Objective:To analyze Helicobacter pylori ( Hp) resistance in Xiaoshan area from 2013 to 2020 and to provide reference for the selection of clinical antibiotics for the eradication of Hp in this area. Methods:Non-repetitive Hp strains isolated from patients treated in the First People′s Hospital of Xiaoshan District, Hangzhou from January 2013 to December 2020 and the drug susceptibility test results of these strains were collected. The patients were grouped by every 10 years of age to analyze the drug resistance of Hp in different groups and its changing trends. Results:A total of 54 912 Hp strains were isolated and cultured. The resistance rates of Hp isolates to amoxicillin, metronidazole, clarithromycin and levofloxacin were 0.42%, 92.94%, 22.41% and 29.83%, respectively. The drug resistance rates to clarithromycin and levofloxacin were increasing year by year. The resistance rates to levofloxacin, clarithromycin and metronidazole increased with age. The resistance rates to clarithromycin, levofloxacin and metronidazole in women were higher than those in men, especially in the 21-60 age group. The resistance rate to clarithromycin was significantly higher in people under 20 years old. In 2017 to 2019, the resistance rate to amoxicillin was higher in people under 20 years old than in other age groups. In 2020, the resistance rates to levofloxacin and clarithromycin in people over 70 years old both exceed 57% and increased rapidly. Conclusions:The resistance rates of Hp to levofloxacin, clarithromycin and metronidazole in Xiaoshan area were all at a high level. It was recommended to use individualized treatments for the eradication of Hp. In addition, attention should be paid to the young and older people.

目的:探讨结肠镜窄带成像（Narrowband imaging，NBI）技术对直径小于2 cm结肠息肉样病变的诊断价值。方法:选取温州医科大学附属萧山医院2020年1月至2021年1月收治的结肠息肉样病变患者172例为观察对象。使用结肠镜不同模式进行病灶的观察，比较不同模式下清晰度评分情况。对所有病理标本进行活检，以病理活检结果作为金标准对NBI诊断效能进行判断。结果:172例患者共计检出病灶数208个，病灶直径（0.73±0.29）cm，最小0.1 cm，最大2.0 cm。病理学检查结果：肿瘤性病灶132个（63.46%），非肿瘤性病灶76个（36.54%）。NBI模式下国际结直肠病变内镜（NBI International Colorectal Endoscopic Criteria，NICE）分型标准示：Ⅰ型78个（37.05%）；Ⅱ型104个（54.81%）；Ⅲ型16个（7.69%）。NBI模式和常规模式鉴别肿瘤与非肿瘤息肉样病变特异度分别为89.47%和81.57%，灵敏度92.42%和81.82%，准确率91.35%和81.73%；与金标准结果一致性系数Kappa=0.814、0.617，两者差异有统计学意义（ P<0.05）。 结论:结肠息肉样病变应用结肠镜NBI模式进行诊断时，能够显著提高图像清晰度，对直径小于2 cm的病变具有较高的鉴别诊断价值，值得临床推广。该研究具有显著创新性和科学性。

目的 探讨粪便23S rRNA基因检测判断幽门螺杆菌(Hp)感染以及克拉霉素耐药性的临床价值.方法 选取2018年1至12月因上消化道疾病于杭州市萧山区第一人民医院就诊、13C呼气试验阳性的患者86例,同时行胃黏膜组织培养联合药敏试验以及粪便23S rRNA基因检测,对比两种方法的Hp阳性率以及对克拉霉素的耐药情况.粪便23S rRNA基因检测的假阴性样本予以16S rRNA高通量测序进行验证.结果 粪便23S rRNA基因检测阳性率为79.07％(68/86),显著高于胃黏膜组织培养阳性率65.12％(56/86)(P<0.05).药敏试验克拉霉素耐药率为23.21％(13/56),低于粪便23S rRNA基因检测克拉霉素耐药率32.35％(22/68).与胃黏膜组织培养相比,粪便23S rRNA基因检测检出Hp阳性的灵敏度为96.43％(54/56),特异度为53.33％(16/30),对克拉霉素耐药的灵敏度为92.31％(12/13),特异度为78.05％(32/41),与药敏结果一致率为81.48％(44/54),Kappa值为0.581,提示一致性强度中等.结论 粪便23S rRNA基因检测具有较高的Hp阳性率和克拉霉素耐药灵敏度,可用于胃镜检查不耐受或13C呼气试验阳性胃黏膜组织培养阴性患者的Hp检测.

重症急性胰腺炎病情急,进展快,早期即可发生全身炎症反应综合征,甚至发展为多脏器功能衰竭,病死率较高.早期出现腹腔内高压和肠功能障碍是重症胰腺炎普遍存在的问题,如何积极有效的早期降低腹腔压力及恢复肠功能成为当前临床研究的热点问题[1].临床研究表明,清胰汤对胰腺炎控制有较好的疗效,能早期促进肠功能的恢复[2-4];而传统的胃管减压引流,胃管最深只能插到胃窦部,减压引流效果一般,而肠梗阻导管是一种新的治疗技术,其对胃内、肠道内积气、积液均能进行良好的减压、引流,可以明显缓解腹腔高压.本研究应用肠梗阻导管引流减压联合注入清胰汤治疗重症胰腺炎,观察临床效果,现报道如下.

Objective To analyze the drug resistance of Helicobacter pylori (Hp) strains isolated from teenagers (aged 13 to 19) in Xiaoshan area to metronidazole,clarithromycin,levofloxacin,amoxicillin and furazolidone. Methods A retrospective study was conducted on 1 452 teenagers who had endoscopic examination in the First People′s Hospital of Xiaoshan District from January 2012 to December 2017. Statis-tical analysis was performed to analyze the antibiotic resistance of Hp to various antibiotics. Results Teen-agers who were positive for Hp infection accounted for 16.46% (239). The resistance rates of Hp isolates to metronidazole and clarithromycin were 71.55% and 16.74% with an upward trend in the past two years. Among all Hp isolates, those resistant to levofloxacin, amoxicillin and furazolidone accounted for 5.02%, 0.0% and 0.84%,respectively. No significant change in the antibiotic resistance patterns of Hp was ob-served. There were 15.06% of Hp isolates resistant to both metronidazole and clarithromycin. No statistical-ly significant difference in antibiotic resistance patterns was found between Hp isolates from male and female teenagers in Xiaoshan area. Conclusion This study suggested that the Hp isolates showed high resistance to metronidazole,moderate resistance to clarithromycin and levofloxacin,and low resistance to amoxicillin and furazolidone. Attention should be paid to monitoring the antibiotic resistance patterns in teenagers and pro-moting individualized treatment with regard to the eradication strategy of Hp infection.

Objective: To explore the method of extracting chaperone antigen peptide complexes from gastric cancer stem cells and its immune function. Methods: Gastric cancer stem cells and gastric cancer cells were screened by low temperature ultrasonic lysis. After salting out and dialysis, the lysate supernatant was processed with SDS-PAGE to analyze the expression of chaperone antigen peptide complexes, and then was separated and purified with CNBr-activated SepharoseTM 4B. Reverse high pressure liquid chromatography (HPLC), SDS-PAGE and Western blotting were used to analyze the purity and nature of the acquired albumen. Lymphocyte proliferation assay and lymphocytotoxicity assay were used to ditermine the immunological activity of the chaperone-antigen peptide complexes. Results: The chaperone antigen peptide complexes of gastric cancer stem cells were prepared and identified successfully, of which the main components were the antigen peptides of HSP60, HSP70, HSP90 and HSP110. 0.75 μg and 1.00 μg HSP70-antigen peptide and 1.00 μg HSP90-antigen peptide activated lymphocytes significantly. Their A(490) values were 0.26±0.03, 0.45±0.05 and 0.32±0.04, respectively, while the corresponding doses of HSP60-antigen peptide and HSP110-antigen peptide did not activate lymphocytes. The killing rates of 1.00 μg HSP70-antigen peptide and 1.00 μg HSP70 were (45.0±2.0)% and (16.0±2.0)%, respectively, showing a significant difference (P=0.012). Similarly, the killing rates of 1.00 μg HSP90-antigen peptide and 1.00 μg HSP90 were (36.0±5.0)% and (13.0±4.0)%, respectively, also showing a significant difference (P=0.048). Conclusions: The amount of chaperone antigen peptide complexes in gastric cancer cells is extremely low, but it is obviously increased in gastric cancer stem cells. After purification, the chaperone antigen peptide complexes with high purity can be prepared. The extracted chaperone antigen peptide complexes have stronger immunogenicity, and can be used to make tumor vaccine in vitro, which may have a good application value in the targeted therapy of gastric cancer.

[Abstract ] Objective Difficulties with the preparation of gastric cancer stem cells (CSCs) have been a main obstacle to the studies of gastric cancer .This article addresses the technology of the serum-free medium suspension cultivation of the MKN-45 gastric cancer cell line and screening of stem cells from the cell line based on the biomarkers of gastric CSCs . Methods MKN-45 cells were cultured in serum-free medium for 8 weeks and those in the logarithmic phase cultivated with hoechst 33342 followed by detection of the side cells by flow cytometry .When the side population cells reached 25%, all the cell microspheres were collected , hatched with CD133 and CD44, and subjected to fluorescence-activated cell sorting.The CDl33 +and CD44 +cells were selected as gastric CSCs . Results About 40%of the MKN-45 gastric CSCs were alive , prolif-erated, and formed floating cell balls .Side population cells constitu-ted 3.4% of the MKN-45 cells and 26.9% of the cell balls.The CDl33 +and CD44 +cells made up 11.2% of the MKN-45 cells and&nbsp;90.3%of the cell balls. Conclusion Cell balls rich in CSCs can be successfully obtained by serum-free medium suspension culti-vation and CSCs can be screened out with hoechst 33342 and surface markers , which may serve as an experimental ground for the stud-ies of gastric CSCs .

目的：观察黄连素片联合复方嗜酸乳杆菌片治疗腹泻型肠易激综合征（IBS）临床疗效和安全性。方法将96例腹泻型IBS患者随机分为三组，A组（联合治疗组）32例，口服黄连素片（300mg/次，3次/d）和复方嗜酸乳杆菌片（1g/次，3次/d）；B、C两组各为32例，分别单用黄连素片和复方嗜酸乳杆菌片，治疗4周后三组进行疗效比较。结果 A组总有效率87.5％，B总有效率65.6%，C组总有效率68.8％， A组总有效率明显优于各单用药物的B、C两组（P<0.05），B组和C组比较，总有效率差异无统计学意义（P>0.05）。三组患者均未发现明显的不良反应。结论黄连素片联合复方嗜酸乳杆菌片治疗腹泻型IBS有效、安全、价廉，值得临床推广使用。

BACKGROUND: Biliary stents have been widely used in a variety of benign and malignant bile duct stricture as a palliative treatment. Its short-term efficacy is significant, but long-term use is limited by stent restenosis. OBJECTIVE: To produce a new antibacterial coating used in biliary stent by means of nano-silver/polyurethane, and to test in vitro antibacterial properties. METHODS: Firstly, composite materials were made of nano-silver and polyurethane by in situ reduction method. Antibacterial test was used to detect in vitro antibacterial properties against Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterococci of three groups: experimental group (nano-silver/polyurethane), positive control group (filter paper soaked in silver nitrate solution) and negative control group (polyurethane), antibacterial zone diameters were measured and analyzed. RESULTS AND CONCLUSION: The difference was not significant between experimental group and positive control group in the antibacterial effect on Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterococci. Nano-silver/polyurethane composite has good antibacterial property and better stability.

目的 探讨内镜黏膜下挖除术(endoscopic submucosal excavation,ESE)处理消化道黏膜下肿瘤(submucosal tumor,SMT)的疗效和安全性. 方法 2009年1～11月内镜发现的22例黏膜下病灶(食管11例、贲门2例、胃8例、结肠1例)作为入选对象,通过内镜超声(endoscopic ultrasonography,EUS)检查明确病灶大小、位置、性质,进行ESE治疗,观察其疗效和并发症情况. 结果 20例(91%)完整挖除,2例ESE术后创面仍有肿瘤残留且病理报告低度恶性,转外科手术扩大切除治疗.病灶直径0.5～3.5 cm(平均1.5 cm),手术时间20～220 min(平均75 min).3例穿孔均保守治愈.术后随访1～12个月(平均6.5月),20例完整挖除者均未见复发. 结论 ESE对消化道的SMT具有可完整挖除病灶、创伤小、术后恢复快等优点,值得推广.

Objective Many studies have shown that bufalin,as a Chinese medicine,can significantly inhibit the proliferation of various of tumor cells.This study was to observe the effects of bufalin on the expressions of p27 and cyclin E in Changliocarcinoma cell line QBC939,and to investigate the pathways of bufalin in inhibiting tumor cell proliferation and its antitumor mechanism.Methods Changliocarcinoma cell line QBC939 was cultured by the routine method,and then treated with bufalin at the concentrations of 0.1,1 and 10 μmol/L.Bufalin toxicity was detected by lactate dehydrogenase(LDH),the proliferation,apoptosis and cell cycle of QBC939 cells investigated by MTT and flow cytometry,and the protein expressions of p27 and cyclin E were determined by Western.Results Bufalin remarkably inhibited the proliferation of Changliocarcinoma cell line QBC939 in a time-and dose-dependent manner.Flow cytometry showed the cell cycle was arrested at G0/G1.Conclusion Bufalin may inhibit the proliferation of QBC939 cells by blocking cell cycle,down-regulating the expression of Cyclin E and up-regulating the expression of P27.