切割球囊对冠状动脉支架内再狭窄的近期及远期疗效

目的　比较切割球囊成形术 (CBA)与普通球囊成形术 (POBA) ,对支架内再狭窄病变的近、远期血管造影结果 ,评价CBA对支架内再狭窄病变的有效性。方法　 16 6例支架内再狭窄PTCA病人 ,按所用球囊不同 ,分为CBA组 (98例 ) ,POBA组 (6 8例 ) ,分别比较术后即刻及远期定量冠脉造影最小血管径 (MLD)、狭窄度及再狭窄率。结果　术后即刻MLD及狭窄度两组差别无显著性 ,CBA组最大扩张压明显为低 [(8 3± 0 9)atm比 (14 7± 4 6 )atm ,P <0 0 5 ]。追踪造影结果 ,CBA组MLD明显大于POBA组 [(1 7± 0 5 )mm比 (1 4± 0 5 )mm ,P <0 0 5 ]、狭窄度明显小于POBA组 [(36± 13) %比(46± 15 ) %,P <0 0 1],再狭窄率低于POBA组 (2 6 1%比 4 0 3%,P <0 0 5 )。结论　CBA的低压扩张效果在支架内再狭窄病变亦是有效的 ,并且获得了较POBA低的再狭窄率 ,值得进一步探讨总结。     

普通球囊与切割球囊成形术对冠状动脉支架内再狭窄的近远期疗效

目的　对切割球囊成形术 (CBA)与普通球囊成形术 (POBA)支架内再狭窄病变的近远期血管造影结果比较 ,评价 CBA对支架内再狭窄病变的有效性。方法　 37例 ,共 39处病变 ,2 3处进入 CBA组 ,16处进入 POBA组。分别比较术后即刻及远期定量冠状动脉造影最小血管径 (ML D)、狭窄度 (DS)、再狭窄率、即刻管腔获得 (AL G)、即刻血管弹性回缩 (AR)及弹性回缩率 (ARR)。结果　术后即刻 ML D、DS、AL G两组差异无显著性。 CBA组最大扩张压、AR及 ARR均较 POBA组低 (P<0 .0 5或 P<0 .0 0 1)。随访造影结果 ,CBA组 ML D明显大于 POBA组 (P<0 .0 5 ) ;DS及再狭窄率均小于 POBA组 (P<0 .0 1)。结论　 CBA组的低压扩张治疗支架内再狭窄病变是有效的 ,对血管损伤小于 POBA,且获得较 POBA低的再狭窄率 ,值得进一步探讨     

经皮切割球囊成形术治疗支架内再狭窄的研究

目的　研究切割球囊成形术对治疗支架内再狭窄的即刻和 6个月内随访效果。方法　 6 9例支架内再狭窄患者随机分配到切割球囊组 (38例 )和普通球囊治疗组 (31例 )。球囊扩张前及扩张后即刻在定量冠状动脉造影和冠状动脉内超声下 ,测定相关参数。观察随访 6个月内临床改善及冠状动脉造影结果。研究终点包括出现心肌梗死 ,需要冠状动脉搭桥或再介入治疗。结果　两组的手术成功率均为 10 0 %。切割球囊组 1例患者扩张后在支架的远端出现夹层。平均随访 (6 .7± 2 .3)个月。切割球囊组于术后 3和 6个月时的再狭窄率显著低于普通球囊组(15 %∶38%及 18%∶4 2 % ,P <0 .0 0 1)。扩张后即刻血管直径获得值在切割球囊组和普通球囊组分别为 (1.72±0 .5 2 )mm和 (1.15± 0 .5 4 )mm ,随访 3个月及随访终点时切割球囊组的血管直径晚期丢失分别为 (0 .2 6± 0 .0 5 )mm(3个月 )及 (0 .38± 0 .0 6 )mm ,同时的普通球囊组丢失值分别为 (0 .78± 0 .19)mm(3个月 )及 (0 .89± 0 .16 )mm。结论　切割球囊成形术治疗老年冠心病患者支架内狭窄效果可靠 ,安全 ,容易操作 ,再狭窄率低     

经皮切割球囊成形术治疗老年冠心病患者冠状动脉支架内再狭窄69例分析

目的　观察切割球囊对老年冠心病患者支架内再狭窄的即刻和 6个月时治疗效果。　方法　 6 9例支架内再狭窄患者分配到切割球囊 (38例 )和普通球囊 (31例 )治疗组。球囊扩张前及扩张后即刻 ,用定量冠状动脉造影和冠状动脉内超声测定相关参数。随访 6个月时临床改善及冠状动脉造影结果。研究终点包括出现心肌梗死、需要冠状动脉旁路移植或再介入治疗。　结果　两组的手术成功率为 10 0 %。切割球囊组 1例患者扩张后在支架的远端出现夹层。平均随访 (6 7± 0 3)个月。切割球囊组于术后 3和 6个月时的再狭窄率显著低于普通球囊组 (分别为 15 %对 38%及 18%对4 3% ,均为P <0 0 0 1)。扩张后即刻血管直径获得值在切割球囊组和普通球囊组分别为 (1 72± 0 5 2 )mm和 (1 15± 0 5 4 )mm ,而 3和 6个月后切割球囊组的血管直径晚期丢失值为 (0 2 6± 0 0 5 )mm及(0 38± 0 0 6 )mm ,普通球囊组丢失值为 (0 78± 0 19)mm及 (0 89± 0 16 )mm(均为P <0 0 0 1)。　结论　切割球囊治疗老年冠心病患者支架内再狭窄效果可靠、安全 ,容易操作 ,再狭窄率低 ,易于被患者接受 ,是一个较有前途的治疗手段。     

切割球囊和普通球囊治疗冠状动脉支架内再狭窄有效性和安全性的Meta分析

目的　评价切割球囊血管成形术（CBA）和普通球囊血管成形术（POBA）治疗冠状动脉支架内再狭窄的有效性和安全性。方法　计算机检索Cochrane图书馆临床对照试验资料库（CCTR）、Pubmed、Embase、万方数据库、中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、维普数据库（VIP）,检索文章时间为各大数据库建库至2013年6月。收集CBA和POBA治疗冠状动脉支架内再狭窄的随机对照试验资料,共纳入7个随机对照试验,960例患者,其中CBA组493例,POBA组467例,使用RevMan　5.0软件进行Meta分析。结果　在治疗冠状动脉支架内再狭窄时,CBA组即刻弹性回缩低于POBA组,二者之间有统计学意义（MD：－0.52,95%CI：-0.76～－0.29,P<0.0001）;弹性回缩率CBA组明显低于POBA组,两组间存在统计学意义（MD：－13.83,95%CI：－16.17～－11.49,P<0.00001）。球囊扩张后冠状动脉直径狭窄度POBA组大于CBA组,两组间有统计学意义（MD：－12.99,95%CI：－18.09～－7.88,P<0.00001）。晚期丢失血管内径CBA组低于POBA组,两组存在统计学意义（MD：－13.83,95%CI：－0.50～－0.28,P<0.00001）。6个月后随访支架内再狭窄率POBA组明显高于CBA组,二者间有统计学意义（MD：0.44,95%CI：0.44,10.24,0.80,P<0.00001）。结论　CBA治疗冠状动脉支架内再狭窄更加安全有效。     

冠心病患者支架置入和经皮冠状动脉腔内成形术治疗后再狭窄的比较

目的　旨在分析冠心病患者冠状动脉 (冠脉 )支架置入和单纯球囊扩张 (PTCA)后晚期冠脉内径丢失及 6个月再狭窄发生率的差异 ,证实支架置入降低再狭窄作用并探讨可能机理。方法　冠心病介入治疗 35 2例中 ,选择连续 6 5例 (86个冠脉狭窄病变 )术后 6个月随访重复冠脉造影者 ,冠脉定量分析 (QCA)术前、术后和随访复查冠脉造影图象 ,并分析随访时内径丢失与支架置入和单纯球囊扩张的关系及术后 6个月再狭窄发生率。结果　冠脉内支架置入后随访期病变血管最小内径较大 ,而绝对内径丢失、相对内径丢失、绝对管腔面积丢失和内径丢失指数均低于单纯PTCA ,支架置入组再狭窄病变内径丢失百分比小于单纯PTCA组 ;再狭窄发生和支架置入呈负相关 (RR 0 86 ,95 %CI0 6 3～ 1 16 ,P <0 0 5 ) ;6个月 41例支架置入再狭窄 12例 (2 9 3% ) ,2 4例单纯PTCA再狭窄 12例(5 0 0 % ,P =0 0 6 9) ;5 3个支架置入病变再狭窄 14个 (2 6 4% ) ,33个单纯PTCA病变再狭窄 16个(48 5 % ,P =0 0 37)。结论　国人冠心病患者冠脉内置入支架可能减少晚期冠脉再狭窄发生     

单纯球囊血管成形术治疗冠脉支架内再狭窄的疗效观察

目的　本文观察单纯球囊扩张血管成形术 (PTCA)方法治疗支架内再狭窄的近期疗效。方法　应用与支架直径相同的球囊对 32例支架内再狭窄的病人行支架内扩张治疗并进行半年临床疗效随访观察。结果　共治疗病变 4 1处。第一次介入治疗前后血管内径分别 1 16± 0 6 1mmVS3 0 9± 0 .75mm ,第二次为 0 .94±1 0. 3mmVS3 0 6± 0 . 72mm。两次治疗后的支架内径无显著差异 (P >0 .0 5 )。 2 9例半年随访见 4例 (13 8% )再次出现支架内狭窄。结论　单纯应用球囊扩张血管成形术治疗半年内发生的支架内再狭窄 ,方法简便、安全、可达到理想的临床疗效。     

球囊血管成形术治疗冠脉支架内再狭窄21例观察

目的　观察单纯采用球囊扩张血管成形术 (PTCA)方法治疗支架内再狭窄的近期疗效。方法　应用与支架直径相同的球囊行支架内扩张治疗 2 1例支架内再狭窄的病人 ,随访半年临床疗效。结果　治疗病变 2 8处。第 1次介入治疗前后血管内径分别为 ( 1 12± 0 71)mm∶( 3 12± 0 87)mm ,第 2次为 ( 0 91± 1 0 5 )mm∶( 3 0 1±0 82 )mm。 2次治疗后的支架内径无显著差别 (P >0 0 5 )。半年随访仅见 3处病变 ( 10 % )再次出现支架内狭窄。结论　单纯应用球囊扩张血管成形术治疗半年内发生的支架内再狭窄 ,可达到理想的临床疗效。     

冠状动脉支架内再狭窄切割球囊成形术在老年患者中的应用

目的观察冠状动脉支架内再狭窄切割球囊成形术在老年冠脉支架术后再狭窄中的应用效果。方法回顾性分析60例老年冠脉支架术后再狭窄患者临床资料,采用随机数字表法将其分为观察组和对照组,每组30例,对照组行普通球囊血管成形术,观察组行切割球囊成形术,对比两组球囊扩张后即刻弹性回缩率、血管最小直径和狭窄程度、管腔丢失和再狭窄发生。结果两组均成功顺利完成球囊血管成形术,手术成功率为100.00%,观察组球囊扩张后即刻弹性回缩率〔(6.28±2.65)%〕明显小于对照组〔(20.08±12.56)%〕(P0.05);观察组术后即刻、随访各时刻血管最小直径均明显大于对照组,血管狭窄程度均明显小于对照组(P0.05);观察组随访3、6、12个月管腔直径丢失明显小于对照组(P0.05);观察组再狭窄率(16.67%)明显低于对照组(40.00%)(P0.05)。结论冠状动脉支架内再狭窄老年患者行切割球囊成形术手术成功率高,术后即刻弹性回缩率低,血管扩张效果明确,再狭窄率低,可作为首选的球囊扩张方案之一。     

后退式旋切导管对冠状动脉支架内再狭窄的治疗

目的 :评价后退式旋切导管 (PAC)治疗冠状动脉支架内再狭窄病变的有效性和安全性以及其即刻和近期定量冠状动脉造影结果。方法 :17例支架内再狭窄病变采用PAC治疗 ,应用定量冠状动脉造影评价即刻和近期疗效 ,并与同期的 38例首次介入治疗病变进行比较。结果 :支架内再狭窄组与首次介入治疗组相比PAC器械成功率分别为 10 0 %∶92 %、即刻造影残余狭窄率为 (36± 10 ) %∶(35± 15 ) %、斑块组织获取率为 94 %∶94 % ,两组差异无显著性意义 (P >0 .0 5 )。PAC所产生的血管腔直径增益为 (0 .78± 0 .6 6 )mm ,略低于首次介入治疗者〔(0 .97± 0 .5 5 )mm〕。PAC造成的主要并发症包括原置入支架带出 2例 ,血管内膜撕裂 3例。 6个月随访造影血管腔直径丢失指数为 0 .4 6± 0 .4 5 ,略低于首次介入治疗组 (0 .5 7± 1.13)。造影再狭窄率为 2 9% ,与首次介入治疗组相近 (2 6 % )。结论 :PAC能有效地用于冠状动脉支架内再狭窄病变的处理 ,具有较理想的即刻和近期有效率。     

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.     

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.