2008年上海农村社区50岁以上人群脑血流动力学指标与卒中危险因素的关系

目的 了解上海农村社区≥50岁人群脑血管功能状况,分析卒中危险因素对脑血流动力学指标（CVHI）的影响。方法以整群抽样的方法,于2008年4-12月抽取上海奉贤区某农村社区50～74岁的人群,检测CVHI,并调查卒中危险因素的暴露情况。观察所研究人群的CVHI分布特征,并分析卒中危险因素对CVHI综合积分值（分值越低脑血管功能损害越严重）的影响。结果纳入调查且资料完整的调查对象为8350人（男3585人,女4765人）。①在反映脑血流动力学的指标中,双侧颈总动脉的平均血流量,最大、最小及平均血流速度,舒张压与临界压的差值,随年龄增加而降低;而外周阻力、特性阻抗、脉搏波速、动态阻力、临界压的数值则随年龄的增加而呈上升趋势。②无卒中危险因素、单纯高血压、糖尿病、心脏病、短暂性脑缺血发作、其他因素（血脂异常、肥胖、卒中家族史3种因素中至少有1种）者的CVHI综合积分值分别为92±15、79±25、69±32、76±28、77±28、77±27（F=164．475,P〈0．01）;脑血流动力学异常者（CVHI〈75分）分别占10．1％、30．1％、45．5％、37．7％、33．8％及32．7％。结论上海农村社区≥50岁人群的脑血管功能损害受卒中危险因素暴露的影响,糖尿病患者的脑血管功能损害最严重,并且年龄越大脑血管功能损害越严重。     

颈内动脉系统短暂性脑缺血发作病人血流动力学的研究

目的探讨颈内动脉系统短暂性脑缺血发作（TIA）病人的脑血流动力，学指标（CVDI）和血液流变学改变及其临床意义。方法对46例颈内动脉系统TIA病人在末次发作后24h内进行脑血流动力学和血液流变学检查。结果TIA组与对照组比较，平均血流量（Qmean）、平均血流速度明显下降（P〈0．05或P〈0．01）；脑血管阻力、特性阻抗（Zc）、脉搏波波速（WV）、动态阻力（LR）、临界压力（CP）都增高（P〈0．01）。病灶侧与病灶对侧比较,脑血管阻力（R）和脑动脉弹性值都增高，病灶侧平均脑血流量下降，血管自身调节功能减退。TIA组的全血黏度、血浆黏度及红细胞聚集性各指标与对照组比较均明显增高（P〈0．01）。结论脑血流动力学障碍是引起颈内动脉系统短暂性脑缺血发作的机制之一。     

急性卒中期患者脑血管血液动力学检测分析

检测55例患者,在发病1周内进行脑血液动力学指标(CVHD)检测。结果:全部患者的CVHD的积分值在75分以下,中位数32.5分。与正常男性70岁年龄组CVHD测定值比较,平均血流速度、血流量、最大血流速度、最小血流速度和舒张压与临界压的差值均有明显降低(P<0.01),而脉搏波速、外周阻力、特异     

超声检测无症状性脑梗死脑血流动力学指标变化的临床意义

目的观察无症状性脑梗死患者脑血管血流动力学指标(CVHI)变化的临床意义。方法回顾性纳入180例行超声检测脑血管血流动力学和头部MRI检查的研究对象,分为3组,60例无症状性脑梗死患者作为无症状性脑梗死(SCI)组,年龄、性别及既往史与之相匹配的有脑血管病高危因素者60例作为脑血管病高危因素(CV-HRF)组,60名同期体检的健康者作为对照组。采用脑血管功能检测仪在双侧颈动脉处采集CVHI,分析比较3组对象CVHI的特征。结果 SCI组、CV-HRF组分别与对照组比较,脑血管血流动力学各项指标差异均有统计学意义,反映脑血管供血状态的指标,包括平均血流量、平均血流速度、最大血流速度、最小血流速度均明显减慢(均P0.05);反映血管弹性特征和阻力状况的指标,包括脉搏波速、特性阻抗、外周阻力、动态阻力均明显上升(均P0.05);反映脑微循环的指标差压下降、临界压力明显上升,差异均有统计学意义(均P0.05);脑血管功能总积分明显下降,分别为(44±9)、(51±5)、(85±7)分,3组总积分值比较差异有统计意义(P0.05)。结论 SCI和CV-HRF患者均出现CVHI变化,脑血管功能总积分值下降,SCI患者更明显,提示CVHI检测对卒中的发生可显示出较好的预警作用。     

脑安胶囊对320例卒中高危患者的干预效果

目的评价脑安胶囊对卒中高危患者的中长期干预效果。方法在门诊与住院患者中,筛选出有高血压、心脏病、糖尿病、血脂异常、卒中家族史等危险因素,同时年龄≥40岁、脑血管血流动力学参数（CVHP）积分〈75分者320例,按随机数字法分为脑安胶囊组162例及阿司匹林组158例。脑安胶囊组口服脑安胶囊,2次/d,2粒/次;阿司匹林组口服拜阿司匹林,100mg/次,1次/d。干预时间均为24～36个月。每年随访1次,随访内容为血压、血脂、CVHP积分的水平以及卒中的发病率及病死率。结果①脑安胶囊组累积随访470人年,卒中发生率和病死率分别为1.915%和0.851%;阿司匹林组累积随访460人年,卒中发生率和病死率分别为4.130%和2.391%。脑安胶囊组卒中综合发生率及病死率均低于阿司匹林组（P〈0.05）。②脑安胶囊组干预前、后,收缩压为（162±11）、（130±7）mmHg,舒张压为（101±9）、（83±6）mmHg,CVHP积分值为（49±13）、（82±9）;阿司匹林组干预前、后,收缩压为（161±10）、（137±5）mmHg,舒张压为（99±7）、（90±4）mmHg,CVHP积分值为（49±12）、（70±11）。两组干预后收缩压、舒张压及CVHP积分值差异均有统计学意义（P〈0.01）。结论脑安胶囊可以降低卒中的发生率和病死率,改善脑血管功能。在卒中高危人群一级预防中长期疗效优于阿司匹林。     

急性卒中期患者脑血管血液动力学检测分析

目的探讨卒中急性期患者脑血管血液动力学(CVHD)指标的特征及其临床意义.方法选择经头颅CT或MRI确诊的55例急性期脑卒中患者,在发病1周内进行CVHD检测,分析各检测指标的特征.结果全部患者的CVHD的积分值均在75分以下,中位数32.5分.与正常男性70岁年龄组CVHD测定值比较,平均血流速度、血流量、最大血流速度、最小血流速度和舒张压与临界压的差值均有明显降低(P<0.01),而脉搏波速、外周阻力、特异性阻抗、以及临界压水平均有显著升高(P<0.01).结论卒中发病一周内脑血管血液动力学积分值降低,各项检测指标均有明显的改变.CVHD检测能较敏感地反映脑血管供血不足或预警卒中发生.     

急性卒中期患者脑血管血液动力学检测分析

目的　探讨卒中急性期患者脑血管血液动力学 (CVHD)指标的特征及其临床意义。方法　选择经头颅CT或MRI确诊的 5 5例急性期脑卒中患者 ,在发病 1周内进行CVHD检测 ,分析各检测指标的特征。结果　全部患者的CVHD的积分值均在 75分以下 ,中位数 32 .5分。与正常男性 70岁年龄组CVHD测定值比较 ,平均血流速度、血流量、最大血流速度、最小血流速度和舒张压与临界压的差值均有明显降低 (P <0 .0 1) ,而脉搏波速、外周阻力、特异性阻抗、以及临界压水平均有显著升高(P <0 .0 1)。结论　卒中发病一周内脑血管血液动力学积分值降低 ,各项检测指标均有明显的改变。CVHD检测能较敏感地反映脑血管供血不足或预警卒中发生     

老年体检人群心电图异常与脑血管血流动力学的关系研究

目的 分析老年体检人群心电图（ECG）异常与脑血管血流动力学的关系。方法 选取2020年6—8月在上海市奉贤区金汇镇泰日社区卫生服务中心参加健康体检的6 613例老年人作为研究对象，查阅老年人的体检资料，记录其人口学特征（性别和年龄）、ECG异常情况、脑血管功能积分及脑血流动力学指标。根据ECG检查情况将老年人分为ECG异常组（n=1 327）和ECG正常组（n=5 286）。根据脑血管功能积分将老年人分为高危组（<75分，n=2 674）和非高危组（≥75分，n=3 939）。老年体检人群脑血管功能积分的影响因素分析采用多因素Logistic回归分析。结果 ECG异常组脑血管功能积分及左侧和右侧平均流量、脉压差低于ECG正常组，左侧和右侧平均流速、最大流速、最小流速慢于ECG正常组，左侧和右侧脉搏波速快于ECG正常组，左侧和右侧特性阻抗、外周阻力、动态阻力、临界压高于ECG正常组（P<0.05）。高危组和非高危组性别、年龄及左心室肥厚、心房颤动、陈旧性心肌梗死、ST段压低、T波低平或倒置、心肌缺血检出率比较，差异有统计学意义（P<0.05）。多因素Logistic回...     

血压水平与脑血管血流动力学变化趋势

目的:分析和探讨不同血压水平脑血管血流动力学(CVHD)积分和各参数的变化趋势.方法:以整群抽样的方法选择上海市奉贤区某镇40岁以上的常住人口10 565例进行血压和CVHD检测.按高血压定义和分类标准进行分组,即正常血压、正常高值、高血压1级、高血压2级、高血压3级以及单纯性收缩期高血压,比较各组间CVHD积分及各单项指标的差异.结果:上述各组CVHD积分值分别为87.69±21.82、83.13±23.14、69.61±29.35、56.91±28.12、41.69±27.56和67.48±29.65;脑血管平均血流速度、最大血流速度、最小血流速度随着血压水平的增高而呈减慢趋势;脉搏波速、外周阻力、特异性阻抗、动态阻力、临界压水平随着血压水平的增高呈升高趋势.结论:随着血压水平的增高,CVHD损害呈现渐进加重趋势.     

老年睡眠呼吸暂停综合征患者脑血流变化的研究

目的研究睡眠呼吸暂停综合征（ＳＡＳ）对脑血流及其脑功能的影响。方法选择年龄、性别和基础疾病相配对的老年患者，ＳＡＳ组３０例，对照组３２例。ＳＡＳ经多导睡眠监测仪检查而诊断。用阿克松多功能彩超仪检测双侧大脑前、中、后动脉的血流速度和频谱形态。结果ＳＡＳ组与对照组的收缩期血流峰值（Ｖｓ）、舒张期血流峰值（Ｖｄ）、平均血流速度（Ｖｍ）、阻力指数（ＲＩ）等９项指标均有显著差异（Ｐ＜０．０５～Ｐ＜０．０１），ＳＡＳ组血流频谱形态异常增多。结论ＳＡＳ患者脑血流速度减慢，频谱形态异常增多，提示ＳＡＳ可促发脑供血不足、脑动脉硬化，易导致缺血性脑卒中等脑血管疾病的发生     

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.