性激素补充治疗和骨质疏松症

性激素补充治疗(HRT)对绝经后妇女骨密度的维持效果已得到公认,目前资料尚不能肯定HRT与骨折的关系,但对已有椎体骨折妇女,HRT可减少再次骨折的发生。对美国妇女健康行动(WHI)临床试验中期研究结果应客观分析,雌孕激素HRT仍是治疗绝经期症状的最佳方案,且在绝经早期开始应用对预防骨质疏松症效果最佳。当然并不推荐所有绝经后妇女常规使用HRT,对无绝经症状的妇女来说,非激素防治骨质疏松应是更好的选择。     

性激素补充治疗和骨质疏松症

性激素补充治疗（HRT）对绝经后妇女骨密度的维持效果已得到公认，目前资料尚不能肯定HRT与骨折的关系，但对已有椎体骨折妇女，HRT可减少再次骨折的发生。对美国妇女健康行动（WHI）临床试验中期研究结果应客观分析，雌孕激素HRT仍是治疗绝经期症状的最佳方案，且在绝经早期开始应用对预防骨质疏松症效果最佳。当然并不推荐所有绝经后妇女常规使用HRT，对无绝经症状的妇女来说，非激素防治骨质疏松应是更好的选择。     

雌孕激素治疗与老年女性外周动脉病危险间关系

有研究显示,在绝经后健康老年女性,接受雌孕激素替代治疗将轻微减少继后颈动脉粥样硬化危险,但并不能减少原有冠心病者的继后外周动脉事件危险。本文意就绝经后健康老年女性接受雌孕激素治疗与继后外周动脉事件危险间关系进行了随机双盲对照分析。对象与方法本文为妇女健康创议(WHI)试验,共纳入16608例绝经后健康老年女性,年龄50～79岁,平均63．3±7．1岁。分为随机双盲服用结合雌激素(0．625mg/d)加醋酸甲羟孕酮(2．5mg/d)的雌孕激素替代治疗组8506例,或仅服安慰剂的对照组8102例。尔后人均用药或随访5．6年,旨在观察两组随访期内新发外周动脉事件(包括新发颈动脉、腹主动脉、肢端外周动脉病症状体征,以及因此需住院、介入治疗者,或经血管超声确诊者)危险的差异。结果两组用药前即被确诊患有冠心病者2．4%、外周动脉病者0．5%。随访期内,两组因新发外周动脉事件而     

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性激素与心血管疾病密切相关。无论男女,雄激素均随年龄增长而下降,且与动脉粥样硬化和冠心病呈负相关。雄激素替代治疗可以改善血脂、血管内皮功能,舒张冠状动脉,缓解心绞痛症状。雌激素通过多个途径对心血管疾病产生影响,绝经后女性心血管事件的发生率迅速升高。雌、孕激素替代治疗(HRT)对心血管疾病的益处与风险存在争议,目前尚无指征采用HRT对绝经期妇女进行心血管疾病的一级或二级预防;对用于缓解更年期症状和防治绝经后骨质疏松症,则需权衡利弊,结合患者具体情况进行个体化治疗。     

绝经后妇女的激素替代治疗与各种心血管危险因子的关系

大多数流行病学研究显示,绝经后妇女的雌激素替代治疗对心血管疾病有预防作用。激素替代治疗可能通过几种机理来降低冠心病的危险性。但是,很少有对雌孕激素联合应用的效果进行充分研究。为此,对绝经后妇女单纯应用外源性雌激素治疗或雌孕激素联合治疗与一些心血管危险因子的关系进     

激素疗法转危为安?

绝经期前后激素疗法争论之中有新的发展。一些权威机构已发布激素疗法(激素疗法)新指南,而过去十几年发布的相关指南令人混淆,充满争议。大约在1960年至2002年间,医生经常开激素疗法处方,用于治疗绝经症状以及预防心脏疾病,因心脏疾病死亡的女性多于其它疾病。2002年,一项精心设计的大型妇女健康倡议(WHI)研究显示,激素疗法增加心脏病发作、卒中、痴呆、乳腺癌、肺部和腿部血凝的风险。可以理解,这些结果使许多医生对激素疗法失去信心。哈佛医学院产科、妇科以及生殖生物学的临床助理教授Martha Richardson说道,"WHI结果出乎大家意料,因而     

运动防治老年骨质疏松研究进展

骨质疏松是一个世界范围的、越来越引起人们重视的健康问题.骨质疏松患者骨量低下,骨组织微结构退化,导致骨脆性增加极易造成骨折.国际上已将骨质疏松与高血压、肿瘤、糖尿病和动脉硬化列为五大老年疾病[1].预防骨质疏松的方法中,常用的有补钙、运动和雌激素替代疗法.补钙主要增加骨矿含量,对骨的结构和弹性影响不大.性激素、钙调激素、甲状腺素、类固醇激素、生长激素等激素对骨量也具有非常重要的作用,其中性激素对骨量的影响最大,这一点已有很多资料证明.常用的有长期性激素补充治疗(HRT)可获得雌激素对骨的最大保护作用,但停止HRT治疗后,雌激素对骨的保护作用随即消失.如美国WHI临床试验报告结果长期应用HRT会增加乳腺癌的风险,且不宜于心血管疾病的预防,因此在应用HRT预防绝经后妇女骨质疏松时,应考虑其对乳腺和心血管疾病的风险.     

激素替代疗法与卒中

激素替代疗法(hormone replacement therapy, HRT)包括给予类固醇性激素,例如雌激素单用或与孕激素联合应用,被广泛用于绝经后女性.HRT有助于缓解更年期症状,并被证实可预防骨质疏松.虽然大多数观察性研究显示HRT可降低心脑血管病风险,但随后的随机对照试验结果却与之相悖.文章从药物种类、用药途径、雌激素剂量、开始时机等方面对HRT与卒中的关系进行了综述.     

绝经妇女激素替代治疗的新进展

1963年Robert Wilson首先采用补充雌激素治疗与绝经有关的症状.预防雌激素缺乏所引起的退化性疾病,被称为“雌激素替代治疗”(ERT).由于多数情况下需加用孕激素,也统称为“激素替代治疗”(HRT).30余年来,随着妇女平均寿命的延长,围绝经期及绝经后妇女人口比重的增加,提高这一年龄段妇女的生活质量已受到了全球范围的广泛关注.关于绝经妇女HRT的基础、临床及流行病学的研究成果大量涌现,更新了人们对这一疗法的认识.现就近年来HRT的新进展进行介绍.     

性激素,激素替代疗法与心血管疾病

绝经前女性的心血管疾病(CVD)风险及其发生率与同龄男性相比均较低,女性的这种性别优势却在绝经后逐渐消失,这表明,性激素,尤其是雌激素,在女性中具有心血管保护的作用。观察性研究显示女性绝经后接受激素替代疗法(HRT)可降低CVD的发病率。但是,随机前瞻性一级或二级预防试验未能证实HRT对心脏有积极影响。女性健康计划(WHI)与心脏及雌/孕激素替代研究(HERSⅠ和Ⅱ)表明,HRT使绝经后女性的CVD风险及患病率增高。HRT有利有弊的这种矛盾特性的原因尚不明确。该文重点讨论了造成这种相悖结果的可能原因,并尽可能揭示为何年青或绝经前女性CVD发病率偏低,绝经后女性并不受益于HRT。此外,在判断HRT效果时,应考虑到剂量、疗程、雌激素的类型及给药途径等因素。总之,基于年青或绝经前女性CVD发病率低,而HRT对绝经后女性并无心血管保护作用的事实,HRT已成为在女性健康方面最具有争议性的课题之一。因此,还需要进一步的研究以阐明为何HRT结果会不一致,并为提高女性生活质量提供新的治疗策略。     

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.     

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.     

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.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.