抗血小板药物对脑梗死患者血小板-白细胞聚集体的影响

目的观察急性脑梗死患者血小板一白细胞聚集体（PLA）的变化以及阿司匹林和氯吡格雷对其的影响。方法对急性脑梗死和对照组患者血小板聚集率（PAR）、可溶性P选择素（sP—sel）、C-反应蛋白（CRP）和PLA进行检测。同时将急性脑梗死患者随机分为阿司匹林组和氯吡格雷组,观察两组患者治疗前后斯堪的纳维亚神经卒中量表（SNSS）评分、PAR、sP—sel、CRP和PLA的变化。结果急性脑梗死患者血小板单核细胞聚集体（PMA）显著高于对照组（P〈0．001）;PMA水平与PAR、sP-sel、CRP、血糖、胆固醇和纤维蛋白原正相关（P〈0．05）;与SNSS评分负相关（P〈0．05）。脑梗死患者治疗后PMA、PAR明显下降（P≤0．001）,且治疗后氯吡格雷组PMA和PAR（ADP）降低较阿司匹林组更明显（P〈0．05）,但PAR（AA）两组间差异无统计学意义;sP-sel在氯吡格雷组治疗后显著下降（P〈0．001）。结论急性脑梗死患者反映血小板活化的敏感指标PMA明显增高,阿司匹林和氯吡格雷可以降低PMA水平,其中氯吡格雷作用较阿司匹林更为明显。     

同型半胱氨酸与脑梗死关系的研究

目的 探讨同型半胱氨酸水平及氧化、抗氧化指标与脑梗死的关系。方法 检测脑梗死及对照组血清同型半胱氨酸（Hcy）、叶酸（FA）、维生素B12（VitB12）、一氧化氮（P-NO）、维生素C（P-VitC）、脂质过氧化物（P-LPO）、红细胞超氧化物歧化酶（E-SOD）水平。结果 脑梗死组Hcy、P-NO、P-LPO水平显著高于对照组（P〈0．001），而P-VitC、E-SOD、FA、VitB12水平显著低于对照组（P〈0．001）。脑梗死组Hcy水平与FA及VitB12水平呈负相关（r=-0．47、-0．32，P〈0．001、P〈0．05），tHcy水平与P-VitC含量呈负相关（r=-0．55，P〈0．001），tHcy水平与P-LPO、P-NO含量呈正相关（r分别为0．38、0．50，P〈0．001）。P-VitC水平与P-LPO含量呈负相关（r=-0．60、P〈0．001），E-SOD活性与P-NO含量呈负相关（r=-0．83、P〈0．001）。脑梗死组中高Hcy亚组P-NO、P-LPO含量显著高于正常Hcy亚组（P〈0．001），而E-SOD、P-VitC含量显著低于正常Hcy亚组（P〈0．01、P〈0．001）。结论 Hcy水平升高与脑梗死密切相关，FA、VitB12缺乏是Hcy水平升高的影响因素；氧化应激反应在脑梗死中起重要作用；Hcy水平升高可能是导致氧化应激产生的一种因素。     

急性脑梗死患者血清CRP动态变化及其临床意义

126例急性脑梗死患者根据梗死灶大小分为大梗死组（〉3．0cm）56例和小梗死组（≤3．0cm）70例,测定其入院后第1、7、28天血清C反应蛋白（CRP）水平,并与122例健康体检者（对照组）比较。发现大、小梗死组在入院后第1、7、28天血清CRP水平均明显高于对照组（P〈0．01）,前两组间亦有明显差异（P〈0．01）。血清CRP异常的急性脑梗死患者预后无变化和死亡病例高于CRP正常者（P〈0．05）。提示动态测定急性脑梗死患者血清CRP水平可作为判定病情及预后的重要生物学指标。     

C-反应蛋白与冠心病关系的研究

目的：探讨高敏C-反应蛋白（hs—CRP）水平与冠状动脉疾病的关系。方法：对经冠状动脉造影确诊或有明确心肌梗塞的冠心病患者82例和同期经冠状动脉造影证实冠状动脉无狭窄的正常对照者43例进行对照研究。所有研究对象在入院初或病情稳定48h后采清晨空腹静脉血，应用微粒子增强透射免疫分析法测定血浆hs—CRP水平。结果：冠心病组的血浆hs—CRP水平显著高于对照组（P〈0．001）；在冠心病组中，急性冠脉综合征（ACS）组（42例）的hs—CRP水平显著高于稳定型心绞痛（SAP）组（40例）（P〈0．001），SAP组的hs—CRP水平也显著高于对照组（P〈0.01）。单支病变（19例）、双支病变（23例）、三支及左主干病变（30例）组的hs—CRP水平均显著高于对照组（P分别〈0.01，〈0.001和〈0.001）。以人群血浆hs—CRP水平的第90分位值3mg／L为截点，将冠心病组中行冠脉造影的对象分为低hs—CRP水平组和高hs—CRP水平组，可见后者多支病变（包括双支病变和三支及左主干病变）的例数（n=36）显著多于前者（n=17）（P〈0．05）。结论：高敏C-反应蛋白水平可反映冠状动脉疾病及其病变的严重程度。     

CRP与糖尿病、心血管并发症的关系

选择体重指数无差异的2型糖尿病（DM）组、2型糖尿病心血管病（DH）及健康对照组。测定其CRP、白细胞计数（wBC）、纤维蛋白原（FIB）及空腹血糖（FPG）等。结果：两组CRP（P〈0．001）FPG（P〉0．001）及FIB（P〈0．05）均高于对照组，且DH组CRP（P〈0．001）高于DM病组，两组间FPG、FIB及其他指标无显著性差异（P〉0．05），两病例组与对照组WBC及血脂结果无显著性差异（P〉0．05）。结论：CRP水平与2型糖尿病及其心血管并发症的发生、发展密切相关。     

脑梗死患者颈动脉粥样硬化与血清超敏C-反应蛋白的相关性研究

目的探讨急性脑梗死患者颈动脉粥样硬化与血清超敏C-反应蛋白（hs—CRP）的相关性。方法对来院就诊的102例急性脑梗死患者和健康体检者96例均进行颈动脉超声检查，测量颈动脉内膜中层厚度（IMT），观察有无颈动脉斑块形成及斑块的性质，同时进行血清hs—CRP浓度的测定。结果两组研究对象IMT正常者中hs—CRP浓度间差异有显著性意义（P〈0．05）。脑梗死组中IMT正常者10例，增厚者19例，生成斑块者73例，3组患者hs—CRP间差异有非常显著性意义（P〈0．01），且两两比较各组患者hs—CRP水平间差异亦均有非常显著性意义（P〈0．01）。颈动脉斑决生成者中稳定斑块者与不稳定斑块者hs—CRP间差异亦有非常显著性意义（P〈0．01）。结论血清hs—CRP与急性脑梗死患者颈动脉粥样硬化的发生有一定相关性，炎症反应可能参与了急性脑梗死颈动脉粥样硬化的形成。     

长春西汀联合血栓通治疗急性脑梗死的临床观察

目的探讨长春西汀联合血栓通治疗急性脑梗死的临床疗效及对C反应蛋白（CRP）水平的影响。方法将80例发病在72h内的急性脑梗死病人,随机分为两组。治疗组联合应用长春西汀及血栓通,对照组仅采用血栓通。观察两组治疗前后C反应蛋白水平和神经功能缺损评分的情况及疗效。结果两组治疗后血清CRP浓度、神经功能缺损评分较治疗前有明显降低（P〈0．05）,但治疗组降低较对照组更显著（P〈0．05）;治疗组临床疗效总有效率为92．5％,优于对照组的80．0％,差异有统计学意义（P〈0．05）。结论长春西汀联合血栓通比单独血栓通治疗急性脑梗死有效,可能与降低CRP水平、神经功能缺损评分有关。     

急性脑梗死患者血清hs-CRP、Hcy和脂联素检测的临床意义

目的探讨血清超敏C反应蛋白（hs—CRP）、同型半胱氨酸（Hcy）和脂联素水平与急性脑梗死的关系。方法检测85例急性脑梗死患者（观察组）及45例健康体检者（对照组）血清hs—CRP（免疫散射法）、Hcy（化学分光法）、脂联素（ELISA法）水平,分析其与梗死体积及神经功能缺损程度的关系。结果观察组hs—CRP和Hcy水平明显高于对照组,脂联素水平明显低于对照组,P均〈0．05;随梗死体积增大及神经功能缺损程度加重hs-CRP和Hcy水平逐渐升高,血清脂联素水平逐渐降低,P〈0．05;hs—CRP和Hcy水平与血清脂联素水平呈显著负相关,P〈0．05。结论hs—CRP、Hcy和脂联素水平可反映急性脑梗死患者的脑梗死状态,对判断病情和预后有重要价值。     

ACS患者血清高敏C反应蛋白水平变化及意义

目的观察急性冠脉综合征（ACS）患者高敏c反应蛋白（hs．CRP）水平变化,并探讨其意义。方法采用酶联免疫吸附法检测60例ACS患者[不稳定型心绞痛32例（UAP组）,急性心肌梗死患者（AMI组）28例]和36例健康人（对照组）血清中的hs—CRP、血脂和心肌酶。结果血清hs．CRP水平UAP组、AMI组均显著高于对照组（P〈0．01）,AMI组高于UAP组（P〈0．05）;ACS患者hs—CRP水平与LDL-C呈正相关（r=0．460）,与HDL-C水平呈负相关（r=-0．350,P〈0．05）,与CK、CK-MB呈正相关（r分别为0．0．53、0．51,P〈0．05）。结论ACS患者血清hs-CRP升高,可作为诊断ACS及判断病情的指标。     

82例急性脑梗死患者血清CRP、D—D水平检测结果临床分析

目的探讨急性脑梗死患者c,反应蛋白（CRP）、D-二聚体（D—D）水平的变化与疾病诊断、治疗之间的关系及其临床价值。方法选择我院收治的82例急性脑梗死患者为观察组,以同期在我院进行体检的82例健康者作为对照组。检测观察组患者入院后第2、7、14、21天CRP、D．D的水平,并将入院后第2天的CRP、D—D水平与对照组的检查结果进行对比。结果观察组患者入院第2天CRP为（16．52±1．31）mg／L,显著高于对照组的（3．15±0．96）mg／L;观察组患者入院第2天D—D为（0．99±0．32）mg／L,显著高于对照组的（O．36±0．28）mg／L,差异均有统计学意义（P〈0．05）。在观察组患者中,入院后第2天,中、重度患者CRP均明显高于轻度患者（P〈0．05）,重度患者CRP、D—D水平明显高于中度患者（P〈0．05）。不同程度急性脑梗死患者不同时间段的CRP、D—D差异有统计学意义。结论CRP、13—13水平的高低可能反映急性脑梗死患者炎症程度及血栓情况,在疾病的诊断、治疗中具有一定指导意义。     

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.