硫酸镁对早期后去极和室性心律失常的抑制作用

镁治疗室性心律失常的机制还不清楚，本实验以Ｆｒａｎｚ心内膜接触电极研究镁对氯化铯引起的大室性心律失常作用。结果表明，氯化铯可引起早期后去极（ＥＡＤ）和室性心律失常，镁治疗组的ＥＡＤ幅度明显低于对照组（９．２±２．２％ＭＡＰ，２０．３±２．４％ＭＡＰ，Ｐ＜０．０１）。室性心律失常的发生率由对照组的１００％降为３７．５％（Ｐ＜０．０１）。硫酸镁可缩短延长了的ＱＴｃ间期。本文提示，硫酸镁对ＥＡＤ的抑制作用可能是抗心律失常的机制所在。     

高血压患者血浆一氧化氮浓度的变化

探讨一氧化氮（ＮＯ）与高血压的发病关系及其临床意义。方法用重氮法检测５０例高血压患者治疗前后和３６例正常对照组血浆ＮＯ浓度的变化。结果（１）高血压患者ＮＯ浓度（１４．９１±２．１８μｍｏｌ／Ｌ）较正常对照组明显地降低（Ｐ＜０．０１）；降压治疗后高血压患者血浆ＮＯ浓度有明显地增高（Ｐ＜０．０１），但仍明显低于正常对照组（Ｐ＜０．０１）。（２）高血压患者血浆ＮＯ浓度Ⅰ期最高，Ⅱ期居中，Ⅲ期最低，各期之间比较差异有显著性（Ｆ＝６７．５８，Ｐ＜０．０１）。（３）重度患者血浆ＮＯ浓度明显地低于轻度、中度患者（Ｐ＜０．０１）；中度明显低于轻度（Ｐ＜０．０１）。（４）并发心力衰竭组血浆ＮＯ浓度明显低于无心力衰竭组（Ｐ＜０．０１）。结论ＮＯ参与高血压的发生和发展，并与病情有关。检测血浆ＮＯ浓度可作为判断高血压患者病情的指标     

老年前期和老年高血压病患者心律失常特点及其与左室肥厚的关系

分析老年前期８２例、老年期１２４例高血压病患者和健康老年前期４６例、老年期６３例的２４小时动态心电图心律失常特点。结果显示老年前期高血压组总房性心律失常和总室性心律失常发生率分别为９０．２％和５９．８％，老年高血压组分别是９８．４％和７５．０％，差异显著（均Ｐ＜０．０１）；老年前期对照组分别为８０．４％和４５．７％，与同期高血压组比较差异不显著（均Ｐ＞０．０５）；老年对照组分别为８７．３％和５２．３％。与同期高血压组比较差异显著（均Ｐ＜０．０１）。老年高血压组中伴左室肥厚（ＬＶＨ）者（６６例）其总室性心律失常和Ｌｏｗｎ’ｓ分级≥３级室性心律失常发生率分别是８４．８％和３６．４％，均高于不伴ＬＶＨ者（５８例）的６３．８％和１３．８％（Ｐ＜０．０１）。在老年前期高血压组中伴ＬＶＨ者其Ｌｏｗｎ’ｓ分级≥３级室性心律失常发生率为１９．０％，高于不伴ＬＶＨ者的２．５％（Ｐ＜０．０５）．提示室性心律失常的发生与ＬＶＨ密切相关。     

卡托普利及C0Q10对扩张型心肌病淋巴细胞线粒体膜磷脂损伤…

以淋巴细胞为研究模型，用随机对照和电镜细胞化学方法，对４２例扩张型心肌病患者在常规抗心力衰竭治疗基础上加用卡托普利、能气朗（Ｃ０Ｑ１０）或安慰剂，经平均２．５个月观察，随着心功能改善，血浆血管紧张素Ⅱ水平恢复，于加用卡托普利及能气朗者，外周淋巴细胞线粒体增生程度减轻；线粒体膜磷脂损伤性改变得到修复（Ｐ均＜０．０１）。而在常规抗心力衰竭治疗基础上加用安慰剂者则改变不明显。提示卡托普利及Ｃ０Ｑ１０对心     

康加尔多联合Ⅰ类抗心律失常药物治疗难治性室性心律失常

作者用康加尔多联合Ⅰ类抗心律失常药物治疗３１例经Ⅰ类药物治疗无效的室性心律失常者，２７例获满意控制。总有效率达８７．１％，室早平均减少１８７次／小时（Ｐ＜０．０１）。二维超声心动图检查显示治疗后左室收缩末内径减小（Ｐ＜０．０１），射血分数增加（Ｐ＜０．０１）。提示康加尔多联合Ⅰ类抗心律失常药物治疗，能控制难治性室性早搏，使用安全、副作用少。     

充血性心力衰竭患者血浆肾上腺髓质素与内皮素、血管紧张素Ⅱ关系的初步研究

目的：研究充血性心力衰竭患者血浆肾上腺髓质素（ＡＭ）含量变化及其与血浆内皮素、血管紧张素Ⅱ的关系。方法：用放射免疫法测定了９５例心力衰竭患者（心力衰竭组）和５０例正常人（正常对照组）的血浆ＡＭ、内皮素和血管紧张素Ⅱ含量，同时用彩色超声心动图测定了５６例心力衰竭患者的左心室射血分数。结果：心力衰竭组患者血浆ＡＭ含量高于正常对照组（５０．６４±２３．１３ｎｇ／Ｌ比１６９２±４．０９ｎｇ／Ｌ，Ｐ＜０．００１）；心力衰竭患者血浆ＡＭ、内皮素、血管紧张素Ⅱ含量升高程度与心力衰竭严重程度相平行；心力衰竭患者血浆ＡＭ与内皮素、血浆ＡＭ与血管紧张素Ⅱ含量均呈显著正相关（ｒ＝０．７２１８，Ｐ＜０．００１；ｒ＝０．６５６６，Ｐ＜０．００１）；血浆ＡＭ含量与左心室射血分数呈显著负相关（ｒ＝－０．６２５８，Ｐ＜０．００１）；血浆ＡＭ与心力衰竭的原发病因无关。结论：ＡＭ参与了心力衰竭的病理生理过程，血浆ＡＭ升高可能与血浆内皮素和血管紧张素Ⅱ含量升高有关     

卡托普利对急性心肌梗塞患者缺血再灌注损伤的保护作用

１０７例急性心肌梗塞患者随机分为Ⅰ组（５７例）和Ⅱ组（５ｏ例）行尿激酶静脉溶栓治疗。Ⅱ组患者在溶栓治疗前后予卡托普利口服。将Ⅰ组中再通３２例作为对照组，Ⅱ组再通２６例作为治疗组进行分析比较，结果表明：①ｃＫ－ＭＢ、ＣＫ峰值，溶栓治疗后４ｈ内加速性心室自主节律和室速的发生率，治疗组均低于对照组（Ｐ＜０．０１）；②溶栓治疗后４、１２、２４、７２ｈ的血浆丙二醛浓度，在对照组均显著高于溶栓治疗前（Ｐ＜０．０１）；而治疗组在溶栓治疗前后则无差异（Ｐ＞０．０５）。提示：卡托普利可防治氧自由基导致的缺血心肌再灌注损伤。     

卡托普利对冠心病患者内源性纤溶功能的影响

目的：冠状动脉粥样硬化性心脏病（冠心病）患者内源性纤溶功能紊乱与肾素—血管紧张素系统激活有关，但转换酶抑制剂能否改善这种功能紊乱尚不十分清楚，本文目的是研究此作用。方法：符合世界卫生组织冠心病不稳定性心绞痛诊断标准，６５％经选择性冠状动脉造影确定冠状动脉狭窄≥５０％的患者３４例，单盲随机分为卡托普利治疗组（１８例）及安慰剂对照组（１６例），４周治疗前、后检测血浆肾素活性、血管紧张素Ｉ、组织型纤溶酶原激活剂（ｔ－ＰＡ）及纤溶酶原激活剂抑制物（ＰＡＩ）含量与活性，两组间的参数比较采用ｔ检验。结果：４周后，治疗组的血浆血管紧张素Ｉ及ｔ－ＰＡ含量、ＰＡＩ活性均显著低于对照组（Ｐ＜０．０５或Ｐ＜０．０１，而ｔ－ＰＡ活性及纤溶活力则显著高于对照组（Ｐ＜０．０５或Ｐ＜０．０１）。结论：卡托普利可通过降低血浆血管紧张素Ｉ水平，改善冠心病患者内源性纤溶功能紊乱。本结果对预防冠状动脉内血栓形成有意义     

高血压病孤立性室间隔肥厚患者心律失常分析

应用２４ｈ动态心电图以每小时房性早搏数（ＰＡＣ／ｈ）和室性早搏数（ＶＰＣ／ｈ）及复杂性室性心律失常发生率作为指标，对２２例高血压病孤立性室间隔肥厚患者、２０例高血压病向心型肥厚患者、２４例高血压病无左室肥厚患者及２０例正常对照者进行检测，结果发现，高血压病孤立性室间隔肥厚组与向心型肥厚组ＶＰＣ／ｈ及复杂性室性心律失常发生率较正常对照组和高血压病无左室肥厚组明显增加（Ｐ＜０．０５～０．０１）；而ＰＡＣ／ｈ的增加仅见于高血压病孤立性室间隔肥厚组（Ｐ＜０．０１）。表明：高血压病孤立性室间隔肥厚与向心型肥厚患者的室性心律失常和复杂性室性心律失常发生率均增高，前者房性心律失常的发生率也增高。     

卡托普利和尼群地平对老年高血压性左室肥厚影响的对比分析

用多普勤超声心动图随机分组比较卡托普利和尼群地平对６０例老年高血压性左室肥厚及舒张功能的影响。平均观察１２个月。卡托普利组空间隔、左室后壁分别减少２．４ｍｍ和１．２ｍｍ（Ｐ分别＜０．０１和０．０５），左室重量指数下降４４ｇ／ｍ２（Ｐ＜０．０１），左室舒张早期流速峰值（ＶＥ）显著增高（Ｐ＜０．０１），ＶＡ／ＶＥ显著降低（Ｐ＜０．０１），等容舒张期ＩＲＴ显著缩短（Ｐ＜０．０５）。尼群地中组室间隔肥厚减轻，左室重量指数下降及几项舒张功能参数改善幅度均小于卡托普利组（Ｐ均＜０．０５）。提示卡托普利逆转左室肥厚及改善舒张功能作用均优于尼群地平。     

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.