二甲双胍联合针灸对肥胖患者胰岛素敏感性和代谢的影响

目的探讨二甲双胍联合针灸治疗对肥胖者胰岛素敏感性和代谢的影响。方法将156例单纯肥胖者随机分成A、B、C、D 4组,A组仅给予生活方式干预;其他3组除生活方式干预外,B组给予二甲双胍、C组给予针灸,D组给予二甲双胍与针灸联合治疗;各组受试者均治疗3个月。观察治疗前后空腹血糖（FPG）、空腹胰岛素（FINS）、体质量指数（BMI）、胰岛素敏感性指数（ISI）、TG、TC、HDL-C、LDL-C的变化。结果治疗前后比较,B、C、D组BMI、FPG、FINS、ISI、HDL-C、TG、LDL-C、TC差异有统计学意义（P〈0.05或〈0.01）。治疗后D组与B组比较,BMI降低、ISI升高（P均〈0.05）;治疗后D组与C组比较,BMI、FPG、FINS、TG、LDL-C、TC降低（P均〈0.05）,HDL-C显著升高（P〈0.05）。结论在生活方式干预基础上,二甲双胍联合针灸治疗单纯性肥胖安全、有效。     

2型糖尿病患者大网膜脂肪组织脂联素mRNA表达的研究

目的研究2型糖尿病（T2DM）患者大网膜脂肪组织脂联素mRNA的表达水平及其与腰围（WC）、BMI、腰臀比（WHR）、FPG、TG、TC、HDL-C、LDL-C、BP、病程等相关指标的关系。方法用半定量RT-PCR法检测T2DM患者（DM组）和非糖尿病患者（non-DM组）大网膜脂肪组织脂联素mRNA的表达水平。常规检测FPG、TG、TC、HDL-C、LDL-C、BP,计算BMI、WHR。结果与non-DM组相比,DM组大网膜脂肪组织脂联素mRNA表达水平显著下降（P〈0.05）,并与WC、TG、FPG、WHR明显负相关,其中以WC的相关性最大;未发现与BMI、HDL-C、LDL-C、TC及BP相关。结论T2DM患者大网膜脂肪组织脂联素mRNA表达显著降低;WC、TG、FPG、WHR、病程等临床指标可间接反映胰岛素抵抗程度,其中以WC的参考意义最大。     

2型糖尿病合并牙周病患者动脉粥样硬化相关因素分析

目的为2型糖尿病合并牙周病患者动脉粥样硬化的防治提供依据。方法采用彩超测定60例2型糖尿病合并牙周病患者（观察组）及50例无牙周病的糖尿病患者（对照组）的颈动脉内膜—中膜厚度（IMT）;取其血液标本,葡萄糖氧化酶法测空腹血糖（FPG）,ELISA法测定空腹胰岛素（FINS）,酶比色法测定TG、TC、HDL-C、LDL-C,免疫比浊法测定C反应蛋白（CRP）,ELISA法测定可溶性细胞间黏附分子-1（sICAM-1）,同时计算BMI、胰岛素抵抗指数（HOMA-IR）,对IMT与上述指标行Pearson相关分析和多元线性逐步回归分析。结果观察组FPG、FINS、TG、CRP、sICAM-1、IMT、HOMA-IR水平均明显高于对照组,而HDL-C水平明显低于对照组（P〈0.05或P〈0.01）。直线相关分析示IMT与年龄、FPG、TC、TG、LDL-C、FINS、HOMA-IR、CRP、sICAM-1、BMI呈正相关（P〈0.05或P〈0.01）,与HDL-C呈负相关（P〈0.01）。多元线性逐步回归分析示IMT与HOMA-IR、CRP、LDL-C呈正相关。结论血清CRP水平升高是影响2型糖尿病合并牙周病患者动脉粥样硬化的独立危险因素之一。     

老年冠心病患者FT3、FT4水平与血脂及高敏C反应蛋白的关系

51例冠心病患者与23例正常对照者检测甲状腺相关激素（FT3、FT4、TSH）及血脂（TC、TG、LDL-C、HDL-C、ApoA、ApoB）、高敏C反应蛋白（hsCRP）。结果冠心病组患者的血FT3、FT4、HDL-C水平均较对照组下降（P〈0.01或〈0.05）;TC、TG、LDL-C则上升（P〈0.01或〈0.05）;冠心病组血hsCRP明显升高（P〈0.01）,hsCRP与FT4、FT3呈显著负相关,与TSH无关。认为冠心病患者存在甲状腺功能降低及血脂代谢异常。     

老年男性血尿酸水平与代谢综合征各组分之间的相关性

目的探讨老年男性血尿酸水平与代谢综合征(MS)各组分之间的关系。方法对来该院进行健康体检的354名老年男性就诊者的身高、体重、腰围、血压、血尿酸、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、餐后2 h血糖(PG 2 h)等基本参数进行测定。并按血尿酸水平的四分位数间距进行分组,分析血尿酸水平与各组分之间的关系。结果体重指数(BMI)、腰围、舒张压、TC、TG、LDL-C、FPG均随着血尿酸水平的升高而升高,HDL-C水平随着血尿酸水平的升高而降低;且随着尿酸水平的升高,高血糖、高血脂、高血压的患病率亦呈上升趋势;相关性分析显示,血尿酸水平与BMI、腰围、舒张压、TC、TG、LDL-C、FPG呈明显正相关,而与HDL-C呈明显负相关。结论血尿酸水平升高与MS各组分密切相关,是MS的重要组成部分,提示临床上在老年代谢性疾病和心脑血管疾病的防治过程中,应注意控制血尿酸水平,并可将检测血尿酸水平作为MS预测及早期防治的一个指标。     

对社区代谢综合征患者进行强化生活方式干预的效果观察

目的观察在社区内对代谢综合征患者进行强化生活方式干预3个月前后代谢指标的变化,评价干预效果。方法将146例社区查体发现的代谢综合征患者分成干预组72例及对照组74例。两组同时给予代谢综合征健康教育,干预组采用强化生活方式干预,而对照组则保持通常的生活方式。测定两组入选前和3个月试验结束时体质量、腰围、血压（BP）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FPG）的变化,并进行组内及组间比较。结果干预组3个月后,体质量、腰围、BP、TG、TC、HDL-C、FPG明显改善,自身比较及与对照组比较均有统计学差异（P〈0.05）。结论强化生活方式干预可作为社区内的代谢综合征患者的一种有效的基础干预措施。     

血管紧张素转换酶基因多态性对肥胖儿童脂质代谢的影响

目的探讨血管紧张素转换酶（ACE）基因多态性对肥胖儿童脂质代谢的影响。方法选择肥胖儿童116例（观察组）和非肥胖的健康儿童78例（对照组）,空腹12 h后抽取静脉血,测定血清中TC、TG、LDL-C、HDL-C的水平。用PCR-RFLP方法及聚丙烯凝胶电泳对ACE基因型进行分析。结果与对照组比较,观察组血清TC、TG、LDL-C水平较高,而HDL-C水平较低（P〈0.05或〈0.01）。观察组比对照组D等位基因检出率高,表现基因型为DD、D I的肥胖儿童血清TC、TG、LDL-C高于Ⅱ型,HDL-C低于Ⅱ型（P〈0.05或〈0.01）。结论 ACE基因多态影响肥胖儿童脂质代谢。     

血清瘦素与糖尿病性心肌病的关系

目的探讨血清瘦素与糖尿病性心肌病（DC）的相关性。方法将65例2型糖尿病患者分为DC组35例、单纯糖尿病（DM组）30例;另选30例体检健康者作为正常对照组。检测并比较三组空腹血糖（EPG）、空腹胰岛素（FINS）、血脂及血清瘦素,分析血清瘦素与DC的相关性。结果 DC组、DM组血清瘦素、FPG、FINS、TC、TG、LDL-C均高于对照组（P均〈0.05）;瘦素水平与DC患者的BMI、FPG、FINS、TC、TG、LDL-C呈正相关,与HDL-C呈负相关（P均〈0.01）,高瘦素水平是DC的独立危险因素。DC患者治疗后血清瘦素明显下降（P〈0.05）。结论 DC患者血清瘦素升高,瘦素与其发病密切相关。     

高血压前期与血尿酸、C-反应蛋白的相关性研究

目的探讨高血压前期与血尿酸（UA）、C-反应蛋白（CRP）水平的关系及临床意义。方法入选2010年门诊体检人群176例,按照血压水平分为血压正常组（n=56）、高血压前期组（n=66）、高血压组（n=54）三组,检测受试者血UA、CRP及总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白-胆固醇（HDL-C）、低密度脂蛋白-胆固醇（LDL-C）、体质指数（BMI）、空腹血糖（FBG）水平。采用多元线性逐步回归分析UA、CRP对血压的影响。结果①三组间TC、TG、LDL-C、HDL-C、BMI及FBG、收缩压（SBP）、舒张压（DBP）水平比较,差异均有统计学意义（P均〈0.01）;②高血压前期组血UA、CRP水平均显著高于正常血压组（P〈0.01）,同时低于高血压组（P〈0.01）;③多元线性回归分析显示血UA、CRP分别与SBP、DBP呈独立相关（P〈0.05～0.01）。结论高血压前期患者已有血UA、CRP水平的升高,血UA、CRP与血压独立相关。     

益气活血解毒汤对实验性动脉粥样硬化家兔血脂、前列环素及血栓素A2的影响

目的通过高脂饲料喂饲诱发动脉粥样硬化家兔模型,探讨中药复方益气活血解毒汤对家兔动脉粥样硬化的干预作用及其作用机制。方法24只日本雄性大耳白兔随机分为4组,分别为空白对照组、模型对照组、益气活血解毒汤组及辛伐他汀组。10周后测定各组血清总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、血栓素B2（TXB2）、6-酮-前列腺素（6-keto-PGF1α）的含量。结果模型对照组TC,TG,LDL-C,TXB2较空白对照组有不同程度升高（P〈0.05或P〈0.01）,6-keto-PGF1α及HDL-C显著下降（P〈0.05）。益气活血解毒汤组及辛伐他汀组TC,TG,LDL-C及TXB2均低于模型对照组,6-keto-PGF1α及HDL-C升高明显（P〈0.01）,益气活血解毒汤组HDL-C与辛伐他汀组比较有所升高（P〈0.05）。结论益气活血解毒汤对家兔动脉粥样硬化有明显的预防和治疗作用,调节血脂、维持PGI2/TXA2的平衡可能是其作用机制之一。     

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.     

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.     

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.