卡托普利逆转高血压左室重构的实验研究

１４周龄的自发性高血压大鼠已形成左室肥厚，心肌胶原浓度及心肌Ｃａ＾２＋增加，左室顺应性下降，经卡托普利治疗５０ｍｇ．ｋｇ．ｄ１４周后，ＬＶＨ消退。心肌胶原及Ｃａ＾２＋消退，左室舒张期弹性硬度改善，表明卡托普利治疗高血压能逆转左室肥厚及心肌胶原重构，并改善心功能。     

原发性高血压伴左心室肥厚病人的胰岛素抵抗和红细胞内钙离子代谢

目的比较原发性高血压（ＥＨ）伴左心室肥厚（ＬＶＨ）和无ＬＶＨ病人各３０例的胰岛素抵抗（ＩＲ）和细胞内游离钙浓度（［Ｃａ２＋］ｉ）的变化。用口服葡萄糖前后血浆胰岛素浓度（Ｉ）和Ｉ与血糖（Ｇ）比值来判断ＩＲ。用Ｆｕｒａ－２荧光染料测定红细胞内Ｃａ２＋。结果（１）ＬＶＨ糖负荷后的Ｉ及Ｉ／Ｇ均显著高于ＬＶＨ（－）；（２）ＬＶＨ的红细胞内Ｃａ２＋在空腹和糖负荷后均显著高于ＬＶＨ（－）；（３）ＬＶＨ的左心室重量指数（ＬＶＭＩ）与Ｉ及Ｉ／Ｇ呈正相关，ＬＶＨ（－）的ＬＶＭＩ仅与糖负荷后１ｈ的Ｉ及Ｉ／Ｇ正相关，ＬＶＨ和ＬＶＨ（－）两组的ＬＶＭＩ与红细胞内Ｃａ２＋正相关。结论ＥＨ病人伴ＬＶＨ时ＩＲ和红细胞内Ｃａ２＋增加。     

卡托普利治疗对SHR大鼠遗传血压,左心室肥厚及心肌胶原的影响

目的探讨卡托普利对自发性高血压大鼠（ＳＨＲ）的血压及左心室肥厚的影响。方法选用一组ＳＨＲ（Ｆ０），从交配之日起每天给卡托普利（２０ｍｇ／ｋｇ），其子代（Ｆ１）持续治疗到１６周时分为２组。第一组Ｆ１ａ在交配时继续用药治疗；第二组Ｆ１ｂ交配时停药。第二代两组小鼠（Ｆ２）出生后，Ｆ２ａ继续用药治疗到１６周停药；Ｆ２ｂ不用药治疗。分别观察其血压，左心室重量（ＬＶＭ），左心室重量与体重比（ＬＶＭ／ＢＷ）及测定左心室羟脯氨酸浓度和计算机图像分析心肌胶原的含量。结果发现在停药前动物血压处于较低的水平，但明显高于ＷＫＹ；而停药后血压明显回升到接近ＳＨＲ的水平。Ｆ２ａ表现基本一致；而Ｆ２ｂ的血压与对照组ＳＨＲ一样，明显高于Ｆ２ａ组。心肌内羟脯氨酸浓度及胶原含量，在Ｆ２ａ明显较ＳＨＲ和Ｆ２ｂ低，接近ＷＫＹ水平。结论卡托普利治疗并不能防止ＳＨＲ的高血压的遗传发展，但可以减低左心室肥厚，且主要是由于用药降低了心肌中胶原的含量     

苯那普利对心肌反应性纤维化影响的实验研究

在二肾一夹肾血管性高血压（２Ｋ１Ｃ－ＲＨＴ）大鼠模型中，观察转换酶抑制剂苯那普利在反应性纤维化阶段对左室质量、心肌胶原形态和生化的影响。结果显示，在反应性纤维化时，收缩压（ＳＢＰ）、左室重（ＬＶ）和左室重与体重比值（ＬＶ／ＢＷ）升高；心肌胶原在血管周围异常堆积，同时胶原容积分数（ＣＶＦ）、血管周围胶原面积（ＰＶＣＡ）和胶原浓度（Ｃｏｌ）增高，而Ⅰ、Ⅲ型胶原比值（Ⅰ／Ⅲ）下降。经苯那普利８周（７．５ｍｇｋｇ－１／ｄ）治疗后，ＳＢＰ、ＬＶ和ＬＶ／ＢＷ降低，异常堆积的胶原消失，ＣＶＦ、ＰＶＣＡ、Ｃｏｌ和Ⅰ／Ⅲ回复到对照水平。提示苯那普利除了有效降压和消退左室肥厚外，还能逆转反应性纤维化，发挥心肌修复作用。     

卡托普利对大鼠肥厚心肌受缺血再灌注损伤的保护作用及其机制探讨

腹主动脉缩窄致大鼠心肌肥厚模型作离体工作心脏灌流，观察卡托普利对大鼠肥厚心肌受缺血再灌注损伤的保护作用及血管紧张素Ⅱ（ＡｎｇⅡ）的影响。结果表明：在心脏停跳液及再灌注Ｋ－Ｈ液中加入卡托普利（２３．０μｍｏｌ／Ｌ）可明显改善肥厚心肌缺血再灌注后心功能的恢复，增加冠状动脉血流量，降低心肌组织乳酸、Ｎａ＋、Ｃａ２＋及ＭＤＡ的含量，并使心肌组织ＣＫ酶峰前移；而ＡｎｇⅡ（１０ｎｍｏｌ／Ｌ）可减弱卡托普利对肥厚心肌受缺血再灌注损伤的保护作用。我们认为，卡托普利对肥厚心肌受缺血再灌注损伤有保护作用，其机制可能与抑制心脏肾素－血管紧张素系统有关     

尼群地平与卡托普利逆转高血压左心室肥厚与左心室小动脉结构和功能的效果比较

目的：比较尼群地平及卡托普利治疗对自发性高血压大鼠（ＳＨＲ）左心室肥厚及左心室小动脉重构的疗效。方法：选用ＳＨＲ及Ｗｉｓｔａｒ－Ｋｙｏｔｏ大鼠（ＷＫＹ）７２只，随机分成１４周龄的ＳＨＲ１４组和ＷＫＹ１４组，２８周龄的ＳＨＲ尼群地平组（３０ｍｇｋｇ－１／ｄ）和卡托普利组（５０ｍｇｋｇ－１／ｄ），２８周龄的高血压对照组（ＳＨＲ２８组）和正常对照组（ＷＫＹ２８组）。每组１２只。观察指标包括左心室心肌重量与体重比值（ＬＶＭ／ＢＷ），冠状动脉血流量，心肌毛细血管密度（ＰＤ），两种不同管径小动脉管壁面积与腔径比值（Ａ／Ｒ），心肌胶原含量及心肌钙离子浓度。结果：１４周龄的ＳＨＲ已有左心室重构，除左心室肥厚外，心肌毛细血管密度减少（２６４±４２ｖｓ．３７２±７１μｍ／μｍ３，Ｐ＜０．０５），Ａ／Ｒ增加，心肌胶原含量（４．６２±０．８４ｖｓ．３．２７±０．９４ｍｇ／１００ｍｇ干重，Ｐ＜０．０５）及心肌钙离子浓度增加，尼群地平或卡托普利降压治疗１４周后，两组的左心室重构的异常表现均有消退或减轻。结论：尼群地平与卡托普利均能逆转ＳＨＲ左心室及心肌血管重构，在降压程度相同时其逆转效果相似。     

左室肥厚和胰岛素敏感性降低对高血压病患者冠状动脉血流储备的…

为研究高血压左心室肥厚病人的冠状动脉血流储备（ＣＦＲ）与胰岛素敏感性降低（ＤＩＳ）的关系。经食管超声（ＴＥＥ）研究２０例正常人（ＮＳ），３２例高血压非左室肥厚病人（ＨＴ＋ｎｏｎＬＶＨ），３３例高血压左室肥厚病人（ＨＴ＋ＬＶＨ）的ＣＦＲ，用正常血糖胰岛素钳夹技术测定胰岛素敏感性。结果显示：（１）ＨＴ＋ＬＶＨ组Ｄ／Ｒ ＰＤＶ，Ｄ／Ｒ ＰＳＶ（１．７４±０．３７，１．６７±０．４１）较ＨＴ－ｎｏｎＬＶＨ     

高血压左室肥厚患者组织纤维化的血清指标观察

目的本研究旨在通过观察高血压病患者组织纤维化血清学指标的变化，以探讨其作为心肌肥厚指标的临床价值。方法测定高血压伴左室肥厚３６例，高血压不伴左室肥厚３１例及正常对照３０例血清中Ⅲ型前胶原（ＰＣⅢ）、层粘连蛋白（ＬＮ）、透明质酸（ＨＡ）的含量。并将左室心肌重量指数（ＬＶＭＩ）与上述各参数作相关分析。结果高血压伴左室肥厚组较高血压不伴左室肥厚组及正常对照组的血清ＰＣⅢ、ＬＮ、ＨＡ含量显著增高（Ｐ＜０．０１）；血清ＰＣⅢ、ＬＮ、ＨＡ均与ＬＶＭＩ呈显著正相关。结论血清ＰＣⅢ、ＬＮ、ＨＡ均可作为高血压左室肥厚患者组织纤维化的血清学指标，为临床诊断高血压心肌肥厚提供间接的依据。     

培哚普利,卡托普利和硝苯地平对高血压左心室肥厚及心功能影响

目的观察培哚普利、卡托普利和硝苯地平对老年高血压心室肥厚（ＬＶＨ）及心功能的影响。方法将９４例老年轻、中度高血压ＬＶＨ病人随机分为培哚普利、卡托普利和硝苯地平３组。服用安慰剂２周后分别用药３个月，剂量递增，于实验前、用药前、用药后每月分别测定动脉血压，超声心动图左室舒张末内径、舒张期室间隔厚度、左室后壁厚度，并由此计算左室质量指数（ＬＶＭＩ），同时测定左室缩短分数，Ｅ／Ａ比值和射血分数。结果３组病人用药前一般情况无明显差别，用药后血压均有显著下降（Ｐ＜０．００１），组间无差异。ＬＶＭＩ培哚普利组（Ｐ＜０．０１）和卡托普利组（Ｐ＜０．００１）用药后有显著减低，Ｅ／Ａ比值明显升高（均Ｐ＜０．００１）。而硝苯地平组仅有Ｅ／Ａ比值升高（Ｐ＜０．０５）。左室缩短分数和射血分数３组均未见明显变化。结论对老年轻中度高血压ＬＶＨ病人，三药均可有效降低血压，卡托普利和培哚普利明显减轻ＬＶＨ，并改善左室舒张功能，硝苯地平亦可改善左室舒张功能     

氨氯地平和西拉普利逆转高血压左室肥厚的效应对比

目的　评价并比较氨氯地平（ＡＭ） 和西拉普利（ ＣＩ） 对老年高血压左室肥厚（ ＬＶＨ） 的逆转作用和左室舒张功能的影响。　方法　５０ 例合并ＬＶＨ 的高血压患者,随机分为ＡＭ 和ＣＩ 治疗组,分别于治疗前及治疗２４周后进行血压测量和超声心动图检查。　结果　ＡＭ 和ＣＩ 治疗后均能显著降低血压（ Ｐ 均＜ ０－０１） ;左室质量指数（ＬＶＭＩ） 均显著下降［ 由（１６４－７ ±３８－２）ｇ·ｍ － ２和（１６３－３ ±３９－２）ｇ·ｍ －２ 分别降至（１３１－０ ±２５－４）ｇ·ｍ －２ 和（１３０－７ ±２６－７）ｇ·ｍ －２,Ｐ 均＜ ０－０１）］ ;左室舒张功能改善（ Ｐ 均＜ ０－０１） ,２ 组间降压幅度、ＬＶＭＩ、Ｅ／ Ａ 变化无显著差异（ Ｐ＞０－０５） 。　结论　ＡＭ 和ＣＩ 每日１ 次给药均可作为治疗高血压伴ＬＶＨ 的有效药物     

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.     

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.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.