瘦素和TGF-α在幽门螺杆菌感染慢性胃炎和胃溃疡患者胃黏膜内的表达及意义

目的:探讨瘦素和转化生长因子-α(TGF-α)在幽门螺杆菌(Hpylori)感染的胃黏膜表达之间的关系.方法:用免疫组织化学法检测Hpylori阳性(Hpylori+)和阴性(Hpylori)慢性胃炎和胃溃疡患者胃体和胃窦部活检标本.结果:瘦素在正常人的胃体黏膜内有弱阳性表达.瘦素和TGF-α在Hpylori+胃炎和胃溃疡患者胃体黏膜内的过表达率较Hpylori者明显增强(瘦素:73.33%vs 23.08%,P＜0.05;70.59% vs 25.00%,P＜0.05;TGF-α:73.33% vs 15.38%,P＜0.05;76.47% vs 25.00%,P＜0.05).瘦素在四组患者的胃窦部表达无差别(P＞0.05).TGF-α在Hpylori+胃炎患者胃窦部的表达较Hpylori-胃炎患者显著增强(53.33% vs 7.69%,P＜0.05).胃体部瘦素与TGF-α的表达呈显著正相关(r=0.80,P＜0.01),胃窦部二者无相关关系.结论:胃体部瘦素与TGF-α在幽门螺杆菌感染慢性胃炎和胃溃疡患者的表达呈显著正相关,胃窦部二者无相关关系.     

不同年龄人群幽门螺杆菌和胃黏膜炎症胃内分布特点及其与年龄的关系

目的探讨幽门螺杆菌及胃黏膜炎症在有消化道症状但内镜诊断大致正常人群胃内的分布部位及其与年龄的相关性.方法以20岁～25岁、40岁～50岁及＞60岁3个年龄组作为研究对象,每组各选20例有症状但胃镜检查结果阴性的患者,在胃窦大弯、胃窦小弯、胃角、胃体大弯和胃体小弯5个部位取材,用于Hp感染严重程度的诊断和胃黏膜炎症严重程度的鉴定.结果在胃窦胃角处,3个年龄组Hp感染率比较差异无显著性（P＞0.05）,而在胃体Hp感染率随年龄的增大而显著增加（P＜0.001）;Hp感染积分在胃窦处没有明显差别（评分随年龄增加分别为1.3、1.5和1.6,P＞0.05）,胃角处有显著差异（评分分别为1.0、1.2和1.6,P＜0.05）,而在胃体则有极显著差异（评分分别为0.6、1.0和1.5,P＜0.001）;同一年龄组不同部位以及同一部位不同年龄组胃黏膜炎症的严重程度均没有显著差异.胃黏膜炎症出现和Hp感染胃内分布表现出较好的一致性（χ^2=30.016,P＜0.01）.结论在有症状但胃镜检查结果阴性的人群中,Hp感染随年龄的增长而加重,且感染部位上移,胃黏膜的炎症发生不具有这样的趋势,但依然和Hp感染分布具有较好的一致性.     

幽门螺杆菌感染在胃癌及癌前病变中的研究

目的　研究胃癌及癌前病变与Hp感染的关系 ,以探讨Hp可能的致癌机制。 方法　经内镜和病理明确诊断的胃癌及癌前病变者共 5 48例 ,包括慢性浅表性胃炎 (CSG) 16 3例、慢性萎缩性胃炎 (CAG) 2 0 7例、肠上皮化生 (IM) 71例 ,异型增生(DYS) 4 5例及胃癌 (GC) 6 2例。每例均活检胃窦大小弯、胃角及胃体大小弯共 5块 ,以WS法检测Hp。结果　癌前病变及胃癌Hp感染均较高 ,CAG(4 2 .5 % ) ,IM(76 .1% ) ,DYS(88.9% )和GC(72 .5 % ) ,与CSG(2 3.9% )有显著性差异 (P <0 .0 5或P <0 .0 1)。随着年龄增大 ,CAG、IM、DYS和GC逐步增多 ,而且≥ 5 6岁年龄组IM、DYS和GC显著多于≤ 40岁组 (P <0 .0 5 ) ,但CSG则相反。肠型胃癌和Hp感染密切相关 (P <0 .0 5 ) ,从胃窦小弯和大弯、胃角及胃体小弯和大弯顺序 ,Hp感染随着CSG、CAG、IM、DYS和GC病变而增高 ,Hp感染部位也在上移 ,尤其在胃体小弯及大弯 ,IM、DYS和GC的Hp感染显著高于CSC部位 (P <0 0 5 )。结论　Hp感染是导致从胃炎→胃萎缩→肠化→异型增生→癌变序列发展的危险因子 ,肠型胃癌和Hp感染密切相关 ,胃镜检查应该多部位取活检作病理及Hp检测 ,尤其是高位     

"酒精胃"内镜下表现1例

患者男,43岁,无消化道不适症状,于2019年6月21日因“健康体检”在解放军总医院第一医学中心消化内镜中心行无痛胃镜检查。既往饮酒20年,平均每天饮白酒(53度)约600 g,近5年有所减少,每日饮白酒250~300 g。常规麻醉后进镜观察,见胃体黏膜粗糙,集合细静脉的规则排列(RAC)征阴性,小弯侧黏膜充血明显,弥漫性发红(图1),胃角、胃窦黏膜充血、水肿,伴渗出、片状红斑(图2、3),内镜下稍吸气观察胃体小弯与两侧黏膜存在明显分界线,喷洒靛胭脂后观察胃体小弯黏膜着色少,可见颗粒样改变(图4、5),胃角、胃窦胃小区结构增大,伴凹陷性糜烂(图6)。分别于胃体小弯、胃角、胃窦小弯各取活检1块。病理诊断结果:胃(体小弯)表浅体型黏膜慢性炎伴急性炎及幽门螺杆菌感染,部分腺体肠化、增生;胃(角)幽门型黏膜慢性炎伴急性炎及幽门螺杆菌感染,部分腺体肠化、增生;胃(窦小弯)幽门型黏膜慢性炎伴急性炎,部分腺体肠化、增生,可见幽门螺杆菌感染。     

原发性十二指肠胃反流程度与胃黏膜炎性反应关系的研究

目的 分析原发性病理性十二指肠胃反流(DGR)患者胃黏膜病变、幽门螺杆菌(Hp)感染及胆汁反流变化以及相互间的关系.方法 对58例原发性病理性DGR患者进行24 h胃内胆汁监测,以反流时间百分23.60%为界,将患者分为高反流组(29例)和低反流组(29例).并行胃镜检查及胃黏膜活检.分析原发性病理性DGR患者胃黏膜炎性反应、Hp感染、胆汁反流间的关系.结果 高反流组及低反流组的Hp阳性率分别为20.7%(6/29)和48.3%(14/29),差异有统计学意义(P＜0.05).高反流组胃窦和胃角部黏膜肠上皮化生检出率高于低反流组(P＜0.05).胃窦、胃角部黏膜新悉尼系统病理积分Hp阳性组高于Hp阴性组(P＜0.05),高反流组高于低反流组(P＜0.05).Hp阳性组胆红素吸收值≥0.25的时间百分比低于Hp阴性组(P＜0.05),HP阳性组短时间反流频率、长时间反流频率、最长反流时间、吸收值最大值、平均值和中位值与Hp阴性组间差异无统计学意义(P＞0.05).Hp阳性组和阴性组胆红素吸收值≥0.25的时间百分比与胃窦、胃角部黏膜新悉尼系统病理积分均呈正相关(P＜0.05).结论 原发性病理性DGR导致胃窦黏膜损伤的主要因素可能为胆汁反流,胆汁反流可抑制HP在胃内定植,Hp感染可能与胆汁反流协同作用导致胃黏膜损伤.     

胃镜诊断35例胃憩室特点分析

目的探讨胃憩室胃镜下表现和特点。方法回顾分析35例经胃镜确诊的胃憩室患者胃镜下表现。结果胃镜检查确诊胃憩室35例,检出率0.058%。男女性别构成差异无统计学意义（P〉0.05）。憩室位于胃底和胃窦者分别占48.57%和42.86%,明显多于8.57%的胃体憩室。胃体憩室直径显著大于胃窦（P〈0.01）,胃体憩室患者年龄也显著大于胃窦憩室患者（P〈0.05）。胃底憩室多见于大弯和后壁,胃窦憩室多见于大弯侧,胃体憩室多见于前、后壁。结论胃憩室是一种罕见病,多见于胃底和胃窦,男女检出率相当,并发症少见。     

内镜下取胃内钢针的体会

内镜下取胃内钢针的体会宋世明患者女，２２岁，吞服钢针６枚，４小时后急送我院。Ｘ线下发现中上腹６条长约３．５ｃｍ密度增高线状阴影。急行胃镜检查，发现胃底部４枚钢针，胃窦部２枚，且见２枚针尖分别刺入胃窦小弯侧，针尾刺入胃窦大弯侧，针体横架于胃窦部。用普通...     

1996年对胃癌高发区人群幽门螺杆菌(HP)感染情况的检查报告

本文对胃癌高发区(山东省牟平县)成年人群1038人进行了 HP 感染的检查。每例均做内镜、快速尿素酶试验及四块胃粘膜活检组织学检查。结果显示:1.以 CLO、WS 同时阳性做为判断 HP 阳性的标准,活动性胃炎的HP 感染率最高84.66%,其次是十二指肠溃疡:84.21%,胃溃疡:81.25%,慢性浅表性胃炎:62.87%,慢性萎缩性胃炎:58.55%。2.以 WS 阳性做为判断 HP 阳性的标准,HP 在胃内分布以胃底部阳性率最高:61.51%,其次为体小弯:55.66%,窦大弯:51.24%,窦小弯:50.85%,胃底部 HP 阳性率明显高于胃窦部:P<0.01。3.活检取胃底加体小弯两块组织的 HP 阳性率接近于取四块组织的 HP 阳性率。     

原发性病理性十二指肠胃反流致病的因素分析

目的 探讨原发性病理性十二指肠胃反流(DGR)胃黏膜病变、幽门螺杆菌(Hp)感染、胆汁反流之间的关系.方法 应用便携式胆汁监测仪监测86例原发性病理性DGR患者胃内24 h胆汁反流情况;另取胃黏膜组织活检,分别行快速尿素酶试验、改良Giemsa染色和HE染色,判断有无Hp感染,并观察胃黏膜慢性炎症、活动性、萎缩、肠化等组织学特征.结果 ①将患者根据有无Hp感染分为Hp阳性组和Hp阴性组,Hp阳性组胃窦部黏膜病理积分、胆红素吸收值≥0.25的时间百分比均显著低于Hp阴性组(P均＜0.05);两组胆红素吸收值≥0.25的时间百分比和胃窦、胃角部黏膜病理积分均呈显著正相关(P均＜0.05).②将患者根据胆汁反流程度分为高反流组和低反流组,高反流组Hp阳性率显著低于低反流组(P＜0.05),胃窦和胃角部黏膜肠上皮化生的检出率、胃窦部黏膜病理积分均显著高于低反流组(P均＜0.05).结论 原发性病理性DGR导致胃窦黏膜损伤的主要因素可能为胆汁反流,随胆汁反流程度加重,胃窦黏膜损伤程度加重;胆汁反流可能抑制Hp在胃窦部定植,Hp感染可能与胆汁反流协同作用导致胃体部黏膜损伤.     

幽门螺杆菌在慢性胃炎患者胃内斑片状分布及与炎症关系的研究

对39例胃镜证实为慢性胃炎,并排除近期内服用抗生素和铋剂的患者分别于胃窦大弯、小弯、胃体、胃底及十二指肠球部各取活检组织1块,各制片2张,以了解组织学炎症情况和HP感染情况.结果提示:HP在以上5个部位的阳性率分别是56.4%,61.6%,51.3%,46.2%,5.1%.胃内4个部位     

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.