终末期肝病模型评估肝硬化失代偿期患者的短期预后

目的评价终末期肝病模型（MELD）、MELD-Na、Child-Turcotte-Pugh（CTP）和包含血肌酐值的CTP（CrCTP）评分对肝硬化失代偿期患者短期预后的价值。方法选择265例具有完整住院资料和随访结果的肝硬化失代偿期患者为研究对象,分别计算每例患者人院后首次MELD、MELD-Na、CTP及CrCTP评分,并了解其3个月内的病死率。以受试者工作特征曲线（ROC）下面积（AUC）衡量各评分系统判断患者3个月生存的能力。结果 3个月内有58例死亡。死亡组MELD、MELD-Na、CTP及CrCTP分值（分别为22.15±5.67、31.45±8.50、11.60±2.70、12.72±2.54）均高于生存组（分别为12.35±3.56、17.24±4.75、8.73±2.35、9.05±2.50）（P〈0.01）,两组在MELD分值和CTP分级的分布上差异具有统计学意义（P〈0.01）。MELD、MELD-Na、CTP及CrCTP评分对肝硬化失代偿期患者3个月预后评估的ROC曲线下面积分别为0.875、0.868、0.758、0.794,MELD评估患者短期预后价值优于CTP评分（P〈0.05）,MELD与MELD-Na、CrCTP评分差异无统计学意义。结论 MELD、MELD-Na、CTP及CrCTP模型均可有效预测肝硬化失代偿期患者的短期预后;MELD评估患者短期预后价值优于CTP;在CTP中引入血肌酐值即CrCTP评分可以提高对患者短期预后判断力。     

多种评分方法对失代偿性肝硬化患者死亡危险的预测价值

目的比较CTP分级、终末期肝病模型(MELD)评分、MELD-Na评分及iMELD评分对失代偿性肝硬化患者3个月死亡危险的预测价值。方法回顾性分析249例肝硬化失代偿期患者的临床资料,按照入院之日起3个月是否存活分为存活组和死亡组,对其CTP评分、MELD评分、MELD-Na评分及iMELD评分进行统计学分析。结果 249例中有77例患者3个月内死亡,存活组(172例,69.1%)与死亡组(77例,30.9%)进行比较,CTP分级、MELD评分、MELD-Na评分、iMELD评分在存活组与死亡组之间差异均有统计学意义(P<0.01)。iMELD评分的分辨力优于CTP评分、MELD评分、MELD-Na评分。结论 CTP分级、MELD评分、MELD-Na评分、iMELD评分对肝硬化失代偿期患者3个月死亡危险均有判断价值,iMELD评分预测价值更佳。     

肝硬化失代偿期空腹血糖变化观察

目的观察肝硬化失代偿期患者空腹血糖值变化及终末期肝病模型(MELD)分值与空腹血糖值的相关性。方法收集120例肝硬化失代偿期患者,按研究开始时是否死亡分为死亡组及生存组,记录死亡组距死亡时间6个月内任何时间点前18、12、6个月及生存组距2009年3月起之前的任何时间点前18、12、6个月空腹血糖值、Child-Turcotte-Pugh(CTP)分级及MELD评分。结果死亡组CTP分级随时间多呈进行性上升或不变,生存组CTP分级随时间多呈不变或波动(P=0.000);死亡组空腹血糖值在死亡前18个月内随时间呈进行性下降,生存组空腹血糖值在生存期18个月内随时间呈波动上升(P=0.000);死亡组MELD评分和空腹血糖值呈负相关,评分每增加1分,空腹血糖值平均降低0.08 mmol/L;生存组MELD评分和空腹血糖值无显著相关性;死亡组距死亡时间前6个月时空腹血糖平均值为(4.36±0.81)mmol/L。结论肝硬化失代偿期患者在死亡前18个月内空腹血糖值有进行性下降的变化趋势,且其MELD评分和空腹血糖值呈负相关。CTP分级进行性上升至C级且伴空腹血糖进行性下降至(4.36±0.81)mmol/L时,可能提示近期(6个月)预后差。     

终末期肝病模型对肝硬化失代偿期患者预后的预测价值

目的评估终末期肝病模型（MELD）、终末期肝病模型联合Na评分（MELD-Na）、终末期肝病模型评分／血钠比值（MESO指数）、Child-Pugh（CTP）分值对失代偿期肝硬化患者预后的预测价值。方法对140例失代偿期肝硬化患者进行回顾性分析。分别比较3、6及12个月内死亡组和存活组之间的MELD评分、MELD-Na评分、MESO指数及CTP分值,并用受试者工作曲线（ROC）及曲线下面积（AUC）比较MELD、MELD—Na评分、MESO指数和CTP分值判断肝硬化患者预后的准确性并获取最佳临界值。结果在随访的3、6及12个月内死亡组和存活组MELD、MELD—Na、MESO及CTP评分比较有显著差异,在判断患者3、6及12个月生存率的ROC曲线Auc比较中,MELD—Na评分与MESO指数、MELD评分及CTP分值比较具有统计学意义差异（P〈O．05）。而MELD评分与Child-Pugh分值比较差异无统计学意义（P〉0．05）。结论MELD—Na评分、MESO、MELD及CTP均能较好预测肝硬化失代偿期患者预后,其中MELD—Na仍是以上预测失代偿期肝硬化预后中最具优势的评分模型。     

MELD和MELD-Na评分系统评估失代偿期肝硬化患者预后的研究

目的比较Child-Pugh(CTP)分级、终末期肝病模型(Model for End-stage Liver Disease,MELD)评分系统及MELD联合血清钠(MELD-Na)对失代偿期肝硬化患者3、6、12个月死亡危险的预测价值。方法入选151例肝硬化失代偿期患者,根据随访3、6、12个月的存活情况,分别观察CTP分级、MELD评分及MELD-Na对肝硬化失代偿期患者死亡率的预测情况。结果151例入选病例中,随访至3个月时,不论是CTP、MELD还是MELD-Na随着各相应分值的增高,生存率均显著降低(P0.01),提示CTP、MELD及MELD-Na均能较好地预测患者短期生存率。随访至6个月及12个月时患者生存率的变化仍可见到这种趋势。本研究应用C-统计学分析,通过CTP、MELD及MELD-Na对比发现,随访至3个月时,CTP、MELD、MELD-Na的AUC分别为0.819、0.835、0.842;随访至6个月时AUC值为0.820、0.818、0.832;随访至12个月时AUC分别为0.795、0.795、0.814。MELD-Na的数值均高于CTP及MELD,但统计学无显著差异。结论CTP、MELD和MELD-Na均可以对终末期肝病患者预后做出较准确的判断。MELD-Na在预测肝硬化失代偿期患者短期生存率方面有一定优势。     

终末期肝病模型及Child-Pugh分级对肝硬化患者的短期预后分析

评价终末期肝病模型(MELD)评分、Child-Pugh(CTP)及包含血肌酐值的CTP(CrCTP)分级对肝硬化患者的短期预后的意义.分别计算104例肝硬化患者的MELD、CTP及CrCTP分值,运用ROC曲线及曲线下面积(AUC)比较MELD评分、CTP及CrCTP分级判断肝硬化患者3个月生存率的准确性.在判断患者3个月生存率的ROC曲线AUC比较中,MELD评分＞CrCTP分级＞CTP分级(P＜0.05).提示在CTP中引入血肌酐值可以提高CTP分级对肝硬化患者短期预后的判断准确性;MELD评分在判断肝硬化患者的短期预后方面优于CTP及CrCTP.     

吲哚菁绿试验对HBV相关肝脏疾病的肝脏储备功能及预后评估价值

目的通过吲哚菁绿清除试验评估HBV相关肝病患者肝脏储备功能,比较吲哚菁绿试验15分钟滞留率(indocyanine green retention rate at 15 minutes,ICG R15)与Child-Turcotte-Pugh score(CTP)分级和终末期肝病模型评分(the model for end-stage liver disease,MELD)对乙型肝炎肝硬化患者预后的评估能力。方法选取56例慢性乙型肝炎(chronic hepatitis B,CHB)和144例乙型肝炎肝硬化患者进行ICG R15检测,采用t检验比较CHB与乙型肝炎肝硬化两者ICG R15的差别,用Spearman相关性分析乙型肝炎肝硬化患者ICG R15与MELD评分及CTP分级的关系;通过受试者工作特征(ROC)曲线法分析ICG R15与MELD评分对肝硬化预后的评估能力。结果56例CHB患者ICG R15为1.40~9.50,平均值为4.43±2.19;144例乙型肝炎肝硬化患者ICG R15为2.40~60.00,平均值为22.80±16.00,显著高于CHB组,差异有统计学意义(P0.01)。CTP分级:A级患者70例,MELD评分4.99±2.76;B级患者54例,MELD评分6.24±4.69;C级患者20例,MELD评分11.71±3.77。在评价肝功能方面ICG R15与MELD评分及CTP分级呈正相关(r=0.414、r=0.67,P0.01)。ICG R15评估乙型肝炎肝硬化患者预后的曲线下面积(AUC)为0.903,最佳截点为9.55%,敏感度为71.5%,特异度为100%。MELD评分AUC为0.634,最佳截点为7.00,敏感度为36.8%,特异度89.3%。结论吲哚菁绿试验能动态反映肝脏储备功能,与MELD评分结合能更好地反映肝脏功能及评估患者预后。     

176例失代偿期肝硬化预后影响因素的回顾分析

目的探讨失代偿期肝硬化预后的影响因素。方法对176例失代偿期肝硬化的临床资料进行回顾性分析,根据患者预后分为死亡组与存活组,比较两组Child-Pugh分级、终末期肝病模型（MELD）评分、并发症发生率及数量。结果乙型肝炎是发生肝硬化的主要原因,死亡组Child-Pugh、MELD分值均显著高于存活组（P〈0．01）,所有患者合并至少一种并发症,死亡组在腹水、感染、电解质紊乱、肝性脑病（HE）、上消化道出血、肝肾综合征（HRS）发生率及合并并发症数量也显著高于存活组（P〈0．05,P〈0．01）。结论Child-Pugh、MELD分值及并发症均影响失代偿期肝硬化患者转归,可作为评价此病预后的重要指标。     

239例肝硬化失代偿期患者的短期预后评估

目的评价终末期肝病模型（MELD）、MELD-Na、Child—Turcotte—Pugh（CTP）和包含血肌酐值的CTP（CrCTP）评分对肝硬化患者短期预后的评估意义。方法回顾性收集自2005年1月-2007年12月我院收治的239例肝硬化失代偿期患者的病例资料,分别应用CTP、CrCTP、MELD和MELD—Na模型进行评分,并了解其3个月内的病死率。以受试者工作特征曲线（ROC）下面积（AUC）衡量各评分系统预测肝硬化失代偿期患者短期预后的能力,并运用Z检验比较各系统的预测能力。结果30例患者在3个月内死亡。死亡组患者的CTP、CrCTP、MELD和MELD—Na分值（分别为11．47±2．46、12,47±2．05、19．70±6．71、27．97±10．79）与生存组（分别为8．73±2．03、8．95±2．13、10．92±4．74、14．48±6．55）相比差异有统计学意义（P〈0．001）。CTP、CrCTP、MELD和MELD-Na评分对肝硬化失代偿期患者3个月预后评估的ROC曲线下面积分别为0．799、0．822、0．873、0．870。结论CTP、CrCTP、MELD和MELD-Na模型均可有效预测我国肝硬化失代偿期患者的短期预后;MELD评分在判断肝硬化失代偿期患者的短期预后方面优于CTP;在CTP中引入血肌酐值即CrCTP评分可以提高对肝硬化失代偿患者短期预后的判断准确性;MELD-Na模型未显示比MELD更佳的预测能力。     

血清前白蛋白和MELD评分对失代偿期乙型肝炎肝硬化患者预后的预测价值

目的研究应用血清前白蛋白(PA)水平联合终末期肝病模型(MELD)评分预测失代偿期乙型肝炎肝硬化患者预后的临床价值。方法 2015年12月～2016年12月我院治疗的失代偿期乙型肝炎肝硬化患者231例,随访6个月。常规检测血清PA水平、计算MELD评分和Child-Pugh评分(CTP评分),在MELD评分的基础上,加入PA项目的评分,建立MELD联合PA评分模型。应用受试者工作特征曲线(ROC)分析各指标对患者死亡的预测效能。结果在随访的6个月里,死亡83例;死亡组血清PA水平为(32.2±9.3)mg/L,显著低于生存组的[(47.3±26.4)mg/L,P0.05];死亡组MELD评分为(24.1±5.6)分,明显高于生存组的[(18.0±6.7)分,P0.05];死亡组CTP评分为(11.8±1.2)分,明显高于生存组的[(9.0±2.0)分,P0.05];ROC曲线分析结果显示,MELD评分预测死亡的ROC下面积(AUC)为0.868(95%CI:0.823～0.912),显著高于CTP评分的[0.753(95%CI:0.690～0.816),P0.05]或血清PA的[0.675(95%CI:0.606～0.743),P0.05];进一步采用MELD联合PA评分分析的AUC为0.896(95%CI:0.857～0.935),显著高于MELD评分(P0.05)。结论应用血清PA联合MELD评分对失代偿期乙型肝炎肝硬化患者6个月内死亡的预测效能显著高于MELD评分或CTP评分,其临床应用价值还需要扩大验证。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

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.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

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.