慢性心力衰竭患者心房结构-心电重塑与心律失常

目的 探讨陈旧性心肌梗死慢性心力衰竭(CHF)患者心房结构-心电重塑与心律失常的关系.方法 采用超声心动图,标准12导联心电图及24 h动态心电图检测陈旧性心肌梗死CHF患者55例(即心功能NYHAⅡ～Ⅳ级患者,其中Ⅱ级23例,Ⅲ级15例, Ⅳ级17例)及陈旧性心肌梗死心功能Ⅰ级(NYHA)患者30例左心房腔大小,P波宽度,P-R间期及室上性心律失常.结果 与心功能I级组比较,CHF组左心房腔显著扩大(CHF组左心房直径(LAD)(32.818±5.399)mm;心功能Ⅰ级组LAD(26.733±6.198)mm，P<0.05).两组间房性心电指标无显著差异(CHF组P波(0.109±0.018) s, P-R间期(0.159±0.052)s;心功能I级组〔P波(0.112±0.012)s,P-R间期(0.160±0.027)s,P>0.05).两组间室上性心律失常亦无显著差异(CHF组室上性早搏(SVP)(1 390.37土3 127.16),室上性心动过速(SVT)(11.25±30.32);心功能Ⅰ级组SVP(746.94±1 113.62),SVT(9.63±16.80),P>0.05).结论 陈旧性心肌梗死CHF时,心房结构重塑显著,心房腔显著扩大,但该研究中心房结构重塑未见引起显著房性心电重塑及室上性心律失常增加,差异不显著.     

急性心梗伴室性心律失常与Q-T离散度分析及研究

为了解急性心肌梗死(AMI)伴室性心律失常及不伴室性心律失常与QT的关系,分析50例AMI患者。结果显示,AMI伴室性心律失常组的QTd与不伴有室性心律失常的QTd与对照差异均有非常显著意义(88.65±28.25)不伴室性心律失常组QTd(58.66±13.73),P<0.05。认为QTd和QTc明显延长,反映心室电位不稳定,而且心室复极化不均匀程度越严重QTd越大所以QTd可以作为预测室性心律失常的一个重要指标。接近80ms或越过80ms,应引起临床高度警惕。心肌梗死时,由于心室结构发生变化,复极不均匀,使QT离散度QTd增加,易产生严重的室性心律失常。实际QT离散度…     

急诊经皮冠状动脉介入治疗对QT间期离散度的影响

目的探讨急诊经皮冠状动脉介入治疗（PCI）后对QT间期离散度（QTd）的影响。方法对70例ST段抬高的急性心肌梗死（AMI）患者行急诊PCI前和PCI后24h内12导联同步心电图QT间期、校正QT间期（QTc）、QTd及校正QT间期离散度（QTcd）4项指标进行对比分析。并监测严重心律失常发生情况。结果PCI后QT和QTc与术前差异无显著性,而QTd和QTcd则较术前明显减少,差异有显著性意义（P<0.01）。28例术前有恶性心律失常,其QTd明显高于无心律失常的患者[（70±18）msvs（52±15）ms,P<0.01];术后QTd降至（45±16）ms（P<0.01）,室性心律失常消失或减少。结论急诊PCI能显著减少AMI患者的QTd和QTcd,降低急性期恶性心律失常的发生。     

热休克蛋白47与PⅠCP在慢性心力衰竭患者中的相关性

目的:慢性心力衰竭（CHF）是一种慢性的,逐渐进展的临床综合征。研究热休克蛋白47(HSP47)与血清Ⅰ型胶原羧基端肽(PⅠCP)在CHF不同心功能分级中的表达及其相关性。方法: 将60名患者分为心功能Ⅰ级、心功能Ⅱ级、心功能Ⅲ级,采用ELISA测定患者血清中的HSP47的含量与PⅠCP的含量,并研究两者与CHF的相关性。结果: 与心功能1级组比较,心功能Ⅱ级组PⅠCP含量显著增高（P<0.01）,且心功能Ⅲ级组较心功能Ⅱ级组PⅠCP含量显著增高（P<0.01）,且血清HSP47含量与PⅠCP含量呈正相关。结论: CHF患者存在心肌纤维化及左心室扩大,两者呈正相关关系,提示CHF患者存在心室结构重构,心肌纤维化在心室重构中起重要作用。CHF患者HSP47和PⅠCP显著升高,且呈显著正相关。     

慢性心力衰竭患者QT间期频率依赖性与室性心律失常的关系

目的探索慢性心力衰竭患者QT问期频率依赖性与室性心律失常的关系。方法选31例慢性心力衰竭患者有效病例资料。检测左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）、QT间期离散度（QTd）、心率变异性（HRV）、QT／RR相关直线的斜率、24h室性早搏（VPB）和非持续性室性心动过速（NSVT）的次数。比较有NSVT和无NSVT患者上述指标的差别,研究上述指标与NSVT的相关性。结果31例心力衰竭患者中,有17例动态心电图记录到NSVT。有NSVT与无NS—VT的患者比较,VPB次数[（5631．2±7218．0）对（285．9±371．7）,P〈0．05],QTe／RR斜率[（0．210±0．049）对（0．161±0．058）,P〈0．05]和QTp／RR斜率[（0．195±0．046）对（0．151±0．041）,P〈0．05]的差异有统计学意义。在全部31例患者中,QTd（r=0．414）、VPB次数（r=0．768）、QTe／RR斜率（r=0．380）、QTp／RR斜率（r=0．433）和NSVT有显著的相关性（P〈0．05）。结论QT间期频率依赖性是反映QT间期动态变化的指标,慢性心力衰竭患者的QT／RR斜率与室性心律失常有较好的相关性,在心脏性猝死的风险评估中有一定价值。     

急性心肌梗死QT离散度与恶性室性心律失常关系的探讨

目的 探讨发生急性心肌梗死时QT离散度（Q-Td）与发生恶性室性心律失常的关系.方法 测量45例患者急性心肌梗死时的Q-Td,计算校正的QT离散度（Q-TdC）.分析Q-Td、Q-TdC与恶性室性心律失常之间的关系.根据有无室性心律失常分为观察组（n=28）与对照组（n=17）.根据Q-TdC水平（分别以60ms、80ms为分界）分析其与室性心律失常和恶性室性心律失常发生的关系.结果 观察组Q-Td、Q-TdC[（70.84±29.87）ms、（79.21±33.58）ms]与对照组[（46.19±17.03）ms、（51.64±17.71）ms]相比,差异均有统计学意义（均P＜0.05）.Q-TdC≥60ms者室性心律失常发生概率（92.30%）高于Q-TdC＜60ms者（21.05%）（P＜0.05）.Q-TdC≥80ms者恶性室性心律失常发生概率（100.00%）高于Q-TdC＜80ms者（10.34%）（P＜0.05）.结论 急性心肌梗死随着Q-Td或Q-TdC值的增大,发生恶性室性心律失常的概率增高.     

厄贝沙坦联合美托洛尔治疗慢性心力衰竭合并房性或室性心律失常患者的疗效

目的:探讨厄贝沙坦联合美托洛尔治疗慢性心力衰竭(CHF)合并房性或室性心律失常患者的疗效。方法:2017年于我院接受治疗的CHF合并房性或室性心律失常患者168例被随机均分为美托洛尔组(在常规治疗基础上接受美托洛尔)和联合治疗组(在美托洛尔组基础上加用厄贝沙坦),两组均治疗3个月。观察比较两组治疗前后LVEF、左室后壁厚度(LVPWT)、室间隔厚度(IVST)、临床疗效。结果:联合治疗组治疗总有效率显著高于美托洛尔组(90.5%比73.8%),P=0.005。与治疗前比较,联合治疗组治疗后LVEF[(55.16±6.52)%比(64.24±8.72)%]显著升高,LVPWT[(14.72±1.78)mm比(13.27±1.14)mm]和IVST[(10.18±1.15)mm比(9.12±0.64)mm]显著减小,P均=0.001;且与美托洛尔组比较LVEF[(56.13±6.15)%比(64.24±8.72)%]升高更显著,LVPWT[(14.35±1.23)mm比(13.27±1.14)mm]和IVST [(9.88±0.85) mm比(9.12±0.64)mm]减小更显著,P均=0.001。两组药物不良反应率无显著差异,P=0.799。结论:厄贝沙坦联合美托洛尔治疗慢性心力衰竭合并房性和室性心律失常疗效显著,安全。对于心室重构的抑制作用可能是其主要机制。     

血清H-FABP、Hcy水平与CHF患者心室重构及预后的关系

目的:分析血清心型脂肪酸结合蛋白(H-FABP)、同型半胱氨酸(Hcy)水平与慢性心力衰竭(CHF)患者心室重构及预后的关系。方法:选择2013年5月至2015年11月我院收治的128例CHF患者为研究对象,根据纽约心脏病学会(NYHA)心功能分级患者被分为三组:心功能Ⅱ级48例、Ⅲ级42例及Ⅳ级38例,另选取同期入院治疗的心功能I级患者35例作为对照。超声心动图检查仪进行心脏检查,获取左室重构相关参数;入院次日采血检测血清H-FABP、Hcy水平;并进行相关性分析。所有患者均给予针对性强心治疗,随访24个月,以发生心脏事件为观察终点,记为预后不良,分析血清H-FABP、Hcy水平与预后的关系。结果:心功能I级、Ⅱ级、Ⅲ级、Ⅳ级患者左心室舒张末期内径(LVEDd)[(40.40±4.41)mm比(42.64±3.22)mm比(45.20±3.41)mm比(46.94±4.22)mm]、左心室后壁厚度(LVPWT)[(8.45±1.15)mm比(9.04±1.21)mm比(10.05±1.35)mm比(11.94±1.27)mm]、室间隔厚度(IVST)[(7.01±0.92)mm比(8.93±1.12)mm比(10.09±1.29)mm比(11.93±1.32)mm]均依次显著增大,左室射血分数(LVEF)[(52.16±4.02)%比(50.32±3.29)%比(48.16±3.32)%比(45.32±2.29)%]依次显著降低(P0.05或P0.01),血清H-FABP[(3.36±0.71)ng/L比(4.13±1.13)ng/L比(5.65±1.42)ng/L比(6.49±1.69)ng/L]及Hcy[(9.46±1.55)μmol/L比(14.49±2.60)μmol/L比(17.71±3.61)μmol/L比(20.26±3.37)μmol/L]水平依次显著升高(P0.05或0.01)。经Pearson相关分析,血清H-FABP、Hcy水平与LVEDd、IVST、LVPWT呈显著正相关(r=0.312～0.392,P0.05),与LVEF显著负相关(r=-0.453,-0.484,P0.05或0.01)。随访24个月,56例(43.75%)CHF患者预后不良,而与预后良好组比较,预后不良组的血清H-FABPP[(4.74±1.43)ng/L比(6.27±1.28)ng/L]及Hcy水平[(11.35±2.03)μmol/L比(18.33±3.46)μmol/L]均显著升高(P均=0.001)。结论:血清H-FABP、Hcy水平与CHF患者心室重构发生过程存在一定相关性,且对病情及预后评估有重要作用。     

老年缺血性心脏病患者跨室壁复极离散度与心功能的相关性研究

目的：探讨老年缺血性心脏病患者跨室壁复极离散度（TDR）与心功能之间的关系。方法选择老年缺血性心脏病患者159例;同时收集同期健康体检者143例为对照组;试验组根据心脏超声心功能参数联合BNP定量评定心功能分级方程进行心功能分级,分为心功能Ⅰ-Ⅱ级亚组68例,Ⅲ级亚组55例,Ⅳ级亚组36例;以上病例均行12导联心电图检查,在心电图上分别测定T波峰末间期（Tp-e）、QTc、QTd、Tp-e/QTc,比较试验组与对照组、试验各亚组的Tp-e、QTc、QTd、Tp-e/QTc;行24h动态心电图,观察各病例室性心律失常发生情况。结果（1）对照组心电图上各项指标与试验组各指标比较,试验组较对照组QTc显著延长（P＜0.05）,Tp-e、QTd、Tp-e/QTc也显著延长（P＜0.01）;（2）心功能Ⅳ级组与Ⅰ-Ⅱ级组比较、Ⅳ级组与Ⅲ级组比较、Ⅲ级组与Ⅰ-Ⅱ级组比较,两者各指标间差异均具有统计学意义（P＜0.05）;（3）试验组恶性心律失常发生率较对照组高（15.7%vs 0.6%,P＜0.05）;试验组的Tp-e、QTd、Tp-e/QTc与恶性心律失常发生率呈正相关（P＜0.05）,对照组的各指标与恶性心律失常发生率均无明显相关。结论（1）老年缺血性心脏病TDR增大,发生室性心律失常的风险增加;（2）缺血性心脏病患者心力衰竭严重程度对TDR有显著影响,随着心功能减退,TDR逐渐增大;TDR增大可在一定程度上反映心肌组织损害的严重程度。     

脑钠肽静脉滴注抑制大鼠心肌梗死后的心室重构

目的验证和比较持续静脉滴注外源性脑钠肽（BNP）和依那普利灌胃对于心肌梗死后心室重构的抑制作用,并观察其对心肌基质金属蛋白酶（MMPs）的影响。方法 SD大鼠随机分为4组：假手术组;对照组;心肌梗死＋依那普利[10mg/（kg·d）]灌胃治疗组;心肌梗死＋脑钠肽[0.06μg/（kg·min）]持续静脉微泵推注治疗组。应用超声心动图、免疫组化、ELISA和Western blot等方法评估各组的心室重构和心功能状况。结果 BNP和依那普利可抑制大鼠心肌梗死后左室质量指数的增加（分别减少13.2%和16.9%,P〈0.05）,改善心肌梗死后大鼠的左室舒张未压（分别降低33.0%和45.8%,P〈0.05）。超声心动图结果提示,给予BNP和依那普利持续治疗28天后,其左室舒张末径（LVEDD）大小和左室短轴收缩率（FS）优于对照组[LVEDD：对照组（8.8±0.6）mm,依那普利组（7.5±0.7）mm,脑钠肽组（7.5±1.0）mm,P〈0.05;FS：对照组（19.2±2.6）%,依那普利组（27.7±5.6）%,脑钠肽组（27.5±3.9）%,P〈0.05]。依那普利和BNP都能够明显抑制心肌梗死后期非梗死区的胶原、特别是Ⅰ型胶原的增生[对照组（6.8±1.4）%,依那普利组（4.0±0.9）%,脑钠肽组（3.7±1.1）%;P〈0.05]。静脉输注BNP治疗可升高心肌的cGMP含量,但抑制心肌血管紧张素Ⅱ的作用不及依那普利。BNP对非梗死区MMP-2和MMP-9含量无明月显影响。结论心肌梗死后持续静脉给予BNP可能通过cGMP介导的信号途径发挥其心脏保护作用,包括抑制心肌梗死后的心脏肥厚、心室扩大,改善心功能,减少非梗死区心肌胶原沉积,对非梗死区MMP-2和MMP-9的表达并无明显影响。     

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.