子痫前期患者脐动脉血流指数与血液流变学指标的相关性及对妊娠结局的影响

目的探讨子痫前期患者脐动脉血流指数（S／D）与血液流变学的相关性及对妊娠结局的影响。方法选取76例子痫前期患者为子痫组,80例正常健康妊娠妇女为对照组。B超检测两组S／D,分析子痫组S／D与血液流变学指标[红细胞压积（HCT）、D-二聚体及血小板最大聚集率（AA）]的相关性;比较两组妊娠并发症及围产儿不良结局发生情况。结果子痫组S／D及血液流变学各指标均明显高于对照组,P〈0．05;S／D与血液流变学各指标呈显著正相关;子痫组妊娠并发症发生率及围产儿不良结局发生率均明显高于对照组;脐血流指数异常（≥3）者妊娠并发症发生率及围产儿不良结局发生率均高于S／D正常者。结论S／D异常者妊娠并发症及围产儿不良结局发生率较高,应针对病因积极治疗,必要时终止妊娠。     

动脉血血气分析评估新生儿窒息的临床意义

目的探讨动脉血血气分析与新生儿窒息的关系。方法对98例足月窒息新生儿和60例正常新生儿出生12h内行动脉血血气分析，并进行新生儿窒息组与对照组，轻度窒息组与重度窒息组pH值和碱剩余（BE）比较。结果新生儿窒息组与对照组、轻度窒息组与重度窒息组新生儿的pH值和BE间差别均有统计学意义（P〈0．05）。结论动脉血血气分析可比Apgar评分更客观、更灵敏地反映新生儿窒息的程度。     

冠心病合并高血压患者血浆内皮素1水平与冠脉病变程度的关系

经冠状动脉造影（CAG）确诊为冠心病患者238例，分为冠心病合并高血压154例（A组），单纯冠心病84例（B组）；另选择健康对照组50例（C组）。测定各组生化指标及内皮素1（ET-1）水平并观察患者CAG病变情况。结果A、B组血脂及ET．1水平显著高于C组（P〈0．05，〈0．01）。A组与B组比较，ET-1水平显著高于B组（P〈0．01）；且A组冠状动脉单支病变、多支病变者ET-1水平均高于B组（P均〈0．01），A、B两组中多支病变者ET-1水平较单支病变者显著增高（P〈0．01，〈0．05）。认为冠心病合并高血压患者ET-1水平与冠状动脉病变程度密切相关。     

芪参益气浸膏促心肌梗死大鼠心肌血管新生实验研究

目的探讨芪参益气浸膏（简称芪参）对大鼠急性心肌梗死后（AMI）心肌血管新生、梗死面积和心功能影响。方法SD雄性大鼠左前降支结扎成急性心肌梗死模型,随机分为假手术组（n=8）、急性心肌梗死对照组（AMI组,n=15）、芪参益气浸膏干预组（芪参组,n=13）;促红细胞生成素干预组（EPO组,n=14）。芪参组给予芪参益气浸膏100mg／kg灌胃,每天一次,连续4周;EPO组给予重组人促红素注射液（5000u／kg）腹腔注射一次。第4周末超声心动图测定左室射血分数（LVEF）、左室短轴缩短率（LVFS）、舒张末期左室内径（LVEDd）。大鼠处死后心肌标本分别进行HE和抗大鼠CD,。免疫组化染色,图像分析系统测量心肌梗死面积,计数梗死、梗死边缘区及非梗死区直径〈10μm新生毛细血管密度。结果1．造模各组LVEF较假手术组降低（P均〈0．01）,其中芪参组及EPO组均较AMI组增高（P〈0．01、P〈0．05）,且芪参组高于EPO组（P〈0．05）;造模各组LVFS较假手术组降低（P均〈0．01）,芪参组高于AMI组（P〈0．01）,EPO组与AMI组无差异（P〉0．05）;造模各组较假手术组LVEDd增大（P均〈0．05）,芪参组与EPO组小于AMI组（P均〈0．05）,芪参组与EPO组间无差别（P〉0．05）。2．芪参组和EPO组心肌梗死面积小于AMI组（P均〈0．01）,前二者间无差异（P〉0．05）。3．造模各组心肌梗死周边区毛细血管密度多于假手术组（P均〈0．01）,芪参组和EPO组较AMI组增加（P均〈0．01）,且芪参组又多于EPO组（P〈0．01）。4．抗大鼠CD31免疫组化标记,芪参组和EPO组心肌梗死周边区的新生毛细血管密度均显著高于AMI组（P均〈0．01）,芪参组明显高于EPO组（P〈0．01）;各组非梗死区及梗死区的心肌新生毛细血管密度两两比较无统计学差异（P均〉0．05）。结论芪参益气浸膏可改善心肌?     

胰岛素-胰岛素样生长因子代谢轴在胎儿生长发育中的作用

目的探讨胰岛素-胰岛素样生长因子（IGF）代谢轴在胎儿宫内生长发育中的作用。方法连续收集266名单胎足月新生儿基本资料,采用放免法检测脐血胰岛素和IGF水平。结果（1）脐血胰岛素水平与出生体重、BMI、身长和胎盘重量均呈正相关（P〈0．01）。（2）脐血IGF水平与出生体重、BMI、身长和胎盘重量均呈正相关（P〈0．01）。（3）脐血胰岛素水平和IGF水平呈显著正相关（P〈0．01）。结论脐血胰岛素、IGF水平可作为评价胎儿宫内生长发育情况的参考指标。     

肝素治疗重度子痫前期疗效观察

重度子痫前期患者80例,随机分为观察组和对照组,各40例,均进行常规治疗,观察组每日加用肝素100mg静滴。治疗后观察组孕周较对照组明显延长（P〈0．05）,观察组胎儿生物物理评分（Minning评分）、新生儿Apgar评分较对照组明显增加（P均〈0．05）,观察组脐动脉血流较对照组明显增加（P〈0．05）,两组母体血压、分娩方式、胎儿双顶径（BPD）及股骨长（FL）、新生儿体质量、产妇产后出血量无明显差异（P均〉0．05）。认为肝素可以改善重度子痫前期患者的妊娠结局,以改善胎儿情况更为明显。     

宫内发育迟缓与胰岛素样生长因子及其结合蛋白关系的研究

为探讨宫内发育迟缓（IUGR）的发生机制,检测了86例新生儿脐血胰岛素样生长因子－1（IGF－1）、胰岛素样生长因子结合蛋白－3（IGFBP－3）水平,并分析上述指标变化与胎儿期生长的关系。将86例新生儿分为两组,IUGR（即小于胎龄儿）组22例,适于胎龄儿（AGA）组64例,采用竞争性放射免疫分析法（RIA）测定两组脐血IGF－1水平,非竞争性免疫放射分析法（IRMA）测定IGFBP－3水平。结果显示,与AGA组相比,IUGR组脐血IGF－1和IGFBP－3水平显著降低（P＜0．001）;IGF－1水平随胎龄及出生体重增加而增加（P＜0．01）;IGFBP－3水平与胎龄及出生体重呈相关（P＜0．01）;IGF－1与IGFBP－3呈正相关（P＜0．01）。认为IUGR与IGF－1及其结合蛋白密切相关,不论何种原因引起的IUGR,其脐血IGF－1、IGFBP－3水平均低,IGF－1水平下降与IGFBP－3下降相伴随;脐血IGF－1、IGFBP－3水平与胎龄及出生体重呈正相关,随着胎龄的增加和出生体重的增长,IGF－1、IGFBP－3水平不断升高。     

糖尿病肾病与血浆内皮素1及C反应蛋白的相关性研究

目的探讨糖尿病肾病（DN）与血浆内皮素1（ET-1）、C反应蛋白（C-RP）的关系。方法测定86例T2DM患者（DM组）和30例健康对照者（NC组）血压、血糖、血脂、SCr、ET-1、C-RP和尿白蛋白排泄率（UAER）。结果血浆ET-1和C-RP在DM组较NC组显著升高（P〈0．05,P〈0．01）,且DM组血浆ET-1和C-RP水平随着SCr、UAER的增加而升高（P〈0．05,P〈0．01）。结论血浆ET-1和C-RP可能参与DN的发生、发展。     

缺氧前、后处理1-磷酸鞘氨醇对心肌细胞缺氧／复氧损伤拮抗作用的差异及相关机制

目的：探讨1-磷酸鞘氨醇（S1P）缺氧前、后处理对心肌细胞缺氧／复氧（H／R）损伤拮抗作用的差异及相关机制。方法：分离SD乳鼠（1—2d龄）心肌细胞进行体外培养。对培养的心肌细胞进行H／R处理以模拟心脏缺血／再灌注（ischemia／reperfusion,r／R）损伤。将培养的心肌细胞随机分为对照组、H／R组、H／R＋SIP缺氧前处理（H／R’pre—S1P）组及I-I／R＋SIP缺氧后处理（I-I／R＋post—S1P）组,采用四甲基偶氮唑蓝（methylthiazolyltetrazo｜ium。MTT）比色法检测心肌细胞的活力,乳酸脱氢酶（1actatedehydrogenase,LDH）检测试剂盒检测培养基中LDH的水平,caspase-3活性检测试剂盒检测心肌细胞中caspase．3的活性,Westernblot检测ATP激活的蛋白激酶（AMPK）、激活的苏氨酸激酶（Akt）、细胞外信号调节激酶1／2（ERKl／2）蛋白磷酸化水平及SIP裂解酶．1（SIPlyase1,SPLl）蛋白表达的水平。结果：与对照组相比,I-1／R组心肌细胞活力显著降低（P〈0．01）,培养基中LDH的浓度和细胞中easpase-3的活性显著增高（P〈0．01）。S1P缺氧前处理可明显增加H／R处理后心肌细胞的活力（P〈0．01）,减少LDH释放和caspase-3的活性（P〈0．01）;而I-I／R＋post—S1P组的各项指标与H／R组比较均无明显差异。Westernblot检测发现,S1P缺氧前处理可明显增高心肌细胞中AMPK、Akt和ERkl／2磷酸化的水平（P〈0．05）,而SIP缺氧后处理未激活AMPK、Akt和ERKl／2生存信号。Westernblot检测发现,缺氧处理组心肌细胞中SPLl表达的水平较对照组显著升高（P〈0．01）。结论：缺氧前用S1P处理可激活AMPK、Akt、ERKl／2生存信号,显著减少心肌细胞凋亡,增加细胞的存活率,减轻心肌细胞H／R损伤;而S1P缺氧后处理不能发挥以上保护作用,其机制可能是缺氧处理导致心肌细胞SPLl的表达上调,通过降解SIP而减弱了其介导的抗心肌细胞H／R损伤的作用。     

早发型重度子痫前期41例临床分析

对41例早发型重度子痫前期患者的临床资料作回顾性分析。28例在严密观察下行保守治疗（2～54d）。按孕周〈28周、28～31^＋5周、32～34周分为三组，保守治疗过程中出现的并发症有胎盘早剥、心力衰竭、肾衰竭、肝功损害、HELLP综合征、低蛋白血症等。新生儿体质量随胎龄增加而增加（P〈0．01），围产儿病死率则随胎龄增加而下降（P〈0．01）。胎儿窘迫及小于孕龄儿（SGA）发生率亦随胎龄增加而上升。终止妊娠孕周越早，引产率越高，相反越近足月，剖宫产率越高（P〈0．05）。认为适当期限内的保守治疗有助于改善母儿结局；剖宫产仍是终止重度子痫前期的主要方法。     

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.