螺内酯对急性前壁心肌梗死患者心率变异性及左室重构的影响

目的探讨螺内酯对急性前壁心肌梗死患者心率变异性(HRV)及左室重构的影响。方法选取80例急性前壁心肌梗死患者,随机分为对照组及螺内酯组,对照组给予常规药物治疗,螺内酯组在常规药物治疗基础上加用螺内酯20 mg,1次/d,入院第7天及治疗3月后测量HRV及左室重构指标变化。结果治疗3月后对照组患者HRV及左室重构指标较治疗前变化不明显。螺内酯组患者HRV指标明显改善,左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)下降,左室射血分数(LVEF)较治疗前显著升高(P0.05)。结论螺内酯能够有效改善急性心肌梗死患者的HRV及左室重构。     

急性广泛前壁心肌梗死抗醛固酮治疗的疗效观察

目的观察醛固酮受体拮抗剂螺内酯对急性广泛前壁心肌梗死患者左心功能的作用。方法将86例急性广泛前壁心肌梗死患者随机分为对照组（42例）和螺内酯组（44例）。对照组给予常规治疗,螺内酯组在常规治疗的基础上加用螺内酯,分别在入院、6个月时检测两组左心室舒张末期内径、左心室收缩末期内径、左心室射血分数、每搏输出量、心脏排血指数及Tie指数。结果两组治疗6个月时与治疗前比较,左室舒张末期容量、左室收缩末期容量、Tie指数等均明显降低,差异均有统计学意义（P〈0.05）;螺内酯组较对照组降低更明显,差异有统计学意义（P〈0.05）;而射血分数、每搏输出量、心脏排血指数均明显增加,差异均有统计学意义（P〈0.05）,螺内酯组较对照组增加更明显,差异有统计学意义（P〈0.05）。结论 急性广泛前壁心肌梗死患者在常规治疗基础上联用小剂量醛固酮受体拮抗剂螺内酯治疗可抑制左室的扩张和纤维化,干预左室重构的发生,改善心功能。     

急性心肌梗死后螺内酯干预对左室重构的影响

目的　探讨急性心肌梗死(AMI)患者应用螺内酯干预对于左室重构(LVRM)的影响。方法　4家医院共入选AMI患者88例,采用多中心、随机、对照的方法,对46例AMI患者在常规治疗的基础上加用螺内酯40mg/d(螺内酯组),对照组(n=42)常规治疗。在6个月干预期内检测两组血清Ⅲ型前胶原氨基端肽(PⅢNP)、脑钠肽(BNP)及超声心动图,以评价左室纤维化、左室功能和左室容积。结果　88例中,急性前壁心肌梗死患者43例,螺内酯组23例、对照组20例;急性下壁心肌梗死患者45例,螺内酯组23例、对照组22例。急性前壁心肌梗死组在治疗3、6个月时螺内酯组与对照组相比,血清PⅢNP和BNP明显降低[PⅢNP分别为( 260 .2±59. 9 )ng/L比( 328 .0±70 .3 )ng/L, P=0 .001, ( 197 .1±46 .3 )ng/L比( 266. 7±52 .4 )ng/L, P<0. 001 ,BNP分别为( 347 .4±84 .0)ng/L比(430 .1±62 .9)ng/L, P<0 .001, (243 .7±79. 7)ng/L比(334. 6±62. 8)ng/L, P<0. 001]。治疗6个月时螺内酯组较对照组左室舒张末期内径、左室收缩末期内径明显降低[分别为(51. 0±5 .5)mm比(55. 6±4 .5)mm, P=0 .005, (35 .7±4 .6)mm比(39 .1±5 .6)mm, P=0 .046]。急性下壁心肌梗死组在治疗6个月时螺内酯组与对照组相比血清PⅢNP、BNP水平无统计学意义,(P>0 05),并且左     

小剂量螺内酯抑制急性前壁心肌梗死患者的左室重构

目的 探讨小剂量螺内酯对急性前壁心肌梗死患者血清脑利钠肽（BNP）水平和左室重构的影响.方法 选择急性前壁心肌梗死患者90例,在常规治疗基础上,随机分为3组：常规治疗组30例,接受转换酶抑制剂、β受体阻滞剂、抗血小板、调脂药物等常规处理;小剂量螺内酯组30例,在上述治疗基础上每日给予螺内酯20 mg;中剂量螺内酯组30例,在上述治疗基础上每日给予螺内酯40 mg.结果 6个月时小剂量螺内酯组、中剂量螺内酯组和常规治疗组左室射血分数显著升高（P＜0.05）.治疗后常规治疗组BNP水平显著下降（P＜0.05）,小剂量螺内酯组和中剂量螺内酯组BNP水平下降更显著（P＜0.01）;小剂量螺内酯组与中剂量螺内酯组比较差异无统计学意义.结论 小剂量螺内酯抑制急性前壁心肌梗死患者的左室重构,血清BNP水平下降.     

螺内酯对慢性心力衰竭患者心率变异性及左室重构的影响

目的探讨螺内酯对慢性心力衰竭患者心率变异性及左室重构的影响。方法选取86例慢性心力衰竭患者,随机分为常规治疗组和螺内酯组,测定治疗前及治疗3月后24h平均正常R-R间期标准差(SDNN)、24h连续5min节段平均正常R-R间期标准差(SDANN)及连续正常R-R间期差的均方根(rMSSD),采用超声诊断仪测定左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)的变化。结果螺内酯组患者的心率变异性指标SDNN、SDANN及rMSSD明显增加,左心重构指标LVEDD、LVESD明显下降,LVEF明显上升(P<0.05)。结论螺内酯能够有效改善慢性心力衰竭患者的心率变异性及改善左室重构。     

比索洛尔、依那普利和螺内酯联合治疗风湿性心脏病慢性心力衰竭的效果

目的:观察比索洛尔、依那普利和螺内酯联合治疗风湿性心脏病（风心病）慢性心力衰竭（心衰,CHF）对心脏重构的影响。方法: 风心病并发心衰患者86例,随机分为比索洛尔、依那普利和螺内酯联合治疗组（试药组）以及常规治疗方案对照组（对照组）。在治疗后1年测定心功能与左室内径等指标。结果: 试药组左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）显著下降,左室射血分数（LVEF）增加显著,与对照组比较有显著差异（均P<0．05）。结论: 比索洛尔、依那普利和螺内酯联合治疗治疗风心病心力衰竭较常规治疗方法在改善心衰,阻止心脏重构方面效果更好。     

急性ST段抬高性心肌梗死后立即使用螺内酯对左室重构的影响

目的评价醛固酮拮抗剂螺内酯对急性ST段抬高型心肌梗死（STEMI）后左室重构和心功能的影响。方法连续入选160例STEMI患者,随机分为两组。在发病24h内,以目前最佳常规药物治疗做对照组（79例）,在常规治疗基础上加用螺内酯做螺内酯组（81例）。两组患者均在STEMI后24h内做多功能超声心动图检查,测定并计算左室收缩末期容积指数（LVESVI）、左室舒张末期容积指数（LVEDVI）、室壁运动积分指数（WMSI）,左室射血分数（LVEF）,1月后由专人复查。结果两组基线临床特征及各项超声心动学指标无显著差异,治疗1月后,两组各项超声心动学指标均有明显改善（P<0.05）,但螺内酯组各项指标的改善又显著优于对照组（P<0.05）。结论在STEMI发病后常规治疗基础上立即加用螺内酯可进一步加强抗左室重构的作用,进一步改善心脏功能。     

螺内酯联合贝那普利治疗急性前壁心肌梗死患者的临床疗效

目的:探讨螺内酯联合贝那普利治疗急性前壁心肌梗死患者的临床疗效及对左心室重构的影响。方法:选择本院收治的100例急性前壁心肌梗死患者为研究对象,按照不同治疗方案分为贝那普利组(50例)和联合治疗组(50例,螺内酯和贝那普利联合治疗),治疗6个月,对两组疗效、左心室重构及不良反应情况进行对比。结果:与治疗前比较,治疗6个月后,两组心率变异性(HRV)各指标和左室射血分数(LVEF)均明显提高,左室收缩末期内径(LVESd)和左室舒张末期内径(LVEDd)均明显缩小(P<0.05或<0.01);且与贝那普利组比较,治疗后联合治疗组HRV各指标,LVEF[(52.45±8.65)%比(57.85±9.70)%]明显提高,LVESd[(36.25±2.13)mm比(30.10±2.06)mm]和LVEDd[(58.60±6.41)mm比(51.29±6.20)mm]明显缩小(P均<0.01);两组治疗后总不良反应率无明显差异(P=1.000)。结论:联合螺内酯和贝那普利治疗急性前壁心肌梗死患者能明显改善患者心率变异性心功能,抑制左心室重构,且不良反应少。     

急性冠脉综合征患者血浆BNP和MCP-1的变化

目的观察急性冠脉综合征（ACS）患者外周血中脑纳尿肽（BNP）及单核细胞趋化蛋白-1（MCP-1）的变化,探讨BNP,MCP-1与ACS的关系。方法住院ACS患者39例,采用ELISA测定血清BNP,MCP-1的水平。结果ACS患者入院即刻血浆BNP和MCP-1水平均显著高于对照组,分别为（560±25）ng/Lvs（42±24）ng/L（P<0.01）和（152±19）ng/Lvs（113±22）ng/L（P<0.01）。ACS组内不稳定心绞痛（UAP）亚组与急性心肌梗死（AM I）亚组比较,AM I亚组BNP水平高于UAP亚组[（557±24）ng/Lvs（172±62）ng/L,P<0.01],而MCP-1水平在AM I亚组和UAP亚组间无显著性差异[（153±19）ng/Lvs（150±22）ng/L]。ACS组患者中BNP和MCP-1水平呈明显正相关（r=0.625,P<0.01）。结论ACS患者外周血BNP和MCP-1水平升高而且两者水平呈正相关。     

芪苈强心胶囊联合螺内酯片对心力衰竭伴慢性心房颤动病人血清脑钠肽、内皮素-1和基质金属蛋白酶-9的影响

目的观察芪苈强心胶囊与螺内酯片对心力衰竭伴慢性心房颤动病人血清脑钠肽(BNP)、内皮素-1(ET-1)和基质金属蛋白酶-9(MMP-9)的影响。方法将102例心力衰竭伴慢性心房颤动病人随机分为两组,对照组51例应用螺内酯片治疗,研究组51例应用芪苈强心胶囊联合螺内酯片治疗,两组均持续治疗4周。比较两组治疗后临床疗效,检测两组治疗前后心功能指标以及血清BNP、ET-1和MMP-9水平,记录两组治疗前后生活质量评分。结果治疗后,研究组临床治疗总有效率显著高于对照组(94.12%与76.47%,P0.05);两组左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)水平均较治疗前显著降低(P0.05),左室射血分数(LVEF)水平均较治疗前显著升高(P0.05),且研究组LVEDD、LVESD水平均显著低于对照组(P0.05),LVEF水平显著高于对照组(P0.05);两组血清BNP、ET-1和MMP-9水平均较治疗前显著降低(P0.05),且研究组血清BNP、ET-1和MMP-9水平均显著低于对照组(P0.05);两组生活质量评分均较治疗前显著升高(P0.05),且研究组生活质量评分显著高于对照组(P0.05)。结论芪苈强心胶囊联合螺内酯片治疗心力衰竭伴慢性心房颤动,能改善心功能,降低血清BNP、ET-1和MMP-9水平。     

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.     

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.     

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.     

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.