目的 探讨醋酸-美蓝双重染色在慢性萎缩性胃炎病理分型诊断中的价值.方法 92例经确诊为慢性萎缩性胃炎的患者,随机分为醋酸-美蓝双重染色组(32例)、美蓝染色组(30例)和盲法活检组(30例).所有患者常规服用二甲硅油等消泡剂后行普通白光胃镜检查,醋酸-美蓝双重染色组对可疑病灶处依次应用醋酸及美蓝染色后活检,美蓝染色组仅用美蓝对病灶进行染色后活检,盲法活检组仅凭操作者个人经验对可疑病灶处进行活检.所有病例均取4块组织活检,且均由同一高年资内镜医师完成,病理切片检查也由同一位经验丰富的病理医师完成.结果 病理检查发现:醋酸-美蓝双重染色组中,伴肠化者20例,检出率为62.5％,不典型增生者9例,检出率为28.1％;美蓝染色组中,伴肠化者14例,检出率为46.7％,不典型增生者5例,检出率为16.7％;盲法活检组中,伴肠化者10例,检出率为33.3％,不典型增生者2例,检出率为6.7％.经检验发现,不论是肠化生,还是不典型增生,双重染色组检出率较其他两组明显要高(P＜0.05).结论 醋酸-美蓝双重染色在慢性萎缩性胃炎病理分型诊断、判定病灶范围上有较大的应用价值.

目的 包装并鉴定人端粒酶逆转录酶(hTERT)启动子特异驱动白介素-24(IL-24)的重组复制缺陷型腺病毒.方法 全基因合成优化后的hTERT启动子,插入质粒pGL3-basic的多克隆位点(pGL3-phTERT);从人外周血单核细胞扩增IL-24,插入pGL3-phTERT质粒的hTERT启动子下游获得pGL3-phTERT-IL24;随后将phTERT-IL24插入pShuttle中间质粒,使用AdEasyTM Adenoviral Vector System包装Ad-phTERT-IL24重组腺病毒;同时包装CMV启动子驱动IL-24的腺病毒载体为阴性对照(Ad-CMV-IL24),以空载腺病毒Ad作为空白对照.用20 MOI重组腺病毒感染SGC-7901、MKN-45、HF细胞,采用PCR及Western blot检测IL-24在RNA及蛋白水平的表达.结果 成功包装Ad-hTERT-IL24重组腺病毒.感染Ad-hTERT-IL24后,hTERT阳性肿瘤细胞内IL-24表达显著上调,但hTERT阴性的HF细胞则无IL-24表达;感染阴性对照Ad-CMV-IL24后,hTERT阳性或阴性细胞内均有IL-24表达,感染空白对照Ad后,hTERT阳性或阴性细胞内均无IL-24表达.结论 Ad-hTERT-IL24腺病毒载体可有效介导IL-24特异表达于hTERT阳性肿瘤细胞内.

目的 探讨经内镜射频治疗消化道息肉的方法、疗效及适用范围.方法 我科2006年1月～2012年12月采用射频治疗胃肠道息肉患者869例,术后观察不良反应、内镜随访,评价治疗的安全性及有效性.结果 869例患者共1465颗息肉(息肉直径＜0.5 cm 368颗,0.5 ～2.0 cm 1062颗,＞2.0 cm 35颗),其中1452颗均一次性治疗成功,13颗直径＞3.0 cm广基息肉分2次处理.1个月后复查胃肠镜,所有息肉均脱落,黏膜恢复正常,少数留有白色瘢痕.术后不良反应有腹胀78例,轻度腹痛30例,烧心9例,对症治疗后均缓解.术后出血1例,予以镜下金属止血夹治疗,得到控制.无穿孔病例发生.结论 经内镜射频治疗消化道息肉,安全有效,操作简单,价格低廉,特别适合于直径0.5 ～2.0 cm的广基或亚蒂息肉.

[目的]观察西药马来酸曲美布丁及吗丁啉配合穴位埋线治疗功能性消化不良的临床疗效。[方法]经确诊为功能性消化不良的患者,随机分为治疗组与对照组。对照组单用西药马来酸曲美布丁及吗丁啉口服治疗,治疗组在此基础上配合穴位埋线治疗。治疗后进行包括症状改善及胃排空时间等临床疗效的比较。[结果]从症状改善上看,治疗组31例中,痊愈12例,显效13例,有效5例,无效1例,总有效率为96.70%;对照组32例中,显效3例,有效9例,无效11例,总有效率为71.80%;治疗组疗效明显优于对照组(P<0.05)。治疗组胃半排空时间为(27.93±4.31)min,胃排空时间为(39.09±7.19)min;对照组分别为(36.63±5.24)min、(48.72±10.0)min;治疗组胃排空时间明显较对照组短(P<0.05)。[结论]马来酸曲美布丁等西药配合羊肠线穴位埋线治疗功能性消化不良疗效明显优于单用西药治疗。

Objective To observe the changes and significance of tumor necrosis factor-α(TNF-α),soluble tumor necrosis factor recepter-1(sTNF-1R),interleukin-10(IL-10) in acute pancreatitis.Methods The 26 patients with mild acute pancreatitis(MAP group) and 22 patients with severe acute pancreatitis(SAP group) were measured the degree of TNF-α,sTNF-1R,IL-10 at 1,4,7,14 d by ELISA.Meanwhile,the 30 healthy patients were control group.Results In both MAP group and SAP group,serum TNF-α,sTNF-1R,IL-10 were approached the peak at the first day,then decreased gradually.In SAP group,serum TNF-α was significantly higher than those in MAP group at 1,4,7 d(P<0.01).Serum TNF-α in MAP decreased to the level of control group 7 days later,while those in SAP decreased to the level of control group 14 days later.Serum sTNF-1R has a similar trend as TNF-α in both MAP and SAP group.Differently,serum sTNF-1R in SAP group still keep high level 14 days later.Serum IL-10 in MAP group was significantly higher than those in SAP group at first day(P<0.01).Conclusion TNF-α,sTNF-1R and IL-10 play important roles in the development of acute pancreatitis,and they may be valuable indexes to predict the severity of acute pancreatitis.

Objective To observe the clinical efficacy and value of magnifying chromogastroseopic Radio frequency in treatment of verrucose gastritis.Methods Magnifying endoscope in combination with methylene blue staining were used to observe the micro-structures of gastric mucosa in patients with verrucose gastritis.68 cases with gastric pit types D,E and F were treated with Radio frequency.Three month after treatment.the patients were once more observed and evaluated clinical effects.Results Radio frequency had treated 306 foci of verrucose gastritis.with an average of 4.5 foci in each patient.Three-month follow-up showed that 63 cases(92.65%)with ameliorated symptoms,while 59 cases(86.76%)of them were with good results(free symptoms).49 patients(72.06%) were with gastric pit types A and B,10 cases(14.71%)with gastric pit type C,5 cases(7.35%)of the patients still had symptoms.The patients,who still had gastric pit types D,E and F,needed to be treated by Radio frequency again.Part of patients after receiving treatment of Radio frequency had upper abdominal hidden painand so on.No serious complication of Hemorrhage,perforation and so on occurred.Conclusion Magnifying hromogastroscopy can accurately identify the micro-structures and shapes of gastric pit,which makes it easy,accurate and effective to treat verrucose gastritis.Not only the curative effect is remarkable,moreover safe simple.

Objective To construct a replication-deficient recombinant adenovirus carrying hTERT-regulated miR-138.Methods The pre-miR-138 sequence was inserted into downstream of CMV promoter of the adenoviral shuttle plasmid pDC315 in sense direction,and the recombinant plasmid pDC315-miR138 was transfected into HEK293 cell together with plasmid pBHGlox(deltaE1,3) containing adenoviral genome,then the replication-deficient recombinant adenovirus expression vector of pre-miR-138(Ad-miR138) was obtained,and identified by infecting test,electronic microscope observation and PCR amplification.Results After purification and concentration,the titer of Ad-miR138 was achieved to 5×1010 pfu/mL.Virus particles could be found in HEK293 cells under transmission electron microscope.Both adenovirus and pre-miR-138 special fragment could be amplified from Ad-miR138 by PCR,whereas pre-miR-138 special fragment could not be amplified from the control Ad-LacZ.Conclusion The replication-deficient recombinant adenovirus carrying miR-138 was constructed successfully.This study establishes a foundation to further research on how microRNAs involves in the carcinoma development and the value of hTERT-regulated miR-138 on tumor therapy.

目的:探讨microRNA-138（miR-138）对人胃癌SCC-7901细胞株增殖能力的影响及可能的机制。方法:采用阳离子脂质体Lipofectamine2000将miR-138 RNA转染人胃癌SGC-7901细胞株,采用荧光实时定量PCR检测miR-138表达丰度;采用流式细胞术检测转染后的细胞周期;采用MTT法检测细胞生长曲线;采用Western blotting检测人端的端粒酶逆转录酶（hTERT）蛋白的表达。结果:转染miR-138 RNA后,SGC-7901细胞内miR-138表达丰度升高,细胞增殖能力受到显著抑制,同时hTERT蛋白表达水平下调。结论:miR-138可抑制人SCC-7901细胞的增殖能力,机制可能是通过抑制靶基因hTERT蛋白的表达。

目的了解食道胃底静脉曲张出血(EGVB)在胃镜下注射国产硬化剂聚桂醇和(或)国产组织粘合剂康派特的疗效及安全性。方法 2009年11月～2010年8月在我科经胃镜证实为EGVB 10例,其中单纯食道静脉曲张7例,同时存在食道胃底静脉曲张2例,孤立性胃底静脉曲张1例。胃镜下发现食道胃底静脉曲张后,先经胃镜活检孔插入注射针,将康派特注射进胃底静脉,采用"三明治"法,即"碘化油+康派特+碘化油",每次注射1～2点,每点康派特0.8～1.0 ml,康派特总量0.8～2.0 ml;后将聚桂醇注射入食道静脉,每根静脉5～10 ml,聚桂醇总量≤40 ml。对胃镜下仅发现胃底静脉曲张者,仅给予康派特治疗;仅食道静脉曲张者,则给予聚桂醇治疗(方法同前)。食道静脉曲张者首次治疗后,每周进行1次序贯硬化治疗,直到静脉明显减轻或消失;胃底静脉曲张首次尽量做到完全闭塞曲张静脉。术后常规禁食24 h,并给予生长抑素治疗1～3 d,观察生命体征变化。结果共进行25次聚桂醇和(或)康派特治疗,都成功止血且无早期再出血。结论胃镜下注射国产聚桂醇和(或)康派特对EGVB治疗是有效和安全的。

目的 评价美常安和蒙脱石散对腹泻型肠易激综合征(IBS)的疗效。方法 将176例确诊为腹泻型IBS的患者随机分成A组60例(服美常安胶囊500 mg,3次/d)、B组58例(服蒙脱石散3.0g,3次/d)和C组58例(服美常安+蒙脱石散,剂量同前),疗程14 d。观察治疗前、后患者的症状、排便次数、粪便性状改善状况。结果 A组和B组疗程结束总有效率分别为86.6％(52/60)和86.2％(50/58),C组达98.2％ (57/58),总有效率C组明显优于A组和B组(x2=5.64,x2=6.19,P均＜0.05)。停药4周内复发率A、B、C组分别为11.6％ (7/60)、32.7％ (19/58)、10.3％ (6/58),A组和C组明显少于B组,差异有统计学意义(x2 =7.34,P＜0.01)。结论 美常安和蒙脱石散对腹泻型IBS均有效,美常安疗效持久。联合应用美常安与蒙脱石散,对腹泻型IBS可达到止泻快且不易复发的效果。

目的研究内镜下美蓝-靛胭脂双重染色对早期胃癌及不典型增生的诊断价值。方法内镜下将104例胃黏膜异常表现患者分为两组,每组各52例。染色组内镜下先喷洒0.2%靛胭脂染色,发现可疑病灶后,再喷洒0.5%美蓝染色,然后在染色异常部位给予活检并送病理组织学检查;对照组不作染色,按肉眼判断,常规活检。结果染色组中检出有19例存在轻度到中度不典型增生,1例存在重度不典型增生,1例为重度不典型增生癌变,黏膜内癌2例,2例经手术及术后病理证实病灶仅限于黏膜层且无淋巴结转移,1例患者去向不明;对照组中分别检出6例轻度至中度不典型增生,早期胃癌0例,6例不典型增生复查时有1例因肉眼高度怀疑癌变而染色,着深蓝色后再次活检,病理报告少量腺体重度不典型增生伴癌变。两组检出率差异有统计学意义(P<0.01)。结论内镜下美蓝-靛胭脂双重染色可显著提高胃不典型增生和早期胃癌的检出率。

Objective To observe the eradication rate and side-effect of probiotics supplementation on anti-Helicobacter pylori triple therapy.Methods The 200 patients with peptic ulcer or chronic gastritis,in whom the results were both positive for the 14C-urea breath test and the rapid urease test,were divided into two groups randomly,i.e,group A was assigned to 14d triple therapy consisting of esomeprazole,clarithromycin and amoxicillin,group B was assigned to 14d triple therapy plus Medilac-S(Bacillus subtilis,Streptococcus faecium).The side-effects questionnaire was filled in once a week.The effect on eradication of Helicobacter pylori was determined by the 14C-urea breath test and the rapid urease test again four weeks later after finishing cure.Results The eradication rate of both groups was approximate,92.30% and 93.88%,respectively(P0.05).The gastrointestinal side-effects were obviously fewer in group B than that in group A(P0.01).Conclution Medilac-S supplementation may cut down gastrointestinal side-effects related to anti-Helicobacter pylori triple therapy,and shows a significant improvement in treatment tolerability.

Objective To compare the curative effect and side-effect of the combined treatment with Shenqi Fuzheng Injection and chemotherapy with only chemotherapy for patients with malignant tumors.Methods 62 cases were randomly divided into 2 groups: observation group(n=32) and control group(n=30);combined treatment was given to observation group and the treatment cycle was 5.7 on average while only chemotherapy was given control group and the cycle was 5.6 on average.Results In observation group,complete remission was found in 3 cases,partial remission in 12 cases,no changes in 11 cases and progressive deterioration in 6 cases,the total effective rate was 46.9%;in control group,complete remission was found in 1 case,partial remission in 9 cases,no changes in 11 cases and progressive deterioration in 9 cases,the total effective rate was 33.3%.After treatment,a comparison between the 2 groups showed that the level of CD3,CD4 and CD4/CD8 in observation group was much higher than that in control group,the difference was of significance(P<0.01);Quality of Life of the patients in observation group was improved much more than that of the patients in control group.Conclusions The combined treatment with Shenqi Fuzheng Injection and chemotherapy can decrease the side-effect of chemotherapy,lead to better compliance of patients,enhance immune function and improve Quality of Life.

Objective To investigate the change of the expression of TTF-1 and SP-A in lung tissue of ALI rats induced by LPS.Methods The protein and mRNA of TTF-1 and SP-A in lung tissue of ALI rats at different hours were measured with immunohistochemistry and RT-PCR method respectively.Results The expression of TTF-1 and SP-A significantly decreased at 12 and 24 hours.A significant positive correlation between TTF-1 and SP-A mRNA expression levels was detected.Conclusion The expression of TTF-1 in lung tissue of ALI rats induced by LPS decreased,which may be related to the occurrence and development of ALI.