颈动脉斑块性质和管腔狭窄与年龄的相关性研究

目的探讨年龄与颈动脉管腔狭窄及斑块性质的关系。方法随机对照研究,选择2012年1月~2014年1月在青岛市市立医院行颈动脉超声检查的患者165例,根据临床及影像学表现分为缺血性脑卒中组100例和非脑卒中组65例,分析缺血性脑卒中发病的危险因素。其次,根据年龄分为中青年组(年龄≤59岁)36例,老年组(60~79岁)98例,高龄组(年龄≥80岁)31例,对3组患者的颈动脉狭窄程度、斑块性质进行统计分析。结果缺血性脑卒中组年龄、高血压、易损斑块及管腔重度狭窄比例明显高于非脑卒中组[(70.6±11.2)岁vs(65.1±12.8)岁,P=0.004;79.0%vs 60.0%,P=0.008;40.0%vs 24.6%,P=0.041;20.0%vs 6.2%,P=0.014]。高龄组管腔重度狭窄比例明显高于中青年组及老年组(54.8%vs 2.8%和6.1%,P0.01)。与中青年组比较,老年组和高龄组稳定斑块及易损斑块检出率明显升高,差异有统计学意义(P0.01)。多因素logistic回归分析显示,年龄是缺血性脑卒中的危险因素(OR=1.039,95%CI:1.011~1.068,P=0.005)。年龄是颈动脉重度狭窄及易损斑块的危险因素(OR=1.225,95%CI:1.125~1.335,P=0.000;OR=1.035,95%CI:1.005~1.065,P=0.023)。结论年龄增长是缺血性脑卒中的危险因素,缺血性脑卒中患者比非脑卒中患者易损斑块多且管腔重度狭窄比例大。年龄≥60岁患者颈动脉易损斑块多于年龄≤59岁患者,年龄≥80岁患者管腔重度狭窄比例最高,发生缺血性脑卒中危险性可能更大。     

老年高血压缺血性脑卒中合并2型糖尿病患者颈动脉粥样硬化程度的分析

目的应用CT血管成像联合颈动脉超声检查对颈动脉粥样硬化斑块进行评价,并探讨其与2型糖尿病的关系。方法选择缺血性脑卒中患者152例,根据诊断分为糖尿病组56例,非糖尿病组96例,并进行CT血管成像联合颈动脉超声检查,分析斑块性质、形态,观察发生缺血性脑卒中事件相关因素,logistic回归分析老年缺血性脑卒中颈动脉粥样硬化程度与糖尿病的相关性。结果与非糖尿病组比较,糖尿病组颈动脉内膜中层增厚及斑块发生率高,易损斑块多,颈总动脉分叉部及动脉狭窄比例高,差异有统计学意义(P<0.05)。logistic回归分析表明,空腹血糖(OR=5.924,95%CI:1.176～2.468,P=0.003)与颈动脉粥样硬化程度密切相关;LDL-C(OR=2.283,95%CI:1.108～4.276,P=0.009)、纤维蛋白原(OR=1.856,95%CI:1.287～3.095;P=0.011)与颈动脉粥样硬化程度相关。结论老年缺血性脑卒中合并2型糖尿病患者颈动脉粥样硬化程度重,危险因素多于非糖尿病患者;常规对于颈动脉粥样硬化患者进行定期的血糖检测有重要参考价值。     

急性缺血性脑卒中患者出院3年血管源性死亡危险因素分析

目的 急性缺血性脑卒中(AIS)患者出院3年血管源性死亡危险因素分析。方法 选择老年AIS患者3361例,出院3年血管源性死亡213例(死亡组),非血管源性死亡3148例(非死亡组)。通过患者病史、人口学信息、实验室、影像学检查等资料分析其3年内血管源性死亡的危险因素。结果 死亡组年龄、脑卒中、心房颤动、冠心病、颈动脉狭窄、入院时美国国立卫生研究院卒中量表(NIHSS)评分、白细胞计数、尿素、肌酐、胱抑素C、脂蛋白(a)水平明显高于非死亡组,吸烟、体质量指数、TG和同型半胱氨酸水平明显低于非死亡组(P<0.05,P<0.01)。多因素Cox回归分析显示,年龄(OR=1.401,95%CI:1.362～1.401,P=0.001)、跌倒评分(OR=1.285,95%CI:1.175～1.402,P=0.001)、颈动脉狭窄(OR=1.435,95%CI:1.048～1.926,P=0.025)、入院时NIHSS评分(OR=1.064,95%CI:1.048～1.105,P=0.001)、白细胞计数(OR=1.079,95%CI:1.022～1.112,P=0.005)是血管源...     

颈动脉粥样硬化与冠状动脉旁路移植术后神经系统并发症相关性研究

目的:探讨颈动脉粥样硬化程度与非体外循环下冠状动脉旁路移植术后,神经系统并发症的关系。方法:连续选择择期行非体外循环下冠状动脉旁路移植术的患者475例,根据颈动脉超声结果分为四组:无狭窄、轻度、中度及重度狭窄,分析狭窄程度与术后神经系统并发症的关系及影响因素。结果:①四组患者之间年龄、脑卒中病史、糖尿病史及神经系统并发症比较,差异有统计学意义(P<0.05);②颈动脉狭窄患者术后神经系统并发症的发生率高于无颈动脉狭窄患者(χ2=3.851,P=0.050);③脑卒中病史(OR=1.835,95%CI:1.023～3.289,P<0.05)、颈动脉重度狭窄(OR=2.793,95%CI:1.296～6.018,P<0.05)与术后神经系统并发症相关(P<0.05)。结论:脑卒中病史、颈动脉重度狭窄是旁路移植术后神经系统并发症的危险因素。颈动脉不论狭窄程度,均可导致术后神经系统并发症发生率增高,低灌注可能为主要原因。     

徐州地区进展性脑卒中相关危险因素

目的探讨徐州地区缺血性进展性脑卒中的相关危险因素。方法利用脑卒中注册数据库,前瞻性连续登记2012年6月至2013年6月急性脑卒中患者的临床资料546例,其中进展性脑卒中80例,对照组为完全性脑卒中组,进行1∶1匹配研究,对可能引起脑卒中进展的危险因素进行单因素分析和二分类Logistic回归分析。结果与完全性脑卒中组相比,进展性脑卒中组既往有饮酒史、糖尿病史及血管狭窄的发生率更高,病程中体温升高及空腹高血糖可能参与了脑卒中的进展,差异有统计学意义(P<0.05)。二分类Logistic回归分析结果显示,高血压(OR=0.028,95%CI 0.001~0.982)、发热(OR=0.019,95%CI 0.000~0.931)对于脑卒中进展的贡献较大。结论徐州地区既往有高血压、饮酒史、糖尿病、血管狭窄及病程中发热的患者容易发展为进展性脑卒中。     

前循环急性进展性缺血性卒中相关危险因素的分析

目的探讨前循环急性进展性缺血性卒中住院患者的危险因素。方法选择前循环急性缺血性进展性卒中100例患者为研究对象,均进行抗血小板聚集治疗。分为进展组32例,非进展组68例。由1名经过相关培训的神经科主治医师询问病史并进行体检,记录与前循环急性进展性缺血性卒中发生可能相关的24个危险因素,进行χ2或t检验,对所有入组的患者以病情是否进展为因变量(Y),以单因素分析后差异有统计学意义的因素作为自变量,采用Logistic多因素逐步回归后退法分析,筛选出独立的危险因素。结果两组患者危险因素的多因素分析显示:有颈动脉狭窄(OR=22.069,95%CI:5.169~94.223)、入院体温增高(OR=13.404,95%CI:1.958~91.736)、有糖尿病史(OR=12.598,95%CI:2.867~55.359)3个因素进入模型(P<0.05)。结论颈动脉狭窄、入院体温增高、有糖尿病史是前循环急性进展性缺血性卒中的主要危险因素。前循环急性进展性缺血性卒中是多种因素、多种机制共同作用的结果。     

超微血流成像对进展性缺血性卒中的判断价值

目的探讨超微血流成像(SMI)技术对进展性缺血性卒中的判断价值。方法前瞻性连续纳入2015年12月至2016年5月中国医科大学附属盛京医院神经内科符合纳入标准的急性缺血性卒中住院患者102例,对其进行双侧颈动脉SMI评估,并记录发病24 h内相关临床数据。将符合欧洲进展性卒中研究组相关诊断标准者分为进展组(18例),其余为非进展组(84例)。比较两组基线资料、颈动脉超声特征及SMI检测的斑块内血流分值的差异;采用多因素Logistic回归分析进展性缺血性卒中的独立危险因素。结果 (1)进展组与非进展组一侧颈动脉重度狭窄、不稳定颈动脉斑块发生率及SMI检测的斑块内血流分值的差异均有统计学意义[一侧颈动脉重度狭窄发生率:66.7%(12例)比27.4%(23例),不稳定颈动脉斑块发生率:61.1%(11例)比40.5%(34例),SMI检测的斑块内血流分值:(3.0±1.0)分比(0.8±0.3)分;均P0.05]。(2)Logistic多因素回归结果显示,一侧颈动脉重度狭窄(OR=1.09,95%CI:1.00~1.55,P=0.04)、不稳定颈动脉斑块(OR=1.86,95%CI:1.15~4.25,P=0.02)、SMI检测的斑块内血流分值(OR=4.24,95%CI:1.93~9.77,P0.01)均为急性缺血性卒中进展的独立危险因素。结论 SMI可通过对颈动脉斑块内新生血管的评估有效地判断急性缺血性卒中的进展,并且斑块内新生血管越多,缺血性卒中发生进展的风险越大。     

缺血性脑血管病患者阻塞性睡眠呼吸暂停低通气综合征与有症状颈动脉狭窄的关系

目的 探讨缺血性脑血管病(ischemic cerebrovascular disease,ICVD)患者阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)与颈动脉狭窄的关系,为制定颈动脉狭窄的干预策略提供参考.方法 从南京卒中注册系统中筛选出87例ICVD患者,根据呼吸暂停低通气指数(apnea-hypopnea index,AHI)将患者分为无OSAHS组(n=21)以及轻度(n=24)、中度(n=27)和重度(n=11)OSAHS组;另外,根据数字减影血管造影(digital subtraction angiography,DSA)结果,将患者分为无颈动脉狭窄组(n=34)和颈动脉狭窄组(n=49).分析脑血管病危险因素和OSAHS对ICVD患者颈动脉狭窄的影响.结果 无OSAHS以及轻度、中度和重度OSAHS组之间饮酒(χ2=8.56,P=0.036)、高血压(χ2=13.2,P=0.004)和颈动脉狭窄(χ2=22.97,P=0.006)患者比例均存在显著差异.单因素分析显示,年龄(OR=1.066,95% CI 1.023～1.112;P=0.003)、高血压(OR=3.587,95%CI 1.294～9.949;P=0.014)、饮酒(OR=5.275,95%CI 1.855～15.001,P=0.002)和OSAHS(OR=1.073,95%CI 1.033～1.115,P=0.000)是颈动脉狭窄的危险因素;多变量logistic回归分析显示,年龄(OR=1.113,95%CI 1.047～1.182;P=0.001)、OSAHS(OR=1.096,95%CI 1.034～1.160;P=0.000)、饮酒(OR=4.292,95% CI 1.217～15.139;P=0.024)是颈动脉狭窄的独立危险因素.Spearman等级相关分析提示,AHI水平与颈动脉狭窄程度呈正相关(r=0.435,P=0.000).无颈动脉病变组(n=34)、单侧病变组(n=22)和双侧病变组(n=27)AHI存在显著差异[(12.97±10.04)次/h对(21.40±16.38)次/h对(29.33±13.81)次/h,F=11.64,P<0.01].结论 OSAHS是颈动脉狭窄的独立危险因素,且与颈动脉狭窄严重程度呈正相关.AHI在一定程度上能反映颈动脉狭窄程度和颈部血管受累范围.     

缺血性脑卒中患者早期神经功能恶化的危险因素研究

目的探讨缺血性脑卒中患者早期神经功能恶化的危险因素。方法选择彭州市人民医院2010年8月—2013年12月收治的缺血性脑卒中患者96例,回顾性分析其临床资料,分析早期神经功能恶化的危险因素。结果96例患者中发生早期神经功能恶化27例(病例组),未发生早期神经功能恶化69例(对照组),早期神经功能恶化发生率为28.1%。单因素分析结果显示,病例组患者高血压、糖尿病、高脂血症、心房纤颤、颈动脉狭窄发生率,白细胞计数,C反应蛋白、D-二聚体水平,美国国立卫生研究院卒中量表(NIHSS)评分高于对照组,凝血酶原时间长于对照组(P0.05)。多因素Logistic回归分析结果显示,高血压〔OR=2.171,95%CI(1.080,4.361)〕、糖尿病〔OR=3.842,95%CI(1.638,9.012)〕、心房纤颤〔OR=6.573,95%CI(1.073,40.286)〕为缺血性脑卒中患者早期神经功能恶化的危险因素(P0.05)。结论缺血性脑卒中患者早期神经功能恶化发生率较高,高血压、糖尿病、心房纤颤是其危险因素。     

脑卒中高危人群血清游离脂肪酸与颈动脉狭窄的关系研究

目的 探讨游离脂肪酸(free fatty acid,FFA)危险因素与颈动脉狭窄之间的相关性。方法 回顾性分析杭州市下城区朝晖街道530例脑卒中高危患者,其中男性211例,女性319例,平均年龄(71.29±7.02)岁。按照患者血清FFA水平分为第一分位数组177例,第二分位数组177例,第三分位数组176例。采用彩色多普勒超声诊断仪检查颈动脉血管狭窄程度。结果logistic回归分析显示,FFA是脑卒中患者颈动脉狭窄病变的独立危险因素(OR=1.003,95%CI:1.001~1.005,P=0.001)。第一分位数组、第二分位数组和第三分位数组体质量指数异常,血压异常,血糖异常,TG异常以及HDL异常的颈动脉狭窄形成率均高于危险因素校正后的第一分位数组。结论脑卒中高危人群颈动脉狭窄与血清FFA水平密切相关,同时提示高水平FFA合并高血压、血糖异常、血脂异常等危险因素对颈动脉狭窄的发生具有促进作用。     

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.