减少不良右室起搏的临床研究

目的观察心室起搏管理(Managing Ventricular Pacing,MVP)功能减少心室起搏百分比的效果。方法选择因病态窦房结综合征或房室阻滞而植入具有MVP功能的美敦力Adapta系列起搏器的患者共50例,分别程控为DDD模式和MVP模式,3个月后交叉程控为MVP模式和DDD模式,再随访3个月。结果两组患者DDD模式期间心室起搏百分比分别为40.5%(1.3%～90.1%)和39.9%(1.0～91.6%),两组患者MVP模式期间心室起搏百分比分别为5.8%(0～40.2%)和6.4%(0～32.4%)。MVP模式期间的心室起搏百分比明显低于DDD模式期间(p<0.05)。结论 MVP起搏模式能够降低因病态窦房结综合征或房室阻滞行永久性双腔人工心脏起搏器治疗患者的心室起搏百分比。     

不同起搏部位对人体心电图Tp-Te间期的影响及临床意义

目的以植入起搏器患者及健康成人为研究对象,比较不同部位起搏时心电图Tp-Te(T峰-末)间期并探讨其临床应用价值。方法选择植入心脏起搏器患者及无心脏病史者,测量心电图V2、V3、V4导联的Tp-Te间期,分别比较植入起搏器组与健康成人组、右室电极位于室间隔组与心尖组、单腔起搏器组与双腔起搏器组以及双心室起搏组与单腔右室起搏组心电图Tp-Te间期。结果植入起搏器组较健康成人组Tp-Te间期明显延长(P<0.001),右室电极位于室间隔组与心尖组Tp-Te间期无显著差异(P>0.05),单腔右室起搏器组与双腔起搏器组Tp-Te间期无显著差异(P>0.05),双心室起搏组Tp-Te间期较单腔右室起搏组明显延长(P<0.05)。结论植入起搏器可能增加室性心律失常的风险,Tp-Te间期不能作为起搏器右室电极固定位置以及单、双腔起搏器选择的参考因素,双心室起搏可提高恶性心律失常的风险。     

MVP功能对右室起搏比率及心功能影响

目的观察具有心室起搏管理功能(MVP)的起搏器对右室起搏比率及心脏功能的影响。方法选取因病态窦房结综合征植入双腔起搏器的患者68例,根据植入后是否开启心室起搏管理功能分为试验组32例及对照组36例,分别在置入前及置入后1周及12个月进行随访,观察两组右室起搏比例,左房内径(LAD),左室射血分数(LVEF),左室舒张末内径(LVEDD),N端前脑钠肽(NT-proBNP)水平。结果术后12个月,与对照组相比,试验组心室起搏比例明显降低[(27.79±17.38%)vs.(59.73±18.72%),p0.001]。与试验组比较,对照组LAD、LVEDD显著增大,LVEF降低(p0.05);术后12个月,对照组NT-proBNP水平显著高于试验组(p0.05)。结论 MVP功能可以明显减少右室起搏比例,并对心功能有一定保护作用。     

病窦综合征患者起搏器术后房室传导方式对血浆BNP水平的影响

目的评估固定的长AV间期下的DDD起搏模式对SSS患者在减少心室起搏方面的效果;比较应用固定的长AV间期保留自身房室传导与最适AV间期下房室顺序起搏两种模式的优劣性,为临床选择具有最佳血流动力学效应的起搏参数设置提供依据。方法选取因SSS而安置双腔心脏永久起搏器进行治疗的45例患者,分3次随访进行,每次随访时间间隔为2个月,将起搏器程控与血液生化指标测量相结合,进行两种不同AV间期下房室顺序起搏模式的血流动力学效应评估与对比。结果与临床经验性AV间期相比,固定的长AV间期(350 ms)下的房室顺序起搏使心室起搏百分比由31.8%降低至1.18%(P=0.000);由最适AV间期下转为固定的长AV间期下的房室顺序起搏模式后,血浆BNP浓度明显降低(P=0.02)。结论固定的长AV间期(350 ms)下的房室顺序起搏能够有效减少心室起搏,且在血流动力学方面优于最适AV间期下的房室顺序起搏。     

双腔起搏器突发起搏AV间期缩短四例

通过对4例双腔起搏器突发起搏AV间期缩短的心电图分析,阐述了引发起搏AV间期缩短的原因,其中1例因起搏器参数设置不当导致心室安全起搏脉冲发放,1例是开启AV间期负滞后搜索功能,1例是开启心室起搏管理功能(MVP),1例是开启心室起搏阈值自动检测功能。     

房室顺序起搏的A-V间期

病态窦房结综合征双结病变型等是植入DDD起搏器的最佳适应证。人体植入DDD起搏器后，就如植入一个窦房结和房室结，心房的电活动可经DDD起搏器设置的A-V间期下传至心室。由于心房激动经体内自身房室结下传更有利于保护心脏的功能，故一般情况下，DDD起搏器将起搏A-V问期程控得比自身P-R间期长，以保证激动尽量经自身房室结下传。研究发现，当P-R间期在120-180ms时心功能较好，故选择合适的AV延迟以及与自主神经（心率）相适应的A-V间期对双腔起搏至关重要。而且，与频率相适应的房室顺序传导，可以产生较好的血流动力学影响。     

EnPulse起搏器自动化功能的临床研究

目的:通过对EnPulse起搏器安置患者的随访,了解心房及心室自动阈值管理、自动AV间期搜索等功能的安全性和有效性.方法:选取置入Enpluse E2D01起搏器患者15例,分别于起搏器置入后1个月及6个月时复查起搏器参数,包括起搏器最近1次自动测量的心房及心室起搏阈值,手动测量心房及心室起搏阈值,记录患者心室感知占心室总事件的比例,并记录由Search AV+所设定AV间期基础上的心室感知事件所占心室总事件的比例.结果:1个月及6个月随访时,手动测量心房及心室阈值与自动测量心房及心室阈值差异无统计学意义.术后病态窦房结综合征患者大部分心室事件为感知事件,其中绝大多数由search AV+功能参与.结论:EnPulse起搏器的自动AV搜索功能、心房及心室自动阈值管理是安全有效的.     

窦房结功能不良与传导阻滞患者植入双腔起搏器后动态心电图的表现及其意义

目的 探讨窦房结功能不良与传导阻滞患者植入双腔起搏器后动态心电图的表现及临床意义。 方法 分析植入DDD型双腔起搏器的160例患者的动态心电图,其中窦房结功能不良组80例,传导阻滞组80例,比较2组患者植入双腔起搏器后的动态心电图表现、主要的工作模式、心室起搏情况、自身心律失常及起搏器所致的心律失常。 结果 窦房结功能不良组与传导阻滞组起搏比例≥60%者均多于起搏比例<60%者（82%比18%、85%比15%）,组间差异无统计学意义。窦房结功能不良组心房按需起搏工作模式显著高于传导阻滞组（31%比2%,P<0.01）,而心室按需起搏/心房同步心室起搏工作模式显著低于传导阻滞组（19%比50%,P<0.01）;组间比较,双腔按需起搏工作模式检出率二者无统计学差异（50%比48%）。窦房结功能不良组心室安全起搏检出率显著高于传导阻滞组（25%比12%,P<0.05）,而心室起搏融合波的检出率则显著低于传导阻滞组（35%比51%,P<0.05）。窦房结功能不良组起搏介导性心动过速及感知房性心动过速触发快速型心室起搏的检出率显著高于传导阻滞组（12%比2%,24%比11%,P<0.05）,房性心动过速和频发房性早搏的检出率亦显著高于传导阻滞组（38%比18%,22%比4%,均P<0.05）。 结论 窦房结功能不良与传导阻滞患者植入双腔起搏器后对应的主要工作模式可以通过动态心电图的各种表现进行识别,全面了解起搏器的工作状态,为起搏器的合理程控以及自身心律失常提供可靠的依据。     

双腔起搏器房室结优先功能与心电图

<正>双腔起搏器房室结优先功能是指通过调整心脏起搏器的房室(AV)间期或转换起搏模式,保证自身心房激动能通过房室结顺传至心室,以获得正常的心室除极和收缩顺序的功能。1房室结优先功能的必要性窦房结功能不良患者置入双腔起搏器后,右心室心尖部(RVA)起搏会导致心室激动顺序异常,心室内与心室间收缩失同步,二尖瓣反流;长期RVA起搏进一步导致心室机械重构,非对称性左心室肥厚和扩张,左心室射血分数降低,甚至抵消双腔起搏的房     

双腔起搏器自动房室间期搜索功能对心房颤动发生的影响

60例置入双腔起搏器患者,分为房室间期搜索（Search AV）组（n=27）和非Search AV组（n=33）。术后6个月Search AV组较非Search AV组心房颤动（简称房颤）发生减少,房颤负荷降低。术后1年Search AV组房颤负荷仍低于非Search AV组。术后6个月及1年非Search AV组心室起搏比例高于Search AV组。心室起搏比例与房颤负荷正相关（P〈0. 05）。结论：双腔起搏器Search AV功能可明显减少心室起搏比例,降低房颤负荷,减少房颤发生。     

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.     

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.     

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.