胃食管反流病胃电活动变化的研究

目的　探讨胃食管反流病 (GERD)的胃电活动变化。方法　主诉反流症状的患者 ,经 2 4小时食管酸、碱监测和 (或 )胃镜检查 ,GERD 43例 ,健康对照组 3 9例 ,进行餐前、餐后体表胃电图 (EGG)监测。结果　GERD组的平均正常胃电慢波百分比 ( 63 .40 %± 3 1.63 %)显著低于对照组 ( 80 .89%± 2 5 .42 %) ,餐前胃电节律异常的发生率 ( 5 8.1%)显著高于对照组 ( 17.0 %) ,餐前主频不稳定系数 ( 5 3 .6± 5 0 .8)也显著高于对照组 ( 3 4.2± 3 3 .1) ;GERD组的餐后胃电节律异常的发生率 ( 3 2 .6%)显著高于对照组 ( 12 .8%)。结论　GERD患者存在餐前、餐后胃电活动异常 ,体表EGG检查有助于了解GERD的胃运动功能情况     

胃电图和胃排空检测的临床价值评价

目的探讨胃电图(EGG)和胃排空检测的临床价值及胃肌电活动和胃排空异常的相关性.方法170例有消化不良症状者[功能性消化不良(FD)组140例,非胰岛素依赖性糖尿病(NIDD)组30例]和20例正常人分别接受EGG和胃排空(同位素法、Rom's法和超声法)检测.结果70%(21/30)的NIDD患者于餐前、66.7%(20/30)于餐后出现胃电节律紊乱,尤以胃动过速为著(餐前36.7%,餐后33.3%);NIDD患者的餐后主频(DF)(2.60cpm±0.30cpm)、餐后/餐前DF(1.01±0.11)、餐后主功率(DP)(121.45V2.cpm+67.00V2.cpm)及餐后/餐前DP(0.81+-0.07)均较正常对照者显著降低(P＜0.05或P＜0.01).FD患者的餐后DP(210.60V2.cpm±68.40V2.cpm)亦显著低于正常对照者(P＜0.01).FD和NIDD患者用3种方法测得的胃半排空时间均较正常对照者延迟(P＜0.05或P＜0.01).121例空腹胃电节律正常者中,胃排空延迟者占39.7%(48/121);69例空腹胃电节律异常者中,胃电节律过缓者45.9%(17/37)胃排空延迟,胃电节律过速者78.1%(25/32)胃排空延迟.结论EGG及胃排空检测对评价胃肌电活动和胃动力异常有一定临床意义,后两者间的确切关系尚不能被证明,但胃电节律过速与胃排空过缓关系密切.     

心理状态变化与自主神经功能改变及胃电节律紊乱在功能性消化不良中的相互关系

目的:探探讨在功能性消化不良(functional dyspepsia,FD)患者中心理状态变化,自主神经功能改变和胃电节律紊乱之间的相互关系.方法:按罗马Ⅲ标准前瞻性分析FD患者85例和正常人30例的HAMD他评抑郁量表,HAMA他评焦虑量表及SCL-90项症状自评量表,同步检测自主神经功能变化及胃电节律紊乱情况.结果:FD患者普遍存在心理状态异常及自主神经功能损害和胃电节律紊乱,与正常人相比均有显著性差异(P<0.01);心理状态变化对自主神经功能改变有关且影响很大(P<0.01,C=0.4908),后者对前者的改变及影响程度较低(P<0.05,C=0.2519):自主神经功能改变与胃电节律紊乱有关且相关性相同(P<0.01,C= 0.4279);心理状态异常与胃电节律紊乱相关性无统计学意义(P>0.05,C=0.1866).结论:FD患者心理状态异常与自主神经功能改变的关系最密切,自主神经功能变化与胃电节律紊乱之间有一定关系,心理状态异常与胃电节律紊乱之间无直接关系.     

负性生活事件在功能性消化不良发病中的作用

目的 :比较功能性消化不良 (FD)患者与健康人在负性生活事件、焦虑、抑郁等方面的差异 ,揭示负性生活事件与FD患者焦虑、抑郁的关系及其在FD发病中的作用。方法 :采用生活事件量表 (LES)、焦虑自评量表 (SAS)、抑郁自评量表 (SDS)对 1 30例FD患者及1 1 0例健康人进行评分。结果 :FD患者组负性生活事件分值显著高于健康人组 (2 8.65± 2 5 .2 3vs 1 5 .38± 1 8.77,P <0 .0 5) ,焦虑、抑郁分值也显著高于健康人组 (52 .65± 1 3 .2 9vs40 .85± 8.55 ;51 .34± 1 4 .67vs41 .67± 7.74,P <0 .0 0 1 )。FD患者负性生活事件分值与焦虑、抑郁分值呈正性相关 (r=0 .56、0 .52 ,P <0 .0 0 1 )。结论 :负性生活事件可能通过对个体心理健康的影响 ,进而影响功能性消化不良的发生。     

胃食管反流病胃肌电活动的变化

目的 分析描述胃食管反流病(GERD)患者的胃肌电活动特点,探讨胃肌电活动的变化在GERD发病中的作用,以期有助于临床诊疗.方法 对65例GERD患者和30例健康志愿者进行餐前、餐后体表胃电图监测.根据内镜检查结果,把GERD患者分为反流性食管炎(RE)组、非糜烂性反流病(NERD)组,行组间胃电参数比较,随访19例胃电节律异常的GERD患者,观察治疗前后胃电参数的变化.结果 GERD组的主频(DF)正常慢波节律百分比(N%)、餐前餐后功率比(PR)与对照组相比明显降低(P<0.05或0.01).胃电节律紊乱,以胃动过缓为主.经1周治疗后,GERD异常胃电参数明显正常化(P<0.05或0.01).餐前RE组胃电节律异常的发生率(37.5%)显著高于NERD组(12.1%).餐后胃电节律异常的发生率RE组和NERD组分别为71.9%和60.6%,两者没有统计学意义(P>0.05).结论 GERD患者存在餐前、餐后胃肌电活动异常,异常胃电节律以胃动过缓节律为主,胃电图能为GERD诊断提供依据.     

功能性消化不良患者胃肌电紊乱的发生率

背景：功能性消化不良（FD）的病理生理机制尚未完全阐明，消化道运动功能异常可能是主要发病机制之一。目的：通过胃电图检查探讨FD患者胃肌电紊乱的发生率，证实胃动力异常在FD发生中的作用。方法：368例FD患者行餐前和餐后体表胃电图榆查，对正常胃慢波百分比和胃电主功率两项参数进行分析。结果：根据正常胃慢波百分比，本组FD患者可分为胃电节律正常组（43．2％）、胃动过缓组（33．2％）、胃动过速组（6．2％）和混合性胃电节律紊乱组（17．4％）。在胃电节律正常的FD患者中，34．0％（54例）存在餐后／餐前胃电主功率比异常。结论：本组71．5％的FD患者存在胃肌电紊乱，证实胃动力异常在FD的发病机制中起有重要作用。     

不同状态糖尿病患者胃电活动的特点

目的: 观察不同状态糖尿病患者的胃电活动特征, 探讨糖尿病胃电紊乱的发展规律.方法: 2005-11/2006-05北京协和医院就诊的糖尿病患者54例, 根据糖尿病并发症及上消化道症状的有无分为3组: 无并发症及上消化道症状组, 有并发症而无明显上消化道症状组, 有并发症及明显上消化道症状组. 记录空腹30min和餐后60 min的体表胃电活动.结果: 糖尿病患者胃电节律异常发生率为74.1%. 餐前胃电活动表现为: 正常节律(46.3%)、胃动过缓(31.5%)、无节律(14.8%)、胃动过速(7.4%); 餐后胃电活动表现为: 胃动过缓(37%)、正常节律(35.2%)、无节律(20.4%)、胃动过速(7.4%). 有并发症及上消化道症状组的PR值显著高于无并发症及上消化道症状组(1.07±1.17 vs 0.93±0.14, P = 0.022).有并发症及上消化道症状者早饱症状的严重程度和PR值负相关( r = -0.535, P = 0.040).结论: 糖尿病患者胃电节律紊乱以胃动过缓最常见, 不同状态糖尿病患者的胃电活动存在差异.     

精神心理因素与老年功能性消化不良的相关性及对患者ADL评分的影响

目的分析精神心理因素与老年功能性消化不良(functional dyspepsia,FD)的相关性及对患者日常生活活动能力评定(activity of daily living, ADL)评分的影响.方法选取2016-08/2017-09本院收治的FD的精神病老年患者60例作为研究组,精神状况良好的FD患者60例作为对照组,对两组患者均进行心理精神状况、胃功能指标等多方面测试.调查统计两组患者焦虑自测量表、抑郁自测量表、24 h心率变异性、水负荷试验的试验结果.结果研究组老年患者的焦虑自评量表、抑郁自评量表评分均显著高于对照组患者(P0.05),研究组患者中出现焦虑、抑郁的人数显著多于对照组(P0.05).研究组患者进行水负荷实验的初始感觉量、最大耐受量均显著低于对照组患者(P0.05),研究组患者胃固体物的半排空时间显著长于对照组患者(P0.05);研究组患者出现不良反应的发生率显著低于对照组患者(P 0.05);研究组老年患者的ADL评分在治疗前后均显著高于对照组患者(P0.05).结论患者精神心理状况对FD的发生与发展有紧密的联系,对患者胃的感觉功能、运动功能造成损害,逐步加深对老年功能性精神心理因素研究,对治疗有着重要的意义.     

胃电起搏治疗胃动力障碍疗效观察

背景:胃电起搏是近年来开展起来的一项治疗胃动力障碍的新方法,其疗效尚不明确。目的:观察胃电起搏治疗对胃动力障碍患者胃肌电活动和症状的影响,以评估其对胃功能紊乱的疗效。方法:对13例胃动力障碍患者行胃电起搏治疗,治疗前后进行胃电图检查和症状评估。结果:胃电起搏治疗后,患者的餐前正常胃电慢波百分比(46.9％±21.6％)与治疗前(41.9％±16.9％)相比无显著差异(P>0.05),餐后正常胃电慢波百分比(78.7％±16.6％)则显著高于治疗前(57.5％±28.6％,P<0.01);治疗后患者的症状亦明显改善。结论:胃电起搏治疗能在短期内改善胃动力障碍患者的胃电节律紊乱和症状。     

胃起搏对胃动力紊乱犬胃排空及胃肌电活动的影响

目的　研究胃起搏对胃动力紊乱犬胃排空及胃电参数的影响。方法　采用双侧迷走神经干切断术联合应用胰高血糖素建立胃动力紊乱犬模型 ;采用 4导联胃肠电系统微机分析仪记录胃肠浆膜肌电活动 ;99mTc 植酸钠标记的半固体试餐 ,单光子计算机断层显像技术 (SPECT)检测胃半排空时间(GEt1/ 2 ) ;采用适宜起搏参数从胃体、胃窦在腹部投影部位输入起搏信号驱动胃电节律。结果　迷走神经干切断术后犬的GEt1/ 2 为 (79.4 2± 1.91)min ,较术前 (5 6 .35± 2 .99)min明显延迟 (P <0 .0 0 1) ,但行胃起搏治疗后GEt1/ 2 为 (6 4 .94± 1.75 )min ,较治疗前明显加快 (P <0 .0 0 1) ;胃起搏治疗前迷走神经干切断犬餐后的胃电频率为 (0 .0 81± 0 .0 0 7)Hz、胃电幅度为 (2 .32± 0 .35 )mV、慢波的传播速度为 (4 .0 6± 0 .4 0 )cm/s ,均较正常对照犬显著降低 [(0 .0 90± 0 .0 0 6 )Hz ,(4 .2 5± 0 .12 )mV ,(6 .92± 0 .2 4 )cm/s,(P <0 .0 5 ) ],治疗后其餐后胃电频率 (0 .0 92± 0 .0 0 5 )Hz、胃电幅度 (3.97± 0 .19)mV和慢波的传播速度 (5 .5 7± 0 .4 8)cm/s均明显高于治疗前 (P <0 .0 5 )。结论　采用适宜起搏参数输入起搏信号可完全触发胃电慢波 ,改善胃电参数 ,纠正药物导致的异常胃电节律 ,加速胃排空 ,恢     

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.     

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.     

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.     

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.