清开灵注射液治疗慢性阻塞性肺疾病临床疗效观察

目的观察清开灵注射液治疗慢性阻塞性肺疾病（COPD）的临床效果。方法将COPD患者90例随机分成治疗组和对照组,每组45例,对照组采用常规治疗,治疗组在此基础上加用清开灵注射液静滴,疗程均为14天,比较两组治疗前后肺功能及血气指标变化和临床疗效。结果治疗组治疗后肺功能及血气指标较对照组改善更明显（P〈0．05）;治疗组总有效率86．67％,对照组总有效率62．22％,两组比较差异有显著性（P〈0．05）。结论清开灵注射液可缓解COPD患者的临床症状,改善肺功能,改善血气指标,提高患者的生活质量。     

舒利迭吸入辅助治疗COPD稳定期患者46例效果观察

将同期收治的80例慢性阻塞性肺疾病（COPD）稳定期患者随机分为观察组46例和对照组34例,两组均予COPD常规治疗,在此基础上观察组予舒利迭吸入,每次1喷,2次／d;对照组口服茶碱缓释片0．1g,2次／d,并酌情予沙丁胺醇（万托林）气雾剂,疗程均为8周。观察两组治疗前后肺功能、血气指标及临床症状评分改善情况。结果治疗后观察组肺功能、血气指标及临床症状评分改善情况均明显优于对照组（P〈0．05）。认为舒利迭吸入能明显改善COPD稳定期患者肺功能及临床症状。     

复方异丙托溴铵溶液雾化治疗中重度COPD急性发作的疗效观察

目的观察复方异丙托溴铵溶液雾化治疗中、重度慢性阻塞性肺病急性发作（AECOPD）的效果。方法中、重度AECOPD患者82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复方异丙托溴铵溶液雾化治疗,监测临床症状、肺功能指标以及血气分析指标。结果治疗组的有效率显著高于对照组,两组疗效比较有显著性差异（P≤0．01）;治疗组临床症状、肺功能指标（FEV1、FVC、FEV,预计值）、血气分析指标（PaO2、PaCO2）改善均显著高于对照组（P≤0．05）。结论在中、重度AECOPD患者中应用复方异丙托溴铵溶液雾化治疗能有效缓解症状,改善肺功能,值得临床推广。     

大剂量富露施对老年慢性阻塞性肺病合并肺间质纤维化患者的临床研究

目的探讨大剂量富露施（fluimucil，Flu）对老年慢性阻塞性肺病（COPD）合并肺间质纤维化（PIF）患者的临床疗效。方法将38例老年COPD合并PIF患者随机分成2组：A组18例，除吸氧、呼吸功能训练外，不给予任何治疗；B组20例，上述治疗基础上给予口服Fh600mg／次，3次／d，疗程为3个月，观察临床症状，肺CT、血气分析及肺功能的变化。结果A组呼吸困难，气短症状，肺CT、血氧分压（PaO2）及肺功能[包括肺总量（TLC）、肺活量（VC）、肺弥漫功能（DLCO）]有所改善，但与治疗前相比，差异无显著性（P〉0．05）；B组上述比较指标明显改善，与治疗前相比差异有显著性（P〈0．05）。两组治疗后上述指标均有显著变化（P〈0．05）。结论Flu对老年COPD合并PIF的患者有良好的临床疗效。     

BiPAP呼吸机用于COPD病人的疗效观察及护理

目的 BiPAP呼吸机面罩式无创通气在治疗慢性阻塞性肺疾病（COPD）急性发作期并Ⅱ型呼吸衰竭（呼衰）中的疗效及护理。方法 观察21例COPD呼衰病人应用BiPAP呼吸机面罩式无创通气治疗2天后血气分析（PH、PaCO2、PaO2）结果和临床症状改善情况，并与同期病情相同21例常规综合治疗后的结果比较。结果 BiPAP组治疗后呼吸频率明显减慢，呼吸困难和紫绀消失，临床症状改善明显，PaO2、PH增加，PaCO2明显降低，与治疗前各参数比较具有高度显著性差异（P〈0．01）。与常规组治疗后比较差异具有显著性（P〈0．05）；对照组治疗前后各参数比较差异无显著性（P〉0．05）。结论 BiPAP呼吸机面罩式无创性通气可明显改善COPD并呼衰患者的临床症状和血气指标，尤其对于轻、中度呼衰患者，只要我们熟练掌握各种护理操作，确保患者有效地通气就能够迅速改善患者症状和低氧血症，避免有创机械通气。     

盐酸戊乙奎醚治疗AECOPD患者的疗效观察

目的探讨盐酸戊乙奎醚治疗慢性阻塞性肺疾病急性加重期（AECOPD）患者的疗效。方法90例AECOPD患者,随机分为观察组和对照组,对照组患者给予常规治疗,观察组在对照组基础上加用盐酸戊乙奎醚治疗,10d为1疗程,疗程结束后进行疗效比较,并在治疗前后分别对患者的临床症状观察指标和评分及血气分析、肺功能检测结果进行比较。结果两组患者疗效比较有显著性差异（P〈0．05）,治疗后观察组临床症状观察指标和评分及血气分析、肺功能检测结果与治疗前比较有显著提高,与对照组相应指标比较,差异亦有统计学意义。结论AECOPD患者应用盐酸戊乙奎醚治疗可明显提高患者的疗效,缓解症状,显著改善患者的血气分析、肺功能指标,且无明显不良反应,值得临床进一步推广。     

参芎葡萄糖注射液辅助治疗AECOPD的疗效观察

目的观察参芎葡萄糖注射液辅助治疗慢性阻塞性肺疾病急性加重期（AECOPD）的临床疗效。方法将200例AECOPD住院患者随机分为治疗组与对照组,各100例;治疗组在常规治疗基础上加用参芎葡萄糖注射液,对照组仅常规治疗。观察两组治疗前治疗后2周内临床症状、肺功能和血气改善情况。结果治疗组临床症状、肺功能、血气分析等改善明显优于对照组。结论参芎葡萄糖注射液为AECOPD有效辅助治疗药物,临床效果好,值得推广。     

喘可治注射液治疗COPD稳定期的临床疗效观察

目的观察喘可治注射液治疗慢性阻塞性肺疾病（COPD）稳定期的临床疗效及安全性。方法将60例患者随机分为治疗组和对照组各30例,对照组予常规治疗,治疗组在常规治疗的基础上加用喘可治注射液,观察两组临床疗效、治疗前后的肺功能及淋巴细胞亚群的变化。结果总有效率治疗组为87%,对照组为80%,两组比较差异有显著性意义（P〈0.05）。治疗组治疗后肺功能较对照组有明显改善（P〈0.05）,CD3^＋、CD4^＋、CD19^＋淋巴细胞亚群及CD4^＋细胞计数较对照组差异有显著性意义（P〈0.01）。结论喘可治注射液治疗COPD患者可以改善患者的肺功能及免疫功能。且无不良反应。     

舒利迭（50／500）对稳定期中重度COPD患者疗效观察

目的观察舒利迭（50／500）对稳定期中重度慢性阻塞性肺疾病（COPD）的疗效。方法将80例经住院治疗处于稳定期中重度COPD患者,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（50／500）。记录治疗前和治疗后的肺功能和血气分析等指标。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）,吸入舒利迭无明显的毒副作用。结论应用舒利迭（50／500）治疗稳定期中重度COPD,能显著改善动脉血气指标,使用安全,值得在临床上推广。     

呼吸肌康复训练对缓解期慢性阻塞性肺病患者生活质量的影响

目的观察呼吸肌康复训练在临床缓解期慢性阻塞性肺病（COPD）中的疗效。方法选择46例处于缓解期合并慢性呼吸衰竭的COPD患者,随机分为治疗组和对照组各23例。治疗组进行3个月的呼吸肌康复训练,包括缩唇呼吸、膈式呼吸、控制性深慢呼吸等,并配合长期家庭氧疗（LTDOT）12—15h／d。对照组仅进行相同时间的LTDOT治疗,分别于治疗开始前及治疗3个月后观察患者的运动能力、血气、肺功能变化。结果治疗组的运动能力、血气、肺功能指标均有明显改善（P〈0．05）。结论呼吸肌康复训练能改善处于缓解期合并慢性呼吸衰竭COPD患者的生活质量。     

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.