高血压病患者发生心房颤动的预测因素

目的评价高血压病患者发生心房颤动(AF)的影响因素.方法回顾性分析97例高血压病患者,通过观察临床症状、24 h动态血压(AMBP)、12导联心电图、超声心动图.结果随访(25±3)月,19例(19.5%) 发生AF,3例 (15.8%) 发生脑栓塞,AF组患者年龄明显增加,AMBP平均日间收缩压 (SBP) 、平均夜间SBP明显增加,最大P波间期(P-max) 和P波离散度 (P-dis) 明显延长,左心室质量 (LVM) 和左心房内径 (LAD) 明显增加,舒张期二尖瓣A波流速(VA)明显减少.多因素分析提示:年龄(OR 3.28,P＜0.001)、平均日间SBP(OR 1.35,P＜0.01)、平均夜间SBP(OR 1.16,P＜0.01)、P-max(OR 2.09,P＜0.01)、P-dis(OR 2.52,P＜0.001)、LVM(OR 1.43,P＜0.01)、LAD (OR 2.81,P＜0.001)、和VA(OR 2.24,P＜0.01)为房颤发生的独立预测因素.结论年龄、24 h AMBP日间SBP、夜间SBP、LAD和LVM的增加、P-max和P-dis延长、A波流速的减少是预测AF因素.     

苯那普利对原发性高血压并阵发性房颤的干预研究

目的探讨原发性高血压(EH)合并阵发性心房颤动(PAF)患者血清内皮素(ET)、血管紧张素Ⅱ(AngⅡ),P波最大时限(Pmax)、P波离散度(Pd)和左心房内径(LAD)的变化,苯那普利的干预作用及预防PAF的机制。方法选择24例健康人做对照(正常对照组),另选择1、2级EH并PAF的患者53例,采用放射免疫法测定血清中ET、AngⅡ浓度,通过12导联同步心电图测定Pmax、Pd,采用彩色多普勒诊断仪测量LAD,观察苯那普利、利尿剂对ET、AngⅡ、Pmax、Pd、LAD的影响及预防PAF的效果。结果1、2级EH并PAF组血清ET、AngⅡ浓度明显高于正常对照组(P<0·001),Pmax、Pd、LAD明显大于正常对照组(P<0·001),EH并AF病人服用苯那普利6月后,血清ET、AngⅡ浓度明显降低,Pmax、Pd明显减小(P<0·05~0·01),LAD无明显扩大(P>0·05)。随访6月中苯那普利组房颤发作次数和持续时间明显低于利尿剂组(P<0.001)。结论ET、AngⅡ、Pmax、Pd、LAD在EH并PAF病人中明显增加,苯那普利可降低ET、AngⅡ、Pmax、Pd,延缓LAD的扩大,预防PAF的复发。     

女性特发性房颤相关危险因素分析

目的:探讨女性特发性房颤的危险因素及预测女性特发性房颤的指标.方法:选择80例女性特发性房颤患者(房颤组)和80名年龄和生活方式匹配的无房颤女性对照者(对照组).比较两组收缩压(SBP)、舒张压(DBP)、体重指数(BMI)、P波最大时限(Pmax)、P波离散度(Pwd)、心肌缺血总负荷(TIB)和左心房内径(LAD)等指标.以Pmax≥110 ms,Pwd≥40 ms为阳性判定标准,评估Pmax、Pwd及Pmax联合Pwd预测女性特发性房颤的价值. 结果:房颤组SBP、DBP、Pmax、Pwd、TIB和LAD均高于对照组(P值均<0.01).多因素Logistic回归分析显示,临界高血压(OR=0.033,95%CI:0.003～0.347,P<0.01)和Pwd增加(OR=287.079,95%CI:35.265～2337.031,P<0.01)与女性特发性房颤密切相关.Pmax、Pwd和Pmax联合Pwd对女性特发性房颤的阳性预测率分别为81.93%、88.61%和89.86%. 结论:心电图Pwd增加和临界高血压是女性特发性房颤的重要危险因素,联合应用Pmax和Pwd可有效预测女性特发性房颤.     

女性特发性房颤相关危险因素分析

目的：探讨女性特发性房颤的危险因素及预测女性特发性房颤的指标。方法：选择80例女性特发性房颤患者（房颤组）和80名年龄和生活方式匹配的无房颤女性对照者（对照组）。比较两组收缩压（SBP）、舒张压（DBP）、体重指数（BMI）、P波最大时限（Pmax）、P波离散度（Pwd）、心肌缺血总负荷（TIB）和左心房内径（LAD）等指标。以Pmax≥110ms,Pwd≥40ms为阳性判定标准,评估Pmax、Pwd及Pmax联合Pwd预测女性特发性房颤的价值。结果：房颤组SBP、DBP、Pmax、Pwd、TIB和LAD均高于对照组（P值均〈0．01）。多因素Logistic回归分析显示,临界高血压（OR=0．033,95％ CI：0．003～0．347,P〈0．01）和Pwd增加（OR=287．079,95％ CI：35．265～2337．031,P〈0．01）与女性特发性房颤密切相关。Pmax、Pwd和Pmax联合Pwd对女性特发性房颤的阳性预测率分别为81．93％、88．61％和89．86％。结论：心电图Pwd增加和临界高血压是女性特发性房颤的重要危险因素,联合应用Pmax和Pwd可有效预测女性特发性房颤。     

高血压病并发阵发性心房颤动P波离散度的研究

为研究P波离散度 (Pd)与高血压病阵发性心房颤动 (PAF)的关系。采用体表心电图和超声心动图测量高血压病并发PAF患者(Ⅰ组)的最大P波时限 (Pmax)、Pd、左房内径 (LAD)、左室重量(LVM)、左室射血分数 (LVEF)、A峰速度、E峰速度,并与 92例无PAF病史的高血压病患者 (Ⅱ组 )进行比较。结果:Ⅰ组Pmax、Pd、LVM和LAD显著高于Ⅱ组 (P<0. 01), A峰速度和LVEFⅠ组显著低于Ⅱ组(P<0. 05),Pmin和E峰速度两组无统计学差异。单因素回归分析: Pmax、Pd、LAD、LVEF和A峰速度均是PAF的预测因子,多因素回归分析仅Pd是PAF的独立预测因子。结论:Pd是高血压病并发PAF的独立预测因子。     

儿童肥胖与炎症指标、糖代谢与血压的关系

儿童肥胖与高血压、高血脂、糖代谢紊乱有关。颈动脉中内层厚度(I MT)是早期动脉粥样硬化的无创指标。该文收集98名肥胖儿童(平均11岁)临床资料,对照组是25例非肥胖同龄儿童。肥胖儿童的I MT中位数为0·6 mm(对照组0·4 mm,P<0·01),I MT与BMI明显相关(r=0·38,P<0·01),体脂百分数(r=0·39,P<0·001),SBP(r=0·39,P<0·001),DBP(r=0·29,P=0·002),血糖(r=0·30,P=0·001),高敏CRP(r=0·29,P=0·002)等明显相关。多因素逐步回归证明I MT与BMI(R2=0·05,P=0·044),SBP(R2=0·15,P=0·013),血糖(R2=0·05,P=0·028),高敏CR…     

腹主动脉结扎引起高血压大鼠心房结构和电生理变化

目的研究腹主动脉结扎大鼠心房结构和电生理特征变化,探讨高血压相关性房颤的发病机制。方法雄性SD大鼠随机分为非手术组(对照组,n=12)和腹主动脉结扎组(实验组,n=12),两组喂养时间均为4周。4周后动物麻醉,描记I导体表心电图,经左侧颈总动脉插管测量收缩压和舒张压。在心脏体外灌流条件下,采用心房短阵刺激评价房间传导时间(IACT)和心房对刺激的反应。取心房组织制作切片,Masson染色,测量纤维组织占总区域的百分比。结果实验组血清AngⅡ水平较对照组明显升高[(1·76±0·5vs0·97±0·4)ng/mL,P<0·01],P波持续时间和IACT也较对照组延长[分别为(27·8±5·1vs23±4·5)ms,P<0·05和(37·3±5vs23·1±3·3)ms,P<0·01],在实验组诱发出4例AF;对照组没能诱发出AF。组织学发现实验组心房纤维组织明显增加,纤维化程度与AF的诱发有相关性(OR=5·75,P<0·01)。结论腹主动脉结扎大鼠心房纤维化程度增加,P波时限增宽,IACT延长,心房有效不应期没有改变。心房纤维化程度增加可能是AF诱发率升高的原因。     

阵发性心房颤动预测因素研究

目的　研究阵发性心房颤动 (PAF)的预测因素。方法　 PAF组 5 9例 ,对照组 31例。同步记录 12导联心电图 ,测量 P波离散度 (Pdis)、P波最大时限 (Pm ax) ;应用超声心动图测量左心房内径 ,计算左室心肌重量指数。结果　与对照组比较 ,PAF组 Pmax、Pdis、左房内径显著增大 (P<0 .0 1) ;Pmax与左房内径和左室心肌重量指数呈正相关 (r =0 .2 6 ,P <0 .0 5 ;r =0 .2 7,P <0 .0 5 ) ;结论　左房内径和 Pm ax为 PAF的独立预测指标 ,P波宽度与左房内径扩大和左室心肌重量指数增加有关。     

P波最大时程和离散度预测房性期前收缩触发心房颤动的价值

目的探讨体表心电图最大P波时程(Pmax)、P波离散度(Pdis)预测房性期前收缩触发阵发性心房颤动(PAF)的价值。方法回顾分析房性期前收缩触发PAF者46例和未触发PAF者84例,比较两组患者Pmax、Pdis的特点。结果房性期前收缩触发PAF患者Pmax、Pdis明显大于房性期前收缩未触发PAF者(P<0.001);以Pmax≥120ms预测PAF发生的敏感性为80.45%(37/46),特异性82.14%(69/48),准确性80.15%,Pdis≥45ms为标准,预测房性期前收缩触发PAF的敏感性为71.74%(33/46),特异性为91.67%(77/84),准确性为84.62%;Pmax≥120ms及Pdis≥45ms同时超过标准时,联合预测PAF,则敏感性为60.62%,特异性为98.51%,准确性为88.46%。结论Pmax≥120ms、Pdis≥45ms可能是预测房性期前收缩触发PAF的良好指标。     

原发性高血压患者夜间血压水平与左室重塑及高敏C一反应蛋白的关系

目的 探讨原发性高血压患者(EH)夜间血压水平与左室重塑及高敏C-反应蛋白(hs - CRP)的关系.方法 140例EH按夜间平均血压增高与不增高分为两组.观察组62例,对照组78例,进行24 h动态血压监测、超声心动图、hs - CRP测定.结果 观察组夜间的最高收缩压(SBP)及舒张压(DBP)、最低SBP、平均SBP和DBP与对照组比较,差异有统计学意义(P＜0.05);观察组左心房内径(LAD)、室间隔厚度(IVST)、左心窒后壁厚度(LVPWT)、左心室重量(LVM)、左心室重量指数(LVM),与对照组比较有统计学意义(P＜0.05)).观察组hs - CRP和对照组比较明显升高(P＜0.05).结论 EH夜间平均血压增高患者,左室重塑较重,hs - CRP水平增高,炎症介质可能加重了左室重塑的过程.     

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.     

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.     

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.     

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.