肾性骨营养不良与继发性甲状旁腺机能亢进

肾性骨营养不良与继发性甲状旁腺机能亢进朱建民随着透析和肾移植技术的发展，慢性肾功能衰竭（肾衰）患者的寿命显著延长，其骨骼病变日益受到各国学者的关注。我国透析疗法起步较晚，但对透析用水均作了处理，铝中毒引起的低转化性骨病中也较国外为少。因而，继发性甲状...     

长期血液透析患者铝蓄积中毒的原因及诊治

长期血液透析患者铝蓄积中毒的原因及诊治刘永泉潘国忠关键词慢性肾功能衰竭透析铝中毒中图法分类号Ｒ４５９．５慢性肾衰（ＣＲＦ）长期血透患者，由于排铝障碍及铝的摄入相对增加，造成体内铝蓄积，久之形成铝中毒。我们对ＣＲＦ长期血透患者进行血清铝普查，对其中超过...     

慢性肾功能衰竭患者铝与骨病的关系

观察了２３例慢性肾功能衰竭（ＣＲＦ）患者，血铝含量平均为１．２７８±０．６４３ｐｐｍ，发铝含量为２．３７３±０．７９３μｇ／ｇ，明显高于正常人血铝０．７３８±０．０８２ｐｐｍ，发铝１．４９５±０．５９μｇ／ｇ，Ｐ值分别＜０．０１及＜０．００１。血铝与血钙水平呈明显负相关，ｒ＝－０．６２５３，Ｐ＜０．０５。肾性骨病（ＲＯＤ）患者血铝明显高于非骨病组，Ｐ＜０．０５。提示ＣＲＦ患者存在明显铝蓄积，并且与ＲＯＤ密切相关。对ＣＲＦ患者一经确诊即应采取有效的防治铝中毒的各项措施。     

慢性肾衰患者血清淀粉酶活力的临床观察

将２８例慢性肾衰（ＣＲＦ）患者分为保守治疗组、维持性腹膜透析（ＣＡＰＤ）组、维持性血液透析（ＨＤ）组，观察了其血清总淀粉酶活力（ＴＡ）的改变，结果发现：３组患者均有血清ＴＡ增高，透析治疗并不影响这种改变。提示：ＣＲＦ患者肾小球滤过率的降低可导致血清ＴＡ增高，在确立慢性肾衰合并胰腺炎的诊断时应考虑肾脏的内生肌酐清除率（Ｃｃｒ）对淀粉酶活力测定值的影响。     

重组人促红素对老年慢性肾衰病人氧自由基及抗氧化酶活性的 …

目的 探讨重组人促红素（ｒＨ－ＥＰＯ）对慢性肾衰患者体内氧自由基及抗氧化酶活性的影响。方法 测定１９例老年慢性肾衰尿毒症期患者ｒＨ－ＥＰＯ治疗前后血浆ＭＤＡ、ＳＯＤ及红细胞ＧＳＨ－Ｐｘ含量。结果 ｒＨ－ＥＰＯ治疗后慢性肾衰病人ＭＤＡ含量降低，ＳＯＤ、ＧＳＨ－Ｐｘ活性升高。结论 ｒＨ－ＥＰＯ纠正肾性贫血同时，可清除体内氧自由基，提高抗氧化酶活性。     

长期血液透析患者继发性甲状旁腺机能亢进症与肾性骨营养不良相关因素探讨

将６０例慢性肾功能衰竭（ＣＲＦ）行血液透析（ＨＤ）患者分式４个组进行临床研究，４０例ＨＤ５年以上，２０例ＨＤ２年以下，各分别服用及不服用罗钙全治疗，分别测定甲状旁腺素（ＰＴＨ）、降钙素（ＣＴ）、碱性磷酸酶（ＡＫＰ）并进行Ｘ线骨照片。结果显示：全部患者ＰＴＨ、ＣＴ明显升高，ＨＤ５年以上者高于２年以下者，不用罗钙全治疗者高于用罗钙全治疗者。ＨＤ５年以上不用罗钙全治疗者有９５％肾性骨营养不良（ＲＯＤ）、用罗钙全治疗者６５％有ＲＯＤ、透析时间越长，ＲＯＤ发生率越高。     

慢性肾功能衰竭与铝中毒

慢性肾功能衰竭患者铝积聚可引起三大症状:透析脑病、透析骨病和非特异性中毒症状。体内铝主要来自口服含铝的磷结合剂和被铝污染的透析液,以及肾衰时铝在体内积聚。可通过限制磷摄入以减少铝制剂的用量及经反渗透处理以去除透析用水中各种形式的铝,或应用螯合剂如去铁敏清除体内铝。此外,影响肾衰时铝中毒的其他因素尚有枸橼酸及甲状旁腺素等。     

维持性透析患者继发性甲状旁腺功能亢进性骨病的诊断与治疗

继发性甲状旁腺功能亢进性骨病是肾性骨营养不良的常见类型。它是影响慢性肾衰（ＣＲＦ）透析患者生活质量及其预后的重要原因之一。目前愈来愈重视对它的发病、诊断与治疗的研究。下面分别对此作以综述。１发病机制终末期肾功能不全患者肾脏的外分泌及内分泌功能均受损。...     

慢性肾衰透析时机的选择

慢性肾衰透析时机的选择汤兵季大玺关键词慢性肾衰血液透析时机选择促红细胞生成素中图法分类号Ｒ６９２．５慢性肾衰（ＣＲＦ）患者开始透析的时机，取决于患者的尿毒症症状及一些客观指标。虽然在过去的几年中，已经找到了延缓肾衰进展、推迟终末期肾衰进入透析的保守疗...     

瘦素与慢性肾功能衰竭

慢性肾功能衰竭（ｃｈｒｏｎｉｃｒｅｎａｌｆａｉｌｕｒｅ，ＣＲＦ）是临床常见病，并发症多，预后差，病理生理紊乱机制复杂。营养不良、高血压、胰岛素抵抗等都是慢肾衰发展到一定阶段的常见并发症，严重影响患者生活质量和预后。其中营养不良还可进一步导致免疫功能低下和贫血，是影响尿毒症透析患者长期生存率的主要因素之一，而食欲低下导致营养摄入减少，可能是引起慢性肾衰营养不良的主要原因。胰岛素抵抗也可加重营养不良，在尿毒症高血压发病中亦起重要作用。目前的透析治疗对尿毒症营养不良、高血压等尿毒症常见病理生理紊乱的纠…     

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.     

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.     

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.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.