急性心肌梗死QT离散度的临床意义探讨

目的观察急性心肌梗死(AMI)QT离散度(QTd)的变化与心律失常的关系以及有效的溶栓治疗对QTd的影响。方法AMI病人42例与正常健康者50例进行对比,所有对象测量12导联心电图不同导联最长与最短的QT间期QTmax和QTmin,QTd=QTmax-QTmin,根据Bazett’s公式,校正QT间期QTc=QT/RR,校正QT离散度(QTcd)=QTcmax-QTcmin。结果AMI病人QTd、QTcd分别为(68.7±16.3)、(74.8±20.1)ms,对照组QTd(32.3±11.4)ms、QTcd(36.4±13.3)ms,P<0.01,有心律失常组QTd(70.4±19.5)ms、QTcd(79.4±22.5)ms,无心律失常组QTd(54.4±16.3)ms、QTcd(63.2±20.1)ms,P<0.01。溶栓有效者与无效者比较差异也有统计学意义(P<0.05,表1)。结论有效的溶栓治疗可使QTd明显减小,减少危险性心律失常的发生,降低AMI患者病死率。QTd对预测AMI患者溶栓疗效以及早期危险性心律失常和预后具有重要价值。     

急性心肌梗死QT离散度的临床意义探讨

目的 观察急性心肌梗死(AMI)QT离散度(QTd)的变化与心律失常的关系以及有效的溶栓治疗对QTd的影响.方法 AMI病人42例与正常健康者50例进行对比,所有对象测量12导联心电图不同导联最长与最短的QT间期Qtmax和Qtmin,QTd=Qtmax-Qtmin,根据Bazett's公式,校正QT间期QTc=QT/(√RR),校正QT离散度(QTcd)=Qtcmax-Qtcmin.结果 AMI病人QTd、QTcd分别为(68.7±16.3)、(74.8±20.1)ms,对照组QTd(32.3±11.4)ms、QTcd(36.4±13.3)ms,P＜0.01,有心律失常组QTd(70.4±19.5)ms、QTcd (79.4±22.5)ms,无心律失常组QTd(54.4±16.3)ms、QTcd(63.2±20.1)ms,P＜0.01.溶栓有效者与无效者比较差异也有统计学意义(P＜0.05,表1).结论 有效的溶栓治疗可使QTd明显减小,减少危险性心律失常的发生,降低AMI患者病死率.QTd对预测AMI患者溶栓疗效以及早期危险性心律失常和预后具有重要价值.     

老年人急性心肌梗死QT离散度变化的探讨

目的观察老年急性心肌梗死(AMI)病人溶栓前后QT离散度(QTd)的变化,分析其与室性心律失常的关系。方法测量40例老年AMI病人的QT间期,计算其QTd及校正后的QT离散度(QTdc)。结果QTd及QTdc>100ms病人中,室性心动过速、心室颤动发生率明显高于QTd、QTdc<100ms者(72.7%及6.9%,P<0.001)。溶栓再通组溶栓后QTd及QTdc分别为51.2ms±21.4ms及62.8ms±21.9ms,较溶栓前缩短(分别为77.4ms±21.1ms及90.0ms±30.6ms,P<0.05)。结论老年AMI病人QTd、QTdc延长者,室性心动过速及心室颤动发生率增高,溶栓后QTd及QTdc缩短提示溶栓后血管再通。     

比索洛尔对老年冠心病患者QT离散度的影响

目的探讨β-受体阻断剂比索洛尔(Bisoprolol)对老年冠心病患者QT离散度(QTd)的影响。方法采用单盲处理的方法,观察48例老年冠心病患者比索洛尔治疗前后的最大QT间期(QTmax)、最小QT间期(QTmin)、心率校正QT间期离散度(QTcd)、QTd及RR间期的变化。结果观察组Bisoprolol治疗后冠心病患者QTmin延长〔(390±32.7)ms vs(357±21.2)ms,P<0.01〕,而QTmax无明显改变〔(428±34.7)ms vs(427±33.6)ms,P>0.05〕,QTd、QTcd则显著缩小〔分别为(39±11.8)ms vs(72±28.6)ms,(42±10.7)ms vs(78±24.6)ms,均P<0.01〕。对照组治疗前后QTd、QTcd均无改变(P>0.05)。结论 Bisoprolol治疗恶性心律失常的可能机制是通过延长冠心病患者的QTmin,缩小心肌复极化离散度,促使心肌细胞复极化趋向同步进行,此种机制有利于防止冠心病患者恶性室性心律失常的发生。     

老年急性心肌梗塞QT离散度改变的临床意义

为探讨老年急性心肌梗塞(AMI)患者严重心律失常与QT离散度(QTd)之间的关系.本文对40例60岁以上老年AMI患者首次心电图的QTa进行了测量。结果表明:老年AMI合并室性心律失常组平均QTd为68.3±26.4ms.而无心律失常组平均QTa为47.3±22.4ms。两组相比较有非常显著的差异(P<<0.01)。而且QTd愈大.室性心律失常发生率愈高,室颤的可能性愈大。因此,AMI早期QTd明显增大者.应高度警惕室性心律失常的发生。     

胺碘酮对冠心病合并室性心律失常患者QT离散度影响的临床观察

目的观察胺碘酮对冠心病合并室性心律失常患者的QT离散度(QTd)及预后影响。方法选择的患者予以可达龙治疗8周,并比较治疗前后室性心律失常疗效及QTd的变化。结果治疗后室性心律失常均明显减少,有效率85.2%,QTd由(65.06±11.24)ms减至(33.9±16.2)ms(P<0.01=)。结论胺碘酮能有效减少冠心病伴室性心律失常而且使患者QTd明显减少,改善患者的预后。     

联合应用心律震荡与QT离散度对大面积急性心肌梗死患者心源性死亡的预测价值

目的探讨联合应用心律震荡(heart rate turbulence,HRT)与QT离散度(QT dispersion,QTd)对大面积急性心肌梗死(acute myocardial infarction,AMI)患者心源性死亡的预测价值。方法入选165例大面积AMI患者,入院后进行24 h动态心电图检查,计算HRT震荡初始(turbulence onset,TO)和震荡斜率(turbulence slope,TS)的两个参数,并测量QTd水平。所有患者根据是否发生心源性死亡分为死亡组和生存组。规定12导心电图中病理性Q波导联数≥4为大面积梗死。结果死亡组TO≥0,TS≤2.5 ms/RR间期的阳性率高于生存组,差异有统计学意义(55.2%vs.15.4%,P0.01)。死亡组QTd水平高于生存组,差异有统计学意义[(109.02±8.77)ms vs.(77.73±9.03)ms,P0.01],且死亡组QTd水平均100 ms。而联合应用TO≥0,TS≤2.5 ms/RR和QTd100 ms作为预测早期大面积AMI患者死亡的检测指标,其阳性预测值、特异度分别为58%、91%,均分别高于QTd100 ms和TO≥0且TS≤2.5ms/RR间期的32%、62%和43%、80%(P0.01;P0.05)。结论联合应用TO≥0,TS≤2.5ms/RR间期和QTd100 ms时,可作为预测大面积AMI患者发生心源性死亡的敏感指标之一。     

胺碘酮对2型糖尿病并发室性心律失常病人QT离散度的影响

目的探讨胺碘酮对2型糖尿病并发室性心律失常病人QT离散度的影响。方法分析总结32例2型糖尿病合并室性心律失常病人服用胺碘酮治疗前后,测定其QT间期及QT离散度的变化。结果胺碘酮治疗后QTd为(56.5±9.0)ms,治疗后降为(38.8±7.8)ms,具有统计学意义(P<0.05)。结论胺碘酮可显著降低2型糖尿病合并室性心律失常者的QTd。     

慢性心衰猝死患者QT离散度的变化

本文观察研究慢性心衰(观察组),和无心脏病病人(对照组)各60例的QT离散度。发现观察组的QT离散度较对照组大。而观察组中心衰猝死者(11例)的QT离散度明显大于观察组心衰存活组(30例)、心衰进展死亡组(19例)的QT离散度(P<0.001)。并发现心衰猝死组QT离散度的增大与心功能分级、电解质的血清浓度无相关性。慢性心衰猝死组QTd均值为96.81ms.提示QT离散度的明显增大,是慢性心衰发生猝死的一项具有警告性的重要标志。     

老年急性心肌梗死QT离散度变化的临床意义

目的观察老年急性心肌梗死（AMI）患者溶栓前后QT离散度（QTd）的变化,分析其与室性心律失常的关系。方法测量40例老年AMI患者的QT间期,计算其QTd及校正后的QT离散度（QTdc）。结果 AMI组QTd及QTdc〉100ms患者中,室性心动过速（室速）、心室纤颤（室颤）发生率明显高于QTd、QTdc〈100ms者（73.0%及6.8%）;溶栓再通组溶栓后QTd及QTdc〔分别为（51.2±21.4）ms及（62.8±21.9）ms〕较溶栓前缩短〔分别为（77.4±21.1）ms及（90.0±30.6）ms〕;未再通组溶栓前后QTd及QTdc差异无显著性。结论老年AMI患者QTd、QTdc延长者室速及室颤发生率增高,溶栓后QTd及QTdc缩短提示溶栓后血管再通。     

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.