小剂量布地奈德/福莫特罗干粉吸入联合茶碱缓释片口服治疗中度哮喘的疗效观察

目的 探讨小剂量布地奈德/福莫特罗干粉联合茶碱缓释片治疗中度支气管哮喘(简称哮喘)的疗效、安全性及药物经济学.方法 选择60例中度哮喘患者,随机均分为A、B两组.A组给予布地奈德/福莫特罗干粉吸入(80、4.5 μg/吸)早、晚各1次,茶碱缓释片0.2g/次、1次/12 h口服;B组给予布地奈德/福莫特罗干粉吸入(160、4.5μg/吸)早、晚各1次.疗程均为12周.观察治疗前后两组临床症状、肺功能、药物不良反应情况,并比较两组治疗费用.结果 两组治疗后临床基本控制率、哮喘控制测试评分、第1秒用力呼气容积(FEV1)和FEV1占预计值的百分比均优于治疗前(P均＜0.01),而两组治疗后比较差异无统计学意义(P均＞0.05).两组不良反应发生率比较差异无统计学意义(P＞0.05).A组3个月人均药物治疗费用较B组低(P＜0.05).结论 小剂量布地奈德/福莫特罗干粉联合茶碱缓释片治疗中度哮喘疗效较好,不良反应较轻,且治疗费用较低.     

信必可治疗稳定期COPD的疗效观察

目的观察吸入信必可[布地奈德/福莫特罗干粉剂（160/4.5μg）]对稳定期Ⅱ~Ⅲ级COPD患者的临床疗效。方法将明确诊断的60例COPD病人随机分为治疗组和对照组,治疗组给予吸入布地奈德/福莫特罗干粉剂;对照组予茶碱缓释片口服;疗程为6个月。治疗前后进行肺功能指标测定。结果治疗前,治疗组和对照组的FEV1/FVC和FEV1/预计值的差异无统计学意义（P〉0.05）。治疗结束时,治疗组FEV1/FVC和FEV1/预汁值较治疗前均有显著提高（P〈0.05）;对照组FEV1/FVC和FEV1/预计值与治疗前的差异无统计学意义（P〉0.05）。结论布地奈德/福莫特罗干粉吸入剂能够改善稳定期Ⅱ~Ⅲ级COPD患者的肺功能和生活质量,降低住院率。     

噻托溴铵联合布地奈德治疗轻中度哮喘的临床疗效评价

目的 观察噻托溴铵联合吸人糖皮质激素对轻中度哮喘患者的临床疗效.方法 60例轻中度哮喘患者随机分为两组:噻托溴铵组给予吸入噻托溴铵干粉剂(18μg,每日1次)与布地奈德干粉剂(200 μg,每日2次);福莫特罗组给予吸入布地奈德福莫特罗干粉剂(160/4.5 μg,每日2次).在治疗前及治疗后8 w测定两组症状体征及肺功能变化.结果 治疗后8w,噻托溴铵组及福莫特罗组患者症状体征评分和肺功能指标明显改善,两组间比较,差异无统计学意义(P＞0.05).结论 在吸入糖皮质激素的基础上加用噻托溴铵,可明显改善轻中度哮喘患者的症状和肺功能,其疗效和加用福莫特罗相当.     

沙美特罗/氟替卡松联合酮替芬和联合孟鲁司特钠治疗支气管哮喘的疗效观察

目的 观察吸入沙美特罗/氟替卡松联合酮替芬与吸入沙美特罗/氟替卡松联合孟鲁司特对支气管哮喘的临床治疗效果及安全性.方法 将我院住院及门诊就诊确诊为支气管哮喘的患者随机分成两组,对照组:吸入沙美特罗/氟替卡松(50μg/250μg)早晚各1吸联合酮替芬口服治疗;观察组:吸入沙美特罗/氟替卡松(50μg/250μg)早晚各1吸联合孟鲁司特钠口服治疗.两组疗程均为8周,比较治疗前后临床症状及肺功能改善情况、哮喘控制测试(ACT)评分,不良反应等.结果 治疗12周后,两组ACT评分比较,差异有统计学意义(P＜0.05);两组第1S用力呼气末容积(FEV1)和呼气峰流量(PEF)比较,差异均无统计学意义(P＞0.05).治疗组不良反应发生率明显低于对照组,差异有统计学意义(P＜0.05).结论 吸入沙美特罗/氟替卡松联合口服孟鲁司特治疗支气管哮喘优于吸入沙美特罗/氟替卡松联合口服酮替芬,能有效改善患者的临床症状,且安全性好,值得在临床推广.     

布地奈德/福莫特罗、沙美特罗/氟替卡松治疗中重度稳定期慢性阻塞性肺疾病疗效观察

目的比较长期联合吸入布地奈德/福莫特罗和沙美特罗/氟替卡松对中重度稳定期COPD病人的肺功能、生活质量的影响。方法 60例中重度稳定期COPD病人随机分为规律吸入布地奈德/福莫特罗（160μg/4.5μg）20例,规律吸入沙美特罗/氟替卡松（50μg/250μg）20例,按需吸入特布他林组20例（对照组）。测定三组试验前及试验后6个月圣·乔治（St·George）呼吸疾病问卷（SGRQ）的评分、6分钟行走距离（6-MWD）、肺功能。结果布地奈德/福莫特罗组与沙美特罗/氟替卡松组治疗后较对照组生活质量改善、6-MWD增加、肺功能改善,差异有统计学意义（P〈0.05）;布地奈德/福莫特罗组与沙美特罗/氟替卡松组间比较,差异无统计学意义（P〉0.05）。结论与沙美特罗/氟替卡松一样,规律吸入布地奈德/福莫特罗能改善中重度稳定期COPD病人的临床症状、运动耐力和肺功能。     

布地奈德联用福莫特罗与双倍剂量布地奈德吸入治疗支气管哮喘的对照研究

目的　比较联合吸入布地奈德和福莫特罗与吸入双倍剂量布地奈德治疗轻、中度支气管哮喘的临床疗效和安全性。方法　采用开放随机平行对照的方法 ,将患者随机分成两组 :(1)观察组 :原有吸入布地奈德40 0～ 80 0 μg/d剂量不变 ,加上福莫特罗 9μg ,每日 2次 ;(2 )对照组 :双倍原有布地奈德剂量 ,即 80 0～ 16 0 0 μg/d。每组 30例 ,疗程 12周。结果　观察组患者平均晨晚间最大呼气流量 (PEF)值的改善和无症状天数的增加较对照组明显 ,两组间有统计学差异。药物不良反应发生率试验组与对照组分别为 3 2 %与 6 3% ,两组间无统计学差异。结论　布地奈德联用福莫特罗 ,通过两者协同互补效应 ,有效改善肺功能、病人生活质量和控制哮喘症状。     

沙美特罗替卡松吸入联合顺尔宁口服治疗儿童哮喘疗效分析

目的探讨沙美特罗替卡松吸入联合顺尔宁口服治疗儿童哮喘的临床疗效。方法将116例哮喘患儿随机分入对照组与观察组,给予56例对照组沙美特罗替卡松吸入治疗,60例观察组患者接受沙美特罗替卡松吸入联合顺尔宁口服,疗程12周,比较两组临床疗效及肺功能的改变。结果观察组治疗有效率显著高于对照组(60.0%vs 37.5%,P<0.05);观察组治疗后日间哮喘症状评分及夜间哮喘症状评分均显著低于对照组(P<0.05);观察组肺功能指标FEV1%和PEF预计值%显著优于对照组(P<0.05)。结论沙美特罗替卡松吸入联合顺尔宁口服治疗儿童哮喘可显著提高临床疗效,改善患儿肺功能。     

沙美特罗替卡松粉吸入剂对轻中度支气管哮喘的疗效分析

目的研究沙美特罗替卡松粉吸入剂治疗轻中度支气管哮喘的临床疗效。方法将117例轻中度支气管哮喘患者随机分为观察组和对照组各57例,对照组给予丙酸氟替卡松气雾剂局部吸入治疗,观察组给予沙美特罗替卡松粉吸入剂(舒利迭)局部吸入治疗。结果观察组患者FEV1、FEV1(%)及PEF均显著高于对照组患者(P<0.05),根据患者哮喘症状、体征评价治疗效果,观察组患者治疗总有效率94.7%显著高于对照组78.9%(P<0.05)。结论沙美特罗替卡松粉吸入剂治疗轻中度支气管哮喘可显著控制症状,改善肺功能并预防发作,疗效明显,值得临床推广应用。     

舒利迭吸入剂对COPD患者缓解期治疗的疗效

目的观察舒利迭[沙美特罗／替卡松粉吸入剂（50μg／100μg）]在慢性阻塞性肺疾病（COPD）缓解期中的疗效。方法我院呼吸科就诊的中重度COPD患者92例,随机分为治疗组和对照组。对照组给予常规治疗,治疗组在此基础上给予吸入舒利迭（50μg／100μg）。结果治疗组的总有效率显著高于对照组,两组疗效比较差异有显著性（P〈0．01）;治疗组在观察期间临床症状、运动耐力较对照组明显改善、因急性发作住院的次数明显低于对照组;治疗组的FEV1、FVC治疗后显著高于对照组（P〈0．05）。结论在中重度COPD缓解期中应用舒利迭（50μg／100μg）的治疗能减少COPD急性发作次数,提高患者肺功能,明显的改善症状与体征。使用安全,值得在临床上推广。     

布地奈德/福莫特罗对咳嗽变异性哮喘患者FeNO及血浆hs-CRP影响的研究

目的 探讨布地奈德/福莫特罗治疗对咳嗽变异性哮喘（CVA）患者呼气一氧化氮（FeNO）及血浆超敏C反应蛋白（hs-CRP）水平的影响,比较FeNO和hs-CRP两种方法在反映CVA患者气道炎症方面的价值.方法 将25例CVA患者作为实验CVA组,24例健康体检者为对照组.所有研究对象均进行肺功能和支气管激发试验.所有CVA患者接受布地奈德/福莫特罗干粉吸入治疗4周（160 μg/4.5 μg,每12小时1次）,比较治疗前后咳嗽症状总积分、FeNO和血浆hs-CRP水平变化,并进行相关性分析.结果 （1）CVA患者治疗前FeNO和hs-CRP水平明显高于正常对照组（P均＜0.01）.FeNO水平与咳嗽症状总积分明显相关（r=0.602,P＜0.01）.（2）布地奈德/福莫特罗吸入治疗4周后患者咳嗽症状总积分、FeNO和hs-CRP较治疗前均明显下降（P＜0.01或P＜0.05）.（3）治疗后咳嗽缓解患者的基线FeNO水平明显高于未缓解者,且FeNO下降的比例与咳嗽总积分下降比例明显相关（r =0.466,P＜0.05）,而hs-CRP下降比例与咳嗽总积分下降比例无明显相关.结论 布地奈德/福莫特罗吸入治疗4周可以有效改善CVA患者症状,同时降低FeNO和血浆hs-CRP水平.相比血浆hs-CRP水平,监测FeNO在评价CVA患者气道炎症及激素治疗反应方面更有优势.     

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.