心室流出道频发室性早搏、室性心动过速的心电图特征及射频消融治疗

目的探讨心室流出道频发室性早搏和/或室性心动过速的心电图特征及射频消融治疗的有效性及安全性。方法对14例(13例右心室流出道频发室性早搏和/或室性心动过速,1例左心室流出道频发室性早搏)的心电图特征进行分析并行射频消融治疗。结果右心室流出道室性早搏及室性心动过速体表12导联心电图QRS波特征:Ⅰ导联呈rs、m、QS及R型,aVRa、VL均呈QS型,Ⅱ、Ⅲ、aVF、V5-6导联均呈单向R波型,胸前导联R波移行区常在V3、V3导联之后,V1、V2导联R高度/S高度比值常<0.3。左心室流出道频发室性早搏和/或室性心动过速的QRS波特征与右心室流出道频发室性早搏和/或室性心动过速类似,但其胸前导联R波移行区常在V2导联之前,V1、V2导联(尤其V2导联)R高度/S高度比值常≥0.8。13例消融成功,手术操作时间45~156min,X线曝光时间8~28min。术后随访2~36个月,无复发病例。结论起源于心室流出道的频发室性早搏和/或室性心动过速有其独特的心电图表现,射频消融治疗能安全、有效地根治此类心律失常。     

射频导管消融治疗的特发性室性心律失常心电图特征分析

目的：探讨不同起源的特发性室性期前收缩（PVCs）和（或）室性心动过速（VT）的心电图特征,提出鉴别流程。方法根据射频导管消融PVCs/VT有效靶点或心室最早激动点的X线胸片进行定位,分析不同起源PVCs/VT的12导联心电图QRS波群。结果828例接受导管消融,580例起源于右心室,248例起源于左心室,左、右心室起源者胸导联移行指数＜0的分别占97.58%及7.24%;左和右心室流出道起源者下壁导联多数呈R型,V1上,多数右心室流出道起源者呈rS型,右室间隔起源呈QS型,主动脉瓣上起源者常呈rS或RS型;下壁导联上,左前分支起源者常呈qR型,左后分支起源者常呈rS型。结论结合体表心电图胸导联移行指数、下壁导联和V1上的QRS波群特征可初步判断特发性PVCs/VT的起源部位。     

体表心电图鉴别心室流出道特发性室性心动过速的起源部位

目的 :评价 12导联心电图在鉴别左室和右室流出道室性心动过速 (VT)及鉴别左室流出道VT中主动脉瓣上起源的VT和主动脉瓣下起源的VT中的价值。方法 :回顾性分析了射频消融术获得成功的 5 6例流出道特发性VT患者体表心电图特点 ,右室流出道VT组 (RVOT VT)组 4 0例 ,左室流出道VT(LVOT VT)组 16例 ,其中主动脉瓣上组 (左冠窦内 ) 10例 ,主动脉瓣下组 6例。结果 :LVOT VT组胸前导联R波移行均早于V4导联 ,87.5 %(14 / 16 )在V1或V2 导联 ,RVOT VT组 82 .5 % (33/ 4 0 )胸前导联R波移行≥V4导联 ,无一例在V3 导联前移行 ;RVOT VT组V1和V2 导联R波时限指数和R/S波幅指数明显小于LVOT VT组 [(30 .4± 12 .6 ) %∶(5 7.4± 14 .2 ) %和 (13.8± 7.5 ) %∶(5 8.2± 11.4 ) % ,均P <0 .0 1]。主动脉瓣上LVOT VT组下壁导联 (Ⅱ ,Ⅲ ,aVF)R波振幅明显高于主动脉瓣下组 ;V5和V6导联或单独V6导联有s波对确定主动脉瓣下起源的LVOT VT敏感性 10 0 % (6 / 6 ) ,V5和V6导联均无s波对确定主动脉瓣上起源的LVOT VT特异性 90 % (9/ 10 )。结论 :体表心电图对初步确定心室流出道VT的起源部位可以提供很大的帮助。     

左束支阻滞型特发性室性心动过速的心电图特征对射频消融成功的影响初探

对心电图呈左束支阻滞型的特发性室性心动过速 (简称室速 )的临床特点和心电图进行分析 ,以了解哪些因素可以预测此类患者从右室流出道行射频消融的成功率。对 2 6例特发性室速的患者进行电生理检查和射频消融手术 ,全部患者室速时的心电图呈左束支阻滞。结果 :2 6例中 ,2 2例于右室流出道进行了成功消融 ,成功和未成功消融的患者临床特征和电生理无明显区别 ,成功消融的患者中胸前V1 导联心电图呈rS型 (1 2例 )和QS型 (1 0例 ) ,而 4例未成功者 ,V1 导联均呈rS型 ,其中 2例经主动脉于左冠状窦消融成功。在成功与未成功消融患者中 ,V1 导联有无R波无明显区别 ,但V1 导联无R波预示室速可以从右室流出道成功消融 ,成功消融的室速患者胸前导联的平均移行区在V4导联 ,而未成功患者胸前导联的移行区在V3 或V2 导联。结论 :某些心电图呈左束支阻滞 ,且额面电轴正常或右偏的特发性室速患者不能成功从右室流出道消融 ,V1 导联有r波且移行区在V3 导联或之前者提示此类心电图特征的室速可能非起源于右室流出道 ,部分可能起源于左室流出道     

不同心电图特征对特发性室性期前收缩右室流出道起源部位诊断价值比较

目的 比较体表心电图鉴别右室流出道室性期前收缩具体起源点的诊断价值。 方法 分析经射频导管消融治疗室性期前收缩靶点明确为右室流出道的139例患者（其中右室流出道间隔部起源的111例,游离壁起源的28例）的体表心电图特点,以室性期前收缩时Ⅰ导联主波形态、QRS波时限、胸前导联移行及下壁三肢体导联有无顿挫进行分析,评估其对鉴别右室流出道室性期前收缩具体起源点的准确性。 结果 以室性期前收缩的QRS波宽度≥140 ms判断为右室流出道游离壁起源的灵敏度为86%,特异度为58%;以下壁三肢体导联均有顿挫或切迹判断为游离壁起源的灵敏度为64%,特异度为91%;以Ⅰ导联主波向上判断游离壁起源的灵敏度为86%,特异度为73%。 结论 I导联主波方向及下壁三肢体导联有无顿挫能对鉴别游离壁还是间隔起源有较大实用价值。     

右室流出道起源与主动脉窦起源室性早搏的分析

目的 探讨右室流出道起源与主动脉窦起源室性早搏心电图的主要区别.方法 回顾分析因频发室性早搏,心电图室性早搏胸前导联呈左束支传导阻滞,Ⅱ、Ⅲ、aVF导联QRS主波向上,行射频消融成功的患者126例,分为右室流出道（RVOT）起源组66例,主动脉窦（ASC）起源组60例.结果 V1、V2导联R波时限指数和R/S波幅指数ASC组高于RVOT组.胸前导联移行区指数RVOT组高于ASC组.ROC曲线分析胸前导联移行区指数鉴别室性早搏起源有较高价值.结论 心电图呈左束支传导阻滞且Ⅱ、Ⅲ、aVF导联QRS主波向上的室性早搏,分析V1、V2导联R波时限指数、R/S波幅指数和胸前导联移行区指数可判断RVOT起源与ASC起源,指导射频消融治疗.     

不同起源右心室流出道性室性心律失常的心电图特征

目的探讨不同起源右心室流出道性室性心律失常的心电图特征。方法比较61例不同起源右心室流出道性室性心律失常的QRS形态和电压。结果右心室流出道性室性心动过速和室性期前收缩心电图均呈典型左束支传导阻滞型伴心电轴右偏,并因起源不同各有特征:①前间隔性:Ⅱ、Ⅲ、aVF及V4～V6R波电压最高,Ⅰ呈QS、rs、qr或m型,r波电压低≤0.2mV;QSaVR/QSaVL比值接近1。②后间隔性:Ⅱ、Ⅲ、aVF及V4～V6R波电压较低,下壁导联R波差值增大(>0.2mV),Ⅰ呈R或M型,电压0.2～0.5mV;QSaVR/QSaVL比值明显增大(平均达2.25)。③游离壁性:Ⅱ、Ⅲ、aVF及V4～V6R波电压最低,下壁导联R波差值进一步增大(>0.3mV);Ⅱ、Ⅲ、aVF有特征性的R波顶峰或降肢切迹且其位置逐渐延迟。结论熟悉不同起源右心室流出道性室性心律失常的心电图特征有利于在射频导管消融前初步判断其起源灶,以缩短手术时间并提高成功率。     

特发性室性心动过速的射频消融

目的对经射频消融术证实的特发性室性心动过速的病例进行总结分析,探讨室性心动过速的发病状况、心电图特点、消融靶点的确定及消融结果。方法对32例特发性室性心动过速的起源部位和体表心电图进行分析,所有患者在诱发出室性心动过速后进行射频消融治疗,观察特发性室性心动过速的射频消融成功率和复发率,以及它们和消融靶点的关系。结果右室特发性室性心动过速心电图表现为左束支传导阻滞,左室特发性室性心动过速心电图则多表现为右束支传导阻滞。消融靶点的确定右室特发性室性心动过速主要采用起搏标测法,左室特发性室性心动过速主要采用激动顺序标测法。右室流出道室速组在起搏标测起搏ECG和VT时ECG的12导联QRS波完全相同处消融成功率较高。结论室性心动过速发作时的体表心电图可初步估计特发性室性心动过速的起源部位,射频消融术治疗特发性室性心动过速成功率高、并发症少。     

体表心电图特征鉴别左右室流出道心律失常的临床分析

目的分析体表心电图特点对鉴别流出道室性心律失常(OTVA)起源部位的临床价值。方法对电生理检查及射频消融明确靶点的87例OTVA患者[(其中起源于右室流出道(RVOT)的64例;起源于左室流出道(LVOT)的23例]体表心电图进行分析,分别以R/S振幅指数、R波时限指数、胸导联移行区(TZ)指数、V2转换率及V2S/V3R指数来评估体表心电图特征,分析其对LVOT/RVOT室性心律失常的鉴别的准确性。结果以V1导联R/S波振幅指数≥30%判断OTVA起源于LVOT的灵敏度为60.87%,特异度92.19%,R波时限指数≥50%判断灵敏性为34.78%,特异度96.87%;TZ指数0判断灵敏度为69.57%,特异度87.5%;以V2转换率0.6的判断灵敏度为69.57%,特异度90.63%;V2S/V3R指数≤1.5的判断灵敏度为65.22%,特异度92.19%。结论V2S/V3R指数≤1.5是一种简便准确地鉴别OTVA起源于左右流出道靶点的体表心电图判断方法,具有很好的临床实用价值。     

特发性流出道室性期前收缩体表心电图207例分析

目的:分析特发性流出道室性期前收缩(室早,premature ventricular contractions,PVC)的体表心电图定位特征,进而指导射频导管消融。方法:回顾性分析连续207例接受射频消融治疗、术中经电生理检查和(或)心室造影,证实起源于左心室流出道(LVOT)或右室流出道(RVOT)室性心律失常(VAs)患者体表心电图特点,测量胸前导联R波、S波的振幅,分析胸前导联QRS波群R/S转换与起源部位的关系,R/S转换在V3导联时计算V2导联R/S振幅比值。结果:VAs时胸前导联R/S转换在V2或以前的VAs患者18(男8,女10)例,年龄23~87(44±17)岁,起源于LVOT 17例,特异性99%,敏感性68%。胸前导联R/S转换在V4或以后的共113(男43,女70)例,年龄4~73(42±14)岁,均起源于RVOT,特异性100%,敏感性62%。胸前导联R/S转换在V3的VAs患者76(男25,女51)例,年龄17~82(46±13)岁;起源于RVOT 68例,起源于LVOT 8例,V2导联R/S值比分别为0.32±0.17vs.0.64±0.21(P<0.05)。结论:流出道室早胸前导联R/S转换早于V2和晚于V4分别提示起源于LVOT和RVOT的特异性和敏感性均较高。转换在V3时,起源于LVOT的VAs胸前V2导联的R/S比值明显高于起源于RV-OT者。     

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.