2007年欧洲高血压协会和欧洲心脏病学会高血压指南新亮点

2007-06-15-19,在意大利米兰召开了2007年欧洲高血压协会(ESH)和欧洲心脏病学会(ESC)学术年会,会议发布了2007年ESC和ESH动脉高血压的治疗指南(简称2007指南).该指南在2003年版指南基础上,综合了近4年的最新进展,不仅对前版进行更新升级,也通过新的证据强化前版中的建议.在引用的825篇参考文献中,2004-2007年文献284篇.现就该指南的新亮点作一概述.     

对2007年ESC/ESH高血压指南的理解及评价

2007年6月12日欧洲心脏病学会（ESC）-欧洲高血压学会（ESH）联合颁布了《欧洲高血压指南》该指南对2003年版予以了部分更新，因为自2003年欧洲高血压指南发布后，国际上完成了一系列有价值的大规模随机对照临床试验，为高血压的治疗提供了许多新证据。新指南的特点是什么？此指南对我国高血压的防治有何意义？下面作一简单阐述。     

论长短而取舍,察异同以会通:欧美高血压新指南带给我们的启示

正继2017年美国高血压指南引起波澜之后,2018年6月9日,欧洲心脏病学会(European Society of Cardiology,ESC)和欧洲高血压学会(European Society of Hypertension,ESH)联合发布了新的欧洲高血压指南的要点[1]。欧洲新指南虽然仍坚持了原有高血压定义,但在内容上积极跟进、推荐了更强力的降压策略。深入探讨欧美指南的长短与异同,无疑更有益于确定     

《2016年欧洲心血管疾病预防的临床实践指南》解读

<正>自从2012年欧洲第5版心血管疾病预防指南(以下简称《2012年指南》)颁布以来,关于心血管疾病预防的新研究证据更加充实[1]。因此,2016年5月欧洲心脏病学会(ESC)联合其他9个心血管疾病预防学会共同发布了第6版《2016年欧洲心血管疾病预防的临床实践指南》(以下简称《2016年指南》)[2]。与《2012年指南》相比,《2016年指南》更     

高血压管理指南扎堆面世

人们期待已久的美国全国联合委员会发布的成人血压管理第八次报告(JNC 8)终于赶在去年年底之前面世了,而在此前不久,美国心脏协会(AHA)、美国心脏病学会(ACC)和疾病预防控制中心(CDC)也发布了一个高血压管理科学建议,再加上欧洲高血压学会/欧洲心脏病学会(ESH/ESC)在去年更早些时候发布的指南,2013年可谓高血压指南扎堆面世的一年。临床医生在管理高血压时或许能从中得到更多的指导和帮助,但也会面临不少的困惑。     

2007年高血压研究领域要点回顾

2007年度,高血压依旧是心血管病领域的研究热点之一,这主要表现在一些指南与共识文件的颁布或更新以及一些具有重要意义的临床试验的揭晓。综观全年,主要有以下要点值得回顾。1 欧洲高血压学会(ESH)/欧洲心脏病学会(ESO)颁布2007版欧洲高血压指南ESH/ESC 高血压指南是全球范围内最具权威性     

2023年欧洲高血压学会新版高血压管理指南简评

<正>2023年6月24日,在意大利米兰召开的第33届欧洲高血压与心血管保护大会上,欧洲高血压学会(European Society of Hypertension,ESH)发布了新版高血压管理指南(新指南),并在线发表在ESH官方期刊Journal of Hypertension上^[1]。自2003年ESH制定欧洲首部高血压指南并取得欧洲心脏病学会(European Society of Cardiology,ESC)支持以来,两大学会于2007、2013及2018年联手制定三版指南,并在Journal of Hypertension^[2-4]及European Heart Journal^[3,5-6]杂志同时在线发表,在全世界范围内取得了较大影响,也成为ESH与ESC通力合作的典范之作。     

欧洲高血压学会提出2007年高血压处理新指南

欧洲高血压学会发布了2007年高血压处理新的指南(J Hypertension,2007,25:1105-1187)。该指南是2003年版的更新,长达82页,参考文献825篇,反映了过去4年间有关高血压的主要成就。该指南提出一些新见解:1)达标血压仍然是140/90mm Hg,已有心血管病或糖尿病者,达标血压为<130/80mm     

2016版欧洲血脂异常管理新指南解读

<正>2016年8月,欧洲心脏病学会(European society of cardiology,ESC)联合动脉粥样硬化学会(European atherosclerosis society,EAS),在欧洲心脏杂志发布了2016版新指南(以下称2016版指南)~([1])。同年10月,我国以近年来心血管病流行病学研究进展和血脂异常大规模随机临床试验为依据,发布了"中国成人血脂异常防治指南修订版"。两指南的主要指导思想相近,共同坚持以降低心血管疾病(cardiovascular disease,CVD)发生率和死亡率为干     

2014房颤指南之四大关键变化

<正>2014年3月28日,美国心脏协会(AHA)、美国心脏病学会(ACC)、美国心律学会(HRS)和美国胸外科学会(STS)等联合发布了《2014年心房颤动患者管理指南》,以代替2006年版房颤指南及2011年更新的2项指南,并反映了部分2012年版欧洲房颤指南。指南全文同时在线发表于《the Journal of the American College of Cardiology》、《Circulation》和《Heart Rhythm》杂     

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.     

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.     

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.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.