高龄急性缺血性脑卒中患者静脉溶栓后出血性转化的危险因素

目的探讨高龄急性缺血性脑卒中(AIS)患者静脉溶栓后出血性转化(HT)的危险因素。方法收集2016年1月至2019年3月海口市第三人民医院急诊科收治的高龄AIS患者326例。根据其静脉溶栓后是否发生HT,分为HT组(51例)和无HT组(275例)。采用SPSS 20.0统计软件进行数据分析。应用单因素分析及多因素logistic回归分析,评价影响高龄AIS患者静脉溶栓后发生HT的危险因素。结果单因素分析显示,HT组的心房颤动、尿蛋白阳性、溶栓后24 h收缩压、血糖、国际标准化比值、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、溶栓后24 h NIHSS评分及发病至溶栓时间3 h明显高于无HT组,差异有统计学意义(P0.05)。多因素logistic回归分析显示,溶栓后24 h收缩压(OR=1.935,95%CI 1.226～4.162)、血糖(OR=2.240,95%CI 1.638～5.237)、溶栓前NIHSS评分(OR=2.435,95%CI 1.805～5.726)、溶栓后24 h NIHSS评分(OR=3.381,95%CI 2.216～7.250)及发病至溶栓时间3 h(OR=2.703,95%CI 1.914～6.116)是高龄AIS患者静脉溶栓后发生HT的独立危险因素(P0.05)。结论溶栓后24 h收缩压、血糖、溶栓前NIHSS评分、溶栓后24 h NIHSS评分及发病至溶栓时间3 h是高龄AIS患者静脉溶栓后发生HT的独立危险因素,可为临床溶栓治疗提供参考。     

高龄急性缺血性脑卒中患者静脉溶栓后出血性转化的危险因素分析

目的 探讨高龄急性缺血性脑卒中(AIS)患者静脉溶栓后出血性转化(HT)的危险因素。方法 收集2016年1月至2019年3月海口市第三人民医院急诊科收治的高龄AIS患者326例。根据其静脉溶栓后是否发生HT,分为HT组(51例)和无HT组(275例)。采用SPSS 20.0统计软件进行数据分析。应用单因素分析及多因素logistic回归分析,评价影响高龄AIS患者静脉溶栓后发生HT的危险因素。结果 单因素分析显示,HT组的心房颤动、尿蛋白阳性、溶栓后24h收缩压、血糖、国际标准化比值、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、溶栓后24h NIHSS评分及发病至溶栓时间>3h明显高于无HT组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,溶栓后24h收缩压(OR=1.935,95%CI 1.226～4.162)、血糖(OR=2.240,95%CI 1.638～5.237)、溶栓前NIHSS评分(OR=2.435,95%CI 1.805～5.726)、溶栓后24h NIHSS评分(OR=3.381,95%CI 2.216～7.250)及发病至溶栓时间>3h(OR=2.703,95%CI 1.914～6.116)是高龄AIS患者静脉溶栓后发生HT的独立危险因素(P<0.05)。结论 溶栓后24h收缩压、血糖、溶栓前NIHSS评分、溶栓后24h NIHSS评分及发病至溶栓时间>3h是高龄AIS患者静脉溶栓后发生HT的独立危险因素,可为临床溶栓治疗提供参考。     

原发性高血压患者血压变异性与左心室舒张功能、二尖瓣口舒张早期血流峰值的相关性

目的研究原发性高血压患者血压变异性与左心室舒张功能的关系。方法选取原发性高血压患者254例,左心室舒张功能测定基于二尖瓣环舒张早期峰值(Ea)及二尖瓣口舒张早期血流峰值(E)检测。根据E/Ea15和E/Ea≥15分为舒张功能不全组86例和舒张功能正常组168例,两组均进行24 h血压检测,血压变异性采用标准差和变异系数计量。多因素Logistic回归分析高血压患者血压变异性与左心室舒张功能的关系。结果舒张功能正常组白天平均收缩压、夜间平均收缩压和舒张压、24 h平均舒张压均显著低于舒张功能不全组(均P0.05);24 h平均收缩压变异系数(OR:1.127,95%CI:1.036～1.225,P0.01)和24 h平均收缩压标准差(OR:1.126,95%CI:1.054～1.203,P0.01)与左心室舒张功能相关,但24 h平均舒张压标准差(OR:1.015,95%CI:0.951～1.084,P0.05)和24 h平均舒张压变异系数(OR:1.027,95%CI:0.972～1.085,P0.05)与左心室舒张功能不相关。结论原发性高血压患者血压变异性与左心室舒张功能不完全相关。     

不同程度颈动脉狭窄的分水岭缺血性脑卒中患者血压变异性分析

目的 分析不同程度颈动脉狭窄的分水岭区急性缺血性脑卒中(AIS)患者血压变异性(BPV)。方法 回顾性分析2018年1月至2019年12月解放军联勤保障部队第906医院215例AIS患者的临床资料,其中83例分水岭区AIS患者为A组,132例非分水岭区AIS患者为B组。比较两组患者入院时BPV情况和颈动脉超声检查结果的差异性。结果 相比B组,A组晨峰血压、日间舒张压标准差(dDSD)、日间收缩压标准差(dSSD)、24 h舒张压标准差(24 hDSD)、24 h收缩压标准差(24 hSSD)均显著提高,差异有统计学意义(t=5.687、7.234、9.143、5.764、5.611,P 0.05)。相比B组,A组不稳定颈动脉斑块和颈动脉重度狭窄发生率均明显升高(χ2=25.552、13.871,P 0.05)。在A组中,颈动脉中度、重度狭窄的患者夜间舒张压标准差(nDSD)较轻度狭窄者均明显提高(F=12.041,P 0.01)。结论 分水岭区AIS患者BPV较明显,且发生颈动脉重度狭窄的风险较高;BPV可能与分水岭区AIS患者颈动脉重度狭窄有关。     

首次腔隙性脑梗死患者扩张的血管周围间隙与动态血压变异性分析

目的探讨首次腔隙性脑梗死患者扩张的血管周围间隙(EVRS)与动态血压变异性(BPV)的关系。方法入选符合标准的腔隙性脑梗死患者118例,均行头颅MRI和24h动态血压监测。利用4分半定量评分系统按EVRS是否2分分为2组,基底节平面:重度组44例,轻度组74例;半卵圆中心平面:重度组54例及轻度组64例。患者完成24h动态血压监测,比较各组动态血压相关参数,进行多因素logistic分析。结果在基底节平面,2组年龄、男性、高血压、冠心病、糖尿病、24h收缩压、昼间收缩压、昼间收缩压标准差、昼间收缩压变异系数和夜间舒张压变异系数有显著差异(P0.05);在半卵圆中心平面,2组年龄、高血压、24h收缩压和夜间收缩压标准差有显著差异(P0.05)。多因素logistic回归分析,基底节平面,年龄(OR=1.16,95%CI:1.01~1.22,P=0.02)、昼间收缩压变异系数(OR=1.62,95%CI:1.47~3.68,P=0.03)、夜间舒张压变异系数(OR=1.32,95%CI:1.12~2.43,P=0.04)是发生重度EVRS的独立危险因素。半卵圆中心平面,BPV与EVRS无相关性。结论首次腔隙性脑梗死患者BPV与基底节平面EVRS密切相关,基底节平面EVRS是高血压相关脑损害的独特表现。     

经阿替普酶静脉溶栓治疗的急性缺血性脑卒中合并心房颤动患者出血转化及预后的影响因素研究

背景出血转化是溶栓治疗的主要并发症,其会加重患者神经功能缺损程度甚至导致患者死亡,因此提前预测患者出血转化风险对临床治疗具有重要意义。目的分析经阿替普酶静脉溶栓治疗的急性缺血性脑卒中(AIS)合并心房颤动患者出血转化及预后的影响因素。方法选取2017—2019年郴州市第四人民医院神经内科收治的AIS合并心房颤动患者60例为研究对象,所有患者入院后接受阿替普酶静脉溶栓治疗。根据溶栓治疗后24 h有无出血转化将所有患者分为出血转化组27例和无出血转化组33例,根据溶栓治疗后3个月预后将所有患者分为预后良好组[改良Rankin量表(m RS)评分≤2分]39例和预后不良组(m RS评分> 2分)21例。收集所有患者出血转化和预后的可能影响因素,并采用多因素Logistic回归分析探讨经阿替普酶静脉溶栓治疗的AIS合并心房颤动患者出血转化及预后的影响因素。结果多因素Logistic回归分析结果显示,溶栓治疗后24 h收缩压> 140 mm Hg [OR=2.356,95%CI(1.337,4.151)]、基线空腹血糖> 5.6 mmol/L[OR=3.525,95%CI(2.190,5.676)]、发病至溶栓治疗时间> 3 h[OR=4.773,95%CI(1.586,14.361)]、基线美国国立卫生研究院卒中量表(NIHSS)评分> 7分[OR=4.609,95%CI(2.258,9.407)]、溶栓治疗后2 h NIHSS评分> 7分[OR=1.241,95%CI(1.047,1.472)]是经阿替普酶静脉溶栓治疗的AIS合并心房颤动患者发生出血转化的独立危险因素(P <0.05);基线空腹血糖> 5.6 mmol/L[OR=2.394,95%CI(1.666,3.440)]、溶栓治疗后2 h NIHSS评分> 7分[OR=2.620,95%CI(1.173,5.851)]是经阿替普酶静脉溶栓治疗的AIS合并心房颤动患者预后不良的独立危险因素(P <0.05)。结论溶栓治疗后24 h收缩压> 140 mm Hg、基线空腹血糖> 5.6 mmol/L、发病至溶栓治疗时间> 3 h、基线及溶栓治疗后2 h NIHSS评分> 7分是经阿替普酶静脉溶栓治疗的AIS合并心房颤动患者发生出血转化的危险因素,基线空腹血糖> 5.6 mmol/L和溶栓治疗后2 h NIHSS评分> 7分是经阿替普酶静脉溶栓治疗的AIS合并心房颤动患者预后不良的危险因素,应引起临床医生重视。     

老年高血压患者内在能力下降与血压变异性的相关性研究

目的 探究老年高血压患者内在能力下降与血压变异性的关系。方法 选择2021年1～11月深圳市人民医院老年医学科就诊的老年高血压患者206例,根据内在能力评估分为内在能力正常组74例和内在能力下降组132例。行24 h动态血压监测,以各时间段(24 h、昼间、夜间)收缩压、舒张压标准差和变异系数代表血压变异性,比较2组血压变异性。分析内在能力下降与血压变异性的关系。结果 内在能力下降组年龄、共病数量≥2种、用药种类≥5种、24 h收缩压标准差、昼间收缩压标准差、夜间收缩压标准差、24 h收缩压变异系数、昼间收缩压变异系数、夜间收缩压变异系数明显高于内在能力正常组,差异有统计学意义(P<0.05,P<0.01)。二分类logistic回归分析显示,老年高血压患者内在能力下降与共病数量≥2种(OR=3.615,95%CI:1.447～9.029,P=0.006)、24 h收缩压标准差(OR=1.341,95%CI:1.013～1.775,P=0.039)、24 h收缩压变异系数(OR=1.397,95%CI:1.023～1.908,P=0.036)显著相关。结论 老年高血压患者内...     

老年急性缺血性脑卒中患者血压变异性与颈动脉病变关系及患者预后影响因素分析

背景研究表明,急性缺血性脑卒中(CIS)的发生与血压变异性(BPV)关系密切,BPV增加可使脑卒中发生风险升高,同时急性CIS发病后血压波动增大,进而加剧脑组织的缺血缺氧,加速病情进展和预后不良,BPV成为临床研究新热点。目的研究老年急性CIS患者BPV与颈动脉病变的关系,并分析患者预后的影响因素,以期为老年急性CIS患者的临床治疗提供参考依据。方法选取2017年8月—2019年8月就诊于安徽中医药大学附属滁州中西医结合医院脑病科的老年急性CIS患者108例为试验组,选取同期本院体检健康者70例为对照组。收集受试者一般资料及试验组尿酸(UA)、空腹血糖(FBG)。检测受试者BPV,包括24 h收缩压标准差(SSD)、24 h舒张压标准差(DSD)、白天收缩压标准差(dSSD)、白天舒张压标准差(dDSD)、夜间收缩压标准差(nSSD)、夜间舒张压标准差(nDSD)。受试者均行颈动脉彩色多普勒超声检查,根据颈动脉狭窄情况将试验组患者进一步分为颈动脉狭窄亚组75例和无颈动脉狭窄亚组33例;根据颈动脉内膜中层厚度(CIMT)将试验组患者进一步分为正常亚组、增厚亚组、斑块亚组,分别为24、38、46例。根据改良Ranking量表(mRS)评分将试验组患者进一步分为预后良好亚组(mRS评分≤2分,72例)和预后不良亚组(mRS评分2分,36例)。老年急性CIS患者预后影响因素分析采用多因素Logistic回归分析。结果试验组24 h SSD、24 h DSD、dSSD、dDSD、nSSD、nDSD大于对照组(P0.05)。试验组颈动脉狭窄程度重于对照组(P0.05)。颈动脉狭窄亚组24 h SSD、24 h DSD、dSSD、dDSD、nSSD大于无颈动脉狭窄亚组(P0.05)。试验组CIMT大于对照组(P0.05)。增厚亚组、斑块亚组24 h SSD、24 h DSD、dSSD、dDSD、nDSD大于正常亚组(P0.05);斑块亚组24 h SSD大于增厚亚组(P0.05)。预后良好亚组年龄、糖尿病发生率、FBG、24 h SSD、24 h DSD、dSSD、dDSD小于预后不良亚组,高血压发生率大于预后不良亚组(P0.05)。多因素Logistic回归分析结果显示,24 h SSD[OR=1.192,95%CI(1.038,1.369)]、dDSD[OR=1.252,95%CI=(1.026,1.528)]是老年急性CIS患者预后的影响因素(P0.05)。结论老年急性CIS患者的BPV与颈动脉狭窄程度、CIMT增加有关,24 h SSD、dDSD是患者预后的影响因素,因此临床应关注BPV,并根据BPV来选择合适的降压药物,这样可以有效防治CIS,积极改善患者预后。     

原发性高血压患者血压变异性对冠状动脉病变的影响及其机制探讨

目的观察原发性高血压患者血压变异性(BPV)对冠状动脉病变的影响,并探讨其机制。方法选择原发性高血压患者186例,根据24 h收缩压标准差(SSD)第50百分位数分为高BPV组和低BPV组各93例。采用冠状动脉CT测算冠状动脉钙化积分,并检测血浆高敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)。结果高BPV组冠状动脉钙化积分及血浆hs-CRP、Hcy均较低BPV组升高,P均<0.05。冠状动脉钙化积分及血浆hs-CRP、Hcy与24 h SSD均呈正相关(r分别为0.553、0.617、0.408,P均<0.05),血浆hs-CRP、Hcy与冠状动脉钙化积分均呈正相关(r分别为0.711、0.578,P均<0.05)。结论高BPV的原发性高血压患者冠状动脉病变加重,与血浆hs-CRP及Hcy水平升高有关。     

Correlation between blood pressure variability and symptomatic intracerebral hemorrhage of ischemic stroke after intravenous thrombolysis

<正>Objective To explore the value of early blood pressure variability (BPV) in predicting the risk of symptomatic intracerebral hemorrhage (s ICH) after intravenous thrombolysis (IVT) in acute ischemic stroke (AIS).     

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.