唾液幽门螺杆菌抗原检测与慢性胃炎活动性及癌前病变关系的研究

目的 评价唾液幽门螺杆菌（Helicobacterpylori，Hp）抗原与慢性胃炎活动性以及胃黏膜癌前病变肠上皮化生与不典型增生的相关性。方法 应用酶联免疫吸附法（ELISA），对2004年6月至2005年6月浙江大学医学院附属第二医院消化内科246例接受胃镜检查患者的唾液标本进行幽门螺杆菌抗原检测，分别比较不同胃病患者唾液中Hp抗原的阳性检出率。结果 慢性活动性胃炎组唾液中Hp抗原阳性检出率为74．29％（26／35）．明显高于慢性非活动性胃炎组46．92％（99／211）（P〈0．05）。慢性胃炎组患者唾液中Hp抗原的阳性检出率为45.98％（80／174），慢性胃炎伴轻度肠上皮化生（肠化）组唾液中Hp抗原阳性检出率为52.63％（20／38），慢性胃炎伴中重度肠化组唾液中Hp抗原阳性检出率为68．18％（15／22），慢性胃炎伴不典型增生组唾液中Hp抗原阳性检出率为83．33％（10／12），结果显示．慢性胃炎伴中重度肠化或不典型增生组与慢性胃炎组相比，差异有统计学意义（P〈0．05）。结论 唾液中存在高Hp检出率现象，1：3腔可能为Hp的重要寄居地．1：3腔内Hp感染程度与胃炎活动程度及部分胃黏膜癌前病变有关，慢性活动性胃炎或伴中重度肠化或不典型增生患者口腔内Hp检出率明显增高，口腔内Hp是否需行根除治疗，值得今后进一步研究探讨。     

幽门螺杆菌与慢性胃炎、胃癌的相关性

目的探讨Hp感染与慢性胃炎、胃癌的相关性．方法象山县下沈镇卫生院1994-06／1997-10经内镜证实的100例慢性胃炎患者，从临床角度分析Hp感染慢性胃炎、胃癌之间关系，结果Hp感染是慢性胃炎的主要致病因素，是胃癌发生的启动因子．WHO列为胃癌的第一危险因素。Hp感染遍于全世界，我国是Hp感染的高发区，且感染率高，感染年龄小．本文100例Hp阳性92例，Hp检出率为92％．100例慢性胃炎中，慢性浅表性胃炎86例，慢性萎缩性胃炎13例，疣状胃炎1例．肠化生18例，不典型增生11例．本组中有4例发展为胃癌死亡，均为肠化生及（或）不典型增生病例．Hp产生的尿素酶、细胞毒素、蛋白水解酶及促进炎症因子等破坏胃粘液，胃粘膜屏障功能．导致粘膜上皮炎性改变和坏死．Hp感染可增加细胞增殖活性和分化，这种增殖与分化使正常粘膜向化生转变，进而癌变．慢性浅表性胃炎－慢性萎缩性胃炎－肠上皮化生－不典型增生－胃癌的演变过程已经明确．胃癌的病理特征是细胞过度异常增生，Hp感染使胃粘膜上皮细胞过度增殖，破坏细胞的增殖与细胞凋亡的平衡，胃癌不仅是细胞增殖与分化异常的病，也是细胞凋亡异常的疾病．细胞凋亡调节基因紊乱细胞凋亡抑制蛋白（BCL-2等）的增加，导致细胞凋亡过度抑制，该死的细胞不死是肿瘤形成的     

根除Hp感染患者胃黏膜组织学变化及胃癌患病率的随访研究

目的研究幽门螺杆菌（Hp）阳性患者根除Hp后对胃黏膜炎症、萎缩和肠上皮化生（IM）及胃癌患病率的影响。方法采用随机、对照研究方法,对在我院行胃镜检查同时行Hp及胃黏膜组织学检查者236例进行随访观察,3a后复查胃镜和组织病理学,评定组织学变化。分析Hp阳性组和阴性组在胃黏膜炎症、萎缩及IM的变化。结果Hp阳性组中胃黏膜的炎症、腺体的萎缩和肠化的总人数明显高于Hp阴性组（P〈0．05）。结论根除Hp感染可减轻胃黏膜活动性炎症、萎缩和肠上皮化生以及胃癌的发病率。     

唾液幽门螺杆菌抗原检测与慢性胃炎活动性及癌前病变关系的研究

目的评价唾液幽门螺杆菌(Helicobacterpylori,Hp)抗原与慢性胃炎活动性以及胃黏膜癌前病变肠上皮化生与不典型增生的相关性。方法应用酶联免疫吸附法(ELISA),对2004年6月至2005年6月浙江大学医学院附属第二医院消化内科246例接受胃镜检查患者的唾液标本进行幽门螺杆菌抗原检测,分别比较不同胃病患者唾液中Hp抗原的阳性检出率。结果慢性活动性胃炎组唾液中Hp抗原阳性检出率为74.29%(26/35),明显高于慢性非活动性胃炎组46.92%(99/211)(P<0.05)。慢性胃炎组患者唾液中Hp抗原的阳性检出率为45.98%(80/174),慢性胃炎伴轻度肠上皮化生(肠化)组唾液中Hp抗原阳性检出率为52.63%(20/38),慢性胃炎伴中重度肠化组唾液中Hp抗原阳性检出率为68.18%(15/22),慢性胃炎伴不典型增生组唾液中Hp抗原阳性检出率为83.33%(10/12),结果显示,慢性胃炎伴中重度肠化或不典型增生组与慢性胃炎组相比,差异有统计学意义(P<0.05)。结论唾液中存在高Hp检出率现象,口腔可能为Hp的重要寄居地,口腔内Hp感染程度与胃炎活动程度及部分胃黏膜癌前病变有关,慢性活动性胃炎或伴中重度肠化或不典型增生患者口腔内Hp检出率明显增高,口腔内Hp是否需行根除治疗,值得今后进一步研究探讨。     

幽门螺杆菌相关胃疾病组织中P53、iNOS的表达

目的通过检测慢性浅表性胃炎、慢性萎缩性胃炎、肠上皮化生、不典型增生、胃癌组织幽门螺杆菌（Hp）和P53、一氧化氮合成酶（iNOS），探讨Hp感染与P53、iNOS表达的关系，以及Hp感染导致胃癌的可能分子机制。方法应用快速尿素酶试验和组织切片革兰氏染色和血清HpCagA抗体检测Hp，用免疫组化SP法检测上述组织的P53、iNOS。结果慢性浅表性胃炎、慢性萎缩性胃炎、肠上皮化生、不典型增生、胃癌组织中Hp检出率分别为45．9％、68．4％、71．4％、75．O％、54．8％，病变各组中P53和iNOS表达阳性率与浅表性胃炎组比较均有显著性差异。除浅表性胃炎组、萎缩性胃炎Hp阳性组的P53表达阳性率外，各病变Hp阳性组的P53和iNOS表达阳性率与各组的Hp感染阳性率呈正相关，各病变组中Hp（＋）组的P53和iNOS表达阳性率显著高于Hp（-）组，均有显著性差异。结论Hp与P53和iNOS阳性表达有一定的相关性。     

幽门螺杆菌感染、胃蛋白酶原和胃泌素-17与胃疾病的关系

幽门螺杆菌（ Helicobacter pylori, Hp ）感染与慢性胃炎、消化性溃疡以及低度恶性胃MALT淋巴瘤的发生密切相关．世界卫生组织已将其列为Ⅰ类致癌因子.根除Hp治疗能明显改善急性和慢性胃炎，降低消化性溃疡的复发，使低度恶性胃MALT淋巴瘤得到治愈，并可能终止胃癌的发生㈣。萎缩性胃炎是胃癌的主要癌前病变，在从慢性非萎缩性胃炎→萎缩性胃炎→肠化生→异型增生→肠型胃癌这一演变过程中，     

根除幽门螺杆菌对胃黏膜癌前病变的影响的Meta分析

目的探讨根除幽门螺杆菌（Hp）对萎缩性胃炎、肠化生等癌前病变的逆转效用。方法全面检索1984年至2008年底国内外生物医学期刊发表的根除Hp对胃黏膜癌前病变影响的临床研究文献及学术会议的交流论文,共6个随机对照试验524例患者进入本系统评价。采用胃黏膜组织学评分、组织学变化作为观察指标。结果（1）Hp根除组胃黏膜萎缩程度改善率显著高于对照组（OR=0．27,95％CI0．17～0．46,P=0．000）;但胃黏膜肠化生改善率在Hp根除组和对照组之间无显著差异（OR=0．55,95％CI0．28～1．08,P=0．082）;（2）Hp根除组Hp根除后胃窦部、胃体、胃底部黏膜的活动性炎症、慢性炎症以及萎缩评分均显著低于对照组（P〈0．01）,但各部位黏膜的肠化生评分改善在Hp根除组和对照组之间无显著差异（P〉0．05）。结论本Meta分析表明,根除Hp可改善慢性萎缩性胃炎的萎缩程度,活动性炎症和慢性炎症程度,但是对胃黏膜肠化生的改善不明显。     

疏肝清热法治疗慢性胃炎临床观察

[目的]观察疏肝清热法治疗慢性胃炎肠上皮化生（IM）、不典型增生、幽门螺杆菌（Hp）感染的疗效。[方法]124例入选病例随机分为2组，各62例，治疗组用疏肝清热法治疗，对照组用胃复春治疗，疗程均3个月，共2个疗程。[结果]治疗组病理组织学显效41．94％，总有效93．55％，对照组分别为14．50％和54．84％；治疗组临床症状显效51．61％，总有效96．77％，对照组分别为14．5％和64．52％；治疗组Hp转阴率为79．55％，对照组17．07％，2组比较差异均有统计学意义（均P〈0．05）。[结论]疏肝清热法治疗慢性胃炎临床疗效显著，有逆转大肠腺IM和抗Hp作用。     

根除幽门螺杆菌对胃黏膜组织学变化及胃癌患病率的3年随访研究

目的幽门螺杆菌(Helicobacter pylori,Hp)是导致胃黏膜病变的重要因子,研究Hp阳性患者根除Hp后对胃黏膜炎症、萎缩和肠上皮化生(IM)及胃癌患病率的关系。方法采用随机、对照研究方法,2006年1月-2009年6月间在我院胃镜检查同时行Hp及胃黏膜组织学检查者236例进行随访观察,3年后复查胃镜和组织病理学,评定组织学变化。分析治疗组(Hp阴性)和对照组(Hp阳性)在胃黏膜炎症、萎缩及IM的变化。结果对照组中胃黏膜的炎症、腺体的萎缩和肠化及发生胃癌的总人数明显高于治疗组的总人数,差异有显著性(P0.05)。结论根除Hp感染可减轻胃黏膜活动性炎症、萎缩和肠上皮化生以及胃癌的发病率。     

幽门螺杆菌感染对Fas/FasL表达的影响在胃癌发生中的作用

目的：观察幽门螺杆菌（Hp）及其不同毒力株（cagA阳性与cagA阴性株）感染对胃黏膜上皮细胞Fas/FasL表达的影响，进而探讨胃癌的发生机制。方法：胃镜下取胃窦黏膜标本，将研究对象按病理结果分为黏膜萎缩组，黏膜萎缩伴轻度不典型增生组，黏膜萎缩伴中度不典型增生组，胃腺癌组，黏膜大致正常组为对照组，再根据Hp感染情况为分Hp阳性组与阴性组，并将Hp阳性组进一步成cagA阳性组及阴性组，共9组80例。以快速尿素酶试验，PCR及组织学第三种方法检测Hp，用PCR方法对Hp进行分型。用免疫组化法检测Fas、FasL等表达情况。结果Hp感染率为60．0％，cagA阳性率为90．47％，非腺癌病人Hp阳性组Fas/FasL表达明显高于Hp阴性组（P＜0．05），腺癌组Fas/FasL表达明显高于大致正常组及黏膜萎缩，黏膜萎缩伴轻度不典型增生，黏萎缩伴中度不典型增生组（P＜0．01）。cagA阳性组Fas/FasL表达与cagA阴性组差异无显著性（P＞0．05）。结论：幽门螺杆菌感染后早期即黏 萎缩阶段已出现Fas、FasL等的表达增加，随细胞凋亡的增加，黏膜上皮细胞萎缩加重，细胞DNA不稳定性增加，并出现不典型增生加重， Fas、FasL的表达随之增强，一旦肿瘤细胞形成，Fas/FasL表达进一步增加，形成局部免疫豁免区，导致肿瘤的浸润生长。cagA阳性的菌株在促成肿瘤的发生过程中无明显作用。     

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.