缬沙坦联用养血清脑颗粒治疗原发性高血压60例疗效观察

目的观察缬沙坦联用养血清脑颗粒的降压疗效。方法选择原发性高血压患者118例,随机分为治疗组60例和对照组58例。对照组给予缬沙坦80mg／d,晨8时顿服;治疗组在此基础上给予养血清脑颗粒1包／次,3次／d;疗程均为4周。记录每日血压变化和自觉症状、不良反应。结果两组治疗前后收缩压、舒张压比较差异均有统计学意义（P均〈0．01）,治疗后两组血压比较差异有统计学意义（P〈0．05或〈0．01）。结论缬沙坦联用养血清脑颗粒治疗高血压疗效确切、安全,无明显不良反应。     

松龄血脉康对高血压患者血液流变学的影响

目的观察松龄血脉康对高血压患者血液流变学的影响。方法选择我院经血液流变学化验确诊异常的高血压患者166例。随机分为治疗组90例和对照组76例，进行给药前、后自身比较和两组间比较。结果治疗组患者治疗前、后全血高切、低切、血浆黏度、全血还原黏度、纤维蛋白原、胆回醇、三酰甘油间差异均有显著性意义（P〈0．05）；对照组患者治疗前、后胆固醇、三酰甘油闻差异有显著性意义（P〈0．05）；两组患者治疗后全血高切黏度、血浆黏度、全血还原黏度间差异均有非常显著性意义（P〈0．05）。两组患者临床疗效间差异有显著性意义（P〈0．05）。结论松龄血脉康对血液流变学多项指标有影响，且能改善患者的临床症状，提高生活质量，可作为防治心脑血管痰病的药物。     

奥美沙坦酯与缬沙坦对原发性高血压患者血压晨峰的影响

目的比较奥美沙坦酯和缬沙坦治疗高血压患者血压晨峰的疗效。方法选择我院76例原发性高血压患者随机分为2组,分别接受奥美沙坦酯20-40mg／d或缬沙坦80-160mg／d治疗,共8周,观察服药前及服药后清晨血压变化。结果奥美沙坦酯组和缬沙坦组治疗后晨峰血压均有明显下降,与治疗前比较差异有统计学意义（P〈0．05）。奥美沙坦酯组和缬沙坦组晨峰血压下降的幅度分别为：／kSBP（10．22±0．35）mmHg、（5．63±0．21）mmHg;△DBP（7．71±0．29）mmHg、（3．55±0．14）mmHg,奥美沙坦酯组血压晨峰下降幅度高于缬沙坦组,差异有统计学意义（P〈0．05）。结论奥美沙坦酯和缬沙坦均可以有效地控制原发性高血压患者血压晨蜂现象,奥美沙坦酯优于缬沙坦。     

比较不同时间服用缬沙坦对高血压患者血压变异性的影响

目的比较不同时间服用缬沙坦及苯磺酸氨氯地平片对原发性高血压（高血压）患者血压变异性（bloodpressurevariability,BPV）的影响。方法采用随机数字法将120例轻一中度高血压患者分成3组,分别为日间口服缬沙坦组、夜间口服缬沙坦组、日间口服苯磺酸氨氯地平组,治疗前、后进行24h动态血压监测。以动态血压变异标准差作为血压变异性指标,比较3个月后3种治疗方案对血压及血压变异性的影响。结果3种治疗方案均能有效降低血压,与治疗前比较差异有统计学意义（P〈0．05）。在控制BPV方面,日间口服缬沙坦组的BPV改善不明显,与治疗前比较差异无统计学意义（P〉0．05）;与治疗前比较,夜间口服缬沙坦组[收缩压变异性：（11±3）mmHg眠（15±4）nlmHg（1mmHg=0．133kPa）,P〈0．05;舒张压变异性：（7±2）mmHgVS．（10±4）mmHg,P〈0．05]和苯磺酸氨氯地平组[收缩压变异性：（10±3）mmHgIJS．（16±3）mmHg,P〈0．05;舒张压变异性：（6±2）mmHgVS．（11±2）mmHg,P〈0．05]的24h动态血压变异性降低,差异有统计学意义;苯磺酸氨氯地平组在改善BPV方面仍优于夜间口服缬沙坦组,差异有统计学意义（P〈0．01）。结论与日间服药相比,夜间服用缬沙坦能更有效改善血压变异性。     

缬沙坦对非勺型高血压患者血压昼夜节律的影响

目的观察缬沙坦对非勺型高血压患者血压昼夜节律的影响。方法选择经24h动态血压监测且诊断为非勺型2级高血压的患者60例为研究对象,将其按电脑数字表法随机均分为治疗组30例：上午7：00和晚上7：00各服缬沙坦80mg;对照组30例：上午7：00服缬沙坦160mg,两组用药8周后复测24h动态血压。比较两组血压昼夜节律的变化。结果两组治疗后24h、白昼、夜间收缩压及舒张压均较治疗前显著下降,差异有统计学意义（P〈0．05）。治疗组的夜间收缩压、舒张压及白昼、夜间血压负荷较对照组显著下降,差异有统计学意义（P〈0．05）。治疗组血压昼夜节律改变有效率明显高于对照组,差异有统计学意义（收缩压：73．33％抵46．67％,P〈0．05;舒张压：76．67％眠43．33％,P〈0．01）。结论应用缬沙坦治疗非勺型高血压,可以很好地控制2级高血压,并改变血压昼夜节律,早晚两次服用,效果更好。     

咪达普利治疗高血压的疗效及安全性研究

目的评价咪达普利对高血压的降压疗效及安全性。方法选择我院112例高血压患者，随机分为观察组（62例）与对照组（50例），观察组给予咪达普利，5mg／次，1次／d，对照组给予卡托普利25mg／次，3次／d，疗程均为4周，监测24h动态血压。结果观察组与对照组治疗后血压、临床疗效间差异均有显著性意义（P〈0．05），咪达普利降压作用可持续24h。两组患者不良反应发生率间差异无显著性意义（P〉0．05）。结论轻、中型高血压患者短期使用咪达普利安全、有效，药物不良反应少。     

联合苯磺酸左旋氨氯地平治疗难治性高血压临床观察

目的观察血管紧张素转化酶抑制剂（ACEI）、β-受体阻滞剂、利尿剂等联合苯磺酸左旋氨氯地平对难治性高血压的临床疗效。方法选择我院难治性．高血压患者76例，随机分为观察组和对照组各38例，对照组患者给予血管紧张素转化酶抑制剂（ACEI）、β-受体阻滞剂、利尿剂等药物联合治疗，观察组患者在此基础上给予苯磺酸左旋氨氯地平片2．5～5．0mg／次，1次／d，疗程均为4周。观察两组患者血压达标率、治疗后血压情况及不良反应情况。结果观察组患者治疗后达标33例（86．8％）对照组患者治疗后达标21例（55．3％），两组患者达标率间差异有非常显著性意义（P〈0．01）。两组患者治疗前、后收缩压（SBP）、舒张压（DBP）间差异均有显著性意义（P〈0．05）；且两组患者治疗后SBP、DBP间差异亦均有显著性意义（P〈0．05）。结论苯磺酸左旋氨氯地平是一个通过拆分技术获得的新药，具有较好的依从性和降压效果，尤其是在治疗难治性高血压方面疗效确切。     

苯磺酸左旋氨氯地平片联合缬沙坦治疗老年原发性高血压的临床观察

目的探讨苯磺酸左旋氨氯地平片（施慧达）联合缬沙坦治疗老年原发性高血压治疗的临床疗效。方法将2010年1月-2012年1月在我院就诊的300例老年原发性高血压病人随机分为两组,对照组采用缬沙坦口服控制血压,治疗组采用施慧达联合缬沙坦治疗,对比分析两组病人的疗效。结果治疗24周末,治疗组与对照组的坐位收缩压、舒张压均有明显下降,组间比较差异无统计学意义。但治疗组脉压下降较对照组明显,差异有统计学意义（P〈0．05）。结论苯磺酸左旋氨氯地平联合缬沙坦在治疗原发性高血压疗效显著,且无明显不良反应。     

缬沙坦联合阿托伐汀治疗对慢性肾脏病患者脉搏波速度的影响

目的观察缬沙坦胶囊联合阿托伐汀对慢性肾脏病（CKD）患者脉搏波速度（PWV）的影响。方法将96例CKD伴有高血压患者分别应用缬沙坦胶囊联合阿托伐汀（治疗组）及单独口服缬沙坦（对照组）治疗6个月。治疗前后分别评价两组患者PWV、血压、心率、服药状况及不良反应,并检测血脂、肾功能等生化指标。结果治疗后,两组Pwv、血脂均有改善,但治疗组优于对照组（P〈0．05）;两组血压均下降明显（P〈0．05）。结论缬沙坦联合阿托伐汀治疗可以改善CKD患者PWV。     

缬沙坦对高血压患者脉压及氧化应激反应的影响

目的探讨氧化应激反应变化在血管紧张素Ⅱ1型受体阻断剂（ARB）改善高血压患者脉作中的作用。方法连续65例门诊就诊的无并发症、半年内未用ARB及血管紧张素转换酶抑制剂类药的高血压患者随机分成两组：对照组32例,常规降压药物治疗;缬沙坦组33例,常规降压药物＋缬沙坦80mg／d治疗。分组治疗12个月。以动态血压观察患者治疗前、后血压变化,并以逆转录聚合链式反应（RT-PCR）方法测定血白细胞p22^phox mRNA的表达。结果治疗前两组患者性别、年龄、基础血压（包括收缩压、舒张压、脉压）及外周血白细胞p220^phox mRNA表达差异均无统计学意义（均P〉0．05）。治疗后两组患者收缩压、舒张压及脉压均较治疗前明显降低,差异有统计学意义（P〈0．05）。治疗后缬沙坦组收缩压及舒张压与对照组比较差异无统计学意义[其中收缩压（134．32±14．52）mmHg比（137．15±12．10）mmHg,舒张压（82．63±13．96）mmHg比（77．35±11．38）mmHg,P〉0．05],但脉压下降程度明显大于对照组（27．39％比11．91％,P〈0．05）。治疗后两组患者白细胞p22^phox mRNA表达均较治疗前降低,其中对照组白细胞p22^phox mRNA表达较治疗前减少18％．但差异无统计学意义（P=O．0732）,缬沙坦组白细胞p22^phox mRNA表达较治疗前减少76％（P〈0．01）。结论缬沙坦治疗12个月,能降低高血压患者的脉压,抑制高血压患者外周血白细胞NAD（P）H氧化酶亚基p22^phox mRNA的表达。缬沙坦改善动脉弹性、抗动脉硬化的效应可能归因于其具有的抗氧化作用。     

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.