老年糖尿病合并肺结核早期规则抗结核治疗的效果研究

将44例老年糖尿病合并肺结核患者,随机分为对照组(吡格列酮、半合成人胰岛素)和观察组(在对照组基础上加用早期规则抗结核治疗)。结果治疗后两组餐后2h血糖、空腹血糖均降低,观察组较对照组低;观察组肺功能指标复常时间、结核症状复常时间均较对照组短;观察组病灶缩小率(90.91%)、痰菌转阴率(95.45%)、治疗总有效率(95.45%)较对照组高。P均0.05。结论早期规则抗结核治疗能降血糖,促进痰菌转阴,提高糖尿病合并肺结核疗效。     

中医护理结合人性化护理在糖尿病合并肺结核患者临床治疗中的应用

目的探讨中医护理结合人性化护理干预在糖尿病合并肺结核患者中的应用,为提高临床护理服务水平提供借鉴。方法将80例糖尿病合并肺结核患者随机分为实验组和对照组各40例,对照组在药物治疗的基础上实施传统常规护理,实验组在药物治疗和常规护理基础上,同时给予中医护理及人性化护理。观察两组患者的血糖及痰菌转阴情况。结果实验组患者痰菌转阴情况及血糖控制情况优于对照组,差异有统计学意义(P0.05)。结论糖尿病合并肺结核患者给予中医护理结合人性化护理,能显著提高患者的血糖控制和结核病的治疗效果,值得推广应用。     

King互动达标理论在初治涂阳肺结核患者门诊督导管理中的应用

目的探讨King互动达标理论在初治涂阳肺结核患者门诊督导管理中的应用效果。方法选取2015-10-01~2015-11-30在该院结核门诊治疗的初治涂阳肺结核患者50例为观察组,取2015-08-01~2015-09-30在该院结核门诊治疗的初治涂阳肺结核患者43例为对照组,两组患者均采用2HREZ/4HR方案治疗、全程督导方式进行管理,对照组采用常规督导方式进行管理,观察组在此基础上运用King互动达标理论进行督导管理。观察两组患者治疗依从性、第2个月末及第5个月末痰菌转阴及治疗效果,以及患者家庭密切接触者结核病感染情况。结果观察组患者治疗依从性(包括服药依从性、定期复查、健康生活方式)均高于对照组,差异有统计学意义(P0.05);观察组2月末痰菌转阴49例(98%),高于对照组35例(81%),差异有统计学意义(P0.05),5月末痰菌转阴率两组比较差异无统计学意义(P0.05);观察组及对照组患者家庭密切接触者结核病感染率均为0。结论在初治涂阳肺结核患者门诊督导管理中应用King互动达标理论,能提高患者治疗依从性、2月末痰菌阴转率及治疗效果。     

胸腺肽在复治肺结核的临床疗效

目的研究胸腺肽在复治涂阳肺结核的临床疗效。方法本研究纳入我院收治的70例复治涂阳肺结核患者,随机数字表法均分为两组,各35例,对照组给予2RDCO/10RDOT方案、常规抗结核治疗,观察组在对照组治疗基础上联合胸腺肽治疗。连续6个月,比较治疗3个月、6个月、12个月病灶吸收率、空洞关闭率及痰菌转阴情况,比较治疗前后免疫细胞水平,并记录不良反应发生情况。结果观察组治疗病灶吸收率、空洞关闭率及痰菌转阴率均显著高于对照组(P 0. 05);两组治疗后免疫细胞水平均显著改善,且治疗后观察组多项免疫指标改善明显好于对照组;两组药物不良反应率差异无统计学意义(P 0. 05)。结论胸腺肽能促进复治涂阳肺结核病灶吸收及痰菌转阴,与胸腺肽增强细胞免疫功能,纠正免疫失调有关。     

痰热清联合抗生素治疗ICU内呼吸机相关性肺炎的临床效果评价

目的评价痰热清联合抗生素治疗ICU内呼吸机相关性肺炎(VAP)的临床效果。方法选取2012年1月—2014年1月在我院ICU内发生VAP的患者66例,将其随机分为观察组和对照组,各33例。对照组采取常规治疗和抗生素治疗,观察组在对照组治疗的基础上加用痰热清。根据患者临床症状、体征变化及影像学检查结果判定临床疗效;检测治疗前后患者VAP的相关指标,包括体温、CRP、PCT及WBC变化;记录机械通气时间、住ICU时间及抗生素使用时间;观察治疗期间不良反应情况。结果观察组总有效率为93.9%,高于对照组的75.8%(P0.05);治疗后观察组患者体温、CRP、PCT、WBC均低于对照组,机械通气时间、住ICU时间、抗生素使用时间短于对照组(P0.05)。治疗期间,两组患者均未出现严重药物不良反应。结论痰热清联合抗生素治疗ICU内VAP的临床疗效显著,能有效缩短患者机械通气时间、住ICU时间和抗生素使用时间,且安全性较好。     

糖尿病合并肺结核的饮食护理干预效果分析

目的探讨饮食护理干预对糖尿病合并肺结核患者临床疗效。方法选择2012年8月—2014年8月该院收治的糖尿病合并肺结核患者64例,按随机数字法分为对照组和观察组,各32例,对照组给予常规治疗及护理,观察组在此基础上实施饮食护理干预,观察比较两组患者空腹血糖、餐后2 h血糖及痰菌转阴时间。结果观察组患者空腹血糖、餐后2 h血糖控制效果显著优于对照组,两组比较差异具有统计学意义(P0.05);观察组患者痰菌转阴时间明显短于对照组,两组比较差异具有统计学意义(P0.01)。结论糖尿病合并肺结核患者于常规治疗及护理基础上,实施有效的饮食护理干预,可有效提高患者血糖控制效果,缩短痰菌转阴时间,值得临床进一步研究推广。     

肺结核合并糖尿病46例临床分析

目的探讨肺结核合并糖尿病病人的临床特点及控制血糖对疗效的影响。方法分析我院收治住院时间>30天的肺结核合并糖尿病患者(A组)及同期住院时间>30天的单纯肺结核初治患者(B组)的临床资料。结果血糖控制良好组的痰菌转阴率、空洞闭合率以及结核病灶吸收好转率显著优于血糖控制不佳组(P<0.05),血糖控制的水平直接影响其疗效。结论肺结核合并糖尿病应积极控制血搪,早期抗结核治疗.预防并发症的发生.能较好地控制结核,改善预后。     

美常安对重症急性胰腺炎肠道屏障的影响

[目的]探讨美常安对重症急性胰腺炎(SAP)肠道屏障的影响.[方法]48例SAP患者于入院后随机分为2组,即治疗组(常规治疗加美常安辅助治疗)25例和对照组(常规治疗组)23例,疗程14d,比较2组患者治疗后临床症状的发生率及检测治疗前、后内毒素(ET)、肿瘤坏死因子(TNF-α) 、C-反应蛋白(CRP)的改变.[结果]2组患者治疗前ET、TNF-α、CRP比较差异无统计学意义;治疗后,治疗组上述指标较对照组明显下降(P＜0.01),临床症状的发生率显著减少(P＜0.05).[结论]加用美常安治疗能显著改善SAP患者的临床症状,减少内毒素血症的发生,从而对SAP肠道屏障起保护作用.     

莲花清瘟胶囊治疗急性病毒性心肌炎的疗效及对血清cTnT、CK-MB、CRP的影响

目的探讨莲花清瘟胶囊治疗急性病毒性心肌炎(AVM)的临床疗效及对血清肌钙蛋T(cTnT)、C反应蛋白(CRP)、肌酸激酶MB型同工酶(CK-MB)水平的影响。方法回顾性分析2010年1月至2013年2月该院99例AVM患者的临床资料。患者均经过常规治疗,其中42例给予莲花清瘟胶囊治疗(治疗组),57例给予黄芪注射液(对照组)。治疗4 w后,对比两组治疗效果、临床相关指标及不良反应情况。结果 2个疗程后,治疗组治愈率和总有效率略高于对照组,但差异均无统计学意义(P0.05);治疗组患者临床症状明显改善时间和血清CK-MB恢复正常时间短于对照组(P0.05);两组患者治疗前血清cTnT、CK-MB、CRP水平比较差异无统计学差异(P0.05),治疗后两组患者以上各指标较治疗前均有明显改善(P0.05),治疗后两组以上个指标水平相当,差异无统计学意义(P0.05);两组间治疗后未发现药源性肝、肾能功能异常、电解质紊乱等不良反应。结论莲花清瘟胶囊和黄芪注射液用于治疗AVM均有较好的临床疗效,均能有效改善血清cTnT、CK-MB、CRP水平,其中莲花清瘟胶囊治疗效果更明显,具有见效快、疗效好的特点。     

芪苈强心胶囊治疗舒张性心衰的临床疗效观察

目的探索芪苈强心胶囊治疗舒张性心衰的临床疗效。方法选取我院的100例舒张性心衰患者,分为观察组和对照组,每组各有50例患者,对照组采用常规治疗,观察组采用芪苈强心胶囊治疗。结果采用常规治疗的对照组LVED、CRP、BNP、EF各项指标显示患者症状无改善,采用芪苈强心胶囊治疗的观察组LVED、CRP、BNP、EF各项指标显示患者症状在明显的好转,观察组治疗后的各项指标优于对照组(P0.05)。结论芪苈强心胶囊治疗舒张性心衰的临床效果显著。     

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.     

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.     

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.     

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.