脑安胶囊对320例卒中高危患者的干预效果

目的评价脑安胶囊对卒中高危患者的中长期干预效果。方法在门诊与住院患者中,筛选出有高血压、心脏病、糖尿病、血脂异常、卒中家族史等危险因素,同时年龄≥40岁、脑血管血流动力学参数（CVHP）积分〈75分者320例,按随机数字法分为脑安胶囊组162例及阿司匹林组158例。脑安胶囊组口服脑安胶囊,2次/d,2粒/次;阿司匹林组口服拜阿司匹林,100mg/次,1次/d。干预时间均为24～36个月。每年随访1次,随访内容为血压、血脂、CVHP积分的水平以及卒中的发病率及病死率。结果①脑安胶囊组累积随访470人年,卒中发生率和病死率分别为1.915%和0.851%;阿司匹林组累积随访460人年,卒中发生率和病死率分别为4.130%和2.391%。脑安胶囊组卒中综合发生率及病死率均低于阿司匹林组（P〈0.05）。②脑安胶囊组干预前、后,收缩压为（162±11）、（130±7）mmHg,舒张压为（101±9）、（83±6）mmHg,CVHP积分值为（49±13）、（82±9）;阿司匹林组干预前、后,收缩压为（161±10）、（137±5）mmHg,舒张压为（99±7）、（90±4）mmHg,CVHP积分值为（49±12）、（70±11）。两组干预后收缩压、舒张压及CVHP积分值差异均有统计学意义（P〈0.01）。结论脑安胶囊可以降低卒中的发生率和病死率,改善脑血管功能。在卒中高危人群一级预防中长期疗效优于阿司匹林。     

医院门诊卒中高危人群筛查与脑安胶囊对其的干预效果

目的评价门诊危险因素暴露者的卒中风险及脑安胶囊预防卒中的效果。方法在2005—2007年秦皇岛军工医院门诊患者中，选择具有高血压、心脏病、糖尿病、脂代谢紊乱、肥胖和中风家族史等卒中危险因素暴露者（1500例），采用有多普勒探头和压力传感探头的脑血管血流动力学监测仪进行颈动脉脑血管血流动力学检测和危险因素的调查，按知情同意的原则，在血流动力学积分值（CVHI）〈75分者中选择278例作为干预对象，并随机分为2组（脑安胶囊组132例，对照组146例），脑安胶囊组在健康教育、指导危险因素治疗等一般干预措施的基础上，口服脑安胶囊（CVHI积分值〈50分者，脑安胶囊2粒／次，2次／d，其中积分值〈25分者，睡前再加服1粒；积分值50—74分的个体，脑安胶囊1粒／次，2次／d。），对照组仅给予一般干预措施，卒中发生率每6个月随访1次，共随访2年。结果1500例门诊患者中，高血压、心脏病、糖尿病、卒中家族史和肥胖的暴露率分别为36．7％（550／1500）、22．4％（336／1500）、19．5％（292／1500）、9．9％（148／1500）和27．6％（414／1500），血流动力学积分值〈75分者占50．7％，脑安胶囊干预组和对照组的2年卒中累积发生率分别为2．3％（3／132）和7．5％（11／146），P=0．0767，脑安胶囊组干预后，CVHI≥50分者由55．6％上升到88．2％，对照组由64．38％上升至84．93％（P〈0．01）。结论医院门诊常见危险因素暴露者中，卒中风险明显升高；脑安胶囊能改善脑血管血流动力学，降低卒中的发生率。     

卒中高危个体药物干预前后脑血管血流动力学综合指标的比较

目的:评价不同药物干预措施对卒中高危个体脑血管功能的影响。方法:将上海社区或郊区农村筛选出的4415例,具有至少1项卒中危险暴露因素且脑血管血流动力学指标(CVHI)积分值<75分的高危个体,随机分为脑安胶囊、阿司匹林50mg和75mg组。1年后从上述3组干预对象中随机分别抽取445例、427例和381例作为评价对象,进行CVHI复查。结果:干预1年中,3组服药率达到96%以上,以脑安胶囊组依从性最好。干预1年后,3组干预对象的收缩压和舒张压水平均有显著降低(P<0.001);CVHI积分值平均水平均有显著提高,CVHI积分值高分的比例显著增高(P<0.001),提高的幅度依次为脑安胶囊组、75mg阿司匹林组和50mg阿司匹林组,3组提高到75分以上者的比例依次为44.0%、32.5%和33.3%。结论:实施干预1年后,脑安胶囊和阿司匹林均能显著改善血压水平和CVHI积分值,脑安胶囊和阿司匹林服药依从性均好。     

抗血小板药加他汀类药预防缺血性卒中患者复发的疗效观察

目的比较氯吡格雷加辛伐他汀与阿司匹林对患者再次发生缺血事件的疗效评价。方法选择2003年1月-2006年1月我院神经科住院治疗的脑梗死患者172例，观察组氯吡格雷75mg／d，顿服，同时，辛伐他汀10mg每晚1次口服；对照组肠溶阿司匹林75-100mg／d，顿服。出院后1、3、6、9、12个月各随访1次。主要终点指标：（1）再次缺血性卒中或短暂性脑缺血发作；（2）证实的脑出血；（3）消化道、眼底或皮肤出血；（4）外周血管栓塞。结果观察组缺血性卒中或发生率（6．1％）低于对照组（25．6％），差异有显著性（P〈0．05）。观察组与对照组出血并发症发生率分别为7．32％和7．8％，差异无显著性（P〉0．05）。结论氯吡格雷加辛伐他汀用于预防缺血事件复发优于阿司匹林，且未增加严重的并发症。     

氯吡格雷在预防冠心病患者脑梗死中的作用

目的：比较氯吡格雷与阿司匹林预防冠心病患者脑梗死的疗效。方法：490例冠心病患者分别在确诊后服用肠溶阿司匹林（100mg，1次／d，n=380）或氯吡格雷（75mg，1次／d，n=110），观察2组脑梗死发生率和安全性。结果：氯吡格雷组脑梗死发生率显著低于阿司匹林组（9．43％比27．5％，P〈0．05），出血和严重胃肠道反应发生率无显著差异。结论：对于冠心病患者，氯吡格雷预防缺血性卒中的效果明显优于阿司匹林，总体安全性至少与后者相当。     

长期口服小剂量肠溶阿司匹林对缺血性卒中合并慢性胃炎的干预作用

目的研究长期口服小剂量肠溶阿司匹林（ASA）对缺血性卒中合并慢性胃炎患者的影响。方法将650例缺血性卒中合并慢性胃炎患者随机分为两组,在常规治疗基础上,观察组给予肠溶ASA75—100mg、1次／d,对照组给予维生素E100mg、1次／d,连续随访3a,观察缺血性卒中、脑出血、上消化道出血和胃炎症状活动发生情况,有上消化道出血和胃炎症状活动的患者进行胃镜复查。结果观察组缺血性卒中发病率显著低于对照组（P〈0．05）;脑出血、上消化道出血、胃炎症状活动发生率两组比较均元统计学差异（P〉0．05）,两组胃镜复查显示胃黏膜病损程度相似。结论合并慢性胃炎的缺血性卒中患者长期口服小剂量肠溶ASA能降低缺血性卒中的再发率,且并发脑出血和胃黏膜损伤的风险性不增加。     

抗血小板药预防缺血性卒中患者缺血事件再发

目的：比较氯吡格雷、阿司匹林和阿司匹林加双嘧达莫对缺血性卒中患者再次发生缺血事件的影响。方法：2003年1月-2005年1月收治的急性脑梗死患者314例，分为氯吡格雷组（82例，75mg/d）、阿司匹林组（106例，肠溶阿司匹林75—100mg/d）和阿司匹林加双嘧达莫组（126例，阿司匹林肠溶75～100mg/d和双嘧达莫150mg/d）。至少在出院后1、3、6、12个月各随访1次。主要终点指标：（1）再次缺血性卒中或短暂性脑缺血发作（TLA）；（2）经CT证实的脑出血；（3）外周血管血栓栓塞；（4）出现胃肠道、眼底或皮肤出血。结果：氯吡格雷组缺血性卒中和TIA的发生率（6．1％）低于阿司匹林组（26．7％，P〈0．05）或阿司匹林加双嘧达莫组（20．6％，P〈0．05），阿司匹林组与阿司匹林加双嘧达莫组组无显著差异（P〉0．05）。氯吡格雷组出血发生率为7．32％，低于阿司匹林组（7．62％）或阿司匹林加双嘧达莫组（7．94％），但无统计学差异（P〉0．05）。结论：氯吡格雷预防缺血事件再发的效果优于阿司匹林或阿司匹林加双嘧达莫，且并未增加出血性并发症。     

六味安消胶囊预防化疗致便秘50例

[目的]观察六味安消胶囊预防化疗所致便秘的疗效。[方法]观察组（50例）化疗期间予六味安消胶囊3粒，3次／d口服，每周期化疗前3d开始至化疗结束后5d为1个疗程。对照组（50例）只给予化疗。化疗2周期后评价预防便秘疗效。[结果]观察组便秘发生率为6．0％，对照组为20．0％（P〈O．05），口服六味安消胶囊不良反应轻微。[结论]六味安消胶囊预防化疗所致便秘疗效确切，可作为化疗的常规辅助中药。     

阿司匹林与氯吡格雷联用对脑梗死急性期高危患者神经功能及生活质量的影响

目的探讨阿司匹林与氯吡格雷联合应用对脑梗死急性期高危患者神经功能与生活质量的影响。方法选取脑梗死急性期高危患者80例,脑梗死发病6 h～7 d,Eeeen卒中评分均〉6分。随机分为观察组和对照组各40例,两组均给予常规治疗,观察组联合应用阿司匹林和氯吡格雷口服,第1～7天给予阿司匹林100 mg、氯吡格雷75 mg,1次/d,共7 d。对照组给予阿司匹林100 mg口服,1次/d,长期服用。入院时及入院后第7天采用美国国立卫生院卒中评分量表（NIHSS）评分对两组患者治疗前后的神经功能进行评价。治疗后1年采用健康调查简表（RAND-36）评估健康相关的生活质量（HRQOL）。结果治疗后,两组NIHSS评分均低于治疗前,观察组NIHSS评分低于对照组,心理健康及活力得分高于对照组（P均〈0.05）。两组患者均无严重不良反应发生。结论阿司匹林与氯吡格雷联合应用可改善脑梗死急性期高危患者的神经功能,提高远期生活质量。     

高血压患者干预前后脑血管血流动力学的观察

目的 :评价“脑卒中高危人群筛检与重点干预”策略实施前后对高血压患者脑血管功能的影响。方法 :选择脑卒中干预队列人群中具有高血压病史 ,脑血管功能积分低于 70分并接受“脑安胶囊”重点干预的卒中高危人群 ,分成单纯的高血压和高血压组 （n=4 2 34）并发其他危险因素组 （n=2 871） ,分别比较两组患者自身干预前后的脑血管血流动力学 （CVHI）。结果 :高血压患者接受“脑安胶囊”重点干预后 ,两组 CVHI均显著改善 ,脑血管功能积分在两组研究对象中分别上升 13.8分和 14 .3分 ,上升幅度分别为 2 8.7%和 32 .5 %。结论 :实施干预策略一年后 ,高血压患者的 CVHI和脑血管功能显著改善。     

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.     

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.     

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.