预防性置入主动脉内球囊反搏应用于高危冠心病患者行冠状动脉旁路移植术临床疗效分析

目的 探讨预防性置入主动脉内球囊反搏（Intra-aortic balloon pump ,IABP)在高危冠心病患者接受冠状动脉旁路移植术（Coronary artery bypass graft,CABG）中的临床疗效。方法 回顾并总结我院2013年01月-2020年06月175例CABG围术期行IABP置入术患者的临床资料,术前平均年龄（61.2±9.2）岁,其中男性131人（74.9%）。根据IABP置入时机分为预防性置入组（术前置入IABP）（n=66）和对照组（术中或术后置入IABP）（n=109）,对比分析两组患者临床资料。结果 两组患者一般基线资料差异无统计学意义（P>0.05）。与对照组相比,预防性置入组IABP支持时间（h,107.5±68.3 vs 130.4±72.6）,机械通气时间（h,76.9±82.1 vs 129.6±160.5）,ICU监护时间（h,145.9±99.9 vs 196.4±180.5）显著减少（P?0.05）。术后急性肾损伤（13.6% vs 28.4%）、低心排量综合征（0 vs 6.4%）、多器官功能衰竭（0 vs 7.3%）发生率降低,差异有统计学意义（P?0.05）。预防性置入组围术期死亡率（10.6%）低于对照组（22.9%）,差异有统计学意义（P?0.05）。结论 对于接受CABG治疗的高危冠心病患者,术前预防性置入IABP可降低患者围术期死亡率,降低术后急性肾损伤、低心排量综合征、多器官功能衰竭发生率,缩短IABP支持时间、机械通气时间、ICU监护时间。     

出院后停用他汀类药物治疗会增加老年急性心肌梗死患者远期死亡率：739例分析

目的 探讨老年急性心肌梗死（AMI）患者出院后终止他汀类药物治疗对其远期预后的影响。方法 对解放军总医院心血管内科2010年1月至2010年12月期间确诊为AMI并行经皮冠状动脉介入治疗（PCI）且符合入选标准的老年患者739例进行出院后随访。根据患者出院后1年内是否终止他汀类药物治疗将其分为终止他汀类药物治疗组（n＝178）和未终止他汀类药物治疗组（n＝561）,比较两组患者远期全因死亡率和心源性死亡率的差异。结果 对患者随访4年后发现,终止他汀类药物治疗的患者有更高的全因死亡率（21.4% vs 13.9%,HR＝1.62,95%CI：1.04～2.85,P＝0.008）和心源性死亡率（14.5% vs 8.1%,HR＝1.98,95%CI：1.26～3.64,P＝0.002）。结论 老年AMI患者出院后终止他汀类药物治疗会显著增加其远期死亡率,因此在患者出院前以及临床随访的过程中均需要对其他汀类药物的用药情况进行有效的教育和严格的监督,以期改善此类患者的远期生存情况。     

脾动脉栓塞治疗肝硬化继发脾脏功能亢进的临床效果观察

目的 探讨脾动脉栓塞术（PSE）治疗肝硬化继发脾脏功能亢进的临床效果.方法 选取我院肝硬化继发脾脏功能亢进患者80例,其中研究组48例,行脾动脉栓塞术;对照组32例,行脾脏切除术,比较两组患者的出血量、住院时间、术后恢复、并发症等.结果 与对照组比较,研究组患者的住院时间缩短、出血量减少,差异有统计学意义（P＜0.05）;两组患者术后不良反应比较,差异无统计学意义（P ＞0.05）;PSE后脾局部梗死后门静脉内径减小,与对照组比较差异无统计学意义（P＞0.05）.结论 PSE治疗肝硬化继发脾脏功能亢进临床效果显著,微创易恢复,门静脉宽度变窄,门脉压力降低.     

年龄对急性ST段抬高型心肌梗死患者急诊行经皮冠状动脉介入治疗术后发生对比剂诱发的急性肾损伤的影响

目的 探讨不同年龄对急性ST段抬高型心肌梗死患者急诊行经皮冠状动脉介入治疗（PCI）术后，发生对比剂诱发的急性肾损伤（CI-AKI）的影响。方法 回顾性分析2006年2月至2012年9月期间在沈阳军区总医院心内科监护病房住院的急性ST段抬高型心肌梗死且急诊行PCI术的患者1 685例。按年龄分为两组：＜60岁组（n＝932）和≥60岁组（n＝753）。比较两组患者的临床资料，对单因素分析有统计学意义的指标进行多因素logistic 回归分析，筛选出独立的危险因素。同时观察术后1个月、6个月、1年及3年两组患者发生主要心脏不良事件（MACE）和全因死亡的相关情况。结果 ≥60岁组患者CI-AKI发病率高于＜60岁组患者（14.7% vs 8.6%，P＜0.001）。年龄、既往心肌梗死病史和对比剂剂量是CI-AKI发生的危险因素。术后3年，≥60岁组患者的累积全因死亡率和心源性死亡率均明显高于＜60岁组患者（4.2% vs 1.5%，P＜0.001；1.5% vs 0.2%，P＝0.011）。结论 临床医师应慎重对待高龄患者，在术前充分评估患者心功能，在术中尽量精准使用对比剂剂量，以期预防CI-AKI的发生。     

动脉切开取栓联合股动脉置管治疗老年急性下肢动脉栓塞的疗效

目的探讨老年急性下肢动脉栓塞患者应用动脉切开取栓联合股动脉置管治疗的疗效。方法回顾性分析该院血管外科经动脉切开取栓联合股动脉置管治疗的老年急性下肢动脉栓塞患者的临床资料共34例(34条肢体),分析患者的一般资料、围术期情况及患肢的保肢率、再栓塞率等。结果 34例患者均取栓成功,术后踝肱指数(ABI)较术前明显改善(P<0.05),术后死亡2例,截肢1例。术后保肢率97.1%,死亡率5.9%。31例患者获得随访,随访6~30个月,平均(18±6)个月,随访期内死亡5例,无截肢病例。随访患者中21例术后长期(>1年)规律抗栓治疗,其中死亡1例,再次发生动脉栓塞1例;术后未长期规律抗栓治疗患者10例,其中死亡4例,再次发生动脉栓塞3例。结论对于老年急性下肢动脉栓塞的患者,动脉切开取栓联合股动脉置管是一种安全、有效的治疗手段,术后长期(>1年)规律的抗栓治疗能够有效降低死亡率和再次动脉栓塞的概率。     

高血糖对急性缺血性脑卒中老年患者溶栓后梗死体积与院内预后的影响

目的 了解就诊时血糖升高与急性缺血性脑卒中老年患者接受重组组织型纤溶酶原激活剂（rt-PA）溶栓后脑梗死体积变化及院内（发病后1周内）预后的关系。方法 发病后3h接受rt-PA的急性缺血性卒中老年患者,按照就诊血糖分为高血糖组与正常血糖组,采用磁共振检查评价溶栓各时间点血管再通率、脑梗死体积变化,并评价各时间段的国立卫生研究院卒中量表（NIHSS）评分及预后指标。结果 共44例纳入本研究,其中高血糖组24例,正常血糖组20例。溶栓即刻高血糖组患者梗死体积与正常血糖患者相比无明显差异[（29.5±56.2） vs （28.3±61.7）,P＝0.90],NIHSS评分明显增高[（17.7±6.6） vs （12.9±6.3）,P＜0.01];高血糖患者溶栓24h后血管再通率与出血转化率相同;发病后24h及1周,高血糖患者脑梗死体积更大[（121.7±101.1） vs （68.8±85.4）,P＝0.03;（170.8±163.9） vs （92.5±113.6）,P＝0.02],NIHSS评分更高[（14.3±6.9） vs （8.6±5.1）,P＜0.01;（8.8±7.4） vs （4.3±3.9）,P＜0.01],发病后1周,高血糖患者的不良预后的比例比正常血糖者明显升高（42% vs 15%,P＝0.05）。结论 就诊时高血糖对脑卒中老年患者rt-PA溶栓血管再通率及安全性无明显影响,高血糖与溶栓后院内梗死延展及预后不良明显相关。     

肺高压型复杂先天性心脏病患者雾化吸入糖皮质激素对术后急性肺损伤及肺功能不全的影响

目的 探讨吸入性糖皮质激素对肺高压型复杂先心病患者体外循环术后急性肺损伤和肺功能不全的疗效。方法 入组2015－2016年武汉亚洲心脏病医院就诊的肺高压型复杂先心病患者,所有患者在体外循环下行矫治术后随机分为两组：试验组给予布地奈德＋基础雾化剂,对照组给予生理盐水＋基础雾化剂,吸入方式、时间及剂量均相同,其他呼吸道管理措施及临床治疗原则无差异。对比分析主要观察指标及次要指标。结果 试验组在无创呼吸机时间、ICU时间及住院时间上短于对照组（43.67±25.52 vs 59.72±20.91,5.89±2.74 vs 7.83±2.31,10.50±6.37 vs 13.11±6.10,均P＜0.05）,其他主要指标无差异,各次要指标在观察阶段中后期试验组优于对照组（如术后第7天白细胞水平11.16±3.26 vs 13.62±3.19,P=0.028）,早期则无差异（如术后第3天白细胞水平15.07±3.22 vs 15.89±3.39,P=0.464）。结论 应用吸入性糖皮质激素可在一定程度上一定时间段内减轻术后急性肺损伤,促进肺功能恢复并缩短病程。     

早期康复护理对急性脑梗死患者动脉溶栓术后功能恢复的效果观察

目的评价早期康复护理对急性脑梗死患者动脉溶栓术后功能恢复的效果。方法将72例急性脑梗死患者随机分为早期康复护理组和常规护理组各36例,常规护理组术后按内科常规护理,早期康复护理组在此基础上予以早期康复护理,观察两组平均卧床时间、住院时间、便秘发生情况及生活自理能力。结果早期康复护理组平均卧床时间、住院时间较常规护理组缩短（P〈0．05）;便秘发生率低于常规护理组（P〈0．05）;出院前生活自理能力评分高于常规护理组（P〈0．05）。结论急性脑梗死患者动脉溶栓术后行早期康复护理,能有效改善患者运动功能,缩短住院时间,提高生活质量。     

缺血后适应对急性下肢动脉栓塞取栓术效果的影响

目的 探讨缺血后适应用于急性下肢动脉栓塞取栓术的效果.方法 将36例急性单侧髂股动脉栓塞患者随机分为对照组及观察组,每组各18例.两组均行常规DSA监视下动脉取栓术;观察组术中于缝合股动脉切口后、恢复下肢血流前行缺血后适应(阻断股动脉1 min、开放再灌注1 min,共3次).比较两组住院天数及手术后血肌酐、肌酸激酶水平及小腿骨筋膜室压力.结果 观察组及对照组住院天数分别为(5.4±1.0)、(6.6±1.2)d,(P＜0.01);观察组术后24、48 h血肌酐、肌酸激酶、小腿骨筋膜室压力均明显低于对照组(P＜0.01).结论 急性下肢动脉栓塞取栓术中行缺血后适应可减轻肢体急性缺血再灌注损伤.     

两种肾脏替代疗法治疗老年乳酸酸中毒患者的疗效比较

目的对比持续静脉-静脉血液滤过(CVVH)以及持续静脉-静脉血液透析(CVVHD)两种肾脏替代治疗对老年患者乳酸酸中毒的改善效果。方法 180例老年乳酸酸中毒患者随机分为CVVH组和CVVHD组,每组90例。所有患者均实施常规基础治疗,CVVH组在常规治疗的基础上采用CVVHD,均进行24 h持续治疗。监测并对比两组患者治疗前与治疗后4、8、12、24、48 h的血液乳酸、血生化、凝血功能与动脉血气;对比两组患者的ICU住院时间和住院病死率。结果与治疗前比较两组患者治疗后的乳酸水平与p H均得以显著改善;但在治疗前与治疗后4、8、12、24、48 h,两组患者之间的乳酸水平与p H无统计学差异(P>0.05)。两组患者的ICU住院时间〔(8.7±2.1 vs 9.0±2.6)d〕、住院病死率(11.1%vs.8.9%)差异无统计学意义(P>0.05)。结论 CVVH与CVVHD均可以有效清除老年乳酸酸中毒患者的乳酸水平,改善酸碱失衡状态,ICU住院时间与住院病死率无显著差异。     

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.