原发性高血压患者尿微球蛋白、转铁蛋白变化的意义及氨氯地平对肾脏的保护作用

对30例正常人（正常对照组）及60例原发性高血压（EH）患者（EH组,其中轻度EH33例、中度27例）进行用药前后尿α1－微球蛋白（α1-MG）,β2－微球蛋白（β2－MG),转铁蛋白测定,结果发现：轻度EH组β2－MG、α1－MG明显高于对照组（P＜0．01）;中度EH组β2－MG、α1－MG、转铁蛋白明显高于轻度EH组和对照组（P＜0．01,P＜0．001）;应用氨氯地平治疗后,EH组尿β2－MG、α1－MG、转铁蛋白均较治疗前明显降低（P＜0．01,P＜0．001）。认为尿β2－MG、α1－MG、转铁蛋白检测能较早识别高血压肾脏损害,氨氯地平在降压的同时预防或延缓肾脏损害的发生发展。     

炎症在高血压病患者肾功能损害中的作用

目的 探讨炎症介质在高血压肾功能损害中的作用。方法 38例高血压病患者(分为肾功能正常组(19例)、肾功能异常组(19例))和38例健康人，分别用放免法测定血浆肿瘤坏死因子。(TNFα）、白介素1β(IL-β)、白介素6(IL6)及尿微量白蛋白(ALB)、α1微球蛋白(αIMG)、β2微球蛋白(β2MG)，用免疫比浊法测定血浆C反应蛋白(CRP)，酶免法测量尿视黄醇结合蛋白(RBP)。比较各组之间血浆CRP、TNFα、IL1β、IL6及尿ALB、α1MG、β2MG、RBP水平及各指标之间相关分析。结果 血浆CRP、TNFα、IL1β、IL6水平在高血压病患者升高，随肾脏功能损害的加重而进一步升高。多元线性回归分析，尿ALB、β2MG、α1MG与SBP呈直线相关，SBP与血浆IL1β、TNFα呈直线关系，尿RBP与血浆IL6呈直线相关。结论 SBP是肾脏功能损害的独立危险因素，炎症在高血压病肾脏功能损害中起重要作用。     

尿α_1-微球蛋白测定早期诊断老年糖尿病肾病肾小管间质损害

目的　探讨应用尿 α1 -微球蛋白 (α1 - MG)早期诊断老年糖尿病肾病肾小管间质损害。方法　用放免法和 SPECT等技术测定 96例老年糖尿病及 34例正常老年人尿α1 - MG、2 4 h尿微量白蛋白排量 (UAE)及肾小球滤过率等肾小球功能。结果　老年糖尿病患者尿 α1 - MG高于正常 ;在正常白蛋白尿阶段的老年糖尿病其尿 α1 - MG已明显高于正常 ,以后随病情进展加重 ,从微量白蛋白尿到临床蛋白尿 ,尿α1 - MG渐升高 ,反映肾小管间质损害逐渐加重 ;随尿α1 - MG升高 ,肾小球滤过率降低 ,UAE渐升高 ,肾小球功能损伤渐加重。结论　老年糖尿病早期已有肾小管间质损害 ,尿 α1 - MG水平能敏感反映肾小管间质损害的程度。     

不同尿液蛋白测定对早期高血压性肾损害的诊断价值及临床意义

目的探讨尿液胱蛋白酶抑制剂C（CystatinC）、α-微量球蛋白（α1-MG）、N-乙酰-β-D-氨基葡萄糖苷酶（NAG）、β2-微球蛋白（β2-MG）和微量白蛋白（mALB）的测定,对高血压早期肾损害诊断的敏感性及其临床意义。方法选择2010年3月-2010年10月在我科住院或门诊体检并明确诊断为原发性高血压患者55例作为病例组,健康体检者38例为对照组。检测两组尿CystatinC、α1-MG、NAG、β2-MG、mALB的含量,并以ROC曲线分析其敏感性。结果病例组尿液中的Cystatin C、α—MG、NAG、β2-MG、mALB含量明显高于正常对照组（P〈0．001）,其中尿α1,MG曲线下面积为0．906,β2-MG曲线下面积为0．855,较尿mALB、CystatinC、NAG具有较高的敏感性（P〈0．001）。结论尿α1-MG和β2-MG的检测对诊断高血压早期肾损害的敏感性高于尿mALB、CystatinC和NAG,尿液中不同蛋白的联合检测有助于高血压肾损害的早期监测,对预防高血压性肾病的发生、发展具有重要的临床价值。     

老年高血压患者血尿微球蛋白测定对肾脏损害的诊断意义

目的　探讨血、尿微球蛋白测定对老年 (≥ 6 0岁 )原发性高血压 (EH)患者肾损害诊断的敏感性。　方法　将 76例EH患者按年龄是否≥或 <6 0岁分为两个亚组 ,另选健康体检者 2 8例作为正常对照 ,取空腹血 3ml,晨尿 3ml。用同位素放射免疫法测定血、尿α1 微球蛋白及 β2 微球蛋白的含量。　结果　EH患者中两组血清α1 微球蛋白明显高于正常对照组 (分别P <0 0 5和 <0 0 1) ,而血清 β2 微球蛋白在老年组升高明显 (P <0 0 5 ) ;EH患者中两组尿液α1 微球蛋白及 β2 微球蛋白亦明显高于正常对照组 (分别P <0 0 1,P <0 0 5 )。尿液α1 微球蛋白及β2 微球蛋白含量在≥ 6 0岁者中显著高于 <6 0岁者 (P <0 0 1)。　结论　血清α1 微球蛋白比 β2 微球蛋白能更早地反映肾小球滤过功能受损 ,敏感性更好。尿液α1 微球蛋白、β2 微球蛋白尤其是α1 微球蛋白比血清更敏感。     

慢性阻塞性肺疾病急性加重期患者早期肾功能损害相关分析

目的分析探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者早期肾功能损害指标,并作相关性分析。方法共募集AECOPD患者76例,健康体检人群30例;收集一般临床资料;进行血肌酐、尿素氮、C反应蛋白(CRP)、动脉血气、尿α_1-微球蛋白(α-MG)、尿β_2-微球蛋白(β_2-MG)测定;及肺功能检查。结果与对照组比较,AECOPD组患者血肌酐、尿素氮及肾小球滤过率差异无统计学意义(P0.05);而尿α_1-MG、尿β_2-MG显著升高(P0.05),其中尿α_1-微球蛋白与氧分压(PaO_2)、FEV_1%及FVC%呈负相关,与CRP呈正相关;尿β_2-微球蛋白与FEV_1%、FVC%及FEV_1/FVC呈负相关。按GOLD 2013年指南肺功能分级进一步亚组分析显示,伴随肺功能严重程度的加重,AECOPD组患者尿α_1-微球蛋白、尿β_2-微球蛋白显著高于对照组,差异有统计学意义(P0.05)。此外,依指南予以正规内科治疗后,AECOPD组肺功能及CRP指标较前改善,血清CRP、尿α_1-微球蛋白、尿β_2-微球蛋白均较前改善,但仍高于正常对照组,差异有统计学意义(P0.05)。结论 AECOPD患者存在早期肾功能损害,尿α_1-微球蛋白、尿β_2-微球蛋白可作为早期肾功能损害指标。对于急性加重期患者,加强尿α_1-MG、尿β_2-MG的监测可及早发现早期肾功能损害,正规的内科治疗可进行有效干预,从而避免肾功能不可逆性损害的发生。     

血清α1-MG和β2-MG联合检测对糖尿病早期肾病的诊断价值

目的探讨血清α1微球蛋白（α1-MG）、β2微球蛋白（β2—MG）二者联合检测对糖尿病早期肾病的诊断价值。方法以美国糖尿病协会（ADA）推荐的尿微量白蛋白比肌酐比值（ACR）作为诊断糖尿病早期肾病的金标准,将154例2型糖尿病病人按ACR介于3．39g／mol-33．9g／mol和ACR〈3．39g／mol,分为早期肾病组（74例）和对照组（80例）,应用R0（2曲线分析血清α1—MG、β2-MG对糖尿病早期肾病的诊断价值,评价两者发现糖尿病早期肾病的灵敏度和特异度,以及二者联合检测时的诊断价值。结果糖尿病早期肾病组血清α1-MG、β2-MG水平均高于对照组,差异有统学意义（P〈0．05）;血清α1-MG、β2-MG诊断糖尿病早期肾病的灵敏度分别为52．7％和48．6％,联合检测灵敏度为74．3％,优于两者单项检测的灵敏度。血清α1-MG、β2—MG诊断糖尿病早期肾病的ROC曲线下面积分别为0．776、0．733。结论血清α1-MG和β2-MG均可用于糖尿病早期肾病的诊断,两者联合诊断时灵敏度较高,推荐临床应用。     

尿微量蛋白检测对老年高血压病肾损害的早期诊断价值

目的：探讨尿微量蛋白水平检测对老年高血压肾损害的早期诊断价值。方法：收集95例老年原发性高血压（EH）患晨尿、空腹静脉血、采用酶联免疫法测定尿微量白蛋白（micro-albumin,MA)及血、尿β2微球蛋白（β2－MG），并测定血尿素氮（BUN），肌酸（Cr)，肾联检阳性为尿MA，血，尿β2－MG中任何一项指标高于正常值。结果：单项指标阳性率：β2－MG71．57％，尿β2－MG68．42％，尿MA53．68％，多项指标联检阳性率85．26％均高于尿常规（14．73％）和BUN，Cr阳性率（29．47％），差异非常显（P＜0．001）。EH2、3级极高危患血、尿微量蛋白肾联检总阳性率100％。结论：血、尿微量蛋白在老年性高血压病肾功能受损时较肾功能指标BUN、Cr改变出现早，是诊断肾功能早期损害的敏感指标。     

慢性肺源性心脏病尿微量蛋白检测的临床意义

尿微量蛋白检测,在早期肾脏损害诊断中的价值已受到重视。我们对87例慢性肺源性心脏病(CCP)患者不同病期尿液α1微球蛋白(α1MG)、β2微球蛋白(β2MG)、白蛋白(ALB)、免疫球蛋白(IgG)、TammHorsfall蛋白(THP)的排泄水平进行测定,探讨其在CCP肾功能损害中的临床意义。对象与方法一、对象:87例CCP患者均为本院连续住院病人,男性76例,女性11例,平均年龄601±72岁,病程201±65年。其中,原发病为慢性支气管炎69例,煤矽肺18例。有发热、咳脓痰、血象升高,胸片浸润阴影之一者伴呼吸困难、体循环瘀血体征任何一种及PaO2≤665kPa、PaCO2…     

炎症在高血压病患者肾功能损害中的作用

目的探讨炎症介质在高血压肾功能损害中的作用.方法 38 例高血压病患者(分为肾功能正常组(19例)、肾功能异常组(19例))和38例健康人,分别用放免法测定血浆肿瘤坏死因子α(TNFα)、白介素1 β(IL1β)、白介素6(IL6)及尿微量白蛋白(ALB)、α1微球蛋白(α1 MG)、β2微球蛋白(β2 MG),用免疫比浊法测定血浆C反应蛋白(CRP),酶免法测量尿视黄醇结合蛋白(RBP).比较各组之间血浆CRP、TNFα、IL1β、IL6及尿ALB、α1 MG、β2MG、RBP水平及各指标之间相关分析.结果血浆CRP、TNFα、IL1β、IL6水平在高血压病患者升高,随肾脏功能损害的加重而进一步升高.多元线性回归分析,尿ALB、β2 MG、α1 MG与SBP呈直线相关,SBP与血浆IL1β、TNFα呈直线关系,尿RBP与血浆IL6呈直线相关.结论 SBP是肾脏功能损害的独立危险因素,炎症在高血压病肾脏功能损害中起重要作用.     

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.