溃疡性结肠炎患者血液流变学检测的临床意义

溃疡性结肠炎(UC)是以结肠黏膜和黏膜下层炎症为特点的慢性炎症性疾病，其发病机制尚未阐明，故治疗比较棘手。1998年8月至2002年3月，我们对49例UC患者6项血液流变学指标进行了检测和分析，旨在探讨其在UC发病中的意义。     

溃疡性结肠炎内镜评分与临床活动度及组织学评分的相关性研究

目的:本研究通过现有的溃疡性结肠炎(ulcerative colitis, UC)内镜评分评估UC患者肠道黏膜状态,并探讨UC内镜评分与临床疾病活动度及组织学活性的相关性。方法:回顾性分析2014年1月—2019年9月于南京鼓楼医院消化内科住院并行乙状结肠镜或结肠镜检查的152例患者的内镜检查结果,使用梅奥内镜子评分(...     

神经激肽-1受体在溃疡性结肠炎黏膜中的表达

目的：了解神经激肽-1受体(NK-1R)在溃疡性结肠炎(UC)病人结肠活检黏膜中的表达，探讨该受体的表达与UC严重程度的关系。方法：38个UC黏膜标本取自因该病而行结肠镜检查的病人，男23例，女15例；对照组结肠黏膜取自15例肠易激综合征(IBS)病人，男8例，女7例。应用逆转录聚合酶链反应(RT-PCR)检测对照组和UC肠黏膜NK-1R的mRNA表达水平，应用Western blot技术检测NK-1R的蛋白水平，以免疫组化方法进行NK-1R的组织学定位。结果：与对照组肠黏膜相比，UC黏膜中NK-1R mRNA和蛋白都过度表达，NK-1R mRNA的表达与疾病的严重程度相关。免疫组化检查显示，NK-1R的表达主要位于UC的肠黏膜表面、黏膜固有层的单核细胞、黏膜下层的动静脉等处。结论：UC黏膜组织中NK-1R的表达水平明显上调，扰乱了神经激肽的作用环节，加剧了肠黏膜的病理改变。     

粪便钙卫蛋白联合粪便免疫化学试验在溃疡性结肠炎患者黏膜愈合中的诊断价值

目的 探讨粪便钙卫蛋白(FC)联合粪便免疫化学试验(FIT)在诊断溃疡性结肠炎(UC)患者黏膜愈合(MH)的临床应用价值。方法 前瞻性纳入2020年9月至2021年6月首都医科大学附属北京友谊医院消化内科门诊就诊UC患者60例。根据Mayo内镜评分(MES)将UC患者分成黏膜未愈合组(MES≥2,n=39)和黏膜愈合组(MES≤1,n=21)。利用酶联免疫吸附试验(ELISA)测定FC水平,利用全自动粪便血红蛋白分析仪测定各组FIT水平。利用受试者工作特征(ROC)曲线评估FC和FIT单独或联合检测对UC患者黏膜愈合的判断效能。结果 纳入60例UC患者,中位年龄37.5岁,其中男性占58.3%,临床缓解期患者占40.0%。黏膜愈合组FC、FIT水平均低于黏膜未愈合组(P<0.01)。在黏膜未愈合UC患者中,FC联合FIT检测预测的ROC曲线下面积为0.846(95%CI∶0.749～0.943),高于单独FC或FIT检测[0.770(95%CI∶0.636～0.905),cut off值281.8μg/g(P=0.001)或0.833(95%CI∶0.731～0.936),cut...     

溃疡性结肠炎患者肠黏膜内镜像与中医体质相关性研究

[目的]研究溃疡性结肠炎(UC)患者肠黏膜内镜像与中医体质之间的关系,为UC的诊断及防治提供依据。[方法]对2014年9月~2015年2月在沈阳军区总医院住院治疗的32例UC患者,进行系统的中医体质量表测定。统计UC患者的结肠黏膜内镜像,归纳常见的结肠黏膜内镜像与中医体质类型之间的关系。[结果]32例UC患者结肠黏膜内镜像表现中以Ⅱ型表现为最多,其次为Ⅰ型,Ⅲ型最少。其中Ⅰ型主要表现为黏膜充血(或)水肿;Ⅱ型主要表现为溃疡、糜烂、弥漫性分布;Ⅲ型表现以息肉、肠腔狭窄、肠管僵硬为多。其体质调查中以阳虚质(75%)与气虚质(65.63%)为最多,其余体质类型相对较少,各体质类型之间差异有统计学意义(χ2=40.365,P0.05)。UC患者结肠镜像表现中弥漫性分布、溃疡、糜烂、黏膜充血(或)水肿、黏膜脆性增加,触之易出血、颗粒样改变的各体质类型之间差异有统计学意义(P0.05)。其余各肠黏膜内镜像的体质类型之间差异无统计学意义(P0.05)。[结论]UC患者以阳虚质与气虚质两种体质类型为主,且多为兼夹体质。结肠内镜像分型与中医体质具有相关性,各内镜像分型均以阳虚质、气虚质为主。     

转录超保守区uc.290高表达促进溃疡性结肠炎肠壁纤维化

目的 研究转录超保守区uc.290与溃疡性结肠炎(ulcerative colitis, UC)肠壁纤维化之间的关系及作用机制。方法 收集2021年1月至2021年10月收治的50例慢性复发型UC住院患者(UC组),选取50例同期收治的结肠息肉内镜下治疗的住院患者(对照组)。两组患者行结肠镜检查并用活检钳获取UC患者结肠炎症部位黏膜及对照组结肠正常黏膜。RT-PCT检测结肠黏膜标本中uc.290、EMT标志性蛋白Vimentin、N-cadherin和E-cadherin的表达，免疫组化检测后三者的表达。采用改良Masson三色染色法检测结肠黏膜中胶原纤维含量并计算纤维化评分。Pearson相关分析uc.290表达与纤维化评分的关系。在模式细胞Caco2中过表达uc.290,RT-PCT、Western blotting分别检测Vimentin、N-cadherin和E-cadherin的表达。结果 UC患者结肠黏膜中uc.290显著高表达，纤维化评分显著升高，且uc.290表达水平与纤维化评分呈正相关(r=0.735,P=0.012)。UC患者结肠黏膜及高表达uc.290的Caco2...     

神经生长因子在溃疡性结肠炎中的表达和意义

背景:溃疡性结肠炎(UC)病因复杂,其发病机制是国内外研究的热点,近年来肠道神经系统(ENS)异常越来越受学者们关注。目的:探讨神经生长因子(NGF)在UC中的表达及其意义。方法:纳入2011年1月-2013年5月山西医科大学第一医院确诊的UC患者40例,选取同时期单纯性结肠息肉患者10例和健康体检者10例作为对照组,采集肠黏膜标本和静脉血。分别采用免疫组化染色和ELISA法检测NGF在UC患者和对照组肠黏膜和血清中的表达。结果:NGF在UC组肠黏膜组织中的表达显著高于对照组(P0.01)。轻度与中度、重度UC患者肠黏膜组织NGF表达差异有统计学意义(P0.05),但中度与重度间差异无统计学意义(P0.05)。UC肠黏膜组织中NGF表达与UC严重程度呈正相关(rs=0.505,P0.05)。NGF在UC肠黏膜组织中的表达与病变部位无关。NGF在UC患者血清中的表达与肠黏膜组织中的表达呈负相关(r=-0.529,P0.05)。结论:NGF在UC肠黏膜组织中的高表达可能与UC发病机制有关,NGF可能是连接神经系统与免疫系统的桥梁,且与UC严重程度呈正相关;NGF在UC患者血清中的表达可有助于疾病程度的判断。     

溃疡性结肠炎与一氧化氮和氧自由基及Cajal间质细胞关系研究

近年来，溃疡性结肠炎（UC）的患病率呈上升趋势，其发病机制尚未完全明了，目前认为炎性细胞因子增高在UC发病中起重要作用。炎症性肠病时结肠黏膜产生过量的一氧化氮（NO），加重黏膜损伤。有研究发现，UC患者结肠Caja1间质细胞（ICC）出现异常，并参与合成NO，且作为NO的靶细胞而起肠功能调节作用。本研究观察UC患者血清、肠黏膜中NO和超氧化歧化酶（SOD）变化，探讨ICC与其的关系。     

乙酰肝素酶在溃疡性结肠炎肠黏膜中的表达及在致病机制中的作用

目的探讨乙酰肝素酶(heparanase，HPSE)在溃疡性结肠炎(ulcerative colitis，UC)患者肠黏膜中表达的改变，及其表达是否与不同临床分期和不同炎症程度相关。同时也讨沦了HPSE表达在UC致病机制中的作用。方法正常对照组为13名健康成人，确诊的28例UC患者中25例根据病情分为活动期11例、缓解期14例，并对24例的病理组织学炎症进行分级，Ⅲ、Ⅳ级10例，Ⅰ、Ⅱ级14例。分别采用RT-PCR和Western印迹法对不同分组的HPSE表达水平进行检测。结果HPSE在正常对照组肠黏膜中无表达，在缓解期和病理分级Ⅰ、Ⅱ级的肠黏膜中均呈现低表达，而在活动期和病理分级Ⅲ、Ⅳ级的肠黏膜中表达显著升高。结论HPSE在UC肠黏膜中呈阳性表达．且其表达水平与病情轻重和炎症严重程度呈正相关，它可能在UC肠黏膜上皮重塑和疾病的发生和发展中起重要作用，而HPSE抑制剂则有可能用于UC的治疗。     

溃疡性结肠炎患者肠黏膜及外周血淋巴细胞表型分析

目的　探讨淋巴细胞各亚群比例在溃疡性结肠炎（UC）发病中的变化及意义。方法 利用双色、三色荧光抗体流式细胞术及细胞内细胞因子检测法对19例UC肠黏膜及外周血淋巴细胞作表型分析。结果 ⑴UC患者外周血及肠黏膜T、B细胞百分比与对照组比较，均差异无显著性；⑵外周血CD4^ 、CD8^ T细胞百分比与对照组相比无改变，肠黏膜CD4^ T细胞百分比高于对照组，CD8^ 细胞百分比低于对照组；⑶外周血及肠黏膜Th1/Th2比值均低于对照组。结论 ⑴T细胞各亚群的变化在UC发病中起重要作用，对T细胞亚群的进一步研究有助于深入揭示其发病机制；⑵肠黏膜及外周血中Th1/Th2比值均明显下降，提示Th2细胞是UC病变中的主要辅助细胞群体，UC是一种Th2细胞占优势的炎症。     

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。     

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。     

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。     

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.