氟伐他汀治疗原发性高胆固醇血症疗效观察

目的;探讨氟伐他汀治疗原发性高胆固醇血症的临床疗效,并观察其安全性。方法：43例高胆固醇血症给氟伐他汀20－40mg,1次／日,口服,比较服药前,后4周,8周血脂变化,结果：服药4周后血清胆固醇（TC）均值下降19．7％（P＜0．01）,甘油三酯（TG）下降11．6％（P＜0．05）,低密度脂蛋白胆固醇（LDL－C）下降24．8％（P＜0．01）,高密度脂蛋白胆固醇（HDL－C）升高4％（P＜0．05）,第8周与4周变化不大,结论：氟伐他汀能有效降低TC,LDL－C和TG,并能轻度升高HLD－C,保护冠状动脉,且安全,价廉,易于接受。     

膳食结构和身体活动度对血脂水平影响的研究

目的分析评价膳食结构和身体活动度对不同地区居民血脂水平的影响。方法2005年7月至9月，同济大学医学院心肺血管中心采用随机抽样的方法分别从上海市、攀枝花城镇及攀枝花乡村人群中分别抽取52、45、48人进行膳食结构和身体活动度的调查及血脂水平的测定。结果上海市居民血糖、血浆总胆固醇（TC）及低密度脂蛋白胆固醇（LDL—C）水平高于攀枝花城镇及乡村居民（P〈0．05），攀枝花城镇居民TC水平高于乡村居民（P〈0．05），血糖及LDL—C水平城乡差异无统计学意义（P〉0、05）。3个地区居民平均每人每日能量摄入量差异无统计学意义（P〉0．05），能量消耗量上海市低于攀枝花城镇（P〈0．05），攀枝花城镇低于乡村（P〈0．05），上海市居民脂肪的摄入量高于攀枝花城镇及乡村（P〈0．05），碳水化合物及膳食纤维的摄入量低于攀枝花城镇及乡村（P〈0．05）。血TC及LDL—C水平与膳食纤维的摄入量呈负相关．而与膳食胆固醇及膳食脂肪供能比呈正相关。结论应针对人群特点，进行适当的健康教育，改善膳食结构，增强体力活动，以获得理想的血脂水平。     

老年人血脂代谢异常

大量流行病学调查资料观察到血脂随年龄变化 ,血脂异常多见于老年人群 ,即使高龄老年人血脂异常仍然是冠心病 (CHD)的重要危险因素。　　一、主要血脂指标及其危险水平分类　　临床所重视的血脂异常主要是总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL C)及甘油三酯 (TG)升高 ,高密度脂蛋白胆固醇 (HDL C)降低。由于起到动脉粥样硬化致病作用的是LDL C ,现在划分心血管病危险水平及制定降脂治疗目标时都主张用LDL C。　　美国国家胆固醇教育计划的防治指南于 1988年提出 ,2 0 0 1年公布了经过大量修改的第 3版 (ATPⅢ ) ,它是根据大量…     

老年高血压、冠心病与血清高密度脂蛋白胆固醇的相关性研究

目的：探讨血清高密度脂蛋白胆固醇（HDL－C）与老年性高血压病（EH）、冠心病（CHD）的相关性。方法：选择住院60岁以上的疗养员879例，分EH组、CHD组和老年性冠心病并高血压病（CHD－EH）组，另139例老年健康人为对照组。检测各组的血压、血清总胆固醇（TC）和血清HDL－C的含量。结果：EH组和CHD－EH组的血清HDL－C含量显低于对照组（P＜0．05）；CHD组的血清HDL－C含量非常显低于对照组（P＜0．01）。对照组TC／HDL－C＝2．72；EH组、CHD－EH组、CHD组的血清TC／HDL－C分别为3．45，4．37，4．57，较对照组均明显升高（P＜0．01）。结论：EH组、CHD组和CHD－EH组的血清HDL－C明显低于对照组。     

慢性心力衰竭194例患者血脂水平的临床分析

目的了解慢性心力衰竭（CHF）患者的血脂水平，为临床治疗提供参考。方法回顾性调查华山医院在2003年1月1日～2005年12月31日出院诊断为CHF（心功能NYHA分级Ⅱ～Ⅳ级）194例患者的病史资料，为CHF组，同期收集出院诊断为冠心病和（或）高血压病、心功能正常、临床特征匹配的150例患者为对照组，分析患者血脂水平。统计采用t检验及卡方检验。结果与对照组相比，CHF组血清总胆固醇（TC）水平（4．43和4．81mmol／L，P〈0．05）及高密度脂蛋白（HDL—C）水平较低（1．16和1．87mmol／L，P〈0．05），低密度脂蛋白（LDL—C）高（2．62和2．07mmol／L）。按NYHA级别分组，各组间血脂水平无明显差异，但随心功能NYHA分级的提高，TC及LDL—C水平有下降趋势。不同病因的亚组分析中，与心功能正常的对照组比较：高血压、冠心病心衰病人存在部分血脂异常，主要的趋势为TC、TG、LDL—C水平的升高及HDL-C水平的降低（P〈0．05）；不同病因心衰组之间血脂水平无显著差异（P〉0．05）。结论CHF患者存在不同程度的血脂代谢异常，主要表现为TC及HDL—C降低，LDL—C升高。心功能分级与血脂异常的关系不明显。高血压及冠心病心衰亚组则表现TC及LDL-C升高，HDL-C降低。     

118例高胆固醇血症患者调脂治疗达标情况分析

目的 调查高胆固醇血症患药物治疗达标率。方法 对现行调脂治疗持续时间≥2个月的118例高胆固醇血症患进行血脂检查,并根据1997年我国制定的《血脂异常防治建议》确定血脂是否达标。结果 总胆固醇（TC）和低密度脂蛋白胆固醇（LDL－C）总达标率分别为23．7％、38．1％,他汀类药物LDL－C总达标率高于海鱼油和绞股兰每日20mg辛伐他汀LDL－C达标率高于每日20mg氟伐他汀。结论 现行调脂治疗达标率较低,可能与选择药物的种类和药物剂量有关。     

有冠心病家族史儿童载脂蛋白E基因多态性的研究

目的：探讨有冠心病（CHD）家族史儿童载脂蛋白（apo)E基因多态性的分布及其对血脂、脂蛋白、apo的影响。方法：采用改良的聚合酶链式反应－限制性片段长度多态性方法,分析83例有CHD家族史的儿童和282例无CHD家族史的儿童apoE基因型。结果：与无CHD家族史的儿童比较,有CHD家族史儿童apoε4等位基因频率较高（分别为6．0％、15．7％,P＜0．01）。早发CHD家族史的儿童ε4等位基因频率较非早发及无CHD家族史儿童为高,三组之间的ε4等位基因频率差异有性（分别为18．3％、14．8％、6．0％,P＜0．05。apoE基因多态性对有CHD家族史儿童的血脂水平有影响,ε2、ε3、ε4等位基因携带有的血总胆固醇（TC）、低密度脂蛋白－胆固醇（LDL－C）、脂蛋白（a)、apoB100、apoE浓度有差异（P＜0．05）;与ε3等位基因携带比较,ε4具有较高的血TC、LDL－C、apoB100水平和较低的apoAⅠ、apoE水平;ε2等位基因携带的血TC、LDL－C和脂蛋白（a)水平较低（P＜0．05）。结论有CHD家族史儿童apoE基因多态性其他儿童不同,并对血浆脂蛋白代谢产生明显影响。     

调脂药物在防治冠心病中的规范应用及其进展

血脂异常是动脉粥样硬化的重要危险因素。血脂异常主要包括高胆固醇血症、高甘油三酯血症、混合性高脂血症、高脂蛋白血症和高密度脂蛋白低水平。高胆固醇血症是冠心病的独立危险因素，血清胆固醇（TC）的水平与冠心病的发病呈线数对数关系，降低TC与低密度脂蛋白胆固醇（LDL—C）可显著减少心血管事件的发生，降低幅度越大，获益越大。高甘油三酯也是冠心病的一个独立危险因素，而且甘油三酯（TG）升高伴TC升高或高密度脂蛋白胆固醇（HDL—C）水平低下会明显增加冠心病的发病危险。HDL—C水平与冠心病发病呈负相关，研究显示：HDL—C水平每增加0．03mmol／L（1mg／dl），冠心病的危险就降低2％～3％。降低TG与升高HDL—C与心血管事件减少相关。     

急性冠状动脉综合征早期不同剂量辛伐他汀降脂疗效观察

目的 随机对比观察急性动脉综合征（ACS）发生后48h内使用两种剂量辛伐他汀的疗效与安全性及对近中期心血管事件的影响。方法 所有临床确定为ACS患入院48h内采空腹静脉血测血脂等生化指标，对总胆固醇（TC）≥4.68mmol/L和（或）低密度脂蛋白胆固醇（LDL－C）≥2.6mmol/L患则按随机原则分别入选辛伐他汀10mg组与20mg组：（1）10mg组；入选98例ACS患，其中男性62例，女性36例，平均年龄61．2岁。（2）20mg组；入选99例ACS患，其中男性61例，女性38例，平均年龄61．3岁。分别于服药后3个月，6个月及12个月时复查血脂，并对临床事件作随访登记，同时观察有药安全性。结果 辛伐他汀10mg与20mg剂量均能有效地降低ACS患血清TC及LDL－II水平，其中20mg剂量组降TC及降LDL－C疗效均明显优于10mg剂量组，两组之间各时间段的达标率差异显（3个月时TC为26．8％比16．5％，LDL－C为29．9％比19．6％，P＜0．05；6个月时TC为29．9％，比24％，P＜0．05；12个月时TC为36．5％，比26．3％，LDL－C为40．3％，比28．2％，P分别＜0．05和P＜0．001）；随访期间辛伐他汀20mg组在心肌梗死发生率，再住院率及再次血管重建率均明显低于10mg组。结论 两种剂是辛伐他汀应用于ACS早期均能安全，有效地降低ACS患血清TC及LDL－C水平；辛伐他汀20mg剂量组的疗效明显优于辛伐他汀10mg组。     

小剂量辛伐他汀对老年冠心病并高胆固醇血症的治疗

目的：观察小剂量辛伐他汀递减法治疗老年冠心病并高胆固醇血症的疗效及安全性。方法：43例老年冠心病并高胆固血症患者每晚服辛伐他汀20mg／d 2周，后调整为10mg／d 4周，再用10mg，隔日1次维持，分别于入院时、4周、10周时查血胆固醇（TC），甘油三酯（TG），低密度脂蛋白-胆固醇（LDL—C），高密度脂蛋白-胆固醇（HDL—C）及肝、肾功能，血糖等指标，并进行统计学分析。结果：与治疗前相比，治疗4周和10周后TC、LDL—C均有明显降低（P〈0．001）；治疗4、10周TG明显降低（P〈0．05～〈0．001）HDL—C有升高，但无统计学意义，无严重不良反应。结论：小剂量辛伐他汀递减法治疗老年冠心病并高胆固醇血症有较好疗效及安全性。     

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.