替比夫定治疗 HBeAg 阳性慢性乙型肝炎疗效的 Meta 分析

目的：评价替比夫定治疗 HBeAg 阳性慢性乙型肝炎的疗效。方法通过检索近10年 PubMED、Science Direct、EBSCO Host、EMbase、The Cochrane Library、中国学术期刊全文数据库、万方数据库、维普中文科技期刊全文数据库,对纳入研究的方法学进行评价。研究者对纳入文献的质量进行严格评价和资料提取,使用 Review manager 5．0软件对符合质量标准的 RCTs 行系统评价。结果12个 RCT 共纳入1379例患者,其中治疗组693例（使用替比夫定）,对照组686例（219例使用恩替卡韦、216例使用阿德福韦酯、251例使用拉米夫定）,系统评价结果显示,相比恩替卡韦组,治疗组可显著提升 HBeAg 阳性慢性乙型肝炎患者的 HBV DNA 低于检测下限率（RR＝1．23、95％CI1．01～1．49）、提升 ALT 复常率（RR＝1．41、95％CI1．02～1．95）、提升 HBeAg 血清转阴率（RR＝1．34、95％CI1．03～1．74）;相比阿德福韦酯组,治疗组可显著提升 HBeAg 阳性慢性乙型肝炎患者的 HBV DNA 低于检测下限率（RR＝1．24、95％CI1．03～1．48）、提升 ALT 复常率（RR＝1．25、95％CI1．02～1．52）、提升 HBeAg 血清转阴率（RR＝1．65、95％CI1．05～2．61）;相比拉米夫定组,治疗组可显著提升 HBeAg 阳性慢性乙型肝炎患者的 HBV DNA 低于检测下限率（RR＝1．72、95％CI1．31～2．25）、提升 ALT 复常率（RR＝1．23、95％CI 1．00～1．50）、提升 HBeAg 血清转阴率（RR＝1．53、95％CI1．12～2．08）。结论替比夫定治疗 HBeAg 阳性慢性乙型肝炎的疗效显著,值得推广。     

人血白蛋白与人工胶体对肝硬化腹水患者引流后疗效比较的Meta分析

目的评估肝硬化合并腹水患者引流后输注白蛋白与人工胶体的疗效差别。方法计算机检索lochrane Library(1993年-2018年2月)、PubMed (1966年-2018年2月)、Embase (1990年-2018年2月)、中国期刊全文数据库(1994年-2018年2月)、中国生物医学文献数据库(1978年-2018年2月)、中文科技期刊数据库(1989年-2018年2月)、中华医学会数字化期刊库(1997年-2018年2月),同时手检相关期刊和会议论文集,纳入有关肝硬化合并腹水患者腹水引流后输注白蛋白与人工胶体的的随机对照试验,按Jadad改良法Cochran系统评价方法提取资料、评价文献质量并进行统计学分析,数据采用RevMan5. 3软件进行Meta分析。结果共纳入7篇随机对照试验,共696例患者,其中人血白蛋白组299例,人工胶体组397例。Meta分析结果显示,白蛋白组低钠血症发生率低于人工胶体组,差异有统计学意义[11. 04%vs 20. 4%,相对危险度(RR)=0. 58,95%可信区间(95%CI):0. 40~0. 84,P=0. 004];对于并发症肾损伤、肝性脑病、消化道出血、腹腔感染、住院病死率的发生,差异均无统计学意义(7. 02%vs 7. 81%,RR=0. 93,95%CI:0. 53~1. 65,P=0. 82; 6. 77%vs 7. 45%,RR=0. 87,95%CI:0. 48~1. 55,P=0. 63;3. 91%vs 3. 65%,RR=0. 97,95%CI:0. 43~2. 22,P=0. 95; 5. 22%vs 4. 56%,RR=1. 07,95%CI:0. 52~2. 18,P=0. 86;12. 78%vs 14. 59%,RR=0. 70,95%CI:0. 47~1. 02,P=0. 06)。结论输注人血白蛋白在预防肝硬化腹水患者腹水引流后低钠血症方面有优势。     

静脉滴注白蛋白预防自发性腹膜炎肾功能减退的研究

目的：探讨静脉滴注白蛋白以提高血容量能否预防肾功能进一步减退,从而降低自发性腹膜炎的病死率。方法：112例肝硬化腹水并发自发性腹膜炎患者随机分成两组进行对照研究,A组56例,用头孢三嗪静脉滴注治疗,B组56例,用头孢三嗪＋白蛋白静脉滴注治疗,总疗程3周,测定患者治疗前后的血清肌酐及血尿素氮变化情况以评价肾功能,结果：A组患者的肾功能损害发病率为33．9％（19／56）,B组为8．9％（5／56）,B组患者的发病率明显低于A组（P＝0．002）,A组患者的院内病死率为30．4％（17／56）,B组为8．9％（5／56）,B组患者的院内病死率也明显低于A组（P＝0．01）,结论：在使用抗生素的同时静脉滴注白蛋白可减少肝硬化自发性腹膜炎患者肾功能损害的发病率,从而降低其病死率。     

益生菌对炎症性肠病诱导缓解、维持治疗和贮袋炎作用系统评价

目的 评价益生菌对炎症性肠病缓解、维持治疗和贮袋炎的作用。方法 检索MEDLINE，EMBASE，the Cochrane Con—trolled Trials Register，OVID，BIOSIS和中国生物科技数据库，两位作者独立选取和炎症性肠病缓解率、复发率以及副作用相关的，对比益生菌治疗和非益生菌治疗的随机对照试验，使用Rev Man4．2．10软件统计分析，同时做亚组分析和敏感性分析。结果21项随机对照试验中共有1515例患者符合入选标准：4项研究评估了缓解率，14项研究评估了复发率，3项研究同时评估了缓解率和复发率。通过荟萃分析，炎症性肠病的总体缓解率相对危险度（relativerisk，RR）为1．05（95％CI=0．84—1．31），克罗恩病的缓解率RR0．85（95％CI=0．64—1．13），溃疡性结肠炎的缓解率RR1．18（95％CI=0．87—1．58）；贮袋炎临床复发率RR0．24（95％CI=0．12—0．48），克罗恩病临床复发率RR1．11（95％CI=0．69—1．80）；内镜复发率的RR1．08（95％CI=0．67—1．74）；益生菌与安慰剂比较，炎症性肠病的复发率RR0．51（95％CI=0．29—0．92）；益生菌与5-氨基水杨酸比较，溃疡性结肠炎的复发率RR0．96（95％CI=0．76—1．19）。结论 溃疡性结肠炎患者使用益生菌作为缓解治疗具有和5-氨基水杨酸相同的效果并优于安慰剂，但在炎症性肠病的诱导缓解中无额外益处。     

血清补体C3和C4预测慢性乙型肝炎肝组织病理学状态的价值

目的探讨血清补体C3和C4预测慢性乙型肝炎肝组织炎症活动度和纤维化程度的价值。方法416例经肝组织病理学检查的慢性乙型肝炎患者人选本研究。血清补体C3和C4采用Beckman—Coulter Immage800免疫化学系统及其配套试剂测定。结果血清补体C3和C4预测显著炎症（≥G2）、中度炎症（≥G3）、重度炎症（=G4）的ROC曲线下面积分别为0．602（95％CI：0．545—0．659）和0．550（95％CI：0．489—0．611）、0．620（95％CI：0．559～0．681）和0．606（95％CI：0．547～0．666）、0．803（95％cI：0．670—0．937）和0．654（95％CI：0．486～0．823）;预测显著纤维化（≥S2）、严重纤维化（≥S3）、肝硬化（=S4）的ROC曲线下面积分别为0．590（95％CI：0．531～0．649）和0．582（95％CI：0．519～0．644）、0．665（95％CI：0．612～0．718）和0．655（95％CI：0．602～0．707）、0．669（95％CI：0．603—0．736）和0．670（95％CI：0．607～0．734）。血清补体C3和C4预测重度炎症和肝硬化的最佳截断值分别为≤0．58g／L和≤0．12g／L,其对应的灵敏度、特异度、准确度分别为0．750和0．480、0．797和0．792、0．796和0．719。结论血清补体C3和C4分别对慢性乙型肝炎肝组织重度炎症和肝硬化有一定的预测价值。     

动态心电图在心力衰竭患者预后中的预测价值

目的探讨动态心电图（AECG）在心力衰竭患者预后中的价值。方法本研究回顾性分析了心功能不全患者78例，每例患者都有完整的临床资料和AECG资料并进行了随访。采用多元Logistic回归模型建立回归方程进行危险因素的筛选。结果在132例患者中，死亡21人。在多元Logistic回归模型中，心力衰竭的危险因素包括年龄（RR：1．02；95％CI：1．01～1．03）、低射血分数（RR：0．963；95％CI：0．948～0．982）、心率过快（RR：1．05；95％CI：1．04～1．07）、心率范围较小（RR：0．973；95％CI：0．961～0．984）、阵发性房颤（RR：1．21；95％CI：1．15～1．28）和非持续性室速（RR：1．31；95％CI：1．22～1．37）。结论AECG所监测的心率范围、阵发性房颤以及非持续性室速是心力衰竭患者死亡的危险因素。因此，AECG在心力衰竭患者的预后中有参考价值。     

白细胞介素4和受体基因多态性与乙型肝炎肝硬化易感性的关系

目的：探讨白细胞介素4（IL-4）及受体（IL-4R）基因多态性与乙型肝炎肝硬化易感性的关系。方法：应用聚合酶链反应．限制性片断长度多态性（PCR—RFLP）分析方法，检测124例健康人群和100例乙型肝炎肝硬化患者IL-4基因启动区．589C／T及IL-4Rα链576位点谷氨酰胺／精氨酸（Q／R）这两个多态性位点，确定其基因型和等位基因频率的分布。结果：肝硬化组与对照组IL-4-589C／T位点其基因型和等位基因频率差异无显著性意义（P〉0．05），而肝硬化组IL-4Rα仅576R中RR基因型和R576等位基因频率与对照组相比差异具有显著性意义（P〈0．05，P〈0．01），Q等位基因相对于R等位基因患肝硬化的机会比为0．569（95％CI：0．332～0．963）。结论：IL-4Rα亚单位Q576R与乙型肝炎肝硬化易感有关，RR基因型携带者肝硬化易感性高，而IL-4—589位点基因多态性与乙型肝炎肝硬化无相关性。     

应用cox回归模型分析脑白质疏松症对病死率的影响

目的：探讨脑白质疏松症（LA）对老年人病死率的影响。方法：按1：1病例对照,对69例老年LA患者与无LA对照组进行5年的随访调查,统计2组病死率,并采用cox回归模型进行多因素分析,以调查LA对老年人病死率的影响。结果：LA组5年病死率显著高于对照组（分别为60．9％及33．3％,P＜0．01）,cox回归分析表明：LA独立于高血压,既往脑卒中病史,心脏病及糖尿病史为老年人死亡的独立危险因素（RR＝1．90;95％可信区间1．11－3．22,P＝0．019）。结论：LA为老年人死亡的独立危险因素。     

他汀类药物对高血压与非高血压病人减少心血管并发症同样有效

应用他汀类药物对高血压与非高血压病人都能减少心血管病发生率与死亡率。作者分析1985年至今，12个安慰剂-对照随机研究，追踪69989名病人≥2年，终点是：心性或心血管性死亡，主要冠脉事件。他汀治疗减少心性死亡率24％[相对危险比（RR）为0．76；95％CI为0．71～0．823，高血压病人RR为0．78（95％CI为0．72～0．84），     

尿KIM-1对心脏术后急性肾损伤的早期诊断价值

目的：评估尿肾损伤分子1（KIM-1）在心脏术后急性肾损伤（AKI）早期诊断中的应用价值。方法通过计算机检索Medline、Cochrane图书馆、EMBASE、Web of Science Database、Elsevier Science Direct Database、 CNKI、VIP数据库、万方数据库,查阅KIM-1早期诊断心脏术后AKI的临床试验,采用诊断精确性研究的质量评估方法（QUADAS）评价文献质量,Stata12．0和Meta-Disc1．4软件进行数据分析。结果共纳入9篇符合标准的诊断性研究,QUADAS得分均﹥9分,Spearman异质性检验r＝0．622、 P＝0．074,发表偏倚Egger线性回归法定量分析P＝0．001;敏感性分析的合并敏感度为0．87（95％CI为0．81～0．92）、P＝0．5776、I2＝0,特异度为0．78（95％CI为0．74～0．81）、P＝0．000、I2＝87．1％,阳性似然比为4．07（95％CI为2．70～7．12）、P＝0．000、I2＝78．2％,阴性似然比为0．19（95％CI为0．13～0．28）、P＝0．7303、I2＝0．0％,诊断比值比为28．03（95％CI为15．95～49．27）、P＝0．8640、I2＝0,汇总受试者工作曲线下面积（AUC）为0．9155。结论尿KIM-1在心脏术后（6～12h）诊断AKI的准确性较高。     

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.