2015年 · 第35卷第11期

China is a country with high incidence of gastric cancer, and it has been increasing in recent years. If gastric cancer can be detected early and treated in time, it can reduce the loss of life and property of patients' families and reduce the social burden. However, the detection rate of early gastric cancer is still low in clinic, mainly due to the atypical performance of early gastric cancer under traditional white light endoscopy. magnifying endoscopy (ME) combined with narrow band imaging (NBI) is a new type of endoscopic imaging technique. Compared with traditional white light endoscopy, it has higher resolution of gastric mucosa surface and microvascular morphology^[1]。 However, there are few clinical studies on the use of ME-NBI for early diagnosis of precancerous lesions such as early gastric cancer and intestinal metaplasia (IM) in high-risk populations of gastric cancer in China. Therefore, this study was intended to evaluate the accuracy of ME-NBI in the detection of gastric cancer in people at high risk of gastric cancer.

Photodynamic therapy is a commonly used method for treating tumors in clinic. It has great advantages for some tumors that cannot be resected by surgery or recurrent cavity organ tumors after surgery. Especially for advanced unresectable colorectal cancer, photodynamic therapy has the advantages of less trauma, high safety and painlessness. At present, the main methods of treating tumors are chemotherapy, radiotherapy and surgery. These methods have good curative effect for early stage tumor treatment, but poor curative effect for late stage or postoperative recurrence patients, and the recurrence rate after operation can reach 40% ~60%^[1,2]。 Photodynamic therapy has been used in laryngeal cancer, breast cancer, esophageal cancer, gastric cancer, colorectal cancer, central lung cancer and gynecological tumors^[3]。 Photodynamic therapy can improve symptoms, reduce suffering, improve the quality of life of patients, and prolong life. The results of 15 patients treated with photodynamic therapy for colorectal cancer in Guangzhou Fuda Cancer Hospital from January 2013 to May 2014 are reported below.

Rectal adenocarcinoma with extracellular mucus composition>50% is rectal mucinous adenocarcinoma, accounting for 5% ~10% of rectal cancer, and the prognosis is poor^[1]。 Based on postoperative histopathological findings, this study compared the extent of intestinal involvement of tumor measured by preoperative MRI, in order to improve the understanding of MRI in the diagnosis and evaluation of rectal mucinous adenocarcinoma.

IBS is a common functional gastrointestinal disease. Although it does not cause serious consequences, its clinical symptoms will seriously affect the quality of life of patients and increase the mental burden of patients. At present, intestinal flora has become a hot spot in IBS research. There are more than 500 kinds of bacteria in human normal intestine, which play an important role in maintaining the balance of intestinal micro-ecology^[1]。 In this study, we used 16S rDNA method to quantitatively analyze 6 species of bacteria in the feces of IBS patients, and observed the differences of intestinal target flora between different subtypes of IBS patients and healthy controls.

Constipation is a common clinical disease in gastroenterology, especially in elderly stroke patients, with a complication rate of 90%^[1]And constipation can affect the disability and mortality of stroke patients^[2]。 Therefore, it is very important to solve the problem of post-stroke constipation quickly and effectively. In this study, 82 outpatients and inpatients with post-stroke constipation from March 2011 to March 2014 were compared with different treatment schemes, and the clinical efficacy of lactulose combined with Bacillus subtilis double live bacteria in the treatment of post-stroke constipation was mainly observed.

autoimmune hepatitis (AIH) is an inflammatory reactive lesion of the liver parenchyma mediated by abnormal autoimmune response. The standard treatment drugs for autoimmune hepatitis are glucocorticoids and azathioprine^[1]。 However, these immunosuppressive drugs all have different degrees of adverse reactions, and some patients with AIH still fail to obtain remission after standard treatment. Therefore, it is necessary to actively explore new treatment options for AIH. ursodeoxycholic acid (UDCA) is currently recognized as the first choice drug for the treatment of primary biliary cirrhosis and overlap syndrome. Studies have shown that it can also be effective or adjuvant in the treatment of AIH. In this study, the clinical data of patients with AIH treated with immunosuppressants or UDCA combined with immunosuppressants were retrospectively analyzed, aiming to analyze the efficacy of UDCA combined with immunosuppressants in the treatment of AIH, and provide clinical reference.

primary biliary cirrhosis (PBC) is a chronic progressive autoimmune disease of the liver, and its pathogenesis is not completely clear at present. It has been clinically observed that patients with PBC may be associated with systemic autoimmune diseases. Some PBC patients with poor response to urodeoxycholic acid (UDCA) had significantly higher mortality^[1]。 Therefore, early diagnosis and treatment are of great significance for PBC patients. lymphadenectasis (LA) can be seen in chronic liver disease, especially in patients with PBC. Hyperplasia of lymph nodes in hepatointestinal ligament may be observed in the early stage of patients with immune liver disease, which may be related to immune damage^[2]However, the research on its significance with clinical characteristics and pathogenesis is rarely reported.

Notch signaling pathway exists widely in invertebrates and vertebrates, and is highly conserved in evolution, which plays an important role in maintaining cell growth and differentiation. It was found that it promotes the growth, invasion and metastasis of hepatocellular carcinoma through Notch1/Jagged1 pathway^[1,2,3]。 However, the relationship between Notch3, one of the main receptors of Notch signaling pathway, and hepatocellular carcinoma is rarely studied at home and abroad. In this study, the expression of Notch3 in human hepatocellular carcinoma was detected by real-time PCR and immunohistochemistry, and its correlation with clinicopathological parameters of hepatocellular carcinoma and its effect on prognosis were analyzed, so as to provide new experimental basis for further research on the role of Notch signaling pathway in hepatocellular carcinogenesis.

The patient was a 77-year-old male, originally from Wenzhou. He was admitted to hospital in September 2012 due to anorexia, skin pigmentation, nail atrophy, accompanied by weight loss, fatigue and diarrhea for half a year. Physical examination: thinning hair, atrophy of nails, pigmentation of finger tips of limbs, dark skin, no yellowing stain of skin sclera, unpalpable superficial lymph nodes, no abnormalities in heart and lungs, no tenderness and rebound pain in abdomen, and no edema in both lower limbs. Thyroid ultrasound revealed: thyroid echo changes, considered as Hashimoto's thyroiditis. Gastroscopy showed congestion and edema of the gastric mucosa, extensive polypoid hyperplasia (Figure 1), pathology suggests chronic mucosal inflammation (Figure 2)。 Colonoscopy showed scattered granular polypoid hyperplasia of the colorectal mucosa, and congestion and edema of the surrounding mucosa (Figure 3)。 The biopsy pathology of the lesion site was consistent with inflammatory polyps (Figure 4)。 Blood, urine routine and biochemical tests were normal, and fecal occult blood test was positive. Thyroid function: total triiodothyronine 1.03 nmol/L, free thyroxine 6.3 pmol/L, thyrotropin 21.79 mU/L, thyroid peroxidase antibody 561.4 U/mL. Combined with the patient's medical history and examination results, the diagnosis was Cronkhite-Canada syndrome; Hypothyroidism, Hashimoto's thyroiditis. He was treated with mesalazine, levothyroxine sodium, prednisolone acetate and nutritional support. After 1 month, the patient's anorexia symptoms improved, and after 2 months, skin pigmentation, alopecia, diarrhea, etc. were significantly relieved. The dose of glucocorticoids was gradually reduced and the treatment was maintained for a long time. At present, the patient's general condition is OK, with anemia, low albumin, occasional abdominal distension, diarrhea and other discomfort at follow-up.

A 45-year-old male was diagnosed with "decompensated cirrhosis after hepatitis B and bleeding from esophageal and gastric varices" in the local hospital in March 2009 due to hematemesis and black stool. In the following 2 years, the patient had repeated episodes of hematemesis and melena. In May 2011, the patient underwent "splenectomy + selective double devascularization of cardia area" in another hospital. One month later, the patient had hematemesis and melena again. In July 2011, a transjugular intrahepatic portosystemic shunt (TIPS) was performed in Drum Tower Hospital affiliated to Nanjing University School of Medicine. A 10 mm diameter covered metal stent was implanted during the operation. Proximal stent stenosis was found during regular review in June 2013. No further treatment was done, and regular review was still performed. In February 2014, the patient had recurrent hematemesis and melena. The admission examination revealed rupture and bleeding of esophagogastric varices, complete occlusion of the proximal end of the stent, and TIPS recanalization was performed. Intraoperatively, a bare metal stent with a diameter of 10 mm was re-inserted into the original stent, and the blood flow in the stent was unobstructed by angiography (Figure 1), and the direct portal pressure before and after stenting was 29.5 mmHg (1 mmHg =0.133 kPa) and 17.0 mmHg, respectively. The patient was successfully discharged on the 5th postoperative day. One week after discharge, the patient experienced personality changes, drowsiness, inability to know family members, and incontinence. Physical examination showed decreased orientation and calculation power, positive flapping tremor, blood ammonia was 89 μ mol/L, oral lactulose, intravenous drip of branched chain amino acid and L-ornithine-L aspartic acid, white vinegar enema and other treatments, the above symptoms improved and discharged from hospital. After discharge, the patient still had intermittent sleep time inversion and apathy, which gradually worsened, causing lethargy and inability to respond to calls. The blood ammonia was 220 μ mol/L. After the above treatment for hepatic encephalopathy, the patient was still sleepy and could not know his family. On April 18, 2014, a 7 mm diameter balloon was inserted into the TIPS stent through the internal jugular vein. The patient's consciousness gradually returned to normal, and the balloon was pulled out 4 days later. After the balloon was extracted, the patient experienced symptoms of hepatic encephalopathy again. After nearly one month of active conservative medical treatment, the patient failed to fully recover, so he underwent double-stent restricted shunt on May 20. After successful puncture of the internal jugular vein, a Rups-100 external sheath was inserted into the TIPS shunt stent under the guidance of a guide wire, a 6 mm ×40 mm bare metal stent was inserted into the previous TIPS stent along the guide wire, and the stent was prevented from being displaced with the Rups-100 external sheath, then a 10 mm ×80 mm covered metal stent was inserted into the bare metal stent, so that the bare metal stent was fixed outside the covered stent to restrict its complete opening, and the stent was expanded with a balloon with a diameter of 6 mm, so that the two stents were completely fitted to prevent the bare metal stent from being displaced. After the operation, the blood flow in the upper segment of the stent was obviously thinned, and the right branch of the portal vein was visualized (Figure 2), portal pressures were 14.0 mmHg and 19.0 mmHg before and after restrictive shunt stent placement, respectively. The symptoms related to hepatic encephalopathy gradually improved after operation, and he completely recovered and was discharged from hospital 2 weeks after operation. Follow-up until the deadline, the patient did not have hepatic encephalopathy again.

A 49-year-old male was admitted to the hospital in July 2014 due to dizziness, unsteady walking for 6 d, gibberish, and hallucinations. Have had hypertension and hyperlipidemia for 5 years in the past, and take antihypertensive drugs irregularly; Drinking history for more than 20 years, drinking>500 mL of white liquor every day; Smoke 20 cigarettes daily. Physical examination at admission: temperature 37.0℃, pulse 80 beats/min, breathing 20 beats/min, blood pressure 115/70 mmHg (1 mmHg =0.133 kPa). He looked indifferent, the sclera of both eyes was slightly yellowed, flapping-like tremor was visible, and his calculation ability was decreased. No liver palm was seen, and scattered spider nevus was seen in the chest area. The abdomen was flat and soft, and the liver and spleen were not reached under the costs. Abdominal ultrasound and CT showed fatty liver, but skull CT showed no abnormality. Blood WBC count 10.39×10⁹/L, Hb 123 g/L, PLT count 143×10⁹/L, blood glucose 5.0 mmol/L, albumin 38.4 g/L, AST 246 U/L, GGT 1 318 U/L, ALT 103 U/L, ALP 161 U/L, TBil 47 μ mol/L, DBil 32 μ mol/L, serum sodium 110 mmol/L, serum potassium 2.86 mmol/L, Blood ammonia was 26 μ mol/L, HBsAg negative, anti-HBs positive, anti-HBe negative, HBeAg negative, and anti-HBc negative. Proposed alcoholic liver disease, hyponatremia, hypokalemia. Treatment such as sodium supplementation and potassium supplementation. Serum sodium was 120 mmol/L, serum potassium was 3.16 mmol/L after 1 day, and serum sodium was 127 mmol/L after 3 days. After 5 days, the patient suddenly had aphasia, choked and coughed after drinking water, could not walk, and had urinary incontinence. Physical examination: motor aphasia. Cervical rigidity (-), Kirschner sign (-). The pupils on both sides are equal in size and round, sensitive to light reflection, and unlimited eye movement. The nasolabial folds on both sides are symmetrical, the tongue is extended in the center, and the muscle tone of the limbs is increased, with the right side. The distal muscle strength of the right upper limb was grade 5, the proximal muscle strength was grade 4, the left upper limb muscle strength was grade 4, and the lower limb muscle strength was grade 5. The mutual aid movement does not cooperate. Bilateral tendon reflex (+ + +). Bilateral depth and shallow sensation symmetry exists. Upper limb muscle strength decreased, bilateral tendon hyperreflex, bilateral pathological signs (+), bilateral ankle clonus (+). The plain MRI scan of the head showed no abnormalities. After 11 days, the reexamination of the skull MRI showed that T2WI was high, T1WI was low, T2FLAIR was high, and DWI was high in the striatum, thalamus and caudate nucleus at the basal ganglia level, with clear boundaries. Sheet T2WI hyperintensity, T1WI hypointensity, T2FLAIR hyperintensity, DWI hyperintensity in the central region of the brainstem, well-defined, seeFigure 1。 Considering the central and bilateral basal ganglia of the pons, thalamic myelinolysis, transferred to the neurology department, and diagnosed as osmotic nerve demyelination syndrome. He was treated with glucocorticoids and vitamin B. Laryngeal obstruction occurred on the 22nd day of admission, and tracheotomy + tracheal intubation was performed. He was also treated with methylprednisolone 1g, gamma globulin 20g shock therapy, ganglioside nerve nutrition and anti-infection therapy. Tracheal extubation 36 d after admission, discharge 45 d later, nasogastric state, consciousness, dysarthria, dysphagia, obvious limb emaciation, muscle tone reduction, muscle strength of both upper limbs grade 1, muscle strength of both lower limbs grade 4, bilateral Babinsky sign positive. Follow-up 4 months after discharge, the patient was able to walk, speak vaguely, have no dysphagia, tremor in both hands, and cannot hold objects.

The intestinal microbiota is one of the important "organs" of the human body, which participates in the body's immune regulation and multiple metabolic pathways, and forms the intestinal mucosal barrier to inhibit the colonization of pathogens. With the increasing understanding of intestinal microbiology, the disorder of intestinal microbiota has been shown to be associated with a variety of diseases inside and outside the gastrointestinal tract, which makes intestinal microbiology one of the hot spots in recent years. fecal microbiota transplantation (FMT) transplanted the intestinal microbiota of healthy humans into the gastrointestinal tract of patients, thereby restoring their intestinal microbiota balance and treating diseases related to intestinal microbiota disorders.

The incidence rate of CD in North America and Europe is as high as 50/100,000~200/100,000. Although the incidence rate in Asia is relatively low, it has been increasing in recent years^[1]。 Refractory CD is defined as a Crohn's disease activity index (CDAI) still between 250 and 400 after treatment with immunosuppressants and TNF-α inhibitors^[2]How to treat refractory CD has become a challenge that Chinese gastroenterologists must face.

IBD is a class of autoimmune diseases that primarily affect the digestive system, including CD and UC. The etiology of IBD is unclear, the diagnosis and treatment are relatively complicated, the inflammatory reaction in the intestine of patients is repeated, and the quality of life is low. In recent 30 years, the incidence of IBD in developing countries has been increasing continuously, which suggests that the change of environmental factors is significantly related to the incidence of IBD. Among them, the westernization of eating habits and the widespread use of antibiotics are important risk factors for IBD. These factors can cause changes in intestinal flora, thus affecting the stability of the intestinal environment. At present, people have a deep understanding of intestinal flora, and found that it can not only nourish intestinal cells and form a defense barrier, but also affect human metabolism, assist the maturation of immune system, and induce the formation of intestinal immune tolerance. Therefore, intestinal flora imbalance is closely related to IBD. regulatory T cell (Treg) is one of the targets of intestinal flora and an important part of immune regulation. In recent years, the influence of intestinal flora on Treg has become a new hot spot in IBD research.