健康成年人群和肥厚型心肌病患者碎裂QRS波群的分布规律与特征

目的：比较健康成年人群和肥厚型心肌病患者碎裂QRS波群（fQRS）的检出率、分布规律与特征。 方法：前瞻性连续入选1500例无症状的健康体检者，同时回顾性入选经心脏核磁共振检查确诊的肥厚型心肌病患者91例，年龄范围均在18~65岁。记录并分析所有患者的常规12导联心电图。fQRS的定义为至少2个连续导联的QRS波群存在≥2个R波或者R波的波顶或S波的波谷出现顿挫波。 结果：健康成人和肥厚型心肌病患者分别有76（5.1%）和19例（20.9%）检出fQRS（P=0.001），fQRS平均导联数目无明显差异（2.3±0.7 vs 2.1±0.3，P=0.082）。健康成人中86.8%（66/76）的fQRS分布于下壁导联，另外13.2%（10/76）分布于胸前导联，而肥厚型心肌病患者的fQRS主要分布在下壁导联（10/19，52.6%），其次分布在前壁导联（6/19，31.8%）以及侧壁导联（3/19，15.8%）（与健康成人相比，P<0.001）。与肥厚型心肌病患者的fQRS相比，健康成人的fQRS的平均额面心电轴更偏左（27.9±30.7°vs 45.5±63.0°，P=0.024）。 结论：肥厚型心肌病患者fQRS的检出率高于健康成年人群。与肥厚型心肌病患者的fQRS相比，见于健康成人的fQRS的分布范围更加集中，主要分布于下壁导联，而且后者的额面心电轴更加偏左。     

碎裂QRS波与Tp-Te间期关系的研究

目的探讨碎裂QRS波群(fQRS)与T波峰-末间期的关系及临床意义。方法选择421例无症状健康体检者,采集静息状态的常规心电图,并同步记录12导联心电图的Ⅱ、V2导联的T波峰-末间期进行测量,分析fQRS与T波峰-末间期的关系。结果 67例(16%)检出fQRS,其中84.5%(56/67)的fQRS分布于肢体导联,另15.5%(11/67)分布于胸前导联。两组间Ⅱ导联Tpe/RR差异具有统计学意义(p<0.05),而QT/RR无统计学意义(p>0.05)。结论健康人心电图fQRS主要分布在肢体导联,有fQRS者较无fQRS者的T波峰-末间期增大。     

碎裂QRS波群的研究现状与评价

碎裂QRS波群（fragmented QRS,fQRS）是指标准12导联心电图至少两个连续导联的QRS波群上存在≥2个R波（即至少一个R＇波）或R波的顶部/S波的底部出现顿挫波。宽QRS波群（QRS≥120ms）及不完全性右束支传导阻滞通常被排除在经典的fQRS定义之外[1]。越来越多的研究显示,fQRS可能是一项对于多种心脏病的远期预后具有预测价值的心电指标。     

非下壁陈旧性心肌梗死致下壁导联碎裂QRS波的分析探讨

目的 探讨非下壁陈旧性心肌梗死(OMI)患者下壁导联碎裂QRS波(fQRS)发生率,并与胸前导联碎裂QRS波发生率进行对比.方法 选择173例陈旧性前间壁(119例)、前壁(44例)、广泛前壁(10例)心肌梗死患者进行静息心电图检查,根据fQRS的有无分为有fQRS组和无fQRS组;根据fQRS所在导联位置,分为Ⅱ导联fQRS组、Ⅲ导联fQRS组、aVF导联fQRS组、≥2个下壁导联fQRS组、≥2个胸前导联fQRS组,并对各组数据进行统计分析.结果 ①前间壁、前壁、广泛前壁三组间fQRS发生率存在明显差异(P=0.008),其中广泛前壁发生率为100％,前壁组fQRS发生率明显高于前间壁组(P=0.014).②前间壁、前壁、广泛前壁三组间单一下壁导联、≥2个下壁导联及≥2个胸前导联的fQRS发生率差异均无统计学意义(P＞0.05);前间壁、前壁、广泛前壁各组内不同下壁导联间fQRS发生率无明显差异(P＞0.05).③前间壁组内比较,≥2个下壁导联的fQRS发生率明显高于≥2个胸前导联(P=0.045);前壁组内比较,≥2个胸前导联的fQRS发生率明显高于≥2个下壁导联(P=0.048).结论 心电图fQRS的形成与心肌梗死的部位有关,且广泛前壁心梗者最易形成fQRS,前壁及前间壁心梗者次之.前壁OMI患者梗死部位相关导联更易出现fQRS,面前间壁OMI患者更易在下壁导联出现fQRS.下壁导联fQRS波形成可能预示着下壁或者前间壁血管或心肌的相关病变.     

碎裂QRS波在冠心病患者中的临床意义

目的 探讨心电图碎裂QRS波(fQRS)在冠心病诊断中的临床意义.方法 选择性冠状动脉造影(CAG)诊断为冠心病的患者118例(冠心病组),同期CAG阴性患者118例(对照组),比较两组心电图fQRS波的发生率及fQRS波在心电图相对应心肌前壁、侧壁和下壁的分布情况.冠心病组患者根据冠状动脉病变情况,分为单支病变、双支病变、三支病变,比较fQRS波在不同病变中分布情况.结果 冠心病组fQRS波发生率为65.25%(77/118),显著高于对照组34.75%(31/118)(P<0.01).冠心病组下壁导联fQRS波发生率为42.37%(50/118),显著高于前壁9.32%(11/118)和侧壁13.56%(16/118),而前壁与侧壁导联fQRS波发生率无差异;fQRS与无fQRS在冠脉病变范围分布是有差异的,fQRS在多支病变比率高于无fQRS.结论 心电图fQRS波对冠心病诊断有预测价值,尤其是Ⅱ、Ⅲ、aVF导联fQRS波提示冠心病可能性大.心电图上fQRS的出现与冠脉病变范围及程度有一定的关系,可作为预测冠脉病变程度的指标,对于多支病变有一定的预测价值.     

30例肢导联电极置胸前对陈旧性下壁心肌梗死临床意义初步探讨

本文报道30例陈旧性下壁心肌梗死,常规心电图与肢体导联电极置胸前心电图的检测比较,肢导联置胸前后4例下壁异常Q波消失(13.33％),肢导联QRS波群综合电压与置胸前导联后QRS波群综合电压有明显差异(Ⅰ导联与Ⅱ导联P<0.05),提示:应用此种检测方法对下壁心肌梗死面积大小及心室功能的标测有一定的临床意义。     

碎裂QRS波预测肥厚型心肌病合并心房颤动患者射频消融术后心律失常复发的探讨

目的:探讨碎裂QRS波(f QRS)与肥厚型心肌病(HCM)合并心房颤动患者导管消融术后的复发是否有关。方法:纳入在北京安贞医院行导管消融术的HCM合并心房颤动患者共91例(阵发/持续性心房颤动:60/31)。消融策略包括:阵发性心房颤动患者行双侧肺静脉隔离(PVI);持续性心房颤动患者行PVI加左心房顶、二尖瓣峡部和三尖瓣峡部线性消融。术前评估基线心电图,fQRS定义为常规12导联心电图中至少2个连续导联的QRS波存在≥2个R波或者R波的波顶或S波的波谷出现顿挫波。术后定期随访,复发定义为导管消融术后心电图或动态心电图记录的任何类型的30s的房性快速性心律失常。结果 68.1%(62/91)患者fQRS阳性。fQRS最常见于下壁导联(75.8%)。平均随访18个月,窦性心律维持率为54.2%(59/91),74.6%(44/59)复发发生在1年以内。fQRS阳性组复发率高于fQRS阴性组(79.0%vs.34.5%,P0.001)。多因素Cox回归分析表明,fQRS是术后快速房性心律失常复发的危险因素(HR=3.243,95%CI:1.147~9.167,P=0.026)。结论:fQRS是HCM合并心房颤动患者导管消融术后房性心律失常复发的预测因子,可用于预测该类患者心房颤动射频术后转归。     

碎裂QRS波与肥厚型心肌病患者心肌纤维化/瘢痕的关系

目的 评价常规12导联心电图检出的碎裂QRS波(fragmented QRS complex,fQRS)与肥厚型心肌病患者心肌纤维化/瘢痕的关系.方法 91例肥厚型心肌病患者,通过心脏磁共振检查检出心肌纤维化/瘢痕.记录所有患者的常规12导联心电图,判读是否存在fQRS.结果 9l例患者中,58例(63.7％)经由心脏磁共振检出了延迟增强(late gadolinium enhancement,LGE),其中19例(20.9％)心电图检出fQRS.LGE阳性患者的fQRS检出率显著高于LGE阴性患者(31.0％对3.0％,P=0.002).在检出fQRS的19例患者中,18例(94.7％)检出了LGE.在检出LGE的患者中,fQRS阳性患者较fQRS阴性患者的LGE节段分布更为广泛(2.8±1.6对2.0±1.1,P=0.035).fQRS在肥厚型心肌病患者中检出心肌纤维化/瘢痕的敏感性和特异性分别为31.0％和97.0％.结论 常规12导联心电图上检出的fQRS是肥厚型心肌病患者存在心肌纤维化/瘢痕的特异性指标,但其敏感性有限.     

从正常人胸表心电位场电势分布看瞬间心电向量的综合

目的探讨正常人瞬间心电向量综合的可能性。方法选择健康体检者同步记录Wilson导联（V1-V6）及其扩展导联（V7-V9、V3R—V9R）和对应头胸导联（HV1～HV9、HV3R—HV9R）的心电图。以环绕胸部一周16个测试点记录的心电图QRS波形态来描绘胸表心电位场电势分布,并以此判断瞬间心电向量的综合情况。结果120例正常人中Wilson右胸导联V4R～V9R QRS波均为主波倒置的宽／深Q波;而对应头胸导联HV4R～HV9R记录到主波正立的rs、RS或qRs波;其余各测试点两导联均记录到明显正立的R（r）波。头胸导联记录的QRS波胸表心电位场电势均呈一致向外分布的现象,与瞬间心电向量综合的结果不符;Wilson导联则均呈大致左胸正、右胸负的偶极分布,似与瞬间心电向量综合的结果相符,但左室前壁的V3、V4、V5导联心电图和左室正后壁V7、V8、V9导联心电图的R波正立且波形都很大,前后体表电位无偶极分布现象,与左室前后壁瞬间心电向量综合的结果相矛盾。结论正常人胸表心电位场的电势分布表明瞬间心电向量综合的可能性存在疑问。     

急性下壁心肌梗死aVR导联QRS波的形态分析

目的探讨下壁心肌梗死时心电图aVR导联QRS波群形态的改变。方法分析89例急性下壁心肌梗死患者心梗前、后以及1年后的心电图和100例经冠状动脉造影证实的无冠心病患者的心电图,分析aVR导联QRS波群形态的变化。结果急性下壁心肌梗死前和无冠心病患者的心电图aVR导联QRS波群多呈q(Q)r型(89.2%),少数呈QS型(10.8%);下壁心肌梗死后及1年后心电图aVR导联QRS波群多呈rs(S)型(86.21%),少数呈QS型(12.77%),极少数呈Qr型(1.02%)。结论下壁心肌梗死后心电图aVR导联QRS波群多呈r(sS)型。     

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.