经皮冠状动脉腔内成形术229例长期预后分析

为了探讨国人经皮冠状动脉腔内成形术（ＰＴＣＡ）后远期疗效及影响疗效的因素，对ＰＴＣＡ成功的２２９例患者用门诊随诊或信访方式进行随访，随访时间０．５～８．４（平均２．３±１．８）年。结果显示：７６例（３３．２％）患者心绞痛症状复发，随访期中死亡２例（０．９％），非致命性急性心肌梗塞６例（２．６％），行冠状动脉旁路移植术４例（１．７％），重复ＰＴＣＡ２９例（１２．７％）。以Ｋａｐｌａｎ－Ｍｅｉｅｒ法计算术后无心脏事件生存率，１年为８４．８％，８年为７０．５％。Ｃｏｘ回归分析表明，术前病变狭窄程度及术后前降支残余狭窄程度与发生心脏事件的相对危险性呈正相关。提示国人ＰＴＣＡ可取得较好远期疗效；术中尽可能减少前降支残余狭窄，可能减少心脏事件发生的相对危险度     

冠状动脉内支架植入术治疗急性心肌梗死的临床应用

目的：评价冠状动脉内支架治疗急性心肌梗死（ＡＭＩ）的效果。方法：对４８例植入支架的ＡＭＩ连续病例进行回顾性分析。结果：心肌梗死相关血管为：前降支３３例，右冠状动脉８例，回旋支４例，左主干１例以及大隐静脉桥２例。４８例患者共植入５７只支架，其中３４例因球囊扩张后结果不理想，１２例因非闭塞性夹层，２例因闭塞性夹层。支架植入成功率为９３８％，术后残余狭窄降至（２４±７１）％。院内严重并发症３例，其中１例（２１％）死亡，２例（４２％）行急诊冠状动脉旁路移植术。对无院内并发症的４５例患者随访１０．１±７２个月，其中３例失访，出院后２例发生再狭窄和１例有慢性充血性心力衰竭，无其它心脏事件发生。结论：本研究结果表明ＡＭＩ时冠状动脉内植入支架成功率高，并发症少，短期预后良好     

急性心肌梗塞直接经皮冠状动脉腔内成形术

目的观察急性心肌梗塞（ＡＭＩ）患者应用直接经皮冠状动脉腔内成形术（ＰＴＣＡ）的安全性和有效性。方法对１１４例ＡＭＩ患者在发病１２小时内行直接ＰＴＣＡ术,其中有５例心原性休克的患者。梗塞相关血管（共１１５支血管）：左主干３例（２．６％）,前降支５６例（４８．７％）,回旋支１２例（１０４％）,右冠状动脉４４例（３８．５％）。ＴＩＭＩ血流：０级８２例（７１．３％）,１级１７例（１４．７％）,２级１６例（１４．０％）。结果１１１例患者手术成功,ＴＩＭＩ血流３级（９７．４％）。住院期间死亡３例（２．６％）,均为心原性休克患者,其中２例经紧急冠状动脉旁路移植术后死亡。８５例患者置入了冠状动脉内支架（７３．９％）。随访９５例患者,２例后期死于心力衰竭,９例出院后出现心肌缺血,其中８例再次行ＰＴＣＡ术。结论直接ＰＴＣＡ是治疗急性心肌梗塞的安全有效措施,成功率较高,并发症少;术后复发心肌缺血发生率较溶栓治疗低。     

不稳定心绞痛经皮腔内冠状动脉成形术190例分析

１９８７年１２月至１９９４年２月该院共完成不稳定心绞痛的经皮腔内冠状动脉成形术（ＰＴＣＡ）１９０例，其中有单支血管病６９例（３６．３％）、双支血管病６７例（３５．２％）、三支血管病５４例（２８．４％）。ＰＴＣＡ共扩张血管２５０支，扩张病变２７８处。Ａ型病变５２处（１８．７％），Ｂ型病变１７５处（６２．９％）、Ｃ型病变５１处（１８．４％）。在１２１例多支血管病中，２３例（１９．０％）为完全血管再通，９８例（８１．０％）为不完全血管再通。６例采用双球囊对吻技术，５例采用灌注球囊导管，４例进行了冠脉内膜定向切除术（ＤＣＡ），４例放置冠状动脉内膜支架。ＰＴＣＡ的病例成功率为９４．７％（１８０／１９０），血管成功率９５．２％（２３８／２５０），病变成功率９５．５％（２６６／２７８），由ＰＴＣＡ术前平均狭窄８８．７％±８．３％至扩张后残余狭窄１７．９％±９．２％。发生严重并发症１８处（６．５％），其中１５处经处理成功，２例发生急性心肌梗塞，１例死亡，无紧急冠状动脉搭桥者。     

心肌灌注断层显像对急性心肌梗死再灌注的研究

目的：通过心肌灌注断层显像研究急性心肌梗死（ＡＭＩ）患者经尿激酶及经皮冠状动脉腔内成形术（ＰＴＣＡ）治疗前后梗死范围的变化。方法：用９９ｍ锝甲氧基异丁基异腈心肌灌注断层显像测定３６例ＡＭＩ患者心肌再灌注前后的心肌梗死面积。结果：再灌注组和无再灌注组首次心肌显像心肌缺损面积无显著性差异（Ｐ＞０．０５）；再灌注组再次显像心肌缺损面积明显小于首次显像（１７．５±２．８％和３１．９±４．５％，Ｐ＜０．０５）；无再灌注组再次显像心肌缺损面积与首次显像无明显差异（２９．６±４．７％和３２．４±５．１％，Ｐ＞０．０５）；预后不良组（ｎ＝６）心肌缺损面积明显高于预后较好组（３４．６±５．１％和２１．４±３．６％，Ｐ＜０．０５）。结论：心肌灌注断层显像可作为ＡＭＩ再灌注疗效评价较准确的手段。     

14962 例急性心肌梗塞患者临床特征──中国心脏研究-Ⅰ 专题报告之五

目的分析１４９６２例急性心肌梗死（ＡＭＩ）患者的临床特征。方法用ＳＡＳ６０４软件统计分析１４９６２例ＡＭＩ患者的４周总病死率和并发症。结果１４９６２例ＡＭＩ患者临床特征为：男性病人７３．９％；平均年龄６１．２±１０．７岁；有心肌梗死、高血压、糖尿病病史者分别占１２．２％，４０．４％，９．４％；基础血压１２６．６±２４．３／８１．３±１４．６ｍｍＨｇ；基础心率７９．３±１８．８ｍｉｎ－１。试验４周期间主要并发症心力衰竭为１７．９％，休克４．６％，心室颤动３．２％，其他类型的心跳骤停２．３％，Ⅱ～Ⅲ度房室传导阻滞５．２％，室性心动过速３．６％，梗塞扩展４．８％，脑卒中１．２％，心脏破裂０．５％。总病死率（２８ｄ）为９．４３％，死于泵衰竭为３．２５％，死于心律失常为４．５６％。     

补救性经皮冠状动脉腔内成形术治疗急性心肌梗塞

目的探讨补救性经皮冠状动脉腔内成形术（ＰＴＣＡ）在治疗急性心肌梗塞（ＡＭＩ）中的作用。方法对溶栓治疗失败的３６例患者进行补救性ＰＴＣＡ治疗。患者心功能Ｋｉｌｐ分级：Ⅲ级和Ⅳ级４例，Ⅱ级和Ⅰ级３２例。冠状动脉造影显示梗塞相关动脉：前降支１７例，右冠状动脉１４例，回旋支４例，中间动脉１例。ＰＴＣＡ前ＴＩＭＩⅠ级和Ⅰ～Ⅱ级血流各２例，余３２例均为ＴＩＭＩ０级。３６例均进行ＰＴＣＡ治疗，其中１３例患者置入了支架。结果术中除３例失败外，３１例患者病变血管血流达到ＴＩＭＩⅢ级，２例ＴＩＭＩⅡⅢ级，残余狭窄≤５０％，成功率为９１．７％。院内并发症：１例在ＰＴＣＡ成功后当天因顽固性休克和心室纤颤死亡；１例于第３天死于心脏破裂，住院病死率为５．６％。１４例患者在术后１～２个月内复查冠状动脉造影，２例发生再狭窄。结论ＡＭＩ患者在溶栓治疗失败后，在有条件的医院可施行补救性ＰＴＣＡ治疗，成功率高，对改善患者的近期和远期预后可能有利     

冠状动脉支架治疗冠状动脉开口病变的近远期结果分析

目的：评价冠状动脉支架治疗冠状动脉开口病变的近远期临床效果。方法：对２８例冠状动脉开口病变的病人,按常规标准方法进行冠状动脉支架植入术,并在术后６个月接受临床和（或）冠状动脉造影随访。结果：支架植入的技术和临床成功率均为１００％,无死亡、急性心肌梗塞及急诊冠状动脉旁路移植术并发症。支架植入手术前、后血管直径狭窄程度分别为（８７±９）％与（－２±５）％（Ｐ＜０．０１）;管腔最小开放直径分别为０．４７±０．３１ｍｍ与３．１６±０．３７ｍｍ（Ｐ＜０．０１）。临床随访心绞痛复发率为２０％（４／２０）,９例病人接受了冠状动脉造影随访,３例发生了再狭窄。结论：冠状动脉支架植入术治疗冠状动脉开口病变是安全有效的,成功率高且并发症发生率较低。     

经皮冠状动脉腔内成形术并发急性血管闭塞

目的：探讨急性血管闭塞的发生及治疗。方法：回顾总结我院１０３４例经皮冠状动脉腔内成形术（ＰＴＣＡ）的急性血管闭塞及治疗情况。结果：３１例（３．０％）患者发生急性血管闭塞,其中８例系急性心肌梗塞（ＡＭＩ）;１６例为不稳定性心绞痛,７例为稳定性心绞痛。发生急性血管闭塞的时间：２８例（９０．３％）患者在ＰＴＣＡ术中,３例在术后。９例患者因血压降低需用升压药,其中５例需主动脉内球囊反搏（ＩＡＢＰ）支持。４例急性血管闭塞时发生心室颤动,１例出现心室停搏。处理结果：３１例患者中２４例用球囊长时间加压;１８例植入支架;２５例治疗成功,成功率为８０．６％。２例（６．５％）死亡;３例（９．７％）发生心肌梗塞;１例（３．２％）急诊行冠状动脉旁路移植手术。结论：急性血管闭塞的发生与不稳定性心绞痛、多支血管病变、复杂病变有关,采取冠状动脉内支架及长时间加压治疗有助于减少并发症。     

国产重组链激酶治疗急性心肌梗塞的临床研究

目的：评价国产重组链激酶（ｒ－ＳＫ）经静脉溶栓治疗急性心肌梗塞（ＡＭＩ）的临床疗效,并观察其不良反应。方法：本院２年间经ｒ－ＳＫ静脉溶栓治疗ＡＭＩ患者１１６例,其中５８例行９０分钟冠状动脉造影。结果：临床血管再通率为６９．０％,血管通畅率为７０．７％,其中心肌梗塞溶栓治疗临床试验（ＴＩＭＩ）３级血流占４３．１％。不良反应发生率：过敏反应６．９％,低血压６．０％,黄疸１．７％,出血１０．３％。９．５％患者急性期发生心力衰竭,与延迟溶栓、血管未通有关。急性期死亡率２．６％。结论：国产ｒ－ＳＫ治疗ＡＭＩ有效且较安全。     

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.