Development and validation of a predictive model for acute-onchronic liver failure after transjugular intrahepatic portosystemic shunt

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a cause of acute-onchronic liver failure(ACLF).AIM To investigate the risk factors of ACLF within 1 year after TIPS in patients with cirrhosis and construct a prediction model.METHODS In total,379 patients with decompensated cirrhosis treated with TIPS at Nanjing Drum Tower Hospital from 2017 to 2020 were selected as the training cohort,and 123 patients from Nanfang Hospital were included in the external validation cohort.Univariate and multivariate logistic regression analyses were performed to identify independent predictors.The prediction model was established based on the Akaike information criterion.Internal and external validation were conducted to assess the performance of the model.RESULTS Age and total bilirubin(TBil)were independent risk factors for the incidence of ACLF within 1 year after TIPS.We developed a prediction model comprising age,TBil,and serum sodium,which demonstrated good discrimination and calibration in both the training cohort and the external validation cohort.CONCLUSION Age and TBil are independent risk factors for the incidence of ACLF within 1 year after TIPS in patients with decompensated cirrhosis.Our model showed satisfying predictive value.

链霉蛋白酶+西甲硅油对无痛胃镜检查效果的影响

目的探讨链霉蛋白酶+西甲硅油在无痛胃镜患者检查前不同时间口服及服用后体位不同对检查效果的影响。方法选择杭州市第一人民医院门诊及住院接受无痛胃镜检查的患者740例,随机分成链霉蛋白酶+西甲硅油组(n=300)、西甲硅油组(n=240)和对照组(盐酸利多卡因胶浆组,n=200)。观察并对比3组患者在无痛胃镜检查前5、10、15、20、25、30、45和60 min口服上述药物及服药后患者采取不同体位[坐位、立位(间断行走)和卧位(间断左右侧身)]的胃镜视野清晰度、丙泊酚使用剂量、胃镜操作时间、恶心呕吐发生率、癌前病变和早期胃癌检出率。结果链霉蛋白酶+西甲硅油组的胃镜视野清晰度、丙泊酚使用剂量、内镜操作时间和癌前病变及早期胃癌检出率明显优于西甲硅油组和对照组(P<0.01),而西甲硅油组又优于对照组(P<0.01);3组患者的恶心呕吐发生率比较,差异无统计学意义(P>0.05)。链霉蛋白酶+西甲硅油组在无痛胃镜检查前20和25 min口服链霉蛋白酶+西甲硅油后,胃镜视野清晰度更佳(P<0.05),但这两者间比较,差异无统计学意义(P>0.05)。链霉蛋白酶+西甲硅油组采取立位(间断行走)和卧位(间断左右侧身)的胃镜视野清晰度优于坐位,差异有统计学意义(χ^(2)_(1)=14.56,P1=0.000;χ^(2)_(2)=16.61,P2=0.000);采取立位(间断行走)和卧位(间断左右侧身)的胃镜视野清晰度比较,差异无统计学意义(χ^(2)_(3)=0.12,P3=0.733)。结论无痛胃镜检查前应用链霉蛋白酶+西甲硅油可有效提高胃镜视野清晰度、缩短内镜操作时间、减少丙泊酚使用剂量、提高癌前病变及早期胃癌检出率;胃镜前20和25 min服药及服药后采取立位(间断行走)及卧位(间断左右侧身)效果更佳。

超声内镜引导下对接技术治疗经内镜逆行胰胆管造影术失败的恶性梗阻性黄疸的疗效研究

目的探讨超声内镜引导下对接技术(EUS-RV)治疗经内镜逆行胰胆管造影术(ERCP)失败的恶性梗阻性黄疸的疗效。方法 12例恶性梗阻性黄疸患者在ERCP不成功后改为EUS-RV治疗。观察其操作成功率、术后1周及1个月肝功能指标恢复情况、并发症发生率、住院时间及患者生存期。结果 12例患者均通过超声内镜穿刺成功,经胃穿刺者8例,经十二指肠穿刺4例,成功率为100.00%;术后1周较术前、术后1个月较术后1周肝功能指标差异有统计学意义(P<0.05);并发出血1例,经保守治疗后改善,并发症发生率8.33%;所有患者住院时间为(20.68±5.76)d;平均生存期为224 d。结论 EUS-RV创伤小、疗效好,可作为ERCP失败的恶性梗阻性黄疸患者的替代治疗。

具有均匀和双峰晶粒尺寸分布的电沉积镍的腐蚀行为（英文）

研究具有均匀和双峰晶粒分布电沉积镍的腐蚀行为。利用SEM、EBSD、TEM和XRD研究样品的显微组织,利用动电位测试法和电化学阻抗谱研究样品的腐蚀行为。结果表明:电沉积纳米晶镍具有(100)和(111)织构。纳米晶镍经不同温度热处理后,可得到具有不同晶粒尺寸分布的样品。晶粒尺寸对样品腐蚀行为的影响依赖于环境钝化能力。当钝化膜在样品表面形成时,耐蚀性随晶粒尺寸的减小而增强;相反,当样品表面无钝化膜形成时,耐蚀性随晶粒尺寸减小而降低。具有双峰晶粒尺寸分布样品的腐蚀行为遵循混合法则。

Improved method increases sensitivity for circulating hepatocellular carcinoma cells

AIM:To improve an asialoglycoprotein receptor(ASGPR)-based enrichment method for detection of circulating tumor cells(CTCs)of hepatocellular carcinoma(HCC).METHODS:Peripheral blood samples were collected from healthy subjects,patients with HCC or various other cancers,and patients with hepatic lesions or hepatitis.CTCs were enriched from whole blood by extracting CD45-expressing leukocytes with monoclonal antibody coated-beads following density gradient centrifugation.The remaining cells were cytocentrifuged on polylysine-coated slides.Isolated cells were treated by triple immunofluorescence staining with CD45antibody and a combination of antibodies against ASGPR and carbamoyl phosphate synthetase 1(CPS1),used as liver-specific markers,and costained with DAPI.The cell slide was imaged and stained tumor cells that met preset criteria were counted.Recovery,sensitivity and specificity of the detection methods were determined and compared by spiking experiments with various types of cultured human tumor cell lines.Expression of ASGPR and CPS1 in cultured tumor cells and tumor tissue specimens was analyzed by flow cytometry and triple immunofluorescence staining,respectively.RESULTS:CD45 depletion of leukocytes resulted in a significantly greater recovery of multiple amounts of spiked HCC cells than the ASGPR+selection(P s<0.05).The expression rates of either ASGPR or CPS1were different in various liver cancer cell lines,ranging between 18%and 99%for ASGPR and between 9%and 98%for CPS1.In both human HCC tissues and liver cancer cell lines,there were a few HCC cells that did not stain positive for ASGPR or CPS1.The mixture of monoclonal antibodies against ASGPR and CPS1identified more HCC cells than either antibody alone.However,these antibodies did not detect any tumor cells in blood samples spiked with the human breastcancer cell line MCF-7 and the human renal cancer cell line A498.ASGPR+or/and CPS1+CTCs were detected in 29/32(91%)patients with HCC,but not in patients with any other kind of cancer or any of the other test subjects.Furthermore,the improved method detected a higher CTC count in all patients examined than did the previous method(P=0.001),and consistently achieved 12%-21%higher sensitivity of CTC detection in all seven HCC patients with more than 40 CTCs.CONCLUSION:Negative depletion enrichment combined with identification using a mixture of antibodies against ASGPR and CPS1 improves sensitivity and specificity for detecting circulating HCC cells.

Consensus on the digestive endoscopic tunnel technique

With the digestive endoscopic tunnel technique(DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscularis propria(MP). Through the tunnel, endoscopic diagnosis or treatment is performed for lesions in the mucosa, in the MP, and even outside the gastrointestinal(GI) tract.At present, the tunnel technique application range covers the following:(1)Treatment of lesions originating from the mucosal layer, e.g., endoscopic submucosal tunnel dissection for oesophageal large or circular early-stage cancer or precancerosis;(2) treatment of lesions from the MP layer, per-oral endoscopic myotomy, submucosal tunnelling endoscopic resection, etc.; and(3) diagnosis and treatment of lesions outside the GI tract, such as resection of lymph nodes and benign tumour excision in the mediastinum or abdominal cavity. With the increasing number of DETTs performed worldwide, endoscopic tunnel therapeutics, which is based on DETT, has been gradually developed and optimized. However, there is not yet an expert consensus on DETT to regulate its indications, contraindications, surgical procedure, and postoperative treatment.The International DETT Alliance signed up this consensus to standardize the procedures of DETT. In this consensus, we describe the definition, mechanism,and significance of DETT, prevention of infection and concepts of DETTassociated complications, methods to establish a submucosal tunnel, and application of DETT for lesions in the mucosa, in the MP and outside the GI tract(indications and contraindications, procedures, pre-and postoperative treatments, effectiveness, complications and treatments, and a comparison between DETT and other operations).

Risk factors for combined hepatocellular-cholangiocarcinoma:A hospital-based case-control study

AIM:To identify risk factors contributing to the development of combined hepatocellular-cholangiocarcinoma(CHC) in China.METHODS:One hundred and twenty-six patients with CHC and 4:1 matched healthy controls were interviewed during the period from February 2000 to October 2012.Logistic regression analysis was used to calculate odds ratios(OR)and 95%confidence intervals(CI)for each risk factor.RESULTS:Univariate analysis showed that the significant risk factors for CHC development were hepatitis B virus(HBV)infection,heavy alcohol consumption,a family history of liver cancer,and diabetes mellitus.Multivariate stepwise logistic regression analysis showed that HBV infection(OR=19.245,95%CI:13.260-27.931)and heavy alcohol consumption(OR=2.186,95%CI:1.070-4.466)were independent factors contributing to the development of CHC.CONCLUSION:HBV infection and heavy alcohol consumption may play a role in the development of CHC in China.

Interventional endoscopic ultrasound for a symptomatic pseudocyst secondary to gastric heterotopic pancreas

Heterotopic pancreas(HP) is a relatively uncommon entity that is defined as pancreatic tissue without a true anatomical or vascular connection to the pancreas. HP does not cause symptoms in most cases but can occasionally produce various manifestations, including nausea, vomiting, abdominal pain, and even heterotopic pancreatitis. Here, we report an unusual case in which heterotopic pancreatitis complicated by the formation of a pseudocyst that caused gastric outlet obstruction was diagnosed based on serum hyperamylasemia and findings from endoscopic ultrasonography(EUS)-guided fine needle aspiration(EUS-FNA) cytology. EUS-guided single pigtail stent insertion was successfully performed for recurrent gastric outlet obstruction. The patient has remained healthy and symptom-free during 4 years of surveillance. In the context of the relevant literature, the described case is a rare case of HP complicated by a pseudocyst treated via EUS-FNA and stent insertion.

可视穿刺经皮肾镜治疗肾盏憩室结石的临床研究

目的探讨可视穿刺经皮肾镜治疗肾盏憩室结石的安全性及临床价值。方法回顾性分析2016年3月-2019年3月采用可视穿刺针式肾镜治疗肾盏憩室结石的患者12例。其中,男7例,女5例;平均年龄(38.4±12.6)岁;憩室位于左肾7例,右肾5例,其中肾上盏憩室结石5例,肾中盏憩室结石3例,肾下盏憩室结石4例,憩室平均最大径(21.3±5.2)mm;结石平均最大径(18.3±4.2)mm。3例患者术前曾行体外冲击波碎石(ESWL)治疗,术中均“一针见石”建立经皮肾通道后碎石。结果12例患者均采用单通道,平均手术时间(54.4±23.3)min,术后住院时间(6.8±2.1)d。8例患者术后血红蛋白浓度下降,平均血红蛋白减少(9.8±4.3)g/L。12例患者均找到憩室管并扩张,1例患者术后出现发热,患者均未出现血气胸、肾周组织损伤等。术后第3天复查泌尿系平片,结石清除率达100.0%。10例患者术后4~10个月复查,8例患者憩室基本塌陷,2例憩室体积缩小达50.0%,憩室结石均无复发。结论使用可视穿刺经皮肾镜治疗肾盏憩室结石更加安全、有效,建立经皮肾通道具有成功率高、出血少、创伤小和患者术后恢复快等优点,值得临床进一步推广应用。

Centralized isolation of Helicobacter pylori from multiple centers and transport condition influences

AIM:To evaluate the efficacy of centralized culture and possible influencing factors.METHODS:From January 2010 to July 2012,66452 patients with suspected Helicobacter pylori(H.pylori) infection from 26 hospitals in Zhejiang and Jiangsu Provinces in China underwent gastrointestinal endoscopy.Gastric mucosal biopsies were taken from the antrum for culture.These biopsies were transported under natural environmental temperature to the central laboratory in Hangzhou city and divided into three groups based on their transport time:5,24 and 48 h.The culture results were reported after 72 h and the positive culture rates were analyzed by a χ2 test.An additional 5736 biopsies from H.pylori-positive patients(5646 rapid urease test-positive and 90 14C-urease breath test-positive) were also cultured for quality control in the central laboratory setting.RESULTS:The positive culture rate was 31.66%(21036/66452) for the patient samples and 71.72%(4114/5736) for the H.pylori-positive quality control specimens.In the 5 h transport group,the positiveculture rate was 30.99%(3865/12471),and 32.84%(14960/45553) in the 24 h transport group.In contrast,the positive culture rate declined significantly in the 48 h transport group(26.25%; P < 0.001).During transportation,the average natural temperature increased from 4.67 to 29.14℃,while the positive culture rate declined from 36.67%(1462/3987) to 24.12%(1799/7459).When the temperature exceeded 24℃,the positive culture rate decreased significantly,especially in the 48 h transport group(23.17%).CONCLUSION:Transportation of specimens within 24 h and below 24℃ is reasonable and acceptable for centralized culture of multicenter H.pylori samples.

高暴露{111}晶面Ag2-xO用于高效电化学析氧反应及其活性和机理

析氧反应(OER)是工业上制约水裂解制氢和CO2综合利用的瓶颈,涉及四电子、四质子耦合以及O-O键的形成,是一个复杂的、高活化能(高过电位)的动力学过程.模拟自然界光系统PS Ⅱ,发展高效、稳定、经济的析氧催化剂(OEC)是一个具有挑战性的研究课题.Ag基催化剂因具有以下优势而成为候选:(1)Ag与Ru同属第五周期性质相近,且有经济性且储量丰富;(2) Ag比第三周期过渡金属具有更高的电子密度和更多可调节配位数;(3) Ag存在Ⅰ, Ⅱ, Ⅲ多种氧化态.本课题组前期工作证明, Ag基配合物[H3AgI(H2O)PW11O39]3–在酸性水溶液体系中能够形成高氧化态AgⅡ和AgⅢ配合物,用于OER时展现出高活性和稳定性.受此启发,我们选择简单银基氧化物用于研究电催化OER活性并探究其催化机理.本文通过恒电流沉积法在含有Ag+离子的0.1 M K2B4O7电解质溶液中设计合成了系列Ag2–xO/FTO-i (i=0.5, 1, 2, 3, 4, 7m Acm–2)电极,并通过XRD, SEM和TEM方法对其组成和形貌进行了表征.XRD结果表明,电极膜由Ag2O组成,随着沉积电流密度增加,其{111}晶面衍射峰向高角度移动,推测是由部分Ag+离子氧化成Ag2+离子所致.SEM显示, Ag2–xO/FTO-1电极膜上Ag2–xO主体呈现三角薄片状,拥有比其它电极Ag2–xO/FTO-i(i=0.5,2,3,4,7)暴露更多的{111}晶面.同时,高倍TEM显示晶面间距为0.267 nm,进一步证明存在较多暴露{111}晶面.线性扫描伏安曲线(LSV)显示, Ag2–xO/FTO-1电极具有最高的OER电流密度,通过对Tafel区域进行拟合,得到Tafel方程η=0.37+0.047 log|j|,计算得出在10 m A cm–2电流密度下Ag2–xO/FTO-1电极具有较低的Tafel斜率47 m Vdec–1和过电位417 m Vvs.RHE,可用作高效的OEC.电化学阻抗谱(EIS)表明,相比其它电极, Ag2–xO/FTO-1具有最佳的电荷转移能力.电流–时间(I–t)曲线显示10h内其电流密度仅下降4%,表明电极稳定性良好.通过XPS和拉曼光谱发现, Ag2–xO/FTO-1经过循环伏安(CV)测试后存在O-O键,说明Ag2–xO电催化OER过程中形成了过氧物种.XPS进一步显示催化反应前后Ag+和Ag2+峰面积比由1.46降至0.65,说明反应后Ag2+含量显著增加.通过对Ag2–xO/FTO-1电极电催化OER机理的研究,我们推测其具有优异活性的原因是Ag2–xO表面更高暴露{111}晶面有利于Ag+/Ag2+吸附OH–和H2O,相邻的吸附氧原子在脱去H+的同时,氧原子上活性电子易于转移给Ag2+形成O-O键和Ag+.电极上Ag+进一步被氧化生成Ag2+, Ag2+将过氧物种氧化,放出O2,完成催化剂的循环再利用.

电子束-物理气相沉积7YSZ热障涂层表面氧化铝纤维制备及其CMAS腐蚀性能（英文）

7YSZ(7wt.%Y2O3 ZrO2)作为热障涂层使用最广的材料,其主要制备方法包括电子束-物理气相沉积(EB-PVD)。随着涡轮前进口温度的逐步提高,CMAS(CaO MgO Al2O3 SiO2)熔盐腐蚀等因素逐渐成为影响柱状结构EB-PVD 7YSZ热障涂层服役寿命的关键因素。本文作者提出一种镀铝表面改性技术,即在柱状涂层表面采用磁控溅射技术制备一层Al膜,然后施加真空热处理工艺。一方面,Al和7YSZ涂层发生原位反应形成α-Al2O3层,抑制CMAS熔盐高温渗透;另一方面,在真空热处理过程中Al膜在高温下发生蒸发和形核,最终在7YSZ热障涂层表面形成氧化铝纳米线,抑制高温下熔融CMAS流动。

Apoptosis of human colon carcinoma HT-29 cells induced by ceramide

瞄准：在人的冒号癌 HT-29 房间上调查外长的导致 ceramide 的 apoptosis 的效果。方法：轻显微镜，传播电子显微镜和荧光显微镜被用来在 HT-29 房间观察 apoptosis 的形态学变化。Agarose 胶化电气泳动被执行检测 DNA 碎片。Mitochondrial 功能被 MTT 试金检测。Bcl-2 家庭基因成员的 mRNA 表示被反向的抄写决定聚合酶链反应(RT-PCR ) 试金。结果：在 C2-ceramide 治疗以后， apoptosis 的典型特征例如原子染色质破裂， apoptotic 身体和 DNA 梯子，能被观察。在到为 12 和 24 h 的 50 micromol/L C2-ceramide 的暴露以后，房间 apoptosis 分别地是 64.1% 和 81.3% ，它有一时间 -- 并且剂量效果关系。Mitochondrial 功能开始在暴露以后从 6 h 减少到酰基鞘氨醇。同时，起来调整或下面调整的酰基鞘氨醇 Bcl-2 家庭基因成员的 mRNA 表示。结论：酰基鞘氨醇由影响 Bcl-2 家庭基因成员的表示并且影响 mitochondrial 功能导致人的冒号癌 HT-29 房间的 apoptosis。

Effects of 530 nm monochromatic light on basic fibroblast growth factor and transforming growth factor-β1 expression in Müller cells

AIMTo expose rat retinal M&#x000fc;ller cells to 530 nm monochromatic light and investigate the influence of varying light illumination times on basic fibroblast growth factor (bFGF) and transforming growth factor-&#x003b2;1 (TGF-&#x003b2;1) expression.METHODSThree groups of rat retinal M&#x000fc;ller cells cultured in vitro under a 530 nm monochromatic light were divided into 6, 12 and 24h experimental groups, while cells incubated under dark conditions served as the control group. The bFGF and TGF-&#x003b2;1 mRNA expression, protein levels and fluorescence intensity of the M&#x000fc;ller cells were analyzed.RESULTSThe bFGF mRNA expression and protein levels were significantly upregulated in M&#x000fc;ller cells in all three experimental groups compared with the control group (P&#x0003c;0.05), while that of TGF-&#x003b2;1 was downregulated (P&#x0003c;0.05). Also, bFGF expression was positively correlated, but TGF-&#x003b2;1 expression was negatively correlated with illumination time. The largest changes for both cytokines were seen in the 24h group. The changes in bFGF and TGF-&#x003b2;1 fluorescence intensity were highest in the 24h group, and significant differences were observed among the experimental groups (P&#x0003c;0.05).CONCLUSIONThe expressions of bFGF and TGF-&#x003b2;1 changed in a time-dependent manner in M&#x000fc;ller cells exposed to 530 nm monochromatic light with 250 lx illumination intensity. M&#x000fc;ller cells might play a role in the development of myopia by increasing bFGF expression or decreasing TGF-&#x003b2;1 expression. Changes in cytokine expression in retinal M&#x000fc;ller cells may affect monochromatic light-induced myopia.

Endoscopic submucosal tunnel dissection of upper gastrointestinal submucosal tumors: A comparative study of hook knife vs hybrid knife

AIM to compare the efficacy and safety of a hook knife(HO) with a hybrid knife(HK) during endoscopic submucosal tunnel dissection(EStD) procedure.METHODS Between August 2012 and December 2015, the ESt D procedure was performed for 83 upper GI submucosal lesions, which originated from the muscularis propria layer identified by upper endoscopy and endoscopic ultrasonography. Of these, 34 lesions were treated by a HO, whereas 49 lesions were treated by a HK. Data regarding age, gender, presenting symptoms, tumor location and size, procedure time, complications, en bloc resection rate and others were analyzed and compared between the two groups.RESULTS there were no significant differences in the age, gender, presenting symptoms and tumor location between the two groups. EStD was successfully completed in all the patients, and no case was converted to laparoscopy. the mean procedure time was significantly shorter in the HK group than in the HO group(41.3 ± 20.3 min vs 57.2 ± 28.0 min, p = 0.004). the mean frequency of device exchange was 1.4 ± 0.6 in the HK group and significantly less than 3.3 ± 0.6 in the HO group(p < 0.001). the differences in tumor size and histopathological diagnoses were not significant between the two groups(p = 0.813, p = 0.363, respectively). Both groups had an equal en bloc resection rate and complete resection rate. Additionally, the complication rate was similar between the two groups(p = 0.901). During the follow-up, no recurrence occurred in either group.CONCLUSION We demonstrate for the first time that HO and HK do not differ in efficacy or safety, but HK reduces the frequency of device exchange and procedure time.

Negative methylation status of Vimentin predicts improved prognosis in pancreatic carcinoma

AIM: To determine the existence of a potential relationship between the methylation state of the Vimentin gene and its prognostic value in pancreatic cancer.METHODS: Sixty-four primary tumor specimens and normal tissues were collected consecutively from pancreatic cancer patients during surgery at Hangzhou First People's Hospital and Affiliated Hospital of the Logistics University of the Chinese People's Armed Police Force. DNA was extracted from the samples and subsequently quantitative methylation-specific polymerase chain reaction was used to detect the Vimentin methylation status of the samples. All of the patients were followed up to December 2012. χ2 test, Kaplan-Meier survival and Cox regression statistical models were used.RESULTS: Out of 64 pancreatic cancer tissues, 21 were marked as Vimentin methylation-positive, and 43 were marked as Vimentin methylation-negative. The location of pancreatic carcinoma was related to the Vimentin methylation state. The pathological T staging(P < 0.001), adjuvant chemotherapy(P = 0.003) and the Vimentin methylation state(P = 0.037) were independent prognostic factors. CONCLUSION: In our study, Vimentin methylation status can predict the prognosis of pancreatic cancer patients. However, additional experiments and clinical trials are needed to accurately validate this observation.

Corneal epithelial thickness analysis of forme fruste keratoconus with optical coherence tomography

AIM:To explore the significance of corneal epithelial thickness analysis in diagnosing early keratoconus.METHODS:There were 26 clinical keratoconus,21 forme fruste keratoconus,40 high corneal astigmatism(ΔK)and 40 low ΔK eyes involved in the study.Fourierdomain optical coherence tomography was used to measure the corneal epithelial thickness of four groups.The morphological features of topographic map and the thickness of corneal epithelial thinnest point were analyzed.The distribution curve of corneal epithelial thickness at 45°,90°,and 135° axial directions that are through the pupil center was also analyzed.One-way ANOVA was performed to compare the data.RESULTS:The topographic map of forme fruste keratoconus corneal epithelial thickness was uniformity shape;crater shape existed only in clinical keratoconus group;and central island shape mainly existed in highΔK group.The thinnest point of corneal epithelial thickness of forme fruste keratoconus group was significantly lower than that of low ΔK group(P=0.022).The thickness of corneal epithelium in the forme fruste keratoconus at 90°was thinner than that in the low astigmatism group at -1,and -2 mm points(P_(-1mm)=0.015,P_(-2mm)=0.036).CONCLUSION:The analysis of the thinnest point in forme fruste keratoconus corneal epithelium appears earlier than corneal epithelial remodeling.The topographic map of corneal epithelium in high ΔK eyes appears in central island shape,and can be used for the differential diagnosis of early keratoconus.

ERCP处理Caroli’s病合并胆道感染:1例案例报告和文献综述

背景 Caroli’s病是一种临床少见的先天性肝内胆管囊性扩张性疾病,继发肝内胆管结石和反复发作的胆管炎是该病的主要合并症,严重者可导致脓毒血症而危及生命.既往多采用外科手术的治疗方式,但是在急性感染期施行外科手术的并发症发生率和死亡率均较高.病例概述 1例中年男性患者因"腹痛伴畏寒、发热11h"来院就诊.患者11年前在外院确诊Caroli’s病,期间患者反复出现胆道感染,约6-10 mo发作一次,经保守治疗后好转.此次入院后先给予药物保守治疗,但患者的血象、体温未见明显好转.在保守治疗无效的情况下,我们成功施行了经内镜逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)下胆管取石术,患者痊愈后出院.结论对于内科保守治疗无效的Caroli’s病合并胆道感染者,ERCP不失为一种安全、可行、有效的处理方法.

Pancreatic fistula after central pancreatectomy: case series and review of the literature

BACKGROUND: Postoperative pancreatic fistula is one of the most common complications after pancreatectomy. This study aimed to assess the occurrence and severity of pancreatic fistula after central pancreatectomy.METHODS: The medical records of 13 patients who had undergone central pancreatectomy were retrospectively studied together with a literature review of studies including at least five cases of central pancreatectomy. Pancreatic fistula was defined and graded according to the recommendations of the International Study Group on Pancreatic Fistula (ISGPF).RESULTS: No death was observed in the 13 patients. Pancreatic fistula developed in 7 patients and was successfully treated nonoperatively. None of these patients required re-operation. A total of 40 studies involving 867 patients who underwent central pancreatectomy were reviewed. The overall pancreatic fistula rate of the patients was 33.4% (0-100%). Of 279 patients, 250(89.6%) had grade A or B fistulae of ISGPF and were treated nonoperatively, and the remaining 29 (10.4%) had grade C fistulae of ISGPF. In 194 patients, 15 (7.7%) were re-operated upon. Only one patient with grade C fistula of ISGPF died from multiple organ failure after re-operation.CONCLUSION: Despite the relatively high occurrence, most pancreatic fistulae after central pancreatectomy are recognized a grade A or B fistula of ISGPF, which can be treated conservatively or by mini-invasive approaches.

Effects of rigid gas permeable contact lens on morphological parameters and vision-related quality of life in keratoconus patients

AIM: To evaluate the effect of rigid gas permeable contact lens(RGP-CL) on corneal morphological parameters and vision-related quality of life in keratoconus(KC) patients.METHODS: Totally 57 eyes of 30 KC patients who were followed-up for more than two years, including 17 RGP wearers(32 eyes) and 13 non-wearers(25 eyes) were retrospectively analyzed. Initial medical history and corneal topography were collected at baseline. Corneal topography, corneal aberration, optical coherence tomography, and vision-related quality of life questionnaires were performed at the last follow-up.RESULTS: According to corneal topography, increase of the flattest keratometric values was higher in RGP wearers than in non-wearers(P=0.038). The morphological parameters, including symmetry index of front corneal curvature(P=0.004) and Baiocchi-Calossi-Versaci index front(P=0.047), were lower in RGP wearers than in nonwearers. Vertical coma was smaller in RGP wearers than non-wearers in 3.0, 5.0, 6.0, and 7.0 mm pupil diameters, respectively(P<0.05). The environmental triggering domain of ocular surface disease index was worse in RGP wearers as compared to non-wearers(P=0.003). At the last followup, there were no significant differences in constituent ratios of KC progression, corneal thickness topography, epithelial thickness topography, morphological parameters of corneal topography, and other questionnaire scores between the two groups(all P>0.05).CONCLUSION: Long-term use of RGP does not worsen KC but may cause corneal epithelial remodeling to increase symmetry of corneal anterior surface, reduce corneal vertical coma and improve visual quality. However, RGP wearing causes a slight decrease in vision-related quality of life. The occurrence of ocular surface symptoms is mainly associated with environmental triggering factors.