高原肺心病急发期时左心功能与氧输送关系

目的研究高原地区肺心病急性发作期左心功能与氧输送的关系，将有益于肺心病的防治。方法２０例急发期肺心病患者１６例为成活组，４例为死亡组，均经颈内静脉置入Ｓｗａｎ－Ｇａｎｚ导管至肺动脉，用热稀释法直接测得心输出量（ＣＯ）。结果（１）肺心病患者心脏指数下降（２．９±０．４Ｌ·ｍｉｎ－１·ｍ－２）、平均肺动脉压（４．９±１．３ｋＰａ）及肺动脉嵌压（１．５±０．８ｋＰａ）升高，左室每搏作功指数下降（３５±１１ｇ·ｃｍ－１·ｍｉｎ－１）；（２）进行综合治疗之后，成活组上述指标改善，心脏指数、左室每搏作功指数增加，死亡组左室每搏作功指数继续下降，平均肺动脉压（ｍＰＡＰ），肺动脉嵌压改善不明显；（３）左室每搏作功能指数与氧输送二者有显著性相关（ｒ＝０．４３１８，Ｐ＜０．０５）。结论肺心病左室每搏作功指数直接影响氧输送水平，并与其预后有密切关系     

风湿性心脏病慢性心房颤动迷宫和二尖瓣手术围术期的血液动力学监测

采用Ｓｗａｎ－Ｇａｎｚ漂浮导管，对１４例同时行迷宫和二尖瓣手术的风湿性心脏病慢性心房颤动（简称房颤）患者在术前和术后２４ｈ、４８ｈ及１个月进行血液动力学监测。结果：①术后２４ｈ、４８ｈ、１个月的心输出量（ＣＯ）、心脏指数（ＣＩ）、每搏指数（ＳＩ）、体循环阻力指数（ＳＶＲＩ）、左室每搏作功指数（ＬＶＳＷＩ）和右室每搏作功指数（ＲＶＳＷＩ）与术前比较差异有显著性（Ｐ＜０．０５～０．０００１）。②心率（ＨＲ）、平均动脉压（ＭＡＰ）、平均肺动脉压（ＭＰＡＰ）、肺动脉毛楔压（ＰＡＷＰ）、中心静脉压（ＣＶＰ）、左心作功指数（ＬＣＷＩ）、肺循环阻力指数（ＰＶＲＩ）、右心作功指数（ＲＣＷＩ）等，术后与术前以及不同时间之间比较均无统计学意义，Ｐ＞０．０５。③ＭＰＡＰ、ＰＡＷＰ、ＣＯ、ＣＩ、ＳＩ、ＳＶＲＩ、ＬＶＳＷＩ的异常发生率术后１个月与术前比较有显著性差异，Ｐ＜０．０５、＜０．０１或＜０．０００１。迷宫术后ＣＯ较术前明显提高，左房压力恢复正常，肺血管压力降低。以上表明风湿性心脏病慢性房颤迷宫和二尖瓣术后ＣＯ、左心功能均有明显改善，无围术期死亡和严重并发症，提示血液动力学监测对及时了解泵功能状态、指导治疗和评价手术疗效是非常?     

氨基酸在长时间心脏停搏中对心肌的保护作用

目的：探讨谷氨酸盐（Ｇ）和天门冬氨酸盐（Ａ）在长时间心脏缺血的心肌保护作用。方法：离体大鼠工作心模型。心脏在１５°Ｃ缺血１５０分钟。４８只Ｗｉｓｔａｒ大鼠分为３组：１组，即对照组（ｎ＝１６），心脏用多剂量４°ＣＳｔ．Ｔｈｏｍａｓ冷晶体心脏停搏液结合温血停搏液诱导及终末再灌注进行心肌保护；２组（ｎ＝１６）同１组，但温血停搏液含Ｇ和Ａ各１３ｍｍｏｌ／Ｌ；３组（ｎ＝１６）同１组，但Ｓｔ．Ｔｈｏｍａｓ冷晶体心脏停搏液和温血停搏液中均含相同浓度的Ｇ和Ａ。结果：温血停搏液中应用Ｇ和Ａ能增加心肌的收缩性和心输出量，使缺血后心肌耗氧量恢复较好（Ｐ＜０．０５）。Ｓｔ．Ｔｈｏｍａｓ冷晶体心脏停搏液和温血停搏液中应用Ｇ和Ａ均明显增加心肌保护，使心功能和心肌耗氧量几乎完全恢复。缺血后心肌酶漏出少，缺血前后心肌高能磷酸盐含量和含水量无明显变化，超微结构改变也不明显。结论：含Ｇ和Ａ温血停搏液诱导及终末再灌注增加冷晶体心脏停搏液对长时间心脏停搏的心肌保护效果，冷晶体心脏停搏液中也应用Ｇ和Ａ能提高心肌对长时间缺血的耐受性     

升主动脉注射鱼精蛋白对体外循环心脏直视手术婴儿肺通透性指数及血浆血栓素A2浓度的影响

目的探讨经升主动脉注射鱼精蛋白对体外循环心脏直视手术婴儿肺通透性指数及血清血栓素A2浓度的影响,进一步证实其肺保护作用。方法选择60例（年龄≤12个月,体质量≤10 kg）在深圳市儿童医院行体外循环心脏直视手术的先天性心脏病患儿,按随机数字表法分为实验组（升主动脉组,n=30例）和对照组（中心静脉组,n=30例）,比较两组体外循环前及注射鱼精蛋白后6 h肺通透性指数的变化、体外循环前及注射鱼精蛋白后1 h血清血栓素A2浓度。结果实验组注射鱼精蛋白6 h后肺通透性指数明显低于对照组,差异有统计学差异（0.021±0.008 vs.0.039±0.006,P〈0.05）;实验组注射鱼精蛋白1 h后血清血栓素A2水平低于对照组,差异有统计学意义[（43.3±2.5）ng/L vs.（64.2±2.1）ng/L,P〈0.05]。结论经升主动脉注射鱼精蛋白能够减轻婴幼儿体外循环心脏直视手术肺组织损伤,是一种良好的肺保护措施。     

急性心肌梗塞早期左室心功能及其重塑的研究

３４例急性心肌梗塞（ＡＭＩ）患者早期（平均４．６小时）左室造影心功能和重塑指标与正常组（ｎ＝１９）对比分析，结果发现：（１）前、侧壁（ｎ＝１８）和下、后壁（ｎ＝１６）ＡＭＩ两组左室心功能变化特点一致为：左室均无扩大，其舒张末容积无显著增加（Ｐ均〉０．０５），而收缩末容积（ＥＳＶ）分别增加了１３５．０％和８１．８％（Ｐ〈０．００１和０．０１）；每搏量、射血分数和心输出量均降低，Ｐ均〈０．０５￣０．０     

老年高血压患者血压昼夜节律与胰岛素抵抗

目的为了探讨高血压病患者２４ｈ血压昼夜节律变化与糖、胰岛素（ＩＳ）代谢的关系。方法４６例老年高血压病患者，按昼夜血压节律不同，分为杓型组（ＤＧ）与非杓型组（ＮＤＧ），行葡萄糖耐量试验和ＩＳ释放试验。结果ＤＧ与ＮＤＧ２组各时相血糖、血糖面积及空腹ＩＳ水平无显著性差异（Ｐ＞００５）；而ＮＤＧ在糖负荷后的６０ｍｉｎ、１２０ｍｉｎＩＳ水平和ＩＳ释放指数（ＩＲＩ）以及ＩＳ面积（ＩＡＵＣ）明显高于ＤＧ（Ｐ＜００１、００５、００１、０００１、００１）；ＤＧ的ＩＳ敏感指数（ＩＳＳＩ）明显大于ＮＤＧ（Ｐ＜００１）；夜间平均血压下降率与ＩＡＵＣ、１２０ｍｉｎＩＲＩ及６０ｍｉｎＩＳ水平呈显著负相关（γ＝－０５９８、－０５１１和－０４８６，Ｐ＜００１、００１和００５），与１２０ｍｉｎＩＳＳＩ呈显著正相关（γ＝０４６２，Ｐ＜００１）。结论老年高血压节律异常者有更显著的胰岛素抵抗及高胰岛素血症。     

接受不同二尖瓣替换术患者术后早期心功能的变化

为了比较常规二尖瓣替换术（ＭＶＲ）与保留瓣下结构的二尖瓣替换术（ＭＶＲＰ）对患者术后早期心功能的影响，对３４例单纯风湿性二尖瓣病变患者于术前经右股静脉导入Ｓｗａｎ－Ｇａｎｚ导管，术后４、２４、４８小时分别测定其血流动力学指标。结果：接受ＭＶＲ患者的术后肺动脉平均压（ＭＰＡＰ）、肺血管阻力（ＰＶＲ）和肺毛细血管嵌压（ＰＣＷＰ）均明显高于接受ＭＶＲＰ者；而心搏指数（ＳＶＩ）、心脏指数（ＣＩ）和左心室每     

肝素涂抹体外循环装置减少补体系统的激活

目的：本研究探讨体外循环（ＣＰＢ）使用肝素涂抹ＣＰＢ装置减少ＣＰＢ引起的补体系统激活，改善ＣＰＢ装置的生物相容性。方法：采用酶联免疫吸附方法测定ＣＰＢ过程中补体Ｃ３、Ｃ４及终末补体复合物Ｃ５ｂ～９的血浆浓度。成人择期心脏瓣膜替换术及冠状动脉旁路移植术２４例，随机分为对照组１２例采用Ｕｎｉｖｏｘ膜式氧合器；实验组１２例采用ＤｕｒａｆｌｏⅡ肝素涂抹ＣＰＢ装置。在ＣＰＢ前（肝素化后１０分）、ＣＰＢ３０分、升主动脉开放后１０分、ＣＰＢ结束即刻及鱼精蛋白中和肝素１０分５个时点进行观察。结果：白细胞计数，补体Ｃ３及Ｃ４血浆浓度两组均无明显变化（实验组鱼精蛋白中和肝素时点的白细胞明显增加）；补体Ｃ５ｂ～９血浆浓度ＣＰＢ中与ＣＰＢ前比均明显增加（Ｐ＜０．０５）；但组间有明显差异（Ｐ＜０．０１）。结论：肝素涂抹ＣＰＢ装置可以抑制补体系统激活，部分改善ＣＰＢ装置的生物相容性。     

一氧化氮对缺氧性肺动脉高压大鼠血浆降钙素基因相关肽？…

目的 探讨一氧化氮（ＮＯ）对缺氧性肺动态高压（ＨＰＨ）大鼠血浆降钙素基因相关肽（ＣＧＲＰ）含量的影响。方法 将Ｗｉｓｔａｒ大鼠４０只分为四组：对照组（ｎ＝１０）,缺氧组（ｎ＝１０）,缺氧＋Ｌ－ＮＡＭＥ组（ｎ＝１０）,缺年头＋Ｌ－Ａｒｇ组（ｎ＝１０）。通过Ｐ５０压力传感器测量定四组大鼠肺动脉平均压（ＰＡＭＰ）,缺氧＋Ｌ－Ａｒｇ组的ＰＡＭＰ显著低于缺氧组（Ｐ〈０．０５）;缺氧组的右室（ＲＶ）干重／左室     

云纤酶对冠状动脉成形术后再狭窄和心脏负荷能力的影响

本研究旨在评价去纤酶对冠状动脉成形术（ＰＴＣＡ）后再狭窄及心脏负荷能力的影响。方法：１４２例ＰＴＣＡ术后患者随机进入去纤酶组（ｎ＝７０）和肝素组（ｎ＝７２），术后分别用去纤酶及肝素治疗，分别于ＰＥＣＡ前、ＰＴＣＡ后７～１４天、３～６个月和１０～１２个月进行心电图运动试验及核素心肌灌注显像负荷试验，可疑再狭窄者行冠状动脉造影。ＰＴＣＡ后２组患者最大运动时间、心率指数、ＳＴ段缺血指数及心肌血流灌注均较     

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.