腺苷蛋氨酸治疗药物性淤胆型肝炎的疗效观察

目的：探讨腺苷蛋氨酸对药物性淤胆型肝炎的疗效。方法：将46例药物性淤胆型肝炎患者分为两组,治疗组和对照组各23例。对照组用综合治疗（不加用任何退黄的药物）,治疗组在综合治疗的基础上加用腺苷蛋氨酸1000mg,溶于5％葡萄糖溶液20mL中静脉推注,每日1次,疗程均为4周。结果：两组患者症状、体征的恢复无明显差异（P〉0．05）。治疗组皮肤瘙痒、粪便灰白的有效率分别为82．6％（19／23）、100％（23／23）,对照组为39．1％（9／23）、52．2％（12／23）,治疗组肝功能损害恢复情况优于对照组,两组差异有显著性（P〈0．01）。结论：腺苷蛋氮酸在治疗药物性淤胆型肝炎上对促进肝脏代谢、修复损伤的肝细胞、缓解瘙痒和改善肝功能有明显疗效。腺苷蛋氨酸是目前临床治疗药物性淤胆型肝炎比较理想安全的药物。     

Oestrogen receptor gene polymorphisms and ovarian stimulation for in- vitro fertilization

Experimental evidence has shown that mice lacking the oestrogen receptor (ESR) gene are infertile with cystic ovaries and follicular arrest. In humans, several polymorphisms and mutations in the ESR gene have been identified. In this study we have analysed a common PvuII and a rare BstUI polymorphism in the ESR gene. Analysis was carried out on DNA samples from women undergoing ovarian stimulation for in-vitro fertilization (IVF) and embryo transfer and controls having at least one pregnancy. Comparisons were done between the three PvuII genotypes, concerning the mean numbers of follicles and oocytes and the mean ratios of follicles to oocytes harvested in two consecutive cycles. Significantly lower ratios were identified in the group lacking the PvuII polymorphism, compared with the groups with heterozygous or homozygous PvuII polymorphisms (P > 0.05 and P > 0.01 respectively). The rare haplotype having both PvuII and BstUI restriction sites on one chromosome was present only in the IVF group. Pregnancies from IVF were significantly rarer in patients who were homozygous for the PvuII polymorphism (P > 0.05). Our results suggest that genetic variability in the ESR has a role in the quality of the ovarian follicles as judged by the ovarian response to stimulation and may also affect implantation.      

Luteinizing hormone response to gonadotrophin-releasing hormone in normal women undergoing ovulation induction with urinary or recombinant follicle stimulating hormone

Oestradiol enhances pituitary sensitivity to gonadotrophin-releasing hormone (GnRH) in normal women, while in women undergoing ovulation induction the putative factor gonadotrophin surge attenuating factor (GnSAF) attenuates the response of luteinizing hormone (LH) to GnRH. To study the relationships between oestradiol and GnSAF during ovulation induction, 15 normally ovulating women were investigated in an untreated spontaneous cycle (control, first cycle), in a cycle treated with daily i.m. injections of 225 IU urinary follicle-stimulating hormone (FSH) (Metrodin HP, uFSH cycle) and in a cycle treated with daily s.c. injections of 225 IU recombinant FSH (Gonal-F, rFSH cycle). Treatment with FSH started on cycle day 2. The women during the second and third cycle were allocated to the two treatments in an alternate way. One woman who became pregnant during the first treatment cycle (rFSH) was excluded from the study. In all cycles, an i.v. injection of 10 microg GnRH was given to the women (n = 14) daily from days 2-7 as well as from the day on which the leading follicle was 14 mm in diameter (day V) until mid-cycle (n = 7). The response of LH to GnRH at 30 min (deltaLH), representing pituitary sensitivity, was calculated. In the spontaneous (control) cycles, deltaLH values increased significantly only during the late follicular phase, i.e. from day V to mid-cycle, at which time they were correlated significantly with serum oestradiol values (r = 0.554, P < 0.01). Initially during the early follicular phase in the uFSH and the rFSH cycles, deltaLH values showed a significant decline which was not related to oestradiol (increased GnSAF bioactivity). Then, deltaLH values increased significantly on cycle day 7 and further on day v with no change thereafter up to mid- cycle. On these two days, deltaLH values were correlated significantly with serum oestradiol values (r = 0.587 and r = 0.652 respectively, P < 0.05). During the pre-ovulatory period, deltaLH values in the FSH cycles were significantly lower than in the spontaneous cycles. Significantly higher serum FSH values were achieved during treatment with uFSH than rFSH. However, serum values of oestradiol, immunoreactive inhibin, and deltaLH as well as the number of follicles > or = 12 mm in diameter did not differ significantly between the two FSH preparations. These results suggest that in women undergoing ovulation induction with FSH, oestradiol enhances pituitary sensitivity to GnRH, while GnSAF exerts antagonistic effects. The rFSH used in this study (Gonal-F) was at least as effective as the uFSH preparation (Metrodin-HP) in inducing multiple follicular maturation in normally cycling women.      

Association between sleep and morning testosterone levels in older men

STUDY OBJECTIVES: The circulating testosterone levels of healthy men decline with advancing age. This process is characterized by considerable inter-individual variability, the causes of which are of significant biological and clinical interest but remain poorly understood. Since sleep quantity and quality decrease with age, and experimentally-induced sleep loss in young adults results in hormonal changes similar to those that occur spontaneously in the course of aging, this study examined whether some of the variability in circulating testosterone levels of older men can be related to objective differences in their sleep. DESIGN: Observational study. SETTING: General community and university clinical research center. PARTICIPANTS: Twelve healthy men ages 64 to 74 years. INTERVENTIONS: Three morning blood samples were pooled for the measurement of total and free testosterone. In addition to overnight laboratory polysomnography, wrist activity monitoring for 6-9 days was used to determine the amount of nighttime sleep of the participants in everyday life settings. MEASUREMENTS AND RESULTS: The main outcome measures were total sleep time and morning testosterone levels. Sleep time in the laboratory was correlated with the usual amount of nighttime sleep at home (Pearson's r = 0.842; P = 0.001). Bivariate correlation and multiple linear regression analyses revealed that the amount of nighttime sleep measured by polysomnography was an independent predictor of the morning total (Beta 0.792, P = 0.017) and free (Beta 0.741, P = 0.029) testosterone levels of the subjects. CONCLUSIONS: Objectively measured differences in the amount of nighttime sleep are associated with a significant part of the variability in the morning testosterone levels of healthy older men.     

Functional differences between two Fc receptor ITAM signaling motifs

Most Ig receptors exist as multi-subunit complexes with a unique ligand binding alpha chain and a common signaling FcR gamma-chain. The myeloid Fc gamma RIIa (CD32) appears unique among FcR because both ligand- binding and signaling capacity are found in the alpha chain. Within the cytoplasmic tails of Fc gamma RIIa and FcR gamma-chain similar, but not identical, activatory motifs (ITAMs) have been defined, in which tyrosines play an important role. Previously, Fc gamma RIIa-ITAM was shown to be critical for both proximal and distal activatory functions in IIA1.6 B-cell transfectants. Triggering of interleukin-2 (IL-2) release and antigen presentation was absent in Fc gamma RIIa, but not in FcR gamma-chain receptor complexes. We now assessed the capacity of Fc gamma RIIa wild-type and Fc gamma RIIa/gamma chimeric molecules to trigger IL-2 production and antigen presentation by B cells. Both of these functions could solely be triggered by receptors containing the FcRIIa was capable of functional interaction with FcR gamma-chain, thus reconstituting the capacity to trigger IL-2 release and antigen presentation. These data document qualitative differences between Fc receptor ITAMs.     

Large paraesophageal varices on endosonography predict recurrence of esophageal varices and rebleeding

BACKGROUND & AIMS: Recurrence of varices and rebleeding after endoscopic therapy is very common. Data on the prediction of recurrent varices after initial obliteration by endoscopic therapy are few. The aim of this study was to correlate the presence and the size of paraesophageal varices (PEVs) in patients after endoscopic variceal ligation with recurrent varices and rebleeding. METHODS: Forty patients who underwent endoscopic banding ligation for esophageal variceal bleeding were studied by endosonography within 4 weeks after obliteration of varices. PEVs were classified as none, small, or large (maximum diameter, > or =0.5 cm). Esophagoscopy and endosonography were then repeated every 6 months for up to 1 year. RESULTS: Two patients (5%) were not detected to have PEVs. Small and large PEVs were identified in 24 (60%) and 14 (35%) patients, respectively. During the follow-up period of 1-year, recurrent submucosal esophageal varices were detected in 24 patients, including 13 patients (93%) with large PEVs and 11 patients (46%) with no or small PEVs (P = 0.0019). Recurrent bleeding occurred in 6 patients (43%) with large PEVs and in 3 patients (12%) with small PEVs (P = 0.044). CONCLUSIONS: Patients with large PEVs have a higher risk of developing recurrent varices and rebleeding. (Gastroenterology 1997 Jun;112(6):1811-6)