阵发性房颤患者房颤发作时心房电极植入的可行性

目的　探讨阵发性房颤患者在房颤发作时植入心房电极的方法和可靠性。方法　对 10例房颤发作时植入心房电极的患者与同期窦律下植入心房电极患者的植入时间、术中以及术后心房电极的感知、起搏功能进行对比随访观察。结果　阵发房颤患者恢复窦性心律后测定心房感知和起搏功能良好 ,房颤发作时所测得的房颤波振幅与窦性心律时所测心房波振幅有相关性 ,其手术时间和X线曝光时间与窦律下植入起搏器的患者无明显差异。结论　房颤发作时植入心房电极临床上是可行的     

永久性心脏起搏器植入术中发生心房纤颤时心房电极导线定位经验

目的:研究永久性心脏起搏器植入术中心房纤颤(房颤)发作时以右心房波振幅最大处为右心房电极导线固定位置的可行性。方法:22例房颤发作时植入右心房电极导线的患者术中,测试右心房波振幅,术后随访恢复窦性心律(窦律)时测试右心房波振幅、起搏阈值,2者进行对比分析。结果:房颤心律时,所测得的右心房振幅与转为窦律后所测得的右心房波振幅有较好相关性,2者差异无统计学意义[(2.4±1.0)mv比(2.7±1.2)mv,P>0.05]。房颤时术中右心房波振幅平均(2.4±1.0)mv(1.6～3.7mv)者,在房颤转为窦律后所测定的心房感知和起搏功能良好。结论:在房颤发作时,右心房波振幅作为永久心脏起搏器合适的感知及起搏参数,有一定的临床实用价值。     

心房颤动发作时心房电极的置入

目的:探讨心脏起搏器置入术中心房颤动(房颤)发作时置入心房电极的方法和可靠性。方法:对24例具有心脏起搏器安置指征的慢快综合征患者房颤发作时置入心房电极的方法、术中术后心房电极的参数进行分析。结果:所有病例全部成功置入心房电极。4例阵发性心房扑动(房扑)患者经超速刺激转复2例;普罗帕酮转复8例阵发性房颤、房扑患者4例成功,胺碘酮转复14例阵发性房颤患者6例成功,总转复率45%。12例术后复律后程控测得P波振幅、心房电极阻抗、起搏阈值与12例术中复律患者测得的参数差异无统计学意义(P>0.05);10例房颤患者术中测得心房波为(0.8±0.6)mV,明显小于术后复律后程控测得的P波(1.4±0.5)mV(P<0.05),但两者阻抗无明显差别(P>0.05)。结论:心脏起搏器置入术中房颤发作时置入心房电极安全可靠。     

阵发性心房颤动发作之前的基础房律特性分析

目的探讨阵发性心房颤动(简称房颤)发作之前的基础房律特性,了解其房律特性是否与房颤发生相关。方法对动态心电图数据库中的8 000份原始电子资料(均由杭州百慧医疗设备有限公司生产的动态心电图记录仪记录),采用相应的软件,在浏览栏中,使用结论"阵发性心房颤动"搜索,寻获相应病例数据,编号,集中备份,再对备份数据采用散点图及逆向技术精细分析。观察到阵发性房颤起始节律后,在此时刻点截取12导联心电图,存储在指定硬盘中,以便后续采用Windows照片查看器将图片放大至适当程度测量房颤发作前Ⅱ、aVR、V_1导联上的P波时限和振幅。统计房颤发生前后各1 h的窦性心律和房颤时的平均心率,以及1 h窦性心律中发生的房性早搏(简称房早)、成对房早、二联律房早以及房性心动过速(简称房速)的个或次数。当阵发性房颤病例(阵发性房颤组)确定后,根据其组病例顺号,按性别匹配在同样的数据库中寻找窦性心律合并房早的病例(对照组),再根据房颤发作前1 h的时刻,在对照组中病例的相应时刻,统计1 h的窦性心率以及房性异位心搏的相应指标,截取一段12导联心电图,作相应存盘,后续采用前述同样方法测量Ⅱ、aVR、V_1导联上P波时限和振幅。结果共获取阵发性房颤79例,最终阵发性房颤组55例(有1例基础节律为心房扑动,故除外),对照组56例。两组年龄比较,无显著差异[(68.7±9.8)岁vs(66.2±15.1)岁,P>0.05]。房颤发作后1 h平均心率明显增快[(99±21)次/分vs(70±12)次/分,P<0.001]。与对照组比较,阵发性房颤组窦性心律时,单个房早的发生无明显差异(中位数:31.0 vs 43.5,P>0.05),而成对、二联律房早以及房速的发生明显增加(中位数:4.0 vs 0;3.0 vs 0;1.0 vs 0;P<0.001)。Ⅱ、aVR和V_1导联上的P波时限和振幅都明显增加[如Ⅱ导联:(112.73±15.92)ms vs(96.61±14.05)ms;(0.176±0.060)mV vs(0.141±0.050)mV,P均<0.001];P波时限和振幅的异常率亦明显增加(如Ⅱ导联,P波时限≥110 ms,75%vs 24%;P波振幅≥0.25 mV,19%vs 4%,P均<0.01,V_1导联,P波时限≥110 ms,24%vs 11%;P波振幅≥0.20 mV,11%vs 0,P均<0.001)。在Ⅱ导联上,1例在房颤开始发作前8个房波为倒置,而在aVR导联上为正向。在V_1导联上,P波的形态分布在两组中无明显差异,但在阵发性房颤组中,有2例P波呈完全负向,在房颤发作之前有小于1 000 ms的心房扑动或颤动的发生,而P波时限和振幅均在正常范围之内。结论①阵发性房颤发作后心室率变快;②房颤发作与其发作之前的成对、二联律房早以及房速发作频度增高有关;③房颤发作与P波的时限延长和振幅增高相关;④房颤的发作可能与房间传导径路变化相关。     

P波振幅预测阵发性心房颤动肺静脉隔离射频消融术后复发的临床价值

目的评价阵发性心房颤动(房颤)肺静脉隔离射频消融患者术前P波振幅与术后复发之间的关系。方法回顾性分析接受肺静脉隔离射频消融治疗阵发性房颤患者的临床特征,测量相关导联P波的时限和振幅。术后随访3个月以上,按照术后复发与否分为复发组与未复发组,评估P波振幅在预测房颤术后复发中的价值。结果在50例患者中术后共13例复发房颤,其中2例再次射频消融成功,总射频消融成功率78.0%(39/50)。复发组患者年龄[(67.75±6.48)岁比(60.82±8.87)岁,P=0.007]、CHA_2DS_2-VASC评分[(2.21±1.25)分比(1.33±1.15)分,P=0.021]和左心房内径[(40.4±4.7)mm比(37.2±4.2)mm,P=0.028]均显著高于未复发组,差异均有统计学意义。复发组患者Ⅰ导联P波振幅[(0.065±0.038)m V比(0.095±0.038)m V,P=0.024]显著低于未复发组。Ⅰ导联P波振幅0.1 m V在预测阵发性房颤肺静脉隔离射频消融术后复发的敏感度为79%,特异度为71%。多元回归分析显示,Ⅰ导联P波振幅0.1 m V为房颤术后复发的独立危险因素(OR 2.36,95%CI 1.96~4.87,P=0.012)。结论Ⅰ导联P波低振幅可能是预测阵发性房颤肺静脉隔离射频消融术后复发的有效指标。     

双腔频率应答起搏对病窦综合征合并的阵发性心房颤动的干预

探讨双腔频率应答起搏对病窦综合征(SSS)合并的阵发性心房颤动(简称房颤)的窦性心律维持及电生理干预。48例SSS并阵发性房颤患者安装了双腔频率应答起搏器,通过起搏器正确的心房感知监测房颤的发作情况,在窦性心律时测量P波时限和P波离散度,心脏B超测量左房内径、左室射血分数。比较术后1,12个月以及房颤控制组与复发组上述指标的差异。结果:置入起搏器术后1年,房颤控制和房颤负荷减少37例,占77%。术后1个月与1年左房内径,P波时限,房颤平均每天发作时间、发作次数均有显著性差异(3.6±0.6cmvs3.2±0.5cm,129.2±11.0msvs111.2±9.3ms,93.6±10.4min/dvs42.8±9.6min/d,8.1±3.2次/天vs5.3±1.4次/天,P<0.001)。与术后房颤复发组比较,房颤控制组术前左房内径较小,P波时限较短、离散度小(P<0.001)。结论:双腔频率应答起搏对SSS合并的阵发性房颤有预防和治疗作用。     

房颤患者心房肌细胞凋亡水平的变化

目的:研究心房颤动(房颤)患者心房肌细胞凋亡指数的变化,探讨房颤与心房肌细胞重构的关系. 方法:38例风湿性心脏病二尖瓣狭窄换瓣术者,其中窦性心律者13例(A组)、阵发性房颤及房颤持续时间＜6个月者8例(B组)、房颤持续时间＞6个月者17例(C组).外科手术时取3组病人右心耳组织少许,利用TUNEL法观察心房肌细胞凋亡指数. 结果:房颤患者(B、C组)心房肌细胞凋亡指数比窦性心律者(A组)显著增高,分别为44.53%±11.08%,67.96%±16.09%对19.68%±15.36%,P均＜0.05;凋亡指数与房颤持续时间成正相关. 结论:心房肌细胞重构可能在房颤的发生或维持中起重要作用,是慢性房颤转复为窦性心律后心房收缩功能延迟恢复的主要原因.     

左房异常与心房颤动相关性分析

目的 观察左房异常与心房颤动发生的关系.方法 将入选患者根据心电图特征分为A组、B组、C组,每组30例.持续性房颤(房颤发作持续时间大于7 d)患者为A组;既有窦性心律P波时限增宽,又有阵发性房颤(房颤发作持续时间小于7 d.一般小于48 h,多为自限性患者为B组;仅有窦性心律P波时限增宽,无阵发性房颤的患者为C组.对3组患者的P波异常,P波离散度及心脏超声波检查结果进行对比分析.结果 心电图P波切迹明显、P波离散度大者房颤发生率高;超声心动图检测左房直径增大者房颤发生率高,持续性房颤比阵发性房颤患者左房直径大(P＜0.01),显示左房扩大、房内阻滞及P波离散度增大者易发生房颤,危险比增高.结论 左房扩大可能是发生房颤的先兆,是心房颤动的独立危险因素,左房内径增大可作为发生房颤预测指标.     

心房总传导时间与阵发性心房颤动射频消融术后复发的关系

目的探讨心房总传导时间(TACT)与阵发性心房颤动(简称房颤)导管射频消融术(RFCA)后复发的关系。方法入选2012~2014年行RFCA的阵发性房颤患者116例,TACT测定即在术前基础心律为窦性心律时,脉冲多普勒采样容积放在二尖瓣环上的左房侧壁,从体表心电图Ⅱ导联P波的起始时间至组织多普勒追踪A’波波峰的时间(PA-TDI)间期,测定3个心动周期,取其平均值,术后3个月空白期后评定治疗效果并随访6个月。根据随访结果将患者分成复发组和未复发组。结果随访结束,116例患者中29例(25%)患者复发,复发组TACT较未复发组长[(144±23)ms vs(124±20)ms,P0.001)],多因素分析发现TACT是预测阵发性房颤RFCA术后复发的独立因素(OR=1.045,95%CI 1.021~1.073,P0.001)。结论 TACT可用于预测阵发性房颤射频消融术后复发。     

风湿性心脏病心外膜标测心房电位的对比研究

采用术中心外膜标测方法 ,对风湿性心脏病 (简称风心病 )慢性心房颤动 (简称房颤 )及其电复律后窦性心律、风心病窦性心律及非风心病窦性心律的心房电位进行比较研究。选择风心病慢性房颤患者 18例 (Ⅰ组 )、风心病窦性心律患者 9例 (Ⅱ组 )、非风心病窦性心律患者 8例 (Ⅲ组 ) ,采用 18导同步心外膜标测 ,通过心外膜电图对房波电位顺序进行分析 ,并对三组患者的心房有效不应期 (ERP)进行比较。结果 :窦性心律患者 (Ⅱ组与Ⅲ组 )以右房侧壁上部房波电位最为领先 ,慢性房颤患者 (Ⅰ组 )左房房波多以后下部最为领先 ;Ⅰ组心房ERP最短 ,Ⅱ组次之 ,Ⅲ组最长 ,以左房后壁中部、中下部、下部相差最为明显 (P <0 .0 1) ,而心房其它部位亦有显著差异 ,P <0 .0 5 ;Ⅰ组左房与右房ERP比较 ,左房中、中下及下部ERP均明显短于右房相应部位的ERP(P <0 .0 5 ) ;Ⅰ组中左房传导时间均明显长于Ⅱ组与Ⅲ组 (P <0 .0 1)。结论 :风心病慢性房颤患者的房波电位多起源于左房 ,其左房传导时间明显长于窦性心律患者 ,而心房ERP明显短于窦性心律患者。     

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.     

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.     

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.     

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.