卡尼汀与曲美他嗪对稳定型劳力性心绞痛患者运动耐量的影响

目的　比较卡尼汀与曲美他嗪对稳定型劳力性心绞痛患者临床疗效及运动耐量的影响。方法　选择 6 0例经冠状动脉造影确诊冠心病稳定型心绞痛伴高脂血症患者 ,经随机分为两组 ,分别予卡尼汀及曲美他嗪治疗 12W ,比较平均每周心绞痛发作次数 ,每周硝酸甘油消耗量 ,平板运动试验检测运动耐量及血脂水平。结果　卡尼汀及曲美他嗪均使心绞痛发作次数、硝酸甘油消耗量明显减少(P <0 0 1) ,运动至出现ST段压低 1mm所需时间、运动至出现心绞痛所需时间、运动诱发ST段缺血型下移之和∑ST明显减少 ,运动持续时间显著延长 (P <0 0 5 ) ,卡尼汀还降低总胆固醇、甘油三酯分别为 17%和 15 % ,高密度脂蛋白升高14 % (P <0 0 5 )。结论　卡尼汀及曲美他嗪均有效缓减稳定型心绞痛患者临床症状 ,改善运动诱发的心肌缺血 ,提高运动耐量 ,疗效相同 ,卡尼汀还改善血脂。     

曲美他嗪对稳定型心绞痛患者校正QT离散度(QTcd)的影响

目的探讨曲美他嗪对冠心病稳定型心绞痛患者校正QT离散度(QTcd)的影响。方法将156例稳定型心绞痛患者随机分为曲美他嗪治疗组(80例)和非曲美他嗪治疗组(76例)。观察分析两组患者经曲美他嗪和非曲美他嗪治疗后3个月、12个月的QTcd的变化。结果治疗前、治疗后3个月,治疗后12个月的曲美他嗪组QTcd分别为(76·4±27·2)ms、(36·3±17·1)ms、(35·4±16·8)ms;非曲美他嗪组QTcd分别为(73·5±22·8)ms、(53·7±13·6)ms、(51·8±14·7)ms。与治疗前比较,两组患者治疗后QTcd均有减少,差异有显著性(P<0·01),以曲美他嗪组减少更为明显;治疗后3个月两组间QTcd比较,差异有非常显著性,而治疗后3个月与12个月QTcd比较则差异无显著性(P>0·05)。结论曲美他嗪可明显降低稳定型心绞痛患者的QTcd,且持续治疗可以保持长期有效。     

曲美他嗪与辅酶Q_(10)治疗老年慢性稳定型心绞痛的临床观察

目的比较曲美他嗪与辅酶Q10对老年慢性稳定型心绞痛患者临床疗效及运动耐量的影响。方法选择70例诊断为慢性稳定型心绞痛老年患者,经随机分为两组,在原有规范的治疗上分别加用曲美他嗪片剂和治辅酶Q10疗8周,比较平均每周心绞痛发作次数,每周硝酸甘油消耗量,平板运动试验指标。结果曲美他嗪与辅酶Q10使心绞痛发作次数、硝酸甘油消耗量明显减少(P<0.05),运动至出现ST段压低1mm所需时间、运动至出现心绞痛所需时间显著延长(P<0.05),且曲美他嗪优于辅酶Q10(P<0.05)。结论曲美他嗪和辅酶Q10均有效缓减老年稳定型心绞痛患者临床症状,改善运动诱发的心肌缺血,提高运动耐量,曲美他嗪优于辅酶Q10。     

由美他嗪联合常规疗法治疗不稳定型心绞痛疗效观察

20 0 0～ 2 0 0 2年 ,我们采用曲美他嗪联合常规疗法治疗不稳定型心绞痛 (U A) ,取得较显著效果。现报告如下。临床资料 :本文 98例患者均符合中国不稳定型心绞痛专题组制定的 U A诊断标准及危险分级标准 ,随机分为治疗组5 0例 ,对照组 48例 ,两组临床资料有可比性 (见表 1)。表 1　两组临床资料比较 (x±s)　　临床资料　治疗组　对照组年龄 (岁 ) 5 2 .43± 5 .2 0 5 0 .36± 7.2 8性别 ( n)男女　　　 31　　　 19　　　 2 8　　　 2 0病程 ( d)　 4.83± 1.2 2　 4.95± 1.87血压 ( mm Hg)收缩压舒张压14 4 .42± 14 .7495 .0 6± 7.5…     

曲美他嗪对冠心病伴不同糖代谢病人运动耐量的影响

探讨曲美他嗪对冠心病伴不同糖代谢病人运动耐量的影响。方法 91例冠心病稳定型心绞痛伴不同糖代谢病人随机分为常规组和曲美他嗪组。常规组采用阿司匹林、美托洛尔缓释片、阿托伐他汀等治疗;曲美他嗪组在常规治疗基础上加服曲美他嗪(20mg/次,3次/天),连续治疗3个月。比较糖代谢正常、糖代谢异常病人在常规治疗及加用曲美他嗪治疗前后运动耐量的差异。结果糖代谢正常和糖代谢异常病人,曲美他嗪组治疗3个月后代谢当量、运动后ST段开始下降1 mm时间、总运动时间均较常规组均明显改善;糖代谢正常病人曲美他嗪组治疗3月后,治疗前后代谢当量差值、运动后ST段开始下降1mm时间差值、总运动时间差值分别(2.6±1.02)METs、(108.56±29.47)s、(112.26±35.34)s,糖代谢异常病人曲美他嗪组治疗前后代谢当量差值、运动后ST段开始下降1mm时间差值、总运动时间差值分别(1.73±0.76)METs、(74.07±21.61)s、(89.41±23.66)s,两组比较差异有明显统计学意义。结论曲美他嗪可提高冠心病心绞痛伴不同糖耐量病人的运动耐量,曲美他嗪对糖代谢正常病人运动耐量的改善程度优于糖代谢异常病人。     

阿替洛尔和曲美他嗪联用治疗稳定型心绞痛疗效观察

近年来 ,我们应用阿替洛尔、曲美他嗪治疗稳定型心绞痛患者 33例 ,取得较好疗效。现报告如下。资料与方法 :本组 33例患者均为男性 ,年龄平均 (5 6± 6 )岁 ;心绞痛病程平均 (2 8.8± 4 .4 )个月。既往有心肌梗死病史16例 ,曾行冠状动脉旁路移植术 1例 ,经皮冠状动脉介入治疗 2例。患者每周心绞痛发作平均 (4.2± 0 .5 )次。符合加拿大心脏病学会制定的心绞痛分级 ～ 级。均经活动平板试验阳性及冠状动脉造影显示冠状动脉明显狭窄而诊断为稳定性心绞痛。方法 :阿替洛尔 12 .5 mg/次口服 ,2次 / d,连用 30天。曲美他嗪 2 0 m g/次口服 ,3次…     

曲美他嗪治疗冠心病伴糖尿病的疗效观察

目的 :观察曲美他嗪治疗伴有糖尿病的冠心病 (CHD)治疗效果。方法 :用曲美他嗪治疗 CHD伴有糖尿病 (A组 )与不伴有糖尿病 (B组 )两组各 4周 ,对两组治疗前后平板运动耐量指标变化进行对照。结果 :两组在治疗后的运动总步行时间、运动至心绞痛出现时间和运动到 ST段压低达到 0 .1m V所需时间均较治疗前有明显延长 (P <0 .0 5 ) ,但 A组的效果比 B组更显著 (P <0 .0 5 )。结论 :曲美他嗪治疗伴有糖尿病的 CHD效果比不伴有糖尿病的 CHD更显著。     

艾司洛尔对心肌桥患者壁冠状动脉血流动力学的作用

目的　探讨β受体阻滞剂艾司洛尔对心肌桥患者的壁冠状动脉受压迫程度和血流速率的影响。方法　8例心肌桥患者在静脉滴注艾司洛尔前后观察壁冠状动脉受压程度的变化,并运用腔内多普勒技术观察壁冠状动脉的基础峰值血流速率 (bAPV)、最大峰值血流速率 (hAPV)、冠状动脉血流储备(CFR)的变化。结果　艾司洛尔使壁冠状动脉受压程度由用药前 ( 58 0±14 7 )%降低至(26 0±9 8)% (P<0 01);艾司洛尔使近段和远段bAPV分别由 ( 19 4±4 9 )cm/s和 ( 18 4±3 6)cm/s下降至(14 7±3 9)cm/s和(15 1±1 5)cm/s,用药前后相比差异均有统计学意义 (P分别为<0 01和<0 05);在充血状态下壁冠状动脉近段和远段的hAPV分别由 ( 54 1±14 9 )cm/s和(44 7±9 4)cm/s变为(49 7±16 4)cm/s和(48 9±10 1)cm/s; 远段和近段的CFR由 (2 8±0 3)和(2 5±0 5)分别上升为(3 4±0 5)和(3 2±0 6) (P均 <0 01)。结论　艾司洛尔可使壁冠状动脉受压程度减轻,CFR增加至正常水平。     

曲美他嗪治疗稳定型心绞痛合并糖尿病疗效观察

目的探讨曲美他嗪(trimetazidine)在稳定型心绞痛合并2型糖尿病患者中的临床疗效。方法选取我院2000年1月～2004年9月102例心绞痛合并糖尿病患者,随机分为常规口服药物治疗组(A组)和曲美他嗪组(B组)。B组在常规口服药物基础上加曲美他嗪20mg,每日3次,持续4周。在服药前以及服药期间每周随诊观察,共4周,询问病史及进行运动负荷(平板)试验。结果患者全部完成疗程,2例服药后有轻微上腹部不适但无需停药。B组胸痛发作每周次数减少(4.2±0.5)次,而A组减少(2.1±0.8)次,两组相比差异有统计学差异(P<0.05)。B组病人硝酸甘油消耗量平均减少(6.1±0.7)片,A组病人平均减少(3.3±0.9)片(P<0.05)。运动平板试验持续时间B组病人增加(63.6±2.3)秒,A组病人增加(31.6±2.2)秒(P<0.05)。结论在传统药物治疗的基础上联用曲美他嗪,可以使稳定型心绞痛合并糖尿病患者受益,且病人耐受良好。     

曲美他嗪改善缺血性心肌病患者心功能的临床研究

目的 :探讨曲美他嗪对缺血性心肌病患者心功能的影响。方法 :2 1例患者在常规疗法基础上 ,每日 3餐后分服曲美他嗪 2 0 m g,4周后考察临床疗效。超声心动图测定治疗前、后左室射血分数 (L VEF)和左室短轴缩短率 (FS)。结果 :临床有效 1 1例 (5 3.4% ) ,L VEF和 FS分别由 0 .42± 0 .0 7和 0 .2 0± 0 .0 6增至 0 .5 3± 0 .0 8和 0 .35±0 .0 5 (P <0 .0 1 )。未发现与药物相关的不良反应。结论 :曲美他嗪能改善缺血性心肌病患者心功能 ,可作为治疗该病的辅助药物     

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.