入院肾小球滤过率对ST段抬高心肌梗死患者急诊介入治疗术后心肌灌注及预后的影响

目的 评价入院估算的肾小球滤过率(eGFR)对接受急诊PCI治疗的ST段抬高型心肌梗死(STEMI)患者冠状动脉血流和预后的影响.方法 回顾性收集因STEMI而在12 h内接受急诊PCI治疗的患者495例.根据患者入院时eGFR分为两组:eGFR≥60 ml·min-1·1.73 m-2组和eGFR ＜60 ml·min-1·1.73 m-2组.比较两组患者的临床资料、介入手术资料和1年随访资料.结果 eGFR＜ 60 ml·min-1·1.73 m-2组96例,eGFR≥60 ml·min-1·1.73 m-2组399例.与eGFR≥60 ml·min-1 ·1.73 m-2组相比,eGFR ＜60 ml·min-1·1.73 m-2组患者入院时年龄更大,男性患者更多,多支病变患者更多,高血压患者更多,既往心肌梗死病史患者增加,入院及出院eGFR更低,Killip's分级更高.eGFR ＜60 ml·min-1 ·1.73 m-2组校正TIMI计帧数比eGFR≥60 ml·min-1 ·1.73 m-2组更高,并且TIMI心肌灌注分级(TMP)0 ～1级患者更多(5.0％比14.6％).入院eGFR＜ 60 ml· min-1·1.73 m-2是接受急诊PCI的STEMI患者心肌灌注不良(校正相对危险度OR=3.95,95％CI:1.23 ～ 6.89)和1年死亡率(校正OR=1.48,95％ CI:1.21 ～ 2.97)的独立预测因子.结论 入院eGFR下降与急诊PCI治疗的STEMI患者心肌灌注不良和预后不良相关.     

估测肾小球滤过率对老年冠心病患者预后影响的研究

目的 研究不同肾功能状态老年冠心病患者的预后.方法 将383例确诊为冠心病患者分为老年组和非老年组,老年组根据估测肾小球滤过率(eGFR)四分位法分为GFR 1组(eGFR:≥89.55 ml·min-1·1.73 m-1),GFR 2组(eGFR:75.54～89.54 ml·min-1·1.73 m-1),GFR 3组(eGFR:62.69～75.53 m1.min-1·1.73 m-2)和GFR 4组(eGFR:<62.69 ml·min-1·1.73m-2),随访约2年,分析各组的累积心血管死亡及发生心血管死亡的相对风险. 结果 (1)老年组、非老年组累积心血管病死率分别为9.4%(24/255)、1.3%(1/76),两组间差异有统计学意义(P=0.019);(2)GFR 1组、2组、3组的累积心血管病死率分别为6.8 0A(4/59)、6.3%(4/64)、4.6%(3/65),3组间差异无统计学意义(均P>0.05);GFR 4组累积心血管病死率为19.4%(13/67),与GFR1组、2组、3组间的差异均有统计学意义(P值分别为0.038、0.025、0.009);(3)多因素回归分析结果 显示,eGFR为影响老年冠心病患者预后的独立危险因素,发生心血管死亡的相对风险为0.965(95%CI为0.946～0.985,P=0.001). 结论 eGFR是老年冠心病患者发生心血管死亡的重要预测因素.     

血浆纤维蛋白原及非高密度脂蛋白胆固醇与老年人2型糖尿病肾病的关系

目的 探讨老年2型糖尿病患者血浆纤维蛋白原(FIB)及非高密度脂蛋白胆固醇(non- HDL-C)水平与糖尿病肾病的相关性. 方法 将152例老年2型糖尿病患者(年龄≥60岁)根据24 h尿白蛋白排泄率,分为正常白蛋白尿(89例)、异常白蛋白尿两组(63例),分别测定体质指数(BMI)、收缩压、舒张压、空腹血糖(FPG)、餐后血糖(2 hPG)、糖化血红蛋白(HbA1c)、血清三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、FIB及24 h尿白蛋白量(UAER)等,并计算non-HDL-C与估算肾小球滤过率(eGFR). 结果 异常白蛋白尿组患者的年龄、并存高血压病史患者数、收缩压、Scr、FIB分别为(74.6±7.3)岁、57例(90.5％)、(146.8±23.2)mm H g、(1.0±0.7)μmol/L、(4.8±1.5)g/L,与正常白蛋白尿组(71.6±7.2)岁、59例(66.3％)、(137.7±19.2) mm Hg、(0.8±0.3)μmol/L、(4.2±1.3)g/L比较均明显升高(t=-2.536、-2.656、-2.474、-2.857,x2=11.936,均P＜0.05);而异常白蛋白尿组患者eGFR( 68.5±31.2)ml· min 1·1.73 m-2,比正常白蛋白尿组(81.4±25.9)ml·min-1·1.73 m-2明显下降(t=2.791,P＜0.05).异常白蛋白尿患者中FIB升高患者数中(45例,71.4％),明显高于FIB正常患者数(18例,28.6％)(X2=8.085,P=0.004)；且FIB升高组(88例)的异常白蛋白尿患者的eGFR(62.6±30.5)ml·min-1·1.73 m-2,明显低于FIB正常组(64例)(83.2±28.7)ml· min-1·1.73m 2(t=2.459,P=0.017).Pearson相关分析显示,UAER与non- HDL-C、TG、TC、FIB均呈正相关(r=0.276、0.268、0.243、0.176,均P＜0.05)；进一步多元逐步回归分析结果显示,FIB是影响老年2型糖尿病患者白蛋白尿的独立危险因素(标准化偏回归系数β=0.166,P＜0.05). 结论 FIB、non-HDL-C水平的升高与老年人2型糖尿病肾病的发生密切相关.     

脂蛋白a与冠心病患者心肾功能的相关性研究

目的:探讨冠心病患者体内血清脂蛋白a[Lp(a)]与肾小球滤过率估测值(eGFR)和左室射血分数(LVEF)的相关性。方法:入选经冠状动脉(冠脉)造影检查确诊的冠心病住院患者555例。将所有患者根据性别分为两组。收集患者一般临床资料及冠脉造影结果。比较不同eGFR、LVEF及Gensini积分情况下Lp(a)的分布特征。采用Pearson相关分析法分析相关性,多元线性回归分析Lp(a)的影响因素。结果:1Lp(a)水平在不同性别、eGFR、LVEF和Gensini积分间的差异有统计学意义(均P0.05)。与eGFR≥90(ml·min-1·1.73m-2)相比,60(ml·min-1·1.73m-2)≤eGFR90(ml·min-1·1.73m-2)和eGFR60(ml·min-1·1.73m-2)两组患者(ml·min-1·1.73m-2)水平更高(均P0.05)。2Lp(a)与eGFR和LVEF呈负相关(均P0.05),与性别、载脂蛋白B、Gensini积分、血肌酐、总胆固醇、低密度脂蛋白胆固醇及年龄呈正相关(均P0.05)。在校正其他因素影响后,Lp(a)与性别、eGFR、载脂蛋白B、Gensini积分及LVEF仍有相关性(β值分别为0.094、-0.123、0.186、0.083和-0.074,均P0.05)。结论:Lp(a)与载脂蛋白B、eGFR、LVEF和Gensini积分相关,对冠心病患者心肾功能有影响。     

慢性丙型肝炎患者肝组织学改变及其影响因素分析

目的探讨慢性丙型肝炎患者肝组织学改变及其影响因素。方法选择经皮肝组织活检的慢性丙型肝炎患者102例,记录患者年龄、性别、体质指数(BMI)、感染途径等,检测ALT水平、AST水平、HCV基因分型、病毒载量和肝脏组织学改变。统计学处理采用t检验和Logistic回归分析。结果肝脏炎症活动指数( HAI)≥4的慢性丙型肝炎患者的ALT、AST水平较高,PLT较低,与HAI＜4的患者相比差异有统计学意义(t=2.209、2.298、2.565,均P＜0.05)。纤维化分期评分(F)≥3的患者平均年龄、ALT水平、AST水平以及感染时间均高于F＜3的患者（t=2.340、3.497、2.758、2.570,均P＜0.05）,而PLT则较低(t=2.761,P=0.007)。女性、ALT＞1×正常值上限(ULN)、AST水平、F≥3、HCV RNA≥6 lgIU/mL和PLT计数是HAI≥4的单因素预测因子;经多因素分析后,Ishak纤维化分期评分是HAI≥4的唯一独立预测因子(OR 3.098,95％ Cl1.884～5.092,P＜0.01)。单因素分析F≥3的预测因子为年龄、BMI≥24 kg/m2、ALT＞1×ULN、AST水平、HAI≥4、PLT计数以及感染年限≥15年;多因素回归分析显示,年龄(OR 1.074,95％CI1.006～1.146,P=0.033)、ALT水平(OR 1.035,95％CI 1.015～1.055,P＜0.01)、AST水平(OR0.969,95％CI 0.948～0.990,P=0.005)、感染年限≥15年(OR 37.215,95％CI 5.816～238.127,P＜0.01)和HAI≥4(OR 1.939,95％CI 1.426～2.636,P＜0.01)是F≥3的独立危险因素。结论年龄、ALT水平、AST水平、感染年限≥15年和HAI≥4是肝组织学显著纤维化的独立预测因子。     

老年原发性高血压患者红细胞分布宽度与早期肾功能损害的相关性分析

目的探讨老年原发性高血压患者红细胞分布宽度(RDW)与早期肾功能损害的关系。方法入选2014年7~12月首都医科大学宣武医院高血压门诊364例老年原发性高血压患者作为观察组,另连续选取100名同期年龄匹配的体检健康者作为对照组,记录两组年龄、性别、收缩压、舒张压、体质指数(BMI)、空腹血糖(FPG)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、尿酸、肌酐、尿素氮、尿蛋白定性及血常规等。采用肾脏病饮食改良(MDRD)简化公式计算估算肾小球滤过率(eGFR),根据eGFR水平将高血压组患者分为两组:eGFR下降组(eGFR<90 ml·min-1·1.73 m-2)102例与e GFR正常组(eGFR≥90 ml·min-1·1.73 m-2)262例。并比较RDW、eGFR、BMI和生化指标等参数在各组间的变化差异,分析RDW与eGFR的相关性。结果 (1)与对照组比较,高血压组患者BMI[(25.84±2.95)kg/m2比(23.79±3.12)kg/m2]、TG[(1.96±1.34)mmol/L比(1.58±0.69)mmol/L]、血尿酸[(325.37±88.97)mmol/L比(296.63±80.11)mmol/L]和RDW(13.05%±0.87%比12.59%±0.61%)水平升高,HDL-C[(1.43±0.38)mmol/L比(1.61±0.33)mmol/L]和e GFR[(104.63±28.47)ml·min-1·1.73 m-2比(124.49±25.96)ml·min-1·1.73 m-2]水平下降,差异均有统计学意义(均为P<0.05);(2)在高血压患者中,与e GFR正常组比较,e GFR下降组的年龄[(62.6±9.3)岁比(59.9±8.8)岁]、BMI[(26.99±3.05)kg/m2比(25.39±2.78)kg/m2]、收缩压[(163.44±15.18)mm Hg比(154.42±12.27)mm Hg]、高血压病程[(12.4±3.7)年比(9.8±3.6)年]、血尿酸[(358.84±97.93)mmol/L比(312.34±81.79)mmol/L]、肌酐[(87.56±21.16)μmol/L比(58.60±11.01)μmol/L]、尿蛋白阳性率(46.10%比21.00%)及RDW(13.45%±0.94%比12.90%±0.79%)均升高,而eGFR[(73.85±12.32)ml·min-1·1.73 m-2比(116.61±23.54)ml·min-1·1.73 m-2]下降,差异均有统计学意义(均为P<0.05);经Pearson相关分析显示,高血压组患者RDW与eGFR水平呈负相关(r=-0.237,P=0.000);(3)Logistic多元回归分析显示,RDW是eGFR的危险因素(OR=1.485,P=0.015)。结论老年原发性高血压患者的RDW与eGFR呈负相关,RDW可作为评估老年原发性高血压患者早期肾功能损害的预测因素。     

489例痰抗酸杆菌涂片和(或)培养阳性的患者非结核分枝杆菌肺病相关危险因素

目的 探讨痰抗酸杆菌涂片和(或)培养阳性的患者患非结核分枝杆菌(NTM)肺病的相关危险因素.方法 选择2006年1月至2011年6月的痰抗酸杆菌涂片和(或)培养阳性的NTM肺病患者163例(NTM肺病组),对同期入院的痰抗酸杆菌涂片和(或)培养阳性肺结核患者采用系统抽样法随机抽取326例作为对照组,进行回顾性研究.采用x2检验对两组的研究因素进行比较,并应用Logistic回归分析筛选出NTM肺病的相关危险因素.结果 NTM肺病患者与肺结核患者年龄、吸烟史、慢性阻塞性肺病(COPD)、支气管扩张、肺内空洞、PPD结果的差异均有统计学意义(均P＜0.05).单因素分析显示,年龄[45～60岁(OR=2.637,95％CI为1.631～4.264,P＜0.001)、＞60岁(OR=4.194,95％CI为2.581～6.813,P＜0.001)]、吸烟史[10～20年(OR=1.842,95％CI为1.084～3.070,P=0.024)、＞20年(OR=2.040,95％CI为1.167～3.567,P=0.012)]、COPD(OR=2.698,95％CI为1.588～4.583,P＜0.001)、支气管扩张(OR=3.566,95％CI为2.343～5.427,P＜0.001)、肺内薄壁空洞(OR=2.592,95％CI为1.581～4.250,P＜0.001)、PPD弱阳性(OR=2.389,95％CI为1.276～4.472,P=0.006)均为NTM肺病的危险因素.多因素分析显示,年龄＞60岁(OR=3.961,95％CI为2.183～7.189,P＜0.001)、支气管扩张(OR=3.880,95％CI为2.342～6.487,P＜0.001)、肺内薄壁空洞(OR=2.898,95％CI为1.567～5.360,P＜0.001)、COPD(OR=2.503,95％CI为1.289～4.857,P=0.007)、年龄45～60岁(OR=2.452,95％CI为1.391～4.325,P=0.002)、PPD弱阳性(OR=2.295,95％CI为1.132～4.652,P=0.021)均为NTM肺病的危险因素.结论 年龄≥45岁、COPD、支气管扩张、肺内薄壁空洞、PPD弱阳性的痰抗酸杆菌涂片和(或)培养阳性患者患NTM肺病的危险性显著增加,临床医师应密切关注菌种鉴定的结果.     

踝臂指数检查在糖尿病足防治中的应用与影响因素分析

目的 探讨踝臂指数(ABI)检查在糖尿病足诊断中的应用并分析其影响因素. 方法 对255例糖尿病患者进行ABI检查,分析其影响因素并与下肢血管彩色多普勒血流显像(B超)检测结果进行对照,评估ABI检查的应用价值. 结果 ABI≤0.9组与＞0.9组比较,年龄≥60岁者更多见(77.3％对53.9％,P=0.036),更易发生足部溃疡(9.1％对0.5％,P=0.026),足背动脉搏动减弱者亦明显增多(28.6％对6.4％,P＜0.001).B超检查结果显示,ABI≤0.9组下肢动脉斑块(68.2％对42.1％,P=0.019)和阻塞(45.5％对22.3％,P=0.01 6)者亦明显增多.回归分析结果显示,动脉斑块(β=1.011,P=0.037)与ABI≤0.9呈正相关. 结论 ABI能判断糖尿病患者的下肢血管情况,年龄≥60岁、体格检查足部动脉搏动减弱的糖尿病患者应定期检测ABI.     

北京市养老院中女性尿失禁的患病现况和危险因素研究

目的 了解北京市养老院中女性尿失禁的患病现况和危险因素,为制订相应的卫生策略提供参考.方法 采用随机抽样的方法,在北京市选择6个区作为调查点,由经过培训的调查员应用统一设计的调查表对养老院中符合条件的老年女性进行询问式问卷调查.数据分析应用SPSS16.0软件完成,危险因素的分析采用非条件Logistic回归分析.结果 642例老年女性完成本次调查,尿失禁患病率为38.0％(244/642).尿失禁患者对自身病情知晓率为38.5％(94/244),就诊率为7.8％(19/244),治疗率为6.6％(16/244).单因素分析结果显示,从事体力劳动和患呼吸、消化、泌尿、心脑血管、神经、妇科疾病及既往月经状况不佳、结婚年龄＜21岁、怀孕≥4次、经历过自然分娩和剖宫产、便秘、排便失禁、活动能力受限、饮酒史等是发生尿失禁的危险因素.经多因素非条件Logistic回归分析,8个因素进入回归方程,为尿失禁独立的危险因素,分别为结婚年龄小于21岁(OR=1.5,95％CI:1.0～2.3,P＜0.05),怀孕≥4次(OR=1.7,95％CI:1.1～2.4,P＜0.05),既往月经状况不佳(OR=1.7,95％CI:1.0～2.7,P＜0.05),患呼吸系统疾病(OR=1.6,95％CI:1.0～2.6,P＜0.05)、泌尿系统疾病(OR=2.4,95％ CI:1.4～4.1,P＜0.01)、心脑血管疾病(OR=2.0,95％CI:1.3～3.0,P＜0.01)、妇科疾病(OR=3.4,95％CI:2.0～5.6,P＜0.01)及活动能力受限(OR=2.5,95％CI:1.5～4.0,P＜0.01).结论 尿失禁在养老院女性中患病率较高,应针对危险因素进行干预和相应的治疗.     

肾小球滤过率对老年冠心病患者冠状动脉病变程度的评估价值

目的 分析行冠状动脉(冠脉)造影检查老年人群中评估肾小球滤过率(eGFR)与冠脉病变程度的相关性.方法 根据冠脉造影结果 ,将初次行选择性冠脉造影的657例患者分为3组,中青年组(<60岁)、老年组(60～69岁)和高龄组(≥70岁).根据简化MDRD公式计算eGFR,定义肾功能正常:eGFR≥90 ml·min-1·1.73 m-2;;肾功能轻度减退:eGFR 60～89 ml·mi-1·1.73 m-2;肾功能中重度减退:eGFR 15-59 ml·min-1·1.73 m-2.比较不同eGFR与冠心病严重程度的关系. 结果 随着冠脉粥样硬化的出现,eGFR呈下降趋势;高龄组中,随着冠脉病变的支数增多,eGFR有下降趋势,多支病变与2支病变组内比较,差异有统计学意义(P=0.035).按改良Gensini评分标准对冠脉病变严重程度评分,并将eGFR与Gensini评分作相关分析,在控制了高血压(降压药使用)、吸烟、血脂异常(降脂药使用)、年龄、糖尿病等变量影响后,eGFR与Gensini评分密切相关(r=0.110,P=0.005). 结论 在老年人群中,eGFR下降与冠脉病变程度相关,并与冠脉病变的Gensini积分呈线性相关,可评价冠脉病变的严重程度与预后.     

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.