动态心电图对不明原因晕厥的诊断意义

目的 探讨动态心电图(Holter)对不明原因晕厥的诊断意义.方法 对320例不明原因的晕厥患者进行24小时动态心电图检查.结果 320例患者经动态心电图检查,116例(36.25%)出现严重心律失常,60例(18.75%)出现晕厥发作,46例(14.37%)晕厥发作与心律失常有关,尤其与R-R间期的长短有一定的相关性...     

202例动态心电图与同期普通心电图的比较

目的将202例晕厥患者动态心电图与同期普通心电图进行研究分析。方法入院后结合病史、体征、胸片、多普勒超声心动图、脑电图等辅检查。结果 Holter发现心律失常174例（86%）,普通心电图仅发现心律失常75例（37%）。晕厥患者动态心电图和普通心电图对比心律失常检出率比较,动态心电图对晕厥的原因的检测明显优于普通心电图。结论不明原因晕厥的发作与心律失常有关,快速对病人进行Holter检查对不明原因晕厥的病因诊断仍然是一种有价值的工具。     

24小时动态心电图在不明原因晕厥患者临床诊断中的应用价值分析

目的分析24小时动态心电图在不明原因晕厥患者临床诊断中的应用价值。方法选择2012年1月—2013年1月我院收治的晕厥患者80例,将其随机分为对照组和观察组,各40例。对照组采取常规心电图检查,观察组采取24小时动态心电图监测,比较两组患者严重心律失常检出情况。结果观察组严重心律失常检出率为100.0%(40/40),高于对照组的65.0%(26/40);其中阵发性心房纤颤或心房扑动、心房纤颤伴长R-R间期≥3.0s、阵发性室性心动过速、短暂心室停搏、Ⅲ度房室传导阻滞检出率均高于对照组(P0.05)。R-R间期≥3.0 s者晕厥发生率高于R-R间期3.0 s者(P0.05)。结论 24小时动态心电图监测可及时发现和明确心源性因素引起的晕厥,在临床诊断中具有重要的价值。     

不明原因性晕厥患者动态心电图的特征分析

目的探究和分析不明原因性晕厥患者动态心电图特征。方法选择我院自2017年1月至2018年1月收治的20例不明原因性晕厥患者作为研究对象,所有患者均行24小时动态心电监测,并根据患者监测期间是否出现晕厥发作将其分成晕厥组(8例)和无晕厥组(12例),对比两组患者动态心电图特征。结果监测期间,共发现13例患者存在心律失常,检出率为65.0%,其中包含6例窦性心动过缓伴窦性停博、4例窦房传导阻滞、2例三度房室传导阻滞、1例阵发性心房颤动;晕厥组患者各种缓慢性或快速性心律失常发生率、R-R间期均明显高于无晕厥组患者,两组对比差异显著,具有统计学意义(P0.05),且R-R间期3.0s者,无1例发生晕厥。结论心律失常是引发不明原因性晕厥再次发作的重要危险因素,采用动态心电图监测不仅能明确不明原因性晕厥患者的病因,还能检测其R-R间期长度,因此,其检出结果能作为指导患者临床治疗的有效依据。     

置入式Holter诊断不明原因晕厥的应用研究

目的探讨置入式Holter(ILR)在诊断不明原因晕厥和指导治疗中的临床价值。方法入选2002年10月至2005年5月求治的不明原因晕厥患者10例,男性4例,女性6例,平均年龄(41±22)岁。有2次以上晕厥或近似晕厥史平均为(4.5±1.4)次/例,经常规检查未能明确晕厥原因。均选用Medtronic公司RevealPlus(9526型ILR。结果10例患者平均随访(17.8±6.6)个月,ILR有效监测时间平均(15.3±3.6)个月,监测期内6例患者再发晕厥或近似晕厥24次。7例患者手动触发19段心电图,ILR自动触发记录460段心电图,共记录211段心电图为心律失常事件。根据症状-心律相关性,7例患者明确为心律失常性晕厥,1例患者明确为非心律失常性晕厥;2例仍不能明确晕厥原因。提示ILR诊断晕厥的效率为80%。10例依据ILR监测结果得到相应治疗,晕厥发作减少或消失。结论ILR用于诊断不明原因晕厥和先兆晕厥安全、高效、长程,可证实或排除患者的部分晕厥或近似晕厥系心律失常所致;具有微创、简单、监测期长、信息量大等优点,可作为现有晕厥诊断方法的重要补充。加强患者的依从性和动态优化工作参数,将进一步提高ILR的诊断价值。     

动态心电图对诊断心源性晕厥的临床意义

目的 探讨心源性晕厥或猝死发作相关的心电图特征.方法 对120例疑为心源性晕厥者行24h12导联动态心电图(DCG)检查.结果 120例中55例(45.8%)出现严重心律失常,检出晕厥发作或猝死共27例;其中21例(17.5%)晕厥发作和3例(2.5%)猝死与严重心律失常有关.尤其与心室停搏(R-R间距)>3.0s及快速室性心律失常有一定的相关性.另外3例晕厥时未记录到任何心律失常.结论 12导联DCG检查可为心源性晕厥或猝死者获得可靠的病因诊断.     

29例心源性晕厥患者动态心电图分析

目的 研究心源性晕厥患者的心律失常发生情况与高危心电图的具体表现.方法 对29例疑为心源性晕厥的患者进行24 h动态心电图监测.结果 29例患者均发生了较严重的心律失常,晕厥15例,R-R间期小于3.0s者无晕厥表现,R-R间期大于3.0s者出现晕厥表现.结论 心律失常尤其是慢性心律失常是造成心源性晕厥的主要原因,一般具有器质性心脏病的患者进行动态心电图检查,可以获得可靠的病因,并进行针对性的治疗.     

心室率控制满意的慢性心房颤动患者的动态心电图表现

目的评价心室率控制满意的持续性心房颤动(房颤)患者的24小时动态心电图(Holter)表现。 方法选择心室率控制满意的122例伴有器质性心脏病的持续性房颤患者。心功能(NYHA)分级Ⅱ～Ⅲ级。回顾性分析其Holter，观察心室率及长RR间期的动态表现，并对部分患者进行随访。 结果Holter检查结果示日平均心室率为78.53±8.12(65～90)次/分。平均最快心率143.79±28.85(90～183)次/分，平均最慢心率51.04±7.52(34～71)次/分。62/122例(50.82%)出现＜50次/分的心动过缓。32/122例(26.23%)出现＜45次/分的心动过缓。95/122例(77.87%)出现＞1.5秒的长RR间期，平均最长RR间期为2.38±0.55(4.64～1.60)秒。14/122例(11.48%)出现＞3.0秒的长RR间期。随访结果表明，长RR间期未见进一步加重。 结论心室率控制满意的房颤患者，休息及睡眠时出现长RR间期及心动过缓是常见现象。     

植入型心电事件记录仪在不明原因晕厥中的应用价值:单中心经验

目的探讨植入型心电事件记录仪(ILR)在不明原因晕厥患者中的应用价值,并筛选可能的心律失常源性晕厥预测因素。方法连续入选2013年1月至2018年10月在大连医科大学附属第一医院诊断为不明原因晕厥,且植入ILR的患者37例,年龄(59±19)岁,男24例。植入后进行常规随访,每3~6个月进行1次随访,主要随访内容:症状、程控事件、是否发生晕厥。如患者发生晕厥,通知回院就诊,接受程控和心电学检查,分析晕厥病因及心律失常类型和相关危险因素。结果共22例(59.46%,22/37)患者记录到晕厥事件,其中9例为窦性心动过缓或窦性停搏,6例为三度或高度房室传导阻滞,1例为室性心动过速,2例为室上性心动过速,4例为心房颤动(房颤)伴RR长间歇(>2 s),在植入后(187.73±177.12)d发生晕厥事件。1例患者记录到房颤伴RR长间歇,但未发生晕厥。16例患者植入永久起搏器,1例患者植入心律转复除颤器,2例患者行导管消融治疗。对性别、年龄、合并基础疾病、植入前晕厥次数、心电信息等进行分析发现,动态心电图中存在RR长间歇(>2 s)是预测晕厥发作的影响因素。结论植入ILR可使不明原因晕厥患者获得明确诊断并接受相应治疗,ILR是明确晕厥病因的有效手段之一。动态心电图中存在RR长间歇(>2 s)是心律失常原因晕厥的重要预测因素。     

严重窦性静止一例

1 临床资料患者男性,32岁。反复发作性黑朦,晕厥,有时抽搐跌倒。每次发作约几秒至几分钟,未经处置而自行缓解。15年来,一直坚持农业重体力劳动。入院查体:除心尖部可闻及Ⅱ级吹风样杂者及心动过缓(HR55次/分)外,余未发现异常。心电图监测RR间期最长达23秒以上,但并未发生阿—斯综合征。RR间期经常>10秒,RR间期<20秒,无任何异常自觉症状。RR间期>20秒时稍有头晕感觉。诊断为病态窦房结综合征、窦性静止、交界性逸搏、交界性心律。     

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.     

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.     

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.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

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.