冠状动脉病变与过氧化物酶体增殖体激活受体γ和基质金属蛋白酶-9的关系

目的通过检测冠心病患者核转录因子过氧化物酶体增殖体激活受体γ(PPARγ) mRNA表达和血浆基质金属蛋白酶-9(MMP-9)水平,探讨PPARγ对冠心病的影响。方法经冠状动脉造影确诊的冠心病患者(冠心病组)153例,RT-PCR法测定外周血中PPARγmRNA表达,ELISA法检测血浆中MMP-9含量,并对冠状动脉病变程度进行分型,分析PPARγmRNA表达、MMP-9与冠状动脉病变程度的相关性。结果冠心病组PPARγmRNA表达(0．40±0．12)与对照组(0．62±0．13)比较显著降低；冠心病组MMP-9为(1．27±0．16)μg/L,与对照组[(1．21±0．05)μg/L]比较明显增加(P＜0．01)。冠心病组中急性冠状动脉综合征患者PPARγ为(0．50±0．05),较稳定性心绞痛(0．50±0．11)降低,MMP-9分别为(1．38±0．14)、(1．25±0．07)μg/L,P＜0．01。PPARγmRNA表达分别与冠状动脉病变支数(r=-0．42,P＜0．01)、病变类型(r=-0．56,P＜0．01)呈负相关,MMP-9水平则与病变支数(r=0．30,P＜0．01)、病变类型(r=0．36,P＜0．01)呈正相关；PPARγmRNA表达和MMP-9水平呈负相关。结论MMP-9对急性冠状动脉综合征患者不稳定斑块有促进作用,PPARγ具有抑制MMP-9的作用,提示通过激活PPARγmRNA表达和降低MMP-9水平对冠心病高危人群具有保护作用。     

老年心房颤动患者的冠状动脉病变分析

目的观察老年患者心房颤动(房颤)的发生与冠心病的关系。方法根据我院1990年以来的尸检资料,选择75岁以上生前有房颤发作记录的76例患者作为房颤组,平均年龄(86.9±6.9)岁,临床均诊断有冠心病;选择与房颤组年龄相近、临床无房颤记录、经尸检病理证实为冠心病的85例患者作为冠心病组,比较两组患者冠状动脉的病变情况。结果房颤组中38例患者经病理证实有冠心病,心肌梗死发生率为39.5%,冠心病组心肌梗死发生率为62.4%,两组比较有统计学差异(P<0.01);房颤组与冠心病组心脏重量、左心室壁厚度分别为[(437.5±80.6)%(434.6±90.3)g,P>0.05;(1.42±0.33)%(1.42±0.38)cm,P>0.05];房颤组冠状动脉达Ⅲ级病变和Ⅳ级病变的血管数量(40 vs.99、27 vs.52,P<0.001)明显少于冠心病组。结论老年患者心房颤动的发生与冠心病之间不存在明确的因果关系。     

冠心病与QTc离散度关系的探讨

本文分析了109例经冠状动脉造影证实的不同类型冠心病患者QTc离散度（QTcd），并与41例临床疑有冠心病而冠状动脉造影正常的患者进行了对照研究。结果显示：冠心病患者的QTcd明显高于对照组（P＜0．001）；单纯陈旧心肌梗塞组的QTcd明显高于心绞痛组（P＜0.05）；陈旧心肌梗塞合并室壁瘤组其QTcd显著大于未伴有室壁瘤组（P＜0．001），而前壁、下壁之间比较，QTcd无明显差异（P＞0．05）；此外，冠脉单支、双支及三支病变组之间QTcd无明显差异（P＞0．05）。提示：冠心病存在明显心肌复极差异，陈旧心肌梗塞伴室壁瘤时QTc离散度增加最显著，QTcd与梗塞部位及冠脉病变支数无关。     

不稳定型心绞痛与急性心肌梗死危险因素及冠状动脉造影病变特点的比较

根据临床和冠状动脉造影结果将122例冠心病患者分为不稳定型心绞痛（UA）组60例和急性心肌梗死（AMI）组62例，对UA与AMI危险因素及病变特点进行比较分析。结果：冠心病的危险因素年龄、高血压、高血脂、糖尿病和吸烟等在UA组及AMI组经统计学处理均无显著性差异（P＞0．05）。冠状动脉造影：单支病变在UA组明显多于AMI组，多支病变在UA组明显少于AMI组，两组间数据经统计学处理均有显著性差异（P＜0．05）；回旋支、右冠状动脉病变在AMI组明显高于UA组，两组间数据经统计学处理有显著性差异（P＜0．05）；完全阻塞和狭窄≥95％在AMI组明显高于UA组，两组间数据经统计学处理有显著性差异（P＜0．001和P＜0．005）。结论：冠心病的危险因素年龄、高血压、高血脂、糖尿病、吸烟及其病程与冠心病的病变程度无相关性；冠状动脉造影显示UA和AMI病变特点有显著性差异。     

老年阻塞性睡眠呼吸暂停低通气综合征并存心肌缺血患者的临床特点和治疗

目的观察老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)并存冠心病心肌缺血患者的临床特点和治疗疗效。方法选择OSAHS并存冠心病患者135例,分为轻、中、重度组,与单纯冠心病对照组45例进行比较,观察其动态心电图(Holter)变化,单纯药物及药物联合经鼻持续气道内正压通气(nCPAP)治疗效果。结果(1)治疗前各组白天心肌缺血发生率差异无统计学意义(P＞0．05)；夜间中、重度组心肌缺血发生率较对照组明显增高,差异有统计学意义(P＜0．05)。(2)药物治疗1个月,各组内比较,白天心肌缺血发生率明显减少,差异有统计学意义(P＜0．05)；中、重度组夜间心肌缺血发生率无明显减少,差异无统计学意义(P＞0．05)。(3)重度组总心血管复合终点事件发生率55．0%,较轻、中度组和对照组(20．0%、30．0%和24．4%)明显增高,差异有统计学意义(均为P＜0．05)。(4)对中、重度组31例发生心血管复合终点事件患者采用药物配合nCPAP治疗1周,与重度组单纯用药者比较,夜间心肌缺血发生率明显改善(77．4%对42．5%,P＜0．05)。结论老年中、重度OSAHS并存冠心病患者夜间心肌缺血发生率明显增高,重度组总心血管复合终点事件发生率增高。单纯抗心绞痛药物治疗能明显改善OSAHS并存冠心病患者白天心肌缺血症状；但是对中、重度患者夜间心肌缺血疗效不佳。药物配合nCPAP治疗能明显改善中、重度患者夜间心肌缺血,降低心血管复合终点事件发生率。     

尿微量白蛋白与冠状动脉病变的相关性研究

目的通过冠心病患者尿微量白蛋白与冠状动脉造影的相关研究，分析尿微量白蛋白与冠状动脉病变程度和范围的相关性。方法冠状动脉造影患者127例，根据冠状动脉造影分为冠心病组与对照组，测定其尿微量白蛋白。结果冠心病组与对照组相比，尿微量白蛋白明显升高，差异有统计学意义（P〈0．01）；单支、双支、三支病变组与对照组相比差异均有统计学意义（P〈0．01）；且三支病变组与单支、双支病变组比较，差异有统计学意义（P〈0．05）；但单支与双支病变组比较，差异无统计学意义。冠心病患者尿微量白蛋白与冠状动脉病变程度两者呈正相关。结论尿微量白蛋白与冠心病密切相关，尿微量白蛋白随冠状动脉病变严重程度增加，可作为预测冠心病发生和发展的临床指标。     

尿微量白蛋白与冠状动脉病变的相关性研究

目的通过冠心病患者尿微量白蛋白与冠状动脉造影的相关研究，分析尿微量白蛋白与冠状动脉病变程度和范围的相关性。方法冠状动脉造影患者127例，根据冠状动脉造影分为冠心病组与对照组，测定其尿微量白蛋白。结果冠心病组与对照组相比，尿微量白蛋白明显升高，差异有统计学意义（P〈0．01）；单支、双支、三支病变组与对照组相比差异均有统计学意义（P〈0．01）；且三支病变组与单支、双支病变组比较，差异有统计学意义（P〈0．05）；但单支与双支病变组比较，差异无统计学意义。冠心病患者尿微量白蛋白与冠状动脉病变程度两者呈正相关。结论尿微量白蛋白与冠心病密切相关，尿微量白蛋白随冠状动脉病变严重程度增加，可作为预测冠心病发生和发展的临床指标。     

雷帕霉素药物支架治疗冠心病的远期疗效

目的 评价雷帕霉素药物洗脱支架（Firebird^TM）在冠心病患者介入治疗中的疗效及其安全性。方法 药物支架组患者接受Firebird^TM支架治疗的老年冠心病患者52例（72枚），普通支架组为选择同期接受普通冠状动脉支架治疗的冠心病患者43例（53枚），比较两组的临床特征、支架置入情况及临床事件发生率。结果 药物支架组中的糖尿病患者占46．2％，明显高于普通支架组（34．9％，P〈0．05）；干预的病变血管呈弥漫性病变，药物支架组占40．9％，高于普通支架组（28.3％，P〈0．05）；病变血管平均参考内径，药物支架组为（2．63±0．23）mm，普通支架组为（3．12±0．17）mm，差异有统计学意义（P〈0．05）；置入支架内径和长度，药物支架组分别为（2．75±0．22）mm和（23．1±4．0）mm，普通支架组分别为（3．05±0．19）mm和（15．6±3．3）m，差异有统计学意义（P〈0．05）。随访12～18个月，心绞痛复发率，药物支架组3．8％，普通支架组16．3％；靶病变血管再次血运重建率，药物支架组0，普通支架组9．3％，P〈0．05）。结论 Firebird^TM支架治疗冠心病安全有效，对冠状动脉弥漫性病变、小血管病变的也有较好的疗效。其近期及远期临床效果均优于普通支架。     

前列腺增生患者逼尿肌中碱性成纤维细胞生长因子的变化

目的探讨前列腺增生症患者膀胱逼尿肌中碱性成纤维细胞生长因子(bFGF)的表达及其意义。方法前列腺增生患者54例,分为逼尿肌稳定组(33例)和逼尿肌不稳定组(21例)；对照组15例为同期在我院因膀胱癌施行开放手术的男性患者。分别应用逆转录聚合酶链反应(RT-PCR)和免疫组化的方法检测各组逼尿肌中bFGFmRNA和bFGF蛋白的表达。结果稳定组和不稳定组bFGFmRNA的表达水平分别为0．5814±0．2362、0．6098±0．1829,明显高于对照组的0．3469±0．2986,差异有统计学意义(P＜0．05和0．01)；bFGF亦高于对照组。稳定组和不稳定组间差异无统计学意义(P＞0．05)结论前列腺增生患者致膀胱出口梗阻后膀胱逼尿肌细胞中bFGF表达水平升高,但与膀胱逼尿肌不稳定的发生无直接关系。     

老年冠心病合并糖尿病患者冠状动脉病变特点及其相关危险因素研究

目的探讨老年冠心病合并糖尿病患者冠状动脉病变特点及其相关危险因素. 方法根据1997年WHO糖尿病诊断标准,对133例冠心病(CHD)患者行口服75 g葡萄糖耐量试验,其中冠心病合并糖尿病(CHD+DM)组65例,单纯CHD组68例,133例患者均行冠状动脉造影(CAG),检测血糖、胰岛素、血脂、血压、血尿素氮(BUN)、血肌酐(Cr).冠状动脉病变程度应用CAG分析,冠状动脉狭窄程度根据美国心脏协会(AHA)1975年分类标准评价,冠状动脉病变的危险因素应用多元逐步直线回归分析. 结果 CHD+DM组多支冠状动脉病变的发生率高于CHD组(75.4%与38.2%,P＜0.05);冠状动脉狭窄(8.6±3.8与6.5±3.9,P＜0.05)及钙化程度(6.6±6.1与3.9±4.1,P＜0.05)高于CHD组;冠状动脉远端病变发生率高于CHD组(41.2%与13.1%,P＜0.05);血脂、胰岛素、血压与冠状动脉粥样硬化程度明显正相关(P＜0.001). 结论老年CHD+DM患者多支冠状动脉病变的发生率增高,病变多呈弥漫性狭窄,远端血管病变发生率高.提示糖尿病、高脂血症、高血压是发生冠状动脉粥样硬化的独立危险因素.     

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.     

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.     

High prevalence of distal sensory polyneuropathy in antiretroviral-treated and untreated people with HIV in Tanzania

Objectives To describe the prevalence of distal sensory polyneuropathy (DSP), a complication of both advanced HIV disease and of antiretroviral therapy (ART), amongst Tanzanians with HIV, on and off ART (including stavudine) with CD4 counts above and below 200 cells/μl. Methods We recruited participants attending ART clinic into four groups: >6 months ART exposure and (i) CD4 < 200 cells/μl or (ii) CD4 > 200 cells/μl (ART/CD4 < 200 and ART/CD4 > 200, respectively); ART‐naïve and (iii) CD4 < 200 cells/μl or iv)CD4 > 200 cells/μl (noART/CD4 < 200 and noART/CD4 > 200, respectively). Primary outcome was DSP, as defined by presence of at least one symptom and one sign. Results Of 326 evaluable participants, 81 (32 men, median age 38 years, median CD4 142 cells/μl) were enrolled in the ART/CD4 < 200 group, 78 (17 men, median age 37 years, median CD4 345 cells/μl) in ART/CD4 > 200, 81 (30 men, median age 37 years, median CD4 128 cells/μl) in noART/CD4 < 200 and 86 (22 men, median age 33 years, median CD4 446 cells/μl) in noART/CD4 > 200. Numbness was the most commonly reported symptom. DSP prevalence ranged from 43.2% in ART/CD4 < 200 to 20.9% in noART/CD4 > 200. DSP was more common among men (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.2–3.3) and older participants (aOR 2.7, 95% CI 1.1–6.2 for age 40 + vs. <30 years). Conclusion Distal sensory polyneuropathy is common amongst those attending this clinic, even those with no ART exposure and a CD4 count above 200 cells/μl. Stavudine and didanosine expose HIV‐infected patients to an additional avoidable risk of DSP. Access to non‐neurotoxic ART regimes as well as earlier HIV diagnosis and initiation of ART is needed.