贵州省安顺地区人群胃食管反流病流行病学调查

目的:探讨贵州省安顺地区人群胃食管反流病(gastroesophageal reflux disease, GERD)的患病.方法:2006-07/2006-12采用中文版反流性疾病问卷(RDQ), 应用随机、整群、分层抽样方法对安顺地区人群进行调查. 调查方式为面试, 所得资料均输入电脑, 建立数据库, 用SPSS14.0软件行卡方检验及t检验等.结果:被调查者共1692例(男836例, 女856例),应答率96.2%; 年龄10-87(平均年龄42.2±15.3)岁. 按RDQ评分(≥12)定义, 安顺地区人群GERD的患病率为6.9%. 男性患病率高于女性, 但差异无统计学意义( P>0.05); 年龄分布,GERD的患病率随年龄增长而增高( P<0.05).结论:贵州省安顺地区人群中GERD患病率明显高于广东省社区人群GERD患病率, 也高于北京, 上海两地GERD患病率.     

消化内科门诊胃食管反流病诊断问卷诊断胃食管反流病的状况及症状特征分析

目的利用胃食管反流病诊断问卷（Reflux disease questionnaire,RDQ）分析消化专家门诊胃食管反流病（GERD）患病情况及患者症状特征。方法对就诊于我院消化专家门诊的1636例患者进行RDQ问卷调查,得分≥12分者诊断为GERD。根据RDQ内容对GERD患者症状特点进行分析。结果1636例消化专家门诊的患者中,GERD的发生率为10．8％。男女发病无差异（11．0％VS10．5％,P〉0．05）。60岁以上年龄组GERD的患病率最高（14．6％）,而15～30岁年龄组患病率最低（7．7％）。各年龄组内患病率性别间比较差异无显著性。GERD症状中,烧心与反酸为最常见的症状。症状频率积分比严重程度积分更重要（P〈0．05）。结论消化门诊就诊患者GERD患病率较高。GERD患病无性别差异。老年人的GERD患病率高于其他年龄组。烧心和反酸为GERD最常见的症状。症状发生频率比严重程度对GERD的诊断更有意义。     

社区人群中胃食管反流病的危险因素及其对生活质量的影响

目的探讨社区人群中胃食管反流病（GERD）的危险因素及其对生活质量的影响。方法2003年5—9月,采用整群和分层抽样的方法,在广东省内随机选取了广州市（较发达城市）、惠州市（中等发达城市）和惠阳县新圩镇（农村地区）作为调查地区,采用最近衍生出的中文版反流性疾病问卷（RDQ）进行调查。对调查中收集到的GERD症状人群进行危险因素和生活质量的分析。在调查中,每发现1例GERD患者,随后即选取2例健康人作为对照以比较和分析生活质量,生活质量的评估采用SF-36量表。用SPSS10．0作卡方检验、t检验和logistic回归分析等。结果调查中共收集到的GERD症状人群（RDQ评分≥12）83例,并选取166例健康人作为对照。男性患病率高于女性,分别为2．6％和2．4％,但两者差异无统计学意义;65岁以上是相对高发人群（3．5％）,但各年龄组GERD的患病率差异亦无统计学意义;体重指数与GERD并无明显的相关性。离婚、分居或丧偶人群（OR4．61）及工作压力大者（OR3．43）倾向于发生GERD。与健康对照组相比,GERD患者的生活质量明显下降。结论心理社会因素在GERD发病中可能起一定的作用,其对患者的生活质量有负面影响。     

上海宝山地区胃食管反流病流行学研究及生活质量评价

[目的]探讨上海宝山地区人群胃食管反流病(GERD)的患病率及发病危险因素。[方法]采用中文版反流性疾病问卷(RDQ),应用随机、整群、分层抽样方法对上海宝山地区≥18岁居民进行调查,调查方式为面试。[结果]实际调查3 126例(男1 635例,女1 491例),年龄18~87(43.5±17.1)岁;按RDQ评分≥12分定义,GERD的患病率为8.5%(266/3 126);30~40岁人群GERD患病率与其他年龄比较,差异有统计学意义(P0.05);男性患病率高于女性,但两性比较差异无统计学意义(P0.05)。GERD组伴发口咽疾病、鼾症、哮喘的比例明显高于非GERD组,2组比较差异有统计学意义(P0.05);饱食、便秘、吸烟是GERD患病的独立危险因素。GERD组SF-36量表8个维度生活质量评分和量表总评分均明显低于非GERD组,差异有统计学意义(P0.05)。[结论]上海宝山地区GERD患病率略高于上海市水平,GERD患者生活质量较正常健康人群明显下降。     

非糜烂性反流病的认识现状

胃食管反流病（gastroesophageal reflux disease，GERD）是临床常见病，严重影响患者的生活质量。亚太地区GERD的患病率较西方国家低，我们采用中国GERD研究协作组改良的中文版反流性疾病问卷在广东省社区人群中调查发现，社区人群中GERD的患病率为2．3％，而每周至少有一次烧心和（或）反酸症状者占6．2％。GERD包括糜烂性食管炎（erosive esophagitis，EE）、非糜烂性反流病（nonerosive reflux disease，NERD）和Barrett食管（BE），约70％的GERD表现为NERD。     

非糜烂性反流病的研究现状与进展

在西方国家，胃食管反流病（gastroesophageal reflux disease，GERD）是一种常见病，严重影响患者的生存质量。亚太地区GERD的患病率较西方国家低，但随着生活方式的改变，GERD的患病率也有上升的趋势。我们采用中国GERD研究协作组改良的中文版反流性疾病问卷，在广东省社区人群中调查发现，社区人群中GERD的患病率为2．3％，而每周至少有1次烧心及（或）反酸症状者占6．2％。GERD主要包括糜烂性食管炎（erosive esophagitis，EE）、非糜烂性反流病（non—erosive reflux disease，NERD）及Barrett食管（BE），50％～70％的GERD表现为NERD。     

福建省人群胃食管反流病流行病学调查

目的 探讨福建省人群胃食管反流病(GERD)发病情况,分析与之相关的危险因素.方法 采用整群分层随机抽样的方法,对福建省福州市人群进行GERD症状及危险因素问卷调查.按反流病诊断问卷(RDQ)评分定义,总积分≥12分为GERD组,＜12分为非GERD组,对两组行相关因素分析.结果 共调查1347例对象,GERD患病率为8.76%(118/1347).男女比例为1∶1.09,差异无统计学意义(x2=0.243,P＞0.05).40岁以上人群GERD患病率较40岁以下人群明显增高(P＜0.05).不同职业GERD患病率统计显示,商人患病率最高[17.91%(12/67)]、离退休者次之[13.48%(12/89)]、军人最低[2.94%(2/68)].GERD组中腹胀、嗳气、恶心、呕吐、纳差等症状的发生率及喉炎、咽炎、口腔溃疡等疾病的发生率均高于非GERD组(P＜0.01).年龄、肥胖、吸烟、常食油腻、进食过饱、常食辛辣食物、常进甜食、常饮咖啡、常饮浓茶和便秘等可能是GERD的危险因素.结论 福建省人群GERD患病率较高,且多种因素与反流密切相关.     

胃食管反流病临床研究中存在的问题

胃食管反流病（GERD）是近年来消化病学研究的热点。在西方国家,GERD的患病率有上升的趋势,这可能是由于饮食的变化、社会老龄化、不良的生活方式等导致GERD的发病率逐渐上升,也可能是与人们对GERD认识的不断加深有关。由于采用的诊断标准不同,不同国家和地区报道的患病率亦有较大差异。Locke等的调查发现,美国社区人群中约20％的人至少每周出现1次和约40％的人至少每月出现1次GERD的相关症状。亚太地区GERD的患病率较西方国家低,但随着生活方式的改变,GERD的症状患病率也有上升的趋势。我们在广东省社区人群中调查发现,社区人群中每周至少有1次烧心和（或）反酸症状者占6．2％。     

胃食管反流病的全球定义和分类-胃食管反流病的蒙特利尔共识意见介绍

胃食管反流病（Gastro-Esophageal Reflux Disease，GERD）是指胃十二指肠内容物反流至食管，引起食管症状和并发症的一类疾病。GERD在西方国家属常见病，患病率为7％～15％。北京、上海流行病学调查，估计我国GERD患病率为5．77％，广东省社区人群中调查发现，每周至少有1次烧心和（或）反酸症状者占6．2％。6％～14％的GERD可能演变为Barrett食管（Barrett＇s Esophagus，BE），而0．5％～1．0％的BE又可能与食管腺癌的发生有关。GERD的典型症状为烧心、反流；还有一些不典型症状如嗳气、上腹痛、恶心、胸骨后痛；食管外表现如哮喘、慢性咳嗽、咽部异物感、声音嘶哑等。近年来，GERD的诊断与心血管和呼吸系统疾病的关系及其鉴别诊断受到临床医生的重视。     

非糜烂性反流病的研究现状与进展

在西方国家,胃食管反流病(gastroesophageal refluxdisease,GERD)是一种常见病,严重影响患者的生存质量。亚太地区GERD的患病率较西方国家低,但随着生活方式的改变,GERD的患病率也有上升的趋势。我们采用中国GERD研究协作组改良的中文版反流性疾病问卷[1],在广东省社区人群中调查发现,社区人群中GERD的患病率为2.3%,而每周至少有1次烧心及(或)反酸症状者占6.2%[2]。GERD主要包括糜烂性食管炎(erosiveesophagitis,EE)、非糜烂性反流病(non-erosive refluxdisease,NERD)及Barrett食管(BE),50%～70%的GERD表现为NERD[3]。1定…     

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.