国产内镜新光学染色技术对直径小于2 cm结直肠息肉病变的临床应用价值

背景 发现并治疗早期较小的结直肠息肉是预防结直肠癌的关键,国产内镜新光学染色技术-聚谱成像及新电复合染色成像在辅助治疗中具有较高的临床价值.目的 探讨国产内镜新光学染色技术-聚谱成像(spectral focused imaging,SFI)及光电复合染色成像(variable intelligent staining technology, VIST)对于直径小于2cm的结直肠息肉的诊断价值.方法 选取2022-01/2022-10期间,在我院诊断的结直肠息肉患者200例,采用白光模式观察诊断和国产新光学染技术(SFI和VIST技术)观察,观察肠息肉的形态、腺管开口类型、毛细血管形态,并进行清晰度评分,最后与病理诊断相对比,评判国产内镜新光学染色技术的诊断价值.结果 1型的结肠息肉样病变为78个(38%), 2型为114个(55%),3型为16个(8%).病理学结果显示,非腺瘤型息肉为76个(37%),腺瘤型息肉为132个(64%).与肠镜白光模式诊断相比,新光学染色模式诊断的灵敏度、特异度和准确率均更高P<0.05).新光学染色模式下诊断直径小于1 cm和1 cm-2 cm腺...     

联动成像模式下氤氲紫改变诊断胃黏膜肠上皮化生的临床应用研究

目的研究联动成像(linked color imaging,LCI)对胃黏膜肠上皮化生病变的临床鉴别价值。方法2017年3—12月在陕西省安康市中心医院拟行胃黏膜内镜检查的患者随机抽样120例分成2组,白光组60例行白光内镜观察,LCI组60例行LCI观察,发现的病变均行病理活检。LCI观察有氤氲紫表现的病变内镜诊断为肠上皮化生。将内镜诊断结果与病理检查结果进行对比。结果白光组发现病灶62处,其中病理诊断肠上皮化生15处(24.2%);LCI组发现病灶74处,其中病理诊断肠上皮化生36处(48.6%),两组肠上皮化生发现率差异具有统计学意义(P=0.003)。LCI模式下有氤氲紫表现的病变34处,其中病理确诊肠上皮化生33处,LCI诊断与病理结果符合率97.1%(33/34)。结论LCI模式下氤氲紫表现对胃黏膜肠上皮化生病变诊断准确率高,是发现胃黏膜早期肿瘤和癌前病变的有效手段。     

窄带成像放大内镜在胃黏膜肠上皮化生随访中的应用

背景：胃黏膜肠上皮化生的随访主要依赖随机活检,窄带成像放大内镜（NBI-ME）可能有助于提高肠上皮化生随访的准确性。目的：探讨NBI-ME在胃黏膜肠上皮化生随访中的应用价值。方法：选取2010年6月~2011年6月上海市第七人民医院120例萎缩性胃炎伴中-重度肠上皮化生随访复查胃镜患者,随机分成NBI-ME组和普通白光内镜（WLE）组,并行组织病理学检查,比较两组胃黏膜肠上皮化生的检出率。NBI-ME组内镜下观察浅蓝色嵴状结构（LBC）,并与组织病理学结果进行对比分析。结果：NBI-ME组56例患者检出胃黏膜肠上皮化生,WLE组为48例,NBI-ME组胃黏膜肠上皮化生的检出率显著高于WLE组（93.3%对80.0%,P〈0.05）;LBC诊断胃黏膜肠上皮化生的敏感性、特异性、阳性预测值和阴性预测值分别为89.4%、90.5%、93.3%和85.1%;NBI-ME下LBC阳性区域黏膜活检可明显提高肠上皮化生的检出率,差异有统计学意义（93.3%对14.9%,P〈0.05）。结论：在胃黏膜肠上皮化生随访中,NBI-ME下LBC阳性区域黏膜活检有助于提高肠上皮化生的检出率。     

NBI放大内镜在胃黏膜糜烂鉴别诊断中的价值

目的探讨NBI放大内镜在胃黏膜糜烂鉴别诊断中的价值,以及在胃黏膜癌前病变中的诊断价值。方法应用NBI电子放大内镜,对310例患者的胃黏膜糜烂灶进行细微结构形态学观察,并与观察部位活检所得的病理组织学改变进行比较分析。结果胃黏膜糜烂灶处胃小凹形态未见到A型、B型者;365处C型中组织病理均为慢性活动性浅表性炎症;160处D型中,92.5%（148/160）为萎缩性炎症;65处E型中,86.15%（56/65）为肠上皮化生;35处F型中,91.42%（32/35）为异型增生,8.57%（3/30）为肠上皮化生。59例肠上皮化生未发现明显异常增生的毛细血管,而32例异型增生的F型黏膜表面。90.63%（29/32）呈现出不同程度异常增生的毛细血管。与病理组织学比较,NBI放大内镜观察胃黏膜糜烂小凹形态与病理组织学改变呈显著正相关（P〈0.01）。结论 NBI放大内镜在胃黏膜糜烂灶性质的判断中有很高的临床应用价值,可应用于胃黏膜癌前病变的普查。     

色素内镜对胃黏膜肠上皮化生的分析及诊断价值

胃黏膜肠上皮化生（IM）是目前国内外公认的癌前病变之一，若能及早通过内镜下识别和治疗使其病变逆转．不失为防治胃癌的有效途径。探讨内镜诊断胃黏膜肠上皮化生．对识别胃黏膜癌前病变准确性提出了更高的要求。献报道，放大内镜对诊断IM准确性达89．69％，但基层医院的内镜医师由于受放大内镜设备的限制。如何利用普通内镜提高对IM诊断率，是值得探讨的。我们采用普通染色内镜进行观察，以探讨其对IM病变诊断的可行性和准确性。     

内镜下醋酸与美兰染色对胃黏膜肠上皮化生的诊断价值

目的比较内镜下醋酸与美兰染色对胃黏膜肠上皮化生的临床诊断价值。方法将陕西省榆林市星元医院2013年1月-2013年12月收治的疑似胃黏膜肠上皮化生患者240例按随机数字表法均分为A、B两组,A组采用醋酸染色,B组采用美兰染色,比较内镜下两种不同方法的诊断结果。结果 A组敏感性、特异性分别为87.6%、91.3%,B组分别为92.7%、90.9%;组间差异无统计学意义(P0.05);B组阴性似然比低于A组,OR明显大于A组,组间差异有统计学意义(P0.05)。结论内镜下醋酸与美兰染色都有助于诊断胃黏膜肠上皮化生,美兰染色诊断价值更高。     

胃体萎缩的内镜诊断

胃体萎缩是较为少见的胃黏膜萎缩,多见于自身免疫性胃炎。胃体萎缩伴肠化生是胃癌的癌前病变。内镜是诊断胃体萎缩的重要手段。本文就胃体萎缩的内镜诊断进展作一综述。     

胃黏膜萎缩、肠上皮化生及异型增生的放大内镜表现及其诊断价值

目的 确定胃黏膜萎缩、肠上皮化生及异型增生的形态学特征，探讨放大内镜结合染色对上述病变诊断的可行性和准确性。方法 应用Fujinon EG485 ZH型放大内镜对100例患者进行检查及0．5％美蓝染色，在确定A、B、C、D、E 5型基本胃小凹形态的基础上，制订放大内镜的诊断分型及放大内镜对萎缩、肠上皮化生和异型增生的判定标准，与相应部位活检所获得的417个病变组织的病理组织学检查结果进行比较分析。结果 胃黏膜萎缩主要表现为胃小凹粗大而分布稀疏，肠上皮化生表现为C、D、E型小凹形态伴美蓝着色阳性，异犁增生表现为轻度凹陷、隆起或平坦性病变伴细微结构消失、细微小凹或细微结构粗糙紊乱放大内镜对萎缩诊断的敏感性、特异性分别为95．85％和95．09％；对肠上皮化生分别为88．30％和90．83％；对异型增生分别为91．52％和94．41％，均明显高于普通内镜。结论 根据放大内镜下萎缩、肠上皮化生和异型增生的形态学特征可以使内镜对上述病变诊断的准确性明显提高。     

内镜下氩离子凝固术治疗胃癌前病变临床研究

目的探讨内镜下氩离子凝固术治疗胃黏膜癌前病变的价值及安全性。方法应用奥林巴斯260电子胃镜结合病理对108例胃黏膜癌前病变患者进行氩离子凝固术治疗,所有病例治疗6月后进行临床随访、内镜及病理组织学复查。结果 108例患者其中胃黏膜肠上皮化生43例（39.8%）及上皮内瘤变65例（60.2%）,104例患者临床症状减轻,复查胃镜示原病灶消失,复查病理组织学示胃黏膜肠上皮化生或上皮内瘤变消失,尚存慢性活动性炎症（92.6%）或萎缩性炎症（5.6%）,治疗有效率98.1%,所有病例治疗中未发生出血、穿孔等并发症。结论内镜下氩离子凝固术治疗胃黏膜癌前病变安全、有效、快捷、经济,值得在基层医院推广。     

激光共聚焦内镜对慢性萎缩性胃炎和肠上皮化生的诊断价值

目的 比较共聚焦内镜与普通白光内镜对萎缩性胃炎和肠上皮化生的诊断价值。方法对2012年1月至5月来我院行胃镜检查的89例患者,全部在普通白光内镜及共聚焦内镜下对胃黏膜进行观察,并对病变部位进行活检病理学诊断。结果89例患者共观察286个病变部位。普通内镜诊断萎缩性胃炎95个部位,共聚焦内镜诊断40个部位,病理学诊断萎缩37个部位,共聚焦内镜与病理学诊断符合率为94．6％,普通内镜与病理学诊断符合率为38．95％;普通内镜诊断肠上皮化生54个部位,共聚焦内镜诊断170个部位,靶向活检诊断161个部位,共聚焦内镜与病理学诊断符合率为84．47％,普通内镜与病理学诊断符合率为33．54％。共聚焦内镜对萎缩性胃炎和肠上皮化生的诊断符合率明显高于普通内镜组,并且共聚焦内镜与病理学诊断具有很好的一致性（P=0．453,kappa值=0．895和P=0．298,kappa值=0．577）。结论共聚焦内镜对萎缩性胃炎和肠上皮化生具有较高的诊断价值,值得临床推广。     

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.     

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.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.     

Morphological and immunocytochemical heterogeneity of cultured pinealocytes from one-week-and two-month-old rats: Planimetric and densitometric investigations

Abstract: In vitro preparations of rat pinealocytes are widely used for biochemical analyses of signal transduction processes. This paper deals with morphological and immunocytochemical features of such preparations. Special attention was paid to the problems of whether pinealocytes represent a heterogeneous cell population and how such heterogeneity may develop during ontogeny. The investigations were performed with cells which were obtained from the pineal organ of one-week-and two-month-old rats, attached to synthetic peptide-coated coverslips or tissue culture chamber slides, and maintained under in vitro conditions overnight. The attached cells were then fixed with paraformaldehyde. These preparations yielded monolayers of spherical cells of different sizes; most cells were isolated, but some of them were aggregated and formed small clusters. On the average, the cells from the one-week-old animals were smaller than the cells from the two-month-old animals. Immunocytochemical demonstration of S-antigen, a pinealocyte-specific marker, showed that the majority of the cells from two-month-old animals were intensely or moderately labelled. Pinealocytes from one-week-old animals were less S-antigen immunoreactive. Only very few cells (less than 1% displayed glial fibrillary acidic protein (GFAP)-immunoreactivity. Planimetric investigations of the cell size and semiquantitative densitometric investigations of the intensity of the S-antigen immunoreaction revealed that (i) pinealocytes kept in vitro form a heterogeneous cell population, and that (ii) this heterogeneity increases during postnatal development from one-week-old to two-month-old animals. Two groups of pinealocytes can be distinguished based on their developmental fate: pinealocytes of one group grow dramatically, but show only a moderate increase in S-antigen immunoreactivity, and pinealocytes of the other group retain their size, but display a distinct increment in S-antigen immunoreacti vitv.     

Effects of pinealectomy and melatonin administration on certain indices of ovarian hyperplasia and/or hypertrophy in rats with both ovaries intact or after unilateral ovariectomy

Abstract: In earlier studies from other laboratories it was shown that melatonin decreased ovarian weight in rats and inhibited compensatory hypertrophy of the remaining ovary after unilateral ovariectomy. This study was designed to examine the influence of melatonin on certain indices of ovarian hyperplasia and/or hypertrophy in adult female rats with both ovaries preserved and with either an intact pineal gland or with the pineal gland removed (pinealectomy, PX) or, finally, in sham-PX animals. Similar studies were conducted on rats after unilateral ovariectomy, referring the examined parameters to the remaining intact ovary. The studies included mitotic activity of granulosa layer cells and corpus luteum cells, ovarian weight, ovarian cross-sectional area, cross-sectional area of the granulosa layer of all the Graafian follicles and the cross-sectional areas of the corpora lutea, visible on the ovarian cross-section. On the basis of results, we conclude that: 1) the effect of PX on the processes of ovarian hyperplasia and hypertrophy may vary; analogously, exogenous melatonin administration may influence ovarian hyperplasia and hypertrophy in different ways; 2) PX and exogenous melatonin may, under certain conditions, exert similar biological effects, even synergistic effects; 3) melatonin inhibits ovarian growth processes, while the effects of PX are variable; 4) the results indicate that in experiments performed on rats, with the use of two control groups, i.e., intact and sham-PX, melatonin effects on these two groups may differ.