内镜下醋酸染色结合NBI在消化道早癌及癌前病变诊断中的应用

新的内镜检查技术不断用于消化道早癌及癌前病变的诊断,如放大内镜、窄带成像技术(narrow-band imaging,NBI)、智能分光比色技术(fuji intelligent chromoendiscopy,FICE)、i-scan技术、激光共聚集内镜等和色素内镜技术(卢戈氏碘、靛胭脂、美蓝、醋酸、结晶紫等),每种方法都有各自的优势,但有设备贵、试剂成本高或延长检查时间等缺点.醋酸喷洒黏膜表面可以看到清晰的微腺管开口形态,NBI内镜在微血管形态方面具有优势,先用醋酸喷洒显示微腺管开口形态,再用普通NBI内镜观察微血管形态,能同时清晰显示病灶微腺管开口形态和微血管形态,结合醋酸白化效应,对消化道早癌及癌前病变的诊断价值大大提高,明显优于单一醋酸染色和单一NBI观察,而且价格低廉,无不良反应,在没有放大内镜的基层医院不失是一种简、便、廉的发现消化道早癌的方法,值得临床推广使用.     

内镜窄带成像技术在胃癌及癌前病变诊断中的应用

目的 探讨内镜窄带成像技术(NBI)对胃癌及癌前病变的诊断价值.方法 217例患者依次在普通内镜、NBI、0.2%靛胭脂染色及内镜放大(×80)模式下观察病变轮廓、胃小凹及微血管形态,评价各检查方法图像的清晰度,并结合病理学检查进行分析.结果 217例患者中,非萎缩性胃炎85例,萎缩性胃炎38例,轻度异型增生19例,中度异型增生9例,重度异型增生4例,早期胃癌5例,进展期胃癌20例,伴有肠化生者91例.NBI对病变轮廓的显示明显优于普通内镜和靛胭脂染色(P值均=0.000).经内镜放大后,NBI对胃微血管形态的显示亦优于普通内镜和靛胭脂染色(P值均=0.000).NBI模式下萎缩性胃炎胃小凹主要表现为Ⅲ、Ⅳ、Ⅴ1型,肠化生主要表现为Ⅲ、Ⅳ、Ⅴ1、Ⅴ2型,异型增生主要表现为Ⅴ1型及Ⅳ型,胃癌主要表现为Ⅵ型.结论 NBI电子染色结合放大技术有助于提高胃癌及异型增生的活检准确率和早期胃癌检出率.     

窄带成像技术在早期胃癌内镜诊断中的应用

目的探讨窄带成像（NBI）技术对早期胃癌的诊断价值。方法46例常规内镜发现病灶者,分别于放大内镜下行NBI及靛胭脂染色,观察黏膜腺管形态及微血管结构变化,计算清晰度评分;评价病变性质并与术后病理检查结果进行比较。结果NBI与靛胭脂染色腺管结构清晰度评分无显著差异,但微血管结构评分前者明显高于后者,P〈0．05。二者诊断早期胃癌的敏感性、特异性及与病理诊断的符合率无明显差异。结论NBI诊断早期胃癌效果确切,其优点为能清晰显示病灶微血管结构变化,从而提高诊断的精确性。     

窄带成像技术结合放大内镜在早期胃癌诊断中的价值研究

目的评价窄带成像技术（NBI）结合放大内镜在早期胃癌诊断中的应用价值。方法2008年3月至2008年12月经普通内镜发现存在胃黏膜可疑病灶且符合研究要求的患者共56例,行NBI结合放大内镜及靛胭脂染色检查,对NBI、靛胭脂染色诊断的胃黏膜腺管及微血管形态的清晰程度评分进行比较。内镜检查之后对所检查部位进行靶向活检,将NBI结合放大内镜及靛胭脂染色检查结果及病理检查结果进行比较。结果56例中有16例经病理诊断为早期胃癌。将NBI结合放大内镜及靛胭脂染色检查结果及病理检查结果进行统计得出：NBI结合放大内镜诊断早期胃癌的诊断符合率、敏感性、特异性、假阳性率、假阴性率分别为94．6％（53／56）、93．8％（15／16）、95．0％（38／40）、5．0％（2／40）、6．3％（1／16）;靛胭脂染色诊断早期胃癌的诊断符合率、敏感性、特异性分别为91．1％（51／56）、87．5％（14／16）、92．5％（37／40）,假阳性率、假阴性率分别为7．5％（3／40）、12．5％（2／16）;二者比较差异均无统计学意义（P均〉0．05）。NBI、靛胭脂染色诊断的胃黏膜腺管及微血管形态的清晰程度评分结果对比显示：NBI与靛胭脂染色在腺管结构显示方面无明显差别,但NBI显示微血管形态明显优于靛胭脂染色。结论NBI结合放大内镜可以提供清晰的胃黏膜血管图像,有助于早期胃癌的诊断,可提高活检检查的准确性,与靛胭脂染色联用可提高早期胃癌的诊断率。     

内镜下白醋联合靛胭脂染色与单纯靛胭脂染色对早期胃癌及癌前病变检出情况的对比研究

目的 对比分析内镜下白醋联合靛胭脂染色与单纯靛胭脂染色对早期胃癌及癌前病变的检出情况。方法 选择2020年1月至2022年12月在北京京煤集团总医院行常规胃镜检查者作为研究对象,经纳入及排除标准筛选,共计160例患者纳入研究。采用随机数表法将患者分为联合染色组和对照组,每组各80例。对照组采用单纯靛胭脂染色,联合染色组采用白醋联合靛胭脂染色。观察2组的染色情况,比较2种染色方法对早期胃癌及癌前病变的阳性检出率。以病理诊断结果为金标准,比较2种染色方法的诊断准确率。观察2种染色方法对于病灶边缘和黏膜微结构形态显示的清晰度。结果 与对照组相比,联合染色组的早期胃癌检出率和上皮内瘤变检出率均较高,但差异均无统计学意义（χ2=1.026,P=0.311;χ2=1.441,P=0.230）。单纯靛胭脂染色和白醋联合靛胭脂染色与病理诊断结果的一致性均较高,Kappa值分别为0.723和0.741,单纯靛胭脂染色和白醋联合靛胭脂染色诊断早期胃癌的准确率分别为97.50%(78/80)和98.75%(79/80),诊断癌前病变的准确率分别为95.00%(76/80)和98.75%(79/80)。在对病...     

普通内镜结合窄带成像技术用于鉴别结直肠息肉良恶性的价值

腺瘤性息肉是结直肠癌的癌前病变,在普通内镜下有时与增生性息肉等不易鉴别。在内镜下对息肉的性质作出正确的定性诊断,对于早期结直肠癌的发现以及指导进一步治疗具有重要意义。窄带成像（NBI）技术通过窄带滤光器过滤掉光源中的宽带光谱,有利于显示黏膜表面腺管开口和微血管形态。本研究旨在探讨普通内镜结合NBI用于鉴别结直肠息肉良恶性的价值。     

内镜窄带成像技术在诊断Barrett食管中的作用研究

目的早期发现和诊断Barrett食管（BE）中的特殊肠上皮化生（肠化）细胞等癌前病变。方法选择2006年4月至11月问29例经胃镜检查确诊为内镜BE的患者，按普通内镜、内镜窄带成像技术（NBI）、内镜靛胭脂染色加放大技术的顺序进行观察，评价各检查方法图像的清晰度；操作医生对NBI下观察到的BE黏膜腺管开口形态进行Endo分型，于改变最显著部位取活检进行病理检查，以明确特殊肠化的检出率。结果在观察鳞一柱状上皮交界的病变轮廓清晰度方面，普通内镜、染色和NBI内镜之间均有统计学差异，其中NBI最清晰，染色次之；在对BE黏膜的腺管开口形态观察中，NBI及内镜染色显著优于普通内镜；在对浅表毛细血管的观察中，NBI具有绝对优势。NBI下根据Endo分型，其Ⅳ型及V型腺管开口形态检出特殊肠化生的准确性达93％，敏感性及特异性分别达89％及95％。结论NBI作为一种新型的内镜检查系统，不仅操作简单，对病变轮廓显示清晰，更可清晰观察到BE黏膜腺管开口及浅表毛细血管结构形态，对BE食管进行靶向病理活检具有良好指导意义和临床实用价值。     

普通窄带成像内镜对结直肠增生性息肉和腺瘤的鉴别诊断价值

目的 分析普通窄带成像(NBI)内镜下结直肠增生性息肉与腺瘤腺管及微血管特征的差异,评价NBI的鉴别诊断价值.方法 将普通内镜下诊断结直肠息肉、病理检查证实为增生性息肉或腺瘤者纳入研究并进行NBI内镜检查.将腺管形态参照改良的工藤分型法分为A型和B型.将微血管形态分为3型,无微血管判为Ⅰ型,微血管沿腺管开口排列、粗细均匀判为Ⅱ型,微血管粗细不均、排列紊乱判为Ⅲ型.比较增生性息肉和腺瘤NBI图像中腺管形态和微血管形态特征的差异,同时对无放大NBI图像观察者间的一致性进行评价.结果 共87例患者的107个息肉(腺瘤73个、增生性息肉34个)进行普通NBI内镜检查.腺瘤组息肉最大径和表面分叶者比例明显高于增生性息肉组(P值分别=0.0023和0.0047).腺瘤组中B型腺管形态[86.3％(63/73)]及Ⅱ或Ⅲ型微血管形态[82.2％(60/73)]者较多.以B型腺管形态、Ⅱ型或Ⅲ型微血管中任一特征诊断腺瘤的敏感度、特异度、准确率分别为97.3％、82.4％、92.5％.以B型腺管形态联合Ⅱ型或Ⅲ型微血管诊断腺瘤的敏感度、特异度、准确率分别为71.2％、91.2％、77.6％.观察者间一致性评价平均Kappa值为0.761.结论 普通NBI内镜下结直肠腺瘤和增生性息肉的微血管特征和腺管特征存在差异,依据以上两方面可在NBI内镜下实时初步鉴别腺瘤和增生性息肉.     

胃癌前病变黏膜微细结构形态变化与组织学改变相关性研究

目的 研究染色放大内镜下胃癌前病变黏膜小凹及微血管的变化与病理组织学的相关性,探讨放大内镜用于诊断癌前病变的可能性.方法 应用Olympus GIF-Q240Z放大内镜对256例胃癌前病变黏膜进行观察,局部喷洒0.4%靛胭脂染色后利用其放大功能观察胃小凹形态及微血管改变并记录.在观察及记录区内取材送病理组织学检查.结果...     

窄带成像放大胃镜联合靛胭脂染色在早期胃癌及癌前病变诊断中的应用病变诊断中的应用

研究表明,如果早期胃癌及癌前病变患者能及早诊断并行内镜下治疗（EMR／ESD）,术后可达到根治效果,5年生存率高于95％^［1］。因此,胃癌的早期诊断和疗效监测显得尤为重要。本研究观察了普通内镜、NBI放大内镜、靛胭脂染色、NBI放大内镜联合靛胭脂染色在早期胃癌及癌前病变诊断中的意义,以期为胃癌的早期诊断提供参考。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

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.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

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.     

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.     

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.