复方海蛇胶囊随机双盲法治疗168例增龄相关记忆障碍的临床研究

目的　进一步观察复方海蛇胶囊(RSC)对增龄相关记忆障碍的疗效。方法　双盲法治疗168例增龄相关记忆障碍(AAMI)(MQ＜90),用药分别为RSC组与空白对照组,均为每次4粒胶囊,每粒0.28g,每日3次,疗程3个月。以WMS评定疗效。结果　83例RSC治疗前与治疗后MQ分别为81.35±7.51及90.94±8.98(P＜0.001);85例对照组治疗前后分别为84.34±6.80及88.60±7.40(P＜0.001)。RSC与对照组治疗后复查MQ增值分别为9.30±6.46及4.31±5.29(P＜0.001)。两组总有效率分别为62.65%及23.53%(P＜0.001)。本组未见明显副作用。结论　RSC可显著提高增龄相关记忆障碍的记忆商,安全有效。     

石杉碱甲胶囊、片剂治疗增龄相关记忆障碍——117例对比分析

目的 比较石杉碱甲胶囊、片剂治疗增龄相关记忆障碍的效果。方法 对117例老年人增龄相关记忆障碍进行双盲观察，疗程二个月。结果 石杉碱甲胶囊(63例)治疗前后MQ(WMS)值分别为85.63±12．81及98.42±16．17(P<0.001)。片剂(54例)治疗前后MQ分别为85.76±9．15及96.24±11.70(P<0.001)。石杉碱甲胶囊与片剂治疗前后MQ增值分别为12.56±8.61及10.46±9．61，无明显差异，显示石杉碱甲胶囊及片剂均有改善记忆功能的作用。石杉碱甲胶囊显效率及有效率分别为26．98％及36．51％，与石杉碱甲片剂24们％及35.19％，无明显差异。两组不良反应发生率无明显差异。结论 石彬碱甲胶囊及片剂均系安全有效的改善记忆(及认知)功能的药物。     

加兰他敏片治疗阿尔茨海默病临床观察

目的 评价加兰他敏片治疗阿尔茨海默病(AD)的疗效及安全性.方法 将83例AD患者随机分为两组,加兰他敏组42例,给予加兰他敏片口服,吡拉西坦组给予吡拉西坦片口服,疗程16周.通过简易智能量表(MMSE)、日常生活能力量表(ADL)、副反应量表(TESS)评定疗效及安全性.结果 加兰他敏组轻度、中度AD患者在治疗16周后ADL及MMSE总分、记忆力、回忆力分值变化有统计学意义(P＜0.01);重度AD的MMSE、ADL分值变化无统计学意义.吡拉西坦组治疗前后MMSE、ADL分值均无统计学意义(P>0.05).结论 加兰他敏治疗阿尔茨海默病是有效、安全的,能改善轻度、中度AD患者的认知功能和日常生活能力,尤其表现在记忆力、回忆力方面.     

老年及高龄老人记忆及认知功能生理增龄性及整体增龄性动态改变的研究

目的研究老年记忆及认知功能生理增龄性及整体增龄性动态改变。方法共调查两个群体3 234例各年龄组对象(其中≥75岁高龄老人1 741例),检测记忆商及MMSE,并定记忆商(MQ;WMS)≥100分,MMSE为28~30为认知正常;MQ<100分,MMSE为28~30为AAM I;MQ<100分,MMSE为24~27分为MC I;MQ<100分,MMSE≤23分为痴呆。研究记忆及认知功能生理性(除外MC I及痴呆)及整体性(排除痴呆,而仍包括MC I)增龄性动态改变。全组中2 666例老年人(≥65岁)除外MC I 782例,痴呆157例后,余1 727例作为生理性增龄改变观察组。而将包括认知正常、AAM I及MC I各867、860及782例共2 509例作为整体性增龄改变观察对象。检测方法用WMS及MMSE。结果①WMS:生理性增龄改变组老年及高龄组量表分平均值介于83.54±15.04~82.12±13.74;MQ计算结果介于99.01±13.05~98.05±12.64.②WMS:整体性增龄改变组观察结果显示老年组量表平均值低于生理性增龄改变组7.5分。③MMSE生理性增龄改变组65~74、75~84、85~98岁组MMSE总分中位值均为29分,高于整体性增龄改变组中位值28分。④MMSE按各年龄组异常标准推算式为“该年龄组MMSE总分x-1.5s”计算,则作为与认知正常区别的切点为≤27分。结论①记忆及认知功能均呈现显著增龄性减退改变。②本文“生理增龄性”组测定结果可作为对一般高龄、长寿老人各年龄组临床判断WMS检测结果意义时的参考(正常参考值)。可将老年人及高龄老人AAM I异常标准定为MQ<100分及量表分<83.0。③MMSE总分≤27分可作为与正常值区别的异常标准。将MMSE总分与痴呆的分界值切点定为≤23分。     

阿尔茨海默病和轻度认知功能障碍的神经心理学研究

目的探讨阿尔茨海默病(AD)与轻度认知功能障碍(MCI)的神经心理学特点。方法52例AD、26例MCI患者及24例正常认知者分别接受临床评估和多项神经心理学检查,包括简易精神状态检查法(MMSE)、临床痴呆评定量表(CDR)、日常生活能力量表(ADL)、临床记忆量表(CMS)。结果AD组、MCI组、正常认知组总成绩MMSE分别为(18．9±5．1)分、(26．9±2．1)分、(29．0±1．1)分;ADL分别为(48．3±17．7)分、(26．7±9．3)分、(22．1±4．1)分;MQ分别为(52．5±26．7)分、(811．3±10．8)分、(101．8±11．6)分;CMS分别为(52．5±26．7)分、(81．3±10．8)分、(101．8±11．6)分。与正常认知组比较,MCI除ADL成绩外,其余各量表值均显著降低;与AD组比较,MCI组MMSE、ADL、记忆商(MQ)和CMS中各项成绩均优于AD(P<0．05)。CMS测验中的图像自由回忆分随痴呆程度加重而明显下降,各组比较,差异均有统计学意义(P<0．05)。结论以本研究设立的诊断标准所确立的MCI,其认知功能介于痴呆和正常认知老年人之间,并与早期AD具有相似的认知功能改变。神经心理学检查对于MCI、痴呆的早期诊断和客观反映痴呆严重程度具有重要价值,图像自由回忆是筛选MCI、早期诊断痴呆、评定痴呆程度的敏感指标。     

尼莫同干预脑卒中伴发认知功能障碍疗效观察

目的研究尼莫同干预脑卒中伴发认知功能障碍疗效以及副作用。方法采用随机单盲选择脑卒中伴发认知功能障碍患者,治疗组38例,口服尼莫同片30mg,每天3次。对照组37例,口服脑复康片0.8,每日3次。治疗12周后观察比较治疗前后2组患者测出记忆商(MQ)、精神状态简易量表(MMSE)评分。结果治疗12周评估时,两组MMSE比较,治疗组显著高于对照组,差异有统计学意义(P<0.05);治疗组的MQ评分显著高于对照组(P<0.05)。结论尼莫同治疗脑卒中伴发认知功能障碍有一定疗效。     

轻度阿尔茨海默病海马萎缩的磁共振研究

目的探讨轻度阿尔茨海默病(AD)海马萎缩的特征.方法对15例轻度AD患者和30名健康对照者行海马导向的磁共振成像(MRI)和简易智能状态量表(MMSE)测定,比较两组间海马体积变化的差异性及其与年龄和MMSE评分间的相关性.结果轻度AD海马结构体积较对照组显著减少[分别为(2.08±0.46)cm3及(3.11±0.09)cm3,t=2.71,P＜0.01)];轻度AD组海马体积与对照组的重叠率为13.3%;以对照组海马体积均数和标准差为参照,轻度AD平均海马结构体积减少了4.42个标准差;两组海马结构体积均存在随增龄减少的现象,但AD患者萎缩速度显著地较对照组快(t=2.07,P＜0.05);轻度AD海马体积与MMSE评分之间成正相关(r=+0.48,P＜0.05),而对照组不存在这种关系(r=0.19,P＞0.05).结论MRI反映的海马体积萎缩可有效地将轻度AD患者与健康对照者区分开来,可视为AD的一个状态指标,有助于AD早期诊断.     

脱氢表雄酮对老年男性记忆力的改善作用

目的　探讨小剂量 (≤ 50 mg)脱氢表雄酮硫酸酯 ( DS)对老年男性记忆力的影响。　方法　双盲对照观察老年男性 64例口服 DS 3个月后记忆力的变化 ,其中治疗 A组每天口服 DS 2 5mg、治疗 B组每天 50 mg。以放免法测定治疗前后血清脱氢表雄酮 ( DHEA)和 DS,韦氏记忆量表测定记忆商 ( MQ)。　结果　治疗 A组 3个月后较服药前 DS提高 ( 2 .7± 0 .5) nmol/ L,MQ提高 ( 1 4 .6±6.1 )分 ( P<0 .0 1 ) ;治疗 B组 3个月后较服药前 DS提高 ( 4.4± 1 .5) nmol/ L,MQ提高 ( 1 2 .2± 8.7)分( P<0 .0 1 )。两治疗组 MQ均较对照组明显提高 ( P<0 .0 1 )。　结论　口服小剂量 DS对老年男性的记忆力有一定的改善作用。     

轻度认知功能损害患者的听觉词语记忆特点

目的比较轻度认知功能损害与轻度阿尔茨海默病患者的听觉词语记忆特点。方法轻度认知功能损害组72例,轻度阿尔茨海默病组45例,对照组62例。听觉词语记忆测定采用中文版听觉词语记忆测验方法。结果与对照组[(30.2±5.6)分,(3.4±1.9)分]比较,轻度阿尔茨海默病组[(9.8±4.1)分,(2.0±1.2)分]及轻度认知功能障碍组[(1 6.4±5.5)分,(2.6±1.7)分]前5次回忆之和与学习能力均受损,组间差异有统计学意义(t=2.26,P<0.05;t=6.84,P<0.01)。轻度认知功能损害组各次回忆的语义串联与对照组的差异有统计学意义。轻度阿尔茨海默病组[(0.1±0.2)分]长延迟回忆的语义串联与轻度认知功能损害组[(0.3±0.6)分]的差异有统计学意义(t=3.11,P<0.01)。结论轻度认知功能损害患者出现了与轻度阿尔茨海默病患者类似的听觉词语记忆损害。     

复方海蛇胶囊（R．S．C．）治疗中、老年记忆减退（Hypomnesis）临床试验总结报告——398例双盲法对比分析

本报告复方海蛇腔囊(RSC．)双盲法治疗398例中．老年记忆减退(包括健忘症)(MQ＜100294例)的临床试验结果．用药分为R.S.C．组与空白对照组，均为每次3粒胶囊．每粒0.28克，每日3次，疗程2个月，以WMS评定疗效：R．S．C治疗前与治疗后MQ分别为91．3±17.3及101.4±18．8（P<0．001)．对照组治疗前后分别90.6±165及94.5±17．1(P＜0．05)．R．S.C与对照组治疗后复查MQ增值分别为10．63±11.71及3．95±8.28（t=6．5261，P＜O.OOl），两组总有效率分别为58.80%及38.46%（P＜0.001），本组未见明显副作用。     

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.