门静脉高压患者胃静脉曲张的内镜识别和分类

背景：肝硬化门静脉高压的出血原因中，食管和（或）胃静脉曲张破裂出血最为常见。胃静脉曲张的发生率较食管静脉曲张低，但再出血率高，出血量大，死亡率亦较高。尽管如此，胃静脉曲张在临床诊治过程中未受到应有的重视。目的：根据内镜下对食管和胃静脉曲张的识别和分类，了解食管和胃静脉曲张的比例。方法：根据Sarin分类，在内镜直视下将114例门静脉高压患者分为单纯食管静脉曲张、胃食管静脉曲张1型（GOV1型）、胃食管静脉曲张2型（GOV2型）、孤立性胃静脉曲张1型（IGV1型）和孤立性胃静脉曲张2型（IGV2型）五种类型。结果：本组患者中单纯食管静脉曲张42例（36．8％），GOV1型40例（35．1％），GOV2型20例（17．5％），IGV1型12例（10．5％），未见IGV2型。结论：半数门静脉高压患者存在胃静脉曲张，临床工作中仅处理食管静脉曲张是很片面的。须努力开展组织黏合剂、球囊闭塞下逆行经静脉栓塞术（B．RTO）或外科分流等治疗：对有条件的患者应鼓励开展肝移植治疗。     

国产生长抑素治疗食管、胃静脉曲张出血多中心研究

门脉高压是慢性肝病常见并发症，是食管、胃静脉曲张主要原因之一，而且25％～35％曲张静脉会发生出血。生长抑素（14肽）作为治疗食管、胃静脉曲张出血的一线用药，已在国内应用10余年，其疗效已得到广大临床医生的认可。国产生长抑素（时士太）系由昆明积大制药有限公司生产，本研究旨在评价国产生长抑素治疗食管、胃静脉曲张出血的临床疗效和安全性。     

内镜套扎及组织胶栓塞治疗食管胃底静脉曲张出血的疗效观察

【摘要】目的探讨内镜下静脉曲张套扎术（EVL）及组织胶栓塞术治疗食管胃底静脉曲张出血的临床疗效。方法回顾性分析452例食管胃底静脉曲张出血患者的食管静脉曲张EVL和胃底静脉曲张组织胶栓塞术治疗及随访情况,对治疗效果及并发症进行总结。结果急诊止血成功率为100．0％（145／145）,早期再出血率为1．8％（8／452）,早期不良反应发生率为50．0％（226／452）,并发症发生率为12．4％（56／452）。EVL治疗食管静脉曲张有效率和显效率分别为32．5％（145／446）和40．4％（180／446）;组织胶栓塞术治疗胃底静脉曲张有效率和显效率分别为32．5％（136／419）和27．4％（115／419）。426例随访9—37个月,平均18个月,再出血发生率为10．1％（43／426）,6个月生存率为97．9％（417／426）,1年生存率为89．9％（383／426）。结论EVL及组织胶栓塞术治疗食管胃底静脉曲张疗效较好,两者联合治疗操作简单、疗效好、患者创伤小,既可以用于急诊止血,也可用于二级预防。     

奥曲肽预防食管静脉曲张硬化治疗后早期再出血的临床研究

背景：食管静脉曲张破裂出血患者经食管静脉曲张硬化治疗（EVS）后再出血发生率仍较高．是导致肝硬化门静脉高压患者死亡的重要原因之一，尤其是早期再出血。奥曲肽能降低门静脉压力。与EVS联合应用可能降低早期再出血发生率。目的：了解EVS加用奥曲肽后降低早期再出血发生率的情况，探讨影响早期再出血发生的因素。方法：80例食管胃静脉曲张患者被随机分为试验组和对照组，每组40例。两组患者均予择期或急诊EVS．根据食管静脉曲张消失情况行3～5次EVS，每隔7d治疗1次，静脉曲张消失或基本消失为一疗程结束。试验组于第1、2、3次EVS术后第4～6d加用奥曲肽治疗。结果：试验组EVS后有1例发生早期再出血，发生率为2．5％．对照组有7例发生早期再出血，发生率为17．5％，试验组早期再出血发生率显著低于对照组（P=0．028）。Logistic逐步回归分析显示奥曲肽对早期再出血发生率有显著影响（P=0．049）。结论：EVS联合奥曲肽治疗可降低EVS后早期再出血发生率。     

门脉高压症出血的药物治疗

门脉高压症所致食管和胃静脉曲张破裂出血（e．sophageal and gastric varices bleeding，EGVB）是最严重并发症，占上消化道大出血的1／3，并且是晚期肝脏疾病的主要死因之一。肝硬化门脉高压患者中有25％～35％发生食管和胃静脉曲张出血。约30％初次出血即为致死性出血；约70％幸存者在1年内有多发出血；首次出血后1年生存率约为32％～80％。因此，对于门脉高压症所致的食管和胃静脉曲张出血的治疗及预防初次、再次出血具有重要的临床意义。     

食管胃静脉曲张出血的预测及其治疗对策

食管胃静脉曲张出血的预测及其治疗对策曾民德门脉高压（ＰＨ）使内脏呈高灌注状态，食管或食管胃静脉曲张（ＥＶ或ＥＧＶ）和门脉高压性胃病（ＰＨＧ）是两类致上消化道出血的主因，其中来自ＥＶ出血（ＥＶＢ）占５０％～８０％，居首位。１０％～５０％可由ＰＨＧ引起，...     

心得安单纯或联合使用在二级预防食管静脉曲张出血中的疗效比较

目的比较单纯心得安、套扎＋心得安、硬化剂＋心得安二级预防食管静脉曲张出血的疗效,探寻心得安二级预防食管静脉曲张出血的最佳组合。方法78例食管静脉曲张出血患者随机分成3组,每组26例,止血后分别给予心得安（心得安组）、套扎＋心得安（套扎组）、硬化剂＋心得安（硬化剂组）,比较各组12个月内再出血率、死亡率,以及各组门脉高压性胃病、胃底静脉曲张发生率、食管曲张静脉复发率。结果12个月内再出血率套扎组为30．77％,明显低于心得安组（53．85％）及硬化组（42．31％）（P均〈0．05）;套扎组和心得安组门脉高压性胃病及胃底静脉曲张发生率相似,都明显低于硬化组（P均〈0．05）;而食管静脉曲张再发率高于硬化组（P〈0．05）。结论在应用心得安的基础上进行套扎治疗可能是目前食管静脉曲张出血最有效的二级预防方法。     

肝硬变上消化道大出血病因的内镜诊断

肝硬变上消化道大出血患者６２例，出血后６小时～１周内行胃镜检查及硬化剂治疗。检查证实无食管胃底静脉曲张２例；胃及十二指肠球部明显糜烂１４例（２２．６％），胃和十二指肠球部溃疡６例（９．７％）。９例（１４．５％）为非静脉曲张性出血，７例（１１．３％）为双因素性出血，表明将肝硬变上消化道大出血一概推断为食管静脉曲张破裂出血是片面的。作者强调早期内镜检查和治疗的重要性。     

经内镜栓塞术联合套扎术治疗食管胃底静脉曲张出血的疗效观察

目的探讨胃底静脉曲张栓塞术联合内镜下食管静脉曲张套扎术（EVL）治疗肝硬化上消化道出血的疗效。方法经急诊胃镜检查发现活动性胃底静脉曲张出血合并Ⅱ°以上食管静脉曲张且排除其他病因的上消化道出血患者共156例,分为治疗组和对照组,治疗组胃底静脉曲张组织粘合剂栓塞同时食管静脉EVL治疗;对照组胃底静脉曲张组织粘合剂栓塞治疗2个月后行食管静脉EVL。结果两组均未发生与治疗相关的并发症。止血成功率治疗组为96．3％（77／80）,对照组为97．4％（74／76）,（P〉0．05）;近期再出血率治疗组为6．4％（5／78）,对照组为21．3％（16／75）,两组差异有统计学意义（P〈0．05）;两组患者随访6个月,再出血率分别为13．0％（9／69）、25．4％（17／67）,差异有统计学性意义（P〈0．05）。胃底静脉曲张改善总有效率治疗组和对照组分别为61．6％、59．1％,食管曲张静脉改善总有效率为74．0％、67．9％,差异均无统计学意义。结论胃底静脉曲张栓塞联合EVL是治疗肝硬化胃底静脉曲张出血并食管静脉曲张的安全有效方法,同时联合治疗更能降低再出血率。     

门脉高压食管静脉曲张出血介入治疗

目的评估ＥＶＳ、ＥＶＬ、组织粘合剂注射及ＴＩＰＳＳ治疗门静脉高压食管胃静脉曲张出血的优缺点。方法对７１２例食管胃静脉曲张出血病人进行了回顾分析。结果ＥＶＳ６１５例，经１８２６次治疗，急诊止血率为９６．９％，食管静脉曲张消失率为８４．６％，并发症发生率为１４．７％，肝硬化患者３４４人随访１２～１０４月，１、３、５年生存率为９１．５２％±１．３６％．７１．４２％２１．７１、４７．１３％±１．８６％。ＥＶＬ３０例，食管静脉消失率为７６．７％，复发出血１３．３％。组织粘合剂注射１２例，急诊６例全部止血。ＴＩＰＳＳ治疗先例。成功率为９０．９％食管静脉曲张消失和好转为８２．３％并发症发生率为３６％。一年内支架闭塞、狭窄、复发出血１６例（３８．０９％），随访１２～４２月，死亡１２人（２１．８％）。结论内镜下介入治疗是食管静脉曲张出血首选方法。急诊止血以ＥＶＳ和内镜下组织粘合剂注射为优，ＥＶＬ浸润性并发症低，但反复出血率较高，ＴＩＰＳＳ治疗中远期疗效不佳。     

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.     

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.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.     

Morphological and immunocytochemical heterogeneity of cultured pinealocytes from one-week-and two-month-old rats: Planimetric and densitometric investigations

Abstract: In vitro preparations of rat pinealocytes are widely used for biochemical analyses of signal transduction processes. This paper deals with morphological and immunocytochemical features of such preparations. Special attention was paid to the problems of whether pinealocytes represent a heterogeneous cell population and how such heterogeneity may develop during ontogeny. The investigations were performed with cells which were obtained from the pineal organ of one-week-and two-month-old rats, attached to synthetic peptide-coated coverslips or tissue culture chamber slides, and maintained under in vitro conditions overnight. The attached cells were then fixed with paraformaldehyde. These preparations yielded monolayers of spherical cells of different sizes; most cells were isolated, but some of them were aggregated and formed small clusters. On the average, the cells from the one-week-old animals were smaller than the cells from the two-month-old animals. Immunocytochemical demonstration of S-antigen, a pinealocyte-specific marker, showed that the majority of the cells from two-month-old animals were intensely or moderately labelled. Pinealocytes from one-week-old animals were less S-antigen immunoreactive. Only very few cells (less than 1% displayed glial fibrillary acidic protein (GFAP)-immunoreactivity. Planimetric investigations of the cell size and semiquantitative densitometric investigations of the intensity of the S-antigen immunoreaction revealed that (i) pinealocytes kept in vitro form a heterogeneous cell population, and that (ii) this heterogeneity increases during postnatal development from one-week-old to two-month-old animals. Two groups of pinealocytes can be distinguished based on their developmental fate: pinealocytes of one group grow dramatically, but show only a moderate increase in S-antigen immunoreactivity, and pinealocytes of the other group retain their size, but display a distinct increment in S-antigen immunoreacti vitv.     

Effects of pinealectomy and melatonin administration on certain indices of ovarian hyperplasia and/or hypertrophy in rats with both ovaries intact or after unilateral ovariectomy

Abstract: In earlier studies from other laboratories it was shown that melatonin decreased ovarian weight in rats and inhibited compensatory hypertrophy of the remaining ovary after unilateral ovariectomy. This study was designed to examine the influence of melatonin on certain indices of ovarian hyperplasia and/or hypertrophy in adult female rats with both ovaries preserved and with either an intact pineal gland or with the pineal gland removed (pinealectomy, PX) or, finally, in sham-PX animals. Similar studies were conducted on rats after unilateral ovariectomy, referring the examined parameters to the remaining intact ovary. The studies included mitotic activity of granulosa layer cells and corpus luteum cells, ovarian weight, ovarian cross-sectional area, cross-sectional area of the granulosa layer of all the Graafian follicles and the cross-sectional areas of the corpora lutea, visible on the ovarian cross-section. On the basis of results, we conclude that: 1) the effect of PX on the processes of ovarian hyperplasia and hypertrophy may vary; analogously, exogenous melatonin administration may influence ovarian hyperplasia and hypertrophy in different ways; 2) PX and exogenous melatonin may, under certain conditions, exert similar biological effects, even synergistic effects; 3) melatonin inhibits ovarian growth processes, while the effects of PX are variable; 4) the results indicate that in experiments performed on rats, with the use of two control groups, i.e., intact and sham-PX, melatonin effects on these two groups may differ.