老年糖尿病肾病透析患者动静脉内瘘术前心功能评估重要性的临床研究

目的为老年糖尿病肾病透析患者行动静脉内瘘术前,心脏功能评估提供理论支持。方法选取老年糖尿病肾病透析患者50例为研究对象,所有患者均行动静脉内瘘术,术前依据患者的射血分数(EF)结果将其分为4组:30%EF≤40%17例、40%EF≤50%14例、50%EF≤60%16例、EF60%3例。记录患者的充血性心力衰竭发生率。所有患者均在内瘘术前、术后3个月、6个月、12个月测量血脑钠肽BNP、肌钙蛋白(cTn IL),并采用辛普森法行心脏彩超测量患者的心功能(左室射血分数LVEF、左心房内径LAd、左心室收缩末内径LVESd、左心室舒张末内径LVEDd、左心室每搏输出量SV、右心室内径RVd)。结果 30%EF≤40%与40%EF≤50%、40%EF≤50%与50%EF≤60%患者充血性心力衰竭发生率比较,差异无统计学意义(P0.05);30%EF≤40%患者充血性心力衰竭发生率明显高于50%EF≤60%患者,差异有统计学意义(P0.05)。随着内瘘时间的延长,患者的BNP、cTn IL水平呈升高趋势;通过相关性分析可知:LAd、LVESd、LVEDd、SV、RVd呈不同程度的扩大,与时间呈相关性;LVEF、与时间呈负相关性。结论动静脉内瘘术前心功能评估在老年糖尿病肾病透析患者中具有重要的临床意义。     

左室射血分数下降人群心功能NYHA分级等情况研究

目的分析左室射血分数（EF）值下降人群心功能NYHA分级及LVDd（心超中左室舒张末期内径）情况。方法整群选取芜湖市二院心内科2010年1月—2010年12月出院的EF下降的住院患者,与随机选取的对照组比较心功能NYHA分级及LVDd情况。第1组EF〈40%的88例,第2组40%≤EF〈50%的94例,第3组EF〉50%的对照组92例。结果第1组心功能NYHA分级显著差于第2组;第2组心功能NYHA分级显著差于第3组;第1组LVDd显著大于第2组;第2组LVDd显著大于第3组。结论 EF下降人群,心功能NYHA分级情况相应较差,LVDd相应较大。一些＂貌似正常＂的EF下降的患者,心功能情况肯定较差,LVDd相对较大。EF下降人群需要更多关注心功能情况,规范治疗,避免感染、过度劳力、情绪激动等心功能急性恶化的诱因。     

应用GMPI评价AMI患者介入治疗前后心肌血流灌注及心功能的变化

目的应用门控心肌灌注显像(GMPI)评估急性心肌梗死(AM I)患者介入治疗前后心肌血流灌注及心功能的变化。方法 30例经典型临床表现、特征心电图及实验室检查确诊为AM I的患者,首先完成静态门控心肌断层显像检查,然后行经皮冠脉介入治疗。根据GMPI所测静息左室射血分数(LVEF)分为:A组EF≥50%,15例;B组EF50%,15例。在行介入治疗8 w后复查静态GMPI检查。结果 30例患者EDV、ESV及MASS在介入治疗8 w后明显降低。EF和CO介入治疗8 w后明显提高(P0.01)。GMPI对单支、双支、三支病变检出的阳性率分别为83.3%(10/12)、90%(9/10)、87.5%(7/8)。A组介入治疗前后灌注减低节段的改善数明显高于B组(P0.05)。结论 GMPI对AM I患者心肌血流灌注及心功能的评价具有重要的临床价值;AM I心功能正常组与心功能异常组比较,介入治疗后心肌血流灌注及心功能明显改善。     

肺动脉压对左心室射血分数正常心力衰竭患者预后的预测价值

目的分析肺动脉压(PAP)在左心室射血分数正常的心力衰竭(HFn EF)患者中的诊断、评估及预后价值。方法入选我院心内科2011年1月至2014年1月临床诊断为HFn EF的210例患者,对其临床资料进行回顾性分析,依照纽约心脏病协会(NYHA)心功能分级分为Ⅱ级(70例)、Ⅲ级(70例)和Ⅳ级(70例)3组,比较3组间PAP和N末端脑钠肽前体(NT-pro BNP)水平等,对PAP特点及住院死亡率、再入院率进行分析。结果 HFn EF患者的左心室射血分数正常(45%~62%),E/A比值均小于1,NT-pro BNP水平明显升高(973~6 100 ng/L),随心功能分级增加,超声心动图显示左心房及右心室明显增大,PAP逐渐升高,心功能Ⅳ级组PAP(67±11)mm Hg高于心功能Ⅲ级组[(45±4)mm Hg,P=0.03],均明显高于心功能Ⅱ级组PAP[(25±5)mm Hg,P<0.01];随PAP升高,重度PAP升高组(>60 mm Hg)3、6和12个月再入院率均高于中度PAP升高组(40~60 mm Hg,P=0.04、0.03和0.02),均高于轻度PAP升高组(20~40 mm Hg,均为P<0.01);重度PAP组的3、6和12个月死亡率均高于中度和轻度PAP升高组(均为P<0.05)。结论 PAP可作为HFn EF诊断、评估及预后的有效指标。     

心功能不全患者红细胞分布宽度特点研究

目的研究心功能不全患者红细胞分布宽度(RDW)与B型利钠肽(BNP)的水平及相关性。方法选取2013年10月至2015年11月中国医科大学附属盛京医院收治的心功能不全患者174例。按LVEF及E/A分2组,心功能不全组(LVEF50%或E/A1,117例),正常对照组(LVEF50%且E/A1,57例)其中心功能不全组分为EF值下降的心功能不全组(LVEF50%,E/A1,81例),射血分数(EF)保留的心功能不全组(LVEF≥50%,E/A1,36例)。检测RDW及BNP等临床资料水平,进行统计分析。结果心功能不全患者中RDW与BNP差异有统计学意义。EF值下降的心功能不全组较EF值保留的心功能不全组,RDW与BNP的值高,BNP与RDW呈显著正相关。RDW及BNP分别与LVEF呈显著负相关,组间差异有统计学意义(P0.05)。结论 RDW对心功能不全可能有潜在诊断价值。     

高血压病人室壁中层缩短率降低的临床意义

目的在原发性高血压病人中探讨室壁中层缩短分数(mFS)的降低与早期心肌收缩功能减退与靶器官器质性损伤的相互关系.方法比较mFS降低组与正常组病人静息位与最大药物负荷时左室射血分数(EF)等的差异、以及心室质量、尿蛋白的组间差异.结果静息位两组病人心功能无差异;mFS减低组的药物负荷核素心血池显象EF多有异常,伴心室质量增加及尿蛋白定性明显增加.结论高血压病人mFS减退提示早期心室功能减退伴心脏、肾脏器质性损害.     

血尿酸水平与射血分数保留心力衰竭的关系

目的:探讨血尿酸水平与射血分数保留心力衰竭(HF-p EF)的关系。方法:本研究选取2014年1月至2015年12月,收入我科的HF-p EF患者133例为主要研究对象,根据纽约心脏病学会(NYHA)心功能分级标准将患者分为三组,心功能Ⅱ级组54例,心功能Ⅲ级组47例,心功能Ⅳ级组32例。并同时选取同期体检中心心功能正常体检者95例为对照组,男性55例,女性40例,年龄30~74岁。两组均检测血尿酸、B型脑钠肽(BNP)、LDL-C及空腹血糖。超声心动图检测左心室舒张末期室间隔厚度(IVST)、左心室舒张末期室壁厚度(LVPWT)、左心室舒张末期内径(LVEDd)、左心室射血分数(LVEF)、E/A等指标,并计算左心室质量指数(LVMI)。结果:HF-p EF组血尿酸浓度高于对照组[(454.00±95.86)vs.(300.57±53.10),P=0.000],差异均有统计学意义。在多因素Logistic回归分析中,血尿酸水平对HFp EF的(OR=1.028,95%CI:1.019~1.038,P=0.000),血尿酸水平是HF-p EF的危险因素。将HF-p EF患者根据NYHA分级情况分为三个亚组,三组间血尿酸水平、BNP水平、射血分数、E/A比值、左心室舒末内径、室间隔厚度、左心室后壁厚度以及左心室质量指数差异均有统计学意义,将上述参数在三组间进行两两比较,结果显示血尿酸水平、BNP水平、E/A比值、室间隔厚度、左心室厚壁厚度以及LVMI差异均有统计学意义;射血分数以及左心室舒末内径在三组间两两比较时差异均无统计学意义。结论:高尿酸血症是HF-p EF的危险因素;血尿酸水平与HF-p EF患者心力衰竭严重程度相关,结合血尿酸水平、BNP、E/A比值以及左心室质量指数有可能对患者的心力衰竭严重程度进行客观的判断。     

核素心功能显像对干细胞移植治疗急性心肌梗死的评价

目的探讨核素心功能显像评价干细胞移植治疗急性心肌梗死后心脏功能的应用价值。方法急性前壁心肌梗死患者60例分为干细胞移植组及常规治疗组各30例,采用核素平衡法门控心血池显像技术得出两组急诊经皮冠状动脉介入术（PCI）后10 d内、第3个月、6个月左室心功能参数,行静息心肌灌注显像并评分。结果干细胞移植组6个月左室整体射血分数（LVEF）、1/3射血分数（1/3EF）、最大射血率（MER）、心肌灌注显像评分较对照组改善显著（P〈0.05）,3个月、6个月高峰充盈时间（TPFR）、高峰充盈率（PFR）及左室前侧壁局部射血分数（rEF）均较对照组改善显著（P〈0.05）。结论核素平衡法门控心血池显像对评价干细胞移植治疗急性心肌梗死后左心室功能恢复的评估有较高的临床价值。     

心衰患者动态血压参数与心衰分级及颈动脉内一中膜厚度的关系研究

目的 探讨心衰患者动态血压参数对心衰分级及颈动脉内一中膜厚度检测的意义.方法 将初诊的86例心衰患者按心功能分级分为A组(心功能Ⅱ级42例),B组(心功能Ⅲ级、Ⅳ级44例),行24 h动态血压监测(ABPM)、超声心动图和颈动脉检查.心衰A组(n=42例心功能Ⅱ级EF45%～35%)、心衰B组(n=44例心功能Ⅲ级、Ⅳ级EF＜35%),颈动脉内一中膜增厚组(n=58例)和非内一中膜增厚但(n=28例)、经询问病史、体检、测定动态血压参数、血脂、血糖等生化指标进行比较.结果 (1)心衰A组(心功能Ⅱ级EF45%～35%)与心衰B组(心功能ⅢⅣ级EF＜35%)临床指标比较差异无统计学意义(P＞0.05);(2)心衰A组(心功能Ⅱ级EF45～35%)与心衷B组(心功能ⅢⅣ级EF＜35%)动态血压参数的比较分别为24 h平均收缩压(128.3±10.3)(106.7±9.3)mm Hg(1 mm Hg=0.133 kPa),24 h平均舒张压(83.4±6.0)(80.2±8.8)mm Hg;白昼平均收缩压(130.2±12.8)(110.2±10.1);白昼平均舒张压(84.9±8.9)(82.1±9.0)mm Hg;夜间平均收缩压(120.1±10.2)(98.2±10.8);夜间平均舒张压(80.2±7.8)(79.3±10.1)mm Hg,24 h脉压(40.2±10.2)(36.8±9.6)mm Hg,白昼脉压(42.8±9.6)(38.2±8.8)mm Hg;夜间脉压(38.2±9.8)(34.9±10.1)mm Hg;24 h收缩压变异系数(8.0 ±2.0)(7.2±1.9),24 h舒张压变异系数(9.3±2.0)(8.0±2.1),动态血压非勺型昼夜节律55.6?.7%,其差异有统计学意义(P＜0.05);(3)颈动脉内-中膜增厚组与非内-中膜增厚组的上述临床指标比较,差异无统计学意义(P＞0.05)与动态血压参数比较差异有统计学意义(P＜0.05).结论 心衰患者血压昼夜节律有明显变化,在心功能受损程度较重的患者中,其动态血压参数异常及颈动脉内-中膜增厚的发生率增多.     

不同左心室射血分数心力衰竭住院患者的临床特征、诊疗情况及结局差异

目的:分析不同左心室射血分数(LVEF)心力衰竭(心衰)住院患者临床特征、院内诊疗及6个月结局差异。方法:从重大慢病国家注册登记研究心衰前瞻队列研究中选取2016年8月至2017年7月全国50家医院连续纳入的18岁以上心衰住院患者,根据LVEF分为射血分数减低的心衰(HFr EF,LVEF 40%)组、射血分数中间值的心衰(HFmrEF,40%≤LVEF50%)组、射血分数保留的心衰(HFpEF,LVEF≥50%)组。比较三组患者的临床特征、院内治疗情况和6个月全因死亡风险。结果:共入选2 781例心衰住院患者,中位年龄67(57,75)岁,37.9%为女性;HFr EF组1 031例(37.1%),HFmrEF组643例(23.1%),HFpEF组1 107例(39.8%)。HFmrEF组患者中位年龄(67岁)高于HFr EF组(62岁),但低于HFpEF组(71岁),HFpEF组的女性比例(51.4%)高于HFr EF组(23.9%)和HFmrEF组(37.3%),差异均有统计学意义(P均0.017)。全部心衰患者中合并比例最高的疾病为高血压(56.4%)、心房颤动(29.5%)和糖尿病(28.3%)。HFmrEF组和HFpEF组高血压(HFmrEF组vs. HFpEF组vs. HFr EF组:60.5%vs. 63.0%vs. 46.8%)和心房颤动(HFmrEF组vs. HFpEF组vs. HFr EF组:32.2%vs. 35.6%vs. 21.3%)的合并比例均明显高于HFr EF组(P均0.017)。HFmrEF组住院期间血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂、醛固酮受体拮抗剂和β受体阻滞剂的使用率分别为66.4%、85.1%、74.5%,HFpEF组分别为55.2%、76.4%、64.1%,两组均低于HFr EF组(75.8%、90.1%、81.2%,P均0.017)。HFmrEF组(HR=0.696,95%CI:0.510～0.951,P=0.02)和HFpEF组(HR=0.493,95%CI:0.366～0.665,P0.01)患者6个月死亡风险均低于HFr EF组患者。结论:本研究中,HFpEF患者和HFmrEF患者在全部心衰住院患者中分别占四成和近四分之一。HFpEF患者和HFmrEF患者的临床特征与HFr EF患者不同,治疗模式相似,出院6个月死亡风险均低于HFr EF患者。     

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.     

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.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.