左旋肉碱与促红细胞生成素联合治疗维持性血液透析患者肾性贫血的临床观察

目的观察左旋肉碱和促红细胞生成素治疗维持性血液透析患者肾性贫血的疗效，及左旋肉碱对促红细胞生成素用量的影响。方法将维持性血液透析肾性贫血患者40例随机分成两组，均于血液透析后皮下注射促红细胞生成素，剂量每周100—150U／kg，分2—3次进行，当血红蛋白（Hb）≥100g／L，红细胞压积（Hct）≥30％后逐渐减量。治疗组于每次血液透析后加用静脉注射左旋肉碱1．0g，疗程8周。结果两组患者的Hb、Hct较治疗前均有所提高（P〈0．01），治疗组提高比对照组更显著（P〈0．01），且治疗组促红细胞生成素的维持用量更少（P〈0．05）。结论左旋肉碱能显著提高促红细胞生成素治疗肾性贫血的疗效，减少促红细胞生成素的用量。     

左卡尼汀联合EPO治疗尿毒症性贫血疗效观察

目的观察左卡尼汀联合红细胞生成素（EPO）治疗尿毒症性贫血的临床效果。方法将维持性血液透析的肾性贫血患者随机分成两组,治疗组在应用EPO的同时口服左卡尼汀,对照组单用EPO。治疗12周,两组红细胞生成素初始用量均为每周150U／kg,当血红蛋白（Hb）≥100g／L,红细胞压积（Hct）≥30％时,EPO逐渐减量至维持量。结果两组Hb、Hct较治疗前均有所提高（P〈0．05）,治疗组提高比对照组更显著（P〈0．05）,且治疗组EPO的维持用量更少。结论左卡尼汀能显著提高EPO治疗尿毒症性贫血的疗效,减少EPO用量。     

左卡尼汀联合促红细胞生成素治疗肾性贫血的疗效观察

目的 观察左卡尼汀联合促红细胞生成素治疗肾性贫血的疗效及不良反应。方法将肾性贫血患者36例随机分成两组各18例，治疗组于每次血液透析后静脉注射左卡尼汀及促红细胞生成素，而对照组仅注射促红细胞生成素，疗程12周，治疗前后观察患者外周血血红蛋白、红细胞压积，记录高血压等不良反应。结果治疗组血红蛋白、红细胞压积升高明显优于对照组，且治疗组促红细胞生成素维持量少，治疗组高血压发生率低于对照组。结论左卡尼汀联合促红细胞生成素治疗肾性贫血能提高促红细胞生成素疗效，减少促红细胞生成素维持量，降低促红细胞生成素的副作用发生率。     

左卡尼汀与促红细胞生成素治疗肾性贫血的疗效评价

目的观察左卡尼汀联用重组人促红细胞生成素（rhEPO）对肾性贫血的疗效。方法将44例维持性血液透析患者分成试验组（22例）和对照组（22例）,试验组给予左卡尼汀）及rhEPO治疗,对照组单用rhEPO,疗程12周。观察血红蛋白（Hb）、红细胞压积（Hct）、rhEPO用量变化及高血压的发生率。结果试验组患者的Hh及Hct上升水平显著高于对照组,rhEPO的用量也低于对照组,且高血压发生率低（P均〈0．05）。结论左卡尼汀联合应用rhEPO治疗肾性贫血安全有效。     

糖尿病肾病维持血液透析患者的左卡尼汀+促红细胞生成素治疗效果及对肾性贫血的影响

目的 探讨糖尿病肾病（diabetic nephropathy, DN）维持血液透析患者左卡尼汀+促红细胞生成素的治疗效果及对肾性贫血的影响。方法 选取2020年4月—2022年4月仪征市人民医院收治的糖尿病肾病维持血液透析患者60例,以随机数表法分为观察组（n=30）与对照组（n=30）,对照组采用促红细胞生成素治疗方法,观察组采用左卡尼汀+促红细胞生成素治疗方法。比较两组不良反应发生情况、临床指标水平、肾性贫血治疗效果。结果 两组不良反应发生率比较,差异无统计学意义（P>0.05）。治疗前,两组血红蛋白、白蛋白、红细胞压积、血肌酐、胆固醇水平比较,差异无统计学意义（P>0.05）;治疗后,观察组血红蛋白、白蛋白、红细胞压积水平均较对照组更高,血肌酐、胆固醇水平均较对照组更低,差异有统计学意义（P<0.05）。观察组治疗总有效率较对照组高,差异有统计学意义（P<0.05）。结论 在糖尿病肾病患者维持血液透析期间,实行左卡尼汀+促红细胞生成素治疗方法,能有效改善患者血红蛋白、白蛋白水平、红细胞压积、血肌酐及胆固醇水平,提高患者肾性贫血纠正率。     

左卡尼汀和蔗糖铁对老年血液透析患者肾性贫血及氧化应激的影响

目的探讨左卡尼汀和蔗糖铁对老年血液透析患者肾性贫血及氧化应激的影响。方法收集该院2008年6月至2013年6月行维持性血液透析的老年患者70例,按照随机数字表法分为研究组和对照组,每组35例,两组均在常规维持性血液透析治疗的基础上,给予促红细胞生成素和蔗糖铁治疗,研究组在每次透析结束时给予左卡尼汀和生理盐水治疗,对照组仅给予生理盐水,观察左卡尼汀和蔗糖铁对老年血液透析患者肾性贫血及氧化应激指标影响。结果观察组总有效率明显高于对照组(P0.05);研究组和对照组治疗前贫血指标〔血细胞比容(HCT)、血红蛋白(Hb)、血清铁蛋白(SF)〕和氧化应激指标〔丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)〕之间差异无统计学意义(P0.05);两组治疗3个月后和6个月后贫血指标和氧化应激指标同期比较差异均有统计学意义(P0.05)。结论左卡尼汀联合蔗糖铁对老年血液透析患者肾性贫血治疗效果较好,明显改善患者贫血指标和氧化指标,提高生命质量,减少氧化应激对身体的伤害。     

左卡尼汀辅助治疗尿毒症血液透析患者肾性贫血的效果观察

目的探讨左卡尼汀治疗尿毒症血液透析患者贫血的临床效果。方法选取78例在接受血液透析治疗过程中出现贫血的尿毒症患者,随机将其分为A、B两组,每组39例。多糖铁复合物A组为990 mg/（周·人）,B组1 010 mg/（周·人）;透析频率为A组2.43次/周,B组2.49次/周;促红细胞生成素（EPO）皮下注射A组为11 566 u/（周·人）,B组为11490 u/（周·人）;A、B两组患者每周服用叶酸及复合维生素B剂量大致相同;B组患者加用左卡尼汀进行治疗。结果 B组患者治疗前后的Hb、HCT升高幅度明显大于A组患者;B组患者在治疗前后的ALT、ALP下降幅度明显高于A组患者;两组患者在治疗过程中,没有出现药物原因导致的不良反应现象。结论左卡尼汀对血液透析治疗过程中出现贫血的尿毒症患者的临床效果非常明显。     

左卡尼汀改善慢性肾衰竭血液透析患者贫血的疗效观察

贫血是慢性肾衰竭（尿毒症）患者的常见并发症,也是影响血液透析患者预后的主要因素之一。导致尿毒症贫血的主要因素是肾脏分泌促红细胞生成素（EPO）减少。此外,肉碱、铁、叶酸、维生素B12缺乏也参与维持性血液透析患者贫血的发生和发展。2008年11月～2009年10月,我们应用左卡尼汀联合重组人EPO治疗肾性贫血,临床疗效好且不良反应发生率低。现报告如下。     

左旋卡尼汀对维持性血液透析患者生活质量和贫血的影响

目的 探讨左旋卡尼汀对维持性血透(MHD)患者生活质量和贫血的影响.方法将30例维持性血透患者随机分为治疗组(15例)和对照组(15例).两组透析结束后均使用重组人促红细胞生成素(rhEFO)3000IU皮下注射2～3次/周,而治疗组每次透析后加静脉注射左旋卡尼汀1 g.随访12周,分别在治疗前及治疗12周末给两组患者应用SF36系统进行生活质量评分并检测血红蛋白、红细胞压积、血浆白蛋白的情况.结果治疗后治疗组患者的生活质量评分较治疗前有明显的上升,较对照组治疗后亦有明显的增高,差异均有统计学意义(P<0.01);治疗组的血红蛋白、血细胞比容、血浆白蛋白水平显著高于对照组,差异有统计学意义(P<0.01).结论静脉注射左旋卡尼汀可明显提高维持性血透患者生活质量和促进改善维持性血液透析患者的贫血.     

左卡尼汀联合促红细胞生成素治疗慢性心力衰竭合并贫血的临床疗效观察

目的探讨左卡尼汀联合促红细胞生成素治疗慢性心力衰竭(CHF)合并贫血的临床疗效。方法选取2013年3月—2014年1月广西柳州钢铁集团公司医院收治的CHF合并贫血患者60例,随机分为试验组和对照组,各30例。对照组患者给予常规综合治疗,试验组患者在常规综合治疗基础上给予左卡尼汀联合促红细胞生成素治疗,均治疗4个月。比较两组患者治疗前后血红蛋白(Hb)、游离脂肪酸(FFA)、红细胞膜K+-Na+-ATP酶活性及左心室射血分数(LVEF)。结果两组患者治疗前Hb、FFA、红细胞膜K+-Na+-ATP酶活性及LVEF比较,差异无统计学意义(P0.05);试验组患者治疗后Hb、红细胞膜K+-Na+-ATP酶活性及LVEF高于对照组,FFA低于对照组,差异有统计学意义(P0.05)。结论左卡尼汀联合促红细胞生成素治疗CHF合并贫血具有一定疗效,能有效改善患者贫血及心功能。     

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.