缬沙坦对慢性充血性心衰患者内皮功能及心功能的影响

用缬沙坦治疗慢性充血性心力衰竭（CHF）患者132例,比较其治疗前后一氧化氮（NO）、内皮素（ET）、血管紧张素Ⅱ（AngⅡ）、内皮依赖性血管舒张功能（FDM）及心功能变化。治疗后患者NO上升,ET及AngⅡ下降,FDM及心功能明显改善（P均〈0．01,〈0．05）。提示缬沙坦可明显改善CHF患者的内皮功能及心功能。     

硝苯地平控释片改善血管内皮功能的探讨

目的 :通过对原发性高血压患者的肱动脉超声及血管肽的测定探讨硝苯地平控释片 (拜新同 )改善内皮功能的机制。方法 :将 40例原发性高血压患者分为硝苯地平控释片组 (n =2 0 )及美托洛尔组 (n =2 0 )进行比较 ,均治疗 8周 ,并将 2 0例正常健康人作为对照 (正常对照组 )。采用肱动脉超声的方法进行血管内皮依赖性舒张功能的判断及放射免疫分析法进行治疗前、后的血管活性肽肾上腺髓质素 (ADM )、一氧化氮 (NO)、内皮素 1(ET 1)及血管紧张素Ⅱ (AngⅡ )的测定。结果 :①两组药物治疗后与治疗前比较血压均明显降低 ,有非常显著性差异 (P <0 .0 1)。②硝苯地平控释片组治疗后发现血流介导的肱动脉内径扩张率增加 11.2 % ,肱动脉血流速度增加 18.4ml/min ,血浆ADM、NO明显增加 ,AngⅡ降低 ,与治疗前比较均有显著性差异 (P <0 .0 5 ) ,而美托洛尔组无此变化。结论 :硝苯地平控释片可能通过促进血管内皮细胞对ADM的分泌及释放 ,介导了NO浓度的增高 ,从而改善了原发性高血压患者的内皮功能。     

降压药拜新同改善血管内皮功能的探讨

目的 探讨硝苯地平控释片(拜新同)改善内皮功能的机制。方法 对20例高血压患者进行拜新同8周治疗,并与15例倍他乐克进行比较,采用肱动脉超声方法判断内皮舒张功能,放射免疫分析法(RIA)测定治疗前、后血管活性肽肾上腺髓质素(ADM)、内皮素-1(ET-1)及血管紧张素Ⅱ(AngⅡ)。用硝酸还原酶比色法测定一氧化氮(NO)。结果 两组药物治疗后血压均比治疗前明显降低,P<0.01。拜新同治疗组治疗后血流介导的肱动脉扩张率△D增加10.2%,肱动脉血流速度增加18.4ml/min。ADM、NO明显增加,AngⅡ降低,与治疗前比较P<0.05,而倍他乐克组无此变化。结论 拜新同可能通过促进血管内皮细胞和平滑肌细胞对肾上腺髓质素的分泌及释放,介导了NO浓度增多,从而改善了高血压患者的内皮功能。     

女性甲减患者甲状腺素治疗改善内皮细胞依赖性血管舒张功能

目的　观察甲状腺功能减退症(甲减)患者甲状腺激素补充治疗后内皮依赖性血管舒张功能的变化。方法　选择初诊的女性临床甲减患者33例、亚临床甲减患者25例及正常健康女性25名。采用高分辨血管外超声法检测肱动脉血流介导的内皮依赖性血管舒张功能和硝酸甘油(GNT)介导的非内皮依赖性血管舒张功能。结果　(1)与对照组比较,临床甲减组和亚临床甲减组治疗前TSH、脂蛋白(a)〔L(a)〕、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL C)水平明显升高,血流介导的血管舒张功能降低(均<0. 05)。(2)与治疗前比较,临床甲减组和亚临床甲减组TSH、Lp(a)、LDL C、载脂蛋白B水平明显降低;血流介导的血管舒张功能明显升高(均P<0. 05)。(3)临床甲减组和亚临床甲减组治疗前后TSH、Lp(a)LDL C的变化与血流介导的血管舒张功能呈负相关(均P<0. 05)。结论　甲减患者内皮依赖性血管舒张功能降低,甲状腺激素补充治疗可改善内皮功能。     

L-精氨酸对心力衰竭患者血管内皮功能的影响

目的 :评价L 精氨酸对心力衰竭 (心衰 )患者血管内皮功能的影响。方法 :应用高分辨率超声诊断仪 ,评估 40例心衰患者和 3 0例健康者 (正常对照组 )的内皮依赖性血管舒张功能和非内皮依赖性血管舒张功能 ,并测定血浆一氧化氮、内皮素 1(ET 1)浓度。 40例心衰患者被随机分为 2组 ,每组 2 0例 ,分别予以 2 0 %L 精氨酸注射液 10 0ml(L 精氨酸治疗组 )和 5 %葡萄糖注射液 10 0ml(安慰剂组 ) ,均在 60min内恒速静脉滴注。随即再次评估内皮依赖性血管舒张功能和非内皮依赖性血管舒张功能 ,同时复测血浆一氧化氮和ET 1浓度。结果 :与正常对照组相比 ,心衰患者内皮依赖性血管舒张功能显著受损 (P <0 0 1) ,非内皮依赖性血管舒张功能无明显变化 (P >0 0 5 )。血浆一氧化氮浓度下降 ,ET 1浓度上升 (P均 <0 0 1)。L 精氨酸治疗组内皮依赖性血管舒张功能得到明显改善 (P <0 0 5 ) ,非内皮依赖性血管舒张功能无变化 (P >0 0 5 ) ,血浆一氧化氮浓度升高 ,ET 1浓度下降 (P均 <0 0 5 )。而安慰剂组均无显著变化 (P >0 0 5 )。结论 :L 精氨酸能改善心衰患者血管内皮功能。     

卡维地洛对急性心肌梗死患者内皮功能及氧化指标的影响

目的观察卡维地洛对急性心肌梗死(AMI)患者血管内皮依赖性舒张功能及血清氧化指标——丙二醛(MDA)的影响。方法将52例AMI患者随机分成卡维地洛治疗组(28例)和常规治疗组(24例),比较观测治疗8周前后超声检测肱动脉流量介导性扩张的血管内皮依赖舒张功能及血清MDA的变化。结果治疗前两组比较,内皮依赖性血管舒张功能差异无统计学意义;卡维地洛治疗8周后内皮依赖性血管舒张功能明显改善;血清MDA水平明显降低,与治疗前比较,差异均有统计学意义(P<0.05或P<0.01)。结论卡维地洛在治疗8周后通过降低血清MDA水平的抗氧自由作用,可明显改善AMI患者血管内皮依赖舒张功能。     

伴及不伴睡眠呼吸暂停的高血压患者内皮功能

目的探讨伴及不伴睡眠呼吸暂停(OSA)高血压患者的内皮功能。方法纳入阴虚阳亢型轻中度高血压患者90例,对患者行便携式睡眠仪监测、24 h动态血压(ABPM)监测,内皮依赖性血管舒张功能(FMD)以及内皮相关指标〔一氧化氮/内皮素-1(NO/ET-1)和肾素-血管经张素-醛固酮系统(PRA、AngⅡ、ALD)〕检测。采用多元逐步回归法分析OSA和血压及内皮功能的关系。结果和不伴OSA的高血压患者相比,伴OSA患者FMD%、NO、NO/ET明显降低(P<0.05),ET-1、PRA、AngⅡ、ALD明显增高(P<0.05);其中PRA、AngⅡ和AHⅠ呈正相关,NO/ET与AHI呈负相关(P<0.05)。结论与不伴OSA患者相比,伴OSA的轻中度高血压患者的内皮损伤更为严重。     

糖耐量减低患者联合干预治疗前后内皮依赖性血管舒张功能的变化

目的为了探讨糖耐量减低(IGT)患者联合干预治疗前后内皮功能的变化。方法选择28例IGT患者,和年龄、性别匹配的健康个体25人。IGT患者采用控制饮食、规则的有氧运动及口服二甲双胍联合干预治疗12周。采用高分辨血管外超声法检测肱动脉内皮依赖性血管舒张功能和内皮非依赖性血管舒张功能。结果IGT患者干预治疗前内皮依赖性血管舒张功能为3.50%,明显低于对照组的4.68%(P<0.05)。多元逐步回归分析结果显示,内皮依赖性血管舒张功能与年龄、LDL-C、Lp(a)、HbA1c、FPG及2hPG呈负相关(P<0.001)。经联合干预治疗12周后,内皮依赖性血管舒张功能明显增高,达到4.17%,明显高于IGT患者干预治疗前(P<0.05)。Spearman分析结果显示,治疗前后内皮依赖性血管舒张功能的变化与FBG、2hBG、LDL-C、HbA1c的变化呈负相关(P<0.05)。结论IGT患者内皮依赖性血管舒张功能降低。联合干预治疗可改善血管内皮功能。     

X综合征患者血管内分泌功能和内皮依赖性舒张功能障碍的研究

的 :研究内皮依赖性舒张功能障碍在X综合征患者发病中的意义。方法 :对 18例X综合征患者和 2 0例正常对照者 ,采用高分辨多普勒超声测定肱动脉基础、反应性充血和舌下含服硝酸甘油后血管舒张末期内径变化。并测定血浆内皮素 (ET)、一氧化氮 (NO)含量。结果 :1 X综合征患者肱动脉血流介导的血管扩张较对照组明显减弱 ,含服硝酸甘油后血管明显扩张 ,但 2组无显著差异。2 X综合征组较对照组ET水平显著升高 ,NO水平显著降低。 3 肱动脉血流介导的血管扩张与血浆ET水平呈显著负相关 ,与NO水平呈显著正相关。结论 :X综合征患者存在血管内分泌功能紊乱、内皮依赖性舒张功能障碍 ,后者与内皮源性松弛因子减少有关。     

阿托伐他汀对高血压患者血管内皮功能的影响

目的探讨高血压患者应用阿托伐他汀治疗后对血管内皮舒张功能、C反应蛋白(CRP)、纤维蛋白原(FIB)、内皮素(ET)的影响。方法137例高血压患者随机分成阿托伐他汀治疗组(阿托伐他汀10mg/dqd,观察组69例)及常规治疗组(对照组68例),比较治疗12周前后应用超声检测肱动脉流量介导性扩张的血管内皮舒张功能及C反应蛋白(CRP)、纤维蛋白原(FIB)、内皮素(ET)水平的变化。结果观察组和对照组治疗前与治疗12周后比较,血管内皮舒张功能均有显著改善(P<0.01和P<0.05);治疗后两组间比较,血管内皮舒张功能(FMD:7.95±0.87vs5.20±0.82;GTN:12.12±5.11vs10.38±5.10)及C反应蛋白(CRP:3.14±0.53vs7.42±0.42)、纤维蛋白原(FIB:236±103vs402±112)、内皮素(ET:3.41±1.94vs4.51±2.70)水平有显著差异(P<0.05)。结论高血压患者应用阿托伐他汀治疗12周后可进一步改善内皮依赖性血管舒张功能,同时可减轻炎症反应,纤溶活性及血浆内皮素均有不同程度的改善。     

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.