幽门螺杆菌与小儿结节性胃炎的关系分析

目的 探讨小儿结节性胃炎的临床特点及与幽门螺杆菌(Hp)的关系,以提高对它的认识.方法 分析我院诊断的小儿结节性胃炎患者内镜、病理表现,以及Hp感染情况和根除治疗的效果.结果 28例结节性胃炎患者中,内镜下表现以胃窦部为主,可扩展至胃体部,为色泽均匀的结节样或颗粒样改变.Hp感染率96.42%,病理检查显示胃黏膜多呈中～重度炎症改变,淋巴滤泡发生率67.86%.明显高于非结节性胃炎.经给予质子泵抑制剂为基础的三联疗法根除治疗后,随着Hp的根除,临床症状消失,胃镜下结节状表现消失,病理炎症程度减轻,淋巴滤泡也随之消失.结论 小儿结节性胃炎为Hp感染的一种特殊征象,是慢性胃炎的一种特殊内镜下表现,是Hp感染的内镜指标,提示对小儿结节性胃炎应考虑Hp根除治疗.     

慢性胃炎结节状改变与幽门螺杆菌感染的关系研究

目的　探讨慢性胃炎结节状改变与幽门螺杆菌 (Hp)感染的关系。方法　对 2 0 0 1～2 0 0 2年中胃镜检查发现的慢性胃炎结节状改变患者进行Hp检测 ,对Hp阳性患者 ,进行Hp根除治疗 ,随访 6个月 ,观察其胃镜下的改变。结果　 4 939例胃镜检查患者中共发现 1 3例慢性胃炎结节状改变 ,占检查总人数的 0 2 6 %。平均年龄 2 9岁 ,均为女性患者。主要症状均为上腹部疼痛。所有患者均有Hp感染。Hp根除成功后 ,症状和胃镜下结节状表现消失 ,病理证实胃黏膜下淋巴滤泡也随之消失。结论　慢性胃炎结节状改变可作为Hp阳性胃炎的内镜下的表现之一。     

慢性胃炎结节状改变的临床研究

目的 研究萎缩性胃炎和结节性胃炎的结节状改变的特征.方法 在2004年4月至2005年3月之间,通过临床特征、内镜及病理结果,来对比分析胃镜检查中发现的慢性胃炎的结节状改变.结果 本次研究显示慢性胃炎的结节状改变分为结节类型A（结节性胃炎）和B（萎缩性胃炎的结节状改变）.结节性胃炎的胃镜下表现为结节具有大小均一、分布密集的特点,多发生于年轻女性,几乎都以上腹部疼痛为主诉,并且感染了幽门螺杆菌,病理检查有淋巴滤泡而没有萎缩和肠上皮化生.而萎缩性胃炎的结节类型B,胃镜下表现为结节大小不一、分布松散,多发生于50岁以上男性,主诉具有多样性的特点,并且幽门螺杆菌检测部分阴性,病理的结果发现有中、重度萎缩和肠上皮化生,而少有淋巴滤泡.结论 拥有结节状改变类型A的结节性胃炎是一种新的特殊胃炎,不同于萎缩性胃炎的结节状改变,应该引起重视.     

胃粘膜淋巴滤泡与幽门螺杆菌关系探讨

目的 探讨含有细胞毒素相关基因A（cagA)菌株感染与胃粘膜淋巴滤泡形成之间的关系，并对胃粘膜淋巴滤泡的发生与幽门螺杆菌（Hp）感染状况的关系等进行观察。方法 对655例慢性胃炎，消化性溃疡的患者进行胃镜检查，取胃窦 粘膜组织作Hp检测和组织病理检查，并选择70份Hp培养阳性的临床分离菌，用PCR扩增法进行cagA基因的检测。结果 Hp感染患者中胃粘膜淋巴滤泡的发生率（60.14%)显著高于非Hp感染者（17.06%)；胃粘膜淋巴滤泡在活动性胃炎比非活动性胃炎中更易检测到；在Hp相关性胃肠病中，慢性胃炎、胃溃疡、地下二指肠球溃这三者之间胃粘膜淋巴滤泡的发生率无显著性差异。结论 胃粘膜淋巴滤泡的发生直接与Hp感染相关， 并可作为一种Hp感染相关性胃肠病中一个较为恒定的形态特征；Hp作为一种抗原刺激胃粘膜产生淋巴滤泡的作用与Hp菌株的毒力（cagA基因）无关。     

幽门螺杆菌相关性胃炎与淋巴组织增生关系的研究

目的:研究幽门螺杆菌(Hp)相关性胃炎病理改变与淋巴组织增生关系及Hp根治后淋巴滤泡消失情况。方法:光镜观察124例Hp阳性的慢性胃炎三联药物治疗前后和胃溃疡64例、十二指肠球部溃疡98例、残胃胃炎24例及Hp阴性正常胃粘膜25例的淋巴滤泡发生率和聚集强度。结果:Hp阳性胃病淋巴滤泡发生率为,胃溃疡90.6％,十二指肠球部溃疡84％,慢性胃炎72.5％,残胃胃炎54.2％,而正常胃粘膜为4％。抗菌治疗后,慢性胃炎的淋巴滤泡明显减少。淋巴滤泡发生率与炎症程度和活动性明显相关。结论:胃粘膜淋巴组织消长与Hp感染关系密切。     

唾液幽门螺杆菌抗原检测与慢性胃炎活动性及癌前病变关系的研究

目的 评价唾液幽门螺杆菌（Helicobacterpylori，Hp）抗原与慢性胃炎活动性以及胃黏膜癌前病变肠上皮化生与不典型增生的相关性。方法 应用酶联免疫吸附法（ELISA），对2004年6月至2005年6月浙江大学医学院附属第二医院消化内科246例接受胃镜检查患者的唾液标本进行幽门螺杆菌抗原检测，分别比较不同胃病患者唾液中Hp抗原的阳性检出率。结果 慢性活动性胃炎组唾液中Hp抗原阳性检出率为74．29％（26／35）．明显高于慢性非活动性胃炎组46．92％（99／211）（P〈0．05）。慢性胃炎组患者唾液中Hp抗原的阳性检出率为45.98％（80／174），慢性胃炎伴轻度肠上皮化生（肠化）组唾液中Hp抗原阳性检出率为52.63％（20／38），慢性胃炎伴中重度肠化组唾液中Hp抗原阳性检出率为68．18％（15／22），慢性胃炎伴不典型增生组唾液中Hp抗原阳性检出率为83．33％（10／12），结果显示．慢性胃炎伴中重度肠化或不典型增生组与慢性胃炎组相比，差异有统计学意义（P〈0．05）。结论 唾液中存在高Hp检出率现象，1：3腔可能为Hp的重要寄居地．1：3腔内Hp感染程度与胃炎活动程度及部分胃黏膜癌前病变有关，慢性活动性胃炎或伴中重度肠化或不典型增生患者口腔内Hp检出率明显增高，口腔内Hp是否需行根除治疗，值得今后进一步研究探讨。     

幽门螺杆菌感染与白细胞介素-8、粒细胞集落刺激因子含量的关系

目的：探讨幽门螺杆菌（Hp)与胃黏膜白细胞介素（IL）－8和粒细胞集落刺激因子（G－CSF）相关胃炎间的关系。方法：应用酶联免疫吸附试验法测定60例接受胃镜检查患者胃窦黏膜组织培养上清中IL－8、G－CSF的含量，比较Hp感染与非感染患者其含量的差异。其中慢性浅表性胃炎14例，胃溃疡13例，十二指肠溃疡13例，胃黏膜正常者20例。结果：60例受检者中Hp感染40例，其胃黏膜IL－8及G－CSF含量明显高于14非Hp感染者（P＜0．01）。慢性浅表胃炎、胃溃疡Hp阳性者IL－8）及G－CSF明显高于正常组织Hp阳性者（P＜0．01）。慢性浅表性胃炎中，Hp阳性组的IL－8及G－CSF含量高于Hp阴性组（P＜0．05）。结论：Hp感染可以诱导胃黏膜炎症细胞合成和释放IL－8及G－CSF，IL－8及G－CSF可能在Hp相关性胃十二指肠疾病的发病过程中发挥关键作用，是引起炎症反应以及进一步病理损害的重要途径。     

老年人原发性胆汁反流性胃炎病理特征分析

目的：探讨原发性胆汁反流对老年人胃黏膜组织损伤的病理特点。方法回顾性地分析2013年1月～2014年8月于我院经胃镜检查诊断的77例老年原发性胆汁反流性胃炎（BRG）患者为观察组,同时取同期诊断为幽门螺杆菌（Hp）感染的非BRG慢性胃炎的78名老年患者为对照组,分析两组患者胃黏膜组织的病理变化特点。结果原发性BRG患者Hp感染率为19.5%。胆汁反流组与Hp感染的非BRG慢性胃炎病理组织特征比较：轻、中、重慢性炎分别为32.5% vs 11.5%、58.4% vs 34.6%和9.1% vs 53.8%,中性粒细胞浸润分级（无、轻、中、重）分别为83.1% vs 41.0%、11.7% vs 20.5%、5.2% vs 32.1%和0.0% vs 6.4%。淋巴滤泡、肠上皮化生和胃黏膜萎缩检出率分别为4.3%vs 26.9%、5.2%vs 17.9%和6.5%vs 25.6%;胆汁反流组中,Hp阳性和Hp阴性患者轻、中、重度慢性炎分别为：13.3% vs 37.1%、53.3% vs 59.7%和33.3% vs 3.2%,中性粒细胞浸润分级（无、轻、中、重）分别为53.3%vs 41%、20.0%vs 9.7%、20.0%vs 0.0%和6.7%vs 0.0%,淋巴滤泡、肠上皮化生和胃黏膜萎缩检出率分别为53.3%vs 4.8%、0.0% vs 6.5%和0.0%vs 8.1%。结论原发性胆汁反流可引起老年患者胃黏膜组织慢性炎症反应、肠上皮化生、腺体萎缩,但其发生率低于Hp感染的慢性胃炎。中性粒细胞浸润和淋巴滤泡形成主要与Hp感染相关,Hp感染并未增加原发性胆汁反流患者胃黏膜萎缩、肠化生不良结局的发生。     

环氧合酶-2在小儿慢性炎症胃黏膜中的表达

目的探讨小儿时期不同炎症胃黏膜环氧合酶也（COX-2）表达特点及可能意义。方法随机抽取正常胃黏膜、普通慢性胃炎、幽门螺杆菌（Hp）相关慢性胃炎、慢性胃炎伴肠上皮化生（无却感染）共110例蜡块重新切片作常规病理学评估，并应用免疫组化法分析胃黏膜COX-2表达。结果COX-2在正常胃黏膜无表达；普通胃炎组9例轻度表达（22．5％）；坳胃炎组27例轻度表达（67．5％），中度表达2例（5．0％）；肠化组轻度表达6例（30．0％）。坳相关胃炎较普通胃炎组及肠化组（均为轻度炎症）COX-2阳性率细显著升高（P=0．000和P=0．002）；普通胃炎组中重度炎症COX-2阳性率较轻度炎症高（P=0．025）。慢性胃炎伴肠化组和普通胃炎组炎症程度无差别（P：0．527），其COX-2阳性表达率一致（P=0．542）。结论小儿胃炎COX-2表达较弱，却感染可诱发COX-2表达，其表达率随炎症程度加重而升高，COX-2表达和肠化无关。小儿早期轻度表达COX-2，其生理意义可能与成人有所不同。     

内镜下胃黏膜颗粒样变与幽门螺杆菌感染及萎缩性胃炎关系的研究

内镜下慢性胃炎的胃黏膜形态改变常有红斑、糜烂或隆起糜烂、皱襞肥厚、血管显露及表面不规则颗粒样变。国外有学者把胃窦部黏膜颗粒样改变描述为结节状或鹅卵石路样,表面光滑,色泽均匀,直径约1～4 mm,活检后血液环绕结节显得更加突出。为了研究胃黏膜颗粒样改变与幽门螺杆菌感染的关系以及对诊断萎缩性胃炎的临床意义,我们对135例胃窦部黏膜呈颗粒样改变的患者进行了胃黏膜     

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.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

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.     

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.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.