Introduction - Eosinophilic gastrointestinal diseases (EGIDs) are rare and heterogeneous diseases characterized by excessive eosinophilic infiltration of the digestive system. D-dimer levels and its possible association with disease course were not reported. Case series - We reported a series of three EGID cases presenting with high levels of D-dimer. No evidence for potential venous thromboembolism was found through computed tomography pulmonary angiogram and vascular ultrasounds. Moreover, D-dimer levels decreased after short-time systemic prednisolone administration, accompanied by remission of clinical symptoms and decrease of peripheral eosinophil counts and IgE levels. Conclusion - Elevation of D-dimer in EGID may not represent thrombotic events but is possibly associated with disease severity. More population-based studies are needed to delineate the potential relationship among D-dimer, thrombosis, and inflammation in EGID.

Background:The effect of cholecystectomy on the development of colorectal cancer (CRC) has prompted a large number of population-based studies. However, the results of these studies are debatable and inconclusive. Our aim in the present study was to conduct an updated systematic review and meta-analysis to explore the causality between cholecystectomy and CRC.Methods:Cohort studies published in the PubMed, Web of Science, Embase, Medline, and Cochrane databases up to May 2022 were retrieved. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were analyzed using a random effects model.Results:Eighteen studies, involving 1,469,880 cholecystectomy and 2,356,238 non-cholecystectomy cases, were eligible for the final analysis. Cholecystectomy was not associated with the development of CRC (P=0.109), colon cancer (P=0.112), or rectal cancer (P=0.184). Subgroup analysis of sex, lag period, geographic region, and study quality revealed no significant differences in the relationship between cholecystectomy and CRC. Interestingly, cholecystectomy was significantly associated with right-sided colon cancer (RR =1.20, 95% CI: 1.04-1.38; P=0.010), especially in the cecum, the ascending colon and/or the hepatic flexure (RR =1.21, 95% CI: 1.05-1.40; P=0.007) but not in the transverse, descending, or sigmoid colon.Conclusions:Cholecystectomy has no effect on the risk of CRC overall, but a harmful effect on the risk of right-sided colon cancer proximally.

肝硬化是各种肝脏疾病的终末阶段,肝硬化能否逆转已争议多年,越来越多的证据表明,肝硬化在去除病因、得到有效治疗后可发生一定程度的逆转.肝纤维化是各种慢性肝病发展为肝硬化的重要中间环节,具有修复和损伤双重性,肝纤维化可进一步发展为肝硬化甚至肝癌,严重威胁患者生命.因此,肝纤维化逆转的研究对于临床诊治具有重要的指导意义.动物实验是生物医学研究的基本手段之一,也是连接基础研究和临床试验的重要桥梁,本文总结不同动物模型包括化学损伤性肝纤维化逆转模型、胆管结扎肝纤维化逆转模型和非酒精性脂肪性肝纤维化逆转模型等,通过归纳不同动物模型的优点与局限性,为肝纤维化逆转研究提供依据,以更好地指导临床实践.

肝硬化是由多种原因引起的以弥漫性纤维组织增生、肝小叶结构破坏、假小叶形成为特征的肝病.在多种肝硬化动物模型及不同病因肝硬化患者中均可见胆管增生.多种神经肽、神经递质及激素等调节因子参与的信号通路调控胆管增生.增生的胆管通过介导星状细胞增殖、活化,促进肝纤维化的形成.总结了肝硬化时肝内胆管系统的改变及其对纤维化进程的影响,胆管细胞增生与肝纤维化相关的信号通路,以及胆管结构的动态演变对肝纤维化程度的预测价值.提出胆管增生可能成为干预肝纤维化的潜在靶点,为早期治疗及逆转肝纤维化提供新的思路和方法.

肝静脉压力梯度(HVPG)是诊断门静脉高压症以及判断其严重程度的"金标准",但因其有创性、操作技术难度大,限制了其在临床中的广泛开展.通过非侵入性方法替代HVPG是目前研究的热点,但现有的血清学及影像学方法的准确度仍有待商榷,尚不能在临床中完全替代HVPG.肝活检已在临床中广泛开展多年,是确诊某些肝脏疾病不可或缺的方法.近来研究发现肝穿刺后的病理学指标,如胶原面积、纤维间隔厚度、结节大小、微血管密度及胆管、淋巴管密度和面积等,不仅能判断肝纤维化的严重程度,而且与门静脉压力也有良好的相关性.这对诊断肝硬化门静脉高压症及评估门静脉高压症严重程度提供了新的思路.

BACKGROUND:Primary intestinal lymphangiectasia (PIL) is a rare protein-losing enteropathy characterized by the loss of proteins, lymphocytes, and immunoglobulins into the intestinal lumen. Increasing evidence has demonstrated an association between PIL and lymphoma.CASE PRESENTATION:A 54-year-old man with a 20-year history of abdominal distension and bilateral lower limb edema was admitted. Laboratory investigations revealed lymphopenia, hypoalbuminemia, decreased triglyceride and cholesterol level. Colonoscopy showed multiple smooth pseudo polyps in the ileocecal valve and terminal ileum and histological examination showed conspicuous dilation of the lymphatic channels in the mucosa and submucosa. A diagnosis of PIL was made. Three years later colonoscopy of the patient showed an intraluminal proliferative mass in the ascending colon and biopsy examination confirmed a malignant non-Hodgkin lymphoma. Then the patient was been underwent chemotherapy, and his clinical condition is satisfactory.CONCLUSION:Our report supports the hypothesis that PIL is associated with lymphoma development.

目的 对四氯化碳(CCl4)化学损伤性以及胆管结扎(BDL)机械梗阻性大鼠门静脉高压模型进行比较,对两种动物模型在门静脉高压形成过程中的特点进行探讨.方法 CCl4模型分为模型组和对照组,BDL模型分为模型组和假手术组.分别于造模后4周、8周、12周测量门静脉压力、取肝脾组织标本.从大鼠一般情况、门静脉压力数值、大体标本变化、病理形态学、体质量、肝脏湿重、脾脏湿重这几方面对两种动物模型进行比较分析.正态分布的资料以均数±标准差表示,两组比较采用t检验.结果 CCl4组肝脏大体变化以肝叶变形、粘连为主,病理表现为纤维间隔分割肝实质,假小叶形成.而BDL组肝叶形态尚存,肝脏呈深褐色,病理表现为大量胆管增生.就门脉高压形成过程而言,CCl4组门静脉压力呈逐渐升高趋势,与对照组相比,造模8周、12周有统计学差异(P<0.05).BDL组门静脉压力呈现短期迅速升高趋势,造模4周、8周及12周较假手术组均明显升高且有统计学差异(P<0.05).在体质量、肝脏湿重、脾脏湿重这几个指标中,脾脏湿重与门脉压力升高趋势一致.在CCl4组,脾脏质量亦是逐渐增加的.而在BDL组,造模4周脾脏质量较假手术组明显增加,造模8周、12周时较假手术组有统计学差异(P<0.05).结论 两种动物模型门静脉高压形成过程及压力变化趋势不同,本文为深入认识不同原因肝硬化门静脉高压提供了实验依据.

中医是我国的传统医药,对许多疾病均有独特的治疗效果,不良反应少,患者易于接受,临床应用广泛.文章介绍中医之调方、换药,供临床医生探讨.

Objective This study was aimed to investigate the repair potential of hepatic fibrosis in rats with carbon tetrachloride(CCl4)-induced liver fibrosis after hepatic progenitor cell(HPC)transplantation. Methods CCl4was intraperitoneally injected for 4 weeks,8 weeks and 12 weeks to establish the model. Immunohistochemical staining was used to detect the expression of OV6-positive HPCs in liver tissues. 14 male SD model rats were randomly divided into spontaneous reversal group(n=7)and HPCs transplantation group(n=7). HPCs transplantation was conducted by intrasplenic injection with 5×106HPCs/0.5 ml. Liver tissues was stained with hematoxylin-eosin and sirius red,and histopathological changes were observed. The expression of OV6 and α-smooth muscle agonists(α-SMA)in liver tissues were detected by immunohistochemical staining,and the α-SMA and tissue inhibitor of matrix metalloproteinases(TIMP)-1 were detected by Western bloting. Serum type I collagen and albumin levels were measured by ELISA. Results The number of OV6 positive cells in liver tissues reached the peak at 8 weeks after intraperitoneal injection of CCl4,and decreased at 12 weeks;the degree of fibrosis was reduced in HPCs-transplanted group,and the area of collagen was significantly decreased as compared with in the spontaneous reversal group[(3.14±0.99)vs.(5.05±0.89),P<0.05];the relative quantification of α-SMA [(1.22 ±0.10)vs.(0.31±0.08)] and TIMP-1 protein [(0.43 ±0.09)vs.(0.25 ±0.032)] in spontaneous reversal group was much higher as compared with in HPCs transplantation group;serum type I collagen levels in the spontaneous reversal group was higher than in the HPCs transplantation group [(41.33±8.08) ng/ml vs.(31.12 ±10.08)ng/ml,P <0.05]. serum albumin levels in spontaneous reversal group was remarkably lower than that in the HPCs transplanta-tion group [(33.18±4.69)g/L vs.(48.30±2.15)g/L,P<0.05]. Conclusion Hepatic progenitor cell transplantation have the potential to accelerate the reverse of liver fibrosis and improve liver function in rats with liver fibrosis.

非糜烂性胃食管反流病(non-erosive reflux disease, NERD)亦被定义为内镜阴性胃食管反流病.随着生活节奏的加快,NERD的发病率及复发率日趋增高.我们将近几年来对NERD的中医药治疗进展从病因病机,辨证分型,中、西医治疗对比,中西医结合治疗,西医治疗,专家经验方法等方面加以综述.提炼专家们的真知灼见,并对其共性经验及个性特点加以总结和阐述.同时分析当前存在的问题及不足.

Objective:To observe the clinical efficacy of Jiedu Zhitong Decoction combined with Meridian Embedding Therapy in treating for acute gouty arthritis patients.Methods:Analyse retrospectively 60 patients with acute gouty arthritis which belongs to Heat and Humid Accumulation syndrome.All patients were randomly divided into two groups,Jiedu Zhitong Decoction combined with Meridian Embedding Medicine group and Jiedu Zhitong decoction combined with voltaren group respectively.Before and after treatment,the symptoms score,the level of blood uric acid,erythrocyte sedimentation rate and C-reactive protein value were compared in both groups.Results:The symptoms score,the level of blood uric acid,erythrocyte sedimentation rate and C-reactive protein value were significant decreased after treatment with Jiedu Zhitong Decoction and Meridian Embedding Medicine,which decreased to 2.20±2.09,291.75±119.22 μmol · L-1,11.70 ±11.06 mm· h 1,7.08 ±6.17 mg· L-1 respectively(P＜ 0.001).In addition,the treatment group has significantly therapeutic effect than the control group.Conclusion:The Jiedu Zhitong Decoction combined with Meridian Embedding Therapy is effective in treating for acute gouty arthritis,which can quickly alleviate clinical symptoms,decrease blood uric acid,erythrocyte sedimentation rate and C-reactive protein.

This paper summarized the literature about traditional Chinese medicine fumigation treatment for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, lumbar disc herniation, cervical spondylosis, periarthritis of shoulder joint pain diseases. This paper aimed to provide reference for the study of Chinese medicine fumigation treatment of joint pain diseases.

Objective: To explore the efficacy of treating ectopic pregnancy in the integrative medicine. Methods: 30 cases of ectopic pregnancy was not efficient of western medicine. Then they were given TCM more. The curing efficiency, serumβ-hCG and mass diameter, etc. were observed; and the efficiency of the integrative medicine were evaluated. Results: The curing efficiency was 90.0%. After treatment the serumβ-hCG was decreased to normal value. Enclosed mass was absorbed. Conclusion: Treating ectopic pregnancy in the integrative medicine could be obviously improve efficiency, decrease the serumβ-hCG, reduce the enclosed mass , relief the pain of surgery.

Recent researchs showed angiogenesis is a hallmark of liver fibrosis as activation of hepatic stellate and accumulation of extracellular matrix during injured repair responding and architecture remodeling. Angiogenesis cooperate with liver injury factors, cytokins, and play a key role to affect the progesssion and prognosis.

门静脉高压症是肝硬化最严重的并发症[1].目前,肝静脉压力梯度(hepatic venous pressure gradient,HVPG)是诊断门静脉高压的"金标准"[2].但由于HVPG属有创性操作,且费用高,难以重复,只能在少数大型医院开展[3],因此对门静脉高压无创性诊断的研究具有重要临床意义.

<正>中医学对狐惑病的研究渊源流长。《金匮要略》对狐惑病的论述堪称经典,其曰:"狐惑之为病,状如伤寒,默默欲眠,目不得闭,卧起不安,蚀于喉为惑,蚀于阴为狐,不欲饮食,恶闻食臭,其面目乍赤、乍黑、乍白。蚀于上部则声喝,甘草泻心汤主之。蚀于