肠易激综合征患者肛门直肠感觉阈值和动力学的改变

采用PC Polygraf HR高分辨多道胃肠功能测定仪,检测42例肠易激综合征(IBS)患者的肛门直肠压力、直肠容量感知、疼痛阈值、耐受阈值等指标,并与15例健康人做对照.结果发现IBS的直肠静息压、肛管括约肌静息压、最大缩窄压及肛管长度与对照组无显著性差异(P＞0.05),而初始感觉阈值、疼痛阈值、排便阈值腹泻组低于正常对照组(P＜0.05),便秘组高于正常对照组(P＜0.05).排便时IBS便秘组患者的肛管松弛压高于正常对照组(P＜0.05).提示IBS患者排便功能和直肠感觉功能存在异常.     

慢性功能性便秘肛门直肠敏感性和排便动力学研究

目的探讨慢性功能性便秘患者肛门直肠感觉功能的改变及排便时肛门直肠动力学特征。方法采用PC Polygraf HR高分辨多道胃肠功能测定仪检测46例功能性便秘患者的肛门直肠压力、直肠容量感知、疼痛阈值、耐受阈值及排便功能等指标，并与16例健康人做对照。结果功能性便秘组直肠静息压、肛管括约肌静息压、最大缩窄压及静态肛管长度与对照组比较差异无显著性，但功能性便秘患者的初始感觉阈值、疼痛阈值、排便阈值、引起肛门直肠抑制反射的最低充气量、排便状态下肛管功能长度和肛管内括约肌松弛压均高于对照组。模拟排便时，功能性便秘组34．78％的患者在直肠收缩时伴有肛管括约肌的矛盾收缩。结论功能性便秘患者直肠黏膜对容量刺激的反应性降低和排便时肛管括约肌的反向矛盾收缩可能是形成便秘的原因之一。     

肠易激综合征患者直肠肛门压力变化及临床意义

为了研究肠易激综合征（ＩＢＳ）患者直肠肛门运动功能，测定了８０例ＩＢＳ患者和２０例正常人直肠肛门压力及排便功能。发现：①直肠静息压、肛门括约肌静息压及其最大缩窄压在ＩＢＳ腹泻组、便秘组及正常对照组均无显著差异。②肛管高压带长度在ＩＢＳ腹泻组及便秘组均显著高于正常对照组。③直肠壶腹部的感觉阈值、最大耐受量、直肠顺应性及直肠－肛门抑制反应的直肠扩张容量在ＩＢＳ腹泻组均显著低于正常对照组，肛门括约肌松弛率ＩＢＳ腹泻组与正常对照组无显著差异。④ＩＢＳ便秘组感觉阈值与正常对照组无差异，但其最大耐受量及引起直肠－肛门抑制反射的直肠扩张容量均显著高于正常对照组，其直肠顺应性和肛门括约肌松弛率显著低于正常对照组。     

肛门直肠测压对诊断慢性便秘的临床意义

目的　探讨肛门直肠测压对诊断慢性便秘的临床意义。方法　对 40例长期便秘的病人使用顶端带气囊水灌注导管检测直肠感觉阈值、初始排便阈、直肠最大耐受容量、直肠肛门抑制反射和肛门括约肌静息压、缩窄压。结果　 40例病人均有直肠感觉阈值、初始排便阈、直肠最大耐受容量的异常 ,直肠肛门抑制反射、肛门括约肌静息压、缩窄压正常。结论　慢性便秘患者直肠肛门测压直肠感觉有异常 ,肛管运动功能无明显改变。该方法简单 ,操作容易 ,无创伤 ,易重复 ,可在临床上推广使用     

肠易激综合征患者直肠肛门动力学研究

为了研究肠易激综合征患者肛门运动功能，我们测定了５０例ＩＢＳ患者在１１例正常人直肠肛门压力衣排便功能；发现：（１）直肠静息压，肛门括约肌静息压及其最大缩窄压在ＩＢＳ腹泻组，便秘组及正常对照组组均无显著差异。（２）肛管高压带长度在ＩＢＳ腹泻组及便秘组均显著高于正常对照组。（３）直肠壶腹部的感觉阈值，最大耐受量等，在ＩＢＳ腹泻组均显著低于正常对照组。（４）ＩＢＳ便秘组感觉阈值与正常对照组差异，但其最大     

便秘型肠易激综合征患者结、直肠肛门动力学的临床研究

目的研究便秘型肠易激综合征患者结肠、直肠动力,直肠感觉功能.方法用结肠传输试验检测结肠传输时间,并用结肠传输指数分型,用肛门直肠测压方法测定便秘型IBS直肠静息压,肛管静息压,肛门括约肌最大缩榨压,模拟排便时,直肠收缩压,肛门括约肌剩余压,直肠对容量扩张刺激的初始感觉阈值,最大耐受容量,直肠顺应性.结果便秘型IBS患者全结肠及各节段结肠传输时间均高于对照组,便秘型IBS患者肛管静息压,直肠静息压与对照组无差异(P＞0.05),肛门括约肌最大缩榨压低于正常对照组,最大耐受容量及直肠顺应性均明显高于对照组(P＜0.01),且发现不同传输类型的便秘型IBS肛门直肠测压表现不同.结论便秘型IBS患者存在结肠、肛门直肠动力及直肠感觉功能异常,结肠传输试验与肛门直肠测压相结合,可体现不同传输类型便秘型IBS肛门直肠动力学病因机制.     

功能性便秘患者直肠肛门压力变化

目的研究功能性便秘患者直肠肛门运动功能,探讨该疾病发生的可能机制。方法测定了35例慢性功能性便秘患者和11例正常对照者的直肠肛门压力及排便功能。结果①直肠静息压、肛门括约肌静息压及其最大缩窄压等在功能性便秘患者和正常人之间无显著差异(P>0.05);②肛管高压带长度在功能性便秘患者显著高于正常人(P<0.0005);③功能性便秘患者直肠壶腹部的感觉阈值和最大耐受量显著高于正常对照组(P<0.05),直肠最大顺应性显著低于正常对照组(P<0.0005),引起直肠肛门抑制反射的直肠扩张容量在便秘组显著高于正常对照组(P<0.05),肛门松弛率在便秘组显著低于正常对照组(P<0.05);④功能性便秘患者排便时肛门内外括约肌松弛反射均障碍,尤以外括约肌明显。结论功能性便秘患者存在直肠肛门运动功能障碍,这在其发病机制中起重要作用。     

出口梗阻型便秘肛门直肠动力及直肠感知功能的特点

[目的]研究出口梗阻型便秘(OOC)患者肛门直肠动力及直肠感知功能特点。[方法]选取57例出口梗阻型便秘患者(OOC组),另选取27例健康志愿者(对照组)进行高分辨率肛门直肠测压检测,对比2组肛门直肠动力及直肠感知功能。[结果](1)OOC组最大肛管静息压(MARP)、肛门括约肌功能长度、缩榨持续时间及直肠排便压与对照组比较,差异无统计学意义。OOC组最大肛门括约肌收缩压(MASP)、模拟排便时肛管残余压均高于对照组,而模拟排便时肛管松弛率低于正常组,且差异均有统计学意义(P0.01);(2)与健康志愿者比较,OOC组最小松弛容积及直肠最大耐受量均高于对照组,但差异无统计学意义。OOC组直肠初始感觉阈值及初始便意阈值均高于对照组,差异有统计学意义(P0.05);(3)女性OOC患者MARP、模拟排便时肛管残余压及肛管松弛率、最小松弛容积、初始感觉阈值、初始便意阈值、最大耐受量均高于男性OOC患者,但差异无统计学意义(P0.05)。女性OOC患者肛门括约肌功能长度、缩榨持续时间、直肠排便压较男性OOC患者降低不明显(P0.05),而女性OOC患者MASP较男性患者降低,差异有统计学意义(P0.05)。[结论](1)OOC患者肛门外括约肌及盆底肌的收缩及协调功能障碍、直肠敏感性下降及对容量刺激的反应较迟钝可能是造成出口梗阻型便秘的重要原因;(2)女性OOC患者肛门外括约肌及盆底肌的收缩功能较男性弱。     

肠易激综合征便秘型和功能性便秘结、直肠肛门动力学研究

目的 研究肠易激综合征(IBS)便秘型和功能性便秘患者结肠、直肠动力,直肠感觉功能.方法 对IBS便秘型患者52例和功能性便秘患者48例进行肛门直肠测压检查,并做结肠传输试验.同时选择正常健康人作对照组.结果 IBS便秘型组和功能性便秘组与对照组间直肠静息压、肛管静息压和肛门括约肌最大缩榨压比较均未见明显差异.IBS便秘型组初感阈值及排便阈值(75.00±34.04 ml,117.31±37.60 ml)较正常对照(97.14±20.54 ml,138.57±19.94 ml)明显降低.功能性便秘组排便阈值及最大耐受阈值(187.92 ±68.62 ml,252.5±93.40ml)较正常对照组(138.57±19.94 ml,181.43±18.34 ml)明显升高.IBS便秘型组各项感觉阈值较功能性便秘组均明显降低.功能性便秘组较IBS便秘型组患者结肠传输试验符合出口梗阻的比例高,但无统计学差异.结论 IBS便秘型直肠感觉过敏,功能性便秘直肠感觉迟钝.     

肠易激综合征中医证型与肛管直肠动力学的相关性研究

目的：观察肠易激综合征（IBS）不同中医证型肛管直肠动力学变化及临床意义。方法：选择符合罗马Ⅱ标准的IBS患者59例，按中医标准分为肝郁脾虚组25例，脾胃虚弱组20例，脾胃阴虚组14例；另选健康志愿者23例为正常对照组（正常组）。采用水灌注式测压系统，测定其肛管直肠动力学。结果：3型患者直肠静息压、肛管静息压及肛管缩窄压均与正常组差异无显著性意义；但肝郁脾虚组直肠最大耐受量较正常组降低，出现肛管直肠抑制反射（RAIR）所需最小空气量、直肠初始感觉阈值与正常组差异无显著性意义；脾胃虚弱组出现RAIR所需最小空气量、直肠初始感觉阈值、直肠最大耐受量均与正常组差异无显著性意义；脾胃阴虚组上述3项指标均较正常组明显增高。结论：肝郁脾虚组直肠耐受性降低；脾胃阴虚组排便反射不协调、直肠敏感性降低而耐受性增高。     

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.