脱落细胞学检查联合胸腹水乳酸脱氢酶在恶性胸腹水中的诊断价值

目的探究脱落细胞学检查联合胸腹水乳酸脱氢酶(LDH)在恶性胸腹水中的诊断价值。方法方便选取2015年7月—2017年7月在该院接受治疗的85例胸腹水患者作为研究对象,根据良恶性不同,将患者分为良性组(n=36例)与恶性组(n=49例),均采取脱落细胞学+LDH检查,比较两组患者胸、腹水中LDH及其相对应血清LDH比值与敏感性、特异性。结果恶性胸腹水患者LDH水平及相对应血清中的LDH比值分别为(421.42±62.13)、(1.83±0.62),均显著高于良性胸腹水患者,两组比较差异有统计学意义(t=12.477、5.367,P<0.05)。恶性组患者断特异性(95.12%)、敏感性(91.84%)均高于良性组患者断特异性(77.78%)、敏感性(72.22%),差异有统计学意义(χ~2=6.579、5.803,P<0.05)。结论对恶性胸腹水患者给予脱落细胞学检查联合胸腹水乳酸脱氢酶诊断,能够有效鉴别良、恶性胸腹水,诊断特异性、敏感性高,能够提升诊断正确性,可广泛应用于临床,具有较高临床诊断价值。

胸水腹水渗出液生化鉴别界线及其应用

目的 探讨 8项生化指标诊断渗出液漏出液的鉴别界线及其应用 ,调查在肿瘤与非肿瘤中的差别。方法 检查 60份胸水、36份腹水各 7项生化项目 ,其中一项不同。研究与应用不同于血清的一套鉴别界线。结果 ( 1 )按照统计学 t检验评价 :1鉴别渗出液与漏出液 :胸水中总胆固醇 2 .49/ 1 .1 5 mmol/ L、总蛋白 45 .5 6/ 2 0 .48g/ L两项有最显著差别 ( P<0 .0 0 1 )。 2鉴别肿瘤 :胸水中氯化物、乳酸脱氢酶、总胆固醇、谷氨酰转肽酶、谷草转氨酶 ,五项有显著差别 ( P<0 .0 0 5～ 0 .0 5 ) ;腹水以总蛋白、谷氨酰转肽酶、谷草转氨酶 ,三项有显著差别 ( P<0 .0 1～ 0 .0 5 )。 ( 2 )按照诊断灵敏度与特异性评价 :1鉴别渗出液界线 ,胸水以总蛋白 30 .0 g/ L、总胆固醇 1 .5 5 mmol/ L最好。 2鉴别肿瘤胸水以谷草转氨酶 >2 7U/ L、总胆固醇 >1 .5 5 mmol/ L、谷氨酰转肽酶 >2 7U/ L;腹水以碱性磷酸酶 >45 U/ L、乳酸脱氢酶 >1 30 U/ L、总蛋白 >2 0 .0 g/ L较好。结论 总蛋白、总胆固醇、GGT、LD、AST、ALP,在区别渗出液与监视肿瘤中有不可否认的价值。

Chylous ascites secondary to hyperlipidemic pancreatitis with normal serum amylase and lipase

A 54-year old man with a family history of hyperlipidemia was admitted with a 12 h history of severe generalized abdominal pain associated with nausea, vomiting and abdominal distension. Examination of the abdomen revealed tenderness in the periumblical area with shifting dullness. Serum pancreatic amylase was 29 IU/L and lipase 44 IU/L, triglyceride 36.28 mmol/L. Ultrasound showed ascites. CT of the abdomen with contrast showed inflammatory changes surrounding the pancreas consistent with acute pancreatitis. Ultrasound (US) guided abdomen paracentesis yielded a milky fluid with high triglyceride content consistent with chylous ascites. The patient was kept fasting and intravenous fluid hydration was provided. Meperidine was administered for pain relief. On the following days the patient’s condition improved and he was gradually restarted on a low-fat diet, and fat lowering agent (gemfibrozil) was begun, 600 mg twice a day. On d 14, abdomen US was repeated and showed fluid free peritoneal cavity. The patient was discharged after 18 d of hospitalization with 600 mg gemfibrozil twice a day. At the time of discharge, the fasting triglyceride was 4.2 mmol/L. After four weeks the patient was seen in the clinic, he was well.

High expression of osteoglycin decreases gelatinase activity of murine hepatocarcinoma Hca-F cells

AIM:To investigate the possible correlation between osteoglycin expression and gelatinase activity of mouse hepatocarcinoma Hca-F cells.METHODS:A eukaryotic expression plasmid pIRE Spuro3 osteoglycin(+)was constructed and transfected into Hca-F cells to investigate the possible correlation between osteoglycin expression and gelatinase activity of Hca-F cells cultured with extract of lymph node,liver,spleen or in DMEM medium.The activity of gelatinases was examined through zymographic analysis.RESULTS:High expression of osteoglycin attenuated the gelatinase activity of Hca-F cells cultured with extract of lymph node,and at the same time,decreased the metastatic potential of Hca-F cells to peripheral lymph nodes in vivo.CONCLUSION:High expression of osteoglycin decreases the gelatinase activity of Hca-F cells cultured with extract of lymph node;regulation of gelatinase activity might be one of mechanisms that osteoglycin contributes to lymphatic metastasis suppression.

Role of ascites adenosine deaminase in differentiating between tuberculous peritonitis and peritoneal carcinomatosis

AIM： To investigate the usefulness of tumor markers and adenosine deaminase in differentiating between tuberculous peritonitis （TBP） and peritoneal carcinoma- tosis （PC）. METHODS： A retrospective analysis of data was per- formed on consecutive patients who underwent perito- neoscopic and abdominal computed tomography （CT） evaluations. Among 75 patients at the Seoul National University Hospital from January 2000 to June 2010 who underwent both tests, 27 patients （36.0%） and 25 patients （33.3%） were diagnosed with TBP and PC, re- spectively. Diagnosis was confirmed by peritoneoscopic biopsy. RESULTS： Serum c-reactive protein （7.88：1：6.62 mg/ dL vs 3.12 ＋ 2.69 mg/dL, P = 0.01）, ascites adenos- ine deaminase （66.76：1：32.09 IU/L vs 13.89 ：l： 8.95 IU/L, P 〈 0.01）, ascites lymphocyte proportion （67.77 ：1： 23.41% vs 48.36 ＋ 18.78%, P 〈 0.01）, and serum- ascites albumin gradient （0.72 ＋ 0.49 g/dL vs 1.05 ＋ 0.50 g/dL, P = 0.03） were significantly different be- tween the two groups. Among tumor markers, serum and ascites carcinoembryonic antigen, serum carbohy- drate antigen 19-9 showed significant difference be- tween two groups. Abdominal CT examinations showed that smooth involvement of the parietal peritoneum was more common in the TBP group （77.8% vs 40.7%） whereas nodular involvement was more common in the PC group （14.8% vs 40.7%, P = 0.04）. From receiver operating characteristic （ROC） curves ascites adeno- sines deaminase （ADA） showed better discriminative capability than tumor markers. An ADA cut-off level of 21 IU/L was found to yield the best results of differ- ential diagnosis; sensitivity, specificity, positive predic- tive value, and negative predictive value were 92.0%, 85.0%, 88.5% and 89.5%, respectively. CONCLUSION： Besides clinical and radiologic findings, ascitic fluid ADA measurement is helpful in the differen- tial diagnosis of TBP and PC.

Expression of Overlapping PCR-generated Shiga Toxin B Gene Fragment in E. Coli and Its Ascitic Polyclonal Antibody

The mature Shiga toxin B （StxB） gene was optimized and generated by overlapping PCR. Recombinant expression vector pQE40-DHFR/StxB was constructed when the gene was cloned into pQE fusion expression vector. Induced by Isopropyl β-D-thiogalactoside （IPTG）, the DHFR/StxB fusion protein was highly expressed to the level of 41.36% in E. coli MI5 cells. The 35 kDa fusion protein with a 6 His-tag was one-step purified from inclusion bodies using Ni-NTA affinity chromatography column under denaturing conditions, and was refolded by dialyzing with a decreasing urea gradient. Purified DHFR/StxB fusion protein was used to immunize Kunming mice for generating the ascitic polyclonal antibody against recombinant StxB protein by injecting sarcoma 180 cells and the titer ofascitic polyclonal antibody is up to 1： 1× 10^6 detected by the indirect enzyme linked immunosorbent assy （ELISA）. Western immunoblotting analysis revealed that the ascitic polyclonal antibody against StxB had a specific affinity for a 70 kDa shiga toxin protein of Shigella dysenteriae type 1. It is a new simple and quick method to produce a large amount of ascitic polyclonal antibody. The antibody is used to develop immunological method for detecting shiga toxin.

Tissue transglutaminase levels above 100 U/mL and celiac disease:A prospective study

AIM:To investigate whether a tissue-transglutaminase antibody(tTGA) level ≥ 100 U/mL is sufficient for the diagnosis of celiac disease(CD).METHODS:Children suspected of having CD were prospectively included in our study between March 2009 and September 2011.All patients with immune globulin A deficiency and all patients on a gluten-free diet were excluded from the study.Anti-endomysium antibodies(EMA) were detected by means of immunofluorescence using sections of distal monkey esophagus(EUROIMMUN,Luebeck,Germany).Serum anti-tTGA were measured by means of enzyme-linked immunosorbent assay using human recombinant tissue transglutaminase(ELiA Celikey IgA kit Phadia AB,Uppsala,Sweden).The histological slides were graded by a single experienced pathologist using the Marsh classification as modified by Oberhuber.Marsh Ⅱ and Ⅲ lesions were considered to be diagnostic for the disease.The positive predictive values(PPVs),negative predictive values(NPVs),sensitivity and specificity of EMA and tTGA along with their 95% CI(for the cut off values > 10 and ≥ 100 U/mL) were calculated using histology as the gold standard for CD.RESULTS:A total of 183 children were included in the study.A total of 70(38.3%) were male,while 113(61.7%) were female.The age range was between 1.0 and 17.6 years,and the mean age was 6.2 years.One hundred twenty(65.6%) patients had a small intestinal biopsy diagnostic for the disease;3 patients had a Marsh Ⅱ lesion,and 117 patients had a Marsh Ⅲ lesion.Of the patients without CD,only 4 patients had a MarshⅠlesion.Of the 183 patients,136 patients were positive for EMA,of whom 20 did not have CD,yielding a PPV for EMA of 85%(95% CI:78%-90%) and a corresponding specificity of 68%(95% CI:55%-79%).The NPV and specificity for EMA were 91%(95% CI:79%-97%) and 97%(95% CI:91%-99%),respectively.Increased levels of tTGA were found in 130 patients,although only 116 patients truly had histological evidence of the disease.The PPV for tTGA was 89%(95% CI:82%-94%),and the corresponding specificity was 78%(95% CI:65%-87%).The NPV and sensitivity were 92%(95% CI:81%-98%) and 97%(95% CI:91%-99%),respectively.A tTGA level ≥ 100 U/mL was found in 87(47.5%) patients,all of whom were also positive for EMA.In all these 87 patients,epithelial lesions confirming CD were found,giving a PPV of 100%(95%CI:95%-100%).The corresponding specificity for this cutoff value was also 100%(95% CI:93%-100%).Within this group,a total of 83 patients had symptoms,at least gastrointestinal and/or growth retardation.Three patients were asymptomatic but were screened because they belonged to a group at risk for CD(diabetes mellitus type 1 or positive family history).The fourth patient who lacked CD-symptoms was detected by coincidence during an endoscopy performed for gastro-intestinal bleeding.CONCLUSION:This study confirms based on prospective data that a small intestinal biopsy is not necessary for the diagnosis of CD in symptomatic patients with tTGA ≥ 100 U/mL.

胸水腹水渗出液生化鉴别界线及其应用

目的：探讨渗出液漏出液的8项生化鉴别界线及其应用。调查在肿瘤与非肿瘤中的差别。方法：检查60份胸水、36份腹水各7项生化。其中一项不同。研究与应用不同于血清的一套鉴别界线。结果：1按照统计学t检验评价：1．1鉴别渗出液：胸水(渗／漏)中以总胆固醇(2．49／1．15)mmol／L、总蛋白(45．56／20．48)g／L两项有最显著差别P<0．001。1．2鉴别肿瘤：胸水以氯化物、乳酸脱氢酶、总胆固醇、谷酰转肽酶、谷草转氨酶，五项有显著差别P<0．005—0．05。腹水以总蛋白、谷酰转肽酶、谷草转氨酶，三项有显著差别P<0．001—0．05。2按照诊断灵敏度与特异性评价：2．1鉴别渗出液，胸水以总蛋白30．0g／L、总胆固醇1．55mmol/L较好。2．2鉴别肿瘤胸水以谷草转氨酶>27U/L、>总胆固醇1．55mmol/L、谷酰转肽酶>27U／L；腹水以碱性磷酸酶>45U／L、乳酸脱氢酶>130U／L、总蛋白>20．0g／L较好。结论：总蛋白，总胆固醇、GGT、LD、AST、ALP，在区别渗出液与肿瘤中有肯定价值。

Effects of fasting and refeeding on expression of MAFbx and MuRF1 in chick skeletal muscle

The present study investigated the effects of fasting and refeeding on the expression of proteasorne-related genes and their downstream targets in the skeletal muscles of chicks. Seven-day-old chicks were fasted for 24 or 48 h and then refed for 4 h. The expression levels of MAFbx and MuRF1, which function as E3 ligases in the ubiquitin-proteasome system, were investigated at the mRNA and protein levels. MAFbx and MuRF1 expression were increased by fasting and these increases were downregulated by refeeding. The expression of the target proteins of these E3 ligases, MyoD and M-CK, was also analyzed. The levels of these proteins were downregulated by fasting, and these decreases were rescued by refeeding. The results of this study indicate that fasting stimulates MAFbx and MuRF1 expression in chicks, possibly leading to increased degradation of their corresponding target proteins.