共聚焦激光显微内镜对组织学胃炎的诊断

目的 评价共聚焦激光显微内镜检查对于组织学胃炎的诊断价值.方法 共有149名患者进行共聚焦激光显微内镜检查.对标准部位和局灶性病变进行共聚焦扫描检查,然后对检查部位进行靶向活检.系统评价共聚焦激光显微内镜检查的结果与组织学诊断结果之间的关系.结果 共聚焦激光显微内镜检查对于萎缩诊断的敏感度、特异度、准确度分别为83.6%、99.6%、97.5%.对于中-重度中性粒细胞活动性诊断的敏感度、特异度、准确度分别为81.9%、99.3%、95.8%.对共聚焦图像进行分组观察,观察者间和观察者内一致性的平均Kappa值分别为0.749和0.811.结论 共聚焦激光显微内镜检查对于组织学胃炎的诊断具有很好的真实性和可重复性,对于组织学胃炎的判断具有潜在的临床应用价值.     

普通窄带成像内镜对结直肠增生性息肉和腺瘤的鉴别诊断价值

目的 分析普通窄带成像(NBI)内镜下结直肠增生性息肉与腺瘤腺管及微血管特征的差异,评价NBI的鉴别诊断价值.方法 将普通内镜下诊断结直肠息肉、病理检查证实为增生性息肉或腺瘤者纳入研究并进行NBI内镜检查.将腺管形态参照改良的工藤分型法分为A型和B型.将微血管形态分为3型,无微血管判为Ⅰ型,微血管沿腺管开口排列、粗细均匀判为Ⅱ型,微血管粗细不均、排列紊乱判为Ⅲ型.比较增生性息肉和腺瘤NBI图像中腺管形态和微血管形态特征的差异,同时对无放大NBI图像观察者间的一致性进行评价.结果 共87例患者的107个息肉(腺瘤73个、增生性息肉34个)进行普通NBI内镜检查.腺瘤组息肉最大径和表面分叶者比例明显高于增生性息肉组(P值分别=0.0023和0.0047).腺瘤组中B型腺管形态[86.3％(63/73)]及Ⅱ或Ⅲ型微血管形态[82.2％(60/73)]者较多.以B型腺管形态、Ⅱ型或Ⅲ型微血管中任一特征诊断腺瘤的敏感度、特异度、准确率分别为97.3％、82.4％、92.5％.以B型腺管形态联合Ⅱ型或Ⅲ型微血管诊断腺瘤的敏感度、特异度、准确率分别为71.2％、91.2％、77.6％.观察者间一致性评价平均Kappa值为0.761.结论 普通NBI内镜下结直肠腺瘤和增生性息肉的微血管特征和腺管特征存在差异,依据以上两方面可在NBI内镜下实时初步鉴别腺瘤和增生性息肉.     

共聚焦内镜诊断Barrett食管的初步研究

目的评价共聚焦内镜对Barrett食管的诊断价值。方法选取胃镜检查疑诊为Barrett食管患者纳入研究,以荧光素钠作为荧光对比剂,进行共聚焦内镜检查。对食管下段柱状上皮间隔2 cm进行四象限检查,并检查局部黏膜粗糙部位,随后对所检查部位黏膜活检。进行共聚焦显微内镜检查后即刻预测组织学诊断,并与病理组织学诊断进行对比。结果对入选的21例患者共进行食管下段70个部位共聚焦内镜检查,最终组织学诊断为:Barrett食管上皮部位41个,食管腺癌部位5个,胃型黏膜部位24个。对源自70个部位的全部2150帧共聚焦图像与组织学资料进行比较,共聚焦内镜诊断Barrett食管的敏感度为95.0%,特异度为90.0%,准确度为85.0%,阳性预测值为92.7%,阴性预测值为93.1%。结论共聚焦内镜可在内镜检查实时进行黏膜组织学检查,诊断Barrett食管敏感度和特异度高,为Barrett食管的诊断提供新的有力工具。     

放大内镜联合智能电子分光技术诊断早期胃癌的临床研究

目的 通过分析放大胃镜联合富士能智能电子分光技术( FICE)诊断早期胃癌的准确度,评价其临床应用价值.方法 2009年4月至2011年3月在常规内镜检查时发现可疑的微小凹陷病变(SDL),则分别用放大胃镜和放大胃镜联合FICE进行观察,参照国外文献,根据病变处腺管开口形态、微血管形态及病变处与周围黏膜的界限三方面指标,初步制定早期胃癌内镜诊断标准,并根据此标准对病变做出内镜诊断.结果 74处可疑SDL中,病理组织学证实癌性病变17例,非癌性病变56例.放大胃镜的敏感度、特异度、准确度分别为41.18％、94.74％和82.43％.放大胃镜联合FICE的敏感度、特异度、准确度分别为86.67％、96.49％和91.89％.放大胃镜联合FICE诊断的敏感度明显高于放大胃镜(P＜0.05).结论 放大胃镜联合FICE可以更清晰的观察病变的腺管开口、微血管及病变与周围组织的界线等微细结构.我们制定的内镜诊断标准,可以更全面的概括了早期胃癌的黏膜微细形态特征,提高内镜诊断的准确度.     

共聚焦激光显微内镜与胃黏膜活检诊断早期胃癌及其癌前病变的对比研究

目的 比较共聚焦激光显微内镜(CLE)和胃黏膜活检对早期胃癌及癌前病变的诊断价值.方法 46例常规内镜诊断为可疑早期胃癌的患者首先行CLE检查,然后改常规白光内镜于病变最明显处取活检2块.将CLE诊断和胃黏膜活检诊断与内镜下切除术后或手术后最终病理结果进行对比,一致性采用Kappa检验,并计算CLE诊断癌性病变的灵敏度、特异度、阳性预测值、阴性预测值和准确率.结果 最终病理诊断炎症1例、低级别上皮内瘤变4例、高级别上皮内瘤变10例、分化型腺癌28例和未分化型癌3例.CLE与最终病理诊断结果一致者38例(82.6％,38/46),两者一致性检验Kappa值为0.720;胃黏膜活检与最终病理诊断结果一致者28例(60.9％,28/46),两者一致性检验Kappa值为0.437.CLE对癌性病变诊断的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为97.6％ (40/41)、80.0％(4/5)、97.6％(40/41)、80.0％ (4/5)和95.7％ (44/46).结论 CLE对早期胃癌及其癌前病变具有较高的诊断价值,与病理组织学一致性高.     

共聚焦激光显微内镜对胃部溃疡型病变的鉴别诊断价值

目的 评价共聚焦激光显微内镜(confoeal laser endomicroscopy,CLE)对胃部溃疡型病变的鉴别诊断价值.方法 将CLE普通内镜模式下诊断为胃部溃疡型病变的患者纳入研究,转为CLE共聚焦内镜模式.对溃疡边缘和(或)表面黏膜进行扫查.随后对相同部位行黏膜活检.将CLE检查结果 与病理组织学结果 进行对比.结果 共43例患者入选,扫查部位150个,获得图像12 769幅.与病理组织学结果 比较,CLE诊断炎性病变的敏感度为83.54%、特异度为85.92%、阳性预测值为86.84%、阴性预测值为82.43%;诊断上皮内瘤变的敏感度为53.57%、特异度为88.52%、阳性预测值为51.72%、阴性预测值为89.26%;诊断胃癌的敏感度为88.37%、特异度为93.46%、阳性预测值为84.44%、阴性预测值为95.24%.在CLE与病理诊断的一致性检验中,对于炎性病变的κ值为0.69,上皮内瘤变的κ值为0.42,胃癌的κ值为0.81.结论 CLE对于胃部溃疡型病变的组织学类型可作出即刻诊断,其诊断的敏感度、特异度、阳性预测值、阴性预测值均较高,有利于指导靶向活检,提高癌前病变及胃癌的检出率.     

放大色素内镜在胃黏膜癌前病变诊断中的价值

目的:探讨放大色素内镜在胃黏膜癌前病变诊断中的应用价值.方法:应用电子放大内镜,结合美蓝染色,对180例患者的胃黏膜糜烂灶进行细微结构形态学观察,将胃黏膜小凹的形态分为:A型(圆点状)、B型(短小棒状)、C型(稀疏而粗大的线状)、D型(斑块状)、E型(绒毛状)和F型(小凹结构模糊不清、消失或伴异常增生毛细血管)6型,并与观察部位活检所得的病理组织学改变进行比较分析.结果:A,B型胃小凹主要见于正常胃黏膜,而C,D,E和F型分别见于活动性、萎缩性炎症和肠上皮化生及轻、重度异型增生的胃黏膜.E型黏膜约81.8%(99/121)为肠上皮化生.F型黏膜常提示病灶已出现不同程度的异型增生86.3%(69/80),F型黏膜伴异常增生毛细血管,89.9%出现异型增生.结论:放大色素内镜能准确识别胃小凹的形态,尤其是准确识别E和F型,有助于对肠上皮化生及异型增生等胃黏膜癌前病变的镜下诊断.     

放大内镜结合窄带成像对胃浅表隆起性低级别腺瘤与早期胃癌的诊断价值

目的研究放大内镜结合窄带成像(M-NBI)对胃浅表隆起性低级别腺瘤与早期胃癌的诊断价值。方法选取2016-09～2018-05于郑州大学第二附属医院行无痛胃镜检查的53例胃浅表隆起性病变的患者,分别采用白光成像(C-WLI)和M-NBI对同一患者进行诊断,分析和比较两种方法的灵敏度、特异度和准确度。结果 C-WLI的诊断灵敏度、特异度和准确度分别为64. 0%、90. 0%、72. 0%; M-NBI的诊断灵敏度、特异度和准确度分别为94. 0%、90. 0%和93. 0%。结论 M-NBI有助于鉴别浅表隆起性胃癌和腺瘤。     

窄带成像技术联合高清放大胃镜在诊断早期胃癌中的价值分析

目的探讨窄带成像技术联合高清放大胃镜(ME-NBI)在早期胃癌诊断中的应用价值。方法选取2015年12月至2017年2月间在我院行胃镜检查发现黏膜异常病变的101例患者,先采用普通白光胃镜(White-lightendoscopy,WLE)模式进行观察及镜下诊断,然后切换ME-NBI模式再次进行观察及镜下诊断,并于病变区取活检行常规病理组织学检查。对比两种检查模式的微血管及黏膜腺管结构的图像质量及对早期胃癌诊断的敏感度、特异度及准确度。结果 ME-NBI模式的微血管及黏膜腺管结构图像质量均明显优于WLE模式(P 0. 01)。ME-NBI模式诊断早期胃癌的敏感度(91. 7%)、特异度(97. 8%)和准确度(97. 0%)明显优于WLE模式的敏感度(50. 0%)、特异度(51. 7%)和准确度(51. 5%)。结论 ME-NBI技术能帮助医生评估患者胃黏微血管及黏膜腺管结构的改变,对于早期胃癌诊断的敏感度、特异度和准确度有显著提高。     

窄带成像技术联合放大内镜与胃镜活检诊断早期胃癌的价值比较

目的:评估比较窄带成像技术联合放大内镜(narrow band imaging-magnifying endoscopy N B I-M E)、内镜病理活检在早期胃癌诊断中的价值.方法:首先在普通白光下系统观察,发现可疑病变(胃黏膜形态或颜色改变)后行NBIME观察,采集照片并做出内镜下诊断,于病灶最明显处取活检并行病理检查.所有患者均行内镜下切除或外科手术治疗,术后行病理活检.分别计算NBI-ME、内镜活检诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率.比较内镜活检与术后切除病理的一致性,并计算Kappa值.结果:123例纳入本研究,最终术后切除病理示胃炎51例,低级别上皮内瘤变(low-grade neoplasia,LGIN)24例,早期胃癌48例.NBIM E诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为97.9%、80.0%、75.8%、98.4%、87.0%,内镜活检的对应值分别为66.7%、94.7%、88.9%、81.6%、83.7%.NBI-ME诊断早期胃癌的敏感度明显高于内镜活检(P0.005),特异度低于内镜活检(P0.005),两者准确率无明显差异(P0.05).内镜下活检病理与术后切除病理Kappa值为0.642(P0.05).结论:NBI-ME对早期胃癌诊断价值较高,对于NBI-ME下符合早期胃癌诊断的患者建议行内镜或手术进一步治疗.     

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.