The indications for biopsy in routine upper gastrointestinal endoscopy

This review describes the indications and contraindications for endoscopic biopsy, in routine practice, of the upper gastrointestinal (GI) tract. We accept that this review provides grounds for controversy, as our stance in certain situations is counter to some national guidelines. Nevertheless, we provide evidence to support our viewpoints, especially on efficiency and economic grounds. We describe the particular controversies concerning the biopsy assessment of Barrett's oesophagus, chronic gastritis and the duodenum in the investigation of coeliac disease. We accept that there are indications for more extensive upper GI biopsy protocols in children than in adults; the latter constitute our main focus in this article. We would encourage detailed discussion between pathologists and their endoscopy colleagues about the indications, or lack of them, for routine upper GI endoscopic biopsy, as studies have shown that adherence to agreed guidelines has resulted in a very considerable diminution in the biopsy workload without compromising patient management. Furthermore, where biopsy is indicated, we emphasise the importance of accompanying clinical information provided to the pathologist, in particular regarding biopsy site(s), and regular feedback to endoscopists to improve and maintain the quality of such information. Finally, local dialogue is also advised, when necessary, to indicate to endoscopists the need to appropriately segregate biopsies into separate, individually labelled specimens, to maximise the information that can be derived by pathological evaluation and thereby improve the quality of the final pathology report.     

中西医结合对小儿厌食症患者血清β-EP、Leptin水平的影响

目的:观察中西医结合治疗小儿厌食症脾胃气虚证的临床疗效及其对患者血清中β-内啡肽(β-endorphin,β-EP)和瘦素(Leptin)水平的影响。方法:将96例厌食症患儿随机分为治疗组和对照组,每组各48例。对照组口服多酶片,治疗组在对照组基础上加服健脾消食汤。观察两组患儿的临床疗效,比较两组患儿治疗前后体质量、体质量指数(BMI)及中医症状评分变化情况。检测两组患儿血清中β-EP和Leptin水平。结果:对照组有效率为83.33%,治疗组有效率为97.92%,两组患儿临床疗效比较,差异具有统计学意义(P0.05)。两组患儿治疗后体质量和BMI显著高于治疗前,且治疗组高于对照组,差异具有统计学意义(P0.05)。两组患儿治疗后中医症状评分明显低于治疗前,且治疗组低于对照组,差异具有统计学意义(P0.05)。两组患儿治疗后血清中β-EP水平显著高于治疗前,Leptin水平明显低于治疗前,且治疗组改善程度优于对照组,差异均有统计学意义(P0.05)。结论:中西医结合治疗小儿厌食症脾胃气虚证疗效明显,可明显改善患者的临床症状,可降低血清中β-EP及Leptin水平。     

Epstein–Barr virus positivity among surgically resected intramucosal gastric cancer

Epstein–Barr virus‐associated gastric cancer (EBV‐GC) accounts for approximately 8% of gastric cancers. However, little is known regarding intramucosal EBV‐GC. The present study aimed to evaluate endoscopic and clinicopathological characteristics of intramucosal EBV‐GC. Pathological data of 172 patients with 173 intramucosal gastric cancers who received gastrectomy with lymph node dissection were obtained for review. EBV‐encoded small RNA in situ hybridization (EBER‐ISH) was carried out using a tissue microarray block. Eight intramucosal early gastric cancers (4.6%) were EBER‐ISH positive in which no cases had any lymph node metastasis. Macroscopic types were either depressed or flat, dominant histology was mixed type of moderate and poorly differentiated adenocarcinoma. In detail, histological features of “lace pattern” or “lymphocyte infiltration into the stroma or cancer nests” were observed.     

P53蛋白在胃癌与肠上皮化生中的表达和意义

目的:检测肠上皮化生的胃黏膜组织和胃癌组织中P53蛋白的表达,探讨其变化规律及意义。方法:选择收集送检胃癌的新鲜标本29例,取癌组织及癌旁4~5个点的组织,采取苏木素-伊红染色、黏液组织化学染色筛选肠上皮化生16例,应用免疫组织化学染色对胃癌组织和肠上皮化生黏膜的P53蛋白的表达进行研究。结果:肠上皮化生和胃癌组织中均有不同程度的P53蛋白表达,但与正常胃黏膜比较,P53蛋白表达由强到弱依次为:不完全性大肠型肠化→不完全性小肠型肠化→癌旁正常黏膜。结论:P53蛋白的表达不仅与肠上皮化生的类型有关,而且与胃上皮的异型增生程度密切相关。     

右侧30°半卧位在胶囊内镜检查 中的作用研究

目的 探讨实时监视下右侧30°半卧位在胶囊内镜检查过程中的应用价值。方法 将80例行胶囊内镜检查的受检者按就诊顺序随机分为观察组和对照组，观察组40例，对照组40例。观察组取右侧30°半卧位，对照组取右侧卧位，两组患者吞入胶囊内镜后由内镜医师通过影像工作站实时监控系统判断胶囊所在位置，待胶囊通过幽门后患者可自由活动，对比分析两组受检者胶囊内镜的胃转运时间、小肠转运时间以及全小肠检查完成率的差异。结果 观察组平均胃转运时间为（54.78±28.75）min，明显短于对照组（77.70±42.04）min（U=566.500，P =0.024）；平均小肠转运时间为（254.85±103.57）min，与对照组（246.26±105.48）min比较差异无显著性（t =0.360，P =0.720）；全小肠检查完成率为75.0%（30/40），明显高于对照组的47.5%（19/40）（χ2=4.381，P =0.036）。结论 实时监视下右侧30°半卧位在胶囊内镜检查中具有较好的临床应用价值。     

王翠霞教授运用补中益气汤加减治疗缺乳经验

缺乳是指产后哺乳期内,产妇乳汁甚少或无乳可下者,称"缺乳"又称"产后乳汁不行,吾师认为导致缺乳的主要病因是由气血虚弱、肝郁气滞所致,根据产后多虚多瘀的特点产虚则宜补,塞则宜通,故导师运用补中益气汤加减治疗缺乳,临床上取得了显著的效果。     

五步小儿推拿治疗小儿厌食症脾胃虚弱型64例临床观察

目的观察五步小儿推拿治疗小儿厌食症脾胃虚弱型的临床疗效。方法选取2018年4月至2019年6月温州市中西医结合医院推拿科门诊收治的127例厌食症患儿,采用随机数字表法分为治疗组64例和对照组63例,2组均予基础性护理和葡萄糖酸锌口服液口服,对照组在基础治疗和护理的基础上予常规小儿推拿治疗,治疗组予五步小儿推拿治疗。治疗8周后观察2组的中医证候积分、临床疗效以及血锌和血红蛋白(Hb)水平的变化情况。结果治疗前2组主要证候积分和次要证候积分比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组主要证候积分和次要证候积分均显著改善,与同组治疗前比较,差异均有统计学意义(P<0.01),且治疗组改善更显著(P<0.05)。对照组痊愈率为1.59%(1/63),治疗组为10.94%(7/64),2组比较,差异有统计学意义(P<0.05)。治疗前2组血锌和Hb水平比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组血锌和Hb水平均显著升高,与同组治疗前比较,差异有统计学意义(P<0.01),且治疗组升高更显著(P<0.05)。结论五步小儿推拿治疗小儿厌食症脾胃虚弱型,能明显改善患儿的临床症状、体征,升高血锌和Hb水平,疗效显著,且操作方便、患儿易于接受,值得临床推广应用。     

附子理中丸汤剂临床新用

附子理中丸系由《伤寒论》中的理中丸加附子而成,具有温中健脾作用。用于脾胃虚寒、脘腹冷痛,呕吐泻泄,手足不温。本着中医"异病同治"的理念,临床运用附子理中汤加减治疗心下痞、消渴、胸痹伴下肢水肿(慢性心衰)、复发性口腔溃疡伴慢性腹泻、便秘等疾病均取得满意效果,值得临床推广。此文章从上述疾病的病因病机、理法方药等方面进行分析阐述其作用机制。