高血压左房内径与E/A值和BNP的相关性分析

目的探讨高血压病人左房内径指数(LADI)与左室舒张早期快速充盈的充盈峰和舒张晚期(心房收缩)充盈的充盈峰的比值(E/A值)、血浆B型脑钠肽(BNP)水平的相关性,评价两者与早期高血压靶器官心脏损害过程中的作用。方法选择2010年12月—2013年12月山西省临汾市中心医院心内科的门诊高血压病人90例,按左房内径指数23 mm/m2分为LADI增高组与LADI正常组,比较两组间E/A值和BNP的差异。结果 LADI增高组E/A值和BNP均明显高于LADI正常组(P0.05)。采用多元线性回归分析对LADI的影响因素以及其影响程度,结果表明存在线性回归关系的影响因素是BNP水平、E/A值、收缩压、舒张压。结论左房内径指数的影响因素及影响程度,BNP水平与左房内径指数的关系最大,E/A值次之。     

老年高血压病人左室肥厚与左室舒张功能的关系

目的：研究老年高血压病人左室肥厚与左室舒张功能各参数的关系,探讨在老年人左室肥厚对左室舒张功能的影响。方法：用彩色多普勒超声心动图测量101例老年高血压病人左心室结构及舒张功能参数。结果：101例高血压病人中,左室肥厚组（48例）的左房内径指数（LADI）、等容舒张时间（IVRT）、舒张期二尖瓣E波减速时间（EDT）显著大于左室正常组（53例,P〈0．05～〈0．01）．多元逐步回归分析发现,左室质量指数（LVMI）与左房射血分数（LAEF）、LADI、IVRT和EDT有明显的相关关系（r分别为0．213,0．251．0．450．0．338．P〈0．05～0．001）结论：老年高血压病人的左室增厚可进一步降低左室舒张功能。     

高血压患者伴发快速房性心律失常与左房室重塑关系的临床分析

目的探讨高血压患者伴发快速房性心律失常与左房室重塑的关系。方法选取在我院住院治疗的原发高血压患者60例为观察组,Holter法检查均为高血压合并快速房性心律失常。选取同期在我院住院治疗的单纯性高血压患者60例为对照组。对两组患者进行超声心动图检测,比较分析两组患者心脏前后径与左右径以及左房容积指数,左室收缩末的容积、内径、质量指数等。结果观察组患者平均年龄大于对照组(P0.01);观察组患者平均病程长于对照组(P0.05);观察组患者左心房前后径(D1)、上下径(D2)与左右径(D3)均大于对照组(P0.05);观察组患者左房容积(LAV)\左房容积指数(LAVI)高于对照组(P0.05);观察组患者收缩末期内径(LVESd)、左室质量指数(LVMI)较对照组患者都有明显增高的趋势。结论高血压伴发快速房性心律失常的患者与单纯性高血压患者相比,其左房重塑明显,体积、容积均有增大,左室重构明显。     

老年高血压患者血压晨峰与心脏重构的关系探讨

目的探讨老年高血压患者血压晨峰与心脏重构的关系。方法将60例老年高血压患者按血压晨峰程度是否超过50mmHg分两组;A组,血压晨峰≥50mmHg组;B组,血压晨峰<50mmHg组。所有受试者进行心脏超声检查。结果A组左室肥厚发生率,左房内径增大发生率较B组高(P<0.05)。结论老年高血压患者血压晨峰程度与心脏重构密切相关。     

超声心动图评估妊娠期高血压疾病患者妊娠晚期心脏形态及心功能变化

目的观察妊娠期高血压疾病妊娠晚期心脏形态及心功能的变化。方法选取2012年3月~2015年4月于湖北省公安县妇幼保健院收治的60例妊娠期高血压疾病患者,并分为3组:妊娠期高血压组(A组,21例)、轻度子痫间前期组(B组,19例)和重度子痫间前期组(C组,20例);另选同期30例正常妊娠者为正常妊娠组。采用彩色多普勒超声诊断仪收集心功能及左室构型指标。结果 A、B和C组左室构型异常例数分别为22.7%、27.3%和50.0%,3组的左室构型异常比例增高,无差异(P0.05)。心脏形态:与正常妊娠组比,妊娠期高血压疾病组的室间隔舒张末期厚度(IVSTd)、左室后壁舒张期厚度(LVPWTd)、左心室舒张末期内径(LVDd)、左房收缩末期内径(LAD)、左心室重量指数(LVMI)和相对室壁厚度(RWT)明显增高(P0.05);与A组相比,C组IVSTd、LVPWTd、LVDd、LAD和LVMI明显增高(P0.05);与B组相比,C组LVDd明显增高(P0.05),A、B和C组3组RWT无差异(P0.05);与A组相比,B组IVSTd、LVPWTd、LVDd、LAD和LVMI有增高趋势,但无差异(P0.05)。左室功能:与正常妊娠组比,妊娠期高血压疾病组的A峰增大(P0.05),E/A和RFF减少(P0.05),与A组相比,C组的A峰明显增高(P0.05),E峰、E/A和RFF明显降低(P0.05),正常妊娠组和妊娠期高血压疾病组心输出量(CO)、心脏指数(CI)和左室射血分数(LVEF)无差异(P0.05)。结论妊娠期高血压疾病的左心室壁增厚,左室舒张功能异常,重度子痫前期的左心室壁增厚和左室舒张功能异常明显。     

脉压对高血压患者左室结构的影响

目的:探讨诊所脉压(PP)对高血压患者左室结构的影响。方法:选择291例高血压患者(高血压组)和107例正常血压者(正常组)。所有入选者测量非同日3次诊所血压,并进行超声心动图检查。2组均根据PP水平:<40mmHg(1mmHg=0·133kPa)、≥40~<50mmHg、≥50~<60mmHg、≥60mmHg分为A、B、C、D4个亚组。结果:高血压组左室质量指数(LVMI)随着PP增宽呈增大趋势,D亚组的LVMI为175·56±30·20;而在正常组中,不同亚组间LVMI差异无统计学意义。结论:PP升高是高血压患者左室肥厚及左室结构异常的重要危险因素。     

高血压患者左房构形超声新表达指标的变化

目的在探索正常人左房构形超声新表达的基础上,进一步观察和认识高血压患者左房构形的变化.方法选择45例高血压患者(Ⅰ、Ⅱ、Ⅲ期各15例)和15例正常成人,心电触发二维切面超声于左室收缩末期测量左房最大内径(LAD)、面积(LAA)和容积(LAV),用体表面积标化出左房内径指数(LADi)、面积指数(LAAi)和容积指数(LAVi),观察各期高血压患者上述六项指标的变化.结果 LAD、LAA、LAV和LADi、LAAi、LAVi在高血压患者均表现增大,并随着高血压分期的加重而愈加显著,其中高血压Ⅰ期LAD、LAA和LAV与正常对照组之间的差异无显著性(P>0.05),LADi、LAAi和LAVi与正常对照组之间的差异有显著性(P均<0.05); 高血压Ⅱ、Ⅲ期6项指标与对照组之间的差异均有显著性(其中Ⅱ期LAV P<0.05,余指标P均<0.01);此外LADi、LAAi和LAVi在高血压各期之间的差异亦有显著性(P均<0.01).结论高血压各期患者左房均表现增大, 体表面积标化的LADi、 LAAi和LAVi较常规指标LAD、LAA和LAV能够更早更敏感地反映高血压患者左房构形的改变.     

老年高血压病病人脉压与靶器官损害的关系

目的探讨脉压(PP)与高血压病靶器官损害的关系.方法 120例药物规则治疗下的老年高血压病病人,根据脉压水平的不同,分为PP＜60 mmHg和PP≥60 mmHg两组,颈动脉超声检测颈动脉粥样斑块发生率(CAPR)、颈总动脉内膜中层厚度(IMT)及内径(LD),超声心动图检测主动脉根部内径(AOD)、左心房内径(LAD)、左心室重量指数(LVMI)、左心室射血分数(LVEF)、左心房收缩期充盈峰值流速与左心室舒张早期充盈峰值流速比值(A/E),生化测定血清尿素氮(BUN)、肌酐(Scr)、内生肌酐清除率(Ccr).评价不同脉压水平的靶器官损害.结果与PP＜60 mmHg组比较,PP≥60 mmHg组CAPR、IMT、LD、AOD、LAD、LVMI、A/E、BUN、Scr均显著升高(P＜0.05),LVEF、Ccr均显著降低(P＜0.05).结论老年高血压病病人脉压增大,可促进心脏、血管及肾脏等靶器官损害,控制脉压可以减轻靶器官损害程度.     

老年高血压病患者动态脉压与左心室肥厚及主动脉根部扩张的相关研究

目的　研究老年高血压病患者动态脉压 ( 2 4hPP)与左心室肥厚 (LVH)及主动脉根部 (AOD)扩张的相关关系。方法　对 118例老年高血压病患者进行动态血压 (ABP)和超声心动图等检查 ,分别测量ABP和超声心动图的各种参数。将 2 4hPP≥ 60mmHg( 1mmHg =0 13 3kPa)的患者 5 8例列为A组 ,2 4hPP <60mmHg的患者 60例列为B组。结果　A、B两组LVH和AOD扩张的发生率有非常显著的差异 (P <0 0 1)。左心室重量指数 (LVMI)与 2 4hPP、2 4h平均收缩压 ( 2 4hSBP)呈密切正相关 (r分别为 0 47、0 42 ,P均 <0 0 1) ,与脉压 (PP)和收缩压 (SBP)呈弱相关 (r分别为 0 2 5和 0 2 1,P均 <0 0 5 )。AOD与 2 4hPP、2 4hSBP、PP、SBP、年龄和病程密切正相关 (r分别为 0 5 9、0 49、0 45、0 3 7、0 2 9和 0 3 4,P均 <0 0 1)。结论　老年高血压病患者的 2 4hPP与LVH及AOD扩张密切相关 ,2 4hPP可作为评价抗高血压药物能否更好地减少高血压患者靶器官损害的重要指标之一     

Tei指数对老年原发性高血压患者左心功能评价的临床研究

目的探讨Tei指数评价老年原发性高血压患者左心功能的价值。方法老年原发性高血压患者47例,平均年龄(75.32±6.01)岁,按Ganau分类法分为4种左室构型:正常构型组(Ⅰ组)、向心性重构组(Ⅱ组)、向心性肥厚组(Ⅲ组)、离心性肥厚组(Ⅳ组);正常对照组平均年龄(73.60±7.82)岁。超声心动图测量舒张末期室间隔、左室后壁厚度、左室舒张末期和收缩末期内径及左房内径(IVS、LVPW、LVEDd、LVEDs、LAD)、二尖瓣口血流频谱舒张早期和舒张晚期血流峰值比值(E/A)、左室射血分数(LVEF)以及左室Tei指数。结果高血压各组和对照组E/A比值均<1,各组间差异无统计学意义;高血压各组和对照组LVEF均大于>50%,各组组间差异无统计学意义;高血压各组左室Tei指数较对照组显著增大〔(0.32±0.06),(0.40±0.06),(0.48±0.06),(0.45±0.05),(0.54±0.07),P<0.05〕,高血压各组中,Ⅱ组和Ⅰ组,Ⅳ组和Ⅰ、Ⅱ、Ⅲ组左室Tei指数的组间差异有统计学意义(P<0.05);对照组中Tei指数与年龄进行相关性分析发现,左室Tei指数与年龄之间无显著相关性(r=0.048,P>0.05)。结论Tei指数是一种能够灵敏地检测出高血压患者早期左心整体功能改变的多普勒超声新方法;当老年高血压患者出现左室构型改变时,Tei指数能够反映其相应左心功能的不同程度损害。     

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.