慢性乙型肝炎患者肝组织内CD4+CD25+Foxp3+调节性细胞的作用

目的 观察慢性乙型肝炎患者肝内调节性T细胞(Treg)与病情活动、肝细胞损伤的关系.方法 对日本长崎大学医学院附属医齿学病院第一内科26例住院慢性乙型肝炎患者进行肝组织活检,采用免疫组织化学方法以单抗Foxp3、单抗CD3检测肝组织内Foxp3+细胞和CD3+细胞频率,计算Foxp3+/CD3+细胞比率,结合肝组织学炎症活动指数(HAI,采用Knodell评分系统)、ALT、AST、HBV DNA水平进行分析.数据用SPSS 13.0软件进行统计分析.结果 Foxp3+Treg主要分布在门脉区;Foxp3+/CD3+细胞(%)在肝实质重度炎症组明显高于轻度炎症组(P=0.007 6);Foxp3+/CD3+细胞(%)的增高与血清ALT、AST水平呈正相关,相关系数分别0.438、0.436(P值分别为0.025、0.026),与血清HBV DNA水平有相关趋势,但差异无统计学意义.结论 CD4+CD25+Foxp3+Treg在慢性乙型肝炎患者的发病机制中参与肝细胞的免疫损伤.     

Diagnostic Clues From the Surfaee ECG to Identify Idiopathic (Fascicular) Ventricular Tachycardia: Correlation with Electrophysiologic Findings

ECG in Idiopathic Fascicular VT. Introduction : An RS interval > 100 msec in precordial leads has been recently described for the diagnosis of ventricular tachycardia (VT). The aim of this study was to assess the value of this criterion when applied to patients with right bundle branch block pattern, left-axis deviation (fascicular) VT sensitive to verapamil.
Methods and Results : Eleven patients (mean age 31 ± 11 years; range 16 to 51) had a mean heart rate of 164 ± 37 beats/min (range 107 to 230) during VT, The QRS complex axis was -92°± -15° (range -80 to -115). The mean QRS duration was 121 ± 9 msec (range 105 to 140). The mean RS interval was 67 ± 9 msec (range 60 to 80). Fusion beats were present in 2 patients (18%), and AV dissociation confirmed by electrophysiologic study was found on ECG in 8 (73%) of 11. During tachycardia, the QRS-H'interval was 19 ± 10 msec (range 10 to 30) in 6 of 11 patients. In seven patients, a fast, unique (or double) presystolic potential lasting 32 msec (range 12 to 40) occurring before the onset of the QRS complex was found at the site of origin of VT, localized in the inferior apical left ventricular septum. In all cases, VT was successfully treated by catheter ablation.
Conclusion : A wide QRS complex tachycardia with right bundle branch block and left-axis deviation sensitive to verapamil observed in a young patient without structural heart disease should not be confused with supraventricular tachycardia with aberrancy but rather suggests the presence of fascicular VT. As opposed to VT associated with structural heart disease, the RS interval is < 80 msec in all precordial leads in all cases. Independent of this parameter, AV dissociation detectable on surface ECG has a sensitivity of 73%, which increases to 82% in the presence of fusion beats.     

Interleukin-6 functions as an autocrine growth factor in a cholangiocarcinoma cell line

Abstract The tumour cells of a human cholangiocarcinoma cell line, HuCC-T1, were found to express mRNA of interleukin-6 (IL-6) and to secrete a large amount of biologically active IL-6 in the culture medium at the concentration of 22.6 ng/mL. Interleukin-6 was demonstrated in the cytoplasm of the cells by immunohistochemical staining. Furthermore, these cells showed the presence of receptors for IL-6 on the surface, and DNA synthesis of the cells was stimulated by the exogenous addition of recombinant human IL-6 into the culture medium. The cell growth was significantly inhibited in the presence of anti-human IL-6 antibody in the culture medium. These findings indicate that IL-6 is one of the autocrine growth factors of this cell line in vitro.     

Echo-Doppler measurements of portal vein and superior mesenteric artery blood flow in humans: Inter- and intra-observer short-term reproducibility

The reproducibility of echo-Doppler measurements of portal vein and superior mesenteric artery blood flow has not been extensively studied. In the present study, two groups of subjects were examined to test inter- and intra-observer reproducibility. Each study population consisted of 15 non-portal hypertensive and 15 portal hypertensive subjects. With a standardized technique, the cross-sectional area and velocity of blood flow in the portal vein and superior mesenteric artery were recorded in triplicate by skilled operators. The flow volume of each vessel was calculated by multiplying the cross-sectional area by the velocity of blood flow. The measurements were performed in a blind fashion over a 60 min period. The reproducibility of measurements was assessed by calculation of intraclass correlation coefficients and coefficients of variation. The intra-observer intraclass correlation coefficient was 0.77 for portal vein blood flow and 0.84 for superior mesenteric artery blood flow, suggesting good reproducibility. The intra-observer coefficient of variation was 11 and 9%, respectively. In contrast, the interobserver intraclass correlation coefficient was calculated to be 0.49 for portal blood vein blood flow and 0.57 for superior mesenteric artery blood flow, indicating fair reproducibility. In addition, the interobserver coefficients of variation were calculted to be 20 and 18%, respectively. These data suggest that intra-observer reproducibility in echo-Doppler measurements of portal vein and superior mesenteric artery blood flow is acceptable but inter-observer reproducibility is not. Examination by a single operator, rather than multiple operators, is therefore advisable. Even when measurements are performed by a single investigator an approximate variance of 10% in the measurement in a single subject should be expected.     

Changes of serum aminotransferase activities in relation to serum hepatitis Be antigen levels in chronic type B hepatitis

The purpose of this study was to determine the level of serum hepatitis Be antigen (HBeAg) during hepatitis B virus carriage and its clinical significance. The mean level of serum HBeAg, quantitated by solid-phase enzyme immunoassay, was 5924 units in asymptomatic carriers (s.d. = 5534, n= 100), 3044 units in patients with chronic persistent hepatitis (s.d. = 4826, n= 34), 3599 units in chronic active hepatitis (s.d. = 4953, n= 45) 1348 units in liver cirrhosis (s.d. = 2379, n= 25) and 766 units in hepatocellular carcinoma (s.d. = 1257, n= 18). In the 10 HBeAg-positive patients with chronic active hepatitis, the fluctuation in HBeAg level was followed by changes in alanine aminotransferase (ALT) activity. Among the 36 peaks of HBeAg and ALT, HBeAg peaks preceded ALT peaks in 22 and simultaneous peaks were present in 14. The changes of HBeAg level were closely related to increase in disease activity as estimated by ALT activities; therefore, HBeAg quantitation can be a useful predictor of disease activity in chronic hepatitis B.     

Alteration of bile acid metabolism in two-thirds hepatectomized rat

Bile acid metabolism after two-thirds partial hepatectomy (PH) in rat was studied. Bile acid kinetics (i.e. synthesis rate and pool size) were determined by wash out method combined with gas liquid chromatography, and serum bile acids by gas liquid chromatography-mass spectrometry. Serum bile acid concentration was highest on the third day after PH, as the liver regeneration progressed but it gradually decreased with increasing cholic acid (CA)/chenodeoxycholic acid (CDCA), reflecting impaired hepatic uptake of bile acids and/or cholestasis during the early post-hepatectomy period. Predominance of CA in bile acid synthesis, pool, and biliary secretion was also found. On the third day after PH, liver weight recovered to 66% of the control value, but enhancement of bile acid synthesis was not observed. Consequently, pool size remained at 50% of control. On the seventh day, synthesis of bile acid, especially of CA, was enhanced and pool size and liver weight returned to 68 and 72% of the respective control values. Bile acid synthesis was returned to the control value on the fourteenth day with concomitant restoration of liver weight and bile acid pool size. These changes in bile acid kinetics parallel the events during hepatic regeneration after PH.     

Acoustic Screening for Laryngeal Cancer

An acoustic screening method for indicating the possible presenceof laryngeal cancer was investigated. Three acoustic parameters,comprising perturbations in pitch-period and peak-amplitudesequences, and vocal noise, were measured from a sustained vowel,e, spoken by the subjects taking part in the investigation.Experiments to discriminate between normal and cancer groupswere performed with voice samples taken from 64 normal controlsubjects and 57 patients with laryngeal cancer. Experimentswere also carried out to test the perceptual significance ofthe three parameters. From the results, we have been able toconclude that their combined use will enable us to build anacoustic screening system for laryngeal cancer.     

Effects of vaso-active agents on hepatic function and blood gases in patients with cirrhosis: A study of vasopressin and nitroglycerin

The effects of vaso-active agents on hepatic function and splanchnic oxygenation were studied in 17 patients with cirrhosis and portal hypertension. Eight patients received vasopressin (0.3 iu/min) and nine patients received nitroglycerin (50 micrograms/min). Both drugs caused a significant reduction in the portal venous pressure gradient. Vasopressin infusion significantly decreased intrinsic clearance of indocyanine green (-23%, P less than 0.01). This may be due to a decreased hepatic perfusion (-28%, P less than 0.01) and portal venous oxygenation (-15% in portal venous oxygen tension, P less than 0.05). In contrast, no changes in hepatic perfusion and portal venous oxygenation were observed after nitroglycerin infusion. Nitroglycerin did not decrease intrinsic clearance of indocyanine green. These results suggest that vasodilators, rather than vasoconstrictors, might be welcome in the treatment of patients with cirrhosis and portal hypertension.