简介：十二指肠的损伤由于增加的汽车事故和强烈事件经常越来越不平常却现在看见。十二指肠的损伤的管理能是复杂的，特别当对pancreatic-duodenal-biliary建筑群的巨大的损害同时发生时。甚至病人及时收到手术，多重手术后的复杂并发症和高死亡是普通的。更好知道并且设法十二指肠的损伤，我们由十二指肠的损伤，治疗，诊断和腹部的关键词在PubMed寻找了最近的相关文学。它证明因为诊断和管理是复杂的，死亡高，十二指肠的损伤应该及时并且机智地被对待。并且新技术的申请能帮助改进管理。在这评论，我们讨论了十二指肠的损伤的发生，诊断，管理，和复杂并发症以及死亡。

简介：Duodenalpolypsorlesionsareuncommonlyfoundonupperendoscopy.Duodenallesionscanbecategorizedassubepithelialormucosally-based,andthetypeoflesionoftendictatesthework-upandpossibletherapeuticoptions.Subepitheliallesionsthatcanariseintheduodenumincludelipomas,gastrointestinalstromaltumors,andcarcinoids.Endoscopicultrasonographywithfineneedleaspirationisusefulinthecharacterizationanddiagnosisofsubepitheliallesions.Duodenalgastrointestinalstromaltumorsandlargeormultifocalcarcinoidsarebestmanagedbysurgicalresection.Brunner＇sglandtumors,solitaryPeutz-Jegherspolyps,andnon-ampullaryandampullaryadenomasaremucosally-basedduodenallesions,whichcanrequireremovalandaretypicallyamenabletoendoscopicresection.Severalanatomiccharacteristicsoftheduodenummakeendoscopicresectionofduodenallesionschallenging.However,advancedendoscopictechniquesexistthatenabletheresectionoflargemucosally-basedduodenallesions.Endoscopicpapillectomyisnotwithoutrisk,butthisprocedurecaneffectivelyresectampullaryadenomasandallowspatientstoavoidsurgery,whichtypicallyinvolvespancreaticoduodenectomy.Endoscopicmucosalresectionanditsvariations（suchascap-assisted,cap-band-assisted,andunderwatertechniques）enablethesafeandeffectiveresectionofmostduodenaladenomas.Endoscopicsubmucosaldissectionispossiblebutverydifficulttosafelyperformintheduodenum.

简介：AIM:Toinvestigatetheaccuracyofendoscopicorbiopsydiagnosesofsuperficialnonampullaryduodenalepithelialtumors(NADETs).METHODS:Clinicopathologicaldatawerereviewedfor84superficialNADETsfrom74patientswhounderwentsurgeryorendoscopicresectionbetweenSeptember2002andAugust2014atasingleprefecturalcancercenter.SuperficialNADETsweredefinedaslesionsconfinedtothemucosaorsubmucosa.Demographicandclinicopathologicaldatawereretrievedfromcharts,endoscopicandpathologicreports.Endoscopicreportsincludedendoscopicdiagnosis,location,grosstype,diameter,color,andpresenceorabsenceofbiopsy.Endoscopicdiagnosesweremadebyanendoscopistinchargeoftheexaminationbeforebiopsyspecimenswereobtained.Endoscopicimageswereobtainedusingroutine,front-view,high-resolutionvideoendoscopy,andchromoendoscopywithindigocarminewasperformedforalllesions.Endoscopicimageswerereviewedbyatleasttwoendoscopiststoassessendoscopicfindingsindicativeofcarcinoma.Preoperativediagnosesbasedonendoscopyandbiopsyfindingswerecomparedwithhistologicaldiagnosesofresectedspecimens.Sensitivity,specificity,andaccuracywereassessedforendoscopicdiagnosisandbiopsydiagnosis.RESULTS:Themajority(81%)ofthelesionswerelocatedinthesecondportionoftheduodenum.Themedianlesiondiameterwas14.5mmaccordingtofinalhistology.Surgerywasperformedfor49lesionsfrom39patients,and35lesionsfrom35patientswereendoscopicallyresected.Finalhistologyconfirmed65carcinomas,15adenomas,and3hyperplasias.Afinaldiagnosisofduodenalcarcinomawasmadefor91%(52/57)ofthelesionsdiagnosedascarcinomabyendoscopyand93%(42/45)ofthelesionsdiagnosedascarcinomabybiopsy.Thesensitivity,specificity,andaccuracyofendoscopicdiagnoseswere80%,72%,and78%,respectively,whereasthoseofbiopsydiagnoseswere72%,80%,and74%,respectively.Preoperativediagnosesofcarcinomasweremadein88%(57/65)ofthecarcinomalesionsviaendoscopyorbiopsy.En

简介：AIM:Todeterminethehypothesisthatinflatingtheballoonsintheduodenalpapilladetermineschangesinthebiochemicalmarkersofpancreatitis.METHODS:Fourgroupsofpigswereused:Grouppapilla(GP),theovertube’sballoonwasinflatedintheareaofthepapilla;GP+doubleballoonenteroscopy(GP+DBE),theovertube’sballoonwaskeptinflatedintheareaofthepapillafor20minbeforeaDBE;GroupDBE(GDBE),DBEwascarriedoutafterinsuringtheballoon’sinflationfarfromthepancreaticpapilla;andGroupcontrol(GC).Serumconcentrationsofamylase,lipaseandC-reactiveprotein(CRP)wereevaluated.Pancreaseswereprocessedforhistopathologyexamination.RESULTS:Mainchangesoccurred24haftertheprocedurecomparedwithbaselinelevels.AmylaselevelsincreasedsignificantlyinGP(59.2%higher)andweremoderatelyhigheringroupsGP+DBEandGDBE(22.7%and20%,respectively).LipaseincreasedinGPandGP+DBE,whereasithardlychangedinGDBEandinGC.CRPincreasedsignificantlyinGP,GP+DBEandGDBE,whilenochangeswerereportedforGC.NostatisticallysignificantdifferencebetweengroupsGPandGP+DBEwasfoundforthehistopathologicalfindings,exceptforvacuolizationandnecrosisofthepancreaticparenchymathatwashigherinGPthaninGP+DBE.CONCLUSION:Themanipulationoftheduodenalpapillabytheinflatedovertube’sballoonduringDBEcausespancreaticstructuraldamageandincreasedbiochemicalmarkersassociatedwithpancreatitis.

简介：AbstractDiabetes mellitus and pancreatic ductal adenocarcinoma are two common diseases worldwidely which are both derived from different components of pancreas. The pancreatic and duodenal homeobox-1 (PDX1) is an essential transcription factor for the early development of pancreas that is required for the differentiation of all pancreatic cell lineages. Current evidence suggests an important role of PDX1 in both the origin and progression of pancreatic diseases. In this review, we discussed recent studies of PDX1 in diabetes mellitus and pancreatic cancer, and the therapeutic strategies derived from this transcription factor.

简介：Superficialnon-ampullaryduodenalepithelialtumor(SNADET)isdefinedasasporadictumorthatisconfinedtothemucosaorsubmucosathatdoesnotarisefromVater’spapilla,anditincludesadenomaandadenocarcinoma.Recentdevelopmentsinendoscopictechnology,suchashigh-resolutionendoscopyandimage-enhancedendoscopy,mayincreasethechancesofdetectingSNADETlesions.However,becauseSNADETisrare,littleisknownaboutitspreoperativeendoscopicdiagnosis.TheuseofendoscopicresectionforSNADET,whichhasnoriskofmetastasis,isincreasing,buttheincidenceofcomplications,suchasperforation,issignificantlyhigherthaninanyotherpartofthedigestivetract.Apreoperativediagnosisisrequiredtodistinguishbetweenlesionsthatshouldbefollowedupandthosethatrequiretreatment.Retrospectivestudieshaverevealedcertainendoscopicfindingsthatsuggestmalignancy.Inrecentyears,severalnewimagingmodalitieshavebeendevelopedandexploredforrealtimediagnosisoftheselesiontypes.EstablishinganendoscopicdiagnostictooltodifferentiatebetweenadenomaandadenocarcinomainSNADETlesionsisrequiredtoselectthemostappropriatetreatment.ThisreviewdescribesthecurrentstateofknowledgeaboutpreoperativeendoscopicdiagnosisofSNADETs,suchasduodenaladenomaandduodenaladenocarcinoma.Newerendoscopictechniques,includingmagnifyingendoscopy,mayhelptoguidethesediagnostics,buttheiradditionaladvantagesremainunclear,andfurtherstudiesarerequiredtoclarifytheseissues.

简介：背景：超声(美国)指导了锁骨的在上或下文锁骨的块通常为上面的极限外科被使用。这使随机化的研究的目的是比较块表演和发作时间，有效性，不利事件和病人的发生是指导美国的在上的接受锁骨或下文锁骨的块。我们假设了在上锁骨的途径，更表面、更容易设想使用10MHz变换器，将生产一更快并且更广泛的感觉的块。方法：120个病人被使随机化到二个相等的组：在上锁骨的(S)和下文锁骨的(I)。每个病人收到了包含ropivacaine的相等的体积的混合物7.5mg/ml和mepivacaine有肾上腺素5μg/ml的20mg/ml，0.5ml/kg身体重量(最小30ml，最大值50ml)。七根终端神经的感觉分数(0削尖的麻醉2点，痛觉缺失1点和疼痛)被估计每10min。当他们在肘下面有有效的外科的块麻醉或五根神经的痛觉缺失时，病人们为外科被宣布准备好了。在块以后的三十分钟，解块的神经被补充。块表演和潜伏时间，外科的有效性，不利事件和病人是接受被记录。结果：显著地，在I的更多的病人组织为在块以后的外科20和30min准备好了。吝啬的块表演时间在I组(NS)是在S组和5.0min的5.7min。块有效性在I组是优异的：93%对78%在S组(P=0.017)。S组病人有中部、尺骨的神经，而是腋的神经的更好的块的显著地更差的块。在10，20和30min的感觉分数不是显著地不同的。在S组的32个病人对在I组的九个病人经历了短暂不利事件(P<0.0001)。病人块的接受在两个组是类似的。结论：Infraclavicular块有更快的发作，更好外科的有效性和更少不利事件。块表演时间和病人是过程的接受在两个组是类似的。

简介：瞄准：为了阐明，在在各种各样的铁地位下面的含铁锡，转铁蛋白和转铁蛋白受体之中的铁的顺序的转移调节。方法：进粘膜、钠的蛋白质的59Fe的加入在控制WKY老鼠被执行。在含铁锡，转铁蛋白和转铁蛋白受体之中的铁的顺序的转移在铁被执行缺乏，控制和铁过载了老鼠。十二指肠的蛋白质被microautoradiography和免疫组织化学被特定的ELISA和原位本地化在双人脚踏车受到免疫降水和quantitation十二指肠的节。人的十二指肠的活体检视(n=36)从有不同的铁的题目镇定地位也为这些蛋白质被染色。结果：铁蛋白作为主要蛋白质被识别在十二指肠的粘膜以一种时间依赖者方式合并了铁。粘膜含铁锡的集中在与控制相比的铁过量组是显著地更高的，熨缺乏的组(731.5+/-191.96对308.3+/-123.36，731.5+/-191.96对256.0+/-1.19，P<0.005)，当比粘膜显著地高的钠转铁蛋白的没在这些组之中不同时(10.9+/-7.6对0.87+/-0.79，11.1+/-10.3对0.80+/-1.20，6.8+/-4.7对0.61+/-0.63，P<0.001)。蛋白质和熨斗分级的原位，和他们的重迭，建议了铁的顺序的转移的出现。这被表明然后通过铁的起始的绑定发生到钠转铁蛋白到吸收性的房间表面转铁蛋白受体。这些蛋白质的染色的紧张在人根据铁营养变化了，与在铁观察的转铁蛋白受体的强烈染色缺乏的题目。结论：肠通过包含钠转铁蛋白，transferrin-transferrin受体和含铁锡的相互作用的顺序的转移收起铁，这被结束。