硝苯地平和比索洛尔治疗原发性高血压前后左室舒张功能的探讨

对原发性高血压患 肖苯地平和比索洛尔，与正常血压组进行比较，高血压组比正常血压组舒张早期时间ⅡＡ－ＤⅡＡ－ＭＶＤ间期延长，左室充盈波Ａ增高，Ａ／Ｒ比增加。硝苯地平使高血压组舒张功能改善缩短。比索洛尔使高血压组ＭＶＯ－Ｄ间期延长，Ａ波振幅降低，改善左舒张功能。     

脉冲多普勒超声心动检测肺静脉血流与左室舒张压的相关性研究

研究经胸脉冲式多普勒超声心动图所检测的肺静脉血流与左室舒张压的相关性。对35例患者的超声心动图及左室造影进行观察，分析肺静脉血流与二尖瓣血流频谱所获指标与左室舒张庄关系。静脉血流A波间期和二尖瓣血流A波间期之差（d－dif）与左室舒张末压呈显著正相关性（r＝0．5658，P＜0．001），以d－dif判断左室舒张功能不全（LVEDP＞15mmHg）的敏感性为75．0％，特异性为86．7％。d－dif与Pre－A和LVa亦具有正相关性（P＜0．01）。d－dif是一项能够较为准确地反映左室舒张压变化的指标。     

比索洛尔对高血压患者异常血压昼夜节律及心功能的影响

56例高血压患者治疗前行超声心动图及动态血压检测并与比索洛尔治疗后12周复查结果进行比较。结果56患者治疗后诊所血压与动态血压各参数均有明显改善，治疗前后比较差异有显著统计学意义（P均〈0．01）。56例治疗后异常血压昼夜节律者中37例恢复正常昼夜节律（66．1％），其左室舒张功能明显改善；未恢复正常血压昼夜节律的19例患者左室功能无改善。认为比索洛尔在有效降压的同时能明显改善患者血压昼夜节律及左室舒张功能。     

比索洛尔和美托洛尔的降压疗效及安全性对比

目的：对比观察国产比索洛尔（博苏）和美托洛尔（倍他洛克）治疗轻、中度高血压患者的临床疗效与安全性。方法：46例轻、中度高血压患者随机分成比索洛尔和美托洛尔两组，分别每日口服1次比索洛尔及2次美托洛尔，治疗8周，并用24小时动态血压监测评价用药前及用药8周后24小时血压变化情况。结果：服药第8周降压总有效率比索洛尔组91．3％，美托洛尔组73．9％，与用药前相比两组治疗后的收缩压及舒张压均显著降低，但比索洛尔组优于美托洛尔组（P〈0．05），且副作用少（P〈0．01），对血脂、血糖无影响。结论：国产比索洛尔降低轻、中度高血压患者的血压，安全有效，并优于美托洛尔。     

DTI技术评价卡维地洛对高血压左室舒张功能的影响

目的 评价卡维地洛对高血压左室舒张功能（LVDF）的影响。方法 采用多普勒组织成像（DTI）技术分析正常人和轻中度高血压左室肥厚组（LVH组）和非左室肥厚组（非LVH组）患者的二尖瓣环的舒张早期，晚期运动速率（Ea,Aa)，并与血流多普勒法检测的二尖瓣口舒张早期，晚期最大速度（E，A）比较，对E／A和Ea/As均＜1者给予卡维地洛（10－20mg／日）治疗12周，观察降压疗效及LVDF的变化。结果 1．高血压组Ea,Ea/As,E,E/A较正常组明显降低，A值明显升高（P＜0．01），而Aa值二组间无差异。EA,Ea/As在LVH组比非LVH组进一步降低（P＜0．05），而E，E／A二组间无差异（P＞0．05）。2 卡维地洛作用 用药12周后，SBP，DBP明显降低（P＜0．01），心率无明显变化。Ea,Ea/As及E，E／A升高，非LVH组A值降低（P＜0．05），LVH组A值无明显变化。结论 DTI技术可较血流多普勒法更敏感准确地反映严重LVDF受损患者的左室舒张功能。卡维地洛对轻中工高血压病具有良好降压作用并能改善左室舒张功能。     

卡维地洛与复方降压片对老年高血压病及其左室舒张功能的疗效

目的：观察卡维地洛与复方降压片治疗老年高血压病的疗效及其对左室舒张功能的影响。方法：高血压病62例，年龄60－81岁，采用随机单盲法被分为2组，其中30例作为A组应用卡维地洛片；32例为B组内服复方降压片。两组均连续用药8周，治疗前，后用多普勒超声心动图进行左室舒张功能观察。结果：降压疗效总有效率A组为86．7％，B组为83．8％，两组比较无显差异（P＞0．05），左室舒张功能各指标（E，A，E／A，DC）在A组用药前后比较差异非常显（P＜0．01），B组亦有显性差异（P＜0．05），两组比较，A组舒张功能各指标改善程度优于B组（P＜0．05）。结论：两药均能有效降低血压，但改善左室舒张功能的作用卡维地洛优于复方降压片，且不良反应少。     

卡维地洛与福辛普利对原发性高血压患者左室舒张功能影响的比较

目的 对比探讨卡维地洛与福辛普利对原发性高血压患者左室舒张功能的影响。方法 91例经多普勒超声心动图证实有舒张功能不全的原发性高血压患者，随机分为卡维地洛组45例与福辛普利组46例。治疗半年，经多普勒超声心动图测定患者治疗前后E峰、A峰、E／A比值、E峰下降时间（EDT）、左搴等容舒张时间（IVRT）。测定、计算治疗前后患者的肺静脉血流图：S／D波幅比值、S／D时间比值。AR波幅及AR波时间。结果 卡维地洛及福辛普利能明显升高E峰、E／A比值（P〈0．01），明显降低A峰（P〈0．01）。卡维地洛较福辛普利E／A升高显著（P〈0．01）。两者均能降低EDT（P〈0．05）。卡维地洛较福辛普利作用略强（P〈0．05）。两者都能降低IVRT（P〈0．05），而且作用相似（P〉0．05）。睁维地洛与福辛普利对S／D波幅比值影响虽均不显著（P〉0．05），但可明显降低S／D时间比值（P〈0．01），且作用近似（P〉0．05）。卡维地洛与福辛普利则可显著降低AR波幅及时间（P〈0．01）。两组降低AR波幅作用亦甚相似（P〉0．05）。结论 卡维地洛及福辛普利均可改善原发性高血压患者左室舒张功能，而卡维地洛作用略优。     

高血压脂代谢异常与高胰岛素血症的关系

对35例原发性高血压患者的血糖（BG）、血清胰岛素S）、C-肽（CP）和血脂测定结果与12例正常血压者进行比较分析。高血压组与正常血压组血糖均在正常范围。血清IS以高血压组明显增高（P＜0．01）。胰岛素释放指数亦以高血压组为高（P＜0．05）。高血压组HDL／LDL、ApoA／ApoB均明显低于正常血压组（P＜0．01）；前者血清IS水平与ApoA／ApoB比值呈显著负相关（r=-0．409，P＜0．01），血清胰岛素释放指数（IS／BG）与ApoA／ApoB比值也呈明显负相关（r=－0.298．P＜0．05）。     

氨氯地平、比索洛尔对高血压合并心绞痛患者中心动脉压、颈动脉内膜-中层厚度的影响

目的：比较氨氯地平、比索洛尔对高血压合并心绞痛患者中心动脉压（ CAP ）及颈动脉内膜—中层厚度（ IMT）的影响。方法选择高血压合并心绞痛患者50例,随机分为氨氯地平组、比索洛尔组,每组25例。氨氯地平组口服氨氯地平5 mg／d、比索洛尔组口服比索洛尔2．5 mg,1次／d,坚持治疗1年。分别于治疗前、治疗1年后检测两组CAP、IMT。结果两组治疗后外周动脉压均明显降低（P均＜0．05）,且氨氯地平组降低效果更明显（P均＜0．05）;氨氯地平组治疗后CAP、IMT明显降低（P均＜0．05）,而比索洛尔组无明显变化（P均＞0．05）。结论氨氯地平、比索洛尔降低外周动脉压程度方面相似;在降低CAP、IMT方面,氨氯地平效果更好。     

美托洛尔对高血压患者左室肥厚及心功能的影响

对高血压病患者54例应用美托洛尔口服，血压稳定后改为维持量随访观察治疗3～4个月，HR，SBP，DBP，MAP及TPR均降低（P＜0．01），总有效率为87％；左室形态结构指标（LAD，LVD，LVMI）显著改善（P＜0．05～0．01）；左室舒张功能指标（A，E，A／E，PFR及NPFR）显著改善（P＜0．05）；左室收缩功能指标（SV，EF及CO）无变化（P＞0．05）。     

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.