HIV阴性结核性脑膜炎患者预后影响因素分析

目的 分析HIV阴性结核性脑膜炎(TBM)患者的临床特征及预后影响因素。方法 回顾性分析2012年1月至2017年12月苏州市第五人民医院结核病科77例临床诊断为HIV阴性TBM患者的资料,并根据患者出院时改良Rankin量表(mRS)评分情况,将患者分为预后良好组(mRS评分:0~2分)和预后不良组(mRS评分:3~6分)。比较预后良好组和预后不良组患者临床特征的差异,并采用条件logistic逐步回归的方法分析影响患者预后的危险因素。结果 77例患者中,常见临床症状为头痛(68例,88.3%)、发热(75例,97.4%)、盗汗(69例,89.6%)。脑脊液葡萄糖水平[中位数(四分位数):1.8(1.4,2.3)mmol/L]、氯化物[(109.37±13.68)mmol/L]升高,蛋白[中位数(四分位数):1994.5(1257.5,2888.3)g/L]降低。77例患者中预后良好者41例,预后不良者36例。预后良好组瘫痪的发生率为7.3%(3/41),明显低于预后不良组的41.7%(15/36),差异有统计学意义(χ ²=12.63,P=0.000)。根据格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分,预后良好组轻度昏迷(13~14分)、中度昏迷(9~12分)、重度昏迷(3~8分)者分别占34.1%(14/41)、61.0%(25/41)、4.9%(2/41);预后不良组轻度昏迷、中度昏迷、重度昏迷者分别占0.0%(0/36)、55.6%(20/36)、44.4%(16/36);两组比较,差异有统计学意义(χ ²=4.99,P=0.000)。logistic回归分析显示,发生瘫痪[OR(95%CI):10.75(1.53~76.92)]和重度昏迷[OR(95%CI):10.42(2.11~52.63)]的HIV阴性TBM患者预后较差。 结论 发热、盗汗、头痛是HIV阴性TBM最常见的临床症状。瘫痪和GCS评分差是HIV阴性TBM患者预后不良的独立危险因素。     

164例结核性脑膜炎患者预后影响因素分析

目的 分析结核性脑膜炎(TBM)的临床特征及预后影响因素。方法 收集2014—2017年在复旦大学附属上海市公共卫生临床中心住院治疗的符合入组标准的164例临床确诊为初治TBM患者的临床资料,包括性别、年龄、卡介苗接种史、体温、脑膜刺激征、TBM严重程度[采用英国医学研究理事会(MRC)评价表评分分级]、脑脊液参数、头颅MR或CT表现(脑积液、脑梗死、脑脓肿或结核瘤、脑膜强化)、胸部CT表现、机械通气、结核感染T细胞斑点试验(T-SPOT.TB)、脑脊液病原学结果、起病2周内应用利奈唑胺的患者例数、预后结局(治疗后9个月内);并根据预后结局将患者分为预后良好组(95例)和预后不良组(69例)。采用条件logistic逐步回归的方法对影响两组患者预后的相关因素进行分析。结果 预后不良组在0~15岁(36.2%,25/69)、MRC Ⅲ级(58.0%,40/69)、脑梗死(45.2%,28/62)、脑积液(54.8%,34/62)、机械通气(19.4%,13/67)患者中的发生率均高于预后良好组[分别为17.9%(17/95)、20.0%(19/95)、4.3%(4/93)、11.8%(11/93)、5.4%(5/92)](χ ²=7.06,P=0.008;χ ²=25.02,P=0.000;χ ²=37.91,P=0.000;χ ²=33.40,P=0.000;χ ²=7.53,P=0.006),而2周内使用利奈唑胺的比率(8.7%,6/69)低于预后良好组(21.1%,20/95)(χ ²=4.58,P=0.032)。logistic回归分析显示,0~15岁[Wald χ ²=4.46,P=0.035,OR(95%CI)=3.51(1.09~11.22)]、MRC Ⅲ级[Wald χ ²=5.82,P=0.016,OR(95%CI)=3.95(1.29~12.09)]、脑梗死[Wald χ ²=22.82,P=0.000,OR(95%CI)=25.90(6.81~98.40)]、脑积液[Wald χ ²=19.13,P=0.000,OR(95%CI)=10.00(3.56~28.07)]是预后不良的危险因素,而早期加用利奈唑胺是保护因素[Wald χ ²=6.48,P=0.011,OR(95%CI)=0.14(0.03~0.64)]。结论 0~15岁、MRC Ⅲ级、脑梗塞、脑积液是TBM预后不良的主要危险因素,早期加用利奈唑胺可以改善其预后。     

222例儿童结核性脑膜炎的临床特征及其预后影响因素分析

目的 探讨分析儿童结核性脑膜炎(tuberculous meningitis, TBM)的临床特征及其预后影响因素。方法 参照TBM诊断标准纳入2015年1月至2019年1月重庆医科大学附属儿童医院收治的222例TBM患儿,通过单因素和多因素logistic回归分析,评估患儿临床各种指标及因素对预后转归(治疗后6个月)的影响。结果 222例患儿中,129例(58.11%)患儿预后良好,93例预后差,其中7例死亡。男童117例(52.70%),中位年龄6岁,其中<5岁者107例(48.20%);108例(48.65%)有与结核病患者的密切接触史;110例(49.55%)确诊时长>21 d;137例(61.71%)患儿存在营养不良;205例(92.34%)结核病灶累及2个及以上部位或脏器,并以并发肺结核最常见[200例(90.09%)];病情分期(按照GCS评分)为Ⅱ期和Ⅲ期的患儿有144例(64.87%)。多因素logistic回归分析显示,脑脊液葡萄糖及氯化物含量高是患者预后良好的保护因素[OR(95%CI)=0.444(0.257~0.769);OR(95%CI)=0.914(0.854~0.980)],两者含量越高预后不良的发生率越低;而意识改变、性格改变、脑积液和梗阻性脑积液的高发生率则是患者发生不良预后的危险因素[OR(95%CI)=6.969(2.283~21.277);OR(95%CI)=2.531(1.105~5.796);OR(95%CI)=3.429(1.546~7.604);OR(95%CI)=10.233(1.059~98.886)]。结论 TBM患儿预后差的发生率和死亡率均较高,积极寻找结核病密切接触史和其他脏器结核感染证据有助于TBM的早期诊断,改善患儿营养不良、降低脑积液的发生率则有助于改善TBM患儿的预后转归。     

Analysis of clinical features and influencing factors of prognosis in 222 children with tuberculous meningitis

目的 探讨分析儿童结核性脑膜炎(tuberculous meningitis, TBM)的临床特征及其预后影响因素。方法 参照TBM诊断标准纳入2015年1月至2019年1月重庆医科大学附属儿童医院收治的222例TBM患儿,通过单因素和多因素logistic回归分析,评估患儿临床各种指标及因素对预后转归(治疗后6个月)的影响。结果 222例患儿中,129例(58.11%)患儿预后良好,93例预后差,其中7例死亡。男童117例(52.70%),中位年龄6岁,其中<5岁者107例(48.20%);108例(48.65%)有与结核病患者的密切接触史;110例(49.55%)确诊时长>21 d;137例(61.71%)患儿存在营养不良;205例(92.34%)结核病灶累及2个及以上部位或脏器,并以并发肺结核最常见[200例(90.09%)];病情分期(按照GCS评分)为Ⅱ期和Ⅲ期的患儿有144例(64.87%)。多因素logistic回归分析显示,脑脊液葡萄糖及氯化物含量高是患者预后良好的保护因素[OR(95%CI)=0.444(0.257~0.769);OR(95%CI)=0.914(0.854~0.980)],两者含量越高预后不良的发生率越低;而意识改变、性格改变、脑积液和梗阻性脑积液的高发生率则是患者发生不良预后的危险因素[OR(95%CI)=6.969(2.283~21.277);OR(95%CI)=2.531(1.105~5.796);OR(95%CI)=3.429(1.546~7.604);OR(95%CI)=10.233(1.059~98.886)]。结论 TBM患儿预后差的发生率和死亡率均较高,积极寻找结核病密切接触史和其他脏器结核感染证据有助于TBM的早期诊断,改善患儿营养不良、降低脑积液的发生率则有助于改善TBM患儿的预后转归。     

结核性脑膜炎伴意识障碍患者的预后影响因素分析

目的 分析结核性脑膜炎(tuberculous meningitis, TBM)伴意识障碍患者的预后影响因素。方法 回顾性分析2013年1月至2019年1月长沙市中心医院112例临床诊断为TBM伴意识障碍患者的资料,其中21例(18.8%)为确诊TBM患者,84例(75.0%)为高度可能的TBM患者,7例(6.2%)为可能的TBM患者。根据患者出院时改良Rankin量表(mRS)评分情况,将患者分为预后良好组48例(42.9%),预后不良组64例(57.1%)。预后良好组男性24例,中位年龄[M(Q₁,Q₃)]18.50(5.31,33.75)岁,中位病程20.00(11.25,30.00)d。预后不良组男性20例,中位年龄27.00(3.06,49.75)岁,中位病程15.00(10.00,20.00)d。采用logistic回归分析影响患者预后不良的影响因素。结果 单因素分析结果显示,住院时间(Z=-1.982,P=0.048)、性别(χ ²=4.043, P=0.044)、疾病分期(χ ²=17.733, P=0.000)、抽搐(χ ²=8.054, P=0.005)、低钠血症(χ ²=9.481, P=0.002)、脑水肿(χ ²=4.386, P=0.036)、脑积液(χ ²=5.992, P=0.014)对TBM伴意识障碍患者预后不良有一定影响。logistic回归分析显示,低钠血症(P=0.043, OR=2.784, 95%CI:1.034~7.495)、疾病分期为Ⅲ期(P=0.002, OR=6.855, 95%CI:2.001~23.480)、脑水肿(P=0.030, OR=3.491, 95%CI:1.132~10.768)是预后不良的危险因素。 结论 低钠血症、疾病分期为Ⅲ期、脑水肿是TBM伴意识障碍患者的预后不良的影响因素。     

老年急性白血病患者的染色体核型分析

目的 探讨急性白血病患者的染色体核型分布特征及不同年龄组患者染色体预后分层特征.方法 采用骨髓短期培养和G显带技术对215例急性白血病患者进行染色体核型分析.结果 215例患者中,有足够可供分析分裂相者202例,检出异常克隆149例(73.8％),各年龄组异常克隆检出率分别为,≤30岁组73.0％(27/37),31～59岁组74.4％(64/86),≥60岁组73.4％(58/79),各年龄组异常克隆检出率差异无统计学意义(P=0.982).在检出分裂相的171例急性髓性白血病(AML)患者中,预后良好核型41例(24.0％),预后中等核型80例(46.8％),预后不良核型50例(29.2％);预后良好核型中以t(15;17)最多(占65.9％);预后中等核型中以正常核型为主(占53.8％);预后不良核型中以复杂异常为主(占84.0％).≤30岁组预后良好、中等及不良染色体核型所占百分比分别为50.0％、36.4％和13.6％;31～59岁组分别为24.3％、48.7％和27.0％;≥60组分别为16.0％、48.0％和36.0％.≤30岁组预后良好核型所占比例较其他两组高(分别为P=0.021和0.001),≥60岁组预后不良核型所占比例高于≤30岁组(P=0.046).29例急性淋巴细胞白血病(ALL)患者具有预后不良核型者10例.结论 急性白血病患者染色体核型分析可为预后分层提供重要依据,AML患者随着年龄增长预后不良核型比例逐渐增高.     

急性缺血性卒中机械取栓后出血性转化和临床转归的影响因素

目的 探讨急性缺血性卒中患者机械取栓治疗后出血性转化(hemorrhagic transformation,HT)和转归不良的危险因素.方法 回顾性纳入接受机械取栓治疗的急性缺血性卒中患者,收集患者的人口统计学、血管危险因素和其他临床资料,应用改良Rankin量表(modified Rankin Scale,mRS)评价发病90d时临床转归,转归良好定义为mRS评分0～2分.根据HT情况将患者分为HT组和非HT组,根据mRS评分将患者分为转归良好组和转归不良组.应用多变量logistic回归分析确定HT和转归不良的独立危险因素.结果 共纳入48例接受机械取栓治疗的急性缺血性卒中患者,男性25例(52.1％),平均年龄(64.77 ±9.14)岁,平均美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(17.70 ±3.77)分.22例(45.8％)发生HT,其中9例为有症状HT;24例(50.0％)转归良好.HT组男性比例显著低于非HT组(30.4％对72.0％;x2=8.293,P=0.004),而糖尿病(65.2％对36.0％;x2=4.090,P=0.043)和心房颤动(78.3％对44.0％;x2=5.880,P=0.015)的患者比例以及基线空腹血糖水平[(8.514±4.400) mmol/L对(6.354±1.472) mmol/L;t =2.319,P=0.025]则显著高于非HT组.多变量logistic回归分析显示,心房颤动[优势比(odds ratio,OR)6.136,95％可信区间(confidence interval,CI)1.617～23.291;P=0.042]是机械取栓后发生HT的危险因素.转归良好组基线NIHSS评分[(16.050±4.865)分对(19.210±4.423)分;=2.354,P =0.023]以及糖尿病(29.2％对70.8％;x2=8.333,P=0.004)、前循环卒中(62.5％对87.5％;x2 =4.000,P =0.046)、大脑中动脉闭塞(29.2％对75.0％;x2=10.101,P=0.002)和脑实质血肿(4.1％对33.3％;P=0.011)患者比例显著低于转归不良组,而心房颤动(75.0％对45.8％;x2=4.269,P=0.039)和椎基底动脉闭塞(37.5％对12.5％;x2=10.113,P=0.006)患者比例显著高于转归不良组.多变量logistic回归分析显示,糖尿病(OR5.898,95％ CI 1.699～20.479;P=0.005)、基线NIHSS评分(OR1.167,95％ CI 1.011 ～1.347;P=0.035)和脑实质血肿(OR 1.295,95％ CI 1.099 ～ 1.875;P =0.028)是转归不良的独立危险因素.结论 心房颤动是急性缺血性卒中患者机械取栓治疗后HT风险的独立预测因素.糖尿病、基线NIHSS评分较高和并发脑实质血肿是转归不良的独立预测因素.因此,在对急性缺血性卒中患者开展机械取栓治疗前应充分评估其HT和转归不良风险.     

血清尿酸水平与自发性脑出血患者的近期临床转归:前瞻性病例系列研究

目的 探讨血清尿酸水平与自发性脑出血患者近期临床转归的关系.方法 前瞻性连续纳入发病24 h内入院的自发性脑出血患者.入院次日检测血清尿酸水平;发病30天时应用改良Rankin量表(modified Rankin Scale,mRS)评估临床转归.将患者分为转归良好组(mRS评分≤2分)与转归不良组(mRS评分≥3分).结果 共纳入92例自发性脑出血患者,其中46例(50％)为男性,平均年龄(63±12)岁,基线格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分为11分(9～12分).在发病后30天时进行的随访中,22例患者(23.9％)转归良好,70例患者(76.1％)转归不良.单变量分析显示,转归良好组GCS评分显著高于转归不良组[(13.85±2.80)分对(11.21±2.51)分;t=4.186,P=0.000],而血肿体积[(25.65 ±5.33)cm3对(34.60±8.97)cm3;t =4.430,P=0.000]和血清尿酸水平[(324.90±86.02) μmol/L对(458.63±72.77) μmol/L;t=7.193,P=0.000]显著低于转归不良组.多变量logistic回归分析显示,基线GCS评分低[优势比(odds ratio,OR)1.810,95％可信区间(confidence interval,CI) 1.382 ～2.382;P =0.001]、血肿体积较大(OR 1.156,95％ CI 1.045 ～ 1.280;P =0.005)和血清尿酸水平增高(OR2.127,95％ CI 1.055 ～4.287;P=0.035)是自发性脑出血患者近期临床转归不良的独立预测因素.结论 血清尿酸水平增高能预测自发性脑出血患者的近期临床转归不良.     

我国新生儿细菌性脑膜炎预后不良因素的Meta分析

背景细菌性脑膜炎(BM)是新生儿常见病之一,由于其临床表现无特异性,识别困难,病死率高,因此早期识别新生儿BM预后的相关因素对降低患儿预后不良发生率具有重大意义。目前关于我国新生儿BM预后不良因素的相关研究普遍存在纳入样本量少、危险因素指标不全面等不足,临床指导意义有限。目的采用Meta分析方法分析我国新生儿BM预后不良的因素。方法计算机检索PubMed、EMBase、Cochrane Library、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据知识服务平台及维普网(VIP),检索时间为建库至2019年7月,检索发表的有关我国新生儿BM预后不良因素的病例对照研究,其中根据出院转归情况分为预后不良组和预后良好组。相关因素包括患儿一般情况、围生期情况、临床表现和实验室检查指标。采用RevMan 5.3软件进行Meta分析。结果最终纳入11篇文献,共1 310例患儿。预后不良组患儿早产率[OR=2.42,95%CI(1.41,4.14)]、出生时低体质量[OR=3.00,95%CI(1.14,7.86)]、抽搐惊厥[OR=3.62,95%CI(2.58,5.08)]、休克[OR=22.40,95%CI(4.73,106.01)]、贫血[OR=4.13,95%CI(2.26,7.53)]、肌张力异常[OR=3.46,95%CI(2.19,5.46)]、嗜睡[OR=1.74,95%CI(1.10,2.74)]发生率,体质量[MD=-017,95%CI(-0.29,-0.06)],脑脊液细胞计数500×10~6/L[OR=6.95,95%CI(4.69,10.31)]、外周血白细胞计数5×10~9/L或20×10~9/L[OR=5.96,95%CI(3.94,9.02)]者所占比例,脑脊液蛋白[MD=0.95,95%CI(0.84,1.06)],降钙素原(PCT)[MD=0.93,95%CI(0.23,1.63)]高于预后良好组,胎龄[MD=-0.57,95%CI(-1.06,-0.09)]、脑脊液葡萄糖水平[MD=-0.79,95%CI(-0.90,-0.68]低于预后良好组(P0.05)。结论早产、胎龄小、出生时低体质量、抽搐惊厥、休克、贫血、肌张力异常、嗜睡、脑脊液细胞计数500×10~6/L、外周血白细胞计数5×10~9/L或20×10~9/L、高脑脊液蛋白、高脑脊液葡萄糖、高PCT与新生儿BM预后不良有关。     

孤立性脑桥梗死的临床和影像学特征:脑桥旁正中梗死与脑桥腔隙性梗死的比较

目的 探讨孤立性脑桥梗死的临床和影像学特征以及早期运动障碍进展(progessive motor deficits,PMD)和短期预后的影响因素.方法 对初次发病24 h内入院的86例孤立性脑桥梗死患者进行回顾性分析,根据梗死灶最大直径和部位分为脑桥旁正中梗死(paramedian pontine infarction,PPI)和脑桥腔隙性梗死(lacunar pontine infarction,LPI),根据早期PMD情况分为PMD组和无PMD组,根据出院时改良Rankin量表(modified Rankin Scale,mRS)评分分为转归不良组(mRS评分＞2分)和转归良好组(mRS评分≤2分),对不同病例组的临床和影像学特征进行比较.结果 PPI组(n=35)高脂血症(57.14％对33.33％;x2=4.80,P=0.028)、偏瘫(97.14％对72.55％;x2=8.718,P=0.003)、基底动脉狭窄(45.71％对17.65％;x2=7.930,P=0.005)和出院时转归不良(54.29％对31.37％;x2=4.515,P=0.034)患者构成比以及基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分[(6.00 ±2.39)分对(4.61 ±3.41)分;t=2.087,P=0.040]均显著性高于LPI组(n＝ 51).PMD组(n=22)基线舒张压水平[(97.82±15.61)mm Hg对(89.55±12.23)mm Hg,1 mm Hg=0.133 kPa;t =2.258,P=0.031]以及PPI(63.64％对32.81％;x2=6.445,P＝0.011)和基底动脉狭窄(59.10％对18.75％;x2=12.922,P=0.000)的构成比均显著性高于无PMD组(n＝64).转归不良组(n＝ 35)基线NIHSS评分[(6.80±2.63)分对(3.73 ±2.55)分;t＝5.426,P＝0.000]和空腹血糖水平[(9.40±5.15) mmol/L对(6.56 ±2.69) mmol/L;t =2.985,P=0.004]以及PPI患者构成比(54.29％对31.37％;x2 =4.515,P＝0.034)均显著性高于转归良好组(n=51).多变量logistic回归分析显示,基底动脉狭窄是PPI发病[优势比(odds ratio,OR)3.801,95％可信区间(confidence interval,CI)1.357～10.646;P=0.011]和孤立性脑桥梗死早期PMD(OR 4.571,95％ CI1.214～17.214;P=0.025)的独立危险因素,基线NIHSS评分≥5分是其短期转归不良的独立预测因素(OR4.277,95％ CI 1.505 ～ 12.151;P=0.006).结论 PPI主要与基底动脉分支病变有关,基线NIHSS评分≥5分可能是孤立性脑桥梗死短期转归不良的独立预测因素,其早期PMD和短期转归不良均可能与基底动脉病变有关.     

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.     

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.     

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.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

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.