高血压左心室肥厚患者心电图QT离散度改变

目的　探讨原发性高血压左心室肥厚患者心电图QT离散度 (简称QTd)变化。　方法　用美国超九 ATL(XO16 3)彩色多谱勒诊断仪二维超声测量其舒张期左心室室间隔厚度和左心室后壁厚度 ,以≥ 1 2cm作为左心室肥厚诊断标准 ,对高血压左心室肥厚组 (n =36 ,男 女 =2 0 16例 ,平均年龄 6 0岁± 12岁 )、高血压左心室非肥厚组(n =5 0 ,男 女 =30 2 0例 ,平均年龄 6 2岁± 12岁 )进行测量 ,再用心电图ECG 8110P( 0 180 8A3)描记其常规 12导联心电图 ,手工测量其最大QT间期 (QTmax)、最小QT间期 (QTmin)和心动周期RR间期 ,计算QTd和心率校正的QTcd ,并随机匹配正常人群组 (n =4 0 ,男 女 =2 4 16例 ,平均年龄 5 8岁± 13岁 )。　结果　高血压左心室肥厚组QTd为6 0ms± 17ms ,QTcd为 6 8ms± 2 4ms,高血压左心室非肥厚组QTd为 4 1ms± 13ms,QTcd为 4 3ms± 17ms ,正常人群组QTd为 4 3ms± 11ms ,QTcd为 4 4ms± 16ms,前两组比较有显著性差异 ,P <0 0 1,后两组比较无显著性差异 ,P >0 0 5。　结论　原发性高血压左心室肥厚患者QT间期离散度增大。     

室性心动过速患者QT离散度变化的临床意义

目的　探讨室性心动过速 (VT)患者 QT离散度 (QTd)变化的意义。方法　对正常对照组 (35例 )和 VT组 (31例 )记录 12导联同步心电图 ,人工测量 QT间期 ,计算 QTd。结果　与对照组相比 ,VT组 12导联QTd明显增加 (P<0 .0 1) ,但两组之间存在很大交叉 ,无法建立正常参考值 ;QT间期明显延长 (P<0 .0 1) ,两组QTmax多见于 V2 、V3、V4 和 V5导联 (分别为 75 .0 %、77.8% ) ,两组 QTmax、QTmin导联分布无显著差异 (P>0 .0 5 )。结论　 VT患者的 QTd不能代表心肌复极的区域性差异 ,仅可作为心肌复极异常简单、粗略的指标。     

急性心肌梗塞早期溶栓治疗前后QT间期离散度变化

探讨急性心肌梗塞溶栓治疗前后QT间期离散度 (QTintervaldispersion ,QTd)的变化 ,我们将 34例施溶栓治疗的急性心肌梗塞 (acutemyocardialinfarction ,AMI)病人分为 2组 :再通组 18例 ,未通组 16例。测定溶栓前及溶栓后 2、8、2 4、4 8h和 1周的同步 12导联心电图QTd。溶栓前再通组与未通组QTd分别为 :58.3± 13.5ms ,56.2± 17.1ms ;溶栓后再通组与未通组QTd分别为 :2h ,70 .2± 14.2ms ,58.5± 13.1ms ;8h ,51.2± 13.6ms ,73.4± 15.8ms ;2 4h ,4 8.7± 16.8ms,66.5± 15.2ms ;4 8h ,4 0 .5± 11.8,66.5± 15.2 ;1周 ,38.6± 13.4 ,50 .1± 15.8。溶栓后 ,再通组与未通组QTd各对应时间段相比 ,有显著性差异 (P <0 .0 1)。溶栓前再通组与未通组QTd相比无显著性差异 (P >0 .0 5)。说明成功的溶栓治疗使心室复极的QTd缩短 ,使QTd最高值提前出现。QTd缩短速度明显加快 ,对于判断溶栓治疗的疗效有一定意义     

T环形态与QT离散度的关系研究

目的　探讨心向量图的T环形态与体表心电图出现QT离散度 (QTd)的关系。方法　使用中卫瑞德SCA Ⅱ型立体心电图仪 ,对确诊的陈旧心肌梗死患者和正常对照健康人各 10 0例进行 2 4条通道同步、实时、连续采样描记 12导联心电图、普通心向量图、9导联时间心向量图及连续心向量图检测 ,分析病例和对照组最大QT间期、最小QT间期在体表心电图各导联的分布特点以及在心向量图上T环的形态差异同QTd的关系。结果　 (1)病例和对照组从体表心电图测得的最大QT间期、最小QT间期几乎均集中在相同的导联 ;(2 )从心电向量额面 (F)、横面 (H)的T环形态来看 :病例组T环以圆小型比例大 (43% ) ,狭长型比例小 (16 % ) ,而对照组以狭长型为主 (6 8% ) ,圆小型最少 (4% )。综合分析发现狭长型T环所对应的体表QTd、校正QT离散度 (QTcd)最小 [(0 0 2 5± 0 0 0 9)s ,(0 0 2 5±0 0 0 9)s],圆小型T环所对应的体表QTd、QTcd最大 [(0 0 4 1± 0 0 17)s,(0 0 4 2± 0 0 18)s,P <0 0 1]。结论　QTd值的大小与额面和横面向量上T环的形态有关。最大QT间期、最小QT间期所集中的导联不会因梗死部位的出现而发生改变     

QT离散度与高血压合并Ⅱ型糖尿病的关系探讨

目的　探讨QT离散度 (QTd)与高血压 (EH)合并Ⅱ型糖尿病 (NIDDM)的关系。方法　测量 5 2例EH合并NIDDM(A组 )和 5 2例EH无并发症患者 (B组 )以及 5 0例正常人 (C组 )的同步 12导联心电图及其最大Q -T间期 (QTmax) ,最小Q -T间期 (QTmin) ,QTd =QTmax -QTmin。用Bazett公式计算校正的QTd(QTcd) ,进行比较分析。结果　QTd、QTcd :A组分别为 (5 5 8± 13 2 )ms和 (63 8± 13 6)ms;B组分别为 (40 6± 8 4)ms和 (46 1± 10 0 )ms;C组分别为 (40 0± 9 7)ms和 (44 1± 10 9)ms。A组与B组、A组与C组比较有非常显著的统计学意义 (P <0 0 1)。结论　QTd、QTcd与高血压合并Ⅱ型糖尿病密切相关 ,可作为预测其心血管受损程度的敏感指标     

小儿扩张型心肌病QT间期离散度测定

目的　探讨小儿扩张型心肌病心电图QT间期离散度 (QTd)改变。　方法　用广东中山博爱心电综合自动分析仪 (SR 10 0 0A)分别采集 4 5例扩张型心肌病患儿 (男 30例 ,女 15例 ,年龄 2岁～ 14岁 ,平均年龄 6 8岁±3 6岁 ) 12导联心电图和 4 0例健康小儿 (男 2 5例 ,女 15例 ,年龄 1岁～ 14岁 ,平均年龄 7 4岁± 3 4岁 )心电图 ,录入软盘 ,计算机回放并程序放大波形 2倍～ 4倍检测 ,增益 1mv =2 0mm 40mm ,纸速 5 0mm s～ 10 0mm s ,测量QTmax、QTmin ,计算QTd(QTmax QTmin) ,微机数理统计。　结果　扩张型心肌病伴室性心律失常组 (12例 )QTd为 6 8 4ms±12 1ms,扩张型心肌病不伴室性心律失常组 (33例 )为 4 4 3ms± 9 3ms ,健康小儿组为 2 7 7ms± 8 5ms ,组间比较方差分析P <0 0 1。　结论　扩张型心肌患儿心电图QT间期离散度增大 ,易于发生室性心律失常。     

静脉溶栓治疗对急性心肌梗死患者QT间期离散度及室性心律失常的影响

目的　研究静脉溶栓心肌再灌注治疗对急性心肌梗死 (AMI)患者QT间期离散度(QTd)与校正的QT间期离散度 (QTcd)及室性心律失常 (VA)恶性程度的影响。方法　分别于入院时及溶栓治疗后 4周记录 15例溶栓成功及 17例溶栓未成功患者常规 12导联心电图 ,计算QTd及QTcd ,并行心电监测 ,记录住院期间发生的VA。结果　再通组 (15例 ) 4周后QTd与QTcd[(5 2 .9± 10 .4)ms、(5 8.7± 12 .3 )ms]与溶栓前QTd与QTcd比较 [(69.7± 15 .5 )ms ,(80 .5± 2 7.0 )ms]显著减小 (P <0 .0 5 )。 4周后再通组较溶栓失败冠脉未通组 (17例 )QTd与QTcd[(63 .7±15 .5 )ms ,(72 .3± 2 5 .4)ms]显著减小 (P <0 .0 5 )。再通组VA恶性程度与未通组比较有显著降低 ,死亡率亦降低。结论　早期静脉溶栓成功心肌再灌注治疗可以显著减小心肌梗死患者的QT间期离散度 ,并降低室性心律失常的恶性程度     

冠脉支架置入术后肌钙蛋白T增高对QT离散度的影响

目的　观察冠脉支架置入术后微小心肌损伤对心肌复极电生理 (QT离散度 )的影响。方法　 82例行单个冠脉支架置入术的冠心病患者 ,于术前 1天及术后 4周行QT离散度 (QTd)测定 ,术前 1h及术后 2 4h行血心肌钙蛋白T(CTnT)及肌酸激酶同工酶 (CK MB)测定。根据其术后CT nT浓度分为CTnT(+ )组 (19例 )及CTnT(-)组 (63例 ) ,分别比较其治疗前后QTd的变化。结果　CTnT(+ )组术前、术后QTd分别为 (61 6± 11 7)ms和 (53 3± 10 4)ms ,P <0 0 1;CTnT(-)组术前、术后QTd分别为 (60 4± 14 8)ms和 (46 2± 12 4)ms ,P <0 0 0 1。同期两组比较 ,CTnT(-)组术后的QTd较CTnT (+ )组明显缩短 ,P <0 0 5,术前两组QTd无显著差异。结论　成功施行冠脉支架置入术后出现微小心肌损伤者 ,其心肌复极电生理受影响 ,QTd的改善受阻 ,提示会影响其远期预后     

室性心动过速与QT离散度的关系

目的　探讨室性心动过速 (VT)与QT离散度 (QTd)之间的关系。方法　测量 3 2例 12导联同步动态心电图 (DCG)VT者的QTd。结果　 3 2例VT组 (A组 )QTd( 70 3± 3 8 4)ms,对照组 (B组 )QTd( 5 0 6± 19 7)ms,两组差异有显著性 (P<0 0 5)。结论　QTd的增大有助于对VT的预测     

贵阳地区5280例心电图Q-T离散度正常参考值

目的为研究正常人12导联同步心电图QT间期离散度(QTd)的平均值。方法采用美国产MarquittMAC1200型12导联同步心电图自动分析记录仪对5280例正常国人进行检测,并根据性别及年龄分组,将自动测量所得数据输入计算机进行统计学处理。结果5280例男女QTd平均值为(43.43±18.41)ms,QTcd平均值为(48.31±22.45)ms;男组性QTd(43.43±19.32)ms,QTcd(48.20±23.72)ms,女性组QTd(43.35±14.24)ms,QTcd(48.76±16.42)ms,两组比较均无显著差异。各年龄组之间的QTd与QTcd亦无显著差异;男女各组之不同年龄组的QTd均<50ms,QTcd<55ms。结论正常国人QTd平均值<50ms,QTcd<55ms,其与性别和年龄无明显关系。     

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.