门冬氨酸鸟氨酸联合易善复治疗非酒精性脂肪性肝炎临床观察

目的观察门冬氨酸鸟氨酸联合易善复对非酒精性脂肪性肝炎的临床疗效。方法非酒精性脂肪性肝炎患者70例,随机分成两组,治疗组采用门冬氨酸鸟氨酸静脉给药(剂量为10 g/次,1次/d)联合易善复口服治疗(456 mg/次,3次/d),对照组仅采用易善复治疗(用法用量同治疗组),于治疗前及治疗4周后观察患者血清谷丙转氨酶、谷草转氨酶、甘油三酯、胆固醇变化,4周后B超观察肝脏形态变化。结果两组患者于治疗前后实验室指标均有明显改善,但治疗组明显优于对照组(P<0.05);4周后治疗组肝脏声像形态评分要明显优于对照组(P<0.05)。结论门冬氨酸鸟氨酸联合易善复治疗非酒精性脂肪性肝炎具有较好的临床疗效,值得进一步研究。     

中西医结合治疗酒精性肝硬化并发肝性脑病25例临床观察

目的:探讨门冬氨酸鸟氨酸、纳洛酮联合醒脑静注射液对酒精性肝硬化并发肝性脑病的治疗作用.方法:酒精性肝硬化并发肝性脑病患者47例,分为治疗组25例,对照组22例.在常规综合治疗的基础上,对照组加用精氨酸、谷氨酸盐;治疗组加用门冬氨酸鸟氨酸、纳洛酮和醒脑静注射液.观察治疗组及对照组治疗前后的症状改善、血氨和肝功能指标,评价临床疗效.结果:治疗组血氨下降明显,治疗组总有效率高于对照组(88.00％ vs 63.64％,P＜0.05).2组患者治疗后血AST、ALT、GGT、TBIL均有不同程度的恢复,但均无统计学意义(P＞0.05).结论:门冬氨酸鸟氨酸、纳洛酮联合醒脑静注射液治疗酒精性肝硬化并发肝性脑病,能有效降低血氨,提高疗效.     

门冬氨酸鸟氨酸治疗酒精性肝病的临床疗效评价

目的探讨门冬氨酸鸟氨酸治疗酒精性肝病的临床疗效。方法将200例酒精性肝病其中脂肪肝140例,酒精性肝炎60例病人随机分为治疗组和对照组,治疗组用门冬氨酸鸟氨酸5.0g/天,对照组用肝安注射液,连用30天,比较两组治疗前后总胆红素、谷丙转氨酶、谷草转氨酶、血清白蛋白、血清球蛋白的水平。结果疗程结束时,治疗组的TBIL、ALT、AST、ALB、及GLB水平与治疗前比均有明显好转(P<0.05);并且治疗组治疗后ALT及AST水平明显低于对照组(P<0.05)。结论门冬氨酸鸟氨酸对酒精性肝病有较好的临床治疗效果。     

门冬氨酸鸟氨酸联合乳果糖、白醋灌肠治疗肝性脑病的临床研究

目的探讨门冬氨酸鸟氨酸联合乳果糖、白醋灌肠治疗肝性脑病(hepatic encephalopathy,HE)的疗效。方法 80例HE患者随机分为乳果糖+白醋灌肠组(A组)26例、常规剂量门冬氨酸鸟氨酸+乳果糖+白醋灌肠组(B组)29例、高剂量门冬氨酸鸟氨酸+乳果糖+白醋灌肠组(C组)25例,疗程均为10 d。观察各组的临床疗效,检测治疗前后血氨、谷丙转氨酶(ALT)、总胆红素(TBIL)水平。结果 B组、C组的显效率(62.1%、72.0%)高于A组(38.5%)(P0.05),三组间总有效率比较差异无统计学意义(P0.05)。三组治疗后血氨、ALT、TBIL均较治疗前明显改善(P0.05);治疗后C组血氨水平较A组明显下降(P0.05);治疗后B组、C组ALT、TBIL水平较A组明显下降(P0.05)。结论门冬氨酸鸟氨酸联合乳果糖、白醋灌肠是治疗HE的有效方法,高剂量门冬氨酸鸟氨酸联合治疗的疗效可能优于常规剂量。     

疏肝消脂颗粒剂治疗非酒精性脂肪性肝炎的临床疗效观察

目的：观察疏肝消脂颗粒剂治疗非酒精性脂肪性肝炎的临床疗效.方法：选择非酒精性脂肪性肝炎患者120例,随机分为治疗组（60例）,对照组（60例）,其中治疗组用疏肝消脂颗粒剂冲服,对照组用多烯磷脂酰胆碱胶囊治疗.两组患者治疗3个月,分别观察其临床症状和体征、肝功能、血脂等指标的变化情况.结果：两组患者临床症状皆能改善,治疗组疗效优于对照组;在改善肝功能、血脂方面,两组患者治疗后均较治疗前有明显改善,差异均有显著性意义（P＜0.05）,治疗组疗效优于对照组,差异有显著性意义（P＜0.05）.结论：疏肝消脂颗粒剂治疗非酒精性脂肪性肝炎的临床疗效确切,可改善患者临床症状和体征、降低肝功能及血脂指标,其疗效优于多烯磷脂酰胆碱胶囊.     

ω-3多不饱和脂肪酸胶丸对非酒精性脂肪肝患者的治疗作用

目的:探讨ω-3多不饱和脂肪酸胶丸(海狗油)治疗非酒精性脂肪肝(单纯性脂肪肝及非酒精性脂肪性肝炎)的治疗效果及临床有效剂量.方法:单纯性脂肪肝或非酒精性脂肪性肝炎患者46例.随机分为3组:ω-3多不饱和脂肪酸胶丸低剂量组(每天8粒,n=15)、高剂量组(每天10粒,n=15)和安慰剂组(n=16),进入双盲期,疗程24 wk.观察患者治疗前,治疗后12、24 wk的肝功能、血脂及B超评分.结果:低剂量和高剂量组患者治疗12、24 wk后,B超评分均有所改善,与治疗前比较差异有统计学意义(9.07±3.20,8.00±2.42 vs 11.20±3.00;8.33±2.44,7.07±2.52 vs 10.40±2.06,均P<0.01),而安慰剂组用药前后比较差异无统计学意义.高剂量组用药24 wk后血清甘油三脂水平出现明显下降,且与治疗前比较差异有统计学意义(1.68±0.77 mmol/L vs 2.66±0.82 mmol/L,P<0.01).治疗24 wk后,各组ALT和GGT较治疗前无明显变化.结论:ω-3多不饱和脂肪酸胶丸在改善非酒精性脂肪肝肝脏B超评分方面有明显作用,尤其是高剂量组作用尤为显著,且高剂量药物对血清甘油三脂的改善也有一定作用.     

水飞蓟素联合辛伐他汀治疗非酒精性脂肪性肝炎临床疗效观察

目的评价水飞蓟素联合辛伐他汀治疗非酒精性脂肪性肝炎的临床疗效。方法非酒精性脂肪性肝炎患者70例,随机分为两组。病例组35例给予水飞蓟素联合辛伐他汀治疗,对照组35例服用护肝片和维生素E治疗,疗程均为12周。治疗前后测定两组患者血清转氨酶（ALT、AST）及血脂（TG、TC）,同时观察患者有无不良反应。结果治疗后两组患者血清ALT均明显降低,尤以病例组降低明显（P〈0.05）,病例组患者治疗后各项血脂指标均显著改善,用药期间两组患者均未出现明显不良反应。结论水飞蓟素联合辛伐他汀对非酒精性脂肪性肝炎有显著疗效且用药安全。     

二氯醋酸二异丙胺治疗非酒精性脂肪性肝病的随机双盲临床研究

目的 研究二氯醋酸二异丙胺治疗非酒精性脂肪性肝病的临床疗效和安全性。方法 用随机双盲多中心剂量半行对照的临床试验设计选择非酒精性脂肪性肝病患者，分别用二氯醋酸二异丙胺高剂量(120mg／d)和低剂量(60mg／d)治疗8周，观察其疗效和安全性。结果 本试验共有l27例患者人选，高剂量组63例，低剂量组64例。术见脱落病例，剔除4例，剔除率3．1％，实际完成病例数l23例，高剂量组6l例，低剂量组62例。治疗后8周高剂量组和低剂量组临缶床疗效总有效率分别为87．8％和79．6‰(P=0．2536)，内氨酸氨基转移酶复常总有效率分别为55．7％和69．4％(P=0．0807)，血脂总有效率分别为67．2％和67．7％(P=O．9320)，B超脂肪肝影像学榆查总有效率分别为51．7％和43．5％(P=O．2879)，两组比较，差异均尢统计学意义。两组患者中各有1例发生不良反应，高和低剂量组的发生率分别为1．6％和1．6％，表现为口干，未见严重的不良反应。结论 二氯醋酸二异丙胺可安全有效地用于治疗非酒精性脂肪性肝病。     

门冬氨酸-鸟氨酸治疗黄疸型慢性病毒性肝炎的临床疗效观察

目的评价门冬氨酸-鸟氨酸治疗黄疸型慢性病毒性肝炎的临床疗效。方法将108例黄疸型慢性病毒性肝炎患者随机分为3组,分别接受4周的门冬氨酸-鸟氨酸、腺苷蛋氨酸和门冬氨酸钾镁等治疗,并检测患者治疗前后的血清总胆红素。结果门冬氨酸-鸟氨酸和腺苷蛋氨酸组在4周治疗结束时降低血清总胆红素的有效率分别为75.0%和72.2%,显著高于门冬氨酸钾镁组（30.6%）,P〈0.01;门冬氨酸-鸟氨酸与腺苷蛋氨酸组患者血清总胆红素每日降幅分别为4.3μmol/L±5.1μmol/L和4.3μmol/L±5.6μmol/L,显著高于门冬氨酸钾镁对照组（2.1μmol/L±8.3μmol/L）,P〈0.01。结论注射用门冬氨酸-鸟氨酸粉针剂能有效降低黄疸型慢性病毒性肝炎患者的血清总胆红素水平。     

壳脂胶囊联合多烯磷脂酰胆碱治疗非酒精性脂肪性肝炎38例

目的：观察壳脂胶囊（主要成分为壳聚糖）联合多烯磷脂酰胆碱（易善复）治疗非酒精性脂肪性肝炎的临床疗效。方法：76例非酒精性脂肪性肝炎患者随机分为治疗组（n=38）和对照组（n=38），治疗组应用壳脂胶囊和易善复片治疗12周，对照组只口服易善复12周，观察治疗前后患者症状及血脂（TG、TC）、肝功能（ALT、AST）及肝脏B超影像图变化。结果：治疗12周后，与对照组相比，治疗组患者TG、TC及肝脏B超影像图变化有统计学意义（P〈0．05）。结论：壳脂胶囊和易善复联合治疗可显著降低非酒精性脂肪性肝炎患者TG、TC水平，促进ALT、AST好转，改善肝细胞内脂质沉积，无明显不良反应发生。     

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.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.     

A single injection of adrenergic agonists enhances pineal melatonin production in Turkish hamsters

Abstract: The purpose of this study was to determine whether the pineal gland of Turkish hamsters (Mesocricetus brandti) responds to adrenergic agonists with an increase in melatonin production, and, if it does, whether the sensitivity of the pineal gland to agonists would differ throughout the dark phase. Adult Turkish hamsters weighing 110–210 g received a subcutaneous injection of isoproterenol (ISO, 1 mg/kg B.W.) or norepinephrine (NE, 1 mg/kg B.W.) at different times of night. Animals exposed to LD 16:8 responded to ISO or NE with increased pineal melatonin content only when injected at dawn, when endogenous melatonin is at basal or near-basal levels. When the 8 hr scotophase was entirely replaced with light, the responsiveness to ISO injections at dawn disappeared. In animals exposed to light from 30 min prior to injection to the time of sacrifice, ISO injections increased pineal melatonin content (P < 0.005, three-way ANOVA), which varied, depending on the specific time of injection (effect of time of night, P < 0.05, three-way ANOVA). These results demonstrate that (1) adrenergic agonists enhance the production of pineal melatonin in Turkish hamsters, (2) this stimulatory effect takes place late, but not early in the 8 hr scotophase, and (3) the adrenergic induction of pineal melatonin production in Turkish hamsters requires priming by darkness during the appropriate circadian phase.     

Immune effector mechanisms in malaria: An update focusing on human immunity

The past decade has witnessed dramatic decreases in malaria‐associated mortality and morbidity around the world. This progress has largely been due to intensified malaria control measures, implementation of rapid diagnostics and establishing a network to anticipate and mitigate antimalarial drug resistance. However, the ultimate tool for malaria prevention is the development and implementation of an effective vaccine. To date, malaria vaccine efforts have focused on determining which of the thousands of antigens expressed by Plasmodium falciparum are instrumental targets of protective immunity. The antigenic variation and antigenic polymorphisms arising in parasite genes under immune selection present a daunting challenge for target antigen selection and prioritization, and is a given caveat when interpreting immune recall responses or results from monovalent vaccine trials. Other immune evasion strategies executed by the parasite highlight the myriad of ways in which it can become a recurrent infection. This review provides an update on immune effector mechanisms in malaria and focuses on our improved ability to interrogate the complexity of human immune system, accelerated by recent methodological advances. Appreciating how the human immune landscape influences the effectiveness and longevity of antimalarial immunity will help explain which conditions are necessary for immune effector mechanisms to prevail.     

Secondary aortoduodenal fistula

Aorto-duodenal fistulae （ADF） are the most frequent aorto-enteric fistulae （80%）, presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication （0.3%-2%） of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.     

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.     

Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients

Objectives To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. Methods We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV‐positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. Results We recruited 148 spouses of smear‐positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear‐positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15–5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV‐positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV‐positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV‐positive community controls. Of 54 HIV‐positive spouses, 18 completed 6‐month IPT. At 2 year follow‐up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34–3.29). Conclusions Spouses are a high‐risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short‐duration therapy.