螺内酯对扩张型心肌病心力衰竭患者某些体液因子的影响

目的 :探讨螺内酯对扩张型心肌病心力衰竭患者血浆儿茶酚胺、肾素活性、血管紧张素Ⅱ及醛固酮的影响。方法 :入选 2 0例扩张型心肌病心力衰竭患者 ,随机分入螺内酯组与对照组 ,各 10例 ,用螺内酯治疗前与治疗 1个月后 ,用高效液相色谱方法测定血浆去甲肾上腺素、肾上腺素 ,同时采用均相竞争放射免疫方法检测血浆肾素活性、血管紧张素 Ⅱ与醛固酮。结果 :治疗 1个月后螺内酯组血浆去甲肾上腺素、肾上腺素、肾素活性及醛固酮明显低于治疗前 ,也低于对照组。结论 :螺内酯可明显抑制扩张型心肌病心力衰竭患者的儿茶酚胺水平 ,降低肾素活性及醛固酮 ,这些改变有可能为螺内酯明显改善心力衰竭病人预后的重要机制     

螺内酯对老年高血压心力衰竭患者某些神经体液因子的影响

目的　探讨螺内酯对老年高血压心力衰竭患者血浆儿茶酚胺、肾素活性、血管紧张素Ⅱ及醛固酮的影响。方法　入选 32例老年高血压心力衰竭患者 ,随机分为螺内酯组与对照组 ,各 16例 ,用螺内酯治疗前与治疗 1个月 ,用高效液相色谱方法测定血浆去甲肾上腺素、肾上腺素 ,同时采用均相竞争放射免疫方法检测血浆肾素活性、血管紧张素Ⅱ与醛固酮。结果　螺内酯治疗 1个月的螺内酯组血浆去甲肾上腺素、肾上腺素明显低于治疗前 ,也低于对照组。结论　螺内酯可明显降低老年高血压心力衰竭患者的儿茶酚胺水平     

螺内酯对慢性心力衰竭患者神经内分泌激素的影响

目的探讨螺内酯对慢性心力衰竭患者神经内分泌激素的影响。方法92例慢性心力衰竭患者(心功能Ⅱ~Ⅳ级),随机分为贝那普利组(对照组),贝那普利+螺内酯组(螺内酯组)。测定治疗前、治疗3个月后血浆去甲肾上腺素、肾上腺素、肾素、血管紧张素Ⅱ、醛固酮、内皮素水平的变化。结果两组治疗后血浆去甲肾上腺素、肾上腺素、内皮素水平均有明显下降(P<0.01),肾素、血管紧张素Ⅱ水平无明显变化(P>0.05)。醛固酮水平在对照组无显著变化(P>0.05),螺内酯组有显著下降(P<0.01)。结论血管紧张素转换酶抑制剂只有与螺内酯长期联合治疗才可以显著降低慢性心力衰竭患者的血浆醛固酮水平。     

苯那普利对充血性心力衰竭患者神经激素及心功能的影响

应用苯那普利对30例充血性心力衰竭患者进行为期4周的治疗，测定治疗前后血浆肾素、血管紧张素Ⅱ、醛固酮以及儿茶酚胺水平，观察心率、血压和心功能改善情况。结果显示治疗后患者血管紧张素Ⅱ、醛固酮、去甲肾上腺素、肾上腺素水平显著下降（P＜0．01），心率减慢、心功能改善，总有效率达93．3％。提示苯那普利能抑制肾素－血管紧张素－醛固酮系统，降低交感神经活性，改善充血性心力衰竭患者心功能。     

氯沙坦与依那普利治疗慢性心力衰竭对比观察

目的:探讨慢性心力衰竭时血流动力学、肾素活性、血管紧张素Ⅱ和醛固酮变化及氯沙坦对其影响.方法:慢性心力衰竭患者60例随机分为氯沙坦组和依那普利组,每组30例,疗程12周.测定治疗前、治疗1、12周血浆肾素活性、血管紧张素Ⅱ、醛固酮和治疗前、治疗12周心功能、血流动力学变化.30例健康体检者作对照组.结果:60例慢性心力衰竭患者血浆肾素活性、血管紧张素Ⅱ和醛固酮水平均较对照组升高(P＜0.01),氯沙坦组治疗后1、12周血浆肾素活性、血管紧张素Ⅱ水平较治疗前升高,以1周升高明显(P＜0.05),而12周与治疗前比较差异无显著性(P＞0.05),醛固酮水平治疗后1、12周与治疗前比较则降低,有显著差异(P＜0.01).依那普利组治疗1周、12周血浆血管紧张素Ⅱ、醛固酮水平较治疗前降低(P＜0.01),而肾素活性水平则升高,以1周升高明显(P＜0.05),而12周与治疗前比较差异无显著性(P＞0.05),治疗前后两组间比较差异无显著性(P＞0.05).氯沙坦组和依那普利组在治疗12周后,多项血流动力学指标与本组治疗前比较均有改善(P＜0.05).结论:慢性心力衰竭患者血流动力学异常、肾素-血管紧张素-醛固酮系统激活是心力衰竭病理生理特征之一,氯沙坦治疗后可获得有益的临床、血流动力学及神经激素效应,且有较好的耐受性.     

血管紧张素转换酶抑制剂及螺内酯对扩张型心肌病心肌纤维化及心功能的影响

目的评价血管紧张素转换酶抑制剂培多普利(商品名:雅思达)及螺内酯逆转原发性扩张型心肌病(DCM)心肌纤维化及改善心功能的作用.方法采用放射免疫方法测定24例正常对照者及原发性DCM应用培多普利及螺内酯治疗前后心肌纤维化指标:血清Ⅲ型前胶原(PCⅢ)、层粘连蛋白(LN)、透明质酸(HA),同时测定血浆血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)浓度,采用超声方法测定左室射血分数(LVEF).结果原发生DCM PCⅢ、LN、HA明显升高,血浆AngⅡ、ALD活性增强,使用培多普利和螺内酯治疗6个月后PCⅢ、LN、HA显著下降,AngⅡ、ALD活性减低,心功能明显改善.结论原发性DCM存在不同程度心肌纤维化.血管紧张素换酶抑制剂及螺内脂通过抑制AngⅡ、ALD逆转心肌纤维化,明显改善心功能.     

布新洛尔对充血性心力衰竭患者神经介质活性的影响

充血性心力衰竭(CHF)时,交感神经系统和肾素-血管紧张素系统激活,以致血浆去甲肾上腺素水平和肾素活性增加。血管紧张素转换酶(ACE)抑制剂虽然有效,但长程治疗中血浆去甲肾上腺素水平仍可继续升高,这说明 ACF抑制剂并不能长期抑制反射性交感神经系统激活。本文评价β受体阻滞剂布新洛尔(bucindolol)对 CHF 患者血浆肾素活性和去甲肾上腺素水平的影响。     

胰岛素诱发大鼠高血压机制中肾素—血管紧张素系统的作用

目的 探讨胰岛素诱发大鼠高血压机制中肾素-血管紧张素系统所发挥的作用。方法雄性Wistar大鼠40只,重259.2±17.35g,随机分组,实验组30只,分为A、B和C组各10只。A组单纯皮下注射精蛋白锌胰岛素,B、C组注射同时分别加服心得安和开搏通。所有大鼠注射前、后测血压,注射后留24小时尿测尿纳,尿儿茶酚胺。后心脏取血测血糖,血浆胰岛素,血浆肾素活性和血管紧张素Ⅱ。对照组10只大鼠,皮下注射等量生理盐水。结果 A组血压,C组尿量较对照组显著升高。A、B和C组尿肾上腺素,B、C组尿去甲肾上腺素较对照组显著升高。A、B和C组血糖较对照组显著降低,血浆胰岛素较对照组显著升高。A组血浆肾素活性,血管紧张素Ⅱ均较对照组显著升高,B、C无明显差异。结论 胰岛素诱发大鼠高血压是由肾素-血管紧张素系统活性升高介导的,注射胰岛素后引起低血糖所致交感-儿茶酚胺系统活性增加是肾素-血管紧张素系统活性增加原因之一。     

血管紧张素Ⅱ受体拮抗剂抗心衰作用及对神经内分泌激素的影响

目的：探讨血管紧张素Ⅱ受体拮抗剂ｃｏｚａａｒ（商品名科素亚）抗心力衰竭疗效及对充血性心力衰竭患者血浆部分神经内分泌激素的影响。方法：３５ 例充血性心力衰竭患者服用ｃｏｚａａｒ ２５ ｍ ｇ／ｄ～５０ｍ ｇ／ｄ 治疗１２ 周,观察其治疗前后血浆肾素活性（ＰＲＡ）、血管紧张素Ⅱ（ＡｎｇⅡ）、去甲肾上腺素（ＮＥ）、肾上腺素（Ｅ）、内皮素（ＥＴ）、一氧化氮（ＮＯ） 水平及治疗前后心功能改变情况。结果：ｃｏｚａａｒ 治疗１２ 周后心功能得到明显改善,血浆ＰＲＡ、ＡｎｇⅡ、ＮＥ、ＥＴ水平均显著下降,ＮＯ水平升高。结论：血管紧张素Ⅱ拮抗剂不仅能抑制肾素一血管紧张素活性,还能抑制交感神经系统活性,调节内皮细胞舒缩功能,改善心功能     

黄芪对心力衰竭患者心室重构的影响

目的观察黄芪对慢性心力衰竭患者心室重构的治疗作用。方法 160例慢性心力衰竭患者随机分为治疗组和对照组,各80例。对照组采用血管紧张素转换酶抑制剂、β受体阻滞剂、利尿剂和正性肌力药等常规治疗,治疗组在常规治疗的基础上加用黄芪免煎颗粒,两组疗程均为12周。观察治疗前后超声心动图及血浆肾素、血管紧张素和醛固酮等指标的变化。结果两组治疗后超声心动图及血浆肾素、血管紧张素和醛固酮等均有改善,治疗组与对照组比较效果更明显(P<0.05)。结论常规治疗与黄芪联合,对慢性心力衰竭患者的肾素-血管紧张素-醛固酮系统活性有明显抑制作用,可进一步改善患者的心室重构和心功能。     

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.