连续性血液净化治疗对SIRS、MODS患者免疫功能的影响

目的观察连续性血液净化技术（CBP）对全身性炎症反应综合征（SIRS）、多器官功能障碍综合征（MODS）患者免疫功能状态的影响.方法选择SIRS、MODS患者采用CBP治疗.ELISA法测定患者在治疗0、2、6、12、24、48、72h细胞因子TNF-α、IL-6、IL-10,同时进行APACHEⅡ评分计算,观察CBP对SIRS、MODS患者炎性因子的影响及与APACHEⅡ评分的相关性.结果 SIRS/MODS患者在行CBP治疗后,TNF-α、IL-6、IL-10水平及APACHEⅡ评分均有不同程度下降,但SIRS组下降更明显.TNF-α、IL-6、IL-10水平与APACHEⅡ评分均存在相关性,其中IL-10的相关性尤其显著.结论 CBP治疗可使SIRS、MODS患者炎性反应不同程度的恢复,同时改善临床状况及预后.动态检测TNF-α、IL-6、IL-10水平变化,对评估危重症患者的病情、指导治疗有重要意义.     

连续性血液净化治疗重症胰腺炎30例疗效观察

[目的]探讨应用连续性床旁血液净化(CBP)治疗重症急性胰腺炎(SAP)的临床效果。[方法]将60例SAP患者随机分为对照组和治疗组(各30例),2组分别采用常规疗法和常规疗法+CBP治疗,记录患者治疗前后APACHEⅡ评分以及实验室检查指标变化情况。[结果]治疗组和对照组患者APACHEⅡ评分以及治疗前后实验室检查指标变化情况均有好转;CBP治疗后,血清淀粉酶(AMS)、血清总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、肌酐(Cr)、C反应蛋白(CRP)、血白细胞计数(WBC)均明显改善,与CBP治疗前比较,差异有统计学意义(P0.05),且治疗后治疗组上述指标改善程度明显好于对照组(P0.01)。[结论]在综合治疗的基础上加用CBP治疗SAP,明显改善脏器功能,降低病死率,疗效确切。     

生长抑素联合连续性血液净化对急性重症胰腺炎患者炎症及并发症的影响

[目的]探讨连续性血液净化(CBP)联合生长抑素强化治疗对急性重症胰腺炎(SAP)患者炎症及并发症的影响。[方法]选取2016年4月～2018年4月我院SAP患者120例,依据随机数字表分为强化组和常规组,每组60例,常规组给予CBP联合常规生长抑素治疗,强化组给予CBP联合生长抑素强化治疗,比较2组炎症[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、IL-7]、病情指标[血和尿淀粉酶(AMS)、急性生理和慢性健康状况评分系统得分(APACHEⅡ)]、临床症状(腹痛、腹胀、恶心呕吐、腹膜刺激征)缓解时间、并发症。[结果]强化组和常规组治疗后TNF-α、IL-6、IL-7、血和尿AMS、APACHEⅡ评分明显低于治疗前,强化组治疗后TNF-α、IL-6、IL-7、血和尿AMS、APACHEⅡ评分明显低于常规组,差异有统计学意义(P0.05);强化组腹痛、腹胀、恶心呕吐、腹膜刺激征缓解时间明显低于常规组,差异有统计学意义(P0.05);强化组并发症率明显低于常规组,差异有统计学意义(P0.05)。[结论]CBP联合生长抑素强化治疗可有效改善SAP患者的炎症、病情及临床症状,有利于减少患者并发症,值得临床推广。     

连续性血液净化治疗严重脓毒症患者的疗效及对细胞因子的影响

目的观察连续性血液净化(CBP)治疗严重脓毒症患者的疗效及对细胞因子的影响。方法回顾性分析60例严重脓毒症并接受CBP患者的临床资料,将其分为常规治疗组与CBP治疗组各30例。观察并记录两组0、24、72 h血清中肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1β、IL-6水平;此外比较两组治疗24 h的急性生理和慢性健康状态评分(APACHE)Ⅱ评分、两组需行机械通气时间。结果 1在入院后经CBP治疗24、72 h患者血清中的TNF-α、IL-1β、IL-6浓度明显下降(P<0.05)。CBP治疗组24、72 h患者血液中的TNF-α、IL-1β、IL-6浓度明显低于常规治疗组(P<0.05)。2治疗24 h两组APACHEⅡ评分明显降低,CBP治疗组明显低于常规治疗组(P<0.05)。3两组需行机械通气时间差异显著(P<0.01)。结论及早行CBP治疗可以有效清除血液中的细胞因子,缩短机械通气时间,改善疾病,提高患者预后。     

连续性血液净化联合参麦注射液治疗多器官功能障碍综合征效果观察

目的观察连续性血液净化(CBP)联合参麦注射液治疗多器官功能障碍综合征(MODS)的临床效果。方法将30例MODS患者随机分为观察组和对照组各15例,两组均进行CBP,观察组另予静脉滴注参麦注射液,疗程均为7 d。观察两组治疗前后APACHEⅡ评分及外周血T淋巴细胞亚群、免疫球蛋白、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、单核细胞数量及人类白细胞抗原-DR位点(HLA-DR)。结果两组治疗后APACHEⅡ评分均低于治疗前(P均<0.05),CD+3、CD+4、CD+4/CD+8T淋巴细胞及Ig A、Ig G、Ig M、单核细胞计数、单核细胞HLA-DR均高于治疗前(P均<0.05)。两组治疗后CD+8T淋巴细胞及CRP、SAA均低于治疗前(P均<0.05),观察组较对照组降低更明显(P均<0.05)。结论 CBP联合参麦注射液可有效改善MODS患者的免疫功能及炎症状态,并且其改善程度优于单纯CBP。     

早期肠道水疗在重症急性胰腺炎治疗中的临床应用价值

[目的]探讨早期肠道水疗对重症急性胰腺炎(SAP)患者的临床应用价值。[方法]随机将54例SAP患者分为常规治疗组、肠道水疗组,比较2组患者不同时间的APACHEⅡ评分、CT严重指数(CTSI)、尿乳果糖/甘露醇(L/M)比值、血浆内毒素和二胺氧化酶(DAO)、血清C反应蛋白(CRP)和肿瘤坏死因-α(TNF-α)。[结果]治疗后第7天,肠道水疗组APACHEⅡ评分、尿L/M比值、血浆内毒素和DAO、血清CRP和TNF-α均较常规治疗组显著降低,差异有统计学意义(P0.05)。入院1周内,2组患者CTSI比较,差异无统计学意义(P0.05);肠道水疗组患者胰腺感染和MODS发生率明显低于常规治疗组,差异有统计学意义(P0.05)。[结论]早期应用肠道水疗能明显减轻SAP患者的全身炎症反应,保护肠道黏膜屏障,从而改善其预后。     

炎症因子水平对阻塞性睡眠呼吸暂停综合征合并肺部感染患者临床预后结局的影响

目的 研究炎症因子对阻塞性睡眠呼吸暂停综合征(OSAS)合并肺部感染患者预后的影响,为诊断和评估此疾病提供新思路。方法 选取2020年1月～2023年3月间在徐州医科大学附属医院符合入排标准的OSAS合并肺部感染患者165例作为研究对象,根据随访28d患者是否再入院或死亡分为预后不良组23例和预后良好组142例。比较两组患者相关临床资料,通过Spearman检验探究炎症因子C-反应蛋白(CRP)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1β、IL-6和IL-10与患者AHI、CPIS和APACHEⅡ评分的相关性;通过Logistic多因素回归分析,探究炎症因子与OSAS合并肺部感染患者预后的关系;通过ROC曲线评价炎症因子对OSAS合并肺部感染患者预后的预测效能。结果 预后不良组患者慢性支气管炎病史比例、AHI、CPIS、APACHEⅡ、CRP、IL-1β、IL-6和TNF-α水平显著高于预后良好组患者,而预后不良组患者氧合指数和IL-10水平显著低于预后良好组患者,差异存在统计学意义(P<0.05);OSAS合并肺部感染患者CRP、IL-1β、IL-6和TNF-α与AH...     

持续血液净化治疗AIDS病人中播散型青霉病致多脏器功能障碍综合征研究

目的研究艾滋病病人中青霉病合并多脏器功能障碍综合征(MODS),应用持续性血液净化(CBP)治疗的效果。方法选择南宁市第四人民医院青霉病致MODS 58例,分为CBP组(13例)和一般治疗组(45例)。CBP组每次治疗12-24小时,同时观察两组病人治疗前后急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、尿素氮(BUN)、血肌酐(Scr)、白细胞(WBC)、C反应蛋白(CRP)、血红蛋白(Hb)、血小板(PLt)等指标的变化。结果治疗后CBP组BUN、Scr、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、WBC、CRP、APACHEⅡ评分较一般治疗组改善明显(P0.01);但两组Hb、PLt与治疗前比较差异无统计学意义(P0.05)。一般治疗组中15例(33.3%)死亡,CBP组中5例(38.46%)死亡,死亡病人一般治疗组存活时间(3.8±0.68)天,CBP组存活时间(4.2±1.02)天,两组的存活时间比较,差异无统计学意义(P0.05)。结论 CBP是治疗艾滋病合并青霉病致多器官功能衰竭病人的一种有效手段,能有效阻断MODS进程,清除代谢产物,改善病人脏器功能,调节内环境的紊乱。     

连续性血液净化治疗对重症肺炎患者血清降钙素原水平的影响

目的动态监测连续性血液净化治疗(CBP)在治疗重症肺炎时血清降钙素原(PCT)水平的变化规律,探讨血清PCT水平与重症肺炎病情严重程度的关系及CBP对重症肺炎患者的临床疗效。方法回顾性分析重症肺炎患者共30例,分为常规治疗组(抗感染及呼吸机辅助通气等治疗)12例和CBP治疗组(在常规治疗基础上给予CBP)18例。比较2组死亡率,同时分析比较2组治疗前及治疗后24 h、48 h、72 h各时间点急性生理与慢性健康评分(APACHEⅡ评分)及血清PCT的变化。结果常规治疗组死亡5例,CBP治疗组死亡2例;与治疗前比较,常规治疗组经治疗后各时间点患者APACHEⅡ评分及血清PCT水平变化不明显(P0.05),而CBP治疗组治疗72 h后,患者APACHEⅡ评分及血清PCT水平均显著降低(P0.01)。结论 CBP能降低重症肺炎患者早期血清PCT水平,降低重症肺炎的炎症反应,改善临床转归,是临床治疗重症肺炎患者的有效手段,具有重要临床应用价值。     

CPAP治疗对OSAHS及其合并高血压患者CRP和IL-6的影响

目的观察持续气道正压通气(CPAP)治疗对阻塞型睡眠呼吸暂停低通气综合征(OSAHS)及其合并高血压患者血清C-反应蛋白(CRP)和白细胞介素-6(IL-6)的影响。方法选择39例中、重度OSAHS患者和20例对照者进行血清CRP和IL-6水平的检测;对39例OSAHS患者进行CPAP治疗并检测治疗前后血清CRP和IL-6水平。比较OSAHS及合并高血压患者血清CRP和IL-6水平与对照者有无差别以及CPAP治疗后对OSAHS及合并高血压患者血清CRP和IL-6水平有无影响。结果单纯OSAHS组及OSAHS合并高血压组的血清CRP及IL-6水平均高于对照组(P0.05),OSAHS合并高血压组血清CRP及IL-6高于单纯OSAHS组(P0.05),OSAHS患者的血清CRP及IL-6水平分别与睡眠呼吸暂停低通气指数(AHI)呈正相关(r1=0.6 8 3、r2=0.6 0 7,P0.0 1)。经CPAP治疗后单纯OSAHS组及OSAHS合并高血压组血清CRP及IL-6水平较治疗前明显降低(P0.05)。结论 OSAHS患者血清CRP和IL-6增高,存在炎症反应,CPAP治疗能降低患者血清CRP和IL-6的水平,减轻OSAHS患者机体的炎症反应。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.     

Intake of energy drinks in association with alcoholic beverages in a cohort of students of the School of Medicine of the University of Messina

BACKGROUND: Energy drinks (ED) are a widely used group of beverages known for their stimulant effects on central nervous system (CNS). The main components of ED are caffeine, taurine, carbohydrates, glucuronolactone, inositol, niacin, pantenol, and beta-complex vitamins. The studies evaluating the effects of ED describe improvements in attention and/or reaction times and indices of alertness. It has been also shown that combination of caffeine and glucose, fundamental constituents of ED, can ameliorate deficits in cognitive performance and subjective fatigue during extended periods of cognitive demand. Moreover, the associated ingestion of alcohol and ED has recently been observed to be becoming more and more widespread. METHODS: With the aim to know the habits and uses of students, we administered a questionnaire containing questions regarding ED drinking alone or in association with alcoholic beverages. Five hundred students of the School of Medicine of the University of Messina were interviewed, and 450 filled the questionnaire. RESULTS: A total of 56.9% of students declared using ED. A great part of users (48.4%) associate frequently ED and alcohol. In particular, 35.8% of ED + alcohol users have used ED + alcohol more than 3 times in the last month. Distinguishing the users into 2 groups (users of ED + alcohol and users of both ED and ED + alcohol), we observed in the second group a major use of cocktail containing a mix of ED and alcoholic beverages. This difference between the 2 groups is less represented about the ingestion of ED + alcohol in the night. CONCLUSIONS: Our data indicate that association of ED + alcohol is very popular among students. This behavior can be dangerous. In fact, the combination of ED + alcoholic drinks can reduce adversive symptoms of alcohol intoxication including the depressant effects. As consequence, users of ED + alcoholic beverages might not feel the signs of alcohol intoxication, thus increasing the probability of accidents and/or favoring the possibility of development of alcohol dependence.