血管内超声指导下对小血管病变的介入治疗

目的评价血管内超声(IVUS)对小血管病变介入治疗的临床意义。方法回顾性分析2010年10月²013年2月于我院接受介入治疗的单支小血管(≤2.5mm)病变患者共237例,其中,IVUS指导下介入治疗的患者105例(Ⅰ组),冠状动脉造影(CAG)指导下介入治疗的患者132例(Ⅱ组)。分析2组患者基线资料、病变特点、介入治疗及随访期间心脏不良事件和再狭窄情况。结果 2组患者介入治疗均成功,Ⅰ组和Ⅱ组置入支架直径[(2.50±0.40)mmvs(2.34±0.37)mm]、支架长度[(28.75±7.77)mmvs(35.78±10.45)mm]、支架高压后扩张(91.4%vs55.3%)和支架内再狭窄(1.9%vs 7.6%)比较,差异有统计学意义(P=0.002,P=0.000,P=0.000,P=0.042);2组串联支架、CAG随访比较差异无统计学意义(P>0.05)。2组患者住院及随访1、3和6个月期间,均无主要不良心脏事件发生。结论对于小血管病变的介入治疗,IVUS具有较好的指导作用。     

药物洗脱支架与金属裸支架对冠状动脉临界病变的远期疗效

目的:评估药物洗脱支架与金属裸支架对于治疗冠状动脉临界病变的远期疗效。方法:自身冠状动脉首次介入治疗病变(在线定量冠状动脉造影分析50%≤管腔狭窄直径≤70%)的患者入选本研究,共计151例患者分为药物洗脱支架组(n=102)和金属裸支架组(n=49),两组的基本临床特征和冠状动脉造影结果差异无统计学意义。术前、术后和随访6～12个月时进行定量冠状动脉造影分析,并在住院期间、30天和6～12个月时观察严重不良心脏事件的发生。结果:151例患者支架置入成功率均为100%。住院期间严重不良心脏事件发生率,在药物洗脱支架组和金属裸支架组差异无统计学意义(0%和2.0%,P=0.15)。在随访30天时,两组均无死亡和支架内血栓形成。6～12个月随访期间,药物洗脱支架组和金属裸支架组比较①严重不良心脏事件发生率(3.9%vs8.1%,P=0.97),②靶病变重复血管重建率(2.9%vs6.1%,P=0.39),③急性心肌梗死发生率(1.96%vs2.04%,P=0.95),差异均无统计学意义。12个月时药物洗脱支架组和金属裸支架组比较,支架内血栓发生率和病死率差异也无统计学意义(1.96%vs0%,P=0.34;0%vs4.08%,P0.05)。定量冠状动脉造影分析显示:远期管腔丢失药物洗脱支架组明显低于金属裸支架组[(0.23±0.73)mmvs(0.95±0.94)mm,P=0.01],两组比较差异有统计学意义;而支架内再狭窄率两组比较差异无统计学意义(12.9%vs25.0%,P=0.34)。结论:药物洗脱支架和金属裸支架对于治疗自身冠状动脉临界病变安全有效,两组远期严重不良心脏事件发生率差异无统计学意义。     

血清C反应蛋白对冠状动脉支架置入术后心血管事件和再狭窄的预测价值

目的　探讨基础血清C反应蛋白 (CRP)水平对冠状动脉支架置入术后 6个月内心血管事件和再狭窄的预测价值。方法　术前测定 78例单支病变的冠状动脉支架置入术患者 [2 8例稳定性心绞痛 (SAP)和 5 0例急性冠脉综合征 (ACS) ]基础血清CRP水平。将患者分为CRP <3 0mg/L(31例 )和CRP≥ 3 0mg/L (4 7例 )两组 ,分析并记录患者术后 1周以及术后 6个月内心血管事件 (心绞痛、心肌梗死及死亡 )发生率及支架内再狭窄 (血管内直径狭窄率≥ 5 0 % )等情况。结果　基础血清CRP水平在ACS组比稳定心绞痛组高 [(7 8± 2 6 )比 (2 8± 0 4 )mg/L ,P <0 0 1];术后 1周内的心血管事件发生率在ACS组、CRP升高组比稳定心绞痛、CRP不高组明显升高 (8%比 3 6 % ,P <0 0 5 ) ;术后6个月的心血管事件及支架内再狭窄发生率亦是CRP高者远高于CRP低者 (2 1 5 %比 7 7% ,P <0 0 1;19 5 %比 7 7% ,P <0 0 1)。结论　基础血清CRP水平是单支冠状动脉病变支架置入术后 6个月内预后的预测指标 ,这提示术后 6个月内心血管事件发生率和支架内再狭窄是和支架置入术前炎症细胞活化程度密切相关。     

雷帕霉素洗脱支架治疗支架术后的再狭窄

目的探讨雷帕霉素洗脱支架(CypherTM)在支架术后再狭窄介入治疗中的安全性和有效性。方法分析在支架术后发生再狭窄而再次介入治疗并置入CypherTM支架的21例患者的即刻疗效和血管造影随访结果。结果21例患者介入治疗均获得成功,21处病变共置入24枚CypherTM支架。住院期间未发生有关的严重并发症。随访期6~12个月,平均为(9.2±3.0)个月内未出现心脏事件。21例患者共有18例复查了冠状动脉造影,CypherTM支架内均无再狭窄。结论CyperTM支架在再狭窄的介入治疗中安全有效。     

真实临床条件下CypherTM支架的应用效果评价

目的　观察在真实临床条件(realworld)下使用西罗莫司(雷帕霉素)药物CypherTM 支架的疗效。方法　入选我科自2 0 0 2年1 2月至2 0 0 4年5月所有应用CypherTM 支架的患者,共2 6 3例,于支架置入后8±2个月,电话及门诊随访应用药物洗脱支架患者的主要不良心脏事件发生率;评价糖尿病亚组及各种类型病变(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、急性闭塞病变及再狭窄病变)的治疗效果。结果　2 6 3例患者支架置入成功率为1 0 0 % ;随访2 4 6例,失访1 7例,随访率93 5% ;主要不良心脏事件有1 0例,发生率为3 8% ;复查冠状动脉造影1 39例,支架内再狭窄率为1 0 1 % ,其中糖尿病亚组为1 2 . 9% ,弥漫病变为1 0 . 0 % ,开口病变6 9% ,慢性闭塞病变1 1 . 1 % ,小血管病变1 1 . 3% ,急性闭塞病变0 ,钙化病变9 1 % ,A型病变8 7% ,左主干病变2 2 . 2 % ,分叉病变1 8 .8% ,再狭窄病变1 1 . 1 %。结论　在真实临床状态下,CypherTM 支架可以明显减少糖尿病患者弥漫病变,急、慢性闭塞病变,小血管病变,开口病变,钙化病变,A型病变等主要不良心脏事件的发生。对于左主干病变、分叉病变和再狭窄病变,提示有益的疗效,临床疗效需进一步观察。     

药物洗脱支架(cypherTM)在急性ST段抬高心肌梗死急诊经皮冠状动脉介入治疗中的应用

目的　探讨雷帕霉素药物洗脱支架 (cypherTM)在急性ST段抬高心肌梗死 (STEMI)急诊经皮冠状动脉介入治疗 (PCI)中应用的安全性和有效性。方法　选择 2 0 0 2年 11月至 2 0 0 4年 2月的STEMI患者 96例 ,随机分为两组 :药物洗脱支架组 ( 4 8例 )和普通支架组 ( 4 8例 ) ,所有患者均于发病12h内行急诊PCI治疗 ,一组置入cypherTM ,另一组置入普通支架。结果　 96例患者急诊PCI治疗均获得成功。 4 8支梗死相关血管 (IRA)的 4 8处罪犯病变置入 4 9枚药物洗脱支架 ,另 4 8支IRA的 4 9处病变置入 4 9枚普通支架。未发生与介入治疗有关的并发症 ,其中 1例置入cypherTM 者术后出现脑梗死 ,于第 7天死于多器官功能衰竭。药物支架组和普通支架组相比较 ,PCI后造影结果和临床结果差异均无显著性。随后对 95例病人进行了 1～ 9个月随访 (平均 4 5± 2 6个月 ) ,药物支架组患者未发生任何心血管事件 ,普通支架组有 2例发生心绞痛。结论　cypherTM 在STEMI急诊PCI中应用与普通支架一样有较强的安全性和有效性     

经桡动脉植入Firebird药物支架86例临床观察

目的 观察经桡动脉途径植入Firebird药物支架在冠状动脉性心脏病(冠心病)介入治疗中的安全性和有效性.方法 回顾性分析86例经桡动脉途径植入国产药物洗脱支架冠心病患者的临床资料,观察术中并发症发生率、术后随访主要心血管不良事件发生率和血管再狭窄率.结果 共植入国产药物洗脱支架113枚.86例患者住院期间无血栓形成和临床随访无主要心血管事件发生,术后6个月冠状动脉造影复查无支架内再狭窄.结论 经桡动脉途径在冠心病介入治疗中安全有效,国产药物支架近期能够有效预防冠状动脉介入治疗后血管再狭窄.     

药物洗脱支架治疗冠脉病变的近期疗效

目的　观察药物洗脱支架治疗冠脉病变的近期疗效。方法　采用经皮冠脉方法 ,对 2 9例冠心病病人进行 3 1例次介入治疗。术后随访采用临床观察及冠脉造影评价其近期疗效。结果　 2 9例冠心病中不稳定性心绞痛 1 7例 ,急性心肌梗死 9例 ,冠脉支架内再狭窄 3例 ,共植入药物洗脱支架 3 3只 ,其中CypherTM支架 2 6只 ,TAXUS支架 7只。全部病例随访 3～ 1 4个月 ,除一例术后死亡外 ,无一例发现胸痛及支架内再狭窄的临床表现。 3例随访中作冠脉造影 ,显示DES内无再狭窄征象。结论　药物洗脱支架治疗冠脉病变的近期疗效肯定 ,且无不良事件增加 ,对具有高度再狭窄可能的复杂病变 ,亦可获益。     

药物洗脱支架治疗支架内再狭窄的对照研究

目的 比较3种药物洗脱支架(DES)治疗支架内再狭窄的长期临床效果.方法 回顾性分析阜外医院对支架内再狭窄病例用DES行经皮冠状动脉介入治疗(PCI)的390例患者,其中雷帕霉素药物洗脱支架(Cypher)组187例(C组),紫杉醇药物涂层支架(Taxus)组89例(T组),国产雷帕霉素涂层支架(Firebird)组114例(F组).结果 T组不稳定性心绞痛比率高于另2组,F组左主干病变比率低于另2组,而3支病变比率高于另2组.3组平均临床随访时间为864、848和719 d,主要不良心脏事件发生率差异无统计学意义(P=0.081),3组总的支架内血栓发生率差异无统计学意义(P=0.605).7个月造影随访支架内和血管段再狭窄率T组有增高的趋势(17.9%比29.4%比13.6%.P=0.214和21.8%比35.3%比15.9%,P=0.132).支架内和血管段的晚期丢失T组均明显大于另外2组[(0.31±0.12)mm比(0.75±0.24)mm比(0.31±0.13)mm,P=0.000和(0.33±0.18)mm比(0.61±0.23)mm比(0.31±0.14)mm,P=0.001].结论 3种DES治疗支架内再狭窄病变的长期疗效相似,Cypher和Firebird抑制内膜增生的作用更强.     

雷帕霉素洗脱支架治疗冠脉左前降支近中段病变的临床疗效评价

目的评价雷帕霉素洗脱支架治疗冠脉左前降支近中段病变的临床疗效。方法以冠脉造影显示左前降支近中段狭窄病变并分别置入雷帕霉素洗脱支架(SES组)或裸金属支架(BMS组)的患者各100例为研究对象。记录患者的一般情况、临床和冠脉病变特征,术后1年临床随访和冠脉造影复查。结果两组患者匹配良好,仅SES组置入支架的长度显著长于BMS组(21.07±7.45mmvs18.25±6.82mm,P=0.0057)。在随访中,无心源性死亡,SES组1例因支架内再狭窄发生急性心肌梗死。冠脉造影复查显示SES组再狭窄率较BMS组显著降低(7.4%vs25.9%,P=0.002),并直接导致不良事件发生率的下降。结论药物洗脱支架显著降低左前降支近中段狭窄病变介入治疗后再狭窄发生率,可作为血运重建的一种有效策略。     

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.