脂联素和非酒精性脂肪性肝病与结直肠腺瘤相关性的临床研究

背景:结直肠癌(CRC)发病率和死亡率在我国呈逐年上升趋势,其可由结直肠腺瘤(CRA)发展而来。研究显示脂联素和非酒精性脂肪性肝病(NAFLD)可能与CRA相关。目的:探讨脂联素和NAFLD与CRA的相关性。方法:纳入2012年2月-2014年3月新疆维吾尔自治区人民医院行结肠镜和腹部CT检查的患者938例,按结肠镜和病理学检查结果分为CRA组和对照组(未发现CRA)。回顾性分析患者临床资料,包括性别、年龄、糖尿病史、高血压病史、吸烟史、血脂和转氨酶水平、空腹血糖等;采用ELISA法检测患者脂联素水平;分析脂联素、NAFLD等因素与CRA的相关性。结果:CRA组脂联素水平为(9.87±2.14)μg/m L,对照组为(12.25±4.78)μg/m L,组间差异有统计学意义(P<0.05)。CRA组NAFLD患者比例显著高于对照组(24.4%对17.6%,P<0.05)。Logistic回归分析显示男性、年龄>50岁、NAFLD、脂联素<12.25μg/m L为CRA的独立危险因素(P<0.05)。结论:脂联素水平降低是CRA的危险因素,NAFLD患者是CRA的易感人群。性别、年龄、脂联素水平、NAFLD与CRA发生相关。     

非酒精性脂肪性肝病与结直肠腺瘤、结直肠癌发生风险相关性的Meta分析

目的系统评价非酒精性脂肪性肝病(NAFLD)的存在及严重程度与结直肠腺瘤(CRA)和结直肠癌(CRC)发生风险的关联性。方法在PubMed、Embase、Web of Science、The Cochrane Library、中国知网、万方、维普数据库检索2019年12月前公开发表的有关NAFLD与CRA和CRC发生风险关系的中英文文献。对检索结果根据纳入和排除标准进行二次筛选、质量评价及相关数据的提取,采用RevMan 5.3软件进行Meta分析。结果共纳入3项纵向队列研究和18项横断面研究,包括130 271例研究对象。Meta分析结果显示:NAFLD患者发生CRA(aOR=1.27,95%CI:1.18～1.36,P 0.000 01)以及进展期CRA/CRC(a OR=1.45,95%CI:1.27～1.65,P 0.000 01)的风险增加。NAFLD的严重程度会影响这种相关性:NASH和/或进展期肝纤维化的患者发生CRA/CRC的风险明显增加(aOR=1.93,95%CI:1.61～2.31,P 0.000 01)。结论 NAFLD的存在与CRA和CRC发生风险的增加相关,而且NAFLD严重程度越高,CRA和CRC的发生风险越高。     

非酒精性脂肪性肝病与结直肠息肉发病的相关性分析

背景:非酒精性脂肪性肝病(NAFLD)是代谢综合征的肝脏表现,其与结直肠息肉发病可能存在相关性,但仍缺乏足够的认识。目的:探讨NAFLD与结直肠息肉发病的相关性。方法:回顾性分析130例无症状体检患者的临床资料,评估NAFLD、结直肠息肉的检出率,并分析其与体重指数(BMI)、hs-CRP、三酰甘油、低密度脂蛋白、总胆固醇、丙氨酸氨基转移酶(ALT)、谷氨酰转肽酶(GGT)等的相关性。结果:与非NAFLD患者相比,NAFLD患者的结直肠息肉检出率显著升高(66.3%对40.0%,P=0.003 9),BMI、三酰甘油、ALT水平显著升高(P0.05);而两组hsCRP、低密度脂蛋白、总胆固醇、GGT无明显差异(P0.05)。与非结直肠息肉患者相比,结直肠息肉患者的平均年龄显著升高(P=0.013),NAFLD检出率显著升高(72.6%对47.4%,P=0.003 9),而两组BMI、hs-CRP、三酰甘油、低密度脂蛋白、总胆固醇、ALT、GGT无明显差异(P0.05)。结论:NAFLD与结直肠息肉的发病可能密切相关。     

代谢综合征患者罹患结直肠腺瘤的风险及其与中性粒细胞/淋巴细胞比值的关系

目的探讨代谢综合征(metabolic syndrome,MetS)患者罹患结直肠腺瘤(colorectal adenoma, CRA)的风险及中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)与结直肠腺瘤(colorectal adenoma,CRA)的关系。方法回顾性分析2015年9月至2017年3月徐州医科大学附属医院接受肠镜检查患者的临床资料,并统计MetS相关指标,即体质量指数(BMI)、空腹血糖、甘油三酯、高密度脂蛋白(HDL)、血常规及相关的代谢疾病与CRA发生的关系。结果将CRA组与非CRA组及对照组进行对比,MetS为CRA的危险因素,且随疾病的发展相关度升高。MetS患者处于高NLR时CRA的发病风险增加。结论 MetS会增加CRA的发病风险,尤其NLR升高的人群其风险更大,对于该类人群积极行肠镜筛查有利于早期发现、治疗CRA,预防结直肠癌。     

结直肠腺瘤内镜下摘除后再发的危险因素分析

目的 评估内镜下摘除后结直肠腺瘤(CRA)再发的危险因素,为内镜治疗后监控策略的选择提供更多依据.方法 选择2017年1月至2018年12月成都市第六人民医院接受内镜下CRA摘除治疗患者220例,回顾性分析CRA摘除后(12(1)月内CRA复发情况及影响因素.结果 220例患者CRA摘除后12个月,内镜复查检出CRA ...     

瘦素和脂联素在老年结直肠腺瘤合并非酒精性脂肪肝患者中的表达及意义

目的:研究老年结直肠腺瘤合并非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)患者结直肠腺瘤的临床特征及探讨瘦素、脂联素的表达与有潜在恶变风险的结直肠腺瘤的关系.方法:82例老年结直肠腺瘤合并NAFLD患者为研究组,286例老年结直肠腺瘤非NAFLD患者为对照组.统计两组患者合并高血压、糖尿病情况,比较两组患者体质量指数(body mass index,BMI)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)、高密度脂蛋白-胆固醇(highdensity lipoprotein-cholesterol,HDL-C)、低密度脂蛋白-胆固醇(low-density lipoproteincholesterol,LDL-C)、脂蛋白a(lipoprotein a,Lpa)及腺瘤发生部位、大小、数目、病理类型、上皮内瘤变.酶联免疫吸附试验法法检测两组患者瘦素和脂联素的表达.结果:老年结直肠腺瘤合并NAFLD组患者同非NAFLD组相比,吸烟、患有糖尿病、高血压、高甘油三酯血症、高低高密度脂蛋白患者更多(P0.05),且BMI明显高于非N A F L D结直肠腺瘤组(P0.05).结肠腺瘤合并NAFLD组老年患者腺瘤个数多于非NAFLD组(P0.05),绒毛状腺瘤比例也高于非NAFLD组结肠腺瘤患者(P0.05).脂联素在NAFLD组表达高于非NAFLD组(P0.05),而瘦素的表达与之相反(P0.05).脂联素在2个及其以上息肉数组的表达高于单个息肉组(P0.05),在绒毛状息肉组的表达低于非绒毛状息肉组(P0.05),在息肉有高级别瘤样变组的表达高于非高级别瘤样变组(P0.05).瘦素在绒毛状息肉组的表达高于非绒毛状息肉组(P0.05),在息肉有高级别瘤样变组的表达低于非高级别瘤样变组(P0.05).结论:老年结直肠腺瘤合并NAFLD患者腺瘤恶变风险更高,脂联素分泌减少及瘦素水平的升高是可能的原因之一.     

非酒精性脂肪肝与结直肠腺瘤性息肉的相关性

目的探讨非酒精性脂肪肝（NAFLD）和结直肠腺瘤性息肉的相关性。方法选择我院2008年10月-2013年5月完善肠镜检查和相关辅助检查资料完整的住院患者2 165例,随机分为结直肠腺瘤性息肉组413例及正常对照组1 752例。统计两组NAFLD患病率,并采用多因素Logistic回归分析NAFLD与结直肠腺瘤性息肉的关系。结果结直肠腺瘤性息肉组NAFLD患病率高于正常对照组（P〈0.05）。多因素Logistic回归分析结果显示,NAFLD是结直肠腺瘤性息肉的独立高危因素（OR：1.16;95%CI：1.04-1.58）。结论 NAFLD可增加患结直肠腺瘤性息肉的风险。     

非酒精性脂肪性肝病并发结直肠粘膜癌变的临床特征

目的探讨NAFLD患者并发结直肠粘膜病变的临床特征.方法在201例NAFLD患者和861例接受肠镜检查者,观察结直肠粘膜病变的病理类型与临床特征.结果 NAFLD患者结直肠病变的检出率为42.8%,显著高于对照组32.9%（P〈0.01）;其中管状腺瘤及伴中度以上不典型增生者均较对照组升高（P〈0.01或P〈0.05）,女性发病年龄高峰较男性提前.结论 NAFLD患者易并发结直肠粘膜病变,应定期进行全结肠镜筛查.     

胰岛素抵抗与结直肠腺瘤发生和复发的相关性分析

背景:降低结直肠腺瘤(CRA)的发生率和复发率是减少结直肠癌发病的关键。有研究表明,胰岛素抵抗可能参与了这一过程。目的:探讨胰岛素抵抗与CRA发生和复发的相关性。方法:收集238例CRA患者的临床资料,以200例名结肠镜检查正常者作为对照。比较两组腰臀比(WHR)、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、脂联素、空腹胰岛素(FINS)、HOMA-IR等指标,探讨胰岛素抵抗与CRA发生和复发的相关性。结果:CRA组和对照组WHR、FPG、TG、FINS、血清脂联素、HOMA-IR相比差异有统计学意义(P 0. 05),而两组BMI、DBP、TC、HDL-C、LDL-C相比无明显差异(P 0. 05)。胰岛素抵抗者的CRA发生率(80. 1%对41. 4%)和复发率(62. 4%对46. 3%)均高于无胰岛素抵抗者。多元Logistic回归分析显示腺瘤家族史、代谢综合征、HOMA-IR是CRA发生的独立危险因素(P 0. 05),代谢综合征、腺瘤家族史、腺瘤数目、腺瘤大小、病理类型、HOMA-IR为CRA复发的独立危险因素(P 0. 05)。结论:存在胰岛素抵抗者的CRA发生率和复发率均高于无胰岛素抵抗的患者。     

医学新信息

NAFLD患者结直肠腺瘤患病率高非酒精性脂肪性肝病(NAFLD)与结直肠腺瘤和结直肠晚期肿瘤的高患病率相关,腺瘤在右侧结肠较为普遍。2011年2月21日《消化道》(GUT)在线发表文章建议,对上述高危人群进行结直肠癌筛查。研究者选取普通人群及经连续肝活检证实为NAFLD的患者,年龄为40～70岁,组成2组研究队列进行结直肠镜筛查,主要观     

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.     

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.     

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.     

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.