血清Na~+浓度对慢性乙型重型肝炎患者预后的评价作用

目的分析慢性乙型重型肝炎患者的血清Na+浓度与预后的关系,比较血清Na+水平、MELD-Na评分与凝血酶原时间(PT)对慢性乙型重型肝炎患者短期预后的预测价值。方法慢性乙型重型肝炎患者85例,分成生存组和死亡组,分别记录患者入院第2天的血清Na+、MELD-Na评分和PT,并分析三者之间的相关性;运用受试者工作特征曲线(ROC)及曲线下面积(AUC)评价血清Na+、MELD-Na评分和PT的预测价值。结果生存组患者血清Na+、MELD-Na评分值和PT分别为136.08±5.66mmol/L,20.42±7.78和22.28±6.37s,死亡组患者血清Na+、MELD-Na分值和PT分别为131.15±6.97mmol/L、34.40±10.72和34.48±10.09s,三项指标均有显著性差异,P0.001。血清Na+与MELD-Na评分值呈显著负相关(r=-0.673,P0.001),血清Na+与PT亦呈负相关(r=-0.238,P0.05),血清Na+浓度、MELD-Na分值和PT的AUC分别为0.261、0.878和0.870。结论低钠血症是影响慢性乙型重型肝炎预后的重要因素,包含血清Na+的MELD-Na评分与PT均能较好地预测慢性乙型重型肝炎患者的短期预后,两者预测能力无显著差异。     

终末期肝病模型预测慢性乙型重型肝炎预后的评估

目的分析终末期肝病模型(model for end-stage liver disease,MELD)评估我国慢性乙型重型肝炎患者预后的临床价值。方法回顾性分析2006年1月至2008年12月5家医院收治的慢性乙型重型肝炎住院患者561例临床资料,分为生存组和死亡组,计算患者入院时的MELD评分,应用t’检验、Logistic回归分析、受试者工作特征(receiver operating characteristic curve,ROC)曲线下面积(area under curve,AUC)评价MELD对慢性乙型重型肝炎预后的预测价值。结果生存组的MELD分值为(22.25±4.35),死亡组MELD分值为(28.94±8.76),差异有统计学意义(P0.01)。Logistic回归分析表明,在其他影响因素均衡的条件下,MELD分值每增加1,死亡的可能性增加至1.182倍,MELD评分的Logistic回归方程预测预后总的正确率为68.4%,且差异有统计学意义(P0.01);MELD评分的AUC为0.759,95%置信区间为(0.720～0.798),MELD界值为27,其诊断的正确度为中等。结论 MELD评分系统预测我国慢性乙型重型肝炎患者的预后有临床应用价值,但效能中等。     

四种评分系统预测慢性重型肝炎预后的价值比较

目的比较终末期肝病模型（MELD）评分、Child-Turcotte-Pugh（CTP）评分、MESO指数和MELD-Na评分系统预测慢性重型肝炎患者预后的价值。方法回顾性分析156例慢性重型肝炎患者的临床资料,计算患者入院时的MELD、CTP、MESO和MELD-Na评分。所有患者均随访1年。绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC）,应用正态Z检验对四者曲线下面积进行比较。结果 156例慢性重型肝炎患者随访1年后有62例患者死亡,死亡组患者MELD、CTP、MESO和MELD-Na评分分别为31.2±6.51、2.4±1.3、2.4±0.6和39.4±9.8,均高于生存组患者（20.2±7.4、10.1±1.5、1.5±0.6和22.5±8.6）,差异具有统计学意义（t=6.71t,=7.20t,=8.14t,=9.65,均P〈0.01）。各评分系统的AUC分别为0.824、0.6750、.826和0.898;MELD-Na评分系统对慢性重型肝炎预后评估价值显著优于MELD、CTP和MESO（均P〈0.01）。结论 MELD-Na是判断慢性重型肝炎患者预后的一个较好的指标,其准确性优于MELD、CTP评分和MESO指数。     

五种评分系统对慢性重型肝炎预后的预测价值比较及其临床意义

目的 比较终末期肝病模型(MELD)评分、Child-Turcotte-Pugh(CTP)评分、Mayo评分、MESO指数和MELD-Na评分系统预测慢性重型肝炎患者预后的价值.方法 回顾性分析温州医学院附属第一医院213例慢性重型肝炎患者的临床资料,计算其MELD、CTP、Mayo、MESO和MELD-Na评分,比较各评分系统在死亡组和生存组中的差异,通过受试者工作特征(ROC)曲线,曲线下面积(AUC)及截断值进行比较分析.计量资料的比较使用成组t检验,各评分系统之间AUC的比较使用MEDCLAC软件.结果 死亡组的MELD、CTP、Mayo、MESO、MELD-Na评分分别是(30.6±9.5)、(11.3±1.5)、(10.4±1.3)、(2.3±0.8)和(39.0±11.8)分,均高于生存组的(21.1±6.8)、(10.6±1.6)、(9.0±1.5)、(1.6±0.5)和(22.6±8.2)分,差异有统计学意义(t=7.31,t=3.10,t=6.70,t=7.90,t=10.21,均P＜0.01);各评分系统的AUC分别为0.810、0.623、0.749、0.829和0.885;Youden指数分别为0.507、0.175、0.389、0.528和0.650.结论 CTP评分判断慢性重型肝炎的预后尚不理想;Mayo评分具有一定的预测能力;MELD、MESO、MELD-Na评分在预测慢性重型肝炎预后方面具有肯定的临床应用价值,且MELD-Na评分优于MESO指数和MELD评分.     

终末期肝病模型评价慢性乙型重型肝炎的预后

目的 研究终末期肝病模型（MELD和MELD-Na）评分系统预测慢性乙型重型肝炎患者预后的价值。方法 采用药物治疗的慢性乙型重型肝炎住院患者42例,记录人院时、1、2和3周的MELD和MELD-Na评分,应用c-statistic（等同于ROC曲线下面积）评估每一预测模型的准确性。观察的终点时间为3个月。结果 患者入院时MELD和MELD-Na评分c-statistic分别为0.728和0.731;入院1周后c-statistic均为0.883。入院1周后判断患者3月内预后的最佳临界值分别是26.14（敏感性91.7%,特异性81.8%）和29.02（敏感性100.0%,特异性77.3%）。结论 MELD和MELD-NA评分系统可以预测慢性乙型重型肝炎短期预后,入院后1周评分优于入院时评分。     

四种评分模型对慢性重型乙型肝炎患者短期预后的比较

目的比较四种评分模型（MELD、MELD-Na、SMSVH及CTP）对慢性重型乙型肝炎患者短期预后的预测价值。方法记录住院后确诊慢性重型乙型肝炎85例患者的临床指标并随访3个月的生存情况,分为生存组和死亡组,并用MELD、MELD-Na、SMSVH和CTP评分模型进行评分。应用受试者工作特征曲线（ROC）评价每一个模型的预测能力,根据各自的最佳临界值用Kaplan-Meier（K-M）分析患者生存时间、生存率,并算出总预测正确率。结果死亡组MELD-Na、MELD、SMSVH和CTP的平均分值明显高于生存组（P〈0.01）。四者ROC曲线下面积分别为0.848、0.833、0.802和0.75。四者的预测能力比较,差异无统计学意义（χ2=6.64,P=0.084）。四者的总预测正确率分别为（82.35%、77.64%、77.65%、71.76%）,差异亦无统计学意义（χ2=2.737,P=0.434）。结论 MELD、MELD-Na、SMSVH和CTP评分模型对慢性重型乙型肝炎患者短期预后判断有较好的作用,四种评分模型预测价值无统计学差异,四者预测价值相当。     

终末期肝病模型在评估慢性重型肝炎预后中的应用

目的 探讨终末期肝病模型(MLED)评分系统对慢性重型肝炎患者短期(3个月)预后的预测能力及其临床应用价值.方法 应用MELD模型公式对125例慢性重型肝炎患者进行评分,观察其3月内的死亡率,以受试者工作特征(ROC)曲线和曲线下面积评价该系统预测患者短期(3个月)预后的准确性,并求出作为判断患者3个月内死亡与否的ME...     

终末期肝病模型联合血清钠对失代偿期肝硬化患者预后评估的价值

目的 评价终末期肝病模型(MELD)联合血清钠MELD-Na、MELDNa、MESO模型对评估我国失代偿期肝硬化患者预后的价值. 方法 对212例失代偿期肝硬化患者进行回顾性分析,随访患者在3、6、12个月的预后,分别应用MELD及MELD-Na、MELDNa、MESO模型进行评分,用受试者特征曲线(ROC)下面积(AUC)比较各评分系统预测患者生存不同时间的准确性.依据ROC曲线的截断值绘制Kaplan-Meier生存曲线.计量资料应用t检验;计数资料用x2检验;ROC曲线下面积的比较采用正态性Z检验;Kaplan-Meier生存曲线的比较用Log rank检验.结果 212例肝硬化患者3、6、12个月内分别死亡46.56、87例.随访3、12个月中,死亡组患者的MELD、MELD-Na、MELDNa及MESO评分均高于生存组患者(P＜0.01).判断患者3、6个月预后,四种模型的AUC均在0.8以上,其中MELDNa(0.846,0.869)及MESO(0.831,0.850)与MELD(0.812,0.841)比较,差异有统计学意义(P＜0.05).判断患者12个月预后,MELD、MELD-Na、MELDNa、MESO的AUC值分别为0.774.0.775、0.786、0.777,各模型之间AUC差异无统计学意义.生存分析显示四种评分系统均可有效预测12个月内可能生存或死亡的患者(P＜0.01). 结论 MELD及其联合血清钠模型均可有效地预测失代偿期肝硬化患者中短期预后,MELDNa和MESO对患者短期预后评估的准确性优于MELD.     

终末期肝病模型评估血浆置换治疗慢性重型肝炎的疗效及预后

目的探讨终末期肝病模型（MELD）评分对血浆置换治疗慢性重型肝炎的疗效和对短期预后的预测能力。方法 210例慢性重型肝炎患者被分成血浆置换组（85例）和对照组（125例）,观察两组在治疗前与治疗后2周MELD评分及3个月时的病死率的变化。采用受试者工作特征（ROC）曲线及曲线下面积评价MELD评分系统的准确性。结果治疗后2周,两组MELD评分均有明显的降低（P〈0.01）,但在MELD〉40的患者,则无明显降低;PE组患者病死率（49.4%）低于对照组（64.8%,P〈0.05）,在MELD≤39的患者,两组病死率差异有统计学意义（P〈0.01）;对照组最佳MELD临界值为26,其敏感度为80.2%,特异度为79.5%,准确性为80.0%,而PE组为30,其敏感度为76.2%,特异度为69.8%,准确性为72.9%。结论 MELD评分能较准确地预测慢性重型肝炎患者的短期预后。     

HBV DNA对不同临床分期慢性乙型重型肝炎预后的影响

目的探讨慢性乙型重症肝炎早、中、晚期患者HBV DNA对预后的影响。方法统计我院2004～2008年197例不同时期慢性乙型重型肝炎HBV DNA阳性情况,并统计早、中、晚期HBV DNA阳性与阴性组的3个月死亡率,入院2周终末期肝病模型(MELD)分值变化情况。结果早期HBV DNA阳性及阴性组3个月死亡率分别为34%、7.4%(P0.01);中期分别为48.8%、44.4%(P0.05);晚期分别为80.0%、76.9%(P0.05)。早期HBV DNA阳性及阴性组入院2周△MELD值分别为3.6±4.8、0.8±4.1(P=0.01);中期分别为1.5±4.2、1.1±6.5(P0.05);晚期分别为-1.6±7.3、-1.1±5.8(P0.05)。结论慢性乙型重型肝炎早期HBV DNA阳性对预后有影响,但中、晚期HBV DNA阳性对预后无影响。     

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.