非酒精性脂肪性肝炎患者血清sCD163和IL-1βmRNA水平变化及其临床意义探讨

目的 探讨非酒精性脂肪性肝炎(NASH)患者血清可溶性白细胞分化抗原163(sCD163)和白介素(IL)1βmRNA水平变化及其临床意义。方法 2016年1月～2018年3月我院消化内科就诊的NASH患者51例和健康人51例。采用ELISA法检测血清sCD163、内脂素和脂联素水平,采用RT-PCR法检测血清IL-1βmRNA水平。结果 NASH患者血糖(Glu)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)和总胆固醇(TC)水平为(6.1±1.4)mmol/L、(3.6±1.1)mmol/L、(2.9±0.4)mmol/L和(6.1±0.6)mmol/L,显著高于健康人【分别为(4.5±0.3)mmol/L、(2.5±0.9)mmol/L、(2.2±0.2)mmol/L和(4.5±0.3)mmol/L,P<0.05】;NASH患者血清sCD163、IL-1βmRNA、内脂素和脂联素水平分别为(70.7±10.4) ng/ml、(0.5±0.1)、(31.1±8.4)μg/ml和(6.8±1.3)μg/ml,与健康人【分别为(30.8±5.9) ng/ml、(0.1±0.2)、(15.9±2.6)μg/ml和(15.2±2.2)μg/ml,P<0.05】比,存在显著性差异; NASH患者血清ALT、AST和GGT水平分别为(73.5±3.9)U/L、(62.7±2.8)U/L和(108.0±4.1)U/L,显著高于健康人【分别为(33.5±3.9)U/L、(32.7±2.8)U/L和(48.0±4.1)U/L,P<0.05】。结论 NASH患者除了存在肝功能指标的异常和血糖血脂代谢紊乱外,还表现为血清血清sCD163、IL-1βmRNA和内脂素水平升高,脂联素水平降低。了解这些变化特征,可能对判断肝组织损伤程度和病情具有重要的临床意义。     

慢加急性乙型肝炎肝衰竭患者血清自噬相关蛋白水平及其临床意义探讨*

目的 探讨慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者血清p62、微管相关蛋白1轻链3-Ⅱ(LC3-Ⅱ)和Beclin1水平变化及其临床意义。方法 2018年9月～2020年9月我院收治的HBV-ACLF患者60例和同期体检的健康人65例,计算终末期肝病模型评分(MELD),采用ELISA法测定血清p62、Beclin1和LC3-Ⅱ水平;应用受试者工作特征曲线(ROC)下面积(AUC)评估指标对HBV-ACLF患者预后的预测效能。结果 60例HBV-ACLF患者血清LC3-Ⅱ和Beclin1水平分别为(66.8±13.5)ng/mL和(11.7±3.6)ng/mL,均显著高于健康人【分别为(35.8±6.2)ng/mL和(8.2±2.9)ng/mL,P＜0.05】,而血清p62水平为(2.5±0.9)ng/mL,显著低于健康人【(4.5±1.6)ng/mL,P＜0.05】;在治疗观察90 d,本组HBV-ACLF患者死亡18例(30.0%);入院时死亡组血清LC3-Ⅱ、Beclin1和MELD评分为(76.25±12.1)ng/mL、(10.9±3.2)ng/mL和(20.1±3.3)分,均显著高于生存组【分别为(62.8±10.2)ng/mL、(13.4±3.5)ng/mL和(16.7±4.6)分,P＜0.05】,而血清p62水平为(1.7±0.6)ng/mL,显著低于生存组【(2.9±0.8)ng/mL,P＜0.05】;ROC曲线分析发现,以血清p62＜2.2 ng/mL、LC3-Ⅱ＞70.3 ng/mL和Beclin1＞12.6 ng/mL为截断点,预测HBV-ACLF患者预后不良的AUC分别为0.856、0.820和0.765,三者联合预测的AUC为0.910,与以MELD评分＞18.3 分为截断点的预测效能为0.917相差无几。结论 应用血清p62、LC3-Ⅱ和Beclin1水平预测HBV-ACLF患者预后有一定的实用意义,值得进一步动态观察。     

乙型肝炎肝衰竭并发感染患者病原菌分布及血清HMGB1和sICAM-1水平变化*

目的 调查乙型肝炎肝衰竭患者并发感染的病原菌分布特点及血清高迁移率族蛋白B1(HMGB1)和可溶性髓系细胞触发受体-1(sTREM-1)水平变化。方法 2015年1月～2019年6月我院感染病科诊治的179例乙型肝炎肝衰竭患者,常规培养分离病原菌,采用ELISA法检测血清HMGB1和sICAM-1水平。结果 在治疗3月内,本组患者发生感染115例(64.2%),未感染64例,其中单部位感染占67.8%,双部位感染占27.0%,三部位感染占5.2%。115例并发感染患者共有感染部位158个,其中腹部感染占61.7%,呼吸系统感染占32.2%,胆道感染占25.2%,败血症占3.5%;在115例感染患者中,培养分离出病原菌205株,其中革兰阴性菌119株(58.0%),以大肠埃希菌为主(41.5%),革兰阳性菌55株(26.8%),以金黄色葡萄球菌为主(12.7%),真菌31株(15.1%),以白色念珠菌为主(8.8%);感染患者腹水发生率为73.9%,显著高于未感染组(29.7%,P<0.05),肝性脑病发生率为37.4%,显著高于未感染组(18.8%,P<0.05),低钠血症发生率为59.1%,显著高于未感染组(26.6%,P<0.05),消化道出血发生率为13.9%,显著高于未感染组(3.1%,P<0.05);感染组血清肌酐水平为(93.7±31.7)μmol/L,显著高于未感染组【(81.0±26.6)μmol/L,P<0.05】,HMGB1水平为(13.1±2.6)ng/ml,显著高于未感染组【(10.2±2.0)ng/ml,P<0.05】,MELD评分为(28.2±5.0)分,显著高于未感染组【(20.3±3.8)分,P<0.05】,而血清sICAM-1水平为(804.3±134.7)ng/ml,显著低于未感染组【(1152.7±263.5)ng/ml,P<0.05】。结论 乙型肝炎肝衰竭患者感染发生率较高,感染部位以腹部最多,病原菌以革兰阴性菌为主,并发感染的乙型肝炎肝衰竭患者并发症发生率较高,血清HMGB1水平升高,sICAM-1水平降低,了解这些指标的变化规律可能有助于临床判断感染的存在。     

血清HBeAg阴性慢性乙型肝炎患者APRI、FIB-4和血清TGF-β1水平变化*

目的 调查血清HBeAg阴性的慢性乙型肝炎(CHB)患者天门冬氨酸氨基转移酶与血小板比值(APRI)、基于4因子指数(FIB-4)和血清转化生长因子-β1(TGF-β1)的变化。方法 2018年1月～2019年5月我院诊治的血清HBeAg阴性的CHB患者78例和同期健康人78例,采用ELISA法测定血清TGF-β1水平,常规检测血生化指标,计算APRI和FIB-4评分。CHB患者接受肝活检,并行肝纤维化分期。结果 CHB患者APRI评分为(0.9±0.4),显著高于健康人【(0.3±0.1),P<0.05】;FIB-4评分为(1.4±0.4),显著高于健康人【(0.5±0.2),P<0.05】,血清TGF-β1水平为(14.5±5.3)ng/ml,显著高于健康人【(7.4±3.5)ng/ml,P<0.05】;33例CHB患者肝组织F0～1者APRI评分为(0.5±0.2),显著低于24例肝组织F2者【(1.0±0.3),P<0.05】,显著低于12例肝组织F3者【(1.3±0.5),P<0.05】,也显著低于9例肝组织F4者【(1.8±1.6),P<0.05】;F0～1患者FIB-4评分为(0.9±0.3),显著低于F2患者【(1.5±0.4),P<0.05】,显著低于F3患者【(1.9±0.4),P<0.05】,也显著低于F4患者【(3.2±0.6),P<0.05】;F0～1患者血清TGF-β1水平为(9.7±3.6)ng/ml,显著低于F2患者【(10.5±4.4)ng/ml,P<0.05】,显著低于F3患者【(15.8±5.9)ng/ml,P<0.05】,也显著低于F4患者【(19.5±6.2)ng/ml,P<0.05】。结论 血清HBeAg阴性的CHB患者APRI、FIB-4和血清TGF-β1水平发生了显著的变化,随着肝纤维化程度的加重,这些指标变化更明显,可能有助于提高对肝纤维化的诊断。     

多种预后评分系统预测慢加急性肝衰竭并发真菌感染患者短期预后价值分析*

目的 探讨应用终末期肝病模型(MELD)、终末期肝病模型联合血清钠模型(MELD-Na⁺)、亚太肝脏研究协会慢加急性肝衰竭研究小组评分(AARC-ACLF)和慢性肝衰竭-序贯器官衰竭评分(CLIF-SOFA)等4种预后评分系统预测慢加急性肝衰竭(ACLF)并发真菌感染(IFI)患者短期预后的价值。方法 2018年1月～2020年10月我院收治的ACLF并发IFI患者60例,给予内科综合治疗,分别计算MELD、MELD-Na⁺、AARC-ACLF和CLIF-SOFA评分,应用受试者工作特征曲线(ROC)评估4种预后评分系统对患者死亡风险的预测效能。结果 在治疗观察12 w末,本组ACLF并发IFI患者病死率为68.3%;41例死亡组血清总胆红素、凝血酶原时间国际标准化比值、肌酐和乳酸水平分别为(362.9±79.7)μmol/L、(2.3±0.2)、(131.7±21.5)μmol/L和(1.6±0.4)mmol/L,均显著高于生存组【分别为(277.4±63.6)μmol/L、(1.7±0.1)、(102.9±15.3)μmol/L和(1.3±0.3)mmol/L,P＜0.05】,而血清白蛋白水平为(29.6±2.2)g/L,显著低于生存组【(31.8±2.7)g/L,P＜0.05】;死亡组并发肝性脑病发生率为43.9%,显著高于生存组的10.5%(P＜0.05);死亡组MELD评分、MELD-Na⁺评分、CLIF-SOFA评分和AARC-ACLF评分分别为(29.1±7.3)分、(30.4±7.5)分、(8.7±1.4)分和(9.2±1.1)分,均显著高于生存组【分别为(20.7±4.6)分、(21.9±5.2)分、(6.8±1.0)分和(7.3±0.8)分,P＜0.05】;ROC曲线分析发现,分别以MELD评分＞22.0分、MELD-Na⁺评分＞23.0分、AARC-ACLF评分＞8.0分和CLIF-SOFA评分＞8.0分为截断点,预测ACLF并发IFI患者12 w死亡风险高的AUC分别为0.687、0.716、0.893和0.884,提示CLIF-SOFA评分和AARC-ACLF评分预测效能显著优于MELD评分或MELD-Na⁺评分(P＜0.05)。结论 应用AARC-ACLF和CLIF-SOFA评分可预测ACLF并发IFI患者近期病死风险,具有一定的临床实用价值。     

肝细胞癌患者血清HSP90α和PIVKA-Ⅱ水平变化及其临床意义探讨*

目的 探讨热休克蛋白90α(HSP90α)和维生素K拮抗剂诱导蛋白-Ⅱ(PIVKA-Ⅱ)在肝细胞癌(HCC)患者血清变化及在预后评估中的价值。方法 2014年1月～2016年6月我院诊治的HCC患者112例、乙型肝炎肝硬化患者96例、慢性乙型肝炎患者82例和健康体检者84例,所有肝癌患者接受经肝动脉化疗栓塞术,采用ELISA法检测血清HSP90α和PIVKA-Ⅱ水平,采用多元Logistic回归分析影响3 a生存的因素,应用ROC曲线评估血清HSP90α和PIVKA-Ⅱ单独或联合预测HCC患者3 a生存率的价值。结果 HCC组血清HSP90α和PIVKA-Ⅱ水平分别为(61.6±5.0)ng/mL和(832.6±66.7)mAU/mL,显著高于乙型肝炎肝硬化组[分别为(13.2±1.6)ng/mL和(29.4±2.9)mAU/mL,P<0.05]、慢性乙型肝炎组[分别为(4.3±0.4)ng/mL和(29.1±3.0)mAU/mL,P<0.05]或健康人组[分别为(3.2±0.4)ng/mL和(26.7±3.2)mAU/mL,P<0.05];入组时55例生存组血清HSP90α和PIVKA-Ⅱ水平分别为(44.4±4.4)ng/mL和(701.3±62.3)mAU/mL,显著低于57例死亡组[分别为(78.3±5.2)ng/mL和(959.2±92.2)mAU/mL,P<0.05];单因素分析表明肝外转移、肿瘤分化程度、Child-Pugh分级、TNM分期、血清HSP90α和PIVKA-Ⅱ水平影响HCC患者生存,而多因素Logistic回归分析发现,肝外转移、肿瘤分化程度低、Child-Pugh C级、TNM Ⅲ~Ⅳ期、血清HSP90α和PIVKA-Ⅱ水平高为影响HCC患者3 a生存率的独立危险因素(P<0.05);ROC曲线分析结果显示血清HSP90α和PIVKA-Ⅱ单独预测HCC患者3 a生存率的AUC分别为0.814和0.836,显著低于两者联合预测的0.929(P<0.05)。结论 血清HSP90α和PIVKA-Ⅱ水平影响肝细胞癌患者生存,对于高水平者,应密切观察其病情变化,并及时给予适当的干预。     

肝衰竭患者血浆置换治疗后血清胆红素和凝血酶原活动度变化规律浅探

目的 研究血浆置换(PE)治疗肝衰竭患者血清胆红素和凝血酶原活动度变化规律。方法 2015年2月～2018年8月安徽医科大学第二附属医院肝病科住院的肝衰竭患者47例,分别接受3次以上PE治疗。采用二元多因素Logistic回归分析影响肝衰竭患者短期预后的因素。结果 在治疗12 w末,本组47例患者生存22例(46.8%),死亡25例;25例死亡患者年龄为(47.5±13.4)岁、基线MELD评分为(33.5±6.1)分、PTA为(23.8±10.1)%、APTT为(93.8±40.6)s,与22例生存患者比,差异显著,死亡组肝性脑病发生率为64.0%,显著高于生存组的27.3%(P＜0.05);多因素 Logistic 回归分析提示年龄和基线PTA是影响肝衰竭患者短期预后的独立危险因素;经线性回归分析发现,PE术后TBIL下降与术前TBIL 水平呈正相关(r=0.866,P＜0.05),首次PE术后PTA升高最显著(P＜0.05)。结论 年龄和凝血酶原活动度是影响肝衰竭患者预后的独立危险因素,了解这些重要的指标对判断病情和及时地给予处理对改善预后很有帮助。     

慢加急性乙型肝炎肝衰竭患者血清聚集素水平变化及其临床意义探讨*

目的 探讨慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者血清聚集素水平变化及其临床意义。方法 2019年1月～2021年1月我院收治住院的HBV-ACLF患者48例和同期入院诊治的慢性乙型肝炎(CHB)患者60例,采用ELISA法检测血清聚集素水平。结果 HBV-ACLF组外周血白细胞计数、血清ALT、AST、TBIL和MELD评分分别为(8.0±2.8)×10⁹/L、(418.2±163.5)U/L、(386.1±139.2)U/L、(226.6±74.4)μmol/L和(23.2±5.3),显著高于CHB组【分别为(6.0±2.3)×10⁹/L、(163.8±75.7)U/L、(118.7±73.3)U/L、(25.6±12.4)μmol/L和(9.6±3.6),P<0.05】,而外周血PLT计数为(101.8±42.0)×10⁹/L,血清Alb水平为(32.6±7.6)g/L,PTA为(35.3±5.3)%,血清聚集素水平为(51.0±5.9)μg/mL,显著低于CHB组【分别为(128.5±54.4)×10⁹/L、(38.1±8.5)g/L、(77.4±9.3)%和(185.9±13.5)μg/mL,P<0.05】;9例HBV-ACLF晚期患者血清凝集素水平为(28.5±3.8)μg/mL,显著低于20例早期【(72.6±7.2)μg/mL,P<0.05】或19例中期【(46.0±5.2)μg/mL,P<0.05】患者,13例感染患者血清凝集素水平为(36.6±4.6)μg/mL,显著低于35例无感染患者【(56.6±6.1)μg/mL,P<0.05】,15例死亡患者血清凝集素水平为(39.8±4.3)μg/mL,显著低于33例生存患者【(72.3±7.6)μg/mL, P<0.05】;死亡患者血清总胆红素水平更高,MELD评分更高,PTA更低,并发肝性脑病为46.7%,并发肝肾综合征为40.0%,与生存患者比,差异显著(P<0.05)。结论 HBV-ACLF患者血清聚集素降低,其降低程度与预后相关,是否可作为一种潜在的生物标志物用于评估HBV-ACLF患者病情的严重程度和预后,值得进一步研究。     

自体骨髓干细胞移植治疗慢加急性乙型肝炎肝衰竭患者疗效初步研究

目的 探讨采取自体骨髓干细胞移植治疗慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者的疗效。方法 2017年5月~2018年12月在我院肝肾内科就诊的94例HBV-ACLF患者,被随机分为对照组47例和观察组47例,在内科综合治疗的基础上分别给予血浆透析滤过(PDF)和PDF联合经肝动脉自体骨髓干细胞移植治疗。采用美国东部肿瘤协作组评分(ECOG)和终末期肝病模型(MELD)评分评价生活质量和肝功能状态。结果 在治疗24周和48周时,观察组生存率分别为72.3%和53.2%,均显著高于对照组的48.9%和31.9%(P<0.05);在治疗24周末,34例观察组生存患者血清白蛋白(ALB)水平为(35.8±3.9)g/L,显著高于25例对照组【(32.3±3.5)g/L,P<0.05】;在治疗24周和48周时,观察组ECOG评分≥2级发生率为26.5%和12.0%,显著低于对照组56.5%和40.0%(P<0.05);在治疗48周时,观察组MELD评分为(9.7±1.3)分,显著低于对照组【(11.4±1.5)分,P<0.05】。结论 采取PDF联合自体骨髓干细胞移植治疗HBV-ACLF患者可显著促进蛋白合成,降低病死率,提高ECOG评分。        

超声引导下经皮经肝胆管穿刺引流术治疗急性梗阻性化脓性胆管炎患者疗效分析

目的 探讨在超声引导下经皮经肝胆管穿刺引流术(PTCD)治疗急性梗阻性化脓性胆管炎(AOSC)患者的疗效。方法 2015年3月~2018年11月我院肝胆外科收治的78例AOSC患者,被随机分为开腹组(n=39)和PTCD(n=39),分别采取开腹手术和在超声引导下PTCD治疗。结果 PTCD组手术时间、出血量、留置引流管时间和住院时间分别为(89.7±7.5)min、(26.3±2.4)ml、(8.8±1.0)d和(9.7±1.5)d,均显著少于或短于开腹组【分别为(120.8±10.6)min、(40.4±4.3)ml、(13.2±2.9)d和(18.6±3.8)d,P<0.05】;治疗后,两组患者肝功能指标变化无统计学差异(P>0.05);PTCD治疗患者血清降钙素原、白介素-6、白介素-4和C反应蛋白水平分别为(5.9±0.8)ng/L、(87.8±7.4)ng/L、(14.7±1.5)ng/L和(2.1±0.5)mg/L,均显著低于开腹组【分别为(8.9±1.2)ng/L、(102.9±11.3)ng/L、(22.4±2.1)ng/L和(3.1±0.7)mg/L,P<0.05】;PTCD治疗组术后并发症发生率显著低于开腹组(5.1%对23.1%,P<0.05)。结论 超声引导下PTCD治疗AOSC患者可有效改善手术相关指标,减少并发症的发生,可能与引起机体炎症反应较轻有关。     

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.