罗格列酮：非酒精性脂肪性肝炎治疗及其可能的合并症

非酒精性脂肪性肝病（NAFLD）是引起转氨酶升高的常见原因。在NAFLD患者中，五分之一的患者可能发展为伴有坏死性炎症和纤维化组织学体征的非酒精性脂肪性肝炎（NASH），进而可进展为终末期肝衰竭肝硬化或肝细胞癌。有报道在酒精性脂肪肝患者中与Q-T间期延长和自发性机能障碍相关的猝死。但尚未提及NAFLD或NASH患者中Q-T间期延长和猝死的问题。     

儿童非酒精性脂肪性肝病研究进展

非酒精性脂肪性肝病（NAFLD）是导致儿童及青少年肝病的最常见原因。近年来,由于肥胖症的发病率逐年升高,NAFLD的患病率也明显增加。对于非酒精性脂肪性肝炎（NASH）的确诊及分级依赖于组织活检。一些非创伤性的检测指标及影像技术的发展有助于在NAFLD高风险人群中进行大范围筛查。在儿童患者中存在两种组织类型不同的NASH,其临床特征及人群特征也有差异。至今并未有儿童NAFLD的最佳治疗方案,但研究人员认为生活方式干预如饮食控制或锻炼具有一定作用。维生素E和二甲双胍对儿童NAFLD的治疗作用正处于临床研究之中。     

蛋白质组学技术在非酒精性脂肪肝研究中的应用

非酒精性脂肪肝（nonalcoholic fatty liver，NAFL），又称非酒精性脂肪性肝病（nonalcoholic fatty liver disease，NAFLD），是一组以肝细胞脂肪变性、坏死、炎性细胞浸润等为主要特征的临床病理综合征，其肝脏组织学病变与酒精性肝病相类似，但无过量饮酒史。根据病理学改变及临床表现，可将NAFLD分为单纯性NAFLD和非酒精性脂肪性肝炎（nonalcoholic steatohepatitis，NASH）。NASH却可逐渐进展为肝硬化、肝癌等终末期肝病，已成为目前仅次于慢性病毒性肝炎和酒精性肝病的重要肝硬化前期病变。     

非酒精性脂肪性肝病的无创诊断进展

现代社会由于肥胖的高度流行，与其相关的非酒精性脂肪性肝病（NAFLD）的患病率不断升高。从疾病的发展而言，非酒精性脂肪性肝病疾病谱包括单纯性肝脂肪变、非酒精性脂肪性肝炎（NASH）及脂肪性肝硬化。目前认为单纯性肝脂肪变为良性病变，而非酒精性脂肪性肝炎则易进展成为肝硬化及肝癌。     

脂肪性肝病的肝移植

随着肥胖症发病率在美国乃至全球的持续上升,非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）的诊断日益增多,并被认为是终末期肝病（ESLD）的病因之一。     

非酒精性脂肪性肝炎的临床试验设计和治疗终点

非酒精性脂肪性肝病（nonalcoholic fatty liver disease。NAFLD）是慢性肝病的常见病因．非酒精性脂肪性肝炎（nonalcoholic steatohepatitis,NASH）是NAFLD的进展形式,与肝病相关病死率和心血管疾病风险增加相关。当前,肝活检是惟一被临床广泛接受的诊断方法．可评估NASH向肝硬化进展．对NASH患者尚无确证的非创伤性诊断方法和公认的治疗措施。     

非酒精性脂肪性肝炎相关肝纤维化的研究现状

随着人们生活方式及饮食习惯的改变．非酒精性脂肪性肝病（NAFLD）的发病率正在逐年递增,在世界范围内成为慢性肝病的常见病因。美国近1／3年轻人患有NAFLD，而我国上海的发病率约占15％。NAFLD的发病率在肥胖、2型糖尿病（DM）、高血压、高脂血症等代谢综合征人群中更高。NAFLD包括单纯性脂肪肝、非酒精性脂肪性肝炎（NASH）和肝硬化。研究显示，单纯性脂肪肝预后较好，而NASH是肝纤维化的重要致病因子，NASH患者中有20％～40％进展至肝纤维化甚至肝硬化。     

非酒精性脂肪性肝炎与肿瘤坏死因子α基因多态性的研究进展

非酒精性脂肪性肝病（NAFLD）是一类肝组织学与酒精性肝病相似，但无过量饮酒史的临床病理综合征，包括单纯性脂肪肝、非酒精性脂肪性肝炎（NASH）、脂肪性肝纤维化和脂肪性肝硬化等4个病理过程。目前多数研究认为，NASH的进展与终末期肝病的发生有关，所以NASH发病机制方面的研究正成为肝病研究的一个热点。针对NASH发病机制的研究主要包括胰岛素抵抗和炎症坏死两方面，在影响炎症坏死过程的众多细胞因子中，TNF-α的重要作用已被重视，TNF-α基因多态性在炎症坏死过程中的作用也日益引起重视，现对NASH与TNF-α基因多态性方面的研究进展作一综述。     

世界胃肠病组织非酒精性脂肪性肝病诊疗指南简介

1前言 在过去的几十年里，非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）已成为西方国家头号肝瘸，其发病率在20年内增加了一倍。与此同时，其他慢性肝病的患病率基本稳定，甚至有所下降。越来越多的资料证实，NAFLD／NASH高发病率在中东、远东、非洲、加勒比海地区、美国和拉丁美洲均有存在。     

非酒精性脂肪性肝病基因多态性

非酒精性脂肪性肝病（NAFLD）是一种遗传-环境-代谢应激相关且无过量饮酒史的临床病理综合征,疾病谱包括单纯性脂肪肝、非酒精性脂肪性肝炎（NASH）、NASH相关肝硬化甚至肝癌。     

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.     

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.     

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.     

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.