空腹血糖及糖耐量受损与冠心病的相关性

目的：分析空腹血糖受损（IFG）、糖耐量受损（IGT）患者冠心病（CHD）发病及冠状动脉病变程度的相关性。方法：选择行冠状动脉造影（CAG）检查的非糖尿病患者826例,按WHO诊断标准,确诊冠心病患者531例,非冠心病患者295例。826例对象按1985-1997年[1]WHO及美国糖尿病学会（ADA）诊断标准分为：血糖正常组367例。空腹血糖受损（IFG）组152例、糖耐量受损（IGT）组307例。531例冠心病患者进一步分组为：血糖正常。组208例;IFG1组t02例;IGT1组221例。结果：①IFG、IGT组CHD发生率分别为67．1％和72．0％,较血糖正常组（56．7％）显著增高（P〈0．05～〈0．01）。②IFG1、IGT1组与血糖正常1组比较在冠状动脉的狭窄程度、病变范围、病变性质各方面都有显著差异（P〈0．05～〈0．01）;③Logistic回归分析：吸烟、IGT、IFG、糖化血红蛋白（HbAlc）、高密度脂蛋白-胆固醇（HDL-C）、收缩压（SBP）、低密度脂蛋白-胆固醇（LDL-C）等是CHD独立危险因素（OR=-0．302～1．738,P〈0．05～〈0．01）。④IGT、HbAlc、SBP、HDL—C与CHD病变严重程度相关（p=-0．722～0．350,P〈O．05～〈0．01）。结论：IFG、IGT阶段发生冠心病的危险度增加,且冠状动脉多支病变多见。程度严重、弥漫。     

维吾尔族和汉族冠心病危险因素与冠状动脉病变对照分析

目的：探讨新疆维吾尔族和汉族冠心病（CHD）患者危险因素及冠状动脉病变的差异。方法：连续收集经冠状动脉造影（CAG）确诊的冠心病住院患者268人，并将其分为维吾尔族CHD组（80例）和汉族CHD组（188例）。设计统一的调查表，分析对比两组CHD危险因素，冠状动脉病变特点和以超重为基础的危险因素聚集情况（高血压，糖尿病，高甘油三酯血症和低水平高密度脂蛋白4个危险因素）。结果：维吾尔族CHD组超重患者明显多于汉族组（P〈0．01），血高密度脂蛋白-胆固醇（HDL-C）水平降低患者明显多于汉族组（P〈0．05）；维吾尔族CHD组3个危险因素聚集患者明显多于汉族组（P〈0．05）；维吾尔族患者冠脉3支病变和狭窄程度为74％～99％者明显多于汉族组（P〈0．05）。结论：新疆维吾尔族CHD患者超重、低HDL-C者较汉族显著增多，且有多种危险因素者，冠状动脉病变范围、程度较汉族广而严重，需特别重视。     

不同程度冠状动脉病变患者的血管性假血友病因子检测

目的探讨不同程度冠脉病变患者的血管性假血友病因子（von Willebrand factor,vwF）水平。方法检测111例冠心病（CHD）及25例非CHD患者的血浆vWF水平。对所有人选患者行冠脉造影检查,将CHD患者根据冠状动脉病变支数分为单支、双支和多支病变组;根据冠状动脉损伤形态分为A型低危病变组、B型中危病变组和C型高危病变组;分析血浆vWF水平与冠状动脉病变的范围及程度的关系。结果CHD多支病变组的血浆vWF水平较单支病变组、双支病变组明显升高[（197．42±6．57）％比（135．24±21．56）％、（170．94±15．75）％,P〈0．01、P〈0．05];双支病变组的血浆vWF水平较单支病变组也明显升高（P〈0．05）;对照组与单支病变组的血浆vWF水平差异无统计学意义。C型病变组vwF高于A型、B型病变组[（195．25±33．71）％比（132．10±28．26）％、（161．13±37．41）％,19〈0．01],B型病变组高于A型病变组（P〈0．01）。结论血浆vwF水平能反映冠脉病变的范围及程度。     

糖尿病患者社区强化管理和治疗——3OO例随访54个月的效果评价

目的对社区300例糖尿病患者强化管理和治疗的效果评价。方法糖尿病患者300例随机分为强化治疗组（n=145）和标准治疗组（n=155），对强化组进行强化综合干预、强化控制达标、规范随访；标准组给予常规门诊治疗管理，为期54个月。结果强化组与标准组比较，干预后18个月HbA1c、胆固醇、LDL-C达标率显著升高（分别为55．8％vs29．9％，68．8％vs56．5％，74．2％vs54．0％，P〈O．05）；干预后36个月和54个月，强化组较标准组HbA1c达标率显著升高（36个月为73．1％vs24．3％，54个月为80．3％vs24．6％，P〈0．05）。强化组人组前和干预后18个月、36个月、54个月4次比较，血压、空腹血糖、HbA1c、胆固醇、HDL-C、用药情况及月花费差异均有统计学意义（P〈0．05）。血压达标率4次分别为57．6％、59．3％、60．5％、83．1％；HbAlc为46．2％、55．8％、73．1％、80．3％；胆固醇为42．1％、68．8％、63．2％、62．9％；HDL-C为70．5％、87．5％、81．6％、81．4％。入组后18个月强化组双胍类药物所占比例较标准组少（56．1％vs67．3％，P〈0．05）；磺脲类和胰岛素明显增加（分别为70．2％vs54．0％，21．3％vs12．0％，P〈0．05）；降糖药月花费强化组增加134．5元，上升53．6％，标准组增加70．5元，上升29．8％。结论社区强化干预可以使血糖得到良好控制，血压、血脂较理想控制，花费略增。     

2型糖尿病并冠心病患者vWF水平变化及其与冠脉病变程度、临床相关因素的关系

目的观察2型糖尿病合并冠心病患者中血管性血友病因子（vWF）的变化及其与冠脉病变程度、临床相关因素的关系。方法2型糖尿病患者582例,其中合并冠心病患者414例（DM-CHD组）、不合并冠心病患者168例（DM．NCHD组）,另选择100例非糖尿病非冠心病患者作为对照组。空腹取血测定3组血浆vWF、TC、LDL-C、HDL-C、TG、尿酸（uA）、糖化血红蛋白（HbA,C）、空腹血糖（FBG）、载脂蛋白A1（ApoAl）、载脂蛋白B（ApoB）;计算胰岛素抵抗指数（IRI）。记录DM．CHD组患者冠脉病变情况及Gensini积分;同时根据ACC／AHA冠脉病变分型建议,将患者冠脉病变分为A、B、C型并比较分析。结果DM．CHD组血浆vwF水平高于DM-NCHD组和对照组,P均〈0．05。DM-CHD组血浆vWF水平与冠脉病变支数、Gensini积分呈正相关（r值分别为0．611、0．635,P均〈0．05）;冠脉C型病变患者血浆vwF水平高于B型病变和A型病变（P均〈0．05）,且B型病变高于A型病变血浆vwF水平（P〈0．05）。DM-CHD组血浆vWF与糖尿病病程、FBG、HbA,c、IRI呈正相关（r值分别为0．541、0．508、0．616、0．796,P〈0．05）,其中与IRI的相关性最高（标准化回归系数0．976,P=0．023）。结论2型糖尿病合并冠心病患者vWF水平升高,且与冠状动脉病变程度、冠脉病变支数呈正相关,与糖尿病病程、FBG、HbA,c、IRI密切相关。vWF在2型糖尿病合并冠心病的发生和发展中具有重要作用,监测血浆vWF水平有助于糖尿病合并冠心病的诊断、判断病情及指导治疗。     

吸烟对冠心病合并糖尿病患者糖化血红蛋白的影响

目的探讨吸烟对冠心病合并糖尿病患者HbA1c水平的影响。方法从北京、上海等7个城市共52家医院心内科2005年6月至9月间冠心病合并糖尿病住院患者中收集有效病例1858例。结果吸烟组HbA1c均值较非吸烟组高（P〈0．01）；HbA1c≥6．5％的比例也高于非吸烟组（P〈0．01）。结论吸烟是HbA1c〉6．5％的冠心病合并糖尿病患者的独立危险因素。应采取积极有效的干预措施降低冠心病合并糖尿病患者的吸烟率。     

踝臂指数联合脉搏波传导速度对冠心病的预测价值

目的探讨踝臂指数（ABI）及肱-踝脉搏波传导速度（baPWV）对冠心病（CHD）及其病变程度的预测价值。方法对经冠脉造影确诊的432例CHD患者和535例非CHD患者进行baPWV、ABI检测,分析CHD患者的baPWV、ABI变化特征,并与非CHD组对照。结果非CHD组、单支病变组、双支病变组、三支病变组baPWV值逐渐增加,且四组间baPWV比较差异有统计学意义（P〈0．01）。冠脉病变组与非病变组之间ABI差异有统计学意义（P〈0．05）,ABI在冠脉病变程度组间逐渐递减,且三支病变组与单支病变组及双支病变组比较差异有统计学意义（尸〈0．05）。结论ABI及baPWV均可反映冠脉病变的程度,且可作为CHD的早期预测指标。     

心血管病危险因素与冠脉病变支数关系的分析

目的探讨冠心病患者冠状动脉血管病变支数与临床危险因素之间的关系。方法回顾性分析349例在我院心内科经冠脉造影诊断为冠心病患者的临床资料,依据冠状动脉造影结果分为单支病变组和多支病变组。应用SPSS13．0分析患者血管病变支数与年龄、性别、冠心病危险囚素（吸烟、高血压、糖尿病、高脂血症）的关系。结果多支冠脉血管病变组吸烟检出率为42％,单支冠脉血管病变组吸烟检出率为30％,两组比较差异有统计学意义（P〈0．05）;多支冠脉血管病变组患者糖尿病检出率为27％,单支冠脉血管病变组患者糖尿病检出率为13％,两组比较差异有统计学意义（P〈0．01）;多支冠脉病变组患者TC升高[（5．06±1．21）mmol／L],与单支冠脉血管病变组比较差异有统计学意义（P〈0．01）;单支冠脉病变患者LDL—C升高[（2．84±0．11）mmol／L],多支冠脉病变组LDL—C升高[（3．06±0．42）mmol／L],两组比较差异有统计学意义（P〈0．01）。多支冠脉血管病变患者平均年龄明显高于单支冠脉血管病变患者,差异有统计学意义（P〈0．01）;多支冠脉血管病变患者高血压检出率57％,单支冠脉血管病变患者高血压检出率47％,两组间比较差异无统计学意义（P〉0．05）;性别构成比、HDL—C水平两组间比较差异无统计学意义（P〉0．05）。结论吸烟或糖尿病患者,以及TC升高、LDL—C升高患者易发生多支冠脉血管病变;随着年龄的增长,患冠心病多支病变比例明显增高。     

老年人冠心病发病与血浆同型半胱氨酸水平相关性研究

目的探讨血浆同型半胱氨酸（HCY）水平与冠心病（CHD）的关系。方法采用循环酶法分别测定CHD患者（117例）及对照组（50例）血浆中HCY水平。结果CHD组血浆HCY水平明显高于对照组（P〈0．001）；不同临床类型患者，HCY水平AMI〉UAP〉SAP〉对照组，其中SAP组与对照组比较差异有显著性（P〈0．005），UAP、AMI组与对照组比较差异均有显著性（P〈0．001），SAP与UAP、AMI组比较差异也存在显著性，分别为P〈0．05和P〈0．001；0、1、2,3支血管病变者血浆HCY浓度呈逐级增高趋势，0支病变组与其他各病变组间比较相差显著（P〈0．001），1支与3支病变组或2支与3支病变组间差异有显著性（P〈0．01），1支与2支病变组之间差异无显著性（P〉0．05）。结论CHD患者血浆HCY水平明显增高，冠状动脉病变支数越多，血浆HCY水平越高，提示HCY水平变化与CHD的发生、发展密切相关，是CHD的一个危险因素。     

HbA1c与冠状动脉病变程度的相关性研究

目的探讨HbA1c水平与冠状动脉病变程度的相关性及临床意义。方法对临床疑诊或诊断为冠心病（CHD）而行冠状动脉造影的541例患者进行HbA1c测定分组,评价HbA1c水平与CHD、冠脉狭窄程度（Gensini积分法）、冠脉狭窄支数及接受PCI治疗等的相关性。结果随HbA,c水平升高,CHD患病率显著上升（P〈0．01）,Spearman等级相关分析显示,HbA1c与CHD、病变支数、Gensini积分和接受PCI治疗显著相关（r=0．211,P〈0．01;r=0．213,P〈0．01;r=0．233,P〈0．01;r=0．137,P〈0．01）。Logistic多元逐步回归分析结果显示,HbA1c为CHD的独立危险因素（OR=1．436,95％CI为1．128-1．828,P〈0．01）。结论HbA1c与冠脉病变程度呈正相关,长期升高可能促进CHD的发生。     

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.