高频超声在类风湿关节炎早期诊断中的应用研究

目的：探讨高频超声在类风湿关节炎（RA）患者早期诊断中的应用价值。方法：RA患者36例,根据病程分为病程〈2年和病程≥2年两组。健康对照30名,分别应用高频超声检测双侧腕关节、第2掌指关节、第2和第3近端指间关节。测量滑膜厚度、示指屈肌腱及尺侧腕伸肌腱腱鞘厚度;观察有无滑膜增殖、滑膜血流增多、关节软骨及软骨下骨侵蚀、肌腱病变。结果：RA组各关节滑膜及腱鞘厚度同健康对照组比较差异有统计学意义（P均〈0.01）。超声检查未发现健康对照组关节内有血流信号、关节腔积液、软骨和软骨下骨侵蚀及肌腱病变。RA组超声发现77%的关节有滑膜增生,67%的关节增厚的滑膜内部及周边血流增多,12个腕关节可见关节腔积液,40%的关节骨皮质有缺损改变。在病程〈2年组,超声发现41个关节有骨侵蚀,而X线只发现21个关节有骨侵蚀。超声发现的肌腱病变主要有腱鞘增宽、肌腱失去正常的纤维状回声结构、肌腱边缘不规则或模糊、不同程度的肌腱撕裂,检出率分别为58%、56%、44%、30%。在病程〈2年组,超声表现主要为滑膜炎和肌腱病变,骨侵蚀性病变多出现在病程≥2年组。结论：高频超声在RA病程早期即可检测出滑膜炎症、肌腱病变、骨侵蚀,较体格检查和X线检测更为敏感,有利于RA的早期诊断。     

肌骨超声检测类风湿关节炎的超声特征、血流变化及意义

目的 探讨肌骨超声检测类风湿关节炎(RA)的超声特征、血流信号特征变化及意义.方法 选取80例RA患者,采用超声对患者960个关节(腕关节160个,掌指关节800个)进行检测,计算各个关节的滑膜厚度、关节积液、骨侵蚀平均评分、滑膜增生处的多普勒血流信号分级,并按照欧洲风湿病防治联合会(EULAR)推荐的RA疾病活动度评分系统(DAS)28评分结果 将80例RA患者分为缓解期组40例、活动期组40例进行组间对比分析.结果 活动期组滑膜厚度、关节积液、骨侵蚀程度评分明显高于缓解期组,差异均有统计学意义(均P<0.05);活动期组关节血流分级与缓解期组比较差异有统计学意义(P<0.05),活动期组关节血流分级水平明显高于缓解期组(P<0.05).结论 RA患者在缓解期与活动期的超声特征、血流具有不一样的特征,对于疾病病情判断有一定的临床价值.     

高频超声在诊断类风湿关节炎患者指关节病变中的应用

目的探讨高频超声在诊断类风湿关节炎（RA）患者手指关节病变中的价值。方法RA患者42例，健康志愿者40名，分别应用高频超声观察双手掌指关节和近端指间关节，测量滑膜厚度，检测有无肌腱、关节腔和骨质病变。结果RA患者79％（33／42）存在滑膜增生，18例患者可见肌腱病变，5例病人可见关节腔积液，5例患者可见骨质破坏，3例患者可见关节融合。病程少于5年的病例主要表现为滑膜增生，而骨质破坏、关节融合的病例病程多在10年以上。结论高频超声可应用于RA患者手指关节病变的诊断。     

高分辨力超声检查在类风湿关节炎膝肘腕关节滑膜炎的应用

目的本研究应用高分辨力超声及多普勒超声技术,观察类风湿关节炎(RA)膝关节、肘、腕关节超声声像特点及血流动力学特点,探讨超声检查在RA诊断中的价值。方法研究了40例RA患者(共240个关节)及20名健康志愿者(共120个关节)的膝关节、肘关节和腕关节滑膜炎的超声声像特征。每例均行双侧对比扫查,超声检查采用美国GE公司LogiQ-9彩色超声诊断仪,高频率线阵式探头,探头中心频率10MHz,直接扫查法扫查。结果RA组共检出191个关节积液,总阳性率79.5%,共检出174个关节滑膜增厚,总阳性率72.5%,检出165个关节内血管过度增生,总阳性率68.7%。结论超声检查为RA关节病变的诊断和炎症活动性的评估提供了一种简便易行,安全有效的方法。     

高分辨率超声检查诊断类风湿性膝关节炎的应用价值

目的应用高分辨率超声和多普勒超声技术,观察类风湿性关节炎（RA）膝关节的二维声像图特点和血流动力学特点,探讨超声对RA的诊断价值。方法研究60例RA患者（共120个关节）和20名健康志愿者（共40个关节）膝关节的超声声像图特点。结果RA组共检出95个关节积液,阳性率为79．1％;83个关节滑膜增厚,阳性率为69．1％;81个关节内血管过度增生,阳性率为67．5％;122个股骨内、外侧髁软骨变薄,阳性率为51．2％。结论超声检查为RA患者膝关节病变的诊断和疾病进展情况的评估提供了一种简易、安全、有效的方法。     

高分辨率超声诊断银屑病关节炎的临床研究

目的 探讨超声检查在银屑病关节炎(PsA)早期诊断中的应用价值.方法 应用高分辨率超声对29例有手指受累的PsA患者的69个手指行双侧对比扫查,观察PsA患者手指的超声声像表现及血流特点,并与30例类风湿关节炎(RA)的70个手指及20名健康志愿者双侧相应手指检查结果对比.采用x2检验进行数据分析.结果 PsA组有临床表现的手指均有超声阳性表现.共检出关节腔积液42个(61％);滑膜炎38个(55％);骨侵蚀28个(41％);腱鞘炎40个(58％);软组织炎29个(42％);附着点炎30个(43％).RA组检出关节腔积液52个(74％);滑膜炎48个(69％);骨侵蚀33个(47％);未检测出腱鞘炎、软组织炎及附着点炎.结论 高分辨率超声是PsA早期诊断和观察手指病变简便易行及安全有效的检查方法.     

类风湿关节炎分类标准(1981年ARA修订标准)

类风湿关节炎分类标准（１９８１年ＡＲＡ修订标准）标准定义１晨僵：关节及其关节周围晨僵持续至少１小时。２３个或３个以上关节区的关节炎：被医生所看到１４个关节区（双侧近端指间关节、掌指关节、腕关节、肘关节、膝关节、踝关节和跖趾指关节中）至少３个关节区域有...     

高频超声与病理学检测评价类风湿关节炎膝滑膜炎的相关性研究

目的 评价高频超声检测类风湿关节炎(RA)膝滑膜炎的效能.方法 95例活动期RA患者行高频彩色多普勒超声检测膝滑膜炎声像,其中51例评价膝病理滑膜炎指标,应用Spearman秩相关分析及受试者工作特征曲线(ROC)等分析临床、病理与高频超声滑膜炎指标的相关性.结果 超声滑膜厚度、彩色多普勒滑膜血流信号分别与病理滑膜炎积分、衬里层增生程度、衬里下层炎症浸润程度呈正相关(滑膜厚度:r值分别为0.438,0.424,0.368,血流信号:r值分别为0.357,0.377,0.347;P均＜0.05).比较病理轻、重度滑膜炎患者的临床滑膜炎指标,差异无统计学意义(均P＞0.05),而重度滑膜炎患者超声滑膜厚度[4.5(2.3～5.0) mm]及血流信号[1.0(1.0～2.0)]显著高于轻度滑膜炎患者[分别为2.4(2.0～2.8)mm,1.0(0～1.0),P=0.001,0.036].超声滑膜厚度≥3.9 mm时诊断重度滑膜炎的特异性为96.7％,敏感性为61.9％.结论 RA关节高频超声滑膜炎声像与滑膜炎病理表现相关并有助于判断病理滑膜炎的严重程度.     

类风湿关节炎合并藤黄微球菌关节炎一例

类风湿关节炎 (rheumatoidarthritis,RA)之膝关节滑膜炎并积液为RA常见症状 ,但合并膝关节藤黄微球菌 (mi crococcusluteus)感染实属罕见 ,现将所遇 1例及其治疗情况报道如下。患者 :女性 ,5 5岁。因四肢大小关节肿痛、晨僵 12年 ,左膝关节肿大伴发热 1周入院。患者于 1979年始出现双手近端指间关节、掌指关节、腕关节对称性肿痛伴晨僵。当地医院确诊为类风湿关节炎 (RA)。每于症状加重时服用中草药、非甾体抗炎药及泼尼松等治疗 ,症状能缓解。 1周前上症复发 ,左膝关节肿大明显并伴发热。无结核等传染病史 ,无脱发、口眼生殖器溃疡、光…     

骨桥蛋白在类风湿关节炎发病机制中的研究进展

类风湿关节炎(rheumatoid arthritis,RA)为慢性炎症性自身免疫病,主要病理特点为滑膜炎、血管翳的形成,以及软骨和骨的破坏.RA病变核心部位在关节滑膜,滑膜主要的组织细胞学改变有:滑膜内膜层细胞[成纤维样滑膜细胞(FLS)和巨噬样细胞]的增生、滑膜内膜下层炎性细胞(巨噬细胞、淋巴细胞等)的浸润,侵蚀关节面的血管翳形成,破骨细胞活化并介导矿化软骨和软骨下骨的侵蚀.病变中涉及到的分子有细胞因子、黏附分子、趋化因子、蛋白酶等.     

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.