运动试验时QT间期离散度诊断冠心病的价值

目的探讨QT离散度（QTd）在运动试验中的变化,及其对冠心病心肌缺血的诊断价值。方法 68例临床诊断或疑诊为冠心病的患者先后行平板运动试验（简称运动试验）及冠状动脉造影（简称冠脉造影）检查。结果 47例运动试验阳性者中30例确诊为冠心病;21例运动试验阴性者中19例冠状动脉正常。冠心病组与冠脉正常组运动前、中、后QTd分别为42.38±19.28 ms、70.58±19.45 ms、50.14±13.56 ms及31.18±6.25 ms、30.01±9.05 ms、28.24±8.12 ms,两者比较,p均〈0.01。冠心病组运动前、后与运动中QTd比较,差异有显著性,p〈0.005;而冠脉正常组QTd变化无显著性。以运动中QTd≥60 ms为异常,诊断冠心病的敏感性为90.9%、特异性100%、准确性94.9%。结论提示运动试验中QTd增加可作为诊断冠心病心肌缺血的敏感而特异的指标。     

运动诱发心肌缺血对QT离散度的影响

目的　通过活动平板试验前后冠心病患者与冠状动脉正常者的 QT离散度变化 ,研究运动引起的心肌缺血对 QT离散度的影响。　方法　分析经冠状动脉造影证实的 41例冠心病患者与 45例冠状动脉造影正常者活动平板试验前和运动高峰时体表 12导联心电图 QT离散度变化。　结果　运动前 ,运动高峰冠心病组 QT离散度分别为 (47.84± 11.19) m s,(6 2 .16± 10 .45 ) ms(P<0 .0 0 1) ;而冠状动脉造影正常者分别为 (2 4.2 2± 15 .15 ) ms,(2 3.11± 14.43) ms(P>0 .0 5 ) ,运动前、后两组相比 P均 <0 .0 0 1。以运动中 QT离散度≥ 5 0 m s判为异常 ,诊断冠心病的敏感性 86 .2 % ,特异性 88.9% ,预测准确性 87.5 %。　结论　冠心病组活动平板试验中 QT离散度进一步增加 ,冠状动脉造影正常组 QT离散度无变化 ,提示运动高峰时较大的 QT离散度有助于反映冠状动脉病变及心肌缺血程度。并提示 QT离散度是活动平板试验中诊断冠心病心肌缺血敏感而特异的指标。     

运动诱发心肌缺血对QT离散度的影响

目的通过平板运动试验(ETT)前后冠心病(CHD)病人与冠状动脉正常者的QT离散度(QTd)变化,研究运动引起的心肌缺血对QTd的影响。方法分析经冠状动脉造影(CAG)证实的41例CHD病人与45例CAG正常者ETT前和运动高峰时体表十二导联心电图QTd变化。结果运动前、运动高峰CHD组QTd分别为(47.84±11.19)ms、(62.16±10.45)ms(P0.01);而CAG正常者分别为(24.22±15.15)ms、(23.11±14.43)ms(P0.05)。以运动中QT≥50ms判为异常,诊断CHD的敏感性为86.2%,特异性88.9%,预测准确性87.5%。结论运动高峰较大的QTd有助于反映冠状动脉病变及心肌缺血程度。并提示QTd是ETT中诊断CHD心肌缺血敏感而特异的指标。     

平板运动试验中IQTd诊断冠心病的价值

目的　评价用心率调整QTd指标 (IQTd)在平板运动试验中对冠心病的诊断价值。方法　 4 3例患者在冠状动脉造影前行平板运动试验 (ETT) ,测量其运动前、运动中与ST段下移最大时或最大负荷心率时 (无ST段下移者 )QTd、校正QTd(QTdr、QTcdr、QTdp、QTcdp) ,分别计算IQTd和IQTcd。ETT后 1周内行冠状动脉造影 (CAG) ,根据CAG结果分为冠心病 (CAD)组 2 3例和冠状动脉正常 (NCAD)组 2 0例。结果　运动前的QTdr和QTc dr在CAD与NCAD组间无显著差别。在冠状动脉正常组 ,运动过程QTdp和QTcdp无显著增加 ,而在冠心病组QTdp和QTcdp有显著性增加 (P <0 0 0 1)。在运动过程中 ,QTdp、QTcdp、IQTd、IQTcd在CAD与NCAD组间有明显差异。在NCAD组QTdp、QTcdp、IQTd、IQTcd95 %上限值分别为 74ms、86ms、0 .17ms/bpm和0 2ms/bpm。用其界值作为诊断标准 ,其特异性显著高于ST段压低 ,IQTd和IQTcd的敏感性和准确性显著高于ST压低 (P <0 0 5 )。结论　提示IQTd、IQTcd可作为平板运动试验中诊断冠心病敏感、准确和特异的指标     

经皮冠状动脉腔内成形术及支架植入术对QT离散度的影响

目的　观察冠心病患者在经皮冠状动脉腔内成形术 (PTCA)及支架植入术后QT离散度(QTd)的变化。方法　 44例冠心病患者经PTCA及支架植入术后血管再通者纳入研究。术前一周内及术后 48h内分别记录体表 12导联同步心电图 ,测量QTd及QTc离散度 (QTcd)。为评价冠状动脉造影对QTd及QTcd可能产生的影响 ,我们还测量了同期 10 8例行冠状动脉造影术的患者手术前后的QTd及QTcd。结果　 (1) 10 8例行冠状动脉造影术者及其亚组 (术前QTd延长组、正常组 ,QTcd延长组、正常组 ,单支病变组 ,二支病变组 )手术前后QTd及QTcd差异均无显著性 ;(2 )PTCA及支架植入术组手术前后QTd差异也无显著性 ,但QTcd却从术前的 (5 8 9± 33 3)ms缩短至术后的 (4 7 6± 2 0 9)ms(P <0 0 5 )。亚组分析表明 :术前QTd延长组 (75 4± 2 5 2 )ms术后明显缩短 (4 7 5± 19 6 )ms,P <0 0 1;术前QTcd延长组 (95 3± 30 3)ms术后也明显改善 (5 2 5± 2 5 6 )ms ,P <0 0 1;单支病变组手术后QTd(4 1 6± 16 9)ms及QTcd(4 4 3± 18 2 )ms均较术前 [QTd及QTcd分别为 (5 5 5± 2 6 4)ms及 (6 0 3± 31 1)ms]明显缩短 (P均 <0 0 5 ) ;而术前QTc或QTcd正常组、二支病变组手术后QTc及QTcd均无明显变化。结论　PTCA及支架术可明显缩短QTcd ;     

冠状动脉狭窄老年患者PTCA术后QT离散度变化

目的 :观察冠状动脉成形术 （PTCA）对老年冠脉狭窄患者心肌复极的影响。方法 :连续测量了 6 8例冠状动脉狭窄老年患者 PTCA术前术后体表心电图的 QT间期与 QT离散度 （QTd） ,并与 5 3例无狭窄对照组比较。结果 :冠状动脉狭窄组较无狭窄组 QT间期显著延长 ,QTd明显增加 （QTm ax分别为 :45 3± 43m s和 392± 35 m s;QTc-max分别为 :482± 49m s和 439± 37ms;QTd为 74± 33m s和 2 9± 15 m s;QTcd为 78± 37ms和 32± 17m s,P<0 .0 1） ;PTCA使 QT间期缩短 ,QTd缩小 （QTcm ax:术前 482± 49ms,术后 1周为 45 2± 40 ms;QTcd在术前 78±37ms,术后 2 4h内 6 3± 2 6 m s,术后 1周为 6 0± 32 m s;QTd在术前 75± 34 m s,术后 2 4h内为 5 8± 2 5 ms及术后 1周 5 6± 31ms,P<0 .0 5 ）。结论 :心肌灌注增加明显缩短 QTd离散度 ,表明心肌复极获得改善 ,这可能有利于减少心律失常的发生。     

QT离散度在冠心病患者运动试验中的意义

目的探讨平板运动试验中冠心病患者与冠状动脉正常者ＱＴ离散度（ＱＴｄ）变化的意义。方法分析经冠状脉动（冠脉）造影证实的１３例冠心病患者与１７例冠脉造影正常者平板运动试验前、试验中ＳＴ段下移０１ｍＶ以上或出现典型心绞痛症状或达亚极量心率时以及运动后体表１２导联心电图ＱＴｄ变化。结果运动前、中、后冠心病组ＱＴｄ分别为４６２±２０１ｍｓ，７１９±２０．４ｍｓ及５１．２±１４．５ｍｓ；而冠状动脉正常组分别为３２．３±６．６ｍｓ，３０．９±９．２ｍｓ与２９．４±８．５ｍｓ，两组相比Ｐ均＜０．０１；冠心病组ＱＴｄ运动中与运动前后相比Ｐ均＜０．０１，而冠脉正常组差异无显著性；以运动中ＱＴｄ≥６０ｍｓ判为异常，诊断冠心病的敏感性为９２．３％，特异性１００％，准确性９６．７％。结论冠心病患者运动试验中ＱＴｄ进一步显著增加，ＱＴｄ是运动试验中诊断冠心病心肌缺血敏感而特异的指标。     

冠状动脉内支架置入术对有与无心肌梗死史患者QT离散度影响的比较

探讨和比较冠心病患者经过成功冠状动脉 (简称冠脉 )内支架置入术对有与无心肌梗死史的病人QT离散度(QTd)影响的程度 ,选择术前QTd≥ 60ms者 1 0 0例 ,根据有无心肌梗死病史分为两组 ,其中无心肌梗死组 62例 ,心肌梗死组 38例 ,于术前、后 72h分别做 1 2导联同步心电图进行测量QTd和计算校正QTd(QTcd)。在无心肌梗死组中 ,支架置入术后 ,QTd、QTcd明显缩短 (分别为 51± 1 9vs 72± 34ms,54± 2 4vs 81± 37ms;P <0 .0 5) ;而在心肌梗死史组中 ,术后QTd、QTcd上无显著变化 (分别为 70± 2 6vs74± 30ms ,80± 30vs82± 32ms;P >0 .0 5)。结论 :冠脉内支架置入术显著缩短无心肌梗死史冠心病患者的QTd和QTcd ,而对有心肌梗死冠心病患者的QTd和QTcd无影响     

冠脉内成形及支架术前后QT离散度的变化

目的　探讨冠脉内成形及支架术对冠心病患者QT离散度的影响。方法　对成功实施了冠脉内成形及支架术的冠心病患者 5 0例 ,记录术前 1天与术后第 1天、第 7天的 12导联心电图 ,计算各QTd、QTcd。结果　冠心病患者冠脉内成形及支架术前 1天、术后第 1天、第 7天QTd和QTcd分别为72 1± 9 3ms和 6 9 5± 8 8ms、5 8 3± 5 2ms和 5 7 4± 5 1ms、4 1 6± 3 6ms和 4 0 2± 3 2ms,术后QTd及QTcd均显著低于术前 (P <0 0 5 )。结论　冠脉内成形及支架术可使冠心病患者QTd明显缩短。     

QT离散度对X综合征的临床价值探讨

分析经冠状动脉造影证实的 1 82例冠心病、94例正常人及 3 8例X综合征者活动平板运动试验前及运动高峰时QT离散度 (QTd)的变化。X综合征组运动前QTd明显小于冠心病组 (2 9.41± 1 5 .1 1msvs 5 4.3 0± 9.2 2ms ,P <0 .0 1 )、而与正常组 2 5 .3 0± 1 3 .2 1ms相似(P >0 .0 5 ) ;X综合征组运动高峰时QTd明显大于正常组 (4 9.92±1 0 .2 3msvs 2 3 .5 2± 1 4.3 2ms,P <0 .0 1 )。结论 :X综合征者运动时QTd明显增加 ,提示运动高峰时较大的QTd可反映冠状动脉微血管病变所致心肌缺血     

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.