非高密度脂蛋白胆固醇与冠状动脉病变严重程度的相关性

目的观察冠状动脉粥样硬化性心脏病(CHD)患者非高密度脂蛋白胆固醇与冠状动脉病变严重程度的相关性,及其预测严重冠状动脉狭窄的能力。方法收集843例CHD患者,根据冠状动脉造影结果将患者分为单支、双支、三支病变组,用Gensini积分评估患者冠状动脉病变狭窄严重程度并按积分四分位数分成Q1～Q4组共4组,分别比较各组间血脂参数差异。用Spearman相关系数分析患者低密度脂蛋白胆固醇(LDLC)、非高密度脂蛋白胆固醇(non-HDLC)、总胆固醇/高密度脂蛋白胆固醇(TC/HDLC)、甘油三酯/高密度脂蛋白胆固醇(TG/HDLC)与Gensini积分的关系。采用受试者工作特征曲线(ROC)和多因素Logistic回归评价LDLC、non-HDLC、TC/HDLC、TG/HDLC预测严重冠状动脉狭窄的能力。结果患者LDLC、non-HDLC、TC/HDLC水平随Gensini积分增高显著增加(P均0.05),Q4组TG/HDLC显著高于Q1和Q2组(P均0.05)。LDLC、non-HDLC、TC/HDLC水平随冠状动脉病变支数增加显著增加(P均0.05),TG/HDLC在各组间差异无显著性。non-HDLC与Gensini积分(r=0.315,P0.01)相关性高于LDLC(r=0.252,P0.01)、TC/HDLC(r=0.242,P0.01)、TG/HDLC(r=0.123,P0.01)。non-HDLC预测高Gensini积分的ROC曲线下面积是0.729(95%Cl 0.691～0.767,P0.01),分别大于LDLC的0.694(95%Cl 0.653～0.734,P0.01)、TC/HDLC的0.681(95%Cl 0.640～0.721,P0.01)、TG/HDLC的0.564(95%Cl 0.521～0.607,P0.01)。用多因素Logistic回归校正冠心病危险因素后,non-HDLC(OR=2.472, 95%Cl 1.962～3.115)预测严重冠状动脉病变的能力轻微优于LDLC(OR=2.265, 95%Cl 1.785-2.875)、TC/HDLC(OR=1.796, 95%Cl 1.483～2.175)、TG/HDLC(OR=1.022, 95%Cl 0.927～1.127)。结论 non-HDLC在预测严重冠状动脉病变方面优于LDLC、TC/HDLC、TG/HDLC,有助于对CHD患者的危险分层。     

血浆中性粒细胞明胶酶相关脂质运载蛋白水平与急性ST段抬高型心肌梗死病变严重程度的关系

目的:探讨无肾脏疾病的急性ST段抬高型心肌梗死(STEMI)患者血浆中性粒细胞明胶酶相关脂质运载蛋白(NGAL)与基质金属蛋白酶-9(MMP-9)、高敏C反应蛋白(hs-CRP)、白细胞介素(IL)-1β和冠状动脉(冠脉)狭窄程度的关系,及其识别冠脉病变严重程度的能力。方法:收集2014-01至2017-03在我院住院的STEMI患者124例(STEMI组),同期纳入没有明显冠脉狭窄的对照患者124例(对照组)。再根据SYNTAX积分将STEMI患者分为高积分亚组(≥33分,n=26)和低积分亚组(33分n=98)。采用Spearman相关系数分析STEMI患者血浆NGAL水平与MMP-9水平、IL-1β水平和冠脉狭窄程度的关系。采用受试者工作特征(ROC)曲线评价血浆NGAL水平识别严重冠脉狭窄的能力。用Logistic回归分析影响SYNTAX积分的相关因素。结果:STEMI组患者血浆NGAL、MMP-9和hs-CRP水平显著高于对照组(P均0.01),IL-1β水平在两组间差异无统计学意义(P=0.272)。血浆NGAL水平与MMP-9水平(r=0.757,P0.01)、SYNTAX积分(r=0.616,P0.01)和IL-1β水平(r=0.185,P0.05)均呈正相关。高积分亚组患者血浆NGAL和MMP-9水平显著高于低积分亚组(P均0.01),而左心室射血分数明显低于低积分亚组(P0.01)。ROC曲线分析显示,在识别严重冠状动脉狭窄的STEMI患者能力方面,血浆NGAL(曲线下面积=0.881,95%Cl:0.813~0.949,P0.01)大于血浆MMP-9(曲线下面积=0.799,95%Cl:0.709~0.890,P0.01)和hs-CRP(曲线下面积=0.446,95%Cl:0.306~0.587,P=0.400)。多因素回归分析显示,STEMI患者血浆NGAL水平与高SYNTAX积分存在独立相关性(OR=1.115,95%Cl:1.107~1.123,P0.01)。结论:STEMI组患者血浆NGAL、MMP-9和hs-CRP水平较对照组显著增高,血浆NGAL水平与MMP-9水平、IL-1β水平和冠脉病变严重程度均呈正相关,在识别严重冠脉狭窄的STEMI患者能力方面NGAL优于MMP-9和hsCRP。NGAL作为新的心脏领域的标志物有助于STEMI患者的危险分层。     

外周血NGAL、PDCD4在STEMI患者中表达及其与冠状动脉病变程度的关系

目的 研究确认外周血中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和程序性细胞死亡因子(PDCD)4在急性ST段抬高型心肌梗死(STEMI)患者中表达及其与冠状动脉病变程度的相关性。方法 回顾性分析2020年1～12月在张家口市第一医院就诊的胸痛患者300例,其中STEMI组108例,稳定性心绞痛(SAP)组92例,对照组100例。收集患者的临床基线资料。采用SYNTAX积分对患者冠状动脉严重程度进行评价,同时分为低积分亚组(SYNTAX积分<33分,n=81)和高积分亚组(SYNTAX积分≥33分,n=27)。冠状动脉造影前应用酶联免疫吸附试验对超敏C反应蛋白(hs-CRP)、基质金属蛋白酶(MMP)-9和NGAL水平进行检测,应用实时荧光定量-聚合酶链反应(PCR)检测患者血浆PDCD4 mRNA水平。结果 STEMI组血清hs-CRP、MMP-9、NGAL、PDCD4 mRNA、吸烟比例、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、白细胞计数(WBC)、中性粒细胞计数(NEUT)和动脉内膜厚度(MOMO)水平均明显高于对照组和SAP组,左室射血分数(LVEF)、淋巴细...     

二肽基肽酶-4水平、超敏C反应蛋白与冠状动脉病变程度的相关性

目的探讨二肽基肽酶(DPP)-4水平、超敏C反应蛋白(hs-CRP)与冠状动脉病变程度的相关性。方法选取经冠状动脉造影(CAG)后明确诊断为冠心病(CAD)的120例患者为CAD组,CAG阴性的40例患者为对照组,通过SYNTAX积分将CAD组分为低危组、中危组和高危组。检测各组糖化血红蛋白(HbA1c)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、肌酐(SCr)、总胆固醇(TC)、三酰甘油(TG)、hs-CRP、DPP-4水平。结果 CAD低、中、高危组的hs-CRP水平均明显高于对照组,中危组的hs-CRP水平明显高于低危组(P<0.05),并随着冠状动脉病变严重程度的增加而上升(P<0.001);CAD高危组和中危组的DPP-4水平均明显高于对照组、低危组(P<0.05)。高危组的DPP-4水平明显高于中危组(P<0.05)。DPP-4水平随着冠状动脉病变严重程度的增加而上升(P<0.001);hs-CRP,DPP-4水平影响冠状动脉病变程度的多重线性回归分析结果示:未调整时,hs-CRP,DPP-4水平与SYNTAX积分呈显著正相关(P<0.01)。调整年龄、性别、β-受体阻滞剂用药史、血管紧张素转换酶抑制剂用药史、SCr、LDL-C因素后,hs-CRP、DPP-4水平与SYNTAX积分仍呈显著正相关(P<0.001)。结论测定血浆hs-CRP,DPP-4水平有利于预测CAD患者冠状动脉病变严重程度,hs-CRP,DPP-4水平与CAD密切相关,DPP-4水平为判断冠状动脉病变程度提供了新的生物学标志物。     

高密度脂蛋白颗粒大小与青年冠心病无症状性心肌缺血的关系

目的 探讨高密度脂蛋白(HDL)颗粒大小与青年冠心病无症状性心肌缺血(SMI)的相关性。方法 共纳入469例青年冠心病患者,其中无症状性心肌缺血组194例(SMI组,n=194),有症状性心肌缺血组275例(non-SMI组,n=275)。收集患者的一般资料,检测血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDLC)、高密度脂蛋白胆固醇(HDLC)、载脂蛋白A1(ApoA1)水平及相关生化指标。计算HDL颗粒大小的量化指标HDLC/ApoA1,以及相关脂质参数TC/HDLC、non-HDLC、TG/HDLC、LDLC/HDLC。应用多因素Logistic回归分析明确HDL颗粒大小(HDLC/ApoA1)与青年冠心病SMI发生的关系。结果 与non-SMI组比较,SMI组患者血清TC、尿酸、LDLC、LDLC/HDLC、TC/HDLC、non-HDL水平偏低,HDLC、ApoA1、HDLC/ApoA1值更大(均P＜0.05)。相关分析结果显示,HDL颗粒大小(HDLC/ApoA1)与Gensini积分呈负相关(r=－0.405,P＜0.05)。多因素分析显示,HDL颗粒大小(HDLC/ApoA1)是青年冠心病患者SMI的独立预测因子(OR=0.697,95%CI:0.233~0.910,P=0.007)。受试者工作特征曲线显示,以0.36为HDL颗粒大小(HDLC/ApoA1)临界值预测青年冠心病SMI发生的灵敏度为92.1%,特异度为75.5%。结论 HDL颗粒大小(HDLC/ApoA1)与青年冠心病SMI患者冠状动脉病变严重程度呈负相关,对青年冠心病SMI具有较强的预测价值。     

血清超敏C-反应蛋白、视黄醇结合蛋白4及血浆结合珠蛋白水平在冠心病患者中的变化及其意义

目的探讨冠心病(CHD)患者血清超敏C-反应蛋白(hs-CRP)、视黄醇结合蛋白4(RBP4)及血浆结合珠蛋白(Hp)水平的变化及其临床意义。方法选取2014年2月至2017年2月广安市人民医院心血管内科经冠状动脉造影检查确诊的CHD患者140例作为CHD组,另选取同期在我院心血管内科住院的非CHD患者60例作为对照组。将CHD组患者根据临床表现分为3个亚组:急性心肌梗死(AMI)组(n=38)、不稳定型心绞痛(UAP)组(n=62)和稳定型心绞痛(SAP)组(n=40)。依据病变支数分为3个亚组:单支病变组(n=27)、双支病变组(n=54)和三支病变组(n=59)。检测各组患者的血清hs-CRP、RBP4、Gensini评分及血浆Hp水平,并分析各指标与病情严重程度的关系。采用SPSS 16.0软件进行数据处理。依据数据类型,组间比较分别采用t检验和x~2检验。相关性分析采用Pearson线性相关分析法。结果 CHD组患者的血清hs-CRP[(7.29±3.65)vs(2.84±1.16)mg/L]、RBP4[(49.64±8.32)vs(42.07±5.51)ng/ml]及血浆Hp[(95.26±19.14)vs(70.13±16.33)mg/L]水平均显著高于对照组(P0.05)。AMI亚组患者的血清hs-CRP、RBP4、Gensini评分及血浆Hp水平均显著高于SAP亚组和UAP亚组患者(P0.05);UAP亚组患者的血清hs-CRP、RBP4、Gensini评分及血浆Hp水平均显著高于SAP亚组患者(P0.05)。三支病变亚组患者的血清hs-CRP、RBP4、Gensini评分及血浆Hp水平均显著高于双支病变和单支比病变亚组患者(P0.05);双支病变亚组患者的血清hs-CRP、RBP4、Gensini评分及血浆Hp水平均显著高于单支病变亚组患者(P0.05)。CHD患者的Gensini评分与血清hs-CRP(r=0.619)、RBP4(r=0.554)及血浆Hp(r=0.592)水平均呈显著正相关(P0.05)。结论 CHD患者血清hs-CRP、RBP4及血浆Hp水平显著升高,且与冠状动脉病变严重程度密切相关。     

急性冠状动脉综合征患者non-HDLC/HDLC比值与颈动脉斑块的关系

目的探讨急性冠状动脉综合征(ACS)患者non-HDLC/HDLC比值与颈动脉斑块之间的关系。方法选择95例ACS患者、30例稳定型心绞痛(SAP)患者及49例无冠心病者,按照颈动脉超声检查结果将颈动脉斑块分为软斑块、纤维斑块和钙化斑块三种类型。酶法测定血清低密度脂蛋白胆固醇(LDLC)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)水平,并计算non-HDLC/HDLC比值。结果与无冠心病组和SAP组比较,ACS组non-HDLC/HDLC比值升高(P0.05或P0.01);与无冠心病组比较,ACS组HDLC水平降低(P0.05);与SAP组比较,ACS组non-HDLC水平升高(P0.05)。与无冠心病组比较,ACS组颈动脉斑块发生率升高(P0.001);与无冠心病组和SAP组比较,ACS组软斑块发生率升高,纤维斑块发生率降低(P0.05或P0.01)。ACS患者钙化斑块组、纤维斑块组和软斑块组non-HDLC水平、non-HDLC/HDLC比值依次升高,且钙化斑块组与软斑块组间non-HDLC水平、non-HDLC/HDLC比较差异显著(P0.05或P0.01)。non-HDLC水平、non-HDLC/HDLC比值对ACS患者颈动脉软斑块诊断的ROC曲线下面积分别为0.722±0.060(95%CI为0.604~0.841,P0.01)、0.669±0.062(95%CI为0.548~0.790,P0.01)。结论 non-HDLC/HDLC比值升高是ACS患者发生软斑块的危险因素。non-HDLC/HDLC比值可作为ACS患者颈动脉软斑块的预测指标。     

血清Betatrophin在新疆哈萨克族及汉族冠状动脉病变中的价值评估

目的探讨血清Betatrophin在新疆哈萨克族及汉族冠状动脉病变中的评估价值。方法选择经动脉造影检查后且无糖尿病的患者为研究对象,其中哈萨克族108例,汉族115例,采用Gensini积分系统评估冠状动脉病变程度,并依据Gensini积分将研究对象分为病例组与对照组,其中病例组132例,对照组91例;采用双抗体夹心酶联免疫吸附法检测血清Betatrophin水平,AB-ELISA法测定血清ANGPTL3含量,ELISA法测定血清脂蛋白脂肪酶(LPL)含量,并检测两组甘油三酯(TG)、总胆固醇(TC)、空腹血糖(FBG)等水平。结果①与对照组比较,病例组的体质指数(BMI)、TC、TG、低密度脂蛋白胆固醇(LDLC)水平升高(P均0.05);与汉族病例组比较,哈萨克族病例组的BMI、TC、TG、LDLC水平升高(P均0.05)。②病例组与对照组的空腹胰岛素(FINS)、FBG、HOMA-IR、HOMA-β差异无显著性(P均0.05)。③哈萨克族病例组血清Betatrophin、ANGPTL3、LPL均高于汉族病例组(P均0.05)。④哈萨克族病例组Gensini积分与TC、TG、LDLC、Betatrophin呈正相关(r分别为0.204、0.454、0.452、0.446,P均0.05);汉族病例组Gensini积分与BMI、TC、TG、LDLC、Betatrophin呈正相关(r分别为0.438、0.195、0.296、0.357、0.393,P均0.05);多元线性回归分析显示TG、哈萨克族为Betatrophin增高的因素;Logistic回归分析显示BMI、LDLC、Betatrophin是影响汉族冠状动脉病变的因素,LDLC、Betatrophin、ANGPTL3、LPL是影响哈萨克族冠状动脉病变的因素。结论 Betatrophin水平升高可能加重新疆哈萨克族及汉族人群的冠状动脉病变,TG、哈萨克族可能是影响Betatrophin血清学水平的因素。     

麝香保心丸联合瑞舒伐他汀治疗对老年冠心病患者血脂、血管内皮功能及外周血microRNA-126和microRNA-137表达的影响

目的探讨麝香保心丸联合瑞舒伐他汀治疗对老年冠心病患者血脂、血管内皮功能及外周血microRNA-126和microRNA-137表达的影响。方法采用随机数字表法将收治的94例老年冠心病患者分为对照组(47例)与麝香保心丸联合组(47例)。对照组患者给予瑞舒伐他汀治疗;麝香保心丸联合组患者在给予瑞舒伐他汀治疗基础上结合麝香保心丸治疗。两组疗程均为12周。比较两组治疗疗效及治疗前后血脂、血管内皮功能麝香保心丸联合组总有效率(93. 62%)高于对照组(70. 21%,P0. 05)。两组治疗后总胆固醇(TC)、低密度脂蛋白胆固醇(LDLC)和甘油三酯(TG)水平较治疗前降低,而高密度脂蛋白胆固醇(HDLC)水平较治疗前升高(P0. 05);麝香保心丸联合组治疗后TC、LDLC和TG水平低于对照组,而HDLC水平高于对照组(P0. 05)。两组治疗后内皮素1(ET-1)水平较治疗前降低,而一氧化氮(NO)水平较治疗前升高(P0. 05);麝香保心丸联合组治疗后ET-1水平低于对照组,而NO水平高于对照组(P0. 05)。两组治疗后microRNA-126表达较治疗前升高,而microRNA-137表达较治疗前降低(P0. 05);麝香保心丸联合组治疗后microRNA-126表达高于对照组,而microRNA-137表达低于对照组(P0. 05)。结论麝香保心丸联合瑞舒伐他汀治疗对老年冠心病患者疗效良好,可改善患者血脂代谢紊乱和血管内皮功能紊乱,上调外周血microRNA-126表达而下调microRNA-137表达,值得临床借鉴。     

OX40L与冠心病相关性的临床研究

目的 分析淋巴细胞OX40配体(OX40L)水平与高敏C反应蛋白(hs-CRP)和血脂的相关性,探索OX40L对冠心病的影响是否通过介导动脉粥样斑块炎症反应而起作用.方法 选择冠心病患者56例分为急性冠脉综合征(ACS)组和稳定型心绞痛(SAP)组.选取性别、年龄相当的健康人30名作为对照组.测定血浆sOX40L、血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、hs-CRP等指标.结果 ACS组和SAP组血浆OX40L水平高于对照组,ACS组hs-CRP水平较SAP组和对照组明显升高,OX40L与hs-CRP呈正相关,与HDL-C呈负相关,与其他血脂未显示相关性.结论 OX40L可作为一个新的炎症标志物来预测冠状动脉粥样硬化.     

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.