64例不典型结核性脑膜炎临床诊断和治疗分析

目的　探讨不典型结核性脑膜炎(结脑)的临床分类、诊断和治疗方法。方法 回顾性总结分析68例不典型结脑临床特点、诊断依据,采用3HS(E)RZ/9HRZ化疗方案,并用地塞米松、降颅压治疗。结果 68例不典型结脑分为脑脊液改变不典型、脑脊液和临床表现均不典型两类;治疗结果67例存活,死亡1例,无明显后遗症。随访2年以上者64例。结论 不典型结脑诊断参考:(1)活动性肺结核表现;(2)不典型脑脊液改变或/和不典型结脑临床表现;(3)抗结核试验治疗有效;(4)除外非结脑疾病;(5)脑脊液PPD抗体阳性、腺苷脱氨酶(ADA)增高;(6)CT或MR符合结脑影像;(7)病理显示结核样改变或脑脊液检出抗酸杆菌;具备1~6项中3项或第7项可诊断。采用HS(E)RZ四联12个月化疗,安全、有效。     

结核性脑膜炎87例临床分析

目的探讨结核性脑膜炎（结脑）的诊断和治疗。方法回顾性分析87例结脑患者的临床资料。结果本组合并肺结核47例，胸膜结核8例，泌尿系结核4例，淋巴结核2例。并发脑积水21例，脑梗死22例；脑脊液多次检查均符合结脑改变，脑脊液PCR—TB—DNA检查67例，有47例（71．1％）扩增到结核DNA片段，20例阴性，87例脑脊液腺苷脱氨酶检查有81例（93．1％）高于9u／L；头颅CT增强扫描阳性率100％。87例结脑患者经抗结核及使用肾上腺皮质激素治疗后均治愈。结论结脑临床表现缺乏特异性，脑脊液改变不典型；脑脊液中PCR—TB—DNA对结脑的诊断可作为一个重要的辅助检查，且腺苷酸脱氨酶是一个敏感及特异性强的指标；影像学检查对诊断该病有重要意义。规范应用抗结核药物及使用肾上腺皮质激素配合鞘内注射效果佳。     

31例非典型结核性脑膜炎临床疗效观察

目的总结非典型结核性脑膜炎（结脑）的诊断方法,提高临床认识,避免误诊,及早治疗。方法结合临床表现、脑脊液、影像学检查以及免疫学,回顾性分析31例非典型结脑临床资料。结果 31例患者经临床表现、脑脊液、影像学及免疫学,临床诊断结脑,给予诊断性抗结核治疗,30例恢复正常好转出院,1例自动出院。结论对非典型结脑的患者应反复行脑脊液及头部核磁共振检查。排除其他颅内感染性病变,尽早做诊断性抗结核治疗,避免病情加重减少并发症的发生。     

新型隐球菌性脑膜炎与结核性脑膜炎的临床鉴别

目的 探讨新型隐球菌性脑膜炎与结核性脑膜炎的鉴别要点。 方法 回顾分析19例隐球菌性脑膜炎及50例结核性脑膜炎患者的临床表现、脑脊液改变和头颅CT或MRI特点。 结果 隐球菌性脑膜炎延误诊断时间为（2.3±1.7）个月,合并颅外结核病26.3%,合并慢性基础病36.8%,颅神经损害发生率5.3%,颅内压（320.0±57.7）mmH₂O,脑脊液葡萄糖含量（1.2±0.8）mmol/L, PCR-TB阳性率0,抗结核抗体阳性率10.5%,红细胞沉降率（42.1±31.2）mm/1h、头颅CT或MRI检查阳性发现率57.9%等方面与结核性脑膜炎存在差异。而2者在临床症状、脑脊液白细胞数、蛋白、氯化物、腺苷脱氨酶含量和头颅CT或MRI表现等方面差异无统计学意义。 结论 隐球菌性脑膜炎临床表现不典型,与结脑不易鉴别,容易误诊。但提高对隐球菌性脑膜炎的认识,并行多项指标检测有利于早期诊断。     

不典型表现的结核性脑膜炎42例诊断分析

目的总结不典型表现的结核性脑膜炎(结脑)的早期诊断，避免诊治延误。方法对42例不典型结脑患者的诊断学资料进行回顾性分析研究。结果本组病例在临床上没有典型的结脑表现，仅表现为头晕、头昏、低热31例(73．8％)；意识障碍12例(28．6％)；乏力、纳差、精神萎靡9例(21．4％)；肢体麻木、无力13例(31．0％)；瘫痪3例(7．1％)；颅神经损害12例(28．6％)；癫痫样发作2例(4．8％)；排便障碍7例(16．7％)。脑脊液(CSF)检查：细胞数增多35例(83．3％)，其中分类以淋巴细胞为主31例(73．8％)，糖降低20例(47．6％)、氯化物降低21例(50．0％)、蛋白升高22例(52．4％)。42例经抗结核治疗痊愈38例，2例恶化，2例死亡。结论结脑在缺乏典型临床表现情况下，脑脊液若非多次实验室检查其改变可不典型，但脑脊液细胞学动态观察，早期可见较多大淋巴细胞、中后期以淋巴细胞为主，脑脊液PPD-IgG、ADA阳性对诊断有较高特异性，头颅CT增强扫描对确诊有较大帮助。     

结核性脑膜炎的诊断与治疗

结核性脑膜炎(结脑)是结核分枝杆菌引起的以脑膜为主的非化脓性炎症,是常见最严重的肺外结核病.近年来,由于耐药结核病例的增加,加之人口流动及AIDS流行等因素,全球结核病发病率明显上升,结脑患者也随之增多.影响结脑预后的关键在于早期诊断和及时治疗.由于结脑临床表现较复杂,脑脊液(CSF)改变不典型,易与其他中枢神经系统感染相混淆.提高结脑早期诊断水平和及时有效的治疗是临床上十分关注的热点,现将结脑的诊断和治疗方法作一概述.     

儿童结核性脑膜炎193例临床分析

目的探讨儿童结核性脑膜炎的临床特点。方法分析193例儿童结核性脑膜炎的临床资料并进行综合分析。结果儿童结脑临床表现呈多样化,合并脑外结核117例（60．6％）,治疗后好转或治愈161例（83．4％）,后遗症32例（16．5％）,未愈及抱走25例（12．9％）,死亡7例（3．6％）。结论仔细询问病史和流行病学资料,结合脑脊液、头颅CT／MR检查是早期诊断的关键;规则的抗结核治疗并联用激素、鞘内注药可以提高治愈率。     

不典型表现的结核性脑膜炎62例临床分析

目的 总结不典表现的结核性脑膜炎(结脑)的诊断与治疗。方法 回顾性分析62例不典型结脑患者的临床资料。结果 本组病例在临床上没有典型的结脑症状，表现意识障碍17例(27．4％)、头晕、低热47例(75．8％)、乏力、精神萎靡13例(21．0％)；肢体麻木21例(33．9％)、瘫痪5例(8．1％)、颅神经损害18例(29．0％)和尿潴留10例；(16．1％)、癫痫样发作4例(6．5％)。胸部影像学检查阳性37例(59．7％)、头颅CT阳性13例(21％)。脑脊液检查：糖降低30例(48．4％)、氯化物降低32例(51．6％)、蛋白升高36例(58．1％)、腺苷酸脱氨酶(ADA)阳性58例(93．5％)、结核抗体(PPD—IgG)阳性48例(77．4％)、涂片抗酸杆菌阳性2例(3．2％)。61例经抗结核治疗痊愈，1例死亡。结论 不典型结脑临床表现缺乏特异性，脑脊液改变不典型，但脑脊液中结核抗体阳性对于诊断中枢神经系统结核病有参考意义，且腺苷酸脱氨酶是一个敏感及特异性强的指标，实验实及影像学检查对确诊该病有重要意义。规范抗结核治疗配合鞘内注射效果佳。     

125例老年性结核性脑膜炎诊断及治疗分析

目的总结老年性结核性脑膜炎(结脑)的诊断方法。方法结合临床表现、脑脊液、影像学检查以及免疫学,分析125例老年性结脑临床资料。结果结合临床症状、体征、脑脊液、影像学及免疫学,125例患者临床诊断为结核性脑膜炎,给予诊断性抗结核治疗,大部分病例好转出院。结论老年性结脑发病缓慢,早期临床症状不典型,诊断困难,误诊率及死亡率高。对结脑的患者均应反复行脑脊液及头部核磁共振检查,排除其他颅内感染性病变、脑血管疾病及肿瘤性疾病,尽早做诊断性抗结核治疗。结核性脑膜炎是中枢神经系统的重症结核病。目前,随者人口老龄化,老年结核性脑膜炎患者呈逐年增多趋势,老年患者因其特殊体质关系,导致临床症状不典型、并发症多、误诊率高,治疗困难。使其病死率及后遗症发生率高。     

心肌梗死超急期不典型心电图分析

目的 分析并总结心肌梗死超急性期不典型临床表现及心电图改变,提高体表心电图对急性心肌梗死的诊断价值.方法 对2010年1月至2013年12月本院可疑超急性心梗病例出现不典型临床表现或不典型心电图改变的病例除记录常规12导联外,加做右室导联（V3R、V4R、V5R）及后壁导联（V7、V8、V9）,定时心电随访,并对应各导联做前后对比.结果 有26例急性心梗病例超急性期出现不典型临床表现或不典型心电图改变.结论 熟悉并掌握心肌梗死超急性期不典型临床表现及心电图变化有利于提高体表心电图对急性心肌梗死的诊断价值.     

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.     

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.     

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.