持续正压通气对阻塞性睡眠呼吸暂停合并难治性高血压患者血压影响的Meta分析

目的:系统性评价持续气道正压通气(CPAP)对阻塞性睡眠呼吸暂停低通气综合征(OSA)合并难治性高血压患者血压的影响。方法:计算机检索Cochrane Library、PubMed、ScienceDirect、Web of Science等数据库并手工检索相关期刊,查找CPAP治疗对OSA合并难治性高血压患者血压影响的临床随机对照试验(RCT),对符合条件的RCT,逐一评价质量,提取资料,采用RevMan5.3和R 3.2.2软件进行Meta分析。结果:共纳入7篇RCT研究。Meta分析结果显示:CPAP治疗后,患者24h平均收缩压/舒张压较对照组有显著改善(P0.05)。24h平均收缩压/舒张压合并效应统计结果为:[WMD=-5.36,95%CI:(-8.60,-2.11),P=0.001;I~2=70%]/[WMD=-4.21,95%CI:(-6.39,-2.04),P=0.000 01;I~2=79%]。结论:CPAP治疗可有效地降低OSA合并难治性高血压患者的血压。     

持续气道正压通气对中国阻塞性睡眠呼吸暂停低通气综合征患者胰岛素抵抗影响的荟萃分析

目的荟萃分析方法评价持续气道正压通气（CPAP）对中国阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者胰岛素抵抗的影响。方法计算机检索PubMed、中国学术期刊全文数据库、中国生物医学文献数据库、万方资源数据库、重庆维普网和中国重要会议论文全文数据库并手工检索相关期刊,全面收集持续气道正压通气对我国阻塞性睡眠呼吸暂停低通气综合征胰岛素抵抗的临床研究,按照纳入、排除标准选择试验并评价质量,采用Stata11．0软件进行荟萃分析。结果最终纳入13篇文献。荟萃分析结果显示：CPAP治疗后单纯OSAHS患者及OSAHS合并糖尿病患者空腹血糖（FBG）明显降低,差异有统计学意义[WMD：0．473,95％CI（0．157,0．790）,P=0．003;WMD=1．358,95％CI（0．921,1．794）,P=0]。CPAP对两组患者空腹胰岛素（FINS）未见明显影响[WMD=0．624,95％CI（-0．512,1．759）,P=0．282;WMD=0．275,95％CI（-0．416,0．965）,P=0．435]。CPAP能降低两组患者胰岛素抵抗指数（HOMA-IR）,差异有统计学意义[WMD=0．483,95％CI（0．119,0．846）,P=0．009;WMD=0．726,95％CI（0．023,1．430）,P〈0．05]。CPAP对OSAHS合并糖尿病患者糖化血红蛋白（HbAlc）有影响,差异有统计学意义[WMD=1．03,95％CI（0．71,1．34）,P〈0．05]。CPAP治疗前后FBG、FINS、HOMA-IR、HbAlc漏斗图均基本呈现下宽上窄左右对称的图形,经Egger检验后,提示单纯OSAHS组HOMA—IR存在明显发表偏倚,其余指标均不存在明显发表偏倚。结论无论是否合并糖尿病,CPAP均改善我国OSAHS患者胰岛素抵抗。     

持续气道正压通气对合并阻塞性睡眠呼吸暂停低通气综合征的2型糖尿病患者糖代谢及糖皮质激素的影响

目的 探讨持续气道正压通气(CPAP)对合并有阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的2型糖尿病(T2DM)患者糖代谢及糖皮质激素的影响.方法 选取2008年7月至2009年12月于卫生部北京医院内分泌科确诊合并有OSAHS的T2DM患者36例.对无禁忌者应用至少30 d的CPAP治疗.在治疗前后检测受试患者血糖、胰岛素敏感性指标及糖皮质激素水平.采用配对t检验对受试者前后指标进行分析.结果 应用CPAP治疗后受试者空腹血糖[(6.5±1.1)mmol/L]及糖化血红蛋白水平(7.1%±1.0%)较治疗前[(10.0±3.0)mmol/L,(9.1±2.2)%]显著降低(t=6.517,P<0.001;t=7.239,P<0.001),治疗后胰岛素抵抗(IR)的稳态模式评估指数(HOMA-IR)显著降低(3.4±1.9和2.6±2.0;t=2.204,P<0.05),促肾上腺皮质激素(ACTH)及皮质醇(COR)水平没有显著变化(P>0.05).结论 CPAP可以全面改善合并有OSAHS的2型糖尿病患者的血糖控制及胰岛素抵抗,是除生活方式干预及药物治疗外的一种行之有效的治疗手段.     

持续气道正压通气对T2DM合并OSAHS患者睡眠、血糖参数及氧化应激的影响

目的：评价持续气道正压通气（CPAP）对2型糖尿病（T2DM）合并阻塞性睡眠呼吸暂停综合征（OSAHS）患者睡眠参数、血糖参数与氧化应激的影响。方法选择2014年3月—2014年7月我院收治的2型糖尿病合并 OSAHS患者40例,分为 CPAP治疗组（治疗组）和非 CPAP治疗组（对照组）。两组患者均进行糖尿病饮食、降糖药物等常规治疗,治疗组患者在此基础上同时使用持续气道正压通气呼吸机治疗。比较两组3个月后睡眠呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSpO2）、空腹血糖（FPG）、糖化血红蛋白（HbA1c）、胰岛素抵抗指数（HOMA IR）、超氧化物歧化酶（SOD）、丙二醛（MDA）、人过氧化氧酶（CAT）、总抗氧化能力（TAC）等指标水平。结果治疗3个月后治疗组 FPG、HbA1c、AHI、SOD、HOMA IR低于对照组,差异有统计学意义（P〈0.05）, LSpO2、MDA水平均显著高于对照组,差异有统计学意义（P〈0.05）。结论 CPAP治疗2型糖尿病合并 OSAHS患者可改善睡眠状态,有效降低血糖、HOMA IR、糖化血红蛋白、血清 SOD,改善 AHI、LSpO2。CPAP是一种非药物治疗2型糖尿病并 OSAHS的有效手段。     

持续气道内正压通气治疗阻塞性睡眠呼吸暂停综合征前后血清瘦素及胃饥饿素的变化

目的为观察阻塞性睡眠呼吸暂停综合征(OSAS)患者在持续气道内正压通气(CPAP)治疗前后血清瘦素和胃饥饿素的变化。方法选择沈阳医学院附属中心医院2004年4月至2005年9月收治的20例OSAS患者。诊断符合中华医学会呼吸学会睡眠学组制定的标准。CPAP治疗前及治疗1周后、6个月后进行空腹血糖(FBG)、真胰岛素(TI)、瘦素和胃饥饿素的测定。结果CPAP治疗1周后,血浆胃饥饿素,瘦素有所下降,但FBG和TI无明显变化。CPAP治疗6个月后,胃饥饿素及瘦素水平明显下降。FBG和TI也有所下降。CPAP治疗有效地改善睡眠呼吸紊乱及低氧状态,生活质量明显提高。结论血清瘦素、胃饥饿素水平通过长期CPAP治疗可明显下降。CPAP长期治疗可以改善OSAS的糖代谢和胰岛素抵抗。因此,OSAS可能是导致胃饥饿素和瘦素代谢紊乱引起体重增加,导致肥胖原因之一。     

持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者体内激素水平的影响

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)导致夜间低氧和正常睡眠节律的紊乱,引起体内激素分泌的改变和激素抵抗的增加。而持续气道正压通气(CPAP)治疗在改善夜间睡眠质量的同时也纠正了体内激素水平的紊乱,为CPAP在阻塞性睡眠呼吸暂停(OSA)方面的应用提供了更充分的依据。     

持续气道正压通气治疗2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征对患者内分泌功能的影响研究

目的探讨持续气道正压通气(CPAP)治疗合并有阻塞性睡眠呼吸暂停低通气综合征(OS-AHS)的2型糖尿病(T2DM)对患者内分泌功能的影响。方法选取2008年7月至2009年12月于卫生部北京医院内分泌科确诊合并有OSAHS的2型糖尿病患者36例。对无禁忌者应用至少30d的CPAP治疗。在治疗前后对受试患者进行空腹血糖、空腹胰岛素、甲状腺激素、生长激素、促肾上腺皮质激素、皮质醇及性腺激素水平的检测。结果受试患者应用CPAP治疗前后的胰岛素敏感性增加(P=0.034),催乳素(PRL)及雌二醇(E2)治疗后较治疗前明显降低(P分别为0.016、0.013),余激素水平无明显变化(P0.05)。结论 CPAP治疗可以改善合并OSAHS的2型糖尿病患者的胰岛素抵抗,但是对于该类患者的其他内分泌激素水平没有明显影响。     

持续气道正压通气对重度OSAHS患者糖代谢的影响及其相关性分析

目的探讨持续气道正压通气(CPAP)对未合并2型糖尿病的重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血糖及糖代谢相关成分水平的影响及其相关性分析。方法收集重度OSAHS患者232例,选取其中未被诊断为糖尿病的患者161例进行研究,将这些患者随机分为CPAP治疗组(n=85)和传统方法治疗组(n=76),治疗3月后观察治疗前后口服葡萄糖耐量试验(OGTT)、血清糖化血红蛋白(HbA1c)、空腹胰岛素等情况,并计算稳态模型胰岛素抵抗指数(HOMA-IR),比较组间差异。结果 (1)治疗后,CPAP治疗组患者HbA1c、服糖后2小时血糖(2h-PG)均明显下降,与治疗前比较差异有统计学意义(P0.05),HOMA-IR及空腹血糖(FPG))也出现不同程度下降,但差异无统计学意义(P0.05);而传统方法治疗组患者,治疗前后相关指标均无显著改善(P0.05)。同时,比较两组患者治疗后指标的变化,HbA1c及2h-PG的差异有统计学意义(P0.05)。(2)相关分析也显示,在CPAP治疗组中,21例患者出现糖耐量减低好转,0例患者出现加重;而在传统治疗组中,有12例患者糖耐量减低好转,10例患者加重,差异有统计学意义(P=0.039,P0.05)。结论 CPAP治疗纠正了间歇低氧、睡眠结构紊乱,从而改善了未合并2型糖尿病的重度OSAHS患者血糖调节,延缓了2型糖尿病的发生,有一定临床意义。     

2型糖尿病与阻塞性睡眠呼吸暂停综合征

2型糖尿病人群中合并阻塞性睡眠呼吸暂停综合征较为常见,而阻塞性睡眠呼吸暂停综合征患者中2型糖尿病患病率也较普通人群明显升高.阻塞性睡眠呼吸暂停综合征导致的夜间间歇性缺氧以及片段睡眠可影响糖代谢及胰岛素敏感性,而2型糖尿病也可影响呼吸中枢及呼吸肌导致呼吸紊乱.对阻塞性睡眠呼吸暂停综合征进行合理治疗可改善血糖控制以及胰岛素抵抗.     

阻塞性睡眠呼吸暂停综合征与胰岛素抵抗的临床研究

目的探讨阻塞型睡眠呼吸暂停综合征（OSAS）与胰岛素抵抗（IR）之间的关系。方法56例OSAS患者,按低氧血症的程度分为两组,监测多导睡眠图各项指标与空腹血糖、胰岛素和餐后2h血糖、胰岛素,计算胰岛素敏感性指数（ISI）,并作统计学分析。另外选择15例不符合OSAS诊断者为对照组。结果OSAS患者较对照组血浆胰岛素、血糖升高,与呼吸暂停低通气指数（AHI）、最长睡眠呼吸暂停时间（SAT）和总睡眠呼吸暂停时间呈正相关。随着缺氧程度的加重,ISI逐渐降低,胰岛素抵抗增加。在OSAS组血糖、胰岛素和ISI影响因素的多元线性回归分析中,总睡眠呼吸暂停时间的贡献度最大。结论OSAS与IR之间存在相关性,OSAS低氧可产生胰岛素抵抗。     

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.     

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.     

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.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.