经静脉胸前植入单导线植入型心律转复除颤器

目的：总结15倒经静脉胸前植入单导线植入型心律转复除颤器的临床应用结果。方法：15例患者，男性13例，女性2例，平均年龄51．7岁。患者植入ICD适应证为：心室颤动(室颤)8倒，顽固性室性心动过速(室速)7倒。所有患者均有院外晕厥史。ICD均为非开胸经静脉单导线系统，其中Medtronic 7219C型2例，7220C型3倒。除颤电流由右心室心内线圈状电极至除颤器外壳本身。CPI Ventak PR×Ⅱ10例，除颤电流由右心室远端线圈状电极至近端线圈状电极。结果：15例患者均成功地植入了经静脉单导线ICD。平均除颤阐值为12．8J(5～15J)。R渡高度为9．9mV(3．7～14．6mV)．电极导线插入途径14例经左锁骨下静脉，1例经右头静脉到右心室。1CD埋于患者晌前壁肌肉下(11例)或皮下(4例)囊袋，2例发生囊袋血肿，经挤压排出血块、局部压迫纠正。平均随访76个月(0．5～18个月)，有3例患者发生了室速，由ICD抗心动过速起搏及低能量电转复终止。1例室颤经高能量除颤终止。结论：经静脉胸前植入单导线ICD是一种操作简单、陈颤效果满意的植入方法。     

除颤电极穿破心肌后再放置致高除颤阈值一例

1例多形性室性心动过速(VT)患者置入埋藏式心脏转复除颤器(ICD),术中测试除颤阈值(DFT)20 J,术后出现心包压塞重新调整电极位置,未重复测试DFT。随访中患者多次发生VT/心室颤动但ICD复律失败,系高除颤阈值所致,经过无创处理无效,放置新电极并调整电极位置得到解决。     

植入型心律转复除颤器治疗与相关技术的最新进展

植入型心室复律除颤器即通常所指的植入型心律转复除颤器 (ICD) ,是目前公认防治致命性室性心律失常 (室速/室颤 )的一线治疗措施。广义上讲 ,植入型心律转复除颤器还包括植入型心房复律除颤器 (IAD)和房室双腔复律除颤器。近年来IAD的实验研究不断增多 ,并已在临床小规模应用 ,可望成为治疗房颤的另一有效手段。房室双腔复律除颤器集IAD和ICD功能于一身 ,能够放电终止房颤、室速和室颤。1　植入型心房复律除颤器目前临床应用的IAD ,体积与普通起搏器相仿 ,重量在10 0g以内 ,除颤脉冲波形为双相 ,放电能量 2～ 10J。其右心房电极主…     

射频消融治疗植入型心律转复除颤器术后电风暴

植入型心律转复除颤器（ICD）已经成为威胁生命的室性心律失常治疗首选方法。但一些患者术后由于无休止室性心动过速（室速）接受多次电除颤治疗,即ICD电风暴^[1]。射频消融在电风暴治疗中越来越受到重视。本文回顾了近两年本中心ICD及心脏再同步治疗除颤器（CRT—D）术后电风暴患者射频消融治疗的经验。     

高除颤阈值的处理(附三例报道)

3例置入埋藏式心脏转复除颤器(ICD),其中1例术中未测试除颤阈值(DFT),术后随访发现ICD多次电复律失败,经过调整除颤脉宽、关闭上腔静脉线圈等无创处理无效,放置新电极并调整电极位置得到解决。2例术中测试DFT大于20 J,1例改变除颤极性后DFT降至20 J以下,另1例通过调整除颤脉宽及电极位置得到解决。     

除颤电极放置于右室流出道的可行性研究

目的比较于右室流出道(RVOT)和右室心尖部(RVA)植入除颤电极的阈值、安全性和疗效的差异。方法按时间先后顺序选取符合入选条件的患者共19例,将除颤电极导线放置于RVA(n=11)或RVOT(n=8),采用双相查找的方法进行除颤阈值的测试。术后6个月随访,对导线的相关参数进行测试,对埋藏式心脏转复除颤器(ICD)记录的相关数据进行统计分析。结果RVA的除颤阈值和RVOT相比,差异无显著性(中位数:15Jvs17.5J,P=0.48);在ICD植入时,两个部位的起搏阻抗、R波振幅、起搏阈值的比较,差异亦无显著性;RVA和RV-OT不恰当识别及治疗事件的发生率无显著差异(4/11vs1/8,P=0.267)。结论RVOT的除颤和起搏效率与RVA相似。     

三腔自动复律除颤器除颤能量确定

美国学者Schuger等对双室起搏加自动复律除颤器植入(ICD-R)患者进行除颤能量研究(DER),确定其真实的除颤阈值及安全边界,并与传统ICD比较,研究2者相关性。对VENTAK CHF/CONTAK CD双室起搏研究中所纳入的患者进行回顾性调查,并随机抽取501人接受该研究。在低限10J基础上应用21J或更少的能量进行诱导性室性心动过速或心室颤动转复,实验标准是相同条件下成功复律2次。用多因素回归分析方法确定导致研究失败的基线预测因子。501位受试者中,有444人(89%)在预定的能量范围内成功转复,获得预期效果。剩余的57人,有34人转复能量大于21J…     

心脏复律除颤器植入术中除颤阈值测试的现代观点

早期埋藏式心脏复律除颤器装置可靠性差,除颤失败率高,对快速的室性心律失常（室性心动过速）或心室颤动事件唯一的治疗方法是电击;因此在植入埋藏式心脏复律除颤器时常规进行除颤阈值测试。现代埋藏式心脏复律除颤器的性能较前明显改善,除颤性能提高,经静脉途径植入埋藏式心脏复律除颤器的平均除颤阈值是20～30J,低于埋藏式心脏复律除颤器最大输出能量,且除颤阈值测试可给患者带来一定的危险;因此许多临床心脏电生理学者开始质疑埋藏式心脏复律除颤器植入术中除颤阈值测试的价值。     

ICD的无痛性治疗

以植入型心律转复除颤器(implantable cardiovert-er defibrillator,ICD)的治疗功能而论,第一代ICD的治疗仅有高能量的电击除颤,第二代的ICD增加了感知功能,对发生的室性心动过速(室速)能进行同步性低能量或高能量的电转复治疗,直到第三代ICD,才增设了室速的抗心动过速起搏与一     

心脏三腔起搏除颤器的临床应用

目的　评价具有心脏再同步化治疗 (CRT)和置入式心脏复律除颤器 (ICD)功能起搏器(CRT D)置入的安全性和有效性。方法　共 11例患者纳入研究。年龄 4 8～ 84 (71 6± 9 5 )岁 ,男 7例 ,女 4例。患者有心脏猝死或室性心动过速或电生理检查出现室性心动过速或心室颤动 ;左室射血分数≤ 35 % ,QRS≥ 12 0ms。所有患者置入的CRT D是美敦力INSYNCⅡMARQUIS 72 89,左心室电极置于冠状静脉窦左心室侧后壁分支或左后壁分支。右心房电极和右心室电极都使用主动螺旋电极 ,后者置于室间隔上部。手术在全麻下进行。术后次日在心脏超声指导下进行AV优化。结果　所有患者顺利度过手术 ,无并发症。放射时间为 19～ 73(44 7± 19 9)min。心房电极的振幅、阻抗和阈值分别为 (2 4 7± 0 77)mV、(5 90± 12 6 )Ω、(1 37± 0 71)V。右心室电极的振幅、阻抗和阈值分别为 (11 0 0± 3 4 8)mV、(5 86± 116 )Ω、(0 6 9± 0 2 1)V。左心室电极的振幅、阻抗和阈值分别为(15 37± 5 .15 )mV、(6 0 2± 12 5 )Ω、(1 6 2± 1 5 9)V。除颤阈 2 0J和 6J的各 3例 ,15J、12J和 3J各 1例。 1例患者因为原有除颤电极失效而更换为皮下电极 ,但仍除颤失败。另 1例患者因为出现心电图ST T变化而暂时未测定除颤阈值。所有患者除颤能量     

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.     

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.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.