西地那非治疗高海拔地区先天性心脏病并发重度肺动脉高压的临床疗效

目的探讨西地那非治疗高海拔地区先天性心脏病并发重度肺动脉高压的临床疗效及安全性。方法选取我院2014年1月—2016年1月收治的先天性心脏病并发重度肺动脉高压患儿70例,随机分为研究组和对照组,对照组采用常规方法治疗,研究组在对照组基础上给予西地那非治疗。观察并比较两组治疗前后临床疗效、N末端B型脑钠肽前体(NT-proBNP)及C反应蛋白(CRP)、心肺功能指标和不良反应。结果研究组临床总有效率明显高于对照组(94.3%与71.4%,P0.05)。治疗后,研究组NT-proBNP、CRP水平低于治疗前,且较对照组明显降低,差异有统计学意义(P0.05)。治疗后,两组患儿较治疗前肺动脉收缩压降低,动脉血氧分压、心排血量、心脏指数及氧合指数上升,且研究组改善程度明显优于对照组(P0.05)。两组不良反应发生率比较,差异无统计学意义(χ~2=0.1613,P0.05)。结论西地那非治疗高海拔地区先天性心脏病并发重度肺动脉高压,可降低患儿NT-proBNP、CRP水平及肺动脉阻力,安全性较高。     

西地那非在高原地区先天性心脏病合并肺动脉高压中的应用

目的:报告西地那非治疗高原地区先天性心脏病合并肺动脉高压的治疗体会。方法:自2008年至今,对18例先天性心脏病合并重度肺动脉高压患者应用西地那非的疗效进行了分析。结果:18例中除2例疗效欠佳外,16例疗效显著,有效率为89%(16/18例次)。结论:西地那非是高原地区先天性心脏病合并肺动脉高压的一种新的有效的治疗药物,临床上值得推广。     

持续正压通气治疗先天性心脏病合并肺动脉高压患儿的疗效分析

目的分析持续正压通气治疗先天性心脏病合并肺动脉高压患儿的疗效。方法选取2012年4月~2014年11月我院收治的先天性心脏病合并肺动脉高压患儿171例作为研究对象,将其随机分为研究组86例与对照组85例。所有患儿入院后均在儿科加强监护病房接受治疗,给予常规能量支持、心功能不全纠正、抗感染、雾化及吸痰保持呼吸道通畅等治疗;研究组在此治疗基础上加用持续性正压通气进行治疗。观察两组患儿的疗效、治疗前后心率、呼吸、Sp O_2及动脉血气比较。结果研究组与对照组总有效率分别为86%、75.3%,持续性正压通气治疗先天性心脏病合并肺动脉高压患儿的疗效显著,差异有统计学意义(P0.05);经治疗,所有患儿的心率、呼吸、Sp O_2及动脉血气分析指标均有改善,研究组总体改善情况明显优于对照组,差异有统计学意义(P0.05)。结论持续正压通气治疗先天性心脏病合并肺动脉高压患儿,可改善其肺功能,对心功能有支持作用,疗效明显,值得临床推广应用。     

高原地区先天性心脏病并发重度肺动脉高压的围术期管理

目的:探讨降低高原地区先天性心脏病并发肺动脉高压患者围术期并发症和手术死亡率的策略,评估吸入一氧化氮（NO)在先天性心脏病并发重度肺动脉高压患儿围术期的治疗效果。方法: 回顾性分析2009年6月~2012年12月我院收治的31例高原地区先天性心脏病并发重度肺动脉高压患者围术期管理经验,分析其术前、术中和术后等治疗因素对患者预后的影响,以及术后患者吸入NO 前后的心率、平均动脉压、中心静脉压、动态肺顺应性及氧合指数的变化。结果: 1例患者死亡,其余30 例患者在经过严格围术期管理及吸入NO 治疗后,心率、血压无明显改变,平均超声肺动脉压力、动态肺顺应性、氧合指数比治疗前明显改善,有统计学意义。结论: 严密的围术期管理及NO吸入治疗对治疗高原地区先天性心脏病并发重度肺动脉高压患者具有较好的临床效果。     

西地那非治疗先天性心脏病相关性肺动脉高压的有效性与安全性

目的:探讨磷酸二酯酶抑制剂西地那非治疗先天性心脏病（congenital heart disease,CHD）所致重度肺动脉高压（pulmonary arterial hypertension,PAH）的有效性及安全性。方法: 对体-肺分流型CHD所致重度PAH患者33例给予西地那非治疗6个月。以6分钟步行距离试验、心电图、心脏X线、彩色多普勒超声心动图、右心导管、血细胞和血生化检查检测评估治疗效果和不良反应。结果: 西地那非治疗6个月后,所有患者6分钟步行距离显著改善(P<0.01),18例（54%）患者自觉症状明显改善,左心室射血分数明显增加（P<0.05)。右心导管检查示肺/体循环血流量比值明显提高(P<0.01),肺血管阻力（P<0.05),肺/体循环压力比值（P<0.01)和血管阻力比值（P<0.01)明显下降,但有8例（24%）患者肺/体循环血流量比值下降同时肺/体循环血管阻力比值增大。不良反应事件包括脸红（n=3）、头痛（n=2）、鼻充血（n=1）,异常阴茎勃起（n=1）等。实验室检查显示红细胞和血红蛋白较治疗前显著降低(P<0.01),而肌酐轻度升高(P<0.05)。结论: CHD并发PAH患者接受西地那非治疗6个月耐受性良好,大部分患者运动耐量和血流动力学明显改善。     

曲前列尼尔在高原地区先天性心脏病并发重度肺动脉高压围术期中的应用

目的 探讨静脉持续注射曲前列尼尔在高原地区先天性心脏病（先心病）并发重度肺动脉高压（S-PAH）患儿围术期应用的安全性和有效性。 方法 分别选择2015年1月~2016年10月和2017年1~-2018年10月入我院的高原地区先心病并S-PAH患儿各33例,前后两个住院时期的患儿按围术期是否使用曲前列尼尔分别设为试药组（33例,2017年1月~2018年10月入院）和对照组（33例,2015年1月~2016年10月入院）。对照组仅口服西地那非治疗,试药组在口服西地那非治疗的同时,给予曲前列尼尔静脉微泵注射给药至出院前,观察并评估每组患儿的一般临床指标、超声心动图、脑钠尿肽（BNP）等指标。 结果 两组患儿一般临床指标和超声指标比较均无统计学意义,与入院时比较,两组患儿出院前肺动脉收缩压（PASP）和末梢氧饱和度明显下降,且试药组患儿PASP显著低于对照组（P<0.05）,但末梢氧饱和度组间比较无显著差异;试药组患儿体外循环时间、呼吸机带管时间和ICU住院时间与对照组比较显著缩短（均P<0.05）,两组患儿主动脉阻闭时间比较无明显差异;两组患儿出院前心排指数（CI）及BNP与术前比较差异显著（P<0.05）,且出院前试药组BNP和CI与对照组比较有显著差异（均P<0.05）,而左室射血分数两组比较差异不显著。 结论 持续静脉注射曲前列尼尔在高原地区S-PAH患儿中能够安全、有效的控制PAH,减少患儿呼吸机带管时间和住院时间。     

新生儿持续性肺动脉高压、先心相关肺动脉高压造成心脏损伤的情况对比分析

目的 对比新生儿持续性肺动脉高压与先天性心脏病相关肺动脉高压在心脏损伤方面的情况。方法 根据入选标准收集2018年1月至2021年12月我院新生儿病房100例符合肺动脉高压的患儿作为本次研究对象,根据疾病类型分为持续性肺动脉高压组与先天性心脏病相关肺动脉高压组,对比两组患儿围生期的基线资料、超声心动图指标以及心肌酶。结果 两组患儿性别、平均胎龄、平均体质量、母亲年龄、分娩方式、窒息发生情况、胎膜早破、母亲妊娠期合并症、母亲吸烟等基线资料比较,差异均无统计学意义（P>0.05）;持续性肺动脉高压组患儿LA、LV低于先天性心脏病相关肺动脉高压组,LVDd、LVEF高于先天性心脏病相关肺动脉高压组（P<0.05）;两组患儿RA、RV、RVDd无显著差异（P>0.05）;先天性心脏病相关肺动脉高压组患儿CK、CK-MB高于持续性肺动脉高压组（P<0.05）。结论 先天性心脏病相关肺动脉高压患儿左心室、左心房及左室射血分数改变较为明显,且对患儿心脏损伤程度相比持续性动脉高压更重。     

鱼精蛋白对先天性心脏病合并重度肺动脉高压的血液动力学影响(摘要)

鱼精蛋白对先天性心脏病合并重度肺动脉高压的血液动力学影响（摘要）吴峻峰孙国勤郭继唐孟丽君１资料与方法３０例经体外循环（ＣＰＢ）手术的先天性心脏病患者分为两组，每组１５例。伴有重度肺动脉高压（ＳＰＨ）组：肺动脉收缩压１２．１５±２．３１ｋＰａ（９１．...     

先天性心脏病合并肺动脉高压患者血清血管紧张素转化酶2活性变化的研究

目的观察先天性心脏病（CHD）伴肺动脉高压（PAH）患者血管紧张素转化酶2（ACE2）活性水平的变化,探讨其与肺动脉高压的关系。方法先天性心脏病患者68例,分为先天性心脏病肺动脉压力正常组36例、先天性心脏病合并轻中度肺动脉高压组19例和先天性心脏病合并重度肺动脉高压组13例。抽取受试者静脉血,应用比色法检测ACE2酶活性水平。结果先心病重度肺动脉高压组血清ACE2酶活性较先心病肺动脉压力正常组明显降低（1．28±0．40比1．92±0．64,P〈0．05）,血清ACE2酶活性与肺动脉压力存在低度负相关关系（r=-0．367,P〈O．01）。结论ACE2酶活性降低可能在先天性心脏病肺动脉高压的发生、发展中起着重要的作用。     

肺动脉高压联合治疗方案效价研究

目的：探讨吸入型伊洛前列素和西地那非2种药物联合应用及单独用药在治疗重度肺动脉高压患者中的效价。方法：29例肺动脉高压患者随机分为单独应用伊洛前列素组（I组）、西地那非组（S组）和伊洛前列素续减合并西地那非递增的联合治疗组（I＋S组），观察治疗4、12、24周时3组的临床疗效和经费。结果：治疗12周时，I组及I＋S组较S组在心排出量、6min步行距离和心功能WHO分级的改善方面均有明显差异（P〈0．05）；但I组与I＋S组相比疗效无显著差异：治疗24周时，3组疗效均无显著差异（P〉0．05）。12周及24周时I＋S组治疗费用较I组明显减少，分别节省32％及64％，S组治疗费用最低。结论：吸入伊洛前列素合并口服西地那非的续减递增联合治疗是重度肺动脉高压患者高效价的治疗方案。     

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.