动态观察血钠波动程度对于APE患者短期预后的预测研究

目的探讨动态血清钠波动程度对急性肺栓塞(acute pulmonary emblism,APE)患者短期预测价值。方法连续性纳入30例APE患者,根据患者的28天死亡率分为存活组(n=19)和死亡组(n=11),动态观察治疗前、治疗后第3天和第7天血清钠水平改变,综合分析血清钠水平波动与患者28天死亡率的关系。结果存活组患者血钠水平逐渐升高,而死亡组患者血钠水平逐渐降低,差异有统计学意义(P0.05)。存活组治疗后第7天血钠水平均高于死亡组(136.7±3.9 mmol/L vs.128.3±3.0 mmol/L,P0.05)。△1(治疗后3天-治疗前)的AUC为0.722,cut-off为-3.9 mmol/L,敏感性为79.9%、特异性为74.4%。△2(治疗后第7天-第3天)的AUC为0.714,cut-off为-4.6 mmol/L,敏感性为81.2%,特异性为81.2%。△3(治疗后第7天-治疗前)的AUC为0.789,cut-off为-5.7mmol/L,敏感性为87.5%、特异性为84.8%。Qanadli栓塞指数的AUC为0.755,cut-off为35.1,敏感性为81.2%、特异性为86.9%。通过Spearman相关性分析发现△1(r=-0.392,P0.05)、△2(r=-0.377,P0.05)和△3(r=-0.573,P0.05)血钠水平与APE患者28天死亡风险呈负相关。△3与Qanadli栓塞指数呈负相关(r=-0.421,P0.05)。Logistic回归发现Qanadli栓塞指数(35.1)(OR=1.20,95%CI 0.90-1.45,P0.05)和△3(OR=1.58,95%CI 0.84-2.25,P0.05)为APE患者28天死亡事件的独立危险因素。结论动态观察血清钠水平波动有助于APE患者临床预后的预测评估。     

平均血小板体积与急性肺栓塞患者近期预后的关系研究

目的探讨平均血小板体积(MPV)与急性肺栓塞(APE)患者近期预后的关系。方法选取2015年1月—2017年1月天门市第一人民医院收治的APE患者130例,根据入院后MPV分为对照组(MPV为7.4~12.5fl,n=90)和观察组(12.5 fl,n=40)。比较两组患者临床资料,MPV与APE患者Wells评分的相关性分析采用Pearson相关性分析,MVP对APE患者入院后3个月预后的影响分析采用多因素Logistic回归分析。结果观察组患者心率、心肌肌钙蛋白I(cTnⅠ)、D-二聚体、脑钠肽(BNP)高于对照组,动脉血氧分压(PaO_2)、C反应蛋白(CRP)及存活率低于对照组,Wells评分分级劣于对照组(P0.05)。Pearson相关分析结果显示,MPV与APE患者Wells评分呈正相关(P0.05)。多因素Logistic回归分析结果显示,MPV是APE患者入院后3个月死亡的独立危险因素[OR=1.341,95%CI(1.163,3.892),P0.05]。结论 MPV与APE患者疾病危险程度呈正相关,是APE患者近期死亡的独立危险因素。     

术前平均血小板体积与早期直肠癌复发的相关性探讨

目的探讨术前平均血小板体积(mean platelet volume,MPV)与早期直肠癌复发的关系。方法选择行外科手术治疗的早期直肠癌患者50例,分为无复发组(41例)和复发组(9例),收集两组患者围手术期临床资料,并进行统计分析。结果术前MPV水平复发组为(12. 46±1. 95) f L,高于无复发组的(9. 85±1. 34) f L,差异有统计学意义(P 0. 05)。Logistic回归分析显示术前MPV (OR=3. 726,95%CI=1. 216～11. 413),CA19-9(OR=0. 010,95%CI=0. 000～0. 449)是早期直肠癌术后复发的独立影响因素。结论术前MPV水平与早期直肠癌有相关性,MPV可能成为预测早期直肠癌患者术后复发的检测指标。     

原发性高血压患者平均血小板体积的变化及其与左心室肥厚的关系

目的研究原发性高血压(EH)患者平均血小板体积(MPV)的变化,探讨MPV与EH以及左心室肥厚(LVH)的关系。方法回顾性分析2013年1月至2016年12月住院的EH患者189例,以同期体检的正常血压者132名为对照组。EH患者按左心室是否肥厚分为左心室正常组(NLVH组,n=75)和左心室肥厚组(LVH组,n=114)。双变量相关分析MPV与其他指标的相关性。多因素logistic回归探讨MPV与EH及LVH的关系。结果 EH患者LVH组及NLVH组的MPV高于对照组[(9.2±1.0),(8.8±1.1)比(8.2±0.7)fL,均P0.05],LVH组的MPV高于NLVH组。Pearson相关分析显示,在对照组中,MPV与血小板计数呈负相关(r=-0.348,P0.05),在EH组中,MPV与舒张压、左心室质量指数(LVMI)呈正相关(r=0.225、0.148,P0.05);与血小板计数呈负相关(r=-0.199,P0.05)。多因素logistic回归分析显示,在校正性别、年龄、血小板计数等因素后,MPV是EH的相关因素,与MPV低值组(MPV8.5 fL)相比,MPV高值组(MPV≥8.5 fL)发生EH的OR值(95%CI)为3.500(1.992～6.149)。同时MPV也是影响LVH发生的相关因素,与MPV低值组(MPV8.8 fL)相比,MPV高值组(MPV≥8.8 fL)发生LVH的OR值(95%CI)为2.036(1.104～3.757)。结论 EH患者MPV升高,MPV可能与EH及LVH有关。     

中性-淋巴细胞比及简化肺栓塞严重指数在急性肺栓塞预后评估中的价值

目的探讨中性-淋巴细胞比(neutrophil-lymphocyte ratio,NLR)及简化肺栓塞严重指数(simplified pulmonary embolism severity index,s PESI)与急性肺栓塞(acute pulmonary embolism,APE)患者住院死亡率的相关性。方法回顾性调查安徽医科大学第一附属医院2005年1月至2016年12月住院确诊的APE患者329例,根据患者住院期间预后将其分为幸存组及死亡组。分析APE预后相关因素:年龄、性别、s PESI、NLR、血小板-淋巴细胞比(platelet-lymphocyte ratio,PLR)、白细胞、心肌肌钙蛋白Ⅰ、脑钠肽及C-反应蛋白。结果存活组与死亡组比较,NLR、PLR、s PESI、白细胞、中性粒细胞、淋巴细胞差异显著(P0.01)。多因素分析提示:s PESI(OR:2.595;95%CI:1.523-4.421)、NLR(OR:1.323;95%CI:1.098-1.595)是影响APE住院死亡率的独立危险因素。结论高NLR及s PESI与APE不良预后相关。     

血小板参数、血糖及血脂检测在2型糖尿病微血管病变防治中的临床意义

目的探讨血小板参数、血糖及血脂检测在2型糖尿病(T2DM)微血管病变防治中的临床意义。方法选择2013年1月至2015年1月来该院治疗的T2DM患者37例作为治疗组,同时选择33例健康体检者作为对照组,主要检测的指标包括血小板参数、血糖及血脂数据,其中血小板参数包括血小板计数(PLT)、平均血小板体积(MPV)以及血小板分布宽度(PDW),血糖则选择空腹血糖(FPG)作为监测指标,血脂指标选择低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、胆固醇(TC)、甘油三酯(TG)以及血尿酸(UA)等,主要对比两组治疗前后指标差异。结果治疗前,治疗组TG、TC、MPV、PDW、UA等指标高于对照组,PLT低于对照组(P0.05),其余指标对比无统计学意义(P0.05),治疗组接受治疗后,血脂水平得到改善,TG、TC、LDL-C及UA水平降低,HDL-C水平升高(P0.05);对治疗组治疗前指标进行双变量相关性分析显示,FPG、MPV呈正相关(r=0.24,P0.05),MPV、PDW呈正相关(r=0.31,P0.05),其他各项指标间无相关性;糖尿病微循环血管病变的主要危险因素为FPG(OR=7.658)、TG(OR=6.932)、TC(OR=6.841)、PDW(OR=4.324)(P0.05)。结论血小板及血脂参数在糖尿病患者存在异常是T2DM微血管病变的主要危险因素,对T2DM微血管病变的预防需要密切监测患者血小板参数和血脂变化。     

心源性脑栓塞的临床特点及抗栓治疗

目的探讨心源性脑栓塞患者的临床特点及不同抗栓治疗方案的预后。方法回顾性收集心源性脑栓塞患者208例,按是否因本次脑卒中3个月内死亡分为死亡组33例及存活组175例,比较2组基线资料及死亡相关危险因素。存活组中164例非瓣膜性心房颤动患者根据抗栓情况分为华法林组34例和抗血小板组130例,比较2组预后情况。结果死亡组双侧脑栓塞、单一大病灶梗死、入院美国国立卫生研究院卒中量表(NIHSS)评分、CHADS2、CHA2DS2-VASc、HAS-BLED评分明显高于存活组,左侧脑栓塞、小型分散病灶比例明显低于存活组,差异有统计学意义(P<0.05,P<0.01)。双侧脑栓塞(OR=2.570,95%CI:1.207~5.472,P=0.014)、单一大病灶梗死(OR=0.433,95%CI:0.242~0.774,P=0.005)和入院较高NIHSS评分(OR=1.179,95%CI:1.082~1.284,P=0.000)是心源性脑栓塞患者死亡的独立危险因素。华法林组1年内颅外出血发生率明显高于抗血小板组(P=0.042)。结论心源性脑栓塞患者死亡受多种因素影响,其中双侧脑栓塞、单一大病灶梗死和入院时较高NIHSS评分是心源性脑栓塞患者死亡的独立危险因素。     

血小板容积与先天性心脏病改良BT管道闭塞关系的研究

目的:平均血小板容积(MPV)和血小板分布宽度(PDW)是反应血小板激活功能的重要指标,本研究旨在评价MPV和PDW在改良Blalock-Taussing(BT)管道闭塞中的作用。方法:本研究共对比分析388例改良BT术患儿,包括闭塞组(OBS)11例和非闭塞组(N-OBS)377例,采用协方差分析比较两组间血小板计数(PC)、MPV、PDW差异。对BT管道直径、PC、MPV、PDW进行危险分层,使用Logistic回归评价BT管道闭塞的危险因素。结果:OBS组与N-OBS组间PC值差异无统计学意义[(221±28.4)vs.(198±69.1)×109/L,P0.05];OBS组与对照组相比,MPV和PDW都明显增高[(8±3.2)vs.(15±6.8)f L,(15±2.1)vs.(20±6.4)%,P0.05]。Logistic回归显示:与5mm管道相比,4mm管道不增加闭塞风险(OR=1.1,95%CI:0.82~1.43,P0.05);PC值不影响BT管道闭塞(P0.05)。MPV异常增高时,管道闭塞风险明显增加(OR=2.1,95%CI:1.47~2.49,P0.05);PDW异常增高时,管道闭塞风险明显增加(OR=2.4,95%CI:1.71~3.87,P0.05)。结论:MPV和PDW增高是影响改良BT术后管道闭塞的重要因素。     

早期平均血小板体积变化对脓毒症休克患者预后的预测价值

目的 探讨早期平均血小板体积(MPV)变化在脓毒症休克患者预后中的预测价值。方法 采用回顾性队列研究方法,选择2018年7月至2020年6月徐州医科大学附属医院重症医学科收治的符合脓毒症3.0诊断标准、年龄≥18周岁的脓毒症休克患者366例,根据28d预后分为生存组和死亡组,比较2组患者的一般资料、基线数据及确诊后5d的MPV、血小板计数(PLT)、血小板分布宽度(PDW)、大型血小板比率(P-LCR)和血小板压积(PCT)。采用SPSS 25.0软件进行数据分析。连续性正态分布的计量资料用均数±标准差(±s)表示,采用独立样本t检验;不符合正态分布的计量资料以中位数和四分位数[M(Q₁,Q₃)]表示,采用非参数检验;计数资料用例数(百分率)表示,采用χ²检验或Fisher确切概率法。结果 纳入患者202例,生存组患者100例,死亡组患者102例。死亡患者年龄更大,更易合并慢性肾脏病,急性生理与慢性健康状况评分Ⅱ(APACHE Ⅱ)及乳酸更高,凝血功能及肝肾功能更差,MPV、PDW、P-LCR更高,PLT、PCT更低,差异均有统计学意义(均P＜0.05);ROC曲线结果示,MPV的受试者工作特征曲线下面积(AUC)最大(AUC=0.92)。多因素回归分析示,MPV(OR=4.78,95%CI 2.75~8.31)、乳酸(OR=2.20,95%CI 1.23~3.93)、APACHE Ⅱ评分(OR=1.87,95%CI 1.41~2.48)、PCT(OR=0.88,95%CI 0.80~0.97)是28d预后的独立危险因素。基于多因素回归结果构建多参数模型,该模型对脓毒症休克28d预后有良好预测价值(AUC=0.98)。结论 MPV早期持续升高是脓毒症休克28d预后的独立危险因素,对脓毒症休克预后有较高的预测价值。     

血液感染后平均血小板体积变化与患者预后的相关性

目的观察血液感染(BSI)期间血小板指标的动态变化及平均血小板体积(MPV)与患者预后的相关性。方法回顾分析350例患者血培养阳性的临床资料,评价血小板指标的动态变化和BSI的临床特点,血小板指标检测分为5个时间段:发病前30~7 d(A期)、发病1 d内(B期)、发病后2~5 d(C期)、发病后6~10 d(D期)、发病后11~20 d(E期)。研究终点为30 d死亡率。结果 BSI患者中,BSI期间的平均血小板数量减低(P0.001);平均MPV水平增加(P0.001)。A期和B期之间非生存患者(n=25)MPV升高程度低于生存患者(P=0.006),B期和C期之间,非生存患者的MPV升高程度高于生存患者(P=0.03)。BSI后MPV升高是BSI的不良预后因素(OR 1.82;95%CI:1.00~3.32;P=0.027)。结论 BSI后的MPV水平变化可作为BSI的预后指标。     

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.