56例肺曲霉病危险因素及临床特征分析

目的探讨侵袭性肺曲霉病(IPA)危险因素和临床特征,提高诊治水平。方法回顾性分析新疆医科大学第一附属医院2010年1月至2016年1月诊断为肺曲霉病患者的临床资料,分析IPA发生的高危因素、临床特点。结果 56例肺曲霉病患者中,24例为IPA,发生率42.86%。使用两种以上抗生素、慢阻肺、有创机械通气、多次痰培养曲霉阳性、重症肺炎为IPA高危因素,其中使用两种以上抗生素为独立危险因素。IPA患者易出现咯血,发热症状;肺部高分辨CT表现为多发、斑片样渗出、胸腔积液较多;IPA总体预后差。结论侵袭性肺曲霉病危险因素多,预后差,使用两种以上抗生素为IPA独立危险因素。     

慢性阻塞性肺疾病合并侵袭性肺曲霉菌病的危险因素分析

目的探讨慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉菌病(IPA)的危险因素。方法采用病例对照研究方法,选取2015-05～2018-05该院呼吸内科住院的COPD合并IPA的住院患者24例为病例组,以年龄为匹配因素(±2岁),按1∶2的比例选取同期住院的COPD患者48例为对照组,采用条件Logistic回归分析对COPD合并IPA的危险因素进行分析。结果单因素分析结果显示COPD频繁急性加重、糖尿病、慢性肾功能不全、应用广谱抗生素≥2周、应用糖皮质激素为COPD合并IPA的危险因素(P0.10);采用条件Logistic分析,糖尿病、应用广谱抗生素≥2周、应用糖皮质激素为COPD合并IPA的独立危险因素(OR=7.384,6.681,32.354,P0.05)。结论糖尿病、应用广谱抗生素≥2周、应用糖皮质激素为COPD合并IPA的独立危险因素。     

侵袭性肺曲霉病的临床特点及其危险因素分析

目的探讨侵袭性肺曲霉病(IPA)的临床特点并分析其危险因素,为早期发现IPA提供临床依据。方法回顾性分析安徽医科大学第一附属医院在2014年8月至2017年8月出院诊断80例IPA患者(包括确诊20例)作为感染组,按1:1配对原则,选取同期同病区并有发热和/或伴呼吸道症状的非IPA患者80例作为对照组。比较两组的临床症状和体征、胸部CT表现、相关实验室检查结果和基础疾病,应用单因素、多因素条件Logistic回归分析,找出IPA感染发生的危险因素。结果两组均可出现发热、咳嗽和肺湿啰音等症状和体征,IPA患者胸部CT可有曲霉球、空洞、新月征和晕轮征等相对特异性表现,且易合并糖尿病和慢性阻塞性肺疾病。广谱抗生素应用、长期及大剂量糖皮质激素应用、低蛋白血症、免疫抑制剂应用、合并慢性阻塞性肺疾病、糖尿病、多次住院、粒细胞缺乏是侵袭性肺曲霉病的危险因素(P0.05);多因素条件Logistic回归分析显示长期应用糖皮质激素、多次住院、合并慢性阻塞性肺疾病和粒细胞缺乏是IPA的独立危险因素(P0.05)。结论接受长期糖皮质激素治疗及多次住院、合并慢性阻塞性肺疾病、粒细胞缺乏患者是IPA感染的独立危险因素,应引起临床重视。     

老年食管癌根治术后发生肺部感染临床危险因素分析

目的探讨老年食管癌术后发生肺部感染临床危险因素分析。方法回顾性分析2015年2月至2018年1月武汉市第一医院行食管癌根治术老年患者临床资料450例。根据患者术后是否发生肺部感染分为感染组(术后发生肺部感染,94例)和未感染组(术后未发生肺部感染,356例),收集两组患者一般临床资料及可疑危险因素,用统计学软件分析影响老年食管癌术后发生肺部感染相关因素。结果单因素分析得出,感染组和未感染组在年龄、吸烟、合并糖尿病、合并慢性阻塞性肺疾病、手术时间、FEV1/FVC、术前白蛋白、手术通气方式方面比较无统计学意义(P 0.05)。多因素分析得出,高龄(OR=2. 614,95%CI为1. 214～5. 628,P 0.05)、吸烟(OR=2.330,95%CI为1.021～5.317,P 0.05)、合并糖尿病(OR=1.614,95%CI为1.102～2.364,P 0.05)、合并慢性阻塞性肺疾病(OR=1. 944,95%CI为1. 301～2.905,P 0. 05)、较长的手术时间(OR=2. 025,95%CI为1.305～3.142,P 0.05)为术后肺部感染的独立危险因素,较高的术前白蛋白(OR=0.885,95%CI为0.813～0.963,P 0.05)、术中采用TLV通气方式(OR=0.682,95%CI为0.813～0.907,P 0.05)为术后肺部感染的独立保护因素。结论影响老年食管癌根治术后肺部感染发生危险因素较多,包括高龄、吸烟、合并糖尿病和慢性阻塞性肺疾病、手术时间延长、术前白蛋白低下、术中OLV通气模式等,临床中应针对性进行干预和预防,以降低老年食管癌根治术术后肺部感染发生风险。     

老年慢性阻塞性肺疾病患者合并侵袭性肺曲霉菌病的危险因素

目的 探讨老年慢性阻塞性肺疾病(COPD)患者合并侵袭性肺曲霉病(IPA)发生的危险因素.方法 通过整群抽样法,回顾性分析55例老年COPD患者的临床资料,将其纳入对照组;回顾性分析同时期收治的55例老年COPD合并IPA患者的临床资料,将其纳入观察组.记录两组一般人口学资料、治疗措施、机械通气等指标,分析老年COPD患者合并IPA的危险因素.结果 入住ICU、并发糖尿病、有创操作、机械通气、使用类固醇及抗生素时间较长、血清白蛋白含量较低及病情较严重均是导致老年COPD合并IPA的危险因素(OR>1,P<0.05).结论 临床应提高COPD患者IPA感染认知,加强预防,对疑似患者应早期完善相关检查,早诊断、早治疗,以改善患者预后,提高生存质量.     

肝衰竭合并侵袭性肺曲霉病临床分析

目的探讨肝衰竭患者合并侵袭性肺曲霉病（IPA）的临床特点及治疗对策。方法对我中心341例肝功能衰竭合并肺部感染患者的临床资料进行回顾性分析。结果组织病理诊断明确的IPA11例,临床诊断病例3例。肺部IPA主要诱因为长期应用广谱抗生素和糖皮质激素;临床症状和影像学变化非特异性和不典型;及时诊断并及时使用卡泊芬净治疗,可以减少IPA患者的病死率。结论对肝衰竭患者需要提高早期诊断、治疗IPA的意识。     

肝硬化患者门静脉血栓形成的临床表现和危险因素

目的研究肝硬化患者门静脉血栓(PVT)形成的临床表现及危险因素。方法收集2008年4月-2015年4月宁夏医科大学总医院收治的肝硬化患者资料541例。其中76例肝硬化合并PVT的患者为研究组,同阶段通过匹配患者的性别、年龄及肝功能Child-Pugh分级,76例肝硬化不合并PVT为对照组。对比分析两组患者的临床资料及相关检查指标。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,并应用非条件Logistic回归模型筛选肝硬化PVT形成的独立危险因素。结果肝硬化PVT患者中,42.1%(32/76)隐匿起病,57.9%(44/76)有明显临床表现。大部分患者肝功能分级为Child-Pugh B和C级。血小板、血糖、中性粒细胞百分比、重度食管胃底静脉曲张、血浆D-二聚体、门静脉宽度、脾脏厚度在两组患者中差异有统计学意义(P值均0.05)。进一步非条件Logistic回归模型分析显示中性粒细胞百分比[比值比(OR)=1.044,P=0.040]、血浆D-二聚体(OR=0.091,P0.001)、门静脉宽度(OR=0.030,P=0.008)、脾脏厚度(OR=0.427,P=0.003)为PVT形成的危险因素。结论肝硬化PVT可隐匿起病,也可伴有不同的临床表现。肝硬化PVT常发生在晚期肝硬化患者中,血浆D-二聚体、门静脉宽度、脾脏厚度、中性粒细胞百分比为肝硬化PVT形成的独立危险因素。     

慢性乙型肝炎合并酒精性肝病患者临床特点及发生肝衰竭的危险因素分析

目的研究乙型肝炎病毒(HBV)合并酒精性肝病(ALD)患者临床特点及发生急性肝衰竭的危险因素分析。方法纳入2014年5月至2019年5月于我院收治的189例HBV合并ALD患者为对象,开展回顾性分析。统计患者一般资料,分析其临床特征及急性肝衰竭发生情况,并采用多因素logistic回归分析法分析患者并发急性肝衰竭的独立影响因素。结果189例患者中56例(29.63%)并发急性肝衰竭。腹水(OR=1.640,95%CI=1.424~1.889)、上消化道出血(OR=1.995,95%CI=1.234~3.225)、总胆红素(OR=1.278,95%CI=1.107~1.475)、CTP评分(OR=1.246,95%CI=1.021~1.521)是HBV合并ALD患者并发急性肝衰竭的独立影响因素(P<0.05)。结论HBV合并ALD患者临床症状无特异性,表现多样,伴肝损害,易并发急性肝衰竭,与腹水、上消化道出血、总胆红素、CTP评分密切相关。     

联合半肝切除的肝门部胆管癌根治术后发生急性肝衰竭的危险因素分析

目的探讨联合半肝切除的肝门部胆管癌(HC)根治术后发生急性肝衰竭的危险因素。方法回顾性分析重庆市肿瘤研究所2000年1月-2014年12月收治的行联合半肝切除的HC根治术的126例患者的临床资料,包括性别、年龄、术前血清TBil、Alb水平,是否保留肝动脉血供,是否行非选择性肝血流阻断,术中失血量和手术时间。计数资料组间比较采用χ2检验,进一步采用Logistic多因素回归分析患者术后发生急性肝衰竭的独立危险因素。结果共有17例(13.49%)发生急性肝衰竭,其中死亡11例(8.73%)。术前血清TBil200μmol/L[比值比(OR)=1.78,95%可信区间(95%CI):1.05~3.04,P=0.029]、术中失血量800 ml(OR=2.64,95%CI:1.33~3.95,P=0.037)、未保留肝动脉血供(OR=3.57,95%CI:2.21~5.09,P=0.002)、采用非选择性肝血流阻断(OR=1.36,95%CI:0.79~1.78,P=0.037)是术后发生急性肝衰竭的独立危险因素。结论术前减黄、减少术中出血、保留肝动脉血供、避免非选择性肝血流阻断对于减少联合半肝切除的HC根治术后发生急性肝衰竭有重要意义。     

老年人慢性阻塞性肺病并发侵袋性曲霉菌感染的临床研究

侵袭性肺曲霉菌病(invasive pulmonary aspergillosis,IPA)在免疫力低下患者中发病率相对较高,对该病的诊断治疗比较困难、病死率高.随着诊断技术的提高,激素和抗生素在肺部慢性阻塞性疾病(COPD)中的广泛及某些不合理的应用以及老年人并存多种基础疾病,COPD合并曲霉菌感染逐渐受到关注.据统计约有2%的COPD患者死于IPA,而曲霉菌感染后使COPD预后更差,研究结果显示,全球COPD合并IPA病死率高达72%～95%[1-2],因此早预防、早诊断、早治疗成为降低该病病死率的关键.我们对60岁以上老年COPD合并肺部曲霉菌感染病例进行总结分析,旨在发现一些临床早期诊治的线索.     

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.     

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.     

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.     

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.     

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.