急性中型颅脑损伤后脑血流动力学改变的经颅多普勒超声诊断

目的 探讨经颅多普勒超声(TCD)对中型颅脑损伤早期诊断中的作用及脑血流动力学特点。方法 对40例脑挫伤患者应用TCD观察脑血流动力学改变，并与正常对照组40名健康者进行比较。结果 40例患者中脑血流异常3l例(占77.5％)，异常患者中26例(83.9％)出现脑血流速度增快，7例(22．6％)出现脑血流速度减慢，13例(41.9％)出现搏动指数(PI)增高，收缩峰高尖频谱，以椎基底动脉为主；有3例(9.7％)颅内外各动脉血流速度广泛增快。中型颅脑损伤脑血液流速各期均呈增高趋势。结论 TCD可以早期发现颅脑损伤时的脑血流动力学的异常，是动态观察脑血流动力学变化的理想方法和手段。     

闭合性颅脑损伤患者的经颅多谱勒分析

目的探讨经颅多谱勒（TCD）对轻、中型闭合性颅脑损伤的临床诊断价值。方法对60例轻型,52例中型患者进行经颅多谱勒检查,观察各动脉平均血流速度及博动指数,并与56例正常对照组比较。结果轻型闭合性颅脑损伤患者TCD异常率为76.9%,主要改变为平均血流速度增高;而中型闭合性颅脑损伤患者TCD异常为94.2%,主要改变为平均血流速度减慢及血管痉挛,两组患者平均血流速度与对照组比较有显著性差异（P〈0.01）,恢复期患者主要表现为平均血流速度增高。结论TCD检查可反映闭合性颅脑损伤脑血流的变化。对临床诊治与判断预后有一定价值。     

一侧大脑前动脉发育不良的经颅多普勒超声检测与分析

目的应用经颅多普勒超声(TCD)分析一侧大脑前动脉发育不良(细小支)的血流动力学特点并探讨TCD的诊断价值。方法对经TCD和磁共振血管造影(MRA)筛查的28例一侧大脑前动脉发育不良的患者,进行颈动脉压迫试验前后细小侧和对侧大脑前动脉交通前段(ACA-A1)的血流动力学改变的观察,并与28例健康者(对照组)比较。结果28例患者细小侧ACA-A1血流速度(62±17)cm/s显著低于对照组(87±15)cm/s(P<0.01),对侧ACA-A1血流速度(123±13)cm/s显著高于对照组(P<0.01),细小侧ACA-A1血流速度平均为对侧的1/2。压迫对侧颈总动脉后,细小侧ACA-A1血流速度增高倍数(3.08±0.51)显著高于对照组(1.97±0.25)(P<0.01),对侧ACA-A1血流速度增高倍数(1.35±0.11)显著低于对照组(P<0.01),细小侧ACA-A1血流速度增高幅度平均为对侧的2倍以上。结论根据颈总动脉压迫试验前后双侧大脑前动脉的血流动力学改变,结合血流信号强度、血流分布等辅助指标,TCD可诊断一侧大脑前动脉发育不良。     

经颅超声在颅脑创伤救治中的应用现状及展望

重型颅脑损伤(severe traumatic brain injury,sTBI)是世界范围内致死率、致残率极高的疾病,经颅多普勒(transcranial Doppler,TCD)可以高效安全地在床边监测s TBI患者的病理生理学变化,其检测结果可重复性高。TCD可以无创、实时获取脑组织二维形态,通过计算颅内血管的血流状态,获得脑血流动力学信息,通过分析脑血流速度及方向、血管自身调节功能、血管阻力变化来评估颅内压。该文就床边TCD在颅脑创伤救治的临床应用现状及展望进行综述。     

老年椎-基底动脉供血不足性眩晕的病因探讨

选择285例椎-基底动脉供血不足（VBI）性眩晕患者（VBI组）和100例健康老年人（对照组）,均行经颅多普勒超声（TCD）和计算机X线检查,比较脑血流动力学和颈椎片的差异,同时分析脑血流动力学的改变与性别、年龄的关系.结果显示,VBI组TCD和X线颈椎片异常率均高于对照组（P均＜0.01）.VBI组TCD异常患者99例（44.8%）血流速度增快,112例（55.2%）血流速度减慢.脑动脉粥样硬化和颈椎病是造成VBI的最主要原因,VBI性眩晕患者的脑血流动力学改变在女性或＜60岁者主要表现为血流速度增快,男性或≥60岁者表现为血流速度减低.     

阿魏酸钠治疗偏头痛的脑血流动力学研究

目的研究阿魏酸钠治疗偏头痛的脑血流动力学改变及临床意义。方法应用经颅多普勒(TCD)技术检测40例偏头痛患者治疗前及用阿魏酸钠治疗后14天时的脑血流改变,并观察治疗效果。结果40例偏头痛患者治疗前头痛侧与非头痛侧大脑中动脉,大脑前动脉的收缩期峰值流速(Vs)比较有显著差异(P<0.01),头痛侧治疗前与治疗后14天比较Vs有显著差异(P<0.01)。结论阿魏酸钠治疗偏头痛的效果确切,且能明显改善偏头痛患者的脑血流异常指标。     

经颅多普勒检测糖尿病患者脑血流动力学变化

目的探讨2型糖尿病患者脑动脉血流动力学的变化.方法应用经颅多普勒超声（TCD）检测103例2型糖尿病患者脑动脉平均血流速度、血流频谱形态、搏动指数、血流速度异常动脉分布情况,并与103例健康者进行比较.结果两组受检动脉均为1 133支,糖尿病组脑内动脉血流速度异常102支,异常率为9.0%;103例患者中血流频谱形态异常83例,占80.6%;46例搏动指数增高,占44.7%,与对照组的3.1%、44.7%及18.4%比较,差异有显著性（P＜0.05）;血流速度减慢的受累动脉以椎-基底动脉为主,血流速度增快和血管狭窄较少见于大脑后动脉.结论TCD检查可为临床2型糖尿病患者脑血管疾病的防治提供依据.     

小儿脑性瘫痪脑血流动力学的研究

目的研究小儿脑性瘫痪(脑瘫)脑血流动力学的变化规律.方法应用经颅多普勒超声对347例脑瘫患儿与30例正常健康儿脑血流动力学参数进行对照检测.结果脑瘫患儿的大脑前动脉、大脑中动脉、大脑后动脉的平均血流较同年龄段的正常小儿显著下降(P＜0.05),而脑血管阻力指数则显著增高(P＜0.05).小于1岁年龄组的平均流速下降及脑血管阻力指数增高较其他年龄组更显著(P＜0.05).结论脑瘫患儿存在脑血流动力学的高阻力、低灌注障碍,早期应用改善脑微循环治疗对于小儿脑瘫的治疗有重要意义.     

脑动脉硬化症患者脑血管血流动力学研究

目的 探讨脑动脉硬化症患者脑血管血流动力学的变化及导致脑梗死的机制.方法 应用上海仁和医疗设备公司生产的脑循环动力学检测仪和以色列Link-9000型经颅多普勒诊断仪(TCD),对26例无明显神经系统体征、CT和MRI上无梗死灶的临床上诊断为脑动脉硬化症的患者进行了血流动力学研究.结果 通过与脑梗死组及正常对照组对照研究,发现脑动脉硬化症患者双侧颈动脉供血量及血流速度与正常对照组相比差异无显著性(P>0.05),脑血管阻力及临界压力升高与正常对照组相比差异有显著性(P<0.05),脑动脉弹性及脑血流自动调节能力下降.TCD显示脑动脉硬化症患者大脑前动脉、大脑中动脉等主要脑动脉的血流速度大致在正常范围,而搏动指数较正常对照组有所增大(P<0.05).脑梗死患者病灶侧大脑半球总供血量及血流速度明显下降,反映脑动脉硬化指标中R、DR、Cp较脑动脉硬化症患者严重.结论 脑动脉硬化的存在并不直接影响一侧大脑半球主要脑血管的供血量,而脑循环阻力增高及自动调节功能减退可能是动脉硬化导致脑梗死血流动力学的重要机制.     

老年颞叶癫痫患者经颅多普勒超声脑血流改变与认知功能障碍的关系

目的探讨老年颞叶癫痫患者经颅多普勒超声(TCD)脑血流改变与认知功能障碍的关系。方法选择自2015年3月至2016年8月在中山大学附属第五医院进行治疗的老年颞叶癫痫患者81例为观察组。另选同期在医院进行体检的健康体检者105例作为对照组。利用韦氏成人智力量表的中国修订版(WAIS-RC)测定两组智商(IQ),利用韦氏记忆量表操作手册的第3版检测其记忆功能(MQ),比较两组TCD脑血流相关指标,分析患者TCD脑血流相关指标与其认知功能的相关性。结果观察组大脑前动脉(ACA)、中动脉(MCA)的峰值流速(Vp)及均值流速(Vm)水平均明显低于对照组,而收缩-舒张期的血流速度比(S/D)、搏动指数(PI)及阻力指数(RI)水平均明显高于对照组(P<0.05)。观察组IQ及MQ认知功能指标水平均明显低于对照组(P<0.05)。患者大脑后动脉(PCA)、椎动脉(VA)及基底动脉(BA)的TCD脑血流相关指标与其认知功能之间无明显相关性,但ACA及MCA的Vp、Vm与认知功能呈正相关,S/D、PI及RI与认知功能呈负相关。结论老年颞叶癫痫患者的TCD脑血流指标与其认知功能障碍之间具有紧密联系。     

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.