BACKGROUND & AIMS: OBJECTIVES:The venous clinical severity score (VCSS) and the Aberdeen varicose vein questionnaire (AVVQ) improve after treating chronic venous insufficiency (CVI). The aim was to examine how and why they improve by evaluating the change in each individual question. METHODS:This was an analysis on prospectively collected data from a clinical study on 100 patients (58% female) with CVI (C2 = 34, C3 = 14, C4a = 29, C4b = 9, C5 = 7, C6 = 7) who were randomized to endovenous laser ablation (n = 50) or foam sclerotherapy (n = 50). The change scores (performance) of each question of the VCSS (questions 1-10) and the AVVQ (questions 1-13) were calculated by subtracting the score at three weeks, and three months, from the pre-treatment score. RESULTS:Both the median, interquartile range (IQR), VCSS and the AVVQ scores improved from 6 (4) and 21.4 (15.1) at baseline to 3 (4) and 18.6 (12.1) at three weeks (P < 0.0005, P = 0.031) to 2 (3) and 8.8 (13.6) at three months, (P < 0.0005, P < 0.0005), respectively. The performance of the first three questions of the VCSS (pain, extent of varicosities, oedema) were the most contributory to the overall score. Questions 5, 7, 8, 9 on ulceration improved the most individually but did not contribute significantly to the overall score. Questions 5, 9 of the AVVQ on stocking use and ulceration failed to contribute statistically to the overall improvement at three months. CONCLUSION:The majority of the individual questions of the VCSS and AVVQ responded to change. However, the cause of a poor response was multifactorial with statistical dilution playing a significant role. Stratification of patients according to ulceration may allow better comparisons.

背景与目标：

BACKGROUND & AIMS: :Recurrent aphthous stomatitis (RAS), are common inflammatory lesions of the oral mucous, usually round or ovoid, circumscribed by erythematous haloes with a yellow-grey floor and mostly painful. The RAS has reached an incidence about 20% in general population, present on any aged group, especially adolescents and young adults. Etiopathogenesis of RAS is not entirely understood. Some factors involved include immune system anomalies, infections, nutritional deficiency, mucous traumatism, food or contact allergy, autoimmunity illness and cancer; together with psychiatric, genetic and environment agents. In this article, main clinical features, etiology related factors, differential diagnosis and initial study of patients consulting for RAS are presented.

背景与目标： : 复发性口疮性口炎 (RAS) 是口腔粘液常见的炎性病变，通常为圆形或卵形，周围有红斑晕，地板呈黄灰色，大部分疼痛。在一般人群中，RAS的发病率约为20%，存在于任何老年人群，尤其是青少年和年轻人中。RAS的病因尚不完全清楚。涉及的一些因素包括免疫系统异常，感染，营养不足，粘液创伤，食物或接触过敏，自身免疫性疾病和癌症; 以及精神病，遗传和环境因素。本文介绍了RAS患者的主要临床特征，病因相关因素，鉴别诊断疾病和初步研究。

BACKGROUND & AIMS: BACKGROUND:Short (or small) saphenous vein (SSV) varices occur as a result of an incompetent sapheno-popliteal junction, where the SSV joins the popliteal vein, resulting in reflux in the SSV; they account for about 15% of varicose veins. Untreated varicose veins may sometimes lead to ulceration of the leg, which is difficult to manage. Traditionally, treatment was restricted to surgery or conservative management. Since the 1990s, however, a number of minimally invasive techniques have been developed; these do not normally require a general anaesthetic, are day-case procedures with a quicker return to normal activities and avoid the risk of wound infection which may occur following surgery. Nerve injury remains a risk with thermal ablation, but in cases where it does occur, the injury tends to be transient. OBJECTIVES:To compare the effectiveness of endovenous laser ablation (EVLA), radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy (UGFS) versus conventional surgery in the treatment of SSV varices. SEARCH METHODS:The Cochrane Vascular Information Specialist searched the Specialised Register (last searched 17 March 2016) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2). We searched clinical trials databases for details of ongoing or unpublished studies. SELECTION CRITERIA:We considered all randomised controlled trials (RCTs) comparing EVLA, endovenous RFA or UGFS with conventional surgery in the treatment of SSV varices for inclusion. DATA COLLECTION AND ANALYSIS:We independently reviewed, assessed and selected trials that met the inclusion criteria; any disagreements were resolved by discussion. We extracted data and used the Cochrane's tool for assessing risk of bias. When the data permitted, we performed either fixed-effect meta-analyses with odds ratios (ORs) and 95% confidence intervals (CIs) or random-effects meta-analyses where there was moderate to significant heterogeneity. MAIN RESULTS:We identified three RCTs, all of which compared EVLA with surgery; one also compared UGFS with surgery. There were no trials comparing RFA with surgery. The EVLA versus surgery comparison included 311 participants: 185 received EVLA and 126 received surgery. In the UGFS comparison, each treatment group contained 21 people. For several outcomes in the EVLA comparison, only a single study provided relevant data; as a result, the current review is limited in its ability to demonstrate meaningful results for some planned outcomes. The quality of evidence according to GRADE was moderate to low for the outcome measures in the EVLA versus surgery comparison, but low for the UGFS versus surgery comparison. Reasons for downgrading in the EVLA versus surgery comparison were risk of bias (for some outcomes, the outcome assessors were not blinded; and in one study the EVLA-surgery allocation of 2:1 did not appear to be prespecified); imprecision (data were only available from a single small study and the CIs were relatively wide); indirectness (one trial reported results at six months rather than one year and was inadequately powered for SSV varices-only analysis). Reasons for downgrading in the UGFS versus surgery comparison were imprecision (only one trial offered UGFS and several participants were missing from the analysis) and a limitation in design (the study was inadequately powered for SSV participants alone).For the EVLA versus surgery comparison, recanalisation or persistence of reflux at six weeks occurred less frequently in the EVLA group than in the surgery group (OR 0.07, 95% CI 0.02 to 0.22; I2 = 51%; 289 participants, 3 studies, moderate-quality evidence). Recurrence of reflux at one year was also less frequent in the EVLA group than in the surgery group (OR 0.24, 95% CI 0.07 to 0.77; I2 = 0%; 119 participants, 2 studies, low-quality evidence). For the outcome clinical evidence of recurrence (i.e. presence of new visible varicose veins) at one year, there was no difference between the two treatment groups (OR 0.54, 95% CI 0.17 to 1.75; 99 participants, 1 study, low-quality evidence). Four participants each in the EVLA and surgery groups required reintervention due to technical failure (99 participants, 1 study, moderate-quality evidence). There was no difference between the two treatment groups for disease-specific quality of life (QoL) (Aberdeen Varicose Veins Questionnaire) either at six weeks (mean difference (MD) 0.15, 95% CI -1.65 to 1.95; I2 = 0%; 265 participants, 2 studies, moderate-quality evidence), or at one year (MD -1.08, 95% CI -3.39 to 1.23; 99 participants, 1 study, low-quality evidence). Main complications reported at six weeks were sural nerve injury, wound infection and deep venous thrombosis (DVT) (one DVT case in each treatment group; EVLA: 1/161, 0.6%; surgery 1/104, 1%; 265 participants, 2 studies, moderate-quality evidence).For the UGFS versus surgery comparison, there were insufficient data to detect clear differences between the two treatment groups for the two outcomes recanalisation or persistence of reflux at six weeks (OR 0.34, 95% CI 0.06 to 2.10; 33 participants, 1 study, low-quality evidence), and recurrence of reflux at one year (OR 1.19, 95% CI 0.29 to 4.92; 31 participants, 1 study, low-quality evidence). No other outcomes could be reported for this comparison because the study data were not stratified according to saphenous vein. AUTHORS' CONCLUSIONS:Moderate- to low-quality evidence exists to suggest that recanalisation or persistence of reflux at six weeks and recurrence of reflux at one year are less frequent when EVLA is performed, compared with conventional surgery. For the UGFS versus conventional surgery comparison, the quality of evidence is assessed to be low; consequently, the effectiveness of UGFS compared with conventional surgery in the treatment of SSV varices is uncertain. Further RCTs for all comparisons are required with longer follow-up (at least five years). In addition, measurement of outcomes such as recurrence of reflux, time taken to return to work, duration of procedure, pain, etc., and choice of time points during follow-up should be standardised such that future trials evaluating newer technologies can be compared efficiently.

背景与目标：

BACKGROUND & AIMS: AIM:This paper is a report of an evaluation of the effectiveness of a newly developed dressing for preventing persistent erythema and pressure ulcer development and improving the water-holding capacity without increasing the skin pH in bedridden older patients. BACKGROUND:Shear forces and skin dryness play important roles in persistent erythema and pressure ulcer development. To eliminate these risks, we developed a dressing to reduce shear forces and improve the water-holding capacity. However, the effects of this dressing in clinical settings remain unknown. METHOD:An experimental bilateral comparison study was conducted at a hospital in Japan in 2004 with 37 bedridden older patients at risk of pressure ulcer development. The dressing was randomly applied to the right or left greater trochanter for 3 weeks. No dressing was applied to the opposite side as a control. The skin was monitored weekly during the 3-week application for persistent erythema and pressure ulcer development. Skin hydration and pH were also assessed during the intervention and for 1 week after dressing removal. FINDINGS:The incidence of persistent erythema was significantly lower in the intervention area than the control area [P = 0.007, RR 0.18 (95% CI: 0.05-0.73) and NNT 4.11 (2.50-11.63) ]. No pressure ulcers occurred in either the intervention or control area. Skin hydration increased significantly during dressing application and remained high after removal (P < 0.001) relative to the control area. Skin pH decreased significantly during the application (P < 0.001) but returned to control levels after removal (P = 0.38). CONCLUSION:This safe and effective dressing can be used for patients with highly prominent bones and dry skin to prevent pressure ulcers.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:The rate of rebleeding from peptic ulcers could differ between Asian and Western populations. This study aimed to determine whether the observed twofold difference in rebleeding rates in two similarly designed clinical trials (one in Hong Kong [n = 240], the other in a predominantly Western population [n = 764, ClinicalTrials.gov identifier: NCT00251979]) can be explained by differences in baseline patient characteristics. METHODS:Two-factor and multifactor analyses (adjusted by demographics, established risk factors for peptic ulcer and peptic ulcer bleeding, and disease severity variables) were performed using pooled data from the two studies. Cox regression analysis was used to predict the rebleeding risk at 3 days. RESULTS:In the two-factor analysis (placebo vs esomeprazole/omeprazole and Western study vs Hong Kong study), data trended towards a reduced risk of rebleeding in the Western study (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.44-1.07, P = 0.094). The risk of rebleeding was similar in both studies after adjusted for multiple factors (HR 1.10, 95% CI 0.60-1.99, P = 0.767). The strongest predictor of rebleeding (apart from study drug) was a classification of American Society of Anesthesiologists (ASA) grade IV (HR 4.15, 95% CI 1.49-11.56, P = 0.006). When such patients were excluded, the difference in rebleeding rates between the studies reduced. CONCLUSION:The difference in rebleeding rates between the two studies is explained by the factors in our analysis, most importantly a classification of ASA grade IV, suggesting that other differences, including ethnicity, did not influence the rebleeding rate.

背景与目标：

BACKGROUND & AIMS: :To examine the correlations of miR-24 expression in peripheral plasma with the onset of diabetic foot ulcer (DFU) and diabetic foot osteomyelitis (DFO) in type 2 diabetes mellitus (T2DM) patients and explore the clinical value of miR-24 as a potential biomarker for the diagnosis and treatment outcomes of DFU and DFO, a total of 60 newly diagnosed T2DM patients without DFU (T2DM group), 112 T2DM patients with DFU (DFU group), and 60 healthy controls (NC group) were included. DFU group were further divided into DFO group (n = 64) and non-DFO group (n = 48). MiR-24 levels were determined by quantitative real-time PCR, while clinical features and risk factors of DFU and DFO were explored. The expression level of miR-24 in T2DM and DFU group was significantly lower than in NC group (P < .05), and that in DFU group was significantly lower than in T2DM group (P < .01). Additionally, the level of miR-24 significantly decreased in DFO group compared to non-DFO group (P < .01). Moreover, it was negatively correlated with the amputation rate in DFU group (P = .043) and positively correlated with healing rate after 8 weeks (P = .036). The multivariate logistic regression analysis confirmed that a low expression of miR-24 was an independent risk factor for DFU and DFO. The ROC curve analysis indicated that the AUC of miR-24 for the diagnosis of DFU and DFO was 0.849 (95% CI, 0.618-0.879, P < .001) and 0.782 (95% CI, 0.595-0.813, P < .001). Thus, a decreased expression of miR-24 of T2DM patients was closely related to the occurrence, development and prognosis of DFU and DFO, suggesting the use of miR-24 as a potential biomarker for the prediction of DFU and DFO.

背景与目标： 目的: 研究2型糖尿病 (T2DM) 患者外周血浆miR-24表达与糖尿病足溃疡 (DFU) 和糖尿病足骨髓炎 (DFO) 发病的相关性，探讨miR-24作为潜在生物标志物对DFU和DFO的诊断和治疗结果的临床价值。纳入60例无DFU的新诊断T2DM患者 (T2DM组) 、112例伴有DFU的T2DM患者 (DFU组) 和60例健康对照者 (NC组)。DFU组分为DFO组 (n = 64) 和非DFO组 (n = 48)。采用实时荧光定量PCR检测MiR-24水平，探讨DFU和DFO的临床特征及危险因素。T2DM组和DFU组miR-24表达水平显著低于NC组 (p  < .05)，DFU组表达水平显著低于T2DM组 (p  < .01)。此外，与非DFO组相比，DFO组的miR-24水平显著降低 (p  < .01)。DFU组与截肢率呈负相关 (P = .043)，与术后8周愈合率呈正相关 (P = .036)。多因素logistic回归分析证实，miR-24低表达是DFU和DFO的独立危险因素。ROC曲线分析表明，miR-24诊断DFU和DFO的AUC为0.849 (95% CI，0.618-0.879，p  < .001) 和0.782 (95% CI，0.595-0.813，p  < .001)。因此，T2DM患者miR-24表达下降与DFU和DFO的发生、发展及预后密切相关，提示miR-24作为预测DFU和DFO的潜在生物标志物。

BACKGROUND & AIMS: :This study was performed to determine the effects of zinc supplementation on wound healing and metabolic status in patients with diabetic foot ulcer. The current randomized, double-blind, placebo-controlled trial was conducted among 60 patients (aged 40-85 years old) with grade 3 diabetic foot ulcer. Participants were randomly divided into two groups (30 participants in each group) to take either 220 mg zinc sulfate supplements containing 50 mg elemental zinc or placebo daily for 12 weeks. After the 12-week intervention, compared with the placebo, zinc supplementation was associated with significant reductions in ulcer length (-1.5 ± 0.7 vs. -0.9 ± 1.2 cm, p = 0.02) and width (-1.4 ± 0.8 vs. -0.8 ± 1.0 cm, p = 0.02). In addition, changes in fasting plasma glucose (-40.5 ± 71.0 vs. -3.9 ± 48.5 mg/dl, p = 0.02), serum insulin concentration (-8.0 ± 15.4 vs. +1.1 ± 10.3 µIU/ml, p = 0.009), homeostasis model of assessment-estimated insulin resistance (-3.9 ± 7.1 vs. +0.8 ± 5.9, p = 0.007), the quantitative insulin sensitivity check index (+0.01 ± 0.03 vs. -0.002 ± 0.02, p = 0.04) and HbA1c (-0.5 ± 0.8 vs. -0.1 ± 0.5%, p = 0.01) in the supplemented group were significantly different from the changes in these indicators in the placebo group. Additionally, significant increases in serum HDL-cholesterol (+4.1 ± 4.3 vs. +1.1 ± 5.1 mg/dl, p = 0.01), plasma total antioxidant capacity (+91.7 ± 213.9 vs. -111.9 ± 188.7 mmol/L, p < 0.01) and total glutathione (+68.1 ± 140.8 vs. -35.0 ± 136.1 µmol/L, p = 0.006), and significant decreases in high sensitivity C-reactive protein (-20.4 ± 24.6 vs. -6.8 ± 21.3 µg/ml, p = 0.02) and plasma malondialdehyde concentrations (-0.6 ± 0.9 vs. -0.2 ± 0.7 µmol/L, p = 0.03) were seen following supplementation with zinc compared with the placebo. Zinc supplementation for 12 weeks among diabetic foot ulcer patients had beneficial effects on parameters of ulcer size and metabolic profiles.

背景与目标： : 本研究旨在确定补充锌对糖尿病足溃疡患者伤口愈合和代谢状态的影响。目前的随机，双盲，安慰剂对照试验是在60例3级糖尿病足溃疡患者 (年龄40-85岁) 中进行的。参与者被随机分为两组 (每组30名参与者)，每天服用含有50 mg元素锌的220 mg硫酸锌补充剂或安慰剂，持续12周。干预12周后，与安慰剂相比，补锌与溃疡长度的显着减少相关 (-1.5   ±   0.7 vs. -0.9   ±   1.2厘米，P   =   0.02) 和宽度 (-1.4   ±   0.8 vs. -0.8   ±   1.0厘米，p   =   0.02)。另外，空腹血糖 (-40.5   ±   71.0对-3.9   ±   48.5 mg/dl，p   =   0.02) 、血清胰岛素浓度 (-8.0   ±   15.4对 + 1.1   ±   10.3 µ iu/ml) 的变化，P   =   0.009)，评估胰岛素抵抗的稳态模型 (-3.9   ±   7.1 vs. + 0.8   ±   5.9，p   =   0.007)，定量胰岛素敏感性检查指标 (+ 0.01   ±   0.03 vs. -0.002   ±   0.02，P   =   0.04) 和HbA1c (-0.5   ±   0.8 vs. -0.1   ±   0.5%，p   =   0.01) 与安慰剂组这些指标的变化有显著差异。此外，血清HDL-胆固醇显著升高 (+ 4.1   ±   4.3 vs + 1.1   ±   5.1 mg/dl，p   =   0.01)，血浆总抗氧化能力 (+ 91.7   ±   213.9 vs. -111.9   ±   188.7 mmol/L，P  <  0.01) 和总谷胱甘肽 (+ 68.1   ±   140.8 vs. -35.0   ±   136.1 µ mol/L，p   =   0.006)，高敏C反应蛋白 (-20.4   ±   24.6对-6.8   ±   21.3 µ g/ml，p   =   0.02) 和血浆丙二醛浓度 (-0.6   ±   0.9对-0.2   ±   0.7 µ mol/L) 显著降低，与安慰剂相比，在补充锌后观察到p   =   0.03)。在糖尿病足溃疡患者中补充锌12周对溃疡大小和代谢特征参数有有益的影响。

BACKGROUND & AIMS: We prospectively examined 137 limbs in 112 consecutive patients with clinical evidence of severe varicosis by color coded duplex sonography and ascending venography (including varicography in 48 limbs) to evaluate the diagnostic capabilities of color coded duplex sonography in the assessment of venous anatomy, variant varicosis, postthrombotic changes, and incompetence of the superficial and perforating venous system. Additionally, descending venography was performed in the first 52 limbs and compared to color coded duplex sonography in the diagnosis of deep and superficial venous reflux. Variant venous anatomy (21 cases) was missed in two limbs and misinterpreted in one limb by ascending venography compared to surgery. Color coded duplex sonography was inconclusive in two cases. Variant varicosis (59 cases) was missed in seven surgically proved cases by venography and in one case by color coded duplex sonography. Color coded duplex sonography was inconclusive in five cases. Ascending venography was slightly superior to color coded duplex sonography in the detection of postphlebitic changes. Good agreement was found between color coded duplex sonography and descending venography in the grading of superficial (k = 0.75) and deep venous reflux (k = 0.79). Excellent agreement was found between ascending venography in the grading of long (k = 0.96) and short (k = 0.94) saphenous vein reflux. More incompetent perforating veins were detected by ascending venography, (and varicography) than by color coded duplex sonography, but the latter technique allows direct preoperative marking of the skin, which is beneficial for the surgeon. We conclude that color coded duplex sonography is a valuable imaging tool before venous stripping and is capable of replacing invasive ascending and descending venography. Only patients with inconclusive color coded duplex sonographic results (e.g., complex variant venous anatomy) should proceed to venography.

背景与目标： 我们通过彩色编码双工超声和上行静脉造影 (包括48条肢体的静脉曲张) 前瞻性检查了112例具有严重静脉曲张临床证据的连续患者的137个肢体，以评估彩色编码双工超声在评估静脉解剖，变异性静脉曲张，血栓后变化，以及浅表和穿孔静脉系统的无能。此外，在前52个肢体中进行了下行静脉造影，并将其与彩色编码的双工超声检查进行了比较，以诊断深静脉和浅静脉反流。与手术相比，两个肢体的静脉解剖变异 (21例) 被遗漏，而一个肢体的静脉造影被误解。在两种情况下，彩色编码的双工超声检查尚无定论。在7例经静脉造影手术证实的病例和1例经彩色编码的双工超声检查中，遗漏了变异性静脉曲张 (59例)。在五例中，彩色编码的双工超声检查尚无定论。在检测静脉曲张后变化方面，上升静脉造影略优于彩色双工超声检查。在浅表 (k = 0.75) 和深静脉反流 (k = 0.79) 的分级中，彩色编码的双工超声检查和下行静脉造影之间发现了良好的一致性。在长 (k = 0.96) 和短 (k = 0.94) 大隐静脉反流的分级中，在上升静脉造影之间发现了极好的一致性。与通过彩色编码的双工超声检查相比，通过上行静脉造影 (和静脉曲张造影) 检测到的不功能的穿孔静脉更多，但是后一种技术可以直接对皮肤进行术前标记，这对外科医生是有益的。我们得出的结论是，彩色编码的双工超声检查在静脉剥离之前是一种有价值的成像工具，并且能够替代侵入性的上升和下降静脉造影。只有具有不确定的彩色编码双工超声检查结果 (例如，复杂的静脉解剖结构) 的患者才应进行静脉造影。

BACKGROUND & AIMS: :The study was performed to examine whether indomethacin administered during the initial period of acetic acid-induced gastric ulcer healing affects future ulcer recurrence. Gastric ulcers were produced in rats by subserosal injection of acetic acid. Indomethacin (1 mg/kg/day, orally) administered either alone or concomitant with ornoprostil (50 micrograms/kg/day, orally) was started on the fourth day and continued for 56 days. In rats whose ulcer healed at the 90th day after production of ulcer, endoscopy was done every 30 days to examine recurrence of ulcer. Gastric specimens were obtained 10, 30, 60, 90, and 240 days after ulcer production for histology, to quantitate the height of regenerated mucosa, thickness of fibrous tissue, degree of polymorphonuclear cell infiltration, and PAS-positive cells. Cumulative ulcer recurrence rate was significantly higher in rats initially treated with indomethacin than in controls. Increased polymorphonuclear cell infiltration was the major histologic abnormality persisting after cessation of indomethacin. Ornoprostil reversed these abnormalities caused by indomethacin. In conclusion, the administration of indomethacin during the initial period of the ulcer healing promoted persistent polymorphonuclear cell infiltration and increased ulcer recurrence rates, possibly via a prostaglandin-dependent mechanism.

背景与目标： : 进行这项研究是为了检查在乙酸引起的胃溃疡愈合的初期服用消炎痛是否会影响未来的溃疡复发。通过浆膜下注射乙酸在大鼠中产生胃溃疡。从第4天开始单独或与ornoprostil (50微克/千克/天，口服) 联合给药吲哚美辛 (1 mg/kg/天，口服)，并持续56天。在溃疡产生后第90天溃疡愈合的大鼠中，每30天进行一次内窥镜检查以检查溃疡的复发。在溃疡产生后10、30、60、90和240天获得胃标本进行组织学检查，以定量再生粘膜的高度，纤维组织的厚度，多形核细胞浸润的程度和PAS阳性细胞。最初用吲哚美辛治疗的大鼠的累积溃疡复发率显着高于对照组。多形核细胞浸润增加是吲哚美辛停止后持续存在的主要组织学异常。Ornoprostil扭转了吲哚美辛引起的这些异常。总之，在溃疡愈合初期给予吲哚美辛可能通过前列腺素依赖性机制促进了持续性多形核细胞浸润并增加了溃疡复发率。

BACKGROUND & AIMS: BACKGROUND AND AIMS:Although the role of H. pylori in peptic ulcer disease is no longer in dispute, certain aspects of eradication therapy in this condition have yet to be settled. Uncertainties still surround the relationship between Helicobacter pylori status and ulcer healing, the efficacy of eradication therapy in alleviating acute symptoms and healing ulcers, and the prognosis after eradication with respect to recurrence of symptoms, ulcers and complications. The present literature review, encompassing studies published up to October 1995, specifically addresses these issues.

RESULTS:Pooled data show that eradication therapy heals > or = 90% of duodenal ulcers and > or = 85% of gastric ulcers, while individual studies repeatedly confirm that it is more effective at healing ulcers than conventional treatment with anti-secretory drugs. Recent reports indicate that triple therapy regimens for 1 week, provided they include an anti-secretory drug, are sufficient to achieve high rates of healing and rapid symptom relief. A detailed analysis of the data, particularly those from studies reporting healing rates in relation to H. pylori status after eradication therapy, provides strong evidence that eradication of H. pylori produces ulcer healing. Follow-up studies show that ulcer recurrence and complications are rare after eradication treatment in patients with either gastric or duodenal ulcer disease. However, while ulcer symptoms are infrequent during follow-up, a proportion of patients appear to develop gastrooesophageal reflux after eradication.

CONCLUSIONS:H. pylori eradication is highly effective in promoting ulcer healing and preventing subsequent ulcer recurrence. These beneficial effects of eradication therapy are observed in patients with either gastric or duodenal ulcers which are associated with H. pylori infection.

背景与目标： 背景和目标 : 尽管幽门螺杆菌在消化性溃疡疾病中的作用不再存在争议，但在这种情况下根除治疗的某些方面尚未解决。幽门螺杆菌状态与溃疡愈合之间的关系，根除治疗在缓解急性症状和溃疡愈合方面的疗效以及根除后症状，溃疡和并发症复发的预后之间的不确定性仍然存在。目前的文献综述，包括1995年10月发表的研究，专门解决了这些问题。结果: 汇总数据显示，根除疗法可以治愈十二指肠溃疡的90% 和胃溃疡的85%，虽然个别研究反复证实，它在治疗溃疡方面比传统的抗分泌药物治疗更有效。最近的报告表明，如果包括抗分泌药物，则三联疗法为期1周，足以实现高治愈率和快速缓解症状。对数据的详细分析，尤其是那些报道根除治疗后与幽门螺杆菌状态相关的治愈率的研究，提供了强有力的证据，证明根除幽门螺杆菌可产生溃疡愈合。随访研究表明，在胃或十二指肠溃疡疾病患者中，根除治疗后溃疡复发和并发症很少见。然而，尽管在随访期间溃疡症状很少出现，但根除后似乎有一部分患者出现胃食管反流。
结论 : 根除幽门螺杆菌在促进溃疡愈合和预防随后的溃疡复发方面非常有效。在与幽门螺杆菌感染相关的胃或十二指肠溃疡患者中观察到根除治疗的这些有益效果。

BACKGROUND & AIMS: Understanding of peptic ulcer disease has dramatically changed within the last years. Today ulcer disease can be considered as a chronic infection. Based on this new pathophysiological concept treatment policies for ulcer bleeding and perforation have to be revised. For ulcer bleeding the standard procedure consists of a diagnostic emergency endoscopy and endoscopic treatment based on the bleeding activity. Patients with recurrent bleeding during hospital stay carry an increased risk for death. More than 50% of these patients have to be operated, nearly 25% die during hospital stay. For that reason an early elective operation can be recommended in patients with a high risk for further bleeding. This includes patients with arterial bleeding (Forrest Ia) and with a vissible vessel (Forrest IIa) with an additional risk (e. g. posterior wall of the duodenum, lesser curvature). All other bleeding activities can primarily treated conservatively. Because of an effective medical treatment of the ulcer disease with eradication, the operation should be restricted to ulcer excision and ulcer oversewing in bleeding or perforated gastric ulcer and duodenotomy, ulcer ligation and extraluminal ligature in bleeding duodenum ulcer and excision and oversewing with pyloroplasty in perforated duodenal ulcer. More definite surgery is not reasonable and should be avoided. With treatment policies based on early elective operation in high risk groups and medical treatment in the other patients a mortality of 5% or less can be achieved.

背景与目标： 在过去的几年中，对消化性溃疡疾病的了解发生了巨大变化。今天，溃疡病可以被认为是一种慢性感染。基于这种新的病理生理学概念，必须对溃疡出血和穿孔的治疗政策进行修订。对于溃疡出血，标准程序包括诊断性紧急内窥镜检查和基于出血活动的内窥镜治疗。住院期间反复出血的患者死亡风险增加。这些患者中有50% 以上必须进行手术，近25% 人在住院期间死亡。因此，对于有进一步出血风险的患者，建议进行早期择期手术。这包括有动脉出血 (Forrest Ia) 和有粘性血管 (Forrest IIa) 且有额外风险 (例如十二指肠后壁，曲率较小) 的患者。所有其他出血活动主要可以保守治疗。由于根除溃疡病的有效药物治疗，手术应仅限于出血或穿孔性胃溃疡的溃疡切除和溃疡缝合和十二指肠切开术，出血性十二指肠溃疡的溃疡结扎和腔外结扎以及穿孔性十二指肠溃疡的幽门成形术的切除和缝合。更明确的手术是不合理的，应该避免。根据高危人群的早期择期手术和其他患者的药物治疗，可以实现5% 或更低的死亡率。

BACKGROUND & AIMS: :The methanolic extract of the leaves of C. mucronata was screened for anti-ulcer properties using animal models. On isolated guinea pig ileum the extract inhibited contractions evoked by acetylcholine, histamine and serotonin. The extract remarkably decreased the propulsive movement of gastrointestinal content. The extract exhibited significant anti-ulcer activity protecting rats from indomethacin, histamine and stress-induced ulcers. It inhibited the growth of both Gram-positive and Gram-negative microorganisms. The oral LD50 value of the extract in mice was estimated to be 8.5 +/- 0.35 g/kg. The results revealed that the plant C. mucronata has potential medicinal value as an anti-ulcer agent.

背景与目标： : 使用动物模型筛选了C. mucronata叶片的甲醇提取物的抗溃疡特性。在离体豚鼠回肠上，提取物抑制乙酰胆碱，组胺和5-羟色胺引起的收缩。提取物显着降低了胃肠道内容物的推进运动。该提取物具有显着的抗溃疡活性，可保护大鼠免受吲哚美辛，组胺和应激性溃疡的侵害。它抑制革兰氏阳性和革兰氏阴性微生物的生长。提取物在小鼠中的口服LD50值估计为8.5 +/- 0.35 g/kg。结果表明，该植物作为抗溃疡剂具有潜在的药用价值。

BACKGROUND & AIMS: BACKGROUND:To prevent or minimize leakage after simple closure of giant perforated peptic ulcers in critically ill elderly patients, we conducted a clinical study using gastric body partition to prevent upstream gastric juice and food from passing through the sutured ulcer. METHODS:Ten critically ill elderly patients with giant (> 2.5 m) perforated peptic ulcer were included in the study of gastric body partition. RESULTS:The patients' mean age was 78.2 years and mean delay in treatment was 95.6 hours. None of the 10 patients had major complications after operation, although minor leakage of the sutured ulcer occurred in 4 patients. Only one patient presented with recurrent anastomotic ulcer and one patient died 28 days after surgery. CONCLUSIONS:Gastric body partition and gastrojejunostomy, in addition to simple closure of a giant perforated peptic ulcer, could be a quick, easy, and potentially effective alternative to avoid or at least to minimize leakage of the sutured ulcer. Moreover, gastric body partition, unlike antral partition, might not necessarily increase risks of hypergastrinemia and marginal ulcer.

背景与目标：

BACKGROUND & AIMS: :The aim of this study was to evaluate of logical program for the management of patients with perforated peptic ulcers. The case records of 75 consecutive patients were reviewed. The average age of the patients was 52 years. Ten patients were older than 80. The logical program was based on preoperative risk factors (concurrent medical illness, preoperative shock, and longstanding perforation more than 48 hours), history of chronic ulcer symptoms, and in selected cases, spontaneous seal on X-Ray gastroduodenogram with a water soluble contrast medium. The program was applied in 75% of cases and not applied in 25%. Out of 9 post-operative deaths (12%), 3 had a surgical cause: leakage of the suture with dehiscence in two cases. The mortality increased progressively with increasing of number of risk factors: 0%, 10% and 55% in patients with no, one, and two or three risk factors respectively. These findings constitute a validation of the predictive factors of death proposed by Boey et al. A logical program for the management of patients based on results of such multifactorial studies on risk factors, and on results of randomized prospective controlled studies may be applied in almost all patients. Our results also suggest that the quality of the perforation suture, and of the abdominal closure, especially in old and obese patients, are the most important factors to decrease the mortality.

背景与目标： : 这项研究的目的是评估用于治疗消化性溃疡穿孔患者的逻辑程序。回顾了75例连续患者的病历。患者的平均年龄为52岁。10名患者年龄在80岁以上。逻辑程序基于术前危险因素 (并发内科疾病，术前休克和超过48小时的长期穿孔)，慢性溃疡症状史，以及在选定的病例中，使用水溶性造影剂在x射线胃十二指肠造影上自发密封。该程序适用于75% 情况，而不适用于25% 情况。在9例术后死亡 (12% 例) 中，有3例是手术原因: 两例缝合线渗漏和裂开。死亡率随着危险因素数量的增加而逐渐增加: 分别没有，一个和两个或三个危险因素的患者的0%，10% 和55%。这些发现构成了对Boey等人提出的死亡预测因素的验证。基于风险因素的多因素研究结果和随机前瞻性对照研究结果的患者管理逻辑程序可能适用于几乎所有患者。我们的结果还表明，穿孔缝合线和腹部闭合的质量，尤其是在老年和肥胖患者中，是降低死亡率的最重要因素。

BACKGROUND & AIMS: :Varicose vein disease is a frequently occurring pathology with multifactorial causes and a genetic component. An intense remodelling of the varicose vein wall has been described and could be at the origin of its weakness and altered elasticity. We have described previously a dysregulation of collagen synthesis in cultured smooth muscle cells from saphenous veins and in dermal fibroblasts from the skin of patients with varicose veins, suggesting a systemic defect in their connective tissue. The present study describes comparative morphological and immunohistochemical data in both the skin and saphenous veins of eight control subjects (undergoing coronary bypass surgery) and eight patients with varicose veins. Histological staining of glycoproteins, the elastic fibre network and collagen bundles showed that the remodelling and fragmentation of elastic fibres observed in varicose veins were also present in the skin of the patients. When compared with control subjects, we observed in both the veins and skin of patients with varicose veins (i) an increase in the elastic network, as quantified by image analysis; (ii) an accumulation of collagen type I, fibrillin-1 and laminin; and (iii) an overproduction of MMP (matrix metalloproteinase)-1, MMP-2 and MMP-3, analysed by immunohistochemistry, but normal levels of other MMPs (MMP-7 and MMP-9) and their inhibitors (TIMP-1, TIMP-2 and TIMP-3). An imbalance of extracellular matrix production/degradation was thus observed in veins as well as in the skin of the patients with varicose veins and, taken together, these findings show that remodelling is present in different organs, confirming systemic alterations of connective tissues.

背景与目标： : 静脉曲张疾病是一种常见的病理，具有多因素原因和遗传因素。已经描述了静脉曲张壁的强烈重塑，这可能是其弱点和弹性改变的根源。我们先前已经描述了来自大隐静脉的培养平滑肌细胞和来自静脉曲张患者皮肤的真皮成纤维细胞中胶原蛋白合成的失调，表明其结缔组织存在全身性缺陷。本研究描述了八名对照受试者 (接受冠状动脉搭桥手术) 和八名静脉曲张患者的皮肤和隐静脉的比较形态学和免疫组织化学数据。糖蛋白，弹性纤维网络和胶原束的组织学染色表明，在静脉曲张中观察到的弹性纤维的重塑和断裂也存在于患者的皮肤中。与对照组相比，我们在静脉曲张患者的静脉和皮肤中观察到 (i) 通过图像分析量化的弹性网络的增加; (ii) I型胶原，fibrillin-1和层粘连蛋白的积累; (iii) 通过免疫组织化学分析MMP-2和MMP-3的MMP (基质金属蛋白酶)-1的过量生产，但其他MMP (MMP-7和MMP-9) 及其抑制剂 (TIMP-1，TIMP-2和TIMP-3) 的正常水平。因此，在静脉曲张患者的静脉以及皮肤中观察到细胞外基质产生/降解的不平衡，这些发现共同表明，重塑存在于不同器官中，从而证实了结缔组织的全身性改变。