心电图活动平板试验阳性患者Q—T离散度变化的意义

目的　探讨心电图活动平板试验 (TET)阳性患者Q -T离散度 (QTd)变化的意义。方法　 93例受试者根据TET分为阳性组 (A组 ) 3 8例 ,男 女 =13 2 5 ,年龄 5 5± 8岁和阴性组 (B组 ) 5 5例 ,男 女 =2 6 2 9,比较两组TET前后QTd、QTcd的变化。结果　运动前QTd、QTcdA组分别为 41± 15ms和 46± 18ms,B组分别 ( 3 8± 14)ms和 ( 46±16)ms,两组比较无显著差异。达次极量运动时A组QTd为 ( 5 1± 17)ms与运动前比较有显著性差异 (P <0 0 5 ) ,QTcd为 ( 79± 2 8)ms ,与运动前比较有非常显著性差异 ( P <0 0 1) ,B组QTd、QTcd分别为 ( 3 7± 16)ms和 ( 5 1± 19)ms,与运动前比较无显著性差异。两组运动后QTd、QTcd比较有非常显著性差异 (P <0 0 1)。结论　TET阳性与QTd之间有良好的临床相关性。可反映运动负荷造成的心肌缺血     

平板运动试验不同时段QT离散度变化的意义

目的探讨平板运动试验(TET)不同时段的QT离散度(QTd)和校正QT离散度(QTcd)变化的意义。方法选择38例TET阳性者不同时段记录的心电图用于测量、分析QTd、QTcd的变化,并与40例TET阴性者作对比分析。结果阳性组运动峰值心率时,运动中或后ST段下移最大时及运动后2、4、6分钟时的QTd、QTcd较运动前显著增大(P<0.01或P<0.05),尤以运动所致ST段下移最大时为明显,而阴性组运动相应时段的QTd、QTcd与运动前比较无明显增大(P>0.05)。结论QTd和QTcd增大,尤其ST段下移最大时的QTd,QTcd增大可作为TET结果判定的一项新的参考指标。     

冠心病与运动前后QT间期离散度的关系

目的了解QT离散度(QTd)在运动试验中的变化对冠心病诊断的敏感性。方法50例可疑冠心病患者先后作运动试验及冠状动脉造影(简称冠造)检查,以冠状动脉造影结果将试验组分为阳性组(23例)和阴性组(27例),比较两组运动前后QTd及校正后QT周期离散度(QTcd)变化的差异。结果阳性组23例有21例运动后QTcd>60ms,占该组91·3%,其运动前后QTcd分别为46·1ms±12·6ms,74·9ms±10·14ms,有显著差异(P<0·05)。阴性组27例有25例运动后QTcd<60ms,占该组92·6%,其运动前后QTcd分别为:39·72±12·3ms,43·7ms±13·9ms。在统计学无显著差异(P>0·05)。结论QTcd在运动后明显增大,QTcd>60ms时可疑为冠心病。     

QT离散度与左心室肥厚及氯沙坦对其干预作用

目的探讨高血压性左室肥厚(LVH)与其QT间期离散度(QTd)的关系,以及氯沙坦对二者的干预作用.方法选择高血压病人伴有左室肥厚的30例和无左室肥厚的32例.服用losartan 50 mg qd共6月.治疗前后,用超声心动图(UCG)检测左室相关参数计算出左室重量(LVM),从心电图上计算出QTd、校正的QT离散度(QTcd).结果 EH伴有LVH病人组的QTd(54±16 ms)、QTcd(67±22 ms)、LVM(345.6±101.2)明显大于无LVH组的QTd(38±13 ms)、QTcd(42±18 ms)、LVM(168.6±67.2 g)(P均<0.05). QTd(54±16 ms)、QTcd(67±22 ms)、LVM(345.6±101.2)分别呈正相关(r=0.74, P<0.001及r=0.63, P<0.001).治疗6月后有LVH组的QTd(54±16 ms /40±12 ms,该分子式表示治疗前的数据/治疗后的数据,下同)、 QTcd(67±22 ms/49±17 ms)、LVM(345.6±101.2g/238.8±89.2g)较治疗前均有明显降低(P均<0.05),且ΔQTd(15±13 ms)、ΔQTcd(18±15 ms)即两者减少的幅度与 LVM降低的幅度(107.8±90.2 g)亦分别呈显著正相关(r=0.60, P<0.001及r=0.56, P<0.001).结论高血压患者左室肥厚可引起QTd、QTcd增大,他们可评估左室肥厚的程度.氯沙坦对二者具有良好的干预作用.     

女性平板运动试验前后QTc离散度变化的意义

目的　探讨女性运动试验前后 QTc离散度 ( QTcd)的变化 (△ QTcd)意义。方法　随机选取经冠状动脉造影证实的冠心病和非冠心病各 30例 ,对比观察它们在平板运动试验前后的 QTcd和△ QTcd。结果　 ( 1)冠心病组运动后 QTcd较运动前显著延长 ( P<0 .0 0 1) ,非冠心病组运动后 QTcd较运动前无明显延长 ( P>0 .0 5 ) ,冠心病组的△ QTcd( 2 3± 12 ms)较非冠心病组的△ QTcd( 2± 10 m s)显著增大( P<0 .0 0 1)。 ( 2 )以△ QTcd>10 ms为运动试验阳性标准 ,诊断冠心病的敏感性、特异性和阳性预测值明显优于 ST段标准 ( 93%对 73% ,90 %对 6 7%和 90 %对 6 9% ,P均 <0 .0 5 )。结论　△ QTcd>10 ms可作为女性运动试验阳性的一项良好的心电学指标     

平板运动试验QTc离散度的变化与冠心病诊断的关系

目的 探讨平板运动试验QTc离散度(QTcd)的变化规律与诊断冠心病的临床意义.方法 对50例疑诊为冠心病者先后行平板运动试验及冠状动脉造影检查,分析运动前、中、后同步十二导联心电图的QTcd.结果 冠心病组运动后QTcd较运动前显著增大[(77.18±13.91)和(45.42±11.40)ms];冠状动脉正常组运动前、后QTcd变化无显著性(P＞0.05).QTcd的变化规律反映了QTcd与冠心病心肌缺血呈正相关性.QTcd＞50ms 作为运动试验阳性标准,诊断冠心病的敏感性为95.2%,特异性为89.7%.传统运动试验标准诊断冠心病敏感性为95.2%,特异性为51.7%.结论 提示运动试验中QTcd＞50 ms可作为判断冠心病的心电学指标之一,且能提高特异性,减少假阳性.运动引起的单纯交感神经兴奋并不增加心肌复极的不均一性,只有在心肌缺血时交感神经兴奋才使QTcd增大.     

运动诱发心肌缺血对心室肌复极的影响

目的　比较运动前和运动终止后仍有 ST段下移时 ,QTd和 QTcd的差值 ,以及 U波的发生率。方法　入选 76例运动中和运动终止后仍有 ST段下移的病例。结果　 1ST段下移时的 QTd和QTcd显著大于运动前 (0 .0 5± 0 .0 2比 0 .0 4± 0 .0 1,P=0 .0 13;0 .0 6± 0 .0 3比 0 .0 4± 0 .0 2 ,P=0 .0 0 0 ) ;除 V1 导联外 ,运动后余导联 QTc均显著大于运动前 (P=0 .0 0 0 )。2 ST段下移时 ,U波倒置发生率显著高于运动前 (P=0 .0 0 0 )。结论　提示心肌缺血可以增加心肌复极的不同步性 ,QTd和 QTcd增加 ;U波倒置可以有助冠心病的诊断。     

冠状动脉内支架置入术对有与无心肌梗死史患者QT离散度影响的比较

探讨和比较冠心病患者经过成功冠状动脉 (简称冠脉 )内支架置入术对有与无心肌梗死史的病人QT离散度(QTd)影响的程度 ,选择术前QTd≥ 60ms者 1 0 0例 ,根据有无心肌梗死病史分为两组 ,其中无心肌梗死组 62例 ,心肌梗死组 38例 ,于术前、后 72h分别做 1 2导联同步心电图进行测量QTd和计算校正QTd(QTcd)。在无心肌梗死组中 ,支架置入术后 ,QTd、QTcd明显缩短 (分别为 51± 1 9vs 72± 34ms,54± 2 4vs 81± 37ms;P <0 .0 5) ;而在心肌梗死史组中 ,术后QTd、QTcd上无显著变化 (分别为 70± 2 6vs74± 30ms ,80± 30vs82± 32ms;P >0 .0 5)。结论 :冠脉内支架置入术显著缩短无心肌梗死史冠心病患者的QTd和QTcd ,而对有心肌梗死冠心病患者的QTd和QTcd无影响     

QT离散度对X综合征的临床价值探讨

分析经冠状动脉造影证实的 1 82例冠心病、94例正常人及 3 8例X综合征者活动平板运动试验前及运动高峰时QT离散度 (QTd)的变化。X综合征组运动前QTd明显小于冠心病组 (2 9.41± 1 5 .1 1msvs 5 4.3 0± 9.2 2ms ,P <0 .0 1 )、而与正常组 2 5 .3 0± 1 3 .2 1ms相似(P >0 .0 5 ) ;X综合征组运动高峰时QTd明显大于正常组 (4 9.92±1 0 .2 3msvs 2 3 .5 2± 1 4.3 2ms,P <0 .0 1 )。结论 :X综合征者运动时QTd明显增加 ,提示运动高峰时较大的QTd可反映冠状动脉微血管病变所致心肌缺血     

缬沙坦对急性心肌梗死患者早期QT间期离散度的影响

通过研究缬沙坦对急性心肌梗死 (AMI)患者早期QT间期离散度 (QTd)的影响 ,探讨缬沙坦对缺血心肌的保护作用。将 34例AMI患者随机分成缬沙坦 +基础治疗组 (治疗组 ,A组 ,17例 )和基础治疗组 (对照组 ,B组 ,17例 )。另设正常人 2 0例作对照组 (正常对照组 ,C组 )。在服药前、服药后 3,7天分别测量QTd及校正的QTd(QTcd) ,并观察服药前及服药 3天后室性心律失常的发生率。结果 :AMI患者的QTd及QTcd较正常人明显延长 (75 .9± 11.9vs 32 .7± 12 .6ms ,85 .5± 12 .8vs 36 .5± 13.2ms,P均 <0 .0 1) ;AMI患者中发生室性心律失常者 (19例 )的QTd及QTcd则较非室性心律失常者 (15例 )明显增加 (81.1± 11.1vs 6 9.3± 9.6ms,92 .0± 10 .5vs 73.6± 18.9ms ,P均 <0 .0 1) ;服药 7天后A组和B组的QTd及QTcd均明显减少 ,但A组比B组减少的更为显著 (41.5± 11.1vs 5 7.9± 10 .8ms,4 6 .9± 12 .3vs 6 5 .5± 12 .5ms ,P均 <0 .0 1) ;服药 3天后A组的QTd及QTcd较服药前也有明显的减少 ;服药 3天后A组中发生室性心律失常者 (2例 )明显减少 ,与治疗前 (10例 )有显著性差异 (P <0 .0 5 )。结论 :AMI患者早期QTd及QTcd较正常人增大 ,并且伴有室性心律失常的患者QTd及QTcd增大更为显著 ,AMI患者早期服用缬沙坦可降低QTd及     

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.     

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.     

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.