老年慢性心力衰竭病人的病因及临床特征分析

目的 通过对不同年龄慢性心力衰竭（CHF）病人的临床资料进行回顾分析，总结老年CHF病人的病因及临床表现特征，为临床诊治老年CHF提供帮助。方法169例39岁-91岁CHF病人按年龄分为两组，〈60岁组和≥60岁组。采用回顾性分析法，对其病因及临床表现特征进行分析比较。结果不同年龄组CHF各有其特点，且随着年龄增加，临床表现出现多方面变化：年龄越大，CHF的症状越不典型。除了呼吸困难外，老年CHF病人常表现为不典型的咳嗽、咳痰、厌食、腹胀、消化不良、焦虑、烦躁、淡漠、失眠、乏力；心率可以不增快，或者心跳徐缓。随着年龄增大，CHF患病率上升。结论 老年CHF病人的临床表现常不典型．且随着年龄增大，CHF患病率显著上升。老年CHF病人易合并主要脏器并发症以至于多器官功能障碍．预后不良。     

1137例不同年龄急性心肌梗死患者心脏功能与预后关系的分析

目的探讨不同年龄急性心肌梗死患者超声心动图表现与预后的关系。方法选择急性心肌梗死患者1 137例,按年龄分为<45岁组(44例)、45～74岁组(905例)、≥75岁组(188例)。根据超声心动图表现及临床心脏并发症进行分析。结果 <45岁组患者男性比例最高,随着年龄增加男性比例逐渐减少,3组间差异有统计学意义(P<0.05)。<45岁组患者有8例(18.2%)发生心脏严重并发症,45～74岁组患音有216例(23.9%)发生心脏严重并发症,≥75岁组患者有93例(49.5%)发生心脏严重并发症,3组间差异有统计学意义。结论≤45岁组急性心肌梗死患者心脏功能减低不明显,并发症少,预后较好。≥75岁组急性心肌梗死患者心脏功能减低明显,心脏并发症多,预后较差。     

不同年龄段急性心肌梗死病人临床特点分析

目的探讨不同年龄段急性心肌梗死病人的临床特点。方法入选2014年6月至2017年5月期间在西安医学院第二附属医院住院治疗的急性心肌梗死病人,共960例。根据年龄将病人分为4组:55岁组(264例)、55~64岁组(300例)、65~74岁组(256例)、≥75岁组(140例)。查阅病历收集病人的临床资料,比较各组病人之间临床特点的差异。结果 (1)随着年龄的增加,女性急性心肌梗死病人的比例增加,而ST段抬高型心肌梗死的比例下降,不同年龄组之间差异均有统计学意义(P0.05)。在冠心病传统危险因素方面,有吸烟史、血脂异常史和早发冠心病家族史病人的比例随着年龄增加而下降,合并高血压的比例随年龄增加而增加,各组之间差异均有统计学意义(P0.05)。(2)急性心肌梗死病人的主要临床表现是持续性胸痛和大汗,分别占65.9%和64%。随着年龄的增加,持续前胸剧痛、大汗和放射痛的比例减低,各组之间的差异均有统计学意义(P0.05)。结论随着年龄增加,急性心肌梗死发病的性别差异逐渐缩小,近半数≥75岁急性心肌梗死病人为女性。老年心肌梗死病人症状不典型,近半数≥75岁急性心肌梗死病人无持续性胸痛和大汗的典型症状。     

不同年龄组急性心肌梗死患者溶栓血管再通率和并发症的对比

目的　旨在对比不同年龄组急性心肌梗死患者溶栓血管再通率和并发症。方法　在冠心病监护病房(CCU) ,根据不同的年龄 ,将用尿激酶治疗的 2 6 6例急性心肌梗死患者 ,分成A组 (年龄 <6 0岁 ,n =111)、B组 (年龄为 6 0～ 6 9岁 ,n =110 )和C组 (年龄≥ 70岁 ,n =45 )。结果　 (1)随年龄的增加冠状动脉梗死相关血管再通率逐渐下降 ,病死率和出血并发症有升高趋势 (P>0 0 5 ) ;(2 )老年人血白细胞、静脉血糖、肌酸激酶均显著高于A组(P <0 0 1,P<0 0 5 ) ;(3)C组肺感染和泵衰竭并发症显著高于A组 (P <0 0 1,P<0 0 5 ) ,心脏破裂并发症亦显著高于B组 (P <0 0 1)。结论　静脉溶栓治疗急性心肌梗死对老年及高龄AMI患者同样有效 ,但尿激酶的剂量应偏小     

老年急性心肌梗死临床分析

目的 探索老年急性心肌梗死(AMI)的临床特征，提出早期诊断、治疗要点。方法 将84例老年AMI患与78例非老年．AMI患进行对比。结果 老年AMI患临床多见，年龄越大发生率越高，临床表现越不典型，首发症状复杂多样，早期并发症多及病死率高。结论 应掌握老年．AMI的临床特点，对怀疑应及时监测全导心电图、血清酶学，有条件应做放射性核素或冠脉造影。     

不同年龄段急性冠状动脉综合征患者临床及预后分析

目的探讨不同年龄段急性冠状动脉综合征患者的临床特点及预后。方法 222例急性冠状动脉综合征患者依据年龄分为45岁、45～59岁、60～75岁及 75岁组,比较四组患者性别、危险因素、急性冠状动脉综合征类型、生化指标、超声参数、冠状动脉造影结果等临床资料,随访两年,分析不同年龄段急性冠状动脉综合征患者主要心血管不良事件发生情况。结果 45岁组急性冠状动脉综合征患者血脂异常、吸烟者多见,ST段抬高型心肌梗死发生率最高; 60～75岁组患者合并高血压比例最高,60～75岁及 75岁组患者非ST段抬高型心肌梗死比例增加。单支冠状动脉病变以45岁组比例最高,三支病变以 75岁组最多,但差异无统计学意义。比较各组发病30天及2年主要心血管不良事件,60～75岁及 75岁组患者主要心血管不良事件发生率增高。结论不同年龄段急性冠状动脉综合征临床表现及预后不同,了解各年龄段患者的临床特点,有利于改善急性冠状动脉综合征患者的预后。     

重视老年甲状腺疾病的防治工作

随着年龄增长,甲状腺功能及激素代谢会发生一定变化,甲状腺疾病发病率也逐渐增高。由于老年甲状腺疾病的表现形式明显不同于年轻人群,年龄越大临床表现越不典型,且常常同时合并有其他疾病,因此很容易造成误诊漏诊,对老年人群危害较大,应引起广大医务工作者的高度重视。     

11年急性心肌梗死住院患者年龄性别特点及变化趋势

目的:分析急性心肌梗死(AMI)患者年龄、性别特点以及11年的变化趋势。方法:收集我院1994年至2004年初发急性ST段抬高心肌梗死患者资料,按照年份、不同年龄、性别进行分组并统计学分析。结果:AMI患者入院人数呈上升趋势,男性较女性增加更为明显;性别、患者平均年龄均无明显变化;男性及女性,60~74岁的患者所占比例高;45~59岁的患者男性所占比例有升高趋势,老年男性(60~74岁)比例有下降趋势。结论:心肌梗死入院患者呈上升趋势,老年人群所占比例高,男性发病有年轻化趋势。     

老年慢性心力衰竭合并心肾综合征的高危因素分析

目的:分析老年慢性心力衰竭(HF)合并心肾综合征(CRS)的发病特点及其临床高危因素。方法:收集年龄 60岁慢性HF患者167例的临床资料,按照血肌酐(Cr)水平分为CRS组(42例)与非CRS组(125例),分析其临床表现及生化指标,通过单因素及多因素回归方法评价慢性HF患者合并CRS的临床高危因素。结果:与非CRS组比较,CRS组患者中既往高血压、糖尿病、急性心肌梗死等基础病以及心功能NYHA分级Ⅲ～Ⅳ级者较多,急性感染患病率和脑血管意外患病率升高(P 0. 05)。多因素Logistic回归分析显示急性感染、血尿酸(UA)、血Cr、既往糖尿病史、高敏C反应蛋白(hs-CRP)是老年慢性HF合并CRS的独立影响因素。结论:老年慢性HF合并CRS存在自身特征性,急性感染、血Cr升高、UA升高、既往糖尿病史及hs-CRP升高是老年慢性HF合并CRS的临床高危因素。     

老年心脏瓣膜病合并肺动脉高压患者行瓣膜手术疗效的影响因素

目的探讨老年心脏瓣膜病合并肺动脉高压(PH)患者行瓣膜手术疗效的影响因素。方法选取280例老年心脏瓣膜病合并PH行瓣膜手术患者,行手术前后左心室射血分数(LVEF)、肺动脉收缩(PASP)及术后相关并发症、死亡率对比,探讨性别、年龄、心功能分级、术前PASP分级对手术疗效的影响。结果经瓣膜手术后,患者PASP与LVEF水平较术前明显好转(P0.05);年龄≥70岁组患者手术前后PASP变化值及LVEF变化值均小于70岁组,而并发症发生率及死亡率均显著高于70岁组(P0.05)。性别在所有患者统计指标中差异均无统计学意义(P0.05);术后PASP值与心功能等级呈正比,手术前后PASP差值越小,LVEF值越低,手术前后LVEF差值越大,并发症及死亡率也越大(P0.05)。术前术后PASP值变化越大,术后并发症及死亡率显著增加(P0.05)。结论老年心脏瓣膜病合并PH患者行瓣膜手术的治疗疗效与年龄有关,与性别无关;术前心功能越差,手术疗效越差;术前PASP值越高,手术疗效亦越差,因此,术前因注意和控制高危因素。     

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.