散发性结直肠癌hMLH1和hMSH2蛋白表达

目的　研究hMLH1及hMSH2两种错配修复 (mismatchrepair,MMR)蛋白在散发性结直肠癌中的表达变化并评估其可能的临床意义。方法　应用EnVision免疫组化两步法检测 1 1 1例散发性结直肠癌中hMLH1和hMSH2的蛋白表达变化 ,采用Kaplan Meier曲线、Log rank检验分析hMLH1蛋白表达变化与患者生存率之间的关系。 结果　 1 1 1例散发性结直肠癌中 ,hMLH1失表达有 1 9例 ,占 1 7 1 % (1 9/ 1 1 1 ) ,hMSH2失表达有 2例 ,占 1 8% (2 / 1 1 1 ) ,两者之和占总散发性结直肠癌病例的 1 8 9% (2 1 / 1 1 1 )。hMLH1或hMSH2蛋白失表达与患者肿瘤部位、组织学类型密切相关。近端结肠、低 -未分化腺癌及黏液腺癌中MMR异常表达比例高 (P <0 0 5 ) ,而与患者年龄、性别、肿瘤大体类型、肿块大小、浸润深度、淋巴结转移与否以及患者的Dukes分期均无显著性相关 (P >0 0 5 )。癌组织中hMLH1正常表达及失表达患者的 5年生存率分别为 6 9 5 7%及73 6 8% ,8年生存率分别为 5 3 5 8%及 73 6 8% ,8年生存率差别较明显 ,然差别无统计学显著性 (P >0 0 5 )。结论　一定比例的散发性结直肠癌中存在MMR基因的缺陷 ,其中hMLH1所起的作用远远大于hMSH2 ,hMLH1失表达与否可能成为有意义的远期生存预后指标     

126例子宫内膜癌中Lynch综合征的初步筛查

目的探讨hMSH2、hMSH6、hMLH1、hPMS2蛋白缺失情况和hMLH1基因启动子甲基化状态及Lynch综合征患者的家系分析,初步进行Lynch综合征相关子宫内膜癌筛查。方法采用免疫组化SP法检测126例子宫内膜癌中hMSH2、hMSH6、hMLH1、hPMS2蛋白表达,并用甲基化特异性PCR检测hMLH1蛋白表达缺失病例的hMLH1基因启动子甲基化状态。结果免疫组化结果显示22%(28/126)的病例出现MMR蛋白缺失表达,其中12例hMLH1~-/hPMS2~-、6例hPMS2~-、4例hMSH2~-/hMSH6~-,hMSH6~-和hMLH1~-各3例,以hMLH1和hPMS2蛋白缺失表达为主。甲基化特异性PCR检测有hMLH1蛋白表达缺失的15例子宫内膜癌中hMLH1基因启动子甲基化状态,证实9例存在hMLH1基因启动子甲基化,提示其为子宫内膜癌的散发性病例。结论对子宫内膜癌患者行MMR蛋白免疫组化SP法染色,结合甲基化特异性PCR检测hMLH1基因启动子甲基化状态,是初步筛查Lynch综合征的有效策略。     

DNA错配修复基因甲基化在肝细胞癌发生发展中的作用

目的探讨DNA错配修复基因(MMR)hMLH1,hMSH2和hMSH3甲基化在肝细胞癌(HCC)发生发展中的作用。方法采用甲基化特异性聚合酶链反应(MSP)法对38例新鲜HCC组织,相应非肿瘤肝组织,2例正常的捐肝组织及6种肝癌细胞系的hMLH1,hMSH2和hMSH3基因启动子CpG岛甲基化进行检测;培养6种肝癌细胞系,MSP法检测加入5-aza-2‘-deoxycytidine前后hMSH2基因在HCC中的甲基化状态改变;逆转录．聚合酶链反应(RT-PCR)方法检测加入5-aza-2’-deoxycytidine前后hMSH2在肝癌细胞株中的mRNA表达改变。结果HCC标本中13．2％(5／38)发生了hMLH1启动子甲基化,68．4％(26／38)发生了hMSH2启动子甲基化;相应的非肿瘤肝组织中hMLH1,hMSH2启动子甲基化阳性率分别为2．6％(1／38),55．3％(21／38);2例正常肝组织中未发现甲基化;6株肝癌细胞系中有5株发生了hMSH2启动子甲基化,而未发现有MLH1启动子甲基化。所有标本中均未发现有hMSH3启动子甲基化。5-aza-2‘-deoxycytidine处理细胞株后,可部分或完全逆转hMSH2启动子甲基化,各细胞株的mRNA均有不同程度的表达增加。结论hMSH3基因启动子CpG岛甲基化与HCC的发生发展关系不大。hMSH2基因甲基化与mRNA表达密切相关,是基因表达调节的一种重要方式。hMLH1和hMSH2基因启动子CpG岛的高甲基化在HCC中是一个常见的基因改变,DNA错配修复基因尤其是hMSH2基因启动子甲基化在HCC的发生中起了重要作用,是早期事件,其可能为临床诊断HCC提供新的检测指标。     

典型遗传性非息肉病性结直肠癌家系临床病理及分子遗传学分析

目的 了解国人遗传性非息肉病性结直肠癌（HNPCC）的临床病理及分子遗传学特征。方法 用微解剖、微卫星不稳定性分析、免疫组织化学及直接DNA测序方法,检测4例HNPCC患者的肿瘤组织微卫星不稳定性状态、错配修复基因hMSH2及hMLH1蛋白水平的表达变化以及生殖细胞突变。结果 4例先证者5个肿瘤组织均表现为高度微卫星不稳定性,3例表现为hMSH2蛋白表达异常,1例表现为hMLH1蛋白表达异常。检测出3个生殖细胞病理性突变。结论 中国人典型HNPCC病例中错配修复基因突变率较高。高度微卫星不稳定性、错配修复基因hMSH2及hMLH1蛋白表达异常与错配修复基因生殖细胞突变密切相关。微卫星不稳定性和错配修复基因蛋白分析可作为DNA测序前的筛选手段。     

p53、p21~(WAF1)蛋白在非小细胞肺癌中的表达及其临床意义

目的　探讨原发性非小细胞肺癌中p5 3、p2 1WAF1蛋白表达与临床病理及预后的关系。方法　应用免疫组织化学 (SP法 )方法。共检测非小细胞肺癌 147例 ,其中腺癌 6 6例 ,鳞癌 6 3例 ,腺鳞癌 14例 ,大细胞癌 4例。结果　p5 3蛋白总阳性率为 6 1.2 % (90 / 147) ,腺癌为 5 7.6 % (38/ 6 6 ) ,鳞癌阳性率为 6 3.5 % (4 0 / 6 3) ,腺鳞癌为 71.4% (10 / 14) ,大细胞癌 2例阳性。p2 1WAF1蛋白总阳性率为40 1% (5 9/ 147) ,腺癌为 42 .4% (2 8/ 6 6 ) ,鳞癌为 41.3% (2 6 / 6 3) ,腺鳞癌 2 8.6 % (4 / 14) ,大细胞癌 1例阳性。肺腺癌p5 3蛋白阳性表达与其预后相关 ,6 6例腺癌中 ,生存率低于 3年组和高于 3年组的p5 3蛋白阳性率分别为 75 % (2 1/ 2 8)和 44 .7% (17/ 38) ,差异有显著性意义 (P <0 .0 2 5 )。p2 1WAF1阳性表达与肺癌预后有关 ,p2 1WAF1阳性表达者 3年生存率 (6 4.4% )高于阴性表达者 (4 6 .6 % ) (P <0 .0 5 )。p5 3阳性而p2 1WAF1阴性的非小细胞肺癌患者的预后比p5 3阴性而p2 1WAF1阳性者差 (P <0 .0 1)。结论　检测p5 3蛋白表达可作为判断肺腺癌预后的指标之一 ;检测p2 1WAF1蛋白表达有利于对非小细胞肺癌预后的判断 ;联合检测p5 3、p2 1WAF1蛋白对判断非小细胞肺癌的预后有重要的意义 ,似可作     

非小细胞肺癌p63基因的表达及其与3号染色体位点变化的关系

目的　探讨非小细胞肺癌 p6 3基因的蛋白表达水平及其与定位在 3号染色体 2 7～ 2 9区域改变的关系。 方法　应用比较基因组杂交 (CGH)技术对 70例原发性肺鳞状细胞癌和肺腺癌标本进行染色体不平衡性分析。采用组织芯片技术构建12 2例原发性非小细胞肺癌石蜡包埋标本组织芯片 ,并采用免疫组织化学方法检测p6 3蛋白表达情况。比较 p6 3蛋白表达及其与 3号染色体末端改变的关系。结果　CGH分析结果发现 ,30例鳞状细胞癌 2 4例出现 3q2 7～ 2 9区域DNA拷贝数目的增加 ,4 0例腺癌仅 8例发现 3q2 7～ 2 9区域DNA获得。p6 3免疫组化染色结果显示 :5 0例 (84 75 % )鳞状细胞癌免疫组化染色为阳性 ;3例大细胞肺癌中 2例 (6 6 6 6 % )为阳性反应 ;腺癌中仅有 1例 (1 6 7% )为阳性。p6 3蛋白的阳性表达率与患者的年龄、性别、肿瘤的分级、肿瘤的转移以及生存率无关 (P >0 0 5 )。p6 3免疫组化阳性率与 3q2 7～ 2 9区域的改变比较结果显示 :p6 3免疫组化阳性反应与 3号染色体长臂 2 7～ 2 9区域的DNA扩增呈正相关 (P <0 0 1)。结论　p6 3基因的扩增与肺鳞状细胞癌发生和发展有密切的关系     

散发性胆囊癌nm23-H1基因遗传不稳定性与错配修复基因hMLH1和hMSH2蛋白表达的研究

目的： 研究人类17号染色体D17S396位点微卫星不稳定性和杂合性缺失，对nm23-H1蛋白表达的影响，同时检测错配修复基因hMLH1和hMSH2蛋白的表达，为揭示nm23-H1基因、hMLH1和hMSH2基因与肿瘤发生和转移机制提供实验依据。方法: 采用石蜡包埋组织抽提DNA、PCR-SSCP、常规银染、Envision免疫组织化学等方法，对50例胆囊癌及其相应的正常组织，进行D17S396位点MSI、LOH的检测和nm23-H1、hMLH1和hMSH2蛋白表达研究。结果: ①原发性胆囊癌D17S396位点遗传不稳定发生率为42.55%，LOH的发生率与肿瘤组织分化程度差异显著（P <0.05）；在肝脏侵润和淋巴转移组高于无肝脏侵润和无淋巴转移组(P <0.01)，在NevinⅣ+Ⅴ期高于Ⅰ+Ⅱ+Ⅲ期(P <0.01)；而MSI发生率则相反；②nm23-H1蛋白阳性率为46.81%，在淋巴转移组低于无淋巴转移组(P <0.01)；NevinⅣ+Ⅴ期低于Ⅰ+Ⅱ+Ⅲ期(P <0.05)；③hMLH1和hMSH2蛋白阳性率分别为51.06%和42.55%，hMLH1蛋白表达在有无淋巴转移组和Nevin分期有显著差异(P <0.01)，肝脏侵润组低于无肝脏侵润组(P <0.05)；④MSI阳性组中hMLH1蛋白阳性率显著高于MSI阴性组(P <0.05)。LOH阳性组中nm23-H1和hMSH2蛋白阳性率显著低于LOH阴性组（P <0.05）；⑤hMSH2蛋白阳性组中nm23-H1蛋白表达明显高于hMSH2蛋白阴性组（P<0.05）。结论:nm23-H1基因的遗传不稳定性可能是胆囊癌发生、发展的一个重要分子机制。nm23-H1基因的MSI和LOH，通过相互独立的途径调控胆囊癌的发生和转移。hMLH1/hMSH2表达异常可能是胆囊癌的早期分子事件。提高胆囊癌局部nm23-H1、hMLH1和hMSH2蛋白的表达，可减缓肿瘤的侵润转移并提高预后率。     

非霍奇金淋巴瘤与p53蛋白表达的关系

目的 :探讨非霍奇金淋巴瘤 (NHL)与 p5 3蛋白表达的关系。 方法 :用免疫组化S P法检测 10 2例 (低度恶性 2 3例 ,中度恶性 36例 ,高度恶性 4 3例 )NHLp5 3蛋白表达 ,根据 p5 3蛋白阳性细胞百分率将其表达水平分为 4级 :0级 (阴性 ) ,1级 (1%～ 2 5 % ) ,2级 (2 6 %～ 5 0 % ) ,3级 (>5 0 % )。结果 :低度恶性组 2 0 / 2 3(87% )p5 3表达为 0级 ,中度恶性组 31/ 36 (86 1% )表达为 1级 ,高度恶性组 33/ 4 3(76 7% )表达为 2～ 3级。 2 5例随访 7～ 6 8个月 ,p5 30～ 1级NHL完全缓解率 (CRR ,11/ 14 )高于p5 32～ 3级NHLCRR (1/ 11,P <0 0 1) ,前者生存率 (13/ 14 )高于后者 (3/ 11,P <0 0 1)。NHLp5 3蛋白表达水平与其恶性度密切相关 (P <0 0 1)。结论 :p5 3蛋白表达阳性细胞百分率是判断NHL恶性度、疗效及预后较可靠的参数。肿瘤性p5 3蛋白表达检测对中高度恶性NHL的诊断有参考价值     

乳腺癌组织P21WAF1基因多态性与蛋白表达的关系

目的 :探讨乳腺癌组织p2 1WAF1DNA多态性与蛋白表达的关系。方法 :分别采用聚合酶链反应单链构象多态性技术 (PCR -SSCP)和免疫组化S -P法检测 10 0例乳腺癌石蜡包埋组织和 4 0例乳腺良性病变组织p2 1WAF1DNA多态性和蛋白表达。结果 :18% (18/ 10 0 )的乳腺癌组织和 5 % (2 / 4 0 )对照组组织分别出现两种p2 1WAF1DNA多态性 ,前者明显高于后者 ,组间有显著差异 (χ2 =3 94 ,P <0 0 5 ) ;5 0 % (5 0 / 10 0 )的乳腺癌组织和 12 5 % (5 / 4 0 )对照组组织表达p2 1WAF1蛋白 ,前者明显高于后者 ,组间有显著差异 (χ2 =16 84 ,P <0 0 1) ;10 0 % (18/ 18例 )的具有p2 1WAF1DNA多态性的乳腺癌组织p2 1WAF1蛋白表达阳性 ,39% (32 / 82 )的无p2 1WAF1DNA多态性乳腺癌组织蛋白表达阳性 ,p2 1WAF1DNA多态性组明显高于无多态性组 ,组间有显著差异 (χ2 =2 1 95 ,P <0 0 1) ;p2 1WAF1DNA多态性与p2 1WAF1蛋白表达呈正相关 (r =0 5 76 ,P <0 0 1)。结论 :乳腺癌组织p2 1WAF1DNA多态性可能产生不同的转录本并生成相应的蛋白质分子。     

口腔鳞癌及癌前病变组织中p27、p53蛋白的表达

目的　探讨 p2 7、p5 3蛋白表达在口腔鳞癌发生发展中的意义。 方法　应用免疫组化S P法分别检测 9例口腔正常黏膜 ,11例单纯性增生、2 6例癌前病变及 5 4例鳞癌组织中p2 7、p5 3蛋白的表达。 结果　p2 7蛋白在口腔正常黏膜和单纯性增生组织中呈高表达 ,在癌前病变和鳞癌组织中高 (低 )表达率分别为 6 1 5 % (38 5 % )、2 5 9% (6 1 1% ) ,在鳞癌中阴性表达率为 13% ;p2 7蛋白的表达与鳞癌的组织分化程度、临床分期相关 (P <0 0 5 )。p5 3蛋白在正常黏膜、单纯性增生及轻、中度不典型增生中未见表达 ,在重度不典型增生和鳞癌中可见 2 8 6 %和 4 8 1%的阳性表达 ,二者差异有高度显著性 (P <0 0 1) ;在鳞癌中 p5 3蛋白表达与组织分化程度相关 (P <0 0 5 ) ;p2 7和p5 3表达在鳞癌中呈负相关 (P <0 0 1)。 结论　p2 7蛋白表达的减少在口腔鳞癌的发生发展中起着重要作用 ,并与其预后因素密切相关。p5 3蛋白的表达在癌前病变向鳞癌转变过程中起重要作用。综合分析 p2 7、p5 3表达有助于口腔鳞癌的早期诊断和患者预后的估计。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The case for allele‐specific recognition by the TCR

There is a sharp difference in how one views TCR structure–function–behaviour dependent on whether its recognition of major histocompatibility complex‐encoded restriction elements (R) is germline selected or somatically generated. The generally accepted or Standard model is built on the assumption that recognition of R is by the V regions of the αβ TCR, which is not driven by allele specificity, whereas the competing model posits that recognition of R is allele‐specific. The establishing of allele‐specific recognition of R by the TCR would rule out the Standard model and clear the road to a consideration of a competing construct, the Tritope model. Here, the case for allele‐specific recognition (germline selected) is detailed making it obvious that the Standard model is untenable.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.