老年原发性高血压患者脉压与靶器官损害的相关性研究

目的探讨老年原发性高血压患者脉压与靶器官损害的严重程度及其相关性.方法将98例老年原发性高血压患者分为脉压＜60mm Hg和脉压≥60mmHg两组,均做心电图、超声心动图、头颅CT、颈动脉超声,血尿素氮（BUN）、血肌酐（Cr）、尿肌酐和尿白蛋白检查.结果脉压≥60 mm Hg组与脉压＜60 mm Hg组比较,其左心室重量指数（LVMI）、左心室舒张末期内径（LVDd）、颈动脉内膜厚度（IMT）、颈动脉斑块发生率（CAPR）、BUN、Cr、尿白蛋白定量等指标均高于脉压＜60 mm Hg组（P＜0.05）,靶器官损害发生率高于脉压＜60 mm Hg组（P均＜0.05）.结论老年原发性高血压患者靶器官损害与增大的脉压有关,控制脉压可以减轻靶器官损害程度.     

原发性高血压患者动态脉压与靶器官损害的关系

对183例原发性高血压患者行24 h无创动态血压监测,按动态脉压分为A组(脉压＜60 mmHg)61例、B组(脉压60～80眦Hg)75例、C组(脉压＞80mmHg)47例,分别行血肌酐、心电图、超声心动图、颈动脉超声检查.发现C组患者左心室重量指数、颈动脉斑块指数、左心室舒张末径均高于其他两组,靶器官损害发生率最高.认为脉压增大是左心室肥厚和颈动脉内膜增厚的危险因素.     

原发性高血压患者动态脉压对心脏、血肌酐及颈动脉的影响

目的 通过对原发性高血压(EH)患者动态脉压的临床资料分析,探讨动态脉压对心脏、血肌酐及颈动脉的影响.方法 对EH患者183例进行24 h无创动态血压监测,按动态脉压分为脉压<60 mmHg(1 mmHg=0.133 kPa)组61例,60～80 mmHg组75例,>80 mmHg组47例.所有入选患者行以下检查:血肌酐、心电图、超声心动图、颈动脉超声,24 h动态血压.结果 脉压>80 mmHg组颈动脉斑块指数、左心室质量指数、左心室舒张末径及血肌酐均高于其他两组;脉压60～80 mmHg次之;提示颈动脉内膜厚度、左心室肥厚及血肌酐与脉压显著相关.结论 EH患者心脏、肾脏及颈动脉损害与增大的脉压有关,脉压是左心室肥厚和颈动脉内膜增厚的预测危险因素.     

原发性高血压患者动态脉压对心脏、血肌酐及颈动脉的影响

目的通过对原发性高血压(EH)患者动态脉压的临床资料分析,探讨动态脉压对心脏、血肌酐及颈动脉的影响。方法对 EH 患者183例进行24 h 无创动态血压监测,按动态脉压分为脉压<60 mmHg(1 mmHg=0.133 kPa)组61例,60～80 mmHg 组75例,>80 mmHg 组47例。所有人选患者行以下检查:血肌酐、心电图、超声心动图、颈动脉超声、24 h 动态血压。结果脉压>80 mmHg 组颈动脉斑块指数、左心室质量指数、左心室舒张末径及血肌酐均高于其他两组;脉压60～80 mmHg 次之;提示颈动脉内膜厚度、左心窒肥厚及血肌酐与脉压显著相关。结论 EH 患者心脏、肾脏及颈动脉损害与增大的脉压有关,脉压是左心室肥厚和颈动脉内膜增厚的预测危险因素。     

原发性高血压患者动态脉压与靶器官损害的相关性研究

目的　探讨原发性高血压患者动态脉压(PP)与靶器官损害之间的关系。方法　对 181例原发性高血压患者(年龄>60岁)行动态血压监测,按动态脉压不同分为脉压<50mmHg组 (PP1)93例和脉压≥50mmHg组(PP2)88例。对所有患者均做超声心动图、颈动脉超声、冠状动 脉造影检查,比较不同组间的检查结果,并进行统计学分析。结果　脉压≥50mmHg组与脉压< 50mmHg组比较,颈动脉内膜厚度[(1.02±0.23)mm比(0.92±0.17)mm]、颈动脉斑块积分指数 [(9.28±2.07)比(4.36±1.57)]、颈动脉狭窄指数[(1.92±0.83)比(1.31±0.67)]、左心室舒张 末期内径[(5.02±0.44)cm比(4.67±0.41)cm]、冠状动脉狭窄指数[(1.85±0.64)比(1.26± 0.41)],差异均有显著性(P<0.001)。结论　原发性高血压患者靶器官损害程度与增大的脉压有 关,脉压是颈动脉内膜厚度与左心室肥厚的危险因素之一。     

动态脉压对老年高血压患者靶器官损害的影响

目的探讨动态脉压对老年高血压患者靶器官损害的影响。方法选择原发性高血压患者146例,按24 h平均脉压(MPP)分为2组:24 h MPP≥60 mm Hg(1 mm Hg=0.133 kPa)为A组(60例),24 h MPP<60 mm Hg为B组(86例);另选健康体检者为对照组(C组,30例)。所有患者均行血清肌酐、动态血压、超声心动图、颈动脉超声检查;计算肌酐清除率(Ccr)、24 h平均收缩压(MSBP)、24 h平均舒张压、24 h MPP、左心室重量指数(LVMI)、LVEF、颈动脉内膜中层厚度(IMT)。结果与C组比较,A组和B组患者24 h MSBP、24 h MPP、LVMI、IMT、左心室肥厚、左心室功能受损、脑损害、肾功能受损、颈动脉斑块发生率明显升高,Ccr、LVEF水平明显降低(P<0.05,P<0.01);与B组比较,A组患者Ccr、LVEF水平明显降低,24 h MSBP、24 h MPP、LVMI、IMT、靶器官损害发生率均明显升高(P<0.05,P<0.01)。24 h MPP与心脑肾和颈动脉损害相关(P<0.05)。结论动态脉压增大与老年高血压患者靶器官结构和功能的损害相关;动态脉压越大,靶器官损害越严重。     

老年原发性高血压患者晨峰现象与靶器官损害

目的 探讨老年原发性高血压晨峰(MBPS)现象对靶器官损害的影响. 方法 老年原发性高血压患者186例,依24 h动态血压分MBPS组(104例)和非MBPS组(82例).所有对象进行心脏和颈动脉超声检查,计算左室质量指数(LVMI)、颈动脉内膜中层厚度(IMT)及斑块的发生率. 结果 MBPS组24 h、白昼以及夜间平均收缩压、脉压均较非MBPS组高(P＜0.05或P＜0.01),MBPS组的LVMI及左右两侧颈动脉IMT均明显高于非MBPS组(P＜0.05或P＜0.01);颈动脉斑块的发生率MBPS组显著高于非MBPS组(P＜0.01). 结论 老年原发性高血压患者具有MBPS现象者有明显的靶器官损害.     

原发性高血压患者动态脉压与颈动脉粥样硬化的关系

根据动态全天平均脉压将171例原发性高血压患者分为脉压40～60mmHg组和〉60mmHg组,采用超声检测患者颈动脉内膜中层厚度、血管内径及斑块发生率,以颈总动脉最大内膜中层厚度作为评价颈动脉粥样硬化程度的指标。结果脉压〉60mmHg组患者颈总动脉内径、颈总动脉最大内膜中层厚度、颈动脉斑块发生率明显高于脉压为40—60mmHg组（P〈0．01）。患者平均脉压、年龄、平均收缩压、高血压病程与颈总动脉最大内膜中层厚度呈明显正相关（P〈0．01）,而平均舒张压与颈总动脉最大内膜中层厚度呈负相关（P〈0．05）。认为脉压增加可使颈动脉粥样硬化性病变的患病率增加。     

老年高血压病病人脉压与靶器官损害的关系

目的探讨脉压(PP)与高血压病靶器官损害的关系.方法 120例药物规则治疗下的老年高血压病病人,根据脉压水平的不同,分为PP＜60 mmHg和PP≥60 mmHg两组,颈动脉超声检测颈动脉粥样斑块发生率(CAPR)、颈总动脉内膜中层厚度(IMT)及内径(LD),超声心动图检测主动脉根部内径(AOD)、左心房内径(LAD)、左心室重量指数(LVMI)、左心室射血分数(LVEF)、左心房收缩期充盈峰值流速与左心室舒张早期充盈峰值流速比值(A/E),生化测定血清尿素氮(BUN)、肌酐(Scr)、内生肌酐清除率(Ccr).评价不同脉压水平的靶器官损害.结果与PP＜60 mmHg组比较,PP≥60 mmHg组CAPR、IMT、LD、AOD、LAD、LVMI、A/E、BUN、Scr均显著升高(P＜0.05),LVEF、Ccr均显著降低(P＜0.05).结论老年高血压病病人脉压增大,可促进心脏、血管及肾脏等靶器官损害,控制脉压可以减轻靶器官损害程度.     

老年高血压患者脉压与颈动脉内膜中层厚度关系

目的 观察老年高血压患者动态血压的变化,以及脉压与颈动脉内膜中层厚度的相关性。方法 测量103例老年高血压患者24h动态血压,计算昼夜之脉压及脉压的变化幅度,根据脉压分为两组：脉压小于60mmHg的低脉压组和脉压大于或等于60mmHg的高脉压组;用多普勒超声检查颈动脉内膜中层厚度。比较两组血压参数与内膜中层厚度的差异,分析内膜中层厚度和脉压各项指标的相关性。结果 高脉压组与低脉压组的颈动脉内膜中层厚度差异有统计学意义（P〈0.01）,脉压与颈动脉内膜中层厚度有较好的相关性。结论 老年高血压患者的脉压尤其是夜间脉压与颈动脉内膜中层厚度明显相关。     

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.