心脏临时起搏支持严重心率缓慢患者的血液净化

目的观察心脏临时起搏对严重心率缓慢患者血液净化的作用。方法7例因各种病因引起的急慢性肾功能衰竭患者伴严重心率缓慢时,经右颈内静脉、左锁骨下静脉途径穿刺置管行气囊电极床边紧急心脏临时起搏,支持血液净化。结果7例中5例行右颈内静脉置管,2例行左锁骨下静脉置管,起搏均成功,效果肯定,起搏时间2～16天,支持血液净化共32次,其中连续性静脉血液滤过(CVVH)2次,8例次行血液透析滤过(HDF),22例次行常规血透(HD),未发现心脏穿孔、气胸、血胸,1例发生导管感染。1例扩张型心肌病患者因低血压心力衰竭不能控制自动出院,其余6例均抢救成功。结论球囊电极床边心脏临时起搏,操作简便快捷,安全有效,可以提高严重心动过缓合并有肾功能不全的重危患者的抢救成功率。     

经静脉床边紧急临时心脏起搏与危重病人的康复

目的：探讨床边经静脉紧急临时心脏起搏对危重病人康复的作用。方法：对36例患者用Seldinger法穿刺左／右锁骨下静脉或右侧颈内静脉，置入临时心内起搏电极，进行床旁紧急临时心脏起搏。结果：36例药物治疗无效，且有明显血液动力学障碍的危重患者，均在短时间内获得起搏成功，并未发现严重并发症。结论：床边经静脉紧急临时心脏起搏在危重病人的康复中有重要的作用，其成功率高，副作用少，值得临床推广应用。     

采用普通电极床旁心脏临时起搏疗效观察

目的探讨普通电极床旁紧急心脏临时起搏的可行性并评价其临床疗效。方法采用普通电极床旁紧急心脏临时起搏患者共34例,其中经右颈内静脉途径22例,左锁骨下静脉途径12例。根据体表起搏心电图形态及起搏阈值判断右室心内膜起搏是否成功。结果全组34例患者右心室心内膜起搏均获成功。2例患者术后24h发生电极移位。无气胸、血胸、心脏穿孔及感染等严重并发症。结论经右颈内静脉及左锁骨下静脉途径,应用普通电极床旁紧急心脏临时起搏安全有效。     

漂浮球囊起搏导管床边临时心脏起搏的应用

目的比较经右颈内静脉、左锁骨下静脉、右锁骨下静脉、右股静脉四种径路进行心脏临时起搏的优缺点。方法收集本院468例缓慢性心律失常患者,在非X线透视条件下,分别使用漂浮球囊起搏导管,经左锁骨下静脉、右锁骨下静脉、右股静脉、右颈内静脉四种途径穿刺插管,行右心室内膜临时心脏起搏。结果 486例均成功起搏,从穿刺到成功起搏用时为5~40min,起搏时间2~15d。入路途径:右颈内静脉276例、左锁骨下静脉156例、右锁骨下静脉40例、右股静脉14例。5例右颈内静脉穿刺不成功,术后有28例电极移位,重新调整电极获成功。全部病例未发生心肌穿孔、气胸、血胸、感染及导管断裂等严重并发症。65例病情稳定后改植永久起搏器。结论漂浮球囊起搏导管床旁心脏临时起搏安全有效、创伤小、并发症少,既可用于危重患者的抢救,也能预防性起搏保护外科患者安全渡过围手术期,值得临床推广应用。     

预成型电极临时心内膜起搏在院前急救中的应用

目的 探讨心电监护下直接推送预成型电极行临时心内膜起搏在院前急救中的价值.方法 18例严重心动过缓患者均在120救护车上紧急穿刺右颈内静脉或左锁骨下静脉,采用心电监护下直接推送预成型电极行心内膜临时起搏,观察耗时长短、起搏的有效性和并发症.结果 18例患者即刻心内膜起搏均成功,其中穿刺右颈内静脉13例,左锁骨下静脉5例,电极置入深度（36.2±3.0） cm,从穿刺开始到成功起搏耗时（3.5±1.5） min,最长5 min,起搏阈值（1.1±0.4） mV,所有患者均成功持续起搏并安全转运至医院进一步治疗,所有患者均无严重并发症发生.结论 120院前急救中直接推送预成型电极临时心内膜起搏抢救严重的缓慢性心律失常安全有效、操作简便.     

非X线指导下经左锁骨下静脉紧急临时心脏起搏

对１８例急性重症缓慢心律失常合并严重血液动力学障碍患者，施行非Ｘ线透视指导下经左锁骨下静脉床边紧急临时心脏起搏，以体表心电图判定起搏情况及电极在右室的位置。１８例起搏均获成功，平均手术时间１６．９±２．５ｍｉｎ、平均穿刺至起搏成功时间６５±５０ｓ、平均电极留置长度２９．９±２．７ｃｍ。对提高穿刺成功率、防止误穿锁骨下动脉、防止电极误入颈内静脉等进行了讨论。     

床边紧急心脏临时起搏治疗42例分析

近年来，笔者经左锁骨下或左锁骨上途径穿刺左锁骨下静脉，床边紧急临时心脏起搏治疗42例严重缓慢性心律失常或心室停搏患者，现报告如下。     

经右颈内静脉紧急床边临时心脏起搏

目的 了解经右颈内静脉紧急床边临时心脏起搏的可行性和效果.方法17例缓慢心律失常的危重患者,穿刺右颈内静脉,送入起搏电极,根据体表心电图判断起搏电极是否在右心室内.结果16例起搏成功,1例因阈值过高而改在X光透视下安置成功.从穿刺至起搏成功约需时3～5min,手术时间10min左右,电极插入深度25～30cm,临时起搏保留时间3～11天.4例急性心肌梗塞患者在溶栓后,穿刺点有出血;2例出现间歇性起搏,调整后恢复正常起搏.无严重并发症.结论 经右颈内静脉紧急床边临时心脏起搏是治疗缓慢性心律失常的一种可靠有效方法.     

普通电极床旁临时起搏78例治疗体会

目的 分析普通电极床旁临时心脏起搏对于心动过缓患者的应用效果及其安装过程中的注意事项及并发症处理.方法 78例缓慢型心律失常患者均在床旁非X线条件下,以改良的Seldinger法穿刺左锁骨下静脉或右锁骨下静脉或右颈内静脉,留置血管鞘.经鞘管送入6F普通起搏电极导管到达右心室,行床旁临时起搏.结果 78例患者完全置入成功,达到有效起搏.所有患者均无血、气胸,心肌穿孔,血栓形成,心包填塞,膈肌跳动等并发症.术后2例患者发生电极脱位,1例患者植入术中发生心室颤动并术后发热,1例患者死于非起搏因素,其他患者均安全度过危险期.结论 普通电极床旁临时心脏起搏在床旁操作,无需X线引导,普通电极即可达到有效起搏,患者痛苦小、创伤小、并发症发生率低,是抢救缓慢性心律失常患者的有效措施.     

床旁经左锁骨下静脉临时心脏起搏治疗缓慢性心律失常的临床应用

目的探讨床旁经左锁骨下静脉临时心脏起搏治疗缓慢性心律失常的疗效与安全性。方法在无X线透视下,为63例缓慢性心律失常患者经左锁骨下静脉路径床旁放置临时心脏起搏器,记录起搏效果、操作时间、电极放置部位等指标。结果 63例患者均穿刺左锁骨下静脉送入临时电极成功,即刻起搏成功率100%,起搏阐值为（1.95±0.12）V,操作时间（7.3±0.37）min,起搏电极放置位置：右心室尖部起搏9例（14.3%,9/63）,右室流出道起搏53例（84.1%,53/63）,冠状静脉窦内起搏1例（1.6%,1/63）。无穿刺失败及其他并发症。结论床旁经左锁骨下静脉临时心脏起搏术操作简便、起搏效果好,适合紧急临时心脏起搏患者使用。     

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.