心理干预对地震灾害所致创伤后应激障碍并支气管哮喘急性发作期患者的影响

目的 探索心理干预对地震灾害所致创伤后应激障碍合并支气管哮喘急性发作期患者的影响.方法 将来自地震灾区的符合美国精神病协会制定的创伤后应激障碍诊断标准的支气管哮喘急性发作期患者40例分为对照组及干预组,分别给予支气管哮喘常规治疗、支气管哮喘常规治疗联合心理干预,比较两组PTSD检查量表(PCL-C)、ACQ5、FEV1%pred、PEF%pred、外周血嗜酸粒细胞(EOS)的变化;分析干预组中PCL-C与ACQ5、FEV1%pred、PEF%pred、EOS之间的关系.结果 干预组的PCL-C、ACQ5、FEV1%pred、PEF%pred较之对照组有明显改善,两组之间的差异有统计学意义(P＜0.05);但EOS改善不明显,两组之间的差异无统计学意义(P＞0.05);干预组中PCL-C与ACQ5呈正相关(r=0.61,P＜0.05),与FEV1%pred、PEF%pred呈负相关(r值分别为-0.53、-0.57),与EOS无直线相关关系(P＞0.05).结论 用心理干预联合支气管哮喘常规治疗的方法治疗地震灾害所致PTSD并支气管哮喘急性发作期患者的疗效优于单纯的常规治疗,但对EOS改善作用不大.     

哮喘儿童肺通气功能检测的临床分析

目的：通过监测哮喘儿童急性发作期与缓解期肺通气功能各指标变化情况,了解其在儿童哮喘病情评估及指导治疗中的作用。方法应用德国Jaeger Master Screen肺功能仪对43例5～12岁哮喘急性发作期和经治疗后进入缓解期的哮喘儿童进行肺通气功能检测,包括大气道指标（ FVC、FEVl、FEV1/FVC、PEF）及小气道指标（ FEF25、FEF50、FEF75、MMEF75/25）,同时收集哮喘患儿病史资料和治疗情况。结果哮喘急性发作期患儿肺功能指标FVC、FEV1、FEV1/FVC、PEF与缓解期及健康对照组儿童比较,差异有统计学意义（ P＜0.01）;哮喘缓解期患儿的FVC、FEV1、PEF与健康对照组比较,差异无统计学意义（ P＞0.05）。小气道功能指标FEF25、FEF50、FEF75、MMEF75/25在哮喘急性发作期患儿中均明显降低,与缓解期组及健康对照组儿童相比差异有统计学意义（ P＜0.01）;哮喘治疗缓解期组中FEF25、FEF50、FEF75、MMEF75/25仍低于健康对照组,差异有统计学意义（ P＜0.05）。哮喘急性发作期不同严重程度患儿的肺通气功能指标（ FVC％pred、FEV1％pred、PEF％pred、FEF25％pred、FEF50％pred、FEF75％pred、MMEF75/25％pred ）随哮喘严重程度增加各指标越低,差异有统计学意义（ P＜0.05）。结论哮喘急性发作期肺通气功能受损,治疗缓解后小气道肺功能指标仍低于正常。肺通气功能的小气道功能指标在儿童哮喘的病情评估及治疗监测指导中意义更大。     

变应性鼻炎对支气管哮喘患者临床控制和肺通气功能的影响

目的 研究变应性鼻炎对支气管哮喘(简称哮喘)患者的临床控制和肺通气功能的影响.方法 分析39例哮喘合并变应性鼻炎患者的变应性鼻炎视觉模拟量表(VAS)评分与哮喘控制测试(ACT)评分、哮喘控制问卷(ACQ)评分和肺通气功能之间的相关性.结果 变应性鼻炎VAS评分与ACT评分呈负相关(r=-0.591,P＜0.05),与ACQ评分呈正相关(r=0.599,P＜0.05).变应性鼻炎VAS评分与FEV1％pred、PEF％ pred、FEF25％ pred、FEF50％ pred、FEF25％75％ pred均呈负相关(r=-0.473,-0.581,-0.591,-0.567,-0.494,P＜0.05).结论 在哮喘合并变应性鼻炎患者中,变应性鼻炎症状越重,哮喘控制越差,肺通气功能越低.     

脉冲振荡法在评价支气管哮喘患者小气道功能中的应用

目的探讨脉冲振荡法（IOS）在支气管哮喘（简称哮喘）患者小气道功能中的应用价值。方法选取40例哮喘患者分别于急性发作期和缓解期应用IOS法和肺通气法检测其肺功能,并与40例健康者相关指标进行比较。结果IOS检测指标R5、Fre5、X5、R5-R20急性发作组明显高于缓解组和健康对照组（P〈0．05）;R5—R20等缓解组亦高于健康对照组（P〈0．05）,而R20两组间差异无统计学意义（P〉0．05）;FVC、FEV1／FVC、FEV1、FVC％pred、PEF、PEF％pred、FEF5。％在急性发作期低于缓慢期和健康组,而缓解组和健康组间差异无统计学意义。结论哮喘缓解期患者通气功能恢复正常,但其小气道功能仍然存在异常;IOS法是哮喘病情监测有效的工具,较常规肺通气法其对小气道功能的检测尤为敏感。     

氯吡格雷对支气管哮喘患者P-选择素影响的研究

目的 观察支气管哮喘患者血清P-选择素的变化,探讨氯吡格雷治疗哮喘的疗效.方法 将60例支气管哮喘患者随机分为两组,常规治疗组和氯吡格雷组（氯吡格雷＋常规治疗）,选择健康体检者为对照组（30名）,进行观察.测定哮喘患者急性发作期和缓解期血清P-选择素水平的变化,同步检测肺功能第一秒用力呼气量（FEV1）、最大呼气流速（PEF）.结果 （1）哮喘患者急性发作期血清P-选择素水平较对照组明显升高（P均＜0.01）.氯吡格雷组缓解期血清P-选择素水平较常规治疗组缓解期明显下降（P均＜0.01）.哮喘患者血清P-选择素水平与FEV1、PEF比较成负相关;（2）氯吡格雷组患者缓解时间少于常规治疗组（P＜0.01）;（3）氯吡格雷组患者人均静脉用甲基强的松龙用量明显少于常规治疗组（P＜0.05）.结论 支气管哮喘患者急性发作期、缓解期血清P-选择素水平较对照组升高,氯吡格雷可以降低血清P-选择素水平,可作为辅助治疗支气管哮喘的药物之一.     

喘可治注射液治疗支气管哮喘急性发作期患者临床观察

目的观察喘可治注射液治疗支气管哮喘急性发作期患者的临床效果。方法选取2013年6月至2014年10月我院收治的支气管哮喘急性发作期患者91例作为观察对象,按照随机数字表法将其分为对照组(45例)和观察组(46例)。对照组患者给予常规治疗,包括止咳化痰、解痉平喘、抗感染、对症治疗等,同时给予异丙托溴铵治疗,观察组患者在对照组患者治疗的基础上加用喘可治注射液治疗,比较两组患者的临床治疗效果及肺功能改善情况。结果治疗4周,观察组患者的治疗总有效率为97.8%,对照组为75.6%,两组比较差异有统计学意义(P0.01);观察组患者的临床疗效显著优于对照组(P0.05)。治疗前,两组患者FEV1、PEF比较差异无统计学意义(P0.05);治疗后,观察组的FEV1、PEF明显改善(P0.05),且显著优于对照组(P0.05)。结论在常规治疗的基础上,加用喘可治注射液治疗支气管哮喘急性发作期患者临床效果确切,可显著改善患者肺功能,值得推广使用。     

综合排痰护理改善老年支气管哮喘急性发作期患者肺功能的研究

目的 探讨综合排痰护理对老年支气管哮喘急性发作期肺功能的影响,为寻求有效的护理手段提供依据。方法选择2011年11月至2013年4月老年支气管哮喘急性发作期住院患者100例,随机分为常规护理组（n=50）和排痰护理组（n=50）,常规护理组患者仅采用常规护理,排痰护理组在常规护理基础上再加综合排痰护理,连续7d。分别对2组患者的临床疗效、肺功能变化[（1秒用力呼气容积／用力呼气量预计值的百分比（FEV1％）,1秒用力呼气容积／用力肺活量百分比（FEV1／FVC）,最大呼气峰值流速实测值占预计值的百分比（PEF％）]等进行检测及统计分析。结果排痰护理纽显效29例、有效14例、无效7例、总有效率为86％,而常规护理组显效22例、有效15例、无效13例、总有效率为74％,排痰护理组总有效率高于常规护理组,但差异无统计学意义（P〉0．05）;与治疗前比较,2组治疗后FEV,％、FEV,／FVC和PEF％均明显升高（P〈0．05）;与常规护理组治疗后比较,排痰护理组治疗后的FEV1％、FEV1／FVC和PEF％皆显著升高,差异有统计学意义（P〈0．05）。结论 综合排痰护理对老年支气管哮喘急性发作期患者肺功能有较显著的改善效果。     

细辛脑雾化吸入佐治老年支气管哮喘急性发作期的临床疗效

目的探讨细辛脑雾化吸人佐治老年支气管哮喘急性发作期的临床疗效。方法选择住院治疗的支气管哮喘急性发作期老年患者70例,其中男性43例,女性27例,年龄60～78岁,平均（69．2±4．8）岁。随机分为常规治疗组（对照组）和细辛脑佐治组（试验组）,每组各35例。常规治疗组患者接受常规治疗;细辛脑佐治组患者在常规治疗基础上加用细辛脑注射液雾化吸人,共7d。对两组患者的疗效、临床症状与体征消失时间、肺功能变化[（第一秒用力呼气容积／用力呼气量预计值的百分比（FEV,％）,第一秒用力呼气容积／用力肺活量百分比（FEV1／FVC％）,最大呼气峰值流速实测值占预计值的百分比（PEF％）]等进行比较及统计学分析。结果细辛脑佐治组的有效率明显高于常规治疗组（P〈0．05）,喘息、咳嗽、胸闷、肺部哮鸣音等症状、体征消失时间明显少于常规治疗组（均P〈0,01、P〈0．05）。与两组治疗前比较,两组治疗后FEV1％、FEV1／FVC％和PEF％均显著升高（P〈0．01）;与常规治疗组治疗后比较,细辛脑佐治组治疗后的FEV1％、FEV1／FVC％和PEF预计值皆明显升高,差异有统计学意义（P〈0．01）。结论细辛脑对老年支气管哮喘有很好的辅助疗效。     

布地奈德雾化吸入佐治老年支气管哮喘的临床疗效研究

目的探讨老年支气管哮喘的治疗方法。方法选择90例老年支气管哮喘急性发作期患者随机分为布地奈德佐治组（试验组）和常规治疗组（对照组）,每组各45例。对照组患者接受常规治疗;试验组患者在常规治疗基础上加用布地奈德雾化吸人,共2W。分别检测两组患者的疗效、临床症状与体征消失时间、第一秒用力呼气容积／用力呼气量预计值的百分比（FEV1％）、第一秒用力呼气容积／用力肺活量百分比（FEV1／FVC％）、最大呼气峰值流速实测值占预计值的百分比（PEF％）,并进行比较与统计学分析。结果布地奈德佐治组的总有效率显著高于常规治疗组（84．44％VS．73．33％,P〈0．05）,咳嗽、喘息、胸闷、肺哮鸣音等症状、体征消失时间明显少于常规治疗组（均P〈0．01、P〈0．05）。各组治疗前后比较,治疗后FEV1％、FEV1／FVC％和PEF％均显著升高（P〈0．01）;与常规治疗组治疗后比较,布地奈德佐治组治疗后的FEV1％、FEV1／FVC％和PEF预计值均明显升高,差异有统计学意义（P〈0．01）。结论布地奈德对老年支气管哮喘有很好的辅助疗效。     

噻托溴铵联合布地奈德治疗轻中度支气管哮喘的疗效观察

目的观察噻托溴铵联合布地奈德治疗轻中度支气管哮喘的临床疗效。方法选择我院2011年11月—2012年12月诊治的轻中度支气管哮喘患者60例,随机分为观察组和对照组,每组30例。对照组患者吸入布地奈德,观察组吸入布地奈德+噻托溴铵。检测两组患者治疗前及治疗后8周第一秒用力呼气容积(FEV1)、呼气峰流速(PEF);记录两组患者治疗后8周支气管哮喘急性发作次数及治疗期间不良反应情况。结果两组患者治疗前FEV1及PEF比较,差异均无统计学意义(P0.05);两组患者治疗后FEV1及PEF高于治疗前,且观察组患者治疗后FEV1及PEF高于对照组(P0.05)。治疗组患者治疗后8周支气管哮喘急性发作次数为(2.3±0.2)次,低于对照组的(9.2±0.3)次(P0.05)。观察组患者治疗期间出现口干2例,对照组患者治疗期间出现失眠1例,两组患者不良反应发生率比较,差异无统计学意义(P0.05)。结论噻托溴铵联合布地奈德治疗轻中度支气管哮喘疗效确切,可有效改善患者肺功能,减少支气管哮喘急性发作次数。     

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.