胎儿消化器官发育中的肥大细胞超微结构特点

实验对１０例不同胎龄肥儿消化器官的胎大细胞进行了超微结构观察，发现胎儿发育接近成熟时，其肥大细胞根据颗粒的超微结构可分ＴＣ肥大细胞和Ｔ肥大细胞两型；胎儿发育后期以大细胞有分泌活动呈活化状态；胎儿肥大细胞与成纤维细胞，上皮细胞，血管，神经等密切接触。     

Central control of upper airway resistance regulating respiratory airflow in mammals

This article reviews recent studies on the importance of glycine receptors for both the spontaneous and the reflex respiratory modulation of the laryngeal abductors and adductors. Our findings show that strychnine blockade of glycine receptors within the brainstem changes the eupneic three-phase respiratory pattern into two phases. This has major implications for glottal control: (i) the inspiratory glottic abduction and early expiratory adduction were both compromised--a finding mimicked by 5% hypoxia; (ii) closure of the glottis during defensive upper airway reflexes became intermittent and the reflex apnoea reversed to sustained inspiratory discharge. Based on these data, we predict that periods of prolonged hypoxia, such as those that occur during sleep apnoeas, will constrain inspiratory glottic abduction thereby impeding inhalation.     

Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction

Adenocarcinoma of the esophagus, or GEJ, has a poor prognosis. Early lesions [i.e. high grade dysplasia (HGD) or T1-carcinoma] are potentially curable. Local endoscopic therapies are promising treatment options for superficial lesions; however, for deeper lesions, surgical resection is considered to be the treatment of choice. To contribute to therapeutic decision-making, we retrospectively analysed the outcome of transhiatal esophagectomy in 120 patients with pathologically proven HGD (n=13) or T1-adenocarcinoma (n=107) of the distal esophagus or gastro-esophageal junction (GEJ). Tumors were subdivided into six different depths of invasion (T1-mucosal m1-m3, T1-submucosal sm1-sm3), and the frequency of lymphatic dissemination and time to locoregional and/or distant recurrence were analysed. Only one of the 79 T1m1-3/sm1 tumors (1%) showed lymph node metastases as compared with 18 out of 41 T1sm2-3 tumors (44%). There was a significant difference in recurrence-free period between T1m1-m3/sm1 versus T1sm2-sm3 tumor patients (P log rank <0.0001), with 5-year recurrence-free percentages of 97% and 57%, respectively. In multivariate analysis including age, gender, tumor differentiation grade, N-stage and depth of invasion, only N-stage was an independent prognostic factor for recurrence-free period (hazard rate=5.9, 95% CI 1.7–20.7). However, if N-stage was excluded from analysis, only depth of invasion (T1sm2-3 versus T1m1-m3/sm1) was an independent prognostic factor for recurrence-free period (hazard rate=7.5, 95% CI 2.0–27.7). These data indicate that T1m1-m3/sm1 adenocarcinomas of esophagus or GEJ show a very low risk of lymphatic dissemination and are therefore eligible for local endoscopic therapy. After transhiatal surgical resection, almost half of the patients with T1sm2-sm3 lesions develop recurrent disease within 5 years, and therefore need additional therapy to improve survival.     

食管入口部的解剖学特点及其临床意义

目的：为全喉切除术后的患者进行发音重建，为制造适合我国人的发音管提供解剖学基础。方法：对４０具正常成人尸体标本食管入口部进行了观察测量，测量食管入口部的内外横径、前后壁厚度，第１、第２气管环之间气管食管共壁的宽度、厚度。结果：发现食管入口部前后壁的厚度相差显著，前壁明显厚于后壁。食管入口部的内横径平均值为１１．９ｍｍ，外横径平均值为１６．６ｍｍ。在第１、第２气管环之间的气管食管共壁宽度的平均值为１２．０ｍｍ；其厚度平均值为６．１ｍｍ等。结论：本研究对进行发音重建、食管镜检查有指导作用，为制造适合我国人的发音管提供数据。     

大鼠消化道神经激肽A的发育研究

应用免疫细胞化学ＰＡＰ法系统研究了大鼠胚胎１３天至成年食道及胃神经激肽Ａ发生发育过程。结果如下：（１）在食道，直至出生前，即胚胎２１天才于环肌层及粘膜肌层出现阳性膨体纤维，出生后，随幼鼠的生长发育相继在上皮内、纵肌层、肌间丛、粘膜下丛出现神经激肽Ａ免疫反应阳性物，其纤维的密度、粗细和着色也逐渐增加，３０天时已具备成年的分布特征，其发育主要在生后４周；（２）在胃，于胚胎１４天，首先在肌间丛处呈现阳性     

Fecal microbiota transplantation for Clostridium difficile infection in Taiwan: Establishment and implementation

Clostridium difficile infection (CDI) remains a major public health issue, and fecal microbiota transplantation (FMT) has become one of the standard therapies for recurrent or refractory CDI. When compared to medical therapies, such as metronidazole or vancomycin, FMT has a high rate of treatment response with acceptable safety and efficiency. Following promulgation of the amendments in September 2018 in Taiwan, FMT has been indicated for recurrent or refractory CDI. The Taiwan Microbiota Consortium contributed to the Taiwan FMT Expert Consensus, which established basic norms and stipulated essential principles, including the indications for transplantation, eligible locations and personnel, donor screening policies, fecal sample handling, and post-FMT follow-up. However, establishing an eligible FMT team in a qualified hospital remains a clinical challenge, and the requirement for facilities and well-screened donors impedes the implementation of FMT. In this review, we aim to provide domestic FMT teams with explicit instructions to facilitate realization and increase the practice of FMT. Based on the Taiwan FMT Expert Consensus and current regulations, we performed a literature review and integrated the experiences of Taiwanese multidisciplinary experts into this article. The content intends to offer clinicians up-to-date evidence and highlight the essential points of FMT.     

Differential expression of pepsinogen isozymogens in a patient with Barrett esophagus

The pepsinogen A (PGA) isozymogens in the gastric mucosa and Barrett epithelium of a female patient with Barrett esophagus were studied on different occasions during a 3-year period by electrophoretic analysis of in vivo steady-state pepsinogen in biopsies by activity staining in combination with variant specific monoclonal antibodies and of de novo synthesized pepsinogen by autoradiography. In Barrett epithelium only one (Pg3) or two (Pg3 and Pg5) primary PGA gene products were detected, whereas in gastric mucosal biopsies three (Pg3, Pg4 and Pg5) primary gene products were demonstrated on all occasions. These differences strongly suggest differential expression/activation of individual gene numbers in the PGA gene cluster in Barrett esophagus and are in line with the preneoplastic nature of this condition. The mechanism behind this deregulation is currently under investigation by cell biology and molecular genetic techniques.     

上消化道出血患者检测血清前白蛋白的临床意义

目的:探讨血清前白蛋白在上消化道出血中的意义。方法:对32例肝硬化并发上消化道出血患者及30例胃十二指肠疾病并发上消化道出血患者进行血清前白蛋白(PA)测定,并与34例正常对照相比较。结果:肝硬化并发上消化道出血患者血清PA低于胃十二指肠疾病并发上消化道出血者及正常对照组,且肝硬化组PA分布与后两者无重迭;Child分级间PA有显著差异。结论:上消化道出血患者检测血清PA有助于肝硬化并发出血的诊断,并可帮助判断病情及估计预后。     

胎儿食管肌间神经丛胆碱能神经元的定位定量研究

用引产后死亡的正常胎儿（３２￣４０周，１５个）食管，将其分颈部，胸部上、中、下，腹部食管５部分。对各部位食管肌间神经丛内胆碱能神经元，进行光镜（ｃｈＡＴ、ＡＣｈＥ）和电镜（ＡｃｈＥ）酶组织化学定位、定量观察。结果表明，胆碱能神经元的分布及细胞内酶含量，在食管各部位不同，ＡＣｈＥ在电镜下定位于粗面内质网。这一研究结果，不仅将使食管胆碱能神经支配及其生理功能等基础理论知识，得到进一步阐明、丰富和发展；     

Development of allergy in children. I. Association with virus infections.

Children born into allergic families, with two allergic parents, are at high risk of developing allergy within the first 5 years of life. In order to observe possible external factors in the sensitization process, a prospective study of 13 such children was done, in which serial clinical and immunologic observations were made at 3- to 6-month intervals over a period of 1 to 4 yr. Eleven of these children are now clinically allergic; 5 have asthma. Immunologic evidence for allergic sensitization was observed in these 11 children by RAST, antigen-induced leukocyte histamine release, lymphoblastogenesis, and rise in serum IgE. Upper respiratory infections (URI) occurred in these 11 allergic children 1 to 2 months prior to the onset of allergic sensitization. In 10 of these 11 URI children, complement-fixing antibodies to viruses (parainfluenza, RSV, CMV) increased in the same blood samples in which immunologic allergic sensitization was first evidenced. This coincidence suggests that certain viruses may contribute to the allergic sensitization process.