新生儿静脉血与脐带血及孕妇静脉血HBV病原学标记物相关性研究

目的 探讨慢性HBV感染孕妇所生新生儿脐带血与静脉血HBV标志物状况的一致性和相关性,以及与孕妇HBV感染标志物的相关性.方法 以HBsAg、HBeAg双阳性且HBV DNA＞1 ×105拷贝/ml孕妇及新生儿为研究对象,孕妇分娩前采集静脉血,新生儿于注射乙肝免疫球蛋白、乙肝疫苗前采集静脉血.在清洁和去除脐带表面污染血液,并用酒精消毒后,用注射器采集脐带血.HBsAg、抗HBs、HBeAg、抗HBe采用雅培微粒子化学发光法(美国雅培公司试剂,Abbott Architac i2000)检测,HBV DNA含量经COBAS TagMan HBV DNA定量检测仪检测.结果 共入组孕妇383例及所生新生儿,静脉血和脐带血HBsAg的阳性检出率分别为61.2％和63.9％,HBeAg阳性检出率分别为83.2％和83.5％,HBV DNA阳性检出率分别为56.0％和59.4％,静脉血和脐带血之间均有一致性.静脉血和脐带血间HBsAg、HBeAg和HBV DNA含量的相关性具有统计学意义(r=0.766、0.857、0.692,P＜0.000).新生儿静脉血和脐带血的HBeAg含量与孕妇的HBeAg含量具有相关性(r=0.362,P=0.000;r=0.352,P=0.000),而静脉血和脐带血的HBsAg含量与孕妇血清的HBsAg含量无相关性(r=0.023,P=0.785;r=0.04,P=0.604).结论 慢性HBV感染孕妇所生新生儿脐带血和静脉血HBV标志物状态有良好的一致性,可以以脐带血的HBV标志物反映新生儿静脉血HBV标志物.     

慢性乙型肝炎干扰素治疗前后树突状细胞的变化及其与疗效相关性研究

目的 探讨慢乙肝干扰素α(IFNα)治疗前后髓样树突状细胞(mDC)和浆样树突状细胞(pDC)的变化及其与病毒学、生化学指标的关系.方法 采集30例HBeAg阳性慢乙肝患者IFNα治疗前和治疗12周时的外周血,用流式细胞仪检测mDC和pDC的频数及CD86表达水平.根据IFNα治疗后生化学指标和病毒学指标变化,把患者分为ALT复常组、ALT未复常组及病毒学应答组、病毒学无应答组,分析IFNα治疗前后不同组DC变化.结果 (1)IFNα治疗12周时ALT复常组pDC频率(0.25％±0.14％)较基线(0.18％±0.09％)升高(P =0.023),ALT未复常组mDC频率(0.58％±0.34％)及表面CD86阳性率(61.80％±22.52％)则较基线(分别为0.88％±0.51％,79.92％±25.94％)下降(P =0.025;P=0.036).(2)IFNα治疗12周时病毒学应答组pDC表面CD86阳性率(46.86±12.22％)较基线(29.42±15.16％)升高(P =0.002),病毒学无应答组的mDC频率(0.51％±0.22％)及表面CD86阳性率(59.63％±22.94％)则较基线(分别为0.94％±0.58％,80.11％±29.34％)下降(P =0.006;P =0.049).结论 慢乙肝干扰素α治疗后,生化和病毒应答与pDC频率和功能增强相关,而mDC频率及功能的降低与IFN治疗后无生化和病毒应答相关.     

慢性HCV感染者外周血中髓样和浆样树突状细胞频数和表型研究

目的 探讨慢性HCV感染者外周血中髓样树突状细胞(mDC)和浆样树突状细胞(pDC)频数和表型的变化,并分析其与丙型肝炎临床指标间的相关性.方法 采用流式细胞术检测HCV感染者及健康对照外周血中mDC和pDC的频数及细胞表面共刺激分子HLA-DR、CD83、CD86、CD40和共抑制分子PD-L1的表达水平,并分析DC频数与HCV感染者血浆病毒载量、谷丙转氨酶(ALT)的相关性.结果 与健康对照组相比,HCV感染者外周血中mDC和pDC的频数明显降低(患者组分别为0.37±0.19和0.19±0.12,对照组为0.51±0.18和0.29±0.13,P＜0.05),且mDC频数与血浆HCV载量和血清ALT水平呈负相关(r=-0.5878,P＜0.0001;r=-0.4628,P=0.003).患者mDC和pDC表面共刺激分子HLA-DR、CD83、CD86、CD40以及共抑制分子PD-L1的表达均有不同程度升高,差别有统计学意义(共刺激分子P＜0.01,共抑制分子P＜0.05或0.01).结论 慢性HCV感染者外周血mDC和pDC频数下降,但DC表面共刺激分子和共抑制分子的表达均明显升高.该结果提示mDC数量的减少可能与HCV的慢性持续性感染有关.

Abstract：

Objective To explore the frequencies and phenotype of myeloid and plasmacytoid dendritic cells (mDC and pDC) in chronic HCV infection and to investigate the relationships between DC frequencies and HCV viral load and serum ALT level. Methods PBMC were isolated from chronic HCV infected patients and healthy control. Multi-color flow cytometry was used to analyze the frequencies and surface marker expression on mDC and pDC. The relationship between DC frequencies and viral load and ALT level was also calculated. Results In comparison with healthy control, frequencies of mDC and pDC in chronic HCV infection were significantly decreased (0. 37 ± 0. 19 and 0. 19 ± 0. 12 vs 0. 51 ± 0. 18 and 0. 29 ± 0.13, P＜0.05). The frequency of mDC was negatively correlated with HCV viral load (r= -0.5878, P ＜ 0. 0001 ) and serum ALT level ( r = - 0. 4628 , P = 0. 003 ). Both costimulatory markers ( HLA-DR, CD83, CD86, and CD40) and coinhibitory marker (PD-L1) expression on mDC and pDC in HCV infection were increased (P＜0.01 for costimulatory marker, P＜0.05 or F＜0.01 for coinhibitory marker). Conclusion The frequencies of mDC and pDC in chronic HCV infection were decreased, while the expression of costimulatory markers and coinhibitory marker were increased or not decreased in HCV infection. The decreased frequency of mDC was probably related to persistance of HCV infection.     

孕妇HBV-DNA载量与胎儿宫内感染的关系

目的探讨孕妇血清中乙型肝炎病毒血清学标志物(HBVM)和DNA(HBVDNA)与胎儿宫内乙型肝炎病毒感染的关系。方法通过荧光定量聚合酶链反应(FQ-PCR)对60例乙肝表面抗原(HBsAg)阳性孕妇的母血及产后新生儿外周血的乙型肝炎血清标志物和DNA进行检测。结果 60例HBsAg阳性孕妇血清中HBeAg和HBV DNA的检出率分别为25%(15/60),35%(21/60)。所生新生儿外周血中HBsAg,HBeAg和HBV DNA的检出率为13.3%、18.3%、3.3%。其中HBeAg和HBV-DNA阳性孕妇所生新生儿外周血HBsAg分别为40%和38%,显著高于HBeAg和HBV-DNA阴性者的4.4%和0(P0.01)。新生儿外周血中HBsAg阳性率随孕妇HBV DNA含量增加而增加。结论孕妇血清中HBeAg和HBV DNA阳性是胎儿宫内感染HBV的高危因素,胎儿宫内感染率随母血中HBV DNA含量增加而增加。     

免疫干预后母婴传播乙肝病毒标记物分析

目的：分析免疫干预后乙肝阳性产妇与新生儿脐带血标本乙肝标志物,评价其临床价值。方法：对我院228例经免疫预防乙肝阳性产妇所生新生儿脐带血资料进行回顾性分析,比较产妇与其新生儿乙肝标志物模式。结果：新生儿脐带血HBsAg和（或）HBeAg阳性23例,宫内感染率10.1%;其中双阳组产妇61例,所娩新生儿脐带血HBsAg和（或）HBeAg阳性21例,宫内感染率34.4%;单阳组167例,所娩新生儿脐带血HBsAg阳性2例,宫内感染率1.2%,两组宫内感染发生率有显著性差异（P〈0.05）。结论：产妇和新生儿HBeAg阳性是宫内感染和HBV感染慢性化的危险因素;对产前孕妇、出身后新生儿进行免疫干预是阻断HBV母婴传播的有效手段。     

胎盘组织TLR9分布与表达及与HBV宫内感染的关系

目的了解TLR9在外周血HBsAg阳性母亲胎盘组织中的表达及分布,探讨其与HBV宫内感染的关系。方法Abbott化学发光法检测新生儿外周血HBsAg;ELISA法检测母亲外周血HBV标志物;SABC免疫组织化学方法检测胎盘组织HBsAg和TLR9的表达和分布。结果胎盘HBV感染率77.27%(17/22),HBsAg分布于蜕膜细胞、滋养层细胞、间质细胞、绒毛毛细血管内皮细胞。TLR9在外周血HBsAg阴性母亲胎盘滋养层细胞表达,在外周血HBsAg阳性母亲胎盘滋养层细胞、间质细胞、绒毛毛细血管内皮细胞均有表达。外周血HBsAg阳性组比阴性组胎盘组织TLR9表达强,差异有统计学意义(P<0.05);而外周血HBsAg阳性母亲的胎盘,未感染HBV者比感染HBV者TLR9表达强,差异有统计学意义(P<0.05)。结论初步认为,胎盘组织TLR9表达与HBV宫内感染有一定关系,TLR9可能是HBV宫内感染的保护因素之一。     

乙型肝炎病毒感染者外周血CD4+T细胞CD25、CD127不同亚群表达的检测及临床意义

目的 研究乙型肝炎病毒(HBV)感染者外周血CD4+T细胞表面CD25、CD127不同亚群的表达情况及临床意义。方法 用荧光抗体CD127-FITC、CD4-PECY5、CD25-PE标记T细胞。用流式细胞仪分别测定53例慢性乙型肝炎患者和53例HBV携带者CD4+T细胞表面CD25、CD127不同亚群的表达情况。对20例HBV-DNA阳性乙型肝炎病毒感染者干扰素治疗进行随访。结果与健康对照组[7.26％(6.15％,8.50％)]比较,慢性乙型肝炎患者[11.23％(9.10％,14.86％)]、HBV携带者[13.34％( 10.73％,18.90％)]CD25-CD 127-均显著升高,差异均有统计学意义(Q=4.559,P＜0.05;Q=6.230,尸＜0.05)。慢性乙型肝炎患者CD25hiCD127low/-[8.78％ (7.62％,10.44％)]显著高于健康对照[6.76％(5.73％,8.23％)]和HBV携带者[6.99％(5.77％,9.34％)],差异均有统计学意义(Q=3.497,P＜0.05;Q=3.103,P＜0.05)。HBV-DNA阳性组CD25-CD127-显著低于阴性组,两者差异有统计学意义[(12.92±5.20)％比(15.78±6.91)％,t=2.290,P=0.024],而CD25+/-CD127+显著高于阴性组,两者差异有统计学意义[(79.27±5.20)％比(76.02±7.04)％,t=2.194,P=0.030]。与治疗前比较,干扰素治疗12周CD25hiCD127low/-显著升高[(9.29±2.51)％比(11.08±2.38)％,t=2.820,P=0.011],而CD4+CD25-CD127-显著降低,两者差异有统计学意义[(13.86±5.72)％比( 10.86±3.60)％,t=2.469,P=0.024]。结论 HBV感染者外周血CD4+T细胞中CD25-CD127-亚群的表达与病毒的感染和清除有关;CD25hiCD 127low/-亚群的表达升高与发病有关。外源性干扰素可升高CD25hiCD127low/-的表达,降低CD25-CD127-的表达,从而抑制免疫反应。     

慢性乙型肝炎患者外周血树突状细胞表面HLA-Ⅱ分子表达模式研究

目的观察经典HLA-Ⅱ分子(HLA-DR/DQ/DP)在慢性乙型肝炎(CHB)患者外周血树突状细胞表面的表达组合模式并探讨其临床意义。方法分离来自健康对照(HC)、慢性乙型肝炎轻中度(MCHB)、慢性乙型肝炎重度(SCHB)以及慢加急性肝衰竭(ACLF)患者的外周血单个核细胞(PBMC),采用流式细胞技术观察髓样树突状细胞(myeloid DC,mDCs)、浆样树突状细胞(plasmacytoid DC,pDCs)及表面HLA-DR/DQ/DP单阳、双阳及三阳性细胞比例,分析其与疾病严重程度之间的相关性。结果 mDC和pDC比例在HC组和MCHB组无明显差别(mDC:0.185%±0.191%vs 0.162%±0.175%,P=0.599;pDC:0.218%±0.246%vs 0.158%±0.154%,P=0.247),但SCHB组(mDC:0.079%±0.049%vs 0.185%±0.191%,P=0.023;pDC:0.095%±0.103%vs 0.218%±0.246%,P=0.027)及ACLF组(mDC:0.076%±0.052%vs 0.185%±0.191%,P=0.022;pDC:0.109%±0.082%vs 0.218%±0.246%,P=0.049)均明显低于HC组。健康对照和CHB患者mDC表面均呈现HLA-DR/DQ共同高表达、HLA-DP低表达的模式;pDC表面HLA-Ⅱ分子在HC组呈现HLA-DR/DQ共同高表达同时HLA-DP低表达模式及HLA-DR/DQ/DP共同低表达的模式,除此之外CHB患者还存在HLA-DR/DQ/DP共同低表达及HLA-DP高表达同时HLA-DR/DQ共同低表达的模式。结论与HC组相比,SCHB组及ACLF组患者的mDC与pDC的比例均明显下降。CHB患者mDC表面的HLA-Ⅱ分子表达模式与健康对照一致,而pDC表面的HLA-Ⅱ分子则呈现出多样化表达模式。差异的HLA-Ⅱ分子表达模式可能对HBV持续感染产生重要作用。     

HBV感染的CD68细胞在隐匿性HBV感染产妇胎盘中的分布及与宫内感染的关系

目的探讨HBV感染的外周血单个核细胞(peripheral blood mononuclear cells,PBMC)在乙肝宫内传播中的作用及机理。方法12例血清HBV DNA(-)、PBMC HBV DNA(+)产妇分娩的新生儿血清HBV DNA(+)和/或PBMC HBV DNA(+)的胎盘作为实验组,10例乙肝标志物均为阴性产妇的胎盘作为对照。采用SP法在连续切片上检测HBsAg和HBcAg在胎盘CD68细胞及各类细胞中的表达。结果8例新生儿血清HBV DNA(-)、PBMCsHBV DNA(+)胎盘绒毛间质5例CD68细胞HBsAg阳性,6例CD68细胞HBcAg阳性;毛细血管内5例CD68细胞HBsAg阳性,8例CD68细胞HBcAg阳性;滋养层细胞和血管内皮细胞均未见HBsAg、HBcAg阳性信号;2例新生儿血清HBV DNA(+)、PBMCs HBV DNA(-)的胎盘滋养层细胞、绒毛间质、毛细血管内皮细胞均有HBsAg、HBcAg的表达,而绒毛毛细血管内CD68细胞未见表达。2例新生儿血清和PBMC HBV DNA均阳性的的胎盘滋养层细胞、绒毛间质、CD68细胞和毛细血管内CD68细胞均有HBsAg、HBcAg的表达,毛细血管内皮细胞无表达。10例乙肝标志物全阴性产妇胎盘中均无阳性信号。结论HBV感染的外周血单个核细胞可作为宫内传播的载体。     

乙型肝炎e抗原、s抗原对Toll样受体及共刺激分子表达的调控和影响

目的：探讨乙型肝炎e抗原、s抗原（HBeAg、HBsAg）对健康人外周血单个核细胞（PBMC）Toll样受体（TLRs）和共刺激分子表达的影响。方法：分别用HBeAg、HBsAg、空质粒以及卵清蛋白（OVA）作为无关蛋白刺激健康人外周血单个核细胞（PBMC）,采用流式细胞技术检测各刺激组CD14＋细胞TLR2、TLR4、CD86、PD-L1的表达水平。结果：健康人PBMC经HBeAg或HBsAg刺激后,CD14＋细胞表面TLR2、TLR4的表达明显低于未刺激组（P〈0.05）,CD14＋细胞PD-L1的表达则明显增高（P〈0.05）;HBeAg刺激后同时可见CD14＋细胞表面共刺激分子CD86的表达水平明显降低（P〈0.02）。结论 HBeAg和HBsAg通过上调单核细胞表面PD-L1的表达,下调CD14＋单个核细胞表面TLR2、TLR4和共刺激分子CD86的表达,削弱机体固有免疫系统的应答能力,降低启动特异性免疫的活化信号,从而导致免疫清除逃避。因此,HBeAg和HBsAg可能是促进HBV感染慢性化的重要因素。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.