Objective:To evaluate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) for treatment of duodenal lesions.Methods:A retrospective analysis was performed on the data of 45 patients with 46 duodenal lesions who underwent ESD at the Second Xiangya Hospital of Central South University from January 2011 to May 2019. The lesion features, en bloc resection rate, complete resection rate, complications, postoperative pathology and recurrence were assessed.Results:Among the 45 patients, 20 were males and 25 were females, with age of 52.0±11.8 years. Of the 46 lesions, 31 (67.4%) were located in the duodenal bulb, 12 (26.1%) in the descending part, and 3 (6.5%) at the junction of bulb and descending part. The diameter of the lesions was 2.4±1.9 cm. There were 14 (30.4%) lesions originated from mucosal layer, 29 (63.1%) from submucosal layer, and 3 (6.5%) from muscularis propria.Postoperative pathology showed 11 (23.9%) cases of Brunner gland tumors, 9 (19.6%) neuroendocrine tumors, 5 (10.9%) ectopic pancreas, 5 (10.9%) lipomas, and 16 (34.8%) other pathological patterns. All 45 patients with 46 lesions underwent ESD successfully, and the en bloc resection rate was 100.0% (46/46), complete resection rate was 91.3% (42/46). Intraoperative bleeding occurred in 1 case (2.2%), which was successfully treated by endoscopy. One (2.2%) delayed perforation occurred and was treated by surgical intervention. Electrocoagulation syndrome occurred in 1 case (2.2%), which was relieved after conservative medical therapy. Two cases received further surgery after ESD. The mean hospital stay was 6.2 days (ranged 2-21 days) and no death occurred. Forty-one cases were followed up for 1-78 months, with mean time of 30 months. During the follow-up period, local recurrence occurred in 1 patient (2.4%).Conclusion:ESD is an effective and safe treatment for duodenal lesions and has a good clinical practical value.

恶性肿瘤已成为继心血管疾病外全球第二大死亡原因.消化系统恶性肿瘤的发病率和死亡率在我国恶性肿瘤排名中均位居前列.肿瘤的发生发展是一个多因素参与、多阶段的过程,蛋白质的乙酰化和去乙酰化在肿瘤的发生发展中起着重要作用.蛋白质的去乙酰化由组蛋白去乙酰化酶(histone deacetylases,HDACs)调控.目前共发现1 8个HDACs,其中HDAC6是该家族中研究最广泛的一类亚型.HDAC6已被证实在多种肿瘤组织中呈高表达状态,并与患者临床病理特征密切相关,HDAC6选择性抑制剂可抑制多种肿瘤细胞生长.本文就HDAC6在消化系统原发恶性肿瘤中的作用及潜在应用价值进行作一述评.

先证者(Ⅱ7) 男,35岁.自幼出现遇冷乏力.每到深秋和冬天遇冷后即感身体暴露部位无力,表现为吹冷风后睁闭眼困难,喝冷饮后咀嚼费力、言语欠流利,浸泡冷水后手指活动不灵活、握拳后难以松开,取暖能促进恢复.日常生活无明显受累.夏天或温暖环境下能胜任中重度体力劳动.无肌肉疼痛,无秃发.既往无白内障,无精神异常,无糖尿病及视力下降。

Objective To investigate the association between the Clock T3111C and T257G gene polymorphisms and sleep epilepsy patients in Han population of Hunan province.Methods Three hundred and eleven subjects with epilepsy ( sleep epilepsy group ( n =112 ),aperiodic group ( n =95 ),awakening epilepsy group ( n =104 ) ) and 300 sex- and age-matched healthy controls were enrolled in the study.Genomic DNAs were extracted from peripheral blood leucocytes by phenol-chloroform methods.The Clock T3111C and T257G polymorphisms were detected by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP).Results (1) Two genotypes(TT and TC) were detected in Clock T3111C.The frequency of Clock site T3111C genotypes in all of the people was 86.09％ (TT,526/611),13.91％(TC,85/611),0( CC),T allele gene frequency was 93.04％ (1134/1222) and C allele gene frequency was 6.96％ (85/1222).There was no significant difference in genotype and gene distribution of Clock gene T3111C polymorphism between sleep epilepsy group,aperiodic group,awakening epilepsy group and control group.(2)Two genotypes(TT and TG) were detected in Clock T257G.The frequency of Clock site T257G genotypes in all of the people was 85.92％ (TT,525/611 ),14.08％ (TG,86/611 ),0( GG),T allele gene frequency was 92.96％ (1136/1222) and G allele gene frequency was 7.04％ (86/1222).There was no significant difference in genotype and gene distribution of Clock gene T257G polymorphisms between sleep epilepsy group,aperiodic epilepsy group,awakening epilepsy group and control group.(3)There was an almost complete correspondence (complete linkage disequilibrium) of bases between the positions 257 and 3111.Conclusion Clock gene T3111C and T257G polymorphisms are not associated with sleep epilepsy in Han population of Hunan province.

临床资料患者女性,35岁,主因"双下肢麻木乏力40 d"于2010年3月30日入院.患者40 d前无明显诱因出现双下肢麻木,无力,以足部明显,并逐渐向上发展,累及腘窝处.偶有双手指尖麻木,无疼痛;偶有头晕、视物模糊,无头痛、恶心呕吐及二便障碍,未予特殊处理,病情呈进行性加重,以"双下肢麻木无力"收住我科.患者近1年来,性欲减退,月经周期延长,皮肤明显变黑,面部肌肉消瘦明显.2010年3月12日查血常规:白细胞11.6×109/L,中性粒细胞9.5×109/L.促甲状腺素(TSH)11.61 mU/L.肝肾功能、心肌酶、电解质、血管炎相关免疫学检查均呈阴性.胸片显示双侧少量胸腔积液、心影改变.