老年急性心肌梗塞合并心衰的康复附13例报告

1983-1996年6月美国Medline资料库中无老年心梗合并心衰康复疗法的专题报道，国内亦然．作协作组报告13例，年龄60-80(平均68±5．94)岁．左室射血分数33%-50%(平均40.61±6.23%)．10例为4周程序，3例为2周程序，康复程序结束时7例完成踏车试验(功率50～100瓦)，2例活动平板运动试验达到Bruce 3级(4kph．坡度10^4)．4例能上、下三层楼或步行300米，本组材料说明基本控制的心衰在严密监护下的康复医疗是安全、有益的。     

老年急性心肌梗塞合并心衰的康复附13例报告

1983—1996年6月美国Medline资料库中无老年心梗合并心衰康复疗法的专题报道,国内亦然。作者协作组报告13例。年龄60—80(平均68±5.94)岁。左室射血分数33％—50％(平均40.61±6.23％)。10例为4周程序,3例为2周程序。康复程序结束时7例完成踏车试验(功率50—100瓦),2例活动平板运动试验达到Bruce 3级(4kph,坡度10°),4例能上、下三层楼或步行300米,本组材料说明基本控制的心衰在严密监护下的康复医疗是安全、有益的。     

早期康复对老年急性心肌梗死合并心衰患者的疗效(英文)

目的:探讨早期康复对老年急性心肌梗死(AMI)合并心衰患者的疗效。方法:选择AMI患者168例,按数字表法随机分为早期康复组(84例,实施早期康复方案)和常规治疗组(84例,实施常规治疗)。比较康复程序结束时两组并发症发生率,踏车试验及步行试验完成情况。结果:两组梗塞后心绞痛、再梗塞、住院期间死亡例数、左室射血分数等对比无显著性差异(P0.05)。与常规治疗组比较,早期康复组程序结束时踏车试验(77.6%比95.0%),步行试验(65.4%比95.8%)完成率显著提高(P均0.01)。早期康复组因长期卧床后易出现的并发症的发生率均显著低于常规护理组(P0.05或P0.01)。结论在严密监护下对老年急性心肌梗死合并心衰(35%左室射血分数50%)患者实施早期康复方案是安全、有益的,可减少长期卧床所致并发症的发生,改善病人的运动功能,提高生活质量。     

老年急性心肌梗死早期运动康复的疗效分析

目的观察13例老年急性心肌梗死(AMI)患者早期运动康复的疗效.方法将13例老年AMI患者分为低危、中危、高危组,分别完成2、3、4周康复程序,其中9例患者出院前进行活动平板运动试验.结果12例患者如期完成康复程序,生活质量及心率变异性明显改善,出院前生活均能自理,其中9例运动试验测定的METS达5.17±0.71.结论老年AMI患者病情平稳后,在密切监测、正确药物治疗下进行早期运动康复是可行、安全的,可改善患者的预后.     

老年急性心肌梗死住院期康复

目的:探讨老年急性心肌梗死(AMI)患者住院期康复治疗的疗效、安全性。方法:比较20例接受四周程序康复治疗的老年AMI患者和19例对照患者的临床疗效、安全性。结果:20例老年AMI患者康复治疗未发生并发症;出院3个月后能生活自理的有18例(90％),左室射血分数(LVEF)>50％的患者13例(65％),未发生心绞痛和再梗。对照组发生心绞痛3例,再梗死1例,心衰2例,心源性猝死1例;出院3个月后能生活自理的仅12例(63％),LVEF>50％的患者仅6例(32％)。康复组的临床疗效及心功能(LVEF)均显著好于对照组(P<0.05)。结论:老年急性心肌梗死康复治疗是安全、有效、可行的。     

急性前间壁心肌梗死合并心力衰竭16例临床分析

1995～ 2 0 0 0年 ,我院共收治前间壁心肌梗死 5 2例 ,其中合并心衰 16例。与前间壁心肌梗死无心衰患者 3 6例比较 ,其临床症状及心电图等均存有明显差别。现报告如下。临床资料 :5 2例患者均符合 WHO前间壁急性心肌梗死的诊断标准 ,心电图表现为在心前导联电极位置固定标记后 ,ECG动态改变仅局限于 V1～ 3导联 (排除心肌梗死延展者 )。 Kilip二级以上心功能者为合并心衰 ,5 2例患者分为前间壁心肌梗死合并心力衰竭 (心衰组 )及前间壁心肌梗死无心力衰竭 (无心衰组 )。心衰组患者 16例 ,男 13例 ,女 3例 ,年龄 ( 63 .8± 5 .0 )岁 ;合并…     

两周康复程序在急性心肌梗死早期康复治疗中的可行性

目的探索两周康复程序对急性心肌梗死的早期康复治疗的可行性.方法根据个体化及活动量循序递增的原则,对42例无严重并发症的急性心肌梗死患者进行2周康复程序的康复治疗,包括饮食指导、戒烟、适量运动及处理应激的训练等.结果所有患者均顺利完成2周康复程序的治疗,门诊随访1～5个月,所有患者均能生活自理,半数以上的患者能坚持参加步行锻炼和家务劳动.结论急性心肌梗死早期康复治疗的2周康复程序是切实可行和安全有效的.     

两周程序康复在急性下壁心梗合并房室传导阻滞患者中的应用（附9例报告）

目的：探讨二同程序对急性下壁心肌梗塞的康复治疗作用．方法：对9例合并有Ⅱ～Ⅲ。AVB的急性下壁心肌梗塞（AMI）患者进行两周程序康复。结果：所有病人均如期完成康复程。有6例患者在出院前顺利完成了症状限制性踏车运动试验，随访3～34月，所有患者均能不同程度地参加家务活动、锻炼或轻松工作。结论；下壁急性心肌梗塞合并Ⅱ。AVB患者慎重采用两周方案仍是可行的，但务须严格掌握禁忌症并采用个体化的原则．才能保证康复活动的顺利进行．     

女性2型糖尿病合并急性ST段抬高型心肌梗死42例溶栓治疗的护理

目的探讨女性2型糖尿病合并急性ST段抬高型心肌梗死患者溶栓治疗的护理要点。方法回顾性分析42例女性2型糖尿病合并急性ST段抬高型心肌梗死患者溶栓治疗的护理特点。结果 42例2型糖尿病合并急性ST段抬高型心肌梗死患者,其中血管再通22例(52.4%);36例好转或稳定出院(85.7%),6例死亡(14.3%)者中,3例并发急性左心衰及心源性休克死亡,2例因并发颅内出血抢救无效死亡,1例因心律失常室速、室颤死亡。结论针对女性糖尿病合并急性心肌梗死患者的溶栓治疗,不仅要实施急性心肌梗塞的常规护理,更要针对其糖尿病血糖波动的特点,严密监测血糖,观察病情变化,,采取综合的护理措施,对预防或减少急性心肌梗死并发症,促进患者康复有重要意义。     

急性心肌梗塞64例康复疗效分析

对64例急性心肌梗塞患者执行福建老年医院急性心肌梗塞四周康复程序(1990年)。患者男47例,女17例,平均65岁、梗塞部位为:下壁25例,广泛前壁15例,前间壁8例,心内膜下4例,下壁 右室壁4例,下壁 正后壁3例,前壁 左室壁3例,前壁 下壁 右室壁 正后壁2例,其中≥60岁40例,大面积心梗12例,严重并发症19例,60例顺利完成程序,4例因合并室壁瘤心衰反复中止康复,总有效率93.75％,表明即使是高龄,大面积心梗,有严重并发症待病情稳定后,以步行训练为主要内容的四周康复程序是安全可行的。     

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.     

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.     

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.     

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.