慢性栓塞性肺动脉高压的误诊分析

目的：为提高对慢性栓塞性肺动脉高压（CTEPH）的认识和诊断。方法：回顾性分析72例慢性栓塞性肺动脉高压患者中,65例在院外被误诊为其它心肺疾病的临床资料。结果：院外误诊率为90．28％,共误诊97例次（有的患者曾误诊多种疾病）,误诊的情况为原发性肺动脉高压22例次（22．68％）、冠心病18例次（18．56％）、先天性心脏病16例次（16．49％）、心肌炎10例次（10．31％）、心肌病9例次（9．28％）、风湿性心脏病5例次（5．15％）、心包炎2例次（2．06％）及肺部疾病15例次（15．46％）。结论：CTEPH误诊率极高,临床医师应提高对CTEPH的认识,减少误诊。     

核素肺显像在慢性血栓栓塞性肺动脉高压诊断和定量评价的应用

目的评价放射性核素肺灌注／通气（Q／V）显像在慢性血栓栓塞性肺动脉高压（CTEPH）诊断和定量评价中的价值。方法78例肺动脉高压住院患者，经超声心动图排除了瓣膜性心脏病和先天性心脏病引起的肺动脉高压，且既往无急性肺栓塞病史。所有患者均接受Q／V显像，并以肺动脉造影确诊，分别计算Q／V显像对CTEPH的诊断敏感性、特异性和准确性。对肺动脉造影确诊为CTEPH患者的肺灌注显像进行定量分析，计算全肺灌注缺损百分数（PPDs％），并对PPDs％分别与平均肺动脉压（mPAP）、肺动脉收缩压（SPAP）进行相关性分析，并进行统计学检验。结果以高度可能分级作为CTEPH的诊断标准，Q／V显像的诊断敏感性、特异性和准确率分别为96．0％，81．1％和86．9％；而如果将高度和中度可能分级均作为CTEPH的判断依据，则分别为100％，69．8％和79．5％。PPDs％与mPAP和SPAP均具有直线相关性，PPDs％与mPAP，r=0．538，P〈0．01；PPDs％与SPAP，r=0．456，P〈0．05。结论Q／V显像是CTEPH诊断和定量评价的有价值的无创性影像学方法。     

肺动脉血栓内膜剥脱术治疗慢性栓塞性肺动脉高压效果分析

目的分析慢性栓塞性肺动脉高压(CTEPH)患者应用肺动脉血栓内膜剥脱术(PTE)治疗的围手术期及中、晚期效果。方法选择CTEPH患者81例,按临床病理分型分为中央型组60例和外周型组21例,在深低温停循环下行PTE,随访5年,观察生存率。回顾性按年龄将患者分为老年组(≥60岁,19例)和非老年组(<60岁,62例),比较2组早期及晚期生存率。结果中央型组围手术期死亡1例。外周型组患者体外循环时间、主动脉阻断时间、深低温停循环时间均显著长于中央型组;围手术期肺动脉高压危象发生率显著高于中央型组,肺再灌注损伤发生率显著低于中央型组;肺动脉收缩压、肺循环阻力显著高于中央型组(P<0.05,P<0.01)。随访期间1例死亡,5年生存率为98.77%。老年组与非老年组术后早期及晚期生存率差异无统计学意义(P>0.05)。结论 PTE治疗CTEPH患者有较好的围手术期及中、晚期生存率,老年患者术后早期及晚期生存率与非老年患者无显著差异。术前准确评估,可提高PTE早期及中、晚期生存率。     

老年患者行经皮腔内肺动脉成形术的短期效果

目的 探索经皮腔内肺动脉成形术(PTPA)对老年慢性血栓栓塞性肺动脉高压(CTEPH)患者的短期有效性和安全性.方法 回顾分析复旦大学附属中山医院2017年12月-2019年12月接受PTPA治疗的CTEPH患者,根据年龄分为非老年组(n=24)和老年组(n=13).比较2组基线和随访时的心功能、6 min步行距离(6...     

慢性血栓栓塞性肺动脉高压

慢性血栓栓塞性肺动脉高压（chronic thromboembolic pul-monary hypertension, CTEPH ）是急性肺栓塞或肺动脉原位血栓形成的长期后果,由于种种原因血栓未溶解而持续存在,通过机化、纤维化形成^[1]。国外文献报道急性肺栓塞发作后存活的患者中0．1％～0．5％发展为CTEPH,该疾病发生率虽然很低,但预后差,若无有效的干预,大多数CTEPH患者多逐渐死于难治性右心衰竭。     

胃癌序贯筛查实施现场胃癌患者术后生存分析—11年随访

探讨胃癌序贯筛查法实施后手术治疗对胃癌患者生存率的影响。方法：参加胃癌序贯筛查的人群及作为对照的非筛查人群中发现胃癌并进行手术治疗的67例患者为研究对象,其中筛查组27例,非筛查组40例,自1987年随访至1997年,详细记录其生存时间等资料并进行生存分析。结果：胃癌筛查组患者术后5年及10年生存率均明显高于非筛查组患者、存在显著统计学差异（5年生存率：73．0％比34．5％,P＜0．05;10年生存率：69．0％比0,P＜0．05）。筛查组早期胃癌患者的比例亦明显高于非筛查组（63％比5％,P＜0．05）。结论：实施胃癌序贯筛查可以探查出更多的早期胃癌,手术治疗可以明显延长患者的生存时间。     

结缔组织病并发肺动脉高压致心功能不全及其治疗

目的探讨结缔组织病并发肺动脉高压与心功能不全的关系，及各种治疗方案对肺动脉高压与心功能不全的疗效。方法回顾性分析1996年2月-2008年7月在本院住院的14例明确诊断为结缔组织病并发肺动脉高压的患者．比较治疗前后患者的心电图、胸部X线检查、超声心动图及临床表现。结果肺动脉高压患者X线胸片示右下肺动脉增宽7例，检出率50％，且主要为重度肺动脉高压患者；心电图示右室肥厚4例，检出率28．57％，仅见于重度肺动脉高压患者。肺动脉高压与右室内径增大及右下肺动脉增宽有一定的相关性。14例结缔组织病并发肺动脉高压的患者中左心功能不全4例（28．57％），全心功能不全5例（35．71％）。在各种抗风湿及抗心功能不全的治疗方案中以激素盼疗效最为显著，治疗前后比较有统计学意义。结论结缔组织病并发肺动脉高压的心功能不全发病率较高，对结缔组织病并发肺动脉高压患者应常规进行超声心动图检查及胸部影像学检查，以在了解肺动脉压的同时了解心功能状况；早期积极治疗可纠正肺动脉高压，并改善心功能。     

CTEPH患者血浆NT-proBNP与右心漂浮导管测定血流动力学的关系

目的探讨慢性血栓栓塞性肺动脉高压(CTEPH)患者血浆N-端脑钠肽前体(NT-pro BNP)水平变化与肺血管阻力、右心功能的关系。方法选取2013年1月-2015年12月在本院诊治的72例CTEPH患者进行研究,其中轻度肺动脉高压9例、中度28例、重度35例,所有患者均进行右心漂浮导管及血浆NTpro BNP检测,比较不同肺动脉高压患者的各项指标并进行多元回归分析。结果不同肺动脉压分级CTEPH患者的肺动脉收缩压、肺动脉舒张压、肺动脉压、肺血管阻力、肺毛细血管楔压,组间比较的关系呈轻度患者中度患者重度患者,组间差异均具有统计学意义(P0.05);不同肺动脉压分级患者的右心输出量、右心做功量组间比较的关系呈轻度患者中度患者重度患者,组间差异均具有统计学意义(P0.05);不同肺动脉压CTEPH分级患者的血浆NT-pro BNP组间比较的关系呈轻度患者中度患者重度患者,组间差异均具有统计学意义(P0.05);CTEPH患者的肺血管阻力与血浆NT-pro BNP水平呈显著的正相关关系(P0.05);CTEPH患者的右心输出量、右心做功量与血浆NT-pro BNP水平呈显著的负相关关系(P0.05)。结论可以通过检测CTEPH患者NT-pro BNP水平对患者的肺动脉阻力及右心功能进行评估。     

闭塞性肺动脉高压的血流动力学和急性药物试验

目的:研究闭寒性肺动脉高压,主要是慢性血栓栓塞性肺动脉高压(CTEPH)和原(特)发性肺动脉高压(PPH)的血流动力学特点和急性中西药物试验反应.方法:上世纪80年代对我院CTEPH患者46例(CTEPH组),PPH患者69例(PPH组)观察了右心导管术血流动力学变化,2组中对49例做了吸纯氧,21例舌下含服硝苯地平20 mg,18例中心静脉推注川芎嗪80 mg等急性药物试验.结果:82.60%(95/115)的患者诊断时已有中、重度[肺动脉平均压＞40 mmHg(1 mmHg=0.133 kPa)]肺动脉高压,56.52%(65/115)合并右心功能不全.PPH组肺动脉压(收缩压、舒张压及平均压)、心脏指数均高于CTEPH组,差异有统计学意义(P＜0.05～0.001).而体动脉收缩压CTEPH组高于PPH组,差异有统计学意义(P＜0.05).76%(37/49)吸氧患者肺动脉压下降,7例出现矛盾性升高,CTEPH组尤为明显(5例).硝苯地平仅19%(4/21)有选择性扩张肺循环作用,部分患者副作用较明显.川芎嗪对肺循环降压作用轻微,副作用也较少.结论:我院就诊的闭塞性肺动脉高压患者绝大多数已属中、晚期,不可避免地会影响其治疗与预后.硝苯地平作为急性药物试验药物副反应较大,不宜应用,川芎嗪未显示对肺循环有良好的降压作用,副作用也较少.     

介入与药物治疗对不稳定型心绞痛长期疗效的对比研究

目的比较经皮冠脉介入治疗（PCI）和药物治疗不稳定型心绞痛的长期疗效。方法对上述两种方法治愈出院的病人114例进行随访研究,其中介入治疗组66例,药物治疗组48例,随访两组患者心脏事件发生率、再住院率、生存率及心功能情况。结果1年时介入组和药物组心脏事件发生率分别为7．6％和16．7％,再住院患者分别为13．6％和33．3％;3年随访时介入组和药物组心脏事件发生率分别为12．1％和22．9％,再住院率分别为16．7％和33．3％,3年时介入组和药物组生存率分别是98．5％和95．8％;治疗后介入组心功能优于药物组（P〈0．05）。结论介入治疗明显降低不稳定型心绞痛病人的心脏事件发生率,减少再住院率,改善心功能,提高生存率。     

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.