磷酸肌酸钠对慢病毒介导Calumenin蛋白沉默阿霉素损伤心肌细胞内质网应激信号通路的作用

目的:探讨磷酸肌酸钠对网腔钙结合蛋白(Calumenin)沉默阿霉素损伤心肌细胞内质网应激信号通路作用。方法:培养乳鼠心肌细胞,构建稳定的慢病毒——Calumenin质粒,转染乳鼠培养心肌细胞,实验分为4组:对照组(正常细胞+3mg/L阿霉素)、模型组(慢病毒感染细胞+3mg/L阿霉素)、磷酸肌酸钠1组(正常细胞+阿霉素+磷酸肌酸钠)、磷酸肌酸钠2组(转染细胞+阿霉素+磷酸肌酸钠)。采用Western blotting技术检测各组心肌细胞Calumenin蛋白、内质网应激伴侣蛋白GRP78及内质网应激信号通路因子PERK、PATF-4PERK、eIF2ɑ、ATF-4、IRE1、CHOP表达。结果:1与对照组比较,模型组及磷酸肌酸钠2组心肌细胞Calumenin蛋白表达明显减少(P0.01)。2与对照组相比,模型组内质网应激伴侣蛋白GRP78及内质网应激信号通路因子PPERK、eIF2ɑ、ATF-4、IRE1、CHOP表达明显增多(P0.01)。3与模型组相比较,磷酸肌酸钠1组及磷酸肌酸钠2组内质网应激伴侣蛋白GRP78及内质网应激信号通路因子P-PERK、eIF2ɑ、ATF-4、IRE1、CHOP表达减少(P0.01)。结论:阿霉素损伤可能诱发ERS,并通过ERS凋亡信号通路PERK→P-PERK→eIF2a→ATF-4→CHOP/IRE1→CHOP引起心肌细胞凋亡;磷酸肌酸钠可抑制阿霉素损伤所诱导内质网应激介导的心肌细胞凋亡,这一作用机制可能是通过Calumenin蛋白抑制ERS及其凋亡信号通路PERK→P-PERK→eIF2a→ATF-4→CHOP/IRE1→CHOP实现的。     

AT1受体自身抗体对糖尿病肾病大鼠肾脏内质网应激通路相关分子葡萄糖调节蛋白78和CCAAT/增强子结合蛋白同源蛋白表达的影响

目的 探讨AT1受体自身抗体(AT1-AA)对DN大鼠肾脏内质网应激(ERS)通路相关分子葡萄糖调节蛋白78(GRP78)和CCAAT/增强子结合蛋白同源蛋白(CHOP)表达的影响. 方法 制备DN大鼠模型,ELISA检测血清AT1-AA,根据ELISA结果随机选择AT1-AA阳性和阴性DN大鼠纳入DN组(n=12),同时设立正常对照组(NC,n=6).电镜观察肾脏超微结构变化;TUNEL法检测肾脏细胞凋亡;RT-PCR测定大鼠肾组织GRP78和CHOP mRNA水平;Western blot分析肾组织中GRP78和CHOP蛋白的表达量. 结果 DN组肾脏细胞凋亡率较NC组升高,其中,AT1-AA阳性大鼠凋亡率高于AT1-AA阴性大鼠[(20.05±1.71)％vs(13.24±4.93)％](P＜0.01).与NC组相比,DN组肾组织GRP78、CHOP蛋白和mRNA水平均上调;进一步比较发现,AT1-AA阳性DN大鼠GRP78,CHOP蛋白及mRNA水平升高较AT1-AA阴性DN大鼠更明显. 结论 AT1-AA可能通过诱导DN大鼠肾脏ERS反应,并经ERS相关的CHOP凋亡信号通路而促进肾脏细胞凋亡,加重肾脏损害.     

低血糖对急性心肌梗死后内质网应激介导心肌细胞凋亡的作用和机制研究

目的通过体内大鼠模型观察低血糖水平对内质网应激(ERS)感受蛋白及凋亡信号分子表达的影响。方法将Wister大鼠40只中随机选20只结扎左冠状动脉前降支建立大鼠急性心肌梗死(AMI)模型;另20只为假手术,再随机分为正常血糖假手术组(SN组)、正常血糖AMI组(MN组)、低血糖假手术组(SL组)、低血糖AMI组(ML组),每组10只。建立术前低血糖模型,术后24h处死取材,评估大鼠心肌细胞凋亡程度、检测心肌组织中葡萄糖调节蛋白78/免疫球蛋白结合蛋白(GRP78/BIP)、蛋白激酶R样内质网激酶(PERK)和C/EBP同源蛋白(CHOP)及Caspase-12的表达情况。结果 ML组及MN组心肌细胞凋亡指数[(29.36±2.15)%、(20.27±2.80)%]明显高于SN组和SL组[(1.82±0.83)%、(1.97±0.96)%,P<0.05];MN组和ML组GRP78、PERK、CHOP及Caspase-12的表达明显高于SN组和SL组(P<0.01);MN组与ML组PERK表达比较,无统计学差异(P>0.05)。结论 AMI前低血糖水平激活了ERS诱导的细胞凋亡通路;内质网特异性标记蛋白表达与心肌细胞凋亡变化规律一致,ERS通路可能参与了大鼠AMI后心肌细胞凋亡的调控。     

慢性间歇低氧对大鼠颏舌肌细胞线粒体功能的影响及脂联素的干预作用

目的 探讨慢性间歇低氧(CIH)对大鼠颏舌肌细胞线粒体功能的影响及脂联素干预作用.方法 健康雄性Wistar大鼠39只,采用随机数字表法分成健康对照(NC)组、CIH组、CIH脂联素干预组(CIH+Ad组),每组13只.NC组大鼠呼吸正常空气,CIH组与CIH+Ad组均接受CIH环境(CIH 8 h/d,共5周),CIH+Ad组加用经静脉脂联素注射10 μg/次,2次/周,共5周.于实验终止(第35天)时测定并比较各组大鼠血清脂联素浓度、颏舌肌线粒体膜电位、线粒体复合物Ⅰ活性、线粒体复合物Ⅳ活性.结果 CIH组血清脂联素浓度明显低于NC组[(1108±112)ng/ml,(2241±121)ng/ml,P＜0.01];CIH+Ad组高于CIH组[(1889±119)ng/ml]但低于NC组[(2241±121)ng/ml,均P＜0.01].CIH组颏舌肌线粒体膜电位相对值(1.82±0.11)明显低于NC组(2.09±0.14,P＜0.01),CIH+Ad组(1.98±0.09)较CIH组略高但低于NC组,差异均有统计学差异(均P＜0.05).CIH组线粒体复合物Ⅰ、Ⅳ浓度[(35.68±1.73)μmol·min-1·mg-1,(2.37±0.11)nmol·min-1·mg-1]最低,CIH+Ad组[(37.18±1.95)μmol·min-1·mg-1,(2.49±0.09)nmol·min-1·mg-1]及NC组[(39.02±1.38)μmol·min-1·mg-1,(2.81±0.12)nmol·min-1·mg-1]依次增高.NC组与CIH组比较差异有统计学意义(P＜0.01),CIH+Ad组与CIH组和NC组比较差异有统计学意义(均P＜0.05).结论 CIH可致大鼠血清脂联素水平降低,并能显著损伤颏舌肌细胞线粒体功能,补充外源性脂联素能部分改善CIH对大鼠颏舌肌细胞线粒体功能的损伤,提示低脂联素血症可能参与CIH导致的颏舌肌能量代谢障碍.

Abstract：

Objective To investigate the effect of chronic intermittent hypoxia (CIH) on mitochondrial function in genioglossus cells of rats and intervention role of adiponectin (Ad). Methods Thirty-nine healthy male Wistar rats were randomly divided into 3 groups, normal control (NC) group, CIH group and CIH + Ad group with 13 rats in each. Rats in NC group were kept breathing normal air, while rats in both CIH and CIH + Ad groups experienced the same CIH environment ( CIH 8 h/day for successive 5 weeks). However, rats in CIH + Ad group was given intravenous Ad supplement at the dosage of 10 μg,twice a week for sucessive 5 weeks. At the end of experiment ( day 35 ), the levels of plasma adiponectin,mitochondrial membrane potential activities of respiratory chain complexes Ⅰ and Ⅳ in mitochondrion of genioglossus cells were compared among different groups. Results Serum Ad level was significantly lower in CIH group than that in NC group [(1108 ± 112) ng/ml vs (2241 ± 121) ng/ml, P＜0.01 ]. Serum Ad level in CIH + Ad group [ ( 1889 ± 119) ng/ml] was significantly higher than that in NC group but lower than that in CIH group ( all P ＜ 0. 01 ). Mitochondrial membrane potential was significantly lower in CIH group than that in NC group [ ( 1.82 ± 0. 11 ) vs (2. 09 ± 0. 14), P ＜ 0. 01 ]. Mitochondrial membrane potential in CIH + Ad group ( 1.98 ± 0. 09) was higher than that in CIH group but lower than that in NC group ( all P ＜ 0. 05 ). The concentrations of mitochondrial respiratory chain complexes Ⅰ and Ⅳ in CIH group ( 35.68 ± 1.73 ) μmol · min - 1 · mg- 1 and (2. 37 ± 0. 11 ) nmol · min - 1 ·mg - 1, respectively) were the lowest but became higher from CIH + Ad group [ (37. 18 ± 1.95) μ mol· min-1 · mg-1 and (2. 49 ±0.09) nmol · min-1 ·mg-1 ,respectively] to NC group (39.02 ± 1.38) μmol · min-1 · mg-1 and (2. 81±0. 12) nmol · min-1 ·mg-1 ,respectively), with a significant difference between NC and CIH groups ( P ＜ 0. 01 ), between CIH + Ad and CIH groups ( P ＜ 0. 05 ), as well as between CIH + Ad and NC groups (P ＜ 0. 05 ). Conclusion CIH could lead to hypoadiponectinemia and impaired mitochondrial function in genioglossus cells of rats. Since such changes could be partially improved by supplement of adiponectin, it was suggested that hypoadiponectinemia might be involved in CIH-induced impairment of genioglossus energy metabolism.     

脂联素对慢性间歇性低氧大鼠颏舌肌收缩功能的影响

目的 探讨慢性间歇性低氧(chronic intermittent hypoxia,CIH)对颏舌肌收缩功能的影响及脂联素(Ad)的干预作用.方法 健康雄性Wistar大鼠39只,随机分为正常氧组(NC组)、CIH组和CIH Ad干预组(CIH+Ad组),每组13只.NC组呼吸正常空气,CIH组与CIH+Ad组接收CIH建模环境(CIH 8 h/d,共35 d),CIH+Ad组织给予颈静脉注射脂联素10 μg/次,2次/周,共5周,NC组与CIH组注射生理盐水0.5 ml/次对照.于实验终止时测定并比较各组大鼠血清Ad浓度及颏舌肌的收缩功能.结果 ①CIH组血清Ad浓度明显低于NC组[(1 210.32±84.20) μg/L,(2 236.43±117.72)μg/L]；②CIH组单刺激收缩最大张力[(0.84±0.072) N/g]、强直收缩最大张力[(3.37±0.29)N/g]、单刺激波峰值张力时间[(93.47±7.4)ms]和1/2松弛时间[(8.79±0.66) ms]较NC组降低(P＜0.05),CIH+Ad组较CIH组改善(P＜0.05)；③三组大鼠强直收缩疲劳指数在第一个20 s下降明显,在此后的100 s,疲劳指数继续下降,但趋势缓慢,NC组、CIH+Ad组抗疲劳性均明显高于CIH组(P＜0.01).结论 CIH可致血清脂联素浓度下降,并影响颏舌肌收缩功能及抗疲劳性能,补充外源性Ad能部分改善CIH对颏舌肌收缩功能及抗疲劳性的影响.     

血管紧张素Ⅱ激活内质网应激促进大鼠血管平滑肌细胞凋亡的研究

目的:探讨内质网应激(ERS)在血管紧张素Ⅱ(Ang Ⅱ)诱导大鼠血管平滑肌细胞(VSMC)凋亡中的作用。方法:Ang Ⅱ诱导大鼠VSMC凋亡模型,并应用ERS抑制剂干预,采用流式细胞仪检测VSMC凋亡率;Western Blot检测ERS相关凋亡因子的表达变化。结果:不同浓度Ang Ⅱ(1、10、50μM)均可诱导VSMC凋亡,其总凋亡率(23.1±5.5)%、(30.0±2.5)%、(55.4±3.3)%与对照组(10.9±2.5)%相比显著升高(P0.05);Ang Ⅱ可诱导大鼠VSMC细胞ERS相关凋亡因子表达升高,与对照组相比,CHOP及Caspase12水平分别升高3.15倍和2.35倍(P0.05);与Ang Ⅱ刺激组相比,应用PERK通路抑制剂可显著降低Ang Ⅱ诱导的CHOP和Caspase12表达水平(P0.05),并降低Ang Ⅱ诱导的总凋亡率((14.6±2.7)%,P0.05)。结论:Ang Ⅱ可通过激活内质网应激CHOP和Caspase12通路诱导大鼠VSMC凋亡。     

化痰通络方对急性脑梗死溶栓后内质网应激未折叠蛋白反应相关因子的影响

目的观察化痰通络方对急性脑梗死大鼠重组组织纤溶酶原激活剂(rt-PA)溶栓后内质网应激(ERS)未折叠蛋白反应(UPR)相关分子基因和蛋白表达的影响,探讨化痰通络方调控急性脑梗死溶栓后内质网稳态的作用机制。方法将160只健康SD大鼠随机分为假手术组、模型组、rt-PA组、rt-PA+化痰通络组,每组40只,采用自身栓子法制备大鼠大脑中动脉栓塞模型(MCAO),rt-PA组与rt-PA+化痰通络组于血栓注入后3 h一次性予以rt-PA溶栓治疗,后者联合给予9 ml/kg化痰通络方浓缩剂灌胃治疗,每日2次,分别于造模后6 h,1 d,3 d,7 d 4个时点,应用Western印迹法及荧光定量PCR检测UPR相关信号转导途径中关键靶点IRE1、PERK、ATF6蛋白和基因及GRP78/Bi P基因表达水平。结果同一组内,与6 h相比,各组IRE1基因和蛋白均以6 h时表达量最高(P0.05),各组PERK、ATF6基因和蛋白与Bi P蛋白以1 d时表达量最高(P0.05);与假手术组相比,模型组在4个时相中各指标的表达量均较假手术组明显增加(P0.05);与模型组相比,rt-PA组、rt-PA+化痰通络组IRE1基因和蛋白、Bi P基因表达量增高(P0.05),PERK、ATF6基因和蛋白表达量降低(P0.05);rt-PA+化痰通络组IRE1基因和蛋白、Bi P蛋白表达量高于rt-PA组,且以6 h、1 d、3 d差异显著(P0.05);PERK基因和蛋白表达与rt-PA组无明显差异(P0.05);rt-PA+化痰通络组ATF6基因和蛋白表达量低于rt-PA组,且以3、7 d差异显著(P0.05)。结论化痰通络方可能通过调控急性脑梗死溶栓后大鼠脑组织ERS中UPR靶分子IREI、Bi P的表达,进而起到防止缺血再灌注损伤的保护作用。     

替米沙坦对糖尿病大鼠肾脏组织中内质网应激介导相关细胞凋亡的保护作用

探讨血管紧张素Ⅱ受体拮抗剂对糖尿病大鼠肾脏组织中内质网应激相关的细胞凋亡的影响.31只雄性SD大鼠分为正常对照组、糖尿病组、替米沙坦干预组.12周试验结束后测量大鼠体重、24h尿蛋白量,检测血糖、血胰岛素、血肌酐等.肾脏细胞凋亡用TUNEL法检测;肾脏细胞内质网应激信号通路分子糖调节蛋白78( GRP78)、caspase12和CHOP用免疫组化及实时定量PCR法检测.糖尿病组的血糖、24h尿蛋白量、血肌酐显著高于对照组(P＜0.05);体重和血胰岛素较对照组低(P＜0.05).替米沙坦干预组的24h尿蛋白量、血肌酐较糖尿病组明显减少(P＜0.05),凋亡指数也显著低于糖尿病组(P＜0.05).大鼠内质网应激信号通路分子GRP78、caspase12、CHOP蛋白及其mRNA的表达,糖尿病组显著高于对照组和替米沙坦干预组(P＜0.05).内质网应激参与了糖尿病大鼠肾脏细胞的凋亡,替米沙坦对内质网应激介导相关的肾脏细胞凋亡有保护作用.     

脂联素缓解慢性间歇低氧所致的颏舌肌线粒体损伤

目的 探讨慢性间歇低氧（CIH）对颏舌肌线粒体的损伤以及脂联素（Ad）的干预作用及机制。方法 45只成年Wistar大鼠随机分为3组：正常对照（NC）组、CIH组及CIH＋Ad组,每组15只。CIH组及CIH＋Ad组的大鼠暴露于同样的间歇低氧环境（8h/d,5周）,而NC组的大鼠则只暴露于正常空气。此外,CIH＋Ad组的大鼠还接受2次/周的Ad静脉注射。结果 与NC组相比,CIH组大鼠的颏舌肌出现以下的损伤性表现：线粒体数量减少、线粒体结构损伤伴Ⅰ型纤维减少（P＜0.05）。但与CIH组相比,CIH＋Ad组的大鼠颏舌肌线粒体结构和功能改善且Ⅰ型纤维的数量有所增加（P＜0.05）。与NC组相比,CIH组大鼠颏舌肌显示LKB1-AMPK-PGC1-α通路蛋白表达下降（P＜0.05）,而CIH＋Ad组较CIH组有明显改善（P＜0.05）。结论 CIH可引起颏舌肌线粒体等损伤,而补充外源性Ad可能通过调节AMPK通路改善上述CIH诱导的颏舌肌病理改变。     

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.     

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.     

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.     

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.