急性缺血性脑卒中老年患者溶栓后联合阿加曲班治疗的临床研究

目的探讨急性缺血性脑卒中溶栓后联用阿加曲班治疗的有效性和安全性。方法收集发病4.5 h行注射用阿替普酶静脉溶栓的急性脑梗死患者108例,根据患者是否加用阿加曲班分为阿加曲班组56例和常规治疗组52例。2组治疗前、治疗后7和14 d用美国国立卫生研究院卒中量表(NIHSS)评分及Barthel指数(BI)评估疗效,同时监测活化部分凝血活酶时间(APTT)及纤维蛋白原(Fib)水平,90 d随访时,记录不良事件情况。结果阿加曲班组治疗后7、14及90 d时NIHSS评分均低于常规治疗组[(8.45±3.77)分vs(11.09±2.31)分、(7.19±3.27)分vs(9.03±3.19)分、(7.11±2.64)分vs(9.01±3.03)分,P=0.000],BI评分高于常规治疗组[(67.14±12.79)分vs(57.48±11.71)分、(68.23±11.25)分vs(58.93±12.16)分、(68.43±10.28)分vs(64.23±12.47)分,P=0.000]。2组治疗后7及14 d的APTT较治疗前无明显变化(P0.05)。阿加曲班组治疗后7 d及14 d的Fib较治疗前明显下降(P0.05)。90 d随访时,2组均无死亡、脑出血及再发脑梗死等患者。结论脑卒中溶栓治疗后联合阿加曲班疗效更好,且无明显不良反应。     

超选择性动脉溶栓与静脉溶栓治疗急性脑梗死的临床效果对比

目的比较超选择性动脉溶栓与静脉溶栓治疗急性脑梗死的临床效果。方法选取滨州医学院烟台附属医院2013年8月—2014年3月收治的急性脑梗死患者120例,按照随机数字表法分为动脉溶栓组和静脉溶栓组,每组60例。动脉溶栓组患者给予超选择性动脉溶栓治疗,静脉溶栓组患者给予静脉溶栓治疗。比较两组患者临床效果,溶栓前及溶栓后2 h、12 h、24 h、3 d、7 d、15 d、30 d美国国立卫生研究院卒中量表(NIHSS)评分,溶栓前及溶栓后6 h、3 d、7 d凝血指标〔凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(FIB)〕,观察并发症发生情况。结果两组患者临床效果比较,差异无统计学意义(u=0.064,P0.05)。两组患者溶栓前及溶栓后15 d、30 d NIHSS评分比较,差异无统计学意义(P0.05);动脉溶栓组患者溶栓后2 h、12 h、24 h、3 d、7 d NIHSS评分均低于静脉溶栓组(P0.05)。溶栓前两组患者TT、PT及FIB水平比较,差异无统计学意义(P0.05);动脉溶栓组患者溶栓后6 h、3 d、7 d TT、PT长于静脉溶栓组,溶栓后6 h、3 d FIB水平高于对照组(P0.05);溶栓后7 d两组患者FIB水平比较,差异无统计学意义(P0.05)。动脉溶栓组并发症发生率为6.17%,低于静脉溶栓组的25.00%(P0.05)。结论超选择性动脉溶栓与静脉溶栓治疗急性脑梗死的临床效果相当,但超选择性动脉溶栓治疗起效时间短,且并发症少。     

急性缺血性脑卒中患者静脉溶栓治疗对神经功能和凝血功能的影响

目的探讨急性缺血性脑卒中患者静脉溶栓治疗对神经功能、凝血功能指标的影响。方法选取141例采用阿替普酶实施静脉溶栓治疗的患者为观察组,监测患者溶栓前、溶栓后2h、溶栓后4h的凝血酶原时间(prothrombin time,PT)、活化部分凝血酶时间(activated partial thrombin time,APTT)、纤维蛋白原(fibrinogen,FIB)、D-二聚体(D-dimer,D-D)及血栓弹力图指标;观察患者治疗前、治疗7天、治疗14天及治疗28天的神经功能缺损评分(national institutes of health stroke scale,NIHSS),选取30例健康对象作为对照组并进行比较。结果观察组患者在静脉溶栓2h、4h后血栓弹力图指标的R值、K值较溶栓前均显著提高(P0.05),Angle角、MA值在静脉溶栓2h、4h后较溶栓前均显著降低(P0.05);观察组R值、Angle角在静脉溶栓前、溶栓2h、溶栓4h后与对照组比较差异有统计学意义(P0.05),观察组K值、MA值在静脉溶栓前、溶栓2h后与对照组比较差异有统计学意义(P0.05);观察组患者在静脉溶栓2h、4h后的PT、APTT较溶栓前均显著提高(P0.05),FIB、D-D在静脉溶栓2h、4h后较溶栓前均显著降低(P0.05);观察组PT、APTT在静脉溶栓前、溶栓4h后与对照组比较差异有统计学意义(P0.05),观察组FIB值、D-D值在静脉溶栓前、溶栓2h后、溶栓4h后与对照组比较差异有统计学意义(P0.05);观察组在治疗7天、治疗14天、治疗28天后NIHSS评分均较治疗前显著降低(P0.05)。结论静脉溶栓治疗急性缺血性脑卒中对患者神经功能恢复具有显著效果,同时可改善患者的高凝状态。     

重组组织型纤溶酶原激活物静脉溶栓治疗超早期脑梗死临床分析

目的:探讨重组组织型纤溶酶原激活物(rt-PA)静脉溶栓治疗超早期脑梗死的临床疗效及预后。方法 :选取我院2009年5月至2014年5月收治的符合入选条件的超早期脑梗死患者336例,行rt-PA静脉溶栓治疗(溶栓组);选取同期非溶栓常规治疗的超早期脑梗死患者306例作为对照组。比较2组患者治疗前后的美国国立卫生研究院卒中量表(NIHSS)评分、治疗效果、24 h内及3个月并发症及预后情况。结果:2组患者治疗前的NIHSS差异无统计学意义。治疗后2组患者的NIHSS分值均有下降,2组间比较差异具有统计学意义(P<0.05);溶栓组的总有效率为93.5%,明显高于非溶栓治疗的80.6%(P0.05);溶栓治疗组能显著改善患者3个月预后(P0.05)。24 h内病死率溶栓组高于对照组(P<0.05),3个月病死率溶栓组仍高于对照组(P     

急性脑梗死静脉溶栓早期治疗效果的相关影响因素

目的探讨影响急性脑梗死静脉溶栓早期治疗效果的相关因素及相关血清学指标的指导意义。方法分析接受静脉溶栓治疗的急性脑梗死患者的临床资料,采用治疗24 h后美国国立卫生研究院脑卒中量表(NIHSS)评分减少情况作为早期疗效评价标准,观察组(有效组,治疗前后NIHSS减少≥4分)34例,对照组(无效组,治疗前后NIHSS减少4分)44例。分别比较两组患者一般临床基线资料、早期溶栓治疗情况及治疗前后NIHSS评分,并对急性脑梗死患者早期静脉溶栓效果影响因素进行Logistic分析,研究不同预后结局患者血清总胆红素、Beclin-1蛋白、尿酸、超敏-C反应蛋白(hs-CPR)水平的差异。结果两组治疗前低密度脂蛋白胆固醇(LDL-C)水平、既往脑卒中史、心房颤动发生率、发病至溶栓时间、治疗前后NIHSS评分比较差异均具有统计学意义(P0.05)。观察组治疗后NIHSS评分较治疗前明显下降(P0.001)。急性脑梗死患者治疗前出现心房颤动、LDL-C异常升高、发病至溶栓时间3 h是影响急性脑梗死患者早期静脉溶栓效果的显著危险因素(P0.05);死亡组患者血清Beclin-1蛋白、尿酸水平显著高于存活组,hs-CPR水平显著低于存活组(P0.05)。结论急性脑梗死患者治疗前出现心房颤动、LDL-C异常升高、发病至溶栓时间延长是影响急性脑梗死患者早期静脉溶栓效果的危险因素,治疗后患者Beclin-1蛋白、尿酸,hs-CPR水平与患者预后有关,可为患者预后情况的监测指标的选择提供参考。     

超早期溶栓联合依达拉奉对急性脑梗死病人神经功能的保护作用

目的探讨超早期溶栓联合依达拉奉对急性脑梗死病人神经功能的保护作用。方法选取2015年12月—2017年12月我院收治的急性脑梗死病人79例,随机分为研究组(40例)与对照组(39例)。对照组给予单纯超早期溶栓治疗,研究组给予超早期溶栓联合依达拉奉治疗。比较两组Barthel指数(BI)、美国国立卫生研究院卒中量表(NIHSS)评分变化及临床疗效。结果溶栓后第24 h、第7天及第14天,研究组BI评分显著高于对照组(P0.05)。溶栓后第7天及第14天,研究组NIHSS评分显著低于对照组(P0.05)。研究组疗效优于对照组(P0.05)。结论超早期溶栓联合依达拉奉治疗可有效保护急性脑梗死病人神经功能。     

前后循环急性脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓的临床疗效比较

目的探讨前、后循环急性脑梗死患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓的临床疗效及相关影响因素。方法回顾性分析接受rt-PA静脉溶栓治疗的178例急性脑梗死患者的临床资料,其中前循环脑梗死(ACS)138例(ACS组),后循环脑梗死(PCS)40例(PCS组),通过患者入院时及24h美国国立卫生研究院卒中量表(NIHSS)评分,90d改良的Rankin量表(mRS)评分,预后良好率,颅内出血及死亡情况,比较2组的临床疗效。结果 2组患者的给药时间、既往心房颤动史、脑卒中及基线NIHSS评分比较差异有统计学意义(P0.05)。在临床转归方面,PCS组90dmRS评分和3个月死亡显著高于ACS组[(3.28±1.87)分vs(2.37±1.88)分和20.00%vs 5.80%,P0.05],预后良好显著低于ACS组(40.00%vs 62.32%,P0.05)。接受rt-PA溶栓的脑梗死患者的症状性颅内出血与年龄、基线NIHSS评分及24hNIHSS评分呈正相关;90d内死亡与前后循环、24h NIHSS评分呈正相关。结论 rt-PA静脉溶栓患者中ACS临床疗效较PCS相对较好。PCS是急性脑梗死rt-PA静脉溶栓治疗后死亡的危险因素之一。     

超早期重组组织型纤溶酶原激活剂静脉溶栓联合依达拉奉对急性脑梗死患者的影响

目的分析超早期重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓联合依达拉奉对急性脑梗死(ACI)患者的影响。方法选取2013年6月—2016年10月张家港市第一人民医院收治的ACI患者76例,采用随机数字表法分为对照组和观察组,每组38例。对照组患者给予超早期rt-PA静脉溶栓治疗,观察组患者给予超早期rt-PA静脉溶栓联合依达拉奉治疗。比较两组患者血管再通情况、治疗前后美国国立卫生研究院卒中量表(NIHSS)评分及Barthel指数(BI)、不良反应发生率。结果观察组患者血管再通情况优于对照组(P0.05)。两组患者治疗前NIHSS评分及BI比较,差异无统计学意义(P0.05);观察组患者治疗后NIHSS评分低于对照组,BI高于对照组(P0.05)。两组患者不良反应发生率比较,差异无统计学意义(P0.05)。结论超早期rt-PA静脉溶栓联合依达拉奉可有效提高ACI患者血管再通率,改善患者神经功能及日常生活活动能力,且安全性较高。     

糖尿病患者凝血状态及影响因素研究

目的观察糖尿病患者与非糖尿病患者的凝血状态差异及其影响因素,为临床治疗糖尿病合并凝血功能异常提供参考。方法选择糖尿病患者251例(糖尿病组),糖尿病组又根据是否有大血管病变分为大血管病变组163例,无大血管病变组88例,另选择健康体检者80例(对照组),观察其凝血酶时间(TT)、活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)的差异。结果糖尿病组TT[(16.28±1.44)s vs(17.80±0.97)s]、APTT[(35.57±3.73)s vs(37.46±4.17)s]、PT[(12.60±1.08)s vs(13.84±0.60)s]较对照组明显缩短,Fib[(3.21±0.87)g/L vs(2.91±0.55)g/L]较对照组明显增高(P<0.05,P<0.01)。大血管病变组Fib较无大血管病变组明显升高(P=0.03)。糖尿病组主要影响凝血指标的是糖化血红蛋白、TC、LDL-C。结论糖尿病患者存在凝血系统的异常,糖化血红蛋白、TC、LDL-C水平与凝血指标具有明显的相关性。     

急性脑梗死静脉溶栓后早期应用前列地尔随机对照研究

目的评价急性脑梗死重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后早期使用前列地尔注射液的临床疗效及安全性。方法纳入急性脑梗死经rt-PA静脉溶栓患者66例,随机分为前列地尔组(溶栓后立即给予前列地尔注射液10μg/d,持续14 d)34例和对照组32例。观察患者美国国立卫生研究院卒中量表(NIHSS)评估溶栓前以及溶栓后1、7、14和30 d的变化,Barthel指数(BI)评分和改良的Rankin量表评定溶栓后7、14和30 d的变化,并记录溶栓后24 h、14 d头颅CT影像学变化。结果与基线NIHSS评分比较,2组溶栓治疗后1、7、14和30 d的NIHSS评分均明显下降(P0.01)。与对照组比较,前列地尔组溶栓后14和30 d的NIHSS评分均明显降低[3.0(1.0,4.0)分vs 4.0(1.0,6.0)分,2.0(1.0,3.0)分vs 3.0(1.0,6.0)分,P0.05];前列地尔组溶栓后14和30 d的BI评分均明显高于对照组[60.0(35.0,90.0)分vs 50.0(25.0,87.5)分,75.0(57.5,92.5)分vs 60.0(30.0,92.5)分,P0.05];前列地尔组溶栓后30 d改良的Rankin量表评分较对照组明显改善[1.0(0.5,2.0)分vs 3.0(0.5,4.0)分,P0.05];2组均未出现皮肤出血、尿道出血、症状性消化道出血、症状性脑出血和死亡患者,2组其他不良反应发生率比较,无统计学差异(P0.05)。结论急性脑梗死rt-PA静脉溶栓后早期应用前列地尔注射液治疗14 d,有进一步改善缺血性脑卒中功能恢复的临床疗效趋势,存在较好的安全性。     

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.