强化阿托伐他汀对急性冠脉综合征C反应蛋白及血脂的影响

目的:观察不同剂量阿托伐他汀(10mg/d和40mg/d)早期干预对急性冠脉综合征(ACS)患者C反应蛋白(CRP)、血总胆固醇(TC)、低密度脂蛋白-胆固醇(LDL-C)水平的影响,以了解较大剂量阿托伐他汀对ACS患者免疫炎症抑制的影响及安全性。方法:72例ACS患者被随机分为两组,A组在常规治疗基础上予阿托伐他汀10mg/d,睡前口服;B组在常规治疗基础上予阿托伐他汀40mg/d,睡前口服,均在入院48h内开始用药,治疗4周,分别予用治疗前、后监测血清CRP、血脂(TC、LDL-C)浓度,同时观察用药安全性。结果:治疗后两组患者血清CRP、血脂均有不同程度的下降(P0.05～0.01),与A组相比较,B组CRP[(16.45±6.45)mg/L:(11.48±6.83)mg/L]、TC[(5.38±0.64)mmol/L:(4.92±0.50)mmol/L]、LDL-C[(2.53±0.46)mmol/L:(1.95±0.39)mmol/L]下降更明显(P均0.05)。两组均无严重不良事件。结论:较大剂量阿托伐他汀早期干预治疗可显著降低急性冠脉综合征患者血清C反应蛋白浓度及血脂水平,并具有良好的安全性。。     

依折麦布联合阿托伐他汀对心房颤动伴脑卒中患者炎症因子的疗效

目的:观察依折麦布联合阿托伐他汀强化降脂治疗对心房颤动伴缺血性脑卒中患者炎症因子水平的疗效。方法:选择180例心房颤动伴缺血性脑卒中患者为研究对象,根据随机数字表法被随机分为阿托伐他汀组(88例)和联合治疗组(92例,口服阿托伐他汀钙片+依折麦布),两组均治疗4个月。在治疗前后,检测比较两组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白-胆固醇(LDL-C)、高敏C反应蛋白(hsCRP)、白介素(IL)-6和肿瘤坏死因子(TNF)-α水平,并分析上述血脂与炎症因子水平的相关性。结果:治疗前,两组上述血脂水平和炎症因子水平无显著差异(P均0.05)。与治疗前比较,两组治疗后上述血脂和炎症因子水平均显著降低(P0.05或0.01);与阿托伐他汀组比较,联合治疗组治疗后TC[(3.12±0.56)mmol/L比(2.78±0.20)mmol/L]、TG[(1.35±0.27)mmol/L比(1.02±0.37)mmol/L]、LDL-C[(1.82±0.60)mmol/L比(1.72±0.53)mmol/L]、hsCRP[(4.12±1.56)mg/L比(2.57±1.84)mg/L]、IL-6[(42.20±9.77)pg/ml比(20.18±9.62)pg/ml]和TNF-α[(18.32±12.80)ng/L比(11.21±9.96)ng/L]水平降低更显著,P0.05或0.01。双变量Pearson积差相关分析显示,TC、TG和LDL-C水平与hsCRP、IL-6和TNF-α水平均呈显著正相关(r=0.810~0.888,P均0.01)。结论:对于心房颤动伴缺血性脑卒中患者依折麦布联合阿托伐他汀降脂、降炎症因子疗效较单纯阿托伐他汀更佳,值得临床推广。     

依折麦布联合阿托伐他汀对冠心病患者血脂水平、心功能及IMT的影响

目的:研究依折麦布联合阿托伐他汀对冠心病患者血脂水平、心功能及颈动脉内膜-中层厚度(IMT)的影响。方法:于我院治疗的128例冠心病患者被随机均分为阿托伐他汀组(在常规治疗基础上加用阿托伐他汀)与联合治疗组(在阿托伐他汀组基础上加用依折麦布),两组均治疗60d。观察比较两组治疗前后甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平、左室舒张末期内径(LVEDd)、左室收缩末期内径(LVESd)、LVEF、IMT以及治疗6个月后主要不良心血管事件(MACE)发生率。结果:与阿托伐他汀组比较,联合治疗组治疗后TG[(1.43±0.14)mmol/L比(1.35±0.12)mmol/L]、TC[(5.29±0.51)mmol/L比(5.03±0.54)mmol/L]、LDL-C [(2.93±0.34)mmol/L比(2.71±0.27) mmol/L]水平、LVEDd [(55.77±5.81)mm比(53.45±5.59)mm]、LVESd [(40.52±4.33)mm比(38.91±4.13)mm]、IMT [(0.96±0.10)mm比(0.91±0.08)mm]降低更显著,HDL-C水平[(1.12±0.11) mmol/L比(1.22±0.12) mmol/L]、LVEF [(46.30±4.25)%比(50.63±5.30)%]升高更显著,P0.05或0.01。联合治疗组治疗6个月后MACE发生率显著低于阿托伐他汀组(3.13%比14.06%,P=0.028)。结论:依折麦布联合阿托伐他汀能显著改善冠心病患者血脂水平及心功能,降低颈动脉内膜-中层厚度,安全性好,值得推广。     

急性冠状动脉综合征患者强化阿托伐他汀治疗对血糖的影响

目的探讨急性冠状动脉综合征患者强化阿托伐他汀治疗对血糖的影响。方法选择2013年6月~2016年1月在潮州市人民医院心血管内科住院的急性冠状动脉综合征患者200例,按照随机数字表法分为对照组和强化组各100例。2组均予冠心病二级预防治疗,对照组阿托伐他汀20mg睡前口服;强化组阿托伐他汀40mg睡前口服。随访6个月,检测治疗前后空腹血糖、糖化血红蛋白、TC、TG、LDL-C和HDL-C。结果对照组治疗后HDL-C较治疗前明显升高,TC、TG、LDL-C较治疗前明显降低,差异有统计学意义(P0.01);强化组治疗后HDL-C、空腹血糖、糖化血红蛋白较治疗前明显升高,TC、TG、LDL-C较治疗前明显降低,差异有统计学意义(P0.05,P0.01)。强化组治疗后HDL-C、空腹血糖、糖化血红蛋白较对照组明显升高[(1.48±0.39)mmol/L vs(1.36±0.20)mmol/L,P0.05;(5.71±0.67)mmol/L vs(5.21±0.53)mmol/L,P0.01;(5.44±0.75)%vs(5.19±0.31)%,P0.01],TC、LDL-C较对照组明显降低[(3.57±0.74)mmol/L vs(4.06±0.62)mmol/L,P0.01;(1.95±0.63)mmol/L vs(2.23±0.53)mmol/L,P0.01]。结论急性冠状动脉综合征患者强化他汀治疗对降低血脂效果更为理想,同时也可能使血糖水平升高,增加新发糖尿病风险。     

阿托伐他汀联合氯吡格雷治疗不稳定型心绞痛患者的效果及预后

目的:分析阿托伐他汀联合氯吡格雷治疗不稳定型心绞痛(UAP)患者的效果及对预后的影响。方法:215例UAP患者随机分为阿托伐他汀组(106例,在常规治疗的基础上行阿托伐他汀治疗)与联合治疗组(109例,在常规治疗的基础上给予阿托伐他汀联合氯吡格雷治疗),对比两组治疗效果,血清超敏C反应蛋白(hsCRP)、血脂、白细胞介素6(IL-6)水平等的变化。结果:联合治疗组总有效率明显高于阿托伐他组(94.5%比76.4%,P<0.01)。两组治疗后hsCRP、IL-6、总胆固醇(TC)水平均较治疗前明显降低(P均<0.01);且与阿托伐他汀组比较,联合治疗组hsCRP[(5.35±1.37)mg/L比(3.36±1.25)mg/L]、IL-6[(17.36±4.58)pg/ml比(12.28±3.24)pg/ml]、TC[(7.69±1.20)mmol/L比(4.35±1.20)mmol/L]、TG[(3.35±1.02)mmol/L比(1.29±0.25)mmol/L]水平降低更显著(P均<0.01)。联合治疗组不良心脏事件总发生率明显低于阿托伐他汀组(3.7%比16.0%,P=0.002)。结论:不稳定型心绞痛患者采用阿托伐他汀联合氯吡格雷治疗能显著提高疗效,有效抑制炎症反应,减小不良心脏事件的发生率。     

阿托伐他汀联合苯扎贝特对急性冠脉综合征患者的疗效

目的:探讨阿托伐他汀联合苯扎贝特对急性冠脉综合征(ACS)患者调脂治疗的价值。方法:选择我院2013年4月~2013年9月收治的121例ACS患者为研究对象,根据治疗方法分为苯扎贝特组(60例,在常规治疗基础上接受苯扎贝特治疗)和联合治疗组(61例,在苯扎贝特组治疗基础上加用阿托伐他汀)。比较两组患者治疗前后总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)水平,血脂达标率以及不良反应发生率。结果:治疗前两组患者各血脂指标水平差异无显著性(P0.05)。与治疗前比较,治疗后两组TC,TG和LDL-C水平均显著降低,HDL-C水平显著升高(P0.05或0.01);治疗后,与苯扎贝特组比较,联合治疗组TC[(4.06±0.49)mmol/L比(3.35±0.29)mmol/L],TG[(1.60±0.33)mmol/L比(1.12±0.21)mmol/L]和LDL-C水平[(2.18±0.39)mmol/L比(1.91±0.26)mmol/L]显著降低,HDL-C水平[(1.09±0.21)mmol/L比(1.26±0.26)mmol/L]显著升高,P均0.05;达标率:TC(41.67%比67.21%),TG(61.67%比85.25%),LDL-C(36.67%比70.49%)和HDL-C(41.67%比90.16%)均显著升高,P均0.05。两组的不良反应发生率(11.48%比10.00%)无显著差异,P0.05。结论:阿托伐他汀联合苯扎贝特对急性冠脉综合征患者调脂治疗,安全、效果显著。     

漳州地区高血压患者血脂分布及不同剂量的阿托伐他汀的降脂达标情况分析

目的分析漳州地区原发性高血压(essential hypertension,EH)患者的血脂分布及他汀类药物应用情况,探讨不同剂量的阿托伐他汀对EH人群的动脉粥样硬化性心血管疾病(ASCVD)一级预防降脂达标效果。方法选择到漳州市医院就诊的EH患者333例,检测血脂[三酰甘油(triacylglycerol,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)]浓度,分析血脂分布及他汀类药物应用情况。按随机数字表法随机分为小剂量阿托伐他汀组(n=170,立普妥10 mg,睡前顿服一次)及常规剂量阿托伐他汀组(n=163,立普妥20 mg,睡前顿服一次),疗程均为3个月。检测两组治疗后血脂浓度,同时对两组血糖、肝功能、肾功能、肌酸激酶进行检测并比较。结果漳州地区高血压患者治疗前TG为(1.67±0.95)mmol/L,TC为(5.58±0.67)mmol/L,LDL-C为(3.42±0.51)mmol/L,HDL-C为(1.23±0.32)mmol/L。治疗3个月后,应用小剂量阿托伐他汀及常规剂量阿托伐他汀组血清TG、TC、LDL-C浓度均显著降低,差异有统计学意义(P均0.01)。常规剂量阿托伐他汀组在降低血清LDL-C浓度的幅度上明显高于小剂量组,差异有统计学意义(P0.01);小剂量阿托伐他汀组达标率为78%,常规剂量阿托伐他汀组达标率为82%,两组达标率比较差异无统计学意义(P0.05)。结论漳州地区EH患者的血脂处于较低水平;小剂量阿托伐他汀能够显著降低血清LDL-C浓度,且副作用少,值得在动脉粥样硬化性心血管疾病一级预防中长期推广应用。     

阿托伐他汀对冠状动脉血流缓慢患者冠状动脉血流储备的影响

目的 探讨冠状动脉血流缓慢患者冠状动脉血流储备(CFR)的改变以及阿托伐他汀对这类患者CFR的影响.方法 入选有胸痛症状但冠状动脉造影结构正常的冠状动脉血流缓慢患者91例,分为治疗组(51例)和无治疗组(40例).治疗组给予阿托伐他汀20 mg治疗8周.另选26例冠状动脉造影正常且运动试验阴性的无心脏疾患者为正常对照组.治疗前后测定治疗组和无治疗组的血脂以及利用腺苷负荷超声记录左前降支远端血流频谱,并评价CFR.结果 (1)冠状动脉血流缓慢者接受阿托伐他汀8周治疗后总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)较无治疗组及正常对照组明显减低[TC:(3.83±0.80)mmol/L比(5.30±1.18)mmol/L和(5.32±1.17)mmol/L,均P＜0.05:LDL=C:(2.26±0.64)mmol/L比(3.28±0.85)mmol/L和(3.30±0.82)mmol/L,均P＜0.05].(2)给予阿托伐他汀前,治疗组与无治疗组CFR(分别为2.32±0.30和2.25±0.33)均低于正常对照组(3.15±0.34,P＜0.05);8周后,治疗组冠状动脉血流速度(CFV)[(26.06±3.22)cm/s]较无治疗组[(29.02±3.36)cm/s]及治疗前静息状态[(28.43±3.40)cm/s]低(均P＜0.05),最大冠状动脉扩张状态CFV高于无治疗组和对照组[分别为(77.63±8.96)、(65.17±7.22)和(64.58±6.26)cm/s,P＜0.05],CFR低于治疗前和无治疗组(分别为3.07±0.29、2.28±0.35和2.32±0.30,P＜0.05),且与正常对照组差异均无统计学意义.结论 冠状动脉血流缓慢患者CFR明显减低,短期阿托伐他汀在调脂的同时可以有效改善其CFR.     

普罗布考联合阿托伐他汀对大动脉源性脑梗死患者血流动力学及血脂的影响

目的:分析普罗布考联合阿托伐他汀对大动脉源性脑梗死患者血流动力学及血脂的影响。方法:92例大动脉源性脑梗死患者被随机均分为阿托伐他汀组与联合治疗组(阿托伐他汀联合普罗布考治疗)。治疗6个月,比较两组临床疗效,治疗前后血脂、炎性因子水平,颅内动脉血流动力学指标等变化。结果:治疗6个月后,与阿托伐他汀组比较,联合治疗组治疗总有效率(69.57%比89.13%P=0.020)显著升高;TC [(4.57±0.82)mmol/L比(3.23±0.71)mmol/L]、TG [(1.37±0.45)mmol/L比(1.02±0.34)mmol/L]、LDL-C [(2.52±0.83)mmol/L比(1.50±0.54)mmol/L]、氧化修饰低密度脂蛋白[ox-LDL,(78.36±14.05)mg/L比(58.37±12.00)mg/L]及左右大脑中动脉搏动指数(PI)[左:(0.84±0.25)比(0.74±0.14),右:(0.84±0.23)比(0.74±0.16)]、炎性因子水平明显下降;左右大脑中动脉收缩期血流速度(Vs)[左:(87.45±15.58)cm/s比(95.48±18.34)cm/s,右:(89.27±14.36)cm/s比(96.18±14.03)cm/s]、平均血流速度(Vm)[左:(60.90±16.19)cm/s比(76.19±17.40)cm/s,右:(62.08±17.23)cm/s比(91.38±19.26)cm/s]显著上升(P0.05或0.01)。两组药物不良反应率无显著差异(P=1.000)。结论:普罗布考联合阿托伐他汀治疗大动脉源性脑梗死疗效明显优于单纯阿托伐他汀治疗,其降脂、抗炎、改善颅内动脉血流动力学作用更加明显。     

动脉粥样硬化性心血管疾病患者血脂分布及不同剂量的阿托伐他汀降脂达标情况分析

目的分析漳州地区动脉粥样硬化性心血管疾病(arteriosclerotic cardiovascular disease,ASCVD)患者的血脂分布及他汀类药物应用情况,探讨不同剂量的阿托伐他汀对ASCVD患者的降脂达标效果。方法选择到漳州市医院就诊的ASCVD患者356例,检测其血脂[三酸甘油(triacylglyceml,TG),总胆固醇(total cholesterol,TC),低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C),高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)]浓度分析血脂分布及他汀类药物应用情况。按随机数字表法分为小剂量阿托伐他汀组(n=179,10 mg睡前顿服一次)及常规剂量阿托伐他汀组(n=187,20 mg睡前顿服一次),疗程均为3个月。检测两组患者治疗后血脂浓度,同时对两组患者的血糖、肝功能、肾功能、肌酸激酶进行检测。结果漳州地区ASCVD患者治疗前TG为(1.66±0.95)mmol/L,TC为(5.76±0.68)mmol/L,LDL-C为(3.52±0.54)mmol/L,HDL-C为(1.23±0.42)mmol/L。治疗3个月后,两组患者的血清TG、TC、LDL-C浓度均比治疗前显著降低,差异有统计学意义(P0.01)。以LDL-C 1.8 mmol/L为降脂目标值,小剂量阿托伐他汀组降幅36%,常规剂量阿托伐他汀组降幅为42.3%,两组达标率为38%和53%。结论漳州地区ASCVD患者的血脂处于较高水平;小剂量及常规阿托伐他汀能够显著降低LDL-C浓度,但达标率仍处于较低水平。     

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.