云南省大理州63例克山病病例分析

云南省成人克山病发病，给克山病防治工作又提出了新的问题，为了掌握成人克山病发病及患病程度，我们在大理病区进行了线索病例的临床流行病学调查，结果确诊克山病６３例，病例以农民为主（９３．７％），其中成人占５７．１％，儿童占４２．９％，男女比例１：１．５。较多地分布于历史重病区，克山病仍严重地危害着病区人民的身体健康。     

克山病知识调查问卷汇总分析

为掌握病区县、乡级医院内科和儿科医生了解克山病知识的程度，我们于２００１年１１月向病区３７所县医院、３８２所乡医院下发了３０００份克山病知识调查问卷。问卷的主要内容为克山病的临床表现、多发人群、诊断及鉴别诊断原则，临床分型及急、慢型克山病抢救治疗原则等。问卷回答方式为多项选择式。截止到２００２年２月，收回县级医院问卷６６９份，乡级医院５４７份，回收率为４０．５％。问卷结果表明：１．问卷中回答知道有克山病这种疾病的医生占９８％，回答了解克山病主要临床表现的占９０％；近１０年来未诊治克山病的占８４％…     

山东省克山病基本控制后的动态观察

目的：动态观察山东省克山病病情及发病相关因素的变化。方法：选择克山病病区莒县龙山和平邑县流峪设立2个监测点，对3－14岁人群及14岁以上可疑患者1488人为重点监测对象，从1995－1999年，对克山病发病情况及2个点区县急型、亚急型、慢型克山病病情变化进行连续5年监测，同时调查内外环境硒、经济收入有人均占有粮食。结果：2个点区县5年间慢型克山病发现1例，无急型、亚急型克山病发病，监测点重点监测对象1995、1997、1999年克山病检出率依次为1．81％，2．90％，2．32％；异常心电图检出率为4．84％，5．05％，5．11％；内环境发硒水平逐年升高，为0．278，0．334，0．360mg/kg；外环境小麦硒含量稳定，龙山点玉米硒含量及流峪点玉米、瓜干硒含量升高；经济收入，人均占有粮食不断增加。结论：山东省克山病发病相关因素不断改善，克山病病情处于基本控制后的稳定态势。     

山东省克山病基本控制后的病情演变

为掌握山东省克山病１９９２年基本控制后的病情演变，选择具代表性的莒县和平邑两县，对近５年克山病发病情况，现存慢型克山病进行了调查，并对３～１４岁易患人群１４８８例进行了全面检查重点调查，同时调查了内外环境硒及生活水平，结果显示近５年来慢型克山病累计发病率０．０２／万，易患人群慢型克山病检出率０．１３％，潜在型１．６８％，现在慢型克山病患病率０．３９％，无急型，亚急型克山病发病，病区居民发硒０．２４     

大理州1985—1996年克山病病情资料分析

1资料来源全部资料来源于1985年1月至1996年12月大理州所辖11个病区县的按月上报的克山病病情资料，部分来自大理州、市医院住院病例资料。2结果分析2．l病情数据：全州1985年～1996年发病共计118例，其中急型9例，占发病总数的763％；亚急型93例，占78．81％；慢型16例，占13．56％。死亡37例，病死率31．36％。2．2病区分布：12年间全州11个历史病区县均有发病，以历史重病区大理和评源两县最多。详见表1。23年度及季节分布：1985～1995年全州克山病呈大幅度下降趋势，无年度高发周期，199O年后病情呈稳定态势，1996年无新发克山病。12年…     

云南省楚雄州近年克山病监测报告

为了进一步探讨克山病发病规律及特点，于2000年和2001年对牟定、武定两县各2个点的1－60岁共2214人，按照《克山病监测标准》和《克山病诊断标准》作了普查监测，结果为：4个点克山病9项心电图改变率为3．4％－6．7％，并以31－45岁和46－60岁年龄组为高。克山病检出率为0．6％－3．0％，且以潜在型居多，占91％，慢型占9％，以31－45岁年龄组为高。人发硒0．131－0．210mg/kg。心电图改变率和克山病检出率都是14岁以下人群为最低，这可能与服硒有关。     

1997年河南省克山病病情监测报告

根据全国克山病病情监测方案要求，我们于１９９７年５月对克山病监测点洛宁县进行了监测，现将结果报告如下：１材料与方法１．１对全县原定慢型病人及可疑慢型病人进行临床检查、描记心电图、拍摄心脏Ｘ线正位片。１．２洛宁县上弋乡杨庄、西坪两村为潜在型监测点，该村...     

1998年度黑龙江省富裕县克山病病情监测分析

目的 探讨国家有克山病监测点区潜、慢型克山病发病的消长趋势。方法 对监测点区（繁荣乡）成人３４３人，在校学生及学龄前儿童１００８人，监测点区以外的１３个村在册的各型病人进行查体、描心电图、部分人摄胸片并投予药物治疗。结果 点区马人及学童年内无急型、亚急型、潜在型及慢型发病。潜在型及慢型患病率分别为１．４３％、及０．１４％，全乡年内新发潜在型１例及怛列克山病，发病率分别为０．００５３％和０．０６１％     

二维超声对扩张性心肌病与克山病的观察

克山病是一种发生在克山病地区原因不明的心脏疾病，心脏各腔室普遍增大，心功能值降低，扩张性心肌病亦是原因不明的心肌病的一种，也是以心脏腔径增大为特点，笔者对近年来积累的克山病图像资料进行了整理，并对照扩张性心肌病做了分析，现报道如下。１资料与方法 整理１９８７年至今收治的克山病５例，发病呈慢性，均来自克山病地区，女性患者４例，男性患者１例，平均年龄４１．６±７．５岁，扩张性心肌病２０例，近年来收治的住院患者，男女各半，平均年龄５４．１±２．９岁。诊断依据：①Ｘ线及超声检查发现心脏扩大；②有充血性心…     

1995～1997年楚雄州克山病监测结果分析

目的　为准确掌握克山病发病消长趋势,科学指导和评价克山病防治工作。方法　按１９９４ 年全国克山病病情监测会议修订的《全国克山病病情监测方案》进行。结果　全州克山病发病率由１９９５ 年的０．５４／１０ 万升至１９９７ 年的１．９１／１０ 万。新发病例主要是成人慢型克山病。监测点连续３ 年普查,慢型克山病检出率在０．０８％ ～０．４０％ 之间,潜在型克山病检出率为１．５１％ ～１．８８％ ,异常心电图检出率在３．７２％ ～２．９４％ 之间。结论　克山病病情平稳低发,成人慢克是防治重点之一。     

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.     

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.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.