老年急性胰腺炎患者的临床特征和诊疗效果分析

目的探讨老年急性胰腺炎(AP)患者的临床特征和诊疗效果。方法回顾性分析2014年1月至2016年12月首都医科大学附属北京世纪坛医院收治的老年AP患者,按年龄分为老年组[≥60岁,(68.8±6.9)岁]102例和非老年组[60岁,(46.7±4.4)岁]213例,收集患者一般资料、病因、临床表现、治疗后住院时间及死亡率。采用SPSS 20.0软件对数据进行统计分析,根据数据类型,采用t检验或χ~2检验进行组间比较。结果两组患者性别、全身并发症、局部并发症比例及重症胰腺炎比例差异均无统计学意义(P0.05)。AP患者主要病因为胆道疾病,其次为高脂血症,酒精及肿瘤,其中老年组胆源性比率明显高于非老年组(70.6%vs 49.8%),高脂血症比率明显低于非老年组(11.8%vs 20.2%),酒精性比率明显低于非老年组(6.9%vs 19.2%),肿瘤性比例明显高于非老年组(4.9%vs 0.0%),差异均有统计学意义(P0.05)。临床表现方面,老年组腹痛比例显著低于非老年组(84.4%vs 95.4%),黄疸比例高于非老年组(66.7%vs 48.4%),差异均有统计学意义(P0.05)。治疗后,两组住院时间差异无统计学意义[(12.9±5.6)vs(11.7±4.6)d,P0.05],但老年组死亡率明显高于非老年组(7.9%vs 1.4%,P0.05)。结论老年AP患者合并基础疾病多,病死率高。老年AP患者应警惕胆源性及肿瘤性原因。     

血小板异常评估急性胰腺炎严重程度的临床价值

目的 探讨血小板在急性胰腺炎（AP）患者中的变化及与AP严重程度和预后的关系.方法 比较重症急性胰腺炎（SAP）组和轻症急性胰腺炎（MAP）组血小板的计数变化.SAP组进一步分为血小板降低组和血小板正常组,比较两组局部并发症和多器官功能不全综合征（MODS）的发生率、病死率以及胰腺坏死程度与血小板计数（PLT）之间的关系,并分析差异有无统计学意义.分析血小板与APACHEⅡ评分系统、BISAP评分系统、CT评分系统、Ranson评分系统之间的相关性.结果 AP患者重症组与轻症组相比,PLT下降,血小板平均体积（MPV）升高,两组比较差异有统计学意义（P＜0.05）,PDW及PCT差异无统计学意义（P＞0.05）;SAP患者发病前3d首次PLT计数（＜100×109/L）的比例明显多于MAP组,差异有统计学意义（P＜0.001）;血小板降低组中局部并发症患者、MODS患者及病死率明显高于血小板正常组,两者相比差异有统计学意义（P ＜0.05）;SAP中胰腺坏死程度与血小板计数水平呈负相关性（P＜0.05）;血小板计数水平与CTSI评分标准相关性最强,其次是APACHEⅡ评分系统,而与Ranson评分系统无明显相关性.结论 血小板计数能够比较准确地反映AP的严重程度和预后,尤其在预测SAP局部并发症、MODS、坏死程度中有较高的临床价值.     

老年重症急性胰腺炎25例临床分析

目的总结老年人重症急性胰腺炎（severe acute pancreatitis,SAP）的临床诊治特点,以提高对老年人重症急性胰腺炎的认识。方法回顾性分析近5年来收治25例老年（60～84岁）SAP患者的例临床资料,并与同期30例非老年人（22—59岁）对照组SAP患者资料进行对比研究。结果老年SAP患者以胆石症为主要病因,多伴其他慢性疾病,老年患者各种临床症状发生率均低于对照组（P〈0．05）;老年组APACHEⅡ（24、48h）和Ranson评分高于对照组（P〈0．05）;老年患者的局部并发症和多器官功能障碍（衰竭）发生率明显高于对照组（P〈0．05）;病死率和死亡原因与对照组无明显差异。结论我国老年SAP病因以胆源性为主,临床症状无特异性,伴发疾病多,并发症和多器官功能障碍（衰竭）发生率较高。老年人急性胰腺炎仍以内科非手术综合治疗为主。     

老年冠心病患者冠状动脉内支架置入术的临床评估

目的　评估老年冠心病患者的冠状动脉内支架置入术(支架术)的安全性和有效性。　方法　将我院123例年龄≥60岁(老年组)和265例年龄＜60岁(非老年组)已行支架术的冠心病患者的临床病灶特点、手术成功率、手术并发症及近、远期临床随访结果进行了回顾性对照分析。　结果　老年组在经皮冠状动脉腔内成形术（PTCA）的基础上行支架术总成功率与非老年组比较差异无显著性(96.7%与99.6%,Ｐ＞0.05);老年组手术死亡率为1.6%（2/123）,但与非老年组相比差异无显著性（Ｐ＞0.05）,两组间冠状动脉血管、外周血管并发症无明显差异;老年组因冠状动脉扩张后发生急性血管闭塞或严重内膜撕裂而置入支架比例明显高于非老年组（23.7%与14.3%,Ｐ＜0.001）;老年组左主干病变比例明显高于非老年组（3.2%比0.3%,Ｐ＜0.001）。随访6～54个月,两组患者恶性心脏事件发生率无明显差异,但老年组患者血运重建率明显高于非老年组（16.3%与7.8%,Ｐ＜0.05）。　结论　随着PTCA及支架置入技术的日臻完善,老年患者行支架术的成功率与非老年患者无明显差异,均达国内先进水平,老年患者的围手术期死亡率、急性期并发症及长期临床疗效与非老年患者比较无明显差异,均与全国注册水平相似,因此支架术是治疗老年冠心病患者安全、有效的方法。     

老年冠状动脉慢性完全性闭塞病变患者行逆向介入治疗的可行性

目的 探讨老年冠状动脉慢性完全闭塞（CTO）病变的患者行逆向介入治疗的可行性。方法 选择2004年1月至2015年5月沈阳军区总医院心内科收治的行逆向介入治疗的≥60岁老年CTO患者119例（老年组）及同期行逆向介入治疗的＜60岁CTO患者136例（非老年组），对比分析两组患者逆向介入治疗手术成功率、治疗效果及并发症的发生率。结果 与非老年组比较，老年组更多合并高血压、糖尿病、脑血管疾病（均P＜0.05）；老年组欧洲心血管手术危险因素评分系统（EuroSCORE）评分明显高于非老年组（P＜0.001）。老年组合并双支和三支血管病变患者多于非老年组（均P＝0.000）；而老年组发生单支血管病变患者数低于非老年组（P＝0.000）。老年组SYNTAX评分高于非老年组，差异具有统计学意义（P＜0.001）。非老年组CTO时间为3～12个月的病例明显多于老年组，而老年组CTO时间为6～9年和＞9年的病例明显多于非老年组（均P＝0.000）。结论 本研究的结果表明逆向介入治疗对老年患者是安全有效的方法。     

老年冠心病患者13 049例经皮冠状动脉介入围术期药物治疗的特点

目的：探讨老年冠心病（CHD）患者经皮冠状动脉介入（PCI）围术期药物治疗的特点。方法回顾性分析2008年7月至2012年11月在沈阳军区总医院接受PCI治疗的13049例CHD患者的临床资料,比较非老年人（＜60岁,n＝5810）、低龄老年人（60～74岁,n＝5640）及高龄老年人（≥75岁,n＝1599）在PCI围术期药物治疗上的差异。结果随年龄增长,患者合并高血压、心律失常、肾功能不全、卒中等基础疾病的比例显著增高。溶栓治疗的比例随年龄增长呈明显阶梯型下降趋势（17.5%vs 14.3%vs 7.2%;P＜0.001）。围术期应用血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂随年龄增长显著降低（32.4% vs 27.2% vs 11.0%;P＜0.001）。低龄老年组和非老年组围术期应用负荷剂量阿司匹林（99.3%vs 98.4%）和氯吡格雷（93.7%vs 93.8%）、高维持剂量阿司匹林（55.4%vs 55.9%）的比例无明显差异（均P＞0.05）,但均显著高于高龄老年组（88.7%,P＜0.001;91.5%,P＝0.006;47.6%,P＜0.001）。3组患者围术期应用肝素的比例无显著差异,但老年患者应用磺达肝癸钠的比例高于非老年患者（35.9% vs 38.0% vs 38.7%;P＝0.026）。老年患者接受心血管基础药物治疗（包括血管紧张素受体Ⅱ抑制剂、钙离子通道阻滞剂、利尿剂、洋地黄、硝普钠等）的比例显著高于非老年患者。结论老年CHD患者PCI围术期应用溶栓及抗栓治疗的比例显著低于非老年患者,而其他心血管基础药物治疗的比例则显著增高。     

急性胰腺炎患者血清降钙素原水平变化及意义

目的观察急性胰腺炎（AP）患者血清降钙素原（PCT）水平变化,探讨其临床意义。方法采用双夹心免疫发光法测定28例重症AP（SAP组）、32例轻症AP（MAP组）入院后第1、3、7天及30例健康体检者（对照组）血清PCT。结果 SAP组、MAP组不同时点血清PCT水平均明显高于对照组（P均〈0.05）;且SAP组不同时点血清PCT水平均明显高于MAP组（P均〈0.05）。根据血清PCT检测结果将患者分为三组,其中低浓度组无并发症发生,中浓度组发生休克、上消化道出血、DIC各1例,高浓度组分别为6、5、4例,高浓度组并发症发生率明显高于其他两组（P均〈0.01）。结论 AP患者血清PCT水平升高,检测PCT有助于AP病情的判定。     

不同年龄段人群发生急性胰腺炎的临床特点回顾分析

背景急性胰腺炎(acute pancreatitis, AP)是临床常见的急腹症之一,以往认为AP患者以青壮年居多,然而,近年来随着我国人口的增长及社会老龄化的形成,老年及儿童AP的发病率也呈上升趋势.不同年龄段人群因其生理学特性从而导致AP发病时的临床表现略有差异.老年及儿童患者临床表现不典型,极易造成误诊、漏诊.本文通过回顾性分析不同年龄段AP患者的临床特点,旨在总结临床经验,为临床诊治提供参考.目的探讨不同年龄段人群发生AP的临床特点.方法回顾性分析2003-01/2016-061758例AP的临床资料,根据年龄进行分组:未成年组(18岁);中青年组(18-60岁);老年组(≥60岁).总结不同年龄段人群发病的一般资料、病因、严重程度、并发症、临床经过及预后以及相关实验室指标的特点.结果未成年组AP男性发病率稍高于女性;轻度AP(mild acutepancreatitis,MAP)比例(78.5%)较另外两组高;并发症的发生率、病死率较其他两组低(P0.05).中青年组AP男性构成比(71.0%)较高,酒精性、高脂血症性胰腺炎发病率(13.4%、21.5%)较其他两组高(P 0.05);中青年AP胰腺坏死的发生率(23.4%)最高,发生胰周渗出、胸腔积液、急性呼吸窘迫综合征、急性肾功能不全的比例也高于未成年组(P0.05).老年组AP男性发病率稍高于女性,发生恶心症状的比例(58.2%)最高(P0.05).老年AP病因中胆源性所占比例(61.2%)最高(P0.05);老年AP发生中度重症AP的比例(43.5%)较其他两组高(P0.05).未成年组AP住院时间(17.97±12.14 d)最长,老年组AP入住重症监护病房的比例(4.1%)及病死率(13.1%)最高(P0.05),不同年龄段AP患者在住院费用方面差异不明显(P0.05).实验室指标结果对比显示,三组外周血白细胞计数差异无统计学意义(P0.05);未成年组C反应蛋白均值较其他两组低,老年组血清淀粉酶较中青年组高;老年组脂肪酶(lipase, LPS)较其他两组高(P0.05),LPS均值在未成年组及中青年组中的差异无统计学意义(P0.05).结论中青年较其他年龄段人群的酒精性、高脂血症性胰腺炎的发病率高;老年AP患者发病时最容易出现恶心,且病死率最高;当未成年患者出现不明原因的呕吐、腹胀时,应警惕AP可能.     

老年营养风险指数、全身免疫炎症指数及甘油三酯葡萄糖指数在老年急性胰腺炎中的临床价值

【摘要】 探讨老年营养风险指数（GNRI）、系统免疫炎症指数（SII）及甘油三酯葡萄糖（TyG）指数在老年急性胰腺炎患者（AP）中的临床价值。方法 选取老年AP患者161例，根据其严重程度分为73例轻度急性胰腺炎（MAP）组、42例中度急性胰腺炎(MSAP)组和46例重度急性胰腺炎（SAP）组。46例SAP患者根据死亡情况分为死亡组17例和存活组29例。比较各组GNRI、SII及TyG指数情况。应用受试者工作特征（ROC）曲线分析GNRI、SII及TyG指数预测老年SAP发生及死亡的价值。结果 SAP组GNRI（84.62±3.73 vs 88.75±6.10，92.80±8.06）明显低于MSAP组和MAP组（P<0.001），而SAP组SII（2738.74±1068.15 vs 1950.42±987.82，1293.27±719.50）及TyG指数（7.92±1.26 vs 6.47±1.02，4.60±0.53）明显高于MSAP组和MAP组（P<0.001）。死亡组GNRI（82.40±3.10 vs 87.53±4.92）明显低于存活组（P<0.001），而死亡组SII（3160.94±1207.15 vs 2318.50±1002.53）及TyG指数（9.36±1.42 vs 6.75±1.16）明显高于存活组（P<0.001）。ROC曲线显示，GNRI、SII及TyG指数三项联合预测老年SAP发生及死亡的AUC分别为0.857（95%CI：0.798～0.916）、0.910（95%CI：0.848～0.971）。结论 GNRI、SII及TyG指数与老年AP严重程度及预后有关，三项联合检测对SAP诊断及预测死亡具有较高的临床价值。     

老年急性胰腺炎患者临床特点分析(附185例报道)

[目的]分析老年急性胰腺炎患者的临床特点及有效的临床诊治措施。[方法]对本院近10年内收治的185例老年急性胰腺炎患者(老年组)的临床资料进行回顾性分析,并与同期192例非老年急性胰腺炎患者(非老年组)的资料进行对比分析。[结果]老年组发生急性胰腺炎的病因主要是胆道疾病,其次是血脂异常及饮酒;与非老年组相比,老年组重症胰腺炎发生率较高(P0.05),且全身并发症休克、感染、多器官功能障碍较多(P0.05);老年组发生急性胰腺炎病死率为9.7%,非老年组病死率为2.1%,2组比较差异有统计学意义(P0.01)。[结论]急性胰腺炎是老年患者的常见疾病,也是致死率较高的疾病;临床给予早期诊断治疗,可以有效地改善老年患者的预后。     

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.     

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.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.     

Morphological and immunocytochemical heterogeneity of cultured pinealocytes from one-week-and two-month-old rats: Planimetric and densitometric investigations

Abstract: In vitro preparations of rat pinealocytes are widely used for biochemical analyses of signal transduction processes. This paper deals with morphological and immunocytochemical features of such preparations. Special attention was paid to the problems of whether pinealocytes represent a heterogeneous cell population and how such heterogeneity may develop during ontogeny. The investigations were performed with cells which were obtained from the pineal organ of one-week-and two-month-old rats, attached to synthetic peptide-coated coverslips or tissue culture chamber slides, and maintained under in vitro conditions overnight. The attached cells were then fixed with paraformaldehyde. These preparations yielded monolayers of spherical cells of different sizes; most cells were isolated, but some of them were aggregated and formed small clusters. On the average, the cells from the one-week-old animals were smaller than the cells from the two-month-old animals. Immunocytochemical demonstration of S-antigen, a pinealocyte-specific marker, showed that the majority of the cells from two-month-old animals were intensely or moderately labelled. Pinealocytes from one-week-old animals were less S-antigen immunoreactive. Only very few cells (less than 1% displayed glial fibrillary acidic protein (GFAP)-immunoreactivity. Planimetric investigations of the cell size and semiquantitative densitometric investigations of the intensity of the S-antigen immunoreaction revealed that (i) pinealocytes kept in vitro form a heterogeneous cell population, and that (ii) this heterogeneity increases during postnatal development from one-week-old to two-month-old animals. Two groups of pinealocytes can be distinguished based on their developmental fate: pinealocytes of one group grow dramatically, but show only a moderate increase in S-antigen immunoreactivity, and pinealocytes of the other group retain their size, but display a distinct increment in S-antigen immunoreacti vitv.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.