老年充血性心力衰竭患者伴或不伴心房颤动的预后观察

目的观察伴心房颤动(AF)与不伴AF的老年心力衰竭(HF)患者的预后。方法回顾性研究72例老年HF患者,根据其是否并发AF的临床特点,分为有AF组(I组)和无AF组(II组),随访观察(24±6)月,观察AF对老年HF患者不良心血管事件发生及预后的影响。结果左心房内径,I组大于II组[(48±6)mm vs(41±7)mm,P<0.05];左心室射血分数,I组低于II组[(32±5)%vs(43±8)%,P<0.05];脑梗死发生率,I组高于II组(36%vs 8%,P<0.05);不良心血管事件发生,I组因HF加重或脑梗死发生的再住院率高于II组(P<0.01);病死率,I组高于II组(33%vs 14%,P<0.01)。结论老年HF患者并发AF,预示着不良心血管事件发生增多,预后相对较差。     

充血性心力衰竭对犬肺静脉肌袖结构的影响

目的探讨充血性心力衰竭（CHF）对犬肺静脉（PV）肌袖结构的影响。方法将16只杂种犬,随机等分为CHF组和对照组,CHF组以240次/min的频率在右室持续起搏4周,建立CHF模型;对照组埋置起搏器但不起搏;Burst刺激诱发心房颤动（AF）。分别取两组犬的PV肌袖组织,用天狼星红染色进行纤维化定量分析和胶原组成分析。用免疫组化染色法对缝隙连接蛋白43（Cx43）进行半定量分析。结果4周后,进行快速右室起搏的CHF组的所有犬均可诱发出稳定CHF。终止起搏后,CHF犬的持续AF（>15min）的诱发率为87.5%（7/8）,显著高于对照犬（P<0.01）。CHF组PV肌袖纤维化的程度明显增加,总胶原的含量显著高于对照组的相应部位[（5.3±1.0）%vs（2.1±0.7）%,P<0.01]。CHF组Ⅲ型胶原的含量及Ⅲ型胶原与I型胶原含量的比值均显著高于对照组[（4.6±1.0）%vs（1.6±0.7）%和（7.9±3.2）vs（3.0±1.9）,P<0.01];但I型胶原的含量与对照组无显著差异[（0.6±0.2）%vs（0.6±0.3）%]。CHF组PV肌袖内Cx43的水平显著高于对照组[（3.3±0.6）%vs（2.8±0.7）%,P<0.05];其PV肌袖内细胞侧侧连接处Cx43的分布较对照组增加。结论CHF对PV肌袖结构具有显著影响。     

经皮直接冠状动脉介入治疗ST段抬高型心肌梗死患者近中期预后的相关因素

目的探讨行直接PCI的ST段抬高型心肌梗死患者近中期预后的相关因素。方法2003年7月2005年12月住院且诊断为ST段抬高型心肌梗死（无心源性休克）患者199例,对这些患者进行住院期观察及出院后随访,随访时间为6个月。结果除女性年龄较大之外[（67±12）岁vs（60±11）岁,P<0.01],两组间临床特征基本相似;住院病死率女性较高（9.1%vs1.5%,P<0.05）;主要不良事件发生率女性也较高（12%vs3.0%,P<0.01）。6个月病死率差异仍然存在[12%vs1.5%,P<0.01];多因素分析显示死亡、心脏主要不良事件和稳定型心绞痛的相关因素:女性、80岁以上的年龄、多支血管病变、严重左室功能不全和术后未规范用药。结论女性、80岁以上、多支血管病变、严重左心室功能不全和术后未规范用药是行直接PC I的ST段抬高型心肌梗死患者近中期预后的主要预测因子。     

女性冠状动脉慢性完全闭塞性病变的临床特点及PCI疗效

目的分析女性冠状动脉慢性完全闭塞性病变（CTO）的临床特点以及冠状动脉介入治疗（PCI）的疗效。方法将2005年1月12月CTO的连续病例,按性别分为男性和女性两组,比较两组患者一般资料、冠脉造影资料、PCI成功率以及院内并发症。结果与男性相比,女性患者年龄大[（69±7）岁vs（59±11）岁,P<0.01],住院时间长[（11±5）dvs（8±3）d,P<0.01],糖尿病,高血脂以及高血压发生率比男性多（42%vs29%,51%vs42%,54%vs41%,均P<0.05）,心功能不全明显高于男性（31%vs11%,P<0.01）,且CTO闭塞时间超过12个月比例明显高于男性（57%vs39%,P<0.01）。典型心绞痛表现较男性少（58%vs76%,P<0.01）,男性患者多有吸烟史和饮酒史（15%vs47%,18.1%vs32%,均P<0.05）。女性患者多支病变、病变残端刀切状,闭塞端≥15 mm,病变近端及病变处钙化比例均高于男性组（42%vs20%,42%vs29%,19%vs10%,均P<0.05）。女性CTO患者行PCI术成功率低于男性组（83%vs92%,P<0.01）。女性组CTO患者术后1年无主要心脑血管事件生存率（MACCE）低于男性组（P<0.05）。结论女性CTO患者人群年龄偏大,易感因素多,病变特征比较复杂,手术成功率低,预后差。     

白细胞计数对急性ST段抬高型心肌梗死患者长期预后的影响

目的探讨白细胞计数对急性ST段抬高型心肌梗死(STEMI)长期预后的影响。方法选择STEMI患者545例,依据白细胞水平将患者分为A组274例(白细胞≤10.0×10~9/L)和B组271例(白细胞10.0×10~9/L),比较2组患者住院期间主要不良心脑血管事件(MACCE)、病死率及长期MACCE发生率。结果 A组平均年龄明显高于B组[(63.8±11.4岁)vs(60.4±11.4岁),P=0.001];A组住院期间MACCE发生率明显低于B组(5.1%vs 10.3%,P=0.013)。随访28个月,A组MACCE发生率明显低于B组(12.9%vs 16.9%,P=0.018),全因病死率明显低于B组(2.6%vs 5.7%,P=0.045)。白细胞计数是STEMI患者长期MACCE的独立预测因素(HR=1.166,95%CI:1.104~1.231,P=0.036)。结论白细胞计数升高预示STEMI患者近、远期预后不良。     

急性心肌梗死并发心源性休克的临床特征

目的分析急性心肌梗死并发心源性休克患者的临床特征。方法连续收集我院1995年2005年初发急性ST段抬高心肌梗死患者资料,按照是否有心源性休克分为两组。分析患者一般情况、化验指标、危险因素、并发症和病死率的差异。结果休克组年龄显著高于非休克组[（70±9）岁vs（63±12）岁,P<0.01];两组间血清磷酸激酶同工酶（CK-MB）、WBC和电解质水平无显著差异;休克组吸烟者明显少于非休克组（19%vs52%,P<0.01）,其他危险因素无显著差异;休克组心律失常和心脏破裂的发生率显著增高,病死率明显高于非休克组（83%vs8%,P<0.01）。结论高龄是心肌梗死并发心源性休克的关键因素之一,心源性休克患者临床情况更为凶险,预后不良。     

超高龄冠心病患者冠状动脉介入术后的随访研究

目的 分析接受经皮冠状动脉介入（PCI）治疗的超高龄患者的随访资料，探讨影响患者预后的危险因素。 方法 入选行冠脉支架植入术1年以上并接受冠状动脉造影复查的患者共397例，根据年龄是否≥80岁分为超高龄组（n=67）与对照组（n=330）。比较两组的临床资料特点、晚期支架内再狭窄率以及超声心动指标，对患者进行长期随访，分析不良心血管事件的发生率。采用Logistic回归分析影响预后的危险因素。 结果 超高龄组患者平均年龄（83 ± 3）岁，明显高于对照组患者（63 ± 9）岁 （P<0.01）。超高龄组患者晚期支架内再狭窄率为40%，对照组患者为32%，组间差异无统计学意义。与对照组患者比较，超高龄组患者白细胞（P<0.05）、血红蛋白含量（P<0.01）、总三碘甲腺原氨酸（T₃）（P<0.01）以及游离T₃ （P<0.01）的水平均偏低；而高血压（P<0.05）及血清肌酐（P<0.01）水平偏高；与对照组患者超声心动结果比较，超高龄组患者室间隔厚度偏大，左室舒张末径偏小，差异有统计学意义（P<0.05）。两组患者射血分数无统计学差异。随访期间，超高龄组的不良事件发生率比对照组显著增加（P<0.01），两组不良事件的构成比例无显著差异；年龄是影响PCI患者预后的独立危险因素。 结论 超高龄PCI患者合并其他系统疾病更常见，远期预后更差。年龄是影响PCI手术远期预后的独立危险因素。     

脑钠尿肽可用于预测孤立性房颤的血栓事件及房颤复律与再发

目的探讨脑钠尿肽（BNP）与孤立性心房颤动（AF）的血栓事件发生、复律及再发之间的关系。方法103例孤立性AF患者行食道超声（TEE）、头颅CT/MRI检查及血BNP测定。根据血栓事件将患者分为血栓事件组（n=15）和无血栓事件组（n=88）。对于有复律指征的患者,根据AF复律情况分为复律失败组（包括即刻复律失败和随访期内再发,n=16）和复律成功组（复律成功并随访期内维持窦性心律,n=7）。分别进行对比研究。结果血栓事件组较无血栓事件组BNP水平高[（150±43）ng/Lvs（84±40）ng/L,P<0.05]。复律失败组较成功组BNP水平高[（178±70）ng/Lvs（60±32）ng/L,P<0.05]、病程长[（8±3）月vs（3±2）月,P<0.05]和左房内径（LAD）扩大[（49±5）mmvs（42±3）mm,P<0.05]。多因素Logistic回归分析:BNP是预测孤立性AF血栓事件的独立危险因素（P<0.05）;BNP、LAD和AF病程是预测AF复律是否成功的独立危险因素（均P<0.05）。结论BNP可作为预测孤立性AF血栓事件和AF复律与再发的临床指标。     

国产替罗非班治疗急性冠脉综合征行PCI术患者的临床效果

目的评价国产血小板膜糖蛋白（GP）IIb/IIIa受体拮抗剂替罗非班（tirofiban）治疗急性冠状动脉综合征（ACS）患者在接受肝素（包括低分子肝素）、盐酸氯吡格雷、阿司匹林基础上实施经皮冠状动脉介入治疗术的有效性和安全性评价。方法将32例ACS患者按就诊顺序随机双盲分为受试组（加用替罗非班）和对照组（加用安慰剂）,所有患者均正规使用肝素（包括低分子肝素）、盐酸氯吡格雷、阿司匹林。疗程48 h,观察指标为心电图改变、出血并发症、血小板聚集率,终点事件是5 d内的复合缺血事件。结果受试组心电图ST段改善情况好于对照组[（0.50±0.08）mVvs（0.42±0.07）mV,P<0.01];出血并发症比对照组有增多趋势,但无统计学差异（14%vs9%）;血小板聚集率受试组明显下降（38%±8%vs44%±8%,P<0.05）,受试组用药前后比较（45%±7%vs38%±8%,P<0.01）,对照组用药前后比较（45%±8%vs44%±8%）;5 d复合终点事件发生率受试组低于对照组（0%vs18%,但差异无显著意义）。结论替罗非班在ACS常规治疗基础上可以进一步改善心电图缺血性改变,并能进一步加强抗血小板作用,且安全性良好。     

冠脉内注射盐酸替罗非班在急性STEMI急诊PCI中应用的有效性及安全性

目的评价冠脉内注射血小板膜糖蛋白（GP）Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班在急性ST段抬高型心肌梗死（STEMI）急诊经皮冠状动脉介入（PCI）治疗中的安全性及有效性。方法我院急性STEMI冠脉造影（CAG）显示梗死相关血管（IRA）有血栓征象的患者67例,分成试药组（PCI前冠脉内注射盐酸替罗非班+PCI,n=35）与对照组（直接PCI,n=32）,对比2组患者PCI术中IRA远端TIMI血流,术后左室射血分数（LVEF）,住院期间的主要不良心血管事件（MACE）及出血情况。结果试药组术中无再流及再灌注心律失常的发生率明显低于对照组（3%vs19%;3%vs16%,P<0.05）;试药组术后LVEF明显高于对照组[（57±5）%vs（51±10）%,P<0.05];住院期间MACE发生率试药组低于对照组（3%vs9%）,两组均未发生严重出血并发症。结论急诊PCI前冠脉内缓慢注射盐酸替罗非班对急性STEMI患者行急诊PCI安全有效。     

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.