核潜艇艇员远航后心脏超声心动图随访观察

目的 :利用二维、M型超声心动图随访核潜艇艇员远航后心脏形态、功能的变化及其规律。方法 :采用美国HP10 0 0型彩色超声诊断仪对 49名长航前后的核潜艇艇员进行超声心动图追踪观察。测量左室舒张末内径（L Vd）、左室收缩末内径 （L Vs）及心电图 R-R间期 ,计算左室舒张末容量 （ESV）、收缩末容量 （EDV）、射血分值（EF）、小轴缩短率 （FS）、心输出量 （CO）及每搏量 （SV） ;分别测量舒张早期房室平面位移值 （T）及左房收缩引起的房室平面位移值 （A）。结果 :49名艇员远航返航后 2 4h内左房 （L A）及主动脉 （AO）内径增大 （3 .2 1± 0 .3 0 vs 3 .10± 0 .2 1cm ,P<0 .0 5;3 .19± 0 .19vs 3 .0 5± 0 .3 0 cm,P<0 .0 1） ,EDV和 SV增加 （10 8± 16vs 98± 15ml,P<0 .0 1;69± 10 vs 63± 10 ml,P<0 .0 1） ,A值明显增大 （0 .64± 0 .12 vs 0 .56± 0 .11cm,P<0 .0 1） ,T值明显变小 （1.3 4±0 .2 3 vs 1.49± 0 .2 4cm,P<0 .0 1）。返航后 3个月末 ,除了 T值尚未完全恢复外 ,其余各项指标均恢复如前。结论 :核潜艇长航可引起艇员短期内心脏形态改变和舒张功能轻微受损 ,但该损伤系可复性改变 ,超声心动图可对其变化规律进行追踪观察     

超声心动图评价水面舰艇艇员环球航行后心功能变化

目的评价水面舰艇艇员环球航海后心功能的变化。方法艇员59名,应用美国GE-vivid5型彩色多普勒超声诊断仪,于胸骨旁取二维左室长轴切面,将M型取样线置于2 a区,测量左室舒张末内径（LVESD）、左室收缩末内径（LVEDS）及心电图R-R间期,计算左室舒张末容量（LVEDV）、收缩末容量（LVESV）、射血分值（LVEF）、左室小轴缩短率（FS）、心排出量（CO）及每搏输出量（SV）;于心尖四腔心切面,将脉冲多普勒取样容积置于二尖瓣尖下,分别测量心室舒张早期峰值流速（VE）及舒张晚期峰值流速（VA）、VE/VA比值、等容舒张时间（IVRT）、E峰减速时间（DT）。结果本组人员远航后LVESV、LVEDV、CO、SV值均增加[分别为（40±21）m lvs（38±10）m l,P<0.01;（112±22）m lvs（94±26）m l,P<0.05;（5.2±1.0）Lvs（4.7±1.0）L,P<0.05;（74±16）m lvs（64±14）m l,P<0.01]。主要收缩功能指标LVEF、FS无明显差异,VE值增加[（95±14）cm/svs（85±14）cm/s,P<0.01];DT、IVRT值均降低[（0.16±0.02）svs（0.17±0.03）s,P<0.05及（0.07±0.12）svs（0.11±0.09）s,P<0.05]。A与E/A无明显差异。结论水面舰艇环航后可致心脏舒张功能减低,而主要收缩功能指标则无明显减低。     

应用Amplatzer封堵器治疗儿童动脉导管未闭封堵术前后左心功能的变化

目的 :应用超声心动图评价 Amplatzer封堵器治疗儿童动脉导管未闭 （PDA）患者封堵前后左心功能的变化。方法 :应用超声心动图测量 PDA封堵前后左室舒张末期内径 （EDD）和收缩末期内径。应用椭圆体体积法计算出左室舒张末期容积 （EDV）、收缩末期容积 （ESV）、每搏搏出量 （SV）、射血分数 （EF）和短轴缩短率 （FS） ,将封堵前后测量数据分别用统计学配对 t检验。结果 :封堵后 EDD,EDV,ESV,SV恢复至正常 ,封堵前后差别有统计学意义（P<0 .0 5 ） ,EF和 FS变化不大。结论 :应用 Amplatzer封堵器治疗儿童 PDA是一种有效的方法 ,能缩短 EDD和改善 PDA患者的左心功能。     

房室平面位移法评价左心室舒张功能

目的　研究房室平面位移法评价左心室舒张功能的可行性。方法　测量正常组与高血压组病人左心房收缩房室平面位移与总房室平面位移的比值及二尖瓣血流频谱 A/E值 ,进行对比研究。结果　高血压组左心房收缩所致房室平面位移与总房室平面位移比值相对正常组增加 ,两者相比差异显著 ,P<0 .0 0 1,该比值与 A/E存在线性相关 ,r=0 .69,P<0 .0 0 1。结论　房室平面位移法可评价左心室舒张功能     

应用Amplatzer封堵器治疗儿童动脉导管未闭封堵术前左心功能的变化

目的：应用超声心动图评价Amplatzer封堵器治疗儿童动脉导管未闭（PDA）患者封堵前后左心功能的变化。方法：应用超声心动图测量PDA封堵前后左室舒张末期内径（EDD）和收缩末期内径。应用椭圆体体积法计算出左室舒张末期容积（EDV）、收缩末期容积（ESV）、每搏搏出量（SV）、射血分数（EF）和短轴缩短率（FS）,将封堵前后测量数据分别用统计学配对t检验。结果：封堵后EDD,EDV,ESV,SV恢复至正常,封堵前后差别有统计学意义（P＜0．05）,EF和FS变化不大。结论：应用Amplatzer封堵器治疗儿童PDA是一种有效的方法,能缩短EDD和改善PDA患者的左心功能。     

超声心功能检测对重症心脏瓣膜病患者手术预后评估的临床价值

目的　观察重症心脏瓣膜病患者手术前后左心功能变化 ,探讨影响手术预后的左心功能指标。方法应用超声心动图检测 4 8例重症心瓣膜病瓣膜置换术患者手术前后左心功能各指标的变化 ,包括左室收缩末期内径 (ESD)、左室舒张末期内径 (EDD)、左室舒张末期容积指数 (EDVI)、左室收缩末期容积指数 (ESVI)、左室心肌质量指数 (L VMI)、左室射血分数 (EF)、左室内径缩短率 (FS)、心脏指数 (CI)。并根据术前 EF值将患者分为 A组2 8例 (EF≥ 4 0 % )和 B组 2 0例 (EF<4 0 % )。另选 10例健康人作为对照组。结果　 A组死亡 1例 ,B组死亡 6例。手术死亡率及术后心功能状况两组差异显著 (P<0 .0 5 )。A组术后除 EF外 ,余各项心功能指标均较术前显著改善 (P<0 .0 5 ) ,除 L VMI仍显著高于对照组 (P<0 .0 1)外 ,余各项心功能指标均恢复到正常范围 (P<0 .0 5 ) ;B组术后除 EF、FS外 ,各项心功能指标较术前有显著改善 (P<0 .0 5 ) ,但与对照组相比仍差异显著 (P<0 .0 5 )。结论　 EF、ESVI、FS、ESD等可作为评价重症瓣膜病左心功能损害程度及估计瓣膜置换手术预后的重要指标     

左室壁内缩短分数评价收缩功能及其与舒张功能相关性的研究

目的:探讨左室壁内缩短分数(mFS )评价高血压患者收缩功能及其与左室舒张功能的关系.方法:收集高血压组51例,正常对照组47例.分析临床特点,行超声心动图检查.收缩功能测定左室室壁厚度,左室内径,左室容量,测定射血分数(EF),缩短分数(FS)以及左室mFS.心脏舒张功能,取二尖瓣血流频谱,记录二尖瓣舒张期血流频谱,记录舒张早期(E)和舒张晚期(A)血流速度峰值.采用组织速度多普勒成像技术测定二尖瓣环室间隔侧和侧壁侧的舒张早期心肌运动速度(Em)和舒张晚期心肌运动速度(Am),取平均值.探讨左室收缩功能和舒张功能的相关性.结果:①收缩功能:高血压组与正常对照组比较:左室舒张末间隔厚度明显增加[(1.18±0.28):(0.95±0.13),P<0.001]、左室舒张末后壁厚度明显增加[(1.01± 0.17):(0.89±0.17),P<0.01]、左室mFS明显降低[( 18.0± 4.9) vs (22.3±5.9), P<0.01],而2组间左室EF和FS差异无统计学意义.②舒张功能:高血压组与对照组比较,二尖瓣血流频谱差异无统计学意义;组织多普勒成像显示,二尖瓣环Em明显降低[(8.22± 2.23):(9.91±2.52),P<0.05],二尖瓣环Em/Am明显降低[(0.72± 0.23):(0.98±0.26),P<0.01]、二尖瓣E/Em明显增加[(9.38±3.19):(7.45±2.10), P<0.01].③mFS与Em/Am显著正相关(r=0.55,P<0.001 )、与E/Em显著负相关(r=-0.38,P<0.05).左室EF和FS与上述指标无相关性.结论:左室mFS是评价高血压患者收缩功能的有力指标,与早期舒张功能受损有关.     

组织多普勒成像评价右室心尖部起搏与右室流出道起搏对心功能的影响

目的研究比较右室心尖部起搏（RVAP）与右室流出道起搏（RVOTP）两种不同起搏方式对室壁运动的同步性、心功能的影响。方法病窦综合征,Ⅲ度房室传导阻滞患者实施右室心尖部起搏15（男9,女6）例;实施右室流出道起搏10（男6,女4）例。所选患者均植入双腔起搏器,时间为术后3个月。利用组织多普勒速度-时间曲线分别测量室间隔及左室各壁的基底段、中间段、心尖段的收缩达峰时间,在常规二维超声切面上测量心排出量（CO）、心脏指数（CI）、每搏量（SV）、心搏出量指数（SVI）、左室射血分数（LVEF）。结果右室流出道起搏比右室心尖部起搏时CO[（4.7±1.1）vs（5.6±1.0）L/min,P<0.05]、CI[（3.1±0.7）vs（3.7±0.5）L/（min.m2）,P<0.05]、SV[（70±14）vs（82±11）ml/次,P<0.05]、SVI[（42±9）vs（49±9）ml/（次.m2）,P<0.05]、LVEF[（46±7）vs（57±15）%,P<0.05]均显著增加,收缩达峰时间显著缩短且一致性好（P<0.05）。结论右室流出道起搏与右室心尖部起搏相比,接近正常的房室和心室激动顺序,使心室的收缩和舒张过程更协调,心室同步化更好,心功能得到更好的改善。组织多普勒技术能定量和半定量心室的同步性,具有广阔的临床应用前景。     

组织多普勒显像技术检测缺血心肌的局部舒张功能

目的 :评价组织多普勒显像 （TDI）技术检测缺血心肌局部舒张功能的价值。方法 :应用超声心动图分别记录心肌缺血组 （2 8例 ）和对照组 （30例 ）舒张期二尖瓣血流频谱 （TMF）及左室基底部、中部和心尖部 3个水平面 15节段心肌 TDI。结果 :两组间左室射血分数相近 （6 2 %± 9% vs 6 6 %± 8% ,P>0 .0 5 ）。心肌缺血组与对照组比较 ,TMF舒张早期减速度时间 （2 82± 17m s vs 2 0 1± 11m s,P<0 .0 5 ）和等容舒张时间 （92± 18ms vs 6 1± 10 m s,P<0 .0 1）延长 ;E/A比值增加 （0 .6 7± 0 .2 vs 1.6± 0 .5 ,P<0 .0 1）。对照组 TDI示左室基底部与中部心肌舒张早期舒张速度 （Em ）高于心尖部 （P<0 .0 5 ） ,缺血节段 Em降低 ,局部早期舒张减速度时间和等容舒张时间延长。结论 :TDI可无创检测左室局部舒张功能。     

左心室旋转运动与收缩功能相关性的临床研究

目的 分析左心室乳头肌水平旋转角度与左室射血分数（LVEF）、左室短轴缩短率（FS）、MAM位移的相关性,探讨其在左室功能评价中的临床价值。 方法 研究对象89例,其中左室收缩功能减退（LVEF <50%）39例,左室收缩正常（LVEF >50%）50例。M型超声心动图测量左室短轴缩短率（FS）、MAM位移;Simpson’s法测量左室射血分数（LVEF）;二维灰阶超声心动图测量左室乳头肌水平旋转角度。 结果 89例研究对象心脏收缩时旋转角度为2.0～13.4度,平均旋转角度（7.73±3.76）度;左室收缩功能减退组较左室收缩正常组LVEF、FS、MAM位移、左室乳头肌水平旋转角度显著减小（P ＜0.001）;左室乳头肌水平旋转角度与LVEF、FS、MAM位移显著正相关（P＜0.001）。 结论 左室乳头肌水平旋转角度可作为评价左室整体收缩功能的一项指标。     

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.