Myocardial infarction in women: risk factors and clinical features

The course of myocardial infarction (MI) in women, especially 60 years of age and older, is characterized by such severe complications as cardiorrhexis, hypovolemic cardiogenic shock, asystole, recurrent ventricular fibrillation and electromechanic dissociation responsible for the majority of lethal outcomes. Especially high MI lethality is in women at the age 70-79 years who have also the highest incidence of recurrent macrofocal MI while small-focal MI occurs in women over 80 years of age (80-89) more frequently than in 60-year-olds and younger. Dominating MI risk factors in women were the following: arterial hypertension detected in 81% patients under 60 and 90.8% cases over 60 years; abnormal lipid spectrum of blood including hypercholesterolemia (HCE), hypertriglyceridemia (HTE) and low concentration of HDLP cholesterol. HCE and HTE closely correlated with abdominal obesity irrespectively of age. Early menopause in women under 60 and diabetes mellitus of type 2 in older women, accumulation of two and more factors of risk contribute to development of coronary heart disease and MI, in females.     

Apoptosis in chronic obstructive pulmonary disease]

Apoptosis is a critical mechanism controlling cellularity in various tissues. It is so far unknown whether apoptosis plays a critical role in the pathogenesis and development of chronic obstructive pulmonary disease (COPD). However, recent evidence suggests that apoptosis may occur in vascular endothelial cells and/or alveolar epithelial cells in COPD lungs, thereby potentially contributing to lung tissue destruction seen in COPD. Apoptosis may also influence cellular infiltrates into the lung, another pathologic feature of COPD, because the survival of inflammatory cells such as neutrophils, lymphocytes, and macrophages are critically determined by the mechanism of apoptosis.     

Corticosteroid therapy and chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is characterized in part by a chronic inflammatory state in the airways (largely from chronic noxious stimuli such as tobacco smoke), punctuated with acute inflammatory exacerbations, which are often infectious. Although pathologically and biochemically different from the inflammation of asthma, the chronic inflammation of chronic obstructive pulmonary disease, especially in subgroups with asthma-like features and especially during exacerbations, might be expected to respond to corticosteroid therapy, as does asthma. Complications from long-term corticosteroid use are important, but they appear less when the corticosteroid is given via the inhaled route. Clinical evidence is particularly strong supporting the use of inhaled corticosteroids to prevent exacerbations and oral corticosteroids to reduce the duration and impact of exacerbations.     

Spa and climate therapy in chronic obstructive pulmonary diseases

The authors remind the main epidemiological and clinical findings of Chronic Obstructive Pulmonary Disease (COPD); the prevalence and incidence of COPD is increasing and COPD is now the IV cause of death in the world. Moreover, it is cause of increasing pharmaceutic and hospital charges. COPD has multifactorial etiology, linked to genetic and exogenous factors, as tobacco smoke, air pollution, microbial infections and cold. The GOLD guide lines of the medical therapy of the COPD are showed. The spa therapy of COPD is based on the inhalation use of mineral water, mainly sulphurous and salsojodic. Sulphurous mineral waters have vasodilating activity on vessels of bronchial mucose, improving its trophic state, and increase the production of secretory IgA and muco-ciliary clearance; they have fluidificant activity on bronchial secretion. Clinical trials showed improvement of cough, sputum and functional indexes as FEV1 and CV. Salsojodic mineral waters increase the fluidity of the bronchial mucus, muco-ciliary clearance and the trophism of the bronchial mucose. The authors remind the properties of sulphate and bicarbonate mineral waters in the spa therapy of COPD. Finally authors refer about some effects of spa therapy and climatic-environmental situations on COPD morbidity.     

心肌梗死患者溶栓治疗疗效与D-二聚体水平的关系

目的评价血浆D-二聚体（DD）在判断急性心肌梗死（AMI）溶栓治疗疗效中的应用价值。方法采用酶联免疫吸附试验（ELISA）检测健康人（对照组）心绞痛、陈旧性心肌梗死（OMI）及AMI患者血浆DD含量（AMI患者发病后进行连续测定）,并比较其结果。结果对照组、心绞痛患者、OMI患者、未接受溶栓的AMI患者、接受溶栓治疗的AMI患者DD含量分别为0．41±0．30mg／L、0．55±0．36mg／L、0．60±0．48mg／L、1．01±0．52mg／L和2．91±1．04mg／L。与对照组相比较,心绞痛组和OMI组DD含量差异无显著性（P〉0．05）,而未溶AMI组和溶栓AMI组DD含量明显升高,差异具有非常显著性（P〈0．001）。溶栓AMI组DD含量显著高于未溶AMI组,差异具有显著性（P〈0．001）。结论血浆DD测定不仅可作为观察心肌梗死病情的指标,对溶栓药物的疗效监测也具有重要价值。     

Serotonin receptors blocker ketanserin in the combined therapy of patients with chronic obstructive bronchitis]

The addition of ketanserin (a blocker of serotonin S2-receptors) to treatment of bronchial obstruction is shown to lower plasma and platelet concentrations of serotonin, leukotriene B4 level in the lavage fluid, to shift prostacyclin-thromboxane balance to the side of prostacyclin. In 40 patients with chronic obstructive bronchitis treated, the above changes were associated with persistent clinical response, a decrease of bronchial obstruction, being the most profound in a group of patients with chronic catarrhal bronchitis.     

Efficacy and indications of home oxygen therapy for patients with chronic obstructive pulmonary disease]

Efficacy of home oxygen therapy (HOT) is well established for patients with chronic obstructive pulmonary disease who fall into chronic respiratory failure. We should consider now how the quality of life improves with HOT in those patients. According to the guideline of the Japanese Respiratory Society, indications of HOT are as follows: 1) A PaO2 of less than 55 Torr at rest while breathing room air, 2) A PaO2 between 55 Torr and 60 Torr in the presence of clear evidence of cor pulmonale, pulmonary hypertension, or a long history of severe hypoxemia during sleep or during exercise. Further studies are definitely required to pick up the patients who do not necessarily meet these indications but who may benefit from HOT.     

The hospital stage of the long-term oxygen therapy of chronic lung failure in patients with chronic obstructive bronchitis]

The authors analyze the role of the initial inpatient stage of long-term oxygen therapy (LOT) in combined treatment of chronic pulmonary failure in patients with chronic obstructive bronchitis, lung emphysema, and pneumosclerosis. The treatment lasted 30 days both in the main and in the control groups. In addition to basic therapy, the main group patients received 38% O2 for 15 h a day. To decrease the risk of PaCO2 elevation with a possible respiratory disorder, particularly in patients with initial hypercapnia, it is suggested that a special oxygen test with simultaneous control of acid-base balance and gas composition of the arterial blood may be carried out. In contrast to the control group, the main group patients demonstrated an improvement of gas composition of the arterial blood and of the parameters such as the alveolar-arterial gradient according to O2, the physiological pulmonary shunt. The combined use of oxygen therapy and resistance at expiration made it possible to ameliorate a number of external respiration function parameters, diffusion lung capacity, and enhanced the effect of oxygen therapy. It is shown that patients with PaO2 may be given LOT within the range of 60-69 mm Hg, provided the pulmonary physiological shunt exceeds 20%.     

推拿治疗慢性阻塞性肺疾病的疗效

目的:观察推拿治疗慢性阻塞性肺疾病、改善肺功能的效应。方法:选择2003-07/2005-08来自上海交通大学附属第一人民医院呼吸科和推拿科收治的缓解期的慢性阻塞性肺疾病患者30例,男28例,女2例,随机分为两组,推拿组和对照组各15例,所有患者均给予常规按需治疗。推拿组患者给予每周5次推拿,每次20min,共8周。头面部及项部操作:①从头顶部到枕部用五指拿法,从枕部到项部用三指拿法。②推桥弓穴。③面部分法。④扫散法。躯干部操作:①横擦前胸部。②横擦肩背、腰部。③斜擦两肋。上肢操作:①直擦上肢。②拿上肢。③运肩关节,理手指,最后搓抖上肢。④重复头面部操作,加震百会、大椎、命门穴。按揉心俞、肺俞、脾俞、肾俞、命门,擦肾俞、命门。治疗前后给予测定肺功能(第1秒用力呼出量、用力肺活量、一秒率);呼吸困难分级评分;6min步行距离实验。结果:30例均进入结果分析,无脱落者。①两组患者康复治疗前后呼吸功能变化:推拿组呼吸困难减轻的有效率明显高于对照组(67%,40%)。②两组患者康复治疗前后肺功能变化:推拿组治疗后第1秒用力呼气量,用力肺活量比治疗前升高犤(1.419±0.953),(1.248±0.743)L;(2.628±0.921),(2.311±0.875)L,P<0.01犦,对照组的升高差异没有显著性。推拿组治疗后肺功能改善情况明显高于对照组(P<0.05)。③两组患者康复治疗前后6min步行距离实验的变化:两组患者6min步行距离实验均有增加,对照组的增加差异不显著(由328m增加到346m),推拿治疗前后差异显著(由330m增加到389m,P<0.01),而且治疗后推拿组较对照组差异有显著性(P<0.05)。结论:推拿治疗缓解期的慢性阻塞性肺疾病,可改善肺功能、减轻呼吸困难,增强运动耐力,值得推广。     

推拿治疗慢性阻塞性肺疾病的疗效

目的：观察推拿治疗慢性阻塞性肺疾病、改善肺功能的效应。方法：选择2003—07／2005—08来自上海交通大学附属第一人民医院呼吸科和推聿科收治的缓解期的慢性阻塞性肺疾病患者30例，男28例，女2例，随机分为两组，推拿组和对照组各15例，所有患者均给予常规按需治疗。推拿组患者给于每周5次推拿，每次20min，共8周。头面部及项部操作：①从头顶部到枕部用五指拿法，从枕部到项部用三指拿法。②推桥弓穴。③面部分法。④扫散法。躯干部操作：①横擦前胸部。②横擦肩背、腰部。③斜擦两肋。上肢操作：①直擦上肢。②拿上肢。③运肩关节，理手指，最后搓抖上肢。④重复头面部操作，加震百会、大椎、命门穴。按揉心俞、肺俞、脾俞、肾俞、命门，擦肾俞、命门。治疗前后给予测定肺功能（第1秒用力呼出量、用力肺活量、一秒率）；呼吸困难分级评分；6min步行距离实验。结果：30例均进入结果分析，无脱落者。①两组患者康复治疗前后呼吸功能变化：推拿组呼吸凼难减轻的有效率明显高于对照组（67％，40％）。②两组患者康复治疗前后肺功能变化：推拿组治疗屙第1秒用力呼气最，用力肺活量比治疗的升高[（1．419&;#177;0.953），（1．248&;#177;0．743）L；（2．628&;#177;0．921），（2.311&;#177;0．875）L，P＜0．01]，对照组的升高差异没有显著性。推拿组治疗后肺功能改善情况明屁高于对照组（P〈0．05）。③两组患者康复治疗前后6min步行距离实验的变化：两组患者6min步行距离实验均有增加，对照组的增加差异不显著（由328111增加到346111），推拿治疗前后差异显著（由330m增加到389m，P＜0．01），而且治疗后推拿组较对照组差异有显著性（P＜0．05）。结论：推拿治疗缓解期的慢性阻塞性肺疾病，可改善肺功能、减轻呼吸困难，增强运动耐力，值得推广。     

Definition of chronic obstructive pulmonary disease]

COPD is a disease manifested by a combination of chronic bronchitis and pulmonary emphysema. The main risk factors of COPD are chronic smoking and genetic dispositions. The current definition of COPD was established in Western countries in the late 1960s and 1970s, but in Japan COPD has long been used as a term for a physiological syndrome showing chronic obstructive airway symptoms including not only chronic bronchitis and pulmonary emphysema, but also asthma, diffuse panbronchiolitis, and even lymphangioleiomyomatosis. This difference in understanding between the West and Japan is probably due to the markedly lower incidence of COPD in Japan. However, increases in the number of patients with pulmonary emphysema from the late 1980s in Japan have been gathering new concern about COPD. In the governmental statistics for 1995, the term COPD was used for the same entity it is used in the West. Also, the Japanese COPD guideline, the definition of COPD is the same as that in the West.     

Cytokines and statin therapy in chronic obstructive pulmonary disease patients

Abstract

Cytokines are biological response modifiers involved in the pathophysiology of chronic obstructive pulmonary disease (COPD). This study investigated the potential use of cytokines as disease severity biomarkers in COPD patients and the possible effect of statin therapy on cytokine expression. Possible associations between cytokines, body mass index (BMI) and smoking have also been studied. Cytokines IFN-γ, IL-2, IL-12 p70, TNF-α, TNF-β, IL-4, IL-5, IL-6, IL-10, IL-1β and IL-8 were measured in the plasma of 100 clinically stable COPD patients using a fluorescent bead immunoassay on a flow cytometer. When patients were grouped according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage (A-D), no significant differences in cytokine concentrations were found (p?>?.05). Significantly decreased concentrations of IL-1β, IL-2, IL-4, IL-8, IL-10, IL-12p70 and TNF-α were found in COPD patients receiving statin therapy in comparison with COPD patients not receiving statin therapy (p?25) had decreased IL-2 (p=.038), IL-8 (p?=?.039) and IL-10 (p?=?.005) concentrations compared to normal BMI (20–25) patients. Current COPD smokers had increased concentrations of IL-5 (p?=?.037) compared to former COPD smokers. Hierarchical cluster analysis showed several patterns of measured cytokines in serum of patients with stable COPD. Statin therapy is associated with decreased expression of selected Th1 and Th2 cytokines in COPD, and this effect could be of relevance in COPD patients with increased cardiovascular risk. Concentrations of Th1 and Th2 cytokines in plasma cannot be used as biomarkers of disease severity or progression of COPD.     

Clinicopathogenetic features of coronary heart disease combined with chronic obstructive pulmonary diseases and efficiency of therapy with trimetazidin

Based on retrospective analysis of 2446 in-patient cards, autopsy protocols, outpatient medical documentation, prevalence and features of clinical manifestation of cardiorespiratory pathology (CRP): coronary heart disease (CHD) combined with chronic obstructive pulmonary disease (COPD)--1 stage of study, and also (after randomization and forming of main and control groups), efficiency of myocardial cytoprotector trimetazidin (TMZ) at its long-term use (1 year) in combined therapy (2 stage of study): 135 CHD patients (stable exertional angina functional class II-III: 92 and 43 persons respectively) with COPD of medium severe (111 persons) and severe course (24 persons), were studied. It is shown that CRP is prevailed in elder age groups (after 45 years) and noticed in 56.7% CHD patients. More sevenre course with great risk of myocardial infarction with Q wave (twice, p < 0.001), prolongation of painless ischemia (62.4+/-11.5 min/day vs. 22.8+/-11.1 min/day), inclination to complicated rhythm disturbances (38 vs. 21.9, p < 0.05) and earlier clinical manifestations of heart failure (4.3+/-0.6 years earlier, p < 0.001) is typical for CHD with COPD vs. patients without pulmonary pathology. In one year after beginning of treatment with TMZ (35 mg) number of weekly pain attacks was decreased in patients of 1st group vs. 2nd group (at the average -50.8% -29.3% vs. +12.5% +16.6% respectively); significant (p < 0.05) decrease in duration of painless myocardial ischemia was registered. Decrease in number of supraventricular and ventricular extrasystoles (42.7+/-1.48 vs. 20.5+/-1.07 cases in a day, a < 0.0001), significant (p < 0.05) increase in ejection fraction and decrease in left ventricle end-diastolic volume (12.2+/-0.4% E 12.2+/-0.3% respectively), in dimensions of left (10.9+/-0.03%) and right (8.8+/-0.9%) atrium, in risk of development of acute coronary syndrome were noticed in the patients of main group received TMZ. Thus, long-term (not less then 1 year) use of TMZ (35 mg) in combined treatment assists to normalization of cardiovascular indices, decreases cardiovascular complication occurrence, improves disease prognosis and do not has negative side-effects.