绝经后妇女应用性激素补充治疗的临床观察

目的 探讨正常绝经妇女应用不同剂量性激素补充疗法对Kupperman症状评分、子宫大小、阴道上皮脱落细胞评分的影响。方法 将70例要求性激素补充治疗的绝经后妇女随机分为4组，第1组为对照组，给予钙尔奇D 300mg，每日2次；第2组倍美力0．3mg／d；第3组倍美力O．45mg MPA 1mg／d；第4组倍美力O．625 mg MPA 2mg／d。用药时和3个月后进行Kupperman症状评分，B超监测子宫大小和内膜厚度。结果 ①对照组和试验组绝经症状均有明显改善。②子官内膜厚度：对照组和第2、3组用药前后无明显变化，第4组用药后子宫内膜厚度的均数增加0．21cm(P＞0．05)。②子宫体积：第2组用药后子宫体积显著增大(P＜0．01)，阴道脱落上皮细胞评分显著增加(P＜0．01)；第4组用药后子宫体积也明显增大(P＜0．05)，阴道脱落上皮细胞评分也显著增加(P＜0．01)。结论 ①雌激素能改善绝经症状，单用钙刑也能改善一定的绝经期症状。②短期内小剂量应用雌激素对子官内膜厚度影响不大，增加雌激素剂量后，加用孕激素后对子宫内膜仍然有增厚的影响。②小剂量单用雌激素使子宫体积明显增大。     

绝经后妇女子宫内膜癌临床特点分析

目的分析绝经后妇女子宫内膜癌临床特点，探讨其预后的影响因素。方法心顾分析子宫内膜癌患者130例，分为绝经前组和绝经后组，比较两组发病因素、临床表现、病理组织类型、雌、孕激素受体表达及其5年生存率情况。结果两组均以阴道异常流血为主要临床表现，经官腔镜检查确诊者绝经后组92．78％（90／97），绝经前组63．64％（21／33）。绝经前组肥胖患者多（P〈0．05），而合并高血压、糖尿病、多囊卵巢综合征等两组差异无统计学意义（P〉0．05）。两组病理类型、病理分期比较差异无统计学意义（P〉0．05），而细胞分化程度、肌层浸润、脉管内转移、雌、孕激素受体表达，差异有统计学意义（P〈0．05）。结论绝经后妇女子宫内膜癌以阴道流血为主要临床表现，以浆液性乳头状腺癌和透明细胞癌多见，分化程度差，易肌层浸润，雌、孕激素受体表达少，5年生存率低。     

雌孕激素治疗与老年女性外周动脉病危险间关系

有研究显示,在绝经后健康老年女性,接受雌孕激素替代治疗将轻微减少继后颈动脉粥样硬化危险,但并不能减少原有冠心病者的继后外周动脉事件危险。本文意就绝经后健康老年女性接受雌孕激素治疗与继后外周动脉事件危险间关系进行了随机双盲对照分析。对象与方法本文为妇女健康创议(WHI)试验,共纳入16608例绝经后健康老年女性,年龄50～79岁,平均63．3±7．1岁。分为随机双盲服用结合雌激素(0．625mg/d)加醋酸甲羟孕酮(2．5mg/d)的雌孕激素替代治疗组8506例,或仅服安慰剂的对照组8102例。尔后人均用药或随访5．6年,旨在观察两组随访期内新发外周动脉事件(包括新发颈动脉、腹主动脉、肢端外周动脉病症状体征,以及因此需住院、介入治疗者,或经血管超声确诊者)危险的差异。结果两组用药前即被确诊患有冠心病者2．4%、外周动脉病者0．5%。随访期内,两组因新发外周动脉事件而     

孕激素对卵巢切除大鼠子宫肌层发育的影响

目的　探讨孕激素对卵巢切除大鼠子宫肌层发育的影响。方法　将4 0只幼年大鼠随机分为A、B、C、D组,每组各10只。A组为假手术组,只行开关腹手术;B、C、D组均切除双侧卵巢,其中C组及D组分别加用大剂量及小剂量孕激素。连续给药6周后,测量各组大鼠子宫重量,用HE染色法加计算机图像分析技术观察子宫内膜、肌层及垂体、肾上腺的组织形态学变化。结果　B组子宫重量明显减轻至(14 5 .0 0±31.0 8) mg,C组子宫重量由(14 5 .0 0±31.0 8) mg增至(5 4 0 .30±86 .30 ) mg;肌细胞直径由(4.83±0 .2 5 ) μm增至(16 .5 2±0 .4 6 ) μm,与B、D组比较P均<0 .0 5。各组大鼠垂体及肾上腺无明显组织学改变。结论　大剂量孕激素可促进卵巢切除大鼠子宫肌层的发育。     

性激素补充治疗和骨质疏松症

性激素补充治疗(HRT)对绝经后妇女骨密度的维持效果已得到公认,目前资料尚不能肯定HRT与骨折的关系,但对已有椎体骨折妇女,HRT可减少再次骨折的发生。对美国妇女健康行动(WHI)临床试验中期研究结果应客观分析,雌孕激素HRT仍是治疗绝经期症状的最佳方案,且在绝经早期开始应用对预防骨质疏松症效果最佳。当然并不推荐所有绝经后妇女常规使用HRT,对无绝经症状的妇女来说,非激素防治骨质疏松应是更好的选择。     

雌-孕激素替代治疗对绝经后妇女血脂和脂蛋白代谢的长期作用

目的　观察雌 孕激素替代治疗 (HRT)对绝经后妇女血脂和脂蛋白代谢的长期作用。方法　 193例健康绝经后妇女分为A组 (高胆固醇血症组 ) 6 3例、B组 (无高胆固醇血症组 ) 6 0例和C组 (对照组 ) 70例 ,A、B组均给予倍美力 (天然结合型雌激素 ) 0 .6 2 5mg d +安宫黄体酮 2mg d治疗 ,连续 3年监测血清性激素、血脂及脂蛋白水平。结果A组总胆固醇 (TC) ,低密度脂蛋白胆固醇 (LDL C)水平分别下降 12 .1% (P <0 .0 1)、15 .7% (P <0 .0 1) ,B组LDL C下降 4 .5 % (P <0 .0 5 ) ,A、B组高密度脂蛋白胆固醇 (HDL C)水平均明显升高 ,分别为 15 .1% (P <0 .0 1)、2 5 .8% (P <0 .0 1) ,均在第 3个月就出现明显改变 ,并在服药期间可保持疗效 ,对照组则变化不明显。B组TC有下降趋势 ,各组甘油三酯 (TG)均有增高趋势 ,但差异均无显著性意义。A、B组血清 17 β雌二醇 (17 βE2 )和孕酮于第 3个月显著升高 ,血清卵泡刺激素、黄体生成素水平则于第 6个月明显下降 ,并在服药期间可保持疗效 ,而对照组变化不明显。结论　绝经后妇女HRT能改善血清TC、TG、LDL水平 ,并在服药期间可保持疗效 ,对具有高胆固醇血症者效果更佳     

北京社区绝经后女性骨质疏松性骨折相关危险因素和防治现况

目的了解北京社区绝经后女性骨质疏松性骨折相关危险因素和防治现况。方法选取2016年3月至2017年11月就诊于北京两个社区卫生服务中心的绝经后女性2 990例,在取得书面知情同意后,由医生询问、受访者回答填写自行设计的骨质疏松症危险因素及防治情况的调查问卷,回收有效问卷2 866份。对问卷内容进行统计分析,将无骨质疏松性骨折史者作为对照组,有骨质疏松性骨折患者作为骨折组,分析骨质疏松性骨折相关危险因素和防治情况。结果受试者中有明确骨质疏松性骨折史170例,占5. 9%。骨折组比对照组年龄更大[(67±7) vs.(62±7)岁,P0. 000 1],绝经年限更长[(16. 9±7. 5) vs.(12. 2±7. 8)年,P0. 000 1],身高下降≥4 cm的比例更大(30. 6%vs. 16. 4%,P0. 000 1)。两组规律服用钙剂的比例均不足30%,均很少补充维生素D。无受试者规律应用双膦酸盐类药物抗骨质疏松治疗。结论年龄、绝经年限、身高下降是否超过4 cm是绝经后女性是否发生骨质疏松性骨折的重要危险因素。即使是已发生骨质疏松性骨折的社区绝经后女性,骨质疏松症的基础措施和抗骨质疏松药物治疗仍极不充分。     

补肾活血复方治疗绝经后骨质疏松症疗效观察

妇女绝经或卵巢切除后,由于体内雌激素水平降低,使骨吸收相对增强,骨逐步丧失,形成骨质疏松。现代医学多用激素替代法治疗,但由于可引起不同程度的副作用,如周期性阴道出血、子宫内膜增生,甚至诱发子宫内膜癌,使得治疗十分棘手。作者采用补肾活血法自拟中药复方治疗绝经后骨质疏松症43例,观察了患者治疗前后主要症状和骨密度（BMD）及X线的改变,现报道如下。     

超小剂量米非司酮治疗子宫腺肌病效果观察

目的探讨口服超小剂量米非司酮治疗子宫腺肌病的临床疗效。方法 100例子宫腺肌病患者给予口服米非司酮5 mg/d,1次/d,疗程3个月。观察治疗前后患者症状、体征、激素和肝功能变化,B超检查患者治疗前后子宫内膜改变情况。结果治疗1个疗程,患者症状和体征有明显缓解,超声检查显示子宫病灶明显缩小,雌、孕激素水平均较治疗前降低（P均〈0.05）。未观察到有肝功能异常的患者。结论口服超小剂量米非司酮治疗子宫腺肌病具有良好的疗效及安全性。     

中波紫外线照射治疗绝经后骨质疏松的临床研究

目的 探讨中波紫外线照射仪对绝经后骨质疏松的治疗作用.方法 选择符合诊断标准的绝经后骨质疏松患者99例随机分为A、B、C三组,在A组35例肾阳虚型绝经后骨质疏松患者用中波紫外线照射治疗;B组34例肾阴虚型绝经后骨质疏松患者用中波紫外线照射治疗,两组均加服钙剂(2 g/ d).对照组C组,30例绝经后骨质疏松患者肌注鲑鱼降钙素,同时加服钙剂 (2 g/ d).观察治疗前后血清1,25(OH)2D3、Young Z、腰椎骨密度(BMD)的变化.结果 中波紫外线照射治疗肾阳虚组血清1,25(OH)2D3、Young Z、腰椎BMD在治疗前后差异均有显著性,与肾阴虚组比较有显著差异.C组各观察指标无明显变化.结论 中波紫外线照射对绝经后肾阳虚型骨质疏松有较好的疗效,可提高骨密度,改善骨代谢.     

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.