不同程度脑白质病变患者认知功能障碍特点

目的探讨不同程度脑白质病变（WMLs）患者认知功能障碍的特点。方法临床收集97名患者,根据MRIT2加权像分为4级,以WMLs 0级作为对照组,分别进行MMSE、积木测验和画钟测验。结果（1）WMs患者的MMSE、积木测验和画钟测验评分与对照组相比,差异有统计学意义（P〈0．01）;（2）与对照组相比．WMLs3级组MMSE总评分、时间定向、语言即刻记忆、注意力、计算力、图形描画、积木测验和画钟测验评分差异有统计学意义（P〈0．01）,而WMLs1级和2级组各项评分差异无统计学意义p〉0．05）。结论（1）WMLs患者主要存在记忆、注意力、计算力和视空间功能的下降;（2）只有当WMLs损害达到一定程度后才引起认知功能的下降。     

血管性认知功能障碍神经心理及事件相关电位的研究

目的探讨非痴呆型血管性认知功能障碍(vascular cognitive impairment no dementia,VCIND)患者神经心理学及事件相关电位P300的特点。方法对64例VCIND患者(VCIND组)及42例其他疾病患者(对照组)行事件相关电位P300检查,使用简易智能状态检查量表(MMSE)、画钟测验(CDT)评定入选者认知功能状态,并进行相关分析。结果与对照组比较,VCIND组患者的CDT、MMSE评分明显降低,差异有统计学意义(P0.01),MMSE评分亚项中的时间定向、地点定向、注意/计算力、短程记忆、言语复述、阅读能力、书写能力、图形描画均明显降低,差异有统计学意义(P0.05,P0.01);P300潜伏期明显延长(P0.01),MMSE评分与P300潜伏期呈负相关(r=-0.615,P0.05)。结论事件相关电位P300检测有助于VCIND的早期诊断。     

培元益智方治疗轻度认知障碍的临床研究

目的观察培元益智方治疗轻度认知障碍（MCI）的临床疗效。方法将68例轻度认知障碍确诊患者随机分为中药组和对照组,各34例,中药组在一般宣教基础上给予口服培元益智方中药,2次／d;对照组只给予一般宣教,不给予任何益智和扩血管类药物;2组治疗观察均3rn。分别检测患者的MMSE值、画钟测验分值。结果经治疗后培元益智方中药组MMSE值、画钟测验分值均有明显提高俨〈0．01、P〈0．05）,而对照组MMSE值、画钟测验分值变化不明显（P〉O．051;治疗后MMSE净增值培元益智方中药组明显高于对照组（P〈0．01）;中药组对MMSE的影响,培元益智方总有效率达64．71％,高于对照组的17．65％（P〈O．01）;以画钟测验为标准,培元益智方中药组总有效率达73．53％,高于对照组的44．12％（P〈O．05）。结论中药培元益智方能有效改善轻度认知障碍患者的认知功能。     

基底核出血和梗死后认知功能的随访研究

目的探讨基底核出血和梗死急性期及恢复期的认知损害特点和差异。方法观察组共91例患者,其中基底核出血48例,基底核梗死43例。观察组在卒中后急性期（卒中后3周内）及卒中后恢复期（卒中后6～9个月）各完成一次神经心理学测验。健康对照组77名,完成一次神经心理学测验。结果基底核出血组和梗死组在急性期的各个认知域评分与对照组比较,差异均有统计学意义（P〈0．05）。除执行功能（语义分类流畅性）外,基底核出血组恢复期的神经心理学测验评分与急性期比较,差异均有统计学意义（P〈0．05）。恢复期基底核出血组的记忆力、执行功能（语义分类流畅性）、信息处理速度（数字符号测验）、视空间结构能力（积木测验和画钟测验）评分与健康对照组比较,差异亦有统计学意义（P〈0．05）,而简易精神状态检查量表（MMSE）、注意力、执行功能（Stroop测验C）和信息处理速度（Stroop测验A）评分与健康对照组比较,差异无统计学意义（P〉0．05）。除注意力（数字广度顺背测验）、记忆力（再认）和执行功能（语义分类流畅性测验）外,基底核梗死组恢复期的神经心理学测验评分与急性期比较,差异均有统计学意义（P〈0．05）。基底核梗死组恢复期记忆力、信息处理速度（数字符号测验）、视空间结构能力（积木测验和画钟测验）评分与健康对照组比较,差异具有统计学意义（P〈0．05）,而MMSE、执行功能（Stroop测验C）和信息处理速度（Stroop测验A）评分与健康对照组比较,差异无统计学意义（P〉0．05）。结论基底核卒中急性期出现多个认知领域的损害,恢复期大部分认知域得到改善,其中部分认知域可基本达到健康对照水平。     

老年代谢综合征患者认知功能障碍的特点

目的 研究老年代谢综合征(MS)患者认知功能损害的特点,探讨MS各组分对认知功能的影响.方法 通过临床神经心理学检查评定认知功能,分析MS及其各组分对认知功能损害的特点,及年龄、各代谢指标对认知功能的影响.结果 MS组在简易智力状态检查量表(MMSE)、画钟测验(CDT)、数字广度测验(DS)、听觉词语学习(AVMT)第一、第二、第三次回忆和延迟记忆的测定分值均较正常对照组明显下降(P<0.05).MS组内高血压伴高血糖组在MMSE、CDT、DS、AVMT即刻、延迟记忆和再认的测定分值均较正常对照组明显下降(P<0.05),而高TG伴低HDL组仅在MMSE、DS、AVMT即刻记忆和延迟记忆的得分均较正常对照组低(P<0.05).组分中高血压、高血糖的比值比分别为1.067、1.299(P<0.05).结论 老年MS患者存在记忆力、注意力、计算力及视觉空间结构等方面的认知功能损害;MS组分组合不同对认知功能损害作用不同;各组分中高血压、高血糖对认知损害起主要作用.     

不同类型脑小血管病伴发非痴呆血管性认知功能损害的研究

目的分析比较脑小血管病不同临床类型的非痴呆血管性认知功能的损害差异。方法纳入脑小血管病患者118例,包括52例腔隙性脑梗死灶(LI)和66例白质疏松(WML),健康对照组80例。对研究对象进行神经心理学测验,包括用蒙特利尔认知评估量表(MoCA)、简易智能状态检查表(MMSE)、语义分类流畅测验(动物)、简短Stroop测验、画钟实验、积木测验、数字广度顺背测验、数字符号测验、逻辑记忆亚测验、再生亚测验。结果与对照组比较,LI组和WML组Stroop测验评分升高,其他各项评分均降低(P<0.05)。LI组语义分类流畅测验(动物)、Stroop测验、数字符号测验、听觉词语学习测验(言语性记忆)、视觉再生亚测验(视觉性记忆)、MoCA、MMSE评分高于WML组(P<0.05)。结论 LI组和WML组患者血管性认知功能均受到损害,且总体上来说WML组患者更为严重。     

银杏叶片G治疗轻度认知障碍记忆损害的疗效

目的 观察银杏叶片G(斯泰隆)对轻度认知障碍(MCI)记忆损害的影响.方法 将符合MCI诊断标准的患者随机分为治疗组和空白对照组,服药1年,在治疗前、治疗半年期、一年期分别采用简易智能状态量表( MMSE)、逻辑记忆(LM)进行记忆功能评估.结果 与治疗前比较,治疗组连续治疗半年、一年MMSE、LM分值明显提高(P＜0.01,或P＜0.05);但治疗组半年期与一年期比较MMSE、LM分值无统计学差异(P＞0.05);治疗组治疗半年期地点定向、延迟回忆分值明显提高(P＜0.05,或P＜0.01),治疗一年期地点定向记忆、注意力与计算力、延迟回忆分值明显提高(P＜0.05,或P＜0.01),但治疗半年期与治疗一年期各分因子值无统计学意义(P＞0.05);与对照组比较,治疗组半年期和一年期的MMSE、LM净增值统计学亦有显著性差异(P＜0.01);治疗组半年期、一年期时间定向记忆、延迟回忆、视空间记忆分值的净增值差异亦有显著性(P ＜0.05或P＜0.01).结论 银杏叶片G(斯泰隆)能够较好地改善MCI患者的记忆功能.     

初发急性基底核出血与梗死患者的认知改变

目的探讨初次发病的急性基底核出血和梗死急性期患者认知变化的特点和差异。方法观察组共91例患者,其中基底核出血48例,基底核梗死43例。观察组卒中患者均在发病3周内,人组当日就完成一次神经心理学测验。健康对照组77名,完成一次神经心理学测验。结果基底核出血组和梗死组在各个认知域的评分均低于健康对照组（P〈0.05）。除数字符号、Stroop测验A部分和积木测验外,基底核出血组的认知域评分均低于基底核梗死组（P〈0.05）。左侧半球基底核出血组简易精神状态检查量表（Mini-Mental State Examination,MMSE）、注意力、记忆力、执行功能、信息处理速度和视空间结构能力的认知域评分均低于同侧基底核梗死组（P〈0.05）。右侧半球基底核出血组的MMSE、记忆力和视空间结构能力评分低于同侧基底核梗死组（P〈0.05）。左侧基底核出血组的MMSE、记忆力、执行功能和信息处理速度评分均低于右侧出血组,左侧基底核梗死组记忆力和执行功能评分也低于右侧半球（P〈0.05）。结论基底核卒中急性期可以出现多个认知领域的损害,基底核出血较梗死受损严重,左侧较右侧受损严重。应早期进行神经心理学评估,以期进行针对性的康复治疗。     

养血清脑颗粒对轻度血管性认知功能障碍病人认知功能减退疗效的临床研究

目的观察养血清脑颗粒对轻度血管性认知功能障碍病人的认知功能的影响。方法将45例轻度血管性认知功能障碍病人随机分为对照组及治疗组，其中治疗组24例，对照组21例，两组病人均接受控制脑血管病危险因素的基础治疗。治疗组加服养血清脑颗粒，每次4g，每日3次，冲服，共服用16周；对照组接受控制脑血管病危险因素的基础治疗（如阿司匹林、他汀类、降压药物等）疗程16周，治疗前和治疗后分别测定简易智力状态量表（MMSE）总分和各个亚项评分及成人韦氏记忆测验记忆商（MQ）总分及各个亚项的评分。结果治疗前两组在MMSE的各个亚项目无统计学意义（P〉0．05）；治疗后治疗组在MMSE的亚项如记忆力、注意力及计算力和回忆力上有统计学意义（P〈0．05），在定向力与语言能力上无明显差异；在成人韦氏记忆量表记忆商方面治疗后的病人主要表现图片回忆、背数、理解力3项上前后的差异性表现显著。对照组治疗前后虽有提高但是无统计学意义。结论养血清脑颗粒对轻度血管性认知功能障碍病人的认知功能减退有所改善，尤其表现在MMSE的主要亚项如记忆力、注意力及计算力和回忆力的评分较治疗前有明显提高。     

老年男性糖尿病患者认知功能与影响因素的临床研究

目的探讨老年男性糖尿病患者认知功能变化的特点,以及与认知功能损伤有关的因素。方法应用简易智力状态检查量表(mini mental state examination,MMSE)、词表学习、画钟测验等对60岁以上糖尿病患者60例(糖尿病组)和健康体检者50例(对照组)进行认知功能检查,应用方差分析和多元回归分析糖尿病认知功能损伤有关的因素。结果糖尿病组患者MMSE、词表学习、视空间技能和画钟测验成绩明显低于对照组,差异有统计学意义(P0.01)。高糖化血红蛋白患者画钟测验成绩较低糖化血红蛋白患者明显降低,差异有统计学意义(P0.05)。同型半胱氨酸浓度与MMSE成绩呈负相关(β=-0.47,t=4.12,P0.05),年龄相关脑白质改变评分与视空间技能成绩呈负相关(β=-0.17,t=3.12,P0.05)。结论糖尿病患者存在认知功能减退。糖化血红蛋白升高、年龄相关脑白质改变与视空间功能减退相关,同型半胱氨酸浓度与总体认知功能呈负相关。     

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.     

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.