枯草杆菌二联活菌肠溶胶囊结合马来酸曲美布汀治疗功能性腹泻的临床疗效观察

[目的]观察枯草杆菌二联活菌肠溶胶囊结合马来酸曲美布汀治疗功能性腹泻的临床疗效。[方法]将63例患者分为2组,治疗组31例,对照组32例,治疗组给予枯草杆菌二联活菌肠溶胶囊结合马来酸曲美布汀治疗,对照组给予马来酸曲美布汀,疗程4周,观察2组患者治疗前后临床疗效及血清胃泌素、胃动素水平并随访。[结果]2组患者临床疗效比较,治疗组总有效率93.45%,对照组总有效率87.5%,2组比较差异有统计学意义（P〈0.05）;2组患者治疗后血清胃泌素、胃动素明显下降,与治疗前比较,差异有统计学意义（P〈0.05）,治疗组下降更为明显,2组患者治疗后同期比较,差异有统计学意义（P〈0.05）;治疗第1周、第2周2组患者腹泻次数比较差异无统计学意义,治疗第3周、第4周2组患者腹泻次数比较,治疗组腹泻次数明显减少,与对照组比较,差异有统计学意义（P〈0.05）。疗程结束后2个月随访,治疗组复发2例,复发率6.5%,对照组复发7例,复发率21.9%,2组患者复发率比较,差异有统计学意义（P〈0.05）。[结论]枯草杆菌二联活菌肠溶胶囊结合马来酸曲美布汀治疗功能性腹泻所取得的临床效果明显优于单纯使用马来酸曲美布汀治疗所取得的效果,并且预后良好,值得推广。     

马来酸曲美布汀联合硝酸异山梨酯治疗原发性贲门失弛缓症的疗效

原发性贲门失弛缓症尚无有效的治疗方法。目的：评价马来酸曲美布汀联合硝酸异山梨酯治疗原发性贲门失弛缓症的临床疗效。方法：54例原发性贲门失弛缓症患者分为治疗组和对照组，治疗组予马来酸曲美布汀200mg tid和硝酸异山梨酯10mg tid，对照组予硝苯地平10mg tid和硝酸异山梨酯10mg tid，疗程均为15d。结果：治疗后，治疗组的总有效率显著高于对照组（P〈0．01）；两组患者的症状显著改善（P〈0．05或P〈0．01），其中治疗组吞咽困难和反食的评分显著低于对照组（P〈0．05）。结论：马来酸曲美布汀联合硝酸异山梨酯能有效改善原发性贲门失弛缓症的吞咽困难和反食症状，其临床疗效明显优于硝酸异山梨酯联合硝苯地平。     

马来酸曲美布汀联合地衣芽孢杆菌治疗腹泻型肠易激综合征疗效分析

目的探讨马来酸曲美布汀联合地衣芽孢杆菌治疗腹泻型肠易激综合征（IBS）的临床疗效。方法将125例腹泻型IBS患者随机分为3组，A组给予曲美布汀及地衣芽孢杆菌，B组单用曲美布汀，C组单用地衣芽孢杆菌，疗程4周，观察各组临床疗效。结果A组临床总有效率为96．2％，B组临床总有效率为60．0％，C组临床总有效率为48．5％，三组疗效比较，P〈0．05，差异有统计学意义。结论马来酸曲美布汀联合地衣芽孢杆菌治疗腹泻型IBS有明显的协同作用，临床疗效确切，可推广应用。     

奥美拉唑联合马来酸曲美布汀治疗反流性食管炎30例

[目的]观察奥美拉唑联合马来酸曲美布汀治疗反流性食管炎（RE）的临床疗效。[方法358例患者随机分为2组,观察组30例,予奥美拉唑20rng,每日2次,马来酸曲美布汀0．1g,每日3次口服;对照组28例：予马来酸曲美布汀0．1g,每日3次口服。疗程均8周,观察烧心、反酸、胸痛等症状,并复查胃镜下愈合率。[结果]观察组临床总有效率100％,内镜下总有效率96．7％;对照组为75．0％及71．4％,2组比较差异有统计学意义（P〈0．05）。[结论]奥美拉唑联合马来酸曲美布汀治疗RE具有较好的疗效。     

马来酸曲美布汀联合双歧四联活菌胶囊治疗肠易激综合征60例临床观察

目的观察马来酸曲美布汀联合双歧四联活茵胶囊治疗肠易激综合征的临床疗效。方法选取60例肠易激综合征患者且给予马来酸曲关布汀片联合双歧四联活茵胶囊（试验组）,另外选取60例肠易激综合征患者采取常规治疗方法（对照组）,同时对两组患者治疗效果进行观察与相关数据统计和评估。结果试验组患者在第1个疗程结束时总有效率迭90．00％,在第2个疗程时达95．00％,对照组则在第一个疗程结束时总有效率达71．67％,第二个疗程时达75．00％,且试验组患者无论近期效果、还是远期效果均好于对照组（P〈0．05）。结论马来酸曲美布汀片联合双歧杆茵四联活菌胶囊治疗肠易激综合征效果显著,是一种行之有效的治疗方案。     

马来酸曲美布汀联合谷维素治疗肠易激综合征72例疗效观察

目的观察马来酸曲美布汀联合谷维素治疗肠易激综合征（IBS）的I}缶床疗效及安全性。方法将同期收治的146例IBS患者随机分为观察组72例和对照组74例。两组均停用其他治疗IBS的药物,禁用影响胃肠功能药物,均予马来酸曲美布汀口服,200mg／次、3次／d。观察组在此基础上加服谷维素,100ms／次、3次／d,均以4周为1个疗程。观察治疗后IBS症状变化及药物不良反应。结果观察组总有效率显著高于对照组（P〈0．01）;两组不良反应发生率无显著差异。结论马来酸曲美布汀联合谷维素治疗IBS效果显著,安全性高。     

马来酸曲美布汀对结肠平滑肌细胞钙激活钾通道的影响

目的研究马来酸曲美布汀对豚鼠结肠平滑肌细胞膜钙激活钾通道的影响。方法酶解法急性分离单个豚鼠结肠平滑肌细胞,利用膜片钳技术在全细胞模式下记录钙激活钾电流[IK（ca）],用含有IK（ca）特异激动剂NS1619的生理盐水灌流细胞,使结肠平滑肌细胞处于超极化状态,检测给马来酸曲美布汀浓度分别为1．19μmol／L、5．95μmol／L、11．91μmol／L后的结肠平滑肌细胞膜IK（ca）。结果浓度为1．19μmol／L、5．95μmol／L、11．91μmol／L的马来酸曲美布汀可抑制豚鼠单个结肠平滑肌细胞膜IK（ca）（P均〈0．01）,当阶跃刺激为＋80mv时,其分别为超极化状态组的（65．87±4．80）％、（48．02±2．39）％、（18．88±2．29）％（P均〈0．01）。结论马来酸曲美布汀能抑制豚鼠结肠平滑肌细胞钙激活钾通道的开放,使细胞兴奋性升高,且呈浓度依赖性,这可能是马来酸曲美布汀治疗肠易激综合征便秘症状的机制之一。     

马来酸曲美布汀联合复方消化酶胶囊治疗便秘型肠易激综合征

目的 观察马来酸曲美布汀联合复方消化酶胶囊治疗便秘型肠易激综合征的临床疗效及安全性.方法 将符合罗马Ⅲ标准的138例便秘型肠易激综合征患者随机分为治疗组72例和对照组66例.治疗组用马来酸曲美布汀片200mg/次,3次/d,复方消化酶胶囊2粒/次,3次/d;对照组单用马来酸曲美布汀片200mg/次,3次/d,疗程均为4周.结果 4周后两组腹痛、腹胀均有明显改善.治疗组腹痛、腹胀缓解总有效率分别为97.2％、98.6％.对照组腹痛、腹胀缓解总有效率分别为84.8％、87.8％.两组Bristol粪便性状分型均明显改善,治疗组对腹痛、腹胀及便秘的改善比对照组更为明显,差异有统计学意义（P＜0.05）.两组不良反应的差异无统计学意义.结论 马来酸曲美布汀联合复方消化酶胶囊可有效治疗便秘型肠易激综合征,且安全性高,值得临床推广应用.     

马来酸曲美布汀联合复方阿嗪米特治疗功能性消化不良疗效观察

目的观察马来酸曲美布汀联合复方阿嗪米特肠溶片治疗功能性消化不良的疗效。方法将确诊为功能性消化不良的患者120例分成3组,观察组（A 组）40例,给予马来酸曲美布汀、复方阿嗪米特肠溶片口服;对照组（B 组）40例,单用马来酸曲美布汀口服;对照组（C 组）40例,单用复方阿嗪米特肠溶片口服,疗程均为4周。观察患者治疗前后腹胀及上腹部不适症状的改善情况。结果3组患者治疗后腹胀及上腹部不适症状改善均有统计学意义（P ＜0．05）,观察组较对照组症状改善明显。结论马来酸曲美布汀和复方阿嗪米特肠溶片联合治疗消化不良,疗效优于单用马来酸曲美布汀和复方阿嗪米特肠溶片。     

马来酸曲美布汀联合复方消化酶对老年肠易激综合征患者临床症状及其对P物质、生长抑素及降钙素基因相肽的影响

[目的]探究复方消化酶胶囊联合马来酸曲美布汀对老年肠易激综合征患者临床症状及其对P物质（SP）、生长抑素（SS）及降钙素基因相肽（CGRP）的影响。[方法]选择2012年9月-2015年9月我院消化内科收治的90例老年肠易激综合征患者,随机将患者分为对照组和观察组,每组各45例。对照组患者给予莫沙必利治疗,观察组患者则在上述治疗的基础上给予复方消化酶胶囊联合马来酸曲美布汀治疗,对比2组患者临床疗效、SP、SS及CGRP水平及其药物不良反应。[结果]观察组患者临床疗效明显优于对照组（P〈0.05）;治疗6周后,观察组患者血浆SP、SS和CGRP水平分别为（43.28±15.24）pg/L、（10.39±2.24）pg/L、（51.16±8.38）pg/ml,对照组血浆SP、SS和CGRP水平分别为（72.86±14.45）pg/L、（14.11±2.15）pg/L、（65.65±9.29）pg/ml,2组血浆SP、SS和CGRP水平均较治疗前下降（P〈0.05）,观察组下降更明显（P〈0.05）;观察组患者药物不良反应发生率明显低于对照组的（P〈0.05）。[结论]复方消化酶胶囊联合马来酸曲美布汀治疗能够有效改善老年肠易激综合征患者临床症状,降低患者体内SP、SS和CGRP水平,该方案具有临床疗效确切、安全高效和不良反应少等特点。     

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.