大肠息肉表面结构与病理组织学的关系研究

目的：探讨大肠息肉表面结构形态与病理组织学的关系，以提高对大肠息肉的实时诊断及治疗水平。方法：对105例大肠息肉进行靛胭脂染色，放大内镜观察其表面结构形态，并参照Kudo法进行分类：I、Ⅱ型为非瘤性息肉，ⅢL、ⅢS、Ⅳ及混合型为腺瘤性息肉，V型为癌变，比较息肉表面结构与大体形态及病理之间的关系。结果：17例有蒂息肉中12例表现为I、Ⅱ型；40例亚蒂息肉和48例广基息肉中I、Ⅱ型分别为15．0％（6／40）和41．7％（20／48），ⅢL、ⅢS、Ⅳ、Ⅴ、混合型合计为85．0％（34／40）和58．3％（28／48）。83．8％（88例）的息肉位于直肠至脾曲结肠，息肉表型与其发生部位无关。炎性及增生性息肉中非瘤性表型为78．6％，瘤性表型为21．4％；腺瘤息肉中非瘤性表型为3．3％，瘤性表型为96．7％；幼年性息肉均为非瘤性表型。I、Ⅱ、ⅢL、ⅢS、Ⅳ、Ⅴ及混合型息肉中腺瘤发生率分别为0％、11．8％、77．3％、75．0％、100．0％、100．0％和70．0％。分型诊断瘤性和非瘤性息肉的敏感性为96．7％和80．0％，特异性为86．6％和94．7％，鉴别诊断准确率为89．5％。结论：用染色放大内镜分析大肠息肉表面结构，能有效鉴别大肠非瘤性息肉、腺瘤和癌，有助于在结肠镜检查的同时决定对病灶的处理。     

糖尿病患者下肢动脉病变及相关因素分析

分析糖尿病下肢动脉病变及其相关危险因素。对144例糖尿病患者进行详细的体格检查，血糖、血脂、血压、纤维蛋白原等生物化学检查和下肢血管彩色多普勒检测。结果发现，144例患者中彩色多普勒提示下肢动脉病变105例（72．9％），两支以上动脉病变发生率高（占检出者的80％），斑块检出率高（占检出者的60％），临床检查下肢动脉病变检出率很低（29．9％）。下肢动脉病变与高血压、冠心病、周围神经病变、纤维蛋白原、空腹血糖、糖化血红蛋白、甘油三酯及总胆固醇／高密度脂蛋白胆固醇比值呈正相关，而与高密度脂蛋白胆固醇呈负相关。结果提示，糖脂代谢紊乱、高血压、冠心病、周围神经病变、纤维蛋白原升高等是糖尿病下肢动脉病变的危险因素，彩色多普勒是早期诊断糖尿病下肢动脉病变的一种方便可靠的方法，可了解动脉硬化的程度。     

老年人大肠息肉与大肠癌

为了解老年人大肠息肉和大肠癌的临床特点，更好地预防老年人大肠肿瘤的发生和早期诊断大肠癌，对２４８例老年人大肠息肉和大肠癌的临床及病理作一回顾性分析。结果老年人大肠息肉和大肠癌的检出率分别为３３．３％和２３．３％，并有以下特点：（１）大肠息肉和大肠癌是老年人便血的主要原因，炎性息肉、腺瘤性息肉及大肠癌三者的便血率依次增高；（２）息肉检出率显著高于普通人群息肉检出率，且腺瘤性息肉占７３．８％；（３）多发性息肉比例较高，并以腺瘤性息肉为主，占８０．７％，且多发生于不同的肠段；（４）老年人大肠癌低恶性程度者多；（５）大肠腺瘤性息肉常与大肠癌并存，二者多发生于不同肠段。因此，我们认为便血是老年人大肠镜检查的有力指征；大肠镜检查时不应满足于远端大肠病变的诊断，应尽可能检查全大肠；对老年人大肠息肉，尤其是多发性息肉及直径大于１．０ｃｍ者应积极切除。     

老年人大肠息肉的临床分析

目的 探讨老年人大肠息肉的临床特点及其与癌变的关系。方法 对我院经结肠镜检出的158例老年大肠息肉患者的临床特点进行回顾性分析，对其中120例进行1－6年（平均4．5年）的结肠镜随访，并与青中年组的437例患者相对照。结果 老年人大肠息肉的检出率、癌变率分别为30．0％及23．4％，均显著高于中青年组的10．2％及6．9％（P＜0．01），随年龄增长检出率有逐渐增加的趋势。分布以直肠和乙状结肠多见，但升结肠的癌变率（37．5％）明显高于左半结肠（14．3％，P＜0．05），且直肠、降结肠、横结肠及升结肠的癌变率也显著高于青中年组的同一部位（P＜0．01）；病理类型以腺瘤性息肉为多，占77．6％，也明显高于青中年组的同一病理类型（P＜0．01）。37例癌变息肉均为腺瘤性息肉，其中绒毛状腺瘤的癌变率（56．9％）显著高于管状腺瘤（3．4％，P＜0．01）。息肉体积大（＞2cm)、基底宽、数量多，癌变率高。腺瘤性息肉经内镜下摘除者其癌变率明显低于未摘除者（P＜0．01）。结论 老年人大肠息肉中的腺瘤性息肉的大小、形态、数量及病理类型是其癌变的主要危险因素，老年人应尽量行全结肠检查，检出大肠息肉者应尽可能首选肠镜下摘除，定期随访，减少癌变的机会。     

老年人大肠息肉与大肠癌

为了解老年人大肠息肉和大肠癌的临床特点，更好地预防老年人大肠肿瘤的发生和早期诊断大肠癌，对２４８例老年人大肠息肉和大肠癌的临床及病理作一回顾性分析，结果老年人大肠息肉和大肠癌的检出率分别为３３．３％和２３．３％，并有以下特点：（１）大肠息肉和大肠癌是老年人便血的主要原因，炎性息肉，腺瘤性息肉及大肠癌三者的便血率依次增高；（２）息肉检出率显著高于普通人群息肉检出率，且腺瘤性息肉占７３．８％（３）多发     

放大结肠镜对大肠息肉的诊断价值

目的探讨大肠息肉黏膜腺管开口形态分型与病理组织学的相关性，提高大肠早期癌的检出率。方法放大结肠镜检查结合0．2％亚甲蓝染色观察151颗大肠息肉黏膜腺管开口形态，采用日本学者Kudo分型，将其分型与病理学相比较。结果151颗大肠息肉中癌变5颗，放大内镜下1颗表现为Ⅳ型，4颗为V型。放大结肠镜对大肠息肉是否瘤性的镜下诊断的灵敏度为94．8％，特异度为89．2％，阳性预测值为96．5％，阴性预测值为84．6％，Kappa值为0．822，具有极好的一致性。结论放大结肠镜有利于鉴别瘤性和非瘤性息肉，镜下判断大肠息肉性质准确率高。     

大肠癌患者一级亲属的电子肠镜与粪便潜血试验的筛查结果分析

目的研究大肠癌先证患者的一级亲属的电子肠镜和粪便潜血试验（faecal occult blood testing, FOBT）筛查的临床意义。方法前瞻性分析大肠癌先证患者的一级亲属186例的电子肠镜和FOBT的筛查结果。FOBT应用试纸免疫法和氨基比林化学法。结果在186例亲属的肠镜检查中阳性病变检出率高达80．1％，其中癌前病变占41．1％，恶性疾病占23．6％。而FOBT的检出率只有22．3％，明显低于肠镜的检出率（P〈0．001）。大肠息肉、息肉癌变和大肠癌在一级亲属的检出率分别为56．5％、6．5％和17．2％，在对照组分别为25．7％、0．5％和6．5％，两组比较，P均小于0．001。本组小于40岁的患者占阳性病变的20．1％和恶性病变的17．1％。肠镜检查检出Dukes A期大肠癌18例，占56．3％，B期12例，占37．5％，C期2例，占6．3％，D期0例。所有大肠癌患者均可进行根治性手术切除。结论在大肠癌先证患者的一级亲属中进行结肠镜筛查明显优于FOBT，具有较高的检出率，并可预防大肠癌和早期诊断大肠癌和提高根治手术率。     

结直肠锯齿状腺瘤内镜表现和病理学特征分析

目的探讨锯齿状腺瘤（SA）内镜下表现和病理学特征。方法回顾分析滨州医学院附属医院2000年1月～2008年5月检出的大肠息肉病例,了解SA的检出率、内镜形态和病理学特征。结果8726例肠镜检查共检出大肠息肉1062例（1457枚）,检出率为12．17％,其中SA32例（60枚）,检出率为0．37％,占息肉构成比为3．01％。SA直径〉1cm者占21．63％,明显大于增生性息肉（8．57％）;SA表现为有蒂息肉所占的比例（8．33％）略高于增生性息肉（5．71％）,但都低于腺瘤性息肉（40．84％）。SA癌变率介于管状腺瘤和绒毛状腺瘤之间,接近于管状绒毛状腺瘤。结论SA内镜形态、病理学特点提示SA是兼有增生性息肉形态学特征和腺瘤性息肉组织学特点的息肉,具有恶变潜能.     

大肠腺瘤性息肉癌变因素的探讨——附245例分析

本文回顾性的总结分析了我院245例大肠腺瘤性息肉的内镜诊断和病理特点，旨在探讨大肠腺瘤癌变过程的相关因素，以提高大肠癌的早期诊断率。临床资料我院1978年～1996年间进行肠镜检查6807例，检出息肉629例，检出率9．24％。其中腺瘤性息肉245例，检出率3．60％。245例腺癌性息肉中，男167例，女78例。男女之比2．14：1。年龄8～81岁，平均44S岁。临床表现以便血或粘液血便为主，占53．88％（132例）。息肉分布：直肠102例（4。63％），乙状结肠79例（3．24％），降结肠19例（．76％），横结肠20例（．16％），升结肠及盲肠17例（．94％）…     

2型糖尿病血管病变与血糖血脂的关系

目的研究2型糖尿病（DM）血管病变与血糖、血脂的关系。方法2型DM有或无血管病变者分为3组，分别检测空腹血糖（FPG）、餐后2h血糖（PG2h）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL—C）和低密度脂蛋白胆固醇（LDL—C）等指标。结果（1）2型DM有血管并发症的空腹及餐后2h血糖显著高于无血管并发症者，二者之间差异有显著性（P〈0．05）。（2）2型DM患者血脂测定显示TG、LDL—C及TC升高者分别占77．38％、51．19％和41．67％。其中有血管并发症者TG、LDL—C及TC显著高于无血管并发症者，二者之间差异有显著性（P〈0．05）。结论2型DM患者40％以上有血脂异常，其中有血管并发症者的血糖、TG、LDL—C及TC水平均显著高于无血管并发症者。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.