临床上很多患者需要肠内营养支持治疗,然而腹泻一直是困扰临床治疗中最常见的不良反应,不仅导致患者延迟治疗,甚至需要终止肠内营养支持,影响患者康复与预后.近年来发现越来越多的研究强调肠黏膜屏障及肠道通透性对健康和疾病的重要作用.作者就黏膜屏障及其在疾病预防和治疗中的作用进行论述,并提出肠壁通透性“阈值”降低可能是导致肠内营养性腹泻原因之一,为进一步治疗肠内营养性腹泻提供可借鉴的方法.

目的:探讨强化治疗对幽门螺杆菌(Helicobacter pylori,Hp)感染患者的临床疗效及安全性.方法:选取2018年1月-2019年10月本院门诊就诊的Hp感染患者260例进行研究,随机分为对照组和观察组各130例.对照组采用含铋剂四联疗法治疗,具体为:阿莫西林1 000 mg+克拉霉素500 mg+雷贝拉唑20 mg+胶体果胶铋200 mg,2次/d,共14 d;观察组在对照组的基础上,再行强化治疗14d,具体为:荆花胃康胶丸160 mg(3次/d)+养胃颗粒5 g(3次/d)+艾普拉唑5 mg(2次/d),总疗程28 d.在疗程结束后至少间隔4周行13C尿素呼气试验检测,比较两组患者的Hp根除率和不良反应发生率.根据自愿原则对其中215例进行Hp抗体分型检测,CagA抗体和/或VacA抗体阳性为Ⅰ型菌株(毒力菌株),共153例;CagA抗体和VacA抗体均阴性为Ⅱ型菌株(低毒菌株),共62例.比较不同致病力菌株的根除率差异.结果:对照组和观察组的Hp根除率分别为81.54％和87.69％,两组根除率比较差异无统计学意义(P＞0.05).对照组和观察组的不良反应发生率分别为9.23％和7.69％,差异无统计学意义(P＞0.05).毒力组和低毒力组的Hp根除率分别为85.62％和83.87％,差异无统计学意义(P＞0.05).结论:在含铋剂四联疗法基础上增加强化治疗对Hp根除率提高不显著,但不良反应无明显增加;不同致病力Hp菌株的根除率相当,Hp抗体分型检测对于临床抗菌治疗用药无明显指导意义,不推荐作为Hp感染诊疗的常规手段.

夏日炎炎，人们白天呆在室内，而且热得没胃口，忍不住想吃点儿生冷的东西解暑，于是待到夜幕降临，便三三两两聚集在夜市大排档，喝着冰镇的啤酒，吃着烧烤，好不爽快！却不知这样给肠胃造成很大的负担，导致消化道疾病高发。急性肠胃炎、急性胆囊炎和急性消化性溃疡，都与夏季不少市民改变了正常的饮食习惯、削弱了肠胃的功能有关。

胰腺神经内分泌肿瘤(PNETs)起源于全身弥散性神经内分泌系统,占胰腺肿瘤的1％～2％[1],根据其是否伴有激素相关的临床特征,可将其分为功能性胰腺神经内分泌肿瘤和无功能性胰腺神经内分泌肿瘤(NF-PNETs).NF-PNETs占胰腺神经内分泌肿瘤的30％～50％[2].由于NF-PNETs总发病率低,临床表现不典型,加之临床医师对其认识不足,常难以与具有相同症状的其他疾病鉴别,早期确诊困难,患者往往被拖延数月甚至数年才获得确诊,确诊时肿瘤多较大,多数患者肿瘤已发生转移.本院2009年5月-2013年7月共收治20例无功能性胰腺神经内分泌肿瘤患者,所有病例均经病理及免疫组织化学证实.本研究回顾性分析上述20例患者的临床资料,现报告如下.

Hepatocellular carcinoma (HCC) is the third most common cancer worldwide, causing over 0.5 million deaths per year, with approximately half of these in China. Chemotherapy is the optimal treatment for patients with advanced HCC, although chemoresistance has become a significant obstacle to successful anti-cancer therapy. The expression of opsin3 (OPN3), also called encephalopsin or panopsin, is lower in 5-fluorouracil (5-FU)-resistant Bel7402(5-FU) cells compared to 5-FU-sensitive Bel7402 cells. To explore the role of OPN3 in 5-FU resistance, OPN3 overexpressing (Bel7402(5-FU)-OPN3) and knockdown (Bel7402-RNAi-OPN3) cell lines were generated. Bel7402(5-FU)-OPN3 cells were more sensitive to 5-FU treatment than controls, while OPN3 knockdown resulted in a significant increase in 5-FU resistance. This result was replicated in a second HCC cell line, HepG2. Further investigation of the mechanism revealed that decreased OPN3 levels in Bel7402(5-FU) cells activated the anti-apoptotic pathway through increasing phospho-Akt and the Bcl2/Bax ratio, while overexpression of OPN3 inactivated this pathway. Taken together, these results suggest that OPN3 depletion is involved in 5-FU resistance, and that therapeutic strategies targeting OPN3 may improve HCC sensitivity to chemotherapy.

目的探讨溃疡性结肠炎(UC)复杂的临床表现,探讨原发性胆汁性肝硬化(PBC)发展为原发性硬化性胆管炎(PSC)的可能。方法详细阐述1例41岁中年女性PSC合并UC患者的临床表现、诊断和治疗。并复习相关文献,分析PBC发展为PSC的可能。结果本例患者10年前肝脏穿刺诊断为PBC,7年前肠镜检查诊断为UC,因出现直肠阴道瘘,通过相关检查诊断为PSC,通过手术探查,确诊并发结肠癌。文献复习提示PSC易合并UC同时存在,而且,随着UC病程的延长,患者容易并发结直肠癌。结论对UC患者进行结肠镜的定期检查能及早发现结直肠癌,并延长生存期,如果UC患者合并PSC,肠黏膜异型增生及癌变的可能性更大。

Objective To evaluate the therapeutic effect of endoscopic full-thickness resection (EFTR) for gastric stromal tumors.Methods A total of 33 patients with gastric stromal tumor orgination from deep muscularis propria layer received EFTR from January 2010 to July 2011.The effectiveness and safety of EFTR were compared with those of other 34 patients with gastric stromal tumor origination from muscularis propria layer who underwent endoscopic submucosal dissection (ESD).Results Except in 2 patients with lesions larger than 3.0 × 3.0 cm,EFTR was successful in others 31 patients,who recovered well and had no recurrence during the follow-up within 12 months.There were no significant differences in resection rate,incidence of complications,body temperature,white blood cell counts or recovery time between 2 procedures (P ＞ 0.05 ).However,the number of clips used in EFTR ( 7.0 ± 3.5 vs.4.9 ± 3.1,P =0.013 ) and postoperative fasting days (3.4 ± 1.5 vs.2.0 ± 1.0,P =0.001 ) were significantly higher than those of ESD procedures.Conclusion EFTR is effective and safe for gastric stromal tumors with no higher risk than ESD,but it is more complex technically.EFTR can be used as an expanding method of ESD in endoscopic treatment of gastric stromal tumors.

Objective To observe the value of thymidine kinase(TK1) on diagnosis and follow-up of colorectal carcinoma.Methods The levels of CEA,TK1 in serum and TK1 in tissue specimen in 140 patients with colorectal carcinoma were determined by enhanced chemi-luminescence assay and immunohistochemistry to observe positive rate of colorectal carcinoma.The combination of TK1 and CEA was compared with serum CEA to determine the better diagnostic method.Then serum TK1 was tested 1,3 and 6 months respectively after surgical operation.Results Positive rate of serum TK1 in diagnosis of colorectal carcinoma was 63.8% while CEA was 59.3%,immunohistochemistry was 78% which had significant difference with CEA and TK1 respectively(P0.05).The combination of serum TK1 and CEA increased the positive rate of diagnosis to 72.0% which had significant difference with CEA(P0.05).The level of serum TK1 was decreased gradually after surgical operation in 1,3 and 6 months compared to pre-operation.It almost reached the normal level after 6 months.Conclusion Though immunohistochemical method is the most sensitive one in diagnosis of colorectal carcinoma,it is complicated and difficult to operate. Serum TK1 can be used as assistant method to colorectal carcinoma diagnosis for its simplicity and stability.Hopefully,TK1 may be widely used in clinical work.

The 40S ribosomal protein S4 gene (RPS4) has been cloned from Culex pipiens pallens. An open reading frame (ORF) of 789 bp was found to encode a putative 262 amino acid protein. The deduced amino acid sequence shares 96% and 91% identity with RPS4 genes from Aedes and Anopheles respectively. Transcript expression of RPS4 was determined by real-time PCR in all life stages of deltamethrin-susceptible and -resistant strains. The results demonstrated that this gene is expressed at all developmental stages. Meanwhile, in pupae and adults, RPS4 is overexpressed in deltamethrin-resistant strain than in -susceptible strain. Our data for the first time suggests that increased expression of the RPS4 gene may play some role in the development of deltamethrin resistance in C. pipiens pallens.

Objective Objective To isolate and sequence Aedes albopictus β-actin gene and test its applicability as an internal control in gene expression studies.Methods Primers were designed based on the conserved nucleotide sequences of insect β-actin genes.A fragment of Ae.albopictus β-actin gene was amplified from the cDNA of C6/36 cells.The expression levels of Ae.albopictus β-actin in RPS4 gene stably transfected and control vector transfected C6/36 cells were both detected by RT-PCR. Results A fragment of 911 bp was isolated which shows over 89% identities with the corresponding sequences of other mosquito β-actin genes.The fragment was also successfully amplified from RPS4 gene transfected and control vector transfected C6/36 cells. Conclusion Ae.albopictus β-actin gene fragment was successfully cloned.As a housekeeping gene,it can be used as an internal control in gene expression studies.

目的:检测幽门螺杆菌（HP）感染患者血清中细胞毒相关蛋白CagA和空泡细胞毒素VacA抗体,观察不同菌株对胃黏膜组织学改变的影响。方法:利用免疫印迹法检测139例HP感染的胃十二指肠疾病患者血清中CagA和VacA抗体,这些患者胃黏膜病理变化均经胃镜证实。观察不同毒力的HP菌株对胃黏膜病理学改变的影响。结果:十二指肠球部溃疡及慢性萎缩性胃炎患者血清中CagA及VacA抗体的检出率明显高于慢性浅表性胃炎的患者,且CagA抗体阳性组患者胃黏膜炎症活动及萎缩的程度较CagA抗体阴性组差异有显著性,而在肠上皮化生方面差异则无显著性。结论:具有CagA及VacA基因的幽门螺杆菌可能在诱导胃黏膜炎症及萎缩方面起了较为重要的作用。

Objective: To evaluate pathologic changes of gastric mucosa after anti-Hp therapy. Methods: 13C urea breath test and gastroendoscopy were conducted in 114 patients one year after therapy of triple anti-Hp, and they were divided into eradicated group and uneradicated group according to the results of 13C urea breath test. One hundred and sixty five patients who did not have triple anti-Hp therapy and had 2 times of gastroendoscopy examination were selected as the control. The pathologic changes of gastric mucosa before and after triple therapy were evaluate. Results: After eradication of Hp, the inflamation, mucosa atropy and intestinal metaplasia were improved significantly compared with non-eradicate patients ( P 0. 01). Conclusion: Eradication of Hp infection is useful in conversion of mucosa lesion.