冠心病合并心力衰竭患者血清脂联素水平变化

目的探讨冠心病合并心力衰竭患者血清脂联素水平的变化及其临床意义。方法选择冠心病患者60例、冠心病合并心力衰竭患者60例[其中心功能（NYHA）Ⅱ级18例、心功能Ⅲ级27例、心功能Ⅳ级15例]、健康对照组25例,测定血清脂联素并对其变化进行两两比较。结果冠心病合并心力衰竭患者血清脂联素为（14．22±5．34）mg／L;冠心病无心力衰竭组血清脂联素为（4．79±1．61）mg／L;健康对照组为（6．98±1．62）mg／L,两两比较差异有统计学意义（P〈0．01）。冠心病合并心力衰竭患者随着心功能分级的升高,血清脂联素水平也显著升高[NYHAII级为（9．25±2．71）mg／L,NYHAⅢ级为（13．72±3．38）mg／L,NYHAIV级为（18．0±6．72）mg／L,P〈0．01]。结论合并心力衰竭的冠心病患者血清脂联素水平是升高的,且随着心功能分级的升高,血清脂联素水平也明显升高。血浆脂联素可能参与冠心病及心力衰竭的发病机制,血清脂联素水平变化对心力衰竭的进展和程度有一定的指导意义。     

单一性低促性腺激素型性腺功能减退症患者血清脂联素与睾酮水平的关系

目的观察对单一性低促性腺激素型性腺功能减退症（IHH）患者脂联素与睾酮水平的关系。方法通过分析临床资料及激素测定、促性腺激素释放激素激发试验确诊IHH，检测23例IHH患者和15名正常男性血清脂联素和睾酮水平。结果与体重指数、腰臀比以及血压均匹配的正常对照组相比，IHH患者睾酮水平显著低于正常[（0．23±0．18 vs 4．20±1．90）μg／L，P〈0．01]，其脂联素水平显著升高[（11．3±1．8vs8．7±1．2）mg／L，P〈0．01]。对两组进行相关分析显示，血清脂联素水平与睾酮水平呈负相关（r=-0．570，P〈0．01）。结论IHH低睾酮水平人群中脂联素水平显著升高，提示脂联素与睾酮水平之间存在密切关系。     

非酒精性脂肪肝患者胰岛素抵抗与脂联素基因表达的关系

目的探讨NAFLD患者胰岛素抵抗（IR）与脂肪组织脂联素基因表达的关系。方法用SYBR GreenI实时定量RT-PCR方法检测脂肪组织脂联素mRNA的表达水平，用稳态模型法计算IR指数。结果肥胖和非肥胖NAFLD患者及对照组IR指数分别为：3．0±0．8、2．8±0．9和2．0±0．6、1．2±0．5，其脂肪组织脂联素基因表达和血浆脂联素浓度较对照各组显著降低（P〈0．05），IR与脂联素基因表达（r=0．5，P〈0．05）和血浆脂联素浓度负相关（，=0．4，P〈0．05），与血清甘油三酯正相关（r=0．3，P〈0．05）。结论NAFLD患者的IR与脂肪组织脂联素基因低表达有关，脂联素基因低表达在IR和NAFLD发病中起了一定作用。     

冠状动脉粥样硬化患者血浆瘦素、脂联素的水平变化及意义

目的探讨冠状动脉粥样硬化患者血浆瘦素、脂联素水平及其与动脉粥样硬化的关系。方法选择242例冠状动脉粥样硬化患者,按冠脉造影结果分为对照组（冠脉狭窄〈50%）107例、冠心病（CHD）组135例,分别检测两组患者血浆瘦素、脂联素水平,并分析其与动脉粥样硬化的关系。结果 CHD组血浆脂联素水平[（4.81±0.96）mg/L]显著低于对照组[（6.04±0.98）mg/L]（P〈0.01）;血浆瘦素水平[（1.71±0.36）μg/L]显著高于对照组[（1.32±0.31）μg/L]（P〈0.01）。Pearson相关分析显示,血浆瘦素与脂联素水平呈显著负相关（r=-0.672,P〈0.01）,且随着Gensini积分增高,血浆瘦素水平逐渐增高,而脂联素水平逐渐下降（P〈0.01）。结论冠状动脉粥样硬化患者冠脉病变程度与血浆瘦素和脂联素水平均有相关性;血浆瘦素与脂联素水平存在相互抑制调节的关系。     

2型糖尿病一级亲属脂联素等与胰岛素抵抗的相关研究

测定糖耐量正常T2DM患者一级亲属35例，及对照组42例的脂联素、抵抗素、TNF-α。结果1．一级亲属组脂联素水平低于正常对照组（12．29±3．64mg／L vs 14．66±3．43mg／L，P〈0．05），而抵抗素、TNF-α水平显著高于正常组（分别是19．02±6．85Pg／ml vs 15．68±6．24pg／ml，P〈0．05；14．12±2．87pg／ml vs 10．43±2．58pg／ml，P〈0．05）；2．一级亲属组IR指数与脂联素呈负相关（r=-0．53，P〈0．05），与抵抗素、TNF-α呈正相关（分别为r=0．62，P〈0．05；r=0．48，P〈0．05）。结论脂联素、抵抗素、TNF-α可能与T2DM患者一级亲属的IR相关。     

冠心病病人血浆凝血酶调节蛋白水平改变及其与合并症关系的研究

目的研究冠心病（CHD）病人血浆中可溶性凝血酶调节蛋白水平,并探讨其与血压、血脂及血糖水平的关系。方法采用酶联免疫吸附试验（ELISA）检测血浆中可溶性凝血酶调节蛋白水平。结果冠心病病人中血浆可溶性凝血酶调节蛋白水平为（4.02±0.86）ng/mL明显高于对照组的（3.66±0.68）ng/mL（P〈0.05）,伴有高血压、高血脂或糖尿病的冠心病病人凝血酶调节蛋白水平与不伴合并症的冠心病者水平无差异。结论冠心病病人中可溶性凝血酶调节蛋白水平的增高反映了此类病人存在血管内皮细胞受损或功能活化,但血浆凝血酶调节蛋白水平与伴发高血压、高血脂及糖尿病无关。     

脂联素与2型糖尿病大血管病变的相关性研究

目的 探讨脂联素与2型糖尿病大血管病变的关系.方法 采用酶联免疫吸附法测定了50例正常对照组和100例2型糖尿病患者（包括单纯2型糖尿病者50例和有大血管病变者50例）血清中的脂联素.结果 2型糖尿病大血管病变组血清脂联素水平为（3.61±0.72）mg/L,显著低于正常对照组的（6.89±3.28）mg/L（P＜0.01）和单纯2型糖尿病组的（4.84±1.92）mg/L（P＜0.01）.多元逐步回归分析显示,低脂联素与HOMA-IR、TG、LDL-C、FPG是大血管病变发生的危险因素.结论 低脂联素血症是2型糖尿病大血管病变发生发展的独立危险因素.     

心房颤动患者血浆及血小板中5-羟色胺变化及其意义

目的 研究心房颤动病人血浆及血小板中5-羟色胺变化及其意义.方法 应用荧光分光光度法测定持续性心房颤动病人和窦性心律病人各30例血浆及血小板中5-羟色胺水平.结果 心房颤动组病人血浆5-羟色胺含量（49±19）μg/L较窦性心律组（窦律组）（35±13）μg/L升高（P＜0.01）,随心力衰竭加重,血浆5-羟色胺含量升高（P＜0.05）;心房颤动组的血小板5-羟色胺含量（25±18）μg/L较窦律组（91±48）μg/L降低（P＜0.01）.结论 心房颤动病人血小板释放5-羟色胺异常增多可能是造成心房颤动病人血浆5-羟色胺水平升高的原因,血浆5-羟色胺水平的升高可能是心房颤动发生和持续的重要因子.     

姜黄素治疗肝纤维化及其作用机制的初步研究

目的观察姜黄素治疗肝纤维化的效果,初步探讨其作用机制。方法四氯化碳腹腔注射制作大鼠肝纤维化模型,以丹参治疗作为阳性对照,检测血清ALT、AST、HA、LN、Ⅲ型前胶原（PCⅢ）、一氧化氮（NO）含量;检测肝组织超氧化物歧化酶（SOD）、羟脯氨酸（Hyp）、丙二醛（MDA）含量;肝组织行HE和Masson胶原染色,光镜下观察病理学改变,并按肝纤维化半定量计分系统进行评分。结果与模型组比较,姜黄素治疗组能明显降低肝纤维化时异常升高的ALT、AST、NO、HA、LN、PCⅢ、MDA、Hyp,模型对照组分别为（693.75±117.57）U/L、（892.50±105.69）U/L、（70.95±10.23）μmol/L、（468.22±93.45）mg/L、（346.44±75.08）mg/L、（279.82±54.00）μg/L、（402.25±39.16）nmol/g、（752.50±77.62）μg/g,姜黄素（每100g体重40mg）治疗组分别为（218.50±48.89）U/L、（376.60±79.13）U/L、（47.96±6.53）μmol/L、（289.96±60.43）mg/L、（107.35±27.24）mg/L、（148.95±28.63）μg/L、（236.10±30.54）nmol/g、（478.40±75.74）μg/g,P值均〈0.05;提升肝纤维化时异常降低的肝组织SOD水平,姜黄素（每100g体重40 mg）治疗组和对照组分别为（90.39±21.23）U/mg、（46.52±20.01）U/mg,P〈0.05;明显改善四氯化碳所致大鼠肝纤维化的病理学改变,肝纤维化评分明显降低（P〈0.05）,接近正常对照组,且该作用随着姜黄素剂量增大而加强。结论姜黄素具有治疗大鼠肝纤维化作用;抗脂质过氧化损伤、直接影响胶原代谢可能是其重要的作用机制。     

老年冠心病患者血浆网膜素1及内脂素水平分析

目的　观察老年冠心病患者血浆网膜素1、内脂素水平的变化,并探讨其临床意义。方法　采用酶联免疫吸附法测定59例老年冠心病患者（年龄≥60岁;冠心病组）及31例健康者（年龄≥60岁;对照组）的血浆网膜素1、内脂素浓度。依据临床症状将冠心病组分为2个亚组：稳定型心绞痛（SAP）组29例,不稳定型心绞痛（UAP）组30例;依据NYHA心功能分级将冠心病组分为3个亚组：即心功能Ⅰ级组11例,心功能Ⅱ、Ⅲ级组36例,心功能Ⅳ级组12例。结果　（1）冠心病组血浆网膜素1水平显著低于对照组（717.63±229.11　ng/L比1115.49±361.41　ng/L,P＝0.000）;SAP组、UAP组均显著低于对照组（780.32±273.19　ng/L比1115.49±361.41　ng/L,652.81±152.94　ng/L比1115.49±361.41　ng/L,均P<0.05）。（2）冠心病组血浆内脂素水平显著高于对照组（19.22±6.73　μg/L比13.31±1.69　μg/L,P＝0.002）,且SAP组、UAP组显著高于对照组（17.92±4.19　μg/L比13.31±1.69　μg/L,20.43±8.31　μg/L比13.31±1.69　μg/L,均P<0.05）。（3）心功能Ⅰ级组、Ⅱ和Ⅲ级组、Ⅳ级组,血浆网膜素1水平（1033.87±277.84　ng/L、676.58±137.25　ng/L、540.35±59.49　ng/L）逐渐下降,内脂素水平（13.00±1.19　μg/L、19.08±2.97　μg/L、25.23±11.30　μg/L）逐渐升高,3组之间比较这两项指标均有显著差异（均P<0.05）。（4）血浆网膜素1水平与收缩压呈显著负相关（r＝－0.264,P＝0.041）,与血浆高密度脂蛋白胆固醇（HDLC）水平呈显著正相关（r＝0.271,P＝0.038）;血浆内脂素水平与总胆固醇呈显著正相关（r＝0.292,P＝0.025）,与HDLC水平呈显著负相关（r＝－0.266,P＝0.039）。（5）血浆网膜素1与内脂素水平之间呈显著负相关（r＝－0.280,P＝0.032）;多元线性逐步回归分析显示网膜素1、内脂素均可能受HDLC水平的影响;Logistic回归分析显示在冠心病的发生中内脂素可能是危险因素。结论　（1）网膜素1水平的降低及内脂素水平的升高均可能参与了冠心病的发生发展过程。（2）网膜素1与内脂素可能分别为保护因子及致炎因子,且均可能与脂代谢有关。（3）内脂素是冠心病发生的独立危险因素。     

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.