心肌桥和壁冠状动脉64层螺旋CT成像与冠状动脉造影比较

目的探讨64层CT冠状动脉成像对心肌桥的诊断及其临床价值。方法1422例患者均行64层CT扫描,所有数据传至工作站进行重建和后处理,观察有无心肌桥,测量心肌桥的长度、厚度、壁冠状动脉狭窄程度等。所有肌桥病例均行冠状动脉造影检查并与CT结果对比。结果共发现104例119段心肌桥,平均长度及厚度分别为5.0±2.7mm、2.0±1.6mm,壁冠状动脉狭窄程度为31%±17%。104例肌桥患者数学减影血管造影技术发现42例44段肌桥,其长度为5.1±3.6mm、狭窄程度为70.2%±28.4%,与CT结果差异存在显著性(P<0.05)。结论64层CT可清晰显示心肌桥和壁冠状动脉,对其诊断有着特殊的临床价值。     

冠状动脉心肌桥CTA影像分析

目的 研究冠状动脉CT血管成像技术（CTA）在检测和评价心肌桥影像特征中的价值.方法 纳入2012年~2013年疑诊或确诊有冠状动脉病变、接受冠状动脉CTA检查后确诊存在心肌桥的患者169例,对心肌桥的病变情况、长度、位置和心肌厚度进行评估.结果 冠状动脉心肌桥位于左冠状动脉前降支、回旋支、右冠状动脉的比例分别为86.4%、10.6%、3%.浅表型和纵深型心肌桥比例分别为73.4%和26.6%,隧道动脉长度平均为（20.1±7.4）mm.心肌组织厚度（0.5～3.0）mm,平均（2.1±0.8）mm.心肌桥的长度与厚度呈显著正相关（r=0.70,P＜0.05）.结论 冠状动脉CTA检查可用于评价心肌桥的结构及特征,是检测该病变的一种有效的、无创的方法.     

320排螺旋CT冠脉成像在心肌桥的诊断应用

目的探讨320排螺旋CT冠脉成像在心肌桥-壁冠状动脉诊断中的应用。方法应用320排螺旋CT对疑似冠状动脉病变患者850例进行CT冠脉成像检查,统计心肌桥的检出率、部位、分型及厚度等,比较有无心肌桥的存在时邻近冠状动脉粥样硬化斑块的特征。结果本组患者共计检出心肌桥123例,检出率14.47%。肌桥位于左前降支121例、中间支2例,均为单支冠脉一段受累。左前降支近段12例,中段102例,远段9例,肌桥长度与位置无关系。壁冠状动脉以表浅型多见,左前降支肌桥121例中的61例于近段检出钙化斑块70处,而其余非肌桥病例110例左前降支近段发现钙化斑块71处,具有统计学差异(P0.05);斑块更易发生在肌桥病例的左前降支近段,但斑块性质、管腔的狭窄程度、长度范围与肌桥的是否存在无关(P0.05)。结论 320排螺旋CT冠脉成像能够使心肌桥和壁冠状动脉清楚的显示,其肌桥检出率高。对肌桥及肌桥附近血管的观察可尽早发现粥样斑块,对预防心血管事件的发生有重要的价值。     

心肌桥的冠状动脉造影特点及临床意义

目的 :探讨心肌桥的冠状动脉 (冠脉 )造影特点及其临床意义。方法 :对 747例接受选择性冠脉造影的病例进行回顾性分析 ,共检出心肌桥 3 8例 ,采用计算机辅助定量冠脉造影系统软件对心肌桥进行定量分析。结果 :3 8例均为前降支肌桥 ,在冠脉投照位中以左肩位及右肩位收缩期狭窄最严重 ,肌桥长度平均 18 8± 5 1mm ,肌桥近端距第一对角支距离平均 2 0 1± 7 6mm ,距前降支起始部距离平均 3 1 3± 9 7mm ,距左冠脉起始部距离平均45 1± 10 4mm。肌桥前有动脉硬化或狭窄表现者 11例 ( 2 9% ) ,合并冠脉瘘 3例 ( 8% ) ,合并肥厚性心肌病 2例 ( 5 % )。结论 :在冠脉造影中心肌桥现象并非罕见 ,左肩位造影发现率高 ,严重心肌桥可以造成心肌缺血。     

冠状动脉心肌桥55例临床分析

目的探讨行选择性冠状动脉造影人群中冠状动脉心肌桥的发生率、临床特点及治疗措施。方法我院2002年6月~2005年7月接受选择性冠脉造影3886例人群中发现冠状动脉心肌桥55例,分析其发生率、临床特点及治疗措施。结果冠状动脉心肌桥发生率为1·5%,除1例为右冠状动脉心肌桥外,其余均为左前降支心肌桥。男性发生率高于女性(P<0·01)。收缩期狭窄30%~99%,平均(55±18)%;肌桥长度15~30mm,平均(24·5±3·5)mm。12例有心绞痛症状,其收缩期狭窄均在75%以上。7例症状较重的患者,在其左前降支心肌桥内植入TAXUS支架后症状消失,其余有症状的病例使用β-受体阻滞剂可缓解心肌桥所致的心绞痛。12例随访1~3年,无一例新发心肌梗死、心脏性猝死及左心功能不全。结论冠状动脉肌桥多发生于左前降支,可致心肌缺血。β-受体阻滞剂可缓解心肌桥所致的心绞痛。冠状动脉内支架术可能是治疗冠状动脉心肌桥安全有效的办法。     

64排128层螺旋CT冠状动脉CTA动态容积再现图像辅助诊断心肌桥准确率分析

目的研究64排128层螺旋CT冠状动脉CTA动态容积再现图像辅助诊断心肌桥的准确率。方法本次纳入2019年1月至2020年6月期间在本院进行64排128层螺旋CT冠状动脉CTA检查的患者236例展开研究,以冠状动脉造影检查为金标准,对确诊者的动态容积再现图像进行观察,评估诊断结果、诊断效能、测量参数。结果经冠状动脉造影检查确诊为心肌桥者60例,静态CTA图像、静态加动态CTA图像的诊断符合率分别为80.00%、95.00%。静态加动态CTA图像的敏感度、准确性高于静态CTA图像,差异具有统计学意义(P0.05);64排128层螺旋CT冠状动脉CTA检查的心肌桥-壁冠状动脉长度高于冠状动脉造影,狭窄程度低于冠状动脉造影,差异具有统计学意义(P0.05)。结论 64排128层螺旋CT冠状动脉CTA动态容积再现图像在心肌桥辅助诊断中具有较高的准确率。     

心肌桥-壁冠状动脉的形态学特征与冠状动脉近段粥样硬化病变的关系

目的通过128层螺旋CT冠状动脉成像技术评价心肌桥-壁冠状动脉(MBMCA)的形态学特征,并分析其与冠状动脉近段粥样硬化病变的关系。方法选取2015年3月~2017年3月于北京市仁和医院收治的单纯MBMCA不伴有动脉粥样硬化患者79例记为对照组,另取同期收治的心肌桥近端冠状动脉伴粥样硬化患者79例作为观察组。两组均接受128层螺旋CT冠状动脉成像技术检查。比较两组患者年龄、性别、心率等基本临床资料,各项冠状动脉检测指标(心肌桥厚度、壁冠状动脉长度、壁冠状动脉两端平滑、壁冠状动脉近端成角、壁冠状动脉远端成角、壁冠状动脉两端成角)水平,并通过多因素Logistic回归分析MBMCA与冠状动脉近段粥样硬化病变的关系。结果观察组年龄明显高于对照组(P0.05);而性别、心率、病程、高血压与糖尿病情况比较,差异均无统计学意义(P均0.05)。观察组壁冠状动脉长度、壁冠状动脉两端平滑患者比例均分别明显低于对照组,而壁冠状动脉远端成角、壁冠状动脉两端成角患者比例均分别明显高于对照组(P均0.05)。经多因素Logistic回归分析可得:年龄(OR=1.421,P=0.037)、壁冠状动脉远端成角(OR=2.147,P=0.042)以及壁冠状动脉两端成角(OR=2.579,P=0.002)均是影响壁近端冠状动脉粥样硬化的独立危险因素,而壁冠状动脉两端平滑是保护性因素(OR=2.736,P=0.012)。结论采用128层螺旋CT冠状动脉成像技术可有效评价MBMCA形态学特征和冠状动脉近段粥样硬化病变情况,且两者存在密切相关,值得临床重点关注。     

老年冠心病患者冠状动脉搭桥术后桥病变的特征及治疗

目的　探讨冠状动脉搭桥术后桥病变的特征及介入治疗的效果。方法　冠状动脉搭桥术后的 38例患者 ,因心绞痛而接受冠状动脉造影复查。多体位投照并记录桥病变特征 ,获得家属书面同意后行支架术。术后即刻进入临床随访 ,随访时间为 6个月 ,记录心脏事件发生次数。患者术后6个月时再次行冠状动脉造影。结果　搭桥术后心脏射血分数由 (5 2± 10 ) %增加到 (5 8± 14 ) % (P <0 0 5 )。 38例患者中静脉桥狭窄者占 15 % ;静脉桥闭塞者占 4 0 % ,均为开口后 1～ 2mm处闭塞 ;静脉桥退行性病变者占 2 4 % ;桥内血栓栓塞为 9例 (计 11个桥 ) ,其中搭桥术后 2例发生院内急性心肌梗死患者的静脉桥均为血栓性闭塞。狭窄桥病变长度平均为 (18± 6 )mm。球囊扩张后残余狭窄 <4 0 %。术中无远端栓塞发生 ,2个静脉桥有桥内血流减慢 ,注射硝酸甘油和维拉帕米后消失 ;夹层见于 2个钙化性桥病变球囊扩张后即刻 ,均于支架置入后消失。共 2 1例患者完成 6个月的临床随访 ,1例患者支架术后 2个月时出现心绞痛 ,其余患者无心脏事件发生。 18例患者在随访 6个月时接受冠状动脉造影 ,4例患者发生支架部位再狭窄 ,靶病变部位再狭窄率为 16 6 % ,无完全闭塞。结论　静脉桥长期效果明显不如动脉桥 ,支架术安全有效。     

应用血管内超声评价心肌桥壁冠状动脉压缩比对其近段冠状动脉粥样斑块的影响

目的:应用血管内超声(IVUS)评价左前降支心肌桥及壁冠状动脉(冠脉)压缩与其近段冠脉粥样硬化程度的关系。方法:入选2015-01-2018-05入住我院心内科患者80例,所有患者冠脉造影证实无明显狭窄病变,而IVUS检查发现左前降支存在心肌桥。应用IVUS测量心肌桥位置、心肌桥长度、心肌桥厚度等解剖参数;IVUS测量壁冠脉压缩比以及心肌桥近端20mm内冠脉的最大斑块负荷(Max PB_prox)。单元线性回归分析壁冠脉压缩程度与心肌桥长度、厚度、位置的关系。根据Max PB_prox三等分点将患者分为A、B、C 3组,比较3组间的临床资料、IVUS测量值是否有统计学差异。结果:(1)测得所有患者心肌桥长度为(20.8±12.7)mm,心肌桥厚度为(0.71±0.49)mm,心肌桥位置为(37.4±11.3)mm,壁冠脉压缩比为(23.9±11.8)%,单元线性回归分析显示壁冠脉压缩程度与心肌桥长度(r=0.287,P=0.067)、心肌桥厚度(r=0.296,P=0.086)和心肌桥位置(r=0.301,P=0.073)均无显著相关性。(2)根据Max PB_prox三等分点分组后,Max PB_prox严重程度与壁冠脉压缩比呈正相关(P<0.05),而与心肌桥长度(P=0.450)、心肌桥厚度(P=0.126)及心肌桥位置(P=0.364)无关。结论:心肌桥近端冠脉粥样斑块负荷与壁冠脉压缩比呈正相关,而与心肌桥长度、厚度及位置无关,这有助于识别高危心肌桥病变患者。壁冠脉压缩程度与心肌桥长度、厚度及位置无显著相关。     

40层螺旋CT对冠状动脉心肌桥的诊断价值

目的 探讨40层螺旋CT（MSCT）对冠状动脉心肌桥的诊断价值。方法298例可疑冠心病患者行冠脉CT成像，检出心肌桥者根据有否冠心病将其分为单纯心肌桥组和心肌桥合并冠心病组，然后比较两组胸痛的临床特点与40MSCT诊断心肌桥的特点。21例心肌桥者行选择性冠状动脉造影。结果40MSCT心肌桥的检出率为26．8％。80例患者共有122处心肌桥，其中左前降支占51．6％。40MSCT显示胸痛患者心肌桥的厚度多≥2．0mm，发生在左前降支；壁冠状动脉长度≥2．6mm的多发生在回旋支，与无胸痛的心肌桥患者相比差异有显著性。80例心肌桥患者中有胸痛者64例（80．0％）。冠心病组多为典型心绞痛，单纯心肌桥组胸痛不典型。其中21例冠状动脉造影仅9例显示心肌桥。冠心病组所有的心肌桥与狭窄的冠状动脉均非同一处血管。结论MSCT空间分辨力高，可准确判断冠状动脉形态、结构异常和心肌密度异常，并可判断冠状动脉和心肌的空间关系。诊断心肌桥敏感可靠，检出率高，优于冠脉造影。     

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.