伊托必利治疗功能性消化不良重叠便秘型肠易激综合征疗效观察

目的 观察伊托必利治疗功能性消化不良(FD)重叠便秘型肠易激综合征(C-IBS)患者的疗效.方法 将符合FD标准及重叠C-IBS患者分为FD治疗组(40例)、FD观察组(20例)、FD重叠C-IBS治疗组(40例)和FD重叠C-IBS观察组(20例),FD治疗组和FD重叠C-IBS治疗组均给予伊托必利100 rag/次,每日3次,疗程8周.观察并记录4组患者上腹饱胀、早饱、腹痛等症状及C-IBS患者便秘改善情况.FD治疗组和FD重叠C-IBS治疗组于治疗前及治疗后2周进行胃排空试验.结果 FD治疗组和FD重叠C-IBS治疗组患者腹痛、上腹饱胀、早饱等症状均有不同程度改善,其中FD重叠C-IBS治疗组改善程度更为明显,且排便情况亦有显著改善.B超监测胃排空显示,与观察组相比,FD治疗组和FD重叠C-IBS治疗组患者治疗后胃窦收缩幅度及胃排空时间均有显著改善(P<0.05).结论 伊托必利治疗FD有效,尤其是对FD重叠C-IBS治疗组的疗效优于FD治疗组.     

伊托必利联合西酞普兰治疗功能性消化不良的临床疗效观察

目的 评价伊托必利联合西酞普兰治疗功能性消化不良(FD)的临床疗效及安全性.方法 将入选的96例FD患者随机分为两组,对照组48例给予口服盐酸伊托必利分散片50 mg,tid;治疗组48例,给予口服盐酸伊托必利分散片50 mg,tid,西酞普兰20 mg,qd.两组的疗程均为4周,比较两组患者临床症状的变化情况.结果 对照组显效率20.83％,总有效率62.50％;治疗组显效率56.25％,总有效率93.75％.两组显效率及总有效率差异有统计学意义(P＜0.05).两组临床症状均明显缓解(P＜0.05):除恶心、呕吐和上腹痛外,其他症状消失率治疗组均优于对照组,两组均未见严重的药物不良反应发生.结论 伊托必利联合西酞普兰治疗FD疗效满意,安全性好,是治疗FD可行的方案.     

伊托必利、多潘立酮和甲氧氯普胺联合治疗功能性消化不良的疗效与安全性分析

目的研究功能性消化不良(FD)患者治疗中伊托必利、多潘立酮和甲氧氯普胺治疗的疗效和安全性。方法选取2012年4月至2016年8月于我院就诊的动力障碍型FD患者150例作为研究对象,另选择15例同时期的健康志愿者作为对照组。将所有研究对象随机分为6组,分别给予5mg甲氧氯普胺、10 mg多潘立酮、50 mg盐酸伊托必利、5 mg甲氧氯普胺+10 mg多潘立酮、5 mg甲氧氯普胺+50 mg盐酸伊托必利、10 mg多潘立酮+50 mg盐酸伊托必利,均为餐前30 min服用,tid,4周为一个疗程。对比各组患者的胃肠排空率和症状积分及缓解率。结果所有FD患者胃肠排空率明显低于对照组(P0.05)。联合使用甲氧氯普胺、多潘立酮或伊托必利等药物的胃肠排空率较单独使用甲氧氯普胺、多潘立酮或伊托必利等药物明显改善(P0.05),但联合用药的三组间胃肠排空率对比无显著性差异(P0.05),单独用药的三组间胃肠排空率对比也无显著性差异(P0.05)。胃肠排空率在联合或单独使用甲氧氯普胺、多潘立酮或伊托必利等药物后改善明显(P0.05)。在肠排空率方面,联合用药组中甲氧氯普胺+伊托必利组与多潘立酮+伊托必利组对比无显著性差异(P0.05),甲氧氯普胺+伊托必利组和多潘立酮+伊托必利组明显优于甲氧氯普胺+多潘立酮组(P0.05);单独用药组中甲氧氯普胺组与多潘立酮组对比无显著性差异(P0.05),伊托必利组明显优于甲氧氯普胺组和多潘立酮组(P0.05),单独用伊托必利组明显优于甲氧氯普胺+多潘立酮组(P0.05)。促肠排空方面,伊托必利明显优于甲氧氯普胺和多潘立酮。FD各组患者服用药物后临床症状,如呕吐、嗳气、早饱、腹胀、疼痛等较用药前明显缓解(P0.05);联合用药组的症状缓解率明显优于单独用药组(P0.05),单独用药组中甲氧氯普胺组和多潘立酮组间对比无显著性差异(P0.05),伊托必利组明显优于甲氧氯普胺组和多潘立酮组(P0.05);在联合用药组中,甲氧氯普胺+伊托必利组与多潘立酮+伊托必利组对比无显著性差异(P0.05),甲氧氯普胺+伊托必利组和多潘立酮+伊托必利组明显优于甲氧氯普胺+多潘立酮组(P0.05)。各组患者用药期间未见明显不良反应。结论伊托必利、多潘立酮和甲氧氯普胺联合用药具有协同增效的作用,对FD患者胃肠动力改善程度明显优于单独用药,且疗效优于单独用药,患者的生活质量得到显著提高,值得临床推广。     

健脾理气中药联合伊托必利治疗功能性消化不良疗效观察

目的观察健脾理气中药联合伊托必利治疗功能性消化不良（FD）中餐后不适综合征（PDS）的临床疗效。方法将118例PDS型FD患者随机分成3组,A组（n=40）给予健脾理气中药加伊托必利,B组（n=40）单纯应用伊托必利,C组（n=38）单纯应用中药,疗程均为6周。观察治疗前后餐后腹胀和早饱症状改善情况,并应用13C-辛酸呼气试验检测治疗前后胃排空的变化。结果治疗后A组餐后腹胀和早饱症状总评分及临床疗效评定与B、C组比较差异均有统计学意义（P〈0.05）。3组治疗后胃半排空时间均较治疗前下降（P〈0.05）,但3组治疗后比较差异无显著性。结论健脾理气中药联合伊托必利治疗PDS对于改善临床症状及临床疗效方面优于单纯应用伊托必利,并能有效改善患者胃排空。     

伊托必利、多潘立酮和甲氧氯普胺联合用药对FD患者胃肠功能和Ghrelin表达的影响

目的:研究伊托必利、多潘立酮和甲氧氯普胺联合应用对功能性消化不良(FD)患者胃肠功能和Ghrelin含量的影响.方法:以FD患者为研究对象,依据罗马Ⅱ标准,将符合纳入标准的患者120例随机分为6组,分别给予盐酸伊托必利,多潘立酮,甲氧氯普胺,以及联合用药给予盐酸伊托必利+多潘立酮,盐酸伊托必利+甲氧氯普胺和多潘立酮+甲氧氯普胺,观察用药前后各临床症状积分改善程度、胃肠排空率及血清Ghrelin的水平改变.结果:各组FD患者服药后消化不良等症状均明显改善,在症状缓解率,联合用药组明显优于单独用药组(P＜0.01);在胃排空率,各联合用药组明显优于单独用药组(54.26%±18.57%,55.12%±18.22%.47.17%±15.21% vs 36.23%±11.68%,32.16%±10.08%,32.24%±10.12%,均P＜0.01);在肠排空率,联合用药组中伊托必利+多潘立酮组和伊托必利+甲氧氯普胺组明显优于多潘立酮+甲氧氯普胺组(89.27%±11.36%.88.67%±13.25% vs 69.16%±19.26%.均P＜0.011:单独用药组中伊托必利明显优于多潘立酮或甲氧氯普胺(78.23%±12.56% vs58.96%±12.20%,58.33%±12.57%,P＜0.01);但伊托必利单独用药明显优于多潘立酮+甲氧氯普胺联合用药(P＜0.05).FD患者血清Ghrelin水平明显降低(P＜0.05).经药物治疗后Ghrelin水平明显回升,联合用药组明显高于单独用药组(P＜0.05或0.01).结论:伊托必利、多潘立酮和甲氧氯普胺联合用药比单独用药更有效,可显著改善FD患者的胃肠动力,该功能可能与血清ghrelin水平改变有关.     

核苷(酸)类似物治疗乙型肝炎病毒相关慢性肝功能衰竭患者近期疗效的Meta分析

目的 通过Meta分析系统评价核苷(酸)类似物治疗HBV相关慢性肝功能衰竭的疗效.方法 检索1990年至2010年在Medline、PubMed、中国知网(CNKI)全文数据库、万方数据库、中国生物医学文献数据库等公开发表的中、英文文献,并辅以文献追述和手工检索的方法,对相关的参考文献严格按照文献纳入、排除标准来筛选,采用RevMan 5.0版统计软件进行Meta分析,应用森林图、漏斗图、失安全系数对判定指标进行敏感性分析和发表偏倚分析.结果 20篇中、英文文献,共计1240例病例纳入研究,HBV DNA转阴率的相对危险度(RR)为3.37,95％可信区间(CI)为2.20～5.16(Z=5.60,P＜0.01);PTA加权均数差(WMD)为34.70,95％CI为25.62～43.79(Z=7.49,P＜0.01);Alb WMD为4.73,95％CI为2.95～6.51(Z=5.21,P＜0.01);ALT WMD 为-42.58,95％CI为-59.74～-25.41(Z=4.86,P＜0.01);TBil WMD为-150.95,95％CI为-199.29～-102.62(Z=6.12,P＜0.01);病死率RR为0.55,95％CI为0.48～0.64(Z=8.09,P＜0.01).结论 核苷(酸)类似物能明显提高HBV相关慢性肝功能衰竭患者HBV DNA转阴率,改善PTA、Alb水平,降低ALT、TBil水平,从而降低HBV相关慢性肝功能衰竭患者的近期病死率.     

复方阿嗪米特联合盐酸依托必利治疗慢性胰腺炎消化不良的临床疗效

[目的]探究采用复方阿嗪米特联合盐酸伊托必利治疗慢性胰腺炎消化不良的临床疗效。[方法]选取就诊于我院的慢性胰腺炎消化不良患者68例,随机分为对照组和实验组,对照组采用盐酸伊托必利治疗,实验组采用复方阿嗪米特联合盐酸伊托必利治疗,观察并比较2组患者的临床疗效。[结果]实验组总有效率(97.05%)明显高于对照组总有效率(52.94%),差异有统计学意义(P<0.05);实验组患者在上腹疼痛、餐后饱胀、食欲不振三项指标的下降值均高于对照组,差异有统计学意义(P<0.05)。[结论]对于慢性胰腺炎消化不良患者,采用复方阿嗪米特联合促动力药盐酸依托必利治疗,效果显著,值得在临床上推广应用。     

伊托必利及黛力新合用治疗功能性消化不良的临床有效性综合评价

[目的]探讨伊托必利联合黛力新治疗功能性消化不良(FD)的临床有效性和安全性。[方法]纳入216例FD患者,随着分为试验组108例和对照组108例,前者采用伊托必利联合黛力新治疗,后者采用伊托必利治疗,治疗4周后,采用χ2检验比较消化道症状和抑郁症状的疗效。[结果]试验组的总有效率为92.59%,显著高于对照组的82.41%(χ2=4.738,P=0.030);治疗后试验组焦虑抑郁症状严重程度的分布有显著变化(χ2=20.270,P0.001),而对照组无明显改变(χ2=5.024,P=0.170),试验组的症状严重程度分布与对照组比较,差异有统计学意义(χ2=9.428,P=0.024);2组不良反应发生率比较差异无统计学意义(P0.05)。[结论]伊托必利联合黛力新对FD的消化道症状和抑郁症状安全有效,值得临床推广应用。     

胃肠道动力药联用黛力新治疗功能性消化不良的对比研究

目的 评价依托必利、莫沙必利、多潘立酮联用黛力新治疗功能性消化不良(FD)的疗效.方法 130例确诊的FD患者随机分为3组,依托必利治疗组50例,依托必利50 mg,tid,黛力新1片,bid;莫沙必利对照组(Ⅰ组)40例,莫沙必利5 mg,tid,黛力新1片,bid;多潘立酮对照组(Ⅱ组)40例,多潘立酮10 mg,tid,黛力新1片,bid.疗程均为4周.观察患者服药前及服药1周、4周后嗳气、烧心、上腹部饱胀等症状的消失情况并做对比分析.结果 治疗1周后嗳气、烧心和上腹部饱胀症状的消失率,治疗组分别为60％、56％,对照Ⅰ组为30％、35％,对照Ⅱ组为25％、25％.治疗组与各对照组之间的差异比较均有显著性(P＜0.05).治疗4周后治疗组的嗳气、烧心和上腹部饱胀症状的消失率为88％、84％,对照Ⅰ组为40％、45％,对照Ⅱ组为25％、30％,治疗组与各对照组之间的差异比较均有非常显著性(P＜0.01).结论 依托必利联用黛力新改善FD患者嗳气、烧心、上腹部饱胀症状的效果最满意,可以作为治疗FD患者的首选药物.     

伊托必利联合复方阿嗪米特治疗功能性消化不良临床观察

目的观察应用伊托必利联合复方阿嗪米特治疗功能性消化不良（FD）患者的疗效和安全性。方法将119例患者随机分为两组,治疗组60例,口服伊托必利50mg／次、复方阿嗪米特2片／次,三餐后服用;对照组59例,口服多潘立酮10mg／次,三餐前服用。两组疗程均为14d。观察治疗前后餐后不适、上腹痛、食欲不振消化不良症状积分变化,计算有效率。结果治疗后两组患者的症状总积分均较治疗前下降,治疗组改善程度优于对照组（P〈0．01）,无明显不良反应。结论伊托必利和复方阿嗪米特联合使用可提高治疗FD的疗效,且安全性好。     

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.     

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.     

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.     

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.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.