病毒性肝炎毛细胆管亚微结构改变的观察

本文研究了42例病毒性肝炎患者的肝穿刺活检,发现胆管的末梢分支有多种形态的亚微结构改变,其变化主要有以下几种:(1)慢迁肝及慢活肝组,由于广泛的肝细胞结合面间隙的扩张及淋巴细胞的浸润,使毛细胆管数量明显地减少。(2)在大部分病例中,都可见到不同程度扩张的毛细胆管,扩张甚者其管腔可达10～15微米。(3)易见肿胀的毛细胆管微绒毛,其顶端呈“棒状”扩     

CD90在肝内胆管细胞癌中的表达及其与患者预后不良的关系

目的 探讨分析CD90在人肝内胆管细胞癌中的表达及与淋巴结转移和预后不良的关系。方法 收集2013年3月-2016年3月承德医学院附属医院手术切除的肝内胆管细胞癌组织标本49例及其癌旁正常组织49例,另选取40例正常肝组织作为对照。采用免疫组化法检测所有标本CD90表达情况,并分析肝内胆管细胞癌患者CD90表达与临床指标、生存预后的关系。计量资料2组间比较采用t检验;计数资料2组间比较采用χ2检验,3组间比较及进一步两两比较均采用Kruskal-Wallis H检验。采用Kaplan-Meier曲线分析术后复发及生存情况,并应用log-rank检验进行比较。结果 肝内胆管细胞癌组织CD90中强度阳性表达率为65.31%,癌旁正常组织CD90中强度阳性表达率为30.61%,正常肝组织CD90中强度阳性表达率为0,肝内胆管细胞癌组织中CD90蛋白中强度阳性表达率显著高于癌旁正常组织与正常肝组织(P值均<0.05)。CD90蛋白表达与肝内胆管细胞癌患者TNM分期及肝门淋巴结转移有关(χ^2值分别为12.837、17.824,P值均<0.001)。CD90蛋白阴性/弱阳性表达患者术后无复发生存率及总体生存率均显著优于中/强阳性表达患者(χ^2值分别为3.845、4.152,P值分别为0.025、0.021)。结论 CD90在人肝内胆管细胞癌组织内高表达,且与患者肝门淋巴结转移及不良预后有关,在肿瘤发生发展及转移过程中发挥着重要作用。     

肝内胆汁淤积发生机制进展

胆汁淤积是指胆汁分泌的阻滞、抑制或胆汁流的障碍,胆汁到达十二指肠减少,导致胆汁成分在血中蓄积。有关肝内胆汁淤积的发生机制,近几年来有了一些新的认识,为胆汁淤积的诊断、治疗及预后估计提供了理论依据。一、肝内毛细胆管及肝内胆管病损原发性胆汁性肝硬化为肝内胆管病损的典型代表。可见叶间胆管出现增生、小叶间胆管壁上皮细胞呈变性、坏死,上皮细胞间有炎症细胞浸润或出现淋巴细胞增殖,在胆管的周围还可见浆细胞浸润。进而毛细胆管出现结     

药物性胆汁淤积

目前已知有许多药物可引起急性肝内胆汁淤积。常见的药物有氯丙嗪、磺胺类、红霉素、呋喃类、睾丸酮及其它蛋白同化激素、口服避孕药等。一、肝内胆汁淤积的发病机制药物引起肝内胆汁淤积,认为是由于变态反应机制损害了肝细胞和毛细胆管侧微绒毛泌胆功能所致。此外,肝细胞肿胀、压迫毛细胆管,胆汁粘稠度增加、细小胆管附近炎症     

人胆管癌可能源于干细胞

目的：研究胆管腺癌中CD34分子和干细胞因子受体c-kit的表达。方法：该试验收集了15例肝内胆管腺癌和17例肝外胆管腺癌的病例。通过Envision检测系统，将被切除的胆管癌组织用石蜡包埋、切片，然后用标记的抗-CD34分子和抗-c-kit抗体进行染色，通过光学显微镜检测其结果。用正常扁桃体和乳腺组织分别作为CD34和c-kit的阳性对照。     

肝内胆汁淤积的病因

肝内胆汁淤积是指任何病因引起肝细胞和/或毛细胆管胆汁分泌功能障碍,或肝内小胆管弥漫性梗阻所致.     

肝内胆汁淤积发病机制

肝细胞膜可分为窦膜 (基膜 )、侧膜和毛细胆管膜 ,二个邻近肝细胞的胆管膜组成毛细胆管 (ｃａｎａｌｃｕｌｕｓ) ,胆管系统以此为起点 ,集合成小胆管 (ｄｕｃｔｕｌｅ)、叶间胆管 (ｉｎｔｒａｌｏｂｕｌａｒｂｉｌｅｄｕｃｔ)和间隔胆管 (ｓｅｐｔａｌｂｉｌｅｄｕｃｔ)。肝内胆汁淤积是指胆汁在上述途径中发生排泄障碍。胆汁排泄依靠细胞支架的功能完整。细胞支架由微丝和微管组成 ,微丝由肌动蛋白组成 ,起自细胞侧膜的带状桥粒 ,围绕毛细胆管 ,以维持其张力 ,使胆汁排泄至小胆管。在正常情况下 ,每日生成 6 0 0～70 0ｍｌ胆汁 ,其中肝细胞…     

胆汁引流时机对大鼠胆管阻塞性肝纤维化的影响

目的探讨胆管结扎肝纤维化大鼠模型胆管引流时机对纤维化的影响。方法大鼠胆管结扎肝纤维化模型,分别于早期（10 d）和晚期（20 d）引流,引流5 d后与模型对照,比较大体形态、肝组织学、肝组织转化生长因子（TGF）β1和基质金属蛋白酶组织抑制因子-1（TIMP-1）mRNA表达情况。结果与同期模型对照组比较,早期引流组大体形态上好转明显,肝组织学纤维面积百分比和纤维化程度半定量计分有明显改善（P〈0.001,P=0.003）,肝组织TGFβ1、TIMP-1 mRNA表达明显下降（P〈0.001,P〈0.001）,而晚期引流组与同期模型组对照差异无统计学意义。结论胆管阻塞时及时进行引流可以有效缓解肝纤维化,而引流开始较晚肝纤维化趋于稳定、单纯引流难以缓解。     

慢性乙肝患者肝组织内CD4+、CD8+和CD25+T淋巴细胞的表达和研究

探讨肝内免疫活性细胞与乙肝病毒（HBV）慢性感染的关系。运用免疫组织化学法分析54例CHB患者肝内CD25^＋T细胞以及部分患者肝内CD4^＋T细胞、CD8^＋T细胞的表达,并与9例正常肝组织进行比较。CD25^＋和CD8^＋T细胞在HBV感染组和非HBV感染组中的表达差异均存在显著性（P〈0．05和P〈0．01）,CIM^＋T细胞在HBV感染组的表达虽有增多的趋势,但统计学上无显著意义（P〉0．05）。HBV感染组CD25^＋T细胞表达与I临床病理炎症分级和ALT的变化相关,随着炎症分级的加重和ALT的升高,其表达逐渐增强（P〈0．05和P〈0．01）。CD4^＋、CD8^＋T细胞表达与临床病理炎症分级和ALT的变化无关（P〉0．05）。CHB患者肝内CD25^＋T细胞表达增强与机体对HBV产生免疫耐受有关,CHB患者肝内CIM^＋、CD8^＋T淋巴细胞的表达异常,功能性免疫活性细胞浸润量不足,不能有效清除HBV。     

肝门部汇管区胆管癌的超声表现

目的探讨肝门部汇管区（左肝管、右肝管与肝总管汇合部）胆管癌的超声诊断价值。方法常规肝胆超声探查,配合患者呼吸动作,在肝门区详细观察肝门部脉管,胆管的走行及分布状,肿块大小及边界,肝内胆管扩张程度和分布范围,远段肝外胆管显示状态,所伴行的门静脉及肝门部其它组织结构回声情况等。将异常所见照片记录,并与CT、MRI及手术结果对照分析。结果超声诊断54例汇管区胆管癌病例中,CT、MRI证实29例,手术证实25例,所有病例均有不同程度的肝内胆管扩张。结论汇管区胆管癌的直接、间接超声表现具有一定的特征性,超声对汇管区胆管癌的判定具有较高的诊断价值。     

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.     

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.     

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.     

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。     

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.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.