组织多普勒显像技术评价高血压患者左室舒张功能的研究

选择轻、中度高血压患者139例，健康对照组33例，测定二尖瓣血流频谱E波速度（E）、A波速度（A）、E／A，并用组织多普勒显像（TDI）技术测量二尖瓣环侧壁收缩期运动速度（Sm）、舒张早期运动速度（Em）、舒张晚期运动速度（Am）及Em／Am。根据左室重量指数（LVMI）将高血压患者分为非左室肥厚（NLVH）组及左室肥厚（LVH）组。结果与对照组比较，NLVH组及LVH组E／A、Em、Em／Am降低；与NLVH组比较，LVH组Em、Em／Am降低。认为TDI技术测量二尖瓣环侧壁组织运动速度能准确评价高血压患者的左室舒张功能。     

TDI技术评价高血压合并代谢综合征患者左室舒张功能的变化

选择69例高血压患者分为单纯高血压组(EH组)和高血压合并代谢综合征(MS)组(EHMS组).应用彩色超声诊断仪首先完成二维超声心动图常规指标的测定,计算左室心肌重量指数(LVMI),然后用脉冲组织多普勒成像(TDI)技术检测二尖瓣环心尖四腔切面间隔和侧壁处、心尖二腔切面前壁和下壁处4个部位舒张早期运动峰值速度Ea、舒张晚期运动峰值速度Aa,并计算Ea/Aa比值,作为评价左室舒张功能的指标.设30例健康对照者(NC组).结果 发现,EHMS组患者LVMI及左室肥厚(LVH)发生率均明显高于EH组(P<0.01);EHMS组患者Ea、Ea/Aa明显低于EH组及NC组(P<0.01).认为高血压患者合并MS时左室舒张功能受损更加严重.     

组织速度成像技术评价糖尿病患者左室舒张功能的临床应用

目的探讨组织速度成像技术评价糖尿病患者左室舒张功能的临床应用。方法66例糖尿病患者分为单纯糖尿病组(DM组,36例)与糖尿病合并左室肥厚组(DM LVH组,30例)两组,设正常健康人38名为对照组。应用组织速度成像技术于二尖瓣环与侧壁交界处测量二尖瓣环舒张早期峰值运动速度(Em)与舒张晚期峰值运动速度(Am);应用常规超声心动图脉冲多普勒超声检查,测量二尖瓣口舒张早期血流速度(E)、舒张晚期血流速度(A);计算Em/Am、E/A和E/Em比值。结果①两组糖尿病患者Em显著低于正常对照组(P<0.01),DM LVH组Em又显著低于DM组(P<0.05);②两组糖尿病患者的E/A≤1与Em/Am≤1检出率显著高于正常对照组,而且各组应用组织速度成像方法检出率明显高于应用常规脉冲多普勒方法(P<0.01);③两组糖尿病患者E/Em显著高于正常对照组,而DM LVH组E/Em又显著高于DM组(P<0.01)。结论组织速度成像技术通过测量二尖瓣环运动速度可以评价糖尿病患者的左室舒张功能,结合传统脉冲多普勒测量二尖瓣口血流速度,可以提高评价糖尿病患者左室舒张功能的准确性。     

左室壁内缩短分数评价收缩功能及其与舒张功能相关性的研究

目的:探讨左室壁内缩短分数(mFS )评价高血压患者收缩功能及其与左室舒张功能的关系.方法:收集高血压组51例,正常对照组47例.分析临床特点,行超声心动图检查.收缩功能测定左室室壁厚度,左室内径,左室容量,测定射血分数(EF),缩短分数(FS)以及左室mFS.心脏舒张功能,取二尖瓣血流频谱,记录二尖瓣舒张期血流频谱,记录舒张早期(E)和舒张晚期(A)血流速度峰值.采用组织速度多普勒成像技术测定二尖瓣环室间隔侧和侧壁侧的舒张早期心肌运动速度(Em)和舒张晚期心肌运动速度(Am),取平均值.探讨左室收缩功能和舒张功能的相关性.结果:①收缩功能:高血压组与正常对照组比较:左室舒张末间隔厚度明显增加[(1.18±0.28):(0.95±0.13),P<0.001]、左室舒张末后壁厚度明显增加[(1.01± 0.17):(0.89±0.17),P<0.01]、左室mFS明显降低[( 18.0± 4.9) vs (22.3±5.9), P<0.01],而2组间左室EF和FS差异无统计学意义.②舒张功能:高血压组与对照组比较,二尖瓣血流频谱差异无统计学意义;组织多普勒成像显示,二尖瓣环Em明显降低[(8.22± 2.23):(9.91±2.52),P<0.05],二尖瓣环Em/Am明显降低[(0.72± 0.23):(0.98±0.26),P<0.01]、二尖瓣E/Em明显增加[(9.38±3.19):(7.45±2.10), P<0.01].③mFS与Em/Am显著正相关(r=0.55,P<0.001 )、与E/Em显著负相关(r=-0.38,P<0.05).左室EF和FS与上述指标无相关性.结论:左室mFS是评价高血压患者收缩功能的有力指标,与早期舒张功能受损有关.     

定量组织速度成像检测早期高血压左室舒张功能

目的研究一级高血压对心脏早期损害表现.方法应用定量组织速度成像技术,分析二尖瓣瓣环和左心室12个节段心肌舒张早期左心室充盈Em波、舒张晚期Am波和Em/Am比值.结果一级高血压患者Em波速度降低,Am波速度增加,共349个心肌节段Em/Am＜1,以室间隔、前壁和后壁多见,同时30%患者二尖瓣瓣环Em/Am＜1.结论一级高血压患者存在左室舒张功能减退.     

定量组织速度成像检测早期高血压左室舒张功能

目的研究一级高血压对心脏早期损害表现.方法应用定量组织速度成像技术,分析二尖瓣瓣环和左心室12个节段心肌舒张早期左心室充盈Em波、舒张晚期Am波和Em/Am比值.结果一级高血压患者Em波速度降低,Am波速度增加,共349个心肌节段Em/Am＜1,以室间隔、前壁和后壁多见,同时30%患者二尖瓣瓣环Em/Am＜1.结论一级高血压患者存在左室舒张功能减退.     

多普勒组织成像和组织追踪技术对正常人心室长轴功能评价

目的探讨正常人左、右心室长轴功能的变化,为临床心脏功能评价提供正常值参考。方法应用脉冲多普勒组织超声技术和组织追踪技术观察110名正常成年人二尖瓣环和三尖瓣环不同位点,收缩峰值速度（Sm）,舒张早期峰值速度（Em）、舒张晚期峰值速度（Am）、Em/Am比值和各位点位移（D）的平均值,比较不同年龄组多普勒组织速度和位移,分析其变化规律和特点。结果二尖瓣环各位点Sm和D随着年龄段的增加而显著降低,左心室前壁和侧壁Sm和D高于其它位点,二尖瓣环平均Sm与年龄和左心室射血分数（LVEF）显著相关;二尖瓣环各位点Em和Em/Am随年龄明显降低,平均Em降低的年龄段比二尖瓣舒张早期充盈速度（E峰）早;三尖瓣环Sm与年龄无关,Em和Em/Am随年龄而明显降低。结论二尖瓣环和三尖瓣环多普勒组织速度和位移随年龄出现不同的变化特点,多普勒组织成像对舒张功能变化比传统超声心动敏感。     

多普勒超声心动图评价年龄对正常成年人左室收缩舒张功能的影响

目的 应用超声心动图评价年龄对正常成年人左室收缩及舒张功能的影响.方法 将804名正常成年受检者分成6组,即1组(20～29岁),2组(30～39岁),3组(40～49岁),4组(50～59岁),5组(60～69岁),6组(70岁以上).于心尖四腔心切面测量二尖瓣口舒张期前向血流频谱,记录舒张早期E波的峰值流速(E) 和舒张晚期A波的峰值流速(A),计算E/ A值;采用Simpson法测量左室射血分数(EF).于心尖四腔及两腔切面分别测量各组受检者左室间隔、侧壁、前壁及下壁二尖瓣瓣环组织多普勒频谱,记录室壁收缩期峰值速度(Sm)、舒张早期峰值速度(Em)、舒张晚期峰值速度(Am)并计算Em/Am,并将每位受检者所得4组数据求平均值.比较各组间数据差异并进行相关性检验.结果 随着年龄的增长,EF值无显著性变化;Sm及E、Em呈逐渐减低趋势(P<0.01);A、Am呈逐渐增高趋势(P<0.01);E/A、Em/Am呈逐渐减低趋势(P<0.01).Sm、E、E/A、Em、Em/Am与年龄呈显著负相关(P<0.001),A、Am与年龄呈显著正相关(P<0.001).结论 正常成年人随着年龄的增长,左室长轴方向的收缩、舒张功能逐渐减低.左室整体舒张功能逐渐减低,而整体收缩功能无变化.     

心肌组织多普勒速度显像定量评价健康老年人心室功能

目的　探讨健康老年人左、右心室功能变化特点 ,为临床老年人心脏功能评价提供参考。　方法　应用脉冲组织多普勒技术观察 5 4名健康老年人三尖瓣环和二尖瓣环不同位点的收缩峰值速度 (Sm)、舒张早期峰值速度 (Em)和舒张晚期峰值速度 (Am)、Em/Am比值 ,并以 5 1名非老年人为对照组 ,分析老年人心脏功能变化规律。　结果　除左室下壁、后壁 ,老年组其余二尖瓣环位点的Sm均显著低于非老年组〔后间隔、左室侧壁、左室前壁、前间隔 2组分别为 (7 8± 1 3)、(9 6±1 2 )、(9 3± 2 1)、(7 6± 1 3)cm/s与 (7 2± 1 2 )、(8 4± 1 9)、(8 3± 1 8)、(6 7± 1 2 )cm/s〕 ,而左心室射血分数 (EF)无显著变化。老年组二尖瓣环和三尖瓣环各位点的Em、Em/Am均显著低于非老年组。　结论　老年人心肌组织收缩和舒张功能均有不同程度的降低 ,二尖瓣环Sm对衰老引起的收缩功能变化比EF敏感。对舒张功能障碍的评价 ,组织多普勒超声比传统的心动超声更敏感。     

组织多普勒成像技术评价健康肥胖老年女性心功能

目的探讨组织多普勒成像(TDI)技术能否早期、准确评价健康肥胖老年女性左心功能的改变。方法入选健康老年女性160例,其中肥胖女性120例,根据体重指数(BMI)分为:轻度肥胖组(Ⅰ组,70例),28.0 kg/m~2≤BMI32.0 kg/m~2;中度肥胖组(Ⅱ组,50例),32.0 kg/m~2≤BMI36.0 kg/m~2;正常体重组(Ⅲ组,40例),18.5kg/m~2≤BMI24.0 kg/m~2。同期选择健康肥胖非老年女性80例,以BMI为依据,分为Ⅳ组40例(BMI同Ⅰ组),V组40例(BMI同Ⅱ组)。超声心动图检查,以TDI技术测量二尖瓣瓣环后间壁、侧壁、下壁、前壁、后壁和前间壁6个取样点的收缩期心肌峰值运动速度(Sm)、舒张早期心肌峰值运动速度(Em)和舒张晚期心肌峰值运动速度(Am)及其比值,并进行对比分析。结果与Ⅲ组比较,Ⅰ、Ⅱ组入选者收缩压、舒张压增高,心率加快,二尖瓣口舒张早期与晚期峰值血流速度比值明显降低(P0.05);Ⅰ、Ⅱ组在二尖瓣环6个取样点Sm、Em、Em/Am和总平均值均明显下降,Am明显上升,差异有统计学意义(P0.05)。与Ⅳ组比较,Ⅰ组在6个取样点Sm、Em、Em/Am和总平均值明显下降,差异有统计学意义(P0.05),与Ⅰ组比较,Ⅱ组亦有相似改变。与Ⅴ组比较,Ⅱ组仅Sm减低,差异有统计学意义(P0.05)。结论心肌组织运动速度测量显示,健康肥胖老年女性已出现心室收缩和舒张功能异常,心肌TDI技术的应用,为这类人群左心室局部和整体功能的评价提供了理想的检测手段。     

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.     

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.     

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.     

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.