2014年 · 第94卷第40期

Endoscopic papillary sphincterotomy (EST) has been safe and mature after nearly 40 years of clinical application and development. It is the standard endoscopic treatment for common bile duct stones, biliary pancreatitis and papillary sphincter dysfunction. The early postoperative complications caused by partial or total incision of Oddi sphincter (SO) by EST mainly include acute pancreatitis, hemorrhage, biliary infection, cholecystitis and perforation, etc. The overall incidence rate is 3.4% ~8.3%, and the mortality rate is 0.2% ~0.6%. Complications after EST can be divided into early (≤30 d after EST) and long-term complications (>30 d after EST)^[1]。 EST-related early complications often appear within 24 hours after surgery, which is closely related to EST operation itself, and its prevention and treatment is often the focus of academic attention^[2]。 However, the long-term complications after EST lithotomy for choledocholithiasis are not very clear. This paper discusses the relationship between EST calculus removal and long-term recurrence of bile duct calculi, cholangitis, cholecystitis, liver abscess, pancreatitis, biliary restenosis and biliary malignant tumor.

Haplotype donor stem cell transplantation (haplo-SCT) and umbilical cord blood transplantation (CBT) have developed rapidly in recent years due to the easy availability of donors, and have gradually become the main alternative donors. haplo-SCT has a good graft-versus-leukemia (GVL) effect, but a high incidence of graft-versus-host disease (GVHD) and non-recurrent mortality (NRM) are always constraints. Cord blood transplantation can reduce the occurrence of GVHD while preserving the effect of GVL, but its longer period of bone marrow emptiness and high risk of implantation failure can lead to prolonged hospital stay and increased risk of infection. With the deepening of the understanding of the two in recent years, the transplantation community has started a new exploration, combining the two to achieve complementary advantages, and initially achieved satisfactory curative effects. Foreign countries call it third party donor (TPD) combined hematopoietic stem cell infusion or dual transplant, which means that the hematopoietic stem cells in the same transplant come from two different types of donors, thus differing conceptually from mixed transplantation from the same donor and different graft types (such as bone marrow combined with peripheral blood stem cells) and double stem cell transplantation from the same type and different donors (such as double cord blood transplantation).

Medical litigation is the last and most advantageous barrier to solve medical disputes at present. However, due to the asymmetry of information between doctors and patients, the loopholes of appraisal system, the lack of medical knowledge of judges, the interference of external factors, etc., medical litigation encounters obstacles in its operation. In view of this problem, scholars propose that the expert assistant system can make up for the deficiency of appraisal and speed up the process of medical litigation. This paper analyzes and discusses the implementation status and existing problems of the expert assistant system, in order to enhance the theoretical basis and practical function of the system in medical litigation.

Human embryonic stem cells (ESCs) are a class of highly undifferentiated stem cells isolated from intracellular masses of human embryos at the blastocyst stage, which have self-renewal stability in vitro and maintain normal karyotype and developmental pluripotency, and even participate in the whole ontogeny^[1]。 Using human ESC or human cells, tissues or organs differentiated from it to test the toxicological characteristics or efficacy of various biomedical materials, foods and drugs on human body can better reflect the real condition of human body than using animal or immortalized cells. Therefore, human ESC and its differentiated cells are expected to develop into a novel biosafety assay and drug screening model^[2]。 At present, most studies still use immortalized cell lines or primary cultured cells to evaluate the safety of biological materials^[3,4]There are disadvantages such as abnormal karyotype or large batch differences, respectively. Human ESC-derived fibroblasts (ES-F) have the advantages of stable source, normal karyotype and easy standardization^[5,6]It is expected to become a new model of biosafety evaluation system^[7]。 Standardizing the method of human ESC differentiation into fibroblasts is the key to ensure the reliability of biosafety testing and evaluation models. Therefore, after repeated discussions, the experts of the project team of the key international scientific and technological cooperation project "Creating a new predictive health and safety system based on human embryonic stem cells" of the Ministry of Science and Technology formulated the "Expert Consensus on Differentiation Methods of Human Embryonic Stem Cells to Fibroblasts" (hereinafter referred to as "Consensus"), aiming at standardizing the differentiation method of human ES-F, improving the purity of human ES-F, ensuring the repeatability of the differentiation method, and making it more systematic, standardized and effective in clinical and biosafety evaluation systems.

A 71-year-old male was admitted to the hospital on February 8, 2012 due to "poor appetite for more than 2 months". The patient went to the local hospital on February 1, 2012 for "poor appetite". Gastroscopy revealed: malignant tumor of gastric fundus? See also duodenal bulb ulcer. Pathology: gastric body adenocarcinoma; Chronic inflammation of the duodenal mucosa. For further treatment, he was transferred to our hospital. There was no obvious abnormality in physical examination at admission, and the morphology of peripheral blood cells was in the normal range. Blood routine: red blood cells: 4.0×10¹²/L, total number of white blood cells: 7.1×10⁹/L, neutrophils: 3.7×10⁹/L, monocytes 1.2×10⁹/L, lymphocytes 2×10⁹/L, eosinophils 0.2×10⁹/L. Reexamination of gastroscopy: a mass was seen in the duodenal bulb (Figure 1), and ulcers were also seen at the base of the stomach (Figure 2), the mucosa is congested and edematous, brittle and easy to bleed, and the possibility of malignant tumor is considered. Pathology: A large number of naive atypical mononuclear-like cells infiltrated in the superficial mucosa (duodenal bulb), small to medium in size, slightly polygonal, with round or elliptical nucleus and kidney-shaped nucleus, thick nuclear membrane, delicate chromatin, and some nucleolus and nuclear abnormality. A small number of immature eosinophils are scattered between tumor cells. Atypical cell infiltration was observed in the local area of the stomach fundus, and its morphology was similar to that of the abnormal cells in the duodenal bulb biopsy specimens (Figure 3)。 Immunophenotype: Myeloperoxidase (MPO) + + + (Figure 4), CD45 positive; CD138, CD20, CD3, CD79a, CK, κ and λ were all negative. Pathological diagnosis: Granulocytic sarcoma of the fundus of stomach and duodenal bulb. There was no obvious abnormality in blood and bone marrow routine, and the clinical diagnosis was primary solitary granulocytic sarcoma (GS) of fundus and duodenal bulb.

Patients with neurodegenerative diseases often experience various sleep disorders, including insomnia, rapid eye movement sleep behavior disorder (RBD), obstructive sleep apnea syndrome (OSAS), excessive daytime drowsiness, sleep-wake rhythm disorder (CRSD), periodic leg movements, restless leg syndrome, sleep breathing disorder, etc.^[1,2]。 Studies have shown that in neurodegenerative diseases such as Parkinson's disease, Lewy body dementia, and multiple system atrophy, alpha-synuclein abnormally accumulates in neurons and glial cells^[3]However, Alzheimer's disease, frontotemporal dementia, Pick's disease, progressive supranuclear palsy and other neurodegenerative diseases have abnormal tau protein accumulation in nerve cell bodies and dendrites^[4]。 Possible association between sleep apnea and Alzheimer's disease^[5], good sleep quality can attenuate the pathological progression of ApoE4 gene on neuronal fibrous tangles, thus affecting the cognitive function of patients with Alzheimer's disease^[6]。 The treatment of sleep disorders in patients with neurodegenerative diseases is also relatively complex. The mechanism and drug treatment of sleep disorders in neurodegenerative diseases are summarized as follows.

A 37-year-old male, Han nationality, driver, was admitted to hospital for "snoring, extreme sleepiness during the day for more than 1 year, accompanied by waking up during night sleep, and unable to recall for more than 1 month afterwards". Two years ago, the patient had daytime drowsiness, obvious snoring at night, breathing often stopped briefly, and talked in his sleep; But I can work normally during the day. Once in the daytime driving, due to sleepiness accident, did not pay attention to it. Six months ago, his wife found that the patient suddenly got up and walked in the house at night, moving chairs, flowerpots, combing his hair, and scolding the child while slapping the carpet. At that time, the child was not at home, and ten minutes later, he went back to bed to continue sleeping. When he was awakened by his wife, his expression was blank, and he couldn't recall what had just happened. Similar situations occurred almost every night. Zeng suddenly got up in his sleep at night, removed the desk lamp at home, and installed it completely. The whole process lasted for nearly 1 hour. At that time, I could answer my wife's questions simply, and I couldn't recall what happened at night when I got up in the morning. The patient came to see a doctor because he often had 3 to 4 similar manifestations and difficulty in falling asleep after sleeping at night recently. No previous history of epilepsy, brain trauma, and taking sedative and hypnotic drugs. Five years ago, I often drank liquor with friends, up to 100 ml/time. Because of obvious snoring at night after drinking, I have stopped drinking for nearly 2 years. Family history is not special.

A 44-year-old female went to our department in June 2013 due to low white blood cells, red blood cells and platelets caused by partially differentiated acute myeloid leukemia (AML-M2). After consultation with hematology experts in Beijing People's Hospital, she was given mitoxantrone combined with cytarabine on June 5, 2013. During chemotherapy, chemotherapy was stopped due to low hemoglobin and platelets. He died on 25 Aug 2013 due to a severe infection with low leukocytosis.

From August 8 to 10, 2014, Guangzhou welcomed the 9th National Clinical Forum on the Diagnosis and Treatment of Helicobacter Pylori and Digestive Diseases. This forum was hosted by Beijing Branch of Chinese Medical Association and China Helicobacter Pylori Information Center, and co-organized by Peking University First Hospital and Chinese Medical Journal. The conference welcomed more than 600 delegates from all over the country, including more than 100 VIP experts. There are also experts from Portugal and Japan involved in cutting-edge academic exchanges. At the opening ceremony, Professor Hu Fulian, the chairman of the conference, pointed out in his speech: The focus of this forum exchange is to summarize the results and expand the research field of Helicobacter pylori (especially in traditional Chinese medicine and microecology). The rapidly developing website of China Helicobacter pylori Information Center is the further expansion and extension of the forum in time and space. Professor Liu Xinmin, Secretary of the Party Committee of Peking University First Hospital, Professor Ke Yang, Executive Vice President of Peking University, and Professor Jin Dapeng, President of Beijing Medical Association, respectively gave important instructions and speeches to the conference, fully affirming the important role of the conference in promoting the research of Helicobacter pylori in China.