依达拉奉对急性脑梗死合并胰岛素抵抗患者的疗效观察

目的探讨依达拉奉对急性脑梗死合并胰岛素抵抗(IR)患者的神经功能缺损程度及IR水平的影响。方法收集急性脑梗死合并IR患者226例,随机分为治疗组113例和对照组113例。治疗组基础治疗+依达拉奉,对照组仅接受基础治疗。采用美国国立卫生研究院卒中量表(NIHSS)评估患者神经功能缺损程度,Barthel指数(BI)评价患者日常生活活动能力。空腹血糖用葡萄糖氧化酶法检测,空腹胰岛素(FINS)用化学发光法检测,计算稳态模型胰岛素抵抗指数(HOMA-IR)。结果与治疗前比较,治疗组治疗第7、14天NIHSS评分、FINS、HOMA-IR(除治疗第7天)明显降低,BI评分明显升高(P<0.05,P<0.01),对照组治疗第14天NIHSS评分明显降低,BI评分明显升高(P<0.05,P<0.01)。与治疗组比较,对照组治疗第14天FINS、HOMA-IR明显升高(P<0.01)。2组治疗前后空腹血糖及不良反应差异无统计学意义(P>0.05)。结论依达拉奉可能改善急性脑梗死合并IR患者的神经功能缺损程度和降低患者的IR水平。     

纳洛酮与依达拉奉联合治疗急性脑梗死的临床疗效观察

目的观察盐酸纳洛酮与依达拉奉联合治疗急性脑梗死的临床疗效。方法选择60例急性脑梗死患者随机分成治疗组30例,对照组30例。治疗组在常规治疗的基础上加用盐酸纳洛酮与依达拉奉。在治疗前,治疗后7d、14d进行神经功能缺损评分。结果治疗组对神经功能缺损的疗效明显优于对照组。结论盐酸纳洛酮与依达拉奉联合治疗急性脑梗死疗效确切。     

依达拉奉右莰醇联合替罗非班辅助综合康复干预治疗老年急性脑梗死的临床疗效

目的 分析依达拉奉右莰醇联合替罗非班治疗老年急性脑梗死患者的临床疗效。方法 选取老年急性脑梗死患者70例，随机分为两组，每组35例。对照组予以依达拉奉右莰醇联合替罗非班治疗；研究组在对照组治疗的基础上予以综合康复干预治疗。治疗前后分别对两组进行神经功能缺损[美国国立卫生研究院脑卒中量表(NIHSS)和改良Rankin(mRS)]评分、日常生活能力(Barthel评分)和运动功能(Fugl-meyer评分)评定；检测血液中炎症相关指标、血常规和肝功检测。结果 治疗后，研究组神经功能缺损评分、Barthel评分及Fugl-meyer评分明显优于对照组(P<0.05)。治疗后研究组炎症标志物水平下降幅度明显大于对照组(P<0.05)。另外，研究组总有效率明显高于对照组(P<0.05)。结论 综合康复干预对辅助依达拉奉右莰醇联合替罗非班药物对老年急性脑梗死有明显改善作用。     

尤瑞克林联合依达拉奉治疗急性脑梗死的疗效观察

目的 观察尤瑞克林联合依达拉奉治疗急性脑梗死的临床疗效及安全性.方法 122例急性脑梗死患者随机分为治疗组(61例)与对照组(61例).对照组予依达拉奉0.03g加入生理盐水100 mL静脉输注,2次/天.治疗组在对照组治疗基础上另予尤瑞克林0.15PNA加入生理盐水100mL中静脉输注,1次/天.两组疗程均为14d.所有病例于治疗前和治疗后14 d采用美国国立卫生研究院脑卒中量表(NIHSS)评定临床神经功能缺损和临床总有效率.结果 治疗后对照组神经功能评分4.87分±4.06分,明显高于治疗组4.13分±2.98分(P＜0.05);治疗组临床总有效率91.8％,明显高于对照组的77.0％ (P＜0.05).结论 尤瑞克林与依达拉奉联合治疗急性脑梗死疗效优于依达拉奉单独使用,且安全性佳.     

尤瑞克林联合依达拉奉治疗急性脑梗死的疗效及对CRP的动态影响

目的观察尤瑞克林联合依达拉奉治疗急性脑梗死的疗效,以及二者联用对急性脑梗死患者治疗后不同时间血清C反应蛋白(CRP)、神经功能缺损评分(NIHSS)的影响。方法将60例急性脑梗死患者随机分为联合组和对照组各30例,两组患者均予对症支持治疗,联合组在此基础上予依达拉奉、尤瑞克林,疗程14 d,比较两组疗效,并动态观察两组患者治疗前及治疗后7、14 d血清CRP、NIHSS的变化。结果联合组治疗14 d后的总有效率(86.6%)明显高于对照组(66.7%),P<0.05。治疗后14 d两组血清CPR水平、NIHSS均较治疗前及治疗后7 d降低,且联合组较对照组明显(P<0.05)。结论尤瑞克林联合依达拉奉治疗急性脑梗死疗效确切,可有效降低患者血清CPR水平,改善患者的预后。     

依达拉奉联合丁苯酞治疗急性脑梗死疗效观察

目的观察依达拉奉联合丁苯酞治疗急性脑梗死临床疗效。方法将84例急性脑梗死的病人随机分为单独使用依达拉奉治疗组(对照组,44例)和依达拉奉联合丁苯酞治疗组(治疗组,40例)。比较两组治疗14 d和90 d的美国国立卫生院卒中量表评分(NIHHS)和日常生活能力评分(ADL)。结果两组治疗后14 d9、0 d NIHSS评分、ADL评分均较治疗前明显改善(P<0.05),但治疗组改善程度优于对照组(P<0.05)。结论依达拉奉联合丁苯酞治疗急性脑梗死可有效减低治疗后14 d和90 d的神经功能缺损,提高病人日常生活能力。     

奥扎格雷钠联合依达拉奉治疗急性脑梗死140例疗效评价

目的探讨奥扎格雷钠联合依达拉奉治疗急性脑梗死的临床疗效及安全性。方法将急性脑梗死患者140例随机分为联合组和对照组各40例。对照组行常规治疗：口服阿司匹林,静滴奥扎格雷钠、胞二磷胆碱等;联合组在对照组用药基础上同时给予依达拉奉静滴。两组疗程均为14 d。治疗前、治疗后第3天、第7天、第14天对两组患者进行神经功能缺损（NIHSS）评定、临床疗效评价和日常生活能力（Barthel指数,BI）评分,并监测凝血常规、肝肾功能、血脂、血糖和心电图。结果联合组临床疗效优于对照组;两组患者治疗后NIHSS评分和BI评分均有明显改善;治疗后第3天、第7天和第14天联合组的改善程度均优于对照组,差异均有统计学意义（P〈0.05）。结论奥扎格雷钠联合依达拉奉治疗急性脑梗死临床效果显著、安全,能明显改善患者的神经功能缺损。     

丁苯酞联合依达拉奉治疗通过降低颈动脉内膜中膜厚度改善老年急性脑梗死患者神经功能

目的探讨丁苯酞联合依达拉奉治疗对老年急性脑梗死患者颈动脉内膜中膜厚度和神经功能的影响。方法纳入2014年1月至2016年3月在我院神经内科收治的老年急性脑梗死患者92例,随机分为依达拉奉治疗组和丁苯酞联合依达拉奉治疗组(简称联合治疗组),每组46例。依达拉奉治疗组给予依达拉奉治疗,联合治疗组同时给予依达拉奉和丁苯酞治疗,共治疗90天。观察两组治疗效果,评估颈动脉内膜中膜厚度和斑块面积,应用NIHSS评分、改良的Rankin量表(m RS)评分和Barthel指数评价神经功能。同时,观察两组患者不良反应的发生情况。结果联合治疗组总有效率显著高于依达拉奉治疗组(P0.05)。治疗后,两组患者颈动脉内膜中膜厚度和斑块面积均较治疗前显著降低(P0.05),且联合治疗组颈动脉内膜中膜厚度和斑块面积显著低于依达拉奉治疗组(P0.05);联合治疗组NIHSS评分、m RS评分低于依达拉奉治疗组(P0.05),Barthel指数显著高于依达拉奉治疗组(P0.05);两组患者不良反应发生率无明显差异(P0.05)。结论丁苯酞联合依达拉奉治疗可显著降低老年急性脑梗死患者颈动脉内膜中膜厚度,改善其神经功能,临床疗效显著,安全性较高。     

醒脑开窍针法联合依达拉奉、纤溶酶治疗对脑梗死急性期患者神经功能的影响

目的探讨醒脑开窍针法联合依达拉奉、纤溶酶治疗脑梗死急性期患者的疗效及对神经功能的影响。方法将脑梗死急性期患者66例随机分为对照组和观察组,每组33例。对照组患者给予依达拉奉和纤溶酶治疗,观察组患者在依达拉奉和纤溶酶治疗的基础上加用醒脑开窍针治疗。治疗14 d后比较两组患者神经功能缺损评分(NIHSS)、日常生活能力Barthel指数(BI)评分、牛津残障评分(OHS)及临床疗效;治疗1 d、3 d、7 d、14 d后分别检测比较两组患者血清C-反应蛋白水平(CRP);观察比较两组患者不良反应发生情况。结果治疗14 d后两组患者NIHSS、OHS评分均显著降低、BI评分显著升高(P0.01),观察组患者NIHSS、OHS评分显著低于对照组、BI评分显著高于对照组(P0.01)。观察组患者治疗总有效率(96.97%)显著高于对照组(75.76%),差异有统计学意义(P0.05);观察组患者临床疗效优于对照组(P0.01)。治疗后3 d、7 d、14 d时,观察组CRP水平显著低于对照组,差异有统计学意义(P0.05或0.01)。治疗期间两组患者均未出现明显的不良反应。结论醒脑开窍针法联合依达拉奉、纤溶酶治疗,能够有效改善脑梗死急性期患者神经功能,临床疗效显著,不良反应少,值得推广使用。     

疏血通注射液联合依达拉奉注射液治疗2型糖尿病伴急性脑梗死的疗效观察

目的观察疏血通注射液联合依达拉奉注射液治疗2型糖尿病伴急性脑梗死的疗效。方法将80例2型糖尿病病人随机分为两组,对照组和试验组。对照组使用依达拉奉注射液,试验组使用疏血通注射液联合依达拉奉注射液,2周后比较其治疗效果。结果两组病人治疗后神经功能功能缺损评分有统计学意义(22.07分±5.02分vs 24.73分±5.53分,P0.05),试验组神经功能恢复优于对照组;两组病人Barthel(巴氏指数)比较有统计学意义(64.00分±9.28分vs 59.63分±8.88分,P0.01),试验组日常生活能力优于对照组;两组治疗前后比较,神经功能及日常生活能力治疗后明显改善,有统计学意义(P0.01)。结论疏血通注射液联合依达拉奉治疗2型糖尿病伴急性脑梗死,优于单纯依达拉奉治疗,效果更显著。     

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.