目的 探究Y染色体性别决定区相关高速泳动族框因子9(SOX9)和周期素依赖性激酶4(CDK4)在结直肠息肉、结直肠癌中的表达及意义.方法 选取中国人民解放军第八十二集团军医院2015年1月至2017年6月收治的结直肠癌病人病理组织标本(结直肠癌组)94例及癌旁正常结直肠组织(正常结直肠组)39例,另取同时期结直肠息肉病人结直肠息肉组织(结直肠息肉组)51例.采用免疫组织化学SP染色法检测SOX9、CDK4的表达情况,分析SOX9、CDK4表达与结直肠癌病人临床病理参数之间的关系;对结直肠癌病人进行术后复查随访,分析结直肠癌病人生存情况.结果 SOX9在正常结直肠组织、结直肠息肉组织和结直肠癌组织中的阳性表达率分别为10.26％(4/39)、27.45％(14/51)、76.59％(72/94),差异有统计学意义(P<0.05);CDK4在正常结直肠组织、结直肠息肉组织和结直肠癌组织中的阳性表达率分别为7.69％(3/39)、21.57％(11/51)、54.84％(51/94),差异有统计学意义(P<0.05);正常结直肠组织中SOX9、CDK4蛋白表达水平低于结直肠息肉组织、结直肠癌组织(P<0.05),结直肠息肉组织中SOX9、CDK4蛋白表达水平低于结直肠癌组织(P<0.05).结直肠癌病人病理组织SOX9、CDK4表达与肿瘤分化程度、临床分期、是否合并淋巴结转移有关(P<0.05);结直肠癌组织SOX9与CDK4表达呈正相关(r=0.58,P<0.001),由TCGA数据库检索结直肠癌组织SOX9、CDK4基因表达相关性显示,二者之间亦呈正相关(r=0.40,P<0.001);SOX9高表达、低表达病人术后3年累积生存率分别为44.6％、72.4％,两组比较Log-rank检验差异有统计学意义(χ2=8.31,P=0.004);CDK4高表达、低表达病人术后3年累积生存率分别为25.6％、76.5％,两组比较Log-rank检验差异有统计学意义(χ2=36.36,P<0.001).结论 SOX9和CDK4在结直肠癌组织、结直肠息肉组织、正常结直肠组织中的阳性表达率逐渐降低,与结直肠癌肿瘤分化程度、临床分期、淋巴结转移情况及预后有关,可能参与结直肠癌的发生发展过程.

目的 探讨Pokemon、TIP30和人宫颈癌基因-1(HCCR-1)在直肠癌组织中的表达及预后的关系.方法 纳入100例2016年6月至2018年6月本院收治的直肠癌患者,收集术中切取的100份直肠癌组织及癌旁组织.采用免疫组织化学方法检测Pokemon、TIP30及HCCR-1蛋白的表达水平.比较Pokemon、TIP30及HCCR-1不同表达水平患者临床资料的差异.对患者进行随访2年,采用多元Logistic回归分析影响直肠癌患者预后生存的危险因素,绘制Kaplan-Meier生存曲线,研究Pokemon、TIP30及HCCR-1蛋白表达情况对直肠癌患者预后生存的影响.结果 直肠癌组织中Pokemon、HCCR-1蛋白表达水平显著高于癌旁组织,而TIP30蛋白表达水平显著低于癌旁组织,差异有统计学意义(P<0.05);年龄、性别、局部浸润程度与直肠癌患者组织Pokemon、TIP30及HCCR-1蛋白表达无相关(P>0.05),但Dukes分期、淋巴结转移与Pokemon、HCCR-1蛋白表达呈正相关,而组织分化程度与TIP30蛋白表达呈负相关(P<0.05);100例直肠癌患者2年生存率为43.00％(43/100).Dukes分期、淋巴结转移、分化程度、Pokemon高表达、TIP30低表达及HCCR-1高表达为影响直肠癌患者预后生存的独立危险因素(P<0.05).Pokemon、HCCR-1蛋白低表达组平均生存时间显著长于高表达组,TIP30蛋白高表达组平均生存时间显著长于低表达组,差异有统计学意义(P<0.05).结论 Pokemon、HCCR-1、TIP30与在直肠癌患者组织中密切相关,可作为预测直肠癌患者预后的分子标志物和肿瘤治疗的潜在靶点.

目的:分析嗜酸性胃肠炎的临床特及诊治方法,建设误诊误治.方法:回顾性分析我院收治的15例误诊为其他疾病的嗜酸性胃肠炎的临床资料,并复习相关文献.结果15例给予药物治疗(醋酸泼尼松40mg),患者临床症状消失,大便成形,血常规示嗜酸性粒细胞正常.结论:嗜酸性肠炎临床表现多样,缺乏特异性,故缺乏经验的首诊医生容易漏诊.

目的 观察聚乙二醇电解质口服溶液在结肠镜检查前肠道清洁的效果.方法 将该院2014年2月—2016年2月实施肠道手术的180例患者作为研究对象,采用随机平均方法将其分为观察组和对照组,其中观察组采用聚乙二醇电解质口服溶液,对照组使用20%甘露醇.对比两组的肠道清洁度、不良反应和研究对象的依从性.结果 观察组和对照组的肠道清洁度有效率分别是100.0%和80.0%,差异有统计学意义(P<0.05);不良反应的发生率分别是5.6%和21.1%,差异有统计学意义(P<0.05);依从率分别是97.8%和80.0%,差异有统计学意义(P<0.05).结论 聚乙二醇电解质口服溶液用于肠道清洁准备中存在效果好、不良反应少、患者依从性较高等优点,可以在临床上进行推广.

Objective It is to observe the curative effect of compound Dachengqi decoction on severe acute pancreatitis ( SAP) and the effect on the levels of serum oxygen -free radicals.Methods 65 cases of patients with SAP were randomly di-vided into treatment group and control group .The control group was treated with diet resistance , continue gastrointestinal de-compression , inhibition of enzyme and keeping waterelectrolyte balance , and the treatment group was treated with compound Dachengqi decoction on the basis of treatment of the control group .The changes of serum SOD , MDA, amylase and lipase were determined in both groups before treatment and 10 d after treatment , reliving time of symptoms and clinical curative effect were observed and compared .ResultsThe reliving time of symptoms of treatment group after treatment was significantly shorter than that of control group (P<0.01), the levels of serum SOD were higher, and the levels of MDA, amylase and lipase were lower than those before treatment in both groups (P<0.01), and the improvements in treatment group were more significant than that in control group (P<0.01).The total effective rate of treatment group was higher than that of control group (P<0. 05).Conclusion Compound Dachengqi decoction can effectively clear serum oxygen -free radicals in the patients with SAP , and it has a good curative effect on this disease .

神经鞘瘤（schwannoma）起源于神经鞘膜 Schwann 细胞，是外周神经系统的常见肿瘤之一，多发生于神经节和神经干周围，部位以头颈部、胸腔、躯干、四肢居多，消化系统神经鞘瘤相对少见，仅占全身神经鞘瘤的0.2%，其中90%为胃神经鞘瘤［1］。肠系膜神经鞘瘤十分罕见，截至2015-01-31，检索万方数据库仅有6例个案报道。

<正>急性重胰腺炎(SAP)是常见急腹症之一,多由胆管疾患、酒精、感染、外伤引起,随着对急性胰腺炎变理变化的深入了解,对其治疗已有较为明确的意义,研究表明中药辅助治疗能显著缩短SAP患者的腹痛缓解时间、住院天数,明显降低病死率[1],研究显示,血清肿瘤坏死因子-α(TNF-α)、白介素-10(IL-

<正>患者,女,32岁,因腹痛腹胀1个月入院,患者1个月前无明显诱因出现上腹持续性胀痛,恶心,呕吐。呕吐为胃内容物。当地县医院化验肝肾功能正常,血常规正常,血淀粉酶稍高。腹部超声胰管稍宽。诊断为急性胰腺炎,给予抗炎,抑酶、抑酸等治疗,腹痛有所减轻,腹胀加重,入院3天前并出现腹泻,大便3-5次/日,绿色稀水样便,无肉眼脓血,既往体健。无药物及食物过敏史。

肝硬化患者由于门脉高压致胃肠道淤血、胆汁酸和胃酸的相对缺乏及胃肠运碍等因素导致肠腔需氧菌增多，结肠的细菌移行至空肠及十二指肠，引起小肠细菌过度增长（SIBO），我科应用莫沙必利联合双歧杆菌疗肝硬化小肠细菌过度增长的患者62例，取得较好效果。现报道如下:

<正>缺血性结肠炎是由于供应结肠的血管或分支阻塞导致肠壁缺血性改变的一种疾病,本病多见于中老年人,多位于结肠脾区、降结肠和乙状结肠,急性结肠缺血大多为一过性,可逆性改变,少数可发生全肠壁坏死、穿孔或持续性结肠缺血,多发生于老年,随着临床认识的不断提高及检查手段的增加,我科2009-2012年收治了11例青年人缺血性

<正>外伤性脑梗死是颅脑损伤患者常见及严重的并发症,一旦发生,脑功能损害加重,严重影响患者预后,预防或减少外伤性脑梗死发生及对外伤性脑梗死患者进行积极有效治疗,显得尤为重要。1资料与方法1.1一般资料选择我院2005年5月至2011年10月收治的50例外伤性脑梗死患者,男35例,女15例;年龄2~60岁,平均年龄36.7岁。致伤原因:车祸伤30例,坠落伤16例,打击4例。1.2临床表现伤后一过性昏迷15例,浅昏迷10例,中度昏迷25例。GCS计分:9~15分15例,患者意识清楚,自觉头痛、头晕、恶心,生理反射存在,病理发射未引出。4~8分35例,患者表现昏迷状态,生理反射正常或迟钝,病理反射阳性,其中合并脑疝10例,偏瘫30例,偏深感觉障碍5例,面瘫6例,失语

Objective To investigate the effects of astragalus the on c-fos and c-jun gene expression in hepatic stellate cells.Methods Hepatic stellate cells (HSC-T6) were cultured in medium containing different concentrations of astragalus (1.0,and 0.5 g/L) and harvested at different incubation time points (8,24,48,and 72 h).Total RNA of HSC-T6 cells was isolated and the c-fos and c-jun gene expression levels were detected by using reverse transcription polymerase chain reaction.Results The c-fos gene expression levels of HSC-T6 cells in two astragalus groups were significantly lower than those in control group (0.63 ±0.13,0.50 ±0.12,0.43 ±0.06,and 0.32 ±0.04) after exposure to astragalus at 8 h (0.32 ±0.10,0.50 ±0.12),24h (0.24 ±0.08,0.42±0.10),48h (0.20±0.04,0.34 ±0.07) and 72 h (0.12 ± 0.03,0.23 ± 0.05).The c-jun gene expression levels of HSC-T6 cells in two astragalus groups were also significantly lower than those in control group (0.93 ±0.13,0.80 ±0.12,0.63 ±0.10,and 0.46 ± 0.07) after exposure to astragalus at 8 h (0.46 ± 0.10,0.66 ± 0.12),24 h (0.36 ± 0.08,0.57 ± 0.11),48 h (0.27 ± 0.08,0.43 ± 0.10) and 72 h (0.19 ± 0.03,0.32 ± 0.05).The c-fos and c-jun gene expression levels in HSC-T6 cells were decreased gradually as the dosage of astragalus increased,and there were significant differences in the c-fos and c-jun gene expression between two astragalus groups.Conclusion Astragalus may down-regulate the c-fos and c-jun gene expression in hepatic stellate cells.

Objective To explore the diagnostic value of the narrow-band imaging(NBI) combined with magnifying endoscopy in treating patients with early esophageal cancer or precancerous lesions.Methods 110 patients′ vascular structures of esophageal mucosal surface during September 2008 and July 2009 were classified esophageal mucosa grades of NBI,types in papillary capillary loop(IPCL) assorted,infiltrating depth determined and biopsy taken by NBI combined with magnifying endoscopy.Results 121 lesions were found in 110 patients in this group.Sug-esophageal mucosa of NBI were divided into three grades and IPCL into five types which were consistent with the infiltrating depth typing of histopathology.Early esophageal cancer or dysplasia lesions were observed brown which were clearer to the limits of normal mucosa by narrow-band imaging combined with magnifying endoscope.21 patients with severe dysplasia or early esophageal cancer underwent ultrasound endoscopy,and lesions did not exceed the submucosa.Conclusion It is valuable to identify the peculiarity and range of early esophageal cancer or precancerous lesions by narrow-band imaging combined with magnifying endoscopy.

口服甘露醇作为结肠镜检查前肠道清洁剂,效果良好,近年来5000余例,仅出现3例急性水中毒.现报告如下. 资料与方法 一般资料:男2例,女1例,年龄56～72岁.均口服甘露醇500ml加水2000ml 2小时内服完.

<正>内镜下成人的结节性胃炎表现易与萎缩性胃炎相混淆,常被忽视甚至误诊为慢性萎缩性胃炎,现对我院近年诊断的成人结节性胃炎病例的临床特点和治疗方法总结分析如下以提高对它的认识。

目的:探讨老年食管结核的临床特点,总结误诊原因,提高本病诊断水平。方法:报告1例老年食管结核,回顾分析本例诊治经过。结果:本例以进行性吞咽困难为主诉入院,吞咽困难以进食固体食物为著,伴嗳气、反酸,偶有咳嗽、咳痰,初诊考虑慢性支气管炎。行胸部CT、纤维胃镜检查、超声内镜、刷片抗酸染色及活检病理检查等,确诊为原发性肺结核、食管继发性结核。转传染科行规范抗结核治疗,病情好转出院。结论:消化科医师对以进食困难为主诉的患者要高度警惕食管结核,及时完善纤维胃镜、胸部CT等检查,活检前行刷片抗酸染色找结核杆菌诊断成立。不能因1次病理阴性放弃诊断,重复检查可提高诊断率。

[病例] 男,30岁.主因早饱、呕吐2个月,加重伴上腹胀15 d就诊.胃镜见:胃底、体交界后壁可见巨大肿物,大小7.0 cm×8.0 cm,呈半球状广基黏膜下隆起,表面黏膜基本完整,可见毛细血管网,无黏膜桥形成(图1见封3),考虑间质瘤、壁外肿物不除外.

我科在丙泊酚麻醉下胃镜检查时发现喉部肿瘤2例,现报告如下. 1 病例报告

[病例]女,65岁.主因吞咽不畅1个月就诊.既往体健.查体上腹部压之不适,未发现其他异常.胃镜检查示:距门齿30～31 cm食管黏膜可见一平坦隆起型病变,表面粗糙,颗粒不平,充血(图1A见封3).

结节性胃炎(nodular gastrtis)是一种内镜下描述,表现为以胃窦部为主可扩展至胃体部的色泽均匀的结节样或颗粒样改变,病理特征为以淋巴细胞为主的炎性细胞浸润,多有伴生发中心的淋巴滤泡(Lymphoid Follicle.LF)增生.