Hydrogen sulfide-induced enhancement of gastric fundus smooth muscle tone is mediated by voltagedependent potassium and calcium channels in mice

AIM:To investigate the effect of hydrogen sulfide(H2S)on smooth muscle motility in the gastric fundus.METHODS:The expression of cystathionineβ-synthase(CBS)and cystathionineγ-lyase(CSE)in cultured smooth muscle cells from the gastric fundus was examined by the immunocytochemistry technique.The tension of the gastric fundus smooth muscle was recorded by an isometric force transducer under the condition of isometric contraction with each end of the smooth muscle strip tied with a silk thread.Intracellular recording was used to identify whether hydrogen sulfide affects the resting membrane potential of the gastric fundus in vitro.Cells were freshly separated from the gastric fundus of mice using a variety of enzyme digestion methods and whole-cell patch-clamp technique was used to find the effects of hydrogen sulfide on voltage-dependent potassium channel and calcium channel.Calcium imaging with fura-3AM loading was used to investigate the mechanism by which hydrogen sulfide regulates gastric fundus motility in cultured smooth muscle cells.RESULTS:We found that both CBS and CSE were expressed in the cul tured smooth muscle cel ls from the gastric fundus and that H2S increased the smooth muscle tension of the gastric fundus in mice at low concentrations.In addition,nicardipine and aminooxyacetic acid(AOAA),a CBS inhibitor,reduced the tension,whereas Nω-nitro-L-arginine methyl ester,a nonspecific nitric oxide synthase,increased the tension.The AOAA-induced relaxation was significantly recovered by H2S,and the Na HS-induced increase in tonic contraction was blocked by 5 mmol/L4-aminopyridine and 1μmol/L nicardipine.Na HS significantly depolarized the membrane potential and inhibited the voltage-dependent potassium currents.Moreover,Na HS increased L-type Ca2+currents and caused an elevation in intracellular calcium([Ca2+]i).CONCLUSION:These findings suggest that H2S may be an excitatory modulator in the gastric fundus in mice.The excitatory effect is mediated by voltagedependent potassium and L-type calcium channels.

Effect of indomethacin on electrical field stimulation-induced contractions of isolated transverse and longitudinal rat gastric fundus strips

AIM: To study the effects of indomethacin on the isolated transverse and longitudinal rat gastric fundus strips.METHODS: The strips were suspended in an organ bath containing oxygenated Krebs solution, and contractile responses to electrical field stimulation were recorded on a physiograph in an isotonic manner after administration of cumulative concentrations of indomethacin. The effects of indomethacin on the strips pretreated with KATP channel modulators, diazoxide and glybenclamide were studied.RESULTS: Treatment of the transverse strips with indomethacin resulted in a concentration-dependent inhibitory response. In longitudinal strips, biphasic responses were seen, which included a stimulatory response at low concentrations of indomethacin, followed by an inhibitory response at higher concentrations.Diazoxide pre-treatment inhibited the stimulatory response of longitudinal strips. Glybenclamide pre-treatment not only blocked inhibitory effect of the low concentrations of indomethacin on transverse strips, but also increased the amplitude of contractions. Moreover, the drug decreased the amplitude of contractions in longitudinal strips.CONCLUSION: Responses of the isolated longitudinal and transverse rat gastric fundus strips to indomethacin are not similar, and are influenced by KATP channel modulators.

胃镜下食管套扎联合胃底组织胶栓堵术治疗食管胃底静脉曲张破裂出血患者的临床效果

目的探讨胃镜下食管套扎联合胃底组织胶栓堵术治疗食管胃底静脉曲张破裂出血的有效性和安全性。方法回顾性选取2018年2月至2020年4月就诊于我院的100例肝硬化食管胃底静脉曲张破裂出血患者作为研究对象,根据治疗方案不同将其分为A组(n=50)和B组(n=50)。A组采用胃镜下食管硬化联合胃底组织胶栓堵术治疗,B组采用胃镜下食管套扎联合胃底组织胶栓堵术。比较两组的再出血情况、治疗效果、实验室指标、并发症发生情况及住院天数。结果B组的再出血率显著低于A组,差异具有统计学意义(P<0.05)。B组的治疗总有效率显著高于A组,差异具有统计学意义(P<0.05)。治疗前、后,两组的血红蛋白(HGB)水平、白细胞计数(WBC)、血小板计数(PLT)、凝血酶原时间(PT)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)以及总胆红素(TBIL)水平比较,差异无统计学意义(P>0.05)。B组的并发症总发生率为34.00%,显著高于A组的8.00%,差异具有统计学意义(P<0.05)。两组的住院天数比较,差异无统计学意义(P>0.05)。结论相比于胃镜下食管硬化联合胃底组织胶栓堵术,胃镜下食管套扎联合胃底组织胶栓堵术治疗食管胃底静脉曲张破裂出血的效果更好,可降低再出血率,提高治疗总有效率,但并发症发生率较高,临床可根据患者的具体情况进行手术方案选择。

胃底腺来源肿瘤15例临床病理分析

目的探讨胃底腺来源肿瘤包括胃泌酸腺腺瘤(OGA)、胃底腺型腺癌(GA-FG)及胃底腺黏膜型腺癌(GA-FGM)的临床病理特征与鉴别诊断。方法收集陆军特色医学中心及重庆市江北区人民医院2020-01—2023-05诊治的15例胃底腺来源肿瘤,分析其病理形态特征、免疫表型及治疗与预后情况并复习相关文献。结果15例患者中男性9例,女性6例,年龄52~76岁,平均年龄62岁;(OGA)5例,(GA-FG)9例,(GA-FGM)1例。所有患者均获得2~30个月随访,均未见复发及转移。结论胃底腺来源肿瘤较少见,OGA/GA-FG其组织学形态、免疫表型具有明显相似性,OGA可能是GA-FG的早期病变;内镜下完整切除是首选治疗方式。胃底腺黏膜型腺癌(GA-FGM)更为罕见,暂未收录到WHO消化系统肿瘤分类中,其生物学行为有待更多病例的进一步观察和探讨。

Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding

AIM To determine the prognostic factors associated with mortality in patients with gastric fundal variceal (GFV) bleeding.METHODS In total, 42 patients were endoscopically diagnosed with GFV bleeding from January 2000 to March 2014. We retrospectively reviewed the patients' medical records and assessed their history, etiology of liver cirrhosis, disease conditions, treatment options for GFV bleeding, medications administered before and after onset of GFV bleeding, blood test results(hemoglobin, albumin, and bilirubin concentrations), and imaging results(including computed tomography and abdominal ultrasonography). We also assessed the prognostic factors associated with short-term mortality(up to 90 d) and long-term mortality in all patients.RESULTS Multivariate analysis showed that prophylactic administration of antibiotics was an independent prognostic factor associated with decreases in short-term mortality (OR = 0.08, 95%CI: 0.01-0.52) and longterm mortality (OR = 0.27, 95%CI: 0.08-0.91) in patients with GFV bleeding. In contrast, concurrent hepatocellular carcinoma (HCC) and regular use of proton pump inhibitors (PPI) were independent prognostic factors associated with increases in shortterm mortality(HCC: OR = 15.4, 95%CI: 2.08-114.75; PPI: OR = 12.76, 95%CI: 2.13-76.52) and long-term mortality (HCC: OR = 7.89, 95%CI: 1.98-31.58; PPI: OR = 10.91, 95%CI: 2.86-41.65) in patients with GFV bleeding. The long-term overall survival rate was significantly lower in patients who regularly used PPI than in those who did not use PPI(P = 0.0074).CONCLUSION Administration of antibiotics is associated with decreased short- and long-term mortality, while concurrent HCC and regular PPI administration are associated with increased short- and long-term mortality.

Application of blunt dissection in ESD of a gastric submucosal tumor

We performed endoscopic submucosal dissection of a gastric fundus tumor.It was difficult to strip the tumor completely due to space limitation,and we used blunt dissection to remove the tumor quickly and safely.Firstly,the basal area of the 2.5 cm submucosal tumor located in the gastric fundus was cut open,and the mucosa was dissected.The tumor was difficult to peel,therefore,a snare was used and the tumor was pulled and tightened slightly.Short electronic coagulation was used during the procedure.The tumor was then bluntly dissected.This method ensured rapid and complete removal of the tumor.

Adiponectin and the regulation of gastric content volume in the newborn rat

BACKGROUND Oral intake is dependent on the gastric ability to accommodate the food bolus.Comparatively,neonates have a smaller gastric capacity than adults and this may limit the volume of their milk intake.Yet,we previously reported that the newborn rat gastric milk volume is greatest after birth and,when normalized to body weight,decreases with postnatal age.Such age-dependent changes are not the result of intake differences,but greater gastric accommodation and reduced emptying rate.AIM Hypothesizing that breastmilk-derived adiponectin is the factor regulating gastric accommodation in neonates,we comparatively evaluated its effects on the rat fundic muscle tone at different postnatal ages.METHODS In freshly dispersed smooth muscle cells(SMC),we measured the adiponectin effect on the carbachol-induced length changes.RESULTS Adiponectin significantly reduced the carbachol-stimulated SMC shortening independently of age.In the presence of the inhibitor iberiotoxin,the adiponectin effect on SMC shortening was suppressed,suggesting that it is mediated via largeconductance Ca^(2+)sensitive K^(+)channel activation.Lastly,we comparatively measured the newborn rat gastric milk curd adiponectin content in one-and twoweek-old rats and found a 50%lower value in the latter.CONCLUSION Adiponectin,a major component of breastmilk,downregulates fundic smooth muscle contraction potential,thus facilitating gastric volume accommodation.This rodent’s adaptive response maximizes breastmilk intake volume after birth.

胃底腺来源腺癌的临床病理学特征及基因分析

目的探讨胃底腺来源腺癌的临床病理学特征及基因特征。方法收集2017年1月至2022年3月山东省临沂市肿瘤医院7例及山东省临沂市中医院2例胃底腺来源腺癌患者,回顾性分析其临床病理学特点,并行免疫组织化学染色及二代测序(NGS)检测。结果8例病变表面被覆正常小凹上皮,其下见低度异型腺体增生,诊断为胃底腺型腺癌(GA-FG);1例黏膜结构层次紊乱,肿瘤性小凹上皮及低度异型腺体混杂增生,诊断为胃底腺黏膜型腺癌(GA-FGM)。其中7例GA-FG及1例GA-FGM周围黏膜未见萎缩、肠上皮化生及幽门螺杆菌感染。免疫组织化学染色结果显示,8例GA-FG均表达黏蛋白(MUC)6、胃蛋白酶原Ⅰ、H^(+)/K^(+)-腺苷三磷酸酶(ATPase),MUC5AC仅在表面正常小凹上皮表达;1例GA-FGM瘤细胞表达MUC6、MUC5AC、胃蛋白酶原Ⅰ、H^(+)/K^(+)-ATPase。NGS检测结果显示,2例GA-FG存在GNAS错义突变,1例GA-FGM存在BRAF、TP53错义突变。结论GA-FG是一种罕见的低度恶性肿瘤,虽常浸润黏膜下层,但大多数预后较好,而GA-FGM具有不同的临床病理学特点,预后稍差。

多学科合作护理对肝硬化食管-胃底静脉曲张破裂出血患者病情控制及自我管理的影响

目的:研究多学科合作护理对肝硬化并发食管-胃底静脉曲张破裂出血(EGVB)患者病情控制及自我管理的影响。方法:根据不同护理方案将110例肝硬化并发EGVB患者分为对照组(n=55,常规护理)与观察组(n=55,多学科合作护理)。比较两组患者出血次数、护理前后的肝功能指标[总胆红素(TBIL)、谷草转氨酶(AST)、丙氨酸氨基转移酶(ALT)]与自我管理能力,并比较两组患者住院时间、并发症、术后3个月的再出血率与病死率。结果:护理后,两组患者血清TBIL、AST、ALT指标均降低(P<0.05),且观察组TBIL、AST指标低于对照组(P<0.05),观察组出血次数少于对照组(P<0.05)。两组患者自我管理能力量表各维度评分增加(P<0.05),且观察组高于对照组(P<0.05)。观察组住院时间、并发症总发生率小于对照组(P<0.05)。两组患者术后3个月再出血率、病死率比较,差异均无统计学意义(P>0.05)。结论:多学科合作护理可减少肝硬化并发EGVB患者出血次数,改善肝功能,同时提高自我管理能力,降低并发症风险。

两种缝合方式在贲门下及胃底黏膜下肿瘤全层切除术中的比较

目的探讨贲门下及胃底≥1 cm的黏膜下肿瘤(submucosal tumors,SMT)经内镜下全层切除(endoscopic full-thickness resection,EFTR)后创面行两种缝合方式的效能和安全性。方法回顾性分析2021年3月—2023年3月于复旦大学附属中山医院厦门医院住院行EFTR的贲门下及胃底SMT(≥1 cm)的患者,共纳入33例患者,其中16例患者的创面采用尼龙绳联合金属夹行荷包缝合法(尼龙绳组),17例患者采用单纯金属夹缝合法闭合创面(金属夹组)。比较术后创面两种缝合方式的手术时间、创面缝合时间、金属夹使用数量、术后并发症、术后留置胃管时间、抗生素应用时间、住院时间。结果两组缝合方式均有效闭合创面。尼龙绳组的手术时间及缝合时间比金属夹组长,差异有统计学意义(P<0.05)。在金属夹使用数量、术后并发症、术后留置胃管时间、抗生素使用时间、住院时间方面,两组差异无统计学意义(P>0.05)。结论两种缝合方式均能有效缝合胃SMT行EFTR术后的创面,但对于贲门下及胃底这类特殊部位的创面,单纯金属夹缝合更加省时。

胃底异位脾种植合并胃角高级别上皮内瘤变内镜下治疗1例并文献复习

异位脾种植是指脾外伤或脾切除术引起的脾脏自体种植,发生于胃黏膜下者极为少见,合并胃黏膜高级别上皮内瘤变尤为罕见。本文报道1例胃异位脾种植合并高级别上皮内瘤变患者的诊治情况,有助于提高对胃异位脾种植的认识,避免误诊、误治。

西甲硅油在内镜胃体胃底观察中的价值

目的探讨西甲硅油在内镜胃体胃底观察中的应用价值。方法对行胃镜检查的患者随机分成两组,检查前研究组予西甲硅油30ml+利多卡因胶浆10ml口服,对照组予利多卡因胶浆10ml口服,根据内镜下视野清晰程度分成ABCD四级,并行统计学分析。结果服用西甲硅油的研究组内镜下视野清晰程度明显高于对照组(P<0·001)。结论应用西甲硅油可明显提高胃镜视野清晰度,尤其对胃体胃底观察具有重要价值。

胃底及贲门区静脉曲张的彩色多普勒声像图表现

目的 探讨胃底及贲门区静脉曲张的彩色多普勒超声表现及其诊断价值。方法 对113 例怀疑有食管胃底静脉曲张的患者进行内镜及经腹部超声检查,其中胃镜证实有静脉曲张78例,无静脉曲张35 例。结果 超声诊断的敏感度为65.4%(51/78),特异度为97.1%(34/35),正确率75.2%(85/113)。静脉曲张组贲门前后径(1.52±0.21)cm,胃底部胃壁厚度(1.21±0.40) cm,曲张静脉内的平均流速为(15.92±3.14) cm/s。结论 超声诊断对贲门胃底区静脉曲张的显像具有较高的应用价值。

腹腔镜辅助胃底贲门癌根治术:附22例报告

目的探讨腹腔镜辅助下行D2式胃底贲门癌根治术的临床效果。方法回顾性分析3年间行腹腔镜辅助下胃底贲门癌根治术22例患者的临床资料。全组均行腹腔镜辅助下近端胃大部切除术。结果无中转开腹，平均手术时间188（162～270）min。术中平均出血182（100～260）mL。淋巴结清扫18．6（10～32）枚。术后患者平均胃肠道功能恢复时间78（48～140）h。1例肿瘤侵犯食管下段的患者术后发生吻合口瘘，经留置空肠营养管、抗炎、充分引流等处理后4周痊愈。无手术死亡。全组术后随访1—37个月，平均9．2个月，无复发转移病例。结论腹腔镜辅助下行D2式胃底贲门癌根治术方法可行，效果好，具有视野清晰、创伤小、出血少、恢复快等优点。

聚桂醇纤维蛋白原凝血酶序贯法治疗胃底静脉曲张出血

目的探讨聚桂醇纤维蛋白原凝血酶序贯法治疗胃底静脉曲张出血的临床价值。方法 152例胃底静脉曲张破裂出血患者随机分为两组,各76例。治疗组采取聚桂醇纤维蛋白原凝血酶序贯法治疗,对照组采取组织胶(α-氰基丙烯酸烷基酯)三明治法治疗,比较两组止血成功率及仪器损害、再出血、静脉改善、并发症等发生情况。结果治疗组与对照组的止血成功率分别为98.68%与93.42%,差异无统计学意义(P>0.05);再出血率分别为4.00%与25.35%,二者差异有统计学意义(P<0.01);两组发热、腹痛不良反应发生率相近(P>0.05),但对照组溃疡发生率高于治疗组(P<0.05);对照组堵针、粘镜发生率高于治疗组(P<0.01)。两组均未出现异位栓塞等严重并发症。结论聚桂醇纤维蛋白原凝血酶序贯法止血效果好,再出血率低,安全可靠。

保留幽门全胃切除间置空肠代胃术

报告6例贲门胃底癌及胃体上部癌行根治性全胃切除，保留幽门问置空肠代胃术的临床效果。选择5、6组淋巴结无转移，不影响根治效果的6例病人，行保留幽门全胃切除术后，将25cm空肠间置于食管与十二指肠之间。术后通过临床观察，上消化道锁餐X线摄片、电子纤维胃镜检查及食管、问五空肠活检等证明此术式有良好的抗返流作用，并延长了食物在“代胃”内停留时间，幽门录作用正常。术后3个月、半年、1年钡餐摄片观察代胃扩张，幽门开放功能良好，无返流现象；术后半年、1年、2年电子胃镜检查并活检，无返流性食管炎发生。生存期与同期不保留幽门间置空肠代胃术相比，无显著性差异。

食管胃底静脉曲张破裂出血相关危险因素的分析

目的:探讨食管胃底静脉曲张破裂出血的相关危险因素。方法:选取135例食管胃底静脉曲张的肝硬化患者,跟踪随访6个月,其中76例并发食管胃底静脉曲张破裂出血患者为出血组,59例未并发食管胃底静脉曲张破裂出血患者为对照组。观察比较食管胃底曲张静脉红色征(RC)、凝血酶原时间(PT)、门静脉主干内径(PVD)、脾门静脉内径(SVD)、脾长径(SPL)、脾厚度(SPT)、腹水最大液性暗区深度(ASmax)等相关指标。结果:出血组RC、PT、PVD、SVD、SPT、ASmax)等指标与对照组比较差异均有统计学意义(P<0.01或P<0.05)。经Logistic逐步分析发现,RC、PT、PVD、ASmax与食管胃底静脉曲张破裂出血关系密切。结论:RC、PT、PVD、ASmax是食管胃底静脉曲张破裂出血的危险因素,临床上应根据其变化及早进行干预,有利于提高肝硬化患者生活质量。

无创评估肝硬化患者食管和(或)胃底静脉曲张因素的分析

目的探讨无创评估肝硬化患者有无食管和(或)胃底静脉曲张的指标或模式。方法收集乙型病毒性肝炎肝硬化患者58例,有食管和(或)胃底静脉曲张的患者34例。检测血常规、肝功能全套项目、凝血因子,同时行B超与胃镜的检查。结果肝硬化患者静脉曲张组与无静脉曲张组比较:血小板,凝血酶原活动度(prothrombin time activity,PTA),活化部分凝血活酶时间,凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅹ,纤维蛋白原,D-二聚体,肝功能指标(前白蛋白、白蛋白、总胆红素、总胆汁酸、胆碱酯酶),门脉宽度,脾脏厚度差异均有统计学意义(P<0.05);Logistic回归分析,LogitP=12.280×门脉宽度+2.901×脾脏厚度-0.145×PTA-17.746,P为预测肝硬化患者发生静脉曲张的概率,预测准确率为68.0%,敏感度为69.2%,特异度为66.6%。Child-PughA级患者静脉曲张组与无静脉曲张组比较:PTA,D-二聚体,凝血因子Ⅱ、Ⅸ,血小板,脾脏厚度,门脉宽度差异有统计学意义(P<0.05)。结论 PTA、脾脏厚度、门脉宽度可能有助于预测乙肝肝硬化患者有无食管和(或)胃底静脉曲张。

生长抑素垂体后叶素及奥美拉唑三联治疗肝硬化食管胃底静脉曲张破裂出血疗效观察

目的评价生长抑素、垂体后叶素及奥美拉唑三联治疗肝硬化食管胃底静脉曲张破裂出血的疗效和不良反应。方法将157例肝硬化并食管胃底静脉曲张破裂出血患者随机分为三组：生长抑素、垂体后叶素及奥美拉唑三联（A）组77例，单用生长抑素（B）组42例及单用垂体后叶素（C）组38例，记录并比较三组药物治疗上消化道出血的疗效及不良反应。结果A组治疗食管胃底静脉曲张破裂出血有效率93％（72／77），明显高于B组78％（33／42）和C组55％（21／38），P均〈0．05。A组药物不良反应发生率为22％，明显低于C组（44％，P〈0．05），而与B组差异无统计学意义（14％，P〉0．05）。结论生长抑素、垂体后叶素及奥美拉唑三联治疗肝硬化食管胃底静脉曲张破裂出血安全、有效。

胰源性门脉高压症11例的诊断与治疗

目的探讨胰源性门脉高压症的诊断与治疗。方法回顾性分析该科3年11例胰源性门脉高压症的临床诊疗过程、结果及随诊。结果 11例患者中,慢性胰腺炎引起4例,胰腺假性囊肿6例,胰腺体尾部肿瘤1例。均有脾肿大,胃镜示胃底(或伴食管)静脉曲张,肝功能基本正常。行单纯脾切除9例,脾及胰体尾切除1例,脾切除、胆囊切除加结肠切除1例。除肿瘤患者外余预后良好。结论良性病变所致的胰源性门脉高压症能取得良好的根治效果。