红细胞分布宽度对重症肺炎预后评估的临床价值

目的:探讨红细胞分布宽度(RDW)对重症肺炎患者预后的评估价值。方法:回顾性分析154例重症肺炎患者的临床资料。根据预后分为死亡组与存活组,比较2组临床资料。根据出院时RDW是否高于入院,分成RDW非升高组和RDW升高组,比较2组的临床资料;运用Kaplan-Meier生存曲线分析RDW升高组和RDW非升高组90 d累积生存率;应用COX回归分析重症肺炎患者死亡的危险因素。结果:死亡组患者RDW、RDW、血乳酸、APACHEⅡ评分均高于存活组(均P0.05),血红蛋白(Hb)、氧合指数低于存活组(均P0.05);RDW升高组的APACHEⅡ评分、入院RDW、乳酸显著高于RDW非升高组,氧合指数低于RDW非升高组(均P0.05)。Kaplan-Meier生存曲线显示RDW升高组90d病死率高于RDW非升高组(χ~2=15.89,P0.01)。COX回归分析显示RDW升高、氧合指数及APACHEⅡ评分是重症肺炎死亡的独立危险因素。结论:RDW的升高能较好显示重症肺炎的严重程度;尤其是RDW的动态上升可作为重症肺炎不良结局的预测指标,对重症肺炎的预后有重要的预测价值。     

APACHEⅢ评分及氧合指数对老年重症肺炎预后影响的分析

目的 探讨APACHEⅢ评分与氧合指数对老年重症肺炎预后的影响.方法 56例患者,根据出院是否存活,分为存活组与死亡组,测定动脉血气,计算氧合指数,进行APACHEⅢ评分,分析APACHEⅢ评分与氧合指数对预后的影响.结果 存活组APACHEⅢ评分及氧合指数与死亡组比较,均有显著差异(P＜0.05),死亡组APACHEⅢ评分随住院延长而增高,氧合指数随住院延长而降低,存活组与之相反.氧合指数与APACHEⅢ评分负相关(r=-0.7542,P＜0.01).结论 APACHEⅢ评分与氧合指数有助判断病情危重程度,观察两者变化,对判断预后有一定的作用.     

早期乳酸清除率、氧合指数在重症肺炎患儿病情判断及预后评估中的价值

目的探讨早期乳酸清除率、氧合指数在重症肺炎患儿病情判断及预后评估中的价值。方法60例重症肺炎患儿根据APACHEHⅡ评分分为轻度组(n=22例,APACHEHⅡ评分≤19分)、中度组(n=20例,20分≤APACHEHⅡ评分≤29分)及重度组(n=18例,APACHEHⅡ评分≥30分),根据预后不同分为存活组(n=46例)和死亡组(n=14例)。比较各组入院即刻测动脉血乳酸水平、6h乳酸清除率及氧合指数(PaO_2/FiO_2),并分析相关性关系。结果不同病情程度患儿入院即刻动脉血乳酸水平比较无显著差异性(P0.05),中、重度组早期乳酸清除率及氧合指数均明显低于轻度组(P0.05),重度组早期乳酸清除率及氧合指数明显低于中度组(P0.05);死亡组APACHEHⅡ评分明显高于存活组,而早期乳酸清除率及氧合指数明显低于存活组(P0.05);APACHEHⅡ评分与早期乳酸清除率、氧合指数均呈负相关性关系(r1=-0.637,r2=-0.725,P0.05)。结论早期乳酸清除率、氧合指数在重症肺炎患儿病情判断及预后评估中具有较高的临床价值。     

红细胞分布宽度联合毛细血管渗漏指数对脓毒症并发急性呼吸窘迫综合征的预后评估价值

目的探讨红细胞分布宽度(RDW)联合毛细血管渗漏指数(CLI)对脓毒症并发急性呼吸窘迫综合征(ARDS)预后的评估价值。方法回顾性分析2017年10月～2019年12月期间我院收治的脓毒症并发ARDS患者,根据患者28天预后情况分为死亡组和存活组,收集性别、年龄、血清白蛋白、CRP、红细胞分布宽度、氧合指数值,计算APACHEⅡ评分、SOFA评分、毛细血管渗漏指数。结果存活组与死亡组比较,性别、SOFA评分差异无统计学意义(P0.05);年龄、RDW、CLI、氧合指数、APACHEⅡ评分差异有统计学意义(P=0.002;P=0.031;P=0.041;P=0.048;P=0.005)。Spearman相关分析结果显示RDW与APACHEⅡ评分呈显著正相关(rs=0.314,P0.001),RDW与氧合指数呈显著负相关(rs=-0.720,P0.001);联合变量(RDW+CLI)的AUC曲线下面积值最大,为0.651,其次是APACHEⅡ评分,为0.647,RDW的AUC值是0.646,CLI的AUC值是0.601。RDW为46.55作为临床诊断界值时,预测ARDS死亡的敏感度和特异度分别为57.8%和71%,CLI为5.87作为临床诊断界值时,预测ARDS死亡的敏感度和特异度分别为53.3%和77.4%,联合预测的敏感度和特异度分别为62.2%和67.7%。结论 RDW联合CLI对脓毒症并发ARDS患者的预后具有一定的评估价值。     

老年脓毒症休克患者血红细胞分布宽度和乳酸水平与预后的关系

目的探讨老年脓毒症休克患者血红细胞分布宽度(RDW)和乳酸水平与预后的关系。方法选择云南省第一人民医院2012年1月至2016年12月70岁以上80例脓毒症休克患者作为脓毒症休克组,80例脓毒症未休克患者为脓毒症未休克组,80例健康体检者为对照组。测定3组血RDW、乳酸、C反应蛋白(CRP)、降钙素原(PCT)水平。结果与对照组比较,脓毒症未休克组和脓毒症休克组血清RDW、乳酸、CRP、PCT水平明显升高(P<0.05);与脓毒症未休克组比较,脓毒症休克组RDW、乳酸、CRP、PCT水平和急性生理与慢性健康评估(APACHE)Ⅱ评分均显著升高(P<0.05)。脓毒症休克死亡组患者RDW、乳酸、CRP、PCT水平和APACHEⅡ评分明显高于存活组(P<0.05)。脓毒症休克多器官功能障碍综合征(MODS)组患者RDW、乳酸、CRP、PCT水平和APACHEⅡ评分明显高于无MODS组(P<0.05)。脓毒症休克患者RDW与乳酸呈正相关,RDW、乳酸与CRP、PCT、APACHEⅡ评分均呈正相关(P<0.05)。RDW、乳酸、PCT、APACHEⅡ评分均为脓毒症休克预后的独立影响因素(P<0.05)。结论老年脓毒症休克患者血RDW、乳酸水平升高,血RDW、乳酸水平与脓毒症休克的病情严重程度和预后关系密切,为脓毒症休克预后的影响因素。     

乳酸和乳酸清除率对老年重症肺炎患者预后的评估

目的研究乳酸和乳酸清除率对老年重症肺炎患者预后的评估价值。方法对62例老年重症肺炎患者进行急性生理学及慢性健康状况评价Ⅱ（acute physiology and chronic health evaluationⅡ,APACHEⅡ）评分,测定入院时和治疗6h后动脉血乳酸水平,计算6h乳酸清除率,根据预后患者分成存活组和死亡组,比较其上述指标的差异。结果存活组、死亡组患者治疗前动脉血乳酸水平分别为2.2±1.5mmol/L和2.7±1.8mmol/L,（P〉0.05）;APACHEⅡ评分分别为19.4±6.9及23.9±7.1（P〈0.05）。存活组6h乳酸清除率明显高于死亡组（P〈0.01）。结论早期乳酸和乳酸清除率可用于评估老年重症肺炎患者的预后。     

甲壳质酶蛋白40与重症肺炎患者预后的关系研究

目的探讨甲壳质酶蛋白40(YKL-40)与重症肺炎患者预后的关系。方法选取2016年4月—2017年5月咸宁市中心医院收治的重症肺炎患者60例,根据预后分为存活组36例和死亡组24例。比较两组患者临床特征、YKL-40、急性生理学与慢性健康状况评价系统Ⅱ(APACHEⅡ)评分及临床肺部感染评分(CPIS);重症肺炎患者预后的影响因素分析采用多因素Logistic回归分析,YKL-40与重症肺炎患者APACHEⅡ评分、CPIS评分的相关性分析采用Pearson相关分析。结果两组患者呼吸频率、白细胞计数、红细胞计数、血红蛋白、降钙素原、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、清蛋白、总胆红素、尿素氮、肌酐、D-二聚体、纤维蛋白原、动脉血二氧化碳分压比较,差异无统计学意义(P0.05);死亡组患者体温、脉搏、YKL-40、国际标准化比值、吸入氧浓度、APACHEⅡ评分及CPIS评分高于存活组,活化部分凝血活酶时间长于存活组,氧合指数、动脉血氧分压低于存活组(P0.05)。多因素Logistic回归分析结果显示,YKL-40[OR=2.125,95%CI(1.320,3.422)]、APACHEⅡ评分[OR=1.868,95%CI(1.195,2.921)]及CPIS评分[OR=1.988,95%CI(1.249,3.163)]是重症肺炎患者预后的影响因素(P0.05)。Pearson相关分析结果显示,YKL-40与重症肺炎患者APACHEⅡ评分、CPIS评分呈正相关(r值分别为0.513、0.303,P0.05)。结论 YKL-40与重症肺炎患者病情严重程度密切相关,是患者预后的影响因素,可作为评估重症肺炎患者病情严重程度和预后的参考指标。     

氧合指数与血管外肺水指数的动态变化对急性呼吸窘迫综合征患者预后的判断价值

目的:探讨氧合指数等相关指标及血管外肺水指数(EVLWI)对急性呼吸窘迫综合征患者(ARDS)预后的判断价值。方法:回顾性分析52例ARDS患者的临床资料,根据患者预后分为存活组与死亡组,分析2组患者在入住ICU病房后心脏指数(CI)、平均动脉压(MAP)、中心静脉压(CVP)、血管外肺水指数(EVLWI)、肺血管通透性指数(PVPI)及氧合指数的变化。结果:与存活组比较,死亡组患者入住ICU病房时的APACHEⅡ评分显著升高(P0.05);存活组氧合指数随时间呈上升的趋势,EVLWI、PVPI随时间呈下降趋势,死亡组氧合指数随时间呈下降的趋势,EVLWI、CI及PVPI随时间呈上升的趋势(均P0.05),与死亡组第2、3天比较,存活组CI、EVLWI显著降低,氧合指数显著升高(P0.05);经Person相关性分析显示,EVLWI与氧合指数呈显著负相关性,与CVP无相关性。结论:动态监测EVLWI及氧合指数对判断ARDS患者的病情及预后具有重要临床价值。     

血乳酸和APACHEⅡ评分对ICU危重病患者预后的评估价值

目的研究危重患者血乳酸水平和慢性健康状况评分(APACHEⅡ评分)对危重患者预后的评估作用。方法对入住重症医学科106例危重患者在入院0.5 h、12 h、48 h后分别进行血乳酸水平的测定,进行血乳酸水平与APACHEⅡ评分的相关性分析。结果危重病患者的死亡危险性与血乳酸浓度有着高度相关性。乳酸高度升高组患者病死率显著高于正常组(P0.05);病死组患者血乳酸浓度显著高于存活组(P0.05);随着血乳酸浓度增高,病死率从11.11%增加至45.95%(P0.05),而死亡组患者的血乳酸浓度、APACHEⅡ评分分值较存活组明显增高,差异有统计学意义(P0.05)。APACHEⅡ评分与血乳酸浓度呈正相关(r=0.714,P0.001)。结论血乳酸水平与APACHEⅡ评分呈正相关,血乳酸水平可作为判断危重病预后的参考指标。     

慢性阻塞性肺疾病患者急性加重期D-二聚体与APACHE Ⅱ评分的相关性分析

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者D-二聚体(D-D)与急性生理学与慢性健康状况Ⅱ评分(APACHEⅡ)的相关性及对预后的作用。方法选取131例住院的AECOPD患者,根据APACHEⅡ评分分为两组:≤15分组及15分组。检测入院后24 h内的D-D、白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)、乳酸及动脉血氧饱和度(Sa O2),比较各组间的差异;研究D-D与APACHE Ⅱ、WBC、hsCRP、乳酸及SaO_2的相关性。根据预后将患者分为死亡组与存活组,比较两组间上述各指标的差异。结果AECOPD患者的D-D、hs-CRP、乳酸随着APACHEⅡ分值的升高而升高,Sa O2在APACHEⅡ分值高于15分组较小于15分组低,(P0.05);Pearson相关分析显示患者的D-D与APACHEⅡ评分呈正相关(P0.05);死亡组的D-D、APACHEⅡ评分均高于存活组,其差异均具统计学意义(P0.05)。结论 AECOPD患者D-D与APACHEⅡ评分具有较好的相关性,可作为判断AECOPD预后的一个指标。     

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.