肝硬化患者心电图改变与Child-Pugh分级及预后的相关性研究

目的探讨肝炎后肝硬化患者心电图改变与Child-Pugh分级及预后的相关性。方法选择本院诊治的146例肝炎后肝硬化患者,按照Child-Pugh评分对其进行分级;同时采集患者体表心电图,并测量计算QTc,记录各种心电图异常表现。结果患者心电图异常改变率62.33%,显著高于慢性肝炎组,且随Child-Pugh分级增加而升高(P0.05);异常心电图以Q-T间期延长为主(占56.85%),QTc值与Child-Pugh分级存在相关性(P0.05);心电图异常组和正常组患者病死率差异有统计学意义(P0.05)。结论肝炎后肝硬化患者心电图改变与Child-Pugh分级及预后密切相关。     

42例扩张型心肌病心电图分析

目的探讨扩张型心肌病患者心电图改变特点。方法对我院收治的扩张型心肌病患者42例的心电图检查资料进行回顾性分析,总结扩张型心肌病心电图特点。结果 42例扩张型心肌病患者的心电图均出现异常,其中异位搏动及异位心律32例(76.1%),ST-T改变18例(占42.9%);传导阻滞17例(占40.5%);房室肥大15例(占25.7%);Q-T间期延长7例(16.7%);异常Q波6例(14.3%);肢导联低电压6例(14.3%)。结论扩张型心肌病有多种心电图表现,异位搏动及异位心律发生率最高,对早期诊断扩张型心肌病具有重要意义。     

七氟醚诱导对老年人Q—T间期的影响

目的 评估七氟醚诱导对老年人Q-T间期的影响.方法 40例行择期手术的老年患者,ASAⅠ～Ⅱ级,年龄65～75岁,术前心电图无异常,随机分为两组,A组(七氟醚组, n=20),B组(异丙酚组,n=20).分别于麻醉前、诱导后2、5、10、30 min行心电图检查,记录心率(HR)、Q-T间期,计算Q-Tc.结果 诱导5 min后七氟醚组Q-T间期和Q-Tc显著延长(P＜0.05);异丙酚组Q-T间期有降低趋势,但无统计学意义(P ＞0.05).结论 七氟醚诱导使老龄患者Q-T间期延长,在临床应用中应引起重视.     

心脏病室性心律失常患者Tp-e间期、Tp-e/Q-T比值的研究

目的探讨器质性心脏病患者Tp-e间期、Tp-e/Q-T比值与室性心律失常的关系。方法选择器质性心脏病患者85例,分为两组,器质性心脏病室性心律失常组(A组)43例,并进一步按LOWN分级分为两个亚组,A1组(LOWN2-3级)20例,A2组(LOWN3级以上)23例;器质性心脏病无室性心律失常组(B组)42例。另选择健康体检者40例为正常对照组(C组)。采用常规12导联同步心电图及24小时动态心电图分析比较各组的Q-T间期、Q-Tc间期、Tp-e间期、Tp-ec间期和Tp-e/Q-T测值。结果 A组Q-T间期、Q-Tc间期、Tp-e间期、Tp-ec间期、Tp-e/Q-T测值比C组显著升高,差异有统计学意义(P<0.05),而Q-Tc间期、Tp-e间期、Tp-ec间期、Tp-e/Q-T比B组显著升高,差异有统计学意义(P<0.05)。上述各测值A2组比A1组显著升高,差异有统计学意义(P<0.05或P<0.01)。结论 Tp-e间期、Tp-e/Q-T等心电学指标与室性心律失常的发生有关,对室性心律失常的发生具有预测意义。     

肝硬化患者心电图Q—Tc间期延长的临床意义

目的探讨肝硬化患者Q-Tc间期变化及相关影响因素。方法检测125例肝硬化患者与50例非肝硬化患者心电图Q-Tc、凝血酶原时间（PT）、血清白蛋白（Alb）、血清总胆红素（TBil）、血清钾、血清钙、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转肽酶（GGT）和碱性磷酸酶（ALP）等指标,组间比较Q—Tc的变化及肝功能、不同Child分级间Q-Tc异常率,采用单因素直线相关回归分析探讨Q-Tc与各项相关指标的关系。结果肝硬化组Q-Tc为（440±15）ms,非肝硬化组为（405±13）ms,两组比较P〈O．001;以Q-Tc≥440ms为异常,肝硬化组异常率为37．90％（47／125）,非肝硬化组为12．00％（6／50）,两组比较P〈0．001。肝硬化组中ChildC级的Q-Tc异常率为72．50％（25／34）,B级为41．50％（19／45）,A级为28．37％（13／46）;A级与C级比较P〈0．01。单因素直线相关回归分析结果显示,Q-Tc与Child积分呈正相关,相关系数r=0．31（P〈0．01）;与腹水程度呈正相关,相关系数r=0．24（P〈0．05）;与血清总胆红素（TBil）呈正相关,相关系数r=0．23（P〈0．05）。结论肝硬化存在Q-Tc异常延长,病因是多因素性的,随肝硬化病情加重,Q-Tc异常率升高。Q-Tc延长是引起室性心律失常的常见诱因,可能也是肝硬化患者出现猝死的原因之一。     

健康孕妇的心电与临床分析

目的探讨健康孕妇的心电改变及其与临床的关系。方法采用美高仪ECGLAB2.0分析479例健康孕妇的心电图资料,并通过与妊娠年龄及妊娠周期的相关性探究。结果 479例健康孕妇中心电图异常226例(47.18%),且与妊娠周期之间的差异具有显著性意义,与妊娠年龄之间的差异无显著性意义;孕期的心电异常以QTc延长、心律失常、短P-R间期、低电压、ST-T改变为多见。结论健康孕妇的心电异常发生率不仅较高,且与孕周呈正相关,多表现为QTc延长、心律失常、短P-R间期、低电压、ST-T异常。     

1320例急性脑血管病患者心电图特点分析

对同期收治的1 320例急性脑血病患者于发病后1～12 h行常规心电图检查,并于3周内复查1～3次.结果 1 320例中心电图异常925例(70.1%),其中ST-T改变544例(58.8%),Q-T间期延长98例(10.6%);1273例存活者中心电图异常885例(69.5%),53例死亡者中心电图异常49例(92.4%).认为急性脑血管病引起的心电图变化与病情及预后有关;进行治疗时应综合分析,避免加重心脏负担和血容量不足,必要时采取心脏保护措施.     

异丙酚或七氟醚诱导对小儿Q-T间期的影响

目的评估异丙酚或七氟醚诱导对小儿Q-T间期的影响。方法 30例行择期手术小儿患者ASAⅠ～Ⅱ级,年龄2～7岁,术前心电图无异常,随机分为两组,S组(七氟醚组15例),P组(异丙酚组15例)。分别于麻醉前、诱导后1min、5min、10min行12导联心电图检查,测定Q-T间期,通过Bazett公式计算Q-TC。结果诱导后七氟醚组Q-T间期和Q-TC显著延长(P0.05);异丙酚组Q-T间期有降低趋势,但无统计学意义(P0.05)。结论七氟醚使小儿Q-T间期延长,异丙酚对小儿Q-T间期无明显影响。     

室性心律失常与 Tp-e 间期、Tp-e／Q-T比值的相关性研究

目的：探讨室性心律失常与T波峰-末间期（Tp-e间期）、Tp-e/Q-T比值的相关性。方法将199例室性心律失常患者按Lown分级分为Lown 1级组（43例）、2级组（40例）、3级组（35例）、4A级组（39例）和4B级组（42例）,再将所有患者分为无器质性心脏病组（107例）和器质性心脏病组（92例）,另选择健康体检者40例为对照组。采用常规12导联同步心电图及24小时动态心电图检测比较各组的Q-T、Q-Tc、Tp-e和Tp-ec间期及Tp-e/Q-T比值。结果 Q-Tc、Tp-e、Tp-ec、TPe/Q-T各测值随Lown级别的增高而增高,与Lown分级呈正相关（ rs＝0.29-0.62,P＜0.01）。Q-Tc、Tp-e、Tp-ec测值心脏病组与无心脏病组及对照组比较差异有统计学意义（ P＜0.05）,无心脏病组与对照组比较差异也有统计学意义（ P＜0.05）;Q-T测值心脏病组与无心脏病组及对照组比较差异有统计学意义（ P＜0.05）,但无心脏病组与对照组比较差异无统计学意义（ P＞0.05）。Tp-e/Q-T比值心脏病组及无心脏病组与对照组比较差异有统计学意义（ P＜0.05）,但心脏病组与无心脏病组比较差异无统计学意义（ P＞0.05）。结论 Tp-e间期、Tp-e/Q-T比值与室性心律失常的严重程度有关,对预测室性心律失常的发生及评估预后有重要的临床意义。     

肺癌肺切除术后心电图分析

目的探讨肺癌患者肺切除术后心电图变化的特点及其病因。方法选择原发性肺癌患者92例,分两组进行检测分析。心包内肺切除组37例、常规肺切除组55例,于术前、术后进行心电图动态检测。结果心包内肺切除术后ST段抬高31例(83.8%),心律失常23例(62.2%),Q-T间期延长19例(51.4%),与常规肺切除比较,差异有统计学意义(P0.05)。常规肺切除术后ST段压低10例(18.2%),与心包内肺切除比较,差异有统计学意义(P0.05)。心包内肺切除术后T波改变26例(70.3%),常规肺切除28例(50.9%),两组比较差异无统计学意义。结论肺癌患者心包内肺切除术后心电图异常率明显增加,主要表现为心律失常、ST段抬高、Q-T间期延长。常规肺切除术后心电图异常主要表现为ST段压低。提示手术对肺癌患者术后心电图变化具有一定的影响。     

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.