胰岛素强化治疗急性脑血管病应激性高血糖疗效观察

目的 探讨短期胰岛素强化治疗对急性脑血管病并发应激性高血糖的临床疗效.方法 将52例急性脑血管病合并应激性高血糖患者随机分为胰岛素强化治疗组(治疗组)和常规组(对照组).观察并比较两组患者的临床疗效.结果 治疗组治疗后神经功能缺损程度较对照组显著降低(P<0.05),治疗组治疗后显著好转率明显高于对照组(P<0.05).结论 急性脑血管病并发应激性高血糖时采用短期胰岛素强化治疗能提高患者的治愈率,减轻伤残程度,对改善急性脑血管病预后有重要临床意义.     

强化胰岛素治疗对糖尿病合并颅脑外伤患者的血糖控制效果

目的给予糖尿病合并颅脑外伤应激性高血糖患者强化胰岛素治疗,对其临床疗效进行观察。方法于该院2019年3月—2021年3月患者中选择110例糖尿病合并颅脑外伤应激性高血糖患者作为研究对象,随机纳入研究组55例、对照组55例,分别应用强化胰岛素治疗、常规胰岛素治疗,统计并对比两组患者的糖化血红蛋白、血糖、血糖达标时间、胰岛素用量、抗生素使用时间、治疗后格拉斯哥评分、住院时间、物质生活、躯体功能、社会功能、心理功能评分等指标。结果研究组患者的糖化血红蛋白、血糖、血糖达标时间、胰岛素用量、抗生素使用时间、治疗后格拉斯哥评分、住院时间、物质生活、躯体功能、社会功能、心理功能评分均优于对照组患者,差异有统计学意义(P0.05)。结论给予糖尿病合并颅脑外伤应激性高血糖患者强化胰岛素治疗,可以提升患者的血糖控制效果、手术治疗效果和预后水平,同时改善患者的生活质量,可见强化胰岛素治疗对颅脑外伤患者应激性高血糖的临床效果良好,值得在临床开展应用。     

短期胰岛素强化治疗在重型颅脑损伤应激性高血糖患者中的应用

目的研究分析短期胰岛素强化治疗在重型颅脑损伤应激性高血糖患者中的应用效果。方法选取2012年9月—2016年9月收治的140例重型颅脑损伤患者。依据患者入院时间先后分为对照组和观察组。对照组实行常规血糖控制,观察组患者采用短期胰岛素强化治疗。对比两组患者临床治疗效率。结果两组患者进入ICU时APACHEⅡ评分、初次血糖指标差异无统计学意义(P0.05),而治疗后对比分析两组患者ICU住院时间、机械通气时间、治疗后血糖值以及最后1 d APACHEⅡ评分,观察组患者优势显著(P0.05);观察组患者院内感染率、病死率均低于对照组(P0.05);出院随访患者3个月,观察组患者神经功能恢复良好率要优于对照组,数据差异有统计学意义(P0.05);且两组患者低血糖发生率差异无统计学意义(P0.05)。结论采用短期胰岛素治疗重型颅脑损伤应激性高血糖患者,可取得良好的效果,对改善患者预后具有促进作用,可推广使用。     

胰岛素强化治疗急性心肌梗死伴应激性高血糖效果评价

目的观察急性心肌梗死（AMI）伴应激性高血糖患者采甩胰岛素强化治疗的临床疗效。方法对86例AMI伴应激性高血糖患者分别采用胰岛素强化治疗（A组）、胰岛素一般治疗（B组）和常规基础治疗（对照组）,达标血糖值分别为4．4～6．1、6．1～10．0、10．0mmol／L以上）,分别在治疗前和治疗后第7天抽取静脉血,测定空腹血糖、高敏C反应蛋白（hs—CRP）、心肌酶等,同时持续进行心电监护,并比较两组的临床疗效。结果三组治疗后hs．CRP水平均较治疗前显著下降（P均〈0．01）。A组和B组的空腹血糖较治疗前显著下降（P均〈0．01）,而对照组无明显变化（P均〉0．05）。心律失常、心源性休克、心力衰竭及死亡发生率A组和B组显著低于C组（P〈0．01）,A组与B组相比有统计学差异（P〈0．05）。结论胰岛素能抑制AMI合并应激性高血糖患者炎性介质的表达,从而改善其预后。     

感染中毒症合并应激性高血糖患者胰岛素强化治疗的疗效观察

目的:探讨胰岛素强化治疗对感染中毒症合并应激性高血糖患者的疗效及其可能的机制。方法:将52例感染中毒症合并应激性高血糖患者随机配对分成强化组(用胰岛素将血糖控制在4.4~6.1mmol/L)和常规组(血糖控制在10.0~11.1mmol/L)。观察并比较两组患者呼吸机使用天数、抗生素使用天数、ICU住院天数、MODS的发生率及ICU住院病死率。同时分别于转入ICU后1、3、5、7d采用ELISA检测血清TNF-α及IL-6水平,并监测CRP变化。结果:强化组的呼吸机使用天数、抗生素使用天数及ICU住院天数均较常规组缩短,其差异有统计学意义(P<0.05)。强化组有5例(19.2%)并发MODS,常规组有12例(46.2%)并发MODS,两者差异有统计学意义(P<0.05)。强化组ICU病死率较常规组有所下降,但无统计学意义(P>0.05)。治疗后3、5、7d强化组TNF-α、IL-6及CRP血浆浓度明显低于常规组,其差异有统计学意义(P<0.05)。结论:胰岛素强化治疗可减少感染中毒症合并应激性高血糖患者呼吸机与抗生素的使用时间,缩短ICU住院时间,降低MODS的发生率,其机制可能与促进合成代谢作用及其抗炎效应相关。     

潘托拉唑治疗急性脑血管病并发应激性胃黏膜病变的疗效及并发症情况分析

目的研究分析潘托拉唑对急性脑血管病并发应激性胃黏膜病变的临床疗效及并发症发生情况。方法选取我院2015年1月至2016年12月期间收治的102例急性脑血管病并发应激性胃黏膜病变患者作为研究对象,并按随机双盲法分为观察组(52例)与对照组(50例),两组患者入院后均给予常规处理及对症治疗,在此基础上,观察组给予潘托拉唑治疗,对照组给予法莫替丁治疗,统计比较两组患者临床疗效。结果观察组临床总有效率为92.31%,显著优于对照组的70.00%(P0.01)。两组治疗前胃液p H值、血清胃泌素水平比较无明显差异(P0.05),两组治疗后胃液p H值较治疗前明显升高,血清胃泌素水平较治疗前降低,且观察组胃液p H值显著高于对照组,血清胃泌素水平显著低于对照组(P0.01)。观察组止血时间(2.3±0.5)d,明显短于对照组的(3.4±0.3)d。观察组并发症发生率少于对照组,但差异无统计学意义(P0.05)。结论潘托拉唑治疗ACVD并发应激性胃黏膜病变临床治疗效显著,可有效降低患者胃内酸度及血清胃泌素水平,止血时间短,并发症少,可作用临床治疗ACVD并发应激性胃黏膜病变的常用药物之一。     

强化胰岛素治疗对烧伤伴应激性高血糖患者的影响

目的探讨强化胰岛素治疗对烧伤伴应激性高血糖患者的影响。方法选取2012—2015年武警四川省总队医院收治的烧伤伴应激性高血糖患者62例,采用随机数字表法分为对照组和观察组,每组31例。在常规治疗及营养支持基础上,对照组患者给予常规胰岛素治疗,观察组患者给予强化胰岛素治疗;两组患者均连续治疗10 d。比较两组患者临床疗效,治疗前后血清肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、清蛋白(ALB)、球蛋白(GLB)水平,治疗后认知障碍发生情况及血糖控制达标情况,并观察两组患者治疗期间院内感染、低糖血症发生情况及院内死亡情况。结果两组患者临床疗效比较,差异无统计学意义(P0.05)。治疗前两组患者血清TNF-α、IL-6、ALB、GLB水平比较,差异无统计学意义(P0.05);治疗后观察组患者血清TNF-α、IL-6水平低于对照组,血清ALB、GLB水平高于对照组(P0.05)。观察组患者治疗后认知障碍发生率低于对照组,血糖控制达标率高于对照组(P0.05)。观察组患者治疗期间院内感染、低糖血症发生率低于对照组(P0.05),而两组患者院内病死率比较,差异无统计学意义(P0.05)。结论与常规胰岛素治疗相比,在常规治疗及营养支持基础上给予强化胰岛素治疗可更有效地减轻烧伤伴应激性高血糖患者炎性反应,提高血糖控制效果,改善营养状况,减少认知障碍、院内感染的发生。     

诺和锐治疗急性心肌梗死合并应激性高血糖的临床疗效

目的探讨应用微量泵静脉泵入诺和锐短期强化治疗急性心肌梗死（AMI）合并应激性高血糖的有效性和安全性。方法选择54例AMI合并应激性高血糖者,按数字随机法分为治疗组和对照组。治疗组（n=26）采用微量泵持续泵入诺和锐强化控制血糖,对照组（n=28）给予糖尿病饮食,避免输入含糖液体治疗。比较2组血糖变化及临床情况,包括胸痛缓解时间、溶栓再通率、并发症及预后。结果治疗组血糖平稳下降,胸痛缓解时间缩短,溶栓再通率高,心律失常、心力衰竭等并发症发生率较对照组低,2组比较差异具有统计学意义（P〈0.05）。结论 AMI合并应激性高血糖采用微量泵静脉泵入诺和锐短期强化治疗能提高AMI的治愈率,改善预后。     

强化血糖控制对AECOPD无创通气的影响

目的探讨强化血糖控制AECOPD伴应激性高血糖在无创通气治疗中的作用。方法 160例AECOPD导致2型呼吸衰竭伴应激性高血糖患者,随机分为强化血糖控制组(强化组)和常规治疗组(常规组),观察两组患者无创通气时间和失败率、28天死亡率;并用酶联免疫吸附试验法(ELISA)测定治疗前、治疗后第3天和7天血清中白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)浓度。结果强化组无创通气时间及无创通气的失败率与常规组相比均显著减少(P<0.05);强化组患者第3天和第7天血清中IL-6和TNF-α的浓度明显低于常规组;两组死亡率无显著统计学差异。结论强化血糖控制提高AECOPD伴应激性高血糖患者的无创通气疗效。     

胰岛素强化降糖疗法用于烧伤延迟复苏小儿应激性高血糖效果观察

目的观察胰岛素强化降糖疗法用于烧伤延迟复苏,＇bJD应激性高血糖的疗效及安全性。方法将56例烧伤延迟复苏后应激性高血糖小儿随机分为观察组和对照组各28例,分别采用胰岛素行强化降糖及常规降糖治疗,即将血糖控制在4．4～6．1 mmol／L及10．0-11．1mmol／L。观察两组住院时间、院内感染发生率、抗生素应用时间、低血糖发生率、多器官功能衰竭发生率、病死率等。结果观察组低血糖发生率明显高于对照组（P〈0．05）,余指标均明显低于对照组（P〈0．05或〈0．01）。结论对于烧伤延迟复苏小儿应激性高血糖采用胰岛素进行强化降糖治疗,可改善预后并缩短抗生素应用时间、住院时间;但应根据病情变化及血糖监测采取个体化泵速,以降低低血糖发生率。     

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.