康复运动对心衰患者血浆可溶性粘附分子水平的影响

目的:通过观察充血性心力衰竭(CHF)患者运动训练前、后血浆可溶性细胞间粘附分子-1(sICAM-1)、血管细胞粘附分子-1(sVCAM-1)和E-选择素(sE-selectin)水平的变化,探讨其临床意义。方法:用ELISA法检测23例CHF患者6 min步行运动试验前、后血浆sICAM-1、sVCAM-1、sE-selectin水平,并以20例健康体检者作为对照,18例患者运动训练一个月后进行了随访。结果:CHF患者基础状态血浆sICAM-1、sVCAM-1和sE-selectin水平显著高于对照组(P<0.05-<0.01),且sICAM-1、sVCAM-1水平与心功能密切相关(P<0.05);运动后即刻sICAM-1、sVCAM-1水平较运动前升高(P<0.05),而sE-selectin水平运动前、后无显著性差异;康复训练一月后,无论基础状态还是运动后,sICAM-1、sVCAM-1水平较前次实验明显降低(P<0.05),而sE-selectin水平无显著性变化。结论:CHF患者血浆可溶性粘附分子水平较正常升高,6 min步行运动试验升高CHF患者血浆sICAM-1、sVCAM-1水平,接近日常生活活动强度的运动训练可降低该二者水平。     

充血性心力衰竭患者运动前后血浆细胞间粘附分子—1含量及临床意义

目的：探讨充血性心力衰竭（CHF）患运动前后血浆细胞间粘附分子－1（ICAM－1）的含量变化及其意义。方法：应用双抗体夹心法测定54例充血性心力衰竭患静息状态及六分钟步行运动后即刻CHF患血浆ICAM－1含量。结果：运动前，CHF患的血浆ICAM－1显高于对照组，且含量与心功能级别密切相关；低钠组CHF患ICAM－1含量明显高于正常血钠组（P＝0．039），运动后CHF患ICAM－1含量较运动前明显增加（O＝0．033），结论：ICAM－1在CHF发生发展中起重要作用。且与病情严重程度相关，CHF患运动后血浆ICAM－1显高于正常人的现象说明CHF患对运动的耐受性明显低于正常人。     

运动训练对心力衰竭患者血液白细胞和肿瘤坏死因子的影响

目的 探讨6min步行运动训练治疗充血性心力衰竭患者的价值;观察同同程度充血性心衰患者白细胞及分类和血浆肿瘤坏死因子（TNF）α水平的变化以及运动训练对其影响。方法 60例Ⅱ、Ⅲ级心功能充血性心衰患者在入院24h之内作6min步行运动实验,记录其行走距离,静息状态和运动后心率,血浆TNFα,血液白细胞总数及分类,然后随机分为两组（训练组32例,对照组28例）,两组均行常规抗心衰药物治疗,但训练组2次行6min步行运动训练,8周后重复检测上述指标。对23例Ⅳ级心功能CHF患者观察了入院时上述血浆细胞因子和白细胞及分类的。结果 Ⅲ、Ⅳ级CHF患者白细胞总数、中性粒细胞和单核细胞百分比较Ⅱ级CHF患者明显增高（P＜0.010;血浆TNFα在Ⅱ、Ⅲ、Ⅳ级CHF中的差异有显著性。运动训练可显著改善CHF症状,减慢增快的心率,增加行走距离。训练组与对照组的差异有显著性（P＜0.05）。运动训练组治疗8周后,CHF患者白细胞、中性粒、单核细胞百分比和血浆TNFα的下降程度较对照组比更显著（P＜0.05）。结论 6min步行运动训练不仅可明显改善心衰患者的TNFα等细胞因子的过度激活,还可改善心衰患者可能存在着的免疫机能缺陷。     

充血性心力衰竭患者血浆TNF-α、可溶性Fas、可溶性ICAM-1、NO和MDA含量的改变

充血性心力衰竭患者血浆TNF-α、可溶性Fas、可溶性ICAM-1、NO和MDA含量的改变     

充血性心力衰竭患者血浆一氧化氮、内皮素-1与肿瘤坏死因子-α的含量及其临床意义

神经肉分泌和细胞因子的异常改变是促进充血性心力衰竭（CHF）发生发展的重要因素。内皮细胞分泌的血管活性物质内皮素-1（ET-1）、一氧化氮（NO）和炎症细胞因子肿瘤坏死因子-α（TNF-α）可能参与了此病理生理过程。本文对不同级别CHF患者血浆NO、ET-1及TNFα水平的变化进行临床观察，探讨CHF的病理机制并为临床病情监测提供新的指标。     

原发性高血压患者血清可溶性细胞间粘附因子(sICAM-1)与一氧化氮、过氧化脂质水平相关性的研究

目的检测原发性高血压患者血清可溶性细胞间粘附因子(sICAM-1)水平并探讨其与一氧化氮(NO)及过氧化脂质水平的相关性.方法采用ELISA法测定血清sICAM-1浓度,分别用硝酸还原酶法、硫代巴比妥酸(TBA)法及黄嘌呤氧化酶法检测NO水平、丙二醛(MDA)含量及超氧化物岐化酶(SOD)活性.结果与正常对照组相比,65例原发性高血压病患者血清sICAM-1浓度和MDA含量升高(P＜0.01),而NO水平和SOD活性降低(P＜0.01).相关分析发现血清sICAM-1浓度和MDA含量呈正相关(r=0.94,P＜0.01),而与NO水平和SOD活性水平呈负相关(r=-0.58、r=-0.93,P值均＜0.01).结论原发性高血压患者血清sICAM-1明显升高,且与机体氧化应激增强及NO降低有关.     

血浆细胞因子水平与老年慢性心力衰竭患者多器官功能衰竭的关系

目的　探讨老年慢性心力衰竭 (CHF)时多器官功能衰竭 (MOF)的发生与血浆细胞因子的关系。方法　 6 2例老年CHF者 ,男 4 4例 ,女 18例 ,平均年龄 (70± 13)岁。根据是否合并MOF分为单纯CHF组和CHF MOF组 ,各 31例 ;再根据治疗后是否存活分为存活及死亡两个亚组。另设正常对照组 31例。分别于入院时和治疗后测定左室射血分数 (LVEF) ,血浆肿瘤坏死因子α(TNFα)、白介素 1β(IL 1β)、可溶性细胞间粘附分子 1(sICAM 1)、心钠素 (ANP)水平。结果　血浆中TNFα ,IL 1β ,sICAM 1水平在存活与死亡之间比较 ,MOF组较CHF组明显升高 ;而组内比较 ,死亡者又较存活者明显增加。CHF组与MOF组在同是存活或死亡之间比较 ,LVEF和ANP无明显差异 ,但两组内存活和死亡者之间比较 ,在治疗后则有明显差异 ;两组治疗后与治疗前比较均有明显差异 ,存活者改善而死亡者恶化。结论　细胞因子TNFα,IL 1β ,ICAM 1的血浆水平增加与MOF的发生发展密切相关 ,通过检测血浆中上述细胞因子的水平 ,可作为判断有无MOF及其严重程度的指标。     

慢性心力衰竭患者氧化应激与细胞因子的变化及卡维地洛的影响

目的　观察慢性心力衰竭患者 (CHF)氧化应激与细胞因子的变化及卡维地洛对其影响。方法　选择 6 7例CHF患者 ,随机分为对照组 (33例 )及卡维地洛组 (34例 ) ,后者在常规治疗基础上合用卡维地洛 5～ 2 0mg/d ,疗程12w。心脏多普勒超声测定左室射血分数 (LVEF)、左室收缩末期容量指数 (LVESVI) ,并测血浆丙二醛 (MDA)、血清超氧化物歧化酶 (SOD)、肿瘤坏死因子 -α(TNF -α)、白细胞介素- 6 (IL - 6 )及基质金属蛋白酶 - 9(MMP - 9)。结果　随着NYHA心功能分级增加 ,CHF患者MDA、TNF -α、IL - 6及MMP - 9显著增高 ,SOD显著降低 (P <0 0 1)。卡维地洛使血浆MDA、TNF -α、IL - 6及MMP - 9明显降低 (P <0 0 1) ,SOD、LVEF增加、LVESVI降低 (P <0 0 5 ) ,LVEF增加与MDA、TNF -α、IL - 6及MMP - 9降低负相关 (γ =- 0 4 0 ,- 0 36 ,- 0 38,- 0 4 3,P <0 0 5 ) ,与SOD增加正相关 (γ =0 38;P <0 0 5 )。结论　卡维地洛改善CHF患者心功能 ,可能与降低氧化应激与细胞因子水平有关。     

氟伐他汀对充血性心力衰竭患者血清sICAM-1和sVCAM-1的影响

目的:探讨氟伐他汀短期治疗对充血性心力衰竭(CHF)患者血清中可溶性细胞间黏附分子-1(sICAM-1)、可溶性血管细胞黏附分子-1(sVCAM-1)和肿瘤坏死因子α(TNF-α)水平的影响。方法:将97例CHF患者随机分为对照组(常规治疗组)和试药组(氟伐他汀组)。采用ELISA测定治疗前及治疗两周后血清中sICAM-1、sVCAM-1和TNF-α水平。结果:两种方法都可以明显降低血清sICAM-1、sVCAM-1和TNF-α水平(P0.05);试药组血清TNF-α水平降低更为显著(P0.05),但血清sICAM-1和sVCAM-1降低水平与对照组无显著差别。结论:在常规治疗基础上短期加用氟伐他汀治疗不能进一步降低CHF患者血清sICAM-1和sVCAM-1水平。     

老年冠心病血清中可溶性L—选择素及细胞间粘附分子—1的研究

目的：检测老年冠心病患者血清可溶性L－选择素（sL-selectin)的水平,探讨它们在冠心病发病中的意义。方法：采用双抗体夹心法检测24例急性心肌梗死患圪,30例不稳定型心绞痛患者及20例健康体检查血清sL-selectin sICAM-1,IL-6,TNF-α的水平。结果：冠心病患者血清中sL-selectin,siCAM-1,IL-6,TNF-α的水平平均高于正常组,心肌梗死组高于心绞痛组,有统计学意义。且sL-selectin,sICAM-1分别与IL－6,TNF－a成正相关。结论：冠心病伴发炎症反应,炎症反应参与缺血性心肌损伤,sL-selectin与sICAM-1在此过程中发挥重要作用。     

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.