老年人颈动脉壁内膜和中膜厚度与高胆固醇血症和其它危险因素的关系

采用高分辨率Ｂ型超声显象法检测９４例例不同血清胆固醇水平的老年人的颈动脉内膜和中膜度，旨在探讨老年人的颈动脉内膜和中膜厚度与冠心病及高胆固醇血症等心血管病危险因素的关系，结果发现，不同胆固醇水平的三组间内膜和中膜厚度差异无显著性，但颈动脉内膜和中膜厚度与年龄，收缩压，总胆固醇和低密度脂蛋白胆固醇水平有显著的正相关性。内膜和中膜厚度增得（≥１．０ｍｍ）吸烟，高血压病，冠心病及脑梗塞的发生率明显高于内     

吡格列酮对2型糖尿病患者颈动脉内膜中膜厚度的影响

目的 探讨吡格列酮对2型糖尿病患者颈动脉内膜中膜厚度的影响。方法 68名2型糖尿病患者，随机双盲分为吡格列酮组（n=34）和安慰荆组（n=34），治疗3个月后，应用B超技术检测患者颈动脉内膜中膜厚度，并检测两组患者服药前后餐后2h血糖、糖基化血红蛋白、血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇水平。结果 与安慰剂组比较，吡格列酮治疗后颈动脉内膜中膜厚度变小（P〈0．01），餐后2h血糖、糖基化血红蛋白和甘油三酯水平明显下降（P〈0．01），高密度脂蛋白胆固醇水平明显增加（P〈0.01），两组血清总胆固醇、低密度脂蛋白胆固醇在治疗后无显著性差异。吡格列酮治疗后颈动脉内膜中膜厚度变化值与低密度脂蛋白胆固醇和高密度脂蛋白胆固醇的变化值密切相关（P〈0.01）。结论 吡格列酮能够显著降低2型糖尿病患者颈动脉内膜中膜厚度，有益于改善2型糖尿病患者大血管并发症。     

辛伐他汀降脂治疗对老年人血管内皮功能及颈动脉内膜—中膜厚度的影响

了解辛伐他汀降脂治疗对老年人血管内皮依赖性舒张功能,颈动脉内膜－内膜厚度的影响,采用高分辨率超声技术检测20例对照者,20例原发性高胆固醇血症及20例冠心病伴高胆固醇血症患者降脂治疗前后血管内皮依赖性舒张功能及颈动脉内膜－中膜厚度的变化。结果发现,与对照组比较,原发性高胆固醇血症患者及冠心病伴高胆固醇血症患者肱动脉血流介导性舒张明显减弱,颈动脉内膜－中膜厚度明显增加,服用辛伐他汀20mg/d,治疗3－4月后,原发性高胆固醇血症患者及冠心病伴高胆固醇血症患者血浆总胆固醇明显下降,肱动脉内皮依赖性舒张较治疗前明显改善,但仍低于对照组,治疗前后颈动脉内膜－中膜厚度无显著性改变,提示老年单纯高胆固醇血症及合并冠心病患者存在内皮功能障碍,经辛伐他汀降脂治疗后,血管内皮依赖性舒张功能明显改善,但颈动脉内膜一中膜厚度无明显改善。     

血浆小而密低密度脂蛋白胆固醇水平与颈总动脉内膜中膜厚度的相关性

目的　评估测定颈总动脉内膜中膜厚度增厚患者小而密低密度脂蛋白胆固醇含量的价值。方法　吴江区第一人民医院2012年6月～2013年6月期间在体检中心行颈动脉超声的体检者130例，经颈动脉彩色多普勒超声检查，以颈总动脉内膜中膜厚度≥0.9　mm作为异常标准，分为正常组62例和增厚组68例；检测这些体检者的血浆小而密低密度脂蛋白胆固醇水平，并与颈总动脉内膜中膜厚度进行相关性分析。结果　颈总动脉内膜中膜厚度增厚组小而密低密度脂蛋白胆固醇显著高于正常组（43.97±11.35　mg/dL比26.01±7.62　mg/dL,P＜0.001），且增厚组小而密低密度脂蛋白胆固醇与颈总动脉内膜中膜厚度厚度显著正相关　（r0.857,P＜0.001）。结论　小而密低密度脂蛋白胆固醇水平对颈总动脉内膜中膜厚度的评价具有价值。     

早发冠心病患者颈动脉内膜中膜厚度特点及其预测价值

探讨早发冠心病患者颈动脉内膜中膜厚度和斑块特征及其对早发冠心病的预测价值。应用B型超声检测早发冠心病患者颈动脉内膜中膜厚度和斑块情况 ,结合冠状动脉造影结果进行对比研究。结果发现 ,早发冠心病患者颈动脉内膜中膜厚度≥ 0 .8mm及斑块检出率明显高于对照组 (5 6 %比 11% ,P <0 .0 5 ) ;颈动脉超声阳性对预测早发冠心病的敏感性为 5 5 .7% ,特异性为 88.9% ,准确性为 87.2 % ;3支冠状动脉病变组平均内膜中膜厚度高于 1支冠状动脉病变组。多因素分析发现 ,颈动脉超声阳性是早发冠心病的独立危险因素 (OR =7.19,95 %CI:1.92～ 2 1.37,P =0 .0 0 7)。结果提示 ,早发冠心病患者颈动脉内膜中膜厚度增厚及斑块检出率升高 ,颈动脉超声阳性对诊断早发冠心病有着较高的特异性和准确性。     

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=24h脉压（PP）均值／24h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&#177;0．07）mm]水平高于A组[（0．12&#177;0．04）mm，P〈0．05]，C组IMT[（0．16&#177;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，PPI是老年EH患者颈动脉病变发生发展的一个重要的独立危险因素。     

颈动脉粥样硬化的超声检测及与危险因素的关系

为探讨能否用超声测定颈动脉内膜中膜厚度来评价颈动脉粥样硬化与主要危险因素的关系。对 14 7例受试者进行了双侧颈动脉超声检查 ,测量了动脉内膜中膜厚度 ,并以内膜中膜厚度大于 1.0mm为诊断标准将受试者分为颈动脉粥样硬化组和非颈动脉粥样硬化组 ,对颈动脉动脉粥样硬化的多项可能危险因素在两组间进行了比较。结果发现 ,年龄、吸烟指数、收缩压、舒张压、总胆固醇、体质指数、糖尿病、冠心病家族史及男性性别为颈动脉粥样硬化的主要危险因素 (P <0 .0 5～P <0 .0 1)。多元回归分析 (P <0 .0 1)发现 ,颈动脉粥样硬化的主要危险因素为男性性别、年龄增高、收缩压增高、吸烟及血清高胆固醇水平。此结果提示 ,颈动脉粥样硬化的主要危险因素与导致冠心病的主要危险因素基本一致 ,提示所测各项主要危险因素对全身的动脉粥样硬化病变均有促进作用。     

急性冠状动脉综合征患者颈动脉斑块与血浆基质金属蛋白酶的相关性

目的研究急性冠状动脉综合征患者颈动脉斑块与血浆基质金属蛋白酶的相关性。方法采用高分辨率超声，测定30例急性冠状动脉综合征患者、29例稳定型心绞痛患者和17例正常对照者的颈动脉内膜中膜厚度及斑块积分，同时采用夹心酶联免疫分析法测定血浆基质金属蛋白酶9和组织型金属蛋白酶抑制因子1的变化。结果三组间的年龄、性别、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇无显著性差异。急性冠状动脉综合征组血浆基质金属蛋白酶9、组织型金属蛋白酶抑制剂、基质金属蛋白酶9，组织型金属蛋白酶抑制剂1及颈动脉内膜中膜厚度、总斑块积分、软斑块积分和硬斑块积分显著高于稳定型心绞痛组和正常对照组。基质金属蛋白酶9与颈动脉内膜中膜厚度、总斑块积分、软斑块积分呈正相关（r=0．468，P〈0．01；r=0．592，P〈0．01；r=0．677，P〈0．01）；组织型金属蛋白酶抑制剂与颈动脉内膜中膜厚度、总斑块积分、软斑块积分、硬斑块积分呈正相关（r=0．449，P〈0．01；r=0．493，P〈0．01；r=0．435，P〈0．01；r=0．227，P〈0.05）；基质金属蛋白酶9，组织型金属蛋白酶抑制剂1与颈动脉内膜中膜厚度、总斑块积分、软斑块积分呈正相关（r=0．253，P〈0．05；r=0．431，P〈0．01；r=0．547，P〈0．01）。去除年龄因素后，偏相关分析显示颈动脉内膜中膜厚度与基质金属蛋白酶9（r=0．461，P〈0．001）、组织型金属蛋白酶抑制剂1（r=0．441，P〈0.001）、基质金属蛋白酶9，组织型金属蛋白酶抑制剂1（r=0．241，P〈0．01）呈正相关关系。结论急性冠状动脉综合征患者血浆基质金属蛋白酶9、组织型金属蛋白酶抑制剂1、基质金属蛋白酶9，组织型金属蛋白酶抑制剂1及颈动脉内膜中膜厚度、总斑块积分、软斑块积分和硬斑块积分显著高于稳定型心绞痛患者和正常对照。血浆基质金属蛋白酶9、组织型金属蛋白酶抑制剂1、基质金属蛋白酶9，组织型金属蛋白酶抑制剂1与颈动脉内膜中膜厚度、总斑块积分、软斑块积分呈正相关关系。     

大连地区血压、生化指标正常人群颈动脉内膜中膜厚度的影响因素

目的探讨大连地区血压、生化指标正常人群颈动脉内膜中膜厚度的危险因素。方法选取大连地区血压、生化指标正常人群736例。所有研究人群均已测量身高、体重、血压、腰围、臀围,检测空腹血糖、糖化血红蛋白、75 g OGTT 2 h血糖、空腹胰岛素、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、总胆固醇、甘油三酯、血尿酸及血肌酐等指标,计算腰臀比、体质指数、尿白蛋白/肌酐、肌酐清除率、胰岛素抵抗指数及脉压差,应用血管彩色多普勒超声检测患者颈动脉内膜中膜厚度。将入选人群根据颈动脉内膜中膜厚度值分为C1组(颈动脉内膜中膜厚度0.9 mm)、C2组(0.9 mm≤颈动脉内膜中膜厚度1.2 mm)及C3组(颈动脉内膜中膜厚度≥1.2 mm),研究上述各指标与颈动脉内膜中膜厚度的相关关系。结果 (1)三组间在年龄、体质指数、腰围、腰臀比、血尿酸、收缩压及脉压差存在组间差异,差异有统计学意义(P0.05)。随着年龄、腰围、血尿酸、收缩压及脉压差的升高,颈动脉内膜中膜厚度有增厚的趋势;而体质指数和腰臀比仅在C3组高于C2和C1组,差异有统计学意义(P0.05)。(2)男性和女性人群颈动脉内膜中膜厚度均随年龄增加有逐渐增加的趋势,差异有统计学意义(P0.05);在40~50岁组,男性颈动脉内膜中膜厚度高于女性,差异有统计学意义(P0.05),在50~60岁组,女性颈动脉内膜中膜厚度高于男性,差异有统计学意义(P0.05)。(3)偏相关分析显示,在控制年龄因素的影响后,无论男性、女性,脉压差、体质指数、腰围、收缩压及血尿酸均与颈动脉内膜中膜厚度呈正相关;单因素Logistic回归分析显示,无论男性、女性,年龄、脉压差均是颈动脉内膜中膜厚度的独立危险因素(P0.05)。结论 (1)在血压、生化指标正常人群中,无论男性、女性,颈动脉内膜中膜厚度均随年龄增加有逐渐增加的趋势,男性颈动脉内膜中膜厚度在40~50岁组明显高于女性,女性颈动脉内膜中膜厚度在50~60岁组明显高于女性。(2)增龄和脉压差是颈动脉内膜中膜厚度增厚的独立危险因素。     

可溶性OX40配体与颈动脉内膜中膜厚度的关系

目的 观察冠心病稳定型心绞痛患者及高危因素患者血浆中可溶性OX40配体水平,同时测定颈动脉内膜中膜厚度,分析两者的相关性,进一步探讨可溶性OX40配体与冠心病的关系.方法 采用酶联免疫吸附法测定35例稳定型心绞痛患者、30例高危因素者及20例正常对照者血浆中可溶性OX40配体浓度,同时利用彩色超声仪测量颈动脉内膜中膜厚度.结果 稳定型心绞痛患者血浆可溶性OX40配体水平(24.95±15.60 ng/L)高于正常对照者(16.44±11.31 ng/L;P<0.05);稳定型心绞痛患者和高危因素者的颈动脉内膜中膜厚度高于正常对照者(P<0.05),且与血浆可溶性OX40配体显著正相关(r=0.376,P=0.001).多因素回归分析显示,在控制年龄、血脂及血压影响后,可溶性OX40配体水平对内膜中膜厚度有独立的贡献(P=0.019).结论 冠心病患者可溶性OX40配体水平显著增高,且与颈动脉内膜中膜厚度独立相关,提示可溶性OX40配体可作为判断冠心痛及动脉粥样硬化新的炎症指标.     

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.