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1.
目的评价三维标测系统(CARTO或EnSite-NavX)指引导管消融治疗心房颤动(房颤)的总体疗效和安全性。方法2004年9月至2006年12月期间入选800例房颤患者,男性482例,女性318例,平均年龄62.1±15.6(18~82)岁。其中阵发性房颤611例,持续性房颤189例,平均左心房内径38.4±9.2(30~60)mm。采用EnSite-NavX系统260例,CARTO系统540例。对于阵发性房颤采取环肺静脉前庭电隔离,对于持续性房颤采取环肺静脉前庭电隔离 心房碎裂电位消融 二尖瓣峡部消融。术后口服华法林及ⅠC类和Ⅲ类抗心律失常药物1~3个月,每月随访心电图、24小时动态心电图一次。对于术后1个月的房颤或房性心动过速(房速)复发进行再次标测和消融。结果795例完成手术。平均手术时间161±33(140~245)min,X线透视时间17±13(12~45)min。左肺静脉电隔离率为96.5%,右肺静脉电隔离率为98.6%。阵发性房颤术中发作98例,消融终止房颤90例。阵发性房颤术后2周内早期复发137例(22.5%),103例2周后不再发作,共57例接受再次消融(6例接受三次消融)。持续性房颤环肺静脉消融恢复窦性心律30例(16.1%),转变为房速/心房扑动(房扑)15例(8.1%)。心房碎裂电位消融恢复窦性心律20例(10.8%),转变为房速/房扑23例(12.4%)。持续性房颤术后早期复发78例(41.9%),14例随访中不再发作。65例再次消融(10例接受三次消融)。所有病例房颤消融术后房扑/房速104例(13.1%),68例随访中自愈,30例再次消融,23例消融成功。并发症:心脏压塞5例(0.6%,3例内科保守治疗成功,2例外科修补),肺静脉狭窄6例(0.7%),一过性脑缺血(TIA)1例,脑栓塞2例,肠系膜动脉栓塞1例。血胸1例,气胸1例。股动脉假性动脉瘤3例,股动静脉瘘1例。术后平均随访16.2±5.7(3~27)个月,阵发性房颤550例(90.3%)无房性快速性心律失常发作(9.4%再次消融,11.5%口服抗心律失常药物);持续性房颤159例(85.5%)无房性快速心律失常发作(34.9%再次消融,28.5%服用抗心律失常药物)。结论三维标测系统(CARTO或EnSite-NavX)指引导管消融治疗房颤疗效较高,安全性好。对于阵发房颤采用环肺静脉前庭电隔离术式即有良好效果;对于持续性房颤结合碎裂电位消融、二尖瓣峡部消融等方法,而且40%患者需要多次消融以提高成功率。  相似文献   

2.
目的比较EnSite-NavX系统与CARTO系统引导进行环肺静脉消融术(CPVA)治疗心房颤动(房颤)的各自特点、CPVA技术参数和临床疗效的差别。方法75例阵发性或持续性房颤患者,随机分为EnSite—NavX(n=40)和CARTO(n=35)引导的环肺静脉消融术两组,房间隔穿刺后,重建左房三维结构和环肺静脉射频消融。对持续性房颤进行线性消融以改良左房基质。消融终点为完全肺静脉电隔离。结果74例顺利完成消融术。CARTO组的总操作时间和X线透视时间显著短于EnSite—NavX组(P=0.03、0.04),左心房三维重建时间和X线透视时间两组差异无统计学意义。环肺静脉消融时,CARTO组的X线透视时间和操作时间显著短于EnSite-NavX组。EnSite.NavX组中14例(35%)房颤放电终止,多于CARTO组的5例(14%),P=0.04。单纯环肺静脉消融EnSite-NavX组实现肺静脉电隔离26例(65%),显著多于CARTO组的11例(31%),P=0.004。平均随访7个月,EnSite—NavX组32例(80%)和CARTO组24例(69%)无房颤发作,P=0.06。CARTO组1例发生心包压塞,经开胸修补痊愈;1例发生肠系膜小动脉栓塞,经药物治疗痊愈。EnSite-NavX组1例出现血胸,经胸腔穿刺引流痊愈。两组均未见肺静脉狭窄。结论三维标测系统引导下的房颤环肺静脉消融术临床效果相似。  相似文献   

3.
目的 探讨慢性心房颤动(房颤)环肺静脉消融术后房性心动过速(房速)的机制及射频消融的方法.方法 慢性房颤消融术后房速患者9例,均为男性,年龄50~70(62.6±7.2)岁.在三维标测系统和环状标测导管联合指导下,对无心房-肺静脉电传导者的房速经标测在关键峡部消融;对存在心房一肺静脉电传导者的房速,在原消融径线上的裂隙处消融.结果 3例为无心房-肺静脉点传导的折返性房速,于关键峡部线性消融后房速终止;6例为存在心房-肺静脉电传导的房速,对原消融径线裂隙消融后,4例房速终止,余2例附加左心房峡部线性消融后房速亦终止.消融术时间为90~295(211.7±75.4)min,X线曝光时间为11.5~67.6(25.5±16.5)min.消融术后各种刺激亦均不能诱发房速,没有出现肺静脉狭窄和其他相关并发症.随访4~8(6.2±1.4)个月,9例患者停用抗心律失常药物后仍为窦性心律.结论 慢性房颤消融术后恢复心房-肺静脉电传导的房速(66.7%)占大多数;无心房-肺静脉电传导的房速多为折返机制;针对恢复传导部位的补点式消融和对折返环关键峡部的线性消融,可以成功终止并发的房速.  相似文献   

4.
目的:探讨心房颤动(房颤)环肺静脉电隔离术后左心房-肺静脉折返性心动过速的心电生理学特征及其消融策略.方法:环肺静脉电隔离术后复发节律规整的心动过速患者9例,三维指引下拖带标测左心房、肺静脉,明确环肺静脉消融线遗留的缝隙,消融缝隙并随访.结果:9例左心房-肺静脉折返性心动过速患者平均年龄(57.9±11.1)岁(42~72岁),心动过速周长(300.1±29.4)m,(264~318 ms),其中持续性心动过速7例,阵发性心动过速2例.所有患者环肺静脉线性消融后电传导恢复,心动过速时左心房与肺静脉之间1:1传导,三维标测显示5例最早心房激动位于右肺静脉前庭、2例位于左肺静脉前庭、1例位于左肺静脉干、1例位于右肺静脉干.拖带标测显示心动过速与左心房、肺静脉以及环肺静脉消融遗留的两个缝隙[间距(34.4±4.1)mm]构成的折返环路有关,单一传导路径消融可以终止心动过速,心动过速终止后消融缝隙,随访15.1 ±411.1(6~32)个月无复发.结论:左心房-肺静脉折返性心动过速与左心房、肺静脉以及环肺静脉电隔离线上遗留的两个缝隙相关,可根据左心房和肺静脉内拖带标测明确诊断,消融缝隙可以根治此类心动过速.  相似文献   

5.
目的总结递进式消融术式治疗持续性心房颤动(简称房颤)的手术过程及临床转归。方法采用递进式消融策略治疗连续200例持续性房颤患者,手术终点为通过单纯消融终止房颤。按以下顺序进行消融:环肺静脉前庭消融达肺静脉电学隔离;心房碎裂电位消融;左房顶部和二尖瓣环峡部线性消融;针对房颤转变而成的房性心动过速(简称房速)行激动标测结合拖带技术明确其机制,并进一步消融终止。经术后3个月空白期,对复发房性心律失常(房颤/房速)的患者进行再次消融。结果 136例患者(68%)术中房颤被消融终止,消融终止房颤组首次术后房性心律失常复发率显著低于未终止组[19.9%(27/136)vs 51.6%(33/64),P<0.01],复发患者经再次消融后,平均随访12.8±7.2个月,本组病例总体手术成功率78.5%(157/200)。消融终止房颤组手术总体成功率高于未终止组[(86.8%(118/136)vs 60.9%(39/64),P<0.01)]。结论递进式消融可能是治疗持续性房颤的一种有效术式。  相似文献   

6.
环肺静脉左心房线性消融术后复发的房性心律失常   总被引:1,自引:0,他引:1  
目的研究心房颤动(房颤)患者环肺静脉左心房线性消融术后复发房性心律失常的机制。方法28例房颤患者接受环肺静脉左心房线性消融术,平均年龄(54±11)岁,其中阵发性房颤10例,持续性房颤18例。采用Carto电解剖标测系统及双Lasso标测导管技术,分别进行环左、右侧肺静脉线性消融;消融终点为肺静脉电位消失,左心房-肺静脉双向阻滞。复发患者再次消融术采用双Lasso导管指导在原环形消融线上标测“漏点”并消融封闭之,对不能终止心动过速者再行拖带标测、激动标测或结合Carto系统标测;对典型心房扑动(房扑)行右心房峡部线性消融。结果初次消融术后平均随访(245±65)d,18例无复发;8例复发房性心律失常包括5例典型房扑、2例其他房性心动过速、1例阵发性房颤;2例左上肺静脉电位未完全隔离者仍持续房颤。除外1例持续性房颤,另外9例接受了再次消融术,证实所有复发患者均有左心房-肺静脉传导恢复;8例射频消融成功并随访(192±92)d无复发。结论左心房-肺静脉传导恢复是环肺静脉左心房线性消融术后复发房性心律失常的重要因素;初次手术附加右心房峡部线性消融可能减少复发率。  相似文献   

7.
目的采用双Lasso导管标测技术行环肺静脉及其周围组织隔离预防心房颤动复发。方法13例心房颤动(房颤)患者,男性8例,女性5例,平均年龄为(56±8)岁,行电生理检查和射频导管消融。其中,8例为频发的阵发性房颤(1~20年),5例为持续性房颤(1~4年)。窦性心律下起搏远端冠状静脉窦或房颤发生时,利用电解剖系统进行左心房重建。然后,将两根Lasso多极导管同时置于右(左)上、下肺静脉之内。在距肺静脉口1cm左右处行环肺静脉及其周围组织电隔离。消融终点为左心房-肺静脉/周围组织完全性阻滞,表现为放电时肺静脉电位消失。结果7例阵发性房颤患者在窦性心律下电隔离成功,5例持续性房颤和1例阵发性房颤患者在窦性心律和房颤发生时电隔离成功。3例患者放电时房颤终止:左肺静脉隔离时房颤终止1例,右肺静脉隔离时房颤终止1例,左肺静脉隔离完成后54s自行终止1例。其余3例需体外电转复。消融术时间为(256±56)min,X线曝光时间为(39±11)min。无并发症发生。在术后平均随访(104±50)d,只有1例患者在第71d时出现不典型心房扑动,自行终止。其余12例患者均无房性快速性心律失常复发。结论有明确心电学隔离指标的环肺静脉及其周围组织电隔离是一种安全有效的方法。肺静脉既可为房颤的诱发机制,亦有可能参与房颤的维持机制。  相似文献   

8.
目的评价一种递进式消融法治疗持续性心房颤动(房颤)的疗效。方法34例持续性房颤患者,年龄(54.8±11.4)岁,病程(36.5±9.8)个月。按以下顺序进行递进式消融:环肺静脉前庭消融达肺静脉电学隔离,左心房顶部和二尖瓣环峡部线性消融,心房碎裂电位消融,针对房颤转变的心房扑动(房扑)/房性心动过速(房速)行Carto激动标测结合拖带技术以明确其机制,并力求通过消融终止。结果递进式消融法使88.2%患者房颤节律发生变化(直接终止或转变为房扑/房速),61.8%直接通过消融恢复窦性心律。随访(12.6±6.2)个月,82.4%患者维持窦性心律(其中42.9%服用胺碘酮)。结论递进式消融是治疗持续性房颤的一种有效方案。  相似文献   

9.
阵发性心房颤动患者肺静脉前庭电生理现象及分析   总被引:2,自引:1,他引:2  
目的采用EnSite/NavX系统指导下,结合单Lasso进行环肺静脉电隔离术治疗阵发性心房颤动(简称房颤),分析消融过程中肺静脉前庭电生理现象。方法入选2004年10月~2005年12月症状性阵发性房颤患者143例,男85例、女58例,年龄60.7±10.3(35~80)岁,房颤病程5.5±6.7年(21天~50年),左房内径36.9±6.4(24~54)mm。在EnSite-NavX系统引导下行环肺静脉消融达到肺静脉电隔离。结果143例完成环肺静脉隔离术,手术时间157±30(90~240)min,放射线时间25.8±8.8(9.8~60.1)min。环单侧左、右肺静脉前庭消融电隔离率分别为81.2%、78.3%,其余病例结合节段性消融(SOA)达到肺静脉电隔离。房颤终止的比例为69.7%(23/33例),第一次消融63.6%(91/143)可记录到肺静脉内自发电位,2.1%(3/143)可记录到肺静脉内快速的自主节律,而体表心电图为稳定的窦性心律。房颤复发患者第二次消融时,所有21例均有肺静脉电位(PVP)恢复,其中第一次消融时结合SOA达到肺静脉隔离的患者:57.1%左侧PVP恢复,55.6%右侧PVP恢复。第二次消融时,85.7%(18/21)例存在肺静脉内自发电位。术后房性心动过速/心房扑动15例(10.5%),12例再次行射频消融治疗,11例消融成功。术后随访10.7±4.9(4~18)个月,包括第二次消融术后患者在内,共90.2%(129/143)在无抗心律失常药物治疗下无房颤发作。心包积液2例,Ensite/NavX电极贴片故障1例。结论心房-肺静脉传导存在优势传导径路,且传导方式并非“全或无”;结合SOA的消融方法复发率较高;多数患者肺静脉隔离后可记录到自发肺静脉电位,复发患者的肺静脉通常具有较高的兴奋性。  相似文献   

10.
三维标测系统指导下环肺静脉消融治疗心房颤动   总被引:1,自引:1,他引:1  
目的 探讨三维标测系统指导下环肺静脉消融治疗心房颤动的安全性和有效性.方法 阵发性心房颤动92例和持续性或永久性心房颤动36例,接受环肺静脉消融术.采用Carto电解剖标测系统,进行环肺静脉左心房线性消融,消融终点为肺静脉电隔离.手术结束时对心律仍为心房颤动者行同步直流电心脏复律.结果 完成"解剖学"环形消融线256条,其中58.6%达到电隔离肺静脉的终点,经寻找缝隙补充消融后最终248条(96.9%)消融线达到终点.手术时间(231±45)min、X线曝光时间(42±13)min和放电时间(66±17)min.术后随访平均10个月,无复发101例(78.9%).接受了再次手术15例,心内电生理检查证实14例有左心房-肺静脉传导,射频消融成功并随访30~270 d,两次射频消融术后总成功率为87.5%,其中阵发性心房颤动成功率为93.0%,持续性或永久性心房颤动为76.7%.并发症发生率为6.2%,包括心包填塞2例、小脑梗死2例、股静脉穿刺部位血肿1例和左侧大量血胸1例,经治疗后均痊愈.结论 以肺静脉电隔离为目标的环肺静脉消融术治疗心房颤动有效和安全.  相似文献   

11.
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.  相似文献   

12.
The immunoneuroendocrine role of melatonin   总被引:19,自引:0,他引:19  
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.  相似文献   

13.
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.  相似文献   

14.
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.  相似文献   

15.
16.
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.  相似文献   

17.
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.  相似文献   

18.
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.  相似文献   

19.
20.
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 Mr 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 (Ka 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 Mr 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.  相似文献   

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