5-羟色胺转运体基因多态性与肠易激综合征的相关性

目的:探讨SERT基因启动子区5-HTTLPR和内含子2 VNTRs多态性在肠易激综合征(IBS) 中的意义．方法:采用PCR方法对51例腹泻型IBS(D- IBS)、58例便秘型IBS(C-IBS)、38例便秘腹泻交替型IBS(A-IBS)患者与48例健康对照者SERT基因启动子区5-HTTLPR和内含子2 VNTRs多态性进行比较分析．结果:C-IBS组L／L基因型及L等位基因频率显著高于对照组(31．0％vs 8．3％,X2=8．229, P<0．05;47．4％vs29．2％,X2=7．342,P<0．05), D-IBS组S／S基因型频率和S等位基因频率显著高于A-IBS和C-IBS组(S／S:56．9％vs 36．8％, 36．2％,P<0．05;S:71．6％vs 56．6％,52．6％, P<0．05),L／L基因频率显著低于A-IBS和C-IBS 组(9．8％vs 28．1％,P<0．05)．IBS各组与对照组之间内含子2 VNTRs多态性分布无显著性差异(P>0．05)．结论:具有L／L基因型和L等位基因的人更易患C-IBS,具有S／S基因型和S等位基因的人更易患D-IBS,L／L基因型可能是D-IBS的保护因素之一．     

肠易激综合征模型大鼠血清胰高糖素样肽-1及结肠组织中其受体的变化

目的 观察肠易激综合征( IBS)不同亚型模型大鼠血清胰高糖素样肽(GLP)-1及结肠组织中GLP-1受体的变化,初步探讨GLP-1及其受体在IBS发病中的作用.方法 40只雄性SD大鼠均分为腹泻型IBS(D-IBS)模型组、灌肠对照组、便秘型IBS(C-IBS)模型组、灌胃对照组及空白对照组.乙酸加束缚应激法制备D-IBS模型,冰水灌胃法制备C-IBS模型.观察大鼠粪便变化,检测粪便重量、粪便含水量及大鼠小肠推进率,给予结直肠扩张(CRD)刺激,记录腹外斜肌放电活动(EMG),评价模型大鼠的内脏敏感性.酶联免疫法测定各组大鼠血清中活性GLP-1的含量.免疫组织化学法、实时定量PCR法及Western印迹法检测各组大鼠近端结肠及远端结肠组织中GLP-1 受体的分布和表达.结果 与各自的对照组及空白对照组相比,D-IBS模型组大鼠粪便湿重、粪便含水量及小肠推进率均上升(P＜0.05);C-IBS模型组粪便湿重、粪便含水量及小肠推进率均降低(P＜0.05).在压力为20、40及60 mm Hg(1 mm Hg=0.133 kPa)的结直肠扩张刺激下各模型组大鼠腹外斜肌放电幅值均较各对照组明显增加,且D-IBS模型组高于C-IBS模型组(P＜0.05).C-IBS模型组血清中活性GLP-1的水平高于D-IBS模型组(P＜0.05),IBS模型组和对照组之间差异无统计学意义.GLP-1受体主要分布在结肠黏膜组织、环肌层及肌间神经丛中.C-IBS模型组结肠组织中GLP-1受体mRNA及蛋白表达量显著高于灌胃对照组,D-IBS模型组结肠组织中表达量低于灌肠对照组(P＜0.05).结论 不同亚型IBS结肠组织中GLP-1受体的表达水平不同,血清GLP-1水平也不同,提示GLP-1及其受体的改变可能与IBS不同亚型的发生有关.     

肠易激综合征患者5-羟色胺转运体的基因多态性

目的 探讨5-羟色胺转运体(SERT)基因多态性在肠易激综合征(IBS)中的意义。方法 用PCR方法对48例健康对照和30例便秘型IBS(C-IBS)、32例腹泻型IBS(D-IBS)和19例交替型IBS(A-IBS)患者SERT基因的VNTRs和5-HTTLPR区多态性进行研究。结果 VNTRs区：IBS患者STin2．12／10基因型频率明显高于对照组,各亚型间基因型频率差异无显著性。5-HTTLPR区：C-IBS组L／L频率显著高于D-IBS、A-IBS和对照组;D-IBS、A-IBS组IMS频率显著高于C-IBS组。C-IBS组12／12-L／L基因型联合的频率显著高于A-IBS和D-IBS组。结论 SERT基因VNTRs区STin2．12／10基因型可能与IBS相关,具有L／L基因型以及12／12-L／L基因型联合的人群可能更易患C-IBS,IMS基因型的人群易患D-IBS和A-IBS。     

肠易激综合征患者精神状态与脑电图改变的相关性研究

目的探讨肠易激综合征(irritable bowel syndrome,IBS)不同类型患者与焦虑和抑郁之间相关性及与脑电图、血小板5-HT水平之间的关系。方法对92例IBS患者独立完成调查问卷(其中D-IBS 32例、C-IBS 31例、A-IBS 29例),包括焦虑自评量表(self-rating anxiety scale,SAS)、ZUNG氏抑郁量表(self-rating depression scale,SDS),并两个半小时脑电图,第一个半小时为适应检查,第二个半小时为正式检查,在未进行任何治疗前,对IBS患者和正常对照组均于上午9时空腹抽取静脉血2 ml,缓慢注入经硅油涂布的含5%依地酸钠0.15 ml抗凝试管中摇匀,测定血小板5-HT。结果 (1)IBS(C-IBS、D-IBS、A-IBS)组中SDS分数50分,表明患者表现出一定的抑郁症状,其中C-IBS组EEG异常占93.55%;D-IBS组EEG异常占84.38%;A-IBS组EEG异常占89.66%。IBS(C-IBS、D-IBS、A-IBS)组中SAS分数50分,表明患者表现出一定的焦虑症状,其中C-IBS组EEG异常占70.97%;D-IBS组EEG异常占78.13%;A-IBS组EEG异常占72.41%。SAS、SDS分数50分者与IBS有相关性;(2)C-IBS、D-IBS、A-IBS组的血小板5-HT水平(μg/109)分别为(142.71±31.52)、(141.62±33.09)、(145.10±30.28),均明显低于对照组的平均血小板5-HT水平(323.87±39.45),且差异具有显著统计学意义(P0.05)。C-IBS、D-IBS、A-IBS三组之间血小板5-HT表达水平无显著统计学意义(P0.05)。IBS组患者的血小板5-HT浓度明显降低,而且IBS各组合并抑郁症患者血小板5-HT浓度降低更明显,IBS组血小板5-HT水平与SDS评分呈正相关(r=0.428,P0.05)。结论部分IBS患者合并焦虑和抑郁负性情绪,患者的脑电图检查异常有显著性;IBS组患者血小板5-HT浓度明显降低。     

老年肠易激综合征患者肠黏膜肥大细胞与血管活性肠肽的表达及意义

目的探讨肠易激综合征(IBS)患者肠黏膜肥大细胞(MC)及血管活性肠肽(VIP)的表达及其可能作用。方法 33例腹泻型IBS患者(D-IBS组)、27例便秘型IBS患者(C-IBS组)及18例健康体检者(对照组)纳入研究。分别取回盲部、乙状结肠黏膜行VIP免疫组织化学染色和甲苯胺蓝染色MC计数,检测肛管直肠压力。结果 1D-IBS组和C-IBS组乙状结肠部MC计数均较回盲部显著降低(P<0.05),两组间各部MC计数比较无统计学差异(P>0.05),但各部位均较对照组显著增高(P<0.05)。2D-IBS组和C-IBS组回盲部和乙状结肠黏膜VIP表达无统计学差异(P>0.05),但各部位均较对照组显著增高(P<0.05)。3三组间静息压、最大收缩压及松弛压均无统计学差异(P>0.05)。D-IBS组和C-IBS组患者感觉阈值、最大容量阈值及疼痛阈值均无统计学差异(P>0.05),但与对照组比较均显著降低(P<0.05)。结论 IBS患者结肠黏膜MC和VIP表达增加,可能对IBS患者内脏高敏感性的形成有一定影响。     

噪音避水应激中心理因素对大鼠免疫功能的影响

目的:探讨噪音联合避水应激中的心理因素对大鼠免疫功能的影响．方法:成年(?)SD大鼠32只,随机分为实验A, B,C组和对照组．A组大鼠接受避水应激．B组接受噪音应激,C组接受噪音避水复合应激．应激结束后,检测所有大鼠肠系膜淋巴细胞增殖反应和外周血NK细胞杀伤功能．结果:以B淋巴细胞为主的淋巴细胞增殖实验及以T淋巴细胞为主的淋巴细胞增殖实验结果均显示,避水组与对照组淋巴细胞刺激指数无明显差异(P>0．05);噪声组的增殖指数低于对照组(LPS:0．71±0．11 vs 1．00±0．00,P<0．05; PHA:0．68±0．08vs1．00±0．00,P<0．05):复合应激组刺激指数明显低于对照组(LPS:0．4±0．05vs1．00±0．00,P<0．01:PHA:0．46±0．06vs1．00±0．00,P<0．01),且与噪声组也存在差异(LPS:0．4±0．05 vs 0．71±0．11,P<0．05; PHA:0．4±0．05 vs 0．68±0．08,P<0．05)．避水组与对照组的NK细胞杀伤活性无明显差异(P>0．051;而噪声组NK细胞杀伤活性低于对照组(1／10:24．6±11．6 vs 39．5±13．1,P<0．05; 1／20:21．8±9．6 vs 34．6±10．4．P<0．05;1／40: 17．8±7．9vs30．2±10．6,P<0．05);复合刺激组NK细胞杀伤活性明显低于对照组(1／10:17．6±8．3vs39．5±13．1,P<0．01;1／20:14．9±5．8 vs34．6±10．4．P<0．01:1／40:10．2±4．3 vs 30．2±10．6,P<0．01),且与噪声组也存在差异(1／10: 17．6±8．3vs24．6±11．6．P<0．05;1／20:14．9±5．8 vs 21．8±9．6．P<0．05;1／40:10．2±4．3vs 17．8±7．9．P<0．05)．结论:应激导致大鼠免疫功能下降,噪音联合避水应激中的心理因素对大鼠免疫系统抑制起一种潜在的作用．     

全反式维甲酸对慢性酒精性肝损伤大鼠肝脏TGF-β1、CTGF和Col1a1表达的影响

目的:通过观察全反式维甲酸对慢性酒精性肝损伤大鼠肝脏TGF-β1、CTGF和Collal表达的影响,探讨该药物对酒精性肝纤维化形成的作用．方法:大鼠24只随机分为3组:酒精组(J组),给予酒精-玉米油混悬液灌胃;治疗组(A组),给予上述混悬液灌胃8 wk后加用0,15 mg／(kg·d) 的全反式维甲酸灌胃;对照组(N组),给予等量的生理盐水和玉米油灌胃．16 wk后处死大鼠．光、电镜下观察肝组织病理改变,高压液相色谱法(HPLC)测肝组织中维甲酸的含量,免疫组化法检测肝组织中转化生长因子β1(TGF-β1)和结缔组织生长因子(CTGF)的蛋白水平,逆转录聚合酶链反应(RT-PCR)检测肝组织中TGF-β1、CTGF和Ⅰ型胶原前胶原α1(Collal)的mRNA水平．结果:光镜下酒精组及治疗组均呈不同程度的酒精性肝炎改变,电镜下酒精组肝细胞线粒体肿胀,内质网扩张,脱颗粒,而治疗组改变轻于酒精组．肝组织中维甲酸含量:酒精组低于正常组,治疗组接近对照组水平．Collal 的mRNA表达在酒精组中较对照组明显增高 (0．18±0．03 vs 0．10±0．02,P<0．01),治疗组较酒精组表达下降(0．14±0．03 vs 0．18±0．03,P <0．05)．TGF-β1的mRNA及蛋白表达在酒精组中增高(0．53±0．17 vs 0．34±0．05,105．93 ±10．12 vs 149．27±10．17,P<0．01),治疗组相对于酒精组有所下降(0．41±0．06 vs 0．53± 0．17,130．80±6.23 vs 105．93±10．12,P<0．05)． CTGF的mRNA及蛋白表达在酒精组中增高 (0．41±0．13 vs 0．17±0．05,130．84±5．72 vs 158.37±6．64,P<0．05),治疗组对于酒精组有所下降(0.30±0．04 vs 0．41±0．13,149．23± 6．65 vs 130．84±5．72．P<0．05)．结论:小剂量全反式维甲酸通过降低慢性酒精性肝损伤大鼠肝脏致纤维化因子TGF-β1, CTGF和Collal的表达抑制早期酒精性肝纤维化的形成．     

A型肉毒毒素腹腔注射对大鼠小肠通过速度及胆碱酯酶和P物质表达的影响

目的:研究A型肉毒毒素(botulinum toxin A, BTA)腹腔注射(ip)对大鼠小肠通过速度及胆碱酯酶(ACHE)和P物质(substance P,SP)表达的影响．方法:8周龄Wistar♂大鼠24只随机分为A,B, C,D4组,每组6只;A,B,C组分别ip含BTA 4, 2,1 U的生理盐水2 mL,D组为对照组,ip生理盐水2 mL．4 wk后行小肠碳沫推进实验,取回肠末段标本行免疫组织化学染色对比AChE及 SP的表达．结果:A,B组大鼠的小肠碳沫推进百分比(分别为53．9％±4．0％和53．2％±3．0％)小于D组 (66．4％±5．6％;P<0．05),但C组(64．3％±5．6％) 与D组无统计学差异;A,B组AChE和SP在回肠肌层及黏膜层表达减少,整合光密度与D组相比差异显著(肌层ChE:99．3±39．3,76．3± 36．4 vs 260．1±114．8,P<0．05;黏膜层AChE: 224．6±85．4,230．1±120．7 vs 230．1±120．7, P<0．05;肌层SP:161．2±90．6,200．7±65．5 vs 355．9±70．9,P<0．05;黏膜层SP:198．6±60.3, 229．7±71．8 vs 412．5±79．2,P<0．05),C组与D 组无统计学差别(P>0．05)．结论:BTA ip能减慢大鼠的小肠碳沫推进速度,减少回肠末段AChE和SP的表达．     

不同营养支持途径给予谷氨酰胺对烧伤大鼠肠上皮细胞线粒体呼吸功能的影响

目的:观察不同营养支持途径给予谷氨酰胺对烧伤大鼠肠上皮细胞线粒体呼吸功能的影响．方法:Wistar大鼠160只采用30％体表面积Ⅲ°烧伤大鼠模型,随机分成正常对照(C)组、烧伤对照(B)组、经静脉补充谷氨酰胺(PN Gln)组和经肠道补充谷氨酰胺(EN Gln)组．各组烧伤大鼠采用等氮、等热卡的营养支持,谷氨酰胺使用剂量为1．0 g／(kg·d),B组使用同等剂量的酪氨酸．观察烧伤后1,3, 5,7,10 d线粒体呼吸控制率(RCR)、磷氧比(P／O)、肠道氧摄取率(Oext)及肠黏膜血流量(IMBF)的变化及不同途径给予谷氨酰胺对其的影响．结果:烧伤后各组线粒体Ⅲ态呼吸率(ST3)明显下降(PBD3:54．4±8．5 vs 70．2±7．4,P<0．05; PBD5:61．2±7．5 vs 72．7±8．2,P<0．05;PBD7: 67．2±7．6 vs 75．6±6．2,P<0．05;PBD10:69．4±6．5 vs 71．2±7．5,P<0．01),Ⅳ态呼吸率(ST4)升高(PBD5:24．5±2．2 vs 21．3±2．0,P<0．05; PBD7:24．1±2．8 vs 22．2±2．1,P<0．05;PBD10: 25．4±2．3 vs 20．2±1．8,P<0．05),RCR显著降低(PBD1:3．2±0．3 vs 3．4±0．3,P<0．01;PBD3: 3．1±0．2 vs 4．0±0．3,P<0．01;PBD5:2．7±0．2 vs 3．5±0．2,P<0．01;PBD7:2．9±0．2 vs 3．6±0．3,P<0．01;PBD10:2．9±0．2 vs 3．6±0．3,P<0．01),同时P／O(PBD3:1．78±0．22 vs 2．25±0．2,P<0．01;PBD5:2．04±0．21 vs 2．58±0．18,P<0．01;PBD7:2．14±0．23 vs 2．81±0．25,P<0．01;PBD10:2．02±0．16 vs 2．55±0．18,P<0．01)、Oext (PBD5:0．3 1±0．04 vs 0．37±0．03,P<0．01;PBD7:0．33±0．02 vs 0．44±0．02,P<0．01;PBD10:0．31±0．02 vs 0．41±0．04,P<0．01)及IMBF(PBD3:98．35±11．54 vs 125．36±13．00,P<0．01;PBD5:118．75±10．45 vs 138．52±11．33,P<0．01;PBD7:135．40±13．60 vs 152．77±13．21,P<0．01;PBD10: 142．30±13．006 vs 162．37±12．00,P<0．01)均明显降低．与B组比较,使用Gln的两组各项指标均低于烧伤对照组(P<0．05(?)0．01),与经静脉补充Gln相比,通过肠道补充Gln的疗效更好(P<0．05→0．01)．结论:严重烧伤后使用谷氨酰胺能改善肠道血供,增加氧摄取率,减轻肠上皮细胞线粒体呼吸功能受抑程度．相比而言,通过肠道给予谷氨酰胺的疗效更佳．     

大鼠急性胰腺炎早期肺损伤机制及前列腺素E1的保护作用

目的:探讨实验性急性胰腺炎(acute pancreatitis,AP)合并肺损伤的发生机制及前列腺素E1(PGE1)的保护作用．方法:健康成年SD大鼠78只,随机平均分为假手术组(SO组)、AP组和PGE1组,采用十二指肠闭袢法建立大鼠AP模型．PGE1组制模后即刻经颈静脉持续每分钟输入PGE160 ng／kg．观察胰腺和肺组织的病理组织学改变,测定血清淀粉酶、肺组织中性粒细胞髓过氧化物酶 (MPO)活性、脂质过氧化产物(LPO)水平及肺毛细血管通透性(LCP),免疫组织化学ABC法检测肺组织细胞黏附分子-1(ICAM-1)的表达．结果:制模后12和24 h,AP组大鼠胰腺和肺组织病理损伤持续加重,肺组织MPO(12 h: 5．65±0．80 vs 1．22±0．71 kat／g,P<0．01;24 h: 7．22±1．05 vs 1．48±0．57 kat／g,P<0．01)和 LPO(12 h:1．44±0．63 vs 0.38±0．07μmol／g． P<0．01;24 h:3．64±0．83 vs 0．44±0．15 μmol／ g,P<0．01)水平以及LCP(12 h:145．4±23．0 vs 47．3±5．5 μg／g组织湿重,P<0．01)明显高于SO组,AP组大鼠肺组织ICAM-1表达呈阳性或强阳性,而SO组呈阴性;与AP组比较, PGE1组的胰腺病理损伤虽未减轻,但肺组织 MPO(12 h:2．96±1．04 vs 5．65±0．80 kat／g, P<0．05;24 h:3．68±1．15 vs 7．22±1．05 kat／g, P<0．05)和LPO (12 h:0．86±0.34 vs 1．44± 0．63 μmol／g,P<0．05;24 h:1．69±0．45 vs 3．64 ±0．83 μmol／g,P<0．05)水平以及LCP(12 h: 105．9±23．9 vs 145．4±23．0 μg／g组织湿重, P<0．05)明显降低,ICAM-1表达下调．肺间质出血、水肿和中性粒细胞(PMN)浸润明显减轻．结论:肺组织ICAM-1过度表达、PMN浸润和氧自由基大量释放与AP早期肺损伤的发生关系密切．PGE1通过降低肺组织ICAM-1表达, 抑制PMN活化和氧自由基释放,从而减轻AP 早期肺损伤．     

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.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.