心理测验、视觉诱发电位检测亚临床肝性脑病的价值

探讨心理测验、视觉诱发电位检测在亚临床肝性脑病 (SHE)诊断中的意义。对 4 5例肝硬化患者及 30例正常人进行数字连接试验 (NCT) ,视觉诱发电位 (VEP)检测。研究其在亚临床肝性脑病诊断中的应用价值。肝硬化组NCT异常占 5 6 % (2 5 / 4 5 ) ,VEP异常占 4 9% (2 2 / 4 5 ) ,NCT和 (或 )VEP异常占 71% (32 / 4 5 ) ,两者均异常 33% (15 /4 5 ) ;对照组NCT异常占 30 % (9/ 30 ) ,VEP异常占 2 7% (8/ 30 )。两组比较差异有显著性意义 (P <0 0 5 )。NCT和VEP可用于诊断SHE ,联合检测可提高SHE检出率 ,对预防肝性脑病的发生有重要意义     

检测脑干听觉诱发电位诊断亚临床肝性脑病的临床研究

亚临床肝性脑病(subclinical hepatic encephalopathy, SHE)无肝性脑病症状和体征,但有脑电活动和智力测定的异常。为探讨脑干听觉诱发电位(BAEPs)对SHE诊断价值,我们检测40例肝硬化患者,同时进行数字连接试验(NCT)、脑电图(EEG)和血氨浓度测定,结果报道如下。     

数字连接试验检测肝病患者亚临床肝性脑病的研究

目的 以数字连接试验(NCT)检测慢性肝病尤其是病毒性肝炎患者的亚临床肝性脑病(SHE)发病率，以了解肝功能与SHE的关系。方法 对177例慢性肝病进行NCT检测。结果 慢性肝病患者的NCT异常率31．1％(55／177)，病毒性肝炎患者的NCT异常率29．7％(47／158)；肝功损害轻度及重症肝炎时，肝硬化组与非肝硬化组的NCT异常率无差别，肝功损害中度和重度时，肝硬化组的异常率高于非肝硬化组，且有显著性差异；肝功分级间的SHE发病率无差异；男女间的NCT异常率无差别。结论肝病病人出现智力障碍与肝功损害及肝硬化的门体分流都有关，而与病因无关；肝功损害程度与SHE的发生率末显示线性关系。     

亚临床肝性脑病46例前瞻性研究

肝性脑病是肝硬化合并症之一,传统分为四期(Ⅰ～Ⅳ)。近年来人们逐渐认识到有相当多的患者虽存有代谢系统、脑机能障碍。却并无肝性脑病的临床症状,这种临床上缺乏症状。常规精神和神经功能检查正常,但智能或心理计量测验异常的肝病患者称为亚临床肝性脑病(SHE)。Gitlin等报道晚期肝硬化患者中60％～70％有这种SHE。我们对46例无精神或意识障碍,常规精神和神经功能检查正常的失代偿期肝硬化患者进行血氨智能测验(数字顺序联结试验NCT)、EEG、VEPs测定,并随访半年。结果报道于下。临床资料     

乳果糖对亚临床肝性脑病肝硬化患者的疗效

在无脑病史的肝硬化患者中,亚临床肝性脑病(SHE)的患病率为30％～84％。乳果糖在有明显脑病患者的治疗中有一定的作用。此研究的目的是评价乳果糖治疗SHE患者的疗效。 病人和方法:此研究包括40例肝硬化患者,男性33例,女性7例。SHE的诊断应作定量的精神定量试验,包括数字连接试验(NCT)图像连接试验(FCT)以及Wechsler成人智力量表中的图片完成试验和方块设计试验。其中     

心理智能测验检测肝动脉化疗栓塞对肝癌合并肝硬化患者亚临床肝性脑病的影响

目的:用心理智能测验研究原发性肝癌合并肝硬化患者并发亚临床肝性脑病(SHE)的情况,了解肝动脉化疗栓塞(TACE)治疗对SHE的影响,并探讨心理智能测验能否作为判断TACE治疗后SHE变化的指标.方法:用数字连接试验(NCT)、数字符号试验(DSy)与数字广度试验(DSp)3种心理智能测验对81例原发性肝癌合并肝硬化并接受TACE治疗的患者及50例对照进行检测,其中48例患者在TACE治疗后2周进行复查.结果:患者组与对照组各项心理智能测验结果存在显著差异,81例患者中共检出SHE 20例(24.7%).患者组TACE治疗前后检查结果无显著差异.因学习效应的影响,对照组2周后复查的成绩明显优于第1次.结论:SHE在原发性肝癌合并肝硬化患者中有一定的发生率.心理智能测验因存在学习效应,不宜作为判断某种治疗对SHE影响的指标.     

亚临床肝性脑病的研究现状

亚临床肝性脑病(Subclinical hepaticencephalopathy,SHE)是指慢性肝病病人无明显肝性脑病临床表现和血生化表现异常,仅能用精细的智力试验和/或电生理检测才能诊断的肝性脑病。它是肝性脑病最常见的形式。国外报道其发生率为30%～84%,国内朱权等人报道一组肝炎后肝硬化患者 SHE 总的发生率为56.7%,钟碧慧等报道为77%,李瑜元等人对亚临床肝性脑病做了较大样本的发病率调查(共136例),结果为50.7%。SHE 患者外表似正常但多数     

肝炎肝硬化并发亚临床肝性脑病的诊断研究

目的探讨及评价亚临床性肝性脑病(SHE)早期诊断的方法。方法对116例肝炎肝硬化患者进行3项心理智能测试及3项脑电诱发电位(EP)检测,并与正常人群比较。结果心理智能测试异常率为58.6%,显著高于EP检测异常率25.9%,两者总异常率达68.0%(80/116例)。6项测试中以数字连接试验(NCT)异常率最高(50%);将患者按Child-Pugh进行肝功能分级,B/C级患者(90例)中心理智能测试异常率为68.9%,心理智能测试与EP检测总异常率为77.8%,显著高于A级患者(26例)心理智能测试异常率(23%,P<0.01)及心理智能测试与EP检测总异常率(38.5%,P<0.01)。结论心理智能测试比EP检测敏感,二者在SHE的诊断中有相互补充的作用;NCT是最敏感的单项测试方法;心理智能测试异常率及SHE发生率的高低与肝脏病变及肝功能损害的严重程度相一致。     

亚临床肝性脑病的流行病学调查

目的 了解亚临床肝性脑病(SHE)患病率及相关因素。 方法 对409例肝硬化患者进行数字连接试验(NCT)和数字符号试验(DST)检查。 结果 肝硬化患者SHE患病率为51.3％,肝硬化与正常对照组各年龄段及总的NCT、DST差异均有显著性,t=4.108～25.231,P<0.01。Child—pugh A、B、C级患者的患病率分别为39.9％(75/188)、55.2％(79/143)、71.8％(56/78),三组间差异有显著性,x2=23.910,P<0.01。小于35、35～44、45～54、55～64和大于64岁五个年龄段的患病率、性别、吸烟与否、酒精性和非酒精性肝硬化患者、不同文化程度,患者之间的患病率比较差异均无显著性。Logistic回归分析显示SHE患病率仅与Child—pugh分级相关,而与年龄、性别、吸烟、病因和文化程度无关。 结论 肝硬化患者SHE患病率为51.3％。Child-pugh分级是重要的危险因子。     

乳果糖联合高压氧治疗亚临床肝性脑病临床研究

亚临床肝性脑病（SHE）是指某些肝硬化患者临床表现、常规精神和神经功能检查正常．但心理学测验或诱发电位检查异常，作为肝性脑病（HE）的特殊类型，在慢性肝病尤其是肝硬化中有较高的发病率，由于无HE的症状和体征而忽视治疗，从而使部分患者发展成HE，危及生命。我们通过测定肝硬化患者的静脉血氨、丙氨酸转氨酶（ALT）、数字连接试验（NCT）、脑干听觉诱发电位（BAEP）异常率及24周随访观察HE的累积发病率，来评估乳果糖联合高压氧治疗SHE的疗效。     

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.     

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.     

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.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.