二氮嗪预处理对深低温停循环兔脑组织兴奋性氨基酸含量的影响

目的 :观察二氮嗪预处理对深低温停循环 (DHCA)兔脑组织兴奋性氨基酸 (EAA)含量的影响。方法 :大耳白兔 2 4只 ,随机分为 3组 ,每组 8只 :A组 (对照组 ) :DHCA 安慰剂组 ;B组 (实验组 ) :DHCA 二氮嗪 (5mg/kg ,CPB前 1 5min静脉注入 )组 ;C组 (二氮嗪拮抗剂组 ) :DHCA 5 HD (2 0mg/kg ,给予二氮嗪前静脉注入 ) 二氮嗪 (5mg/kg ,CPB前 1 5min静脉注入 )组。DHCA时间 6 0分钟。停机后取脑组织 ,氨基酸自动分析仪检测脑皮质中的谷氨酸 (Glu)和天冬氨酸 (Asp)的含量。结果 :B组脑组织Glu含量明显高于A组 (1 2 9 6± 2 4 3μg/ 1 0 0mgvs 87 0± 1 5 9μg/ 1 0 0mgP <0 0 1 )和C组 (1 2 9 6±2 4 3μg/ 1 0 0mgvs1 0 5 5± 1 0 7μg/ 1 0 0mgP <0 0 5 ) ;C组Glu含量与A组比无统计学意义。结论 :二氮嗪可抑制EAA的释放 ,可能是二氮嗪预处理的脑保护机制之一。     

乌司他丁联合平衡超滤术对体外循环术后患者肺功能的保护作用

将体外循环（CPB）心脏直视手术患者30例随机分成三组。对照组预充液中加入2780U抑肽酶；U组在对照组基础上加乌司他丁；U＋P组在U组基础上＋平衡超滤。设CPB前（T1）为基础值，比较CPB结束后10min（T2）、60min（13）、240min（T4）时肺顺应性（Cs）、动态肺顺应性（Cd）、呼吸指数（RI）的变化。结果与对照组比较，T2、T3时U＋P组RI值降低，Cs、Cd升高；U组Cd升高（P〈0．01、0．05）。与T1时比较，U、U＋P组RI值T2时高，对照组T2、T3时高（P〈0．01、0．05）；对照组Cs、Cd值T2、T3、T4时低（P〈0．01、0．05）；U组Cs值T2、T3时低，Cd值T2时低（P〈0．01、0．05）；U＋P组Cs、Cd值T2时低（P〈0．01、0．05）。提示乌司他丁＋平衡超滤技术对CPB术后的肺损伤有保护作用，其效果优于单用乌司他丁。     

紫外线照射充氧自体血灌注对体外循环心肌的保护作用

目的研究紫外线照射充氧自体血（UBIO）冠状动脉顺行灌注对体外循环（CPB）心肌的保护作用。方法将46例风湿性心脏病CPB下心瓣膜替换术患者随机分为观察组和对照组各23例，观察组于麻醉后经锁骨下静脉按10ml／kg体质量放血行紫外线照射充氧。升主动脉阻断后，将UBIO作为心停搏液行首次冠状动脉顺行灌注，之后每30min常规以4：1冷血／晶体灌注；对照组除不用UBIO灌注外，其他方法同观察组。结果观察组从转流结束到术后6h血清心肌肌钙蛋白I（cTnI）、肌酸激酶MB同工酶（CK—MB）明显低于对照组（P〈0．05）；开放升主动脉后，观察组冠状静脉窦血清cTnI、CK—MB水平和左心室心肌丙二醛（MDA）水平低于对照组（P〈0．05），左心室心肌超氧化物歧化酶（SOD）活性和ATP水平高于对照组（P〈0．05）。结论CPB过程中首次冠状动脉顺行灌注UBIO能降低心肌损伤标志物的水平，有较好的心肌保护作用。     

乌司他丁对心脏瓣膜置换术患者CPB中血浆TNF-α、IL-8、IL-10水平的影响

目的观察乌司他丁对体外循环（CPB）患者血浆中TNF-α、IL-8、IL-10水平的影响。方法选取心脏瓣膜置换手术患者50例,随机分为对照组和实验组,各25例。实验组在麻醉诱导后开始恒速静注乌司他丁6000U／kg（30min内输完）,然后以1000U／（kg·h）的速度持续静滴至手术结束;对照组不给予乌司他丁。分别于麻醉诱导前（T1）、CPB开始后1h（T2）及CPB停止后1（T3）、24（T4）h抽取动脉血,用ELISA法检测血浆TNF-α、IL-8、IL-10水平。结果T2-T4时两组血浆TNF-α、IL-8和IL-10水平与CPB前比较,P均〈0．05;T2-T4时实验组血浆TNF-α和IL-8水平明显低于对照组（P〈0．05）,IL-10水平明显高于对照组（P〈0．05）。结论乌司他丁能抑制CPB过程中TNF-α和IL-8释放,促进IL-10的释放,有效降低由CPB引发的炎症反应。     

大剂量乌司他丁在兔常温体外循环中对血小板的影响

目的观察兔常温体外循环（CPB）前应用大剂量乌司他丁对血小板数量和功能的影响。材料和方法20只大耳白兔随机分成2组：乌司他丁组（U组，n=10）和对照组（C组，n=10）。U组在CPB前给予乌司他丁10×10^4U／kg，C组给予等量生理盐水，CPB30min，流量为180—300ml／min，肛温维持在36．5～37．5℃。分别记录CPB前、停机、停机后1h、2h和3h的血流动力学指标，测定血小板计数、血小板粘附率（PAR）和血小板膜糖蛋白GPⅠb、GPⅡb、GPⅢa的分子数。结果CPB后各时间点两组血小板计数较CPB前显著减少（P〈0．01），同时间点两组间无统计学差异（P〉0．05）。CPB后两组PAR较CPB前显著下降（P〈0．01），同时间点C组PAR下降较U组更明显（P〈0．05）。CPB后两组GpⅠb、GpⅡb、GpⅢa分子数较CPB前显著减少（P〈0．01），停机后逐步恢复，同时间点C组较U组更明显（P〈0．05）。结论CPB后血小板数目减少，膜糖蛋白分子数降低，粘附能力下降。CPB前应用大剂量乌司他丁可减少CPB中血小板膜糖蛋白受体的分解，保护血小板功能。     

紫外线照射充氧自体血心脏停搏液对体外循环中心肌保护作用的研究

目的 研究紫外线照射充氧自体血（UBIO）心脏停搏液冠状动脉间断顺行灌注对体外循环（CPB）中心肌的保护作用。方法 将20只健康成年杂种犬（雌雄不拘）随机分为实验组和对照组，每组10只。CPB中实验组采用紫外线照射充氧自体血心脏停搏液问断灌注;对照组用等量4℃St．Thomas Ⅰ号冷晶体液作为心脏停搏液间断灌注，两组其余操作相同。结果 开放升主动脉后，实验组冠状静脉宴血清cTnI、CK-MB水平和左心室心肌MDA水平低于对照组（P〈0．05），左心室心肌SOD活性和ATP水平高于对照组（P〈0．05）;心脏自动复跳率明显高于对照组（P〈0．01）。心肌超微结构观察显示，实验组左心室心肌纤维结构完整，细胞内线粒体轻度水肿，而对照组心肌纤维部分断裂、溶解，线粒体基质外溢，糖原颗粒减少。结论 UBIO血心脏停搏液有较好的心肌保护作用，且能减少心脏停搏液的灌注次数，延长心脏停搏时间;本研究为UBIO血心脏停搏液的临床应用奠定了基础。     

钙离子拮抗剂对肝硬化患者门脉血流量影响的观察

目的观察钙离子拮抗剂对肝硬化患者门脉血流量的影响。方法选择90例乙型肝炎肝硬化门脉高压症患者．随机分为三组，分别给予维生索c（安慰剂组．n=32）、汉防已甲素（对照组，n=26）和硫氮卓酮联合尼卡地平（治疗组，n=32）治疗4周。采用彩色多普勒超声仪分别测定给药前及绐药4周后患者门静脉和脾静脉的血流量。结果安慰剂组治疗前后门静脉血流量（771．19±200．47对772．34±201．94ml／min）和脾静脉血流量（334．52±141．26对329．39±132．33ml／min）变化差异无统计学意义（P〉0．05）；对照组治疗前后门静脉血流量（769．96±208．7l对591．74±162．23ml／min）和脾静脉血流量（329．37±121．95对295．44±123．09ml／min）变化差异有显著意义（P〈0．05）；治疗组治疗前后门静脉血流量（778．37±210．41对604．29±170．37）和脾静脉血流量（336．40±162．56对301．65±145．94ml／min）相差具统计学意义（P〈0．05）。结论硫氮卓酮与尼卡地平合用可有效地降低肝硬化患者门脉血流量，预防上消化道出血。     

脂糖舒对糖尿病大鼠血液T淋巴细胞亚群和免疫器官系数的影响

目的探讨脂糖舒对糖尿病大鼠血液T淋巴细胞亚群和免疫器官系数的影响。方法采用链脲霉素30mg／kg腹腔注射1次／3d制备糖尿病大鼠模型．用不同剂量脂糖舒0．5g／kg或1．0g／kg和二甲双胍156．25mg／kg灌胃8周；另取健康大鼠作正常对照。应用流氏细胞仪检测血液T淋巴细胞亚群CD3^＋、CD3^＋／CD4^＋及CD3^＋／CD8^＋的百分率。计算CD4^＋／CD8^＋产比值；然后称体重，处死大鼠，取出胸腺和脾脏称重，计算胸腺和脾脏器官系数。结果①模型组CD3^＋、CD3^＋／CD4^＋和CD3^＋／CD5^＋及体重、胸腺系数和脾系数均显著低于正常组（P〈0．01），比值显著高于正常组（P〈0．05）；②脂糖舒-Ⅱ组与模型组比较，除CD4^＋／CD8^＋比值无显著性差异〉0．05）外。其余指标均显著升高（P〈0．05）；二甲双胍组的脾系数和CD4^＋／CD8^＋比值与模型组无显著性差异（P〉0．05），其余指标显著升高（P〈0．05）；③与二甲双胍组比较，脂糖舒-Ⅱ组的体重和胸腺系数显著升高（P〈0．05），其余指标无差异（P〉0．05）；④与脂糖舒-Ⅰ组比较，脂糖舒-Ⅱ组仅胸腺系数显著升高（P〈0．05），其余指标无差异（P〉0．05）。结论大剂量脂糖舒具有明显的增强糖尿病大鼠细胞免疫作用。     

银杏叶提取物对体外循环脑损伤的干预作用

目的探讨体外循环（CPB）脑损伤的发生机制及银杏叶提取物（GBE）的干预作用。方法选择44例需CPB下手术的风湿性心脏瓣膜病患者,随机分为观察组和对照组各22例。观察组在CPB预充液中加入GBE（2mg／kg体质量）,对照组应用常规预充液。分别在术前、主动脉阻断后1h、术后6、12、24、48h抽取静脉血标本,检测血清IL-10、IL-18和S100蛋白水平。结果观察组血清IL-10在术后6h开始升高,至术后48h达高峰,且显著高于对照组（P〈0．05）。观察组血清IL-18主动脉阻断1h高于对照组（P〈0．05）,但术后6、12、24、48h显著低于对照组（P均〈0．05）。对照组S100蛋白自CPB结束开始升高,持续至实验结束;自主动脉阻断1h开始至术后48h血清S100蛋白水平对照组均显著高于观察组（P均〈0．05）。结论CPB心脏直视手术细胞因子IL-18参与脑组织损伤过程,GBE可调节细胞因子,显著减轻CPB引起的脑损伤。     

乌司他丁和地塞米松对心肺脑复苏早期大鼠脑组织含水量及IL-1β水平等的影响

目的探讨乌司他丁、地塞米松以及两者联合应用对心肺脑复苏早期大鼠脑组织含水量及脑组织IL-1β、外周血肿瘤坏死因子α（TNF-α）含量的影响。方法将40只SD大鼠随机分为假手术对照组、心肺脑复苏（CPCR）组、地塞米松组、乌司他丁组、乌司他丁＋地塞米松组，每组各8只大鼠。采用夹闭气管法建立大鼠心肺脑复苏模型。于自主呼吸循环恢复后2h，采用干湿法检测各组大鼠脑组织含水量，采用放射免疫法检测大鼠脑组织IL-1β和外周血TNF-α水平。结果①脑组织含水量：CPCR组为（80．4±2．0）％，较对照组（76．7±1．3）％显著增加（P〈0．01）；乌司他丁组、地塞米松组、乌司他丁＋地塞米松组，3组间差异无统计学意义（P〉0．05），但均较CPCR组显著减少（P〈0．01）。②脑组织IL-1β含量：CPCR组为（0．235±0．051）ng／mg，较对照组（0．108±0．020）ng／mg明显增高（P〈0．01）；地塞米松组、乌司他丁组与CPCR组比较，差异无统计学意义；乌司他丁＋地塞米松组IL-1β含量为（Q（365±Q021）ng／mg，明显低于CPCR组（0．235±0．051）ng／mg（P〈0．001）。③外周血TNF-α水平：CPCR组为（3．07±0．74）ng／ml，较对照组（1．03±0．51）ng／ml明显增高（P〈0．01）；乌司他丁组、地塞米松组、乌司他丁＋地塞米松组均比CPCR组显著降低（P〈0．01），但3组间差异无统计学意义（P〉0．05）。结论CPCR早期即可发生脑水肿，脑组织IL-1β及外周血TNF-α水平显著增加；应用乌司他丁、地塞米松能有效降低脑组织含水量、IL-1β和外周血中TNF-α水平。     

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.