大剂量尿激酶静脉给药溶栓治疗急性心肌梗塞

本文采用非创伤性冠脉再通指标,比较尿激酶快慢速静脉给药治疗的20例和10例不用尿激酶治疗的 AMI 患者出现冠脉再通的机率,并估价再通后的临床意义。结果提示:大剂量尿激酶快速给药方法可提高早期再通率;在 AMI 发病早期少数患者还可出现自发再通;早期再通可使少数患者不出现 Q 波;再通成功可能使患者有较多濒死心肌得到挽救。     

老年急性心肌梗塞静脉输注尿激酶的临床疗效分析

近年来静脉溶栓疗法重新受到重视,经多数研究证明静脉溶栓疗法溶栓率与冠状动脉内溶栓法接近。笔者将尿激酶(UK)按其用量分三组治疗急性心肌梗塞(AMI)并判断各组的临床疗效,旨在探讨UK有效剂量和再灌注的临床表现,并评价非创伤性冠状动脉再通指标的临床价值。     

急性心肌梗死静脉溶栓冠状动脉再通指标出现的时间顺序探讨

目的探讨急性心肌梗死(AMI)病人梗死相关冠状动脉静脉溶栓再通指标出现的时间顺序。方法将67例静脉溶栓治疗的AMI病人分为再通组和未通两组,再将再通组根据AMI发病时间分为<2h、2h~6h和>6h3个亚组,观察静脉溶栓后各组再灌注心律失常时间、胸痛缓解时间、心电图ST段下降达50%时间及肌酸激酶(CK)峰时间。结果再通组从再灌注心律失常时间、胸痛缓解时间到ST段下降达50%时间呈依此延长(P<0.05或P<0.01),且前述各指标随梗死时间的延长而相应延长,未通组的CK峰时间明显长于再通组及各亚组(P<0.05)。结论AMI静脉溶栓梗死相关冠状动脉再通指标按先后顺序为再灌注心律失常、胸痛缓解、ST段下降达50%及CK峰时间,且随梗死时间延长而相应延长。     

急性前(间)壁心肌梗死后无Qv_1对判断闭塞血管再通的价值

急性心肌梗死（ＡＭＩ）后闭塞血管能否很快再通对心功能的保护至关重要,为了达到血管再通的目的,人们在不断地努力研究和应用溶栓药,近几年又开展了ＡＭＩ的直接经皮冠脉腔内成形术（ＰＴＣＡ）治疗,均取得了令人瞩目的效果。如何用非创伤性方法判断闭塞血管已发生了...     

早期T波倒置判断冠脉再通的价值

目的探讨溶栓后早期T波倒置对闭塞冠状动脉再通的诊断价值及预后。方法选择78例急性心肌梗死(AMI)接受溶栓治疗的患者,分为24h内T波倒置组和未倒置组,依据临床间接血管再通标准观察两组再通情况。结果早期T波倒置组与未倒置组比较,前者较后者:①血管再通率高(p0.01);②心肌酶酶峰明显提前,峰值显著下降(p0.05);③心电图ST段迅速回降(p0.01);④再灌注心律失常的发生率高(p0.01);⑤心脏事件发生率低(p0.05);⑥半年后左室LVEF改善明显(p0.05)。结论早期T波倒置可作为冠脉再通的无创性可靠指标有助于检出高危患者。     

静脉溶栓治疗对糖尿病并发急性心肌梗死患者近远期效果的影响

目的:本研究探讨静脉溶栓治疗对糖尿病并发急性心肌梗死(AMI)患者近远期效果的影响。方法:对本院连续住院治疗的116例AMI的溶栓治疗患者,按临床诊断分成糖尿病组(n=26)、非糖尿病组(n= 90)。根据胸痛症状、心电图ST段抬高和下降情况及心肌酶水平峰值变化,采用中华医学会心血病学分会制定的间接标准及其组合判断方法评定梗塞相关血管是否再通,随访观察和分析2组治疗效果。结果:开始溶栓时间:糖尿病组平均为(5.69±2.24)h,非糖尿病组平均为(4.68±1.80)h,两组比较糖尿病组时间延长,有显著性差异(P<0.05)。梗塞血管再通:糖尿病组有13例,再通率为56.5%,非糖尿病组66例,再通率为75.9%,两组再通率相比,糖尿病组明显低于非糖尿病组,有显著性差异(P<0.025)。心力衰竭发生率在糖尿病组溶栓后有42.3% (11例),非糖尿病组21.1%(19例),两组发生率比较糖尿病组严重心力衰竭的发生率高于非糖尿病组,有显著性差异(P<0.05)。住院病死率在糖尿病组死亡5例(占19.2%),非糖尿病组死亡9例(占10.0%),两组相比,糖尿病组死亡率有增多趋势,但尚无显著性差异(P>0.05)。平均随访5.6年(2.2～7.5年),糖尿病组病死率高于非糖尿病组(P<0.05)。结论:糖尿病并发急性心肌梗死患者经溶栓治疗后,仍有较差的近期及远期预后,其溶栓治疗再通率较低,与糖尿病患者开始溶栓时间延迟有关。     

溶栓治疗在基层医院的优势

目的观察尿激酶溶栓治疗急性心肌梗死的效果和心脏事件的情况。方法 64例急性心肌梗死病人依发病到就诊时间的早晚分为尿激酶溶栓组和非溶栓组,溶栓组以150万U尿激酶静脉溶栓,非溶栓组给予一般治疗,1周后做冠状动脉造影观察冠状动脉再通情况并记录心脏事件。结果静脉溶栓组血管再通率67.7%,非溶栓组血管再通率27%,溶栓组心功能损害较非溶栓组轻。结论静脉溶栓治疗仍可以是基层医院治疗急性心肌梗死的主要方法 ,转院将延误再灌注治疗。     

大血管内介入治疗缺血性脑卒中的临床观察

目的观察大血管内介入治疗缺血性脑卒中的临床效果和预后。方法选取我院2009年11月—2016年7月收治的急性缺血性大血管闭塞脑卒中病人39例,其中血管内介入溶栓治疗15例,非介入治疗24例。结果介入组总再通率为86.67%;其中,前循环再通率为80.00%,后循环再通率为100.00%;发病6h病人13例,再通率为84.62%。介入组治疗前后美国国立卫生研究院卒中量表(NIHSS)、改良Rankin(mRS)量表评分比较差异有统计学意义(P0.05);非介入组NIHSS评分治疗前后比较差异有统计学意义(P0.05)。两组治疗后NIHSS评分比较差异无统计学意义(P0.05),mRS评分比较差异有统计学意义(P0.05)。结论大血管内介入治疗急性缺血性卒中可显著提高大血管闭塞的再通率,挽救缺血半暗带,改善神经功能缺损,提高病人生存率及生存质量。     

52例急性心肌梗死溶栓治疗后T波早期倒置的意义

观察溶栓治疗的急性心肌梗死患者52例.根据溶栓开始后T波倒置时间≤4h或＞4h将患者分成A、B两组,A组22例、B组30例.分析其临床判断溶栓后血管再通率及冠脉造影TIMI分级情况.结果按临床标准判断A组再通率100%,B组再通率50%(P＜0.01),1月内行冠脉造影36例,A组冠脉再通率明显高于B组(TIMI2～3级者A组14/16例、B组8/20例).早期T波倒置提示良好的再灌注,可作为血管再通的又1项临床指标.     

冠脉狭窄时创伤性和非创伤性检测左心室收缩功能的实验研究

在11条狗上,用冠状动脉微米狭窄器造成左旋支不同程度的狭窄。比较正常、临界和重度狭窄时创伤性和非创伤性左心室收缩功能的变化,认为非创伤性指标左心室射血时间（LVET）、射血前期（PEP）和它们的比值（PEP/LVET）虽然没有创伤性指标敏感,但可以较好地反映冠脉缺血时心功能的变化。同时指出,PEP/LVET等的变化和冠脉血流量（CBF）、左心室收缩峰压（LVSP）和左心室压力上升最大速率（dp/dtmax）呈负相关。从而可以用非创伤性指标估算创伤性左心室收缩功能。     

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.     

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.     

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.     

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.