阿托伐汀联用依那普利对老年单纯收缩期高血压的作用

目的观察阿托伐汀联用依那普利对老年单纯收缩期高血压患者血压的影响。方法老年单纯收缩期高血压78例，血清胆固醇正常。单用依那普利组38例，12I服依那普利10mg／d；联用阿托伐汀组40例，口服依那普利片10mg／d和阿托伐汀20mg／d。观察12周，每2周记录血压1次。结果治疗12周后，两组患者收缩压、舒张压和脉压均较治疗前下降（P〈0．05）；单用依那普利组脉压从治疗前（74±8）mmHg降至（68±6）mmHg；联用阿伐他汀组脉压从治疗前（75±7）mmHg降至（60±6）mmHg；两组间差异有统计学意义（t=5．255，P〈0．01）。结论阿托伐汀联用依那普利有助于改善单纯收缩期高血压老年人脉压，可降低老年心脑血管事件的危险性。     

阿托伐他汀并厄贝沙坦对单纯收缩期高血压患者脉压的影响

目的：观察阿托伐他汀和厄贝沙坦片联合用药对老年单纯收缩期高血压（ISH）患者脉压（PP）的影响。方法：64例老年ISH患者被随机分为两组，对照组32例用厄贝沙坦（150mg／d），治疗组32例用厄贝沙坦（150mg／d）加阿托伐他汀（10mg／d），观察12周，每2周随访血压1次并记录。结果：在治疗12周时，对照组PP从治疗前（74．67±7．77）mmHg降至（67．37±5．53）mmHg；治疗组PP从治疗前（75．06±6．96）mmHg降至（59．75±5．92）mmHg。治疗后两组PP的差异有显著性（t=5．255，P〈0．01）。结论：阿托伐他汀和厄贝沙坦联合用药有助于改善老年ISH患者的PP。     

赖诺普利与依那普利治疗轻、中度高血压病的疗效比较

目的：比较赖诺普利与依那普利治疗轻、中度高血压病的疗效和安全性。方法：随机开放对照试验，经1周药物冲洗期及2周安慰剂导入期，218例轻、中度高血压患进入8周的治疗期，每日1次服用赖诺普利10mg(118例）或依那普利5mg(100例），2周后如坐位舒张压≥90mmHg则剂量加倍，4周后如仍无效则每日加服双氢克尿噻25mg。每组各随机选择10例患于导入期末及治疗期末行24小时ABPM。结果：两组药物均能明显降低血压（P＜0．001）赖诺普利有效率94．1％，依那普利有效率96．0％，两组无显差异（P＞0．05）。赖诺普利和依那普利分别有33．3％和46．0％患加用利尿剂（P＞0．05）。降压谷峰值赖诺普利为56．4％／64．8％，依那普利为49．4％／22．6％。最常见不良反应是咳嗽，两组分别为9．3％和10．0％。结论：对于轻、中度高血压病赖诺普利是一种有效、安全且易耐受的降压药，每日1次能维持24小时降压效应。     

吲达帕胺及(或)非洛地平对老年高血压患者动态血压的影响

目的探讨降压药物吲达帕胺缓释片联合非洛地平缓释片在老年高血压患者中的降压效果。方法选择老年高血压病患者150例,平均年龄(65±4)岁,按就诊顺序随机分3组:分别给予吲达帕胺缓释片1.5mg/d、非洛地平缓释片5mg/d和吲达帕胺缓释片1.5mg/d+非洛地平缓释片5mg/d,疗程3个月。观察治疗前后24h、白昼及夜间平均收缩压/舒张压和平均收缩压/舒张压负荷以及平均心率。结果治疗结束时3组24h、白昼和夜间平均收缩压/舒张压均较服药前明显下降;血压负荷值亦明显减少;而联合治疗组与单药治疗组比较下降更明显,差异具有统计学意义。治疗前后心率没有明显变化。结论小剂量长效利尿剂联合钙拮抗剂治疗高血压疗效显著,稳定性好,不良反应少。老年高血压病患者应尽量选择长效利尿剂联合钙拮抗剂。     

非洛地平治疗老年高血压的临床观察

目的：探讨非洛地平治疗老年高血压的临床疗效。方法：30例老年高血压病患应用非洛地平治疗，5－10mg/d，治疗4周。结果：非洛地平有显降压作用，显效率66.7%，总有效率90％；可减少心绞痛发作次数，改善患心脏功能，无明显不良反应；对血脂、血糖、肾功能无明显影响。结论：非洛地平可作为治疗老年高血压的首选药物之一。     

依那普利加强异舒吉抗心绞痛作用的研究

目的：观察异舒吉(isoket)与依那普利联合治疗不稳定型心绞痛(UAP)的临床疗效。方法：将60例不稳定型心绞痛病人随机分为两组，治疗组30例给异舒吉，每天30mg，依那普利每次5mg--10mg口服，每日2次；对照组30例单用异舒吉。两组基础治疗相同，14d为一疗程。观察治疗后心绞痛的发作频率、程度、维持时间、心率、血压和心电图变化。结果：异舒吉联合依那普利治疗UAP临床总有效率为93．3％，心电图改善总有效率为76．6％，与对照组比较有统计学意义(P＜0．05)。结论：依那普利能加强异舒吉的抗心绞痛及抗心肌缺血作用，延缓或防止耐药性产生，降低UAP的病死率及AMI发生率。     

依那普利和非洛地平对高血压左室肥厚的疗效比较

为了比较观察依那普利和非洛地平对轻中度高血压病患者左室肥厚的疗效,将84例轻中度高血压左室肥厚的病人随机分为两组,分别用依那普利和非洛地平治疗6个月,检测治疗前后病人的血压,左室肥厚和左心室肥厚的病人随机分为两组,分别用依那普利和非洛地平治疗6个月,检测治疗前后病人的血压,左室肥厚和左心室肥厚的病人随机分为两组,分别用依那普利和非洛地平治疗6个月,检测治疗前后病人的血压,左室肥厚和左心功能。结果发现：（1）两种药物均有明显的降压作用;（2）治疗后病人的左室质量和左心室质量指数均显著减低（P＜0．001）,超声心动图中E／A比值均明显升高（P＜0．001）,两组比较,左室质量和左心室质量指数下降幅度及E／A比值上升幅度,依那普利组均大于非洛地平组（P＜0．05）,此结果提示：依那普利和非洛地平均能降低血压,逆转比值上升幅度,依那普利组均大于非洛地平组（P＜0．05）,此结果提示：依那普利和非洛地平均能降低血压,逆转左室肥厚,改善左心舒张功能,但依那普利优于非洛地平,因此,建议治疗高血压伴左室肥厚者优先选用依那普利。     

新型β阻滞剂降压效果良好

新型高度β1选择性，1次／d，β阻滞剂奈必洛尔降压效果良好。该文系2个随机双盲研究综合结果，先收治1716名轻-中度高血压病人，治疗12周，病人服用最低剂量（1．25mg）奈必洛尔。坐位DBP可降6．9mmHg，最大剂量（40．0mg）可降10．1mmHg，安慰剂组仅降3．8mmHg。1．25、5．0、10．0、40．0mg奈必洛尔，SBP分别下降2．4、5．7、5．7、7．6mmHg，安慰剂组降0．7mmHg。如以DBP〈90mmHg或下降≥10mmHg为疗效指标，可见服用1．25mg奈必洛尔有效率为45．8％。剂量增加为20、40mg时，有效率可达64．5％与65．1％。     

血管紧张素转换酶抑制剂对高血压胰岛素抗性的影响

采用血管紧张素转换酶抑制剂（卡托普利、依那普利、赖诺普利）治疗原发性高血压患者30例。剂量分别为12．5～37．5，5～15，10～30mg／　d，疗程4周，血压从治疗前171／106mmHg降到143／88mmHg。治疗后的血胰岛素水平、血胰岛素／葡萄糖比值均较治疗前明显降低（P＜0．05），显示有明显的改善胰岛素抗性效应。     

吲哒帕胺缓释片与依那普利治疗老年高血压并2型糖尿病人疗效比较

高血压并2型糖尿病人（T2DM）要减少尿微量白蛋白和控制好血压。该研究是吲哒帕胺缓释片与依那普利治疗高血压并T2DM病人的微量尿白蛋白研究（NESTOR）的亚组分析。570名高血压并T2DM，持续有尿微量白蛋白的病人参加研究。其中187名（33％）年龄≥65岁。本研究就是分析这187名病人的疗效。95名服用缓释吲哒帕胺1．5mg，92名病人服用依那普利10mg／d，必要时可加用氨氯地平及（或）氨酰心安。结果：吲哒帕胺缓释组白蛋白／肌酐比减少46％，依那普利组减少47％，两组无区别。平均血压吲哒帕胺缓释组下降18mmHg，依那普利下降15mmHg，两组无区别（P=0．11）。老年病人对两药的效果总体上与全组病人无区别，只是尿微量白蛋白下降的比较明显。两种治疗耐受良好，在糖、脂代谢方面，两组的影响也类似。结论：吲哒帕胺缓释片在〉65岁高血压并T2DM的病人中降血压，减少微量白蛋白等方面不比依那普利差。     

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.