心肌声学密度定量分析检测高血压心肌纤维化

目的 观察原发性高血压患者心肌声学密度和血清Ⅲ型前胶原末端肽(PⅢNP)含量的变化情况,以评估心肌声学密度定量分析技术检测高血压心肌纤维化的临床价值.方法 入选原发性高血压患者75例(高血压组),另选健康体检者75例为对照组.应用超声心动图测量声学密度各项值,采用放免法测定PⅢNP的浓度.结果 高血压组的声学强度(CAI)显著高于健康对照组(P＜0.01),而高血压组的背向散射积分周期变化值(CVIB)(室间隔:6.07±0.85,左室后壁:7.00±1.15)显著低于健康对照组(室间隔:8.60±3.12,左室后壁:11.85±3.06,P＜0.05);高血压组血清PⅢNP含量(109.9±7.5)μg/L显著高于健康对照组[(43.9±5.9)μg/L,P＜0.01];血清PⅢNP与室间隔和左室后壁声学强度呈显著正相关(P＜0.01),与室间隔和左室后壁CVIB呈显著负相关(P＜0.01).结论 心肌声学密度定量分析技术是检测高血压心肌纤维化的一项可靠技术.     

心肌声学密度定量分析检测高血压心肌纤维化

目的观察原发性高血压患者心肌声学密度和血清Ⅲ型前胶原末端肽(PⅢNP)含量的变化情况,以评估心肌声学密度定量分析技术检测高血压心肌纤维化的临床价值。方法入选原发性高血压患者75例(高血压组),另选健康体检者75例为对照组。应用超声心动图测量声学密度各项值,采用放免法测定PⅢNP的浓度。结果高血压组的声学强度(CAI)显著高于健康对照组(P<0·01),而高血压组的背向散射积分周期变化值(CVIB)(室间隔6·07±0·85,左室后壁7·00±1·15)显著低于健康对照组(室间隔8·60±3·12,左室后壁11·85±3·06,P<0·05);高血压组血清PⅢNP含量(109·9±7·5)μg/L显著高于健康对照组[(43·9±5·9)μg/L,P<0·01];血清PⅢNP与室间隔和左室后壁声学强度呈显著正相关(P<0·01),与室间隔和左室后壁CVIB呈显著负相关(P<0.01)。结论心肌声学密度定量分析技术是检测高血压心肌纤维化的一项可靠技术。     

不同类型认知功能障碍患者的脂蛋白结合磷脂酶A2水平

目的评价各种类型认知功能障碍患者脂蛋白结合磷脂酶A2（Lp—PLA2）的表达水平。方法研究共纳入212例疑似认知功能障碍患者,经筛选及评定后分为轻度认知功能障碍（MCI）组46例、阿尔茨海默病（AD）组58例、血管性痴呆（VD）组84例及对照组24例,测定并比较各组患者的血浆Lp—PLA2浓度,通过Cox比例风险模型分析痴呆与Lp—PLA2水平的关系。结果①MCI组的Lp—PLA2水平为（45±4）μg/L、AD组的Lp—PLA2水平为（83±15）μg/L、VD组的Lp—PLA2水平为（112±22）μg/L,均高于对照组的（34±3）μg/L,差异均有统计学意义,P〈0．05。②AD组男性的Lp—PLA2水平为（93±8）μg/L,高于女性（73±13）μg/L;VD组男性的Lp—PLA2水平为（127±21）μg/L,高于女性的（97±10）μg/L,差异均有统计学意义,P〈0．05。③Cox比例风险模型分析显示,高水平Lp—PLA2与认知功能障碍高风险相关,VD的相关性最高,AD次之,MCI相关性最低。结论高水平Lp—PLA2与认知功能障碍具有相关性,Lp—PLA2在AD组及VD组中具有性别差异,检测Lp—PLA2水平有助于认知功能障碍的早期诊断。     

脉压指数与原发性高血压左心室功能的相关性研究

目的探讨脉压指数（PPI）与原发性高血压患者左心室功能损害程度的关系。方法178例经外周肱动脉压力测定收缩压（sBP）、舒张压（DBP）,以PPI〉0．40、PPI≤0．40分组,两组进行分析。比较两组左心形态、左心室收缩功能和舒张功能情况。结果PPI〉0．40组左心房内径明显增大[PPI〉0．40、PPI≤0．40的LAD分别为（35．02±3．15）mm、（28．05±2．01）mm,P〈0．05];左心室内径无明显改变（P〉0．05）;室间隔、左心室后壁明显增厚,E／A值降低（P〈0．05）,而左心室射血分数差异无统计学意义（P〉0．05）。结论原发性高血压患者左心室舒张功能异常出现早于左心室收缩功能异常,PPI〉0．40提示高血压患者早期合并有舒张功能异常。     

替米沙坦对压力超负荷左心室肥厚大鼠心肌I型胶原代谢的影响

目的：探讨压力超负荷左心室肥厚大鼠I型胶原代谢特点及替米沙坦的干预效果。方法：24只雄性Spargue—Dawley大鼠随机分为假手术组（n=8）、左心室肥厚组（n=8）和替米沙坦组（n=8）。行腹主动脉缩窄术建立高血压左心室肥厚大鼠模型。各组干预4周后处死大鼠,称其体质量及左心室质量,计算左心室质量指数（LVMI）。将左心室心肌行Masson染剂染色,观察并测量其胶原容积分数（CVr）。用ELISA法检测3组大鼠血清I型前胶原羧基端肽（PICP）及I型胶原羧基端交联肽（ICTP）的浓度,并计算PICP／ICTP的比值,直线相关分析PICP及PICP／IC—TP比值与CVF的相关性。结果：与假手术组相比,左心室肥厚组左心室质量、LVMI、CVF、血清PICP及PICP／ICTP的比值均显著升高（均P〈0．05）;与左心室肥厚组相比,替米沙坦组左心室质量、LVMI、CVF、血清PICP、PICP／ICTP的比值均显著降低（均P〈0．05）。3组问的ICTP相比较,差异无统计学意义;PICP及PICP／ICTP比值均与CVF呈正相关（r值分别为0．830、0．842,均P〈0．01）。结论：压力超负荷左心室肥厚大鼠I型胶原合成增加、降解相对不足,合成与降解的不平衡是造成其左心室心肌间质纤维化的原因之一。替米沙坦可以抑制I型胶原的合成,纠正其合成与降解不平衡,从而有效地抑制及逆转心肌间质纤维化。     

老年原发性高血压患者左心房/左心室容量比值的变化

目的本文旨在探讨老年原发性高血压患者左心房容量／左心室容量比值变化的临床意义。方法老年正常对照组32例。老年原发性高血压无室壁肥厚患者35例，老年原发性高血压患者伴室壁肥厚者33例。应用实时三维三平面显像方式测量左房、左室容量，对3组病人的左房容量，左房内径，左房容量指数和左心房容量／左心室容量比值进行分析。结果左房容量，左房内径，左房容量指数和左心房容量／左心室容量比值在高血压室壁肥厚组与对照组之间均存在极显著差异（P〈0．01），但左房内径在原发高血压无室壁肥厚组与对照组之间无显著差异（P〉0．05）。左房容量、左房容量指数在原发高血压无室壁肥厚组与对照组之间差异有显著性（P〈0．05），左心房容量／左心室容量比值在原发高血压无室壁肥厚组与对照组之间差异更为显著（P〈0．01）且变异性最小。结论左心房容量／左心室容量比值是一种新的参数，能够灵敏地反映老年原发性高血压患者舒张功能减低的血流动力学改变。     

血清网膜素-1与心房颤动患者心房纤维化血清生化标记物的相关性研究

目的 探讨房颤患者血清网膜素-1与心房纤维化血清生化标记物之间的相关性。 方法 酶联免疫吸附法检测阵发性、持续性房颤患者及健康对照组血清网膜素-1、I型胶原羧基端前肽（PICP）、III型胶原前多肽（PIIINP）、基质金属蛋白酶-1（MMP-1）、组织型基质金属蛋白酶抑制因子-1（TIMP-1）、透明质酸（HA）和层黏连蛋白（LN）的水平,线性相关分析网膜素-1与以上血清标记物的相关性。结果 持续性房颤患者血清网膜素-1的水平为（46.43±5.74）μg/L,显著低于阵发性房颤患者（（64.14±5.27）μg/L）和对照组患者（（87.88±4.42）μg/L）,差异具有统计学意义（P<0.05）;持续性房颤患者血清PICP（（173.41±7.46）μg/L）、PIIINP（（7.00±0.47）μg/L）、MMP-1（（17.05±0.72）μg/L）、TIMP-1（（151.46±6.26）μg/L）、HA（（139.81±5.78）μg/L）和LN（（145.05±8.28）μg/L）的水平均显著高于阵发性房颤组和对照组,差异具有统计学意义（P<0.05）;此外,血清网膜素-1与以上心房纤维化血清生化标记物呈显著负相关。结论 持续性房颤患者血清网膜素-1的水平显著降低,且与心房纤维化血清生化标记物呈显著负相关,提示血清网膜素-1与房颤心房纤维化密切相关。     

PICP和PCⅢ评价高血压心肌纤维化的临床价值

目的探讨血清Ⅰ型前胶原羧基端肽（PICP）、Ⅲ型前胶原（PCⅢ）水平作为高血压病（EH）心肌纤维化（MF）血清标志物的临床价值。方法采用放免法测定41例EH左室肥厚（EH-LVH组）和53例EH非左室肥厚（EH-NLVH组）及32例正常人（对照组）血清PICP、PCⅢ水平；用二维超声及多普勒技术测量左室重量指数及舒张功能参数[二尖瓣E波与A波峰值速度（VE、VA）、左室等容舒张时间（IVRT）]。结果①EH-LVH组和EH-NLVH组PICP、PCⅢ浓度均显著高于对照组，EH-LVH组均显著高于EH-NLVH组；EH-LVH组及EH—NLVH组VE／VA较对照组显著降低；EH—LVH组IVRT较对照组及EH-NLVH组显著延长，EH—NLVH组较对照组显著延长。（2）PICP与VA正相关，r=0．301，P〈0．01；PCⅢ与VE负相关，r=-0．329，P〈0．01；PICP、PCⅢ均与IVRT呈正相关，分别为r=0．324，P〈0．01；r=0．513，P〈0．001。结论血清PICP、PCⅢ可作为评价MF及反映左室舒张功能的敏感参数。     

高血压左室肥厚心肌纤维化指标的变化及ACEI的影响

目的:观察高血压左室肥厚患者血清心肌纤维化指标的变化及血管紧张素转换酶抑制剂降压治疗的影响。方法:应用放射免疫法测定39例高血压左室肥厚患者和32例正常人血清Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(ⅣC)、层粘连蛋白(LN)和透明质酸(HA)浓度,并与用血管紧张素转换酶抑制剂(ACEI)治疗12个月后患者复查的以上指标进行比较。结果:高血压左室肥厚患者PCⅢ、ⅣC、HA和LN分别为189.7±24.2、69.21±20.7、172.35±36.2μg/L和196.32±24.5 μg/L,明显高于正常对照组的106.4±14.7、51.67±15、89.53±28.31μg/L和112.26±24.3μg/L(P<0.05-P<0.01)。用ACEI治疗12个月后,高血压左室肥厚组以上指标分别下降至112.24±21.5、55.24±18.51、19.25±18.23μg/L和122.26±10.37μg/L,P<0.01或P<0.05,均有显著差异。结论:血清PCⅢ、ⅣC、HA和LN均可作为高血压左室肥厚患者心肌纤维化指标;ACEI在降压的同时可使以上纤维化指标水平下降。     

F-PSA/T-PSA对T-PSA<4.0μg/L前列腺癌的早期诊断价值

目的探讨游离与总量前列腺特异性抗原（PSA）比值（F-PSA/T-PSA）对T-PSA〈4.0μg/L前列腺癌（PCa）早期诊断价值。方法采用电化学发光免疫分析技术检测136例正常健康男性（A组）,87例T-PSA≥4.0μg/L PCa患者（B组）及12例T-PSA〈4.0μg/L的PCa患者（C组）血清T-PSA和F-PSA,并计算F-PSA/T-PSA。结果A、B、C组T-PSA、F-PSA及F-PSA/T-PSA分别为（1.43&#177;1.13）μg/L、（0.44&#177;0.34）μg/L、0.36&#177;0.15,（31.25&#177;20.68）μg/L、（4.21&#177;3.12）μg/L、0.17&#177;0.08,（2.56&#177;1.11）μg/L、（0.43&#177;0.29）μg/L、0.18&#177;0.09。A组T-PSA、F-PSA/T-PSA比较P均〈0.01,B、C组的T-PSA、F-PSA相比P〈均0.01,而F-PSA/T-PSA相比P〉均0.05。将F-PSA/T-PSA分为〈0.10、0.11～0.15、0.16～0.20、0.21～0.25、0.26～0.30以及〉0.31 6个截点,在0.20截点以内C组患者占有率为75%,B组患者占有率为78%,两者0.20截点内占有率相比P〉0.05。结论F-PSA/T-PSA对血清T-PSA≥4.0μg/L和〈4μg/L的PCa患者均有良好的诊断价值,     

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.