白大衣高血压对心脏功能的影响

目的 :了解白大衣高血压患者左心结构及左室收缩功能和舒张功能状况。方法 :通过汞柱血压计测量及 2 4h动态血压监测将患者分为白大衣高血压组 (35例 ) ,持续性高血压组 (30例 )及正常血压组 (30例 )。采用彩色多普勒超声心动图测量每组患者的左房及左室结构、左室重量指数 ;测定左室舒张功能并进行组间比较。结果 :各组的左室收缩功能参数无明显差别。白大衣高血压组左房室内径、室间隔及左室后壁、左室重量指数均高于正常血压组 (P <0 .0 5 ) ,左室舒张功能参数 (E/ A比值 )低于正常血压组 ,介于持续性高血压组和正常血压组之间。结论 :白大衣高血压患者已出现左室结构改变及舒张功能受损 ,应密切关注并予以防治。     

白大衣高血压靶器官损害的研究进展

高血压病是老年人群中最常见的疾病之一。其心、脑、肾、血管损害亦是老年人致死、致残的主要原因之一。(1)白大衣高血压对于部分靶器官尤其是心脏结构和舒张功能以及血管的结构已经造成损害，其程度介于持续性高血压和正常血压之间。(2)白大衣高血压可能为持续性高血压的初期，其心脑血管事件发生率与持续性高血压之间存在明显差异。(3)对于白大衣高血压药物治疗问题，目前尚存争议，对已存在靶器官损害者主张积极治疗，但仍有待临床实践加以证实。     

白大衣高血压靶器官损害的研究进展

高血压病是老年人群中最常见的疾病之一.其心、脑、肾、血管损害亦是老年人致死、致残的主要原因之一.(1)白大衣高血压对于部分靶器官尤其是心脏结构和舒张功能以及血管的结构已经造成损害,其程度介于持续性高血压和正常血压之间.(2)白大衣高血压可能为持续性高血压的初期,其心脑血管事件发生率与持续性高血压之间存在明显差异.(3)对于白大衣高血压药物治疗问题,目前尚存争议,对已存在靶器官损害者主张积极治疗,但仍有待临床实践加以证实.     

白大衣高血压患者血压变异性对靶器官损害的影响

目的探讨血压变异性对白大衣高血压患者靶器官损害的影响。方法门诊患者119例,根据24 h动态血压和诊室血压分为正常血压组(NT)和白大衣高血压组(WCH)。其中白大衣高血压组根据24 h收缩压变异程度分为:白大衣高血压血压变异性低组(WCH-L),白大衣高血压血压变异性高组(WCH-H)。心脏和颈动脉超声检查:计算二尖瓣环心肌舒张早期峰值运动速度(Em)与舒张晚期峰值运动速度(Am)比值(Em/Am),评价左心室舒张功能及颈动脉损害的发生率。结果 (1)NT组左心室舒张功能减退发生率(21.87%,7例/32例)、颈动脉损害的检出率(18.75%,6例/32例)与WCH-L组(31.11%,14例/45例;22.22%,10例/45例)相近,组间差异无统计学意义(P=0.370、0.711);(2)WCH-H组左心室舒张功能减退发生率(52.38%,22例/42例)、颈动脉损害的检出率(42.85%,18例/42例)明显高于NT组(P=0.008、0.028)和WCH-L组(P=0.044、0.040),差异均有统计学意义。结论血压变异性较大的白大衣高血压患者具有较高的靶器官损害发生率。     

老年高血压病患者高脉压与靶器官损害

目的　观察在药物规则治疗下的老年高血压病患者脉压 (PP)与心脏、血管和肾脏等靶器官损害的关系 ,为临床更好地控制血压 ,防治靶器官损害提供依据。方法　用 2 4小时动态血压仪监测 2 63例老年高血压病患者全天平均脉压(ABPP) ,多普勒超声检查颈动脉粥样斑块发生率 (CAPR)、颈总动脉分叉处内膜 -中膜厚度 (IMT)及内径 (CAD)、左室重量指数 (LVMI)、左室舒张早期充盈峰值流速与心房收缩期充盈峰值流速比值 (E/A值 )、射血分数 (EF) ,生化测定内生肌酐清除率 (Ccr)及 2 4小时尿微量白蛋白排泄量 (MAU)。评价不同ABPP值对心脏、颈动脉、肾脏结构或功能的影响。结果　老年高血压病患者PP≥ 60mmHg与PP <60mmHg比较 ,E/A值、EF和Ccr均下降 (P <0 0 5) ,而LVMI、CAD、CAPR、IMT、MAU升高 (P <0 0 5)。结论　老年高血压病患者脉压增大 ,可促进心脏、血管及肾脏等靶器官损害 ,提示在老年高血压病患者中脉压也是预测心脏、血管及肾脏损害有价值的指标 ,控制脉压可以减轻老年高血压病患者靶器官损害     

氯沙坦钾对白大衣高血压人群靶器官损伤的保护效应

目的：研究氯沙坦钾对白大衣高血压人群靶器官的保护作用。方法：给予符合白大衣高血压诊断标准的、且存在靶器官损伤的100例患者为期24周的氯沙坦钾干预,比较氯沙坦钾治疗前后各项观测指标的变化,从而了解此药对白大衣高血压患者靶器官是否有保护作用。结果：采用超声心动图测量室间隔及左室后壁、左室重量指数、颈内动脉的阻力指数均较用药前明显减小（P〈0．05）,EF指数和E／A值却较前明显升高（P〈0．01）,而对左房和左室内径未见明显改变。结论：氯沙坦钾可明显改善白大衣高血压患者的左室收缩和舒张功能,从而减少了白大衣高血压对这类患者靶器官的损伤效应。     

依贝沙坦治疗老年原发性高血压32例

目的 :观察依贝沙坦对老年原发性高血压病人降压效果及对靶器官的影响。方法 :对 3 2例病人口服依贝沙坦 80mg/d ,8周为 1个疗程 ,治疗前后采用偶测血压及 2 4h动态血压监测 ,以彩色超声多普勒测定左室重量指数 (LVMI)及心脏舒张功能 ,同时检测空腹血糖 (Glu)、尿素氮 (BUN)、肌酐 (Cr)、2 4h尿蛋白定量。结果 :依贝沙坦治疗后偶测血压、2 4h动态血压监测均明显降低(P <0 .0 1) ,左室重量指数明显减小 (P <0 .0 5 ) ,左室舒张功能显著改善 (E峰升高 ,A峰降低 ,E/A比值增加 ) ;另外治疗后 2 4h尿蛋白定量、Glu也显著降低 (P <0 .0 5 ) ,而BUN、Cr治疗前后无明显变化。结论 :依贝沙坦对老年高血压病人的降压效果明显 ,对靶器官有保护作用。     

白大衣高血压患者血清TNF-α、sIL-2R、IL-6水平的临床意义

目的 :观察白大衣高血压患者血清肿瘤坏死因子 - α(TNF- α)、可溶性白细胞介素 - 2受体 (s IL- 2 R)与白细胞介素 - 6 (IL- 6 )水平 ,评价其临床意义。方法 :采用酶标法 (EL ISA)测定原发性高血压组 (EH组 ,32例 )、白大衣高血压组 (30例 )及正常血压组 (30例 )血清 TNF-α(ng/ L )、s IL - 2 R(k IU / L )、IL - 6 (ng/ L )水平 ,并测量诊室血压及2 4h动态血压 (ABPM)值。结果 :1诊室血压参数 :EH组及白大衣高血压组收缩压 (SBP)、舒张压 (DBP)明显高于正常血压组 (P <0 .0 1 )。ABPM参数 ,EH组平均日间、平均夜间、平均 2 4h SBP及平均 2 4h DBP均明显高于白大衣高血压组及正常血压组 (P<0 .0 1 )。EH组平均日间、平均夜间 DBP高于白大衣高血压组及正常血压组(P <0 .0 5 )。2 EH组血清 TNF- α,s IL- 2 R,IL- 6水平均高于白大衣高血压组 (P <0 .0 5 )和正常血压组 (P <0 .0 1 )。白大衣高血压组 s IL- 2 R,TNF- α及 IL- 6水平明显高于正常血压组 (P <0 .0 5 ,<0 .0 1 )。结论 :白大衣高血压患者血清细胞因子水平介于 EH者与正常血压者之间 ,反映白大衣高血压时机体已产生免疫调节与自身保护 ,提示白大衣高血压是介于高血压与正常血压之间的临床状态 ,应视为 EH早期的表现之一     

老年白大衣高血压与持续性高血压、正常血压人群基本情况比较

目的通过对老年白大衣高血压患者与持续性高血压、正常血压者基本代谢情况的比较,探讨三组人群代谢特点及差异,同时探讨三者在心血管疾病危险因素方面的差异。方法根据详细的询问病史、体格检查及血脂、肾功能等生化指标检测,分析三组人群之间的差异。结果1.三组病例基本生化指标无明显差异(P>0.05)。2.白大衣高血压组超重和高脂血症现象普遍存在,与正常血压组存在显著差异(P<0.05);白大衣高血压组中存在不良生活习惯发生率高于正常血压组和持续性高血压组。3.脑卒中发生率白大衣高血压组与正常血压组相近,而持续性高血压组的发生率是白大衣高血压的3.5倍。结论根据有限的观察病例数,较正常血压组和持续性高血压组,老年白大衣高血压不良生活习惯发生率、超重和高脂血症率均高,但脑卒中发生率明显低于持续性高血压组。     

高血压左房内径与E/A值和BNP的相关性分析

目的探讨高血压病人左房内径指数(LADI)与左室舒张早期快速充盈的充盈峰和舒张晚期(心房收缩)充盈的充盈峰的比值(E/A值)、血浆B型脑钠肽(BNP)水平的相关性,评价两者与早期高血压靶器官心脏损害过程中的作用。方法选择2010年12月—2013年12月山西省临汾市中心医院心内科的门诊高血压病人90例,按左房内径指数23 mm/m2分为LADI增高组与LADI正常组,比较两组间E/A值和BNP的差异。结果 LADI增高组E/A值和BNP均明显高于LADI正常组(P0.05)。采用多元线性回归分析对LADI的影响因素以及其影响程度,结果表明存在线性回归关系的影响因素是BNP水平、E/A值、收缩压、舒张压。结论左房内径指数的影响因素及影响程度,BNP水平与左房内径指数的关系最大,E/A值次之。     

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.