疏血通注射液治疗原发性脑出血的临床研究

目的观察疏血通注射液(其主要成分为水蛭素)对原发性脑出血血肿吸收、血肿周围低密度区改变和神经功能恢复的影响。方法465例原发性脑出血患者随机分为治疗组和对照组。治疗组给予疏血通注射液6mL,1次/d静滴,连用21d,甘露醇作为基础治疗药物。于治疗第4、10和第21天行CT检查测量血肿体积、血肿周围低密度区改变,肢体功能改变采用欧洲卒中量表(ESS)进行评价。结果与对照组相比,第10和21天治疗组血肿体积和血肿周围低密度区明显缩小(P<0·01),ESS评分较高(P<0·05)。结论疏血通注射液能促进脑出血时的血肿吸收、血肿周围低密度区缩小和神经功能改善。     

疏血通注射液治疗原发性脑出血的临床研究

目的：观察疏血通注射液（其主要成分为水蛭素）对原发性脑出血血肿吸收、血肿周围低密度区改变和神经功能恢复的影响。方法：465例原发性脑出血患者随机分为治疗组和对照组。治疗组给予疏血通注射液6mL，1次／d静滴，连用21d，甘露醇作为基础治疗药物。于治疗第4、10和第21天行CT检查测量血肿体积、血肿周围低密度区改变，肢体功能改变采用欧洲卒中量表（ESS）进行评价。结果：与对照组相比，第10和21天治疗组血肿体积和血肿周围低密度区明显缩小（P〈0．01），ESS评分较高（P〈0．05）。结论：疏血通注射液能促进脑出血时的血肿吸收、血肿周围低密度区缩小和神经功能改善。     

疏血通注射液治疗原发性脑出血的临床研究

目的观察疏血通注射液对原发性脑出血血肿吸收、血肿周围低密度区改变和神经功能恢复的影响。方法将160例患者采用成组设计随机分为两组:对照组给予甘露醇、呋塞米脱水降颅内压,控制血压,防止出血等常规治疗。治疗组在常规治疗的基础上加用疏血通注射液6 mL加5%葡萄糖250 mL静脉输注,1次/日,连续21 d。于治疗第4天、第10天和第21天行CT检查测量血肿体积、血肿周围低密度区,并进行美国国立卫生院神经功能缺损评分(NIHSS)。结果两组血肿体积、NIHSS评分总的变化有统计学意义(P0.01),于治疗后第10天、第21天治疗组血肿体积、NIHSS评分较对照组明显缩小(P0.01);两组血肿周围低密度区范围总的变化趋势有统计学意义(P0.01),治疗组在第4天、第10天和第21天小于对照组(P0.01)。结论疏血通注射液能促进脑出血时的血肿吸收、血肿周围低密度区缩小和神经功能改善。疏血通对于小于30 mL,6 h～24 h后稳定脑出血是安全有效的。     

疏血通注射液治疗急性脑出血的临床研究

目的观察疏血通注射液对原发性脑出血患者血肿吸收、血肿周围低密度区改变及神经功能恢复情况的影响;同时进行凝血酶-抗凝血酶复合物(TAT)含量的测定,观察疏血通注射液对TAT含量的影响。方法将64例原发性脑出血患者随机分为治疗组(33例)和对照组(31例),治疗组给予疏血通注射液6mL,每日静脉输注1次,连用14d,其他常规治疗同对照组。两组于治疗前、治疗后24h、治疗第7天、治疗第14天行头颅CT检查测量血肿体积、血肿周围低密度区体积,同时采用酶联免疫法(ELISA法)行TAT含量的测定;神经功能改变采用斯堪的那维亚卒中量表(SSS)进行评价。结果治疗后24h两组血肿体积均无明显改变,且两组间无统计学意义;治疗第7天、第14天治疗组与对照组比较血肿体积缩小(P<0.05)。治疗后24h两组血肿周围低密度区体积均增大,且两组间无统计学意义;治疗第7天、第14天治疗组较对照组血肿周围低密度区范围减小(P<0.05),治疗第7天、第14天治疗组较对照组SSS评分明显改善(P<0.05);治疗第14天两组TAT含量均减低,且两组间无统计学意义。结论疏血通注射液能促进急性脑出血时的血肿吸收、血肿周围低密度区缩小和改善神经功能,并可以有效抑制凝血酶的活性。     

黄角颗粒治疗自发性脑出血的临床研究

目的观察黄角颗粒治疗自发性脑出血的临床疗效。方法选取59例符合条件的脑出血患者,随机分为观察组(30例)与对照组(29例)。对照组采用西医常规治疗,观察组在常规治疗基础上加用黄角颗粒治疗,在入院第1天,治疗后第4天、第8天采用颅脑CT测量,依据多田氏公式计算两组患者脑血肿量的大小和血肿周围低密度容积的大小;并进行中医证候积分和神经功能缺损评分评定。结果入院第1天,两组中医证候积分、神经功能缺损评分、血肿量大小及血肿周围低密度容积大小方面比较无统计学意义(P0.05);治疗后第4天、第8天,观察组中医证候积分、神经功能缺损评分、血肿量大小及血肿周围低密度容积的大小均低于对照组(P0.05或P0.01)。结论黄角颗粒治疗脑出血无论在减轻血肿周围低密度容积、脑血肿方面,还是改善中医证候积分、神经功能缺损评分方面均优于常规治疗。     

舒血宁注射液对高血压性脑出血血肿吸收速度的影响

目的观察舒血宁注射液对原发性脑出血血肿吸收的影响。方法将64例原发性脑出血患者随机分为治疗组和对照组。对照组给予一般性支持疗法;治疗组在一般性支持疗法的基础上,每日静脉滴注舒血宁注射液(10ml加入5%葡萄糖注射液250ml)1次,连续用药3周。于治疗第7、14、21d时分别用CT检查测量血肿体积。结果与对照组相比,治疗结束后治疗组血肿体积显著缩小(P0.01)。结论舒血宁注射液能促进脑出血患者的血肿吸收和神经功能改善。     

血栓通注射液治疗脑出血恢复期病人184例

目的观察脑出血恢复期病人应用血栓通注射液治疗对改善微循环的临床疗效。方法352例脑出血病人随机分为治疗组与对照组,治疗组于脑出血10d~14d时在基础治疗的同时加血栓通注射液治疗,疗程为14d;对照组仅予基础治疗。两组均于治疗前及治疗后第14天、第28天进行神经功能缺损评分(NDS)评定与头颅CT复查。结果第28天时治疗组的神经功能改善评分为(5.03±1.71)分,明显优于对照组的(7.43±1.68)分(P<0.01)。头颅CT观察示血肿吸收及水肿消退为(2.46±1.51)mL,明显低于对照组的(8.29±2.86)mL(P<0.01)。结论血栓通注射液对脑出血恢复期病人的微循环改善有一定疗效。     

尼莫地平对锥颅血肿抽吸术后病灶周围水肿的影响

目的观察高血压性脑出血(HICH)患者行锥颅血肿抽吸术后尼莫地平对病灶周围水肿面积及神经功能的影响。方法高血压脑出血患者58例,被随机分为治疗组30例,对照组28例。两组患者均采用颅内血肿锥颅抽吸术及脱水、止血、抗炎、控制血压等治疗。治疗组在此基础上加用尼莫地平,10mg/d静脉滴注,15d为1疗程。观察两组患者第7天、第15天与第1天病灶周围水肿面积及神经功能缺失评分之差。结果治疗组、对照组第1天与第7天病灶周围水肿面积之差分别为(1.01±0.06)cm2、(0.01±0.03)cm2,两组比较差异有显著意义(P<0.01);两组第1天与第15天病灶周围水肿面积之差为(1.87±0.11)cm2、(0.60±0.08)cm2,神经功能缺失评分之差为(7.24±0.23)分、(2.67±0.31)分,两组比较差异均有显著意义(P<0.01)。结论尼莫地平能明显减小锥颅血肿抽吸术后病灶周围水肿面积,使神经功能恢复水平进一步提高。     

实验性大鼠脑出血后细胞凋亡与蛋白激酶C同工酶表达的关系及水蛭素的干预作用

目的探讨大鼠脑出血后蛋白激酶C同工酶表达及细胞凋亡程度,以及水蛭素对二者的影响。方法采用未抗凝新鲜自体股动脉血注入大鼠尾状核建立脑出血动物模型,75只大鼠随机分为对照组、脑出血组及水蛭素组。用免疫组织化学法及原位末端标记法分别测定脑出血后6 h、1天、3天、6天、10天等时间点血肿周围组织蛋白激酶C同工酶的表达和细胞凋亡程度,以及水蛭素对二者的影响。结果与对照组比较,血肿周围组织中蛋白激酶C同工酶水平及凋亡细胞数在脑出血后6 h升高(P<0.05),第3天达高峰(P<0.001),此后下降,10天时的表达接近正常,差异无显著性(P>0.05);水蛭素能够降低各个时间点蛋白激酶C同工酶水平及凋亡细胞的表达。结论脑出血后血肿周围蛋白激酶C同工酶水平及凋亡细胞的表达均上调,而水蛭素能够抑制细胞凋亡,其机制可能与抑制蛋白激酶C同工酶的表达有关。     

灯盏花素治疗急性脑出血的临床疗效观察

目的 探讨灯盏花素对脑出血患者血肿吸收、周围水肿改善及神经功能恢复的影响。 方法 将86例患者随机分为治疗组(43例)和对照组(43例),分别于入组第1、7、21天利用CT测量血肿体积、水肿而积,并行临床神经功能评分(CSS)。治疗组给予5％葡萄糖500 ml加灯盏花素50 mg,1次／d,连用14 d。结果 治疗组水肿面积、血肿体积和CSS均较对照组明显改善(P<0.01)。应用灯盏花素治疗后第21天水肿面积由(4.3±0.6)cm2变为(2.8±0.7)cm2,血肿体积由(19±5)ml变为(6±6)ml,CSS由22±9变为9±7。对照组第21天水肿面积由(4.5±0.7)cm2变为(3.2±0.6)cm2,血肿体积由(20±5)ml变为(11±7)ml,CSS由23±8变为14±8。两组比较,差异有显著意义(P<0.01)。 结论 灯盏花素可能何益于促进脑出血患者的血肿吸收、水肿消退和神经功能的改善。     

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.     

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.     

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.     

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.