右束支阻滞对急性心肌梗死预后的判断

目的 :观察并发右束支阻滞的急性心肌梗死 (AMI)患者的临床预后。方法 :将该院近 7年收治的2 39例AMI患者分为两组 :对照组 ,无新发的右束支阻滞 ;观察组 ,为伴有新出现的右束支阻滞。后者又根据右束支阻滞持续时间长短及是否并发其他传导阻滞分为 4个亚组。分析各组并发心功能不全、恶性室性心律失常及住院病死率的情况。结果 :观察组恶性室性心律失常的发生率、心功能受损及住院病死率分别为 19.0 %、4 7.6 %、30 .0 % ,较对照组相应的 3.0 %、19.8%、17.3%有显著增加 (P <0 .0 5 ) ;但后二者并非源自于单纯右束支阻滞 ,而与并发的其他传导阻滞有显著相关性 (P <0 .0 5 ) ;右束支阻滞持续时间周期对心功能受损及住院病死率的影响亦有明显相关性 (P <0 .0 5 )。结论 :伴随AMI新出现的右束支阻滞使患者的预后不良     

急性心肌梗死并发右束支传导阻滞的预后

目的　了解伴随急性心肌梗死出现的完全性右束支传导阻滞的临床特点和预后意义。方法　观察有新出现持续性完全性右束支传导阻滞的急性心肌梗死患者 2 0例 (观察组 ) ,同期收治的无右束支传导阻滞的急性心肌梗死患者 184例 (对照组 )的CK峰值、Killip分级、严重心律失常发生率、LVEF和住院病死率等情况。结果　观察组CK峰值15 30± 10 6 9U/L及CK -MB峰值 2 39± 16 5U/L明显高于对照组 95 6± 713U/L及 117 1± 6 0 6U/L ,P <0 0 1。观察组Killip平均级别 (2 5 5± 0 95 )明显高于对照组 (1 71± 0 82 ) ,P <0 0 1。观察组室性恶性心律失常发生率 2 0 % ,明显高于对照组3 8%P均 <0 0 1。观察组的住院病死率 30 %显著高于对照组 7 1% ,P <0 0 1。结论　急性心肌梗死出现持续性完全性右束支传导阻滞提示临床病情危险 ,预后不良     

急性前壁心肌梗死合并RBBB的临床特点

目的 探讨急性前壁心肌梗死合并右束支阻滞(RBBB)的临床特点.方法 回顾性对比分析2016年5月至2021年6月在我院住院治疗的急性前壁心肌梗死合并与不合并右束支阻滞的患者的临床经过、心电图和预后.结果 观察组为急性前壁心肌梗死合并右束支阻滞患者,共有81例,其中48例为急性ST段抬高型心肌梗死,33例为急性非ST段...     

急性心肌梗死患者新出现右束支阻滞的意义

目的探讨心肌缺血事件发生时心电图新出现的右束支阻滞在急性心肌梗死中的临床意义。方法对给予经皮冠状动脉成形术的急性心肌梗死患者80例做回顾性分析,术前心电图有新出现右束支阻滞14例为观察组,无束支阻滞62例及新出现左束支阻滞4例为对照组。研究右束支阻滞出现及再灌注后持续的时间,并对其一般情况、心肌酶学(CK-MB)、心梗部位、心功能分级(Killip分级)、罪犯血管、心律失常及病死率情况分析。结果右束支阻滞出现时间为超级性期或急性期。观察组心肌酶学(CK-MB)最高值明显高于对照组1(p0.05),然而和对照组2比较无统计学意义(p0.05)。观察组的心功能差,和对照组1比较有统计学意义(p0.05);右束支阻滞组恶性心律失常发生率高,和其他两组比较均无统计学意义(p0.05)。结论心肌缺血症状30min的患者,超急性期或急性期新出现的右束支阻滞对急性心肌梗死有一定诊断价值,且可以协助判断罪犯血管及对病情评估。     

急诊PCI对急性心肌梗死合并新发右束支传导阻滞患者左室重构的影响

目的探讨急诊经皮冠状动脉介入治疗（PCI）对急性心肌梗死合并新发右束支传导阻滞患者左室重构的影响。方法86例新发右束支传导阻滞的AMI患者随机分为急诊PCI治疗组（45例，观察组）及静脉溶栓治疗组（41例，对照组），分别于人院后24h、I周、1个月及3月行超声心动图检查，测量左心室舒张末期容积指数、左心室收缩末期容积指数和左心室射血分数。结果急诊PCI组与静脉溶栓治疗组于术后1个月及3个月左心室容积均减小，左心室射血分数升高；术后3个月两组左心室舒张期末容积指数[（63．4±5．8）ml／m^2比（67．3±6．4）ml／m^2]、左心室收缩期末容积指数[（30．5±3．4）ml/m^2比（34．6±4．0）ml／m^2]和左心室射血分数[（0．53±0．04）％比（0．50±0．02）％]，差异有统计学意义。结论急诊PCI治疗可明显抑制新发右束支传导阻滞的急性心肌梗死患者左室重构，改善左心室功能。     

慢性阻塞性肺病心电图改变的临床意义

目的 研究探讨慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)的心电图表现以及相关的临床意义.方法 回顾性分析2006年4月至2010年10月在我院住院诊断为COPD患者的住院病历资料60例,男30例,女30例.心电图结果均为专业心电图医师对标准十二导联心电图进行的分析诊断,将不同心电图表现进行比较.结果 18例为前间壁心肌梗死,其中男12例,女6例.3例为非梗死性Q波,5例为不完全性右束支阻滞,4例为完全性右束支阻滞,窦性心动过速10例,肺型P波6例,ST-T改变5例,房性期前收缩6例,室性期前收缩3例.结论 COPD患者易并发前间壁心肌梗死,且男性患者发病率多于女性.     

右束支传导阻滞在急性心肌梗死中的临床意义

目的　评价伴随急性心肌梗死 (AMI)出现的右束支传导阻滞 (RBBB)的临床意义。方法　 2 94例 AMI分为RBBB组和非 RBBB组 ,比较两组患者的年龄、梗死部位、血清磷酸肌酸激酶 (CK)及其同工酶 (CK- MB)水平、心功能状态、严重并发症及住院死亡率。结果　 RBBB组血清 CK、CK- MB平均峰值为 (2 2 82 .0± 6 74.3) u/ L、(2 5 2 .6±137.3) u/ L ,明显高于非 RBBB组的 (192 0 .4± 5 6 9.2 ) u/ L、(114.8± 5 6 .7) u/ L (P<0 .0 0 5和 P<0 .0 1)。 RBBB组killip平均级别为 2 .33± 0 .5 4级 ,非 RBBB组为 1.46± 0 .6 3级 (P<0 .0 5 ) ,RBBB左心室舒张期末内径 (5 3.2± 9.6 m m )大于非 RBBB组 (4 5 .8± 8.2 m m,P<0 .0 5 ) ,左心室射血分数 [(4 8.9± 7.6 ) %]小于非 RBBB组 [(6 7.0± 3.7) %,P<0 .0 1]。 RBBB组心脏并发症发生率和住院死亡率高于非 RBBB组 (分别为 70 .8%和 39.0 %,P<0 .0 1;43.8%和 14.6 %,P<0 .0 1)。结论　 AMI并 RBBB患者梗死面积大 ,严重心脏并发症发生率和住院死亡率高。     

急诊经皮冠状动脉介入治疗对急性心肌梗死并发右束支传导阻滞患者临床及近期预后的影响

目的:探讨急诊经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)并发右束支传导阻滞患者临床及预后的影响。方法:92例新发右束支传导阻滞的AMI患者被随机分为急诊PCI治疗组(观察组,47例)及静脉溶栓治疗组(对照组,45例)。测定2组肌酸激酶(CK)及CK同工酶(CK-MB)峰值水平,左心室舒张期末容积指数、左心室收缩期末容积指数、左心室射血分数;观察严重心律失常、梗死后心绞痛发生情况、住院期间病死率。结果:与对照组比较,观察组术后CK及CK-MB峰值水平明显减低;术后3个月左心室容积减小,左心室射血分数升高;严重心律失常、梗死后心绞痛发生率、住院期间病死率明显减低,差异均有统计学意义(均P<0.05)。结论:急诊PCI治疗对改善AMI并发右束支传导阻滞患者预后有积极的影响。     

急性心肌梗塞早期左心室容积参数与收缩功能关系的研究

目的 :研究急性心肌梗塞早期左心室收缩末容积、左心室舒张末容积、每搏搏出量及左心室射血分数改变特点及其相互关系和意义。　　方法 :首次急性心肌梗塞患者 37例为患者全组 ,平均年龄 6 1.2± 10 .0岁 ,平均发病时间 6 .6± 5 .8小时 ,其中前壁组 2 2例 ,下壁组 15例 ,另设正常对照组 11例。采用双探头门控单光子发射计算机断层摄影系统采集心肌显像资料 ,由计算机内已设程序自动计算左心室射血分数及各容积参数。　　结果 :1左心室舒张末容积 :患者全组为 110 .0± 45 .2 ml,其中前壁组和下壁组分别为 12 5 .4± 43.9ml和 87.9±38.3ml,正常对照组为 74.7± 12 .2 ml,患者全组与正常对照组、下壁组和前壁组间均差异显著 (P<0 .0 5 )。 2左心室收缩末容积 :正常对照组 ,患者全组 ,前壁组和下壁组分别为 2 5 .3± 5 .8ml,6 4.0± 35 .9ml,79.0± 33.7ml和 42 .0±2 7.3ml。正常对照组与患者全组之间差异十分显著 (P<0 .0 0 1) ,前壁组与下壁组之间差异显著 (P<0 .0 1)。 3每搏搏出量 :正常对照组 ,患者全组 ,前壁组和下壁组四者两两之间均无差异。 4左心室射血分数 :患者全组显著低于正常对照组(0 .6 6± 0 .0 5比 0 .45± 0 .13,P<0 .0 0 1) ,前壁组低于下壁组 (0 .38± 0 .0 8比 0 .5 5± 0 .11,P<0     

108例急性前间壁心肌梗死患者右胸导联心电图分析

1990年以来,我们对住院的冠心病患者常规作18导联心电图,即除常规12导联外,加作V_(3R)—V_(5R)和V_7—V_9导联心电图。现就108例急性前间壁心肌梗死患者的右胸导联(V_(3R)—V_(5R))心电图作初步分析。 资料和方法 1.病例选择 108例急性心肌梗死患者均符合下述条件:(1)病史、心电图和心肌酶学检查确诊为急性心肌梗死。(2)发病后14h内入院并有完整18导联心电图资料和心肌酶学检查。(3)心电图定位为急性前间壁心肌梗死。(4)除外急性下壁、后壁和侧壁梗死,并除外右心室肥大、肺心病、心包炎、心肌病和束支传导阻滞等。男76例,女32例,年龄36—78(平均54.9±12.6)岁。另设对照组120例,为近2年来干部健康体检者。对照组除确定不患有心肌梗死外,其它方面如年龄、性别等与急性心肌梗死组均无差别。     

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.