70岁以上老年急性髓性白血病的治疗及预后分析

目的探讨70岁以上老年急性髓性白血病临床及生物学特征、影响预后的因素及个体化治疗方案。方法对我院1994~2005年收治58例老年AML患者(≥70岁)回顾性分析了其临床及生物学特征、影响预后的因素及治疗方案的比较。结果亚标准剂量组(A组)33例,减量组(B组)9例,支持治疗组(C组)8例。A组与B组缓解率差异无统计学意义(P>0.05),分别为39.4%,22.2%。生存期明显异常(P=0.01),分别为167天和68天。C组生存期176天,与亚标准化疗组差异无统计学意义(P>0.05),但化疗引起副反应明显减少,平均住院时间缩短(P<0.05)。预后因素分析表明:生存状态,继发性,PBWBC>10×109/L,骨髓原始细胞比率>50%,染色体核型,免疫表型是预后的显著影响因素。结论70岁以上AML患者有特殊的临床和生物学特征,治疗应个体化,其预后与多种因素有关。     

高血糖对老年急性ST段抬高心肌梗死急诊介入治疗患者心功能及预后的影响

目的 观察入院时随机血糖对老年急性ST段抬高心肌梗死急诊经皮冠状动脉介入治疗(PCI)患者心功能及术后1年病死率的影响.方法 对284例急诊PCI的老年急性ST段抬高心肌梗死患者的资料进行回顾性分析.根据入院后即刻的随机血糖,将患者分为3组:A组(血糖<7.8mmol/L)、B组(血糖7.8～10.9 mmol/L)及C组(血糖≥11.0 mmol/L).结果 (1)与A组比较,B组、C组患者女性所占比例较高(分别为26.5%比33.3%、40.2%,均P<0.01),平均住院时间较长(分别为13.9 d比16.0 d、16.6 d,均P<0.05).C组有高血压病史患者的比例高于A组(72.1%比54.9%,P<0.01).(2)急诊PCI后,合并高血糖的B组、C组患者TIMI心肌灌注分级(TMPG)0～1级所占比例高于血糖正常的A组(分别为22.6%、34.1%比13.3%,均P<0.05),TMPG达3级所占比例低于A组(分别为74.3%、57.6%比84.4%,均P<0.05).C组术中并发症发生率高于A组及B组(分别为42.5%比20.6%、26.6%,均P<0.01),术中应用主动脉内球囊反搏比例高于A组及B组(分别为19.5%比4.9%、6.4%,均P<0.01).(3)C组心功能Killip分级≥2级患者所占比例明显高于A组及B组(分别为44.8%比23.5%、27.7%,均P<0.01).与A组比较,C组患者住院期间病死率(8.0%比1.1%,P<0.05)及术后1年病死率(18.7%比3.4%,P<0.05)较高.结论 合并高血糖的老年急性ST段抬高心肌梗死患者急诊PCI术后心肌组织水平灌注、心功能及预后均较差.     

不同治疗方案对70岁以上晚期肺腺癌患者生存期的影响

目的探讨不同治疗方案对70岁以上晚期肺腺癌患者预后的影响。方法回顾分析67例70岁以上晚期肺腺癌患者的治疗经过,根据所接受的治疗分为3组:靶向治疗组(A组)、化疗组(B组)和最佳支持治疗组(C组)。进一步将B组分为3个亚组:单纯化疗并完成首次4~6个治疗周期(B1组),在治疗中使用过靶向药物(B两组)和未完成4-6个化疗周期的患者(B3组),比较各组患者1年生存率,2年生存率,无进展生存期及生存期的差异。结果 A、B两组的1年生存率(35.3%,40.0%)均高于C组(6.6%)(P0.01),三组患者的2年生存率无显著差异。A、B两组的无进展生存期(6.9月,4.7月)均高于C组(2.2月)(P0.05)。A、B两组的中位生存期无显著差异(8.2月,9.1月),均高于C组(3.4月)(P0.01)。在亚组分析中,B1组和B两组的1年生存率高于B3组(分别为46.7%、58.3%及0.0%)(P0.05),3组患者的2年生存率分别为26.7%,41.7%和0.0%。B1组(5.1月)与B两组(4.5月)的无进展生存期均高于B3组(2.4月)(P0.01)。3组患者的中位生存期分别为11.7月,15.1月和3.2月,B1、B两组高于B3组(P0.01)。B1组的中位生存期比A组增加了3.7月(P0.05)。结论对于老年晚期肺癌患者,化疗或靶向治疗疗效均优于最佳支持组。化疗联合或交替使用靶向药物可能使该患者群体受益。     

液体复苏救治老年创伤失血性休克的临床研究

目的研究不同的液体复苏方法对老年创伤失血性休克(HTS)患者的作用效果。方法选取136例老年HTS病例。随机分为3组:生理盐水+乳酸林格液组(A组),生理盐水+羟乙基淀粉组(B组),生理盐水+7.5%高渗氯化钠溶液组(C组)。记录患者复苏1 h所需液体量,28 d内MODS的发生率和患者死亡率,复苏前和复苏后1 h PT、APTT、FIB、RBC、Hb、P lt的检验结果。结果 A组输液量(2 545±587)m l最多,C组输液量(1 652±386)m l最少。C组MODS的发生率明显低于A组和B组(P<0.05),A、B、C三组的死亡率无明显差异(P>0.05)。A组和B组复苏1 h后的PT、APTT值明显高于C组(P<0.05),A组复苏1 h后的RBC、Hb值明显低于其他两组(P<0.05)。结论复苏早期给予小剂量高渗盐溶液有利于HTS患者的救治。     

抗血小板治疗患者起搏器围术期不同抗栓治疗策略的临床对比研究

目的探讨长期口服阿司匹林进行抗血小板治疗的患者起搏器围术期的抗栓治疗策略。方法 2010年1月~2014年1月连续入住河北大学附属医院的长期服用阿司匹林并且安装永久起搏器的老年患者112例,分为3组:A组36例,围术期不停用阿司匹林;B组42例,起搏器术前3~5d停用阿司匹林,术后12h恢复;C组34例,术前停用阿司匹林3~5d,以低分子肝素桥接替代治疗,术前12h停用,术后12h恢复。结果 A、B、C组渗血的发生率分别为5.6%,7.1%,23.5%(P=0.044),囊袋血肿发生率分别为2.8%,2.4%,17.6%(P=0.025),C组渗血和囊袋血肿发生率明显高于A组和B组,A组与B组比较无统计学差异(P0.05)。所有患者均未发生大出血事件。B组和C组平均住院时间显著较A组长[(10.5±3.0)d和(11.6±2.9)d vs(7.5±2.3)d,P=0.000];住院期间3组患者均无囊袋感染及缺血事件发生。结论起搏器置入围术期持续应用阿司匹林治疗出血风险无明显增加,肝素桥接替代治疗明显增加出血发生率并延长住院时间。     

不同剂量右美托咪定对老年妇科恶性肿瘤手术患者围术期疼痛、认知功能及肾功能的影响

目的探讨不同剂量右美托咪定对老年妇科恶性肿瘤手术患者围术期疼痛、认知功能及肾功能的影响。方法选取老年妇科恶性肿瘤并行手术患者136例,随机分为4组:A、B、C组右美托咪定分别为0.1、0.2、0.4μg/(kg·h),对照组给予常规麻醉处理,各34例。比较4组围术期疼痛、认知功能及肾功能情况。结果 C组术后2、24 h视觉模拟评分法(VAS)评分均显著低于A组、B组、对照组(P<0.05)。4组术后2、24、48 h血清人中性粒细胞明胶酶相关性脂质运载蛋白(NGAL)水平均明显升高,血清血肌酐(Scr)水平均明显降低(P<0.05);术后24 h,B、C组血清Scr水平均明显高于对照组(P<0.05);B组术后24 h、C组术后2 h胱抑素血清(Cys)C水平均明显低于术前,C组术后24 h显著高于B组、对照组(P<0.05)。术后1 d,B组、C组简易精神状况检查(MMSE)评分显著高于A组、对照组(P<0.05)。术后120 min内,4组尿量均明显多于气腹120 min内,且C组明显多于A组、B组、对照组(P<0.05)。术后1 d,A组、B组、C组MMSE评分均明显高于对照组,B组、C组明显高于A组(P<0.05)。结论对老年妇科恶性肿瘤手术患者使用右美托咪定可有效减轻其术后疼痛,增加患者术中及术后尿量,对肾脏有保护作用,且该作用呈剂量依赖性,可提高患者术后的认知功能。     

稳心颗粒与乙胺碘肤酮联用治疗老年高血压合并阵发性房颤

目的探讨稳心颗粒与乙胺碘肤酮联合应用治疗老年高血压合并阵发性房颤(PAF)的临床疗效。方法将老年高血压合并 PAF 病人215例随机分3组:稳心颗粒组(A 组)72例,乙胺碘肤酮组69例(B 组),稳心颗粒加乙胺碘肤酮组(C 组)74例,观察3组治疗前后的有效率、临床症状、P 波离散度(Pd)及不良反应。结果 1)A 组总有效率为70.8%,B 组总有效率为69.6%,C 组总有效率为86.5%。C 组有效率比 A 组、B 组均显著增高(P<0.05)。2)治疗前后临床症状比较:C 组临床症状改善程度比 A 组、B 组均显著明显(P<0.05)。3)治疗后3组Pd 比治疗前均显著降低(P<0.05),C 组 Pd 显著低于 A 组、B 组(P<0.05)。结论稳心颗粒联合应用乙胺碘肤酮治疗老年高血压合并 PAF 疗效明显优于各自单用,不良反应少,安全性高。     

危险度分层下个体化治疗方案治疗老年急性髓系白血病的疗效及预防

目的探讨危险度分层下个体化治疗方案治疗老年急性髓系白血病(AML)的的疗效及预防价值。方法选择2011年4月至2013年12月该院收治的老年AML患者100例,根据化疗方法不同分为给予标准化疗方案的对照组和按照危险度分层下指定个体化化疗方案的观察组,从完全血液学缓解(CHR)、完全细胞遗传学缓解(CCyR)以及完全分子学缓解(CMoR)判断化疗的有效性,从白细胞计数、中性粒细胞计数、血小板计数、血红蛋白判断不良反应,从自我实现、健康责任、运动、营养、人际关系、应对压力判断生存质量。结果 (1)化疗有效性:两组患者CHR、CCyR以及CMoR例数的差异无统计学意义(P>0.05);(2)不良反应:观察组患者发生Ⅲ-Ⅳ度白细胞计数不良反应、中性粒细胞计数不良反应、血小板计数不良反应、血红蛋白不良反应(6%、10%、8%、16%)均明显低于对照组(P<0.05);(3)观察组患者的自我实现、健康责任、运动、营养、人际关系、应对压力评分(29.3±4.1、25.1±3.3、26.9±3.2、27.4±3.1、34.3±4.2、33.1±4.2)均明显高于对照组(P<0.05)。结论危险度分层下个体化治疗方案能取得与标准化疗方案相当的缓解效果,并减少不良反应发生率、提高生存质量,是老年AML理想的化疗方案。     

稳心颗料乙胺碘肤酮联用治疗老年高血压合并阵发性房颤

目的 探讨稳心颗粒与乙胺碘肤酮联合应用治疗老年高血压合并阵发性房颤(PAF)的临床疗效.方法 将老年高血压合并PAF病人215例随机分3组:稳心颗粒组(A组)72例,乙胺碘肤酮组69例(B组),稳心颗粒加乙胺碘肤酮组(C组)74例,观察3组治疗前后的有效率、临床症状、P波离散度(Pd)及不良反应.结果 1)A组总有效率为70.8%,B组总有效率为69.6%,C组总有效率为86.5%.C组有效率比A组、B组均显著增高(P<0.05).2)治疗前后临床症状比较:C组临床症状改善程度比A组、B组均显著明显(P<0.05).3)治疗后3组Pd比治疗前均显著降低(P<0.05),C组Pd显著低于A组、B组(P<0.05).结论 稳心颗粒联合应用乙胺碘肤酮治疗老年高血压合并PAF疗效明显优于各自单用,不良反应少,安全性高.     

低分子肝素治疗老年不稳定型心绞痛的研究

目的:观察低分子肝素(LMWH)治疗老年不稳定心绞痛(UAP)的疗效及安全性。方法:78例老年UAP患者随机分为三组:A组(n=26):阿斯匹林120 mg/d;B组(n=26):阿斯匹林120 mg/d,普通肝素300 IU/kg·d;C组(n=26):阿斯匹林120 mg/d,LMWH 0.4 ml皮下注射,2次/d;疗程均为7 d。观察疗效:治疗前、后凝血指标的变化以及治疗后30 d和180 d内心绞痛再发率,急性心肌梗塞(AMI)发生率。结果:A、B、C三组总有效率分别为53.8%,88.5%和92.3%。B,C两组比较无显著性差异(P>0.05)。B、C两组与A组比较均有显著性差异(P<0.001),治疗30 d、180 d C组的心绞痛再发率显著低于A、B组(P均<0.05),30 d、180 d AMI发生率C组显著少于A、B组(P<0.05)。B组有2例出血并发症,C组各项凝血指标在治疗前、后均无显著差异(P> 0.05)。结论:联合应用阿斯匹林及LMWH抗凝治疗对老年UAP患者,可明显降低心绞痛的再发率和AMI发生率。     

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.     

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.     

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.     

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.