老年非瓣膜性心房颤动患者f波特点与血栓栓塞危险性的关系

目的 探讨老年非瓣膜性心房颤动(NVAF)患者ECG f波特点与血栓栓塞危险性的关系.方法 选择老年NVAF患者69例,根据是否合并血栓栓塞事件,将患者分为栓塞事件组(23例)和无栓塞事件组(46例).描记ECG V1导联,测量f波的振幅、f波时限和f-f间期,并经胸超声心动图检查,进行相关分析及logistis回归分析.结果 栓塞事件组患者f波振幅较无栓塞事件组低(0.076±0.018)mV vs(0.092±0.033)mV,差异有统计学意义(P＜0.05);f-f间期较无栓塞事件组短(0.115±0.009)s vs(0.126±0.016)s,差异有统计学意义(P＜0.05),两组f波时限比较无显著差异(P＞0.05);相关分析显示f波振幅与年龄呈负相关(r=-0.29,P＜0.05),而与左心房、LVEF均无显著相关性(P＞0.05);logistic回归分析显示f波振幅减低是老年NVAF患者血栓栓塞事件的独立危险因素.结论 ECG f波特点有助于评估老年NVAF患者血栓栓塞危险性.     

血小板激活及内皮损伤血液标志物对心房颤动血栓栓塞危险性的评价

目的:研究心房颤动(Af)患者是否存在血小板激活和内皮损伤,探讨其对评价Af血栓栓塞危险性的价值。方法:Af患者共89例,按是否接受了经食管超声心动图(TEE)检查分为两个亚组:①TEE检查亚组:35例,发现左心房和(或)左心耳有血栓者10例,有明确外周动脉血栓栓塞并发症者8例,无血栓者17例;②未检查亚组:54例。另选33例非Af者为对照组。用ELISA法测定两组的血浆可溶性P选择素(sP选择素)、血管性血友病因子(vWF)、D二聚体(DD)水平,用全自动生化分析仪测定平均血小板体积(MPV),对其结果进行对照分析。结果:Af患者血浆sP选择素、vWF、MPV、DD水平显著升高(P<0.05),其中血浆sP选择素、DD、MPV水平在血栓和无血栓者中差异有统计学意义(P<0.05)。且sP选择素与DD水平呈正相关(r=0.311,P<0.05)。结论:Af患者存在有血小板激活及内皮损伤,与其血栓形成及栓塞并发症有一定关系。     

心房颤动患者血栓形成与抗凝血酶Ⅲ关系的探讨

本文对术前部分心房颤动患者血浆抗凝血酶Ⅲ(AT-Ⅲ)的含量及功能活性进行测定。随意选其中有血栓和无血栓者各25例进行比较发现,血栓组AT-Ⅲ含量及功能活性均明显低于无血栓组(P<0.001),同时发现左房内径和二尖瓣口径血栓组也明显小于无血栓组(P<0.05)。     

慢性心房颤动患者心房自发声学显影与血流动力学和凝血标记物关系的研究

目的研究瓣膜性心房颤动(房颤)和非瓣膜性房颤患者左心房自发声学显影(SEC)的形成机制.方法患者61例分为3组,其中健康对照组17例,非瓣膜性房颤组23例和瓣膜性房颤组21例.测定血浆纤维蛋白原(Fg)、血管性血友病因子(vWF)、D-二聚体(DD)、血小板颗粒膜糖蛋白-140(GMP-140)、凝血酶抗凝血酶Ⅲ复合物(TAT)和纤溶酶原激活物抑制物-1(PAI-1);应用经食管超声心动图技术测量房颤患者左心耳和肺静脉血流速度;应用背向散射积分(IBS)技术定量测定左心耳SEC.结果与对照组比较,房颤患者血浆Fg、vWF、DD、TAT和PAI-1显著升高(P＜0.05),GMP-140差异无显著性(P＞0.05);房颤两组间差异无显著性.相关分析结果,瓣膜性房颤组左心房SEC与TAT正相关(r=0.64,P=0.0026),与肺静脉血流D波平均流速负相关(r=-0.49,P=0.044),其余无相关性;非瓣膜性房颤组左心房SEC与左心耳排空血流流速积分负相关(r=0.43,P=0.045),与肺静脉血流D波平均流速负相关(r=-0.43,P=0.048),其余无相关性.结论血液高凝状态和局部血流淤滞可能是瓣膜性房颤左心房SEC形成的主要机制;局部血流动力学紊乱可能是非瓣膜性房颤左心房SEC形成的主要机制,血浆凝血标记物对非瓣膜性房颤左心房SEC的预测价值尚待进一步研究.     

房颤合并血栓栓塞患者血浆N-末端脑钠肽前体水平的临床意义

目的 探讨血浆N-末端脑钠肽前体(NT-proBNP)水平在房颤(AF)合并血栓栓塞患者的临床意义及其与心功能状态、左房大小的关系.方法 36例房颤合并血栓栓塞患者和30例慢性持续性房颤患者,排除心瓣膜病变及先天性心脏病,抽取肘静脉血2 mL检测血浆NT-proBNP浓度.结果 血栓栓塞组血浆NT-proBNP浓度为(1 397.1±1 191.1) pg/mL,高于无血栓栓塞组(980.2±730.6) pg/mL(P<0.01).血栓栓塞合并心功能不全组血浆NT-proBNP浓度(1 552.8±1 106.2) pg/mL,高于无心功能不全组(830.4±565.6) pg/mL(P<0.01),且与左室射血分数(LVEF)呈负相关,与左室舒张末内径(LVEDd)、左房内径(LA)呈正相关.结论 AF患者血浆NT-proBNP差异与血栓形成有关,血浆NT-proBNP浓度与心功能状态、左房大小有相关性.     

肝癌介入治疗前后弥漫性血管内凝血分子标志物的检测及临床意义

目的:通过检测原发性肝癌(HCC)患者在介入治疗前后不同时段全身与局部血浆中较敏感的DIC分子标志物的动态变化,探讨介入治疗对HCC患者全身与局部凝血状态的影响,为临床防治介入治疗后血栓并发症提供实验依据。方法:21例原发性肝癌经肝动脉插管栓塞化疗(TACE)患者分别于插管前(全身)、注射栓塞剂前(局部)、注射栓塞剂后30分钟(局部)、注射栓塞后3小时(全身)以及术后24小时(全身)5个时段,测定血浆TF(组织因子)、vWF(血管性血友病因子)、GMP-140(血浆α-颗粒膜蛋白)、FⅡα(凝血酶)、AT-Ⅲ(抗凝血酶Ⅲ)和D-Dimer(D-二聚体)含量;12名健康志愿者组成正常对照组,同时测定上述指标,对结果进行统计学分析。结果:HCC患者在介入治疗前TF、vWF、GMP-140、FⅡα、AT-Ⅲ、D-Dimer和正常组比较,差异均有显著性意义(P<0.01或P<0.05);随着手术进行,各指标发生了不同程度的动态变化,TF、vWF、GMP-140、FⅡα、D-Dimer各时段均有不同程度的升高,而AT-Ⅲ则有下降趋势。结论:大多数HCC患者介入治疗前已存在高凝状态,介入治疗短期内进一步加重了机体的凝血功能障碍。积极开展凝血功能监测、早期进行适量抗凝治疗对防治介入治疗后并发症具有重要的临床意义。     

肥厚性心肌病合并左心室血栓的临床分析

目的 探讨合并左心室血栓的肥厚性心肌病(HCM)患者的临床特征和预后.方法 回顾性分析阜外心血管病医院2002年1月至2012年12月住院患者中经心脏磁共振证实有左心室血栓的HCM患者的临床资料及随访情况.结果 经磁共振证实有左心室血栓的HCM患者共6例(血栓组),左心室无血栓的HCM患者共284例(无血栓组),血栓组患者的心血管病家族史、室性心律失常和室壁瘤比例明显高于无血栓组(66.67％比21.48％,66.67％比5.63％,66.67％比0.35％,均为P＜0.05),左心房内径、左心室内径明显大于无血栓组[(47.67±6.28) mm比(39.88 ±7.37)mm,(55.83±7.13)mm比(45.25±6.55)mm,均为P＜0.05],而左心室射血分数和流出道梗阻比例明显低于无血栓组(41.50％±18.50％比67.14％±9.47％,0比47.54％,均为P＜0.05).有左心室血栓的患者接受华法林抗凝治疗,随访17～59个月,未发现血栓栓塞,2例复查血栓消失,3例死亡,l例进行了全心脏移植.结论 HCM合并左心室血栓见于有室壁瘤或左心室射血分数减低的患者,多合并室性心律失常,预后较差;还可发生栓塞事件,华法林可有效治疗左心室血栓.     

1 041例非瓣膜性心房颤动患者左心房内径的分析

目的:了解非瓣膜性心房颤动(房颤)患者左心房内径与房颤类型、房颤病程、左心房血栓及血栓栓塞危险因素等方面的关系. 方法:选择2001-01至2008-01在我院住院的非瓣膜性房颤患者共1 041例,入选条件:①心电图或24小时动态心电图证实的房颤发作;②超声心动图证实的非瓣膜性心脏病.分组情况:按左心房有无血栓分为无左心房血栓组(,n=950)与有左心房血栓组(n=91). 结果:1 041例患者中,男性666例,女性375例,平均年龄为(64.26 ±12.43)岁.左心房增大的有658例(63.2%).左心房内径随着病程出现阵发性、持续性、永久性房颤而增加,左心室射血分数随着病程出现阵发性、持续性、永久性房颤而降低,持续性房颤和永久性房颤与阵发性房颤比较,差异均有统计学意义(P<0.05).左心房内径的大小随着房颤病程延长而增加.有左心房血栓组的房颤病程、左心房内径大于无左心房血栓组,差异有统计学意义(P<0.05),且具有房颤血栓栓塞危险因素的发生率有随着左心房内径增大而增加的趋势. 结论:房颤是左心房扩大的原因之一,房颤持续时间越长,左心房扩大越明显.左心房扩大在其血栓形成中起着重要作用.     

利伐沙班治疗伴低抗凝血酶Ⅲ肾病综合征患者静脉血栓栓塞症的疗效

目的:观察利伐沙班治疗肾病综合征(NS)伴低抗凝血酶Ⅲ(AT-Ⅲ)血症患者血栓栓塞并发症的临床疗效与安全性。方法:16例经血管超声、肾静脉或肺动脉CT血管造影确诊并发血栓栓塞症的低AT-Ⅲ的NS患者,随机分为利伐沙班组(8例):口服利伐沙班30 mg/d治疗(早20 mg、晚10 mg,间隔12h);低分子肝素组(8例):皮下注射低分子肝素5 000 IU/12h治疗。总疗程4周,在随访基线(入组时)及第2、4周观察记录患者各项临床指标及CT血管造影。主要疗效终点为患者已有血栓消失或血栓体积缩小≥90%。次要指标包括:原有血栓扩大或新发血栓或深静脉血栓脱落致新发肺栓塞;由肺动脉或静脉血栓导致死亡;临床严重出血并发症;治疗过程中血清AT-Ⅲ变化情况。结果:两组各7例患者累积到达疗效终点,其中利伐沙班组第2周达疗效终点者5例,第4周达疗效终点者2例;低分子肝素组则分别为4例和3例。两组均无血栓加重及新发血栓情况发生,无临床严重出血并发症及死亡事件发生。利伐沙班组中所有患者在第2周血清AT-Ⅲ水平升至正常范围。低分子肝素组中6例患者于第2周血清AT-Ⅲ升至正常范围,2例患者于第4周时血清AT-Ⅲ升至正常。结论:利伐沙班与低分子肝素治疗伴低AT-Ⅲ血症的NS并发的血栓栓塞症的患者,疗效及安全性相当,无明显不良反应。     

血清尿酸和高敏C反应蛋白水平与非瓣膜性心房颤动患者血栓栓塞事件的相关性分析

目的探讨血清尿酸和高敏C反应蛋白(hs-CRP)水平与非瓣膜性心房颤动(NVAF)患者血栓栓塞事件的关系。方法回顾分析462例NVAF住院患者,按有无血栓栓塞事件分为栓塞组(n=63)和无栓塞组(n=399),比较组间的危险因素,分析血清尿酸水平与血栓栓塞事件的关系。结果栓塞组患者高血压、糖尿病、冠心病、心功能不全、高龄≥75岁者占比,血尿酸、hs-CRP、纤维蛋白原水平均高于无栓塞组,左心室射血分数(LVEF)低于无栓塞组,差异均有统计学意义(均P0.05)。血清尿酸水平与hs-CRP呈显著正相关(r=0.787,P0.01)。多因素logistic逐步回归分析显示血清尿酸水平升高是NVAF患者出现血栓栓塞事件的独立危险因子(OR1.05,95%CI 1.02~1.17,P0.05)。结论血清尿酸升高与NVAF患者血栓栓塞事件存在一定相关性。     

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.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.