卡维地洛改善充慢性心力衰竭患者心功能的临床研究

目的:观察卡维地洛(Carvedilol)治疗慢性心力衰竭(CHF)的临床疗效.方法:将80例NYHA心功能Ⅱ～Ⅳ级CHF患者随机分为两组:Carvedilol组40例,采用常规治疗(ACEI、利尿剂、血管扩张剂、有或无洋地黄) Carvedilol;Betaloc组40例,常规治疗 Betaloc.随访1～2年,观察两组治疗前后血流动力学、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)、6 min步行距离(6-MWD)及心功能变化. 结果:两组治疗后心率(HR)、收缩压(SBP)、心肌耗氧量(HR×SBP)、LVEDD、LVESD、LVEF、左室短轴缩短分数(LVFS)、NYHA心功能分级均较治疗前显著改善(P＜0.01),而Carvedilol组在血流动力学及心功能改善上较Betaloc组更明显(P＜0.05);但治疗后组间HR降低无显著差异(P＞0.05).两组治疗后6-MWD也均较治疗前显著增加(P＜0.01),尤其Carvedilol组(P＜0.05).Carvedilol组无不良反应出现. 结论:联用Carvedilol治疗CHF安全有效.     

卡维地洛治疗慢性心力衰竭疗效观察

目的观察卡维地洛治疗慢性心力衰竭(CHF)的临床疗效。方法将120例CHF患者随机分为治疗组和对照组。对照组采用常规治疗,治疗组在对照组治疗基础上加用卡维地洛。分别检测两组患者治疗前后心率(HR)、左室后壁厚度(LVP)、室间隔厚度(IVS)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)及左室射血分数(LVEF)。结果与对照组治疗后比较,治疗组HR明显减慢,LVP、IVS厚度明显减小,LVEDD、LVESD明显减小,LVEF明显增加(P0.05)。结论卡维地洛具有逆转左室重构和改善心功能的作用。     

美托洛尔治疗慢性心力衰竭的临床疗效观察

目的：观察酒石酸美托洛尔治疗慢性心力衰竭（CHF）的临床疗效及安全性。方法：将66例慢性心力衰竭患者随机分成两组,治疗组33例给予内科常规抗心力衰竭治疗,对照组33例在常规治疗的基础上加用酒石酸美托洛尔治疗。治疗前后观察静息心率（HR）、收缩压（SBP）、舒张压（DBP）、心功能级别、左室舒张末内径（LVEDD）、左室收缩末期内径（LVESD）左室射血分数（LVEF）。结果：两组患者的各项指标在治疗后均较治疗前有明显改善,但治疗组较对照组改善更为显著,其临床疗效优于对照组（P〈0．05）。结论：酒石酸美托洛尔可明显改善CHF患者心功能,提高生存率,是一种安全、有效的临床治疗方法。     

益心舒治疗冠心病慢性心力衰竭临床观察

目的：评价益心舒胶囊对冠心病慢性心力衰竭（CHF）患者的临床疗效。方法：选择80例冠心病CHF患者,随机分为对照组（40例）,益心舒组（40例,常规治疗的基础上加服益心舒胶囊1．2g,3次／d）,服用6个月后观察两组治疗前后NYHA心功能、左室射血分数（LVEF）、左室收缩末期内径（LVESD）、左室舒张末期内径（LVEDD）、6min步行试验、24h心肌缺血发作次数以及再住院率和病死率。结果：益心舒组总有效率（95％）优于对照组（65％）,NYHA心功能、LVEF、LVESD、6min步行试验、24h心肌缺血发作次数较对照组有显著改善（P〈0．05～〈0．01）,益心舒组的再住院率较对照组明显降低（15％：40％,P〈0．05）．但病死率两组无显著差异,未发现与药物相关的不良反应。结论：在常规治疗冠心病心衰的基础上加用益心舒,可进一步提高疗效,改善心功能。     

马来酸依那普利联合阿替洛尔对慢性心力衰竭患者心功能的影响

目的探讨马来酸依那普利联合阿替洛尔对慢性心力衰竭(CHF)患者心功能的影响。方法选取2015年1月—2017年5月南方医科大学第五附属医院收治的CHF患者150例,采用随机数字表法分为对照组和观察组,每组75例。对照组患者采用常规治疗,观察组患者在常规治疗基础上口服马来酸依那普利片联合阿替洛尔片;两组患者均连续治疗3周。比较两组患者治疗前后心功能指标[包括左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、收缩压(SBP)、舒张压(DBP)、心率(HR)]、临床疗效及治疗期间不良反应发生情况。结果治疗前两组患者LVEF、LVEDD、LVESD、SBP、DBP、HR比较,差异无统计学意义(P>0.05);治疗后观察组患者LVEF高于对照组,LVEDD、LVESD、SBP、DBP、HR低于对照组(P<0.05),且治疗后两组患者LVEF均高于治疗前,LVEDD、LVESD、SBP、DBP、HR均低于治疗前(P<0.05)。观察组患者临床疗效优于对照组(P<0.05)。两组患者治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。结论马来酸依那普利联合阿替洛尔治疗CHF的临床疗效确切,可有效改善患者心功能,且安全性较高。     

替米沙坦联合辛伐他汀治疗慢性充血性心衰的疗效观察

目的 观察替米沙坦联合辛伐他汀治疗慢性充血性心力衰竭（CHF）的疗效.方法 将114例CHF患者随机分为替米沙坦＋辛伐他汀治疗组（联合治疗组）、辛伐他汀组和常规对照组,各组均38例,随访180 d,观察治疗前、后NYHA心功能分级,以超声心动图检测左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）、左室射血分数（LVEF）及E/A,观察治疗效果.结果 联合治疗组总有效率92.1%,优于辛伐他汀组（78.9%）和常规对照组（65.8%）（P＜0.05）. LVEF、LVEDD改变辛伐他汀组优于常规对照组（P＜0.05）,与常规治疗组比较,联合治疗组LVEDD、LVESD、LVEF及E/A改变更加显著（P＜0.05）.结论 替米沙坦联合辛伐他汀治疗CHF比单用辛伐他汀的临床疗效更好.     

托拉塞米联合环磷腺苷葡胺治疗老年慢性心功能不全的应用价值

目的分析托拉塞米联合环磷腺苷葡胺治疗老年慢性心功能不全(CHF)的临床应用价值。方法抽选老年CHF患者126例,数字标注盲法分组,观察组63例,给予托拉塞米联合环磷腺苷葡胺治疗;对照组63例,仅常规抗心力衰竭干预,对比两组临床疗效。结果观察组用药2 w后,左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)及血浆脑钠肽(BNP)改善效果均明显优于对照组(P0. 05);观察组临床疗效显著优于对照组(P0. 05);两组不良反应发生率差异无统计学意义(P0. 05)。结论老年CHF给予托拉塞米联合环磷腺苷葡胺治疗疗效确切,短期内改善心功能,减少不良反应,安全性高。     

增强型体外反搏联合曲美他嗪对冠心病慢性心力衰竭病人心功能的影响

目的探讨增强型体外反搏联合曲美他嗪治疗对冠心病慢性心力衰竭病人心功能的影响。方法 120例病人按随机数字表法分为对照组及治疗组。对照组给予常规抗心力衰竭治疗;治疗组在对照组基础上给予增强型体外反搏及曲美他嗪治疗,疗程均为3个月。比较两组治疗前后的左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)、6 min步行试验(6MWT)、N末端脑钠肽前体(NT-proBNP)、美国纽约心脏病协会(NYHA)心功能分级等。结果治疗后两组的LVEDD、LVESD及NT-proBNP较治疗前明显下降(P0.05),LVEF、6WMT及NYHA心功能分级较治疗前明显改善(P0.05),且与对照组相比,治疗组的LVEDD、LVESD及NT-proBNP显著下降(P0.05),LVEF、6WMT明显升高(P0.05),治疗有效率明显升高(P0.05)。结论增强型体外反搏联合曲美他嗪治疗冠心病慢性心力衰竭,可显著提高LVEF,改善心功能。     

比索洛尔联合曲美他嗪对高龄冠心病心力衰竭患者心肌重塑的影响

目的探讨比索洛尔联合曲美他嗪对高龄冠心病心力衰竭患者心肌重塑的影响。方法选择高龄冠心病心力衰竭患者60例,按照随机数字表法分为研究组和对照组,对照组采用曲美他嗪,研究组在常规治疗的基础上加用比索洛尔,比较两组治疗效果、不良反应及心功能[左室射血分数(LVEF)]、心肌重塑[左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)]情况。结果研究组治疗总有效率(90. 0%)明显高于对照组(66. 7%,P0. 05)。两组均未发生明显不良反应,顺利完成治疗。治疗前两组LVEF及LVEDD、LVESD比较差异无统计学意义(P0. 05);治疗后两组LVEF均明显升高,LVEDD、LVESD均明显缩小,但研究组LVEF明显高于对照组,LVEDD、LVESD明显小于对照组(均P0. 05)。结论比索洛尔辅助治疗高龄冠心病心力衰竭,能够改善心功能,降低心肌重塑风险,提高治疗效果。     

美托洛尔治疗慢性充血性心力衰竭38例临床疗效分析

目的观察美托洛尔治疗慢性充血性心力衰竭(chronic hear failure,CHF)的安全性、有效性及对心功能的影响。方法将我院收治的76例CHF患者随机分为对照组和观察组各38例,对照组患者采用CHF常规治疗:强心、利尿、扩张血管,观察组患者在同对照组治疗的基础上加用美托洛尔治疗。比较两组患者治疗总有效率,左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)、左室射血分数(LVEF)、每搏输出量(SV)、心率(HR)等变化。结果观察组临床疗效优于对照组(P=0.020)。治疗后两组LVEDD、LVESD、LVEF、SV、HR等指标均优于治疗前(P均<0.05);观察组LVEF改善程度较对照组更明显(P<0.05)。两组患者均无明显不良反应。结论美托洛尔治疗CHF安全有效,无明显的不良反应。     

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.