急性高原病发病机制的研究进展

高原环境具有低压性低氧、寒冷、辐射强等一系列特点,其中低氧对机体的影响最大。急性高原病是指人在到达海拔超过2500米的高原时,可能发生的急性高原反应、高原脑水肿以及高原肺水肿的总称。随着人们对进入高原地区的需求日益增加,急性高原病的发病机制、预防和治疗也得到了更多的关注。目前,该病的发病机制尚未完全阐明,防治也并未出现更多的进展。本文总结了急性高原病发病的可能机制,旨在为急性高原病的预防和治疗提供新的作用靶点。     

短期低氧暴露对小鼠肺脏中水通道蛋白家族的影响

随着西部地区开发开放政策的推广,急性高原病(acute mountain sickness,AMS)逐渐增多.AMS是由低海拔进入3000 m以上的高度或更高海拔地区时发生的头痛、恶心、呕吐、胸闷、气急等一系列不适反应,严重者会发生急性高原性肺水肿(HAPE)或高原性脑水肿.     

高原世居藏族居民罹患重症急性高原病的临床特点

目的对高原世居藏族居民重症急性高原病的发病情况及其临床特点进行探讨。方法对西藏军区总医院1956年6月至2005年6月的全部高原肺水肿、高原脑水肿病历进行回顾性分析，并对其中的高原世居藏族病例的发病情况及其临床特点进行分析。结果共检出24例高原世居藏族重症急性高原病病例，其中高原肺水肿21例、高原脑水肿3例，世居藏族居民重症急性高原病发病率为0．75％（24／3184）。24例患者均存在明显的诱发因素，诱因主要有从高原到更高海拔地区、劳累、受凉和饮酒。9例患者并发多器官或多系统功能障碍。结论高原世居藏族居民在往返于高原与平原或进入更高海拔地区时，机体器官、系统明显存在低氧损伤，在一定因素作用下亦可罹患重症急性高原病和并发多器官、多系统功能障碍。     

高原肺水肿研究进展

高原肺水肿属急性高原病重症,发病迅速,病死率高.现综述高原肺水肿的发病机制、诊断以及防治措施等方面的研究进展.     

高原病134例临床分析及其发病因素探讨

目的　探讨急、慢性高原病的诱发原因素 ,分析细胞因子和血管活性物质在高原病中的作用。方法　 134例高原病 ,急性高原肺水肿 5 8例 ,慢性高原病 76例 ,采用放射免疫方法检测 2 0例高原肺水肿外周血内皮素 ,一氧化氮。采用ELISA方法 ,按试剂盒说明检测 2 6例高原心脏病患者血管内皮生长因子 ,用放射免疫方法检测肿瘤坏死因子α。结果　 5 8例急性高原肺水肿中 ,发病前有上呼吸道感染者占 6 5 5 % ,来藏后活动量大占 6 8%。白细胞升高者占 84 % ,大量吸烟占 2 8 9% ,尿路感染占 18 9%。高原肺水肿外周血浆内皮素 (382 6 3± 192 35 )ng/L比高原健康组 (10 7 77± 4 2 35 )ng/L明显升高 ,高原肺水肿外周血一氧化氮 (2 3 4 9± 8 34) μmol/L比高原健康组(33 4 7± 5 97) μmol/L减低。 76例慢性高原病患者中大量吸烟占 6 3 15 % ,从事重体力劳动者占 5 3 3% ,白细胞增高者占 6 5 7% ,肺部有炎症占 5 5 2 6 % ,尿路感染占 18 4 2 %。高原心脏病患者血管内皮生长因子 (4 4 1±2 7 95 )pg/ g与高原健康者 (2 5 5± 2 173)pg/ g对比明显升高。高原心脏病患者肿瘤坏死因子α(4 3 6 5± 11 95 )fmol/L ,高原健康者 (2 4 36± 3 6 2 )fmol/L ,两组有显著差异性 ,高原心脏病组比高原健康组增高。结论     

急性高原病脑脊液,血液酸碱及气体成分的改变

作者采用自身对比实验,观察了拉萨市的12例急性高原病治疗前及恢复后的脑脊液、血液的酸碱及其气体成分变化,结果显示急性高原反应及高原肺水肿患者均存在着不同程度的脑水肿,缺氧引起的脑水肿可能是急性高原病发病过程中的重要环节。     

脑钠肽、低氧诱导因子-1α、心肌型脂肪酸结合蛋白在高原肺动脉高压中的研究进展

<正>高原肺动脉高压(high altitude pulmonary hypertension,HPH)是指生活在海拔2 500 m以上地区的人群,因对高原环境适应不全引起的肺小血管功能性及器质性改变,从而导致低氧肺动脉高压及相关临床表现~([1-3])。青海省为高海拔地区,有许多不利于人类的因素,以低氧为著,高原肺动脉高压发病率高,病情危害严重,而显著的肺动脉高压又是各型高原病(高原肺水肿、高原红细胞增多症和高原心脏病)的发病     

高原康胶囊对快速进入高原者脂质过氧化反应的影响及其意义

人体脑组织富含胆固醇和不饱和脂肪酸，易受到氧自由基的攻击而发生脂质过氧化反应，所以许多急性高原病（AHAD）患者首先表现为神经生理功能的变化，如头痛、头昏等。已有研究证明急性轻型高原病（AMAD）、高原肺水肿（HAPE）、高原脑水肿（HACE）都不同程度地存在脑水肿，因此脂质过氧化反应与AHAD的发病有着密切的关系。     

高原肺水肿合并高原脑水肿124例治疗体会

急性高原病是个体由平原进入高原（海拔3000m以上）或高原进入更高海拔由于缺氧致使机体适应不全而发生的高原地区特有的常见病和多发病，主要包括急性轻型高原病、高原肺水肿、高原脑水肿，并且以上疾病常常同时并存，其中以高原肺水肿合并高原脑水肿较为常见，其发病急，病情变化快，是高原地区危重症之一，加之其救治仍在高原现场进行，缺氧、寒冷、空气干燥、紫外线强等恶劣的自然条件依然存在，故临床救治难度相对较大，若治疗不当或不及时，常危及生命。     

高原肺动脉高压发病机制研究进展

高原肺动脉高压主要是由于高原习服不适应或不良适应而产生的高原疾病并发症。高原低氧环境下,低氧导致肺血管收缩,持续低氧能够诱导低氧性肺动脉高压的产生和发展。慢性低氧造成肺血管重构和右心室肥厚等病理生理现象,进而会导致肺水肿、脑水肿等高原病。因此,明确高原性肺动脉高压发病机理为高原病的预防和治疗奠定基础。现就近几年对高原性/低氧肺动脉高压发病机制方面的相关研究进行综述。     

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.