钙拮抗剂干预对高血压合并左心室肥厚的影响

目的　探讨钙拮抗剂非洛地平逆转高血压 (EH )合并左心室肥厚 (L VH )的作用及其机制。方法　选择 EH合并 L VH的患者 30例 ,测定非洛地平治疗 (5～ 10 mg/ d) 2 4周前后左室重量指数 (L VMI)、胰岛素敏感指数 (ISI)及血浆肾素活性 (PRA)、血管紧张素 (Ang )、醛固酮 (AL D)、内皮素 (ET)、一氧化氮 (NO)、去甲肾上腺素 (NE)水平。结果　非洛地平治疗后 ,L VMI减小 (P<0 .0 1) ,ET降低 (P<0 .0 5 ) ,NO、ISI升高 (P均 <0 .0 1) ,而 PRA、Ang 、AL D、及 NE无显著变化。结论　钙拮抗剂非洛地平可以逆转 EH合并 L VH,其机制可能与非洛地平改善内皮细胞功能和胰岛素抵抗 ,而对肾素 -血管紧张素 -醛固酮系统 (RAAS)及交感神经系统 (SYS)无激活作用有关     

彩色多普勒评价高血压左心室舒张功能的价值

目的　探讨多普勒组织成像 (DTI)技术评价高血压病 (EH)患者左心室舒张功能的价值 ,以寻求一种可靠、客观的评价高血压左心室舒张功能的新方法。方法　采用放免法测定 2 0例正常人和 4 2例 EH患者 (伴心肌肥厚者2 0例和不伴心肌肥厚者 2 2例 )的血清 I型前胶原 (PC )和 型前胶原 (PC )的浓度。用 DTI法检测正常人及 EH患者二尖瓣环舒张早期运动速度 (Ea)、舒张晚期运动速度 (Aa)及 Ea/Aa,并用二尖瓣血流多普勒法检测舒张期血流速度 E、A及 E/A,比较两种方法测值与血清 PC 、PC 型前胶原的相关性。结果　 1.EH患者非左心室肥厚(non- L VH )组及左心室肥厚 (L VH )组二尖瓣口血流参数、二尖瓣环 DTI参数均明显低于正常对照组 (P<0 .0 1) ;2 .EH患者 non- L VH组与 L VH组间 E、E/A无明显差异 (P>0 .0 5 ) ,但 L VH组 Ea、Ea/Aa明显低于 non- L VH组(P<0 .0 5 ) ;3.EH患者 non- L VH组血清 PC 、PC 与 E/A及 Ea/Aa均呈负相关 ;而 L VH组血清 PC 、PC 与Ea/Aa亦呈负相关 ,与 E/A无明显相关。结论　 DTI能更准确定量高血压患者二尖瓣环舒张期运动速度的改变 ,DTI法检测二尖瓣环运动速度之比与反应心肌纤维化程度的血清 PC 、PC 浓度相关良好 ,有利于舒张功能受损程度的判断 ,优于传统的二尖瓣口血流法。     

高血压病左室结构功能变化与血浆内皮素的相关性

目的 :探讨高血压病患者左室结构 ,功能变化与血浆内皮素 （ET）的关系。方法 :原发性高血压不伴左室肥厚（L VH）组 （EH） 35例 ,伴 L VH组 （EH+ L VH） 2 8例 ,正常对照组 30例。放射免疫法测定血浆 ET水平 ,超声心动图检测心脏结构与功能。计算左室重量指数 （L VMI） ,平均室壁厚度 （MWT） ,相对室壁厚度 （RWT）。结果 :EH组及 EH+ L VH组血浆 ET高于正常对照组 （P<0 .0 1） ,EH + L VH组 ET高于 EH组 （P<0 .0 1） ,ET与 L VMI,MWT室间隔厚度 ,左室后壁厚度呈正相关 （r分别为 0 .42 4,0 .316 ,0 .2 6 8和 0 .317,均 P<0 .0 1） ,ET与 E/ A呈负相关 （r=-0 .30 4,P<0 .0 1）。结论 :ET与高血压和 L VH相关。     

强肝胶囊对慢性肝病肝纤维化指标的影响

目的 :了解强肝胶囊对慢性肝病患者血清肝纤维化指标 [透明质酸 (HA)、 型胶原 (C )、 型前胶原 (PC )、层粘连蛋白 (L N) ]的影响。方法 :12 1例慢性肝炎患者随机分为两组 :治疗组 (6 9例 )给予强肝胶囊 ,每日3次 ,每次 5粒 ,连服 3个月 ;对照组 (5 2例 )采用常规护肝降酶等治疗。治疗前、后分别检测两组血清 HA、C 、PC 、L N水平。结果 :治疗组血清 HA、C 、PC 、L N明显下降 ,与对照组比较差异有显著性意义 (P <0 .0 1)。结论 :强肝胶囊有较好的抗肝纤维化作用 ,是治疗肝纤维化的有效药物。     

高血压病患者血清Ⅰ型和Ⅲ型前胶原浓度变化及其临床意义探讨

目的　探讨高血压病 (EH)患者心肌纤维化的无创性检测指标。方法　采用放免法测定 30例正常人和 6 0例EH患者 (伴心肌肥厚者 35例和不伴心肌肥厚者 2 5例 )血清Ⅰ型前胶原 (PCⅠ )和Ⅲ型前胶原 (PCⅢ )的浓度 ,用M型超声测算左室重量指数 (LVMI) ,用多普勒超声测定二尖瓣口舒张早期和晚期最大血流速度 (VE 和VA)。结果　①EH患者血清PCⅠ和PCⅢ均明显高于正常对照组 [(4 6 6 5± 11 0 1)μg/Lvs (34 31± 5 91) μg/L ,P <0 0 5和 (146 0 0± 2 9 35 ) μg/Lvs (96 2 4± 2 1 18) μg/L ,P <0 0 1]。②EH非左室肥厚组血清PCⅢ浓度明显高于正常对照组 [(12 0 6 2± 16 2 3) μg/Lvs(96 2 4± 2 1 18) μg/L ,P <0 0 1],而血清PCⅠ与正常对照组无差别 [(33 73± 6 83) μg/Lvs (34 31± 5 91) μg/L ,P >0 5 ];EH左室肥厚组血清PCⅢ高于非肥厚组 [(16 4 14±2 2 2 8) μg/Lvs (12 0 6 2± 16 2 3) μg/L ,P <0 0 1]和正常对照组 [(16 4 14± 2 2 2 8) μg/Lvs (96 2 4± 2 1 18) μg/L ,P <0 0 1];血清PCⅠ亦高于非肥厚组 [(5 5 88± 12 86 ) μg/Lvs(33 73± 6 83) μg/L ,P <0 0 1]和正常对照组 [(5 5 88±12 86 ) μg/Lvs (34 31± 5 91) μg/L ,P <0 0 1]。③血清PCⅢ与V     

原发性高血压患者血清Ⅰ型和Ⅲ型前胶原水平及药物干预研究

目的　测定血清 型和 型前胶原 (procollagen,PC)水平 ,评价高血压患者心肌纤维化程度 ,并分析使用抑平舒 (Cilazapril)或波依定 (Felodipine)抗高血压治疗对二者的影响。方法　 4 9例原发性高血压患者分为两组 :抑平舒治疗组 (n=2 2 )和波依定治疗组 (n=2 7) ,2 3例未经治疗的高血压患者作为实验对照组 ,2 0名同龄健康者为正常对照组 ,采用放射免疫分析法测定其血清 PC 、PC 水平 ,用超声测量其左心室解剖参数 ,计算左心室质量指数(L VMI)。结果　高血压实验对照组 L VMI、血清 PC 、PC 水平较正常对照组显著升高 (L VMI:110 .0 7± 19.31对 83.73± 15 .5 0 ,PC :12 0 .96± 2 4 .4 2对 71.6 3± 17.80 ,PC :95 .92± 9.75对 6 7.90± 9.37,P<0 .0 1)。高血压患者中未经治疗者 L VMI、血清 PCI水平显著高于经抑平舒或波依定治疗 6个月的患者 (L VMI:110 .0 7± 19.31对 96 .95± 2 1.92 ,110 .0 7± 19.31对 98.5 1± 19.2 5 ;PC :12 0 .96± 2 4 .4 2对 80 .5 1± 19.6 6 ,12 0 .96± 2 4 .4 2对93.0 5± 19.6 1,P<0 .0 1) ,血清 PCI水平抑平舒治疗组低于波依定治疗组 (80 .5 1± 19.6 6对 93.0 5± 19.6 1,P<0 .0 5 ) ,而血清 PC 水平高血压患者三组间均无差异。结论　 1.血清 PC 和 PC 浓度可以?     

原发性高血压患者血清胰岛素样生长因子Ⅰ的变化

目的 :探讨胰岛素样生长因子 ( IGF- )与原发性高血压 ( EH)的关系 ,评价 IGF- 对EH左心室肥厚 ( L VH)患者的病理生理意义。方法 :采用特异性放射免疫分析法测定了 30例未治疗的 EH患者和 2 0例正常人的血清 IGF- 水平。结果 :EH患者血清 IGF- 水平明显高于正常人〔( 13.90± 3.5 0 ) nmol/ L∶ ( 9.40± 1.60 ) nmol/ L,P<0 .0 0 1〕,而且随病情的加重而升高 ;EH伴有L VH者 IGF- 高于无 L VH者〔( 15 .34± 3.48) nmol/ L∶ ( 12 .2 5± 2 .82 ) nmol/ L ,P <0 .0 2〕;EH伴有肾功能损害者亦高于无相应病变者〔( 15 .79± 3.79) nmol/ L∶ ( 12 .64± 2 .73) nmol/ L,P <0 .0 2〕。结论 :EH患者的循环 IGF- 水平升高 ,其升高程度与 EH病情的严重程度有关 ,IGF- 可能参与 EH心肌肥厚的调节。     

高血压和非高血压2型糖尿病人血清中Ⅲ型前胶原与透明质酸含量的观察

目的　比较高血压和非高血压 2型糖尿病人与对照者血清中 型前胶原和透明质酸含量 ,以了解糖尿病人心肌纤维化的情况。方法　分别用放射免疫法测定、超声心功图检查比较了 4 0例糖尿病人 ,无糖尿病对照者 32名血清中人 型前胶原 (Procollagen ,PC )、透明质酸 (Hyaluronic,HA)含量和左心室质量指数 (left venticularmass index,L VMI)及左心室血流速度 E/ A比值。分组 :糖尿病无高血压组 DMl;糖尿病人有高血压组 DM2 ;对照无高血压组 CO1;对照有高血压组 CO2。并对 PC 的相关因素进行了多元逐步回归分析。结果　 (1)糖尿病组和糖尿病有高血压组 PC 较高 ,与相应对照组、糖尿病无高血压组相比含量存在显著差异 (P<0 .0 5 ) ;糖尿病有高血压组与糖尿病无高血压组相比还存在 L VMI较高 ,射血分数 (ejection fraction,EF)较低的特点 (P<0 .0 5 ) ;(2 )糖尿病高 L VMI组比正常 L VMI组的 PC 含量高并有统计学意义 ;(3)多元逐步回归分析显示糖尿病组 (n=4 0 ) :PC 与年龄、病程正相关 ,与 Hb A1c、血管紧张素 (Ang )等无相关。结论　 (1)糖尿病患者血清 PC 高提示心肌比非糖尿病人有更明显的纤维化的改变 ,高血压使之加重 ,左心室肥厚者具有较高的血清 PC 水平 ,心脏 PC 含量还随糖尿病病程的延长和增龄而     

高血压病患者与正常人血清胶原代谢的对比研究

目的　测定高血压病 (EH)患者血清Ⅰ型前胶原羧基端肽 (PⅠP)、Ⅲ型前胶原氨基端肽 (PⅢP)和Ⅰ型胶原羧端交联肽 (ICTP)水平的改变 ,探讨其在高血压性心肌纤维化中的诊断价值。方法　采用放射免疫法测定 4 2例EH患者、30例正常对照者血清PⅠP、PⅢP及ICTP浓度 ,并对结果进行统计学分析。结果　EH患者血清PⅠP、PⅢP的含量分别为 (12 1 2± 2 0 8) μg/L和 (5 2± 3 2 ) μg/L ,明显高于正常对照组 (分别为 92 8μg/L± 13 3μg/L和 3 8μg/L±1 5 μg/L) ,P <0 0 5 ;ICTP的含量EH组虽有增加的趋势 (4 4± 1 7) μg/L ,但与正常组 (4 1± 1 5 )μg/L相比 ,P >0 0 5。有左心室肥厚 (LVH)的EH患者血清PⅠP水平高于无左心室肥厚 (无LVH)组 (12 7 6 μg/L± 18 5 μg/Lvs 10 5 3μg/L±12 4 μg/L,P <0 0 5 ) ,有LVH组血清ICTP水平低于无LVH组 (4 2 μg/L± 1 1μg/Lvs 5 0 μg/L± 1 2 μg/L ,P <0 0 5 ) ,而PⅢP水平两组无统计学差异 (P >0 0 5 )。结论　EH患者可能有Ⅰ型胶原及Ⅲ型胶原的合成增加 ,降解相对不足 ,测定PⅠP、PⅢP及ICTP可作为了解EH患者心肌纤维化的间接指标     

米诺环素对急性心肌梗死大鼠心肌基质金属蛋白酶-2及转化生长因子-β1表达的影响

目的探讨大鼠心肌梗死后心肌间质基质金属蛋白酶-2(MMP-2)及转化生长因子-β1(TGF-β1)的表达与心室重塑的关系及米诺环素的干预影响.方法结扎SD大鼠冠状动脉前降支建立急性心肌梗死模型,随机分成心肌梗死对照组和米诺环素(30mg·kg-1·d-1)治疗组,2组又随机分为1、2和4周亚组;另设假手术组.应用免疫组化方法测定胶原的表达.用逆转录-聚合酶链反应法及免疫组化方法检测MMP-2、TGF-β1mRNA和蛋白表达情况.结果与假手术组相比,心肌梗死对照组MMP-2、TGF-β1的mRNA表达在各亚组明显升高(均P＜0.05),各亚组MMP-2、TGF-β1蛋白表达也均增高(均P＜0.05),非梗死区Ⅰ/Ⅲ胶原比例在2周和4周随之升高(均P＜0.05).而米诺环素治疗组MMP-2mRNA和蛋白表达在1、2和4周亚组,TGF-β1 mRNA和蛋白表达在1、2周亚组,均较心肌梗死对照组显著降低(均P＜0.05),Ⅰ/Ⅲ胶原比例在2周和4周亚组也显著降低(均P＜0.05).结论大鼠心肌梗死后心肌间质内MMP-2、TGF-β1的表达增高,非梗死区Ⅰ/Ⅲ胶原比例上升,是心室重塑发生发展的重要机制.米诺环素可通过抑制MMP-2、TGF-β1的表达,逆转Ⅰ/Ⅲ胶原比例改善心肌梗死后心室重塑.     

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.     

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.     

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.     

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.     

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.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.