急性心肌梗塞后左室附壁血栓临床研究

目的：提高对左室附壁血栓的认识，了解其危险因素，并探讨不同治疗方法的影响。方法：对住院的805例急性心肌梗塞(AMI)后有左室附壁血栓的45例(经彩色多普勒证实44例，磁共振证实5例)作一回顾性分析。结果：总的左室附壁血栓临床检出率为5．6％(45／805)，在AMI发病5d内发现者占80％，10d内发现者为20％；血栓：29例(64．4％)见于广泛前壁梗塞，10例(22．2％)见于前间壁梗塞，4例(8．9％)见于前侧壁梗塞，2例(4．5％)见于下壁并右室梗塞。Killip泵功能分级4级13例(28．9％)，3级者24例(53．3％)，2级6例(13．3％)，1级2例(4．5％)。超声心动图见异常团块影者66．6％，分层状等回声影者17．8％，云雾状回声15．6％。有6例(13．3％)发生伴动脉(脑、肠系膜、股动脉)栓塞。26例接受单纯抗凝治疗，血栓完全消失61．59／6，平均消失时间为25．7天，血栓减小者30．89／6；加尿激酶溶栓者17例，血栓完全消失者70．6％，平均消失时间为14．1天，血栓减小者23．59／5；加用rt—PA溶栓2例，血栓均于7天内7肖失。死亡8例(17．8％)，分别死于心力衰竭，心律失常，心脏破裂。结论：左室附壁血栓是急性心肌梗塞的严重并发症，死亡率高，和梗塞面积、部位、泵衰竭程度等关系密切；超声心动图是目前敏感的诊断手段；用肝素等抗凝，可以使血栓完全消失或减小。     

射频消融术治疗阵发性室上性心动过速

目的 总结12例射频消融术(RFCA)治疗室上性心动过速(SVT)临床资料。方法 用RFCA技术治疗难治性SVT。结果 房室折返性心动过速9例，共10条旁道皆消融成功，成功率100％，房室结折返性心动过速(AVNT)3例，成功率100％，本组无1例严重并发症，随访2个月—10个月，无1例复发。结论 RFCA为治疗SVT安全有效方法，有条件基层医院可以开展此项技术。     

冠心病患者非持续性室性心动过速:电生理测试指导治疗

本文回顾分析的对象为60±10岁的连续62例慢性冠心病患者,经Holter监测证实均有非持续性室性心动过速(NSVT)。除3例外,均有心肌梗塞史,此后平均43(2～180)个月进行电生理测试。16例形成左室壁瘤。电生理测试前停用抗心律失常药物至少48小时。经右心电极导管程控刺激右室(期外刺激至多3个)。28例(45％)诱发持续性窒性心动过速(SVT),给予抗心律失常药物后复查:12例药物有效即仅能诱发心搏≤10次的室性心动过速(VT),另12例则否。15例(24％)诱发NSVT,仅11例伴有晕厥或心悸者给药后复查:7例药物有效即未能诱发VT,另4例则否。19例(31％)未能诱发VT。共34例未能诱发SVT。     

依那普利对高血压病左室肥厚的逆转作用

采用超声心动图(UCG)对73例高血压病患者进行检测,发现28例(38％)有左心室肥厚(LVH)。对28例LVH者与16例无LVH者均采用依那普利进行为期9.75±1.5个月的治疗,治疗前后UCG对比发现LVH组室间隔、左室后壁厚度变薄,差异显著(P<0.001,P<0.001),左心室重量指数(LVMI)降低(18.6％)。无LVH组无显著差异(P>0.05)。提示长期应用依那普利对LVH有逆转作用。     

自发性早搏在室上速鉴别诊断中的作用探讨

目的探讨自发性早搏在短RP室上性心动过速(SVT)鉴别诊断中的作用。方法回顾性分析49例自发性早搏伴短RP之SVT者的心电图(ECG)资料,研究自发性早搏与SVT同时出现时,对SVT产生机理的揭示作用,以期早搏能起到"无创心电生理检查"的效果。结果本组病例中根据自发性早搏在SVT的ECG表现可基本确定SVT产生机理者26例,其中提示AVRT者10例,AVNRT者15例,AT者1例。结论对自发性早搏合并SVT时的ECG表现的仔细分析、合理解释,能起到"无创心电生理检查"的作用,具有较高的实用价值。     

血管紧张素Ⅱ对不同年龄大鼠异丙基肾上腺素激动β受体效应的影响

目的　研究 3 5月龄与 12 0月龄SD大鼠心脏血管紧张素Ⅱ (AngⅡ )对 β肾上腺素受体(β AR)激动剂异丙基肾上腺素 (Iso)诱导的环磷酸腺苷 (cAMP)蓄积水平的影响和激动血管紧张素Ⅱ受体 (ATR)对 β AR激动后介导的正性变力效应的影响。　 方法　采用放射免疫法测定心脏cAMP、环磷酸鸟苷 (cGMP)水平 ,采用离体左心房收缩功能实验测定心脏正性变力效应。　结果　Iso刺激后 3 5月龄大鼠心脏cAMP水平明显升高〔(10 2 7± 16 9)pmol·mg心肌组织 - 1 与 (14 0 0± 2 6 7)pmol·mg心肌组织 - 1 ,P <0 0 5〕 ;AngⅡ加Iso联合刺激后 3 5月龄与 12 0月龄大鼠心脏cAMP水平均明显升高〔(10 2 7± 16 9)pmol·mg心肌组织 - 1 与 (186 5± 32 9)pmol·mg心肌组织 - 1 ,P <0 0 1;(10 4 7± 2 6 6 )pmol·mg心肌组织 - 1 与 (16 97± 4 30 )pmol·mg心肌组织 - 1 ,P <0 0 1)〕 ;Iso刺激后 3 5月龄大鼠心脏cGMP水平明显下降 ;在 3 5月龄大鼠离体左心房用 10个不同浓度的AngⅡ刺激未能诱导出正性变力效应 ;AngⅡ使 3 5月龄大鼠心脏Iso的累积浓度 收缩效应曲线左移 ,最大收缩效应增强 ,但在 12 0月龄大鼠则没有出现这种变化。　结论　AngⅡ对Iso诱导的心脏cAMP蓄积有明显的正协同作用 ;AngⅡ可增强 3 5月龄大鼠心脏      

5-FU局部用药治疗尖锐湿疣28例

2004年以来，我们采用5-FU局部外敷加注射治疗尖锐湿疣28例，效果满意。现报告如下。 临床资料：本组男23例，女5例；年龄21～59岁，平均32．8岁。病变位于阴茎头、包皮口、冠状沟及系带处17例，位于阴束及肛门周围6例，位于外阴及肛周5例。均经病理检查诊断为尖锐湿疣，疣体≥0．5cm&#215;0．5cm者8例，疣体〈0．5cm&#215;0．5cm者20例，28例患者均为多发，最多达30余个，本组患者有50％为复发者，其中用疣委平治疗后复发者5例，激光治疗后复发者4例。     

抗去唾液酸糖蛋白受体酶联免疫检测法的建立及临床初评

目的 建立肝脏特异性自身抗体的ELISA检测方法，辅助自身免疫性肝炎的诊断。方法 利用亲和层析法从人肝脏组织中直接纯化去唾液酸糖蛋白受体(ASGPR)，经免疫学鉴定后以此纯化抗原包被微孔板，酶联免疫固相吸附试验检测去ASGPR的自身抗体(抗-ASGPR)。结果 本研究从10g肝组织纯化ASGPR，总量为1．6mg。经SDS-PAGE和Dot-ELISA验证，纯化ASCGPR纯度高、具有抗原活性。ASGPR预吸附可阻断血清抗体与ASGPR间的免疫反应，类风湿因子、梅毒阳性血清不干扰本ELISA法的抗原抗体反应。33例自身免疫性肝炎(AIH)患者中检出抗-ASGPR24例，阳性率为72．7％。在临床上高度怀疑AIH的10例患者中，抗-ASGPR阳性者有7例。原发性胆汁性肝硬化、病毒性肝炎、肝炎后肝硬化、肝癌、胆囊炎患者中阳性检出率分别为21．4％(9／42)、16．8％(16／95)、16．1％(10／62)、10．7％(3／28)、14．3％(1／7)。药物性肝炎、酒精性肝炎、系统性红斑狼疮和类风湿性关节炎患者中未检测到抗-ASGPR。200名健康体检者阳性率为4．6％。抗-ASGPR检测对AIH诊断的特异性为89．6％。结论 本研究所建立的抗-ASGPR ELISA检测方法可靠、特异性好。抗-ASGPR检测有助于AIH的诊断，尤其是对那些抗核抗体、平滑肌抗体、肝肾微粒体-1型抗体等自身抗体均阴性、临床高度怀疑AIH病例的诊断可能更为有用。     

射频消融治疗儿童室上性心动过速的应用体会

目的　旨在探讨射频消融(RFCA)在治疗儿童室上性心动过速(SVT)中的应用价值。方法　我院自1998年8月～1999年12月用RFCA治疗小儿SVT共9例,其中男7例,女2例。年龄8～14岁。经检查无器质性心脏病。在骶管或局部麻醉下,经皮穿刺右颈内静脉、股静脉、股动脉插入四极电极导管,先行心内电生理检查明确心律失常电生理机制,后以大头导管精确定位标测,最后从小电能开始RF放电直至有效消融成功。结果　心内电生理检查结果示显性预激综合征6例(3例右侧,3例左侧),右侧隐匿性预激综合征1例,房室结双径路1例,持续性房室交界区反复性心动过速(PJRT)1例。RFCA治疗9例SVT,8例根治,1例复发,无严重并发症发生。结论　RFCA治疗儿童SVT疗效确切,创伤小,可重复应用。对顽固性SVT病儿,需终身服抗心律失常药物及影响儿童学习者通过RFCA可得到根治。然RFCA对幼小婴儿心肌的长远影响尚待积累更多的资料。     

晚期大肠癌加用羟基喜树碱治疗20例疗效及毒性分析

目的 观察对含氟脲嘧啶联合化疗方案对药的大肠癌，在加用HCPT后的联合化疗效及毒性变化。方法 晚期大肠癌患者接受5-FU／CF治疗2个周期后未达到PR及以上疗效者于第3、4周期在原方案的基础上，加用HCPT治疗2个或2个以上周期，结果 20例用5-FU／CF治疗未达PR的患者，加用HCPT后。仍有15％的有效率(PR)。毒副反应无明显增加。结论 对5-FU耐药的晚期大肠癌患者的原方案基础上加用HCPT，仍可取得一定疗效，且毒副作用无明显增加。     

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.     

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.     

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.     

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.     

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.     

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.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.