心电图运动试验对急性心肌梗塞后患者残余心肌缺血的评价

５２例急性心肌梗塞后２～１２周患者进行次极量蹬车心电图运动试验，心肌缺血发生率为４４．２％。与冠状动脉造影对比，多支病变者阳性率高于单支病变（Ｐ＜０．０１）；与运动２０１铊心肌显像对比，前者阳性率较低（Ｐ＜０．０１）；心电图运动试验中非梗塞区心肌缺血组阳性率高于梗塞周围缺血组（Ｐ＜０．０２５）；ＳＴ段抬高组左室射血分数低于ＳＴ段正常或压低组（Ｐ＜０．０１）。心电图运动试验对诊断梗塞后残余心肌缺血，特别是非梗塞区心肌缺血有一定价值，运动中ＳＴ段抬高可能预示较差的心功能。     

无心肌梗塞患者运动诱发ST段抬高1例

无心肌梗塞患者运动诱发ＳＴ段抬高１例魏雪梅马瑞贞张玉梅（山东省单县中心医院单县２７４３００）关键词心绞痛；运动试验；心电描记术病例患者男性，４４岁，因劳动时反复阵发性胸痛１个月，于１９９４年３月１３日来我院就诊。查体：血压１５／１０ｋＰａ，心肺听诊正...     

无心肌梗塞患者运动诱发ST段抬高1例

无心肌梗塞患者运动诱发ＳＴ段抬高１例魏雪梅马瑞贞张玉梅（山东省单县中心医院单县２７４３００）关键词心绞痛；运动试验；心电描记术病例患者男性，４４岁，因劳动时反复阵发性胸痛１个月，于１９９４年３月１３日来我院就诊。查体:血压１５／１０ｋＰａ，心肺听诊正...     

无心肌梗塞病人运动诱发ST段抬高二例

无心肌梗塞病人运动诱发ＳＴ段抬高二例李莹，周聊生运动中出现ＳＴ段抬高被认为是一过性严重的广泛心肌缺血的表现，大多出现于有心肌梗塞（ＭＩ）病史的病人，而在无ＭＩ病史的病人极为罕见。我们曾遇２例无ＭＩ病史运动诱发ＳＴ段抬高者，现予报道。例１男，５８岁，因...     

无并发症急性心肌梗塞患者早期运动试验的临床意义

对确诊的31例无并发症急性心肌梗塞（AMI）患者（年龄61．2±8．4岁）在梗塞后25．5±6．1天行平板运动试验，并随访23．5±8.2个月。结果显示，阳性25例中ST既有Q波导联抬高，也有非Q波导联下移，或二者兼而有之（分别为11、6和8例）。10例室壁瘤者均有Q波导联静息ST段抬高或运动后抬高。随访期间4例发生心绞痛，3例死亡，死亡者均有室壁瘤。运动时有ST段改变或胸闷者易发心绞痛。结果提示无并发症AMI早期运动试验时有ST段改变者具有一定的预后意义。     

急性心肌梗塞合并室壁瘤的运动试验

对７例急性心肌梗塞合并室壁瘤患者行平板运动试验，引起不同程度的ＳＴ段抬高，前壁的ＳＴ段抬高较下壁的明显。５例致Ｑ波导联ＳＴ段抬高及无Ｑ波导联ＳＴ段下移，其中２例再发心绞痛。提示梗塞部位以外存在心肌缺血的可能，舒张压升高可能与室壁瘤导致心功能欠佳有关。     

低分子量肝素钙治疗不稳定性心绞痛和非Q波心肌梗死疗效和安全性观察

本文旨在观察国产低分子量肝素钙（立迈青）治疗不稳定性心绞痛（ＵＡ）和非Ｑ波心肌梗死（ＮＱＭＩ）的疗效和安全性,并与速避凝（低分子量肝素,赛诺菲公司生产）进行比较。 资料与方法 一、病例入选与排除标准 １．入选标准：（１）各种类型的ＵＡ（初发、恶化劳力及自发型）,在７２ ｈ内至少有一次心绞痛发作;（２）无心电图ＳＴ段抬高的 ＮＱＭＩ,距发病７２ ｈ以内。 ２．排除标准：（１）稳定性心绞痛;（２）心电图ＳＴ段抬高的Ｑ波心肌梗死;（３）有出血、凝血疾患及有出血倾向者。（４）对所观察药物过敏。 二、用药方法 Ｕ…     

前壁急性心肌梗死V_1和V_(3R)导联ST段变化与冠状动脉分布的关系

目的：探讨前壁急性心肌梗死病人Ｖ１和Ｖ３Ｒ导联ＳＴ段变化与冠状动脉分布的关系。方法：前壁急性心肌梗死病人３４例，入院时均采集标准１２导联及Ｖ３Ｒ导联心电图，入院１０天内进行冠状动脉造影，评价心电图变化与冠状动脉分布的关系。根据Ｖ１导联ＳＴ段抬高幅度将病人分为两组：Ａ组（ＳＴ段抬高≥１．５ｍｍ，１５例）和Ｂ组（ＳＴ段抬高＜１．５ｍｍ，１９例）。将起源于右冠状动脉的圆锥动脉分为两种类型：小圆锥支型和大圆锥支型。结果：Ｖ３Ｒ导联ＳＴ段抬高在Ａ组和Ｂ组分别为１４例（９３％）和６例（３２％，Ｐ＜０．００１），小圆锥支型者在Ａ组和Ｂ组分别为１２例（８０％）和３例（１５％，Ｐ＜０．００１），大圆锥支型者１３例，均来自Ｂ组。结论：前壁急性心肌梗死病人入院时Ｖ１导联ＳＴ段抬高与Ｖ３Ｒ导联ＳＴ段抬高密切相关，均为小圆锥支型者。前壁急性心肌梗死Ｖ１导联无ＳＴ段抬高，表明除左前降支的间隔支供血外，心室间隔还得到大圆锥支型的血液供应而受到保护。     

65例活动平板运动试验与冠状动脉造影对照分析

本文报告６５例平板运动试验与冠状动脉造影对比分析的结果，６５例中冠状动脉狭窄≤５０％者２９例，其中平板运动试验阳性２２例，阴性７例，冠状动脉正常者３６例，平板运动试验阳性７例，阴性２９例。平板运动试验检出冠心病的敏感性７６％，特异性８０％，预测准确性７６％。敏感性与冠状动脉病变范围有关，文中２、３支病变者敏感性（８８％，８３％）明显高于单支病变者（６４％）。预测准确性与受检人群的患病率有关，文中典型心绞痛２９例中平板运动试验阳性２２例，其中真阳性２０例，预测准确性７６％，而３６例不典型心绞痛患者平板运动试验阳性仅８例，其中真阳性仅２例，预测准确性仅２５％。运动试验早期低运动量时出现心肌缺血提示３支病变，本文３支病变者运动诱发心肌缺血，心电图显示缺血型ＳＴ段压低≥１ｍｍ的时间为２５６．７±１３２．３秒，较单支病变（４５７．３±２５１；７秒）２支病变（３４１．４±１７０．８秒）为短Ｐ＜０．００１。     

室性早搏诊断变异型心绞痛三例

室性早搏诊断变异型心绞痛三例宋绍林王光风蔡红变异型心绞痛的诊断主要根据临床症状和心电图ＳＴ段的抬高，但室性早搏（室早）对其诊断亦有一定帮助。我们遇到３例介绍如下。例１男，６０岁。发作性胸骨后闷痛半年加重２天，于１９８９年１１月１９日入院。检查：心率７...     

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.     

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.