卒中相关性感染的危险因素

急性卒中患者极易并发感染,严重影响预后.随着卒中相关性感染发病机制研究的不断深入,其相关危险因素亦越来越明确,包括卒中严重程度、卒中类型和部位、营养不良、糖尿病、吞咽障碍、意识障碍、侵袭性操作、制酸药的使用等.文章对卒中相关性感染的主要危险因素进行了综述.     

水痘—带状疱疹病毒与单纯疱疹病毒—1对脑神经细胞的致病性

水痘-带状疱疹病毒(VZV)是一种常见病毒。资料显示至少有95%的成人感染。初次感染 VZV 以后,病毒可在部分机体内潜伏。当机体免疫功能受到破坏或抑制。病毒可从潜伏状态下复活,进而引起中枢神经系统的感染。临床 VZV 脑炎多见于免疫功能异常的患者。单纯疱疹病毒(HSV)为散发性病毒性脑炎的主要病原之一,易感人群与 VZV 感染存在一定差异。为了观察在没有体内免疫因素影响下,VZV 和 HSV 对脑神经组织的致病性。实验采用体外脑神经细胞感染,以比较两种病毒对中枢神经系统的致病特点。     

卒中相关性肺炎的综合防治措施

卒中相关性肺炎(stroke-associated pneumonia,SAP)是指原先无肺部感染的卒中患者罹患的感染性肺实质(含肺泡壁,即广义的肺间质)炎症[1-2].SAP亦被称为卒中后肺炎(post-stroke pneumonia),是指卒中发病时无感染,也不处于感染潜伏期,而是在卒中发病48 h后发生的肺炎[3].SAP是卒中最主要的严重并发症之一,发生率高达10％[4-5],被认为是卒中患者转归不良和死亡的最重要原因之一[6-9].     

恶性血液病患者合并带状疱疹26例临床分析

带状疱疹是由水痘一带状疱疹病毒（VZV）引起的急性疱疹性皮肤病。初次感染VZV后，临床上表现为水痘（儿童多见）或呈隐性感染，此后病毒侵入感觉神经末梢，再移动并持久潜伏于脊髓后根神经节的神经元中。免疫功能低下时，如某些传染病、恶性肿瘤、系统性红斑狼疮、外伤、放射治疗、使用某些药物（如砷剂、免疫抑制剂等）均可引起病毒的再活动，     

气温骤降条件下炎性细胞因子、基因表达与卒中发病的关系

除受传统危险因素影响之外,卒中发病还与气温骤降有关.对绝大多数地区的研究发现,卒中与冷天气关系密切,后者通过多种机制影响卒中的发病,如血管调节机制的季节变化、血液成分的改变以及对感染因素的影响等.研究证实,炎症凶子在动脉粥样硬化和卒中发病中起着重要作用,而寒冷应激对卒中患者基凶表达产生的影响也町能起着重要作用.文章概述了气温骤降与卒中发病的关系和机制.     

近期细菌和病毒感染是脑缺血的危险因素

作者采用病例对照法，探讨了近期（病前１周内）感染作为卒中危险因素的作用，以及感染与卒中发病的联系。研究包括１６６例急性脑缺血病人（脑缺血组）男１１０例，女５６例；平均年龄６１２岁±１３８岁）和１６６例同期住院的其他神经系统疾病病人（对照组），两组...     

卒中后抑郁的发病机制

卒中后抑郁是脑卒中的常见并发症。本文就卒中后抑郁的发病机制进行综述，结果提示卒中后抑郁的发病机制非常复杂，可能是神经生物学因素和社会心理因素共同作用的结果，其发生机制可能有以下2种学说：①原发性内源性学说；②反应性机制学说。从生物、心理及社会3方面进行干预是防治卒中后抑郁的有效途径。     

急性缺血性卒中最初24h内赖诺普利治疗高血压及随访

急性缺血性卒中后即刻高血压与残疾率和病死率增高有关，但在卒中发病后即刻进行抗高血压治疗的资料却寥寥无几。英国Leicester Warwick医学院衰老和卒中医学系的Eveson等进行了一项平行分组的随机双盲安慰剂对照研究，以探讨卒中发病后24h内开始口服赖诺普利的血流动力学效应和安全性。     

重度睡眠呼吸暂停为老年人缺血性卒中的危险因素之一

业已证实，睡眠呼吸暂停与中年人卒中发病有关。然而关于睡眠呼吸暂停是否同为老年人卒中发病的独立危险因素尚待清楚，本文就此进行了前瞻纵向研究。     

急性缺血性卒中发病的昼夜差异

为了明确缺血性卒中在一天中某一时段发病和其不同亚型的昼夜发病差异，作者对医院卒中登记资料作了研究，分析了首发卒中和复发卒中发病的昼夜节律是否不同。研究对象是１９９４年３月～１９９６年５月连续收治的缺血性卒中病人，发病后４８ｈ内作了ＣＴ检查（至少１次）。缺血性卒中分为腔隙性、非腔隙性和不确定性卒中；非腔隙性卒中又分为心源栓塞性（栓塞性卒中，ＰＥＳ）和非心源栓塞性（血栓形成性卒中，ＰＴＳ）两亚型。作者对首发卒中和复发卒中也作了分析。病人首次表述因卒中症状被惊醒，其卒中可能在睡眠中发病；病人首次表述从…     

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.