2016年 · 第36卷第03期

In January 2016, the European Association for the Study of the Liver (EASL)Journal of HepatologyGuidelines for Hepatic Vascular Diseases published in (EASL clinical practical guidelines: vascular diseases of the liver)^[1], further clarified the classification of hepatic vascular diseases, and introduced the natural course, clinical manifestations, diagnosis and treatment strategies of hepatic vascular diseases, which are compiled as follows for domestic clinicians to learn and learn from.

spontaneous bacterial peritonitis (SBP) is a common and fatal primary bacterial infection of ascites, which often occurs in patients with cirrhotic ascites and has different clinical manifestations. Unlike secondary peritonitis, its diagnosis lacks an intraabdominal source of infection or inflammatory response pathway^[1]。 Because the early clinical manifestations of SBP are atypical, and 1/3 of patients may be asymptomatic, it is easy to be misdiagnosed or missed. In order to diagnose and treat SBP more accurately and timely, the possibility of combined SBP should be considered in the diagnosis and treatment of every decompensated cirrhosis patient, so as to diagnose and treat SBP more effectively earlier^[2]。

In recent years, studies have found that hyperhomocysteine (HCY) aemia is one of the risk factors for malignant tumors^[1]。 Kato et al.^[2]The study found that the concentration of HCY in peripheral blood of patients with colorectal adenocarcinoma was significantly elevated, and hyperHcyemia was a risk factor for colorectal adenocarcinoma. Colorectal adenomatous polyps are recognized as precancerous lesions. At present, it is believed that 60% ~80% of colorectal cancers originate from colorectal adenomas. Therefore, early screening and diagnosis of colorectal tumors are of great significance to clinical treatment. This study aimed to investigate the relationship between colorectal adenoma and HCY. Colorectal adenomatous polyps were divided into high-risk adenoma group and non-high-risk adenoma group according to their malignant tendency, and the plasma HCY levels of patients in the two groups were measured separately for comparison, so as to explore the correlation between HCY and colorectal high-risk adenoma.

UC is a chronic intestinal inflammatory disease caused by abnormal immune response of intestinal mucosa. It has the characteristics of easy recurrence, difficult control, long treatment period and high treatment cost. Excessive death of intestinal epithelial cells plays an important role in the occurrence and development of abnormal immune response in intestinal mucosa, but it does not occur completely in the form of apoptosis. Necrotic apoptosis is a newly discovered mode of programmed death with necrosis-like characteristics. receptor interacting protein (RIP) 3 is a key protein in necrotic apoptosis^[1]mixed lineage kinase domain-like (MLKL) is a specific downstream protein of RIP3^[2], initiating the eventual necrotic apoptotic process. In this study, the expression of RIP3 and MLKL in intestinal mucosa of patients with UC was examined to investigate the role of necrotizing apoptosis in intestinal inflammatory response of UC.

UC is a chronic intestinal inflammatory disease, while IBS is a common gastrointestinal dysfunction, usually without significant morphological and blood biochemical abnormalities. The clinical manifestations of UC and IBS are very similar, and colonoscopy is usually required for differential diagnosis. However, some patients cannot complete this examination for various reasons. Therefore, the study of non-invasive serum markers is particularly important for the diagnosis and treatment of UC, as well as the differential diagnosis of UC and irritable bowel syndrome-diarrhea (IBS-D). This study investigated the significance of S100A12 in the differential diagnosis of UC and IBS-D patients by detecting the serum levels of S100A12. At the same time, the correlation between serum S100A12 level and the scope and severity of the disease was studied.

post-traumatic stress disorder (PTSD) is a kind of mental and psychological disorder that occurs after severe traumatic stress events. There are extensive pain sensitization phenomena in PTSD^[1]。 At present, the incidence of IBS and functional gastrointestinal diseases after PTSD is on the rise.N-methyl-D-aspartate receptor 2B (N-methyl-D-aspartate receptor 2B, NR2B) It is mainly distributed in the hippocampus, cerebral cortex and spinal cord of the central system. NR2B is involved in the regulation of many kinds of pain by mediating the transmission of glutamate signaling and plays an important role in the formation of central pain sensitization. ceftriaxone, as a specific agonist of glutamate transporter 1 (GLT-1), can selectively induce the transcription of the gene encoding GLT-1 and increase the uptake of glutamate in the synaptic gap, thereby inhibiting the activation of NR2B and exerting an anti-nociceptive stimulating effect^[2]。 Therefore, it is speculated that NR2B is involved in the formation of visceral hypersensitivity-central sensitization in PTSD state, and ceftriaxone exerts an antinociceptive effect by affecting the expression of NR2B in the spinal cord.

A 51-year-old female was admitted to the hospital on 5 January 2015 due to frequent vomiting with 1-month weight loss. The patient experienced vomiting during the rehabilitation treatment of right clavicle trauma 1 month before admission. The vomit was brown stomach content, the specific amount was unknown. Before the attack, it was mostly accompanied by nausea, pain under the xiphoid process, and no fever. The patient complained that the above symptoms could be relieved after abdominal hot compress, so there was no special diagnosis and treatment. In the past 1 month, the body weight has decreased>5 kg, and the stool is normal. The patient was taking NSAID for a long time due to "migraine". Physical examination showed no obvious positive signs. The white blood cell count after admission was 10.26×10⁹/L, neutrophils 7.62×10⁹/L, PLT Count 361×10⁹/L, CRP 10.3 mg/L. Abdominal Doppler ultrasound showed multiple solid weak retroperitoneal echoes, the largest of which was located on the lateral side of the left lobe of the liver, with a size of about 3.0 cm ×2.3 cm. It is considered that enlarged lymph nodes may be possible. Gastroscopy showed multiple gastric ulcers, the largest of which was located in the vertical part of the small curve of the gastric body, with a size of about 30 mm ×50 mm (Figure 1), the whole stomach wall is stiff without peristalsis, considering Borrmann type III gastric cancer,H.pylori(＋＋)。 Biopathological examination showed necrosis of foci-like tissue with inflammatory exudation, proliferation of surrounding granulation tissue, and large round fungal spores in local necrotic tissue, considering coccidioides infection (Figure 2)。 Special staining: acid-resistant staining (-), periodate Schiff staining (+), hexamine silver method (+), gram staining (+), alisin blue-periodate Schiff staining (+). Immunohistochemistry: epithelial cells (+), focal lymphocytes Ki-67 about 60%. Further abdominal CT and positron emission tomography (PET) showed thickening of the stomach wall with multiple lymph nodes in the abdominal cavity (Figure 3), the maximum value of standard uptake value (SUV) at the most concentrated point was 10.4, and the average value of standard uptake value was 5.6. At that time, the diagnosis was ① multiple gastric ulcers and coccidioids infection; ② Borrmann type III gastric cancer cannot be excluded; ③ Gastric MALT lymphoma is not excluded.

A 64-year-old male was admitted to the emergency department on December 10, 2006 due to abdominal pain and hematochezia for 1 d. One day before admission, the patient had persistent distension and pain in the whole abdomen without obvious trigger, released blood and stools twice, with a total amount of about 200 mL, accompanied by nausea and vomiting of stomach contents, but no hematemesis. One syncope 10 h before admission without headache or fever. No previous history of hypertension, diabetes, coronary atherosclerosis and heart disease. Diaphragmatic hematoma evacuation + diaphragmatic repair was performed more than 1 month ago. Physical examination at admission: vital signs were stable, chronic disease volume, emaciation, one swollen lymph node was palpable in the left supraclavicular fossa and left inguinal area, 0.5 cm ×0.5 cm and 1.0 cm ×0.5 cm, respectively, tough in texture, good mobility, and no tenderness. There were no cardiopulmonary abnormalities. Veins were exposed in the abdominal wall, abdominal muscle tension was high, total abdominal tenderness, no rebound pain, liver and spleen were not palpated under the costs, and there was no moving turbidity. There was no edema in both lower limbs. Blood routine: Hb 113 g/L, PLT count 139×10⁹/L, WBC count 7.5×10⁹/L. Colonoscopy showed that when it reached the ileocecal region, a large amount of bloody paste in the cavity was attached to the surface of the intestinal wall, and the tip of the descending colonic mucosal folds was pale, without obvious ulcers or bulging lesions (Figure 1)。 Gastroscopy showed no obvious abnormalities in esophagus, stomach and duodenum. There were no abnormalities in small intestinal barium angiography. Abdominal CT showed: Considering the possibility of poor mesenteric rotation, accompanied by formation of superior mesenteric collateral vessels, swelling of part of the small intestine wall, and swelling of soft tissue around splenic vein. Angiography of celiac trunk artery, superior and inferior mesenteric artery showed that the distal branches of left gastric artery were increased, tortuous and disordered; The branches of hepatic artery were abnormally dilated, and some branches of blood vessels showed bile duct-like changes; Abnormal filling of contrast medium in the ileal artery; Femoral artery tortuosity (Figure 2)。 After admission, hemostasis, symptomatic treatment, abdominal pain relief, defecation normal discharge. Discharge diagnosis: ① lower gastrointestinal bleeding, possible ischemic bowel disease; ② Intestinal obstruction.

Gastric cancer is the third cause of tumor-related death^[1]。 China is a high incidence area of gastric cancer, with more than 300,000 deaths due to gastric cancer and its complications every year, accounting for more than 40% of gastric cancer deaths in the world. The prognosis of gastric cancer is closely related to the stage. The 5-year survival rate of early gastric cancer is>95%, while the 5-year survival rate of advanced gastric cancer is usually<30%^[2]。 Therefore, early detection, early diagnosis and early treatment of gastric cancer are of great significance to reduce the mortality rate. Consensus Opinions on Screening and Endoscopic Diagnosis and Treatment of Early Gastric Cancer in China (Changsha, 2014) formulated by Digestive Endoscopy Branch of Chinese Medical Association and Cancer Endoscopy Professional Committee of Chinese Anti-Cancer Association^[3]People over 40 years old with high incidence of gastric cancer,H.pyloriThose with infection, previous gastric precancerous lesions and other factors are recommended as high-risk groups for gastric cancer and are screened. However, the consensus high-risk population for gastric cancer is too broad, such asH.pyloriAlthough infection is an important risk factor for gastric cancer, less than 1% of infected people will develop gastric cancer, and it is difficult for such a large population to carry out screening. Therefore, according to the risk factors related to gastric cancer, formulating corresponding gastric cancer risk stratification evaluation standards, conducting individualized gastric cancer risk screening and assessment, and regular follow-up of high-risk groups of gastric cancer will be the focus of future work.

Presence of 1×10 in the human gastrointestinal tract¹³～1×10¹⁴A microorganism comprising a range of archaea, bacteria, eukaryotes, and viruses. Together they make up the gastrointestinal microecosystem. In recent years, numerous studies have shown that the gastrointestinal microecosystem is closely related to human diseases, including esophageal adenocarcinoma. Research data show that esophageal adenocarcinoma has become one of the fastest growing malignant tumors in developed countries^[1]。 GERD and Barrett's esophagus as major risk factors for esophageal adenocarcinoma^[2]。 The research status and prospect of the relationship between gastrointestinal microecology and esophageal adenocarcinoma are summarized.

IBS is a common functional gastrointestinal disease with abdominal pain, abdominal distension and abnormal defecation as clinical manifestations. At present, the etiology of IBS is unclear, and in recent years it is believed that intestinal microecology plays an important role in it. The proportion of comorbid mental disorders, especially anxiety and depression, in IBS patients is significantly higher than that in the general population, and it promotes each other with recurrent gastrointestinal symptoms; At the same time, intestinal flora imbalance can cause emotional changes. With the deepening of research on the brain-gut-microbial axis, the internal mechanism linking the three axes has been continuously elucidated. This paper reviews the recent literature on the role of intestinal microecology in IBS and its related psychological disorders.