儿童过敏性紫癜与肺炎支原体感染的临床观察

目的探讨肺炎支原体（MP）感染并发过敏性紫癜（HSP）的临床特征、治疗及转归。方法对30例诊断为HSP及MP感染的患儿进行回顾性分析，对其临床特点、治疗及转归加以总结。结果对30例MP感染并发HSP的患儿，均在常规抗过敏、抗凝、改善循环等综合治疗的基础上给予阿奇霉素正规治疗，治愈27例，好转3例。结论MP感染可并发HSP，其临床特点是除典型紫癜外，多伴发热、呼吸道感染，且病情重，易反复，给予及时、足疗程的抗MP感染治疗对缩短病程，预防复发尤为重要，大多预后良好。     

静脉用丙种球蛋白对HSP患儿D-二聚体的影响

将66例过敏性紫癜(HSP)患儿随机分为治疗组33例及对照组33例,两组均给予常规治疗,治疗组加用静脉用丙种球蛋白(IVIG)。治疗7d后,观察两组治疗前后血浆D-二聚体水平的变化。结果HSP患儿血浆D-二聚体水平增高,治疗后水平下降(P<0.01),治疗组下降比对照组更明显(P<0.05)。表明IVIG可降低HSP患儿血浆D-二聚体水平,改善其血液高凝状态。     

过敏性紫癜患者血凝状态的临床和实验室检查特点

过敏性紫癜(HSP)是血管变态反应性炎症病变,其病理变化涉及体液、细胞免疫、细胞因子、凝血因子、PLT、WBC、RBC等因素.本文结合文献对HSP患者血凝状态的临床和实验室检查特点综述如下.     

复方丹参治疗过敏性紫癜的疗效与血小板聚集功能观察

我们应用复方丹参注射液治疗过敏性紫癜 (HSP) ,并观察其对血小板聚集功能的影响。临床资料 :5 0例 HSP皆为本院住院及门诊患儿 ,均符合HSP的诊断标准。治疗组及对照组各 2 5例 ,两组患儿在年龄、症状和并发症等方面经统计学处理无差异。治疗方法 :两组患儿均应用抗生素、肾上腺皮质激素、抗过敏等常规治疗。治疗组加用复方丹参注射液 ,按 0 .2～ 0 .5 ml/ (kg· d)加入 10 %葡萄糖液中静滴 ,每日 1次 ,连用 1周。治疗前及治疗 1周后分别检测血小板聚集功能 ,并观察皮肤紫癜消退天数、住院 (或治疗 )天数。数据以 x± s表示 ,两组资料差…     

过敏性紫癜与幽门螺杆菌感染相关性研究进展

过敏性紫癜(Henoch-Schonlein purpura,HSP)在儿童及青少年人群中常见,已知多种因素可导致其发生、发展。近年来,随着人们对幽门螺杆菌(Helicobacter pylori,H.pylori)的认识,其在HSP的发生、发展中的作用越来越引起重视。本文就HSP与H.pylori感染相关性研究进展作一概述。     

小儿过敏性紫癜性肾炎诊治中的几个问题

过敏性紫癜性肾炎(HSPN)是指过敏性紫癜(HSP)时肾实质受累而言，临床上在HSP病程中(包括病程6个月以内)出现血尿和(或)蛋白     

成人和儿童过敏性紫癜肺炎支原体/衣原体感染率分析

目的：探讨儿童和成人过敏性紫癜（HSP）临床肺炎支原体/衣原体感染率差异。方法：对我院2002年1月～2007年7月共147例过敏性紫癜患者的上呼吸道感染病史、临床表现及血清肺炎支原体/衣原体IgG、IgM检测结果进行回顾性分析。比较儿童组和成人组HSP患者在病（诱）因方面的差异。结果：①儿童组HSP患者近期上呼吸道感染病史较成人组多;②进一步血清肺炎支原体/衣原体IgG、IgM检测结果表明儿童组肺炎支原体/衣原体IgG、IgM感染率明显高于成人组。结论：儿童和成人HSP在发病诱因上所不同。上呼吸道感染,尤其肺炎支原体/衣原体感染是儿童HSP的多见诱因,对儿童组HSP发病有重要影响。     

成人过敏性紫癜35例临床分析

目的 分析成人过敏性紫癜(HSP)临床特点,以提高临床诊治水平.方法 对1993年9月至2005年12月天津医科大学总医院血液科收治的35例成人HSP患者的发病特点、临床表现、相关实验室检查等方面资料进行回顾性分析.结果 成人HSP以男性及青壮年患者为主.冬季为主要发病季节.上呼吸道感染及进食鱼、虾、蟹等为主要诱因.多数患者以皮肤损害为首发表现.混合型HSP多见.所有患者在病程中均先后出现皮肤损害,双下肢为皮疹最易侵犯的部位.有关节损害者15例(42.9%).有胃肠道损害者20例(57.1%).有肾脏损害者20例(57.1%).结论 成人过敏性紫癜的临床特点有其特殊性,易发生严重肾损害和多器官受累.     

阿奇霉素序贯联合多药治疗小儿肺炎支原体感染致过敏性紫癜的临床研究

目的探讨阿奇霉素序贯联合多药治疗小儿肺炎支原体感染致过敏性紫癜(HSP)的效果。方法选取2014年5月-2016年12月医院收治的小儿支原体感染致HSP患儿70例作为研究对象,采用随机数字表法将患儿分为观察组和对照组,对照组给予红霉素治疗,观察组给予阿奇霉素序贯治疗,1周为1个疗程,均治疗3个疗程。评估两组临床疗效及不良用药反应,记录呼吸道症状及过敏性紫癜症状消失时间,检测T淋巴细胞亚群、免疫球蛋白水平。结果观察组治疗有效率为88.57%明显高于对照组的65.71%,不良用药反应发生率11.43%明显低于对照组的31.43%(P0.05);观察组治疗后呼吸道症状消失时间、过敏性紫癜症状消失时间明显短于对照组(P0.05);观察组治疗后CD4~+、CD4~+/CD8~+细胞高于对照组,CD8~+细胞、IgA、IgE低于对照组(P0.05)。结论阿奇霉素序贯联合多药治疗小儿肺炎支原体感染致过敏性紫癜可改善免疫功能,提高临床疗效,且无明显不良反应。     

炎症反应在过敏性紫癜性肾炎发病中的作用

过敏性紫癜(HSP)是一种坏死性小血管炎,其特征主要表现为免疫球蛋白A(IgA)在患者关节、皮肤和肾脏中的沉积。过敏性紫癜性肾炎(HSPN)是HSP患者最严重的并发症,炎症反应在HSPN的发病中发挥着重要的作用。本文主要就炎症反应如细胞因子和细胞黏附因子(ICAM)在HSPN发病中的作用进行综述,旨为提高临床对HSPN的诊治水平提供参考。     

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.     

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.     

High prevalence of distal sensory polyneuropathy in antiretroviral-treated and untreated people with HIV in Tanzania

Objectives To describe the prevalence of distal sensory polyneuropathy (DSP), a complication of both advanced HIV disease and of antiretroviral therapy (ART), amongst Tanzanians with HIV, on and off ART (including stavudine) with CD4 counts above and below 200 cells/μl. Methods We recruited participants attending ART clinic into four groups: >6 months ART exposure and (i) CD4 < 200 cells/μl or (ii) CD4 > 200 cells/μl (ART/CD4 < 200 and ART/CD4 > 200, respectively); ART‐naïve and (iii) CD4 < 200 cells/μl or iv)CD4 > 200 cells/μl (noART/CD4 < 200 and noART/CD4 > 200, respectively). Primary outcome was DSP, as defined by presence of at least one symptom and one sign. Results Of 326 evaluable participants, 81 (32 men, median age 38 years, median CD4 142 cells/μl) were enrolled in the ART/CD4 < 200 group, 78 (17 men, median age 37 years, median CD4 345 cells/μl) in ART/CD4 > 200, 81 (30 men, median age 37 years, median CD4 128 cells/μl) in noART/CD4 < 200 and 86 (22 men, median age 33 years, median CD4 446 cells/μl) in noART/CD4 > 200. Numbness was the most commonly reported symptom. DSP prevalence ranged from 43.2% in ART/CD4 < 200 to 20.9% in noART/CD4 > 200. DSP was more common among men (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.2–3.3) and older participants (aOR 2.7, 95% CI 1.1–6.2 for age 40 + vs. <30 years). Conclusion Distal sensory polyneuropathy is common amongst those attending this clinic, even those with no ART exposure and a CD4 count above 200 cells/μl. Stavudine and didanosine expose HIV‐infected patients to an additional avoidable risk of DSP. Access to non‐neurotoxic ART regimes as well as earlier HIV diagnosis and initiation of ART is needed.     

Prise en charge d’un paragangliome rétropéritonéal

Paragangliomas are rare tumors arising from extraadrenal chromaffin cells. We report a 43-year-old man who presented with abdominal pain. An abdominal computed tomography scan revealed a large retroperitoneal mass. During an endoscopic biopsy of this tumor, the patient experienced marked hemodynamic fluctuations with tachycardia and high blood pressure, and an extraadrenal pheochromocytoma was suspected. Measurements of plasma and urinary catecholamines and urinary total metanephrines ruled in the diagnosis. Echocardiography disclosed acute myocardial dysfunction that returned to normal after surgical resection of the paraganglioma. This report also underlines the importance of the anesthetic preparation and monitoring around the surgical procedure and the need of a long-term follow-up to detect malignant paraganglioma in the absence of histological criteria of benign tumor.