不同年龄老年人急性心肌梗死治疗与预后观察

目的比较≥75岁和＜75岁两组急性心肌梗死的老年人(AMI)的治疗及近期预后.方法急性心肌梗死128例,分成两个不同年龄组,采集患者的临床资料、治疗手段、并发症.观察一个月,观察终点为死亡或再梗.结果≥75岁58例,＜75岁70例,≥75岁患者近期死亡率明显升高(P＜0.01),AMI后左心衰发生率较高(P＜0.01).接受溶栓(34.5%比62.9%,P＜0.01)冠状动脉成形术和冠脉搭桥术(17.2%比37.1%,P＜0.05)明显减少.结论给予老年人适当的血运重建治疗可改善其预后,降低死亡率.     

老年人急性心肌梗死尿激酶静脉溶栓的临床评价

目的　评价尿激酶在老年人急性心肌梗死静脉溶栓中的疗效及安全情况。方法　５０ 例老年人急性心梗分为溶栓组和非溶栓组（ 对照组）,溶栓组２６ 例采用尿激酶静脉溶栓治疗,再与６５ 岁以下的２１ 例急性心梗溶栓组比较。结果　溶栓组再灌注率为５７－６ ％ ,住院病死率为７－６％ ,心梗后心绞痛发生率为３－８％ ,与非老年的溶栓组比较无明显差异。溶栓组与对照组比较,心梗后心绞痛分别为７－６％ 和２５％ 有明显差异（ Ｐ＜０－０１）,溶栓后再通病例与对照组比较,心肌酶（ＣＫ和ＣＫ－ ＭＢ）的峰值均高于对照组,两者达到峰值的时间均早于对照组（Ｐ＜ ０－０５～０－０１）。结论　老年人急性心肌梗死用尿激酶静脉溶栓安全有效,而且无出血及其它明显副作用。     

静脉溶栓治疗老年急性心肌梗死患者的体会

目的探讨老年（≥75岁）急性心肌梗死患者静脉溶栓的疗效及安全性。方法将62例老年急性心肌梗死患者随机分为溶栓组和常规治疗组；溶栓组32例。采用尿激酶静脉溶栓加皮下注射小剂量低分子肝素钙。常规治疗组30例，除不用尿激酶及小剂量低分子肝素钙外，其余治疗均与溶栓组相同。结果冠状动脉再通率溶栓组为65．6％（21／32），常规治疗组为16．7％（5／30），两组比较差异具有显著性（P〈0．05）；溶栓组病死率6．3％（2／32），而常规治疗组病死率为23．3％（7／30），两组比较具有显著差异性（P〈0．05）；两组无严重出血并发症，出血并发症比较差异无显著性（P〉0．05）。结论 尿激酶静脉溶栓治疗老年急性心肌梗死可以提高冠状动脉再通率，降低死亡率和改善预后，是可行性治疗措施。     

急性心肌梗死溶栓后联合使用阿司匹林及氯吡格雷的疗效和安全性研究

目的探讨急性心肌梗死患者接受标准剂量尿激酶溶栓后给予阿司匹林及氯吡格雷的疗效和安全性。方法我院住院的急性心肌梗死患者52例，因各种原因未行急诊PCI（经皮冠状动脉介入治疗）患者，同时符合溶栓条件，且发病时间在6h内，均给予尿激酶溶栓后随机分为2组：治疗组26例．给予阿司匹林0．3g，1次／d．7d后改为0．1g，1次／d，同时给予氯吡格雷负荷量300mg，然后75ng1次／d；对照组26例，给予阿司匹林0．3g，1次／d，7d后改为0．1g，1次／d，治疗观察30d。比较两组间心绞痛发作次数及发作平均持续时间、再梗发生率、病死率及不良反应的发生情况。结果（1）治疗组心绞痛发作次数及发作平均持续时间较对照组明显降低（P〈0．05）；（2）再梗发生率、病死率较对照组均明显下降（P〈0．05）。结论强化抗血小板治疗可改善急性心肌梗死患者溶栓后的临床症状和预后，提高生活质量，减少严重出血等不良事件。     

基层医院尿激酶静脉溶栓治疗急性心肌梗死128例临床观察

目的探讨基层医院早期尿激酶静脉溶栓治疗急性心肌梗死的临床效果。方法回顾性分析128例以尿激酶静脉溶栓治疗的急性心肌梗死患者的临床资料,根据发病时间将患者分为3组（〈3h组,3～6h组及6～12h组）,比较3组经溶栓治疗后的再通率。结果 128例急性心肌梗死患者接受溶栓治疗,总再通率71.09%,无死亡患者。〈3h组再通率显著高于3～6h组[93.33%（28/30）vs.68.49%（50/73）,P〈0.05]及6～12h组[93.33%（28/30）vs.52.00%（13/25）,P〈0.05],差异有统计学意义。溶栓后2h内出现心律失常30例（23.43%）,溶栓24h出现上消化道出血2例（1.56%）,低血压2例（1.56%）,急性左心衰6例（4.68%）,经对症治疗未造成严重后果。结论尿激酶早期溶栓治疗急性心肌梗死患者能有效地挽救濒死心肌,改善患者的预后,是一种有效治疗方法。     

急性心肌梗死急诊经皮冠状动脉介入治疗的近期疗效观察

目的评价急诊经皮冠状动脉介入（PCI）治疗急性ST段抬高型心肌梗死（STEMI）的近期疗效。方法109例STEMI患者行急诊PCI治疗（PCI组），并与178例同期接受尿激酶静脉溶栓的STEMI患者（UK组）进行住院期间疗效比较。结果与同期溶栓治疗相比，急诊PCI胸痛缓解迅速，120min ST段回落明显，再灌注成功率高（P〈0．01）；住院期间梗死后心绞痛（P〈0．01）、再梗死及死亡率明显降低（P〈0．05）；严重并发症发生率无明显增加。结论急诊PCI是急性心肌梗死（AMI）安全有效的治疗方法，并可进一步降低死亡率。     

急性心肌梗死尿激酶静脉溶栓52例临床分析

目的探讨急性心肌梗死患者经尿激酶静脉溶栓后ST段与心血管事件发生率的关系。方法选择我院收治的发病12h内的ST段抬高型急性心梗患者52例进行急诊尿激酶静脉溶栓治疗,分为ST段回落组29例及ST段无回落组23例,患者在住院期间及出院后应门诊随访6个月观察其心血管事件的发生率。结果再发生心血管事件的患者中ST段回落组为7例（24．14％）,低于ST段无回落组10例（43．48％）,两组比较差异有统计学意义（P〈0．05）。结论经尿激酶静脉溶栓后的急性心肌梗死患者中ST段回落的临床预后良好。     

碎裂QRS波与急性心肌梗死患者预后的相关陛

目的探讨碎裂QRS（fQRS）波与急性心梗预后的相关性以及在评估急性心梗预后中的应用价值。方法随机入选120例急性心肌梗死（sT段抬高型）患者分为三组：A组（行急诊PCI或静脉溶栓治疗）、B组（择期PCI）、C组（非再灌注治疗）,分别于发病后的4周、8周、12周,应用同步十二导联心电图观察fQRs波群,使用斑点追踪成像分析软件测量心室前壁径向收缩期应变率（RSR）及纵向收缩期应变率（LSR）,随访三组患者入院后半年内心脏不良事件的发生情况。结果①A、B、C三组病例出现fQRs波的导联数均逐渐下降;其中c组病例fQRs波阳性导联数要明显高于A、B两组,A组最少（p〈0．05）;②A组患者LSR、RSR的改善程度要明显优于B组和C组,B组结果优于c组（p〈0．05）;③三组LVEF值均有提高（p〈0．05）,其中A组提高最为显著;j组患者的血NT—proBNP浓度均有所下降,A组的浓度下降最为明显,B组次之（p〈0．05）;④三组患者心脏不良事件的比较差异有统计学意义（p〈O．05）,A组发生比例明显高于c组,B组位于A、C二组之间。结论常规心电图中fQRs波的变化情况可以作为评估急性心肌梗死后患者心功能的恢复及预后的指标之一,为临床治疗提供较可靠的客观依据。     

老年急性心肌梗死再灌注治疗的研究现状

老年人中急性心肌梗死（AMI）的发生率较高。据统计，在全部AMI患者中，年龄≥75岁者几乎占1／3.老年人心肌梗死常与高血压、糖尿病、心力衰竭等并存，加之老年人冠状动脉顺应性差，冠状动脉病变广泛，狭窄更严重等，使高龄成为AMI预后不良的独立预测因素。正因如此，多数用以评价ST段抬高型心肌梗死（STEMI）再灌注治疗疗效的大型随机临床试验，均系统地将老年人作为除外标准之一。即使是纳入老年人的临床试验，老年人所占比例也很小。因此，人们对老年人STEMI患者的再灌注策略知之甚少。由于缺乏有关老年人STEMI时再灌注疗法风险／效益比资料，老年人AMI症状不典型，并存病多，就诊迟等原因，使老年人AMI接受再灌注疗法的比例随年龄增长而下降：65～69岁者64．8％，70～74岁者60．1％，75～79岁者50．4％，80～84岁者35．4％，≥85岁者20．4％。近年来。老年人STEMI行再灌注治疗者的比例有所上升。日本学者Yagi等报道一组1855例AMI，其中年龄75～85岁的高龄者483例，采用再灌注治疗者264例（55％），再灌注成功率92％。此外，静脉溶栓与经皮冠状动脉干预（PCI）比较，究竟哪种再灌注疗法更优？至今仍不明确。本文搜索MEDLINE数据库中近年来有关老年人STEMI患者再灌注疗法的文献资料，综述老年人AMI后溶栓疗法与PCI的疗效及安全性。     

高龄急性心肌梗死患者静脉溶栓治疗的临床观察

目的：探讨高龄（≥75岁）急性心肌梗死（AMI）患者静脉溶栓治疗的疗效和安全性。方法：将61例高龄AMI患者随机分为溶栓组和常规治疗组，溶栓组30例，在常规治疗基础上采用尿激酶（UK）静脉溶栓＋口服阿斯匹林（ASA）。常规治疗组31例，除不用UK外，其余治疗均与溶栓组相同。结果：血管再通率溶栓组为66．7％（20／30），常规治疗组为12．9％（4／31），两组血管再通率比较，差异有显著性（P＜0．05）。溶栓组住院4周病死率为3．3％，常规治疗组为22．6％，两组比较差异亦有显著性（P＜0．05）。溶栓组未见严重出血等并发症。结论：UK＋ASA治疗高龄AMI可以提高冠脉再通率，降低病死率和改善预后。     

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.     

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.     

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.