颈总动脉内膜-中膜厚度及粥样斑块与冠心病的关系

目的:研究颈总动脉内膜-中膜厚度(CIMT)及粥样斑块检出率与冠心病发病及冠脉病变严重程度的关系。方法:114例具有至少一项冠心病危险因素的患者,按冠状动脉造影结果分为冠心病组(70例)和对照组(44例),测定所有病例的双侧CIMT、颈总动脉内径和颈总动脉粥样斑块情况。结果:两组间各项冠心病危险因素均无显著差异。超声结果显示,冠心病组CIMT、粥样斑块检出率均显著增高(P<0.01),颈总动脉内径略增大,但差异不显著。CIMT≥0.8mm和检出粥样斑块为预测冠心病发病的独立指标(P<0.01)。CIMT和粥样斑块检出率均与冠脉病变严重程度呈正相关,在控制了多项影响因素后,相关性仍显著。结论:CIMT增厚、粥样斑块检出为冠心病发病的独立预测因素,并且与冠脉病变严重程度正相关。     

颈总动脉粥样硬化斑块形成对心脑血管预后的影响

目的:评价颈总动脉粥样硬化斑块形成对心脑血管预后的影响。方法:198例有冠状动脉(冠脉)粥样硬化性心脏病(冠心病)危险因素并行冠脉造影的患者,依据颈动脉超声检测将有无颈总动脉粥样硬化斑块分为动脉粥样硬化组(AS组)(120例)和对照组(78例),随访、比较2组心脑血管不良事件发生率,应用Cox回归分析与心脑血管预后相关的独立因素。结果:基线时,AS组平均年龄大(P<0.001)、慢性肾病患者多(P<0.05)、冠心病患者多(P<0.001)、血清肌酐(Scr)水平高(P<0.05)、颈总动脉内膜中膜厚度(IMT)平均值大(P<0.001)、颈总动脉内径(C-Di)较高(P<0.05)、服用他汀类药物患者较多(P     

青年冠心病患者中性粒细胞与淋巴细胞比值与冠状动脉病变严重程度的关系

目的研究青年冠状动脉粥样硬化性心脏病(冠心病)患者中性粒细胞与淋巴细胞比值(NLR)与冠状动脉(冠脉)病变严重程度的关系,探讨NLR对青年冠心病患者冠脉病变严重程度的预测作用。方法选择2015年1月～2016年4月于中国医科大学附属盛京医院心血管内科行冠脉造影术的134例存在冠脉病变的青年患者和51例无冠脉病变的青年患者作为研究对象,查阅其病程记录及相关检查。根据Gensini积分(GS)将冠脉病变组患者分为2个亚组(轻中度冠脉粥样硬化组,GS 1～49,n=80和严重冠脉粥样硬化组,GS49,n=53)。采用Logistic回归分析了严重冠脉粥样硬化的独立危险因素及NLR预测冠脉病变严重程度的效能,以受试者工作特性(ROC)曲线分析NLR预测严重冠状动脉病变的最佳切点及诊断价值。结果冠状动脉病变组患者年龄、心率、白细胞计数、中性粒细胞计数、NLR、血小板、总胆固醇、低密度脂蛋白胆固醇、三酰甘油、肌钙蛋白I均高于无冠状动脉病变组(P均0.05);严重冠脉粥样硬化组心率、白细胞计数、中性粒细胞计数、NLR、肌钙蛋白I均高于轻中度冠脉粥样硬化组(P0.05)。NLR是预测高Gensini积分的独立危险因素;ROC曲线分析证实NLR预测高Gensini积分的最佳切点是3.02,特异性81.3%,敏感性63%。结论 NLR与青年冠心病患者冠脉病变严重程度有关。NLR升高是青年冠心病患者冠脉存在严重动脉粥样硬化的独立危险因素。NLR水平越高,患者冠脉病变程度越重。尤其当NLR3.02时表明存在严重冠脉粥样硬化。     

颈部血管超声检查粥样斑块与缺血性中风的关系探讨

目的 探讨颈部血管超声检查发现的粥样斑块情况与缺血性中风的关系.方法 选择2006年-2007年我院77例缺血性脑卒中病人(梗死组)、83例非缺血性脑卒中病人及正常体检者(对照组)行颈部血管超声和血液生化检查,比较两组病人颈动脉粥样硬化斑块的部位、数量、性质、颈动脉内径及缺血性脑卒中危险因素间的差异.结果 两组颈动脉粥样硬化斑块检出率、左右颈总动脉内径间差异均有统计学意义(P<0.05).颈动脉粥样硬化斑块位于颈总动脉最多(78.0%),其次是颈总动脉分叉处(15.8%),颈内动脉颅外段最少(6.2%).斑块部位与缺血性脑卒中部位有显著同侧相关性(P<0.05).两组年龄及合并高血压、糖尿病、代谢综合征间差异无统计学意义(P>0.05).结论 颈动脉粥样硬化斑块与缺血性脑卒中发生有密切关系,颈部血管超声检查粥样斑块对早期预测及预防缺血性脑卒中发生具有重要的临床意义.     

外周动脉粥样硬化与冠状动脉病变Gensini评分的相关性

目的探讨颈动脉和足背动脉粥样硬化与冠状动脉粥样硬化病变Gensini评分的相关性。方法对270例行冠脉造影的患者进行Gensini积分评分。所有患者同时行血管超声检查,检测颈动脉IMT、粥样斑块面积、Crouse积分以及足背动脉IMT、血管内径、峰值流速,并与冠状动脉Gensini积分行相关性分析。结果 (1)从Gensini积分0组到积分4组,颈动脉IMT、斑块面积、斑块Crouse积分和足背动脉IMT逐渐增高,足背动脉内径和峰值流速逐渐降低;(2)颈动脉IMT、斑块面积、斑块Crouse积分、足背动脉IMT与冠状动脉Gensini积分呈正相关(P<0.01),足背动脉内径与冠状动脉Gensini积分呈负相关(P<0.01);(3)颈动脉IMT、斑块面积、斑块Crouse积分、足背动脉IMT以及足背动脉内径均为冠状动脉病变程度的独立相关因子。结论血管超声检查颈动脉和足背动脉粥样硬化与冠状动脉粥样硬化病变程度相关性较好,包括冠脉早期病变,通过外周血管超声检查可客观评估冠状动脉病变的进展情况,尤其可为早期冠状动脉粥样硬化病变人群的管理和干预提供可靠依据。     

超声诊断老年冠心病患者临床价值及血流动力学变化特点

目的探讨超声诊断老年冠心病患者的临床价值及其血流动力学特点。方法接受冠状动脉造影(CAG)检查的87例患者,按照CAG检查结果分为对照组、冠心病组,按照冠脉阻塞的支数将冠心病患者分为单支病变组、双支病变组及三支病变组,比较各组超声检出颈动脉斑块情况及血流动力学指标。结果各组颈总动脉内径比较差异均无统计学意义(P0.05),冠心病患者内-中膜厚度(IMT)显著高于对照组(P0.05),且三支病变组IMT显著高于单支病变组(P0.05)。冠心病患者斑块检出率显著高于对照组(P0.05),而冠心病各组病变间斑块检出率无差异(P0.05)。冠心病患者斑块厚度与斑块积分显著高于对照组(P0.05),且三支病变组斑块厚度与斑块积分显著高于单支病变组(P0.05)。冠心病组PSV与RI显著高于对照组(P0.05),而冠心病各病变组间PSV与RI无显著差异(P0.05),对照组与冠心病组EDV水平无显著变化(P0.05)。结论超声对冠心病患者动脉粥样硬化及血流动力学指标诊断具有一定的临床应用价值,且有利于患者疾病严重程度的判断。     

颈动脉内膜-中膜厚度与冠状动脉硬化的关系

目的 探讨颈动脉内膜-中膜厚度与冠状动脉粥样硬化的关系.方法 对186例因冠心病及可疑冠心病而入院接受冠状动脉造影的病人,根据冠状动脉造影结果分为冠状动脉正常组和冠状动脉病变组,后者根据冠脉病变数目分为三组:单支病变组、双支病变组、三支病变组.采用高频超声探测双侧颈总动脉、颈内动脉及颈外动脉,测量血管壁内中膜厚度(IMT).结果 冠状动脉病变组的IMT值明显高于冠状动脉正常组(p＜0.05);冠状动脉病变组的斑块检出率与冠脉正常组比较有显著差异性(P＜0.05);双支病变和三支病变的检出率比单支病变高,三支病变的检出率比双支病变高.颈动脉斑块超声检查对冠心病有良好的预测价值,总的预测符合率为85.48％.结论 通过对颈动脉的超声检测,可以早期发现冠状动脉病变,并可初步预测冠状动脉病变的程度.     

颈、股动脉粥样硬化超声标识与冠心病的关系研究

目的:利用高频超声研究颈、股动脉粥样硬化超声标识与冠状动脉粥样硬化的关系。方法:对91例冠状动脉造影受检者术前行双侧颈、股动脉超声检查,测定血管后壁内膜中层厚度(IMT)和斑块厚度,记录斑块数目,半定量估计斑块的严重程度。根据冠状动脉造影结果分为正常组和冠心病组。冠心病组分别按血管狭窄≥50%所累及主要病变血管支数分:单支病变、双支病变、3支病变,其中左主干累及定为双支病变。结果:随着冠状动脉病变程度的增加,颈、股动脉IMT值均增加,冠心病组与正常组比较差异有统计学意义(P<0.05);颈、股动脉斑块分级与冠状动脉病变血管支数分级间显著相关(P<0.05);股动脉斑块对冠心病预测的准确度(69.23%)高于颈动脉斑块(56.04%)。结论:颈、股动脉粥样硬化超声标识似用以预测冠心病的严重程度。     

慢性肾病患者动脉僵硬度与冠状动脉病变相关性

目的 探讨慢性肾病患者动脉僵硬度与冠状动脉(冠脉)病变的相关性及对冠心病风险评估的意义.方法 203例具有至少一项冠心病危险因素的患者中,慢性肾病(67例)和对照组(136例)两组,分别测定动脉僵硬度指标并行冠脉造影和估价Gemini冠脉病变严重程度.结果 慢性肾病组年龄较大,肱动脉收缩压、舒张压增高(P＜0.01).与对照组比较,慢性肾病组动脉僵硬度增加、冠心病发病率和冠脉病变程度增高.在校正年龄和外周血压影响后,两组动脉僵硬度指标仍有显著差异.PWV＞12和Aix@75＞25为预测冠心病发病的独立指标(P＜0.05).慢性肾病组中,PWV、Aix@75与冠心病发病率、冠脉病变严重度呈正相关(P＜0.01).在控制了多项影响因素后,相关性仍显著.结论 慢性肾病患者动脉僵硬度与冠心病发病以及冠脉病变严重程度呈 正相关.     

颈动脉粥样硬化与冠心病关系的研究

目的:研究颈动脉粥样硬化与冠心病的关系。方法:对301例冠状动脉造影的患者作双侧颈动脉超声检查,根据冠脉造影结果分为正常组及冠心病组,冠心病组根据冠状动脉病变支数再分为一支病变组,二支病变组,三支病变组3个亚组。测量颈总动脉后壁内中膜厚度(IMT),斑块厚度,计算斑块积分及粥样斑块发生率。结果:(1)冠心病组IMT,斑块积分及斑块发生率明显高于正常对照组(P<0.01)。(2)随冠脉病变支数增加,斑块积分及IMT增加,亚组比较有显著性差异(P<0.01)。(3)以IMT>0.85mm和(或)出现粥样斑块预测冠心病,特异性75.3％,敏感性84.6％,阳性预测率88.4％。结论:通过颈动脉超声检查可为冠心病的诊断提供依据。     

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.