心电图与体表电位标测诊断心肌梗死的对比研究

目的 :比较体表电位标测 （BSPM）各种图形与心电图 （ECG）诊断心肌梗死 （MI）的敏感性 ,方法采用 BSPM- 型体表电位标测微机系统 ,对 42例 MI患者和健康人的体表差电位图、峰电位图、等时间图、等积分图及 ECG进行了对比研究。结果 :前壁和下壁 MI,BSPM各种图形均有典型异常特征 ,QRS差电位图、峰电位图、Q等时图和等积分图检测 MI的敏感性 （阳性率 ）分别为 10 0 % ,10 0 % ,10 0 %和 98% ,而 ECG为 81% ,差异显著 （P<0 .0 5 ）。结论 :体表差电位图、等时图、峰电位图及等积分图均为诊断 MI的敏感指标     

陈旧性心肌梗塞体表的差电位图

本文通过临床研究陈旧性心肌梗塞(下简称心梗)的差电位图表现与核素心血管造影及心肌灌注断层显像结果进行对照。80例陈旧性心梗分为前壁、下后壁、前壁 下后壁心梗三组。差电位田显示,心室兴奋早中期,前壁及下后壁心梗组的负区部位、范围及出现时间与心梗后电位丧失区域对应。前壁 下后壁心梗组负区意义难定。差电位图平均负区面积百分比与核素心血管造影所示左室相位分布的标准差及半定量计分法测定的局部相位延迟呈正相关,与左室射血分数之间为负相关。与33例心肌灌注断层显像缺损体积呈正相关。     

缺血性心室晚电位的实验研究

本文将14只麻醉犬采用Harris氏法二期结扎左冠状动脉前降支（LAD），从心外膜实时记录心室晚电位（VLP）为标准，对比研究了体表和心外膜信号平均心电图（SA－ECG）检测VLP的价值。结果表明：（1）梗塞区心外膜SA－ECG显示的VLP与实时记录结果显著相关（r=-0.84,P<0.05)；(2)结扎LAD3小时内，体表SA－ECG的VLP阳性率为71．4％（10／14），3－6天降至50％（6／12）；（3）体表SA－ECG特异性较强（91．67％），而敏感性较差（66．67％）；（4）初步确定犬SA－ECG的VLP阳性指标为DQRS≥60ms、D40≥20ms和V20≤16μV。     

体表电位T波标测对冠状动脉狭窄的诊断和定位诊断价值

本文报告56例正常人和42例冠心痫患者（冠状动脉狭窄≥50%）的 T 波等电位图（BSPM）变化特点,探讨 T 波 BSPM 对冠脉狭窄的诊断和定位诊断价值。结果表明:正常人 T 波等电位图不受年龄和性别的影响,正区占居前胸和后背大部,形如“伞”状。负区仅位于右前胸和右肩部。左前降支狭窄时,T 波 BSPM 在左前胸锁骨中线附近出现,伸向正区的负区带或岛状负区。右冠脉狭窄的 T 波 BSPM,左前胸和后背部出现异常负区。而冠脒左旋支狭窄时,异常负区占居整个下胸背部,正区仪占居左前胸上部和左肩部,形如“碗”状。T 波 BSPM 异常检测冠心病慢性心肌缺血的灵敏发为81.0%,特异度为90.0%,准确度为83.9%。     

QRS波群等电位图对陈旧性心肌梗死的诊断价值

为探讨QRS波群等电位对陈旧性心肌梗死的诊断价值,分析陈旧性心肌梗死36例、非心肌梗死168例QRS波群等电位图。结果显示:陈旧性心肌梗死组与非心肌梗死组在心室除极早期负电位的分布各具特征性。两组间的逆转时刻、负电位占据前胸时刻及最小值差异有显著意义(P<0.05)。QRS波群等电位图对心肌梗死诊断的敏感性、特异性分别为:前壁100％、98％;前间壁50％、100％;下壁90％、98.9％。认为QRS波群等电位图对诊断陈旧性心肌梗死有重要价值。     

核素心室造影评价不同部位心肌梗死患者的左室整体和局部功能

目的应用放射性核素心室造影技术对不同部位的左室心肌梗死（MI）患者进行左室整体和局部收缩和舒张功能参数的对比分析。方法选择对照组15例、下壁MI组24例、前壁MI组29例,利用放射性核素心室造影技术评价3组的左室整体和局部的收缩与舒张功能参数。结果①左室整体收缩功能,在左室射血分数和峰射血率二个参数中,下壁MI组与对照组相比有显著下降（P<0.05）,前壁MI组与对照组和下壁MI组相比,分别有显著下降（P<0.05）。②左室整体舒张功能,在峰充盈率和前1/3充盈分数二个参数中,前壁MI组与对照组和下壁MI组相比分别有显著下降（P<0.05）。③左室局部收缩功能,在以左室局部射血分数为参数时,下壁MI组在4个节段与对照组相比有显著下降（P<0.05）,前壁MI组在4个节段与对照组相比有显著下降（P<0.05）,前壁MI组在2个节段比下壁MI组有显著下降（P<0.05）。④左室局部舒张功能,在以LVR1/3FF为参数时,下壁MI组和前壁MI组分别与对照组相比在4个节段上有显著下降（P<0.05）,前壁MI组在2个节段上比下壁MI组有显著下降（P<0.05）。结论前壁MI对左室整体和局部收缩与舒张功能的损害重于下壁MI。     

识别真正有临床意义的T波改变

心室除极形成心电图（ECG）QRS波群,心电向量图（VCG）形成QRS环。心室除极是通过特殊传导系统,将激动电流迅速传给整个心室,正常时限为60～80ms。心室肌细胞在除极之后,均可自行恢复到极化状态,以行下次除极。所以,复极时间一般较除极时间长,     

心肌梗死后心室晚电位检测结果的分析

目的：探讨心肌梗死后心室晚电位（VLP）的阳性率。方法：采用泰安市医疗仪器研究所研制的SXG－7000VLP记录仪，x、y、z正交心电图双极导联，检测心肌梗死（MI）后3小时至1年不等患的心室晚电位。结果：80例MI患VLP阳性29例，阴性30例。AMI44例中VLP阳性15例（34．1％），陈旧性心肌梗死（OMI）36例中阳性14例（38．8％），前壁MI28例中阳性5例（17．8％），下壁MI 47例中阳性24例（51．0％）。结论：相比较而言，以急性心肌梗死，下壁心肌梗死的心室晚电位阳性率为高。     

体表电位标测、心电图和高频心电图诊断冠心病价值的对比研究

目的 :比较体表电位标测 （BSPM）、心电图 （ECG）和高频心电图 （HFECG）三种心电方法对冠心病 （CHD）的诊断价值。方法 :使用 BSPM- 型体表电位标测微机系统 ,对冠脉造影确诊的 60例 CHD患者和 60例正常人进行BSPM,并分析 T峰值图图形和极小值位置的变化。同时记录 ECG和 HFECG,并由专业人员盲法分析其变化 ,评价三种方法的诊断价值。结果 :ECG,HFECG和 BSPM诊断的敏感度分别为 67% ,87%和 85 % ,特异度分别为63% ,75 %和 90 % ,准确度分别为 65 % ,81%和 88%。诊断的敏感度 HFECG和 BSPM均显著高于 ECG（P<0 .0 5 ） ,特异度 HFECG与 ECG无差别 （P>0 .0 5 ） ,而 BSPM非常显著高于 ECG（P<0 .0 1） ,也显著高于 HFECG（P<0 .0 5 ）。结论 :ECG诊断 CHD的敏感度和特异度都较低 ,HFECG能提高敏感度 ,而 BSPM既能提高敏感度 ,又能提高特异度 ,BSPM是一种价值较高的 CHD诊断方法。     

心肌梗塞患者的心室晚电位分析

用美国 ART 体表高分辨心电图(HR-ECG)记录分析系统(ART-S),对正常人120例和冠心病心肌梗塞(MI)患者98例,作心室晚电位(VLP)检测和随访分析,发现 MI 患者的 VLP 阳性率为46.94%,VLP 与 MI 的部位、范围、室壁运动障碍以及恶性心律失常(MA)和心脏猝死有一定的关系,认为 VLP 对 MI 患者发生 MA 及猝死有一定的预测价值。     

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.