2型糖尿病60例下丘脑-垂体-肾上腺轴功能的变化

目的探讨2型糖尿病患者下丘脑-垂体-肾上腺（HPA）轴功能的变化及其相关因素。方法测定60例2型糖尿病患者（糖尿病组）和30例健康体检者（对照组）的血浆皮质醇（F）、促肾上腺皮质激素（ACTH）、空腹胰岛素（FINS）、空腹血糖（FPG）、血脂、糖化血红蛋白（HbA。c）的水平以及血压、体重、腰围、臀围,计算体质量指数（BMI）、腰臀比（WHR）、胰岛素抵抗指数（HOMA-IR）。结果糖尿病组皮质醇昼夜节律紊乱发生率高于对照组（53．33％vs26．67％,P〈0．05）;糖尿病组高皮质醇发生率高于对照组（46．67％v820％,P〈0．05）;糖尿病组0时皮质醇、8时皮质醇及日平均皮质醇高于正常对照组（P〈0．01）。糖尿病组ACTH昼夜节律紊乱发生率高于对照组（60．00％vs36．67％,P〈0．05）;糖尿病组0时ACTH及日平均ACTH高于对照组（P〈0．01）。直线相关分析显示糖尿病组日平均皮质醇水平与WHR、FPG、HbA1c、HOMA-IR、甘油三酯（TG）呈正相关,与高密度脂蛋白-胆固醇（HDL-C）呈负相关。糖尿病组日平均ACTH与WHR、FPG、HbA。C、HOMA—IR呈正相关。结论2型糖尿病患者存在HPA轴功能紊乱,以皮质醇和ACTH昼夜节律紊乱、皮质醇活性亢进为主。     

溃疡性结肠炎患者血清TNF-α、IL-8的检测及意义

目的探讨TNF-α、IL-8在溃疡性结肠炎（UC）发病中的作用及临床意义。方法采用ELISA法测定38例活动期（病情为轻度12例、中度15例、重度11例）、22例缓解期UC患者（观察组）及20例查体健康者（对照组）血清TNF-α及IL-8水平。结果观察组活动期患者TNF-α和IL-8水平均显著高于缓解期和对照组（P均〈0．05）,缓解期患者显著高于对照组（P〈0．05）。轻、中、重度患者血清TNF-α和IL-8水平逐渐升高（P〈0．05）。结论TNF-α和IL-8参与了UC的炎症过程;血浆TNF-α和IL-8水平可作为判断UC患者病变严重程度和复发的重要指标。     

溃疡性结肠炎患者血小板α颗粒膜蛋白和血小板平均容积检测及临床意义

目的 探讨血小板α颗粒膜蛋白（GMP-140）和血小板平均容积（MPV）在溃疡性结肠炎（UC）发生发展中的作用。方法 检测67例UC患者（观察组）及30例健康人（对照组）血清GMP-140水平和MPV,分析两者与UC病情的相关性。结果 观察组GMP-140水平明显高于对照组（P〈0．05）,活动期患者明显高于缓解期患者（P〈0．05）;观察组MPV明显低于对照组（P〈0．05）,活动期患者明显低于缓解期患者（P〈0．05）;UC病情为重度、中度患者GMP-140水平明显高于轻度者（P〈0．05）、重度者明显高于中度者（P〈0．05）;重度、中度患者MPV明显低于轻度组（P〈0．05）、重度者明显低于中度者（P〈0．05）。结论 GMP-140和MPV可反映UC的病情活动性及严重程度。     

感染中毒症患者血清神经元特异性烯醇化酶的变化

目的：探讨感染中毒症患者血清神经元特异性烯醇化酶（NSE）的变化及意义。方法：用双抗体夹心法测定52例感染中毒症患者血清NSE浓度。结果：感染中毒症组血清NSE浓度显著高于对照组（P〈0．05）;严重感染中毒症和感染中毒症休克组血清NSE浓度显著高于普通感染中毒症组（P〈0．01）,普通感染中毒症组血清NSE浓度与对照组相比差异无统计学意义（P=0．055）。结论：血清NSE浓度升高可作为提示感染中毒症患者神经元细胞受损的辅助性指标,也是判断病情预后的指标之一。     

普伐他汀对急性冠状动脉综合征患者血浆sCD40L及MMP-9影响的观察

选择急性冠状动脉综合征（ACS）患者35例（ACS组），稳定型心绞痛（SAP）患者31例（SAP组），正常健康体检者28例（／E常对照组），前两组口服普伐他汀20mg／d，连用8周。采用酶联免疫吸附法（ELISA）测定三组治疗前后血浆可溶性白细胞分化抗原40配体（sCD40L）及基质金属蛋白酶-9（MMP-9）浓度。结果治疗前ACS组血浆sCD40L及MMP-9显著高于SAP组及正常对照组（P〈0．05），SAP组MMP-9显著高于正常对照组（P〈0．05），SAP组sCD40L与正常对照组之间无差异（P〉0．05），普伐他汀治疗8周后ACS组血浆sCD40L及MMP-9水平显著下降（P〈0．05，P〈0．01），SAP组MMP-9显著下降（P〈0．05），sCD40L无明显改变（P〉0．05）。认为sCD40L及MMP-9升高可能与ACS发病机制密切相关，sCD40L及MMP-9可作为ACS诊断及病情判断的重要指标；普伐他汀能降低ACS患者sCD40L及MMP-9水平。     

冠心病患者血清IL-6和IL-10水平检测的临床意义

目的探讨血清可溶性白细胞介素-6（IL-6）和白细胞介素-10（IL-10）水平与冠心病（CHD）病情及与冠状动脉病变程度的关系。方法将165例冠心病患者按临床诊断分为3组：急性心肌梗死（AMI）组60例、不稳定性心绞痛（UAP）组50例、稳定性心绞痛（SAP）组55例;健康对照组55例。用酶联免疫吸附试验检测各组血清可溶性IL-6和IL—10的水平,并比较各组间的差异。结果AM／组、UAP组及SAP组的血清可溶性IL-6和IL-10水平比对照组高（P〈0．05）,AMI组、UAP组血清IL-6水平高于SAP组（P〈0．05）;AMI组和UAP组血清IL-10水平低于SAP组（P〈0．05）;AMI组和UAP组血清IL-10的水平相似（P〉0．05）;结论冠心病患者血清可溶性IL-6及IL-10明显升高,且在一定程度上反映了病情、病变的严重程度,可作为CHD危险分层及病变程度评估的参考指标。     

胰岛素样生长因子-1与冠状动脉病变程度的关系

目的探讨冠心病患者胰岛素样生长因子-1（IGF-1）与冠状动脉病变程度的关系。方法42例冠心病患者分为急性心肌梗死（AMI）组12例，不稳定型心绞痛（UAP）组15例，稳定型心绞痛（SAP）组15例，16例冠状动脉造影（CAG）结果正常者为对照组。采用酶联免疫吸附法（ELISA）测定血清IGF-1水平。结果AMI和UAP组中IGF-1明显高于SAP和对照组（P〈0．01）。SAP组IGF-1明显低于对照组（P〈0．01）；IGF-1在单支病变组、双支病变组、三支病变组均高于对照组（P〈O．05），但单支、双支、三支病变组之间差异无统计学意义（P〉O．05）。结论IGF-1参与动脉硬化粥样斑块的发生发展过程，可作为预测斑块稳定性的标志物。     

2型糖尿病患者皮质醇分泌和调节变化

目的探讨2型糖尿病（T2DM）患者皮质醇分泌和下丘脑-垂体-肾上腺（HPA）轴活性的改变。方法选取2型糖尿病患者114例（T2DM组）和17例单纯向心性肥胖患者、正常对照80名（NC组）,T2DM组再按腰围分为肥胖组和非肥胖组,比较4组皮质醇分泌水平和HPA轴活性。结果4组患者皮质醇基础水平无差异;用地塞米松后T2DM＋OB组女性患者皮质醇被抑制程度较NC组少（P〈0．05）;与T2DM＋OB组、NC组比较,T2DM组患者肾上腺被兴奋程度最高,尤其在男性（P〈0．05）。结论不同体脂分布、不同性别T2DM患者存在HPA轴活性的差异。     

急性胰腺炎患者血清肿瘤坏死因子-α水平检测的临床价值

[目的]探讨急性胰腺炎（AP）患者血清肿瘤坏死因子-α（TNF-α）水平动态变化对病情判断的价值以及与APACHEⅡ评分的相关性。[方法336例AP患者分为轻症AP（MAP）组26例和重症AP（SAP）组10例，评定APACHEⅡ评分；对照组10例，均为健康志愿者。采用ELISA法检测血清TNF-α水平。[结果]①入院第1天2患者组血清TNF-α水平较对照组明显升高（P〈0．05）；随后MAP组逐渐下降，第7天降至正常；SAP组则持续升高，第3天达峰值；第3、7、14天明显高于MAP组（P〈0．05）。②SAP组的TNF-α水平和APACHEⅡ评分明显高于MAP组，血清TNF-α水平与APACHEⅡ评分呈显著正相关（r=0．837，P〈0．01）。[结论]AP患者血清TNF-α水平变化与APACHEⅡ评分有良好的相关性；TNF-α水平变化与AP的发生发展密切相关，入院第3天的TNF-α水平可作为AP病情程度判断的参考指标，测定TNF-α水平有助于判断预后。     

胃癌组织中HIF—1α、HPA的表达及意义

采用免疫组化SP法检测80例胃癌患者及12例健康志愿者胃黏膜组织中缺氧诱导因子-1α（HIF-1α）和乙酰肝素酶（HPA）。结果胃癌组织中HIF—1α、HPA的阳性表达率分别为53．75％、61．25％,明显高于正常胃黏膜组织的0和16．67％（P均〈0．01）。胃癌组织中HIF-1α、HPA阳性表达与肿瘤的浸润深度、有无淋巴结转移及临床TNM分期有显著相关性（P均〈0．01）。胃癌组织中HPA阳性表达与HIF-1α阳性表达呈显著正相关（r=0．497．P〈0．05）。认为HPA和HIF-1α在胃癌中高表达,且与胃癌的生长、浸润和转移密切相关。     

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.     

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.     

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.