急性与慢性冠状动脉综合征患者电子束CT冠状动脉钙化的比较

目的：比较急性与慢性冠状动脉综合征患电子束CT（EBCT）冠状动脉钙化（CAC）的不同模式。方法：264例患（包括67例SAP、94例UAP和103例AMI）行选择性冠状动脉造影以检测粥样硬化狭窄的程度，行EBCT检查以计算CAC积分，分析各组患CAC积分的差异及其与狭窄程度的关系。结果：（1）SAP组CAC检测阳性率为100％，显高于UAP组的87．23％和AMI组的86．41％（P＜0．05）。（2）SAP组严重钙化的病人和动脉比例显高于UAP组和AMI组（P＜0．05），钙化积分自然对数转换值（In[CS 1])的均数SAP组显高于UAP组和AMI组（P＜0．001）。（3）不同CAC程度在不同狭窄冠状动脉上的分布在SAP组与UAP组有明显差异。（4）AMI组梗死相关动脉多数无钙化或仅有轻度钙化，钙化积分显低于非梗死相关动脉。结论：应用电子束CT研究显示，急性与慢性冠状动脉综合征患存在不同的冠状动脉钙化模式，此点有助于理解这两类冠心病之间在临床和病理方面的差异。     

冠状动脉瘤样扩张与电子束CT检测的冠状动脉钙化

为探讨冠状动脉瘤样扩张患者电子束CT检测的冠状动脉钙化的特点及其临床和病理意义 ,将 2 7例经选择性冠状动脉造影确诊的冠状动脉瘤样扩张患者行电子束CT检查以计算钙化积分 ,并与 2 7例年龄和性别匹配的冠状动脉造影正常者进行比较。结果发现 ,冠状动脉瘤样扩张组钙化阳性率、钙化积分中位数及钙化积分的自然对数转换值均显著高于正常对照组 (P <0 .0 1或 0 .0 0 1)。冠状动脉瘤样扩张组中 2 1例粥样硬化性瘤样扩张患者钙化阳性率为 81.0 % ;弥漫性扩张动脉的钙化积分对数转换值显著低于局限性扩张动脉 (1.2 2± 1.79比 2 .86± 1.85 ,P <0 .0 5 )。结果提示 ,粥样硬化性冠状动脉瘤样扩张患者多数存在较为广泛的冠状动脉钙化 ,且钙化程度与病变类型有关。     

电子束CT对判断2型糖尿病患者冠状动脉病变的意义

目的应用电子束CT(EBT)心脏扫描,评价EBT在判断2型糖尿病冠状动脉病变中的应用价值。方法94例受试者行心脏EBT扫描,计算冠状动脉钙化(CAC)率、钙化积分、冠状动脉狭窄支数和软斑数,同时收集血糖、糖化血红蛋白(HbA1c)、血脂等相关临床信息。结果血糖异常组(包括糖耐量减低者、糖尿病者)、冠心病组CAC发生率较血糖正常组明显升高(93.33%,96.43%,90.91%∶56.00%,P<0.01),钙化积分有明显升高趋势,但差异无统计学意义,冠状动脉狭窄支数和软斑数有明显增加(2.200±2.024,2.964±1.915,2.273±1.679∶0.520±1.295,P<0.01和2.467±2.360,2.893±1.771,2.372±1.819∶0.511±1.197,P<0.01)。Pearson相关分析,发现钙化积分与年龄有明显相关(r=0.423,P<0.01),冠状动脉狭窄数与年龄(r=0.215,P<0.05)、餐后血糖(r=0.224,P<0.05)、胆固醇(r=0.275,P<0.01)密切相关。结论2型糖尿病患者有明显的冠状动脉病变,EBT钙化需与EBT增强扫描、三维血管重建结合,来共同判断糖尿病患者的冠状动脉病变状态。     

电子束CT检测冠状动脉钙化对诊断老年冠心病的价值

目的　探讨电子束CT检测冠状动脉钙化 (CAC)对诊断老年人冠心病的价值。方法　 2 2 9例老年患者行电子束CT检测CAC并计算每例的CAC总积分 ,行选择性冠状动脉造影以确定冠状动脉粥样硬化狭窄的有无及其程度。结果　 (1) 2 2 9例患者中 ,CAC检测阳性 2 2 0例 ,总阳性率 96 .0 7% ;造影显示有 2 13例存在不同程度的冠状动脉狭窄 ,其中 16 8例确诊为冠心病。 (2 )全组CAC诊断老年人冠心病的总体敏感性、特异性、阳性预测值和阴性预测值分别为 99%、13%、76 %和 89% ,诊断老年人冠状动脉粥样硬化的相应指标则分别为 97%、19%、94%和 33%。(3)老年男性组CAC诊断冠心病的敏感性较高特异性较低 ;老年女性则特异性较高而敏感性较低。综合考虑敏感性及特异性 ,对于老年男性 ,以CAC积分为 2 0 0作为诊断冠心病的分值较好 ,而对于老年女性则以 5 0作为诊断分值较佳。结论　电子束CT检测冠状动脉钙化对诊断老年人冠心病具有一定价值 ,但应结合性别和钙化分值进行综合分析。     

冠状动脉钙化在肥厚型心肌病诊断中的临床意义

评价冠状动脉钙化在肥厚型心肌病鉴别诊断中的临床价值。连续调查了 99例 30岁以上临床确诊肥厚型心肌病患者资料 ,分析其年龄、性别分布和冠状动脉钙化特点 ,并与同期同年龄段冠心病患者资料进行对比。结果发现 ,99例肥厚型心肌病患者的冠状动脉钙化积分与钙化阳性率随年龄增加而增加 ,存在性别差异 ,钙化总积分和钙化阳性率分别是 2 1.1± 4 .9和 32 .3% ,均显著低于冠心病组 (2 0 3.2± 34.9和 6 6 .7% ;P <0 .0 1) ;但仍在国人正常的钙化积分切点范围内。调整性别、年龄因素后 ,肥厚型心肌病患者的冠状动脉钙化积分和钙化阳性率仍显著低于冠心病组 (P <0 .0 1)。结果提示 ,电子束CT检测冠状动脉钙化有助于疑似或合并冠心病的肥厚型心肌病患者的鉴别诊断 ,具有重要的临床价值。     

电子束CT冠状动脉钙化与影像学斑块负荷的量化关系

探讨经电子束CT检测的冠状动脉钙化积分与影像学斑块负荷的量化关系。 32 0例临床疑诊为冠心病而行选择性冠状动脉造影的患者行电子束CT检查 ,并计算冠状动脉钙化积分 ,分析钙化积分与冠状动脉粥样斑块负荷之间的关系。结果发现 ,全组冠状动脉钙化积分为 0～ 3 346 ,中位数 45 ,钙化积分的自然对数转换值平均为 3 .64± 2 .1 8。钙化积分的自然对数转换值与狭窄程度呈轻度正相关 (r=0 .385 ,P <0 .0 0 1 ) ,与斑块负荷总分呈高度正相关 (r=0 .768,P <0 .0 0 1 )。结果提示 ,电子束CT检测的冠状动脉钙化积分与斑块负荷之间有良好的相关性 ,而与狭窄程度的相关性较差。     

X综合征女性患者电子束CT测定冠状动脉钙化的临床特点

为探讨X综合征女性患者冠状动脉钙化及临床情况 ,利用电子束CT对 2 6例X综合征女性患者和 2 2例冠状动脉造影及运动试验均正常的女性胸痛者冠状动脉进行检测 ,同时对其冠心病危险因子进行评估 ,测定血脂和血浆氧化型低密度脂蛋白水平 ,对比不同病例的冠状动脉钙化积分及病变血管支数。结果发现 ,有 19例(73% )X综合征女性患者存在冠状动脉钙化 ,而正常组中仅 4例 (18% )存在冠状动脉钙化 ;有冠状动脉钙化的X综合征女性患者冠心病危险因子明显高于正常组 (1.8± 1.3比 1.1± 0 .9,P <0 .0 5 ) ,前者的血浆氧化型低密度脂蛋白浓度也明显高于后者 (5 2 .38± 6 .89比 39.92± 7.87,P <0 .0 5 ) ;其中 13例为绝经期患者。绝经后X综合征患者冠状动脉钙化积分和有冠状动脉钙化的血管支数与非绝经期者相比无明显差异 ,但这两组均较正常组明显增高 (P<0 .0 5 )。结果提示 ,有相当数量的X综合征女性患者存在冠状动脉钙化 ,这种钙化似乎与绝经与否无关 ,有必要对这类患者的临床资料进行评估并作相应治疗     

血清妊娠相关血浆蛋白-A与急性冠状动脉综合征的临床相关性

目的 :探讨血清妊娠相关血浆蛋白 A(PAPP A)与急性冠状动脉综合征 (ACS)的关系。方法 :经冠状动脉造影 (CAG)确诊的冠心病患者 6 1例 ,其中ACS患者 4 6例 ,包括急性心肌梗死 (AMI) 16例 ,不稳定型心绞痛 (UAP) 30例 ;稳定型心绞痛 (SAP) 15例 ;另设CAG排除冠心病患者 2 4例作为正常对照组。运用酶联免疫吸附法测定各组血清PAPP A浓度。结果 :ACS患者组、SAP组、正常对照组血清PAPP A浓度分别为 (2 1.10±6 .95 )、(15 .2 1± 3.87)、(15 .5 0± 3.18)mIU/L ;此外 ,ACS组内AMI和UAP者血清PAPP A浓度分别为 (2 4 .79± 7.88)、(19.13± 5 .6 0 )mIU/L。SAP组与AMI及UAP者之间PAPP A浓度差异有统计学意义 (P <0 .0 1和P<0 .0 5 ) ,SAP组与正常对照组之间差异无统计学意义 (P >0 .0 5 ) ;AMI与UAP者之间差异有统计学意义 (P<0 .0 5 )。血清PAPP A水平与C反应蛋白、白细胞之间呈明显的正相关。与总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血小板计数之间无明显相关性。结论 :ACS患者血清PAPP A浓度明显升高 ,与冠状动脉斑块的稳定性密切相关 ,提示其有助于冠心病的危险分型 ,可作为冠心病患者的临床监测指标之一     

血清脂联素水平与冠状动脉病变程度的关系

目的 :研究血清脂联素与冠状动脉 (冠脉 )病变狭窄程度的相关性以及对血管病变稳定性的预测价值。方法 :入选 10 5例男性患者 ,分为 3组 ,急性冠脉综合征 (ACS)患者 5 1例 ,稳定型心绞痛 (SAP)患者 2 9例 ,非冠心病对照组 2 5例 ,进行血清脂联素测定 ,采用Gensini积分系统评定冠脉血管病变狭窄程度。结果 :ACS组血清脂联素水平的对数值 [(0 .6 4± 0 .18)mg/L]明显低于SAP组和对照组 [(0 .81± 0 .2 1)、(0 .81± 0 .2 8)mg/L],均P <0 .0 1。而SAP组和对照组之间差异无统计学意义 (P >0 .0 5 )。脂联素与冠脉病变程度Gensini积分呈负相关 (r =- 0 .38,P <0 .0 1)。结论 :脂联素与冠脉狭窄程度以及稳定性显著相关 ,有助于临床评价冠心病病变程度及其进展。     

急性心肌梗死冠状动脉斑块特征的血管内超声研究

目的:应用血管内超声(IVUS)比较急性心肌梗死(AMI)和稳定型心绞痛(SAP)患者冠状动脉斑块特征。方法:AMI组患者45例和SAP组患者50例,接受冠状动脉造影及 IVUS检查。通过 IVUS评价斑块偏心指数、钙化、夹层/破裂、血栓、重构、斑块长度及面积等特征。结果: 两组患者斑块偏心指数及钙化差异无统计学意义,但AMI组血栓(20%)、夹层/破裂(33.3%)、正性重构(81.3%)、低回声斑块(64.4%)明显高于 SAP组分别为0,4.0%,53.4%,28.0%,P<0.05 或0.01;AMI组斑块长度[(17.2±9.8)mm]、斑块面积[(12.4±5.9)mm2]较SAP组[分别为(10.3±6.2)mm,(9.1±4.3 )mm2 ]差异有统计学意义(P<0.05 或 0.01)。结论:血栓、夹层/破裂、正性重构、较长斑块长度、较大斑块负荷及低回声斑块为 AMI患者梗死相关斑块的特征,AMI发生与事件前斑块特征有关。     

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.