目的 观察肠梗阻患者并发急性肾损伤(acute kidney injury,AKI)的临床特点并分析其相关影响因素.方法 回顾性分析2017年1月至2019年12月武汉大学人民医院收治的63例肠梗阻并发AKI患者的临床资料,并将其作为A组,再随机选取肠梗阻未发生肾功能损伤的63例患者作为B组;分析患者的基线资料,如年龄、性别、相关血清指标、合并疾病等.比较两组患者上述资料的差异,对可能导致患者发生AKI的因素进行分析,并经多因素Logistic回归分析找出导致可能影响肠梗阻发生AKI的危险因素.结果 两组患者在性别、是否复发、腹盆部手术史、糖尿病、浆膜腔积液、肾结石的患病率对比,差异无统计学意义(P＞0.05);A组患者在年龄、发病时间、住院时间、血尿素氮、血尿酸、合并高血压、心血管疾病、感染的比例显著高于B组,差异有统计学意义(P＜0.05);通过 Logistic 回归分析显示,年龄≥65岁(OR=10.140,95％CI:3.197～32.164,P=0.000)、合并高血压(OR=3.682,95％CI:1.128～12.02,P=0.031)、血尿酸升高(OR=1.008,95％CI:1.002～1.015,P=0.008)可能是影响肠梗阻发生 AKI 的危险因素.结论 高龄、高血尿酸、合并高血压可能是肠梗阻并发AKI的危险因素,对于伴发相关风险因素的老年肠梗阻患者,临床上应早期识别并实施干预措施,以降低AKI的发生率,进一步减少预后不良风险的发生.

Objective To investigate the safety and efficacy of endoscopic submucosal dissection ( ESD) for early stage colorectal cancer and precancerous lesions. Methods Clinical data of 108 patients who received ESD for early stage colorectal cancer and precancerous lesions from December 2016 to June 2017 in Renmin Hospital of Wuhan University were analyzed. The lesion characteristics, postoperative pathological features, intraoperative and postoperative complications and postoperative follow-up outcomes were analyzed. Results The 108 patients all underwent ESD successfully with median operation time of 45 min. The rate of intraoperative perforation and postoperative delayed bleeding was 2. 8％ ( 3/108) and 2. 8％ (3/108), respectively. No postoperative delayed perforation occurred. Postoperative pathology showed that there were 41 cases ( 38. 0％) of tubular adenoma, 4 ( 3. 7％) villous adenoma, 39 ( 36. 1％) villous tubular adenoma [ including 41 ( 38. 0％) low-grade intraepithelial neoplasia and 16 ( 14. 8％) high-grade intraepithelial neoplasia] , 19 ( 17. 6％) adenocarcinoma, and 5 ( 4. 6％) other types. Among the 19 cases of adenocarcinoma, there were 11 cases of well-differentiated, 5 median-differentiated and 3 low-differentiated. The complete resection rate was 100. 0％ and the en bloc resection rate was 92. 3％ ( 100/108) . The mean follow-up time was 8. 1 months, and no recurrence was found during this period. Conclusion ESD is safe and effective in the treatment of early stage colorectal lesions. It is important to improve preoperative assessment, strengthen surgical skills, analyze postoperative pathological features and regularly follow up to guarantee the treatment quality of ESD.

Objective To explore the expression of macrophage capping protein（CapG）in colorectal carcinoma tissues,and to investigate its effects on proliferation and migration of colorectal carcinoma cells.Methods From September10th,2015 to March 2nd,2016,the clinical data and tissues specimen of 84 patients with colorectal operation

Objective To investigate the safety and effectiveness of endoscopic submucosal dissection(ESD) for elderly patients(≥60 years old) with colorectal lesions. Methods Data of 31 elderly patients(≥60 years old) and 23 non-elderly(<60 years old) patients who were found to have colorectal mucosal lesions by colonoscopy and underwent ESD treatment between January 2012 to January 2014 were retrospectively studied. Results There were no statistical differences between the two groups in gender, concomitant diseases, lesion location, lesion size and postoperative pathological diagnosis(P>0.05). Thirty-two lesions in elderly group and twenty-five lesions in non-elderly group were all curative resection. En bloc resection rates were 96.9%(31/32)and 96.0%(24/25)in the elderly group and non-elderly group respectively; the rates of bleeding during ESD procedure were 3.2%(1/31)and 4.3%(1/23); delayed bleeding rates were 12.9%(4/31)and 13.0%(3/23); the rates of perforation was 12.9%(4/31)and 0; postoperative infection rates were 3.2%(1/31) and 4.3%(1/23) respectively. There were no statistical differences between the two groups in any of these data(P>0.05). The mean time of follow-up were(14.8±1.7)months in elderly group and(14.7±1.8)months in non-elderly group, and there was no significant difference between two groups. No residual lesion or recurrent lesion was found in the follow-up period. Conclusion ESD is a safe and effective treatment for the elderly patients with colorectal lesion. Key words: Aged; Endoscopic submucosal dissection; Colorectum

Objective It is to approach the relationships of the expression of survival element( Survivin)in pancreatic cancer tissue and cysteine aspartic acid protease -3(Caspase -3)protein with the clinical pathological characteristics and survival time of patients. Methods 70 cases of pancreatic cancer tissue and 30 cases of acute pancreatitis tissue specimens were collected to detect the expression of Survivin and Caspase-3 protein by immunohistochemical SP staining,and analyze the clinical pathological features. Results The positive expression rate of Survivin,Caspase -3 protein was 84%,86% in pancreatic cancer tissue respectively,and was 33%,33% in acute pancreatitis tissues respectively,the positive expression rate of Survivin,Caspase-3 protein and expression intensity of pancreatic cancer were significantly higher than those of acute pancreatitis group(all P<0. 05). There was no significant correlation between the gender,age of pancreatic cancer patients, the tumor site,TNM stage,tumor size,Whether the vessels have been violated,histological differentiation and the positive ex-pression of Survivin,Caspase-3 in pancreatic tissue(all P >0. 05),the Survivin positive expression rate was significantly higher than patients with no lymph node metastasis(P<0. 05),but there was no significant correlation between positive ex-pression rate of Caspase-3 and without lymph node metastasis(P>0. 05). There was significant difference in survival time of patients with different expression intensity of Survivin and Caspase -3(P <0. 05). There were 29 patients in pancreatic cancer tissue with Survivin,Caspase-3 common positive expression,80% of the patients with positive expression of Survivin alone had with negative expression of Caspase-3. Spearman correlation analysis showed that there was a negative correlation between the positive expression of Survivin and Caspase-3 protein(P <0. 05). Conclusion The expression of Survivin and Caspase-3 protein in pancreatic cancer tissues is abnormal. The relative positive expression of Survivin in patients with&nbsp;Caspase-3 negative expression is raised,there is a negative correlation. There is a closely associated with lymph node metas-tasis in patients with Survivin,prompt Survivin protein may be based on the inhibition of Caspase-3 protein and influence the apoptosis of pancreatic cancer tissues and cells,and may participate in the process of pancreatic cancer metastasis,Survivin and Caspase-3 protein expression levels of monitoring can be used as prognostic evaluation.

The coexistence of hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs) in patients with hepatitis B virus (HBV) infection has been discovered and explained for several decades, but debate still exists. This study was to explore the relationship between this special serological pattern and mutations in S gene region. Fifteen patients with coexisting HBsAg and anti-HBs were selected as the experimental group, and 27 patients with HBsAg positive only were selected as the control group. The S gene region was amplified and sequenced. No significant differences were observed between the two groups with regard to age, gender, alanine aminotransferase level, HBsAg titer, genotype, and HBV DNA level. The patients from the two groups were infected with HBV of the genotype B and C. Compared with the control group, the experimental group showed a higher variability in amino acid within the N-terminal region and the MHR, especially the a determinant. The most frequent change in patients from the experimental group was located at positions s126. The coexistence of HBsAg and anti-HBs might be associated with the increased amino acid mutations in the a determinant. Further studies should be performed to determine the clinical implication of this serological pattern, including the binding of anti-HBs to HBsAg, escape from immune system, and efficacy of antiviral therapy. J. Med. Virol. 87:2067-2073, 2015. (c) 2015 Wiley Periodicals, Inc.

Doxorubicin (Dox) is a commonly used chemotherapeutic drug in human colon cancer. However, it becomes increasingly ineffective with tumor progression, the underlying mechanism of which remains to be elucidated. Emerging evidence has led to the identification of an association between chemoresistance and the acquisition of epithelial-mesenchymal transition (EMT) in cancer. However, it remains to be elucidated whether this process is involved in the development of resistance to Dox in colon cancer. In HCT116 human colon cancer cells treated with Dox (50 nmol/l), EMT was induced, and transforming growth factor (TGF)β signaling and multi-drug resistant plasma membrane glycoprotein levels were significantly increased. By contrast, silencing of Smad4, using stable RNA interference, inhibited TGFβ signaling, reversed the process of EMT and markedly increased the sensitivity of HCT116 cells to Dox. The results of the present study suggested that the combination of Dox with the downregulation of TGFβ signaling may be a potential novel therapeutic strategy with which to overcome chemoresistance during colon cancer chemotherapy.

Background/Aims: Esophageal squamous cell carcinoma is a common malignant tumor in recent years, and the key for improving the survival rate is early diagnosis and treatment. Computed virtual chromoendoscopy with the Fujinon intelligent color enhancement (FICE) system was reported to improve visualization of neoplastic and non-neoplastic lesions in gastroscopy and colonoscopy. The purpose of this study was to evaluate the value of FICE in the diagnosis of early esophageal squamous cell carcinoma and precancerous lesions.Materials and Methods: Two hundred fifty-seven patients with suspicious lesions of the esophagus were examined successively by FICE, magnifying FICE, Lugol chromoendoscopy, and magnifying Lugol chromoendoscopy in the hospital. The lesions and the intrapapillary capillary loop (IPCL, microvessels at the surface of esophageal carcinoma) were observed and compared with the pathologic diagnosis that was regarded as the golden standard.Results: The positive rates of early esophageal squamous cell carcinoma were 92.6% and 88.9% as examined by FICE and Lugol chromoendoscopy (p > 0.05), and 96.3% and 92.6% as examined by magnifying FICE and magnifying Lugol chromoendoscopy (p > 0.05), respectively. The magnifying FICE could observe the IPCL of the esophagus clearly. Early esophageal squamous cell carcinoma and high-grade intraepithelial neoplasia were mainly type IV and type V. Low-grade intraepithelial neoplasia and esophagitis were type II and type III, and normal esophagus was type I; however, the observation of the IPCL by magnifying Lugol chromoendoscopy was not clear.Conclusion: Fujinon intelligent color enhancement and magnifying FICE are complements to Lugol chromoendoscopy and magnifying Lugol chromoendoscopy in the diagnosis of early esophageal lesions.

目的 探讨内镜黏膜下剥离术(ESD)治疗胃食管广基底病变的疗效及安全性.方法 回顾性分析2012年1月～ 2014年1月我院应用电子食管胃镜发现的直径≥2.0 cm胃食管广基病变(息肉、癌前病变、早期局限性肿瘤)患者的临床资料,经超声内镜检查位于黏膜肌层以下(包括黏膜肌层)的病灶纳入选择,并行ESD治疗.结果 本组研究共64例患者,54例病灶位于胃内,10例病灶位于食管内,所有病变经ESD完整剥离,术后经病理证实标本基底及边缘均无病变组织残留.胃组:5例(9.26％)发生术中少量渗血,出血量2～10ml,予以电热活检钳电凝成功止血;1例(1.85％)患者术后8小时出现呕血,鲜红色,Hb从132g/L降至100 g/L,急诊胃镜止血成功.食管:病灶内均未见出血、穿孔、皮下气肿等并发症.随访58例,术后l,3,6个月复查胃镜,创面愈合良好,未见病变残留和复发.结论 ESD治疗胃食管广基病变安全、有效,并发症发生率低,能维持正常的生理结构.

2004-11-19 Abstract AIM: To investigate the role of NF-  B in the pathogenesis of TNBS-induced colitis in rats. METHODS: Thirty-two healthy adult Sprague-Dawley (SD) rats were randomly divided into four groups of eight each: normal, NS, model I, model II groups in our study. Rat colitis model was established through 2-,4-,6-trinitrobenzene sulfonic acid (TNBS) enema. At the end of four weeks, the macroscopical and histological changes of the colon were examined and mucosa myeloperoxidase (MPO) activities assayed. NF-  B p65 expression was determined by Western blot assessment in cytoplasmic and nuclear extracts of colon tissue, and the expressions of TNF-  and ICAM-1 protein in colon tissue were examined by immunohistochemistry. The relativities between expression of NF-  B p65 and other parameters were analyzed. RESULTS: TNBS enema resulted in pronounced pathological changes of colonic mucosa in model II group (macroscopic and histological injury indices 6.25±1.39 and 6.24±1.04, respectively), which were in accordance with the significantly elevated MPO activity (1.69±0.11). And the nuclear level of NF-  B and expression of TNF-  , ICAM-1 in rats of model II group were higher than that of normal control (9.7±1.96 vs 1.7±0.15, 84.09±14.52 vs 16.03±6.21, 77.69±8.09 vs 13.41±4.91 P<0.01), Linear correlation analysis revealed that there were strong correlations between the nuclear level of NF-  B and the tissue positive expression of TNF-  and ICAM-1, MPO activities, macroscopical and histological indices in TNBS-induced colitis, respectively (r = 0.8235, 0.8780, 0.8572, 0.9152, 0.8247; P<0.05). CONCLUSION: NF-  B plays a pivotal role in the pathogenesis of ulcerative colitis, which might

AIM:To evaluate whether SB203580,a p38MAPK inhibitor,reduces resistance of colon cancer HCT116 cells to doxorubicin and to explore possible mechanisms involved.METHODS:Doxorubicin alone or in combination with SB203580 was used to treat subcultured HCT-116 cells.After treatment,cell growth was determined by MTT assay,and Akt and p-AKt expression was detected by Western blotting.RESULTS:Either doxorubicin or SB203580 inhibited HCT-116 cell growth,and the latter had a stronger inhibitory effect than the former (26.60% vs 33.87%).Combined use of doxorubicin and SB203580 had more strong inhibitory effect than treatment with either of them alone (56.04%).Expression of Akt showed no significant difference between cells treated with doxorubicin alone and those treated with combined doxorubicin and SB203580,while the phosphorylation of Akt was significantly higher in the doxorubicin group than in the combination group.CONCLUSION:The p38 MAPK inhibitor SB203580 could block the Akt signaling pathways and increase the sensitivity of colon cancer cells to doxorubicin.

Objective To investigate the role of leptin and leptin receptor in carcinogensis and development of esophageal carcinoma. Methods The expression of leptin and leptin receptor was detected in 52 cases of esophageal carcinoma tissues and 49 cases of normal esophageal tissues by immunohistochemistry. The correlation between their expression and clinicopathological parameters was also analysized. Results The expression rate of leptin and leptin receptor in esophageal carcinoma was 78. 8% (41/52) and 82.7% (43/52) respectively, and the rate in normal esophagus was 58.3% (28/49) and 59.2% (29/49) respectively. The expression rate of leptin and leptin receptor both had statistically significantly differences between esophageal carcinoma and normal esophagus tissues (P ＜ 0. 05). The expression rate of leptin was associated with position, tumor size, differentiation, lymphatic metastasis and TNM stage (P ＜ 0. 05 ). Conclusion Leptin and leptin receptor were dually expressed in esophageal carcinoma.They played important roles in the process of carcinogensis and development of esophageal carcinoma.

AIM To examine the effects of combined treatment of oxaliplatin and phosphatidylinositol 3'-kinase inhibitor, 2-(4-morpholinyl)-8-phenyl-4H-1-benzopyran-4-one (LY294002) for gastric cancer. METHODS Cell viability was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Apoptotic cells were detected by flow cytometric analysis and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assay. Western blotting and immuno-precipitation were used to examine protein expression and recruitment, respectively. Nuclear factor κB (NFκB) binding activities were investigated using electrophoretic mobility shift assay. Nude mice were used to investigate tumor growth. RESULTS Treatment with combined oxaliplatin and LY294002 resulted in increased cell growth inhibition and cell apoptosis in vitro, and increased tumor growth inhibition and cell death in the tumor mass in vivo. In MKN45 and AGS cells, oxaliplatin treatment promoted both protein kinase B (Akt) and NFκB activation, while pretreatment with LY294002 significantly attenuated oxaliplatin-induced Akt activity and NFκB binding. LY294002 promoted oxaliplatin-induced Fas ligand (FasL) expression, Fas-associated death domain protein recruitment, caspase-8, Bid, and caspase-3 activation, and the short form of cellular caspase-8/FLICE-inhibitory protein (c-FLIP(S)) inhibition. In vivo, LY294002 inhibited oxaliplatin-induced activation of Akt and NFκB, and increased oxaliplatin-induced expression of FasL, inhibition of c-FLIP(S), and activation of caspase-8, Bid, and caspase-3. CONCLUSION Combination of oxaliplatin and LY294002 was therapeutically promising for gastric cancer treatment. The enhanced sensitivity of the combined treatment was associated with the activation of the death receptor pathway.

Objective:To compare the effect of ilaprazole- and esomeprazole-based triple therapy regimens on duodenal ulcer with helicobacter pylori(Hp) infection.Method:120 patients with duodenal ulcer with Hp infection were randomly divided into 3 groups,which were treated with ilaprazole 15,20 mg and esomeprazole 20 mg separately,and also given clarithromycin 500 mg and amoxicillin 1 000 mg at the same time twice daily for 10 days.After this treatment,all the patients were given the same dosage of corresponding PPI for 4 weeks,the ulcer,re-examined by endoscopy and the Hp, detected.Then the ulcer healing rates and eradication rates of Hp as well as adverse effects of the medication were evaluated and compared.Result:At the end of 2 weeks,the ulcer healing rates of ilaprazole 15,20 mg and esomeprazole 20 mg were 82.5%,75%,77.5%(P>0.05).At the end of 4 weeks,the ulcer healing rates of ilaprazole 15,20 mg and esomeprazole 20 mg were 90%,87.5%and 87.5%(P>0.05).The Hp eradication rates of ilaprazole 15,20 mg and esomeprazole 20 mg were 85%,82.5%and 90%(P>0.05).There was no serious adverse reaction.Conclusion:The ilaprazole -based triple therapy could eradicate Hp infection,relieve symptoms and promote duodenal ulcer healing effectively and safely.There was no relationship between the efficacy and the dosage.The result also showed that the differences between ilaprazole and esomeprazole were not significant.

Objective To evaluate the Fuji intelligent chromo endoscopy (FICE) in the diagnosis of Barrett esophagus (BE).Methods From September 2010 to March 2011,a total of 180 patients with suspected reflux esophagitis were examined successively by FICE,magnifying FICE,acetic dyeing endoscopy and magnifying acetic dyeing endoscopy.The diagnosis was made out under the observation of lesion extensions,superficial mucosa contrast ratio,pit patterns and capillary forms of BE.The endoscopic diagnosis was made and compared with the pathologic diagnosis,and the consistency of the diagnosis was evaluated by Kappa value.Results BE was confirmed in 35 patients ( 19.4％ ) pathologically.The consistency rates of diagnosis under FICE and acetic dyeing endoscopy were 81.7％ and 72.8％ ( P ＜ 0.05 ).The consistency rates of diagnosis under magnifying FICE and magnifying acetic dyeing endoscopy were 97.8％ and 85.6％,respectively (P ＜ 0.05).FICE magnifying endoscopy revealed better mucosal structures of capillaries than magnifying acetic dyeing endoscopy did ( P ＜ 0.05 ),but there was no significant difference in revealing of duct openings (P ＞ 0.05).The specificity,sensitivity,positive predictive value,negative predictive value and Kappa value of FICE in diagnosis of BE were 82.1％,80.0％,51.9％,94.4％ and 0.52,respectively,which were 73.2％,71.4％,39.1％,91.4％ and 0.34 of acetic dyeing endoscopy,98.6％,94.3％,94.3％,98.6％ and 0.93 of magnifying FICE,and 88.3％,74.3％,60.5％,93.4％ and 0.58 for magnifying acetic dyeing endoscopy.Conclusion As a neotypical endoscopic system,magnifying FICE could exhibit clearly the pit patterns and microvascular structures of esophagus mucosa,and it can capture the optimal images of Barrett's epithelium.FICE could improve the diagnosis of BE in vivo.

>大肠黏膜隆起性病变80%以上是腺瘤性或增生性息肉。大肠息肉是老年人的一种常见疾病,因其临床特点、癌变率及组织学类型与中青年人不同。在诊断老年人大肠息肉时需选取适当的内镜检查。本研究初步探讨了应用内镜分光比色技术(FICE)的放大内镜对老年人大肠黏膜隆起性病变的诊断价值。一、资料与方法

慢性萎缩性胃炎（CAG）是消化系统常见的癌前疾病之一。目前，内镜结合病理组织学活检是诊断CAG的金标准，不过普通内镜诊断CAG的符合率差异较大。富士智能分光比色技术（FICE）通过计算机模拟色素内镜，增强了胃肠黏膜表面对比度，联合放大内镜可清晰显示黏膜表面腺管开口类型和毛细血管网结构，从而可提高胃肠道疾病的诊断准确率。本研究分别应用3种内镜模式对单纯慢性胃炎患者进行上消化道内镜检查，旨在评价FICE内镜诊断CAG的临床价值。

胃癌居我国恶性肿瘤之首[1],但早期胃癌(EGC)目前诊断率不高.胃癌发展到晚期,尽管确诊后及时手术,或放化疗等积极治疗,5年存活率仅为30％.然而EGC手术治疗10年存活率为90％以上,微小胃癌几乎可达到100％存活率,因此EGC的诊断在临床上十分重要,但由于EGC无特征性临床表现,故胃镜检查结合黏膜活检是目前最可靠的诊断手段.我院近几年来共检出EGC 23例,现分析报道如下.1临床与方法1.1 临床资料23例EGC均为我院门诊及住院病人,其中男19例,女4例,年龄20 ～68(平均年龄42)岁.病程3个月～12年.临床表现为上腹部疼痛18例,消瘦、乏力17例,呕血、便血3例.

目的:探讨FICE放大内镜10组波长组合对大肠息肉的观察效果,并选出最佳波长组合.方法:选择武汉大学人民医院2007-05/2010-05进行常规内镜检查,资料保存完整的大肠息肉患者378例.采用FICE放大技术预先设定的10组波长分别对病变进行腺管开口分型及毛细血管形态观察,并对图像清晰度进行评分,选出最佳波长组合,利用最佳波长组合判断病灶的性质,最终与病理结果相比较.结果:378例患者共发现大肠息肉432个.FICE放大内镜10组波长对病灶观察效果具有显著差异性（P＜0.001）,波长组合7（R=520nm,G=450nm,B=400nm）显示腺管开口优于其他波长组合（Rank%=25.73）,在观察黏膜毛细血管形态结构方面波长4（R=520nm,G=500nm,B=405nm）优于其他波长组合（Rank%=25.76）;二者结合与病理比较对病灶性质的判断符合率为95.6%,敏感性90.7%,特异性86.8%.结论:波长组合7及4分别对观察大肠息肉腺管开口和黏膜毛细血管效果较理想,且二者相结合可提高诊断符合率.