血清瘦素在慢性阻塞性肺疾病患者营养不良发生中的意义

目的探讨血清瘦素及肿瘤坏死因子-α(TNF-α)在慢性阻塞性肺疾病(COPD)患者营养不良发生中的意义.方法用放射免疫法测定68例COPD患者(分为营养不良组,即COPDⅠ组35例;非营养不良组,即COPDⅡ组33例)及30例健康对照的血清瘦素、TNF-α浓度、体重指数(BMI)、理想体重百分比(NW%)、肱三头肌皮皱厚度(TSF)、上臂中部臂围(MAC),血清白蛋白(ALB)、总淋巴细胞计数(LYM)等指标.分析瘦素与各项参数及TNF-α的相关性.结果①COPD(Ⅰ+Ⅱ)组血清瘦素浓度明显低于对照组;COPDⅠ组血清瘦素浓度低于Ⅱ组和对照组;COPDⅡ组血清瘦素浓度低于对照组.②COPD患者血清TNF-α水平明显高于对照组,且COPDⅠ组高于COPDⅡ组.③各组内血清瘦素浓度与BMI和NW%呈显著正相关,在COPD组瘦素浓度与TSF、MAC、ALB和LYM呈显著正相关,在COPDⅠ组和对照组瘦素浓度与TSF呈显著正相关.各组内血清瘦素浓度与TNF-α浓度之间无显著相关性.④血清瘦素浓度在COPD组患者女性高于男性,差异有显著性意义;对照组血清瘦素浓度女性也高于男性,但差异无显著性意义.结论血清瘦素浓度与COPD患者的营养参数、性别有关,瘦素的调节不受TNF-α系统的控制,瘦素可能参与了COPD患者的营养不良.     

肝硬化并自发性腹膜炎患者血清及腹水瘦素、肿瘤坏死因子-α、白细胞介素-6临床意义的探讨

目的:探讨肝硬化并发自发性腹膜炎(SBP)患者血清及腹水中瘦素、肿瘤坏死因子(TNF-α)、白细胞介素(IL-6)水平的变化和临床意义.方法:采用放射免疫法测定67例肝硬化腹水患者(SBP组32例,漏出液组35例)血清及腹水瘦素水平,同时采用双抗体夹心ELISA法测定血清及腹水的TNF-α、IL-6水平.结果:SBP组患者血清及腹水瘦素、TNF-α、IL-6水平明显高于漏出液组(P<0.01),且腹水瘦素、TNF-α、IL-6又高于血清中的水平(P<0.01或P<0.05);感染控制后,血清和腹水中瘦素、TNF-α、IL-6水平明显降低(P<0.01或P<0.05);SBP组治疗无效者初始血清和腹水中瘦素、TNF-α、IL-6水平明显高于治疗有效者(P<0.01或P<0.05);肝硬化患者血清和腹水中瘦素与TNF-α、IL-6变化呈正相关.结论:肝硬化并发SBP患者血清和腹水中的瘦素、TNF-α、IL-6明显升高,临床上检测血清和腹水的瘦素、TNF-α、IL-6水平对SBP的早期诊断、疗效判断及预后评估均有一定意义.     

慢性阻塞性肺疾病急性加重期合并肺结核患者外周血清中IL-6、TNF-α和IFN-γ水平变化及临床意义

目的 探究慢性阻塞性肺疾病急性加重期(AECOPD)合并肺结核患者外周血清中IL-6、肿瘤坏死因子α(TNF-α)和干扰素γ(IFN-γ)水平变化及临床意义.方法 将研究对象分为AECOPD合并肺结核组、AECOPD组、肺结核组和健康对照组,根据肺结核患者影像学检查结果将肺结核患者分为单侧病变组、双侧病变组、无空洞组和有空洞组,根据AECOPD合并肺结核患者治疗后的情况分为好转组和恶化组.采用ELISA法检测各组患者血清中的IL-6、TNF-α和IFN-γ水平.结果 AECOPD合并肺结核组血清中的IL-6和TNF-α水平显著高于AECOPD组和肺结核组(P＜0.05);单侧病变组患者血清中的IL-6、TNF-α和IFN-γ的水平显著低于双侧病变组(P＜0.05);无空洞组患者血清中的IL-6、TNF-α和IFN-γ的水平显著低于有空洞组(P＜0.05);病情好转组治疗后IL-6、TNF-α和IFN-γ水平显著低于治疗前(P＜0.05).结论 IL-6、TNF-α和IFN-γ在AECOPD合并肺结核的发病机制中起着一定的作用,其外周血清中水平的动态变化在一定程度上可以反映AECOPD合并肺结核病情的发展与转归.     

新辅助化疗方案对三阴性乳腺癌患者血清LEP、IGF-1、TNF-α水平的影响研究

目的探讨新辅助化疗方案对三阴性乳腺癌的疗效及其对患者血清血清瘦素(LEP)、胰岛素样生长因子-1(IGF-1)以及肿瘤坏死因子α(TNF-α)水平的影响。方法将入住本院的90例TNBC患者按照随机数字表法分为对照组与观察组,各45例。对照组采用常规化疗方案:80 mg/m~2的奈达铂(d1)+1 000 mg/m~2的吉西他滨(d1,d8),静滴;观察组采用新辅助化疗方案:75 mg/m~2的多西他赛(d1)+1 000 mg/m~2卡培他滨(d1~14),每3周为一个化疗周期,化疗周期均为2个周期。比较两组临床控制总有效率及临床收益率、治疗前后血清LEP、IGF-1及TNF-α水平、毒副反应发生情况。结果观察组临床控制总有效率及临床收益率均高于对照组;观察组患者治疗后血清LEP水平均低于治疗前及对照组治疗后,观察组患者治疗后IGF-1及TNF-α水平均高于治疗前及对照组治疗后,以上差异均有统计学意义(P0.05)。两组患者毒副反应(贫血、中性粒细胞减少、血小板减少、恶心呕吐、便秘以及脱发)发生率差异均无统计学意义(P0.05)。结论新辅助化疗方案可通过改善TNBC患者血清LEP、IGF-1、TNF-α的水平而发挥作用,应在临床中进行推广。     

血液透析联合血液灌流改善慢性肾衰患者钙磷代谢紊乱的疗效观察

目的:观察分析血液透析联合血液灌流改善慢性肾衰患者钙磷代谢紊乱的疗效及IL-6、hs-CRP、TNF-α水平变化。方法:将104例慢性肾衰患者采用随机数表法分为血液透析组(HD组52例)与血液透析联合血液灌流组(HD+HP组52例),分别给予血液透析与血液透析联合血液灌流治疗。测定2组患者治疗6个月前、后血钙、血磷、钙磷乘积、iPTH水平、炎症因子水平(IL-6、hs-CRP、TNF-α)、BUN、Scr及ALB水平,并进行统计学分析。结果:治疗前2组患者血钙、血磷、钙磷乘积、iPTH水平、IL-6、hs-CRP、TNF-α水平、BUN、Scr、ALB水平比较差异均无统计学意义(P0.05)。连续治疗6个月后,2组患者血钙无明显变化(P0.05),血磷、钙磷乘积及iPTH水平明显降低,且HD+HP组明显低于HD组,差异有统计学意义(P0.05)。连续治疗6个月,HD组患者炎症因子变化不明显,HD+HP组患者的IL-6、hs-CRP、TNF-α水平明显降低,且低于HD组,差异有统计学意义(P0.05)。治疗6个月后,2组患者BUN、Scr水平明显降低,ALB水平明显升高,且HD+HP组患者BUN、Scr、ALB水平明显优于HD组,差异有统计学意义(P0.05)。结论:血液透析联合血液灌流可明显改善慢性肾衰患者钙磷代谢紊乱,缓解炎症情况,有效控制肾功能、改善营养状况、有利于患者预后。     

肝硬化患者血清瘦素、肿瘤坏死因子α水平及其临床意义

目的探讨乙型肝炎肝硬化患者血清瘦素和肿瘤坏死因子α(TNF-α)水平变化的临床意义。方法采用酶联免疫吸附试验(ELISA)法和放免法(RIA)测定55例肝硬化患者和36例正常人的血清瘦素和TNF-α水平。结果与正常对照组比较,肝硬化患者血清瘦素水平降低但差异无显著性;肝硬化组血清TNF-α水平则显著高于正常对照组(P<0.01)。结论肝硬化患者血清瘦素水平与正常对照组无明显差异,而TNF-α水平明显高于对照组。     

早期肠内营养对老年慢性心力衰竭患者血清炎症介质及瘦素的影响

目的探讨早期肠内营养对老年慢性心力衰竭(CHF)患者心功能及血清炎症介质和瘦素等的影响。方法选取2017年6月至2019年1月在浙江医院住院的老年CHF患者80例,随机分为对照组38例和治疗组42例,两组患者在常规抗心力衰竭治疗下,对照组予自由饮食,治疗组予日常膳食联合肠内营养制剂治疗2~4 w,检测治疗前后两组患者的营养指标、心功能指标、血清炎症介质及瘦素水平。结果治疗2 w后,治疗组体质量指数(BMI)、上臂肱三头肌皮褶厚度(TSF)、血清前白蛋白、血红蛋白水平、6分钟步行距离均高于同组治疗前(t=-5.468、-5.842、-3.978、-4.810、-2.974,P<0.05),血浆B型脑钠肽(BNP)、肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)及瘦素水平均低于同组治疗前(t=3.796、3.417、2.499、7.121,P<0.05);治疗4 w后,除了BNP及TNF-α外,治疗组各项指标较治疗2 w后改善更为明显(P<0.05)。且治疗4 w后,治疗组BMI、TSF、血清白蛋白、前白蛋白、血红蛋白水平、左室射血分数(LVEF)、TNF-α、IL-6及瘦素水平,较均对照组有改善(t=-4.150、-3.844、-2.085、-3.144、-2.256、-2.064、3.758、2.130、2.083,P<0.05)。结论早期肠内营养治疗可改善老年CHF患者营养状态,提高心功能,降低TNF-α、IL-6及瘦素水平,治疗时间越长患者的心功能及炎症介质改善越明显。     

强化胰岛素治疗对烧伤伴应激性高血糖患者的影响

目的探讨强化胰岛素治疗对烧伤伴应激性高血糖患者的影响。方法选取2012—2015年武警四川省总队医院收治的烧伤伴应激性高血糖患者62例,采用随机数字表法分为对照组和观察组,每组31例。在常规治疗及营养支持基础上,对照组患者给予常规胰岛素治疗,观察组患者给予强化胰岛素治疗;两组患者均连续治疗10 d。比较两组患者临床疗效,治疗前后血清肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、清蛋白(ALB)、球蛋白(GLB)水平,治疗后认知障碍发生情况及血糖控制达标情况,并观察两组患者治疗期间院内感染、低糖血症发生情况及院内死亡情况。结果两组患者临床疗效比较,差异无统计学意义(P0.05)。治疗前两组患者血清TNF-α、IL-6、ALB、GLB水平比较,差异无统计学意义(P0.05);治疗后观察组患者血清TNF-α、IL-6水平低于对照组,血清ALB、GLB水平高于对照组(P0.05)。观察组患者治疗后认知障碍发生率低于对照组,血糖控制达标率高于对照组(P0.05)。观察组患者治疗期间院内感染、低糖血症发生率低于对照组(P0.05),而两组患者院内病死率比较,差异无统计学意义(P0.05)。结论与常规胰岛素治疗相比,在常规治疗及营养支持基础上给予强化胰岛素治疗可更有效地减轻烧伤伴应激性高血糖患者炎性反应,提高血糖控制效果,改善营养状况,减少认知障碍、院内感染的发生。     

苦参素联合复方丹参对慢性乙型肝炎患者肝纤维化血清学指标、肿瘤坏死因子-α和瘦素的影响

背景：传统中医药对慢性乙型肝炎有较好的治疗效果，但其作用机制尚不完全清楚。目的：观察苦参素联合复方丹参对慢性乙型肝炎患者肝纤维化血清学指标、肿瘤坏死因子（TNF）-α和瘦素水平的影响。方法：慢性乙型肝炎后肝纤维化患者60例，随机分为两组。试验组30例，予苦参素联合复方丹参片治疗，对照组30例，予水飞蓟素片治疗，疗程均为6个月。测定两组患者治疗前后肝纤维化血清学指标：透明质酸（HA）、Ⅳ型胶原（Ⅳ-C）和层黏蛋白（LN）以及TNF-α、瘦素水平。结果：与治疗前比较，治疗后试验组血清HA、Ⅳ-C和LN水平均明显下降，其中尤以HA、Ⅳ-C下降显著（P〈0．01），且TNF-α和瘦素水平亦有显著下降（P〈0．01）；对照组治疗前后肝纤维化指标、TNF-α和瘦素水平无明显变化（P〉0．05）。治疗后试验组各项肝纤维化血清学指标和TNF-α、瘦素水平均显著低于对照组（P〈0．05）。结论：苦参素联合复方丹参具有明显的抗乙型肝炎后肝纤维化的作用，且用药安全，其作用机制可能与下调TNF-α和瘦素表达有关。     

瘦素与急性胰腺炎的相关性研究

目的检测急性胰腺炎（AP）患者血清中瘦素和TNF-α浓度,探讨瘦素与急性胰腺炎及体重指数的关系。方法采用放射免疫法（RIA）检测20例急性胰腺炎患者的血清瘦素和TNF-α的水平,并分析其意义,对照组为37例肥胖者。结果在病例组中,瘦素水平明显高于对照组（P〈0.05）,血清瘦素水平与TNF-α、BMI均没有相关（P〉0.05）;在对照组中,血清瘦素水平与TNF-α、BMI均呈正相关（P〈0.05）。结论AP患者血清瘦素水平显著高于正常健康肥胖者;AP患者血清瘦素含量的增加可能来源于胰腺的释放;血清瘦素是急性胰腺炎生物学指标之一,对损伤的胰腺具有保护作用。     

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.     

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.     

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.     

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.