肝病患者血清TNFα和sTNFαR的相关关系及临床意义初探

采用ＥＬＩＳＡ双抗体夹心法和＾３Ｈ－ＴｄＲ释放法分别对１７６例各种肝病患者及３６例正常人血清ＴＮＦα和ｓＴＮＦαＲ进行测定。结果发现各种肝病患者血清ＴＮＦα和ｓＴＮＦαＲ均明显高于正常对照组（Ｐ〈０．０５），ＴＮＦα和ｓＴＮＦαＲ呈明显正相关。ＰＨＣ和ＣＡＨ患者血清ｓＴＮＦαＲ１／ｓＴＮＦαＦαＲ２比值明显升高；而ＭＨＣ和ＣＰＨ患者血清ｓＴＭＦαＲ／ｓＴＮＦ－Ｒ呃比值则明显减小（Ｐ〈０．０５）。疗     

慢性肾功能衰竭患者胆囊运动的变化和血浆胃动素水平的关系

为了解慢性肾功能衰竭（ＣＲＦ）患者血浆胃动素水平对胆囊运动功能的影响，通过Ｂ超测定了１７例正常人和２２例ＣＲＦ患者口服红霉素前后，胆囊运动功能的变化；并采用放射免疫分析法测定两组空腹血浆胃动素。结果显示：ＣＲＦ组空腹胆囊体积（ＦＧＶｓ）和剩余胆囊体积明显小于正常组（Ｐ均〈０．０１），但两组最大排空率差异无显著性（Ｐ〉０．０５），口服红霉素后正常组ＦＧＶｓ和剩余胆囊体积均明显减少（Ｐ均〈０．０５），     

血清嗜酸性细胞阳离子蛋白与可溶性白细胞介素Ⅱ受体在支气管哮喘中的应用

目的 研究ＥＣＰ与ｓＩＬ－２Ｒ在哮喘病中的致病机制和关系。方法 采用酶免疫荧光法和ＢＡ－ＥＬＩＳＡ法分别测定３０例健康者,６１例重症支气管哮喘患者的血清ＥＣＰ和ｓＩＬ－２Ｒ值,并追踪测试３７例患者治疗后血清ＥＣＰ和ｓＩＬ－２Ｒ水平。结果 急性期患者血清ＥＣＰ,ｓＩＬ－２Ｒ含量均明显高于对照组（Ｐ〈０．０１）,治疗后二者水平明显下降,较治疗前非常显著性差异（Ｐ〈０．０１）。结论 ＥＣＰ是促进气道炎症     

急性颅脑损伤后脑脊液中心钠素和精氨酸加压素含量变化及其临床意义

对３４例急性脑外伤患者脑脊液（ＣＳＦ）中心钠素（ＡＮＦ）和精氨酸加压素（ＡＶＰ）的含量进行放射免疫测定。结果表明脑外伤后４８小时和６～１０天ＣＳＦ中ＡＮＦ含量较对照组均明显降低（Ｐ＜０．００１）；ＡＶＰ含量较对照组明显升高（Ｐ＜０．００１）。伤后２～３周ＣＳＦ中ＡＮＦ水平升高，与对照组相比无明显差异（Ｐ＜０．０５）；ＡＶＰ水平降低，但仍明显高于对照组（Ｐ＜０．０１）。Ｇｌｏｓｇｏｗｃｏｍａｓｃａｌｅ（ＧＣＳ）≤８分者ＣＳＦ中ＡＶＰ含量高于ＧＣＳ＞８分者（Ｐ＜０．０５）；ＣＳＦ压力≥１．９６ｋＰａ者ＡＶＰ含量高于ＣＳＦ压力＜１．９６ｋＰａ者（Ｐ＜０．０５）。ＡＮＦ的含量变化与ＧＣＳ计分和ＣＳＦ压力无关，提示ＡＮＦ和ＡＶＰ可能参与颅脑损伤的病理生理变化，ＡＮＦ的分泌减少与ＡＶＰ的释放增加可能是导致脑外伤后继发脑水肿的重要因素。     

急性肾功能衰竭患者尿表皮生长因子的变化及其临床意义

本文探讨了各种病因的急性肾功能衰竭（ＡＲＦ）２９例尿中表皮生长因子（ＥＧＦ）变化的临床意义。ＡＲＦ急性期血肌酐水平为６．８４±３．８０ｍｇ／ｄｌ，尿ＥＧＦ水平为０．９８±０．１７ｎｇ／ｍｌ，与对照组尿ＥＧＦ水平（２７．１７±２２．６３ｎｇ／ｍｌ）比较，有明显降低（Ｐ＜０．００１）。在ＡＲＦ恢复期，血肌酐降为１．３２＋０．３５ｍｇ／ｄｌ，尿ＥＧＦ水平５．４１±４．６９ｎｇ／ｍｌ，比急性期有明显上升（Ｐ＜０．００１）。ＡＲＦ患者尿ＥＧＦ与血肌酐水平之间呈负相关（ｒ＝－０．４６１８，Ｐ＜０．０１）。本文结果表明尿ＥＧＦ水平在ＡＲＦ病程不同阶段有明显动态变化，此变化有助于了解患者ＡＲＦ的程度及所处阶段，值得深入研究。     

肝癌患者血清可溶性肿瘤坏死因子受体Ⅰ的表达及临床意义

用ＥＬＩＳＡ方法测定了３０例肝癌患者血清可溶性肿瘤坏死因子受体Ⅰ（ｓＴＮＦＲ－Ⅰ）水平。结果表明，肝癌患者血清ｓＴＮＦＲ－Ⅰ水平明显高于正常人（ｐ＜０．０１），且血清ｓＴＮＦＲ－Ⅰ水平与临床分期相关。治疗有效者，血清ｓＴＮＦＲ－１水平均明显下降（ｐ＜０．０１）．治疗后２～８月，３例无癌生存者，血清ｓＴＮＦＲ－１水平降至正常，而７例局部未控或复发转移者，血清ｓＴＮＦＲ－１水平则进行性上升。提示，血清ｓＴＮｌＦＲ－Ⅰ测定对肝癌患者的诊断、疗效观察及预后判断可能有一定的参考价值。     

肝癌患者血清可溶性肿瘤坏死因子受体I的表达及临床意义

用ＥＬＩＳＡ方法测定了３０例肝癌患者血清可溶性肿瘤坏死因子受体Ｉ（ｓＴＮＦＲ－Ｉ）水平。结果表明，肝癌患者血清ｓＴＮＦＲ－Ｉ水平明显高于正常人（ｐ〈０．０１），且血清ｓＴＮＦＲＩ水平与临床分期相关。治疗有效者，血清ｓＴＮＦＲ－Ｉ水平均明显下降（ｐ〈０．０１）。治疗后２￣８月，３例无癌生存者，血清ｓＴＮＦＲ－Ｉ水平降至正常，而７例局部未控或复发转移者，血清ｓＴＮＦＲ－Ｉ水平则进行性上升。提示，血清ｓ     

Graves病血清可溶性白细胞介素-2受体(SIL-2R)的变化及与甲状腺自身抗体的关系

按临床表现、体征、ＦＴ３、ＦＴ４、ＴＳＨ测定及治疗情况将６３例Ｇｒａｖｅｓ病患者分为未治组与治疗缓解组。用ＥＬＩＳＡ法测定血清ＳＩＬ－２Ｒ。结果显示血清ＳＩＬ－２Ｒ未治组与治疗缓解组相比是显著增高的（Ｐ＜０．０１）,但治疗缓解组与正常对照组无差异。血清ＳＩＬ－２Ｒ在未治组与ＦＴ３水平及甲状腺刺激抗体（ＴＳＩ）、甲状腺蛋白抗体（ＴＧ－Ａｂ）滴度呈正相关（ｒ分别为０．６７８、０．５８０、０．７３０,Ｐ均＜０．０１）。提示：血清ＳＩＬ－２Ｒ水平可作为判断Ｇｒａｖｅｓ病活动及治疗效果的一种有价值的免疫学指标     

GFR,ERPF和RI联合测定对糖尿病肾病诊断价值的探讨

对５１例ＮＩＤＤＭ患者测定了ＧＦＲ、ＥＲＰＦ和ＲＩ值，并与２０例正常人进行比较，结果表明，ＮＩＤＤＭ组中正常白蛋白尿患者ＧＦＲ、ＥＲＰＦ和ＲＩ值均升高（Ｐ〈０．０５），且与空腹血糖水平呈正相关；微量白蛋白尿患者仅ＲＩ降低（Ｐ〈０．０５），ＧＦＲ、ＥＲＰＦ无明显变化；大量白蛋白尿患者ＧＦＲ、ＲＩ均降低（Ｐ〈０．０１）。提示ＧＦＲ、ＥＲＰＦ和ＲＩ联合测定可明确肾功能正常、肾小球高滤过、隐性糖尿病肾病和     

四氯化碳肝纤维化大鼠储脂细胞表皮生长因子受体的变化

目的：研究四氯化碳（ＣＣｌ_４）所致实验性肝纤维化大鼠肝脏储脂细胞（ＦＳＣ）表皮生长因子受体（ＥＧＦ－Ｒ）的变化,探讨ＥＧＦ－Ｒ在ＦＳＣ激活中的作用。方法：~（１２５）Ｉ标记ＥＧＦ,放射配体结合分析测定正常和ＣＣｌ４肝纤维化大鼠肝脏原代ＦＳＣ的ＥＧＦ－Ｒ　结果：ＣＣｌ４肝纤维化大鼠肝脏ＦＳＣ数量（６．７１× １０~±５．３２ × １０~７）较正常大鼠（２．６３×１０~７±１．０４×１０~７）显著增多（Ｐ＜０．０５）;正常与 ＣＣｌ_４肝纤维化大鼠ＦＳＣ的ＥＧＦ－Ｒ最大结合位点数（ＲＴ）、解离常数（ｋＤ）分别为：２．２２ ×１０~３ｓｉｔｅｓ／ｃｅｌｌ,４．０９ × １０~(－１０）Ｍ和９．２７× １０~３ｓｉｔｅｓ／ｃｅｌｌ,３．２６× １０~(－１０）Ｍ。肝纤维化时ＥＧＦ－Ｒ明显增高（Ｐ＜０．０５）。结论：ＣＣｌ_４引起肝纤维化时ＦＳＣ增殖,同时ＥＧＦ－Ｒ的表达增加。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

Intake of energy drinks in association with alcoholic beverages in a cohort of students of the School of Medicine of the University of Messina

BACKGROUND: Energy drinks (ED) are a widely used group of beverages known for their stimulant effects on central nervous system (CNS). The main components of ED are caffeine, taurine, carbohydrates, glucuronolactone, inositol, niacin, pantenol, and beta-complex vitamins. The studies evaluating the effects of ED describe improvements in attention and/or reaction times and indices of alertness. It has been also shown that combination of caffeine and glucose, fundamental constituents of ED, can ameliorate deficits in cognitive performance and subjective fatigue during extended periods of cognitive demand. Moreover, the associated ingestion of alcohol and ED has recently been observed to be becoming more and more widespread. METHODS: With the aim to know the habits and uses of students, we administered a questionnaire containing questions regarding ED drinking alone or in association with alcoholic beverages. Five hundred students of the School of Medicine of the University of Messina were interviewed, and 450 filled the questionnaire. RESULTS: A total of 56.9% of students declared using ED. A great part of users (48.4%) associate frequently ED and alcohol. In particular, 35.8% of ED + alcohol users have used ED + alcohol more than 3 times in the last month. Distinguishing the users into 2 groups (users of ED + alcohol and users of both ED and ED + alcohol), we observed in the second group a major use of cocktail containing a mix of ED and alcoholic beverages. This difference between the 2 groups is less represented about the ingestion of ED + alcohol in the night. CONCLUSIONS: Our data indicate that association of ED + alcohol is very popular among students. This behavior can be dangerous. In fact, the combination of ED + alcoholic drinks can reduce adversive symptoms of alcohol intoxication including the depressant effects. As consequence, users of ED + alcoholic beverages might not feel the signs of alcohol intoxication, thus increasing the probability of accidents and/or favoring the possibility of development of alcohol dependence.