雷帕霉素洗脱支架治疗多支冠状动脉病变的临床研究

目的:探讨多支冠状动脉病变患者置入雷帕霉素洗脱支架(Cypher支架)预防再狭窄的疗效及安全性。方法:2001年12月-2004年5月连续725例接受多支冠状动脉支架置入术的冠心病患者,剔除急性心肌梗死及再次血运重建患者。Cypher支架组187例,普通金属支架(普通支架)组538例。比较两组支架术后的近期及远期结果。结果:除糖尿病患者比例在Cypher支架组较高外,两组患者冠心病危险因素、心功能、冠状动脉病变严重程度、介入手术成功率及并发症发生率均无显著差异。690例患者平均随访(18.8±11.7)个月,Cypher支架组和普通支架组造影随访率分别为52.4%vs58.2%(P>0.05)。尽管Cypher支架组患者冠心病危险因素多、平均年龄63.5岁、不稳定性心绞痛占66.3%、糖尿病占41.6%、3支血管病变占57.8%、B2/C型复杂病变占86.2%,但造影复查再狭窄率和主要不良心脏事件(MACE)发生率均明显低于普通支架组(3.1%vs16.6%,5.5%vs16.7%,P均<0.01),心功能改善率高于普通支架组(63.1%vs30.6%,P<0.01)。两组完全血运重建率无显著差异(81.3%vs86.8%,P>0.05),但发生MACE的患者中,Cypher支架组不完全血运重建者比例高于普通支架组(60.0%vs23.5%,P<0.05);两组发生MACE的患者中完全血运重建患者比例均低于本组总的完全血运重建率(Cypher支架组:40.0%     

ST段抬高的急性心肌梗死急诊置入药物洗脱支架与普通金属裸支架的比较

目的对比观察雷帕霉素药物洗脱支架（Cypher）与普通金属支架（Bx-sonic）在急性ST段抬高心肌梗死（STEAMI）急诊冠脉介入（PCI）治疗中应用的安全性和临床疗效。方法选择我院急诊住院的82例STEAMI患者,在发病时间12h内急诊行直接PCI治疗,其中50例于梗死相关血管的靶病变植入Cypher支架（Cypher支架组）,32例植入Bx-sonic支架（普通支架组）。并对其临床资料,病变特征,术后住院期间及随访期间再梗死、死亡、靶血管再成形等心脏不良事件发生率进行分析。结果两组支架术患者住院期间心脏不良事件发生率无显著差异。平均随访（6.2±2.3）个月,Cypher支架组心绞痛发生率较普通支架组显著减低（5%vs21%,P<0.01）。Cy-pher支架组无心脏事件生存率显著高于普通支架组（95%vs78%,P<0.01）。普通支架组支架内再狭窄率较Cy-pher支架组高。再梗死、心源性死亡、中风等不良事件发生率无显著差异。结论雷帕霉素药物洗脱支架与普通支架一样在STEAMI急诊PCI中是安全有效的。     

国产与进口雷帕霉素药物洗脱支架临床对比研究

目的对比研究国产雷帕霉素洗脱支架和进口雷帕霉素洗脱支架临床应用疗效.方法本研究总结了我科自2003年11月至2004年8月157例患者,分为Cypher支架组和Firebird支架组,其中Cypher支架组110例,Firebird支架组47例.157例患者共植入Cypher支架150枚,植入Firebird支架70枚.结果两组患者平均年龄,男性比例,吸烟史、高血压、高血脂、糖尿病,稳定性心绞痛、不稳定性心绞痛、急性ST段抬高心肌梗死和急性非ST段抬高心肌梗死、陈旧心肌梗死数据对比,P值均＞0.05,统计学无差异性.两组患者单支血管病变、二支血管病变、三支血管病变、分叉病变、慢性闭塞病变、左主干病变数据对比,P值均＞0.05,统计学分析无差异性.两组患者平均靶血管直径和平均靶病变长度对比[Cypher支架组比Firebird支架组为(2.87±0.29)mm比(2.97±0.40)mm,(20.54±6.14)mm比(18.14±5.68)mm)],P值均＜0.05,统计学分析有差异性.临床随访6个月,两组患者均无急性和亚急性支架内血栓形成,无再发心肌梗死及死亡.再发心绞痛、再次血运重建和MACE对比,P值均＞0.05,统计学无差异性.结论国产和进口雷帕霉素药物洗脱支架近期和远期疗效相似.     

国产雷帕霉素药物洗脱支架治疗冠心病1年临床随访——多中心注册研究

目的:多中心、前瞻性评估国产Firebird雷帕霉素洗脱支架在冠心病患者中应用的安全性及1年临床随访结果.方法:2004年6月至9月,入选上海地区6家医院接受国产雷帕霉素药物洗脱支架治疗的冠心病患者360例.记录各例基础临床、介入治疗情况及1年临床随访结果,并与RESEARCH研究结果进行比较.结果:与RESEARCH研究资料比较,本研究组中患者高胆固醇血症(24.2%对56%)、既往接受CABG(0.3%对9%)或PCI(7.2%对19%)、多支冠脉病变(27.2%对54%)、复杂病变(B2型病变:30%对49%,C型病变:36.4%对43%)及支架术后行后扩张者(13.1%对55%)较少,P均＜0.001.本研究介入治疗成功率高于RE-SEARCH研究(99.2%对97%,P=0.03).术后1年临床随访率93.9%,严重心脏不良事件(MACE,包括死亡、非致命性心梗及靶血管再次血运重建)发生率为8.3%,与RESEARCH研究中药物支架组相似(9.7%,P=0.58),显著低于普通支架组(14.8%,P=0.001).Firebird支架术后1年血栓事件发生率为0.9%. 结论:国产Firebird雷帕霉素洗脱支架治疗冠心病安全、有效,术后1年MACE发生率与RE-SEARCH研究Cypher支架组相似.     

药物洗脱支架治疗冠状动脉小血管病变的疗效分析

目的通过分析比较裸金属支架(BMS)与药物洗脱支架[DES,包括雷帕霉素(Cypher)支架和紫杉醇(TAXUS)支架]治疗冠状动脉小血管病变疗效的差异,为DES治疗多支及单支小血管病变冠心病提供依据。方法连续入选2002年12月至2005年5月沈阳军区总医院首次接受经皮冠状动脉介入治疗(PCI)、靶血管为小血管病变且达到完全血运重建的486例患者,其中多支小血管病变(多支)150例。分为BMS组214例(多支63例)、Cypher组140例(多支46例)和TAXUS组132例(多支41例),对比分析各组患者住院期间及随访6个月的临床情况。结果3组患者冠脉病变特点、PCI成功率及住院期间主要不良心脏事件(MACE)发生率等指标差异均无显著性(P>0·05)。冠脉造影随访显示,两个DES组再狭窄率均明显低于BMS(Cypher组4·9%,TAXUS组7·5%对BMS组29·2%,P<0·05),随访期间MACE发生率亦明显低于BMS(Cypher组2·9%,TAXUS组3·9%对BMS组12·0%,P<0·01)。进一步分析多支小血管病例,发现两个DES组的再狭窄率及随访期间MACE发生率仍然明显低于BMS组(再狭窄率Cypher组6·7%,TAXUS组7·1%对BMS组37·5%,P<0·05;MACE发生率Cypher组4·1%,TAXUS组4·8%对BMS组21·0%,P<0·05)。结论Cypher和TAXUS支架治疗小血管病变安全可行,疗效显著,治疗多支小血管病变可得到相同的疗效。     

国产与进口药物洗脱支架治疗冠心病合并糖尿病患者的安全性和有效性

目的 观察国产雷帕霉素药物洗脱支架(Partner)在冠心病合并糖尿病患者中应用的安全性和有效性.方法 选择269例冠心病合并糖尿病患者置入雷帕霉素药物涂层支架,其中Partner组135例患者置入国产雷帕霉素药物洗脱支架(Partner支架),134例患者置入Cypher支架(Cypher组),术前术后常规用药,术后进行随访,观察患者临床主要不良心脏事件的发生情况,部分患者进行了冠状动脉造影随访.结果 269例患者共置入447枚支架,分析表明C型病变、双支、三支病变为多,两组患者一般临床情况差异无统计学意义.两组靶病变部位、病变长度、狭窄程度及病变类型差异均无统计学意义.其中Partner组置入支架229枚,Cypher组218枚.平均随访(360±50)d,其中Partner组复发心绞痛13例(9.6％),1例发生心肌梗死(0.7％);Cypher组复发心绞痛11例(8.2％),无心肌梗死发生(0.0％),Partner组发生再狭窄2例(1.5％),Cypher组发生再狭窄2例(1.5％).两组无支架内血栓形成和死亡.结论 对比Cypher支架,使用Partner支架在冠心病合并糖尿病患者中应用安全有效,在降低主要心脏不良事件预防再狭窄获得满意的临床效果.     

药物洗脱支架与金属裸支架在急性ST段抬高心肌梗死急诊介入治疗中应用长期随访结果的比较

目的 探讨与金属裸支架(BMS)相比,Cypher支架(Cordis公司,美国)在急性ST段抬高心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)中应用的安全性和长期有效性.方法 连续选择2002年12月至2005年3月间STEMI患者407例,均于发病12 h内行急诊PCI治疗,于梗死相关血管靶病变置入Cypher支架或BMS.对所有病例随访1.5～4.0年(平均28.7±11.7个月),比较两类支架院内及出院后严重心脏不良事件(MACE,包括死亡、再发心肌梗死、靶病变重建等)发生的差异.结果 407例患者中置入Cypher支架者131例,置入BMS者276例.Cypher支架组所置入支架的直径明显小于BMS组(3.0 mm与3.2 mm,P=0.00).两组在随访期间心因性死亡(1.5%与6.9%,P=0.02)以及随访期间总的主要不良心脏事件(MACE)(6.1%与12.7%,P=0.04)差异均有统计学意义.应用Cox回归比例风险模型计算Cypher支架组在随访期间发生总MACE的相对危险度为0.45(P＜0.05).两组的支架内血栓形成发生率差异无统计学意义,支架内再狭窄发生率以及靶病变重建率差异亦无统计学意义,但Cypher支架较之BMS有明显降低的趋势.结论 在STEMI的急诊PCI治疗时,置入Cypher支架具有较好的安全性和长期有效性,与BMS相比可以降低远期复合MACE以及心因性死亡的发生率. 2)以及随访期间总的主要不良心脏事件(MACE)(6.1%与12.7%,P=0.04)差异均有统计学意义.应用Cox回归比例风险模型计算Cypher支架组在随访期间发生总MACE的相对危险度为0.45(P＜0.05).两组的支架内血栓形成发生率差异无统计学意义,支架内再狭窄发生率以及靶病变重建率 异亦无统计学意义,但Cypher支架较之BMS有明显降低的趋势.结论 在STEMI的急诊PCI治疗时,置人Cypher支架具有较好的安全性和长期有效性,与BMS相比可以降低远期复合MACE以及心因性死亡的发生率. 2)以及随访期间总的主要不良心脏事件(MACE)(6.1%与12.7%,P=0.04)差异均有统计学意义.应用Cox回归比例风险模型计算Cypher支架组在随访期间发生总MACE的相对危险度为0.45(P＜0.     

药物洗脱支架联用普通金属支架治疗多支冠状动脉病变的疗效评价

目的探讨多支冠状动脉病变患者药物洗脱支架与普通金属支架(普通支架)联用预防再狭窄的疗效及安全性。方法801例行多支冠状动脉内支架置入术达到完全血运重建的冠心病患者分3组。药物洗脱支架组206例、药物洗脱支架与普通支架联用组(联用组)158例及普通支架组437例。比较3组支架术后近期及远期结果。结果3组患者冠心病危险因素、心功能、冠状动脉病变程度、支架术成功率及并发症发生率均无显著差异。术后平均随访(17.3±10.9)个月,总随访率和造影随访率无显著差异。联用组普通支架置入于31.3%的前降支病变(均为A、B1型病变)及81.6%的回旋支病变和69.9%的右冠状动脉病变。与普通支架组相比,药物洗脱支架组和联用组造影再狭窄率明显降低,分别为20.3%vs7.3%和8.8%(P均<0.05),且主要不良心脏事件发生率均较低,分别为18.4%vs6.5%和9.9%(P均<0.05)。但药物洗脱支架组与联用组相比上述各指标无显著差异。结论多支冠状动脉病变患者单用药物洗脱支架或合理联用普通支架后再狭窄率降低,安全性近似,均优于单用普通支架。     

EXCEL支架在冠状动脉分叉病变应用的研究

目的:探讨EXCEL雷帕霉素洗脱支架治疗冠状动脉分叉病变的安全性和有效性。方法:共56例病人有57处冠状动脉真性分叉病变(其中前降支/对角支30例,左回旋支/钝缘支17例,右冠脉/后降支8例,前降支/回旋支1例)接受主支血管EXCEL雷帕霉素洗脱支架和分支血管球囊扩张术,回顾性分析其结果。结果:手术即刻成功率100%,住院期间无主要不良心脏事件(MACE)发生。6~18个月随访[临床随访率100%,造影随访38例(67.9%)]结果显示:MACE发生1例(1.8%,1/56),为造影证实的支架内再狭窄70%,并实施了再次PCI。造影再狭窄率为5.3%(2/38)。结论:EXCEL雷帕霉素洗脱支架治疗冠状动脉分叉病变安全,有效。     

进口与国产雷帕霉素洗脱支架一年临床疗效比较

目的对因冠状动脉粥样硬化性心脏病接受择期经皮冠状动脉介入治疗（PCI）的患者,对比接受国产雷帕霉素药物洗脱支架（Firebird）和进口雷帕霉素药物洗脱支架（CypherSelect）治疗后1年的临床疗效。方法连续入选2004年1月至2006年12月于北京安贞医院接受介入治疗置入国产和进口雷帕霉素药物洗脱支架（SES）的冠心病患者2000例,根据置入支架类型,分为国产Firebird组（Firebird;1004例）和进口Cypher组（Cypher;996例）。随访1年的临床疗效。初级终点为两组患者支架术后主要心血管不良事件（MACE）的发生率,包括全因死亡、非致死性心肌梗死及靶血管重建。次级终点为1年内的支架内血栓发生率。结果 1年的随访结果显示,国产和进口雷帕霉素药物洗脱支架（SES）组的MACE发生率差异无统计学意义（17.8%比18.6%,P=0.666）。两组患者的死亡（4.7%比5.1%,P=0.649）、心肌梗死（4.2%比4.8%,P=0.493）和靶血管重建率（9.0%比8.6%,P=0.795）均相近。两组患者12个月确定/可能性支架内血栓的发生率亦差异未见统计学意义（1.1%比1.0%,P=0.841）。多因素回归分析表明,DES类型不是1年内MACE的独立预测因素。结论国产FirebirdSES和进口CypherSES在术后1年内具有相同的临床疗效和安全性。     

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.