经皮球囊二尖瓣成形术前后心房利钠肽和脑钠肽的变化

目的探讨风湿性心脏病二尖瓣狭窄患者行经皮球囊二尖瓣成形术(PBMV)前后及不同心律时,外周静脉血中心房利钠肽(ANP)和脑钠肽(BNP)变化及与血液动力学参数之间的关系。方法选择成功行PBMV的风湿性二尖瓣狭窄患者36例,其中窦性心律11例,心房颤动25例。于PBMV术前及术后1天、3天取外周静脉血,分别用放射免疫法和酶链免疫法测定血浆中ANP、BNP值;用心导管测定左房平均压(LAP)、肺动脉压(PAP);术后1天行超声心动图测左房内径(LAD)、二尖瓣口面积(MVA)、二尖瓣跨瓣压差(MPG)。结果PBMV术后ANP逐渐下降,由术前216.09±73.84pg/mL降至术后1天188.70±59.22pg/mL,术后3天140.70±41.53pg/mL(P<0.05),其中窦性心律组比心房颤动组ANP下降明显(64.09±32.89pg/mL比32.93±25.73pg/mL,P<0.05)。术后,窦性心律组中BNP先升高、后降低,由术前545.50±206.20pg/mL升至术后1天662.00±270.16pg/mL,术后3天降至430.05±206.30pg/mL(P<0.05);而心房颤动组BNP变化差异无统计学意义。术后1天与术前比较,ANP降低(ΔANP)与LAP下降相关性最好(r=0.565,P<0.01),BNP的差值(ΔBNP)与MPG的差值(ΔMPG)呈负相关(r=-0.474,P<0.05),而ΔANP/ΔBNP与MPG下降负相关(r=-0.556,P<0.05)。结论PBMV术后,窦性心律患者比心房颤动患者血浆中ANP、BNP下降明显。PBMV术能有效改善患者的血液动力学。ΔANP/ΔBNP比值是反应MPG变化的有效指标。     

二尖瓣球囊扩张术对患者血浆B型利钠肽水平的影响

目的:观察二尖瓣球囊扩张术(PBMV)对二尖瓣狭窄患者血浆B型利钠肽(BNP)水平的影响。方法:检测30例成功施行PBMV的二尖瓣狭窄患者(窦性心律21例,心房颤动9例)术前、术后20 min及术后24 h的血浆BNP浓度,与8例对照者比较,并将BNP浓度与血流动力学参数作相关分析。结果:术前30例二尖瓣狭窄患者血浆BNP水平显著高于对照者(P<0．01);且与平均左心房压(r=0．441,P< 0．05)和肺动脉压(r=0．488,P<0．01)呈正相关。心房颤动患者与窦性心律患者BNP浓度无明显差异。术后20 mim及术后24 h窦性心律患者BNP浓度较术前显著下降(P均<0．05),术后24 h左心室舒张末容量(P<0．01)和每搏输出量(P<0．05)较术前相应增加,左心室舒张末压不变;术后20 min的BNP浓度变化与平均左心房压变化(r=0．696,P <0．01)及肺动脉压变化(r=0．456,P<0．05)呈正相关。术后心房颤动患者BNP浓度较术前无明显改变,左心室舒张末容量和每搏输出量相应不变,左心室舒张末压术后20 min较术前增加(P<0．01)。结论:二尖瓣狭窄患者血浆BNP浓度升高和左心房压及肺动脉压升高相关。心脏节律对球囊扩张术后血浆BNP的变化起重要作用,BNP是反映窦性心律患者球囊扩张术后左心房压及肺动脉压变化的敏感指标,但这一指标不适用于心房颤动患者。     

二尖瓣球囊成形术后几种心血管调节激素血浓度的变化

本文观察了23例二尖瓣狭窄患者二尖瓣球囊成形术(PBMV)前后血浆心钠素(ANF)、血管紧张素Ⅱ(AII)、血管加压素(VP)和内源性类洋地黄因子(EDLF)浓度的动态变化.术前ANF和EDLF均高于正常,而AII低于正常;术后15分钟随左房压的下降,ANF迅速下降(164.9±156.8ng/L,与术前比较P<0.01),VP则显著升高(9.6±2.5ng/L,与术前比P相似文献   

二尖瓣球囊扩张术前后血浆一氧化氮、内皮素及血流动力学的变化

目的:研究30例风湿性心脏病二尖瓣狭窄患者经皮球囊二尖瓣扩张术(PBMV)前、后血浆一氧化氮(NO)、内皮素(ET)及血流动力学变化。方法:用化学比色法、放射免疫分析法分别测定患者 PBMV前、后的NO、ET的血浆浓度;用二维彩色多普勒超声和心导管测定二尖瓣瓣口面积(MVA)、左心房内径(LAD)、平均二尖瓣压力阶差(mMPG)、肺动脉平均压(mPAP)和左房平均压(mLAP)。结果: NO 浓度术前及术后分别为(107.350±33.614)、(74.462±23.913)μmol/L; ET 浓度术前及术后分别为(131.632±43.284)、(100.147±31.904)ng/L。NO、ET浓度术后明显低于术前( 均P<0.01)。术前MVA、LAD及mLAP、mMPG、mPAP分别为(1.026±0.201)cm2、(5.168±0.548)cm及(2.765±0.597)、(1.748±0.729)、(5.601±0.728)kPa;术后分别为(1.725±0.248)cm2、(4.895±0.585)cm及(1.738±0.418)、(0.862±0.415)、(4.155±0.436)kPa。术后血流动力学较术前有明显改善(均P<0.05),血浆NO浓度与 mLAP、mPAP呈正相关( r分别为 0.564、0.453,均 P<0.01);血浆ET浓度与mLAP、mPAP也呈正相关( r分别为0.527、0.528,均P<0.01);且 NO、ET浓度与心功能有关。结论:NO、ET可作为判断风湿性心脏病二尖瓣狭窄病情和PBMV疗效及心功能的良好指标。     

二尖瓣球囊扩张术前后血浆心钠素和内源性类洋地黄物质的变化

为探讨影响心钠素(ANP)和内源性类洋地黄物质分泌的因素,我们研究了26例患者二尖瓣球囊扩张术(PBMC)前后血浆ANP和EDLS与心率(HR)、心输出量(CO)、心脏指数(CI)、平均右房压(MRAP)、平均左房压(MLAP)、平均二尖瓣跨瓣压差(MPG)和二尖瓣口面积(MVA)的变化和关系。结果显示,术后血浆ANP水平从316.92±103.41(与对照组113.90±33.52 pg/ml比较,P<0.001)降到205.96±64.50 pg/ml(与术前及对照组比较,P<0.001)。血浆EDLS水平也从323.04±231.25(与对照组113.38±61.47 pg/ml比较,P<0.001)降到145.92±96.97pg/ml(与术前比较P<0.001,与对照组比较P>0.1)。血浆ANP水平与HR、MRAP、MLAP和MPG呈显著正相关(r=0.784、0.389、0.819和0.435,P<0.001、0.005、0.001和0.002),与CO和MVA呈显著负相关(r=-0.294和-0.366,P<0.05和0.01)。血浆EDLS水平与HR、MLAP和MPG呈显著正相关(r=0.761、0.356和0.342,P<0.001、0.01和0.02)。血浆ANP与EDLS水平无显著相关(r=0.259,P>0.05)。     

先天性心脏病介入治疗前后脑利钠肽前体水平的比较

目的了解小儿心脏病患者血浆氨基末端脑利钠肽(brainnatriureticpeptide,BNP)前体(N-pro-BNP)水平与心功能的关系及其在介入治疗前后的变化。方法收集自2004年7月至2005年1月间左向右分流先天性心脏病患儿共58例,所有患儿在介入治疗前后均进行心功能分级的临床评价,通过二维超声心动图测定射血分数(EF)、缩短分数(FS)、左心室舒张末期内径(LVDd)及N-pro-BNP水平,比较介入前后的改变。结果58例均成功接受介入治疗。介入治疗前后LVDd,EF,FS和血浆N-pro-BNP水平分别为36·7±5·2mm比35·4±4·2mm,78·1%±5·3%比75·3%±6·5%(P<0·05),41·1%±5·4%比38·3%±4·9%(P<0·05),194·7±154·7ng/L比561·0±594·2ng/L(P<0·05)。室间隔缺损(VSD)组术前N-pro-BNP水平(68·7±60·8ng/L)明显低于动脉导管未闭(PDA) 房间隔缺损(ASD)组(277·5±279·5ng/L),VSD组术后N-pro-BNP水平(436·8±793·6ng/L)较术前(68·7±60·8ng/L)明显升高(P<0·05),PDA ASD组手术前后差异无统计学意义。结论介入治疗后48h内EF和FS有所下降,血浆N-pro-BNP水平则明显升高。VSD组内术后N-pro-BNP水平较术前明显升高,推测可能是操作过程中对左心室反复的机械刺激所致。     

经皮球囊二尖瓣成形术后房颤患者ANP和BNP水平变化研究

目的探讨房颤患者行经皮球囊二尖瓣成形术（PBMV）后心房利钠肽（ANP）和脑钠肽（BNP）变化及与血流动力学参数的关系。方法选择因风湿性二尖瓣狭窄伴持续性房颤成功行PBMV患者38例,术前、术后1d及半年分别用放射免疫法和酶链免疫法测定血浆中ANP、BNP值,由超声心动图测左房内径（LAD）、二尖瓣口面积（MVA）、二尖瓣跨瓣压差（MPG）及肺动脉压（PAP）。结果PBMV术后患者血流动力学参数明显改善;术后1d及半年ANP水平较术前明显下降,BNP变化不明显。术后半年与术前比较,LAD与ANP下降相关（r=0．774,P〈0．05）,△BNP与△MPG相关（r=0．574,P〈0．05）。结论房颤患者PBMV术后半年血中ANP逐步下降,BNP降低不明显。房颤律时△ANP和△BNP仍是反映LAD和MPG变化的有效指标。     

急性心肌梗死的心肌再灌注血流与脑钠肽的关系

目的探讨急性心肌梗死(AMI)心肌血流再灌注水平与血浆脑钠肽(BNP)水平的关系及其临床意义。方法对67名AMI成功行急诊介入治疗(PCI)的患者分别进行TIMI心肌灌注分级(TMPG)、心肌灌注显影分级(MBG)和校正的TIMI血流帧数计数(CTFC),采用荧光免疫抗原抗体结合方法测定发病24h即刻血浆脑钠肽(BNP)水平并评价其相互关系。结果TMPG方法评定的心肌灌注水平中,TMPG0/1级组12例,TMPG2级组29例,TMPG3级组26例,其对应血浆BNP平均水平分别为(1026±1119)ng/L,(346±192)ng/L和(219±95)ng/L。各组间血浆BNP水平差异有统计学意义(P=0·001)。其中TMPG0/1级组血浆BNP水平分别高于TMPG2级组和TMPG3级组(P<0·01,P<0·001);TMPG2级组高于TMPG3级组(P<0·01)。MBG方法评定的心肌灌注水平中,MBG0/1级组22例,MBG2级组25例,MGG3级组20例,其对应血浆BNP平均水平分别为(735±886)ng/L,(343±137)ng/L和(148±65)ng/L。各组间血浆BNP水平差异有统计学意义(P<0·001)。其中MBG0/1级组血浆BNP水平分别高于MBG2级组和MBG3级组(P<0·05,P<0·001);MBG2级组高于MBG3级组(P<0·001)。CTFC方法评定的冠脉血流中CTFC>40帧组20例,CTFC≤40帧组47例,血浆BNP平均水平分别为(453±265)ng/L和(397±650)ng/L,CTFC>40帧组血浆BNP水平高于CTFC≤40帧组(P=0·0036)。结论AMI患者心肌血流再灌注水平与血浆BNP水平负相关,再灌注水平越低组血浆BNP水平越高。心肌缺血损伤是BNP释放的重要刺激因素。     

经皮球囊二尖瓣成形术后心房颤动复律患者血浆中利钠肽和脑钠肽的变化

目的:观察经皮球囊二尖瓣成形术(PBMV)后心房颤动(房颤)成功复律与未复律患者血浆中心房利钠肽(ANP)和脑钠肽(BNP)的变化,并探讨与血流动力学参数的关系.方法:选择成功PBMV的风湿性二尖瓣狭窄伴持续房颤律患者48例,其中成功复律组20例,未复律28例,获得外周静脉血及血流动力学完整资料.分别用放射免疫法和酶链免疫法测定血浆中ANP、BNP值,由超声心动图测左房内径(LAD)、二尖瓣口面积(MVA)、二尖瓣跨瓣压差(MPG)、左室舒张末径(LVEED).结果:随访至PBMV后1年,复律组患者血浆中ANP和BNP逐步下降,而未复律组BNP呈下降趋势,但差异无统计学意义(P>0.05), 复律组LAD和MPG较未复律组显著缩小(P<0.05).ANP、BNP与血流动力学指标之间相关性比较显示:复律组,术后1年与术前比较△LAD与△ANP下降仍呈正相关性(r=0.774;P<0.05),而△BNP与△MPG有相关(r=0.574;P<0.05).结论:PBMV后,房颤复律可进一步改善血流动力学,缩小LAD,降低血浆中ANP和BNP水平,复律后ANP和BNP的变化,仍是间接反映LAD和MPG变化趋势的有效指标.     

经皮腔内球囊二尖瓣成形术前后肿瘤坏死因子和一氧化氮血浆水平变化的研究

目的 :研究经皮腔内球囊二尖瓣成形术 (PTBMV)前后肿瘤坏死因子 (TNF-α)和一氧化氮 (NO)血浆水平变化。方法 :2 0例二尖瓣狭窄 (MS)患者 (MS组 )分别于 PTBMV前、后采静脉血和左房血各 5 ml,术后 5 d再采静脉血 5 ml。同期还采 12例正常者 (对照组 )静脉血 5 m l。以酶联免疫吸附法检测血浆 TNF-α浓度 ,重氮反应比色法检测血浆 NO浓度。MS组 PTBMV前、后均检测二尖瓣口面积 (MVA)、左房平均压 (ML AP)、舒张期跨二尖瓣压差 (DMTV G)及心排血指数 (CI)。将血浆 TNF- α和 NO浓度与血流动力学参数作相关分析。结果 :MS组术前静脉血 TNF- α和 NO浓度均明显高于对照组 (P <0 .0 1)。术后 30 m in静脉血浆和左房血浆 TNF- α和N O浓度均较术前显著升高 (P <0 .0 1)。术后第 5天静脉血浆 TNF- α和 NO浓度较术前及术后 30 m in均显著下降 (P <0 .0 1) ,但仍显著高于对照组 (P <0 .0 1)。MS组不同时点及部位血浆 TNF- α与 NO浓度均值之间呈显著性正相关 (r =0 .97,P <0 .0 1)。术前及术后第 5天静脉血浆 TNF- α和 NO浓度分别与 DMTVG呈正相关 (r=0 .92 ,P <0 .0 1和 r =0 .93,P <0 .0 1) ,与 CI呈负相关 (r =- 0 .86 ,P <0 .0 1和 r =- 0 .89,P <0 .0 1)。结论 :TNF- α和 NO可能参与 MS的病理生理过程 ,     

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.     

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.     

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.