升(P0.001)。649名TST≥10 mm者胸片检查结果发现,疑似结核病患者8人,其中非领养儿童1例,领养儿童7例。结核分枝杆菌实验室检测结果发现,8例疑似肺结核患者中,1例为耐多药结核患者。〔结论〕加强儿童,特别是生活条件和营养条件差的儿童结核病的筛查,提高卡介苗覆盖率及接种质量对于儿童肺结核的防控具有重要意义。     

酚醛树脂铸造车间空气中毒物含量控制研究

铸造车间空气中酚、甲醛、氨的浓度与酚醛树脂中游离酚、甲醛含量和固化剂乌洛托品在酚醛树脂砂中的用量有关。作者利用酚、甲醛易溶于水的原理，在酚醛树脂生产工艺中增加水蒸馏步骤，以降低酚醛树脂中酚和甲醛的含量，并在配砂工艺中减少乌洛托品用量，以控制车间空气中酚、甲醛和氨的浓度。酚醛树脂原材料中酚与甲醛的含量从６．３２％和０．０６２％分别下降至４．９％和０．０３７％，车间空气中酚、甲醛与氨的浓度从２．９４、１．７２和１２．９ｍｇ／ｍ３分别下降至０．６１、０．６９和５．１ｍｇ／ｍ３，皮肤病发病率从８０．２％下降为０。     

Study of paraoxonase-1 function on tissue damage of dichlorvos

To examine the protective efficacy of paraoxonase-1 (PON1) against tissue damage caused by dichlorvos, purified rabbit PON1 was injected intravenously into rats 30 min before they were given dichlorvos, while dichlorvos administration group and corn coil administration group were conducted to compare. Blood was collected at different time points after dichlorvos administration to examine the acetyl cholinesterase (AChE) inhibition level and clinical signs were observed after poisoning. 72 h later, animals were anesthetized and the hippocampus, liver, lung and kidney were removed for observation of ultrastructure. AChE activities in PON1 pretreament group were statistically significant from dichlorvos administration group (P < 0.01). The clinical signs were alleviated by PON1 significantly (P < 0.05). The most common change of organophosphorus poisoning damage to liver was small lipid-like structures could be seen throughout the liver structure. In kidney, dense bodies were seen. The most significant changes in lung were lost of lamellar structure of lamellar bodies in type II alveolar epithelial cell. As for changes of hippocampus, demyaliation takes place after acute organophosphorus, but neural edema was not improved significantly in our study. In conclusion, PON1 can decrease the AChE inhibition, and alleviated clinical signs and tissue damage caused by dichlorvos.     

Reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-9) in the general population

Objective

Depression is one of the most common mental illnesses. The reliability and the validity of the Patient Health Questionnaire (PHQ)-9, a depression screening tool, have not been examined in the general population in China. Thus, this study evaluated the reliability and the validity of the Chinese version of the PHQ-9 in detecting major depression in residents of a Chinese community.

Methods

A total of 1045 participants from a Shanghai community were enrolled in our study. Participants completed the Chinese versions of the PHQ-9, the Self-Rating Depression Scale (SDS), the 36-item Short Form Health Survey (SF-36), and the Mini International Neuropsychiatric Interview. One hundred participants were randomly selected to complete the PHQ-9 again 2 weeks after the initial assessment. The reliability, the validity and the receiver operating characteristic (ROC) curve of the PHQ-9 were analyzed.

Results

Cronbach's alpha for the internal consistency reliability of the Chinese version of the PHQ-9 was 0.86 for the entire scale. The correlation coefficient for the 2-week test–retest of the total score was 0.86. The PHQ-9 scale correlated positively with the SDS (r=0.29, p<0.001) and correlated negatively with all subscale scores of the SF-36 (correlation coefficients ranged from − 0.11 to − 0.47, p<0.001). The area under the curve of the ROC was 0.92 (95% confidence interval: 0.86–0.97). A cutoff score of 7 or higher on the PHQ-9 had a sensitivity of 0.86 and a specificity of 0.86.

Conclusions

In the general Chinese population, the Chinese version of the PHQ-9 is a valid and efficient tool for screening depression, with a recommended cutoff score of 7 or more.     

Imatinib Mesylate Versus Allogeneic Hematopoietic Stem Cell Transplantation for Patients with Chronic Myelogenous Leukemia

Purpose: To compare the relative merits of imatinib and allogeneic hematopoietic stem cell transplantation (allo-HSCT) for chronic myelogenous leukemia (CML). Materials and Methods: This cohort study was designed to compare the outcomes of imatinib (n=292) versus allo-HSCT (n=141) for CML, the clinical data of these patients being retrospectively analyzed so as to compare the event free survival (EFS) and overall survival (OS) between these two groups with patients in the chronic phase (CP) and advanced phases, including accelerate (AP) and blast phases (BP). Results: (1) Patients treated with imatinib (278 in the CP) demonstrated superior EFS, OS, 5-year EFS and 5-year OS rates of 88.5% versus 70.0% (P<0.05), 93.2% versus 80.0% (P<0.05), 84% versus 75.0% (P<0.05) and 92% versus 79.0% (P<0.05), respectively, to those treated with allo-HSCT (120 patients in the CP). (2) Both treatments resulted in similar survival, with EFS and OS rates of 42.9% versus 47.6% (P>0.05), 42.9% versus 57.1% (P>0.05), respectively, for imatinib (14 patients in the AP and BP) and allo-HSCT (21 patients in the AP and BP). Conclusions: Imatinib confers signi cant survival advantage (EFS and OS) for CML patients with CP compared with allo-HSCT treatment. However, the outcomes are equally good with both treatments in AP and BP patients.     

80岁以上超高龄患者胸部术后肺部并发症的高危因素分析

目的：分析80岁以上患者行胸部手术后发生肺部并发症的独立危险因素,评估其危险度,以期为其防治提供依据。方法回顾性分析该院2011年8月至2013年8月收治41例80岁以上超高龄患者围术期临床资料。采用 SPSS17．0软件单因素和多因素方法分析患者开胸术后发生肺部并发症的独立危险因素。结果共21例（51．2％）患者发生术后肺部并发症,其中术后肺部感染13例,肺不张5例,低氧血症2例,气胸1例。单因素和多因素分析结果显示,BMI＞24、吸烟指数大于或等于400、第1秒用力呼气容积占用肺活量的百分比（FEV1％）＜65％、最大通气量（MVV）＜60％、手术时间大于或等于4 h和清蛋白水平小于30 g/L是80岁以上超高龄患者胸部手术后发生肺部并发症的独立危险因素。结论 BMI＞24、吸烟指数大于400以及肺功能和营养状况较差的超高龄患者术后发生肺部并发症的风险增加。