Crohnology： A tale of time and times and inflammatory bowel diseases

Time, times and timing are key words in inflammatory bowel diseases （IBD）. The leifmotif of this issue or World Journal of Gastroenterology is time. We have asked experts to review on the epidemiology of these diseases over time, the changes in innate immunity that could be present in the first time, and then the timing of key treatments. The correct time of using azathioprine, mercaptopurine, infliximab, cyclosporine and surgery are reviewed. We have chosen experts with not only great clinical expertise but also personal interest in clinical and basic investigation. Our goal in this monograph is to get an idea not only of the present but of the immediate future in some of the key management issues in IBD. To this end, we think that the authors are the most adequate.     

Distribution of PDE8A in the nervous system of the Sprague-Dawley rat

Phosphodiesterases (PDEs) are essential regulators of cyclic nucleotide signaling. Little is known of the distribution and function of the cyclic adenosine monophosphate (cAMP) hydrolyzing PDE8A family.Employing immunohistochemistry and Western blots this study maps the distribution of PDE8A in the brain of adult male Sprague-Dawley rats and in the trigeminal ganglion.PDE8A was confined to neuronal perikaryal cytoplasm and to processes extending from those perikarya. The neurons exhibiting PDE8A-immunoreactivity were widely distributed in the forebrain, brain stem, and cerebellum. Strongly immunoreactive neurons were located in the olfactory bulb, the septal area, zona incerta, and reticular nucleus of the thalamus. Less immunoreactivity was seen in the hippocampus and cerebral cortex. Intense staining was detected in both the substantia nigra and the sensory trigeminal nucleus. In cerebellum PDE8A immunoreactivity was located not only in the Purkinje cells, but also in the granular cells as well as the parallel fibres in the molecular layer. PDE8A immunoreactivity was represented in the epithelial lining of the choroids plexus, the dura mater, and the neurons of the trigeminal ganglion.The localization of the cAMP degrading PDE8A may indicate a role for PDE8A in cAMP signaling related to pain transmission, motor function, cognition and olfaction.     

卵巢癌患者外周血CD4+CD25hiCD127lo调节性T细胞格局变化及临床意义

目的:观察卵巢癌患者外周血中CD4+CD25hiCD127lo调节性T细胞格局变化及其相关免疫细胞因子TGF-β1、IL-10的变化及与临床病理特征之间的关系,探讨其临床意义.方法:采用流式细胞术(FCM)和酶联免疫吸附法(ELISA)检测70例卵巢癌患者、50例卵巢良性疾患及70例健康者外周血单个细胞中调节性T细胞的比率和血浆TGF-β1、IL-10的水平.结果:①卵巢癌患者外周血中CD4+CD25hiCD127loTreg调节性T细胞占CD4+细胞的比例为6.32%±1.46%(n=70),显著高于卵巢良性疾患4.03%±1.25%(n=50)和健康对照组3.21%±0.96%(n=70),均P＜0.01.术后患者CD4+CD25hiCD127loTreg比率与术前比较无明显差异.②卵巢癌患者血浆中TGF-β1、IL-10水平(256.68±56.34) pg /ml、(28.24±3.12) ng/ml,明显高于良性疾患(156.48±43.68) pg /ml、(20.58±2.39) ng/ml与健康对照组(130.24±35.60) pg/ml、(18.38±2.98) ng/ml,有统计学差异,分别P＜0.001,P＜0.01.③术前卵巢癌患者外周血CD4+CD25hiCD127loTreg比率、血浆中TGF-β1、IL-10水平与患者的临床分期、淋巴结转移以及远处转移有关,P＜0.05～P＜0.001.④相关分析显示,卵巢癌患者外周血 CD4+CD25hiCD127loTreg比率与血浆中TGF-β1水平、IL-10水平呈正相关,r=0.734,P＜0.01;r=0.665,P＜0.01.结论:①CD4+CD25hiCD127loTreg在卵巢癌患者外周血中表达显著增高,这可能是卵巢癌患者免疫功能下降的一个重要原因,并与临床病理特征存在显著相关性;②卵巢癌患者血浆中抑制性细胞因子TGF-β1、IL-10水平明显升高,并与临床病理特征存在显著相关性;③CD4+CD25hiCD127loTreg与TGF-β1、IL-10水平存在正相关,CD4+CD25hiCD127loTreg可能通过产生抑制性细胞因子TGF-β1、IL-10 对效应性T细胞发挥抑制作用.     

Heart Rate Turbulence

Heart rate turbulence (HRT) is a baroreflex-mediated biphasic reaction of heart rate in response to premature ventricular beats. Heart rate turbulence is quantified by: turbulence onset (TO) reflecting the initial acceleration of heart rate following premature beat and turbulence slope (TS) describing subsequent deceleration of heart rate. Abnormal HRT identifies patients with autonomic dysfunction or impaired baroreflex sensitivity due to variety of disorders, but also may reflect changes in autonomic nervous system induced by different therapeutic modalities such as drugs, revascularization, or cardiac resynchronization therapy. More importantly, impaired HRT has been shown to identify patients at high risk of all-cause mortality and sudden death, particularly in postinfarction and congestive heart failure patients. It should be emphasized that abnormal HRT has a well-established role in stratification of postinfarction and heart failure patients with relatively preserved left ventricular ejection fraction. The ongoing clinical trials will document whether HRT can be used to guide implantation of cardioverter-defibrillators in this subset of patients, not covered yet by ICD guidelines. This review focuses on the current state-of-the-art knowledge regarding clinical significance of HRT in detection of autonomic dysfunction and regarding the prognostic significance of this parameter in predicting all-cause mortality and sudden death.     

精神分析发展的若干问题

在中国，精神分析曾经与其他心理治疗方法一样被视为唯心的理论。如今，临床经验已经证明，该方法为探讨深层精神活动，理解病态行为和思维的途径，文章介绍了精神分析的发展史及临床应用情况。     

Long-term effectiveness of verapamil in stable and unstable angina pectoris. One-year follow-up of patients treated in placebo-controlled double-blind randomized clinical trials

The possibility that denervation supersensitivity might result from left stellectomy was investigated because of its potential clinical implications. The study was conducted in 12 conscious dogs by injecting norepinephrine as a bolus dose or as an infusion before and 2 to 4 weeks after left stellectomy. The variables analyzed were the first derivative of left ventricular pressure (dP/dt max) and the number of premature ventricular complexes. Under control conditions dP/dt max was unaffected by left stellectomy (3,572 +/- 280 versus 3,549 +/- 235 mm Hg/s). Bolus injections and infusions produced the same results and showed no difference in the increases in dP/dt max produced by norepinephrine observed before and after left stellectomy. For example, with the largest dose of norepinephrine, 1.25 microgram/kg, the changes from the control value were 4,533 +/- 269 and 5,032 +/- 668 mm Hg/s, respectively (difference not significant). The number of premature ventricular complexes resulting from the two largest doses of norepinephrine was significantly decreased after left stellectomy (85 +/- 12 versus 46 +/- 14, P less than 0.05), and ventricular tachycardia, which occurred in three dogs under control conditions, was never observed after left stellectomy. This study reveals another aspect of the antiarrhythmic effect of left stellectomy and demonstrates that it does not produce denervation supersensitivity.     

Inflammatory bowel diseases： A disease （s） of modern times？ Is incidence still increasing？

Inflammatory bowel diseases （IBD） are a heterogeneous group of diseases, not always easy to diagnose, even more difficult to classify, and diagnostic criteria are not always uniform. Well done population-based studies are not abundant, and so comparisons among different geographical areas or populations are not always very reliable. In this article, we have reviewed epidemiological studies available on the world＇s population while making a critical review of published data.     

双能量减影技术在胸部结节性病变诊断上的优势

背景和目的：胸部疾病首选的检查方法是X线摄影,而一直以来胸片上肋骨和胸部组织前后重叠给观察者带来“视觉障碍”,影响病变的观察和分析。本研究的目的是探讨采用直接数字化X线摄影双能量减影技术对诊断位于肺和肋骨重叠处的胸部结节性病变的价值。方法：选择35例胸部直接数字化X线摄影中发现肺和肋骨重叠处有结节性病变的患者,利用直接数字化X线摄影双能量减影技术进行胸部结节性病变诊断和鉴别诊断。结果：双能量减影图像对病变的清晰显示率为94．3％,高于直接数字化X线摄影图像的45．7％。直接数字化X线摄影双能量减影技术,能将骨与软组织单独分开显示,减少遮挡。结论：采用直接数字化X线摄影双能量减影技术,可以提高肺结节性病变的可视性,能鉴别胸部小结节是肺内还是肋骨的病变,更好地为胸部结节性病变定性。