高血压病左心室肥厚患者血浆脑钠素水平

目的观察高血压病左心室肥厚患者血浆脑钠素(BNP)水平,并血管紧张素转换酶抑制剂(ACEI)治疗前后左心室肥厚的逆转情况,探讨血浆BNP水平可否作为判断左心室肥厚与逆转的临床指标.方法筛选高血压病伴左心室肥厚组患者40例,高血压病无左心室肥厚组患者30例及正常血压对照组30例,予以高血压病患者喹那普利5～10 mg治疗24周,采用超声心动图测定左心室质量指数(LVMI),E/A比值;放射免疫分析法测定血浆BNP水平,对BNP与LVMI、E/A比值作直线相关分析.结果高血压病左心室肥厚患者组的血浆BNP水平明显高于高血压病无左心室肥厚患者组和正常血压对照组(P<0.01),经ACEI治疗后高血压病左心室肥厚患者组血浆BNP水平明显下降(P<0.01),且与LVMI呈显著正相关(治疗前r=0.45,P<0.01;治疗后 r=0.39,P<0.01),与E/A比值呈显著负相关(治疗前r=-0.70,P<0.01;治疗后r=-0.69,P<0.01).结论血浆BNP水平可作为判断高血压病左心室肥厚与逆转的一个敏感指标.     

单纯收缩期高血压患者血浆B型钠尿肽水平与左心室肥厚、舒张功能变化的关系

目的观察非高血压病者和单纯收缩期高血压病(ISH)伴或不伴左心室肥厚(LVH)者血浆B型钠尿肽(BNP)水平,及血管紧张素受体阻滞剂(ARB)治疗前后BNP、左心室肥厚及舒张功能变化情况,探讨BNP变化与左心室肥厚、舒张功能改变的关系。方法筛选非高血压病者(正常对照组)33例,ISH患者38例,ISH+LVH患者42例,予高血压病患者口服缬沙坦片80~120 mg/d,治疗前后采用超声心动图测定左心室质量指数(LVMI),E/A比值;放射免疫分析法测定血浆BNP水平。结果高血病各组血浆BNP水平明显高于正常对照组(P0.01或P0.05);与ISH组相比,ISH+LVH组LVMI增高(P0.05),而E/A值降低(P0.01);经ARB治疗后,血浆BNP水平在高血压病各组中均表现降低(P0.05或P0.01),LVMI值在ISH+LVH组表现为下降(P0.01),而E/A值表现为增高(P0.01);治疗前,血浆BNP水平与LVMI呈显著正相关(r2=0.61,P0.01),与E/A值呈显著负相关(r2=0.26,P0.01)。结论血浆BNP水平可作为判断ISH左心室肥厚、舒张功能改善的敏感指标。     

血浆脑钠素浓度与老年高血压患者左室肥厚及心功能的关系

目的观察老年高血压患者左室肥厚与血浆脑钠素(BNP)浓度的关系,并以贝那普利治疗前后左室肥厚及左室舒张功能不全的变化情况,探讨血浆BNP浓度可否作为判断左心室肥厚的逆转及左室舒张功能改变的临床指标.方法老年高血压患者74例,平均年龄(72.0±11.6)岁,其中伴左心室肥厚组患者34例、不伴左心室肥厚组患者40例,正常对照组30例,予以高血压病患者贝那普利5～10 mg/d治疗36周,所有对象行超声心动图测定左心室质量指数(LVMI),E/A比值;采用美国博适Triage及其试剂盒快速测定血浆BNP水平,对BNP与LVMI、E/A比值作相关分析.结果老年高血压左心室肥厚患者组的血浆BNP水平明显高于高血压病不伴左心室肥厚患者组和正常对照组(P<0.01),经贝那普利治疗后高血压病左心室肥厚患者组血浆BNP水平明显下降(P<0.05),且与LVMI呈显著正相关,与E/A比值呈显著负相关.结论血浆BNP浓度能较好地反映老年高血压患者左心室肥厚及左室舒张功能状态.     

血浆脑钠素浓度与老年高血压患者左室肥厚及心功能的关系

目的观察老年高血压患者左室肥厚与血浆脑钠素(BNP)浓度的关系,并以贝那普利治疗前后左室肥厚及左室舒张功能不全的变化情况,探讨血浆BNP浓度可否作为判断左心室肥厚的逆转及左室舒张功能改变的临床指标。方法老年高血压患者74例,平均年龄(72.0±11.6)岁,其中伴左心室肥厚组患者34例、不伴左心室肥厚组患者40例,正常对照组30例,予以高血压病患者贝那普利5~10mg/d治疗36周,所有对象行超声心动图测定左心室质量指数(LVMI),E/A比值;采用美国博适Triage及其试剂盒快速测定血浆BNP水平,对BNP与LVMI、E/A比值作相关分析。结果老年高血压左心室肥厚患者组的血浆BNP水平明显高于高血压病不伴左心室肥厚患者组和正常对照组(P<0.01),经贝那普利治疗后高血压病左心室肥厚患者组血浆BNP水平明显下降(P<0.05),且与LVMI呈显著正相关,与E/A比值呈显著负相关。结论血浆BNP浓度能较好地反映老年高血压患者左心室肥厚及左室舒张功能状态。     

高血压左室肥厚及心功能与血浆脑钠肽浓度变化的关系探讨

目的 探讨高血压患者左室肥厚及左室舒张功能与血浆脑钠肽（BNP）浓度的关系.方法 高血压患者62例,其中伴左心室肥厚组患者32例,不伴左心室肥厚组患者30例;健康对照组30名.高血压患者给予厄贝沙坦片75～150 mg/d,治疗6个月.所有对象行超声心动图测定左心室重量指数（LVMI）、E/A（二尖瓣舒张期E峰/A峰）比值.采用美国博适Triage及其试剂盒快速测定血浆BNP水平,对BNP与LVMI、E/A比值作相关分析.结果 高血压左心室肥厚患者组的血浆BNP水平（ng/L）明显高于高血压不伴左心室肥厚患者组和健康对照组（54.8±16.9比36.7±15.4,P＜0.05;54.8±16.9比16.4±12.7,P＜0.05）.经厄贝沙坦治疗后,高血压左心室肥厚患者组血浆BNP水平（ng/L）明显下降（54.8±16.9比36.8±12.6,P＜0.05）,E/A比值明显上升（0.86±0.57比1.09±0.65,P＜0.05）,差异有统计学意义,且与LVMI呈显著正相关 （r＝0.57,P＝0.028）,与E/A比值呈显著负相关（r＝-0.68,P＝0.009）.结论 血浆BNP浓度能较好地反映高血压患者左心室肥厚及左室舒张功能状态.     

缬沙坦对原发性高血压伴左心室肥厚及血浆N—proBNP水平的影响

目的观察原发性高血压伴左心室肥厚患者的血浆N—proBNP水平及缬沙坦治疗前后的影响。方法选取原发性高血压伴左心室肥厚患者（观察组）,原发性高血压无左心室肥厚患者（疾病对照组）及血压正常者（正常对照组）各40例,用缬沙坦80一160mg／d治疗24周。分别采用彩色超声多普勒和电化学发光法检测治疗前后左心室质量指数（LVMI）,左心室射血分数（LVEF）和血浆N—proBNP浓度。结果（1）治疗前血浆N—proBNP水平观察组较疾病对照组及正常对照组明显升高（P〈0．05）。（2）血浆N—proBNP与左心室质量指数呈显著正相关（r=069,P〈005）,与E／A比值呈显著负相关（r=-034,P〈001）。（3）治疗后观察组左心室质量指数较治疗前明显减小（P〈0．05）;治疗后观察组血浆N—proBNP水平较治疗前明显降低（P〈0．05）。而对照组的改变无统计学意义。结论血浆N—proBNP是预测原发性高血压发生左心室重构的良好指标。缬沙坦能够降低血浆N—proBNP浓度,可有效逆转原发性高血压性左心室重构。     

比索洛尔、赖诺普利对原发性高血压患者左室肥厚及血浆脑钠肽的影响

目的探讨比索洛尔、赖诺普利对原发性高血压（EH）患者左室肥厚（LVH）、血浆脑钠肽（BNP）的影响。方法选择124例EH患者,根据有无LVH分为LVH组76例、无LVH组48例,LVH组口服比索洛尔、赖诺普利12个月;检测两组血浆BNP及LVH组治疗前后A/E比值、左室质量指数（LVMI）变化。结果 LVH组血浆BNP明显高于无LVH组（P〈0.05）;LVH组治疗12个月后,A/E比值、LVMI和血浆BNP均明显降低（P〈0.05或〈0.01）,且其血浆BNP水平与LVMI呈正相关（r=0.60,P〈0.01）。结论比索洛尔、赖诺普利可逆转EH患者的LVH,降低其血浆BNP水平。     

缬沙坦对高血压病患者血清Ⅲ型前胶原水平及左室舒张功能的影响

目的评价缬沙坦对高血压病患者血清Ⅲ型前胶原(PCⅢ)水平及左室舒张功能的影响.方法测定分析18例无左室肥厚的高血压病患者(NLVH组)、16例伴左室肥厚的高血压病患者(LVH组)缬沙坦治疗前、后血清PCⅢ水平及左室舒张功能指标的变化,并与15例健康人(正常对照组)进行比较.分析血清PCⅢ水平与血浆血管紧张素Ⅱ(AngⅡ)的相关性.结果二组高血压病患者血清PCⅢ水平均高于正常对照组,其增高程度与左室舒张功能指标E/A比值呈显著负相关(r=-0.8257,P＜0.05),与血浆AngⅡ水平无明显相关性(r=0.3362,P＞0.05).缬沙坦治疗后二组血压和血清PCⅢ水平均较治疗前显著降低(P均＜0.05),左室舒张功能指标E峰峰值增高、E/A比值增大(P＜0.05),A峰峰值降低(P＜0.05).LVH组的左室重量指数(LVMI)明显下降(P＜0.05).结论高血压病患者血清PCⅢ水平增高,左室舒张功能下降,缬沙坦可降低血清PCⅢ水平,改善左室舒张功能.     

高血压病患者脑钠肽水平与心脏测量指标的相关性

目的探讨高血压病患者脑钠肽（brain natriuretic peptide,BNP）水平与心脏测量指标的相关性。方法选择57例明确诊断为高血压病的患者和30例年龄相仿的健康对照者。测定其室间隔厚度（left ventricular septum thickness,LVST）、左心室后壁厚度（posterior wall thickness,PWT）、左室质量指数（left ventricular mass index,LVMI）、左室舒张末内径（left ventricular end diastolic diameter,LVEDD）和BNP浓度,并进行对照比较。结果高血压病患者血浆中BNP浓度明显较健康对照组升高（P<0.01）,并随血压分级增加而升高;BNP与LVST、PWT、LVMI、LVEDD呈显著正相关（r=0.52,P<0.05;r=0.46,P<0.05;r=0.42,P<0.05;r=0.40,P<0.01）。伴左室肥厚的高血压病患者组的血浆BNP水平较不伴左室肥厚的高血压病患者组显著升高（P<0.05）。结论高血压病患者的血浆BNP浓度显著升高,BNP浓度与血压分级密切相关,并与左室肥厚相关。     

老年高血压患者脉压与血浆脑钠素的关系

目的观察老年高血压患者脉压（PP）与血浆脑钠素（BNP）水平的关系，探讨脉压和血浆BNP水平可否作为判断左室功能不全的临床指标。方法用24小时动态血压仪监测74例老年高血压病患者全天平均脉压（ABPP），据ABPP值分两组：（1）PP／〉60mmHg，41例；（2）PP〈60mmHg，33例。采用超声心动图测定反映左室功能不全指标E／A比值和左室射血分数（LVEF）；采用美国Triage及其试剂盒快速测定血浆BNP水平，对BNP、PP与LYEF、E／A比值作直线相关分析。结果老年高血压病患者中PP≥60mmHg组的血浆BNP水平显著高于PP〈60mmHg组（P〈0．01），PP与血浆BNP呈显著正相关（r=0．42，P〈0．01）；PP与E／A比值呈显著负相关（r=-067．P〈0．01）。结论老年高血压患者PP与血浆BNP水平密切相关，PP和血浆BNP可作为判断左室功能不全的临床指标。     

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.