慢性肝病和肝癌中HCV核心区三种寡肽抗原的抗体检测

检测１４８例慢性肝病和肝癌患者血清中丙型肝炎病毒核心区３种寡肽抗原的抗体，结果显示其阳性率在慢性迁延型肝炎、慢性活动型肝炎、肝炎肝硬化和原发性肝癌患者分别为７．７％，２３．１％，，２３．５％和１６．３％。在抗体阳性者中８０％以上有乙型肝炎病毒感染证据，提示我国ＨＢＶ和ＨＶＣ重叠感染较为常见。     

Expression of cell-matrix molecules and integrin receptors in human liver grafts during chronic rejection

Abstract The inflammatory response of immune cells to target cells and cell-matrix molecules is regulated by several receptor-ligand molecules. As fibrosis develops in ongoing chronic rejection after liver transplantation, it is of interest to analyze patterns of integrin receptors and cell-matrix molecules in order to study the relation between immune cells and the stromal and parenchymal cells. In the present study, we demonstrated the expression of these molecules in chronic rejected human liver grafts using immunohistochemical techniques. The results showed a differential expression and induction of integrin receptors and cell-matrix molecules on resident liver cells, especially on sinusoids, reflecting a state of chronic inflammation and a specific interaction between integrin receptors and cell-matrix molecules. The patterns of induced integrin receptors on graft-infiltrating cells was closely related to the local production of cell-matrix molecules and reflected the final sequence of a stepwise progress of the inflammatory reaction.     

A model to predict long-term sustained response to interferon therapy in chronic hepatitis C

Interferon therapy is used widely for chronic hepatitis C but only a minority of treated patients achieve a long-lasting sustained response. We have developed, by logistic regression, a mathematical model to estimate the probability of sustained response in an individual patient with chronic hepatitis C when treated with interferon-α (IFN-α). The model, which includes age, sex, disease duration, pretreatment serum γ-glutamyl-transpeptidase, alanine aminotransferase and virus genotype, was developed from a database of 307 patients and validated in a new set of 200 patients. It performed well as goodness-of-fit ( P = 0.71 and P = 0.15 in the development and test sample, respectively) and discrimination (area under receiver operating curve = 0.79 in the development and 0.78 in the test sample, respectively). This model may provide decision support in the treatment of chronic hepatitis C with IFN-α.     

β-endorphin in the brain. A role in nociception

We have known the endogenous opioid peptide β-endorphin for 20 years. Surprisingly, our knowledge of the physiological role of this peptide and its receptors in modulation of pain perception is still fragmentary. Whereas most studies have tried to elucidate the physiological role of β-endorphin by reversing evoked responses by the opioid antagonist naloxone, this review focuses on quantification of release of β-endorphin in the brain as the approach to define physiological and pathophysiological roles of β-endorphin in relation to nociception. Using a lateral ventricle-cisterna magna perfusion model in the anesthetized rat, it was shown that depolarization of neurons in the arcuate nucleus of the hypothalamus, where β-endorphin is produced, was followed by release of β-endorphin to the cerebrospinal fluid compartment. Intense activation of spinal nociceptive pathways by intrathecal capsaicin injections also led to β-endorphin release. It is concluded that there may still be good reason to quantify β-endorphin in human cerebrospinal fluid to elucidate the role of β-endorphin in pain perception.     

老慢支患者与健康老人甲皱微循环对照

本文通过对老年度性支气管炎与健康老年人甲皱微循环的对照观察，发现管袢密度、畸形管袢、输入枝管径、管袢长度、流态积分存在显著性统计学差异，提示临床应注意血管、血流因素对慢性支气管炎治疗及预后的影响。     

Boundary Ambiguity in Parents With Chronically Ill Children: Integrating Theory and Research

Abstract: This article integrates theory and research related to boundary ambiguity in parents of children with a chronic health condition. We propose that boundary ambiguity is a risk factor for psychological distress in these parents. Clinical applications and a case example highlight how boundary ambiguity can be assessed and managed in clinical settings by professionals working with parents with chronically ill children. Questions are provided for assessing boundary ambiguity in clinical and research settings, and implications for research are discussed.     

Infantile chronic tubulo-interstitial nephritis with cortical microcysts: variant of nephronophthisis or new disease entity?

Over a 15-year period we observed seven children (four girls, three boys) who presented within the first months of life with severe renal failure and acidosis, associated with hypertension in five patients and polyuria in four. In addition, one patient had a severe cholestatic liver disease. In two families, a similarly affected sibling had died previously. Four patients were referred with the clinical diagnosis of polycystic kidney disease because of moderate enlargement of kidneys, but renal imaging (intravenous pyelography and ultrasonography) did not confirm this diagnosis. A renal biopsy, performed in all patients, showed similar features characterized by a diffuse chronic tubulo-interstitial nephritis (TIN) and particularly by the presence of microcystic dilatation of proximal tubules and Bowman's space. Liver pathology was normal in two patients, including one with hepatomegaly. However, in the patient with cholestasis there was inflammatory portal fibrosis with mild duct proliferation. Progression of the renal disease was extremely rapid and all patients reached end-stage renal failure (ESRF) before the age of 2 years (11–22 months). Two children had successful renal transplants. Although this chronic TIN shares some features with nephronophthisis, we suggest that it represents a distinct entity both on clinical and morphological grounds. The specific clinical features of this disease are its early onset and rapid progression to ESRF. Pathologically, it differs from nephronophthisis by the absence of medullary cysts and thickened tubular basement membranes and by the presence of cortical microcysts.     

Reduction in acute rejections decreases chronic rejection graft failure in children: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS).

Chronic rejection accounted for 32% of all graft losses in 7123 pediatric transplants. In a previous study acute, multiple acute and late acute rejections were risk factors for the development of chronic rejection. We postulated that the recent decrease in acute rejections would translate into a lower risk for chronic rejection among patients with recent transplants. We reviewed our data on patients transplanted from 1995 to 2000, and using multivariate analysis and a proportional hazards model developed risk factors for patients whose grafts had failed due to chronic rejection. A late initial rejection increased the risk of chronic rejection graft failure 3.6-fold (p < 0.001), while a second rejection resulted in further increase of 4.2-fold (p < 0.001). Recipients who received less than 5 mg/kg of cyclosporine at 30 days post-transplant had a relative risk (RR) of 1.9 (p = 0.02). Patients transplanted from 1995 to 2000 had a significantly lower risk (RR = 0.54, p < 0.001) of graft failure from chronic rejection than those who received their transplants earlier (1987-94). Since we were able to demonstrate that there is a decreased risk of chronic rejection graft failure in our study cohort, we would conclude that the goal of future transplants should be to minimize acute rejections.     

Utility of pulmonary function testing in the management of chronic obstructive pulmonary disease

This study sought to measure the effect of pulmonary function testing (PFT) data on the decisions made by generalist physicians in the management of chronic obstructive pulmonary disease (COPD). 148 physicians were randomly assigned to two groups, both of which were asked to manage two identical fictitious but representative cases of COPD, which included history, physical, x-ray, and laboratory results. The experimental group received PFT results in addition. No significant difference was noted between the two groups in management based on availability of PFT data. The optimum utility of PFT data in the management of COPD may be exaggerated and has yet to be determined. Received from the Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Presented at the Annual Scientific Meeting of the American College of Chest Physicians, October 28, 1992, Chicago, Illinois.     

结肠回肠反流与回肠黏膜结肠化相关性的实验研究

目的探讨结肠回肠反流后回肠末端黏膜结肠化的机制.方法取SD大鼠60只,均为雄性,体重25¨3∞g,随机分为实验组和对照组,分别进行末端回肠-盲肠侧侧吻合术或回肠末端手术缝线,2个月后处死动物并取组织进行观察.结果实验组术后一般状况良好.大体形态学观察:实验组回肠末端黏膜表现为绒毛萎缩、间距增宽、沟变浅、光滑性增强.病理组织学:实验组表现为黏膜绒毛萎缩、间距增宽、沟变浅、上皮细胞变短、杯状细胞增多.电镜观察:实验组可见绒毛变小、变短或脱落;微绒毛变短、分布不均匀;杯状细胞数目在非坏死区增多.结论结肠-回肠反流后可导致回肠末端黏膜结肠化的变化,它可能是慢性末端回肠炎的发病基础或前期表现.