体外治疗性超声对正常心肌的影响

目的 :探讨体外治疗性超声 (ETUS)对正常心肌的影响。方法 :30例健康志愿者 ,随机均分成两组 ,ETUS组和空白对照组 ,ETUS的频率和声强分别为 0 .8MHz和 1.8W cm2 ,观察ETUS前 10min及ETUS后 12～ 2 4h内血清心肌肌钙蛋白I(cTnI)和肌酸磷酸激酶同工酶 (CK MB)水平的变化。结果 :ETUS前后 ,血清cTnI和CK MB水平差异无显著性意义 (P >0 .0 5 )。结论 :安全剂量的ETUS对正常心肌无明显损伤作用。     

丹参对缺血性心肌损伤保护的非循环机制

目的 :通过丹参注射液对培养心肌细胞缺血性损伤中的心肌酶、心肌细胞超微结构和心肌细胞凋亡的影响 ,探讨其保护作用和机制。方法 :将培养第4天的心肌细胞随机分为 4组 :正常对照组 (A组 ) ,缺糖缺氧组 (B组 ) ,小剂量丹参组 (C组 ) ,大剂量丹参组 (D组 ) ,实验结束取培养液上清液检测LDH、α -HBDH ,收集细胞分别做透射电镜及细胞凋亡的检测。结果 :LDH、α -HBDHB组明显高于A组 (P <0 .0 1) ,C组、D组分别低于B组 (P <0 .0 5 ) ,而稍高于A组 (P >0 .0 5 ) ,C组、D组间无统计学意义 (P >0 .0 5 ) ;置显微镜下心肌细胞A组完好 ,B组其内有空泡形成 ,颗粒增加 ,甚至有变性坏死 ,C组、D组细胞也有少量空泡形成 ,细胞核尚正常 ;电镜下心肌细胞A组线粒体结构完好 ,B组可见线粒体肿胀 ,细胞膜不完整。C组、D组仅见少许线粒体肿胀 ,嵴少 ,与A组相近 ;心肌细胞A组有一定的凋亡 ,而B组凋亡数量明显上升 ,与A组相比有统计学意义 (P <0 .0 1) ,C组、D组凋亡数量无统计学意义 (P >0 .0 5 ) ,与B组相比明显下降 (P <0 .0 5 ) ,但仍比A组稍多 (P >0 .0 5 )。结论 :丹参注射液对心肌细胞缺糖缺氧 (缺血性 )损伤有较好的保护作用 ,其机制可能为降低损伤时细胞内酶的漏出 ,减轻心肌细胞缺血性损害超微结构及形态学的变化     

按摩通过改善VEGF活性及血供促进兔骨骼肌损伤修复

目的研究按摩对兔股四头肌损伤中血管内皮生长因子(VEGF)的影响,探讨按摩促进肌肉损伤修复的作用机制。方法健康成年新西兰大白兔42只,体重(2.0±0.5)kg,随机分为6组,正常组(A组,n=3)、按摩前损伤组(B组,n=3)、损伤后第5天按摩组(C组,n=9)和自然恢复组(D组,n=9)、损伤后第10天按摩组(E组,n=9)和自然恢复组(F组,n=9)。A组实验动物不作任何处理,作为正常对照;其余五组实验动物用自制打击器制备兔股四头肌损伤模型。C、E组于造模后第3天开始按摩,每天1次(转速2 600 r/min,时间15 min),至处死取材为止;D、F组不予按摩。所有组实验兔于伤后各时间段行超声检查。于损伤后第5天和第10天取材,将标本分别进行H&E染色和Westen印迹检测,并与A、B组两组标本进行比较。结果所有实验动物均存活至实验完成。H&E和超声显示,损伤后按摩组同自然恢复组相比炎症反应不明显,且肌纤维间隙变小、排列逐渐紧密;按摩组坏死范围减少,内部血管部分生成,其周围微泡密度和亮度均较自然恢复组高。VEGF在损伤后修复过程中,各组与正常组比较表达均显著增多(P<0.01);按摩组VEGF表达水平与自然恢复组比较差异显著(P<0.01)。结论按摩能促进骨骼肌损伤修复时肌肉形态和血液供应,促进VEGF表达。     

局灶驱动在心房颤动机制中的意义

根据导管消融的不同方法、消融过程中的特征表现和消融结果阐明局灶驱动在阵发性心房颤动 (简称房颤 )机制中的作用。自 1998年 8月至 2 0 0 4年 5月共对 2 6 9例药物治疗无效的阵发性房颤患者进行了导管消融治疗 ,男194例、女 6 5例 ,年龄 2 9～ 75岁。A组 (n =5 3) :肺静脉内局灶消融组 ,早期病例采用这种方法消融 ;B组 (n =78) :消融过程中无房颤或仅有房颤短暂发作、有房颤但是房颤不自行终止或不因消融终止 ;C组 (n =12 3) :消融过程中有明确消融终止房颤 ,消融方法包括环状标测电极指导下节段性消融肺静脉电隔离、超声球囊肺静脉口环状消融术、三维标测指导下肺静脉口外环状消融术及补充应用的局灶消融 ;D组 (n =15 ) :消融仅限于房颤局灶 ,除三尖瓣环 下腔静脉峡部外未在其它部位消融 ,房颤局灶根据标测确定。房颤治疗成功的定义是无房颤发作或房颤发作显著减少。结果 :①近期成功率B、C和D组分别为 4 1.0 3% (32 / 78) ,74 .80 % (92 / 12 3)和 10 0 % (15 / 15 ) ,D组与C、B组、B组与C组相比差异均具有显著性 ,P <0 .0 5。②中期成功率A、B、C和D组分别为 2 8.30 % (15 / 5 3) ,34.6 2 % (2 7/ 78) ,6 5 .0 4 % (80 / 12 3)和 80 % (12 / 15 )。D组与A、B组 ;C与A、B组差异具有显著性 ,P <0 .     

急性心肌梗塞患者福辛普利干预前后校正QT间期离散度的变化

目的 :探讨急性心肌梗塞 (AMI)患者福辛普利 (fosinopril)干预前后校正 QT间期离散度 (QTcd)的变化。　　方法 :46例 AMI患者分基础治疗 福辛普利 10 mg/ d治疗组 (A组 ,2 3例 )和基础治疗组 (B组 ,2 3例 ) ,并对治疗前和治疗 7天后的 QTcd进行对比分析。另设正常人组 2 0例 (C组 )作对照。　　结果 :A组、B组患者 QTcd较 C组明显增加 (P<0 .0 1) ,在 46例 AMI患者中伴室性心律失常者 (n=30 )高于无室性心律失常者 (n=16 ,P<0 .0 1) ,前壁心肌梗塞 (n=31)与下后壁心肌梗塞 (n=15 )间 QTcd差异无显著性 (P>0 .0 5 )。治疗 7天后 A、B两组的 QTcd均较治疗前明显降低 (P均 <0 .0 1) ,但 A组较 B组下降更为显著 ,两组间有显著性差异 (P<0 .0 1)。　　结论 :AMI患者早期 QTcd增加 ,并且与室性心律失常的发生有关 ,福辛普利可降低 AMI早期 QTcd。本结果对改善 AMI近期预后有重要意义。     

不同种类心脏停搏液对心肌线粒体及三磷酸腺苷的影响

目的探讨含不同比例自体血冷心脏停搏液对体外循环下未成熟心肌线粒体超微结构及三磷酸腺苷(adenosine triphosphate,ATP)浓度的影响。方法选择年龄≤1岁,体质量≤10 kg,体外循环心脏直视手术患儿240例,随机分成HTK液灌注组(A组,n=20)、改良ST.Tomas液灌注组(B组,n=55),4:1含自体血停搏液组(C组,n=55),1∶1含自体血停搏液组(D组,n=55),1∶4含自体血停搏液组(E组,n=55),体外循环开始前5 min和主动脉开放后5 min分别取右心房心肌组织标本,透视电镜观察心肌线粒体超微结构改变,用高效液相色谱法(high performance liquid chromatography,HPLC)法测定心肌ATP浓度。结果 A组和E组心肌线粒体损伤程度低于B、C、D组,而心肌细胞ATP含量明显高于B、C、D组(P0.05);E组心肌线粒损伤程度高于A组,心肌细胞ATP浓度低于A(P0.05)。结论 HTK液及1∶4含自体血心脏停搏液对体外循环心脏直视手术未成熟心肌保护作用优于其他心脏停搏液。     

中药芪芍五味合剂对病毒性心肌炎小鼠心肌细胞凋亡和坏死的影响

取 2 4 0只 4周龄 Balb/ c雄性小鼠 ,随机等分为 6组 (每组 4 0只 ) ,即 :正常对照组 (A组 )、中药对照组 (B组 )、病毒对照组 (C组 )、中药治疗组 (D组 )、维生素 C治疗组 (E组 )、病毒唑治疗组 (F组 )。 A、B两组每只小鼠均腹腔接种 0 .1ml不含病毒的 Eagle's液 ,C～F组每只小鼠服腔接种 0 .1ml10 7.5TCID/ ml的柯萨奇 B3(CVB3)病毒液。根据分组分别给予不同的药物治疗。结果 :病毒性心肌炎时心肌细胞的凋亡率和坏死率均显著增加。心肌细胞凋亡高峰在CVB感染后 7～ 10天 ,而心肌坏死高峰出现在 CVB3感染后 14天 ,并且与组织形态学观察一致。应用中药黄芪、赤芍治疗后 ,心肌细胞凋亡率和坏死率均显著降低 (P <0 .0 5 ) ,维生素 C和病毒唑均可降低心肌细胞坏死率 ,但对心肌细胞凋亡影响不大。 CVB感染 3～ 7天内 ,各感染组心肌细胞凋亡率和坏死率均与心肌内病毒滴度呈正相关 (r =0 .76、P <0 .0 1,r=0 .5 4、 P <0 .0 5 ) ;而感染 10～ 30天 ,凋亡率及坏死率与病毒含量无相关性。各感染组心肌细胞凋亡率与坏死率均与心肌病理积分呈正相关 (r=0 .5 5、P <0 .0 5 ,r=0 .76、P<0 .0 1)。中药黄芪、赤芍、五味子可明显减轻病毒性心肌炎小鼠的病理损害程度 ,显著降低病毒性心肌炎心肌细胞凋亡率和坏死率 ,对     

84例甲亢病人的糖化血红蛋白分析

对象①84例甲亢病人,41岁～50岁24人,51岁以上5人.②41例正常人,41岁～50岁10人,51岁～55岁1人.受检者分三组,A:正常组(n=41),B:甲亢治愈组(n=30),C:甲亢发病组(初发和复发),其中C1组(n=30),T3、T4均升高,C2组(n=7),T3升高,T4正常,C3组(n=17),T4升高,T3正常.     

不同严重程度脑梗死患者的心肌损伤程度及预后

目的探讨不同严重程度急性脑梗死患者心肌损伤程度,并分析其预后。方法 113例脑梗死患者根据NIHSS评分分为轻度脑梗死组(A组,n=24),中度脑梗死组(B组,n=55)和重度脑梗死组(C组,n=34)。对3组患者一般资料,肌钙蛋白Ⅰ、肌红蛋白、肌酸激酶同工酶(CKMB)、心电图以及预后情况进行分析。结果 A、B、C 3组患者高血压、糖尿病、高胆固醇史等基础资料差异无统计学意义(P>0.05)。3组患者肌钙蛋白Ⅰ、肌红蛋白、CK-MB水平差异显著(P<0.05),均表现为C组最高、A组最低。3组患者心电图异常发生率差异显著(P<0.05),C组发生率最高,B组次之,A组最低。A、B、C 3组患者死亡率分别为4.17%、5.45%、17.65%,差异有统计学意义(χ~2=4.700,P<0.05)。结论重度脑梗死患者多存在肌钙蛋白Ⅰ、肌红蛋白以及CK-MB水平升高以及心电图异常,预后不良,死亡率较高。     

异丙酚对幼兔心肌缺血再灌注损伤的保护作用

目的观察异丙酚对幼兔未成熟心肌缺血再灌注损伤的影响,初步探讨其作用机制。方法24只日本大耳幼兔(雌雄不限,兔龄21～28d)随机分为缺血再灌注组(A组)、异丙酚组(B组)和对照组(C组)3组。结扎冠状动脉前降支(LAD)制作在体兔心肌缺血再灌注损伤动物模型,其中C组只穿线不结扎,B组于结扎前给予异丙酚300μg·kg-1·h-1,A、B组结扎LAD60min,再灌注120min时抽取动脉血测血清一氧化氮(NO)、丙二醛(MDA)和同型半胱氨酸(Hcy)浓度,取缺血区心肌测心肌含水量,透射电镜观察缺血区心肌超微结构。结果与C组比较,A组血清NO浓度[(246.04±11.65)μmol/L]、MDA浓度[(10.20±1.90)nmol/L]、Hcy浓度[(18.62±6.33)μmol/L]和心肌含水量[(77.26±0.42)%]均升高(P<0.05),B组血清NO浓度[(280.00±13.23)μmol/L]升高(P<0.05)。与A组比较,B组血清NO浓度[(280.00±13.23)μmol/L]升高,MDA浓度[(8.00±1.17)nmol/L]、Hcy浓度[(10.54±3.76)μmol/L]和心肌含水量[(74.16±0.28)%]下降(P<0.05)。电镜观察显示,B组心肌超微结构损伤程度轻于A组,C组心肌结构接近正常。结论异丙酚对幼兔心肌缺血再灌注损伤有保护作用,其机制与异丙酚增加心肌的NO浓度、减少MDA发挥其抗氧化作用及减轻Hcy堆积等有关。     

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.