心室再同步起搏治疗慢性心力衰竭伴室内传导延迟患者的近期观察

目的　观察双心室同步起搏治疗慢性心力衰竭 (心衰 )的临床效果。方法　慢性心衰伴心室内传导延迟患者 56例 ,男性 43例 ,女性 1 3例 ,平均年龄 52 9岁。心功能均在Ⅲ～Ⅳ级 (NYHA) ,体表心电图QRS波平均为 (1 4 3 1± 1 9 4)ms。其中 5例为慢性心房颤动 (房颤 ) ,其余为窦性心律患者 ,患者均进行了双心室同步起搏。慢性房颤患者先行房室结消融术。术前先进行逆行冠状静脉窦造影了解冠状静脉窦分支血管分布 ,然后将起搏电极导线分别置于右心房、右心室及冠状静脉窦分支血管起搏左心室 ,慢性房颤患者仅进行左、右心室起搏。观察双心室起搏前后左心室射血分数变化以及体表心电图QRS波变化。结果　双心室同步起搏后 ,患者心功能得到明确改善 ,左心室射血分数从 (2 6 1± 7 6) % ,提高至 (34 2± 8 9) % (P <0 0 5) ,左心室充盈时间延长 ,二尖瓣反流量减少。心功能平均改善Ⅰ级。QRS波时限由术前的 (1 4 3 1± 1 9 4)ms缩短至 (1 2 4 8± 1 6 7)ms(P <0 0 5)。结论初步临床观察提示 ,双心室同步起搏可有效改善慢性心衰伴心室内传导延迟患者的近期心功能 ,远期效果有待进一步观察     

三腔双心室起搏治疗20例充血性心力衰竭患者的近期临床效果

目的 观察三腔双心室同步起搏治疗充血性心力衰竭的临床效果。方法 充血性心力衰竭伴心室内阻滞患者20例,男性16例,女性4例,平均年龄54.7岁。心功能均在Ⅲ-Ⅳ（NYHA分级）,体表心电图平均QRS时限为142.6ms。患者均进行了三腔双心室同步起搏,起搏电极导线分别置于右心房、右心室以及经由冠状静脉窦置于一支心脏静脉起搏左心室。观察双心室起搏前后左心室射血分数变化以及体表心电图QRS波变化。结果 双心室同步起搏后,患者心功能得到明显改善,左心室射血分数（left ventricular ejection fraction,LVETF)从24.4%提高至32.1%,左心室充盈时间延长,二尖瓣返流量减少,心功能从Ⅲ-Ⅳ级改善至Ⅱ-Ⅲ级,QRS时限由术前的142.6ms缩短至124.8ms。结论 初步临床观察提示,三腔双心室同步起搏可有效改善充血性心力衰竭伴心室内阻滞患者的心功能。     

普通心室电极在双室右房三心腔起搏治疗充血性心力衰竭中的初步应用

目的 观察普通心室电极起搏治疗扩张性心肌病（DCM）伴充血性心力衰竭（CHF）的疗效。方法患者,男,2例,女2例,平均年龄62.6岁±7.7岁（52岁～70岁）,均为扩张性心肌病伴充血性心衰,且有完全性左束支传导阻滞或左前分支传导阻滞,行双室右房三心腔起搏治疗。左心室起搏通过冠状静脉窦植入剪去一部分尖端羽翼的普通心室电极,置于冠状静脉窦的分支静脉起搏左心室,左右心室电极导线通过Y形转换器与双腔起搏器心室孔相连接。结果 以普通心室电极起搏并辅以合适的房室间期（AVP）,患者心力衰竭的症状明显改善,NY-HA心功能分级从Ⅲ～Ⅳ级提高到Ⅰ～Ⅱ级,超声心动图示心功能指标改善,起搏后心电图QRS时限缩短,其中一例患者已基本上停止服药数月。结论 初步临床应用表明,普通心室电极实行双心室同步起搏治疗心力衰竭既行之有效,又价廉物美。     

双心室起搏治疗慢性心力衰竭的临床疗效

目的评价双心室起搏对改善慢性心力衰竭(心衰)心功能及心室重塑的作用. 方法超声检查左心室射血分数(LVEF)＜35%,二尖瓣中、重度反留,A、E峰融合,QRS波群时限＞120ms的心衰患者11例(男7例,女4例),年龄(65±11)岁,NYHA心功能Ⅲ级6例,Ⅳ级5例,植入三腔双心室起搏器,左心室电极导线经冠状静脉窦插入抵达侧静脉或后侧静脉以达到左心室起搏夺获.     

双心室起搏治疗充血性心力衰竭

探讨双心室起搏技术治疗慢性充血性心力衰竭的临床疗效。 11例充血性心力衰竭患者 ,男 9例、女 2例 ,年龄 5 4± 7岁。心功能 (NYHA)Ⅲ～Ⅳ级 ,均伴有心室内传导阻滞。全部患者置入三腔双心室起搏器 ,左心室电极置于冠状静脉侧支及后侧分支内。结果 :手术全部成功。所有患者于置入后症状改善 ,体表心电图QRS时限由 15 9.8± 4 .4 2ms缩至 130 .5± 3.6 9ms ,P <0 .0 1。随访 6～ 18个月 ,超声心动图显示左室射血分数由 0 .2 5± 0 .0 5增至 0 .38± 0 .0 5 ,P <0 .0 1、舒张期充盈改善、二尖瓣返流减少。结论 :双心室起搏可以改善药物控制困难的伴室内传导阻滞的心衰患者的临床症状 ,改善心功能 ,提高生活质量。     

双心室再同步治疗难治性心力衰竭

目的观察双心室再同步治疗对药物难治性心力衰竭的临床疗效。方法扩张型心肌病10例,心功能Ⅳ级,合并完全性左束支阻滞,QRS正常时限超过130ms,左心室舒张末内径超过55mm,左心室射血分数小于0．35,置入三腔双心室同步起搏器治疗,观察术后临床症状及超声心电图指标变化。结果术后患者心功能改善1～2级,心电图QRS时限明显缩短,心胸比例、二尖瓣反流面积、左心室舒张末内径和左心房舒张末内径明显减小,左心室射血分数和左心室短轴缩短率明显增加（P〈0．05）。结论双心室再同步治疗可明显改善伴室内传导阻滞的难治性心力衰竭患者的心脏收缩功能。     

双心室起搏治疗充血性心力衰竭的血流动力学观察

目的 观察双心室起搏治疗充血性心力衰竭的血流动力学效果。方法 充血性心力衰竭伴心室内阻滞患者６例，男性５例，女性１例，平均年龄５４岁。心动均在Ⅱ～Ⅳ级（ＮＹＨＡ），体表心电图平均ＱＲＳ时限为１４１ｍｓ。患者均进行了双心室起搏，左心室起搏通过冠状静脉窦植入２１８７或２１８８导线，于其血管分支内进行左心室起搏。左、右心室导线通过Ｙ形转接器与双腔起搏器连接。术后应用超声心动图检查，观察双心室起搏的血流动     

双心室起搏逆转心脏结构重塑的临床观察

观察双心室同步起搏治疗慢性充血性心力衰竭 (简称心衰 )逆转心脏结构重塑的中远期疗效并探讨其可能机制。4例扩张性心肌病中晚期患者 ,心功能NYHA分级Ⅲ级 2例、Ⅳ级 2例 ,均伴有心室内阻滞。其中 3例置入三腔双心室起搏器、1例为四腔起搏。术后对心功能、二维超声心动图、动态心电图、心脏远达正侧位片等进行了 12～ 2 0个月的随访。所有双心室起搏器均一次性安置成功。随访资料显示 4例患者各房室内径 ,心胸比率缩小 ;心脏搏出量、左室射血分数等显著提高 ;二尖瓣返流、QRS波时限减少 ,NYHA分级提高到Ⅰ～Ⅱ级 ,6min步行距离明显增加。心脏结构重塑时间发生在术后 6个月内 ,以后结构趋于稳定。 4例中 1例猝死 ,无一例因严重心衰而住院或死亡。结论 :双心室起搏能逆转慢性心衰患者的心脏结构重塑 ,明显改善心功能 ,提高生活质量。     

长期右心室心尖部起搏对心室重构的影响

目的探讨长期右心室心尖部（RVA）起搏对心室重构的影响。方法回顾性分析1997年6月至1998年11月,92例因病态窦房结综合征首次植入双腔起搏器的患者。对照组共有45例患者入选。起搏器植入术前行12导联心电图和超声心动图检查,术后随访时记录未起搏的心电图和超声心动图。结果传统双腔起搏组患者平均心室累积起搏比例为（90．1±4．0）％,平均随访时间为（3．3±0．5）年。起搏组患者自身QRS时限由术前（874-9）ms增加到随访时的（94±10）ms（P〈0．001）。左心室舒张末内径（LVEDD）由（464-3）mm增加到（50±4）mm（P〈0．001）,左心室射血分数（LVEF）由0．63±0．04降低到0．57±0．05（P〈0．001）。Logistic回归分析显示,起搏器植入时老龄（〉65岁）（OR3．41,95％CI1．07～10．90,P=0．04）、长期RVA起搏（OR3．91,95％CI1．10～13．89,P=0．03）和冠心病史（OR7．33,95％CI1．09～50．29,P=0．04）是QRS时限增宽（〉7ms）的独立预测因素。对照组各指标随访前后差异无统计学意义。结论长期RVA起搏可能引起自身QRS时限增宽,提示RVA起搏引起心脏特殊传导系统和／或心室肌传导功能损害。起搏器植入时老龄、RVA起搏和冠心病史是自身QRS时限增宽的独立预测因子。     

单左室起搏配合自身房室传导对慢性心力衰竭患者心室重构和同步性的影响

目的 比较基于自身房室传导的单独左心室起搏（LVP）与双心室起搏（BVP）对慢性心力衰竭（CHF）患者心脏再同步化治疗（CRT）术后的心功能、心室同步性、心室重构的影响。方法 选取2016年6月至2019年6月贵州省人民医院心内科收治的植入CRT的合并完全性左束支传导阻滞的CHF患者31例,在术后前3个月进行BVP,于第4个月随机分为2组,分别程控为BVP(BVP组,n=14)和LVP(LVP组,n=17)。分别于术前、术后3月、术后6月测量两组患者的体表心电图QRS波时限、左室射血分数（LVEF）、左室舒张末内径（LVEDD）、二尖瓣反流面积（MRA）、室间隔与左心室后壁间的收缩延迟时间（SPWMD）。结果 两组间术前、术后3个月同时段比较,QRS波时限、LVEF、LVEDD、MRA、SPWMD的差异均无统计学意义（P均>0.05）;两组间术后6个月同时段比较,QRS波时限、LVEF、MRA及SPWMD的差异均无统计学意义（P均>0.05）,BVP组的LVEDD小于LVP组[（52.71±4.60）mm比（56.29±3.22）mm,P<0.05）];两组术后3个月...     

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.     

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.     

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.     

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.