IκB激酶β在非酒精性脂肪性肝炎发病机制中的作用

目的:探讨IκB激酶β(inhibit kappa B kinase beta,IKKβ)在非酒精性脂肪性肝炎(nonalcoholic steatohepatitis,NASH)大鼠肝组织中的表达及意义.方法:健康♂Wistar大鼠40只,随机分为正常对照组(n=20)和高脂模型组(n=20),分别给予标准饲料喂养和高脂饲料喂养.16 wk末空腹处死全部大鼠,收集血清和肝组织标本.检测血清中ALT、AST及ELISA法检测血清TNF-α水平;光镜下观察肝组织病理变化;RT-PCR和EMSA法分别检测肝组织IKKβmRNA表达和核因子-κB(NF-κB)活性改变.结果:模型组大鼠血清ALT、AST、TNF-α水平、肝组织IKKβmRNA表达及NF-κB活性均较正常对照组明显增强(96.63±14.2 U/L vs 39.50±12.2 U/L,156.13±14.7 U/L vs 71.25±14.4 U/L.48.23±3.4 U/L vs 6.74±1.3 U/L,0.85±0.03 vs 0.22±0.02.10.12±1.34 vs 1.58±1.23,P<0.01);病理则表现不同程度的脂肪变性、炎症、坏死及窦周纤维化与对照组相比有显著差异(25.63±7.21 vs 1.24±3.24,3.21±0.52 vs 0.49±0_36.6.26±1.86 vs 3.02±1.17,P<0.01).相关分析显示:肝组织IKKβmRNA的表达与NF-κB活性(r=0.930)、脂肪变性(r=0.681)和炎症坏死程度(r=0.864)以及血清TNF-α水平(r=0.762)正相关(P<0.05).结论:IKKβmRNA表达增加在NASH发病机制中发挥重要作用,其通过介导NF-κB活化,引起TNF-α的大量生成、释放,诱导加重NASH的发生发展.     

维生素E、硒对非酒精性脂肪肝大鼠肝细胞色素P4501A1及脂质过氧化的干预作用

目的:研究维生素E、硒对非酒精性脂肪肝大鼠肝细胞色素P4501A1及脂质过氧化的干预作用.方法:♂SD大鼠,随机均分为5组:对照组(普通饲料)、模型组(高脂饲料)、VE干预组、Se干预组、VE Se干预组,建模5wk处死全部大鼠.生化方法检测血清及肝组织超氧化物歧化酶(SOD)和丙二醛(MDA)含量的变化,逆转录聚合酶链反应(RT-PCR)测定肝细胞色素P4501A1mRNA表达的变化,免疫组化方法测定肝组织中肿瘤坏死因子-α(TNF-α)、核因子-κB(NF-κB)表达的变化.结果:与对照组比较,模型组血清及肝组织中SOD显著降低(312.72±49.51kU/Lvs583.23±63.37kU/L;8.13±0.63U/mgprot.vs13.99±2.33U/mgprot.,P<0.01),MDA增高(13.40±4.24mmol/Lvs6.43±1.76mmol/L;9.79±0.94nmol/mgprot.vs6.80±0.97nmol/mgprot.P<0.01),细胞色素P4501A1mRNA表达水平,肝组织TNF-α、NF-κB蛋白表达明显增强(0.628±0.116vs0,0.230±0.013vs0.03±0.006,0.069±0.01vs0.003±0.001;P<0.05).与模型组比较VE组、Se组的血清及肝组织中SOD增高,MDA降低,细胞色素P4501A1mRNA表达水平略下降;肝组织TNF-α、NF-κB蛋白表达下降(P<0.05).VE Se组与模型组比较,血清SOD明显增高,其值接近对照组水平;细胞色素P4501A1mRNA表达水平显著下降(0.324±0.070vs0.628±0.116,P<0.05).结论:非酒精性脂肪肝的脂质过氧化损伤及相关因子的表达可能与肝细胞色素P4501A1表达上调有关.VitE和硒能提高机体的抗氧化能力,对非酒精性脂肪肝有保护作用,二者联合作用更明显.     

乌司他丁抑制NF-κB通路对脓毒症急性肝损伤的保护作用

目的观察乌司他丁对脓毒症急性肝损伤患者核因子κB(NF-κB)炎症通路的影响,以及其相关的临床效果。方法收集我院2017年1月至2018年9月治疗的脓毒症急性肝损伤患者112例,使用随机数表法将患者纳入观察组和对照组,每组56例。对照组常规治疗,观察组在对照基础上加用乌司他丁10万单位静脉滴注。p65、TNF-α、IL-6、TBil、AST和ALT使用ELISA法检测。结果疗程结束后观察组p65、TNF-α和IL-6分别为(15.25±3.26)、(43.64±8.71)和(30.72±7.26)μg/L,显著低于对照组的(23.57±5.42)、(52.53±10.62)和(41.95±10.12)μg/L(P0.05)。疗程结束后观察组TBil、AST和ALT分别为(26.22±5.0)μmol/L、(64.58±14.36)U/L和(60.14±13.68)U/L,显著低于对照组的(32.02±8.14)μmol/L、(64.58±14.36)U/L和(60.14±13.68)U/L(P0.05)。疗程结束后观察组APACHEⅡ评分为(8.82±3.14)分,显著低于对照组的(11.13±3.65)分(P0.05)。结论乌司他丁可以抑制脓毒症急性肝损伤患者NF-κB炎症通路,发挥对肝脏的保护作用,有利于患者病情的恢复。     

生长抑素对溃疡性结肠炎模型大鼠肠道炎性损伤的治疗作用

目的: 观察生长抑素(奥曲肽)对溃疡性结肠炎(ulcerative colitis,UC)大鼠模型的作用,初步探讨其可能机制.方法: ♂SD大鼠随机分为正常对照组、奥曲肽对照组、模型组、治疗组,每组7只. 模型组、治疗组大鼠用三硝基苯磺酸(TNBS)/乙醇溶液灌肠复制UC模型. 观察各组实验大鼠体质量变化、大体及组织病理学改变. 采用酶联免疫吸附法检测细胞因子(IL-6、IL-10、TNF-α)的含量、蛋白质印迹杂交法检测结肠组织NF-κB p65蛋白的表达.结果: 生长抑素可以缓解大鼠体质量的减轻,减少腹泻及便血的发生,并且能够显著改善结肠组织大体和组织学评分. 与正常组比较,模型组大鼠结肠黏膜IL-6、TNF-α表达明显升高(188.27±11.65 ng/L vs 102.13±7.12 ng/L,87.39±6.74 ng/L vs 121.51±8.56 ng/L,均P<0.01);IL-10表达明显下降(71.40±8.28 ng/L vs 202.97±12.26 ng/L,P<0.01);与模型组比较,治疗组大鼠结肠黏膜IL-6、TNF-α表达均明显降低(142.03±12.68 ng/L,90.87±9.26ng/L,均P<0.01),IL-10表达明显升高(124.07±10.05 ng/L,P<0.01). 模型组结肠组织中NF-κB的蛋白含量明显高于治疗组(1059.60±96.35vs 471.23±11.61,P<0.01).结论: 生长抑素对TNBS诱导的大鼠溃疡性结肠炎具有显著治疗作用,其作用机制可能是通过影响炎症反应的信号通路NF-κB的活化,进而下调促炎细胞因子及上调抗炎细胞因子的产生和表达.     

黄芪多糖对LPS损伤小肠上皮细胞的保护作用

目的:探讨黄芪多糖(APS)在内毒素-脂多糖(LPS)损伤小肠上皮细胞(IEC-6)中的作用机制及对细胞因子和核因子-κB(NF-κB)表达的影响.方法:以小肠上皮细胞株IEC-6为研究对象, 将培养的细胞分为6组: 对照组、LPS组、LPS APS 50 mg/L组、LPS APS 100 mg/L组、LPS APS 200 mg/L组和LPS APS 500 mg/L组. 采用RT-PCR法检测细胞因子TNF-α和IL-8 mRNA的表达, 采用凝胶电泳迁移率法分析NF-κB蛋白活性.结果: LPS损伤IEC-6细胞后, TNF-α, IL-8 mRNA水平和NF-κB蛋白定量表达均升高, 均显著高于对照组(TNF-a: 1.26±0.06 vs 0.65±0.05, IL-8 mRNA: 1.19±0.05 vs 0.57±0.06, NF-kB: 2.76±0.07 vs 0.07±0.03, P均<0.01). 而黄芪多糖呈浓度和时间依赖性地抑制LPS诱导IEC-6细胞分泌的TNF-α, IL-8等细胞因子的mRNA的表达水平(P<0.01), 并能降低NF-κB的表达活性(P<0.01).结论:APS具有抑制LPS刺激IEC-6细胞产生的TNF-α, IL-8炎性因子的作用, 并能降低NF-κB的表达活性, 其对LPS所致的肠道损伤具有保护作用.     

N-乙酰半胱氨酸对重症急性胰腺炎大鼠肝损伤的保护作用

目的:探讨N-乙酰半胱氨酸(N-acetylcysteine,NAC)对重症急性胰腺炎(severe acute pan-creatitis,SAP)大鼠肝损伤的保护作用及作用机制.方法:Wistar大鼠42只随机分为3组,SAP组(SAP,n=18),采用逆行十二指肠胰胆管注射50 g/L牛黄胆酸钠溶液制备SAP模型;SAP+NAC组(SAP+NAC,n=18),建模前2 h给予NAC 300 mg/kg体质量预处理;假手术组(SO,n=6).建模成功后3、6和12 h,分别取下腔静脉血液、胰腺和肝脏组织.光镜下观察胰腺和肝脏组织病理改变,全自动生化分析仪检测各时段血液ALT和AST水平,逆转录-聚合酶链反应(RT-PCR)检测肝脏组织中TNF-αmRNA表达,SP免疫组化法检测肝脏组织中NF-κB活化.结果:SO组血液ALT、AST以及肝胰组织病理无显著性变化.SAP组各时间点肝胰病理改变较SO组严重.术后3、6和12 h时间点ALT及AST均较SO组显著升高(186.67±27.28,321.17±56.14,492.50±69.77 vs 36.83±7.02;255.50±44.15,343.17±43.70,425.33±58.37 vs 41.67±5.35,P<0.05或0.01);TNF-αmRNA表达均显著高于SO组(0.37±0.03,0.77±0.04,0.54±0.04 vs 0.24±0.03,P<0.05或0.01):NF-κB活性术后3、6 h均显著高于SO组(51.95±4.76.24.67±4.93 vs 9.33±2.05,P<0.05或0.01),12 h与SO组相比差异无显著性意义.SAP+NAC组各时间点肝胰组织病理改变均较SAP组减轻,术后3-12 h血液ALT及AST水平(143.67±16.62,203.33±25.41,301.17±26.82;136.33±26.27,221.50±38.31,310.50±38.17)均显著低于SAP组(P<0.05或0.01);各时间点肝脏TNF-αmRNA表达(0.25±0.03,0.50±0.05,0.43±0.03)显著低于SAP组(P<0.05或0.01);术后3-6 h NF-κB活性(37.60±6.37,12.88±2.66)均较SAP组显著降低(P<0.05).结论:NF-κB活化与TNF-αmRNA表达上调参与了SAP大鼠肝损伤过程,NAC 300 mg/kg预处理能够有效减轻SAP大鼠肝损伤,其作用机制可能与抑制NF-κB活化进而下调炎性细胞因子TNF-αmRNA表达水平相关.     

异甘草酸镁对CCl4诱导小鼠急性肝损伤的保护作用

目的:研究异甘草酸镁(MI)对CCl4诱导急性肝损伤小鼠的保肝降酶作用与及其对肝组织中核因子-κB(nuclear factor kappa B,NF-κB)、细胞间黏附分子-1(ICAM-1)表达的影响.方法:30只♂昆明小鼠(284±2.2g),随机分为3组,即正常对照组、模型组和异甘草酸镁组.正常对照组ip生理盐水(0.1 mL/10 g),模型组ip 0.1?l4(0.1 mL/10g),异甘草酸镁组于ip 0.1?L4(0.1 mL/10 g)前15 min予MI(15mg/kg体质量)ip,1次/d,共5次.采用生化法测定血清ALT、AST及肝组织MDA和SOD含量.采用HE染色观察肝组织病理损伤.SP免疫组化染色检测NF-κB、ICAM-1表达.结果:肝损伤组ALT、AST及MDA较正常组显著升高(465.10±35.90 kU/L vs 47.40±4.13 kU/L;582.37±25.63 kU/L vs 116.06±12.82 kU/L;4.07±0.38 nmol/mg vs 1.39±0.03nmol/mg;均P＜0.01),SOD明显降低(29.71±2.25U/mg vs 87.02±4.84U/mg,P＜0.01).在正常组织中无NF-κKB、ICAM-1表达,肝损伤模型组中NF-κB有较强表达,ICAM-1在肝坏死区强表达.MI组ALT、AST及MDA(263.51±22.89 kU/L,292.56±26.01 kU/L,2.17±0.03nmol/mg)较肝损伤组显著降低(P＜0.01),SOD(58.04±2.56 U/mg)明显升高(P＜0.05),NF-κB、ICAM-1表达均较肝损伤组减弱,肝组织坏死程度也轻.结论:NF-κB、ICAM-1在CCl4诱导小鼠急性肝损伤中表达明显增强,MI可减少NF-κB及ICAM-1表达并减轻肝损伤程度.     

紧密连接蛋白Occludin在非酒精性脂肪肝大鼠肠上皮细胞中的表达及其与TNF-α的关系

目的:研究非酒精性脂肪性肝病(NAFLD)大鼠肠上皮细胞中紧密连接蛋白Occludin的表达及与肿瘤坏死因子α(TNF-α)的关系.方法:30只♂ SD大鼠平均分为2组,对照组普通饮食,模型组给予高脂饮食,喂养12 wk后处死.模型组肝脏HE染色显示脂肪肝造模成功.采用放免法检测血清TNF-α水平,取肝脏组织行免疫组织化学检测TNF-α的表达,取空肠组织应用免疫组织化学检测肠上皮细胞间紧密连接蛋白Occludin表达并电镜下观察肠上皮细胞间紧密连接部位的变化.结果:模型组血清TNF-α水平较对照组明显增高,差异具有统计学意义(3.21 μg/L±0.45 μg/L vs 2.10 μg/L±0.29 μg/L,t=-6.157,P<0.01).模型组大鼠肝脏TNF-α阳性物质主要分布在肝细胞的胞质,呈棕黄色细颗粒状.而对照组仅个别散在肝细胞阳性.对照组Occludin蛋白主要沿大鼠空肠黏膜上皮细胞膜的顶端呈线状分布,而模型组阳性染色较之明显减弱,呈非连续性分布.电镜下模型组紧密连接明显短于对照组,具有显著性差异(0.50 μm±0.21 μmvs 0.78 μm±0.19 μm,P<0.05).结论:TNF-α可能抑制了空肠上皮细胞中紧密连接蛋白Occludin的表达,从而破坏了肠黏膜机械屏障,促进NAFLD的发生及发展.     

核因子-κB及其下游因子TNF-α、Bcl-2在急性肝损伤中的作用及机制

目的:探讨核因子-κB(nuelear factor-kappa B,NF-κB)及其下游因子TNF-α、Bcl-2在急性肝损伤的作用及机制.方法:(↑○) Wistar大鼠90只随机分为正常组,硫代乙酰胺(TAA)造模组及脯氨酸二硫代氨基甲酸酯(PDTC)预处理组(n=30).三组大鼠分别于造模完成后6、24、48 h 3个时间点处死.每个时间点各取10只大鼠.鲎试剂显色基质法测定大鼠血浆内毒素,放免法测定血浆TNF-α水平,取肝脏行病理学及免疫组化检测.制备肝脏单细胞悬液检测肝细胞凋亡指数.结果:与正常组相比,TAA细在6、24、48h时间点均可见血浆内毒素(Eu/mL)及TNF-α(ug/L)水平明显升高(内毒素:0.64±0.08 vs 0.23±0.02,P<0.01;0.96±0.14 vs 0.25±0.02,P<0.01;1.15±0.17 vs 0.25±0.03,P<0.01;TNF-α:5.97±1.07 vs 1.44±0.52,P<0.01;12.52±2.09 vs 1.57±0.62,P<0.01;10.76±1.95 vs 1.49±0.57.P<0.01),肝组织NF-κB及Bcl-2明显活化(NFκB:87.1l%±8.23% vs 4.64%±1.82%.78.55%±6.82% vs 4.58%±1.91%,74.27%±6.26%vs 4.73%±1.89%,均P<0.01;Bcl.2:51.11%±4.23% vs 6.74%±3.93%.71.59%±6.82% vs 6.68%±3.88%,82.19%±8.54% vs 6.81%±4.14%,均P<0.01).随着时间延长,肝细胞凋亡指数增加,TAA组肝脏病理变化明显,抑制NF-κB活性后,可见肝脏病理变化减轻.结论:TAA所致急性肝损伤中,TNF-α水平明显升高,发挥了促炎及诱导凋亡作用.其促凋亡作用相对拮抗Bcl-2抗凋亡作用.NF-κB通过调控其下游基因加重肝脏损伤.     

华夏小葱制剂对脂肪肝大鼠的防治作用

目的:探讨华夏小葱制剂对大鼠脂肪肝的防治作用及其机制.方法:60只SD大鼠随机平均分为6个组:空白对照组,模型对照组,华夏小葱制剂低、中、高剂量组以及东宝肝泰片组.除空白对照组外,其他组用高脂饮食及酒精水喂养,并结合皮下注射小剂量四氯化碳色拉油溶液建立大鼠脂肪肝模型.华夏小葱制剂低、中、高剂量组及东宝肝泰片组分别给予相应剂量的华夏小葱制剂0.06,0.12,0.24 g/kg或东宝肝泰片混悬液0.7 g/kg.8 wk后计算肝脏指数(肝湿质量/体质量),取肝左叶作组织病理学检查,全自动生化分析仪测定总胆固醇(TC)、甘油三酯(TG)等指标,放射免疫法测定血浆内皮素(ET-1)含量,RT-PCR测定肿瘤坏死因子-α(TNF-α)mRNA的表达,Western blot检测核转录因子-κB(NF-κB)p65蛋白的表达.结果:模型对照组肝指数、TC、TG、ET、TNF-αmRNA及NF-κB值分别是2.33%±0.08%,1.39±0.31 mmol/L,0.48±0.08 mmol/L,138.67±21.84 ng/L,0.47±0.01,110.67±12.90)显著高于空白对照组(P＜0.01);华夏小葱低、中、高剂量组及东宝肝泰片组肝指数、TC、TG、ET-1、TNF-αmRNA、NF-κBp65值(肝指数:2.59%±0.12%,2.55%±0.19%,2.65%±0.25%,2.57%±0.16%,P＜0.01;TC:1.67±0.31,1.65±0.17,1.69±0.29,1.52±0.31mmol/L.P＜0.05or P＜0.01;TG:0.65±0.23,0.60±0.29,0.55±0.17,0.61±0.27 mmol/L,P＜0.05 or P＜0.01:ET-1:149.39±17.82.136.91±22.48,130.52±24.93,154.45±18.46 ng/L,P＜0.05 or P＜0.01:TNF-αmRNA:0.79±0.01,0.73±0.03,0.64±0.05,0.71±0.02,P＜0.01或无显著性差异;NF-κB p65:158.67±8.08,141.33±9.29,115.67±14.05,118.00±9.85,P＜0.05 orP＜0.01)低于模型对照组(分别是3.45%±0,20%,2.03±0.38 mmol/L,1.18±0.57 mmol/L,180.22±9.80 ng/L,0.84±0.04,180.33±8.391).结论:华夏小葱制剂对实验性大鼠脂肪肝具有较好的防治作用,其机制可能与降低NF-κB的激活、减少ET-1和TNF-α的损伤有关.     

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.     

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.