别嘌呤醇对冠心病患者内皮功能及心功能的影响

目的 :观察别嘌呤醇对冠心病并高尿酸血症患者内皮依赖性血管舒张功能及心功能的影响。方法 :选择经冠状动脉造影确诊为冠心病的患者 71例 ,对其中 46例冠心病并高尿酸血症患者随机分成两组 (各组n =2 3 ) ,别嘌呤醇组给予别嘌呤醇 0 4g/d ,安慰剂组给予谷维素 60mg/d ;另 2 5例冠心病尿酸正常患者为尿酸正常组 ,给予别嘌呤醇 0 4g/d ,均观察 4周 ,采用高精度血管超声技术检测肱动脉内皮依赖性血管舒张功能及心脏彩色多普勒超声测定左心室舒张功能指标 :舒张早期峰值速度 /舒张晚期峰值速度 (E/A)、峰减速时间、峰减速率 ;收缩功能指标 :左心室射血分数、左心室短轴内径缩短率 ,同时测定血清尿酸、血浆丙二醛水平。结果 :仅别嘌呤醇组治疗后较治疗前比较血清尿酸、血浆丙二醛水平降低 ,肱动脉内皮依赖性血管舒张功能增强 ,均有极显著性差异 (P <0 0 1) ,E/A、峰减速率增加 ,均有显著性差异 (P <0 0 5及P <0 0 1) ,左心室射血分数、左心室短轴内径缩短率有增加趋势 (P >0 0 5 ) ,但未达到统计学显著性。Δ血清尿酸与Δ肱动脉内皮依赖性血管舒张功能、ΔE/A、Δ峰减速率负相关 ,相关系数分别为 -0 47、-0 3 9、-0 41(P <0 0 5 ) ,与Δ射血分数、Δ短轴内径缩短率相关系数分别为 -0 2 9、-0 2     

彩色多普勒检测肺静脉血流评价冠心病患者左心室舒张功能

目的　探讨彩色多普勒超声心动图检测冠心病患者肺静脉血流频谱评估左心室舒张功能的价值。方法　冠心病组 4 0例 ,无心脏疾患者 (对照组 ) 30例 ,用彩色多普勒超声心动图检测各组肺静脉血流频谱(PVEP)、二尖瓣血流频谱 (MVFP)的变化和左室舒张功能的关系。结果　与对照组比较 ,冠心病组PVEP中S峰速度加快 ,D峰速度减慢 ,S/D >1,AR波明显加快 ,持续时间延长 ,两组之间有明显差异 (P <0 0 0 1) ;MVFP中E峰降低 ,A峰增加 ,E峰减速时间 (EDT)延长 ,E/A <1。结论　肺静脉血流频谱结合二尖瓣血流频谱能较全面评价冠心病患者的左心室舒张功能。     

对比卡维地洛与美托洛尔对缺血性心肌病患者心功能和心室重塑的影响

目的　探讨卡维地洛与美托洛尔两种不同类型的 β 受体阻滞剂对缺血性心肌病心功能和心室重塑的影响。方法　将 64例缺血性心肌病患者在常规治疗心力衰竭 (心衰 )基础上随机分为卡维地洛组 (A组 3 3例 )和美托洛尔组 (B组 3 1例 ) ,应用超声心动图分别于治疗前、治疗 6个月后测量左心室短轴缩短分数 (FS)、左心室射血分数 (LVEF)、舒张早期充盈峰速度 (E峰 )、舒张晚期充盈峰速度 (A峰 )、E/A、左心室重量指数和左心室球径指数。结果　 (1)A组 2 8例、B组 2 7例用于分析。 (2 )两组治疗后 ,左心收缩功能、舒张功能及心室重塑各参数与治疗前比较 ,均有显著改善(P <0 .0 5 )。 (3 )治疗后LVEF在A组与B组比较差异有显著性 (P <0 .0 5 ) ;而FS、E峰、A峰和E/A两组比较差异无显著性 (P >0 .0 5 )。 (4 )治疗后A、B两组的左心室重量指数和左心室球径指数比较差异有显著性 (P <0 .0 5 )。结论　卡维地洛在改善左心室射血分数和心室重塑方面较美托洛尔更显著 ,治疗缺血性心肌病更优越。     

急诊冠状动脉介入治疗对急性心肌梗死患者左室舒张功能及结构的影响

目的　通过多普勒超声心动图探讨直接经皮冠状动脉介入 (PCI)治疗对急性心肌梗死 (AMI)患者左室舒张功能及结构的影响。方法　 4 0例发病 12小时内的AMI患者分为PCI组、溶栓组 ,分别于治疗后 1周、4周行多普勒超声心动图检查 ,并获得左室最大早期舒张血流速度 (E峰 ) ,晚期最大舒张血流速度 (A峰 )得出舒张早期和晚期最大血流速度比 (E/A)和E峰减速时间 (DT) ,左室舒张末期和收缩末期容积指数(LVEDVI,LVESVI)。结果　溶栓组 :溶栓后 4周与 1周相比 ,E峰值增高、A峰值降低、E/A值增加、DT值减少均有显著差异 (P <0 0 5～ 0 0 1) ;第 4周的LVEDVI和LVESVI与第 1周的结果 ,无明显差异 (P >0 0 5 )。PCI组 :PCI治疗后 4周与后 1周相比E峰值增高、A峰值降低、E/A值增加、DT值减少均有显著差异 (P <0 0 5～0 0 1) ;第 4周的LVEDVI和LVESVI结果与第 1周的结果 ,无明显差异 (P >0 0 5 )。PCI组与溶栓组比较 :治疗1周后 ,PCI组与溶栓组在E峰值、A峰值、E/A值、DT值及LVEDVI和LVESVI结果方面无显著差异 (P >0 0 5 ) ,而 4周PCI组在E峰值增高、A峰值降低、E/A值增加、DT值减少方面较溶栓组有明显改善 (P <0 0 5 )。结论　心肌梗死患者行冠脉介入术 ,有利于患者心功能的及早恢复 ,阻止左室重构的发生和发展     

卡维地洛对急性心肌梗死患者血清Ⅲ型前胶原氨基端肽及左心功能的影响

目的 :观察卡维地洛对急性心肌梗死患者血清Ⅲ型前胶原氨基端肽 (PⅢNP)水平及左心功能的影响。　　方法 :将 80例急性心肌梗死患者随机分为常规治疗组 (40例 )和卡维地洛组 (40例 ) ,采用放射性免疫法测定血清PⅢNP及血浆内皮素的含量 ,采用彩色Doppler超声心动图仪测量左心室舒张功能和收缩功能参数。另选 3 0例体检健康者为对照组。　　结果 :血清PⅢNP水平 :治疗后 1、 3、 4、 8周末常规治疗组和卡维地洛组与同组发病第 2天比较均升高 ,有显著性差异 (P <0 0 5或P <0 0 1) ;常规治疗组和卡维地洛组组间比较治疗后 1、 3、 8周亦有显著性差异 (P <0 0 5)。血浆内皮素水平、左心室射血分数和二尖瓣血流舒张早期流速 /心房收缩流速 :发病第 2天常规治疗组和卡维地洛组较对照组降低 ,有显著性差异 (P <0 0 1) ;常规治疗组和卡维地洛组组间比较治疗后 4周末亦有明显差异 (P <0 0 5或P<0 0 1)。治疗期间心脏事件发生率卡维地洛组明显低于常规治疗组 (P <0 0 5)。　　结论 :卡维地洛能降低血清PⅢNP水平 ,改善心功能     

应用多普勒组织成像技术观察曲美他嗪对冠心病左心室局部收缩和舒张功能的影响

目的观察曲美他嗪(trimetadine,TMZ)对冠心病左室局部收缩和舒张功能的影响,并评价多普勒组织成像技术(DTI)在研究药物改善局部心肌功能中的价值.方法42例冠心病患者,随机分为两组.对照组20例,服用硝酸异山梨酯+钙通道阻滞剂+阿司匹林;TMZ组22例,在上述药物基础上加用TMZ.应用DTI技术测量两组服药前后左室壁12个节段收缩期峰值速度(VS),和舒张早期峰值速度(VE).并计算12节段心肌平均收缩峰值速度(VS)和舒张早期峰值速度(VE).结果(1)TMZ组用药后室壁12节段中,有7个节段的VS和VE显著升高(均P＜0.05),对照组治疗前后比较VS和VE差异无显著性.(2)VS和VE在TMZ组治疗后,分别由(3.94±1.26)cm/s升高至(4.78±1.30)cm/s(P＜0.05);(4.15±1.33)cm/s升高至(5.04±1.37)cm/s,均P＜0.05.(3)TMZ组治疗后运动异常节段的恢复数显著高于对照组(P＜0.0).结论(1)TMZ可改善冠心病患者的左室局部收缩和舒张功能.(2)DTI能够定量分析冠心病缺血心肌对药物治疗前后室壁运动的变化,对指导临床用药有一定应用价值.     

2型糖尿病合并原发性高血压患者的动态血压及脉压和左心室结构功能的关系

目的 :探讨 2型糖尿病 (DM)、原发性高血压 (EH)及DM +EH时 2 4小时动态血压和脉压的变化特点及与左心室结构和功能的关系。　　方法 :将 2 45例患者分为DM组 (n =72 )、EH组 (n =96)及DM +EH组 (n =77) ,进行动态血压及超声心动图检查。　　结果 :DM +EH组全天收缩压、全天脉压、左心室重量显著大于DM组及EH组 (P <0 0 5 )。左心室射血分数、短轴缩短率、舒张早期血流峰值速度 /舒张晚期血流峰值速度 (E/A)值、等容舒张时间 3组间无显著差异。相关分析表明 ,DM组左心室重量和全天脉压相关 (P <0 0 1) ;EH组左心室重量和全天收缩压相关 (P <0 0 5 ) ;DM +EH组左心室重量和全天收缩压及全天脉压相关 (P <0 0 5 )。 3组左心室舒张功能异常患者的全天收缩压、全天脉压均显著高于左心室舒张功能正常患者 (P均 <0 0 5～ 0 0 1) ,左心室的收缩功能正常患者和异常患者比较 ,2 4小时动态血压和脉压值均无显著差异 (P均 >0 0 5 )。　　结论 :DM组、EH组和DM +EH组 3组患者全天收缩压、全天脉压及左心室重量有显著差异 ,左心室重量和血压及脉压的相关性在 3组患者中不完全一致 ,可能与 3组患者体液及压力因素在左心室肥厚中的作用各不相同有关。     

Rho激酶抑制剂对冠心病左心室舒张功能不全患者左心室舒张功能的影响

目的探讨Rho激酶抑制剂(盐酸法舒地尔)对冠心病左心室舒张功能不全患者左心室舒张功能的影响。方法选取82例冠心病伴左心室舒张功能不全的患者,将其随机分为法舒地尔组和对照组。对照组仅采用常规抗心肌缺血治疗,治疗组在常规治疗的基础上给予盐酸法舒地尔,均治疗15d,用组织多普勒成像技术(TDI)测量左房室瓣前后叶瓣环运动的收缩期运动速度(Sm)、舒张早期运动速度(Em)、舒张晚期运动速度(Am)及Em/Am以评价左心室舒张功能。结果与对照组比较,盐酸法舒地尔组的Em、Em/Am升高,Am降低,差异有统计学意义(P<0.05)。结论盐酸法舒地尔可显著改善冠心病患者的左心室舒张功能。     

高血压病的康复医疗及其对左室舒张功能的影响

目的：观察中西医结合康复医疗对高血压病患的降压疗效，并探讨其对左室舒张功能的影响。方法：82例高血病人被随机分为常规治疗组(30组)，康复治疗组(常规治疗 中药茶饮 康复运动，52例)。用多普勒超声心动图测定高血压病患治疗前后左室舒张功能(二尖瓣血流E峰值、A峰值、E／A比值)。结果：①2周内和1年内血压控制率康复组均高于对照组(P＜0．01)，1年内并发症的发生率康复组低于对照组(P＜0．05)；②对症状的改善，康复组优于对照组(P＜0．01)；③治疗前后两组左室舒张功能均有改善，康复组改善更明显(P＜0．01)。结论：中西医结合康复医疗较单纯西药降压治疗在控制血压、改善症状、降低并发症等方面有更明显效果；且更能改善左心室的舒张功能。     

PCI对冠心病合并左心舒张功能不全患者心功能的影响

目的：探讨冠状动脉介入（ PCI）改善冠心病患者心脏舒张功能不全的临床价值。方法选取冠心病合并左心舒张功能不全而左心射血分数正常患者48例,随机分成观察组和对照组各24例。两组均行常规药物治疗,在此基础上观察组行PCI治疗。两组治疗前及治疗后1、3、6个月采用超声心动图测量心脏等容舒张时间（IVRT）、舒张早期及晚期二尖瓣血流频谱E峰与A峰比值（E／A）、肺静脉血流反流速度（Ar）,治疗后6个月评价临床疗效。结果治疗后6个月随访,两组总有效率差异有统计学意义（P＜0．05）。与对照组比较,观察组治疗后1、3、6个月IVRT缩短,E／A升高,Ar降低,差异均有统计学意义（P＜均0．05）。结论 PCI治疗能明显改善冠心病合并左心舒张功能不全患者的心脏功能。     

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.