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：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：胃肠道柿石较为多见,现报道5例我院经手术证实的胃肠道柿石病例.例1:女性患儿,5岁,因频繁呕吐、上腹部疼痛急诊入院.查体:精神不振,全身无力,心肺无异常,腹平软,右上腹可触及一3.5cm×3cm大小的包块,形状不规则,质较硬,无压痛,活动良好.询问病史,患者在1个月前曾相继进食柿子及黑枣各2市斤左右.诊断为肠道柿石致不完全性肠梗阻.保守治疗1周后病情未能缓解,手术探查发现距屈氏韧带6cm空肠段有一柿石嵌于肠道,肠壁菲薄,上下移动困难,遂切开肠壁取石.术后7天患儿痊愈出院.例2:男,51岁,上腹隐痛不适2年,近半年加重,常有嗳气、反酸,食欲下降,明显消瘦.入院前10天患者触及上腹有一包块而来院就诊,自诉半年前常进食柿子.查体:上腹可触及一球形鸭蛋大肿物,质硬,光滑,可移动,无压痛.胃肠造影示胃内充盈缺损,肿物可移动.诊断为胃内柿石.剖腹取出1枚柿石.术后随访3年,患者情况良好.另3例患者均为儿童,年龄分别为11岁、7岁和3岁.5例患者中,胃内柿石2例,肠道柿石3例.最大柿石如鸭蛋大,重82克,位于成人胃内.肠道柿石最大如鸡蛋,重53克,位于5岁小儿肠腔内.从进食柿子到就诊时间最长为半年,儿童为0.5～2个月.讨论:胃内柿石的初始表现为上腹不适、嗳气,可闻到酸臭味,以后渐出现上腹无规律性疼痛伴呕吐.本组3例肠道柿石均以肠梗阻而来院就诊,表现为呕吐、腹痛伴水、电解质紊乱.查体均触及腹部包块,质硬,形状不规则,有较大范围的活动度,无触痛.2例胃内柿石患者服稀钡造影可见胃内充盈缺损,团块游离可动,可排除肿瘤.柿子含有收敛性红鞣质,与胃酸接触后易凝结成块而积于胃内,因此在胃内较为多见,肠道柿石为胃内柿石碎块排入肠道,与食物残渣聚积而成,患者多因肠梗阻而就诊.所以,如遇腹部活动性包块,应考虑到胃肠道柿石的可能,仔细询问�

简介：近年来,有关肝炎并发血液病的报道日益增多,为探讨病毒性肝炎与血液病的关系,现将我院1999年1月～2000年11月住院病人中5例肝炎合并血液病的典型病例报告如下.

简介：

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：背景：肠易激综合衙（IBS）是一种功能性胃肠道疾病，其病因和发病机制迄今尚未完全阐明。目的：探讨5-羟色胺（5-HT）和5-HT3受体（5-HT3R）在腹泻型IBS（D—IBS）患者结肠黏膜中的变化及其临床意义。方法：对18名正常人和28例D—IBS患者行结肠镜检查并分别取升结肠、横结肠、降结肠和乙状结肠黏膜标本各两块。以免疫组化方法检测5-HT阳性细胞；以蛋白质印迹分析半定量检测5-HT3R的表达。结果：D—IBS组4个部位结肠黏膜的5-HT阳性细胞数和5-HT3R的表达均较正常对照组显著增多（P〈0．05），但4个部位之间相互比较均无显著差异。结论：D—IBS患者结肠黏膜5-HT合成和分泌增多，5-HT3R表达上调，提示5-HT和5-HT3R可能为D—IBS的分子生物学基础之一，为D—IBS的治疗提供了分子靶点。

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

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:Toobservethereversaleffectsofwide-typep53geneonmulti-drugresistanceto5-FU(LOVO/5-FU).METHODS:AftertreatmentwithAd-p53,LOVO/5-FUsensitivityto5-Fuwasinvestigatedusingtetrazoliumdyeassay.Multidrugresistancegene-1(MDR1)geneexpressionwasassayedbysemi-quantitativereversetranscriptionpolymerasechainreactionandtheexpressionofp53proteinwasexaminedbyWesternblotting.RESULTS:Thereversalactivityaftertreatmentwithwidetypep53genewasincreasedupto4.982foldat48h.TheexpressionofMDR1genedecreasedsignificantlyaftertreatmentwithwide-typep53gene,andtheexpressionofp53proteinlastedforabout5d,withapeakat48h,andbegantodecreaseat72h.CONCLUSION:Wide-typep53genehasaremarkablereversalactivityforthehighexpressionofMDR1geneincolorectalcancers.Thereversaleffectsseemtobeinatimedependentmanner.Itmighthavegoodprospectsinclinicalapplication.

简介：AIM:Toinvestigatethemutationsofthe5'noncodingregionofBCL-6geneinChinesepatientswithprimarygastriclymphomas.METHODS:PCRanddirectDNAsequencingwereusedtoidentifyBCL-6genemutationsinthe5'noncodingregionin29casesofgastricdiffuselargeB-celllymphoma(DLBCL)and18casesofgastricmucosa-associatedlymphoidtissue(MALT)lymphomaaswellas10casesofreactivehyperplasiaoflymphnode(LRH).RESULTS:Sixof29gastricDLBCLs(20.7%),4of18gastricMALTlymphomas(22.2%)and1of10LRHs(10%)werefoundtohavemutations.Allmutationsweresingle-basesubstitutionsandthefrequencyofsingle-basechangeswas0.20x10-2-1.02x10-2perbp.CONCLUSION:Pointmutationsinthe5'noncodingregionofBCL-6genearefoundinChinesepatientswithprimarygastricDLBCLsandMALTlymphomas,suggestingthattheymay,insomeextent,participateinthepathogenesisofprimarygastricDLBCLsandMALTlymphomas.

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。

简介：目的了解干扰素治疗HBeAg阴性慢性乙型肝炎远期疗效.方法对20例HBeAg阴性慢性乙型肝炎患者采用干扰素抗病毒治疗,并定期随访HBV标志物、HBVDNA和肝功能.结果疗程结束时HBeAg阴性慢性乙型肝炎的完全应答率为0%,部分反应率为40%;随访结束时,持续应答率为35%.结论干扰素治疗HBeAg阴性慢性乙型肝炎疗效显著.