人类免疫缺陷病毒感染/艾滋病合并肺结核患者与无HIV感染肺结核患者分枝杆菌药敏结果对比分析

目的回顾性分析肺结核患者(PTB)与人类免疫缺陷病毒(HIV)感染/艾滋病(AIDS)合并PTB患者的分枝杆菌药敏和菌株鉴定结果,期望为HIV感染/AIDS合并PTB患者早期有效抗结核治疗提供数据参考。方法搜集重庆市公共卫生医疗救治中心结核科和感染科2013年1月1日至2013年12月31日期间1708例无HIV感染PTB患者和106例HIV感染/AIDS合并PTB患者临床资料,统计分枝杆菌药敏试验和菌株鉴定的结果,分析耐药特征,采用卡方检验,以P0.05为差异具有统计学意义。结果无HIV感染PTB组与HIV感染/AIDS合并PTB组的总耐药率、初治耐药率、复治耐药率差异均有显著统计学意义(P均0.01);HIV感染合并PTB组耐药率12.5%(2/16)与AIDS合并PTB组耐药率24.4%(22/90)差异无显著统计学意义(P0.05)。结论该中心收治的痰结核培养阳性患者中,HIV感染/AIDS合并PTB患者耐药趋势远低于PTB患者,HIV感染合并PTB组耐药状况与AIDS合并PTB组大体一致。     

获得性免疫缺陷综合征常见机会性感染的诊治(二)——分枝杆菌

结核分枝杆菌感染一、流行病学结核分枝杆菌(MTB)感染是我国获得性免疫缺陷综合征(AIDS)患者最为常见的机会感染之一,全球近4000万人类免疫缺陷病毒(HIV)感染或AIDS患者中约有36%合并     

合并HIV/AIDS肺结核患者单纯抗结核治疗的近期疗效分析

艾滋病（AIDS）患者和HIV（人类免疫缺陷病毒）感染者逐渐增多，艾滋病患者中有1／3同时感染结核分枝杆菌，且两病相互影响，互为因果。结核病加重艾滋病病毒感染者的病程发展，缩短了他们的寿命，1／3的艾滋病死于结核病。因此，加强对艾滋病机会性感染特别是结核病的治疗，是控制艾滋病的发展、改善预后的有效手段之一。本文对32例合并HIV／AIDS肺结核患者进行抗结核治疗观察，现将结果报告如下。     

合并HIV/AIDS肺结核患者单纯抗结核治疗的近期疗效分析

艾滋病（AIDS）患者和HIV（人类免疫缺陷病毒）感染者逐渐增多,艾滋病患者中有1/3同时感染结核分枝杆菌,且两病相互影响,互为因果^[1]。结核病加重艾滋病病毒感染者的病程发展,缩短了他们的寿命,1/3的艾滋病死于结核病^[2]。因此,加强对艾滋病机会性感染特别是结核病的治疗,是控制艾滋病的发展、改善预后的有效手段之一。本文对32例合并HIV/AIDS肺结核患者进行抗结核治疗观察,现将结果报告如下。     

艾滋病合并肺结核12例临床分析

人类免疫缺陷病毒（HIV）感染,特别是艾滋病（AIDS）比其他因素更能促使患者感染结核分枝杆菌（MTB）^[1]或引起结核病（TB）的复燃,增加社区内MTB传播的风险^[2],且耐多药结核菌株极易在AIDS/HIV人群中传播而造成耐多药结核病的爆发流行^[3]。HIV感染与结核可相互促进病变的进展、恶化,并迅速导致患者死亡。为了解湖北省随州市HIV/AIDS患者的结核患病的情况,2005年1—3月,我们对当地的HIV/AIDS患者进行了结核筛查,发现并治疗艾滋病合并肺结核（AIDS/TB）患者12例,现将结果报告如下。     

结核病与艾滋病病毒感染的相互影响

目前,全球感染艾滋病(AIDS)病毒(人免疫缺陷病毒,HIV)人数估计>3 600万人,而全球60亿人口中,有约1/3感染了结核分枝杆菌(MTB)。结核病(TB)不仅直接威胁人类健康,同时又“助纣为虐”,使得目前全球AIDS和TB双重感染的病例逐年增加。所以在21世纪,人类必须正视TB合并HIV/AIDS     

肺结核与艾滋病

目的 了解结核病院人类免疫缺陷病毒(HIV)/结核分枝杆菌(MTB)双重感染发病情况及发现病例的临床表现?治疗对策?方法 对1995年2月～1999年2月3707例住院结核病患者常规检测HIV抗体?结果 3707例中HIV(+)4例,阳性率108‰?男3例,女1例?平均年龄295岁,占21～40岁年龄组的314‰?4例中血源性感染1例,异性间感染2例,另1例血源性?异性间感染难以确定?4例均可诊断为艾滋病(AIDS)?结论 对具有HIV感染危险因素的结核患者,特别是中青年,应常规进行HIV抗体检测,对HIV/MTB双重感染患者抗结核治疗时应特别注意药物副反应?在抗痨同时并用中西药抗AIDS治疗,结核病取得较好近期疗效?     

肺结核与艾滋病(附四例报告)

目的 了解结核病院人类免疫缺陷病毒(HIV)/结核分枝杆菌(MTB)双重感染发病情况及发现病例的临床表现?治疗对策?方法 对1995年2月～1999年2月3707例住院结核病患者常规检测HIV抗体?结果 3707例中HIV(+)4例,阳性率108‰?男3例,女1例?平均年龄295岁,占21～40岁年龄组的314‰?4例中血源性感染1例,异性间感染2例,另1例血源性?异性间感染难以确定?4例均可诊断为艾滋病(AIDS)?结论 对具有HIV感染危险因素的结核患者,特别是中青年,应常规进行HIV抗体检测,对HIV/MTB双重感染患者抗结核治疗时应特别注意药物副反应?在抗痨同时并用中西药抗AIDS治疗,结核病取得较好近期疗效?     

T细胞斑点试验在老年性HIV/AIDS中的临床诊断价值

目的探讨T细胞斑点试验(T-spot.TB)检测在老年性人类免疫缺陷病毒(HIV)/获得性免疫缺陷综合征(AIDS)患者中的临床诊断价值。方法选择感染科及结核病科住院的老年HIV/AIDS患者作为研究对象,合并结核病者41例(试验组),未合并结核者56例(对照组)。对两组患者进行T-spot.TB检测,分析其对老年性HIV/AIDS合并结核病的诊断价值。结果试验组35例(85.25%)T-spot.TB检测阳性;而对照组T-spot.TB检测阳性5例,阳性率8.93%,两组差异有统计学意义(χ~2=20.08,P0.05)。T-spot.TB对老年HIV/AIDS患者合并结核病的灵敏度为86.9%,特异度为91.1%,阳性预测值为87.5%,阴性预测值为89.5%。结论 T-spot.TB试验可用于诊断老年HIV/AIDS患者是否合并结核病,具有较高的灵敏度和特异度。     

艾滋病合并结核性脑膜炎的治疗与护理

目前,我国艾滋病（acpuired immunedeficiency syndrome,AIDS）患者和人类免疫缺陷病毒（HIV）感染者日益增多。结核性脑膜炎（结脑）是由于结核分枝杆菌侵入蛛网膜下腔进而累及脑实质和脑血管的病变,是重症结核病。大约有1／3的艾滋病患者同时感染了结核分枝杆菌。而HIV感染后,机体对结核菌的杀伤力显著下降,结核菌得以快速生长繁殖而发病,两病互相影响。我院2005年1月至2008年5月,收治10例艾滋病合并结脑患者,现将治疗过程中的护理体会总结如下。     

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.     

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.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.