多潘立酮对肝硬化患者门脉系统血流量的影响

背景:肝硬化病程迁延且内外科治疗效果均不理想,寻找有效的治疗药物一直是该领域研究的热点。目的:探讨多潘立酮对肝硬化患者门脉系统血流量的影响。方法:以20名健康人作为正常对照,用多普勒超声分别测定32例肝硬化患者服用多潘立酮前和服用2周后的门静脉、脾静脉和肠系膜上静脉血流参数。多潘立酮的用法为10mg tid口服。结果:多潘立酮治疗前,肝硬化患者的门静脉血流量(PVF)显著低于正常对照组(P<0.01),脾静脉血流量(SVF)和肠系膜上静脉血流量(SMVF)显著高于正常对照组(p<0.01);治疗后,肝硬化患者的PVF较治疗前无显著差异,SVF和SMVF虽显著低于治疗前(P<0.01),但仍高于正常对照组(P<0.05)。结论:多潘立酮可能对肝硬化患者的内脏高动力循环状态有改善作用。     

肠生物反馈对孤立性直肠溃疡综合征患者直肠黏膜血流的影响

目的研究孤立性直肠溃疡综合征(solitary rectal ulcer syndrome,SRUS)患者的直肠黏膜血流变化,并分析肠生物反馈对SRUS患者症状及直肠黏膜血流的影响.方法16例SRUS患者及20例正常对照组,于生物反馈治疗前后分别采用激光多普勒血流计检测16例SRUS患者的直肠黏膜血流量,同时采用标准问卷表分别记录治疗前后症状变化.结果16例中有12例(75%)自觉症状缓解;16例中有5例(31%)结肠镜检查示溃疡愈合;治疗前SRUS患者直肠黏膜血流量明显低于正常对照组(P＜0.01),生物反馈治疗后,治疗组直肠黏膜血流量明显上升(P＜0.01),其中自觉症状缓解者直肠黏膜血流量增加尤为显著(P=0.001).结论肠生物反馈是一种治疗SRUS患者的有效行为疗法,其治疗效果与直肠黏膜血流的增加有关.     

增强型体外反搏对冠心病患者外周循环即时血流动力学影响的临床观察研究

目的观察冠状动脉粥样硬化性心脏病(冠心病)患者在增强型体外反搏(EECP)的作用下,其对外周循环(颈总动脉、肱动脉)血流动力学的即时影响。方法连续入选2018年8月至2018年12月于中山大学附属第八医院(深圳福田)心内科门诊及住院的冠心病患者(n=97),所有患者均进行1次45 min体外反搏治疗,在体外反搏治疗前、中、后使用超声多普勒评价颈总动脉和肱动脉血流动力学参数的变化特性,包括收缩期峰值流速(PSV)、舒张期峰值流速(PDV)、舒张末期流速(EDV)、时间-平均峰值流速(TAMAX)、搏动指数(PI)、阻力指数(RI)和血流量(FR)。结果颈总动脉血流量在反搏过程中升高(P0.01),反搏后仍有上升趋势,而肱动脉血流量在反搏前、反搏中及反搏后差异无显著性(P0.05)。在反搏过程中,PI、RI及PDV均升高(P0.05),而EDV显著降低(P0.01),反搏后均恢复至反搏前水平。PSV、TAMAX在反搏前、反搏中及反搏后差异无显著性(P0.05)。结论 EECP能有效增加颈总动脉及肱动脉舒张期血流速度,并增加颈动脉平均血流量,提示EECP干预对冠心病患者外周循环的血流动力学有积极的影响。     

缩/扩血管活性药物合用对肝硬化门体循环及肝动脉血流动力学的影响

目的探讨血管活性药物血管收缩剂垂体后叶素(VP)单用及与血管扩张剂硝酸甘油(NTG)联合用药对肝硬化患者门脉系统、肝动脉及体循环血流动力学参数的影响.方法应用多普勒超声技术检测41肝硬化患者VP单用及与NTG联合用药时门静脉血流量(Qpv)、肝动脉阻力指数(RI)和体循环平均动脉压(MAP)、心率(HR)的变化;评价其与Child-Pugh肝功能分级的关系.结果A、B、C三级肝硬化组对VP反应性相同,表现为QPv血流量较基础水平明显减少(P＜0.001),而降低幅度相近,约40%(P＞0.05);加用NTG后均未见Qpv进一步减低或增加.A、B、C三级肝硬化患者应用VP静滴后,肝动脉RI均显著增加(P＜0.01);联合应用NTG后,RI较单用VP时有所降低(P＜0.05),但与用药前的基础水平相比,RI仍有所升高(P＜0.05).VP静滴15 min后,MAP升高14.4%,HR降低5.2%;加用NTG后,MAP较VP用药水平降低10.7%、HR增加10.5%(P＜0.001),而且与用药前的基础水平比较无显著性差异.结论不同程度的肝硬化,其门脉系统血流动力学对VP的敏感性一致,门脉高压程度不影响VP降低门脉血流的效应.NTG在VP通过降低门脉血流量发挥降低门脉压方面无相加作用;但作为血管扩张剂,NTG亦无拮抗VP的作用.VP对肝动脉具有直接收缩作用,肝动脉血流阻力增加.NTG能够部分逆转VP导致的肝动脉供血减少.而且NTG与VP联合用药能够逆转或避免VP对体循环的不良影响.     

缩窄性心包炎患者的肺静脉血流特征及其诊断价值

目的 :利用双平面或多平面经食管超声了解缩窄性心包炎 (CP)患者的肺静脉血流 (PVF)特征及其辅助诊断的价值。方法 :对 2 4例经超声或临床诊断为CP而接受心脏手术治疗的患者和 15例正常人的PVF特征进行分析。结果 :①CP患者平静呼气末的PVF较正常显著减少 (P <0 .0 5或 <0 .0 1) ;与之相比 ,吸气时患者肺静脉前向性血流进一步显著减少 ,且以收缩期为著 (P <0 .0 1) ,而心房收缩期血流改变不显著。非CP患者的PVF较正常减少 (P <0 .0 5 ) ,但吸气时无显著改变。②依据M型及二维超声诊断CP的敏感性、特异性分别为76 .5 %、87.5 % ,而结合吸气时收缩分数减少 >2 0 %或收缩期峰值血流速度减少 >30 %和舒张期峰值血流速度减少 >2 0 %诊断CP的敏感性、特异性分别为 94 .1%、10 0 %。结论 :CP患者的PVF表现及吸气时的改变有一定的特异性 ,正确认识有助于CP的诊断     

经胸多普勒超声心动图观察冠状动脉旁路移植术围术期左乳内动脉-左前降支桥血管的血流变化

目的:分析经胸多普勒超声心动图观察左乳内动脉(LIMA)-左前降支(LAD)的吻合的冠状动脉(冠脉)旁路移植术(CABG)围术期LIMA桥的血流变化。方法:选取2015-2016年间于我院心外科接受CABG的患者94例,男性75例(79.8%),平均年龄(63.4±9.6)岁;受试者均术前行经胸多普勒超声检查,均接受了LIMA-LAD的吻合。术中使用瞬时血流测量仪(TTFM)测量LIMA桥的血流量和搏动指数(PI),术后1周出院前再次行经胸多普勒超声检查LIMA桥。结果:LIMA桥的血流量及搏动指数,术后1周[(39.81±23.87)ml/min、(35.86±27.72)ml/min;1.54±0.64、3.05±1.54]均较术前[(27.08±16.48)ml/min、(35.87±39.46)ml/min;4.24±1.50、4.01±1.80]和术中[(28.23±21.00)ml/min;2.78±1.50]均显著增加(P均0.001)。术前双侧乳内动脉直径差异无统计学意义(P=0.425),术后LIMA的直径较右乳内动脉显著增大[(2.26±0.21)mm vs(2.20±0.25)mm,P=0.043)。结论:术后经胸多普勒超声心动图可作为术后早期评估桥血管血流通畅性的重要手段之一,相较于术前和术中,术后1周LIMA桥血流较前明显增加。     

卡维地洛对肝硬化患者肝静脉压力梯度及门静脉系统血流动力学的影响

目的探讨卡维地洛对肝硬化患者门静脉系统血流动力学及肝静脉压力梯度(HVPG)的影响,为卡维地洛治疗门静脉高压的临床应用提供依据。方法入选2010年3月至2011年3月山东省立医院肝硬化门静脉高压合并食管胃静脉曲张患者33例,分别于卡维地洛治疗前、治疗1周后行HVPG测定及门静脉彩色多普勒血流动力学指标检测。结果 30例患者完成治疗前后的HVPG和门静脉系统超声血流动力学指标观察。该30例患者卡维地洛治疗前HVPG(13.02±4.49)mm Hg,1周后降至(10.62±4.86)mm Hg,差异有统计学意义(P=0.002);其中40%(12例)患者HVPG降低至12 mm Hg以下或者HVPG降低幅度达基础值的20%以上。卡维地洛治疗前后门静脉主干内径(DPV)、门静脉主干血流速度(VPV)、门静脉主干血流量(QPV)、脾静脉血流速度(VSV)、脾静脉血流量(QSV)均显著降低(P0.05),而脾静脉内径(DSV),肠系膜上静脉内径(DSMV)、血流速度(VSMV)和血流量(QSMV)变化无统计学意义(P0.05)。有3例患者出现低血压、头晕,其中1例不耐受而停药退出临床试验;未发现哮喘、房室传导阻滞等其他严重不良反应。结论卡维地洛能显著降低肝硬化患者脾静脉和门静脉主干的血流速度和血流量,从而减少门静脉系统的血流灌注,显著降低HVPG,具有潜在的预防静脉曲张破裂出血的应用前景。     

不同部位皮炎湿疹接触性变应原分析

目的了解新疆呼图壁县不同部位皮炎湿疹患者接触性变应原分布情况,为该病的预防和治疗提供依据。方法应用斑贴诊断试剂盒对206例皮炎湿疹患者（手部患者110例,面部患者96例）进行皮肤斑贴试验。结果手部患者斑贴试验阳性率67.3%（74/110）,面部患者阳性率69.8%（67/96）;手部皮炎阳性患者中排在前5位的变应原依次为：橡胶添加剂、白降汞、对苯二胺、香料、硫酸镍;面部皮炎阳性患者中排在前5位的变应原依次为：白降汞、硫酸镍、香料、橡胶添加剂、重铬酸钾;其中橡胶添加剂、硫酸镍的阳性率在不同部位之间差异有统计学意义（χ^2=4.914,P0.05;χ^2=5.132,P〈0.05）,对苯二胺的阳性率在不同部位之间差异有显著性（χ^2=14.701,P=0.000）;手部与面部患者1种变应原阳性率分别为46.4%（51/110）、30.2%（29/96）,2种及以上变应原阳性率分别为20.9%（23/110）、39.6%（38/96）。结论阳性变应原在手部、面部等不同部位的分布有差异,斑贴试验有助于明确不同部位皮炎湿疹患者接触性变应原。     

H2受体阻滞剂联合多潘立酮对肝硬化患者门脉血流的影响

目的:探讨H2受体阻滞剂联合多潘立酮对肝硬化患者门静脉系统血流量的影响.方法:以20名健康人作为正常对照,60例肝硬化患者随机分成3组,分别给予口服高舒达、口服多潘立酮以及联合用药,治疗前后采用多普勒超声测定门静脉(PVF)、脾静脉(SVF)和肠系膜上静脉(SMVF)血流量(mL/min).结果:治疗后,H2受体阻滞剂组的PVF显著高于治疗前(850.23±140.78 vs 695.22±221.44,P＜0.01),SVF和SMVF低于治疗前,但无显著差异.多潘立酮组PVF较治疗前有增高,无显著差异,而SVF和SMVF显著低于治疗前(SVF:598.13±272.33 vs 816.40±279.61,P＜0.05;SMVF:504.23±1 88.54 vs 640.30±200.12,P＜0.05).联合用药组则PVF显著高于治疗前(876.76±178.65 vs 70534±200.15,P＜0.05),而SVF、SMVF显著低于治疗前(SVF:605.33±252.86 vs 798.33±280.45,P＜0.01;SMVF:503.43±175.25 vs 650.19±190.62,P＜0.01).结论:H2受体阻滞剂组及多潘立酮都具有改善门静脉系统血流的作用,联合应用作用更为明显.     

笑/氧混合气吸入镇痛在高龄患者结肠镜诊疗中的应用

[目的]评估笑/氧混合气吸入镇痛在高龄患者结肠镜诊疗中的临床效果。[方法]对43例≥70岁的高龄患者(观察组)在常规结肠镜检查中采用笑/氧混合气吸入镇痛,选择同期常规结肠镜检查的57例≥70岁的高龄患者为对照组。观察2组的镇痛效果及术前、术中、术后患者心率(HR)、血氧饱和度(SpO2)、血压(BP)的变化情况,并记录其疼痛程度。[结果]观察组术中HR、SpO2、BP与对照组比较差异有统计学意义(P0.05),且观察组镇痛效果较对照组显著(P0.05)。[结论]高龄患者结肠镜诊疗时应用笑/氧混合气吸入镇痛快、效果好、操作简便安全。     

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.