比索洛尔和胺碘酮治疗房颤比较

目的 观察、比较比索洛尔和胺碘酮治疗心房颤动的疗效和不良反应.方法 2001-2006年心内科门诊确诊为非瓣膜性心房颤动患者117例[男85例,女32例,年龄(65±15)岁],随机分为比索洛尔组(A组)、胺碘酮组(B组)两组.分别应用比索洛尔(5～10 mg/d,n=61)和胺碘酮(200～400 mg/d,n=56),治疗4周,疗效达到即可.未达到疗效者剂量加倍,再治疗4周即结束.观察疗效和不良反应.结果 A组和B组转律率差异无统计学意义(18.0% vs 21.4%,P＞0.05).A组心室率控制率明显大于B组(62.3% vs 35.7%,P＜0.01).A组治疗无效率明显低于B组(19.7% vs 42.9%,P＜0.01).A组症状改善率明显高于B组(96.7% vs 35.7%,P＜0.01).非心脏不良反应B组明显多于A组.结论 比索洛尔优于胺碘酮,可作为治疗房颤的一线药物.     

阿托伐汀联用依那普利对老年单纯收缩期高血压的作用

目的 观察阿托伐汀联用依那普利对老年单纯收缩期高血压患者血压的影响.方法 老年单纯收缩期高血压78例,血清胆固醇正常.单用依那普利组38例,口服依那普利10 mg/d;联用阿托伐汀组40例,口服依那普利片10 mg/d和阿托伐汀20 mg/d.观察12周,每2周记录血压1次.结果 治疗12周后.两组患者收缩压、舒张压和脉压均较治疗前下降(P＜0.05);单用依那普利组脉压从治疗前(74±8)mm Hg降至(68±6)mm Hg;联用阿伐他汀组脉压从治疗前(75±7)mm Hg降至(60±6)mm Hg;两组间差异有统计学意义(t=5.255,P＜0.01).结论 阿托伐汀联用依那普利有助于改善单纯收缩期高血压老年人脉压,可降低老年心脑血管事件的危险性.     

氟对大鼠骨代谢的影响

目的 观察氟对大鼠骨代谢的影响,探讨氟骨症的发病机制.方法 Wistar雄性大鼠80只,体质量80～100 g.将大鼠按体质量随机分为4组:对照组(饮用自来水),低剂量组(NaF,50 mg/L),中剂量组(NaF,100 mg/L),高剂量组(NaF,150 mg/L),每组20只.饲养12周,乙醚麻醉处死大鼠,观察大鼠氟斑牙发生率;股动脉取血,放射免疫法测定血清骨钙素(BGP)、甲状旁腺激素(PTH)、降钙素(CT);比色法测定血清碱性磷酸酶(ALP)、酸性磷酸酶(ACP).结果大鼠氟斑牙检出率组间比较差异有统计学意义(x2=82.81,P＜0.01);其中低(80%,16/20)、中(100%,20/20)、高剂量组(100%,20/20)与对照组(0,0/20)比较差异有统计学意义(x2值分别为22.67、40.00、40.00,P均＜0.01).大鼠血清BGP、PTH、CT组间比较差异有统计学意义(F值分别为38.614、20.778、3.023,P＜0.01或＜0.05);但ALP、ACP组问比较差异无统计学意义(F值分别0.609、2.895,P均＞0.05).血清BGP:低、中、高剂量组[(19.60±12.79)、(33.41±10.81)、(39.46±9.51)mg/L]高于对照组[(7.35±3.22)mg/L,P均＜0.01],中、高剂量组高于低剂量组(P均＜0.01);血清PTH:低、中、高剂量组[(72.27±25.38)、(67.80±12.01)、(106.52±36.37)pmol/L]高于对照组[(47.08±9.22)pmol/L,P均＜0.01],高剂量组高于低、中剂量组(P均＜0.01);血清CT:中、高剂量组[(13.39±2.07)、(15.05±4.77)pmol/L]低于对照组[(26.06±28.31)pmol/L,P均＜0.05],也低于低剂量组[(24.49±14.10)pmol/L,P＜0.05].结论氟影响大鼠的骨代谢,BGP、PTH、CT在氟骨症发病中起着重要的作用.     

染氟小鼠成骨细胞系MC3T3-E1细胞中还原型谷胱甘肽和氧化型谷胱甘肽观察

目的 观察染氟小鼠成骨细胞系MC3T3-E1细胞中还原型谷胱甘肽(GSH)和氧化型谷胱甘肽(GSSG)的水平.方法 采用噻唑蓝(MTT)法检测不同染氟条件下[F-剂量分别为0(对照)、0.5、1.0、2.0、4.0、8.0、12.0、20.0 mg/L]MC3T3-E1细胞1、2、4、10 d的细胞活性.另外,按染氟剂量,将MC3T3-E1细胞分为0(对照)、2、8、20 mg/L组,分别染氟2、4、10 d,采用高效液相色谱—串联四极杆质谱技术检测细胞内GSH、GSSG和谷氨酰胺(Gln)水平.结果 染氟1d时2.0 mg/L组细胞活性(0.57±0.05)明显高于对照组(0.49±0.03,P＜0.01);染氟4d时8.0、12.0 mg/L组细胞活性(0.49±0.07、0.47±0.09)明显低于对照组(0.63±0.06,P＜ 0.05或＜ 0.01);染氟10d时8.0 mg/L组细胞活性(1.52±0.29)明显高于对照组(0.86±0.23),而20.0 mg/L组细胞活性(0,54±0.07)明显低于对照组(P均＜0.01).染氟2、10d时20 mg/L组细胞中GSH水平[(13.92±4.63)、(0.53±0.30) μmol/L]明显低于相应的对照组[(26.42±3.67)、(24.85±5.68)μmol/L,P均＜0.01].染氟2d时2 mg/L组、染氟4d时8 mg/L组、染氟10 d时8 mg/L组细胞内GSSG水平[(1.12±0.62)、(2.13±0.62)、(2.97±1.30)μmol/L]明显高于相应的对照组[(0.55±0.22)、(1.46±0.46)、(1.35±0.50)μmol/L,P＜ 0.05或＜ 0.01].染氟4d时2 mg/L组和染氟10d时8、20 mg/L组细胞内Gln水平[(62.80±17.41)、(122.26±19.51)、(19.38±8.11) μmol/L]明显低于相应的对照组[(83.28±14.32)、(147.15±16.95) rmol/L,P均＜0.05或＜ 0.01].结论 染氟能明显改变成骨细胞内的GSH、GSSG和Gln水平,从而影响细胞内氧化还原平衡态.     

肺部真菌感染患者伏立康唑血药浓度监测的临床应用

目的 通过监测肺部真菌感染患者伏立康唑的血药浓度,探讨伏立康唑血药浓度与临床疗效和不良反应的相关性以及在不同病区的特点.方法 采用高效液相色谱法一荧光法测定伏立康唑血药浓度,观察不同病区肺部真菌感染患者在治疗期间的临床疗效和不良反应发生的情况.结果 共纳入87例患者,伏立康唑血药浓度检测次数为133次,87例患者首次检测的血药浓度为(3.37±2.6) mg/L,133次检测的血药浓度为(2.98±2.28) mg/L;静脉治疗时血药浓度(3.30±2.61) mg/L,口服治疗时血药浓度为(2.31±2.02) mg/L,静脉治疗的血药浓度显著高于口服治疗的血药浓度(P=0.018);门诊患者血药浓度为(3.06±2.2) mg/L,普通病区患者血药浓度为(2.6±2.5) mg/L,ICU患者血药浓度为(3.1±2.5)mg/L,三组间差异无统计学意义,但对于同一患者而言,门诊患者药物浓度波动幅度较小,ICU患者血药浓度波动幅度较大.87例患者中,68例治疗成功(78％),19例治疗失败(22％),比较治疗成功组和失败组伏立康唑血药浓度,两组差异无统计学意义,提示血药浓度与疗效无明显相关性,但在治疗失败组中,血药浓度低于1 mg/L的比例明显高于治疗成功组,两组差异有统计学意义(36.8％ vs 14.7％,P=0.048).87例患者中,低钾血症发生率为32％,肝功能受损为14％,肾功能受损为3.4％,皮疹为3.4％,视觉障碍为2％.其中,视觉障碍和肝功能受损发生率与血药浓度有关系(均P＜0.05).结论 伏立康唑血药浓度波动范围大,平均血药浓度为(3.37±2.6) mg/L.血药浓度与临床疗效无明显相关性,但血药浓度低于1 mg/L,治疗失败率可能增加;神经系统的不良反应和肝功能受损与较高的血药浓度有关;建议治疗期间血药浓度维持在(1～5) mg/L.在使用伏立康唑时,不同来源的患者应监测其血药浓度,尤其是ICU患者,应加强血药浓度的监测,及时调整用药方案,以减少药物不良反应.     

葛根素对去卵巢大鼠机体骨代谢影响的观察

目的 观察葛根素对去卵巢大鼠机体骨代谢的影响,探讨其对雌激素缺乏引起的骨质疏松症的治疗作用.方法 3月龄清洁级SD大鼠60只,背驮式切除双侧卵巢后每日灌胃葛根素5 mg/kg(P-5组),10 mg/kg(P-10组)和20 mg/kg(P-20组),并设假手术组(Sham),模型组(OVX)和己烯雌酚阳性对照组(E).3个月后处死动物,测定大鼠胫骨干重、灰分重量和矿物质含量,胫骨Ca、P含量以及血清相关骨代谢指标.结果 与OVX组相比,葛根素各组的胫骨矿物质含量(mg/g)均有增加(574±17,590±22和597±18),其中P-20组差异显著(P＜0.05);葛根素各组的胫骨Ca含量(mg/g)高于OVX组 (132±10,222±7,228±8),其中P-10,P-20两组差异显著(P＜0.05,P＜0.01),说明服用葛根素后大鼠骨量得到增加;同时,葛根素各组的碱性磷酸酶(U/L)与OVX组有所降低(101±26,90±20,71±15),其中P-10,P-20两组差异显著(P＜0.05,P＜0.01),说明去卵巢大鼠骨的高转换状态得到改善.结论 葛根素能抑制去卵巢大鼠骨量的丢失,对骨代谢有较好的调节作用,对雌激素缺乏引起的骨质疏松症有一定的治疗作用.     

阿托伐他汀联合肠溶阿司匹林对颈动脉粥样硬化患者斑块稳定性及脑血管事件的影响

目的 观察标准剂量阿托伐他汀联合肠溶阿司匹林对颈动脉粥样硬化患者斑块稳定性及脑血管事件的影响. 方法 将67例颈动脉粥样硬化患者随机分成2组,治疗组34例,对照组33例,治疗组口服阿托伐他汀(10 mg/d)和肠溶阿司匹林(100 mg/d),对照组仅口服肠溶阿司匹林(100 mg/d).观察2组患者在治疗6月、12月后颈动脉粥样硬化斑块缩小程度及脑血管事件的发生率.结果 治疗6月后2组颈动脉斑块大小及脑血管事件的发生率变化无统计学差异(P＞0.05),但治疗组稳定性斑块数目增加,与治疗前比较差异有统计学意义(P＜0.01).治疗12月后2组斑块大小、稳定性斑块数目及脑血管事件的发生率与治疗前比较均有统计学差异(P＜0.01),2组间也存在显著性差异(P＜0.05).结论 阿托伐他汀联合阿司匹林治疗可通过调节颈动脉粥样硬化患者炎性细胞因子,抑制血小板活化,缩小或稳定颈动脉粥样硬化斑块,长时间服用可降低脑血管事件的发生率.     

多重危险因素干预与老年颈动脉粥样硬化斑块关系的研究

目的 探讨多重危险因素干预与老年人颈动脉粥样硬化和斑块的关系,评估强化他汀降脂治疗重要性、安全性、有效性及达标剂量. 方法 入组181例经彩色颈动脉超声检查确诊为颈总动脉内中膜(IMT)增厚和颈动脉粥样硬化斑块伴有多重危险因素患者.数字抽签随机分为2组给予综合控制血脂、血压、血糖等,常规治疗组阿托伐他汀10 mg,强化治疗组阿托伐他汀20 mg,治疗24个月. 结果 两组患者干预后的血压、血脂、血糖、微量白蛋白尿(MAU)及超高敏C反应蛋白(hs-CRP)较治疗前均有改善(P％0.05或P＜0.01);强化治疗组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)及hs-CRP差值分别为(0.9±0.6) mmol/L,(1.3±0.7)mmol/L、(3.9±3.0) mg/L,常规治疗组分别为(0.3±0.3) mmol/L、(1.0±0.6) mmol/L、(2.9±1.9) mg/L,差异有统计学意义(均P＜0.01).强化治疗组颈动脉IMT、颈动脉斑块的性质改善(P＜0.01);斑块个数两组均减少,强化治疗组的变化趋势更显著(P＜0.01);强化治疗组颈动脉双侧斑块面积均改善(P＜0.05). 结论 多重危险因素综合干预治疗,可稳定、延缓颈动脉粥样硬化及斑块,老年人常规剂量他汀治疗可使LDLC达到目标值.     

肾小球疾病患者霉酚酸血药浓度监测及其临床意义

目的监测接受霉酚酸酯(MMF)治疗的肾小球疾病患者霉酚酸(MPA,MMF的脱酯活性成分)血药浓度,分析剂量-血药浓度-不良反应的关系,以及血药浓度的影响因素. 方法110例经肾穿刺活检明确诊断的肾小球疾病患者,包括狼疮性肾炎(n=73)、系统性血管炎(n=16)和IgA肾病(n=21).患者分别接受MMF 1.5 g/d(n=74)或2.0 g/d(n=36)治疗后,采用高效液相色谱法(HPLC)测定MPA血药浓度. 结果(1)1.5 g/d和2.0 g/d MMF组MPA 平均血药浓度分别为(44.86±12.89)mg·h/L和(51.29±15.12)mg·h/L,2.0 g/d MMF组明显高于1.5 g/d MMF组(P《0.05).达到有效血药浓度(30～60 mg·h/L)者在1.5 g/d MMF组为78.36%,2.0 g/d MMF组为72.22%.MPA血药浓度《30 mg·h/L比例在1.5 g/d MMF组明显高于2.0 g/d MMF组(P《0.05);》60 mg·h/L比例明显低于2.0 g/d MMF组(P《0.05).(2)1.5 g/d MMF组和2.0 g/d MMF组不良反应发生率相比无统计学差异,但2.0 g/d MMF组有增高的趋势(P》0.05).(3)两组患者MPA 血药浓度与血白蛋白和血肌酐呈显著正相关(P《0.01和P《0.05),与体重呈显著负相关(P《0.01和P《0.05),而与性别和年龄无相关性. 结论肾小球疾病患者无论接受1.5 g/d或2.0 g/d MMF都有70%以上的MPA血药浓度值维持在30～60 mg·h/L有效范围内.但是,服用2.0 g/d MMF的患者MPA血药浓度》60 mg·h/L比例明显高于1.5 g/d MMF,发生不良反应的机会也有增加的趋势.体重、血白蛋白和肾功能均对MPA血药浓度有影响.临床上有必要根据疗效、不良反应,结合上述指标和血药浓度来调整MMF剂量,以期达到最大限度地发挥药物的治疗作用,同时减少不良反应的发生.     

脂质体携载前列腺素E1对冠心病合并糖尿病患者发生造影剂肾病的预防作用

目的 探讨脂质体携载前列腺素E1(PGE1)对冠心病合并糖尿病的患者发生造影剂肾病的预防作用.方法 选取行冠脉造影或介入治疗的合并糖尿病的冠心病患者198例,随机分为对照组和PGE1组.PGE1组在常规治疗的基础上予PGE1 20μg+生理盐水20ml静脉注射,1次/d,共10 d,比较两组造影前、造影后48 h、5d血肌酐(Scr)、尿素(BUN)、胱抑素C(CysC)水平及造影剂肾病发生率等.结果 造影后48 h、5dScr、BUN、Cys C等在PGE1组分别为(113.92±54.89)μmmol/L、(7.85±4.05)mmol/L、(1.38±0.34)mg/L和(86.72±35.26)μmmol/L、(6.61±3.09 )mmol/L、(1.29±0.29)mg/L优于对照组(129.22±50.18)μmmol/L、(9.26±3.95) mmol/L、(1.56±0.23)mg/L和(109.83±31.76)μmmol/L、(8.07±3.11)mmol/L、(1.37±0.21)mg/L,差异有统计学意义(均P＜0.05).经直线相关分析,造影剂剂量与BUN、Scr呈显著正相关(r=0.74,P＜0.05; r=0.82,P＜0.01).结论 PGE1对冠心病合并糖尿病的患者发生造影剂肾病有预防作用.     

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.     

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.