糖尿病兔心肌梗死后心脏自主神经的变化及其与室性心律失常的关系

目的 探讨糖尿病合并心肌梗死后兔心脏自主神经的变化及其与室性心律失常的关系.方法 选择新西兰兔作为研究对象,通过高脂高糖喂养2月后由耳缘静脉注射四氧嘧啶(80 mg/kg)制作糖尿病模型,并随机分为糖尿病+心肌梗死组、糖尿病假手术组和非糖尿病假手术组,通过结扎冠状动脉前降支制作心肌梗死模型.手术后所有入选成活兔均常规喂养8周,随之行活体电生理检查诱发心律失常,并采用免疫组织化学法观察心脏交感神经的形态、分布及密度变化.结果 糖尿病+心肌梗死组兔室性心律失常诱发率显著高于糖尿病假手术组(P<0.05);糖尿病+心肌梗死组梗死灶周及非梗死左心室游离壁酪氨酸羟化酶阳性神经纤维密度显著高于糖尿病假手术组(P<0.05),且神经纤维分布较为紊乱.结论 糖尿病兔心肌梗死后在自主神经损害的基础上出现了交感神经增生和异常再生即自主神经重构,从而使心肌梗死后室性心律失常的易感性增加.     

甘松对大鼠心肌梗死后交感神经重构的影响

目的:探讨甘松对大鼠心肌梗死后交感神经重构的影响。方法:将SD大鼠随机分为假手术组、模型组和甘松组,每组15只。采用结扎大鼠左冠状动脉前降支制备心肌梗死模型。免疫组织化学法检测各组大鼠梗死周边区生长相关蛋白43(GAP43)和酪氨酸羟化酶(TH)阳性神经纤维密度。采用程序刺激各实验组大鼠,诱发室性心律失常。检测心肌组织中超氧化物歧化酶(SOD)和丙二醛(MDA)含量。结果:与假手术组比较,模型组阳性神经纤维密度明显增加,室性心律失常诱发率明显升高(均P0.05);与模型组比较,甘松组大鼠阳性神经纤维密度降低,室性心律失常诱发率减少(均P0.05)。与假手术组相比,模型组大鼠MDA水平增高,SOD活力降低(均P0.05);与模型组比较,甘松组大鼠MDA水平降低,SOD活力升高(均P0.01)。结论:甘松可以有效改善心肌梗死大鼠交感神经重构,预防室性心律失常,其机制可能与改善氧化应激有关。     

美托洛尔和卡维地洛对心肌梗死后交感神经重构和电重构的影响

目的比较美托洛尔和卡维地洛对家兔心肌梗死(简称心梗)慢性期梗死周边区交感神经重构和电重构的影响及差异。方法40只家兔随机分为两组,每组各20只,采用结扎左冠状动脉前降支(LAD)的方法制备心梗模型,美托洛尔组和卡维地洛组分别给予美托洛尔和卡维地洛各5 mg.kg-1.d-1灌胃。持续给药8周后分别测量梗死周边区基础状态下,刺激交感神经前后的单相动作电位(MAP),计算跨室壁复极离散度(TDR)和TDR的变化(ΔTDR);测定心室颤动(简称室颤)阈值。免疫组化法研究梗死周边区心肌中生长相关蛋白43(GAP43)和酪胺酸羟化酶(TH)阳性纤维的分布和密度。结果在基础状态下两组动物的TDR之间的差异无显著性,交感神经刺激时卡维地洛组的TDR和ΔTDR均较美托洛尔组显著降低(31.6±8.8 m s,5.8±11.2 m s vs 38.5±8.6 m s,13.3±3.0 m s,P均(0.01),室颤阈值提高(21.6±4.4 V vs 18.7±3.8 V,P(0.05);卡维地洛组梗死周边区神经纤维密度较美托洛尔组显著降低(GAP43:1 958.6±346.8μm2/mm2vs 2 549.9±553.7μm2/mm2,TH:1 417.7±252.6μm2/mm2vs 1 778.9±457.8μm2/mm2,P均(0.01)。结论卡维地洛比美托洛尔能更有效地抑制心梗后梗死周边区神经重构,改善电重构。     

犬急性心肌梗死早期冠状动脉旁路移植术对梗死周边区心肌神经纤维密度的影响

目的探讨犬急性心肌梗死早期行冠状动脉旁路移植术(CABG)对梗死周边区心肌神经纤维密度的影响及意义。方法结扎犬冠状动脉前降支制备心肌梗死模型(30只)。分别在心肌梗死后第1、2、4和6周行CABG作为实验组,其中第2周4只,其余各组6只;分别为每个实验组设立未行CABG的心肌梗死对照组,每组2只。CABG术8周后开胸切取心脏,分别切取每只犬的梗死周边区作为实验组样本,并取未结扎冠状动脉相应区域的心肌组织作为空白对照组。采用免疫组化方法检测样本的生长相关蛋白43(GAP-43)、酪氨酸羟化酶(TH)的表达。应用Metamorph UIC(US)软件及Olympus/Evolution MP 5.0/BX51(JP)显微镜组成的计算机图像处理系统定量测定神经纤维密度。结果心肌梗死对照组GAP-43表达水平明显高于空白对照组和实验组[心肌梗死对照组:(1333.3±169.1)μm2/mm2;空白对照组:(625.4±121.7)μm2/mm2;实验组:第1、2、4和6周行CABG实验组:(656.9±147.5)μm2/mm2、(683.0±157.2)μm2/mm2、(737.0±158.3)μm2/mm2和(847.8±169.4)μm2/mm2,P<0.01];心肌梗死对照组的TH表达水平明显高于空白对照组和实验组[心肌梗死对照组:(1082.0±114.3)μm2/mm2;空白对照组:(435.7±106.9)μm2/mm2;第1、2、4和6周行CABG实验组:(440.2±105.2)μm2/mm2、(484.0±112.2)μm2/mm2、(521.8±100.1)μm2/mm2和(692.4±117.1)μm2/mm2,P<0.01],其中第6周行CABG实验组的TH表达水平明显高于空白对照组及其他时间行CABG实验组(均为P<0.05);心肌梗死对照组及第6周行CABG实验组的TH/GAP-43明显高于空白对照组和其他时间行CABG实验组(心肌梗死对照组:81%±2%;空白对照组:69%±6%;第1、2、4和6周行CABG实验组:67%±4%、71%±4%、71%±7%和82%±2%,P<0.05)。结论犬急性心肌梗死早期行CABG可以减少梗死周边区心肌中神经纤维密度,尤其是4周内行CABG可以减轻梗死周边区心肌交感神经重构。     

美托洛尔对急性心肌梗死大鼠心肌神经生长因子表达和神经重构的影响

目的 探讨β受体阻滞剂美托洛尔对大鼠急性心肌梗死(AMI)后心肌神经生长因子(NGF)表达和交感神经再生的影响.方法 结扎大鼠左前降支,建立AMI模型,存活者随机分为美托洛尔治疗组(MI-B组,n=10)和梗死对照组(MI-C组,n=10),另设假手术组(S组,n=8).MI-B组给予4周美托洛尔治疗,MI-C组和S组给予同体积生理盐水静脉注射和灌胃,4周后检测梗死周边区和梗死远端心脏神经纤维分布和密度以及心肌NGF基因和蛋白表达的变化.结果 与S组相比,MI-C组梗死周边和梗死远端心肌组织中NGF基因和蛋白表达明显升高(P＜0.05),梗死周边和梗死远端神经支配密度增高(P＜0.01).与MI-C组比较,MI-B组心肌细胞内NGF表达明显下降(P＜0.05),神经支配密度亦明显下降(P＜0.01).结论 早期美托洛尔治疗AMI可以改善心肌NGF表达和交感神经再生.美托洛尔改善交感神经再生的作用机制至少部分与其降低神经生长因子的表达和释放作用有关.     

地昔帕明对心肌缺血后交感神经重构和室颤阈值的影响

目的: 研究地昔帕明对大鼠急性心肌缺血后交感神经重构和室颤阈值的影响,并探讨交感神经重构与室颤阈值的关系。方法: 将60只SD大鼠随机分为3组,每组各20只:即心肌缺血组:夹闭左冠状动脉前降支30 min;地昔帕明组:先单次静脉给予地昔帕明0.8 mg/kg,5 min后夹闭左冠状动脉前降支30 min及假手术组:仅开胸但不夹闭左冠状动脉。喂养1周后,开胸测定室颤阈值。用免疫组化染色法检测大鼠心室肌中生长相关蛋白43（GAP43）和酪氨酸羟化酶（TH）阳性神经纤维的分布和密度,并用RT-PCR测定梗死周边区GAP43和TH mRNA表达的水平。 结果: 地昔帕明组的室颤阈值(11.0±2.65)V较心肌缺血组(7.2±1.30)V显著增高（P<0.05）;与假手术组的(13.0±2.12)V比较无明显差异。心肌缺血组GAP43和TH阳性神经纤维的分布紊乱,密度明显高于地昔帕明组和假手术组（P<0.05）。与心肌缺血组相比,地昔帕明组GAP43和TH mRNA表达的水平显著降低（P<0.05）。结论: 地昔帕明可改善心肌缺血后交感神经重构,提高室颤阈值,增加缺血心脏的电稳定性。     

大鼠心肌梗死后左心室重构、电重构和交感神经重构的关系

目的 应用超声心动图、免疫组织化学技术和电生理技术记录心肌梗死大鼠梗死周边区的有效不应期(ERP)及缝隙连接蛋白43(Cx43)改变,交感神经神经(TH)及神经生长因子(GAP43)改变,探讨心肌梗死大鼠心室重构、电重构及交感神经重构之间的关系.方法 将成年SD大鼠30只,随机分为假手术组和心肌梗死组.假手术组仅开胸,不结扎冠状动脉.结果 与假手术组相比,心肌梗死组LVIDd、LVIDs均显著增大(P＜0.01),EF和FS缩短率显著降低(P＜0.01).与假手术组相比,心肌梗死组梗死周边区ERP显著缩短,差异有统计学意义(P＜0.01).心肌梗死组Cx43阳性蛋白表达低于假手术组,差异有统计学意义(P＜0.01).与假手术组相比,心肌梗死组GAP43阳性神经密度明显增加,差异有统计学意义(P＜0.01).心肌梗死组TH阳性神经密度不均一明显增加,差异有统计学意义(P＜0.01).结论 大鼠心肌梗死后心室不但发生结构重构,同时也会发生神经重构和电重构,以及三者之间相互影响和共同作用导致恶性心律失常和猝死的发生.     

兔右房快速起搏后交感神经重构的动态变化

目的:动态观察快速起搏右房后心房肌神经生长因子(NGF)和酪氨酸羟化酶(TH)的动态表达,从分子水平揭示心房颤动(房颤)交感神经动态重构的规律。方法:从快速起搏后的兔右心房和左心房取材,通过免疫组化并结合计算机图像处理技术对心肌中NGF蛋白表达及交感神经支配进行研究。结果:与假手术组比较,快速起搏后4h,NGF蛋白的表达在右心房[(412.75±7.49)μm2/mm2∶(563.87±15.53)μm2/mm2]和左心房[(275.87±16.74)μm2/mm2∶(449.75±17.58)μm2/mm2]心肌中明显增加(P0.05);TH阳性神经纤维平均密度[右心房(72.00±8.02)μm2/mm2∶(83.87±7.18)μm2/mm2,左心房(58.00±10.65)μm2/mm2∶(70.50±6.65)μm2/mm2,P0.05]均显著增加;且右心房和左心房中交感神经支配与NGF蛋白的表达呈正相关(r=0.53,P0.05)。快速起搏后12h,兔心房中NGF蛋白的表达[右心房(869.50±17.28)μm2/mm2,左心房(830.75±11.73)μm2/mm2]与TH阳性神经纤维平均密度[右心房(120.87±8.57)μm2/mm2,左心房(100.25±10.25)μm2/mm2]均明显高于假手术组及快速起搏后4h组(P0.05~0.01),且二者呈正相关(r=0.69,P0.05)。快速起搏后24h,NGF蛋白表达[右心房(1115.7±92.35)μm2/mm2,左心房(949.12±43.20)μm2/mm2]及TH阳性神经纤维平均密度[右心房(158.12±11.28)μm2/mm2,左心房(121.12±14.71)μm2/mm2]均明显高于快速起搏后4h、12h(P0.01~0.001)。结论:快速起搏后心肌中神经生长因子蛋白呈动态表达,并与交感神经支配相关,提示神经生长因子可能在心肌局部发挥神经营养作用,进而参与交感神经的重构。     

兔陈旧性心肌梗死心室肌中神经纤维的形态学变化及增生对室颤阈值的影响

目的　研究神经纤维在兔陈旧性心肌梗死 (HMI)心室肌中的分布及形态学改变 ,并观察HMI兔中神经纤维的过度增生对室颤阈值的影响 ,为阐明自主神经在HMI心律失常和猝死中的作用提供实验依据。方法　 30只兔随机分为三组 :( 1)HMI组结扎冠状动脉左回旋支 ;( 2 )神经生长因子组结扎左回旋支并通过颈部皮下置管于左侧星状神经节 ,给予神经生长因子 4 0 0U× 30d ;( 3)假手术组开胸但不结扎冠状动脉和皮下置管。 3个月后三组动物均进行室颤阈值测定 ,免疫组化法研究兔心室肌中S 10 0蛋白和酪胺酸羟化酶 (TH)的分布和密度。结果　假手术组心室肌中的神经纤维呈非均态分布 ,HMI组心室肌神经分布紊乱。HMI组存在神经纤维再生和增生 ,特别是梗死周边区 ,具有特殊的表型 ,以TH阳性染色为主。神经生长因子组神经纤维密度明显较假手术组和HMI组增高 (P <0 0 5 ) ,其室颤阈值为 ( 7 0 0± 1 0 4 )V ,较HMI组和假手术组的 ( 9 16± 1 2 3)V和( 13 31± 2 12 )V明显降低 (P <0 0 5 )。结论　HMI心室肌中神经分布紊乱 ,存在神经再生和增生 ,以TH阳性染色为主 ,心肌梗死后过度的神经纤维增生可进一步促进梗死心脏的电不稳定性。     

心肌梗死后迷走神经重构及普奈洛尔对其作用的研究

目的通过对心肌梗死大鼠心肌中迷走神经支配的研究,探讨心肌梗死后迷走神经重构现象及β受体阻滞剂在其中的作用.方法建立大鼠左心室心肌梗死模型,分为3、7、30天心梗组及普奈洛尔+30天心梗组,并分别以假手术组作为各组的对照组.普奈洛尔用量为50mg·kg-1·d-1.分白从各组大鼠的梗死周边区、室间隔和右心室取材,通过抗囊泡乙酰胆碱通道(VACHT)的免疫组化方法并结合计算机图像处理技术检测心室中迷走神经支配的密度和范围.结果①心肌梗死后3天,迷走神经支配密度在梗死周边、室间隔心肌中有增加趋势[(1078.60±1316.77)μm2/mm2vs.(305.00±428.33)μm2/mm2,(846.20±338.50)μm2/mm2vs.(325.60±206.25)μm2/mm2,P＞0.05],在右心室中同对照组相比无明显差异[(462.80±437.46)μm2/mm2vs.(303.80±330.87)μm2/mm2];心肌梗死后7天,迷走神经支配密度在梗死周边心肌中有增加趋势[(2718.00±1446.27)μm2/mm2 vs.(1314.40±562.42)μm2/mm2,P＞0.05],在室间隔、右心室中明显增加[(3832.80±1129.11)μm2/mm2vs.(254.40±255.78)μm2/mm2,P＜0.01;(1067.80±468.63)μm2/mm2vs.(287.00±411.78)μm2/mm2,P＜0.05];心肌梗死后30天,迷走神经支配密度在梗死周边、室间隔、右心室中均明显增加[(5695.40±1887.57)μm2/mm2vs.(1420.40±447.87)μm2/mm2,(7377.80±1595.26)μm2/mm2vs.(341.60±346.82)μm2/mm2,(4504.60±1708.01)μm2/mm2vs.(282.20±349.13)μm2/mm2,P＜0.01].同时心肌梗死后7天和30天时,各部位心肌中膜均可见到密度较高的迷走神经支配.②普奈洛尔降低左心室梗死周边、室间隔、右心室心肌中的迷走神经支配密度[(1718.80±726.24)μm2mm2,P＜0.01;(3699.40±1607.12)μm2mm2,P＜0.01;(1920.00±1672.80)μm2mm2,P＜0.05],并促使各部位心肌中膜处增高的迷走神经支配密度趋于正常.结论左心室心肌梗死后的梗死周边、室间隔和右心室心肌中具有迷走神经重构现象,普奈洛尔能改善心肌梗死后心室中的迷走神经重构.     

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.