努力提高我国艾司洛尔的临床应用水平

1988年,诺贝尔生物学奖授给了James W Black教授,表彰他在1962年发明了第一个β受体阻滞剂Pronethalol.评奖委员会对他的贡献给予了极高的评价:"自200年前发现洋地黄以来,β受体阻滞剂是药物防治心脏疾病最伟大的突破".2010年3月22日,85岁的James W Black教授辞世,但他开创的β受体阻滞剂的研究与应用仍在持续发展着.     

重新审视β-受体阻滞剂和血压

对于单纯高血压患者来说,单用β-受体阻滞剂并不是最好的选择。 很久以来,β-受体阻滞剂都是高血压患者降压治疗的中流砥柱。第一种β-受体阻滞剂,心得安（普奈洛尔）。于1964年上市。因为它给心绞痛的治疗疗效带来巨大的提高．并且揭示心脏的调节机制．它的发明者James Black获得了诺贝尔奖。     

β受体阻滞剂治疗高血压的现状

2005年Lindholm发表了一项有关β受体阻滞剂治疗高血压的临床研究荟萃分析,比较β受体阻滞剂与其他降压药物对心血管事件的影响,结果发现β受体阻滞剂组发生脑卒中的相对危险较其他降压药高16％,而心肌梗死和全因死亡率差异没有统计学意义.     

阻断心血管事件链,抑制交感神经过度兴奋,β受体阻滞剂不可或缺

抑制交感神经系统的过度兴奋是β受体阻滞剂在高血压治疗中发挥有益作用的主要原因和机制。应用β受体阻滞剂可获得"一箭双雕"的效果。1β受体阻滞剂仍是主要一类降压药     

β受体阻滞剂临床使用的若干问题

自1964年Prichard BNC首次描述了β受体阻滞剂的降压作用以来,β受体阻滞剂用于高血压治疗已逾半个多世纪,1984年JNC首次将β受体阻滞剂推荐为高血压治疗的一线药物,并延续到今.近10年,有些研究对β受体阻滞剂的临床效果提出质疑,医生/患者对β受体阻滞剂的应用还存在疑虑,临床使用率偏低,剂量偏小.随着新型β受体阻滞剂的问世,需要我们不断地深化对其的认识和应用.     

静脉β受体阻滞剂在急性冠脉综合征的应用进展

β受体阻滞剂在心血管领域应用40年来,随着新的β受体阻滞剂及静脉制剂的应用,其重要性倍受关注。本文拟就β受体阻滞剂作用机制的新进展、静脉β受体阻滞剂在急性冠脉综合征早期使用的相关研究及现状作一概述。     

β阻滞剂治疗急性心肌梗死临床实践注意点

β受体阻滞剂治疗心肌梗死,无论是急性期、稳定期以及梗死后的长期二级预防,均有循证医学提供的确切证据,肯定了β受体阻滞剂的益处.国际指南包括2004年ACC/AHA STEMI指南和2003年ESC AMI指南和2004年ESC β受体阻滞剂专家共识文件,都将口服β受体阻滞剂作为Ⅰ类推荐、A级证据;静脉应用β受体阻滞剂则为Ⅱa类推荐、B级证据.COMMIT/CCS-2研究为临床合理应用β受体阻滞剂提供了进一步证据.同时,根据COMMIT/CCS-2研究结果,在临床实践中,有两点值得注意:     

β受体阻滞剂治疗高血压的临床应用

β受体阻滞剂治疗高血压的临床应用郑德裕β肾上腺素能受体阻滞剂（简称β受体阻滞剂），应用于临床治疗高血压约有３０年历史。１９７８年世界卫生组织（ＷＨＯ）提出的高血压阶梯治疗方案，将β受体阻滞剂列为第一阶梯治疗药物，以普萘洛尔（ｐｒｏｐｒａｎｏｌｏｌ）...     

急性心肌梗死应用β-受体阻滞剂调查分析

目的 探讨基层医院在急性心肌梗死患者中应用β-受体阻滞剂的情况及使用达标率.方法 收集2003年-2007年我院收住的急性心肌梗死患者317例,剔除使用β-受体阻滞剂禁忌患者29例,并统计使用β-受体阻滞剂3 d后心率情况.结果 急性心肌梗死患者使用β-受体阻滞剂达51.74%,静息状态下3 d心室率控制在77/min.结论 基层医院对β-受体阻滞剂使用认识不足和副反应的顾虑,阻碍了循证医学证实的结论性证据在临床的应用.     

β-受体阻滞剂在高血压治疗中的应用研究

目的研究β-受体阻滞剂在高血压治疗中的应用效果。方法选取福建省南安市医院2013年4月至2016年3月期间收治的60名高血压患者,用随机的方式分成2组,分别是研究组和对照组,每组30名高血压患者,对照组给予"络活喜"钙离子拮抗剂治疗,研究组给予"美托洛尔"β-受体阻滞剂治疗,将这两组患者治疗后的效果进行比较分析,同时对研究组患者通过"美托洛尔"β-受体阻滞剂治疗后发生的不适反应进行独立研究。结果研究组治疗总有效率显著高于对照组,P0.05,两组显示的差异具有统计学意义;β-受体阻滞剂治疗后不适反应的发生率是39.1%,其中8名(26.67%)患者发生心血管系统方面的不适反应,4名(13.00%)发生神经系统方面的不适反应,还有3名(10.00%)发生消化系统方面的不适反应。结论应用β-受体阻滞剂治疗高血压患者的效果比较好,但在对高血压患者治疗的过程中也应该掌握β-受体阻滞剂药物的禁忌和适应症,减少此类药物引发的不适反应,进而提高药物对高血压患者的治疗效果。     

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.     

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.     

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.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.