简介：Symptomatichepato-diaphragmaticinterpositionofabowellooporChilaiditi'ssyndromeisapeculiaranatomicalconditionmostoftenfoundbychance.Itsdescribedsymptomsrangefromintermittent,mildabdominalpainanddyspepsiatoacuteintestinalobstruction.Wereportacaseofhepato-diaphragmaticmigrationofthehepaticflexureofthecolonassociatedtoanunusual,heretoforeunreported,angina-likepainexclusivelyevokedbytheleftlateraldecubitus.Tomaximizethechanceofobservinganatomicalchangesindifferentpostures,computedtomographyofthechestandabdomenwasperformedafterairinsufflationintothecolon.Whilefrankherniationintothechestwasexcluded,thescanshowedthatthehepaticflexure-withtheinterpositionofthediaphragm-cameincontactwiththerightsideoftheheartintheleftlateral,butnotinthesupine,decubitus.Thisfindingwasreproducedbyechocardiographywhichalsoshowedvirtuallyunalteredhemodynamicsafterthechangeofposture.ECG,leftandrightventricularglobalandregionalfunctionaswellascardiacinjurymarkersalsoremainedunchangedduringthemaneuver,indicatingthatthepainevokedbythelatterwasunlikelyduetomyocardialischemia.ThiscasesuggeststhatChilaiditi'ssyndromeshouldbeincludedamongthepossible,althoughrare,causesofunexplainedangina-likesymptoms.

简介：煽动性的肠疾病(IBD)经常与象眼的神经炎那样的extraintestinal表明(EIM)被联系(在上)尽管这到目前为止在仅仅一些成年病人被描述了，所有谁与Crohns疾病(CD)被影响。而且，在上并且demyelinating疾病比的被表明了在IBD病人更经常在控制人口。在我们的当前的案例报告，我们与活跃CD描述一个孩子开发了突然的盲目由于在那上双边不与任何已知的原因有关，并且那即时对类固醇的高剂量作出回应。调查和临床的后续到目前为止在这个病人排除了demyelinating疾病的发展。到我们的知识，这是第一份报告在上在有CD的一个小儿科的病人。对这个案例的可能的解释包括活跃的肠疾病的阵发性的EIM，联系自体免疫的混乱例如一周期性孤立在上，多重硬化的第一表明，或能出现在以后的后续的另一demyelinating疾病。

简介：

简介：AIM:Toinvestigatethelifetimeriskofdevelopmentofesophagealadenocarcinomaand/orhigh-gradedysplasiainpatientsdiagnosedwithBarrett’sesophagus.METHODS:DatawereextractedfromtheUnitedKingdomNationalBarrett’sOesophagusRegistryondateofdiagnosis,patientageandgenderof7877patientsfromwhohadbeenregisteredfrom35UnitedKingdomcenters.LifeexpectancywasevaluatedfromUnitedKingdomNationalStatisticsdatabasedupongenderandageatyearatdiagnosis.Thesedatawerethenusedwithpublishedestimatesofannualadenocarcinomaandhigh-gradedysplasiaincidencesfrommetaanalysesandlargepopulation-basedstudiestoestimateoveralllifetimeriskofdevelopmentofthesestudyendpoints.RESULTS:ThemeanageatdiagnosisofBarrett’sesophaguswas61.6yearsinmalesand67.3yearsinfemales.Themeanlifeexpectancyatdiagnosiswas23.1yearsinmales,20.7yearsinfemalesand22.2yearsoverall.Usingdatafrompublishedmeta-analyses,thelifetimeriskofdevelopmentofadenocarcinomawasbetween1in8and1in14andthelifetimeriskofhigh-gradedysplasiaoradenocarcinomawas1in5to1in6.Usingdatafrom3largerecentpopulation-basedcohortstudiesthelifetimeriskofadenocarcinomawasbetween1in10and1in37andofthecombinedendpointofhigh-gradedysplasiaandadenocarcinomawasbetween1in8and1in20.AgeatBarrett’sesophagusdiagnosisisreducingandlifeexpectancyisincreasing,whichwillpartiallycounter-balancelowerannualcancerincidence.CONCLUSION:Thereisasignificantlifetimeriskofdevelopmentofhigh-gradedysplasiaandadenocarcinomainBarrett’sesophagus.

简介：Hirschsprungs疾病是现场发生在1:5000的先天的混乱出生。它被伤寒神经原的缺席沿着胃肠的道的一个可变区域描述。Hirschsprungs疾病作为multigenic混乱被分类，因为一样的显型在多重不同基因与变化被联系。而且，Hirschsprungs疾病的遗传高度复杂、不严格地孟德尔。在Hirschsprungs疾病观察的phenotypic可变性和不完全的外显率也建议修饰词基因的参与。这里，我们总结基于人和动物研究位于Hirschsprungs疾病下面的遗传的当前的知识，集中于修饰词基因的主要原因的基因，他们的相互作用，和角色。

简介：输尿管痉挛性疼痛绝大部分为输尿管结石、输尿管炎症等所致，疼痛剧烈，呈放射性，常以急症就诊。在明确诊断后，解除患者的剧烈疼痛应为首先采取的治疗措施。自1995—08／1998—10用维生素K3加阿托品治疗输尿管痉挛性疼痛85例，镇痛效果良好，现分析如下。

简介：患者男，40岁。因乏力、纳差1年加重伴腹胀1周于2006年6月27日入院。缘于2005年5月起出现乏力、纳差、肝功能异常，在当地医院诊断为慢性乙型肝炎，经保肝降酶等治疗症状缓解，继续工作。近1周因疲劳后再次出现乏力、纳差伴腹胀。体检：体温36．5℃，脉搏80次／分，呼吸17次／分，血压110／70mmHg。神志清楚，慢性肝病面容，皮肤、巩膜轻度黄染，有蜘蛛痣，心肺听诊无异常。腹平软，无明显腹壁静脉曲张，腹部无压痛，肝肋下未触及，脾肋下2cm，质地中等，移动性浊音（±）。

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简介：hepatocellular癌(HCC)的发展被归因于几个因素，包括长期的病毒的感染，白酒消费，到黄麴毒素B1的暴露和新陈代谢的混乱。几份最近的报告证明了HCC能当另外的内在的高风险的肝疾病不在时与长期的Crohns疾病(CD)发生在病人。然而，可以在CD和hepatocarcinogenesis之间有一个协会为这的精确机制要求进一步的调查。

简介：AIM:Toevaluatetherelationshipbetweenthiopu-rineS-methyltransferase(TPMT)polymorphismsandthiopurine-inducedadversedrugreactions(ADRs)ininflammatoryboweldisease(IBD).METHODS:EligiblearticlesthatcomparedthefrequencyofTPMTpolymorphismsamongthiopurine-tolerantand-intolerantadultIBDpatientswereincluded.StatisticalanalysiswasperformedwithReviewManager5.0.Sub-analysis/sensitivityanalysiswasalsoperformed.RESULTS:Ninestudiesthatinvestigatedatotalof1309participantsmetourinclusioncriteria.Theinci-denceofTPMTgenemutationwasincreased2.93-fold(95%CI:1.68-5.09,P=0.0001)and5.93-fold(95%CI:2.96-11.88,P<0.00001),respectively,inIBDpatientswiththiopurine-inducedoverallADRsandbonemarrowtoxicity(BMT),comparedwithcontrols.TheORforTPMTgenemutationinIBDpatientswiththiopurine-inducedhepatotoxicityandpancreatitiswas1.51(95%CI:0.54-4.19,P=0.43)and1.02(95%CI:0.26-3.99,P=0.98)vscontrols,respectively.CONCLUSION:Thismeta-analysissuggeststhattheTPMTpolymorphismsareassociatedwiththiopurine-inducedoverallADRsandBMT,butnotwithhepatotoxicityandpancreatitis.

简介：目的探讨PreS1抗原检测的临床价值。方法采用酶联免疫吸附试验法检测421例慢性乙型肝炎患者血清PreS1抗原和HBV标记物;采用荧光定量PCR法检测HBVDNA。结果在421例慢性乙型肝炎患者中,HBVDNA阳性者367例,其中PreS1Ag阳性者188例（51.2%）,HBeAg阳性者119例（32.4%）,后两者有显著性差异（P〈0.01）;在高HBVDNA载量（105～107copies/ml和〉107copies/ml）组患者中,PreS1Ag阳性率（60.2%,60.0%）显著高于HBVDNA阴性组（33.3%）和低载量（103～105copies/ml）组（41.9%,P〈0.01）;但在421例患者中,PreS1Ag阳性率（48.9%）低于HBVDNA（87.2%,P〈0.01）。结论PreS1Ag能够较HBeAg更好地反映HBV在体内的复制状态,但尚不能代替HBVDNA的检测。

简介：AIMTocharacterizepunctualmutationsin23SrRNAgeneofclarithromycin-resistantHelicobacterpylori(H.pylori)anddeterminetheirassociationwiththerapeuticfailure.METHODSPCRproductsof23SrRNAgeneVdomainof74H.pyloriisolates;34resistanttoclarithromycin(29fromalow-riskgastriccancer(GC)population:Tumaco-Colombia,and5fromahigh-riskpopulation:Tuquerres-Colombia)and40fromasusceptiblepopulation(28fromTumacoand12fromTúquerres)weresequencedusingcapillaryelectrophoresis.TheconcordancebetweenmutationsofVdomain23SrRNAgeneofH.pyloriandtherapeuticfailurewasdeterminedusingtheKappacoefficientandMcNemar’stestwasperformedtodeterminetherelationshipbetweenH.pylorimutationsandclarithromycinresistance.RESULTS23SrRNAgenefromH.pyloriwasamplifiedin56/74isolates,ofwhich25wereresistanttoclarithromycin(20fromTumacoand5fromTúquerres,respectively).In17resistantisolates(13fromTumacoand4fromTúquerres)thefollowingmutationswerefound:A1593T1,A1653G2,C1770T,C1954T1,andG1827CinisolatesfromTumaco,andA2144GfromTúquerres.ThemutationsT2183C,A2144GandC2196TinH.pyloriisolatesresistanttoclarithromycinfromColombiaarereportedforthefirsttime.NoassociationbetweentheH.pylorimutationsandinvitroclarithromycinresistancewasfound.However,therapeuticfailureoferadicationtreatmentwasassociatedwithmutationsof23SrRNAgeneinclarithromycin-resistantH.pylori(κ=0.71).CONCLUSIONThetherapeuticfailureoferadicationtreatmentinthetwopopulationsfromColombiawasassociatedwithmutationsofthe23SrRNAgeneinclarithromycinresistantH.pylori.

简介：AIM:ToassesstheutilityofanautologousCD34+andCD133+stemcellsinfusionasapossibletherapeuticmodalityinpatientswithend-stageliverdiseases.METHODS:Onehundredandfortypatientswithendstageliverdiseaseswererandomizedintotwogroups.Group1,comprising90patients,receivedgranulocytecolonystimulatingfactorforfivedaysfollowedbyautologousCD34+andCD133+stemcellinfusionintheportalvein.Group2,comprising50patients,receivedregularlivertreatmentonlyandserveda...

简介：瞄准：在Crohn的疾病(CD)调查单核白血球的函数病人并且相关这与联系疾病的核苷酸绑定oligomerizationdomain-2(NOD2)基因变体。方法：从47个连续地提交的CD病人和9健康供血者的单核白血球与interleukin(IL)是有教养的-4和granulocyte巨噬细胞刺激殖民地的因素(GM-CSF)，并且与脂肪的多糖(LPS)或muramyldipeptide(MDP)刺激了，NOD2的通常认为的ligand。结果：我们发现从CD病人的单核白血球区分了在试管内到成熟树枝状的房间(DC)，由免疫显型和形态学决定了。NOD2遗传型在所有题目被估计，并且我们观察到在NOD2的不成熟、刺激LPS的DC上的高CD86表示变异CD病人，作为与wtNOD2CD病人和控制相比。由对比，导致到成熟，MDP源于变异NOD2的题目的DC的CD86表示层次比得上正常题目的那些。在耐心房间的文化的IL-12p70的数量与MDP比在在LPS治疗，然而并非术后疗法以后的控制大。结论：我们的结果建议在NOD2基因与变化从病人获得的DC显示高CD86表示描绘的激活的显型，但是当与终端相比区别分阶段执行时，有减少的回答到MDP。我们推测单核白血球的改变的区别可能导致在发炎和单核白血球的杀死的能力之间的不平衡，并且可能与CD的致病相关。

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简介：目的观察小鼠对HBVS基因和基因疫苗的应答。方法用已构建的HBVS基因疫苗(pCR3.1-S)和C基因疫苗(pCR3.1-C)分别给Balb/c小鼠多点肌肉注射,2wk后追加免疫一次,用ELISA法及MTT法检测小鼠血清抗体及脾细胞对HBsAg或HBcAg的特异性增殖反应。结果免疫接种2wk后小鼠血清抗体滴度明显高于对照组,pCR3.1-C组的刺激指数明显高于pCR3.1-S注射组。结论HBVS和C基因疫苗诱导较强的体液和细胞免疫应答强度;C基因尤以细胞免疫增高明显。

简介：目的:探讨分析5S管理对消化科手术室优质护理服务的促进作用。方法:选取2017.03-2018.03在我院进行5S管理的60例消化科手术室工作记录作为研究组,同期未进行5S管理的60例消化科手术室工作记录作为对照组,对比其护理情况。结果:研究组术间、术后物品归位摆放程度,患者衣物及时归还率以及护士综合素质合格率显著高于对照组,手术准备时间显著低于对照组,两组间差异性显著,P<0.05,有统计学意义,对照组患者术后不良反应发生率也低于对照组,P<0.05,有统计学意义。结论:在消化科手术室优质护理服务中采用5S管理可提高护士的自主护理意识,降低消化科患者的不良反应发生率,有利于优质护理服务的顺利进行。

简介：AIMToinvestigatetheroleofthecomplement5a(C5a)/C5areceptor(C5aR)pathwayinthepathogenesisofacuteliverfailure(ALF)inamousemodel.METHODSBALB/cmicewererandomlyassignedtodifferentgroups,andintraperitonealinjectionsoflipopolysaccharide(LPS)/D-galactosamine(D-GalN)(600mg/kgand10μg/kg)wereusedtoinduceALF.TheKaplanMeiermethodwasusedforsurvivalanalysis.Serumalanineaminotransferase(ALT)levels,atdifferenttimepointswithina1-wkperiod,weredetectedwithabiochemistryanalyzer.Pathologicalexaminationoflivertissuewasperformed36hafterALFinduction.Serumcomplement5(C5),C5a,tumornecrosisfactor-α(TNF-α),interleukin(IL)-1β,IL-6,high-mobilitygroupproteinB1(HMGB1)andsphingosine-1-phosphatelevelsweredetectedbyenzyme-linkedimmunosorbantassay.Hepaticmorphologicalchangesat36hafterALFinductionwereassessedbyhematoxylinandeosinstaining.ExpressionofC5aR,sphingosinekinase1(SphK1),p38-MAPKandp-p38-MAPKinlivertissue,peripheralbloodmononuclearcells(PBMCs)andperitonealexudativemacrophages(PEMs)ofmiceorRAW264.7cellswasanalyzedbywesternblotting.C5aRmRNAlevelsweredetectedbyquantitativereal-timePCR.RESULTSActivationofC5andup-regulationofC5aRwereobservedinlivertissueandPBMCsofmicewithALF.BlockadeofC5aRwithaC5aRantagonist(C5aRaC5aRa)significantlyreducedthelevelsofserumALT,inflammatorycytokines(TNF-α,IL-1βandIL-6)andHMGB1,aswellasthelivertissuedamage,butincreasedthesurvivalrates(P<0.01forall).BlockadeofC5aRdecreasedSphK1expressioninbothlivertissueandPBMCssignificantlyat0.5hafterALFinduction.C5aRapretreatmentsignificantlydownregulatedthephosphorylationofp38-MAPKinlivertissuesofALFmiceandC5astimulatedPEMsorRAW264.7cells.Moreover,inhibitionofp38-MAPKactivitywithSB203580reducedSphK1proteinproductionsignificantlyinPEMsafterC5astimulation.CONCLUSIONTheC5a/C5aRpath

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简介：背景：研究表明神经肽S受体1（NPSR1）基因多态性与欧洲人群炎症性肠病（IBD）的遗传易感性相关，但尚无研究探讨两者在中国人群中的相关性。目的：探讨中国汉族人群中NPSR1基因多态性与IBD的关系。方法：收集武汉大学中南医院457例确诊IBD患者[溃疡性结肠炎（UC）组355例，克罗恩病（CD）组102例]和500名健康对照者，以PCR和测序技术分析NPSR1基因rs323922（C→G突变）、rs740347（G→C突变）位点多态性。结果：UC组与对照组间、CD组与对照组间rs323922、rs740347位点的基因型频率和等位基因频率差异均无统计学意义（P〉0.05）。基因型与IBD临床表型的相关性分析显示：①rs323922位点突变型CG基因型与男性CD（OR：0.441，95%CI：0.230~0.844）和结肠型CD（OR：0.425，95%CI：0.199~0.911）相关，为保护因素。②rs740347位点突变型CC基因型与CD早期发病（〈16岁）相关（OR：15.019，95%CI：2.634~86.470），突变型C等位基因与结肠型CD相关（OR：2.142，95%CI：1.709~4.294），两者均为危险因素。结论：NPSR1基因rs323922、rs740347位点多态性与中国汉族人群的IBD遗传易感性无关，但与IBD的某些临床表型有关。