缺血性脑血管病患者血浆肾上腺髓质素与内皮素的测定及其临床意义

目的　监测缺血性脑血管病患者血浆肾上腺髓质素 (ADM)含量变化及其与血浆内皮素 (ET- 1)的关系 ,探讨其在缺血性脑血管病发生发展中的作用及其临床意义。方法　应用放射免疫法测定 88例缺血性脑血管病患者 (包括 4 0例脑梗死和 4 8例腔隙性脑梗死 )和 4 5例正常对照者的血浆 ADM和 ET- 1含量。结果　缺血性脑血管病组患者血浆 ADM含量及 ET- 1含量均高于正常对照组含量 (P<0 .0 5 ) ;脑梗死组血浆 ADM水平高于腔隙性脑梗死组的水平 (P<0 .0 5 ) ;缺血性脑血管病组血浆 ADM水平与血浆 ET- 1呈显著正相关 (r=0 .5 85 ,P<0 .0 5 )。结论　肾上腺髓质素参与了缺血性脑血管病的发生发展过程 ,可能对缺血性脑组织有保护作用。血浆ADM可作为脑梗死患者血管内皮损伤程度的指标之一     

非糖尿病的2型糖尿病一级亲属血浆内皮素水平的研究

目的　研究 2型糖尿病 (T2 DM)及非糖尿病的 T2 DM的一级亲属 (FDRs)血浆内皮素 - 1 (ET- 1 )的变化 ,并探讨其与胰岛素抵抗(IR)、血脂、血糖、病程、吸烟以及糖尿病大血管并发症的关系。方法　测定 31例正常人 ,48例一级亲属 ,51例 T2 DM的血浆 ET- 1值。结果　胰岛素敏感指数 (IAI)在对照组、FDRs、T2 DM组逐渐降低 ,且有显著差异 (P<0 .0 5)。FDRs和 DM组血浆 ET- 1显著高于对照组 (P<0 .0 5)。血浆 ET- 1与IAI呈显著负相关 (r=- 0 .2 98,P<0 .0 1 )。在 T2 DM组血浆 ET- 1与病程呈正相关 (r=0 .353,P=0 .0 1 3) ,伴高血压、冠心病及周围血管病变的糖尿病患者与无并发症的糖尿病患者 ET- 1水平无显著差异。有糖尿病家族史者比无糖尿病家族史者血浆 ET- 1水平升高 (P<0 .0 5)。结论　 T2 DM及非糖尿病的 2型糖尿病一级亲属血浆 ET- 1升高。     

慢性充血性心力衰竭患者血浆中C-反应蛋白、肾上腺髓质素及内皮素水平变化的研究

目的 :以血浆 C-反应蛋白 ( CRP)的浓度作为体内细胞因子激活程度的指标 ,研究心力衰竭时细胞因子激活后 CRP的变化及对肾上腺髓质素 ( ADM)及内皮素 - 1( ET- 1)等血管活性物质的影响。　　方法 :CRP采用散射比浊法测定 ,ET- 1及 ADM采用放射免疫分析法测定。对 3 0例失代偿性心功能衰竭患者 (为心力衰竭组 )及 2 5例心功能正常的原发性高血压患者 (为心功能代偿组 )血浆 CRP、ADM及 ET- 1的浓度进行测定。　　结果 :心力衰竭组血浆 CRP、ADM及 ET- 1浓度较心功能代偿组均明显升高 ;在心力衰竭组 ,不同心功能 ( NYHA)分级的患者随心功能衰竭加重 ,血浆 CRP及 ADM的浓度均有所升高 ,而 ET- 1浓度在不同心功能分级的患者中无显著差异 ;心力衰竭组患者血浆 CRP浓度及 ADM浓度呈正相关。　　结论 :慢性充血性心力衰竭患者体内存在着细胞因子、ADM及 ET- 1的激活 ,细胞因子活化可能通过促进 ADM等的合成作用于心力衰竭的体液调节 ,但与 ET- 1的活化没有明显的关系。     

阻塞性睡眠呼吸暂停低通气综合征患者ET-1、ADM相关性研究

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清内皮素(ET-1)、肾上腺素质素(ADM)水平变化及意义.方法 选择确诊为OSAHS患者38例,其中轻度组12例、中度组13例、重度组13例,选择14例健康者为健康对照组.采用ELISA法测定血清ET-1、ADM.结果 OSAHS组血清ET-1、ADM水平均高于正常对照组(P<0.05).血清ET-1、ADM水平随OSAHS严重程度增高而升高(P<0.05).ET-1、ADM变化与睡眠呼吸暂停低通气指数(AHI)、PSG指数最低SaO2呈负相关,ET-1与ADM 呈正相关.结论 OSAHS患者的血清ET-1、ADM水平反映了夜间睡眠呼吸紊乱所致血管内皮功能异常,可能与OSAHS的发病有一定关系.     

慢性肺心病患者血浆尾加压素Ⅱ、肾上腺髓质素水平的变化及家庭氧疗的影响

目的探讨慢性肺心病患者血浆肾上腺髓质素（ADM）和尾加压素Ⅱ（UⅡ）的变化及其临床意义,并观察家庭氧疗对ADM、UⅡ水平的影响。方法测定84例慢性肺心病患者急性加重期和缓解期血浆ADM、UⅡ、内皮素-1（ET-1）水平及动脉血氧分压（PaO2）、平均肺动脉压（mPAP）,并与40例当地健康人对照。出院后42例患者接受家庭氧疗（治疗组）,34例未氧疗（对照组）,随访6周后复测上述指标。结果急性加重期和缓解期血浆ADM、UⅡ均显著高于健康正常组（P均〈0．01）,急性发作期均高于缓解期（P均〈0．01）。急性期和缓解期血浆ADM、UⅡ均与PaO2呈显著负相关,与ET-1及mPAP呈显著正相关。6周后,治疗组ADM、UⅡ、mPAP均显著低于对照组（P均〈0．05）,而PaO2显著高于对照组（P〈0．05）。结论血浆ADM、UⅡ可能参与了肺心病的病理生理过程。氧疗可能通过对ADM、ET-1、UⅡ水平起调节作用进而改善症状及提高患者生存质量。     

老年高血压患者肾上腺髓质素与肾功能损害的关系

目的研究老年原发性高血压(EH)患者血浆肾上腺髓质素(ADM)水平的变化及其与肾功能损害的关系。方法用放射免疫法测定老年EH患者(其中高血压1级16例、2级22例、伴肾功能损害者14例)与健康对照者的血浆ADM水平,比较不同组间血浆ADM水平的差异,直线相关分析老年EH患者血浆ADM与血清肌酐(Cr)水平的关系。结果老年EH患者血浆ADM水平显著高于对照组,但1级与2级高血压组间血浆ADM水平无显著差别;老年EH伴肾功能损害组血浆ADM水平显著高于肾功能正常组;老年EH患者血浆ADM水平与血清Cr水平呈显著正相关(P<005)。结论老年EH患者血浆ADM水平显著升高,老年EH患者血浆ADM水平与血压分级无关但与肾功能损害进展有关。     

冠心病患者血浆肾上腺髓质素与内皮素的变化

目的探讨冠心病患者血浆肾上腺髓质素(ADM)、内皮素(ET-1)含量的变化及其与心功能的关系.方法应用放射免疫法测定92例冠心病患者和30名正常对照者(对照组)血浆ADM和ET-1水平,同时用彩色超声心动图测定40例急性心肌梗塞患者(AMI组)的左心室射血分数.结果冠心病各组血浆ADM水平均高于对照组(P<0.05);AMI组血浆ADM显著高于不稳定性心绞痛组(UA组)和稳定性心绞痛组(SA组)(P<0.05),而UA组与SA组比较差异无显著性(P>0.05),AMI患者按心功能分组,各组间血浆ADM差异有显著性(P<0.05).血浆ADM水平与ET-1呈显著正相关(r=0.5743,P<0.01);AMI组血浆ADM水平与左心室射血分数呈显著负相关(r=-0.6152,P<0.01).结论 ADM参与了冠心病及心力衰竭的病理生理过程,血浆ADM升高可能与ET-1升高有关.     

充血性心力衰竭患者血浆Apelin水平及其与肾上腺髓质素和血管紧张素Ⅱ的关系

目的:研究充血性心力衰竭患者在不同心功能状态下及治疗前后血浆Apelin水平,及其与肾上腺髓质素(ADM)和血管紧张素Ⅱ(AngⅡ)含量之间的关系。方法:用放射免疫法测定30例心力衰竭患者和25例心功能正常的血浆Apelin和ADM、AngⅡ含量。结果:①心力衰竭患者血浆Apelin和ADM、AngⅡ含量均较心功能正常明显增高(P<0·05,P<0·01),且随心功能级别增高而升高(P<0·01)。②心功能改善后,血浆Apelin和ADM、AngⅡ含量较治疗前显著下降(P<0·01),但仍高于心功能正常组(P<0·05,P<0·01)。③心力衰竭患者治疗前及治疗后血浆Apelin和ADM、AngⅡ含量均呈显著正相关。结论:血浆Apelin含量能反映心力衰竭程度;Apelin可能与ADM、AngⅡ一起参与心力衰竭的发生发展。     

妊娠期高血压疾病患者血浆肾上腺髓质素和血管紧张素Ⅱ的变化

目的 探讨肾上腺髓质素(ADM)及血管紧张素Ⅱ(AngⅡ)在妊娠期高血压疾病患者和正常晚孕期妇女及未妊娠妇女血浆中含量的变化.方法 采用放射免疫法测定妊娠期高血压疾病患者、正常晚孕期妇女及未妊娠妇女血浆中ADM及AngⅡ含量.结果 妊娠期高血压疾病组血浆ADM和AngⅡ的含量明显高于正常妊娠组(P<0.05);妊娠期高血压疾病患者血浆ADM和AngⅡ水平:子痫前期重度>子痫前期轻度>妊娠期高血压,三者间比较,差异有统计学意义(P<0.05).未妊娠组与正常妊娠组血浆ADM与AngⅡ两组比较具有统计学意义(P<0.05).结论 ADM与AngⅡ参与妊娠期高血压疾病的病理生理过程,血浆ADM升高可能与AngⅡ含量升高有关.     

肾上腺髓质素等血管活性物质与原发性高血压遗传关系的研究

目的　研究血管活性物质肾上腺髓质素 (ADM )和肾素 (PRA)、血管紧张素Ⅱ (ATⅡ )及醛固酮 (ALD)在有原发性高血压 (EH)家族史的健康子女中的作用和意义。方法　 6 0例有EH家族史的健康子女作为研究组 ,其中 30例为双亲均患EH(双亲组 ) ,30例为父或母亲患EH(单亲组 ) ,2 0例无EH家族史的健康子女为对照组 ,放射免疫法测定各组血浆ADM、PRA、ATⅡ及ALD的含量。结果　血浆ADM、PRA、ATⅡ、ALD的水平在研究组明显高于正常对照组 (P <0 .0 1) ,而在双亲组与单亲组之间差别无统计学意义 (P >0 .0 5 )。血浆ADM与ATⅡ水平呈正相关(r=0 .5 10 ,P <0 .0 5 )。结论　有EH家族史的健康子女因遗传因素的影响在血压升高之前 ,已出现血管活性物质改变 ,缩血管因子和扩血管因子失衡可能导致高血压的发生和发展     

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.