完全控制的支气管哮喘患者肺功能和气道高反应性测定

目的检测完全控制的支气管哮喘患者肺功能和气道反应,探讨其临床意义。方法选择71例完全控制的支气管哮喘患者,测定肺功能和气道反应性。选择30名急性发作期支气管哮喘患者和15名健康老年人作为对照。结果71例完全控制的支气管哮喘患者中,49例(84.5%)支气管激发试验阳性,9例(15.5%)支气管激发试验阴性。完全控制哮喘组和哮喘组患者FEV1占预计值%和FEV1/FVC分比较差异有统计学意义(P0.01);完全控制哮喘组和健康对照组受试对象FEV1占预计值%和FEV1/FVC比较差异无统计学意义(P0.05)。结论完全控制的支气管哮喘患者多数存在气道高反应性,测定患者气道反应性有助于指导哮喘治疗。     

沙美特罗替卡松联合布地奈德治疗支气管哮喘的临床疗效观察

目的探讨沙美特罗替卡松联合布地奈德治疗支气管哮喘的临床疗效。方法选择2010年2月—2013年2月韶关市第三人民医院收治的支气管哮喘患者80例,随机分为试验组和对照组,各40例。在对症治疗的基础上对照组患者给予布地奈德治疗,试验组患者给予沙美特罗替卡松联合布地奈德治疗,均连续治疗7 d为1个疗程。比较两组患者治疗前后肺功能指标,包括:呼气峰值流速占预计值的百分比(PEF%)和第一秒用力呼气末容积/用力肺活量占预计值的百分比(FEV1/FVC%)[3];记录两组患者临床症状消失时间,临床症状包括:肺部啰音、喘息、呼吸困难及咳嗽;评定两组患者临床疗效。结果治疗前两组患者PEF%和FEV1/FVC%比较,差异无统计学意义(P0.05);治疗后试验组患者PEF%和FEV1/FVC%高于对照组(P0.05)。试验组患者肺部啰音、喘息、呼吸困难及咳嗽消失时间均短于对照组(P0.05);试验组患者总有效率为90%,高于对照组的80%(P0.05)。结论沙美特罗替卡松联合布地奈德治疗支气管哮喘疗效显著,能有效改善患者肺功能及临床症状。     

布地奈德雾化吸入治疗妊娠期支气管哮喘的临床疗效观察

目的观察布地奈德雾化吸入治疗妊娠期支气管哮喘的临床疗效。方法选取2010年1月—2014年3月九江学院附属医院呼吸内科收治的妊娠期支气管哮喘急性发作患者90例,按照随机化原则分为对照组和观察组,各45例。两组患者均给予常规治疗,观察组患者在常规治疗基础上给予布地奈德雾化吸入治疗。观察两组患者喘憋消失时间、哮鸣音消失时间及住院时间;检测两组患者治疗前后肺功能指标〔第1秒用力呼气末容积占正常预计值百分比(FEV1%)、FEV1/用力肺活量(FEV1/FVC%)及最大呼气流量占正常预计值百分比(PEF%)〕;检测两组患者治疗前后血尿常规、肝肾功能,观察药物不良反应发生情况。结果观察组患者喘憋消失时间、哮鸣音消失时间及住院时间均短于对照组(P0.05)。两组患者治疗前FEV1%、FEV1/FVC%及PEF%比较,差异无统计学意义(P0.05);观察组患者治疗后FEV1%、FEV1/FVC%及PEF%均高于对照组(P0.05)。两组患者治疗期间均未出现血尿常规、肝肾功能异常及明显不良反应。结论布地奈德雾化吸入能有效改善妊娠期支气管哮喘患者哮喘症状及肺功能,且安全性较高。     

布地奈德雾化吸入治疗妊娠期支气管哮喘的临床疗效观察

目的 观察布地奈德雾化吸入治疗妊娠期支气管哮喘的临床疗效。方法 选取2010年1月—2014年3月九江学院附属医院呼吸内科收治的妊娠期支气管哮喘急性发作患者90例,按照随机化原则分为对照组和观察组,各45例。两组患者均给予常规治疗,观察组患者在常规治疗基础上给予布地奈德雾化吸入治疗。观察两组患者喘憋消失时间、哮鸣音消失时间及住院时间;检测两组患者治疗前后肺功能指标〔第1秒用力呼气末容积占正常预计值百分比(FEV1%)、FEV1/用力肺活量(FEV1/FVC%)及最大呼气流量占正常预计值百分比(PEF%)〕;检测两组患者治疗前后血尿常规、肝肾功能,观察药物不良反应发生情况。结果 观察组患者喘憋消失时间、哮鸣音消失时间及住院时间均短于对照组(P<0.05)。两组患者治疗前FEV1%、FEV1/FVC%及PEF%比较,差异无统计学意义(P>0.05);观察组患者治疗后FEV1%、FEV1/FVC%及PEF%均高于对照组(P<0.05)。两组患者治疗期间均未出现血尿常规、肝肾功能异常及明显不良反应。结论 布地奈德雾化吸入能有效改善妊娠期支气管哮喘患者哮喘症状及肺功能,且安全性较高。     

肺功能及哮喘控制测试(ACT)在哮喘患者管理中的价值

目的探讨肺功能及哮喘控制测试在支气管哮喘患者管理中的价值。方法将肺功能及ACT应用于支气管哮喘患者136例。每月填写1次ACT,在哮喘患者应用ACT前药物治疗时、应用ACT 6个月结束时测定第1秒用力呼气量(FEV1)、FEV1占预计值百分比(FEV1%预计值)和用力肺活量(FVC)、FVC占预计值百分比(FVC%预计值),同时测定ACT评分观察哮喘患者在药物治疗、肺功能检查,应用ACT 6个月末时ACT使用率、治疗的依从性、哮喘控制情况。结果每月1次坚持应用ACT 132例,使用率97%;坚持使用规范的治疗128例,治疗依从性达94%;症状完全控制率达47%,良好控制率达74.2%。ACT评分治疗6个月后较入选时升高,肺功能指标亦有明显改善,FEV1与ACT评分呈正相关(r=0.82,P<0.01)。结论肺功能及ACT用于支气管哮喘患者的管理能提高患者对治疗的依从性和哮喘控制率。     

胃食管反流病对哮喘患者肺功能影响的研究

目的探讨胃食管反流病对哮喘患者肺功能的影响。 方法收集2015年5月至2017年8月新疆维吾尔自治区人民医院收治并确诊哮喘226例患者的临床资料,根据是否合并有胃食管反流病(GERD)患者分为GERD组102例和非GERD组124例,比较2组患者FEV1占预计值%、FVC占预计值%及FEV1 /FVC%等肺功能指标。 结果GERD发生率45.1%(102/226),GERD组患者FEV1占预计值%、FVC占预计值%及FEV1/FVC%,明显低于非GERD组,差异有统计学意义(P<0.05)。 结论哮喘与GERD密切相关,GERD对哮喘患者肺功能影响大,GERD与哮喘是因果还是伴随关系仍需进一步研究。     

重组抗IgE人源化单克隆抗体治疗支气管哮喘急性发作期的疗效

目的通过检测肺功能来评价重组抗Ig E人源化单克隆抗体治疗支气管哮喘急性发作期的疗效。方法采用酶联免疫吸附法(ELISA)检测患者血清中Ig E水平,每2 w或4 w给予Ig E抗体皮下注射,检测患者肺功能(FVC、FEV1、FEV1/FVC%、MMEF75/25),评价重组抗Ig E人源化单克隆抗体治疗支气管哮喘急性发作期的疗效。结果治疗后FVC、FEV1、FEV1/FVC%,MMEF75/25较治疗前比较差异显著(P0.05),三组间无差异(P0.05)。结论重组抗Ig E人源化单克隆抗体治疗轻中重支气管哮喘急性发作期均有效,但轻、中、重度急性治疗效果三组间无明显差异。     

桂哌齐特注射液联合无创正压通气对慢性肺心病急性发作期患者临床疗效及血栓前状态的影响

目的观察桂哌齐特注射液联合无创正压通气对慢性肺心病患者临床疗效及血栓前状态(PTS)的影响。方法 77例慢性肺心病患者按随机对照法分成对照组(n=42)和治疗组(n=35),对照组予肺心病常规治疗及无创正压机械通气(NIPPV),治疗组在此基础上加用桂哌齐特注射液320 mg静滴,1次/d,疗程均为14 d。观察治疗前后患者肺功能、血气分析及PTS指标的变化。结果最终有72例患者完成研究(对照组40例,治疗组32例)。治疗前,两组肺功能[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1占预计值百分比(FEV1%)、FEV1/FVC%)]、血气分析[pH值、动脉血二氧化碳分压(PaCO_2)及氧分压(PaO_2)]及PTS指标[血管性假血友病因子(vWF)、D-二聚体(D-D)及内皮素(ET)-1]差异均无统计学意义(P0.05)。治疗后,两组肺功能指标(FEV1、FVC、FEV1%、FEV1/FVC%)及动脉血pH值、PaO_2均较治疗前明显上升(P0.01,P0.05);动脉血PaCO_2及血清vWF、D-D及ET-1含量均较治疗前明显下降(P0.01,P0.05);与对照组比较,治疗组肺功能、血气分析及PTS指标改善更明显(P0.01,P0.05)。结论桂哌齐特注射液能协同NIPPV改善肺心病患者PTS、肺功能及血气指标,比单用NIPPV具有更好的临床效果。     

中药辅助治疗支气管哮喘急性发作50例疗效观察

目的探讨射干麻黄汤联合小青龙汤辅助治疗支气管哮喘急性发作的临床疗效。方法选取2012年1月至2014年1月收治的支气管哮喘患者100例,随机分为观察组和对照组,每组50例。对照组患者予常规西医治疗。观察组患者在同对照组患者治疗的基础上加用射干麻黄汤联合小青龙汤辅助治疗。2周后比较两组患者的临床疗效以及两组患者治疗前后FEV1、FVC、PEF及中医症候积分的变化。结果观察组患者治疗总有效率(96.0%)显著高于对照组患者(78.0%),两组比较差异有统计学意义(P0.01),秩和检验结果显示观察组患者临床疗效显著优于对照组患者(P0.05)。治疗后两组患者的FEV1、FVC、PEF均较治疗前显著升高,且观察组患者的FEV1、FVC、PEF明显高于对照组患者,差异有统计学意义(P0.01)。治疗后两组患者的中医症候积分均较治疗前明显降低,观察组患者治疗后的中医症候积分显著低于对照组,差异有统计学意义(P0.01)。结论射干麻黄汤联合小青龙汤辅助治疗支气管哮喘急性发作能明显提高疗效,明显改善患者的临床症状及肺功能,值得推广和应用。     

布地奈德联合硫酸特布他林治疗支气管哮喘急性发作的效果分析

目的探讨布地奈德联合硫酸特布他林治疗支气管哮喘急性发作的临床效果。方法将76例支气管哮喘急性发作患者随机分为两组,对照组给予常规综合治疗,观察组给予布地奈德与硫酸特布他林联合雾化吸入治疗,观察两组患者临床症状消失时间及肺功能改善情况,并评价临床疗效。结果观察组患者气促、憋喘、哮鸣音、咳嗽等临床症状消失时间均明显短于对照组(P0.05);经治疗后,两组患者FEV1/FVC%和PEP均较治疗前明显改善(P0.05),而观察组改善程度明显优于对照组(P0.05),观察组患者疗效优于对照组,差异具有统计学意义(P0.05)。结论布地奈德联合硫酸特布他林雾化吸入治疗支气管哮喘急性发作患者临床疗效显著,能迅速缓解哮喘,明显改善肺通气功能,值得临床推广应用。     

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.