培哚普利治疗慢性心力衰竭长期随访

目的 观察血管紧张素转换酶抑制剂培哚普利对慢性心力衰竭（CHF）的远期预后。方法 选择CHF患者72例，随机分为对照组（29例）和治疗组（43例）。对照组采用综合疗法。治疗组在上述基础上加用培哚普利（2-4mg/d)。在治疗前和观察期满4年时分别对心功能NYHAⅡ-Ⅲ级患者作踏车负荷试验，记录患者所能耐受的最大运动功率和运动持续时间。结果 4年期间，对照组和治疗组因心力衰竭加重再住院率分别为82．76％和25．58％（P＜0．005），病死率分别为31．03％和9．30％（P＜0．025）；与治疗前相比，治疗组心功能（NYHA分级）、最大运动功率和运动持续时间均明显改善（P＜0．001），而对照组各项指标无明显改善。结论 培哚普利可显著改善CHF患者的远期预后。     

应用依那普利联合美托洛尔治疗慢性心力衰竭的临床观察

目的观察血管紧张素转换酶抑制剂依那普利和β-受体阻滞剂美托洛尔联合应用对慢性心力衰竭(CHF)的远期疗效.方法共选择CHF患者94例,随机分为对照组(46例)和治疗组(48例).对照组采用常规治疗(即强心、利尿、扩血管).治疗组在此基础上加用依那普利5～10(mg/d)和美托洛尔37.5～100(mg/d),在治疗前和观察期满5年时分别对心功能NYHA Ⅱ～Ⅲ级患者作6 min步行试验,记录步行距离.结果 5年期间,对照组和治疗组因心力衰竭加重再住院率分别为80.43%和27.08%(P<0.005), 病死率分别为32.61%和8.33%(P<0.05); 与治疗前比较,治疗组心功能(NYHA分级)及6 min步行距离有明显改善(P<0.05),而对照组无明显改善.结论依那普利联合美托洛尔可显著改善CHF患者的远期预后.     

氯沙坦对充血性心力衰竭远期预后的影响

目的观察血管紧张素Ⅱ受体阻滞剂(ARB)治疗充血性心力衰竭(CHF)的远期预后.方法选择CHF患者64例,随机分为对照组(28例)和观察组(36例).对照组采用综合疗法.观察组在上述基础上加用氯沙坦(50～100mg/d).在治疗前和观察期满3年时,分别进行超声心动图检测左室射血分数(LVEF)、每搏输出量(SV)、心脏指数(CI).结果3年间,对照组和观察组因心力衰竭加重再住院率分别为75.0%和25.0%(P＜0.05),病死率分别为32.5%和8.3%(P＜0.05);与治疗前相比,观察组心功能(NYHA)分级,LVEF、SV、CI均显著改善(P＜0.01),而对照组无明显改善.结论氯沙坦可显著改善CHF患者的远期预后.     

应用依那普利联合美托洛尔治疗慢性心力衰竭的临床观察

目的　观察血管紧张素转换酶抑制剂依那普利和 β -受体阻滞剂美托洛尔联合应用对慢性心力衰竭 (CHF)的远期疗效。方法　共选择CHF患者 94例 ,随机分为对照组 (46例 )和治疗组 (48例 )。对照组采用常规治疗 (即强心、利尿、扩血管 )。治疗组在此基础上加用依那普利 5～ 10 (mg/d)和美托洛尔 37 5～ 10 0 (mg/d) ,在治疗前和观察期满 5年时分别对心功能NYHAⅡ～Ⅲ级患者作 6min步行试验 ,记录步行距离。结果　 5年期间 ,对照组和治疗组因心力衰竭加重再住院率分别为80 4 3%和 2 7 0 8% (P <0 0 0 5 ) ,病死率分别为 32 6 1%和 8 33% (P <0 0 5 ) ;与治疗前比较 ,治疗组心功能 (NYHA分级 )及 6min步行距离有明显改善 (P <0 0 5 ) ,而对照组无明显改善。结论　依那普利联合美托洛尔可显著改善CHF患者的远期预后     

卡维地洛治疗慢性心力衰竭的远期预后观察

目的观察β受体阻滞剂卡维地洛对慢性心力衰竭（CHF）的远期预后。方法选择CHF病人71例，随机分为对照组（28例）和治疗组（43例），对照组采用综合疗法，治疗组加用卡维地洛（10～40）mg／d，在治疗前和观察期满5年时，分别对心功能NYHAⅡ级～Ⅲ级病人进行评估。结果5年期间，对照组和治疗组因心力衰竭加重再住院率分别为85.71％和25．58％（P〈0.005），病死率分别为32．14％和9.30％（P〈0．05），与治疗前相比，治疗组心功能（NYHA分级）明显改善（P〈0．001），而对照组无明显改善。结论卡维地洛可显著改善CHF病人的远期预后。     

坎地沙坦联合美托洛尔治疗慢性心力衰竭临床观察

目的 观察坎地沙坦联合美托洛尔治疗慢性心力衰竭(心衰)的疗效.方法 97例慢性心衰患者,NYHA心功能分级为 Ⅱ级～Ⅳ级,随机分为两组.治疗组50例,在心衰常规治疗基础上加用坎地沙坦、美托洛尔治疗.对照组47例为心衰常规治疗.观察两组患者临床疗效及治疗前后心率、左室射血分数和心肌耗氧量等指标的变化.结果 治疗组和对照组治疗后临床疗效总有 效率分别为92.0%和70.2%(P＜0.05).治疗后治疗组心率及心肌耗氧量下降程度、左心室射血分数升高程度均显著优于对照组 (P＜0.05).结论坎地沙坦联合美托洛尔治疗慢性心力衰竭能更好的增加左室射血分数、减少心肌耗氧量、改善心功能.     

瑞舒伐他汀对慢性心力衰竭患者血清hs-CRP及心功能分级的影响

目的 探讨瑞舒伐他汀对慢性心力衰竭(CHF)患者血清超敏C反应蛋白(hs-CRP)及心功能分级的影响.方法 选择心功能NYHA分级Ⅲ～Ⅳ级、左室射血分数≤50％的CHF患者120例,将其随机分为治疗组、对照组各60例.两组均采用常规抗心衰治疗,治疗组加服瑞舒伐他汀10 mg、每晚1次,连服12周.治疗前后观察两组hs-CRP、血脂及心功能分级变化.结果 治疗组、对照组治疗后LDL-C、血清hs-CRP均明显降低,心功能指标明显改善(P均＜0.05),以治疗组改善更明显(P均＜0.05).结论 常规治疗加瑞舒伐他汀可更好地改善CHF患者的预后,提高其运动耐力及生存质量.     

地高辛与美托洛尔或地尔硫(艹卓)合用对慢性心力衰竭伴慢性心房颤动患者的对比研究

目的对比地高辛联用美托洛尔和联用地尔硫(艹卓)对慢性心力衰竭(CHF)伴慢性心房颤动(AF)患者的近期疗效与远期预后.方法选择CHF伴慢性AF 81例,随机分为美托洛尔组(42例)和地尔硫(艹卓)组(39例),两组均常规使用地高辛、利尿剂、血管紧张素转换酶抑制剂(ACEI)、抗凝剂,美托洛尔组加用美托洛尔(12.5～50.0 mg/d)而地尔硫(艹卓)组加用地尔硫(艹卓)(45～90 mg/d),观察两组的短期疗效并随访2年期间因心脑血管事件的再住院率、病死率.结果治疗1个月后,两组均能显著降低静息心室率和运动前后即刻心室率差值(HD)(P＜0.01)及增加6 min步行距离(S)和每搏量(SV)(P＜0.05)并且显著改善心功能(NYHA分级,P＜0.01),且两组间差异无显著性(P＞0.05).随访2年,美托洛尔组和地尔硫(艹卓)组相比,因心力衰竭再住院率较低(52.38%对76.92%,P＜0.025),病死率亦较低(38.10%对61.54%,P＜0.05).地尔硫(艹卓)组存活的病例、NYHA分级、S、SV、左心室收缩末容积(LVESV)、左心室舒张末容积(LVEDV)及左心室射血分数(LVEF)与美托洛尔组相比,差异有显著性(P＜0.05).结论在常规使用利尿剂、ACEI、抗凝剂治疗的基础上,地高辛联用美托洛尔其短期疗效与联用地尔硫(艹卓)相近,但远期预后却明显优于地尔硫(艹卓).     

卡维地洛治疗慢性心力衰竭25例疗效观察

将48例慢性心力衰竭（CHF）患者随机分为观察组25例和对照组23例，两组均予常规治疗（强心、利尿和扩血管），观察组在此基础上口服卡维地洛，对照组口服美托洛尔。结果治疗6个月观察组心功能改善效果优于对照组。认为卡维地洛治疗CHF远期疗效优于美托洛尔。     

参竹心康汤联合美托洛尔治疗慢性心力衰竭的临床疗效观察

目的探讨参竹心康汤联合美托洛尔治疗慢性心力衰竭(CHF)的临床疗效。方法选择2015年5月—2016年5月我院收治的CHF病人95例,随机分为观察组和对照组,对照组47例接受美托洛尔治疗,观察组48例在对照组基础上加服参竹心康汤治疗。检测两组病人血清基质金属蛋白酶9(MMP-9)、金属蛋白酶组织抑制剂1(TIMP-1),记录治疗前后左心室射血分数(LVEF)、纽约心脏病协会(NYHA)心功能分级,依据Lee氏计分系统评价CHF疗效。结果对照组总有效率为68.09%,观察组总有效率为89.58%,观察组总有效率高于对照组(P 0.05);治疗后观察组LVEF高于对照组(P 0.05),心功能分级优于对照组(P 0.05);治疗后观察组血清MMP-9浓度低于对照组(P 0.05),TIMP-1浓度高于对照组(P 0.05)。结论参竹心康汤联合美托洛尔治疗CHF,可提高射血分数,改善病人心功能,临床疗效显著优于单纯使用美托洛尔,其作用机制可能与改善MMP-9、TIMP-1活性有关。     

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.