食管异物是常见的临床急症,如不及时诊断或治疗方式不正确可引起食管穿孔甚至死亡. 2019年4月我们收治1例食管及胃多发异物,报道如下. 1 临床资料 女,35岁,2019年4月30日以"自吞美工刀片等异物后吞咽困难伴吞咽痛4h"为主诉急诊就诊.患者自吞美工刀片、金属针前大量饮酒,出现吞咽困难、吞咽痛及恶心,伴咽部异物感,无胸闷、胸痛、大汗及呼吸困难,无呕血及便血. 既往有长期饮酒史,否认肝炎、结核等传染病史,否认吸毒、冶游史、精神疾病史. 查体:患者呈醉酒躁动状态,生命体征平稳,体温36.8 ℃,脉搏86次/min,血压120/80 mm Hg,咽部检查不配合,胸骨上窝压痛( +) ,颈胸部皮肤视诊如常,触诊无捻发音. 胸腹部CT示食管内T2 ～T4 水平(图1A)、胃内(图1B)可见不规则高密度影,诊断为食管及胃内异物.

Objective To explore the clinical value of matrix metalloproteinase(MMPs)antibody chip in the diagnosis of gastric cancer(GC). Methods Serum samples from 12 patients with gastric cancer (GC)and 10 patients with non?neoplastic gastric disease(NGD)diagnosed in our hospital from November 2016 to March 2017 were collected to form a training set. Human MMP arrays were used to quantitative measurement of 7 major secretory MMPs and 3 tissue inhibitors of metalloproteinases (TIMPs) simultaneously in the above patients. Their concentration differences between GC and NGD groups and their diagnostic efficacy for GC were compared. The MMP subtypes with the greatest concentration difference between the two groups were screened for further study. Serum samples from 40 patients with GC and 38 patients with NGD diagnosed in our hospital from April 2017 to July 2017 were collected to form a validation set. The concentration of TIMP?4 in serum of these patients was detected by suspension microbead chip. Then the levels of TIMP?4 was compared between the GC and NGD groups and its diagnostic value was assessed by ROC curve. Results The MMP subtypes with high expression(>10 000 pg/ml)in the training set included:MMP?1,MMP?3,MMP?9 and TIMP?1;medium expression(1 000?10 000 pg/ml):MMP?8,TIMP?2 and TIMP?4;low expression(<1 000 pg/ml):MMP?2,MMP?10 and MMP?13. Compared with the NGD group, except MMP?2,MMP?3 and MMP?13,other MMPs showed an upward trend in the GC group,but no significant difference. Only TIMP?4 increased significantly in the GC group than NGD group(P<0.05). The area under the curve(AUC)of the MMP family members for the diagnosis of GC ranged from 0.500 to 0.858,and their combined AUC was 0.925(95%CI :0.782?1.000). Particularly,TIMP?4,whose AUC was the highest,was 0.858 (95%CI :0.692?1.000). At the optimal cut?off value of 2 438.3 pg/ml,its sensitivity,specificity and Yoden index for the diagnosis of GC were 83.3%,80% and 0.633,respectively. In the validation set,the concentrations of TIMP?4 in the GC and NGD groups were(1 148.0±691.5)pg/ml and (834.3 ± 397.2) pg/ml, respectively (P<0.05). Its AUC was 0.628 (95%CI : 0.498?0.758). Conclusions The detection of serum MMP expression profile is expected to be a new method for assistant diagnosis and screening of GC. TIMP?4 has certain reference value for the diagnosis of GC,but its diagnostic ability needs further verification.

临床实习阶段是将理论与实践结合的重要桥梁课程,是提高医学生临床思维的有效方法.将PDCA循环管理程序联合CBL教学法运用于消化科临床实习教学中,包括教学计划 、实施 、检查和改进,通过循环不断发现新问题 、修订计划 、实施,不断规范教学行为,提高教师教学水平,从而提高教学质量.

这些人易患脂肪肝 由于地区差异,成人中大约10％ ～20％人群有脂肪肝.肥胖人群(腹型肥胖)最多见. ●应酬多的公关人员. ●突击减肥后的年轻人. ●素食主义者. ●孕妇、哺乳期妇女等等. ●营养过剩和营养不良、饮酒、药物等都会引起肝细胞脂肪变性,发生脂肪肝.

Background: Early diagnosis of gastric cancer (GC) is crucial for improving patients' outcome, but reliable biomarkers are scarce. This study measured gastric juice pH value, aromatic amino acid (AAA), and total protein concentrations to build a model using these parameters to diagnose GC. Method: We performed a case-control study by comparing the different levels of gastric juice parameters between GC and non-neoplastic gastric disease (NGD) patients. Gastric juice was collected from 200 consecutive patients who underwent gastroscopy at our institution. A total of 120 samples were divided into the derivation subgroup, and others into the validation subgroup by simple random sampling. The demographic and clinicopathological data were also assimilated. Results: Significantly higher levels of male to female ratio, pH value, and AAA content in gastric juice were observed in GC patients than in NGD individuals in the derivation subgroup (all P<0.001). By performing logistic regression analysis with these parameters, we developed a predicting model, defined as gastric juice index (GJI). For the detection of GC, the AUC of GJI was 0.897 (95% CI, 0.838-0.956) in the derivation subgroup and 0.805 (95% CI, 0.704-0.906) in the validation subgroup. Importantly, for the detection of early GC, its AUC was 0.848 (95% CI, 0.771-0.924). At the optimal cutoff value (8.995), its sensitivity, specificity, and accuracy were 75.0%, 78.9%, and 78.2%, respectively. Conclusion: The GJI model established with the above parameters is effective in predicting the existence of GC, and may be used as a diagnostic tool for early GC.

Objective To clarify the necessity of further examination in patients with grade Los Angeles classification (LA)-A reflux esophagitis diagnosed under endoscopy by evaluating the clinical and pathological characteristics.Methods From September 1st,2011 to December 1st,2012,patients with reflux esophagitis (LA-A,LA B and LA-C) diagnosed under endoscopy were enrolled.All patients underwent gastroesophageal reflux disease questionnaire (GerdQ) score,endoscopy examination,tissue pathological examination,24-hour esophageal pH monitoring and proton pump inhibitor (PPI) test.According to the results of 24-hour esophageal pH monitoring,the patients were regrouped.Group 1 was grade LA-A,the results of 24-hour esophageal pH monitoring indicating DeMeester score ＜14.7 and symptom index ＜50％;group 2 was grade LA-A,the results of 24-hour esophageal pH monitoring indicating DeMeester score ≥ 14.7 and symptom index≥ 50％;group 3 was grade LA-B and LA-C.Pathological examinations included proportion of basal cell layer in the epithelium layer,the proportion of elongation papillae in the cpitbelium layer,inflammatory cell number,congestion and bleeding of the papillae,vascular dilation in the papillae and dilated intercellular spaces (DIS) value.Mann-Whitney test or chi square test was performed for statistical analysis.Results A total of 155 patients with reflux esophagitis were enrolled,among which 94 cases were LA-A,49 were LA-B,and 12 were LA-C.There was no significant difference in the age,gender,body mass index (BMI),proportion of GerdQ score ≥8,proportion of symptom index≥50％ and percentage of positive PPI test in LA-A group compared with LAB group and LA-C group (all P＞0.05).The median DcMeester score of grade LA-A group was 22.1,which was lower than that of grade LA-B group (32.1) and LA-C group (53.9),and the differences were statisticallysignificant (Z =4.273,P=0.039;Z=7.210,P =0.007).Among 155 patients,thcprimary symptoms of 87 cases (56.1 ％) were hcartburn and regurgitation;the secondary symptoms of 88 cases (56.8％) were heartburn and regurgitation.Between group 1 and group 2,there was no significant difference in the DIS,inflammatory cell number,proportion of basal cell layer in the epithelium layer and the proportion of elongation papillae in the epithelium layer (all P＞ 0.05).The DIS value and the proportion of elongation papillac in the epithelium layer of group 3 were (1.229 9±0.393 0) μm and 59.1％,which were higher than those of group 1 ((0.973 9±0.317 3) μm and 52.1％),and the differences were statistically significant (t=-3.156,P=0.002;Z =-2.051,P=0.040).However,there was no statistically difference in inflammatory cells number and proportion of basal cell layer in the epithelium layer between two groups (both P＞0.05).There was no statistically significant difference in the incident rates of papillae congestion and vascular dilation in the papillae among group 1,group 2 and group 3 (all P＞0.05).The incidence of bleeding in the papillae of group 1 was 27.6％ (8/29),which was lower than that of group 2 (49.2％,32/65) and group3 (50.8％,31/61).Andthcdifferenccswere statistically significant (x2=4.843,P=0.024;x2 =4.605,P=0.032).Conclusion Patients can be diagnosed as grade LA-A reflux csophagitis according to symptoms and the results of endoscopic examination,dispensing with further 24 hour esophageal pH monitoring and pathological examination.

Objective To investigate the potential factors that may be associated with clinical significant endoscopy findings (CSEF) and the characters of the appropriate patients for upper endoscopy.Methods Information of the out-patients was collected from the questionnaires that were performed before undergoing upper endoscopy from 26 September 2011 to 23 December 2011,including demographics characteristics,symptoms,gastroesophageal reflux disease questionnaire (Gerd Q) score,comorbidities,medication and purpose for upper endoscopy.The analyses were performed by Logistic regression to find the potential factors that were associated with CSEF.Results A total of 942 cases were enrolled.There were 471 (50.0％) patients with dyspepsia and reflux symptoms,300(31.8％)patients with dyspepsia and without reflux symptoms,and 86(9.1％)patients with reflux symptoms and without dyspepsia.Sum to 325 (34.5％) patients were diagnosed with CSEF,119(12.6％) with erosive esophagitis,28(3.0％) with Barrett esophagus,102 (10.8％)with peptic ulcers,66 (7.0％) with gastric dysplasia,and 13 (1.4％) with upper malignancy.Multivariate Logistic regression analysis showed that men (OR=1.677,95％CI:1.148 to 2.451),older age (OR=1.032,95％CI:1.021 to 1.044),alcohol intake (OR=1.761,95％CI:1.068 to 2.903),Gerd-Q score increase (OR=1.079,95％ CI:1.003 to 1.160),and presence of acid regurgitation (OR=1.659,95 ％CI:1.143 to 2.408) were significantly associated with increasing risk of diagnosis for CSEF,while taking proton pump inhibitors (OR=0.298,95％CI 0.109 to 0.818)was associated with lower possibility of detection.Conclusions Factors such as male,older age,alcohol intake,Gerd-Q score increase,presence of acid regurgitation and taking proton pump inhibitors,may have a certain significance for screening out patients and further improving the cost efficiency of gastroscopy.

AIM:To evaluate the diagnostic value of dilation of intercellular spaces(DIS) of squamous epithelium in the lower esophagus for non-erosive reflux disease(NERD).METHODS:Sixty-six NERD patients and thirtyeight healthy volunteers were enrolled.All participants underwent evaluation using the gastroesophageal reflux disease questionnaire(GerdQ),24 h esophageal pH monitoring,gastroscopy,and biopsy of mucosa in the lower esophagus at the Z-line and 2 cm above the Z-line for measurement of diameter of intercellular spaces by transmission electron microscopy(TEM).NERD patients with negative pH monitoring resultsunderwent proton pump inhibitor test to confirm the diagnosis.RESULTS:The mean diameter of intercellular spaces of squamous epithelium at the Z-line and 2 cm above the Z-line were(0.90 ± 0.11) μm and(0.92 ± 0.16) μm in the NERD group,and were(0.65 ± 0.08) μm and(0.67 ± 0.08) μm in the control group,without significant differences within the groups(both P > 0.05),but with significant differences between the two groups(both P < 0.05).No significant differences in the mean diameter of intercellular spaces of squamous epithelium at the Z-line and 2 cm above the Z-line in NERD patients were observed between pH(+) and pH(-) groups and between GerdQ(+) and GerdQ(-) groups.Positive correlations were found between the DeMeester scores and mean intercellular space diameters either at the Z-line(r = 0.33,P = 0.001) or 2 cm above the Z-line(r = 0.35,P = 0.001),and between the GerdQ scores and mean intercellular space diameters either at the Z-line(r = 0.32,P = 0.006) or 2 cm above the Z-line(r = 0.45,P < 0.001).The best cut-off values for mean intercellular space diameter were both 0.81 μm at the Z-line and 2 cm above the Z-line,with a highest Youden index of 0.808 at the Z-line(sensitivity 80.8%,specificity 100%) and 0.731 2 cm above the Z-line(sensitivity 78.8%,specificity 97.4%).CONCLUSION:The diameter of intercellular spaces of squamous epithelium in the lower esophagus of patients with NERD is significantly increased and correlates with acid reflux and reflux symptoms.Dilated intercellular space can serve as a sensitive and objective histopathological indicator for the diagnosis of NERD.

Ellagic acid is widely used as today's functional food ingredients and health-care food supplements because of its biological activities, pH-gradient counter-current chromatography was applied to the successful separation of ellagic acid from a crude sample. The experiment was performed with a two-phase solvent system composed of methyl tert-butyl ether-butanol-acetonitrile-distilled water (4:2:3:8, v/v) where 10 mM trifluoroacetic acid (TFA) was added to the upper organic stationary phase as a retainer and 10 mM ammonia to the aqueous mobile phase as an eluter. The separation of 0.6 g crude sample yielded ellagic acid at a high purity of over 98% as determined by HPLC, MS and NMR. This template explains and demonstrates how to prepare your camera-ready paper for Trans Tech Publications. The best is to read these instructions and follow the outline of this text.

目的分析肝硬化食管胃底静脉曲张破裂出血住院患者短期预后因素。方法总结2000年1月~2006年12月因肝硬化食管胃底静脉曲张破裂出血首次住院的肝硬化患者175例资料,记录患者入院时生命体征、化验结果、治疗方案、出院情况,按公式计算Child-Pugh分级、MELD评分。男121例,女54例。住院死亡11例。结果单因素Cox回归分析显示Child-Pugh分级、MELD评分、出血次数、血白细胞计数、凝血酶原时间、国际标准化比率（INR）是肝硬化食管胃底静脉曲张破裂出血短期预后的危险因素,HR分别为8.956、1.020、3.449、1.112、1.134和2.359（P＜0.05）;血钠、血白蛋白和凝血酶原活动度是保护因素,HR分别为0.856、0.857和0.919（P＜0.05）。结论 Child-Pugh分级、MELD评分、血白细胞计数以及血钠是影响肝硬化食管胃底静脉曲张破裂出血患者住院死亡的预后因素。

Objective To evaluate the risk factors for prognosis in liver cirrhotic patients with acute esophageal variceal bleeding (EVB). Methods Retrospective analysis was carried out in patients with liver cirrhosis,who were admitted to the hospital for EVB between January 2000 and December 2006 . All patients were follow-up to August 31st, 2009. The death of the patients was identified as the end of the study. The vital signs and results of laboratory tests were recorded when patients were admitted to the hospital. Child-Pugh score/grade, model for end stage liver disease (MELD) score and Rockall score were calculated. Results Ninty-five cases (66 males and 29 females) were enrolled in the study. Among them, 60 cases died and 35 cases survived for (42. 61±33.21) months (ranged from 2 days to 114 months). Univariate Cox regression analysis showed that age, male, Child-Pugh score/grade, MELD score, Rockall score, white blood cell counts and active hepatitis B were risk factors for death in liver cirrhotic patients with EVB (P＜0.05), while high level of hemoglobin and high hematocrit, endoscopic variceal sclerosis therapy or surgical treatment were protective factors (P＜0.05). Multivariate Cox regression analysis revealed that Child-Pugh grade (RR= 4. 997,95%CI:2. 787～8. 960, P＜0.01),Rockall score (RR= 1. 284,95%CI:1. 062～1. 553,P=0. 010), high counts of white blood cells (RR= 1. 072,95%CI: 1. 001 ～ 1. 148, P= 0. 046) were risk factors for prognosis of liver cirrhotic patients with EVB. Conclusion It is demonstrated that Child-Pugh grade,Rockall score and high counts of white blood cells are risk factors for prognosis of liver cirrhotic patients with EVB.

目的 探讨细胞周期素D1(cyclin D1)、Ki67蛋白在食管鳞状细胞癌(esophageal squamous cell carcinoma,ESCC)中的表达及其临床意义. 方法 应用免疫组化方法检测28例ESCC组织和33例食管炎组织中cyclin D1蛋白、Ki67蛋白的表达. 结果 在ESCC与食管炎组织中cyclin D1阳性表达率分别为60.7%(17/28)和33.3%(11/33)(χ2=4.573,P=0.032),Ki67标记指数(Ki67 LI)分别为(49.21±25.15)%和(11.62±9.87)%(t=7.908,P=0.000).ESCC组TNM分期中Ⅰ期cyclin D1阳性表达率为14.3%(1/7),Ⅱ期为55.6%(5/9),Ⅲ期为85.7%(6/7),Ⅳ期为100%(5/5),Ⅲ期与Ⅰ期、Ⅳ期与Ⅰ期相比,差异有显著性(P值分别为0.029,0.015).有淋巴结转移者cyclin D1阳性表达率为90.9%(10/11),无淋巴结转移者为41.2%(7/17)(P=0.016).28例ESCC随访6～34个月,(25.0±4.2)月,死亡4例(3例为原发病进展,1例脑血管意外),生存19例,失访5例. 结论 cyclin D1的表达与进展期肿瘤、淋巴结转移有关.Ki67在肿瘤中高表达,表达强弱与肿瘤分化程度及肿瘤分期无关.

【Objective】To estimate the diagnostic value of Lugol's chromoendoscopy for detection of early esophageal cancer and precancerous lesion.【Methods】The pathological results of the biopsies following Lugol staining were retrospectively studied,and the relationship between Lugol staining and pathological results was discussed.【Results】Eighty-seven patients who received routine endoscopy showed minor abnormal changes which were examined by the Lugol dyeing on the esophageal lesions with 2.5% Lugol's solution and biopsy was taken on the unstaining and staining lesions from January,2005 to December,2006,in our hospital.In the 47 Lugol voiding lesions,19 cases of esophageal cancer and 9 cases of atypical hyperplasia were diagnosed by the pathology.In the 29 minor staining lesions and 11 Lugol staining lesions,the pathology showed esophagitis.The detection rate of esophageal caner and atypical hyperplasia in Lugol voiding lesions was significantly higher than that in Lugol lightly staining and staining lesions(χ2=35.139,P 0.001).In Lugol voiding lesions,the appearance of atypical hyperplasia and esophageal cancer was like coarse mucosa(8 cases,31.6 %),uneven tubercle(16 cases,63.2 %),flat protrusion(12 cases,42.9 %);all of above added up to 78.8 percent of the detection rate.Other appearance included red mucosa(4 cases),superficial ulcer(2 cases),loss of mucosa(2 cases) and leukoplakia(1 case).【Conclusion】Lugol dye staining is useful for the differentiation of esophageal abnormal lesions and increases of the endoscopy sensitivity for the detection of atypical hyperplasia and early esophageal cancer.

急性胰腺炎(acute pancreatitis, AP)是临床常见的急腹症之一.老年人胰腺炎的发病率逐渐增多,急性重型胰腺炎(severe acute pancreatitis, SAP)的比例较高.现将我院收治AP患者的5年病历进行回顾性分析,比较老年AP患者与非老年AP患者临床特点,探讨老年患者的临床特征,为改善老年AP患者的预后提供参考.