可生物降解涂层药物洗脱支架介入治疗的近期疗效

目的 评估国产新型西罗莫司可生物降解涂层支架在急性心肌梗死患者介入治疗(percutaneous coronary intervention,PCI)中的疗效及安全性.方法 急性心肌梗死患者56例,其中ST段抬高性心肌梗死48例,非ST段抬高性心肌梗死8例,均置人西罗莫司可生物降解涂层洗脱支架,观察手术成功率、支架内血栓等并发症及主要不良心脏事件(main adverse coronary events,MACE)发生率,术后随访1～14个月,6～9个月行冠状动脉造影复查.结果 成功行PCI 55例,手术即刻成功率98%.82处病变共置入西罗莫司支架98枚,其中17枚(17.3%)为直接支架术.4例出现无复流现象,1例使用主动脉气囊反搏.1例术后6 h猝死,考虑急性支架内血栓.术中及住院期间无其他严重并发症发生.50例(89.3%)随访1～14个月,无晚期支架内血栓发生,无MACE;复查冠状动脉造影19例,1例发生支架内再狭窄,无需血运重建.结论 国产西罗莫司可生物降解涂层支架在急性心肌梗死患者行PCI治疗有较好疗效及安全性.     

国产西罗莫司洗脱支架与紫杉醇洗脱支架临床效果比较研究

目的比较国产西罗莫司洗脱支架(FBS)和进口紫杉醇洗脱支架(PES)治疗冠状动脉狭窄的效果。方法选择阜外心血管病医院2004年4月至2005年8月连续接受国产西罗莫司洗脱支架或紫杉醇洗脱支架治疗,并且进行冠状动脉造影随访的228例冠心病患者。排除支架置入失败、位置不理想者。所有的患者术后均接受阿司匹林300mg/d、氯吡格雷75mg/d等规范药物治疗。患者在支架术后6个月后接受冠状动脉造影随访。结果共228例患者(198名男性,30名女性)314个靶病变接受治疗并完成造影随访。其中C型病变占总数的40.1%,平均术前参考血管直径2.80±0.47mm。平均每个病变支架长度25.90±14.54mm。228例患者中118例置入紫杉醇洗脱支架,100例置入西罗莫司洗脱支架。两组在患者基本条件方面,国产西罗莫司洗脱支架组患者年龄大于紫杉醇洗脱支架组,紫杉醇洗脱支架组有更多的2型糖尿患者;在病变基本条件方面,国产西罗莫司洗脱支架组病变更多偏心性病变,其他没有差别。6个月后随访结果国产西罗莫司洗脱支架组的支架再狭窄率明显低于紫杉醇洗脱支架组(5.3%比21.9%,P<0.001)。国产西罗莫司洗脱支架组的靶病变血管重建率(TLR)明显低于紫杉醇洗脱支架组(3.8%比13.1%,P<0.001)。国产西罗莫司洗脱支架组支架内晚期腔径丢失明显小于紫杉醇洗脱支架组(0.18±0.41mm比0.58±0.69mm,P<0.001)。结论国产西罗莫司涂层支架用于临床实践有良好的疗效。     

国产西罗莫司洗脱支架早期介入治疗非ST段抬高急性冠状动脉综合征

目的分析国产西罗莫司洗脱支架早期介入治疗非ST段抬高的急性冠状动脉综合征的疗效。方法采用回顾性分析研究方法,在88例非ST段抬高的急性冠状动脉综合征患者置入国产西罗莫司洗脱支架,随访住院及术后1年内主要心脏不良事件发生率和无心脏事件生存率。结果随访1年中,不稳定心绞痛复发8例,非ST段抬高心肌梗死1例,再次冠状动脉内支架治疗2例,无死亡病例。结论国产西罗莫司洗脱支架早期介入治疗非ST段抬高的急性冠状动脉综合征安全、有效,并发症少,再狭窄率低。     

国产药物洗脱支架治疗冠状动脉多支病变临床随访

目的:评价冠状动脉多支病变患者置入≥4枚国产药物洗脱支架(DES)的疗效.方法:2004-11至2006-11就诊于我科接受经皮冠状动脉介入治疗(PCI)的冠心病患者1 127例,其中185例为置入支架≥4枚的多支病变患者,随访院内外主要心脏不良事件(MACE)包括心性死亡、急性心肌梗死和靶病变再次血运重建的发生率.结果:处理冠状动脉病变720处,其中复杂病变525处,置入国产DES 836枚.院内1例高龄患者术后常规抗凝治疗死于脑出血,其余184例临床随访42(30～54)个月,发生急性心肌梗死4例,靶病变再次血运重建12例,院外MACE发生率8.6%.冠状动脉造影随访108例,DES边缘再狭窄5例,支架内再狭窄9例,再狭窄率13.0%.结论:冠状动脉多支病变患者置入≥14枚国产DES长期随访效果满意.     

西罗莫司洗脱支架存在晚期再狭窄现象

意大利学者Cosgrave等研究发现，冠心病患者置入西罗莫司洗脱支架后存在晚期再狭窄现象。 作者对米兰EMO Centro Cuore Columbus医院2003年3月以前置入西罗莫司洗脱支架（Cypher）的433例患者的928个病变资料进行分析，入选患者分别进行术后1、6、9、12、24及36个月临床随访和6—9个月的冠状动脉造影随访。1年后的造影随访只有在患者出现新发生的症状时才进行。     

国产西罗莫司洗脱支架治疗急性心肌梗死的安全性和有效性

目的:评估国产西罗莫司药物洗脱支架Firebird2TM治疗急性心肌梗死的安全性和有效性. 方法:连续入选2010年9月至2011年12月因急性心肌梗死在我院行介入治疗的120例患者.观察并分析所有患者冠状动脉的靶血管特点、支架植入情况、住院期间和支架植入术后6个月的主要心脏不良事件(MACE,包括死亡、再发心梗、靶血管的再次血运重建)发生率和支架内血栓发生率. 结果:120例急性心肌梗死患者靶血管共植入支架152枚,术后即刻TIMI3级获得率95.8％,住院期间死亡1例.术后6个月临床随访总MACE事件的发生率为5％,死亡2例,靶血管的再次血运重建4例,无再发心梗和支架内血栓发生. 结论:国产西罗莫司洗脱支架Firebird2TM对急性心肌梗死患者具有良好的安全性和疗效.     

国产与进口西罗莫司药物洗脱支架治疗冠心病临床疗效对比

目的评估国产西罗莫司药物洗脱冠状动脉(冠脉)支架在冠心病患者中应用的安全性及1年临床随访结果,并与同期应用进口药物洗脱支架(Cypher和Taxus)比较。方法与结果2003年5月至2004年6月,共计673例经冠脉造影证实的冠心病患者接受药物洗脱支架治疗,其中接受国产西罗莫司药物洗脱支架(Firebird,上海微创公司)224例,进口西罗莫司药物洗脱支架(Cypher,美国强生公司)246例,进口紫杉醇药物洗脱支架(Taxus,美国波士顿公司)203例。各组基础临床情况及造影特征均相似,尽管Firebird组患者平均每例置入支架数目较多且支架总长度较长,但其住院总费用仍显著低于其他两组。术后1年临床随访严重心脏不良事件(包括心源性死亡、非致命性心肌梗死和靶血管再次血运重建)发生率在Firebird组为9·0%、Cypher组为8·4%、Taxus组为11·2%,相互比较差异无统计学意义。造影证实Firebird组2例(0·9%)、Cypher组2例(0·9%)和Taxus组3例(1·6%)发生支架内血栓形成。结论国产西罗莫司药物洗脱冠脉支架治疗冠心病安全,其1年临床疗效与进口西罗莫司及紫杉醇药物洗脱冠脉支架相似。     

小直径肾动脉狭窄应用西罗莫司洗脱支架的安全性和有效性

目的评估小直径肾动脉粥样硬化性狭窄患者应用冠状动脉西罗莫司洗脱支架的安全性和有效性。方法两年内入选15例患者,平均年龄67·7岁。双侧肾动脉狭窄或闭塞和单侧肾动脉狭窄各6例,副肾动脉狭窄3例。应用2种国产西罗莫司洗脱(火鸟和同心)冠状动脉支架。研究主要终点包括术后1、3和6个月靶病变直径狭窄程度(再狭窄率)和肾功能状态。结果在15例患者19处病变共成功置入22个支架,其中西罗莫司洗脱支架19个,肾动脉金属裸支架3个。全部患者完成了1个月肾动脉Doppler超声随访和血清肌酐随访,其中5例和7例分别完成了3个月和6个月的前述随访,还有3例进行了6个月血管造影随访。随访结果均未显示靶血管再狭窄,并且肾功能较术前没有明显变化。结论冠状动脉西罗莫司洗脱支架可以安全和有效应用于治疗小直径肾动脉粥样硬化性狭窄患者。     

国产BuMA支架在冠心病大小血管病变经皮冠状动脉介入治疗中的疗效比较

目的 评价国产BuMA生物降解药物涂层冠状动脉支架在冠心病小血管病变经皮冠状动脉介入治疗中的临床疗效及安全性.方法 选择182例行经皮冠状动脉介入治疗（PCI）的冠心病患者,其中小血管病变组102例,大血管病变组80例,均置入BuMA生物降解药物涂层冠状动脉支架,比较观察手术成功率、术中并发症及在1～12个月随访期间的心绞痛、猝死、主要不良心脏事件（MACE）发生率及复查冠状动脉造影情况.结果 大血管病变组和小血管病变组手术即刻成功率均为100％,两组共发现203处靶病变,共置入支架273枚.术中均无严重并发症发生.对入选182例患者进行出院后第1、3、6、12个月门诊随访发现,小血管病变组8例心绞痛复发,其中1例为糖尿病患者.大血管病变组5例复发心绞痛.于术后第6～9个月复查冠状动脉造影证实,小血管病变组2例分别为右冠状动脉主干、左前降支支架内远段再狭窄达75％～80％,大血管病变组1例为左前降支支架近端再狭窄75％.两组心绞痛复发、冠状动脉造影支架内再狭窄及靶病变血运重建主要MACE发生率的差异均无统计学意义.两组均未出现迟发性支架内血栓、无心肌梗死及猝死.结论 国产BuMA生物降解药物涂层冠状动脉支架应用于冠心病小血管病变介入治疗安全、有效,疗效不逊于用于冠心病大血管病变时.     

真实临床条件下国产西罗莫司药物支架的临床评价

目的观察国产西罗莫司药物支架的临床和造影随访效果。方法选择北京安贞医院心内科自2006年8月至2007年10月516例应用国产西罗莫司药物支架的患者,于置入支架9个月（±2个月）后进行电话或门诊随访主要心血管事件（MACE,包括心源性死亡、非致死性心肌梗死、靶血管血运重建）的发生率,尽量进行冠状动脉造影随访,观察患者MACE事件总发生率;同时观察糖尿病亚组的治疗效果;初步评价各种类型病变,包括左主干病变、分叉病变、慢性闭塞病变、钙化病变、开口病变、小血管病变、急性闭塞病变、再狭窄病变的治疗效果;评价药物支架对于以上各类病变的疗效。结果516例患者共置入国产西罗莫司药物支架872枚,成功率为99.5%,其中随访到482例,随访率93.4%。随访到的患者中有18例患者发生MACE事件,发生率为3.5%。造影随访共239例患者,占总例数的46.3%,再狭窄率为11.3%。糖尿病亚组再狭窄率为14%。并对左主干病变、分叉病变、弥漫病变、慢性闭塞病变、小血管病变、钙化病变、急性闭塞病变、开口病变、再狭窄病变分别进行了描述。结论大样本研究显示应用国产西罗莫司药物支架可以取得比较好的疗效。糖尿病亚组患者应用国产药物支架效果良好、初步判断国产药物支架对于弥漫、开口、小血管、再狭窄病变有较好的疗效;对于左主干病变、分艾病变的疗效提示有益的结果,需要继续总结观察。     

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.