老年慢性心力衰竭β受体阻滞剂治疗的1年随访

目的：探讨老年慢性心力衰竭（CHF）患β受体阻滞剂治疗随访1年的疗效。方法：CHF住院老年患78例，随机分为对照组和β受体阻滞剂组，出院后随访1年。结果：β受体阻滞剂组与对照组随访1年期内心血管病死亡、心力衰竭恶化、心痛分级（Ⅲ-Ⅳ级）比较差异显（P＜0．05）。β受体阻滞剂组运动耐量和生活自理能力与对照组比较统计学上差异亦显（P＜0．05）。结论：长期应用小剂量β受体阻滞剂能够降低老年CHF患的心血管病死亡率（包括猝死），心力衰竭恶化率，可缓解心绞痛症状，提高运动耐量和改善生活质量。     

老年男性骨质疏松症与血清雌二醇及睾酮关系的研究

目的探讨老年男性骨质疏松症（OP）与血清雌二醇及睾酮的关系。方法采用双能X线法检测189例老年男性骨密度,分别检测雌二醇（E2）、睾酮（T）、降钙素（CT）、25羟维生素D（25-OH—VitD）、甲状旁腺素（PTH）、钙（Ca）、磷（P）及碱性磷酸酶（ALP）的指标。结果OP组的血清E2、CT及25-OH—VitD水平均低于骨量正常组（P〈0．05）,PTH高于骨量正常组（P〈0．05）,两组的血清T水平差异无统计学意义（P〉0．05）,OP组70～90岁及≥80岁两组的血清E2水平均低于60～69岁组（P〈0．05）,三组的血清T水平呈下降趋势,但差异无统计学意义（P〉0．05）,OP组血清E2水平与骨密度呈正相关（P〈0．05）。结论血清E2水平与老年男性OP密切相关,应重视E2对老年男性OP的预警作用。     

男性类风湿关节炎患者的血清性激素水平测定及其临床意义

采用放射免疫法检测34例男性类风湿关节炎（RA）患者（RA组）的血清雌二醇（E2），睾酮（T），硫酸脱氢表雄酮（DHEAS）水平，并与30例健康男性（对照组）作对照。结果发现患者血清T，DHEAS水平明显低于正常对照组（P＜0．05，P＜0．001），而E2水平虽低于对照组，但无显著差异（P＞0．05），提示雄激素减低在男性RA的发病中起一定的作用。     

2型糖尿病并发冠心病的血脂水平变化

目的；研究2型糖尿病合并冠心病（CHD）患血脂水平的变化。方法：采用美国贝克曼全自动生化分析仪对门诊的60例2型糖尿病无CHD患（I组），37例2型糖尿病合并CHD患（Ⅱ组）及72例正常对照组（Ⅲ组）进行系列血脂指标的测定。结果：I组TC、TG、LDL－C、ApoA、ApoB水平显高于对照组（P＜0．05－＜0．01）；Ⅱ组TC、TG、ApoB水平显高于对照组（P＜0．05－＜0．01）；I、Ⅱ两组之间的HDL－C水平存在显性差异（P＜0．05）。Ⅱ组的TG／HDL－C比值显高于I组和对照组（P＜0．05）。结论：2型糖尿病无CHD患与2型糖尿病合并CHD患之间的脂质代谢紊乱有所不同，HDL－C水平降低，TG／HDL－C比值异常升高，可能是糖尿病患发生CHD的易患因素。     

北京健康人群睾酮和雌二醇水平及其增龄性变化

目的 调查北京地区各年龄段健康人群血清睾酮及雌二醇水平，分析其与增龄的相关性。方法用放免法测定血清样本睾酮及雌二醇浓度。结果 北京地区60～69及70-79岁二组男性健康人群血清睾酮水平显著低于青、中年人群（P〈0．05）；女性健康人群血清睾酮水平分别在30-39及60-69岁二个年龄段呈快速下降，而在30-59岁年龄区间呈相对稳定；北京地区50-59岁及60-69岁二组健康女性血清雌二醇水平显著低于20～49年龄段人群；血清睾酮及雌二醇水平与增龄间均无显著直线相关（r〉-0．975）。结论 北京地区健康人群血清睾酮及雌二醇亦平随增龄呈规律性下降，但不适宜作为人群增龄或老化的生物学指征。     

慢性心力衰竭患者血清铁蛋白的测定及其临床意义

目的：探讨慢性心力衰竭患血清铁蛋白的变化及其临床意义。方法：采用放射免疫法测定110例慢性心力衰竭患血清铁蛋白（SF）水平,并与25例健康组相对照。结果：慢性心力衰竭患SF显高于对照组（P＜0．05）,其中合并感染组显高于无感染组（P＜0．01）,合并心脏恶液质综合征显低于无该合并症,随心力衰竭的加重,I,II,Ⅲ度心力衰竭组间SF依次显递减（P＜0．01）。结论：对慢性心力衰竭患进行SF的监测,有助于对疾病严重程度和预后的判断。     

2型糖尿病患者的脂代谢紊乱及其与冠心病的关系

目的：探讨2型糖尿病患脂代谢紊乱与并发冠心病（CHD）的关系。方法：56例2型糖尿病（DM）患（其中32例并发冠心病），测定其血脂、载脂蛋白浓度及血糖、胰岛素水平，与30例例健康人比较。结果：与对照组比较，2型DM并发CHD患高密度脂蛋白胆固醇（HDL－C）水平降低（P＜0．005），低密度脂蛋白胆固醇（LDL－C）及载脂蛋白B（ApoB)水平升高（P＜0．05）。单纯2型DM组仅有HDL－C水平的降低（P＜0．005）及LDL－C水平的升高（P＜0．05），无ApoB的变化，单纯DM及DM＋CHD组血糖及胰岛素水平无显差别，但均较对照组升高非常显（P＜0．005）；DM＋CHD组的ApoB水平较单纯DM组的显升高（P＜0．05）。结论：本组结果提示HDL－C水平的降低，LDL－C及ApoB水平的升高是2型DM并发冠心病的重要危险因素。     

美托洛尔在慢性心力衰竭中的应用及其对心率变异性的影响

目的：探讨酒石酸美托洛尔对慢性充血性心力衰竭（CHF）患心功能及心率变异性（HRV）的影响。方法：60例患,随机分为两组,在强心,利尿,扩血管治疗的同时,治疗组从小剂量开始加服美托洛尔,缓慢增加剂量。结果：治疗3周后E／A值明显增加（P＜0．05）,治疗6周后E／A值及LVEF值均增加（P＜0．05）,治疗前,后两组的HRV时域值差异显（P＜0．05）,且随访20周内,治疗组的死亡率,再住院率均少于对照组（P＜0．05）,结论：在常规治疗的基础上,联合应用小剂美托洛尔治疗CHF,可增强疗效,提高HRV,改善预后。     

血栓通与普伐他汀治疗高脂血症患者的临床研究

目的：研究并比较血栓通与普伐他汀对高脂血症患的疗效。方法：选择90例符合1997年中华心血管病学会提出的中国人的血脂异常防治建议诊断标准的高脂血症患，分为两组；观察组（n=60,采用血栓通）；对照组（n=30,采用普伐他汀），疗程均为4周，分别检测血脂水平变化。结果：两组治疗后血清TC，LDL－C和TG水平均显下降（P＜0．01），HDL－C水平也有较明显升高（P＜0．01），但观察组与对照组比较，无显性差异（P＞0．05）。结论：血栓通治疗高脂血症有明显效果，有广泛前景。     

血脂和雌性激素水平与胆囊结石的关系

目的探讨血脂和雌性激素水平与胆囊结石的关系方法选择经B超、手术证实的胆囊结石患者104例（A组）进行血清雌二醇（EZ）、孕酮（P）、总胆固醇（TC）、甘油三酯（TG）测定，并与54例（B组）健康人进行对比分析．结果男性A组E2，P水平明显高于B组（P＜0．05～0．01），女性育龄期E2水平A,B两组相比差异无显著性（P＞0．05），P高于B组（P＜0．01）．绝经期A组E2，P均高于B组（P＜0．01），女性两组E2／P比值A组均显著低于B组（P＜0．01）.而血清TG，TC及TG／TC比值在男女性A组均高于B组（P＜0．01）。结论胆囊结石患者存在雌性激素及脂类代谢紊乱．     

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.