直接经皮冠状动脉介入治疗对急性前壁心肌梗死并室壁瘤患者心室重构和心功能关系的对比研究

目的　观察和评价直接经皮冠状动脉介入治疗 ( PCI)对急性前壁心肌梗死 ( AMI)合并室壁瘤形成患者左心室重构和心功能的影响。方法　对发病后 12 h以内入院的首次前壁 AMI患者行 PCI、尿激酶静脉溶栓、AMI常规治疗。所有患者均在治疗后 2周行超声心动图 ( UCG)筛查有无室壁瘤形成。入选有室壁瘤者并于 2周、12周、2 4周行 UCG检查。结果　共入选患者 76例 ,其中PCI组 2 8例 ( A组 ) ,溶栓组 2 6例 ( B组 ) ,对照组 2 2例 ( C组 )。结果显示 :( 1)治疗后 2周 ,A组左心室收缩末期容积指数( LVESVI)、左心室舒张末期容积指数 ( LVEDVI)、左心室质量指数 ( L VMI)、局部室壁运动指数 ( RWMI)低于 C组 ( P均 <0 .0 5 ) ,左心室射血分数 ( LVEF)高于 C组 [( 4 8.3 3± 4.5 6) % vs( 3 5 .3 3± 4.2 8) % ,P<0 .0 5 ] ;B组 L VESVI、LVEDVI、LVMI、RWMI低于 C组 ( P均 <0 .0 5 ) ,L VEF高于 C组 ( P<0 .0 5 ) ;A组 LVESVI、L VEDVI低于 B组 ( P均 <0 .0 5 ) ,L VEF高于 B组 ( P<0 .0 5 )。( 2 )治疗后 12周 ,A组 LVESVI、L VEDVI低于 B组 ( P均 <0 .0 5 ) ;A、B组 LVESVI、L VEDVI、L VMI、RWMI均低于 C组 ( P均<0 .0 5 ) ,L VEF均高于 C组 ( P均 <0 .0 5 )。 ( 3 )治疗后 2 4周 A组 L VESVI仍低于 B组 3 6.60     

急诊或延迟PTCA对急性心肌梗死患者心功能的影响

目的　探讨急诊经皮腔内冠状动脉成形术 (PTCA) (<6h)与延迟 PTCA对急性心肌梗死近期左心室重构及功能的影响。方法　选择本院住院的急性心肌梗死病人 5 8例 ,按发病到达医院时间的不同随机分为两组 ,6h以内为 A组共 2 2例行急诊 PTCA,6h以后 3 6例为 B组行延迟 PTCA。于术后 3 d、3 0 d、90 d行二维超声心动图检查。结果　 A组男 18例 ,女 4例 ,平均年龄 5 8.65±8.94岁。 B组男 2 9例 ,女 7例 ,平均年龄 5 7.2 3± 11.3 6岁 ,发病至 PTCA时间为 8.4± 3 .6d。两组实施 PTCA后血管再通率均为10 0 %。术后 3 d、3 0 d及 90 d,A组左心室舒张末期容积指数 (EDVI)、收缩末期容积指数 (ESVI)和左心室射血分数 (L VEF)均显著优于 B组 (P<0 .0 5 ,P<0 .0 5 ,P<0 .0 5 )。 A组左心室功能于 3 0 d明显改善 ,EDVI及 ESVI均显著缩小 (P<0 .0 5 ,P<0 .0 5 ,P<0 .0 5 ) ;90 d时左心室功能、EDVI、ESVI仍有改善 ,但与 3 0 d比无显著差异。 B组左心室功能、EDVI、ESVI 3 0 d与术后 3 d比较有所改善但无显著性差异 ;90 d与 3 d比较 ,EDVI、ESVI显著改善 (P<0 .0 5 ,P<0 .0 5 ) ,左心室功能有所改善但无显著性差异。结论　急诊 PTCA能挽救濒死心肌、抑制左心室重构、改善左心室功能 ,其效果优于延迟 PTCA;延迟 PTCA虽不?     

应激性高血糖对老年急性心肌梗死预后的影响

目的研究老年AMI后应激性高血糖对预后的影响.方法 101例不伴糖尿病的老年AMI患者根据入院早期空腹血糖水平分成3组.A组55例,血糖正常(≤6.1mmol/L).(2)B组21例,血糖介于6.1与8.0mmol/L之间.(3)C组25例,血糖≥8.0mmol/L.对3组临床资料进行回顾分析.结果 3组梗死部位无差异,P>0.05.B组,C组心衰发生率较A组高,P<0.05.C组心源性休克,死亡率较A组高,P<0.05.死亡组血糖水平高于存活组(8.1±3.1mmol/L vs6.6±2 1mmol/L,P<0.01).结论老年AMI伴应激性高血糖心衰发生率高,当血糖≥8.0mmol/L时,心源性休克及死亡率亦增加,AMI后应激性高血糖提示预后不良,应引起临床医生重视.     

急性心肌梗死急诊介入治疗后患者心肌灌注的动态演变

目的:观察急性心肌梗死(AMI)患者梗死相关血管再通达心肌梗死溶栓治疗临床试验(TIMI)3级血流后心肌组织灌注的动态演变,以探讨心肌无复流现象的临床特点及意义。方法:43例AMI患者,急诊冠状动脉介入治疗后梗死相关血管血流达TIMI 3级。分别于冠状动脉介入治疗后即刻、24 h内、2周和3个月时行单光子发射型计算机断层扫描(SPECT)。根据心肌灌注缺损积分,将患者分为无复流组(17例)和复流组(26例)。分析两组心肌灌注缺损积分、左心室射血分数、左心室舒张末期容积(LVEDV)和左心室收缩末期容积(LVESV)的变化规律,并进行组间比较。结果:(1)无复流组在冠状动脉介入治疗后即刻、24 h内、2周和3个月时的心肌灌注缺损积分分别为8．5±1．9, 6．4±2．3、4．6±2．1和4．2±1．7,复流组为4．1±1．0、1．7±1．2、0．5±1．1和0．4±1．0;无复流组和复流组冠状动脉介入治疗后积分在2周内均呈逐渐减低趋势,至2周时趋与稳定,2周和3个月之间比较均无显著差异(P>0．05);两组间同时相点比较,无复流组心肌灌注缺损积分在各点均显著高于复流组(P<0．01)。(2)两组左心室射血分数均呈逐渐增加趋势,但无复流组左心室射血分数较复流组恢复延迟,且在各时点均显著低于复流组。复流组冠状动脉介入治疗后左心室舒张末容积逐渐减小,无复流组则继续增加,2周时达高峰,而后开始减小,3个月时虽低于2周时,但仍显著大于冠状动脉介入治疗后24 h内(P<0．01);无复流组的左心室舒张末容积在各时相点均显著大于复流组。(3)无复流组冠状动脉介入治疗后即刻的灌注缺损积分与同时相点和3个月时的左心室射血分数均呈显著负相关(分别为r=-0．512,P< 0．05和r=-0．498,P<0．05)。结论:AMI血运重建后梗死相关血管血流达TIMI 3级的患者仍存在心肌无复流现象,但心肌无复流现象有随时间改善的趋势,至2周左右趋于稳定;早期的心肌灌注状况与后期的心功能恢复及左心室重构的发生密切相关。     

雌激素对兔动脉粥样硬化形成及某些体液因子的影响

目的　建立雌激素抗兔动脉粥样硬化模型 ,阐明雌激素作用的可能机制。　方法　 2 1只纯种新西兰兔随机分入 :A组 (切除卵巢未补充雌激素 )、B组 (切除卵巢补充雌激素 )、C组 (未切除卵巢 ) ,给予 1%胆固醇饮食 ,8周时比较动脉形态学变化 ,测定动脉一氧化氮及一些体液因子。　结果　 (1) A组兔主动脉内膜面积〔(1.35± 0 .44 ) m m2 〕高于 B、C组〔(0 .2 0± 0 .2 9)及 (0 .34± 0 .2 9) mm2 〕(P<0 .0 5 ) ;(2 ) A组兔内皮素 - 1高于 B组及 C组 (P<0 .0 5及 P<0 .0 1) ,血浆肾素活性、血管紧张素 高于 C组 (P<0 .0 5 ) ;(3) B、C组血浆雌二醇〔(2 12± 78)及 (2 2 9± 10 3) ng/ L〕和主动脉一氧化氮〔(0 .41± 0 .18)及 (0 .44± 0 .16 ) nmol/ m g〕高于 A组〔(10 3± 6 9) ng/ L及 (0 .2 5± 0 .0 6 ) nm ol/ m g〕(P<0 .0 5 )。　结论　雌激素可明显抑制动脉粥样硬化形成 ,可能与促进一氧化氮生成、抑制内皮素生成、抑制肾素血管紧张素系统活性有关。     

右束支传导阻滞在急性心肌梗死中的临床意义

目的　评价伴随急性心肌梗死 (AMI)出现的右束支传导阻滞 (RBBB)的临床意义。方法　 2 94例 AMI分为RBBB组和非 RBBB组 ,比较两组患者的年龄、梗死部位、血清磷酸肌酸激酶 (CK)及其同工酶 (CK- MB)水平、心功能状态、严重并发症及住院死亡率。结果　 RBBB组血清 CK、CK- MB平均峰值为 (2 2 82 .0± 6 74.3) u/ L、(2 5 2 .6±137.3) u/ L ,明显高于非 RBBB组的 (192 0 .4± 5 6 9.2 ) u/ L、(114.8± 5 6 .7) u/ L (P<0 .0 0 5和 P<0 .0 1)。 RBBB组killip平均级别为 2 .33± 0 .5 4级 ,非 RBBB组为 1.46± 0 .6 3级 (P<0 .0 5 ) ,RBBB左心室舒张期末内径 (5 3.2± 9.6 m m )大于非 RBBB组 (4 5 .8± 8.2 m m,P<0 .0 5 ) ,左心室射血分数 [(4 8.9± 7.6 ) %]小于非 RBBB组 [(6 7.0± 3.7) %,P<0 .0 1]。 RBBB组心脏并发症发生率和住院死亡率高于非 RBBB组 (分别为 70 .8%和 39.0 %,P<0 .0 1;43.8%和 14.6 %,P<0 .0 1)。结论　 AMI并 RBBB患者梗死面积大 ,严重心脏并发症发生率和住院死亡率高。     

脑利钠肽对急诊冠状动脉介入治疗急性心肌梗死左室结构和功能的评估价值

目的:观察急性心肌梗死(AMI)患者接受急诊经皮冠状动脉介入(PCI)治疗前后的脑利钠肽(BNP)水平变化及其与左室功能,心室重构的关系,探讨BNP在急诊PCI治疗AMI患者预后评估中的作用.方法:入选2008-06-2009-02,发病后12 h内接受急诊PCI治疗的ST段抬高型急性心肌梗死(STEMI)患者120例,入院即时及出院时采用酶联免疫法测定患者血浆BNP水平,出院前行超声心动图检测左室射血分数,并根据PCI治疗后7 d的BNP水平将患者分为3组:A组<100 ng/L,B组为100～400 ng/L,C组>400 ng/L.所有患者术后6个月进行超声心动图检查,根据左室射血分数、左室舒张末期容积、左室收缩末期容积变化评估左室功能及心室重构.结果:BNP水平与AMI病变范围呈正相关,与左室射血分数呈负相关;PCI治疗后不同心肌梗死部位BNP水平较治疗前均明显下降;3组患者PCI治疗后6个月的超声心动图比较,患者左室射血分数、左室舒张末期容积、左室收缩末期容积B组、C组与A组相比差异有统计学意义(P<0.05),C组与B组比较差异也有统计学意义(P<0.05).结论:血浆BNP水平可反映AMI的严重程度;BNP增加的程度与梗死的范围呈正相关;AMI患者急诊PCI后BNP水平有显著下降趋势;BNP水平可能可以作为患者左室功能及心室重构的预测因子.     

二维斑点追踪技术评价社区人群左心房应变率与左心室舒张功能的相关性

目的:应用二维斑点追踪技术评价社区人群左心房应变率,及其与左心室舒张功能分级的相关性。方法:研究对象为左心室射血分数正常的社区人群,共708例脱机处理,根据多普勒二尖瓣口血流、二尖瓣环组织、肺静脉血流对左心室舒张功能进行分组:A组(左心室舒张功能正常组)、B组(左心室舒张功能轻度受损组)、C组(左心室舒张功能中/重度受损组)。采用二维斑点追踪技术(STE),测量收缩期左心房应变率峰值SRs,舒张早期左心房应变率峰值SRe和舒张晚期左心房应变率峰值SRa。结果:①B组、C组SRs较A组降低,分别为(1.07±0.35)s-1、(0.90±0.24)s-1和(1.12±0.28)s-1(P<0.01),B组、C组SRe较A组亦明显降低,分别为(-0.79±0.35)s-1、(-0.65±0.29)s-1和(-1.02±0.33)s-1(P<0.01);SRa在B组高于A组[分别为(-1.60±0.58)s-1和(-1.48±0.47)s-1,P<0.05],亦高于C组[分别为(-1.60±0.58)s-1和(-1.24±0.48)s-1,P<0.01],且C组显著小于A组[分别为(-1.24±0.48)s-1和(-1.48±0.47)s-1,P<0.01]。②SRs、SRe与左心室舒张功能分级均呈负相关(r分别为-0.178和-0.366,P<0.01)。结论:二维斑点追踪技术测量左心房应变率,可间接反映左心室舒张功能。     

多普勒超声心动图评价急性心肌梗塞后左室重构及心功能改变

应用多普勒超声心动图对56例不同部位急性心肌梗塞（AMI）后患者及40例正常人左室结构（LVR）、收缩舒张功能参数进行对比分析研究。结果显示AMI后患者左室舒张及收缩末期内径、左心室舒张末期容积、左心室收缩末期容积、左室射血前期与射血时间比、舒张晚期峰值血流速度、A峰面积增大；射血分数、短轴缩短率、舒张早期峰值血流速度、E峰／A峰面积则降低，两组间比较有极显著性差异（P＜0．01）。认为AMI后患者心脏不同程度的发生了LVR及收缩舒张功能减退。     

血管紧张素Ⅱ受体拮抗剂对原发性高血压患者左心室肥厚和舒张功能的影响

目的　应用超声心动图评价血管紧张素 1型受体 ( AT1 )拮抗剂对原发性高血压患者左心室肥厚和舒张功能的影响。方法　分别于 AT1 拮抗剂 (氯沙坦 )治疗前和治疗 6个月后 ,对 3 0例原发性高血压患者进行超声心动图检查。 M型超声心动图测量舒张末期左心室内径、室间隔和左心室后壁厚度 ,计算左心室重量指数 ;在心尖左心长轴切面上 ,用多普勒超声心动图测量二尖瓣口舒张早期峰值速度 E、舒张晚期峰值速度 A和 E峰减速时间 ,并计算E/A比值。结果　氯沙坦治疗 6个月后 ,左心室重量指数从 12 4± 2 1g/m2减低为 10 2± 2 2 g/m2 ( P<0 .0 0 1) ;E/A比值 ( 1.2 5± 0 .2 7)明显高于服用前 ( 0 .94± 0 .2 6,P<0 .0 0 1) ,E峰减速时间从 2 2 1± 3 2 ms下降到 180± 2 7ms( P<0 .0 0 1)。结论　 AT1 拮抗剂氯沙坦治疗 6个月使原发性高血压患者左心室肥厚得到消退 ,并改善了其舒张功能     

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.