急性心肌梗死患者再灌注治疗预后与外周血白细胞计数相关性研究

目的 探讨急性心肌梗死(AMI)患者再灌注治疗的预后与外周血白细胞计数(WBC)的相关性.方法 选择AMI WBC增高并进行经皮冠脉介入治疗患者187例,分别于入院后24、48、96 h查WBC,记录住院期间心脏事件情况,比较再灌注治疗成功组和失败组WBC与住院心脏事件的发生情况.结果 AMI后的再灌注治疗成功可使WBC迅速降至正常,WBC水平与心血管事件的发生率正相关(P<0.05).结论 动态观察WBC变化可以预测AMI再灌注治疗患者心脏事件的发生率.     

老年冠心病患者血清IL-8与外周血白细胞总数检测的临床意义

目的 探讨血清白细胞介素(IL)-8水平和外周血白细胞(WBC)总数与冠心病病情及冠状动脉病变程度的关系.方法 148例老年冠心病患者按临床诊断分为3组:急性心肌梗死(AMI)组50例、不稳定性心绞痛(UAP)组50例、稳定性心绞痛(SAP)组48例和对照组50例.用酶联免疫吸附试验检测各组血清IL-8的水平,并比较各组间的差异.同时对冠心病患者的外周血WBC总数变化及其与血清IL-8水平进行直线相关分析.结果 AMI组、UAP组及SAP组的血清IL-8水平均高于对照组(P＜0.05);AMI组、UAP组IL-8水平明显高于SAP组;AMI组和UAP组结果相似;冠心病患者血清IL-8与外周血WBC总数变化呈正相关.结论 血清IL-8升高可能是老年冠状动脉粥样硬化的标志,参与了冠心病的发病过程,血清IL-8水平与冠状动脉病变程度密切相关.     

外周血白细胞水平与老年ST段抬高型心肌梗死患者急诊冠状动脉介入治疗预后的关系

目的探讨入院时外周血白细胞(WBC)计数水平与老年ST段抬高型心肌梗死(STEMI)患者急诊冠状动脉介入治疗(PCI)心血管预后的相关性。方法 STEMI急诊老年PCI老年患者,以入院即刻外周血WBC计数(×109/L)分为<10组、10~12组、12~14组、14~16组、≥16组,分析各组30 d的心血管终点事件。结果外周血WBC≥12×109/L的所有患者中,随外周血WBC计数升高急诊PCI术中发生慢血流或无复流发生率增加,30 d联合终点事件及死亡率与外周血WBC计数呈正相关。外周血WBC≥10×109/L的所有患者中,随外周血WBC计数升高,各组间死亡率呈增加,外周血WBC水平与肌钙蛋白I、肌酸激酶同工酶及N端脑钠肽测定正相关,与左心室射血分数(LVEF)负相关。结论入院时外周血WBC计数是老年STEMI患者急诊PCI近期心血管事件预后的独立危险因素。     

急性心肌梗塞时白细胞增多与近期预后关系的探讨

对300例急性心肌梗塞(AMI)患者进行研究以探讨AMI早期白细胞计数增高与其近期预后关系。结果表明,AMI患者早期白细胞>15×10~9/L者其心衰、心律失常、心源性休克及住院病死率均较白细胞4×10~9～8.999×10~9/L为高(P<0.05～P<0.01),白细胞>15×10~9/L者较9×10~9～14.999×10~9/L者心衰、心源性休克、住院病死率高(P<0.01)。因此AMI早期外周血白细胞增高是估计近期预后的一个指标。     

冠心病患者CCL20-CCR6轴及IL-17表达与预后的相关性研究

目的 探讨冠心病患者趋化因子配体20(CCL20)、趋化因子受体6(CCR6)和白介素-17(IL-17)的表达与预后的关系。方法 选择2016年7月至11月温州医科大学附属第一医院心内科收治的急性心肌梗死（AMI）患者96例,稳定型心绞痛（SAP）患者45例,无冠心病患者65例。采用酶联免疫吸附法检测血浆CCL20和IL-17水平。实时定量PCR检测单核细胞中CCR6 m RNA水平。采用logistic回归分析确定冠心病的危险因素。Gensini评分评价冠状动脉狭窄程度,分析CCL20、CCR6和IL-17与Gensini评分的相关性。对AMI患者进行随访以观察主要不良心血管事件（MACE）风险。结果AMI组和SAP组患者血浆CCL20和IL-17水平、外周血单核细胞CCR6 m RNA表达水平均显著高于对照组（均P<0.01）。多因素分析显示,CCL20和IL-17是冠心病发生的独立危险因素（均P<0.01）。CCR6 m RNA、CCL20和IL-17水平均与Gensini评分呈正相关（r=0.32、0.65、0.56,均P<0.01）。随访期间CCL20表达...     

老年急性心肌梗死患者白细胞计数与心血管病死率的研究

目的 探讨不同白细胞参数对老年急性心肌梗死(AMI)患者心血管病死率的预测作用.方法 连续入选本院收治的年龄≥65岁的AMI患者1299例,将随访中因心血管死亡的307例为事件组,无事件存活的992例为无事件组.入院后患者均检测白细胞计数(WBC)、中性粒细胞(NEU)、单核细胞(MON)和淋巴细胞(LYM)水平,计算...     

急性冠脉综合征患者血清IL-7的表达水平及其对预后的影响

目的：探讨急性冠脉综合征（ACS）患者血清白细胞介素（IL）-7表达水平并分析其与预后的关系.方法：选择ACS患者130例（急性心肌梗死70例,不稳定型心绞痛60例）、稳定型心绞痛患者33例（SAP组）、健康体检者89例（健康对照组）,使用ELISA法检测各组IL-7水平并进行比较,并跟踪随访130例ACS患者的病情,通过Logistic回归分析判断IL-7水平与预后的关系.结果：与健康对照组和SAP组比较,UAP组和AMI组IL-7水平均显著升高[（1.84±0.47） pg/ml、（2.11±0.63） pg/ml比（4.87±0.52） pg/ml、（5.15±0.71） pg/ml,P＜0.05或P＜0.01],健康对照组与SAP组,UAP组与AMI组之间IL-7水平无显著差异（P均＞0.05）;Logistic回归分析显示,ACS患者血清中IL-7的水平是发生不良心血管事件的独立危险因素（OR=1.212,95％CI：1.061～1.418）.结论：白细胞介素-7作为机体重要的炎症因子之一,其水平在急性冠脉综合征患者的异常升高,可能具有判断疾病预后的重要价值.     

急性颅脑损伤患者白细胞计数变化及临床意义

目的探讨急性颅脑损伤（ABI）患者白细胞（WBC）计数变化的临床意义。方法测定104例ABI患者伤后24h内入院即刻、3d、7d及出院时的外周血WBC计数，并结合格拉斯哥昏迷评分分型及格拉斯哥预后评分分级进行组间比较。结果ABI患者伤后外周血WBC计数显著升高，且与损伤程度呈正比，入院7d及出院时渐降至正常；WBC计数与患者的预后有明显相关性。结论外周血WBC计数测定可作为判断ABI程度及患者预后的监测指标，具有临床参考价值。     

修正休克指数及红细胞分布宽度可预测老年急性心肌梗死患者再发不良心血管事件

摘要 目的：评价修正休克指数（MSI）及红细胞分布宽度（RBCDW）对老年急性心肌梗死（AMI）患者短期预后的预测价值。方法：收集老年AMI患者500例，随访1年，根据出院后是否再发不良心血管事件，将患者分为不良预后组(98例)和对照组(402例)。比较2组患者临床特征、MSI及RBCDW差异，使用受试者工作特性曲线(ROC)比较MSI及RBCDW对老年AMI患者的预测价值。结果：与对照组比较，不良预后组MSI及RBCDW增加(P均＜0.05)；2组患者白细胞计数(WBC)比较，差异无统计学意义(P＞0.05)。MSI对老年AMI患者再发不良心血管事件的预测价值最高，曲线下面积为0.775（95%CI:0.721~0.829，P=0.000)；RBCDW对老年患者再发不良心血管事件具有较好预测价值(P＜0.05）。多因素logistics回归分析显示MSI及RBCDW均是老年AMI患者再发不良心血管事件的危险因素(P均＜0.05)。结论：MSI及RBCDW对预测老年AMI患者再发不良心血管事件具有一定价值，但MSI价值更高。     

血浆N末端B型利钠肽原对急性冠脉综合征患者近期预后的预测价值（英文）

目的：评价血浆N末端B型利钠肽原（NT-proBNP）对急性冠脉综合征（ACS）患者近期预后的预测价值。方法：连续检测600例住院的ACS患者的血浆NT-proBNP浓度。依据住院期间患者有无心血管事件（心源性死亡、心源性休克、充血性心力衰竭）分为事件组（108例）和无事件组（n=492例）,比较两组NT-proBNP水平,并用回归分析法判断血浆NT-proBNP是否为ACS患者近期心血管事件的独立预测因素。结果：事件组血浆NT-proBNP浓度显著高于无事件组[1361.2（965.3,2088.6）pmol/L比605.7（274.5,1177.8）pmol/L,P〈0.01]。Lo-gistic多元逐步回归分析表明,血浆NT-proBNP是ACS患者近期发生心血管事件的独立预测因素（OR=1.000,P=0.000）。结论：入院时血浆N末端B型利钠肽原是急性冠脉综合征患者近期预后的独立预测因素。     

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.