稳定型心绞痛患者与不稳定心绞痛患者冠状动脉血管内超声特点的比较

目的:通过对稳定型心绞痛（SAP）与不稳定心绞痛（UAP）患者冠状动脉血管内超声（IVUS）测定,进行斑块定性及定量分析,比较不同心绞痛患者冠状动脉斑块影像学特征性改变。方法:分别对37例SAP患者与34例UAP患者行冠状动脉造影及IVUS影像学检查;分析冠状动脉斑块性质,测定最小面积处外弹力膜面积（EEMA）、管腔横截面积、斑块面积（PA）、斑块负荷、重构指数等指标,并对各指标进行统计学分析。结果:UAP患者冠状动脉病变脂质斑块数明显多于SAP患者（P＜0.05）,而钙化斑块例数在两组间未见显著性差异;定量分析显示两组患者EEMA未见显著差异,而斑块负荷（PA/EEMA）的比较中两组间有显著性差异（P＜0.01）。UAP患者病变处倾向于表现为正性重构,而SAP患者多为负性重构。结论:SAP与UAP冠状动脉病变斑块性质及血管重构存在差异,IVUS能有效反映冠状动脉病变斑块特点。     

血管内超声探测的衰减斑块对经皮冠状动脉介入治疗患者术中及术后的影响:12个月临床随访结果

目的对急性心肌梗死(AMI)患者行血管内超声(IVUS)检查探测衰减斑块,观察及探讨衰减斑块患者行经皮冠状动脉介入治疗(PCI)术中情况及术后12个月临床随访结果。方法纳入2012年12月至2014年4月北京安贞医院急诊危重症中心收治的急性心肌梗死患者85例,行冠状动脉造影并进行IVUS检查,必要时行PCI术。根据IVUS是否探测到衰减斑块将患者分为衰减斑块组和非衰减斑块组,比较两组患者围术期IVUS影像学结果。球囊扩张术后TIMI血流情况及术后12个月主要不良心脑血管事件(MACCE)发生率。结果 85例AMI患者IVUS检测结果分为衰减斑块组35例(41.2%),非衰减斑块组50例(58.8%)。两组患者年龄、性别、合并糖尿病、合并高血压病、低密度脂蛋白胆固醇等方面比较,差异均无统计学意义(均P0.05);衰减斑块组患者脑钠肽显著低于非衰减斑块组[(55.92±10.27)pg/ml比(60.32±9.22)pg/ml,P=0.029],差异有统计学意义。两组患者术前TIMI血流分级比较,差异均无统计学意义(P0.05);但在球囊扩张术后,衰减斑块组患者TIMI血流0~Ⅱ级比例(37.1%比10.0%,P=0.003)显著高于非衰减斑块组,差异有统计学意义。IVUS探测下衰减斑块组患者病变血管截面积[(15.48±3.22)mm~2比(11.71±3.01)mm~2,P0.001]、斑块面积[(14.40±4.11)mm~2比(10.69±2.85)mm~2,P0.001]、斑块负荷[(87.42±3.83)mm~2比(80.14±4.18)mm~2,P0.001]、参考血管截面积[(14.18±3.12)mm~2比(11.22±2.89)mm~2,P0.001]、偏心性(68.6%比36.0%,P0.001)显著大于非衰减斑块组,差异均有统计学意义。术后随访12个月,两组患者总MACCE发生率比较,差异无统计学意义(P0.05)。结论在IVUS探测下发现的衰减斑块,可导致球囊扩张术后无复流及慢血流发生率的增加。     

冠心病患者靶病变钙化特征的研究

目的观察冠心病患者靶病变钙化的特征,并比较不同临床类型之间的差异。方法连续入选2011年11月至2012年12月于东方医院心内科行冠状动脉造影和血管内超声检查的171例冠心病患者,其中稳定型心绞痛（SAP）30例（SAP组）,急性冠状动脉综合征（ACS）141例（ACS组）,分析靶病变的钙化类型、分布和长度。结果冠状动脉造影发现,钙化患者48例（28.1%）,而IVUS发现钙化患者为122例（71.3%）。按照造影来进行钙化程度的分组,使用IVUS测量的病变长度及斑块负荷,重度钙化组明显大于无或轻度钙化组,且有统计学意义[病变长度：（27.7±12.0）mm比（17.4±8.7）mm,P〈0.01;斑块负荷：（70.8±8.1）%比（67.2±7.0）%,P〈0.05],而重度钙化组和中度钙化组差异无统计学意义。三组间靶病变外弹力膜面积（EEM-CSA）及最小管腔面积（MLA）差异则无统计学意义。IVUS测定的钙化长度和最大钙化弧度,三组间差异有统计学意义,重度钙化组病变的钙化长度及最大钙化弧度大于其他两组（P〈0.05）。SAP组和ACS组之间,在EEM-CSA、MLA、斑块负荷及钙化的发生率方面,差异无统计学意义。但SAP组浅表性钙化与弥漫性钙化的发生率明显高于ACS组,而ACS组深部或混合钙化、点状钙化明显高于SAP组（P均〈0.05）。两组最大钙化弧度均值差异无统计学意义,但ACS组病变最大钙化弧度小于90°者高于SAP组（47.5%比26.1%,P〈0.05）;SAP组钙化弧度在90°以上者高于ACS组（73.9%比52.5%,P〈0.05）,以上结果ACS的不稳定斑块钙化程度尤其在横断面分布程度低于SAP的靶病变。ACS组IVUS检出存在斑块破裂的18例患者中,17例（94.4%）为点状钙化或混合钙化;ACS组未观察到斑块破裂且存在钙化的81例患者中,点状钙化的发生率仅为45例（55.6%）,两组差异具有统计学意义（P〈0.01）。结论 IVUS对检出钙化的敏感性远高于冠状动脉造影。与SAP相比,ACS患者靶病变钙化弧度小、深部多见,存在斑块破裂的病变以点状钙化为主。     

碱性磷酸酶联合血管内超声对ACS患者经皮冠状动脉介入治疗后非靶血管病变进展的预测价值

目的 探讨碱性磷酸酶(alkaline phosphatase,ALP)联合血管内超声(intravenous ultrasound,IVUS)对急性冠状动脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后非靶血管病变进展的预测价值。方法 选择2017年6月至2019年7月在河南中医药大学人民医院心内科收治住院并行PCI治疗的ACS患者241例为研究对象，根据随访1年是否出现非靶血管再狭窄分为再狭窄组(28例)和对照组(213例)，对比分析两组患者间观察指标的差异。结果 ALP、病变长度、IVUS显示钙化、IVUS钙化分类、IVUS钙化长度、钙化弧度、钙化特征评分、最小管腔面积(minimum lumen area,MLA)≤4 mm²、斑块负荷(plaque load,PB)>70%均为PCI治疗后非靶血管斑块进展的危险因素(P<0.05)。钙化特征评分预测PCI治疗后非靶血管斑块进展灵敏度为69.44%，特异度为75.81%，曲...     

冠状动脉斑块负荷对急性ST段抬高型心肌梗死老年患者预后的预测价值

目的探讨冠状动脉斑块负荷对急性ST段抬高型心肌梗死老年患者预后的预测价值。方法回顾性收集急性ST段抬高型心肌梗死老年患者150例,对患者随访1年,根据患者是否再发不良心血管事件,将患者分为不良心血管事件组(n=43)和对照组(n=107)。行冠脉CT血管成像,测量斑块负荷参数,分析两组斑块负荷参数差异,同时使用多因素Logistic回归分析急性ST段抬高型心肌梗死老年患者再发不良心血管事件的危险因素。结果与对照组比较,观察组斑块数、非钙化斑块体积、钙化斑块体积、总斑块体积、非钙化斑块负荷、钙化斑块负荷、总斑块负荷、血管狭窄程度、重建指数均明显升高(P<0.05)。斑块数、非钙化斑块体积、钙化斑块体积、总斑块体积、非钙化斑块负荷、钙化斑块负荷、总斑块负荷、血管狭窄程度、重建指数增高是急性ST段抬高型心肌梗死老年患者再发不良心血管事件的危险因素(P<0.05)。结论急性ST段抬高型心肌梗死老年患者冠状动脉斑块负荷较大,可以作为再发不良心血管事件的预测因素。     

冠状动脉钙化与急性心肌梗死的关系简

目的 探讨冠状动脉钙化与急性心肌梗死之间的关系.方法 22 537例患者中,男13 204例,女9 333例,年龄（58.53±9.48）岁,共有急性心肌梗死患者2 254例.依据冠状动脉造影术中能否发现冠状动脉钙化分为钙化组（A组）和无钙化组（B组）,统计两组间心肌梗死发病率的区别,并探讨其原因.结果 钙化组心肌梗死患病率明显高于无钙化组,差异有统计意义（18.16％vs.8.84％,P＜0.001）;钙化组较无钙化组男性多见（62.46％ vs.58.04％,P＜0.001）、年龄偏大[（64.61±7.92）岁vs.（57.67±9.37）岁,P＜0.001];糖尿病（25.64％ vs.15.28％,P＜0.001）、原发性高血压（高血压）发病率高（74.00％vs.57.13％,P＜0.001）;易发生血管病变（93.70％ vs.7.32％,P＜0.001）,且以多支血管病变为主.即使在心肌梗死患者中,钙化组血管病变的发生率及多支血管病变所占比例也超过非钙化组,差异有统计意义（99.61％vs.94.32％,P＜0.05;91.18％ vs.66.23％,P＜0.05）.两组均以ST段抬高型急性心肌梗死为主,两组心肌梗死部位比较,差异无统计学意义（P＞0.05）.结论 冠状动脉钙化患者,男性多见、年龄偏大;糖尿病、高血压发病率高;易发生血管病变,容易导致心肌梗死.     

老年女性急性ST段抬高型心肌梗死患者行急诊PCI的临床特点及冠状动脉病变特点分析

目的 探讨急性ST段抬高型心肌梗死（STEMI）行急诊经皮冠状动脉介入治疗（PCI）的老年女性患者临床及冠脉病变特点。方法 回顾性分析了2006年至2012年我院连续收入的首次诊断为STEMI并接受急诊PCI术的女性患者366例。根据年龄分为两组：老年组（≥65岁;n＝211）和非老年组（＜65岁;n＝155）。分析两组患者临床及冠脉病变特点。结果 与非老年组患者相比,老年组中糖尿病发生率和空腹血糖值均显著较高（P＜0.05）,吸烟者的比例和肾小球滤过率显著较低（P＜0.05）,老年组患者冠脉三支病变率显著增加（P＜0.05）,靶血管为左前降支（left anterior descending branch,LAD）的概率显著降低（P＜0.05）。老年组和非老年组患者接受急诊PCI的成功率分别为98.58%和98.87%。结论 不同年龄阶段的女性STEMI患者具有不同的危险因素特点,老年女性STEMI患者较非老年女性患者,冠状动脉病变更为复杂。     

不同再血管化治疗对冠心病伴糖尿病患者预后的影响

目的探讨不同再血管化治疗对冠心病伴糖尿病患者预后的影响。方法选取2012年1月—2013年6月期间该院收治的120例冠心病伴糖尿病患者作为此次调查对象,所有患者均进行再血管化治疗,并将其分为经皮冠状动脉成形术(PCI组)及冠状动脉旁路移植术(CABG组)以SYNTAX评分将两组患者进行高、中、低亚组分类,对两组患者之间的不良事件发生率进行比较。结果 PCI组患者术后12个月内再发心肌梗死比例明显高于CABG组(P0.05)。但两组患者之间的总不良事件发生率差异无统计学意义(P0.05)。SYNTAX评分PCI组中只有高分组的不良事件发生率高于CABG组(P0.05)。结论SYNTAX评分高分组患者以CABG法进行治疗可降低不良事件发生率,其余患者可进行PCI治疗。     

血管内超声在急性心肌梗死患者中的应用

<正>急性心肌梗死(acute myocardial infarction,AMI)主要由自发斑块破裂或侵蚀及继发血栓形成所致[1]。血管内超声(intravascular ultrasound,IVUS)在检测斑块特点、围术期并发症及评估药物治疗后斑块演变方面起到重要的作用。PCI术前,通过IVUS检测能够提供血管管腔大小、斑块长度,评估斑块形态、钙化程度及血管重构类型;发现易损斑块(包括斑块破裂、血栓形成、斑块衰减、透亮斑块、点状钙化斑块及薄帽的纤维粥样斑块);检测是否存在血管夹层及动脉     

非ST段-抬高急性冠脉综合征与稳定型心绞痛的血管内超声斑块虚拟成像特点比较

目的 比较非ST段-抬高急性冠脉综合征（non-ST-segment elevation acute coronary syndrome,NSTE-ACS）与稳定型心绞痛（stable angina,SA）患者冠状动脉病变斑块的血管内超声虚拟组织成像（virtual histology intravascular ultrasound,VH-IVUS）特点.方法 入选81例确诊冠状动脉粥样硬化性心脏病（冠心病）患者行冠状动脉造影及VH-IVUS检查,根据临床表现、心电图及心肌坏死标志物水平分为NSTE-ACS组（47例,70处病变）和SA组（34例,46处病变）.对所有病变进行IVUS影像定量分析,测量指标包括最小管腔直径、最小管腔面积、坏死核心、纤维脂质成分、纤维成分、钙化部分、外弹力膜、斑块负荷及薄纤维帽粥样斑块发生率.结果 NSTE-ACS组斑块病变成分中坏死核心[（1.98±1.07） mm2vs.（1.18±0.81）mm2,t=4.312,P=0.000]、斑块负荷（73.35％±7.73％vs.68.00％±10.28％,t=3.193,P=0.002）及薄纤维帽粥样斑块发生率[45.7％（32/70）vs.19.6％（9/46）,x2=8.306,P=0.005]与SA组比较显著增加,差异有统计学意义,其余指标比较差异无统计学意义（P＞0.05）.结论 NSTE-ACS患者斑块成分与SA患者差异明显,坏死核心、斑块负荷明显增加,薄纤维帽粥样斑块发生率明显升高.     

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.