الملخص
Background:Celiac disease is an autoimmune enteropathy which can present with patchy mucosal lesions.Therefore,the diagnosis of the disease requires histological evaluation of multiple site biopsies.Aims:To analyze the pathological characteristics of multiple site small intestinal biopsies in adult patients with celiac disease and provide reference for early identification and diagnosis of celiac disease.Methods:The pathological data of 22 adult patients who were newly diagnosed as having celiac disease at the People's Hospital of Xinjiang Uygur Autonomous Region from August 2019 to April 2022 were collected retrospectively.All patients were positive for serum anti-tissue transglutaminase antibody IgA,and biopsies of duodenal bulb,descending part of the duodenum and terminal ileum were obtained under endoscopy.Histological examination was performed by experienced pathologists according to the modified Marsh grading system.Results:The most common pathological grade of duodenal bulb(50.0%)and descending part of the duodenum(45.5%)was Marsh Ⅲc,while those of terminal ileum was Marsh Ⅲa(63.6%).All of the bulb biopsies,95.5%of the descending part and 72.7%of the terminal ileum biopsies showed characteristic histological changes of celiac disease.Mucosal pathology was patchy in 7 patients,of which one patient was duodenal bulb and terminal ileum involved,and 6 were duodenum involved only.Fifteen patients had diffuse small intestinal mucosal pathology involving duodenal bulb,descending part and terminal ileum,of which 4 patients showed concordant histology(the same Marsh grade in duodenal bulb,descending part and terminal ileum)and 11 patients showed discordant histology.In 18 patients(81.8%),duodenum was the only affected site or duodenum showed more serious mucosal lesions compared with terminal ileum.Conclusions:Adult celiac disease may affect the whole small intestine,and the mucosal involvement may be patchy,which highlights the importance of taking small intestinal biopsies from multiple sites repeatedly in the diagnostic work-up of celiac disease.
الملخص
The concept of enhanced recovery after surgery (ERAS) has attracted more and more attention so far, but there are different opinions on it. ERAS philosophy covers many fields, in which anesthesiology plays an irreplaceable role by virtue of its professional advantages. Based on ERAS philosophy, anesthesiologists will provide guidance on preoperative assessment, preoperative prehabilitation, intraoperative fluid management, analgesia, temperature management, and postoperative rehabilitation to improve patient comfort and satisfaction.
الملخص
Sepsis is a life-threatening systemic inflammatory response syndrome (SIRS) caused by the host's maladjustment response to infection, which eventually leads to septic shock and multiple organ failure. Pancreatic injury was found to be an important pathological change in sepsis. Autophagy is a crucial way to maintain the normal metabolism of cell substances and energy, which plays an important role in many diseases. Recent studies have found that autophagy plays a dual role in pancreatic injury in sepsis. Moderate autophagy can protect the pancreas and reduce the injury, while excessive autophagy can cause apoptosis-related autophagic cell death and aggravate the pancreatic injury. In sepsis, activated nuclear factor-κB (NF-κB) has a promoting effect on autophagy, and lysosome associated membrane protein (LAMP) degradation can result in impaired autophagy flux and aggravate pancreatic injury. The exploration of the mechanism of autophagy in pancreatic injury of sepsis will help to restore the normal autophagy function, so as to find a new target for the treatment of pancreatic injury of sepsis.