心肌标志物在不稳定型心绞痛和急性心肌梗死的临界值

目的 探讨不稳定型心绞痛和急性心肌梗死心肌标志物的临界值。方法 测定不稳定型心绞痛34例和急性心肌梗死病人64例在发病后5日内多时间点的血清心肌标志物浓度,包括心肌肌钙蛋白、肌酸激酶同工酶MB质量和活性、肌红蛋白、肌酸激酶、天冬氨酸转氨酶和乳酸脱氢酶活性,并通过时量曲线分析心肌标志物诊断急性心肌梗死的临界值。结果 34例不稳定型心绞痛病人中仅有7例心肌标志物不同程度升高;而在急性心肌梗死病人,心肌肌钙蛋白、肌酸激酶同工酶MB和肌红蛋白的峰值分别为24,16,8小时。其诊断急性心肌梗死临界峰值分别为0.25,16.6,75.6 μg/L,结论 诊断区分急性心肌梗死和不稳定型心绞痛的心肌标志物的临界值为心肌肌钙蛋白0.25 μg/L,肌酸激酶同工酶MB为16.6 μg/L,肌红蛋白为75.6 μg/L。     

血栓前体蛋白和心肌肌钙蛋白Ⅰ联合检测在诊断急性冠脉综合征中的临床价值

目的研究血清血栓前体蛋白(TpP)、心肌肌钙蛋白Ⅰ(cTnI)联合检测在诊断急性冠脉综合征中的临床价值。方法选取2009年5年—2014年5月于我院心内科住院的急性冠脉综合征病人93例,根据临床症状分为急性心肌梗死组(A组)、不稳定型心绞痛组(B组),随机选取同时期于我院进行体检的健康人群40名(C组),分别测定发作6 h内及发病24 h的血清血栓前体蛋白、心肌肌钙蛋白Ⅰ含量。结果在发病的6 h内,急性心肌梗死病人的血清血栓前体蛋白和心肌肌钙蛋白Ⅰ有明显升高(P0.05);不稳定型心绞痛病人心肌肌钙蛋白I有明显升高(P0.05);且心肌梗死病人心肌肌钙蛋白I升高程度高于不稳定心绞痛病人,差异有统计学意义(P0.05)。发病24 h时,急性心肌梗死病人的血清血栓前体蛋白(TpP)已恢复正常;急性心肌梗死和不稳定心绞痛病人心肌肌钙蛋白I明显升高(P0.05),差异有统计学意义(P0.05)。结论血清血栓前体蛋白、心肌肌钙蛋白I联合诊断有助于提高诊断速度和准确率,对于该病的临床防治工作有重要意义。     

高敏C反应蛋白、肌红蛋白、心肌肌钙蛋白和肌酸激酶同工酶联合检测在急性心肌梗死诊断中的应用

目的探究高敏C反应蛋白(hs-CRP)、肌红蛋白(Myo)、心肌肌钙蛋白T(cTnT)和肌酸激酶MB同工酶(CK-MB)联合检测对急性心肌梗死(AMI)诊断中的应用。方法随机选取并回顾性分析2011年6月至2012年66月于我院诊断为急性心肌梗死患者70例及同时期进行体检的健康人群70例。研究组为急性心梗患者,发病均在6h内;对照组为签署知情同意书的体检健康人群。采用化学发光法测定两组研究对象hs-CRP、MYO、cTnT、CK-MB四项指标的阳性率及研究组发病3h、6h、12h、24h内的指标变化。结果观察两组患者高敏C反应蛋白(hs-CRP)、肌红蛋白(Myo)、心肌肌钙蛋白T(cTnT)和肌酸激酶同工酶(CK-MB)检测值,研究组检测值明显高于对照组,差异存在统计学差异(P0.05);hs-CRP最高峰出现在发病后12-24h之间,Myo最高峰出现在发病后6-12h内,cTnT最高峰出现在发病后6-12h,CK-MB最高峰出现在发病后12-24h内。结论 AMI患者血清内Myo、hs-CRP、CK-MB和cTnT值均在AMI发病2h后不同程度的升高,四项联合检测对AMI的诊断中有较大参考价值,可作为AMI发生早期有效实验室指标。     

急性心肌梗死与不稳定型心绞痛患者血栓前体蛋白和肌酸激酶的检测

为了解检测血栓前体蛋白对急性冠状动脉综合征转归的早期诊断价值 ,5 1例临床确诊冠心病患者分为不稳定型心绞痛和急性心肌梗死两组 ,采用酶联免疫吸附法检测各组血浆中血栓前体蛋白含量 ,采用干化学法同步检测患者血清磷酸肌酸激酶及其同工酶。结果发现 ,急性心肌梗死组 2 5例患者血栓前体蛋白均值为 9.9± 3.9mg L ,不稳定型心绞痛组 2 6例患者血栓前体蛋白均值为 2 .6± 1.7mg L ,前者明显升高 ,差别有显著性意义 (P <0 .0 1) ;急性心肌梗死组磷酸肌酸激酶均值为 5 95± 4 32u L ,磷酸肌酸激酶同工酶均值为 10 1± 74u L ,不稳定型心绞痛亚组磷酸肌酸激酶均值为 137± 4 0u L ,磷酸肌酸激酶同工酶均值为 10± 7u L ,前者亦明显升高 ,差别均有显著意义(分别为P <0 .0 5和P <0 .0 1)。结果提示 ,血栓前体蛋白对急性冠状动脉综合征具有早期诊断和鉴别价值     

心肌型脂肪酸结合蛋白(H-FABP)在诊断早期AMI中的临床应用

目的探讨血清心肌型脂肪酸结合蛋白（H—FABP）在早期急性心肌梗死（AMI）诊断中的价值。方法选择疑似急性冠脉综合征患者102例,采用酶联免疫吸附法（Elisa）测定AMI发病3h内,4～6h、7～12h时血清中H—FABP浓度,并与心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK—MB）的检测结果进行比较,分析三种心肌损伤标志物在诊断不同发病时间段AMI的敏感性和特异性。结果在AMI发病3h内,H—FABP的诊断敏感性（66．7％）优于cTnI和CK—MB（P〈0．05）;在发病4～6h内,H—FABP的敏感性（94．4％）高于cTnI（61．1％）和CK—MB（50．0％）,差异有统计学意义（P〈0．05）。结论在AMI发病6h内,H—FABP是最敏感的心脏标志物,尤以发病3h内敏感。     

白细胞介素-1受体拮抗蛋白诊断早期急性心肌梗死的临床价值

急性心肌梗死(AMI)的早期诊断对决定溶栓治疗起着十分重要的作用.对临床症状表现不典型、心电图呈非特异性改变的AMI患者,常用的心肌损伤标志物如肌红蛋白(Mb)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)等对AMI早期诊断的灵敏度和特异性均不太理想[1-3].为此本研究通过对发病6 h内AMI患者血清白细胞介素-1受体拮抗蛋白(IL-1Ra)水平进行检测,并与其他心肌损伤标志物进行比较,旨在探讨其在AMI早期诊断中的临床价值.     

心肌型脂肪酸结合蛋白在急性心肌梗死早期诊断中的应用

目的　评定脂肪酸结合蛋白 (H FABP)在急性心肌梗死 (AMI)早期诊断中的应用。　方法　采用自行开发的H FABP酶联免疫吸附试验一步夹心法对 12 6名健康体检者和 5 3例AMI患者血清H FABP进行检测 ,同时测定肌红蛋白 (MYO)、肌酸激酶同工酶 (CK MB)、肌钙蛋白I(cTnI) ,并对AMI进行动态观察 ,对早期诊断的敏感性、特异性、时效性等进行分析。　结果　H FABP在AMI后 (1 84± 0 6 4 )h血浆浓度即开始升高 ,比CK MB、cTnI早 (P <0 0 1) ;时间浓度动态曲线与MYO相似 ,与CK MB、cTnI相比曲线前移。AMI后 2h的敏感性和特异性分别为 76 4 7%、80 4 1% ;4h的敏感性和特异性分别为 89 16 %、91 2 6 %。　结论　AMI后 2、4hH FABP检测对AMI早期诊断具有较高的敏感性和特异性 ,可望成为重要的早期和排除诊断的血清心肌标志物的手段之一。     

血清TpP、hs-CRP、CKMB、cTnI在急性心肌梗死中的诊断意义

目的探讨血栓前体蛋白(TpP)、高敏C反应蛋白(hs-CRP)、肌酸激酶同工酶(CKMB)及心肌肌钙蛋白I(cTnI)联合检测在急性心肌梗死(AMI)中的诊断价值。方法 测定26例急性心肌梗死患者胸痛发作6小时内及24小时TpP、hs-CRP、CKMB及cTnI。结果AMI胸痛发作6小时内TpP的敏感性最高,发病6小时后hs-CRP、CKMB及cTnI显著升高,cTnI阳性持续时间长,而hs-CRP在AMI时可出现明显升高。结论TpP对于AMI具有早期诊断价值,cTnI与hs-CRP、CKMB一起相互补充,具有重要的临床诊断及判断预后的意义。     

心脏型脂肪酸结合蛋白在急性心肌梗死早期诊断中的价值

目前临床早期诊断急性心肌梗死(AMI)的指标主要有肌酸激酶(CK)、肌酸激酶异构酶(CK-MB)、肌钙蛋白I(TroponinI)、肌钙蛋白T(Troponin T)和肌红蛋白(Myoglobin)等。但CK-MB、肌钙蛋白I、肌钙蛋白T缺乏敏感性,它们在胸痛后6～8h浓度才上升;肌红蛋白则缺乏特异性,虽然在胸痛后2～3h浓度上升,但其不能区分骨骼肌和心肌损伤。近来Alhadi等〔1,2〕报道心脏型脂肪酸结合蛋白(h-FABP)在胸痛后2～3h后浓度开始上升,在4～8h内达到最高值,在12～24h内恢复到正常水平,且h-FABP的免疫性不同于其他类型的FABP,具有特异性,不会发生交叉反应,…     

心肌型脂肪酸结合蛋白(H-FABP)与cTnI、CK-MB组合在诊断早期AMI中的比较

目的研究血清心肌型脂肪酸结合蛋白（H—FABP）在早期急性心肌梗死（AMI）诊断中的价值,比较不同心肌损伤标志物组合诊断早期AMI的价值。方法选择疑似急性冠脉综合征患者102例,采用酶联免疫吸附法（Elisa）测定AMI患者发病1h、2h、3h、4～6h、7～12h时血清H—FABP浓度变化,并与心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK—MB）的检测结果进行比较,分析3种心肌损伤标志物及不同心肌标志物组合H—FABP＋cTnI与H—FABP＋CK—MB在诊断不同发病时间段AMI的敏感性和特异性。结果①在AMI发病3h内,H—FABP的诊断敏感性（66．7％）优于cTnI（0％）和CK—MB（0％）,差异有统计学意义（P〈0．05）。在AMI发病4～6h内,H—FABP的敏感性（94．4％）仍高于cTnI（61．1％）和CK—MB（50％）,差异有统计学意义（P〈0．05）。②H—FABP＋cTnI组合对AMI的诊断敏感度最高（95．8％）,特异度亦最高（100％）。H-FABP＋cTnI组合次之,分别为93．75％和97．2％。这两种组合对AMI的诊断敏感度与单个H—FABP、cTnI和CK—MB比较,差异有统计学意义（P〈0．05）,诊断特异度亦明显升高。结论在AMI发病6h内,H—FABP是最为敏感的心脏标志物,尤以发病3h内最敏感。H—FABP与不同心肌损伤标志物cTnI和CK—MB的组合均具有较高的敏感性和特异性,可提高早期诊断AMI的准确率。     

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.     

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.     

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.