缺血性结肠炎与溃疡性结肠炎临床特征、内镜特点比较分析

目的 提高缺血性结肠炎(IC)和与溃疡性结肠炎(UC)诊断的正确率.方法 选择2008年1月至2011年6月的住院患者,确诊IC 43例,UC 36例,对其临床特征、内镜特点进行回顾性比较分析.结果 组间性别、年龄、病程和基础疾病比较差异有统计学意义(P＜0.05),而主要临床表现比较,差异无统计学意义.IC组以老年女性多见,病程短,多伴发心脑血管等基础疾病(29/43,67.0％).IC组C反应蛋白高于UC组,血小板低于UC组(P＜0.05).IC多累及乙状结肠,直肠少见;病变为区域局限性,溃疡为纵形或不规则形,病灶愈合迅速,病理以黏膜炎症为主.UC组病变多起源于直肠,一般累及肠壁全周,病变为倒灌连续性,以散在针尖样地图状溃疡为主,病理表现为隐窝炎和脓肿.结论 年龄、病程、基础疾病、C反应蛋白、内镜及病理特征是鉴别诊断的要点.     

AIF-1在溃疡性结肠炎及缺血性肠炎结肠组织中表达的差异

目的比较溃疡性结肠炎(ulcerative colitis,UC)与缺血性肠炎(ischemic colitis,IC)患者结肠黏膜中同种异体移植物炎症因子-1(allograft inflammatory factor-1,AIF-1)、白细胞介素-1(interleukin-1,IL-1)表达水平的差异,以探讨AIF-1参与UC发病的可能性。方法收集2010年1月-2014年12月34例确诊为UC和31例确诊为IC的患者结肠黏膜标本,另以12名正常人为对照,用ELISA方法检测AIF-1、IL-1的表达水平。结果 UC患者结肠黏膜AIF-1表达水平较IC和正常人高(P0.05),IC患者结肠黏膜AIF-1水平与正常人比较,差异无统计学意义(P0.05)。UC患者结肠黏膜IL-1表达水平与IC患者比较,差异无统计学意义(P0.05),但二者均高于正常人(P0.05)。UC及IC患者AIF-1与IL-1表达水平无相关性(P0.05)。结论 AIF-1可能参与了UC的发病。     

青年溃疡性结肠炎57例临床分析

目的 探讨住院青年溃疡性结肠炎(UC)患者的临床特点.方法 对我院2009年1月～2012年1月收治的57例青年UC患者的临床资料进行回顾性分析.结果 青年UC患者病变范围以全结肠为主,肠外表现发生率(43.9％,25/57)较中老年患者(23.8％,15/63)明显增高(P＜0.01).青年患者与中老年患者的病理表现比较差异无统计学意义.结论 青年UC患者临床表现相对较重,水杨酸制剂及糖皮质激素治疗效果与中老年组比较差异无统计学意义.     

老年人缺血性结肠炎的特点和处理策略

缺血性结肠炎(IC)多见于老年人群,是急性下消化道出血的主要原因之一。各种原因甚至老年人便秘所致的低血流灌注状态为其主要发病机制。临床表现与缺血累及范围和时间有关。发作性腹部疼痛不适伴排便急迫感、24 h内出现鲜红色或暗红色血便或血性腹泻,是老年人IC的主要临床表现。腹盆腔CT检查是明确肠道受累部位和病变范围首选的检查方法。结肠镜检查为确诊方法,如无肠坏死或肠穿孔,应于48 h内行结肠镜检查。内科治疗包括肠道休息、静脉补液、纠正电解质紊乱、治疗原发疾病和应用抗菌药物,必要时予肠外营养。与其他部位的结肠缺血相比,孤立性右半结肠缺血预后较差。对于孤立性右半结肠或全结肠缺血以及存在肠坏死的患者,应及时请外科会诊讨论有无手术治疗的可能性。     

老年与非老年溃疡性结肠炎患者直肠肛门运动及直肠感觉功能对比分析

目的 探讨老年溃疡性结肠炎(UC)患者肛门直肠运动及直肠感觉变化特点.方法 采用瑞典CTD-SYNECTICS公司生产的PC-Polygraf HR高分辨多道胃肠功能消化道检测仪,对35例非老年UC及19例老年UC患者肛门直肠动力和直肠感觉功能进行检测,并与20例非老年健康人和28例老年健康人进行比较.结果 (1)肛门静息压、括约肌压力、肛门括约肌最大缩窄压,老年UC组与相应对照组比较差异均无统计学意义(t值分别为1.311、1.298、1.401,P＞0.05);增加腹压时,老年UC组肛门括约肌净增压为(2.8±1.1)kPa,低于相应对照组的(3.8±1.2)kPa,差异有统计学意义(t=2.238,P＜0.05).(2)直肠对容量刺激的最低敏感量、最大耐受性和顺应性,老年UC组为(85±30)ml、(180±69)ml和(26.5±8.8)ml/kPa,低于老年对照组的(95±31)ml、(205±78)ml和(32.9±12.9)ml/kPa,差异均有统计学意义(t值分别为3.121、3.135、3.146,P＜0.01).(3)直肠对容量刺激的最低敏感量、最大耐受性、顺应性,老年UC组均高于非老年UC组(t值分别为2.246、2.239、2.240,P＜0.05);直肠最低敏感量、最大耐受性老年对照组高于非老年对照组(t值分别为2.238,2.301,P＜0.05).结论 UC患者存在肛门直肠运动异常,肛门自控能力减弱;UC患者直肠对容量刺激存在高敏感、低耐受、低顺应性现象.健康老年人直肠对容量刺激的感受阈较高,老年UC患者对容量扩张刺激敏感性比非老年UC患者弱.     

小肠细菌过度生长与溃疡性结肠炎关系的研究进展

<正>溃疡性结肠炎(ulcerative colitis, UC)是一种发病原因尚不明确的慢性结肠炎症性病变,常见于青壮年,对患者生活质量影响较大。目前UC的发病机制尚不明确,大量研究证明,个体遗传易感、肠道微生物区系、     

缺血性结肠炎研究现状

缺血性结肠炎(IC)是缺血性肠病中最常见的类型,人群发病率为(4.5～9.9)/10万人年,老年人高发,女性患者相对多见。临床表现主要为左下腹痛、血性腹泻和便血,症状轻重与缺血程度有关,多数为轻度黏膜或黏膜下损伤引起的短暂可逆性症状,少数表现为急性暴发性缺血伴透壁性梗死,可进展至结肠坏死甚至致死。IC常与心血管疾病、缩血管药物的使用、腹部血管手术、肠易激综合征、便秘等有关。     

溃疡性结肠炎中Fas/FasL介导的结肠上皮

目的探讨Fas/FasL介导的结肠上皮细胞凋亡在溃疡性结肠炎(UC)发病机制中的作用.方法按Powell-Tuck评分系统对UC患者疾病活动性进行评分.免疫组化法检测35例UC和15例对照标本Fas、FasL表达,M30Cytodeath特异性检测结肠上皮细胞凋亡,图像分析仪定量分析.结果UC组表达Fas、FasL的水平平均为(27.1±2.9)%、(16.5±3.2)%,凋亡指数平均为(3.5±1.0)%,均比对照组明显增高[分别为(11.6±3.1)%、(5.3±2.4)%及(0.3±0.1)%,P＜0.01];UC表达Fas、FasL的水平与疾病活动性评分有正相关性(r=0.42和r=0.38,P＜0.05),而与组织学分级没有相关性(P＞0.05);组织学分级与疾病活动性评分呈显著正相关(r=0.848,P＜0.01).Fas与M30可共同表达且具有相关性.结论Fas/FasL介导的结肠上皮细胞大量凋亡可能是UC上皮层破坏的机制之一.     

强直性脊柱炎髋关节病变的相关因素分析

目的 探讨强直性脊柱炎(AS)患者髋关节病变的危险因素.方法 将同期住院的102例有髋关节破坏性病变的AS患者(A组)和54例无髋关节破坏性病变的患者(B组)临床资料和治疗方法分别进行单因素和非对称多因素Logistic回归分析.结果 A组患者比B组发病年龄早[(17±8)岁与(24±7)岁]、病程短[(5±4)年与(11±5)年]、幼年发病多见(37.3%与20.4%)、首发髋关节起病较多(38.2%与25.9%),以及外周关节炎重(39.2%与20.4%),差异均有统计学意义(P均＜0.05).A组患者红细胞沉降率(ESR)、C反应蛋白(CRP)、免疫球蛋白(IgG、IgM)水平,以及骶髂关节病变率显著高于B组(P均＜0.05).A组使用糖皮质激素剂量显著多于B组,使用柳氮磺吡啶和沙利度胺剂量显著少于B组(P均＜0.05).Logistic回归分析显示仅有5个髋关节病变相关因素,包括发病年龄、病程、幼年发病、首发髋关节起病以及服用柳氮磺吡啶(P＜0.05或P＜0.01).结论 发病年龄早、幼年发病、病程短以及髋关节起病的AS患者可能易于发生首发髋关节病变,而足量的柳氮磺吡啶可能是AS起病发生髋关节病变的保护因素.     

老年肺结核患者血清血管活性肠肽的变化及临床意义

目的 探讨血管活性肠肽(VIP)在老年肺结核患者血清中的改变及与白细胞介素4(IL-4)、γ干扰素(IFN-γ)的相关性.方法 采用放射免疫分析(RIA)法检测40例老年活动性肺结核患者(老年活动性肺结核组)、30例老年非活动性肺结核患者(老年非活动性肺结核组)、30例中青年活动性肺结核患者(中青年活动性肺结核组)及20例老年健康人(健康组)血清VIP水平,酶联免疫吸附(ELISA)法检测血清IFN-γ、IL-4水平.老年活动性肺结核组中,病灶范围大或有空洞形成患者17例,病变范围小患者23例.结果 老年活动性肺结核组血清VIP、IL-4水平高于老年非活动性肺结核组及健康组(均P ＜0.01).老年活动性肺结核组IFN-γ水平低于健康组,差异有统计学意义(P＜0.05).病灶范围大或有空洞形成患者血清VIP、IL-4水平高于病变范围小患者(P＜0.05).老年活动性肺结核患者血清VIP、IL-4及IFN-γ水平与中青年活动性肺结核患者比较差异无统计学意义.老年活动性肺结核患者血清VIP与IL-4呈正相关(r=0.672,P＜0.01),与IFN-γ呈负相关(r=-0.406,P＜0.01).老年非活动性肺结核组、健康组血清VIP与IL-4、IFN-γ之间均无相关性.结论 VIP可能对评价老年肺结核病情严重程度、活动性以及判断其转归具有一定的参考意义.     

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.     

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.     

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.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

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.