逆向开通冠状动脉慢性完全性闭塞病变中预塑型导丝的应用

目的:探讨预塑型导丝在逆向开通复杂冠状动脉慢性完全性闭塞性病变(CTO)中通过侧支循环及闭塞段的有效性及安全性。方法:入选18例因血管条件不佳或闭塞段较长正向开通CTO病变失败的患者。分别穿刺双侧股动脉,植入7F鞘管,正向指引导管内采用Runthrough导丝携带130cm微导管于闭塞段处备用,逆向指引导管内采用Runthrough导丝携带150cm微导管至侧支循环内,藉由逆向微导管,分别采用普通软导丝或SION black预塑型导丝尝试通过侧支循环,直至进入靶血管远段真腔内,前送逆向微导管至闭塞段,分别交换为普通硬导丝或Gaia系列预塑型导丝直至成功逆向通过CTO闭塞段,采用微导管对接技术或内膜下寻径技术(CART),促使正向Runthrough导丝至CTO远段真腔内,后续球囊扩张后植入支架,完成经皮冠状动脉介入治疗术(PCI)。结果:在18例患者中,SION black及Gaia预塑型导丝表现出良好的通过侧支循环及穿刺闭塞段的能力,减少了手术及曝光时间,术后患者无心包填塞、恶性心律失常等并发症的发生。结论:SION black及Gaia系列预塑型导丝与非预塑型导丝相比,在通过侧支循环所用时间及闭塞段通过率上均有优异的表现,且具有良好的安全性,应广泛应用于今后逆向开通CTO病变的PCI手术中。     

冠状动脉慢性闭塞病变介入治疗中经桡动脉行对侧血管造影定位导丝方法的研究

目的:评价冠状动脉慢性闭塞病变(CTO)患者介入治疗中,经绕动脉行对侧冠状动脉造影定位导丝方法的可行性及安全性。方法:11例经股动脉造影证实冠状动脉CTO,且病变远端有对侧冠状动脉侧支循环形成。在导引导管及导丝到位后,穿刺桡动脉,在对侧冠状动脉放置造影导管,在操纵导丝通过病变处时借助桡动脉造影使靶血管远端显影,判断导丝是否在靶血管腔中。结果:10例成功经皮冠状动脉腔内成形术(PTCA)及支架置入术,1例失效,术中无冠状动脉夹层及穿孔等并发症发生。结论:经桡动脉进行对侧血管造影,通过侧支循环使CTO远端显影,判断导丝位置是有效安全的途径。     

扩张微导管在慢性完全闭塞病变中的应用价值--经桡动脉正向介入治疗

目的：评价135 cm扩张微导管（corsair导管,Asahi Intec Co,Japan）在冠状动脉慢性完全闭塞（chronic total occlusion,CTO）病变经桡动脉正向经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）中的有效性及安全性。方法回顾性入选了本中心2010年6月至2014年2月81例经桡动脉途径应用135 cm扩张微导管进行正向导引钢丝技术治疗的CTO病变患者,分析正向CTO-PCI成功率、扩张微导管通过闭塞病变成功率、球囊导管通过闭塞病变情况及导引钢丝通过闭塞病变情况,并观察住院期间不良事件发生率。结果81例应用135 cm扩张微导管经桡动脉正向介入治疗的患者中,66例患者正向导引钢丝通过CTO病变,65例患者正向CTO-PCI成功,成功率为80.2%;另有8例成功进行逆向导引钢丝介入治疗,总体PCI成功率90.1%。66例正向导引钢丝通过闭塞病变后,135 cm扩张微导管成功通过闭塞病变56例（84.8%）;扩张微导管通过闭塞病变后,球囊导管的使用数量为1.3个,显著低于扩张微导管未通过闭塞病变患者。66例正向导引钢丝通过闭塞病变的患者中,应用Fielder XT导引钢丝34例（51.5%）。住院期间随访未见扩张微导管嵌顿、折断、头端受损、血管穿孔等不良事件发生,无严重不良心脏事件发生。结论应用扩张微导管经桡动脉途径行正向CTO-PCI治疗是安全、有效的,可以简化介入治疗操作步骤,减少球囊导管等器械的使用,提高CTO病变介入治疗的手术成功率。     

Finecross微导管在逆行导丝技术治疗冠状动脉慢性完全闭塞病变中的应用

目的观察Finecross微导管在逆行导丝技术治疗慢性完全闭塞病变（CTO）中应用的效果。方法 35例CTO患者,其中20例右冠闭塞,15例前降支闭塞,闭塞病变的靶血管远端均有良好的侧支循环血管逆行供血,35例均采用Finecross微导管支撑导丝进行逆行冠状动脉介入治疗。结果 Finecross微导管直接通过侧支循环为25例,经小外径球囊低压力扩张侧支循环血管后Finecross微导管通过侧支循环为8例,手术最终成功30例,3例逆行导丝未通过闭塞病变,无并发症发生;2例Finecross微导管因侧支循环血管迂曲故未通过,其中1例导丝通过后微导管无法通过,且发生心包填塞,经及时治疗后未发生心血管事件,余34例未发生心血管事件。结论冠脉慢性完全闭塞病变血管成形术中合理应用Finecross可获得较好的安全性和有效性。     

Finecross微导管在冠状动脉慢性完全闭塞病变介入治疗中的应用

目的 了解Finecmss微导管在慢性完全闭塞（chronic total occlusion,CTO）病变介入治疗中的有效性和安全性.方法 对56例在茂名市人民医院行冠状动脉造影发现CTO病变并对其进行介入治疗的患者的临床资料和手术过程进行回顾性分析.结果 56例CTO病变闭塞时间为（6.8±3.2）个月;闭塞段长度（32 ±22） mm.介入治疗成功43例,其中正向33例,逆向10例.13例失败患者中,正向6例,原因为导丝不能进入血管真腔内;逆向7例中4例导丝不能穿过病变（2例微导管和1例导丝不能通过侧支循环而终止）,2例微导管不能通过闭塞病变,1例患者术中生命体征不稳定.所有患者术后住院期间无主要心血管事件发生.结论 Finecmss微导管在CTO病变的介入治疗中是安全和有效的.     

切割球囊冠状动脉腔内成形术52例临床分析

目的　应用切割球囊行冠状动脉腔内成形术并对其疗效进行评价。方法　对 5 2例冠心病患者的 63处病变行切割球囊扩张治疗 ,对其进行分析 ,并短期随访。结果　 63处血管直接切割球囊扩张治疗 ,成功率92 1% ,其中 9例完全闭塞性病变中 7例获得成功。 2例支架内再狭窄均扩张成功。 63处病变切割球囊扩张后安放支架 43个 (支架安放率 68 3 % ) ,2 0例单纯行切割球囊扩张术者残余狭窄为 0～ 2 0 % [平均为 ( 7 2±5 6) % ]。 1例患者术后出现心包填塞 ,无严重内膜撕裂、急性闭塞、急诊冠脉架桥术及急性心肌梗死发生。随访6～ 12个月 ,1例单纯行切割球囊扩张术患者于术后 1月出现心绞痛 ,经冠脉造影证实为再狭窄。其他患者随访期间无心脏事件发生。结论　切割球囊行冠状动脉腔内成形术安全、有效 ,短期疗效良好     

绕行钙化斑块正向内膜下重回真腔技术开通左前降支慢性完全闭塞病变1例

冠状动脉慢性完全闭塞病变及钙化病变是导致冠状动脉介入治疗失败的常见原因。本文报道1例中年女性左前降支慢性闭塞合并严重钙化患者,冠状动脉介入治疗术中通过导丝绕行钙化病变重回远段真腔,从而开通左前降支,为临床实践提供新的治疗思路。     

Guidezilla?导引延长导管在复杂冠状动脉病变中的初步应用经验

目的观察Guidezilla?导引延长导管在复杂冠状动脉病变行经皮冠状动脉介入治疗(PCI)中应用的安全性和有效性。方法 13例患者均为冠状动脉复杂病变,PCI术中球囊或支架难以送达靶病变时,应用Guidezilla?导引延长导管技术。结果 13例患者中慢性完全闭塞病变7例,钙化病变7例,迂曲病变6例,弥漫病变8例,远段病变8例,靶血管有支架置入史8例。13例患者手术均获成功,术后靶血管残余狭窄20%,TIMI血流Ⅲ级。1例术中发生Guidezilla?导管嵌顿,于该处置入支架后改善。无血管夹层或破裂、急性支架内血栓、导丝所致的穿孔和心脏压塞等事件发生。结论 Guidezilla?导引延长导管用于复杂冠状动脉病变行PCI是安全、有效的。     

应用子母导管介入治疗复杂冠状动脉病变

目的:复杂冠状动脉病变（慢性闭塞性病变、严重迂曲病变、弥漫钙化）的介入治疗往往需要指引导管提供较强支撑力,单纯指引导管自身能提供的支撑力常常不够。本研究旨在初步探索子母导管系统在复杂冠状动脉病变介入治疗中需要强支撑力时应用的有效性与安全性。方法: 选择泰尔茂公司的Heartrail子母导管系统,系由一根5F的子指引导管和一根6F或7F的母指引导管构成。5F Heartrail子指引导管为直头指引导管,其内径为0059 in（1 in=254 mm）,长度为120 cm,比母指引导管长20 cm。使用方法是,母指引导管到位后,送入经皮腔内冠状动脉成形术（PTCA）导丝至冠状动脉内,沿PTCA导丝送入子导管至母导管远段,但不伸出远端,送入PTCA球囊至冠状动脉内,沿球囊导管推送子母导管进入冠状动脉内,根据需要提供的支撑力决定子母导管伸出指引导管的长度。结果: 自2008年6月~2010年12月共选择常规方法导丝、球囊或支架不能通过的复杂冠脉病变共26例（左前降支5例,左回旋支6例,右冠状动脉15例）,其中慢性闭塞性病变6例（23%）,血管迂曲15例（58%）,近段血管有支架植入10例（38%）,钙化病变15例（58%）,其中24例成功完成支架植入,成功率为92%,2例失败,均为球囊不能通过病变处,术中发生空气栓塞2例（8%）,经冠脉注射动脉血后血流通畅,术中无血管夹层及冠脉穿孔等并发症。随访6个月无死亡、再发心梗等心脏事件。结论: 子母导管系统应用于常规方法不能成功的冠脉复杂病变可增加支撑力,有助于远端支架植入,应用有效且安全,但术中需注意空气栓塞的发生。     

冠状动脉慢性完全闭塞的外科治疗

目的探讨冠状动脉慢性完全闭塞病变的外科手术方法及临床体会。评价冠状动脉造影在冠状动脉慢性完全闭塞病变诊断中的价值。方法753例928支冠状动脉慢性完全闭塞病变(其中冠状动脉造影无逆显影148支,有逆显影780支)患者行冠状动脉搭桥术(术前冠状动脉造影无逆显影的冠状动脉慢性完全闭塞病变术中有31支有血流,而有逆显影的冠状动脉慢性完全闭塞病变中有75支无血流),搭桥根数2501根。其中152例患者行内膜剥脱后冠状动脉搭桥155支,37例患者行心中静脉原位静脉动脉化37支。术中736例在非体外循环下完成手术,17例因血流动力学不稳定,由非体外改为体外循环下冠状动脉搭桥术,其中8例安放主动脉内球囊反搏,术后8例应用了连续性静脉—静脉血液透析滤过。结果术中无死亡病例。152例行内膜剥脱后冠状动脉搭桥患者术后死亡2例,其中1例死于严重低心排出量,1例死于肾功能衰竭,另150例患者随访1月~9年,术后2年猝死1例,心绞痛症状均消失132例(88.6%),心绞痛症状缓解14例(9.4%),NYHA心功能分级Ⅰ~Ⅱ级;其余601例术后住院期间死亡5例,其中1例死于严重低心排出量,2例死于肾功能衰竭,1例死于围术期心肌梗死,1例死于脑血管意外。术后随访心绞痛缓解率99%,心功能恢复。结论冠状动脉慢性完全闭塞病变患者采用冠状动脉搭桥术可以取得良好的效果,如果可能尽量采取非体外循环技术。及时应用主动脉内球囊反搏及连续性静脉—静脉血液透析滤过可以改善危重患者的预后。冠状动脉造影在评价冠状动脉完全闭塞上有一定的局限性,冠状动脉血管内视镜技术和血管内超声可以协助诊断。     

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.