刺五加联合盐酸多奈哌齐治疗血管性痴呆认知功能障碍的疗效

目的 探讨刺五加联合盐酸多奈哌齐对血管性痴呆患者认知功能障碍的治疗作用.方法 对82 例血管性痴呆患者,随机分为观察组(41例)和对照组(41例),观察组在基础治疗基础上应用刺五加注射液及盐酸多奈哌齐,两组均在治疗前后进行瑞文测验联合型(CRT) 及临床记忆量表(CMS) 的检测.结果 ①CRT评分:除知觉障碍评分外,观察组治疗后的类同比较、比较推理、系列关系、抽象思维、总分与对照组治疗后比较,差异有统计学意义(P<0.05);②CMS评分:除了图像回忆外,观察组治疗后的联想学习、指向记忆、图形再认、人像特点回忆、总分与对照组治疗后比较,差异有统计学意义(P<0.05).结论 刺五加联合盐酸多奈哌齐对改善血管性痴呆患者的认知障碍具有显著疗效.     

丙戊酸镁缓释片联合盐酸多奈哌齐胶囊治疗老年痴呆精神行为障碍的疗效观察

目的:探讨丙戊酸镁缓释片联合盐酸多奈哌齐胶囊治疗老年性痴呆(AD)患者精神症状的疗效及不良反应。方法:64例老年痴呆患者随机分成治疗组及对照组(各32例),治疗16周,治疗前后用简易智能精神状态检查量表(MMSE)、AD评定量表(ADAS)及阿尔茨海默病病理行为评分量表(Blessed-Roth)评价患者认知功能及痴呆严重程度、精神行为异常(ADAS non-cog)及日常生活自理能力(ADL),并进行疗效及安全性评价。结果:治疗16周后2组患者MMSE评分均显著下降(均P0.05),治疗组降低更显著。ADAS认知部分、ADAS non-cog及Blessed-Roth日常生活自理能力部分均有改善,治疗组改善更显著。结论:丙戊酸镁缓释片联合盐酸多奈哌齐胶囊治疗老年性痴呆患者有较好的疗效并安全性好,副作用小,适合临床应用。     

银丹心脑通软胶囊联合多奈哌齐治疗老年性痴呆

目的观察银丹心脑通软胶囊联合多奈哌齐对老年性痴呆患者的临床疗效。方法 98例老年性痴呆患者随机分为治疗组(50例)和对照组(48例)。治疗组给予银丹心脑通软胶囊1.2g,每日3次。同时联合多奈哌齐5mg,每天一次,1月后改为10mg,每天一次。对照组单纯采用多奈哌齐,用法同前。治疗24周前后,评价简易智能精神状态评估量表(MMSE)、日常生活功能量表(ADL)、长谷川痴呆量表(HDS),并进行对比研究。结果与对照组比较,治疗组MMSE、ADL、HDS评分指标均有统计学意义(P<0.05)。结论银丹心脑通胶囊和多奈哌齐联合治疗老年性痴呆可有效改善患者认知、行为能力,达到良好的治疗效果。     

盐酸多奈哌齐联合银丹心脑通软胶囊对血管性痴呆患者认知功能的影响

目的 探讨盐酸多奈哌齐联合银丹心脑通软胶囊治疗血管性痴呆(VD)认知功能及生活能力的疗效.方法 将符合纳入标准的80例轻、中度VD患者随机分为两组.对照组单独给予盐酸多奈哌齐,观察组在对照组治疗基础上加用银丹心脑通软胶囊治疗.在治疗前和治疗6个月后用简明智力检查量表(MMSE)和长谷川痴呆智能检查量表(HDS)对患者认知功能进行评价,使用日常生活能力量表(ADL)对生活能力进行评价,使用不良反应量表(TESS)对安全性进行评价.结果 两组治疗后HDS评分、MMSE评分在治疗后均升高,ADL评分在治疗后均下降,与治疗前比较有统计学意义(P<0.05或P<0.01).治疗后观察组HDS评分、MMSE评分较同期对照组比较,差异有统计学意义(P<0.05).治疗后两组的ADL评分比较差异无统计学意义(P<0.05).两组安全性比较无统计学意义(P>0.05).结论 盐酸多奈哌齐联合银丹心脑通软胶囊在改善认知功能方面较单用盐酸多奈哌齐疗效显著,可以作为临床上治疗VD的联合用药.     

脑蛋白水解物注射液联合盐酸多奈哌齐对阿尔茨海默病的认知改善观察

目的观察脑蛋白水解物注射液联合盐酸多奈哌齐对阿尔茨海默病病人认知改善的临床疗效。方法入选阿尔茨海默病病人52例,分别用脑蛋白水解物注射液联合盐酸多奈哌齐(治疗组,26例)、盐酸多奈哌齐(对照组,26例)治疗。以治疗前及治疗3个月、6个月、12个月后对两组进行简易精神状态评价(MMSE量表)、日常生活能力评分(ADL量表)、阿尔茨海默病评价量表-认知分量表评分(ADAS-cog量表),治疗前后临床疗效评定作为观察指标。结果脑蛋白水解物注射液联合多奈哌齐治疗组治疗阿尔茨海默病病人12个月后,认知功能和行为能力的改善均明显好于盐酸多奈哌齐对照组(P0.05)。结论脑蛋白水解物注射液联合盐酸多奈哌齐对阿尔茨海默病的认知改善具有明显疗效。     

盐酸多奈哌齐治疗血管性痴呆有效性及安全性临床分析

目的评估盐酸多奈哌齐治疗轻、中度血管性痴呆的临床疗效以及安全性。方法 95例可能或可疑血管性痴呆患者,随机分为3组,治疗1组患者每日服用盐酸多奈哌齐5 mg,共48周;治疗2组患者每日服用盐酸多奈哌齐5 mg,共24周,第25～36周隔日服用一次盐酸多奈哌齐5 mg,第37～48周停药;对照组30例,随访共48周。每12周随访一次,评估采用ADAS-cog、ADL、MMSE、CDR量表。结果治疗12、组MMSE、ADAS-cog评分与对照组比较均有统计学差异（P〈0.05）。治疗1、2组治疗后ADAS-cog、ADL、MMSE、CDR评分均较治疗前改善（P〈0.05）。结论盐酸多奈哌齐能显著改善轻、中度血管性痴呆患者的认知功能,且短期减药、停药不会导致认知功能恶化。     

参志胶囊联合多奈哌齐治疗帕金森病的疗效及对血清CysC、Hcy和脑神经递质的影响

目的探讨参志胶囊联合多奈哌齐治疗帕金森病患者临床疗效及对患者血清胱抑素(Cys)C、同型半胱氨酸(Hcy)和脑神经递质的影响。方法选择帕金森病患者93例,按照随机数字表法随机分为治疗组(n=47)与对照组(n=46)。治疗组患者采用参志胶囊联合多奈哌齐治疗,对照组患者采用多奈哌齐治疗。两组疗程均为3个月。比较两组治疗前后帕金森病评分量表(UPDRS)和日常生活能力(ADL)、CysC和Hcy、脑神经递质变化及治疗疗效。结果两组治疗后UPDRS评分显著降低而ADL评分显著增加(P<0.05);治疗组治疗后UPDRS评分显著低于对照组而ADL评分显著高于对照组(P<0.05)。两组治疗后血清CysC和Hcy水平显著降低(P<0.05);治疗组治疗后血清CysC和Hcy水平显著低于对照组(P<0.05)。两组治疗后P物质水平显著降低而DA水平显著增加(P<0.05);治疗组治疗后血清P物质水平显著低于对照组而DA水平显著高于对照组(P<0.05)。治疗组总有效率显著高于对照组(P<0.05)。结论参志胶囊联合多奈哌齐治疗帕金森病患者临床疗效良好,可降低血清CysC和Hcy水平,改善脑神经递质水平。     

多奈哌齐对阿尔茨海默病并精神异常患者认知功能及日常生活自理能力的影响

目的探讨多奈哌齐对阿尔茨海默病(AD)并精神异常患者认知功能及日常生活自理能力的影响。方法随机选取AD并精神行为异常患者80例,依据治疗方法将其分为研究组(n=40)和对照组(n=40)。给予研究组患者多奈哌齐治疗,给予对照组患者氢溴酸加兰他敏治疗,然后对两组患者的认知功能、日常生活自理能力、临床疗效及不良反应发生情况进行统计。结果研究组患者的MMSE评分显著高于对照组(P0.05),BPRS、ADL评分均显著低于对照组(P0.05),但研究组和对照组患者治疗的总有效率75.0%(30/40)、72.5%(29/40)之间的差异不显著(P0.05),不良反应发生率7.5%(3/40)、7.5%(3/40)之间的差异不显著(P0.05)。结论多奈哌齐能够有效提升AD并精神行为异常患者认知功能及日常生活自理能力。     

多奈哌齐联合盐酸美金刚治疗阿尔茨海默病的临床疗效

目的探讨联合使用多奈哌齐及盐酸美金刚片对阿尔茨海默病(AD)的临床疗效。方法选取AD患者117例,依据治疗方案不同分为观察组(多奈哌齐片+盐酸美金刚)及对照组(多奈哌齐片)。治疗12 w后评估疗效,包括:总体治疗效果、精神症状、系统性炎症反应及治疗不良反应发生情况。结果治疗后,两组AD认知评定量表(ADAS-cog)评分及日常生活能力量表(ADL)评分均显著降低(P<0. 05),且观察组显著低于对照组(P<0. 05)。两组治疗后神经精神科问卷(NPI)评分显著降低(P<0. 05),而简易精神状态检查(MMSE)评分显著增高(P<0. 05),且观察组与对照组比较差异有统计学意义(P<0. 05)。两组治疗后IL-6及IL-8水平均显著降低(P<0. 05),且观察组显著低于对照组(P<0. 05)。两组治疗前后IL-10水平差异无统计学意义(P>0. 05)。两组治疗期间药物不良反应发生率比较差异无统计学意义(χ2=0. 206,P=0. 650)。结论联合使用多奈哌齐及盐酸美金刚治疗老年AD的临床疗效优于单独使用多奈哌齐。     

螺旋CT在遗忘型轻度认知障碍诊断和疗效评估中的价值分析

目的探讨螺旋CT在遗忘型轻度认知障碍诊断和疗效评估中的价值。方法选取88例遗忘型轻度认知障碍患者作为观察组,选取同期认知、记忆检查正常者30例作为对照组。采用临床记忆量表检测患者记忆力,利用螺旋CT检查颞角宽度及海马指数。将观察组88例遗忘型轻度认知障碍患者随机分为两组,每组44例;多奈哌齐组予多奈哌齐(5 mg/d)治疗,安慰剂组予维生素C(1 g/d)治疗,治疗18周后比较多奈哌齐组及安慰组患者记忆功能指标、颞角宽度、海马指数。结果观察组患者治疗前人像特点联想回忆、无意义图形再认、图像自由回忆、联想学习以及指向记忆等指标评分明显低于对照组正常者,差异有统计学意义(P0.05),观察组患者治疗前颞角宽度、海马指数明显高于对照组正常者(P0.05)。多奈哌齐组患者治疗后人像特点联想回忆、无意义图形再认、图像自由回忆、联想学习以及指向记忆等记忆功能评分显著高于安慰剂组(P0.05),颞角宽度、海马指数明显低于安慰剂组(P0.05)。结论遗忘型轻度认知障碍患者均有一定程度的记忆损伤,多奈哌齐治疗遗忘型轻度认知障碍具有一定疗效,采取CT检查能为临床诊治提供参考依据。     

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.