Oesophageal epithelial innervation in health and reflux oesophagitis

BACKGROUND: The response of the oesophagus to refluxed gastric contents is likely to depend on intact neural mechanisms in the oesophageal mucosa. The epithelial innervation has not been systematically evaluated in health or reflux disease. AIMS: To study oesophageal epithelial innervation in controls, and also inflamed and non-inflamed mucosa in patients with reflux oesophagitis and healed oesophagitis. PATIENTS: Ten controls, nine patients with reflux oesophagitis, and five patients with healed oesophagitis. METHODS: Oesophageal epithelial biopsy specimens were obtained at endoscopy. The distribution of the neuronal marker protein gene product 9.5 (PGP), and the neuropeptides calcitonin gene related peptide (CGRP), neuropeptide Y (NPY), substance P (SP), and vasoactive intestinal peptide (VIP) were investigated by immunohistochemistry. Density of innervation was assessed by the proportion of papillae in each oesophageal epithelial biopsy specimen containing immunoreactive fibres (found in the subepithelium and epithelial papillae, but not penetrating the epithelium). RESULTS: The proportion of papillae positive for PGP immunoreactive nerve fibres was significantly increased in inflamed tissue when compared with controls, and non-inflamed and healed tissue. There was also a significant increase in VIP immunoreactive fibres within epithelial papillae. Other neuropeptides showed no proportional changes in inflammation. CONCLUSIONS: Epithelial biopsy specimens can be used to assess innervation in the oesophagus. The innervation of the oesophageal mucosa is not altered in non-inflamed tissue of patients with oesophagitis but alters in response to inflammation, where there is a selective increase (about three- to fourfold) in VIP containing nerves.     

穴位刺血对实验性变应性鼻炎鼻分泌物的影响

以卵清蛋白致敏原,建立豚鼠实验性变应性鼻炎模型;对动物模型给予穴位刺血治疗。观察治疗过程中豚鼠鼻痒、喷嚏、鼻溢变化,治疗前后鼻分泌ＥＣ、ＭＣ细胞学、鼻粘膜病理学变化;并与二丙酸氯地米松治疗及空白组对照比较。结果显示,模型动物有典型的变应性鼻炎行为,鼻分泌物镜下见大量的ＥＣ和ＭＣ,ＭＣ脱颗粒现象明显,阳性检出率分别为８７．５％、７５％,鼻粘膜呈炎性破坏。治疗后穴位刺血组和二丙酸氯地米松组豚鼠鼻痒、喷嚏、鼻溢缓解和消失,鼻分泌物ＥＣ、ＭＣ显著减少,阳性检出率降为２５％和１２．５％,鼻粘膜炎性破坏得以基本恢复。推论穴位刺血治疗豚鼠实验性变应性鼻炎的治疗效果可能与其改善鼻粘膜炎症介质细胞（ＥＣ、ＭＣ）介导的反应及改善鼻粘膜病理形态学变化有关     

Serum levels of matrix metalloproteinase‐13 in patients with eosinophilic fasciitis

Matrix metalloproteinase‐13 (MMP‐13), a member of the collagenase family, has been implicated in the pathogenesis of connective tissue diseases characterized by extracellular matrix remodeling. Since serum MMP‐13 levels reflect disease severity of systemic sclerosis and localized scleroderma, we evaluated the clinical significance of serum MMP‐13 levels in eosinophilic fasciitis (EF). All the EF patients had serum MMP‐13 levels lower than the mean – 2SD of healthy controls. Serum MMP‐13 levels were also significantly decreased in EF patients compared with diffuse cutaneous systemic sclerosis, limited cutaneous systemic sclerosis, and generalized morphea patients. Although serum MMP‐13 levels did not reflect any clinical and serological features of EF, these results indicate that MMP‐13 may be involved in the development of this disease.     

垂体瘤45例疗效分析

本文分析了45例垂体瘤的治疗,经随访总控制率为78％。并就治疗方法,放疗剂量与疗效的关系进行了讨论。认为该病宜首选放疗,其放疗剂量以4000—5000rad较合适。复发后可行放疗或手术治疗。     

Observational study of the natural history of eosinophilic bronchitis

BACKGROUND: Eosinophilic bronchitis is an important cause of chronic cough. Treatment with inhaled corticosteroids is associated with a short-term improvement in cough and reduced sputum eosinophil count but the long-term outcome is uncertain. OBJECTIVE: To determine the long-term outcome in patients diagnosed with and treated for eosinophilic bronchitis. METHODS: We have performed a longitudinal study of symptoms, eosinophilic airway inflammation, spirometry and airway hyper-responsiveness in all patients diagnosed with eosinophilic bronchitis over 7 years. RESULTS: We identified 52 patients with eosinophilic bronchitis and longitudinal data of greater than 1 year (mean 3.1 years) was available in 32 patients, all of whom were treated with inhaled steroids. Three (9%) patients developed symptoms consistent with asthma and a methacholine PC20<8 mg/mL on one or more occasion. Five (16%) patients developed fixed airflow obstruction defined by a persistent post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity<70%. One (3%) patient had complete resolution of symptoms and eosinophilic airway inflammation off treatment. The remaining patients had ongoing eosinophilic airway inflammation and/or continuing symptoms. Multiple linear regression identified smoking, female gender and area under the curve of sputum eosinophil count over time as the most important predictors of decline in FEV1. CONCLUSIONS: The most common outcome in eosinophilic bronchitis is continuing disease and complete resolution is rare. Asthma and fixed airflow obstruction developed in relatively few patients. The most important factors associated with a more rapid decline in FEV1 were female gender, smoking and prolonged eosinophilic airway inflammation.     

Itchy folliculitis and human immunodeficiency virus infection: clinicopathological and immunological features, pathogenesis and treatment

The predominant itchy folliculitis associated with human immunodeficiency virus (HIV) infection appears to be an eosinophilic folliculitis (EF). This is characterized by lytic degeneration of sebaceous glands and an inflammatory infiltrate in which eosinophils and CD8+ T lymphocytes predominate. All patients have low CD4 counts and present late on in their HIV disease. Lesional distribution is mainly truncal, with a significant proportion also having facial involvement. Our prospective survey has shown that it is impossible to differentiate clinically between infective folliculitis and EF, and we recommend therefore that all cases are biopsied. We review the clinicopathological and immunological aspects of HIV-associated itchy folliculitis, in particular HIV-associated EF as well as current theories on pathogenesis and treatment. We suggest that HIV-associated EF is an autoimmune disease with the sebocyte or some constituent of sebum acting as the autoantigen.     

广州管圆线虫致嗜酸细胞性脑脊膜神经根炎

目的　报道１０ 例广州管圆线虫引起的嗜酸细胞性脑脊膜神经根炎，以期提高对该病的认识和重视。方法　对１０ 例患者的临床全过程及实验室检查进行系统的观察及随访，并结合当地流行病学资料及国内外文献，实行对比研究。结果　该组病例具有如下特征：①急性起病（１０ 例） ；②剧烈头痛（１０ 例） 和（或）躯体痛性感觉障碍（８ 例），伴发热（８ 例） 、全身违和（１０ 例） ；③可有脑神经（３例）或脊神经根（８ 例）受累；④无明显颈抵抗及病理征（１０ 例） ；⑤脑脊液（６ 例） 及外周血（１０ 例）中嗜酸细胞数增高；⑥血清和脑脊液广州管圆线虫蚴抗体均呈阳性（５／５ 例） ；⑦病程自限，预后良好（１０例）；⑧病前食用过生淡水螺肉（８ 例）；⑨所在地为广州管圆线虫新疫源地；⑩已排除其他蠕虫感染。结论　一度在温州暴发流行的一种“怪病”实属广州管圆线虫所致的嗜酸细胞性脑脊膜神经根炎。     

人胎胸腺的组织发生

本文在光镜和电镜下研究50例人胎的胸腺。8(1/2)周胎胸腺尚未分小叶,也不能分辨皮质和髓质。12周胸腺间充质隔分隔小叶,同时髓质内可见胸腺小体。14～16周小叶数量增多,皮质分化出内、外二区。外皮质色浅系T淋巴细胞繁殖区。17～20周胸腺的发育已较完善。胎期胸腺间充质隔及皮髓交界区发现一些非上皮网状细胞和大量嗜酸髓细胞。