血压参数与老年人认知功能障碍的关系

目的探讨血压参数与老年人认知功能障碍之间的关系。方法对开滦集团公司1063名离退休职工进行健康查体,同时进行简易精神状况检查表(MMSE)测试以评价认知功能,资料完整并符合入选标准的共计890例,认知功能障碍者作为病例组222名,非认知功能障碍者为对照组668名。测定血压并进行统计学分析。结果病例组收缩压(SBP)、脉压(PP)、脉压指数(PPI)均高于对照组(P<0.05);病例组舒张压(DBP)低于对照组(P<0.05)。线性趋势检验分析中随SBP、PP、PPI的增高,认知功能障碍的患病率增加(P<0.05);随DBP的增高,认知功能障碍的患病率下降(P<0.05)。结论SBP、PP、PPI增加,DBP下降与认知功能障碍有关。     

老年高血压患者动态血压指标与脉搏波传导速度的相关性

目的探讨老年高血压患者脉搏波传导速度(PWV)与动态血压(ABPM)监测指标的关系。方法选择2010年1月至2011年12月门诊治疗的年龄≥60岁的老年原发性高血压患者100例作为研究对象,另选择同期收治的年龄<60岁非老年高血压患者100例作为对照组;对所有入选对象进行24 h动态血压监测,应用脉搏波速度测定仪测定上臂-脚踝间PWV(baPWV),分析脉搏波传导速度与动态血压各指标之间的关系。结果非老年组患者身高、体质量、偶测收缩压、偶测舒张压、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)等指标与老年高血压组患者比较差异均无显著性(P<0.05);非老年组患者腰臀比(WHR)、24 h平均脉压(PP)、脉压指数(PPI)、baPWV等指标均低于老年高血压组患者(P<0.05);两组患者中baPWV≥14 m/s者SBP、DBP、PP、PPI均高于组内baPWV<14 m/s者(P<0.05或P<0.01);年龄、WHR、PPI、PP、SBP、与PWV呈正相关,DBP与PWV呈负相关。结论随血压水平程度升高,PWV明显增快,PPI与PWV关系密切,PPI、PWV可作为全身心血管疾病的一个危险信号,以指导早期预防干预。     

动态脉压指数对高血压患者左心室肥厚的影响

目的:探讨动态收缩压(SBP)、舒张压(DBP)、脉压(PP)和脉压指数(PPI)对高血压患者左心室肥厚的影响,评价PPI反映左心室肥厚的价值。方法:用动态血压监测仪测量128例高血压患者的PPI,按PPI≤0.40(28例)、0.41~0.50(47例)、0.51~0.60(35例)和>0.60(18例)分为4组;进行超声心动图检查,并测量各种参数,计算左室重量指数(LVMI);比较各组LVMI的差异。结果:随着PPI的增加,LVMI明显增大(P<0.05);经Spearman's相关分析,PPI与LVMI的相关系数r值(0.467)大于PP、SBP及DBP的r值(0.423,0.304,0.296)。结论:PPI可作为高血压患者左心室肥厚的预测指标。     

脉压指数与冠状动脉狭窄程度的相关性研究

目的探讨脉压指数(PPI)与冠脉病变狭窄程度的关系。方法对156例入选病例均行冠脉造影术,其中男性103例,女性53例,年龄33～81(59.15±10.60)岁。所有病例均在术中测量主动脉血压,术后监测24h动态血压,并在术前、术后测量仰卧位肱动脉血压,记录其平均值。最后计算各PPI。冠脉病变的狭窄程度用病变的血管支数及Gensini积分表示。结果高血压(EH)组较非EH组冠心病(CHD)患病率明显增高(73.6%比58.5%,P=0.032);EH组患者冠脉3支血管病变的患病率显著高于非EH组(35.2%比12.3%,P=0.001);冠脉狭窄组,三种测压方式各收缩压(SBP)、脉压(PP)及PPI均显著高于冠脉正常组,差异有统计学意义(P<0.05),且各SBP、PP及PPI均随冠脉血管狭窄支数的增加而逐渐增加。多因素Iogistic回归分析结果显示,各PPI均与CHD冠脉狭窄程度的关系最为密切;且24h动态PPI较其他因素与CHD冠脉狭窄程度的关系更佳。结论各PPI均是CHD冠脉狭窄发生、发展的独立危险因素,且24h动态PPI的预测价值更佳。     

原发性高血压患者血压分级与脉搏波速度的关系

目的 探讨原发性高血压(EH)患者血压分级与肱动脉踝动脉脉搏波速度(baPWV)之间的关系和影响baPWV的危险因素.方法 测定252例EH患者诊室血压、动态血压和血生化指标,应用脉搏波传导速度(PWV)自动测量系统测定患者baPWV,进行不同血压水平和baPWV之间比较.结果 1)高血压3级组的baP-WV显著高于高血压1级组(P<0.05);高血压3级组空腹血糖(FPG)水平高于1级高血压组(P<0.05);高血压3级组餐后2 h血糖(2 h PG)水平高于1级、2级高血压组(P<0.05).2)baPWV与24 h平均收缩压(SBP)、平均脉压(PP)、白昼SBP、白昼PP、白昼及夜间SBP负荷呈显著正相关(P均<0.05).3)baPWV增高者的年龄、SBP、舒张压(DBP)、三酰甘油(TG)均高于正常对照组(P均<0.05).4)baPWV与年龄、SBP、PP、FPG、2 h PG呈显著正相关(P<0.05),其中年龄与FPG是影响baPWV的独立危险因素.结论 伴有心血管危险因素的原发性高血压3级患者动脉僵硬程度显著增加;24 h平均SBP及PP、白昼及夜间SBP负荷越高,baPWV越高;年龄、FPG升高是影响baPWV的独立危险因素.     

脉压对老年高血压病患者左心室肥厚的影响

目的探讨脉压对老年高血压病患者左心室肥厚的影响。方法随机选取我院230例确诊为高血压病的老年患者,测定其血压水平,脉压指数(PPI),测定体重指数及体表面积,测定左心室重量指数(LVMI)。PP与PPI的相关性采用Pearson相关分析,LVMI与各指标的关系采用多元线性相关分析;分析脉压对老年高血压病患者左心室肥厚的影响,以P0.05为有显著性差别,差异有统计学意义。结果高PPI组和低PPI组资料比较,两组患者LVMI、SBP、DBP、年龄、高血压病程比较,差异有统计学意义。LVH组与非LVH组资料比较,两组患者年龄、SBP、PP、PPI、高血压病程、DBP差异有统计学意义(均P0.05)。LVMI与年龄、病程、SBP、PP、PPI呈正相关,随其增加而显著增大。结论患者的年龄、病程、SBP、PP、PPI均为LVMI的危险因素,LVMI与PPI呈正相关,随其增加而显著增大。     

老年原发性高血压患者颈动脉病变与动态脉压指数

目的探讨老年原发性高血压(EH)患者颈动脉病变与动态脉压指数(PPI)的相关性。方法对103例老年 EH 患者行颈动脉超声和动态血压测定,PPI=24 h 脉压(PP)均值/24 h 收缩压(SBP)均值,按 PPI 值分为 A组(PPI<0.40,n=15)、B 组(PPI:0.40～0.49,n=48)、C 组(PPI≥0.50,n=40)3组,观察各组颈动脉内膜中膜厚度(IMT)的水平。结果 B 组IMT[(0.15±0.07)mm]水平高于 A 组[(0.12±0.04)mm,P<0.05],C 组 IMT[(0.16±0.05)mm]水平高于 B 组(P<0.05),并显著高于 A 组(P%0.01),随着 PPI 逐渐增大,IMT 明显增加(P<0.05);老年 EH 患者颈动脉内膜增厚的发生与 PP 及 PPI 相关(P<0.05);Logistic 回归分析显示,在矫正总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿酸、SBP、DBP 与 PP 后,PPI 仍然是颈动脉内膜中膜厚度增厚主要决定因素(P=0.009)。结论老年 EH 患者 PPI 和 PP 与颈动脉病变呈正相关,...     

原发性高血压患者血压水平和脉压与心脑血管事件的关系

目的探讨原发性高血压患者并发各种心脑血管事件的患病率及其与不同收缩压(SBP)、舒张压(DBP)、脉压(PP)水平的关系.方法收集原发性高血压单纯并发心脑血管事件住院病例共238例,计算脑出血(CH)、蛛网膜下腔出血(SAH)、脑梗死(CI)、高血压性心脏病所致的心力衰竭(HF)、急性心肌梗死(AMI)的发生率以及其在不同SBP、DBP、PP水平的发生率.结果 CI 94例(39.5%);CH 52例(21.8%);HF 46例(19.3%);SAH、AMI分别为30例(12.6%)和16例(6.7%).各种心脑血管事件的发生率均随SBP、DBP、PP水平的增高(大)而增高.SBP≥160 mm Hg,CH、SAH占同组病例90%以上,CI、HF占70%,AMI占50%.DBP≥90 mm Hg,CH、HF占同组病例90%以上,SAH占80%,CI、AMI占75%以上.PP＞40 mm Hg,各种心脑血管事件占同组病例90%以上.结论原发性高血压患者并发各种心脑血管事件的发生率CI最高,CH次之,HF居第3位.各种心脑血管事件的发生率随着SBP、DBP、PP的增高(大)而增高.SBP≥160 mm Hg,DBP≥90 mm Hg,PP≥40 mm Hg,各种心脑血管事件的发生率最高.     

血脂康联合降压治疗对动态血压及其平滑指数的影响

目的观察调脂联合降压治疗对动态血压、脉压指数(PPI)及降压平稳性的影响。方法 220例诊断为原发性高血压的患者随机分为单纯降压组和调脂降压治疗组,调脂降压治疗组在降压基础上加用血脂康60 mg,2次/d,所有病人均于治疗前及治疗6后月行血脂及动态血压检查,记录24 h 平均收缩压(24 hSBP)及24 h 平均舒张压(24 hDBP),计算24 h 动态脉压(24 hPP)、PPI和收缩及舒张压平滑指数(SI_(SBP)和 SI_(DBP)),比较两组病人治疗前后血脂、动态血压值及其稳定性的变化。结果两组血压控制良好,6月后调脂降压治疗组血脂水平明显降低(P<0.01),PP 及 PPI 低于单纯降压组(P<0.05),调脂降压治疗组 SI 较单纯降压组升高(SI_(SBP) P<0.01,SI_(DBP) P<0.05)。结论降压协同血脂康降脂治疗能降低动态血压的 PP 和 PPI,并且能提高降压药物的 SI。     

动态脉压指数与冠脉狭窄程度的相关性研究

目的 探讨动态各脉压指数(PPI)与冠脉病变狭窄程度的关系.方法 对156例入选病例均行冠脉造影术,其中男103例,女53例.年龄33岁～81岁(59.15岁±10.60岁).所有病例均于术后监测24 h动态血压,并计算各病例24 h PPI、白昼PPI及夜间PPI.冠脉病变的狭窄程度用病变的血管支数及Gensini积分表示.结果 冠脉狭窄组24 h动态血压监测,无论24 h、白昼还是夜间,其收缩压(SBP)、脉压(PP)及PPI均显著高于冠脉正常组(P＜0.05),且SBP、PP及PPI均随冠脉血管狭窄支数的增加而逐渐增加.多因素Logistic回归分析结果显示动态各PPI均与冠心病(CHD)冠脉狭窄程度的关系最为密切;且夜间PPI较其他因素与CHD冠脉狭窄程度的关系更密切.结论 动态各PPI均是CHD冠脉狭窄发生发展的独立危险因素,且夜间PPI的预测价值更佳.     

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.