目的 探讨按需内镜治疗在老年肝硬化上消化道出血患者中的疗效,评估其预防出血的作用.方法 2013年1月至2021年1月上海交通大学医学院附属瑞金医院北院院区消化内科收治的肝硬化并发上消化道出血患者186例,均为老年患者.分为内镜治疗组和药物治疗组,各93例.内镜治疗组患者均为初次行内镜下静脉曲张套扎术(endo sco pic variceal ligation,EVL),术后定期复查,于3～6个月后序贯内镜治疗.药物治疗组患者仅行药物治疗.分析2组治疗后再发出血的情况.结果 内镜治疗组患者中,13例(14.0％)于EVL术后半年内再发出血;药物治疗组患者中,47例(50.5％)于治疗后半年内再发出血,差异有统计学意义(P<0.05).随访至1年后,内镜治疗组中7例(7.5％)患者再发出血,药物治疗组中27例(29.0％)再发出血,差异有统计学意义(P<0.05).分别对两组患者进行半年内再出血相关因素分析,结果年龄、性别、脾脏切除术、Child-Pugh分级均与再次出血无显著相关(P>0.05).结论 对于老年肝硬化上消化道出血患者,按需内镜治疗安全有效.经内镜序贯治疗后,对比药物治疗组再次发生消化道出血率显著下降.

目的 分析结直肠进展期腺瘤(advanced colorectal adenoma,ACA)在不同年龄患者中的特点,探讨影响其漏诊及再发的因素.方法 收集2012年1月至2017年12月在上海交通大学医学院附属瑞金医院北部院区接受肠镜检查的患者,共纳入符合条件的ACA 835枚,分析这些患者的年龄、性别、检出ACA基数、大小、形态、位置、肠道准备情况,初步了解中青年(≤60岁)及老年(>60岁)患者的ACA特点,探讨其漏诊及再发的相关因素.结果 在漏诊的中青年ACA中,性别、肠道准备情况组间比较,差异有统计学意义(P<0.05),男性及肠道准备欠佳者易出现漏诊情况(P=0.001、P=0.000),而肠镜ACA基数、大小、位置组间比较,差异无统计学意义(P>0.05).在再发的中青年ACA中,性别组间比较差异有统计学意义(P=0.005).在漏诊的老年ACA中,男性、多发ACA、扁平或宽蒂的结直肠ACA、肠道准备欠佳者易出现漏诊情况(P=0.002、P=0.023、P=0.001、P=0.000),而ACA大小、位置组间比较,差异无统计学意义(P>0.05).在再发的老年ACA中,同中青年ACA,性别组间比较差异有统计学意义(P=0.040),而肠镜ACA基数、大小、形态、位置、肠道准备情况差异无统计学意义(P>0.05).对ACA的漏诊及再发相关因素进行Logistic回归分析发现,患者的年龄(OR=0.608,P=0.007)、性别(OR=2.553,P=0.000)、Boston评分(OR=0.464,P=0.000)是影响ACA漏诊的独立危险因素,而患者的性别(OR=1.589,P=0.018)是影响ACA再发的独立危险因素.结论 年龄越大、男性、肠道准备差会导致ACA的漏诊,而男性ACA的再发风险更高.

Objective To analyze the therapeutic effect of endoscopic injection of tissue adhesive combined with hardener for the portal hypertensive patients with gastric varicose and prognosis. Methods A total of 84 patients with upper gastrointestinal hemorrhage and gastric varices diagnosed by gastroscopy during 2006 to 2015, who were performed endoscopic injection with tissue adhesive with hardener, were included in this study. The rate of gastric hemorrhage was compared before and after endoscopic treatment. The rate of gastric varices elimination and the prognosis were analyzed. Results There were 111 times of endoscopic treatment for 84 cases with an average of(1.32±0.68) times per case. Bleeding was (0.72±0.54) times/month before treatment and (0.30±0.82) times/month after treatment respectively with significant difference statistically(P<0.01). The eradication rate of varicose veins with almost disappearance was 75.0% during the period of 6 months post endoscopic treatment and 70.8% after 6 months of endoscopic treatment. No re-bleeding was found without any complications, ectopic embolization and infection after follow-up of (14.82±19.30) months. Conclusions Endosco-pic injection of tissue adhesive and hardener for gastric varices would reduce the rate of bleeding of gastric varicose and the varicose vein, which was an important procedure for prevention of re-bleeding of gastric varicose vein and could be applied clinically.

Objective:To analyze the autosomal dominant inheritance of five families of adenomatous polyposis (FAP).Methods:Five FAP families were investigated and examined. Peripheral blood and feces were taken for whole-exon sequencing to screen colorectal cancergenes. Colonoscopy was performed and biopsy tissues were taken for pathological analysis.Results:In the five families, FAP occurred in successive generations. When the father or mother had FAP, the probability of FAP occurred in the offspring was equal (50%) without gender difference. All the patients had adenomatous polyposis coli gene (APC) mutation. Some patients had more than two types of tumors.Conclusions:In families with a history of FAP, FAP generally does not develop in juveniles, and APC gene testing and colonoscopy are needed in adults. Once adenoma is found, endoscopic treatment should be performed as soon as possible to avoid the occurrence of colorectal cancer.

Abstract The interaction between intestinal epithelial cells (IECs) and lymphocytes is known to regulate mucosal barrier function, immune responses, and by extension, to play an etiologic role in the development of chronic inflammation in Ulcerative colitis (UC). However, the biologic function of lymphocytes and their relationship with IECs is insufficiently understood. In this study, we report, for the first time, the establishment of 3-dimensional (3D) co-culture systems of lymphocytes and mouse primary colonic organoids.C57BL/6 mice were treated with dextran sulfate sodium to induce acute colonic inflammation. Primary colonic organoids were established from cells isolated from mouse colons. Lymphocytes isolated from spleens by Ficoll density gradient assays. Colonoids and lymphocytes were co-cultured. The effects of the tested drugs on the co-culture system were assayed by Enzyme-linked Immune Sorbent Assay (ELISA) for inflammatory molecules. Inflammatory stimulation resulted in a significant increase in inflammatory cytokines in the supernatant of the colonoid-lymphocyte organoid system. Treatment with drugs known to be effective in patients with UC demonstrated a reduction in inflammatory cytokines. These findings argue that the colonoid-lymphocyte system can be utilized to model inflammation in vitro as well as for drug discovery. To validate these findings, we tested three other drugs. We produced experimental evidence that, indeed, these three drugs also induced a decrease in inflammatory cytokines of varying degrees. We report, for the first time, the successful establishment of a 3D colonoid-lymphocyte system and we validate its ability to predict the anti-inflammatory properties of several small molecules.

Objective:To investigate the value of fecal calprotectin(FC)in the diagnosis of patients with inflammatory bowel disease(IBD)in Jiading district of Shanghai of China.Methods:The fecal samples of 43 subjects from March 2020 to May 2020 in North District of Shanghai Ruijin Hospital were collected and divided into two groups: IBD group(n=28)and healthy control group(n=15). Fluorescence immunochromatography was used to quantitatively detect FC concentration in feces.Results:The FC concentration in 15 healthy subjects was 40.63 μg/g, and that in 28 patients with was 323.45 μg/g.There was a significant difference in FC concentration between IBD group and control group(P<0.05). When 60 μg/g was taken as the critical value, the sensitivity and specificity of FC to determine whether IBD was active or not were 82.14% and 86.67%, respectively.There were also significant differences in FC concentrations between active IBD patients and inactive IBD patients and healthy subjects(P<0.05).Conclusion:FC test, as a non-invasive diagnosis and treatment method, can be used as an alternative index for endoscopic diagnosis of disease activity, which has a good application value in the diagnosis of IBD and the assessment of disease activity in Jiading district of Shanghai of China.

Objective:To investigate the time from symptom onset to visit doctor and diagnosis of gastric cancer in Jiading district of Shanghai.To understand the influencing factors and analyze the reasons for its gap with the international community.Methods:The clinical data of 1 279 patients with gastric cancer diagnosed by pathology in the Ruijin Hospital North Affiliated to Shanghai Jiao Tong University School of Medicine from December 2012 to April 2020 were collected.The symptoms of patients first visit(according to common " gastric cancer alarm symptoms" : abdominal pain, abdominal distension, acid regurgitation, belching, nausea and vomiting, hematemesis and melena, weakness and poor appetite, etc.), visiting time and diagnosis time(endoscopic biopsy or surgical pathological diagnosis)were investigated.Multivariate Logistic regression model and other methods were used for statistical analysis of the factors influencing the visiting and diagnosis of patients.Results:The main symptoms of 1 279 patients were abdominal pain in 556(43.47%), bloating, acid regurgitation and belching in 389(30.42%), black stools, hematemesis and fatigue in 205(16.03%), food obstruction, nausea and vomiting in 87(6.80%), and elevated tumor indexes found by physical examination in 42(3.28%). The average medical visit time was(1.25±0.55)months, which was related to the patients′ symptoms, the distance and the way of payment of medical expenses.The average diagnosis time was(4.76±1.85)months, which was related to the time of the patients′ visit and whether the first visit was performed by gastroscopy.Logistic regression analysis showed that symptoms(OR=1.545, 95% CI: 1.341-1.781)and medical expenses payment method(OR=1.939, 95% CI: 1.021-3.681)were risk factors for timely diagnosis of gastric cancer.Medical treatment distance(OR=1.695, 95% CI: 1.509-1.989)and the choice of gastroscopy for first visit(OR=1.008, 95% CI: 1.049-1.124)were protective factors for timely diagnosis of gastric cancer.Conclusion:The symptoms of gastric cancer patients in Jiading area of Shanghai are mainly abdominal pain, distension, regurgitation of acid, belching, hematemesis, black stools, and fatigue.The time of visit and diagnosis was longer than that in foreign countries, which was related to the patients′ awareness of gastric cancer and gastroscopy, medical treatment distance, medical expense payment route and other factors.

目的 通过微信推送,提前建立护患关系,将预住院进行电子结肠镜检查患者的饮食宣教前移至入院前,让患者提前了解肠道准备要求,在家中完善肠道前期准备,减轻住院后肠道准备难度,达到肠道清洁的效果.方法 将2019年8月—9月184例住院进行电子结肠镜检查的患者作为对照组,按常规流程宣教;将2019年10月—11月128例住院进行电子结肠镜检查的患者作为观察组,在患者住院前通过微信进行宣教.对比两组患者进行肠镜诊治前的饮食依从性和服药依从性,运用波士顿评估量表对患者肠道准备清洁度进行评估.结果 观察组的饮食依从性和服药依从性均高于对照组(P<0.05),肠道准备清洁度高于对照组,差异有统计学意义(P<0.05).结论 通过微信饮食宣教前移至住院前,提前建立护患关系,对提高预行电子结肠镜检查患者的肠道准备清洁度有显著效果.

肝小静脉闭塞病( hepatic veno-occlusive disease, HVOD)是一种以肝脏小静脉闭塞为特征的疾病.此病的发病机制还未完全阐明,国内报道主要由服用土三七引起. 研究发现,土三七有肝毒性,可能与其含有吡咯里西啶生物碱( pyrrolizidine alkaloids, PAs)有关[1]. 临床主要表现为黄疸、肝区疼痛、肝脏肿大、体重增加并伴或不伴有腹水等[2]. 由于HVOD是一种少见病,然近几年多发,现将护理体会报道如下.

目的 利用信息化闭环管理,解决病区在传统静脉输注高警示药品时存在的问题.方法 从医生开具医嘱至输液结束,设置关键业务节点,借助电脑终端和智能移动终端,构建在静脉输注高警示药品时的信息化闭环管理.通过医护人员对高警示药品认知度和满意率调查及实施前后输液规范性对比,评价使用效果.结果 利用信息化技术可对临床高警示药品使用实行全程实时监控并储存相关信息,使药物使用更精准,减少因人为因素造成的不良后果.结论 信息化闭环管理在静脉输注高警示药品中的应用,能提高医护使用高警示药品的安全意识,降低患者医疗风险,为临床护理安全提供保障,提升护理管理水平.

*Corresponding author: Yunlin Wu, Department of Gastroenterology, Shanghai Jiaotong University Medical School, Ruijin North Hospital, Shanghai, China, E-mail: 15026691592@139.com Introduction Colorectal Cancer (CRC) is a common malignancy associated with mutations in multiple genes. It may take 10 years to progress from a benign tumor to CRC in 80% of the affected people. Therefore, CRC screening is critical for early detection and treatment of this disease. The Fecal Occult Blood Test (FOBT) and colonoscopy are the mainstay of CRC screening. However, the FOBT has a low diagnostic performance especially for colorectal adenoma [1-3]. Colonoscopy is the gold standard for diagnosing CRC with good sensitivity and specificity but is associated with a high risk of complications and low compliance [3]. Cancer cells from early-stage CRC are continuously shed into the colonic lumen and mixed into stool. Tests for genetic and Abstract

目的:采用RNA靶向干扰技术,研究人胃癌细胞BGC823中微小RNA(microRNA,miRNA,miR)-200c的靶点锌指E盒增强子结合蛋白2(zinc finger E-box enhancer binding protein 2,ZEB2)基因的表达情况,并检测相关的波形蛋白基因表达情况,观察miR-200c对胃癌BGC823细胞功能的影响.方法:构建ZEB2基因表达的干扰质粒shZEB2,用Lipofectamine 2000转染胃癌BGC823细胞,用G418筛选稳定转染细胞株,进行实时定量聚合酶链反应(polymerase chain reaction,PCR)检测人BCG823细胞中ZEB2 mRNA、miR-200c及波形蛋白基因的表达水平,并用蛋白印迹法检测ZEB2蛋白、波形蛋白表达水平,噻唑蓝(methylthiazolyldiphenyl-tetrazolium bromide,MTT)法检测细胞增殖能力;Transwell小室检测细胞侵袭能力,划痕实验检测细胞迁移能力.结果:干扰ZEB2分子表达后,miR-200c表达水平增高,而BGC823细胞的增殖、迁移及侵袭能力明显下降.结论:ZEB2是miR-200c的检测靶点,干扰ZEB2后,胃癌细胞BGC823的增殖、迁移及侵袭能力明显降低.

Patient screening is important for early diagnosis of colorectal cancer (CRC). The present study aimed to compare the multitarget stool DNA (mt-sDNA) test with the fecal occult blood test (FOBT) for CRC screening. A total of 151 individuals were screened using colonoscopy, mt-sDNA and FOBT for the detection of CRC and adenoma. The results of the mt-sDNA test and FOBT were compared with colonoscopy to examine their sensitivity and specificity. Subsequently, the sensitivity and specificity of the mt-sDNA test were compared with those of FOBT in CRC and large adenoma. Stool samples were collected from patients with CRC (n=50) or large adenoma (n=51), as well as from normal controls (n=50). The mt-sDNA test outperformed FOBT in detecting CRC with a sensitivity of 90.0% (45/50) vs. 42.0% (21/50), advanced adenoma with a sensitivity of 70.6% (36/51) vs. 19.6% (10/51), stage I-III CRC with a sensitivity of 91.9% (34/37) vs. 29.7% (11/37), and stage IV CRC with a sensitivity of 84.6% (11/13) vs. 76.9% (10/13). In addition, the mt-sDNA test exhibited a specificity of 94.0% (47/50) in detecting CRC, which was superior to FOBT with a specificity of 90.0% (45/50). Therefore, the mt-sDNA test may have higher sensitivity and specificity compared with FOBT in diagnosing both CRC and advanced adenoma.

皮硝别名硫酸钠,在医学上常用于外敷来治疗浮肿、水肿、乳肿等疾病.本科室常将皮硝用于急性胰腺炎[1]及腹水严重的患者[1 ,2].皮硝呈碎颗粒状,外敷需要先将其盛装在皮硝袋内,再将皮硝袋置于患者身上需要治疗的部位.现使用的皮硝袋为柔软布料制成的,包括并排设置的6个袋体,袋体之间依次连接但不连通.每个袋体上端有约7 cm宽的开口,开口的内表面上设置有一对一魔术贴,通过魔术贴来将开口打开或闭合.传统方法是将皮硝装入皮硝袋需要使用者打开一个袋体的开口并将一只手撑在开口处,用另一只手配合漏斗将皮硝装入皮硝袋内,装好后闭合开口,再依次装好所有的袋体(见图1).

Objective To observe the endoscopic morphology of gastric varices of patients with portal hypertension type one isolated gastric varices (IGV-1) and to explore the etiology,treatment and prognosis of portal hypertension IGV-1.Methods From January 2006 to June 2018,at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and North Branch of Ruijin Hospital,54 patients with portal hypertension IGV-1 were retrospectively analyzed.The varices were classified according to the endoscopic morphology and the etiology treatment,therapeutic efficacy and prognosis were also analyzed.Descriptive method was used for statistical analysis.Results Among the 54 patients with portal hypertension IGV-1,the endoscopic morphology of varices were tuber type in 24 patients (44.4％),grape string type in nine patients (16.7％),strip type in five patients (9.3％),dendritic type in three patients (5.6％) and mixed type in 13 patients(24.1％).Etiological analysis showed that the primary disease of 34 cases (63.0％) were hepatogenic,11 cases (20.4％) were pancreatic origin,and nine cases (16.7％) were from other diseases.As to treatment,three cases (5.6％) were treated with adhesive,two cases (3.7％) were treated with sclerotherapy,and 49 cases (90.7％) were treated with combination of adhesive and sclerotherapy.Therapeutic efficacy evaluation showed that 46 cases (85.2％) were significantly effective,eight cases were effective,0 case was ineffective,and all the 54 cases (100.0％) were improved.The prognostic analysis showed that 35 cases (64.8％) had no bleeding in five years and eight cases (14.8％) had no bleeding in 10 years.Nine patients (16.7％) died,including six cases of pancreatic cancer,two cases of liver failure and one case of gastrointestinal bleeding.Conclusions The endoscopic morphology of IGV-1 portal hypertension in mainly tuber type.The main cause is hepatogenic and the combination of adhesive and sclerotherapy is beneficial to the regression of gastric varices.

目的 了解和分析上海市嘉定区胃癌患者在选择就医至确诊为胃癌的影响因素.方法 收集2013年1月至2018年4月上海交通大学附属瑞金医院北院接受外科胃癌根治术患者共589例的临床资料.调查患者的主诉、学历、有无医保、常住地址、发病年龄、就医后选择是否为胃镜检查方式对患者确诊为胃癌的影响.并采用x2检验、多因素Logistic回归模型等方法进行统计学分析.结果 589例患者及时就诊的影响因素包括患者是否存在报警症状(即主诉)及常住地址(与就诊医院的距离)(P＜0.05).患者来院就诊后选择下一步接受胃镜检查,或是坚持服药缓解症状,则与患者主诉、是否有医保、常住地址、发现症状及时就医与否有关(P＜0.05).患者首次就医至确诊时间的长短,与患者的主诉、常住地址、就医后是否选择胃镜检查方式相关(P＜0.05).Logistic回归分析显示,主诉(OR=1.550,95％ CI:1.346～1.784)、有无医保(OR=1.942,95％ CI:1.023 ～3.686)是胃癌确诊及时性的危险因素.而发病年龄(OR=0.970,95％ CI:0.947～0.994)、常住地址(OR=1.699,95％CI:1.519～1.943)、就医后选择方式(OR=1.010,95％ CI:1.052～1.128)是胃癌确诊及时性的保护因素.结论 患者出现症状、就诊、确诊为胃癌的及时性,与患者有无医保、不适主诉、常住地址等密切相关.

目的 探讨护理信息化建设过程中,智能化电子输液卡在优化临床输液治疗中的应用效果.方法 通过前期设计及沟通,于2016年6月逐步推进全院电子输液卡的使用.通过随机抽查各病区使用电子输液卡前后(分别抽取2016年5—8月的200份纸质输液卡作为对照组,抽取2016年10月—2017年1月的200份电子输液卡作为观察组)的输液记录质量,并调查患者满意度(电子输液卡使用前后分别调查250例患者)来评价电子输液卡的使用效果.结果 使用电子输液卡后,静脉输液过程中的护理差错发生率明显降低,患者满意度有所提高.结论 智能化电子输液卡可有效加强静脉输液过程中的质量控制,规范护理行为,提高护理记录质量,有利于节约人力、物力,维护患者权益,提高患者满意度.

Objective To investigate the effects of nursing supplementary intervention on cirrhosis patients after esophageal variceal ligation so as to provide reference for clinical nursing work. Methods A total of 87 cirrhosis patients with endoscopic variceal ligation in the Department of Gastroenterology of Ruijin Hospital North Affiliated to Shanghai JiaoTong University School of Medicine from May 2015 to May 2016 were collected.All the patients were randomly divided into two groups as the control group(43 cases)and the observation group(44 cases)by random number table method.The patients in the control group received the traditional nursing cares, and the patients in the observation group received the nursing supplementary interventions including psychological intervention, dietary intervention, drug interventionand discharge guidance.The nursing effects of the two groups were observed and compared. Results The nursing effects were statistically analyzed between the two groups: (1)The recurrent hemorrhage rate of patients in the observation group was 9.09%, which was lower than that of patients in the control group(25.58%), and the difference was statistically significant(P<0.05). (2)The postoperative complication rate of the observation group was 11.36%, which was lower than that of the control group(30.23%), and the difference was statistically significant(P<0.05). (3)The patient satisfaction of the observation group was 95.45%, which was higher than that of the control group(76.74%), and the difference was statistically significant(P<0.05). Conclusion The nursing supplementary intervention can obviously reduce the recurrent hemorrhage rate and complication rate of patients after esophageal variceal ligation, and then significantly improve the patient satisfaction and improve the quality of nursing service. Key words: Nursing supplementary intervention; Esophageal variceal ligation; Recurrent hemorrhage rate; Postoperative complication rate; Patient satisfaction

目的 随访嘉定地区2年内结肠直肠息肉临床特点及内镜下治疗后的改变,以期更好地指导今后的临床及科研工作.方法 收集2年间上海交通大学医学院附属瑞金医院北院就诊的结肠镜检查结肠直肠息肉性疾病治疗前后患者的临床资料,根据基本信息,包括性别、年龄、发病时的症状、结肠镜检查结果及后续其他检查手段,分析病情的变化并进行统计学分析.结果 结肠直肠息肉需经内镜治疗1 265例,男776例,女489例,临床表现为无症状(10.1％)、血便/黑便/粪隐血阳性(27.8％)、腹痛(10.7％)、腹泻(22.0％)及其他(29.4％).以远端结肠(直肠、乙状结肠)分布为主(49.7％),多息肉患者占25.0％.青年组581例(45.9％),老年组684例(54.1％).老年和青年组内息肉的病理类型、形态学、大小中以管状腺瘤、山田Ⅰ型、＜1.0 cm发病率最高,组内比较,差异有统计学意义(P＜0.05);而老年组及青年组组间比较,差异无统计学意义(P＞0.05).1265例患者内镜下治疗中热活检钳除52例,APC电凝581例,EMR模式切除622例,ESD模式切除10例.均成功切除息肉,无死亡病例.并发症主要表现为:腹痛45例,出血36例,肠穿孔2例,发热4例.术前及术后息肉病理学比对一致率为85.6％.随访时间为1年,再发现率为39.9％.结论 上海市嘉定地区结肠直肠息肉处于高发病率状态,注重肠镜筛查尤为重要.在内镜下的治疗中,注意多种手术方式的有机结合,注重疾病的长期随访和治疗,对预防疾病的复发尤为关键.