目的 探究改良复方聚乙二醇电解质散(SF-PEG)方案应用于结肠镜肠道准备中对肠道清洁效果和患者依从性的影响.方法 前瞻性选取2018年5月至2019年6月于河北医科大学第三医院进行结肠镜检查的200例患者为研究对象,随机数字表法分为对照组和观察组,每组各100例.对照组按常规法(2 h内饮完3 L SF-PEG水溶液)进行肠道准备,观察组按改良法(分2次,每次1 h内饮完1.5 L SF-PEG水溶液,并加用西甲硅油乳剂)进行肠道准备.比较两组肠道清洁效果[Boston肠道准备量表(BBPS)]、肠腔内气泡、患者依从性、耐受性和安全性.结果 观察组患者的横结肠、左半结肠、右半结肠的BBPS评分、肠腔内气泡评分及肠道清洁优良率分别为(2.59±0.61)分、(2.61±0.58)分、(2.23±0.56)分、96.00％,均高于对照组[(2.23±0.54)分、(2.29±0.58)分、(1.84±0.53)分、84.00％],差异均有统计学意义(P<0.05).观察组总依从率、总耐受率、再次肠道准备接受率分别为95.00％、92.00％、87.00％,均明显高于对照组(81.00％、78.00％、73.00％),差异均有统计学意义(P<0.05).观察组不良反应总发生率为14.00％,明显低于对照组(26.00％),差异有统计学意义(P<0.05).结论 改良SF-PEG方案用于结肠镜肠道准备中可明显提高肠道清洁效果,改善患者治疗依从性和耐受度,并可降低不良反应发生率.

目的 评估香砂平胃颗粒联合四联疗法治疗幽门螺杆菌(Helicobacter pylori,H.pylori)相关性胃炎伴消化不良症状的有效性及安全性.方法 选取河北医科大学第三医院2017年10月-2018年12月收治的H.pylori相关性胃炎伴消化不良症状患者240例,采用随机数字表法分为对照组和观察组,每组120例.对照组采用枸橼酸铋钾220 mg+雷贝拉唑10 mg+阿莫西林1000 mg+克拉霉素500 mg,口服每天2次,疗程14 d;观察组在对照组基础上,加用香砂平胃颗粒10 g,2次/d,疗程14 d.比较2组患者H.pylori根除率,中医临床症状评分,血清胃蛋白酶原(pepsinogen,PG)Ⅰ、PGⅡ、PG Ⅰ/Ⅱ的比值(pepsinogen ratio,PGR)水平变化以及不良反应情况.结果 2组患者H.pylori根除率差异有统计学意义(90.4％ vs.93.8％,x2=0.890,P=0.345).观察组总有效率为89.5％,明显高于对照组的79.5％,x2=4.325,P=0.038.2组患者各项中医症状积分均随时间延长而降低,观察组中医症状积分下降幅度显著大于对照组,观察组中医症状积分整体水平均明显低于对照组.2组患者血清PG Ⅰ、PGⅡ、PGR水平均随时间延长而降低,观察组上述指标下降幅度明显大于对照组.观察组上述指标整体水平均明显低于对照组,观察组出现不良反应20例(17.5％),明显低于对照组[32例(28.6％),x2=3.878,P=0.049].结论 香砂平胃颗粒联合四联疗法治疗H.pylori胃炎合并消化不良,具有较好的临床疗效及安全性,值得临床推广.

目的:观察比较结肠镜检查前低渣饮食1天、3天对肠道准备效果和患者耐受性的影响.方法:将某医院结肠镜检查前预行肠道准备的门诊和住院患者221例随机分为低渣饮食1天组111例和低渣饮食3天组110例.所有患者均服用复方聚乙二醇电解质散和西甲硅油进行肠道准备.比较两组肠道准备质量,以及盲肠插镜时间、退镜时间、息肉检出率、患者耐受度和是否愿意再次采用该种饮食方式进行肠道准备等.肠道准备质量采用波士顿肠道准备量表(BBPS)进行评估,患者耐受度采用饥饿-舒适度标尺进行评价.结果:两组肠道准备BBPS总分低渣饮食1天组(6.54±1.45)分,与低渣饮食3天组(6.55±1.86)分比较,差异不显著(P＞0.05).两组在盲肠插镜时间、退镜时间、息肉检出率、患者耐受度等方面比较,差异不显著(P＞0.05).低渣饮食1天组受试者认为该种饮食方式"很简单遵从或简单遵从"的比例非常显著高于低渣饮食3天组(P＜0.01),低渣饮食1天组受试者愿意再次采用该种饮食方式进行肠道准备的比例显著高于低渣饮食3天组(P＜0.05).结论:低渣饮食1天或3天对结肠镜检查前肠道准备质量没有显著影响;低渣饮食1天受试者耐受度更高,更容易被接受.

目的 研究微创治疗内痔新方法内镜下套扎术治疗内痔的疗效及安全性.方法 收集2017年2月-2018年2月于该院行内镜下套扎术治疗的54例Ⅱ至Ⅲ期内痔患者,随访1、6和12个月,观察患者症状改善情况、并发症发生及复发情况,应用疼痛评分、出血评分、生活质量评分和脱出程度评分来评估内镜下套扎术的疗效及安全性.结果 术后随访12个月,47例治疗有效,治疗有效率87.0％,均未出现严重并发症,进行疼痛视觉模拟评分(VAS)、出血评分、生活质量及脱出程度评分,对比治疗前后,各个指标均有明显下降,VAS评分由(3.9±2.1)分降至(1.9±1.1)分(P=0.012),出血评分由(5.5±2.4)分降至(2.3±1.5)分(P=0.000),生活质量评分由(2.6±0.7)分降至(1.2±0.6)分(P=0.039),脱出程度评分由(2.4±0.5)分降至(1.6±0.6)分(P=0.002),2例(3.7％)患者出现复发,分别发生于10和11个月.结论 内镜下套扎术治疗内痔临床疗效确切,是一种安全有效的治疗方法.

目的 探讨急性结肠憩室炎的临床特点.方法 回顾性分析2007年1月-2017年12月该院收治的资料完整且经腹部CT、结肠镜和/或手术确诊的急性结肠憩室炎132例患者的临床资料.结果 男89例,女43例,男女比例为2.1:1.0,发病年龄(51.8±13.1)岁;急性单纯性结肠憩室炎119例(90.2％),急性复杂性结肠憩室炎13例(9.8％);发病部位:盲肠升结肠82例(62.1％),乙状结肠23例(17.4％),降结肠16例(12.1％),横结肠8例(6.1％),同时累及两个部位者3例(2.3％);主要症状:腹痛132例(100.0％),发热117例(88.6％),腹部压痛132例(100.0％);外周血白细胞计数(WBC)升高者103例(78.0％),WBC计数(15.8±5.1)×109/L,C反应蛋白(CRP)升高者124例(93.9％),CRP数值(34.1±15.3)mg/L;所有患者均行腹部CT检查,有结肠壁增厚表现者124例(93.9％),结肠周围脂肪组织密度增高者78例(59.1％);119例急性单纯性憩室炎患者均经静脉输注抗生素后好转,13例急性复杂性憩室炎患者中,3例经单纯静脉输注抗生素后好转,5例单纯腹腔脓肿和2例腹腔脓肿伴腹腔积液者静脉输注抗生素,同时行腹腔引流管引流后好转,2例腹腔游离气体及1例腹腔脓肿并瘘管形成、腹腔积液患者行开腹手术治疗后好转,在院期间无死亡病例.结论 急性结肠憩室炎好发于中老年男性,常见临床表现为腹痛、发热、腹部压痛,腹部增强CT在其诊断及病情评估中起重要作用,大部分患者无并发症,预后良好.

Objective: To investigate the efficacy and safety of Compound Lactobacillus Tablets or Saccharomyces boulardii Sachets combining with bismuth quadruple therapy for Helicobacter pylori(H.pylori) eradication. Methods: A total of 360 H. pylori- infected patients were enrolled and randomly assigned into three groups. Group A received esomeprazole 20 mg bid+ bismuth potassium citrate 220 mg bid+ amoxicillin 1 000 mg bid+ furazolidone 100 mg bid for 10 days. Group B or group C received the same quadruple therapy for 10 days as group A, as well as Compound Lactobacillus Tablets 1 000 mg tid or Saccharomyces boulardii Sachets 500 mg bid for 14 days. Drug-related side effects and adverse reactions were collected during the therapy, and H. pylori eradication results were confirmed by (13)C/(14)C-UBT at least 4 weeks after cessation of therapy. Results: The H. pylori eradication rates in group A, B and C were 81.7%, 84.2% and 85.0% by ITT analysis (P=0.768) and 92.5%, 90.1% and 93.6% by PP analysis (P=0.770), respectively. The overall side effects and adverse reactions rates (P=0.008) and occurrence of diarrhea (P<0.001) were significantly lower in group B than group A. The overall side effect rates (P=0.003) and occurrence of diarrhea (P<0.001), abdominal distension (P=0.004) and constipation(P=0.002) were significantly lower in group C than group A. There was no significant difference in side effects and adverse reactions rates between the two probiotics groups. Conclusions: Both Compound Lactobacillus Tablets and Saccharomyces boulardii Sachets, combining with bismuth quadruple therapy, reduced the overall side effects and adverse reactions rates for H. pylori eradication. Moreover, the former can reduce the incidence of diarrhea, and the latter can reduce the incidence of diarrhea, abdominal distension and constipation.

Whether insulin-like growth factor 1 (IGF1) inhibits or promotes the osteogenic differentiation in vitro remains controversial. Moreover, the biological mechanisms and signaling pathways by which IGF1 affects osteogenic differentiation remain obscure. Transcriptional coactivator with PDZ-binding motif (TAZ) plays a vital role in the osteogenic differentiation of mesenchymal stem cells (MSCs), and strongly activates runt related transcription factor 2 (RUNX2)-driven genes during the terminal osteogenic differentiation. In the present study, we found that IGF1 increased the ALP activities and calcium depositions of MSCs derived from rat bone marrow dose-dependently, with a peak at 100–200ng/ml. IGF1 increased TAZ and RUNX2 expression mainly at the early stage of osteogenic differentiation, but increased OCN expression at the late stage. Our data further demonstrated that down-regulation of TAZ expression by siRNA inhibited the IGF1 induced increase in osteogenic differentiation. Moreover, UO126 (the MEK–ERK inhibitor), not LY294002 (the PI3K-Akt inhibitor), inhibited the IGF1 induced increase in TAZ expression. Taken together, we provide evidence to demonstrate that IGF1 promotes the osteogenic differentiation of rat MSCs by increasing TAZ expression, and that the increased TAZ expression induced by IGF1 is mostly mediated by the MEK–ERK pathway.

Alu元件（约280bp）是人类基因组中的重要重复序列,串联Alu呈长度依赖性下调GFP报告基因表达,在Alu串联序列上游正向或反向插入SV40PolyA（简称PolyA,240bp）,解除Alu串联序列对GFP基因的抑制作用.PCR法扩增PolyA反序（PolyAas）不同位置的60bp片段,插入pAlu14质粒（14个Alu正向串联插入pEGFP-C1）的GFP基因和Alu14之间,瞬时转染HeLa细胞,通过荧光显微镜观察和Northern检测,1F1R（PolyAas5′端第1个60bp片段）和4F4R（自PolyAas5′端计算第4个60bp片段）不能活化基因;2F2R和3F3R（PolyAas中间的2段）可以解除Alu14对GFP基因的抑制作用.将2F2R和3F3R各自反复首尾串联,分别插入pAlu14质粒GFP基因和Alu串联序列之间,瞬时转染HeLa细胞,用插入4个2F2R的pAlu28,插入4个3F3R的pAlu18,插入4个3F3R的pAlu28作长度对照,以排除由于插入片段长度增加可能对结果造成的干扰,发现2～4个拷贝的2F2R和3F3R活化基因作用高于一个拷贝的同样片段,但是多于8拷贝以后,活化GFP基因作用减弱.本实验证明,SV40 PolyAas至少含有两段活化基因序列,活化基因序列（2F2R,3F3R）的最适活化基因条件需要合适的拷贝数.

Our previous studies showed that tandem Alu repeats inhibited GFP gene expression when they were inserted into the downstream of GFP gene in pEGFP-C1 vector and HeLa cells were then transfected transiently. The sequence named 2F2R (second 60 bp from the 5' end of SV40PolyA antisense strand) eliminated the repression of GFP gene expression induced by Alu repeats when 2F2R was inserted between GFP and Alu repeats. In this study the deletion of 2F2R DNA showed that 45R (45 bp in 2F2R 5'end), 30R (30 bp in 2F2R 5' end) and 22R (22 bp in 2F2R 5' end) activated GFP gene expression, and the activating actions of the double tandem sequences were stronger than those of their corresponding single sequences. Secloop (22 bp near the center in 2F2R) and Poly4 (30 bp in 2F2R 3' end) sequences did not activate GFP gene expression. The activating action of 30R-Poly4 sequence formed by ligating 30R with Poly4 by 9 bp was lower than that of 2F2R. The linking base number between two 22R sequences did not influence the GFP gene expression obviously. Sequence 22R (5'-GTGAAAAAAATGCTTTATTTGT-3') contains an imperfect palindrome sequence and may form an imperfect stem-loop structure including a 3nt loop, 3 bp first stem, 2nt bulge, and 3bp second stem. The mutations changing stem-loop structure of 22R influenced the GFP gene activation significantly and neither the excessively stable nor excessively unstable stem-loop structures were in favour of GFP gene activation, which suggested that the suitably imperfect stem-loop structures had something with gene activation.

The presence of Alu repeats downregulates the expression of the green fluorescent protein (GFP) gene. We found that SV40PolyA (PolyA, 240 bp), in either orientation, eliminated the inhibition of GFP gene expression induced by Alu repeats when it was placed between the GFP gene and the Alu repeats. In this study, 4 different segments (each 60 bp) were amplified from antisense PolyA (PolyAas) by PCR, and inserted upstream of Alu14 in pAlu14 plasmid (14 Alu repeats inserted downstream of the GFP gene in vector pEGFP-C1 in a head-tail tandem manner). Segments 1F1R (the first 60 bp segment at the 5' end of PolyAas) and 4F4R (the fourth 60 bp segment from the 5' end of PolyAas) did not activate GFP gene expression, whereas 2F2R and 3F3R (the middle two segments) did (as detected by Northern blot analysis and fluorescent microscopy). Different copy numbers of 2F2R and 3F3R segments, in a head and tail tandem manner, were inserted downstream of the GFP gene in pAlu14. p2F2R*4-Alu28, p3F3R*4-Alu18 and p3F3R*4-Alu28 were used as length controls to verify that the decrease in the expression of GFP was not due to the increased length of the inserted segment in the expression vectors. We found that 2 and 4 copies of 2F2R or 3F3R activated the GFP gene more strongly than one copy of them. However, more than 8 copies of 2F2R or 3F3R reduced the activation of the GFP gene. We concluded that SV40PolyAas contained at least two gene-activating elements (2F2R and 3F3R) and 2-4 copies of 2F2R or 3F3R were optimal for the expression of the GFP gene.