七氟醚预处理对缺血再灌注大鼠心肌活性氧产生的影响及其发挥心肌保护作用的机制

目的: 观察七氟醚预处理对缺血再灌注大鼠心肌活性氧以及一氧化氮(NO)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GPx)、过氧化氢酶(CAT)活性的影响,进一步探讨活性氧在七氟醚预处理减轻心肌缺血再灌注损伤中的作用。方法: 60只SD大鼠随机分为8组。在体用2%七氟醚预处理30 min 后结扎冠状动脉前降支30 min,然后再灌注120 min。以心肌梗死面积和凋亡指数反映心肌损伤情况,心肌梗死面积用氯化三苯基四氮唑染色显示,细胞凋亡用TUNEL染色显示。活性氧用活性氧荧光探针二氢乙啶测量。使用活性氧清除剂N-(2-巯基丙酰基)甘氨酸(2-MPG)以及一氧化氮合酶抑制剂N^ω-硝基-L-精氨酸甲酯(L-NAME)作为阻滞剂,用酶标仪测定心肌匀浆的NO、SOD、GPx和CAT活性,并进一步分析阻断活性氧及NO产生对七氟醚减轻心肌缺血再灌注损伤的影响。结果: 与对照组比较,七氟醚预处理在缺血再灌注前诱导活性氧产生(12.0±0.8 vs 2.6±0.5, P<0.05),在缺血再灌注后减少活性氧产生(16.2 ±0.9 vs 24.9±1.3, P<0.05);在缺血再灌注前,2-MPG减少七氟醚预处理心肌活性氧产生(5.1±0.7 vs 12.0±0.8, P<0.05),在缺血再灌注后2-MPG+七氟醚预处理组与缺血再灌注组比较无显著差别(24.9±1.4 vs 24.9±1.3, P>0.05);与对照组比较,七氟醚预处理同样诱导NO产生(34.5±3.2 vs 15.9±1.4, P<0.05),增加SOD(1.5±0.5 vs 0.6±0.2, P<0.05)、GPx(22.8±2.5 vs 12.7±2.2, P<0.05)和CAT(15.5±1.8 vs 11.2±1.4, P<0.05)的活性;2-MPG消除了七氟醚对NO、SOD、CPx和CAT的诱导作用和对缺血再灌注心肌的保护作用; L-NAME同样消除七氟醚预处理对SOD、GPx和CAT的诱导作用和心肌保护作用。结论: 七氟醚预处理减少心肌梗死面积和凋亡指数;七氟醚预处理产生的亚损伤量的活性氧和NO诱导缺血再灌注心肌SOD、GPx和CAT的产生,进而抑制缺血再灌注活性氧的产生和心肌损伤。     

心肌缺血时NO代谢的动态变化

目的:探讨心肌缺血过程中一氧化氮(NO)代谢的动态变化。方法:采用小鼠在体心肌缺血模型和大鼠离体心脏灌流模型,分别观察不同程度和时间缺血对心肌NO浓度的影响,并进一步观察缺血对心肌一氧化氮合酶(NOS)和NOS基因表达的影响。结果:在一定范围内,随着垂体后叶素(Pit)剂量的增加和Pit加入后时间的延长,心肌NO代谢产物浓度逐渐下降。在体实验中,Pit剂量为30U/kg及Pit注入后30min,心肌NO代谢产物浓度显著低于对照组(P<0.01);离体实验中,Pit剂量为200U/L和Pit加入后15min,心肌NO代谢产物浓度亦显著低于对照组(P<0.01)。同时,缺血组心房肌和心室肌内NOS阳性细胞数[分别为(5.70±1.30)个/5个视野和(6.19±1.01)个/5个视野]和NOS活性以及NOSmRNA基因表达(灰度测定值分别为28.33±5.50和33.67±6.67)均少于正常对照组[NOS阳性细胞数分别为(13.94±2.35)个/5个视野和(17.68±2.76)个/5个视野,灰度测定值分别为52.83±5.19和60.33±8.50](P<0.01)。结论:心肌缺血引起心肌NO浓度的显著下降,其机制可能是缺血引起了NOSmRNA基因表达的减少。     

心肌缺血预处置对心肌组织11,12-二十碳三烯酸的影响

目的: 观察心肌缺血预处置和再灌注损伤时心肌内源性11,12-环氧二十碳三烯酸(11,12-epoxyeicosatrienoicacid, 11,12-EET)的改变, 探讨内源性11,12-EET在缺血预处置中的作用。方法: 使用雄性Wistar大鼠,通过结扎(60 min)和松开(30 min)冠状动脉左前降支, 复制心肌缺血/再灌注模型; 采用缺血5 min, 再灌注5 min两次造成缺血预处置。实验分5组: ①假手术组(sham); ②缺血再灌注组(I/R); ③短阵缺血预处置组(SI); ④短阵缺血预处置缺血/再灌注组(SI+I/R)。采用气相色谱法测定心肌11,12-EET的含量, 并观察再灌注过程中心功能的变化。结果: I/R组+dp/dt_max、-dp/dt_max以及LVDP均低于、心肌11,12-EET高于sham组及SI+I/R组(P<0.01); 而SI+I/R组心肌11,12-EET也高于sham组(P<0.01)。结论: 整体动物心肌再灌注使大量内源性11,12-EET释放, 是再灌注损伤机制之一;缺血预处置抑制再灌注时心肌11,12-EET的增加, 可能与缺血预处置心肌保护作用有关。     

缺血后处理对抗大鼠离体心脏缺血再灌注损伤及其作用机制

目的： 研究缺血后处理（postconditioning）对抗大鼠离体心脏缺血再灌注损伤及其作用机制。方法：采用SD大鼠心肌缺血/再灌注模型，并于再灌注一开始即给予3次全心停灌30 s，再灌30 s处理作为缺血后预处理。记录心肌收缩功能指标，以Even’s blue-TTC法监测心肌梗死范围，并对心律失常严重程度进行定量分析。结果：缺血后处理组左室峰压（LVSP）、最大左室收缩速率（+dp/dt_max）以及心率明显高于缺血对照组。缺血后处理可明显缩小心肌梗死范围（22.97%±3.96% vs 缺血对照组 44.30%±13.61%，P<0.01）。观察复灌10 min时心律失常评分发现，缺血后处理组明显低于缺血对照组。缺血后处理组和缺血预处理组具有类似的心肌保护作用。5-HD组LVSP和+dp/dt_max低于缺血后处理组，心律失常评分增高，心肌梗死范围扩大。结论: 缺血后处理对大鼠缺血再灌注损伤具有心脏保护作用，其作用机制可能是部分通过激活线粒体ATP依赖性钾离子(mitoK_ATP)通道起作用。     

心肌缺血预处置对心肌组织11,12-环氧二十碳三烯酸的影响

目的 :观察心肌缺血预处置和再灌注损伤时心肌内源性 1 1 ,1 2 -环氧二十碳三烯酸 (1 1 ,1 2 -epoxye icosatrienoicacid ,1 1 ,1 2 -EET)的改变 ,探讨内源性 1 1 ,1 2 -EET在缺血预处置中的作用。方法 :使用雄性Wistar大鼠 ,通过结扎 (60min)和松开 (30min)冠状动脉左前降支 ,复制心肌缺血 /再灌注模型 ;采用缺血 5min ,再灌注 5min两次造成缺血预处置。实验分 5组 :①假手术组 (sham) ;②缺血再灌注组 (I/R) ;③短阵缺血预处置组 (SI) ;④短阵缺血预处置缺血 /再灌注组 (SI+I/R)。采用气相色谱法测定心肌 1 1 ,1 2 -EET的含量 ,并观察再灌注过程中心功能的变化。结果 :I/R组 +dp/dtmax、-dp/dtmax以及LVDP均低于、心肌 1 1 ,1 2 -EET高于sham组及SI +I/R组 (P <0 0 1 ) ;而SI+I/R组心肌 1 1 ,1 2 -EET也高于sham组 (P <0 0 1 )。结论 :整体动物心肌再灌注使大量内源性 1 1 ,1 2 -EET释放 ,是再灌注损伤机制之一 ;缺血预处置抑制再灌注时心肌 1 1 ,1 2 -EET的增加 ,可能与缺血预处置心肌保护作用有关。     

精胺减轻大鼠在体心肌缺血/再灌注损伤的作用及机制初探

目的: 观察低浓度外源性精胺对大鼠心肌缺血/再灌注损伤的影响。方法: Wistar大鼠随机分成假手术（Sham）组、缺血/再灌注损伤（I/R）组、盐水对照（NS）组和精胺干预（Sp）组（n=10）。结扎冠脉复制心肌缺血/再灌注损伤模型。Sp组缓慢静脉推注 0.5 mmol/L 精胺 2 mL/kg。观察指标：心电图，心功能参数，血清SOD、LDH、NO、MDA水平和心肌超微结构等。结果: I/R组心律失常发生率高达90％，心肌超微结构损伤严重，LVSP 和±dp/dtmax明显降低，血清中NO、MDA及LDH升高，SOD活性降低（P<0.05或P<0.01 vs Sham组）。Sp组与I/R组及NS组相比，上述指标均有显著差异（P<0.05或P<0.01）。结论: 低浓度外源性精胺能减轻大鼠心肌缺血/再灌注损伤，其机制可能与抗氧化和减轻氧自由基损伤有关。     

丹参酮ⅡA磺酸钠对家兔缺血预处理心肌保护作用的影响

目的观察丹参酮ⅡA磺酸钠对家兔缺血预处理心肌保护作用及血浆和心肌组织NO代谢产物含量的影响。方法家兔24只 ,随机分为心肌缺血再灌注组 (IR ,n=8)、缺血预处理组 (IPC,n=8)和丹参酮ⅡA磺酸钠联合缺血预处理组 (DS-201 IPC,n=8) ;TTC染色测定梗塞面积 ;HE染色病理组织学观察。采用硝酸还原酶法检测缺血前、缺血后30min和再灌注30min三个时点血浆及心肌组织NO代谢物含量。结果 (1)TTC染色称重结果显示 ,IPC组心肌梗死面积 (梗死区重量/缺血区重量为9.54±5.79)明显小于IR组 (梗死区重量/缺血区重量为35.48±3.84Δ ,P<0.05) ,DS201 IPC组心肌梗死面积 (梗死区重量/缺血区重量为5.66±1.6)明显小于IPC组心肌梗死面积 (P<0.05)。病理学检测显示 ,与IR组相比 ,IPC组组织损伤程度明显减轻。与IPC组相比 ,DS201 IPC组组织损伤程度明显减轻。 (2)缺血30min和再灌注30minIR组血浆NO代谢产物[缺血30min(11.2±3.9)μmol/L,再灌注30min(11.6±5.6)μmol/L]和心肌组织NO代谢产物[再灌注30min末(23.0±5.3)μmol/mg]显著低于缺血前[血浆NO代谢产物为(28.5±6.8)μmol/L,心肌组织NO代谢产物为(49±18.3)μmol/mg](P<0.05) ;缺血30min和再灌注30minIPC组血浆NO代谢产物[缺血30min(19.5±2.5)μmol/L,再灌注30min(1     

替罗非班对大鼠心肌缺血再灌注后无复流及NF-κB激活的影响

目的： 研究血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班对大鼠心肌缺血再灌注后无复流及NF-κB激活的影响。方法：雄性Wistar大鼠,随机分为假手术组、心肌缺血再灌注组和替罗非班治疗组（60 μg/kg,再灌注前30 min股静脉注射）。心肌缺血再灌注组和替罗非班治疗组采用开胸冠状动脉结扎方法,缺血90 min再灌注120 min建立急性心肌缺血再灌注无复流模型。观察大鼠心肌缺血、梗死及无复流范围;免疫组织化学方法半定量分析心肌细胞及微动脉核因子-κB p65（NF-κB p65）的阳性表达;测定心肌髓过氧化物酶（MPO）活性及丙二醛（MDA）含量。结果： 心肌缺血再灌注组和替罗非班治疗组大鼠缺血区心肌细胞及微动脉NF-κB p65的阳性表达、心肌MPO活性、MDA含量高于假手术组;替罗非班治疗组大鼠缺血区心肌细胞及微动脉NF-κB p65的阳性表达、心肌MPO活性、MDA含量低于心肌缺血再灌注组（P＜0.05）;心肌无复流范围及梗死范围小于心肌缺血再灌注组（34.36%±6.04% vs 52.09%±6.89%, P＜0.01; 80.41%±8.48% vs 90.13%±5.72%, P＜0.05）。结论： 大鼠心肌缺血90 min再灌注120 min时,可发生无复流现象;替罗非班可缩小心肌无复流及梗死范围,抑制NF-κB激活,减少中性粒细胞浸润及氧自由基释放。     

低浓度11,12-EET预干预对大鼠心肌缺血/再灌注损伤的影响

目的 :观察外源性低浓度 11,12 -EET预干预对大鼠在体心肌缺血 /再灌注损伤的影响。方法 :雄性Wistar大鼠 ,开胸 ,结扎和松开冠状动脉左前降支 ,复制心肌缺血 /再灌注模型 ;采用缺血 5min/再灌注 5min两次造成缺血预处置。实验分 3组 :对照组 ;缺血预处置组 ;外源性 11,12 -EET预干预组。每组再分为A、B 2小组 :A组动物心肌缺血 10min/再灌注 10min ,主要观察缺血 /再灌注各时程之心律失常 ;B组动物缺血 6 0min/再灌注 30min ,主要观察缺血期心律失常、心功能的变化及再灌注后心肌梗死范围。结果 :缺血预处置和 11,12 -EET(6 2 4× 10 -8mol/L)预干预均可减轻缺血 /再灌注心律失常及心功能的变化 ,降低心肌梗死范围。结论 :11,12 -EET预干预具有类缺血预处置样的心肌保护作用     

缺血后处理对离体大鼠心肌线粒体功能的影响

目的：建立离体大鼠心肌缺血/再灌注损伤模型,观察缺血后处理对大鼠心肌线粒体功能的影响,并探讨线粒体ATP敏感性钾通道（mitoK_ATP）在缺血后处理心肌保护中的作用。方法：采用Langendorff装置建立离体大鼠心肌缺血/再灌注损伤模型。将SD大鼠随机分为对照组（C）、模型组（M）、缺血后处理组（IPO）、5-羟癸酸拮抗缺血后处理组（5-HD+IPO）,每组8只。各组均先灌注平衡20 min,C组：续灌70 min;M组：缺血前灌注4 ℃ St.Thomas停跳液（10 mL/kg）,全心缺血40 min,复灌30 min;IPO组：全心缺血40 min,复灌前先开放10 s,缺血10 s,反复6次,时间为2 min,复灌28 min;5-HD+IPO组：缺血后处理前给予含5-羟癸酸（100 μmol/L）的K-H液灌注5 min,余同IPO组,复灌23 min。观察各组平衡末与再灌注末心肌线粒体膜电位、氧自由基及呼吸功能的变化。结果：(1) 各组再灌注末心肌线粒体膜电位较平衡末显著降低,而C组显著高于其它3组,IPO组明显高于5-HD+IPO与M组,5-HD +IPO组高于M组。(2) 各组再灌注末与平衡末比较,心肌线粒体氧自由基含量显著升高,其中M组显著高于其它3组,5-HD +IPO组高于IPO及C组,IPO组高于C组。(3) 各组再灌注末较平衡末线粒体呼吸功能明显受损,且C组优于其它3组,IPO组优于5-HD+IPO与M组,5-HD +IPO组优于M组。结论：(1) 缺血后处理通过维护线粒体膜电位稳定、减少线粒体氧自由基的产生、保护线粒体呼吸链及功能,减轻心肌的再灌注损伤。(2) 5-HD不能完全阻断缺血后处理的心肌保护作用。(3) 缺血后处理的心肌保护效应可通过激活心肌mitoK_ATP实现,同时还有其它因素参与了缺血后处理的心肌保护。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.