组织多普勒显像技术评价高血压患者左室舒张功能的研究

选择轻、中度高血压患者139例，健康对照组33例，测定二尖瓣血流频谱E波速度（E）、A波速度（A）、E／A，并用组织多普勒显像（TDI）技术测量二尖瓣环侧壁收缩期运动速度（Sm）、舒张早期运动速度（Em）、舒张晚期运动速度（Am）及Em／Am。根据左室重量指数（LVMI）将高血压患者分为非左室肥厚（NLVH）组及左室肥厚（LVH）组。结果与对照组比较，NLVH组及LVH组E／A、Em、Em／Am降低；与NLVH组比较，LVH组Em、Em／Am降低。认为TDI技术测量二尖瓣环侧壁组织运动速度能准确评价高血压患者的左室舒张功能。     

阻塞性睡眠呼吸暂停低通气综合征病人心脏结构及左心室功能变化研究

目的观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)病人心脏结构及左心室功能的变化。方法选取我院60例OSAHS病人为观察组;我院门诊健康体检者60名为对照组。两组均接受彩色多普勒超声检测仪检查心脏结构和左心室舒张功能,并测定每搏量(SV)、左室短轴缩短率(FS)、左室射血分数(LVEF)、心输出量(CO)。比较两组心脏结构和左心室舒张功能的变化。结果观察组病人左室舒张末内径(LV)、左室后壁厚度(LVPW)、左房舒张末内径(LA)、室间隔厚度(IVS)、右室舒张末内径(RV)、肺动脉内径(PA)、右房舒张末内径(RA)、主动脉内径(AO)指标均高于对照组(P0.05);观察组病人二尖瓣血流频谱二尖瓣舒张早期血流速度(E)、E/二尖瓣舒张晚期血流速度(A)、室间隔舒张早期运动速度(Em)、室间隔Em/舒张晚期运动速度(Am)、左室后壁Em、左室后壁Em/Am、二尖瓣环Em、二尖瓣环Em/Am功能均低于对照组(P0.05),二尖瓣环Am、室间隔Am、左室后壁Am均高于对照组(P0.05);观察组病人FS、LVEF、二尖瓣环收缩期运动速度(Sm)、室间隔Sm及左室后壁Sm功能均低于对照组(P0.05)。结论 OSAHS病人心脏结构发生明显变化,且左心室收缩、舒张功能明显减弱。     

组织多普勒成像技术对2型糖尿病病人心脏舒张功能的评价

目的应用组织多普勒成像技术(TDI)评价2型糖尿病病人心脏舒张功能。方法选择80例2型糖尿病病人为糖尿病组,同期80名正常健康人作为正常对照组,采用脉冲多普勒技术检测二尖瓣口血流频谱测量舒张早期峰值流速(E)、舒张晚期峰值流速(A)、E/A值,使用TDI检测二尖瓣环获取瓣环运动频谱,并测量其舒张早期运动速度峰值(Em)、舒张晚期运动速度峰值(Am)及Em/Am。结果与对照组比较,糖尿病病人E峰减少,A峰增加,E/A的值减少,差异有统计学意义(P0.05)。与对照组比较,糖尿病病人Em减少,Am增加,Em/Am的值减少,差异有统计学意义(P0.05)。对照组均E/A1,Em/Am1。糖尿病组,E/A1所占比例67.5%,Em/Am1所占比例91.25%。结论与测量E/A相比,使用TDI技术检测糖尿病病人Em/Am,可简单快捷、无创有效地评价糖尿病病人左心室舒张功能。     

左室壁内缩短分数评价收缩功能及其与舒张功能相关性的研究

目的:探讨左室壁内缩短分数(mFS )评价高血压患者收缩功能及其与左室舒张功能的关系.方法:收集高血压组51例,正常对照组47例.分析临床特点,行超声心动图检查.收缩功能测定左室室壁厚度,左室内径,左室容量,测定射血分数(EF),缩短分数(FS)以及左室mFS.心脏舒张功能,取二尖瓣血流频谱,记录二尖瓣舒张期血流频谱,记录舒张早期(E)和舒张晚期(A)血流速度峰值.采用组织速度多普勒成像技术测定二尖瓣环室间隔侧和侧壁侧的舒张早期心肌运动速度(Em)和舒张晚期心肌运动速度(Am),取平均值.探讨左室收缩功能和舒张功能的相关性.结果:①收缩功能:高血压组与正常对照组比较:左室舒张末间隔厚度明显增加[(1.18±0.28):(0.95±0.13),P<0.001]、左室舒张末后壁厚度明显增加[(1.01± 0.17):(0.89±0.17),P<0.01]、左室mFS明显降低[( 18.0± 4.9) vs (22.3±5.9), P<0.01],而2组间左室EF和FS差异无统计学意义.②舒张功能:高血压组与对照组比较,二尖瓣血流频谱差异无统计学意义;组织多普勒成像显示,二尖瓣环Em明显降低[(8.22± 2.23):(9.91±2.52),P<0.05],二尖瓣环Em/Am明显降低[(0.72± 0.23):(0.98±0.26),P<0.01]、二尖瓣E/Em明显增加[(9.38±3.19):(7.45±2.10), P<0.01].③mFS与Em/Am显著正相关(r=0.55,P<0.001 )、与E/Em显著负相关(r=-0.38,P<0.05).左室EF和FS与上述指标无相关性.结论:左室mFS是评价高血压患者收缩功能的有力指标,与早期舒张功能受损有关.     

绝经前后女性左室舒张功能超声心动图检测与分析

目的 通过多普勒超声心动图检测,评价绝经前后女性左室舒张功能改变及其意义.方法 随机选取门诊及住院的绝经前后女性受试者123例,其中围绝经期女性61例,绝经早期女性62例.于心尖四腔切面,应用组织多普勒成像(TDI)获得二尖瓣环附着处左室舒张早期及舒张晚期峰值速率(Em、Am),计算Em/Am.应用脉冲多普勒(PW)测量二尖瓣E峰及A峰流速,计算E/A.并计算E/Em.同时检测两组人群性激素水平,进行统计学分析.结果 绝经早期较围绝经期女性的E/A比值及Em/Am比值显著减低(P<0.01)、E/Em增高(P<0.05).结论 绝经后女性心脏左室舒张功能较绝经前显著降低,可能与绝经后女性体内性激素水平改变相关.     

组织多普勒技术对充血性心力衰竭患者右室舒张功能评价

目的:应用脉冲组织多普勒显像技术评价充血性心力衰竭(CHF)患者的右室舒张功能。方法:应用脉冲多普勒测量35例心功能(NYHA)Ⅲ~Ⅳ级CHF患者(CHF组)和40例健康人(对照组)舒张早期三尖瓣血流峰值速度(E),舒张晚期峰值速度(A),并计算E/A;应用脉冲组织多普勒测量三尖瓣隔叶及前叶瓣环处舒张早期峰值速度(Em)、舒张晚期峰值速度(Am),Em/Am,等容舒张时间及E/Em值;并对2种检测方法和各组测值进行比较。结果:CHF组Em/Am均<1,Em降低,等容舒张时间较对照组明显延长(P<0.01),E/Em增高,对照组Em/Am>1;CHF组的A及Am均高于对照组(P<0.05)。结论:组织多普勒显像能够反映CHF患者右室舒张功能的变化。     

超声二维斑点追踪显像技术评价2型糖尿病患者左心室心肌扭转运动

目的探讨超声二维斑点追踪显像技术(STI)在2型糖尿病(T2DM)患者左心室心肌扭转运动中的运用价值。方法选择该院2014年1月至2015年1月收治的T2DM患者50例,根据组织多普勒成像技术(TDI)检查结果,二尖瓣环舒张早期峰值运动速度(Em)/舒张晚期峰值运动速度(Am)>1患者为左室舒张功能正常组(TN组)19例,Em/Am≤1患者为左室舒张功能异常组(TA组)31例,另纳入同期来该院体检的健康成人24例为对照组。所有研究对象入院后接受彩色多普勒超声检查,并应用超声二维STI软件分析扭转角度峰值(PTw)、扭转角度达峰时间(TPTV)、解旋速度峰值(PUV)和解旋率(Untw R)。结果 TN组和TA组PTw、PUV均显著高于对照组(均P<0.05),TN组和TA组Un Tw R均显著低于对照组(均P<0.05),且TA组显著低于TN组(P<0.05),三组TPTV比较无统计学意义(P>0.05)。结论超声二维STI技术对于评价T2DM患者左室心肌功能具有更高的敏感性,能够较早发现患者左室扭转异常。     

组织多普勒显像评估有机磷农药中毒患者左心功能变化

目的 探讨组织多普勒显像评估急性有机磷农药中毒对左心功能的影响.方法 选择78例南华医院就诊的有机磷农药中毒病人,分为轻中度中毒42例和重度中毒36例2组,与我院同期体检的正常对照组32例进行比较,入院后行血胆碱酯酶、肌酸激酶同功酶、心电图等检查.应用组织多普勒显像采集标准心尖四腔心切面左心室二尖瓣环的运动频谱,测量六位点平均收缩期峰速度(Sm)、舒张早期峰值速度(Em)、舒张晚期峰值速度(Am) 、等容舒张时间(IVRT),然后用传统脉冲多普勒超声测定二尖瓣口血流速度参数(E、A),计算E/A、Em/Am、E/Em 、Tei指数进行对照分析.结果 (1)E/A、Em/Am 、胆碱酯酶:正常对照组＞轻中度中毒组＞重度中毒组患者,差异有统计学意义(P<0.001);(2)IVRT、 E/Em、Tei指数、肌酸激酶同功酶:正常对照组＜轻中度中毒组＜重度中毒组患者,差异有统计学意义(P<0.05);而重度中毒组患者左心室Em/Am＜E/A＜1,IVRT较对照组延长.E/A 与Em/Am呈正相关(P<0.001).结论 重度中毒组患者左心室收缩和舒张功能均有不同程度受损.组织多普勒显像可准确、定量、无创地评价有机磷农药中毒患者左心室功能,较传统超声、心肌酶谱更可靠,对预防心脏并发症有一定临床价值.     

组织多普勒成像联合Tei指数对原发性醛固酮增多症患者左心室舒张功能评估的相关性研究

目的探讨组织多普勒成像参数改变联合Tei指数与原发性醛固酮增多症(PA)患者左室舒张功能精准评估的相关性。方法选择2017年1月—2018年12月于本院住院行PA筛查最终确诊为PA的患者45例和匹配相同年龄、性别、病程、血压水平的原发性高血压患者45例入组。通过脉冲多普勒测量二尖瓣舒张早期血流峰值流速(E)、舒张晚期血流峰值流速A以及E/A比值,应用组织多普勒技术分别测量室间隔二尖瓣瓣环处SEm、SAm、SEm/SAm、E/SEm及左室侧壁二尖瓣瓣环处LEm、LAm、LEm/LAm、E/LEm、等容舒张期时间间隔(IVRT),取两者平均值代表整体Em、Am、Em/Am、EEm,计算LEm/SEm及TDI-Tei指数。分析常规超声参数与组织多普勒超声参数的相关性。结果两组LEm、LAm、LEm/LAm、SEm、SAm、SEm/SAm、LEm/SEm对比具有显著性差异(P 0. 05),两组E/SEm、E/LEm、IVRT、整体Em、整体Am、整体Em/Am、整体EEm、整体TDI-Tei指数对比具有显著性差异(P 0. 05);相关性分析LEm/SEm与E/A呈正相关(r=0. 426,P 0. 05),与整体TDI-Tei指数、IVRT呈负相关(r=-0.513、-0. 376,P 0. 05),与整体Em和整体E/Em呈正相关(r=0. 521、0. 446,P 0. 05),提示PA患者左室舒张功能明显降低,E/Em值与PA患者舒张功能评价具有临床意义。结论 PA患者左室舒张功能出现一定程度改变,组织多普勒参数LEm/SEm、整体Em、整体EEm、整体TDI-Tei指数与左室舒张功能具有较好相关性,可作为评价PA早期左室舒张功能改变的影像指标,具有较高的临床应用价值。     

心血管病患者血浆脑钠素与左室舒张功能的关系

目的:探讨左室舒张功能障碍患者血浆脑钠素(BNP)水平变化及其意义。方法:选择左室舒张功能障碍患者60例(患者组)及健康体检者20例(对照组),采用固相免疫放射分析法检测血浆BNP浓度。超声多普勒结合组织多普勒显像(TDI)测定左室结构、左室舒张功能及左室舒张末压。结果:①与对照组相比,患者组BNP浓度升高,左房内径增大、室间隔和左室后壁增厚,差异有统计学意义(P<0.01);但左室内径和左室射血分数差异无统计学意义(P>0.05)。②记录患者组二尖瓣舒张早期最大血流速度(E)与舒张晚期的最大血流速度(A)及其比值,二尖瓣瓣环-室间隔交界处舒张早期的速度峰值(Em间)和二尖瓣瓣环-侧壁交界处舒张早期的速度峰值(Em侧),计算出E/Em间呈E/Em侧,与对照组比较,患者组E/A比值降低、E/Em侧升高(P<0.01)。③患者组血浆BNP浓度与E/Em侧、E/Em间呈正相关(均r=0.29,P<0.05)。结论:左室舒张功能障碍患者BNP浓度明显升高,左室舒张末压升高是刺激BNP分泌的因素。     

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.     

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.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.