消化性溃疡与幽门螺杆菌

自１９８３年Ｍａｒｓｈａｌｌ和Ｗａｒｒｅｎ从人胃粘膜活检标本中分离培养出幽门螺杆菌（ＨＰ）以来,大量的研究发现其在消化性溃疡（ＰＵ）的致病中具有非常重要的作用。病因认识的突破,使ＰＵ的防治策略发生了彻底变革。１　ＨＰ感染致ＰＵ的依据１．１　ＰＵ患者有较高的ＨＰ检出率　研究证实,８０％～１００％的十二指肠溃疡患者存在ＨＰ感染,胃溃疡ＨＰ检出率也在５９％～８６％。１．２　ＨＰ引起的胃炎是发生ＰＵ的重要基础　大量研究证实,ＰＵ均发生在慢性胃炎的组织学基础上,慢性胃炎患者ＨＰ的检出率＞７０％,而活动性胃…     

建立萎缩性胃炎幽门螺旋杆菌感染动物模型的方法

将Ｗｉｓｔａｒ大鼠采用主动免疫、寒凉胆汁灌胃、自然口服去氧胆酸钠及饮食不节的综合法，制成大鼠萎缩性胃炎模型，然后在此基础上附加幽门螺旋杆菌（ＨＰ）感染。结果表明，本动物模型在胃粘膜组织中能检查到井分离出ＨＰ，病理组织学检查证实其胃粘膜组织呈现出萎缩性胃炎及ＨＰ感染的双重复合病理变化、从而为研究萎缩性胃炎ＨＰ感染提供了一个较为合适的动物模型。     

胃癌前期病变与幽门螺杆菌感染的关系及临床观察

本文对１２２例胃癌前期病患者进行了幽门螺杆菌（ＨＰ）检测．并进行了病变程度、中医证型与ＨＰ关系的分析．同时给予相应的辨证治疗。结果表明：ＨＰ阳性率为７２．１３％，轻－中度组、中度组较重度组ＨＰ感染率明显增多，ＨＰ阳性率在不同中医证型中依次为脾虚湿蕴＞脾虚气滞＞气阴两虚，治疗后ＨＰ阳性率较治疗前明显降低，ＨＰ转阴率为５２．２７％。     

酶联免疫法检测粪便幽门螺杆菌特异性抗原

目的：探讨酶联免疫法（ＥＬＩＳＡ）检测粪便幽门螺杆菌（ＨＰ）特异性抗原（ＨＰＳＡ）在诊断ＨＰ感染中的价值。方法：９９例患者通过快速尿素酶试验及组织学Ｗａｒｔｈｉｎ－Ｓｔａｒｒｙ银染法检测，分为ＨＰ感染组和非感染组，用酶联免疫法检测粪便中ＨＰＳＡ。结果：粪便酶联免疫法检测ＨＰ感染的敏感性为１００％，特异性为８５．７１％。结论：酶联免疫法检测粪便中ＨＰＳＡ敏感性、特异性高，且取材方便，方法简单，适合临床应用。     

幽门螺杆菌清除前后胃粘膜增殖状态的变化

本研究以流式细胞技术对幽门螺杆菌（ＨＰ）阳性和阴性患者胃粘膜细胞周期进行对比分析，并通过银染技术对ＨＰ清除前后胃粘膜细胞核仁组成区嗜银蛋白（ＡｇＮＯＲｓ）的变化进行随访观察。结果表明，ＨＰ阳性胃粘膜Ｓ期细胞比率和增殖指数均显著高于ＨＰ阴性胃粘膜，ＡｇＮＯＲｓ数量与胃粘膜增殖指数呈显著正相关。经治疗ＨＰ转阴者其胃粘膜细胞ＡｇＮＯＲｓ数量显著下降（Ｐ＜０．０１），而ＨＰ仍为阳性者ＡｓＮＯＲｓ数量则无显著变化（Ｐ＞０．０５）。ＨＰ清除后胃粘膜炎症明显好转。结果提示ＨＰ感染的胃粘膜处于高增殖状态，ＨＰ感染可能通过刺激胃粘膜细胞的增殖加速，从而增加患胃癌的危险性。     

消化性溃疡与幽门螺杆菌感染关系的中西医结合研究

经过纤维胃镜检查的３６１０例病人中有７７８例为消化性溃疡病人。对其中４０１例消化性溃疡病人胃窦部粘膜作了幽门螺杆菌（ＨＰ）检测、ＨＰ阳性者为３５６例，阳性率为８６．６％。与同期检测胃炎组阳性率５５．１％相比明显为高，差异显著。ＨＰ被认为是慢性胃窦炎的主要病因，也是消化性溃疡的重要致病因素。根除ＨＰ可提高ＤＵ治愈率，降低ＤＵ复发。ＨＰ阳性率在中医证型中表现为非脾虚组明显高于脾虚组，其中以脾胃湿热组最高。     

唾液抗幽门螺杆菌IgG检测诊断幽门螺杆菌感染的评价

目的 评价唾液抗幽门螺杆菌（ＨＰ）抗体诊断ＨＰ感染的价值。方法 ９３例病人同时进行唾液抗ＨｐＩｇＡ测定、快速尿素酶试验（ＲＵＴ）、组织涂片ＨＥ染色及病理ＷＳ银染色法诊断ＨＰ感染结果 唾液抗ＨｐＩｇＧ检测阳性率近似于ＲＵＴ法，高于组织涂片ＨＥ染色法和病理ＷＳ银染色法，其诊断ＨＰ感染的敏感性与９６．９７％，特异性８８．２３％，准确性９５．１８％，阳性预测值９７％，阴性预测值８８．２４％，结论唾液抗Ｈｐ     

四黄调胃汤治疗幽门螺杆菌阳性消化性溃疡

幽门螺杆菌（ＨＰ）与消化性溃疡的发生密切相关［１］,为提高ＨＰ的根除率,自１９９７年１月～１９９８年１０月我们对ＨＰ感染与脾虚的相互关系及脾虚与胃肠道粘膜屏障的关系进行初步探讨,并用中药四黄调胃汤加抗生素联合治疗脾虚型ＨＰ阳性消化性溃疡,取得了一定疗效,现报告如下。１　资料与方法１．１　临床资料：观察对象为我院门诊患者,采用日本ＯＬＹＭＰＵＳＥＦ１３０胃镜检查、尿素酶试验、１３Ｃ呼气试验检查,按文献［１～４］标准确诊的中医脾虚证消化性溃疡患者６２例,其中胃溃疡１２例,十二指肠溃疡４８例,复合性溃…     

功能性消化不良的亚型调查及其与幽门螺杆菌关系的探讨

目的：了解功能性消化不良（ＦＤ）的不同亚型比例,探讨其与幽门螺杆菌（ＨＰ）等因素的关系。方法：对１８６例ＦＤ患者以问卷形式询问病史,按症状给予分型,用尿素酶试验、涂片染色、培养法检测ＨＰ。结果：各亚型的比例及ＨＰ阳性率分别显：反流型１１．２９％、１４．２９％;溃疡型１３．９８％、４６．１５％;运动障碍型４８．３９％、４１．１１％;复合型２６．３４％,３８．７８％,ＦＤ的ＨＰ总阳性率为３８．１７％。结论：ＦＤ中以运动障碍亚型最为多见。部份亚型之间有重叠。ＦＤ与ＨＰ感染无关。反流型中的ＨＰ阳性率较低。     

聚合酶链反应对胃活检标本中幽门螺杆菌DNA的检测

应用聚合酶链反应（ＰＣＲ）对幽门螺杆菌（ＨＰ）特异性的尿素酶Ａ基因进行扩增，４０个循环可以检测出１０个ＨＰ，加用非同位素地高辛探针杂交，可以检出单个ＨＰ。用本法对１００例胃镜活检标本进行ＰＣＲ检测，其阳性率达８２％，而尿素酶水解试验，细菌涂片及培养的阳性率则分别为６８％、４６％、１８％。ＰＣＲ方法能快速、敏感，特异地检测出临床标本中ＨＰ，对于研究ＨＰ与上消化道疾病之间的关系，指导抗菌治疗均具有重要意义。     

伊伐布雷定在心血管疾病中应用的研究进展

伊伐布雷定为特异性的 I f通道阻滞剂，通过调节窦房结的起搏，发挥特有电生理学作用，可减慢心率但不影响心肌收缩力、心内传导、心室复极等，因其不良反应少，安全性高，目前不仅被广泛应用于慢性稳定性心衰、冠心病等疾病，而且最新临床及动物试验证实，伊伐布雷定药物的应用在不断的拓展，一些临床不良反应也得到进一步证实，该文就其近年来在心血管疾病中的新的应用进展予以综述。     

Nanostructured mesoporous silica matrices in nanomedicine

In the last few years the biomedical research field has shown a growing interest towards nanostructured mesoporous silica materials, whose chemical composition is silica and present nanometric pores. These bioceramics exhibit two important features: they can regenerate osseous tissues – the bond bioactivity of these materials has been confirmed by the formation of biological‐like nanoapatites on their surface when in contact with physiological fluids – and they are able to act as controlled release systems. Drugs in the nanometre scale can be loaded on those matrices and then locally released in a controlled fashion. It is possible to chemically modify the silica walls to favour the adsorption of certain biomolecules such as peptides, proteins or growth factors. It is even possible to design smart biomaterials where the drug is released under an external stimulus. Thus, looking at all those properties, a question arises: Have these bioceramics good expectations to be used in clinical medical practice? Their biocompatibility, bioactivity, capacity to regenerate bone and ability to act as controlled release systems of biologically active species have been confirmed. In fact, their preliminary in vitro and in vivo essays have been positive. Now it is the time to adequate all these properties to the actual clinical problems, and to evaluate their efficiency in comparison with materials already known and currently employed such as bioglasses.     

Squamous cell carcinoma after radiofrequency ablation for Barrett’s dysplasia

Barrett’s oesophagus(BO)is a usually indolent condition that occasionally requires endoscopic therapy.Radiofrequency ablation(RFA)is an effective endoscopic treatment for high grade dysplasia(HGD)and intramucosal cancer in BO.It has a good efficacy,durability and safety profile although complications can occur.Here we describe a case of RFA in a patient with high grade dysplasia.Although the response to treatment was initially very good with the development of neosquamous epithelium,the patient very rapidly developed a squamous cell cancer of the oesophagus confirmed on radiology,histology and immunohistochemistry.Sanger sequencing confirmed that the original HGD and the squamous cell cancer(SCC)were derived from separate clonal origins.The report highlights the fact that SCC of the oesophagus has been noted after endoscopic ablation for BO previously and suggest that ablation of BO may encourage the clonal expansion of cells carrying carcinogenic mutations once a dominant clonal population has been eradicated.     

单克隆抗体M26-32靶抗原基因片断融合蛋白的表达和特性分析

用温度诱导方法获得了 M2 6 - 32靶抗原基因片断表达的融合蛋白。 Western- blot分析显示 ,该融合蛋白能与单克隆抗体 M2 6 - 32反应 ,证实了获得的基因序列是单克隆抗体 M2 6 - 32的靶抗原基因片断。该融合蛋白能与抗间日疟原虫和抗恶性疟原虫血清反应 ,且抗该融合蛋白抗体和纯化融合蛋白的抗血清还能与间日疟原虫和恶性疟原虫的胞浆抗原反应 ,表明该靶抗原基因片断内含有间日疟原虫和恶性疟原虫的共同基因序列 ,且这一共同基因表达的蛋白存在于间日疟原虫和恶性疟原虫抗原之中     

Questions and answers on the role of faecal calprotectin as a biological marker in inflammatory bowel disease

Faecal calprotectin has been proposed as a non-invasive surrogate marker of intestinal inflammation in inflammatory bowel disease. Close correlation between faecal calprotectin concentration and faecal leukocyte excretion quantified with ¹¹¹indium has been described. This faecal marker can be detected using simple and cheap techniques. Faecal calprotectin has a good diagnostic precision for separating organic and functional intestinal diseases. However, the specificity for the diagnosis of inflammatory bowel disease is lower than desirable, as several diseases other than inflammatory bowel disease – specially colorectal neoplasia and gastrointestinal infection – can also increase faecal calprotectin. High concentration of calprotectin in faeces is a strong argument to carry out a colonoscopy in order to rule out the presence of inflammatory bowel disease or other organic pathologies. Parallelism between faecal calprotectin levels and inflammatory bowel disease activity has been confirmed, although this faecal marker appears to better reflect the disease activity in ulcerative colitis than in Crohn's disease. Faecal calprotectin's capacity to predict inflammatory bowel diseases relapse is promising. It has been suggested that, in inflammatory bowel disease patients receiving treatment, a normalization or decrease in faecal calprotectin concentrations is an accurate indicator of endoscopic healing. Greater faecal calprotectin concentration has been shown in asymptomatic first-degree relatives of patients with inflammatory bowel disease, suggesting that there is a high prevalence of subclinical intestinal inflammation in them.     

Persistent fifth aortic arch diagnosed by echocardiography and confirmed by angiography: Case report and literature review

Persistent fifth aortic arch is a rare congenital anomaly that can be discovered incidentally or at postmortem exam. It can be associated with major congenital heart malformations involving the systemic or the pulmonary circuits. It usually has no clinical significance but can be either, beneficial as in systemic outflow tract obstructions or cause hemodynamic compromise when associated with a significant left to right shunt. We report an infant with persistent fifth aortic arch associated with Shone’s complex diagnosed accurately by transthoracic echocardiography and confirmed by cardiac catheterization and computed tomography.     

A platypnea-orthodeoxia syndrome

We report the case of a 68 years old patient with platypnea orthodeoxia syndrome who has been clinically suspected on cutaneous saturation position's variation. It has been confirmed by transthoracic and transesophageal echocardiography (TEE). TEE showed the size of patent foramen ovale (PFO), visualised the right to left shunt. A right heart angiography confirmed echocardiographic data and allowed successful closure by a Cardioseal percutaneous transcatheter button device implantation. Symptom's disappearance and a TEE control after 2 months confirmed the success of the procedure.     

Hirudin: Its biology and clinical use

Over a century has passed since the anticoagulant properties of hirudin were identified. Our understanding of this unique and promising 65 amino acid polypeptide has grown steadily, allowing clinical experience to be gained. In acute myocardial infarction, hirudin has been associated with a higher incidence of early and sustained TIMI grade 3 flow, a higher rate of infarct-related artery patency at 18–36 hours with a decreased rate of reocclusion, and a lower incidence of in-hospital death and reinfarction as compared with heparin. Hirudin has also been associated with a stable level of anticoagulation and an acceptable hemorrhagic complication rate when given in carefully chosen doses. In acute coronary syndromes, the initial results indicate that hirudin can improve the resolution of coronary thrombus and reduce the incidence of recurrent ischemic events. Similarly impressive reductions in thrombotic complications and ischemia have been observed in the early balloon angioplasty experience. Promising results have also been seen with hirudin in preventing deep venous thrombosis following orthopedic surgery. The favorable effects of hirudin as compared with heparin in phase II clinical trials have prompted further investigation in two large phase III trials, TIMI 9 and GUSTO 2. It is hoped that these initial results can be confirmed and that hirudin can be proved to be a safe and effective treatment for thrombotic syndromes of the venous and arterial circulatory systems.     

Quantitative Hemagglutination Studies in the Rh Blood Group System. II. A Study of the D (Rho) Agglutinogen

The reactivity of Rh positive red cells with saline anti-D sera has beeninvestigated by means of quantitative hemagglutination methods. The inhibitory effect of C on the D antigen has been confirmed and the possibility ofinhibition by this antigen in the cis position suggested. It is also suggested thatthe e antigen has suppressive effect on D. The presence of companion antigensresults in a -D-> R₂ > R_o > R₁ progression of decreasing agglutinability.Within families differences in the agglutination behavior between homozygousand heterozygous D positive cells were found. The heterogeneity of thisantigen was confirmed.

Accepted on November 20, 1960     

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大量研究证实强化降脂治疗能阻断或逆转动脉粥样硬化病变进展.目前认为,对于急性冠脉综合征患者的强化治疗时间至少应坚持2年.而稳定型冠心病也需大幅度降低胆固醇.但需要认识到大幅度降低胆回醇的潜在危害和局限性,降脂不是越低越好,同时也要监测可能发生的不良反应.