胸腺类癌致异位促肾上腺皮质激素综合征一例

患者男，44岁，因反复咳嗽、咳痰10年，复发伴下肢水肿半个月，于2006年4月15日收入呼吸科，因发现血糖升高2d后转入内分泌科。10年前，患者进行性体重增加伴打鼾，1年前性欲减退，半年前始全身皮肤色素沉着，以面部明显，半个月前四肢水肿、口渴、多饮、夜尿增多、嗜睡，无头昏、头痛，无腹泻、胸痛、胸闷、乏力。有痛风、脂肪肝病史。吸烟史20年，40支／d。母亲患高血压。

加味四逆散对慢性心理应激大鼠胸腺糖皮质激素受体作用的研究

目的 :观察加味四逆散对慢性心理应激大鼠胸腺细胞糖皮质激素受体作用的影响。方法 :大鼠随机分为正常对照组 (C组 )、模型组 (M组 )、加味四逆散组 (C1 组 )、人参皂甙组 (C2 组 )。采用放射免疫方法检测大鼠胸腺细胞糖皮质激素受体的数目、核转移率。结果 :M组胸腺重量指数显著低于C组 ,糖皮质激素受体 (GCR)的数目差异不显著 ;胸腺糖皮质激素受体的核转移率显著高于C组 (P <0 0 1 )。C1 组与C2 组的大鼠胸腺细胞糖皮质激素受体复合物的核转移率均显著低于M组 ,胸腺重量指数显著高于M组 (P <0 0 1或P <0 0 5)。在受体核转移率下降方面 ,C1 组作用大于C2 组 (P <0 0 5)。此外 ,C1 组各项检测数据与C组相比无统计学差异。结论 :加味四逆散能显著减轻糖皮质激素对胸腺的抑制作用。

探讨肾上腺皮质激素在呼吸内科临床使用的具体效果

分析肾上腺皮质激素在呼吸内科的应用价值。方法:选取70例呼吸内科患者,年限为2018年2月至2020年2月。随机将患者分为治疗组和常规组,各35例。对比两组的治疗后的效果、症状评分。结果:治疗后,较之常规组,治疗组的日间、夜间症状评分均明显降低(P<0.05);治疗组的治疗总有效率(94.29%)较常规组(77.14%)高(P<0.05)。结论:肾上腺皮质激素应用于呼吸科疾病中,明显提高了治疗效果,改善了患者的临床症状。

艾灸对类风湿性关节炎大鼠下丘脑-垂体-肾上腺皮质轴的影响

目的 :探讨艾灸对类风湿性关节炎 (RA)大鼠下丘脑 垂体 肾上腺皮质轴 (HPAA)的影响。方法 :福氏完全佐剂塑造大鼠实验性RA病理模型 ,手术摘除大鼠双侧肾上腺 ,测定大鼠足容积 ,放免法检测大鼠血浆促肾上腺皮质激素 (ACTH)和血清皮质酮 (CS)含量 ,观察艾灸对实验性RA大鼠足肿胀度、血浆ACTH及血清CS含量的影响。结果 :艾灸能显著降低实验性RA大鼠足肿胀度 (P <0 0 5～ 0 0 1) ,明显降低RA大鼠血浆ACTH含量 (P <0 0 1)和升高血清CS含量 (P <0 0 5 ) ,但对去肾上腺的实验性RA大鼠的足肿胀度、血浆ACTH及血清CS含量无明显影响 (P >0 0 5 )。结论 :HPAA在艾灸治疗实验性RA中具有重要作用。

虚拟现实或等速运动训练对慢性腰痛患者疼痛、运动障碍和血清应激激素的影响

目的 探讨虚拟现实(virtual reality,VRT)或等速运动训练(isokinetic training,IKT)对慢性腰痛患者疼痛、运动障碍和血清应激激素的影响。方法 选择2019年6月~2020年12月在我院就诊的93例慢性非特异性腰痛(chronic non-specific low back pain,CNSLBP)患者为研究对象,采用随机数字表法分为VRT组、IKT组和对照组各31例,分别给予VRT、IKT和核心肌训练。观察三组患者干预前、干预后和随访8周时VAS评分、运动恐惧症坦帕量表(tampa scale for kinesiophobia-17,TSK-17)评分、促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)和皮质醇(cortisol,Cor)水平。结果 干预后和随访8周时,三组患者的VAS和TSK-17评分均较干预前显著降低(P<0.05),且IKT组和VRT组VAS和TSK-17评分均显著低于对照组(P<0.05),但IKT组和VRT组差异无统计学意义(P>0.05)。干预后和随访8周时,三组患者的ACTH和Cor水平均较干预前显著降低(P<0.05),且IKT组和VRT组ACTH和Cor水平均低于对照组(P<0.05);随访8周时,VRT组ACTH和Cor水平低于IKT组(P<0.05)。结论 VRT和IKT均是较常规核心肌训练更为有效的策略,在改善CNSLBP患者疼痛和运动恐惧方面均优于常规核心肌训练。

大鼠严重创伤后早期下丘脑c-fos和CRH mRNA的表达

目的 探讨严重创伤后下丘脑c fos蛋白和CRHmRNA表达变化的关系。方法 以大鼠右肺中部重度撞击伤加右股骨中段骨折为模型 ,采用Western印迹和RT PCR方法观察大鼠下丘脑组织内c fos蛋白和CRHmRNA表达变化。结果 伤后下丘脑c fos含量 3 0min达高峰 ,以后迅速下降 ;CRHmRNA表达的变化明显迟于c fos的变化 ,创伤后下丘脑CRHmRNA含量于 2h增加最为明显 ,然后持续增加 ,12h达最高。结论 严重创伤后早期下丘脑迅速增加的c

Possible involvement of integrin signaling pathway in the process of recovery from restraint stress in rats

Objective To search novel genes or pathways involved in the recovery process after restraint stress in rats. Methods We compared the hypothalamus transcriptional profiles of two different recovery patterns （fast recovery vs slow recovery） from restraint stress in rats using oligonucleotide microarray, the recovery pattern was determined by the decrement of plasma adrenocorticotropic-hormone （ACTH） and corticosterone levels during one hour recovery period after stress. A real-time quantitative RT-PCR was applied to validate the differential expressed genes. Results Analysis of the microarray data showed that most of genes were not differentially expressed between fast recovery group and slow recovery group. Among the differentially expressed genes we found that talin, together with serine/threonine protein phosphatase PPl-beta catalytic subunit （PP-1B） and integrin α-6 precursor （VLA-6） genes, were at least 1.5 fold upregulated in the fast recovery group, while junctional adhesion molecule 1 （F11r） was 1.5 fold down-regulated in the fast recovery group. Conclusion The results implied that integrin signaling pathway may be involved in the recovery from restraint stress in rats. The present study provided a global overview of hypothalamus transcriptional profiles during the process of recovery from the restraint stress in rats. The integrin signaling pathway seems to be involved in the recovery process, which deserves further study to clarify the integrin-mediated recovery mechanism after restraint stress.

Changes of serum adrenocorticotropic hormone and cortisol levels during sleep seizures

Objective Measuring the serum concentrations of adrenocorticotropic hormone （ACTH） and cortisol in epileptic seizures during sleep to investigate their link to the EEG changes. Methods Pre-surgical evaluation was performed by videoEEG monitoring using 24 channel recording. Thirty six epilepsy patients could be attributed to two groups： 28 patients had spontaneous seizures, and the other 8 patients whose seizures were induced by bemegride. Another 11 persons with confirmed psychogenic non-epileptic seizures （PNES） served as control group. Blood samples were obtained at five points： wake （08：00 a.m.）, sleep （00：00 a.m.）, and shortly before, during and after an epileptic seizure. The serum ACTH and cortisol were measured and analyzed by chemiluminescent immunoassay. Results The levels of ACTH and cortisol in serum underwent significant changes： declining below the average sleep-level shortly before seizures, increasing during seizures, and far above the average wake-level after seizures （P 〈 0.001）. Such changes did not occur in the control group （P 〉 0.05）. The ACTH and cortisol levels had no significant difference between spontaneous group and bemegride-induced group （P 〉 0.05）. Conclusion The serum concentrations of ACTH and cortisol during sleep seizures are linked with pre-ictal and ictal EEG changes in epilepsy patients.

狼疮性肾炎治疗现状

应用肾上腺皮质激素。

联合应用曲安奈德与复方水杨酸乙二醇透皮吸收贴剂治疗膝关节骨性关节炎疗效分析——附128例报告

曲安奈德(同息通)与复方水杨酸乙二醇透皮吸收贴剂(好及施)联合应用治疗128例膝关节骨性关节炎患者。结果显示,临床控制68例,显效41例,有效19例,显效率为85%,总有效率达100%,且均无出现明显不良反应,疗效显著。

静坐养生古今谈

静坐养生古今谈文／友国如今，古老的“炼养文化”又被注入了新的血液，一个强身防病，益寿延年的“静坐养生”之术，正在风靡全球。ｌ炼养文化源于东方追溯静坐的历史，不外两大派系，各源于东方的两大文明古国——中国和印度。中国自古以来的导引、行气、吐纳、打坐、练...

警惕医源性高血压

医源性高血压,就是指由于药物本身的药理作用或毒理作用以及用药方法不当引起的高血压,属于继发性高血压的一种。了解必要的用药常识,有助于减少其发病。

小儿流行性乙型脑炎的护理

小儿流行性乙型脑炎是由乙脑病毒引起的以急性脑实质炎症为主要病变的急性传染病。易引起患儿死亡，或留下不同程度的后遗症。如能及时早期诊断，给予恰当的治疗和护理便能挽救患儿生命，避免或减轻其后遗症。本文结合我科临床实践将护理体会报告如下。

Effect of electro-acupuncture on substance P, its receptor and corticotropin-releasing hormone in rats with irritable bowel syndrome

AIM： To investigate the effect and mechanism of electro-acupuncture lEA） at ST25 and ST37 on irritable bowel syndrome （IBS） of rats. METHODS： A total of 21 male Sprague-Dawley rats were randomly divided into normal group, model group and EA group. A rat model of IBS was established by constraining the limbs and distending the colorectum of rats. Rats in EA group received bilateral EA at ST25 and ST37 with a sparse and intense waveform at a frequency of 2/50 Hz for 15 min, once a day for 7 d as a course. Rats in normal and model groups were stimulated by distending colorectum （CR）. An abdominal withdrawal reflex （AWR） scoring system was used to evaluate improvements in visceral hypersensitivity. Toluidine blue-improved method, immunohistochemistry and radioimmunoassay were used to observe mucosal mast cells （MC）, changes of substance P （SP） and substance P receptor （SPR） in colon and change of corticotropin-releasing hormone （CRH） in hypothalamus. RESULTS： The threshold of visceral sense was significantly lower in model group than in normal group,and significantly higher in EA group than in model group. The number of mucosal MC was greater in model group than in normal group and significantly smaller in EA group than in model group. The CRH level in hypothalamus of rats was significantly higher in model group than in normal group, which was remarkably decreased after electro-acupuncture treatment. The SP and SPR expression in colon of rats in model group was decreased after electro-acupuncture treatment. CONCLUSION： EA at ST25 and ST37 can decrease the number of mucosal MC and down-regulate the expression of CRH in hypothalamus, and the expression of SP and SPR in colon of rats with IBS.

Suspended moxibustion relieves chronic visceral hyperalgesia and decreases hypothalamic corticotropin-releasing hormone levels

AIM:To evaluate the effect of suspended moxibustion(SM) on rectal sensory thresholds and to analyze the possible mechanisms involved in SM treatment of chronic visceral hypersensitivity(CVH) in rats.METHODS:SM was administered once daily to 37-dold CVH rats for 7 d.The two pairs of acupoints(ST25 and ST37,bilateral) were simultaneously treated with SM.Each treatment lasted for 30 min.Rats undergoing treatment with SM were not anesthetized.Untreated CVH rats and normal rats were used as controls.The abdominal withdrawal reflex was determined 30-90 min after the seven treatments.The hypothalamic corticotropin-releasing hormone(CRH) mRNA level was measured using real-time quantitative reverse transcriptionpolymerase chain reaction.RESULTS:We found that SM treatment significantly decreased visceral sensitivity to colorectal distention in this rat model.In treated animals,SM also decreased the relative hypothalamic CRH mRNA expression level to control levels.CONCLUSION:Lower hypothalamic CRH levels may mediate the beneficial effects of SM in this rat irritable bowel syndrome model.

Peripheral corticotropin releasing hormone mediates post-inflammatory visceral hypersensitivity in rats

AIM:To investigate whether peripheral corticotropin releasing hormone (CRH), which is up-regulated in intestinal inflammation, mediates the post-inflammatory visceral hypersensitivity in a rat model of colitis. METHODS:We measured mucosal myeloperoxidase (MPO) activity as a marker of inflammation, plasma CRH level, and abdominal withdrawal reflex (AWR) to colorectal distension as a visceral nociceptive response at 2, 7 and 14 d after the induction of colitis with 4% acetic acid. RESULTS:Colonic inflammation, quantified by MPO activity, significantly increased on d 2 and subsided thereafter, which indicated a resolution of inflammation within 7 d. On the contrary, plasma CRH level and AWR score were increased on d 2, remained high on d 7, and returned to control level on d 14. Intraperitoneal injection of a CRH antagonist, astressin (30 μg/kg), significantly attenuated the post-inflammatory visceral hypersensitivity on d 7. Furthermore, intraperitoneal administration of CRH (3 and 10 μg/kg) mimicked the post-inflammatory visceral hypersensitivity in naive rats. CONCLUSION:These results suggest that increased peripheral CRH mediates the enhanced visceral nociception in rats recovered from experimental colitis.

MAGNETIC RESONANCE IMAGING CHARACTERISTICS AND SURGICAL RESULTS OF ADRENOCORTICOTROPIN-SECRETING PITUITARY ADENOMAS

Objective To evaluate magnetic resonance imaging （MRI） characteristics and surgical results of adrenocorticotropin （ACTH） -secreting pituitary adenomas. Methods MRI characteristics and relationship between MRI positive rate and surgical results of 266 patients with pathologically confn＇med Cushing＇s disease were analyzed retrospectively. All patients underwent thin-section sagittal and coronal scans of the pituitary gland before and after administration of gadolinium-diethylene triamine pentaacetic acid （Gd-DTPA） on a 1. 5 Tesla MR/scanner, and dynamic enhanced MR/was performed in 39 patients. All patients underwent transsphenoidal adenomectomy. Endocrinological examinations and assessments were performed. Results Preoperative MR/revealed normal results in 41 （ 15.4% ） cases, microadenoma in 179 （67. 3% ）, macroadenoma in 42 （ 15.8% ）, and huge adenoma in 4 （ 1.5% ）. Pituitary apoplexy was found in 13 （4.9%） cases. Positive rate of ACTH-secreting adenomas was 84.6% （225/266） on MR/scans, and that of small microadenomas was 87.2% （34/39） on dynamic enhanced MRI scans. Preoperative endocrinological tests of 199 cases supported the diagnosis of typical Cushing＇s disease, while the other 67 cases had atypical endocrinological results. The endocrinological cure rate, remission rate, and inefficacy rate were 85.7%, 7.9%, and 6. 4%, respectively. There was no difference in the initial endocrinological cure rate between the patients with positive and normal MRI results （90% vs. 87. 8%, P =0. 904）. Conclusions Enhanced coronal pituitary MR/ is helpful for preoperative localization of ACTH-secreting pituitary microadenoma. Dynamic enhanced MR/may improve detection rate of microadenoma. There is no marked difference in the surgical results for patients with preoperative MR/results indicating presence or absence of microadenoma.

Significance of glucocorticoid receptor expression in colonic mucosal cells of patients with ulcerative colitis

AIM: Glucocorticoid (GC) resistant ulcerative colitis (UC) remains a serious disease and is difficult to manage. Although the molecular basis of GC insensitivity is still unknown, GC receptors (GRAAA and GRp) may play an important role in it. This study was aimed to investigate the relationship between the expression of GRa and GRp in colonic mucosal cells of patients with UC, the efficacy of GC therapy and the intensity of inflammation. METHODS: Twenty-five cases of UC were classified into: GC sensitive (n = 16) and GC resistant (n - 9) cases. Patients consisted of mild (n = 6), moderate (n = 8) and severe (n = 11) cases. GRa and GRp expression in colonic mucosal specimens were investigated by immunohistochemistry, and compared between GC resistant and sensitive groups, and also among various degrees of inflammation. RESULTS: All cases were positive for GRa and GRp expression. Both positive association between GRa expression and the response of UC to GC and strong negative association between GRp expression and the response of UC to GC were identified. There was no significant association between GRa/GRp expression and the degree of inflammation of UC. CONCLUSION: These findings suggest that both GRa and GRp may play an important role in the action of GC, and that GRp functions as a dominant negative inhibitor of GRa. Expression of GRa and GRp in colonic mucosal cells of patients with UC may serve as predictors of glucocorticoid response, but can not function as markers of inflammatory intensity.

Effects of repetitive transcranial magnetic stimulation on hypothalamic-pituitary-adrenal axis of patients with depression

Objective： To investigate the effects of sleep electroencephalogram-modulated repetitive transcranial magnetic stimulation （SEM-rTMS） and conventional rTMS （C-rTMS） on the activity of hypothalamic-pituitary-adrenal （HPA） axis in patients with depression. Methods： In a double-blind, randomized controlled trial, 164 patients diagnosed with depression were randomized to treatment with SEM-rTMS （n=57）, C-rTMS （n=55） or sham rTMS （n=52） for 30 rain every day for 10 d. Before and after treatment plasma concentrations of adrenocorticotropic hormone （ACTH） and cortisol （CORT） were measured, and the 24-item Hamilton Depression Rating Scale （HAMD-24） was used for assessment. Results： The HAMD-24 scores and plasma ACTH and CORT concentrations of these depressive patients before treatment were significantly different from those of the normal control group （P〈0.05）. The HAMD-24 scores and plasma ACTH and CORT concentrations in the SEM-rTMS group and conventional rTMS group were decreased significantly （P〈0.05）. There was a significant positive correlation between the HAMD-24 scores and plasma ACTH （n=240, r=0.105, P=0.048） and CORT concentrations （n-240, r=0.126, P=0.023） in the patients with depression before and after treatment. Conclusion： The antidepressant effect of rTMS, including SEM-rTMS, may be related to its decreasing HPA axis activity. （This trail was registered. No： ChiCTR-TRC-00000465）