缬沙坦或吲达帕胺对中青年男性高血压患者性功能影响

目的探讨缬沙坦和吲达帕胺对中青年男性高血压患者降压的疗效以及对性功能的影响.方法将入选的120例患者随机分为两组,一组服用缬沙坦,另一组服用吲达帕胺,观察治疗8周前后血压及性功能变化.结果缬沙坦和吲达帕胺均能显著降压(P＜0.01).缬沙坦治疗后明显增加了勃起功能指数(17.7±4.6 vs14±5.6,P＜0.01)和每周性交次数(3.2±1.2次/周vs2.2±1.1次/周),两者差异显著(P＜0.01);而吲达帕胺治疗前后患者性功能无明显改变(P＞0.05).结论缬沙坦在降压的同时能显著改善男性性功能.     

复方利血平氨苯蝶啶片(降压0号)与吲达帕胺治疗原发性高血压患者的疗效和安全性——一项随机对照临床研究

目的比较复方利血平氨苯蝶啶片(降压0号)与吲达帕胺治疗高危的轻中度原发性高血压患者的疗效和安全性。方法采用多中心、整群随机、活性药对照、前瞻性的临床研究,入选2003年1月至2005年12月,全国10个地区13家医院就诊的高血压患者,随访2年。观察降压0号(1片/d)与吲达帕胺(2.5mg/d)的疗效和安全性。结果入选不同区域高血压患者4062例,降压0号组2324例,吲达帕胺组1738例。治疗2年后,降压0号组和吲达帕胺组收缩压明显降低,但降压幅度比较,差异无统计学意义[(30.2±17.2)比(29.1±19.6)mm Hg,P=0.053];降压0号组的血压达标率(140/90mm Hg)高于吲达帕胺组(62.6%比56.6%,P0.05)。随访2年,降压0号组新发低血钾(1.8%比3.5%)、血肌酐增加(49.5%比61.1%)和尿酸增高(50.2%比57.2%)的比例低于吲达帕胺组(均P0.05);降压0号组药物相关或可能相关不良事件发生率低于吲达帕胺组(2.45%比3.22%,P=0.046)。两组的心脑血管事件发生率分别为0.38%和0.46%。结论降压0号和吲达帕胺治疗高危的轻中度高血压患者安全有效,适宜在基层长期应用,降压0号有更低的低血钾风险。     

缬沙坦与吲达帕胺治疗原发性高血压的对比研究

目的 :评价缬沙坦 (valsartan)降压疗效的同时 ,探讨其降压外的其它作用。方法 :入选的原发性高血压患者被随机分为缬沙坦组和吲达帕胺 (indapamide)组。用药前后进行诊所血压、心脏超声多普勒及血浆一氧化氮 (NO)、血管紧张素Ⅱ (AngⅡ )、血浆醛固酮、空腹胰岛素及血脂 ,血清尿酸、血电解质、空腹血糖、肝肾功能及血尿常规检查 ,并计算空腹胰岛素 /空腹血糖值作为胰岛素抵抗指标。对已婚男性患者进行关于性功能障碍的问卷调查。结果 :治疗后 ,缬沙坦组和吲达帕胺组血压均有所下降 ,降压疗效相似 (总有效率分别为 6 7 5 %和 6 6 7% ) ,左心房指数均改善 ,有显著性差异 (P <0 0 5 ) ,舒张功能指标 (A/E)好转 ,有显著性差异 (P <0 0 1和P <0 0 5 ) ;缬沙坦组患者的AngⅡ和NO均升高 ,有显著性差异 (P <0 0 5和P <0 0 1) ,空腹胰岛素 /空腹血糖值降低 ,有显著性差异 (P <0 0 1) ,左心室心肌重量指数减低 ,有显著性差异 (P <0 0 5 ) ;此外 ,缬沙坦组患者的性活动增加 ,有显著性差异 (P <0 0 5 )。结论 :除了确切而缓和的降压作用外 ,缬沙坦具有良好的依从性和靶器官保护作用     

92例吲达帕胺联合缬沙坦对高血压合并糖尿病患者临床指标产生的影响

目的观察吲达帕胺联合缬沙坦对高血压合并糖尿病患者临床指标的影响。方法选取2012年3月—2013年4月该院收治的高血压合并糖尿病患者92例,随机分为对照组和观察组,对照组采用缬沙坦治疗,观察组在对照组基础上加用吲达帕胺治疗,比较两组患者各项临床指标的变化。结果观察组治疗后各项指标水平均低于治疗前(P0.05),且与对照组治疗后比较有显著差异(P0.05),观察组的降压总有效率明显高于对照组(χ2=5.392,P0.05)。结论吲达帕胺联合缬沙坦治疗高血压合并糖尿病可以起到降压和改善各项临床指标的效果,值得在临床上大力推广。     

依那普利治疗高血压并阵发性房颤的超声改变和疗效

目的：探讨依那普利对原发性高血压并阵发性房颤患者的干预作用并观察P波最大时限（Pmax）、P波离散度（Pd）、左心房内径（LAD）的变化。方法：治疗组给予依那普利5mg/d,服用1周,无效者在第2周开始将依那普利加大剂量至10～15mg/d,患者出院后,每1周门诊随访1次,共6个月;对照组给予吲达帕胺2.5mg/d,随访同上。用药期间及用药后观察患者的临床症状及体征变化,记录房颤的发作次数和持续时间,并观察生化指标的改变,服药6个月后复查12导联同步ECG及心脏彩超。结果：（1）治疗后两组有显著的降压效果,但无显著差异（P〉0.05）;（2）治疗6个月后,①窦性心律时,吲达帕胺组治疗前后Pmax,Pd无显著性差异（P〉0.05）;依那普利组则Pmax,Pd均显著降低（P〈0.05）;②LAD：吲达帕胺组较治疗前明显扩大（P〈0.05）,而依那普利组则无明显改变（P〉0.05）;（3）在随访的6个月中,依那普利组平均每例房颤发作次数显著少于吲达帕胺组（6.1±2.5）次∶（7.6±2.8）次,P〈0.05;平均每次房颤发作的时间（min）明显短于吲达帕胺组（146.8±39.4）min∶（197.2±43.7）min,P〈0.05。结论：依那普利治疗房颤优于吲达帕胺,其可能机制为降低交感神经张力,改善心房重构。     

吲达帕胺治疗老年单纯收缩期高血压疗效及其对代谢的影响

目的 :探讨吲达帕胺对老年单纯收缩期高血压 (ISH)的疗效及其对代谢的影响。方法 :10 2例老年ISH患者随机分为吲达帕胺治疗组 (n =5 2 ,吲达帕胺 1.2 5～ 2 .5mg/d)和非洛地平治疗组 (n =5 0 ,非洛地平 5～ 15mg/d)。每 1～ 2周测量坐位血压 1次。治疗前和治疗后 2个月后分别检测空腹血糖 ,血脂 ,血尿酸 ,血肌酐 ,血钾、钠和氯。结果 :两组治疗前后降压疗效差异均有非常显著性意义 (P <0 .0 1) ,但组间相比差异无显著性意义 (P 0 .0 5 )。两组治疗前后空腹血糖 ,血脂 ,血尿酸 ,血肌酐 ,血钾、钠和氯亦无统计学差异。结论 :吲达帕胺治疗老年ISH安全、有效 ,对空腹血糖 ,血脂 ,血尿酸 ,血肌酐 ,血钾、钠和氯无明显不良影响 ,是治疗老年ISH的第一线药物     

氯沙坦与吲达帕胺或氢氯噻嗪合用的降压疗效观察

目的 :研究和评价氯沙坦与吲达帕胺或氢氯噻嗪合用降压疗效及对代谢的影响。方法 :选择 45例轻—中度原发性高血压患者 ,随机分成 3组 ,每组各 15例。氯沙坦组 :单用氯沙坦 5 0～ 10 0mg ,每日一次 ;氯沙坦与吲达帕胺合用组 :氯沙坦 5 0mg ,每日一次 ,加吲达帕胺 2 .5mg ,每日一次 ;氯沙坦与氢氯噻嗪合用组 :氯沙坦 5 0mg ,每日一次 ,加氢氯噻嗪 12 .5mg ,每日二次。三组疗程均为 12周。观察三组治疗前后的随测血压 (CBP)和 2 4小时动态血压 (ABPM)及生化指标。结果 :氯沙坦加吲达帕胺或加氢氯噻嗪组降压总有效率及随测血压、2 4小时动态血压的变化均明显优于氯沙坦单用组 ,且治疗前后心率和生化指标无明显改变。结论 :氯沙坦与吲达帕胺或氢氯噻嗪联合应用降压效果较单用氯沙坦更有效 ,且对代谢无影响     

缬沙坦合并吲达帕胺治疗高血压疗效观察

目的研究分析采用缬沙坦合并吲达帕胺治疗高血压的临床效果。方法选取2011年9月至2013年11月,在我院接受治疗的72例高血压患者,随机分为观察组和对照组,每组36例。观察组患者采用缬沙坦合并吲达帕胺治疗,对照组单纯采用缬沙坦治疗,比较两组患者的治疗效果、治疗前后的血压变化及不良反应情况。结果观察组的治疗总有效率要优于对照组的总有效率(P0.05);治疗2周后,观察组的收缩压和舒张压下降幅度均要优于对照组(P0.05),治疗4周后,观察组的收缩压先于对照组降至正常(P0.05),治疗6周后,两组患者的舒张压差距加大,整个治疗期间观察组的舒张压下降幅度均低于对照组(P0.05);两组患者的不良反应情况比较无显著差异(P0.05),不具有统计学意义。结论高血压患者采用缬沙坦合并吲达帕胺治疗的临床效果显著,而且不良反应少,值得临床推广和应用。     

缬沙坦联合吲达帕胺治疗高血压的效果探究

目的对缬沙坦联合吲达帕胺治疗高血压的效果进行分析。方法将我院2016年8月至2017年8月间收治的高血压患者118例作为临床研究对象,采取随机数字法分为研究组(n=59)及对照组(n=59)。对照组采取缬沙坦治疗;研究组采取缬沙坦联合吲达帕胺治疗,比较两组患者治疗效果。结果研究组总有效率(94.92%)较对照组(83.05%)更高(P0.05);治疗前,两组患者收缩压、舒张压水平比较无明显差异(P0.05);治疗后,两组患者收缩压、舒张压均有所下降,但研究组水平要明显低于对照组(P0.05)。结论缬沙坦联合吲达帕胺治疗高血压可获得更好的降压效果,有利于进一步稳定患者病情。     

盐酸贝尼地平、缬沙坦联合吲达帕胺或氢氯噻嗪治疗顽固性高血压的疗效观察

目的观察盐酸贝尼地平、缬沙坦联合吲达帕胺或氢氯噻嗪治疗顽固性高血压的临床疗效。方法入选难治性高血压病人98例,随机分为治疗组(A组)和对照组(B组)。两组均给予盐酸贝尼地平片4mg,每日1次口服,缬沙坦胶囊80 mg,每日1次口服。在此基础上,A组病人给予吲达帕胺片2.5mg,每日1次口服;B组给予氢氯噻嗪12.5mg,每日1次口服。观察两组病人治疗3d、10d及3个月血压水平,10d、3个月血钾、肾功能及血糖改变情况。结果经过3d、10d及3个月治疗后,两组病人收缩压及舒张压均有较明显下降,且A组病人血压下降更显著(P0.05)。治疗组治疗后3d、10d、3个月总有效率高于对照组,差异有统计学意义(P0.05);与治疗后3d比较,治疗组治疗后10d、3个月治疗后总有效率比较差异有统计学意义(P0.05)。结论贝尼地平联缬沙坦、吲达帕胺以及贝尼地平联缬沙坦、氢氯噻嗪均具有较好的降压作用,但以联合吲达帕胺组降压效果更明显,短期内降压效果显著,达标率更高。     

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.