胞外信号调节激酶在大鼠肝纤维化形成中的作用机制研究

目的 研究胞外信号调节激酶（ERK）在大鼠肝纤维化形成中的表达及作用机制。方法 对32只雄性SD大鼠皮下注射四氯化碳（CCl4）,制备大鼠肝纤维化模型,分别于注射后1、4、8周处理动物,采用免疫组化、RT-PCR等方法对大鼠肝组织中ERK1表达进行检测。结果 免疫组化显示,ERK1主要表达于肝星状细胞（HSC）中。注射CCl4诱导后,大鼠肝组织中ERK1表达较正常对照组明显增强（P〈0．01,〈0．05）,且1、4、8周肝组织中ERK1的表达强度呈明显递增趋势（P〈0．01,〈0．05）。RT-PCR检测结果显示,ERK1mRNA表达与其酶蛋白改变一致。结论 ERK激活促进HSC活化增殖,参与了肝纤维化的发生发展过程。     

瘦素在实验性大鼠肝纤维化发生中的作用机制初探

目的通过检测肝纤维化大鼠血清及肝组织中瘦素（Leptin）的表达水平，初步探讨瘦素在大鼠肝纤维化发生中的作用机制。方法32只雄性SD大鼠，皮下注射四氯化碳（CCl4）油剂制备肝纤维化模型。分别于注射后1、4、8周处理动物。抽取血清并留取肝组织，采用放射免疫学方法检测血清中瘦素的表达水平。应用免疫组化方法检测肝组织中瘦素及转化生长因子β1（Transforming growth factor β1，TGF—β1）的表达。结果放免及免疫组化结果均显示，与正常对照组相比，注射CCl4诱导后，肝纤维化大鼠血清及肝组织中瘦素的表达水平明显升高（P〈0．01．〈0．05），且1，4，8周组瘦素的表达强度呈明显递增趋势（P〈0．01，〈0．05）。瘦素主要表达于肝星状细胞胞质中。结论瘦素主要表达于肝星状细胞，并可能通过窦内皮细胞发挥重要的促纤维化作用。     

结缔组织生长因子基因表达与大鼠肝纤维化关系初步研究

目的探讨结缔组织生长因子（connective tissue growth factor，CTGF）基因在肝纤维化大鼠肝组织中的表达及其在肝纤维化发展中的作用。方法采用四氯化碳（CCl4）皮下注射制备肝纤维化模型，并于注射后1、4、8周取大鼠肝组织，免疫组化检测CTGF的表达，RT—PCR检测肝组织结缔组织生长因子和I型胶原α2[COL Ⅰ（α2）]基因的转录，并作图像扫描和统计学分析。结果CTGF免疫组化显示正常大鼠肝组织未见明显阳性着色，模型组大鼠注射CCl4 1周后，肝窦周和汇管区细胞出现阳性染色，随着CCl4注射时间的延长，其表达逐渐增强趋势。正常大鼠肝组织COLⅠ（α2）无表达，注射CCl4 1周后有弱表达，注射CCl4 4周后表达增强，8周时达到高峰。CTGF基因的表达与Ⅰ型胶原（α2）的表达呈正相关。结论CTGF作为TGF-β1的下游细胞因子在肝纤维化的发生和发展中可能发挥重要作用。     

Smad3、Smad7基因表达与肝纤维化发病关系研究

目的：探讨Smad3和Smad7编码基因在肝纤维化大鼠肝星状细胞（HSC）中的表达及意义。方法：注射四氯化碳（CCl4)制备大鼠肝纤维模型，按诱导时间将动物随机分为1、4、8周及正常对照组4例，行肝组织胶原VG染色，转化生产因子（TGF）β1免疫组化检测，同时分别以RT－PCR、Western blot检测原工分离HSC的Smad3、Smad7mRNA和蛋白表达。结果：肝纤维化形成过程中肝组织胶原生成逐渐增多，TGFβ表达增强。与正常对照相比，各期肝纤维化大HSC中Smad3mRNA表达增加（P＜0．05），注射CCl4后1周，Smad7mRNA较正常一过性升高（P＜0．05）。第4周和第8周表达水平则持续下降（P＜0．01），Smad3和Smad7的蛋白表达与其mRNA基本一致。结论：Smad3和Smad7在肝纤维化发生，发展中起不同的介导作用，提示通过靶向性阻断HSC Smad3信号和（或）加强Smad信号有望成为治疗肝纤维化的新手段。     

结缔组织生长因子在慢性乙型肝炎和肝硬化组织中的表达及意义

目的探讨结缔组织生长因子（CTGF）的肝内表达与肝纤维化或肝硬化的关系。方法对93例慢性乙型肝炎和肝炎肝硬化的肝组织活检标本采用免疫组化方法进行CTGF肝内表达研究,比较分析慢性乙型肝炎和肝炎肝硬化的CTGF肝内表达及表达的细胞定位。结果肝炎肝硬化CTGF的表达强度明显高于慢性乙型肝炎（P〈0．01）;CTGF的表达与慢性乙型肝炎的炎性活动明显相关（P〈0．05）;CTGF的表达主要集中于汇管区和纤维化区,肝星状细胞、成纤维细胞和窦状隙内皮细胞染色阳性。结论CTGF的表达在肝纤维化和肝硬化中发挥着重要作用,肝星状细胞、成纤维细胞和窦状隙内皮细胞是肝内CTGF的重要来源。     

银杏叶提取物对大鼠肝纤维化Activin A表达的影响

目的研究银杏叶提取物（EGB）对肝纤维化大鼠Activin A表达的影响及抗纤维化作用。方法2004-10-2005-4武汉大学人民医院消化内科将30只雄性大鼠随机分为3组：正常组、模型组及EGB干预组。模型组及EGB干预组给予四氯化碳（CCl4）腹腔注射造模，干预组同时每天给予EGB灌胃。8周后处死动物，取肝脏液氮冻存及甲醛固定，行HE染色，免疫组化及RT-PCR检测Activin A的表达。结果光镜下组织学检查纤维化分级EGB干预组低于模型组（P〈0．05），免疫组化及RT-PCR检测Activin A的表达EGB干预组低于模型组（P〈0．01）。结论EGB对CCl4诱导的大鼠肝纤维化有良好的防治作用，作用机制可能与肝组织Activin A表达减少有关。     

NF—κB、TGF-β1在肝纤维化中的改变及护肝片的影响

目的探讨中、晚期纤维化大鼠肝组织核转录因子-κB（NF-κB）、转化生长因子β1（TGF-β1）的变化及护肝片对其影响。方法采用12．5％CCl4诱导的大鼠肝纤维化模型，自造模之目起，大鼠分组灌胃给药（护肝片921mg·kg^-1）或溶媒，每日1次，直至8或13周末，分别处死动物，取左叶肝组织石蜡包埋，制作组织芯片，免疫组化S．P法检测大鼠肝组织NF-κB p65、TGF-β1蛋白的表达，并用MetaMorph图像分析系统对NF-κBp65、TGF-β1蛋白表达量进行定量分析。结果（1）模型复制8和13周，模型组的肝损伤及其纤维化分级均明显高于正常组（P〈0．01），护肝片组的肝损伤及其纤维化分级均轻于模型组。（2）模型复制8和13周，模型组NF-κB p65、TGF-β1蛋白的表达较正常组明显增强（P〈0．01）；NF-κBp65蛋白和TGF-β1蛋白的表达之间呈显著的正相关（P〈0．01）；（3）护肝片显著抑制8、13周纤维化肝组织NF-κBp65、TGF-β1蛋白的表达（P〈0．01）。结论护肝片可减轻肝组织的损伤及其纤维化程度，抑制NF-κB、TGF-β1的表达可能是其抗肝纤维化作用的靶点之一。     

依那普利对肝组织bax和bcl-2基因表达的影响

目的探讨血管紧张素转化酶抑制剂（ACEI）依那普利（Ena）对大鼠肝纤维化的防治作用及其部分机制，及对肝组织bax和bcl-2基因表达的影响。方法以四氯化碳（CCl4）诱导形成大鼠肝实质损伤性肝纤维化模型。大鼠分为空白对照组、模型对照组、预防组及治疗组。除空白对照组外，其余各组大鼠均皮下注射40％CCl4橄榄油混合液，每3日1次，共10周。预防组同时给予Ena灌胃。治疗组则在造模第5周给予Ena灌胃。对肝组织标本炎症及纤维化程度进行评价，并用RT—PCR技术观察Ena对肝组织bax和bcl-2基因表达的影响。结果Ena高剂量预防及高剂量治疗组肝组织炎症和纤维化程度较模型对照组显著减轻（P〈0．01）。Ena高剂量预防及高剂量治疗组肝组织bax基因表达显著弱于模型对照组（P〈0．01），bcl-2基因表达显著强于模型对照组（P〈0．01），bax／bcl-2基因表达比值和肝纤维化程度呈显著直线正相关（P〈0．01）。结论Ena能有效防治大鼠肝纤维化，抑制促凋亡基因bax的表达，促进抑凋亡基因bcl-2的表达，是其可能机制之一。bax／bcl-2基因表达比值与肝纤维化程度正相关。     

参七内金散对肝纤维化模型大鼠肝组织转化生长因子-β1表达的影响

目的：探讨参七内金散抗大鼠肝纤维化的作用机制。方法：雄性SD大鼠32只随机分为3组：正常组、模型组、参七内金散组。除正常组外所有大鼠以CCl4皮下注射造模,首次注射100％CCl4 5ml／kg体重,之后40％CCl4-橄榄油溶液3ml／kg皮下注射,2次／周,连续注射6周。造模成功后参七内金散组以0．8g／kg的参七内金散灌胃大鼠,正常组与模型组大鼠则予以等量生理盐水灌胃,共2周。以盐酸水解法测定3组大鼠肝组织羟脯氨酸（Hyp）含量,分别以HE、天狼猩红染色观察大鼠肝组织的炎症与纤维化病理;以Real-time PCR及免疫印迹法检测大鼠肝组织TGF（转化生长因子）-β1 mRNA及蛋白表达。结果：与正常组比较,模型组大鼠肝组织可见大量肝组织脂肪变性及胶原病理沉积,并可见纤维间隔形成;参七内金散能显著改善模型大鼠肝组织脂肪变性与胶原病理沉积,降低肝组织Hyp含量;正常组大鼠肝组织可见少量TGF-β1mRNA及蛋白表达,模型组大鼠肝组织TGF-β1表达在mRNA和蛋白水平均显著性升高（P〈0．01）,参七内金散组大鼠肝组织TGF-β1mRNA及蛋白表达明显下调（P〈0．01）。结论：参七内金散具有抗肝纤维化作用;下调TGF-β1的表达可能是参七内金散抗肝纤维化的机理之一。     

肌细胞增强因子2A与肝星状细胞活化关系的体内实验研究

背景：转录调控在肝星状细胞（HSC）活化过程中起重要作用,研究显示转录因子肌细胞增强因子2（MEF2）参与了HSC的活化过程。目的：探讨肝纤维化形成过程中MEF2家族成员MEF2A与HSC活化的关系。方法：实验开始时处死6只大鼠作为0周对照组,64只大鼠随机分为正常对照组和肝纤维化模型组。模型组大鼠皮下注射60％CCL（0．3ml／100g,每周2次）复制肝纤维化模型;正常对照组大鼠与模型组于相同条件下饲养,不予任何处理。造模开始后3、6、9、12周分批处死大鼠,取肝组织,实时荧光定量聚合酶链反应（PCR）检测MEF2AmRNA表达．蛋白质印迹法检测MEF2A蛋白和HSC活化标记物α-平滑肌肌动蛋白（α-SMA）表达,VanGieson染色定量分析肝内胶原含量。结果：正常肝组织中仅有少量MEF2AmRNA和蛋白表达;随着肝纤维化的形成,肝组织MEF2AmRNA和蛋白表达量逐渐增加（P〈0．05）,MEF2A与Q—SMA蛋白表达呈正相关（r=0．88,P〈0．05）。肝内胶原含量随肝纤维化的形成呈递增趋势（P〈0．01）。结论：MEF2A参与了CCl4。诱导的大鼠肝纤维化形成过程中HSC的活化和增殖。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.