再生障碍性血患者白细胞介素－2与T细胞亚群的检测及意义探讨

本文检测了１７例再障患者外周血淋巴细胞经植物血凝素（ＰＨＡ）刺激后白细胞介素２（ＩＬ－２）的活性水平及Ｔ细胞亚群。结果：再障患者白细胞介素２的活性水平明显高于正常对照（Ｐ＜０．０１），Ｔ＿８明显增高，Ｔ＿４／Ｔ＿８比值倒置，ＩＬ－２活性水平与Ｔ＿８成正相关。表明再障患者Ｔ淋巴细胞及淋巴因子网络失衡，与再障的发病有关。     

环孢素A治疗Ⅰ型糖尿病临床研究

将３３例新发病的Ⅰ型糖尿病（ＩＤＤＭ）随机分为两组。治疗组接受环孢素Ａ（ＣｓＡ）和胰岛素治疗３～６个月，对照组单纯以胰岛素治疗。治疗第３、６和９个月时，治疗组完全缓解率分别为５２．９％、４６．７％和４０．０％；对照组为１２．５％、６．３％和６．３％（Ｐ＜０．０１、０．２５和０．０５）。缓解率与病程有关。治疗第６个月时，治疗组糖刺激状态的Ｃ肽水平明显高于对照组（Ｐ＜０．０５）。ＣｓＡ治疗后，外周血ＯＫＴ＿４／ＯＫＴ＿８细胞比值降至正常水平。平均最高血肌酐水平上升１１．９％，未发现严重副作用。ＣｓＡ治疗可保护和改善胰岛功能，促进发病早期ＩＤＤＭ缓解。     

急性心肌梗死溶栓治疗肌钙蛋白T动态变化

目的：观察静脉溶栓治疗急性心肌梗死（ＡＭＩ）患者肌钙蛋白Ｔ（ＴｎＴ）的血清浓度动态变化特点，探讨其对溶栓疗效判定价值。方法：采用全自动酶联免疫吸附测定（ＥＬＩＳＡ）法，测定３９例ＡＭＩ患者肌钙蛋白Ｔ血清浓度变化。结果：１４例ＡＭＩ溶栓再通组的肌钙蛋白Ｔ第１高峰时间（１３．４３±４．０３小时）较１３例溶栓未通组（１８．６２±４．０３小时，Ｐ＜０．０１）及１２例非溶栓组（２４．００±１４．８７小时，Ｐ＜０．０５）明显前移；肌钙蛋白Ｔ发病第１２小时／第７２小时比值，在溶栓再通组（２．４４±１．５２）大于溶栓未通组（１．１２±０．８３）及非溶栓组（１．００±１．０３，Ｐ均＜０．０５）；对ＡＭＩ溶栓再通预测的敏感性、特异性及准确性：在以肌钙蛋白Ｔ第１峰时间≤１４小时为界时分别为７１．４％、８４．６％、７８．０％，在肌钙蛋白Ｔ第１２小时／第７２小时比值≥２．０时为６６．７％、８４．６％及７５．７％。结论：肌钙蛋白Ｔ对ＡＭＩ溶栓疗效具有一定的判定价值。     

拉米夫定、治肝灵冲剂联合治疗慢性乙型肝炎近期疗效研究

研究单用拉米夫定（３－ＴＣ）及联合应用中药治肝灵冲剂对慢性乙型肝炎（ＣＨＢ）的治疗作用，探讨两者联合治疗的近期疗效和安全性。５０例ＣＨＢ患者随机分为Ａ，Ｂ两组，Ａ组采用３－ＴＣ和治肝灵冲剂联合治疗；Ｂ组单用３—ＴＣ，疗程均为６个月，治疗前、治疗２周、４周、８周、１２周、１６周，２０周、２６周分别检测ＨＢＶ标志、肝功能，血清学指标，肾功能，并记录治疗期间临床和实验室检查发生的一切不良事件。治疗２６周后Ａ组血清ＨＢｅＡｇ转阴率６４．０％（１６／２５）．明显高于Ｂ组１６．０％（４／２５）Ｐ＜０．０１． Ａ组与Ｂ组分别有４例（１６．０％），２例（８．０％）实现ＨＢｅＡｇ血清转换。Ｐ＞０．０５。转阴患者未发现ＨＢＶ前Ｃ区变异株。Ａ组和Ｂ组ＨＢＶＤＮＡ转阴例数分别为２４（９６．０％）和２３（９２．０％）Ｐ＞０．０５。治疗结束时Ａ组和Ｂ组ＡＬＴ的复常率分别为８８．０％（２２／２５）、６４．０％（１６／２５），Ｐ＜０．０５。采用３－ＴＣ与治肝灵冲剂联合治疗ＣＨＢ，短期疗效明显优于单一用药组，且副作用少，是安全、有效的治疗ＣＨＢ的方案。     

甲状腺疾病患者血清TSAb和TBII的检测

采用细胞培养生物学方法和放射受体分析法检测甲状腺疾病患者血清甲状腺刺激抗体（ＴＳＡｂ）和促甲状腺激素结合抑制免疫球蛋白（ＴＢＩＩ）。发现Ｇｒａｖｅｓ病未治组ＴＳＡｂ和ＴＢＩＩ活性与阳性率明显高于Ｇｒａｖｅｓ病缓解组和桥本甲状腺炎（ＨＴ）组，后两组ＴｓＡｂ和ＴＢＩＩ活性与阳性率高于甲状腺腺瘤组和正常对照组。Ｇｒａｖｅｓ病未治组、缓解组和ＨＴ组其ＴＳＡｂ和ＴＢＩＩ的检出率分别为９１．７％和７９．２％、４８．０％和４４．０％及２３．１％和６１．５％。甲状腺腺瘤组和对照组ＴＳＡｂ和ＴＢＩＩ均为阴性，其活性亦无统计学差异。血清ＴＳＡｂ与ＴＢＩＩ活性以及ＴＳＡｂ、ＴＢＩＩ活性与Ｔ＿３、Ｔ＿４、ＦＴ＿３和ＦＴ＿４浓度之间均无显著相关性。提示ＴＳＨ受体抗体具有异质性，联合检测这两种抗体对了解自身免疫性甲状腺疾病（ＡＩＴＤ）的发病机理，合理诊治甲状腺疾病具有重要的临床价值。     

胸腺肽α1单用及联合干扰素—α1b治疗慢性乙型肝炎疗效观察

目的研究单用胸腺肽α１（Ｔα１）及联合应用干扰素（ＩＦＮ）对慢性乙型肝炎（ＣＨＢ）的治疗作用。方法３６例ＣＨＢ患者随机分为Ａ、Ｂ两组,Ａ组采用Ｔα１和ＩＦＮ联合治疗;Ｂ组单用Ｔα１,疗程均为６个月。结果治疗后６月时ＡＬＴ水平在Ａ、Ｂ两组分别下降至（７２．１±４．７７）Ｕ／Ｌ和（７３．７±３７．９）Ｕ／Ｌ,较治疗前（２２６．７±２１９．４）Ｕ／Ｌ和（１７０．１±１６５．６）Ｕ／Ｌ明显下降（Ｐ＝０．００２７和０．０００３）。ＨＢＶＤＮＡ水平在Ａ、Ｂ两组分别下降到（１３０±２８３）ｍＥｑ／ｍｌ和（３７３±８２５）ｍＥｑ／ｍｌ,较治疗前（８０７±１２２２）ｍＥｑ／ｍｌ和（８８３±１４３８）ｍＥｑ／ｍｌ明显下降（Ｐ＝０．００１９和０．０１９）。治疗后６月时,具有ＡＬＴ完全反应者,Ａ组和Ｂ组分别为８例（４４％）和９例（５０％）,具有ＨＢＶ清除反应者Ａ组为８例（４４．４％）,Ｂ组为７例（３８．８％）。结论采用Ｔα１或Ｔα１联合ＩＦＮα１ｂ治疗ＣＨＢ均能取得较好的效果     

乐胃煎逆转胃癌前病变AgNOR及细胞图像分析

目的研究乐胃煎逆转胃癌前病变不完全结肠型肠化和／或中度异型增生的疗效．方法胃镜病理证实为不完全结肠型肠化和／或中度异型增生４６例．治疗组３０例用乐胃煎，对照组１６例用德诺（Ｄｅ＿Ｎｏｌ）．治疗前后胃镜活检胃窦固定部位粘膜标本作ＡｇＮＯＲ染色及细胞图像分析．结果乐胃煎对不完全结肠型肠化及中度异型增生总有效率均高于Ｄｅ＿Ｎｏｌ，分别为７２％比２５％（Ｐ＜００５）和８９５％比４４４％（Ｐ＜００５）．乐胃煎治疗前后，ＡｇＮＯＲ计数分别为７３０±１１６和４８１±１５０（Ｐ＜００１），Ｄｅ＿Ｎｏｌ组为７７３±０９２和７０５±１０２（Ｐ＜００１）．两组治疗前后ＡｇＮＯＲ计数差值均数相比，统计学上也有显著性差异，分别为２５２±１５４和０６９±０４８（Ｐ＜００１）．乐胃煎组中２０例作细胞图像分析，治疗后各参数（长轴、短轴、核浆比、结构异型指数等）均有不同程度的降低，有显著性差异．结论乐胃煎确有较好地逆转胃癌前病变的功效．     

98例食管心房调搏终止室上速的4种方法比较

目的：比较９８例经食管心房调搏（ＴＥＡＰ）终止室上速（ＰＳＶＴ）的４种方法学疗效，并对其作用机理进行探讨。方法：应用国产的ＸＤ－２或ＤＦ－４Ａ型心脏电生理诊断仪对９８例因频敏发作ＰＳＶＴ的患进行ＰＳＶＴ终止，诱发试验，分别采用（１）亚速刺激法，（２）Ｓ１Ｓ２程控刺激法，（３）短阵超速抑制法，（４）超短阵猝发刺激法，终止ＰＳＶＴ。结果：超短阵发刺激法在上各类ＰＳＶＴ的成功离最高平均达９０．９％，高于Ｓ１Ｓ２法程度控刺激法６２．７％（Ｐ〈０．０５）与亚速刺激法４０．５％（Ｐ〈０．１），略优于短阵超速抑制法８８．６％（Ｐ〉０．０５），结论：ＴＥＡＰ终止ＰＳＶＴ，对心肌收缩力，心脏传导系统无影响，无并发症可重复使用，安全且效果评价直观，可作为终止治疗ＰＳＶＴ的首选方法。     

维拉帕米抗高血压作用及其对肾素系统活性的影响

采用单盲随机研究方法，观察５０例不同分期的高血压患者服用维拉帕米的降压效果，并检测治疗前后血浆肾素活性（ＰＲＡ）、血管紧张素Ⅱ（ＡＴⅡ）、醛固酮（ＡＬＤ）和心钠素（ＡＮＰ）的浓度，旨在探讨维拉帕米对肾素系统（ＲＡＡＳ）活性的影响。研究结果表明：（１）维拉帕米治疗后，收缩压和舒张压较治疗前均有非常显著的下降（Ｐ＜０．０１）。（２）维拉帕米治疗高血压总有效率８８．０％，各期之间疗效无显著性差异（Ｐ＞０．０５）。（３）高血压组ＰＲＡ、ＡＴⅡ、ＡＬＤ和ＡＮＰ浓度均高于正常对照组（Ｐ＜０．０１）。（４）治疗后ＰＲＡ、ＡＴⅡ、ＡＬＤ和ＡＮＰ浓度均降低，治疗前后比较均有显著性差异（Ｐ＜０．０１）。提示维拉帕米降压机制除阻断钙离子内流以外，可能与其抑制ＲＡＡＳ活性有关。     

血清甲状腺激素（T_3、T_4）的固相酶联免疫测定──方法学探讨及临床应用

本实验用β－半乳糖苷酶分别标记Ｔ＿３及Ｔ＿４，均获得具有良好酶活性及免疫原活性的酶－抗原结合物。以国产聚苯乙烯微孔扳为固相载体，建立了血清Ｔ＿３及Ｔ＿４的固相酶联免疫测定法。方法学检测数据如下：最小检出量，Ｔ＿３为０．２ｎｍｏｌ／Ｌ，Ｔ＿４４．０ｎｍｏｌ／Ｌ；回收率，Ｔ＿３为１．０２，Ｔ＿４０．９８；批内变异系数，Ｔ＿３为７．２％，Ｔ＿４５．３％；批间变异系数，Ｔ＿３为８．２％，Ｔ＿４１０．５％；两种抗血清对相应抗原的同类物的交叉反应率都极低。用本法与放免法同时测定３０份标本，同一激素的两法测定结果呈显著相关。     

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.     

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.