铊-201负荷心肌洗脱率评价心肌缺血与冠状动脉血流储备的对比研究

目的　评价铊 2 0 1( 2 0 1 Tl)负荷心肌洗脱率在心肌缺血方面的应用价值 ,观察2 0 1 Tl负荷洗脱率与冠状动脉 (冠脉 )血流储备的相关性。方法　选择经冠脉造影证实的冠心病 (冠脉狭窄≥ 5 0 % )住院患者 2 5例 ,另外 2 3例经冠脉造影检查显示冠脉正常或狭窄 <5 0 %者作为对照组。行2 0 1 Tl双嘧达莫 (潘生丁 )负荷心肌显像检查 ,处理出靶心图后 ,计算局部室壁洗脱率。洗脱率 =(负荷态放射性计数 -延迟态放射性计数 ) 负荷态放射性计数× 10 0 %。在核素检查前后两周内行冠脉造影及冠脉内多普勒血流测定。结果　冠脉狭窄组室壁洗脱率显著低于对照组 [前壁 ( 2 6 89± 4 39) %vs ( 4 3 5 4± 9 0 8) % ;下壁 ( 16 81± 6 13) %vs ( 4 5 0 4± 9 6 6 ) % ;侧壁 ( 2 7 76± 9 0 1) %vs ( 4 3 87± 9 17) % ,P <0 0 0 1];冠脉狭窄组所测冠脉血流储备 (CFR =充血相平均峰值流速 静息相平均峰值流速 )值显著低于对照组CFR( 1 6 7± 0 6 3vs 2 85± 0 6 4 ,P <0 0 0 1) ;前壁洗脱率与前降支狭窄程度的相关性、侧壁洗脱率与回旋支狭窄程度的相关性差 (r =- 0 4 6 9,P =0 0 5 ;r =- 0 394 ,P =0 16 4 ) ;但下壁洗脱率与右冠脉狭窄程度之间的相关性较好 (r=- 0 6 6 1,P =0 0 0 5 ) ;室壁洗脱率与     

冠状动脉造影正常而心电图有心肌缺血改变者的相关冠状动脉血流储备功能减低

目的 :观察临床上心电图长期有心肌缺血改变但冠状动脉 (冠脉 )造影完全正常者的冠脉血流储备情况。方法 :临床上冠脉造影完全正常者 33例 ,以心电图有无缺血性ST T改变 (ST水平型或下斜型压低≥ 0 0 5mV或成组导联T波深倒置 )分为两组。甲组 17例 ,心电图有ST T改变 ,乙组 16例 ,无ST T改变。采用冠脉内多普勒导丝血流速度测定的方法计算冠脉血流储备 ,并对两组受试者的冠脉微血管病危险因素做比较分析。结果 :甲组心电图示前壁心肌缺血者的前降支血流储备以及下壁心肌缺血者的右冠脉血流储备值显著低于乙组( 2 16± 0 48vs .2 92± 0 5 2 ,P =0 0 0 2及 2 2 7± 0 5 1vs .3 40± 0 6 3,P <0 0 0 1) ,有显著性差异 ;甲组中有 14例( 82 35 % )存在冠脉血流储备的异常 ,乙组中仅有 2例 ( 12 5 0 % )存在异常 ;甲组 17例中有 13例 ( 76 47% )有冠脉微血管病基础 ,而乙组 16例中仅有 5例 ( 31 2 5 % )有冠脉微血管病危险因素 ,两组差别有统计学意义 (P =0 0 35 )。结论 :冠脉造影正常而心电图有心肌缺血改变者中 82 35 %的患者存在相关冠脉血流储备异常 ,提示存在冠脉微血管病变     

胸痛患者冠状动脉血流储备的超声研究

目的 :应用多平面经食管多普勒超声心动图 (TEE)潘生丁负荷试验 ,探讨胸痛患者的冠状动脉 (冠脉 )循环特点及血流储备 (CFR)功能。方法 :将受试者分为 4组 :冠脉前降支重度狭窄 (A组 ) 10例 ,轻度狭窄 (B组 ) 6例 ,X综合征 (C组 ) 7例 ,冠脉造影正常 (对照组 ) 15例。应用TEE测定冠脉前降支血流频谱 ,以基础状态下(R)和潘生丁负荷后 (D)冠脉舒张期最大流速比值 (D/RPDV)为CFR的指标。结果 :与对照组比较 ,其他 3组基础状态时冠脉血流速度差异无显著性意义 ;CFR明显减低 ,以A组最为明显〔(1.5 5± 4 3)∶(3.4 3± 0 .6 2 )cm/s,P<0 .0 0 1〕 ,狭窄程度与D/RPDV高度相关 (r =0 .83,P <0 .0 0 1) ;B组与C组比较 ,CFR减低程度一致〔(2 .6 2± 0 .71)∶(2 .19± 0 .36 )cm/s,P >0 .0 5 )〕。结论 :CFR反映了冠脉狭窄时冠脉的血流动力学改变 ,可用于判断冠脉狭窄的程度 ;CFR减低是冠脉造影正常患者胸痛的原因     

冠状动脉微血管病患者的三支冠状动脉血流储备的差异

目的 :观察冠状动脉 (冠脉 )造影正常而有冠脉微血管病基础者的三支冠脉血流储备 (Coronaryflowreserve ,CFR)之间是否有差异。方法 :临床上有不典型胸闷或胸痛的患者 4 5例 ,冠脉造影及左室射血分数正常 ,按有无冠脉微血管病基础分为甲、乙两组。甲组为冠脉微血管病组 ,共 2 9例 ,男 19例 ,女 10例 ,年龄 37～ 78(5 8±9.9)岁 ,其中心电图有左室肥厚或劳损表现的高血压患者 11例 ,糖尿病 3例 ,肥厚型心肌病 2例 ,长期吸烟者 10例 ,高血脂 8例 ;乙组为无冠脉微血管病组 ,共 16例 ,男 11例 ,女 5例 ,年龄 38～ 5 8(5 1± 8.6 )岁。冠脉造影过程中随机测定冠脉CFR值 (甲组 6 2支 ,左冠脉前降支 2 4支 ,冠脉左旋支 17支 ,右冠脉 2 1支 ;乙组 36支 ,左冠脉前降支13支 ,冠脉左旋支 8支 ,右冠脉 14支 )。结果 :甲组 6 2支冠脉的平均CFR为 2 .32± 0 .6 1,乙组 3.15± 0 .5 5 ,P <0 .0 1。甲组三支冠脉之间的CFR差异有统计学意义 ,P <0 .0 1;乙组三支冠脉的CFR差别无统计学意义P >0 .0 5。甲组前降支的CFR远低于右冠脉与回旋支 (2 .0 4± 0 .5 2∶2 .5 9± 0 .6 5 ,2 .39± 0 .5 5 ,均 P<0 .0 5 ) ;回旋支较右冠脉的CFR低 ,但差异无统计学意义 (2 .39± 0 .5 5∶2 .5 9± 0 .6 5 ,P >0 .0 5 )。结论 :冠脉微血     

冠状动脉内支架术后即刻血流储备的变化

目的 :研究冠状动脉 (冠脉 )内支架术后冠脉血流储备的变化。　　方法 :18例冠脉造影示单支病变进行支架术的患者测定支架术前后的冠脉血流储备 ,并以术后血流储备 2 5为界将患者分为 2组 (恢复组 :7例 ,支架术后冠脉血流储备 >2 5 ,异常组 :11例 ,支架术后冠脉血流储备≤ 2 5 ) ,比较 2组冠脉血流储备的变化及一般情况。　　结果 :恢复组和异常组 2组术后较术前血流储备均明显增高 (恢复组 :2 2± 0 6和 3 1± 0 3 ,P <0 0 5 ;异常组 :1 3± 0 4和 1 9± 0 4,P <0 0 5 )。与恢复组比较异常组中心肌梗死患者明显增多 (7/11和 1/7,P <0 0 5 ) ,高血压者明显增多 (9/11和 2 /7,P <0 0 5 )且冠脉狭窄程度严重〔(84± 4) %和 (65± 9) % ,P <0 0 0 1〕。　　结论 :支架术后即刻冠脉血流储备改善 ,其程度与心肌梗死、高血压及狭窄严重性有关。     

多普勒导丝对腺苷预处理保护冠状动脉微循环功能的评价

目的 :观察腺苷预处理 (APC)对缺血心肌相关冠状动脉 (冠脉 )微循环功能的保护作用。方法 :将建立心肌缺血模型的 12只中国小型家猪随机分为两组 :对照组 6只 ,仅制备心肌缺血模型 ;APC组 6只 ,制备模型前经冠脉注入腺苷 6mg。应用冠脉内多普勒导丝观察模型相关冠脉平均峰值流速 (APV)、舒张收缩流速比值(DSVR)、冠脉血流储备 (CFR)的变化。结果 :两组模型冠脉狭窄后 10min时APV、DSVR、CFR均较基础状态时明显下降 (P <0 .0 5或 <0 .0 1) ,APV、DSVR在随后实验过程中无明显变化 ;30min时两组CFR均有进一步降低趋势 (P >0 .0 5 ) ;6 0min时对照组CFR较 30min时明显降低〔(0 .96± 0 .2 7)∶(1.74± 0 .4 9) ,P <0 .0 5〕 ,而APC组CFR与 30min时相比差异无统计学意义〔(1.6 4± 0 .30 )∶(1.79± 0 .38) ,P >0 .0 5〕 ;但 12 0min时APC组CFR较前明显下降〔(0 .94± 0 .31)∶(1.6 4± 0 .30 ) ,P <0 .0 1〕 ,与同时间点对照组相比差异无统计学意义。结论 :心肌缺血模型相关冠脉在急性重度狭窄 6 0min时发生微循环功能障碍 ,APC对冠脉微循环功能具有保护作用 ,但持续时间较短。     

冠状动脉内支架术对冠状动脉血流储备的远期影响

目的　采用经胸多普勒超声心动图冠状动脉 (冠脉 )血流显像技术观察冠脉支架置入术对冠脉血流储备 (CFR)的远期影响。方法　对 34例冠心病患者分别于支架术术前、术后 72h内及随访期 [( 6 .7± 1.5 )个月 ]记录病变血管远端静息舒张期血流峰速 (r Vd)、注射潘生丁及等长握力实验时最大舒张期血流峰速 (d Vd)及CFR。每例患者于随访期复查冠脉造影。结果　随访期造影无再狭窄 2 8例。据术后 72h内CFR分为CFR受损组 ( 10例 ,CFR≤ 2 .5 )及CFR未受损组( 18例 ,CFR >2 .5 )。术后近期CFR受损组r Vd较CFR未受损组明显增高 (P <0 .0 1) ;随访期时CFR受损组CFR升高至CFR未受损组水平 (P >0 .0 5 )。随访期出现再狭窄 6例 ,CFR均 <2 .0 ,降至术前水平。结论　 ( 1)成功的支架术后部分患者存在暂时性CFR降低 ,CFR的降低及其恢复与r Vd的一过性增高及恢复有关 ;( 2 )再狭窄患者冠脉血流储备于随访期显著降低 ,达到术前水平。经胸冠脉血流显像技术可作为冠脉介入治疗后一种简便、安全、无创的随访方法。     

老年糖尿病患者冠状动脉血流储备的变化

目的　应用彩色多普勒超声仪检测冠状动脉血流储备 (CFR) ,观察老年糖尿病患者 CFR的变化。方法　 2 5例老年糖尿病患者为患者组 ,2 5例健康志愿者为对照组 ,比较两组的空腹血糖 (FBG)、餐后 2 h血糖 (P2 h BG)、糖化血红蛋白 (Hb A1 C)、总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL- C)及甘油三酯 (TG)、内皮素 - 1 (ET- 1 )、静息状态时患者冠状动脉的基础血流速度 (b FV)、潘生丁注射后的最大血流速度 (m FV)及 CFR。结果　糖尿病组的 FBG、P2 h BG、Hb A1 C、TG及 ET- 1水平显著高于对照组〔分别为 :9.1 2± 3.2 6 mmol/ L与 5.34± 0 .76 mmol/ L ;1 5.78± 4.98mmol/L 与 6.89± 2 .38mmol/ L;(6.3h8.5) %与 (5.2± 7.9) % ;2 .96± 0 .56与 1 .69± 0 .82 mmol/ L及 1 53.91± 1 3.50 pg/ ml与 76.2 3± 1 0 .78pg/ ml,P均<0 .0 1〕,两组的 TC及 LDL- C水平无显著差异 ,静息时的基础冠脉血流速度 (b FV)较对照组轻度上升 (P>0 .0 5) ,而潘生丁注射后 m FV及 CFR(CFR=m FV/ b FV)较对照组明显下降 (分别为 58.1± 7.9cm/ s与 73.5± 9.8cm/ s及 2 .31± 0 .49与 3.58± 0 .46,P均 <0 .0 1 )。结论　老年糖尿病患者冠状动脉血流储备明显下降。     

再灌注治疗后心肌灌注状态对心电图QT离散度的影响

目的　探讨急性心肌梗死 (AMI)再灌注治疗后心肌微循环灌注状态与心电图QT离散度 (QTd)和临床预后的关系。方法　经静脉溶栓和经皮冠状动脉腔内球囊成形术 (PTCA)再灌注治疗成功的AMI患者 30 8例 ,再灌注治疗后 1h按照 12导联心电图ST段的下移幅度分为A和B两组。A组为ST段迅速下降组 (下降≥ 5 0 % ) ,共 2 2 1例 ;B组为ST段持续抬高组 (下降 <5 0 % ) ,共 87例。分别计算两组患者入院即刻、再灌注治疗后 1h和 2 4h心电图的QTd ,并进行比较。结果　A组患者CK、CK MB峰值均明显小于B组 (P <0 0 5 ) ,分别为 (315 5± 2 0 4 6 )vs(4 2 5 3± 2 76 2 ) ;(12 9± 80 )vs(181± 94 )。A组左心室射血分数明显高于B组 (5 7%vs 4 7% ,P <0 0 5 ) ,左心功能不全、梗死后心绞痛发生率均明显低于B组 (P <0 0 5 ,7 5 %vs10 4 % ;4 6 %vs 8 3% )。A组再灌注治疗后 1h、2 4h心电图QTd均明显低于B组 (P <0 0 5 ) ,分别为 (4 0± 14 )vs(4 6± 12 ) ;(37± 13)vs(4 5± 15 )。结论　AMI再灌注治疗后 ,心肌组织水平灌注状态与临床预后及QTd有相关性 ,QTd和心电图ST段回落速度是判断心肌微循环灌注状态的简易实用指标。     

99Tcm-甲氧基异丁基异腈(MIBI)显像与甲状腺癌远处转移的关系研究

目的 探讨甲状腺癌原发灶摄取和清除99Tcm-MIBI的能力与其发生远处转移的关系.方法 80例甲状腺癌患者行99Tcm-MIBI双时相甲状腺局部静态显像,利用感兴趣区技术,分别计算MIBI早期、延迟肿瘤与正常组织的放射性计数比值(T/N)及洗脱率.根据临床检查结果,将患者分为远处转移组(31例)和无远处转移组(49例),并对两组结果进行统计学分析.结果 远处转移组MIBI早期、延迟T/N和洗脱率分别为(2.92 ±0.97)%、(1.99 ±0.99)%和(34 ±5.91)%;无远处转移组分别为(1.74 ±0.78)%、(1.97 ±0.86)%和(13 ±4.21)%,远处转移组MIBI早期T/N和洗脱率均高于无远处转移组(P ＜ 0.05),两组间MIBI延迟T/N差异无显著性(P＞ 0.05).结论 99Tcm-MIBI显像早期T/N及洗脱率与甲状腺癌的远处转移关系密切,有进一步深入研究的价值.     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

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.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

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.     

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.