转化生长因子β1对原发性肝癌诊断价值的初步探讨

为了解转化生长因子β１（ＴＧＦβ１）在原发性肝癌中的诊断意义，用酶联免疫吸附试验法（ＥＬＩＳＡ）测定了４７例原发性肝癌（ＰＨＣ）、７７例其他各种肝病和消化道恶性肿瘤及２０例正常对照者的血清ＴＧＦβ１水平。结果：ＰＨＣ血清ＴＧＦβ１水平明显高于正常对照及其他各病组（Ｐ值分别＜０．０５或０．０１）。血清ＴＧＦβ１诊断ＰＨＣ的敏感性和特异性分别为７２．３％和７７．９％，甲胎蛋白（ＡＦＰ）阴性ＰＨＣ诊断阳性率为７８．６％，其中７例小肝癌有５例（７１．４％）血清ＴＧＦβ１阳性，与ＡＦＰ联合检测可提高ＰＨＣ诊断阳性率，达９３．６％。血清ＴＧＦβ１作为一种新的ＰＨＣ血清标志物应用于ＰＨＣ的诊断、监测和疗效判断，尤其是对ＡＦＰ阴性或早期肝癌的诊断，有重要临床意义。     

三种肝癌标志物对肝癌诊断特异性的再评价

三种肝癌标志物对肝癌诊断特异性的再评价谢先火，沈鼎明，沈薇近年来，出现了一系列对原发性肝癌（ＰＨＣ）有诊断价值的血清肝癌标志物，如血清α＿１－抗胰蛋白酶ＬＣＡ结合型异质体（ＬＣＡ－ＡＡＴ）、α－Ｌ－岩藻糖苷酶（ＡＦＵ）及γ－谷氨酰转肽酶ＩＩ（ＧＧＴＩ...     

人胎肝GGT抗血清对原发性肝癌的诊断价值

人胎肝ＧＧＴ抗血清对原发性肝癌的诊断价值黄介飞，姚登福，孟宪镛，魏群，倪润洲，张弘，肖明兵人体γ－谷氨酰移换酶（ＧＧＴ）作为原发性肝癌（ＰＨＣ）标记物已受到重视，众多肝癌研究者已把ＧＧＴ视为ＰＨＣ诊断的标记酶［１］。以化学药物２－ＦＡＡ诱发鼠肝癌，经...     

两种肝癌标志物对原发性肝癌诊断意义的评价

为判断肝癌标志物对原发性肝癌诊断的意义，对１９７例良、恶性肝病、恶性胃肠道肿瘤病人及５１例正常人进行了γ－谷氨酰转肽酶同功酶ＩＩ（γ－ＧＴＰ－ＩＩ）、血清甲胎蛋白（ＡＦＰ）的检测，并对全部肝癌病人及４３例伴有ＡＦＰ升高的良性肝病病人进行了ＡＦＰ异质体分析。在１０４例原发性肝癌（ＰＨＣ）中，γ－ＧＴＰ－ＩＩ特异性最高（９５．７％），ＡＦＰ异质体的敏感性最好（８４．６％），其各自的阳性率在ＡＦＰ≥４００μｇ／Ｌ组及ＡＦＰ＜４００μｇ／Ｌ组差异均无显著性；在血清ＡＦＰ浓度不同时，两者各自的阳性率亦未见差异（Ｐ＞０．０５）；两者联合检测，共检出１０４例ＰＨＣ中的９７例（９３．３％），阳性率在ＡＦＰ≥４００μｇ／Ｌ组为９５．２％，在ＡＦＰ＜４００μｇ／Ｌ组为９１．９％。结果提示：γ－ＧＴＰ－ＩＩ和ＡＦＰ异质体联合检测能提高ＰＨＣ病人的检出率，对ＡＦＰ低浓度升高的ＰＨＣ患者同样有较好的诊断价值，可部分弥补单项检测ＡＦＰ的不足。有助于ＰＨＣ病人的及早诊断。     

血清首氨酰脯氨酸二肽氨基肽酶同工酶对原发性肝癌的诊断价值

目的研究血清甘氨酰脯氨酸二肽氨基肽酶（ｇｌｙｃｙｌｐｒｏｌｉｎｅ　ｄｉｐｅｐｔｉｄｙｌ　ａｍｉｎｏｐｅｐｔｉｄａｓｅ,ＧＰＤＡ）同工酶对ＰＨＣ的诊断价值,提高早期 ＰＨＣ和 ＡＦＰ阴性ＰＨＣ诊断水平。方法采用阶段梯度垂直平板聚丙烯酰胺凝胶电泳法进行血清ＧＰＤＡ同工酶分离检测,同步测定比较ＰＨＣ患者血清ＧＰＤＡ同工酶与ＧＰＤＡ,Ｑ．活性（ＴＧＰＤ）、ＡＦＰ、肿瘤大小及ＡＬＴ的关系。结果血清ＧＰＤＡ按其泳动速度可分为快带（ＧＰＤＡ－Ｆ）与慢带（ＧＰＤＡ－Ｓ）两种同工酶。ＰＨＣ患者血清ＧＰＤＡ－Ｆ的阳性率为８５．３％,而肝外肿瘤、转移性肝癌、肝炎后肝硬化、慢性肝炎中阳性率均较低,正常对照组以及良性肝占位全部阴性。ＧＰＤＡ－Ｆ阳性率在ＴＧＰＤＡ活性增高组明显高于正常组（９４．４％对７５０％）,ＧＰＤＡ－Ｆ与ＡＦＰ及肿瘤大小无关系。良性肝病ＡＬＴ升高组ＧＰＤＡ－Ｆ阳性率高于ＡＬＴ正常组,而ＰＨＣ患者ＧＰＤＡ－Ｆ与ＡＬＴ无关。ＰＨＣ患者ＧＰＤＡ－Ｆ呈持续阳性,良性肝病患者ＧＰＤＡ－Ｆ常为一过性阳性。结论ＧＰＤＡ－Ｆ为一新的ＰＨＣ血清标志物,有助于ＰＨＣ的定性诊断,尤其对早期ＰＨＣ及ＡＦＰ阴性ＰＨＣ的诊断具有重要价值。     

血浆前列腺素E2测定对原发性肝癌的诊断价值

为研究血浆ＰＧＥ２对原发性肝癌诊断价值，测定３００例夺发性肝癌（ＰＨＣ）、１００例酒精性肝病、３９０例肝硬化及３０例正常对照者的血浆ＰＧＥ２值。结果提示ＰＨＣ患者血冰ＰＧＥ２水平显著增加（Ｐ〈０．００１），且转移性肝癌患者中更为显著（Ｐ〈０．０１），良性肝病患者无显著增加（Ｐ〉０．０５）。检测ＰＧＥ２水平对早期发现肝硬化转化ＰＨＣ，及控制ＰＨＣ的增殖与转移具有一定价值。     

树突状细胞体外诱导抗肝癌免疫

目的应用树突状细胞（ＤＣ）在体外诱导高效而特异抗肝癌免疫．方法自肝癌患者外周血中分离ＤＣ;以粒／巨噬细胞集落刺激因子（ＧＭＣＳＦ）及白介素４（ＩＬ４）联合刺激ＤＣ;以人肝癌细胞系ＨｅｐＧ２肿瘤细胞的肿瘤相关抗原（ＴＡＡ）激活ＤＣ;ＤＣ诱导自体Ｔ淋巴细胞增殖、分化为细胞毒性Ｔ细胞（ＣＴＬ）;检测ＣＴＬ及其上清液对ＨｅｐＧ２肿瘤细胞、ＬＯＶＯ肿瘤细胞及ＨＯＳ８６０３肿瘤细胞的细胞毒作用．结果经人肝癌细胞系ＨｅｐＧ２肿瘤细胞的ＴＡＡ激活并经ＧＭＣＳＦ及ＩＬ４联合刺激后,肝癌患者外周血ＤＣ能够诱导自体Ｔ淋巴细胞增殖分化为ＣＴＬ,该ＣＴＬ及其上清液对ＨｅｐＧ２肿瘤细胞均有高效而特异性的杀伤作用（杀伤率分别为９２％±１０５％和４１％±８９％）．结论肝癌患者外周血ＤＣ体外能够诱导高效而特异抗肝癌免疫．提示ＤＣ作为一新概念上的抗肿瘤疫苗可能在肿瘤治疗及预防中发挥重要作用．     

人肝癌组织中γ-谷氨酰转移酶异常表达及其基因甲基化程度的研究

目的探讨γ谷氨酰转移酶（ＧＧＴ）基因在人类肝癌发生过程中的表达及改变机制。方法以病理组织学、生物化学和分子生物学方法,将自身配对的肝癌、癌旁组织和远癌组织中总ＲＮＡ纯化,对ＧＧＴ的表达与改变进行了分析;并设计两套引物,以逆转录巢式ＰＣＲ法扩增ＧＧＴ５′非编码区（ＮＣ）基因和限制性内切酶消化分析了不同肝癌组织中ＧＧＴ基因的甲基化程度。结果在病理组织学证实的２４例肝癌、癌旁和远癌组织中：①从肝癌灶至远癌的不同组织中,总ＲＮＡ浓度呈逐步升高趋势,三种不同组织间的差异均有显著性（Ｐ＜０．０５）;②癌组织中总ＧＧＴ比活性（Ｕ／ｇ）较癌周和远癌组织明显升高（Ｐ＜０．０５）;③以自行设计建立的逆转录巢式ＰＣＲ法,成功地扩增ＧＧＴ的５′ＮＣ基因片段,特异性强且区带清晰,ＰＣＲ产物经酶切分析证明,ＧＧＴ基因５′ＮＣＭ３位点（ＣＣＧＧ）,其内位Ｃ在癌灶、癌周和远癌组织中的低甲基化频率分别为７０．８３％,５８．３３％和５４．１７％,非常明显地高于同组中已甲基化程度。结论肝癌组织中ＧＧＴ基因甲基化程度较低,且与肝癌ＧＧＴ的异常表达关系密切,对肝细胞癌变可能起促进作用。     

血清甘氨酰脯氨酸二肽氨基肽酶对原发性肝癌的诊断价值探讨

对３１例原发性肝癌（ＰＨＣ）、３２例肝硬化患者及２０例正常人进行了血清甘氨酰脯氨酸二肽氨基肽酶（ＧＰＤＡ）的活性测定,对３１例ＰＨＣ患者治疗前后ＧＰＤＡ的含量进行了对比分析,并与甲胎蛋白（ＡＦＰ）的诊断价值进行对比。结果显示,ＧＰＤＡ对ＰＨＣ的诊断敏感性为７４．２％,优于ＡＦＰ诊断敏感性６７．７％,特别是在ＡＦＰ阴性的ＰＨＣ患者中,ＧＰＤＡ的阳性率高达６０％,弥补了ＡＦＰ对ＰＨＣ诊断阳性率低的不足     

骨钙素测定在原发性肝癌患者中的应用价值

骨钙素（ＢＧＰ）通常是作为骨骼成骨性增生的一种特异性标记物，在原发性肝癌（ＰＨＣ）患者中的变化则少见报告。本文应用放射免疫分析法测５０例ＰＨＣ患者血清中ＢＧＰ，增高者为６６％（３３／５０）。其中６例ＡＦＰ阴性ＰＨＣ患者有３例ＢＧＰ增高，经统计学处理ＢＧＰ与ＡＦＰ含量变化无相关性。增高的原因可能与患者病情的严重程度有关，是肝肾功能不全的一种指征。     

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.     

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.     

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.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.